Patients In Late Period Research Articles

The chronological change of indications and outcomes for single-incision laparoscopic cholecystectomy: a Korean multicenter study.

Although single-incision laparoscopic cholecystectomy (SILC) is a common procedure, the change in its surgical indications and perioperative outcomes has not been analyzed. We collected the clinical data of patients who underwent pure SILC in 9 centers between 2009 and 2018 and compared the perioperative outcomes. In this period, 6497 patients underwent SILC. Of these, 2583 were for gallbladder (GB) stone (39.7%), 774 were for GB polyp (11.9%), 994 were for chronic cholecystitis (15.3%), and 1492 were for acute cholecystitis (AC) (23%). 162 patients (2.5%) experienced complication, including 20 patients (0.2%) suffering from biliary leakage. The number of patients who underwent SILC for AC increased over time (p = 0.028), leading to an accumulation of experience (27.4 vs 23.7%, p = 0.002). The patients in late period were more likely to have undergone a previous laparotomy (29.5 vs 20.2%, p = 0.006), and to have a shorter operation time (47.0 vs 58.8min, p < 0.001). Male (odds ratio [OR]; 1.673, 95% confidence interval [CI] 1.090-2.569, p = 0.019) and moderate or severe acute cholecystitis (OR; 2.602, 95% CI 1.677-4.037, p < 0.001) were independent predictive factors for gallbladder perforation during surgery, and open conversion (OR; 5.793, 95% CI 3.130-10.721, p < 0.001) and pathologically proven acute cholecystitis or empyema (OR; 4.107, 95% CI 2.461-6.854, p < 0.001) were related with intraoperative gallbladder perforation CONCLUSION: SILC has expanded indication in late period. In this period, the patients had shorter operation times and a similar rate of severe complications, despite there being more numerous patients with AC.

Aggressive placement of distal limb perfusion catheter in venoarterial extracorporeal membrane oxygenation.

The aim of this study is to review the impacts of aggressive placement of a distal perfusion catheter on the outcomes in patients supported with venoarterial extracorporeal membrane oxygenation via femoral cannulation. Analysis was performed with 143 consecutive femoral venoarterial extracorporeal membrane oxygenation cannulation. Patients were divided into two groups: the early period (October 2010 to December 2012, N = 47) where placement of a distal perfusion catheter was attempted percutaneously but not surgically and the late period (January 2013 to November 2018, N = 96) in which placement of distal perfusion catheter was aggressively utilized both percutaneously and surgically. The modification of venoarterial extracorporeal membrane oxygenation cannulation protocol for the late period involved (1) an immediate insertion of a distal perfusion catheter regardless of the size of femoral arterial cannula, (2) an open insertion of a distal perfusion catheter if percutaneous approach failed, and (3) when venoarterial extracorporeal membrane oxygenation cannulation was completed at a non-extracorporeal membrane oxygenation cannulation center, it was encouraged that they attempt insertion of a distal perfusion catheter at the time of cannulation. In the late period, a distal perfusion catheter was placed in 96% (92/96) which was significantly increased from 66% (31/47) in the early period. Of these 92 patients in late period, nine patients (9.8%) required open direct insertion of a distal perfusion catheter. The incidence of lower limb ischemia (early vs. late period 26% vs 12%, P = 0.031) was significantly decreased in the late period. Logistic regression analyses showed that distal perfusion catheter placement was the only factor for preventing lower limb ischemia. Aggressive insertion of a distal perfusion catheter even utilizing surgical cut-down technique was shown to decrease the incidence of distal limb complications.

Rehabilitation of patients in late period after spinal cord injury: a meta-analysis of literature data

Material and Methods . The study design is a meta-analysis of publications with levels 1a, b, c, and 2a evidence and a level A recommendations. An electronic search was conducted in the PubMed, Web of Science, Scopus, Cochrane Library, CrossRef, AO Spine, Eurospine, ResearchGate, eLIBRARY, and MEDLINE databases, and in references of key articles. Inclusion criteria were systematic reviews, randomized controlled studies, multicenter cohort studies with a level 1a, b, c, and 2a evidence and level A recommendations for adult patients with long-term sequelae of spinal cord injury (more than 4 months after injury). Exclusion criteria were topic articles, clinical cases, observations, cohort uncontrolled studies, experimental articles, reports, articles with levels 2b, c, 3a, b, 4, and 5 evidence and level B, C, and D recommendations, pediatric patients, early period after spinal cord injury (less than 4 months), and non-traumatic lesions of the spinal cord. Results . The search returned 108 articles with publication date within 1997–2019. The inclusion criteria was met by 65 publications: 33 systematic reviews, 12 randomized controlled studies, 19 multicenter studies; and one open prospective study was included in the review due to the particular treatment method used. The greatest evidence base for the rehabilitation of patients in the long-term period after spinal cord injury is presented for physical methods of rehabilitation. The most effective are locomotor training to develop skills of movement. Auxiliary verticalization and robotic devices are needed to restore and improve proprioceptive innervation. In case of violation of the spinal tracts, the restoration of motor functions occurs due to the activation of supraspinal interneuronal connections. Epidural electrical stimulation of the lumbar thickening of the spinal cord activates a generator of voluntary movement of the limbs and, in combination with training of proprioceptive sensitivity, leads to a regression of movement disorders. The constant use of electrostimulation blocks proprioceptive sensitivity and inhibits the recovery of spinal conductivity. Parameters of clinical application are not defined for areas of regenerative medicine. Conclusion . The main problem in rehabilitation of patients in late period after spinal cord injury is the lack of a unified concept, developed strategies of rehabilitation technologies, and criteria for assessment of the initial status and treatment efficiency.

Challenging treatment of hidradenitis suppurativa with happy ending

Background: Hydradenitis supurativa (HS) is a chronic, recurrent and inflammatory disease which involves skin and subcutaneous fatty tissue. The aim of this study was to retrospectively evaluate the treatment results of 12 patients who were diagnosed as hidradenitis suppurativa with local or multiple site involvements in our clinic.Methods: Data of 12 patients with local or multiple site involvement, who had hidradenitis suppurativa surgery between January 2013 and January 2018 were evaluated retrospectively.Results: Twelve patients, who were male, were included in the study. The average age was 39.4 (25-56) years old. A total of 5 patients were with local and 7 patients were with multiple region involvements. 8 patients had axillary, 3 patients had genitalia, 4 patients had perianal and 7 patients had sacral region involvements. Two of 4 patients with perianal region had protective stomas. In total, 16 surgical procedures were performed to the patients. In 6 patients, some parts of wounds were primary closed and followed-up with secondary healing. Skin grafting was performed for the four of these patients in late period. In 4 patients, defects were closed with primary closure and with rotation flaps in 2 patients. No recurrence was observed among the patients. The average duration of follow-up was 32.5 months.Conclusions: The surgical treatment process of hidradenitis suppurativa, which is a chronic disease, is not more difficult and longer than its natural course. In recent years, complete recovery can be achieved with current surgical methods.