scholarly journals Role of preoperative ultrasound mapping in the surgical management of deep infiltrating endometriosis: a prospective observational study

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Samar M. El-Maadawy ◽  
Nesreen Alaaeldin ◽  
Charles B. Nagy
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Imaging Method ◽  
Deep Infiltrating Endometriosis ◽  
Patient Counselling ◽  
Preoperative Mapping ◽  
Significant Difference ◽  
Operative Complications ◽  
Infiltrating Endometriosis ◽  
Post Operative Complications

Abstract Background Endometriosis is a challenging gynecological condition that has a profound influence on the quality of life of affected women. Transvaginal ultrasound is considered the first-line imaging method in preoperative assessment of the extent and severity of endometriosis. Accurate preoperative mapping can aid the surgeon in patient counselling, selection of the most appropriate surgical method that minimizes the operative and post-operative complications. The aim of our study is to evaluate the accuracy of transvaginal sonography (TVS) in precisely assessing the size, location and extent of deep infiltrating endometriosis (DIE) using a new modified endometriosis mapping proforma with histopathological confirmation. Our prospective observational study included 101 women with clinically suspected DIE who underwent TVS followed by laparoscopy from October 2018 to December 2020 with a maximum of 4 weeks interval. Precise mapping of DIE was done during TVS and laparoscopy. Results were correlated with histopathology findings. Results DIE was confirmed by histopathology in 88 patients. Sensitivity and specificity for individual DIE locations were rectovaginal septum 67.9% and 98.6%; vagina 52.2% and 98.7%; uterosacral ligaments 82.5% and 96.2%; torus 96.4% and 97.3%; parametrium 68.8% and 96.9%; rectum 100% and 98.8%; bladder 100% and 100%, ureters 63.4% and 99.0%; scar endometriosis 100% and 100%; pouch of Douglas obliteration 97.7% and 100%. No statistically significant difference was detected between ultrasound and histopathology size. Ultrasound tended to underestimate the lesion size; the underestimation was more pronounced for lesions > 3 cm. “Butterfly” and “tram-track” signs are two new sonographic signs related to posterior compartment DIE. No post-operative complications were recorded. There were no cases of DIE recurrence. Eleven out of 22 cases of infertility achieved pregnancy during 18 months follow-up. Conclusion TVS provides a thorough and accurate evaluation of the extent of endometriosis. An experienced radiologist can use E-PEP to provide an accurate demonstration of the location and extent of DIE which helps the surgeon select the most appropriate surgical approach ensuring radical treatment of the disease and minimizing short- and long-term complications.

scholarly journals Efficacy of two-person technique for I-gel insertion: a prospective observational study

2021 ◽  
Vol 9 (4) ◽  
pp. 1076
Author(s):  
Ratindra Kumar Barman ◽  
Plabon Hazarika ◽  
Ananta Hazarika
Keyword(s):  
Observational Study ◽  
Tidal Volume ◽  
General Anaesthesia ◽  
Sore Throat ◽  
Prospective Observational Study ◽  
Insertion Time ◽  
Haemodynamic Response ◽  
Mild Pain ◽  
Operative Complications ◽  
Post Operative Complications

Background: Recently anesthesiologists favoring I-gel over ET in securing airway during general anaesthesia because of better haemodynamic response and post-operative complications. In this study, we have assessed the efficacy of two -person technique for insertion of I- gel in paralysed patients.Methods: I- gel is insertion was done in 40 patients undergoing general anaesthesia. Insertion time, number of attempts, air leaks, Tidal volume (TV) and expired tidal volume (ETV), emergence from anaesthesia, post-operative complications were assessed.Results: Mean insertion time was 14.02±1.99 seconds. Insertion was successful in 37 patients (92.5%) in first attempt. 3 (7.5%) patients needed second attempts. Emergence from anaesthesia was satisfactory in all cases (100%).3 patients (7.5%) had mild cough and there were blood stained in the device in 2 cases (5%).6 patients (15%) had mild, 5 patients (12.5%) had moderate sore throat in first 24 hours. 4 patients (10%) had mild pain during swallowing.Conclusions: Two- person technique for insertion of I-gel is easier and lower insertion time with fewer complications.

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 Changes in perioperative hemoglobin and hematocrit in patients undergoing total knee arthroplasty: a prospective observational study of optimal timing of measurement

2020 ◽  
Vol 48 (11) ◽  
pp. 030006052096930
Author(s):  
Chenrong Ke ◽  
Naifeng Tian ◽  
Xiumeng Zhang ◽  
Mochuan Chen
Keyword(s):  
Total Knee Arthroplasty ◽  
Observational Study ◽  
Knee Arthroplasty ◽  
Prospective Observational Study ◽  
Optimal Timing ◽  
Preoperative Period ◽  
Hidden Blood Loss ◽  
Significant Difference ◽  
Total Knee ◽  
Hb Concentration

Objective This study was performed to depict the patterns of change in the perioperative hemoglobin (Hb) concentration and hematocrit (Hct) and to identify the optimal timing of Hb and Hct measurement in patients undergoing total knee arthroplasty (TKA). Methods This prospective observational study involved 302 consecutive patients who underwent TKA. The patients were kept in hospital for 1 full week postoperatively. Hb and Hct measurements were performed preoperatively and on days 1 to 7 postoperatively and then during clinic visits at 1, 3, and 6 months postoperatively. Results The Hb concentration and Hct decreased during the first few days postoperatively and reached a nadir on postoperative day 4 and 3, respectively; they then recovered in the following days. Significant differences in the Hb concentration and Hct were detected between the preoperative period and day 1, between days 1 and 2, between days 2 and 3, between day 7 and 1 month, and between 1 and 3 months. A significant difference in the Hct was also detected between 3 and 6 months. Conclusion The optimal timing of Hb and Hct measurement is on postoperative day 3 or 4. This timing accurately reflects ongoing hidden blood loss to better guide blood transfusions.

Thromboelastrography Reduces Blood Product Transfusion in Pediatric Cardiac Surgery

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 1176-1176
Author(s):  
Michael Ritchie ◽  
Cathy Woodward ◽  
Lauren Kane ◽  
Melissa Frei-Jones
Keyword(s):  
Cardiac Surgery ◽  
Congenital Heart ◽  
Blood Product ◽  
Pediatric Cardiac Surgery ◽  
Blood Product Transfusion ◽  
Red Cell ◽  
Time Period ◽  
Significant Difference ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Abstract 1176 Thromboelastography (TEG) has emerged as an important tool to guide blood product transfusions in pediatric cardiac surgery requiring cardio-pulmonary bypass (CPB). Blood product transfusions are associated with risk including transfusion transmitted infections, transfusion reactions, and allo-immunization. Previous studies have reported fewer red cell and plasma transfusions but increased platelet transfusions with no difference in post-operative bleeding in pediatric CPB using TEG to determine transfusion needs. In this study, we evaluated the use of intra-operative TEG to reduce blood product transfusion in pediatric cardiac surgery with CPB. A retrospective case control study of 150 patients, age birth to 18 years, who required CPB during cardiac surgery, was performed from January 1, 2010 to May 31, 2012. Cases were chosen serially during the time period when TEG was utilized by anesthesia. Controls were chosen from the time period before TEG was available. Exclusion criteria were a personal or family history of bleeding or clotting disorder. Controls were matched 2:1 on age and Risk Adjustment for Congenital Heart Surgery score (RACHS). The type and amount of blood product transfusions were compared between cases and controls in addition to post-operative complications including bleeding, infection and thrombosis. This study included 50 cases and 100 controls. Average age and gender were not different between cases and controls (19 mo (0–213) vs 20 mo (0–255), p=0.86; 52% (26/50) males vs 62% (62/100), p=0.24). Ethnicity was similar between groups and primarily Hispanic (66% (33/50) vs 70% (70/100), p=0.71). The most common congenital heart defect was Tetralogy of Fallot (20% (10/50) vs 22% (22/100); p=0.84). The median RACHS score between groups was the same (3 (2–6) vs 3 (2–6), p=0.88). There was no significant difference in pre-surgical or post-surgical blood counts, coagulation testing or CPB pump time. The average number of TEGs performed per case was 2.6 (1–6). Cases received significantly fewer platelet and cryoprecipitate (cryo) units but similar red cell and plasma units to controls as shown in Figure 1. The difference persisted when transfusions were adjusted for weight. Cases received fewer platelets (13 (0–49) ml/kg vs 21 (0–119) ml/kg, p=0.015), and cryo (3 (0–36) ml/kg vs 6.3 (0–47) ml/kg, p=0.029) with the most significant difference seen in patients less than 10 kg (platelets 15 ml/kg vs 25 ml/kg, p=0.007; cryo 4 ml/kg vs 8 ml/kg, p=0.03). There was no difference in red cell volume (130 (0–332) ml/kg vs 133 (0–680) ml/kg, p=0.88), or plasma volume (109 (0–277) ml/kg vs 107 (0–553) ml/kg, p=0.9) at any weight between groups. There was no statistical difference in PICU length of stay (LOS), hospital LOS, mechanical ventilation, survival to discharge or frequency of post-operative bleeding or thrombosis. There was a 50% reduction in hospital cost of platelet transfusions ($29,750 vs $65,450) and cryo ($1,950 vs $4,700) for the 50 cases compared to controls. The cost of three TEGs per 50 cases was $3,450 ($23/TEG) for a total cost savings of $35,000. Intra-operative TEG reduced the amount of platelet and cryoprecipitate transfusions used during pediatric CPB without an increase in post-operative complications. The reduction in blood product administration by using TEG resulted in decreased cost. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Prospective Observational Study of an Eye-tracking Device for Under 12 Months of Age Infants; the Feasibility of Gazefinder

2021 ◽  
Author(s):  
Tomoo Takahashi ◽  
Kazuki Tsukamoto ◽  
Misaki Matsumura ◽  
Ryo Takigawa ◽  
Yasuo Sakai ◽  
...  
Keyword(s):  
Observational Study ◽  
Eye Tracking ◽  
Prospective Observational Study ◽  
Assessment Tool ◽  
Positive Association ◽  
Autism Spectrum ◽  
Fixation Time ◽  
Developmental Problems ◽  
Significant Difference ◽  
The Mean

Abstract Eye-tracking to evaluate gaze patterns has developed as an assessment tool for children with Autism Spectrum Disorder (ASD). Gazefinder is one of Eye-tracking devices and few studies have investigated whether it can measure the gaze data of infants under 12 months of age. We conducted a prospective observational study from April 2019 to March 2020 in a periodic health checkup in Ohchi County, Shimane, Japan. Participants included infants between 4 and 11 months of age who were not suspected the presence of developmental problems. Ninety-three participants’ datapoints were analyzed. The mean age was 6.5 months and mean developmental quotient was 88%. The mean fixation time percentage of all sequences was 81.0% (standard deviation; 4.4), and there was no significant difference in each age group. Infants in all groups showed a significantly higher predilection for eyes than for mouths. There was a positive association of age with human gaze and a negative association with geometric gaze. Moreover, we confirmed that joint attention skills were enhanced in accordance with their growth process. The eye-tracking data were almost corresponding to previous studies’ data of infant with typical development and Gazefinder could be applied to infants starting at 4 months of age.

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