scholarly journals COMPLICATIONS OF OPEN SURGICAL PROCEDURES IN PATIENTS WITH PANCREATIC CYSTS

2021 ◽  
Vol 11 (2) ◽  
pp. 53-55
Author(s):  
Aleksandr Gerasimov ◽  
Valeriy Nikolskiy ◽  
Aleksandr Mitroshin ◽  
Sergey Frolov ◽  
Ekaterina Titova
Keyword(s):  
Surgical Procedures ◽  
Open Surgery ◽  
Pancreatic Cysts ◽  
Surgical Interventions ◽  
Postoperative Pancreatitis ◽  
Number Of Patients ◽  
History Of ◽  
Cyst Recurrence

The incidence of pancreatic cysts is constantly growing due to an increasing number of patients with a history of pancreatitis. Furthermore, complications after surgical interventions for pancreatic cysts occur in 30-40% of patients. Objective: to analyze the complications in patients with pancreatic cysts after open surgery. We observed 68 patients who underwent open surgical interventions: cystogastrostomy and cystojejunostomy. All patients with pancreatic cysts were divided into 2 groups depending on the type of procedure. In 27 patients (29%) of the first group cystogastrostomy and in 41 patients (81%) of the second group cystojejunostomy was performed. In 1st group complications were diagnosed in 8 cases (29.6%): postoperative pancreatitis (5 — 18.5%), cyst recurrence (3 — 11.1%). In the second group complications occurred in 7 patients (17.1%): postoperative pancreatitis in 4 cases (9.8%), recurrent cysts in 3 cases (7.3%). Thus, cystojejunostomy is less associated with complications than cystogastrostomy. K E Y W O R D S — pancreatic cy

scholarly journals Outcomes of Percutaneous Nephrolithotomy in Patients with Previous Ipsilateral Open Renal Stone Surgery

2020 ◽  
Vol 18 (2) ◽  
pp. 277-281
Author(s):  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parash Mani Shrestha ◽  
Biswa Raj Joshi
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Open Surgery ◽  
Renal Stone ◽  
Standard Technique ◽  
Study Groups ◽  
Average Hospital ◽  
Number Of Patients ◽  
History Of ◽  
Renal Stone Surgery ◽  
First Time

Background: Nephrolithiais is a recurrent disease. Recent advances have enabled stone surgeries to be performed by minimal invasive techniques; but still a large number of patients present with history of ipsilateral open renal stone surgery. Previous scar to the kidney and overlying muscles are fraught with possibility of increased complications. This study was conducted to evaluate the perioperative results of percutaneous nephrolithotomy in patients with a history of open stone surgery and to compare with those undergoing percutaneous nephrolithotomy for the first time.Methods: A retrospective study of all the percutaneous nephrolithotomy performed by standard technique within four years at Bir Hospital was made. Patients were divided into those undergoing percutaneous nephrolithotomy for the first time and those who had undergone open renal stone surgery in the past. Preoperative and intraoperative variables were recorded and postoperative stone free status and complications were evaluated. Results: Six hundred and twenty seven patients; out of 691, who had undergone percutaneous nephrolithotomy were included. Demographic variables and stone characteristics were similar in the two study groups. percutaneous nephrolithotomy was found to be statistically similar in the two groups in terms of the number of tracts made (p= 0.1642) and operative time (0.9197). Exit strategies were similar in both groups. Stone free rate was 83.33% in patients undergoing percutaneous nephrolithotomy for first time and 82.08% in those with history of open surgery. Average hospital stay was 3 days in both groups. Although the group with history of previous surgery had significantly more complications (p= 0.0207), Clavien grading was similar in the two groups.Conclusions: This study shows that the rate of complications is more in patients with history of open surgery, most complications are minor, not requiring intensive management. percutaneous nephrolithotomy is efficient and safe in patients with history of open renal stone surgery. Keywords: Complications; open renal stone surgery; percutaneous nephrolithotomy

scholarly journals Current trends in routine myocardial revascularization

2021 ◽  
Vol 10 (2) ◽  
pp. 25-35
Author(s):  
S. V. Ivanov ◽  
A. N. Sumin
Keyword(s):  
Perioperative Complications ◽  
Myocardial Revascularization ◽  
Fold Increase ◽  
Perioperative Mortality ◽  
Surgical Interventions ◽  
The Past ◽  
Number Of Patients ◽  
History Of ◽  
The Mean ◽  
Artery Disease

Highlights. A 12-year experience of myocardial revascularization at the Research Institute of Complex Issues of Cardiovascular Diseases is reported. An increase in the number of patients with comorbidities resulted in more complex surgeries. Perioperative mortality and complication rates are consistent with the reported global data.Aim. To assess the temporal changes in baseline characteristics of patients with coronary artery disease (CAD), the range of surgical interventions, and the structure of significant in-hospital complications following coronary artery bypass grafting (CABG).Methods. 9,043 patients who underwent CABG between 2006 and 2018 were identified from a prospective CABG registry. 1,847 (20.4%) were women (the mean age of 63.11±7.4 years) and 7,196 (79.6%) were men (the mean age of 59.0±7.9 years). The main parameters on the underlying cardiovascular disease and comorbidities, the prevalence and extent of non-cardiac atherosclerosis, the type of CABG, and the volume of associated surgical interventions as well as the structure of perioperative complications were included in the statistical analysis.Results. We determined several trends characterizing the temporal changes in the clinical, morphological, and functional status of patients. The number of women undergoing CABG has increased 2.7-fold. The mean age of patients undergoing CABG has increased by 7.3 years. Patients are present with higher rates of comorbidities, including AF, diabetes (a 2.5-fold increase), hypertension (a 12% increase), as well as severe BCA stenoses (a 2.7-fold increase), a positive history of stroke, or TIA (a 2.1-fold increase). The number of combined surgical procedures during CABG has increased by 2.9. The prevalence of perioperative neurological and hemorrhagic complications requiring revision surgery, and deep wound infection have increased 4.3-fold. Waiting time for elective CABG has significantly reduced. The number of patients with a history of myocardial infarction (a 14.5% decrease) and severe peripheral artery disease has decreased. In-hospital mortality has decreased over the past decade.Conclusion. Over the past decade, the number of patients with comorbidities who require more complex surgeries has increased at the Research Institute for Complex Issues of Cardiovascular Diseases. Perioperative mortality tends to decrease. However, an increase in the number of neurological, hemorrhagic, and infectious perioperative complications requires the initiation of new preventive measures.

Global Risk Profile Verification in Patients with Venous Thromboembolism (GRIP VTE) in Five Gulf Countries.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 4067-4067
Author(s):  
Faisal Al Sayegh ◽  
Wael Almahmeed ◽  
Mahmoud Marashi ◽  
Ahmed Bahr ◽  
Hasan Al Mahdi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Surgical Procedures ◽  
Risk Profile ◽  
Orthopedic Procedures ◽  
Global Risk ◽  
Surgical Interventions ◽  
Gulf Countries ◽  
History Of ◽  
Calf Pain

Abstract Background: The Global Risk Profile Verification in Patients with Venous Thromboembolism (GRIP VTE) was the first prospective multicenter registry conducted in five Gulf countries to explore the epidemiology of venous thromboembolic (VTE) disorders and to provide data on diagnosis and disease management. Methods: Data on 242 patients with confirmed VTE were submitted between September 2003 and November 2003 by multidisciplinary specialists from 28 contributing hospitals in the Gulf region (Kuwait, Bahrain, Qatar, Oman, and the UAE). Patients with a suspected diagnosis of VTE were included. The data management team at a sponsor-independent study coordinating center ensured data quality. Differences between groups were assessed by the Chi square test or Fisher exact test for categorical variables. The Student t-test was used for testing proportions. A two-tailed P value <0.05 was considered significant. Doppler ultrasound and lung scans were the most preferred modalities in the diagnosis of deep vein thrombosis (DVT) and pulmonary embolism (PE). Results: The table shows the incidence of VTE. The most common symptoms of DVT and DVT/PE patients were calf pain (72%), calf swelling (63.8%), and localized tenderness (52.2%). Calf pain and localized tenderness were significantly greater (P <0.001) in cases of DVT alone than in cases of DVT/PE. The most common symptoms in patients with PE alone and DVT/PE were dyspnea (83.6%), thoracic pain (69.1%), and cough (40%). Cough and hemoptysis occurred more frequently in PE cases than in cases of DVT/PE (P <0.001). Risk factors for VTE were immobilization >3 days (41.3%), age >65 years (28.9%), a history of VTE (20.7%), and trauma (19%). Surgical intervention in the previous year was an independent risk factor for VTE, 83.8% of such patients experiencing VTE within 4 weeks of surgery. There was a strong association between VTE and orthopedic procedures (P=0.0016). Among surgical interventions, orthopedic procedures induced the greatest number of VTE cases, followed by general surgical procedures and gynecological procedures. Low molecular weight heparins (LMWHs) were chosen to treat 33.7% of DVT cases, while unfractionated heparin (UFH) was used in 21.9% of cases. UFH use in PE and DVT/PE was 57.1% and 55%, respectively, and LMWHs use was 14.3% each for PE and DVT/PE. Oral anticoagulant use in DVT/PE, DVT, and PE was 30%, 19.8%, and 2.9%, respectively. Conclusion: The main risk factors predisposing to VTE are immobilization, age >65 years, a history of VTE, and trauma. The highest incidence was observed in medical patients, necessitating prophylaxis in patients at risk. Previous surgical interventions were independent risk factors for VTE, requiring extended prophylaxis, including outpatient thromboprophylaxis, in patients undergoing extensive surgical procedures. Incidence of DVT, PE, and DVT/PE DVT PE DVT/PE Frequency of cases - n (%) 187 (77.27%) 35 (14.46%) 20 (8.26%) Departments Medical 74 (39.5%) 19 (54.28%) 10 (50%) Surgical 61 (32.62%) 9 (25.71%) 6 (30%) Others 52 (27.8%) 7 (20%) 4 (20%)

The Diagnostic Value of Pericardial Fluid and Pericardial Biopsy: Single Center Experiences

2016 ◽  
Vol 19 (1) ◽  
pp. 023 ◽  
Author(s):  
Mehmet Yildirim ◽  
Recep Ustaalioglu ◽  
Murat Erkan ◽  
Bala Basak Oven Ustaalioglu ◽  
Hatice Demirbag ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Thoracoscopic Surgery ◽  
Pericardial Tamponade ◽  
Pericardial Fluid ◽  
Pathological Examination ◽  
Common Disease ◽  
Pericardial Window ◽  
Surgical Interventions ◽  
History Of ◽  
Recurrent Pericardial Effusion

<strong>Background:</strong> Patients with recurrent pericardial effusion and pericardial tamponade are usually treated in thoracic surgery clinics by VATS (video-assisted thoracoscopic surgery) or open pericardial window operation. The diagnostic importance of pathological evaluation of the pericardial fluid and tissue in the same patients has been reported in few studies. We reviewed pathological examination of the pericardial tissue and fluid specimens and the effect on the clinical treatment in our clinic, and compared the results with the literature. <br /><strong>Methods:</strong> We retrospectively analyzed 174 patients who underwent pericardial window operation due to pericardial tamponade or recurrent pericardial effusion. For all patients both the results of the pericardial fluid and pericardial biopsy specimen were evaluated. Clinicopathological factors were analyzed by using descriptive analysis. <br /><strong>Results:</strong> Median age was 61 (range, 20-94 years). The most common benign diagnosis was chronic inflammation (94 patients) by pericardial biopsy. History of malignancy was present in 28 patients (16.1%) and the most common disease was lung cancer (14 patients). A total of 24 patients (13.8%) could be diagnosed as having malignancy by pericardial fluid or pericardial biopsy examination. The malignancy was recognized for 12 patients who had a history of cancer; 9 of 12 with pericardial biopsy, 7 diagnosed by pericardial fluid. Twelve of 156 patients were recognized as having underlying malignancy by pericardial biopsy (n = 9) or fluid examination (n = 10), without known malignancy previously. <br /><strong>Conclusion:</strong> Recurrent pericardial effusion/pericardial tamponade are entities frequently diagnosed, and surgical interventions may be needed either for diagnosis and/or treatment, but specific etiology can rarely be obtained in spite of pathological examination of either pericardial tissue or fluid. For increasing the probability of a specific diagnosis both the pericardial fluid and the pericardial tissues have to be sent for pathologic examination.

Quality of life after anti-reflux surgical interventions: possible solutions to the problem

2020 ◽  
pp. 3-25
Author(s):  
D. Lukanin ◽  
G. Rodoman ◽  
M. Klimenko ◽  
A. Sokolov ◽  
A. Sokolov
Keyword(s):  
Quality Of Life ◽  
Hiatal Hernia ◽  
Antireflux Surgery ◽  
Nissen Fundoplication ◽  
Laparoscopic Nissen Fundoplication ◽  
Partial Fundoplication ◽  
Surgical Interventions ◽  
Number Of Patients ◽  
Laparoscopic Nissen

The article presents the results of a prospective controlled parallel clinical study of a new modification of laparoscopic antireflux surgery in the treatment of gastroesophageal reflux disease in combination with a hiatal hernia compared with laparoscopic Nissen fundoplication in terms of assessing quality of life after surgery. Clinical and instrumental examination of patients was carried out a year after surgical interventions. In accordance with the results of instrumental examination after surgery, the proposed modification of laparoscopic partial fundoplication is not inferior to laparoscopic Nissen fundoplication both, in terms of relief of reflux esophagitis symptoms and in relation to the recurrence of hiatal hernia. Clinical monitoring indicates a significantly higher quality of life for patients after the modified antireflux surgery, which is associated with a number of factors. The implementation of this fundoplication led to a decrease in the number of patients with complaints of dysphagia, the development of which is directly related to the surgery performance, as well as to a statistically significant reduction of bloating in the upper abdomen. Another advantage of the modified surgery is a significantly smaller number of cases of gas-bloat syndrome. In addition, the disorders developing in the framework of the gas bloat syndrome after laparoscopic Nissen fundoplication are more severe.

scholarly journals 570. “I don’t know”: The Typical Response When Taking Pneumococcal Immunization Histories in Kidney Transplant Candidates

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S349-S351
Author(s):  
Jahanavi M Ramakrishna ◽  
Tambi Jarmi ◽  
Claudia R Libertin
Keyword(s):  
Infectious Disease ◽  
Kidney Transplant ◽  
Pneumococcal Vaccine ◽  
Patient Population ◽  
Pneumococcal Vaccination ◽  
Prior History ◽  
Vaccine Preventable Diseases ◽  
Number Of Patients ◽  
Order Completion ◽  
History Of

Abstract Background Vaccine-preventable diseases account for significant morbidity and mortality in the kidney transplant (KT) patient population. AST Guidelines support review and documentation of pneumococcal vaccines in KT candidate infectious disease (ID) evaluations. The objective of this study is to determine the number of KT candidates screened for prior pneumococcal immunizations and the frequency of vaccines ordered by providers when indicated at Mayo Clinic Florida’s (MCF) Transplant Center. Methods This study was an institution-based retrospective analysis of all KT candidates evaluated at MCF from December 2, 2019 – January 14, 2020. Data collection was obtained by electronic health record review. Outcomes included known history and documentation rates of prior pneumococcal vaccinations (both Prevnar 13 and Pneumovax 23) by infectious disease (ID) providers, as well as pneumococcal vaccine order frequency during ID pre-transplant evaluation when indicated. Data analysis was done using simple descriptive statistics. Results Sixty-one patients underwent KT evaluation during the study period. Among the 61 patients, 20 (32.8%) and 20 (32.8%) had a known prior history of receiving Prevnar 13 and Pneumovax 23 vaccinations, respectively. Vaccine history was unknown for Prevnar 13 and Pneumovax 23 in 39 (63.9%) patients. Vaccine status was not documented by ID providers in 2 (3.3%) patients. When appropriate, ID providers ordered Prevnar 13 and Pneumovax 23 in 38 (92.7%) and 41 (100%) patients, respectively. Orders included both electronic and written documentation to account for patients planning immunization elsewhere. Of the 38 patients advised to receive the Prevnar 13 vaccine, 17 (41.5%) patients were documented completing immunization. Pneumovax 23 order completion rates were not recorded since the study period only lasted six weeks due to closure by COVID-19. Table 1. Pneumococcal Vaccine History Documentation Rates Obtained by Patient Recall or Records Table 2. Pneumococcal Vaccine Order Rates at Pre-Kidney Transplant Consultations Table 3. Prevnar 13 Order Completion Rate by Documentation Conclusion The data reflect a high number of patients who either do not recall or have documentation of prior pneumococcal vaccination available at time of KT ID evaluation. Providers documented history of pneumococcal vaccinations extremely well, ordering immunizations when necessary. This study highlights lack of portability of immunization histories in a given patient population and opportunity for improved care. Disclosures Claudia R. Libertin, MD, Pfizer, Inc. (Grant/Research Support, Research Grant or Support)

scholarly journals Hemi- and Homozygous Loss-of-Function Mutations in DSG2 (Desmoglein-2) Cause Recessive Arrhythmogenic Cardiomyopathy with an Early Onset

2021 ◽  
Vol 22 (7) ◽  
pp. 3786
Author(s):  
Andreas Brodehl ◽  
Alexey Meshkov ◽  
Roman Myasnikov ◽  
Anna Kiseleva ◽  
Olga Kulikova ◽  
...  
Keyword(s):  
Medical History ◽  
Splice Site Mutation ◽  
Pathogenic Mutation ◽  
Large Deletion ◽  
Loss Of Function ◽  
Arrhythmogenic Cardiomyopathy ◽  
Site Mutation ◽  
Snp Arrays ◽  
Number Of Patients ◽  
History Of

About 50% of patients with arrhythmogenic cardiomyopathy (ACM) carry a pathogenic or likely pathogenic mutation in the desmosomal genes. However, there is a significant number of patients without positive familial anamnesis. Therefore, the molecular reasons for ACM in these patients are frequently unknown and a genetic contribution might be underestimated. Here, we used a next-generation sequencing (NGS) approach and in addition single nucleotide polymor-phism (SNP) arrays for the genetic analysis of two independent index patients without familial medical history. Of note, this genetic strategy revealed a homozygous splice site mutation (DSG2–c.378+1G>T) in the first patient and a nonsense mutation (DSG2–p.L772X) in combination with a large deletion in DSG2 in the second one. In conclusion, a recessive inheritance pattern is likely for both cases, which might contribute to the hidden medical history in both families. This is the first report about these novel loss-of-function mutations in DSG2 that have not been previously identi-fied. Therefore, we suggest performing deep genetic analyses using NGS in combination with SNP arrays also for ACM index patients without obvious familial medical history. In the future, this finding might has relevance for the genetic counseling of similar cases.

scholarly journals Injuries, treatment, and impairment caused by different types of fireworks; results of a 10 year multicenter retrospective cohort study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Daan T. Van Yperen ◽  
Esther M. M. Van Lieshout ◽  
J. Niels Dijkshoorn ◽  
Cornelis H. Van der Vlies ◽  
Michael H. J. Verhofstad
Keyword(s):  
Surgical Procedures ◽  
Hospital Admissions ◽  
Case Series ◽  
Secondary Outcome ◽  
Number Of Patients ◽  
Whole Person ◽  
Type Of Injury ◽  
Clear Increase ◽  
Level 1 Trauma Center ◽  
Head Neck

Abstract Objectives The primary aim of this study was to evaluate the number of patients reported to a hospital with injuries from consumer fireworks in the months December–January in the past 10 years, and to describe the association between the type of fireworks, injury pattern, treatment, and permanent impairment. Methods A multicenter, retrospective, observational case series. Patients were selected from two hospitals in the Southwest Netherlands: a level 1 trauma center and a specialized burn center. All patients with any fireworks-related injuries treated between December 1 and January 31, during 2007 (December) to 2017 (January), were eligible for participation. The primary outcome was the number of patients with any type of injury caused by fireworks. The secondary outcome measures were patient and injury characteristics, treatment details, and whole person impairment (WPI). The percentage WPI expresses a patient’s degree of permanent impairments as a result of fireworks-related injuries. Results Of the 297 eligible patients, 272 patients were included. From 2007 to 2017, between 21 and 40 patients were treated, and no clear increase or decrease was observed in the number of patients and in the number of patients per type of fireworks. Explosive fireworks mainly caused upper extremity (N = 65; 68%) injuries, while rockets (N = 24; 41%) and aerials (N = 7; 41%) mainly affected the head/neck. Decorative fireworks predominantly resulted in burns (N = 82; 68%), and explosive fireworks in soft tissue lacerations (N = 24; 25%), fractures (N = 16; 17%), and amputations (N = 14; 15%). Patients injured by explosive and homemade fireworks were most often admitted to a hospital (respectively N = 24; 36% and N = 12; 80%), and resulted in the highest proportion undergoing surgical procedures (respectively N = 22; 33% and N = 7; 47%). WPI found in this study was between 0 to 95%, with a median of 0%. In 34 (14%) patients, the injuries resulted in a WPI of ≥1%, mostly as a result of explosive fireworks (N = 18; 53%). Conclusion This study found no increase or decrease in the number of patients treated in two specialized hospitals. Explosive and homemade fireworks could be considered as most dangerous, as they result into the most hospital admissions, surgical procedures, and into the most injuries with permanent impairment as a result.

Outcome of Surgical Interventions and Deliveries in Patients with Bleeding of Unknown Cause: An Observational Study

2021 ◽  
Author(s):  
Caroline S. B. Veen ◽  
Elise J. Huisman ◽  
Lorenzo G. R. Romano ◽  
Celesta W. A. Schipaanboord ◽  
Marjon H. Cnossen ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Major Bleeding ◽  
Prophylactic Treatment ◽  
Bleeding Complications ◽  
Bleeding Tendency ◽  
Limited Data ◽  
Surgical Interventions ◽  
Tertiary Center ◽  
Low Threshold ◽  
Work Up

Abstract Background The most optimal management for patients with bleeding of unknown cause (BUC) is unknown, as limited data are available. Objective Evaluate management and outcome of surgical procedures and deliveries in patients with BUC. Materials and Methods All patients ≥12 years of age, referred to a tertiary center for a bleeding tendency, were included. Bleeding phenotype was assessed and hemostatic laboratory work-up was performed. Patients were diagnosed with BUC or an established bleeding disorder (BD). Data on bleeding and treatment during surgical procedures and delivery following diagnosis were collected. Results Of 380 included patients, 228 (60%) were diagnosed with BUC and 152 (40%) with an established BD. In 14/72 (19%) surgical procedures major bleeding occurred and 14/41 (34%) deliveries were complicated by major postpartum hemorrhage (PPH). More specifically, 29/53 (55%) of the BUC patients who underwent surgery received prophylactic treatment to support hemostasis. Despite these precautions, 4/29 (14%) experienced major bleeding. Of BUC patients not treated prophylactically, bleeding occurred in 6/24 (25%). Of pregnant women with BUC, 2/26 (8%) received prophylactic treatment during delivery, one women with and 11 (46%) women without treatment developed major PPH. Conclusion Bleeding complications are frequent in BUC patients, irrespective of pre- or perioperative hemostatic treatment. We recommend a low-threshold approach toward administration of hemostatic treatment in BUC patients, especially during delivery.

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