Mean Blood Loss In Group Research Articles

Uterine artery embolisation combined with local methotrexate for treatment of caesarean scar pregnancy

The aim of the study was to determine the efficacy of uterine artery embolisation (UAE) combined with local methotrexate (MTX) for the treatment of caesarean scar pregnancy, compared with other traditional modalities, and to investigate the complications associated with this treatment. A retrospective cohort study. A large obstetrics and gynaecology unit within a university hospital in China. Women who were diagnosed with a caesarean scar pregnancy between January 2003 and December 2008, and who had informative case records, were included in the study. We reviewed the results for all women who received one of three treatments: dilation and curettage (D&C) (11 patients; group A), systemic MTX (17 patients; group B), and UAE and local MTX (38 patients; group C). The main outcome measures were success rate, blood loss, time for beta human chorionic gonadotrophin (beta-hCG) to decline to normal values, and the duration of hospital stay. Success was defined as a complete recovery with no severe complications and with the preservation of fertility. A total of 66 women diagnosed with caesarean scar pregnancy between January 2003 and December 2008 were identified, and their data were analysed. The success rate in group C was significantly higher than that in groups A and B after adjusting for beta-hCG level (89.5 versus 27.3 and 58.8%, respectively; P < 0.001). The mean blood loss in group C was lower than in the other two groups (240.5 versus 855.5 and 639.4 ml, respectively; P = 0.008 and 0.009, respectively). The average time for beta-hCG to decline to normal values was significantly shorter in group C than in group B (28.1 versus 44.3 days; P = 0.021). A significantly shorter duration of hospital stay was observed in group C compared with group B (12.5 versus 22.0 days; P = 0.024). UAE combined with local MTX is of benefit to women wishing to preserve fertility, and is suitable for use as the primary treatment for caesarean scar pregnancy.

Scoliosis in Duchenne’s muscular dystrophy: a changing trend in surgical management

A non-randomised retrospective study to compare the results of surgical correction of scoliosis in Duchenne's muscular dystrophy (DMD) patients using three different instrumentation systems-Sublaminar instrumentation system (Group A), a hybrid of sublaminar and pedicle screw systems (Group B) and pedicle screw system alone (Group C). Between 1993 and 2003, 43 patients with DMD underwent posterior spinal fusion and instrumentation. Group A (n = 19) had sublaminar instrumentation system, Group B (n = 13) had a hybrid construct and Group C (n = 11) was treated with pedicle system. The mean blood loss in Group A was 4.1 l, 3.2 l in Group B and 2.5 l in Group C. Average operating times in Group A, B and C were 300, 274 and 234 min, respectively. Mean pre-operative, post-operative and final Cobb angle in Group A was 50.05 +/- 15.46 degrees , 15.68 +/- 11.23 degrees and 21.57 +/- 11.63 degrees , Group B was 17.76 +/- 8.50 degrees , 3.61 +/- 2.53 degrees and 6.69 +/- 4.19 degrees and Group C was 25.81 +/- 9.94 degrees , 5.45 +/- 3.88 degrees , 8.90 +/- 5.82 degrees , respectively. Flexibility index or the potential correction calculated from bending radiographs were 60 +/- 6.33, 70 +/- 4.65 and 67 +/- 6.79% for Group A, Group B and Group C respectively. The percentage correction achieved was 72.5 +/- 14.5% in Group A, 82 +/- 6% in Group B and 82 +/- 8% in Group C. The difference between percentage correction achieved and the flexibility index was 12.45 +/- 8.22, 12.05 +/- 1.3 and 15.00 +/- 1.21% in Group A, B and C, respectively The percentage loss of correction in Cobb angles at final follow-up in Group A, B and C was 12.5 +/- 3.5, 16.5 +/- 1. and 12.5 +/- 2.5%, respectively. Complications seen in Group A were three cases of wound infection and two cases of implant failure; Group B had a single case of implant failure and Group C had one patient with wound infection and one case with a partial screw pull out. Early surgery and smaller curve corrections appears to be the current trend in the management of scoliosis in DMD. This has been possible due to early curve detection and surgery thus having the advantage of less post-operative respiratory complications and stay in paediatric intensive care. Also, early surgery avoids development of pelvic deformity and extension of instrumentation to the pelvis thereby reducing blood loss. This trend reflects the advent of newer and safer instrumentation systems, advanced techniques in anaesthesia and cord monitoring. Sublaminar instrumentation system group had increased operating times and blood loss compared to both the hybrid and pedicle screw instrumentation systems due to increased bleeding from epidural vessels and pelvic instrumentation. Overall, the three instrumentation constructs appear to provide and maintain an optimal degree of correction at medium to long term follow up but the advantages of lesser blood loss and surgical time without the need for pelvic fixation seem to swing the verdict in favour of the pedicle screw system.

A Prospective Randomized Study of Clinical Outcomes in Patients With Cervical Compressive Myelopathy Treated With Open-Door or French-Door Laminoplasty

A prospective randomized clinical study. To compare the clinical outcomes of open-door and French-door laminoplasties. Expansive laminoplasty for cervical compressive myelopathy is well established and a variety of modifications procedures have been developed. The procedures are mainly classified into open-door and French-door. It has never been prospectively investigated as to which surgical procedure, open-door or French-door laminoplasty, results in a more favorable outcome. After informed consent was obtained from 40 patients, they were randomized into 2 surgical groups A and B. Patients in group A had open-door laminoplasty, and patients in group B underwent French-door laminoplasty with reattachment of the spinous process and extensor musculatures. The following criteria were evaluated: operation time, blood loss, perioperative complications, Japanese Orthopedic Association (JOA) scores, recovery rates, axial pain, and short-form 36 (SF-36). For radiographic evaluation, cervical lordosis was reviewed as lordotic angles, which were measured at C2-C7. Although the operation time was significantly less in group A as compared with group B, the mean blood loss in group A was significantly more than group B. Perioperative complications occurred more frequently in group A than in group B. Although there were no significant differences in postoperative JOA scores and recovery rates between the 2 groups, axial pain was significantly decreased in group B at final follow-up. The scores of every subscale of the SF-36 were higher in group B than group A. Perioperative complications occurred more frequently in open-door laminoplasty than in French-door laminoplasty. JOA scores and recovery rates suggested that both open-door and French-door laminoplasties could be similarly effective in decompressing the spinal cord. Axial pain was improved in French-door laminoplasty but became worse in open-door laminoplasty. SF-36 suggested that French-door laminoplasty could be more beneficial than open-door laminoplasty for patients with cervical compressive myelopathy.

Less Invasive Total Hip Arthroplasty: Description of a New Technique

We describe a new technique and aim to justify its use in total hip arthroplasty. The incision is short and there is minimal soft tissue dissection: piriformis and most of quadratus femoris remain intact. A meticulous capsular repair is performed. Patients are mobilized without restrictions. One hundred total hip arthroplasties by the standard posterior approach (group 1) were compared with 100 by the less invasive approach (group 2). Minimum follow-up was 2 years. Mean blood loss in group 1 was higher ( P < .0001) and inpatient stay longer ( P < .0001). There was greater improvement in WOMAC scores for up to 1 year in the less invasive group ( P = .027). In conclusion, the less invasive approach is safe and the functional benefits last up to 1 year.

Comparison of Ileal Conduit and Transureteroureterostomy with Ureterocutaneostomy Urinary Diversion

Introduction: We compare the postoperative early and late complications of patients who had undergone ileal conduit (IC) urinary diversion and transureteroureterostomy (TUU) with ureterocutaneostomy (UC) urinary diversion during the same interval and by the same surgeons. Materials and Methods: Between 1992 and 2004, we performed TUU with UC urinary diversion in 27 men and 7 women (group I) and ileal conduit urinary diversion in 57 men and 10 women (group II). The mean age of the TUU with UC diversion and the ileal conduit patients was 57 ± 11.2 (range 51–76) and 64 ± 12.6 (range 54–76) years, and the mean follow-up was 37 (range 14–52) and 56 (range 14–72) months, respectively. The 6F or 8F stents were used routinely. Results: Of 34 TUU with UC cases 8 (23.52%) had early postoperative complications and 2 (5.88%) had early reoperation rates, whereas 11 (16.42%) of 67 ileal conduit cases had early postoperative complications and 4 (5.97%) had early reoperation. The mean hospital stay was 7 (range 5–25 day) and 11 (range 7–34 day) days for each group, respectively. Of the TUU and UC cases, 6 (17.64%) had late complications and 3 had (8.82%) late reoperation, whereas 14 conduit cases (20.89%) had late complications and 6 had (8.9%) late reoperation. Early postoperative complications were defined as those that occurred before hospital discharge or within 30 days from the date of surgery and late complications were defined as those occurring greater than 30 days from the date of surgery as previously described. In group I, the mean operative time was 170 min (range 120–325) compared with 260 min (range 170–473) in group II. The mean blood loss in group I was 474 ml (range 250–1,400) and 589 ml (range 300–1,700) in group II (p > 0.05). Conclusions: Our results suggest that patients undergoing a TUU and UC diversion have no additional risk of reoperation and the TUU with UC urinary diversion is a safe procedure with postoperative early and late complications.