Patients In First Group Research Articles

Optimal Infusion Rate of Norepinephrine for Prevention of Spinal Hypotension for Cesarean Delivery: A Randomized Controlled Trial, Using Up-Down Sequential Allocation.

Norepinephrine has recently been suggested to be as effective as phenylephrine for the prevention of hypotension after spinal anesthesia for cesarean delivery. Moreover, compared to phenylephrine, norepinephrine may be superior in maintaining heart rate (HR) and consequently, cardiac output (CO). A recent study demonstrated that norepinephrine given as a single intravenous bolus is approximately 13 times more potent than phenylephrine. However, it is uncertain whether this finding can be applied when these vasopressors are administered as infusions. Therefore, the optimum infusion rate of norepinephrine remains unknown. We aimed to determine the median effective dose (ED50; defined as the rate of vasopressor infusion required to prevent spinal hypotension in 50% of subjects) of both drugs needed to maintain maternal systolic blood pressure within 20% of the baseline after spinal anesthesia for cesarean delivery and to derive the relative potency ratio. Sixty healthy patients undergoing elective cesarean delivery with standardized spinal anesthesia were randomized into 2 groups. The first patient in group 1 received phenylephrine 1200 µg in normal saline 0.9% w/v 60 mL at 60 mL/h infusion rate (20 µg.min-1). The first patient in group 2 received norepinephrine 96 µg in normal saline 0.9% w/v 60 mL at 60 mL/h infusion rate (1.6 µg.min-1). Using up-down sequential allocation technique, the vasopressor dose for every subsequent patient was determined by the response in the previous patient. If effective, the next patient received a dose reduced by 150 µg of phenylephrine (2.5 µg.min-1) or 12 µg (0.2 µg.min-1) of norepinephrine. If ineffective, the dose for the next patient was increased by the same amount. The ED50s were determined according to the Dixon-Massey formula. Stroke volume (SV), HR, and CO were also measured. The ED50 was 12.7 µg.min-1 (95% CI, 10.5-14.9) for phenylephrine and 1.01 µg.min-1 (95% CI, 0.84-1.18) for norepinephrine, giving a potency ratio of 12.6 (95% CI, 9.92-15.9). HR, SV, and CO did not differ between the groups. Norepinephrine is more potent than phenylephrine by a factor of approximately 13 when administered as infusion for equivalent maternal blood pressure control. Based on these findings, we recommend a variable rate prophylactic infusion of norepinephrine to be initiated at 1.9 to 3.8 µg.min-1 for the management of hypotension during cesarean delivery under spinal anesthesia.

Comparative Investigation of Mobile Portable Complex System Functional and Laboratory Diagnostics with Stationary Equipment

The aim of the current study is to evaluate the effectiveness of using mobile portable complex system functional and laboratory diagnostics in patients compared to stationary equipment. The scientific study examined the results of functional and laboratory diagnostics of 123 patients who were at JSC NSMC at the time of diagnosis and treatment. The study covered a 1-year period from January 2023 to December 2023. Patients were divided into two groups: 1 group  - 63 patients, who were diagnosed using expert stationary equipment of NNMC; 2 group- 60 patients who were diagnosed using the mobile portable complex Health Examination System HES-7 (Konsung Technology; 2023). Results: Laboratory diagnostics were performed in 63 (100%) patients of the 1<sup>st</sup> group and in 60 (100%) patients of 2<sup>nd</sup> group. The compared groups had the same characteristics, for instance anaemia was detected in 4 (6.35%) patients of first group and in 5 (8.33%) patients of the second group. Mortality was not observed in the compared groups. According to all data obtained minor differences in diagnostic findings were found (1 to 6%). In addition, HES-7 demonstrated quite accurate functional analysis: electrocardiography, pulse oximetry, and spirography. Conclusion: The use of the digital mobile complex of functional and laboratory diagnostics Health Examination System HES-7 is safe and can be effectively used in primary health care settings by experienced nursing staff.

Noninvasive activation mapping during the cardiac conductive system pacing

Aim. To identify the features of activation of the right and left ventricles during cardiac conductive system pacing.Methods. There are 2 groups of the study. The cardiac conductive pacing carried in patients of first group. The cardiac conductive pacing not carried in patients of second group. Before and after implantation of the pacemaker, all patients underwent ECG, noninvasive activation mapping using the Amycard software and hardware complex, the width of the QRS, the activation time of the left (LVAT) and right (RVAT) ventricles were determined initially and against the background of pacing. The parameter values are presented in the format: median and interquartile range (Me [25; 75]).Results. The study protocol was performed in 30 patients: first group - 20 patients, second group - 10. The age of the patients was 73 [57; 81] and 71 [63; 75] years, respectively. The value of native QRS complexes in first group was 106 [100; 132] msec, in second group - 144 [109; 155] msec; LVAT 70 [60; 93] msec and 88 [75; 115] msec, respectively; RVAT 62 [50; 74] msec and 85 [67; 117] msec, respectively. There were no statistically significant differences between the groups (p > 0.05) in age, values of native QRS, LVAT, RVAT. The implantable electrode model is identical in both groups. The value of the QRS complex during pacing in first group was 117 [109; 125] msec and 160 [145; 173] msec in second group; LVATp 76 [65; 89] msec and 129 [119; 148] msec, respectively; RVAT 67 [60; 80] msec and 108 [90; 128] msec, respectively. The study revealed statistically significant differences between the two groups of all evaluated parameters against the background of pacing: QRS (p = 0.01), LVAT (p = < 0.01), RVAT (p < 0.01). It should be noted that the initial values and values against the background of pacing of the QRS, LVAT, RVAT complex in patients of group No. 1 did not differ (p > 0.05); in patients of the second group, the values of the QRS, LVAT, RVAT complex initially and against the background of stimulation had significant differences (p = 0.11, p < 0.01 and p = 0.038 respectively).Conclusion. Cardiac conductive system paving is a promising method of cardiac pacing, which allows to achieve activation of the myocardium of the left and right ventricles, which does not differ significantly from activation with a sinus rhythm.

The effect of the combined use of myo-inositol, vitaminD and selenium on the cytokine status in women of reproductive age with autoimmune thyroiditis

Background. In recent years, in Ukraine and other countries of the world, there has been an increase in the frequency of autoimmune thyropathies. A significant role in the pathogenesis of autoimmune thyroiditis (AIT) is played by cytokines whose production is increased significantly during immunopathological reactions. The purpose of study was to investigate the effect of the combined use of myo-inositol, vitamin D and selenium on the cytokine status of women with euthyroidism, subclinical hypothyroidism and overt hypothyroidism against the background of autoimmune thyroiditis. Materials and methods. One hundred and forty-seven women aged 18–43 with AIT and 30women of the control group were under observation. Patients of first group (n = 74) received myo-inositol at a dose of 2000 mg/day, cholecalciferol 2000 IU/day, and selenium 100 μg/day additionally to the main treatment. Patients of the second group (n = 73) received only cholecalciferol at a dose of 2000 IU/day and selenium 100μg/day additionally to the main treatment. The functional state of the thyroid gland was studied by determining the levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine, antibodies to thyroid peroxidase (Ab-TPO) and antibodies to thyroglobulin (Ab-TG). The state of the systemic and local inflammatory process was evaluated according to parameters of tumor necrosis factor α, interleukins 6, 10, 17, and 23. Results. It should be noted all patients with AIT had changes in cytokine status, with some differences depending on the clinical variant of autoimmune thyroid disease. After three months of treatment of patients of the first group with myo-inositol at a dose of 2000 mg/day, cholecalciferol 2000 IU/day and selenium 100 μg/day, and patients of the second group only with cholecalciferol at a dose of 2000 IU/day and selenium at 100 μg /day, a significant difference was found between the indicators in both studied cohorts. Conclusions. The administration of myo-inositol, vitamin D, and selenium had a combination effect on the reduction of cytokine indicators, Ab-TPO and Ab-TG levels, which contributed to the compensation of the underlying disease.

Endoscopic Stapedotomy: Overcoming Limitations and Improving Surgical Outcomes

Background: Stapedotomy is being practiced as a preferred surgical modality for the management of otosclerosis. The operating microscope has been utilized as the conventional tool for stapes surgery over the years. However, certain shortcomings too have been observed. Endoscope provides better and wider field of vision than an operating microscope. Aims and Objectives: The study is aimed to compare the technical challenges faced during microscopic versus endoscopic stapedotomy. Material and Methods: Forty patients with diagnosed otosclerosis were randomly assigned into 2 groups- patients in first group underwent microscopic stapedotomy, while the other group underwent endoscopic stapedotomy. The 2 groups were then observed in terms of extent of the postero- superior canal bone curettage/drilling required for clear visualization of operating area, need for chorda tympani manoeuvring, visualization of the incudo- stapedial complex, operative time, ease of piston insertion, patient head positioning, post-operative pain, vertigo, effect on hearing and taste impairment. Result: Endoscopic stapedotomy offered better access to the oval window requiring less bone removal and chorda tympani manoeuvring. The operating time, pain post operatively, and taste impairment were significantly less in the endoscopic group. No significant difference was observed with respect to hearing outcome and post operative vertigo. Endoscopic stapedotomy had disadvantage of handling the endoscope with one hand and placing the piston with other. Conclusion: Endoscopic stapedotomy has clear cut advantage over microscopic stapedotomy in terms of the technicality and accessibility to the operating area.

MO541: Secondary Hyperparathyroidism Influence on Parathyroid Hormone Levels After Kidney Transplantation

Abstract BACKGROUND AND AIMS Optimal parathyroid hormone (PTH) control in patients before kidney transplantation (KT) might decrease the subsequent risk of parathyroid hyperplasia and hyperparathyroidism (HPT) after surgery. We evaluated the patient characteristics and HPT markers control before and over the first post-transplant year. METHOD We studied 210 patients (107 women, 103 men and age 45 ± 9 years) with end-stage renal failure (ESRF). All patients underwent primary KT. The duration of the pre-transplant period ranged from 0 to 158 months (median 19). The determination of HPT markers was carried out before 3 and 12 months after KT. The target PTH after KT was considered to be 130 pg/mL. Serum concentrations of PTH, calcium, phosphorus, total alkaline phosphatase activity, albumin and creatinine were determined using standard methods, estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI formula and stratification of chronic kidney disease stages was carried out according to the eGFR. RESULTS Patients were divided into two groups based on PTH before KT. In the first group were 63 patients with PTH > 585 pg/mL (median 866, Q1–Q3: 667; 1078), in the second group there were 147 patients with PTH 130–585 pg/mL (median 300, Q1–Q3: 225; 400). Patients with secondary HPT versus target PTH group had long duration of dialysis therapy (27 months versus 15 months; P = 0.005), frequency of hyperphosphatemia (87% versus 57%; P < 0.001) and increased activity of blood alkaline phosphatase (21% versus 4%; P < 0.001). Initial renal transplant function was the same in both groups: acute tubular necrosis amounted to 57% and 46% respectively (P = 0.07), duration of acute tubular necrosis 2 and 0 days respectively (P = 0.087). Three months after kidney transplantation in the first group median blood PTH decreased to 247 pg/mL (Q1–Q3: 163; 452), the prevalence of PTH > 130 pg/mL had 88% patients, in the second group median blood PTH decreased to 150 pg/mL (Q1–Q3: 120; 210), the prevalence of PTH > 130 pg/mL had 59% patients (P < 0.001). Hypercalcemia was in 13% patients of first group and 0 in second group (P < 0.001). Serum creatinine and eGFR did not differ and amounted respectively to 114 (Q1–Q3: 86; 150) and 110 (Q1–Q3: 80; 136) μmol/L (ns), 60 (Q1–Q3: 45; 80) and 60 (Q1–Q3: 49; 80) mL/min (ns). The ratio of stages of chronic kidney disease was the same (Figure 1). A total of 12 months after KT the blood level PTH was 180 (Q1–Q3: 95; 247) and 106 (Q1–Q3: 88; 125) pg/mL (P = 0.004), the prevalence of PTH > 130 pg/mL had 54% and 15% (P < 0.001) patients respectively. Kidney transplant function did not differ as well as after 3 months (median serum creatinine 120–121 μmol/L, eGFR 55 and 55 mL/min). In the post-transplant period, patients of the first group were more often prescribed vitamin D preparations and its analogues, five were treated with cinacalcet due to hypercalcemia and seven underwent parathyroidectomy after 1.5–2.5 years. CONCLUSION Secondary HPT before KT predicted a higher PTH level in the first year after surgery. Patients with ESRF who are on the waiting list for KT need careful monitoring of blood PTH and adequate treatment of secondary HPT.

Prognostic value of the liver stiffness in patients with acute decompensated heart failure

Abstract Funding Acknowledgements Type of funding sources: None. Background. Shear wave elastography (SWE) is a novel ultrasound technique for charactering tissues stiffness and widely used in liver diseases. In patients with heart failure (HF) liver stiffness (LS) seems directly influenced by central venous pressure. However, clinical implication of liver SWE for prognosis in heart failure remains unknown. Study aimed to evaluate the prognostic value of assessing liver stiffness by SWE in HF. Methods We enrolled 214 consecutive patients with acute decompensated heart failure, but 33 of them were excluded due to the presence of other factors that could influence the LS measurement. In addition to traditional cardiac test, all patients were undergone liver stiffness measurement by point shear wave elastography at admission and at discharge. The remaining 181 patients were divided into three groups: 1. LS value > 8.8 kPa at admission and delta decrease in LS value at discharge < 4 kPa (n = 67); 2. LS value > 8.8 kPa at admission, and delta decrease in LS value at discharge > 4 kPa (n = 78); 3. LS value < 8.8 kPa at admission, and in LS value by pSWE at discharge > 4 kPa (n = 36). A median follow up period was 12 month. Results. Adverse cardiac events, i.e., death or readmission to hospital, occurred in 54% of patients in first group, 34% of patients in second group and 15 % of patients in third group (P = 0.001). After adjusting for age, sex, left ventricle ejection fraction a LS ≥ 8.8 kPa and lack of decrease LS during admission was still significantly associated with cardiac events. Conclusion. Liver stiffness by SWE in patients with HF can be used as a prognostic marker to predict cardiac events.

Increase in Intra-Ocular Pressure after Intravitreal Triamcinolone Acetonide in Non-Diabetics and Diabetic Patients

Objective: The objective of this research study was to find out the occurrence of raised IOP (Intra-ocular Pressure) following IVTA (Intra-vitreal Triamcinolone Acetonide) in the patients of diabetes and non-diabetics subjects suffering from different chorio-retinal complications. Methodology: This study was conducted in Benazir Bhutto Shaheed Teaching Hospital Abbottabad and the duration of this study was from May 2019 to April 2021. Total 237 eyes of one hundred and eighty patients were recruited with ninety patients in groups: diabetics & non-diabetics patient groups, in need of IVTA. We injected the IVTA 4.0mg/0.10 milliliter and measured the IOP at 7 days, one month, 3 months and 6 months in the patients of both groups. Results: In the group of diabetics, there were 47.80% (n: 43) males and 52.20% (n: 47) female patients, whereas in the group of non-diabetics, there were 62.20% (n: 56) male and 37.80% (n: 34) female patients. The average age of the patients in the 1st group was 52.21±9.60 years and in the patients of 2nd group was 51.13±10.75 years. Average pre-operative IOP was approximately 3.60±2.80mmHg and 14.10±2.40mmHg in first and second group correspondingly. In the patients of first group, average IOP with standard deviation was 16.40±4.90mmHg, 14.60±3.60mmHg, 17.60±9.70mmHg and 15.50±7.09mmHg at 7 days, one month, 3 months and 6 months after the injection. Whereas in the patients of second group, average IOP with standard deviation was 14.80±3.33mmHg, 15.90±4.2mmHg, 15.50±4.20 mmHg and 14.10±3.20mmHg at 7 days, one month, 3 months and 6 months during the follow up period. We observed an increase in one hundred and seventeen eyes (49.0%) in the patients of both groups, with 65.0% (n: 78) eyes in first group and 33.0% (n: 39) eyes in the patients of second group. Conclusions: After injecting the IVTA, there was a clear high rise in the level of IOP in the patients of diabetes as compared to the patients who were non-diabetics. Keywords: IVTA, IOP, complications, injection, standard deviation, average, mmHg, treatment.

CLINICAL EFFICACY COMPARATIVE EVALUATION OF THE TREATMENT METHODS OF COMBINED DEFECTS AND DEFORMITIES OF THE ZIGOMA AND ORBIT

Introduction. Zigoma and orbital defects still become an actual problem of maxilla-facial surgery due to limited possibilities to precise restoration of their complex anatomy. Functional unity of zigoma and orbit in aspects of eyeball support and protection increases requirements to reconstructive precision. The total and subtotal defects are the most difficult for reconstruction when traditional methods of reconstruction demonstrate unconvincing efficiency. Complex anatomy of zigoma and orbit, as combination of convexities, depressions limited an application of free or vascularised bone transplants for precise 3D restoration of the face. Facing this, new possibilities of reconstructed were developed, based on CAD/CAM technologies. Application of patient specific implants (PSI), designed according personal anatomy of the patient and manufactured by additive technologies, open new modalities to reconstruction in orthognatic surgery, cranioplasty and others, demonstrated promising results. So, these achievements and experience possible could be implemented for zigoma reconstruction. The aim of the study was to evaluate and compare clinical efficacy of zigoma and orbital defect treatment with traditional methods of reconstruction.
 Materials and methods. To reach this purpose, fifty-one patients, who underwent reconstruction procedures regarding zigoma defects, were enrolled to retrospective study. All of them were clinically examined before and after surgery. CT examination was performed before, 1 week and 1 year after surgery in all cases. The patients, included to the study, were divided on two groups – main and control, equal concerning age, sex and anatomical-topographic patterns of the defects. The main group consisted of 27 patients, who underwent zigoma reconstruction with PSI. The rest of the patients, treated with traditional approach (free or vascularised bone grafting, reconstructive plates or reconstruction with temporal muscle), were included to control group.
 Clinical efficacy was evaluated applying esthetical estimation of experts according to ranking scale. Additionally, frequency of complication and precision of reconstruction according to CT were analysed. Orbital volume differences were calculated for cases of orbital reconstruction.
 Results. Comparative analysis of esthetical results revealed higher quality of reconstruction in a main group. The patients did not require any further surgical procedures in 66,7% of cases, in contrast, in a control group additional interventions were indicated or performed in 85,3% of patients (p<0,05). Mean rate of aesthetic estimation by experts were 3,15+1,2 in main group and 1,96+0,8 in control. Follow-up period was longer than 12 months for both main and control groups. Mean follow-up were 20,4 ±9,3 and 26,2 ± 13,5 months respectively. During follow-up any kind of complications were observed between the patients of the main group in 14,8% of cases as well in control – 54,2 % (p=0,01). The main complication between the patients of first group was exposure of the implants, which was noted only in 3 cases, and was caused mainly extension of soft tissues above the implant or compromised soft tissue covering due to incomplete vascularisation of the flaps. At the same time the most frequently observed complications of the main group were total or partial resorption of the grafts (two cases), implant exposure (n=7) and limitation of mouth opening. Additionally, deformity of the fixators with bone fragment displacement was noted in 25,0 % cases.
 Eyeball displacement was defined in 66,7% of all cases. Mean volume difference in main group was 1,5±0,7 см3, when between patients of control it was 2,3±1,2см3 (р=0,032). The frequency of diplopia was equal for both group.
 Conclusions. The main advantage of PSI application for zigoma reconstruction is the possibility of the precise 3D restoration of its complex anatomy, renewal of the correct position of the zigoma. Relatively to the clinical tasks, PSI could be used as fixator or endoprosthesis separately or with bone graft procedures. In some clinical situations separate application of PSI as endoprosthesis may be consider as effective alternative for free tissue transfer procedures.

108P Comparative analysis of two-stage hepatectomy and enhanced one-stage hepatectomy in the setting of bilobar colorectal liver metastases

Multiple bilobar colorectal liver metastases (CLM) is a big challenge for surgeon oncologist due to high risk of postoperative morbidity and mortality. Two-stage hepatectomy (TSH) is a nowadays surgical standard. As alternative enhanced one-stage hepatectomy (e-OSH) with intraoperative ultrasound control to reduce the resection of the unaffected parenchyma could be performed. 665 patients with CLM who underwent liver resection at the Privolzhsky District Medical Center from 2010 to 2017 were retrospectively analyzed. Inclusion criteria were multiple CLM in one lobe with at least one lesion in the contralateral lobe. 76 patients (11,5%) were included in the study: 49 with TSH and 27 with e-OSH. Post-operative complications rate and overall survival in 2 groups were investigated and compared. Among 49 patients in first group (TSH) 23 reached to the second stage. Drop-out rate of TSH was 53%. Compared to the e-OSH patients who reached to the second stage had similar overall morbidity (TSH – 30.4% vs. e-OSH – 33.3% p = 0.827), liver-specific morbidity (TSH – 17.4% vs. e-OSH – 29.6%, p = 0.313) severe morbidity (TSH – 21.7% vs. e-OSH – 22.2% p = 0.968) and overall mortality (TSH – 8,7% vs. e-OSH – 14,8% p = 0.507). R0 resection rate was similar between groups. Completed TSH and e-OSH had similar overall survival rate (1-year 83% vs. 73% р = 0.313; 3-year 39% vs. 38% р = 0.880). e-OSH may be considered as the surgical treatment of choice due to the absence of drop-out risk and a similar to TSH rate of morbidity, mortality, and overall survival. TSH is preferable to perform in cases where postoperative fatal liver insufficiency is highly likely.

304 DOES INTRAOPERATIVE FLUID MANAGEMENT INFLUENCE THE POSTOPERATIVE HOSPITALIZATION IN PATIENTS UNDERGOING ROBOTIC-ASSISTED ESOPHAGECTOMY

Abstract Esophageal resection is a formidable surgery which is often associated with high morbidity and mortality rate despite an improvement in postoperative care. Fluid administration has been described to be a major factor that contributes to the development of postoperative complications after esophagectomy. The aim was to study the relationship between intraoperative fluid administration and the postoperative hospitalization stay Methods After hospital ethical committee approval, 69 patients who underwent Robotic-assisted esophagectomy dated from January 2011 to till date were accessed from the hospital electronic databank. Single lung ventilation was used in all of the patients during the thoracic approach. 69 patients were divided into two groups with respect to patients in first group who received 4 litres and below and the second group who received 4litres and above of crystalloids. Variables studied were ASA status, demographic data, intraoperative fluids administered, ventilator mode, positioning, postoperative parameters studied were icu stay, sepsis, ionotropic support, respiratory distress, reexploration, readmission to icu. Results None of the variables studied except fluid administration were shown as risk factor. Conclusion Anesthetic regimen directed at a restrictive intraoperative fluid of less than 4 litres has reduced the postoperative morbidity rates and the duration of hospital stay in patients undergoing Robotic esophagectomy.

Perampanel as first add-on choice on the treatment of mesial temporal lobe epilepsy: an observational real-life study.

To evaluate the efficacy of perampanel (PER) in patients with a diagnosis of mesial temporal lobe epilepsy (MTLE) taking PER as first add-on option due to inefficacy of first antiepileptic drug (AED), rather than late add-on choice. Thirty-seven MTLE patients aged ≥ 12 years were recruited consecutively with a minimum duration of follow-up of 1 year and intermediate follow-up of 3 months. Patients were divided into two groups: 20/37 taking PER as first add-on due to inefficacy of first AED (first group) and 17/37 taking PER as late add-on due to inefficacy of ≥ 2 AEDs (second group). Efficacy, retention rate, and safety were evaluated. At 3 months, the 70% of the first group had a reduction > 50% of seizure frequency, with six patients becoming also seizure free, while in the second group, only the 23.5% had a reduction > 50% of seizure frequency and none became seizure free (p = 0.005). Six patients of first group were also switched to a monotherapy of PER and five out of six remained seizure free at 12 months. At 1 year of follow-up, efficacy of PER was 70% for the first group, while only of 29.4% for the second group (p = 0.014). Retention rate of the first group at 3 months and 1 year was 85%, while for the second group was, respectively, 82.3% and 64.7%. PER was significantly successful and tolerated in MTLE patients when used as first add-on option rather than as late add-on.

Compare the clinical and postoperative outcomes: laparoscopic versus open surgery

Background: To assess the several postoperative complications and clinical outcomes, a retrospective comparison between laparoscopic or open surgery was performed.Methods: We evaluated patients baseline characteristics clinical characteristics, perioperative, intraoperative, inflammatory stress markers and postoperative outcomes between the two groups by univariate analysis.Results: Total 73 patients’ data were included and divided into two groups. 38 patients in first group (laparoscopic surgery) and 35 patients in second group (open surgery). There were no statistically significance differences between gender, age, weight, body mass index and type of surgery of the patients (p>0.05). There was no significant difference between groups in history of infliximab, history of steroid usage, history of appendectomy and perianal disease (p>0.05). There was no significant difference between groups in total protein, albumin, hemoglobin, skeletal muscle mass and soft lean mass. Operative time, length of incision and blood loss was significantly (p<0.001) different in both groups, respectively. Total number of complications was less in the laparoscopic surgery; however, there was no statistically significant difference. Laparoscopic surgery can shorten the hospital stay by around one day. Patients had better postoperative outcomes after laparoscopic surgery than after open surgery. No significant difference was present in edema grades between groups preoperatively. More patients developed slight edema and edema in open surgery than in laparoscopic surgery on postoperative day (POD-3), but not on POD-5.Conclusions: Laparoscopic surgery has more benefits, safe and high-quality care and better postoperative clinical outcomes for all patients compared to open surgery.

Post-Molar Stage I Low-Risk Gestational Trophoblastic Neoplasia: Transvaginal Ultrasound Findings and Their Correlation with Chemotherapy Response

Background: Early diagnosis of gestational trophoblastic neoplasia and its complications are pivotal for prompt and efficacious treatment. Transvaginal pelvic ultrasound could detect myometrial invasion and endometrial thickening following dilation and evacuation of hydatiform mole and also in the assessment of response to chemotherapy. Objectives: In this study we aimed to investigate transvaginal ultrasound findings of stage I low-risk gestational trophoblastic neoplasia (GTN) and whether there is an association between ultrasound findings and chemotherapy response. Patients and Methods: This study included 31 consecutive patients with postmolar stage I low-risk GTN. We recorded International Federation of Gynecology and Obstetrics (FIGO) score, and transvaginal ultrasound findings including color and pulsed Doppler interrogation at the time of beta human chorionic gonadotropin (β-hCG) rise. The number of Act-D cycles that each patient needed to achieve complete remission was also recorded. Results: Of the 31 patients with post-evacuation trans-vaginal ultrasound evaluation, 2 (6.5%) patients had no detectable finding, 4 (12.9%) had lesions limited to the endometrium, 12 (38.7%) had lesions with 50% invasion into myometrium, 4 (12.9%) had lesions that reached uterine serosal surface and 2 (6.5%) had arteriovenous malformation (AVM)-like myometrial lesions. The number of Act-D cycles patients needed to achieve remission was 6 cycles in patients with no finding, lesion limited to endometrium and less than 50% myometrial invasion and was 8 cycles in patients with > 50% invasion ± involvement of serosal surface. One patient in first group and two in second group need multi-agent chemotherapy. But these differences were not significant (P = 0.172). Conclusion: There was a non-significant increase in treatment duration and need of multiagent chemotherapy with more extensive ultrasound findings among patients with stage I low risk GTN.

Management Of Suryavarta With Katphala Churna Nasya And Danti Pravala Yoga W.S.R. To Frontal Sinusitis

Suryavarta is one of Shiroroga described by Acharyas characterised by headache which start early in morning and increases as day passes and become maximum at noon and is a Tridoshaja vyadhi. As its symptoms ressemble frontal headache this was selected for study . The present study was done on 29 patients of Suryavarta , who were grouped into three groups with 9 patients in first group, 9 patients in second group and 11 patients in third group. Group I was treated with Katphala churna nasya, Group II was treated with Danti pravala yoga as oral drug and in Group III both therapies was given. The signs and symptoms were studied before and after the treatment. Results of study show better results in Group III as 50% patients were markedly improved, 40% were mildly improved and 10% were cured.

Torakotomi Yapılan Hastalarda Sürekli Erektör Spina Düzlem Bloğunun Analjezik Etkinliğinin Değerlendirilmesi

INTRODUCTION: The erector spinae plane block (ESPB) is performed by injection of local anesthetic deep into the erector spinae muscle. It is a relatively simple and safe technique for pain management. It has been started to be widely used in pain relief. This randomized, controlled study aimed to report continue comparing the effectiveness of ESPB and intercostal block applications in thoracic surgery. METHODS: Forty patients who were scheduled to undergo elective thoracotomy and Video-Assisted Thoracic Surgery (VATS) were included in the study. Patients in first group underwent erector spinae plane block. In the second group intercostal block(ICB) was applied. Static, and dynamic Pain scores in the ESPB group were lower than the ICB group in the early postoperative period. In the postoperative period, the time to the first analgesic requirement was longer in the ESPB group. RESULTS: The difference between the groups in terms of time to the first analgesia requirement was found to be statistically significant (p<0.001). There was no difference in the number of doses of tramadol hydrochloride and dexketoprofen used. It was found that the static VAS value was higher in the ICB group in all time periods except the second hour and this difference was statistically significant. It was determined that dynamic VAS values; in all time periods, were higher in the ICB group than the ESPB group. Dynamic VAS values were found to be statistically significantly higher in the ICB group from the 3rd up to the 24th hour. DISCUSSION AND CONCLUSION: ESPB performed in thoracic surgery is very effective for postoperative analgesia plan. Few complications were also noted.

The Use of Probiotic with ORS and ORS Only in Children with Acute Diarrhea.

To compare the mean number of stools per day in children treated with combination of probiotic (lactobacillus rhamnosus) with ORS and ORS only in acute diarrhea. Randomised control trial. Department of Pediatric Medicine, PNS Shifa Hospital, from February to July, 2017. A total of 80 children with acute watery diarrhea were randomly divided into two groups. Forty patients in first group were given probiotic with ORS and 40 patients in second group (control) were given ORS only. All children were monitored from 0 day (inclusion day) to next 5 days. Demographic data was collected regarding age, gender, weight and frequency of loose stools. Dehydration status was also assessed at the time of admission by the attending physician. Data was collected through a structured proforma. The average age of the children was 24.3 ±18.65 months. There were 47 (58.8%) males and 33 (41.3%) females. Mean number of stools was significantly low in those patients who were treated with combination of probiotic (lactobacillus rhamnosus) with ORS than those who were treated with ORS only in acute diarrhea (3.25 ±1.13 vs. 4.13 ±0.79; p<0.001). Probiotics are found to be significantly more effective in reducing the stool frequency in acute diarrhea.

Clinical outcome of delayed surgical treatment of grade III acromioclavicular joint dislocation with and without acromioclavicular capsule reconstruction

Background: Surgical management of grade III acromioclavicular joint dislocation should be considered in patients who have significant deformity, tenting of the skin, or persistent pain despite nonsurgical management, or in patients who have a higher functional demand. Coracoclavicular ligament reconstruction alone may not be sufficient to prevent anteroposterior translation at the acromioclavicular joint despite preventing superior translation. Reconstruction of the acromioclavicular capsule may be necessary for additional joint stability. The aim of this study was to evaluate the necessity of the capsular reconstruction in the treatment of acromioclavicular dislocation. Methods: This is a retrospective comparative study between two groups. The first group, 14 patients, had anatomical coracoclavicular ligament reconstruction without capsular reconstruction. The second group, 19 patients, had capsular reconstruction in addition to acromioclavicular ligament reconstruction. Results: Pain, American Shoulder and Elbow Surgery, and Constant Shoulder scores were better in the second group. No cases of failure were reported in any group. Loss of reduction occurred in seven patients in first group (50%). Conclusions: Reconstruction of the acromioclavicular capsule in surgical treatment of grade III acromioclavicular joint dislocation may play an important role against loss of reduction.

EXPRESSION PATTERNS OF CHEMOKINE RECEPTORS CXCR3 AND CCR6, AND THEIR LIGANDS IN PERIPHERAL BLOOD OF PATIENTS WITH CHRONIC HEPATITIS C DURING ANTIVIRAL THERAPY USING PEGYLATED INTERFERONS

The work presents data on forty-one patients with chronic hepatitis C (HCV, genotype 1), at different liver fibrosis stages. The studies were performed in the course of interferon-containing treatment regimens, i.e., pegylated interferon combined with ribavirin and pegylated interferon; ribavirin together with NS3/4A inhibitor of HCV serine protease. Concentrations of cytokines/chemokines (TNFα, CCL2/MCP-1, CCL20/MIP-3α, CXCL9/MIG, CXCL10/IP-10, CXCL11/ITAC) were measured in blood plasma samples, using xMAP multiplex analysis. Flow cytometry studies were also performed in order to reveal cells with CCR6 and CXCR3 receptors in lymphocyte populations. The obtained results were analyzed using a statistical program package R. Results: 36 out of 41 patients achieved virological response, while 5 patients did not respond to the therapy. The responders were split into two groups, as follows: (1) liver fibrosis-free; (2) patients with fibrosis stages 1, 2 and 3. In the group of fibrosis-free patients, the decrease of CXCL11/ITAC concentration and the increase of TNFαwere observed, as well as increase of CTL CXCR3+content by the 12th week of therapy and an increase of NK CXCR3+by the end of treatment. In addition, this group exhibited a decrease in the CXCR3+B lymphocyte contents at this timepoint. Concentrations of CCL2/MCP-1 during treatment were increased in the patients with different stages of liver fibrosis, as compared to baseline. By the end of therapy, an increase in the relative content of NK CXCR3+and TNK CCR6+was also detected. The study confirmed a potential role of cytokines/chemokines TNFα, CCL2/MCP-1 and CXCL11/ITAC in activation of the cell-mediated immunity and elimination of the hepatitis C virus from the body. The results indicate that activation of T cellmediated immunity in both groups of the patients and reduction of B cells with CXCR3 receptor in the patients of first group is a positive prognostic factor showing efficiency of interferon therapy. Two of studied cytokines/ chemokines (TNFαand CCL20/MIP3α) differed in the groups of responders and non-responders at the start of therapy. Statistical evaluation of pre-treatment results has shown a tendency for differing concentration of TNFα, and CCL20/MIP3αamounts were significantly different for the patients of these groups. The plasma concentrations of CCL20/MIP3αin non-responders were &gt; 4-fold higher than in responders to the therapy. Hence, the present study allowed us to propose the chemokine CCL20/MIP3α as a potential predictor of treatment outcomes in HCV infection.

OC22 ECLS IN PRIMARY REFRACTORY CARDIOGENIC SHOCK: IMPACT OF SHORT-TERM EXTRACORPOREAL MECHANICAL CIRCULATORY SUPPORT ON SURVIVAL

Abstract Background/Aim: Previous studies have demonstrated dubious results of ECMO for the treatment of refractory cardiogenic shock (RCS) after 9 days of support. The use of short-term extracorporeal mechanical circulatory support (ST-MCS) has emerged in the last years. We therefore evaluate the outcome of patients that needed prolonged support and underwent ST-MCS implantation compared to conventional ECMO implantation. Methods: Between January 2009 and October 2017, 183 patients were treated with extracorporeal life support (ECLS) in our centre for primary RCS; we selected the 101 patients that exceed the 9 days of ECLS. 44 cases (44%) were treated exclusively with ECMO implantation (Group 1), while 57 cases (56%) underwent left ventricular or biventricular extracorporeal ST-MCS implantation (Group 2). Among these last patients, in 42 cases the ST-MCS was intended as upgrade of ECMO support. Results: Average duration of the support was 17 ± 9 days in the Group 1 and 13 ± 9 days in the Group 2 (p = 0.08), while mean rates support of the maximal theoretic flow were 62 ± 15% and 79 ± 20% (p &lt; 0.01), respectively. 12 patients of first group and 9 patients of second one died during ECLS support (p = 0.12); 30-days survivals were 61% and 70% (p = 0.24) and rates of hospital discharge were 43% and 61% (p = 0.04), respectively. Kaplan-Meier analysis (Fig.1) demonstrates a better survival in Group 2 rather than in Group 1 (p = 0.04) at median follow-up of 16 ± 24 months. Conclusions: ST-MCS has proved to increase the survival respect single-stage ECMO in patients with primary RCS who need prolonged ECLS and full hemodynamic support.