Pediatric Intussusception and Interventional Radiology in a Developing Country: Experience and Challenges of Ultrasound Saline Reduction Complementary to Primary Surgery

Nonoperative reduction is considered a safe and effective treatment procedure for pediatric intussusception. However, the procedures are yet to be adopted in some developing countries. This study evaluates our experience with ultrasound saline reduction of pediatric intussusception in southeast Nigeria. Retrospective analysis of 58 children managed for intussusception from June 2009 to May 2013 at the University of Nigeria teaching hospital, Enugu. The median age at presentation was 7 months (IQR = 5 to 9 months), and the average duration of symptoms before diagnosis was 3.9 days (range, 1 to 14 days). Thirteen (22.4%) had saline hydrostatic reduction initially (11 succeeded, 2 failed), and a total of 47 cases had operative treatment (including the 2 with failed saline reduction). Operative procedures were right hemicolectomy in 24 cases, manual reduction 18, ileal resection 3, and colonic resection 2. Eighteen (38.3%) cases developed postoperative complications, and there were 2 postoperative deaths from unremitting septicemia. Comparison of the cases that had saline reduction with cases that underwent operative treatment showed a difference in the average time to diagnosis, need for preintervention transfusion, onset of oral intake, and average duration of admission. Challenges in the saline reduction procedure were delayed presentation, insufficient facilities and trained personnel. Ultrasound saline reduction procedure for pediatric intussusception is feasible in our setting. Despite the delay in presentation in most of our cases, this procedure may still be applied initially to patients who do not have clinical or radiologic contraindications.

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Change in Functional Impairment, Disability, and Quality of Life Following Operative Treatment for Degenerative Cervical Myelopathy: A Systematic Review and Meta-Analysis

Global Spine Journal ◽

10.1177/2192568217710137 ◽

2017 ◽

Vol 7 (3_suppl) ◽

pp. 53S-69S ◽

Cited By ~ 21

Author(s):

Michael G. Fehlings ◽

Lindsay A. Tetreault ◽

Shekar Kurpad ◽

Darrel S. Brodke ◽

Jefferson R. Wilson ◽

...

Keyword(s):

Systematic Review ◽

Operative Treatment ◽

Functional Impairment ◽

Cervical Myelopathy ◽

Surgical Intervention ◽

Japanese Orthopaedic Association ◽

Duration Of Symptoms ◽

Degenerative Cervical Myelopathy ◽

The Impact

Study Design: Systematic review. Objectives: The primary objective of this systematic review was to define the change in impairment, disability, and pain following surgical intervention in patients with degenerative cervical myelopathy (DCM). Secondary objectives included to assess the impact of preoperative disease severity and duration of symptoms on outcomes and to summarize complications associated with surgery. Methods: A systematic literature search was conducted to identify prospective studies evaluating the effectiveness and safety of operative treatment in patients with DCM. Outcomes of interest were functional status, disability, pain, and complications. The quality of each study was evaluated using the Newcastle-Ottawa Scale, and the strength of the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. Results: Of the 385 retrieved citations, 32 met inclusion criteria and are summarized in this review. Based on our results, pooled standard mean differences showed a large effect for improvement in Japanese Orthopaedic Association or modified Japanese Orthopaedic Association score from baseline at short-, medium-, and long-term follow-up: 6 to 12 months (1.92; 95% confidence interval [CI] = 1.41 to 2.43), 13 to 36 months (1.40; 95% CI = 1.12 to 1.67), and ≥36 months (1.92; 95% CI = 1.14 to 2.69) (moderate evidence). Surgery also resulted in significant improvements in Nurick, Neck Disability Index, and Visual Analogue Scale scores (low to very low evidence). The cumulative incidence of complications was low (14.1%; 95% CI = 10.1% to 18.2%). Conclusion: Surgical intervention for DCM results in significant improvements in functional impairment, disability, and pain and is associated with an acceptably low rate of complications.

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Espondilodiscite Brucélica: Casuística dos Últimos 25 Anos

Acta Médica Portuguesa ◽

10.20344/amp.4117 ◽

2014 ◽

Vol 27 (2) ◽

pp. 204 ◽

Cited By ~ 3

Author(s):

Ana Lebre ◽

Jorge Velez ◽

Diana Seixas ◽

Eduardo Rabadão ◽

Joaquim Oliveira ◽

...

Keyword(s):

Average Duration ◽

Signs And Symptoms ◽

Neurological Deficits ◽

Imaging Method ◽

Low Back ◽

Positive Serology ◽

Abscess Drainage ◽

Duration Of Symptoms ◽

Spinal Magnetic Resonance Imaging ◽

Appropriate Therapy

Introduction: Brucellosis is an endemic zoonosis in Portugal. Brucellar spondylodiscitis is one of the most frequent focal manifestations which may cause severe sequelae despite appropriate therapy. Material and Methods: Retrospective study of patients with diagnosis of brucellar spondylodiscitis admitted to the Infectious Diseases Department of Centro Hospitalar e Universitário de Coimbra, over a 25-year period (1988-2012). Results: We identified 54 patients, 55.6% male, mean age of 54.8 years. In 81.5% an epidemiological context was identified, mostly contact with sheep and goats. The duration of symptoms prior to diagnosis was 5.5 months. The most common signs and symptoms were pain (98.1%), fever (46.3%) and neurological deficits (25.9%). Spinal magnetic resonance imaging was the most used imaging method (77.8%) showing abscesses in 29.6% of patients. Lumbar location predominated (77.7%). Diagnosis was attained in 47 patients (87.0%): positive blood cultures (3 patients), positive serology (32 patients) or by both methods (12 patients). Combined regimens of doxycycline and rifampicin (64.8%), or streptomycin (24.1%) were most used, for an average duration of 4.4 months. A patient was referred for surgery for abscess drainage. Evolution was mostly favorable (92.6%), no deaths occurring. Discussion: Research of the epidemiologic context turned out to be a major key leading to the diagnosis. Treatment of osteoarticular brucellosis is still controversial. Conclusions: Brucellar spondylodiscitis should be considered in the differential diagnosis of patients with low back pain, even in the absence of fever, particularly in regions where the disease is endemic. Antibiotic regimen, its’ duration and the need for surgery should be individualized to achieve a better prognosis. Cases have declined over the years, a fact related to better control of animal endemic.

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Surgical management of bronchopulmonary carcinoids: A single center experience

South Asian Journal of Cancer ◽

10.4103/2278-330x.202568 ◽

2017 ◽

Vol 06 (01) ◽

pp. 006-010 ◽

Cited By ~ 1

Author(s):

Ashish Jakhetiya ◽

Pankaj Kumar Garg ◽

Rambha Pandey ◽

Palaniappan Ramanathan ◽

Sunil Kumar ◽

...

Keyword(s):

Surgical Treatment ◽

Histopathological Examination ◽

Postoperative Mortality ◽

North India ◽

Biological Behavior ◽

Long Term Results ◽

Surgical Approaches ◽

Delayed Presentation ◽

Duration Of Symptoms ◽

Tertiary Teaching

Abstract Introduction: Bronchopulmonary carcinoids are uncommon tumors with relatively indolent biological behavior but a distinct malignant potential. Surgery is the mainstay of treatment. Our aim was to study preoperative characteristics, surgical approaches, and outcome in patients with bronchopulmonary carcinoid tumors. Patients and Methods: This retrospective study was done in the Department of Surgical Oncology of a Tertiary Teaching Hospital of North India. The case records of all the patients who underwent surgical treatment for lung neoplasms and were diagnosed to have bronchopulmonary carcinoids were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, postoperative complications, and outcome were retrieved from the case records. Results: Sixteen patients who underwent surgical treatment were found to have bronchopulmonary carcinoids on histopathological examination. The median age of the patients was 34 years (range 18–62 years). There were 11 men and five women. All patients were symptomatic, and the median duration of symptoms was 12 months (range 6–72 months) before presentation. Six patients had received antitubercular treatment before presentation, and one patient had been treated with chemotherapy due to misdiagnosis. Surgical procedures included six pneumonectomies (one with carinoplasty), four bilobectomies, three lobectomies, and three bronchoplastic procedures (two with lobectomy and one with bilobectomy). There was no postoperative mortality; three patients had morbidity in the form of lobar collapse, prolonged pleural collection, and surgical site infection. With a median follow-up time of 11 months (range 2–85 months), all the 16 patients are alive and disease-free. Conclusions: Delayed presentation and misdiagnosis of bronchial carcinoid are major concerns in North India. Adequate surgical resection can be performed without undue morbidity and is associated with good long-term results.

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TP10.1.5The reorganisation of Emergency General Surgery services during the COVID-19 pandemic in the UK: Outcomes of delayed presentation, mortality and BAME patients

British Journal of Surgery ◽

10.1093/bjs/znab362.131 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Anthony Chan ◽

Panos Stathakis ◽

Paul Goldsmith ◽

Stella Smith ◽

Christian Macutkiewicz

Keyword(s):

General Surgery ◽

Lower Proportion ◽

University Teaching ◽

Perioperative Outcomes ◽

Delayed Presentation ◽

Global Public Health ◽

Emergency General Surgery ◽

Duration Of Symptoms ◽

Co Morbidity ◽

The Uk

Abstract Background The COVID-19 pandemic is a global public health emergency. The reconfiguration of local healthcare systems to accommodate the increase in Critical Care capacity has put strain on ‘non-COVID’ specialities. This study characterises the utilisation of Emergency General Surgery (EGS) services at a busy UK university teaching hospital during the COVID-19 lockdown period to evaluate outcomes and to identify patient groups with worse outcomes. Method This retrospective study compares EGS admissions during the UK’s lockdown period (23rd March-28th May 2020) to the same period in 2019. Patient demographics were recorded together with details of their hospital stay and treatment outcomes. Results A total of 645 patients were included, comprising 223 in the COVID-19 and 422 in the non-COVID-19 periods. There was no difference in age, sex, co-morbidity or socioeconomical status. A lower proportion of Black, Asian and Minority Ethnic (BAME) patients were admitted during the COVID-19 period (20.6% vs 35.4%, p < 0.05). The duration of symptoms prior to presentation were longer, and admission Early Warning Scores and serum inflammatory markers were higher. More patients present with acute kidney injury (9.9% vs 4.7%, p = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p = 0.023). Conclusion We show that the UK reorganisation of EGS services has been successful in terms of outcomes and access to services despite a more unwell population. There was a lower proportion of BAME admissions suggesting additional barriers to access to healthcare under pandemic lockdown conditions.

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PS01.174: AN EXAMINATION OF OUTCOMES AFTER ANTE-THORACIC ROUTE WITH RIGHT HEMICOLON RECONSTRUCTION AFTER ESOPHAGECTOMY.

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.174 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 99-99

Author(s):

Yuki Hirata ◽

Hirofumi Kawakubo ◽

Shuhei Mayanagi ◽

Kazumasa Fukuda ◽

Rieko Nakamura ◽

...

Keyword(s):

Postoperative Complications ◽

Gastric Tube ◽

Conflicts Of Interest ◽

Average Duration ◽

Oral Intake ◽

Recurrent Nerve ◽

Nerve Paralysis ◽

Recurrent Nerve Paralysis ◽

Reconstruction Group ◽

Group 1

Abstract Background In our institute, we usually use gastric tube for reconstruction organ after esophagectomy. When we can’t use gastric tube, we use right hemi-colon with ante-thoracic route. Previously, we reconstructed by 1-step after esophagectomy, but from 2012, we have done by 2-step for reduce postoperative complications. Methods We enrolled 15 esophageal cancer patients who underwent esophagectomy and right hemicolon reconstruction between April 2004 and December 2016. Results The average age of 15 patients is 67.3. The reasons of using right hemicolon are as follows; post gastrectomy 13, stomach double cancer 2. The reasons of gastrectomy are as follows; gastric cancer 8, duodenum cancer 1, gastric ulcer 4. The average duration from gastrectomy to esophagectomy is 12.5 year. We reconstructed by 1-step for 5 patients, and after 2012, we reconstructed by 2-step for 10 patients. Anastomotic leakages were found in 2 cases (40.0%) in 1-step reconstruction group, and 3 cases (20.0%) in 2-step reconstruction group. In 1-step reconstruction group, 1 case occurred multiple anastomotic leakages and DIC, and another 1 case was found necrosis of reconstructive colon. In 2-step reconstruction group, we found 1 case of major leakage and 1 case of recurrent nerve paralysis and 2 cases of postoperative pneumonia. However, there were no case of tracheotomy. The incidence of pneumonia did not differ between the two groups. And the term of postoperative oral intake tend to shorter in 2-step reconstruction group (P = 0.06). 2 severe postoperative complications (Clavian-Dindo V or IVa) cases were found in 1-step reconstruction group, on the other hand, 2 cases severe complications (CD IIIa) in 2-step reconstruction group. Conclusion In the case of using right hemicolon as a reconstructive organ, 2-step reconstruction approach is useful and superior from the viewpoints of postoperative complications. Disclosure All authors have declared no conflicts of interest.

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The Natural History of Adult Trigger Thumb

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90120-5 ◽

1993 ◽

Vol 18 (2) ◽

pp. 247-248 ◽

Cited By ~ 6

Author(s):

C. B. SCHOFIELD ◽

N. D. CITRON

Keyword(s):

Natural History ◽

Average Duration ◽

Adult Patients ◽

Full Recovery ◽

Trigger Thumb ◽

Duration Of Symptoms ◽

History Of ◽

Average Loss ◽

Functional Reduction

30 consecutive adult patients presenting with trigger thumb (31 thumbs) were entered prospectively into a study to determine the natural history of the condition. Five patients insisted on treatment and could not be followed to resolution, but the rest resolved spontaneously after an average duration of symptoms of 6.8 months (range 2–15). There was a small but non-functional reduction in movement of the thumb in some of the patients: six lost an average of 7° of abduction and ten had an average loss of opposition of 1.4 (Kapandji grade). The remaining patients made a full recovery.

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TREATMENT OF CHRONIC MALLET FRACTURES USING EXTENSION-BLOCK KIRSCHNER WIRE

Hand Surgery ◽

10.1142/s0218810414500348 ◽

2014 ◽

Vol 19 (03) ◽

pp. 399-403 ◽

Cited By ~ 5

Author(s):

Kenichi Asano ◽

Goro Inoue ◽

Masaki Shin

Keyword(s):

Operative Treatment ◽

Average Duration ◽

Kirschner Wire ◽

Bone Union ◽

Younger Patients

Eleven patients with chronic mallet fractures that were seen later than four weeks after injury were treated by extension-block Kirschner wire technique. The average duration from injury to operative treatment was 56 days (range, 28–111). The follow-up evaluations took place after a mean of eight months. The radiographic bone union was obtained in all patients. The average extension loss of the DIP joint was 4 degree (range, 0–15) and the average flexion was 68 degree (range, 43–90). The results according to Crawford's criteria were six excellent, two good, two fair, and one poor. We would say that the technique we treated is effective method of treatment for younger patients with chronic mallet fractures.

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Clinical Characteristics According to Age and Duration of Symptoms to Be Considered for Rapid Diagnosis of Pediatric Intussusception

Frontiers in Pediatrics ◽

10.3389/fped.2021.651297 ◽

2021 ◽

Vol 9 ◽

Author(s):

In Kyu Park ◽

Min Jeng Cho

Keyword(s):

Abdominal Pain ◽

Clinical Characteristics ◽

Age Groups ◽

Oral Intake ◽

Clinical Findings ◽

Bloody Stool ◽

Ileocolic Intussusception ◽

Duration Of Symptoms ◽

Poor Oral Intake ◽

Paroxysmal Pain

Purpose: The purpose of this study was to evaluate whether clinical findings in children with ileocolic intussusception differ based on age and duration of symptoms and to assess the clinical characteristics of diagnosed and undiagnosed patients to determine which symptoms make diagnosis more difficult.Methods: We reviewed 536 medical records of <15-year-old children diagnosed with ileocolic intussusception between 2008 and 2019. We divided the children into three categories according to age (<1 year, 1–2 years, and ≥2 years). The children were also divided into two groups based on whether symptoms lasted for more or <6 h. Diagnosed and undiagnosed children were assessed separately during for the initial evaluation.Results: Following analysis of the three age groups, bloody stool, post-enema bloody stool, diarrhea, vomiting, poor oral intake, and lethargy were more frequent in children aged <1 year. In children aged ≥2 years, non-specific abdominal pain was more frequent and the undiagnosed rate was higher. Following analysis of the duration of symptoms, paroxysmal pain was significantly more frequent in the early group (<6 h), and bloody stool and fever were significantly more frequent in the late group (≥6 h). Nonspecific abdominal pain was more frequent and the door-to-diagnosis time was significantly longer in the undiagnosed group than in the diagnosed group.Conclusions: Clinical findings of ileocolic intussusception vary depending on the age and duration of symptoms. Younger children with paroxysmal pain, vomiting, bloody stool, poor oral intake, or lethargy should be suspected of having intussusception. In older children, non-specific abdominal pain without bloody stool may be a symptom of intussusception. Glycerin enema is helpful in diagnosing intussusception in children with no typical symptoms.

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1378The effect of vitamin D supplementation on acute respiratory infection -analysis of the D-Health Trial

International Journal of Epidemiology ◽

10.1093/ije/dyab168.531 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Hai Pham ◽

Mary Waterhouse ◽

Catherine Baxter ◽

Briony Romero ◽

Donald McLeod ◽

...

Keyword(s):

Vitamin D ◽

Observational Studies ◽

Regression Models ◽

Average Duration ◽

Acute Respiratory Tract Infection ◽

Vitamin D Supplementation ◽

Duration Of Symptoms ◽

Potential Impact ◽

Rate Ratios ◽

Randomised Controlled

Abstract Background Observational studies link vitamin D deficiency with acute respiratory tract infection (ARTI) but results from randomised controlled trials are heterogeneous. Methods We used data from The D-Health Trial (N = 21,315); ARTI was a pre-specified trial outcome. Participants were men and women aged 60 to 79 years (with volunteers aged up to 84 years), supplemented with monthly doses of 60,000 international units of vitamin D and followed for up to 5 years. Participants were asked to report occurrence of ARTI over the previous month via annual surveys, and a subset of participants completed 8-week respiratory symptom diaries in winter. We used regression models to estimate odds ratios, rate ratios and rate differences. Results Vitamin D supplementation did not reduce the risk of ARTI (survey OR 0.98, 95% CI 0.93 to 1.02; diary OR 0.98, 95% CI 0.83 to 1.15). Analyses of diary data showed that vitamin D reduced the average duration by 0.5 days (95% CI 0.2 to 0.7 days) and the average number of days with severe symptoms by 0.4 days (95% CI 0.3 to 0.6 days). Conclusions Monthly bolus doses of 60,000 IU of vitamin D did not reduce the overall risk of ARTI but slightly reduce the duration of symptoms in the general population. Key messages The reduction in the duration of symptoms suggests a potential impact of vitamin D on the immune response to infection.

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LAPAROSOPIC ASSISTED RIGHT HEMICOLECTOMY

The Professional Medical Journal ◽

10.29309/tpmj/2015.22.08.1148 ◽

2015 ◽

Vol 22 (08) ◽

pp. 1020-1023

Author(s):

Jahangir Sarwar Khan ◽

Muhammad Salman Shafique

Keyword(s):

Surgical Site Infection ◽

Hospital Stay ◽

Oral Intake ◽

Length Of Hospital Stay ◽

Right Hemicolectomy ◽

Site Infection ◽

Carcinoma Colon ◽

Duration Of Operation ◽

Age Range ◽

Surgical Unit

Objective: Experience with Laparosopic assisted Right Hemicolectomy ispresented. Study Design: Prospective study. Setting: Surgical Unit-I, Holy Family Hospital,Rawalpindi, Pakistan. Period: 2010 to 2014. Materials and Methods: 20 patients underwentlaparosopic assisted right hemicolectomy. Duration of operation, postoperative pain, durationof post operative analgesia, frequency of surgical site infection and length of hospital stay werenoted. Results: There were 13 male and 7 female patients with the age range of 25-70 years(45±11years). Eleven (11) patients were suffering from carcinoma colon wheras nine (09)were suffering from Tuberculosis. Mean operative time was about 92 minutes. Only four opiodinjections were required as post-operative analgesia. Oral intake was started after 24 hours. Themean length of hospital stay was 5.5 days with no case of surgical site infection. Conclusion:Laparoscopic assisted right hemicolectomy is a safe and viable option in our setup.

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