scholarly journals Portacaval Shunt for Portal Hypertensive Gastropathy

HPB Surgery ◽  
1997 ◽  
Vol 10 (5) ◽  
pp. 333-335
Author(s):  
John Craig Collins ◽  
I. James Sarfeh

Portal hypertensive gastropathy is a vascular disorder of the gastric mucosa distinguished by ectasia of the mucosal capillaries and submucosal veins without inflammation. During 1988 to 1993, 12 patients with biopsyproven cirrhosis (10 alcoholic, 2 posthepatitic) were evaluated and treated prospectively by portacaval shunt for active bleeding from severe portal hypertensive gastropathy. Eleven patients had been hospitalized for bleeding three to nine times previously, and one was bleeding uncontrollably for the first time. Requirement for blood transfusions ranged from 11 to 39 units cumulatively, of which 8 to 30 units were required specifically to replace blood lost from portal hypertensive gastropathy. Admission findings were ascites in 9 patients, jaundice in 8, severe muscle wasting in 10, hyperdynamic state in 9. Child's risk class was C in 7, B in 4, A in 1. Ten of the 12 patients had previously received repetitive endoscopic sclerotherapy for esophageal varices, which has been reported to precipitate portal hypertensive gastropathy. Eight patients had failed propranolol therapy for bleeding. Portacaval shunt was performed emergently in 11 patients and electively in 1, and permanently stopped bleeding in all by reducing the mean portal vein-inferior vena cava pressure gradient from 251 to 16 mm saline. There were no operative deaths, and two unrelated late deaths after 13 and 24 months. During 1 to 6.75 years of followup, all shunts remained patent by ultrasonography, the gastric mucosa reverted to normal On serial endoscopy, and there was no gastrointestinal bleeding. Recurrent portal-systemic encephalopathy developed in only 8% of patients. Quality of life was generally good. It is concluded that portacaval shunt provides definitive treatment of bleeding portal hypertensive gastropathy by eliminating the underlying cause, and makes possible prolonged survival with an acceptable quality of life.

2021 ◽  
pp. 1-13
Author(s):  
Ben-Max De Ruiter ◽  
Abel N. Keijzer ◽  
Maarten C.C.M. Hulshof ◽  
Adriaan D. Bins ◽  
Theo M. de Reijke ◽  
...  

BACKGROUND: Health related Quality of Life (HRQoL) is an important factor regarding treatment for localized Muscle Invasive Bladder Carcinoma (MIBC), as it may affect choice of treatment. The impact of chemoradiotherapy (CRT) for MIBC on HRQoL has not yet been well-established. OBJECTIVE: To systematically evaluate evidence regarding HRQoL as assessed by validated questionnaires after definitive treatment with CRT for localized MIBC. METHODS: We performed a critical review of PubMed/MEDLINE, EMBASE, and the Cochrane Library in October 2020. Two reviewers independently screened articles for eligibility and assessed the methodological quality of the included articles using Joanna Briggs Institute critical appraisal tools. A narrative synthesis was undertaken. RESULTS: Of 579 articles identified, 11 studies were eligible for inclusion, including three RCTs and 8 non-randomized studies, reporting on HRQoL data for 606 CRT patients. Global health declined at End of treatment (EoT), and recovered 3 months following treatment. Physical function declined from baseline at EoT and recovered between 3 and 24 months and was maintained at 5 years follow up. CRT had little effect on social and emotional function in the short-term, but HRQoL results in the long-term were lower compared to the general population. Urinary function declined from baseline at EoT, but returned to baseline at 6 months following CRT. After initial decline in bowel function, a complete return to baseline occurred 4 years following treatment. The majority of studies assessing sexual function showed no to little effect on sexual function. CONCLUSIONS: HRQoL recovers to baseline within 3 months to 2 years in almost all domains. The amount of available evidence regarding HRQoL following CRT for MIBC is limited and the quality of evidence is low.


2021 ◽  
Vol 10 (2) ◽  
pp. e30510212535
Author(s):  
Gabriel Kiaro Leite Nunes ◽  
Karinne Alice Santos de Araújo ◽  
Thais Ranielle Souza de Oliveira ◽  
Marcelina da Conceição Botelho Teixeira ◽  
Ieler Ferreira Ribeiro ◽  
...  

The COVID-19 pandemic brought about major changes in the lifestyle of the world population. Due to the lack of vaccines or a definitive treatment for disease, governments around the world have adopted social isolation and quarantine as methods to control the spread of the virus. Objective: Thus, the objective of this study was to discuss how social isolation and quarantine periods affected people's mental health and quality of life during the COVID-19 pandemic. Methods: An integrative literature review was carried out during the COVID-19 pandemic between March and September 2020, establishing the following guiding question: How did social isolation and quarantine affect the mental health and quality of life of the population in the COVID-19 pandemic? Results: The final sample consisted of nineteen (19) articles, two (2) addressed depression during the pandemic period, three (3) presented the pandemic and the relationship with sociodemographic aspects, five (5) analyzed mental health in the pandemic, four (4) reported the impact of COVID-19 on the population's style and quality of life and the last five (5) demonstrated the quality of human relationships and emotional aspects in the face of the pandemic. Conclusion: It was demonstrated that isolation and the quarantine period had a negative impact on the population's quality of life and long-term mental health.


Author(s):  
A.Z. Sharafeev ◽  
L.V. Glushchenko

The aim of the study was to assess the quality of life in patients after endovascular prophylaxis (inferior vena cava filter) and PATE conservative (drug) therapy. Materials and Methods. The authors examined efficacy of treatment and assessed the quality of life in 226 patients with deep vein thrombosis, IVC thrombosis, and PATE. All the patients underwent medical treatment at the Ulyanovsk Regional Clinical Hospital in 2006–2016. Patients with IVC filter (n=91) were included in the main group. Experimental group consisted of patients undergoing conservative treatment (n=135). Hospital patients underwent some diagnostic measures, including Doppler ultrasound, X-ray computed tomography, and echocardiography. MOS 36-Item Short Form Health Survey was used to study the effect of long-term complications on the patients’ quality of life. Results. The number of complaints per patient was higher in the experimental group (6.67) than in the main group (4.13). However, instrumental research methods showed that IVC filter caused secondary complications in 31.11 % of patients from the main group. In the long-term follow-up, patients from the experimental group rated a number of their health parameters on the mental status scales reliably higher (“social functioning” – 8.1 in the main group and 25.4 in the experimental group, “role-emotional functioning” – 25.3 in the main group and 33.3 in the experimental group, “mental status” – 57.8 in the main group and 70.2 in the experimental group). Conclusion. Despite a greater number of subjective complaints from the patients of the experimental group, the patients of the main group had more long-term complications, which affected patients’ quality of life, namely social functioning, role-emotional functioning and mental status. Keywords: vascular surgery, IVC filter, pulmonary thromboembolism, floating deep vein thrombosis of the lower extremities. Цель исследования – оценить качество жизни пациентов после эндоваскулярной профилактики (имплантации кава-фильтра) и консервативной (медикаментозной) терапии ТЭЛА. Материалы и методы. Было проведено исследование эффективности лечения и оценка качества жизни 226 пациентов, находившихся на лечении в период с 2006 по 2016 г. в ГУЗ Ульяновская областная клиническая больница с диагнозами «тромбоз глубоких вен», «тромбоз НПВ», «ТЭЛА». Пациенты, которым была проведена имплантация кава-фильтров, составили основную группу (91 чел.); пациенты, получавшие консервативное лечение, – группу сравнения (135 чел.). В стационаре проводился комплекс диагностических мероприятий, включавший ультразвуковую доплерографию, рентгеновскую компьютерную томографию, эхокардиографию. Для изучения влияния отдаленных осложнений на качество жизни пациентов проводилось анкетирование с использованием опросника MOS 36-Item Short Form Health Survey. Результаты. Количество жалоб на одного пациента было больше в группе сравнения (6,67), чем в основной (4,13). Однако инструментальные методы исследования показали, что кава-фильтр стал причиной вторичных осложнений у 31,11 % пациентов основной группы. В отдаленные сроки наблюдения пациенты из группы сравнения достоверно выше оценивали ряд показателей своего здоровья по шкалам психического состояния («социальное функционирование» – 8,1 в основной группе и 25,4 в группе сравнения, «ролевое функционирование, обусловленное эмоциональным состоянием» – 25,3 в основной группе и 33,3 в группе сравнения, «психическое здоровье» – 57,8 в основной группе и 70,2 в группе сравнения). Выводы. Несмотря на большее количество субъективных жалоб у пациентов группы сравнения, объективно у пациентов основной группы отмечалось большее число отдаленных осложнений, которые сказывались на качестве жизни пациентов по шкалам «социального функционирования», «ролевого функционирования, обусловленного эмоциональным состоянием» и «психического здоровья». Ключевые слова: сосудистая хирургия, кава-фильтр, тромбоэмболия лёгочных артерий, флотирующий тромбоз глубоких вен нижних конечностей.


2019 ◽  
Vol 21 (2) ◽  
pp. 142-146
Author(s):  
Kundan Kumar Shrestha ◽  
R.R. Joshi ◽  
A.S. Rijal ◽  
A. Dhungana ◽  
S. Maharjan

 Nasal obstruction, the most common presenting symptom in nasal and sinus disease, is defined as patient discomfort manifested as a sensation of insufficient airflow through the nose. Nasal septal deviation is the most common anatomical cause of nasal obstruction. Surgical correction of a deviated septum, nasal septoplasty, is the definitive treatment for septal deviation. Many studies have discussed about outcomes of septoplasty. However, there is limited published literature on nasal septoplasty and its outcome in Nepal. The aim of this study is to evaluate the outcome of septoplasty using Nasal Obstruction Symptom Evaluation (NOSE) scale, a validated outcome instrument assessing quality of life (QoL) related to nasal obstruction. A total of 52 patients aged 18 years and above, with nasal obstruction at least for 3 months, undergoing septoplasty alone were included in the study. Baseline NOSE score was calculated a week before surgery. The patients were followed up after 3 months to record postoperative NOSE score. On statistical analysis, the mean NOSE scores before and 3 months after septoplasty were 45.58±21.38 and 8.46±8.37 respectively. The mean difference was 37.11± 21.22 and p value on paired t test was less than 0.001(highly significant). The mean differences of each component of the NOSE scale questionnaire were also found to be highly significant statistically with p values less than 0.001. Gender and age did not seem to affect the outcomes. In conclusion, NOSE scale is a valid, reliable and responsive instrument that is brief and easy to complete and has potential use for outcome studies in adults with nasal obstruction. This instrument showed that septoplasty, if done in properly selected patients, results in significant improvement in nasal obstruction and disease specific quality of life with high patient satisfaction.


2019 ◽  
Vol 18 (6) ◽  
pp. 606-613
Author(s):  
Rafael A Vega ◽  
Jeffrey I Traylor ◽  
Ahmed Habib ◽  
Laurence D Rhines ◽  
Claudio E Tatsui ◽  
...  

Abstract BACKGROUND Epidural spinal cord compression (ESCC) is a common and severe cause of morbidity in cancer patients. Minimally invasive surgical techniques may be utilized to preserve neurological function and permit the use of radiation to maximize local control. Minimally invasive techniques are associated with lower morbidity. OBJECTIVE To describe a novel, minimally invasive operative technique for the management of metastatic ESCC. METHODS A minimally invasive approach was used to cannulate the pedicles of the thoracic vertebrae, which were then held in place by Kirschner wires (K-wires). Following open decompression of the spinal cord, cannulated screws were placed percutaneously with stereotactic guidance through the pedicles followed by cement induction. Stereotactic radiosurgery is performed in the postoperative period for residual metastatic disease in the vertebral body. RESULTS The minimally invasive technique used in this case reduced tissue damage and optimized subsequent recovery without compromising the quality of decompression or the extent of metastatic tumor resection. Development of more minimally invasive techniques for the management of metastatic ESCC has the potential to facilitate healing and preserve quality of life in patients with systemic malignancy. CONCLUSION ESCC from vertebral metastases poses a challenge to treat in the context of minimizing potential risks to preserve quality of life. Percutaneous pedicle screw fixation with cement augmentation provides a minimally invasive alternative for definitive treatment of these patients.


2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 587-587
Author(s):  
B. T. Samuelson ◽  
E. K. Fromme ◽  
J. Waller ◽  
C. R. Thomas

587 Background: Therapy for GI malignancies has long been known to have a marked impact on quality of life, yet this relationship remains poorly understood. Methods: A retrospective, IRB-approved chart review was performed of 722 patients receiving RT for any cancer diagnosis between 1/1/2006 and 12/31/2008. Subjects completed the Functional Assessment of Cancer Therapy General (FACT-G) questionnaire before and after RT. Pre- and immediately post-RT course scores were compared using student t-tests with Bonferroni correction for multiple comparisons (5 comparisons, alpha =.01). Results: 722 of 1369 (52.7%) possible patients participated in the database. Complete pre and post RT spirituality data were available for 73 (64.6%) patients with GI malignancies. Average age was 62 years, 58 (79%) were male and 52 (71%) received definitive treatment. 27 (37%) had esophageal or gastric cancer, 22 (30%) had colorectal cancer and 24 (33%) had other GI malignancies such as pancreatic or hepatobiliary. Colorectal cancer patients fared better in overall QOL as compared to esophageal and gastric patients, pancreatic and hepatobiliary patients and patients with GI malignancies as a whole, and were the only group in which decline in overall QOL as measured by the FACT-G (77.22 to 73.08, p=0.216) did not reach or approach significance. This appeared to be largely driven by differences in physical and especially functional well-being, in which colorectal patients demonstrated the smallest decline (16.14 to 15.59, p=0.466) of any group. Colorectal patients did, however, demonstrate a larger decline in physical well-being (22.35 to 18.05, p=0.010) and overall QOL than did all-comers with any primary malignancy (22.1 to 19.4, p<.001) and (81.3 to 78.9, p<.001) respectively. Conclusions: Physical and functional well-being, as well as overall quality of life are known to decline in patients with GI malignancies. Patients with colorectal disease appear to fare better than those with esophageal, stomach, pancreatic or hepatobiliary malignancies by these measures. Additional investigations are warranted to further define these differences. No significant financial relationships to disclose.


2014 ◽  
Vol 7 (10) ◽  
pp. 581-586 ◽  
Author(s):  
Rebecca Fisher ◽  
Jeanne Fay

There are relatively few true emergencies in palliative care, but an ability to deal with those that do occur is crucial. Managing major haemorrhage, superior vena cava obstruction or terminal agitation may be a daunting prospect for GPs, and equipping ourselves with the necessary skill set in advance of needing to apply it is vital. In situations where immediate action is required, the goal is usually to prevent a sudden or catastrophic worsening in the patient’s quality of life or symptoms, or to manage a potentially unpleasant mode of death.


1995 ◽  
Vol 6 (5) ◽  
pp. 1392-1400
Author(s):  
T J Tsai ◽  
J S Lai ◽  
S H Lee ◽  
Y M Chen ◽  
C Lan ◽  
...  

Breathing-coordinated exercise is a traditional Chinese exercise. These exercise maneuvers consist of slow diaphragmatic breathing, end-inspiratory pause, and Kegel's exercise. A total of 30 patients were enrolled in this study, with 12 patients as controls, to evaluate its effect on hemodialysis patients. Exercise was performed for 25 to 30 min twice a day for at least 3 months. Results from the exercise group showed a subjective improvement in appetite and physical strength, and an increase in the frequency of bowel movements, in addition to enhanced sexual activity and a significant increase in Karnofsky scores. Six patients in the exercise group underwent bicycle ergometry and demonstrated a stable maximal oxygen consumption, whereas the control group revealed a decline in maximal oxygen consumption. Photoelectric plethysmography and laser-Doppler flowmetry demonstrated a pulsatile enhancement of the peripheral microcirculation. Abdominal sonography revealed an oscillatory change in the diameter of the inferior vena cava. It was concluded that these gentle exercise maneuvers may improve the quality of life in hemodialysis patients, especially weak dialysis patients. The mechanism may be partly related to an improvement in microcirculation.


2020 ◽  
Author(s):  
Lucy Dabner ◽  
Guido E Pieles ◽  
Colin G Steward ◽  
Julian P Hamilton-Shield ◽  
Andrew R Ness ◽  
...  

BACKGROUND Barth syndrome is a rare, life-threatening, X-linked recessive genetic disease that predominantly affects young males and is caused by abnormal mitochondrial lipid metabolism. Currently, there is no definitive treatment for Barth syndrome other than interventions to ameliorate acute symptoms, such as heart failure, cardiac arrhythmias, neutropenia, and severe muscle fatigue. Previous mechanistic studies have identified the lipid-lowering drug bezafibrate as a promising potential treatment; however, to date, no human trials have been performed in this population. OBJECTIVE The aim of this study is to determine whether bezafibrate (and resveratrol in vitro) will increase mitochondrial biogenesis and potentially modify the cellular ratio of monolysocardiolipin (MLCL) to tetralinoleoyl-cardiolipin (L4-CL), ameliorating the disease phenotype in those living with the disease. METHODS The CARDIOMAN (Cardiolipin Manipulation) study is a UK single-center, double-blinded, randomized, placebo-controlled crossover study investigating the efficacy of bezafibrate in participants with Barth syndrome. Treatment was administered in two 15-week phases with a minimum washout period of 1 month between the phases where no treatment was administered. The primary outcome is peak oxygen consumption (VO<sub>2</sub> peak). Secondary outcomes include MLCL/L4-CL ratio and CL profile in blood cells, amino acid expression, phosphocreatine to adenosine triphosphate ratio in cardiac muscle and skeletal muscle oxidative function on phosphorus-31 magnetic resonance spectroscopy, quality of life using the Pediatric Quality of Life Inventory questionnaire, absolute neutrophil count, cardiac function and rhythm profiles at rest and during exercise, and mitochondrial organization and function assessments. Outcomes were assessed at baseline and during the final week of each treatment phase. RESULTS A total of 12 patients were scheduled to participate across three consecutive research clinics between March and April 2019. In total, 11 participants were recruited, and the follow-up was completed in January 2020. Data analysis is ongoing, with publication expected in 2021. CONCLUSIONS This trial was approved by the United Kingdom National Research Ethics Service Committee and the Medicines and Healthcare products Regulatory Agency. The feasibility of the CARDIOMAN study will help to inform the future conduct of randomized controlled trials in rare disease populations as well as testing the efficacy of bezafibrate as a potential treatment for the disease and advancing the mechanistic understanding of Barth syndrome. CLINICALTRIAL International Standard Randomized Controlled Trial Number (ISRCTN): 58006579; https://www.isrctn.com/ISRCTN58006579 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/22533


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