scholarly journals Multinodular goitre surgery complications and directly observed surgeons’ skills: a prospective double-blind observational cohort study

2021 ◽  
Author(s):  
Hafiz Naweed Ahmad ◽  
Fayyaz Ahmad ◽  
Admin
Keyword(s):  
Surgical Technique ◽  
Direct Observation ◽  
Real Life ◽  
University Hospital ◽  
Double Blind Study ◽  
Multinodular Goitre ◽  
Double Blind ◽  
Group 2 ◽  
The One ◽  
Group 1

Objective: To study multinodular goitre patients’ surgery by direct observation of surgical technique, and to compare complications with surgeons’ skills and experience, for improved training of future thyroid surgeons. Methods: Based on positivist epistemology and analytical observational design, this prospective double-blind study of a cohort of multinodular goitre patients operated upon by variedly experienced surgeons, was conducted at Bahawal Victoria Hospital Bahawalpur and Nishtar Medical University Hospital Multan, Pakistan, from December 2016 to April 2019. Patients were admitted through outpatient department and operated upon in routine operation lists. The surgeons were specialists/senior registrars, assistant professors, associate professors and professors. The patients were divided into two virtual groups: the one operated upon by surgeons with >3 years of post-fellowship experience and the other operated upon by surgeons with <3 years of post-fellowship experience. Surgeries were directly observed and differences in surgical technique and complications were recorded for respective groups. Data was analysed using SPSS 20. Results: Of the 134 patients, there were 73(54.5%) in group 1 and 61(45.5%) in group 2. Overall, there were 119(88.8%) females and 15(11.2%) males. The overall mean age was 37.17+/-13.41 years (range: 14-80 years). Of the 25 surgeons, 13(52%) were in group 1 and 12(48%) in group 2. Group 1 had fewer complications compared to group 2, which on certain parameters was statistically significant (p<0.05). Conclusion: Surgeons’ experience and technique were found to have significant relationship with the rate of complications. Direct observation of surgeries is significant for real life evaluation and training of junior surgeons.

Adding herbal extracts to silicone gel on post-sternotomy scar: a prospective randomised double-blind study

2020 ◽  
Vol 29 (Sup4) ◽  
pp. S36-S42
Author(s):  
Palakorn Surakunprapha ◽  
Kengkart Winaikosol ◽  
Bowornsilp Chowchuen ◽  
Kriangsak Jenwitheesuk ◽  
Kamonwan Jenwitheesuk
Keyword(s):  
Aloe Vera ◽  
Median Sternotomy ◽  
Centella Asiatica ◽  
Herbal Extract ◽  
Double Blind Study ◽  
Herbal Extracts ◽  
Double Blind ◽  
Silicone Gel ◽  
Group 2 ◽  
Group 1

Objective: Silicone gel has been shown effective in improving healing post-sternotomy scars. It remains to be determined whether adding herbal extracts to the gel would augment the healing effect. Method: After median sternotomy, patients were randomised into two groups. Group 1: topical silicone gel plus herbal extract gel (Allium cepa, Centella Asiatica, Aloe vera and Paper Mulberry) and Group 2: silicone gel. Patients were treated for six months. The postoperative scars were assessed at three and six months by plastic surgeons using the Vancouver Scar Scale (VSS) and the patient assessment scar scale. Results: Each group comprised 23 patients (n=46 in total). The VSS was significantly lower in Group 1 than in Group 2 (p=0.018 and p=0.051, respectively). In Group 1, the four differences from baseline were vascularity scores at three and six months (–0.391, p=0.025; –0.435, p=0.013, respectively), and pigmentation scores at three and six months (–0.391, p=0.019; –0.609, p=0.000, respectively). In Group 2, differences from baseline were the pigmentation and vascularity score at six months (–0.6609, p=0.000; –0.348, p=0.046, respectively). Conclusion: Our results suggest, post-sternotomy scars trend to have better vascularity and pigmentation when treated with silicone gel plus herbal extracts.

scholarly journals Effect of intravenous magnesium sulphate on hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy: A prospective, double blind study

2019 ◽  
Author(s):  
Karishma Bansal ◽  
Maharishi Markandeshwar ◽  
Utkarsh Garg ◽  
Kritesh Goel ◽  
Divya Vijay ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Magnesium Sulphate ◽  
Hemodynamic Response ◽  
Blind Study ◽  
P Value ◽  
Double Blind Study ◽  
Double Blind ◽  
Intravenous Magnesium ◽  
Group 2 ◽  
Group 1

Background and Aim: Pneumoperitoneum (PP) for laparoscopic surgery is known to induce a pressor response. It can be attenuated by drugs, like opioids, vasodilators, beta blocking agents and alpha-2 agonists, but these drugs have their side effects. This study investigated the efficacy of magnesium sulphate to attenuate hemodynamic response associated with pneumoperitoneum in patients undergoing laparoscopic cholecystectomy.Methodology: This randomized, double blind, prospective study was carried out at Department of Anesthesiology, Maharishi Markandeshwar University, Mullana, Haryana (India). A total of 60 patients of ASA grade I or II, aged 20-60 y, of either sex, undergoing laparoscopic cholecystectomy, were randomly allocated into one of the two groups of 30 each. Standardized general anesthesia was administered to all patients. Group 1 patients received magnesium sulphate (30 mg/kg) intravenously as a bolus before induction of PP and Group 2 patients received same volume of 0.9% normal saline. Hemodynamic variables, e.g. heart rate (HR), systolic (SBP), diastolic (DBP), mean arterial pressures (MAP) were recorded from the start of surgery till extubation. Statistical analysis: SPSS version 17.0 for windows was used and p value of < 0.05 was considered significant.Results: Mean HR was 81.50 ± 8.44 vs. 93.03 ± 6.93/min, SBP was 126.37 ± 13.03 vs. 150.20 ± 10.45 mmHg, DBP was 82.50 ± 11.20 vs. 94.73 ± 8.33 mmHg, and MAP 98.43 ± 10.29 vs.113.27 ± 9.16 mmHg in Group 1 and Group 2, respectively, at 10 min after PP. Statistically significant fall in HR, SBP, DBP, MAP was seen in Group 1 at 10 min after PP till extubation. (p < 0.05).Conclusion: Intravenous magnesium sulphate effectively attenuates the hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy under general anesthesia.Citation: Bansal K, Santpur MU, Garg U, Goel K, Vijay D, Tatineni Bansal. Effect of intravenous magnesium sulphate on hemodynamic response to pneumoperitoneum in laparoscopic cholecystectomy: A prospective, double blind study. Anaesth pain & intensive care 2019;23(3):290-294

scholarly journals Pregabalin Effect on Acute and Chronic Pain after Cardiac Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Aik Bouzia ◽  
Vassilios Tassoudis ◽  
Menelaos Karanikolas ◽  
George Vretzakis ◽  
Argyro Petsiti ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Cardiac Surgery ◽  
Sleep Disturbances ◽  
Median Sternotomy ◽  
Double Blind Study ◽  
Double Blind ◽  
Elective Cardiac Surgery ◽  
Group 2 ◽  
Postoperative Morphine ◽  
Group 1

Introduction. Pain after cardiac surgery affects long-term patient wellness. This study investigated the effect of preoperative pregabalin on acute and chronic pain after elective cardiac surgery with median sternotomy. Methods. Prospective double blind study. 93 cardiac surgery patients were randomly assigned into three groups: Group 1 received placebo, Group 2 received oral pregabalin 75 mg, and Group 3 received oral pregabalin 150 mg. Data were collected 8 hours, 24 hours, and 3 months postoperatively. Results. Patients receiving pregabalin required fewer morphine boluses (10 in controls versus 6 in Group 1 versus 4 in Group 2, p=0.000) and had lower pain scores at 8 hours (4 versus 3 versus 3, p=0.001) and 3 months (3 versus 2 versus 2, p=0.000) and lower morphine consumption at 8 hours (14 versus 13 versus 12 mg, p=0.000) and 24 hours (19.5 versus 16 versus 15 mg, p=0.000). Percentage of patients with sleep disturbances or requiring analgesics was lower in the pregabalin group and even lower with higher pregabalin dose (16/31 versus 5/31 versus 3/31, p=0.000, and 26/31 versus 16/31 versus 10/31, p=0.000, resp.) 3 months after surgery. Conclusion. Preoperative oral pregabalin 75 or 150 mg reduces postoperative morphine requirements and acute and chronic pain after cardiac surgery.

Cephradine and cefazolin plasma levels during cardiac surgery

Perfusion ◽  
1986 ◽  
Vol 1 (1) ◽  
pp. 41-45 ◽  
Author(s):  
Sergio V Moran ◽  
Francisco Montiel ◽  
Guillermo Acuña ◽  
Jeanette Vergara ◽  
Manuel J Irarrazaval ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Plasma Levels ◽  
Early Postoperative Period ◽  
Good Choice ◽  
Double Blind Study ◽  
Double Blind ◽  
Postoperative Course ◽  
Group 2 ◽  
Group 1

A prospective, randomized, double-blind study was carried out to evaluate two prophylactic regimes in patients undergoing cardiac surgery with cardiopulmonary bypass. Antibiotic plasma levels were measured in fifty consecutive adult patients undergoing valve and coronary surgery. They were divided into two comparable groups of 25 patients, each matched in age, sex, type of operation and duration of cardiopulmonary bypass. Group 1 received 1 g of cephradine with the anaesthetic premedication, 1 g in the prime of the oxygenator and 1 g every six hours during the first 72 hours of the postoperative course. Group 2 received cefazolin following the same protocol except that they received 1 g every eight hours during the postoperative course. There were no allergic or toxic reactions and no infections up to two months follow-up in both groups. Antibiotic plasma levels were significantly higher (p < 0·001) in the cefazolin group in four out of five sampling periods. Antibiotic plasma levels for group 1 versus group 2 were as follows: initial level 11·7 ± 5.2 mcg/ml vs 31 4 ± 35·4 mcg/ml. During cardiopulmonary bypass 26·6 ± 9·5 mcg/ml vs 51·7 ± 21 ·1 mcg/ml. Final levels 13·6 ± 7·0 mcg/ml vs 32·2 ± 17·8 mcg/ml. Baseline levels 2·7 ± 2·3 mcg/ml vs 6·· ± 7·7 mcg/ml and peak level 44·0 ± 16·2 mcg/ml vs 51·2 ± 23·4 mcg/ml (NS). The results of this study demonstrate that cefazolin achieved significantly higher plasma levels during the different phases of the operation and early postoperative period. Also, cefazolin and cephradine levels are above the minimal inhibitory concentrations for the gram positive and gram negative susceptible bacteria, except for the basal levels obtained by cephradine. The favourable pharmacokinetic characteristics of cefazolin, makes it a good choice for prophylactic use during cardiac surgery.

scholarly journals Effectiveness of Traditional Japanese Herbal (Kampo) Medicine, Daiobotanpito, in Combination with Antibiotic Therapy in the Treatment of Acute Diverticulitis: A Preliminary Study

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Keiko Ogawa ◽  
Koji Nishijima ◽  
Fumio Futagami ◽  
Takashi Nakamura ◽  
Genichi Nishimura
Keyword(s):  
Acute Diverticulitis ◽  
Statistical Significance ◽  
Kampo Medicine ◽  
Double Blind Study ◽  
Open Label ◽  
Double Blind ◽  
Patient Demographics ◽  
Intravenous Antibiotics ◽  
Group 2 ◽  
Group 1

In traditional Japanese herbal (Kampo) medicine, daiobotanpito (DBT) or Da Huang Mu Dan Tang in Chinese has been used in medical treatment of acute diverticulitis for many years based on the experience. Our aim was to investigate whether the treatment of acute diverticulitis can be treated with intravenous antibiotics plus orally administrated DBT than intravenous antibiotics alone. A retrospective nonrandomized open-label trial was established to compare patients with acute diverticulitis who received oral DBT associated with intravenous antibiotics with those who received intravenous antibiotic alone. We included 34 patients, eleven patients in group 1 with DBT and 23 patients in group 2 without DBT. Both groups were comparable in patient demographics and clinical characteristics. There was a significantly better outcome in the group treated with DBT than in the group without DBT when comparing duration of fever, abdominal pain, and antibiotics administration. A trend toward a day shorter mean hospital stay and fasting was seen in group 1, although this did not reach statistical significance. In conclusion, most patients with acute diverticulitis can be managed safely with oral DBT. Although randomized, double-blind study must be done, we could show the possibility to use daiobotanpito as an additional option in treating acute diverticulitis.

scholarly journals A comparison of three different gauge Quincke’s spinal needles in patients undergoing elective surgery under spinal anaesthesia: a prospective randomized study

2019 ◽  
Vol 7 (11) ◽  
pp. 4188
Author(s):  
Kiranpreet Kaur ◽  
Suresh K. Singhal ◽  
Anu Mehla
Keyword(s):  
Success Rate ◽  
Spinal Anaesthesia ◽  
Elective Surgery ◽  
Randomized Study ◽  
Double Blind Study ◽  
Double Blind ◽  
Male Patients ◽  
Group 2 ◽  
Traumatic Effect ◽  
Group 1

Background: The present study was conducted to compare three different Quincke’s spinal needles i.e. 23, 25 and 26 gauge in patients undergoing elective surgery under spinal anaesthesia (SA).Methods: The prospective randomized double-blind study was conducted on 150 male patients in the age group of 18-50 yrs., having physical status class I to II, scheduled for elective surgery under SA. Patients were randomly divided into three groups comprising 50 patients each. SA was administered using Quincke’s spinal needles of 23, 25 and 26 gauge in group 1, 2 and 3 respectively. Ease of insertion, number of attempts and time of appearance of CSF and incidence of PDPH was recorded in all the patients.Results: Ease of insertion was graded easy in 98%, 84% and 82% in group 1, 2 and 3 respectively. First attempt success rate was highest in group 1, (98%). Meantime for appearance of CSF beyond hub was maximum in group 3 i.e. 14.60±2.56 sec. Mild PDPH was reported in 6% and 2% patients after 24 hrs in group 1 and group 2 respectively.Conclusions: Finer spinal needle proved to be more dependable in generating less traumatic effect on the dura and preventing PDPH but are technically more difficult thus decreasing first attempt success rate.

scholarly journals High-security closed devices are efficient and safe to protect human oocytes from potential risk of viral contamination during vitrification and storage especially in the COVID-19 pandemic

2021 ◽  
Author(s):  
Eleonora Porcu ◽  
Maria Lucrezia Tranquillo ◽  
Leonardo Notarangelo ◽  
Patrizia Maria Ciotti ◽  
Nilla Calza ◽  
...  
Keyword(s):  
Research Question ◽  
Randomized Study ◽  
Implantation Rate ◽  
University Hospital ◽  
Miscarriage Rate ◽  
Human Oocytes ◽  
High Security ◽  
Group 2 ◽  
And Storage ◽  
Group 1

Abstract Purpose The main purpose and research question of the study are to compare the efficacy of high-security closed versus open devices for human oocytes’ vitrification. Methods A prospective randomized study was conducted. A total of 737 patients attending the Infertility and IVF Unit at S.Orsola University Hospital (Italy) between October 2015 and April 2020 were randomly assigned to two groups. A total of 368 patients were assigned to group 1 (High-Security Vitrification™ - HSV) and 369 to group 2 (Cryotop® open system). Oocyte survival, fertilization, cleavage, pregnancy, implantation, and miscarriage rate were compared between the two groups. Results No statistically significant differences were observed on survival rate (70.3% vs. 73.3%), fertilization rate (70.8% vs. 74.9%), cleavage rate (90.6% vs. 90.3%), pregnancy/transfer ratio (32.0% vs. 31.8%), implantation rate (19.7% vs. 19.9%), nor miscarriage rates (22.1% vs. 21.5%) between the two groups. Women’s mean age in group 1 (36.18 ± 3.92) and group 2 (35.88 ± 3.88) was not significantly different (P = .297). A total of 4029 oocytes were vitrified (1980 and 2049 in groups 1 and 2 respectively). A total of 2564 were warmed (1469 and 1095 in groups 1 and 2 respectively). A total of 1386 morphologically eligible oocytes were inseminated by intracytoplasmic sperm injection (792 and 594 respectively, P = .304). Conclusions The present study shows that the replacement of the open vitrification system by a closed one has no impact on in vitro and in vivo survival, development, pregnancy and implantation rate. Furthermore, to ensure safety, especially during the current COVID-19 pandemic, the use of the closed device eliminates the potential samples’ contamination during vitrification and storage.

scholarly journals Comparison of Clinical and Radiological Parameters with Two Different Surgical Methods for Anterior Cruciate Ligament Reconstruction

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0027
Author(s):  
Osman Çiloğlu ◽  
Hakan Çiçek ◽  
Ahmet Yılmaz ◽  
Metin Özalay ◽  
Gökhan Söker ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Surgical Technique ◽  
Femoral Tunnel ◽  
Cruciate Ligament ◽  
Tunnel Widening ◽  
Isokinetic Muscle Strength ◽  
Group 2 ◽  
Anterior Cruciate ◽  
Group 1

Objectives: We investigated the effects anatomic or nonanatomic femoral tunnel positions and tunnel fixation methods obtained using two different surgery methods on tunnel widening and clinical results in anterior cruciate ligament (ACL) reconstructions. Methods: Patients with isolated anterior cruciate ligament rupture are included to study who don’t have intra-and extra-articular additional pathology of the knee, without previously a history of operations of both knees. 2 groups were created. Group 1 Aperfix implant were used which can be able to perform non anatomical femoral tunnel and intra tunnel fixation with transtibial technique. In Group 2 Endobutton CL implant were used which can make fixation from outside the cortex with anatomic femoral tunnel in use of anteromedial portal techniques. 27 patients (average age 29,33, range 18 to 55 years) in group 1 and 27 patients (average age 27,51, range 16 to 45 years) in group 2 totally 54 patients were performed surgery. All patients were assessed using the IKDC (International knee documentation committee), Tegner Activity Scala and Lysholm II Functional Scores. Muscle strength measurements in both groups compared to intact knee was measured with an isokinetic dynamometer Biodex System 3 Pro. The location of the femoral tunnel aperture and tunnel widening were imaged with 3D reconstructive computed tomography. All measurements were performed using the same software application by the same radiologist. Results: The two groups were similar with respect to age and sex distribution, operated side, the size of the tunnel created, and follow-up period (p>0.05). After surgery in both groups, the clinical scores showed significant improvement compared to preoperative (p=0,0001). However, postoperative clinical outcomes in the two groups did not show a difference significantly (p>0,005). Isokinetic muscle strength study showed significant differences between the two groups (p=0,0001). Location of femoral tunnel aperture on the medial wall of the lateral femoral condyle showed a significant differences in the two groups (p=0,0001). The expansion of proximal and distal femoral tunnel in two groups showed significant differences (p=0,0001). There was relationship between distal femoral tunnel widening and location of femoral tunnel aperture. Conclusion: Although there is no statistically significant difference between the two groups clinically, difference noticed in terms of isokinetic muscle strength may be due to differences in the degree of shift as a result of multiple loading depending on the biomechanical properties of materials. We thought that the difference seen in the widening of tunnel in the proximal or distal may be due to, the technique of graft fixation, the distance between the fixation point and the joint, and to the location of the femoral tunnel aperture on medial wall of lateral condyle from anatomical or non anatomical region. There is no golden standard in neither surgical technique nor material of fixation. Proper theoretical knowledge and extensive clinical experience are important in the light of an accurate surgical technique applied. We thought that information we have reached in our study should be supported by biomechanical studies

scholarly journals Pulsed Radiofrequency for Chronic Inguinal Neuralgia

2015 ◽  
Vol 2;18 (2;3) ◽  
pp. E147-E155
Author(s):  
Yasser M. Amr
Keyword(s):  
Pain Relief ◽  
Nerve Root ◽  
Small Sample ◽  
Pulsed Radiofrequency ◽  
Group 2 ◽  
One Year ◽  
The One ◽  
Inguinal Neuralgia ◽  
Group 1

Background: Chronic inguinal neuralgia has been reported after inguinal herniorrhaphy, caesarean section, appendectomy, and trauma to the lower quadrant of the abdomen or inguinal region. Objectives: This study was designed to evaluate the efficacy of pulsed radiofrequency in management of chronic inguinal neuralgia. Study Design: Randomized, double-blind controlled trial. Setting: Hospital outpatient setting. Methods: Twenty-one patients were allocated into 2 groups. Group 1 received 2 cycles of pulsed radiofrequency (PRF) for each nerve root. In Group 2, after stimulation, we spent the same time to mimic PRF. Both groups received bupivacaine 0.25% + 4 mg dexamethasone in 2 mL for each nerve root. Visual Analogue Scale (VAS) was assessed. Duration of the first block effective pain relief was reported. Repeated PRF blockade was allowed for any patient who reported a VAS > 30 mm in both groups during the one year follow-up period. The number and duration of blocks were reported and adverse effects were also reported. Results: Significantly longer duration of pain relief was noticed in Group 1 (P = 0.005) after the first block, while the durations of pain relief of the second block were comparable (P = 0.59). In Group 1 the second PRF produced pain relief from the twenty-fourth week until the tenth month while in Group 2, pain relief was reported from the sixteenth week until the eighth month after the use of PRF. All patients in Group 2 received 3 blocks (the first was a sham PRF) during the one year follow-up period. Meanwhile, 2 PRF blocks were sufficient to achieve pain relief for patients in Group 1 except 4 patients who needed a third PRF block. No adverse events were reported. Limitations: Small sample size. Conclusion: For intractable chronic inguinal pain, PRF for the dorsal root ganglion represents a promising treatment modality. Key words: Radiofrequency, chronic, inguinal neuralgia

scholarly journals Clinical Utilization of Point-of-care Ultrasound After Training: A Prospective Study

2021 ◽  
Author(s):  
Wan-Ching Lien ◽  
Chih-Heng Chang ◽  
Kah-Meng Chong ◽  
Meng-Che Wu ◽  
Cheng-Yi Wu ◽  
...  
Keyword(s):  
Image Quality ◽  
Positive Impact ◽  
University Hospital ◽  
Point Of Care Ultrasound ◽  
Global Rating ◽  
Clinical Trial Registration ◽  
Clinical Utilization ◽  
Global Ratings ◽  
Group 2 ◽  
Group 1

Abstract Background: This study aimed to investigate the clinical utilization of PoCUS of the first post-graduate year residents after a PoCUS curriculum. Methods: It was conducted at the emergency department of the National Taiwan University Hospital between July 2015 and October 2017. Every resident had one-month ED training and a curriculum was implemented during the first week. The post-training objective structured clinical examination (OSCE) global ratings were obtained, as well as the sonographic examinations by the residents. The participants were categorized into 4 groups: group 1 performed PoCUS before and after the curriculum; group 2 performed only after the curriculum; group 3 performed only before the curriculum; the last did not perform any examinations. Results: Two hundred and thirty-nine residents participated. The median global rating was 4 (interquartile ranges, 4-5). A significantly increasing number of residents integrated PoCUS into patient care (64 vs. 170, p=0.037) with acceptable image quality after the curriculum. Nearly 30% of residents did not use PoCUS although no differences existed in the OSCE global ratings. Group 1 performed more cases with better image quality and using ≥2 ultrasound applications (8/100 vs. 82/359, p=0.0009) after the curriculum. Group 1 performed more cases with better image quality than group 2 after the curriculum. In groups 3 and 4, “no suitable cases” (25/69), and “choosing other imaging priorities” (43/69) were the main feedbacks for not performing PoCUS. Conclusions: A focused training had a substantial positive impact on the utilization of PoCUS of the residents. The global ratings could not predict whether to integrate PoCUS into clinical practice. Further studies would be needed for the sustained effects of the curriculum and how to encourage these residents in groups 3 and 4 to use PoCUS.Clinical trial registration: NCT03738033.

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