scholarly journals Screw fixation failure after 360° fusion at the lumbar level

2020 ◽  
Vol 27 (4) ◽  
pp. 11-18
Author(s):  
Olga N. Leonova ◽  
Evgenii S. Baykov ◽  
Aleksandr V. Krutko
Keyword(s):  
Bone Density ◽  
Hospital Stay ◽  
Perioperative Period ◽  
Infectious Complications ◽  
Spinal Diseases ◽  
Fixation Failure ◽  
Degenerative Lumbar Diseases ◽  
Lumbar Level ◽  
Intergroup Comparison ◽  
Significant Difference

Aim: to identify possible predictors of screw loosening (SL) in patients after decompression and fusion at the lumbar level for degenerative spinal diseases. Methods. The data of patients with degenerative lumbar diseases who underwent primary decompression and fusion and who were re-hospitalized were analyzed. Clinical data (demography, characteristics of primary surgical procedures and characteristics of the perioperative period), results of radiological methods (presence and characteristics of resorption around screws, bone density (BMD) by densitometry and CT, intervertebral fusion grade and implant subsidence) were evaluated. Results. The study included 19 patients with SL and 37 patients without resorption, median age 59.1 [51.4; 63.1] years, men 20 (35.7%). When comparing patients with and without SL, there was no significant difference in gender, age, method of surgery, length of the fixation (p 0.05). According to CT scans, the bone density of the vertebrae between the groups did not differ significantly (p 0.05). In the group with SL, fusion failure was more common than in the group without SL (22.6% versus 20.7%), but the differences are not significant (p 0.05). In the intergroup comparison, it was determined that, in general, there were more complications in the group with SL than in the group without SL (p = 0.00015) due to the greater number of infectious complications (p = 0.00044). Also, patients with SL had a significantly longer duration of primary hospital stay (p = 0.000021). Conclusion. Patients with SL after primary surgery have a significantly longer hospital stay duration, mainly (45.8%) due to infectious complications. Patients with SL have comparable bone density in both the vertebral bodies and pedicles compared to patients without SL.

scholarly journals Preoperative endoscopic biliary stenting before pancreatico duodenectomy: Does timing matter?

2020 ◽  
Author(s):  
Abu Bakar Hafeez Bhatti ◽  
Roshni Zahra Jafri ◽  
M Kashif Khan ◽  
Faisal Saud Dar
Keyword(s):  
Obstructive Jaundice ◽  
Hospital Stay ◽  
Mortality Rates ◽  
Infectious Complications ◽  
Wound Infections ◽  
Biliary Stenting ◽  
Endoscopic Biliary Stenting ◽  
Significant Difference ◽  
The Impact ◽  
Surgery Duration

Abstract BackgroundRole of preoperative biliary stenting (PBS) before pancreaticodoudenectomy (PD) in patients with obstructive jaundice is debatable. The objective of the current study was to assess outcomes after PD in patients who underwent upfront surgery or PBS and determine the impact of stent to surgery duration on outcomes after PD. Methods We reviewed 147 patients who underwent PD between 2011 and 2019. Patients were grouped based on whether they underwent upfront surgery (N=76) or PBS (N=71). We further assessed outcomes based on stent to surgery interval < 4 weeks or > 4 weeks. We looked at 30 and 90 day morbidity and mortality rates in these patients.Results A significant increase in wound infections (7% vs 25%)(P=0.003), overall infectious complications (22.5% vs 38.1%)(P=0.04), re admissions (0 vs 10.5%)(P=0.005) and hospital stay (9 vs 10 days)(P=0.006) was seen in the PBS group. There was no significant difference in 30 day mortality (2.8 % vs 6.5%)(P=0.4). When compared with upfront surgery group, patients with stent to surgery duration > 4 weeks had higher rates of wound infection (7% vs 29%)(P=0.009), sepsis (11.2% vs 29%)(P=0.02), overall infectious complications (22.5% vs 45.1%)(P=0.02), re admissions (0 vs 12.9%) (P=0.007) and hospital stay (9 vs 10 days)(P=0.03). The lowest rate of infectious complications was seen when PD was performed within 2 weeks (22.2%) or 6-8 weeks (12.5%) after stenting. None of the patients with stent-surgery duration < 2 weeks developed sepsis. ConclusionsPBS appears to increase infection related morbidity after PD. In patients with PBS, low morbidity is seen with early (< 2 weeks) and delayed PD (6-8weeks).

Perioperative management of patients with operated nasal cavity and paranasal sinuses

2021 ◽  
Vol 20 (4) ◽  
pp. 102-109
Author(s):  
E. L. Savlevich ◽  
◽  
T. G. Pelishenko ◽  
V. S. Kozlov ◽  
F. N. Koryagin ◽  
...  
Keyword(s):  
Nasal Cavity ◽  
Paranasal Sinuses ◽  
Nasal Septum ◽  
Antimicrobial Agents ◽  
Perioperative Period ◽  
Objective Evaluation ◽  
Infectious Complications ◽  
Deviated Nasal Septum ◽  
Systemic Antibiotic Therapy ◽  
Significant Difference

Nowadays due to the growth of the antibiotic resistance of the bacteria, the issue of the perioperative prophylaxis in surgery of the nasal cavity and paranasal sinuses has become especially relevant. Although the use of antibiotics more than 24 hours after surgery for prophylactic purposes does not increase the effectiveness of perioperative prevention of infectious complications, systemic antibiotics are often continued in the otorhinolaryngology departments for 5-7 days after surgery. Objective: Evaluation of the possibility of using of alternative antimicrobial agents in the framework of perioperative prevention of infectious complications during operations of the nasal cavity and paranasal sinuses. 178 patients undergoing surgical treatment for deviated nasal septum, chronic hypertrophic rhinitis, chronic rhinosinusitis without polyps, were divided into 2 groups. In the first group, 2 weeks before the operation and within 7 days of the postoperative period, applications were applied to the nasal cavity with a gel with Otofag bacteriophages, 2 doses 3 times a day for 60 minutes. In the second group, systemic antibiotic therapy (ceftriaxone 1.0 intramuscularly once) was prescribed 40-60 minutes before the operation. Results: There wasn’t a significant difference in the regression of reactive phenomena of the nasal mucosa and intoxication syndrome, except for the intensity of crust formation in the nasal cavity, the severity of which was 1.9 ± 0.1 points in the first and 4.19 ± 0.54 points in the second group on the 7’th day after surgery. Conclusion: The use of the gel with Otofag bacteriophages can be recommended in the perioperative period during planned operations on the nasal septum, inferior turbinates, and paranasal sinuses, which will allow avoiding the use of standard antibacterial drugs in these patients.

scholarly journals Thyroidectomy in patients with a high BMI: a safe surgery?

2014 ◽  
Vol 171 (1) ◽  
pp. 99-105 ◽  
Author(s):  
J B Finel ◽  
S Mucci ◽  
F Branger ◽  
A Venara ◽  
P Lenaoures ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Operation Time ◽  
Infectious Complications ◽  
Bleeding Complications ◽  
Significant Difference ◽  
Complications Of Thyroidectomy ◽  
Partial Thyroidectomy ◽  
A Prospective Study

ObjectiveTo study and compare the specific postoperative complications of thyroidectomy in a population with a BMI ≥25 with a population having a BMI below 25.DesignA prospective study was carried out from September 2010 to January 2013.MethodsPostoperative calcemia, laryngeal mobility, bleeding or infectious complications, postoperative hospital stay, and operation time were studied and compared statistically by a χ2-test or Student's t-test.ResultsA total of 240 patients underwent total thyroidectomy and 126 underwent a partial thyroidectomy. Of them, 168 patients had a BMI below 25 and 198 patients had a BMI ≥25. There was no statistically significant difference in the occurrence of early or permanent hypoparathyroidism, recurrent laryngeal nerve palsy, bleeding complications, or postoperative duration of hospital stay. There was, however, a significant operative time in patients with a BMI ≥25.ConclusionDespite the longer operative time, thyroidectomy (total or partial) can be performed safely in patients with a BMI ≥25.

scholarly journals Does hospital delay in appendectomy affect immediate surgical outcome in adults with acute appendicitis?

2017 ◽  
Vol 5 (4) ◽  
pp. 112-115
Author(s):  
Saroj Prasad Dhital ◽  
Udaya Koirala ◽  
Kushal Karki ◽  
Bijendra Dhoj Joshi ◽  
Amit Mani Upadhyaya
Keyword(s):  
Retrospective Study ◽  
Hospital Stay ◽  
Surgical Outcome ◽  
Length Of Hospital Stay ◽  
Medical College ◽  
Duration Of Hospital Stay ◽  
Intergroup Comparison ◽  
Significant Difference ◽  
Prospective Trials ◽  
Time Of Presentation

Background: Emergency appendectomy is the commonest emergency surgical procedure being performed for many years. Till now, the dictum is that it should be done as soon as possible from the onset of attack.Objectives: To evaluate immediate surgical outcome in cases undergone appendectomy after hospital delay of more than 12 hours duration compared with appendectomy done immediately within 12 hours of presentation.Methods: This is a retrospective study of 118 patients on whom appendectomies were done between 1st June 2008 to 31st August 2010. These patients were divided into two groups on the basis whether the appendectomy was done ≤ 12hours or >12 hours from the time of presentation in the hospital and intergroup comparison was made regarding length of hospital stay, rate of perforation and post operative complications.Results: A total of 118 patients were included in the study. Out of which 71(60.2%) were male and 47(39.8%) were female. Mean age of patients was 30.97 ± 12 years. Mean duration of hospital stay was 4.35 ± 1.75 days. In comparison of two groups of ≤ 12 hours or >12 hours from the time of presentation in the hospital, there were no statistically significant difference in length of hospital stay (4.29 vs 4.4 days, p=0.7), rate of perforation of appendix (9.25% vs 10.93%, p=0.3) and post-operative wound infection (16.66% vs 17.18%, p = 0.9).Conclusion: Delaying an appendectomy for a valid reason can be considered. Prospective trials are required to establish findings of this study.Journal of Kathmandu Medical College, Vol. 5, No. 4, Issue 18, Oct.-Dec., 2016, Page: 112-115

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

Comparison of the Effects of Fenugreek Vaginal Cream and Ultra Low- Dose Estrogen on Atrophic Vaginitis

2020 ◽  
Vol 17 (9) ◽  
pp. 815-822
Author(s):  
Maryam Safary ◽  
Sevil Hakimi ◽  
Noushin Mobaraki-Asl ◽  
Paria Amiri ◽  
Habib Tvassoli ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Low Dose ◽  
Intervention Group ◽  
Clinical Signs ◽  
Control Group ◽  
Conjugated Estrogens ◽  
Atrophic Vaginitis ◽  
Vaginal Cream ◽  
Intergroup Comparison ◽  
Significant Difference

Introduction: Atrophic vaginitis is a common problem in postmenopausal women and results from decreased levels of blood estrogen. It is associated with symptoms of itching, burning, dyspareunia, and postmenopausal bleeding. The present study evaluated the effects of fenugreek extract on atrophic vaginitis. Materials and Methods: This randomized controlled clinical trial was performed on 60 postmenopausal women in Ardabil, Iran, in 2018. The participants were selected using block randomization with the allocation ratio 1:1. Those in the intervention group received 0.5g (the applicator filled to the half-full mark) fenugreek vaginal cream 5% twice a week for 12 weeks. The control group received conjugated estrogens vaginal cream at the dose of 0.625 mg (the applicator filled to the half-full mark) containing 0.3 mg of conjugated estrogens. Atrophic vaginitis was evaluated before and after the treatment through clinical examination, clinical signs, and measurement of Vaginal Maturation Index (VMI). Findings: After the 12-week intervention and modification of the baseline score, the mean (standard error) score for atrophic vaginitis signs was 3.100 (1.43-4.75). This difference was statistically significant in intragroup comparison and in favor of the control group in intergroup comparison (p=0.001). VMI was less than 49% in 86.7% and 46.7% of the participants in the intervention and control groups, respectively. This was a significant difference in favor of the control group (p=0.001). Conclusion: The results of this study showed that total fenugreek extract could be effective in treating signs of atrophic vaginitis, but it was not as effective as ultra-low-dose estrogen.

Is alcohol septal ablation in women performed too late?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Batzner ◽  
D Aicha ◽  
H Seggewiss
Keyword(s):  
Hospital Stay ◽  
Pacemaker Implantation ◽  
Posterior Wall ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Icd Implantation ◽  
Alcohol Septal Ablation ◽  
Significant Difference ◽  
Surgical Myectomy

Abstract Introduction Alcohol septal ablation (PTSMA) was introduced as interventional alternative to surgical myectomy for symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM) 25 years ago. As gender differences in diagnosis and treatment of HOCM are still unclear we analyzed baseline characteristics and results of PTSMA in a large single center cohort with respect to gender. Methods and results Between 05/2000 and 06/2017 first PTSMA in our center was performed in 952 patients with symptomatic HOCM. We treated less 388 (40.8%) women and 564 (59.2%) men. All patients underwent clinical follow-up. At the time of the intervention women were older (61.2±14.9 vs. 51.9±13.7 years; p&lt;0.0001) and suffered more often from NYHA grade III/IV dyspnea (80.9% vs. 68.1%; p&lt;0.0001), whereas angina pectoris was comparable in women (62.4%) and men (59.9%). Echocardiographic baseline gradients were comparable in women (rest 65.0±38.1 mmHg and Valsalva 106.2±45.7 mmHg) and men (rest 63.1±38.3 mmHg and Valsalva 103.6±42.8 mmHg). But, women had smaller diameters of the left atrium (44.3±6.9 vs. 47.2±6.5 mm; p&lt;0001), maximal septum thickness (20.4±3.9 vs. 21.4±4.5 mm; p&lt;0.01), and maximal thickness of the left ventricular posterior wall (12.7±2.8 vs. 13.5±2.9 mm; p&lt;0.0001). In women, more septal branches (1.3±0.6 vs. 1.2±0.5; p&lt;0.05) had to be tested to identify the target septal branch. The amount of injected alcohol was comparable (2.0±0, 4 in women vs. 2.1±0.4 ml in men). The maximum CK increase was lower in women (826.0±489.6 vs. 903.4±543.0 U / l; p&lt;0.05). During hospital stay one woman and one man died, each (n.s.). The frequency of total AV blocks in the cathlab showed no significant difference between women (41.5%) and men (38.3%). Furthermore, the rate of permanent pacemaker implantation during hospital stay did not differ (12.1% in women vs. 9.4% in men). Follow-up periods of all patients showed no significant difference between women (5.7±4.9 years) and men (6.2±5.0 years). Overall, 37 (9.5%) women died during this period compared to only 33 (5.9%) men (p&lt;0.05). But, cardiovascular causes of death were not significantly different between women (2.8%) and men (1.6%). Furthermore, the rates of surgical myectomy after failed PTSMA (1.3% in women vs. 2.3% in men), ICD implantation for primary prevention of sudden cardiac death according to current guidelines (4.1% in women vs. 5.9% in men) or pacemaker implantation (3.6% in women vs. 2.0% in men) showed no significant differences. Summary PTSMA in women with HOCM was performed at more advanced age with more pronounced symptoms compared to men. While there were no differences in acute outcomes, overall long-term mortality was higher in women without differences in cardiovascular mortality. Therefore, women may require more intensive diagnostic approaches in order not to miss the correct time for gradient reduction treatment. Funding Acknowledgement Type of funding source: None

Comparative Analysis of Patients with Robotic Hiatal Hernia Repairs with and without Collis Gastroplasty

2021 ◽  
pp. 000313482198905
Author(s):  
John A. Perrone ◽  
Stephanie Yee ◽  
Manrique Guerrero ◽  
Antai Wang ◽  
Brian Hanley ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Statistical Analysis ◽  
Hospital Stay ◽  
Hiatal Hernia ◽  
Collis Gastroplasty ◽  
Significant Difference ◽  
Related Quality

Introduction After extensive mediastinal dissection fails to achieve adequate intra-abdominal esophageal length, a Collis gastroplasty(CG) is recommended to decrease axial tension and reduce hiatal hernia recurrence. However, concerns exist about staple line leak, and long-term symptoms of heartburn and dysphagia due to the acid-producing neoesophagus which lacks peristaltic activity. This study aimed to assess long-term satisfaction and GERD-related quality of life after robotic fundoplication with CG (wedge fundectomy technique) and to compare outcomes to patients who underwent fundoplication without CG. Outcomes studied included patient satisfaction, resumption of proton pump inhibitors (PPI), length of surgery (LOS), hospital stay, and reintervention. Methods This was a single-center retrospective analysis of patients from January 2017 through December 2018 undergoing elective robotic hiatal hernia repair and fundoplication. 61 patients were contacted for follow-up, of which 20 responded. Of those 20 patients, 7 had a CG performed during surgery while 13 did not. There was no significant difference in size and type of hiatal hernias in the 2 groups. These patients agreed to give their feedback via a GERD health-related quality of life (GERD HRQL) questionnaire. Their medical records were reviewed for LOS, length of hospital stay (LOH), and reintervention needed. Statistical analysis was performed using SPSS v 25. Satisfaction and need for PPIs were compared between the treatment and control groups using the chi-square test of independence. Results Statistical analysis showed that satisfaction with outcome and PPI resumption was not significantly different between both groups ( P > .05). There was a significant difference in the average ranks between the 2 groups for the question on postoperative dysphagia on the follow-up GERD HRQL questionnaire, with the group with CG reporting no dysphagia. There were no significant differences in the average ranks between the 2 groups for the remaining 15 questions ( P > .05). The median LOS was longer in patients who had a CG compared to patients who did not (250 vs. 148 min) ( P = .01). The LOH stay was not significantly different ( P > .05) with a median length of stay of 2 days observed in both groups. There were no leaks in the Collis group and no reoperations, conversions, or blood transfusions needed in either group. Conclusion Collis gastroplasty is a safe option to utilize for short esophagus noted despite extensive mediastinal mobilization and does not adversely affect the LOH stay, need for reoperation, or patient long-term satisfaction.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

scholarly journals Effects of early corticosteroid use in patients with severe coronavirus disease 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong Hoon Hyun ◽  
Moo Hyun Kim ◽  
Yujin Sohn ◽  
Yunsuk Cho ◽  
Yae Jee Baek ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Corticosteroid Treatment ◽  
Threshold Value ◽  
Steroid Use ◽  
Corticosteroid Administration ◽  
Significant Difference ◽  
Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

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