scholarly journals Effects of perioperative enteral glutamine on surgical outcome in gastrointestinal cancer patients

2019 ◽  
Vol 6 (3) ◽  
pp. 903
Author(s):  
Raghavendra . ◽  
Raghupathi S.
Keyword(s):  
Hospital Stay ◽  
Anastomotic Leak ◽  
Gastrointestinal Cancer ◽  
Gastrointestinal Surgery ◽  
Length Of Hospital Stay ◽  
Complication Rates ◽  
Ultrasound Guided ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Previous trials have shown that perioperative glutamine could protect patients from infectious complications after gastrointestinal cancer operations.Methods: 54 patients with a planned elective operation for gastrointestinal cancer were divided into two groups: GROUP A: patients given glutamine enriched enteral nutrition perioperatively (n=27), GROUP B: patients given enteral feed without glutamine (n=27). Patients were assessed in terms of post-operative complications like infective complications, anastomotic leak, need for reintervention, length of hospital stay and mortality.Results: In group A seven patients and in group B six patients had surgical site infection post operatively (p=0.750). In group A five patients and in group B three patients had lung and urinary tract infection post operatively (p=0.444). In group A three patients and in group B five patients had intra-abdominal abscess/collection post operatively (p=0.444). In group A one patient and in group B three patients had anastomotic leak post operatively (p=0.299). In group A three patients and in group B three patients had reintervention in form of ultrasound guided aspiration and ultrasound guided pigtail aspiration for intra-abdominal collection (p=1.000). In group A and in group B mean length of hospital stay was 26 days and 23 days respectively (p=0.346). In group A and in group B mean length of post-operative hospital stay was 13 and 12 days respectively (p=0.642). There was no mortality in our study. No significant difference between the groups was found in complication rates, length of hospital stay.Conclusions: Routine perioperative glutamine to the patients undergoing major gastrointestinal surgery is not beneficial.

Alvimopan as an essential component of ERAS protocol to decrease length of hospital stay.

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 517-517
Author(s):  
Peter Hanna ◽  
Arveen Kalapara ◽  
Subodh Regmi ◽  
Kalyana Srujana ◽  
Joseph Zabell ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Hospital Stay ◽  
Radical Cystectomy ◽  
Smoking Status ◽  
Length Of Hospital Stay ◽  
Significant Difference ◽  
Bowel Movements ◽  
Group A ◽  
Group B ◽  
Eras Protocol

517 Background: Radical cystectomy for muscle invasive bladder cancer is the gold standard. However, it is frequently associated with a prolonged length of hospital stay (LOS). We study the effect of ERAS protocol implementations and Alvimopan use in patients undergoing radical cystectomy and its impact on length of hospital stay (LOS). Methods: Retrospective cohort study involving consecutive patients undergoing radical cystectomy for bladder cancer at our institution from 2010 through 2018. We evaluated Alvimopan use plus an ERAS protocol post radical cystectomy versus patients who underwent ERAS protocol alone versus those who were managed prior to ERAS protocol implementation. Primary outcome of interest was LOS, controlling for age, sex, smoking status and Charleson comorbidities index. Results: 146 patients (49.32 %) received standard care (non-ERAS) (group A), 102 patients (34.45 %) underwent ERAS protocol alone (group B) and 47 patients (15.87 %) underwent ERAS protocol plus Alvimopan (group C). There was no significant difference in length of stay between group A and group B (p=0.856). However, group C experienced a shorter LOS (16.6%) compared to group A (p=0.015). Similarly, group B was not significantly associated with the days to bowel movements compared to group A (p=0.112), however, group C demonstrated a significantly shorter time (16.3%) to bowel movements compared to group A (p=0.015). On other hand, group c wasn’t significantly associated with time tolerance to regular diet (p=0.068). Limitations include retrospective nature of some of the data, non-randomized approach and confounders such as a mix of robot and open approaches to cystectomy. Conclusions: Of all ERAS protocol components, Alvimopan appeared to be the most significant contributor in accelerating GI recovery and decrease LOS in our cohort.

Comparative Analysis of Early versus Late Enteral Feeding after Gastrointestinal Surgeries

2021 ◽  
Vol 15 (8) ◽  
pp. 2050-2053
Author(s):  
Amnah Ilyas Khan ◽  
Nazish Masood ◽  
Usman Ilyas ◽  
Zahra Raza ◽  
Jehangaiz Khan
Keyword(s):  
Enteral Nutrition ◽  
Hospital Stay ◽  
Anastomotic Leak ◽  
Enteral Feeding ◽  
Controlled Trial ◽  
Gastrointestinal Surgery ◽  
Early Enteral Nutrition ◽  
Duration Of Hospital Stay ◽  
Group A ◽  
Group B

Background: Despite of widespread belief, clinical studies and animal experiments have suggested that initiation of early feeding after surgery has many advantages. Present study was planned for comparing outcomes of early and late enteral feeding in patients who were undergoing gastrointestinal surgeries in our settings. This would help the surgeons to select better option for earlier recovery after surgery Objective: To compare the outcome of early versus late enteral feeding in patients undergoing gastrointestinal surgeries. Design: It was a randomized controlled trial. Study Settings: The study was conducted at Department of General Surgery, PIMS Islamabad for a period of six months w.e.f 20-12-2017 to 19-06-2018. Patients and Methods: A total of two hundred (n=200) patients of both gender between age 15-70 years, who had been scheduled for elective or emergency gastrointestinal surgery were enrolled in the study. Patients were randomized early (Group A, <24 hours after surgery) and late enteral feeding (Group B, <24 hours after surgery). Outcomes were estimated in terms of infection, anastomotic leak and duration of hospital stay in both groups. Results: Mean age of the patients was 36.8±11.2. There were total 85 females and 115 males with female to male ratio of 1:1.35. Mean duration of hospital stay was 2.62 days ± 0.71 in group A and it was 6.55 days ± 0.71 2.93SD in groups B (P=0.001). Wound infection rate (8% vs 33%, P=0.001) and anastomotic leak rate (0% vs 10%, P=0.001) was also significantly lower in group A when compared with group B. Conclusion: Initiation of early enteral feeding (within 24 hours post operatively) in patients undergoing gastrointestinal surgeries has an immediate advantage of caloric intake and results in faster recovery with fewer complications. Similar results are found in the literature. We recommend early initiation (within 24 hours after surgery) of enteral feeding in patients undergoing gastrointestinal surgeries. Keywords: Anostomotic leak, early enteral nutrition (EEN), late enteral nutrition (LEN).

scholarly journals Does Clarithromycin Use in Acute Viral Bronchiolitis Shorten Length of Hospital Stay?

2020 ◽  
pp. 62-65
Author(s):  
Gülnur Esenülkü ◽  
Fatma Hancı
Keyword(s):  
Hospital Stay ◽  
Clinical Status ◽  
Length Of Hospital Stay ◽  
High Rate ◽  
Clinical Practices ◽  
Pediatric Clinic ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Acute Viral Bronchiolitis

Introduction: Acute bronchiolitis is the most common cause of hospitalization among infants. Although antibiotics are not recommended in the absence of secondary bacterial infection, rates of antibiotic usage is high rate in clinical practices Objectives: To test the hypothesis that clarithromycin use in infants with acute viral bronchiolitis shortens length of hospital stay. Materials and Methods: One hundred sixty-seven patients aged 1-24 months hospitalized for treatment with a diagnosis of acute viral bronchiolitis at pediatric clinic between April 2017 and May 2018 were investigated retrospectively. The patients were divided into two separate groups, Group A (122 patients), using clarithromycin therapy during hospitalization, and Group B (45 patients), which did not receive clarithromycin (Group B). Demographic and clinical data, treatments received, and duration of hospital stay were obtained from patients’ records. Results: The rate of clarithromycin use in this study was 73%. No statistically significant difference in length of hospital stay was determined between patients receiving clarithromycin and those receiving no antibiotic therapy. However, length of hospital stay decreased with age. Clarithromycin use elicited no statistically significant decrease in hospital stay in patients with acute viral bronchiolitis. Conclusions: The routine use of clarithromycin is not recommended in acute viral bronchiolitis in the light of its cost and side-effects, and the fact is has no impact on clinical status and hospital stay

scholarly journals Avoidance of hydrocele after non microsurgical varicocelectomy by pre-emptive eversion of tunica vaginalis in infertile men with varicocele

2019 ◽  
Vol 6 (5) ◽  
pp. 1462
Author(s):  
Hosam Farouk Abdelhameed ◽  
Mohammed Abu El‑Hamd ◽  
Mena Zarif Helmy
Keyword(s):  
Hospital Stay ◽  
Sperm Count ◽  
University Hospital ◽  
Complication Rates ◽  
Tunica Vaginalis ◽  
Infertile Men ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Background: In infertile men with varicocele, controlled studies clearly indicate that varicocelectomy improves pregnancy rates.  Non microsurgical varicocelectomy is associated with many complications; hydrocele is the most common one. Many techniques have been done to reduce the incidence of post-varicocelectomy hydrocele which is somewhat difficult to be done. This study aimed to evaluate the efficacy of pre-emptive eversion of tunica vaginalis in avoidance of post-operative hydrocele after non microsurgical varicocelectomy and its effect on fertility.Methods: A total number of 115 infertile men with varicocele underwent varicocelectomy during August 2015 to December 2016 in Sohag university hospital. Fifty five patients underwent bilateral microsurgical varicocelectomy (group A), were compared with 60 patients who underwent bilateral non microsurgical varicocelectomy with pre-emptive eversion of tunica vaginalis (group B) as regard, development of post-operative hydrocele, operative time, complication rates, hospital stay and effect on spontaneous pregnancy.Results: Group A has longer duration of surgery (26±11.7minutes versus 20±10.2minutes) while there was no significant difference in hospital stay (6±2.5 hours versus 6±1.5 hours) in both groups. No post-operative wound infection in both groups. There was one case (1.6%) develop scrotal haematoma in (group B) only. No post-operative recurrence in both groups.  No post-operative hydrocele developed in both groups. Improvement in sperm count, motility and morphology occurred in both groups. No significant difference in percentage of paternity during 6-24 months.Conclusions: Pre-emptive eversion of tunica during non- microsurgical varicocelectomy might be offered as an adjunctive technique to avoid development of post-operative hydrocele that is easy, not time consuming and has comparable results of microsurgical varicocelectomy.

scholarly journals Comparative evaluation of nebulised 3% saline versus nebulised 0.9% saline in the treatment of acute bronchiolitis

2019 ◽  
Vol 6 (3) ◽  
pp. 1182
Author(s):  
Pragalatha Kumar A. ◽  
Indhuja Rajarathinam ◽  
Aruna Gowdra
Keyword(s):  
Hospital Stay ◽  
Severity Score ◽  
Length Of Hospital Stay ◽  
Signs And Symptoms ◽  
Clinical Severity ◽  
Controlled Study ◽  
Acute Bronchiolitis ◽  
Clinical Severity Score ◽  
Group A ◽  
Group B

Background: Acute bronchiolitis is the most common respiratory tract infection in young children. Despite the high prevalence of acute bronchiolitis, no consensus exists on the management. Studies have shown that except oxygen therapy, no other treatment found to be effective. Hence, the present study was conducted to find out the efficacy of nebulised 3% saline versus is 0.9% saline for the treatment of acute bronchiolitis.Methods: A prospective randomized controlled study of 150 children between the age group of 2 months to 24 months with signs and symptoms of Acute Bronchiolitis admitted to Indira Gandhi Institute of Child Health, Bangalore from January 2016 to December 2016 formed the study group, they were randomized into 2 groups, one received 3% saline nebulization and the other received 0.9% saline.Results: A total of 150 children were enrolled in the study, 75 children (group A) received 0.9% saline and 75 children (group B) received 3% saline. At 24 hours, the mean clinical severity score for group A was 2.49±1.03 and group B was 2.16±0.49 (P=0.013). The duration of hospital stay was shorter (1-3 days) in 3% saline with a mean of 2.35 days and was longer (3-5 days) in 0.9% saline with mean value of 4.04 days which was statistically significant (p <0.001).Conclusions: 3% saline nebulization can be used as an effective treatment for acute bronchiolitis. It significantly reduced the clinical severity score and length of hospital stay compared to 0.9% normal saline.

Surgical treatment of multiple brain metastases

1993 ◽  
Vol 79 (2) ◽  
pp. 210-216 ◽  
Author(s):  
Rajesh K. Bindal ◽  
Raymond Sawaya ◽  
Milam E. Leavens ◽  
J. Jack Lee
Keyword(s):  
Brain Metastases ◽  
Survival Time ◽  
Prognostic Indicators ◽  
Survival Duration ◽  
Surgical Removal ◽  
Complication Rates ◽  
Multiple Brain Metastases ◽  
Significant Difference ◽  
Group A ◽  
Group B

✓ The authors conducted a retrospective review of the charts of 56 patients who underwent resection for multiple brain metastases. Of these, 30 had one or more lesions left unresected (Group A) and 26 underwent resection of all lesions (Group B). Twenty-six other patients with a single metastasis who underwent resection (Group C) were selected to match Group B by type of primary tumor, time from first diagnosis of cancer to diagnosis of brain metastases, and presence or absence of systemic cancer at the time of surgery. Statistical analysis indicated that Groups A and B were also homogeneous for these prognostic indicators. Median survival duration was 6 months for Group A, 14 months for Group B, and 14 months for Group C. There was a statistically significant difference in survival time between Groups A and B (p = 0.003) and Groups A and C (p = 0.012) but not between Groups B and C (p > 0.5). Brain metastasis recurred in 31% of patients in Group B and in 35% of those in Group C; this difference was not significant (p > 0.5). Symptoms improved after surgery in 65% of patients in Group A, 83% in Group B, and 84% in Group C. Symptoms worsened in 13% of patients in Group A, 6% in Group B, and 0% in Group C. Groups A, B, and C had complication rates per craniotomy of 8%, 9%, and 8%, and 30-day mortality rates of 3%, 4%, and 0%, respectively. Guidelines for management of patients with multiple brain metastases are discussed. The authors conclude that surgical removal of all lesions in selected patients with multiple brain metastases results in significantly increased survival time and gives a prognosis similar to that of patients undergoing surgery for a single metastasis.

Clinical Results Of A Lamina With Spinous Process And An Iliac Graft As Bone Grafts In The Surgical Treatment Of Single-Segment Lumbar Pyogenic Discitis: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Weiyang Zhong ◽  
Xinjie Liang ◽  
Xiaolin Wang ◽  
Ke Tang ◽  
Tianji Huang ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Spinous Process ◽  
Bone Grafts ◽  
Clinical Results ◽  
Single Segment ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Segmental Angle

Abstract Background: A retrospective study investigated and compared the results of a lamina withspinous process (LSP) and an iliac graft (IG) as bone grafts in single-segment lumbar pyogenic discitis (LPD) through one-stage-posterior-only approach with radical debridement and internal instrumentation.Methods: Data from 37 patients were reviewed. A LSP was placed in 17 patients (group A), and an IG was implemented in 20 patients (group B). The surgery time, surgery hemorrhage, hospital stay, drainage, and follow-up (FU) were reviewed. The visual analogue scale (VAS), Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, segmental angle, intervertebral height and bony fusion time were compared preoperatively and at the final FU.Results: All patients were followed-up for a mean of 27.94±2.35 months in group A and 30.29±1.89 months in group B, without a difference. The mean age was younger in group A than in group B (P<0.05). The surgery time, surgery hemorrhage, and hospitalization cost were lower in group A than in group B (P<0.05), except for the hospital stay and drainage time. Fever occurred in 10 patients in group A and 12 patients in group B. The ESR, CRP level, and VAS and ODI scores were significantly decreased, and there were no significant differences between the groups at the final FU. The distribution of bacterial agents in blood culture was 1 case of Aerobacter cloacae, 2 of Staphylococcus aureus, 2 of Escherichia coli, and 1 of Streptococcus viridis in group A and 1 of S. aureus，1 of Staphylococcus warneri and 2 of Klebsiella pneumoniae in group B. Pyogenic infection was observed in the pathological findings of all patients. No significant difference was found in the mean segmental angle or mean intervertebral height preoperation and at the final FU between the groups.Conclusion: The use of LSP as a new bone graft is reliable, safe, and effective for surgical management for the LPD while surgery is proposed as a good management strategy for LPD in carefully selected patients.

scholarly journals Comparison of early versus standard timing for silicone stent removal following External Dacrocystorhinostomy under local anaesthesia

2019 ◽  
Vol 11 (1) ◽  
pp. 24-28
Author(s):  
Ben Limbu ◽  
Hannah S Lyons ◽  
Mohan Krishna Shrestha ◽  
Geoffrey C Tabin ◽  
Rohit Saiju
Keyword(s):  
Success Rate ◽  
Financial Burden ◽  
Controlled Trial ◽  
Nasolacrimal Duct ◽  
Complication Rates ◽  
Tube Removal ◽  
Significant Difference ◽  
Silicone Stent ◽  
Group A ◽  
Group B

Introduction: The first line treatment for nasolacrimal duct obstruction (NLDO) is external dacrocystorhinostomy (DCR). Following DCR, patients are required to return to Tilganga Institute of Ophthalmology (TIO) six weeks postoperatively for the removal of a silicone stent. As the majority of patients travel large distances at significant cost to reach TIO, most often patients remain within Kathmandu during this six weeks interval. This places a large financial burden on patients. Methods: A randomized controlled trial was designed to compare patient outcomes after early (two weeks postoperatively) versus standard (six weeks postoperatively) removal of silicone stents. 50 selected patients were randomized into two equal groups. Results: At the time of publication, 31 patients (14 in group A and 17 in group B) had completed three months follow up. A success rate of 92.9% was noted in Group A and a success rate of 94.1% observed in group B. No significant difference was found between the two groups for success rate and rate of complications. Conclusion: Early tube removal post DCR appears to cause no significant difference in outcome or complication rates compared to standard tube removal.

scholarly journals Comparative Study of Efficiency between Povidone Iodine and Normal Saline Lavage in the Treatment of Acute Peritonitis

2018 ◽  
Vol 4 (1) ◽  
pp. 15-20
Author(s):  
Haridas Saha ◽  
Mohammad Ibrahim Khalil ◽  
Aminul Islam ◽  
Abdullah Al Mamun ◽  
Md Margub Hossain
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Normal Saline ◽  
Povidone Iodine ◽  
Medical College ◽  
Acute Peritonitis ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Saline Lavage

Background: Control of the primary site of sepsis is the main determinant of good surgical outcome. Objective: The purpose of the present study was to compare the efficiency between povidone iodine and normal saline lavage in the treatment of acute peritonitis. Methodology: This was a randomized clinical trial conducted in the Department of Surgery at Dhaka Medical College & Hospital, Dhaka, Bangladesh. Patients with acute peritonitis due to gastrointestinal causes who were admitted in the different units of Dhaka Medical College Hospital during the study period were selected as study population. Among them patients who were treated with povidone iodine were enrolled in the present study in group A and patients who were treated with conventional normal saline were in group B. Results: A total number of 1050 patients were recruited for this study. Among them 100 patients were enrolled in the present study of which group A (50 patients) for povidone iodine and group B (50 patients) for conventional normal saline. On 7th POD wound infection was found in Group A and Group B were 11(22.4%) and 21(44.7%) respectively. Statistically significant difference in post operative complication of wound infection was observed on 7th POD between the groups (p<0.05). Post operative hospital stay in Group A and Group B were 11.50 ± 4.48 and 13.46 ± 5.13 days respectively. There is statistically significant difference in post operative hospital stay between the groups (p<0.05). Conclusion: Statistically significant difference observed in post operative complication of wound infection and burst abdomen on 7th POD between the groups. The present study there is statistically significant difference in post operative hospital stay between the groups also observed. Bangladesh Journal of Infectious Diseases 2017;4(1):15-20

scholarly journals Comparison of conventional fenestration discectomy with Transforaminal endoscopic lumbar discectomy for treating lumbar disc herniation:minimum 2-year long-term follow-up in 1100 patients

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Quanyi Li ◽  
Yongchun Zhou
Keyword(s):  
Hospital Stay ◽  
Lumbar Disc ◽  
Length Of Hospital Stay ◽  
Bed Rest ◽  
Intraoperative Blood Loss ◽  
Postoperative Length ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy

Abstract Purpose To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) with transforaminal endoscopic lumbar discectomy (TELD) for treating lumbar disc herniation (LDH). Methods The clinical data of 1100 patients who had been diagnosed with LDH between January 2012 and December 2017 were retrospectively analysed. IFD was performed on 605 patients in Group A, whereas TELD was performed on 505 patients in Group B. The Oswestry Disability Index, Visual Analogue Scale for pain and modified MacNab criteria were used to evaluate the outcomes. The surgery duration, intraoperative blood loss, postoperative off-bed activity and postoperative length of hospital stay were recorded. Results The follow-up period ranged from 24 to 60 months, with an average of 43 months. The excellent and good outcome rates were 93.5% in Group A and 92.6% in Group B. There was no significant difference in efficacy between the groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest duration and postoperative length of hospital stay than Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions Although conventional IFD and TELD had similar levels of efficacy in treating LDH, TELD had several advantages. There was less intraoperative bleeding, shorter length of hospital stay and shorter bed rest duration. It can be considered a safe and effective surgical option for treating LDH.

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