Preferred Choice For Patients Research Articles

Evaluation of the effect of parenteral nutrition on mortality and morbidity in hospitalized patients with non-variceal upper gastrointestinal bleeding

Objective: Nutritional support products should preferably be administered orally whenever possible, with rare exceptions, one of which is gastrointestinal bleeding. In our study, we examined the effects of parenteral nutrition support, which we have recently introduced in the treatment of patients with gastrointestinal bleeding, on the hospitalization duration and mortality-morbidity of these patients. Methods: We analyzed the patients admitted to the Internal Medicine Service with non-variceal upper gastrointestinal bleeding in our study. Patients were retrospectively analyzed in two groups, based on the years in which total parenteral nutrition (TPN) was initiated (2016-2017) and not initiated (2012-2013). Hospitalization durations and discharge methods were compared between the two groups. Results: Our study included a total of 369 cases after screening and application of our exclusion criteria. 35.5% of these cases received TPN, while 64.5% did not. When evaluated based on the TPN administration status after stabilizing the Rockall score of the patients, as well as considering the need for erythrocyte suspension (ES), fresh frozen plasma (FFP) replacement, and length of hospital stay, the length of hospital stay was significantly longer in those receiving TPN compared to those who did not. Conclusion: Although TPN may be the preferred choice in patients with upper gastrointestinal bleeding for whom oral nutrition is not suitable, our study suggests that this preference not only does not lead to a reduction in the number of blood and blood product replacements but also prolongs the hospital stay. While it is believed that complications of nutritional support with TPN may contribute to this result, our retrospective study did not provide data on this. Comprehensive prospective studies are needed on this issue.

Efficacy of Oral Medications or Intrauterine Device-Delivered Progestin in Patients with Endometrial Hyperplasia with or without Atypia: A Network Meta-Analysis.

The aim of this systematic review was to evaluate the efficacy of oral medication or intrauterine device-delivered progestins in patients with endometrial hyperplasia (EH) with or without atypia. We systematically examined PubMed, EMBASE, the Cochrane Library, and clinicaltrials.gov to identify studies reporting the regression rate of patients with EH who received progestins or non-progestins. The regression rates after different treatments were compared using a network meta-analysis in terms of the relative ratios (RRs) and 95% confidence intervals (CIs). Begg-Mazumdar rank correlation and funnel plots were performed to evaluate the publication bias. Five non-randomized studies and 21 randomized controlled trials involving 2268 patients were included in the network meta-analysis. The levonorgestrel-releasing intrauterine system (LNG-IUS) was associated with a higher regression rate than medroxyprogesterone acetate (MPA) (RR 1.30, 95% CI 1.16-1.46) in patients with EH. Among those without atypia, the LNG-IUS was associated with a higher regression rate than any of the three types of oral medications (MPA, norethisterone, or dydrogesterone (DGT)) (RR 1.35, 95% CI 1.18-1.55). According to the network meta-analysis, combining the LNG-IUS with MPA or metformin increased regression rate, while DGT was associated with the highest regression rate among all oral medications. The LNG-IUS may be the best choice for patients with EH, and combining it with MPA or metformin may further improve its efficacy. DGT may be the preferred choice for patients who are unwilling to use the LNG-IUS or who cannot tolerate its side effects.

Effectiveness and Mechanisms of Low-Intensity Pulsed Ultrasound on Osseointegration of Dental Implants and Biological Functions of Bone Marrow Mesenchymal Stem Cells.

Dental implant restoration is the preferred choice for patients with dentition defects or edentulous patients, and obtaining stable osseointegration is the determining factor for successful implant healing. The risk of implant failure during the healing stage is still an urgent problem in clinical practice due to differences in bone quality at different implant sites and the impact of some systemic diseases on bone tissue metabolism. Low-intensity pulsed ultrasound (LIPUS) is a noninvasive physical intervention method widely recognized in the treatment of bone fracture and joint damage repair. Moreover, many studies indicated that LIPUS could effectively promote the osseointegration of dental implants and improve the osteogenic differentiation of bone marrow mesenchymal stem cells (BMSCs). This review is aimed at investigating the research progress on the use of LIPUS in dental implant medicine from three aspects: (1) discuss the promoting effects of LIPUS on osseointegration and peri-implant bone regeneration, (2) summarize the effects and associated mechanisms of LIPUS on the biological functions of BMSCs, and (3) introduce the application and prospects of LIPUS in the clinical work of dental implantation. Although many challenges need to be overcome in the future, LIPUS is bound to be an efficient and convenient therapeutic method to improve the dental implantation success rate and expand clinical implant indications.

Hyperuricemia as a risk factor for cardiovascular events in hypertensive patients

Hypertension (HTN) remains one of the most important risk factors for cardiovascular events. Modification of additional risk factors, along with a blood pressure decrease, significantly affects the risk of cardiovascular events. Hyperuricemia is one of the new factors that has a high prevalence in the population and affects the risk for cardiovascular events in hypertensive patients. In the treatment with fixed-dose combinations in patients with hypertension and hyperuricemia, metabolic neutrality is of particular importance. When prescribing diuretics, the practitioner faces additional difficulties. These drugs are highly synergistic when added to other major antihypertensives’ classes, but, in some cases, may worsen the metabolic profile. The use of the thiazide-like diuretic indapamide largely avoids a negative effect on the metabolic profile, making it the preferred choice for patients with hyperuricemia.

Restoration of Ocular Surface and Correction of Irregular Corneas Caused by Radial Keratotomy Using EyePrintPRO<sup>TM</sup> Technology (Case Report)

Background. The number of laser refractive surgeries to treat myopia is growing, and so does the number of complications. One of these complications, leading to progressive loss of vision, is iatrogenic corneal ectasia, which is difficult to correct and often causes work incapacity.Purpose. The purpose of this case report is to demonstrate the possibilities of correcting iatrogenic corneal ectasia with contact lenses utilizing EyePrintPROTM technology.Materials and methods. A clinical case describes the correction of iatrogenic progressive hyperopia with EyePrintPROTM contact lenses in a 52-year-old white male. The patient underwent several refractive surgeries, including Radial Keratotomy, Lasik and Cross-Linking, which resulted in peripheral corneal ectasia and progressive hyperopia. Previously fitted scleral lenses did not provide comfort and caused hyperemia and a foreign body sensation. The patient underwent a complete ophthalmological examination, including special examinations required for calculation of contact lens parameters. The EyePrintPROTM lenses were made by taking an impression of the anterior ocular surface. In addition, an analysis of literature on corneal ectasia available on PubMed, eLibrary, Cyberleninka, Crossref metadata search and other resources was carried out.Results and discussion. Thanks to EyePrintPROTM technology, it was possible to restore visual acuity and comfort: visual acuity increased from 0.16 to 1.0 in OD and from 0.4 to 1.0 in OS. Despite the presence of a pinguecula in the left eye, an adequate fit was achieved as demonstrated by optical coherence tomography (OCT) of the anterior segment of the eye. The discussion section provides a literature-based analysis of the causes leading to the occurrence of iatrogenic ectasia and expands on specifics of treatment of this pathology.Conclusion. Impressionbased contact lenses may be a preferred choice for patients with corneal and scleral irregularities.

C92. Successful Percutaneous Coronary Intervention (PCI) in Rare Case of Anomalous Aortic Origin of the Right Coronary Artery from the Opposite Sinus (AAORCA) Presenting as Inferior ST Elevation Myocardial Infarction (STEMI)

Abstract Background AAORCA from opposite sinus is a rare congenital anomaly that can present with symptoms similar to coronary artery disease, even sudden cardiac death. AAORCA with Inferior STEMI is a rare combination situation. Management of acute myocardial infarction with AAORCA is not well established and still debatable. Case Summary We presented a case 61 years old aged male with STEMI and AAORCA. He admitted to our hospital with complaint of retrosternal chest pain with ST segment elevation in inferior lead thus we diagnosed as Inferior STEMI. He underwent an emergency coronary angiography (CAG) that showed anomalous of right coronary artery (RCA) and total occlusion of the proximal RCA with atherosclerotic lesion. Stent then implanted at proximal of RCA. Further work-up by Computed Tomography Angiography (CTA) revealed an AAORCA with interarterial course. Discussion AAORCA with interarterial course that presents as inferior STEMI is a rare case. Diagnosis requires CAG and coronary CTA to identify anatomy and physiology so revascularization can be carried out appropriately. It is still arguable whether atherosclerosis or the interarterial course of AAORCA that caused acute MI. There is evidence that anomalous coronary arteries doesn’t increase atherosclerosis risk than normal. Total occlusion located at the distal to interarterial course reinforce that atherosclerosis may be the possible cause of acute MI. PCI could be the preferred choice in patients with inferior STEMI accompanied by AAORCA with evidence of atherosclerotic lesion, because may result in complete reperfusion and good clinical outcome.

C92. Successful Percutaneous Coronary Intervention (PCI) in Rare Case of Anomalous Aortic Origin of the Right Coronary Artery from the Opposite Sinus (AAORCA) Presenting as Inferior ST Elevation Myocardial Infarction (STEMI)

Abstract Background AAORCA from opposite sinus is a rare congenital anomaly that can present with symptoms similar to coronary artery disease, even sudden cardiac death. AAORCA with Inferior STEMI is a rare combination situation. Management of acute myocardial infarction with AAORCA is not well established and still debatable. Case Summary We presented a case 61 years old aged male with STEMI and AAORCA. He admitted to our hospital with complaint of retrosternal chest pain with ST segment elevation in inferior lead thus we diagnosed as Inferior STEMI. He underwent an emergency coronary angiography (CAG) that showed anomalous of right coronary artery (RCA) and total occlusion of the proximal RCA with atherosclerotic lesion. Stent then implanted at proximal of RCA. Further work-up by Computed Tomography Angiography (CTA) revealed an AAORCA with interarterial course. Discussion AAORCA with interarterial course that presents as inferior STEMI is a rare case. Diagnosis requires CAG and coronary CTA to identify anatomy and physiology so revascularization can be carried out appropriately. It is still arguable whether atherosclerosis or the interarterial course of AAORCA that caused acute MI. There is evidence that anomalous coronary arteries doesn’t increase atherosclerosis risk than normal. Total occlusion located at the distal to interarterial course reinforce that atherosclerosis may be the possible cause of acute MI. PCI could be the preferred choice in patients with inferior STEMI accompanied by AAORCA with evidence of atherosclerotic lesion, because may result in complete reperfusion and good clinical outcome.

Esophagectomy versus definitive chemoradiotherapy as initial treatment for clinical stage I esophageal cancer: a systematic review and meta-analysis.

Esophagectomy and definitive chemoradiotherapy are commonly used in the treatment of stage I esophageal cancer (EC). The present study aims to compare the efficacy and safety of esophagectomy and definitive chemoradiotherapy as the initial treatment for clinical stage I EC. This study was registered with the International Prospective Register of Systematic Reviews (CRD42020197203). Relevant studies were identified through PubMed, Web of Science, EMBASE, and Cochrane Library from database inception to June 30, 2020. Hazard ratio (HR) with 95% confidence intervals (CI) was employed to compare overall survival (OS) and progression-free survival (PFS). Odds ratio (OR) with 95% CI was employed to compare treatment-related death, complications, and tumor recurrence. A total of 13 non-randomized controlled studies involving 3,346 patients were included. Compared with definitive chemoradiotherapy, esophagectomy showed an improved OS (HR 0.69, 95% CI 0.55-0.86; P < 0.001), PFS (HR 0.47, 95% CI 0.33-0.67; P < 0.001), and a lower risk of tumor recurrence (OR 0.43, 95% CI 0.30-0.61; P < 0.001). There was no significant difference in the incidence of complications (OR 1.11, 95% CI 0.75-1.65; P = 0.60) and treatment-related death (OR 1.15, 95% CI 0.31-4.30; P = 0.84) between the two treatments. Current evidence shows esophagectomy has superior survival benefits as the initial treatment for clinical stage I EC. It is still the preferred choice for patients with clinical stage I EC. However, future high-quality randomized controlled trials are needed to validate this conclusion.

Advances in targeted therapy in non-small cell lung cancer with actionable mutations and leptomeningeal metastasis.

WHAT IS KNOWN AND OBJECTIVE?: Leptomeningeal metastasis (LM) is a serious complication of advanced non-small cell lung cancer (NSCLC) that is diagnosed in approximately 3%-5% of patients. LM occurs more frequently in patients with NSCLC harbouring epidermal growth factor receptor (EGFR) mutations or anaplastic lymphoma kinase (ALK) rearrangements and is usually accompanied by a poor prognosis, with a median overall survival (OS) of several months if patients receive conventional treatments. However, tyrosine kinase inhibitor (TKI) therapy after LM diagnosis is an independent predictive factor for extended survival. Here, we aim to summarize the latest advances in targeted therapy for LM and provide patients with better treatment options. METHODS: By reviewing the recent progress of targeted therapy in NSCLC with LM, especially the efficacy of newer generation TKIs, we aim to provide clinicians with a reference to further optimize patient treatment plans. RESULTS AND DISCUSSION: Osimertinib was confirmed to have a several-fold higher CNS permeability than other EGFR-TKIs and was recommended as the preferred choice for patients with EGFR-positive LM whether or not they harboured the T790M mutation. Second-generation ALK-TKIs have a higher rate of intracranial response and can be positioned as front-line drugs in NSCLC with LM. However, the sequence in which ALK-TKIs are administered for effective disease control requires further evaluation. In addition, targeted therapy revealed a potential choice in patients with LM and rare mutations, such as ROS1 and BRAF. WHAT IS NEW AND CONCLUSIONS?: The development of therapeutic agents with greater CNS penetration is vital for the management of CNS metastasis from NSCLC, particularly in the EGFR-mutant and ALK-rearranged subtypes. Systemic therapy with newer generation TKIs is preferred as the initial intervention. This is because newer generation TKIs are designed to penetrate the blood-brain barrier and possess significantly higher intracranial activities. However, their further effectiveness is limited by inadequate blood-brain barrier penetration and acquired drug resistance. Further studies are needed to further understand the mechanisms underlying resistance to treatment.

Optimal Management of Chronic Lymphocytic Leukemia and Economic Constraints.

In this article, we carry out an overview on the management options available for chronic lymphocytic leukemia (CLL) patients and discuss possible treatment decisions, taking into account the issue of sustainability and availability. Targeted agents have shown to be superior compared with chemoimmunotherapy (CIT) in terms of progression-free survival in high-risk CLL. In the majority of studies, however, continuous treatment was compared with fixed-duration CIT and no overall survival or progression-free survival-2 (time from randomization to second progression or death) advantage could be documented. Meanwhile, a substantial financial burden on both patients and payers has raised issues about affordability and adherence to treatment. Therefore, value-based pricing of new drugs has been used to set up price negotiation policies in several countries, and fixed-duration therapy has shown to be less costly than continuous treatment. Thus, CIT continues to have a role in the treatment of CLL patients with a favorable genetic profile, that is, with a mutated IGHV gene profile and a wild-type TP53. Targeted treatment represents the preferred choice in patients with an unmutated IGHV gene configuration and/or a TP53 disruption, provided that adherence to treatment is guaranteed and bearing in mind that should costly drugs not be available for frontline treatment, new agents can be very effective as first salvage treatment.

Effect on post Tonsillectomy pain control with IV and infiltrated dexamethasone and infiltrated bupivacaine: A Randomized Controlled Trial.

Objectives: To evaluate the effect on post tonsillectomy pain control with IV and infiltrated dexamethasone and infiltrated bupivacaine. Methodology: This randomized controlled trial study was conducted in the department of ENT and neck surgery of Holy Family hospital, Rawalpindi, over a period of one year from May 2019 to May 2020. A total of 140 pediatric patients were selected and were divided into four equal groups randomly by lottery method. Patients in all four groups had endotracheal intubation with general anesthesia. As premedication, all the patients received intravenous midazolam (1mg). Intravenous fentanyl (1.5mg/kg) and propofol (2.5 mg/kg) followed by endotracheal intubation facilitated with atracurium (0.5 mg/kg) were used as general anesthesia in all patients. Results: There was no significant (p-value &gt;0.05) difference in gender, age of children, postoperative heart rate, postoperative SPO2, and fentanyl consumption. The duration of surgery was significantly (p-value &lt; 0.05) different in all four groups. According to the results, no significant (p-value &gt;0.05) difference was found based on postoperative nausea and vomiting and the requirement of antiemetics. The requirement of analgesics was significantly (p-value &lt;0.05) different among four groups. Minimum number (22.86%) of patients who required the analgesic were in IV dexamethasone group and highest requirement rate (60%) was found in local dexamethasone group followed by bupivacaine (48.57%) group. Conclusion: Intravenous dexamethasone was found to be more effective for early postoperative pain control and reduction in requirement of analgesics. The use of dexamethasone can be a preferred choice in patients undergoing tonsillectomy.

Physicians perception in the management of allergic rhinitis: a Pan-India survey

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Allergic rhinitis (AR) affects a wide proportion of the population across all age groups. There are several guidelines and consensus statements in AR management, the effect of this is implicit from a physician's perspective. The present cross-sectional survey was conducted to understand physicians approach to the management algorithm in the treatment of allergic rhinitis and medication choice.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Physicians from diverse specialties such as pulmonologists, consultant physician, paediatricians, Allergists, ENT specialists and general practitioners were invited to participate in the survey, which focused on recognizing the burden of disease, clinical presentation, and management methods.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 1,261 Physicians participated in this survey, belonging to different specialties. Oral H1 antihistamine was favoured as a first-line therapy, followed by the combination of oral H1 histamine and leukotriene receptor antagonist. Fexofenadine was the most frequently prescribed. Majority believed, bilastine as antihistamine with the least sedative potential and was identified as the most effective treatment. Bilastine was preferred in patients with mild- moderate hepatic/renal impairment and in patients with persistent allergic rhinitis. Most physicians prefer bilastine in all AR clinical profiles. Aside from AR, bilastine is also use in management of upper respiratory tract infections and urticaria respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;AR is still a growing challenge in India with majority of physician preferring oral antihistamine either as monotherapy or in combination. Bilastine is a preferred choice in patients with impaired liver and renal function and was also referred as least sedative antihistamine by majority of physicians across India. &lt;/p&gt;

The impact of atrial fibrillation on outcomes in patients undergoing radical prostatectomy.

To assess the role of atrial fibrillation (AF) on complicating inpatient outcomes of radical prostatectomy (RP). We identified patients treated with RP during 2012-2014 within National Inpatient Sample (NIS) database. Length of stay, cost of hospitalization, and in-hospital complications were compared between patients with or without diagnosis of AF. Propensity score matching methods and multivariable regression analysis were used to adjust for potential confounders and a trend analysis was conducted. Patients with AF had a significantly longer hospital stay (coefficient 0.19, 95% CI 0.09-0.29, P < 0.001) and higher cost (coefficient 0.10, 95% CI 0.06-0.15, P < 0.001). Post-operative cardiac complications were significantly higher for patients with AF (OR 16.38, 95% CI 7.72-34.74, P < 0.001), while no differences were found in other complications between the two groups. Similar results were shown in propensity score matching methods. The cardiac complications after laparoscopic RP (OR: 37.71, 95% CI 1.85-768.73, P = 0.018) and open RP (OR: 16.78, 95% CI 1.41-199.51, P = 0.026) were significantly higher than robot-assisted RP (RARP) in patients with AF. The results of trend study indicated that postoperative cardiac complication rates showed a trend of decreasing year by year while the prevalence of AF was rising. Perioperative AF is associated with increased cardiac complications, longer hospital stay and higher cost in PCa patients undergoing RP. RARP may be a preferred choice for patients with AF. Attention should be paid to this special patient population. Reasonable pre-operative risk stratification and standardized management should be done to decrease perioperative complications.

The depth of catheter in chronic subdural haematoma: does it matter?

ABSTRACTObjective: To investigate the appropriate depth of drainage catheter in the patients with chronic subdural haematoma (CSDH).Methods: We retrospectively analysed the data of 190 patients with CSDH undergoing single parietal burr-hole evacuation and drainage.Results: According to the depth of catheter (DC), 190 patients were divided into three groups: shallow group (DC <4.3 cm), middle group (DC 4.3 ~ 5.4 cm) and deep group (DC > 5.4 cm). During postdischarge 6 months, two, six and nine patients had recurrences in shallow, middle and deep groups, respectively. The recurrence rate in shallow or middle group was significantly lower than that in deep group. No significant difference in preoperative haematoma volume (PHV) was observed in three groups. While the residual subdural space (RSS) in shallow group was significantly smaller than those in the other two groups. The duration of drainage in shallow, middle and deep groups increased successively, and the differences were statistically significant. The total drainage volume (TDV) in shallow group showed no significant difference when compared with the other two groups.Conclusion: The depth of catheter may affect the outcome of CSDH. Inserting drainage catheter shallowly might be a preferred choice in patients with CSDH undergoing burr-hole evacuation and drainage.

A15456 Efficacy of Cilnidipin vs. Amlodipin on microalbuminuria in hypertensive patients- clinical experience

Objectives: 1. To find the efficacy of cilnidipin vs. amlodipin on microalbuminuria in hypertensive patients 2. To evaluate changes in hypertension, s. uric acid level and presence of ankle edema on patients on cilnidipin vs. amlodipin. Methods: A retrospective analysis of our clinical data from jan-2017 till feb-2018 was carried out. Inclusion criteria: Ø Hypertension 3–5 years Ø age: 50–70 years Ø no monotherapy – either cilnidipin or amlodipin Exclusion criteria: established CVD, acute illness. Patients were analyzed & grouped according to the inclusion criteria and statically evaluated to find the objectives. Patient who were detected with microalbuminuria & were on amlodipin were shifted to cilnidipin and followed up after 1 month. Results: 476 patient were found who matched the inclusion criteria (M = 261 F = 215) Patients on cilnidipin at baseline = 290 (F = 143; F = 147) Patients on amlodipin at baseline = 186 (F = 79; M = 107) Patients with microalbuminuria shifted from amlodipin to cilnidipin = 113 (F = 39; M = 74) These patients (n = 91- F = 17; M = 42) when followed up further after 1 month for microalbuminuria showed improvement (n = 59) or absence (n = 32) of albuminuria. Patients on amlodipin also had s/e of ankle edema (n = 41) vs. those on cilnidipin (n = 27). S.uric acid was evaluated in the patients shifted from amlodipin to cilnidipin & it showed non-significant improvement. Improvement in blood pressure values is almost the same in both groups of patient. Conclusion: Based on our clinical experience, we could affirm the fact that although amlodipin is an effective hypertensive agent. Cilnidipin has an additional benefit of improvement in microalbuminuria, which makes it the preferred choice in patients.

Management strategies for patients with placenta accreta spectrum disorders who underwent pregnancy termination in the second trimester: a retrospective study

BackgroundThe unique clinical features of pregnancy termination in the second trimester with concurrent placenta accreta spectrum (PAS) disorders place obstetricians in a complex and delicate situation. However, there are limited data on this rare and dangerous condition. The objective of this research was to investigate and evaluate the clinical management strategies of this patient group.MethodsThe medical records of patients who were diagnosed and treated in our hospital from December 2005 and December 2015 were retrospectively reviewed.ResultsA total of 29 patients were included in this analysis. A prenatal diagnosis was suspected in 8 (27.6%) patients, and the remaining 21 (72.4%) patients were diagnosed after pregnancy termination in the second trimester. In the subgroup with a prenatal diagnosis, a planned hysterotomy was performed in 7 patients who had total placenta previa and previous cesarean delivery. The remaining patient received medical termination. A subtotal hysterectomy was performed in 3 (10.3%) patients for life-threatening bleeding during hysterotomy, and the uterus was preserved with an in situ placenta in the remaining 5 patients. In the subgroup with a postnatal diagnosis, the implanted placenta remained partly or completely in situ in all 21 patients under informed consent. Ultimately, the implanted placenta remained partly or completely in situ in 26 (89.7%) patients in the two subgroups. With the application of adjuvant treatments, including uterine artery embolization and medication followed by curettage under ultrasound guidance, the implanted placenta was passed 76.6 (range: 19 to 192) days after termination. Uterus preservation was achieved in all 26 patients. The complications associated with conservative management included delayed postnatal hemorrhaging (2 cases, 7.7%), fever (6 cases, 23.1%), G1 transaminase disorder (4 cases, 15.4%), and myelosuppression (1 case, 3.8%). Seven women (26.9%) had a spontaneous pregnancy after conservative management, and no patient experienced recurrent PAS disorders.ConclusionsLeaving the implanted placenta in situ is the preferred choice for patients with PAS disorders who underwent pregnancy termination in the second trimester and desired fertility preservation. Multiple adjuvant treatment modalities, either alone or in combination, may help to promote the passing or absorption of the implanted placenta under close monitoring.

Management of Complicants of Acute Pancreatitis

Background /Aim: Acute pancreatitis (AP) is a complex disease with various etiology, most frequent biliary and alcoholic. Clinical presentation shows different degree of severity with biphasic evolution. The aim of this study is to evaluate the surgical procedures with mini-invasive approach as preferred choice in patients with pancreatitis. Methods: Biliary lithiasis and excessive alcohol consumption are the most frequent causes, reaching as a whole the total incidence of 80%. Moreover numerous other causes of pancreatitis are recognized, which on the whole represent 20% of the total. In our Institution from 2000 to 2017 we have observed and treated 351 pancreatitis: 339 acute biliary pancreatitis and 12 chronic alcoholic pancreatitis. Mean age was 49 years (Range: 30-86 yrs). Male female ratio was 1:1, 33. Biliary etiology was confirmed in 339 pts, including 22 pts with recurrent unexplained pancreatitis at initial etiological assessment. The clinical morphological assessment of 339 acute biliary pancreatitis was the following: mild 182, moderate-severe 78, severe 61, early severe 18. We employed a biphasic therapeutic program to control and treat general complications in the first phase. In biliary pathogenesis endoscopic retrograde cholangiopancreatography/ endoscopic sphincterotomy ( ERCP-ES) to assure papillary patency after cholestasis verification. In the second phase control and treatment of pancreatic gatherings and belated acute postnecrotic pseudocysts. Results: In biliary pancreatitis, the therapeutic program includes assuring papillary patency and CBD cleaning with ERCP/ES. After ERCP, it is necessary to perform laparoscopic cholecystectomy (LC) to complete gallstones treatment. The timing of LC is connected with AP evolution because it is preferable to wait for the stabilization of the general conditions. Treatment of the later phase of AP consists in control and treatment of local complications: infections, haemorrhage, pancreatic and peripancreatic fluid necrotic collections. Conclusions: In summary in AP it should be preferred the mini-invasive approach for various clinical manifestations.

Near total parathyroidectomy for the treatment of renal hyperparathyroidism

Different surgical strategies are used to treat medical refractory renal hyperparathyroidism. Our preferred choice in patients with moderate secondary hyperparathyroidism (SHPT) and in patients with low compliance with medical treatment is to leave a very small parathyroid remnant in situ: we name this operation "near total parathyroidectomy" (ntPTX). We report here our results with this technique. Retrospective study [2001-2015] of all patients submitted to ntPTX in a single centre. Forty-seven patients were submitted to ntPTX (32 males) aged 47.3 years. Follow-up time is 8.5 years. Thirty-five patients (74%) are alive, 12 are dead. One patient in this series had a functioning renal transplant at time of ntPTX (tertiary hyperparathyroidism), and other 27 subsequently received a renal transplantation (RTx) after ntPTX (still functioning at last follow-up or at death in 19). Amongst the 35 current survivors, the renal graft is functioning in 16 (45.7%). Parathyroid hormone (PTH) at follow-up was 116.1±135.5 pg/mL and calcium 8.6±0.9 mg/dL. Among patients with a functioning RTx PTH was 83 pg/mL and calcium 8.7 mg/dL. There was no persistent disease, and 3 patients (6.4%) had a relapse of hyperparathyroidism at follow-up. ntPTX is associated to very satisfying rates of normal parathyroid function and of relapse of hyperparathyroidism (6.4%) at long term, either in case of RTx or of maintenance hemodialysis: the concept of "small amount" remnant represents a valuable choice for patients undergoing PTX with a realistic chance of receiving a RTx.

The treatment of early-stage liver cancer

Although the diagnostic rate of early-stage liver cancer is low, only these patients have a chance of radical treatment, and thus related treatment modalities deserve attention. Surgical resection is the preferred choice for the treatment of early-stage liver cancer. For patients with high selectivity, local treatment including radiofrequency ablation can achieve satisfactory outcomes. Liver transplantation is the preferred choice for patients with decompensated liver cirrhosis. Early-stage liver cancer has a high postoperative recurrence rate, and the research and development of postoperative adjuvant therapy should be taken seriously.

Avulsion of radial artery during coronary angiogram – A case report

Trans-radial intervention increases patient comfort and reduces vascular complications. Trans-radial access has become the preferred choice of patients and cardiologists. Radial artery spasm is commonly encountered during procedure and it depends upon factors like artery anatomy, built of the patient, procedure variables. We report a case of radial artery spasm leading to avulsion in a 69-year old short Asian female during coronary angiogram, which was managed successfully by conservative measures. A brief note of various management procedures like drugs and device are mentioned.