Times In Different Patients Research Articles

Clinical Observation of Laparoscopic Cholecystectomy at Different Times in Patients with Acute Cholecystitis after Puncture and Drainage

Clinical Observation of Laparoscopic Cholecystectomy at Different Times in Patients with Acute Cholecystitis after Puncture and Drainage

Impact of shift work on surgical outcomes at different times in patients with acute type A aortic dissection: A retrospective cohort study.

To investigate the effect of shift work on surgical outcomes at different times in patients with acute type A aortic dissection (ATAAD). Patients with ATAAD who underwent total arch replacement at Qilu Hospital of Shandong University from January 2015 to March 2022 were retrospectively analyzed. All patients were managed according to the green channel emergency management strategy, and a professional cardiac team was arranged during off-hours. Based on surgery time and symptom onset to procedure time, the patients were divided into weekday, weekend and holiday groups; daytime and nighttime groups; intervention time ≤48 h and >48 h groups; working hours and off-hours groups. In-hospital mortality between these groups was compared. In total, 499 ATAAD patients underwent surgery within 7 days of symptom onset, and the in-hospital mortality rate was 10% (n = 50/499). Among the 499 patients, 320 (64.13%), 128 (25.65%) and 51 (10.22%) underwent surgery on weekdays, weekends and holidays, respectively. In-hospital mortality and 7-day mortality showed no significant difference among the three groups. Two hundred twenty-seven (45.5%) underwent daytime surgery, and 272 (54.5%) underwent nighttime surgery. Durations of ICU stay and hospital stay were significantly different between the two groups (P < 0.05). There was no significant differences in in-hospital mortality (9.2% vs. 10.7%) and 7-day mortality (4.4% vs. 6.6%). 221 patients (44.3%) and 278 patients (55.7%) were included in the intervention time ≤48 h and >48 h groups, respectively. Acute renal injury, ICU stay and hospital stay were significantly different (P < 0.05) whereas 7-day mortality (5.0% vs. 6.1%) and in-hospital mortality (8.6% vs. 11.1%) were not. Furthermore, 7-day (1.9% vs. 6.6%) and in-hospital mortality (11.1% vs. 9.8%) showed no difference between working hours group (n = 108) and off-hours group (n = 391). Cox regression analysis showed that postoperative acute renal injury (HR = 2.423; 95% CI, 1.214-4.834; P = 0.012), pneumonia (HR = 2.542; 95% CI, 1.186-5450; P = 0.016) and multiple organ dysfunction (HR = 11.200; 95% CI, 5.549-22.605; P = 0.001) were the main factors affecting hospital death in ATAAD patients. Under the management of a professional cardiac surgery team with dedicated off-hours shifts, surgery time was not related to in-hospital mortality in ATAAD patients.

Особенности интраоперационного периода на фоне предварительного введения ингибитора ангиогенеза в хирургии пролиферативной диабетической ретинопатии

Purpose. To carry out a comparative analysis of the intraoperative period of vitrectomy against the background preliminary intravitreal injection inhibitor of angiogenesis performed at different times in patients with proliferative diabetic retinopathy. Material and methods. The study included 134 patients (134 eyes) with proliferative diabetic retinopathy (PDR) on the background of type II diabetes mellitus. 1 st group consisted of 30 patients (30 eyes) who underwent vitrectomy (VE) 1 month after intravitreal injection (IVI) inhibitor of angiogenesis (IA); 2 nd group included 104 patients (104 eyes) underwent VE 10–14 days after IVI IA, followed by a comparative assessment of intraoperative period and morphological and functional results of the eyes after 1 month. Results. In 1 st group of patients, moderate hemorrhagic complications were observed in 23.4 % of cases, severe – in 76.6 %, which significantly hampered visualization of surgical field during VE. In 2 nd group, minor hemorrhagic complications prevailed in 55.8 % of cases (p1-2 &lt;0.05). Moderate and severe – in 26 % and 18.2 % of cases, respectively (p1-2 &lt;0.05). Perfluorocarbon tamponade was used in 83.3 % of cases in 1 st group and in 22.1 % of cases in 2 nd group. Surgical intervention in 1 st group was ended with gas-air tamponade in 30 % of cases, with silicone oil in 70 % of cases, at patients of 2 nd group – in 63.4 % of cases with gas-air tamponade and 36.6 % of cases with silicone oil. Conclusion. The obtained clinical and morphological and functional results indicate the effectiveness of preliminary IVI IA before VE, minimally invasive, sparing nature of surgical intervention and uncomplicated course of the intraoperative period in patients with PDR. Keywords: proliferative diabetic retinopathy, vitrectomy, inhibitor of angiogenesis, intraoperative period, hemorrhagic complications, vitreous cavity tamponade.

Evaluation of four supraglottic devices used by paramedical staff for securing airway in simulated emergency airway management

BackgroundPrehospital emergency airway management challenges every paramedic. Emergencies evacuated from difficult areas by armed forces need airway maintenance throughout evacuation. Effective use of supraglottic airway (SGA) devices during prehospital transfer is life saving. This study compared use of four commonly available SGAs by Armed Forces paramedics in simulated emergency situations. MethodsThis prospective observational study conducted in a tertiary care institution, included 58 volunteer paramedics. They were trained on manikins before the study in basic airway skills and insertion of the four SGA devices under study viz. Classic laryngeal mask airway (cLMA), laryngeal tube (LT), I-gel, and Combitube. SGA device insertions were performed on 474 patients scheduled for short elective surgical procedures under general anesthesia. All volunteers inserted and assessed the four SGA devices equal number of times in different patients. Overall success rate, time for successful insertion, first attempt success rate, number of attempts for successful insertion, oro-pharyngeal leak pressures, ease of insertion, durability of device, and complications were recorded. ResultsDifferences among the four groups were statistically significant in all parameters. Intergroup comparison revealed that both I-gel and LT were comparable to each other, however superior to cLMA and Combitube in all outcome measures except ease of insertion and durability of device where I-gel was better and oro-pharyngeal seal pressures where Combitube was better. ConclusionConsidering all parameters, I-gel proved superior with minimal complications compared with other SGA devices tested. I-gel may be recommended for emergency airway rescue use in patients by military paramedics.

Comparative study of indwelling gastric tube at different times in patients with invasive mechanical ventilation

Objective Comparative study of gastric tube implantation at different times in patients with invasive mechanical ventilation. Methods Random sampling was used to divide 160 patients who were incubated with mechanical ventilation at the hospital into two groups, There were 80 patients in each group. Two groups of patients were routinely placed gastric tube by a stationary nurse.The observation group was treated with ordinary silica gel stomach tube at early stage (immediately) after trachea cannula, the control group still used the ordinary silica gel stomach tube after the trachea cannula late (24 hours later).The one-time successful rate, the total successful rate, the operation time and the result of the two methods were observed in the two groups. Results The observation group Placing stomach tube one-time successful rate and the total successful rate was 75% (60/80), 97.5% (78/80), significantly higher than the control group 27.5% (22/80), 72.5% (58/80), the difference was statistically significant (χ2=36.12, 19.61, P<0.01).The operation time of gastric tube in observation group was (1.49 ± 0.45) min, which was significantly lower than that of control group (3.07 ± 0.32) min, the difference was statistically significant (t=25.48, P<0.01). The observation group only heard gurgling not pumped to the gastric juice of 10 cases (12.50%), only smoke into the gastric juice does not hear the gurgling in 0 cases, both in 70 cases (87.50%), both in 0 cases, the control group were 37 cases (46.25%), 0 cases, 40 cases (50.00%), 3 cases (3.75%). There were significant differences between the 2 groups in determining the success of gastric tube placement, and the difference was statistically significant (χ2=39.36, P<0.01). Conclusions After the trachea cannula, the ordinary silica gel gastric tube was placed in the early stage (immediately), which improved the successful rate of gastric tube placement in the mechanical ventilation patients, Shortened the operation time, improved the work efficiency and alleviated the patient′s pain. Key words: Trachea cannula; Mechanical ventilation; Silicagel stomach tube; Success rate

Blood coagulation parameters after intravitreal injection of aflibercept in patients with neovascular age-related macular degeneration.

The aim of this study was to evaluate the effect of intravitreal injection of aflibercept (IVA) on blood coagulation tests in neovascular age-related macular degeneration (AMD) patients. Thirty-four patients with neovascular AMD (study group) and 32 healthy individuals (control group) were enrolled. Prothrombin time (PT) and activated partial thromboplastin time (aPTT) were measured at different times in patients with neovascular AMD. The levels of PT and aPTT after IVA were decreased at 1month after the first injection and 1month after the second injection compared to the baseline measurement in the study group. IVA may cause a decrease in the levels of PT and aPTT at 1month after the first injection and 1month after the second injection although these results are not statistically significant in our study.

Cuantificación de citoquinas y su relación con la presencia de bacteriemia en leucemias agudas y neutropenia febril postquimioterapia

ObjectivesTo describe the properties of several cytokines and their relationship with the presence of bacteraemia by measuring interleukins 1β, 6, 8, 10, 12p70, and tumour necrosis factor (TNFα) at four different times in patients with acute leukaemia and febrile neutropenia. MethodsPlasma samples were obtained on diagnosis of neutropenia, at the onset of fever, and at 24hours and 48hours thereafter. They were stored at -70° C and then thawed for processing by flow cytometry. Medians were used along with their corresponding dispersion measurements. ResultsThere were no reports of death at discharge. The rate of positive blood cultures was 25%, which was similar to that reviewed in the literature, with predominance of the isolation of Gram negative bacteria. Interleukins 10 and 6 showed a higher percentage of variation during the time of fever on comparing the bacteraemia group with the non- bacteraemia group. IL1, IL12p70, and TNFα±showed serum levels below the detection limit of the test. ConclusionsCytokines could play a promising role in the monitoring of febrile neutropenic patients, given the potential association with the presence of bacteraemia, an outcome well known as a predictor of morbidity and mortality in this population. However, more studies with a larger population are required to define a clear recommendation in the management guidelines for febrile neutropenia after chemotherapy.

Safety of implantation permanent pacemaker at different times in patients with dual antiplatelet therapy

To investigate the safety of implantation permanent pacemaker (PM) at different times in patients with dual antiplatelet (DAPT) therapy after implantation of drug-eluting stent (DES). A total of 105 patients who implanted pacemakers with DAPT therapy (clopidogrel and aspirin) after implantation of DES admitted to our hospital from January 2009 to January 2015 were enrolled in the study. The patients were divided into 3 groups: dual antiplatelet therapy (DAP) group: implanting PM within 3 months after coronary stenting, continuous DAPT during perioperative period; low molecular weight heparin (LMWH) bridging group: implanting PM within 3 to 6 months after coronary stenting, DAPT interruption for 5 days replaced with subcutaneous injection of enoxaparin (1 mg/kg), twice per day, enoxaparin was stopped 12 h before operation; asprin group, implanting PM after coronary stenting 6 months, clopidogrel interruption for 5 days. Oral DAPT was returned 12-24 after operation according to the patients' condition. Peri-operative cardiovascular events and bleedings, infections were observed. There was no major adverse cardiac event (MACE) and pouch infection were observed among 3 groups in perioperation. The incidence of pocket hemorrhage and errhysis in bridging group was significantly higher than that of DAP group and asprin group (16.7%, 8.0%, 0.0% χ(2)=10.431, P=0.005 and 29.2%, 12.0%, 7.1% χ(2)=6.321, P=0.042 respectively). 3 patients had severe bleeding (12.5%, 3/24) in bridging group; compared with the other 2 groups, there were significant difference (χ(2)=9.161, P=0.010). The incidence of hematoma and hemorrhage of asprin group was lowest. LMWH bridging therapy significantly increases the risk of pacemaker pocket hematoma and hemorrhage, and the pacemaker implantation may be safer after DES implantation 6 months.

Usefulness of (18)F-FDG PET/CT in Evaluating Disease Activity at Different Times in a Patient With Chronic Periaortitis.

We report the case of a 53-year-old man with a chronic periaortitis (CP) in whom Fluorine-18-Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) has been useful in assessing the disease extent at diagnosis, in evaluating the treatment response, in diagnosing the relapse, and in monitoring the disease activity during follow-up (Fig. 1). This case highlights the usefulness of FDG-PET/CT at different times in patients with CP. Fig. 1 A 53-year-old man was admitted to our hospital for a suspected chronic periaortitis (CP) based on clinical (abdominal pain), laboratory data (increased serological inflammatory markers, such as erythrocyte sedimentation rate [ESR] and C reactive protein ... CP is a rare inflammatory disorder that affects the abdominal aorta and the retroperitoneum [1–3]. Imaging procedures are essential to diagnose and monitor the disease course [1–3]. Ultrasonography may be used as first-line screening test, and is particularly useful to monitor patients with hydronephrosis and aortic aneurysms. However, CT or magnetic resonance imaging (MRI) of the abdomen are currently considered the investigations of choice to diagnose CP [1–3]. In active CP, the periaortic mass usually enhances on CT and MRI. Both these methods can be used to monitor the disease course of CP and to evaluate response to treatment. A note of caution: signs of vasculitis seen on MRI and CT may persist for some time, despite achievement of clinical remission. A further limitation of abdominal CT and MRI is that neither technique can detect vasculitis in vessels other than the abdominal aorta, which has been described in 43 % of patients with CP [1]. FDG-PET/CT has been proposed as useful tool in inflammatory diseases, such as aortitis, because metabolic changes assessed by FDG-PET usually precede morphological changes assessed by conventional imaging methods [4–8]. Our case highlights the usefulness of FDG-PET/CT at different times in patients with CP. This method may be useful in assessing disease activity and extent at diagnosis, in evaluating the treatment response, in diagnosing the relapse, and in monitoring the disease during follow-up.

The Role of a Tethering Device Attached to the PillCam ESO for the Evaluation and Diagnosis of Esophageal Disorders

Major drawbacks of capsule endoscopy in the esophagus include among others: unpredictable transit time, inability to examine any area of interest more than once, and the compromised quality of pictures by secretions/bubbles that cannot be cleared. The attachment of a tethering device to the Pill Cam ESO has not been previously described and may help to circumvent these deficiencies. Aim: To determine the utility of string capsule endoscopy using the Pill Cam Eso device in evaluation and diagnosis of esophageal disorders. Methods: Thirty-six patients: 14 with Barrett's esophagus, 12 with cirrhosis and portal hypertension and 10 with new esophageal symptoms undergoing EGD were enrolled. The tethering device was attached to the Pill Cam ESO. The study was divided in 2 consecutive diagnostic parts: 1) diagnosis by using the Pill Cam ESO following the manufacturer's recommendations of ingestion and progressive elevation of the head of the bed; 2) diagnosis during the maneuvering of the capsule using the tethering device after the first diagnostic part was completed and/or after the device had entered the stomach. An experienced endoscopist blinded to the EGD findings reviewed the pictures and rendered his diagnoses. Diagnoses were compared to the diagnosis by EGD. In addition the following times were recorded: time to swallow, to first visualization of the z line; to first gastric image; time from 1st Z-line to 1st gastric images and total procedure time. All procedures were carried out using the Real time viewer. Each Pill Cam ESO was retrieved, cleaned, disinfected and used 3 times in different patients. Patients were asked about their preference compared to EGD. Results: Of the 36 patients studied, the mean time from the 1st Z-line to the 1st gastric images was 50.1 sec. However, there were 2 patients in whom the capsule never went into the stomach; 3 patients in whom the time from the z-line to the stomach was zero and 8 additional patients in whom the interval time was ≤ 5 sec. There were 14 patients (38.9%) in whom a firm diagnosis could not be made during the first diagnostic part of the study. The use of the tethering device provided a diagnosis that matched the EGD diagnoses in all except 1 patient (EGD: small varices; string capsule short segment Barrett's). Conclusion: 1) The addition of the tethering device may increase the yield in up to 38% patients in whom the diagnosis cannot be firmly established using the conventional Pill Cam ESO method. 2) Eso-string capsule is a safe, well tolerated procedure without any complications. 3) The majority of patients (86.1%) preferred this tool to EGD.

New Directions in Radionuclide Sources for Brachytherapy.

Brachytherapy continues to play an important role in the management of cancers of several sites, including the head and neck, brain, uterine cervix, endometrium, and prostate. The physical advantages of brachytherapy result from a superior localization of dose to the tumor volume. In brachytherapy, as radiation is continuously delivered over a period of time, repair of sublethal and potentially lethal damage, proliferation, and other cell kinetic effects modify the response of tumor and normal tissues, resulting in complex dose rate effects that also influence the therapeutic ratio for brachytherapy. There are two different forms of brachytherapy. There are two different forms of brachytherapy: intracavitary irradiation using radioactive sources that are placed in body cavities in close proximity to the tumor, and interstitial brachytherapy using radioactive seeds implanted directly into tumor volume. Intracavitary radiation is always temporary and usually takes about 1 to 4 days. On the other hand, interstitial brachytherapy can be temporary or permanent. Radioactive sources emtting higher energy photons have better tissue penetration but are more difficult to shield for radiation protection purposes than sources emitting lower energy photons. Longer-lived radioactive sources can be used several times in different patients, which reduces their effective cost compared with shorter-lived radioisotopes. However, for permanent implants, shorter-lived radionuclides can provide higher initial dose rate, which may have biological advantages in some cases. These characteristics of various forms of brachytherapy dictate the choice of radioactive sources for a specific treatment. Recently, a number of new radionuclide sources have been developed, making a wide variety of half-lives and photon energies available to the brachytherapy community. Conventional sources for brachytherapy in the United States are cesium 137, iridium 192, iodine 125, and gold 198. The physical characteristics of these sources and of the newly developed sources, americium 241, palladium 103, samarium 145, and ytterbium 169, are described.

Phenotypic Characterization of a Large Family With RP10 Autosomal-Dominant Retinitis Pigmentosa: An Asp226Asn Mutation in the IMPDH1 Gene

To evaluate the clinical features associated with the RP10 form of autosomal-dominant retinitis pigmentosa in 11 affected members of various ages from one family with a defined IMPDH1 mutation (Asp226Asn). Prospective, observational case series. Visual function assessment included visual acuity, color vision, visual field, dark adaptometry, full-field electroretinography (ffERG), and multifocal electroretinography (mfERG). Ophthalmologic examinations, fundus photography, and optical coherence tomographic scans were also performed. Blood samples were obtained to screen for basic immune function. Visual acuity was slightly reduced in the teenage years and substantially reduced in association with cystoid macular edema (CME) at all ages. Color defects were observed in three patients (one teen, two adults). Dark-adapted thresholds were elevated. Visual fields were markedly constricted by age 40 (<or=20 degrees). Rod and cone a-wave and b-wave ffERG responses were small or nondetectable by age 20, with greater rod than cone loss at all ages. The normal to significantly delayed ffERG cone b-wave implicit times in different patients were explained by their mfERG implicit times from the central retina. The amplification factors (log S) and recovery kinetics derived from the full-field rod a-waves were normal. Optical coherence tomography revealed subretinal fluid accumulation in the majority of eyes. Cystoid macular edema was diagnosed in four patients. No unusual immunologic findings were noted. The Asp226Asn mutation is associated with a severe, early-onset form of retinal degeneration in members of this family.

Childhood Chronic Inflammatory Demyelinating Polyneuropathy: Clinical Course And Long‐Term Outcome

We reviewed the clinical history, electrophysiologic and pathologic findings, and response to therapy of 16 children with chronic inflammatory demyelinating polyneuropathy. The majority presented with lower limb weakness. Sensory loss was uncommon. The illness was monophasic in seven children, relapsing in six, and three had a slowly progressive course. All patients were treated with immunosuppressive agents. In 11, the initial treatment was prednisolone. All had at least a short‐term response but five went on to develop a relapsing course. Intravenous immunoglobulin was the initial treatment in four patients. Three responded rapidly, with treatment being stopped after a maximum of 5 months. In resistant chronic inflammatory demyelinating neuropathy, in addition to prednisolone and immunoglobulin, plasma exchange, azathioprine, cyclosporine, methotrexate, cyclophosphamide and pulse methylprednisolone were tried at different times in different patients. On serial neurophysiologic testing slowing of nerve conduction persisted for long periods after clinical recovery. Follow‐up was for an average of 10 years. When last seen 14 patients were asymptomatic, two having mild residual deficits. Childhood chronic inflammatory demyelinating neuropathy responds to conventional treatment and generally has a favourable long‐term outcome.

New directions in radionuclide sources for brachytherapy

Brachytherapy continues to play an important role in the management of cancers of several sites, including the head and neck, brain, uterine cervix, endometrium, and prostate. The physical advantages of brachytherapy result from a superior localization of dose to the tumor volume. In brachytherapy, as radiation is continuously delivered over a period of time, repair of sublethal and potentially lethal damage, proliferation, and other cell kinetic effects modify the response of tumor and normal tissues, resulting in complex dose rate effects that also influence the therapeutic ratio for brachytherapy. There are two different forms of brachytherapy. There are two different forms of brachytherapy: intracavitary irradiation using radioactive sources that are placed in body cavities in close proximity to the tumor, and interstitial brachytherapy using radioactive seeds implanted directly into tumor volume. Intracavitary radiation is always temporary and usually takes about 1 to 4 days. On the other hand, interstitial brachytherapy can be temporary or permanent. Radioactive sources emtting higher energy photons have better tissue penetration but are more difficult to shield for radiation protection purposes than sources emitting lower energy photons. Longer-lived radioactive sources can be used several times in different patients, which reduces their effective cost compared with shorter-lived radioisotopes. However, for permanent implants, shorter-lived radionuclides can provide higher initial dose rate, which may have biological advantages in some cases. These characteristics of various forms of brachytherapy dictate the choice of radioactive sources for a specific treatment. Recently, a number of new radionuclide sources have been developed, making a wide variety of half-lives and photon energies available to the brachytherapy community. Conventional sources for brachytherapy in the United States are cesium 137, iridium 192, iodine 125, and gold 198. The physical characteristics of these sources and of the newly developed sources, americium 241, palladium 103, samarium 145, and ytterbium 169, are described.

Percutaneous procedures for trigeminal neuralgia: Microcompression versus radiofrequency thermocoagulation. Personal experience

This paper reports the results achieved in the treatment of trigeminal neuralgia using two different percutaneous procedures: radiofrequency (RF) thermocoagulation (33 patients) and the new percutaneous microcompression (PMC; 74 patients) of the trigeminal ganglion. Acute pain relief was accomplished in 93.2% of the patients treated with PMC and in 81.8% of those treated with the RF method. Two years after the operation, neuralgia had recurred in 56% of the PMC patients and in 42.4% of the RF patients. The average recurrence time was 6.5 months after PMC and 18.5 months after RF. Side effects were essentially of 2 kinds: marked dysaesthesia that occurred after RF lesion in 24.2% and after PMC in 6.7% of the patients, and weakness of the masticatory muscles that was fairly common after PMC, although clinically relevant in only 1 case. The procedure has the benefit of simplicity and fewer side effects. The results obtained by using different compression times in different patients indicates that the most suitable compression time is between 4 and 6 min. When pain recurred the procedure was repeated unless the pain was in the third division, in which case an RF lesion was made. If the pain recurred a second time, RF lesions were made if the pain was in the second or third division.

Predicting lower urinary tract dysfunctions in patients with spinal cord injury

The results of combined cystometry and perineal electromyography were reviewed retrospectively in 75 consecutive, traumatic spinal cord-injured patients to predict lower urinary tract dysfunctions. In patients with vertebral spinal injuries at vertebral level T7 or above a reflex neurogenic bladder eventually developed. In those with vertebral level injuries T11 or below a lower motor neuron bladder dysfunction developed. Injuries at the vertebral levels T8, T9, and T10 represent a gray zone; and, depending on adjacent soft tissue injury, in these patients an upper or lower motor neuron bladder dysfunction developed. The transition from spinal shock (areflexia) to reflex neurogenic (hyperreflexia) bladder occurred at different times in different patients and could not be correlated to level of injury or its severity. The periurethral striated muscle was generally denervated if a lower motor neuron bladder dysfunction existed, however, rarely, dissociation may occur. When a reflex neurogenic bladder existed, sphincter dyssynergia was present 68 per cent of the time. This also could not be correlated with time after injury, level of injury, or severity of injury.

Steady-state plasma concentrations of alprenolol in man.

Plasma concentrations of alprenolol during one inter-dose interval and steady-state plasma concentrations have been determined in 30 patients treated for a prolonged period. The latter varied 25-fold between patients who received identical doses. Peak plasma concentrations were achieved at similar times in different patients, but only the level 5–7 h after administration was well correlated (r=0.997) with the steady-state concentration. The type of pharmacokinetic analysis described here is recommended for studies of the relationships between plasma concentration and effects of drugs with short half-lives.