scholarly journals Comparison of the methods of fibrinolysis by tube thoracostomy and thoracoscopic decortication in children with stage II and III empyema: a prospective randomized study

2011 ◽  
Vol 3 (4) ◽  
pp. 29 ◽  
Author(s):  
Ufuk Cobanoglu ◽  
Fuat Sayir ◽  
Salim Bilici ◽  
Mehmet Melek
Keyword(s):  
Low Cost ◽  
Treatment Options ◽  
Randomized Study ◽  
Bronchopleural Fistula ◽  
Length Of Hospital Stay ◽  
Pleural Empyema ◽  
Stage Ii ◽  
Success Rates ◽  
Fibrinolytic Agent ◽  
Significant Difference

Today, in spite of the developments in imaging methods and antibiotherapy, childhood pleural empyema is a prominent cause of morbidity and mortality. In recent years, it has been shown that there has been an increase in the frequency of pleural empyema in children, and antibiotic resistance in microorganisms causing pleural empyema has made treatment difficult. Despite the many studies investigating thoracoscopic debridement and fibrinolytic treatment separately in the management of this disease, there is are not enough studies comparing these two treatments. The aim of this study was to prospectively compare the efficacy of two different treatment methods in stage II and III empyema cases and to present a perspective for treatment options. We excluded from the study cases with: i) thoracoscopic intervention and fibrinolytic agent were contraindicated; ii) immunosuppression or additional infection focus; iii) concomitant diseases, those with bronchopleural fistula diagnosed radiologically, and Stage I cases. This gave a total of 54 cases: 23 (42.6%) in stage II, and 31 (57.4%) cases in stage III. These patients were randomized into two groups of 27 cases each for debridement or fibrinolytic agent application by video-assisted thoracoscopic decortication (VATS). The continuity of symptoms after the operation, duration of thoracic tube in situ, and the length of hospital stay in the VATS group were of significantly shorter duration than in the streptokinase applications (P=0.0001). In 19 of 27 cases (70.37%) in which fibrinolytic treatment was applied and in 21 cases of 27 (77.77%) in which VATS was applied, the lung was fully expanded and the procedure was considered successful. There was no significant difference with respect to success rates between the two groups (P=0.533). The complication rate in our cases was 12.96% and no mortality was observed. Similar success rates in thoracoscopic drainage and enzymatic debridement, and the low cost of enzymatic drainage both served to highlight intrapleural streptokinase treatment as a reliable method in reducing the need for surgery in complicated empyema.

The Effect of Omentoplasty on the Rate of Anastomotic Leakage after Intestinal Resection: A Randomized Controlled Trial

2017 ◽  
Vol 83 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Shirzad Nasiri ◽  
Babak Mirminachi ◽  
Reyhaneh Taherimehr ◽  
Roya Shadbakhsh ◽  
Mohsen Hojat
Keyword(s):  
Hospital Stay ◽  
Anastomotic Leakage ◽  
Controlled Trial ◽  
Randomized Study ◽  
Intestinal Resection ◽  
Length Of Hospital Stay ◽  
Fistula Formation ◽  
Intestinal Surgery ◽  
Increased Risk ◽  
Significant Difference

Anastomotic leakage is a major postoperative complication after intestinal surgery leading to increased risk of morbidity and mortality. Omentoplasty has been evaluated to prevent anastomotic leakage in several studies. However, there is no consensus regarding whether or not omentoplasty should be used to decrease the rate of anastomotic leakage after intestinal resection. A prospective, randomized study was conducted to evaluate the influence of omentoplasty on anastomotic leakage after intestinal resection. A total of 124 patients who underwent intestinal resection were enrolled in this prospective study. Patients were randomly assigned to receive either the omentoplasty or nonomentoplasty. In the omentoplasty group, the omentum was wrapped around the anastomotic region. Age, gender, site and type of anastomosis, duration of hospital stay, and performance of omentoplasty were recorded. This study was registered in Iranian Registry of clinical trial (number: IRCT201412316925N3). The rate of anastomotic leakage was significantly lower in the omentoplasty group (P = 0.04). Patients in the omentoplasty group developed a significantly lower rate of postoperative infection and peritonitis (P < 0.05). There was no significant difference of abscess and fistula formation between the two groups (P > 0.05). The length of hospital stay was longer in the nonomentoplasty group, compared with that for omentoplasty patients (P < 0.05). No death occurred in the omentoplasty subjects, while six nonomentoplasty patients died (P < 0.05). Our data demonstrated that omentoplasty is useful to lower the rate of postoperative complications in patients underwent intestinal surgery.

scholarly journals First Canadian experience with robotic single-incision pyeloplasty: Comparison with multi-incision technique

2016 ◽  
Vol 10 (3-4) ◽  
pp. 83 ◽  
Author(s):  
Jeffrey Law ◽  
Neal Rowe ◽  
Jason Archambault ◽  
Sofia Nastis ◽  
Alp Sener ◽  
...  
Keyword(s):  
Single Incision ◽  
Single Port ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Success Rates ◽  
Access Port ◽  
Significant Difference ◽  
Site Access ◽  
Da Vinci Robotic System ◽  
Incision Technique

<p><strong>Introduction:</strong> We compared the outcomes of single-incision, robotassisted laparoscopic pyeloplasty vs. multiple-incision pyeloplasty using the da Vinci robotic system.</p><p><strong>Methods:</strong> We reviewed all consecutive robotic pyeloplasties by a single surgeon from January 2011 to August 2015. A total of 30 procedures were performed (16 single:14 multi-port). Two different single-port devices were compared: the GelPort (Applied Medical, Rancho Santa Margarita, CA) and the Intuitive single-site access port (Intuitive Surgical, Sunnyvale, CA).</p><p><strong>Results:</strong> Patient demographics were similar between the two groups. Mean operating time was similar among the single and multi-port groups (225.2 min vs. 198.9 minutes [p=0.33]). There was no significant difference in length of hospital stay in either group (86.2 hr vs. 93.2 hr [p=0.76]). There was no difference in success rates or postoperative complications among groups.</p><p><strong>Conclusions:</strong> Single-port robotic pyeloplasty is non-inferior to multiple-incision robotic surgery in terms of operative times, hospitalization time, success rates, and complications. Verifying these results with larger cohorts is required prior to the wide adoption of this technique. Ongoing objective measurements of cosmesis and patient satisfaction are being evaluated.</p><p> </p>

Abstract 15507: CPR Education in Middle School Students During Physical Education Class

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kae Watanabe ◽  
Dalia Lopez-Colon ◽  
Jonathan J Shuster ◽  
Joseph Philip
Keyword(s):  
Middle School ◽  
Physical Education ◽  
Life Support ◽  
Low Cost ◽  
Statistical Significance ◽  
Randomized Study ◽  
The United States ◽  
School Students ◽  
Knowledge And Skills ◽  
Significant Difference

Introduction: AHA advocates for CPR education as a required element of the secondary school curriculum. Unfortunately, many states have not adopted CPR education as part of their standard curriculum. Our aim was to investigate a low-cost, and time effective method to educate students on Basic life Support (BLS) during a physical education (PE) class, including evaluation of the use of re-education. Hypothesis: We hypothesize that a 45 minute BLS class during PE class is sufficient to provide with CPR and AED knowledge and skills. Methods: This is a prospective, randomized study. The study included forty one 8 th grade students in an Alachua County Middle School in Gainesville, Florida. Education was performed by an AHA-certified provider during a 45 minute PE class. Education was limited to chest compressions and the usage of an Automatic External Defibrillator (AED). Students were randomized into two groups; one group received repeat education at two months post-initial education, while the second group did not. Students had a skills and knowledge test administered pre- and post-education, given after initial education and repeated two and four months later to assess retention. Total scores were compared between pre- and post- education, as well as between groups. Results: There was a significant difference in CPR skills and knowledge when comparing pre- and post-education results for all time-points (p<0.001). When assessing retention, no significant difference in mean total scores was observed between the initial post-education as compared to two and four months (p>0.1). Mean total scores compared between groups showed no statistical significance of re-education. However, a statistical significance was noted for AED usage in the repeat education group. Conclusions: Our study indicates significant increase in CPR knowledge and skills following a one-time 45 minute session. Repeat education may be useful as a yearly event, but would need further investigation. If schools across the United States invested one 45-60 minute period a year for each school year, this would ensure widespread CPR knowledge with minimal cost and loss of school time.

scholarly journals Study comparing the stroke unit outcome and conventional ward treatment: a randomized study in Joinville, Brazil

2003 ◽  
Vol 61 (2A) ◽  
pp. 188-193 ◽  
Author(s):  
Norberto L. Cabral ◽  
Carla Moro ◽  
Giana R. Silva ◽  
Rosana Herminia Scola ◽  
Lineu César Werneck
Keyword(s):  
Hospital Stay ◽  
Stroke Unit ◽  
Survival Curve ◽  
Clinical Status ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
General Ward ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

BACKGROUND AND PURPOSE: To assess the impact of a stroke unit (SU) on acute phase treatment when compared to a conventional general ward treatment (GW). METHOD: Seventy-four patients with acute stroke were randomized between a SU and conventional general ward (GW). We compared both groups regarding the length of hospital stay, lethality and functional and clinical status within 6 months, using the Scandinavian scale and Barthel index. RESULTS: Thirty-five and thirty-nine patients were allocated at SU and GW, respectively. Lethality on the 10th day at SU and GW achieved 8.5% and 12.8% respectively (p= 0.41), whereas 30-days mortality rates achieved 14.2% and 28.2% (p= 0.24), 17.4% and 28.7% on the 3rd month (p= 0.39), and 25.7% and 30.7% on the 6th month (p= 0.41). Thirty-day survival curve achieved 1.8 log rank (p= 0.17), with a trend for lower lethality in the SU. In order to save one death in 6 months in SU, NNT (the number need to treat) was 20; to get one more home independent patient NNT was 15. No significant difference was found between the length of hospital stay and morbidity. CONCLUSION: No significant benefit was found in SU patients compared to GW group. However,an evident benefit in absolute numbers was observed in lethality, survival curve and NNT in thirty days period after stroke. Further collaborative studies or incresead number of patients are required to define the role of SU.

scholarly journals A Comparative Evaluation of Closed and Open Treatment in the Management of Unilateral Displaced Mandibular Subcondylar Fractures: A Prospective Randomized Study

2018 ◽  
Vol 11 (3) ◽  
pp. 205-210 ◽  
Author(s):  
Virendra Singh ◽  
Neeraj Kumar ◽  
Amrish Bhagol ◽  
Neha Jajodia
Keyword(s):  
Treatment Options ◽  
Randomized Study ◽  
Mouth Opening ◽  
Treatment Results ◽  
Treatment Groups ◽  
Advantages And Disadvantages ◽  
Closed Treatment ◽  
Significant Difference ◽  
Open Treatment

The aim of the study is to evaluate closed and open treatment in the management of unilateral displaced mandibular subcondylar fractures. Twenty patients with unilateral subcondylar fractures of the mandible were evaluated with degree of displacement of more than 20 degrees and ramal height shortening of more than 10 mm. They were informed of the need for 6-month follow-up. Patients were thoroughly informed, explaining the possible advantages and disadvantages of the open and closed treatment options. Radiographic parameters included the level of fracture, deviation of fragment, and ramal height shortening. Correct anatomical reduction is achieved by open treatment as compared with closed treatment. Regarding pain, mouth opening, and lateral excursion movement, statistically significant difference was found in both groups ( p < 0.01). In radiographic assessment of ramal height shortening and fracture displacement, statistically significant difference was found ( p < 0.01). And no significant complication is found in both treatment groups. The results of this study favor the open treatment for the management of displaced subcondylar fractures. However, the treatment results are also acceptable for closed group.

scholarly journals Treatment Optimization of Post-pneumonectomy Pleural Empyema

Folia Medica ◽  
2019 ◽  
Vol 61 (4) ◽  
pp. 500-505
Author(s):  
Danail B. Petrov ◽  
Dragan Subotic ◽  
Georgi S. Yankov ◽  
Dinko G. Valev ◽  
Evgeni V. Mekov
Keyword(s):  
Hospital Volume ◽  
Lung Resection ◽  
Treatment Options ◽  
Bronchopleural Fistula ◽  
Pleural Empyema ◽  
Definitive Treatment ◽  
High Morbidity ◽  
Treatment Optimization ◽  
Antibiotic Solution ◽  
The Individual

Introduction: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Despite various therapeutic options developed during the last five decades it remains a major surgical challenge.&nbsp;Results: There is no widely accepted treatment for post-pneumonectomy pleural empyema (PPE) and the management depends mostly on the presence or absence of broncho-pleural fistula (BPF) and the patient&rsquo;s general condition. In the absence of BPF, the role of surgery is still not clear because of its high morbidity and impossibility to prevent recurrences. In the earlier period, the definitive treatment consisted of open window thoracostomy followed by obliteration of the pleural cavity with antibiotic solution at the time of chest wall closure. Subsequently, the proposed different methods and modifications improved the outcome. There is an association between hospital volume and operative mortality after the lung resection. Hospital volume and the surgeon&rsquo;s specialty have more influence on the outcome than the individual surgeon&rsquo;s volume.Conclusions: Treatment management of PPE should be individualized. Definitive treatment options comprise aggressive surgery that is not possible in quite a high proportion of impaired patients. Hospital volume, surgeon&rsquo;s volume and surgeon&rsquo;s specialty may influence the prognosis.

scholarly journals Two-year follow-up after holmium laser enucleation of the prostate and bipolar transurethral resection of the prostate: a prospective randomized study

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Mamdouh M. El-Hawy ◽  
Amr Eldakhakhny ◽  
Ahmed AbdEllatif ◽  
Emad A. Salem ◽  
Ahmed Ragab ◽  
...  
Keyword(s):  
Transurethral Resection ◽  
Treatment Options ◽  
Randomized Study ◽  
Preoperative Assessment ◽  
Holmium Laser ◽  
Prospective Randomized Study ◽  
Significant Difference ◽  
Laser Enucleation ◽  
Holmium Laser Enucleation

Abstract Background Different treatment options are available for the management of BPH. Our study aimed to compare the surgical outcomes of a holmium laser enucleation of the prostate (HoLEP) and a bipolar transurethral resection of the prostate (Bipolar-TURP) after 2 years. Methods Our prospective randomized study included 114 patients: 55 patients underwent HoLEP procedure and 59 patients underwent bipolar TURP procedure. All patients underwent a complete preoperative assessment and a physical examination. The postoperative follow-up data included Q max and IPSS recordings at 1, 3, 6, 12, and 24 months and PVR urinary volume recordings at 6 and 12 months. Any postoperative complications were also recorded. Results There were no statistically significant differences between both groups regarding IPSS and Q max scores at one and 24 months postoperative. Also, there were no statistically significant differences between both groups regarding postoperative PVR at 6 and 12 months. One patient in the HoLEP group developed total incontinence after surgery. Conclusion Our study did not show a significant difference between HoLEP and bipolar TURP regarding postoperative Q max and IPSS scores at 24 months of follow-up.

Final results of OV16, a phase III randomized study of sequential cisplatin-topotecan and carboplatin-paclitaxel (CP) versus CP in first-line chemotherapy for advanced epithelial ovarian cancer (EOC): A GCIG study of NCIC CTG, EORTC-GCG, and GEICO.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 5502-5502 ◽  
Author(s):  
Andres Cervantes-Ruiperez ◽  
Paul Hoskins ◽  
Ignace Vergote ◽  
Elizabeth A. Eisenhauer ◽  
Prafull Ghatage ◽  
...  
Keyword(s):  
Residual Disease ◽  
Performance Status ◽  
Randomized Study ◽  
Objective Response ◽  
Progression Free Survival ◽  
Stage Ii ◽  
Phase Iii ◽  
Combination Regimen ◽  
Ecog Performance Status ◽  
Significant Difference

5502 Background: Topotecan was evaluated in a novel combination regimen in comparison to standard therapy in front-line EOC. Methods: Women with newly diagnosed advanced EOC stages IIB-IV, ECOG performance status (PS) 0-1, age < 75, were randomized to either Arm 1: cycles 1 - 4: cisplatin 50 mg/m2 d1 plus topotecan 0.75 mg/m2 d1-5 IV; cycles 5 - 8: paclitaxel 175 mg/m2over 3 hrs d1 followed by carboplatin AUC5 day 1 or Arm 2: paclitaxel plus carboplatin as in Arm 1 for 8 cycles. The primary endpoint was progression free survival (PFS) and secondary endpoints included objective response, overall survival (OS), adverse event (AE) and Quality of Life (QoL). The sample size required 800 pts and 631 events to detect an improvement in PFS from 16 to 20 months (power 80%, 2-sided alpha 0.05). Results with 3.6 years median follow-up (MFU) were reported previously: there was no significant difference in PFS (Hoskins P, JNCI 2010). Final results including OS after MFU of 8.2 years are reported. Results: From 2001 to 2005, 819 pts (409 Arm 1, 410 Arm 2) were randomized. 704 PFS events and 605 deaths have occurred. PFS results are similar to first report: Median (months [mo]): 14.6 (Arm 1) and 16.2 (Arm 2), hazard ratio (HR) 1.03 (95% CI:0.81-1.30; p = 0.83). Median OS is 44.2 mo (Arm 1) and 44.8 mo (Arm 2), HR: 0.92 (95% CI:0.71-1.19; p=0.54). Baseline factors found to be independent predictors of OS in multivariate analysis are: a) pre-randomization surgery (debulking with no macro residual disease (MRD) to no debulking HR: 0.47; 95%CI:0.37-0.58; p < 0.0001; debulking with MRD (<1 cm) to no debulking HR: 0.76; 95%CI:0.61-0.94; p = 0.01), b) Stage (stage II to III or IV HR:0.52; 95%CI:0.36-0.76; p = 0.0007) and c) PS (0 vs 1 HR:0.76; 95%CI:0.63-0.91; p = 0.004). Post-treatment AEs were not significantly different in the two arms. Conclusions: OV16 final results confirm that sequential doublets of topotecan and cisplatin followed by carboplatin and paclitaxel offer no improvement in outcomes compared to carboplatin and paclitaxel. Pretreatment debulking, stage II and PS 0 are predictive of longer OS. Clinical trial information: NCT00028743.

scholarly journals A comparative study between totally extraperitoneal and transabdominal preperitoneal laparoscopic inguinal hernia repair techniques

2017 ◽  
Vol 4 (2) ◽  
pp. 663 ◽  
Author(s):  
Samir Ushakant Rambhia ◽  
Rajan Modi
Keyword(s):  
Inguinal Hernia ◽  
Hernia Repair ◽  
Randomized Study ◽  
Length Of Hospital Stay ◽  
Laparoscopic Inguinal Hernia Repair ◽  
Laparoscopic Inguinal Hernia ◽  
Significant Difference ◽  
Lost To Follow Up ◽  
Laparoscopic Tep

Background: Laparoscopic groin hernia repair can be done by trans-abdominal pre-peritoneal (TAPP) approach and also by total extra peritoneal (TEP) approach. The objective of this study was to compare the clinical effectiveness and relative efficiency of trans-abdominal pre-peritoneal (TAPP) versus totally extra peritoneal (TEP) techniques of laparoscopic inguinal hernia repair.Methods: All the patients aged 18 years and above admitted in HBT Hospital undergoing laparoscopic inguinal hernia repair were included in this study from June 2014 to January 2016. Diagnosis was made based on history and clinical examination and ultrasound scan of the abdomen. Patients undergoing open hernia surgery and those having contra-indications to laparoscopic hernia repair were excluded from the study. The patients underwent laparoscopic TAPP or laparoscopic TEP repair of hernia based on surgeon’s preference.Results: Total 56 patients were included in the study. It was a non-randomized study, where patients were allocated in TAPP and TEP group based on surgeon’s preference. Hence, 29 patients were included in TAPP group while 27 patients were allocated to TEP group. Post-operatively all patients were evaluated for pain at 6 hours, 12 hours, 24 hours, 1week, 6 months and 1 year. They were also evaluated for length of hospital stay and any operative site complication like hematoma/seroma, wound/mesh infection, recurrence, port site hernia, persisting numbness. 2 patients in TAPP group and 3 in TEP group were lost to follow up at the end of 1 month. Further 4 patients in TAPP group and 1 patient in TEP group were also lost to follow up at 6 months. Apart from statistically significant difference in pain at 24 hours, which was more in TAPP group than TEP group, we found no other significant difference between the two methods.Conclusions: In this prospective non-randomized study comparing laparoscopic TEP and TAPP repair, for the standard parameters of duration of surgery, conversion, serious adverse event, post-operative pain, local complications, recurrence both locally and port site and length of hospital stay, we had a follow up of 1 year which is adequate for most parameters except recurrence. Our follow up does not allow us to make any conclusion about recurrence. Though the patient numbers are small, our study resonates with the larger studies regarding most parameters. This study leaves us none the wiser as to the superiority of one technique and hence, it is the individual surgeon’s preference and proficiency which dictates the choice of procedure.

scholarly journals Segmental Versus Circumferential Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

2020 ◽  
Vol 8 (B) ◽  
pp. 85-98
Author(s):  
Ahmed Moustafa Wedn ◽  
Ahmed Eldamaty ◽  
Moataz Elhalag ◽  
Rania Elsherif ◽  
Hesham Alaasr
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Antiarrhythmic Drugs ◽  
Randomized Study ◽  
Pulmonary Veins ◽  
Controlled Study ◽  
Success Rates ◽  
Group 14 ◽  
Significant Difference ◽  
Linear Ablation

INTRODUCTION: Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation techniques for the treatment of paroxysmal atrial fibrillation (PAF), with significantly improved efficacy compared to antiarrhythmic drugs as shown in CABANA trial. However, the question arises in which PAF patients whether the procedure can be limited to PVs only showing potentials (segmental), or it is really necessary to isolate all PV (circumferential). Even though success rates for circumferential PV ablation (CPVA) have been reported to be higher (up to 90%), than segmental PV ablation, most CPVA procedures previously reported included left atrial linear ablation, additional ablation lesions or lines connecting the mitral valve to the posterior PVs or along the roof of the left atrium which made bias to these studies. AIM: Thus, we initiated this randomized controlled study to evaluate the efficacy of CPVA versus SPVI in subjects undergoing ablation of PAF. METHODS: Our study included 31 consecutive patients who underwent their first radiofrequency ablation for PAF between March 2015 and March 2017. Patients were randomized for circumferential or segmental ablation on the day of the procedure. We had two groups, circumferential (17 patients) and segmental group (14 patients). RESULTS: There was no difference between two groups on our primary endpoint, the recurrence, which was 2 out of 14 patients (14.3%) in the segmental ablation group, compared to 3 out of 17 patients (17.6%) who were circumferential ablated. This difference is statistically insignificant (p = 1). For other endpoints, there was also no statistically significant difference between circumferential and segmental regarding fluoroscopy time, 53.47 ± 8.7 min versus 54.93 ± 15.02 min, p = 0.738, procedure time, 184.18 ±19.28 min versus 191.43 ± 20 min p = 0.315, and even for radio frequency time which was lower in segmental group but did not differ statistically, 35.71 ± 5.73 min versus 34.79 ± 5.29, min p = 0.649. CONCLUSION: The previous studies showed the superiority of circumferential PVI on segmental strategy regarding effectiveness, but in those studies, linear ablations were added to circumferential strategy and done in cases of persistent and PAF. In our randomized study, we compared between two methods in cases of PAF, which showed that segmental ablation is not inferior to circumferential ablation of PVI.

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