EP.TH.15Review of cholecystectomies laparoscopic & open plus conversion rate in a five year period

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Elmurtada Ahmed ◽  
Deborah Jenner ◽  
Basim Al-Robaie
Keyword(s):  
Gall Bladder ◽  
Conversion Rate ◽  
Bile Leak ◽  
Admission Rate ◽  
Wound Complications ◽  
Previous Surgery ◽  
Female Ratio ◽  
Severe Inflammation ◽  
Rate Information ◽  
Male To Female

Abstract Aim Look & audit our practice of cholecystectomy & try to identify areas that require improvement Method Look at all cholecystectomies, laparoscopic & open in 5 years from January 2014 till December 2018, we looked at demographics, number of operations per year, conversion & re-admission rate, information collected from electronic note record Results male to female ratio similar to national figures, number of laparoscopic operations (2422 in that period, 61 cases converted, conversion rate 2.5%) going up steadily over the 5 years while open & conversion rate are dropping significantly, early re-admission rate higher than national figure, reasons for conversion determined & analysed Reasons for doing it open from the start also determined, commonest cause for conversion in our trust is: previous surgery/adhesions, obscure anatomy & severe inflammation of gall bladder . Commonest cause of re-admission is pain followed by wound complications collections retained stone & bile leak. Number of open cholecystectomies was 22 in 2104 dropping to only 2 in 2018. 3 deaths occurred in the group giving rise to a mortality of 0.12% Conclusion Majority of cases attempted laparoscopically & most patients discharged home within 48 hours, our conversion rate is low = 2.5% with consultants with higher number of operation having less conversions, ours re-admission rate is high mainly for pain, our mortality is low. We recommend looking closer at re-admissions to see how that number could be reduced.

scholarly journals Surgical outcome of percutaneous transhepatic gallbladder drainage in acute cholecystitis: Ten years’ experience at a tertiary care centre

2021 ◽  
Author(s):  
Szabolcs Ábrahám ◽  
Illés Tóth ◽  
Ria Benkő ◽  
Mária Matuz ◽  
Gabriella Kovács ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Acute Cholecystitis ◽  
Conversion Rate ◽  
Clinical Success ◽  
Definitive Treatment ◽  
Success Rates ◽  
Female Ratio ◽  
Gallbladder Drainage ◽  
Percutaneous Transhepatic Gallbladder Drainage ◽  
Grade Iii

Abstract Background Percutaneous transhepatic gallbladder drainage (PTGBD) plays an important role in the treatment of elderly patients and/or patients in poor health with acute cholecystitis (AC). The primary aim of this study is to determine how these factors influence the clinical outcome of PTGBD. Moreover, we assessed the timing and results of subsequent cholecystectomies. Patients and Methods We retrospectively examined the results of 162 patients undergoing PTGBD between 2010 and 2020 (male–female ratio: 51.23% vs. 48.77%; mean age: 71.43 ± 13.22 years). Patient’s performance status and intervention outcomes were assessed with clinical success rates (CSR) and in-hospital mortality. The conversion rate (CR) of possible urgent or delayed, elective laparoscopic cholecystectomies (LC) after PTGBD were analysed. Results PTGBD was the definitive treatment in 42.18% of patients, while it was a bridging therapy prior to cholecystectomy (CCY) for the other patients. CSR was 87.97%, it was only 64.29% in grade III AC. In 9.87% of the cases, urgent LC was necessary after PTGBD, and its conversion rate was approximately equal to that of elective LC (18.18 vs. 17.46%, respectively, p = 0.2217). Overall, the post-PTGBD in-hospital mortality was 11.72%, while the same figure was 0% for grade I AC, 7.41% for grade II and 40.91% for grade III. Based on logistic regression analyses, in-hospital mortality (OR 6.07; CI 1.79–20.56), clinical progression (OR 7.62; CI 2.64–22.05) and the need for emergency CCY (OR 14.75; CI 3.07–70.81) were mostly determined by AC severity grade. Conclusion PTGBD is an easy-to-perform intervention with promising clinical success rates in the treatment of acute cholecystitis. After PTGBD, the level of gallbladder inflammation played a decisive role in the course of AC. In a severe, grade III inflammation, we have to consider low CSR and high mortality.

scholarly journals Disparities between IgG4-related kidney disease and extrarenal IgG4-related disease in a case–control study based on 450 patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Qiaozhu Zeng ◽  
Jingyuan Gao ◽  
Xinyu Zhang ◽  
Aichun Liu ◽  
Zhenfan Wang ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Clinical Laboratory ◽  
Imaging Finding ◽  
Age At Onset ◽  
Female Ratio ◽  
Related Disease ◽  
Igg4 Related Disease ◽  
Peking University ◽  
Chinese Cohort ◽  
Male To Female

AbstractWe aimed to compare the demographic, clinical and laboratory characteristics between IgG4-related kidney disease (IgG4-RKD+) and extrarenal IgG4-related disease (IgG4-RKD−) in a large Chinese cohort, as well as describing the radiological and pathological features of IgG4-RKD+. We retrospectively analyzed the medical records of 470 IgG4-related disease (IgG4-RD) patients at Peking University People’s Hospital from January 2004 to January 2020. The demographic, clinical, laboratory, radiological and pathological characteristics between IgG4-RKD+ and IgG4-RKD− were compared. Twenty IgG4-RD patients who had definite etiology of renal impairment including diabetes, hypertension and etc. were excluded. Among the remained 450 IgG4-RD patients, 53 were diagnosed with IgG4-RKD+ . IgG4-RKD+ patients had older age at onset and at diagnosis. Male to female ratio of IgG4-RKD+ patients is significantly higher. In the IgG4-RKD+ group, the most commonly involved organs were salivary gland, lymph nodes and pancreas. It was found that renal function was impaired in approximately 40% of IgG4-RKD+ patients. The most common imaging finding is multiple, often bilateral, hypodense lesions. Male sex, more than three organs involved, and low serum C3 level were risk factors for IgG4-RKD+ in IgG4-RD patients. These findings indicate potential differences in pathogenesis of these two phenotypes.

scholarly journals P129 The utility of routine operative swab culture in uncomplicated peri-anal abscesses

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Apoorva Khajuria ◽  
Tuba Rahim ◽  
Mariam Baig ◽  
Kai Leong ◽  
Apoorva Khajuria
Keyword(s):  
Inflammatory Bowel Disease ◽  
Perianal Abscess ◽  
Female Ratio ◽  
Incision And Drainage ◽  
Common Presentation ◽  
History Of ◽  
Inflammatory Bowel ◽  
Operative Findings ◽  
The Cost ◽  
Male To Female

Abstract Introduction Despite perianal abscess being a common presentation, certain aspects of its management remain controversial, especially the routine use of intra-operative swab cultures. Methods A retrospective review of patients that underwent incision and drainage procedures for a perianal abscess over a six-month period was undertaken. Results Over 6 months, 50 patients were identified. The male to female ratio was 3:1 and median ASA score was 1. Only 6/50 patients presented with recurrent abscess and 1 patient had history of inflammatory bowel disease. On the basis of operative findings, 39 patients (78%) had uncomplicated abscess (not associated with cellulitis, sinus or fistula); swab cultures were performed in 26 (67%) of these patients. All patients were discharged on the same day; microbiology reports did not impact the treatment and no patients were followed up in clinic post-operatively or presented with recurrence. The number of unnecessary microbiology swabs undertaken in this cohort equates to approximately 52 unnecessary swabs a year. The cost of one swab is £10.10p, which means £520 could potentially be saved annually. Conclusion Routine intra-operative swab cultures do not impact management decisions, add to unnecessary costs and therefore should not be undertaken in uncomplicated or first presentation of peri-anal abscesses.

scholarly journals High rates of gastroesophageal cancers in patients with dyspepsia undergoing upper gastrointestinal endoscopy in Uganda

2021 ◽  
Vol 09 (07) ◽  
pp. E997-E1000
Author(s):  
Ronald Mbiine ◽  
Cephas Nakanwagi ◽  
Olivia Kituuka
Keyword(s):  
Positive Association ◽  
Referral Hospital ◽  
Outcome Variable ◽  
Mulago Hospital ◽  
Upper Gastrointestinal Endoscopy ◽  
Female Ratio ◽  
Mulago National Referral Hospital ◽  
Male To Female ◽  
Upper Gastrointestinal ◽  
National Referral Hospital

Abstract Background and study aims Dyspepsia is the most common presenting symptom in the gastrointestinal clinic of Mulago National Referral hospital. The etiology is essentially not fully described in our patient population. This study was therefore conducted to establish the causes of dyspepsia based on endoscopic diagnosis among patients with dyspepsia seeking care at the National Referral hospital of Uganda. Patients and methods This retrospective study conducted in the endoscopy unit of Mulago hospital reviewed 356 patient endoscopy reports spanning January 2018 to July 2020 with a focus on those with a referral indication of dyspepsia. Age and sex were the independent variables of interest while the endoscopy findings as reported by the endoscopist were the outcome variable of interest. Results Of the 356 endoscopy reports reviewed, 159 met the inclusion criterion of dyspepsia as the indication. Participant mean age was 47.7 years (± 16.53) with the majority (25.79 %) in the fifth decade while the male to female ratio was 1. The majority of patients had organic dyspepsia (90.57 %) while the commonest finding was gastritis 69 (43.4 %). Gastroesophageal cancers represented (18) 11.32 % of all findings. There was a positive association between age > 50 years with gastroesophageal cancers (7.639) as well as age < 50 years and functional dyspepsia (2.794); however, all these were not statistically significant (P = 0.006 and (P = 0.095, respectively). Conclusions Organic/structural dyspepsia comprises over 90 % of investigated dyspepsia with 11 % comprising cancer among patients seeking endoscopy at the National Referral Hospital of Uganda.

Astrocytomas of the spinal cord in children and adolescents

1985 ◽  
Vol 63 (5) ◽  
pp. 669-675 ◽  
Author(s):  
Ronald Reimer ◽  
Burton M. Onofrio
Keyword(s):  
Spinal Cord ◽  
Histological Grade ◽  
Extended Period ◽  
Spinal Deformities ◽  
Duration Of Symptoms ◽  
Female Ratio ◽  
Content Type ◽  
Orthopedic Procedure ◽  
Male To Female ◽  
Fine Print

✓ The authors review 32 cases of spinal cord astrocytoma in patients under 20 years of age who were treated at the Mayo Clinic between 1955 and 1980. There was a 1.3:1 male to female ratio. Twenty patients were between 6 and 15 years of age at the time of diagnosis. The duration of symptoms prior to definitive diagnosis varied from 5 days to 9 years, with an average of 24 months. The most common symptoms were pain (62.5%), gait disturbance (43.7%), numbness (18.8%), and sphincteric dysfunction (18.8%). The most common neurological findings were a Babinski response (50.0%), posterior column sensory dysfunction (40.6%), and paraparesis (37.5%). A median follow-up period of 8.6 years (range 0.8 to 25.5 years) revealed that the survival time diminished with increased histological grade of the astrocytoma (p < 0.001). The development of postlaminectomy spinal deformities represented a serious postoperative complication. This occurred in 13 patients and was first recognized between 8 and 90 months postoperatively. Six deformities occurred following cervical laminectomy, and eight patients required at least one orthopedic procedure. It is crucial to follow these patients for an extended period of time to watch for postoperative spinal deformities.

scholarly journals Clinicohematological Study of Thrombocytosis in Children

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Nathiya Subramaniam ◽  
Suneel Mundkur ◽  
Pushpa Kini ◽  
Nalini Bhaskaranand ◽  
Shrikiran Aroor
Keyword(s):  
Platelet Count ◽  
Myeloid Leukemia ◽  
Prospective Observational Study ◽  
Myelogenous Leukemia ◽  
Distribution Width ◽  
Female Ratio ◽  
Reactive Thrombocytosis ◽  
Acute Myelogenous ◽  
Male To Female ◽  
Primary Thrombocytosis

Introduction. Primary thrombocytosis is very rare in children; reactive thrombocytosis is frequently observed in children with infections, anemia, and many other causes. Aims and Objectives. To identify the etiology of thrombocytosis in children and to analyze platelet indices (MPV, PDW, and PCT) in children with thrombocytosis. Study Design. A prospective observational study. Material and Methods. A total of 1000 patients with thrombocytosis (platelet > 400×109/L) were studied over a period of 2 years. Platelet distribution width (PDW), mean platelet volume (MPV), and plateletcrit (PCT) were noted. Results. Of 1000 patients, 99.8% had secondary thrombocytosis and only two children had primary thrombocytosis (chronic myeloid leukemia and acute myelogenous leukemia, M7). The majority of the children belonged to the age group of 1month to 2 years (39.7%) and male to female ratio was 1.6 : 1. Infection with anemia (48.3%) was the most common cause of secondary thrombocytosis followed by iron deficiency alone (17.2%) and infection alone (16.2%). Respiratory infection (28.3%) was the predominant infectious cause observed. Thrombocytosis was commonly associated with IDA among all causes of anemia and severity of thrombocytosis increased with severity of anemia (P=0.021). With increasing platelet count, there was a decrease in MPV (<0.001). Platelet count and mean PDW among children with infection and anemia were significantly higher than those among children with infection alone and anemia alone. None were observed to have thromboembolic manifestations. Conclusions. Primary thrombocytosis is extremely rare in children than secondary thrombocytosis. Infections in association with anemia are most commonly associated with reactive thrombocytosis and severity of thrombocytosis increases with severity of anemia.

scholarly journals Follow-up of the air pollution and the human male-to-female ratio analysis in São Paulo, Brazil: a times series study

BMJ Open ◽  
2013 ◽  
Vol 3 (7) ◽  
pp. e002552 ◽  
Author(s):  
Simone Georges El Khouri Miraglia ◽  
Mariana Matera Veras ◽  
Luis Fernando Amato-Lourenço ◽  
Fernando Rodrigues-Silva ◽  
Paulo Hilário Nascimento Saldiva
Keyword(s):  
Air Pollution ◽  
Sao Paulo ◽  
Ratio Analysis ◽  
São Paulo ◽  
Female Ratio ◽  
Times Series ◽  
Human Male ◽  
Male To Female ◽  
Series Study

DEMOGRAPHIC PROFILE OF ACUTE FEBRILE ENCEPHALOPATHY CASES IN PEDIATRIC AGE GROUP PATIENTS: A STUDY FROM WESTERN RAJASTHAN

2021 ◽  
pp. 72-73
Author(s):  
Laxmi Rathore ◽  
P. K. Khatri ◽  
Saroj K. Meena ◽  
Archana Bora ◽  
Suneel Bhooshan
Keyword(s):  
Lower Class ◽  
Mental States ◽  
Clinical Feature ◽  
Female Ratio ◽  
Pediatric Age Group ◽  
History Of ◽  
Laboratory Investigations ◽  
Demographic Distribution ◽  
Viral Etiologies ◽  
Male To Female

Acute Febrile Encephalopathy is a clinical term used to describe patients presenting with short febrile illnesses with altered mental states. Demographic distribution plays an essential role in the diagnosis of viral etiologies. One hundred ve suspected AFE cases were enrolled in the study. A detailed history by predesigned performa and laboratory investigations was obtained for data collection. Viral etiology was diagnosed in 32 (30.48%) cases. The male to female ratio was 1.39:1. Total 56.25% of positive cases were from the lower class, 28.13% from the middle class, and 15.63% from the upper class. 24 (75%) cases from rural, while only 8 (25%) of the urban population showed viral etiologies. In 19 (59.4%) cases were either history of incomplete vaccination or not vaccinated, 13 (40.6%) cases had a history of complete immunization among positive cases. The predominant clinical feature was fever (100%) followed by seizures 66(62.86%), vomiting 37(35.24%), headache 14(13.33%), paresis in 16(15.24%) and altered sensorium in 29(27.62%), respectively. To conclude, the etiologic panorama of AFE varies with several factors such as time and demographical location, age, and immunization status. There is an urgent need to conduct more studies to prole the viral etiologies according to their prevalence in geographical areas so the treatment can be tailored accordingly and prophylaxis treatment or immunization can be boosted in the population at risk of getting the disease.

COMPARISON OF CLINICO-SOCIAL PROFILE OF PULMONARY AND EXTRA PULMONARY TUBERCULOSIS IN TERTIARY CARE HOSPITAL IN A RURALAREA: A RETROSPECTIVE STUDY

2021 ◽  
pp. 70-72
Author(s):  
Gaurav Santosh Nemade ◽  
Sumit Nitin Dhus ◽  
Arushi Ramesh Shetty ◽  
Neha Dhananjay Firake
Keyword(s):  
Tertiary Care ◽  
Care Hospital ◽  
Female Ratio ◽  
Extra Pulmonary Tuberculosis ◽  
Younger Age ◽  
Tobacco Addiction ◽  
History Of ◽  
Early Case ◽  
Male To Female ◽  
Clinical Characteristic

BACKGROUND AND OBJECTIVES: The burden of tuberculosis (TB) in India is the highest accounting for 26% of the global incidence. A total of 1.4 million people died from TB in 2019 (including 208 000 people with HIV). India accounts for a fourth of the global burden of TB and 29% of global mortality. Therefore, we carried out this study to compare demographic, lifestyle and clinical characteristic between pulmonary TB (PTB) and extrapulmonary TB (EPTB). MATERIALS AND METHODOLOGY:Aretrospective analysis was carried of 348 patients diagnosed in DOTS centre, Pravara Rural Hospital, Loni. Characteristics of demographic and clinical characteristics were obtained from medical case records. RESULTS:Among the 348 cases, 71.3% were PTB and 28.7% were EPTB including, pleural (36%), meningeal (27%) and lymphatic (20%) cases. The male to female ratio in PTB and EPTB are 1.99 and 1.22 respectively. EPTB was more common at younger age (<25 years). Tobacco addiction (10.9%), diabetes mellitus (4.03%), HIV positivity (12.1%) and history of contact with Tb patients (17.7%) were more likely to be associated with PTB. CONCLUSION:Increased awareness of the risk factors may facilitate early case nding and better management outcomes for these patients.

Frequency of High MELD Score in Cirrhotic Patients undergoing Liver Resection due to Hepatocellular Carcinoma

2021 ◽  
Vol 15 (9) ◽  
pp. 2841-2843
Author(s):  
Muhammad Omer Farooq ◽  
Niaz Ahmed ◽  
Hassan Nadeem ◽  
Kashif Rafi ◽  
Sadia Jabbar ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Resection ◽  
Cross Sectional Study ◽  
Meld Score ◽  
Cross Sectional ◽  
Female Ratio ◽  
Score Study ◽  
Insignificant Difference ◽  
Cirrhotic Patients ◽  
Male To Female

Objective: To determine the frequency of high MELD score in cirrhotic patients undergoing liver resection due to hepatocellular carcinoma also compare the frequency of mortality in patients with high or low MELD score. Study Design: Cross sectional study Place and Duration: Department of Gastroenterology, Shaikh Zayed Hospital, Lahore. Duration: 6months i.e. 23 12-2017 to 22-06-2018. Methodology: 75 patients were enrolled. Then blood sample was obtained. Reports assessed and MELD score calculated. Scores were labeled as high or low. Patients underwent liver resection according to BCLC. The mortality was noted. All the collected data was entered and analyzed on SPSS version 22. Results: In this study out of total 75 cases 60 were males and 15 females. The mean age of patients was 39.44±9.76 years, male to female ratio was 4:1. Low MELD class was noted in 45 (60%) cases and high MELD class noted in 30(40%) cases. Mortality occurred in 27(36%) cases. Insignificant difference found between the MELD class with mortality. Conclusion: High MELD score was seen in 40% cirrhotic patients undergoing liver resection due to HCC. Post HCC resection, mortality occurred in 36% patients within three months of surgery. No significant association was found between the mortality and MELD score. Keywords: MELD, Hepatocellular Carcinoma, Mortality, Cirrhosis

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