PATHOMORPHOLOGICAL ASPECTS OF THE DEVELOPMENT OF BILIARY REFLUX AFTER MINI-GASTRIC BYPASS

INTRODUCTION. MGB is considered to be the best alternative to Roux-en-Y gastric bypass (RYGB) due to the shorter operation time and fewer possible complications. The OBJECTIVE of this study was to determine biliary reflux in patients undergoing MGB with a hand-sewn gastroenteroanastomosis, and MGB with a stapler gastroenteroanastomosis.MATERIAL AND METHODS. This study included the analysis of results of treatment of 122 patients with morbid obesity and metabolic syndrome who had undergone laparoscopic MGB. Patients were divided into two clinical groups depending on the method of applying gastroenteroanastomosis. Clinical and endoscopic assessment was used to determine bile reflux; biliary reflux index (BRI) was used. In the postoperative period, the possibility of developing biliary reflux using fibrogastroscopy with biopsy of the gastric mucosa, microscopy of biopsy materials was evaluated. Microscopy of biopsy specimens was performed by a pathologist who evaluated each sample of gastric tissue in accordance with the system for determining the biliary reflux index (BRI).RESULTS. During fibrogastroscopy, biliary reflux was diagnosed in 9 (15.5 %) cases in the study group and 16 (26.6 %) cases in the control group. In the study group of patients, biliary reflux index (BRI) > 14 was determined in 3 patients (5.153 %). In the control group of patients, BRI> 14 was in 7 cases (10.94 %). The difference was significant (p<0.05).CONCLUSION. Determination of BRI index in patients undergoing MGB could be used as a screening method for diagnosing the biliary reflux in order to prevent and develop the tactic for further management of patients from a risk group of complications associated with the toxic effects of an aggressive bile refluxate.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

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Algorithm for the prevention of pulmonary complications after thoracic surgeries

Reports of Vinnytsia National Medical University ◽

10.31393/reports-vnmedical-2021-25(3)-20 ◽

2021 ◽

Vol 25 (3) ◽

pp. 462-465

Author(s):

O. Yu. Usenko ◽

A. V. Sydiuk ◽

O. E. Sydiuk ◽

A. S. Klimas ◽

G. Yu. Savenko ◽

...

Keyword(s):

Thoracic Surgery ◽

Pulmonary Complications ◽

Control Group ◽

Study Group ◽

Thoracic Cavity ◽

Term Survival ◽

Statistical Software ◽

Results Of Treatment ◽

Retrospective Comparison ◽

The Difference

Annotation. The biggest problem after operations on the thoracic cavity is the number of pulmonary complications (according to various authors 26-38% of cases). Despite the development of numerous methods for the prevention and treatment of these complications, they remain one of the leading causes of hospital mortality and may be an independent risk factor for worse long-term survival. Therefore, the aim of the work was to improve the results of treatment of patients after operations on the thoracic cavity by developing an algorithm for anesthesia for perioperative prevention of pulmonary complications. Participated in the study 192 patients with diseases of the thoracic cavity (esophagus, lungs, mediastinum), operated on in the thoracoabdominal department of the National Institute of Surgery and Transplantology named after O.O. Shalimov. Retrospective comparison group - 96 patients after thoracic surgery, which used conventional methods of perioperative management. The study group consisted of 96 patients after thoracic surgery, who used a perioperative anesthesia algorithm for the prevention of pulmonary complications. Statistical software EZR v. Was used for statistical calculations. 1.54 (graphical user interface for statistical software R version 4.0.3, R Foundation for Statistical Computing, Vienna, Austria). When conducting a multifactor analysis, it was found that the proposed method of prevention of pulmonary complications can reduce (p=0.001) the risk of development, HS=0.27 (95% CI 0.13-0.58) compared with the control group (with standardization by sex, weight, ASA of the patient). Pulmonary complications developed in 33 (34.4%) patients of the control group and in 13 (13.5%) patients of the study group, the difference was statistically significant, p=0.001. Thus, the application of the proposed technique reduces (p = 0.001) the risk of complications, BP=0.39 (95% CI 0.22 - 0.70) compared to traditional methods.

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SINGLE ANASTOMOSIS GASTRIC BYPASS (ONE ANASTOMOSIS GASTRIC BYPASS OR MINI GASTRIC BYPASS): THE EXPERIENCE WITH BILLROTH II MUST BE CONSIDERED AND IS A CHALLENGE FOR THE NEXT YEARS

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-6720201700040010 ◽

2017 ◽

Vol 30 (4) ◽

pp. 267-271 ◽

Cited By ~ 6

Author(s):

Italo BRAGHETTO ◽

Attila CSENDES

Keyword(s):

Gastric Bypass ◽

Bile Reflux ◽

Late Complication ◽

Operation Time ◽

One Anastomosis Gastric Bypass ◽

Mini Gastric Bypass ◽

Esophageal Mucosa ◽

Billroth Ii ◽

Single Anastomosis Gastric Bypass ◽

Single Anastomosis

ABSTRACT Introduction: Single anastomosis gastric bypass (one anastomosis gastric bypass or mini-gastric bypass) has been presented as an option of surgical treatment for obese patients in order to reduce operation time and avoiding eventual postoperative complications after Roux-en-Y gastric bypass.The main late complication could be related to bile reflux. Aim: To report the experiences published after Billroth II anastomosis and its adverse effects regarding symptoms and damage on the gastric and esophageal mucosa . Method: For data recollection Medline, Pubmed, Scielo and Cochrane database were accessed, giving a total of 168 papers being chosen 57 of them. Results: According the reported results during open era surgery for peptic disease and more recent results for gastric cancer surgery, bile reflux and its consequences are more frequent after Billroth II operation compared to Roux-en-Y gastrojejunal anastomosis. Conclusion: These findings must be considered for the indication of bariatric surgery.

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Biliary reflux after laparoscopic modified antireflux monoanastomotic gastric bypass surgery

Pathologia ◽

10.14739/2310-1237.2021.3.239911 ◽

2021 ◽

Vol 18 (3) ◽

pp. 311-320

Author(s):

M. V. Nikolaiev

Keyword(s):

Morbid Obesity ◽

Gastric Bypass ◽

Bypass Surgery ◽

Gastric Bypass Surgery ◽

Clinical Manifestations ◽

Main Group ◽

Mini Gastric Bypass ◽

Control Group ◽

Biliary Reflux ◽

Gastric Bypass Operation

Aim. Determination of biliary reflux in patients with morbid obesity after a single-anastomotic gastric bypass operation performed in the clinic's modification and according to the classical Roux-en-Y gastric bypass technique. Development of diagnostic criteria for biliary reflux Materials and methods. The results of treatment of 36 patients with morbid obesity who underwent bypass surgery were studied. The patients are divided into two groups. Clinically modified laparoscopic monoanastomotic gastric bypass surgery was performed in 25 patients (main group). The control group included 11 patients after the standard technique of Roux-en-Y laparoscopic gastric bypass. Inclusion criteria were: persons of both sexes aged 18-60 years with morbid obesity and a body mass index of 40 or more, as well as 35 or more in the presence of comorbid diseases (type 2 diabetes mellitus, arterial hypertension, dyslipidemia, sleep apnea syndrome). In both groups, impedance pH measurements were performed in the postoperative period. Statistical processing was performed using the Statistica 13.0 software package using parametric and nonparametric statistical methods. Results: Clinical manifestations of the enterogastric biliary reflex were found in both groups; in addition, clinical manifestations of the corresponding symptoms were noted by patients of both groups. The analysis of daily pH-metry in the studied groups showed that in the esophagus the time with pH <4 in the main group 2.83 (1.55; 3.95)% 3.00 (2.30; 3.50)% in the control group, time with pH 4-6.9 (physiological for the esophagus) 92.40 (90.65; 94.20)% and 94.10 (89.80; 95.50)%, respectively, time with pH> 7 (weak alkaline) was 4.80 (3.45; 5.85)% and in the control group 2.90 (1.20; 7.20)%. There was no statistically significant difference in these indicators (p> 0.05). Conclusions. Monoanastomotic gastric bypass surgery in the modification of the clinic has the same positive properties as the Rouen-Wye technique, allowing you to avoid the risks associated with possible pathological reflux of bile into the esophagus. Patients who have undergone mini-gastric bypass surgery require a thorough examination with fibrogastroscopy in combination with pH impedance measurement at least 1 time per year in order to determine biliary reflux and morphological changes both in the lumen of the esophagus and in the stomach stump. The level of quality of life of patients after surgery in the control group and the main group does not significantly differ, as evidenced by the results of the questionnaire survey using the GERG Q questionnaire, which indicates the effectiveness of the methodology of laparoscopic monoanastomotic gastric bypass surgery modified in the clinic. Key words: morbid obesity, gastric bypass surgery, surgical treatment, mini-gastric bypass, biliary reflux.

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A method of endoprosthesis implantation in patients with breast cancer

Science and Innovations in Medicine ◽

10.35693/2500-1388-2019-4-4-50-52 ◽

2019 ◽

Vol 4 (4) ◽

pp. 50-52

Author(s):

Sergey V. Kozlov ◽

Aleksandr P. Borisov ◽

Aleksandr A. Moryatov ◽

Maksim V. Tkachev

Keyword(s):

Breast Cancer ◽

New Method ◽

Control Group ◽

Study Group ◽

Subcutaneous Mastectomy ◽

Results Of Treatment ◽

The Difference ◽

Time Of Operation ◽

Mean Time ◽

Oncology Center

Objectives - to improve the immediate results of treatment in patients with breast cancer, using a new method of reconstruction. Material and methods. The prospective study included 215 patients diagnosed with breast cancer. The patients received medical treatment in the Samara Regional Clinical Oncology Center from 2013 to 2016. The patients in the control group (n = 111) underwent a subcutaneous mastectomy with a standard endoprosthesis plastic, with complete muscular shelter of the endoprosthesis. The patients of the study group (n = 104) underwent a subcutaneous mastectomy with a new method of single-stage reconstruction. Results. The mean time of operation in the control group was 115 ± 15 minutes, in the study group - 90 ± 10 minutes, the difference was statistically significant (p = 0.000). Intraoperative blood loss in the patients of the control group reached 115 ± 15 ml, in the study group - 70 ± 10 ml (p = 0.000). The duration of postoperative lymphorrhea in the control group was 14.6 ± 3.5 days, in the study group - 10 ± 3.4 days (p = 0.000). Postoperative bed-day in the control group was 17.1 ± 3.7, and in the study group - 14.2 ± 2.4 days (p = 0.001). Conclusion. The use of the new method of reconstruction statistically significantly improves the immediate results of treatment in patients with breast cancer in comparison with the group of patients who underwent a mastectomy with plastic surgery with the endoprosthesis in the standard way.

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The Advantages of DiLEP Operation in the Treatment of BPH Patients and the Observation of Postoperative Urinary Control Effect

Tobacco Regulatory Science ◽

10.18001/trs.7.5.1.87 ◽

2021 ◽

Vol 7 (5) ◽

pp. 3155-3160

Author(s):

Chao Wang ◽

Lijun Yang ◽

Haili Li ◽

Zhi Qu

Keyword(s):

Surgical Complication ◽

Statistical Significance ◽

Operation Time ◽

Control Group ◽

Study Group ◽

Control Effect ◽

Early Recovery ◽

Postoperative Rehabilitation ◽

The Difference ◽

Urinary Control

Objective: To evaluate the efficacy of Semiconductor laser trefoil enucleation of the prostate (DiLEP) in the treatment of patients with benign prostatic hyperplasia (BPH). Methods: 120 BPH patients scheduled for prostate surgery in our hospital were randomly divided into two groups: study group (DiLEP treatment) and control group (transurethral plasma bipolar resection of the prostate treatment), with 60 cases in each one. Surgical process indicators, postoperative rehabilitation indicators, Qmax before and after surgery, post-void residual volume (PVR), international prostate symptom score (IPSS), hemoglobin (Hb), urinary control and surgical complications for two groups were compared. Results: The operation time, intraoperative blood loss, bladder irrigation time, urinary catheter indwelling time and hospital stay in the study group were lower than those in the control group (P<0.05). The weight of resected tissue in the study group was higher than that in the control group (P <0.05). The difference in Qmax, PVR, IPSS scores and Hb between the study group and the control group before operation and one month after operation had no statistical significance (P>0.05). The Qmax and Hb scores in the study group were higher than those in the control group (P<0.05), while the PVR and IPSS scores were lower than those in the control group (P<0.05); five days and two weeks after operation, the urinary control rates in the study group were all higher than that in the control group (P<0.05); one month after operation, the difference in the urinary control rates between the two groups had no statistical significance (P>0.05); the difference in the surgical complication rate between the study group and the control group had no stastiscal significance (P>0.05). Conclusion: DiLEP is beneficial for early recovery of urodynamics in patients with BPH, with less trauma and faster recovery of urinary control after surgery.

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The effects of information platform-based nursing on preventing venous thromboembolism (VTE) in patients with hip fractures (Preprint)

10.2196/preprints.20947 ◽

2020 ◽

Author(s):

Yuan Gao ◽

Xiaojie Fu ◽

Mingxing Lei ◽

Pengbin Yin ◽

Qingmei Wang ◽

...

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Subgroup Analysis ◽

Nursing Intervention ◽

Control Group ◽

Study Group ◽

Drug Compliance ◽

Information Platform ◽

The Difference ◽

Length Of Hospitalization

BACKGROUND Mobile apps are becoming increasingly relevant to health care. Apps have been used to improve symptoms, quality of life, and adherence for oral drugs in patients with cancers, pregnancy, or chronic diseases, and the results were satisfying . OBJECTIVE This study aims to develop an information platform with the help of a mobile app and then evaluate whether information platform-based nursing can improve patient’s drug compliance and reduce the incidence of VTE in patients with hip fractures. METHODS We retrospectively analyzed hip fracture patients performed with traditional prevention and intervention of VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients conducted with nursing intervention based on the information platform (study group) between January 2016 and September 2017. The information platform can be divided into medical and nursing care end and the patient’s end. Based on the information platform, we could implement risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up and other aspects of nursing interventions for patients. We compared basic characteristics, outcomes including drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. RESULTS Regarding baseline data, patients in the study group had more morbidities than those in the control group (P<0.05). The difference of drug compliance between the two groups was statistically significant (P<0.001): 64.7% of the patients in the control group had poor drug compliance and only 6.1% patients had poor drug compliance in the study group. In terms of VTE, 126 patients (10.7%) in the control group had VTE, while only 35 patients (7.1%) in the study group had VTE, and the difference was statistically significant (P=0.024). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 d vs. 13.7 d, P=0.000). Subgroup analysis of the study group showed that the incidence of VTE in patients with non-compliance, partial compliance, and good compliance was 56.7%, 5.8% and 2.8%, respectively (P=0.000). CONCLUSIONS Poor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of patients with hip fracture and thus significantly reduce the incidence of VTE.

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Analysis of the Impact of Personalized Nursing Service and Hospice Care on the Quality of Life of Elderly Cancer Patients

Tobacco Regulatory Science ◽

10.18001/trs.7.4.24 ◽

2021 ◽

Vol 7 (4) ◽

pp. 469-473

Author(s):

Ting Fang ◽

Nian Wang ◽

Meng Chen ◽

Hongmei Ma

Keyword(s):

Quality Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Hospice Care ◽

Pain Treatment ◽

Control Group ◽

Study Group ◽

The Difference ◽

The Impact

Objective Explore the impact of personalized nursing services and hospice care on the quality of life of elderly patients with advanced cancer. Method We selected 80 elderly cancer patients admitted to our hospital from September 2020 to May 2021, and divided these patients into a study group and a control group using a random number table method. The patients in the control group used conventional nursing methods to treat and care for the patients, and the patients in the study group used hospice care measures and combined personalized nursing measures. The quality of life and pain treatment effects of the two groups of patients before and after treatment were compared. Result Before treatment, the quality-of-life scores of the two groups of patients were low, and there was no statistical difference (P>0.05); After treatment, the quality of life of the two groups of patients improved, but compared with the control group, the improvement was more obvious in the study group, and the difference was statistically significant (P<0.05). In terms of pain treatment effect, the total effective rate of pain treatment in the study group was 87.5%, which was significantly better than the 62.5% in the control group. The difference was statistically significant (P<0.05). Conclusion Personalized nursing services and hospice care are conducive to improving the survival and treatment of elderly patients with advanced cancer, and can be used as a clinical application program for the care of advanced cancer patients.

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Study on the method of enucleation of anterior uterine fibroids by transverse incision of the lower uterine segment during cesarean section

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04226-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yan Dai ◽

Li Xia ◽

Jinxiao Lin ◽

Rongli Xu ◽

Wenqiang You

Keyword(s):

Cesarean Section ◽

Operation Time ◽

Anterior Wall ◽

Control Group ◽

Study Group ◽

Transverse Incision ◽

Postoperative Fever ◽

Postoperative Changes ◽

Perioperative Bleeding ◽

Surgical Data

Abstract Introduction A retrospective study was conducted to investigate the effectiveness and feasibility of fibroid enucleation in the anterior wall of the uterus by transverse uterine incision during cesarean section. Methods The medical history, surgical data, preoperative and postoperative changes in the blood system, and complications of 90 pregnant women who underwent myomectomy of the anterior uterine wall during cesarean section at the second Department of Maternal and Child Health Hospital of Fujian Province were analyzed retrospectively. Results No significant differences were noted in the leiomyoma number, pathological type, preoperative and postoperative hemoglobin level, perioperative bleeding incidence, blood transfusion frequency, postoperative fever incidence, and duration of lochia between the study and control groups. The proportion of large fibroids was slightly higher in the study group than in the control group (p < 0.05), and the operation time and average hospitalization time were slightly longer in the study group than in the control group (p < 0.05). The distribution of type III–V fibroids was slightly more in the study group than in the control group (p < 0.05), and the distribution of type VI fibroids in the study group was less than that in the control group (p < 0.05). Conclusion Fibroid enucleation is safe and effective in the anterior wall of the uterus through the lower uterine transverse incision in cesarean section. It has the potential to reduce the risk of pelvic and intrauterine adhesions in the future.

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True and Pseudo Cholinesterase levels in short and long-term of pesticides exposures

International Journal of Clinical and Biomedical Research ◽

10.31878/ijcbr.2020.64.03 ◽

2020 ◽

pp. 9-12

Author(s):

Mohammed Abdul Rahman ◽

Raghunatha Rao D ◽

Vasantha L

Keyword(s):

Whole Blood ◽

Acute Poisoning ◽

Mean Value ◽

Serum Cholinesterase ◽

Control Group ◽

Study Group ◽

Chronic Poisoning ◽

The Mean ◽

The Difference ◽

And Control

The present study is aimed to study and analyze the true and pseudo Cholinesterase levels in the subjects exposed to pesticides during short term by intentional or accidental intake and long term exposure due to their occupation were studied at Department of Biochemistry, SVS medical college and hospital mahbubnagar district. Whole blood cholinesterase levels and Pseudo cholinesterase levels were estimated. 150 people were taken as controls who had no medical illness and a total number of 300 cases of pesticide poisoning were selected, aged between 20 to 55 years, which consist of 150 acute poisoning and 150 chronic poisoning subjects in Mahbubnagar district, were taken as case study, the detailed case history and the type of organophosphorus pesticide taken were recorded. Mean and standard deviation (S.D) of all variables were calculated and compared with those of controls. Statistical significance was assessed and P-value <0.05 were considered significant. During acute poisoning the mean value of Whole blood cholinesterase/True cholinesterase (U / L) in acute poisoning cases on first day was 1.267± 0.612 on 3th day was 1.651±0.647, on 7th day was 2.221±0.684 and at the end of 6 months was 3.970±0.404.The difference between the study group and control group (4.0 ± 0.39) was found to be statistically significant in1st, 3rd, 7th day but not significant at the end of 6 months. The mean value of serum cholinesterase/pseudo cholinesterase (U/L) in acute poisoning cases on first day was 2213.05 ± 1749.81, on 3th day was 2862.3 ± 2025.6, on 7th day was 4008.4 ± 2355.9 and at the end of 6 months was 7708.34 ± 880.72.The difference between the study group and control group (7991.97 ± 1276.5) was found to be statistically significant in1st, 3rd, 7th day but not significant at the end of 6 months. During chronic poisoning (exposure) the mean value of Whole blood cholinesterase (U/L) in controls is 4.0 ± 0.39 as compared to 3.019 ± 0.848 in cases of chronic poisoning. The difference between the study group and control group was found to be statistically significant. The mean value of serum cholinesterase/pseudo cholinesterase (U/L) in controls was 7991.97 ± 1276.5 as compared to 6214 ± 1189 in cases of chronic poisoning. The difference between the study group and control group was found to be statistically significant.

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The Role of P53 in Sepsis-Induced Cardiomyopathy

Acta Medica Transilvanica ◽

10.2478/amtsb-2021-0049 ◽

2021 ◽

Vol 26 (3) ◽

pp. 45-47

Author(s):

Peter Michael Reil ◽

Teodor Traian Maghiar ◽

Karlheinz Seidl ◽

Claudia Teodora Judea Pusta ◽

Ciprian Borza ◽

...

Keyword(s):

Cardiac Tissue ◽

Medical Problem ◽

Statistical Correlation ◽

Control Group ◽

Study Group ◽

Septic Cardiomyopathy ◽

Pulmonary Infections ◽

P53 Expression ◽

The Difference

Abstract Septic cardiomyopathy remains a difficult medical problem to manage in critically ill patients. With all currently available therapeutic options, the mortality rate in these patients remains high. Our study included 29 patients diagnosed clinically with sepsis. A control group was used to compare the results. In all patients, p53 expression was assessed in cardiac tissue obtained from these patients and a statistical correlation was made with clinical data. The different expression rates of p53 do not correlate with patient’s age, having appropriate means in years, but with an increasing tendency with increasing expression (p=0.2110). The pulmonary infections are responsible for the majority of the septic state in the study group (over 55%). The difference between the infection sites is statistically significant (p<0.0001).

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