Novel Trocar-Free Elastic Liver Retractor in Bariatric Surgery Patients: Comparison of a Standard Laparoscopic Retraction With the First Series Using the LiVac Sling System

2020 ◽  
Vol 27 (2) ◽  
pp. 187-192
Author(s):  
Claudia Bures ◽  
Philippa Seika ◽  
Rossano Alvim Keppler Fiorelli ◽  
Dino Kröll ◽  
Ricardo Zorron
Keyword(s):  
Bariatric Surgery ◽  
Adverse Events ◽  
Demographic Data ◽  
Gastrointestinal Surgery ◽  
Skin Incision ◽  
Study Data ◽  
Liver Retraction ◽  
Liver Injuries ◽  
Liver Retractor ◽  
Surgical Field

During upper gastrointestinal surgery, retraction of the liver plays an essential role in the visualization and creation of an optimal surgical field. Liver retraction may be problematic, particularly in obese patients. The use of conventional liver retractors requires additional skin incision and has the potential to cause pain as well as liver injuries. The present study is the first to evaluate the performance and safety of the LiVac Sling (Livac Pty Ltd, Melbourne, Australia) trocar-free retractor system in bariatric surgery patients. In this retrospective study, data from laparoscopic primary or revisional bariatric surgeries that were performed with the LiVac Sling system and a standard retractor between May 2017 and December 2017 were collected. Demographic data, body mass index, type of surgery, number and indication of LiVac Sling system used, surgery time, and complications were analyzed. In total, 51 procedures were included. Twenty Sling devices have been used in 17 patients (13 female; 75%). The distribution of baseline characteristics was similar between the standard retractor group and LiVac Sling retractor group. In the LiVac Sling group, the number of trocars used was significantly reduced over the study period. Within 30 days postoperatively, no complications could be identified, and no device-related adverse events were reported. In this bariatric population, the use of the LiVac Sling for liver retraction was safe. No device-related adverse events were registered, and compared with standard retraction, the number of trocars used could be reduced by one.

Intra-abdominal Trocar-Free Vacuum Liver Retractor for Upper-Gastrointestinal Surgery

2017 ◽  
Vol 24 (2) ◽  
pp. 186-191 ◽  
Author(s):  
Christian Benzing ◽  
Helmut Weiss ◽  
Felix Krenzien ◽  
Matthias Biebl ◽  
Johann Pratschke ◽  
...  
Keyword(s):  
Gastrointestinal Surgery ◽  
Obese Patients ◽  
Liver Retraction ◽  
Upper Gi ◽  
Single Port Surgery ◽  
Clinical Series ◽  
Liver Retractor ◽  
Study Population ◽  
Male Patients ◽  
Upper Gastrointestinal

Background. In laparoscopic upper-gastrointestinal (GI) surgery, an adequate retraction of the liver is crucial. Especially in single-port surgery and obese patients, problems may occur during liver retraction. The current study seeks to evaluate the efficacy and safety of the LiVac trocar-free liver retractor in laparoscopic upper-GI surgery. Methods. The present study is a nonrandomized dual-center clinical series describing our preliminary results using the LiVac system for liver retraction. The primary end points of the present study included the effectiveness and safety of the LiVac device as well as complications and documentation of problems with the device during surgery. Results. The device was used in 11 patients for simple and complex laparoscopic procedures. The mean age of the study population was 59.6 years (SD = 20.6; range = 30-84). There were 6 female and 5 male patients with a mean body mass index (BMI) of 31.9 kg/m2 (SD = 8.1; range = 26.0-45.3). The efficacy of the device was excellent in all cases, reducing the number of trocars needed. There were no device-related complications. Conclusion. The LiVac liver retractor is easy to use and provides a good exposure of the operative field in upper-GI laparoscopic surgery, even in obese patients with a high BMI.

Comparison of a Novel, Trocar-Free Internal Liver Retractor to Standard Liver Retraction in Bariatric Surgery

2019 ◽  
Vol 29 (9) ◽  
pp. 3071-3075 ◽  
Author(s):  
Andrew Sweeny ◽  
Larry Buglino ◽  
Erika La Vella ◽  
Don Yarbrough
Keyword(s):  
Bariatric Surgery ◽  
Liver Retraction ◽  
Liver Retractor

scholarly journals Adverse events of special interest in clinical trials of rheumatoid arthritis, psoriatic arthritis, ulcerative colitis and psoriasis with 37 066 patient-years of tofacitinib exposure

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001595
Author(s):  
Gerd R Burmester ◽  
Peter Nash ◽  
Bruce E Sands ◽  
Kim Papp ◽  
Lori Stockert ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Ulcerative Colitis ◽  
Clinical Trials ◽  
Psoriatic Arthritis ◽  
Adverse Events ◽  
Special Interest ◽  
Phase 1 ◽  
Incidence Rates ◽  
Study Data ◽  
System Organ Class

ObjectivesTo analyse adverse events (AEs) of special interest across tofacitinib clinical programmes in rheumatoid arthritis (RA), psoriatic arthritis (PsA), ulcerative colitis (UC) and psoriasis (PsO), and to determine whether the incidence rates (IRs; unique patients with events per 100 patient-years) of these events are consistent across diseases.MethodsThe analysis included data from patients exposed to ≥1 dose of tofacitinib in phase 1, 2, 3 or 3b/4 clinical trials and long-term extension (LTE) studies (38 trials) in RA (23 trials), PsA (3 trials), UC (5 trials) and PsO (7 trials). All studies were completed by or before July 2019, except for one ongoing UC LTE study (data cut-off May 2019). IRs were obtained for AEs of special interest.Results13 567 patients were included in the analysis (RA: n=7964; PsA: n=783; UC: n=1157; PsO: n=3663), representing 37 066 patient-years of exposure. Maximum duration of exposure was 10.5 years (RA). AEs within the ‘infections and infestations’ System Organ Class were the most common in all diseases. Among AEs of special interest, IRs were highest for herpes zoster (non-serious and serious; 3.6, 1.8, 3.5 and 2.4 for RA, PsA, UC and PsO, respectively) and serious infections (2.5, 1.2, 1.7 and 1.3 for RA, PsA, UC and PsO, respectively). Age-adjusted and sex-adjusted mortality ratios (weighted for country) were ≤0.2 across cohorts.ConclusionsThe tofacitinib safety profile in this analysis was generally consistent across diseases and with longer term follow-up compared with previous analyses.

scholarly journals Prevalence of obesity and diabetes in older people with sarcopenia defined according to EWGSOP2 and FNHI criteria

2021 ◽  
Author(s):  
Francesca Remelli ◽  
Elisa Maietti ◽  
Pasquale Abete ◽  
Giuseppe Bellelli ◽  
Mario Bo ◽  
...  
Keyword(s):  
Demographic Data ◽  
Study Data ◽  
Pharmacological Therapy ◽  
Cognitive Status ◽  
Sarcopenic Obesity ◽  
Diabetic Patients ◽  
Functional Abilities ◽  
Prevalence Data ◽  
Obesity And Diabetes ◽  
Prevalence Of Obesity

Abstract Background Although the prevalence of sarcopenic obesity is increasing, nowadays a universally accepted definition still does not exist. Because, this clinical entity is defined as the combination of obesity and sarcopenia, the diagnosis appears to be strictly linked to criteria used for sarcopenia and the available prevalence data are not uniform. To investigate the prevalence of sarcopenic obesity in older persons according to EWGSOP2 and FNIH criteria. Second, to evaluate the prevalence of diabetes in patients with sarcopenia diagnosed by the two definitions. Methods Observational multicenter study performed in 2014 on older patients admitted to 12 Italian hospitals (GLISTEN Study). Data were collected through standardized questionnaires, which assessed: socio-demographic data, cognitive status, functional abilities, pharmacological therapy, comorbidities, and blood tests. Moreover, muscle mass and strength and physical performance were evaluated. Results Six hundred and ten were included in the analyses. Among sarcopenic patients, the prevalence of sarcopenic obesity was 30.8% with FNIH and 0% with EWGSOP2 criteria. According to EWGSOP2 criteria, 23.7% of sarcopenic and 30.8% of non-sarcopenic patients were affected by diabetes (p = 0.101); otherwise, using FNIH criteria, 36.3% of sarcopenic and 26.9% of non-sarcopenic patients were diabetic (p = 0.030). After adjustment for potential confounders, diabetic patients had a 73% higher probability of being sarcopenic according to FNIH criteria (OR 1.73; 95% CI 1.13–2.64). Conclusions The EWGSOP2 and FNIH sarcopenia criteria are differently related to the prevalence of obesity and diabetes. The EWGSOP2 criteria seem to be not suitable to identify people with sarcopenic obesity.

scholarly journals Knowledge of conjunctivitis among high school students in Pokhara valley of Western Nepal

2020 ◽  
Vol 13 (1) ◽  
pp. 19-22
Author(s):  
Sarita Tuladhar ◽  
Jamuna Gurung
Keyword(s):  
High School ◽  
High School Students ◽  
Health Education ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Study Data ◽  
School Students ◽  
Government Schools ◽  
Cross Sectional ◽  
Pokhara Valley

Introduction: Conjunctivitis is a common health problem in Nepal. It is inflammation of conjunctiva presenting as red eye. It is a communicable eye disease. Health education to the students and proper management can help spread of the disease. Knowledge of conjunctivitis among school students will help in prevention of the disease. So the study was carried out to assess the knowledge of conjunctivitis among high school students in Pokhara valley of Western Nepal. Materials/ Methods: A school based cross sectional study was performed among six government schools in western Nepal from May 2019 to June 2019. Students from grade eight, nine and ten were included in the study. Data was collected using structured questionnaire including demographic data, knowledge regarding sign symptoms of conjunctivitis, treatment, prevention, complication of conjunctivitis. Data was analysed using SPSS version 11.6. Result: A total of 523 students were included in the study. The mean age of the students was 14.7 ± 1.2 years with majority of females (53%). Nearly 2/3rd of the students (61.6%) had heard of conjunctivitis. Majority of the students (87.4%) of the students mentioned that it is communicable while 80.3% of the students correctly mentioned its etiology. Majority of the students (97.9%) mentioned that it is curable with treatment as first option (97.5%). Majority of the students (98.3%) correctly responded to the preventive measures but majority of the students (83.2%) wrongly mentioned mode of transmission. Conclusion: Secondary school students in Western Nepal have poor knowledge of conjunctivitis. Appropriate eye health education should be given to school students to prevent rapid spread of infective conjunctivitis.  

Why Are Patients Readmitted? An Analysis of Adverse Events Leading to Readmission, Reintervention, or Reoperation After Bariatric Surgery

2018 ◽  
Vol 13 (4) ◽  
pp. 163-170
Author(s):  
Kamyar Hariri ◽  
Matthew Dong ◽  
Eric D. Edwards ◽  
Subhash U. Kini ◽  
William B. Inabnet ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Adverse Events

scholarly journals Quality of Clinical Evaluation from Viewpoint of Nurse Interns and Nursing Unit Clerks; Nursing Students of the School of Nursing and Midwifery

2016 ◽  
Vol 9 (1) ◽  
pp. 17
Author(s):  
Zahra Riahi Roohi ◽  
Shayesteh Salehi
Keyword(s):  
Nursing Students ◽  
Clinical Evaluation ◽  
Demographic Data ◽  
Evaluation Process ◽  
Study Data ◽  
Nurse Training ◽  
Nursing Unit ◽  
School Of Nursing ◽  
Open Questions

Quality of nurse training programs requires clinical evaluation. The purpose of this study was to achieve a perspective of realities from viewpoint of nursing students during their internship and clerkship. This study was descriptive and quantitative; 180 nurse inters and nursing unit clerks were enrolled for the study. Data was collected using a researcher made questionnaire. Content validity of the questionnaire was confirmed by a group of faculty members and clinical professors; reliability of the questionnaire was confirmed by Cronbach's alpha (0.89). The questionnaire consisted of two parts; demographic data and data related to clinical evaluation in four areas including content of evaluation, the role of instructor in evaluation, evaluation process and outcome of evaluation. The questionnaire was scored on a five-point Likert scale from always to never. At the end, there were two open questions about suggestions on clinical evaluation. Data were analyzed by SPSS22, descriptive and analytic statistics. Results showed that nurse interns evaluated the instructor as good (4.05 ± 0.06), evaluation content as average (3.65 ± 0.06), evaluation process as average (2.77 ± 0.76) and outcome of evaluation as poor (2.41 ± 0.69). Nursing unit clerks evaluated the instructor as good (3.84 ± 0.59), evaluation content as average (3.51 ± 0.68), evaluation process as average (2.60 ± 0.78) and outcome of evaluation as poor (2.56 ± 0.63). According to the results, quality of clinical evaluation of nursing students requires a review in existing processes and tools, as well as revision in programs and clinical evaluations by planners and instructors.

scholarly journals Incidence of gastric cancer, its subtypes, and correlation with Helicobacter Pylori

2013 ◽  
Vol 3 (5) ◽  
pp. 403-407
Author(s):  
Shiva Raj KC ◽  
GL Amatya ◽  
A Lakhey ◽  
S Basnet ◽  
G Aryal
Keyword(s):  
Gastric Cancer ◽  
Helicobacter Pylori ◽  
Demographic Data ◽  
College Teaching ◽  
Study Data ◽  
Upper Gastrointestinal Endoscopy ◽  
Tubular Adenocarcinoma ◽  
Common Cause ◽  
Medical College ◽  
H Pylori

Background: Gastric cancer is the fourth most commonly diagnosed cancer and the second most common cause of cancer related death worldwide. It is the common cause of cancer related death in Nepal. Helicobacter Pylori has been classified as a definite carcinogen along with other factors. The aim of this study was to fi nd the incidence of gastric cancer among the patients undergoing upper gastroscopy, its various subtypes and association with Helicobacter Pylori. Materials and Methods: This is a retrospective and prospective study carried out at GRP Polyclinic and Kist Medical College Teaching Hospital. All the patients undergoing upper gastrointestinal endoscopy were included in this study. Data of all the gastric endoscopic biopsies done from June 2011 to January 2013 were collected and analyzed. All the biopsy specimens were processed routinely in histopathology laboratory. Specimens showing carcinoma were enrolled in this study and all the relevant demographic data were collected. Results: Out of 3395 biopsy cases; 49 cases (1.44%) were diagnosed as adenocarcinoma stomach. The overall mean age for carcinoma was 47.6 years with a mild male preponderance. Thirty cases (61.2%) were of intestinal type, (n=11; 22.4%) were of diffuse type and (n=8; 16.3%) were mixed type of adenocarcinoma. According to WHO classifi cation the most common subtype was tubular adenocarcinoma (n=35; 71.5%) followed by signet ring type (11 cases; 22.4%). Out of 49 cases of adenocarcinoma stomach 39 cases (79.5%) were Helicobacter Pylori positive. Conclusion: This study shows that gastric carcinoma is a male predominant neoplasm usually of old age but can occur at younger ages. It predominantly occurs in Helicobacter Pylori infected patients and H. Pylori eradication will help to decrease the incidence rate and mortality of stomach cancer. Journal of Pathology of Nepal (2013) Vol. 3, No.1, Issue 5, 403-407 DOI: http://dx.doi.org/10.3126/jpn.v3i5.7869

Outcomes of IDH1/2 mutant AML patients treated with IDH1/2 inhibitors: A single institutional experience.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19010-e19010
Author(s):  
Constantine Nick Logothetis ◽  
Chetasi Talati ◽  
Gregoire Calon ◽  
Nathan P Horvat ◽  
Virginia Olivia Volpe ◽  
...  
Keyword(s):  
Adverse Events ◽  
Somatic Mutations ◽  
Demographic Data ◽  
Response Duration ◽  
Initial Response ◽  
Median Number ◽  
Resistance Mechanisms ◽  
Overall Response ◽  
Line Therapy ◽  
Number Of Patients

e19010 Background: Recent studies showed that IDH1/2 are frequently mutated in AML and that aberrant 2-HG elevation driven by the mutant IDH1/2 proteins plays a pivotal role in AML development. Subsequent clinical trials of IDH1/2 inhibitors demonstrated promising outcomes in IDH1/2mut AML patients. In this single institutional retrospective study, we explored the efficacy and safety outcomes of IDH1/2mut AML patients treated with Ivosidenib or Enasidenib. Methods: We retrospectively identified AML patients who had IDH1/2 somatic mutations based on NGS assessments. Clinical and demographic data were extracted from the medical records. Statistical analyses were performed using GraphPad Prism (v.7.03) and SPSS (v.24.0). Results: A total of 43 ( IDH1mut, n = 12; IDH2mut, n = 33; both IDH1/2mut, n = 2) patients were included in the study. Median age at AML diagnosis was 67.6 (24.2-83.3) years and 24 (55.8%) patients were male. Eighteen (42%) patients had secondary AML and 13 (34.2%), 17 (44.7%), and 8 (21.1%) patients had favorable, intermediate, and adverse risk, respectively. A total of 23 (53.5%) and 9 (20.9%) patients received intensive chemotherapy and hypomethylating agents as their 1st line therapy. One patient received Enasidenib as the 1st line therapy and the rest of the patients had relapsed/refractory disease prior to IDH1/2 inhibitor therapy. Median number of treatment prior to IDH1/2 inhibitors was 4 (0-8). The median duration of IDH1/2 inhibitor treatment was 3.2 (0.2-31.6) months ( IDH1 mut, 2.5 [0.7-13.5]; IDH2 mut, 3.4 [0.2-31.6]). Treatment response was assessed in 38 patients and 18 had overall response (CR, n = 7 [18.4%]; PR, n = 11 [28.9%]). Among these, 13 patients had concurrent somatic mutations in FLT3, KRAS, NRAS, or PTPN11. The overall response rate in these patients was not statistically different compared to patients who did not have these mutations (38.5% vs. 40%, p > 0.05). The median PFS was 3.9 (0.4-14.7) months ( IDH1 mut, 5.6 [1.7-11.5] vs. IDH2 mut, 3.7 [0.4-14.7], p > 0.05) and median OS was 7.6 (0.4-44.1) months. The most common reason for IDH1/2 inhibitor discontinuation was disease progression (n = 21) followed by adverse events (n = 3) and allogeneic transplant (n = 2). The adverse events were assessed in 41 patients and the most common adverse events were differentiation syndrome ( IDH1 mut, n = 3; IDH2 mut, n = 5) and leukocytosis ( IDH1 mut, n = 4; IDH2 mut, n = 4) followed by hepatic toxicity ( IDH2 mut n = 7), and QTc prolongation ( IDH1 mut, n = 3). Conclusions: Our study indicates that IDH1/2 inhibitors remain a reasonable option for the refractory/relapsed IDH1/2mut AML. However, significant number of patients failed to show any response and many of the patients who showed initial response had short response duration. These findings warrant further studies to identify underlying resistance mechanisms of IDH1/2 inhibitors and the optimal combination therapeutic strategies.

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