scholarly journals The Expansion of Cholangioscopy: Established and Investigational Uses of SpyGlass in Biliary and Pancreatic Disorders

Diagnostics ◽  
2020 ◽  
Vol 10 (3) ◽  
pp. 132
Author(s):  
Michael Yodice ◽  
Joseph Choma ◽  
Micheal Tadros
Keyword(s):  
Guide Wire ◽  
Prophylactic Antibiotic ◽  
Cost Effective ◽  
Antibiotic Use ◽  
Complication Rates ◽  
Visually Guided ◽  
Endoscopic Retrograde ◽  
Pancreatic Disorders ◽  
Selective Cannulation ◽  
Repeat Procedures

Direct visualization of bile and pancreatic duct pathology is proving to be beneficial in patients where previous techniques have failed. Recent advancements in technology and the development of the SpyGlass system have led to an increased use of cholangioscopy. It is already known that SpyGlass is beneficial in patients with difficult bile duct stones and indeterminate biliary lesions through the use of targeted lithotripsy and visually guided biopsy. Cholangioscopy allows the visualization of hidden stone and guide wire placement across difficult strictures and selective cannulation of the intrahepatic and cystic ducts. It is also demonstrating its utility in investigational applications such as post-liver transplant and primary sclerosing cholangitis stricture treatment, evaluation of hemobilia, and guided radiofrequency ablation of ductal tumors. In addition to having clinical utility, cholangioscopy may also be cost-effective by limiting the number of repeat procedures. Cholangioscopy overall has similar complication rates compared to other standard endoscopic retrograde cholangioscopy (ERCP) techniques, but there may be higher rates of cholangitis. This could be mitigated with prophylactic antibiotic use, and overall, cholangioscopy has similar complication rates compared to other techniques.

Complications Associated With Totally Implanted Venous Access Devices in the Arm Versus the Chest: A Short-Term Retrospective Study

2021 ◽  
pp. 084653712110408
Author(s):  
Samuel Pike ◽  
Kiat Tan ◽  
Brent Burbridge
Keyword(s):  
Venous Thrombosis ◽  
Pulmonary Thromboembolism ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Venous Access ◽  
P Value ◽  
Complication Rates ◽  
Infection Rates ◽  
Short Term ◽  
Venous Access Devices

Purpose: To retrospectively compare complications for totally implanted venous access devices (TIVADs or ports) in the arm vs. the chest. One participating institution implanted all TIVADs in the arm, whereas the other institution implanted them in the chest. Methods: Subjects were consecutive patients > 18 years with a device inserted between July 2017 and January 2019 at either Hospital A, where all devices were implanted in the arm, or at Hospital B, where all devices were implanted in the chest. Complications (rates/1,000 catheter-days and frequencies) were compared between the arm and chest locations. Results: 201 arm devices (71% female, mean age 59.4 years) and 203 chest devices (66% female, mean age 61.5 years) were assessed. Overall complication rates did not differ between the arm and chest [arm: 30 complications per 56,938 catheter-days (0.530/1,000 catheter-days) vs. chest: 47 complications per 63,324 catheter-days (0.742/1,000 catheter-days), p-value 0.173]. Periprocedural complications and mechanical malfunction also did not differ. Although prophylactic antibiotic use was higher in the chest (79.3% vs. 1.50%, p-value < 0.0001), infection rates did not differ. Arm venous thrombosis was significantly higher in the arm cohort (0.205 vs. 0.017/1,000 catheter-days, p-value 0.003) and pulmonary thromboembolism in the chest cohort (0.269 vs 0.056/1,000 catheter-days, p-value 0.002). Conclusions: While arm venous thrombosis was higher in the arm and pulmonary thromboembolism in the chest cohort, other complications were similar. Antibiotic use was more frequent in the chest cohort, while infection rates remained similar in both cohorts.

scholarly journals Local anaesthetic-only upper blepharoplasty: a viable alternative?

2019 ◽  
Vol 2 (2) ◽  
pp. 17-20
Author(s):  
Robert Phan ◽  
Frank Lin
Keyword(s):  
Surgical Site Infection ◽  
General Anaesthesia ◽  
Revision Surgery ◽  
Local Anaesthetic ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Complication Rates ◽  
Site Infection ◽  
Site Use ◽  
Upper Blepharoplasty

Introduction: Local anaesthetic-only upper blepharoplasties are not routinely performed in the clinic in Australia. There is a lack of data to demonstrate whether they are any less safe or efficacious compared with upper blepharoplasties performed with sedation or general anaesthesia (GA) in theatre. Perioperative and postoperative antibiotics may also be administered for surgical site infection (SSI) prophylaxis. This paper aims to determine whether local-only upper blepharoplasties are safe and efficacious compared with upper blepharoplasties performed with sedation or GA, and whether prophylactic antibiotic use is indicated. Method: A retrospective analysis of patients undergoing upper blepharoplasties from a single surgeon’s private clinic was performed from March 2014 to October 2018. The clinic’s database was interrogated and patient age, anaesthetic type, operative site, use of peri- or postoperative antibiotics, and complications were recorded including infection, return to theatre, chemosis and asymmetry noted by the patient and requiring revision surgery. Results: A total of 97 patients were included for analysis. Complication rates of local-only upper blepharoplasties performed in the clinic were not higher than when performed under sedation or GA in theatre. When analysing antibiotic use, although 32 of the 97 patients (33%) were not prescribed antibiotics preoperatively, postoperatively, or pre- and postoperatively, no patients developed infections. Conclusion: When performed by a qualified surgeon with appropriate equipment, local-only upper blepharoplasties carried-out in the clinic are as safe and efficacious as those performed with sedation or GA in theatre. Prophylactic antibiotic use demonstrated no advantage in SSI prevention for patients undergoing upper blepharoplasties.

Is perioperative antibiotic necessary in straightforward implant placement procedures?

2020 ◽  
Author(s):  
Elçin Bedeloğlu ◽  
Mustafa Yalçın ◽  
Cenker Zeki Koyuncuoğlu
Keyword(s):  
Clavulanic Acid ◽  
Dental Implant ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Implant Failure ◽  
Control Group ◽  
Implant Placement ◽  
Significant Difference ◽  
Amoxicillin Clavulanic Acid ◽  
Experimental Group

The purpose of this non-random retrospective cohort study was to evaluate the impact of prophylactic antibiotic on early outcomes including postoperative pain, swelling, bleeding and cyanosis in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 males, 30 females) whose dental implant placement were completed, included to the study. Patients used prophylactic antibiotics were defined as the experimental group and those who did not, were defined as the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 h preoperatively and 1 g amoxicillin + clavulanic acid twice a day for 5 days postoperatively while the control group had received no prophylactic antibiotic therapy perioperatively. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration and implant failure were analyzed on postoperative days 2, 7, and 14 and week 12. No statistically significant difference was detected between the two groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 ( p &gt;0.05), while the severity of pain and swelling were greater on day 2 compared to day 7 and 14 and week 12 in both groups ( p =0.001 and p &lt;0.05, respectively). Similarly, no significant difference was found between the two groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the two groups with regard to the percentage of flap dehiscence assessed at other time points. Within limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized control clinical studies with higher numbers of patients and implants are needed to substantiate our findings.

scholarly journals Biliary cannulation in endoscopic retrograde cholangiography: How to tackle the difficult papilla

2021 ◽  
Author(s):  
Mark op den Winkel ◽  
Jörg Schirra ◽  
Christian Schulz ◽  
Enrico N. De Toni ◽  
Christian J. Steib ◽  
...  
Keyword(s):  
Biliary Drainage ◽  
Guide Wire ◽  
A Priori ◽  
Endoscopic Retrograde Cholangiography ◽  
Endoscopic Retrograde ◽  
Biliary Cannulation ◽  
Increased Risk ◽  
Difficult Biliary Cannulation ◽  
Needle Knife ◽  
Transpancreatic Sphincterotomy

Background: In the setting of a naïve papilla, biliary cannulation is a key step in successfully performing endoscopic retrograde cholangiography (ERC). Difficult biliary cannulation (DBC) is associated with an increased risk of post-ERCP-pancreatitis and failure of the whole procedure. Summary: Recommendations for biliary cannulation can be divided in (a) measures to reduce the likelihood of a difficult papilla-situation a priori and (b) rescue techniques in case the endoscopist is actually facing DBC. (a): careful inspection of the papillary anatomy and optimizing its accessibility by scope-positioning is fundamental. A sphincterotome in combination with a soft-tip hydrophilic guide-wire rather than a standard catheter with a standard guide-wire should be used. (b): The most important rescue techniques are needle-knife precut, double-guidewire technique and transpancreatic sphincterotomy. In few cases, anterograde techniques are needed. To this regard, the EUS-guided biliary drainage (EUS-BD) followed by rendezvous is increasingly used as an alternative to percutaneous-transhepatic biliary drainage. Key Messages: Biliary cannulation can be accomplished with alternative retrograde or less frequently by salvage-anterograde techniques, once conventional direct cannulation attempts have failed. Considering recent favorable data for the early use of transpancreatic sphincterotomy, an adopted version of the 2016 European-Society-for-Gastrointestinal-Endoscopy (ESGE)-algorithm on biliary cannulation is proposed.

scholarly journals Antibiotic Prophylaxis in Orbital Fractures

2017 ◽  
Vol 11 (1) ◽  
pp. 11-16 ◽  
Author(s):  
Benjamin Reiss ◽  
Lamise Rajjoub ◽  
Tamer Mansour ◽  
Tony Chen ◽  
Aisha Mumtaz
Keyword(s):  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
University Hospital ◽  
Orbital Fracture ◽  
Number Needed To Treat ◽  
Orbital Fractures ◽  
Oral Antibiotics ◽  
George Washington ◽  
Amoxicillin Clavulanate ◽  
Trauma Teams

Purpose: To determine whether prophylactic antibiotic use in patients with orbital fracture prevent orbital infection. Design: Retrospective cohort study. Participants: All patients diagnosed with orbital fracture between January 1, 2008 and March 1, 2014 at The George Washington University Hospital and Clinics. Main Outcome Measures: Development of orbital infection. Results: One hundred seventy-two patients with orbital fracture met our inclusion and exclusion criteria. No orbital infections were documented. Twenty subjects (12%) received no prophylactic antibiotic, and two (1%) received only one dose of antibiotics pre-operatively for surgery. For primary antibiotic, 136 subjects (79%) received oral antibiotics, and 14 (8%) received intravenous (IV) antibiotics (excluding cefazolin). Cephalexin and amoxicillin-clavulanate were the most prescribed oral antibiotics that are equally effective. Five-to-seven day courses of antibiotics had no increased infections compared to ten-to-fourteen day courses. Calculated boundaries for effectiveness of prophylactic antibiotics ranged from a Number Needed to Treat (NNT) of 75 to a Number Needed to Harm (NNH) of 198. Conclusion: Antibiotics for prevention of orbital infection in patients with orbital fractures have become widely used. Coordination between trauma teams and specialists is needed to prevent patient overmedication and antibiotic resistance. Should antibiotics be used, shorter courses and avoidance of broad spectrum agents are recommended. Additional studies are needed.

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