scholarly journals Group B Streptococcus Infected Tenosynovitis in Diabetic Foot Ulcers

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0048
Author(s):  
Olivia Waldman ◽  
Thomas Sajda ◽  
Irvin Oh ◽  
Aron Sulovari
Keyword(s):  
Inflammatory Markers ◽  
Group B Streptococcus ◽  
Unplanned Readmission ◽  
Diabetic Foot Ulcers ◽  
Irrigation And Debridement ◽  
Operative Complications ◽  
Group B ◽  
Severe Soft Tissue ◽  
Ray Amputation ◽  
Post Operative Complications

Category: Diabetes; Other Introduction/Purpose: The incidence of Streptococcus agalactiae (Group B Streptococcus, GBS) infection in diabetic foot ulcers (DFU) has been on the rise. Severe soft tissue damage, which often leads to septicemia and amputation, has been reported in many cases. With the paucity of literature, we aimed to investigate the clinical outcome of GBS infected DFU patients. We hypothesize that GBS patients have a greater severity of infection as indicated by elevated inflammatory markers, more frequent wound complication, and a higher rate of unplanned readmission and reoperation. Methods: Data was retrospectively collected in a single academic orthopedic surgeon’s practice from February 2015 to October 2019. Seventy-eight patients with infected DFUs who underwent surgical treatment formed the basis of this study. Infected bone samples were obtained intraoperatively and sent for standard culture. The microbe data, demographic data (age, gender, race, ethnicity, and BMI), comorbidities, and initial lab values (HgA1C, CRP, ESR, WBC, and glucose) were recorded for all patients. Sixteen GBS infected DFU patients (20.5%) were identified. Among them, GBS infection occurred in 9 acute (<2 wks), 2 subacute (4-6 wks), and 5 chronic (>6 wks) DFUs. Clinical outcome was assessed by surgical outcome, wound healing status, post-operative complications, unplanned readmission, and unplanned reoperation within 3 months following initial surgery. Mean, standard deviation, percentage and range were calculated for patient demographics and inflammatory markers. Statistical significance of inflammatory markers between patients with and without GBS was also calculated. Results: The initial procedures were irrigation and debridement (n=11), toe amputation (n=1), ray amputation (n=2), transmetatarsal amputation (n=1), and a partial calcanectomy (n=1). Five GBS patients (31.3%), as compared to eighteen (29%) DFU patients without GBS, developed post-surgical complications (wound dehiscence, recurrent infection, septicemia) which required unplanned readmission and reoperation. Repeat operations were irrigation and debridement (n=1), metatarsal ray amputation (n=1), ray amputation (n=1), and below knee amputation (n=2) with average number of 2 repeat operations (range: 1 - 5). Hemoglobin A1C (p=.0067) was statistically higher in GBS patients. When comparing acute GBS ulcers (n=9) and acute ulcers without GBS (n=18), CRP (p=.037), HgA1C (p=.026), and blood glucose (p=.046) were all found to be significantly higher in patients with GBS DFUs. Conclusion: GBS infected DFU patients generally showed more extensive and severe soft tissue inflammation, as indicated by higher inflammatory markers at initial presentation. Compared to other patients with DFUs, GBS patients had significantly higher HgA1C values, and in those experiencing acute ulcers, had higher CRP, HgA1C, and blood glucose values. They have higher rates of post-operative complications that required unplanned readmission and reoperation at more proximal level. Surgeons should consider time sensitive and aggressive surgical treatment for GBS infected DFUs and counsel patients on the high risk of post- operative complications and repeat surgery. [Table: see text]

Laparoscopic versus open partial nephrectomy for the management of highly complex renal tumors with PADUA score ⩾10: A single center analysis.

2021 ◽  
pp. 039156032110016
Author(s):  
Francesco Chiancone ◽  
Marco Fabiano ◽  
Clemente Meccariello ◽  
Maurizio Fedelini ◽  
Francesco Persico ◽  
...  
Keyword(s):  
Partial Nephrectomy ◽  
Operation Time ◽  
Renal Tumors ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
Significant Difference ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Post Operative Complications

Introduction: The aim of this study was to compare laparoscopic and open partial nephrectomy (PN) for renal tumors of high surgical complexity (PADUA score ⩾10). Methods: We retrospectively evaluated 93 consecutive patients who underwent PN at our department from January 2015 to September 2019. 21 patients underwent open partial nephrectomy (OPN) (Group A) and 72 underwent laparoscopic partial nephrectomy (LPN) (Group B). All OPNs were performed with a retroperitoneal approach, while all LPNs were performed with a transperitoneal approach by a single surgical team. Post-operative complications were classified according to the Clavien-Dindo system. Results: The two groups showed no difference in terms of patients’ demographics as well as tumor characteristics in all variables. Group A was found to be similar to group B in terms of operation time ( p = 0.781), conversion to radical nephrectomy ( p = 0.3485), and positive surgical margins ( p = 0.338) while estimated blood loss ( p = 0.0205), intra-operative ( p = 0.0104), and post-operative ( p = 0.0081) transfusion rates, drainage time ( p = 0.0012), pain score at post-operative day 1 (<0.0001) were significantly lower in Group B. The rate of enucleation and enucleoresection/polar resection was similar ( p = 0.1821) among the groups. Logistic regression analysis indicated that preoperative factors were not independently associated with the surgical approach. There was a statistically significant difference in complication rate (<0.0001) between the two groups even if no significant difference in terms of grade ⩾3 post-operative complications ( p = 0.3382) was detected. Discussion: LPN represents a feasible and safe approach for high complex renal tumors if performed in highly experienced laparoscopic centers. This procedure offers good intraoperative outcomes and a low rate of post-operative complications.

scholarly journals A Comparative Study on Efficacy of Amoxicillin and Azithromycin in Prevention of Postoperative Sequelae Following Third Molar Surgery

2019 ◽  
Vol 21 (3) ◽  
pp. 224-229
Author(s):  
Rashmi Shakya Gurung ◽  
K. Bimb ◽  
D. Shrestha
Keyword(s):  
Maxillofacial Surgery ◽  
Third Molar ◽  
Controlled Study ◽  
Third Molar Surgery ◽  
Mandibular Third Molar ◽  
Surgical Extraction ◽  
Operative Complications ◽  
Alternative Drug ◽  
Group B ◽  
Post Operative Complications

Amoxicillin is the commonly prescribed antimicrobial for prevention of post-operative complications following surgical extraction of mandibular third molar. However recently, the use of macrolideantibiotics had been encouraged in dentistry. The aim of this study was to compare the efficacy of Amoxicillin and Azithromycin in preventing post-operative sequelae following third molar surgery. An open- labeled randomized controlled study was carried out in Department of Oraland Maxillofacial surgery, college of Dental Sciences and Hospital, Nepal Medical College (CODSHNMC), Attarkhel, Kathmandu, Nepal from May 2018 to June 2019. One hundred and twenty patients undergoing surgical extraction of impacted mandibular third molar were randomized by lottery method into two groups: Group A received Amoxicillin and Group B received Azithromycin. Both the groups were assessed postoperatively on 1st, 3rd and 7th days for post-operative complications- pain, swelling, trismus and pus discharge. The present study revealed no significant differences between the efficacy of Amoxicillin and Azithromycin in preventing postoperative sequelae following surgical extraction of impacted third molar. Amoxicillin and Azithromycin were therefore found to be equally effective. Thus, Azithromycin can be used as an alternative drug to Amoxicillin in case of resistance and intolerance to Amoxicillin.

scholarly journals COMPARISON OF OUTCOMES BETWEEN EARLY AND DELAYED LAPAROSCOPIC CHOLECYSTECTOMY IN ACUTE CALCULOUS CHOLECYSTITIS

2021 ◽  
Vol 71 (3) ◽  
pp. 796-800
Author(s):  
Muhammad Ismail ◽  
Nasir Mehmood Wattoo ◽  
Muhammad Qasim Butt ◽  
Fareeha Naz
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Hospital Stay ◽  
Operation Time ◽  
Acute Calculous Cholecystitis ◽  
Delayed Laparoscopic Cholecystectomy ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Calculous Cholecystitis ◽  
Post Operative Complications

Objective: To compare early versus delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of mean operative time, hospital stay, conversion rate to open surgery and post-operative complications. Study Design: Quasi experimental study. Place and Duration of Study: Army Liver Transplant Unit, Department of Surgery, Pak-Emirates Military Hospital Rawalpindi, from Jul to Dec 2018. Methodology: A total of 170 patients (85 in each group) diagnosed as a case of acute calculous cholecystitis who met the sample selection criteria were included. Group A patients underwent early laparoscopic cholecystectomy within 72 hours of admission while group B patients underwent conservative management followed by delayed laparoscopic cholecystectomy after 6 weeks. All patients were followed for operative time, hospital stay, per-operative difficulties encountered and post-operative complications. Results: Group A had a mean operation time of 43.9 ± 11.1 minutes, while group B had a mean operation time of 45.8 ± 10.1 minutes (p=0.83). The mean duration of hospitalization was 2.8 ± 1.1 days in group A and 5.3 ± 0.8 days in group B (p<0.001). Complications were measured at a frequency of 14.1% in group A and 5.9% in group B (p=0.07). Conclusion: Early laparoscopic cholecystectomy is better than delayed laparoscopic cholecystectomy in acute calculous cholecystitis in terms of hospital stay and per-operative difficulties faced. The post-operative complications between the two groups are comparable.

Comparison of Post-Operative Complications Between Sublay and Onlay Mesh Repair in Incisional Hernia

2021 ◽  
Vol 15 (12) ◽  
pp. 3384-3386
Author(s):  
Azizullah Khan Sherani ◽  
Saleem Javed ◽  
Muhammad Idrees Achackzai
Keyword(s):  
Incisional Hernia ◽  
Wound Infection ◽  
Mesh Repair ◽  
Seroma Formation ◽  
Onlay Technique ◽  
Sublay Technique ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Post Operative Complications

Objective: To compare the post-operative complications between sublay and onlay mesh repair in incisional hernia. Materials & Methods: This randomized controlled trial was conducted at Department of Surgery, Sandeman Provincial Hospital Quetta from May 2019 to November 2019. Total 250 patients with incisional hernias for more than 3 months, having age 20-40 years either male or female were selected. Then selected patients were placed randomly into two groups i.e. Group A (Sublay group) & Group B (Onlay group), by using lottery method. Patients were called for follow up 15th day for post-operative complications in term of wound infection and seroma formation. Results: The mean age of patients in group A was 34.73 ± 4.32 years and in group B was 34.51 ± 4.67 years. Out of these 250 patients, 161 (64.40%) were female and 89 (35.60%) were males with female to male ratio of 1.8:1. Wound infection was seen in 07 (5.60%) patients in group A (Sublay technique) and 17 (13.60%) patients in group B (Onlay technique) with p-value of 0.033. Seroma formation was seen in 09 (7.20%) patients in group A (Sublay technique) and 26 (20.80%) patients in group B (Onlay technique) with p-value of 0.002. Conclusion: This study concluded that rate of wound infection and seroma formation is less after sublay mesh repair for incisional hernia as compared to onlay repair. Keywords: Hernia, incisional, onlay, sublay, seroma.

Round Block Technique versus Grisotti Technique in Juxta Areolar Breast Cancer

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Ahmed Helmy Shehab ◽  
Karim Fahmy Abd Elmoaty ◽  
Mahmoud Refaat Mohamed Elsebaai
Keyword(s):  
Breast Cancer ◽  
Operating Time ◽  
Breast Cancer Patients ◽  
Areola Complex ◽  
Operative Complications ◽  
Group A ◽  
Cosmetic Outcomes ◽  
Group B ◽  
Slight Advantage ◽  
Post Operative Complications

Abstract Background Breast cancer is the most common cancer in women all over the world representing 18% of all women reported cases of cancer. It represents the leading cause of women mortality as representing 23% of all women cancer deaths. Objectives To compare aesthetic and surgical outcome of Round block technique and Grisotti technique in juxta areolar breast cancer. Patients and Methods In our study 20 breast cancer patients are subdivided into group (A) 10 females which underwent round block technique and group (B) 10 femaleswhich underwent grisotti technique. Patient and tumor criteria including age, co morbidities, tumor size and distance between tumor and nipple-areola complex were considered to be nonsignificant between 2 groups so the only difference is the surgical technique. Results The study shows that the round block technique and grisotti technique have the same results regarding operative time, intra-operative blood loss, post operative complications and re-excision rates with slight advantage to round block technique because of its slightly better cosmetic outcomes. So, the round block technique is slightly preferred for selected cases. Conclusion When to compare between round block technique and grisotti technique In treatment of juxta areolar breast cancer, there in no evident difference in operating time, post operative complications or need of re-excision between these two groups of patients

125I Seed-Loaded Stents and 125I Seed Strips for the Treatment of Unresectable Malignant Obstructive Jaundice

2020 ◽  
Vol 12 (3) ◽  
pp. 418-425
Author(s):  
Wenhui Wang ◽  
Shuangxi Li ◽  
Baohua Li
Keyword(s):  
Biliary Obstruction ◽  
Malignant Biliary Obstruction ◽  
125I Seed ◽  
Malignant Obstructive Jaundice ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Single Blind ◽  
Post Operative Complications

Brachytherapy can provide longer obstruction-free time and prolonged survival in patients with unresectable malignant biliary obstruction (MBO). A randomized, single-blind, single-center trial was performed to compare the safety and efficacy of 125I seed-loaded stents to 125I seed strips for the treatment of unresectable MBO. Subjects diagnosed with MBO were divided randomly into two groups. Patients in group A were treated with 125I seed-loaded stents, patients in group B were treated with 125I seed strips. Study outcomes included post-operative complications, quality of life (QOL), time without biliary obstruction and survival. There were no significant differences in complications and morbidity that developed perioperatively. However, the incidence of post-operative complications was significantly higher in group B (n = 20) compared to group A (n = 19) (P < 0.05). Apart from those assessing pain (P = 0.91) and nausea and vomiting (P = 0.07), EORTC-QLQC30 scores in patients in group A were significantly higher than those reported for group B. The median time to relief of biliary obstruction was 144 ± 107 days (95% CI, [92.5–195] days) for group A and 231 ± 150 days (95% CI, [160.92–301.58] days) for group B (P = 0.045). Median survival time was 272.58 ± 258.73 days (95% CI, [147–397] days) for group A and 268 ± 143 days (95% CI, [201–335] days) for group B (P = 0.992). We observed no significant differences with respect to survival were. Although administration of 125I seed strips resulted in a prolonged period without biliary obstruction, use of the 125I seed-loaded stent implant was associated with a lower rate of complications and significantly improved QOL.

scholarly journals Comparison of Intra-Operative and Post-Operative Complications between Non-Descent Vaginal Hysterectomy and Total Abdominal Hysterectomy

2018 ◽  
Vol 8 (3) ◽  
pp. 128-134
Author(s):  
Sayma Afroz ◽  
Gulshan Ara
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Vaginal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Operative Blood Loss ◽  
Operative Complications ◽  
Abdominal Route ◽  
Group A ◽  
Group B ◽  
Post Operative Complications

Background: Hysterectomy is one of the most common surgical procedures performed by the gynaecologists and can be done through abdominal and vaginal routes. Vaginal hysterectomy technique has been introduced and performed centuries back, but is less popular due to lack of experience and misconception that the abdominal route is easier and safer. Worldwide gynaecologists continue to use abdominal route for hysterectomy that could be performed vaginally which is less invasive and has minimal complications.Objective: To compare the complications during intra-operative and post-operative period between vaginal hysterectomy and abdominal hysterectomy in non-descent uterus.Materials and Methods: This prospective randomised study was performed in Enam Medical College & Hospital, Savar, Dhaka during a period of one year. Sixty consecutive patients requiring hysterectomy for benign diseases were included in this study. Group A (n=30) underwent vaginal hysterectomy (non-descent vaginal hysterectomy) and were compared with Group B (n=30) who underwent abdominal hysterectomy. The primary outcome measures were operative time, intra-operative blood loss, post-operative complications like wound infection, febrile morbidity, post-operative systemic infection and hospital stay. Secondary outcome measures were conversion of vaginal to abdominal route and re-laparotomy. Data were collected in structured questionnaire and analysed by computer using R programming version 3.4.3.Results: Baseline characteristics were similar in two groups. There were no intra-operative complications in either group. Intra-operative blood loss was significantly more in Group B than in Group A. The overall complication rate was significantly higher with abdominal hysterectomy with a rate of 56.67% against 30% for vaginal hysterectomy. Wound infection (23.33%) was significantly higher in Group B as compared to Group A (0%). Post-operative hospital stay was significantly higher in Group B (7.03 days) than in Group A (4.57 days).Conclusion: Considering intra-operative blood loss, post-operative complications and hospital stay, vaginal route was found safer than abdominal route in this study.J Enam Med Col 2018; 8(3): 128-134

scholarly journals Outcome of Laser Urethrotomy in Comparison with Optical Internal Urethrotomy in Recurrent Stricture Urethra Following Perineal Anastomotic Urethroplasty for PUDD

2020 ◽  
Vol 23 (2) ◽  
pp. 181-187
Author(s):  
Ripan Debnath ◽  
Md Nabid Alam ◽  
Md Towhid Belal ◽  
Prodyut Kumar Saha ◽  
Uttam Karmaker ◽  
...  
Keyword(s):  
Internal Urethrotomy ◽  
Average Hospital ◽  
Recurrent Stricture ◽  
Stricture Urethra ◽  
Operative Complications ◽  
Group A ◽  
Group B ◽  
Optical Internal Urethrotomy ◽  
Anastomotic Urethroplasty ◽  
Post Operative Complications

Objective: To compare the outcome of laser urethrotomy and optical internal urethrotomy(OIU) for the treatment of recurrent stricture urethra following perineal anastomotic urethroplasty for posterior urethral distraction defect. Materials and methods: The study was conducted in Dhaka Medical College Hospital from January 2013 to December 2014.Male patients presented with obstructed voiding symptoms following perineal anastomotic urethroplasty were evaluated by their history, physical findings and investigations (urinalysis, uroflowmetry, retrograde urethrogram and micturiting cystourethrogram ) & primarily 64 patients are selected by purposive sampling. Patients are divieded again by random allocation into group A and group B and underwent for OIU and laser urethrotomy respectively. Results: Comparison was made to find out the better method between optical urethrotomy and laser urethrotomy. Overall per-operative complications (bleeding, extravasations of irrigating fluid, false passage and broken knife) in the former group were 31.3% compared to none in the latter group. Post-operative complications like bleeding, haematoma, penile oedema and erectile dysfunction were found only in Group-A (p=0.002). The mean duration of postoperative catheterization and average hospital stay were observed to be much higher in Group-A than that in Group-B (p=0.000008; p=0.0006). Comparison of final outcome (development of stricture) between groups at 1 year of evaluation in Group-A and Group-B was not significant (p= 0.320). Conclusion: Laser urethrotomy is better than optical urethrotmy in regards of peroperative and post-operative complications. Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.181-187

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