Comparative analysis of surgery for acute cholecystitis: before and after national recommendations acceptance

Aim. To determine the ways to reduce postoperative morbidity and mortality in acute cholecystitis. Material and metods. Retrospective (2013–2014 years) and prospective non-randomized (2015–2016) analysis of outcomes in 804 patients with acute cholecystitis was performed. Analysis was carried out within two periods – before and after acceptance of national clinical recommendations “Acute cholecystitis” (2015). Protocols of diagnosis and treatment developed by our clinic were applied in the first period (2013–2014). 220 patients (group I) underwent surgery in the first period, 290 (group II) – in the second period. Results. There was significantly reduced incidence of conversions for laparoscopic and minimally invasive cholecystectomy from 4.09% to 2.41% (p < 0.05) (OR – 1.724; 95% CI 0.632–4.705). Incidence of extrahepatic bile ducts lesion, postoperative thrombotic, thromboembolic complications, cardiovascular complications (including myocardial infarction) were similar in both groups (p > 0.05) (for cardiovascular complications OR – 0.758, 95% CI 0.047–12.183). There was reduced length of hospital-stay from 11.5 ± 0.8 to 9 ± 0.5 days (p < 0.05). Slight augmentation of postoperative mortality in the second period (from 0.45% to 1.37%) was observed (p < 0.05) (OR – 3.063, 95% CI 0.340–27.599). Conclusion. Reduced number of conversions was predominantly caused by cholecystectomy in patients with milder gallbladder inflammation. It is explained by earlier surgery (within 24–48 h) when severe infiltration of surrounding tissues is absent. Preoperative prolonged medication (3–5 days) aggravates these processes, creates significant intraoperative technical difficulties and increases incidence of conversions.

Download Full-text

Centralisation of Oesophagogastric Cancer Services: Can Specialist Units Deliver?

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x130624 ◽

2006 ◽

Vol 88 (6) ◽

pp. 566-570 ◽

Cited By ~ 26

Author(s):

MJ Forshaw ◽

JA Gossage ◽

J Stephens ◽

D Strauss ◽

AJ Botha ◽

...

Keyword(s):

Postoperative Morbidity ◽

Survival Rates ◽

Length Of Hospital Stay ◽

High Volume ◽

Cardiovascular Complications ◽

Pulmonary Complications ◽

Minimal Impact ◽

Cancer Services ◽

Clinically Significant ◽

Oesophagogastric Cancer

INTRODUCTION Oesophagogastric cancer surgery is increasingly being performed in only centralised units. The aim of the study was to examine surgical outcomes and service delivery within a specialist unit. PATIENTS AND METHODS The case notes of all patients undergoing attempted oesophagogastrectomy between January 2000 and May 2003 were identified from a prospective consultant database. RESULTS A total of 187 patients (median age, 63 years; range, 29–83 years; M:F ratio, 3.9:1) underwent attempted oesophagogastrectomy. Of these, 91% were seen within 2 weeks of referral and treatment was instituted after a mean of 31 days (range, 1–109 days). More patients underwent surgery (63%) than neoadjuvant therapy (56%) within 1 month of referral. The main indication for surgery was invasive malignancy in 166 patients (89%). The 30-day mortality was 0.5% (1 death) and in-hospital mortality was 1.1% (2 deaths). The median length of hospital stay was 14 days (range, 7–69 days). Significant postoperative morbidity included: pulmonary complications (36%), cardiovascular complications (16%), wound infection (13%) and clinically significant anastomotic leaks (7%). Of the study group, 28 patients (15%) were admitted to ICU with a median stay of 10 days (range, 1–44 days); this accounted for 0.9% of ICU bed availability. Twelve patients (6.4%) were returned to theatre, most commonly for bleeding. The 1-year survival rates were 78%. During 2002–2003, national waiting list targets for both hernia repair and cholecystectomy were achieved. CONCLUSIONS Despite recent increases in workload, high volume specialist units can deliver an efficient and timely service with both good treatment outcomes and minimal impact upon elective surgical waiting lists and ICU provision.

Download Full-text

Extended Postoperative Antibiotics Versus No Postoperative Antibiotics in Patients Undergoing Emergency Cholecystectomy for Acute Calculous Cholecystitis: A Systematic Review and Meta-Analysis

Surgical Innovation ◽

10.1177/1553350619835347 ◽

2019 ◽

Vol 26 (4) ◽

pp. 485-496 ◽

Cited By ~ 1

Author(s):

Shahab Hajibandeh ◽

Petya Popova ◽

Sheik Rehman

Keyword(s):

Postoperative Morbidity ◽

Postoperative Mortality ◽

Length Of Hospital Stay ◽

Surgical Site Infections ◽

Infectious Complications ◽

Acute Calculous Cholecystitis ◽

Antibiotic Group ◽

Tract Infections ◽

Emergency Cholecystectomy ◽

Calculous Cholecystitis

Objectives. To compare the outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy. Methods. We performed a systematic review and conducted a search of electronic information sources to identify all randomized controlled trials comparing outcomes of extended postoperative antibiotics versus no postoperative antibiotics in patients with acute calculous cholecystitis undergoing emergency cholecystectomy. Postoperative infectious complications and surgical site infections were primary outcome measures. The secondary outcome measures included postoperative morbidity, postoperative noninfectious complications, urinary tract infections, pneumonia, length of hospital stay, postoperative mortality, and need for readmission. Random or fixed effects modeling was applied to calculate pooled outcome data. Results. Four randomized controlled trials enrolling 953 patients were identified. The included populations in the extended antibiotic group and no antibiotic group were comparable in terms of baseline characteristics. There was no difference between the 2 groups in terms of postoperative infectious complications (odds ratio [OR] =0.94, P = .79), surgical site infections (OR = 1.13, P = .72), postoperative morbidity (OR = 0.93, P = .70), postoperative noninfectious complications (OR = 0.85, P = .57), urinary tract infections (OR = 0.69, P = .55), pneumonia (OR = 0.33, P = .14), length of hospital stay (mean difference = 0.78, P = .25), postoperative mortality (risk difference = −0.00, P = .65), and need for readmission (OR = 0.87, P = .70). Conclusions. Our results suggest that extended postoperative antibiotic therapy does not improve postoperative infectious or noninfectious outcomes in patients with mild or moderate acute calculous cholecystitis undergoing emergency cholecystectomy. Postoperative antibiotics should not be routinely used and should be preserved only for selected cases.

Download Full-text

Laparoscopic versus open distal pancreatectomy: a single centre propensity score matching analysis

Updates in Surgery ◽

10.1007/s13304-021-01039-x ◽

2021 ◽

Author(s):

Riccardo Casadei ◽

Carlo Ingaldi ◽

Claudio Ricci ◽

Laura Alberici ◽

Emilio De Raffele ◽

...

Keyword(s):

Propensity Score ◽

Hospital Stay ◽

Distal Pancreatectomy ◽

Pancreatic Neoplasms ◽

Postoperative Morbidity ◽

Laparoscopic Approach ◽

Length Of Hospital Stay ◽

Single Centre ◽

Oncological Outcomes ◽

Open Distal Pancreatectomy

AbstractThe laparoscopic approach is considered as standard practice in patients with body-tail pancreatic neoplasms. However, only a few randomized controlled trials (RCTs) and propensity score matching (PSM) studies have been performed. Thus, additional studies are needed to obtain more robust evidence. This is a single-centre propensity score-matched study including patients who underwent laparoscopic (LDP) and open distal pancreatectomy (ODP) with splenectomy for pancreatic neoplasms. Demographic, intra, postoperative and oncological data were collected. The primary endpoint was the length of hospital stay. The secondary endpoints included the assessment of the operative findings, postoperative outcomes, oncological outcomes (only in the subset of patients with pancreatic ductal adenocarcinoma-PDAC) and total costs. In total, 205 patients were analysed: 105 (51.2%) undergoing an open approach and 100 (48.8%) a laparoscopic approach. After PSM, two well-balanced groups of 75 patients were analysed and showed a shorter length of hospital stay (P = 0.001), a lower blood loss (P = 0.032), a reduced rate of postoperative morbidity (P < 0.001) and decreased total costs (P = 0.050) after LDP with respect to ODP. Regarding the subset of patients with PDAC, 22 patients were analysed: they showed a significant shorter length of hospital stay (P = 0.050) and a reduction in postoperative morbidity (P < 0.001) after LDP with respect to ODP. Oncological outcomes were similar. LDP showed lower hospital stay and postoperative morbidity rate than ODP both in the entire population and in patients affected by PDAC. Total costs were reduced only in the entire population. Oncological outcomes were comparable in PDAC patients.

Download Full-text

Bilateral Nephrectomy in Patients with Autosomal Dominant Polycystic Kidney Disease and End-Stage Chronic Renal Failure

Nephron ◽

10.1159/000513168 ◽

2021 ◽

pp. 1-7

Author(s):

Alexander E. Lubennikov ◽

Nicolay V. Petrovskii ◽

German E. Krupinov ◽

Evgeniy M. Shilov ◽

Roman N. Trushkin ◽

...

Keyword(s):

Kidney Disease ◽

Large Bowel ◽

Elective Surgery ◽

Length Of Hospital Stay ◽

Bowel Injury ◽

Polycystic Kidney ◽

Group I ◽

Group Ii ◽

Autosomal Dominant Polycystic Kidney ◽

End Stage

Background: In patients with autosomal dominant polycystic kidney disease (ADPKD) and end-stage kidney disease, bilateral nephrectomy (BN) is currently performed predominantly via the laparoscopic approach. We analysed the results of BN depending on the approach and preoperative and perioperative factors. Patients and Methods: This was a single-centre retrospective study carried out from April 2010 to March 2020, including a total of 142 patients presenting with ADPKD who were treated by BN. Of these, 108 patients meeting the inclusion criteria were selected to analyse the results. We compared therapeutic outcomes depending on the surgical approach (laparotomy or laparoscopy) and the type of the operation (emergent or elective). Results: Of the 108 eligible patients, 36 (group I) underwent laparoscopic BN and the remaining 72 patients (group II) were subjected to midline laparotomy. Sixty-nine patients underwent elective surgery and 39 endured emergent operations. The most frequent indications (87 patients, 80.6%) for surgical treatment were urinary tract infection and infected cysts. The median length of hospital stay for group I and group II patients amounted to 8 days (IQR: 7.5–9) and 12.5 days (IQR: 9–16.5), respectively (p < 0.001). However, comparing the patients operated on electively, the actual difference in the length of hospital stay was inconsiderable: median 8 days (IQR: 7–9) in group I and 9 days (IQR: 9–11.5) in group II. The median duration of the operation was significantly (p < 0.001) longer in group I amounting to 217.5 min (IQR: 197.5–305) than in group II equalling 115 min (IQR: 107.5–145). The frequency of postoperative complications, lethal outcomes, and blood loss volume did not statistically significantly differ depending on the surgical approach. Only patients operated on emergency underwent releparotomy due to intraoperative large bowel injury. Lethal outcomes (n = 18, 16.7%) after surgery were observed only in emergent patients. Sepsis prior to surgery, systemic inflammation response syndrome (SIRS) with the CRP level above 173 mg/mL, prolonged preoperative antibacterial therapy, and undiagnosed large bowel injury were associated with a lethal outcome after BN. Conclusion: The results of open and laparoscopic BN in elective surgery were comparable. Emergency operations for infected renal cysts and SIRS were associated with increased incidence of large bowel injury and lethal outcomes.

Download Full-text

Perinatal Profile of Twin Pregnancies: A Retrospective Review of 11 Years (1969–1979) at Hôpital Notre-Dame, Montréal, Canada

Acta geneticae medicae et gemellologiae twin research ◽

10.1017/s0001566000008242 ◽

1982 ◽

Vol 31 (3-4) ◽

pp. 157-163 ◽

Cited By ~ 6

Author(s):

Marie-Françoise Desgranges ◽

Xavier De Muylder ◽

Jean-Marie Moutquin ◽

Francisco Lazaro-Lopez ◽

Bernard Leduc

Keyword(s):

Perinatal Mortality ◽

Perinatal Care ◽

Fetal Mortality ◽

Ultrasound Technique ◽

Intrauterine Growth ◽

Before And After ◽

The Impact ◽

Second Period ◽

Twin Pregnancies ◽

Main Factor

Four hundred and thirty four twins occurring in 220 women were studied during a period of 11 years (1969–1979) at Notre-Dame Hospital.Perinatal mortality (< 28 days) was compared before and after 1974, and the impact of ultrasound technique upon perinatal outcome was assessed during the second period (1974–1979). The main factor associated with perinatal mortality was low birth weight caused by either prematurity or intrauterine growth retardation.While fetal mortality remained unchanged within the two study periods, neonatal mortality decreased from 68.2/1,000 to 28.9/1,000 mainly due to increased survival rate of twins below 1,500 g at birth.With identical perinatal care during the same period, perinatal mortality and incidence of intrauterine growth-retarded twins remained unchanged despite early diagnosis by ultrasound.

Download Full-text

Endothelin effects in isolated, perfused lamb lungs: role of cyclooxygenase inhibition and vasomotor tone

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1991.261.2.h443 ◽

1991 ◽

Vol 261 (2) ◽

pp. H443-H450 ◽

Cited By ~ 2

Author(s):

H. Toga ◽

J. Usha Raj ◽

R. Hillyard ◽

B. Ku ◽

J. Anderson

Keyword(s):

Vasomotor Tone ◽

Cyclooxygenase Inhibition ◽

Group Iii ◽

Group I ◽

Before And After ◽

Pulmonary Arterial ◽

Group Ii ◽

Sites Of Action ◽

Arteries And Veins

We have determined the sites of action of endothelin-1 (ET) in the lamb pulmonary circulation. The influence of cyclooxygenase inhibition and baseline vasomotor tone on ET effects was also studied. Lungs of 14 lambs (6-9 wk of age, 12.1 +/- 0.6 kg body wt) were isolated and perfused with blood. Group I lungs (n = 5) were untreated, group II lungs (n = 5) were treated with indomethacin to inhibit cyclooxygenase, and group III lungs (n = 4) were treated with indomethacin and a thromboxane A2 analogue, U-46619, to elevate vasomotor tone. All lungs were perfused with constant flow in zone 3, with left atrial and airway pressures being 8 and 6 cmH2O, respectively. We measured pulmonary arterial pressure and, by the micropuncture servo-null method, pressures in 20- to 50-microns diameter subpleural venules, both before and after each dose of ET was infused (50, 100, 250, and 500 ng/kg). Group I lungs, with high baseline vasomotor tone, exhibited a biphasic response to ET; 50-100 ng/kg of ET dilated both arteries and veins, whereas 500 ng/kg of ET constricted both arteries and veins. In group II lungs with low vasomotor tone, all doses of ET caused constriction of arteries only. In group III lungs (indomethacin treated with elevated vasomotor tone), 50-100 ng/kg of ET caused dilation of arteries and veins, whereas 500 ng/kg of ET induced constriction, this time only in arteries. We conclude that ET has both dilator and constrictor effects in arteries and veins of isolated, perfused lamb lungs. ET-induced arterial and venous dilation is dependent on initial vasomotor tone but not on cyclooxygenase metabolites.(ABSTRACT TRUNCATED AT 250 WORDS)

Download Full-text

Effect of Virtual Reality‐Based Rehabilitation on Physical Fitness in Patients with Chronic Obstructive Pulmonary Disease

Journal of Human Kinetics ◽

10.2478/hukin-2019-0022 ◽

2019 ◽

Vol 69 (1) ◽

pp. 149-157 ◽

Cited By ~ 3

Author(s):

Sebastian Rutkowski ◽

Anna Rutkowska ◽

Dariusz Jastrzębski ◽

Henryk Racheniuk ◽

Witold Pawełczyk ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Virtual Reality ◽

Physical Fitness ◽

Pulmonary Disease ◽

Training Group ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Group I ◽

Before And After ◽

Group Ii

Abstract The aim of the study was to evaluate the effects of rehabilitation in patients with chronic obstructive pulmonary disease (COPD) using the Kinect system during stationary rehabilitation. The study included 68 patients with COPD (35 men, 33 women, mean age 61.3 ± 3.7). The subjects were randomly assigned to one of the two experimental groups described below. Group I included 34 patients – non‐participants in Kinect training. Group II included 34 patients – participants in Kinect training. In all patients before and after rehabilitation physical fitness was assessed using the Senior Fitness Test (SFT). The Xbox 360 and Kinect motion sensor were used to carry out virtual reality training. In group I, statistically significant improvements in SFT performance were observed. Patients in group II also showed statistically significant improvement in physical fitness in all attempts of the SFT. Virtual rehabilitation training in patients with COPD seems to be a practical and beneficial intervention capable of enhancing mobility and physical fitness.

Download Full-text

Binocular responses and vertical strabismus

Vojnosanitetski pregled ◽

10.2298/vsp0702109r ◽

2007 ◽

Vol 64 (2) ◽

pp. 109-115 ◽

Cited By ~ 1

Author(s):

Dusica Risovic ◽

Lidija Petrovic ◽

Natalija Kosanovic-Jakovic ◽

Katarina Misailovic ◽

Branislav Stankovic ◽

...

Keyword(s):

Binocular Vision ◽

Oblique Muscle ◽

Common Pattern ◽

Inferior Oblique Muscle ◽

Group I ◽

Significant Difference ◽

Before And After ◽

Group Ii ◽

Sensory Tests ◽

Dissociated Vertical Deviation

Background/Aim. Elevation in adduction is the most common pattern of vertical strabismus, and it is mostly treated with surgery. The results of weaking of inferior oblique muscle are very changeable. The aim of this study was to evaluate binocular vision using sensory tests before and one and six months after the surgery. Methods. A total of 79 children were divided in two groups: the first, with inferior oblique muscle of overaction (n = 52), and the second with dissociated vertical deviation (DVD), and primary inferior oblique muscle overaction (n = 27). We tested them by polaroid mirror test (PMT), Worth test at distance and near, fusion amplitudes on sinoptofore, Lang I stereo test and Wirt-Titmus stereo test. We examined our patients before and two times after the surgery for vertical strabismus. Results. Foveal suppression in the group I was found in 60.5% of the patients before, and in 56.4% after the surgery. In group II Foveal suppression was detected in 64.7% of the patients before, but in 55.6% 6 months after the surgery with PMT. Worth test revealed suppression in 23.5% of the patients before, and in 40.7% after the vertical muscle surgery. Parafoveal fussion persisted in about 1/3 of the patients before the surgery, and their amplitudes were a little larger after the surgery in the group I patients. Lang I stereo test was negative in 53.9% before and 51.9% after the surgery in the group I, and in 48.2% of the patients before and after the surgery in the group II patients. Wirt-Titmus stereo test was negative in 74.5% of the patients before and in 72.9% after the surgery in the group I, but in the group II it was negative in 70.8% before and in 68.0% of the patients 6 months after the surgery. Conclusion. Binocular responses were found after surgery in 65.7% of the patients the group I and in 55.6% patients the group II. There was no significant difference between these two groups, but binocular responses were more often in the patients of the group I.

Download Full-text

Consent for the discontinuation of life-prolonging treatment in cancer patients: a retrospective comparative analysis before and after the enforcement of the Life Extension Medical Decision law

10.21203/rs.3.rs-118257/v1 ◽

2020 ◽

Author(s):

YuJin Chung ◽

JinHo Beom ◽

JiEun Lee ◽

Incheol Park ◽

Junho Cho

Keyword(s):

Emergency Room ◽

Hospital Stay ◽

Cancer Patients ◽

Average Length ◽

Length Of Hospital Stay ◽

Life Extension ◽

Medical Decision ◽

Patient Consent ◽

Before And After ◽

The Law

Abstract Background The Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of nonsensical life-prolonging treatment, and its enactment raised big controversy in Korean society. However, there is no study on whether the actual life-prolonging treatment for patients has decreased after enforcing the law. This study aimed to compare the provision of patient consent before and after the enforcement of the law among cancer patients who visited a tertiary university hospital's emergency room to understand the effects of the law on cancer patients' clinical care. Methods This retrospective single cohort study included advanced cancer patients over 19 years of age who visited the emergency room at a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the average length of hospital stay. The consent rate for cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes. Results The average length of hospital stay decreased after the law was enforced, from 4 days to 2 days (p= 0.001). The rates of direct transfers to secondary and nursing hospitals increased from 8.2% to 21.2% (p=0.001) and from 1.0% to 9.7%, respectively (p<0.001). The rate of provision of consent for admission to the ICU decreased from 6.7% to 2.3% (p=0.032). For CPR and CRRT, the rate of provision of consent decreased from 1.0% to 0.0% and from 13.9% to 8.8%, respectively, but the differences were not significant (p=0.226 and p=0.109, respectively). Conclusion According to previous research, for patients wishing only conservative treatment, the reduction in hospital stays at tertiary hospitals ultimately reduces the physical, emotional, financial burdens and also improves the quality of end-of-life at home or in a hospice facility. In this context, this research ultimately show that the purpose of the LEMD law has been achieved. Further research in several hospitals including those patients who completed the consent after hospitalization is needed to generalize the clinical implication of the LEMD law.

Download Full-text

EFFECT OF SKY YOGA AND PRANAYAMA ON EMOTION AMONG COLLEGE GIRLS

10.36106/gjra/1006268 ◽

2019 ◽

pp. 1-2

Author(s):

S. Neelavathy ◽

R. P. Balasubramania

Keyword(s):

The State ◽

Psychological Effects ◽

Control Group ◽

Not Given ◽

Psychological Change ◽

Group I ◽

State Of Mind ◽

Before And After ◽

Post Test ◽

Experimental Group

Emotion is the ability of a person to express the state of mind which he is, but when a person is mentally, physically, emotionally, and spiritually unstable results in a psychological change and helpless on situations. The purpose of the study was to nd out Effect of SKY yoga and pranayama on emotion among college girls .To achieve the purpose of the study 45 College girls were selected randomly from Coimbatore as the subjects. The subject's age ranged from 18 to 21 years. . The selected subjects were divided into 3 groups. Experimental Group I under went on sky yoga only & Experimental Group II went on pranayama only for 50 minutes per day, six days a week for 12 weeks. The control group was not given any practice. The pre-test and post-test were conducted before and after the training for all three groups. The data collected from the groups before and after the training period were statistically analysed by using Analysis of Co-Variance (ANACOVA) to determine the signicant difference and tested at 0.05 level of signicance. The result of the study showed that there was signicant improvement in the emotion of the Experimental Groups I, II subjects than the Controlled group. Through the SKY yoga and Pranayama Emotion got controlled. The conclusion was that SKY yoga controlled emotions and got reduced the psychological effects depression and stress etc. among college girls.

Download Full-text