Balloon-assisted maturation of autogenous arteriovenous fistulae: A randomized controlled prospective study

Vascular ◽  
2020 ◽  
pp. 170853812097987
Author(s):  
Mohammed Elkassaby ◽  
Nashaat Elsaadany ◽  
Khaled Mowaphy ◽  
Mosaad Soliman
Keyword(s):  
Controlled Study ◽  
Complication Rates ◽  
Arteriovenous Fistulae ◽  
Early Maturation ◽  
Randomized Controlled ◽  
Functional Maturation ◽  
Increased Risk ◽  
Group A ◽  
Group B

Background Current guidelines recommend referral of patient with renal failure for access creation 6 months before planned dialysis. There is a growing cohort of patients that require long-term hemodialysis without adequate preparation. Temporary dialysis catheters and rapid access arteriovenous grafts (AVG) are far from being an ideal solution in this scenario. In an effort to expedite maturation of autogenous arteriovenous fistulae (AVF), balloon-assisted maturation (BAM) was advised by some authors. This technique still lacks the support of high-level evidence studies. We investigated the ability of intra-operative BAM to induce early functional maturation of AVFs. Methods This is a prospective randomized controlled study conducted in a tertiary referral center, with a catchment area of more than 15 million population. Cases were divided into two groups; Group (A), where BAM technique was performed, while in the control group (B), the standard technique was used (NO BAM) for creation of AVFs. Results Between June 2017 and May 2019, 300 cases were recruited from a total of 648 primary AVF creation instances. Patients’ age ranged from 19 to 89 (mean 51.17 ±SD 15.5) years. Group A (BAM) included 52.3% ( n = 157) AVFs, while Group B included 47.7% ( n = 143) AVFs. The average maturation time was 3.7 weeks (SD ± 1.3, 95% CI 3.55–3.95) and 5.91 weeks (SD ± 2.2, 95% CI 5.55–6.26) for both groups, respectively ( p = 0.0001). 78.3% of the AVFs that underwent BAM showed early maturation within 2–4 weeks vs 32.2% only in the NO BAM group ( p = 0.002). Successful functional maturation was higher among cases of the BAM group (93%), compared to the NO BAM group (77%) ( p = 0.001). Complication rates were 9.6% and 4.9% in the two groups, respectively ( p = 0.042). Conclusion BAM can play a pivotal role in helping the dialysis society meet the goals of the Fistula First Initiative, keeping in mind that this comes with an increased risk of complications. BAM should be considered only when unplanned early access to long-term dialysis is required.

scholarly journals Reconstructive Approaches in Surgical Management of Congenital Pseudarthrosis of the Tibia

2020 ◽  
Vol 9 (12) ◽  
pp. 4132
Author(s):  
Andrea Laufer ◽  
Adrien Frommer ◽  
Georg Gosheger ◽  
Robert Roedl ◽  
Frank Schiedel ◽  
...  
Keyword(s):  
External Fixation ◽  
Bone Transport ◽  
Bone Union ◽  
Complication Rates ◽  
Union Rate ◽  
Bone Fusion ◽  
Group A ◽  
Primary Bone ◽  
Group B

Treatment of congenital pseudarthrosis of the tibia remains a major challenge in pediatric orthopedics. Ideal timing and preference of surgical procedures are discussed controversially. A variety of reconstructive treatment strategies have been described in literature, but so far none has proven its superiority. The aim of treatment is to obtain long-term bone union, to prevent refracture, and to correct angular deformities and leg length discrepancies. This study retrospectively evaluates the outcome of different reconstructive strategies. Sixty-nine patients were identified who presented to our outpatient department between 1997 and 2019. Twenty-six of these patients underwent reconstructive surgical treatment and were included in this study. The study cohort was divided into three groups. Excision of the pseudarthrosis was performed in all patients in Group A and B, and in two patients of Group C. Group A (six/26 patients) received subsequent bone transport through external fixation maintaining original length. In Group B (15/26 patients), patients underwent either previous, simultaneous, or subsequent extrafocal lengthening through external fixation to reconstitute length. In Group C (five/26 patients), internal fixation with intramedullary nails was applied. Radiological and clinical evaluation was performed to assess bone union and complication rates. Results varied considerably between the study groups. Overall, the primary bone fusion rate was 69.2%. There were four refractures, all occurring in Group B. The long-term bone union rate without refracture was 53.8%. The overall complication rate was 53.8% and 23.1% showed persistent pseudarthrosis. Two secondary amputations were performed due to failed bone fusion. In conclusion, excision of the pseudarthrosis and extrafocal lengthening achieves a satisfying bone union rate and limb reconstruction, while bone transport does not offer significant advantages but shows higher complication rates. Intramedullary stabilization should be applied to maintain bone union, but shows lower bone union rates when used as a stand-alone treatment regimen. Regardless of the primary bone fusion rates, the probability of long-term bone union remains unpredictable.

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 Quality of life, clinical outcomes and safety of early prophylactic levothyroxine administration in patients with Graves' hyperthyroidism undergoing radioiodine therapy: a randomized controlled study

2016 ◽  
Vol 174 (4) ◽  
pp. 491-502 ◽  
Author(s):  
David Taïeb ◽  
Claire Bournaud ◽  
Marie-Claude Eberle ◽  
Bogdan Catargi ◽  
Claire Schvartz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Primary Endpoint ◽  
Radioiodine Therapy ◽  
Controlled Study ◽  
Thyroid Function Tests ◽  
Randomized Controlled ◽  
Sf 36 ◽  
Group A ◽  
Group B

ObjectiveWhile radioiodine therapy is commonly used for treating Graves' disease, a prolonged and clinical hypothyroidism may result in disabling symptoms leading to deterioration of quality of life (QoL) of patients. Introducing levothyroxine (LT4) treatment in the early post-therapeutic period may be an interesting approach to limit this phenomenon.MethodsA multicenter, prospective, open-label randomized controlled trial enrolled 94 patients with Graves' hyperthyroidism randomly assigned to the experimental group (n=46) (group A: early prophylactic LT4treatment) or the control group (n=48) (group B: standard follow-up). The primary endpoint was the 6-month QoL. The secondary endpoints were other QoL scores such as Graves' ophthalmopathy (GO) outcomes, thyroid function tests and safety.ResultsThe primary endpoint at 6 months was achieved: the mental composite score (MCS) of Short Form 36 (SF-36) was significantly higher in group A compared to group B (P=0.009). Four other dimension scores of the SF-36 and four dimension scores of the thyroid-specific patient-reported outcome (ThyPRO) significantly differed between the two groups, indicating better QoL in group A. After adjustment for variables, the early LT4administration strategy was found as an independent factor for only two scores of SF-36: the MCS and the general health (GH) score. There were no differences in GO, final thyroid status and changes in the anti-TSH receptor antibodies (TRAbs) levels between the two groups. No adverse cardiovascular event was reported.ConclusionEarly LT4administration post-radioactive iodine (RAI) could represent a safe potential benefit for patients with regard to QoL. The optimal strategy taking into account administered RAI activities and LT4treatment dosage and timing remains to be determined.

scholarly journals Unifocalization cannot rely exclusively on native pulmonary arteries: the importance of recruitment of major aortopulmonary collaterals in 249 cases†

2019 ◽  
Vol 56 (4) ◽  
pp. 679-687 ◽  
Author(s):  
David J Barron ◽  
Ramesh S Kutty ◽  
John Stickley ◽  
Oliver Stümper ◽  
Phil Botha ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Borderline Cases ◽  
Collateral Arteries ◽  
Increased Risk ◽  
Group A ◽  
Aortopulmonary Collaterals ◽  
Group B ◽  
Late Survival

Abstract OBJECTIVES: We sought to define the early and late outcomes of unifocalization based on a classification of the native pulmonary artery (nPA) system and major aortopulmonary collateral arteries (MAPCAs) with a policy of combined recruitment and rehabilitation and to analyse the role of unifocalization by leaving the ventricular septal defect (VSD) open with a limiting right ventricle-pulmonary artery (RV-PA) conduit in borderline cases. METHODS: An analysis of 271 consecutive patients assessed for unifocalization at a single institution between 1988 and 2016 was performed. Patients were classified according to the pulmonary blood supply: group A, unifocalization based on nPA only; group B, based on nPA and MAPCAs; group C, MAPCAs only (absent nPAs). RESULTS: Unifocalization was achieved in 249 (91.9%) cases with an early mortality of 2.8%. Group A included 72 (28.9%) patients, group B 119 (47.8%) patients and group C 58 (23.3%) patients with no difference in early survival between groups. Survival at 5, 10 and 15 years was 90.0% (85.9–94.3), 87.2% (83.5–91.2) and 82.3% (75.2–89.9), respectively. Late survival in groups A and B was similar but 10- and 15-year survival in group C decreased to 79.2% (68.2–92.1) and 74.3% (61.1–90.4) (P = 0.02), respectively. A mean of 1.9 (±0.6) MAPCAs were recruited per patient (range 0–6). The VSD was left open with a limiting RV-PA conduit in 97 (39.0%) cases, but subsequently closed in 48 patients, giving a total of 200 (80.3%) patients achieving VSD closure (full repair). Delaying VSD closure was not associated with increased risk for early or late survival. A central shunt to rehabilitate the nPAs was used in 56 (22.5%) cases. This was associated with a reduction in the number of MAPCAs recruited, but still required a mean of 1.8 (±0.5) MAPCAs recruited per patient to achieve unifocalization. In multivariate risk analysis, those suitable for single-stage full repair had the best long-term outcomes. Group C anatomy was associated with poor late survival compared to groups A and B (hazard ratio 2.7). CONCLUSIONS: Survival is maximized by a combined approach of rehabilitation and recruitment. MAPCAs should always be recruited if they supply areas with absent nPA supply. A strategy of leaving the VSD open with a limiting RV-PA conduit is a safe and effective way of managing borderline cases.

scholarly journals Comparison of marsupialization under nasal endoscopy versus lacrimal probing for treatment of congenital dacryocystoceles: a report of 40 cases

2020 ◽  
Author(s):  
Yan-Hui Cui ◽  
Peng Sun ◽  
Li-Xing Tang ◽  
Cheng-Yue Zhang ◽  
Qian Wu ◽  
...  
Keyword(s):  
Success Rate ◽  
Reoperation Rate ◽  
Nasal Endoscopy ◽  
Controlled Study ◽  
Lacrimal Duct ◽  
Nasal Endoscope ◽  
Randomized Controlled ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background: This study was performed to compare the efficacy of marsupialization under nasal endoscopy versus lacrimal probing for the treatment of congenital dacryocystocele. Methods: A prospective randomized controlled study. Forty neonates (43 eyes) diagnosed with congenital dacryocystoceles were divided into Group A (nasal endoscopic marsupialization) and Group B (lacrimal probing). The patients were followed up for 1 year after surgery. The efficacy, incidence of complications, and reoperation rate were compared between the two groups. Results: The male:female ratio was 25:15 patients (27:16 eyes). In Group A, the success rate was 100%, the incidence of complications was 5%, and the reoperation rate was 0%. In Group B, the success rate was 90%, the incidence of complications was 20%, and the reoperation rate was 30%. There was no significant difference in the success rate between the two groups, but the incidence of complications and the reoperation rate in the lacrimal probing group(Group B) were significantly higher than those in the nasal endoscopic marsupialization group(Group A). Conclusion: In the treatment of congenital dacryocystoceles, nasal endoscope marsupialization has the same success rate as lacrimal duct probing, but the former is more effective and safer in clinical practice.

scholarly journals Emergency Laparoscopic Cholecystectomy with Low Pressure Pneumo-Peritoneum in Cardiopulmonary Risk Patients: Fundus-Calot Cholecystectomy VS Calot first Cholecystectomy. Randomized Controlled Trial.

2020 ◽  
Author(s):  
Tamer A.A.M Habeeb ◽  
Gamal Osman ◽  
Amr Ibrahim ◽  
Mohamed Riad ◽  
Abd-Elrahman M. Metwalli ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Low Pressure ◽  
Controlled Study ◽  
Open Approach ◽  
Randomized Controlled ◽  
Bladder Diseases ◽  
Risk Patients ◽  
Group A ◽  
Group B

Abstract Background:The numbers of elderly persons have greatly increased worldwide due to improvement of medical health. Elderly complains of cardiopulmonary diseases and the incidence of emergent gall bladder diseases increase with age. Laparoscopic cholecystectomy is the usual approach in dealing with cholithiasis that greatly replace open approach even in acute emergency gall bladder diseases.Aim: compare between initial Fundus first cholecystectomy followed by Calot dissection VS Calot first cholecystectomy in Emergency laparoscopic cholecystectomy with low pressure pneumo-peritoneum in cardiopulmonary risk patients as regard intraoperative data and postoperative complications.Patients and methods:This prospective randomized controlled study was carried out in the Department of Emergency General Surgery on 470 cases with acute cholecystitis, biliary colic, mucocele and pyocele of gall bladder. The patients were divided into two groups, Group A: fundus-Calot group (235cases) and Group B (235cases): classical Calot first approach.ResultsIn most cases of group A, the operating time was up to 90 minutes, while in group B, most cases were more than 90 minutes. Intraoperative bleeding, visceral injury and biliary injury were higher in group B than in group A and therefore the conversion was higher in group B than in group A (14% vs. 4%). Postoperative sequelae were reported to be greater than in group B in regard to bleeding, biliary leakage and wound infections. Remote complications were more pronounced for biliary restrictions in Group B (14%) than in Group A (2%)Conclusion:Laparoscopic low-pressure pneumoperitoneum cholecystectomy with initial Fundus first method is an excellent and safe approach in treating acute gallbladder diseases in cardiopulmonary risk patients.

scholarly journals Prevention of Hypertension at Intubation: A Controlled Study of Sublingual Nifedipine

2020 ◽  
Vol 2 (1) ◽  
pp. 37-40
Author(s):  
Nirmal Kumar Gyawali
Keyword(s):  
Controlled Study ◽  
Control Group ◽  
Double Blind ◽  
Inhalation Anesthesia ◽  
Randomized Controlled ◽  
Sublingual Nifedipine ◽  
Group A ◽  
Prevention Of Hypertension ◽  
Group B ◽  
Adrenergic Blocking

Background: Hypertension and tachycardia-induced after laryngoscopy and intubation can be prevented by various methods like deep inhalation anesthesia, intravenous opioids, topical intravenous lidocaine, intravenous adrenergic blocking drugs, and pretreatment with antihypertensive.Methods: It is a randomized controlled double-blind prospective study of two groups consisting of 30 patients in each group. Group A was the control group and group B were Nifedipine group who were pretreated with Nifedipine. This study aimed to assess the effectiveness of pretreatment with nifedipine in the prevention of the hypertensive response to laryngoscopy and endotracheal intubation in normotensive patients undergoing elective surgery.Result: Sublingual nifedipine was significantly effective in decreasing systolic and diastolic blood pressure produced by laryngoscopy and tracheal intubation, but its role in decreasing pulse rate was not significant. Conclusion: Nifedipine is useful to prevent laryngoscopy and intubation induced hemodynamic response.

Single or two instillations of pirarubicin as prophylaxis for recurrence after transurethral resection of Ta and T1 transitional cell bladder cancer: A prospective, randomized controlled study.

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. LBA266-LBA266
Author(s):  
Takashi Saika ◽  
Tomoyasu Tsushima ◽  
Yasutomo Nasu ◽  
Hiromi Kumon ◽  
Keyword(s):  
Transurethral Resection ◽  
Intravesical Instillation ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
Control Group ◽  
Randomized Controlled ◽  
Group A ◽  
Muscle Invasive ◽  
Group B

LBA266 Background: Although single intravesical instillation chemotherapy immediately after transurethral resection (TUR) is the standard treatment for non-muscle-invasive bladder tumors, 40% to 80% of tumors show intravesical recurrence. In this prospective randomized controlled study, we try to evaluate the prophylactic efficacy and safety of twice intravesical instillation using pirarubicin (THP) administered immediately after TUR and on the next day following TUR by comparison with single instillation immediately after TUR. Methods: Between 2005 and 2009, 250 patients with Ta and T1 solitary bladder carcinoma were enrolled in this study. Patients were randomized into two groups. Group A patients were treated with two intravesical instillations of THP 30 mg/50 ml saline immediately after TUR and within 24 hours. Group B patients were treated with single instillation of the same dose immediately after TUR as a control group. The primary endpoint was duration to the first recurrence, and the secondary endpoint was safety. Results: The enrollment was closed on 2009, and the follow-up phase is in process. Of the 250 patients, 125 in Group A and 125 in Group B could be evaluated as full analysis set. One hundred eight male and 17 female were in Group A, on the other hands, one hundred five male and 20 female were in Group B. Eighty-six cases (69%) in group A, and 88 cases (70%) in group B were primary tumor. Fifty-seven cases (46%) in group A, and 56 cases (45%) in group B were small tumor (less than 10mm). There was no difference between backgrounds of both groups. The randomization worked well. In this ad interim report, median follow up was 48 months. Two-year recurrence-free rates were 76.8% in group A and 67.5% in group B. Adverse reactions related to instillation were observed in about 20% of the patients. These toxicities were mild and transient. Only the incidence of frequency in group A was higher than that in group B (20% vs. 8%, p=0.0106). Conclusions: Intravesical instillation of THP 30 mg twice within 24 hours after TUR was effective as prophylactic therapy for non-muscle-invasive cancer with tolerable toxicity problems.

Advanced cancer patients' priorities regarding wishes at the end of life: A randomized controlled study.

2015 ◽  
Vol 33 (29_suppl) ◽  
pp. 44-44
Author(s):  
Marvin Omar Delgado-Guay ◽  
Alfredo Rodriguez-Nunez ◽  
Vera J De la Cruz ◽  
Susan Frisbee-Hume ◽  
Janet L. Williams ◽  
...  
Keyword(s):  
End Of Life ◽  
Randomized Controlled Study ◽  
Controlled Study ◽  
P Value ◽  
Advanced Cancer Patients ◽  
Randomized Controlled ◽  
Group A ◽  
Important People ◽  
Group B ◽  
Group D

44 Background: Conversations about wishes around the end-of-life(EOL) are challenging for clinicians. There is limited literature about the type and stability of patient’s reported EOL planning priorities. We compared a set of 36 cards (“Go-wish-Game”: GWG) v. a paper list of statements (LOS) to assist patients in establishing priorities. Methods: Randomized controlled study. Pts. were randomized to the GWG or to 36 LOS and were asked to categorize them as very, somewhat, or not important; Group A received LOS followed by LOS 4-24 hours later; group B: GWG-GWG; group C: GWG-LOS, and group D: LOS-GWG. The State-Trait Anxiety inventory for Adults(STAI) was done after the first set of questionnaires. Results: 100 pts. Median age (IQR): 56 (27-83) years. 60% female. 68% White, 17% Hispanic, and 9% African-American. 62% married. Age, marital status, religion, education and cancer diagnosis were not significant different among groups. All pts. were able to complete the GWG. 43/50 (88%) agreed that instructions of GWG were clear. 45/50 (92%) agreed that GWG was easy to understand. 31/50 (64%) patients exposed to both tools, preferred GWG. 39/50 (79%) expressed that GWG did not increased their anxiety. 31/50 (63%) expressed that having conversations about priorities near EOL is beneficial to them (p=NS). STAI median (IQR) score after GWG was 48 (39-59) v. 47 (27-63) for LOS, p=0.2952. The 10 most common “Very important” wishes expressed by pts. the first and second time they received the test (%; Spearman, p-value) were: to be at peace with God(74% v. 71%; r=0.73, p<0.0001), to pray(62% v. 61%, r=0.53, p<0.0001), to have my family with me(57% v. 61%; r=0.23, p=0.02), to be free from pain(54% v. 60%, r=0.31, p=0.001), not being a burden to my family(48% v. 49%, r=0.23, p=0.02), to trust my doctor(44% v. 45%; r=0.49, p<0.0001), to keep my sense of humor(41% v. 45%; r=0.53, p<0.0001), to say goodbye to important people in my life(41% v. 37%; r=0.46, p<0.0001); to have my family prepared for my death(40% v. 49%; r=0.48, p<0.0001). Conclusions: EOL wishes were similar and persistent using both GWG and LOS. Completing both GWG and LOS did not increase anxiety. All patients were able to complete and most preferred GWG.

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