Duodenal Atresia: Open versus MIS Repair—Analysis of Our Experience over the Last 12 Years

Objective. Duodenal atresia (DA) routinely has been corrected by laparotomy and duodenoduodenostomy with excellent long-term results. We revisited the patients with DA treated in the last 12 years (2004–2016) comparing the open and the minimally invasive surgical (MIS) approach.Methods. We divided our cohort of patients into two groups. Group 1 included 10 patients with CDO (2004–09) treated with open procedure: 5, DA; 3, duodenal web; 2, extrinsic obstruction. Three presented with Down’s syndrome while 3 presented with concomitant malformations. Group 2 included 8 patients (2009–16): 1, web; 5, DA; 2, extrinsic obstruction. Seven were treated by MIS; 1 was treated by Endoscopy. Three presented with Down’s syndrome; 3 presented with concomitant malformations.Results. Average operating time was 120 minutes in Group 1 and 190 minutes in Group 2. In MIS Group the visualization was excellent. We recorded no intraoperative complications, conversions, or anastomotic leakage. Feedings started on 3–7 postoperative days. Follow-up showed no evidence of stricture or obstruction. In Group 1 feedings started within 10–22 days and we have 1 postoperative obstruction.Conclusions. Laparoscopic repair of DA is one of the most challenging procedures among pediatric laparoscopic procedures. These patients had a shorter length of hospitalization and more rapid advancement to full feeding compared to patients undergoing the open approach. Laparoscopic repair of DA could be the preferred technique, safe, and efficacious, in the hands of experienced surgeons.

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Comparison of peribulbar anesthesia and topical anesthesia on outcome of phacoemulsification

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20172456 ◽

2017 ◽

Vol 5 (6) ◽

pp. 2608 ◽

Cited By ~ 2

Author(s):

Rishi Mehta ◽

Sharda Punjabi ◽

Nutan Bedi ◽

Chandra Kant Nagar

Keyword(s):

Intraoperative Complications ◽

Visual Outcome ◽

Topical Anesthesia ◽

Satisfaction Score ◽

The Other ◽

Patients Satisfaction ◽

Peribulbar Anesthesia ◽

Group 2 ◽

A Prospective Study ◽

Group 1

Background: Due to advancement in phacoemulsification techniques, there has been growing shift from peribulbar anesthesia (PA) to topical anesthesia (TA). But dilemma exists regarding the supremacy of one over the other as both types have certain advantages and disadvantages.Methods: A prospective study was conducted. Patients were divided into two groups. Group-1 underwent PA while group-2 underwent TA. Satisfaction score of patients and surgeons and incidence of complications were noted. The data was analyzed.Results: Lowest patients’ satisfaction score among group-1 vs. group-2 was 160 (87.9%) vs.82 (45.81%). Highest surgeons satisfaction score among group-1 and group-2 was 74(40.65%) vs. 2(1.1%). Intraoperative complications among the group-1 and group-2 were 35 (19.2%) vs. 86(48.0%).Conclusions: While TA provides initial painless phase of surgical procedure, PA results in lesser intraoperative complications resulting in better visual outcome.

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BLADDER CALCULI TWO DIFFERENT ENDOSCOPIC TECHNIQUES IN ITS MANAGEMENT

10.36106/ijsr/4326430 ◽

2020 ◽

pp. 1-2

Author(s):

Rahul Goel

Keyword(s):

Operating Time ◽

Complete Clearance ◽

Endoscopic Techniques ◽

Bladder Calculi ◽

Bladder Stones ◽

Significant Difference ◽

Stone Treatment ◽

Group 2 ◽

Group 1

Introduction- presenting our experience of comparison of two endoscopic treatments for bladder stones. Material and Methods - Study includes 45 patients of vesical calculi, treated in our hospital between June 2010 to December 2017, randomly assigned in two groups group 1- transurethral removal using nephroscope and group 2 -percutaneous suprapubic removal using nephroscope. Results- Significant difference was observed in operating time group 1 (32.1+8.5 mins) and group 2 (46+7.3), statistically difference was seen in the post operative stay of patient which was higher in group 2, complete clearance was seen in both groups, while group 1 had maximum number of urethral entries in comparison to supra pubic group Conclusion -Transurethral vesical stone treatment using nephroscope is effective route of treatment of large vesical stones without increasing morbidity and without giving a supra pubic scar.

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Short-Time Estimation of Fractionation in Atrial Fibrillation with Coarse-Grained Correlation Dimension for Mapping the Atrial Substrate

Entropy ◽

10.3390/e22020232 ◽

2020 ◽

Vol 22 (2) ◽

pp. 232

Author(s):

Aikaterini Vraka ◽

Fernando Hornero ◽

Vicente Bertomeu-González ◽

Joaquín Osca ◽

Raúl Alcaraz ◽

...

Keyword(s):

Atrial Fibrillation ◽

Real Time ◽

Correlation Dimension ◽

Coarse Grained ◽

Long Term Results ◽

Operating Characteristics ◽

Type Iv ◽

Group 2 ◽

Short Time ◽

Group 1

Atrial fibrillation (AF) is currently the most common cardiac arrhythmia, with catheter ablation (CA) of the pulmonary veins (PV) being its first line therapy. Ablation of complex fractionated atrial electrograms (CFAEs) outside the PVs has demonstrated improved long-term results, but their identification requires a reliable electrogram (EGM) fractionation estimator. This study proposes a technique aimed to assist CA procedures under real-time settings. The method has been tested on three groups of recordings: Group 1 consisted of 24 highly representative EGMs, eight of each belonging to a different AF Type. Group 2 contained the entire dataset of 119 EGMs, whereas Group 3 contained 20 pseudo-real EGMs of the special Type IV AF. Coarse-grained correlation dimension (CGCD) was computed at epochs of 1 s duration, obtaining a classification accuracy of 100% in Group 1 and 84.0–85.7% in Group 2, using 10-fold cross-validation. The receiver operating characteristics (ROC) analysis for highly fractionated EGMs, showed 100% specificity and sensitivity in Group 1 and 87.5% specificity and 93.6% sensitivity in Group 2. In addition, 100% of the pseudo-real EGMs were correctly identified as Type IV AF. This method can consistently express the fractionation level of AF EGMs and provides better performance than previous works. Its ability to compute fractionation in short-time can agilely detect sudden changes of AF Types and could be used for mapping the atrial substrate, thus assisting CA procedures under real-time settings for atrial substrate modification.

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Congenital Duodenal Obstruction in Neonates: Over 13 Years’ Experience from a Single Centre

Journal of Neonatal Surgery ◽

10.21699/jns.v5i4.461 ◽

2016 ◽

Vol 5 (4) ◽

pp. 50 ◽

Cited By ~ 5

Author(s):

Parveen Kumar ◽

Chiranjiv Kumar ◽

Prince Raj Pandey ◽

Yogesh Kumar Sarin

Keyword(s):

Birth Weight ◽

Duodenal Obstruction ◽

Down's Syndrome ◽

Down’S Syndrome ◽

Duodenal Atresia ◽

P Value ◽

Associated Anomalies ◽

Congenital Duodenal Obstruction ◽

Impact On Survival ◽

Duodenal Web

Aim: To study the prevalence of associated anomalies with neonatal duodenal obstruction and factors impacting short-term survival.Material and methods: Records of 31 neonates with neonatal duodenal obstruction could be retrieved and analyzed for a 13.5-year-period (October 2003-May 2016). M:F ratio was 1.58:1. The mean birth weight was 2.15 kg; 12 patients were preterm. Etiologies included duodenal atresia (n=23), duodenal web (n=8) and malrotation of gut (n= 6).Results: Associated anomalies were seen in 19/31: Down’s syndrome (n=6), anorectal malformation (ARM) (n=5), annular pancreas (n=5), cardiac anomalies (n=4), esophageal atresia with trachea-esophageal fistula (EA with TEF) (n=3). Mortality in the series was 22.5%; 5 deaths and 2 patients left against medical advice in moribund state (hidden mortality). Mortality in associated anomalies group was 5/19; and 2/12 in the no anomalies group, though this difference was not statistically significant (p=0.676). Similarly, low birth weight (LBW) did not have impact on survival (p=0.639) but preterm status had highly significant p value (Conclusion: Duodenal atresia was the commonest cause of neonatal duodenal obstruction. Associated anomalies were noted in 61% patients, Down’s syndrome being the most frequent. These anomalies did not have any significant impact on the survival, nor did LBW. Preterm status had significant impact on prognosis.

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Comparative Outcomes Assessment: Hip Hemiarthroplasty as an Alternative to THA in Patients with Surgically Pristine Acetabulum—Is There Still a Role?

ISRN Orthopedics ◽

10.1155/2013/632126 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6

Author(s):

Thomas B. Pace ◽

Brad Prather ◽

Brian Burnikel ◽

Brayton Shirley ◽

Stephanie Tanner ◽

...

Keyword(s):

Overall Survival ◽

Survival Rate ◽

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Groin Pain ◽

Long Term Results ◽

Overall Survival Rate ◽

Total Hip ◽

Group 2 ◽

Group 1

This is a retrospective review of 243 hip arthroplasties treated with either hemiarthroplasty (61 surgeries-Group 1) or total hip arthroplasty (182 surgeries-Group 2). The mid- to long-term results of relatively similar, predominately young patient cohorts were assessed annually via radiographs and the Harris Hip Scores for pain and clinical function. Groin pain persisted in 16.4% of Group 1 and 5.5% of Group 2 (). Thigh pain persisted in 11.5% of Group 1 and 2.2% of Group 2 (). Complications in Group 1 were 4/61 including 2 revisions with an overall survival rate of 96.7% versus Group 2 complication rate of 29/182 with 15 revisions and an overall survival rate of 91.8%. There were no cases of acetabular protrusio in Group 1, but 2 cases (1%) in Group 2 had cup loosening or osteolysis. Two cases were revised in Group 1 (3.2%). Both were undersized femoral stems. The fifteen revisions (8.2%) in Group 2 included loose stem (1), instability (8), infections (3), cup loosening (2), and accelerated polyethylene wear (1). Hemiarthroplasty has a higher incidence of thigh and groin pain but fewer complications compared with total hip arthroplasty.

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A Prospective Controlled Study on Long-Term Outcomes of Facial Lacerations in Children

Frontiers in Pediatrics ◽

10.3389/fped.2020.616151 ◽

2021 ◽

Vol 8 ◽

Author(s):

Sonja Fontana ◽

Clemens M. Schiestl ◽

Markus A. Landolt ◽

Georg Staubli ◽

Sara von Salis ◽

...

Keyword(s):

Treatment Time ◽

Trial Registration ◽

Long Term Results ◽

Controlled Study ◽

Tissue Adhesives ◽

Scar Assessment ◽

Group 2 ◽

Group 1

Background: Although skin adhesives have been used for decades to treat skin lacerations, uncertainty remains about long-term results, and complications.Methods: In this prospective, controlled, single-blinded, observational cohort study, outcomes were assessed by five plastic surgeons with standardized photographs at 6–12 months using a modified Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS); additionally, the POSAS was performed by the patients/caregivers and the physician; pain, requirement of anesthesia, treatment time, costs, complications, and quality of live (QoL) were assessed.Results: A total of 367 patients were enrolled; 230 were included in the main analysis; 96 wounds were closed using tissue adhesives (group 1); 134 were sutured (group 2). Assessment by the independent observers revealed an improved mean modified overall POSAS score in group 1 in comparison with group 2 [2.1, 95% CI [1.97–2.25] vs. 2.5, 95% CI [2.39–2.63]; p < 0.001, d = 0.58] and mean VSS score [1.2, 95% CI [0.981–1.34] vs. 1.6, 95% CI [1.49–1.79], p < 0.001, d = 0.53]. At the early follow-up, dehiscence rate was 12.5% in group 1 and 3.7% in group 2 (p < 0.001); later on, one dehiscence remained per group. Mild impairment of QoL was found at the early follow-up in both groups, with no impairment remaining later on. Duration of treatment and treatment costs were lower in group 1.Conclusion: Both modalities of wound closure yield favorable esthetic results, and complications are rare. Adhesives are more cost-effective, and its application is less time-consuming; therefore, tissue adhesives offer considerable advantages when used appropriately.Trial Registration: Public trial registration was performed at www.ClinicalTrials.gov (Identifier: NCT03080467).

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Transseptal Suturing Reduce Patient Anxiety after Septoplasty Compared to Nasal Packing

Acta Medica (Hradec Kralove Czech Republic) ◽

10.14712/18059694.2017.40 ◽

2016 ◽

Vol 59 (4) ◽

pp. 133-136 ◽

Cited By ~ 1

Author(s):

Kamran Sari ◽

Ali Irfan Gul ◽

Yunus Kantekin ◽

Ozgul Karaaslan ◽

Zeliha Kapusuz Gencer

Keyword(s):

Trait Anxiety ◽

Clinical Assessment ◽

Operating Time ◽

The State ◽

Nasal Packing ◽

State Trait Anxiety Inventory ◽

Patient Anxiety ◽

The Difference ◽

Group 2 ◽

Group 1

Background: We measured postoperative anxiety in patients who underwent transseptal suturing or nasal packing after septoplasty. Materials and Methods: Transseptal suturing was performed on Group 1 patients and nasal splints with airway were placed after septoplasty in Group 2 patients. Postoperative 48-h anxiety levels of both groups were measured using the State-Trait Anxiety Inventory (STAI) clinical assessment scale, prior to removal of nasal packing in Group 2. Results: Transseptal suturing was performed after septoplasty in 28 patients and nasal packing in 34 patients. The State-Trait Anxiety Inventory clinical assessment state (STAI-S) and trait (STAI-T) instruments were used to measure postoperative anxiety. The STAI-S scores were found 35.00 in the transseptal suturing group and 43.8 in the nasal packing group; the difference was found significant (p < 0.05). The STAI-T scores were found 42.6 in the transseptal suturing group and 45.7 in the nasal packing group; the difference was not found significant (p > 0.05). The rate of minor hemorrhage was found 10.7% in Group 1 patients. Conclusions: Transseptal suturing is simple and reliable when performed after septoplasty. The technique is painless and comfortable, and reduces patient anxiety (compared to that associated with nasal packing) with only a minor increase in operating time and hemorrhage.

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Immediate and long-term results of carotid endarterectomy in different periods of ischemic stroke

I P Pavlov Russian Medical Biological Herald ◽

10.23888/pavlovj2020283312-322 ◽

2020 ◽

Vol 28 (3) ◽

pp. 312-322

Author(s):

Anton N. Kazantsev ◽

Konstantin P. Chernykh ◽

Nona E. Zarkua ◽

Roman Yu. Lider ◽

Ekaterina A. Burkova ◽

...

Keyword(s):

Myocardial Infarction ◽

Long Term Results ◽

Lethal Outcome ◽

Group 4 ◽

Hospitalization Period ◽

Rehabilitation Period ◽

Group 3 ◽

Group 2 ◽

Group 1

Aim. Analysis of hospital and long-term results of carotid endarterectomy (CEA) in different periods of acute cerebrovascular event (ACVE). Materials and Methods. The given study was retrospective and was conducted using the method of patients sampling. In the period from 2010 to 2019, 1113 patients with ACVE in history who were later conducted CEA, were selected. Depending on the time interval between the last ACVE and CAE, all the patients were divided into 4 groups: the 1st group in the acutest period of ACVE (1-3 days) (n=24; 2.2%); the 2nd group in the acute period of ACVE (up to 28 days) (n=493; 44.3%); the 3rd group in the early rehabilitation period of ACVE (up to 6 months) (n=481; 43.2%); the 4th group in the late rehabilitation period of ACVE (up to 2 years) (n=115; 10.3%). The long-term period was 34.812.5 months. Results. In the hospitalization period of observation the following complications were found: lethal outcome ((group 1 0%; group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р=0.16)); myocardial infarction ((group 1 0%; group 2 0.4% (n=2); group 3 0%; group 4 0.9% (n=1); р=0.35)); ACVE/transient ischemic attack (TIA), ((group 1 4.2% (n=1); group 2 0.4% (n=2); group 3 0.2% (n=1); group 4 0%; р1-2=0.01; р1-3=0.009; р1-4=0.01)). By the end of hospitalization period the composite endpoint consisting of lethal outcome + myocardial infarction + ACVE/TIA made in group 1 4.2% (n=1), in group 2 1.2% (n=6), in group 3 0.4% (n=2), in group 4 2.6% (n=3), р=0.08. Complications of the long-term follow-up period were: lethal outcome from all causes ((group 1 25% (n=6); group 2 5.5% (n=27); group 3 7.3% (n=35); group 4 14% (n=16); р1-2=0.002; р1-3=0.008; р2-4=0.012)); lethal outcome from cardiovascular causes ((group 1 4.2% (n=1); group 2 3.6% (n=18); group 3 4.8% (n=23); group 4 5.2% (n=6); р=0.79)), myocardial infarction ((group 1 12.5% (n=3); group 2 3.6% (n=18); group 3 5.4% (n=26); group 4 6.1% (n=7); р=0.15)), ACVE/TIA ((group 1 16.6% (n=4); group 2 6.3% (n=31); group 3 6% (n=29); group 4 11.3% (n=13); р=0.05)); composite endpoint including lethal outcome + myocardial infarction + ACVE/TIA ((group 1 54.2% (n=13); group 2 15.4% (n=76); group 3 18.7% (n=90); group 4 31.3% (n=36); р1-2=0.0001; р1-3=0.0001; р1-4=0.005; р2-4=0.0006; р3-4=0.012)). Conclusion. Application of CEA demonstrated effectiveness and safety in the acute and early rehabilitation period of ACVE.

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Long-term results of surgical treatment of thyroid adenomas

Kazan medical journal ◽

10.17816/kmj2019-892 ◽

2019 ◽

Vol 100 (6) ◽

pp. 892-897

Author(s):

Stanislav Olegovich Artyukhin ◽

Vladimir Georgievich Aristarhov ◽

Denis Anatolyevich Puzin

Keyword(s):

Surgical Treatment ◽

Needle Aspiration ◽

Long Term Results ◽

Fine Needle ◽

Thyroid Adenomas ◽

Follicular Tumor ◽

Group 3 ◽

Group 2 ◽

Group 1

Aim. To study the long-term results of surgical treatment of patients with thyroid adenomas. Methods. From 2004 to 2006, 667 patients with follicular adenomas of the thyroid gland, including 134 (20.1%) men and 533 (79.9%) women, were operated on in the surgical department №2 of city clinical hospital №11 of Ryazan. 3 groups of patients were defined: group 1 operated on for solitary adenomas of the thyroid gland, 103 patients, hemithyreoidectomy performed; group 2 operated on for multiple adenomas of the thyroid in both lobes, 101 patients, thyroidectomy performed; group 3 32 patients operated on for multiple adenomas of the thyroid in the same lobe, hemithyreoidectomy performed. Patients were examined 14 years after the surgery. Results. Hypothyroidism was diagnosed in: group 1 18 (17.5%) patients, group 2 101 (100%), group 3 0. All patients with hypothyroidism were compensated with hormone replacement therapy. Permanent hypoparathyroidism was diagnosed only in group 2 8 (4.8%) patients. Unilateral laryngeal paralysis was found in group 1 in 1 (0.9%) patient, group 2 in 2 (1.9%) patients, group 3 contained no such patients. Recurrence (node more than 1 cm according to ultrasound) was observed in group 1 in 12 (11.7%) patients; fine-needle aspiration found colloidal nodes in 8 (7.8%) patients (Bethesda II), in 4 (3.9%) follicular tumor (IV). Group 2 had no recurrences. In group 3 11 (34.3%) patients had recurrence; fine-needle aspiration found colloidal nodes in 1 (3.1%) patient (Bethesda II), in 10 (31.3%) follicular tumor (Bethesda IV). Conclusion. In solitary adenomas it is possible to perform organ-saving operations, which reduces the percentage of postoperative complications; in multiple adenomas, the optimal volume of surgery is thyroidectomy; when multiple adenomas are localized in one lobe, the chance of recurrence of the disease (31.3%) is high leading to re-surgery.

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Features of free skin grafting to correct post-burn neck deformities in children

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors41937 ◽

2021 ◽

Vol 9 (1) ◽

pp. 77-86

Author(s):

Olga V. Filippova ◽

Konstantin A. Afonochev

Keyword(s):

Preventive Measures ◽

Preventive Measure ◽

Skin Grafting ◽

Long Term Results ◽

Neck Extension ◽

Scar Contracture ◽

Aesthetic Results ◽

Group 2 ◽

Grade Iii ◽

Group 1

BACKGROUND: In the literature, various methods of reconstructive plastic surgery for neck cicatricial contractures, from free skin grafting to expander dermotension and microsurgical tissue complex autotransplantation, are widely covered. However, very little attention has been paid to conservative measures aimed at stabilizing surgical treatment results. AIM: This study aims to evaluate the long-term results of free skin grafting of neck granulating wounds after burns and secondary relapsing scar contracture correction. The study also aims to analyze the causes of poor results and demonstrate the possibility of using free skin grafting to correct neck contractures with basic preventive measures. MATERIALS AND METHODS: Forty-six patients with neck burn cicatricial sequelae were treated at the clinic of trauma sequelae in H. Turner National Medical Research Center from 2017 to 2019. The patients were divided into two groups: group 1 patients with neck contractures after plasty of granulating wounds with free skin autografts, and group 2 patients with a relapse of neck contracture after corrective reconstructive surgery. Anamnestic data analysis enabled establishing the actual volume of preventive rehabilitation measures in both patient groups. The classification by N.E. Povstyany (1973) was used to determine the severity of contracture. RESULTS: The most severe neck contractures, grade III and IV, developed in group 1 patients (grade III 41.2%). In group 2 patients, there was a limitation of neck extension, corresponding to grades I (33.3%) and II (58.3%). Conservative preventive measures as immobilization and compression therapy were absent in group 1 in 100% of cases. The most common preventive measure was the prescription of topical anti-scar drugs. Two-stage skin grafting with full-thickness skin autografts combined with conservative measures made it possible to correct neck contractures of grade I-IV completely and obtain good aesthetic results. CONCLUSION: The main reason for neck contractures development is the retraction of skin autografts, which inevitably develops in the absence of appropriate preventive measures. Correction of neck contractures using free skin grafting combined with preventive immobilization using a Schantz collar and a compression half-mask allows obtaining good functional and aesthetic results.

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