Caiman Versus LigaSure Hemorrhoidectomy: Postoperative Pain, Early Complications, Long-Term Follow-up, and Costs

2020 ◽  
Vol 27 (3) ◽  
pp. 272-278
Author(s):  
Chiara Eberspacher ◽  
Pietro Mascagni ◽  
Domenico Di Nardo ◽  
Daniele Pironi ◽  
Stefano Pontone ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Operative Time ◽  
Healing Time ◽  
Visual Analog Score ◽  
Historical Cohort ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B

Purpose. Recently, the use of radiofrequency for hemorrhoidectomy has minimized incidence of postoperative complications. Effectiveness of LigaSure is demonstrated, but it is quite expensive. This study aims to compare LigaSure with Caiman, a cheaper instrument that uses radiofrequency for hemorrhoidectomy. Methods. A total of 35 patients were enrolled in this study between January 2015 and December 2017: 35 (Group A: Caiman) patients were matched with 35 control patients (Group B) from our historical cohort, treated with LigaSure. They were checked at 1 week after operation, at 4 weeks, and then after 2, 6, and 12 months. We considered different factors: intraoperative (operative time, number of piles removed, necessity of stiches or ligation), immediate postoperative (pain, bleeding within 4 weeks, incontinence, soiling within 4 weeks, healing time of anal wounds, return to working activities), and with a long-term follow-up. Results. There were no statistically significant differences between the 2 groups in analyzed intraoperative data: operative time (Group A 35 minutes vs Group B 33 minutes; P = .198) and stitches used. Postoperative data were comparable too, in particular pain (Group A 1 day Visual Analog Score = 6.25 vs Group B = 5.4, P = .178; Group A 1 week Visual Analog Score = 2.7 vs Group B = 1.14, P = .22) and bleeding (Group A = 2 vs Group B = 4; P = .2). Conclusions. According our initial experience, Caiman can be a safe and cheaper alternative to LigaSure for hemorrhoidectomy.

Laparoscopic Incisional and Ventral Hernia Repair with Absorbable Tacks in a Long Term Follow-up: A Retrospective Control Study

2019 ◽  
Vol 14 (2) ◽  
pp. 141-146
Author(s):  
Simone Zanella ◽  
Enrico Lauro ◽  
Francesco Franceschi ◽  
Francesco Buccelletti ◽  
Annalisa Potenza ◽  
...  
Keyword(s):  
Hernia Repair ◽  
Ventral Hernia ◽  
Ventral Hernia Repair ◽  
The Elderly ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B ◽  
Absorbable Tacks

Background: Laparoscopic Incisional and Ventral Hernia Repair (LIVHR) is a safe and worldwide accepted procedure performed using absorbable tacks. The aim of the study was to evaluate recurrence rate in a long term follow-up and whether the results of laparoscopic IVH repair in the elderly (≥65 years old) are different with respect to results obtained in younger patients. Methods: One hundred and twenty-nine consecutive patients (74 women and 55 men, median age 67 years, range = 30-87 years) with ventral (N = 42, 32.5%) or post incisional (N = 87, 67.5%) hernia were enrolled in the study. Patients were divided into two groups according to their age: group A (N = 55, 42.6%) aged <65 years and group B (N = 74, 57.4%) aged ≥65 years. Results: The mean operative time was not significantly different between groups (66.7 ± 37 vs. 74 ± 48.4 min, p = 0.4). To the end of 2016, seven recurrences had occurred (group A = 3, group B = 4, p = 1). Complications occurred in 8 (16%) patients in group A and 21 (28.3%) patients in group B. Conclusion: In conclusion, our results confirm that the use of absorbable tacks does not increase recurrence frequency and laparoscopic incisional and ventral repair is a safety procedure also in elderly patients.

Thalidomide Based Regimens (TBR) for Relapsed/Refractory Multiple Myeloma Patients: Long Term Follow Up, Unmaintained Remissions and Disease Control after Subsequent Treatments.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4812-4812
Author(s):  
Maria Roussou ◽  
Efstathios Kastritis ◽  
Athanasios Anagnostopoulos ◽  
Evangelos Eleftherakis-Papaiakovou ◽  
Charis Matsouka ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Progression Free Survival ◽  
Free Survival ◽  
Refractory Multiple Myeloma ◽  
Long Term Follow Up ◽  
Group A ◽  
Pulse Dexamethasone ◽  
Group B

Abstract Introduction: The effectiveness of thalidomide based regimens (TBR) in patients with relapsed/refractory multiple myeloma is well established. However, there are still limited data regarding the long term follow up after such regimens and the outcome of patients when they progress and they receive further treatment. In order to answer these questions we evaluated a series of 114 patients with relapsed/refractory multiple myeloma who were treated with TBR. None of these patients had previously received thalidomide, bortezomib or lenalidomide. Patients and Methods: All patients were treated with thalidomide and dexamethasone with or without other oral agents. More specifically 41 patients had received continuous thalidomide and pulse dexamethasone, 25 patients clarithromycin, continuous thalidomide and pulse dexamethasone, 43 patients intermittent thalidomide, pulse dexamethasone and cyclophosphamide and 5 patients continuous thalidomide, pulse dexamethasone and cyclophosphamide. Type of treatment at the time of progression after TBR, response to this treatment and progression free survival were recorded for each patient. Moreover, patients who received novel agents after progression to TBR, were divided into 2 subgroups, according to their resistance to thalidomide. In group A, patients had refractory or progressive myeloma while on TBR or within 2 months after discontinuation of TBR. In group B, myeloma progressed more than 2 months after discontinuation of TBR. Results: Among the 114 patients, 41 had not responded to TBR and 73 (64%) had achieved at least a partial response. The median PFS for all patients was 8 months. As of June 2007, 10 patients remain without progression from 28 to 81 months (median 54 months). Eight patients remain off treatment and without progression for a median of 56 months (range 28–81). Patients who did not respond to or progressed after TBR were analyzed for further treatment and outcome. Thirty eight patients (37%) died before receiving further treatment, 23 patients (23%) received conventional chemotherapy and 41 patients (40%) received continuous thalidomide and dexamethasone +/− clarithromycin or cyclophosphamide (17 patients), bortezomib and dexamethasone (7 patients), melphalan-bortezomib-dexamethasone and intermittent thalidomide (12 patients) or lenalidomide with dexamethasone (5 patients). Among these 41 patients, 24 were classified in group A (thalidomide resistant) and 17 in group B. Overall 17 (41%) achieved at least partial response after retreatment with novel agent-based regimens. A response was observed in 46% of patients in group A and in 35% of patients in group B. The median progression free survival of the 41 patients who received retreatment with novel agents was 9.2 months and the median survival was 17 months. Among the 23 patients who received conventional chemotherapy only five (21%) patients responded and the progression free survival and the median survival were 5.3 and 10.2 months, respectively. Conclusions: After an oral TBR regimen 6 (5%) patients remain without treatment and free of progression for more than 4 years. A significant number of patients who progressed after TBR and who received further treatment which included a novel agent achieved a response, including several patients who were resistant to TBR.

The Effect of Postoperative KT-1000 Arthrometer Score on Long-Term Outcome After Anterior Cruciate Ligament Reconstruction

2017 ◽  
Vol 45 (7) ◽  
pp. 1522-1528 ◽  
Author(s):  
Andrew D. Goodwillie ◽  
Sarav S. Shah ◽  
Malachy P. McHugh ◽  
Stephen J. Nicholas
Keyword(s):  
Postoperative Period ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Long Term Follow Up ◽  
Kt 1000 ◽  
Group A ◽  
Anterior Cruciate ◽  
Group B

Background: Many long-term studies have looked at outcomes after anterior cruciate ligament reconstruction (ACLR), but none have correlated long-term outcomes with postoperative laxity greater than 5 mm. It has been stated previously that more than 5 mm of postoperative graft laxity constituted a procedural failure. Purpose: To directly compare tight grafts (<3 mm) and loose grafts (>5 mm) to determine the effect of graft laxity, as measured by KT-1000 arthrometer, after ACLR on long-term clinical outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: The study included 171 consecutive patients who had undergone transtibial bone–patellar tendon–bone ACLR between 1992 and 1998. At 6, 12, and 24 months postoperatively (the immediate postoperative period), patients were evaluated. Group A included patients with a maximal side-to-side (STS) difference in the immediate postoperative period of less than 3 mm (tight grafts), and group B included patients with a maximal STS difference of greater than 5 mm (loose grafts). Any patient with a history of ipsilateral or contralateral ACLR or ACL injury, meniscectomy, or cartilage restoration was excluded. Patients were prospectively followed to long-term follow-up, when a telephone interview was conducted regarding knee function and to document Lysholm, Tegner, Knee injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) subjective outcome scores. Results: Eighty-seven patients met inclusion criteria: 66 tight grafts (group A) and 21 loose grafts (group B). The mean ± SD time to follow-up was 16.3 ± 1.5 years in group A (n = 46) and 16.8 ± 1.3 years in group B (n = 15). Tegner ( P = .77), Lysholm ( P = .85), KOOS ( P = .96), and IKDC ( P = .42) were found to have no statistically significant difference between groups at long-term follow-up. Both Tegner and Lysholm scores significantly improved in tight and loose grafts in the immediate postoperative period as well as at long-term follow-up compared with preoperatively. There were 2 ACL revisions in group A and none in group B. Eleven of 46 patients (24%) in group A required subsequent procedures versus 1 of 15 patients (6.7%) in group B ( P = .146). Conclusion: Postoperative laxity of greater than 5 mm STS difference as measured by KT-1000 arthrometer does not appear to place patients at a worse clinical outcome at long-term follow-up, nor does it lead to significantly more subsequent procedures. In addition, transtibial ACLR can provide excellent clinical results at long-term follow-up.

scholarly journals Does the Age Affect the Outcomes of Cardiac Resynchronization Therapy in Elderly Patients?

2021 ◽  
Vol 10 (7) ◽  
pp. 1451
Author(s):  
Teresa Strisciuglio ◽  
Giuseppe Stabile ◽  
Domenico Pecora ◽  
Giuseppe Arena ◽  
Salvatore Ivan Caico ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Clinical Response ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Composite Event ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B

Background: More and more heart failure (HF) patients aged ≥ 75 years undergo cardiac resynchronization therapy (CRT) device implantation, however the data regarding the outcomes and their predictors are scant. We investigated the mid- to long-term outcomes and their predictors in CRT patients aged ≥ 75 years. Methods: Patients in the Cardiac Resynchronization Therapy Modular (CRT MORE) Registry were divided into three age-groups: <65(group A), 65–74 (group B) and ≥75 years (group C). Mortality, hospitalization, and composite event rate were evaluated at 1 year and during long-term follow-up. Results: Patients (n = 934) were distributed as follows: group A 242; group B 347; group C 345. On 12-month follow-up examination, 63% of patients ≥ 75 years displayed a positive clinical response. Mortality was significantly higher in patients ≥ 75 years than in the other two groups, although the rate of hospitalizations for HF worsening was similar to that of patients aged 65–74 (7 vs. 9.5%, respectively; p = 0.15). Independent predictors of death and of negative clinical response were age >80 years, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Over long-term follow-up (1020 days (IQR 680-1362)) mortality was higher in patients ≥ 75 years than in the other two groups. Hospitalization and composite event rates were similar in patients ≥ 75 years and those aged 65–74 (9 vs. 11.8%; p = 0.26, and 26.7 vs. 20.5%; p = 0.06). Conclusion: Positive clinical response and hospitalization rates do not differ between CRT recipients ≥ 75 years and those aged 65–74. However, age > 80 years, COPD and CKD are predictors of worse outcomes.

scholarly journals Long-Term Follow-Up Trial of Oral Rifampin-Cotrimoxazole Combination versus Intravenous Cloxacillin in Treatment of Chronic Staphylococcal Osteomyelitis

2009 ◽  
Vol 53 (6) ◽  
pp. 2672-2676 ◽  
Author(s):  
G. Euba ◽  
O. Murillo ◽  
N. Fernández-Sabé ◽  
J. Mascaró ◽  
J. Cabo ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Foreign Body ◽  
Comparative Studies ◽  
Chronic Osteomyelitis ◽  
Comparative Trial ◽  
Long Term Follow Up ◽  
Group A ◽  
Group B

ABSTRACT Oral therapies alternative to fluoroquinolones against staphylococcal chronic osteomyelitis have not been evaluated in comparative studies. Consecutive nonaxial Staphylococcus aureus chronic osteomyelitis cases were included in a comparative trial after debridement. Fifty patients were randomized: group A (n = 22) was treated with cloxacillin for 6 weeks intravenously plus 2 weeks orally (p.o.), and group B (n = 28) was treated with rifampin-cotrimoxazole for 8 weeks p.o. During follow-up (10 years), five relapses occurred: two (10%) in group A and three (11%) in group B. Foreign-body maintenance was associated with relapse (P = 0.016). Oral rifampin-cotrimoxazole treatment showed outcomes comparable to those for intravenous cloxacillin treatment.

Nivolumab in patients with DNA mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) metastatic colorectal cancer (mCRC): Long-term survival according to prior line of treatment from CheckMate-142.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 554-554 ◽  
Author(s):  
Michael J. Overman ◽  
Francesca Bergamo ◽  
Raymond S. McDermott ◽  
Massimo Aglietta ◽  
Franklin Chen ◽  
...  
Keyword(s):  
Term Survival ◽  
Long Term Survival ◽  
Dna Mismatch ◽  
Long Term Follow Up ◽  
Group A ◽  
Grade 3 ◽  
Group B ◽  
Line Setting

554 Background: Nivolumab (NIVO) provided durable responses (ORR, 32% per central assessment) and disease control (DCR, 64%) in pre-treated pts with dMMR/MSI-H mCRC (NCT02060188; Overman MJ et al Lancet Oncol 2017). NIVO was approved in the US for pts with dMMR/MSI-H mCRC who progress after standard chemotherapy (SC) with a fluoropyrimidine (F), oxaliplatin (Ox), and irinotecan (Iri). Here we present long-term survival and outcomes by prior chemotherapy with NIVO in CheckMate-142. Methods: Pts with dMMR/MSI-H mCRC received NIVO 3 mg/kg Q2W. The primary endpoint was ORR per RECIST 1.1. Other endpoints were DCR, DOR, PFS, OS, and safety/tolerability. Results: Of 74 pts evaluated, 53 had received F, Ox and Iri (group A); 21 pts had ≤ 2 SC regimens (group B). Median follow-up was 21 mo. Efficacy by central assessment is shown in the Table. In the 74 pts, ORR was 34%; CRs increased from 3% in prior database lock (DBL) to 9%. Numerically higher responses were noted in group B vs group A (Table). Grade 3–4 TRAEs were reported in 20% (all pts), 25% (group A), and 10% (group B) of pts. No treatment-related deaths were reported. Conclusions: NIVO continued to provide clinically meaningful durable responses and long-term overall survival in pts with dMMR/MSI-H mCRC. Of note, CR rate increased with longer follow-up. No new safety signals were reported with long-term follow-up. Enhanced responses in pts with ≤ 2 SC regimens support ongoing evaluation of NIVO combinations in first-line setting. Clinical trial information: NCT02060188. [Table: see text]

Endoscopic treatment of suprasellar arachnoid cysts in children

2011 ◽  
Vol 8 (1) ◽  
pp. 6-14 ◽  
Author(s):  
Nasser M. F. El-Ghandour
Keyword(s):  
Endoscopic Procedure ◽  
Arachnoid Cysts ◽  
Initial Surgery ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Group A ◽  
Cyst Recurrence ◽  
Group B

Object Suprasellar arachnoid cysts (SACs) are rare, comprising approximately 10% of all intracranial arachnoid cysts. Although neuroendoscopic management is emerging as a safe effective alternative to microsurgery, the type of endoscopic surgery whether ventriculocystostomy (VC) or ventriculocystocisternostomy (VCC) is still controversial. This study evaluates the role of endoscopy in the treatment of SACs in children. It compares VC and VCC to determine which procedure is superior in the long term. Methods Twenty-five children (14 boys and 11 girls; mean age 26 months) with symptomatic SACs associated with hydrocephalus are the subject of this study. According to the surgical procedure adopted, patients were divided into 2 groups. Patients in Group A (11 patients) underwent VC with a mean follow-up of 55 months, and those in Group B (14 patients) underwent VCC with a mean follow-up of 64.7 months. Results Both procedures proved to be effective clinically and radiologically. The incidence of improvement of hydrocephalus-related symptoms was 63.6% in Group A compared with 85.7% in Group B. Improvement in cyst size and hydrocephalus after VC was 81.8% and 63.6%, respectively, compared with 100% and 85.7%, respectively, after VCC. There were no deaths or permanent morbidity, and no patient was left with a permanent shunt. Recurrence occurred in 3 cases after VC (27.3%), whereas no recurrence (0%) was encountered after VCC. At a second endoscopic procedure, the fenestration was found to be closed in all 3 recurrent cases. Conclusions An endoscopic procedure is recommended in the treatment of SACs in children because it is simple, effective, minimally invasive, and associated with low morbidity and mortality rates. Both procedures, VC and VCC, proved to be almost equally effective clinically and radiologically. Nevertheless, because of the statistically significant difference between the incidence of recurrence after VC and VCC during long-term follow-up, the author concludes that VCC should be considered as the procedure of choice in the treatment of these cases. The important finding of reclosure of the VC fenestration in the recurrent cases underscores the significance of performing cystocisternostomy at initial surgery to guard against cyst recurrence.

Two-year experience with telemedicine in the follow-up of patients in home peritoneal dialysis

2007 ◽  
Vol 13 (6) ◽  
pp. 288-292 ◽  
Author(s):  
Paloma Gallar ◽  
Ana Vigil ◽  
Isabel Rodriguez ◽  
Olimpia Ortega ◽  
Magdalena Gutierrez ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Study Group ◽  
Hospital Visit ◽  
Long Term Follow Up ◽  
Group A ◽  
The Mean ◽  
Hospital Visits ◽  
Group B

We evaluated the use of telemedicine in the long-term control of stable patients undergoing peritoneal dialysis at home. From September 2003 to August 2005, patients were randomly selected from current cases and invited to join study group A, in which they had telemedicine support. Patients not selected for this group, or who refused the invitation, were placed in study group B, and used for comparison. There were 25 patients in group A and 32 patients in group B. Videoconferencing equipment was installed in each patient's home, connected to a videoconferencing unit at the hospital by three ISDN lines. Patients in group A were followed for a mean of 8 months (range 3–24) with alternate months of teleconsultations and hospital visits. A total of 172 teleconsultations were conducted. A mean of 22 min (SD 9) were spent on each teleconsultation, significantly less than in hospital consultations, which took a mean of 33 min (SD 8) ( P<0.01). In 148 teleconsultations (89%) medical treatment was modified. In 4 cases (2%) patients needed a hospital visit. In all instances (100%) the condition of the catheter exit site and the presence of oedema could be evaluated. In group A, the estimated cost of telemedicine was €198 and that of a hospital visit was €177. The mean hospitalization rate was 2.2 days/patient/year in group A and 5.7 days/patient/year in group B ( P<0.05). Home telemedicine appears to be clinically useful in the long-term follow-up of stable patients undergoing peritoneal dialysis, and the costs and savings also seem to be encouraging.

scholarly journals 439 Conservative Versus Surgical Management of Complicated Diverticulitis - A Retrospective Study of Long-Term Outcomes

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Durity ◽  
G Elliott ◽  
T Gana
Keyword(s):  
Complicated Diverticulitis ◽  
Complication Rates ◽  
Long Term Outcomes ◽  
Female Ratio ◽  
Stoma Reversal ◽  
Group A ◽  
Grade 3 ◽  
Group B

Abstract Introduction Management of complicated diverticulitis has shifted towards a conservative approach over time. This study evaluates the feasibility and long-term outcomes of conservative management. Method We retrospectively evaluated a consecutive series of patients managed with perforated colonic diverticulitis from 2013-2017. Results Seventy-three (73) patients were included with a male to female ratio of 1:2. Thirty-one (31) underwent Hartmann’s procedure (Group A) and 42 patients were managed with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years). CT Grade 3 and 4 disease was observed in 64.5% and 40.4% of Group A and Group B patients, respectively. During follow-up, 9 (21.4%) Group B patients required Hartmann’s. Group A had longer median length of stay compared to Group B (25.1 vs 9.2 days). Post-operative complications occurred in 80.6% with 40% being Clavien-Dindo grade III or higher in group A. Stoma reversal was performed in 8 patients (25.8%). Conclusions In carefully selected cases, complicated diverticulitis including CT grade 3 and 4 disease, can be managed conservatively with acceptable recurrence rates (16.7% at 30 days, 4.8% at 90 days, 19.0% at 5 years). Surgical intervention on the other hand, carries high post-operative complication rates and low stoma reversal rates.

scholarly journals The Role of Quantic Molecular Resonance (QMR) in the Treatment of Inferior Turbinate Hypertrophy (ITH): Our Experience With Long-Term Follow-Up in Allergic and Nonallergic Rhinitis Refractory to Medical Therapy. Preliminary Results

2021 ◽  
pp. 014556132110015
Author(s):  
Filippo Ricciardiello ◽  
Davide Pisani ◽  
Pasquale Viola ◽  
Raul Pellini ◽  
Giuseppe Russo ◽  
...  
Keyword(s):  
Nasal Obstruction ◽  
Inferior Turbinate ◽  
Nonallergic Rhinitis ◽  
Turbinate Hypertrophy ◽  
Group A ◽  
Group B ◽  
Inferior Turbinate Hypertrophy ◽  
Molecular Resonance

Objective: The aim of this study was to assess the long-term effectiveness of quantic molecular resonance (QMR) in the treatment of inferior turbinate hypertrophy (ITH) in allergic and nonallergic rhinitis refractory to medical therapy. Methods: This study enrolled 281 patients, 160 males (56.9%) and 121 females (43.1%), mean age 37.8 ± 4.1 years, range 18 to 71. Fifty-four patients have been lost to follow up and have been therefore excluded from the final analysis. Based on skin prick test results, 69 patients were considered allergic (group A) and 158 nonallergic (group B). All subjects underwent before surgery (T0) and 3 (T1), 12 (T2), 24 (T3), and 36 months (T4) after QMR treatment to: 4-phase rhinomanometric examination, nasal endoscopy evaluation, and visual analogue scale to quantify the subjective feelings about nasal obstruction. Results: Subjective and objective parameters showed statistically significant improvement in both groups. Group B parameters not changed during follow-up, while group A showed significant worsening between T1 and subsequent assessments. T4 outcome indicates a better result in nonallergic patients. Conclusions: In accordance with the literature, our preliminary data validate QMR treatment as a successful therapeutic option for nasal obstruction due to ITH. Nonallergic patients had a very good T4 outcome. Allergic patients showed a worsening trend after 1 year probably due to other causes.

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