scholarly journals Interventional radiology in rendezvous technique for choledocholitiasis in elderly patients

2021 ◽  
Vol 26 (3) ◽  
pp. 52-59
Author(s):  
O. I. Okhotnikov ◽  
V. D. Lutsenko ◽  
M. V. Yakovleva ◽  
O. S. Gorbacheva ◽  
S. N Grigoriev ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Elderly Patients ◽  
Statistical Significance ◽  
Control Point ◽  
Endoscopic Intervention ◽  
Rendezvous Technique ◽  
Group I ◽  
Biliary Pathology ◽  
Group Ii ◽  
Transhepatic Access

Aim. Define the safety and effectiveness of rendezvous technique for choledocholithiasis.Material and methods. We performed a retrospective and prospective analysis of the results in percutaneous transhepatic access to the bile ducts and endoscopic intervention in the rendezvous technique for choledocholithiasis in 100 elderly patients. The patients were divided into 2 groups for 50 people. The implementation of the rendezvous began from the antegrade stage in patients from group I; in patients of group II – from the retrograde stage. Postmanipulation complications and failures were When analyzed. The control point of the study is the identification of complications associated with manipulation from the next stages of the rendezvous technique.Results. We revealed a direct dependence of the results in sequence of rendezvous technique for elderly patients with choledocholithiasis and obstructive jaundice. This fact allows recommending percutaneous transhepatic access before endoscopic intervention for these patients with statistical significance. The frequency of complications and failures in patients of group I was 18%, in group II – 52%. This allows for such patients percutaneous transhepatic access before endoscopic intervention in the rendezvous technique. The frequency of complications and failures in patients of group I was 18%, in group II – 52%.Conclusion. Dilatation of intrahepatic segmental and subsegmental 2 and 3 biliary ducts with moderate and severe obstructive jaundice is a predictor of complications with ineffective endoscopic approach. In such situations, preventive antegrade drainage of the biliary tract with rendezvous technique makes possible to prevent cholangitis, effectively eliminate biliary hypertension, clarify the severity of stenosis of the papilla with antegrade balloon revision, and also secure delayed endoscopic resolution of biliary pathology.

Comparison of a PGA Sheet with a Commercial ePTFE Sheet as a Staple-Line Reinforcement in Lung Surgery

2007 ◽  
Vol 342-343 ◽  
pp. 849-852
Author(s):  
Keon Hyeon Jo ◽  
Seok Whan Moon ◽  
Young Du Kim ◽  
Young Jo Sa ◽  
Si Young Choi ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Polyglycolic Acid ◽  
Lung Surgery ◽  
Resection Margins ◽  
Air Leakage ◽  
Staple Line Reinforcement ◽  
Group I ◽  
Significant Difference ◽  
Similar Threshold ◽  
Group Ii

To prevent prolonged air leakage after lung surgery, we developed a biodegradable polyglycolic acid (PGA) sheet and compared it with an expanded polytetrafluoethylene (ePTFE). Eighteen adult mongrel dogs were used in this experiment. The airway pressures at which air first leaked at the stapled resection margins were measured immediately after surgery in group I (N=5), 2 days after surgery in group II (N=5), and 7 days after surgery in group IIII (N=5), Based on the presence of SLR, there were 3 subgroups in each group: there was no SLR in subgroup a; ePTFE in subgroup b; PGA sheet in subgroup c. The histologic examination was performed 2 months after surgery (N=3). In group I, there was a significant difference in air leakage pressures (mm Hg) between no reinforcement and SLR. We observed the same results in group II and III with statistical significance. However, there was no significant difference between the reinforcement groups. The histologic findings demonstrated more severe adhesions and biodegradation in the dogs in which the PGA sheet was used. Our PGA sheet was considered a useful reinforcement material, because it had a similar threshold for air leakage with the ePTFE with excellent biodegradation.

scholarly journals Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty

2020 ◽  
Vol 27 (1) ◽  
pp. 31-35
Author(s):  
K. Yu. Ukolov ◽  
V. L. Ayzenberg ◽  
M. V. Kapirina ◽  
M. E. Mikitina
Keyword(s):  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Knee Arthroplasty ◽  
Hip Arthroplasty ◽  
Postoperative Nausea And Vomiting ◽  
Anaesthetic Agents ◽  
Group I ◽  
Primary Knee Arthroplasty ◽  
Group Ii ◽  
Knee And Hip Arthroplasty

Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic. Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement. Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups. Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups. Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.

scholarly journals Impact of Age on Short- and Long-Term Outcomes after Pancreatoduodenectomy for Periampullary Neoplasms

2020 ◽  
Vol 2020 ◽  
pp. 1-6 ◽  
Author(s):  
Mario Gruppo ◽  
Francesca Tolin ◽  
Boris Franzato ◽  
Pierluigi Pilati ◽  
Ylenia Camilla Spolverato ◽  
...  
Keyword(s):  
Overall Survival ◽  
Elderly Patients ◽  
Adjuvant Treatment ◽  
Long Term Outcomes ◽  
Group I ◽  
Periampullary Neoplasms ◽  
Short And Long Term ◽  
Group Ii ◽  
The Impact

Background. Although mortality and morbidity of pancreatoduodenectomy (PD) have improved significantly over the past years, the impact of age for patients undergoing PD is still debated. This study is aimed at analyzing short- and long-term outcomes of PD in elderly patients. Methods. 124 consecutive patients who have undergone PD for pancreas neoplasms in our center between 2012 and 2017 were analyzed. Patients were divided into two groups: group I (<75 years) and group II (≥75 years). Demographic features and intraoperative and clinical-pathological data were collected. Primary endpoints were perioperative morbidity and mortality; complications were classified according to the Clavien-Dindo Score. Secondary endpoints included feasibility of adjuvant treatment and overall survival rates. Results. A total of 106 patients were included in this study. There were 73 (68.9%) patients in group I and 33 (31.1%) in group II. Perioperative deceases were 4 (3.6%), and postoperative pancreatic fistulas were 34 (32.1%). Significant difference between two groups was demonstrated for the ASA Score (p=0.004), Karnofsky Score (p=0.025), preoperative jaundice (p=0.004), and pulmonary complications (p=0.034). No significance was shown for diabetes, radicality of resection, stage of disease, operative time, length of stay, postoperative complications according to the Clavien-Dindo Score, postoperative mortality, pancreatic fistula, and reoperation rates. 69.9% of the patients in group I underwent adjuvant treatment vs. 39.4% of the older ones (p=0.012). Mean overall survival was 28.5 months in group I vs. 22 months in group II (p=0.909). Conclusion. PD can be performed safely in elderly patients. Advanced age should not be an absolute contraindication for PD, even if greater frailty should be considered. The outcome of elderly patients who have undergone PD is similar to that of younger patients, even though adjuvant treatment administration is significantly lower, demonstrating that surgery remains the main therapeutic option.

Ventilation and thoracoabdominal asynchrony during halothane anesthesia in infants

1993 ◽  
Vol 74 (4) ◽  
pp. 1591-1596 ◽  
Author(s):  
M. Benameur ◽  
M. D. Goldman ◽  
C. Ecoffey ◽  
C. Gaultier
Keyword(s):  
Tidal Volume ◽  
Minute Ventilation ◽  
Statistical Significance ◽  
Age Group ◽  
Halothane Anesthesia ◽  
Minimal Alveolar Concentration ◽  
Group I ◽  
Wall Compliance ◽  
Group Ii ◽  
Thoracoabdominal Asynchrony

To evaluate the ventilatory consequences of high chest wall compliance during anesthesia in infants, we assessed the effects of halothane at different fractions of minimal alveolar concentration (0.75, 1.0, and 1.5 MAC) on ventilation and movements of the rib cage and abdomen in infants < or = 12 mo of age (group I) and children (group II) > or = 12 mo of age. Minute ventilation decreased in group I, (20.6%, 0.75 to 1.5 MAC), but the change in group II did not reach the level of statistical significance. Tidal volume decreased with halothane level between 0.75 and 1.5 MAC, and its fall was greater in group I (32.7 +/- 11.2 vs. 22.6 +/- 9.3% in group II, P < 0.05). Duty cycle, or ratio of inspiratory to total time (TI/TT), increased in group II with halothane level but did not change in group I, resulting in a decreased TI in group I at higher halothane levels. Thoracic paradox increased with halothane level in group I but not group II. The increase in thoracic paradox in association with the fall in tidal volume between 0.75 and 1.5 MAC was greater in group I than group II (P < 0.05). We conclude that smaller infants depend more on inspiratory intercostal muscle activity to stabilize the thorax, leading to a greater degree of depression of ventilation during halothane depression of inspiratory intercostal activity.

scholarly journals Education in plastic surgery: Are we headed in the right direction?

2014 ◽  
Vol 47 (01) ◽  
pp. 109-115 ◽  
Author(s):  
Nishant Khare ◽  
Vinita Puri
Keyword(s):  
Plastic Surgery ◽  
Statistical Significance ◽  
Maxillofacial Surgery ◽  
Aesthetic Surgery ◽  
Microvascular Surgery ◽  
Chi Square ◽  
Surgery Group ◽  
Group I ◽  
Group Ii ◽  
And Training

ABSTRACT Introduction: Plastic surgery in India is in an era of transition. The speciality faces many challenges as it grows. The present study attempts to identify these challenges and the prevalent mood among the teachers and the trainees. Materials and Methods: The study was conducted from September 2011 to June 2012. In an E-mail based survey a questionnaire was mailed to professionals actively involved in teaching and training of residents in plastic surgery in many institutes running MCh courses in plastic surgery (Group I) [Appendix 1]. Another questionnaire was mailed to residents undergoing training in plastic surgery and those who had completed their training within past 2 years (Group II) [Appendix 2]. Chi-square test was applied to test for statistical significance. Observations: 29 Group I and 33 Group II subjects responded to the questionnaire. While 72.4% teachers believed that the current system is producing plastic surgeons with enough skill level, only 9.1% of the respondents in Group II thought the same (Chi-square = 28.1; df = 2; P < 0.001). Whereas 58.6% Group I respondents thought that their student is sufficiently equipped to compete in today’s scenario [Figure 1], only 18.2% Group II respondents thought that their training is enough [Figure 2]. (Chi-square = 16.4; df = 2; P < 0.001). Nearly 28% respondents in Group I and only 3% in Group II thought that scientific research and publications should be made mandatory for successful completion of plastic surgery training (Chi-square = 9.4; df = 2; P = 0.009). Adequate exposure was thought to be available in general plastic surgery (Group I: 92% Group II: 81%), maxillofacial surgery (Group I: 72% Group II: 68%) and hand surgery (Group I: 84% Group II: 69%). Both groups agreed that exposure is lacking in craniofacial surgery, aesthetic surgery and microvascular surgery. Aesthetic surgery (38.7%) and microvascular surgery (32.6%) were the most frequent response when the Group II respondents were enquired about the subspeciality they would like to focus on in their practice. Inter-departmental exchange of students for limited period of time was favoured by 86.2% of Group I respondents and 93.9% Group II respondents (Chi-square = 1.3; df = 2; P = 0.49). Conclusion: The current training programme is differently perceived by teachers and the trainees. We recommend that constant deliberations at national and regional forums should take place regarding our education and training programmes.

scholarly journals Treatment of slipped capital femoral epiphysis - a comparative study during twelve years period

2019 ◽  
Vol 147 (5-6) ◽  
pp. 335-340
Author(s):  
Bojan Bukva ◽  
Sinisa Ducic ◽  
Vladimir Radlovic ◽  
Goran Vrgoc ◽  
Branislav Krivokapic ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Closed Reduction ◽  
Statistical Significance ◽  
Slipped Capital Femoral Epiphysis ◽  
Cannulated Screw ◽  
Cast Immobilization ◽  
Group I ◽  
Before And After ◽  
Group Ii ◽  
Screw Group

Introduction/Objective. The purpose of this study was to compare two methods of treatment and to evaluate the advantages in the final outcome of transcervical fixation of the femoral head using one cannulated screw in the treatment of slipped capital femoral epiphysis. Methods. This study included 65 pediatric patients (35 boys and 30 girls), aged 6?16 years (average 11.86), during a 12-year period (2000?2012). We compared the slipping degree before and after the treatment (Southwick angle), the range of motion before and after treatment, and complication occurrence between two groups of children. The first group of children (26 patients) underwent closed reduction and cast immobilization (Group I). The other group (39 patients) was treated with transcervical fixation using one cannulated screw (Group II). Results. Comparing preoperative and postoperative Southwick angle, we found much better improvement in Group II, but without statistical significance between the two groups of patients (p = 0.09). Observing the range of motion of the hips before and after treatment, we found improvement in both groups of patients, especially in patients treated using transcervical fixation with cannulated screw (Group II). In complication occurrence, the patients in Group II had less complication occurrence compared to Group I (p = 0.02). Conclusion. The transcervical fixation using one cannulated screw has better clinical outcome and lower complication rate in relation to closed reduction and cast immobilization in the treatment of slipped capital femoral epiphysis.

Analysis of risk factors and diseases associated with atherosclerosis in the progression of carotid artery stenosis

Vascular ◽  
2015 ◽  
Vol 24 (1) ◽  
pp. 59-63 ◽  
Author(s):  
Nayara Cioffi Batagini ◽  
Erasmo Simão da Silva ◽  
Carlos AV Pinto ◽  
Pedro Puech-Leão ◽  
Nelson de Luccia
Keyword(s):  
Risk Factors ◽  
Carotid Stenosis ◽  
Statistical Significance ◽  
Carotid Bifurcation ◽  
Inflammatory Factors ◽  
Plasma Urea ◽  
Atherosclerotic Stenosis ◽  
Asymptomatic Patients ◽  
Group I ◽  
Group Ii

Objective The objective of this study was to analyze the roles of demographic, clinical, and laboratory factors on the progression of atherosclerotic stenosis in carotid bifurcation. It was based on prospective information from records entered on a specific application form for follow-up outpatients at a tertiary university service. Methods Consecutive symptomatic and asymptomatic patients ( n = 210) who had undergone more than one carotid duplex scan but no surgical intervention were selected for the analysis. The patients were divided into two groups: patients whose duplex scans did not show bilateral progression of carotid stenosis and patients with carotid stenosis progression of <50%, 50%–69%, or >70%. Clinical and demographic parameters were compared between groups. Results Group II levels of plasma urea (51.6 ± 27.8 mg/dl) and fibrinogen (493.2 ± 113.3 mg/dl) were higher than the Group I levels (43.0 ± 14.9 mg/dl and 441.3 ± 106.7 mg/dl, respectively) with statistical significance (p urea = 0.013 and p fibrinogen = 0.018). Paradoxically, the mean body mass index was higher in Group I (26.4 ± 4.6 kg/m2) than in Group II (24.6 ± 3.9 kg/m2; p = 0.02). Conclusions Traditional risk factors for the development of atherosclerosis in a carotid bifurcation are important but not unique. Metabolic and inflammatory factors can contribute to disease progression.

scholarly journals COMPARATIVE ASSESSMENT OF BILE DUCT DECOMPRESSION METHODS IN PATIENTS WITH OBSTRUCTIVE JAUNDICE OF NON-TUMOR GENESIS

2019 ◽  
Vol 72 (7) ◽  
pp. 1247-1252
Author(s):  
Oleg Y. Kanikovskyi ◽  
Yaroslav V. Karyi ◽  
Yura V. Babiichuk ◽  
Yevhen V. Shaprynskyi
Keyword(s):  
Alkaline Phosphatase ◽  
Bile Duct ◽  
Obstructive Jaundice ◽  
Bile Ducts ◽  
Biliary Duct ◽  
Biliary Decompression ◽  
External Drainage ◽  
Group Iii ◽  
Group I ◽  
Group Ii

Introduction: Obstructive jaundice is one of the most common diseases of the digestive system observed in 10-15% of the world’s population. The question of making a choice among methods of bile duct decompression is still under discussion, since both single-stage and two-stage methods of biliary decompression lead to progression of hepatic insufficiency after restoration of bile passage. The aim: To determine a tempo of biliary decompression after external and internal drainage of bile ducts, endoscopic transpapillary interventions in patients with obstructive jaundice of non-tumor genesis. Materials and methods: We analyzed the outcomes of surgical treatment of 180 patients with obstructive jaundice of the non-tumor genesis. The patients were divided into three groups: group I (n = 86), where endoscopic methods of biliary decompression were used; group II (n = 48), where biliodigestive anastomoses were formed; and group III (n = 46), where the external drainage of bile ducts was conducted. The average age was 62 ± 6.0 years. The average duration of obstructive jaundice was 20 ± 3.7 days. Results: The patients of the group I demonstrated a gradual decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 7. The patients of the group II demonstrated normal levels of bilirubin and alkaline phosphatase on Day 14. The patients of the group III demonstrated rapid decrease of bilirubin and alkaline phosphatase levels, which reached the normal readings on Day 28. The transaminase level in each group of patients had reached the norm earlier. Conclusions: No significant disturbances of the functional state of the liver after endoscopic transpapillary interventions were observed. Formation of areflux biliodigestive anastomoses was accompanied by a moderate rate of biliary duct decompression. The external drainage of biliary ducts was characterized by a rapid rate of biliary decompression, leading to a post-compression syndrome.

scholarly journals Electrolyte disturbances in elderly patients with severe diarrhea due to cholera.

1995 ◽  
Vol 6 (5) ◽  
pp. 1463-1467
Author(s):  
J Cieza ◽  
Y Sovero ◽  
L Estremadoyro ◽  
F Dumler
Keyword(s):  
Elderly Patients ◽  
Normal Saline ◽  
Extracellular Fluid ◽  
Anion Gap ◽  
Severe Diarrhea ◽  
Electrolyte Disturbances ◽  
Group I ◽  
Intravenous Hydration ◽  
Group Ii ◽  
Time Of Admission

The purpose of this clinical study was to evaluate prospectively electrolyte disturbances in elderly patients with severe diarrhea due to cholera. A total of 20 adult (Group I; < 60 yr) and 22 elderly (Group II; > or = 60 yr) patients were studied. In all patients, extracellular fluid (ECF) volume reexpansion was achieved with normal saline at 50 mL/kg per hour. Once a diuresis of 40 mL/h was achieved, intravenous therapy was discontinued and patients' ECF volumes were reexpanded orally with a polyelectrolyte solution. Blood and urine samples were obtained on admission, at the time when adequate diuresis ensued, and after 12 h of oral ECF volume reexpansion. On admission, both groups had severe ECF volume contraction but only mild increases in osmolality (308 +/- 12 and 310 +/- 13 mosmol/kg for Groups I and II respectively; P = NS). Acidemia (pH) was equally severe in both (Group I: 7.13 +/- 0.11; Group II: 7.11 +/- 0.09; P = NS), and the anion gap was comparably increased in both groups (30 +/- 8 and 26 +/- 7 mmol/L for Groups I and II, respectively; P = NS). None of the patients was hypokalemic at the time of admission (Group I: 4.3 +/- 0.5 mmol/L; Group II: 4.5 +/- 0.5 mmol/L; P = NS). Adequate diuresis was achieved at 2.0 +/- 0.7 h in both groups. At the end of the rapid ECF volume reexpansion phase, the anion gap normalized in both groups (Group I: 15.6 +/- 3.7 mmol/L; Group II: 14.4 +/- 2.8 mmol/L; P = NS), and serum potassium concentrations remained normal (Group I: 4.4 +/- 0.4 mmol/L; Group II: 4.1 +/- 0.4 mmol/L; P = NS). We conclude that use of aggressive intravenous hydration with normal saline followed by oral ECF volume reexpansion allows prompt correction of electrolyte abnormalities in adult and elderly patients with severe diarrhea as a result of cholera.

scholarly journals Postoperative radiotherapy of the cervical carcinoma in elderly patients: Over 60 years

2007 ◽  
Vol 54 (3) ◽  
pp. 153-158 ◽  
Author(s):  
V. Plesinac-Karapandzic ◽  
S. Zoranovic ◽  
S. Plesinac ◽  
Z. Milosevic ◽  
D.M. Masulovic
Keyword(s):  
Elderly Patients ◽  
Cervical Carcinoma ◽  
Radiation Effects ◽  
Postoperative Radiotherapy ◽  
External Beam ◽  
External Beam Irradiation ◽  
Group I ◽  
Group Ii ◽  
Brachy Therapy

The purpose of the study was to analyze survival and late radiation effects according to performed surgery and radiation therapy in elderly patients. Between 1996-1997. year 44 patients with cervical carcinoma older then 60 years were treated with postoperative radiotherapy. Radiotherapy included external beam irradiation with TD 36-45 Gy in 18-22 fractions and endocavitar brachy-therapy with TD 28-35Gy in 4-5 fractions. We analyzed two groups of patients group I 29/44 (65,9%) had radical operation by Werthaim-Meigs vs group II 15/44 (34,1%) patients had standard operation. Median follow-up was 48 months. Survival for all patients was 70,43%. Late postirradiation effects in the gastrointestinal tract were 40,9% and in urinary tract 25% - in both groups. A larger percent of late postirradiation sequeles were on GIT in group I vs group II (44,8% vs 33,3%) and on UR tract also (31,03% vs 13,3%). The doses of external beam irradation were equalize in both groups, while brachytherapy regime 4xTD7,5Gy was more represent in group I. Late side effects and complications after postoperative radiotherapy are acceptable, but it is necessary to carry out randomized trials with different dose regime in brachytherapy.

Sign in / Sign up

Export Citation Format

Share Document