RA05.04: MANAGEMENT & OUTCOMES OF ANASTOMOTIC LEAKS FOLLOWING ESOPHAGECTOMY: A PROSPECTIVE 10-YEAR SINGLE-SITE EXPERIENCE

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 28-28
Author(s):  
Joel Lambert ◽  
Sanya Caratella ◽  
Eloise Lawrence ◽  
Bilal Alkhaffaf
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Surgical Intervention ◽  
Type I ◽  
Oral Contrast ◽  
Open Approach ◽  
Type Ii ◽  
Anastomotic Leaks ◽  
Type Iii ◽  
Significant Difference

Abstract Background Anastomotic leak after esophagectomy is associated with high levels of morbidity and may impact negatively on oncological outcomes. The aim of this single centre study was to describe our experience in managing these complications Methods From 2007–2017 data was reviewed retrospectively from our prospectively maintained electronic database. All patients underwent either 2 or 3 phase esophagectomy for cancer of the oesophagus or esophago-gastric junction. All histological sub-types and stage of cancer were included in the analysis. Anastomotic leaks were classified according to the Esophagectomy Complications Consensus Group (ECCG) guidelines; type I—conservative management, type II—non-surgical intervention, type III—surgical intervention. Results 224 esophagectomies were included in our analysis (104 (46%) minimally invasive, 120 (54%) open approach). The incidence of all anastomotic leaks was 10% (23/224). Surgical approach did not influence the incidence of anastomotic leak (minimally invasive 10 (43%), open approach 13(57%), P = 0.76). Five patients (22%) had a type I leak, 9 patients (39%) type II and 9 (39%) had a type III leak. There was an increase in the number of leaks managed non-surgically over the last 5 years compared to those in the first five years of our dataset (2012–2017: 11/23 (48%) vs 2007–2012: 4/23 (17%) P = 0.08). The median time for leak diagnosis was 8 days. Most leaks were diagnosed with oral contrast CT 19 (83%). Median hospital stay after anastomotic leak was 58.5 days. Type III leaks were associated with an increased length of stay (median 84 days) compared to type I&II leaks (median (38.5 days) (P = 0.002 95% CI 18.19- 74.41). There was no significant difference in 30-day mortality between type I&II (0 patients) and type III leaks (1 patient) P = 0.260. Conclusion Low mortality rates with anastomotic leak can be achieved. In centres with experienced radiological and endoscopic skills, most anastomotic leaks can be managed non-surgically. Disclosure All authors have declared no conflicts of interest.

Minimally Invasive Surgical Management as Effective First-Line Treatment of Large Pyogenic Hepatic Abscesses

2019 ◽  
Vol 85 (8) ◽  
pp. 813-820
Author(s):  
Ryan C. Pickens ◽  
Stephanie Jensen ◽  
Jesse K. Sulzer ◽  
Maria Baimas-George ◽  
Erin H. Baker ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Surgical Intervention ◽  
Type I ◽  
Type Ii ◽  
Line Treatment ◽  
First Line ◽  
Algorithmic Approach ◽  
Type Iii ◽  
Minimally Invasive Surgical ◽  
First Line Treatment

Management of pyogenic hepatic abscesses (PHA) varies among surgeons and institutions. Recent studies have advocated for first-line percutaneous drainage (PD) of all accessible hepatic abscesses, with surgery reserved as rescue only. Our study aimed to internally validate an established multimodal algorithm for PHA at a high-volume hepatopancreatobiliary center. Patients treated by the hepatopancreatobiliary service for PHA were retrospectively reviewed from 2008 through 2018. The algorithm defined intended first-line treatment as antibiotics for type I abscesses (<3 cm), PD for type II (≥3, unilocular), and surgical intervention (minimally invasive drainage or resection, when possible) for type III (≥3 cm, multilocular). Outcomes were compared between patients who received first-line treatment following the algorithm versus alternate therapy. Of 330 patients with PHA, 201 met inclusion criteria. Type III abscesses had significantly lower failure following algorithmic approach with surgery compared with PD (4% vs 28%, P = 0.018). Type II abscesses failed first-line PD in 27 per cent (13/48) with 11 patients requiring surgical rescue, whereas first-line surgery failed in only 13 per cent (2/15). No deaths occurred after any surgical intervention, and there was no statistical difference in major complications between first-line surgical intervention and PD for type II or III abscesses. These results support the algorithmic approach and demonstrate that minimally invasive surgical intervention is a safe and effective modality for large PHA. We recommend that select patients with large, complex abscesses should be considered for a first-line minimally invasive surgical approach depending on surgical experience and available resources.

scholarly journals Use of Metaphyseal Sleeves in Revision Knee Arthroplasty

2017 ◽  
Vol 24 (2) ◽  
pp. 5-10
Author(s):  
M. V Girkalo ◽  
I. A Norkin
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Type I ◽  
Type Ii ◽  
Short Term ◽  
Type Iii ◽  
Revision Knee Arthroplasty ◽  
Total Knee

Purpose. To study the short-term results of revision knee arthroplasty performed using metaphyseal sleeves. Patients and methods. During the period from 2013 to 2015 the total number of 40 patients was operated on. Type I femoral defects (by AORI classification) were diagnosed in 11 (27.5%), type II - in 26 (65.0%), type III - in 3 (7.5%) cases. Type I tibial defects were diagnosed in 2 (5.0%), type IIa - in 24 (65.0%), type IIb - in 11 (27.0%) and type III - in 3 (7.54%) cases. Metaphyseal femoral sleeves were used in 8 and metaphyseal tibial sleeve - in 40 patients. Results. Follow up period made up from 12 to 43 (mean 32.8) months. Excellent and good results by KSS scale were achieved in 30 (75.0%) of patients, by functional KSS scale - in 24 (60.0%) patients. Mean point by Knee Society Total Knee Arthroplasty Roentgenographic Evaluation scale in patients with femoral and tibial metaphyseal sleeves made up 2.35 versus 0.375 that confirmed the absence of progressive bone resorption. No one case of aseptic instability of the revision implant was observed. Repeated surgical intervention due to reinfection and knee joint contracture with pain syndrome was performed in 2 (5.0%) patients. Conclusion. The obtained data enable to recommend the use of metaphyseal sleeves for revision knee arthroplasty in patients with tibial and femoral defects of types II and III by AORI classification.

scholarly journals The Value of Contrast-Enhanced Ultrasound Classification in Diagnosis of Pancreatic Cystic Lesions

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Yixi Wang ◽  
Yanjie Wang ◽  
Zhihui Fan ◽  
Jun Shan ◽  
Kun Yan
Keyword(s):  
Diagnostic Accuracy ◽  
Diagnostic Value ◽  
Type I ◽  
Cystic Lesions ◽  
Type Ii ◽  
Contrast Enhanced Ultrasound ◽  
Type Iii ◽  
Type Iv ◽  
Contrast Enhanced ◽  
Significant Difference

Objective. To compare the consistency of contrast-enhanced ultrasound (CEUS) classification results with magnetic resonance imaging (MRI) and to investigate the diagnostic value of CEUS classification in pancreatic cystic lesions. Methods. 84 cases of pancreatic cystic lesions were enrolled in this study. According to the CEUS classification methods of previous study in our center, all the lesions were classified into four types: type I, unilocular cysts; type II, microcystic lesions; type III, macrocystic lesions; and type IV, cystic lesions with enhanced solid components. The consistency of CEUS and MRI typing results was analysed. Among the 84 cases, 45 cases had pathological results. The CEUS results were compared with the pathological results, and the diagnostic value of CEUS classification in diagnosing pancreatic cystic lesions was explored. Results. Among the 84 cases, CEUS diagnosed 8 cases of type I, 24 of type II, 8 of type III, and 45 of type IV. MRI diagnosed 10 cases of type I, 25 of type II, 7 of type III, and 43 of type IV. The classification typing results of CEUS were highly consistent with that of enhanced MRI (kappa value: 0.852). Among the 45 cases with pathological results, the diagnostic accuracy of each type was 91.1%, 95.6%, 93.3%, and 88.9%. The accuracy of CEUS and MRI in diagnosing pancreatic cystic lesions was 75.56% (34/45) and 80% (36/45), respectively. The diagnostic accuracy of CEUS had no significant difference from that of MRI (P=0.687). Conclusion. The classification results by CEUS and MRI are in excellent agreement. The classification of pancreatic cystic lesions by CEUS is significantly helpful for clinical diagnosis.

The development of lampbrush chromosome-type transcription in the early diplotene oocytes of Xenopus laevis: an electron-microscope analysis

1980 ◽  
Vol 44 (1) ◽  
pp. 87-101
Author(s):  
R.S. Hill ◽  
H.C. Macgregor
Keyword(s):  
Linear Regression ◽  
Xenopus Laevis ◽  
Linear Regression Analysis ◽  
Transcription Unit ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Significant Difference ◽  
Germinal Vesicles ◽  
The Mean

Oocytes of Xenopus laevis in pachytene and early diplotene of meiosis have been studied using the Miller spreading technique. Transcription first appears in germinal vesicles 25–40 micrometers in diameter, when the oocyte is in early diplotene. Transcription at this stage consists of arrays of short RNP transcripts, irregularly distributed along the DNP axis. Linear regression analysis has shown that many of these arrays are transcription units (Type I) with the transcripts having a common point of origin. The lengths of these early transcription units (mean = 7.06 +/− 5.06 micrometers), calculated from the linear regression data, are comparable to the lengths of transcription units from later stages, including Dumont stage 3. The polymerase granules of Type I transcription units are widely and irregularly spaced, having a mean spacing of 505 +/− 748 nm. More advanced transcription units (Type II, mean length = 8.72 +/− 3.77 micrometer) are usually found in the same chromosome set as the Type I units. Type II transcription units have closer and more regularly spaced polymerase granules than Type I transcription units (mean spacing = 92 +/− 49 nm). Both Type I and II transcription units have comparatively short RNP transcripts, the mean values for the slopes of their regression lines being 0.1336 and 0.1440 respectively. By the time the germinal vesicles are about 50–60 micrometers in diameter the transcription units have a quite different morphology (Type III). The lengths of the Type III transcription units are comparable to the Type I and II units, the mean length being 6.34 +/− 4.03 micrometers. The spacing of the polymerase granules in the Type III units is closer and more regular than the earlier stages (70 +/− 40 nm). Another significant difference between Type III and Types I and II transcription units is a decrease in the foreshortening of the Type III RNP transcripts. The mean slope of the regression lines for Type III transcription units is 0.2439. The morphological appearance of the Type III transcription unit is virtually identical to that of the transcription units from Dumont stage 3 oocytes, both with respect to the length and the spacing of the polymerase granules. However, the transcripts in Type III transcription units are still more foreshortened than those of Dumont stage 3 oocytes, having mean regression slopes of 0.4728. From the data obtained in the present study, it has been concluded that the pattern of lampbrush-type transcription is virtually fully established by the time most germinal vesicles are about 50 micrometers in diameter.

scholarly journals Use of Metaphyseal Sleeves in Revision Knee Arthroplasty

2017 ◽  
pp. 5-10
Author(s):  
M. V. Girkalo ◽  
I. A. Norkin
Keyword(s):  
Knee Arthroplasty ◽  
Surgical Intervention ◽  
Pain Syndrome ◽  
Type I ◽  
Type Ii ◽  
Short Term ◽  
Type Iii ◽  
Revision Knee Arthroplasty ◽  
Total Knee

Purpose.To study the short-term results of revision knee arthroplasty performed using metaphyseal sleeves.Patients and methods. During the period from 2013 to 2015 the total number of 40 patients was operated on. Type I femoral defects (by AORI classification) were diagnosed in 11 (27.5%), type II - in 26 (65.0%), type III - in 3 (7.5%) cases. Type I tibial defects were diagnosed in 2 (5.0%), type IIa - in 24 (65.0%), type IIb - in 11 (27.0%) and type III - in 3 (7.54%) cases. Metaphyseal femoral sleeves were used in 8 and metaphyseal tibial sleeve - in 40 patients.Results. Follow up period made up from 12 to 43 (mean 32.8) months. Excellent and good results by KSS scale were achieved in 30 (75.0%) of patients, by functional KSS scale - in 24 (60.0%) patients. Mean point by Knee Society Total Knee Arthroplasty Roentgenographic Evaluation scale in patients with femoral and tibial metaphyseal sleeves made up 2.35 versus 0.375 that confirmed the absence of progressive bone resorption. No one case of aseptic instability of the revision implant was observed. Repeated surgical intervention due to reinfection and knee joint contracture with pain syndrome was performed in 2 (5.0%) patients.Conclusion. The obtained data enable to recommend the use of metaphyseal sleeves for revision knee arthroplasty in patients with tibial and femoral defects of types II and III by AORI classification.

scholarly journals A Comparison of The Clinical Characteristics Comprising Abdominal Wall Endometriosis of Various Types

2021 ◽  
Author(s):  
YuShi Wu ◽  
Yi Dai ◽  
Junji Zhang ◽  
Xiaoyan Li ◽  
Jinghua Shi ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Recurrence Rate ◽  
Clinical Characteristics ◽  
Tissue Type ◽  
Type I ◽  
Type Ii ◽  
Pelvic Endometriosis ◽  
Type Iii ◽  
Abdominal Wall Endometriosis ◽  
Significant Difference

Abstract Purpose To classify abdominal wall endometriosis (AWE) according to the invasive levels of tissue mass, and to compare the differences in clinical characteristics between different types of AWE. Methods In this study, we retrospectively analyzed the clinical data of 367 patients who had undergone resection of abdominal-wall endometriotic lesions at the Peking Union Medical College Hospital from January 2008 to December 2018, and we divided the patients into three types according to their deepest level of lesion invasion. Type I designated invasion of skin and subcutaneous tissue; type II, of fascia and rectus abdominis; and type III, of peritoneum. We classified, compared, and analyzed the general conditions, clinical manifestations, auxiliary examinations, surgical conditions, postoperative conditions, and recurrence status of patients. Result s Of the 367 patients, type I patients accounted for 13.62%, type II patients for 56.68%, and type III for 29.7%. With respect to group comparisons, we observed that as the location of the mass deepened, the rate of concurrent pelvic endometriosis increased (P = 0.007), recurrent AWE was augmented (P = 0.02), the size of the mass increased (P < 0.001), the rate of multiple lesions became elevated (P < 0.001), the rate of mesh implantation increased (P < 0.001), the length of postoperative hospital stay (P < 0.001) was lengthened, the number of postoperative fever cases (P = 0.006) increased, and the risk of drainage placement (P < 0.001) was enhanced. The 5-year cumulative recurrence rate was 3.3%, and there was no significant difference in the recurrence rate among various types of AWE. Conclusion Various types of AWE manifest different clinical characteristics, surgical options, associations with pelvic endometriosis, and postoperative conditions.

scholarly journals AB0525 NATURAL HISTORY OF CRYOGLOBULINEMIA FROM 2000 TO 2018 FROM THE LABORATORY POINT OF VIEW: AN ANALYSIS OF CRYOGLOBULIN CHARACTERISTICS IN A SINGLE CENTER.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1559.3-1560
Author(s):  
G. Sandri ◽  
A. Spinella ◽  
P. Natali ◽  
D. Debbia ◽  
D. Campioli ◽  
...  
Keyword(s):  
Big Data ◽  
Chronic Hepatitis ◽  
Rare Condition ◽  
Relevant Information ◽  
Strategic Decision ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Significant Difference

Background:Big data refers to large amounts of information. With today’s ever-improving technologies created by the automation and digitization, it becomes easier to convert data into relevant information, which can be used to provide better patient management, especially when it occurs a rare condition such as cryoglobulinemia (CRG).CRG is due to an immunoglobulins (Ig) that precipitate at low temperatures. There are 3 types of CRG: type I: monoclonal Ig; type II: monoclonal Ig + polyclonal Ig; type III: 2 polyclonal Ig.Objectives:The aim of this study was to analyse the available data coming to the Department of Laboratory Medicine of Modena to describe the population of patients suffering of CRG.Methods:Data from the Modena Labs network were extracted by means of the software “Pagoda”, for statistical purposes, directly connected to the Laboratories Information System (LIS). Considered time period 2000-2018Results:The analysed samples were 28,847, 4901 (17%) of which positive to the cryoglobulins (CR) detection. The typing positive CR were 4190 (85%): type 1 7.8 %, type II 48.54% and type III 43.8% The positive samples belonged to 2528 patients. Patients were 1563 (62%) women, average age 66±16, and 965 (38%) men, average age 62±16. (female/male ratio = 1.62) No statistically significant difference regarding sex and age between the 3 types. The cryoglobulinemia phenomenon is quite complex and the typing of monoclonal, polyclonal components of the Ig classes and chains has made it possible to identify 41 possible combinationsOut of 115 patients with Type 1 cryoglobulin, 73% had a monoclonal IgM and 36% monoclonal IgG; 11.2% both monoclonal IgG and IgM. The к light chain was the most frequent: 55,6% IgM-k and 23,4% IgG-k vs 29% IgM-λ and 18.2% IgG-λ. Two patients had an IgA-k cryoglobulin.Patients with Type 2 cryo were 781: monoclonal IgM-k 587 (75.1 %), 126 IgM-λ (16.1 %), 52 IgG-k (6.6 %), IgG-λ (5%), 1 IgA-λ; 2.8% had both IgG and IgM. Out of 1204 patients with Type 3 cryo, 74.8% had both polyclonal IgG and IgM, 13,8% had isolated IgM or IgG (9%); 4.8 % IgG-IgA-IgM together, both IgG and IgA in only 0,5% of patients. Almost the 50% (1255) of the patients had a diagnosis supporting the request of CR:HCV, 604 (48%); chronic hepatitis, 177 (14%); rheumatologic disorder, 107 (9%); autoimmune diseases, 83 (7%), nephropathy, 80 (7%); others, 204 (15%).Genotyped HCV+ patients were 290 (48%), with the following results: 1b, 136 (47%); 2a/2c, 65 (22%); 3a, 26 (9%); others 63 (22%).Conclusion:The data show that CRG is a pathology which affects the elderly and especially women, as in autoimmune and rheumatological diseases. The predominant CRG type is the III and the most frequently related pathology to the request for CR is HCV+ and chronic hepatitis. The most common HCV genotype are 1b and 2a/2c The cryoglobulinemia phenomenon is complex and laboratory typing is intriguing.Starting from this preliminary descriptive study, it will be possible, with the available data, to perform elaborations that allow to relate CRG with the diagnosis and verify the effect of therapy.Big Data methods’ application represents an undeniable resource for public institutions when carrying out strategic decision-making processes.Disclosure of Interests:None declared

The Study of Sexual Dimorphism in Lip Print Patterns Among Igbos in Anambra State of Nigeria: A Cross-Sectional Study

2020 ◽  
Vol 11 (2) ◽  
pp. 240-244
Author(s):  
Chijioke Mmadueke Okeke ◽  
Onyechege Ann ◽  
Ukoha Ukoha Ukoha ◽  
Uchechukwu Dimkpa ◽  
Ijeoma Enemuo
Keyword(s):  
Sex Determination ◽  
Cross Sectional Study ◽  
Frequent Pattern ◽  
Type I ◽  
Type Ii ◽  
Sectional Study ◽  
Cross Sectional ◽  
Type Iii ◽  
Type Iv ◽  
Significant Difference

Aim: To characterize the lip print pattern in a study population and to ascertain its potential for sex determination. Materials and Methods: A cross-sectional study was conducted among 300 undergraduate students (144 males and 156 females). Simple random sampling was used. Lip prints were obtained with lipstick and were classified according to Suzuki and Tsuchihashi classification. Data were analyzed with the Statistical Package for Social Sciences (SPSS) version 22 (IBM Corp., Armonk, NY, USA). The prevalence of lip print patterns was presented as frequencies and percentages, and the test of significance of gender difference was done with chi-square at the 95 percent confidence interval. Result: No two lip print patterns were found to be the same. There was a significant difference in the lip print patterns of females and males. In females, the pattern with the highest frequency was type II (40.4%). This was followed by type I (36.5%), type III (13.5%), type V (7.1%), and type IV (2.6%). In males, the pattern with the highest frequency was type IV (28.5%). This was followed by type III (26.4%), types I and V (each 16.0%), and type II (13.2%). When both sexes were considered together, type II was the most frequent pattern. Conclusion: Lip print is unique to individuals and it has potential for sex determination. The most prevalent patterns in females and males were type II and type IV, respectively.

Effort and the Forced Expiratory Volume in One Second (FEV1)

1970 ◽  
Vol 39 (6) ◽  
pp. 747-755 ◽  
Author(s):  
J. R. Kemm ◽  
P. L. Kamburoff
Keyword(s):  
Healthy Subjects ◽  
Forced Expiratory Volume ◽  
The Body ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Significant Difference ◽  
Maximum Effort ◽  
The Mean ◽  
The Relationship

1. The relationship between volumes expired and the maximum intrathoracic pressures developed within the first second of expiration was examined in a group of healthy subjects and patients with airways obstruction who exhaled with varying degrees of effort. 2. The body plethysmographic method was used to ensure that expirations started from total lung capacity. 3. Three different types of volume-effort curves could be distinguished: Type I; in this the volume expired increased with greater effort. Type II; after a phase in which the volume expired increased with effort, a plateau was reached after which increasing effort made no difference to the volume expired. Type III; this resembles Type II except that instead of a plateau being established at maximum expired volume, increasing effort resulted in diminishing expired volume. Correction for the degree of compression of the intrathoracic gas failed to account for this phenomenon. Type III curves were found in healthy subjects as well as in patients. 4. In most cases the maximum Forced Expiratory Volume in 1 s (FEV1) was not found to coincide with the maximum oesophageal pressure (Poes), nor was there a significant difference between the mean and the maximum FEV1 produced with an effort greater than 75% of maximum. 5. Blowing ‘half as hard’ is an unnatural procedure; all subjects tend to blow nearly as hard as possible or very gently. In the latter case, the resulting FEV1 tracing is easily recognizable as technically unsatisfactory. 6. We conclude that for practical purposes, measurements of FEV1 depend for their reliability upon ensuring that they are started from full inspiration; insistence upon maximum effort is less important because FEV1 is independent of effort for the greater part of the effort range.

scholarly journals Peptide Bound Hypohydroxyprolinuria in Handigodu Disease: A Familial Syndrome of Spondylo Epi(meta)physeal Dysplasia

2009 ◽  
Vol 27 (1) ◽  
pp. 7-12
Author(s):  
Mallikarjun Badadani ◽  
S. V. Suresh Babu ◽  
K. T. Shetty ◽  
S. S. Agarwal
Keyword(s):  
Bone Turnover ◽  
Patient Group ◽  
Southern India ◽  
Type I ◽  
Type Ii ◽  
Collagen Biosynthesis ◽  
Post Translational Modification ◽  
Type Iii ◽  
Significant Difference ◽  
And Control

Handigodu Disease (HD) is disorder of the osteoarticular system prevalent in few villages of two districts of the state Karnataka in southern India. 24 hrs urinary excretions of proline (Pro) and 4-hydroxyproline (Hyp) were analyzed by HPLC. Decreased peptide bound Hyp excretions (μmole/24 hrs) were found in patient group when compared with controls (Nonaffected; 113.02 ± 67.96, Type-I; 36.22 ± 20.76, Type-II; 45.74 ± 14.95, Type-III; 40.46 ± 22.68) and without significant difference in Pro excretions. Significant increased peptide bound Pro to Hyp ratio were found in patient group compared to control (Nonaffectedn= 63: 2.02 ± 1.65, Type-In= 18: 3.144 ± 1.42, Type-IIn= 28: 4.21 ± 1.95, Type-IIIn= 8: 8.60 ± 6.55). 24 hrs urinary excretions of deoxypyridinoline (DPD) crosslinks were found without significant difference among affected and control, hence HD ruled out from general bone reduction. These results suggest hypohydroxyprolinuria may be because of reduced bone turnover or defective hydroxylation of prolyl residues during post translational modification of collagen biosynthesis.

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