scholarly journals Impact of a Novel Oblique-Tip Papillotome for Biliary Cannulation during ERCP: A Nonrandomized Coarsened Exact Matching Study

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Hiroo Imazu ◽  
Shiaw-Hooi Ho ◽  
Shoryoku Hino ◽  
Khean-Lee Goh ◽  
Mitsuhiko Moriyama ◽  
...  
Keyword(s):  
University Hospital ◽  
Exact Matching ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Coarsened Exact Matching ◽  
Patient Allocation ◽  
Cannulation Technique ◽  
The Mean ◽  
A Prospective Study ◽  
The University

Background. We developed a novel oblique-tip papillotome (OT-papillotome) to facilitate biliary cannulation during endoscopic retrograde cholangiopancreatography (ERCP). This study was performed to evaluate the utility of the OT-papillotome for contrast-guided cannulation (CGC) and wire-guided cannulation (WGC) during ERCP, compared with standard cannulation by WGC using a standard-tip papillotome (ST-papillotome). Methods. A prospective study was performed at two centers. CGC with the OT-papillotome (OT-CGC group) was performed at Jikei University Hospital, while WGC was done with the OT-papillotome and ST-papillotome (OT-WGC and ST-WGC groups, respectively) at the University of Malaya Medical Centre. The results of the OT-CGC and OT-WGC groups were compared with those of the ST-WGC group after performing coarsened exact matching (CEM) to reduce bias due to nonrandomized and center-based patient allocation. Results. Eighty patients were enrolled in each of the OT-CGC, OT-WGC, and ST-WGC groups. After CEM, the successful biliary cannulation rate was significantly higher in the OT-CGC and OT-WGC groups than in the ST-WGC group, while rescue cannulation was reduced. The mean number of unintended pancreatic access events in the OT-WGC and OT-CGC groups was similar to the ST-WGC group. However, it was significantly lower in the OT-WGC group than in the OT-CGC group. Multivariate analysis revealed that the OT-papillotome was independently associated with less frequent rescue cannulation and a higher successful biliary cannulation rate. Conclusions. Although use of the OT-papillotome in biliary cannulation did not reduce unintended pancreatic access events or PEP compared to the ST-papillotome, the OT-papillotome increased the successful biliary cannulation rate, while reducing the frequency of rescue cannulation procedures. Combining the OT-papillotome with WGC might be the best cannulation technique for minimizing unintended pancreatic access.

Ultra-resistant schizophrenia and potentiation strategies

2017 ◽  
Vol 41 (S1) ◽  
pp. s834-s834 ◽  
Author(s):  
S. Khouadja ◽  
R. Ben Soussia ◽  
S. Younes ◽  
A. Bouallagui ◽  
I. Marrag ◽  
...  
Keyword(s):  
Treatment Resistance ◽  
Cost Benefit ◽  
Clinical Excellence ◽  
University Hospital ◽  
Dsm Iv ◽  
Competing Interest ◽  
A Prospective Study ◽  
Psychiatric Department ◽  
The Cost ◽  
The University

IntroductionTreatment resistance to clozapine is estimated at 40–70% of the treated population. Several clozapine potentiation strategies have come into clinical practice although often without evidence-based support.ObjectiveThe aim of our work was to identify the potentiation strategies in ultra-resistant schizophrenia depending on the subtype of schizophrenia.MethodologyThis is a prospective study conducted on patients with the diagnosis of schizophrenia, based on DSM-IV-TR criteria, and hospitalized in the psychiatric department of the university hospital in Mahdia, Tunisia. The study sample consisted of patients meeting the resistant schizophrenia criteria as defined by national institute for clinical excellence (NICE), and the prescription of clozapine for 6 to 8 weeks was shown without significant improvement.Resultswe have collected 10 patients. The mean serum level of clozapine was 462.25 mg/L. The potentiation strategies were different depending on the subtype of schizophrenia. For the undifferentiated schizophrenia, we have chosen ECT sessions. For the disorganized schizophrenia, we opted for amisulpiride and aripiprazole. For the paranoid forms, we have chosen the association of risperidone and ECT. A psychometric improvement was noted in BPRS ranging from 34 to 40%.ConclusionEvery potentiation strategy entails a cost, whether it is an additional monetary cost, adverse effects or greater stress to caregivers. The cost/benefit equation should be thoroughly evaluated and discussed before commencing a strategy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Correlation Between Dysphagia and Malocclusion in Rett Syndrome: A preliminary study

2019 ◽  
Vol 18 (4) ◽  
pp. 489
Author(s):  
Serena Cocca ◽  
Massimo Viviano ◽  
Michele Loglisci ◽  
Stefano Parrini ◽  
Giovanni Monciatti ◽  
...  
Keyword(s):  
Rett Syndrome ◽  
Epileptic Seizures ◽  
University Hospital ◽  
Severe Dysphagia ◽  
Feeding And Eating Disorders ◽  
Craniofacial Dysmorphism ◽  
The Mean ◽  
Preliminary Study ◽  
The University ◽  
Mild Dysphagia

Objectives: Rett syndrome (RS) is a severe neurological developmental disorder characterised by stereotypical hand movements, epileptic seizures, craniofacial dysmorphism and digestive dysfunction. This study aimed to examine the correlation between the severity of malocclusion and dysphagia in patients with RS. Methods: This preliminary study was conducted at the Ear, Nose & Throat Clinic of the University Hospital of Siena, Siena, Italy, from January 2014 to December 2017. A total of 56 patients with RS were examined and grouped according to the severity of dysphagia (absent, mild, moderate or severe) and malocclusion (<2 mm, 2–3 mm, 3–4 mm or >4 mm). Results: All of the patients were female and the mean age was 11.3 years. Eight (14.3%) patients had mild, 18 (32.1%) had moderate and 30 (53.6%) had severe dysphagia. Four (7.1%) patients had <2 mm occlusion, 10 (17.9%) had 2–3 mm occlusion, 26 (46.4%) had 3–4 mm occlusion and 16 (28.6%) had >4 mm occlusion. Mild dysphagia was observed in 100% and 40% of patients with <2 and 2–3 mm malocclusion, respectively, while moderate dysphagia was present in 60% and 38.5% of patients with 2–3 and 3–4 mm malocclusion, respectively. Severe dysphagia was observed in 28.6% and 87.5% of patients with 3–4 and >4 mm malocclusion, respectively. There was a significant correlation between dysphagia and malocclusion severity (P <0.001). Conclusion: A higher degree of malocclusion was associated with more severe dysphagia among a cohort of patients with RS.Keywords: X-Linked Mental Retardation; Rett Syndrome; Dysphagia; Malocclusion; Feeding and Eating Disorders of Childhood.

scholarly journals Acute Polyhydramnios Complicating Twin Pregnancies

1985 ◽  
Vol 34 (3-4) ◽  
pp. 179-184 ◽  
Author(s):  
K.T.M. Schneider ◽  
K. Vetter ◽  
R. Huch ◽  
A. Huch
Keyword(s):  
Mortality Rate ◽  
Amniotic Fluid ◽  
Bed Rest ◽  
Positive Influence ◽  
University Hospital ◽  
Monozygous Twin ◽  
The Mean ◽  
The University ◽  
Twin Pregnancies ◽  
Placental Vessel

AbstractAcute polyhydramnios in the second trimestr is a typical complication in monozygous twin pregnancies. It is caused by a feto-fetal transfusion with anemia on the donor and polycytemia on the recipient twin. Contrary to the chronic hydramnios, there is no increase in malformations. In view of the high mortality rate (100%, according to most authors), the clinical management has to be reconsidered. During the years 1979 to 1983, 10 cases of acute polyhydramnios have been observed at the University Hospital in Zurich. This corresponds to an incidence of 9% in our twin population. All cases investigated were MZ twin pregnancies. With the exception of one patient, who underwent an abortion, all women were hospitalized, had bed rest and received recurrent removals of amniotic fluid and prophylactic tocolysis. The mean gestational age at the time of diagnosis was 23 4/7 weeks and at delivery 30 3/7 weeks. In two cases – one of which is presented in detail – with an unintentional puncture of a placental vessel, the recurrence of the hydramnios did not appear. Eight of 18 newborns survived. No malformations were found. Bed rest, tocolysis and recurrent amniocenteses seem to have a positive influence on the prolongation and outcome of the gestation in acute polyhydramnios.

scholarly journals Fistulotomy-First Approach is Safe and Effective in Endoscopic Retrograde Cholangiography: Results of a Prospective Case Series

2020 ◽  
Author(s):  
Konstantinos Hnaris ◽  
Connie Taylor ◽  
Lawrence Hookey ◽  
Robert Bechara
Keyword(s):  
Case Series ◽  
Endoscopic Retrograde ◽  
Successful Cannulation ◽  
Cannulation Technique ◽  
The Common ◽  
The Mean ◽  
Prospective Case Series ◽  
Needle Knife ◽  
Mild Acute Pancreatitis ◽  
Access Technique

Abstract Background and Aims The aim of this study was to assess the safety and efficacy of using needle-knife fistulotomy (NKF) as a primary cannulation technique in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) with a native papilla. Patients and Methods This prospective feasibility study enrolled 50 patients between December 2018 and June 2019. The procedure was performed by two expert endoscopists (R.B. and L.H.). The primary outcome was the incidence of post-ERCP pancreatitis. Other variables assessed included the success rate of cannulation of the common bile duct (CBD), time to successful cannulation, and incidence of adverse events. Results Between December 2018 and June 2019, 50 patients enrolled in the study. The mean age was 63.4 years (standard deviation 18.1), and there were 26 females. Indications included biliary obstruction secondary to malignancy (n = 14) and choledocholithiasis (n = 36). Successful cannulation of the CBD through the fistulotomy occurred in 49/50 cases. The time to successful cannulation was 5.1 minutes (range 0.5 to 23 minutes). Mild acute pancreatitis occurred in two cases (4%). Post-ERCP bleeding occurred in three patients (6%) Conclusions In this pilot study, NKF was used as the primary biliary access technique and it was demonstrated that it appears to be at least as safe as the traditional access technique with a sphinctertome. However, its role as a primary cannulation technique requires further investigation with multicenter, randomized control studies.

scholarly journals Laparoscopic Appendectomy in Children: Preliminary Study in Pediatric Hospital Albert Royer, Dakar

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mbaye Fall ◽  
Doudou Gueye ◽  
Ibrahima Bocar Wellé ◽  
Faty Balla Lo ◽  
Aloise Sagna ◽  
...  
Keyword(s):  
Acute Appendicitis ◽  
Complicated Appendicitis ◽  
University Hospital ◽  
Male Predominance ◽  
Average Production ◽  
Radiological Data ◽  
The Mean ◽  
Preliminary Study ◽  
The University ◽  
Douglas Pouch

Appendiceal pathology’s management has benefited in recent years from the advent of laparoscopic surgery. This study is to make a preliminary assessment of laparoscopic management of acute and complicated appendicitis in children after a few months of practice at the University Hospital Albert Royer, Dakar. This is a retrospective study of 22 cases of patients, all operated on by the same surgeon. The parameters studied were age, sex, clinical data and laboratory features, radiological data, and results of surgical treatment. The mean age of patients was 9.5 years with a male predominance. The series includes 14 cases of acute appendicitis and 8 complicated cases. Appendectomy anterograde is practiced in 81% of cases. Appendectomy was associated with peritoneal wash in 17 patients including 9 cases of acute appendicitis. Drainage of Douglas pouch is performed in 2 patients with complicated appendicitis; the average production was 300 cc of turbid liquids and any complications were not founded. An abscess of Douglas pouch is noted in 2 patients with complicated appendicitis undrained. These Douglas abscesses were treated medically. No conversion of laparotomy was performed in the series. After an average of 8 months no other problems were noted.

Demonstrating competence in Endoscopic Retrograde Cholangiopancreaticography (ERCP): recently credentialed operator’s performance for deep biliary cannulation over 1 year period from tertiary care hospital in Pakistan

2020 ◽  
pp. 1-12
Author(s):  
Om Parkash ◽  
Umar Bhatti ◽  
Hasnain Zafar ◽  
Saeed Hamid
Keyword(s):  
Success Rate ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Study Data ◽  
University Hospital ◽  
Oesophageal Perforation ◽  
Care Hospital ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Endoscopic Retrograde Cholangiopancreaticography

Abstract Objective: To measure the success rate of endoscopic retrograde cholangiopancreaticography biliary cannulation of a recently credentialed endoscopist at a tertiary hospital. Methods: The clinical audit was conducted at the Aga Khan University Hospital. Karachi, and comprised data of all patients who underwent endoscopic retrograde cholangiopancreaticography under the care of a single operator during 2016. Data was retrospectively extracted from patient charts by an assistant blinded to the study. Data extracted included demographics, admission type, details and indication for the procedure, diagnosis, cannulation outcome, duct clearance, complications, follow-up surgical intervention, radiological imaging and mortality post-endoscopy. Data was analysed using SPSS 19. Results: Of 143 procedures performed, 102(71.3%) were included. The mean age was 52±17 years and 54(52.9%) of them were females. Most common indication was choledocholithiasis in 70(68.6%). The average procedure time was 41.5±5.5 minutes. Cannulation success rate was 96(94.1%). Complications included post-procedure pancreatitis in 5(4.9%), minimal bleeding in 8(7.8%) and oesophageal perforation in 1(0.98%). There was no procedure-related mortality. Conclusion: The success rate was high and complications were low Continuous...

scholarly journals Does the presence of a trainee compromise success of biliary cannulation at ERCP?

2017 ◽  
Vol 05 (07) ◽  
pp. E559-E562 ◽  
Author(s):  
John Frost ◽  
Arun Kurup ◽  
Sharan Shetty ◽  
Neil Fisher
Keyword(s):  
Primary Outcome Measure ◽  
Success Rates ◽  
Serious Adverse Events ◽  
Biliary Cannulation ◽  
Exact Test ◽  
Cannulation Technique ◽  
Cannulation Success ◽  
A Prospective Study ◽  
Mean Time ◽  
Training Protocol

Abstract Background and study aims Findings in the literature are conflicting on whether trainee involvement in endoscopic retrograde cholangiopancreatography (ERCP) procedures is detrimental to cannulation success rates. We addressed this in a prospective study, where cannulation success with or without trainee presence was the primary outcome measure. Patients and methods We prospectively recorded data on 2 senior endoscopists and their trainees over an 18-month period for ERCPs in patients with a virgin ampulla. Presence or absence of a trainee at ERCP procedures was pragmatic, reflecting their other service or training commitments or annual leave. For trainee presence, the training protocol allowed them 6 minutes of supervised time in which to achieve biliary cannulation after reaching the ampulla. Study outcome measures included cannulation success, time to cannulation, technique, whether this was achieved independently by the trainee, and complications. Results There were 219 procedures recorded and analyzed (134 with a trainee, 85 without). Three trainees were involved. Selective biliary cannulation was achieved in 201 (92 %) of cases. When a trainee was present, cannulation was successful in 122/134 procedures (91 %), compared to 79/85 (93 %) with a senior endoscopist alone (P = 0.8, Fisher’s exact test). Mean time to biliary cannulation with a trainee present was 7 minutes, compared with 5 minutes with no trainee. Mean time for successful independent cannulation by the trainee was 4 minutes, and 9 minutes for a consultant following a trainee’s attempt. There were no serious adverse events. Conclusion Our study shows that with this training protocol, involvement of a trainee on a routine secondary care ERCP list does not impair biliary cannulation success, and does not prolong a subsequent attempt by the senior endoscopist if initially unsuccessful. These findings support the involvement of trainees in routine ERCP lists with this training protocol.

scholarly journals Epidemiological and clinical aspects of neurosyphilis in Morocco

2005 ◽  
Vol 11 (3) ◽  
pp. 470-477
Author(s):  
M. Yahyaoui
Keyword(s):  
Optic Atrophy ◽  
University Hospital ◽  
Clinical Aspects ◽  
Tabes Dorsalis ◽  
Clinical Presentations ◽  
The Mean ◽  
The University

Neurosyphilis accounts for 56%-70% of all visceral syphilis and is a complication in 5%-10% of cases of untreated syphilis. The aim of this study was to evaluate the epidemiological aspects and clinical presentations of neurosyphilis in Morocco through a series of 201 patients attending the Centre for Neurological Services at the university hospital in Rabat between 1986 and 1997. The mean age of the patients was 41.26 [SD 9.23] years [range:17-70 years] ; the majority [91%] were male. The incidence of neurosyphilis in Morocco is high. From 31 cases per year in 1985, it has fallen since 1990 to reach 10 cases in 1997. Among the different clinical presentations recorded, chronic meningoencepahalitis was the commonest, followed by meningovasculitis, tabes dorsalis and optic atrophy

scholarly journals Procedimentos invasivos e sepse em recém-nascidos de muito baixo peso: estudo descritivo

2016 ◽  
Vol 15 (4) ◽  
pp. 704
Author(s):  
Flavia do Valle Andrade Medeiros ◽  
Valdecyr Herdy Alves ◽  
Cristina Ortiz Sobrinho Valete ◽  
Eny Dórea Paiva ◽  
Diego Pereira Rodrigues ◽  
...  
Keyword(s):  
Birth Weight ◽  
Medical Records ◽  
Neonatal Intensive Care ◽  
Secondary Data ◽  
Delivery Room ◽  
University Hospital ◽  
Central Catheter ◽  
The Mean ◽  
The University ◽  
The City

Aim:  To  identify  the  type  of  sepsis  which  affected  newborns  withvery  low  birth  weight  and  invasive  care  procedures  to  which  they were  subjected  in  a university hospital in the city of Niterói, between the years 2008 and 2012. Method: This is a retrospective descriptive study using secondary data research in the medical records of  newborns  admitted  to  the  Neonatal  Intensive  Care  Unit  of  the  University  Hospital Antônio Pedro. Results: Of the 49 infants studied, 35 were diagnosed with early sepsis, eight with early and late sepsis and six late. The mean gestational age was 30.5 weeks and  the  weight  1.176,1  kg.  The  most  frequently  performed  care procedures  were: peripheral  venipuncture  (87.8%),  central  catheter  peripheral  venipuncture  (81.6%), assistance  to  ventilation  in  the  delivery  room  (69.4%)  and  intubation  in  the  delivery room  (28.6%).  Conclusion:  It is inferred  that the  lower  birth  weight is  associated  with the higher incidence of sepsis.

scholarly journals Limited Mobility to the Bed Reduces the Chances of Discharge and Increases the Chances of Death in the ICU

2021 ◽  
Vol 12 (1) ◽  
pp. 8-16
Author(s):  
Talita Leite dos Santos Moraes ◽  
Joana Monteiro Fraga de Farias ◽  
Brunielly Santana Rezende ◽  
Fernanda Oliveira de Carvalho ◽  
Michael Silveira Santiago ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Retrospective Study ◽  
Medical Records ◽  
High Mobility ◽  
University Hospital ◽  
Limited Mobility ◽  
The Mean ◽  
The University

Background: Progressive mobility in the ICU has been recommended; however, the definitions of low, moderate, and high mobility in the ICU still diverge between studies. Therefore, our objective was to classify the mobility of the sample from verticalization and active withdrawal from the bed, and from that, to analyze the chances of discharge, death, and readmission to the ICU. Materials and methods: This is an observational and retrospective study that consults the medical records of individuals admitted to the ICU of the University Hospital of Sergipe (HU/SE) between August 2017 and August 2018. Mobility level was classified based on the Intensive Care Unit Mobility Scale (IMS). Results: A total of 121 individuals were included. The mean age was 61.45 ± 16.45, being 53.7% female. Of these, 28 (23.1%) had low mobility, 33 (27.3%) had moderate mobility, and 60 (49.6%) had high mobility. Individuals with low mobility were 45 times more likely to die (OR = 45.3; 95% CI = 3.23–636.3) and 88 times less likely to be discharged from the ICU (OR = 0.22; 95% CI = 0.002–0.30). Conclusion: Those who evolved with low mobility had a higher chance of death and a lower chance of discharge from the ICU. Moderate and high mobility were not associated with the investigated outcomes.

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