Role of intraoperative neuromonitoring of the recurrent laryngeal nerves during thyroid reoperations of recurrent goiter

2017 ◽  
Vol 89 (3) ◽  
pp. 11-15 ◽  
Author(s):  
Jan Sopiński ◽  
Krzysztof Kuzdak ◽  
Masoud Hedayati ◽  
Krzysztof Kołomecki
Keyword(s):  
At Risk ◽  
Statistical Significance ◽  
Operation Time ◽  
Intraoperative Neuromonitoring ◽  
Number Of Patients ◽  
Recurrent Goiter ◽  
Group A ◽  
Procedure Duration ◽  
Recurrent Laryngeal Nerves ◽  
Group B

Reoperations of the thyroid gland are challenging to any surgeon. Such procedures are technically difficult and involve higher risk of complications than primary procedures. Recurrent laryngeal nerve (RLN) palsy is one of such complications The aim of the study was to evaluate the effectiveness of intraoperative neuromonitoring (IONM) in preventing RLN palsy during recurrent goiter operations. Material and methods. We retrospectively analyzed the results of thyroid reoperation performed at the Department of Endocrine, General and Vascular Surgery of Medical University of Lodz in the period from January 2014 to June 2016. The study included 80 patients, who were divided into 2 groups: group A consisted of 27 patients, who had undergone surgery with the use of IONM, while group B included 53 patients, in whom RLN was identified visually. During statistical analysis we took into account the number of nerves at risk, not the number of patients. There were 47 nerves at risk In group A and 86 in group B. We analyzed whether application of IONM had any effect on the frequency of RLN palsy and procedure duration. Results. The frequency of RLN palsy was 10.64% (5/47) in group A and 15.12% (13/86) in group B (no statistical significance, p=0,47). Mean operation time was shorter in group B 71.29 ± 17.125 minutes vs. 75.75 ± 17.94 minutes in group A (no statistical significance, p=0,377). Conclusion. Use of IONM did not significantly reduce the occurrence of RLN palsy and procedure duration.

The Effect of Combined Clopidogrel and Aspirin Therapy after Off-Pump Coronary Surgery

2009 ◽  
Vol 4 (5) ◽  
pp. 265-268 ◽  
Author(s):  
Emir Mujanovic ◽  
Midhat Nurkic ◽  
Jasmin Caluk ◽  
Ibrahim Terzic ◽  
Emir Kabil ◽  
...  
Keyword(s):  
Artery Bypass ◽  
Postoperative Bleeding ◽  
Median Sternotomy ◽  
Operation Time ◽  
Graft Patency ◽  
Off Pump ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. Methods Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. Results Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. Conclusions Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.

Stereotactic radiosurgery for brain metastases: a case-matched study comparing treatment results for patients 80 years of age or older versus patients 65–79 years of age

2014 ◽  
Vol 121 (5) ◽  
pp. 1148-1157 ◽  
Author(s):  
Shinya Watanabe ◽  
Masaaki Yamamoto ◽  
Yasunori Sato ◽  
Takuya Kawabe ◽  
Yoshinori Higuchi ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Statistical Significance ◽  
Disease Status ◽  
Competing Risk ◽  
Treatment Results ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
Matched Study

Object Recently, an increasing number of patients with brain metastases, even patients over 80 years of age, have been treated with stereotactic radiosurgery (SRS). However, there is little information on SRS treatment results for patients with brain metastases 80 years of age and older. The authors undertook this study to reappraise whether SRS treatment results for patients 80 years of age or older differ from those of patients who are 65–79 years old. Methods This was an institutional review board–approved, retrospective cohort study. Among 2552 consecutive brain metastasis patients who underwent SRS during the 1998–2011 period, we studied 165 who were 80 years of age or older (Group A) and 1181 who were age 65–79 years old (Group B). Because of the remarkable disproportion in patient numbers between the 2 groups and considerable differences in pre-SRS clinical factors, the authors conducted a case-matched study using the propensity score matching method. Ultimately, 330 patients (165 from each group, A and B) were selected. For time-to-event outcomes, the Kaplan-Meier method was used to estimate overall survival and competing risk analysis was used to estimate other study end points, as appropriate. Results Although the case-matched study showed that post-SRS median survival time (MST, months) was shorter in Group A patients (5.3 months, 95% CI 3.9–7.0 months) than in Group B patients (6.9 months, 95% CI 5.0–8.1 months), this difference was not statistically significant (HR 1.147, 95% CI 0.921–1.429, p = 0.22). Incidences of neurological death and deterioration were slightly lower in Group A than in Group B patients (6.3% vs 11.8% and 8.5% vs 13.9%), but these differences did not reach statistical significance (p = 0.11 and p = 0.16). Furthermore, competing risk analyses showed that the 2 groups did not differ significantly in cumulative incidence of local recurrence (HR 0.830, 95% CI 0.268–2.573, p = 0.75), rates of repeat SRS (HR 0.738, 95% CI 0.438–1.242, p = 0.25), or incidence of SRS-related complications (HR 0.616, 95% CI 0.152–2.495, p = 0.49). Among the Group A patients, post-SRS MSTs were 11.6 months (95% CI 7.8–19.6 months), 7.9 months (95% CI 5.2–10.9 months), and 2.8 months (95% CI; 2.4–4.6 months) in patients whose disease status was modified–recursive partitioning analysis (RPA) Class(es) I+IIa, IIb, and IIc+III, respectively (p < 0.001). Conclusions Our results suggest that patients 80 years of age or older are not unfavorable candidates for SRS as compared with those 65–79 years old. Particularly, even among patients 80 years and older, those with modified-RPA Class I+IIa or IIb disease are considered to be favorable candidates for more aggressive treatment of brain metastases.

scholarly journals 1379. Comparison of Inpatient Tuberculosis Screening Methods and Their Effect on Patient Duration in Airborne Isolation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S501-S501
Author(s):  
Mary Katherine. Theoktisto ◽  
Delvina Ford ◽  
Omar Khan ◽  
Kelly R Reveles ◽  
Jose Cadena
Keyword(s):  
Statistical Significance ◽  
Nucleic Acid Amplification ◽  
Health Concern ◽  
Smear Microscopy ◽  
Screening Methods ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Crude Analysis

Abstract Background Tuberculosis (TB) remains a significant public health concern, and exposure in healthcare settings is prevalent. Current guidelines recommend testing for TB by acid-fast bacilli (AFB) smear microscopy with 3 sputum samples and/or using nucleic acid amplification test (NAAT), and mycobacterium culture. The purpose of this project is to compare how different TB diagnostic tests affect the duration of stay in respiratory isolation. Methods This study was conducted at the Veteran Affairs South Texas hospital, which includes a total of 437 beds. Data were collected retrospectively from medical records. Eligibility included patients admitted to the hospital and placed in airborne isolation for TB screening and diagnosis, had 3 sputum samples collected 8 hours apart and/or had 2 PCR MTB/RIF. Patients were excluded if they had TB or were not undergoing evaluation for TB. Three time periods analyzed included, 3 AFB sputum samples analyzed in-house from December 2012 to January 2014 (Group A), 3 AFB sputum samples analyzed at outside facility during 2013 to 2014 as well as 2 months in 2012 (Group B), and 2 MTB PCR/RIF in house during 2017 and 2018 (Group C). Duration of isolation was compared between groups using the Kruskal–Wallis test. A total number of 815 patients were screened, leaving 105 patients for analysis after exclusion. There were 49 patients analyzed from Group A, 28 from Group B, and 28 from Group C. Results Crude analysis of the data showed numerical differences in the total number of days and hours in isolation between the 3 groups. The average (mean) days in isolation were 4.2 for Group A, 7.4 for Group B, and 5.5 for Group C. There was no statistically significant difference in either days or hours of airborne precautions by “rule out” method. Days of isolation in airborne precautions (median IQR) was 4 for all groups (P = 0.3313). Likewise, hours of airborne precautions had a median IQR of 96 for all groups P = 0.4347. Conclusion Although there was no statistical significance between the groups, crude analysis did show a numerical difference in the mean total airborne days and hours. Lack of statistical difference may be due to low number of patients, timing of order placement for in-house PCR, and longer than expected stay in airborne precautions. Disclosures All authors: No reported disclosures.

scholarly journals Early or delayed sigmoid resection in complicated diverticular disease? A single center experience

2020 ◽  
Author(s):  
Peter Tschann ◽  
Daniel Lechner ◽  
Benedikt Feurstein ◽  
Stephanie Adler ◽  
Paolo Girotti ◽  
...  
Keyword(s):  
Diverticular Disease ◽  
Therapy Group ◽  
Operation Time ◽  
Sigmoid Resection ◽  
Complicated Diverticulitis ◽  
Western World ◽  
First Episode ◽  
Number Of Patients ◽  
Group A ◽  
Group B

Abstract Background:Diverticular disease appears to be one of the most common conditions in the western world. The standard approach in treatment of diverticular disease is a laparoscopic resection, usually after an inflammation free time of 4 to 6 weeks. The aim of this study was to evaluate the timing of operation.Methods:61 patients underwent left-sided colonic resection because of diverticular disease between January 2017 and February 2020. 37 patients were treated because of complicated diverticulitis (CDD stage 2a or 2b) either early within 7 days after first symptoms (group A: n = 17) or delayed about 6 weeks after the first contact and conservative therapy (group B: n = 20).Results:Overall mortality was 0%. The average operation time was shorter in the early elective group (Group A: 140,4 min vs. Group B: 151,2 min (p = 0,29). The hospital stay (group A: 9,9 d vs. group B: 16,9 d) and the postoperative stay (group A: 4,8 d vs. group B: 8,1 d) was significantly longer in group B (p = 0,01). We observed – although not reliable due to low number of patients - more postoperative complications in the delayed group (group A: 5,9% vs. group B: 15,0%) (p = 0,61).Conclusion:The data in this study confirm the early operation as safe and efficient due to lower costs. We can recommend an early approach in selected cases with the first episode of a complicated diverticulitis.

scholarly journals Early or delayed sigmoid resection in complicated diverticular disease? A single-center experience

2020 ◽  
Author(s):  
Peter Tschann ◽  
Daniel Lechner ◽  
Benedikt Feurstein ◽  
Stephanie Adler ◽  
Paolo Girotti ◽  
...  
Keyword(s):  
Diverticular Disease ◽  
Therapy Group ◽  
Operation Time ◽  
Sigmoid Resection ◽  
Complicated Diverticulitis ◽  
Western World ◽  
First Episode ◽  
Number Of Patients ◽  
Group A ◽  
Group B

Summary Background Diverticular disease appears to be one of the most common conditions in the Western world. The standard approach in treatment of diverticular disease is a laparoscopic resection, usually after an inflammation-free time of 4 to 6 weeks. The aim of this study was to evaluate the timing of operation. Materials and methods A total of 61 patients underwent left-sided colonic resection because of diverticular disease between January 2017 and February 2020. Because of complicated diverticulitis (CDD stage 2a or 2b) 37 patients were treated either early within 7 days after first symptoms (group A: n = 17) or delayed about 6 weeks after the first contact and conservative therapy (group B: n = 20). Results Overall mortality was 0%. The average operation time was shorter in the early elective group (group A: 140.4 min vs. group B: 151.2 min; p = 0.29). The hospital stay (group A: 9.9 days vs. group B: 16.9 days) and the postoperative stay (group A: 4.8 days vs. group B: 8.1 days) were significantly longer in group B (p = 0.01). We observed—although not reliable due to the low number of patients—more postoperative complications in the delayed group (group A: 5.9% vs. group B: 15.0%; p = 0.61). Conclusion The data in this study confirm the early operation as safe and efficient due to lower costs. We can recommend an early approach in selected cases with the first episode of a complicated diverticulitis.

A Modified Open-Door Laminoplasty with Reconstruction of the Cervical Posterior Ligamental Complex to Decrease Axial Pain in Cervical Spondylotic Myelopathy

2021 ◽  
Author(s):  
Yayun Zhang ◽  
Liangxi Chen ◽  
Hao Li ◽  
Xianlei Gao ◽  
Hongwei Zhao ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Statistical Significance ◽  
Operation Time ◽  
Open Door ◽  
Post Surgery ◽  
Curvature Index ◽  
Group A ◽  
Axial Symptoms ◽  
Axial Pain ◽  
Group B

Abstract Background:Cervical spondylotic myelopathy patients with multiple segments are usually treated with the posterior approach. But expansive open laminoplasty (ELAP) often results in heavy, rigid, and acid bilges feelings in the neck, shoulder, and back, collectively known as axial symptoms. Objective: To evaluate the effect of modified posterior cervical ligament complex reconstruction and single-door laminoplasty with titanium plate fixation on postoperative axial symptoms in patients. Methods: A retrospective analysis conducted from June 2016 to March 2018 collected more than 132 cases of cervical spondylotic myelopathy at our institute. Group A includes 74 patients and Group B includes 58 patients who use different surgery method. Gender, age, operation time, intraoperative blood loss, post-operative drainage volume, and follow-up time, Visual analogue scoring (VAS), cervical curvature index (CCI) and the cross-sectional area of the posterior cervical muscles of the two groups were recorded. Results: There was statistical significance in the incidence of axial pain 3 months after surgery (P =0.001), 6 months after surgery (P =0.006), and 1 year after surgery (P =0.015). And the VAS score was decreased in group A 1 week (P <0.0001), 1 ,3 month(P=0.0001), 6 months(P=0.0076), and 1 year(P=0.0085) post-surgery compared to group B. Also the CCI and the posterior cervical muscle area between groups A and B (P < 0.0001).Conclusion: Modified single open-door laminoplasty could relieve cervical axial pain in patients with cervical spondylotic myelopathy.

The Effect of Forewarning on the Occurrence of Side-Effects and Discontinuance of Medication in Patients on Dothiepin

1976 ◽  
Vol 4 (4) ◽  
pp. 237-240 ◽  
Author(s):  
E D Myers ◽  
E J Calvert
Keyword(s):  
Side Effects ◽  
Statistical Significance ◽  
Final Analysis ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
Patients Experience ◽  
Larger Sample

Dothiepin was prescribed for 100 depressed out-patients alternately allocated to one of two groups. Patients in Group A were forewarned about side-effects and patients in Group B were not forewarned. None of the patients had previously received dothiepin. After two weeks the patients were questioned regarding side-effects and continuance with medication. Eighty-nine patients were included in the final analysis. The results failed to confirm the hypotheses that forewarning patients of side-effects causes a greater number of patients to complain of such effects, or that where patients experience side-effects, forewarning is associated with any less frequent discontinuance of therapy. Compared with a previous study with amitriptyline, the results of this study are much closer to statistical significance. This may be due to the lower overall incidence of side-effects with dothiepin and calls for further work with a larger sample of patients.

scholarly journals Determining Relation between Gallstone and Lipid Profile

2018 ◽  
Vol 3 (2) ◽  
pp. 418-422 ◽  
Author(s):  
Rabin Raj Singh ◽  
Sunil Chandra Adhikari ◽  
Ravi Bastakoti ◽  
Sunil Regmi ◽  
Ravindra Baskota ◽  
...  
Keyword(s):  
Lipid Profile ◽  
Serum Cholesterol ◽  
Statistical Significance ◽  
Serum Triglyceride ◽  
P Value ◽  
Number Of Patients ◽  
Increased Risk ◽  
Group A ◽  
Group B ◽  
Low Serum

Introduction: Cholelithiasis is presence of stone in gallbladder. Female sex, obesity, pregnancy, fatty foods, all are associated with an increased risk of developing gallstones. There is paucity of information regarding relation of cholelithiasis and lipid profile. In this study the association of serum lipids to cholelithiasis has been tried to been elucidated.Objectives: The general objective was to determine the relation of Serum lipid in cholelithiasis. The specific objectives were to compare the relation between serum cholesterol, serum triglyceride, serum HDL and serum LDL in patients with and without gallstones.Methodology: A prospective, observational, hospital based study was conducted at Koshi Zonal Hospital from March 2017 to February 2018. Fifty four patients having gallstone (Group A) were compared with equal number of patients without gallstone (Group B). Data was entered into SPSS/MS Excel. Statistical Analysis was done by using Chi-square test. A 95% confidence interval was taken, and P value less than 0.05 was considered as statistically significant.Results: In Group A, 61%(33) patients were of age less than 45 years and 91%(49) were female. In group A, 3.7 %(2) and in group B, 7.4%(4) had raised serum cholesterol. Greater number of patient in group A had raised serum triglyclyceride and LDL as compared to group B. 18.5%(10) of group A had low serum HDL, and 9.3% (5) of group B had low serum HDL. Except for finding of gallstone more common in female, other findings had no statistical significance.Conclusion: There exists an inverse correlation between Serum Cholesterol and serum HDL with gallstone and positive association between serum Triglyceride and serum LDL with cholelithiasis. However the association could not reach the statistical significance.  BJHS 2018;3(2)6:418-422.

scholarly journals The Influence of the Physiotherapeutic Program on Selected Static and Dynamic Foot Indicators and the Balance of Elderly Women Depending on the Ground Stability

2021 ◽  
Vol 18 (9) ◽  
pp. 4660
Author(s):  
Joanna Matla ◽  
Katarzyna Filar-Mierzwa ◽  
Anna Ścisłowska-Czarnecka ◽  
Agnieszka Jankowicz-Szymańska ◽  
Aneta Bac
Keyword(s):  
Elderly Women ◽  
Statistical Significance ◽  
Exercise Program ◽  
Control Group ◽  
Balance Assessment ◽  
Motor Functions ◽  
Static Test ◽  
Group A ◽  
Group B ◽  
The Impact

Seniors are a constantly growing group of people in many societies. It is necessary to develop physiotherapeutic programs to improve their mobility. The aim of this study was to assess the impact of the physiotherapeutic program conducted unstable ground on selected indicators of motor functions of elderly women. Sixty women (60–80 years) participated in the research. Group A (N = 20) underwent a 12-week physiotherapeutic program on stable ground, group B (N = 20) followed an exercise program on unstable ground, and group C (N = 20) (control group) had no therapeutic intervention. The effects of the therapy were assessed by using a FreeMed platform (foot load analysis) and a Biosway balance system. The results were compared using ANOVA (the one-way analysis), the Kruskal–Wallis test and also the post hoc tests (Tukey’s test and the multiple comparison test). In group A, a statistically significant change was observed in the static test and balance assessment, in group B this was observed in the static and dynamic foot tests and balance assessment, in group C, no statistical significance was achieved. The authors’ physiotherapeutic program had a statistically significant effect on changes in the balance and selected indicators of the motor functions of the examined people. Comparing the results before and after the therapy more improvement changes were noted in women training on an unstable ground compared to women training on a stable ground.

scholarly journals Marginal Integrity of CAD/CAM Ceramic Crowns Using Two Different Finish Line Designs

2021 ◽  
Author(s):  
Jaber Hussain Akbar ◽  
Ridwaan Omar ◽  
Yacoub Al Tarakmah
Keyword(s):  
Dental Treatment ◽  
Statistical Significance ◽  
United States Public Health ◽  
Finish Line ◽  
Marginal Integrity ◽  
Computer Aided ◽  
Cad Cam ◽  
Group A ◽  
Group B ◽  
Line Design

Statement of problem- Research on evaluation of crowns made by the latest CAD/CAM systems for their marginal adaptation is scarce. Purpose- The purpose of this in vitro study was to evaluate the marginal integrity of crowns fabricated by the latest Chairside Economical Restorations of Esthetic Ceramic (CEREC) system using two different finish line preparation designs: Chamfer and Shoulder. Material and methods- Typhodont teeth were equally divided into two groups, group A and B. The teeth were prepared for full coverage crowns with a shoulder (group A) and chamfer finish line design (group B). An experienced prosthodontist prepared all crown preparations. Evaluation of six sites per sample was completed by two calibrated, experienced prosthodontists using the modified United States Public Health Services (USPHS) criteria. The descriptive statistics and Z-test were used to evaluate the results. Results- A total of 180 teeth were included in the study (90 teeth in each group). Only two crowns in group A and one crown in group B were clinically unacceptable. There was no statistical significance (p=0.282) between the two groups regarding finish-line design. Conclusions- CEREC system provides clinically acceptable crowns and can safely be utilized in dental treatment. Therefore, Contemporary Dental Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) restorations should be considered as a safe treatment modality by dental professionals.

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