The impact of acetylcholinesterase inhibitors on ileus and gut motility following abdominal surgery: a clinical review

Abstract Background and aim: Heterotaxy syndrome, being right atrial isomerism (RAI) or left atrial isomerism (LAI), often presents with Congenital Heart Disease (CHD). Intestinal abnormalities, including malrotation are common. We assessed the spectrum of gut abnormalities and their impact on medium-term outcome in a cohort of patients with fetal and postnatal diagnoses of heterotaxy syndrome. Methods: We reviewed the cardiology records of heterotaxy syndrome patients from two centres, regarding the presence of CHD, time for cardiac intervention, presence of gastrointestinal abnormalities, and type/time of surgery. A questionnaire about gastrointestinal status was sent to patients <18 years old. Kaplan–Meier curves were derived for survival data and freedom from intervention. Results: Data were included for 182 patients (49 RAI and 133 LAI) of 247 identified. Questionnaires were sent to 77 families and 47 replied. CHD was present in all RAI and 61.7% of LAI cases. Thirty-eight patients had abdominal surgery (20.9%), similar for RAI and LAI (20.4% versus 21%, p> 0.99): Ladd procedure in 17 (44.7%), non-Ladd in 12 (31.5%), and both procedures in 9 (23.7%). Ten-year freedom from Ladd procedure for all was 86% for the whole cohort (RAI = 87%; LAI = 85%, p = 0.98). Freedom from any gastrointestinal surgery at 10 years was 79% for the whole cohort (RAI = 77%; LAI = 80%, p = 0.54). Ten-year freedom from cardiac surgery was 31% for the whole cohort (RAI = 6%; LAI = 43%, p < 0.0001). Conclusions: In our cohort, one in five patients required abdominal surgery, mostly in their first year of life, similar for RAI and LAI. Between 1 and 10 years of follow-up, the impact of gastrointestinal abnormalities on outcome was minimal. Medium term survival was related to CHD.

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The impact of previous open abdominal surgery on the outcome of laparoscopic colorectal surgery

Annals of Medical Research ◽

10.5455/annalsmedres.2020.05.548 ◽

2021 ◽

Vol 28 (12) ◽

pp. 2122

Author(s):

Ismail Eray ◽

Ugur Topal ◽

Orcun Yalav ◽

Kubilay Dalci ◽

Ahmet Saritas ◽

...

Keyword(s):

Colorectal Surgery ◽

Abdominal Surgery ◽

Laparoscopic Colorectal Surgery ◽

Open Abdominal Surgery ◽

The Impact

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The Impact of Clinical Review Bias on Child Language Grammaticality

Communication Disorders Quarterly ◽

10.1177/1525740119853243 ◽

2019 ◽

Vol 41 (4) ◽

pp. 214-221

Author(s):

Anny P. Castilla-Earls ◽

Brittany Harvey ◽

Katrina Fulcher-Rood ◽

Christopher D. Barr

Keyword(s):

Clinical Review ◽

Language Impairment ◽

Binary Data ◽

Mixed Model ◽

Linear Mixed Model ◽

Child Language ◽

Communication Disorders ◽

The Impact ◽

English Students ◽

Language Sample

The purpose of this study was to examine the impact of clinical review bias on the coding of grammaticality in child language. Seventy-four native-English students studying communication disorders and sciences made judgments about the grammaticality of 250 utterances presented in five language samples. Each language sample included grammatical, ungrammatical, and ambiguous utterances. Participants were randomly assigned to a blind or nonblind group. The nonblind group was presented with diagnostic information, whereas the blind group was not. We employed a generalized linear mixed model to examine the binary data. Our results suggest that both blind and nonblind participants were accurate in judging grammatical and ungrammatical utterances. However, nonblind participants were slightly more likely to judge ambiguous utterances as ungrammatical when the language sample identified the child as having a language impairment, suggesting that there was an effect of clinical review bias in this study. This effect, although statistically significant, was small.

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The impact of memantine in combination with acetylcholinesterase inhibitors on admission of patients with Alzheimer’s disease to nursing homes: cost-effectiveness analysis in France

The European Journal of Health Economics ◽

10.1007/s10198-013-0523-y ◽

2013 ◽

Vol 15 (8) ◽

pp. 791-800 ◽

Cited By ~ 18

Author(s):

Jacques Touchon ◽

Jean Lachaine ◽

Catherine Beauchemin ◽

Anna Granghaud ◽

Benoit Rive ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cost Effectiveness ◽

Nursing Homes ◽

Acetylcholinesterase Inhibitors ◽

Cost Effectiveness Analysis ◽

Effectiveness Analysis ◽

The Impact

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The Impact of Perioperative Glutamine-supplemented Parenteral Nutrition on Outcomes of Patients Undergoing Abdominal Surgery: A Meta-analysis of Randomized Clinical Trials

The American Surgeon ◽

10.1177/000313481307900527 ◽

2013 ◽

Vol 79 (5) ◽

pp. 506-513 ◽

Cited By ~ 10

Author(s):

Chao Yue ◽

Weiliang Tian ◽

Wei Wang ◽

Qian Huang ◽

Risheng Zhao ◽

...

Keyword(s):

Clinical Trials ◽

Abdominal Surgery ◽

Parenteral Nutrition ◽

Hospital Stay ◽

Clinical Outcomes ◽

Nitrogen Balance ◽

Infectious Complication ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

The Impact

The objective of this study was to evaluate the impact of perioperative glutamine-supplemented parenteral nutrition (GLN-PN) on clinical outcomes in patients undergoing abdominal surgery. MEDLINE, EMBASE, and the Cochrane Controlled Clinical Trials Register were searched to retrieve the eligible studies. Eligible studies were randomized controlled trials (RCTs) that compared the effect of GLN-PN and standard PN on clinical outcomes in patients undergoing abdominal surgery. Clinical outcomes of interest were postoperative mortality, length of hospital stay, morbidity of infectious complication, and cumulative nitrogen balance. Statistical analysis was conducted by RevMan 5.0 software from the Cochrane Collaboration. Sixteen RCTs with 773 patients were included in this meta-analysis. The results showed a significant decrease in the infectious complication rates of patients undergoing abdominal surgery receiving GLN-PN (risk ratio [RR], 0.48; 95% confidence interval [CI], 0.32 to 0.72; P = 0.0004). The overall effect indicated glutamine significantly reduced the length of hospital stay in the form of alanyl-glutamine (weighted mean difference [WMD], -3.17; 95% CI, -5.51 to -0.82; P = 0.008) and in the form of glycyl-glutamine (WMD, -3.40; 95% CI, -5.82 to -0.97; P = 0.006). A positive effect in improving postoperative cumulative nitrogen balance was observed between groups (WMD, 7.40; 95% CI, 3.16 to 11.63; P = 0.0006), but no mortality (RR, 1.52; 95% CI, 0.21 to 11.9; P = 0.68). Perioperative GLN-PN is effective and safe to shorten the length of hospital stay, reduce the morbidity of postoperative infectious complications, and improve nitrogen balance in patients undergoing abdominal surgery.

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Concurrent Ventral Hernia Repair Is Effective in Patients Undergoing Abdominally Based Microsurgical Breast Reconstruction

Journal of Reconstructive Microsurgery ◽

10.1055/s-0040-1713149 ◽

2020 ◽

Vol 36 (08) ◽

pp. 572-576

Author(s):

Casey T. Kraft ◽

Albert H. Chao

Keyword(s):

Abdominal Surgery ◽

Hernia Repair ◽

Breast Reconstruction ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Donor Site ◽

Control Groups ◽

And Control ◽

The Impact ◽

Experimental Group

Abstract Background The abdomen remains the most preferable donor site for autologous breast reconstruction. Many patients in this population will have had prior abdominal surgery, which is the chief risk factor for having a ventral hernia. While prior studies have examined the impact of prior abdominal surgery on breast reconstruction, limited data exist on the management of patients with a preexisting ventral hernia. The objective of this study was to investigate outcomes of performing ventral hernia repair concurrent with abdominally based microsurgical breast reconstruction. Methods A 5-year retrospective review of patients undergoing abdominally based microsurgical breast reconstruction was performed. The experimental group consisted of patients with a preexisting ventral hernia that was repaired at the time of breast reconstruction, and was compared with a historical cohort of patients without preexisting hernias. Results There were a total of 18 and 225 patients in the experimental and control groups, respectively. There was a higher incidence of prior abdominal surgery in the experimental group (p = 0.0008), but no other differences. Mean follow-up was 20.5 ± 5.2 months. There were no instances of recurrent hernia or flap loss in the experimental group. No significant differences were observed between the experimental and control groups in the incidence of donor-site complications (27.8 vs. 20.9%, respectively; p = 0.55), recipient site complications (27.8 vs. 24.0%, respectively; p = 0.78), operative time (623 ± 114 vs. 598 ± 100 minutes, respectively; p = 0.80), or length of stay (3.4 ± 0.5 vs. 3.1 ± 0.4 days, respectively; p = 0.98). Conclusion Concurrent ventral hernia repair at the time of abdominally based microsurgical breast reconstruction appears to be safe and effective. Larger studies are needed to further define this relationship.

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1247. Multicenter Study on Risk Factors for Surgical Site Infection After Exploratory Laparotomy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1110 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S449-S449

Author(s):

Túlio Alves Jeangregório Rodrigues ◽

Guilherme Fernandes de Oliveira ◽

Júlia G C Dias ◽

Laís Souza Campos ◽

Letícia Rodrigues ◽

...

Keyword(s):

Risk Factors ◽

Length Of Stay ◽

Abdominal Surgery ◽

Surgical Site Infection ◽

Exploratory Laparotomy ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Hospital Death ◽

Site Infection ◽

The Impact

Abstract Background Exploratory laparotomy surgery is abdominal operations not involving the gastrointestinal tract or biliary system. The objective of our study is to answer three questions: (a) What is the risk of surgical site infection (SSI) after exploratory abdominal surgery? (b) What is the impact of SSI in the hospital length of stay and hospital mortality? (c) What are risk factors for SSI after exploratory abdominal surgery? Methods A retrospective cohort study assessed meningitis and risk factors in patients undergoing exploratory laparotomy between January 2013 and December 2017 from 12 hospitals at Belo Horizonte, Brazil. Data were gathered by standardized methods defined by the National Healthcare Safety Network (NHSN)/CDC procedure-associated protocols for routine SSI surveillance. 26 preoperative and operative categorical and continuous variables were evaluated by univariate and multivariate analysis (logistic regression). Outcome variables: Surgical site infection (SSI), hospital death, hospital length of stay. Variables were analyzed using Epi Info and applying statistical two-tailed test hypothesis with significance level of 5%. Results A sample of 6,591 patients submitted to exploratory laparotomy was analyzed (SSI risk = 4.3%): Hospital length of stay in noninfected patients (days): mean = 16, median = 6, std. dev. = 30; hospital stay in infected patients: mean = 32, median = 22, std. dev. = 30 (P < 0.001). The mortality rate in patients without infection was 14% while hospital death of infected patients was 20% (P = 0.009). Main risk factors for SSI: ügeneral anesthesia (SSI = 4.9%, relative risk – RR = 2.8, P < 0.001); preoperative hospital length of stay more than 4 days (SSI=3.9%, RR=1.8, P = 0.003); wound class contaminated or dirty (SSI = 5.4%, RR = 1.5, P = 0.002); duration of procedure higher than 3 hours (SSI = 7.1%, RR = 2.1, P < 0.001); after trauma laparotomy (SSI = 7.8%, RR = 1.9, P = 0.001). Conclusion We identified patients at high risk of surgical site infection after exploratory laparotomy: trauma patients from contaminated or dirty wound surgery, submitted to a procedure with general anesthesia that last more than 3 hours have 13% SSI. Patients without any of these four risk factors have only 1.2% SSI. Disclosures All authors: No reported disclosures.

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