scholarly journals Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases

2021 ◽  
Vol 10 (21) ◽  
pp. 5183
Author(s):  
Olivier Donnez
Keyword(s):  
Rectal Resection ◽  
Preoperative Imaging ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Deep Endometriosis ◽  
Pelvic Nerves ◽  
Lower Complication ◽  
Challenging Situation ◽  
The Right

Deep endometriosis infiltrating the rectum remains a challenging situation to manage, and it is even more important when ureters and pelvic nerves are also infiltrated. Removal of deep rectovaginal endometriosis is mandatory in case of symptoms strongly impairing quality of life, alteration of digestive, urinary, sexual and reproductive functions, or in case of growing. Extensive preoperative imaging is required to choose the right technique between laparoscopic shaving, disc excision, or rectal resection. When performed by skilled surgeons and well-trained teams, a very high majority of cases of deep endometriosis nodule (>95%) is feasible by the shaving technique, and this is associated with lower complication rates regarding rectal resection. In most cases, removing a part of the rectum is questionable according to the risk of complications, and the rectum should be preserved as far as possible. Shaving and rectal resection are comparable in terms of recurrence rates. As shaving is manageable whatever the size of the lesions, surgeons should consider rectal shaving as first-line surgery to remove rectal deep endometriosis. Rectal stenosis of more than 80% of the lumen, multiple bowel deep endometriosis nodules, and stenotic sigmoid colon lesions should be considered as indication for rectal resection, but this represents a minority of cases.

Dual surgeon operating lists for complex revision arthroplasty surgery: changing orthopaedic surgical practice

2020 ◽  
Vol 81 (12) ◽  
pp. 1-6
Author(s):  
M Bansal ◽  
NA Sandiford
Keyword(s):  
Personal Development ◽  
Revision Arthroplasty ◽  
Ageing Population ◽  
Complication Rates ◽  
Quality Of Patient Care ◽  
Increasing Trend ◽  
Lower Complication ◽  
Arthroplasty Surgery

There is an increasing trend towards dual surgeon operating in complex surgeries in various specialties. This is driven by regionalisation of services, increasing complexity of surgical procedures, the ageing population and challenges imposed by changes in surgical training. Dual surgeon cases have lower complication rates and better quality of patient care. This practice not only facilitates professional and personal development, but also provides valuable support to surgeons in the early part of their career. There is a paucity of literature to support this practice, however, and prospective studies are required to demonstrate the benefit of this approach.

Inpatient management of epistaxis: Outcomes and cost

2005 ◽  
Vol 132 (5) ◽  
pp. 707-712 ◽  
Author(s):  
John C. Goddard ◽  
Evan R. Reiter
Keyword(s):  
Nasal Packing ◽  
Hospital Charges ◽  
Group Differences ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Arterial Ligation ◽  
Lengths Of Stay ◽  
Inpatient Management ◽  
Head Neck

OBJECTIVE: Evaluate treatments for epistaxis. STUDY DESIGN AND SETTING: Retrospective review of Nationwide Inpatient Sample (1998-2000). RESULTS: A total of 9778 admissions with admitting diagnosis “epistaxis” were identified. Among admissions involving 1 treatment, 454 (9.6%) received arterial ligation, 94 (2.0%) embolization, and 4188 (88.4%) nasal packing. There were no differences in length of stay, transfusions, complications, or deaths between groups (all P >0.05). Mean total hospital charges were $6,282 for the packing group, $12,805 for the ligation group, and $17,517 for the embolization group; differences between ligation and packing groups, and embolization and packing groups demonstrated significance ( P >0.05). CONCLUSIONS: Nasal packing is used commonly for epistaxis that requires inpatient management. Although embolization and arterial ligation are associated with higher hospital charges, complications, transfusion rates, and lengths of stay are similar. Further studies are needed to quantify other outcome measures, such as recurrence rates and patient quality of life. SIGNIFICANCE: Nasal packing is associated with lower hospital charges and similar complication rates as arterial ligation or embolization. (Otolaryngol Head Neck Surg 2005;132:707-12.)

scholarly journals Update on Robotic Rectal Prolapse Treatment

2021 ◽  
Vol 11 (8) ◽  
pp. 706
Author(s):  
Giampaolo Formisano ◽  
Luca Ferraro ◽  
Adelona Salaj ◽  
Simona Giuratrabocchetta ◽  
Andrea Pisani Ceretti ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Rectal Prolapse ◽  
Length Of Hospital Stay ◽  
Social Impairment ◽  
Conventional Laparoscopy ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Lower Morbidity

Rectal prolapse is a condition that can cause significant social impairment and negatively affects quality of life. Surgery is the mainstay of treatment, with the aim of restoring the anatomy and correcting the associated functional disorders. During recent decades, laparoscopic abdominal procedures have emerged as effective tools for the treatment of rectal prolapse, with the advantages of faster recovery, lower morbidity, and shorter length of stay. Robotic surgery represents the latest evolution in the field of minimally invasive surgery, with the benefits of enhanced dexterity in deep narrow fields such as the pelvis, and may potentially overcome the technical limitations of conventional laparoscopy. Robotic surgery for the treatment of rectal prolapse is feasible and safe. It could reduce complication rates and length of hospital stay, as well as shorten the learning curve, when compared to conventional laparoscopy. Further prospectively maintained or randomized data are still required on long-term functional outcomes and recurrence rates.

scholarly journals Laparoscopic treatment of deep endometriosis with a diode laser: our experience

2021 ◽  
Author(s):  
Stefano Angioni ◽  
Luigi Nappi ◽  
Felice Sorrentino ◽  
Michele Peiretti ◽  
Angelos Daniilidis ◽  
...  
Keyword(s):  
Diode Laser ◽  
Laser System ◽  
Operation Time ◽  
Laparoscopic Treatment ◽  
University Hospitals ◽  
Recurrence Rates ◽  
Deep Endometriosis ◽  
Pain Scores

Abstract Purpose To evaluate whether laparoscopic treatment with a diode laser is feasible, safe, and effective in symptomatic patients affected by deep endometriosis (DE). Methods This retrospective study was performed using medical record data. The surgical reports, chronic pain scores, and quality of life (QoL) data were evaluated for 50 patients who had undergone laparoscopic surgery between November 2017 and March 2019 at two university hospitals (Monserrato (CA) and Foggia, Italy). Indications for surgery were chronic pelvic pain and/or infertility in patients who wished to conceive spontaneously. Endometriosis lesions/nodules were excised using a diode laser (Leonardo®, Biolitec® DUAL 45) that can combine 980 and 1470 nm wavelengths transmitted through a 1000 µm conical optical fibre. Results The median patient age was 32 years (range 21–44), with a body mass index (BMI) mean of 21.7  ±  2.9 kg/m2. The mean operation time was 147 min (range 106–190). No intraoperative or early complications (< 30 days) were reported. All patients left the hospital, on average, within 3 days (range 2–9 days) after surgery. A significant improvement in pain was observed at the 3-, 6-, and 12-month follow-up (p < 0.01) in all patients. Moreover, patients reported a significant QoL improvement at the 12-month follow-up. Conclusion The diode laser confirmed its feasibility and safety for treating endometriosis. During the shaving surgical procedure, the diode laser system ensures a safe and effective laparoscopic dissection of deep endometriotic lesions. Further comprehensive randomized trials are necessary to confirm these preliminary data in terms of efficacy, recurrence rates, and pregnancy outcomes.

The Impact of Preoperative Double-J Stent on Perioperative Complications, Recurrence, and Quality of Life in Adult Patients Undergoing Pyeloplasty

2021 ◽  
pp. 1-8
Author(s):  
Mike Wenzel ◽  
Benedikt Hoeh ◽  
Marieke J. Krimphove ◽  
Clara Buchholz ◽  
Matthias Müller ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Perioperative Complications ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Double J Stent ◽  
Robotic Pyeloplasty ◽  
Subgroup Analyses ◽  
The Impact

<b><i>Purpose:</i></b> This study aimed to evaluate the impact of preoperative double-J stent (DJ) in pyeloplasty patients on perioperative complications, recurrence, and quality of life (QoL). <b><i>Methods:</i></b> Pyeloplasties due to ureteropelvic junction obstructions between January 2010 and December 2020 were consecutively identified. A standardized follow-up questionnaire was used. Tabulation was made according to preoperative DJ versus no DJ. Subgroup analyses addressed primary robotic pyeloplasties. <b><i>Results:</i></b> Of 95 pyeloplasty patients, 62% received a preoperative DJ. Patients with preoperative DJ exhibited higher rates of Clavien-Dindo (CD) 2 (22 vs. 11%) complications, but not of CD3 (8.5 vs. 8.3%, <i>p</i> = 0.5). After a median follow-up of 61 months, 9 patients exhibited a recurrence, of whom 7 had a preoperative DJ. In QoL assessment, comparable findings were made between patients with and without preoperative DJ. In robotic pyeloplasty patients (<i>n</i> = 73), patients with preoperative DJ (58%, <i>n</i> = 42) experienced higher CD3 complication rates, compared to patients without preoperative DJ (12 vs. 6.5%). Moreover, higher rates of recurrences were observed in preoperative DJ patients (12 vs. 3.2%). <b><i>Conclusion:</i></b> In a contemporary pyeloplasty cohort, the midterm success rate was good with 91%. Our findings suggest that preoperative DJ is associated with higher recurrence rates. However, QoL did not differ between patients with and without preoperative DJ.

scholarly journals Peripheral vascular access from the arms for electrophysiology procedures using ultrasound guidance

2021 ◽  
Author(s):  
Suraj Kadiwar ◽  
Jack Griffiths ◽  
Stefan Ailoaei ◽  
Bruce Barton ◽  
Nelly Samchkuashvili ◽  
...  
Keyword(s):  
Vascular Access ◽  
Brachial Artery ◽  
Complication Rates ◽  
Portable Ultrasound ◽  
Increased Risk ◽  
Lower Complication ◽  
Femoral Vessels ◽  
Brachial Vein ◽  
The Right ◽  
Superior Approach

Introduction Vascular access has traditionally been gained from the femoral vessels, however, a ‘radial-first’ approach has become increasingly popular and resulted in lower complication rates and reduced healthcare costs. A “superior” approach has been reported for electrophysiology (EP) studies but is associated with an increased risk. To provide comprehensive anatomical evidence that the vessels of the arms are suitable for use during EP procedures, as assessed by vascular ultrasound. Methods A portable ultrasound device was used to measure the diameter of the brachial artery, brachial, basilic & cephalic veins on the left and right upper limbs of 63 healthy volunteers. A subgroup of 15 volunteers had additional measurements taken with a tourniquet. Results The basilic vein had the largest diameter with a median of 4.6 mm and 4.5 mm (right and left diameter, respectively), followed by the cephalic (median of 3.1 and 3.0 mm) and the brachial vein (median of 2.8 mm). 100% of volunteers had at least one vein that was equal to a 3 mm diameter (which would allow for an 8F sheath), with 98% having 2 suitable veins and >80% having 3 suitable venous vessels. More than 90 % had a suitable diameter for both the right and left brachial artery. There was no correlation between BMI, height, weight, but men had significantly larger basilic veins and brachial arteries (p<0.05). Conclusion We demonstrate the anatomic evidence that the vessels in the arm(s) are capable of housing the size of sheath commonly used in the EP lab.

scholarly journals Transperitoneal laparoscopic pyeloplasty: a single center experience of 28 cases

2018 ◽  
Vol 5 (2) ◽  
pp. 653
Author(s):  
Ranjit Chaudhary ◽  
Chirag Shanti Dausage
Keyword(s):  
Functional Results ◽  
Renal Stones ◽  
The Other ◽  
Complication Rates ◽  
Laparoscopic Pyeloplasty ◽  
Single Center Experience ◽  
Lower Complication ◽  
The Mean ◽  
The Right

Background: To evaluate prospectively the results obtained in 28 patients undergoing laparoscopic pyeloplasty through transperitoneal access.Methods: From January 2014 to June 2016, twenty-eight patients between 12 and 55 years old underwent laparoscopic pyeloplasty for primary ureteropelvic junction (UPJ) obstruction via a transperitoneal approach. Eighteen cases had the obstruction on the left side and the other ten on the right side. All patients had radiographic evidence of obstruction with signs, symptoms or deterioration of renal function. Anderson-Hynes dismembered pyeloplasty was performed in 25 patients and Fenger technique in the other 3 cases. Three patients had non-obstructing renal stones and underwent concomitant pyelolithotomy.  Patients were evaluated clinically and by imaging in the postoperative period at 3 and 6 months and then followed-up annually.Results: The operative time ranged from 190 to 330 min. The average blood loss was 70 mL. Analgesic requirements were also minimal with patients requiring PCA for an average of 1.1 days. Average days to free fluids were 1.5 days. The mean hospital stay was 3.76 days. The time to return to normal activities ranged from 7 to 12 days. Crossing vessels were identified in 16 patients, intrinsic stenosis in 14 patients and 5 patients had high implantation of the ureter. There were no conversions to open. One patient had longer urinary fistula (9 days), 2 patients had prolonged ileus and 3 patients had port site infection. The follow up ranged from 6 to 72 months. From the later postoperative complications, 2 patients had re-stenosis. The success rate was 92.85%.Conclusions: Laparoscopic pyeloplasty has functional results comparable to conventional open technique. It offers less morbidity, with aesthetic and post-operative convalescence benefits and lower complication rates.

ANALYSIS OF REGULATIONS REGARDING THE SETTLEMENT OF ISSUES ON THE REMOVAL AND RECOVERY OF PLANTATIONS IN THE RIGHT-OF-WAY OF PUBLIC ROADS

2020 ◽  
pp. 55-60
Author(s):  
Nataliia Kharytonova ◽  
Olha Mykolaienko ◽  
Tetyana Lozova
Keyword(s):  
Traffic Safety ◽  
Climatic Factors ◽  
Visual Orientation ◽  
Right Of Way ◽  
Adverse Weather ◽  
Overhead Power Lines ◽  
The Right ◽  
Neck Diameter ◽  
Proper Operation

Greening of roads contributes to the protection of roads and their elements from influence of adverse weather and climatic factors; it includes the measures for improvement and landscaping of roads, ensures the protection of roadside areas from transport pollution, provides visual orientation of drivers. The solution of these issues will ensure creation and maintenance of safe and comfortable conditions for travelers. Green plantings in the right-of-way road area include woody, bushy, flower and grass vegetation of natural and artificial origin. For proper operation of public roads and satisfaction of other needs of the industry, there may be the need in removing the greenery. The reason for the removal of greenery in the right-of-way road area may be due to the following factors: construction of the architectural object, widening of the motor road, repair works in the security zone of overhead power lines, water supply, drainage, heating, telecommunications facilities, cutting of hazardous, dry and fautal trees, as well as self-grown and brushwood trees with a root neck diameter not exceeding 5 cm, elimination of the consequences of natural disasters and emergencies. The removal of plantations in the right-of-way area is executed in order to ensure traffic safety conditions and to improve the quality of plantations composition and their protective properties. Nowadays, in Ukraine there is no clear procedure for issuing permits for removing of such plantations. In order to resolve this issue, there is a need in determining the list of regulations in the area of forest resources of Ukraine and, if needed, the list of regulatory acts that have to be improved; to prepare a draft of the regulatory legal act that would establish the procedure of plantations cutting, the methodology of their condition determination, recovery costs determination, the features of cutting. Keywords: plantations, cutting, right-of-way, woodcutting permit, order.

Modifikasi Model Pembelajaran Problem Based Learning (PBL) dengan Strategi Pembelajaran Tugas dan Paksa

2019 ◽  
Vol 2 ◽  
Author(s):  
Tita Mila Mustofani ◽  
Ita Hartinah
Keyword(s):  
Critical Thinking ◽  
Learning Strategies ◽  
Student Motivation ◽  
Problem Based Learning ◽  
Learning Model ◽  
Learning Material ◽  
Task Strategies ◽  
The Right ◽  
Increasing Student Learning

This writing aims to help teachers to increase motivation, activity, creativity, and critical thinking of students in solving problems in class. The way to increase student motivation in learning in class is to choose the right learning model with ongoing learning material. One learning model that increases students' creativity and critical thinking in problem solving is a Problem Based Learning (PBL) learning model. To improve students' insights in order to easily solve problems there is a need to do tasks, if students do not do the task then they must accept the agreed upon consequences when making learning contracts, thus modifying the Problem Based Learning (PBL) learning model with task strategies and forced. The results of the modification of learning with the Problem Based Learning (PBL) learning model through forced and forced strategies are expected to improve the learning process so that students become more disciplined and do not waste time doing assignments. The advantages of modifying the Problem Based Learning (PBL) learning model with task and forced learning strategies are increasing student learning motivation, improving the quality of learning, training students' understanding by giving assignments continuously, teaching discipline to students in order to be accountable for tasks assigned, and reducing laziness in students.

THE VALUE OF LOVE IN THE SYSTEM OF FORMATION OF THE PROFESSIONAL MATURITY OF THE EDUCATOR

2020 ◽  
Vol 1 (10(79)) ◽  
pp. 12-18
Author(s):  
G. Bubyreva
Keyword(s):  
Russian Federation ◽  
The State ◽  
Educational Process ◽  
Wide Range ◽  
The Family ◽  
The Russian Federation ◽  
The Government ◽  
The Individual ◽  
The Right

The existing legislation determines the education as "an integral and focused process of teaching and upbringing, which represents a socially important value and shall be implemented so as to meet the interests of the individual, the family, the society and the state". However, even in this part, the meaning of the notion ‘socially significant benefit is not specified and allows for a wide range of interpretation [2]. Yet the more inconcrete is the answer to the question – "who and how should determine the interests of the individual, the family and even the state?" The national doctrine of education in the Russian Federation, which determined the goals of teaching and upbringing, the ways to attain them by means of the state policy regulating the field of education, the target achievements of the development of the educational system for the period up to 2025, approved by the Decree of the Government of the Russian Federation of October 4, 2000 #751, was abrogated by the Decree of the Government of the Russian Federation of March 29, 2014 #245 [7]. The new doctrine has not been developed so far. The RAE Academician A.B. Khutorsky believes that the absence of the national doctrine of education presents a threat to national security and a violation of the right of citizens to quality education. Accordingly, the teacher has to solve the problem of achieving the harmony of interests of the individual, the family, the society and the government on their own, which, however, judging by the officially published results, is the task that exceeds the abilities of the participants of the educational process.  The particular concern about the results of the patriotic upbringing served as a basis for the legislative initiative of the RF President V. V. Putin, who introduced the project of an amendment to the Law of RF "About Education of the Russian Federation" to the State Duma in 2020, regarding the quality of patriotic upbringing [3]. Patriotism, considered by the President of RF V. V. Putin as the only possible idea to unite the nation is "THE FEELING OF LOVE OF THE MOTHERLAND" and the readiness for every sacrifice and heroic deed for the sake of the interests of your Motherland. However, the practicing educators experience shortfalls in efficient methodologies of patriotic upbringing, which should let them bring up citizens, loving their Motherland more than themselves. The article is dedicated to solution to this problem based on the Value-sense paradigm of upbringing educational dynasty of the Kurbatovs [15].

Sign in / Sign up

Export Citation Format

Share Document