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 Evaluation and Comparison of the Outcomes of Endoscopic Dacryocystorhinostomy with and without Silicone Stent

2021 ◽  
Vol 28 (3) ◽  
pp. 221-227
Author(s):  
Bipin Kishore Prasad ◽  
Krishna Kamal Ghosh
Keyword(s):  
Success Rate ◽  
Symptom Relief ◽  
Nasolacrimal Duct ◽  
Complete Relief ◽  
Success Rates ◽  
Endoscopic Dacryocystorhinostomy ◽  
Silicone Stent ◽  
Group A ◽  
Group B ◽  
Sac Syringing

Introduction   Endoscopic dacryocystorhinostomy aims to establish a patent nasolacrimal fistula. Use of silicone stent is a preferred modification to achieve long term patency of neo-ostium, though it has been blamed for granulations, synechia and punctal erosion. Present study was done to  evaluate and compare the outcomes of Endoscopic dacryocystorhinostomy with and without stent.  Materials and Methods 40 patients of with chronic dacryocystitis and nasolacrimal duct blockage were selected for the study. Nasal endoscopy was done for suitability of surgical access and to detect any nasal pathology. Sac syringing was done to assess the site of blockage and Dacryoscintigraphy to confirm it. 20 patients in Group A underwent Endoscopic dacryocystorhinostomy without stent and remaining 20 in Group B with silicone stent. Success rates were determined by subjective relief from epiphora and by endoscopic visualization of rhinostomy opening, granulation tissues/ synechiae at rhinostomy site and by result of sac syringing.  Results In Group A, complete relief was obtained in 75% patients, significant relief in 10% and no relief in 15% patients thus recording overall success rate of 85%; whereas in Group B complete relief of symptom was obtained in 70% patients, significant relief in 10% and no symptom relief in 20% patients thus recording the overall success rate of 80%. Cases in Group B were also found to have persistent epiphora (17.5%), stenosis of ostium (25%), granulation (35%) and synechia (37.5%).  Conclusion Stenting does not significantly improve the success of Endoscopic dacryocystorhinostomy but is associated with more complications.

Endoscopic endonasal dacryocystorhinostomy vs nasolacrimal duct intubation in pediatric nasolacrimal duct obstruction - a comparative study

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Rana Atia ◽  
Magda Samy ◽  
Sheriff Elwan ◽  
Thanaa Helmy ◽  
Ashraf Shaat ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Success Rate ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Endoscopic Endonasal ◽  
Duct Obstruction ◽  
Tube Removal ◽  
Group A ◽  
The Difference ◽  
Group B

Abstract Study design; Pilot randomized controlled study. Objective To compare success rates of endoscopic endonasal dacryocystorhinostomy and nasolacrimal duct intubation in congenital nasolacrimal duct obstruction (NLDO) in a trial to define the superiority of either technique. Patients & Methods Sixty-six eyes of 61 patients were diagnosed as having epiphora and mucopurulent discharge due to congenital NLDO. The patients were randomly divided into two groups; Group A; 33 eyes of 28 patients (treated by probing and silicone intubation only (NLDI)) and Group B; 33 eyes of 33 patients (treated by endoscopic endonasal dacryocystorhinostomy and silicone tube intubation (EDCR). All tubes were removed 6 months after the operation. Results The success rate, defined as complete resolution of clinical symptoms and signs after 6 months of follow up, was 72.7 % in Group A and 81.8% in Group B. Although the success rate was higher in Group B, yet the difference was shown to be statistically nonsignificant. Preoperative symptoms were assessed postoperatively after tube removal. Complete cure had a higher rate of occurrence in Group B than in Group A (27eyes (81.8%) versus 25 eyes of 22 patients (75.8%) respectively). Postoperative positive fluorescein dye disappearance test (FDDT) after tube removal was more in Group B than in Group A (27 eyes (81.8) versus 24 eyes of 21 patients (72.7 %) respectively). In Group A, silicone tubes had to be repositioned due to prolapse in 3 eyes of 3 patients (9.1%) and had to be removed early in 3 eyes of 3 patients (9.1%) due to failure of repositioning. In Group B, silicone tubes did not require early tube extraction before the date of removal in any of the patients. Intraoperative, there was only one case (3.0%) of fat prolapse during EDCR in Group B with no subsequent postoperative complications. Hemostasis did not represent a problem in any of the patients. Postoperative complications occurred more in Group B than Group A (21 eyes (63.6%) versus 13 eyes of 13 patients (39.4 %) respectively). Late complications occurred more in Group B than Group A (18 eyes (54.5%) versus 12 eyes of 12 patients (36.4%) respectively) in the form of persistent epiphora and tube prolapse. Conclusion The success rate of pediatric EDCR was higher than that of pediatric NLDI. The difference was statistically non-significant. Complications were comparable between the two groups. The study, being pilot in its comparative aspect between endoscopy and intubation, opens the horizon for further study on a larger group that probably will expand this difference.

scholarly journals A Comparative Study of Dacryocystorhinostomy with or without Stent in a Tertiary Teaching Hospital of Telangana

2021 ◽  
Vol 8 (20) ◽  
pp. 1532-1537
Author(s):  
Imtiaz Ahmed Khan ◽  
Naseeruddin Mujahid ◽  
Nabeel Nabeel
Keyword(s):  
Success Rate ◽  
Symptomatic Relief ◽  
Nasolacrimal Duct ◽  
Chronic Dacryocystitis ◽  
Duct Occlusion ◽  
Tertiary Teaching ◽  
Significant Difference ◽  
Group A ◽  
Endonasal Dcr ◽  
Group B

BACKGROUND Epiphora is a common annoying symptom, embarrassing the patient both socially and functionally and may even endanger the eye. Chronic Dacryocystitis is the most common cause of epiphora which arises from nasolacrimal duct occlusion. Dacryocystorhinostomy (DCR) is the procedure of choice in the management of Dacryocystitis. We wanted to study the final outcome following endonasal DCR for chronic dacryocystitis with or without using silicon stent, evaluate the causes of persistence of epiphora in patients with or without the use of lacrimal stents and identify the methods of overcoming them postoperatively. METHODS A case control study to compare the results of Endonasal DCR with and without stent was conducted among 96 patients of both genders aged above 20 years with symptoms and signs suggestive of nasolacrimal duct blockage. All the cases and controls were randomly selected and included as group A and group B. RESULTS 96 patients were included in this study and they were divided into two groups (Group A and Group B) with 48 patients in each group. More than 75 % of the patients were between 31 and 60 years of age with a mean age of 44.36 ± 3.15 years. In Group B, 72.91 % of the cases were between 31 and 60 years of age with a mean age of 45.50 ± 4.10 years. There was no statistically significant difference in both groups. In group A (DCR with stent) success rate or relief of symptoms was 96 % whereas in group B (DCR without stent) success rate or symptomatic relief was 80 %. CONCLUSIONS Endoscopic endonasal DCR with stent is a safe and minimally invasive procedure and is an effective treatment for patients who have failed primary endoscopic DCR without stent and also in cases of mucocele and pyocele of the sac. KEYWORDS Chronic Dacryocystitis, Dacryocysto-Rhinostomy, Nasolacrimal Duct and Endoscopic Dacryocysto-Rhinostomy

scholarly journals A comparative study in the use of topical mitomycin-C versus nasolacrimal stent in endoscopic dacryocystorhinostomy for chronic dacryocystitis

2017 ◽  
Vol 4 (1) ◽  
pp. 176 ◽  
Author(s):  
Vikas Gupta ◽  
Inderdeep Singh ◽  
Gunjan Dwivedi ◽  
Sunil Goyal ◽  
Manoj Kumar ◽  
...  
Keyword(s):  
Success Rate ◽  
Mitomycin C ◽  
P Value ◽  
Lacrimal Sac ◽  
Endoscopic Dacryocystorhinostomy ◽  
Chronic Dacryocystitis ◽  
Significant Difference ◽  
Silicone Stent ◽  
Group A ◽  
Group B

<p class="abstract"><strong>Background:</strong> Inflammation of the lacrimal sac and duct is a common and unpleasant condition, leading to troublesome epiphora and recurrent dacryocystitis. Surgery is the preferred treatment modality of chronic dacryocystitis which can be performed by external approach or endoscopic nasal approach. Endoscopic dacrycocystorhinostomy (EnDCR) is now a well-established procedure to relieve nasolacrimal duct obstruction, becoming ENT surgeons’ domain. The aim of this study is to assess the efficacy and compare results of intraoperative use of nasolacrimal stent in comparison of mitomycin-C (MMC) in endoscopic dacryocystorhinostomy.</p><p class="abstract"><strong>Methods:</strong> A prospective study of 56 patients with acquired NLDO with epiphora and recurrent dacryocystitis who were evaluated and managed between Oct 2014 and Oct 2016. All patients were offered surgical line of management by endoscopic route. They were randomly assigned into two groups-mitomycin-C group (Group A) and silastic nasolacrimal stenting (Group B). 46 patients who matched inclusion criteria’s were included in the study after formal evaluation by ENT surgeon and Ophthalmologist. 26 patients underwent endoscopic dacryocystorhinostomy with Mitomycin-C application intra – op, 20 patients underwent nasolacrimal silicone stent placement.  </p><p class="abstract"><strong>Results:</strong> At 6-month follow-up visit, the management was considered successful if the lacrimal sac irrigation succeeded with relief of symptoms. The success rate in Group A was 92.30%. Group B had 85% success rate. However, no significant (p value=0.37) was noticed between two groups.</p><p><strong>Conclusions:</strong> Despite, no significant difference in outcome between two modalities, there is a trend towards the better outcome with use of mitomycin-C. Mitomycin-C is a safe, effective, and economical adjuvant in endoscopic DCR assisting in improved outcomes of surgery. </p>

scholarly journals Results of early versus standard silicone stent removal following external dacryocystorhinostomy under local anesthesia

2020 ◽  
Vol 17 (3) ◽  
pp. 263-272
Author(s):  
Ben Limbu ◽  
Benjamin Sim ◽  
Mohan K. Shrestha ◽  
Geoffrey Tabin ◽  
Rohit Saiju
Keyword(s):  
Statistical Difference ◽  
Financial Burden ◽  
Controlled Trial ◽  
Silicone Tube ◽  
Number Of Patients ◽  
Tube Removal ◽  
Silicone Stent ◽  
External Dacryocystorhinostomy ◽  
Lost To Follow Up

Introduction: Many patients in Nepal travel vast distances to have their surgeries in Kathmandu. They often remain close by until their follow-up visit for their silicone tube removal, which contributes to a large financial burden on them and their families. Hence, reducing the time for which silicone tubes remain in situ following external dacryocystorhinostomy (DCR) provides significant benefits to patients. Furthermore, this is the first comparative study which has successfully demonstrated the earliest timeframe for which silicone tubes can be removed following DCR in the medical literature. Methods: A randomized controlled trial consisting of 144 patients was designed to compare patient outcomes after early (2 weeks postoperatively) versus standard (6 weeks postoperatively) removal of silicone stents. The success of their procedures was determined when patients were assessed both symptomatically and anatomically at their 6-month follow-up. Results: The surgical success in both groups was high at 97.8% collectively in both groups and there were only a small number of patients who were lost to follow-up (5 patients) at 6 months. There was no statistical difference at removing silicone stents at 2 or 6 weeks postoperatively. Conclusion: These results were consistent with our pilot study, which showed no statistical difference in long-term success following silicone tube removal at 2 and 6 weeks.

scholarly journals Comparison of Recovery Time of Propofol and Midazolam with Propofol Alone for Sedation in Endoscopic Retrograde Cholangiopancreatography

2021 ◽  
Vol 15 (5) ◽  
pp. 1024-1027
Author(s):  
Asma Samreen ◽  
Aamir Waseem ◽  
Muhammad Azam ◽  
Itrat Hussain Kazmi ◽  
Aamir Bashir ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Recovery Time ◽  
Controlled Trial ◽  
P Value ◽  
Time Data ◽  
Endoscopic Retrograde ◽  
Intravenous Anesthetic ◽  
Significant Difference ◽  
Group A ◽  
Group B

Background: Procedural sedation is required for multiple short duration procedures outside of the operating rooms especially in radiology and endoscopy suites. Intravenous anesthetic agent with rapid recovery profile is desirable in such circumstances. This study aims to compare two regimens of intravenous anesthetic agents. Aim: To compare the mean recovery time of propofol and midazolam with propofol alone for sedation in endoscopic retrograde cholangiopancreatography. Study Design: Randomized controlled trial. Settings: Department of Anesthesia, Shalamar Hospital, Lahore. Study Duration: June 2017 to December 2017. Methods: A total of 70 adult patients aged 20-60 years undergoing ERCP under sedation were included. Patients were given a combination of propofol and midazolam in group A while propofol alone was given in group B. After procedure, pts were transferred to recovery room and were followed for assessment of recovery time. Data were analyzed in SPSS vr 21, Independent t-test was applied & p-value ≤0.05 was considered statistically significant. Results: Significant difference was found in mean recovery time amongst both the groups. Mean recovery time in Group A (propofol and midazolam) was 19.29±4.50 minutes while in Group B (propofol alone) was 26.66±3.70 minutes showing statistically significant result with p-value = 0.0001. Conclusion: We conclude that mean recovery time with propofol plus midazolam is shorter as compared to propofol alone for sedation in ERCP. Keywords: Propofol, midazolam, sedation outside operation theatre.

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.

Randomized controlled trial of chest tube removal aided by a party balloon

2017 ◽  
Vol 25 (7-8) ◽  
pp. 522-527
Author(s):  
Puwadon Thitivaraporn ◽  
Natawat Narueponjirakul ◽  
Pasurachate Samorn ◽  
Supparerk Prichayudh ◽  
Sukanya Sriussadaporn ◽  
...  
Keyword(s):  
Valsalva Maneuver ◽  
Controlled Trial ◽  
Block Design ◽  
Trauma Patients ◽  
Optimal Method ◽  
Thoracostomy Tube ◽  
Recurrent Pneumothorax ◽  
Tube Removal ◽  
Group A ◽  
Group B

Background Recurrent pneumothorax is one of the most common complications after thoracostomy tube removal. The purpose of this study was to assess the optimal method of thoracostomy tube removal by comparing party balloon-assisted Valsalva and classic Valsalva techniques. Methods Trauma patients with indications for tube thoracostomy from 2014 to 2015 were recruited. Exclusion criteria were age < 15- or > 64-years-old, history of chronic lung disease, Glasgow Coma Scale < 13, latex allergy, or tracheostomy. Participants were randomly allocated by randomized block design into 4 groups using different Valsalva maneuvers: group A: classic inspired, group B: classic expired, group C: balloon-inspired; and group D: balloon-expired. The primary and secondary outcomes were recurrent pneumothorax and respiratory complications. Results Forty-eight tube thoracostomies were randomized for analysis; 4 patients had bilateral tube thoracostomies. The mean patient age was 38.1 ± 19.9 years. The incidence of recurrent pneumothorax confirmed by chest radiography was 15.4% in group A, 16.8% in group B, and none in groups C and D ( p = 0.31). When group A combined with group B was compared with groups C and D, the incidence was 16% vs. 0%, respectively ( p = 0.11). The thoracostomy tube reinsertion rate in all 4 groups was 0%, 8.33%, 0%, and 0%, respectively, which was not significant ( p = 0.38). Conclusions Performing the Valsalva maneuver correctly during full inspiration may be the method of choice for removing thoracostomy tubes. Using a party balloon forces the patient perform the Valsalva maneuver adequately and is simpler to explain.

scholarly journals Role of silicone stenting in endoscopic dacryocystorhinostomy

2020 ◽  
Vol 6 (2) ◽  
pp. 248
Author(s):  
Abdussalam M. Jahan ◽  
Yousef M. Eldanfur ◽  
Abdulhakim B. Ghuzi
Keyword(s):  
Success Rate ◽  
Medical Center ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
P Value ◽  
Success Rates ◽  
Duct Obstruction ◽  
Significant Difference ◽  
Silicone Stent ◽  
Endoscopic Dcr

<p class="abstract"><strong>Background:</strong> Dacryocystorhinostomy (DCR) is a surgical procedure performed to relief nasolacrimal duct obstruction, which involves the creation of ostium at the lacrimal bone to form a shunt in the nasolacrimal pathway. Closure of the rhinostomy opening was considered a major factor for surgical failure. Use of silicone stent in endoscopic DCR to improve the success rate of the operation have been tried by many surgeons. In this study we assess the success rates of endoscopic DCR with and without silicone stents.</p><p class="abstract"><strong>Methods:</strong> Prospective study includes 30 patients were operated in the Department of ENT, Misrata Medical Center, from April 2017 to March 2018. They underwent endonasal endoscopic DCR for primary acquired nasolacrimal duct obstruction.<strong> </strong>These patients were randomly divided in two groups: A and B with 15 patients in each group. The group A patients underwent endoscopic DCR with silicone stent and group B patients underwent endoscopic DCR without stent. The results were statistically analyzed by chi-square test.  </p><p class="abstract"><strong>Results:</strong> 30 patients were included in this study, their age ranged from 17 to 60 years, complaining of epiphora, 24 (80%) were females and 6 (20%) were males. The success rate was higher in patients with silicone stent (93.33%) as compared to patients without silicone stent (86.67%) but this difference in the results is not statistically significant (As p value is 0.542 which is &gt;0.05).</p><p><strong>Conclusions:</strong> Endoscopic DCR is safe, successful procedure for treatment of nasolacrimal duct obstruction and there was no significant difference in the success rates of performing endonasal DCR with silicone or without silicone stents.</p>

scholarly journals A comparative study of the effect of piroxicam versus diclofenac on wound healing in clean abdominal wounds

2018 ◽  
Vol 5 (3) ◽  
pp. 1041 ◽  
Author(s):  
Chandrashekar Reddy J. Madinur ◽  
Prashant Tubachi ◽  
Prashant Tubachi ◽  
A. S. Godhi ◽  
A. S. Godhi
Keyword(s):  
Wound Healing ◽  
Controlled Trial ◽  
Research Centre ◽  
Female Ratio ◽  
Factors Affecting ◽  
Significant Difference ◽  
Group A ◽  
One Year ◽  
Group B ◽  
The Individual

Background: The primary function of the skin is to serve as a protective barrier against the environment. The process of wound healing constitutes an array of interrelated and concomitant events. Understanding these processes and various factors affecting these processes continue to expand. The present study was undertaken to compare and evaluate the effect of piroxicam versus diclofenac on wound healing in clean abdominal wounds.Methods: The present one year randomized controlled trial was conducted on all the patients undergoing appendicectomies for uncomplicated appendicitis and uncomplicated inguinal hernia repairs in the Department of Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belgaum during the period of one year. Based on the thumb rule a total of 60 patients divided into two groups of 30 each were studied. Based on the computer-generated randomization patients were allocated to two groups that is group A (Inj. Piroxicam) and Group B (Inj. Diclofenac).Results: In the present study, males outnumbered females with male to female ratio between of 1.72 to 2:1. The mean age in group A was30.9±7.86 years and in group B it was 30.3±7.97 years. Both the groups that is Group A and B were graded under grade I (Good wound healing) from the POD 3 onwards. Overall the individual score and total scores had no influence of the final grading (outcome) of the wound.Conclusions: Overall, better results were seen on wound healing in patients who received Inj piroxicam with significantly less post-operative redness and edema. However, this did not have significant difference in the final outcome of the grading of the wound. 

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