Incidence Of Postoperative Fever Research Articles

Internal Iliac Artery Balloon Occlusion for Placenta Previa and Suspected Placenta Accreta: A Randomized Controlled Trial.

To investigate the effect of intraoperative balloon occlusion of the internal iliac arteries in women with placenta previa and antenatally diagnosed placenta accreta. In this single-center, randomized controlled trial, women with placenta previa and antenatally suspected placenta accreta were randomly assigned to either the balloon occlusion group or to the control group. The perioperative management approach was similar for both groups, other than preoperative balloon catheter placement and intraoperative occlusion of bilateral internal iliac arteries. The primary outcome was the number of packed red blood cell (RBC) units transfused. With a two-sided α of 0.05 and a power of 0.8, a sample size of 48 women per group was calculated to detect a mean reduction of 2 units packed RBCs transfused with an expected SD of 3.5. From August 2017 to July 2018, we randomized 50 eligible women to the balloon group and 50 to the control group. Demographic, obstetric, and placental imaging characteristics were similar between groups. The number of packed RBC units transfused was not significantly different between groups (5.3±5.3 in the occlusion group vs 4.7±5.4 in the control group, P=.54). Hospitalization costs and incidence of postoperative fever were significantly higher in the balloon group. No significant differences were found in other outcomes. Intraoperative balloon occlusion of the internal iliac arteries did not reduce the number of packed RBC units transfused in women with placenta previa and antenatally suspected placenta accreta. Chinese Clinical Trial Registry, ChiCTR-IOR-17012244.

Comparison of the clinical benefits for non-small cell lung cancer patients between different volume of pleural lavage fluid following video-assisted thoracoscopic lobectomy and systematic mediastinal lymph node dissection: study protocol for a randomized controlled trial

BackgroundPleural lavage is regularly performed before closing the chest wall in pulmonary surgeries to prevent pleural implantation of tumor cells and postoperative infection. However, scant data could be found in the literature regarding the optimal regimen for performing pleural lavage. To establish a proper volume of pleural lavage, we herein designed a protocol for a randomized controlled trial.MethodsA total of 400 participants with non-small cell lung cancer undergoing video-assisted thoracoscopic surgery (VATS) lobectomy and systematic mediastinal lymph node dissection (MLND) will be randomly assigned to one of two groups: group A (500 mL pleural lavage fluid) and group B (3000 mL pleural lavage fluid). The primary outcomes include the levels of leukocytes, neutrophils, and inflammatory factors on the first postoperative day. The secondary outcomes include (i) the levels of leukocytes, neutrophils, and inflammatory factors on the second and third postoperative days; (ii) the incidence of postoperative fever on the first, second, and third postoperative days; (iii) the volumes of chest drainage within the first 3 operative days, the duration of drainage, and postoperative hospitalization; and (iv) the incidence of postoperative complications (incision infection, pain, atelectasis, hemorrhage, etc.) and the incidence of pleural effusion requiring thoracic puncture or drainage within 30 days after surgery. The main content of the analysis includes effectiveness and safety analysis. We will perform subgroup analyses to identify potential influence factors.DiscussionAs far as we know, this will be the first randomized controlled trial to compare the clinical outcomes between different volumes of pleural lavage fluid following VATS and MLND. Findings from this trial will determine the appropriate amount of pleural lavage before chest wall closure.Trial registrationThis study was registered with the Chinese Clinical Trial Registry ( on 17 March 2019. ChiCTR 1900021950).

Is plasma sterilization the modality of choice of sterilization today for endourological procedures such as ureterorenoscopy and retrograde intrarenal surgery? A single-center retrospective evaluation of 198 patients.

Introduction:The prevalence of infective complications among patients undergoing Retrograde Intrarenal Surgery (RIRS) for renal stone is 1.7%-18%, including fever, Systemic Inflammatory Response Syndrome (SIRS) and sepsis. The infectious complications of RIRS can be minimised by strict aseptic precautions and plasma sterilization. The Sterrad Next Generation (Sterrad NX) System, a low-temperature sterilizer represents the next generation of low-temperature hydrogen peroxide gas plasma sterilizers. This study was conducted to evaluate the efficacy of plasma sterilization among patients undergoing ureterorenoscopy (URS) and RIRS. The primary endpoint of this study was incidence of septicemia or related complications. Till date, there is no study on the incidence of infection rate in RIRS in relation to a specific mode of sterilization.Material and Methods:This is a retrospective study comprising of 198 patients undergoing URS and/or RIRS. The parameters studied were incidence of post-operative fever, Systemic Inflammatory Response Syndrome (SIRS), pyelonephritis or septicemic shock.Results:Out of 198 patients, incidence of post-operative fever was 3.5%, SIRS was 1.7%, pyelonephritis was 0.7% and septicemic shock was 0%. This is statistically significantly low septicemia rate among patients undergoing URS and /or RIRS as compared to the available literature. No health hazards of plasma sterilization were noted. No damage to the endoscopes or instruments was noted.Conclusion:Sterrad NX based on hydrogen peroxide gas plasma (HPGP) technology is highly efficacious, safe and the modality for sterilization of instruments, including heat labile instruments such as semi rigid, flexible and chip on the tip endoscopes and other EndoUrology armamentarium.

A Prospective observational study of single-dose prophylactic antibiotic in caesarean delivery and its effect on maternal infectious morbidity

Introduction: Caserean delivery is the most commonly performed in obstetrics. Antibiotics have revolutionised the surgical practice in this era. But multidrug resistance is a challenging issue in practice. So antibiotics have to be administered judiciously at the appropriate time with respect to surgery. Aim: To determine whether the administration of single-dose injection ceftriaxone 1gm intravenously prior to skin incision was superior to the administration at the time of cord clamping for prevention of post-caesarean maternal infectious. Material and Methods: A prospective observational study was conducted in BLDE (DU) Shri B M Patil medical college and research centre, Vijayapura, Karnataka. Patients undergoing caesarean sections for singleton term pregnancies both elective and emergency with intact membranes were included in the study during the one-year period. Alternatively, Group A received 1gm Injection ceftriaxone intravenously 60 mins before skin incision and group B received at the time of cord clamping during surgery. Results: Incidence of obstetric complications such as nausea (0.5% vs 0.0%) and wound infections (6.6% vs 4.1%) were more in patients received a single dose of ceftriaxone at cord clamping than patients received the same antibiotic, preoperatively. Whereas, the incidence of postoperative fever was more in patients received a single dose of ceftriaxone preoperatively (4.1%) than intraoperatively (3.3%) which was although not significant but is an important finding in our study. Conclusion: Administration of single-dose antibiotic either preoperatively or at the time of cord clamping was not statistically significant in reducing the incidence of wound infections. However, we noticed that the antibiotic administration pre-operatively reduced the infections compared to the cord clamp group.

Single Dose Prophylactic Antibiotic in Caesarean Delivery and its Effect on Maternal Infectious Morbidity: A Prospective Observational Study

Introduction: Caesarean delivery is the most common surgery performed in obstetrics. Antibiotics have revolutionised the surgical practise in this era. But multidrug resistance is a challenging issue in day to day practise. So, antibiotics have to be administered judiciously at the appropriate time with respect to surgery. Aim: To determine whether the administration of single dose injection ceftriaxone 1 gm intravenously prior to skin incision was superior to administration at the time of cord clamping for prevention of post-caesarean maternal infection. Materials and Methods: A prospective observational study was conducted in BLDE (DU) Shri BM Patil Medical College and Research Centre, Vijayapura, Karnataka, India. Patients undergoing caesarean sections for singleton term pregnancies both elective and emergency with intact membranes were included in study during one-year period. Alternatively, group A received 1 gm injection ceftriaxone intravenously 60 minutes before skin incision and group B received at the time of cord clamping during surgery. Chi-square (χ2) test was used for association between two categorical variables. Results: Incidence of obstetric complications such as nausea (0.5% vs 0.0%) and wound infections (6.6% vs 4.1%) were more in patients who received a single dose of ceftriaxone at cord clamping than patients receiving the same antibiotic, preoperatively whereas, incidence of postoperative fever was more in group A (4.1%) than group B (3.3%) which was although not significant but is an important finding in this study. Conclusion: Administration of single dose antibiotic either preoperatively or at the time of cord clamping was not statistically significant in reducing the incidence of wound infections.

The incidence and risk factors for surgical site infection in older adults after gastric cancer surgery: A STROBE-compliant retrospective study.

Surgical site infection (SSI) is a well-known complication in older adults. However, there have been no studies on SSI after gastrectomy in older adults. Therefore, we aimed to investigate the incidence, risk factors, and outcomes of SSIs after gastrectomy in older adults.We performed a retrospective cohort study of older adults, aged 65 years or older, who underwent gastrectomy between January 2015 and December 2015 at the Severance Hospital in Seoul, Korea. The incidence and outcomes of SSIs after gastrectomy were evaluated, and the risk factors for SSI were identified using multivariate analyses.We identified 353 older adults who underwent gastrectomy. Of these, 25 patients (7.1%) developed an SSI. Multivariate analysis indicated that open surgery (odds ratio, 2.71; 95% confidence interval, 1.13–6.51; P = .03) and a longer operation time (odds ratio, 1.01; 95% confidence interval, 1.00–1.01; P = .04) were independent risk factors for SSI after gastrectomy. In the SSI group, the incidence of postoperative fever (84.0% vs 51.8%; P < .001), length of postoperative hospital stay (13 days vs 6 days; P < .001), and re-admission rates within 30 days postoperatively (32.0% vs 3.4%; P < .001) were significantly higher than those in the non-SSI group.The risk factors for SSI in older adults after gastrectomy were open surgery and a longer operation time. When an SSI occurred, the postoperative hospital stay was prolonged and the chances of having a postoperative fever and being re-admitted within 30 days increased.

Myomectomy at the time of Cesarean Section: A Prospective Multicentre Study

Background: Myomectomy can be performed during cesarean section.&#x0D; Objective: The purpose of the present study was to assess the safety and efficacy of myomectomy during cesarean section.&#x0D; Methodology: The study design was a prospective multi-centre study done in three tertiary care hospitals Dhaka Medical Collage, BSMMU &amp; private Hospital in Dhaka City. The subject were 65 pregnant women elective or emergency myomectomy during cesarean section. All cesarean section myomectomy were performed by consultants. Intra-operative and post-operative complications such as change in haematocrit, length of operation, blood loss were estimated. Length of hospital stay was also recorded.&#x0D; Results: 79 Fibroid of various sizes (2 to 6cm) were removed from 65 women. Fibroid were on the anterior uterine wall with most being sub serous and intra mural. Four patients had one unit of whole blood transfusion in post-operative period. No hysterectomy was done at the time of cesarean section. There was no significant change of haematocrit: incidence of post-operative fever and duration of operation. The mean duration of post-operative hospital study was 7.3±1.2 days, 5 patients subsequently became pregnant, were also underwent repeated cesarean section in the study period.&#x0D; Conclusion: In selected cases myomectomy during cesarean section does not appear to result in an increased risk of intrapartum or short-term post-partum morbidity if performed by an experienced practitioner. Cesarean myomectomy is a safe surgical options with no significant complications.&#x0D; Journal of Current and Advance Medical Research 2019;6(1):18-22

Safety and Efficacy of Percutaneous Nephrolithotomy in Patients with Large Stones

Aims: The aim of the study is to evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) in patients with large stones. Subjects and Methods: From January 2011 to June 2016, 425 tubeless PCNLs were performed at our hospital. All patients underwent a single-stage procedure with a metal dilator. Of the 425 patients, 93 had stone sizes ≥5 cm (mean: 7.77 cm, Group 1) and 332 patients had stone sizes &lt;5 cm (mean: 2.75 cm, Group 2). Data analysis was performed using Statistical Package for the Social Sciences, V. 21.0. Numerical variables were compared by independent-samples t-test. Categorical variables were compared by Chi-square or Fisher's exact test as appropriate. P &lt; 0.05 was deemed statistically significant. Results: The duration of surgery was longer in Group 1 than in Group 2 (93.6 vs. 70.4 min, P &lt; 0.001). There were no significant differences between the two groups in the incidence of postoperative fever (8% vs. 7%) or sepsis (both 1%). In addition, no significant difference was observed in the length of postoperative hospital stays (3.05 vs. 3.2 days) although the transfusion rate was higher in Group 1 (6/93 vs. 4/332, P = 0.003). No other major complications or conversion to open surgery occurred in either group. Conclusions: Tubeless PCNL performed in patients with stones ≥5 cm in size has a reasonable and acceptably higher transfusion rate, with no other associated major complications.

Institutional Audit on Percutaneous Nephrolithotomy

Background : Percutaneous nephrolithotomy (PCNL) is commonly used in the management of large upper renal tract stones. It is highly effective but carries a greater risk of significant morbidity than less invasive treatment options such as ureteroscopy or extracorporeal shock wave lithotripsy Aims and Objectives : To analyse contemporary PCNL practice within our institute with an emphasis on outcome measures, including stone free and reduced complication rates and compare our data with previously published series. Material and Methods : A prospective study was conducted in 145 patients from January 2015 to June 2016 in Department of Urology, Indira Gandhi Institute of Medical Sciences who underwent PCNL procedure as per standard protocols. Effectiveness was assessed by stone-free rates and safety according to complications including blood transfusion, fever, and sepsis rates Results : From January 2015 to June 2016, data on 145 patients who had PCNL procedures were collected. A total 17 of 145 procedures (11.7%) were for staghorncalculi, 84 (58%) for stones >2 cm, 41(28.3%) for stones 1–2 cm, and 3 (2.1%) for stones<1 cm. Complete stone clearance has been achieved in more than three fourth of the cases (76.6.%). Totally tubeless procedures were not associated with higher complication rates but did lead to a significant reduction in median length of stay (3 d vs 1.5 d; p <0.0001). Blood transfusion was required in 10 of 145 patients (6.4%). The incidence of postoperative fever was 19% and of sepsis was 4%. Conclusion : The PCNL data registry is a unique resource providing vital information on current practice and critical outcome data. Using the registry, endourologists can audit their practice against national outcome data for this benchmark procedure. It will help surgeons counsel patients during consent for this complex endourologic procedure about the possible outcome in their hands.

Is nephrostomy tube a rule following all Percutaneous Nephrolithotomy (PCNL)? A prospective randomized study

Introduction: Exit strategy at the end of percutaneous nephrolithotomy (PCNL) differs from center to center and patient to patient. Standard PCNL has been practiced so far with minor postoperative morbidities. Tubeless PCNL, which obviates most of the nephrostomy related morbidities, has been challenged for its safety. So this study was conducted to compare the safety and morbidity of tubeless PCNL with standard PCNL.&#x0D; Methods: Patients who had undergone PCNL, were randomized into group 1 (standard) and group 2 (tubeless) using computer generated random table. In group 1, nephrostomy tube was placed at the end of the procedure and tubes were omitted in group 2 patients. All preoperative, intraoperative and postoperative parameters were recorded and compared in between the groups.&#x0D; Results: Ninety six PCNLs were randomized into group 1 (47 patients) and group 2 (49 patients). Patients’ characteristics including age, sex, comorbidities, preoperative parameters, size and number of stones and mean operation time were comparable in between the groups. The incidence of postoperative fever, pain and analgesic requirement and urinary leak were found more in group 1 patients. The incidence of postoperative complications and events were comparable in both the groups except for blood transfusion. The mean length of postoperative hospital stay for patients in group 2 was significantly low as compared to group 1.&#x0D; Conclusion: Tubeless PCNL is safe and has less morbidity as compared to standard PCNL in selected cases.

Comparison of renal pelvic pressure and postoperative fever incidence between standard- and mini-tract percutaneous nephrolithotomy

This study was proposed to compare the clinical effectiveness of mini-tract percutaneous nephrolithotomy (MPCNL) with standard-tract percutaneous nephrolithotomy (SPCNL) and verify whether MPCNL is associated with both higher renal pelvic pressure (RPP) and incidence of postoperative fever. A total of 228 patients with kidney stone were randomly allocated to the MPCNL group (n=114) and SPCNL group (n=114). Both intraoperative and postoperative indexes along with the incidence of complications were compared between the two treatment groups. RPP was measured using a baroreceptor which was connected to an open-ended ureteric catheter during the operation of percutaneous nephrolithotomy. The MPCNL group exhibited significantly longer average operation time, more average amount of flush water, and lesser average amount of bleeding during the operation than the SPCNL group (p<0.05). Moreover, significantly lesser average amount of postoperative serum creatinine, shorter average hospital stay, and more average amount of postoperative hemoglobin were observed in the MPCNL group than in the SPCNL group (p<0.05). MPCNL were more applicable to clear caliceal stones (p<0.05), whereas SPCNL were more effective for the removal of simple pelvic stones. The difference in the incidence of postoperative fever between the two treatment groups also appeared to be significant (p<0.05). Logistic regression provided solid evidence that both RPP and its accumulation time at which RPP≥30 mmHg significantly affected the incidence of postoperative fever. MPCNL was correlated with both higher RPP and increased likelihood of postoperative fever compared with SPCNL.

Bilateral Same-Session Ureteroscopy for Treatment of Ureteral Calculi: A Systematic Review and Meta-Analysis.

The traditional procedure for the management of bilateral ureteral stones is staged ureteroscopic lithotripsy (URS). However, in recent years particularly, some urologists advocate same-session bilateral URS on the ground of success rates and minimal morbidity. This systematic review is to evaluate the efficacy and safety of same-session bilateral ureteroscopy for the treatment of ureteral calculi. We conducted a bibliographic search using MEDLINE (1980 to August 2015) and EMBASE (1980 to August 2015). Review articles and abstract data were excluded and only studies in English reporting on outcomes of bilateral URS were included in this meta-analysis. Two reviewers independently assessed the quality of each included studies and extracted data. STATA 12.0 was used for meta-analysis. In 11 studies, 431 patients were reportedly treated with bilateral URS. Most of the stone sizes were not larger than 20 mm. The mean stone-free rate is 96% for the distal ureter, 85% for the middle ureter, and 72% for the proximal ureter. The mean operative time ranged from 45 to 100 minutes with an average hospital stay from 2 to 4 days. The overall complications rates were 17%, with the incidence of postoperative fever 4%, postoperative pain 20%, and gross hematuria 4%. Other complications, including urosepsis, urinary tract infection, small mucosal laceration, stone migration, and ureteral perforation, accounted for 6% of overall complications. This meta-analysis found that bilateral same-session ureteroscopy could achieve a high overall stone-free rate. There might be a relatively higher complication incidence, but most of the complications are minor. For selected cases, bilateral URS could be safe and effective.

Systematic evaluation of brucea javanica oil adjuvant therapy of primary hepatocellular carcinoma

Objective To review the efficacy and safety of brucea javanica oil in the adjuvant therapy of primary hepatocellular carcinoma (HCC). Methods China National Knowledge Infrastructure (CNKI), China Biology Medicine (CBM), VIP, Wanfang database, Pubmed, Web of Science, ScienceDirect, and Cochrane Library were searched from their inception to December 2015. Then contact with the field experts and correspondence authors for gray literature. Two reviewers independently searched the databases, performed data extraction, and appraised the publications. The Reviewer Manager 5.3 software was employed for data analysis. Results Fifteen clinical trials with 1 128 HCC patients were included. Meta-analysis confirmed that the brucea javanica oil group, compared to the control group, was more advantageous to reduce the incidence of postoperative fever, bone marrow suppression, and gastrointestinal reaction. In addition, it might reduce the level of alpha fetoprotein (AFP), enhance immunity, and improve clinical symptoms. However, more evidence would be needed to support these results. Conclusions Brucea javanica oil is considered to reduce toxicity and increase efficiency in the adjuvant therapy for the HCC, but more high quality, multi-center, large sample, randomized, double-blind clinical trials are also needed for supporting this view. Key words: BRUCEA JAVANICA/AD; Liver neoplasms/ZD

Contributing Factors for Fever After Tubeless Percutaneous Nephrolithotomy

To evaluate the contributing factors for fever after tubeless percutaneous nephrolithotomy (PCNL). Between May 2009 and December 2013, 395 tubeless PCNLs were performed at our hospital. After stone extraction, the bleeding points were cauterized for hemostasis to enable tubeless modification. In patients with troublesome bleeding after cauterization, oxidized regenerated cellulose (Surgicel) strips were used to tamponade the access tract to facilitate bleeding control. The contributory factors for fever were evaluated by a retrospective chart review. Forty-four patients (11.7%) developed fever after tubeless PCNL. There was no difference in gender, age, and body mass index in the development of fever. Episodes of febrile or septic urinary tract infection before PCNL were found to have occurred in 35 patients, but the incidence of postoperative fever was not significantly higher in these patients. There is no significant difference in the mean stone size in fever and nonfever patients. Complete staghorn stones were noted in 40 patients, and their fever rate was not significantly higher than patients with nonstaghorn stone. The operation time is not significantly higher in the group with urinary tract infection. Patients with postoperative fever had a high incidence of residual stones than the remaining patients (38.9% vs 20.4%). There was no significant difference in incidence of postoperative fever in patients with struvite stones than patients with nonstruvite stones. In patients who received Surgicel packing, the incidence of fever was not significantly higher. Incomplete stone extraction is a major contributing factor for the development of fever after tubeless PCNL.

Myomectomy at Cesarean Delivery in Aba, Southeastern Nigeria

INTRODUCTION: Myomectomy during cesarean delivery is usually avoided because of the risk of intractable hemorrhage. This study was undertaken to compare the efficacy and safety of cesarean myomectomy with a control group with uterine fibroids who had cesarean delivery without myomectomy. METHODS: A prospective clinical trial of cesarean myomectomy compared with cesarean delivery without myomectomy in women with uterine fibroids in pregnancy was carried out in Nigerian Christian Hospital, Aba, between March 2004 and March 2010. Thirty-four patients with uterine fibroids in pregnancy and who had cesarean delivery and myomectomy for various indications were selected. Thirty patients who also had uterine fibroids in pregnancy and had cesarean delivery alone were selected as control participants. RESULTS: The estimated blood loss, postoperative packed cell volume, and the need for blood transfusion and operation time were significantly higher in the cesarean myomectomy group when compared with those in the control group. Among patients in the study group, the need for blood transfusion and operation time were significantly higher in those who had greater than 10 myomas when compared with those who had less than 10 myomas. There was no significant difference in the incidence of postoperative fever and duration of hospital stay between the cesarean myomectomy patients and those in the control group. CONCLUSION: This study adds to growing body of evidence demonstrating the safety and efficacy of cesarean myomectomy in selected patients but it also shows that it should be carried out with caution and adequate cross matched blood, especially in patients with multiple fibroids.

Antimicrobial prophylaxis in tonsillectomy: the efficacy of preoperative single-dose oral administration of azithromycin in preventing surgical site infection

Conclusion: The results indicate that oral administration of azithromycin (AZM) is equivalent to intravenous administration of cefazolin (CEZ) for preventing surgical site infection (SSI) in patients undergoing tonsillectomy, and should be used as cost-effective antimicrobial prophylaxis. Objective: Staphylococcus aureus, Streptococcus spp., and pharyngeal anaerobes have been described as major pathogens causing SSI in transpharyngeal operations such as tonsillectomy. The purpose of this study was to explore whether administration of AZM, an oral antimicrobial agent, might be equivalent to intravenous administration of a first-generation cefem antimicrobial agent for preventing SSI in patients undergoing tonsillectomy. Methods: Patients undergoing tonsillectomy were divided into an AZM-treated group and a CEZ-treated group, for intergroup comparison of responses. AZM was administered once orally, 2 days before the operation, whereas patients in the CEZ-treated group received CEZ intravenously 30 min before the operation, 4 h postoperatively, and then twice daily for 3 consecutive days beginning the day after the operation. Results: There were no significant intergroup differences in mean duration of hospitalization after the operation, incidence of postoperative hemorrhage, postoperative analgesic effect, or hematologic/blood biochemical findings. The incidence of postoperative fever was significantly lower in the AZM-treated group. Diarrhea occurred as an adverse drug reaction in the AZM-treated group, but no clinically significant adverse reactions were noted.

Evaluation of Total Laparoscopic Hysterectomy With and Without the Use of Barbed Suture

ObjectiveTo evaluate the outcome of total laparoscopic hysterectomy with and without the use of barbed suture. MethodsWe conducted a retrospective study among patients who underwent total laparoscopic hysterectomy between February 2008 and August 2012. The parameters evaluated were age, BMI, operative time, hospital stay, pre- and postoperative hemoglobin levels, uterine weight, intraoperative blood loss, and postoperative complications. ResultsA total of 202 women underwent total laparoscopic hysterectomy; barbed suture (V-Loc) was used in 63 women, and polydioxanone (PDS) in 139. Estimated blood loss, difference in hemoglobin level before and after surgery, operative time, and the duration of hospital stay were comparable between the two groups of patients. The incidence of postoperative fever was higher in the V-Loc group than in the PDS group (P = 0.003). Multiple linear regression analysis showed that the incidence of postoperative fever was related to BMI (P = 0.02, r = 0.22) and estimated blood loss (P = 0.004, r = 0.28) and not to age, operative time, or uterine weight. ConclusionThe use of barbed suture to close the vaginal vault after laparoscopic hysterectomy, compared with standard suture, results in similar operative time, blood loss, and duration of hospital stay. The use of barbed suture is technically less demanding than the use of regular sutures.

Micropercutaneous nephrolithotomy (microperc) vs retrograde intrarenal surgery for the management of small renal calculi: a randomized controlled trial

To compare micropercutaneous nephrolithotomy (microperc) and retrograde intrarenal surgery (RIRS) for the management of renal calculi <1.5 cm with regard to stone clearance rates and surgical characteristics, complications and postoperative recovery. Seventy patients presenting with renal calculi <1.5 cm were equally randomized to a microperc or a RIRS group between February 2011 and August 2012 in this randomized controlled trial. Randomization was based on centralized computer-generated numbers. Patients and authors assessing the outcomes were not blinded to the procedure. Microperc was performed using a 4.85-F (16-gauge) needle with a 272-μm laser fibre. RIRS was performed using a uretero-renoscope. Variables studied were stone clearance rates, operating time, need for JJ stenting, intra-operative and postoperative complications (according to the Clavien-Dindo classification system), surgeon discomfort score, postoperative pain score, analgesic requirement and hospital stay. Stone clearance was assessed using ultrasonography and X-ray plain abdominal film of kidney, ureter and bladder at 3 months. There were 35 patients in each group. All the patients were included in the final analysis. The stone clearance rates in the microperc and RIRS groups were similar (97.1 vs 94.1%, P = 1.0). The mean [sd] operating time was similar between the groups (51.6 [18.5] vs 47.1 [17.5], P = 0.295). JJ stenting was required in a lower proportion of patients in the microperc group (20 vs 62.8%, P < 0.001). Intra-operative complications were a minor pelvic perforation in one patient and transient haematuria in two patients, all in the microperc group. One patient in each group required conversion to miniperc. One patient in the microperc group needed RIRS for small residual calculi 1 day after surgery. The decrease in haemoglobin was greater in the microperc group (0.96 vs 0.56 g/dL, P < 0.001). The incidence of postoperative fever (Clavien I) was similar in the two groups (8.6 vs 11.4%, P = 1.0). None of the patients in the study required blood transfusion. The mean [sd] postoperative pain score at 24 h was slightly higher in the microperc group (1.9 [1.2] vs 1.6 [0.8], P = 0.045). The mean [sd] analgesic requirement was higher in the microperc group (90 [72] vs 40 [41] mg tramadol, P < 0.001). The mean [sd] hospital stay was similar in the two groups (57 [22] vs 48 [18] h, P = 0.08). Microperc is a safe and effective alternative to RIRS for the management of small renal calculi and has similar stone clearance and complication rates when compared to RIRS. Microperc is associated with higher haemoglobin loss, increased pain and higher analgesic requirements, while RIRS is associated with a higher requirement for JJ stenting.

1544 RISK FACTORS FOR FEVER AND SEPSIS AFTER PERCUTANEOUS NEPHROLITHOTOMY

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopy or Percutaneous Stone Removal (I)1 Apr 20131544 RISK FACTORS FOR FEVER AND SEPSIS AFTER PERCUTANEOUS NEPHROLITHOTOMY Alejandro Gonzalez-Ramirez, Leopoldo Camarena, and Jorge Gutierrez-Aceves Alejandro Gonzalez-RamirezAlejandro Gonzalez-Ramirez Guadalajara, Mexico More articles by this author , Leopoldo CamarenaLeopoldo Camarena Guadalajara, Mexico More articles by this author , and Jorge Gutierrez-AcevesJorge Gutierrez-Aceves Winston Salem, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3034AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous nephrolithotomy (PCNL) is a safe and effective treatment option for large renal calculi. However after PCNL 10 to 35% of patients develop systemic inflammatory response with sepsis progression in 2.5%. The incidence of postoperative fever following PCNL may be as high as 37%, in one third of patients fever is developed despite negative preoperative urine cultures. These often incur in prolonged hospitalization and higher health cost. Due to the high morbidity of urosepsis, it is crucial to identify the patients that are in a high risk to develop sepsis. The purpose of the study is recognize pre and intraoperative factors that may increase the risk to develop fever and urinary sepsis after PCNL. METHODS Retrospective analysis of the database over the last 5 years in a single center from patients who underwent percutaneous nephrolytothomy. We define fever more than 100.4°F, sepsis is defined by the International Sepsis Definitions Conference of 2001 as the presence of a source of infection with systemic inflammatory syndrome (SIRS). The demographics and surgical characteristics from patients who develop fever or sepsis (Group1) were compared with those that did not develop these complications (Group2), taking the next variables for analysis: Gender, BMI, diabetes, previous urine culture, staghorn stone, multiple tract, surgical time, transfusion and nephrostomy tube. Chi-square, Fisher Exact and T-Test were used for the statically analysis with SPSS 18. RESULTS From a total of 280 patients treated with PCNL, 58 patients developed postoperative fever and 6 more developed sepsis. BMI less than 18.5 (0.005), the presence of staghorn stone (0.001), bleeding during surgery, higher transfusion rate (0.032) and a longer operative time (0.004) were statistically significant for fever development. Bleeding and transfusion were significant factors for the development of sepsis (p=0.02 and p=0.005 respectively). CONCLUSIONS Staghorn stones, BMI<18.5, bleeding, and surgical time are risk factors for fever development while bleeding is a significant risk factor to develop sepsis. Traumatic surgery may be related to parenchyma damage and bleeding that may favor bacterial migration to bloodstream. In our population we did not found that a previous positive urine cultures, a multiple tract procedure or the presence of a nephrostomy tube were significant risk factors to develop fever. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e633 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alejandro Gonzalez-Ramirez Guadalajara, Mexico More articles by this author Leopoldo Camarena Guadalajara, Mexico More articles by this author Jorge Gutierrez-Aceves Winston Salem, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Justification for hysterectomies and frequency of histopathological lesions of hysterectomy at a Teaching Hospital in Peshawar, Pakistan

Objective: To determine the justification for hysterectomies and the frequencies of histopathological lesions and complications in hystrectomised patients. Methodology: As a part of a quality assurance process at the Mercy Teaching Hospital, hysterectomies performed between 1st January, 2010 and 1st Jan 2012 were retrospectively analyzed for presenting complaints, surgical indication, histologic findings, and postoperative complications. The hysterectomy was considered justified if the preoperative diagnosis was verified by the pathology report or if significant alternate pathology was present. Results: A total of 123 hysterectomies were performed during this period. Eleven (8.9%) patients’ results could not be traced. The other 91.1% had some pathology found. Histologic findings reconfirmed the clinical diagnoses. The hysterectomies were considered justified if p=0.000. Hysterectomy was performed abdominally in 88 (71.5%) patients, vaginally in 35 patients (28.4%). The most common indication for hysterectomy was fibroid related menorrhagia n=40(32.5%), followed by third degree uterovaginal prolapse n=30(24.4%), and dysfunctional uterine bleeding 29(23.6%) patients. Fever was the most common 7(5.7%) post operative complication followed by urinary tract infection 5(4.9%) The incidence of postoperative fever was greater following abdominal surgery, while urinary tract infection was greater following vaginal hysterectomy (P=0.370). Conclusion: Almost 91.1% of all hysterectomies in this study were justified. Clinical diagnoses were related to presenting complaints (p=0.000) and were confirmed by histopathogic findings (p=0.000). Most of the hysterectomies were carried out abdominally in part because fewer patients presented with prolapse.