Postoperative Symptoms In Patients Research Articles

Postoperative myocardial injury after major head and neck cancer surgery

Background/objective: This narrative review aims to assess the causes and evaluate the scientific evidence concerning the increased risk of postoperative myocardial infarction (PMI) in patients undergoing major head and neck surgery. Method: A comprehensive review of literature was conducted and findings from clinical trials, meta-analysis as well as observational studies were incorporated to explore the risk factors associated with PMI after a major head and neck surgery. Preoperative risk factors, appropriate diagnostic plans, biomarkers, risk stratification strategies, and treatment options were also assessed. Result: The review highlights that patients undergoing head and neck surgery are at a significant risk of developing PMI primarily due to surgical trauma, anesthesia, and the extensive nature of head and neck surgeries. However, pre-existing conditions like renal insufficiency, cerebrovascular diseases, and diabetes may also exacerbate this risk. Moreover, ECG and regular observation of troponin has proven to be successful in detecting PMI, which can be easily masked due to its ambiguous symptoms in postoperative patients that are receiving pain reducing medications. Once diagnosed, PMI is treated with standard medication for myocardial infarction, however, more emphasis has been put on its timely diagnosis through routine troponin testing. Conclusion: Head and neck cancers are prevalent in developing nations such as Pakistan where the use of tobacco is widespread. As a result of such aggressive cancer, patients may undergo surgery, which places them at a risk of developing PMI. This can be avoided through routine troponin testing which still requires further research on localized patient population considering the physiologic differences.

Clinical effect of full endoscopic lumbar annulus fibrosus suture

PurposeThe aim of this study was to investigate the clinical efficacy of full endoscopic lumbar annulus fibrosus suture in the treatment of single-segment lumbar disc herniation (LDH).MethodsThe clinical data of patients with single-segment LDH who underwent full endoscopic lumbar discectomy from January 2017 to January 2019 in our hospital were retrospectively analysed. Patients with full endoscopic lumbar discectomy combined with annulus fibrosus suture were divided into group A, and those with simple full endoscopic lumbar discectomy were divided into group B. The general information, surgery-related data, visual analog scale (VAS), Oswestry disability index (ODI), modified MacNab score at the last follow-up, reoperation rate and recurrence were compared between the two groups.ResultsAll patients were followed up for 12 to 24 months, and the surgical time was 133.6 ± 9.6 min in group A and 129.0 ± 11.7 min in group B. The difference was not statistically significant (p > 0.05). The blood loss of group A was higher than that of group B, and the difference was statistically significant when comparing the groups (p < 0.05). The postoperative symptoms of patients in both groups were significantly relieved, and the VAS score of low back pain and ODI index were significantly lower than the preoperative ones at all postoperative time points (1 month after surgery, 3 months after surgery, and at the last follow-up) (p < 0.05), but there was no significant difference between the groups (p > 0.05). The excellent rate of MacNab at the last follow-up in the two groups were 93.55% and 87.80%, respectively, with no statistically significant difference (p > 0.05). At the last follow-up, the recurrence rate of group A was significantly lower than that of group B, and the difference was statistically significant (p < 0.05), while the difference between the reoperation rate of the two groups was not statistically significant (p > 0.05).ConclusionsFull endoscopic lumbar discectomy combined with annulus fibrosus repair reduces the postoperative recurrence rate and achieves satisfactory clinical outcomes.

The Role of Fundoplication after Laparoscopic Heller Myotomy in Reducing Postoperative Symptoms in Patients with Achalasia: A Controlled Clinical Trial.

Background: Laparoscopic Heller myotomy (LHM) is considered the standard surgical approach in patients newly diagnosed with achalasia worldwide. However, proceeding to fundoplication after LHM remains controversial due to the observed postoperative symptoms, including dysphagia and regurgitation. This study was conducted to compare the postoperatively experienced regurgitation and dysphagia between those undergoing LHM with fundoplication and those with mere LHM. Methods: This four-year controlled clinical trial was performed on adult patients with esophageal type two achalasia, referring to the Shariati Hospital, who gave their written informed consent to enroll. The diagnosis of achalasia was confirmed using manometric assessments. The control group underwent LHM with fundoplication, while the cases received LHM without fundoplication. The validated Achalasia Patients Questionnaire was used for assessing the experienced symptoms pre- and postoperatively. Also, esophagography was used to investigate the alterations of the symptoms pre- and postoperatively. Results: A total of 48 patients were evaluated. 23 were assigned to the case group, while 25 were considered the controls (male to female ratio: 25 to 23). The mean age of the patients was 36.94 years, and the average disease duration was 6.22 years. Cases and controls were matched demographically. There was no statistically significant difference between the cases and controls regarding postoperative active or passive regurgitation or dysphagia to either solids or fluids. Also, the mean score of total clinical symptoms after the surgery was not significantly different between cases and controls. Lastly, esophagography revealed significant improvement regarding all the symptoms postoperatively (P=0.001); however, no statistically significant difference existed in this regard between cases and controls. Conclusion: Our results indicate no significant difference regarding the postoperative achalasia-related symptoms, namely regurgitation and dysphagia, between those patients undergoing LHM with and without fundoplication. However, further studies are required to thoroughly investigate the effects of various fundoplication techniques in relation to all achalasia-related symptoms to confirm these results.

Relationship Between the Perception of Self-Efficacy and Early Post-Operative Symptoms in Patients Undergoing Coronary Artery Bypass Graft Surgery with Median Sternotomy

Relationship Between the Perception of Self-Efficacy and Early Post-Operative Symptoms in Patients Undergoing Coronary Artery Bypass Graft Surgery with Median Sternotomy

The Impact and Clinical Implications of Gastric Surgery on the Gastric Conduction System

Chronic symptoms of gastric dysfunction are common following gastric surgery, but the mechanisms underlying these have remained poorly understood. Disturbances of foregut motility are suspected to play a central role, however knowledge of how these abnormalities manifest and relate to symptoms requires elucidation. Emerging data suggests that abnormalities of the gastric conduction system are a common consequence of gastric surgery and may contribute to dysmotility and post-operative symptoms. This review provides a primer on the gastric conduction system. The normal physiology of the gastric conduction system and factors that influence resilience to surgery are outlined, together with focused discussion on three surgical procedures that impact post-operative gastric dysfunction: resection of the gastric pacemaker, resection or bypass of the pylorus, and vagotomy. The mechanistic pathways that underpin the clinical effects of these procedures are discussed. Future horizons are also evaluated, including newly established body surface gastric mapping techniques that provide a non-invasive method to detect changes in the gastric conduction system and relate these to symptoms in postoperative patients, with the goal of developing targeted interventions for prevention and therapy.

Profiling symptom burden and its influencing factors at discharge for patients undergoing lung cancer surgery: a cross-sectional analysis

BackgroundFollowing lung cancer surgery, patients often experience severe symptoms which are not properly assessed at discharge. The aim of this study was to identify the clinical presentation at discharge and the influencing factors of postoperative symptoms in patients who have undergone lung cancer surgery.MethodsThis cross-sectional study analysed data from patients who participated in a prospective cohort study that enrolled patients who underwent lung cancer surgery at six tertiary hospitals in the People’s Republic of China, from November 2017 to January 2020. Patient symptoms at discharge were measured using the MD Anderson Symptom Inventory Lung Cancer module. The five core symptoms were defined according to ratings of moderate to severe symptoms (≥ 4 on a 0–10 scale). A multivariate linear regression model was used to identify the influencing factors of each symptom at discharge.ResultsAmong the 366 participants, 51.9% were male and the mean (SD) age was 55.81 (10.43) years. At discharge, the core symptoms were cough (36.4%), pain (28.2%), disturbed sleep (26.3%), shortness of breath (25.8%), and fatigue (24.3%), and more than half of the participants (54.6%) had one to five of the core symptoms, with moderate to severe severity. A low annual income and the use of two chest tubes were significantly associated (P = 0.030 and 0.014, respectively) with higher mean scores of the core symptoms.ConclusionThough clinically eligible for discharge, more than half of the participants had severe symptoms at discharge after lung cancer surgery. Special attention should be given to patients who have two chest tubes after surgery and those who have a low annual income.

The Effect of Preoperative Anxiety on Postoperative Symptoms in Patients Without a History of Anxiety Scheduled for Coronary Artery Bypass Grafting

The aim of this study was to measure the level of preoperative anxiety in patients scheduled for coronary artery bypass grafting (CABG) to assess the relationship between anxiety and postoperative symptoms.&#x0D; Materials and Methods. This descriptive study was conducted at a single university hospital from February to November 2021. Seventy-four CABG patients who completed the Anxiety Specific to Surgery Questionnaire, the Visual Analogue Scale, the Modified Borg Scale, the Rhodes Index of Nausea, Vomiting and Retching were included in the study. The data were analyzed by the mean, standard deviation, frequency distribution, Mann-Whitney U Test, and Spearman’s correlation analysis.&#x0D; Results. The average age of participants was 65.55 ± 8.35; 66.2% of them were males. The ASSQ total scores of female participants were significantly higher as compared to male participants (p &lt; 0.05). There was a statistically significant positive relationship between the levels of anxiety in patients before CABG and the levels of postoperative pain and dyspnea severity (p &lt; 0.05).&#x0D; Conclusions. Patients were found to experience predominantly moderate to severe anxiety before CABG, and increased dyspnea complaints and pain in the postoperative period. A coordinated, multidisciplinary approach to preoperative training of healthcare professionals may offer a promising way to provide more efficient and productive services.

Climacteric symptoms in postoperative patients among endometrial cancer, cervical cancer, and ovarian cancer: a cross-sectional study

PurposeTo date, no studies have assessed climacteric symptoms after hystero-adnexectomy for endometrial, cervical, or ovarian cancer. Thus, this study aimed to compare climacteric symptoms among patients who underwent surgery for these three cancer types.MethodsIn this cross-sectional study, we interviewed patients who were registered at a menopausal outpatient clinic between January 1999 and July 2016 after undergoing total hysterectomy, intrapelvic only or intrapelvic plus para-aortic lymph node dissection, and bilateral adnexectomy performed via laparotomy as a cancer treatment. Climacteric symptoms were assessed using a patient-reported questionnaire covering core domains with five symptoms only at the initial consultation. Each symptom was graded from 0 (no symptoms) to 3 (severe symptoms). We evaluated the frequency of symptom severity according to the time elapsed since surgery and the cancer type.ResultsThe numbers of patients with endometrial, ovarian, and cervical cancer were 328, 90, and 107, respectively. Overall, climacteric symptoms were more severe in patients with cervical cancer than in those with endometrial or ovarian cancer; symptom severity decreased with increasing time since surgery. However, symptom severity did not decrease significantly over time in patients with cervical cancer even after > 5 years had elapsed since surgery.ConclusionThe climacteric symptoms were less severe in patients with endometrial or ovarian cancer with longer time elapsed since surgery but not in those with cervical cancer. Patients with cervical cancer may require more prompt interventions, including symptomatic treatment and longer follow-up period, than those with endometrial or ovarian cancer.

Preoperative high-resolution esophageal manometry and postoperative symptoms in patients undergoing bariatric surgery: a retrospective cohort study.

The increasing incidence of obesity has led to a rise in bariatric surgeries. Obesity can be associated with various gastrointestinal symptoms as well as abnormal findings on high-resolution esophageal manometry (HRM). Bariatric procedures have variable effects on esophageal function and may contribute to postoperative symptoms. Preoperative HRM is not performed routinely on patients undergoing bariatric surgery but may identify patients likely to experience postoperative esophageal symptoms via delineation of structural or functional abnormalities. To evaluate whether prebariatric surgery HRM could predict persistent or de novo postoperative esophageal symptoms. Academic tertiary care hospital, United States. Retrospective data were collected for 20 patients undergoing HRM and 100 controls 18 years and older from May 2012 to May 2015. Propensity score matching was performed to adjust for baseline differences between the 2 groups. Preoperative and postoperative esophageal symptoms (reflux, dysphagia, nausea/vomiting, bloating, fullness, early satiety, pain, and intolerance) were compared between HRM and control patients, and associations among HRM findings, Chicago Classification, and symptoms were analyzed. All included patients had follow-up beyond 3 months postoperatively. Data were analyzed with 2-tailed Fisher's exact test, Wilcoxon rank-sum test, and odds ratio. Compared to controls, patients undergoing preoperative HRM had a higher rate of postoperative chronic intolerance (25% versus 8%, P = .041). This difference was not observed in propensity score matching analysis. Identification of elevated integrated relaxation pressure and esophagogastric junction outflow obstruction predicted chronic intolerance (odds ratio = 21.0; 95% confidence interval: 1.40-314; P = .027 for each). Preoperative HRM abnormalities were associated with postoperative symptoms in patients undergoing bariatric surgery. HRM can identify patients who are more likely to experience postoperative esophageal symptoms and may aid in discussion of suitability for surgery and selection of bariatric intervention.

Clinical outcome after surgery on schwannomas in the extremities.

BACKGROUNDSchwannoma is a benign, encapsulated and slowly growing tumor originating from Schwann cells and is rarely seen in the peripheral nerve system. Typical symptoms are soreness, radiating pain and sensory loss combined with a soft tissue mass.AIMTo evaluate pre- and postoperative symptoms in patients operated for schwannomas in the extremities and investigate the rate of malignant transformation.METHODSIn this single center retrospective study design, all patients who had surgery for a benign schwannoma in the extremities from May 1997 to January 2018 were included. The location of the tumor in the extremities was divided into five groups; forearm, arm, shoulder, thigh and leg including foot. The locations of the tumor in the nerves were also categorized as either; proximal, distal, minor or major nerve. During the pre- and postoperative clinical evaluation, symptoms were classified as paresthesia, local pain, radiating pain, swelling, impairment of mobility/strength and asymptomatic tumors that were found incidentally (with magnetic resonance imaging). The patients were evaluated after surgery using the following categories: Asymptomatic or symptomatic patients (radiating and/or local pain) and those with complications. The follow up period was from the time of surgery until last examination of the particular physician. Multivariate logistic regression analysis was performed to identify independent prognostic factors for postoperative significant symptoms at follow-up.RESULTSWe identified 858 cases from the institutional pathology register. We excluded cases with duplicate diagnoses (n = 407), pathology not including schwannomas (n = 157), lesions involving the torso, spine and neck (n = 150) leaving 144 patients for further analysis. In this group 99 patients underwent surgery and there were five complications recorded: 2 infections (treated with antibiotics) and 3 nerve palsies (2 involving the radial nerve and one involving the median nerve) that recovered spontaneously. At the end of follow-up, 1.4 mo (range 0.5-76) postoperatively, we recorded a post-operative decrease in clinical symptoms: Local pain 76% (6/25), radiating pain 97% (2/45), swelling 20% (8/10). Symptoms of paresthesia increased by 2.8% (37/36) and there was no change in motor weakness before and after surgery 1% (1/1). Multivariate analysis showed that tumors located within minor nerves had a significantly higher prevalence of postoperative symptoms compared with tumors in major nerves (odds ratio: 2.63; confidence intervals: 1.22-6.42, P = 0.029). One patient with schwannoma diagnosed by needle biopsy was diagnosed to have malignant transformation diagnosed in the surgically removed tumor. No local recurrences were reported.CONCLUSIONSurgery of schwannomas can be conducted with low risk of postoperative complications, acceptable decrease in clinical symptoms and risk of malignant transformation is low.

Predictive Factors and Effects of Replaced Rectorectal Intussusception on Functional Outcomes in Patients with Rectoanal Intussusception Who Have Undergone Laparoscopic Ventral Rectopexy

Rectoanal intussusception (RAI) treated using laparoscopic ventral rectopexy (LVR) may give rise to rectorectal intussusception (RRI) during defecation postoperatively. However, only a few studies have analyzed the results of LVR using pelvic floor imaging, which is important when interpreting postoperative symptoms in patients with RAI. Thus, this study was designed to find the preoperative variables that may help predict the postoperative occurrence of RRI and to determine whether RRI may have negative effects on bowel symptoms after LVR for RAI. Consecutive patients treated between 2012 and 2017 were included. Defecatory function was evaluated using the Constipation Scoring System (CSS) and the Fecal Incontinence Severity Index (FISI). Defecography was performed before and 6 months after LVR. Of the 66 patients with RAI preoperatively, 34 had mixed obstructed defecation (OD) and fecal incontinence (FI), 18 had OD alone, and 12 had FI alone. Twelve months after surgery, a reduction of at least 50% was observed in the CSS score of 25 patients (52%) with OD and in the FISI of 37 incontinent patients (87%). Postoperatively, RAI was replaced with RRI in 21 and posterior RAI in 2 patients. These anatomical changes were found in patients who had a greater anorectal angle at rest preoperatively. However, the improvement in bowel symptoms was unrelated to the anatomical changes. Improvement in bowel symptoms after LVR for RAI was unrelated to the postoperative occurrence of RRI or posterior RAI, which were found in patients who had a vertical rectum at rest preoperatively.

A modified procedure of single-level transforaminal lumbar interbody fusion reduces immediate post-operative symptoms: a prospective case-controlled study based on two hundred and four cases.

This is a prospective case-controlled study. The purpose of this study is to investigate the effect of a modified transforaminal lumbar interbody fusion (TLIF) on the immediate post-operative symptoms in patients with lumbar disc herniation (LDH) accompanied with stenosis. A total of 204 LDH patients with single-level TLIF were enrolled. According to the sequence of the placement of rods and cage, patients were divided into group R (rod-prior-to-cage) and group C (cage-prior-to-rod). Neurological function was evaluated by the Japanese Orthopedic Association (JOA) score. Radiological assessment includes height of intervertebral space (HIS), foraminal height (FH), foraminal area (FA), and segmental lordosis (SL). Change of original symptoms (pain/numb) and new-onset symptoms (pain/numb) after surgery were also recorded. Patients in group R had less change of HIS at L3/4, L4/5, and L5/S1 levels compared with pre-operation (all p > 0.05), whereas group C had larger change (all p < 0.05). No statistical difference was found in FH between the two groups before and after surgery at L3/4, L4/5, and L5/S1, respectively (all p > 0.05). In terms of FA, patients in group R had better improvement after surgery than those in group C at L3/4 and L4/5 (both p < 0.05). Patients in both groups acquired good improvement of neurological function. However, there were fewer patients in group R who experienced post-operative leg pain or numb compared with those in group C (p < 0.05). The modified open TLIF can significantly reduce the incidence of immediate post-operative symptoms for patients with single-level lumbar disc herniation via installation of rods prior to insertion of cage and the "neural standard" should serve as the goal of decompression for spine surgeons to restore disc/foraminal height and to minimize nerve distraction.

A randomized control study to compare the efficacy of intranasal fluticasone propionate and intranasal budesonide in controlling postoperative symptoms in patients with nasal polyposis after endoscopic sinus surgery

Abstract BACKGROUND. Sinonasal polyposis represents a chronic inflammatory condition characterized by nasal obstruction, reduction in the sense of smell and impaired quality of life. Intranasal steroids play an important role in preventing the postoperative recurrences in these cases. We carried out a study to evaluate and compare intra nasal budesonide and intranasal fluticasone propionate in the postoperative management of ethmoidal nasal polyposis. MATERIAL AND METHODS. 106 patients with ethmoidal polyposis were treated with endoscopic polypectomy and were postoperatively started and maintained on intranasal steroids. 54 patients were managed with budesonide and 52 patients maintained on fluticasone propionate nasal spray. The patients were followed-up for 6 months and recurrences and control of symptoms evaluated. RESULTS. There was a statistical difference in the SNOT-22 (p&lt;0.0001) and Lund-Kennedy scores (p=0.015) between patients using fluticasone propionate as compared to those using budesonide intra nasal spray by the end of the 6th month. CONCLUSION. Both intranasal budesonide and fluticasone propionate are effective in controlling symptoms after endoscopic sinus surgery in patients with sinonasal polyposis; however, intranasal fluticasone propionate was more efficacious than budesonide in the control of postoperative symptoms.

P2453Value of pre-operative left atrial minimum volume as a surrogate for post-operative symptoms in patients with aortic stenosis who underwent aortic valve replacement

Abstract Background Previous reports have shown that symptoms after aortic valve replacement (AVR) are not uncommon depending on severity of myocardial fibrosis in patients with severe aortic stenosis (AS). Pre-operative minimum left atrial volume (LAVmin) at end-diastole determined by direct exposure of left ventricular end-diastolic pressure may be used as a surrogate for post-operative symptoms in patients with severe AS undergoing AVR. Purpose The purpose of this study was to examine the value of pre-operative echocardiographic LAVmin index (LAVImin) to predict post-operative symptomatic status after AVR in patients with severe AS. Methods The study population consisted of 219 patients with severe AS who underwent AVR and were followed up for 1000 days after AVR. Pre-operative maximum LAV index (LAVImax), LAVImin, LA emptying fraction (LAEF), LV volume indexes, LV ejection fraction (LVEF) by biplane Simpson's method, aortic valve area index (AVAI), mean aortic valve pressure gradient (mAV-PG), E/A, mean E/e' from LV inflow and mitral annular velocity, and pulmonary artery systolic pressure (PASP) were evaluated by Doppler echocardiography. Results After exclusion of 136 patients who met the exclusion criteria (atrial fibrillation, significant coronary artery disease, significant mitral valve diseases, pacemaker rhythm, and inadequate echocardiographic images), the final study population consisted of 75 patients (75±7 years old, 46 female). During a follow-up, 19 patients (25%) complained post-operative symptoms. There were no significant differences in pre-operative serum hemoglobin, creatinine, BNP, chronic obstructive pulmonary disease, hypertension, diabetes, LV volume indexes, LVEF, AVA, mAV-PG between patients with and without post-operative symptoms. There were significant differences in pre-operative LAVImax, LAVImin, and LAEF between patients with and without post-operative symptoms. (60±15 vs 47±15 ml/m2, 45±15 vs 28±1 ml/m2, and 29±12 vs 42±11 ml/m2, respectively). E/A, mean E/e', and PASP in patients with symptoms were significantly greater compared with patients without symptoms (1.0±0.3 vs 0.7±0.2, 25±3 vs 18±2, 44±17 vs 32±9 mmHg, respectively). In the multivariate analysis, pre-operative LAVImin was the independent predictor of the post-operative symptomatic status after AVR (odds ratio: 1.11, 95% confidence interval: 1.04 - 1.18). Receiver operating characteristic analysis revealed that area under the curve (AUC) of LAVImin (cutoff: 30ml/m2) for post-operative symptoms was the largest (0.84) among the other echocardiographic parameters, and significantly larger than that of mean E/e' (0.67, *p&lt;0.01) and LVEF (0.53, **p&lt;0.05) (figure). Figure 1. ROC analysis Conclusions The present results suggest that pre-operative echocardiographic LAVImin may be used as a surrogate for post-operative symptomatic status after AVR in patients with severe AS.

Using patient-reported outcomes to manage postoperative symptoms in patients with lung cancer: protocol for a multicentre, randomised controlled trial

IntroductionSurgery is one of the primary treatments for lung cancer. The postoperative symptom burden experienced by patients with lung cancer is substantial, seriously delaying their recovery from surgery and impairing...

Preoperative left atrial minimum volume as a surrogate marker of postoperative symptoms in senile patients with aortic stenosis who underwent surgical aortic valve replacement

BackgroundPrevious reports have shown that postoperative symptoms despite successful surgical aortic valve replacement (AVR) are not uncommon depending on severity of myocardial fibrosis in patients with aortic stenosis (AS). Left atrial minimum volume (LAVmin) at end-diastole determined by direct exposure of left ventricular end-diastolic pressure may be useful as a surrogate marker of postoperative symptoms in patients with AS undergoing AVR. Methods and resultsWe studied 75 patients with AS who underwent AVR and were followed up to 600 days after AVR. We examined the postoperative symptomatic status which occurred between 60 days to 600 days after AVR. The study patients were divided into 2 groups: 19 patients (25%) with postoperative symptoms (symptomatic group) and 56 without symptoms (asymptomatic group). There were no significant differences in preoperative left ventricular volumes and ejection fraction and AS severity by echocardiography between the two groups. There were significant differences in preoperative echocardiographic LAVmin index (LAVImin) between symptomatic group and asymptomatic group (45±15 vs. 28±11ml/m2). Using receiver operating characteristic curve analysis, LAVImin≥30ml/m2 detected postoperative symptoms with the large area under the curve (0.84) (sensitivity 94% and specificity 68%). In the multivariate analysis, preoperative LAVImin was the independent predictor of the postoperative symptomatic status after AVR (odds ratio: 1.11; 95% CI: 1.04–1.18). ConclusionsThe preoperative echocardiographic LAVImin measurement is useful as a surrogate marker of symptomatic status after AVR in patients with AS.

The curative effect of ESWL postoperative renal calculi in the treatment of lithotripsy (Physical vibration outside the body) was analyzed

Objective To understand the difference of the curative effect of physical vibration platter and traditional SLATE method for the treatment of calculi patients (ESWL postoperative renal calyx), and the clinical application experience of this method. Methods From April 2014 to September 2016, 130 patients with renal calyx calculi underwent ESWL surgery were studied, the 49 cases of patients in experimental group (extracorporeal physical vibration assisted stone removal) and 65 patients in the control group (traditional stone removal therapy). The indicators of statistical differences of two groups were compared before and after surgery, including stone free rate (calculus), biochemical indicators (ADC values, NGAL, Cys C, beta 2-MG) and major clinical manifestations, etc. Results There was significant difference in the clearance rate between the two groups (P<0.05), and the difference between the two groups (1, 7 and 14 d) was significant (P<0.05), and the stone rate in the experimental group was higher than that in the control group. The difference of ADC value, NGAL, Cys C, and 2-MG was significant (P<0.05), and the difference between ADC, NGAL, Cys C, and 2-MG was significant (P<0.05). Compared two groups of patients before and after treatment, clinical symptoms constituted a significant change (P<0.05). Compared with before discharge, clinical manifestations of the experimental group (blood in the urine, a positive urine WBC, waist pain, fever) in the number of cases were significantly less than the control group 24 h after surgery (P<0.05). Conclusions Compared with the traditional stone method, the rate of stone discharge and the discharge of stone are generally higher. At the same time, postoperative symptoms of patients receiving the treatment were relatively better. Key words: Kidney Calculi; Lithotripsy

Hypercholesterolemia Is Associated with the Subjective Evaluation of Postoperative Outcomes in Patients with Idiopathic Carpal Tunnel Syndrome Who Undergo Surgery: A Multivariate Analysis.

Carpal tunnel syndrome is a compression neuropathy of the median nerve at the wrist; its symptoms include neuropathic pain and sensory and motor disturbance distributed by the median nerve. Carpal tunnel syndrome and hypercholesterolemia have similar backgrounds, but the effect of these similarities on postoperative outcomes has not been reported. Using multivariate analysis, the authors analyzed the relationship between prognostic factors, including the presence of hypercholesterolemia, and subjective postoperative outcomes of patients with idiopathic carpal tunnel syndrome. Of 168 hands with carpal tunnel syndrome that were treated surgically, 141 that were followed up and assessed 1 year postoperatively or thereafter were included. The mean postoperative follow-up period was 40.8 months. Surgery was performed through a small palmar skin incision under local anesthesia. The outcomes were postoperative symptoms, including pain and numbness, and overall Kelly assessment. Preoperative numbness and pain resolved and alleviated in 94 of 141 hands and was diminished in 59 of 64 hands. Univariate analysis showed that postoperative numbness and Kelly assessment were significantly associated with hypercholesterolemia. Multivariate analysis showed that postoperative numbness was significantly associated with smoking and hypercholesterolemia, and Kelly assessment was significantly associated with smoking (adjusted OR, 3.3; 95 percent CI, 1.1 to 10; p = 0.04) and hypercholesterolemia (adjusted OR, 2.9; 95 percent CI, 1.4 to 6.3; p = 0.01). Hypercholesterolemia, usually a systemic condition in sites other than the hand, is associated with the subjective evaluation of postoperative symptoms in patients with idiopathic carpal tunnel syndrome. Risk, III.

Comparative Study of Improvement of Nasal Symptoms Following Septoplasty with Partial Inferior Turbinectomy Versus Septoplasty Alone in Adults by NOSE Scale: A Prospective Study.

To compare the symptomatic improvement of nasal symptoms following septoplasty with partial inferior turbinectomy (groups A) versus septoplasty alone (groups B) and to assess the improvement of nasal symptoms in both surgical groups before and after surgery by NOSE scale. This Tertiary Hospital based study was carried out between August 2012 and April 2014. 60 cases with septal deviation and contralateral inferior turbinate hypertrophy. Nasal Obstruction Symptom Evaluation (NOSE) scale for evaluating nasal symptoms. Patients were alternatively divided into two surgical groups, group A. Septoplasty with partial inferior turbinectomy and group B septoplasty alone. Post-operative patient's symptoms evaluated by NOSE scale at 1, 3 and 6months. Data analysed using tables, graph and percentage and test of significance like paired t test, Friedman test, Chi square test used. Post operative improvement following both group A septoplasty with partial inferior turbinectomy and group B in those undergoing septoplasty alone was highly significant (p<0.001) at post-op 1, 3 and 6months subjectively. When both groups were compared those undergoing partial inferior turbinectomy surgery with septoplasty had highly significant results (p<0.001) for subjective assessment by NOSE scale. This study showed that hypertrophied turbinate need to be addressed in chronic cases of nasal obstruction with deviated nasal septum and contralateral turbinate hypertrophy. partial inferior turbinectomy should be done in addition to septoplasty, its highly effective modality for the treatment of nasal obstruction in patients with deviated nasal septum. NOSE score can be used as a subjective tool for symptomatic measurement of patients with nasal obstruction.

Analysis of pre- and post-operative symptoms of patients with mild trigonocephaly using several developmental and psychological tests.

Over the past decade, we collected the cases where patients underwent decompressive cranioplasty for the treatment of mild metopic suture synostosis (mild trigonocephaly) with developmental delays. To evaluate the effectiveness of this surgery, we administered several developmental and psychological examinations to children with this condition who underwent decompressive cranioplasty. Thirty-four children (32 boys and 2 girls) who had developmental disorders with mild trigonocephaly underwent four different tests at three different time points (pre-operation, 3 and 6months after surgery) including the: (a) Kyoto form developmental test (2001) to calculate the developmental quotient (DQ), (b) National Rehabilitation Center Sign-Significance Test (NRC S-S test) to evaluate the patients' language use and acquisition, (c) Pervasive Developmental Disorders Autism Society Japan Rating Scale (PARS) to identify autistic tendencies, and (d) Japanese Child Behavior Checklist (J-CBCL) to evaluate behavioral problems. The scores were initially analyzed using analyses of variance. When significant results were observed, Tukey-Kramer multiple comparison tests were applied for further statistical evaluation. Significant DQ improvements were observed, as assessed by the Kyoto form developmental test. Additionally, significant improvement in the expression of words (measured with the NRC S-S test), the scores on PARS, and some behavioral factors (measured with the J-CBCL) were observed. The results in this cohort suggest that decompressive cranioplasty may play an important role in supporting the improvement of developmental delays in these patients.