Magnetic marking clip for easier laparoscopic localization of small gastrointestinal tumors.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 386-386
Author(s):  
Sang Hoon Kim ◽  
Bora Keum ◽  
Han Jo Jeon ◽  
Se Hyun Jang ◽  
Kang Won Lee ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Medical Center ◽  
Gastrointestinal Tumors ◽  
Tumor Localization ◽  
Detection Time ◽  
Efficacy And Safety ◽  
Tumor Identification ◽  
Laparoscopic Trocar ◽  
Endoscopic Clipping ◽  
Intraoperative Localization

386 Background: Laparoscopic surgery for gastrointestinal tumors requires fast and precise tumor localization. As tumor palpation is not possible during laparoscopic surgery, tumor identification is often difficult for some cases. Despite various methods, such as tattooing or endo-clipping, have been introduced for the localization of tumors, these methods own clear limitations. To overcome the drawbacks of these conventional marking methods, we designed a magnetic marking device linked to an endo-clip(MMC, Magnetic Marking Clip) for endoscopy. We performed preoperative endoscopic clipping with MMC and analyzed the intraoperative localization efficacy and safety during laparoscopic surgery. Methods: Study enrolled 30 patients with gastric and colorectal neoplasms scheduled to undergo endoscopic clipping before laparoscopic surgery at the Korea University Medical Center, Korea, between August 2017 and June 2019. A silicone-coated high-power neodymium marking device (ring or rod type) was fixed together with an endo-clip and applied on the center of the lesion during preoperative endoscopy. During laparoscopic surgery, a detecting magnetic body was inserted through a laparoscopic trocar and was used to localize the tumor that is marked with MMC. The time needed for endoscopists to place MMC at the lesion, laparoscopic clip detection time and success rate were studied. Results: Endoscopists placed MMC within 30 seconds. It was possible to find MMC in all cases of laparoscopic surgery. Time needed to find the MMC laparoscopically was relatively shorter than the time conventionally taken just with an endo-clip itself. There was no reported dislodgement of the clip before the surgery or any other adverse events associated with the MMC procedure. Conclusions: The MMC method enabled simple and fast tumor localization and showed excellent outcomes in efficacy of tumor localization. The MMC method may help surgeons localize GI tumor lesions easily and safely during laparoscopic surgery.

scholarly journals Efficacy and Safety of Lenvatinib Therapy for Unresectable Hepatocellular Carcinoma in a Real-World Practice in Korea

Liver Cancer ◽  
2021 ◽  
pp. 1-11
Author(s):  
Myung Ji Goh ◽  
Joo Hyun Oh ◽  
Yewan Park ◽  
Jihye Kim ◽  
Wonseok Kang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Prognostic Factors ◽  
Disease Progression ◽  
Real World ◽  
Medical Center ◽  
Objective Response ◽  
Progression Free Survival ◽  
Efficacy And Safety ◽  
Eligibility Criteria ◽  
Unresectable Hepatocellular Carcinoma

<b><i>Background:</i></b> Lenvatinib has been recently approved as a first-line treatment option for patients with unresectable hepatocellular carcinoma (HCC) in Korea. We aimed to study the efficacy and safety of lenvatinib therapy in a real-world practice and to find prognostic factors related to survival and disease progression. <b><i>Methods:</i></b> A hospital-based retrospective study was conducted on 111 consecutive patients who had unresectable HCC and were treated with lenvatinib at Samsung Medical Center from October 2018 to March 2020. Efficacy was determined using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria in 111 patients who completed 1st tumor assessment. Safety was evaluated in 116 HCC patients including 5 patients who discontinued lenvatinib due to adverse events (AEs) before 1st tumor assessment using Common Terminology Criteria for AEs version 5.0. <b><i>Results:</i></b> A total of 111 patients with a median age of 59 years were analyzed during a median follow-up duration of 6.2 (4.4–9.0) months. The Kaplan-Meier estimate of overall survival was 10.5 months, and the median progression-free survival was 6.2 months. Based on mRECIST criteria, the objective response rate was 18.9% and disease control rate was 75.7%. AEs developed in 86/116 (74.1%) patients, and grade ≥3 AEs developed in 16/116 (13.8%) patients. Diarrhea, hand-foot skin rash, abdominal pain, hypertension, and anorexia were identified as the AEs with the highest frequencies of any grade. REFLECT eligibility criteria including tumor extent ≥50% liver occupation or inadequate bone marrow function and occurrence of anorexia were prognostic factors for survival, and occurrence of diarrhea was a favorable factor for disease progression. <b><i>Conclusion:</i></b> Lenvatinib therapy showed a favorable efficacy and safety in a real-world practice. The REFLECT eligibility criteria and specific AEs could be one of the prognostic markers.

Preoperative endoscopic clipping for rectal tumor localization in laparoscopic anterior resection

2018 ◽  
Vol 28 (6) ◽  
pp. 326-331 ◽  
Author(s):  
Jong Hee Hyun ◽  
Kyung Su Han ◽  
Byung Chang Kim ◽  
Chang Won Hong ◽  
Jae Hwan Oh ◽  
...  
Keyword(s):  
Anterior Resection ◽  
Rectal Tumor ◽  
Tumor Localization ◽  
Laparoscopic Anterior Resection ◽  
Endoscopic Clipping

Utility of Anakinra in Acute Crystalline Diseases: A Retrospective Study Comparing a University Hospital with a Veterans Affairs Medical Center

2018 ◽  
Vol 46 (7) ◽  
pp. 748-750 ◽  
Author(s):  
Julianna Desmarais ◽  
Cong-Qiu Chu
Keyword(s):  
Retrospective Study ◽  
Adverse Effects ◽  
Medical Center ◽  
Veterans Affairs ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Acute Gout ◽  
Efficacy And Safety ◽  
Inpatient Management ◽  
Gout Flares

Objective.To evaluate the efficacy and safety of anakinra in inpatient management of acute gout and pseudogout.Methods.Hospitalized patients with acute gout (n = 77) or pseudogout (n = 11) or both (n = 3) were analyzed for response to anakinra and adverse effects.Results.Half of all patients had comorbidities limiting the treatment choice. Anakinra was well tolerated, and 92% of gout flares and 79% of pseudogout flares responded to treatment.Conclusion.Anakinra is an effective and safe treatment for acute gout and pseudogout in hospitalized patients, particularly in those with comorbidities.

scholarly journals Efficacy and safety of laparoscopic surgery in the management of recurrent gynecologic malignancies

2019 ◽  
Vol 35 (2) ◽  
pp. 191-198
Author(s):  
Baku Nakakita ◽  
Saeko Yamazoe ◽  
Asuka Sakiyama ◽  
Aya Matsubayashi ◽  
Nobutaka Hayashi ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Efficacy And Safety ◽  
Gynecologic Malignancies

scholarly journals The Efficacy and Safety of Nabufen and Sufentanil in the Prevention of Visceral Pain After Gynecological Laparoscopic Surgery: A Randomised Controlled Trial

2020 ◽  
Author(s):  
Xiaoxia Gu ◽  
Jingjing Wang ◽  
Huihua Liao ◽  
Jian Mo ◽  
Weiming Huang ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Adverse Reactions ◽  
Visceral Pain ◽  
Sedation Score ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Group D ◽  
Ramsay Sedation Score

Abstract Background: To compare the efficacy and safety of different compatibility schemes in the prevention of visceral pain after gynecological laparoscopic surgery. Methods: from April 2019 to April 2020, patients undergoing elective gynecological laparoscopic surgery in our hospital were randomly divided into four groups: group A: sufentanil 3 μ g / kg; group B: low-dose nalbuphine group: 0.1 mg / kg of nabufen + 3 μ g / kg of sufentanil; group C: medium dose of nabufen group: 1 mg / kg of nabufen + 2 μ g / kg of sufentanil; group D: high-dose nabufen 2 There were 30 cases in each group. The degree of pain and the number of adverse reactions at 2, 4, 8, 12, 24 and 48 hours after operation were observed and recorded. The number and dosage of morphine used as a remedial analgesic were recorded. The pain degree was assessed by visual analogue scale (VAS). The total amount of analgesic pump used, the total number of times of pressing and the effective times of pressing were recorded. The adverse reactions included respiratory depression, nausea and vomiting, drowsiness, restlessness and skin The skin itches. Results: the analgesic effect of group B was similar to that of group A, and there was no significant difference in the number of invalid pressing, total pressing times and rescue analgesia rate (P > 0.05), while the invalid pressing times, total pressing times and remedial analgesia rate of group C and group D were significantly lower than those of group A (P < 0.05). There was no significant difference between group C and group D in the number of invalid compressions, the total number of compressions and the rate of remedial analgesia (P > 0.05), suggesting that increasing the dose of nalbuphine could not significantly increase the analgesic effect. The incidence of postoperative nausea and vomiting, skin pruritus, lethargy and Ramsay Sedation score in group B and group C were significantly lower than those in group A (P < 0.05). Ramsay Sedation score and incidence of drowsiness were lower than those in group D, which indicated that the incidence of adverse reactions was higher in group D than group B and group C.Conclusion: the combination of 1 mg / kg nabufen and 2 μ g / kg sufentanil is a safe and effective combination scheme for the prevention of visceral pain after gynecological laparoscopic surgery with small adverse reactions.Trial registration: http://www.chictr.org.cn/showproj.aspx?proj=40635Registration number：ChiCTR1900025076 . Prospectively registered on 10 August 2019.

Efficacy and safety of intravenous pamidronate for parathyroid hormone-dependent hypercalcemia in hospitalized patients

2021 ◽  
Author(s):  
Rachel Chava Rosenblum ◽  
Orit Twito ◽  
Liat Barzilay-Yoseph ◽  
Erez Ramaty ◽  
Noa Klein ◽  
...  
Keyword(s):  
Parathyroid Hormone ◽  
Serum Calcium ◽  
Medical Center ◽  
Tertiary Care ◽  
Laboratory Data ◽  
Safety Data ◽  
Kidney Injury ◽  
Efficacy And Safety ◽  
Retrospective Case ◽  
Tertiary Care Medical Center

Abstract Context Bisphosphonates are effective for hypercalcemia of malignancy (HOM). Efficacy and safety data for bisphosphonates in parathyroid hormone-related hypercalcemia (PTHRH) are rare, including pamidronate, which is not indicated for this condition. Objective To evaluate the efficacy and safety of pamidronate for moderate-to-severe PTHRH. Design Retrospective case-control study. Setting Tertiary care medical center. Patients Adults hospitalized with serum calcium levels ≥12mg/dL, 29/10/2013–17/12/2019. Interventions Etiology was categorized as PTHRH or PTH-independent. Clinical and laboratory data of PTHRH patients treated with pamidronate (PTHRH-Pam+) were compared to pamidronate-untreated counterparts (PTHRH-Pam-). Results Thirty-four patients with 37 hospitalizations for PTHRH (pamidronate-treated and untreated) met the inclusion criteria. Pamidronate was given in 24/37 cases (64.8%). Admission serum calcium levels for the PTHRH-Pam+ group were higher than for PTHRH-Pam- (14.4mg/dL vs. 13.0mg/dL, p=0.005). Median total pamidronate dose was 60mg (range 30–180mg) in the treated group. Serum calcium decreased 3.5mg/dL for PTHRH-Pam+ vs. 1.6mg/dL for PTHRH-Pam- (p=0.003). No PTHRH-Pam+ patients developed hypocalcemia or acute kidney injury. Nadir serum phosphorus levels were lower in the PTHRH-Pam+ vs. PTHRH-Pam- group (1.7mg/dL vs. 2.4mg/dL, respectively, p=0.005). Three PTHRH-Pam+ patients developed severe hypophosphatemia; all resolved with intravenous and oral supplementation. Seventeen patients underwent parathyroidectomy, of whom 10 received pamidronate within 28 days preoperatively. Post-operatively, 4 developed hypocalcemia and 3 hypophosphatemia. Conclusions This study demonstrates that pamidronate is effective and safe for treating PTHRH, while ensuring close laboratory monitoring of calcium and phosphorus metabolism. Larger, prospective studies are needed to establish the role of pamidronate and other potent bisphosphonates in moderate-to-severe PTHRH.

Selective Laparoscopic Management of Adhesive Small Bowel Obstruction Using CT Guidance

2009 ◽  
Vol 75 (3) ◽  
pp. 227-231 ◽  
Author(s):  
In Kyu Lee ◽  
Do Hyoung Kim ◽  
D. Lee Gorden ◽  
Yoon Suk Lee ◽  
Seung Eun Jung ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Medical Center ◽  
Preoperative Imaging ◽  
Adhesive Small Bowel Obstruction ◽  
Abdominal Ct ◽  
Laparoscopic Adhesiolysis ◽  
Adhesive Band

Small bowel obstruction after intra-abdominal surgery is a common cause of morbidity necessitating reoperation. The aim of this study was to determine the feasibility of and indications for laparoscopic surgery for acute adhesive small bowel obstruction (AASBO). We conducted a retrospective review of all patients with AASBO who underwent laparoscopic adhesiolysis at a major university medical center. Laparoscopic treatment was performed successfully in 16 patients, and conventional treatment was performed in 13 patients. The rate of conversion from laparoscopic to open was 16.7 per cent. In 15 of 16 total patients who underwent laparoscopic surgery, laparoscopic bandlysis was performed and one patient underwent laparoscopic adhesiolysis. Laparoscopic surgery was performed successfully in nine who had a single adhesive band demonstrated on an abdominal CT, and conventional surgery was performed in all 10 patients without a single adhesive band identified radiographically. Abdominal CT scans facilitate the selection of operative approach for AASBO based on preoperative identification of the obstruction site. Laparoscopic adhesiolysis is a safe and effective treatment modality for patients with AASBO with a single band or single transition zone identified by preoperative imaging.

Radioguided Occult Colonic Lesion Identification (Rocli) during Open and Laparoscopic Surgery

2002 ◽  
Vol 88 (3) ◽  
pp. S19-S22 ◽  
Author(s):  
R Rezzo ◽  
G Scopinaro ◽  
M Gambaro ◽  
P Michetti ◽  
G Anfossi
Keyword(s):  
Laparoscopic Surgery ◽  
Open Surgery ◽  
Gamma Probe ◽  
Colon Surgery ◽  
Colonic Lesion ◽  
Clinical Method ◽  
Intraoperative Detection ◽  
Inflammatory Bowel ◽  
Endoscopic Marking ◽  
Intraoperative Localization

Aims and Background Intraoperative localization, during open and laparoscopic surgery, of small, nonpalpable colonic lesions located at peculiar sites or with concurrent inflammatory bowel alterations (diverticulosis, perivisceritis) is often difficult. The aim of our work was to assess the validity of radioguided identification after preoperative labeling. Methods and Study Design Patients who were candidates for colon surgery for occult lesions that, because of their size and location, were assumed to be difficult to detect, underwent colonoscopy 1 to 2.5 hours before surgery. A small dose of labeled albumin macroaggregates was injected with a sclerotherapy needle into the subserosa underneath the lesion. Immediately following injection the lesion was identified with a transcutaneously placed gamma detecting probe. Intraoperative tracer detection was performed either during open surgery or by means of a laparoscopic probe (detection time 3-5 mins). The position of the lesion was marked with a suture or with a clip. Surgery was performed according to the type of lesion to be treated. Results In our initial clinical experience 15 colon lesions were preoperatively marked in 14 patients and were subsequently detected during surgery (four under laparoscopy) with a gamma detecting probe. This technique allows highly accurate, fast, and inexpensive surgical localization of lesions without irradiation and without complications. Conclusion Our experience shows that preoperative endoscopic marking of nonpalpable colon lesions with 99mTc-labeled albumin macroaggregates followed by intraoperative detection with a gamma probe is a useful clinical method that is highly accurate and without complications.

scholarly journals P15 Lacosamide monitoring in the serum of children with refractory epilepsy

2019 ◽  
Vol 104 (6) ◽  
pp. e23.1-e23 ◽  
Author(s):  
N Kronenfeld ◽  
E Kohn ◽  
M Lezinger ◽  
N Brandriss ◽  
E Heyman ◽  
...  
Keyword(s):  
Serum Concentration ◽  
Refractory Epilepsy ◽  
Medical Center ◽  
Serum Levels ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
Trough Serum ◽  
Median Plasma ◽  
Antiepileptic Medications ◽  
Serum Monitoring

BackgroundLacosamide is indicated for various types of refractory epilepsy and as adjunctive therapy to other antiepileptic medications. Data on monitoring serum levels of lacosamide in pediatric patients is scarce.ObjectiveTo evaluate the correlation between serum levels of lacosamide and the tolerability in children with refractory epilepsy.MethodsThe medical records of 22 children with refractory epilepsy treated with lacosamide at Assaf Harofeh Medical Center were reviewed. Trough serum levels of lacosamide was measured using HPLC and correlated with its efficacy and safety.ResultsMean age of the children was 11 ± 4 (3–18) years. Median lacosamide daily dose was 9.3 (6.6–11) mg/kg and median plasma concentration was 7.1 (5.9–11.9) ug/ml. The therapeutic range of lacosamide serum concentration is 10 to 20 ug/ml. No change in seizures frequency was reported in 21.4% of children with lacosamide concentrations below 10 ug/ml. However, in 40% of the children, reduction of the seizures frequency was reported when serum concentration was above 10 ug/ml. No serious adverse events were reported during therapy. The prospective part of the study was initiated, and the first patients were recruited.ConclusionLarge studies, preferably prospective, on lacosamide serum monitoring including information on correlation with efficacy and safety are warranted.Disclosure(s)Nothing to disclose

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