scholarly journals The value of endobronchial cryotherapy in the management of malignant endobronchial obstruction in patients with inoperable NSCLC: a prospective analysis of clinical and survival outcomes

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Alaa Rashad ◽  
Mohamed Shahat Badawy ◽  
Mohammed Mustafa Ali ◽  
Haggagy Mansour ◽  
Mohamed Abdel-Bary
Keyword(s):  
Median Survival ◽  
Performance Status ◽  
Blood Gases ◽  
University Hospital ◽  
Survival Outcomes ◽  
Safe Procedure ◽  
Karnofsky Score ◽  
Arterial Blood ◽  
Group A ◽  
Group B

Abstract Background Malignant endobronchial obstruction (MEBO) is the most debilitating complication in non-small cell lung cancer (NSCLC). The therapeutic role of cryotherapy and its impact on survival has not been well addressed. This is to clarify whether the combination of endobronchial cryotherapy (EBCT) and chemoradiotherapy (CRT) improved symptoms, respiratory functions, performance status, and survival outcomes in inoperable NSCLC with symptomatic MEBO compared to that obtained by CRT alone. Results A prospective cohort study included 60 cases presented to Qena University Hospital, Egypt, between December 2016 and May 2019. They were divided into two groups. Group A included 30 patients who were managed with EBCT plus CRT. Group B included 30 patients who were managed with CRT alone. The outcomes assessed were symptoms relief, respiratory function tests (RFT), performance status, and survival outcomes at baseline and 4 weeks of follow-up. Group A patients showed a highly significant improvement in symptoms (cough, dyspnea, and hemoptysis), RFT, 6MWD test, and arterial blood gases, compared to group B. The mean Karnofsky score increased from 57.33±5.67% at baseline to 60.67±6.39% post-EBCT (P=0.036); group A was significantly improved compared to group B (P=0.04). The Kaplan-Meier median survival for all patients was 9.7±0.4 months (95% CI= 8.86–10.54), and group A cases (10.77±0.44 months, 95% CI= 9.9–11.6) was significantly longer than that of group B cases (8.6±0.68 months, 95% CI= 7.3–9.97; T test = 2.631, P=0.011). Conclusion The use of EBCT with CRT for the management of MEBO in symptomatic patients with inoperable NSCLC is an efficient and safe procedure. EBCT improves clinical outcomes, RFT, performance status, and median survival. Trial registration ClinTrial.Gov registration: NCT04710459 on 4/3/2021.

Value of endobronchial cryotherapy in the management of malignant endobronchial obstruction in patients with inoperable NSCLC: A prospective analysis of clinical and survival outcomes

2020 ◽  
Author(s):  
Alaa Rashad ◽  
Mohamed Shahat Badawy ◽  
Mohammed Mustafa Ali ◽  
Haggagy Mansour ◽  
Mohamed Abdel Bary
Keyword(s):  
Median Survival ◽  
Performance Status ◽  
Blood Gases ◽  
University Hospital ◽  
Survival Outcomes ◽  
Safe Procedure ◽  
Karnofsky Score ◽  
Arterial Blood ◽  
Group A ◽  
Group B

Abstract Background: Malignant endobronchial obstruction (MEBO) is the most debilitating complication in non-small cell lung cancer (NSCLC). The therapeutic role of cryotherapy and its impact on survival has not been well addressed. This is to clarify whether the combination of endobronchial cryotherapy (EBCT) and chemoradiotherapy (CRT) improved the outcomes in inoperable NSCLC patients with symptomatic MEBO compared to that obtained by CRT alone.Methods: A prospective ranomized cohort study included 60 cases presented to Qena University Hospital, Egypt, between December 2016 and May 2019. Group A included 30 patients were managed with EBCT plus CRT. Group B included 30 patients were managed with CRT alone. The outcomes assessed were symptoms relief, respiratory function tests (RFT), performance status and survival outcomes at baseline and 4 weeks of follow-up.Results: Group A patients showed a highly significant improvement in symptoms, RFT, 6MWD test and arterial blood gases, compared to group B. The mean Karnofsky score increased from 57.33±5.67 % at baseline to 60.67±6.39 % post-EBCT (P=0.036); group A was significantly improved compared to group B (P=0.04). The Kaplan-Meier median survival for all patients was 9.7±0.4 months (95% CI= 8.86-10.54), and group A cases (10.77±0.44 months, 95% CI= 9.9 -11.6) was significantly longer than that of group B cases (8.6±0.68 months, 95% CI= 7.3-9.97; T-test = 2.631, P= 0.011). Conclusion: The use of EBCT with CRT for the management of MEBO in symptomatic patients with inoperable NSCLC is an efficient and safe procedure. EBCT improves the clinical outcomes, RFT, performance status and median survival.

Does size matter concerning impact of position on oxygenation status in spontaneously breathing patients with unilateral effusion?

2017 ◽  
Vol 94 (1108) ◽  
pp. 81-86 ◽  
Author(s):  
Stylianos A Michaelides ◽  
Avgerinos-Romanos Michailidis ◽  
George D Bablekos ◽  
Antonis Analitis ◽  
Maria Michalatou ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Body Position ◽  
Blood Gases ◽  
Costal Margin ◽  
Arterial Blood ◽  
Group A ◽  
Group B ◽  
Spontaneously Breathing ◽  
Size Matter ◽  
The Impact

BackgroundInconsistent and contradictory findings have appeared in the literature concerning the impact of body position on oxygenation in pleural effusion.MethodsWe attempted to elucidate whether the size of the pleural effusion in patients with no parenchymal disease is the main determinant of posture-induced alterations in oxygenation parameters. We studied 62 spontaneously breathing patients aged 65.3±7.8 years (mean±SD), of whom 36 had large and massive-sized effusions (Group A) and 26 had small and moderate-sized effusions (Group B). Arterial blood gases were determined in four different body positions: sitting (SIT), supine (SUP), ipsilateral (IPS) and contralateral (CON) to the effusion side, after remaining relaxed for at least 20 min in each position. Separation into groups A and B was deliberately set from the position of the fluid meniscus line on a posteroanterior chest film just above the upper costal margin of the sixth anterior rib. A two-way ANOVA model with outcome variables PaO2, PaCO2 and [A–a] DO2 was used.ResultsIn both groups the best oxygenation was found in SIT. The worst oxygenation (highest [A–a] DO2 value) occurred in group A in CON compared with IPS (59.4±7.6 vs 49.0±7.5 mm Hg, p<0.001) and in group B in IPS compared with CON (51.0±8.7 vs 39.5±9.2 mm Hg, p<0.001). Also, PaCO2 showed significant differences in both groups in IPS compared with CON (p=0.002).ConclusionsPatients with large-sized effusions exhibit the worst oxygenation when lying on the side contralateral to the effusion, while those with small-sized effusions exhibit the worst oxygenation when lying on the side ipsilateral to the effusion.

Vasopressor Effect of Epinephrine with and without Dopamine during Cardiopulmonary Resuscitation

1988 ◽  
Vol 22 (11) ◽  
pp. 868-872 ◽  
Author(s):  
Edgar R. Gonzalez ◽  
Joseph P. Ornato ◽  
Ronald L. Levine
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Radial Artery ◽  
Life Support ◽  
Blood Gases ◽  
High Dose ◽  
Arterial Blood ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Dose Dependent

We prospectively studied nine prehospital cardiac arrest patients (six M, three F; aged 60 ± 8 yr) to determine the vasopressor response following incremental (1, 3, and 5 mg) doses of intravenous epinephrine given 5 minutes apart with or without dopamine 15 μg/kg/min. All patients were in ventricular fibrillation on arrival of the paramedics and were not resuscitated with standard advanced cardiac life support therapy. Cardiopulmonary resuscitation (CPR) was performed with a computerized Thumper at 60 compressions/min with a 50:50 downstroke-to-upstroke ratio. All patients were intubated and received 12 ventilations/min at a fraction of inspired oxygen of 80 percent. Radial artery pressure was monitored through a #20 gauge radial artery catheter inserted by cutdown within ten minutes after arrival at the emergency room. Five patients received epinephrine alone (group A) and four received epinephrine plus dopamine (group B). The patient's age, paramedic response time, arterial blood gases, and initial diastolic blood pressure (BP) did not differ significantly between treatment groups. Baseline systolic BP was significantly higher (p < 0.01) in group B (68 ± 10 mm Hg) than in group A (35 ± 5 mm Hg). Epinephrine produced a dose-dependent vasopressor response in group A, but not in group B. In group A, peak systolic BP following epinephrine 1, 3, and 5 mg was 57 ± 20, 69 ± 23, and 76 ± 27 mm Hg, respectively (p < 0.05 for 5 mg vs. baseline). No statistically significant difference was observed among the respective values in group B (81 ± 13, 80 ± 18, and 78 ± 19 mm Hg). In group A, peak diastolic BP following epinephrine 1, 3, and 5 mg was 24 ± 8, 28 ± 16, and 31 ± 6 mm Hg, respectively (p < 0.05 for epinephrine 5 mg vs. baseline). No statistically significant difference was observed among the respective values in group B (33 ± 10, 33 ± 11, and 34 ± 13 mm Hg). Epinephrine produces a dose-dependent vasopressor response during CPR in humans. The administration of high doses of epinephrine to patients receiving high-dose dopamine does not produce an additive vasopressor response.

Regional blood flow in the brain and spinal cord of hypothermic rats

1989 ◽  
Vol 257 (3) ◽  
pp. H785-H790
Author(s):  
T. Sakamoto ◽  
W. W. Monafo
Keyword(s):  
Spinal Cord ◽  
Blood Flow ◽  
Brain Stem ◽  
Regional Blood Flow ◽  
Experimental Conditions ◽  
Pentobarbital Sodium ◽  
Arterial Blood ◽  
Group A ◽  
Group B ◽  
The Brain

[14C]butanol tissue uptake was used to measure simultaneously regional blood flow in three regions of the brain (cerebral and cerebellar hemispheres and brain stem) and in five levels of the spinal cord in 10 normothermic rats (group A) and in 10 rats in which rectal temperature had been lowered to 27.7 +/- 0.3 degrees C by applying ice to the torso (group B). Pentobarbital sodium anesthesia was used. Mean arterial blood pressure varied minimally between groups as did arterial pH, PO2, and PCO2. In group A, regional spinal cord blood flow (rSCBF) varied from 49.7 +/- 1.6 to 62.6 +/- 2.1 ml.min-1.100 g-1; in brain, regional blood flow (rBBF) averaged 74.4 +/- 2.3 ml.min-1.100 g-1 in the whole brain and was highest in the brain stem. rSCBF in group B was elevated in all levels of the cord by 21-34% (P less than 0.05). rBBF, however, was lowered by 21% in the cerebral hemispheres (P less than 0.001) and by 14% in the brain as a whole (P less than 0.05). The changes in calculated vascular resistance tended to be inversely related to blood flow in all tissues. We conclude that rBBF is depressed in acutely hypothermic pentobarbital sodium-anesthetized rats, as has been noted before, but that rSCBF rises under these experimental conditions. The elevation of rSCBF in hypothermic rats confirms our previous observations.

Comparison of Outcome of one Versus two Drains Insertion for Seroma Formation Following Modified Radical Mastectomy in Breast Carcinoma

2021 ◽  
Vol 17 (1) ◽  
pp. 52-55
Author(s):  
Shiraz Shaikh ◽  
Ambreen Munir ◽  
Shahnawaz Abro ◽  
Shahida Khatoon ◽  
Zameer Hussain Laghari ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
General Surgery ◽  
Stable Condition ◽  
Radical Mastectomy ◽  
Seroma Formation ◽  
University Hospital ◽  
P Value ◽  
Modified Radical Mastectomy ◽  
Group A ◽  
Group B

Objective: Comparative outcome of one versus two drains insertion for in the term of seroma formation following modified radical mastectomy in breast carcinoma. Methodology: This Prospective Interventional trial was conducted at Department of General Surgery, Liaquat University Hospital Hyderabad from February 2018 to January 2019.  Females with breast carcinoma admitted for modified radical mastectomy were included. Patients were divided into two groups.  Groups I underwent one drain placement and group II underwent two drains placement. All patients were observed to measure and record the volume of the fluid. Patients were discharged from Hospital in stable condition and after removal of drains, and followed up weekly for one month. Data was recorded on self-made proforma and analyzed by using SPSS-20. Results: Total of 80 patients were selected, 38 in group A and 42 in group B. Mean age of patients of group A was 49.08 ± 9.89 years and group B was 51.40 ± 13.59 years. , Excised Mass weight was lesser in group A as compared to group B. Mean volume of drain discharge was significantly higher in Group B 323.43 ± 158.88 ml, while it was in group A 230.29± 200.98, findings were statistically significant 0.013. Seroma formation was statistically insignificant among both groups as 8(21.1%) in group A and   10(23.8%) in group B, p-value 0.768. Conclusion: One-drain and two-drain insertion are equally effective to reduce the seroma formation after modified radical mastectomy; however, one drain insertion leads to more patient compliance and comfort with probably less morbidity and cost.

A Comparative Study of Epidemiology, Clinicopathologic Features and Outcome of Colorectal Cancer Patients between Ain Shams University Hospitals and Luxor International Hospital

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Tarek Hussein Kamel ◽  
Amr Lotfy Farag ◽  
Dr/Sherif Hassanin Ahmed ◽  
Chresteen Talaat Samy Hanna
Keyword(s):  
Colorectal Cancer ◽  
Comparative Study ◽  
Disease Free Survival ◽  
University Hospital ◽  
Treatment Modalities ◽  
Clinicopathologic Features ◽  
Free Survival ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Background Colorectal cancer (CRC) is one of the leading causes of mortality and morbidity in the world. It is the third most common malignancy after lung & breast and the fourth leading cause of cancer-related deaths worldwide, accounting for approximately 1,400,000 new cases and about 700,000 deaths worldwide. Objectives The aim of this retrospective study is to compare the epidemiology, clinicopathologic features, different treatment modalities and outcomes regarding disease free survival (DFS), progression free survival (PFS) & overall survival (OS) of colorectal cancer disease between cases presented to Ain shams university hospital & to Luxor international hospital in 3 consecutive years. Patients and Methods The study is retrospective comparative study. Clinical oncology department in Ain Shams University Hospital and Luxor International Hospital. The data Collected from January 2013 to December 2015. This study analyzed hospital records of patients who diagnosed with colorectal cancer (CRC) and allocated into two groups: Group A: CRC patients presented to Ain-Shams University Hospital from January 2013 to December 2015, group B: CRC patients presented to Luxor International Hospital from January 2013 to December 2015. Results There was no statistically significant difference regarding age parameter in LIH when compared to ASU, but the study was consistent with higher incidence in patients who were aged more than forty- accounted about 70.5% in all CRC cases. Cases less than 40 years old, in group A were 35.2%, while in Group B were 23.5%. Even there was no statistically significant difference but it may be attributable to more westernization in Lower Egypt. Other explanation may be due to decreased low socioeconomic status and different lifestyle factors in more developing region what increase risk of colorectal cancer. Among our cases, there is no statistically significant difference regarding gender between the two hospitals. Both sexes almost were affected equally, females appeared to be at a slightly higher risk of developing CRC cancer with current prevalence 1.3:1 in ASU group, and 1.1:1 in LIH group. Conclusion The need to increase awareness about CRC in Egypt especially upper Egypt, is recommended. An awareness campaign should be performed to promote detection of CRC at its earliest and most curable stage by recognizing early symptoms and enabling early referrals for colonoscopy. Those at higher risk should be offered more intensive surveillance. Similarity of the data from different centers suggests that this is the picture of colorectal cancer typical of Egypt.

Relationship between portal venous and hepatic arterial blood flows: spectrum of response

1990 ◽  
Vol 259 (6) ◽  
pp. G1010-G1018 ◽  
Author(s):  
T. Kawasaki ◽  
F. J. Carmichael ◽  
V. Saldivia ◽  
L. Roldan ◽  
H. Orrego
Keyword(s):  
Blood Flow ◽  
Arterial Blood Flow ◽  
Portal Vein Ligation ◽  
Artery Ligation ◽  
Blood Flows ◽  
Arterial Blood ◽  
Group A ◽  
Group B ◽  
The Relationship ◽  
Group D

The relationship between portal tributary blood flow (PBF) and hepatic arterial blood flow (HAF) was studied in awake, unrestrained rats with the radiolabeled microsphere technique. Six distinct patterns of response emerged. In group A (PBF+, HAF 0), ethanol, acetate, glucagon, prostacyclin, and a mixed diet increased PBF without a change in HAF; in group B (PBF+, HAF+), adenosine and histamine increased both PBF and HAF; in group C (PBF 0, HAF+), isoflurane and triiodothyronine did not change PBF but increased HAF; and in group D (PBF-, HAF+), halothane and vasopressin decreased PBF and increased HAF. Acute partial portal vein ligation decreased PBF (56%) and increased HAF (436%). Hypoxia (7.5% O2) decreased PBF (28%) and increased HAF (110%). In group E (PBF+, HAF-), acute hepatic artery ligation increased PBF (35%) and reduced HAF (74%), while in group F (PBF-, HAF-), thyroidectomy reduced PBF and HAF (36 and 47%, respectively). All blood flow responses were accompanied by the expected changes in both portal tributary and hepatic arterial vascular resistances. The data suggest that the portal and hepatic arterial vascular territories have regulatory mechanisms that allow for independent changes.

scholarly journals Prophylactic corneal cross-linking in LASIK surgery: effects on visual outcome and recovery time

2020 ◽  
Vol 17 (1) ◽  
pp. 61-68
Author(s):  
Dominique Clare Oh ◽  
Yiong Huak Chan ◽  
Sao Bing Lee ◽  
Jovina Li Shuen See
Keyword(s):  
Visual Acuity ◽  
Side Effects ◽  
Recovery Time ◽  
Visual Outcome ◽  
Cross Linking ◽  
Safe Procedure ◽  
Distance Visual Acuity ◽  
Visual Outcomes ◽  
Group A ◽  
Group B

Introduction: Collagen cross-linking is a useful adjunct in preventing corneal ectasia after laser-assisted in situ keratomileusis (LASIK). This study aimed to evaluate whether prophylactic cross-linking in IntraLase LASIK affects optimum visual outcome and recovery time in the immediate post-surgery period and is associated with any side effects. Methods: This was a retrospective case study on the right eyes of 100 Chinese subjects aged 18 to 40 years who underwent IntraLase LASIK. Fifty subjects who underwentcross-linking after completing LASIK (Group A) were compared with 50 subjects who did not undergo LASIK (Group B). Cases were evaluated for pre- and post-operative spherical equivalent, uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA), recovery time and presence of side effects. Results: At 1 week post-LASIK, mean (SD) UDVA of Group A subjects was poorer than Group B, at 1.05 (0.19) vs 1.17 (0.19) (p = 0.036); however, there was no significant difference in CDVA (p = 0.095). By 1 month post-LASIK, differences in both UDVA and CDVA were insignificant (p = 0.055, 0.106, respectively). Mean recovery time was 2.72 (95% confidence interval [CI] = 0.64-4.7) days longer in Group A (p = 0.010), although by 1 month post-LASIK, both groups were able to achieve CDVA equal to or better than that achieved pre-LASIK. Incidence of mild inflammation and dry eyes post-LASIK was similar in both groups (p = 1.00, 0.749, respectively); no other complications were observed. Conclusion: No differences in visual outcomes at and occurrence of side effects at 1 month post-LASIK were observed between subjects who underwent cross-linking prior to refractive surgery and those who did not. However, the group that underwent cross-linking had a slightly longer mean recovery time. Our study supports prophylactic cross-linking as a safe procedure that does not affect immediate visual outcomes among the Chinese population when used in adjunct with LASIK surgery.

scholarly journals Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study

2021 ◽  
Vol 18 (21) ◽  
pp. 11534
Author(s):  
Stefano Sartini ◽  
Laura Massobrio ◽  
Ombretta Cutuli ◽  
Paola Campodonico ◽  
Cristina Bernini ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Adverse Outcome ◽  
University Hospital ◽  
Rt Pcr ◽  
Threatening Condition ◽  
Life Threatening ◽  
Group A ◽  
Group B ◽  
The University

COVID-19 respiratory failure is a life-threatening condition. Oxygenation targets were evaluated in a non-ICU setting. In this retrospective, observational study, we enrolled all patients admitted to the University Hospital of Genoa, Italy, between 1 February and 31 May 2020 with an RT-PCR positive for SARS-CoV-2. PaO2, PaO2/FiO2 and SatO2% were collected and analyzed at time 0 and in case of admission, patients who required or not C-PAP (groups A and B) were categorized. Each measurement was correlated to adverse outcome. A total of 483 patients were enrolled, and 369 were admitted to hospital. Of these, 153 required C-PAP and 266 had an adverse outcome. Patients with PaO2 <60 and >100 had a higher rate of adverse outcome at time 0, in groups A and B (OR 2.52, 3.45, 2.01, respectively). About the PaO2/FiO2 ratio, the OR for < 300 was 3.10 at time 0, 4.01 in group A and 4.79 in group B. Similar odds were found for < 200 in any groups and < 100 except for group B (OR 11.57). SatO2 < 94% showed OR 1.34, 3.52 and 19.12 at time 0, in groups A and B, respectively. PaO2 < 60 and >100, SatO2 < 94% and PaO2/FiO2 ratio < 300 showed at least two- to three-fold correlation to adverse outcome. This may provide simple but clear targets for clinicians facing COVID-19 respiratory failure in a non ICU-setting.

Energy-Based Devices Affect the Aesthetic Outcome of Cervical Thyroidectomy and Parathyroidectomy. A Retrospective Study

2021 ◽  
Vol 39 ◽  
Author(s):  
Antonella Pino ◽  
◽  
Lorenzo Gasco ◽  
Daqi Zhang ◽  
Paolo Carcoforo ◽  
...  
Keyword(s):  
Body Dysmorphic Disorder ◽  
The Body ◽  
University Hospital ◽  
Aesthetic Outcome ◽  
Aesthetic Result ◽  
Scar Assessment ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
The Impact

Introduction: Thyroid and parathyroid diseases are very common. Most of these cases are in women and may be amenable to surgery. The patient’s perception that these are not life-threatening diseases leads them to expect an excellent aesthetic result, since the surgical incision area is clearly visible. Objective: To evaluate different scarring outcomes using three different energy-based devices (Harmonic Focus®, Johnson & Johnson, New Brunswick, NJ; Thunderbeat Open Fine Jaw®, Olympus Medical, Tokyo, Japan; LigaSure Small Jaw®, Medtronic, Dublin, Ireland) and to determine the impact of post-thyroidectomy/parathyroidectomy scars on the patient’s quality of life. Methods: One hundred female patients who underwent thyroidectomy or parathyroidectomy between September 2017 and September 2019 at the Endocrine and Minimally Invasive Surgery Department of Messina University Hospital were recruited. A retrospective analysis assessed the thickness of the cervical scar via ultrasound imaging, and the patient’s degree of satisfaction through the Patient and Observer Scar Assessment Scale (POSAS) and the Body Dysmorphic Disorder Questionnaire (BDDQ). Results: The patients were divided into three groups according to the energy-device used: group A (LigaSure SJ (n=38), group B (Harmonic F, n=32) and group C (Thunderbeat OFJ, n=30). The three groups were homogeneous with respect to number of patients, age and surgical procedures. The best aesthetic result, which correlated with the lowest scar thickness, was observed in group A; these patients were more satisfied than those in the other two groups. Moreover, correlations between scar thickness and quantitative variables (such as age or BMI) were not found in any of the groups. Conclusions: Based on the data collected and our experience, the LigaSure Small Jaw® (Medtronic) seems to offer the best aesthetic outcome in patients who undergo transverse cervicotomy for thyroid and parathyroid diseases. However, further prospective studies involving a greater number of cases are needed.

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