scholarly journals Evaluation and management of cholelithiasis in children: a hospital based study

2016 ◽  
Vol 4 (1) ◽  
pp. 246
Author(s):  
Sanjay Kumar Bhasin ◽  
Ankit Gupta ◽  
Sunita Kumari
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Prospective Study ◽  
Low Socioeconomic Status ◽  
Expectant Management ◽  
Clinical History ◽  
Postoperative Recovery ◽  
Hindu Religion ◽  
The Mean ◽  
Set Up

Background:Earlier cholelithiasis was extremely unusual in childhood. Presently there is sharp increase in detection of cholelithiasis in children, which forms basis to investigate the overall changing pattern of cholelithiasis. This prospective study in referral centre has been under taken to evaluate childhood cholelithiasis and its management.Methods: The present prospective study was conducted in the Postgraduate Department of Surgery, GMC Jammu, Jammu & Kashmir, India over a period of two years. 80 patients in age group of 3-14 years were included in the study group with ultrasound proved cholelithiasis. Data reviewed with respect to patient demographics profile, clinical history including risk factors, imaging studies, operative techniques, postoperative complications, postoperative recovery and primary outcome parameters assessed accordingly.Results:During the study period 80 children (52 males and 28 females) with cholelithiasis were evaluated and treated by laparoscopic cholecystectomy. The mean age was 10.1 years (range 5 to 14 years). 75% patients (n = 60) belonged to rural background and rest to urban set up, 56 patients belonged to hindu religion and rest were muslims. In 47.5% patients no risk factor could be traced. Fifty two children (65%) had mixed gallstones. 78 patients underwent LC, two needed conversion and rest 02 children were subjected to mini cholecystectomy. The mean operative duration was 29.92 minutes (range 15-50 minutes). The average duration of hospital stay was 3.82 days (range 3-8 days). No major intra operative or post-operative complications could be detected except 01 case biliary peritonitis.Conclusions:Cholelithiasis in children was reported about three centuries back, remained relatively uncommon in the past but now it is evolving and ever increasing in frequency. In this part of country in almost 50% of patients risk factors could not be traced, obesity could not be held responsible for cholelithiasis. Male children with low socioeconomic status, rural area and belonging to Hindu religion were more affected by the disease. In view of high incidence of serious complications of gall stones in children and because of longer life expectancy we also recommend that expectant management of gallstones may not be safe and hence laparoscopic cholecystectomy must be done even in asymptomatic cholelithiasis.

scholarly journals Surgical glove use for specimen removal in laparoscopy, the cheapest available: a prospective study

2019 ◽  
Vol 50 (1) ◽  
pp. 94-99
Author(s):  
Shariful Islam ◽  
Vinoo Bheem ◽  
Anthony Maughn ◽  
Patrick Harnarayan ◽  
Dilip Dan ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Laparoscopic Surgery ◽  
Prospective Study ◽  
Surgical Glove ◽  
Retrieval Time ◽  
Surgical Gloves ◽  
Specimen Retrieval ◽  
Port Site Hernia ◽  
The Mean ◽  
A Prospective Study

Despite the proven benefits of laparoscopic surgery, it is indeed very costly. The aim of our study was to show an effective way to reduce one of the costs. Between January 2012 and December 2018, we used sterile unpowdered latex-free surgical gloves for specimen retrieval in 243 selected cases of laparoscopic cholecystectomy and appendectomy. The mean retrieval time was 6.7 ± 3.6 min. All procedures were performed safely. Minor wound infection was noted in three patients but there was no case of port site hernia in our series. We conclude that specimen retrieval using sterile, unpowdered, latex-free surgical gloves is safe, effective and cheap. No special additional preparation is required.

scholarly journals Risk of Complications in Spine Surgery: A Prospective Study

2015 ◽  
Vol 9 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Rodolfo Casimiro Reis ◽  
Matheus Fernandes de Oliveira ◽  
José Marcus Rotta ◽  
Ricardo Vieira Botelho
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Spine Surgery ◽  
Absolute Risk ◽  
Surgical Site Infections ◽  
Spine Instrumentation ◽  
Increased Risk ◽  
The Mean ◽  
A Prospective Study ◽  
Epidemiological Characteristics

Purpose : Complications are the chief concern of patients and physicians when considering spine surgery. The authors seek to assess the incidence of complications in patients undergoing spine surgery and identify risk factors for their occurrence. Methods : Prospective study of patients undergoing spine surgery from 1 February 2013 to 1 February 2014. Epidemiological characteristics and complications during the surgical hospitalization were recorded and analyzed. Results : The sample comprised 95 patients (mean age, 59 years). Overall, 23% of patients were obese (BMI =30). The mean BMI was 25.9. Approximately 53% of patients had comorbidities. Complications occurred in 23% of cases; surgical site infections were the most common (9%). There were no significant differences between patients who did and did not develop complications in terms of age (60.6 vs 59.9 years, p = 0.71), sex (56% female vs 54% female, p = 0.59), BMI (26.6 vs 27.2, p = 0.40), or presence of comorbidities (52% vs 52.8%, p = 0.87). The risk of complications was higher among patients submitted to spine instrumentation than those submitted to non-instrumented surgery (33% vs 22%), p=0.8. Conclusion : Just over one-quarter of patients in the sample developed complications. In this study, age, BMI, comorbidities were not associated with increased risk of complications after spine surgery. The use of instrumentation increased the absolute risk of complications.

scholarly journals Natural history of insomnia symptoms in the transition from childhood to adolescence: population rates, health disparities, and risk factors

SLEEP ◽  
2020 ◽  
Author(s):  
Julio Fernandez-Mendoza ◽  
Elizaveta Bourchtein ◽  
Susan Calhoun ◽  
Kristina Puzino ◽  
Cynthia K Snyder ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Socioeconomic Status ◽  
Clinical History ◽  
Population Based ◽  
Self Report ◽  
Full Remission ◽  
Penn State ◽  
Racial Ethnic ◽  
Insomnia Symptoms

Abstract Study Objectives To determine the sociodemographic, behavioral, and clinical risk factors associated with the persistence, remission, and incidence of insomnia symptoms in the transition from childhood to adolescence. Methods The Penn State Child Cohort is a random, population-based sample of 700 children (5–12 years at baseline), of whom 421 were followed-up as adolescents (12–23 years at follow-up). Subjects underwent polysomnography, clinical history, physical exam, and parent- and self-reported scales at baseline and follow-up. Insomnia symptoms were defined as a parent- or self-report of difficulty falling and/or staying asleep. Results The 421 subjects with baseline (Mage = 8.8 years) and follow-up (Mage = 17 years) data were 53.9% male and 21.9% racial/ethnic minorities. The persistence of childhood insomnia symptoms (CIS) was 56% (95% CI = 46.5–65.4), with only 30.3% (95% CI = 21.5–39.0) fully remitting. The incidence of adolescent insomnia symptoms was 31.1% (95% CI = 25.9–36.3). Female sex, racial/ethnic minority, and low socioeconomic status as well as psychiatric/behavioral or neurological disorders, obesity, smoking, and evening chronotype were associated with a higher persistence or incidence of insomnia symptoms. Conclusions CIS are highly persistent, with full remission occurring in only a third of children in the transition to adolescence. Sex-, racial/ethnic-, and socioeconomic-related disparities in insomnia occur as early as childhood, while different mental/physical health and lifestyle/circadian risk factors play a key role in the chronicity of CIS versus their incidence in adolescence. CIS should not be expected to developmentally remit and should become a focus of integrated pediatric/behavioral health strategies.

scholarly journals Risk Profile of Uterovaginal Prolapse

2018 ◽  
Vol 1 (2) ◽  
pp. 42-46
Author(s):  
Una Pant ◽  
R. Pradhan ◽  
B. Aryal
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Pelvic Organ Prolapse ◽  
Low Socioeconomic Status ◽  
Genital Prolapse ◽  
Pelvic Organ ◽  
Home Delivery ◽  
Uterovaginal Prolapse ◽  
The Mean ◽  
Post Menopausal

Introduction: Pelvic Organ Prolapse is a common problem in Nepal. The aim of this study was to assess the magnitude of pelvic organ prolapse and risk factors associated with it. Methods: This hospital based retrospective descriptive study was conducted in gynecological Out Patient Department of College of Medical Sciences Teaching Hospital, Bharatpur, Chitwan from October 2011 and September 2013.The data were retrieved from the records and analyzed. Women who were earlier subjected for surgical correction of prolapses Cases with pregnancy were excluded from study. Results: There were total 375 cases of genital prolapse out of total 2075 cases of total gynecological admission i.e. 18% incidence. The mean age of patients was 56.79 years with the mean parity of 5.67. 72% cases developed prolapse during their post-menopausal years. Majority of them (84%) lived in hilly area and (57.3%) cases were involved with heavy occupational activities. 50.7% of genital prolapse were from the lower socioeconomic status. Proplase was seen with patients with higher BMI (26-30). Risk factors identified were unsupervised home delivery, rapid succession of pregnancies, and no rest after delivery. Most common clinical presentation of Pelvis Organ Prolapse was mass per vagina (60%). Conclusions: Prolapse is common among rural, farmers, multiparous and post-menopausal women where most of them delivered at home with prolonged labor. Age, low socioeconomic status and heavy manual activities were associated with the prolapse.

scholarly journals Factors affecting perioperative serum albumin variation and short term complications in pediatric patients undergoing major gastroenterology surgery

2020 ◽  
Author(s):  
Qingshuang Liu ◽  
Kai Gao ◽  
Xiaomin Sun ◽  
Chunbao Guo
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Pediatric Population ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Postoperative Recovery ◽  
Perioperative Outcomes ◽  
Perioperative Morbidity ◽  
Charcot’S Triad ◽  
The Mean

Abstract Background: Albumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. The decrease in serum albumin might be important for perioperative morbidity, even in patients with normal preoperative levels in pediatric population. We here intend to determine the perioperative factors associated with the reduction in serum albumin within 2 postoperative days compared with the preoperative level (∆ALB) and its influence on the perioperative outcome in a pediatric general surgical cohort. Methods: This single-center retrospective review included 939 patients who underwent Roux-en-Y hepaticojejunostomy between August 2010 and Aug 2019. Based on the mean valure of ∆ALB (14.6%), patients were separated into two groups, including a high ∆ALB group (≥14.6%) and a low ∆ALB group (<14.6%). Multivariable logistic regression analyses were performed to determine the independent risk factors for the reduction in serum albumin. Propensity score matching was performed to adjust for any potential selection bios for the two groups. In 366 matched patients, influences of operating time on perioperative outcomes, including postoperative recovery, complications measurement, and length of hospital stay between the two groups were analyzed. Results: For all 996 patients reviewed, 939 patient records were enrolled into the final analysis. Controlling for other factors, multivariate analysis showed that the high CRP on POD 3 or 4 (odds ratio[OR] =2.36 [95% CI, 1.51-3.86]; p =0.007), presence of Charcot's triad (OR=1.73[95% CI, 1.05-2.83]; p = 0.031), the longer operating time (OR=1.18[95% CI, 1.00 -1.53]; p=0.014) were factors that predicted the high ∆ALB level. The high ∆ALB level was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (p= 0.013) and first bowel movement (p=0.019) and the high occurrence of postoperative complications (16.1% vs 10.9%, OR, 1.57; 95 %CI, 1.02-2.41, P=0.0026). The mean length of postoperative stay was longer than that of patients with ∆ALB < 14.0% group, although no statistic significant was stained (p=0.057). Conclusions: We showed that change in albumins was associated with postoperative outcomes. The risk factors for ∆ALB could be intervened in the perioperative period to permit patients gain a safe recovery and discharge after major abdominal operations.

Premonitory and Resolution Symptoms in Migraine: A Prospective Study in 100 Unselected Patients

Cephalalgia ◽  
2006 ◽  
Vol 26 (9) ◽  
pp. 1051-1060 ◽  
Author(s):  
E Quintela ◽  
J Castillo ◽  
P Muñoz ◽  
J Pascual
Keyword(s):  
Risk Factors ◽  
Prospective Study ◽  
Migraine With Aura ◽  
Severe Pain ◽  
Disability Assessment ◽  
General Physician ◽  
Assessment Scores ◽  
The Mean ◽  
A Prospective Study

The nosology of migraine premonitory (PS) and resolution (RS) symptoms was studied in 100 migraineurs consulting their general physician. They were asked to fill in, for three attacks, a PS and RS questionnaire. ‘True’ PS/RS were those experienced the day before (or the day after) the headache had started only if they were not present in a questionnaire completed in a pain-free period. True PS and RS were experienced by 84± and 80±, respectively, of subjects for the first attack. The mean and range (per patient) of PS were 6.8 and 0–21 and of RS 4.7 and 0–15. Anxiety, phonophobia, irritability, unhappiness and yawning were the commonest PS, whereas asthenia, tiredness, somnolence and concentration difficulties were the most common RS. Gender, age and Migraine Disability Assessment scores did not influence PS and RS. Both PS and RS were more frequent in migraine with aura subjects. Patients on preventatives showed a decreased frequency of PS and, to a lesser degree, of RS. Severity of headache was associated with a higher frequency of RS. Individual RS and especially PS were quite consistent after three attacks. Almost two-thirds of the symptoms were noticed in at least two out of three attacks, while more than a half of PS and more than a quarter of RS repeated in three out of three attacks. In conclusion, around 80± of unselected migraineurs experience RS and PS. Migraine with aura and severe pain are risk factors for experiencing PS and RS, while preventatives were protective, especially for PS.

scholarly journals Factors affecting conversion rates in laparoscopic cholecystectomy: a single surgeon study

2020 ◽  
Vol 7 (6) ◽  
pp. 1746
Author(s):  
Jayant Moger ◽  
Suresh Badiger
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Prospective Study ◽  
Open Cholecystectomy ◽  
Intraoperative Complication ◽  
Factors Affecting ◽  
Calot’S Triangle ◽  
Conversion Rates ◽  
Cirrhosis Of Liver ◽  
A Prospective Study

Background: There is need for conversion in laparoscopic cholecystectomy (LC) in some special situation to open cholecystectomy (OC) in order to minimize intraoperative and post-operative complications. The risk factors may be patient related, the gallbladder’s pathology and the surgeon. Most studies with regards finding the risk factors for conversion in LC involved multiple surgeons which is one of the factors. Our study is prospective study where in all cholecystectomy were done by the single surgeon so as to find out other risk factors for conversion.Methods: This was a prospective study conducted between January 2017 to 2020, where in a total 152 patients posted for LC and 27 got converted to OC. The factors analyzed were the age and sex of the patient, elective or emergency surgery, acute or chronic cholecystitis, comorbid conditions, previous abdominal surgery, post endoscopic retrograde cholangiopancreatography, intra operative adhesions, intraoperative complication like bile duct injury, bleeding from cystic artery or gall bladder bed, bile leak.Results: Out of 152 patient 27 (17.8%) got converted to open cholecystectomy. Mean age was 48.86 with lowest 15 and highest age operated was 83 years, among them 63 (41.4%) were male and 89 (56.8%) were female. Fibrosis at Calot’s triangle, intraoperative adhesions, cirrhosis of liver and age older than 60 years, were all significantly correlated with an increased conversion rate to laparotomy.Conclusions: The risk factors may help to predict the difficulty of the procedure. This would permit the surgeon to better inform patients about the risk of conversion from laparoscopic to open cholecystectomy. 

Factors Increasing Risk of Septicemia in Acute Cholycystectomy Patients

2021 ◽  
Vol 15 (11) ◽  
pp. 3155-3156
Author(s):  
Shafqat Ullah ◽  
Samina Karim ◽  
Dileep Kumar ◽  
Muhammad Aqil Razzaq ◽  
Muhammad Hanif ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Retrospective Study ◽  
Kidney Disease ◽  
Clinical History ◽  
Medical College ◽  
Systematic Inflammatory Response Syndrome ◽  
Operative Complications ◽  
The Mean ◽  
Increasing Risk

Background: Septicemia is defined as systematic inflammatory response syndrome which is formed as a result of an infection. Objective: To identify the factors increasing risk of septicemia in acute cholecystectomy patients. Study Design: Retrospective study Place and Duration of Study: Department of Surgery, Sahara Medical College, Narowal from 1st August 2020 to 31st May 2021. Methodology: One hundred and seventy acute cholecystectomy patients were enrolled. The patient’s demographic, clinical history, comorbidities and post-operative complications were listed. All procedures were done through laparoscopic method. Results: There were 54.1% females and 45.9% males. The mean age of patients was 52.17±14.33 years. There were 11.7% cases who developed septicemia. The immune deficient patients were 0.9% and 1.8% had perforated gall bladder. There were 2.7% cases having obesity, cirrhosis or complicated diabetes with 3.6% having chronic kidney disease. Conclusion: The factors of complicated diabetes, cirrhosis, obesity and chronic kidney disease are associated with risk of septicemia in acute cholecystectomy. Key words: Cholecystectomy, Septicemia, Risk factors, Obesity, Chronic kidney disease

scholarly journals Outcome of Perforated Gallbadder during Laparoscopic Cholecystectomy

2021 ◽  
Vol 17 (1) ◽  
pp. 26-30
Author(s):  
Raad Faraj Hanashe ◽  
Hasanain Talib Essa ◽  
Mohanad Abdul Wahid Abdul Razaq
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Significant Risk ◽  
Male Gender ◽  
Gallbladder Perforation ◽  
Early Complications ◽  
Hospital Data ◽  
Prospective Comparative Study ◽  
The Mean

Background: Laparoscopic cholecystectomy (LC) has become the standard treatment for symptomatic cholelithiasis. Bile duct injury and accidental gallbladder perforation with spillage of bile and stone are common complications of LC. This study was carried out to assess the early complications of gallbladder perforation during LC, and identify the risk factor of that perforation. Objectives: to evaluate the early complications which may occur after the perforation of the gallbladder during laparoscopic cholecystectomy and to determine the risk factors which are associated with the perforation of the gall bladder.  Subjects and methods: A prospective comparative study on 192 patients who underwent LC between August 2012 to January 2014 in Baghdad teaching hospital. Data were collected, Patients with and without gallbladder perforation were compared in terms of gender, age, anatomic difficulty, the experience of the surgeon, omental and other organ adhesions to the gall bladder. Results: fifty-five patients had a perforation of GB during LC, 46 patients had GB perforated during dissection of gallbladder bed from hepatic fossa. The mean operative time and duration of postoperative hospitalization were longer in the perforated group, perforation occurs more frequently in acute cholecystitis compared to chronic cholecystitis. There were significant risk factors related to gallbladder perforation which include male gender, AC, adhesion around the gallbladder, and experience of the surgeon. Conclusion: accidental gallbladder perforation leading to longer operative and hospital time which loss the advantage of LC. The male gender, AC, and experience of the surgeon had the main risk factors of the perforated gallbladder.

scholarly journals Factors affecting perioperative serum albumin variation and short-term complications in pediatric patients undergoing major gastroenterology surgery

2020 ◽  
Author(s):  
Qingshuang Liu ◽  
Kai Gao ◽  
Xiaomin Sun ◽  
chunbao guo
Keyword(s):  
Risk Factors ◽  
Serum Albumin ◽  
Pediatric Population ◽  
Operating Time ◽  
Multivariable Analysis ◽  
Postoperative Recovery ◽  
Perioperative Outcomes ◽  
Charcot’S Triad ◽  
Significant Difference ◽  
The Mean

Abstract Background: Albumin is considered a negative acute-phase protein because its concentration decreases during injury and sepsis. The decrease in serum albumin may be important for perioperative morbidity, even in patients with normal preoperative levels in the pediatric population. Here, we intend to determine the perioperative factors associated with the reduction in serum albumin within 2 postoperative days compared with the preoperative level (∆ALB) and its influence on perioperative outcome in a pediatric general surgical cohort.Methods: This single-center retrospective review included 939 patients who underwent Roux-en-Y hepaticojejunostomy between August 2010 and August 2019. Based on the mean value of ∆ALB (14.6%), patients were separated into two groups, a high ∆ALB group (≥14.6%) and a low ∆ALB group (<14.6%). Multivariable logistic regression analyses were performed to determine the independent risk factors for a reduction in serum albumin. Propensity score matching was performed to adjust for any potential selection bias for the two groups. In 366 matched patients, the influences of operating time on perioperative outcomes, including postoperative recovery, complications measurement, and length of hospital stay between the two groups were analyzed.Results: Among the 996 patients reviewed, 939 patient records were enrolled in the final analysis. Controlling for other factors, multivariable analysis showed that a high CRP on POD 3 or 4 (odds ratio [OR] =2.36 [95% CI, 1.51-3.86]; p =0.007), the presence of Charcot's triad (OR=1.73 [95% CI, 1.05-2.83]; p = 0.031), and a longer operating time (OR=1.18 [95% CI, 1.00 -1.53]; p=0.014) were factors that predicted a high ∆ALB level. A high ∆ALB level was associated with postoperative gastrointestinal functional recovery, reflected by the first defecation (p= 0.013) and first bowel movement (p=0.019) and the high occurrence of postoperative complications (16.1% vs 10.9%, OR, 1.57; 95% CI, 1.02-2.41, P=0.0026). The mean length of postoperative stay of patients in the high ∆ALB group was longer than that of patients in the ∆ALB < 14.0% group, although no statistically significant difference was observed (p=0.057). Conclusions: We showed that a change in albumin level was associated with postoperative outcome. The risk factors for ∆ALB could be addressed in the perioperative period to permit patients to obtain a safe recovery and discharge after a major abdominal operation.

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