PS01.062: REFLUX ASPIRATION SURGICAL OUTCOMES: DOES LAPAROSCOPIC FUNDOPLICATION SIGNIFICANTLY DECREASE QUANTITATIVE AND SYMPTOMATIC PULMONARY ASPIRATION?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 67-67
Author(s):  
Oleksandr Khoma ◽  
Susanna Falk ◽  
Leticia Burton ◽  
Hans Van Der Wall ◽  
Gregory Falk
Keyword(s):  
Laparoscopic Fundoplication ◽  
Conflicts Of Interest ◽  
Pulmonary Aspiration ◽  
Objective Data ◽  
Inclusion Criteria ◽  
Short Term ◽  
Life Data ◽  
Oesophageal Dysmotility

Abstract Background Pulmonary aspiration of gastric refluxate is one of the indications for anti-reflux surgery. Effectiveness of surgery in preventing pulmonary aspiration post-operatively has not been previously tested. Methods Retrospective analysis of prospectively populated database of patients with confirmed aspiration of gastric refluxate on scintigraphy. Patients that have undergone anti-reflux surgery between 01/01/2014 and 31/12/2015 and had scintigraphy post-operatively were included. Objective data such as resolution of aspiration, degree of proximal aero-digestive contamination, surgical complications and oesophageal dysmotility as well as patient quality of life data was analysed. Results Inclusion criteria were satisfied by 39 patients (11 male and 28 female). Pulmonary aspiration was prevented in 24 out of 39 patients (61.5%) post operatively. Significant reduction of isotope contamination of upper oesophagus supine and upright (P = 0.002) and pharynx supine and upright (P = 0.027) was confirmed on scintigraphy post operatively. Severe oesophageal dysmotility was strongly associated with continued aspiration post-operatively OR 15.3 (95% CI 2.459–95.194; P = 0.02). Majority (24/31, 77%) of patients were satisfied or very satisfied with surgery, whilst 7/31 (23%) were dissatisfied. Pre-operative GIQLI scores were low (mean 90.5, SD 18.8), modest improvements at 6 months (mean 92.8, SD 23.9) and 12 months (mean 92.2, SD 27), were not significant (P = 0.07). Conclusion Surgery is partially effective in reversing pulmonary aspiration of gastric refluxate on short-term follow up. Severe oesophageal dysmotility is a predictor of inferior control of aspiration with surgery. Overall satisfaction with surgery in patients with pulmonary aspiration is inferior compared to other patients undergoing anti-reflux surgery. Disclosure All authors have declared no conflicts of interest.

RA06.03: SURGICAL OUTCOMES OF GIANT HIATAL HERNIA REPAIR IN PATIENTS OVER THE AGE OF 80

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 30-30
Author(s):  
Oleksandr Khoma ◽  
Miho Mugino ◽  
Gregory Falk
Keyword(s):  
Quality Of Life ◽  
Hernia Repair ◽  
Hiatal Hernia ◽  
Laparoscopic Fundoplication ◽  
Conflicts Of Interest ◽  
Hiatal Hernia Repair ◽  
Post Operative Period ◽  
Giant Hiatal Hernia

Abstract Background Patients with giant hiatal herniae are often symptomatic and have significantly reduced quality of life (QoL). Laparoscopic fundoplication is an established treatment of giant hiatal hernia. Advanced age has been previously shown to be the most significant predictor of mortality and morbidity in hiatal hernia repair. Reported outcomes of laparoscopic fundoplication in patients over the age of 80 are limited to case reports and small case series. Methods Data was extracted from a prospectively populated single surgeon database of laparoscopic fundoplication procedures between 1995 and 2014. Patients who were operated for giant HH (> 30% of stomach in the chest) that were aged 80 or older at the time of surgery were included. Quality of life (QOL) data was collected pre-operatively, in early post-operative period (within 12 months) and late post-operative period (24 months or later). QOL data included gastro-intestinal quality of life index (GIQLI), Visick score, dysphagia score and overall satisfaction with surgery. Search of Ryerson index (was conducted to establish month and year of death and calculate post-operative life expectancy. Results Inclusion criteria were met by 89 patients. Average age was 84 (80–93). The proportion of herniated stomach was 70.9% on average (range 30–100%; SD 27.25), the hiatal defect was large in all patients. There was 1 perioperative death from myocardial infarction at 30 days after surgery. There were no other major complications (Clavien-Dindo Grade III-IV). Post-operative survival was an average of 74.5 months (SD 47.8; range 1–233). GIQLI was reduced pre-operatively (mean 91.8; SD 19.4). There was improvement in GIQLI scores on early (mean 101.45; SD 21.2) and late (mean 106.7; SD 19.2; P = 0.005) post-operative follow up. Pre-operative Visick scores (mean 2.92; SD 0.98) have improved significantly in early (mean 1.94; SD 0.97; P = 0.000) and late (mean 2.03; SD 0.99; P = 0.001) post-operative periods. During early post-operative follow up 97% of the patients were satisfied with overall outcome of their operation, whilst 3% were dissatisfied. Overall satisfaction scores remained high on late follow up (93.3% satisfied, 6.7% dissatisfied). Conclusion Findings of this study demonstrate that in carefully selected patients with giant HH surgery is safe and results in improved quality of life post operatively. Disclosure All authors have declared no conflicts of interest.

Cathartic Effect of Suicide Attempts Not Limited to Depression

Crisis ◽  
2003 ◽  
Vol 24 (2) ◽  
pp. 73-78 ◽  
Author(s):  
Yves Sarfati ◽  
Blandine Bouchaud ◽  
Marie-Christine Hardy-Baylé
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Personality Traits ◽  
Rating Scales ◽  
Suicide Attempts ◽  
World Health ◽  
Life Questionnaire ◽  
Short Term

Summary: The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.

Do We Have Another Option to Treat Bleeding Hemorrhoids? The Emborrhoid Technique: Experience in 16 Patients

2020 ◽  
Vol 15 ◽  
Author(s):  
Elisabetta Moggia ◽  
Giuseppina Talamo ◽  
Gaetano Gallo ◽  
Gaetano Gallo ◽  
Matteo Barattini ◽  
...  
Keyword(s):  
Rectal Bleeding ◽  
Hemorrhoidal Disease ◽  
Severe Bleeding ◽  
Conventional Surgery ◽  
Short Term ◽  
Selective Embolization ◽  
Invasive Techniques ◽  
Bleeding Hemorrhoids

Background: Hemorrhoidal disease is very common in western countries and rectal bleeding is the main symptom complained by patients. Nowadays the ultimate goal of treatment is to block the bleeding with minimally-invasive techniques to minimize post-procedural pain. Objective: The aim of this study is to assess the preliminary results of the emborrhoid technique (embolization of the superior rectal arteries branches) as a new tool for the proctologist to treat severe bleeding hemorrhoids causing anemia. Many categories of patients might benefit from this treatment, such as patients not eligible for conventional surgery, patients not responding to conventional treatment and fit patients with severe bleeding who refused endorectal surgical therapy. Method: From May 2017 to November 2018 a total of 16 patients with chronic rectal bleeding due to hemorrhoids underwent super-selective embolization of the superior rectal arteries at the department of General Surgery in La Spezia, S. Andrea Hospital, Italy. Median age was 59 years. 14 patients were males (87.5 %). Results: No post-procedural and short-term complications were observed at maximum follow up (12 months). The reduction of rectal bleeding with improvement of the quality of life was obtained in 14 patients (87.5%). Conclusion: Our study, although small in number, demonstrates that embolization of superior rectal arteries with coils to treat severe bleeding due to hemorrhoids is safe and effective and does not lead to immediate complications.

scholarly journals POSTOPERATIVE DYSPHAGIA AFTER LAPAROSCOPIC FUNDOPLICATION AS A TREATMENT FOR GASTROESOPHAGEAL REFLUX DISEASE

2021 ◽  
Vol 108 (Supplement_3) ◽  
Author(s):  
B Carrasco Aguilera ◽  
S Amoza Pais ◽  
T Diaz Vico ◽  
E O Turienzo Santos ◽  
M Moreno Gijon ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Surgical Technique ◽  
Gastroesophageal Reflux ◽  
Hiatal Hernia ◽  
Reflux Disease ◽  
Laparoscopic Fundoplication ◽  
Descriptive Study ◽  
Postoperative Dysphagia

Abstract INTRODUCTION Laparoscopic Fundoplication (LF) as a treatment for gastroesophageal reflux disease (GERD) has positive clinical outcomes. However, postoperative dysphagia (PD) may appear as a side effect. Our objective is to analyze PD in patients operated on for LF in our center. MATERIAL AND METHODS Retrospective and descriptive study of patients operated on for GERD from September 1997 to February 2019. RESULTS 248 patients (60.5% men), with a mean age of 49.7 (21-82), were operated. 66.1% of the patients presented associated comorbidities, highlighting obesity (19.8%). 75% manifested typical symptoms, 19% presenting with Barrett’s esophagus. Sliding hiatal, paraesophageal, mixed and complex hernia were diagnosed in 151 (60.9%), 23 (9.3%), 12 (4.8%), and 4 (1.6%) patients, respectively. The LF Nissen was the most frequent technique (91.5%), using a caliper in 46% of the cases. PD was the most frequent symptom, present in 57 (23%) patients. It was resolved with dilation in 9 patients, requiring 6 patients surgical reintervention. In those PD cases, a caliper was used in 28 (49.1%) patients, without finding significant differences between them (P = .586). Nor were there significant differences between PD and obesity (P = .510), type of hiatal hernia (P = .326), or surgical technique (P = .428). After a median follow-up of 50.5 months, quality of life was classified as Visick I-II, III, and IV in 76.6%, 6.9% and 1.2% of the cases, respectively. CONCLUSION No association between PD and the use of calipers, surgical technique or type of hiatal hernia was found in our series.

Common late complications of longitudinal forefoot amputations in neuropathic foot treatment

2021 ◽  
Vol 30 (6) ◽  
pp. 498-503
Author(s):  
Rodrigo Sousa Macedo ◽  
Lucas Sousa Macedo ◽  
Marcos Hideyo Sakaki ◽  
Rafael Barban Sposeto ◽  
Rafael Trevisan Ortiz ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Reoperation Rate ◽  
Late Complications ◽  
Inclusion Criteria ◽  
Patients With Diabetes ◽  
Partial Amputation ◽  
Neuropathic Foot ◽  
Foot Clinic ◽  
Ray Amputation

Objective: To describe and quantify the complications arising in consecutive neuropathic patients undergoing partial longitudinal amputations of the foot. Method: A retrospective study was conducted with data collected from the medical records of patients monitored at the Insensitive Foot Clinic of the Foot and Ankle Group of our institution who underwent partial amputation of foot rays from 2000 to 2016. Results: A total of 28 patients met the inclusion criteria, with a total of 31 amputated/partially amputated feet. Of these, 18 (58.1%) feet were amputated/partially amputated due to diabetes, seven (22.6%) due to leprosy, two (6.5%) due to alcoholic neuropathy, two (6.5%) secondary to traumatic peripheral nerve injury, and two (6.5%) due to other causes. Fifth ray amputation was the most frequent type (n=12). The cause of amputation was the presence of an infected ulcer in 93.6% of the samples. At a mean follow-up time of 60 months, 13 (41.9%) feet required new amputations—five (38.5%) transtibial, five (38.5%) transmetatarsal, two (15.4%) of the toes, and one (7.7%) at Chopart's joint. Patients with diabetes had a 50.0% reamputation rate. Patients who initially underwent amputation of the fifth ray had a 58.3% reamputation rate. Conclusion: Partial longitudinal amputation of the foot in neuropathic patients exhibited a high reoperation rate, especially in patients with diabetes or in patients with initial amputation of the peripheral rays. Declaration of interest: The authors have no conflicts of interest.

scholarly journals Does a missed obstetric anal sphincter injury at time of delivery affect short-term functional outcome?

2018 ◽  
Vol 100 (1) ◽  
pp. 26-32 ◽  
Author(s):  
L Ramage ◽  
C Yen ◽  
S Qiu ◽  
C Simillis ◽  
C Kontovounisios ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anal Sphincter ◽  
Short Form ◽  
Primary Repair ◽  
Obstetric Anal Sphincter Injury ◽  
Short Term ◽  
Sphincter Injury ◽  
Anal Sphincter Injury

Introduction This study aimed to ascertain whether missed obstetric anal sphincter injury at delivery had worse functional and quality of life outcomes than primary repair immediately following delivery. Materials and methods Two to one propensity matching was undertaken of patients presenting to a tertiary pelvic floor unit with ultrasound evidence of missed obstetric anal sphincter injury within 24 months of delivery with patients who underwent primary repair at the time of delivery by parity, grade of injury and time to assessment. Outcomes compared included Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ), Wexner Incontinence Score, Short Form-36, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire and anorectal physiology results. Results Thirty-two missed anal sphincter injuries were matched two to one with sixty-two patients who underwent primary repair of an anal sphincter defect. Mean time to follow-up was 9.31 ± 6.79 months. Patients with a missed anal sphincter injury had suffered more incontinence, as seen in higher the Birmingham Bowel, Bladder and Urinary Symptom Questionnaire (BBUSQ; 30.56% ± 14.41% vs. 19.75% ± 15.65%, P = 0.002) and Wexner scores (6.00 ± 3.76 vs. 3.67 ± 4.06, P = 0.009). They also had a worse BBUSQ urinary domain score (28.25% ± 14.9% vs. 17.01 ± 13.87%, P = 0.001) and worse physical functioning as measured by the Short Form-36 questionnaire (P = 0.045). There were no differences in other outcomes compared, including anorectal physiology and sexual function. Discussion In the short-term, patients with a missed obstetric anal sphincter injury had significantly worse faecal incontinence and urinary function scores, however quality of life and sexual function were largely comparable between groups. Conclusions Longer-term follow-up is needed to assess the effects of missed obstetric anal sphincter injury over time.

scholarly journals The effectiveness of M-Health associated with cardiac rehabilitation on functional capacity and cardiovascular risk factors: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A C Campagnolo Goncalves Toledo ◽  
N Soares De Almeida ◽  
A Pierucci ◽  
A Straioto Salomao ◽  
I Ribeiro Lemes ◽  
...  
Keyword(s):  
Functional Capacity ◽  
Meta Analysis ◽  
Medium Term ◽  
Short Term ◽  
High Quality ◽  
Quality Of Evidence ◽  
High Quality Evidence ◽  
Quality Evidence

Abstract Introduction Smartphone applications for health (M-Health) seem to overcome barriers to access Cardiovascular Rehabilitation Programs (CRP), because of their high degree of acceptance and also their potential to influence the frequency of physical exercise in weight loss. Objective To analyze the effectiveness of the combination of M-Health and CRP compared to CRP alone on functional capacity, adherence to CRP, management of cardiovascular risk factors in cardiac patients. Design Systematic Review and Meta-Analysis. Methods The following databases were used Medline via Ovid, EMBASE, Central, PEDro and SPORTDiscus via EBSCOhost from their inception until July/2020. We included randomized controlled trials investigating the effects of M-Health in combination with CRP compared to CRP alone in adults with heart disease, and the interventions with M-Health consisted of text messages, e-mails, and applications. The primary outcome of this review was functional capacity, measured by VO2peak, or self-reported physical activity (METs.min/week). PEDro scale was used to assess the methodological quality of the studies and the GRADE approach to assess the overall quality of evidence. Pooled estimates were calculated using a random effect model to obtain mean difference (MD) or standardized mean differences (SMD) and their respectives 95% confidence intervals (CI). Results Nineteen RCTs were eligible, the median risk of bias was 7 out of 10 points. The primary endpoint was analyzed by subgroups, time of intervention and kind of type CRP, eigthteen of these studies assessed functional capacity. CRP in combination with a m-health intervention was more effective than CRP alone in improving VO2peak, ml/min/kg, (MD: 0.84, CI: 0.30 to 1.38; I2=0%, high quality evidence, 12 trials, n=1889) at short-term follow-up, but at medium-term follow-up (MD: 0.84, CI: −0.26 to 1.41; I2=0%, high quality evidence, 8 trials, n=927,). Similarly, CRP associated with m-health was superior to CRP alone in increasing self-reported at short-term, METs.min/week, (MD:1.31, CI: −0.24 to 2.37; I2 = not aplicable, very low quality evidence, 1 trial, n=18), and at medium-term follow-up (MD: 0.18, CI: −0.01 to 0.36; I2=56%, moderate quality evidence, 4 trials, n=1107). Conclusion High quality of evidence shows that M-Health improves cardiorespiratory fitness at short-term follow-up. In addition, supervised program showed to be more effective than non-supervised. Funding Acknowledgement Type of funding sources: None.

scholarly journals Short-term health-related quality of life in patients with ischaemic stroke after PFO closure

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
G Christopoulou ◽  
E Sigala ◽  
D Aragiannis ◽  
E Stamatopoulou ◽  
P Manthou ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischaemic Stroke ◽  
Physical Function ◽  
Health Related Quality ◽  
Short Term ◽  
Related Quality ◽  
Health Related ◽  
Pfo Closure

Abstract Funding Acknowledgements Type of funding sources: None. Introduction/Purpose: Patent foramen ovale (PFO) is common in asymptomatic adults and is associated with cryptogenic stroke (CS). We sought to evaluate the impact of PFO closure in health-related quality of life (HRQoL) in PFO patients with CS.  Method In this pilot study, 19 patients (mean age 47 ± 7.7; 13 male) who underwent PFO closure at our center were invited to a short-term clinical follow up (mean follow-up period 6-10 months). All patients had suffered an ischaemic stroke and their disability level was assessed using the Modified Rankin Scale (MRS, no significant disability 63%). HRQoL was assessed using the 36-Item Short Form Survey (SF-36) and the European Quality of Life-5 Dimensions Questionnaire (EQ-5D) preoperatively and at follow-up.  Results Both SF36 and EQ-5D scores improved after the operation as shown by the self-rating scores (20,67% and 40,52% higher scores, respectively). Patients with major mobility problems were more likely to be current smokers (r = 0.481) and those who had lower scores on the MRS scale (r=-0.571) rated higher their scale diagram.  The categories of energy/fatigue (r = 0.459; p = 0.048), social functioning (r = 0.547; p = 0.015) and pain (r = 0.550; p = 0.015) were positively correlated with physical function. Finally, there was a positive correlation between role limitations due to emotional problems and energy/fatigue (r = 0,519; p = 0.023), and between energy/fatigue and emotional well-being (r = 0.519; p = 0,023). Conclusions The results of our study indicate that shortly after PFO, subjects perceive improvements in their QoL. However, it seems that poorly rated physical function was more common in active smokers, and affects patients" social life and their emotional state. Health care professionals should encourage these patients to participate in rehabilitation and psychological support programs postoperatively.

The Impact of Emergency Surgery versus Self-expanding Metallic Stents on Anal Function and Quality of Life in Patients with Complete Obstructing Left-sided Colon Cancer

2021 ◽  
Author(s):  
GanBin Li ◽  
Tao Yu ◽  
Hao-Yu Zhang ◽  
Zhen-Jun Wang ◽  
Guang-Hui Wei ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Colon Cancer ◽  
Regression Analysis ◽  
Short Term ◽  
Anal Function ◽  
Eortc Qlq C30 ◽  
Eortc Qlq ◽  
Better Than

Abstract Background: Emergence surgery (ES) and self-expanding metallic stents (SEMS) are traditional approaches for complete obstructing left-sided colon cancer. A strategy of “stents-chemotherapy-surgery” was applied in our center recently. Studies assessing the anal function and quality of life of patients with complete obstructing left-sided colon cancer are still lacking.Methods: Patients with complete obstructing left-sided colon cancer were included, and three treatment strategies were used, including ES, SEMS, and SEMS followed by neoadjuvant chemotherapy (NAC) for patients with complete obstructing left-sided colon cancer. The Wexner, Vaizey, and low anterior resection syndrome (LARS) scores were used to assess anal function and the EORTC QLQ C30 score was used to assess quality of life. Logistic regression analysis was used to detect risk factors affecting short-term anal function of patients.RESULTS: The Wexner scores were similar among the groups during the follow-up period. The Vaizey (H=18.415, P=0.001) and LARS scores (H=3.660, P=0.04) both revealed that anal function among patients receiving SEMS and NACwas significantly better than patients who underwent ES at the 1-month post-operative follow-up evaluation; no significant difference existed at the 6- and 12-month follow-up evaluations. The EORTC QLQ C30 score revealed that social function of patients receiving SEMS and NAC was also significantly better than patients undergoing ES (H=7.035, P=0.03). Logistic regression analysis suggested that a one-stage stoma in an emergent setting is an independent risk factor for short-term reduction of anal function among patients with complete obstructing left-sided colon cancer (OR=5.238, 95% CI: 1.569~17.484, P=0.007).Conclusion: Compared to ES, SEMS might be able to improve the quality of life and short-term anal function in patients with complete obstructing left-sided colon cancer.

Intra-arterial chemotherapy for retinoblastoma: an updated systematic review and meta-analysis

2019 ◽  
Vol 11 (12) ◽  
pp. 1266-1272 ◽  
Author(s):  
Krishnan Ravindran ◽  
Lauren A Dalvin ◽  
Jose S Pulido ◽  
Waleed Brinjikji
Keyword(s):  
Metastatic Disease ◽  
Meta Analysis ◽  
Inclusion Criteria ◽  
First Line ◽  
Short Term ◽  
Systemic Complications ◽  
Substantial Heterogeneity ◽  
Insight Into

Background and purposeIntra-arterial chemotherapy for retinoblastoma has been adopted as a first-line treatment option by numerous tertiary centers. The effect of intra-arterial chemotherapy on future rates of metastatic disease as well as on globe salvage in advanced eyes remains relatively unknown.MethodsA search of PubMED, MEDLINE, EMBASE, and Web of Science electronic databases was conducted from inception until January 2019 for studies with a minimum of 10 patients reporting outcomes and complications following intra-arterial chemotherapy for retinoblastoma.ResultsA total of 20 studies met the inclusion criteria for analysis, comprising 873 patients and 1467 eyes. Only one study was comparative; there was substantial heterogeneity in reported outcomes and several overlapping patient cohorts that were published. Across all studies, 174 of 1467 eyes were enucleated (11.8%). Metastatic disease occurred in 8 of 513 patients (1.6%). Globe salvage was achieved in 318 of 906 (35.6%) cases of advanced retinoblastoma. The most common ocular complication was retinal detachment, occurring in 23% of eyes, and the most common systemic complications were transient fever and nausea/vomiting.ConclusionsThere is a paucity of higher-level evidence with adequate follow-up surrounding the long-term safety of intra-arterial chemotherapy and effect on metastasis in retinoblastoma. Studies to date have been limited by short-term follow-up. Longitudinal prospective studies could provide greater insight into the ability of intra-arterial chemotherapy to reduce the risk of retinoblastoma metastasis.

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