scholarly journals Outcome of manual hemorrhoidopexy in the management of hemorrhoids

2014 ◽  
Vol 9 (2) ◽  
pp. 15-19
Author(s):  
Sujit Kumar ◽  
P Kafle ◽  
SJ Shrestha ◽  
S Agrawal ◽  
BN Patowary
Keyword(s):  
Medical Sciences ◽  
Analgesic Requirement ◽  
Conventional Hemorrhoidectomy ◽  
Significant Difference ◽  
Internal Hemorrhoids ◽  
Group A ◽  
Male Patients ◽  
A New Technique ◽  
Group B ◽  
A Prospective Study

Background: Manual hemorrhoidopexy is a new technique of treating second degree hemorrhoids. In contrast to the conventional resectional techniques (Milligan-Morgan), manual hemorrhoidopexy is a novel technique as described by T Carlo. It does not involve excision but plication with fixation of the prolapsing hemorrhoid. Objective: To study the outcome of manual hemorrhoidopexy and to compare manual hemorrhoidopexy with the traditional hemorrhoidectomy. Methods: This is a prospective study conducted over 16 months (January 2012 to April 2013) in the College of Medical Sciences Teaching Hospital (COMS-TH), Bharatpur, Chitwan, Department of Surgery. The patients who presented with third degree internal-hemorrhoids on a random basis, and underwent either conventional hemorrhoidectomy (Group A) or Manual hemorrhoidopexy (Group B) by senior consultant surgeons were included. The patients who had external hemorrhoids in addition to internal were excluded. Preoperative, intraoperative, and postoperative characteristics were evaluated. Results: Twenty five patients with median age group 42.5 years underwent conventional (Milligan-Morgan) hemorrhoidectomy (Group A) and 25 patients with mean age of 40.1 years underwent manual hemorrhoidopexy (Group B). Male patients were predominant in both groups. The patients in group A had more postoperative pain as compared to group B (as assessed by the visual analogue scale and requirement of post-operative analgesic) and this was statistically significant (p<0.001). There was no significant difference among the other post-operative urinary retention. Twelve percent (n=3) patients in group A had post-operative bleeding and only 4% (n=1) in group B which was statistically significant (p<0.001). Mean duration of hospital stay in group A was 2.5 days as compared to 1.5 day in group B. Median follow up in both the study group was 3 (2-4) months. Conclusion: Manual hemorrhoidopexy has comparable outcomes in term of postoperative analgesic requirement, and post operative complications. Journal of College of Medical Sciences-Nepal, 2013, Vol-9, No-2, 15-19 DOI: http://dx.doi.org/10.3126/jcmsn.v9i2.9682

CLINICAL OUTCOME AND COST COMPARISON OF CARPAL TUNNEL WOUND CLOSURE WITH MONOCRYL® AND ETHILON®: A PROSPECTIVE STUDY

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 189-192 ◽  
Author(s):  
Anis Dosani ◽  
Sameer K. Khan ◽  
Sheila Gray ◽  
Steve Joseph ◽  
Ian A. Whittaker
Keyword(s):  
Carpal Tunnel ◽  
Wound Closure ◽  
Unit Cost ◽  
Cost Effective ◽  
Cost Comparison ◽  
Absorbable Suture ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
A Prospective Study

This prospective non-randomised two-cohort study compares the use of an absorbable suture (Poliglecrapone [Monocryl]: Group A) and a non-absorbable suture (Polyamide [Ethilon]: Group B) in wound closure after elective carpal tunnel decompression. The primary outcome was scar cosmesis as assessed by the Stonybrook Scar Evaluation Scale (SBSES); the financial cost of wound closure was compared as a secondary outocome. All fifty patients completed follow-up. At six weeks, there was no significant difference in the two groups regarding scar tenderness (p = 0.5), although residual swelling was more evident in the absorbable group (p = 0.2). The mean SBSES score at six weeks was 4.72 in Group A, and 4.8 in Group B (p = 0.3). The unit cost per closed wound of Monocryl was three times than Ethilon (p < 0.05). Ethilon is thus cost-effective without compromising the cosmetic outcome, and we recommend using this as the preferred suture for closure of carpal tunnel wounds.

scholarly journals Androgen versus erythropoietin for the treatment of anemia in hemodialyzed patients: a prospective study.

1996 ◽  
Vol 7 (1) ◽  
pp. 140-144
Author(s):  
J L Teruel ◽  
R Marcen ◽  
J Navarro-Antolin ◽  
A Aguilera ◽  
G Fernandez-Juarez ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Recombinant Human Erythropoietin ◽  
Dry Weight ◽  
Pressure Control ◽  
Therapeutic Approaches ◽  
Human Erythropoietin ◽  
Group A ◽  
Male Patients ◽  
Group B ◽  
A Prospective Study

According to this facility's protocol for the treatment of anemia in hemodialyzed patients, androgens were administered to male patients aged over 50 yr and recombinant human erythropoietin was administered to male patients below 50 yr of age and to female patients. In the study presented here, both therapeutic approaches have been prospectively analyzed. Patients were divided into two groups. Group A was composed of 18 patients, aged 62 +/- 12 yr, treated with nandrolone decanoate (200 mg/wk im) for 6 months; Group B was composed of 22 patients (6 men, 16 women) aged 47 +/- 15 yr, treated with subcutaneous recombinant human erythropoietin (initial dose, 6000 IU/wk) for 6 months. The increases of hemoglobin were similar in both groups; Group A, from 7.3 +/- 0.8 to 10.8 +/- 1.7 g/dL (P < 0.001), and Group B, from 7 +/- 0.6 to 10.4 +/- 1 g/dL (P < 0.001). In Group A, increases of triglycerides (159 +/- 71 versus 267 +/- 153 mg/dL, P < 0.001), serum albumin (3.9 +/- 0.3 versus 4.2 +/- 0.3 g/dL, P < 0.05), and dry weight (62.1 +/- 9.8 versus 64.9 +/- 10.1 kg, P < 0.001) were observed, which remained unmodified in Group B. Blood pressure control worsened in one patient (6%) from Group A, and in ten patients (45%) from Group B (P < 0.05). In conclusion, androgens produced an improvement in anemia in selected patients, similar to that achieved by use of recombinant human erythropoietin but at a lower cost. Androgens also have an appreciable anabolic effect and did not increase the blood pressure.

Outcomes of Flank-Free Modified Supine Percutaneous Nephrolithotomy Based on BMI

2020 ◽  
pp. 1-6
Author(s):  
Esam Desoky ◽  
Khaled M. Abd Elwahab ◽  
Islam M. El-Babouly ◽  
Mohammed M. Seleem
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Supine Position ◽  
Normal Weight ◽  
Significant Difference ◽  
Group A ◽  
Morbid Obese ◽  
Group B ◽  
A Prospective Study ◽  
Nonobese Patients ◽  
The Impact

<b><i>Objective:</i></b> To evaluate the impact of body mass index (BMI) on the outcomes of percutaneous nephrolithotomy (PCNL) in the flank-free modified supine position. <b><i>Patients and Methods:</i></b> A prospective study was carried out in the urology department during the period from May 2015 to October 2019 on 464 patients admitted for PCNL. The patients were divided into 4 matched groups according to their BMI: group A, normal weight with 18.5 ≤ BMI &#x3c;25 kg/m<sup>2</sup>; group B, overweight with 25 ≤ BMI &#x3c;30 kg/m<sup>2</sup>; group C, obese with 30 ≤ BMI &#x3c;40 kg/m<sup>2</sup>; and group D, morbid obesity with BMI ≥40 kg/m<sup>2</sup>. All operative data as well as postoperative outcomes are recorded and compared to each other. <b><i>Results:</i></b> The 4 studied groups were matched regarding age. The comorbidities were slightly higher in groups C and D. The operative time and fluoroscopy time were slightly high in obese and morbid obese groups but with no significant difference. The rate of complications either major or minor was comparable in all groups. No significant difference was seen among all groups regarding hemoglobin loss, stone-free rate, hospital stay, and need for auxiliary procedures. <b><i>Conclusions:</i></b> The outcome of PCNL in flank-free modified supine position is not affected by changes in BMI. The procedure can be performed in obese and morbid obese patients safely with results similar to and comparable to nonobese patients.

scholarly journals The effect of pre-incision urethral plate width and glanular width on the outcome of Tubularized Incised Urethral plate repair surgery in distal penile Hypospadias, A prospective study

2020 ◽  
Author(s):  
Tarek Abd Elbaky ◽  
Diaa Eldin Taha ◽  
Hossam Nabeeh ◽  
Khaled Zein elabden ◽  
Mohamed Galal
Keyword(s):  
Cosmetic Outcome ◽  
Urethral Plate ◽  
Tubularized Incised Plate ◽  
Significant Difference ◽  
Urinary Stream ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
A Prospective Study ◽  
Plate Width

Abstract Objective:To determine the cosmetic and functional outcomes of hypospadias repair in relation to the width of the urethral plate in addition to granular width and configuration.Materials and methodsThe study was a prospective evaluation of patients operated for hypospadias after approval of ethical committee a formal consent were taken from parents. The urethral plate width (UPW) and glans width (GW) of the patients were measured preoperatively using standard calipers. The width of the urethral plate was correlated to the cosmetic outcome (using hypospadias objective penile evaluation [HOPE]) and functional outcome (using the urinary stream) of hypospadias repair.All patients were managed via the same technique using Snodgrass tubularized incised plate repair (TIP). All operations were performed by a single surgeon. All intaoperative data were recorded. All patients were followed up for 1 year. Success was defined as slit shaped meatus at the tip of the glans with no stenosis, fistula or diverticulum.Results:All 38 patients were evaluated at 6 months and 1 year follow up. The mean age at surgery was 4.5 ± 2.1 years. Overall, the mean ± SD of UPW was 10.92 ± 1.24 mm. a 24 patients (61.5 %) (Group A) had a urethral plate width of less than 8 mm while 14 patients (35.9 %) (group B) had a urethral plate width greater or equal to 8 mm. the mean ± SD of GW was 9.52 ± 1.56 mm. Success was documented in 36/38 patients (94.3%).The only complication was Fistula in two patient (6.7 %), glans dehiscensce in three patients (10%). Success rate was not statistically different in correlation of UPW and GW (p=0.5).The only statistically significant difference between all patients was a longer operative time in the patients with deficient urethral plate compared to others with adequate urethral plate (p= 0.005). The urinary stream was straight in 32 boys and sprayed in 6. Overall, mean ± SD HOPE score was 39.1 ± 8.83. A significant correlation found between the cosmetic outcome of the two groups and HOPE score (p = 0.06).Conclusions:The pre-incision urethral plate width and glanular width was not correlated with the TIP outcome. A better HOPE score is associated with wide urethral plate.

Clinical trial to assess role of ketamine in post operative analgesia after laparoscopic cholecystectomy

2021 ◽  
Vol 23 (05) ◽  
pp. 421-432
Author(s):  
Dr. Mohammad Kheiri Mahmod ◽  
◽  
Dr. Bashar Naser Hussein ◽  
Dr. Ammar Hamid Hanoosh ◽  
◽  
...  
Keyword(s):  
Clinical Trial ◽  
Laparoscopic Cholecystectomy ◽  
Postoperative Pain ◽  
Analgesic Effect ◽  
Analgesic Requirement ◽  
Pain Scores ◽  
Post Operative Pain ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: The physiological consequences of post-operative pain including Stress response to surgery, Respiratory complications, cardiovascular complications, Thromboembolic complications, Gastrointestinal complications, Musculoskeletal complications and Psychological complications, all of which could delay or impair postoperative recovery and increase the economic cost of surgery as a result of the longer period of hospitalization. Inadequate post-operative pain control may also lead to the development of chronic pain after surgery .Aim of This study: is to evaluate the preemptive analgesic effect of intravenous ketamine in laparoscopic cholecystectomy. Patients and Methods: double blinded randomized clinical trial conducted at Al-Yarmouk teaching hospital, over a period of one year from March 2013 to March 2014 on a total of 120 adult patients scheduled for elective laparoscopic cholecystectomy, Patients were divided in to three groups of 40 patients each, the study drug administered intravenously during induction. Groups A and B received ketamine in a dose of 1 and 0.5 mg/kg, respectively, whereas group C received isotonic saline. The degree of pain at rest and deep breathing postoperatively were estimated using VAS, time of first analgesic dose, total opioid consumption, nausea, vomiting and hallucination were recorded for 24 h postoperatively. Results: postoperative pain scores were significantly low in group A when compared with the other groups at most times in the first 24 hours. Highest pain score was in group C at 0 h. Postoperative analgesic consumption was minimum in group A then group B and highest in group C. There was little significant difference in the pain scores between groups B and C. Group A had a significantly higher blood MAP than group B at 0, 0.5 and 1 h. 7.5% incidence of hallucinations were in group A. Conclusion: According to this study we conclude that preemptive ketamine in a dose of 1 mg/kg has a definitive role in reducing postoperative pain and analgesic requirement in patients undergoing laparoscopic cholecystectomy. A low dose of 0.5 mg/kg had little significant in preemptive analgesic effect and in reducing analgesic requirement.

A comparative study between the effect of Aminophylline, Neostigmine and Gabapentin on prevention of post dural puncture headache after cesarean section

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Asmaa Abd Elfattah Saafan ◽  
Mohammed Sidky Mahmoud Zaki ◽  
Safaa Ishak Ghaly ◽  
Ahmed Moneir Ahmed Youssef
Keyword(s):  
Side Effects ◽  
Dural Puncture ◽  
Antiinflammatory Drugs ◽  
Analgesic Requirement ◽  
Pharmacological Agents ◽  
Post Dural Puncture Headache ◽  
Arterial Blood ◽  
Significant Difference ◽  
Group A ◽  
Group B

Abstract Objectives Post dural puncture headache (PDPH), since it is first described by August Bier in 1898, remains a common complication in spinal anesthesia (SA). Many pharmacological agents are suggested for PDPH management as acetaminophen, caffeine, non-steroidal antiinflammatory drugs, corticosteroids, and sumatriptan. Aim The aim of this study is to compare between the prophylactic effect of each of; aminophylline, gabapentin, and neostigmine added to atropine on the occurrence of PDPH after caesarean section (CS) under SA. Subjects and Methods This prospective randomized controlled clinical study was carried out 75 pregnant female patients 20-40 y, 60-100 kg. ASA physical status II undergoing elective CS. Patients were randomly divided into 3 groups (25 patients in each); group A: received 250 mg aminophylline IV immediately after delivery of the infant, group B: received IV neostigmine 20 µg/kg added to atropine 10 µg/kg immediately after delivery of the infant and group C: received 3 capsules gabapentin 300 mg; the 1st before SA by 2 h with sip of water, the 2nd after CS by 6 h and the 3rd after 14 h from CS. Results The incidence of PDPH was lower in group A (8% vs 40% in group B and 24% in group C. The onset of PDPH was significantly delayed in group C than group A and in group C than B, but insignificant between group A and B. The duration of PDPH and total dose of analgesic requirement was significantly lower in group A than group B and C and in group B than C. Heart rate (HR) showed significant increase in group A (post aminophylline than pre) only. HR in the other groups and mean arterial blood pressure showed insignificant difference among the three groups (between pre and post administration of drugs). As regards VAS, there was no significant difference in the three groups at 3 h. There was significant difference among the three groups at 6, 12, 24, 36, 48 and 72 h. (between group A & B from 24h up to 72h, between group A & C from 6 up to 72h and between group B & C at 6 h only (delayed onset with neostigmine)). Side effects were minimal and tolerable. Conclusion Aminophylline reduced the incidence and duration of PDPH after CS under SA more than gabapentin and neostigmine with less analgesic requirement and minimal side effects. Also, neostigmine was superior than gabapentin in delaying the onset and decreasing the duration of PDPH.

A Study of Mechanical Properties of Human Femoral Heads Using Nanoindentation

2010 ◽  
Vol 126-128 ◽  
pp. 957-962 ◽  
Author(s):  
Chih Ling Lin ◽  
Han Huang ◽  
Bronwen W. Cribb ◽  
Anthony Russell
Keyword(s):  
Mechanical Properties ◽  
Replacement Surgery ◽  
Hip Replacement Surgery ◽  
Reduced Modulus ◽  
Significant Difference ◽  
Femoral Heads ◽  
Group A ◽  
Trabecular Bones ◽  
Male Patients ◽  
Group B

Human bone fracture associated with osteoporosis was hypothesized to be related to the alteration of mechanical properties in bones. In this work, cortical and trabecular bones from human femoral heads were studied. Bone samples of eight female and four male patients, with ages varying from 37 to 93 years, were collected from total hip replacement surgery. Reduced modulus (Er) and hardness (H) of osteons, interstitial lamellae and trabeculae were characterized by nanoindentation. The results showed both the reduced modulus and hardness of the interstitial lamellae were significant higher than those of osteons and trabeculae. Though there was no significant difference in microstructures in the Group A (age < 60 years) and B (age > 60 years), the Group B bones demonstrated to be stiffer.

Dedicated Barrett's surveillance sessions managed by trained endoscopists improve dysplasia detection rate

Endoscopy ◽  
2017 ◽  
Vol 49 (06) ◽  
pp. 524-528 ◽  
Author(s):  
Joanne Ooi ◽  
Patrick Wilson ◽  
Giles Walker ◽  
Paul Blaker ◽  
Sabina DeMartino ◽  
...  
Keyword(s):  
Detection Rate ◽  
Lesion Detection ◽  
Low Grade ◽  
Protocol Biopsy ◽  
Significant Difference ◽  
Risk Of Progression ◽  
Group A ◽  
Group B ◽  
A Prospective Study ◽  
Barrett’S Surveillance

Abstract Background and study aim Barrett’s esophagus (BE)-associated dysplasia is an important marker for risk of progression to esophageal adenocarcinoma (EAC) and an indication for endoscopic therapy. However, BE surveillance technique is variable. The aim of this study was to assess the effect of dedicated BE surveillance lists on dysplasia detection rate (DDR). Patients and methods This was a prospective study of patients undergoing BE surveillance at two hospitals – community (UHL) and upper gastrointestinal center (GSTT). Four endoscopists (Group A) were trained in Prague classification, Seattle protocol biopsy technique, and lesion detection prior to performing BE surveillance endoscopies at both sites, with dedicated time slots or lists. The DDR was then compared with historical data from 47 different endoscopists at GSTT and 24 at UHL (Group B) who had undertaken Barrett’s surveillance over the preceding 5-year period. Results A total of 729 patients with BE underwent surveillance endoscopy between 2007 and 2012. There was no significant difference in patient age, sex, or length of BE between the two groups. There was a significant difference in detection rate of confirmed indefinite or low grade dysplasia and high grade dysplasia (HGD)/EAC between the two groups: 18 % (26 /142) Group A vs. 8 % (45/587) in Group B (P  < 0.001). Documentation of Prague criteria and adherence to the Seattle protocol was significantly higher in Group A. Conclusion This study demonstrated that a group of trained endoscopists undertaking Barrett’s surveillance on dedicated lists had significantly higher DDR than a nonspecialist cohort. These findings support the introduction of dedicated Barrett’s surveillance lists.

Quantitative Radio-Isotope Scanning of the Sacroiliac Joints in Ankylosing Spondylitis

1992 ◽  
Vol 33 (2) ◽  
pp. 169-171 ◽  
Author(s):  
Ø. Skaar ◽  
K. Dale ◽  
M. W. Lindegaard ◽  
O. Førre ◽  
E. Kåss
Keyword(s):  
Ankylosing Spondylitis ◽  
Control Group ◽  
Sacroiliac Joints ◽  
Radioisotope Scanning ◽  
Significant Difference ◽  
Group A ◽  
Static Part ◽  
Group B ◽  
A Prospective Study ◽  
Radiographic Changes

A method for applying 99mTc-MDP for dynamic and static quantitative radioisotope scanning (QRS) of the sacroiliac joints (SI) in early progressive sacroiliitis in ankylosing spondylitis (AS) is described. In a prospective study, 2 groups of male AS patients were investigated, one with increased elevated erythrocytic sedimentation rate (ESR) (group A, n = 7) and one with normal ESR (group B, n = 8). In both groups an increased uptake of the radiotracer was found in the static part of the study versus a control group C (n = 9). An increased uptake versus group C was also found for group A in the dynamic part of the study (p = 0.01) while there was no significant difference dynamically between groups B and C. The results of the dynamic study in group A indicate ESR to be a parameter of inflammatory activity in the SI joints. The study also seems to indicate QRS to be a valuable diagnostic method in early AS without definite radiographic changes in the SI joints.

scholarly journals A prospective study of diathermy versus scalpel skin incision in abdominal surgery

2019 ◽  
Vol 6 (10) ◽  
pp. 3554
Author(s):  
Arun Kumar Gupta ◽  
Tejinder Singh Dall ◽  
Darpan Bansal
Keyword(s):  
Prospective Study ◽  
Harmonic Scalpel ◽  
Skin Incision ◽  
Recent Past ◽  
Medical Sciences ◽  
Power Set ◽  
Group A ◽  
Group B ◽  
A Prospective Study ◽  
Time Of Administration

Background: Various methods of skin incision have been identified in the recent past. Traditional skin incisions were made with stainless steel scalpel but recently electrocautery instruments like harmonic scalpel are also in use. With rise of seropositive cases, we aimed to evaluate whether the electrocautery can replace scalpel in operation theater, to avoid unfortunate injury to surgeons with scalpel. So we compared the usefulness of diathermy skin incision vs. scalpel skin incision in general surgical patients.Methods: This prospective study designed to include 120 patients admitted in the Department of General Surgery, Sri Guru Ram Das Institute of Medical Sciences and Research, Vallah, Sri Amritsar and who were undergoing elective abdominal surgical procedures namely cholecystectomy, appendectomy and inguinal hernia repair etc. Patients were randomly allocated into 2 groups of 60 patients each. In Group A, incision were made with electrocautery on cut mode and power set to 60-70. In group B, skin incisions were made with scalpel.Results: No statistical difference was found between group A and group B with regard to time of administration of pain killer injection, seroma formation, discharge being noticed from wound in both groups. Moreover the results were statistically non-significant for vascularity, pigmentation and pliability of wound observed.Conclusions: We concluded that electrocautery can effectively and efficiently replace scalpel in operation theater.

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