scholarly journals Effects of Permissive Hypercapnia on Laparoscopic Surgery for Rectal Carcinoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Lei Wang ◽  
Lina Yang ◽  
Jing Yang ◽  
Shiqiang Shan
Keyword(s):  
Laparoscopic Surgery ◽  
Adverse Events ◽  
Rectal Carcinoma ◽  
Peak Pressure ◽  
Dynamic Compliance ◽  
Plateau Pressure ◽  
Control Group ◽  
Permissive Hypercapnia ◽  
Arterial Blood ◽  
And Control

Background. Permissive hypercapnia has been recommended during the treatment of chronic diseases; however, there are insufficient clinical data to investigate the feasibility of permissive hypercapnia in relatively long-term surgeries such as laparoscopic surgery for rectal carcinoma. This prospective study is aimed at investigating the efficacy and safety of permissive hypercapnia under different CO2 pneumoperitoneum pressures during the laparoscopic surgery for rectal carcinoma. Methods. A total of 90 patients undergoing laparoscopic surgery for rectal carcinoma were recruited from July 2016 to March 2017. They were randomly assigned to high hypercapnia group (n=30), low hypercapnia group (n=30), or control group (n=30), whose PaCO2 levels were maintained at 56-65 mmHg, 46-55 mmHg, or 35-45 mmHg, respectively. The primary endpoint was peak pressure. Plateau pressure, dynamic compliance, arterial blood analysis, and hemodynamic measures were collected as secondary outcomes. Adverse events were monitored. Results. High hypercapnia group were reported to be associated with significantly lower peak pressure and plateau pressure, but higher dynamic compliance compared to low hypercapnia and control group (all P<0.01). Moreover, patients in the high hypercapnia group had higher postoperation oxygenation index values compared to those in the low hypercapnia and control group (all P<0.01). There is no significant difference in the pH, Spo2, MAP, heart rate, and adverse events among the three groups. Conclusion. Permissive hypercapnia with a PaCO2 level of 56-65 mmHg was able to improve respiratory function after laparoscopic surgery in rectal cancer patients.

scholarly journals Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility

2021 ◽  
Vol 10 (11) ◽  
pp. 2355
Author(s):  
Dean Decter ◽  
Nissim Arbib ◽  
Hila Markovitz ◽  
Daniel S. Seidman ◽  
Vered H. Eisenberg
Keyword(s):  
Laparoscopic Surgery ◽  
Retrospective Study ◽  
Statistical Analysis ◽  
Conservative Management ◽  
Transvaginal Ultrasound ◽  
Control Group ◽  
Study Group ◽  
Control Groups ◽  
Increased Risk ◽  
And Control

We compared the prevalence of ultrasound signs of adenomyosis in women with endometriosis who underwent surgery to those who were managed conservatively. This was a retrospective study of women evaluated at a tertiary endometriosis referral center who underwent 2D/3D transvaginal ultrasound. Adenomyosis diagnosis was based on the presence of at least three sonographic signs. The study group subsequently underwent laparoscopic surgery while the control group continued conservative management. Statistical analysis compared the two groups for demographics, symptoms, clinical data, and sonographic findings. The study and control groups included 244 and 158 women, respectively. The presence of any, 3+, or 5+ sonographic signs of adenomyosis was significantly more prevalent in the study group (OR = 1.93–2.7, p < 0.004, 95% CI; 1.24–4.09). After controlling for age, for all findings but linear striations, the OR for having a specific feature was higher in the study group. Women in the study group with ≥ 5 sonographic signs of adenomyosis had more than twice the risk of experiencing infertility (OR = 2.31, p = 0.012, 95% CI; 1.20–4.45). Sonographic signs of adenomyosis are more prevalent in women with symptomatic endometriosis who underwent surgery compared with those who continued conservative management. Women with 5+ findings have a significantly increased risk of infertility. Adenomyosis on ultrasound should be considered in the management decisions regarding these patients.

Excess Morbidity Associated With Interhospital Transport

PEDIATRICS ◽  
1992 ◽  
Vol 90 (6) ◽  
pp. 893-898 ◽  
Author(s):  
Robert K. Kanter ◽  
Nancy M. Boeing ◽  
William P. Hannan ◽  
Deborah L. Kanter
Keyword(s):  
Intensive Care ◽  
Adverse Events ◽  
Critically Ill ◽  
Pediatric Patients ◽  
Morbidity Rate ◽  
Control Group ◽  
Interhospital Transfer ◽  
Excess Morbidity ◽  
Interhospital Transport ◽  
And Control

A prospective study was performed to determine whether excess morbidity occurred in critically ill and injured pediatric patients during interhospital transport compared with morbidity in a control group. Control observations were made during the first 2 hours of pediatric intensive care unit (PICU) care of patients emergently admitted from within the same institution and not requiring interhospital transport. The first 2 PICU hours of control patients corresponded to the interval of transport in those who required interhospital transfer. Transport care was provided by nonspecialized teams from referring hospitals. Morbidity occurred in 20.9% of 177 transported patients, exceeding the morbidity rate of 11.3% in 195 control patients (P &lt; .05). The difference in morbidity was due to intensive care-related adverse events (eg, plugged or dislodged endotracheal tubes, loss of intravenous access) in 15.3% and 3.6% of transported and control patients, respectively (P &lt; .05). Physiologic deterioration occurred at similar rates of 7.9% and 8.7% in transported and control patients, respectively (P &gt; .05). Slightly greater pre-ICU severity of illness in transported than control patients (median Pediatric Risk of Mortality Score = 10 and 7, respectively, P &lt; .05) and greater pre-ICU therapy relative to severity (P &lt; .05) in control patients are potential confounding sources of the morbidity differences. If patients are stratified into subgroups of similar pre-ICU severity, an excess of intensive care-related adverse events in transported patients remains evident in the severe subgroup (P &lt; .05). Further investigation is warranted to determine whether specialized transport teams can reduce the excess morbidity associated with interhospital transport of critically ill and injured pediatric patients.

scholarly journals Comparison of laparoscopic surgery versus traditional laparotomy for the treatment of emergency patients

2019 ◽  
Vol 48 (3) ◽  
pp. 030006051988919
Author(s):  
Ning Cui ◽  
Jun Liu ◽  
Haiyan Tan
Keyword(s):  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Gastrointestinal Surgery ◽  
Length Of Hospital Stay ◽  
Control Group ◽  
Observation Group ◽  
Duration Of Surgery ◽  
Clinical Benefits ◽  
Gastrointestinal Emergency ◽  
And Control

Objective To investigate the clinical efficacy of laparoscopic gastrointestinal emergency surgery and postoperative complications. Methods Data for 604 patients undergoing emergency gastrointestinal surgery between January 2013 and December 2018 were analyzed retrospectively. Treatment efficacy and postoperative complications were compared between 300 patients (control group) undergoing traditional laparotomy and 304 patients (observation group) undergoing laparoscopic surgery. Results Clinical features were significantly better in the observation group than in the control group, including duration of surgery (59.12 ± 10.31 minutes vs. 70.34 ± 12.83 minutes), intraoperative blood loss (41.21 ± 10.45 mL vs. 61.38 ± 9.97 mL), postoperative pain score (1.25 ± 0.25 points. vs. 5.13 ± 0.43 points), length of hospital stay (5.13 ± 0.24 days vs. 7.05 ± 0.13 days), and time to free activity (13 ± 2.96 hours vs. 22 ± 3.02 hours). The total complication incidence in the observation group was 3.9%, compared with 16% in the control group (16%). No significant differences in direct medical costs were recorded between the observation and control groups. Conclusions For patients undergoing emergency gastrointestinal surgery, laparoscopic surgery resulted in better clinical outcomes than traditional laparotomy without incurring additional costs. The potential clinical benefits of emergency laparoscopic gastrointestinal surgery warrant further study.

scholarly journals Hypertensive patients features of the microcirculation type after new coronavirus infection of COVID-19

2022 ◽  
Vol 20 (4) ◽  
pp. 45-51
Author(s):  
I. A. Zolotovskaya ◽  
G. R. Gimatdinova ◽  
I. L. Davydkin
Keyword(s):  
Blood Flow ◽  
Heart Disease ◽  
Family History ◽  
Adverse Events ◽  
Skin Blood Flow ◽  
Control Group ◽  
Doppler Flowmetry ◽  
Hypertensive Patients ◽  
History Of ◽  
And Control

Introduction. The COVID-19 pandemic multiplies the incidence of long-term adverse events. Family history of heart disease predicates the necessity of study hemostasis in hypertensive patients. The purpose was to study the microcirculation in hypertensive COVID-19 survivors. Materials and methods. We selected patients treated at the hospitals of Samara from January to March 2021. COVID-19 survivors (diagnosis was confirmed by polymerase chain reaction analysis) were divided into 2 groups and analysed: the group with family history of hypertension (167 patients) and control group with no relevant past medical history (68 patients). The main microcirculation characteristics were evaluated by laser Doppler flowmetry of skin blood flow. Results. The average age of COVID-19 survivors was 52.3±14.2 years, n=86 (51.4 %) – male. The majority of patients (n=61/36.5 %) were 45 to 54 years. A fifth of the patients (n=35/20.9 %) showed no complaints about the underlying disease, the clinical manifestations of the rest were general weakness, fever, shortness of breath, cough, headaches, unstable blood pressure, inflammation of the ENT organs. By comparison the microcirculation parameters of the case patients and control group, a decreased perfusion was detected. It requires a preventive medicine to prevent from early and distant micro and macrothrombosis. Conclusion. The study of microcirculation essential features by the LDF of skin blood flow revealed a pathological type with a predominance of vasoconstrictions in patients with a history of hypertension. Taking into account the proven increase in the incidence of thrombotic events in COVID-19 survivors, the noticed changes in microcirculation require a new approach to prevent from adverse events concerning the hypercoagulation process, especially in patients with famil y history of heart disease.

scholarly journals The Role of Chewing Gum on Post-operative Bowel Recovery after Gynecological Laparoscopic Surgery: A Short Report and Updated Review

2021 ◽  
Vol 9 (B) ◽  
pp. 1123-1127
Author(s):  
Nicko Pisceski Kusika ◽  
Imelda E. B. Hutagaol ◽  
Muhammad Yusuf ◽  
Suyanto Suyanto ◽  
Shinta Puja Tilusari
Keyword(s):  
Laparoscopic Surgery ◽  
Literature Review ◽  
Oral Feeding ◽  
Chewing Gum ◽  
Control Group ◽  
Short Report ◽  
Post Surgery ◽  
Significant Difference ◽  
And Control

BACKGROUND: Adverse post-operative complication of gynecological laparoscopic surgery, post-operative ileus, could be reduced by mimicking early post-operative oral feeding; however, the role of chewing gum is still lack evidence. AIM: This study was conducted to assess chewing gum’s role in post-operative bowel recovery after gynecological laparoscopic surgery. METHODS: This prospective clinical trial recruited 60 participants who had undergone gynecological laparoscopic surgery under general anesthesia. The study was conducted at Arifin Achmad Hospital, Riau Province, Indonesia, from January to April 2021. The patients were equally divided into two groups: Intervention (n = 30) and control (n = 30). They were asked to chew sugar-free gum every 2 h after the surgery (i.e. 5 times within 10 h post-surgery). Time of the first flatus and the first bowel sounds were recorded (i.e. 5 times of assessment within 10 h post-surgery). In addition, a literature review was conducted to add evidence of the role of chewing gum on postoperative bowel recovery after gynecological laparoscopic surgery. RESULTS: Patients from both groups had a close age range (23–44-year-old versus 21–42-year-old). Our data suggested a significant difference in the time of the first flatus between the treatment and control group (15.95 h vs. 45.05 h), p < 0.001. The length of stay in the hospital among those from the treatment group was also significantly shorter compared to controls (15.50 h vs. 45.50 h), p < 0.001. The literature review of four updated randomized clinical trials suggests chewing gum in the early onset of first flatus and bowel movement. CONCLUSION: Chewing gum following gynecological laparoscopic surgery could accelerate gastrointestinal recovery.

scholarly journals Efficacy and safety of chloroquine or hydroxychloroquine in moderate type of COVID-19: a prospective open-label randomized controlled study

2020 ◽  
Author(s):  
Lan Chen ◽  
Zhen-Yu Zhang ◽  
Jian-Guo Fu ◽  
Zhi-Peng Feng ◽  
Su-Zhen Zhang ◽  
...  
Keyword(s):  
Adverse Events ◽  
Oral Treatment ◽  
Drug Repurposing ◽  
Control Treatment ◽  
Controlled Study ◽  
Control Group ◽  
Open Label ◽  
Duration Of Hospitalization ◽  
Novel Coronavirus ◽  
And Control

ABSTRACTThe outbreak of novel coronavirus disease 2019 (COVID-19) has become a pandemic. Drug repurposing may represent a rapid way to fill the urgent need for effective treatment. We evaluated the clinical utility of chloroquine and hydroxychloroquine in treating COVID-19.Forty-eight patients with moderate COVID-19 were randomized to oral treatment with chloroquine (1000 mg QD on Day 1, then 500 mg QD for 9 days; n=18), hydroxychloroquine (200 mg BID for 10 days; n=18), or control treatment (n=12).Adverse events were mild, except for one case of Grade 2 ALT elevation. Adverse events were more commonly observed in the chloroquine group (44.44%) and the hydroxychloroquine group (50.00%) than in the control group (16.67%). The chloroquine group achieved shorter time to clinical recovery (TTCR) than the control group (P=0.019). There was a trend toward reduced TTCR in the hydroxychloroquine group (P=0.049). The time to reach viral RNA negativity was significantly faster in the chloroquine group and the hydroxychloroquine group than in the control group (P=0.006 and P=0.010, respectively). The median numbers of days to reach RNA negativity in the chloroquine, hydroxychloroquine, and control groups was 2.5 (IQR: 2.0-3.8) days, 2.0 (IQR: 2.0-3.5) days, and 7.0 (IQR: 3.0-10.0) days, respectively. The chloroquine and hydroxychloroquine groups also showed trends toward improvement in the duration of hospitalization and findings on lung computerized tomography (CT). This study provides evidence that (hydroxy)chloroquine may be used effectively in treating moderate COVID-19 and supports larger trials.

Pulmonary hypertension induced by repeated pulmonary inflammation in the rat

1981 ◽  
Vol 51 (3) ◽  
pp. 755-761 ◽  
Author(s):  
J. Herget ◽  
F. Palecek ◽  
P. Preclik ◽  
M. Cermakova ◽  
M. Vizek ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Pulmonary Hypertension ◽  
Lung Inflammation ◽  
Pulmonary Inflammation ◽  
Control Group ◽  
Arterial Blood ◽  
The Media ◽  
Pulmonary Arterial ◽  
The Mean ◽  
And Control

The effect of repeated lung inflammation on the pulmonary vascular bed was studied in rats. Nonbacterial lung inflammation was induced by repeated carrageenan instillations into the lungs. Three days after the single carrageenan injection, the mean pulmonary arterial blood pressure was only slightly raised [16.3 +/- 0.6 (mean +/- SE) Torr in controls and 19.5 +/- 0.5 Torr in rats with lung inflammation, P less than 0.001]. A substantial pulmonary hypertension was found in rats 3 days after the sixth lung inflammation (24.6 +/- 1 Torr). In this group, arterial hypoxemia, hypercapnia, and right-heart hypertrophy were found. In the 14th day of recovery after the last injection of carrageenan, the mean pulmonary artery blood pressure decreased (18.5 +/- 0.9 Torr) but remained higher than in the control group. There was no difference in cardiac output measured by dye-dilution technique between the experimental and control groups. After repeated inflammation, the media of distal pulmonary vessels thickened and the number of pulmonary arterioles with distinct media increased.

Should Olanzapine be Advocated Over Conventional Anti-Emetics for the Prevention of Chemotherapy-Induced Nausea and Vomiting? An Updated Meta-Analysis of Randomized Control Trials

2019 ◽  
Vol 15 (2) ◽  
pp. 80-90
Author(s):  
Eshak Ibrahim Bahbah ◽  
Ahmed Ramadan Abdalla ◽  
Khalid Abdelshafy ◽  
Ahmed Diaa Almohandes ◽  
Amr Menshawy ◽  
...  
Keyword(s):  
Adverse Events ◽  
Active Control ◽  
Acute Phase ◽  
Meta Analysis ◽  
Final Analysis ◽  
Complete Response ◽  
Fixed Effect Model ◽  
Control Group ◽  
And Control ◽  
Delayed Phase

Objective: The aim of this study is to synthesize the evidence about the efficacy of Olanzapine for the prevention of CINV. Methods: A computer literature search of PubMed, EBSCO, Ovid, and Cochrane CENTRAL databases has been conducted. Studies were screened for eligibility and data were extracted. The proportion of patients with complete response (CR) and those with no nausea were pooled as risk ratio (RR) in a fixed effect model meta-analysis using Review Manager Version 5.3 for windows. Results: Nine randomized controlled trials (n=1572) were pooled in the final analysis. In all studies, olanzapine was given as 10 mg PO. Olanzapine was superior to active control in terms of CR rate in acute phase (RR 1.12, 95% CI [1.02, 1.22], p=0.01]), delayed phase (RR 1.31, 95% CI [[1.10, 1.56], p=0.002), and overall phase (RR 1.30, 95% CI [1.09, 1.55], p=0.004). Rates of no nausea were significantly higher in olanzapine 10 mg group compared to active control group in acute phase (RR 1.20, 95% CI [1.04, 1.38], p=0.01), delayed phase (RR 1.72, 95% CI [1.42, 2.08], p<0.00001), and overall phase (RR 1.57, 95% CI [1.39, 1.77], p <0.00001). The incidence of adverse events was similar in olanzapine and control groups, with the most frequently reported treatment-related emergent adverse events being fatigue, constipation, and headache. Conclusion: Olanzapine is a well-tolerated drug for cancer patients and has shown superiority against conventional antiemetics for the prevention of CINV.

Abstract 77: Effects Of Short-term Fasting On Mortality, Inflammatory And Coagulation Responses To Endotoxin-induced Shock In Rats

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Kyoko Kobayashi ◽  
Takumi Taniguchi ◽  
Ken Yamamoto
Keyword(s):  
Mortality Rate ◽  
Blood Gases ◽  
Mortality Rates ◽  
Control Group ◽  
Short Term ◽  
Coagulation Parameters ◽  
Arterial Blood ◽  
Sepsis And Septic Shock ◽  
And Control ◽  
Thrombin Antithrombin Iii Complex

Obesity is a common problem in sepsis. We evaluated the effects of short-term fasting on the mortality rate, inflammatory and coagulation response in rats with endotoxin-induced shock. Male Wister rats (n=30) were used. Animals were randomly assigned to one of two groups: control group (n=15), receiving intravenous Escherichia coli endotoxin (15 mg/kg over 2 mins); fasted group (n=15), short-term fasting for 3 days before endotoxin injection. The mortality rates, hemodynamics, arterial blood gases, plasma cytokine concentrations and coagulation parameters were measured. The mortality rates at 8hrs after endotoxin injection were 75% and 7% for control and fasted groups, respectively. Hypotension and the increases of TNF-alpha and interleukin-6 concentrations were less for the fasted group than the control group. Moreover, the increase of the prothrombin-time and thrombin-antithrombin III complex were less for the fasted group than the control group. The present study showed that short-term fasting inhibited hypotension and elevations in cytokine concentrations, reducing the mortality rate of rats with endotoxin-induced shock. Moreover, short-term fasting inhibited the elevation of coagulation parameters. These findings suggest that short-term fasting may exert favorable effects during sepsis and septic shock. Survival curves for fasted and control groups

scholarly journals The safety of ceftolozane-tazobactam for the treatment of acute bacterial infections: a systemic review and meta-analysis

2021 ◽  
Vol 12 ◽  
pp. 204209862110270
Author(s):  
Li-Ting Wang ◽  
Wei-Ting Lin ◽  
Chih-Cheng Lai ◽  
Ya-Hui Wang ◽  
Cheng-Hsin Chen ◽  
...  
Keyword(s):  
Adverse Events ◽  
Bacterial Infections ◽  
Therapeutic Option ◽  
Meta Analysis ◽  
Study Drug ◽  
Adult Patients ◽  
Control Group ◽  
Clinical Safety ◽  
Acute Bacterial Infections ◽  
And Control

Objective(s): The aim of this study was to conduct a meta-analysis to assess the clinical safety of ceftolozane-tazobactam for the treatment of acute bacterial infections in adult patients. Methods: The PubMed, Embase, and Cochrane databases were searched from their inception until May 2020 for relevant randomized controlled trials (RCTs). Only RCTs evaluating the risk of adverse events (AEs) for ceftolozane-tazobactam and comparative treatments for acute bacterial infections in adult patients were included. Results: Overall, four RCTs including a total of 2924 patients (1475 in the ceftolozane-tazobactam group and 1449 in the control group) were included in the meta-analysis. The rate of treatment-emergent AEs was 51.3% (748/1458) in the ceftolozane-tazobactam group, which was comparable to the control group, 49.9% [714/1430; odd’s ratio (OR), 1.06; 95% confidence interval (CI), 0.91–1.25; I2 = 0%]. In addition, no difference was observed between the ceftolozane-tazobactam and control groups in terms of the risk of serious AEs (OR, 1.22; 95% CI, 0.93–1.61; I2 = 15.5%) and the risk of discontinuing the study drug due to AEs (OR, 0.85; 95% CI, 0.55–1.33; I2 = 0%). The rate of all-cause mortality did not significantly differ between the ceftolozane-tazobactam and control groups (OR, 1.11; 95% CI, 0.82–1.50; I2 = 0%). The only exception was the risk of Clostridiodes difficile ( C. difficile) colitis, where ceftolozane-tazobactam treatment was associated with a significantly higher risk compared with the control group [0.72% (10/1376) versus 0.14% (2/1391), OR, 3.84; 95% CI, 1.23–11.97; I2 = 0%]. Conclusion: Ceftolozane-tazobactam treatment is as tolerable as comparative treatment options for acute bacterial infections in adult patients, however it has an increased risk of C. difficile infection. As a novel broad-spectrum antibiotic, ceftolozane-tazobactam could be a safe therapeutic option for use in common clinical practice. Plain language summary The safety of ceftolozane-tazobactam (an antibiotics) for the treatment of acute bacterial infections Objective(s): Ceftolozane-tazobactam is an effective antibiotic for the treatment of acute bacterial infections. This study conducts a meta-analysis to assess the clinical safety (side effects) of ceftolozane-tazobactam for the treatment of acute bacterial infections in adult patients compared with other drugs. Methods: We extracted data from four randomized controlled trials, including a total of 2924 patients (1475 in the ceftolozane-tazobactam group and 1449 in the control group). Results: The rate of treatment related adverse events (AEs) was similar in the ceftolozane-tazobactam group (51.3%) and control group (49.9%). There was also no difference in risk of serious adverse events, the risk of discontinuing the study drug due to AEs, and all-cause mortality. The only exception was the risk of Clostridiodes difficile colitis (a cause of antibiotic-associated diarrhea), where ceftolozane-tazobactam treatment was associated with a significantly higher risk compared with the control group. Conclusion: In conclusion, as a novel broad-spectrum antibiotic, ceftolozane-tazobactam could be a safe therapeutic option for use in clinical practice.

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