Comparative Study of Low Pressure versus Standard Pressure Carbon Dioxide Pneumoperitoneum in Reducing Shoulder Tip Pain Post Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is the gold standard treatment for cholelithiasis. Postoperative shoulder tip pain is common complaint. Evidences suggest that using low pressure pneumoperitoneum (8-10 mmHg) during the procedure rather than standard pressure (12-14 mmHg) decreases the incidence and severity of shoulder tip pain without compromising working space. Aims: The aim of this study was to evaluate the impact of low pressure and standard pressure pneumoperitoneum on shoulder tip pain post laparoscopic cholecystectomy. Methods: A prospective hospital based study conducted at Nepalgunj Medical College, Kohalpur from January 2019 to December 2020. Hundred patients were enrolled, fifty each in “low pressure carbondioxide pneumoperitoneum” and “standard pressure carbondioxide pneumoperitoneum” groups, who underwent laparoscopic cholecystectomy. The two groups were compared in terms of incidence and severity of shoulder tip pain, surgeon’s satisfaction score, top-up analgesia requirement, procedural time, conversion to standard pressure, intraoperative complications and length of hospital stay. Results: There were 45 (90%) females and five (10%) males in low pressure group and 44 (88%) females and six (12%) males in standard pressure group. Fourteen (28%) patients in low pressure and 32 (64%) patients in standard pressure group had shoulder tip pain (p=0.001). The severity of shoulder tip pain was less in low pressure group and was significant at eight hours (p=0.006) and 12 hours (p=0.008). Top-up analgesia was required more in standard pressure group. There were no intraoperative complications but only one conversion to standard pressure. Surgeon’s satisfaction score, conversion to open cholecystectomy and procedural time were comparable in both groups with shorter hospital stay in low pressure group. Conclusion: Low pressure carbondioxide pneumoperitoneum is safe and effective strategy in reducing incidence and severity of shoulder tip pain after laparoscopic cholecystectomy.

Chronic subdural hematoma pressure measurement and its correlation with clinical characteristics and postoperative neurological outcome

Background: The pressure of the chronic SDH (subdural haemotoma), the age of the patient, preoperative GCS score and midline shift were considered prognostic dependent factors. The study aimed at the significance of the pressure of chronic SDH in the outcome of patients.Methods: A correlation between subdural hematoma pressure and preoperative and postoperative clinical variables such as hematoma volume, midline shift, age, GCS score and postoperative modified ranking scale score as well as complications were assessed and analyzed.Results: According to the pressure of chronic SDH, 56 patients were grouped into 4 groups. In the pressure group <15 cm/h20 group the mean age was 85 and postoperative ranking score was 3 and the recurrence was 21 % while in high pressure group (>25 cm/h20) the mortality was 14% and no recurrence.Conclusions: The pressure of the chronic SDH has significant prognostic value in chronic SDH surgeries.

Clinical consequences of Hypotension in patient with organophosphate poisoning

Objective: Aim of study is to describe the clinical consequences of hypotension in patient with organophosphate poisoning. Method: In the retrospective cohort study, we analyzed data of 66 patients with organophosphate poisoning who were treated at Bir Hospital, Nams Kathmandu. Data from those with hypotension and normal blood pressure were compared to identify significant clinical consequences. Results: All together 66 patients were enrolled in this study out of which 44(66.7%) were female and 22(33.3%) were male. After analyzing data, we found 18.2% of case with severe poisoning (ACHE < 700 U/L). Among all, 41(62%) were found to have normal blood pressure and 25(37.9%) were found to have low blood pressure. Among those with hypotension, around 56% were found to have prolonged QTc interval, p < 0.003 and there was statistically significant association between QTc prolongation and vasopressor requirement, X2(1) = 22.98, P < 0.001. Patients requiring higher dose to reach atropinization had statistically significant hypotension, P < 0.001. Those with low blood pressure were found to require more days of hospital admission, P < 0.001. Patients with hypotension were found to have severe poisoning both on the basis of POP Score severity grading, 16(64%) P <0.002 and ACHE Severity scale, 7(28%) P < 0.05. In comparison with normal blood pressure group, low blood pressure group had significantly more chance of developing complications like septic shock (2), aspiration pneumonia (5), ARDS (1) and bed sore, P = 0.002. Vasopressor requirement was significantly more among those with low blood pressure, P < 0.001. Most of hypotensive patients were needing ICU care, found to have higher WBC count P = 0.002 and lower GCS Score at admission P < 0.001. There was positive correlation between hypotension and POP Score at admission P < 0.001. Conclusion: Hypotension is a common complication in patient with organophosphate poisoning and is associated with higher POP Score, lower ACHE level, lower GCS Score, increased vasopressor requirement, more hospital stays, increasing ICU admission, more chance of developing septic shock and aspiration pneumonia.

Effect of coarctation of aorta anatomy and balloon profile on the outcome of balloon angioplasty in infantile coarctation

Objective Coarctation of the Aorta (CoA) is a relatively common cardiovascular disorder. The present study aimed to evaluate the effect of COA anatomy and high versus low-pressure balloons on the outcome of balloon angioplasty among neonates and infants. Methods In this retrospective study, the neonates and infants undergoing balloon angioplasty at Namazi hospital were enrolled. After balloon angioplasty, immediate data results were promptly recorded.Moreover, midterm echocardiographic information was collected via electronic cardiac records of pediatric wards and clinical and echocardiographic data at least 12 months after balloon angioplasty. Finally, data were analyzed using SPSS-20. Results In this study, 42 infants were included. The median age at the time of balloon angioplasty was 1.55 (range 0.1–12) months and 66.7% of the patients were male. The mean pressure gradient of coarctation was 38.49 ± 24.97 mmHg, which decreased to 7.61 ± 8.00 mmHg (P < 0.001). A high-pressure balloon was used in 27, and a low-pressure balloon was used in 15 patients. COA's pressure gradient changed 30.89 ± 18.06 in the high-pressure group and 24.53 ± 20.79 in the low-pressure balloon group (P = 0.282). In the high-pressure balloon group, 14.81% and in the low-pressure group, 33.33% had recoarctation and need second balloon angioplasty (p < 0.021). The infant with discrete coarctation had a higher decrease in gradient and lower recoarctation. Conclusion Recoarctation rate was lower in the high-pressure balloon. The infant with discrete COA had a better response to the balloon with more decrease in gradient and lower recoarctation rate. Therefore, the stenotic segment anatomy needs to be considered in the selection of treatment methods.

Pressure Groups Under MMP: a Study of Behaviour and Influence

<p>This thesis examines the impact of MMP on pressure group behaviour and strategies. MMP altered the distribution of public policy decision-making power. As a consequence, it was expected to influence the strategies and behaviours of pressure groups seeking to influence public policy. The thesis finds that most expectations of pressure groups under MMP have been borne out. In particular, pressure groups have developed a wider range of political relationships and access points, have achieved more success through engagement with select committees and have been more willing to lobby and campaign publicly in opposition to Executive policy. In addition, it finds pressure groups have adopted an increasingly flexible and politically independent mentality and it finds there has been a blurring of boundaries between insider and outsider pressure groups. Finally, it concludes that policy influence has become more complex under MMP and created the need for increased pressure group sophistication. Chapter 1 introduces New Zealand's pluralist traditions as well as the history and importance of pressure group activity. It describes the rationale for the adoption of MMP and the relationship between this electoral system and the public policy process - "the rules of the game" - within which pressure groups operate and seek to influence. Chapter 2 provides an overview of the core political theory that underpins pressure group behaviour under different electoral systems - including theories of state structure and of weak and strong legislatures. It outlines the various methods of influence available to pressure groups and reviews the international literature to identify the main themes, strategies and tendencies that might be expected of pressure groups in an MMP environment. These include a drift in emphasis from Ministers and the bureaucracy to Parliament and a broadening of Parliamentary relationships, a stronger focus on select committees, increased media and mobilisation activity, as well as some additional emphasis on quality information and political gamesmanship. These expectations are set out as five hypotheses for examination. Chapter 3 discusses and reviews the extent and nature of structural change to public policy decision-making in New Zealand under MMP - as an important context for the analysis of pressure group behaviour. It finds that MMP has delivered substantial structural change to the distribution of decision-making power, but that this has been highly variable and changed from one term of government to the next. Chapter 4 first describes the methodology used for researching and reviewing pressure group behaviour and strategies under MMP. It sets out a qualitative approach that involved a mixture of expert interviews and public policy case studies. Chapter 5 returns to and examines the five hypotheses set out in Chapter 2 and concludes that most expectations have been met, particularly the development of broader Parliamentary relationships by pressure groups. Chapter 6 sets out those key conclusions and underlying themes beyond examination of the five hypotheses.</p>

Pressure Groups Under MMP: a Study of Behaviour and Influence

<p>This thesis examines the impact of MMP on pressure group behaviour and strategies. MMP altered the distribution of public policy decision-making power. As a consequence, it was expected to influence the strategies and behaviours of pressure groups seeking to influence public policy. The thesis finds that most expectations of pressure groups under MMP have been borne out. In particular, pressure groups have developed a wider range of political relationships and access points, have achieved more success through engagement with select committees and have been more willing to lobby and campaign publicly in opposition to Executive policy. In addition, it finds pressure groups have adopted an increasingly flexible and politically independent mentality and it finds there has been a blurring of boundaries between insider and outsider pressure groups. Finally, it concludes that policy influence has become more complex under MMP and created the need for increased pressure group sophistication. Chapter 1 introduces New Zealand's pluralist traditions as well as the history and importance of pressure group activity. It describes the rationale for the adoption of MMP and the relationship between this electoral system and the public policy process - "the rules of the game" - within which pressure groups operate and seek to influence. Chapter 2 provides an overview of the core political theory that underpins pressure group behaviour under different electoral systems - including theories of state structure and of weak and strong legislatures. It outlines the various methods of influence available to pressure groups and reviews the international literature to identify the main themes, strategies and tendencies that might be expected of pressure groups in an MMP environment. These include a drift in emphasis from Ministers and the bureaucracy to Parliament and a broadening of Parliamentary relationships, a stronger focus on select committees, increased media and mobilisation activity, as well as some additional emphasis on quality information and political gamesmanship. These expectations are set out as five hypotheses for examination. Chapter 3 discusses and reviews the extent and nature of structural change to public policy decision-making in New Zealand under MMP - as an important context for the analysis of pressure group behaviour. It finds that MMP has delivered substantial structural change to the distribution of decision-making power, but that this has been highly variable and changed from one term of government to the next. Chapter 4 first describes the methodology used for researching and reviewing pressure group behaviour and strategies under MMP. It sets out a qualitative approach that involved a mixture of expert interviews and public policy case studies. Chapter 5 returns to and examines the five hypotheses set out in Chapter 2 and concludes that most expectations have been met, particularly the development of broader Parliamentary relationships by pressure groups. Chapter 6 sets out those key conclusions and underlying themes beyond examination of the five hypotheses.</p>

The Effect of Curing Pressure on Shear Bond Strength of Zirconia to Resin Cement

Background: Nowadays, the esthetics demand is continuously increasing; therefore, metal-free materials are widely used, like a zirconia-based ceramic, which is conveniently fabricated via computer-aided design and computer-aided manufacturing (CAD/CAM) system for restorations from single to full mouth rehabilitation. Objective: This study evaluated the effect of pre-curing pressure on the shear bond strength of zirconia to the resin cement. Methods: A total of sixty-three sandblasted cylindrical zirconia mounted in autopolymerizing resin were randomly assigned to three groups; Group 1: no treatment (control), Group 2: negative pressure, and Group 3: positive pressure to resin cement after resin cement application and resin composite columns bonded to zirconia. Thirty-three of the samples were stored in distilled water at 37 °C for 24 hr before the shear bond strength test for thirty samples and three samples were cross-sectionally cut for interfacial observation with FESEM. Another thirty samples were thermocycled for 5,000 cycles in distilled water at 5°C to 55 °C before testing. The shear bond strength and failure mode were evaluated. Examination of the bonding interface was also done. Results: The results were analyzed using two-way ANOVA. The means of shear bond strength of non-thermocycle of the control group were 8.01 ±1.74 MPa, 9.10 ±1.90 MPa, and 9.14 ±2.58 MPa, whereas that of thermocycle group were 5.71 ±0.84 MPa, 5.53 ±0.68 MPa, and 5.68 ±0.77 MPa in zero pressure group, negative pressure group, and positive pressure group, respectively. It showed no statistically significant differences in shear bond strength in all pressure groups (p > 0.05). The pre-curing pressure did not influence the shear bond strength of the zirconia and resin cement. Conclusion: There was no difference in the shear bond strength between the pressure groups and the no treatment control group. The positive and negative pressure did not influence the shear bond strength of the zirconia and resin cement.

Changes in Eyelid Pressure and Dry Eye Status after Orbital Decompression in Thyroid Eye Disease

The aim of this prospective observational study was to examine changes in eyelid pressure and dry eye status after orbital decompression in thyroid eye disease (TED). In 16 patients (29 sides), upper eyelid pressure at plateau phase and maximum pressure were measured. TED status was evaluated through the Hertel exophthalmometric value and margin reflex distance (MRD)-1 and 2. Dry eye status was quantified through corneal fluorescein staining, tear break-up time, Schirmer test I results, meibomian gland dysfunction (MGD), tear meniscus height, and superior limbic keratoconjunctivitis (SLK). Patients were classified into two groups: patients with decreased eyelid pressure (Group 1) and those with elevated pressure (Group 2). Consequently, neither the maximum upper eyelid pressure nor pressure at plateau phase significantly changed after surgery (p > 0.050). Some parameters about MGD improved after surgery, but the other parameters on dry eye, MGD, and SLK worsened or did not change. MRD-1 decreased more (p = 0.028), and the ratio of patients in whom SLK improved after surgery was larger in Group 1 (p = 0.030). These results indicate that upper eyelid pressure tends to decrease postoperatively in patients with a high upper eyelid position, resulting in improvement of SLK.