scholarly journals Comparison of postoperative analgesic efficacy of preemptive USG-guided TAP block, USG-guided local infiltration and intravenous dexketoprofen in inguinal hernia repair

2020 ◽  
Author(s):  
Fikret Salık ◽  
Mustafa Bıçak ◽  
Hakan Akelma
Keyword(s):  
Inguinal Hernia ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Number Of Patients ◽  
Vas Scores ◽  
Group 3 ◽  
Group 2 ◽  
Local Anesthetic Infiltration ◽  
Group 1

Abstract Background Although regional techniques have been suggested more in order to provide postoperative analgesia in inguinal hernia repairs, the ideal method is still controversial. The aim of this study was to evaluate the effect of preemptive transversus abdominis plane (TAP) block, local anesthetic infiltration (LAI) and intravenous dexketoprofen (IVD) on postoperative pain in inguinal hernia repairs. Methods This prospective study included 120 patients with American Society of Anesthesiologists status 1-3 between 18-75 years of age who undergoing elective inguinal hernia surgery under spinal anesthesia. The patients were allocated into three groups: USG-guided TAP block (Group 1, n = 40), USG-guided LAI (Group 2, n = 40) and IVD (Group 3, n = 40) before surgical incision. The mean of tramadol consumption, number of patients in requiring rescue analgesics, duration of postoperative analgesia and complications were recorded for 24 hours postoperatively. VAS scores were evaluated at the 30 minute, 1, 2, 4, 8, 12, 16 and 24th hours. Results There was no significant difference between the postoperative mean tramadol consumption [Group 1: 22.5 mg; Group 2: 20 mg; Group 3: 27.5 (p 0.833)]. The number of patients requiring rescue analgesics was statistically similar (p 0.787). VAS scores at 30. min, 1, 2, 4, 8 and 12 hours were statistically lower in Group 1 than in the other groups (p 0.003, 007, 0013, 0049, 0015, 0021). VAS scores at 30. min and 2. h were lower in Group 1 than Group 2 (p 0.049, 0.037). İn addition, VAS scores at 30 min, 1, 2, 8 and 12 hours were lower in Group 1 than in Group 3 (p 0.003, 0.006, 0.021, 0.017, 0.016). VAS scores at all hours were statistically similar between Group 2 and Group 3. Conclusion This study demonsrated that preemptive transversus abdominis plane block, local anesthetic infiltration or iv dexketoprofen for postoperative analgesia in inguinal hernia repairs had similar effects on postoperative tramadol consumption and number of requiring rescue analgesic patients. However, TAP block provides lower VAS values and excellent analgesia in more patients in the first 24 hours postoperatively.

scholarly journals The effect of hormonal disbalance on the aging rate change in the patients with arterial hypertension and comorbid endocrinopathies

2019 ◽  
Vol 23 (2) ◽  
pp. 277-282
Author(s):  
V. D. Nemtsova ◽  
I. A. Ilchenko ◽  
V. V. Zlatkina
Keyword(s):  
Arterial Hypertension ◽  
Premature Aging ◽  
Endocrine Disorders ◽  
Anthropometric Parameters ◽  
Aging Rate ◽  
Age Related ◽  
Number Of Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Due to the growing number of patients with age-related diseases, the aim of the study was to investigate in the changes of aging rate (AR) in patients with comorbid course of arterial hypertension (H), type 2 diabetes mellitus (T2DM) and subclinical hypothyroidism (SH) and to study the features of these changes depending on hormonal imbalance. 118 patients (63 women and 55 men, average age — 53.6±4.3 years) were divided into 3 groups: group 1 (n=37) with isolated H; group 2 (n=42) — with H and T2DM; group 3 (n=39) — with H, T2DM and SH. The investigation program included: measurement of anthropometric parameters (blood pressure, height, body weight (BW), body mass index (BMI)), carbohydrate and thyroid metabolism using standard methods, biological age (BA) by V.P. Voitenko et al. Statistical processing was performed using the Statistica for Windows 8.0 software package. When evaluating AR, physiological aging was found in 8 patients (21.6%) of group 1, in 4 (9.5%) patients of group 2 and 3 (7.7%) of patients in group 3. In the overwhelming majority of the examined patients, premature aging (PA) was noted, however, the acceleration of PA between patients of groups 2 and 3 was not differ significantly (p>0.05). The increase in AR in group 2 patients was accompanied by an increase in BA by 7.2 years, in 3 group patients — by 7.3 years compared with their chronological age. A correlation analysis revealed a positive relationship between BMI and coefficient of aging rate (CAR) (r=0.679; p<0.05); BMI and BA (r=0.562; p<0.05) and CAR and the TSH level (r=0.050; p=0.388) in the 3rd group. Thus, the presence of hypertension and comorbid endocrinopathies — T2DM and SH significantly increases the AR and when assessing the effect of endocrine disorders, the presence of T2DM is more important than SH.

scholarly journals Single sitting multimodality management of hemorrhoid

2021 ◽  
Vol 8 (11) ◽  
pp. 3302
Author(s):  
Mahendra P. Singh
Keyword(s):  
Variable Number ◽  
Concomitant Treatment ◽  
Stage Management ◽  
Group 4 ◽  
Number Of Patients ◽  
Clinical Complexity ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: It is usual to face clinical complexity in piles patients. They usually present with variable number of pile masses and in different grades of progression. This led to the idea of offering concomitant single stage management in our hemorrhoid patients matching to our criteria. We conducted hospital based descriptive study among the patients coming to my clinical practice falling in grade-1-3.Methods: All the patients falling in grade-1-3 and matching to our criteria were included. The study was conducted   from January 2012 to December 2020. Place of study was basically at two centres: Karamdeep medical centre, Kanpur and Mayo health care, Mohali. Total number of patients were 581. Patients having grade-4 piles and with local co-morbidities were excluded from the study. Modalities of treatment used were sclerotherapy, band ligation and hemorrhoidectomy.Results: Patients managed were divided into four groups – group 1 included patients with piles in grade-1; group-2 included patients having piles in grade-1 and 2; group-3 included patients having piles in grade-1 and 3; and group-4 included patients having piles in grade-1, 2 and 3. Total 952 pile masses were treated in 581 patients. Sclerotherapy was required in 732 (77%) masses, banding in 99 (10.3%) masses and surgery in 122 (12.7%) masses.Conclusions: Concomitant treatment policy proved to be comprehensive way to tackle pile patients of grade-1-3. Mixed and matched method using surgical and non-surgical modalities in a single sitting proved to be beneficial. 86.4% cases were cured this way. Cost of the treatment was economical with lesser complications including local mutilation and better quality of life.

Evaluation of intra-articular and subcutaneous administration of meloxicam for postoperative analgesia following stifle surgery in dogs

2011 ◽  
Vol 24 (01) ◽  
pp. 32-38 ◽  
Author(s):  
G. Hosgood ◽  
E. Rowe ◽  
K. A. Lemke ◽  
P. Moak
Keyword(s):  
Postoperative Analgesia ◽  
Cruciate Ligament ◽  
Subcutaneous Administration ◽  
Cranial Cruciate Ligament ◽  
Treatment Groups ◽  
Routes Of Administration ◽  
Vas Scores ◽  
Group 3 ◽  
Effect Of Treatment ◽  
Group 2

SummaryThe objective of this study was to compare the efficacy of meloxicam when given by intra-articular (IA) and subcutaneous (SC) routes of administration for postoperative analgesia versus a placebo for dogs undergoing stifle surgery. Twenty-five dogs with cranial cruciate ligament rupture (CCLR) were randomly assigned to one of three treatment groups, each with nine dogs, before surgical repair of twenty-seven stifles using a modified lateral retinacular imbrication technique. Group 1 dogs received IA administration of meloxicam and SC placebo. Group 2 dogs received IA placebo and SC meloxicam. Group 3 dogs received IA and SC administration of placebo. Dogs were assessed for pain by blinded observers using a visual analog scale (VAS), a numerical pain scoring system (NPS), and measurement of pain threshold using an algometer applied to the affected stifle. Assessments were made prior to pre-medication, postoperatively at the time of extubation, and at 1, 2, 4, 6, 8, 10, 12, 16, 20, and 24 hours following extubation. The results did not identify any significant effect of treatment between groups on the VAS data, algometer readings, or NPS data. Significantly increased VAS scores and decreased algometer readings were noted from preoperative to postoperative times. No differences were noted in early postoperative pain between dogs treated with IA meloxicam, SC meloxicam, or placebo.While intra-articular non-steroidal anti-inflammatory drug administration has shown efficacy in joint surgery for people, we did not find any evidence to support its use in dogs undergoing repair of CCLR.

Does Upfront Therapy with Fludarabine Increase the Risk of Histological Transformation In Patients with Follicular Lymphoma?

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4885-4885
Author(s):  
Sobia Yaqub ◽  
Todd W. Gress ◽  
Oscar Ballester
Keyword(s):  
Follicular Lymphoma ◽  
Relapse Rate ◽  
Group 4 ◽  
Number Of Patients ◽  
Histological Transformation ◽  
Group 3 ◽  
Group 2 ◽  
Time To Relapse ◽  
Group 1

Abstract Abstract 4885 Introduction: Fludarabine has been reported to increase the incidence of relapse and histological transformation in chronic lymphocytic leukemia (Thornton PD, Leukemia research, 2005) and Waldenstrom macroglobulinemia (Leleu X, J Clincal Oncology, 2009). The purpose of our study was to investigate the role of Fludarabine and the risk of transformation and relapse in follicular lymphoma (FL). Patients and Methods: This is a retrospective single institution study. We included 50 patients consecutively diagnosed with FL Grade I and II based on WHO classification of lymphoid malignancies. Grade III patients were excluded from the study. Median follow up is 2.86 years. Patients were grouped according to the initial therapy chosen by their treating physicians: Group 1(n=14) included patients on observation and radiation therapy, Group 2 (n=6) included patients on Fludarabine based regimens, Group 3(n=13) included CVP-R and other rituximab regimens and Group 4(n=17) included R-CHOP. Data collected included time to the onset of biopsy proven transformation, time to relapse, mortality and overall survival. Level of significance was set at <0.05. Results: Median age of the patients was 56.5 and it was not significantly different for the various groups. High risk FLIPI score was seen in 66% of patients treated with Fludarabine regimens as compared to 61% of R-CHOP treated patients. Overall, relapse occurred in 38% patients and transformation occurred in 16% patients during the follow up period. Fludarabine treated patients had the highest relapse rate: 50% (p=0.03). R-CHOP group has lowest relapse rate: 11%. Transformation rate was highest in the Fludarabine group: 33%, as compared to 13% to 17% in other groups (p=0.10). Mortality rate was 7% in group 1, 16% in group 2, 23% for group 3 and 5% in group 4 (p=0.44). Time to relapse/progression in group 1 was 2.9 years; in group 2 was 2.1 years; in group 3 was 2.7 years and in group 4 was 5.8 years. Conclusions: In our study, Fludarabine treated patients appear to be at higher risk for relapse and transformation compared to patients treated with R-CHOP. The differences can not be explained on the basis of known prognostic factors such as age or FLIPI score. The retrospective nature of the study and the small numbers of patients preclude more definitive conclusions. Further research is needed with large number of patients. Disclosures: No relevant conflicts of interest to declare.

Changes in Components of the Natural Coagulation Inhibitor System, in Patients with Antiphospholipid Antibodies and/or the Lupus Inhibitor.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4031-4031
Author(s):  
Yale S. Arkel ◽  
De-Hui W. Ku ◽  
Evelyn Y. Ku ◽  
Jeffrey Birnbaum ◽  
Xuam Lam
Keyword(s):  
Antiphospholipid Antibodies ◽  
Assay Method ◽  
Apparent Difference ◽  
Endothelial Protein C Receptor ◽  
Protein Z ◽  
Number Of Patients ◽  
Coagulation Assay ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract The cell surface glycoproteins thrombomodulin (TM) and endothelial protein C receptor (EPCR) are major intermediaries in the down-regulation of thrombin and are noted to be shed from endothelial cells (ECs) due to the actions of proinflammatory cytokines, thrombin and other agents. Antiphospholipid antibodies (APLA) have been described as perturbing ECs. The level of protein S (PS) and protein Z (PZ) have been reported to inconsistently relate to the presence of antibodies and clinical outcomes. We previously reported using a coagulation assay system to demonstrate that adverse pregnancy outcomes (APO) are associated with a greater incidence of resistance to the anticoagulant effects of TM. In the current study we measured the plasma levels of soluble TM (sTM), soluble EPCR (sEPCR) as a possible indicator of APLA-EC interaction. We measured levels of free PS, PZ, sTM and sEPCR in patients (pts) with APLA and/or lupus inhibitor (LI), and correlated the findings with a positive or negative history for thrombosis [THRM(+) or (−)]. APO were not assessed at this time. The study group consisted of 26 males and 60 females, ages ranging from 25 to 90 years; mean of 56. GROUP 1: 33 pts with increased (inc) APLA and 24 of them THRM(+), GROUP 2: 16 pts positive for LI and 7 of them THRM(+), GROUP 3: 37 pts positive for both APLA & LI and 21 of them THRM(+). The pts were compared to 49 normal APLA negative donors (CTR). Pts who have moderate to high levels of anticardiolipin and/or anti-β2 glycoprotein I are APLA positive. LI positive pts have prolonged LI sensitive PTT, and are positive for at least two of the confirmatory tests (Hexagonal phase assay, platelet neutralization procedure, and diluted Russel Viper Venom Time Ratio). GROUP 1 has statistically significant (SS) (p&lt;0.05) decreased (dec) sTM, sEPCR, and free PS when compared to CTR (sTM 1.0+/−1.4 vs 5.1+/−3.3ng/ml, sEPCR 43+/−53 vs 145+/−140ng/ml, free PS 63+/−25 vs 76+/−14%). Free PS is SS lower in the THRM(−) vs. THRM(+). PZ levels do not demonstrate SS differences in the subset comparisons. 8% of THRM(+) pts have PZ deficiency (PZ &lt;1.0ug/ml) with none noted in the THRM(−) pts. Free PS is dec in a majority of the THRM(−). This might be related to the much higher % of females in the THRM(−). Therefore issues such as use of OCP, estrogens, current or recent pregnancy might influence PS. The incidents of dec sTM levels (&lt;2.0ng/ml) are surprisingly higher in this group of patients (82%). This is strikingly higher than the CTR (4%). There is no apparent difference in the THRM(+) to THRM(−). The number of patients with dec sEPCR (&lt;5ng/ml) is much lower however; none of the THRM(−) has dec levels. Inc sTM (&gt;8.0ng/ml) nor inc sEPCR (&gt;284ng/ml) is noted in any of the Pts. In GROUP 2, there is SS dec sTM & sEPCR (sTM 1.6+/−1.8ng/ml, sEPCR 42+/−32ng/ml) vs. CTR with no SS difference in the THRM(+) vs. THRM(−). In GROUP 3, sEPCR is SS dec in pts (sEPCR 68+/−100ng/ml) vs. CTR and CTR vs THRM(+) (sEPCR 29+/−25ng/ml). sTM is SS dec in the CTR vs. THRM(+) (sTM 1.3+/11.4ng/ml). Our data shows low levels of sTM and sEPCR in the APLA patients. This might indicate that the levels are consumed by antibody interactions and could indicate that the APLA and associated other antibodies might interfere with their functions. Previous reports indicating a resistance to TM in a coagulation assay method in patients with THRM and APO raises the possibility of an inhibiting substance present in the APLA. Further work in larger patient groups is necessary to clarify these issues.

scholarly journals Efficacy and opioid-sparing effect of interpleural bupivacaine in patients undergoing laparoscopic cholecystectomy: Prospective observational study (Running title: Efficacy of inter-pleural bupivacaine in laparoscopy)

2021 ◽  
Vol 43 (5-6) ◽  
pp. 103-110
Author(s):  
A.K. Prasath ◽  
Senthil Kumar ◽  
Mohanhariraj Angamuthammal ◽  
Agnes Evangleen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Pain Relief ◽  
Study Groups ◽  
P Value ◽  
Number Of Patients ◽  
Significant Difference ◽  
Vas Scores ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Introduction: Laparoscopic cholecystectomy is considered minimally invasive, but pain following laparoscopy is moderate to severe, leading to increased morbidity and length of hospital stay. Various medications, including opioids, NSAIDs, and techniques like intraperitoneal local anesthetic infiltration, are used. In this study, we investigated interpleural block with bupivacaine for pain relief following laparoscopic cholecystectomy. Methods: A total of 60 patients were included in the study. 30 patients received 20 ml of 0.5% interpleural bupivacaine (group 1), and 30 patients recieved 20 ml of 0.9% normal saline (group 2). We recorded visual analog score (VAS), vital signs, and postoperative opioid requirements. Tramadol (2 mg/kg) was rescue medication if VAS ≥ 5. Results: Significant difference between study groups was recorded among VAS scores measured at 30 minutes, 1, 2, 6, 10, and 12 hours (p value < 0.05). The difference in VAS scores at 15 minutes and 14 hours between study groups was insignificant (p value > 0.05). The number of patients who received tramadol was 9 (30%) patients in group 1 and 29 (96.7%) patients in group 2. The difference in proportion for tramadol intake at 6 hours was significant among study groups (p-value < 0.05). Conclusion: Interpleural bupivacaine 20 ml of 0.5% used as analgesia reduces post-operative opioid requirement following laparoscopic cholecystectomy. Hence interpleural block can be safely used as a regional technique for pain relief following laparoscopic cholecystectomy.

scholarly journals POSTERIOR SPINAL INSTRUMENTATION FOR TUBERCULOSIS SPONDYLITIS

2006 ◽  
pp. 048-054
Author(s):  
Aleksandr Yuryevich Mushkin ◽  
Dmitry Vladimirovich Kuklin ◽  
Mikhail Viktorovich Belyakov ◽  
O. V. Dolenko
Keyword(s):  
Posterior Instrumentation ◽  
Spinal Instrumentation ◽  
Posterior Fixation ◽  
Anterior Fusion ◽  
Spinal Reconstruction ◽  
Number Of Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective. To study potentialities of posterior instrumentation for treatment of TB spondylitis in adults. Material and Methods. Data on the treatment outcomes of 93 adult patients with TB spondylitis at T2–L5, which underwent radical reconstructing and restorative surgeries in the period of active inflammatory process were analyzed. In 40 cases a traditional technique was used (Group 1); in 11 cases this technique was supplemented by posterior fixation with Harrington rods or CITO-plates (Group 2) and in 42 – with CDI (Group 3). Deformity dynamics, character of complications, and changes in neural disorders and pain dynamics defined the operative effect. Results. The absence of instrumented fixation in Group 1 was accompanied with the most significant decrease in graft sizes and most numerous complications in a zone of anterior fusion. Both these characteristics have least values in Group 3. Use of conventionally semi-rigid constructs in Group 2 caused 7 complications in a zone of posterior fixation out of 11 cases (66.4 %). There were 2 complications out of 42 cases (4.3 %) in Group 3. Short-term pain intensity decrease was achieved in all groups. However augmenting of pain syndrome was registered in a considerable number of patients in Groups 1 and 2 in a long-term period, while there were no negative long-term outcomes in Group 3. Conclusion. Combination of radical spinal reconstruction and fixation with segmented instrumentation of the third generation for TB spondylitis provides considerable improvement of treatment results and reduction of rehabilitation and in-hospital periods.

scholarly journals Ultrasound Guided Quadratus Lumborum Block versus Transversus Abdominis Plane Block for Postoperative Analgesia in Patients Undergoing Total Abdominal Hysterectomy- A RCT

2021 ◽  
Author(s):  
Usha Shukla ◽  
Pratima Kumari ◽  
Jay Brijesh Singh Yadav ◽  
Atit Kumar
Keyword(s):  
Patient Satisfaction ◽  
Postoperative Analgesia ◽  
Abdominal Hysterectomy ◽  
Transversus Abdominis ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Analgesic Requirement ◽  
Patient Satisfaction Score ◽  
Quadratus Lumborum ◽  
Vas Scores

Introduction: Abdominal Hysterectomy (AH) is one of the most common surgeries performed in gynaecology and is associated with a medium to high pain level. Newly discovered peripheral blocks such as Transversus Abdominis Plane (TAP) block and Quadratus Lumborum (QL) block have gained immense popularity as an adjunct to regional and general anaesthesia for postoperative pain management and reducing analgesic requirements. Aim: To compare the analgesic efficacy of QL block with TAP block in patients undergoing total AH. Materials and Methods: This was a double-blinded Randomised Clinical Trial (RCT). The study population comprised of 105 patients posted for elective total AH under spinal anaesthesia. They were randomly allocated into three groups of 35 patients each. Group Q received bilateral QL block with 40 mL of 0.25% bupivacaine divided on either side, Group T received bilateral TAP block with 40 mL of 0.25% bupivacaine divided on either side and in Group C no block was given. Patients were monitored for Visual Analogue Scale (VAS) scores at 0, 15 minutes, 30 minutes, 1st, 2nd, 6th, 12th and 24th hour postoperatively, time for first analgesic requirement, total analgesic requirement in 24 hours and patient satisfaction score after 24 hours and also adverse effects, if any. Data were analysed using Statistical Package For The Social Sciences (SPSS) version 16 (Chicago, IL, USA) with independent t-test and Chi-square test as appropriate. The p<0.05 was considered statistically significant. Results: There were significantly lower VAS scores in group Q than group T at 2nd and 6th hour with p-value of 0.003 and 0.001, respectively. The time for first analgesic was early in group C with mean value of 1.37±0.74 hours and it was 4.63±0.97 hours in group T and 7.77±1.51 hours in group Q. The total analgesic requirement was lesser in group Q when compared to group C and T. Patient satisfaction score was comparable between group Q and T (p=0.97). No significant difference in complications among the three groups was observed (p=0.51). Conclusion: QL block is a better postoperative analgesic technique than TAP block for postoperative analgesia in hysterectomy patients.

scholarly journals Effect of Renal Function on Success and Complications of Percutaneous Nephrolithotomy

2021 ◽  
pp. 68-73
Author(s):  
Serkan Yarimoglu ◽  
Mehmet Erhan Aydin ◽  
Murat Sahan ◽  
Omer Koras ◽  
Onur Erdemoglu ◽  
...  
Keyword(s):  
Renal Function ◽  
Glomerular Filtration ◽  
Percutaneous Nephrolithotomy ◽  
Kidney Stones ◽  
Complication Rates ◽  
Number Of Patients ◽  
Group 3 ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective: In this study, we aimed to compare the success and complication rates of percutaneous nephrolithotomy (PCNL) according to preoperative glomerular filtration rates (GFR) of patients who underwent PCNLdue to kidney stones. Material and Methods: Between January 2012 and December 2016, 794 patients who underwent PCNL due to kidney Stones were evaluated retrospectively. Preoperative GFR values of patients were calculated according to Cockcroft –Gault formula. The patients with preoperative GFR values>90 ml/min, 60-90 ml/min, 30-60 ml/min were respectively defined as group-1, group-2 and group-3. Preoperative and perioperative values, Stone free rates and complication rates were compared between the groups. Postoperatively , <4 mm residual stone was identified as success. Results: There were 466 patients in Group-1, 259 in Group-2 and 67 patients in Group-3. The mean preoperative GFR values of the patients were 118.53 ml/min, 77.76 ml/min and 48.52 ml/min, respectively in group-1, group-2 and group-3 (p <0.001).The mean age of the patients was 62.8±11.47, 51.86±11.10, and60.31±12.7, respectively, in group-1, group-2 and group-3 (p<0.001).The mean Stone burden of the patients were 497.34±518.60 mm2, 517.6±493.8 mm2and 711.06±679.07 mm2, respectively, in group-1, group-2 and group-3 (p=0.013). The number of patients identified with success after surgery was 355 (86.2%), 195 (76.1%) and 50 (74.6%) in group-1, group-2 and group-3, respectively (p = 0.542). The number of patients who develop complications was 114 (%24.65), 57 (%22) and 11 (%16.4) in group-1, group-2 and group-3, respectively (p=0.310). Conclusion: Preoperative GFR valuesare not lonely sufficient to predict success and complications after PCNL. Keywords: Percutaneous nephrolithotomy, renal function, renal stone, glomerular filtration rates

P1025Incidence and characteristics of pulmonary vein reconduction after second-generation cryoballoon-based pulmonary vein isolation: Impact of different ablation strategies

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C H Heeger ◽  
E R Rexha ◽  
S M Maack ◽  
L Rottner ◽  
T Fink ◽  
...  
Keyword(s):  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Second Generation ◽  
Success Rates ◽  
Protocol Group ◽  
Number Of Patients ◽  
Group 3 ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Funding Acknowledgements none Introduction The second-generation CB (CB2, Arctic Front Advance, Medtronic Inc., Minneapolis, USA) has demonstrated high procedural success rates, relatively short procedure times, high durability of PVI and convincing long-term clinical success rates. Nevertheless, data on the impact of different ablations protocols on durability after CB2 based PVI is limited. Purpose We aimed at comparing durability of pulmonary vein isolation (PVI) following three different ablation strategies utilizing the second-generation cryoballoon (CB2) in patients with recurrence of atrial fibrillation (AF) or atrial tachycardia (AT) undergoing repeat procedures. Methods In 192 patients a total of 751 PVs were identified. All PVs (751/751, 100%) were successfully isolated during index PVI. Thirty-one out of 192 (16%) patients were treated with a bonus-freeze protocol (group 1), 67/192 (35%) patients with a no bonus-freeze protocol (group 2), and 94/192 (49%) patients with a "time-to-effect"-guided ablation protocol without bonus freezes (group 3). Results Persistent PVI was documented in 419/751 (55.8%) PVs, and in 41/192 (21%) patients all PVs were persistently isolated. The number of patients with all PVs being persistently isolated was not significant between the groups (p = 0.594). The total rate of PV reconnection was not significantly different between the three groups (p = 0.134) and the comparison of individual PVs revealed also no differences for different ablation protocols (p-values for RSPV: 0.424, RIPV: 0.541, LSPV: 0.788, LIPV: 0.346, LCPV: 0.865). The procedure times were significantly reduced in non-bonus freeze ablation protocols and/or when applying individualized application times (group 1: 123.4 ± 31.5min, group 2: 112.9 ± 39.8 min, group 3:  86.67 ± 28.4 min, p &lt;0.001). Conclusions A considerably high rate of persistent PVI was demonstrated in patients after index CB2-based PVI. No differences for durable PVI were detected for different ablation protocols. Therefore, individualized ablation protocols might be a beneficial ablation strategy during CB2-based PVI.

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