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PURPOSE: We evaluate the role of transanal tube drainage (TD) as a conservative treatment for patients with anastomotic leakage (AL). METHODS: Patients treated for AL who had undergone a low or an ultralow anterior resection with colorectal or coloanal anastomosis for the treatment of rectal cancer between January 2013 and January 2017 were enrolled in this study. The data were collected prospectively and analyzed retrospectively. The primary outcomes were the diagnosis and the management of AL. RESULTS: Two hundred thirteen consecutive patients, 122 males and 91 females, were included. The mean age was 66.91 ± 11.15 years, and the median body mass index was 24 kg/m2 (range, 20–35 kg/m2). The median tumor distance from the anal verge was 8 cm (range, 4–12 cm). Ninety-three patients (44%) received neoadjuvant therapy for nodal disease and/or locally advanced rectal cancer. Only 13 patients (6%) developed AL. Six patients developed subclinical AL as they had a defunctioning ileostomy at the time of the initial procedure. They were treated conservatively with TD under endoscopic guidance in the endoscopy unit and received intravenous antibiotics. Six weeks after discharge, these 6 patients underwent follow-up flexible sigmoidoscopy which showed a completely healed anastomotic defect with no residual stenosis. Seven patients developed a clinically significant AL and required reoperation with pelvic abscess drainage and Hartmann colostomy formation. CONCLUSION: These results suggest that TD for management of patients with AL is safe, cheap, and effective. Salvaging the anastomosis will help decrease the need for Hartmann colostomy formation. Proper patient selection is important.
Subject(s)
Female , Humans , Male , Abscess , Anastomotic Leak , Anti-Bacterial Agents , Body Mass Index , Colostomy , Constriction, Pathologic , Diagnosis , Drainage , Endoscopy , Follow-Up Studies , Ileostomy , Neoadjuvant Therapy , Patient Selection , Prospective Studies , Rectal Neoplasms , Reoperation , Retrospective Studies , SigmoidoscopyABSTRACT
Background and objectives: Awake fiber optic intubation [AFOI] is recommended technique in securing the airway in predicted difficult airway patients with sedation. However, it is not easy to achieve a comfortable sedation so conscious sedation is the key for a successful AFOI. The goal of the study to compare different conscious sedation strategies aimed to improve comfort and safety in patients prepared for elective surgeries
Subjects and Methods: Case control, randomized controlled study in predicted difficult airway patients scheduled for elective surgery under GA carried out at AL-Azhar University Hospitals after approval by the local ethical committee. 120 patients of age group 18-60 years old with ASA I and II prepared for nasal [AFOI] under conscious sedation after giving their informed written consent to participate in our study. The patients were randomly assigned into 4 groups: Group dexmedetomidine [DEX], group ketofol, group magnesium sulfate and group midazolam. HR, MAP, Oxygen saturation and end tidal CO2 were monitored. Sedation score, patient tolerance, patient satisfaction and intubation score [vocal cord movement and coughing] were assessed
Results: All patients were successfully intubated by fiber optic and none of them developed bradycardia or reduced MAP more than 20% from the base line during intubation. Group DEX mild decrease in MAP and HR [<10% fall when compared with the baseline value] after loading of drug and during intubation in contrast to midazolam, ketofol and magnesium sulphate, which increase during intubation. There was no statistically significant difference in the intubation scores, grimace score, time of intubation, number of attempts and saturation in between the groups with one episode of desaturation in group ketofol and two in group midazolam [P > 0.05]. Group ketofol and midazolam patients were sedated deeper after the start of the study drugs than group DEX and none of the patients were sedated to a score of < 2 [modified OAA/S score] in either of the groups. Group magnesium showed lighter sedation level significantly different with other groups
Conclusion: Study showed DEX provides optimum sedation without compromising airway or hemodynamic stability with favorable intubation time and less intubation attempts during AFOI in comparison to magnesium sulphate, ketofol and midazolam patients with better patient tolerance and satisfaction
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Background: decisions regarding fluid therapy, whether in the operating theatre, intensive care unit, emergency department, are among the most challenging and important tasks that clinicians face on a daily basis. Specifically, almost all clinicians would agree that both hypovolaemia and volume overload increase the morbidity and mortality of patients. The therapeutic goal of fluid administration is to increase preload, or the stressed venous volume, leading to an increased stroke volume and cardiac output. However, studies of patients with acute illness or hypotensive patients in the intensive care unit consistently demonstrate that approximately 50% of fluid boluses fail to achieve the intended effect of increasing cardiac output
Aim of the Work: this study was done to evaluate the correlation between central venous pressure [CVP] measurements and ultrasound measurements of the inferior vena cava diameter, and collapsibility index. The secondary aim was to evaluate the value of ultrasound as a noninvasive tool in assessment of intravascular volume status and fluid responsiveness in critically ill intensive care unit patients
Patients and Methods: after obtaining the approval of the Al-Azhar University Ethical Committee and written informed consent, 50 patients aged 30-60 years of either sex, ASA I-III admitted in the ICU of Al-Azhar teaching hospitals who had a functioning central venous catheter inserted for any clinical indication, were involved in this single blinded correlational study. Hemodynamic parameters were monitored continuously including heart rate and non-invasive mean arterial blood pressure. CVP measurements were taken with the patient in the supine position. Clinical assessment was done for signs of hypovolemia like hypotension, tachycardia, prolongation of capillary refill: >3 seconds, acidosis, increased serum lactate more than 2 mmol/L or loss of skin turgor
Results: in our study, there was a significant correlation between CVP and the two studied ultrasound parameters, IVC CI and IVCdmax. Analysis of the receiver operating characteristic curve ROC showed that inferior vena cava collapsibility index [IVC CI] had the most favorable performance of the two ultrasound parameters in predicting CVP < 10 cm H2O. As regards prediction of fluid responsiveness, analysis of the ROC showed a better diagnostic accuracy of IVC collapsibility index and IVC diameter for predicting fluid responsiveness
Conclusion: ultrasound of the inferior vena cava may be used as a feasible non-invasive, rapid and simple adjuvant method to assess the intravascular volume and guide fluid responsiveness in critically ill intensive care unit patients, inferior vena cava collapsibility index may be used to predict low central venous pressure and predict fluid responsiveness
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Background: The choices of premedication and anesthetic techniques are able to influence the neurohormonal stress response by modulating the pathophysiological pathways. Various pharmacological agents like nitroglycerine, beta blocker, and opioids were used to decrease surgical stress of laparoscopic procedures to improve outcome, with their own limitations
Objective: It was to compare the effect of opioid-free [using dexmedetomidine and propofol] and opioid-based [using fentanyl and propofol] TIVA techniques on hemodynamic stability, sedation postoperative pain intensity and the incidence of side effects in patients scheduled for LC
Patients and Methods: Eighty patients who were scheduled for elective laparoscopic cholecystectomy were included in this study. Before induction of anesthesia, patients were randomly divided into two equal groups: [40 each]. Dexmedetomidine group [Non-opioid group] received dexmedetomidine [1 Mug/kg] over 10 minutes before induction of anesthesia followed by continuous infusion of 0.5 Mug/kg/hr. till the end of surgery and Fentanyl group [Opioid group] received fentanyl [1.0 Mug/kg] over 10 minutes before induction of anesthesia followed by continuous infusion of 0.4 Mug/kg/hr. till the end of surgery
Results: The results of the present study showed that there were no significant differences between the two groups regarding HR and MAP except after loading dose of the studied drugs, after intubation, after pneumoperitoneum, 15 min, 30 min, 45 min, and 60 min after induction where it was lower in dexmedetomidine group than fentanyl group. There were no significant differences between two groups regarding intraoperative SPO2, postoperative SPO2 and blood glucose level [mg/dl]
Conclusion: This study concluded that dexmedetomidine is better than fentanyl for patients who undergo elective laparoscopic cholecystectomy due to perioperative maintaining of hemodynamic stability, decrease dosages of postoperative analgesics, prolong the duration of postoperative analgesia and decrease postoperative nausea and vomiting
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PURPOSE: This review reports the incidence of mesh-related erosion after ventral mesh rectopexy to determine whether any difference exists in the erosion rate between synthetic and biological mesh. METHODS: A systematic search of the MEDLINE and the Ovid databases was conducted to identify suitable articles published between 2004 and 2015. The search strategy capture terms were laparoscopic ventral mesh rectopexy, laparoscopic anterior rectopexy, robotic ventral rectopexy, and robotic anterior rectopexy. RESULTS: Eight studies (3,956 patients) were included in this review. Of those patients, 3,517 patients underwent laparoscopic ventral rectopexy (LVR) using synthetic mesh and 439 using biological mesh. Sixty-six erosions were observed with synthetic mesh (26 rectal, 32 vaginal, 8 recto-vaginal fistulae) and one (perineal erosion) with biological mesh. The synthetic and the biological mesh-related erosion rates were 1.87% and 0.22%, respectively. The time between rectopexy and diagnosis of mesh erosion ranged from 1.7 to 124 months. No mesh-related mortalities were reported. CONCLUSION: The incidence of mesh-related erosion after LVR is low and is more common after the placement of synthetic mesh. The use of biological mesh for LVR seems to be a safer option; however, large, multicenter, randomized, control trials with long follow-ups are required if a definitive answer is to be obtained.
Subject(s)
Humans , Diagnosis , Follow-Up Studies , Incidence , MortalityABSTRACT
The fourth author's affiliation should be corrected.
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The first author's affiliation should be corrected.
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PURPOSE: The aim of this study is to investigate the impact of age on short-term outcomes after colorectal surgery in terms of the 30-day postoperative morbidity and mortality rates. METHODS: The subjects for the study were patients who had undergone colorectal surgery. Patients were divided into 2 groups according to age; groups A and B patients were ≥80 and <80 years old of age, respectively. Both groups were manually matched for body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index and procedure performed. RESULTS: A total of 200 patients, 91 men (45.5%) and 109 women (54.5%), were included in this retrospective study. These patients were equally divided into 2 groups. The mean ages were 85 years in group A (range, 80 to 104 years) and 55.3 years in group B (range, 13 to 79 years). The overall 30-day postoperative mortality rate was 1% of total 200 patients; both of these 2 patients were in group A. However, this observation had no statistical significance. No intraoperative complications were encountered in either group. The overall 30-day postoperative morbidity rate was 27% (54 of 200) for both groups. The 30-day postoperative morbidity rates in groups A and B were 28% (28 of 100) and 26% (26 of 100), respectively. However, these differences between the groups had no statistical significance importance. CONCLUSION: Age alone should not be considered to be more of a contraindication or a worse predictor than other factors for the outcome after colorectal surgery on elderly patients.
Subject(s)
Aged , Female , Humans , Male , Body Mass Index , Colorectal Neoplasms , Colorectal Surgery , Comorbidity , Intraoperative Complications , Mortality , Retrospective StudiesABSTRACT
In this article, the sixth author's name was misprinted unintentionally. The sixth author's name should be corrected.
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In our study, we investigated the factors that may participate to false-negative colposcopic biopsy results. It was a descriptive study. Damanhour National Medical Institute Hospital [DNMI] during the period from January 2004 to August 2006. A computerized search identified patients with ASC Pap test results and positive results of reflexive high-risk HPV DNA testing during the period of study. Patients who underwent subsequent colposcopic-directed biopsy and/or endocervical curettage with no histologic evidence of HPV infection or dysplasia were selected for the study. Three levels were obtained from each block and stained with H and E. The original H and E-stained glass slides were reviewed. For cases that still were diagnosed as negative for dysplasia or HPV cytopathic effect on review, 3 additional H and E-stained levels were obtained. For the few cases in which there was disagreement with regard to the original and reviewed diagnoses, the discrepancy was recorded, and no other tissue sections were ordered. Patients with atypical squamous cells of undetermined significance [ASC] in Papanicolaou smears, with positive HPV DNA results, but negative cervical histopathologic findings accounted for 4.5% of all ASC smears submitted for HPV DNA testing. We found 4% of the cases had focal HPV infection or mild dysplasia. When serial sectioning of the biopsy material were examined, we found that 31% had clinically significant lesions: HPV infection or cervical intraepithelial neoplasia [CIN] 1, 19%; CIN 2/3, 8%; and dysplasia, not otherwise specified, 3%. Of the remaining patients, follow-up revealed squamous abnormalities in 25%. About 5% of patients with positive HPV DNA results had a negative follow-up biopsy result. [False-negative] biopsies.We recommend that additional levels have to be obtained when initial histologic sections do not demonstrate evidence of dysplasia or HPV cytopathic changes after a cytologic diagnosis of ASC and a positive HPV DNA test result
Subject(s)
Humans , Female , DNA Probes, HPV , Biopsy , Cervix Uteri , Uterine Cervical Dysplasia , PathologyABSTRACT
This multicenteric study included 38 patients with a fracture of the humeral shaft, treated with antegrade Russel-Taylor interlocking humeral nail. Twenty patients had acute fractures, ten had pathological fractures and eight had pseudoarthrosis. A closed nailing was performed in 16 acute fractures and in all pathological fractures. All open fractures and pathological fractures had no reaming. All patients with pathological fractures had a good relief of pain and an improved function of the upper limb. The mean healing time was 1.2 weeks for acute fractures and 16.75 weeks for pseudoarthrosis. An excellent to satisfactory result was achieved in 96% of the patients for acute fractures and in 75% for pseudoarthrosis. Locking nailing with Russel-Taylor humeral nail is a valuable stabilization technique for acute and pathological humeral shaft, fractures and pseudoarthrosis yielding a high rate of union and good functional results with a few minor complications
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Humans , Male , Female , Fracture Fixation, Intramedullary , Fracture Healing , Treatment Outcome , Postoperative ComplicationsABSTRACT
We reviewed the results of twenty patients [twenty-five hips] who had operative treatment for correction of neglected developmental dislocation of the hip. We had special interest in the study of acetabular remodeling potential after open reduction and femoral osteotomy. Marked spontaneous correction of the acetabular index was observed in all but one hip and only one pelvic osteotomy was needed for full correction of this hip. The average follow-up was five years and three months [2-6 years]. At the end of follow up the acetabular index improved from an average of 34 degrees preoperatively [range 30 degrees to 40 degrees] to 18 degrees postoperatively [range 12 degrees to 22 degrees]
Subject(s)
Humans , Male , Female , Acetabulum , Osteotomy , Treatment Outcome , Follow-Up Studies , ChildABSTRACT
Nine patients, average age 32 years, were treated with surgical repair for a neglected rupture of Achilles tendon. The mean time from acute injury to repair was 4.2 months. The method of repair included: excision of the interposed scar tissue, V in Y tendinous flap, end-to-end anastomosis, and augmentation in 6 patients with a free plantaris tendon graft and in 3 patient with a gastrocnemius aponeurotic flap. The gap length after trimming ranged from 4.5 to 6.5 cm. The follow-up period averaged 24 months, and the recovery time from repair to full activity ranged from 5.5 to 10 months, All patients were satisfied with the results, and all have been able to return to their preinjury activity level. No reruptures were encountered and few complications were recorded. MRI study was available in 6 patients for preoperative evaluation and for assessment of healing process. The overall results of this combined surgical technique are very encouraging; a strong, clinically functional Achilles tendon complex can be obtained. This technique is recommended for neglected rupture when end- to-end anastornosis is impossible due to extensive scar and retracted rupture ends
Subject(s)
Humans , Male , Female , Sutures , Plastic Surgery Procedures , Magnetic Resonance Imaging , Rupture , Bone TransplantationABSTRACT
Plasma lipids [cholesterol, triglycerides and total lipids] were studied in 40 patients with type II diabetes mellitus [NIDDM] before and after antidiabetic therapy. All patients were divided into 2 groups according to the type of antidiabetic therapy received: Group A, 20 patients treated with glibenclamide and group B, 20 patients treated with insulin. A significant elevation of triglycerides was found in diabetic patients while cholesterol and total lipids showed insignificant elevation. Insulin appears to be more effective in lowering both triglycerides and cholesterol than glibenclamide, but the two drugs are effective as regards the total lipids. The better effect of insulin in lowering the blood lipids than glibenclamide may be attributed to a more better control of the diabetic state