scholarly journals Application of mediastinal drainage tube in intrathoracic esophageal anastomotic leakage for early diagnosis and effective treatment: a retrospective study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hainong Ma ◽  
Xu Song ◽  
Jie Li ◽  
Guofang Zhao

Abstract Background Intrathoracic esophageal anastomotic leakage (AL) is one of the most fatal complications after esophagectomy. In this study, we placed an additional drainage tube in the esophagus bed and evaluated its effect in early diagnosis and treatment of AL. Methods From January 2010 to August 2020, 312 patients with esophageal or cardia carcinoma underwent esophageal resection with intrathoracic esophagogastric anastomosis. A total of 138 patients with only one pleural drainage tube were divided into the “Control Group” and 174 patients with a pleural drainage tube and an additional mediastinal drainage tube (MDT) were divided into the “Tube Group”. For all patients, the incidence of postoperative AL, the time to diagnosis, time to recovery, and patient outcome were analyzed. Results No significant differences were observed in the AL rate (P = 0.837) and postoperative pain between two groups. However, in the Tube Group, almost all the patients were diagnosed prior to the appearance of hyperpyrexia, which was considered as the earliest and most common symptom after AL. In the Tube Group, a significant decrease was observed in the incidence of incurable fistula, which required re-operation or variable treatments under gastroscopy when compared to the Control Group (P = 0.032). Finally, patients in the Tube Group showed reduced post AL hospital day (P = 0.015) and a lower mortality, however, when compared to the Control Group, no significant differences were observed (P = 0.188). Conclusions Placement of an MDT does not prevent AL, but it is an effective approach for earlier diagnosis of AL and facilitates fistula healing and patient recovery.

2020 ◽  
Author(s):  
Hainong Ma ◽  
Xu Song ◽  
Jie Li ◽  
Guofang Zhao

Abstract Background: Intrathoracic esophageal anastomotic leakage (AL) is one of the most fatal complications after esophagectomy. In this study, we tried to place an additional drainage tube in esophagus bed and evaluate its effect in early diagnosis and treatment of AL.Methods: From January 2010 to August 2020, a total of 312 patients, who suffered from esophageal or cardia carcinoma, underwent esophageal resection with intrathoracic esophagogastric anastomosis. Among them, we identified 138 patients with only one pleural drainage tube as “Control Group” and 174 patients with a pleural drainage tube and an additional mediastinal drainage tube (MDT) as “Tube Group”. The incidence of postoperative AL, time to diagnosis, time to recovery, and patient outcome were analyzed.Results: There were no significant differences in the AL rate (P = 0.837) and postoperative pain between two groups. However, in the Tube Group, almost all the patients were definitely diagnosed prior to the appearance of hyperpyrexia, which was regarded as the earliest and most common symptom after AL. Moreover, in the Tube Group, there was significant decrease in the incidence of uncurable fistula, which required re-operation or variable treatments under gastroscopy, when compared to the Control Group (P = 0.032). Finally, patients in the Tube Group were associated with reduced post AL hospital day (P = 0.015) and lower mortality, although there was no significant difference (P = 0.188), than in the Control Group.Conclusions: Placement of a MDT can not prevent the AL, but it is an effective method to diagnose AL earlier and facilitate the fistula healing and patient recovery.


2021 ◽  
Vol 11 (3) ◽  
pp. 667-671
Author(s):  
Jiang Jie ◽  
Qin Zhanxiong ◽  
Wu Li ◽  
Xie Xiaojie ◽  
Zhao Xunran ◽  
...  

Objective: To investigate the value on early diagnosis of experimental rat according to computed tomography (CT) combined with the serum level of Serum Soluble Mesothelin-related Proteins (SMRP). Methods: Thirty-two SD rat were divided into three groups, including group A (experimental group) of 20 rats with pleural cavity injection of crocidolite suspension, group B (negative control group) of 6 rats with pleural cavity injection of saline, group C (blank control group) of 6 rats without any processing. Chest and abdominal CT scan and enhancement were performed in the three months and six months after induction and the pleural thickening was analyzed. The serum level of SMRP was measured at the different time period including pre-injection, the postinjection first month, the second month, the third month and the sixth month. The correlation between pleural thickening and serum level of SMRP was analyzed. Results: In group A: 20 cases were performed on CT scan in post-injection third month and we found 13 cases without pleural lesions and 7 cases with pleural lesions including of 4 cases with mild pleural thickening, 1 moderate thickening and 2 severe thickening (2 cases died). Moreover, 18 cases were done by CT in post-injection third month and we found 3 cases without pleural lesions and 15 cases with pleural lesions including of 6 cases with mild pleural thickening, 5 moderate thickening and 4 severe thickening (3 cases died). No pleural lesions were found in group B and group C. SMRP expression level differences in the three groups was statistically significant. However, there was no difference in pre-injection in the three groups and there were no difference in group B and C at the different time period. In group A, there was no difference between post-injection first month and second month, whereas, there had statistically difference in post-injection third and sixth month. In group A, SMRP level gradually increased over time. The high correlation between pleural thickening and serum level of SMRP was seen at the post-injection third and sixth month, which the expression of SMRP gradually increased as the pleural thickening. Conclusion: Serum SMRP expression level has a certain value for early diagnosis and staging of MPM, which can be used as an important biomarker for early screening of high-risk groups exposed to asbestos.


2021 ◽  
Vol 15 (7) ◽  
pp. 1864-1867
Author(s):  
Muhammad Imran ◽  
Khalifa Rahat Rashed ◽  
Amjad Ali ◽  
Jahangir Anjum ◽  
Muazzam Fuaad ◽  
...  

Objective:To determine the effectiveness of prone positioning in patients of covid-19 deisease presented with respiratory failure. Study Design: Retrospective/Observational study Place and Duration: Medicine department of BKMC/MMC, Mardan and Mohiuddin Teaching Hospital, Mirpur AJK for six months during the period from August 2020 to January 2021. Methods: Total 100 patients of respiratory failure admitted to ICU were included in this study. Patients detailed demographics age,sex and body mass index were recorded after taking informed written consent. Patients were aged between 25-80years.Patients were divided in to two groups I and II. Group A had 50 COVID-19 patients underwent prone position and group Bwith50 patients taken as control. Chest X-ray of both groups were taken. Patients of group A were kept in prone position whilegroup B received invasive ventilation and follow up was taken in duration of 15-days. Reduction of intubation rate, mortality, hospital stay and complications were identified among both groups. Complete data was analyzed by SPSS 22.0 version. Results:Majority of the patients was males 76% and the rest were females 24%. Mean age of the patients in prone positioning group was 52.42±13.18 years with mean BMI 26.14±7.13 kg/m2 and in control group A itwas 50.44±14.65 years with mean BMI 26.41±7.13 kg/m2. 55% patients had moderate and 45% had severe covid-19 disease. Mean duration of prone position was 5.14±6.31 hours. Most of the patients 81% had bilateral lung involvementinterstitial infiltrates. Fever, cough and dyspnea were the most common symptom found in both groups. Mean PF ratio was increases in prone group as compared to controlled group. Mean hospital stay in group A was 12.9±4.76 days and in group B mean hospital stay was 17.32±10.24 days. Mortality in group A was 3 (3%) and in group Bmortality was found in 7 (7%). No any severe complications were observed among both groups. Conclusion:We concludedin this study that the use of prone position among patients of COVID-19 was effective and safe method to reduce intubation, mortality and hospital stay. There was no any complication were found after this treatment. Keywords: Prone Position, Covid-19, Respiratory Failure, Mortality


1979 ◽  
Author(s):  
G. Palareti ◽  
M. Poggi ◽  
G. Fortunato ◽  
S. Coccheri

A series of 40 patients with TIA (25 males and 15 females) was thoroughly investigated by means of angiography and computerized tomography, and divided into a group (A) of 15 “sine materia”, and a group (B) of 25 with direct or indirect evidence of vascular occlusive or stenotic changes. Blood viscosity at 230 sec-1 37° was cp 4.2 ± 0.3 in the controls, cp 4.7 ± 0.7 in all patients (p < 0.05) cp 4.98 ± 0.7 in all male patients (p < 0.01 versus male controls), and cp 4.75 ± 0.8 in group B (p < 0.02). Haematocrit and Fibrinogen were also significantly increased in all male patients and in group B. Circulating platelet aggregates (CPA) were increased in 40% of the patients. Almost all patients with elevated CPA were males, with a slight prevalence in group B. Changes in blood viscosity parameters and in platelet aggregation in TIA patients were therefore related both to evidence of vascular lesions, and to sex, since they were found to prevail in male patients of both groups.


Author(s):  
Dr. Mukesh Batra

Background: Leukoderma is an acquired disease of pigmentation which is presented by depigmented areas of different shape and sizes on the skin. In various researches it was reported that these defects in melanocytes occurred due to autoimmune pathway or the complex causation of oxidative stress and genetics. Material & Methods: In the present cross‑sectional prospective study 100 patients who were diagnosed with Leukoderma and controls who were not having depigmentation of skin and without any known clinical disease were enrolled for present study by simple random sampling. Written informed consent was taken from each study participant. Clearance from institutional ethical committee was also taken prior to the study. Results: The prevalence of psychiatric illness among leukoderma group was 22% and among 78% patients we did not found any psychiatric illness. The most common symptom was depression which was present among 22% of patients with Leukoderma and 18% patients with Leukoderma had anxiety symptoms. Among the control group depression was present in 5 % subjects and anxiety symptoms were present in 7% of subjects. The mean WHO-Quality of life scores was low among Leukoderma group in relation to the control group (p value <0.05). On correlation with psychiatric illness, observations were statistically non-significant (p > 0.05) with HAMA-A and HAMA- D. The observations were statistically significant (p < 0.05) with GHQ total and BSA score. Conclusion:  Higher prevalence of psychitric morbidity among patients with leukoderma and it was found associated with duration of disease and BSA scores. The most common symptom was depression which was followed by anxiety symptoms. Key words: Leukoderma, psychiatric illness, anxiety, depression.


According to the Tambovagrochemcenter data, zinc deficiency in animal rations exceeds 33%. To de-termine the efficiency of ration additives 3 groups of calves were formed, one of which was control and received regular feed, first test group received additional Zinc Sulphate, and second test group received additional Zinc Bioplex. To assess the results, we take into account the following values: chemical com-position and nutritional values of the feed, body mass value, amount of immunoglobulins in blood, bio-chemical and hematological values of blood, morphological values of fur and skin. Noticeable results were achieved in 4 months, with first and second test groups receiving accordingly 3,15% and 6,13% more body mass increase over the control group. A tendency towards higher albumin concentration in both test groups was noted, and calves of the second test group had higher amounts of hemoglobin and higher concentrations of it per erythrocyte. In samples of epidermis and hairs of the second test group the papillary layer was well developed, with the amount of hair and hair follicles exceeding 7 in the field of view, with the thickness of hairs being at least 70 μm. Inner papilla of hair contained 6 to 8 layers of hair, thickness of awn hairs reaching 80-90 μm, down hairs reaching 40 μm, with the hair cortex making up more than 80% of the hair thickness. Thus, introducing zinc salts and chelated zinc compounds to the milk-fed calves’ ration, has resulted in monetary profit increases over the control group by 255,0 and 612,0 roubles accordingly. By all researched values, the highest results were reached from adding zinc bioplex with approximately 360 mg added per animal for the entire duration of the growth process.


2020 ◽  
Vol 16 ◽  
Author(s):  
Molla Imaduddin Ahmed ◽  
Rosalind V Saunders ◽  
Srini Bandi

: We reviewed the clinical presentation and management of children with Invasive group A streptococcal infections admitted to our tertiary Children’s Hospital in the last eight years. Our study highlighted the varied symptomatology and management practices in children with iGAS and showed that early diagnosis and prompt initiation of appropriate antibiotics for iGAS can help in resolution of symptoms and good outcome.


2020 ◽  
Vol 02 ◽  
Author(s):  
Laurel Stringer ◽  
Sarah Malley ◽  
Darrell M. Hutto ◽  
Jason A. Griggs ◽  
Susana M. Salazar Marocho

Background: The most common approach to remove yttria stabilized zirconia (YSZ) fixed-dental prostheses (FDPs) is by means of diamond burs attached to a high-speed handpiece. This process is time-consuming and destructive. The use of lasers over mechanical instrumentation for removal of FDPs can lead to efficient and predictable restoration retrievability. However, the heat produced might damage the tooth pulp (>42˚C). Objective: The purpose of this study was to determine the maximum temperature (T) reached during the use of different settings of the erbium, chromium:yttrium-scandium-gallium-garnet Er,Cr:YSGG laser through a YSZ ceramic. Methods: YSZ slices (1 mm thick) were assigned into 7 groups. For the control group, a diamond bur was used to cut a 1 mm groove into the YSZ slices. For the 6 experimental groups, the laser was operated at a constant combination of 33% water and 66% air during 30 s with two different power settings (W) at three frequencies (PPS), as follows (W/PPS): 2.5/20, 2.5/30, 2.5/45, 4.5/20, 4.5/30, 4.5/45. The T through the YSZ slice was recorded in degrees Celsius by using a digital thermometer with a K thermocouple. Results: The median T of the control group was 26.5˚C. The use of 4.5 W resulted in the median T (˚C) of 44.2 at 20 PPS, 53.3 at 30 PPS, and 58.9 at 45 PPS, while 2.5 W showed 34.6, 31.6, and 25.0 at 20, 30, and 45 PPS, respectively. KruskalWallis one-way ANOVA showed that within each power setting, the T was similar. The high power and lowest frequency (4.5/20) showed no significant difference from the 2.5 W settings and the control group. Conclusion: The lower power setting (2.5 W) is a potential method for the use of the Er,Cr:YSGG laser to debond YSZ structures. The higher power (4.5 W) with high frequencies (30 and 45 PPS) is unsuitable.


Author(s):  
Patil Aniket ◽  
Dindore Pallavi ◽  
Arbar Aziz ◽  
Kadam Avinash ◽  
Saroch Vikas

The quest for excellence in mental and physical health is not new. We find various references and formulations in Ayurvedic classics meant for promoting mental and physical health of a child. Suvarna Prashan is one of the formulations explained in age old Ayurvedic classic Kashyap Samhita. This formulation is very widely used now days as a memory and immune booster for children. But there is very little systematic documented study which can be used to evaluate the efficacy of the formulation. Suvarna Bhasma was prepared in Ayurved Rasayani Pharmacy, Pune. Madhu and Ghrita were collected from KLE Ayurveda Pharmacy, Belgaum. Suvarna Bindu Prashan was prepared in KLE Ayurved pharmacy, Belgaum. It contains Suvarna Bhasma, Ghrita and Madhu. Twenty apparently healthy male and female children with age group of three to four years were ready to sign inform consent form were selected into two groups each. Subjects in Group A received Suvarna Bindu Prashan where as Group B (Control group) did not receive any treatment. Both the groups were observed for six months. Children in Suvarna Bindu Prashan group showed significant reduction in the scores of eating habits, behavior, mood, temperament and scores of event of illness. However there was no significant difference in the score of sleeping habit. There was significant increase in IQ percentage.


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