Smith, J Patrick; Samra, Navdeep S; Ballard, David H; Moss, Jonathan B; Griffen, Forrest D
Surgical site infections with elective laparoscopic cholecystectomy are less frequent and less severe, leading some to suggest that prophylactic antibiotics (PA) are no longer indicated. We compared the incidence of surgical site infections before and after an institutional practice change of withholding PA for elective laparoscopic cholecystectomy. Between May 7, 2013, and March 11, 2015, no PA were given to patients selected for elective cholecystectomy by two surgeons at a single center. The only patients excluded were those who received antibiotics before surgery for any reason. All others, including those at high risk for infection, were included. The incidence and severity of infections were compared with historical controls treated with prophylaxis by the same two surgeons from November 6, 2011, to January 13, 2013. There were 268 patients in the study group and 119 patients in the control group. Infection occurred in 3.0 per cent in the study group compared with 0.9 per cent in the controls (P = 0.29). All infections were mild except one. Based on these data, the routine use of PA for elective laparoscopic cholecystectomy is not supported.
Abu-Eshy, Saeed A.; Al-Rofaidi, Abdallah A.; Al-Faki, Ahmed S.; Ghalib, Hashim W.; Moosa, Riyadh A.; Sadik, Ali A.; Salati, Mohammad I.
Laparoscopic cholecystectomy, a minimal access surgery, is fast replacing open cholecystectomy and is being associated with less trauma. The objective of this study was to compare the proinflammatory cytokine levels in both laparoscopic cholecystectomy and open cholecystectomy. This study was carried out at Aseer Central Hospital, Aseer region, Abha Private Hospital and the College of Medicine and Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia, during the time period October 1998 through to November 2000. Sixty-one patients were included in the study, 27 of them had laparoscopic cholecystectomy and 34 had open cholecystectomy. Cytokines [Interleukin-6 Interleukin-1b, Tumor necrosis factor -a and Interleukin- 8] were measured in blood samples collected from the patients before, at and 24 hours post surgery, using commercially available kits. Interleukin-6 levels were significantly increased at 24 hours post surgery in the open cholecystectomy group of patients compared to the laparoscopic cholecystectomy group (P<0.04). No differences were found in the other cytokines levels (Interleukin-1b, tumor necrosis factor -a and Interleukin-8) between the open cholecystectomy and laparoscopic cholecystectomy groups. Laparoscopic cholecystectomy, a minimal access surgery, is associated with lower levels of the proinflammatory interleukin-6 cytokine compared to open cholecystectomy. (author)
Rashid, T.; Farooq, U.; Naheed, A.; Iqbal, M.; Barkat, N.
Background: Laparoscopic cholecystectomy is getting popularity in developing countries especially in Pakistan. Conversion from laparoscopic to open cholecystectomy is also common. This study intends to evaluate the causes of conversion from laparoscopic cholecystectomy to open cholecystectomy and to establish the efficacy and safety of the procedure. Methods: This descriptive case series was conducted in the department of General Surgery at Social Security Teaching Hospital Islamabad from November 2012 to October 2015. Patients of more than 20 years of age presenting in OPD with symptomatic gallstones were included in the study. Patients with dilated CBD (>8 mm in diameter), jaundice, acute cholecystitis, mass at porta hepatis and positive hepatitis B or C virology were excluded. Results: A total of 300 patients were included in the study; 262 (87.33 percentage) were females and 38 (12.67 percentage) were males. Twenty-one (7 percentage) patients were converted to open cholecystectomy. Most common cause of conversion was dense adhesions followed by obscure anatomy at Calots triangle. Other common causes were bleeding, bile leakage, visceral injuries and instrument failure. In the first 100 cases, 10 percentage patients were converted to open cholecystectomy followed by 6 percentage in the next 100 cases. Only 5 percentage patients were converted to open cholecystectomy in the last 100 cases. Conclusion: Most common cause of conversion from laparoscopic cholecystectomy to open cholecystectomy was dense adhesions followed by obscure anatomy at Calots triangle. (author)
Campbell, Beth M; Lambrianides, Andreas L; Dulhunty, Joel M
The laparoscopic approach to cholecystectomy has overtaken open procedures in terms of frequency, despite open procedures playing an important role in certain clinical situations. This study explored exposure and confidence of Australasian surgical trainees and new fellows in performing an open versus laparoscopic cholecystectomy. An online survey was disseminated via the Royal Australasian College of Surgeons to senior general surgery trainees (years 3-5 of surgical training) and new fellows (fellowship within the previous 5 years). The survey included questions regarding level of experience and confidence in performing an open cholecystectomy and converting from a laparoscopic to an open approach. A total of 135 participants responded; 58 (43%) were surgical trainees, 58 (43%) were fellows and 19 (14%) did not specify their level of training. Respondents who were involved in more than 20 open cholecystectomy procedures as an assistant or independent operator compared with those less exposed were more likely to feel confident to independently perform an elective open cholecystectomy (87.8% vs. 57.3%, P = 0.001), independently convert from a laparoscopic to open cholecystectomy (87.8% vs. 58.7%, P = 0.001) and independently perform an open cholecystectomy as a surgical consultant based on their level of exposure as a trainee (73.2% vs. 45.3%, P = 0.004). This study suggests the need to ensure surgical trainees are exposed to sufficient open cholecystectomies to enable confidence and skill with performing these procedures when indicated. Greater recognition of the need for exposure during training, including meaningful simulation, may assist. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.
Xu, Xiequn; Hong, Tao; Li, Binglu; Liu, Wei
It is a growing trend that patients seek health information on the internet to self-educate and self-diagnose, which impacts their health decisions. The aim of the study was to investigate how Chinese patients undergoing elective laparoscopic cholecystectomy (LC) sought information about their disease and treatment, how they preferred the information to be presented, and how it influenced them. A descriptive, cross-sectional-designed questionnaire was employed to obtain information from 248 Chinese patients undergoing elective LC in Peking Union Medical College Hospital. A total of 223 patients (89.9 %) sought health information from the internet. Patients searching the internet for information about LC were younger than those who did not. It varied with employment status, educational level, and household average income. Among patients searching the internet for LC information, 35.4 % felt more worried and 37.2 % felt more assured; 15.2 % went to visit other doctors and 8.5 % considered changing their treatment because of internet use. A significant proportion of patients used the internet to obtain information about their disease. Age, employment status, educational level, and household average monthly income had an effect on internet usage for LC information. The use of the internet could cause mixed emotional outcomes among patients. Physicians should guide Chinese patients to professional websites of high quality and take time to discuss the information with patients during their visits and consultations.
Full Text Available Aim: Laparoscopic cholecystectomy has become the gold standard for the treatment of gallstones. Background: The objective of our study was to identify the preoperative predictors of conversion of laparoscopic cholecystectomy into open cholecystectomy. Materials and Methods: We carried out a cross-sectional study in the Surgical Unit 1, Holy Family Hospital, Rawalpindi, from September 2016 to February 2017. All patients undergoing laparoscopic cholecystectomy were included in the study. Patients undergoing open cholecystectomy due to the presence of contraindication to laparoscopic cholecystectomy or patients in which laparoscopic cholecystectomy was a part of some other laparoscopic intervention were not included in the study. SPSS version 21 was used to analyze the data. Results: The overall mean age of the patients was 43.67 ± 13.54 years. The male patients were significantly older as compared to the female patients. The conversion rate was higher in patients who had an elevated total leukocyte count and alanine aminotransferase before the operation (P < 0.05. The rate of conversion was significantly higher in male patients aged ≥50 years (P < 0.05. Difficulty in the dissection of the triangle of Calot, difficulty in dissecting the gallbladder fossa, bleeding in gallbladder fossa, presence of duodenal fistula, and autolyzed gangrenous gallbladder were the reasons for the conversion to open cholecystectomy. Conclusion: The rate of conversion of laparoscopic cholecystectomy to open cholecystectomy was found to be 5%. Male patients aged ≥50 years, acalculous acute cholecystitis, acute cholecystitis, elevated preoperative total leukocyte count, and alanine aminotransferase levels were found to be significant predictors of conversion to open cholecystectomy.
Cheung, Cherry X
Chylous ascites a rare complication post cholecystectomy. There are to our knowledge only 3 reported cases in the literature. We describe a case of chylous ascites post open cholecystectomy in a patient with recent severe pancreatitis. We propose a potential relationship between acute biliary pancreatitis and the development of chylous ascites.
Tandon, A.; Shahzad, K.; Nunes, Q.; Shrotri, M.; Lunevicius, R.
Background: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. Methods: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted. A final group consisted of 2,079 adult patients. We estimated the incidence of perioperative blood transfusion attributable to laparoscopic cholecystectomy. The results of eight other studies are presented. Results: A preoperative blood group and save test was performed in 907 patients (43.6%), whereas cross-matching was documented in 28 patients (3.1%). None required an intraoperative blood transfusion. Twelve patients (0.58%) underwent blood transfusion postoperatively following laparoscopic cholecystectomy, of which ten were transfused due to severe intra-abdominal bleeding (0.48%). There were no deaths. Conclusions: The likelihood of blood transfusion attributable to elective laparoscopic cholecystectomy is 1:200. A routine preoperative blood group and save testing is unnecessary. It neither alters the management of severe hypovolemia, secondary to perioperative bleeding, nor does it lead to better outcomes. (author)
Full Text Available Background : Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Routine drainage after laparoscopic cholecystectomy is an issue of considerable debate. Therefore, a controlled randomised trial was designed to assess the value of drains in elective laparoscopic cholecystectomy. Materials and Methods: During a two-year period (From April 2008 to January 2010, 80 patients were simply randomised to have a drain placed (group A, an 8-mm pentose tube drain was retained below the liver bed, whereas 80 patients were randomised not to have a drain (group B placed in the subhepatic space. End points of this trial were to detect any differences in morbidity, postoperative pain, wound infection and hospital stay between the two groups. Results : There was no mortality in either group and no statistically significant difference in postoperative pain, nausea and vomiting, wound infection or abdominal collection between the two groups. However, hospital stay was longer in the drain group than in group without drain and it is appearing that the use of drain delays hospital discharge. Conclusion : The routine use of a drain in non-complicated laparoscopic cholecystectomy has nothing to offer; in contrast, it is associated with longer hospital stay.
Shrestha, B B; Karmacharya, M; Gharti, B B; Timilsina, B; Ghimire, P
Laparoscopic cholecystectomy (LC) is elective surgical procedure for uncomplicated gallstone disease and gallbladder polyp. The objective of this study was to assess the efficacy of Dexamethasone and Pheniramine hydrogen maleate on reducing stress response and pain after surgery in patients undergoing laparoscopic cholecystectomy. After obtaining approval from the institutional ethics committee and written informed consent, 120 patients undergoing elective laparoscopic cholecystectomy were enrolled in the study from Sep 2103 to Aug 2014 at Department of Surgery, Manipal College of Medical Sciences, Pokhara, Nepal. Patients were randomized to receive either 8mg/2ml of Dexamethasone + 45.5/2ml Pheniramine hydrogen maleate (treatment group, n= 60) or 5 ml of normal saline (control group, n=60) 90 minutes before skin incision. There was a reduction of total bilirubin, C-reactive protein (CRP) value and Visual Analogue Score (VAS) in treatment group as compared to control group (p Pheniramine hydrogen maleate prior to surgical skin incision helps to reduce both postoperative pain and acute physiological stress.
Rafiq, Muhammad Salman; Khan, Mah Muneer
To compare patient-satisfaction, scar-pain and cosmesis between laparoscopic and open-cholecystectomy. Cross-sectional survey. Khyber Teaching Hospital, Peshawar, from August 2012 to May 2014. A total of 400 patients, who had undergone open or laparoscopic cholecystectomy in all units of the Surgical Department, were included. Data was collected on questionnaires given and read to the patients along with counselling and information regarding scar-pain using visual analog score, and satisfaction and cosmesis on a 0 - 10 scale, by a medical professional in the patients' native language. This was done postoperatively on patients' follow-up visits at 1 and 4 weeks. Mean scar pain score at 1 and 4 weeks postoperatively was higher for open-cholecystectomy; 4.96 ±1 and 0.96 ±1, compared to 2.24 ±0.6 and 0, respectively for laparoscopic-cholecystectomy (p < 0.001 and < 0.001). Cosmesis was higher for laparoscopic-group; 8.6 ±1.2 vs. 6.2 ±1.46 for open-cholecystectomy (p < 0.001). Patient-satisfaction was higher for laparoscopic-cholecystectomy; 9.28 ±1.5 vs. 8.32 ±2.3 for open-cholecystectomy (p < 0.001). Mean-cosmesis score was higher for laparoscopic-cholecystectomy for those younger than 40, females and unmarried. Mean patient-satisfaction score was higher for those older than 40 years who had undergone open-cholecystectomy, women who had undergone laparoscopic-cholecystectomy and for unmarried patients who had laparoscopic-cholecystectomy. Overall patient-satisfaction and cosmesis scoring was higher for laparoscopic-cholecystectomy especially among females, unmarried and younger than 40 years. Patients of 40 years and older had greater satisfaction scoring for open-cholecystectomy. Therefore, laparoscopic-cholecystectomy should be favoured in females and unmarried patients and those younger than 40 years.
Altuntas, Yunus Emre; Oncel, Mustafa; Haksal, Mustafa; Kement, Metin; Gundogdu, Ersin; Aksakal, Nihat; Gezen, Fazli Cem
OBJECTIVE: This study aimed to reveal the risk factors and outcomes of gallbladder perforation (GP) during laparoscopic cholecystectomy. METHODS: Videotapes of all patients who underwent an elective cholecystectomy at our department were retrospectively analyzed, and the patients were divided into two groups based on the presence of GP. The possible risk factors and early outcomes were analyzed. RESULTS: In total, 664 patients [524 (78.9%) females, 49.7±13.4 years of age] were observed, and GP occurred in 240 (36.1%) patients, mostly while dissecting the gallbladder from its bed (n=197, 82.1%). GP was not recorded in the operation notes in 177 (73.8%) cases. Among the studied parameters, there was no significant risk factor for GP, except preoperatively elevated alanine transaminase level (p=0.005), but the sensitivity and specificity of this measure in predicting GP were 14.2% and 7.4%, respectively. The two groups had similar outcomes, but the operation time (35.4±17.5 vs 41.4±18.7 min, p=0.000) and incidence of drain use (25% vs 45.8%, p=0.000) increased in the GP group. CONCLUSION: The present study reveals that GP occurs in 36.1% of patients who undergo laparoscopic elective cholecystectomy, but it may not be recorded in most cases. We did not find any reliable risk factor that increases the possibility of GP. GP causes an increase in the operation time and incidence of drain use; however, the other outcomes were found to be similar in patients with GP and those without. PMID:29607432
Tapash Kumar Maitra
Full Text Available Background and objectives:Laparoscopic cholecystectomy (LC has virtually replaced conventional open cholecystectomy (OC as the standard procedure of treatment for cholelithiasis and cholecystitis. However, OC sometimes becomes a necessity considering the feasibility and safety of the surgical procedure. But the factors that demand conversion from LC to OC differ widely. The present study aimed to determine the prevalence of conversion from LC to OC and to assess the causes of conversion and risk factors related to conversion. Methods: The study was conducted in a referral hospital – ‘Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM’ from September 2014 to September 2016. Cases of cholelithiasis with or without cholecystitis, and other gall bladder pathology were included in the study. A team of experienced surgeon performed LC of all selected cases. The causes of conversion to OC were systematically recorded by the surgical team and the risk factors (age, sex, obesity, history of previous abdominal surgery, gallbladder thickness related to conversion from LC to OC was investigated. Results: A total of 261 (M / F = 87 /174 patients were considered eligible for the study. The mean age of all patients was 43 (±1.75 years. For the male and female groups the mean ages were 44±1.9 and 42±1.6 years respectively. Of the total 261 cases, 210 (80.5% patients had cholelithiasis with chronic cholecystitis, 47 (18.0% had gallbladder stone plus acute cholecystitis and 4 (1.5% had gallbladder polyp. Open conversion was required in case of 19 patients. Thus, overall conversion rate was 7.3%. The common causes of conversion were a difficulty in defining Calot’s triangle (42.1%, b injury to cystic artery (21.1% and c injury to bile duct (15.8%. Both male and female had equal risk for conversion. The investigated risk factors like history of previous abdominal surgery, preoperative ERCP, acute
Ali, M.A.; Niazi, W.A.K.
The aim of the study was to make a comparison between skin incisions made with electrocautery versus scalpel in terms of their safety, efficacy and post-operative complications. Design: A randomized controlled study. Setting: The study was conducted in Combined Military Hospital (CMH) Kharian, Pakistan airforce (PAF) Hospital Sargodha. Duration of Study: May 2008 to August 2011. Patients and Methods: Ninety seven patients who underwent open cholecystectomy were randomly divided into two groups on the basis of the use of electrocautery versus steel scalpel for making skin incision and sub-cutaneous tissue dissection. Parameters recorded were, time taken from skin incision to full incising of the peritoneum, length of the wound, amount of blood loss during this step of surgery in each group. Post-operative pain scoring using visual analogue scale was done. Wound complications such as infection, haematoma/seroma and dehiscence were noted too. One month of follow up was recorded in each group. Subsequently a comparison of these findings was done. Results: Incision time (sec/cm/sub 2/) was longer in scalpel group than in diathermy group (p = 0.001), whereas, incision blood loss (ml/cm/sub 2/) was significantly less in diathermy group than in scalpel group (p = 0.03). There was no difference in post-operative pain perception as delineated by visual pain analogue scoring system between the two groups (p = 0.57). Post-operative wound complications and the final healing of wound at 01 month of follow-up were almost similar in both groups. Conclusion: Electrocautery may be used safely without any untoward complication in making skin incision and sub-cutaneous tissue dissection with an advantage of reduced incision time and and less blood loss. (author)
Cholecystectomy - open; Gallbladder - open cholecystectomy; Cholecystitis - open cholecystectomy; Gallstones - open cholecystectomy ... a medical instrument called a laparoscope ( laparoscopic ... Open gallbladder surgery is used when laparoscopic surgery cannot ...
Tosun, Alptekin, E-mail: email@example.com [Giresun University Hospital, Department of Radiology (Turkey); Hancerliogullari, Kadir Oymen [Giresun University Hospital, Department of Pediatric Surgery (Turkey); Serifoglu, Ismail [Bulent Ecevit University Hospital, Department of Radiology (Turkey); Capan, Yavuz [Gaziantep Primer Hospital, Department of Surgery (Turkey); Ozkaya, Enis [Dr. Sami Ulus Maternity and Children' s Health Training and Research Hospital, Department of Obstetrics and Gynecology (Turkey)
Highlights: •The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. The study may be a guide for the surgeon to prefer laparoscopic or open surgery. -- Abstract: Background: Laparoscopic cholecystectomy is the first step treatment in cholelithiasis. The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. Methods: This study included 176 patients who had undergone laparoscopic cholecystectomy. Preoperative ultrasonographic findings were assessed and we gave points to each finding according to results from correlation analysis. After the scoring we investigated the relationship between ultrasonographic findings and conversion from laparoscopic cholecystectomy to open surgery. Results: Scoring significantly predicted failure in laparoscopic approach (AUC = 0.758, P = 0.003,). Optimal cut off score was found to be 1.95 with 67% sensitivity and 78% specificity. Score > 1.95 was a risk factor for failure in laparoscopic approach [odds ratio = 7.1(95% CI,2-24.9, P = 0.002)]. There were 8 subjects out of 36(22%) with high score underwent open surgery while 4 out of 128 (3%) subjects with low score needed open surgery (p = 0.002). Negative predictive value of 128/132 = 97%. Mean score of whole study population was 1.28 (range 0–8.8) and mean score of subjects underwent open surgery was 3.6 while it was 1.1 in successful laparoscopic approach group (p < 0.001). Mean Age and BMI were similar between groups (p > 0.05). Sex of subjects did not affect the success of surgery (p > 0.05). Conclusion: The contribution of preoperative ultrasonography is emphasized in many studies. Our study suggests quantitative results on conversion from laparoscopic cholecystectomy to open surgery. We believe that radiologists have to indicate the risk of conversion in their ultrasonography reports.
Dian, A.; Azam, U.F.; Malik, N.A.; Khan, J.S.; Khan, M.
Introduction: Open cholecystectomy (OC) has gradually been superseded by laparoscopic cholecystectomy (LC) for the treatment of cholelithiasis. Laparoscopic cholecystectomy is associated with fewer complications than open cholecystectomy when performed in experienced hands. The study was conducted to compare the two techniques for management of symptomatic gall stones. Objective: Our objective was to compare the management outcomes of laparoscopic cholecystectomy with those of open holecystectomy in the treatment of symptomatic cholelithiasis. Study Design: Quasi experimental study. Settings: It was carried out at Surgical Unit - I of Holy Family Hospital, Rawalpindi. Subjects and Methods: Eighty consecutive patients with symptomatic cholelithiasis confirmed on ultrasonography from September 2007 to March 2008 were included in the study. They were randomly allocated to LC or OC and were eventually operated. Results: Mean operating time of LC was 64 minutes (30-90) (SD=13.4) where as in OC it was 37.12 minutes (25-70) (SD-9.6). Return of bowel sounds postoperatively was within 12 hours (9-18) (SD=3.25) in LC while it was 16 hours (9-30) in OC group (SD=4.75). Postoperative hospital stay was 1.5 days mean (1-4 days) (SD=0.71). In LC while it was 2.9 days (2-5) in OC group (SD=0.84). The duration of injectable analgesia requirement was 1.3 days (1-3) (SD=0.51) and 1.8 days (1-3) (SD=0.7) in LC and OC patients respectively. The gall bladder perforation was 22.5% in OC and 15% in LC. The common bile duct injury occurred in 2% of patients with LC while none with OC. The conversion rate was 5%. Conclusion: Laparoscopic cholecystectomy is safe treatment of cholelithiasis with short duration of postoperative hospital stay, lesser post operative pain, early return of normal bowel activity as compared to the open cholecystectomy. (author)
Surgeons are still following the old habit of routine subhepatic drainage following laparoscopic cholecystectomy (LC). This study aims to compare the outcome of subhepatic drainage with no drainage after LC. This prospective study was conducted in two phases. Phase I was open, randomized controlled trial (RCT), conducted in Civil Hospital Karachi, from August 2004 to June 2005. Phase II was descriptive case series, conducted in author's practice hospitals of Karachi, from July 2005 to December 2009. In phase I, 170 patients with chronic calculous cholecystitis underwent LC. Patients were divided into two groups, subhepatic drainage (group A: 79 patients) or no drainage (group B: 76 patients). The rest 15 patients were excluded either due to conversion or elective subhepatic drainage. In phase II, 218 consecutive patients were enrolled, who underwent LC with no subhepatic drainage. Duration of operation, character, and amount of drain fluid (if placed), postoperative ultrasound for subhepatic collection, postoperative chest X-ray for the measurement of subdiaphragmatic air, postoperative pain, postoperative nausea/vomiting, duration of hospital stay, and preoperative or postoperative complications were noted and analyzed. Duration of operation and hospital stay was slightly longer in group A patients (P values 0.002 and 0.029, respectively); postoperative pain perception, nausea/vomiting, and postoperative complications were nearly same in both groups (P value 0.064, 0.078, and 0.003, respectively). Subhepatic fluid collection was more in group A (P = 0.002), whereas subdiaphragmatic air collection was more in group B (P = 0.003). Phase II results were nearly similar to group B patients in phase I. Routine subhepatic drainage after LC is not necessary in uncomplicated cases.
Hamid Reza Hemati
Full Text Available Introduction: Wound infection is one of the most common complications of surgical procedures.At present, different procedures are used to reduce wound infection including prophylactic antibiotics.Since laparoscopy controls the most sources of wound infection such as mechanical factors, the role ofprophylactic antibiotic therapy may be in doubt. In this study, we evaluated the antibiotic effects inprevention of wound infection in laparoscopic cholecystectomy.Methods and Materials: In this double-blind clinical trial study, patients who were candidate forlaparoscopic cholecystectomy were divided randomly into two groups: antibiotic receivers (38patients and placebo (Normal Saline receivers (32 patients group. The patients were visited in 24hours, 4-7, 10-15 and 30 days after surgery for wound infection and then 2 groups compared.Results: The study showed that there were no significant differences between two groups withrespect to age, body mass index and smoking. In addition, no wound infection was observed in first 24hours, 4-7, 10-15 and 30 days after operation in both groups.Conclusion: The findings showed that prophylactic antibiotic therapy in laparoscopiccholecystectomy has no effect on the incidence of wound infection. Therefore, it is suggested thatprophylactic antibiotic therapy does not use in laparoscopic cholecystectomy because of producingantibiotic resistance, unnecessary complications and also reducing economical costs.
Hadi, A.; Aman, Z.; Khan, S.A.
Objective: To evaluate the management of bile duct injuries following open and laparoscopic cholecystectomy in a tertiary care hospital. Methods: The descriptive case series was conducted from July 2002 to June 2008 at Hayatabad Medical Complex Peshawar, Pakistan. A total of 32 patients who sustained extra hepatic bile duct injuries during open and laparoscopic cholecystectomy were included. Patients having hepatobiliary malignancy or those managed through endoscopic retrograde cholangiopancreatography and stenting were excluded. Patients were thoroughly investigated including to reach a final diagnosis, and were followed up for 02 years. Results: The mean age of patients was 45.4+9-2.7 years with a female preponderance (M:F=1:9.7). The time of presentation was up to 03 months after initial surgery. Seven (21.87%) patients sustained bile duct injury during laparoscopic cholecystectomy, while 25 (78.13%) sustained injury during open procedure. Abdominal ultrasound scan was performed in 29 (90.63%) cases, endoscopic retrograde cholangiopancreatography in 14 (43.75%) and magnetic resonance cholangiopancreatography in 26 (81.25%) cases. Eleven (34.37%) patients had common bile duct leak, 9 (28.13%) had common hepatic duct injury, 9 (28.13%) had CBD strictures and 3 (09.37%) had injury to the biliary tree at porta hepatis level. Operative procedures performed included Roux-en-Y hepaticojejunostomy in 19 (59.38%) cases, choledochoduodenostomy in 7 (21.88%) cases, Roux-en-Y portoentrostomy and primary repair in 3 (09.37%) cases each. Postoperative morbidity included recurrent cholangitis 9 (28.12%), wound infection 4 (12.50%) and bile leakage 2 (06.25%). Hospital stay ranged 08-16 days. Hospital mortality rate was 03.13%, (n=1). Conclusion: The most frequent site of bile duct injury during open and laparoscopic cholecystectomy was the common bile duct, and Roux-en-Y hepaticojejunostomy was the procedure of choice by experienced surgeons for the management of such injuries
Ahmad, Nasir Zaheer
BACKGROUND AND OBJECTIVES: Liver function tests (LFTs) include alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and bilirubin. The role of routine testing before and after laparoscopic cholecystectomy was evaluated in this study. PATIENTS AND METHODS: A total of 355 patients were retrospectively analyzed by examining the LFTs the day before, the day after, and 3 weeks after the surgery. The Wilcoxon signed-rank test and Student t test were performed to determine statistical significance. RESULTS: Alterations in the serum AST, ALT, and GGT were seen on the first postoperative day. Minor changes were seen in bilirubin and ALP. An overall disturbance in the LFTs was seen in more than two-thirds of the cases. Repeat LFTs performed after 3 weeks on follow-up were found to be within normal limits. CONCLUSION: Mild-to-moderate elevation in preoperative LFTs may not be associated with any deleterious effect, and, in the absence of clinical indications, routine preoperative or postoperative liver function testing is unnecessary.
Karaman, Kerem; Bostanci, Erdal Birol; Aksoy, Erol; Ulas, Murat; Yigit, Tuba; Erdemli, Mehmet Ozcan; Ercin, Ugur; Bilgihan, Ayse; Saydam, Gul; Akoglu, Musa
Laparoscopic cholecystectomy (LC) still leads to significant postoperative nausea and vomiting (PONV) and pain. Our aim was to evaluate the efficacy of dexamethasone or pheniramine hydrogen maleate, either alone or combined, in reducing the stress response and symptoms after LC. Patients were randomly assigned to 1 of 4 groups, each consisting of 20 patients: control, dexamethasone (8 mg/2 mL), pheniramine hydrogen maleate (45.5 mg/2 mL), and the combined group. The drugs were given before anesthesia induction. C-reactive protein levels (CRP) and visual analog scale (VAS) scores were significantly less in the dexamethasone (P = .003) and combined groups (P pheniramine hydrogen maleate (P = .005) significantly reduced PONV. Dexamethasone significantly reduced postoperative pain and the systemic acute-phase response, whereas these effects were only partially attained with pheniramine hydrogen maleate. Both dexamethasone and pheniramine hydrogen maleate significantly reduced PONV. An additive effect seemed to occur if these drugs were used in combination. Copyright © 2013 Elsevier Inc. All rights reserved.
Gerard, Justin; Luu, Minh B; Poirier, Jennifer; Deziel, Daniel J
The revised Tokyo Guidelines include criteria for determining the severity of acute cholecystitis with treatment algorithms based on severity. The aim of this study was to investigate the relationship of the revised Tokyo Guidelines severity grade to clinical outcomes of cholecystectomy for acute cholecystitis. We identified 66 patients with acute cholecystitis from a prior study of difficult cholecystectomy cases. We examined the relationship between severity grade and multiple variables related to perioperative and postoperative outcomes. A more severe revised Tokyo Guidelines grade was associated with a higher number of complications (p = 0.03) and a higher severity of complications (p = 0.01). Severity grade did not predict operative time, estimated blood loss, intensive care unit admission or length of stay. Compared to planned open cholecystectomy, intended laparoscopic cholecystectomy was associated with significantly fewer total and Clavien-Dindo grade 3 complications, fewer intensive care unit admissions, and shorter length of stay (p values range from 0.03 to < 0.0001). In technically difficult operations for acute cholecystitis, the revised Tokyo guidelines severity grade correlates with the number and severity of complications. However, intended performance of laparoscopic cholecystectomy rather than open cholecystectomy in difficult operations predicts broader beneficial outcomes than severity grade.
Fa-Si-Oen, Patrick Regnier
Mechanical bowel preparation is a long standing practice in elective open colon surgery dating from the 1970's. It has always been believed to reduce the rate of postoperative complications in the form of anastomotic leakage and wound infection. In this thesis we broadly and thoroughly examine the
Comajuncosas, Jordi; Hermoso, Judit; Jimeno, Jaime; Gris, Pere; Orbeal, Rolando; Cruz, Antonio; Parés, David
Laparoscopic cholecystectomy is the gold standard treatment for gallbladder stones. Complications due to laparoscopic procedure are rare, but rate of wound infection in some studies is about 8 %. From January 2007 to December 2008, 320 laparoscopic cholecystectomies were performed at our hospital, and in 4.7 % of them, wound infection of the umbilical trocar was identified. We believe that this infection rate could be lower and that it is necessary to implement a new technique to reduce the wound infection. The aim of the study was to evaluate the benefits of bag extraction of gallbladder to prevent the wound infection. Two-arm, parallel, 1:1, randomised controlled trial (ISRCTN38095251). All patients suffering from symptomatic gallbladder stones of low risk were enrolled for this study and were divided into two groups in basics gallbladder extraction: with (80 patients) or, as usually, without bag (76 patients). All patients with cholecystitis or accidental gallbladder perforation were excluded. We compared all the results to establish whether meaningful differences were found. The final sample analysed (156 patients) consisted of 121 women and 35 men; there were 80 in the control group and 76 in the study group. There were 15 (9.6 %) diagnosed wound infections, eight cases in the study group and seven in the control group. There were no statistically significant differences. The determinant of wound infection in elective laparoscopic cholecystectomy is not the direct contact of the gallbladder with the wound; therefore, bag extraction is not necessary.
Newman, Richard M; Umer, Affan; Bozzuto, Bethany J; Dilungo, Jennifer L; Ellner, Scott
As the cost of health care is subjected to increasingly greater scrutiny, the assessment of new technologies must include the surgical value (SV) of the procedure. Surgical value is defined as outcome divided by cost. The cost and outcome of 50 consecutive traditional (4-port) laparoscopic cholecystectomies (TLC) were compared with 50 consecutive, nontraditional laparoscopic cholecystectomies (NTLC), between October 2012 and February 2014. The NTLC included SILS (n = 11), and robotically assisted single-incision cholecystectomies (ROBOSILS; n = 39). Our primary outcomes included minimally invasive gallbladder removal and same-day discharge. Thirty-day emergency department visits or readmissions were evaluated as a secondary outcome. The direct variable surgeon costs (DVSC) were distilled from our hospital cost accounting system and calculated on a per-case, per item basis. The average DVSC for TLC was $929 and was significantly lower than NTLC at $2,344 (p day discharge. There were no differences observed in secondary outcomes in 30-day emergency department visits (TLC [2%] vs NTLC [6%], p = 0.61) or readmissions (TLC [4%] vs NTLC [2%], p > 0.05), respectively. The relative SV was significantly higher for TLC (1) compared with NTLC (0.34) (p < 0.05), and SILS (0.66) and ROBOSILS (0.36) (p < 0.05). Nontraditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal. Copyright © 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
El-Awadi, Saleh; El-Nakeeb, Ayman; Youssef, Tamer; Fikry, Amir; Abd El-Hamed, Tito M; Ghazy, Hosam; Foda, Elyamany; Farid, Mohamed
Improved laparoscopic experience and techniques have made laparoscopic cholecystectomy (LC) feasible options in cirrhotic patients. This study was designed to compare the risk and benefits of open cholecystectomy (OC) versus LC in compensated cirrhosis. A randomized prospective study, in the period from October 2002 till December 2006, where 110 cirrhotic patients with symptomatic gallstone were randomly divided into OC group (55 patients) and LC group (55 patients). There was no operative mortality. In LC group 4 (7.33%) patients were converted to OC. Mean surgical time was significantly longer in OC group than LC group (96.13+17.35 min versus 76.13+15.12) P<0.05, associated with significantly higher intraoperative bleeding in OC group (P<0.01), necessitating blood transfusions to 7 (12.72%) patients in OC group. The time to resume diet was 18.36+8.18 h in LC group which is significantly earlier than in OC group 47.84+14.6h P<0.005. Hospital stay was significantly longer in OC group than LC group (6+1.74 days versus 1.87+1.11 days) P<0.01 with low postoperative morbidity. LC in cirrhotics is still complicated and highly difficult which associates with significant morbidity compared with that of patients without cirrhosis. However, it offers lower morbidity, shorter operative time; early resume dieting with less need for blood transfusion and reducing hospital stay than OC.
Hu, Alan Shiun Yew; Donohue, Peter O'; Gunnarsson, Ronny K; de Costa, Alan
Valid and user-friendly prediction models for conversion to open cholecystectomy allow for proper planning prior to surgery. The Cairns Prediction Model (CPM) has been in use clinically in the original study site for the past three years, but has not been tested at other sites. A retrospective, single-centred study collected ultrasonic measurements and clinical variables alongside with conversion status from consecutive patients who underwent laparoscopic cholecystectomy from 2013 to 2016 in The Townsville Hospital, North Queensland, Australia. An area under the curve (AUC) was calculated to externally validate of the CPM. Conversion was necessary in 43 (4.2%) out of 1035 patients. External validation showed an area under the curve of 0.87 (95% CI 0.82-0.93, p = 1.1 × 10 -14 ). In comparison with most previously published models, which have an AUC of approximately 0.80 or less, the CPM has the highest AUC of all published prediction models both for internal and external validation. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.
P.W. Plaisier; M.Y. Berger (Marjolein); R.L. van der Hul (René); H.G. Nijs (Huub); R. den Toom (Rene); O.T. Terpstra (Onno); H.A. Bruining (Hajo); S.M. Strasberg (S.)
textabstractShortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the
Full Text Available BACKGROUND: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion. However, there is a need to devise a risk-scoring system based on the identified risk factors to (a predict the risk of conversion preoperatively for selected patients, (b prepare the patient psychologically, (c arrange operating schedules accordingly, and (d minimize the procedure-related cost and help overcome financial constraints, which is a significant problem in developing countries. AIM: This study was aimed to evaluate preoperative risk factors for conversion from laparoscopic to open cholecystectomy in our setting. SETTINGS AND DESIGNS: A case control study of patients who underwent laparoscopic surgery from January 1997 to December 2001 was conducted at the Aga Khan University Hospital, Karachi, Pakistan. MATERIALS AND METHODS: All those patients who were converted to open surgery (n = 73 were enrolled as cases. Two controls who had successful laparoscopic surgery (n = 146 were matched with each case for operating surgeon and closest date of surgery. STATISTICAL ANALYSIS USED: Descriptive statistics were computed and, univariate and multivariate analysis was done through multiple logistic regression. RESULTS: The final multivariate model identified two risk factors for conversion: ultrasonographic signs of inflammation (adjusted odds ratio [aOR] = 8.5; 95% confidence interval [CI]: 3.3, 21.9 and age > 60 years (aOR = 8.1; 95% CI: 2.9, 22.2 after adjusting for physical signs, alkaline phosphatase and BMI levels. CONCLUSION: Preoperative risk factors evaluated by the present study confirm the likelihood of conversion. Recognition of these factors is important for understanding the characteristics of patients at a higher risk of conversion.
Ahmed, A.; Ahmed, M.
Objective: To assess the role of Intraperitoneal infiltration of Ropivacaine for post-op analgesia in open cholecystectomy in a low resource setting. Study Design: Randomized controlled trial. Place and Duration of Study: Study was conducted at department of Anesthesia, Scouts Hospital Chitral, from Jul 2014 to Jun 2016. Material and Methods: After taking approval from hospital ethical committee, total 126 patients were divided randomly in two groups. Group I (study group) was given intraperitoneal ropivacaine and group II (control group) was given routine standard analgesia. After complete recovery, pain was measure on VAS score (1-10) at 1 hour, 6 hour and 24 hour in all patients. Patients having pain score of 4 or more were managed with nalbuphine 5 mg IV bolus. Data was analyzed by SPSS version 16. Results: The comparison of pain score (after 1, 6and 24 hours of surgery), showed that study group had significantly (p-value<0.05) less mean pain score as compared with placebo group. Significant rate of nausea/vomiting was observed (p-value<0.05) higher (62%) in placebo group as compared with (38%) in study group. Statistically there was no significant difference (p-value>0.05) between groups on the basis of mean age (47.89 ± 8.56 vs. 48.75 ± 9.36), gender (Females 70% vs. 68%), duration of the surgery (88.54 ± 12.34 minutes vs. 91.70 ± 13.50 minutes) and American society of anesthesiologist (ASA) grades in study and placebo group patients respectively. Conclusion: Intraperitoneal ropivacaine infiltration helped in reducing the post op pain significantly in open cholecystectomy. (author)
Carraro, Amedeo; Mazloum, Dania El; Bihl, Florian
Gallbladder diseases are very common in developed countries. Complicated gallstone disease represents the most frequent of biliary disorders for which surgery is regularly advocated. As regards, cholecystectomy represents a common abdominal surgical intervention; it can be performed as either an elective intervention or emergency surgery, in the case of gangrene, perforation, peritonitis or sepsis. Nowadays, the laparoscopic approach is preferred over open laparotomy. Globally, numerous cholecystectomies are performed daily; however, little evidence exists regarding assessment of post-surgical quality of life (QOL) following these interventions. To assess post-cholecystectomy QOL, in fact, documentation of high quality care has been subject to extended discussions, and the use of patient-reported outcome satisfaction for quality improvement has been advocated for several years. However, there has been little research published regarding QOL outcomes following cholecystectomy; in addition, much of the current literature lacks systematic data on patient-centered outcomes. Then, although several tools have been used to measure QOL after cholecystectomy, difficulty remains in selecting meaningful parameters in order to obtain reproducible data to reflect postoperative QOL. The aim of this study was to review the impact of surgery for gallbladder diseases on QOL. This review includes Medline searches of current literature on QOL following cholecystectomy. Most studies demonstrated that symptomatic patients profited more from surgery than patients receiving an elective intervention. Thus, the gain in QOL depends on the general conditions before surgery, and patients without symptoms profit less or may even have a reduction in QOL.
Full Text Available JCMSBackground and Objectives: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. The present study was designed to determine the safety of open bedside tracheostomy (OBT as a routine intensive care units (ICU procedure without any selection criteria, considering its peri and postoperative complications.Materials & Methods: Retrospective medical chart review of all patients that underwent elective tracheostomy between June 2014 and January 2015.Results: The study group comprised 52 patients with a mean age of 40.4±15.1 years. The incidence of intra-procedure complications was 5.7% and post-procedure complications was 3.8%.Conclusions: Open bedside tracheostomy seems to be a safe and simple procedure, even when performed by a trained resident under controlled circumstances, and should be considered as an option for ICU patients.JCMS Nepal. 2015;11(1: 9-11
Full Text Available The present study is undertaken to establish the usefulness of laparoscopic cholecystectomy and to know its merits and demerits as compared to open cholecystectomy in children. In all, 28 patients who underwent cholecystectomy (8 open and 20 laparoscopic cholecystectomy in B.Y.L. Nair hospital between July 1999 and March 2004 were analyzed. Calculous cholecystitis was found to be the most common indication for surgery. Operative time for laparoscopic cholecystectomy was more than that in open cholecystectomy in the early phase of laparoscopy, which got reduced as we gained experience. The requirement of parenteral antibiotics and analgesics and the duration of stay were significantly shorter with laparoscopy. The advantages for a child in laparoscopic cholecystectomy as compared to open cholecystectomy are minimal pain, avoidance of an upper abdominal incision, cosmesis and shorter duration of hospitalization with quick return to home and school. Thus, laparoscopic cholecystectomy is safe and efficacious in children.
Montano, D.; Polnitsky, J.; Pisano, A.
The authors present 107 cholecystectomies performed in CRAMI during 1999 for gallstone disease.52 were laparoscopic cholecystectomies and 55 open cholecystectomies, 24 in the urgency.The length of stay was 1.04 days for the laparoscopic cholecystectomies and 3.06 and 4.04 for open cholecystectomies in coordinated and urgency procedures.Less than 1/5 of analgesic and antibiotic were needed in laparoscopic cholecystectomies
Thesbjerg, Simon E; Harboe, Kirstine Moll; Bardram, Linda
Conversion from laparoscopic to open cholecystectomy may not be desirable due to the increased complication rate and prolonged convalescence. In Denmark, nationwide data show that 7.7% of the laparoscopic cholecystectomies are converted to open surgery. This article aims to document the relations...
Shah, S.F.; Waqar, S.; Chaudry, M.A.; Hameed, S.
To compare three ports laparoscopic cholecystectomy and four ports laparoscopic cholecystectomy in terms of complications, time taken to complete the procedure, hospital stay and cost effectiveness in local perspective. Methodology: This randomized control trial included 60 patients who underwent elective laparoscopic cholecystectomy at Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2013 to June 2013. These patients were randomized on computer generated table of random numbers into group A and Group B. In Group A patients four ports were passed to perform laparoscopic cholecystectomy and in Group B patients three ports were passed to perform the procedure. Results: The mean age in both groups was 44 years (range 18-72). Three ports laparoscopic cholecystectomy (43 min) took less time to complete than four ports laparoscopic cholecystectomy (51 min). Patients in three ports laparoscopic cholecystectomy experienced less pain as compared to four ports group. The total additional analgesia requirement in 24 hours calculated in milligrams was less in three port laparoscopic cholecystectomy group as compared four port laparoscopic cholecystectomy group. The mean hospital stay in three port laparoscopic cholecystectomy group is 25 hours while the mean hospital stay in the four port laparoscopic cholecystectomy group is 28 hours. Conclusion: Three ports laparoscopic cholecystectomy is safe and effective procedure and it did not compromise the patient safety. (author)
PLAISIER, PW; BERGER, MY; VANDERHUL, RL; NIJS, HGT; DENTOOM, R; TERPSTRA, OT; BRUINING, HA
Shortly after extracorporeal shock wave lithotripsy (ESWL) was introduced as a promising new treatment modality for gallstone disease, a randomized controlled study was performed to assess the cost-effectiveness of ESWL compared to open cholecystectomy, the gold standard. During the performance of
Full Text Available Background: A major challenge in the postoperative period is pain management which, if not adequately controlled, may contribute to patient discomfort and decreased patient satisfaction, and possibly increased morbidity and mortality. Both Thoracic paravertebral block and oblique subcostal transversus abdominis plane block can be used as analgesic techniques for abdominal surgeries. Our aim in this research was comparison of cumulative 24-h post-operative morphine consumption between ultrasound-guided oblique subcostal transversus abdominis plane block and ultrasound-guided thoracic paravertebral block in patients who underwent an open cholecystectomy under general anesthesia. Patients and methods: This study was performed on 46 patients who underwent open cholecystectomy under general anesthesia. All patients were randomly allocated alternatively to one of two equal groups to either undergo ultrasound-guided unilateral oblique subcostal transversus abdominis plane block Group (I or to undergo ultrasound-guided unilateral thoracic paravertebral block Group (II. Both groups were subjected to a similar analgesic regimen in the immediate post-operative period that involved intravenous patient-controlled morphine analgesia which was used in both groups. Results: The total morphine consumption in the first postoperative 24 h was lower in thoracic paravertebral block Group (II (9.9 mg in thoracic paravertebral block group vs. 15.4 mg in oblique subcostal transversus abdominis plane block Group (I with p < 0.001. The mean time of first request of analgesia in Group (I was 248.7 min compared to 432.1 for Group (II with p < 0.001. Conclusions: Both ultrasound-guided oblique subcostal transversus abdominis plain block and single injection ultrasound guided thoracic paravertebral block are effective analgesic techniques for upper abdominal surgeries and reduces postoperative opioid requirements. However, thoracic paravertebral block is more
Full Text Available Introduction: Laparoscopic cholecystectomy has clearly become the choice over open cholecystectomy in the treatment of hepatobiliary disease since its introduction by Mouret in 1987. This study evaluates a series of patients with chronic calculus cholecystitis who were treated with laparoscopic and open cholecystectomy and assesses the outcomes of both techniques. Objective: To evaluate the efficacy of laparoscopic vs open cholecystectomy in chronic calculus cholecystitis and establish the out-comes of this treatment modality at Lumbini Medical College and Teaching Hospital. Methods: This was a retrospective analysis over a one-year period (January 1, 2012 to December 31, 2012, per-formed by single surgeon at Lumbini Medical College and Teaching Hospital located midwest of Nepal. 166 patients underwent surgical treatment for chronic calculus cholecystitis. Patients included were only chronic calculus cholecystitis proven histopathologocally and the rest were excluded. Data was collected which included patients demographics, medical history, presentation, complications, conversion rates from laparoscopic. cholecystectomy to open cholecystectomy, operative and postoperative time. Results: Patients treated with laparoscopic cholecystectomy for chronic calculus cholecystitis had shorter operating times and length of stay compared to patients treated with open cholecystectomy for chronic calculus cholecystitis. Conversion rates were 3.54% in chronic calculus cholecystitis during the study period. Complications were also lower in patients who underwent laparoscopic cholecystectomy versus open cholecystectomy for cholelithiasis. Conclusions: Laparoscopic cholecystectomy appears to be a reliable, safe, and cost-effective treatment modality for chronic calculus cholecystitis.
Rothman, Josephine Philip; Burcharth, Jakob; Pommergaard, Hans-Christian
were suitable for 7 meta-analyses on age, gender, body mass index, previous abdominal surgery, severity of disease, white blood cell count, and gallbladder wall thickness. CONCLUSIONS: A gallbladder wall thicker than 4-5 mm, a contracted gallbladder, age above 60 or 65, male gender, and acute...... cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell count and conversion to open surgery....
Hodgett, Steven E; Hernandez, Jonathan M; Morton, Connor A; Ross, Sharona B; Albrink, Michael; Rosemurgy, Alexander S
The journey from conventional "open" operations to truly "minimally invasive" operations naturally includes progression from operations involving multiple trocars and multiple incisions to operations involving access through the umbilicus alone. Laparoscopic operations through the umbilicus alone, laparoendoscopic single site surgery (LESS), offer improved cosmesis and hopes for less pain and improved recovery. This study was undertaken to evaluate our initial experience with LESS cholecystectomy and to compare our initial experience to concurrent outcomes with more conventional multiport, multi-incision laparoscopic cholecystectomy. All patients referred for cholecystectomy over a 6-month period were offered LESS. Outcomes, including blood loss, operative time, complications, and length of stay were recorded. Outcomes with our first LESS cholecystectomies were compared to an uncontrolled group of concurrent patients undergoing multiport, multi-incision laparoscopic cholecystectomy at the same hospital by the same surgeon. Twenty-nine patients of median age 50 years undergoing LESS cholecystectomy from November 2007 until May 2008 were compared to 29* patients, median age 48 years, undergoing standard multiport, multiple-incision laparoscopic cholecystectomy over the same time period. Median operative time for patients undergoing LESS cholecystectomy was 72 min and was not different from that of patients undergoing multiport, multi-incision laparoscopic cholecystectomy (p = 0.81). Median length of hospital stay was 1.0 day for patients undergoing LESS cholecystectomy and was not different from patients undergoing standard laparoscopic cholecystectomy (p = 0.46). Operative estimated blood loss was less than 100 cc for all patients. No patients undergoing attempted LESS cholecystectomy had conversions to "open" operations; two patients had an additional trocar(s) placed distant from the umbilicus to aid in exposure. Three patients undergoing LESS cholecystectomy had
Garner, J P; Sood, S K; Robinson, J; Barber, W; Ravi, K
Biliary symptoms whilst awaiting elective cholecystectomy are common, resulting in hospital admission, further investigation and increased hospital costs. Immediate cholecystectomy during the first admission is safe and effective, even when performed laparoscopically, but acute laparoscopic cholecystectomy has only recently become increasingly commonplace in the UK. This study was designed to quantify this problem in our hospital and its cost implications. The case notes of all patients undergoing laparoscopic cholecystectomy in our hospital between January 2004 and June 2005 were examined for details of hospital admissions with biliary symptoms or complications whilst waiting for elective cholecystectomy. Additional bed occupancy and radiological investigations were recorded and these costs to the trust calculated. We compared the potential tariff income to the hospital trust for the actual management of these patients and if a policy of acute laparoscopic cholecystectomy on first admission were in place. In the 18-month study period, 259 patients (202 females) underwent laparoscopic cholecystectomy. Of these, 147 presented as out-patients and only 11% required hospital admission because of biliary symptoms whilst waiting for elective surgery. There were 112 patients who initially presented acutely and were managed conservatively. Twenty-four patients were re-admitted 37 times, which utilised 231 hospital bed-days and repeat investigations costing over 40,000 pounds. There would have been a marginal increase in tariff income if a policy of acute laparoscopic cholecystectomy had been in place. Adoption of a policy of acute laparoscopic cholecystectomy on the index admission would result in substantial cost savings to the trust, reduce elective cholecystectomy waiting times and increase tariff income.
Roberts Michael S
Full Text Available Abstract Background Surgical site infections are common, so effective antibiotic concentrations at the sites of infection are required. Surgery can lead to physiological changes influencing the pharmacokinetics of antibiotics. The aim of the study is to evaluate contemporary peri-operative prophylactic dosing of cefazolin by determining plasma and subcutaneous interstitial fluid concentrations in patients undergoing elective of semi-elective abdominal aortic aneurysm (AAA open repair surgery. Methods/Design This is an observational pharmacokinetic study of patients undergoing AAA open repair surgery at the Royal Brisbane and Women's Hospital. All patients will be administered 2-g cefazolin by intravenous injection within 30-minutes of the procedure. Participants will have samples from blood and urine, collected at different intervals. Patients will also have a microdialysis catheter inserted into subcutaneous tissue to measure interstitial fluid penetration by cefazolin. Participants will be administered indocyanine green and sodium bromide as well as have cardiac output monitoring performed and tetrapolar bioimpedance to determine physiological changes occurring during surgery. Analysis of samples will be performed using validated liquid chromatography tandem mass-spectrometry. Pharmacokinetic analysis will be performed using non-linear mixed effects modeling to determine individual and population pharmacokinetic parameters and the effect of peri-operative physiological changes on cefazolin disposition. Discussion The study will describe cefazolin levels in plasma and the interstitial fluid of tissues during AAA open repair surgery. The effect of physiological changes to the patient mediated by surgery will also be determined. The results of this study will guide clinicians and pharmacists to effectively dose cefazolin in order to maximize the concentration of antibiotics in the tissues which are the most common site of surgical site infections.
Full Text Available Background: Dextromethorphan, the D-isomer of the codeine analog levorphanol, is a weak, noncompetitive N-Methyl-D-Aspartate (NMDA receptor antagonist. It has been suggested that NMDA receptor antagonists induce preemptive analgesia when administered before tissue injury occurs, thus decreasing the subsequent sensation of pain. Materials and Methods: The study was conducted in the Dr. Ali Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran, between February 2005 and December 2006. In this study, 72 patients scheduled for elective cholesyctectomy were randomized into three groups to receive either oral dextromethorphan 45 mg (Group D45 = 24, dextromethorphan 90 mg (Group D90 = 24, or placebo (Group C, n = 24, as premedication, 120 minutes before surgery. A visual analog scale (VAS for pain of each patient was measured at arrival in the ward and six and 24 hours after surgery. Results: The demographic characteristics of patients, ASA physical status class, duration of surgery, and the basal VAS pain score were similar in the two groups. There was no significant difference in the mean of the VAS pain scores measured over time or morphine consumption among the three groups. Conclusion: Dextromethorphan 45 mg and 90 mg, administrated orally, two hours before surgery, had no effect on postoperative morphine requirement and pain intensity.
Full Text Available BACKGROUND Postoperative pain after open cholecystectomy is associated with respiratory dysfunction, increased stress response and prolonged hospital stay. We compare intravenous paracetamol (7.5 mg/kg plus intercostal nerve block with local anaesthetic ropivacaine 0.5% to intravenous paracetamol (15 mg/kg on pain control after open cholecystectomy. MATERIALS AND METHODS 140 patients, who underwent for open cholecystectomy, were randomly divided into two groups of 70. The patients were randomly allocated to any of the following two groups depending upon the drug used for analgesia (Group P or Group I Intravenous paracetamol 15 mg/kg was given to patients of group P and paracetamol 7.5 mg/kg with Intercostal nerve block in right side 6-10 intercostal nerves with 2 ml local anaesthetic ropivacaine 0.5% in each space was given to patients of group I just after intubation before incision. When the patients were transferred to postoperative recovery room, intensity of pain was recorded by response from the patients using 100 mm linear visual analogue scale ranging from 0 to 100. The pain scoring was done in the immediate postoperative period (when the patient was able to communicate in the post anaesthesia care unit, at 30 minutes, 1 hr. then hourly up to 24 hrs. till patient complained of pain with VAS score 40 or more. RESULTS The severity of pain in VAS score was lower in immediate postoperative period, at 30 minutes, 1 hour and 2 hours postoperatively in group I than the group P and those were statistically significant (p<0.001. Duration of analgesia also significantly lower in group I. Mean duration of analgesia in group P is 161.9 ± 42.6 min and in group I is 241.3 ± 44.2 min (p<0.001. CONCLUSION Adding Intercostal nerve block to intravenous infusion of Paracetamol infusion (7.5 mg/kg is better than sole intravenous infusion of Paracetamol (15 mg/kg in controlling pain severity even after reducing dose of paracetamol after open
Mar 5, 2018 ... Trend Over Time for Cholecystectomy following the Introduction of. Laparoscopy in a Nigerian Tertiary ... How to cite this article: Adisa AO, Lawal OO, Adejuyigbe O. Trend over time for cholecystectomy following .... The challenges with record keeping in the era of open cholecystectomy in our center made it ...
Objective: To determine the incidence of intraoperative anesthesia-related complications of laparoscopic cholecystectomy. Results: One hundred patients with male to female ratio of 1:8.09 in the age range of 20-80 years (mean 39 years) underwent general anesthesia for laparoscopic cholecystectomy. The duration of operation in 94 laparoscopic cholecystectomy was from 20 to 80 minutes (mean 60.63 minutes). The incidence of intraoperative hypotension was 9%. Four percent of the patients developed arrhythmias. Increase in end-tidal-carbon dioxide (ETCO/sub 2/) was observed in 3% of cases. Conversion rate to open cholecystectomy was 6%. Damage to intraabdominal vessels with trocar insertion occurred in 1% of cases. Conclusion: Although laparoscopic cholecystectomy has major surgical and anesthetic advantages, there are anesthesia related complications requiring specific anesthetic interventions to improve patients outcome without compromising their safety. (author)
Palanivelu, Chinnasamy; Rajan, Pidigu Seshiyer; Jani, Kalpesh; Shetty, Alangar Roshan; Sendhilkumar, Karuppasamy; Senthilnathan, Palanisamy; Parthasarthi, Ramakrishnan
Open cholecystectomy is associated with considerable morbidity and mortality in cirrhotic patients. Laparoscopic cholecystectomy may offer a better option because of the magnification available and the availability of newer instruments like the ultrasonic shears. We present our experience of 265 laparoscopic cholecystectomies and attempt to identify the difficulties encountered in this group of patients. Between 1991 and 2005, 265 cirrhotic patients of Child-Pugh Classification A and B, with symptomatic gallstones, were subjected to laparoscopic cholecystectomy. We describe here our tailored approach and our techniques of subtotal cholecystectomy. Features of acute cholecystitis were present in 35.1% of the patients, and 64.9% presented with chronic cholecystitis. In 81.5% of the patients, the diagnosis of cirrhosis was established preoperatively. In 8.3% of the patients, a fundus first method was adopted when the hilum could not be approached despite additional ports. Modified subtotal cholecystectomy was performed in a total of 206 patients. Mean operative time in the subtotal cholecystectomy group was 72 minutes; in the standard group, it was 41 minutes. There was no mortality. In 15% of patients, postoperative deterioration in liver function occurred. Worsening of ascites, port site infection, port site bleeding, intraoperative hemorrhage, bilious drainage, and stone formation in the remnant were the other complications encountered. Laparoscopic cholecystectomy is a safe and effective treatment for calculous cholecystitis in cirrhotic patients. Appropriate modification of subtotal cholecystectomy should be practiced, depending on the risk factors present, to avoid complications.
Gurusamy, Kurinchi Selvan; Vaughan, Jessica; Rossi, Michele; Davidson, Brian R
Traditionally, laparoscopic cholecystectomy is performed using two 10-mm ports and two 5-mm ports. Recently, a reduction in the number of ports has been suggested as a modification of the standard technique with a view to decreasing pain and improving cosmesis. The safety and effectiveness of using fewer-than-four ports has not yet been established. To assess the benefits (such as improvement in cosmesis and earlier return to activity) and harms (such as increased complications) of using fewer-than-four ports (fewer-than-four-ports laparoscopic cholecystectomy) versus four ports in people undergoing laparoscopic cholecystectomy for any reason (symptomatic gallstones, acalculous cholecystitis, gallbladder polyp, or any other condition). We searched the Cochrane Central Register of Controlled Trials (CENTRAL; Issue 8, 2013), MEDLINE, EMBASE, Science Citation Index Expanded, and the World Health Organization International Clinical Trials Registry Platform portal to September 2013. We included all randomised clinical trials comparing fewer-than-four ports versus four ports, that is, with standard laparoscopic cholecystectomy that is performed with two ports of at least 10-mm incision and two ports of at least 5-mm incision. Two review authors independently identified the trials and extracted the data. We analysed the data using both the fixed-effect and the random-effects models. For each outcome, we calculated the risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI) based on intention-to-treat analysis, whenever possible. We found nine trials with 855 participants that randomised participants to fewer-than-four-ports laparoscopic cholecystectomy (n = 427) versus four-port laparoscopic cholecystectomy (n = 428). Most trials included low anaesthetic risk participants undergoing elective laparoscopic cholecystectomy. Seven of the nine trials used a single port laparoscopic cholecystectomy and the remaining two trials used three-port laparoscopic
The educational technology of massive open online courses (MOOCs) has been successfully applied in a wide variety of disciplines and are an intense focus of educational research at this time. Educators are now looking to MOOC technology as a means to improve professional medical education, but very little is known about how medical MOOCs compare with traditional content delivery. A retrospective analysis of the course evaluations for the Medicine as a Business elective by fourth-year medical students at Southern Illinois University School of Medicine (SIU-SOM) for the 2012-2015 academic years was conducted. This course was delivered by small group flipped classroom discussions for 2012-2014 and delivered via MOOC technology in 2015. Learner ratings were compared between the two course delivery methods using routinely collected course evaluations. Course enrollment has ranged from 6-19 students per year in the 2012-2015 academic years. Student evaluations of the course are favorable in the areas of effective teaching, accurate course objectives, meeting personal learning objectives, recommending the course to other students, and overall when rated on a 5-point Likert scale. The majority of all student ratings (76-95%) of this elective course are for the highest possible choice (Strongly agree or Excellent) for any criteria, regardless if the course was delivered via a traditional or MOOC format. Statistical analysis of these ratings suggests that the Effective Teacher and Overall Evaluations did not statistically differ between the two delivery formats. Student ratings of this elective course were highly similar when delivered in a flipped classroom format or by using MOOC technology. The primary advantage of this new course format is flexibility of time and place for learners, allowing them to complete the course objectives when convenient for them. The course evaluations suggest this is a change that is acceptable to the target audience. This study suggests that
Marcella Giovana Gava
Full Text Available Objective: to investigate the effects of preoperative fasting abbreviation with oral supplementation with carbohydrate in the evolution of grip strength in patients undergoing cholecystectomy by laparotomy. Methods : we conducted a clinical, randomizeddouble blind study with adult female patients, aged 18-60 years. Patients were divided into two groups: Control Group, with fasting prescription 6-8h until the time of operation; and Intervention Group, which received prescription of fasting for solids 6-8h before surgery, but ingested an oral supplement containing 12.5% carbohydrate, six (400ml and two (200ml hours before theprocedure. The handgrip strength was measured in both hands in both groups, at patient's admission (6h before surgery, the immediate pre-operative time (1h before surgery and 12-18h postoperatively. Results : we analyzed 27 patients, 14 in the intervention group and 13 in the control group. There was no mortality. The handgrip strength (mean [standard deviation] was significantly higher in the intervention group in the three periods studied, in at least one hand: preoperatively in the dominant hand (27.8 [2.6] vs 24.1 [3.7] kg; p=0.04, in the immediate preoperative in both hands, and postoperatively in the non-dominant hand (28.5 [3.0] vs 21.3 [5.9] kg; p=0.01. Conclusion : the abbreviation of preoperative fasting to two hours with drink containing carbohydrate improves muscle function in the perioperative period.
Citerio, Giuseppe; Franzosi, Maria Grazia; Latini, Roberto; Masson, Serge; Barlera, Simona; Guzzetti, Stefano; Pesenti, Antonio
Many studies have attempted to determine the "best" anaesthetic technique for neurosurgical procedures in patients without intracranial hypertension. So far, no study comparing intravenous (IA) with volatile-based neuroanaesthesia (VA) has been able to demonstrate major outcome differences nor a superiority of one of the two strategies in patients undergoing elective supratentorial neurosurgery. Therefore, current practice varies and includes the use of either volatile or intravenous anaesthetics in addition to narcotics. Actually the choice of the anaesthesiological strategy depends only on the anaesthetists' preferences or institutional policies. This trial, named NeuroMorfeo, aims to assess the equivalence between volatile and intravenous anaesthetics for neurosurgical procedures. NeuroMorfeo is a multicenter, randomized, open label, controlled trial, based on an equivalence design. Patients aged between 18 and 75 years, scheduled for elective craniotomy for supratentorial lesion without signs of intracranial hypertension, in good physical state (ASA I-III) and Glasgow Coma Scale (GCS) equal to 15, are randomly assigned to one of three anaesthesiological strategies (two VA arms, sevoflurane + fentanyl or sevoflurane + remifentanil, and one IA, propofol + remifentanil). The equivalence between intravenous and volatile-based neuroanaesthesia will be evaluated by comparing the intervals required to reach, after anaesthesia discontinuation, a modified Aldrete score > or = 9 (primary end-point). Two statistical comparisons have been planned: 1) sevoflurane + fentanyl vs. propofol + remifentanil; 2) sevoflurane + remifentanil vs. propofol + remifentanil. Secondary end-points include: an assessment of neurovegetative stress based on (a) measurement of urinary catecholamines and plasma and urinary cortisol and (b) estimate of sympathetic/parasympathetic balance by power spectrum analyses of electrocardiographic tracings recorded during anaesthesia; intraoperative
Yousef, Gamal T.; Lasheen, Ahmed E.
Background: Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. Objective: This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery an...
Rosenberg-Adamsen, S; Skarbye, M; Wildschiødtz, G
.01). SWS was absent in four of the patients after operation, whereas in six patients it was within the normal range (5-20% of the night). The proportion of rapid eye movement (REM) sleep was not significantly changed after operation. There were no changes in arterial oxygen saturation on the postoperative...... compared with the preoperative night. Comparison of our results with previous studies on SWS and REM sleep disturbances after open laparotomy, suggests that the magnitude of surgery or administration of opioids, or both, may be important factors in the development of postoperative sleep disturbances.......The sleep pattern and oxygenation of 10 patients undergoing laparoscopic cholecystectomy were studied on the night before operation and the first night after operation. Operations were performed during general anaesthesia and postoperative analgesia was achieved without the administration...
Full Text Available Abstract Background Many studies have attempted to determine the "best" anaesthetic technique for neurosurgical procedures in patients without intracranial hypertension. So far, no study comparing intravenous (IA with volatile-based neuroanaesthesia (VA has been able to demonstrate major outcome differences nor a superiority of one of the two strategies in patients undergoing elective supratentorial neurosurgery. Therefore, current practice varies and includes the use of either volatile or intravenous anaesthetics in addition to narcotics. Actually the choice of the anaestesiological strategy depends only on the anaesthetists' preferences or institutional policies. This trial, named NeuroMorfeo, aims to assess the equivalence between volatile and intravenous anaesthetics for neurosurgical procedures. Methods/Design NeuroMorfeo is a multicenter, randomized, open label, controlled trial, based on an equivalence design. Patients aged between 18 and 75 years, scheduled for elective craniotomy for supratentorial lesion without signs of intracranial hypertension, in good physical state (ASA I-III and Glasgow Coma Scale (GCS equal to 15, are randomly assigned to one of three anaesthesiological strategies (two VA arms, sevoflurane + fentanyl or sevoflurane + remifentanil, and one IA, propofol + remifentanil. The equivalence between intravenous and volatile-based neuroanaesthesia will be evaluated by comparing the intervals required to reach, after anaesthesia discontinuation, a modified Aldrete score ≥ 9 (primary end-point. Two statistical comparisons have been planned: 1 sevoflurane + fentanyl vs. propofol + remifentanil; 2 sevoflurane + remifentanil vs. propofol + remifentanil. Secondary end-points include: an assessment of neurovegetative stress based on (a measurement of urinary catecholamines and plasma and urinary cortisol and (b estimate of sympathetic/parasympathetic balance by power spectrum analyses of electrocardiographic tracings recorded
... was no conversion to open surgery, no major complications and no case of readmission to the hospital. Conclusions: Day case laparoscopic cholecystectomy in our environment could be safely promoted but will depend on improved facilities and patient enlightenment. Keywords: Day case, laparoscopic cholecystectomy, ...
Rothman, Josephine Philip; Burcharth, Jakob; Pommergaard, Hans-Christian
to weekdays. METHODS: The population originated from the Danish Cholecystectomy Database. It consists of adult patients, who had a cholecystectomy performed by standard four-port laparoscopic or open surgery. Adjusted analyses were used to study if day of the week had an influence on conversion, readmission...
Awaiz, A; Rahman, F; Hossain, M B; Yunus, R M; Khan, S; Memon, B; Memon, M A
The utility of laparoscopic repair in the treatment of incisional hernia repair is still contentious. The aim was to conduct a meta-analysis of RCTs investigating the surgical and postsurgical outcomes of elective incisional hernia by open versus laparoscopic method. A search of PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane Central Register of Controlled Trials published between January 1993 and September 2013 was performed using medical subject headings (MESH) "hernia," "incisional," "abdominal," "randomized/randomised controlled trial," "abdominal wall hernia," "laparoscopic repair," "open repair", "human" and "English". Prospective RCTs comparing surgical treatment of only incisional hernia (and not primary ventral hernias) using open and laparoscopic methods were selected. Data extraction and critical appraisal were carried out independently by two authors (AA and MAM) using predefined data fields. The outcome variables analyzed included (a) hernia diameter; (b) operative time; (c) length of hospital stay; (d) overall complication rate; (e) bowel complications; (f) reoperation; (g) wound infection; (h) wound hematoma or seroma; (i) time to oral intake; (j) back to work; (k) recurrence rate; and (l) postoperative neuralgia. These outcomes were unanimously decided to be important since they influence the practical and surgical approach towards hernia management within hospitals and institutions. The quality of RCTs was assessed using Jadad's scoring system. Random effects model was used to calculate the effect size of both binary and continuous data. Heterogeneity amongst the outcome variables of these trials was determined by the Cochran Q statistic and I (2) index. The meta-analysis was prepared in accordance with PRISMA guidelines. Sufficient data were available for the analysis of twelve clinically relevant outcomes. Statistically significant reduction in bowel complications was noted with open surgery compared to the
Nielsen, Liv Bjerre Juul; Harboe, Kirstine Moll; Bardram, Linda
The number of Danish inhabitants older than 65 years is increasing, and cholecystectomy is one of the most common surgical procedures performed for this age group. This study aimed to analyze the role of age as an independent predictor of outcome for elderly cholecystectomy patients....
Henriksen, Nadia A; Al-Tayar, Haytham; Rosenberg, Jacob
Specially designed surgical instruments have been developed for single-incision laparoscopic surgery, but high instrument costs may impede the implementation of these procedures. The aim of this study was to compare the cost of operative implements used for elective cholecystectomy performed...
Thapa, P B; Maharjan, D K; Tamang, T Y; Shrestha, S K
Safe dissection of Calot's Triangle is important during the performance of laparascopic cholucystectomy. The purpose of the study is to determine the frequency of demonstrable Rouviere's sulcus in patients with symptomatic gall stones and its role in safe dissection in Calot's triangle. This is a prospective descriptive study design done in Department of surgery, Kathmandu Medical College Teaching Hospital from Jan 2013 to Jan 2015. Patients who were posted for laparoscopic cholecystectomy were included. During laparoscopy, Rouviere's sulcus was noted in the operative note and classified according to following: Type I: Open type was defined as a cleft in which the right hepatic pedicle was visualized and the sulcus was opened throughout its length. Type II: if the sulcus was open only at its lateral end. Type III If the sulcus was open only at its medial end. Type IV: Fused type was defined as one in which the pedicle was not visualized. A total of 200 patients underwent laparoscopic cholecystectomy during period of 2 years. Out of which Rouviere's sulcus was visualized in 150 patients (75 %).Type I (open type) was commoner in 54%, type II in 12%, Type III in 9% and type IV (fused type) in 25%. Rouviere's Sulcus is an important extra biliary land mark for safe dissection of Calot's triangle during laparoscopic cholecystectomy. Rouviere's Sulcus, Laparoscopic cholecystectomy, Bile duct injury.
Full Text Available Abstract Background Epidemiological data on characteristics of patients undergoing open or laparoscopic cholecystectomy are limited. In this register study we examined characteristics and mortality of patients who underwent cholecystectomy during hospital stay in Sweden 2000 – 2003. Methods Hospital discharge and death certificate data were linked for all patients undergoing cholecystectomy in Sweden from January 1st 2000 through December 31st 2003. Mortality risk was calculated as standardised mortality ratio (SMR i.e. observed over expected deaths considering age and gender of the background population. Results During the four years of the study 43072 patients underwent cholecystectomy for benign biliary disease, 31144 (72% using a laparoscopic technique and 11928 patients (28% an open procedure (including conversion from laparoscopy. Patients with open cholecystectomy were older than patients with laparoscopic cholecystectomy (59 vs 49 years, p Conclusion Laparoscopic cholecystectomy is performed on patients having a lower mortality risk than the general Swedish population. Patients with open cholecystectomy are more sick than patients with laparoscopic cholecystectomy, and they have a mortality risk within 90 days of admission for cholecystectomy, which is four times that of the general population. Further efforts to reduce surgical trauma in open biliary surgery are motivated.
Callister, Lynn Clark; Cox, Amy Harmer
Although international opportunities are the hallmark of nursing education at a large private university, the meaning of participating in such clinical nursing electives has not been described. The purpose of this phenomenological study of nurses was to examine the personal and professional meaning of participating in international clinical nursing electives during their undergraduate nursing studies. Audiotaped interviews were conducted with 20 former nursing students who had had this opportunity. "Opening our hearts and minds" was described by the study's participants, with the following themes: increasing understanding of other cultures and peoples, increasing understanding of global sociopolitical and health issues, increasing the commitment to make a difference, experiencing personal and professional growth, contributing to professional development in the host country, making interpersonal connexions, and developing cultural competence. This study makes an important contribution to the documentation of the meaning of participating in international nursing clinical experiences. Data are being used for long-term curricular planning in the development and refinement of future international clinical nursing electives and to provide outcomes data for professional accreditation. There are broader implications for the movement beyond individual cultural competence to increasing global consciousness and the improvement of global health care.
Full Text Available Background. The aim of this population-based study was to describe characteristics of patients with liver cirrhosis undergoing cholecystectomy and evaluate the risk for perioperative and postoperative complications during the 30-day postoperative period. Method. All laparoscopic and open cholecystectomy procedures registered between 2006 and 2011 in the Swedish Registry for Gallstone Surgery and ERCP (GallRiks were included. Patients with liver cirrhosis were identified by linking data to the Swedish National Patient Registry (NPR. Results. Of 62,488 patients undergoing cholecystectomy, 77 (0.12% had cirrhosis, of which 29 patients (37.7% had decompensated cirrhosis. Patients with cirrhosis were older and had more often gallstone complications at the time for surgery. Postoperative complications were registered in 13 (16.9% patients with liver cirrhosis and in 5,738 (9.2% patients in the noncirrhotic group (P1 day (OR = 2.3, CI 1.11–4.84, P<0.05 than noncirrhotic patients. Conclusion. Patients with cirrhosis undergoing cholecystectomy have a higher incidence of postoperative complications than patients without cirrhosis. However, cholecystectomy is safe and if presented with adequate indication, surgery should not be delayed due to fears of surgical complications.
Ainsworth, Alan Patrick; Axelsen, Anne Reiss; Rasmussen, Lars
It is recommended that children with typical clinical signs of biliary colic should be offered surgery if gallstones are present. The aim of this study was to describe a population of children having undergone cholecystectomy.......It is recommended that children with typical clinical signs of biliary colic should be offered surgery if gallstones are present. The aim of this study was to describe a population of children having undergone cholecystectomy....
Choke, E; Lee, K; McCarthy, M; Nasim, A; Naylor, A R; Bown, M; Sayers, R
To develop and validate an "in house" risk model for predicting perioperative mortality following elective AAA repair and to compare this with other models. Multivariate logistics regression analysis was used to identify risk factors for perioperative-day mortality from one tertiary institution's prospectively maintained database. Consecutive elective open (564) and endovascular (589) AAA repairs (2000-2010) were split randomly into development (810) and validation (343) data sets. The resultant model was compared to Glasgow Aneurysm Score (GAS), Modified Customised Probability Index (m-CPI), CPI, the Vascular Governance North West (VGNW) model and the Medicare model. Variables associated with perioperative mortality included: increasing age (P = 0.034), myocardial infarct within last 10 years (P = 0.0008), raised serum creatinine (P = 0.005) and open surgery (P = 0.0001). The areas under the receiver operating characteristic curve (AUC) for predicted probability of 30-day mortality in development and validation data sets were 0.79 and 0.82 respectively. AUCs for GAS, m-CPI and CPI were poor (0.63, 0.58 and 0.58 respectively), whilst VGNW and Medicare model were fair (0.73 and 0.79 respectively). In this study, an "in-house" developed and validated risk model has the most accurate discriminative value in predicting perioperative mortality after elective AAA repair. For purposes of comparative audit with case mix adjustments, national models such as the VGNW or Medicare models should be used. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
Courtemanche, Karim; Elkouri, Stephane; Dugas, Jean-Philippe; Beaudoin, Nathalie; Bruneau, Luc; Blair, Jean-François
Concern about allogeneic blood product cost and complications has prompted interest in blood conservation techniques. Intraoperative autotransfusion (IAT) is currently not used routinely by vascular surgeons in open elective infrareanl abdominal aortic aneurysm (AAA) repair. The objective of this study is to review our experience with IAT and its impact on blood transfusion. We retrospectively reviewed the medical records of consecutive patients treated electively over a 4-year period and compared 2 strategy related to IAT, routine use IAT (rIAT) versus on-demand IAT (oIAT). Outcomes measured were number of units of allogeneic red blood cells and autologous red blood cells transfused intraoperatively and postoperatively, preoperative, postoperative, and discharge hemoglobin levels; postoperative infections; length of postoperative intensive care stay; and length of hospital stay. T-independent and Fisher exact test were used. A total of 212 patients were included, 38 (18%) in the rIAT and 174 (82%) in the oIAT. Groups were similar except for an inferior creatinine and a superior mean aneurysm diameter for the rIAT group. Patients in the rIAT group had a lower rate of transfusion (26% vs 54%, P = .002) and a lower mean number of blood unit transfused (0.8 vs 1.8, P = .048). These findings were still more significant for AAA larger than 60 mm (18% rIAT vs 62% oIAT, P = .0001). Postoperative hemoglobin was superior in the rIAT group (107 vs 101 g/L, P = .01). Mean postoperative intensive care length of stay was shorter for the rIAT group (1.1 vs 1.8 days, P = .01). No difference was noted for infection, mortality, or hospital length of stay. The rIAT reduced the exposure to allogeneic blood products by more than 50%, in particular for patients with AAA larger than 60 mm. These results support the use of rIAT for open elective infrarenal AAA repair.
Full Text Available This article examines the tools, approaches, collaboration, and findings of the Web Archives for Historical Research Group around the capture and analysis of about 4 million tweets during the 2015 Canadian Federal Election. We hope that national libraries and other heritage institutions will find our model useful as they consider how to capture, preserve, and analyze ongoing events using Twitter. While Twitter is not a representative sample of broader society - Pew research shows in their study of US users that it skews young, college-educated, and affluent (above $50,000 household income – Twitter still represents an exponential increase in the amount of information generated, retained, and preserved from 'everyday' people. Therefore, when historians study the 2015 federal election, Twitter will be a prime source.On August 3, 2015, the team initiated both a Search API and Stream API collection with twarc, a tool developed by Ed Summers, using the hashtag #elxn42. The hashtag referred to the election being Canada's 42nd general federal election (hence 'election 42' or elxn42. Data collection ceased on November 5, 2015, the day after Justin Trudeau was sworn in as the 42nd Prime Minister of Canada. We collected for a total of 102 days, 13 hours and 50 minutes. To analyze the data set, we took advantage of a number of command line tools, utilities that are available within twarc, twarc-report, and jq. In accordance with the Twitter Developer Agreement & Policy, and after ethical deliberations discussed below, we made the tweet IDs and other derivative data available in a data repository. This allows other people to use our dataset, cite our dataset, and enhance their own research projects by drawing on #elxn42 tweets. Our analytics included: breaking tweet text down by day to track change over time; client analysis, allowing us to see how the scale of mobile devices affected medium interactions; URL analysis, comparing both to Archive
Full Text Available Objectives: The most common indication for abdominal surgery in elderly (65 & older is gallstone disease.The elderly are more prone to complication of such surgery due to their other co-morbidity and thus they may benefit mostly from a safer method of surgical procedure. The purpose of this study was to evaluate the safety and outcome of laparoscopic cholecystectomy in elderly compare to the conventional method. Methods & Materials: Via prospective study from June 2005 to March 2008 included all patient older than 60 years of age who underwent cholecystectomy by open (Group A and laparoscopic (Group B method in Milad Hospital.The demographic data (sex age, American Society of Anesthesiologists’ (ASA score, postoperative mortality morbidity, length of stay and operative time were recorded for each patient and were compared between two methods. Data of patient’s analysis by SPSS with chi-square and t test. Results: The study included 311 elderlies (34% men and 66% women. Hundred fifty-seven patients underwent open cholecystectomy; 154 patients underwent laparoscopic cholecystectomy. The mean age was 7141 years. The outcome in group B (laparoscopic included: morality 0%, morbidity 2%, postoperative hospital stay 1 days, mean operation time was 40 minutes. In group A(open: mortality and morbidity rate were 21% and 12% respectively with postoperative hospital stay 331 days and similar operation time as group A. Conclusion: Laparoscopic cholecystectomy is the gold standard treatment and safe procedure in elderly patient and aging is not considered to be a contraindication laparoscopic surgery in such patients.
Full Text Available Background. After more than decade of routine use of laparoscopic cholecystectomy for treatment of symptomatic gallbladder stones, the incidence of biliary injuries, which are potentially life threatening and cause prolonged hospitalization and major morbidity, seems to be increased in laparoscopic cholecystectomy compared with open operation. Injury rate was from some reports 2.5 to 4 times higher than with open operation. There are many proposed classifications of types of biliary injuries.The most frequent direct causes of laparoscopic biliary injury are misidentification of the common bile duct, cautery injuries to the bile duct and improper application of clips to the cystic duct.Conclusions. To avoid misidentification of ducts one should conclusively identify cystic duct and artery, the structures to be divide, in every laparoscopic cholecystectomy. To achieve that goal, Calot’s triangle must be dissected free of fat and fibrous – tissue and the lower end of the gallbladder must be dissected of the liver bed. The only two structures entering the gallbladder should be visible – cystic duct and artery. With avoidance of blind application of cautery and clips to control bleeding one should avoid injury of bile duct. Low cautery settings should be used in portal dissections to prevent arc.With meticulous care in dissection and conclusive identification of cystic duct and artery we can prevent injuries of bile duct, which still have impermissible high incidence. In the article 504 laparoscopic cholecystectomies performed at the Department of abdominal surgery in BPD in 2002 were analysed. We follow priciples of safety in laparoscopic cholecystectomy. There were no biliary injuries reports.
Masud, M.; Adil, M.; Ashraf, F.; Aqil, A.
To evaluate laparoscopic cholecystectomy by a clinical practice audit at Military Hospital, Rawalpindi. Study Design: Prospective study. Place and Duration of Study: Surgical department Military Hospital from Jul 2011-Dec 2013. Material and Methods: A total of 1020 patients who underwent laparoscopic cholecystectomy for acute or chronic cholecystitis and gallstone pancreatitis were included in our study while those who had previously undergone abdominal surgeries, those with high risk for general anesthesia, immunocompromised patients, with age greater than 70 years and having comorbidities like cardiac insufficiency, severe asthma, chronic liver disease with ascites and compromised renal functions were excluded from the study. Patients demographic data, operative time, intra-operative findings, intra-operative difficulties, post-operative complications, conversion rate to open cholecystectomy and post-operative recovery time were recorded. Data was analyzed by using SPSS version 21. Results: Out of 1020 patients 907 were females while 113 were males with male to female ratio of 1:8.02. Age range was 20-70 with mean age of 50 ± 10.456 years. 44.7% patients presented with the clinical features of acute cholecystitis, 540 (52.94%) with chronic cholecystitis and 23 (2.28%) with acute pancreatitis. Mean operative time was 20 minutes in asymptomatic patients, while 40 minutes in acute cholecystitis and 35 minutes in chronic gallstone disease. Gall bladder perforation, bleeding from cystic artery and bile spillage were mostly encountered per-operative difficulties. Only 37 (3.6%) patients were converted to open cholecystectomy. Post-operative complications occur in only 122 (12%) patients. 938 (92%) patients were discharged within 48 hours. of surgery. Conclusion: Laparoscopic cholecystectomy in our setup has comparable results to the data available from other surgical facilities around the world and it has become a gold standard technique for the treatment of non
Initial 100 consecutive laparoscopic cholecystectomies performed by one surgeon were studied prospectively. The standard technique was modified in that the gallbladder removal was accomplished through the upper epigastric incision; there was no need to change the location of the camera. The conversion rate to open cholecystectomy was 2%. There were no major complications and no mortality. Minor complications occurred in 9% of the patients. Laparoscopic cholecystectomy can be performed safely ...
Williams, J K; Rosemurgy, A S; Albrink, M H; Parsons, M T; Stock, S
Laparoscopic cholecystectomy was performed on a pregnant woman at 18 weeks of gestation without complications. Considering the risk/benefit ratio, laparoscopic cholecystectomy in pregnant women is preferable to conventional cholecystectomy.
Christoffersen, Mette W; Brandt, Erik; Oehlenschläger, Jacob
and matched 1:2 with patients subjected to CLC using pre-defined criteria. Follow-up data were obtained from the Danish National Patient Registry, mailed patient questionnaires, and clinical examination. A port-site hernia was defined as a repair for a port-site hernia or clinical hernia located at one......BACKGROUND: Conventional laparoscopic cholecystectomy (CLC) is regarded as the gold standard for cholecystectomy. However, single-incision laparoscopic cholecystectomy (SLC) has been suggested to replace CLC. This study aimed at comparing long-term incidences of port-site hernia and chronic pain...... after SLC versus CLC. METHODS: We conducted a matched cohort study based on prospective data (Jan 1, 2009-June 1, 2011) from the Danish Cholecystectomy Database with perioperative information and clinical follow-up. Consecutive patients undergoing elective SLC during the study period were included...
Beleña, José M; Núñez, Mónica; Anta, Diego; Carnero, Maria; Gracia, José L; Ayala, José L; Alvarez, Raquel; Yuste, Javier
A comparison of the efficacy and safety of the Laryngeal Mask Airway (LMA) Supreme (LMAS) versus the LMA Proseal (LMAP) in elective laparoscopic cholecystectomy. To compare the LMAS with LMAP in terms of ventilatory efficacy, airway leak pressure (airway protection), ease-of-use and complications. Prospective, single-blind, randomised, controlled study. The Hospital del Sureste and Hospital Ramon y Cajal, Madrid, between May 2009 and March 2011. The Hospital del Sureste is a secondary hospital and Hospital Ramon y Cajal is a tertiary hospital. Patients undergoing elective laparoscopic cholecystectomy were studied following informed consent. Inclusion criteria were American Society of Anesthesiologists physical status I to III and age 18 or more. Exclusion criteria were BMI more than 40 kg m, symptomatic hiatus hernia or severe gastro-oesophageal reflux. Anaesthesiologists experienced in the use of LMAP and LMAS participated in the trial. One hundred twenty-two patients were randomly allocated to LMAS or LMAP. Our primary outcome measure was the oropharyngeal leak pressure (OLP). Secondary outcomes were the time and number of attempts for insertion, ease of insertion of the drain tube, adequacy of ventilation and the incidence of complication. Patients were interviewed postoperatively to evaluate the presence of sore throat, dysphagia or dysphonia. Two patients were excluded when surgery changed from laparoscopic to open. A total of 120 patients were finally included in the analysis. The mean OLP in the LMAP group was significantly higher than that in the LMAS group (30.7 ± 6.2 versus 26.8 ± 4.1 cmH2O;P drain tube, complications and postoperative pharyngolaryngeal adverse events were similar in both groups. The LMAP has a higher OLP and achieves a higher maximum tidal volume compared to the LMAS, in patients undergoing elective laparoscopic cholecystectomy. The success of the first attempt insertion was higher for the LMAS.
Siewert, J R; Ungeheuer, A; Feussner, H
Laparoscopic cholecystectomy is both resulting in a slightly higher incidence of biliary lesions and a change of prevalence of the type of lesions. Damage to the biliary system occurs in 4 different types: The most severe case is the lesion with a structural defect of the hepatic or common bile duct with (IVa) or without (IVb) vascular injury. Tangential lesions without structural loss of the duct should be denominated as type III (IIIa with additional lesion to the vessels, type IIIb without). Type II comprehends late strictures without obvious intraoperative trauma to the duct. Type I includes immediate biliary fistulae of usually good prognosis. The increasing prevalence of structural defects of the bile ducts appears to be a peculiarity of laparoscopic cholecystectomy necessitating highly demanding operative repair. In the majority of cases, hepatico-jejunostomy or even intraparenchymatous anastomoses are required. Adaptation of well proven principles of open surgery is the best prevention of biliary lesions in laparoscopic cholecystectomy as well as the readiness to convert early to the open procedure.
Khan, Iftikhar A.; El-Tinay, Omer E.
To determine if preoperative clinical, laboratory and radiology data can predict conversion of laparascopic cholecystectomy for acute cholecystitis to open procedure. Retrospective analysis of 44 laparascopic cholecystectomies were performed for acute cholecystitisbetween August 2000 and July 2002 at King Khalid University Hospital, Riyadh, kingdom of Saudi Arabia. Data related to age and sex of patients, maximum body temprature,white blood cell count, gallbladder wall thickness or ultrasonography and timing of surgery from onset of symptoms were collected.The procedure was converted from laparascopic to open cholecystectomy in 10 patients (23%). Conversion rate was significantly high (33% versus zero; p=0.01) if the gallbladder wall was thickened. Conversion rate was significantly low ( Zero versus 32%: p=0.01) if the procedure was performed within 48 hours from the onset of the symptoms. The data relawted to age, sex, white blood cell count and body temprature did not reliably predict conversion of laparascopic cholecystectomy (LD) for acute cholecystitis to open procedure. There was no mortality or major morbidity. Laparascopic cholecystectomy is a safe modality of treatment for acute cholecystitis. Factors associated with increased conversion rate are thickened gallbladder wall on ultrasonographyand delay in surgery for more than 48 hours from the onset of symptoms. (author)
Sindhu, M. A.; Haq, I.; Rehman, S.
Objectives: To evaluate the results of 160 consecutive laparoscopic cholecystectomy using sectorisation based port site selection to improve ergonomics for surgeons. Design: Descriptive study. Place and Duration of study: PNS Shifa Karachi, Pakistan from Feb 2011 to Feb 2012. Patients and Methods: In this prospective study, 160 consecutive patients had undergone laparoscopic cholecystectomy in a tertiary care hospital using sectorisation for trocar placement. All patients with symptomatic gallstones, acute calculous cholecystitis and empyema gallbladder were included. Patients with choledocholithiasis were excluded from the study. The collected data included age, sex, diagnosis, history of previous surgery, conversion to open surgery and its reasons, operative time, post-operative hospital stay, complications and laparoscopy related complications to the surgeon such as shoulder pain, wrist stress and pain, finger joint pain and stress exhaustion. Result: One hundred and sixty patients underwent laparoscopic cholecystectomy with mean age 45 +- 12.9 years. Female to male ratio was 7.8:1. A total of 110 patients had chronic cholecystitis / biliary colic, 34 patients were with acute cholecystitis and 16 patients had diagnosis of empyema gallbladder. The mean operative time was 35.3+-14.6 min. Conversion rate to open surgery was 1.2%. Complications included bleeding from cystic artery (n=1) and injury to common hepatic duct (CHD) (n=1). One patient developed port site hernia post operatively. There was no incidence of laparoscopy related complications in surgeon such as pain shoulder, strains on the wrist joint, stress exhaustion and hand-finger joint pain. Conclusion: Sectorisation technique can be used in laparoscopic cholecystectomy in order to avoid the physical constraints of laparoscopic shoulder, hand finger joint pain, tenosynovitis, stress exhaustion, and hand muscle injury without increasing any morbidity to the patients. (author)
Full Text Available Irene Sellbrant,1 Gustaf Ledin,2 Jan G Jakobsson2 1Department of Anaesthesia, Capio Lundby, Gothenburg, 2Department of Anaesthesia and Intensive Care, Institution for Clinical Science, Karolinska Institutet, Danderyds Hospital, Stockholm, Sweden Abstract: Laparoscopic cholecystectomy is one of the most common general surgical procedures. The aim of the present paper is to review current evidence and well-established practice for elective laparoscopic perioperative management. There is no firm evidence for best anesthetic technique, further high quality studies assessing short as well as more protracted outcomes are needed. Preventive multi-modal analgesia, combining non-opioid analgesics, paracetamol, nonsteroidal anti-inflammatory drugs or coxib, and local anesthesia, has a long history. Local anesthesia improves postoperative pain and facilitates discharge on the day of surgery. Whether transversus abdominis plane-block has clinically important advantages compared to local infiltration analgesia needs further studies. Single intravenous dose steroid, dexamethasone, reduces postoperative nausea and vomiting, pain, and enhances the recovery process. Multi-modal analgesia is reassuringly safe thus having a positive benefit versus risk profile. Adherence to modern guidelines avoiding prolonged fasting and liberal intravenous fluid regime supports rapid recovery. The effects of CO2 insufflation must be acknowledged and low intra-abdominal pressure should be sought in order to reduce negative cardiovascular/respiratory effects. There is no firm evidence supporting heating and humidification of the insufflated gas. The potential risk for CO2/gas entrainment into vasaculture, gas emboli, or subcutaneous/intra-thoracic into the pleural space must be kept in mind. Laparoscopic cholecystectomy in ASA 1-2 patients following a multi-modal enhanced recovery protocol promotes high success rate for discharge on the day of surgery. Keywords: laparoscopic
Prabin Bikram Thapa
Full Text Available Introduction: Safe dissection of Calot’s Triangle is important during the performance of laparascopic cholucystectomy. The purpose of the study is to determine the frequency of demonstrable Rouviere’s sulcus in patients with symptomatic gall stones and its role in safe dissection in Calot’s triangle. Methods: This is a prospective descriptive study design done in Department of surgery, Kathmandu Medical College Teaching Hospital from Jan 2013 to Jan 2015. Patients who were posted for laparoscopic cholecystectomy were included. During laparoscopy, Rouviere’s sulcus was noted in the operative note and classified according to following: Type I: Open type was defined as a cleft in which the right hepatic pedicle was visualized and the sulcus was opened throughout its length. Type II: if the sulcus was open only at its lateral end. Type III If the sulcus was open only at its medial end. Type IV: Fused type was defined as one in which the pedicle was not visualized. Results: A total of 200 patients underwent laparoscopic cholecystectomy during period of 2 years. Out of which Rouviere’s sulcus was visualized in 150 patients (75 %.Type I (open type was commoner in 54%, type II in 12%, Type III in 9% and type IV (fused type in 25%. Conclusions: Rouviere’s Sulcus is an important extra biliary land mark for safe dissection of Calot’s triangle during laparoscopic cholecystectomy. Keywords: Rouviere’s Sulcus, laparoscopic cholecystectomy, bile duct injury.
Vohra, Ravinder S; Spreadborough, Philip; Johnstone, Marianne; Marriott, Paul; Bhangu, Aneel; Alderson, Derek; Morton, Dion G; Griffiths, Ewen A
Cholecystectomy is one of the most common general surgical operations performed. Despite level one evidence supporting the role of cholecystectomy in the management of specific gallbladder diseases, practice varies between surgeons and hospitals. It is unknown whether these variations account for the differences in surgical outcomes seen in population-level retrospective data sets. This study aims to investigate surgical outcomes following acute, elective and delayed cholecystectomies in a multicentre, contemporary, prospective, population-based cohort. UK and Irish hospitals performing cholecystectomies will be recruited utilising trainee-led research collaboratives. Two months of consecutive, adult patient data will be included. The primary outcome measure of all-cause 30-day readmission rate will be used in this study. Thirty-day complication rates, bile leak rate, common bile duct injury, conversion to open surgery, duration of surgery and length of stay will be measured as secondary outcomes. Prospective data on over 8000 procedures is anticipated. Individual hospitals will be surveyed to determine local policies and service provision. Variations in outcomes will be investigated using regression modelling to adjust for confounders. Research ethics approval is not required for this study and has been confirmed by the online National Research Ethics Service (NRES) decision tool. This novel study will investigate how hospital-level surgical provision can affect patient outcomes, using a cross-sectional methodology. The results are essential to inform commissioning groups and implement changes within the National Health Service (NHS). Dissemination of the study protocol is primarily through the trainee-led research collaboratives and the Association of Upper Gastrointestinal Surgeons (AUGIS). Individual centres will have access to their own results and the collective results of the study will be published in peer-reviewed journals and presented at relevant
BACKGROUND: Elective open infrarenal Abdominal Aortic Aneurysm (AAA) repair is major surgery performed on high-risk patients. Routine ICU admission postoperatively is the current accepted standard of care. Few of these patients actually require a level of care that cannot be provided just as effectively in a surgical high dependency unit (HDU). Our aim was to determine, \\'can high risk patients that will require ICU admission postoperatively be reliably identified preoperatively?\\'. METHODS: A retrospective analysis of all elective open infrarenal AAA repairs in our institution over a 3-year period was performed. The Estimation of Physiological Ability and Surgical Stress (E-PASS) model was used as our risk stratification tool for predicting post-operative morbidity. Renal function was also considered as a predictor of outcome, independent of the E-PASS. RESULTS: 80% (n = 16) were admitted to ICU. Only 30% (n = 6) of the total study population necessitated intensive care. There were 9 complications in 7 patients in our study. The E-PASS comprehensive risk score (CRS)\\/Surgical stress score (SSS) were found to be significantly associated with the presence of a complication (p = 0.009)\\/(p = 0.032) respectively. Serum creatinine (p = 0.013) was similarly significantly associated with the presence of a complication. CONCLUSIONS: The E-PASS model possessing increasing external validity is an effective risk stratification tool in safely deciding the appropriate level of post-operative care for elective infrarenal AAA repairs.
Friis, C; Rothman, J P; Burcharth, J; Rosenberg, J
Endoscopic retrograde cholangiopancreatography followed by laparoscopic cholecystectomy is often used as definitive treatment for common bile duct stones. The aim of this study was to investigate the optimal time interval between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. PubMed and Embase were searched for studies comparing different time delays between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Observational studies and randomized controlled trials were included. Primary outcome was conversion rate from laparoscopic to open cholecystectomy and secondary outcomes were complications, mortality, operating time, and length of stay. A total of 14 studies with a total of 1930 patients were included. The pooled estimate revealed an increase from a 4.2% conversion rate when laparoscopic cholecystectomy was performed within 24 h of endoscopic retrograde cholangiopancreatography to 7.6% for 24-72 h delay to 12.3% when performed within 2 weeks, to 12.3% for 2-6 weeks, and to a 14% conversion rate when operation was delayed more than 6 weeks. According to this systematic review, it is preferable to perform cholecystectomy within 24 h of endoscopic retrograde cholangiopancreatography to reduce conversion rate. Early laparoscopic cholecystectomy does not increase mortality, perioperative complications, or length of stay and on the contrary it reduces the risk of reoccurrence and progression of disease in the delay between endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy.
Lau, James Y W; Leow, Chon-Kar; Fung, Terence M K; Suen, Bing-Yee; Yu, Ly-Mee; Lai, Paul B S; Lam, Yuk-Hoi; Ng, Enders K W; Lau, Wan Yee; Chung, Sydney S C; Sung, Joseph J Y
In patients with stones in their bile ducts and gallbladders, cholecystectomy is generally recommended after endoscopic sphincterotomy and clearance of bile duct stones. However, only approximately 10% of patients with gallbladders left in situ will return with further biliary complications. Expectant management is alternately advocated. In this study, we compared the treatment strategies of laparoscopic cholecystectomy and gallbladders left in situ. We randomized patients (>60 years of age) after endoscopic sphincterotomy and clearance of their bile duct stones to receive early laparoscopic cholecystectomy or expectant management. The primary outcome was further biliary complications. Other outcome measures included adverse events after cholecystectomy and late deaths from all causes. One hundred seventy-eight patients entered into the trial (89 in each group); 82 of 89 patients who were randomized to receive laparoscopic cholecystectomy underwent the procedure. Conversion to open surgery was needed in 16 of 82 patients (20%). Postoperative complications occurred in 8 patients (9%). Analysis was by intention to treat. With a median follow-up of approximately 5 years, 6 patients (7%) in the cholecystectomy group returned with further biliary events (cholangitis, n = 5; biliary pain, n = 1). Among those with gallbladders in situ, 21 (24%) returned with further biliary events (cholangitis, n = 13; acute cholecystitis, n = 5; biliary pain, n = 2; and jaundice, n = 1; log rank, P = .001). Late deaths were similar between groups (cholecystectomy, n = 19; gallbladder in situ, n = 11; P = .12). In the Chinese, cholecystectomy after endoscopic treatment of bile duct stones reduces recurrent biliary events and should be recommended.
Karam, K.; Khan, B.I.
Pain after laparoscopic cholecystectomy is mild to moderate in intensity. Several modalities are employed for achieving safe and effective postoperative analgesia, the benefits of which adds to the early recovery of the patients. As a part of multimodal analgesia, various approaches of Transversus abdominis plane (TAP) block has been used for management of parietal and incisional components of pain after laparoscopic cholecystectomy. This study was designed to compare the analgesic efficacy of two different approaches of ultrasound guided TAP block, i.e., Subcostal-TAP block technique with ultrasound guided Posterior-TAP block for post-operative pain management in patients undergoing laparoscopic cholecystectomy under general anaesthesia. Methods: In this double blinded randomized controlled study, consecutive nonprobability sampling was done and a total of 126 patients admitted for elective laparoscopic cholecystectomy fulfilling the inclusion criteria were selected. After induction of general anaesthesia, patients were randomized through draw method and received either ultrasound guided posterior TAP block with 0.375% bupivacaine (20ml volume) on each side of the abdomen or subcostal TAP block bilaterally with the same. Up to 24 hours postoperatively, static and dynamic numeric rating pain scores were assessed. Results: We found statistically significant difference in mean static pain scores over 24 hours postoperatively in subcostal TAP group, suggesting improved analgesia. However, mean dynamic postoperative pain scores were comparable between the two groups. Whereas, patients in both groups were satisfied with pain management. Conclusions: Ultrasound guided subcostal TAP block provides better postoperative analgesia as compared to the Posterior TAP block in laparoscopic cholecystectomy. Otherwise both of the approaches improve patient outcomes towards early recovery and discharge from hospital. (author)
Coelho, Júlio Cezar Uili; Contieri, Fabiana L C; de Freitas, Alexandre Coutinho Teixeira; da Silva, Fernanda Cristina; Kozak, Vanessa Nascimento; da Silva Junior, Alzemir Santos
This study reviews our experience with laparoscopic cholecystectomy in the treatment of cholelithiasis in transplant patients. Demographic data, medications used, and operative and postoperative data of all transplant recipients who were subjected to laparoscopic cholecystectomy for cholelithiasis at our hospital were obtained. A total of 15 transplant patients (13 renal transplantation and 2 bone marrow transplantation) underwent laparoscopic cholecystectomy. All patients were admitted to the hospital on the day of the operation. The immunosuppressive regimen was not modified during hospitalization. Clinical presentation of cholelithiasis was biliary colicky (n=12), acute cholecystitis (n=2), and jaundice (n=1). The operation was uneventful in all patients. Postoperative complications were nausea and vomiting in 2 patients, prolonged tracheal intubation in 1, wound infection in 1 and large superficial hematoma in 1 patient. Laparoscopic cholecystectomy is associated to a low morbidity and mortality and good postoperative outcome in transplant patients with uncomplicated cholecystitis.
Full Text Available Background/Aim. Abdominal aorta aneurysm (AAA represents a pathological enlargment of infrarenal portion of aorta for over 50% of its lumen. The only treatment of AAA is a surgical reconstruction of the affected segment. Until the late XX century, surgical reconstruction implied explicit, open repair (OR of AAA, which was accompanied by a significant morbidity and mortality of the treated patients. Development of endovascular repair of (EVAR AAA, especially in the last decade, offered another possibility of surgical reconstruction of AAA. The preliminary results of world studies show that complications of such a procedure, as well as morbidity and mortality of patients, are significantly lower than with OR of AAA. The aim of this paper was to present results of comparative clinical prospective study of early inflammatory response after reconstruction of AAA between endovascular and open, conventional surgical technique. Methods. A comparative clinical prospective study included 39 patients, electively operated on for AAA within the period of December 2008 - February 2010, divided into two groups. The group I counted 21 (54% of the patients, 58-87 years old (mean 74.3 years, who had been submited to EVAR by the use of excluder stent graft. The group II consisted of 18 (46% of the patients, 49-82 (mean 66.8 years, operated on using OR technique. All of the treated patients in both groups had AAA larager than 50 mm. The study did not include patients who have been treated as urgent cases, due to the rupture or with simptomatic AAA. Clinical, biochemical and inflamatory parameters in early postoperative period were analyzed, in direct postoperative course (number of leucocytes, thrombocytes, serum circulating levels of cytokine - interleukine (IL-2, IL-4, IL-6 and IL-10. Parameters were monitored on the zero, first, second, third and seventh postoperative days. The study was approved by the Ethics Commitee of the Military Medical Academy. Results
Ivan J Pokorny
Full Text Available Initial 100 consecutive laparoscopic cholecystectomies performed by one surgeon were studied prospectively. The standard technique was modified in that the gallbladder removal was accomplished through the upper epigastric incision; there was no need to change the location of the camera. The conversion rate to open cholecystectomy was 2%. There were no major complications and no mortality. Minor complications occurred in 9% of the patients. Laparoscopic cholecystectomy can be performed safely in a community hospital setting. Simplified technique of gallbladder extraction is recommended.
Hernandez, Jonathan; Ross, Sharona; Morton, Connor; McFarlin, Kellie; Dahal, Sujat; Golkar, Farhaad; Albrink, Michael; Rosemurgy, Alexander
The applications of laparoendoscopic single-site (LESS) surgery, including cholecystectomy, are occurring quickly, although little is generally known about issues associated with the learning curve of this new technique including operative time, conversion rates, and safety. We prospectively followed all patients undergoing LESS cholecystectomy, and compared operations undertaken at our institutions in cohorts of 25 patients with respect to operative times, conversion rates, and complications. One-hundred fifty patients of mean age 46 years underwent LESS cholecystectomy. No significant differences in operative times were demonstrable between any of the 25-patient cohorts operated on at our institution. A significant reduction in operative times (p < 0.001) after completion of 75 LESS procedures was, however, identified with the experience of a single surgeon. No significant reduction in the number of procedures requiring an additional trocar(s) or conversion to open operations was observed after completion of 25 LESS cholecystectomies. Complication rates were low, and not significantly different between any 25-patient cohorts. For surgeons proficient with multi-incision laparoscopic cholecystectomy, the learning curve for LESS cholecystectomy begins near proficiency. Operative complications and conversions were infrequent and unchanged across successive 25-patient cohorts, and were similar to those reported for multi-incision laparoscopic cholecystectomy after the learning curve. Copyright © 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Islim, F.; Ors, S.; Salik, A.; Guven, K.; Yanar, F.; Alis, H.
Full text: Introduction: The risk of bile duct injury after laparoscopic cholecystectomy is higher than open cholecystectomy. Objective: To discuss the importance of minimally invasive treatment options in the management of bile duct injuries after laparoscopic cholecystectomy and to present our approach in the management. Materials and methods: Management of 25 patients with symptomatic bile duct injury after laparoscopic cholecystectomy was retrospectively evaluated. Percutaneous collection drainage, endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic cholangiography (PTC) and percutaneous biliary drainage were performed for the management of the patients. Results: Mean age of the patients (15 women, 10 men) was 55. Either ultrasonography or computed tomography guided percutaneous drainage was performed in 13 patients. 9 of them completely recovered only with percutaneous drainage. In 4 of them ERCP was performed because of high drainage volume. In 9 of the patients with jaundice and high bilirubin levels ERCP was performed as the first option. And 3 patients were reoperated because of acute abdomen signs. ERCP, MRCP and PTC revealed type A in 7, type E2 in 3, type E3 in 3 and type E4 in 1 of the patients according to Strasberg classification. Conclusion: Presenting symptoms of the patients with symptomatic bile duct injury are useful in the determination of the treatment option.
Jensen, K; Kehlet, H; Lund, Claus
functions. We investigated the feasibility and efficacy of a standardized, evidence-based anaesthesia/analgesic regime to identify residual problems in the early post-operative phase. METHODS: One hundred and thirty-four consecutive patients admitted for elective laparoscopic cholecystectomy at Hvidovre...
Ali, A.; Saeed, S.; Khawaja, R.; Samnani, S.S
Laparoscopic cholecystectomy is considered to be gold standard treatment for symptomatic gall stones. Despite several benefits there are still disadvantages of laparoscopic cholecystectomy in difficult cases where anatomy is disturbed even in experienced hand. Aim of this study is to identify advantages of early conversion to open cholecystectomy in difficult cases and how it should not be associated with surgeon's failure. Methods: Observational study was conducted at tertiary care hospital of Karachi, Pakistan from January 2012 till June 2015. All patients who presented to general surgery department with symptomatic gall stones and planned for laparoscopic cholecystectomy was included in the study. Demographic data was collected. Preoperative workup includes baselines investigations with liver profile test and imaging study (ultrasound scan). All patient underwent laparoscopic cholecystectomy at first. Operative difficulties, incidence of conversion, reason for conversion and complication intra-operative or postoperative were recorded. Data was analyzed using SPSS 20. Results: Out of 1026 patients, 78.26 percent (803) were female. Mean age of patients were 41.30+-8.43 years (range 26-68 years). Common presenting symptoms were pain at upper abdomen and dyspepsia. Most of the patients had multiple gall stones (93.85 percent). Nine hundred and ninety-two patients (96.68 percent) of patients underwent successful laparoscopic cholecystectomy. This includes patients in whom dissections were difficult because of disturbed anatomy of calots triangle. Only 3.13 percent of patients were converted to open cholecystectomy. There was a significant difference (<0.05) in complications observed between completed and converted cholecystectomies. Conclusion: Conversion from laparoscopic to open procedure should be done in cases of technically difficult situations to avoid significant mortality and morbidity. Surgeons experience had a pivotal role in determining its need and
Full Text Available Aim: To evaluate the role of laparoscopic cholecystectomy (LC in the management of cholelithiasis in children. Methods: A retrospective review of our experience with LC for cholelithiasis at our institution, between April 2006 and November 2008, was done. Data included patient demographics, clinical history, hematological investigations, imaging studies, operative technique, postoperative complications, postoperative recovery, and final histopathological diagnosis. Results: During the study period of 32 months, 18 children (8 males and 10 females with cholelithiasis were treated by LC. The mean age was 9.4 years (range 3-18. Seventeen children had symptoms of biliary tract disease and 1 child had incidentally detected cholelithiasis during an ultrasonography of abdomen for unrelated cause. Only 5 (27.8% children had definitive etiological risk factors for cholelithiasis and the remaining 13 (75.2% cases were idiopathic. Sixteen cases had pigmented gallstones and 2 had cholesterol gallstones. All the 18 patients underwent LC, 17 elective, and 1 emergency LC. The mean operative duration was 74.2 min (range 50-180. Postoperative complications occurred in 2 (11.1% patients. The average duration of hospital stay was 4.1 days (range 3-6. Conclusion: Laparoscopic chloecystectomy is a safe and efficacious treatment for pediatric cholelithiasis. The cause for increased incidence of pediatric gallstones and their natural history needs to be further evaluated.
Full Text Available Various strategies have been proposed for the management of retained calculi within the biliary tree following cholecystectomy. We present a unique case of a cystic duct remnant calculus causing Mirizzi syndrome, only the fourth such case of its kind. An open procedure was planned, however the calculus was eventually extracted endoscopically. The pathophysiology and management of Mirizzi syndrome and retained calculi within the cystic duct remnant are discussed along with the merits of a minimally invasive approach.
Kejriwal, Aditya Kumar; Begum, Shaheen; Krishan, Gopal; Agrawal, Richa
Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial. We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient. We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml?1 mixed with 0.5 ml of fentanyl 50 ?g ml?1. Other drugs we...
Staehr-Rye, Anne K; Rasmussen, Lars S.; Rosenberg, Jacob
: In this assessor-blinded study, 48 patients undergoing elective laparoscopic cholecystectomy were administered rocuronium for neuromuscular blockade and randomized to either deep neuromuscular blockade (rocuronium bolus plus infusion maintaining a posttetanic count 0-1) or moderate neuromuscular blockade...... (rocuronium repeat bolus only for inadequate surgical conditions with spontaneous recovery of neuromuscular function). Patients received anesthesia with propofol, remifentanil, and rocuronium. The primary outcome was the proportion of procedures with optimal surgical space conditions (assessed by the surgeon...
Pina, Aaron D
.... In 2002, the Palestinian Authority (PA), under increasing internal and external pressure, announced a so-called 100-Day Reform Plan for institutional reform and elections in order to rejuvenate PA leadership...
Donatsky, Anders M; Jørgensen, Lars N; Meisner, Søren
INTRODUCTION: Despite several benefits, patients are concerned that transvaginal cholecystectomy has a negative impact on sexual health. The objective of this systematic review was to assess the impact of transvaginal cholecystectomy on postoperative dyspareunia and sexual function. METHOD......: A literature search was performed in the PubMed and EMBASE databases. Papers reporting on postoperative dyspareunia, vaginal pain or discomfort, and sexual function were included. RESULTS: Seventeen papers reported on dyspareunia and vaginal pain or discomfort. Two papers reported a rate of de novo dyspareunia...... of 3.8% and 12.5%, respectively. One study reported a nonsignificant reduction in painful sexual intercourse and the remaining 14 reported no incidents of dyspareunia. Eight papers reported on sexual function. One paper using a nonvalidated questionnaire found impaired sexual function. The papers...
Verhoye, Jean-Philippe; Belhaj Soulami, Reda; Fouquet, Olivier; Ruggieri, Vito Giovanni; Kaladji, Adrien; Tomasi, Jacques; Sellin, Michel; Farhat, Fadi; Anselmi, Amedeo
Our goal was to evaluate the operative outcomes of the frozen elephant trunk technique using the E-Vita Open Plus® hybrid prosthesis in chronic aortic arch diseases and report clinical and radiological outcomes at the 1-year follow-up. As determined from a prospective multicentre registry, 94 patients underwent frozen elephant trunk procedures using the E-Vita Open Plus hybrid device for the treatment of chronic aortic conditions, including 50% chronic aortic dissections, 40% degenerative aneurysms and 10% miscellaneous indications. Fifty percent of the cases were reoperations. The perioperative mortality rate was 11.7%. Spinal cord ischaemia and stroke rates were 4% and 9.6%, respectively. The mean cardiopulmonary bypass time was 252 ± 97 min, cardiac ischaemia time was 152 ± 53 min and cerebral perfusion time was 82 ± 22 min. Concomitant procedures were observed in 15% of patients. Among the 83 surviving patients, the survival rate after the 1-year follow-up was 98%. Eleven percent of patients underwent endovascular completion, whereas 4% of patients required aortic reintervention at 1 year. The E-Vita Open Plus hybrid device confirms the favourable short- and mid-term outcomes offered by its predecessor in frozen elephant trunk procedures in patients with chronic aortic arch disease. Implantation of the E-Vita Open Plus is associated with good 1-year survival rates, good rates of favourable aortic remodelling in both chronic dissection and degenerative aneurysms and a reproducible technique in a multicentre registry. Continued follow-up is required due to the risk of evolution at the downstream aorta. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Song, Myung Eun; Chung, Moon Jae; Lee, Dong Jun; Oh, Tak Geun; Park, Jeong Youp; Bang, Seungmin; Park, Seung Woo; Song, Si Young; Chung, Jae Bock
Cholecystectomy in patients with an intact gallbladder after endoscopic removal of stones from the common bile duct (CBD) remains controversial. We conducted a case-control study to determine the risk of recurrent CBD stones and the benefit of cholecystectomy for prevention of recurrence after endoscopic removal of stones from the CBD in Korean patients. A total of 317 patients who underwent endoscopic CBD stone extraction between 2006 and 2012 were included. Possible risk factors for the recurrence of CBD stones including previous cholecystectomy history, bile duct diameter, stone size, number of stones, stone composition, and the presence of a periampullary diverticulum were analyzed. The mean duration of follow-up after CBD stone extraction was 25.4±22.0 months. A CBD diameter of 15 mm or larger [odds ratio (OR), 1.930; 95% confidence interval (CI), 1.098 to 3.391; p=0.022] and the presence of a periampullary diverticulum (OR, 1.859; 95% CI, 1.014 to 3.408; p=0.045) were independent predictive factors for CBD stone recurrence. Seventeen patients (26.6%) in the recurrence group underwent elective cholecystectomy soon after endoscopic extraction of CBD stones, compared to 88 (34.8%) in the non-recurrence group; the difference was not statistically significant (p=0.212). A CBD diameter of 15 mm or larger and the presence of a periampullary diverticulum were found to be potential predictive factors for recurrence after endoscopic extraction of CBD stones. Elective cholecystectomy after clearance of CBD stones did not reduce the incidence of recurrent CBD stones in Korean patients.
Casillas-Berumen, Sergio; Rojas-Miguez, Florencia A; Farber, Alik; Komshian, Sevan; Kalish, Jeffrey A; Rybin, Denis; Doros, Gheorghe; Siracuse, Jeffrey J
Open aortic aneurysm repair (AAA) repair can be resource intensive and associated with a prolonged length of stay (LOS). We sought to examine patient and aneurysm predictors of prolonged LOS to better identify those at risk in the preoperative setting. Patient data were obtained from the targeted AAA American College of Surgery National Surgical Quality Improvement Program database from 2012 to 2014 of patients undergoing open AAA repair. Multivariable logistic regression was used to determine predictors of prolonged postoperative LOS defined as greater than 10 days (75th percentile). There were 1172 open AAA repairs identified. The majority (54%) of patients were older than 70 years and male (74%). Surgical approach was transperitoneal (70.9%) and retroperitoneal (29.1%). Aneurysms were 51.4% infrarenal, 33% juxtarenal, 5.7% pararenal, 7.4% suprarenal, and 2.5% type IV thoracoabdominal. Mean and median LOS were 9.1 ± 7.4 and 7 (0-72) days, respectively. Independently associated with extended LOS factors were visceral revascularization (odds ratio [OR]: 5.32, 95% confidence interval [CI]: 2.77-10.22, P AAA repair. Prospective identification of high-risk patients may allow physicians and hospitals to engage in multidisciplinary collaborations preoperatively to try to improve LOS in this resource-intensive population.
Full Text Available Introduction: Postoperative pain as an important medical concern is usually treated by opioids which also are of various inevitable side effects. The aim of this study was to assess the efficacy of multimodal preincisional premedication on preventing post-cholecystectomy acute pain. Methods: In a randomized clinical trial, sixty patients undergoing open cholecystectomy were randomized into two groups. Before anesthesia induction, Diclofenac suppository (100 mg and oral Clonidine (0.2 mg were administered in the first group. Immediately before operation, patients received Ketamine (1 mg/kg IV while the control group received placebo. The site of incision was infiltrated by the surgeon with 20 mL Bupivacaine 0.25% in both groups. Anesthesia induction and maintenance were similar in both groups. The severity of pain was recorded 2, 4, 6, 12, 24 and 48 hours after operation according to Visual Analogue Scale. Results: The severity of pain at two defined stages (6 and 12 hours later was significantly less in the intervention group than the control group (P<0.005. The average pain severity score was less than the control group (P<0.005. Conclusion: In our study, the administration of Clonidine, Diclofenac and Ketamine and bupivacaine infiltration to the site of incision, altogether was associated with a significant decrease in pain score and opioid requirement after cholecystectomy in comparison to bupivacaine infiltration to the site of incision.
Salleh, A A M; Affirul, C A; Hairol, O; Zamri, Z; Azlanudin, A; Hilmi, M A; Razman, J
This present study sought to review the feasibility and patients' satisfaction of laparoscopic cholecystectomy to be perform as daycare procedure. Sixty-two patients with symptomatic gallstones were recruited within a year. They were randomized into overnight stay and daycare groups. The outcomes and post-operative complications were analyzed. Fifty-eight patients were eligible for analysis and four patients were excluded because of conversion to open cholecystectomy. All patients in daycare group reported no fever but two patients in the overnight stay group complaint of post-operative fever (p=0.150). The mean pain score using Visual Analogue Score (VAS) in daycare group was 2.93 but in the overnight stay was recorded as 3.59 (p=0.98). Five patients had post-operative nausea and vomiting (PONV) in daycare group compared to 2 patients in the overnight stay group (p=0.227). Patient's satisfaction were higher in the daycare group (p=0.160). All patients in daycare group were back at work within a week but in overnight stay, 11 patients had to stay off work for more than one week (p=0.01). Daycare laparoscopic cholecystectomy is safe and feasible. The satisfaction of daycare surgery is higher than overnight stay group. Patients' selection is an important aspect of its success.
Han, In Woong; Jang, Jin-Young; Kang, Mee Joo; Lee, Kyoung Bun; Lee, Seung Eun; Kim, Sun-Whe
Percutaneous transhepatic gallbladder drainage (PTGBD) is a procedure to resolve acute cholecystitis (AC). It may decrease the technical difficulty of laparoscopic cholecystectomy (LC) and thus may facilitate successful surgery when a patients' condition improves. However, the timing of LC after PTGBD remains controversial. From 2004 to 2010, cholecystectomy after PTGBD was performed in 67 patients with AC. Group I members underwent LC within 72 h of PTGBD (n = 21), whereas group II members underwent LC at more than 72 h after PTGBD (n = 46). The open conversion rate was similar in the two groups. The perioperative complication rate was higher in group I than in group II, but with marginal significance (19.0 vs. 4.3%; p = 0.07). Mean operative time was longer in group I than in group II (79.3 ± 25.3 vs. 53.7 ± 45.3 min; p = 0.02). However, overall hospital stay was shorter in group I than in group II, but with marginal significance (10.8 ± 4.5 vs. 14.7 ± 9.3 days; p = 0.08). Pros and cons were well balanced between the two groups. Decisions on the timing of cholecystectomy after PTGBD should be made based on considerations of patient condition, hospital facilities, and surgical experience.
Full Text Available BACKGROUND: We report the results of our experience on laparoscopic cholecystectomy in sickle cell disease patients in Niger, which is included in the sickle cell belt. METHODS: A prospective study covering a period of 45 months, from July 2004 to March 2008. We included all sickle cell disease patients that underwent laparoscopic cholecystectomy. Blood transfusion was done for patients with haemoglobin (Hb levels less than 9g/dl. Homozygous and composite heterozygous patients were admitted in intensive care unit for 24 hours or plus post operatively. RESULTS:The series included 47 patients operated by the same surgeon, 31 females (66% and 16 males (34% (Ratio: 0.51. The average age was 22.4 years (range: 11 to 46 years and eleven (23.4% of them were aged less than 15 years. The types of sickle cell disease found were 37 SS, 2 SC, 1 S beta-thalassemia and 7 AS. Indications for surgery were biliary colic in 29 cases (61.7% and acute cholecystitis in 18 cases (38.3%. The mean operative time was 64 min (range: 42 to 103 min. Conversion to open cholecystectomy in 2 cases (4.2 % for non recognition of Calot‘s triangle structures. The postoperative complications were: four (4 cases of vaso-occlusive crisis and one case of acute chest syndrome. The mean postoperative hospital stay was 3,5days (range: 1 to 9 days. No mortality was encountered. CONCLUSION: Laparoscopic cholecystectomy is a safe procedure in sickle cell patients. It should be a multidisciplinary approach and involve a haematologist, an anaesthesiologist and a surgeon.
J. Bueno Lledó
Full Text Available Objective: to contribute our experience for five years in the implemetation of outpatient laparoscopic cholecystectomy (LC. Patients: between January 1999 and March 2004 we performed 504 outpatient LCs. We applied both exclusion and inclusion criteria, an anesthetic and surgical protocol, and discharge-specific criteria. Postoperative management in "fast track" regime. Postoperative period controlled by protocol, including phone calls after cholecystectomy. Results: the ambulatory percentage in the global series was 88.8%, and mean hospital stay was 6.1 hours. Fifty-one patients required overnight stays (10.1%, most of them for "social" causes. Five patients required admission (between 24 and 48 hours for different causes (conversion to laparotomy, intraoperative neumothorax, and postoperative medical complications. Six patients (1.1% were readmitted, and we observed 11.6% postoperative complications in the global series, with abdominal parietal pain being most frequent. Phone localization by 22.00 p.m. in the same day of surgery was 100% complete for outpatient cases. Postoperative surveillance within the first month after surgery was completed in 93.9%, and within th first year in 86.7% of patients. Conclusions: outpatient LC is safe and feasible, and probably represents a new "gold standard" in the treatment of symptomatic cholelithiasis.
Scott, N B; Mogensen, T; Bigler, D
Twenty patients undergoing elective cholecystectomy were prospectively randomised to receive either intrapleural (bolus 20 ml followed by 10 ml/h) or thoracic epidural (bolus 9 ml followed by 5 ml/h) bupivacaine 0.5% for 8 h postoperatively to assess the effect of these two techniques on pain...
Afzal, M.; Butt, M.Q.
To analyze the complications of first 400 laparoscopic cholecystectomies (LC) for patients with symptomatic gall stone disease at a tertiary care hospital. Study Design: Quasi-experimental study. Place and Duration of Study: PNS Shifa Karachi and CMH Lahore, Pakistan from Nov 2009 to Jan 2013. Patients and Methods: A prospective analysis of complications occurring in first 400 consecutive laparoscopic cholecystectomies by a single consultant/unit at a tertiary care hospital was made. Out of total 421 patients presenting with symptomatic gall stone disease in a single unit, 21 cases that underwent open cholecystectomy were excluded from the study. Laparoscopic cholecystectomies were performed using three port and four port technique and data including age, sex, diagnosis, number of trocar placements, conversion to open surgery and its reasons, operative time, post-operative hospital stay and complications was collected on personal computer and analyzed using Statistical package for social sciences (SPSS) version 13. Results: Total 400 patients were included in study with median age of 44 years. Female to male ratio was 5.3: 1. Depending upon the preoperative diagnosis and laparoscopic findings, patients had diagnosis of Chronic cholecystitis / biliary colic 68.25%, acute cholecystitis 23.75%, empyema gall bladder 7.25%, gallstone pancreatitis 0.5% and mucocele gallbladder 0.25%. Median operating time was 30min. Median hospital stay was 1 days (range 1 -20 days). Conversion rate was 1.25%. Postoperative complications included bleeding 0.5%, biliaryperitonitis due to cystic duct leak 0.25%, biloma 0.25%, sub hepaticabscess 0.25%, subcutaneous fat necrosis right flank at drain site 0.25%, umbilical trocarsite infection 2%, keloid at umbilical port site 0.25% and incisional hernia at umbilicus 0.25%. There was one hospital death due to myocardial infarction on 2nd post-operative day. Conclusion: Laparoscopic Cholecystectomy is associated with some serious complications
Wells, Katie M; Lee, Yu-Jin; Erdene, Sandag; Erdene, Sarnai; Sanchin, Urjin; Sergelen, Orgoi; Zhang, Chong; Rodriguez, Brandon P; deVries, Catherine R; Price, Raymond R
The benefits of laparoscopic cholecystectomy, including rapid recovery and fewer infections, have been largely unavailable to the majority of people in developing countries. Compared to other countries, Mongolia has an extremely high incidence of gallbladder disease. In 2005, only 2% of cholecystectomies were performed laparoscopically. This is a retrospective review of the transition from open to laparoscopic cholecystectomy throughout Mongolia. A cross-sectional, retrospective review was conducted of demographic patient data, diagnosis type, and operation performed (laparoscopic versus open cholecystectomy) from 2005-2013. Trends were analyzed from 6 of the 21 provinces (aimags) throughout Mongolia, and data were culled from 7 regional diagnostic referral and treatment centers and 2 tertiary academic medical centers. The data were analyzed by individual training center and by year before being compared between rural and urban centers. We analyzed and compared 14,522 cholecystectomies (n = 4,086 [28%] men, n = 10,436 [72%] women). Men and women were similar in age (men 52.2, standard deviation 14.8; women 49.4, standard deviation 15.7) and in the percentage undergoing laparoscopic cholecystectomy (men 39%, women 42%). By 2013, 58% of gallbladders were removed laparoscopically countrywide compared with only 2% in 2005. In 2011, laparoscopic cholecystectomy surpassed open cholecystectomy as the primary method for gallbladder removal countrywide. More than 315 Mongolian health care practitioners received laparoscopic training in 19 of the country's 21 aimags (states). By 2013, 58% of cholecystectomies countrywide were performed laparoscopically, a dramatic increase over 9 years. The expansion of laparoscopic cholecystectomy has transformed the care of biliary tract disease in Mongolia despite the country's limited resources. Copyright © 2016 Elsevier Inc. All rights reserved.
Khan, S.; Oonwala, Z.G.
To evaluate the outcome of Laparoscopic Cholecystectomy in Gall stone disease, critically analyzing the complication rate, morbidity and mortality rate. All patients (>12 years) with cholelithiasis were included in this study. Patients with common bile duct dilatation (>8mm) or stones, or gall bladder mass or jaundice, and those declared unfit for anaesthesia were excluded. The detailed data of all the cases was compiled and analyzed. Out of the total of 1345 patients operated during the study period, 1234 (91.75%) were females and 111 (8.25%) males; their ages ranged from 12 to 89 years, majority were in the age bracket of 30-50 years. Our conversion rate was 6.4%. Nine (0.67%) patients developed bleeding from the port site, 30 (2.23%) port site infection, 43 (3.20%) umbilical port hernia, two bile ducty injury and one colonic injury. There was no mortality in this series. Laparoscopic Cholecystectomy is a safe and effective treatment for Cholelithiasis. (author)
Electronic voting technology is a two edged sword. It comes with many risks but brings also many benefits. Instead of flat out rejecting the technology as uncontrollably dangerous, we advocate in this paper a different technological angle that renders electronic elections trustworthy beyond...... the usual levels of doubt. We exploit the trust that voters currently have into the democratic process and model our techniques around that observation accordingly. In particular, we propose a technique of trace emitting computations to record the individual steps of an electronic voting machine...... for a posteriori validation on an acceptably small trusted computing base. Our technology enables us to prove that an electronic elections preserves the voter’s intent, assuming that the voting machine and the trace verifier are independent....
The prostaglandin I(2) (PGI(2)) analogue iloprost, a potent vasodilator and inhibitor of platelet activation, has traditionally been utilized in pulmonary hypertension and off-label use for revascularization of chronic critical lower limb ischemia. This study was designed to assess the effect of 72 hr iloprost infusion on systemic ischemia post-open elective abdominal aortic aneurysm (EAAA) surgery. Between January 2000 and 2007, 104 patients undergoing open EAAA were identified: 36 had juxtarenal, 15 had suprarenal, and 53 had infrarenal aneurysms, with a mean maximal diameter of 6.9 cm. The male-to-female ratio was 2.5:1, with a mean age of 71.9 years. No statistically significant difference was seen between the study groups with regard to age, sex, risk factors, American Society of Anesthesiologists (ASA) grade, or diameter of aneurysm repaired. All emergency, urgent, and endovascular procedures for aneurysms were excluded. Fifty-seven patients received iloprost infusion for 72 hr in the immediate postoperative period compared with 47 patients who did not. Patients were monitored for signs of pulmonary, renal, cardiac, systemic ischemia, and postoperative intensive care unit (ICU) morbidity. Statistically significantly increased ventilation rates (p=0.0048), pulmonary complication rates (p=0.0019), and myocardial ischemia (p=0.0446) were noted in those patients not receiving iloprost. These patients also had significantly higher renal indices including estimate glomerular filtration rate changes (p=0.041) and postoperative urea level rises (p=0.0286). Peripheral limb trashing was noted in five patients (11.6%) in the non-iloprost group compared with no patients who received iloprost. Increased rates of transfusion requirements and bowel complications were noted in those who did not receive iloprost, with their ICU stay greater than twice that of iloprost patients. All-cause morbidity affected 67% of patients not receiving iloprost compared to 40% who did
Liu, Gui-Bao; Mao, Yuan-Yuan; Yang, Chang-Ping; Cao, Jin-Lin
The best method to ligate the arteries during laparoscopic cholecystectomy or appendectomy remains controversy. The aim of this study is to introduce a new approach during laparoscopic combined cholecystectomy and appendectomy using a monopolar electrocautery to seal the cystic and appendix arteries. We retrospectively reviewed data from 57 patients who underwent laparoscopic combined cholecystectomy and appendectomy between December 2006 and June 2016. Each laparoscopic combined cholecystectomy and appendectomy was performed by coagulating and sealing the cystic and appendix arteries. Absorbable clip or coils were then used to ligate the proximal of cystic duct and the stump of appendix. The other side of the cystic duct and appendix which subsequently were to be removed from abdomen were used titanium clips or silk ligature. Of the 57 patients, 3 patients (5.3%) were converted to open surgery due to severe abdominal adhesions or gallbladder perforation. The mean operative time was 56 minutes (range, 40-80 minutes). Mean blood loss was 12 mL (range, 5-120 mL), and the mean postoperative hospital stay was 3.0 days (range, 2-5 days). No postoperative bleeding, biliary leakage, infection, or mortality occurred. Monopolar electrocautery to seal the cystic and appendix arteries is a safe, effective, and economical surgical procedure during laparoscopic combined cholecystectomy and appendectomy. Further randomized controlled clinical trials are required to validate our findings.
Full Text Available United European Gastroenterology provide wide studies and researches on the economic impact of the digestive diseases across the countries that are members of the European Union, very useful in planning health services, in making the case for investment in research where there are clear gaps in knowledge, and in reflecting the economic differences across the EU member states in the funding available to support health services. These studies reflect that there are important disparities in the accessibility to high-quality healthcare even among the industrialized countries. Out of all the digestive diseases, the gallstone disease is one of the most common and expensive of the health problems, in industrialized countries, like those of the European Union are. In general, symptomatic or complicated gallstone disease is treated by cholecystectomy, with surgical removal of the gallbladder. The advent of laparoscopic cholecystectomy has revolutionized the management of the gallstone disease, causing an increase in the rate of cholecystectomies. This study represents an analysis of the hospitalization costs involved by two surgical treatment options: laparoscopic cholecystectomy and open cholecystectomy. The investigation of the costs was done according to the type of intervention chosen and comprised the direct costs of hospitalization, including diagnostic tests and general expenses of medical assistance, pharmaceutical and medical supplies. The results are based on the analysis of the costs of cholecystectomies in the surgical department of the Emergency County Hospital Oradea for the year 2014 (781 cases. The average cost per hospitalized patient was 1.970 RON, lower in patients with laparoscopic cholecystectomy (1.579 RON. The average cost per patient with open cholecystectomy was 55% higher than for laparoscopic surgery (2.442 RON. Even if the laparoscopic operation cost is higher because of the equipment it uses, the reduction of the number of
Siada, Sammy S; Schaetzel, Shaina S; Chen, Allen K; Hoang, Huy D; Wilder, Fatima G; Dirks, Rachel C; Kaups, Krista L; Davis, James W
Recent studies have suggested higher complication and conversion to open rates for nighttime laparoscopic cholecystectomy (LC) and recommend against the practice. We hypothesize that patients undergoing night LC for acute cholecystitis have decreased hospital length of stay and cost with no difference in complication and conversion rates. A retrospective review of patients with acute cholecystitis who underwent LC from October 2011 through June 2015 was performed. Complication rates, length of stay, and cost of hospitalization were compared between patients undergoing day cholecystectomy and night cholecystectomy. Complication rates and costs did not differ between the day and night groups. Length of stay was shorter in the night group (2.4 vs 2.8 days, p = 0.002). Performing LC for acute cholecystitis during night-time hours does not increase risk of complications and decreases length of stay. Copyright © 2017 Elsevier Inc. All rights reserved.
Mosquera P, Manuel S; Kadamani, A Akram; Gomez D, Oscar M and others
Since 1987 when this procedure began in France and them, became popular all over the world, it isn't any doubt that is the best choice for Cholecystectomy in patients with cholelytiasis. We began our experience in 1996 they have been operated 562 patients by this technique over 1839 cholecystectomy until April 2004, which corresponds to a 31%. We have suffered all the changes in the interpretation and application of law 100, which excludes the procedure from the State Obligatory Health insurance and many Promoting health Enterprises prohibit it's practice, essentially because they ignore the good results it has which are similar to open cholecystectomy. We registered our patients and procedures since the beginning of this experience for evaluation, also to compare it with the medical literacy about it and to verify by ourselves the benefits of minimal invasive surgery
Sammartino, P; De Cesare, A; Barillari, P; Bononi, M; Chirletti, P; Bovino, A; Atella, F; Cioè, I
From March 1992 to September 1994, 281 patients were submitted to laparoscopic cholecystectomy for cholelithiasis. 27 patients were admitted with diagnosis of acute cholecystitis and in 17 patients common duct stones were discovered and managed by ERCP before laparoscopic procedure. Surgical procedure was the standard one described by Cox. The mean duration of the operation was 60 minutes and was significantly related to the surgeon's experience; the incedence of conversion to open procedure was 5.7%. There was no postoperative mortality; the total morbility rate was 2.8%, with 3 major complications, and 5 minor complications.
Burns, Brigid R; Hofmeister, Erik H; Brainard, Benjamin M
To determine if dogs that undergo laparotomy for cholecystectomy suffer from a greater number or magnitude of perianesthetic complications, including hypotension, hypothermia, longer recovery time, and lower survival rate, than dogs that undergo laparotomy for hepatic surgery without cholecystectomy. Retrospective cohort study. One hundred and three dogs, anesthetised between January 2007 and October 2011. The variables collected from the medical record included age, weight, gender, surgical procedure, pre-operative bloodwork, American Society of Anesthesiologists (ASA) status, emergency status, total bilirubin concentration, anesthetic agents administered, body temperature nadir, final body temperature, hypotension, duration of hypotension, blood pressure nadir, intraoperative drugs, anesthesia duration, surgery duration, time to extubation, final diagnosis, days spent in the intensive care unit (ICU), total bill, survival to discharge, and survival to follow-up. No significant difference in body temperature nadir, final temperature, presence of hypotension, duration of hypotension, blood pressure nadir, the use of inotropes, or final outcome was found between dogs undergoing cholecystectomy and dogs undergoing exploratory laparotomy for other hepatic disease. Dogs that had cholecystectomy had longer anesthesia durations and longer surgery durations than dogs that did not have cholecystectomy. No significant differences existed for temperature nadir (34.8 versus 35.3°C; non-cholecystectomy versus cholecystectomy), final temperature (35.6 versus 35.9°C), time to extubation (30 versus 49 minutes), duration of hypotension (27 versus 21 minutes), or MAP nadir (56 versus 55 mmHg). Hypotension occurred in 66% and 74% and inotropes were used in 64% and 53%, for non-cholecystectomy and cholecystectomy patients, respectively. Dogs that underwent cholecystectomies did not suffer a greater number of anesthesia complications than did dogs undergoing hepatic surgery without
Horstmann, R; Kern, M; Joosten, U; Hohlbach, G
An ultrasound dissector especially developed for laparoscopic surgery was used during laparoscopic cholecystectomy on 34 patients. The ultrasound power, the volume of suction and irrigation could be determined individually at the generator and activated during the operation with a foot pedal. With the dissector it was possible to fragmentate, emulgate and aspirate simultaneously fat tissue as well as infected edematous structures. The cystic artery and cystic duct, small vessels, lymphatic and connective tissue were not damaged. Therefore this system seems to be excellent for the preparation of Calot's trigonum and blunt dissection of the gallbladder out of its bed, particularly in fatty, acute or chronic infected tissue. No complications were observed within the peri- and postoperative period.
Bigler, D; Dirkes, W; Hansen, R
Twenty patients undergoing elective cholecystectomy via a subcostal incision were randomized in a double-blind study to either thoracic paravertebral blockade with bupivacaine 0.5% (15 ml followed by 5 ml/h) or thoracic epidural blockade with bupivacaine 7 ml 0.5% + morphine 2 mg followed by 5 ml...... by forced vital capacity, forced expiratory volume and peak expiratory flow rate decreased about 50% postoperatively in both groups. In conclusion, the continuous paravertebral bupivacaine infusion used here was insufficient as the only analgesic after cholecystectomy. In contrast, epidural blockade...... with combined bupivacaine and low dose morphine produced total pain relief in six of ten patients....
Gurusamy, Kurinchi Selvan; Vaughan, Jessica; Davidson, Brian R
Generally, before being operated on, patients will be given informal information by the healthcare providers involved in the care of the patients (doctors, nurses, ward clerks, or healthcare assistants). This information can also be provided formally in different formats including written information, formal lectures, or audio-visual recorded information. To compare the benefits and harms of formal preoperative patient education for patients undergoing laparoscopic cholecystectomy. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2013), MEDLINE, EMBASE, and Science Citation Index Expanded to March 2013. We included only randomised clinical trials irrespective of language and publication status. Two review authors independently extracted the data. We planned to calculate the risk ratio with 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) or standardised mean difference (SMD) with 95% CI for continuous outcomes based on intention-to-treat analyses when data were available. A total of 431 participants undergoing elective laparoscopic cholecystectomy were randomised to formal patient education (215 participants) versus standard care (216 participants) in four trials. The patient education included verbal education, multimedia DVD programme, computer-based multimedia programme, and Power Point presentation in the four trials. All the trials were of high risk of bias. One trial including 212 patients reported mortality. There was no mortality in either group in this trial. None of the trials reported surgery-related morbidity, quality of life, proportion of patients discharged as day-procedure laparoscopic cholecystectomy, the length of hospital stay, return to work, or the number of unplanned visits to the doctor. There were insufficient details to calculate the mean difference and 95% CI for the difference in pain scores at 9 to 24 hours (1 trial; 93 patients); and we did not identify clear evidence of
Hun, T.S.; Burud, I.A.S.; Lin, L.S.; Roy, P.; Selwyn, D.; Tata, M.D.
Objectives: To identify pre-operative factors that predisposes to conversion of laparoscopic cholecystectomy. Methodology: Patients with symptomatic cholelithiasis from a tertiary hospital were selected for this cross-sectional study. The patient data was obtained from the hospital online database. Patients aged ?18 years with clinical diagnosis of symptomatic cholelithiasis who underwent laparoscopic cholecystectomy from January 2013 to December 2014 were included in the study. Those who underwent planned open cholecystectomy, patients with gallbladder polyps, acalculous cholecystitis and history of previous laparotomy were excluded from the study. Data were analyzed using chi-square test, Fisher's exact test and logistic regression. Results: Two hundred patients fulfilled the inclusion criteria. Conversion to open cholecystectomy was seen in 28 patients (14%). Patients with acute cholecystitis were 3.4 times more likely and males were 2.5 times more likely to undergo conversion. The likelihood of conversion increased by 0.9 times for each year of increase in age. Patients with diabetes mellitus were 3.8 times more likely to undergo conversion. Hypertension was also a significant factor contributing to a conversion. After a logistic regression analysis, only three factors remained statistically independently significant: diabetes mellitus (95% CI: 0.1 to 0.6), acute cholecystitis (95% CI: 0.1 to 0.7) and male gender (95%CI: 0.7 to 0.9). Conclusions: Decision to convert laparoscopic cholecystectomy to open should be taken earlier in a male patient with diabetes mellitus, acute cholecystitis and advancing age. (author)
M. G. Clarke
Full Text Available Background. Day-case laparoscopic cholecystectomy (LC is a safe and cost-effective treatment for gallstones. In 2006, our institution recorded an 86% laparoscopic, 10% day-case, and 5% readmission rate. A gallbladder pathway was therefore introduced in 2007 with the aim of increasing daycase rates. Methods. Patients with symptomatic gallstones, proven on ultrasound, were referred to a specialist-led clinic. Those suitable for surgery were consented, preassessed, and provided with a choice of dates. All defaulted to day case unless deemed unsuitable due to comorbidity or social factors. Results. The number of cholecystectomies increased from 464 in 2006 to 578 in 2008. Day-case rates in 2006, 2007, 2008, and June 2009 were 10%, 20%, 30%, and 61%, respectively. Laparoscopic and readmission rates remained unchanged. Conversion rates for elective cholecystectomy fell from 6% in 2006 to 3% in 2009. Conclusions. Development of a gallbladder pathway increased day-case rates sixfold without an associated increase in conversion or readmission rates.
Figueroa-Balderas, Lorena; Franco-López, Francisco; Flores-Álvarez, Efrén; López-Rodríguez, Jorge Luis; Vázquez-García, José Antonio; Barba-Valadez, Claudia Teresa
Laparoscopy cholecystectomy for the surgical treatment of cholelithiasis has been considered the gold standard. The referred pain to the shoulder (omalgia) may be present to 63% of the patients and limits outpatient management. The study was to evaluate the usefulness of acetazolamide associated with ketorolac for reduction of the omalgia to minimally invasive treatment. We performed a clinical trial, randomized, double blind in patients undergoing laparoscopic cholecystectomy to assess the reduction of post-operative omalgia comparing ketorolac and ketorolaco+acetazolamida. 31 patients in each group were studied. The study group: 250 mg of acetazolamide before anesthetic induction and 30 mg of ketorolac in the immediate postoperative period. one tablet of placebo prior to the anesthetic induction and 30 mg of ketorolac in the immediate postoperative. The presence of omalgia was assessed using the analog visual scale. The variables recorded included: age, sex, flow of carbon dioxide intra-abdominal pressure, surgical time, urgent or elective surgery, omalgia, severity of pain evaluated by analog visual scale, addition analgesia. Both groups were homogeneous and statistical analysis showed no differences in the variables studied. The omalgia in the study group was presented at 9.67% and in the group control was the 58.06% (p < 0.001). 250 mg oral acetazolamide associated 30 mg of ketorolac reduces significantly the development of omalgia in patients undergoing laparoscopic cholecystectomy.
Full Text Available Since its introduction at the end of the 20th century, laparoscopic cholecystectomy has evolved into a safe and convenient minimally invasive surgical method, which is now the gold standard therapy for cholelithiasis worldwide. Physicians have continued to improve upon the procedure, creating methods that further minimize the related scarring and pain, such as the laproendoscopic single-site cholecystectomy and the gasless-lift laparoscopy. Additionally, the primary challenge of limited operative space in these procedures remains a key feature requiring improvement. In this review, the development and progression of laparoscopic cholecystectomy over the past 26 years is discussed, highlighting the current advantages and disadvantages that need to be addressed by practicing physicians to maximize the clinical value of this important therapy.
Yousef, Gamal T; Lasheen, Ahmed E
Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation. This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction. A total of 90 patients undergoing elective laparoscopic cholecystectomy, between January 2010 and May 2011, were randomized into three equal groups to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under segmental thoracic (TSA group) or conventional lumbar (LSA group) spinal anesthesia or general anesthesia (GA group). To achieve a T3 sensory level we used (hyperbaric bupivacaine 15 mg, and fentanyl 25 mg at L2/L3) for LSAgroup, and (hyperbaric bupivacaine 7.5 mg, and fentanyl 25 mg at T10/T11) for TSAgroup. Propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation were used for GA group. Intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction were compared between the three groups. All procedures were completed laparoscopically by the allocated method of anesthesia with no anesthetic conversions. The time for the blockade to reach T3 level, intraoperative hypotensive and bradycardic events and vasopressor use were significantly lower in (TSA group) than in (LSA group). Postoperative pain scores as assessed throughout any time, postoperative right shoulder pain and hospital stay was lower for both (TSA group) and (LSA group) compared with (GA group). The higher degree of patients satisfaction scores were recorded in patients under segmental TSA. The present study not only confirmed that both segmental TSA and conventional
Wakizaka, Yoshitaka; Sano, Syuichi; Nakanishi, Yoshimi; Koike, Yoshinobu; Ozaki, Susumu; Iwanaga, Rikizo; Uchino, Junichi.
We studied the indications for laparoscopic cholecystectomy (LC) and values of preoperative imaging findings in 82 patients who underwent preoperative imaging diagnostic tests (abdominal echogram, abdominal CAT scan, ERCP). We analyzed mainly patients who were considered to be indicated for LC but whose gallbladders could be removed by open laparotomy, or whose gallbladders were removed by open laparotomy but were considered indicated for LC from retrospective study. We found the following results. LC could be easily performed in patients with a history of severe acute cholecystitis if they had no findings of a thickened wall or negative gallbladder signs. Abdominal echogram and CAT scan were the best preoperative imaging tests for determining the gallbladder's state, especially for obstruction of the cystic duct. These results are important today when the operative indications of LC are extremely indefinite because of the accumulation of operative experience and technological improvements. (author)
Ye, Jian; Yang, Chaoyu; Gan, Qi; Ma, Rong; Zhang, Zeshu; Chang, Shufang; Shao, Pengfei; Zhang, Shiwu; Liu, Chenhai; Xu, Ronald
In this paper we proposed a portable fluorescence microscopic imaging system to prevent iatrogenic biliary injuries from occurring during cholecystectomy due to misidentification of the cystic structures. The system consisted of a light source module, a CMOS camera, a Raspberry Pi computer and a 5 inch HDMI LCD. Specifically, the light source module was composed of 690 nm and 850 nm LEDs, allowing the CMOS camera to simultaneously acquire both fluorescence and background images. The system was controlled by Raspberry Pi using Python programming with the OpenCV library under Linux. We chose Indocyanine green(ICG) as a fluorescent contrast agent and then tested fluorescence intensities of the ICG aqueous solution at different concentration levels by our fluorescence microscopic system compared with the commercial Xenogen IVIS system. The spatial resolution of the proposed fluorescence microscopic imaging system was measured by a 1951 USAF resolution target and the dynamic response was evaluated quantitatively with an automatic displacement platform. Finally, we verified the technical feasibility of the proposed system in mouse models of bile duct, performing both correct and incorrect gallbladder resection. Our experiments showed that the proposed system can provide clear visualization of the confluence between the cystic duct and common bile duct or common hepatic duct, suggesting that this is a potential method for guiding cholecystectomy. The proposed portable system only cost a total of $300, potentially promoting its use in resource-limited settings.
Sumanta Kumar Ghosh
Full Text Available Double gallbladder is a rare embryological anomaly of clinical significance. Despite availability of modern imaging, only 50% of recently reported cases had preoperative diagnosis, which is desirable in every case to avoid serious operative complications. Double pathology in double gallbladder is extremely rare with only 3 reporting′s available till date to the best of author′s knowledge. With a preoperative diagnosis of double gallbladder, laparoscopic cholecystectomy can be safely and successfully performed with meticulous dissection, aided by operative cholangiogram. However in all such attempts a lower threshold should be kept for conversion to open surgery. Awareness about this anomaly amongst radiologists and surgeons is of crucial importance. Double gallbladder does not present with any specific symptom, neither it increases disease possibility in either lobe. Prophylactic cholecystectomy has no role in asymptomatic cases diagnosed accidentally. Author reports a case of a symptomatic young male with double gallbladder who presented with short history of dyspepsia, abdominal pain and fever. Definite preoperative diagnosis was reached with ultrasound scan and magnetic resonance cholangio pancreatography and subsequently dealt with laparoscopically. Calculous cholecystitis affected one lobe and acalculous empyema the other. While the 1st lobe drained though a cystic duct into common bile duct (CBD, the 2nd was without any communication with either CBD or its counterpart, thus remained as a blind vesicle.
Ghosh, Sumanta Kumar
Double gallbladder is a rare embryological anomaly of clinical significance. Despite availability of modern imaging, only 50% of recently reported cases had preoperative diagnosis, which is desirable in every case to avoid serious operative complications. Double pathology in double gallbladder is extremely rare with only 3 reporting's available till date to the best of author's knowledge. With a preoperative diagnosis of double gallbladder, laparoscopic cholecystectomy can be safely and successfully performed with meticulous dissection, aided by operative cholangiogram. However in all such attempts a lower threshold should be kept for conversion to open surgery. Awareness about this anomaly amongst radiologists and surgeons is of crucial importance. Double gallbladder does not present with any specific symptom, neither it increases disease possibility in either lobe. Prophylactic cholecystectomy has no role in asymptomatic cases diagnosed accidentally. Author reports a case of a symptomatic young male with double gallbladder who presented with short history of dyspepsia, abdominal pain and fever. Definite preoperative diagnosis was reached with ultrasound scan and magnetic resonance cholangio pancreatography and subsequently dealt with laparoscopically. Calculous cholecystitis affected one lobe and acalculous empyema the other. While the 1st lobe drained though a cystic duct into common bile duct (CBD), the 2nd was without any communication with either CBD or its counterpart, thus remained as a blind vesicle.
Slack, Daniel R; Grisby, Shaunda; Dike, Uzoamaka Kimberly; Kohli, Harjeet
Many risk factors have been identified in minimally invasive cholecystectomies that lead to higher complications and conversion rates. No study that we encountered looked at nonvisualization of the gallbladder (GB) during surgery as a risk factor. We hypothesized that nonvisualization was associated with an increased risk of complications and could be an early intraoperative identifier of a higher risk procedure. Recognizing this could allow surgeons to be aware of potential risks and to be more likely to convert to open for the safety of the patient. We looked at minimally invasive cholecystectomies performed at our institution from January 2015 through April 2016 and had the performing resident fill out a survey after the surgery. Outcomes were conversion rates, intraoperative complications, and blood loss and were analyzed via Pearson χ 2 test or Mann-Whitney U test. The primary outcome showed a conversion rate of 37% in nonvisualized GBs versus 0% in visualized ( P = .001). Secondary outcomes showed significant differences in GB perforations (74% vs 13%, P = .001), omental vessel bleeding (16% vs. 0%, P = .005), and EBL (46 mL vs 29 mL, P = .001). Intraoperative nonvisualization of the GB after adequate positioning caused significantly increased risk of intraoperative complications and conversion. This knowledge could be useful during intraoperative assessment, to decide whether a case should be continued as a minimally invasive procedure or converted early to help reduce risk to the patient. Further randomized controlled studies should be performed to further demonstrate the value of this assessment.
2013 Elections to Staff Council Vote! Make your voice heard and be many to elect the new Staff Council. More details on the elections can be found on the Staff Association web site (https://ap-vote.web.cern.ch/elections-2013). Timetable elections Monday 28 October to Monday 11 November, 12:00 am voting Monday 18 and Monday 25 November, publication of the results in Echo Tuesday 19 November, Staff Association Assizes Tuesday 3 December, first meeting of the new Staff Council and election of the new Executive Committee The voting procedure is monitored by the Election Committee.
Araki, Kenichiro; Shirabe, Ken; Watanabe, Akira; Kubo, Norio; Sasaki, Shigeru; Suzuki, Hideki; Asao, Takayuki; Kuwano, Hiroyuki
Although single-incision laparoscopic cholecystectomy is now widely performed in patients with cholecystitis, some cases require an additional port to complete the procedure. In this study, we focused on risk factor of additional port in this surgery. We performed single-incision cholecystectomy in 75 patients with acute cholecystitis or after cholecystitis between 2010 and 2014 at Gunma University Hospital. Surgical indications followed the TG13 guidelines. Our standard procedure for single-incision cholecystectomy routinely uses two needlescopic devices. We used logistic regression analysis to identify the risk factors associated with use of an additional full-size port (5 or 10 mm). Surgical outcome was acceptable without biliary injury. Nine patients (12.0%) required an additional port, and one patient (1.3%) required conversion to open cholecystectomy because of severe adhesions around the cystic duct and common bile duct. In multivariate analysis, high C-reactive protein (CRP) values (>7.0 mg/dl) during cholecystitis attacks were significantly correlated with the need for an additional port (P = 0.009), with a sensitivity of 55.6%, specificity of 98.5%, and accuracy of 93.3%. This study indicated that the severe inflammation indicated by high CRP values during cholecystitis attacks predicts the need for an additional port. J. Med. Invest. 64: 245-249, August, 2017.
Christopher Nonso Ekwunife
Full Text Available Background and Objective: Laparoscopic cholecystectomy has been the default operation for cholelithiasis at Federal Medical Centre, Owerri for the past 2 years and the outcomes have been good. The duration of post operative stay has been decreasing. We therefore initiated a preliminary 2-year prospective study in May 2010 to determine the feasibility of carrying out day case laparoscopic cholecystectomy in our hospital. Materials and Methods: Patients undergoing laparoscopic cholecystectomy were included in the study if they satisfied the following criteria: Age < 65 years, body mass index < 35 kg/m 2 , American Society of Anaesthesiology physical status class I and II, patient residence within 20 km radius of the hospital, patient acceptance of the procedure and absence of previous complicated upper abdominal surgery. Results: Twelve patients (10 females, 2 males were worked up with the intent of achieving same-day discharge of the patients. Five of the patients (41.7% were discharged on the day of operation. The reasons for overnight stay included inadequate pain control, insertion of drain and patient wishes. There was no conversion to open surgery, no major complications and no case of readmission to the hospital. Conclusions: Day case laparoscopic cholecystectomy in our environment could be safely promoted but will depend on improved facilities and patient enlightenment.
Kassem, Mohamed I; Hassouna, Ehab M
Cirrhotic patients have been known to be more affected with gallstones than their non-cirrhotic counterparts; since laparoscopy was introduced, it has been generally approved as the standard approach for cholecystectomies with the exception of end-stage cirrhosis. The purpose of this study was to evaluate the safety and efficacy of clipless laparoscopic cholecystectomy using the harmonic scalpel in complicated cholelithiasis in cirrhotic patients. This prospective study was conducted on 62 cirrhotic patients presenting to the Gastrointestinal Surgery Unit in Alexandria Main University Hospital with complicated gallstones between March 2013 and March 2016. Both intraoperative time and blood loss were calculated in addition to rates of conversion to open cholecystectomy, morbidity and mortality. Most of our cases were females with a ratio of 1.7:1, with a mean age of 45.21 years, ranging from 25 to 65 years. The most common cause of cirrhotic liver was hepatitis C in 45.1% of patients. Among the 62 patients included in the study, 56 patients (90.3%) were presenting with acute cholecystitis and six patients were operated at the onset of acute biliary pancreatitis. The mean operative time was 72.9 min with mean blood loss 45.45 mL. The study concluded safety of total clipless laparoscopic cholecystectomy using a harmonic scalpel in Child A and B type cirrhotic patients, who presented with complicated gallstones. © 2017 Royal Australasian College of Surgeons.
Influência da morfina peridural na função pulmonar de pacientes submetidos à colecistectomia aberta Influencia de la morfina peridural en la función pulmonar de pacientes sometidos a la colecistectomía abierta The influence of epidural morphine in the pulmonary function of patients undergoing open cholecystectomy
Gilson Cassem Ramos
medio del test t de Student conjugado. EL valor de p BACKGROUND AND OBJECTIVES: Upper abdominal surgeries may cause postoperative respiratory dysfunction. The objective of this study was to evaluate the pulmonary function after laparoscopic and open cholecystectomies, with and without epidural morphine. METHODS: In this randomized, double-blind clinical trial, 45 patients undergoing cholecystectomies were divided in three groups: GL, GA, and GAM, composed of 15 patients each. The GL group underwent laparoscopic surgery, while GA and GAM underwent open cholecystectomy, but the former received epidural morphine. Pre- and postoperative spirometry and arterial blood gases were performed. ANOVA was used to verify the hypothesis of equality of the means among the groups. When results were statistically significant, the Tukey test was performed. Paired test t Student was used to verify the hypothesis of equality within a group. A p < 0.05 was considered significant. RESULTS: The pre and immediately postoperative spirometry results were used to determine: a forced vital capacity (FVC in GL versus GA (p = 0.000 and GL versus GAM (p = 0.000; percentage of the reduction of FVC in GA versus GAM (p = 0.001; b within each group: in GL, FVC (p = 0.020 and forced expiratory volume in 1 second (FEV1 (p = 0.022; in GA, FVC (p < 0.001 and FEV1 (p < 0.001; and in GAM, FVC (p = 0.007 and FEV1 (p = 0.001. The arterial oxygen pressure (PaO2 was reduced in all three groups. CONCLUSIONS: One can conclude that respiratory dysfunction was less severe in patients operated by laparoscopy and that epidural morphine reversed, partially, the postoperative ventilatory disturbances of open cholecystectomy.
Kroh, Matthew; Chalikonda, Sricharan; Chand, Bipan; Walsh, R Matthew
Recent enthusiasm in the surgical community for less invasive surgical approaches has resulted in widespread application of single-incision techniques. This has been most commonly applied in laparoscopic cholecystectomy in general surgery. Cosmesis appears to be improved, but other advantages remain to be seen. Feasibility has been demonstrated, but there is little description in the current literature regarding complications. We report the case of a patient who previously underwent single-incision laparoscopic cholecystectomy for symptomatic gallstone disease. After a brief symptom-free interval, she developed acute pancreatitis. At evaluation, imaging results of ultrasonography and magnetic resonance cholangiopancreatography demonstrated a retained gallbladder with cholelithiasis. The patient was subsequently referred to our hospital, where she underwent further evaluation and surgical intervention. Our patient underwent 4-port laparoscopic remnant cholecystectomy with transcystic common bile duct exploration. Operative exploration demonstrated a large remnant gallbladder and a partially obstructed cystic duct with many stones. Transcystic exploration with balloon extraction resulted in duct clearance. The procedure took 75 minutes, with minimal blood loss. The patient's postoperative course was uneventful. Final pathology results demonstrated a remnant gallbladder with cholelithiasis and cholecystitis. This report is the first in the literature to describe successful laparoscopic remnant cholecystectomy and transcystic common bile duct exploration after previous single-port cholecystectomy. Although inadvertent partial cholecystectomy is not unique to this technique, single-port laparoscopic procedures may result in different and significant complications.
McGrath, D S
Two female patients with Cystic Fibrosis, attending the Adult Regional Cystic Fibrosis centre at the Cork University Hospital, were investigated for upper abdominal pain and found to have gallstones at ultrasonography. Laparoscopic cholecystectomy was performed successfully and, without complication, in both patients.
Hernandez, Jonathan M; Morton, Connor A; Ross, Sharona; Albrink, Michael; Rosemurgy, Alexander S
Laparoendoscopic single site (LESS) surgery promises improved cosmesis and possibly less pain. However, given the small series reported to date, true estimates of the advantages and possible disadvantages of LESS surgery remain unknown. This study was undertaken to evaluate the first 100 patients undergoing LESS cholecystectomy at our institution. Patients referred for cholecystectomy since November 2007 were considered for LESS cholecystectomy. Outcomes, including blood loss, operative time, complications, and length of stay, were recorded. Outcomes are compared with an uncontrolled concurrent group of patients undergoing multi-incision laparoscopic (i.e., conventional) cholecystectomy. One hundred patients with a median age of 44 years underwent LESS cholecystectomy; 30 patients with a median age of 46 years underwent conventional cholecystectomy over the same time period. Median operative time (70 vs 66 minutes, P = 0.67, Mann-Whitney) and hospital length of stay (1 vs 1 day, P = 0.81, Mann-Whitney) were not different for patients undergoing LESS or multi-incision cholecystectomies, respectively. Five patients undergoing LESS cholecystectomy had postoperative complications: cystic duct stump leak (one), pain control issues (three), and urinary retention (one). LESS cholecystectomy is a safe and effective alternative to conventional cholecystectomy. It can be undertaken without added operative time and provides patients with minimal, if any, scarring.
McCloy, R.; Randall, D.; Schug, S.A.
BACKGROUND: In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision ... using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision > or = 25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other.......00001]. CONCLUSIONS: The data included in this review suggest that reducing the size of trocar incision results in some limited improvements in surgical outcomes after LC. However, it carries a higher risk of conversion to conventional LC or open cholecystectomy Udgivelsesdato: 2008/12...
Full Text Available BACKGROUND: Dexmedetomidine a newer generation highly selective alpha - 2 adrenergic agonist are well known to inhibit catecholamine release. The present study compares the effects of intravenously administered dexmedetomidine to attenuate hemodynamic response to pneumoperitoneum to laparoscopic cholecystectomy under general anaesthesia. METHODOLOGY: 60 patients ASA Physical status I and II, aged between 18 and 50 years of either sex, scheduled for elective laparoscopic cholecy stectomy were randomized in to 2 groups ( group D and S inn a double blind fashion to receive either Dexmedetomidine ( 1microgram/kg in 100ml of 0.9% normal saline or only 0.9%plain normal saline respectively. It is given 30 min prior to induction. Patient vitals like HR, SBP, DBP, MAP were monitored during the study at various time intervals. RESULTS: Following intubation and pneumoperitoneum there significant rise in HR, MAP, SBP, DBP in group S but no significant rise in Group D. CONCLUSION: Dexmedetomid ine given in a dose of 1microgram/kg as a premedication is e ffective in attenuating the hemodynamic responses in laparoscopic surgery
Harboe, Kirstine Moll; Bardram, Linda
included 20,307 patients (82% of all cholecystectomies). The conversion rate was 7.6%. Male sex, acute cholecystitis, and previous upper abdominal surgery were risk factors for conversion, with respective odds ratios of 1.50, 4.61, and 3.54. The mean LOS was 1.5 days, and 37.3% of the patients had same.......27%. Age older than 60 years, American Society of Anesthesiology (ASA) score exceeding 1, and open procedure were significant risk factors for all the outcomes. Body mass index (BMI) was not a risk factor for any of the outcomes. Conclusion The quality of cholecystectomy is high in Denmark, with a low......Background Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstones. The quality of the procedure frequently is included in quality improvement programs, but outcome values have not been described to define the standard of care for a general population. This study included...
Köksoy, F N; Bulut, T; Köse, H; Soybir, G; Yalçin, O; Aker, Y
In this prospective, clinical study, four groups, each consisting of 12 patients were established to determine how gastric emptying is influenced in cholelithiasis with accompanied flatulent dyspepsia and the relationship of symptoms and gastric emptying after cholecystectomy: group 1--healthy people; group 2--patients with dyspeptic cholelithiasis; group 3--patients with no dyspepsia after cholecystectomy; group 4--patients with dyspepsia after cholecystectomy. Groups are compared according to solid phase gastric emptying scintigraphies performed with Tc 99m sulphur colloid bound with scrambled eggs. Gastric emptying delayed in groups 2 (P 0.005). These results demonstrate that dyspepsia, in cholelithiasis and persisting after cholecystectomy, has a close relation with delay in gastric emptying.
Full Text Available Elections in Serbia have been held quite often over the past 26 years. Yet, of all elections that have taken place since the introduction of the multiparty system in 1990, the elections held on April 24 2016, were the most confusing. They were held early, but were neither a product of political, nor economic crisis. So why were they necessary?
North Carolina State Dept. of Public Instruction, Raleigh. Div. of Social Studies Education.
This materials packet contains information on teaching about the electoral process and the elections of 1988, and on participation in a mock election for students whose schools would take part in the 1988 North Carolina Mock Election. Suggestions for teachers' preparations are given, including a classroom skit and a mock candidates' election…
To describe and evaluate a new cholecystectomy technique combining classical dissection with currently available mini-instrumentation (3 and 5 mm) and gallbladder removal through a short gastrotomy. After a feasibility study, we set up a protocol for this procedure using instrumentation currently available on the market. We performed 106 procedures, including 99 in a prospective study between January 2008 and July 2010. Cholecystectomy was performed with the described technique in 99 of 106 eligible patients (22 males and 77 females, mean age 45.8 years (range 18-77); median BMI 26.4 kg/m2 (range 22-36)). Forty-eight patients had at least one gallstone larger than 10 mm. There were no postoperative gastric complications and recovery was always rapid. This procedure is technically feasible, safe and reproducible. The results are good, with minimal abdominal wall trauma. Normal physical activity can be resumed rapidly with no risk of incisional hernia.
Egawa, Noriyuki; Ueda, Junji; Hiraki, Masatsugu; Ide, Takao; Inoue, Satoshi; Sakamoto, Yuichiro; Noshiro, Hirokazu
Abstract Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy. PMID:27462188
Full Text Available Gallbladder rupture due to blunt abdominal injury is rare. There are few reports of traumatic gallbladder injury, and it is commonly associated with other concomitant visceral injuries. Therefore, it is difficult to diagnose traumatic gallbladder rupture preoperatively when it is caused by blunt abdominal injury. We report a patient who underwent laparoscopic cholecystectomy after an exact preoperative diagnosis of traumatic gallbladder rupture. A 43-year-old man was admitted to our hospital due to blunt abdominal trauma. The day after admission, abdominal pain and ascites increased and a muscular defense sign appeared. Percutaneous drainage of the ascites was performed, and the aspirated fluid was bloody and almost pure bile. He was diagnosed with gallbladder rupture by the cholangiography using the endoscopic retrograde cholangiopancreatography technique. Laparoscopic cholecystectomy was performed safely, and he promptly recovered. If accumulated fluids contain bile, endoscopic cholangiography is useful not only to diagnose gallbladder injury but also to determine the therapeutic strategy.
Full Text Available We aimed to present the phenomenon of laparoscopic cholecystectomy and abdominoplasty which we diagnosed at the same period the abdominal laxation, diastase of rectum and cholelithiasis that we think in the literature the first samples without leaving any trocar entrance mark.A 58 year old female patient has consulted to the polyclinic of plastic surgery due to prolapsus on the abdominal region. Gall bladder multiplestones were ascertained through abdominal ultrasonograpy. On request and to provide minimal cosmetic failure to the patient, cholecystectomy and abdominoplasty is performed at the same session. Patients with abdominal pathologies that may occur after operations requiring surgery such as abdominoplasty very serious impact on cosmetics. Concordantly, we strongly suggest to take abdominal USG, even if there is no additional complaints especially before the plastic surgery operations and abdominoplasty, for ascertain the existent patologies. [Cukurova Med J 2013; 38(2.000: 319-324
We report seven patients in whom five dropped surgical clips and two gallstones were visualized in the peritoneal cavity, on radiological studies. In two, subphrenic abscesses and empyemas developed as a result of dropped clips into the peritoneal cavity during or following laparoscopic cholecystectomy. In one of these two, a clip was removed surgically from the site of an abscess. In two other patients dropped gallstones, and in three, dropped clips led to no complications. These were seen incidentally on studies done for other indications. Abdominal abscess secondary to dropped gallstones is a well-recognized complication of laparoscopic cholecystectomy (LC). We conclude that even though dropped surgical clips usually do not cause problems, they should be considered as a risk additional to other well-known causes of post-LC abdominal sepsis
Full Text Available Laparoscopic cholecystectomy (LC has become the "gold standard" of treatment for benign gallbladder disease. This paper summarizes various surgical safety measures used in recent years, and suggests an emphasis on perioperative imaging examination, preoperative prevention of risk factors, training of surgical skills, and introduction of fast-track surgery concept, so as to avoid the incidence of complications and improve the safety of LC.
O. A. Dolina
Full Text Available The paper presents the results of a comparative study of different methods for preventing respiratory distress after laparoscopic cholecystectomy. It shows the advantages of use of noninvasive assisted ventilation that ensures excessive positive pressure in the respiratory contour, its impact on external respiratory function, arterial blood gases, oxygen transport and uptake. A scheme for the prevention of respiratory diseases applying noninvasive assisted ventilation is given.
Conrad, Claudius; Wakabayashi, Go; Asbun, Horacio J; Dallemagne, Bernard; Demartines, Nicolas; Diana, Michele; Fuks, David; Giménez, Mariano Eduardo; Goumard, Claire; Kaneko, Hironori; Memeo, Riccardo; Resende, Alexandre; Scatton, Olivier; Schneck, Anne-Sophie; Soubrane, Olivier; Tanabe, Minoru; van den Bos, Jacqueline; Weiss, Helmut; Yamamoto, Masakazu; Marescaux, Jacques; Pessaux, Patrick
An expert recommendation conference was conducted to identify factors associated with adverse events during laparoscopic cholecystectomy (LC) with the goal of deriving expert recommendations for the reduction of biliary and vascular injury. Nineteen hepato-pancreato-biliary (HPB) surgeons from high-volume surgery centers in six countries comprised the Research Institute Against Cancer of the Digestive System (IRCAD) Recommendations Group. Systematic search of PubMed, Cochrane, and Embase was conducted. Using nominal group technique, structured group meetings were held to identify key items for safer LC. Consensus was achieved when 80% of respondents ranked an item as 1 or 2 (Likert scale 1-4). Seventy-one IRCAD HPB course participants assessed the expert recommendations which were compared to responses of 37 general surgery course participants. The IRCAD recommendations were structured in seven statements. The key topics included exposure of the operative field, appropriate use of energy device and establishment of the critical view of safety (CVS), systematic preoperative imaging, cholangiogram and alternative techniques, role of partial and dome-down (fundus-first) cholecystectomy. Highest consensus was achieved on the importance of the CVS as well as dome-down technique and partial cholecystectomy as alternative techniques. The put forward IRCAD recommendations may help to promote safe surgical practice of LC and initiate specific training to avoid adverse events. © 2017 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Full Text Available BACKGROUND This study aimed at assessing the outcome of laparoscopic cholecystectomy (LC by determining the frequency of complications, especially of bile duct injuries. MATERIALS AND METHODS The case files of all patients undergoing laparoscopic cholecystectomy between January 2008 and December 2016 at Government General Hospital, Kakinada were retrospectively analysed. We evaluated the data according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose resections had to be converted from laparoscopic to open. RESULTS During the eight years (January 2008 and December 2016, 336 patients underwent LC for chronic cholecystitis (CC, of whom 22 (6.5% developed complications. Among those who developed complications, two patients had major bile duct injuries (0.4%; 43 other patients (12.8% had planned laparoscopic operations converted to open cholecystectomy intra-operatively. None of the patients in this study died as a result of LC. CONCLUSION Bile duct injury is a major complication of LC. Anatomical anomalies, local pathology, and poor surgical techniques are the main factors responsible. The two patients who had severe common bile duct injury in this study had major anatomical anomalies that were only recognized during surgery.
Stavrou, George; Fotiadis, Kyriakos; Panagiotou, Dimitrios; Faitatzidou, Afroditi; Kotzampassi, Katerina
Due to the current economic crisis in Greece, major cutbacks on healthcare costs have been imposed, resulting in a shortage of surgical supplies, including laparoscopic materials. In an attempt to reduce costs, we developed a homemade specimen retrieval bag for laparoscopic cholecystectomy. We used the polyethylene bag containing the catheter of a Redon drainage set. The bag was cut in half and pleated longitudinally; then, the gallbladder was placed in the bag and removed through the umbilicus with a grasping forceps. From September 2011 to June 2012, we used our homemade bag on 85 patients undergoing laparoscopic cholecystectomy. No rupture, accidental opening, or bile leak was observed. The learning curve was found to be five cases. Our homemade specimen retrieval bag seems to be a safe, effective, and easy tool for tissue extraction. Further studies need to be conducted to evaluate its full potential. © 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
Jakobsen, Henrik Loft; Vilmann, Peter; Rosenberg, Jacob
Management strategy for common bile duct (CBD) stones is controversial with several treatment options if stones in the CBD are recognized intraoperatively. The aim of this study was to report our experience with same-session combined endoscopic-laparoscopic treatment of gallbladder and CBD stones....... We retrospectively evaluated 31 patients with cholecystolithiasis and CBD stones undergoing same-session combined endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and endoscopic stone extraction and laparoscopic cholecystectomy. Same-session ERCP and sphincterotomy were...... performed in all patients, and stone extraction was successfully performed in 29 patients (93%) with 2 failures (7%) due to impacted stones. In 8 patients (26%), the laparoscopic procedure was converted to open cholecystectomy because of dense adhesions or unclear anatomy. Two patients (7%) developed mild...
Keogh, Brad; Culliford, David; Guerrero-Ludueña, Richard; Monks, Thomas
To quantify the effect of intrahospital patient flow on emergency department (ED) performance targets and indicate if the expectations set by the National Health Service (NHS) England 5-year forward review are realistic in returning emergency services to previous performance levels. Linear regression analysis of routinely reported trust activity and performance data using a series of cross-sectional studies. NHS trusts in England submitting routine nationally reported measures to NHS England. 142 acute non-specialist trusts operating in England between 2012 and 2016. The primary outcome measures were proportion of 4-hour waiting time breaches and cancelled elective operations. Univariate and multivariate linear regression models were used to show relationships between the outcome measures and various measures of trust activity including empty day beds, empty night beds, day bed to night bed ratio, ED conversion ratio and delayed transfers of care. Univariate regression results using the outcome of 4-hour breaches showed clear relationships with empty night beds and ED conversion ratio between 2012 and 2016. The day bed to night bed ratio showed an increasing ability to explain variation in performance between 2015 and 2016. Delayed transfers of care showed little evidence of an association. Multivariate model results indicated that the ability of patient flow variables to explain 4-hour target performance had reduced between 2012 and 2016 (19% to 12%), and had increased in explaining cancelled elective operations (7% to 17%). The flow of patients through trusts is shown to influence ED performance; however, performance has become less explainable by intratrust patient flow between 2012 and 2016. Some commonly stated explanatory factors such as delayed transfers of care showed limited evidence of being related. The results indicate some of the measures proposed by NHS England to reduce pressure on EDs may not have the desired impact on returning services to previous
Harboe, Kirstine M; Bardram, Linda
To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones.......To evaluate whether quality improvements in the performance of cholecystectomy have been achieved in Denmark since 2006, after revision of the Danish National Guidelines for treatment of gallstones....
Michael C Meadows
patient benefits are likely to accrue, in comparison to traditional laparoscopic cholecystectomy or single incision laparoscopic surgery (SILS, is unclear. Development of instrumentation to facilitate novel NOTES techniques is in its infancy, but is critical if NOTES is to be broadly applicable. Larger human trials, the development of technological and educational platforms, and an open discussion regarding the ethical concerns are necessary if this approach is to move forward.Keywords: natural orifice transluminal endoscopic surgery, NOTES, cholecystectomy, transvaginal, transgastric, transrectal, transcolonic
Full Text Available Aim: To assess the causes, frequency and time of conversion from laparoscopic to classic cholecystectomy in our ownmaterial.Material and methods: 547 patients were qualified for laparoscopic cholecystectomy in the Surgery Department ofthe Mogilno District Hospital in Strzelno during the period of 1999-2005; 515 minimally invasive operations were performedand 32 patients required conversion.Results: The 547 patients were qualified for the laparoscopic operation; of these 148 were operated on as emergencycases and 399 as elective cases. There were 20 conversions among emergency patients and 12 conversions amongelective patients. On average the decision to convert was made in the 35th min of the operation. The shortest time toconversion was 15 min and the longest was 90 min. Five conversions were performed in the 25th and 35th minand 4 in the 20th, 30th, and 40th mine. Most frequently conversions occurred between the 20th and 40th min of theprocedure. Intentional conversions were performed in 27 patients. Adhesions and clumps around the gallbladder werethe cause of conversion in 10 patients and that was the most frequent reason for the operative modality change. Thenext cause of conversion was changes observed in the course of acute cholecystitis in the form of gallbladder empyemaor cholecystocele (9 patients. Small, fibrotic gallbladder, immersed in the liver, was the reason for conversion ina further 4 patients. In 4 cases the conversion was caused by difficulties in the identification of anatomical structures.Four cases of forced conversions and 1 anticipated conversion were found in the analysed material.Conclusions: A change of operative modality during laparoscopic cholecystectomy was made on average in 5.85% ofoperations. The average time before the conversion was 35 min. Emergency patients required a change of operativemodality 4 times more often. The most frequent were intentional conversions (84%, caused by pericystic adhesionsand by
Ahmad, J.; Khan, Z.A.; Khan, A.
The aim of this study was to assess the analgesic efficacy of Bupivacaine application at port-site and intraperitoneal infiltration in patients with laparoscopic cholecystectomy. Study Design: Randomized Controlled Clinical Trial. Place and Duration: The study was conducted at Rehman Medical Institute (RMI) Peshawar, Pakistan from June 2009 to June 2012. Materials and Methods: Patients who underwent elective laparoscopic cholecystectomy during the study period were included in the study. Eighty patients were randomized into two groups, study group and control group. The study group received 40 ml of 0.25% bupivacaine intraoperatively as intraperitoneal infiltration and local infiltration at the port sites. Pain assessment was done using visual analogue pain score (VAS) of 0-10 at fixed intervals during the first 24 hours post surgery. Results: The mean VAS score in the study group was less as compared to the control group throughout the 24 hours assessment period, however this difference was statistically significant (p<0.001) only during the first three assessments at 1 hour, 4 hours and 8 hours post surgery. The analgesia requirement was also significantly (p<0.001) decreased in the study group. Conclusion: Port site and intraperitoneal application of local anesthetic bupivacaine significantly reduced pain during the first 8 hours post surgery and total analgesia requirement was also significantly reduced. It is a simple and easily applicable technique which increases patient comfort and can be safely used to decrease post operative pain in patients undergoing laparoscopic cholecystectomy. (author)
Langballe, Karen Oline; Bardram, Linda
into the secure Web site by the surgeon immediately after the operation. In the present analysis, we have included children ≤ 15 years from the five year period January 1, 2006, to December 31, 2010. RESULTS: In the study period 35,444 patients were operated with a cholecystectomy. Of these, 196 (0.5%) were ≤ 15......BACKGROUND: An increase in the frequency of cholecystectomy in children has been described during the last decades. Part of the reason is that more cholecystectomies in children are performed for dyskinesia of the gallbladder and not only for gallstone disease. We conducted the first nationwide...... study to describe outcome of cholecystectomies performed in children in Denmark by using data from the national Danish Cholecystectomy Database (DCD). METHODS: In the DCD, two data sources were combined: administrative data from the National Patient Registry (NPR) and clinical data entered...
Sun Wei; Zhu Gaohong; Wei Jiangliang; Hu Jianwei
Objective: To investigate the effects of laparoscopic cholecystectomy on the plasma levels of endothelin and calcitonin gene-related peptide (CGRP)in elderly patients. Methods: Sixty patients undergoing elective laoaroscopic cholecystectomy were divided into 65 years old group according to their ages (30 cases in each group). The plasma levels of endothelin and CGRP were measured before surgery, after intubation, at the time of gallbladder removal, immediately after surgery and 24 hours after surgery by radioimmunoassay. Results: There was no significant difference in endothelin levels between the two groups before the surgery (t=0.971, P>0.05). The endothelin levels in both groups gradually increased after the intubation, but more significantly in the > 65 years old group (t=4.258, P 65 years old group (t=5.134, P 65 years old group continued to increase, but it decreased in the 0.05). The CGRP levels had not significantly changed during the perioperative period in the 65 years old group, CGRP levels decreased after anaesthesia, but increased during the surgery, and then reached the highest level at the time of the surgery completed. CGRP levels were significant difference between the two groups after intubation and immediately after surgery (t=4.084 and t=4.085, P<0.05). Conclusion: The levels of endothelin and CGRP had significantly changed elderly patients than those in young patients, especially for endothelin. (authors)
Aziza M Hussain
Full Text Available Background: Evidence regarding gender affecting the response to pain and its treatment is inconsistent in literature. The objective of this prospective, observational study was to determine the effect of gender on pain perception and postoperative analgesic consumption in patients undergoing laparoscopic cholecystectomy. Materials and Methods: We recruited 60 male and 60 female patients undergoing elective laparoscopic cholecystectomy. Patients were observed for additional intraoperative and postoperative analgesia. Numerical rating scale was documented at 10 min interval for 1 h in post-anesthesia recovery room and at 4, 8, and 12 h postoperatively. Boluses of tramadol given as rescue analgesia were also noted. There were no dropouts. Results: The mean pain scores were significantly higher in female patients at 20 and 30 min following surgery. Mean dose of tramadol consumption was significantly higher in female patients for the first postoperative hour (P = 0.002, but not in the later period. Conclusion: Female patients exhibited greater intensity of pain and required higher doses of analgesics compared to males in in the immediate postoperative period in order to achieve a similar degree of analgesia.
Mumtaz KH Al-Naser
Full Text Available Background: Port site infection (PSI is an infrequent surgical site infection that complicates laparoscopic surgery but has a considerable influence in the overall outcome of laparoscopic cholecystectomy. The aim of this study was to evaluate factors that influence PSI after laparoscopic cholecystectomies and to analyze which of these factors can be modified to avoid PSI in a trail to achieve maximum laparoscopic advantages. Methods: A prospective descriptive qualitative study conducted on patients who underwent laparoscopic cholecystectomies. Swabs were taken for culture & sensitivity in all patients who developed PSI. Exploration under general anaesthesia, for patients, had deep surgical site infections and wound debridement was done, excisional biopsies had been taken for histopathological studies, and tissue samples for polymerase chain reaction for detection of mycobacterium tuberculosis was done. All patients were followed up for six months postoperatively. Factors as gender, site of infected port, type of microorganism, acute versus chronic cholecystitis, type of infection (superficial or deep infection and intraoperative spillage of stones, bile or pus were analyzed in our sample. Results: Port site infection rate was recorded in 40/889 procedures (4.5%, higher rates were observed in male patients 8/89 (8.9%, in acute cholecystitis 13/125 (10.4%, when spillage of bile, stones or pus occurred 24/80 (30%, and at epigastric port 32/40 (80%. Most of the PSI were superficial infections 77.5% with non-specific microorganism 34/40 (85%. Conclusion: There is a significant association of port site infection with spillage of bile, stones, or pus, with the port of gallbladder extraction and with acute cholecystitis. Especial consideration should be taken in chronic deep surgical site infection as mycobacterium tuberculosis could be the cause. Most of the PSIs are superficial and more common in males.
Andersen, Julie; Thorup, Jens; Wille-Jørgensen, Peer
Previous studies have shown that preoperative bowel preparation does not influence the frequency of postoperative complications after elective open colonic resections. The Danish Colorectal Cancer Group (DCCG) recommends that mechanical bowel preparation (MBP) should be omitted prior to elective...
Kienzle, H F
The Expert Commission for medical malpractice which is part of the Medical Chamber of Nordrhein received about 60 applications in connection with laparoscopic cholecystectomy; as of August 1998 5 complaints were let off and 11 of them are still being considered. So far 44 complaints have been considered and in 25 of them medical malpractice has been established. The medical malpractice detected laparoscopic cholecystectomy cases were mainly bile duct injuries of which 13 required a biliodigestive anastomosis for reconstruction, four cases required and end-to-end anastomosis and in one case a T-tube drainage was needed. The youngest one of these patients was 21 years old, the oldest one was 61 years old. Four times the bile duct injury was not considered as malpractice, because it could be intraoperatively made out and immediately treated. Trocar injuries were twice a cause for malpractice and once it was not. Each of the following cases was also recognized as a malpractice. One lost gallstone one dislocated Roedersnare, one electric injury, one delayed reintervention and one insufficient information. The following cases were decided as non-malpractice: in two cases a slipped clip, in five cases subhepatical hematoma/abscess, in three cases a secondary bleeding, once a lesion of the splenic capsule and finally a running sore with subsequent incisional hernia. Three courses of treatment with consequence of death also contained mistakes: one electric injury of the bowel, one bile duct lesion and one information rebuke. The bile duct injury is the most considerable risk for laparoscopic cholecystectomy and implies also a high risk for the future health. The experienced surgeon distinguishes himself by the fact that he is right about the situation and converts sooner that later to conventional cholecystectomy if there's any doubt. In open surgery the principle is applied that structures may be only divided when they are clearly identified. The same goes even on a wider
Hajong, Ranendra; Hajong, Debobratta; Natung, Tanie; Anand, Madhur; Sharma, Girish
Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=post-operative pain, with lesser analgesic requirements (p=operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC.
Ayabe, Reed I; Parrish, Aaron B; Dauphine, Christine E; Hari, Danielle M; Ozao-Choy, Junko J
It has become increasingly important to expose surgical residents to robotic surgery as its applications continue to expand. Single-site robotic cholecystectomy (SSRC) is an excellent introductory case to robotics. Resident involvement in SSRC is known to be feasible. Here, we sought to determine whether it is safe to introduce SSRC to junior residents. A total of 98 SSRC cases were performed by general surgery residents between August 2015 and August 2016. Cases were divided into groups based on resident level: second- and third-years (juniors) versus fourth- and fifth-years (seniors). Patient age, gender, race, body mass index, and comorbidities were recorded. The number of prior laparoscopic cholecystectomies completed by participating residents was noted. Outcomes including operative time, console time, rate of conversion to open cholecystectomy, and complication rate were compared between groups. Juniors performed 54 SSRC cases, whereas seniors performed 44. There were no significant differences in patient age, gender, race, body mass index, or comorbidities between the two groups. Juniors had less experience with laparoscopic cholecystectomy. There was no significant difference in mean operative time (92.7 min versus 98.0 min, P = 0.254), console time (48.7 min versus 50.8 min, P = 0.639), or complication rate (3.7% versus 2.3%, P = 0.68) between juniors and seniors. SSRC is an excellent way to introduce general surgery residents to robotics. This study shows that with attending supervision, SSRC is feasible and safe for both junior and senior residents with very low complication rates and no adverse effect on operative time. Copyright © 2017 Elsevier Inc. All rights reserved.
Noguera, José F; Cuadrado, Angel; Dolz, Carlos; Olea, José M; García, Juan C
Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. Sixty female patients between the ages of 18 and 65 years who were eligible for elective cholecystectomy were randomized in a ratio of 1:1:1 to receive hybrid transvaginal NOTES (TV group), hybrid transumbilical NOTES (TU group) or conventional laparoscopy (CL group). The main study variable was parietal complications (wound infection, bleeding, and eventration). The analysis was by intention to treat, and losses were not replaced. Cholecystectomy was successfully performed on 94% of the patients. One patient in the TU group was reconverted to CL owing to difficulty in maneuvering the endoscope. After a minimum follow-up period of 1 year, no differences were noted in the rate of parietal complications. Postoperative pain, length of hospital stay, and time off from work were similar in the three groups. No patient developed dyspareunia. Surgical time was longer among cases in which a flexible endoscope was used (CL, 47.04 min; TV, 64.85 min; TU, 59.80 min). NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.
Gurusamy, Kurinchi Selvan; Samraj, Kumarakrishnan; Fusai, Giuseppe; Davidson, Brian R
trial. There was no significant difference in the proportion of patients who required conversion to open cholecystectomy (2 trials; 4/63 (weighted proportion 6.4%) in the robot assistant group versus 5/70 (7.1%) in the human assistant group; RR 0.90; 95% CI 0.25 to 3.20). There was no significant difference in the operating time between the two groups (4 trials; 324 patients; MD 5.00 minutes; 95% CI -0.55 to 10.54). In one trial, about one sixth of the laparoscopic cholecystectomies in which a robot assistant was used required temporary use of a human assistant. In another trial, there was no requirement for human assistants. One trial did not report this information. It appears that there was little or no requirement for human assistants in the other three trials. There were no randomised trials comparing one type of robot versus another type of robot. Robot assisted laparoscopic cholecystectomy does not seem to offer any significant advantages over human assisted laparoscopic cholecystectomy. However, all trials had a high risk of systematic errors or bias (that is, risk of overestimation of benefit and underestimation of harm). All trials were small, with few or no outcomes. Hence, the risk of random errors (that is, play of chance) is high. Further randomised trials with low risk of bias or random errors are needed.
Pickuth, D; Leutloff, U
Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments; however, it is controversial. We have developed a new diagnostic strategy for the detection of bile duct stones. The concept is based on an ultrasound examination and on screening for the presence of six risk indicators of choledocholithiasis. A total of 120 patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of these six risk indicators: history of jaundice, history of pancreatitis, hyperbilirubinemia, hyperamylasemia, dilated bile duct, and unclear ultrasound findings. The sensitivity of ultrasound and intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. Twenty percent of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (P concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that routine use of intraoperative cholangiography is not necessary.
Wallis, W D
The Mathematics of Elections and Voting takes an in-depth look at the mathematics in the context of voting and electoral systems, with focus on simple ballots, complex elections, fairness, approval voting, ties, fair and unfair voting, and manipulation techniques. The exposition opens with a sketch of the mathematics behind the various methods used in conducting elections. The reader is lead to a comprehensive picture of the theoretical background of mathematics and elections through an analysis of Condorcet’s Principle and Arrow’s Theorem of conditions in electoral fairness. Further detailed discussion of various related topics include: methods of manipulating the outcome of an election, amendments, and voting on small committees. In recent years, electoral theory has been introduced into lower-level mathematics courses, as a way to illustrate the role of mathematics in our everyday life. Few books have studied voting and elections from a more formal mathematical viewpoint. This text wi...
Planells Roig, Manuel; Arnal Bertomeu, Consuelo; Garcia Espinosa, Rafael; Cervera Delgado, Maria; Carrau Giner, Miguel
Difference analysis of ambulatorization rate, pain, analgesic requirements and daily activities recovery in patients undergoing laparoscopic cholecystectomy with standard multiport access (CLMP) versus a minilaparoscopic, 3mm size, technique. Prospective randomized trial of 40 consecutive patients undergoing laparoscopic cholecystectomy. Comparison criteria included predictive ultrasound factors of difficult cholecystectomy, previous history of complicated biliary disease and demographics. Results are analyzed in terms of ambulatorization rate, pain, analgesic requirements, postoperative recovery, technical difficulty, hemorrhage intensity, overnight stay, readmission rate and total or partial conversion. Both procedures were similar in surgery time, technical score and hemorrhage score. MLC was associated with similar ambulatorization rate, 85%, and over-night stay 15%, with only 15% partial conversion rate. MLC showed less postoperative pain (P=.026), less analgesic consumption (P=.006) and similar DAR (P=.879). MLC is similar to CLMP in terms of ambulatorization with less postoperative pain and analgesic requirements without differences in postoperative recovery. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.
Köksoy, F N; Bulut, T; Köse, H; Soybir, G; Yalçin, O; Aker, Y
In this clinical study, four groups, each consisting of 12 patients are established to determine how gastric emptying is influenced in cholelithiasis with accompanied flatulent dyspepsia and the relationship of symptoms and gastric emptying after cholecystectomy. 1. group: healthy people, 2. group: patients with dyspeptic cholelithiasis, 3. group: patients who have no dyspepsia after cholecystectomy, 4. group: patients whose dyspepsia is continued after cholecystectomy. Groups are compared according to solid phase gastric emptying scintigraphies performed with Tc 99m sulfur colloid bound with scrambled eggs. Gastric emptying delayed in second (p 0.005). These results demonstrate that dyspepsia, in cholelithiasis and persisting after cholecystectomy have a close relation with delay in gastric emptying.
McCormack, T. T.; Abel, P. D.; Collins, C. D.
A prospective trial to assess the effect of suction in an abdominal drain following cholecystectomy was carried out. Three types of closed drainage system were compared: a simple tube drain, a low negative pressure drain, and a high negative pressure drain: 120 consecutive patients undergoing cholecystectomy were randomly allocated to one of the three drainage groups. There was no significant difference in postoperative pyrexia, wound infection, chest infection, or hospital stay. This study f...
Full Text Available ObjectiveTo investigate the clinical experience of laparoscopic cholecystectomy (LC for acute cholecystitis. MethodsA retrospective analysis was performed on the clinical records of 216 patients with acute cholecystitis who underwent LC in Qingpu Branch of Zhongshan Hospital, Fudan University from January 2010 to January 2013. LC was performed under intubation general anaesthesia, with three holes conventionally and four holes if necessary. After operation, the drainage tube was placed for 1-3 d, and antibiotics were administered for 3-5 d. The time of operation, length of postoperative hospital stay, and incidence of postoperative complications were determined. All patients were followed up for at least 0.5 year after operation. ResultsLC was successfully performed in 188 (87.0% of all patients; 28 (13.0% of all patients were converted to open surgery. The mean time of operation was 62.00±11.27 min; the mean length of hospital stay was 4.60±2.16 d; the incidence of postoperative complications was 2.3%(5/216. All patients were cured and discharged. During follow-up, no patients developed other complications and all recovered well. ConclusionLC is safe and feasible in the treatment of acute cholecystitis. Correct manipulation of the Calot's triangle and proper abdominal drainage are the key to successful operation.
Full Text Available Liver cirrhosis is a major health problem worldwide with a prevalence that varies greatly from one geographical area to another. Besides the risk factors common to the general population to develop gallstone disease such as advanced age, female sex or positive family history of gallstones, in patients with liver cirrhosis there are additional risk factors that contribute to the occurrence of gallstones. They are more frequent in patients with a longer duration of the disease and in Child B and C stages. Gallstones disease occurs three times more frequently in patients with liver cirrhosis than in noncirrhotic patients. Surgery is required if symptoms or complications related to the presence of gallstones occur and a thorough preoperative evaluation and optimization of patient’s condition is necessary prior to surgery. The procedure of choice in these situations is laparoscopic cholecystectomy. The technique has some particularities resulting from local anatomical changes and conversion to open technique remains low and morbidity and mortality rates are within acceptable limits.
Full Text Available Elections do not always advance democratisation, yet they can. We outline a democratisation-by-elections model according to which the opportunities for political change opened up by each electoral round build on previous election-related democratic progress. We focus on Nigeria, interpret the recent executive turnover in light of previous elections, and set the country within the comparative context of Africa’s democratisation. Using a new Africa Leadership Change dataset, we use election-related events to examine the diverse routes that African regimes have taken since 1990. The analysis highlights two major syndromes: democratic stagnation and recession. In a sizeable group, however, the institutionalisation of democracy has been making gradual progress. While there is no predetermined way to advance democracy, the reiteration of elections can be instrumental in such advancement.
Pandya, Seema R; Paranjape, Saloni
An increasing number of cardiac transplants are being carried out around the world. With increasing longevity, these patients present a unique challenge to non-transplant anesthesiologists for a variety of transplant related or incidental surgeries. The general considerations related to a cardiac transplant recipient are the physiological and pharmacological problems of allograft denervation, the side-effects of immunosuppression, the risk of infection and the potential for rejection. A thorough understanding of the physiology of a denervated heart, need for direct vasoactive agents and post-transplant morbidities is essential in anesthetic management of such a patient. Here, we describe a case of a heart transplant recipient who presented for a cholecystectomy at our center.
Kristiansen, Simon; Sørensen, Matias; Stidsen, Thomas Riis
Efficient planning increasingly becomes an indispensable tool for management of both companies and public organizations. This is also the case for high school management in Denmark, because the growing individual freedom of the students to choose courses makes planning much more complex. Due...... to reforms, elective courses are today an important part of the curriculum, and elective courses are a good way to make high school education more attractive for the students. In this article, the problem of planning the elective courses is modeled using integer programming and three different solution...... for the Elective Course Planning Problem has been described in the literature before. The proposed algorithms are tested on data sets from 98 of the 150 high schools in Denmark. The tests show that for the majority of the problems, the optimal solution can be obtained within the one hour time bound. Furthermore...
City and County of Durham, North Carolina — Voting totals for the 2016 Presidential Election by voting method and precinct. Voting Method Definitions: PROV = Provisional IN-PERSON = In PersonABS-1STOP =...
Stergiopoulou, A; Birbas, K; Katostaras, T; Mantas, J
Aim of this study is the evaluation of the impact of a multimedia CD (MCD) on preoperative anxiety and postoperative recovery of patients undergoing elective laparoscopic cholecystectomy (LC). Sixty consecutive candidates for elective LC were randomly assigned to four groups. Group A included 15 patients preoperatively informed regarding LC through the MCD presented by Registered Nurse (RN). Patients in group B (n = 15) were informed through a leaflet. Patients in group C (n = 15) were informed verbally from a RN. Finally, the control Group D included 15 patients informed conventionally by the attending surgeon and anesthesiologist, as every other patient included in groups A, B, and C. Preoperative assessment of knowledge about LC was performed after each informative session through a questionnaire. Evaluation of preoperative anxiety was conducted using APAIS scale. Postoperative pain and nausea scores were measured using an NRS scale, 16 hours after the patient had returned to the ward. Statistical processing of the results (single linear regression) showed that patients in groups A, B, and C achieved a higher knowledge score, less preoperative anxiety score and less postoperative pain and nausea, compared to Group D. In multiple regression analysis, group A had a higher knowledge score compared to the four groups (p Informative sessions using MCD is an effective means of improving patient's preoperative knowledge, especially in day-surgery cases, like LC.
D'Costa, H; Taylor, E W
The management of patients after uncomplicated elective gastrointestinal operations is frequently left to junior members of the surgical team once they have learnt their seniors' regimens. The use of nasogastric (N/G) tubes, the volume of intravenous (IV) fluid replacement and the reintroduction of oral fluids and solids are topics not generally covered in the surgical textbooks and so are learnt in hospital. A postal survey of all consultant general surgeons in Scotland was conducted to assess the variations in management of patients after cholecystectomy, right haemicolectomy and sigmoid colectomy. A completed questionnaire was received from 111 (81%) of the surgeons circulated. As might be expected, patient management varied widely from surgeon to surgeon, and from unit to unit. There would appear to be a need for prospective studies in this area of patient management. This may indicate that the use of N/G tubes could be further reduced and that oral fluids and solids could be reintroduced sooner after operation with improved patient comfort and reduced hospital stay, yet without detriment to patient care.
Perini, Rafael F.; Uflacker, Renan; Cunningham, John T.; Selby, J. Bayne; Adams, David
Purpose. Laparoscopic cholecystectomy (LC) is the treatment of choice for gallstones. There is an increased incidence of bile duct injuries in LC compared with the open technique. Isolated right segmental hepatic duct injury (IRSHDI) represents a challenge not only for management but also for diagnosis. We present our experience in the management of IRSHDI, with long-term follow-up after treatment by a multidisciplinary approach. Methods. Twelve consecutive patients (9 women, mean age 48 years) were identified as having IRSHDI. Patients' demographics, clinical presentation, management and outcome were collected for analysis. The mean follow-up was 44 months (range 2-90 months). Results. Three patients had the LC immediately converted to open surgery without repair of the biliary injury before referral. Treatments before referral included endoscopic retrograde cholangiopancreatography (ERCP), percutaneous drainage and surgery, isolated or in combination. The median interval from LC to referral was 32 days. Eleven patients presented with biliary leak and biloma, one with obstruction of an isolated right hepatic segment. Post-referral management of the biliary lesion used a combination of ERCP stenting, percutaneous drainage and stent placement and surgery. In 6 of 12 patients ERCP was the first procedure, and in only one case was IRSHDI identified. In 6 patients, percutaneous transhepatic cholangiography (PTC) was performed first and an isolated right hepatic segment was demonstrated in all. The final treatment modality was endoscopic management and/or percutaneous drainage and stenting in 6 patients, and surgery in 6. The mean follow-up was 44 months. No mortality or significant morbidity was observed. Conclusion. Successful management of IRSHDI after LC requires adequate identification of the lesion, and multidisciplinary treatment is necessary. Half of the patients can be treated successfully by nonsurgical procedures
Costa, D.W. da; Bouwense, S.A.; Schepers, N.J.; Besselink, M.G.; Santvoort, H.C. van; Brunschot, S. van; Bakker, O.J.; Bollen, T.L.; Dejong, C.H.; Goor, H. van; Boermeester, M.A.; Bruno, M.J.; Eijck, C.H. van; Timmer, R.; Weusten, B.L.; Consten, E.C.; Brink, M.A.; Spanier, B.W.; Bilgen, E.J.; Nieuwenhuijs, V.B.; Hofker, H.S.; Rosman, C.; Voorburg, A.M.; Bosscha, K.; Duijvendijk, P. van; Gerritsen, J.J.; Heisterkamp, J.; Hingh, I.H. de; Witteman, B.J.; Kruyt, P.M.; Scheepers, J.J.; Molenaar, I.Q.; Schaapherder, A.F.; Manusama, E.R.; Waaij, L.A. van der; Unen, J. van; Dijkgraaf, M.G.; Ramshorst, B. van; Gooszen, H.G.; Boerma, D.
BACKGROUND: In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission
da Costa, David W.; Bouwense, Stefan A.; Schepers, Nicolien J.; Besselink, Marc G.; van Santvoort, Hjalmar C.; van Brunschot, Sandra; Bakker, Olaf J.; Bollen, Thomas L.; Dejong, Cornelis H.; van Goor, Harry; Boermeester, Marja A.; Bruno, Marco J.; van Eijck, Casper H.; Timmer, Robin; Weusten, Bas L.; Consten, Esther C.; Brink, Menno A.; Spanier, B. W. Marcel; Bilgen, Ernst Jan Spillenaar; Nieuwenhuijs, Vincent B.; Hofker, H. Sijbrand; Rosman, Camiel; Voorburg, Annet M.; Bosscha, Koop; van Duijvendijk, Peter; Gerritsen, Jos J.; Heisterkamp, Joos; de Hingh, Ignace H.; Witteman, Ben J.; Kruyt, Philip M.; Scheepers, Joris J.; Molenaar, I. Quintus; Schaapherder, Alexander F.; Manusama, Eric R.; van der Waaij, Laurens A.; van Unen, Jacco; Dijkgraaf, Marcel G.; van Ramshorst, Bert; Gooszen, Hein G.; Boerma, Djamila
Background In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission
Da Costa, David W.; Bouwense, Stefan A.; Schepers, Nicolien J.; Besselink, Marc G.; van Santvoort, Hjalmar C.; Van Brunschot, Sandra; Bakker, Olaf J.; Bollen, Thomas L.; Dejong, Cornelis H.; Van Goor, Harry; Boermeester, Marja A.; Bruno, Marco J.; Van Eijck, Casper H.; Timmer, Robin; Weusten, Bas L.; Consten, Esther C.; Brink, Menno A.; Spanier, B. W Marcel; Bilgen, Ernst Jan Spillenaar; Nieuwenhuijs, Vincent B.; Hofker, H. Sijbrand; Rosman, Camiel; Voorburg, Annet M.; Bosscha, Koop; Van Duijvendijk, Peter; Gerritsen, Jos J.; Heisterkamp, Joos; De Hingh, Ignace H.; Witteman, Ben J.; Kruyt, Philip M.; Scheepers, Joris J.; Molenaar, I. Quintus; Schaapherder, Alexander F.; Manusama, Eric R.; Van Der Waaij, Laurens A.; Van Unen, Jacco; Dijkgraaf, Marcel G.; Van Ramshorst, Bert; Gooszen, Hein G.; Boerma, Djamila
Background In patients with mild gallstone pancreatitis, cholecystectomy during the same hospital admission might reduce the risk of recurrent gallstone-related complications, compared with the more commonly used strategy of interval cholecystectomy. However, evidence to support same-admission
Full Text Available We remind you of some technical artifices required in order to resolve difficult cases, such as: antegrade laparoscopic cholecystectomy (LC, subtotal laparoscopic cholecystectomy (SLC and the “stairs” clipping of the cystic duct. Also we acknowledge the closing of the cystic duct. We analyzed the medical records of 15251 laparoscopic cholecystectomies performed during 1994-2015, with emphasis on: surgical technique, conversion rate, hemorrhage, postoperative bile leaking, iatrogenic MBD injuries and mortality. We divided the cases in 5 study groups, group 1 (1994- 2004 N= 5138, group 2 (2005-2015 N= 10113, group 3 (fundus first cholecystectomies, N=2348, group 4 (retrograde cholecystectomies, N=12889 and group 5 (subtotal laparoscopic cholecystectomy-SLC, N=14 which we compared regarding the main parameters. We prefer to perform a “step by step” clipping each time the length of the clip does not cover all the circumference of the cystic duct. This artifices, is a simple laparoscopic gesture easy to perform and has the advantage of avoiding a large excessive and risky laparoscopic dissection in the vicinity of the main biliary duct. More seldom we appeal to the suture of the cystic stump using the intracorporeal knots or a simple stump ligation with an extracorporeal preformed not. We did not encounter any late or early complications following the implementation of this technical laparoscopic artifice. Laborious laparoscopic cholecystectomies performed by a well-trained surgical team ensure the premises of a good performance even while adopting laparoscopic ingenious and difficile gestures that also respect the intraoperatory rules and principals.
Al-Sultan, Ali I.; Parashar, Shyam K; Al-Ghamdi, Abulmohsin A.
The purpose of study was to find out the reasons for selecting elective rotations during a rotating medical internship.One hundred and seventy-eight medical interns in the College of Medicine, King Faisal University,Dammam, Kingdom of Saudi Arabia during the period March 2001 to August 2002 completed a questionnaire for their selection reasons with responses on a scale of 1-5.The study comprised 60% males and 98.3% Saudis. The most frequently chosen elective is Dermatology 28.1% ,radiology 20.8%, anesthesia 9.6% and otorhinolaryngology (ear, nose and throat [ENT]) 9%. Significantly, more males (89.2%) chose radiology rotation and more females (75%) chose ENT rotation.The leading reasons to choose an elective rotations are;1, to gain broad medical training and education,2, to assist in choice of future speciality and,3, being relevant to future speciality .The mean score for ENT and dermatology is higher than radiology and anesthesia for the response to participate in medical practice in different institute , while dermatology is higher than anesthesia for response to help for getting aceptance for job in the same instituteand radiology is higher than ENT and anesthesia for the response i t has infrequent or no night duties . The reason chosen reflect the educational value of electives and their important role in choosing future career. Dermatology and radiology rotations are most popular electives ,with additional and though different reasons. (author)
Bisgaard, T; Klarskov, B; Kristiansen, V B
undergoing elective laparoscopic cholecystectomy. In addition, all patients received multi-modal prophylactic analgesic treatment. Fifty-eight patients were randomized to receive a total of 286 mg (66 mL) ropivacaine or 66 mL saline via periportal and intraperitoneal infiltration. During the first 3...... postoperative h, the use of morphine and antiemetics was registered, and pain and nausea were rated hourly. Daily pain intensity, pain localization, and supplemental analgesic consumption were registered the first postoperative week. Ropivacaine reduced overall pain the first two hours and incisional pain...... for the first three postoperative hours (P ropivacaine group (P
Thiels, Cornelius A; Yu, Denny; Abdelrahman, Amro M; Habermann, Elizabeth B; Hallbeck, Susan; Pasupathy, Kalyan S; Bingener, Juliane
Reliable prediction of operative duration is essential for improving patient and care team satisfaction, optimizing resource utilization and reducing cost. Current operative scheduling systems are unreliable and contribute to costly over- and underestimation of operative time. We hypothesized that the inclusion of patient-specific factors would improve the accuracy in predicting operative duration. We reviewed all elective laparoscopic cholecystectomies performed at a single institution between 01/2007 and 06/2013. Concurrent procedures were excluded. Univariate analysis evaluated the effect of age, gender, BMI, ASA, laboratory values, smoking, and comorbidities on operative duration. Multivariable linear regression models were constructed using the significant factors (p historical surgeon-specific and procedure-specific operative duration. External validation was done using the ACS-NSQIP database (n = 11,842). A total of 1801 laparoscopic cholecystectomy patients met inclusion criteria. Female sex was associated with reduced operative duration (-7.5 min, p < 0.001 vs. male sex) while increasing BMI (+5.1 min BMI 25-29.9, +6.9 min BMI 30-34.9, +10.4 min BMI 35-39.9, +17.0 min BMI 40 + , all p < 0.05 vs. normal BMI), increasing ASA (+7.4 min ASA III, +38.3 min ASA IV, all p < 0.01 vs. ASA I), and elevated liver function tests (+7.9 min, p < 0.01 vs. normal) were predictive of increased operative duration on univariate analysis. A model was then constructed using these predictive factors. The traditional surgical scheduling system was poorly predictive of actual operative duration (R 2 = 0.001) compared to the patient factors model (R 2 = 0.08). The model remained predictive on external validation (R 2 = 0.14).The addition of surgeon as a variable in the institutional model further improved predictive ability of the model (R 2 = 0.18). The use of routinely available pre-operative patient factors improves the prediction of operative
Accidental rupture of the gallbladder is an event which occurs in up to 20% of laparoscopic cholecystectomies, mainly in those where dissection is difficult, or during extraction when the gallbladder is withdrawn directly through the laparoscope port. It has been commonly assumed that contamination by bile in the abdominal cavity could be a cause of infection and lead to the formation of a residual abscess or even to surgical wound infection. It is common practice, therefore, for the surgeon to prescribe the application of an antibiotic at the moment when gallbladder perforation occurs. To compare 2 groups of similar patients, to determine whether administration of antibiotics, started during surgery, is actually useful in reducing the risk of residual abscess or infection in the surgical wound. The study considered a total of 166 patients who had suffered accidental perforation of the gallbladder during elective laparoscopic cholecystectomy. This total was divided at random into 2 groups: group A (80 patients) who received a dose of 1 g of Cefotaxime at the moment of gallbladder rupture, followed by 2 more doses at intervals of 8 hours in the immediate postoperative period; and group B (86 patients) who did not receive any antibiotic treatment at all. The dependent variables observed were surgical wound infection and residual abscess: and the control variables were age, sex, length of operation time, intercurrent illnesses, and American Society of Anesthesiologists (ASA) classification. Two patients (2.5%) in group A developed a surgical wound infection, against 3 cases (3.4%) in group B, the result having no statistical significance. No patients developed residual abscess. In a multivariant analysis, the following were identified as independent factors significantly associated with the onset of surgical wound infection (Pgallbladder during laparoscopic cholecystectomy is not necessary. In the case of patients with diabetes mellitus, those who are older than 60
Ambe, Peter C; Kaptanis, Sarantos; Papadakis, Marios; Weber, Sebastian A; Zirngibl, Hubert
Acute cholecystitis is a common diagnosis. However, the heterogeneity of presentation makes it difficult to standardize management. Although surgery is the mainstay of treatment, critically ill patients have been managed via percutaneous cholecystostomy. However, the role of percutaneous cholecystostomy in the management of such patients has not been clearly established. This systematic review will compare the outcomes of critically ill patients with acute cholecystitis managed with percutaneous cholecystostomy to those of similar patients managed with cholecystectomy. Systematic searches will be conducted across relevant health databases including the Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, Embase, and Scopus using the following keywords: (acute cholecystitis OR severe cholecystitis OR cholecystitis) AND (cholecystectomy OR laparoscopic cholecystectomy OR open cholecystectomy) AND (Cholecystostomy OR percutaneous cholecystectomy OR gallbladder drain OR gallbladder tube OR transhepatic gallbladder drain OR transhepatic gallbladder tube OR cholecystostomy tube). The reference lists of eligible articles will be hand searched. Articles from 2000-2014 will be identified using the key terms "acute cholecystitis, cholecystectomy, and percutaneous cholecystostomy". Studies including both interventions will be included. Relevant data will be extracted from eligible studies using a specially designed data extraction sheet. The Newcastle-Ottawa scale will be used to assess the quality of non-randomized studies. Central tendencies will be reported in terms of means and standard deviations where necessary, and risk ratios will be calculated where possible. All calculations will be performed with a 95 % confidence interval. Furthermore, the Fisher's exact test will be used for the calculation of significance, which will be set at p < 0.05. Pooled estimates will be presented after consideration of both clinical and
Caius Mihai Breazu
Full Text Available Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1 OSTAP-Placebo (treated with normal saline; 2 OSTAP-Bupivacaine (treated with 0.25% bupivacaine; and 3 OSTAP-Pethidine (treated with 1% pethidine. The efficacy of pethidine in achieving the OSTAP block was analyzed using visual analog scale (VAS, intraoperative opioid dose, opioid consumption in post anesthesia care unit, and opioid consumption in the first 24 postoperative hours. The pain scores assessed by VAS at 0, 2, 4, 6, 12, and 24 hours were significantly lower in OSTAP-Pethidine than in OSTAP-Placebo group (p < 0.001. The mean intraoperative opioid consumption was significantly lower in OSTAP-Pethidine compared to OSTAP-Placebo group (150 versus 400 mg, p < 0.001, as well as the mean opioid consumption in the first 24 hours (20.4 versus 78 mg, p < 0.001. Comparing VAS assessment between OSTAP-Bupivacaine and OSTAP-Pethidine groups, statistically significant differences were observed only for the immediate postoperative pain assessment (0 hours, where lower values were observed in OSTAP-Pethidine group (p = 0.004. There were no statistically significant differences in the incidence of postoperative nausea and vomiting (p = 0.131 between the groups. The use of 1% pethidine can be an alternative to 0.25% bupivacaine in achieving OSTAP block for laparoscopic cholecystectomy.
Breazu, Caius Mihai; Ciobanu, Lidia; Bartos, Adrian; Bodea, Raluca; Mircea, Petru Adrian; Ionescu, Daniela
Pethidine is a synthetic opioid with local anesthetic properties. Our goal was to evaluate the analgesic efficacy of pethidine for achieving the ultrasound-guided oblique subcostal transversus abdominis plane (OSTAP) block in laparoscopic cholecystectomy. This prospective, double-blind study included 79 patients of physical status I and II according to American Society of Anesthesiologists, scheduled for elective laparoscopic cholecystectomy. The patients were randomly allocated into three groups, depending on the drug used to achieve preoperative bilateral OSTAP block: 1) OSTAP-Placebo (treated with normal saline); 2) OSTAP-Bupivacaine (treated with 0.25% bupivacaine); and 3) OSTAP-Pethidine (treated with 1% pethidine). The efficacy of pethidine in achieving the OSTAP block was analyzed using visual analog scale (VAS), intraoperative opioid dose, opioid consumption in post anesthesia care unit, and opioid consumption in the first 24 postoperative hours. The pain scores assessed by VAS at 0, 2, 4, 6, 12, and 24 hours were significantly lower in OSTAP-Pethidine than in OSTAP-Placebo group (p consumption was significantly lower in OSTAP-Pethidine compared to OSTAP-Placebo group (150 versus 400 mg, p consumption in the first 24 hours (20.4 versus 78 mg, p < 0.001). Comparing VAS assessment between OSTAP-Bupivacaine and OSTAP-Pethidine groups, statistically significant differences were observed only for the immediate postoperative pain assessment (0 hours), where lower values were observed in OSTAP-Pethidine group (p = 0.004). There were no statistically significant differences in the incidence of postoperative nausea and vomiting (p = 0.131) between the groups. The use of 1% pethidine can be an alternative to 0.25% bupivacaine in achieving OSTAP block for laparoscopic cholecystectomy.
Rizzotti, L; Vassiliou, M; Amygdalou, A; Psarakis, Ch; Rasmussen, T R; Laopodis, V; Behrakis, P
The influence of laparoscopic cholecystectomy (LC) on the mechanical properties of the respiratory system (RS) was examined using multiple regression analysis (MRA). Measurements of airway pressure (PaO) and flow (V') were obtained from 32 patients at four distinct stages of the LC procedure: 1) Immediately before the application of pneumoperitoneum (PP) at supine position, 2) 5 min after the induction of PP at Trendelenburg position, 3) 5 min after the patients position at reverse Trendelenburg, and 4) 5 min after the end ofthe surgical procedure with the patient again in supine position. Evaluated parameters were the RS elastance (Ers), resistance (Rrs), impedance (Zrs), the angle theta indicating the balance between the elastic and resistive components of the impedance, as well as the end-expiratory elastic recoil pressure (EEP). Ers and Zrs increased considerably during PP and remained elevated immediately after abolishing PP Rrs, on the contrary, returned to pre-operative levels right after the operation. Change of body position from Trendelenburg (T) to reverseTrendelenburg (rT) mainly induced a significant change in theta, thus indicating an increased dominance of the elastic component of Zrs on changing fromT to rT. There was no evidence of increased End-Expiratory Pressure during PP
Illinois State Board of Education, Springfield.
This election-education program is designed to help develop an informed electorate and to instill in future voters an appreciation of the importance of the right to vote. It provides a framework for discussions of the electoral process and gives students an opportunity to face the responsibilities and challenges associated with citizenship and…
Elections to fill all seats in the Staff Council are being organized this month. The voting takes place from the 31st of October to the 14th of November, at noon. As you may have noted when reading Echo, many issues concerning our employment conditions are on the agenda of the coming months and will keep the next Staff Council very busy. So, make your voice heard and take part in the elections for a new Staff Council. By doing so, you will be encouraging the men and women who will be representing you over the next two years and they will doubtless appreciate your gratitude. Every member of the Staff Association will have received an email containing a link to the webpage which will allow voting. If you are a member of the Staff Association and you did not receive such an email, please contact the Staff Association secretariat (firstname.lastname@example.org). Do not forget to vote * * * * * * * Vote Make your voice heard and be many to elect the new Staff Council. More details on the election...
Stergiopoulou, Antonia; Birbas, Konstantinos; Katostaras, Theophanis; Diomidous, Mariana; Mantas, John
Aim of this study is the evaluation of the impact of preoperative informative session using a Multimedia Health Educational Program (MHEP) on patients undergoing elective Laparoscopic Cholecystectomy (LC) for cholelithiasis, preoperative anxiety and postoperative pain and nausea. Sixty consecutive patients scheduled for elective LC were considered for enrollment in the trial. Patients were assigned randomly to four groups: Group A included 15 patients, preoperatively informed regarding LC through the MHEP presented by a Registered Nurse (RN). Group B included 15 patients preoperatively informed through a leaflet (designed and developed using the exact contents of the MHEP). In Group C, there were 15 patients who were being informed verbally from the RN. Finally, the control Group D included 15 patients, who had the conventional preoperative information about the operation and postoperative course by the attending surgeon and anesthesiologist, as every other patient included in groups A, B, C. Preoperative assessment of patient's knowledge about cholelithiasis and LC was performed after informative session, and was based on a specifically developed "closed, true-false" questionnaire. Preliminary results suggest that conventional information provided by the attending surgeon (Group D) is inadequate. Specifically developed informative sessions with the contribution of MHEP seems to be effective on reducing preoperative anxiety and postoperative pain, in patients undergoing elective LC.
Full Text Available Laparoscopic cholecystectomy is the gold standard method for treating gallstone related disease. Despite its widespread and well established application, clear consensus is not arrived at regarding the comparative risks and benefits of acute versus interval cholecystectomy. The complications of this technique are well known, with respect to both the operative intervention and the technique used. This case describes a case of cholecystitis in a 76-year-old man, who underwent acute laparoscopic cholecystectomy for cholecystitis refractory to antibiotic therapy. Postoperative complications included subhepatic collections bilaterally, eventually leading to the formation of an enterocutaneous fistula to the left chest wall - a previously undocumented phenomenon. The protracted course of the disease is discussed, with reference to investigations performed and the eventual successful outcome.
DeJonckheere, Melissa; Fisher, Andre; Chang, Tammy
The 2016 presidential election season and subsequent political events have had physical and emotional impacts on youth. We collected qualitative insights from 14 to 24 year olds across the US related to these events over time. Open-ended probes were sent via text message at three time points before and after the 2016 presidential election. The majority of youth reported emotional stress during all three time points, and female participants were significantly more likely to experience emotional responses. White participants were more likely to report negative symptoms than their peers both pre-election and at 4-months post-election. While preliminary, the results indicate that feelings of stress, anxiety, and fear have persisted in the months following the election, particularly for young women. Additional research is needed to examine the long-term effects of political events on the emotional and physical health of youth.
Natalya V. Lebedeva
Theoretical approaches to elections defining develop the nature, essence and content of elections, help to determine their place and a role as one of the major national law institutions in democratic system.
Natalya V. Lebedeva
Full Text Available Theoretical approaches to elections defining develop the nature, essence and content of elections, help to determine their place and a role as one of the major national law institutions in democratic system.
Bogdanic, Branko; Bosnjak, Zrinka; Budimir, Ana; Augustin, Goran; Milosevic, Milan; Plecko, Vanda; Kalenic, Smilja; Fiolic, Zlatko; Vanek, Maja
The third most common healthcare-associated infection is surgical site infection (SSI), accounting for 14%-16% of infections. These SSIs are associated with high morbidity, numerous deaths, and greater cost. A prospective study was conducted to assess the incidence of SSI in a single university hospital in Croatia. We used the Hospital in Europe Link for Infection Control through Surveillance (HELICS) protocol for surveillance. The SSIs were classified using the standard definition of the National Nosocomial Infections Surveillance (NNIS) system. The overall incidence of SSI was 1.44%. The incidence of infection in the open cholecystectomy group was 6.06%, whereas in the laparoscopic group, it was only 0.60%. The incidence density of in-hospital SSIs per 1,000 post-operative days was 5.76. Patients who underwent a laparoscopic cholecystectomy were significantly younger (53.65±14.65 vs. 64.42±14.17 years; pconcept for the monitoring of SSI, but in the case of cholecystectomy, additional factors such as antibiotic appropriateness, gallbladder entry, empyema of the gallbladder, and obstructive jaundice must be considered.
Full Text Available A 79-year-old man, with history of recent laparoscopic cholecystectomy, came to our attention for persistent hiccup, dysphonia, and dysphagia. Noninvasive imaging studies showed a nodular lesion in the right hepatic lobe with transdiaphragmatic infiltration and increased tracer uptake on positron emission tomography. Suspecting a malignant lesion and given the difficulty of performing a percutaneous transthoracic biopsy, the patient underwent surgery. Histological analysis of surgical specimen showed biliary gallstones surrounded by exudative inflammation, resulting from gallbladder rupture and gallstones spillage as a complication of the previous surgical intervention. This case highlights the importance of considering such rare complication after laparoscopic cholecystectomy.
Full Text Available Background: A majority of gallbladder specimens show changes associated with chronic cholecystitis; however few harbour a highly lethal carcinoma. This study was conducted to review the significant histopathological findings encountered in gallbladder specimens received in our laboratory.Materials and Methods: Four hundred cholecystectomy specimens were studied over a period of five years (May, 2002 to April, 2007 received at department of pathology, Kasturba Medical College, Mangalore, India. Results: Gallstones and associated diseases were more common in women in the 4th to 5th decade as compared to men with M: F ratio of 1:1.33. Maximum number of patients (28.25% being 41 to 50 years old. Histopathologically, the most common diagnosis was chronic cholecystitis (66.75%, followed by chronic active cholecystitis (20.25%, acute cholecystitis (6%, gangrenous cholecystitis (2.25%,xanthogranulomatous cholecystitis (0.50%, empyema (1%, mucocele (0.25%, choledochal cyst (0.25%, adenocarcinoma gallbladder (1.25% and normal gallbladders (1%.Conclusion: All lesions were found more frequently in women except chronic active cholecystitis. Gallstones were present in (80.25% cases, and significantly associated with various lesions (P value 0.009. Pigment stones were most common, followed by cholesterol stones and mixed stones. Adequate sectioning is mandatory in all cases to assess epithelial changes arising from cholelithiasis and chronic cholecystitis as it has been known to progress to malignancy in some cases.
Widjaja, Sandra P; Fischer, Henning; Brunner, Alexander R; Honigmann, Philipp; Metzger, Jürg
Currently, most patients undergoing laparoscopic cholecystectomy (LC) in Switzerland are inpatients for 2-3 days. Due to a lack of available hospital beds, we asked whether day-case surgery would be an option for patients in central Switzerland. The questions of acceptability of outpatient LC and factors contributing to the acceptability thus arose. Hundred patients suffering from symptomatic cholecystolithiasis, capable of communicating in German, and between 18 and 65 years old, were included. Patients received a pre-operative questionnaire on medical history and social situation when informed consent on surgery and participation in the study was obtained. Exclusion criteria were patients suffering from acute cholecystitis or any type of cancer; having a BMI >40 kg/m 2 ; needing conversion to open cholecystectomy or an intraoperative drainage; and non-German speakers. Surgery was performed laparoscopically. Both surgeon and patient filled in a postoperative questionnaire. The surgeon's questionnaire listed medical and technical information, and the patients' questionnaire listed medical information, satisfaction with the treatment and willingness to be released on the same day. These data from both questionnaires were grouped into social and medical factors and analysed on their influence upon willingness to accept an ambulatory procedure. No outpatient follow-up apart from checking for readmission to our hospital within 1 month after discharge was performed. Of the 100 participants, one-third was male. More than two-thirds were Swiss citizens. Only one participant was ineligible for rapid release evaluation due to need of a drainage. Among the social factors contributing to the acceptability of ambulatory care, we found nationality to be relevant; Swiss citizens preferred an inpatient procedure, whereas non-Swiss citizens were significantly more willing to return home on the same day. Household size, sex and age did not correlate with a preference for
Alistarh, Dan; Gelashvili, Rati; Vladu, Adrian
The problem of electing a leader from among $n$ contenders is one of the fundamental questions in distributed computing. In its simplest formulation, the task is as follows: given $n$ processors, all participants must eventually return a win or lose indication, such that a single contender may win. Despite a considerable amount of work on leader election, the following question is still open: can we elect a leader in an asynchronous fault-prone system faster than just running a $\\Theta(\\log n...
Breazu, Caius Mihai; Ciobanu, Lidia; Hadade, Adina; Bartos, Adrian; Mitre, Călin; Mircea, Petru Adrian; Ionescu, Daniela
Pain control after a laparoscopic cholecystectomy can represent a challenge, considering the side effects due to standard analgesia methods. Recently the transversus abdominis plane block (TAP Block) has been used as a part of multimodal analgesia with promising results. The subcostal approach (OSTAP Block), a variant on the TAP block, produces reliable unilateral supraumbilical analgesia. This study evaluated the efficacy of the OSTAP block with bupivacaine in laparoscopic cholecystectomy compared with the placebo OSTAP block. Sixty ASA I/II adult patients listed for elective laparoscopic cholecystectomy were randomly allocated in one of two groups: Group A (OSTAP placebo) received preoperatively bilateral OSTAP block with sterile normal saline and Group B (OSTAP bupivacaine) received bilateral preoperatively OSTAP block with the same volumes of 0.25% bupivacaine. Twenty-four hours postoperative opioid consumption, the dose of opioid required during surgery, opioid dose in the recovery unit (PACU) and PACU length of stay were evaluated. The quality of analgesia was assessed by the Visual Analogue Scale (VAS) at specific interval hours during 24 h, at rest and with movement. The mean intraoperative opioid consumption showed a significant difference between the two groups, (385 ± 72.52 mg in group A vs 173.67 ± 48.60 mg in group B, p consumption showed a statistically significant difference between groups (32 ± 26.05 mg vs 79 ± 16.68 mg, p < 0.001). PACU length of stay was significantly lower for group B patients compared with group A patients (20.67 ± 11.27 min vs 41.67 ± 12.41 min, p < 0.001). The OSTAP bupivacaine group had a statistically significant lower pain score than the OSTAP placebo group at 0, 2, 4, 6, 12, 24 h, both at rest and with movement. No signs or symptoms of local anaesthetic systemic toxicity or other complications were detected. OSTAP block with bupivacaine 0.25% can provide effective analgesia up to 24 hours after laparoscopic
Markussen, Randi; Ronquillo, Lorena; Schürmann, Carsten
This paper discusses the Decryption and Counting Ceremony held in conjunction with the internet voting trial on election day in the Ministry of Local Government and Regional Development of Norway in 2013. We examine the organizers' ambition of making the decryption and counting of electronic votes...... public in order to sustain trust in internet voting. We introduce a pragmatic approach to trust that emphasises the inseparability of truth from witnessing it. Based on this and on a description of how the event was made observable and how the complexities in the counting process were disclosed, we...... discuss what we term economy of truth from the perspective of the IT community involved in the ceremony. We claim that broadening the economy of truth by including more explicitly social and political perspectives in the ceremony, and in internet elections in general, and how witnessing is brought about...
DeJonckheere, Melissa; Fisher, Andre; Chang, Tammy
The 2016 presidential election season and subsequent political events have had physical and emotional impacts on youth. We collected qualitative insights from 14 to 24 year olds across the US related to these events over time. Open-ended probes were sent via text message at three time points before and after the 2016 presidential election. The majority of youth reported emotional stress during all three time points, and female participants were significantly more likely to experience emotiona...
Awad, Imad T
STUDY OBJECTIVES: To compare the prophylactic antiemetic efficacy of the combination of ondansetron and droperidol with that of droperidol alone in patients undergoing elective laparoscopic cholecystectomy. DESIGN: Randomized, double-blind controlled trial. University affiliated teaching hospital after induction of standardized general anesthesia. PATIENTS: 64 ASA physical status I or II patients aged 18 to 80 years, undergoing elective laparoscopic cholecystectomy. INTERVENTION: Following induction of general anesthesia, patients received either droperidol 1.25 mg intravenously (IV; n = 30; Group D) or the combination of droperidol 1.25 mg IV and ondansetron 4 mg IV (n = 34; Group D+O). MEASUREMENTS: Number and severity of nausea episodes, number of emetic episodes, total analgesic consumption, and rescue antiemetic administration were assessed at 1, 3, and 24 hours after admission to the recovery room. Data were analyzed using Fisher\\'s Exact test and unpaired Student\\'s t-test; a p-value <0.05 was considered significant. RESULTS: The proportions of patients who experienced nausea (70% and 53% for D and D+O groups, respectively) and vomiting (30% and 19% for D and D+O groups, respectively) were similar in the two groups. The frequency of moderate and severe nausea (requiring administration of antiemetic) was less in group D + O (7%) compared with group D (19%; p < 0.05). CONCLUSIONS: Patients who received the combination of droperidol and ondansetron experienced less severe nausea compared with patients who received droperidol alone.
Spaziani, Erasmo; Di Filippo, Annalisa; Orelli, Simone; Fiorini, Flavia; Spaziani, Martina; Tintisona, Orlando; Torcasio, Angelo; De Cesare, Alessandro; Picchio, Marcello
Skin preparation with antiseptic agents is commonly recommended for incisional site cleansing before surgery. We present the result of a prospective case series submitted to a scheduled pre-operative antiseptic procedure combining chlorhexidine gluconate and povidone-iodine before elective laparoscopic cholecystectomy. Consecutive patients underwent pre-operative standardized cleansing of the operation site combining chlorhexidine gluconate and povidone-iodine. Patients were reviewed one week and four weeks post-operatively. Post-operative infection was observed in seven patients (4.3%). All observed infections were port-site infections, always located at the level of the umbilical incision. In all cases infections involved skin and subcutaneous tissue. Staphylococcus aureus was isolated in five patients (71.4%) and miscellaneous aerobic gram-positive bacteria in two subjects (28.6%). Post-operative hospital stay was the only factor significantly associated with the development of port-site infections. Port-site infections are a common complication after elective laparoscopic cholecystectomy. The proposed pre-operative disinfection procedure is effective in reducing port-site infections. Reducing hospital stay may contribute to limiting the occurrence of this complication.
What happens to the newly elected, and the re-elected delegates after the election of the new Staff Council? (see Écho No 47-48 / 2016). It is the outgoing Staff Council which is responsible for preparing the new staff representatives to take on their new roles. To do this, information days are organized in the form of assizes. This year they took place on November 23 in the afternoon; as well as on November 24, bringing together the new Staff Council. These days mainly aim to inform delegates about the role of the Staff Association (SA) at CERN, ist the organs, committees, forums, etc.; with whom the SA interacts, how the work of the Staff Association is organization, the issues on which it works (e.g., the Five-Yearly Review..). These days are like a kind of "induction". Inform, but not only! Assizes are also aiming to integrate the newcomers, inviting them to discover the various internal committees of the SA, explaining to them the challenges ahead as well as defining the act...
What happens to the newly elected, and the re-elected delegates after the election of the new Staff Council? It is the outgoing Staff Council which is responsible for preparing the new staff representatives to take on their new roles. To do this, information days are organized in the form of assizes. This year they will take place on November 27 in the morning; as well as on November 28, bringing together the new Staff Council. These days mainly aim to inform delegates about the role of the Staff Association (SA) at CERN, the bodies, committees, forums, etc.; with whom the SA interacts, how the work of the SA is organized, the issues on which it works. These days are like a kind of "induction". Inform, but not only! Assizes are also aiming to integrate the newcomers, inviting them to discover the various internal committees of the SA, explaining to them the challenges ahead as well as defining the action plan for 2018. They offer new delegates, if they wish, a godparent (a kind of mentor). I...
Moses Etila Shaibu
Full Text Available The paper examined the challenges that confront Election Management Bodies (EMBs in conducting free and fair elections in Nigeria. It aligns with the position of extant literature on the subject that elections in Nigeria have been anything but free and fair, and argues that all the EMBs that have so far conducted elections in Nigeria are complicit in perpetrating electoral malpractices. In other words, though there are external factors that undermine the conduct of free, fair and credible elections in Nigeria, EMBs in Nigeria also present themselves as willing tools in the hands of politicians to compromise the integrity of the electoral process. The number of litigations and level of both international and local denunciations that attend every election in Nigeria underscores the magnitude of electoral malfeasance inherent in the elections conducted by successive EMBs in Nigeria. The paper analysed the major challenges that inhibit the conduct of free and fair elections in Nigeria and proffered solutions to them. Relying heavily on the documentary methods of data collection, the paper concludes that until all these challenges confronting EMBs in Nigeria in the conduct of free and fair elections are comprehensively addressed, credible elections will continue to be a mirage in the country.
Nicholson, Tony; Travis, Simon; Ettles, Duncan; Dyet, John; Sedman, Peter; Wedgewood, Kevin; Royston, Christopher
Purpose: The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Methods: Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. Results: Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. Conclusion: Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication
Donkervoort, S. C.; Kortram, K.; Dijksman, L. M.; Boermeester, M. A.; van Ramshorst, B.; Boerma, D.
Complication rates after a laparoscopic cholecystectomy are still up to 10 %. Knowledge of individual patient risk profiles could help to reduce morbidity. The aim of this study is to create risk profiles for specific complications to anticipate on individual outcome. Individual patient outcome for
Holte, Kathrine; Bardram, Linda; Wettergren, André
Bile duct injury (BDI) after cholecystectomy remains a serious complication with major implications for patient outcome. For most major BDIs, the recommended method of repair is a hepaticojejunostomy (HJ). We conducted a retrospective review aiming to examine the perioperative and the long...
Conclusion: According to above statistically significant relation, we recommend that in patients who are candidate for cholecystectomy, if elevated preoperative serum alkaline phosphatase or elevated preoperative serum bilirubin or abnormal ultrasound findings were observed, more diagnostic evaluation should be done for them including MRC and ERC.
Electrocautery remains the main energy form used for dissection in laparoscopic cholecystectomy. However, due to its many risks the search continues for safer and more efficient forms of energy. This chapter assesses the outcomes of dissection using ultrasonic energy as compared to monopolar electrocautery during laparoscopic cholecystectomy. Studies included are trials of prospectively randomized adult patients with symptomatic gallstone disease subject either ultrasonic or monopolar electrocautery dissection during laparoscopic cholecystectomy. Seven trials were included in this review, with a total patient number of 695 randomized to two dissection methods: 340 in the electrocautery group and 355 in the ultrasonic group. Ultrasonic dissection is shown to be superior to monopolar electrocautery in laparoscopic cholecystectomy. Disadvantages include a difficult maneuvering technique and overall cost. Appropriate training programs may be implemented to overcome the first disadvantage, and it might be argued that given the combined cost of factors associated with standard clip and cautery technique, cost issues may be outweighed by the benefits of ultrasonic dissection. However, this necessitates further cost-benefit analysis.
risk of gallstone formation in transplant patients because of reasons such as immunosuppressive drugs, obesity, hyperlipidemia, and diabetes mellitus. Laparoscopic cholecystectomy, when performed in this group of patients, has been reported to have similar morbidity and mortality as in non-transplant patients. Here ...
Blichfeldt-Eckhardt, Morten Rune; Ording, Helle; Andersen, Claus
Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1week postoperatively...
Bartosiak, Katarzyna; Liszka, Maciej; Drazba, Tomasz; Paśnik, Krzysztof; Janik, Michal R
Gallbladder specimens are routinely sent for histopathological examination after cholecystectomy in order to rule out the presence of unexpected pathological findings. To establish the overall incidence of unexpected pathological findings in patients who underwent laparoscopic cholecystectomy for symptomatic gallbladder disease and determine whether the macroscopic appearance of the gallbladder in ultrasound examination could be a valid method for identifying patients with gallbladder malignancy. A retrospective study was conducted between 2013 and 2015. All histological reports (n = 1131) after cholecystectomy were searched for unexpected pathological findings. In cases where unexpected pathological findings were identified the additional analysis of preoperative abdominal ultrasound examination (USG) was done to determine the usefulness of USG in diagnosis of gallbladder malignancy. Of the 1131 patients included in the study, 356 (31.47%) were male and 774 (68.43%) were female. Unexpected pathological findings were present in 21 cases. The overall incidence of unexpected pathological findings was 1.86%. Only in 5 patients were suspicious appearances of gallbladder observed in preoperative ultrasound examination. In 16 patients there was no suspicion of malignancy. The positive predictive value of USG was 0.238. The incidence of unexpected pathological findings after laparoscopic cholecystectomy was 1.86%. Ultrasonography has low positive predictive value for identifying patients with malignant findings in a gallbladder specimen.
Borly, L; Anderson, I B; Bardram, L
patients completed all questionnaires. Twenty-one patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an introverted personality...
L.S.G.L. Wauben; R.H.M. Goossens (Richard); D.J. van Eijk (Daan); J.F. Lange (Johan)
textabstractBackground: Iatrogenic bile duct injury remains a current complication of laparoscopic cholecystectomy. One uniform and standardized protocol, based on the "critical view of safety" concept of Strasberg, should reduce the incidence of this complication. Furthermore, owing to the rapid
Badru, Faidah; Saxena, Saurabh; Breeden, Robert; Bourdillon, Maximillan; Fitzpatrick, Colleen; Chatoorgoon, Kaveer; Greenspon, Jose; Villalona, Gustavo
Little data exist regarding the recurrence of pancreatitis in pediatric patients with gallstone pancreatitis awaiting cholecystectomy. This study evaluates the recurrence rate of pancreatitis after acute gallstone pancreatitis based on the timing of cholecystectomy in pediatric patients. A retrospective chart review of all patients admitted with gallstone pancreatitis from 2007 to 2015 was performed. Children were divided into the following five groups. Group 1 had surgery during the index admission. Group 2 had surgery within 2 wk of discharge. Group 3 had surgery between 2 and 6 wk postdischarge. Group 4 had surgery 6 wk after discharge, and group 5 patients had no surgery. The recurrence rates of pancreatitis were calculated for all groups. Forty-eight patients with gallstone pancreatitis were identified in this study. The 19 patients in group 1 had no recurrence of their pancreatitis. Of the remaining 29 patients, nine (31%) had recurrence of pancreatitis or required readmission for abdominal pain prior to their cholecystectomy. In group 2, two of the eight patients (25%) had recurrent pancreatitis. In group 3, three of eight patients (37.5%) developed recurrent pancreatitis. In group 4, three of five patients (60%), and in group 5, one of eight. No children in group 5 had demonstrable gallstones at presentation, only sludge in their gallbladder. Cholecystectomy during the index admission is associated with no recurrence or readmission for pancreatitis. Therefore, we recommend that cholecystectomy be performed after resolution of an episode of gallstone pancreatitis during index admission. Copyright © 2017 Elsevier Inc. All rights reserved.
Efendiyeva, M T; Abdurakhmanova, A Z
Investigation of efficiency of liquid synbiotics and structure-resonance electric magnetic therapy (SRMT) among patients after cholecystectomy. 90 patients after cholecystectomy have been investigated (CE). Along with general clinical meth-ods of investigation, patients passed US investigation of abdomen, biochemical blood tests, bacteriological test of faeces, investigation of short-chain fatty acids (SCFA) by gas-liquid osteal chromatographic analysis. State of vegetative nervous system passed analysis according to variability of heart rhythm (VHR) by spectral analysis method using "Cardiac technic 4000 AD" cardiac monitor in frame of 24-hr ECG monitoring. Estimation of life quality (LQ) of patients after cholecystectomy has been conducted by "SF-36 Health status survey". Patients have been divided into 3 groups, comparable according to the main clinical and functional indicators. Patients of first group (30 people) passed correction of dysbiosis by liquid synbiotics. Patients of a second group (30 persons) passed complex treatment of SRMT and liquid synbiotics. Control group was composed by 30 patients after cholecystectomy who had been receiving diet therapy. In term of investigation 90% of patients have shown decrease of number and methabolic activity of microflora, change of activity of anaerobic microorganisms. Analysis of variability of heart rhythm have displayed relative prevalence of sympathetic modulation of a rhythm on the background of elevated ergotropic component of the total capacity of a spectrum; estimation of life quality (LQ) has shown that limitation of physical activity is a most considerable contribution to decrease of LQ among patients after cholecystectomy. After a course of liquid synbiotics and SMRT recovery and improvement of intestines and improvement of all indicator of life quality is observed.
Polat, Murat; Ozcan, Onder; Sahan, Leyla; Üstündag-Budak, Yasemin; Alisik, Murat; Yilmaz, Nigar; Erel, Özcan
We aimed to investigate the short-term effect of laparoscopic surgery on serum thiol-disulfide homeostasis levels as a marker of oxidant stress of surgical trauma in elective laparoscopic cholecystectomy patients. Venous blood samples were collected, and levels of native thiols, total thiols, and disulfides were determined with a novel automated assay. Total antioxidant capacity (measured as the ferric-reducing ability of plasma) and serum ischemia modified albumin, expressed as absorbance units assayed by the albumin cobalt binding test, were determined. The major findings of the present study were that native thiol (283 ± 45 versus 241 ± 61 μmol/L), total thiol (313 ± 49 versus 263 ± 67 μmol/L), and disulfide (14.9 ± 4.6 versus 11.0 ± 6.1 μmol/L) levels were decreased significantly during operation and although they increased, they did not return to preoperation levels 24 hours after laparoscopic surgery compared to the levels at baseline. Disulfide/native thiol and disulfide/total thiol levels did not change during laparoscopic surgery. The decrease in plasma level of native and total thiol groups suggests impairment of the antioxidant capacity of plasma; however, the delicate balance between the different redox forms of thiols was maintained during surgery.
Kejriwal, Aditya Kumar; Begum, Shaheen; Krishan, Gopal; Agrawal, Richa
Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial. We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient. We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml -1 mixed with 0.5 ml of fentanyl 50 μg ml -1 . Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension, or pruritus during or after surgery. The patient was reviewed 2 days postoperatively in ward. The thoracic spinal anesthetia was performed easily in the patient. Some discomfort which was readily treated with 1mg midazolam and 20 mg ketamine intravenously. There was no neurological deficit and hemodynamic parameters were in normal range intra and post-operatively and recovery was uneventful. We used a narrow gauze (26G) spinal needle which minimized the trauma to the patient and the chances of PDPH, which was more if 16 or 18G epidural needle had been used and could have increased further if there have been accidental dura puncture. Also using spinal anesthesia was economical although it should be done cautiously as we are giving spinal anesthesia above the level of termination of spinal cord.
Gupta, A. Kumar Chandra; Kumar, P.; Vasanth Kumar, N.
The Geospatial Delhi Limited (GSDL), a Govt. of NCT of Delhi Company formed in order to provide the geospatial information of National Capital Territory of Delhi (NCTD) to the Government of National Capital Territory of Delhi (GNCTD) and its organs such as DDA, MCD, DJB, State Election Department, DMRC etc., for the benefit of all citizens of Government of National Capital Territory of Delhi (GNCTD). This paper describes the development of Geospatial Map based Election portal (GMEP) of NCT of Delhi. The portal has been developed as a map based spatial decision support system (SDSS) for pertain to planning and management of Department of Chief Electoral Officer, and as an election related information searching tools (Polling Station, Assembly and parliamentary constituency etc.,) for the citizens of NCTD. The GMEP is based on Client-Server architecture model. It has been developed using ArcGIS Server 10.0 with J2EE front-end on Microsoft Windows environment. The GMEP is scalable to enterprise SDSS with enterprise Geo Database & Virtual Private Network (VPN) connectivity. Spatial data to GMEP includes delimited precinct area boundaries of Voters Area of Polling stations, Assembly Constituency, Parliamentary Constituency, Election District, Landmark locations of Polling Stations & basic amenities (Police Stations, Hospitals, Schools and Fire Stations etc.). GMEP could help achieve not only the desired transparency and easiness in planning process but also facilitates through efficient & effective tools for management of elections. It enables a faster response to the changing ground realities in the development planning, owing to its in-built scientific approach and open-ended design.
Make your voice heard, support your candidates! We hope that you will be many to vote and to elect the new Staff Council! By doing so, you can support and encourage the women and men, who will represent you over the next two years. The voting takes place from 23 October to 13 November, at noon at https://ap-vote.web.cern.ch/elections-2017. Elections Timetable Monday 13 November, at noon Closing date for voting Tuesday 21 November and Tuesday 5 December Publication of the results in Echo Monday 27 and Tuesday 28 November Staff Association Assizes Tuesday 5 December (afternoon) First meeting of the new Staff Council and election of the new Executive Committee The voting procedure will be monitored by the Election Committee, which is also in charge of announcing the results in Echo on 21 November and 5 December. Candidates for the 2017 Elections
Vote Elections to fill all seats in the Staff Council are being organized this month. Voting will begin on Monday 31 October. Make your voice heard and be many to elect the new Staff Council. By doing so, you will be encouraging the men and women who will represent you over the next two years and they will doubtless appreciate your gratitude. More details on the elections can be found on the Staff Association web site. (http://association.web.cern.ch) Elections Timetable Monday 31 October, at noon start date for voting Monday 14 November, at noon closing date for voting Monday 21 November, publication of the results in Echo Tuesday 22 and Wednesday 29 November Staff Association Assizes Tuesday 6 December, at 10.00 a.m. first meeting of the new Staff Council and election of the new Executive Committee The voting procedure is monitored by the Election Committee.
Make your voice heard, support your candidates! Be many to vote and to elect the new Staff Council. By doing so, you will be encouraging the men and women who will represent you over the next two years and they will without doubt appreciate your gratitude. The voting takes place from the 26th of October to the 9th of November, at noon at https://ap-vote.web.cern.ch/elections-2015. Elections Timetable Monday 9 November, at noon Closing date for voting Monday 16 and Monday 23 November, publication of the results in Echo Tuesday 8 December, at 10.00 a.m. first meeting of the new Staff Council and election of the new Executive Committee The voting procedure will be monitored by the Election Committee, which is also in charge of announcing the results in Echo on 16 and 24 November. Candidates for the 2015 elections
Amirthalingam, Vinoban; Low, Jee Keem; Woon, Winston; Shelat, Vishalkumar
The aim of this study was to determine whether early laparoscopic cholecystectomy (LC) is safe and feasible for patients diagnosed with moderate (grade 2) and severe (grade 3) acute cholecystitis (AC) according to the Tokyo Guidelines 2013 (TG13). Early cholecystectomy is the current accepted standard of care for patients with mild (grade 1) and selected grade 2 AC based on TG13. For selected grade 2 and grade 3 AC, early percutaneous cholecystostomy (PC) followed by delayed cholecystectomy is recommended. Patients diagnosed with AC over a 14-month period were identified and divided into three grades of AC based upon chart review using the grading and severity indicators according to TG13. A total of 149 patients underwent emergency LC. Eighty-two (55 %) patients were male. Eighty-four (56.4 %) patients were classified as grade 1 AC, 49 (32.9 %) as grade 2, and 16 (10.7 %) as grade 3. Eighty-three (98.8 %) patients with grade 1 AC underwent emergency LC, and 1 patient (1.2 %) underwent PC followed by emergency LC. The median length of hospital stay for grade 1 AC patients was 2 (1-11) days. There were 2 (2.4 %) readmissions with fever and no additional complications. Among the 65 patients identified with grade 2 or 3 AC, 6 (9.2 %) underwent PC followed by emergency LC. Fifty-nine (90.8 %) patients underwent emergency cholecystectomy: 58 (98.3 %) LC and one (1.7 %) open cholecystectomy. Among the 58 patients with LC, 3 (5.2 %) patients had open conversion and 10 (17.2 %) patients required subtotal cholecystectomy. One patient was converted to open due to bile duct injury and had hepaticojejunostomy repair. Two other patients were converted due to dense adhesions and inability to safely dissect Calot's triangle. The median length of hospital stay was 4 (1-28) days. There was one readmission for ileus. Severity grading of AC is not the sole determinant of early LC. Patient comorbidity also impacts clinical decision. Confirmation in a larger cohort is
The political, economical and social situation in Germany after the election and attitude to nuclear energy are summarised. The Coalition agreement include: 1.Extension of the remaining lifetimes of the nuclear power plants (Nuclear Power considered as “Bridging technology”; Safety first; Skimming of additional profits) 2. No nuclear new builds in Germany 3. Approval and promotion (loan guarantees) of nuclear exports 4. Reversal of the moratorium regarding the exploration of Gorleben salt dome (Completion of the exploration; International Peer Review Group) 5.Further research regarding competence preservation and safety
development time, or second dynamically, i.e. monitoring while an implementation is used during an election, or after the election is over, for forensic analysis. This thesis contains two chapters on this subject: the chapter Analyzing Implementations of Election Technologies describes a technique...... process. The chapter Measuring Voter Lines describes an automated data collection method for measuring voters' waiting time, and discusses statistical models designed to provide an understanding of the voter behavior in polling stations....
Lee, Sang Chul; Choi, Byeong-Jo; Kim, Say-June
In an effort to overcome the limitations of single-port laparoscopic cholecystectomy (LC) while preserving the cosmetic benefits of reduced ports cholecystectomy, we have developed a 2-port LC that allows for the full, unrestricted use of 4 laparoscopic instruments. We retrospectively analyzed data of patients who had undergone either 4-port LC or 2-port LC for benign gallbladder diseases between March 2007 and March 2013. Two incisions of 2-port LC were composed of an umbilical incision as the manner of single-port laparoscopic surgery and a 5-mm epigastric incision. These two incisions were utilized for comfortable bimanual manipulation under the liver-elevated vision provided by a liver retractor. During the study period, 766 patients underwent LC; 263 (34.3%) started with 4-port LC, and 503 (65.7%) started with 2-port LC. Of patients started with 2-port LC, 486 patients (96.6%) was ended up with 2-port without open conversion or addition of port(s). The two groups had similar operative time, open conversion rate, incidence of complications, analgesic requirement, and length of postoperative hospital stay. Multivariate analyses revealed that the independent factors related to prolonged operative time (≥ 90 th percentile) in 2-port LC were the presence of cholecystitis (odds ratio [OR] 2.412, 95% CI 1.246-4.668, p = 0.009) and admission through the emergency department (OR 2.132, 95% CI 1.135-4.004, p = 0.019). This study suggests that 2-port LC for benign gallbladder diseases is as safe and feasible as 4-port LC when it is performed by surgeons trained in conventional laparoscopic techniques. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.
CERN - EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH PENSION FUND ELECTIONS - Pension Fund This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate: First name: Michel Name: Goossens The CERN/ESO Pension Fund represents, for most staff, the sole source of income when they retire. The health of our Pension Fund is thus of the utmost importance to ensure the payment of pensions up to the death of the last beneficiary. The 2003 actuarial review showed a large deficit and several corrective measures have already been taken. The next months will see the results of the 2006 actuarial review. We hope they will show that the measures taken last year are going in the right direction. However, we must remain proactive since further measures will no doubt be necessary. New and imaginative proposals must be prepared and discussed in the widest possible forum, by regular direct contact with staf...
CERN - EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH PENSION FUND ELECTIONS - Pension Fund This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate: First name: Michel Name: Goossens The CERN/ESO Pension Fund represents, for most staff, the sole source of income when they retire. The health of our Pension Fund is thus of the utmost importance to ensure the payment of pensions up to the death of the last beneficiary. The 2003 actuarial review showed a large deficit and several corrective measures have already been taken. The next months will see the results of the 2006 actuarial review. We hope they will show that the measures taken last year are going in the right direction. However, we must remain proactive since further measures will no doubt be necessary. New and imaginative proposals must be prepared and discussed in the widest possible forum, by regular direct contact with staff...
CERN - EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH PENSION FUND ELECTIONS - Pension Fund This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate: First name: Michel Name: Goossens The CERN/ESO Pension Fund represents, for most staff, the sole source of income when they retire. The health of our Pension Fund is thus of the utmost importance to ensure the payment of pensions up to the death of the last beneficiary. The 2003 actuarial review showed a large deficit and several corrective measures have already been taken. The next months will see the results of the 2006 actuarial review. We hope they will show that the measures taken last year are going in the right direction. However, we must remain proactive since further measures will no doubt be necessary. New and imaginative proposals must be prepared and discussed in the widest possible forum, by regular direct contact ...
ORGANISATION EUROPEENNE POUR LA RECHERCHE NUCLEAIRE CERN EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH CAISSE DE PENSIONS / PENSION FUND Caisse de Pensions - ELECTIONS - Pension Fund This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate : Name : CHIAVERI First Name : Enrico I have been a CERN staff member since 1973 and have always been interested in our working conditions. As a member of the Executive Committee of the Staff Association I participated from 1980 to 1984 in the Working Group on Pensions mandated by the CERN Council. This commitment led to my becoming a member of the Governing Board of the Pension Fund in 1983, since when I have taken an active part in various commissions and working groups (Real Estate Asset Management Committee, Working Group on Actuarial Matters etc.); in so doing I have gained a thorough knowledge of different areas of the Pension Fund. Since ...
Elections to fill all seats in the Staff Council are being organized this month. The voting takes place from the 28 of October to the 11th of November, at noon. As you may have noted when reading Echo, many issues concerning our employment conditions are on the agenda of the coming months, and in particular the Five-yearly-Review 2015, subject of the questionnaire that you probably recently filled out. All this will keep the next Staff Council very busy indeed. So, make your voice heard and take part in the elections for a new Staff Council. By doing so, you will be encouraging the men and women who will be representing you over the next two years and they will doubtless appreciate your gratitude. Every member of the Staff Association will have received an email containing a link to the webpage which will allow voting. If you are a member of the Staff Association and you did not receive such an email, please contact the Staff Association secretariat (email@example.com). Do not forget to v...
Lee, Ji Hyun; Huh, Jin; Kim, Duk Kyung; Gil, Jea Ryoung; Min, Sung Won; Han, Sun Sook
Laparoscopic cholecystectomy (LC) has traditionally been performed under general anesthesia, however, owing in part to the advancement of surgical and anesthetic techniques, many laparoscopic cholecystectomies have been successfully performed under the spinal anesthetic technique. We hoped to determine the feasibility of segmental epidural anesthesia for LC. Twelve American Society of Anesthesiologists class I or II patients received an epidural block for LC. The level of epidural block and the satisfaction score of patients and the surgeon were checked to evaluate the efficacy of epidural block for LC. LC was performed successfully under epidural block, with the exception of 1 patient who required a conversion to general anesthesia owing to severe referred pain. There were no special postoperative complications, with the exception of one case of urinary retention. Epidural anesthesia might be applicable for LC. However, the incidence of intraoperative referred shoulder pain is high, and so careful patient recruitment and management of shoulder pain should be considered.
Hance, Julian; Aggarwal, Rajesh; Moorthy, Krishna; Munz, Yaron; Undre, Shabnam; Darzi, Ara
Standardized short courses in laparoscopic cholecystectomy aim to teach laparoscopic skills to surgical trainees, although end-of-course assessments of performance remain subjective. The current study aims to objectively assess psychomotor skills acquisition of trainees attending laparoscopic cholecystectomy courses. Thirty-seven junior surgical trainees had their laparoscopic skills assessed before and after attending 1 of 3 separate 2-day courses (A, B, and C), all with identical format. Assessments were comprised of a standardized simulated laparoscopic task, with performance measured using a valid electromagnetic hand-motion tracking device. Overall, trainees made significant improvements in path length (P=.006), number of movements (Ppsychomotor skills on courses. In addition to providing participants with an insight into their skills, these data can be used to demonstrate course efficacy.
Ege, B.; Gulen, M.
The need to integrate aspects of functional, psychosocial and cosmetic impairment into medical care is increasingly accepted among the physicians and the patients. For these reasons, single-port robotic surgery emerges as the most advanced approach using the technology. In this study, authors used a new robotic dissector with monopolar electrocautery feature in order to determine the device's safety and efficacy. Between January 2015 and February 2016, 10 out of 11 consecutive cholecystectomies were included in the study. There was no significant differences in port placement and docking time between two groups (p=0.382, p=0.789). The time spent by surgeon was significantly shorter in group 2 (p=0.005). Using robotic dissector with monopolar cautery significantly shortened the console time. This new instrument (Maryland monopolar dissector) provides more feasible and faster dissection of the Calot's triangle, supporting further the advantages of robotic single-site cholecystectomy. (author)
Type of surgery. Breast. 16 (32). Simple mastectomy. Simple mastectomy with axillary clearance. Quadrantectomy with axillary clearance. Endocrine. 25 (50). Thyroidectomy. Parathyroidectomy. Adrenalectomy. GIT. 7 (14). Colectomy. Laparascopic cholecystectomy. Reversal of Hartman's procedure. Hernioplasty. Others.
This article argues that the increasing international interest in elections as exemplified by the rise of international election monitoring induces temporal shifts in the use of violent intimidation by political actors. The presence of international electoral missions lowers the potential for
Webster, Gerald R.
Outlines the historical development of women's legal and political status in the United States, focusing on suffrage, the three "waves" of women's movements, and access to elected office. Discusses three impediments of electing women candidates to public office: (1) solidarity; (2) political culture; and (3) the impact of the single-member…
Family planning centres are structures designed to receive and care for women requesting elective abortions. Here the specially trained, dedicated teams offer personalised care. The instrumental elective abortion is prepared in the same way as a surgical procedure and is subject to the same monitoring. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Harboe, Kirstine Moll; Anthonsen, Kristian; Bardram, Linda
and postoperative complications RESEARCH DESIGN AND SUBJECTS: Data from 1360 medical records of patients undergoing cholecystectomy were compared to the relevant administrative data from the National Patient Registry. The medical records served as the "gold standard". The association between the individual...... indicators and the occurrence of a postoperative complication was assessed. MEASURES: Validation of administrative data against the gold standard was done by the calculation of per cent agreement (including kappa-values) sensitivity/specificity and predictive values. The association between indicators...
Gabriel Hideki Vatanabe Brunello
Full Text Available Polls for majoritarian voting systems usually show estimates of the percentage of votes for each candidate. However, proportional vote systems do not necessarily guarantee the candidate with the most percentage of votes will be elected. Thus, traditional methods used in majoritarian elections cannot be applied on proportional elections. In this context, the purpose of this paper was to perform a Bayesian inference on proportional elections considering the Brazilian system of seats distribution. More specifically, a methodology to answer the probability that a given party will have representation on the chamber of deputies was developed. Inferences were made on a Bayesian scenario using the Monte Carlo simulation technique, and the developed methodology was applied on data from the Brazilian elections for Members of the Legislative Assembly and Federal Chamber of Deputies in 2010. A performance rate was also presented to evaluate the efficiency of the methodology. Calculations and simulations were carried out using the free R statistical software.
Routine use of intraoperative cholangiography during laparoscopic cholecystectomy is still widely advocated and standard in many departments, however, this is discussed controversially. We have developed a new diagnostic strategy to detect bile duct stones. The concept is based on an ultrasound examination and on a screening for the presence of six risk indicators of choledocholithiasis. 120 consecutive patients undergoing laparoscopic cholecystectomy were prospectively screened for the presence of six risk indicators of choledocholithiasis: history of jaundice; history of pancreatitis; hyperbilirubinemia; hyperamylasemia; dilated bile duct; unclear ultrasound findings. The sensitivity of ultrasound and of intraoperative cholangiography in diagnosing bile duct stones was also evaluated. For the detection of bile duct stones, the sensitivity was 77% for ultrasound and 100% for intraoperative cholangiography. 20% of all patients had at least one risk indicator. The presence of a risk indicator correlated significantly with the presence of choledocholithiasis (p concept, we would have avoided 80% of intraoperative cholangiographies without missing a stone in the bile duct. This study lends further support to the view that the routine use of intraoperative cholangiography in patients undergoing laparoscopic cholecystectomy is not necessary.
Ikonen, T S; Antikainen, T; Silvennoinen, M; Isojärvi, J; Mäkinen, E; Scheinin, T M
Simulators are widely used in occupations where practice in authentic environments would involve high human or economic risks. Surgical procedures can be simulated by increasingly complex and expensive techniques. This review gives an update on computer-based virtual reality (VR) simulators in training for laparoscopic cholecystectomies. From leading databases (Medline, Cochrane, Embase), randomised or controlled trials and the latest systematic reviews were systematically searched and reviewed. Twelve randomised trials involving simulators were identified and analysed, as well as four controlled studies. Furthermore, seven studies comparing black boxes and simulators were included. The results indicated any kind of simulator training (black box, VR) to be beneficial at novice level. After VR training, novice surgeons seemed to be able to perform their first live cholecystectomies with fewer errors, and in one trial the positive effect remained during the first ten cholecystectomies. No clinical follow-up data were found. Optimal learning requires skills training to be conducted as part of a systematic training program. No data on the cost-benefit of simulators were found, the price of a VR simulator begins at EUR 60 000. Theoretical background to learning and limited research data support the use of simulators in the early phases of surgical training. The cost of buying and using simulators is justified if the risk of injuries and complications to patients can be reduced. Developing surgical skills requires repeated training. In order to achieve optimal learning a validated training program is needed.
Angelou, Anastasios; Skarmoutsos, Athanasios; Margonis, Georgios A; Moris, Demetrios; Tsigris, Christos; Pikoulis, Emmanouil
Minimally invasive techniques are used more and more frequently. Since conventional laparoscopic approach has been the gold standard, surgeons in their effort to further reduce the invasiveness of conventional laparoscopic cholecystectomy have adopted Single Incision approach. The widespread adoption of robotics has led to the inevitable hybridization of robotic technology with laparoendoscopic single-site surgery (LESS). As a result, employment of the da Vinci surgical system may allow greater surgical maneuverability, improving ergonomics. A review of the English literature was conducted to evaluate all robotic single port cholecystectomy performed till today. Demographic data, operative parameters, postoperative outcomes and materials used for the operation were collected and assessed. A total of 12 studies, including 501 patients were analyzed. Demographics and clinical characteristics of the patients was heterogeneous, but in most studies a mean BMI port cholecystectomy is a safe and feasible alternative to conventional multiport laparoscopic or manual robotic approach. However, current data do not suggest a superiority of robotic SILC over other established methods.
Ross, Sharona; Rosemurgy, Alexander; Albrink, Michael; Choung, Edward; Dapri, Giovanni; Gallagher, Scott; Hernandez, Jonathan; Horgan, Santiago; Kelley, William; Kia, Michael; Marks, Jeffrey; Martinez, Jose; Mintz, Yoav; Oleynikov, Dmitry; Pryor, Aurora; Rattner, David; Rivas, Homero; Roberts, Kurt; Rubach, Eugene; Schwaitzberg, Steven; Swanstrom, Lee; Sweeney, John; Wilson, Erik; Zemon, Harry; Zundel, Natan
Many surgeons attempting Laparo-Endoscopic Single Site (LESS) cholecystectomy have found the operation difficult, which is inconsistent with our experience. This article is an attempt to promote a standardized approach that we feel surgeons with laparoscopic skills can perform safely and efficiently. This is a four-trocar approach consistent with the four incisions utilized in conventional laparoscopic cholecystectomy. After administration of general anesthesia, marcaine is injected at the umbilicus and a 12-mm vertical incision is made through the already existing anatomical scar of the umbilicus. A single four-trocar port is inserted. A 5-mm deflectable-tip laparoscope is placed through the trocar at the 8 o'clock position, a bariatric length rigid grasper is inserted through the trocar at the 4 o'clock position (to grasp the fundus), and a rigid bent grasper is placed through the 10-mm port (to grasp the infundibulum). This arrangement of the instruments promotes minimal internal and external instrument clashing with simultaneous optimization of the operative view. This orientation allows retraction of the gallbladder in a cephalad and lateral direction, development of a window between the gallbladder and the liver which promotes the "critical view" of the cystic duct and artery, and provides triangulation with excellent visualization of the operative field. The operation is concluded with diaphragmatic irrigation of marcaine solution to minimize postoperative pain. Standardization of LESS cholecystectomy will speed adoption, reduce intraoperative complications, and improve the efficiency and safety of the approach.
Sumiyoshi, Kinjiro; Sato, Norihiro; Akagawa, Shin; Hirano, Tatsuya; Koikawa, Kazuhiro; Horioka, Kohei; Ozono, Keigo; Fujiwara, Kenji; Tanaka, Masao; Sada, Masayuki
Single-incision laparoscopic cholecystectomy (SILC) is a promising alternative to standard multi-incision laparoscopic cholecystectomy (LC). However, generalization of SILC is still hampered by technical difficulties mainly associated with the lack of trocars used for retraction of the gallbladder. We therefore developed a modified method of SILC with the use of needle graspers (SILC-N) for optimal retraction and exposure. In addition to two trocars inserted through a single transumbilical incision, two needle ports were placed on the right subcostal and lateral abdominal wall, through which needle graspers were used for retraction of the gallbladder. Since December, 2009, 12 patients with symptomatic cholelithiasis were treated by SILC-N. SILC-N was successfully performed in all but one patient requiring a conversion to the 4-port LC with a mean operative time of 71.5 (48-107) minutes. None of the patients experienced intraoperative or postoperative complications. The transumbilical incision and pinholes for needle graspers were almost invisible on discharge. Our preliminary results suggest that SILC-N is a simple, safe and feasible technique of cholecystectomy offering similar postoperative recovery and better cosmetic outcome as compared to conventional LC.
Cuadrado-Garcia, Angel; Noguera, Jose F; Olea-Martinez, Jose M; Morales, Rafael; Dolz, Carlos; Lozano, Luis; Vicens, Jose-Carlos; Pujol, Juan José
Natural orifice transluminal endoscopic surgery (NOTES) makes it possible to perform intraperitoneal surgical procedures with a minimal number of access points in the abdominal wall. Currently, it is not possible to perform these interventions without the help of abdominal wall entryways, so these procedures are hybrids fusing minilaparoscopy and transluminal endoscopic surgery. This report presents a prospective clinical series of 25 patients who underwent transvaginal hybrid cholecystectomy for cholelithiasis. The study comprised a clinical series of 25 consecutive nonrandomized women who underwent a fusion transvaginal NOTES and minilaparoscopy procedure with two trocars for cholelithiasis: one 5-mm umbilical trocar and one 3-mm trocar in the upper left quadrant. The study had no control group. The scheduled surgical intervention was performed for all 25 women. No intraoperative complications occurred. One patient had mild hematuria that resolved in less than 12 h, but no other complications occurred during an average follow-up period of 140 days. Of the 25 women, 20 were discharged in 24 h, and 5 were discharged less than 12 h after the procedure. Hybrid transvaginal cholecystectomy, combining NOTES and minilaparoscopy, is a good surgical model for minimally invasive surgery. It can be performed in surgical settings where laparoscopy is practiced regularly using the instruments normally used for endoscopy and laparoscopic surgery. Due to the reproducibility of the intervention and the ease of vaginal closure, hybrid transvaginal cholecystectomy will permit further development of NOTES in the future.
Full Text Available ObjectiveTo investigate whether operative time of laparoscopic cholecystectomy impacts the carbonyl hemoglobin (COHb concentration in peripheral blood. MethodsForty patients with gallstones and indications for laparoscopic cholecystectomy were enrolled in the study. Peripheral venous blood samples were collected at the beginning and end of the operative procedure. COHb concentration was measured by UV spectroscopy. The significance of changes in COHb concentration in relation to time of the operative procedure (rounded to the nearest minute was assessed by statistical correlation coefficient test. ResultsThe laparoscopic procedure was completed in 38 cases, and two patients required conversion to laparotomy. The content of COHb in peripheral venous blood had significantly increased during the laparoscopic operation (operation beginning: 11.07%±1.18% vs. operation end: 1.44%±0.26%, P＜0.05. The change was positively correlated with operation time (r=0.85. ConclusionCarbon monoxide produced during the laparoscopic cholecystectomy procedure can lead to an increase in peripheral venous blood COHb. The longer the operation lasts, the greater the increase in COHb.
Go, P. M.; Stolk, M. F.; Obertop, H.; Dirksen, C.; van der Elst, D. H.; Ament, A.; van Erpecum, K. J.; van Berge Henegouwen, G. P.; Gouma, D. J.
In order to strike the most favorable balance between health benefits and costs, three treatment modalities for symptomatic cholelithiasis were compared in a cost-effectiveness study: extracorporeal shock-wave lithotripsy (ESWL), conventional cholecystectomy (CC), and laparoscopic cholecystectomy
Haberkern, CM; Neumayr, LD; Orringer, EP; Earles, AN; Robertson, SM; Abboud, MR; Koshy, M; Idowu, O; Vichinsky, EP; Black, D.
Cholecystectomy is the most common surgical procedure performed in sickle cell anemia (SCA) patients. We investigated the effects of transfusion and surgical method on perioperative outcome. A total of 364 patients underwent cholecystectomy: group 1 (randomized to aggressive transfusion) 110
Kwon, O-K; Oh, C W; Park, H; Bang, J S; Bae, H-J; Han, M K; Park, S-H; Han, M H; Kang, H-S; Park, S-K; Whang, G; Kim, B-C; Jin, S-C
In order to prevent unexpected events such as aspiration pneumonia, cerebral angiography has been performed under fasting in most cases. We investigated prospectively the necessity of fasting before elective cerebral angiography. The study is an open-labeled clinical trial without random allocation. In total, 2554 patients who underwent elective cerebral angiography were evaluated on development of nausea, vomiting, and pulmonary aspiration during and after angiography. Potential risks and benefits associated with fasting were provided in written documents and through personal counseling to patients before the procedure. The patients chose their fasting or nonfasting option. No restriction in diet was given after angiography. The patients were observed for 24 hours. Nausea and vomiting during and within 1 hour after angiography was considered as a positive event associated with cerebral angiography. The overall incidence of nausea and vomiting during and within 1 hour after angiography was 1.05% (27/2554 patients). There was no patient with pulmonary aspiration. No statistical difference in nausea and vomiting development between the fasting and the diet groups was found. The incidence of nausea and vomiting associated with cerebral angiography is low and not affected by diet or fasting. Pulmonary aspiration had no difference between the diet and the fasting group. Our study suggests that fasting may not be necessary for patients who undergo elective cerebral angiography.
Pizzi, R; Cracknell, J; David, S; Laughlin, D; Broadis, N; Rouffignac, M; Duong, D V; Girling, S; Hunt, M
Nine adult Asiatic black bears (Ursus thibetanus) previously rescued from illegal bile farming in Vietnam were examined via abdominal ultrasound and exploratory laparoscopy for liver and gall bladder pathology. Three bears demonstrated notable gall bladder pathology, and minimally invasive cholecystectomies were performed using an open laparoscopic access approach, standard 10 to 12 mmHg carbon dioxide pneumoperitoneum and a four-port technique. A single bear required insertion of an additional 5 mm port and use of a flexible liver retractor due to the presence of extensive adhesions between the gall bladder and quadrate and left and right medial liver lobes. The cystic duct was dissected free and this and the cystic artery were ligated by means of extracorporeal tied Meltzer knot sutures. The gall bladder was dissected free of the liver by blunt and sharp dissection, aided by 3.8 MHz monopolar radiosurgery. Bears that have had open abdominal cholecystectomies are reported as taking four to six weeks before a return to normal activity postoperatively. In contrast, these bears demonstrated rapid unremarkable healing, and were allowed unrestricted access to outside enclosures to climb trees, swim and interact normally with other bears within seven days of surgery.
Stefanidis, Dimitrios; Chintalapudi, Nikita; Anderson-Montoya, Brittany; Oommen, Bindhu; Tobben, Daniel; Pimentel, Manuel
The reported incidence (0.16-1.5 %) of bile duct injury (BDI) during laparoscopic cholecystectomy (LC) is higher than during open cholecystectomy and has not decreased over time despite increasing experience with the procedure. The "critical view of safety" (CVS) technique may help to prevent BDI when certain criteria are met prior to division of any structures. This study aimed to evaluate the adherence of practicing surgeons to the CVS criteria during LC and the impact of a training intervention on CVS identification. LC procedures of general surgeons were video-recorded. De-identified recordings were reviewed by a blinded observer and rated on a 6-point scale using the previously published CVS criteria. A coaching program was conducted, and participating surgeons were re-assessed in the same manner. The observer assessed ten LC videos, each involving a different surgeon. The CVS was adequately achieved by two surgeons (20 %). The remaining eight surgeons (80 %) did not obtain adequate CVS prior to division of any structures, despite two surgeons dictating that they did; the mean score of this group was 1.75. After training, five participating surgeons (50 %) scored > 4, and the mean increased from 1.75 (baseline) to 3.75 (p < 0.05). The CVS criteria were not routinely used by the majority of participating surgeons. Further, one-fourth of those who claimed to obtain the CVS did so inadequately. All surgeons who participated in training showed improvement during their post-assessment. Our findings suggest that education of practicing surgeons in the application of the CVS during LC can result in increased implementation and quality of the CVS. Pending studies with larger samples, our findings may partly explain the sustained BDI incidence despite increased experience with LC. Our study also supports the value of direct observation of surgical practices and subsequent training for quality improvement.
Full Text Available Abstract Objective The study aims to investigate whether laparoscopic cholecystectomy (LC is a cost-effective strategy for managing gallbladder-stone disease compared to the conventional open cholecystectomy(OC in a Thai setting. Design and Setting Using a societal perspective a cost-utility analysis was employed to measure programme cost and effectiveness of each management strategy. The costs borne by the hospital and patients were collected from Chiang Rai regional hospital while the clinical outcomes were summarised from a published systematic review of international and national literature. Incremental cost per Quality Adjusted Life Year (QALY derived from a decision tree model. Results The results reveal that at base-case scenario the incremental cost per QALY of moving from OC to LC is 134,000 Baht under government perspective and 89,000 Baht under a societal perspective. However, the probabilities that LC outweighed OC are not greater than 95% until the ceiling ratio reaches 190,000 and 270,000 Baht per QALY using societal and government perspective respectively. Conclusion The economic evaluation results of management options for gallstone disease in Thailand differ from comparable previous studies conducted in developed countries which indicated that LC was a cost-saving strategy. Differences were due mainly to hospital costs of post operative inpatient care and value of lost working time. The LC option would be considered a cost-effective option for Thailand at a threshold of three times per capita gross domestic product recommended by the committee on the Millennium Development Goals.
Schwartz, Diane A; Shah, Adil A; Zogg, Cheryl K; Nicholas, Lauren H; Velopulos, Catherine G; Efron, David T; Schneider, Eric B; Haider, Adil H
Health care providers are increasingly focused on cost containment. One potential target for cost containment is in-hospital management of acute cholecystitis. Ensuring cholecystectomy within 24 hours for cholecystitis could mitigate costs associated with longer hospitalizations. We sought to determine the cost consequences of delaying operative management. The Nationwide Inpatient Sample (2003-2011) was queried for adult patients (≥16 years) who underwent laparoscopic cholecystectomy for a primary diagnosis of acute cholecystitis. Patients who underwent open procedures or endoscopic retrograde cholangiopancreatography were excluded. Generalized linear models (GLMs) were used to analyze costs for each day's delay in surgery. Multivariable analyses adjusted for patient demographics, hospital descriptors, Charlson comorbidity index, mortality, and length of stay. We analyzed 191,032 records. Approximately 65% of the patients underwent surgery within 24 hours of admission. The average cost of care for surgery on the admission day was $11,087. Costs disproportionately increased by 22% on the second hospital day ($13,526), by 37% on the third day ($15,243), by 52% on the fourth day ($16,822), by 64% on the fifth day ($18,196), by 81% on the sixth day ($20,125), and by 100% on the seventh day ($22,250) when compared with the cost of care for procedures performed within 24 hours of admission. Subset analysis of patients discharged 24 hours or earlier from the time of surgery demonstrated similar trends. After controlling for patient- and hospital-related factors, we noted significant costs associated with each day's delay in operative management. Cost containment practices for acute cholecystitis justify consideration of same-day or next-day surgery where the diagnosis is straightforward. Economic and value-based analysis, level III.
Full Text Available Marina Yiasemidou, Daniel Glassman, Peter Vasas, Sarit Badiani, Bijendra Patel Barts and the London School of Medicine and Dentistry, Department of Upper GI Surgery, Barts and The Royal London Hospital, London, UK Background: Virtual reality simulators have been gradually introduced into surgical training. One of the enhanced features of the latest virtual simulators is haptic feedback. The usefulness of haptic feedback technology has been a matter of controversy in recent years. Previous studies have assessed the importance of haptic feedback in executing parts of a procedure or basic tasks, such as tissue grasping. The aim of this study was to assess the role of haptic feedback within a structured educational environment, based on the performance of junior surgical trainees after undergoing substantial simulation training. Methods: Novices, whose performance was assessed after several repetitions of a task, were recruited for this study. The performance of senior house officers at the last stage of a validated laparoscopic cholecystectomy curriculum was assessed. Nine senior house officers completed a validated laparoscopic cholecystectomy curriculum on a haptic simulator and nine on a nonhaptic simulator. Performance in terms of mean total time, mean total number of movements, and mean total path length at the last level of the validated curriculum (full procedure of laparoscopic cholecystectomy was compared between the two groups. Results: Haptic feedback significantly reduced the time required to complete the full procedure of laparoscopic cholecystectomy (mean total time for nonhaptic machine 608.83 seconds, mean total time for haptic machine 553.27 seconds; P = 0.019 while maintaining safety standards similar to those of the nonhaptic machine (mean total number of movements: nonhaptic machine 583.74, haptic machine 603.93, P = 0.145, mean total path length: for nonhaptic machine 1207.37 cm, for haptic machine 1262.36 cm, P = 0
Sucandy, Iswanto; Nadzam, Geoffrey; Duffy, Andrew J; Roberts, Kurt E
The concept of reducing the number of transabdominal access ports has been criticized for violating basic tenets of traditional multiport laparoscopy. Potential benefits of reduced port surgery may include decreased pain, improved cosmesis, less hernia formation, and fewer wound complications. However, technical challenges associated with these access methods have not been adequately addressed by advancement in instrumentations. We describe our initial experience with the NovaTract™ Laparoscopic Dynamic Retractor. A retrospective review of all patients who underwent two-port laparoscopic cholecystectomy between 2013 and 2014 using the NovaTract retractor was performed. The patients were equally divided into three groups (Group A, B, C) based on the order of case performed. Eighteen consecutive patients underwent successful two-port laparoscopic cholecystectomy for symptomatic cholelithiasis. Mean age was 39.9 years and mean body mass index was 28.1 kg/m(2) (range 21-39.4). Overall mean operative time was 65 minutes (range 42-105), with Group A of 70 minutes, Group B of 65 minutes, and Group C of 58 minutes (P = .58). All cases were completed laparoscopically using the retraction system, without a need for additional ports or open conversion. No intra- or postoperative complications were seen. All patients were discharged on the same day of surgery. No mortality found in this series. The NovaTract laparoscopic dynamic retractor is safe and easy to use, which is reflected by acceptable operative time for a laparoscopic cholecystectomy using only two ports. The system allows surgical approach to mimic the conventional laparoscopic techniques, while eliminating or reducing the number of retraction ports.
Schürmann, Carsten; Barrat, Jordi; Bolo, Eden
Information and communication technologies play a critical role in the administration and organization of modern elections. Any breakdown of an election technology, security breach or programming error can incur tremendous cost for the electoral management body (EMB)—and may undermine voters’ trust......, starting during the feasibility study, and especially if it is bound by law to provide such a certification. The evaluation reports and related documents can also be used to increase the transparency of the election, improve the dialogue between EMBs and voters, and increase the EMB’s credibility....
Zubair, M; Habib, L; Mirza, M R
underwent laparoscopic cholecystectomy for symptomatic cholelithiasis at Jamal Noor Hospital and Hamdard University Hospital, Karachi from January 2007 to January 2009. Video recording of all 200 laparoscopic cholecystectomies were analyzed for the IGBP. The different factors; sex of the patient, type...
Full Text Available The results of a comprehensive examination of 136 patients after cholecystectomy are provided. High efficiency and informativeness of the 13C-mixed triglyceride breath test for determining exocrine pancreatic insufficiency at its early stages was noted in patients after cholecystectomy.
Jani, Kalpesh; Rajan, P S; Sendhilkumar, K; Palanivelu, C
This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease.
Jani, Kalpesh; Rajan, P S; Sendhilkumar, K; Palanivelu, C
This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease
Rosemurgy, Alexander; Ryan, Carrie; Klein, Richard; Sukharamwala, Prashant; Wood, Thomas; Ross, Sharona
Robotic application to cholecystectomy has dramatically increased, though its impact on cost of care and reimbursement has not been elucidated. We undertook this study to evaluate and compare cost of care and reimbursement with robotic versus laparoscopic cholecystectomy. The charges and reimbursement of all robotic and laparoscopic cholecystectomies at one hospital undertaken from June 2012 to June 2013 were determined. Operative duration is defined as time into and time out of the operating room. Data are presented as median data. Comparisons were undertaken using the Mann-Whitney U-test with significance accepted at p ≤ 0.05. Robotic cholecystectomy took longer (47 min longer) and had greater charges ($8,182.57 greater) than laparoscopic cholecystectomy (p depreciation, interest, and taxes (EBDIT), and Net Income were not impacted by approach. Relative to laparoscopic cholecystectomy, robotic cholecystectomy takes longer and has greater charges. Revenue, EBDIT, and Net Income are similar after either approach; this indicates that costs with either approach are similar. Notably, this is possible because much of hospital-based costs are determined by cost allocation and not cost accounting. Thus, the cost of longer operations and costs inherent to the robotic approach for cholecystectomy do not translate to a perceived financial burden.
Demiryas, Suleyman; Donmez, Turgut; Erdem, Vuslat Muslu; Erdem, Duygu Ayfer; Hatipoglu, Engin; Ferahman, Sina; Sunamak, Oguzhan; Zengin, Lale Yoldas; Kocakusak, Ahmet
Laparoscopic cholecystectomy (LC) is usually performed under general anesthesia. Recently, laparoscopic cholecystectomy under regional anesthesia has become popular, but this creates a serious risk of thromboembolism because of pneumoperitoneum, anesthesia technique, operative positioning, and patient-specific risk factors. This randomized controlled trial compares the effects of two different anesthesia techniques in laparoscopic cholecystectomy on coagulation and fibrinolysis. This randomized prospective study included 60 low-risk patients with deep vein thrombosis (DVT) who underwent elective LC without thrombo-emboli prophylaxis. The patients were randomly divided into two groups according to the anesthesia technique: the general anesthesia (group 1, n = 30) and spinal epidural anesthesia (group 2, n = 30) groups. Measurement of the prothrombin time (PT), thrombin time (TT), international normalized ratio (INR), activated partial thromboplastin time (aPTT), and blood levels of D-dimer (DD) and fibrinogen (F) were recorded preoperatively (pre), at the first hour (post 1) and 24 h (post 24) after the surgery. These results were compared both between and within the groups. The mean age was 51.5 ±16.7 years (range: 19-79 years). Pneumoperitoneum time was similar between group 1 (33.8 ±7.8) and group 2 (34.8 ±10.4). The TT levels significantly declined postoperatively in both groups. The levels of PT, aPTT, INR, D-dimer and fibrinogen dramatically increased postoperatively in both groups. While there was not any DVT, there was a significant decline in TT. There was a dramatic rise in the PT, INR, D-dimer, fibrin degradation products (FDP), and fibrinogen following LC. This may be attributed to the effects of pneumoperitoneum and anesthesia techniques on portal vein flow.
Become a delegate, it’s simple! CERN’s employment conditions have had a rather hard time over the past few years. The Staff Association, with the support of the staff, has managed to avoid the worst on many occasions. The next few years will be decisive, which is why we must continue to be on the scene, active, a source of proposals, and a real negotiating partner. The Staff Association is your only formal representative vis-à-vis the Management and the Member States, and the Staff Council your voice. A rapidly evolving Staff Association In November, all 60 seats in the Staff Council must be filled. All delegates are therefore outgoing. About a dozen current delegates have informed us that they will not stand for election again, which corresponds to a standard turnover. We thank these outgoing delegates for their past investment. If you are interested in the work of the Staff Association, become involved. We need new, talented, enthusiastic people who are willing to inv...
This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate: Name: MAURIN First Name: Guy I have been a member of the personnel since 1967 and as early as 1972 I was involved, in my capacity as President of the Staff Association, in the improvement of the Pension Fund benefits. As for most of us the Pension Fund is the only social provident scheme to which we belong, it is important to ensure that it is well managed and in balance. As a member of the Governing Board since 1974 and Vice-Chairman of this Board since 1977, I have continued to pursue these objectives. One of the main responsibilities of the Governing Board is our asset investment policy. The Investment Committee, of which I am Chairman, must have an overall view of the management of our 4 billion Swiss francs and seek the best yield with minimum risk. The investment structure must continuously be adapted i...
This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate: Name: RANJARD First Name: Florence Having been a member of the Governing Board of the Pension Fund since 1983 as Guy Maurins alternate, I am standing for a further 3-year term of office. Over the past few years work has concentrated essentially on following items: Monitoring of the work of the fund managers and their performances. The three-yearly study of the Funds actuarial situation. The pension guarantees second phase. The Fund is approaching its maturity: the level of benefits exceeds contributions. In this context it has to strike a suitable balance between management of the risk from a dynamic investment policy, while by a prudent policy avoiding any significant loss of its capital. These will be my concerns within the Governing Board of the Pension Fund if you give me your support.
MARISA DE CARVALHO BORGES
Full Text Available ABSTRACT Objective: to evaluate the pulmonary function of women submitted to conventional and single-port laparoscopic cholecystectomy. Methods: forty women with symptomatic cholelithiasis, aged 18 to 70 years, participated in the study. We divided the patients into two groups: 21 patients underwent conventional laparoscopic cholecystectomy, and 19, single-port laparoscopic cholecystectomy. We assessed pulmonary function through forced vital capacity (FVC, forced expiratory volume in the first second (FEV1, and the FEV1/FVC ratio, measured before and 24 hours after the procedure. Results: in both groups, FVC and FEV1 were lower in the postoperative period than those obtained in the preoperative period, with a greater reduction in the group undergoing conventional laparoscopic cholecystectomy. Regarding the FEV1/FVC (% values, there was no statistically significant difference in any of the groups or times analyzed. Conclusion: there was a greater decline in FVC and FEV1 in the postoperative group of patients submitted to conventional laparoscopic cholecystectomy.
Gaurav V Kulkarni
Full Text Available Traditional management of gallstone pancreatitis (GP has been to perform cholecystectomy during the same hospital admission after resolution. However, when GP develops in the immediate postoperative period from a major colorectal operation, cholecystectomy may be fraught with difficulty due to the inflammatory response that occurs. Thus, delaying cholecystectomy until the inflammatory response subsides may be worthwhile, and it maximizes the chances of completing the cholecystectomy laparoscopically. We have described our management of 2 patients with GP occurring after colorectal operations, which required proximal diverting ileostomy. In both cases, we deferred management of GP with either endoscopic retrograde cholangiopancreatography (ERCP or medical conservative measures during the acute attack and performed laparoscopic cholecystectomy during ostomy reversal surgery utilizing the existing ostomy takedown site for port placement. Both patients tolerated this management well.
Iraq's political system, the result of a U.S.-supported election process, is increasingly exhibiting peaceful competition but continues to be riven by sectarianism and ethnic and factional infighting...
.... The Administration is expressing optimism that the passage of key laws in 2008, including a law to govern new provincial elections to held in early 2009, will heal remaining rifts and continue to reduce violence...
Nunnari, S.; Zápal, Jan
Roč. 25, č. 4 (2017), s. 505-534 ISSN 1047-1987 Institutional support: RVO:67985998 Keywords : elections * political polarization Subject RIV: AH - Economics OBOR OECD: Economic Theory Impact factor: 3.361, year: 2016
Nunnari, S.; Zápal, Jan
Roč. 25, č. 4 (2017), s. 505-534 ISSN 1047-1987 Institutional support: Progres-Q24 Keywords : elections * political polarization Subject RIV: AH - Economics OBOR OECD: Economic Theory Impact factor: 3.361, year: 2016
Full Text Available BACKGROUND With the enormous advancement in the field of laparoscopic cholecystectomy, postoperative pain has substantially reduced as compared to open procedures. However, postoperative pain is still the most frequent complaint, which can hamper recovery, mandate inpatient admission and thereby increase the cost of such care. Preemptive analgesia attenuates sensitisation of pain before surgery so as to reduce postoperative hyperalgesia and allodynia. Pregabalin is a structural analog of γ-aminobutyric acid, which shows analgesic, anticonvulsant, and anxiolytic effects. The aim of the present study was to evaluate the effectiveness of preemptive oral pregabalin on postoperative pain and opioid consumption in patients undergoing laparoscopic cholecystectomy. MATERIALS AND METHODS Eighty adult patients of ASA I and II undergoing laparoscopic cholecystectomy were randomly divided into two groups to receive either pregabalin 150 mg capsule or a matching placebo (vitamin B complex capsule 1 hour before surgery. Anaesthesia technique was standardised in both the groups. Postoperative pain was assessed at 0, 1, 2, 3, 6, 9, 12, 18 and 24 hours period postoperatively by a 10 cm visual analogue scale, where 0, no pain; 10, worst imaginable pain. Subjects received Inj. Tramadol hydrochloride (1 mg/kg IV as a rescue analgesic whenever VAS score was ≥4. Occurrence of any side effects like nausea, vomiting, sedation, headache and dizziness was also noted. Statistical Analysis Used- Data analysis was done using PASW 18.0 software. Results were analysed by Mann-Whitney U-test, large sample difference in proportion test and Fisher’s Exact test. RESULTS Patients in the pregabalin group had significantly lower pain scores at all the time intervals in comparison to placebo group (p<0.05. Total postoperative tramadol consumption in the pregabalin group was statistically significantly lower than in the control group (p<0.05 and also time to first request for
Vontz, Thomas S.; Nixon, William A.
Although elections are an annual theme in many social studies classrooms, presidential election years prompt increased interest among students in the electoral process and offer an opportunity to teach about a national election as it happens. This ERIC Digest describes the legal requirements and traditions of U.S. presidential elections, processes…
... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Runoff elections. 2422.28 Section 2422.28... FEDERAL LABOR RELATIONS AUTHORITY REPRESENTATION PROCEEDINGS § 2422.28 Runoff elections. (a) When a runoff may be held. A runoff election is required in an election involving at least three (3) choices, one of...
van Ham, C.T.
Holding elections has become a global norm. Unfortunately, the integrity of elections varies strongly, ranging from “free and fair” elections with genuine contestation to “façade” elections marred by manipulation and fraud. Clearly, electoral integrity is a topic of increasing concern. Yet electoral
... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Election forms. 847.303 Section 847.303...) ELECTIONS OF RETIREMENT COVERAGE BY CURRENT AND FORMER EMPLOYEES OF NONAPPROPRIATED FUND INSTRUMENTALITIES Procedures for Elections Under the Retroactive Provisions § 847.303 Election forms. (a) Eligible employees...
Khalid, A.; Siddiqui, S.Z.; Aftab, S.; Sabbar, S.
To compare the recovery profile in terms of time of extubation, eye opening, orientation and mobility and frequency of Postoperative Nausea and Vomiting (PONV) between propofol and isoflurane based anesthesia in patients undergoing laparoscopic cholecystectomy with prophylactic antiemetic. After informed consent, a total of 60 ASA I-II patients scheduled for laparoscopic cholecystectomy were divided in two equal groups I and P. Anesthesia in all patients were induced by Nalbuphine 0.15 mg/kg, Midazolam 0.03 mg/kg, Propofol 1.5 mg/kg and Rocuronium 0.6 mg/kg. Anesthesia was maintained with Isoflurane in group I and propofol infusion in group P, while ventilation was maintained with 50% N/sub 2/O/sub 2/ mixture in both the groups. All patients were given antiemetic prophylaxis. Hemodynamics were recorded throughout anesthesia and recovery period. At the end of surgery, times of extubation, eye opening, orientation (by modified Aldrete score) and mobility (recovery profile) were assessed. PONV was observed and recorded immediately after extubation, during early postoperative period (0-4 hours) and late period (4-24 hours). Antiemetic requirements were also recorded for the same periods in both the groups. Propofol provided faster recovery (extubation and eye opening times) and orientation in immediate postoperative period with statistically significant differences between the groups (p<0.0001). Recovery characteristics were comparably lower in group I. More patients achieved full points (8) on modified Aldrete score at different time until 30 minutes in group P. Postoperative nausea and vomiting in early and late periods were significantly reduced in group P. Moreover, requirement of rescue antiemetic doses were significantly lower in group P in 24 hours (p<0.0001). In this series, recovery was much faster with earlier gain of orientation with propofol anesthesia compared to isoflurane in the early recovery periods. Propofol is likely to be a better choice of
Lacher, Martin; Yannam, Govardhana R; Muensterer, Oliver J; Aprahamian, Charles J; Haricharan, Ramanath N; Perger, Lena; Bartle, Donna; Talathi, Sonia S; Beierle, Elizabeth A; Anderson, Scott A; Chen, Mike K; Harmon, Carroll M
The treatment of children with biliary dyskinesia (BD) is controversial. As we recently observed an increasing frequency of referrals for BD in our institution the aim of the study was to re-evaluate the long-term outcome in children with BD. Children with laparoscopic cholecystectomy (LC) for suspected BD between 8/2006 and 5/2011 were included. A pathologic ejection fraction (EF) was defined as <35%. The long-term effect of cholecystectomy was assessed via a Likert scale symptom questionnaire. 82 children (median age 13.5 years, mean BMI 25.8) were included. CCK-HIDA scan was pathologic in 74 children (90.2%). Mean EF was 16.4%. Histology revealed chronic cholecystitis in 48 (58.5%) children and was normal in 30 children (36.5%). The frequency of LC for suspected BD increased by a factor of 4.3 in the last 10 years. Long term follow-up showed that only 23/52 children (44.2%) were symptom-free after LC. Patients with chronic inflammation were more likely to have persistent symptoms (p=0.017). An EF<15% was associated with a resolution of symptoms (p=0.031). The frequency of LC for suspected BD in our institution has increased significantly during recent years. The long-term efficacy in our cohort was only 44.2%. We believe that laparoscopic cholecystectomy is likely helpful in patients with an EF<15%. However, in children with an EF of 15%-35%, based upon our data, we would highly recommend an appropriately thorough pre-op testing to exclude other gastrointestinal disorders prior to consideration of operative management. Copyright © 2013 Elsevier Inc. All rights reserved.
Goossens, Richard H. M.; van Eijk, Daan J.; Lange, Johan F.
Background Iatrogenic bile duct injury remains a current complication of laparoscopic cholecystectomy. One uniform and standardized protocol, based on the “critical view of safety” concept of Strasberg, should reduce the incidence of this complication. Furthermore, owing to the rapid development of minimally invasive surgery, technicians are becoming more frequently involved. To improve communication between the operating team and technicians, standardized actions should also be defined. The aim of this study was to compare existing protocols for laparoscopic cholecystectomy from various Dutch hospitals. Methods Fifteen Dutch hospitals were contacted for evaluation of their protocols for laparoscopic cholecystectomy. All evaluated protocols were divided into six steps and were compared accordingly. Results In total, 13 hospitals responded—5 academic hospitals, 5 teaching hospitals, 3 community hospitals—of which 10 protocols were usable for comparison. Concerning the trocar positions, only minor differences were found. The concept of “critical view of safety” was represented in just one protocol. Furthermore, the order of clipping and cutting the cystic artery and duct differed. Descriptions of instruments and apparatus were also inconsistent. Conclusions Present protocols differ too much to define a universal procedure among surgeons in The Netherlands. The authors propose one (inter)national standardized protocol, including standardized actions. This uniform standardized protocol has to be officially released and recommended by national scientific associations (e.g., the Dutch Society of Surgery) or international societies (e.g., European Association for Endoscopic Surgery and Society of American Gastrointestinal and Endoscopic Surgeons). The aim is to improve patient safety and professional communication, which are necessary for new developments. PMID:18224485
Nickel, Felix; Brzoska, Julia Anja; Gondan, Matthias
Objective: This study compared virtual reality (VR) training with low cost blended learning (BL) in a structured training program. Background: Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Methods: Laparoscopy-naïve medical students...... were randomized in two groups stratified for gender. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, USA). Each group trained 3×4 hours...
Uriza, Luis F; Rodriguez Jose L; Caballero, Ligia M.
We report a case of a woman who consulted for right upper quadrant abdominal pain with history of cholecystectomy six weeks ago. The ultrasound showed sub phrenic and peri hepatic nodular images, interpreted as biliary stones, confirmed with CT. Some of these nodules showed peripheral enhancement and suggested the presence of abscesses. The patient underwent surgery confirming the imaging findings. The case is very important for the role of imaging studies in the diagnostic approach of a surgical complication which has various clinical presentations that range from the absence of symptoms to a septic life-threatening disease.
Bala S Bhaskar
Full Text Available Bartter′s syndrome is a rare inherited anamoly with defect in the thick segment of the ascending limb of the loop of Henle, with reduced reabsorption of potassium. Growth is affected with worsening renal function, hypokalaemia, hypochloraemic metabolic alkalosis, hypocalcemia, hypomagnesemia, increased levels of aldosterone, renin and angiotensin without hypertension and lack of responses to vasopressors. Treatment consists of potassium supplementation along with other medications. We present the case report, probably the first, of a child suffering from Bartter′s syndrome with gall stones posted for laparoscopic cholecystectomy. The pre-operative correction of hypokalemia and successful anaesthetic and fluid and electrolyte management of the patient are discussed.
Iwashita, Yukio; Ohyama, Tetsuji; Honda, Goro; Hibi, Taizo; Yoshida, Masahiro; Miura, Fumihiko; Takada, Tadahiro; Han, Ho-Seong; Hwang, Tsann-Long; Shinya, Satoshi; Suzuki, Kenji; Umezawa, Akiko; Yoon, Yoo-Seok; Choi, In-Seok; Huang, Wayne Shih-Wei; Chen, Kuo-Hsin; Watanabe, Manabu; Abe, Yuta; Misawa, Takeyuki; Nagakawa, Yuichi; Yoon, Dong-Sup; Jang, Jin-Young; Yu, Hee Chul; Ahn, Keun Soo; Kim, Song Cheol; Song, In Sang; Kim, Ji Hoon; Yun, Sung Su; Choi, Seong Ho; Jan, Yi-Yin; Sheen-Chen, Shyr-Ming; Shan, Yan-Shen; Ker, Chen-Guo; Chan, De-Chuan; Lee, King-Teh; Toyota, Naoyuki; Higuchi, Ryota; Nakamura, Yoshiharu; Mizuguchi, Yoshiaki; Takeda, Yutaka; Ito, Masahiro; Norimizu, Shinji; Yamada, Shigetoshi; Matsumura, Naoki; Shindoh, Junichi; Sunagawa, Hiroki; Hasegawa, Hiroshi; Rikiyama, Toshiki; Sata, Naohiro; Kano, Nobuyasu; Kitano, Seigo; Tokumura, Hiromi; Yamashita, Yuichi; Watanabe, Goro; Nakagawa, Kunitoshi; Kimura, Taizo; Yamakawa, Tatsuo; Wakabayashi, Go; Endo, Itaru; Miyazaki, Masaru; Yamamoto, Masakazu
Serious complications continue to occur in laparoscopic cholecystectomy (LC). The commonly used indicators of surgical difficulty such as the duration of surgery are insufficient because they are surgeon and institution dependent. We aimed to identify appropriate indicators of surgical difficulty during LC. A total of 26 Japanese expert LC surgeons discussed using the nominal group technique (NGT) to generate a list of intraoperative findings that contribute to surgical difficulty. Thereafter, a survey was circulated to 61 experts in Japan, Korea, and Taiwan. The questionnaire addressed LC experience, surgical strategy, and perceptions of 30 intraoperative findings listed by the NGT. The response rate of the survey was 100%. There was a statistically significant difference among nations regarding the duration of surgery and adoption rate of safety measures and recognition of landmarks. The criteria for conversion to an open or subtotal cholecystectomy were at the discretion of each surgeon. In contrast, perceptions of the impact of 30 intraoperative findings on surgical difficulty (categorized by factors related to inflammation and additional findings of the gallbladder and other intra-abdominal factors) were consistent among surgeons. Intraoperative findings are objective and considered to be appropriate indicators of surgical difficulty during LC. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Lyons, Jennifer L.; Coleman, Mary E.; Engstrom, John W.
Objective: To ascertain the current status of global health training and humanitarian relief opportunities in US and Canadian postgraduate neurology programs. Background: There is a growing interest among North American trainees to pursue medical electives in low- and middle-income countries. Such training opportunities provide many educational and humanitarian benefits but also pose several challenges related to organization, human resources, funding, and trainee and patient safety. The current support and engagement of neurology postgraduate training programs for trainees to pursue international rotations is unknown. Methods: A survey was distributed to all program directors in the United States and Canada (December 2012–February 2013) through the American Academy of Neurology to assess the training opportunities, institutional partnerships, and support available for international neurology electives. Results: Approximately half of responding programs (53%) allow residents to pursue global health–related electives, and 11% reported that at least 1 trainee participated in humanitarian relief during training (survey response rate 61%, 143/234 program directors). Canadian programs were more likely to allow residents to pursue international electives than US programs (10/11, 91% vs 65/129, 50%, p = 0.023). The number of trainees participating in international electives was low: 0%–9% of residents (55% of programs) and 10%–19% of residents (21% of programs). Lack of funding was the most commonly cited reason for residents not participating in global health electives. If funding was available, 93% of program directors stated there would be time for residents to participate. Most program directors (75%) were interested in further information on global health electives. Conclusions: In spite of high perceived interest, only half of US neurology training programs include international electives, mostly due to a reported lack of funding. By contrast, the majority
Minutolo, V; Gagliano, G; Rinzivillo, C; Li Destri, G; Carnazza, M; Minutolo, O
Laparoscopic cholecystectomy (LC) actually represents the most used and proper treatment for gallbladder lithiasis, because its many and known advantages in comparison with 'open' abdominal surgery. But there are some problems during and after LC due to the use of the electric scalpel and these have brought to the search of an alternative system of dissection and coagulation. The ultrasonically activated scalpel (Harmonic Scalpel, HS) allows to perform dissection and coagulation with a minimal thermal side effect for surrounding tissues, unlike the electrocoagulation. Furthermore, the use of the HS brings a series of advantages in comparison to the other electromagnetic forms of energy (electro-scalpel, laser). HS cuts and coagulates with the same effectiveness of the electro-scalpel but, unlike this, it doesn't introduce risks of wandering currents. Moreover, HS contributes to have a more clean and clear (smokes-free) field of operation and it reduces the operative time, the bleeding and the costs of the operation without an increase of the complications and of the percentages of 'open' conversion, and perhaps leads to a less negative influence on the postoperative systemic immune response. The Authors report their experience that confirm these observations, according also with results reported in a brief review of the recent scientific literature, and support wider diffusion and technical development of this ultrasonically-operating surgical team.
Pellegrini, Pablo; Campana, Juan Pablo; Dietrich, Agustín; Goransky, Jeremías; Glinka, Juan; Giunta, Diego; Barcan, Laura; Alvarez, Fernando; Mazza, Oscar; Sánchez Claria, Rodrigo; Palavecino, Martin; Arbues, Guillermo; Ardiles, Victoria; de Santibañes, Eduardo; Pekolj, Juan; de Santibañes, Martin
Acute calculous cholecystitis represents one of the most common complications of cholelithiasis. While laparoscopic cholecystectomy is the standard treatment in mild and moderate forms, the need for antibiotic therapy after surgery remains undefined. The aim of the randomised controlled Cholecystectomy Antibiotic Randomised Trial (CHART) is therefore to assess if there are benefits in the use of postoperative antibiotics in patients with mild or moderate acute cholecystitis in whom a laparoscopic cholecystectomy is performed. A single-centre, double-blind, randomised trial. After screening for eligibility and informed consent, 300 patients admitted for acute calculus cholecystitis will be randomised into two groups of treatment, either receiving amoxicillin/clavulanic acid or placebo for 5 consecutive days. Postoperative evaluation will take place during the first 30 days. Postoperative infectious complications are the primary end point. Secondary end points are length of hospital stay, readmissions, need of reintervention (percutaneous or surgical reinterventions) and overall mortality. The results of this trial will provide strong evidence to either support or abandon the use of antibiotics after surgery, impacting directly in the incidence of adverse events associated with the use of antibiotics, the emergence of bacterial resistance and treatment costs. This study and informed consent sheets have been approved by the Research Projects Evaluating Committee (CEPI) of Hospital Italiano de Buenos Aires (protocol N° 2111). The results of the trial will be reported in a peer-reviewed publication. NCT02057679. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Pérez-Ayuso, Rosa María; Hernández, Verónica; González, Berta; Carvacho, Claudia; Navarrete, Carlos; Alvarez, Manuel; González, Robinson; Marshall, Guillermo; Miquel, Juan Francisco; Nervi, Flavio
Cholelithiasis is the second cause of hospital admissions in Chile. To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island. In the period 2000-2001, we contacted to 71% (1127 subjects) and to 61% (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound. In 1993, 30-35% of gallstone patients were symptomatic (approximately 70% women). During the lapse 1993-2001, only 50% of subjects from La Florida and 25% of patients from Huapi Island were cholecystectomized (p Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40% of all cholecystectomies performed in the National Health Service Hospitals. This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5% of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510
Make your voice heard, support your candidates! After verification by the Electoral Commission, all candidates for the elections to the Staff Council have been registered. It is now up to you, members of the Staff Association, to vote for the candidate(s) of your choice. We hope that you will be many to vote and to elect the new Staff Council! By doing so, you can support and encourage the women and men, who will represent you over the next two years. We are using an electronic voting system; all you need to do is click the link below and follow the instructions on the screen. https://ap-vote.web.cern.ch/elections-2017 The deadline for voting is Monday, 13 November at midday (12 pm). Elections Timetable Monday 13 November, at noon Closing date for voting Tuesday 21 November and Tuesday 5 December Publication of the results in Echo Monday 27 and Tuesday 28 November Staff Association Assizes Tuesday 5 December (afternoon) First meeting of the new Staff Council and election of the new Executive Committee The ...
Feng, Yuanyuan; Wong, Christopher; Park, Adrian; Mentis, Helena
Although simulation-based training allows residents to become proficient in surgical skills outside the OR, residents still depend on senior surgeons' guidance in transferring skills accumulated from simulators into the operating room. This study aimed to identify and classify explicit instructions made by attending surgeons to their residents during laparoscopic surgery. Through these instructions, we examined the role gaze guidance plays in OR-based training. A total of ten laparoscopic cholecystectomy cases being performed by PGY4 residents were analyzed. The explicit directional instructions given by the mentoring attending surgeons to their residents were identified and classified into four categories based on their locations in the coordinate system. These categories were further combined into two classes, based on the target of instructions. The frequencies of instructions in the two classes were compared, and effect size was calculated. There were 1984 instructions identified in the ten cases. The instructions were categorized into instrument guidance (38.51%) and gaze guidance (61.49%). The instrument guidance focused on moving the instruments to perform surgical tasks, including directions to targets, instrument manipulation, and instrument interaction. The gaze guidance focused on achieving common ground during the operation, including target identification and target fixation. The frequency of gaze guidance is significantly higher than instrument guidance in a laparoscopic cholecystectomy (p guidance has become the main focus of OR-based training. The results show a tight connection between adopting expert gaze and performing surgical tasks and suggest that gaze training should be integrated into the simulation training.
Alam, Mohammed K.
The objective of this report was to study the sensitivity of indicators used for predicting bile duct stones and their endoscopic removal before laparoscopic cholecystectomy. A retrospective study was conducted on 104 patients who successfully underwent endoscopic retrograde cholangiopancreatogram (ERCP) before laparoscopic cholecysectomy at Riyadh Medical Complex between 1992 and 1994 (1412H-1414H). Six indicators --- jaundice, biliary pancreatitis, stones in bile duct on sonography, dilated bile duct (>7mm) on ultrasonography, dilated bile duct with deranged liver function test and deranged liver function test without jaundice ---were used for suspecting choledocholithiasis and endoscopic removal before laparoscopic cholecystectomy. Ultrasound correctly predicted bile duct stone in 75%, followed by dilated bile duct with deranged liver function test (46%). Clinical jaundice and biliary pancreatitis were equally sensitive indicators (42% each). Sensitivity of only dilated bile duct on ultrasonography in predicting duct stone was 36%. Deranged liver function without jaundice was the least sensitive (22%) of the predictors. Overall, these indicators correctly diagnosed bile duct stones in 34% of patients. Until laparoscopic exploration of bile duct or a noninvasive technique, such as magnetic resonance cholangiopancreatogram (MRCP), is widely available, these predictors will help in selecting patients with bile duct stones for preoperative removal. Other workers have suggested combining these indicators to improve the predictive value. (author)
Alekberzade, A V; Lipnitsky, E M; Krylov, N N; Sundukov, I V; Badalov, D A
To analyze the outcomes of single-port laparoscopic cholecystectomy. Early and long-term postoperative period has been analyzed in 240 patients who underwent laparoscopic cholecystectomy (LCE) including 120 cases of single-port technique and 120 cases of four-port technique. Both groups were compared in surgical time, pain syndrome severity (visual analog scale), need for analgesics, postoperative complications, hospital-stay, daily activity recovery and return to physical work, patients' satisfaction of surgical results and their aesthetic effect. It was revealed that single-port LCE is associated with lower severity of postoperative pain, quick recovery of daily activity and return to physical work, high satisfaction of surgical results and their aesthetic effect compared with four-port LCE. Disadvantages of single-port LCE include longer duration of surgery, high incidence of postoperative umbilical hernia. However hernia was predominantly observed during the period of surgical technique development. Further studies to standardize, evaluate the safety and benefits of single-port LCE are necessary.
Jurczak, F; Pousset, J-P; Raffaitin, P
To evaluate a newly developed cholecystectomy technique which combines classical dissection with currently available mini-instrumentation (3 and 5 mm) and removal of the gallbladder through a short gastrotomy. After a feasibility study, we set up a protocol for this procedure using instrumentation currently available on the market. The resected gallbladder was removed through a short gastrotomy on the anterior gastric wall, thereby minimizing abdominal wall trauma and permitting the patient to resume physical activity more quickly with no risk of trocar herniation. Cholecystectomy was performed by the described technique in 18 of 23 eligible patients between April 2008 and August 2008. There were seven males and 11 females with a mean age of 48 (range: 28-77); median BMI was 30 kg/m2 (range: 22-36). Eleven patients had a gallstone larger than 12 mm. There were no postoperative complications and recovery was rapid for all patients in our study. This procedure is technically feasible, safe and reproducible; results are good with minimal trauma to the abdominal wall. Normal physical activity can be rapidly resumed with no risk of incisional hernia.
Park, Woo Young; Lee, Kwang Ho; Lee, Young Bok; Kim, Myeong Hoon; Lim, Hyun Kyo; Choi, Jong Bum
Laparoscopic upper abdominal surgery can cause spontaneous respiration due to diaphragmatic stimulation and intra-abdominal CO 2 inflation. Therefore, sufficient muscle relaxation is necessary for a safe surgical environment. We investigated if the combination of rocuronium and cisatracurium can counteract the delayed onset of cisatracurium's action and delayed recovery of muscle relaxation and whether the dosage of rocuronium, which is metabolized hepatically, can be reduced. A total of 75 patients scheduled for laparoscopic cholecystectomy with an American Society of Anesthesiology physical status I-II, in the age range of 20-60 years, and with a 20-30 kg/m 2 body mass index were included in the study. The patients were divided into the following groups: combination group (Group RC, rocuronium 0.3 mg/kg and cisatracurium 0.05 mg/kg), rocuronium group (Group R, rocuronium 0.6 mg/kg), and cisatracurium group (Group C, cisatracurium 0.1 mg/kg), and the onset, 25% duration, recovery index, and addition/time ratio were measured. Patients in Group RC exhibited a significantly different addition/time ratio compared with patients in the other two groups (p = 0.003). During laparoscopic cholecystectomy, the 95% effective dose of rocuronium in combination with cisatracurium is expected to provide a sufficient muscle relaxant effect.
Bisgaard, Thue; Schulze, S.; Hjortso, N.C.
cholecystectomy. Methods In a double-blind placebo-controlled study, 200 patients were randomized to oral administration of prednisone (50 mg) or placebo 2 h before laparoscopic cholecystectomy. Patients received a similar standardized anaesthetic, surgical, and analgesic treatment. The primary outcome was pain......-h pain, fatigue or malaise scores or any other variables were found (P > 0.05). Conclusion There is no important clinical gain of preoperative oral steroid administration compared with placebo in patients undergoing laparoscopic cholecystectomy Udgivelsesdato: 2008/2...
Clemens, Norman A
In a democracy, elections are the way in which the collective thought processes of the voters arrive at a decision to direct their government. The author explores how the individual voter assesses and resolves many conflicting internal and external forces to arrive at a vote. The midterm elections of 2010 illustrate the parallel between individual resolution of conflicting forces and the process of a campaign leading to the outcome of an election. The psychodynamic concepts of conflict and compromise, affects, aggression, unconscious forces, mechanisms of defense, superego, and the ego's integrative functions are evident in both the individual voter and the collective electoral process. The author expresses concern about the historical vulnerability of democracies and the unbalancing effect of allowing limitless infusion of anonymous corporate money to pour into campaigns.
This article examines the effects of Russia's parliamentary elections on the Russian energy sector and gives details of Russia's legislation concerning Production Sharing Agreement (PSA). The importance of party politics, use of the energy sector as a ready source of cash for electoral campaigns, the government's strengthening of its representation on the board of Gazprom, the role of foreign investors, the bankruptcy of the Siberian Far Eastern Oil Company (Sidanko), the postponement of reforms, and the wait-and-see attitude of investors especially with the forthcoming presidential and Duma elections are discussed. (UK)
Full Text Available General elections are held every five years in South Africa. During the 12 to 24 hour period after the close of the voting booths, the expected final results are of huge interest to the electorate and politicians. In the past, the Council...
Full Text Available The use of Twitter is open up the space for freedom of expression and opinion. But also raised a new phenomenon called cyberstalking (bullying. Acts of bullying (violence/intimidation are also occur in cyberspace. People are free to commit violence and intimidate others without either use a personal account, institutional and anonymous. Especially when the Election arrives. This action is more intense uncontrolled. This study was carried out to get an overview of the phenomenon of cyberstalking on Twitter in 2014 elections that carried the account @ TrioMacan2000. The method used is a qualitative content analysis of the unit of analysis is the whole message (tweet on account @ TrioMacan2000 during the legislative election campaign period opens March 16 to April 5, 2014. The study concluded that most of the tweets are also pictures posted on the account @ TrioMacan2000 throughout the campaign period of election legislation, cyberstalking entered in all categories studied, namely the desire to hurt; post power imbalance; repetition, as well as the pleasure that is felt by the perpetrators.
L.S.G.L. Wauben; R.H.M. Goossens (Richard); J.F. Lange (Johan)
textabstractBackground Laparoscopic cholecystectomy (LC) is the most performed minimal invasive surgical procedure and has a relatively high complication rate. As complications are often revealed postoperatively, clear, accurate, and timely written operative notes are important in order to recall
van Bruwaene, Siska; Schijven, Marlies P.; Napolitano, Daniel; de Win, Gunter; Miserez, Marc
As conventional laparoscopic procedural training requires live animals or cadaver organs, virtual simulation seems an attractive alternative. Therefore, we compared the transfer of training for the laparoscopic cholecystectomy from porcine cadaver organs vs virtual simulation to surgery in a live
Natalie E. Cookson
Full Text Available Background. Laparoscopic cholecystectomy represents the gold standard approach for treatment of symptomatic gallstones. Surgery-associated complications include bleeding, bile duct injury, and retained stones. Migration of surgical clips after cholecystectomy is a rare complication and may result in gallstone formation “clip cholelithiasis”. Case Report. We report a case of a 55-year-old female patient who presented with right upper quadrant pain and severe sepsis having undergone an uncomplicated laparoscopic cholecystectomy 10 years earlier. Computed tomography (CT imaging revealed hyperdense material in the common bile duct (CBD compatible with retained calculus. Endoscopic retrograde cholangiopancreatography (ERCP revealed appearances in keeping with a migrated surgical clip within the CBD. Balloon trawl successfully extracted this, alleviating the patient’s jaundice and sepsis. Conclusion. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy which may lead to choledocholithiasis. Appropriate management requires timely identification and ERCP.
Mohammad Ali Pakaneh
Full Text Available Abstract Backgrounds: There are controversies among surgeons about prophylaxis of deep vein thrombosis (DVT in laparoscopic cholecystectomy. The aim of this study was the assessment of patients’ condition after laparoscopic cholecystectomy without any prophylactic measure. Methods: 100 cases of laparoscopic cholecystectomy without DVT prophylaxis were followed by duplex scanning in the first postoperative day and by physical examination and patient history at the first to second postoperative week however no clinical sign was found for DVT. Results: Only one case of partially thrombosis (1% was found by duplex scanning which was managed conservatively. Conclusion: Laparoscopic cholecystectomy may consider as a low-risk procedure and routine prophylaxis may not be justified in the absence of other risk factor.
Andersen, T F; Brønnum-Hansen, H; Jørgensen, T
It has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population-based study of the long-term survival after cholecystectomy in order to reassess this assumption. Based on data...... to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within 6 years after surgery. Patients with prior somatic admissions and patient with acute...... admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR = 1.3 (1.1-1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy...
Alfaro, Ricardo; Han, Lixing; Schilling, Kenneth; Birgen, Mariah
Students sometimes have difficulty calculating the result of a voting system applied to a particular set of voter preference lists. Saari triangles offer a way to visualize the result of an election and make this calculation easier in the case of several important voting systems.
Elections Timetable Monday 26 October, at noon Start date for voting Monday 9 November, at noon Closing date for voting Monday 16 and Monday 23 November, publication of the results in Echo Monday 23 and Tuesday 24 November Staff Association Assizes Tuesday 1st December, at 10.00 a.m. first meeting of the new Staff Council and election of the new Executive Committee The voting procedure will be monitored by the Election Committee, which is also in charge of announcing the results in Echo on 16 and 24 November. During its meeting of March 17 2015, the Staff Council approved the election rules, which define the allocation of seats in each department, as follows: Number of seats in the electoral colleges Departments BE EN TE DG/DGS FP GS HR/PF IT PH Career paths AA - D 2 3 3 1 1 2 1 1 2 Career paths E - G 2 2 2 1 1 1 1 2 3 Global CERN Career paths AA - G 14 Number of seats for fellows representatives Global CERN 5 For more informat...
Elections Timetable Monday 21 September, at noon Start date for receipt of the application Friday 16 October, at noon Closing date for receipt of the applications Monday 26 October, at noon Start date for voting Monday 9 November, at noon Closing date for voting Monday 16 and Monday 23 November, publication of the results in Echo Monday 23 and Tuesday 24 November Staff Association Assizes Tuesday 1st December, at 10.00 a.m. first meeting of the new Staff Council and election of the new Executive Committee The voting procedure will be monitored by the Election Committee, which is also in charge of announcing the results in Echo on 16 and 24 November. During its meeting of March 17 2015, the Staff Council approved the election rules, which define the allocation of seats in each department, as follows: Number of seats in the electoral colleges Departments BE EN TE DG/DGS FP GS HR/PF IT PH Career paths AA - D 2 3 3 1 1 2 1 1 2 Career paths E - G 2 2 2 1 1 1 1 2 3 ...
Results of a research project which hypothisized that: Other things being equal, the heavier a candidate's usage of broadcast advertising in a primary election campaign, the greater will be his share of the votes in the election. (Author/HB)
...Line, or by completing and filing the appropriate paper TSP form with the TSP record keeper in... elections for different sources of contributions; (3) A participant who elects for the first time to invest...
Office of Personnel Management — LATTE - Log and Time Tracking for Elections is a time tracking and voucher preparation system used to schedule employees to cover elections, to document their time...
Apr 19, 2011 ... 'pulpits' were angels that may shun the acceptance of gratification to uphold or upturn ..... INEC in the 2007 election, it will be out of place for election tribunal to use .... Democratic theory and practice: The Nigerian experience.
Strengthening Democratic Governance through ICTs : Post Election ... has had several consequences, culminating in the disputed general elections of December 2007. ... Linking research to urban planning at the ICLEI World Congress 2018.
Full Text Available Available evidence of the relationship between cholelithiasis, cholecystectomy, and risk of liver cancer and hence we conducted a meta-analysis to investigate the relationships. PubMed, EMBASE, and ISI Web of Knowledge were searched to identify all published cohort studies and case-control studies that evaluated the relationships of cholelithiasis, cholecystectomy and risk of liver cancer and single-cohort studies which evaluated the incidence of liver cancer among patients who understood cholecystectomy (up to February 2013. Comprehensive meta-analysis software was used for meta-analysis. A total of 11 observational studies (six cohort studies and five case-control studies were included in this meta-analysis. The result from meta-analysis showed that cholecystectomy (risk ratio [RR]: 1.59, 95% confidence interval [CI]: 1.01-2.51, I2 = 72% and cholecystolithiasis (RR: 5.40, 95% CI: 3.69-7.89, I2 = 93% was associated with more liver cancer, especially for intrahepatic cholangiocarcinoma (ICC (cholecystectomy: RR: 3.51, 95% CI: 1.84-6.71, I2 = 26%; cholecystolithiasis: RR: 11.06, 95% CI: 6.99-17.52, I2 = 0%. The pooled standardized incidence rates (SIR of liver cancer in patients who understood cholecystectomy showed cholecystectomy might increase the incidence of liver cancer (SIR: 1.57, 95% CI: 1.13-2.20, I2 = 15%. Based on the results of the meta-analysis, cholecystectomy and cholecystolithiasis seemed to be involved in the development of liver cancer, especially for ICC. However, most available studies were case-control studies and short-term cohort studies, so the future studies should more long-term cohort studies should be well-conducted to evaluate the long-term relationship.
Full Text Available This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease
Tanaka, Takayuki; Haraguchi, Masashi; Tokai, Hirotaka; Ito, Shinichiro; Kitajima, Masachika; Ohno, Tsuyoshi; Onizuka, Shinya; Inoue, Keiji; Motoyoshi, Yasuhide; Kuroki, Tamotsu; Kanemastu, Takashi; Eguchi, Susumu
A 50-year-old male was examined at another hospital for fever, general fatigue and slight abdominal pain. He was treated with antibiotics and observed. However, his symptoms did not lessen, and laboratory tests revealed liver dysfunction, jaundice and an increased inflammatory response. He was then admitted to our hospital and underwent an abdominal computed tomography scan and magnetic resonance cholangiopancreatography (MRCP), which revealed common bile duct (CBD) stones. He was diagnosed with mild acute cholangitis. As the same time, he was admitted to our hospital and an emergency endoscopic retrograde cholangiopancreatography was performed. Vater papilla opening in the third portion of the duodenum and presence of a peripapillary duodenal diverticulum made it difficult to perform cannulation of the CBD. In addition, MRCP revealed that the CBD was extremely narrow (diameter 5 mm). We therefore performed laparoscopic cholecystectomy and endoscopic sphincterotomy using the rendezvous technique for choledocholithiasis simultaneously rather than laparoscopic CBD exploration. After the operation, the patient was discharged with no complications. Although the rendezvous technique has not been very commonly used because several experts in the technique and a large operating room are required, this technique is a very attractive and effective approach for treating choledocholithiasis, for which endoscopic treatment is difficult.
Full Text Available A 50-year-old male was examined at another hospital for fever, general fatigue and slight abdominal pain. He was treated with antibiotics and observed. However, his symptoms did not lessen, and laboratory tests revealed liver dysfunction, jaundice and an increased inflammatory response. He was then admitted to our hospital and underwent an abdominal computed tomography scan and magnetic resonance cholangiopancreatography (MRCP, which revealed common bile duct (CBD stones. He was diagnosed with mild acute cholangitis. As the same time, he was admitted to our hospital and an emergency endoscopic retrograde cholangiopancreatography was performed. Vater papilla opening in the third portion of the duodenum and presence of a peripapillary duodenal diverticulum made it difficult to perform cannulation of the CBD. In addition, MRCP revealed that the CBD was extremely narrow (diameter 5 mm. We therefore performed laparoscopic cholecystectomy and endoscopic sphincterotomy using the rendezvous technique for choledocholithiasis simultaneously rather than laparoscopic CBD exploration. After the operation, the patient was discharged with no complications. Although the rendezvous technique has not been very commonly used because several experts in the technique and a large operating room are required, this technique is a very attractive and effective approach for treating choledocholithiasis, for which endoscopic treatment is difficult.
A large Danish study has shown that high bilirubin plasma levels and the genetic variant rs6742078 TT of the enzyme bilirubin glucuronidase UGT1A1 are associated with an increased risk of developing symptomatic gallstone disease. Recent reports regarding the significant association between bilirubin levels and symptomatic gallstone disease open a new chapter about the indication and exclusion criteria for oral dissolution therapy of symptomatic gallstone disease. A highly select subgroup of patients with small, single, radiolucent cholesterol gallstones who received oral dissolution therapy with ursodeoxycholic acid (UDCA had a reported recurrence of symptomatic gallstone disease of 50% over five years. This is probably related to the persistence of other causal risk factors for gallstones in addition to that of cholesterol suprasaturation. A subgroup of patients with high plasma bilirubin levels and the UGT1A1 genetic variant rs6742078 have a greater risk of recurrence. In conclusion, oral dissolution therapy with UDCA might still be appropriate for patients that refuse laparoscopic cholecystectomy provided they have small (< 0.5 cm, radiolucent cholesterol gallstones and a functioning gallbladder, and have mean plasma bilirubin levels below 1.33 mg/dL and are not homozygous for the UGT1A1 rs6742078 TT genotype. [Arch Clin Exp Surg 2014; 3(3.000: 161-165
Veres needle in the umbilical fundus, followed by the insertion of a 5-mm trocar. A second 3-mm trocar was placed in the right upper quadrant. A colpotomy was performed, and a 12-mm trocar placed inside the vagina allowed the insertion of a videogastroscope as far as the hilum of the liver. Results: cholecystectomy was performed by using a combination of working tools inserted through the entry port for the minilaparoscopy and the videogastroscope. The gallbladder was removed transvaginally through the videogastroscope. There were no postoperative complications, and the patient was discharged within 24 hours. Conclusions: transvaginal cholecystectomy is possible and safe when performed by a multidisciplinary team working together. Natural orifice transluminal endoscopic surgery (NOTES is an emerging modality that seeks to be less invasive, better tolerated, and more respectful of esthetics than laparoscopic surgery. It will probably open the way for very important medical and technological innovations over the coming years.
BACKGROUND: Small cell carcinoma of the cervix is a rare cancer, comprising less than 3% of all cervical neoplasms. It uniformly has a poor prognosis, and has a high mortality even with early stage disease. It can metastasise rapidly and metastatic sites include lung, liver, brain, bone, pancreas and lymph nodes. CASE: Here, we report the case of a 60-year-old woman with no symptoms of cervical pathology who developed post-renal failure following a laparoscopic cholecystectomy. The cause was bilateral ureteric obstruction from metastatic small cell cervical cancer and metastases were subsequently found on her gallbladder specimen. CONCLUSION: This is an unusual presentation of small cell cervical cancer and demonstrates the aggressive nature of this disease.
Marmorale, C; Scibé, R; Siquini, W; Massa, M; Brunelli, A; Landi, E
Laparoscopic cholecystectomy (VALC) represents the treatment of choice for the symptomatic gallstones. However the occurrence of an adenocarcinoma of the gallbladder results a controindication for this surgical technique. We present a case of a 52 years old woman who underwent a VALC; histology revealed a gallbladder adenocarcinoma. For this reason the patient underwent a second operation that is right hepatic trisegmentectomy. Six months later the patient presented with a parietal recurrence at the extraction site of the gallbladder. We discuss the possible mechanism responsible for carcinomatous dissemination during laparoscopic surgery and we raccommend the use of some procedures in order to limit the risk and eventually to treat a neoplastic parietal seeding. These complications suggest the problem about the utility and the future played by video assisted laparoscopic surgery in the diagnosis and treatment of intraabdominal malignancies.
Lehrskov, Lars Lang; Larsen, Søren S; Kristensen, Billy B
INTRODUCTION: Intraoperative fluorescent cholangiography is a novel non-invasive imaging technique to visualise the extrahepatic biliary tract during laparoscopic cholecystectomy. It has been proven feasible, fast and cost effective. Never-theless, there is only sparse data on the capacity...... of fluorescent cholangiography to visualise the biliary anatomy. METHODS: Based on a non-inferiority design, patients with complicated gallstone disease are randomised to either -intraoperative conventional X-ray cholangiography (reference group, n = 60) or intraoperative fluorescent cholangiography (n = 60......). The primary outcome is visualisation of the junction between the cystic duct, the common hepatic duct and the common bile duct. CONCLUSION: The present study may show that fluorescent cholangiography is as valid for visualisation of important structures of the extrahepatic biliary tract as conventional X...
Pan, Jun J; Ahn, Woojin; Dargar, Saurabh; Halic, Tansel; Li, Bai C; Sankaranarayanan, Ganesh; Roberts, Kurt; Schwaitzberg, Steven; De, Suvranu
Natural Orifice Transluminal Endoscopic Surgery (NOTES) provides an emerging surgical technique which usually needs a long learning curve for surgeons. Virtual reality (VR) medical simulators with vision and haptic feedback can usually offer an efficient and cost-effective alternative without risk to the traditional training approaches. Under this motivation, we developed the first virtual reality simulator for transvaginal cholecystectomy in NOTES (VTEST™). This VR-based surgical simulator aims to simulate the hybrid NOTES of cholecystectomy. We use a 6DOF haptic device and a tracking sensor to construct the core hardware component of simulator. For software, an innovative approach based on the inner-spheres is presented to deform the organs in real time. To handle the frequent collision between soft tissue and surgical instruments, an adaptive collision detection method based on GPU is designed and implemented. To give a realistic visual performance of gallbladder fat tissue removal by cautery hook, a multi-layer hexahedral model is presented to simulate the electric dissection of fat tissue. From the experimental results, trainees can operate in real time with high degree of stability and fidelity. A preliminary study was also performed to evaluate the realism and the usefulness of this hybrid NOTES simulator. This prototyped simulation system has been verified by surgeons through a pilot study. Some items of its visual performance and the utility were rated fairly high by the participants during testing. It exhibits the potential to improve the surgical skills of trainee and effectively shorten their learning curve. Copyright © 2016 Elsevier Inc. All rights reserved.
Oh, Hyung Jin; Lee, Jae Mun; Jung, Seung Eun; Kim, Eung Kook; Kim, Jae Kwang; Han, Sung Tae
The purpose of this study was to prospectively compare the clinical applicability of magnetic resonance cholangiography (MRC) with that of endoscopic retrograde cholangiography (ERC) in the evaluation of combined choledocholithiasis in patients with gall stones who were candidates for laparoscopic cholecystectomy. Twenty-seven patients with gall stones underwent fast spin-echo MR cholangiography using the half-Fourier acquisition single-shot turbo spin echo (HASTE) method, and half-Fourier rapid acquisition using the relaxation enhancement (RARE) method. Within five hours the same patients underwent ERC. The results of MRC was reviewed by two radiologists blinded to the results of ERC. The number and size of CBD stones and gall stones, and the degree of CBD dilatation, as seen on HASTE and RARE images, were compared with the results of ERC. MRC depicted common bile duct stones in 10 of 11 patients shown by ERC to have stones, while in the 16 patients in whom ERC did not reveal stones, MRC demonstrated the same finding. The number of CBD stones was exactly demonstrated by HASTE imaging in eight of eleven patients (73%) and by RARE imaging in ten of eleven patients (91%) in whom ERC revealed choledocholithiasis. The size of common bile duct stones visualized by ERC correlated in nine of eleven patients (82%) on HASTE images and in seven of eleven (64%) on RARE images. MRC showed CBD dilatation in all patients in whom dilatation was demonstrated by ERC. For the evaluation of choledocholithiasis before laparoscopic cholecystectomy in patients with gall stones, MRC and ERC are equally accurate. A comparison of HASTE imaging with RARE imaging, as used in the diagnosis of choledocholithiasis, revealed no significant differences. (author)
Full Text Available Background and Aims: Perioperative beta blockers are also being advocated for modulation of acute pain and reduction of intraoperative anesthetic requirements. This study evaluated the effect of perioperative use of esmolol, an ultra short acting beta blocker, on anesthesia and modulation of post operative pain in patients of laproscopic cholecystectomy. Material and Methods: Sixty adult ASA I & II grade patients of either sex, scheduled for laparoscopic cholecystectomy under general anesthesia, were enrolled in the study. The patients were randomly allocated to one of the two groups E or C according to computer generated numbers. Group E- Patients who received loading dose of injection esmolol 0.5 mg/kg in 30 ml isotonic saline, before induction of anesthesia, followed by an IV infusion of esmolol 0.05 μg/kg/min till the completion of surgery and Group C- Patients who received 30 ml of isotonic saline as loading dose and continuous infusion of isotonic saline at the same rate as the esmolol group till the completion of surgery. Results: The baseline MAP at 0 minute was almost similar in both the groups. At 8th minute (time of intubation, MAP increased significantly in group C as compared to group E and remained higher than group E till the end of procedure. Intraoperatively, 16.67% of patients in group C showed somatic signs as compared to none in group E. The difference was statistically significant. 73.33% of patients in group C required additional doses of Inj.Fentanyl as compared to 6.67% in group E. Conclusions: We conclude that intravenous esmolol influences the analgesic requirements both intraoperatively as well as postoperatively by modulation of the sympathetic component of the pain i.e. heart rate and blood pressure.
Gumbs, Andrew A; Hoffman, John P
The role of minimally invasive surgery in the surgical management of gallbladder cancer is a matter of controversy. Because of the authors' growing experience with laparoscopic liver and pancreatic surgery, they have begun offering patients laparoscopic completion partial hepatectomies of the gallbladder bed with laparoscopic hepatoduodenal lymphadenectomy. The video shows the steps needed to perform laparoscopic resection of the residual gallbladder bed, the hepatoduodenal lymph node nodes, and the residual cystic duct stump in a setting with a positive cystic stump margin. The skin and fascia around the previous extraction site are resected, and this site is used for specimen retrieval during the second operation. To date, three patients have undergone laparoscopic radical cholecystectomy with hepatoduodenal lymph node dissection for gallbladder cancer. The average number of lymph nodes retrieved was 3 (range, 1-6), and the average estimated blood loss was 117 ml (range, 50-200 ml). The average operative time was 227 min (range, 120-360 min), and the average hospital length of stay was 4 days (range, 3-5 days). No morbidity or mortality was observed during 90 days of follow-up for each patient. Although controversy exists as to the best surgical approach for gallbladder cancer diagnosed after routine laparoscopic cholecystectomy, the minimally invasive approach seems feasible and safe, even after previous hepatobiliary surgery. If the previous extraction site cannot be ascertained, all port sites can be excised locally. Larger studies are needed to determine whether the minimally invasive approach to postoperatively diagnosed early-stage gallbladder cancer has any drawbacks.
Sujka, Joseph A; Safcsak, Karen; Bhullar, Indermeet S; Havron, William S
To determine if pager interruptions affect operative time, safety, or complications and management of pager issues during a simulated laparoscopic cholecystectomy. Twelve surgery resident volunteers were tested on a Simbionix Lap Mentor II simulator. Each resident performed 6 randomized simulated laparoscopic cholecystectomies; 3 with pager interruptions (INT) and 3 without pager interruptions (NO-INT). The pager interruptions were sent in the form of standardized patient vignettes and timed to distract the resident during dissection of the critical view of safety and clipping of the cystic duct. The residents were graded on a pass/fail scale for eliciting appropriate patient history and management of the pager issue. Data was extracted from the simulator for the following endpoints: operative time, safety metrics, and incidence of operative complications. The Mann-Whitney U test and contingency table analysis were used to compare the 2 groups (INT vs. NO-INT). Level I trauma center; Simulation laboratory. Twelve general surgery residents. There was no significant difference between the 2 groups in any of the operative endpoints as measured by the simulator. However, in the INT group, only 25% of the time did the surgery residents both adequately address the issue and provide effective patient management in response to the pager interruption. Pager interruptions did not affect operative time, safety, or complications during the simulated procedure. However, there were significant failures in the appropriate evaluations and management of pager issues. Consideration for diversion of patient care issues to fellow residents not operating to improve quality and safety of patient care outside the operating room requires further study. Copyright © 2018. Published by Elsevier Inc.
... 29 Labor 1 2010-07-01 2010-07-01 true Election process. 44.3 Section 44.3 Labor Office of the Secretary of Labor PROCESS FOR ELECTING STATE AGENCY EMPLOYMENT STATISTICS REPRESENTATIVES FOR CONSULTATIONS WITH DEPARTMENT OF LABOR § 44.3 Election process. (a) Process. The Commissioner of Labor Statistics of...
Undemocratic features in the election process results in the election of unsuitable or incompetent candidates which has a detrimental effect on the governance of public schools. It is therefore recommended that a new set of nationally uniform SGB election regulations, which allows for transparent deliberation between ...
... 29 Labor 2 2010-07-01 2010-07-01 false Runoff election. 102.70 Section 102.70 Labor Regulations... Runoff election. (a) The regional director shall conduct a runoff election, without further order of the... objections are filed as provided in § 102.69. Only one runoff shall be held pursuant to this section. (b...
Klomp, Jeroen; de Haan, Jakob
This paper addresses two empirical questions. Is fiscal policy affected by upcoming elections? If so, do election-motivated fiscal policies enhance the probability of re-election of the incumbent? Employing data for 65 democratic countries over 1975-2005 in a semi-pooled panel model, we find that in
Harney, John O.; Morwick, Carolyn
The recent midterm elections brought New England two new governors. Rhode Island elected its first woman chief executive in Gina Raimondo (D). Massachusetts elected Charlie Baker (R), a former Harvard Pilgrim CEO and official in the Weld and Cellucci administrations. Otherwise, the New England corner offices cautiously welcomed back incumbents:…
Currently, Democracy is realised through representatives elected by the people. These elections are periodic activities. They involve expenditure of big amounts of manpower, money, time and other resources. It is important to note that during an election, the administration and day-to-day lives of people are affected as election activities take centre stage. Present day elections are amenable to influence where Voters can possibly be intimidated to vote against their will. In many instances, ...
Full Text Available The study aims to analyze the factors supporting the electability of women candidates in Central Java DPRD election 2014. This type of research is descriptive. Techniques of data collection used the in-depth interviews with all women members of the Central Java DPRD election results 2014. Data processing techniques are data reduction, data display, concluding and verifying. The study found women candidate’s electability factors because they master/control the political capital, social capital and economics capital. By political capital (party officials so candidate nominated in small number candidacy and electoral district party base. Social capital (activists of social/professional organizations support the loyalty and solidity candidate team and candidate voice, and economics capital to support the political cost. Some of them have kinship with the party elite /social elite so openly their access to social and politics capital. An open list proportional electoral system makes it difficult increasing women representation if not followed party policy affirmations committed. In order to reach the 30% the representation of women in the legislature should be intervention laws forcing the party implementing gender justice policies candidacyPenelitian ini bermaksud menganalisa faktor-faktor pendukung keterpilihan caleg perempuan di DPRD Jawa Tengah dalam Pemilu 2014. Tipe penelitian ini deskriptif.Teknik pengumpulan data menggunakan wawancara mendalam terhadap seluruh perempuan anggota DPRD Jawa Tengah hasil Pemilu 2014. Teknik pengolahan data dalam penelitian ini adalah reduksi data, display data, penarikan kesimpulan dan verifikasi. Hasil Penelitian menemukan faktor-faktor keterpilihan caleg perempuan karena mereka menguasai modal politik (pengurus partai sehingga dicalonkan dinomor urut kecil dan dapil basis partai, modal sosial (pengurus organisasi sosial/profesi yang membantu kerja dan mendapat dukungan suara, dan modal ekonomi untuk biaya
... of election, whether it is a primary, general or special election. Section 14(c)(1). This includes... and referendums. Federal, State and local elections are covered as are elections of special districts, such as school districts and water districts. (b) Elections for statewide office. If an election...
Information technology is changing the way elections are organized. Technology renders the electoral process more efficient, but things could also go wrong: Voting software is complex, it consists of over thousands of lines of code, which makes it error-prone. Technical problems may cause delays...... bounded model-checking and satisfiability modulo theories (SMT) solvers can be used to check these criteria. Voter Experience: Technology profoundly affects the voter experience. These effects need to be measured and the data should be used to make decisions regarding the implementation of the electoral...... at polling stations, or even delay the announcement of the final result. This thesis describes a set of methods to be used, for example, by system developers, administrators, or decision makers to examine election technologies, social choice algorithms and voter experience. Technology: Verifiability refers...
The election of the Staff Council for the period 2018-2019 is now over and the first lesson is a turnout for the vote of 56.15 %, higher than for the previous election. This clearly shows the interest that members of the Staff Association attach to the work and dedication of their delegates. Of course we also thank all those who stood up as candidates and expressed their commitment to actively defend the interests of the staff and of CERN. This newly-elected Staff Council (see its composition below) is truly representative of all sectors and professions of the Organization. This will be a major asset when representatives of the Staff Association discuss with Management and Member States on issues which we will have to address during the next two years. Strong with this vote of confidence, we are certain that we can count on your active and ongoing support of our members and all personnel at CERN for the future. We know there will be no shortage of challenges. Together we will be stronger and more creative to...
The election of the Staff Council for the period 2018-2019 is now over and the first lesson is a turnout for the vote of 56.15 %, higher than for the previous election. This clearly shows the interest that members of the Staff Association attach to the work and dedication of their delegates. Of course we also thank all those who stood up as candidates and expressed their commitment to actively defend the interests of the staff and of CERN. This newly-elected Staff Council (see its composition below) is truly representative of all sectors and professions of the Organization. This will be a major asset when representatives of the Staff Association discuss with Management and Member States on issues which we will have to address during the next two years. Strong with this vote of confidence, we are certain that we can count on your active and ongoing support of our members and all personnel at CERN for the future. We know there will be no shortage of challenges. Together we will be stronger and more creative to ...
Association du personnel
The elections to renew the Staff Council for the 2010-2011 period are now behind us and we are very pleased to have had at least as many candidates as posts in five of the six electoral colleges. Furthermore, the average rate of participation of 56.8% in these elections is a very good result compared to previous years. We thank the candidates who have committed themselves to actively defending the interests of the staff, and all our members have shown, by voting, their full support of the candidates in their college and Department. This newly-elected Staff Council (see its composition on the following page) will therefore be truly representative of all the sectors and professions of the Organization, which will be a major asset when the Staff Association representatives begin discussions with the Management and Member States in 2010 on the key issues of the five-yearly review and the measures to be taken to absorb the deficit of our Pension Fund. Armed with this vote of confidence, we know that we can count o...
Association du personnel
Elections Timetable Starting with Echo of 26 September, posters, etc. call for applications Wednesday 26 October, at noon closing date for receipt of the application Monday 31 October, at noon start date for voting Monday 14 November, at noon closing date for voting Monday 21 November, publication of the results in Echo Tuesday 22 and Wednesday 29 November Staff Association Assizes Tuesday 6 December, at 10.00 a.m. first meeting of the new Staff Council and election of the new Executive Committee The voting procedure will be monitored by the Election Committee, which is also in charge of announcing the results in Echo on 21 November. In its meeting on 19 September 2011, the Electoral Commission decided on the following distribution of seats in colleges 0.1 to 0.6: Sector Department Career path AA – A – B – C – D Career path E – F – G – H Accelerators and Technology BE TE EN Electoral college 0.1 18 si&e...
Elections Timetable Starting with Echo of 16 September, posters, etc. call for applications Monday 21 October, at noon closing date for receipt of the applications Monday 28 October, at noon start date for voting Monday 11 November, at noon closing date for voting Monday 18 and Monday 25 November, publication of the results in Echo Tuesday 19 November Staff Association Assizes Tuesday 3 December, at 10.00 a.m. first meeting of the new Staff Council and election of the new Executive Committee The voting procedure is monitored by the Election Committee, which is also in charge of announcing the results in Echo on 18 and 25 November. n its meeting on 11 September 2013, the Electoral Commission decided on the following distribution of seats in colleges O.1 to O.6: Sectors Departments Career paths AA – A – B – C – D Career paths E – F – G – H Accelerators and Technology BE TE EN Electoral college 0.1 13 si&...
Elections Timetable Starting with Echo of 16 September, posters, etc. call for applications Monday 21 October, at noon closing date for receipt of the applications Monday 28 October, at noon start date for voting Monday 11 November, at noon closing date for voting Monday 18 and Monday 25 November, publication of the results in Echo Tuesday 19 November Staff Association Assizes Tuesday 3 December, at 10.00 a.m. first meeting of the new Staff Council and election of the new Executive Committee The voting procedure is monitored by the Election Committee, which is also in charge of announcing the results in Echo on 18 and 25 November. n its meeting on 11 September 2013, the Electoral Commission decided on the following distribution of seats in colleges O.1 to O.6: Sectors Departments Career paths AA – A – B – C – D Career paths E – F – G – H Accelerators and Technology BE TE EN Electoral colle...
Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M.
Background The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Methods Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. Results There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Conclusion Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it
Lu, Ping; Yang, Nan-Ping; Chang, Nien-Tzu; Lai, K Robert; Lin, Kai-Biao; Chan, Chien-Lung
Although numerous epidemiological studies on cholecystectomy have been conducted worldwide, only a few have considered the effect of socioeconomic inequalities on cholecystectomy outcomes. Specifically, few studies have focused on the low-income population (LIP). A nationwide prospective study based on the Taiwan National Health Insurance dataset was conducted during 2003-2012. The International Classification of ICD-9-CM procedure codes 51.2 and 51.21-51.24 were identified as the inclusion criteria for cholecystectomy. Temporal trends were analyzed using a joinpoint regression, and the hierarchical linear modeling (HLM) method was used as an analytical strategy to evaluate the group-level and individual-level factors. Interactions between age, gender and SES were also tested in HLM model. Analyses were conducted on 225,558 patients. The incidence rates were 167.81 (95% CI: 159.78-175.83) per 100,000 individuals per year for the LIP and 123.24 (95% CI: 116.37-130.12) per 100,000 individuals per year for the general population (GP). After cholecystectomy, LIP patients showed higher rates of 30-day mortality, in-hospital complications, and readmission for complications, but a lower rate of routine discharge than GP patients. The hospital costs and length of stay for LIP patients were higher than those for GP patients. The multilevel analysis using HLM revealed that adverse socioeconomic status significantly negatively affects the outcomes of patients undergoing cholecystectomy. Additionally, male sex, advanced age, and high Charlson Comorbidity Index (CCI) scores were associated with higher rates of in-hospital complications and 30-day mortality. We also observed that the 30-day mortality rates for patients who underwent cholecystectomy in regional hospitals and district hospitals were significantly higher than those of patients receiving care in a medical center. Patients with a disadvantaged finance status appeared to be more vulnerable to cholecystectomy surgery
Jayaraman, Shiva; Davies, Ward; Schlachta, Christopher M
The value of robotics in general surgery may be for advanced minimally invasive procedures. Unlike other specialties, formal fellowship training opportunities for robotic general surgery are few. As a result, most surgeons currently develop robotic skills in practice. Our goal was to determine whether robotic cholecystectomy is a safe and effective bridge to advanced robotics in general surgery. Before performing advanced robotic procedures, 2 surgeons completed the Intuitive Surgical da Vinci training course and agreed to work together on all procedures. Clinical surgery began with da Vinci cholecystectomy with a plan to begin advanced procedures after at least 10 cholecystectomies. We performed a retrospective review of our pilot series of robotic cholecystectomies and compared them with contemporaneous laparoscopic controls. The primary outcome was safety, and the secondary outcome was learning curve. There were 16 procedures in the robotics arm and 20 in the laparoscopic arm. Two complications (da Vinci port-site hernia, transient elevation of liver enzymes) occurred in the robotic arm, whereas only 1 laparoscopic patient (slow to awaken from anesthetic) experienced a complication. None was significant. The mean time required to perform robotic cholecystectomy was significantly longer than laparoscopic surgery (91 v. 41 min, p robotic procedures (14 v. 11 min, p = 0.015). We observed a trend showing longer mean anesthesia time for robotic procedures (23 v. 15 min). Regarding learning curve, the mean operative time needed for the first 3 robotic procedures was longer than for the last 3 (101 v. 80 min); however, this difference was not significant. Since this experience, the team has confidently gone on to perform robotic biliary, pancreatic, gastresophageal, intestinal and colorectal operations. Robotic cholecystectomy can be performed reliably; however, owing to the significant increase in operating room resources, it cannot be justified for routine use. Our
Full Text Available This research aims to identify and to analyze the legal status of the Election Organizer Ethics Council in the General Election in Indonesia. This research is a normative research by using statute approach official records and the judges verdict which is then described qualitatively. These results indicate that the legal status of the Election Organizer Ethics Council in the general election in Indonesia as supporting organ that serves to uphold ethics rule of ethics and guarding democracy. The authority of Election Organizer Ethics Council in the general election in Indonesia sometimes out of authority. Ideal concept of the legal status of the Election Organizer Ethics Council in general elections was as supporting organ which have the infrastructure secretary general and administrative staff so it has a public legal entity as similar to the Election organizers serve as code of ethics enforcement agencies code of ethics and can equated to other state institutions.
Hibi, Taizo; Iwashita, Yukio; Ohyama, Tetsuji; Honda, Goro; Yoshida, Masahiro; Takada, Tadahiro; Han, Ho-Seong; Hwang, Tsann-Long; Shinya, Satoshi; Suzuki, Kenji; Umezawa, Akiko; Yoon, Yoo-Seok; Choi, In-Seok; Huang, Wayne Shih-Wei; Chen, Kuo-Hsin; Miura, Fumihiko; Watanabe, Manabu; Abe, Yuta; Misawa, Takeyuki; Nagakawa, Yuichi; Yoon, Dong-Sup; Jang, Jin-Young; Yu, Hee Chul; Ahn, Keun Soo; Kim, Song Cheol; Song, In Sang; Kim, Ji Hoon; Yun, Sung Su; Choi, Seong Ho; Jan, Yi-Yin; Sheen-Chen, Shyr-Ming; Shan, Yan-Shen; Ker, Chen-Guo; Chan, De-Chuan; Wu, Cheng-Chung; Toyota, Naoyuki; Higuchi, Ryota; Nakamura, Yoshiharu; Mizuguchi, Yoshiaki; Takeda, Yutaka; Ito, Masahiro; Norimizu, Shinji; Yamada, Shigetoshi; Matsumura, Naoki; Shindoh, Junichi; Sunagawa, Hiroki; Gocho, Takeshi; Hasegawa, Hiroshi; Rikiyama, Toshiki; Sata, Naohiro; Kano, Nobuyasu; Kitano, Seigo; Tokumura, Hiromi; Yamashita, Yuichi; Watanabe, Goro; Nakagawa, Kunitoshi; Kimura, Taizo; Yamakawa, Tatsuo; Wakabayashi, Go; Endo, Itaru; Miyazaki, Masaru; Yamamoto, Masakazu
Generally, surgeons' perceptions of surgical safety are based on experience and institutional policy. Our recent pilot survey demonstrated that the acceptable duration of surgery and criteria for open conversion during laparoscopic cholecystectomy (LC) vary among workplaces. A web-based survey was distributed to 554 expert LC surgeons in Japan, Korea, and Taiwan. The questionnaire covered LC experience, safety measures and recognition of landmarks, decision-making regarding conversion to open/partial cholecystectomy and the implications of this decision. Overall responses were compared among nations, and then stratified by LC experience level (lifetime cases 200-499, 500-999, and ≥1,000). The response rate was 92.6% (513/554); 67 surgeons with ≤199 LCs were excluded, and responses from 446 surgeons were analyzed. We observed significant differences among nations on almost all questions. Differences that remained after stratification by LC experience were on questions related to acceptable duration of surgery, adoption rates of intraoperative cholangiography, the "critical view of safety" technique, identification of Rouvière's sulcus, recognition of the SS-Inner layer theory, and intraoperative judgment to abandon conventional LC. Even among experts, surgeons' perceptions during LC are workplace-dependent. A novel grading system of surgical difficulty and standardized LC procedures are paramount to generate high-level evidence. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.
Shibao, Kazunori; Takagi, Tsuyoshi; Higure, Aiichiro; Yamaguchi, Koji
We recently developed an oval-shaped E•Z Access device designed exclusively for use with the LAP PROTECTOR™ Oval type device (Hakko Co. Ltd., Tokyo, Japan). The transverse abdominal opening diameter made by round-shaped (Alexis® Wound Retractor, Applied Medical, Rancho Santa Margarita, CA; and LAP PROTECTOR™ Round type) and oval-shaped (LAP PROTECTOR™ Oval type) wound retractors was measured and compared in 5 patients with cholecystolithiasis. Each device was placed through a single 25-mm longitudinal umbilical incision, and the length of trocar separation was compared. LESS cholecystectomy was then performed using the oval-shaped E•Z ACCESS/LAP PROTECTOR™. The transverse abdominal opening diameter was maximized with the LAP PROTECTOR™ Oval type device. The average distance between the working-ports for the glove method, round-shaped, and oval-shaped E•Z ACCESS/LAP PROTECTOR™ devices in the 25-mm umbilical incisions were 20 ± 0.8 mm, 24 ± 1.5 mm, and 35 ± 0.8 mm, respectively. Wider trocar separation was achieved using the oval-shaped device, making the surgical procedures easier to perform. No perioperative port-related or surgical complications were observed. LESS cholecystectomy using the E•Z ACCESS Oval type device was found to be technically feasible. The Oval type device appears to allow for wider trocar separation, thereby reducing stress on the surgeon, ensuring patient safety, and providing cosmetic benefits.
Kramp, Kelvin H; van Det, Marc J; Hoff, Christiaan; Lamme, Bas; Veeger, Nic J G M; Pierie, Jean-Pierre E N
Global Operative Assessment of Laparoscopic Skills (GOALS) assessment has been designed to evaluate skills in laparoscopic surgery. A longitudinal blinded study of randomized video fragments was conducted to estimate the validity and reliability of GOALS in novice trainees. In total, 10 trainees each performed 6 consecutive laparoscopic cholecystectomies. Sixty procedures were recorded on video. Video fragments of (1) opening of the peritoneum; (2) dissection of Calot's triangle and achievement of critical view of safety; and (3) dissection of the gallbladder from the liver bed were blinded, randomized, and rated by 2 consultant surgeons using GOALS. Also, a grade was given for overall competence. The correlation of GOALS with live observation Objective Structured Assessment of Technical Skills (OSATS) scores was calculated. Construct validity was estimated using the Friedman 2-way analysis of variance by ranks and the Wilcoxon signed-rank test. The interrater reliability was calculated using the absolute and consistency agreement 2-way random-effects model intraclass correlation coefficient. A high correlation was found between mean GOALS score (r = 0.879, p = 0.021) and mean OSATS score. The GOALS score increased significantly across the 6 procedures (p = 0.002). The trainees performed significantly better on their sixth when compared with their first cholecystectomy (p = 0.004). The consistency agreement interrater reliability was 0.37 for the mean GOALS score (p = 0.002) and 0.55 for overall competence (p < 0.001) of the 3 video fragments. The validity observed in this randomized blinded longitudinal study supports the existing evidence that GOALS is a valid tool for assessment of novice trainees. A relatively low reliability was found in this study. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
Full Text Available Background and Aims: Transversus abdominis plane (TAP block is a popular technique for post-operative analgesia in abdominal surgeries. The aim of the study was to evaluate the relative efficacy of bupivacaine versus ropivacaine for post-operative analgesia using ultrasound-guided TAP block in laparoscopic cholecystectomies. Methods: Sixty adults undergoing elective laparoscopic cholecystectomy were randomised to receive ultrasound-guided TAP block at the end of the surgical procedure with either 0.25% bupivacaine (Group I, n = 30 or 0.375% ropivacaine (Group II, n = 30. All patients were assessed for post-operative pain and rescue analgesic consumption at 10 min, 30 min, 1 h, 4 h, 8 h, 12 h and 24 h time points. Means for normally distributed data were compared using Student′s t-test, and proportions were compared using Chi-square or Fisher′s exact test whichever was applicable. Results: Patients receiving ultrasound-guided TAP block with ropivacaine (Group II had significantly lower pain scores when compared to patients who received the block with bupivacaine (Group I at 10 min, 30 min and 1 h. However, both the drugs were equivalent for post-operative analgesia and 24 h cumulative rescue analgesic requirement (median [interquartile range] (75.00 [75.00-75.00] in Group I vs. 75.00 [75.00-93.75] in Group II, P = 0.366. Conclusion: Ultrasound-guided TAP block with ropivacaine provides effective analgesia in the immediate post-operative period up to 1 h as compared to bupivacaine. However, both the drugs are similar in terms of 24 h cumulative rescue analgesic requirement.
Haricharan, Ramanath N; Proklova, Lyudmila V; Aprahamian, Charles J; Morgan, Traci L; Harmon, Carroll M; Barnhart, Douglas C; Saeed, Shehzad A
The purpose of this study was to determine the effectiveness of laparoscopic cholecystectomy in children with biliary dyskinesia. Reports of children with an abnormal cholecystokinin (CCK)-stimulated HIDA scan between January 2001 and July 2006 who underwent laparoscopic cholecystectomy were reviewed. Postoperatively, a 23-item Likert scale, symptom questionnaire was administered to parents. Sixty-four children with chronic abdominal pain and no gallstones on ultrasound had an abnormal CCK-HIDA scan. Twenty-three children (median age, 14 years; 16 girls), with mean (SD) ejection fraction of 17% (8), underwent laparoscopic cholecystectomy and were further analyzed. Preoperatively, these children had right upper quadrant/epigastric pain (78%), nausea (52%), vomiting (43%), and generalized abdominal pain (22%) lasting for a median of 3 months (range, 1 month to 2.5 years). Median postoperative follow-up was 2.7 years. Sixteen (70%) parents completed the questionnaire. Of those who responded, 63% indicated that their children had no abdominal pain, 87% had no vomiting, and 69% had no nausea in the month preceding the questionnaire. Overall, 67% of parents indicated that their children's symptoms were completely relieved after cholecystectomy, whereas 7% indicated that the symptoms were not relieved. Laparoscopic cholecystectomy is effective in providing both short-term and long-term improvement of symptoms in children with biliary dyskinesia.
Ross, S B; Mangar, D; Karlnoski, R; Patel, R S; Camporesi, E M; Barry, L K; Luberice, K; Sprenker, C J; Rosemurgy, A S
Transumbilical Laparo-Endoscopic Single Site (LESS) surgery promises improved cosmesis, quick recovery, reduced postoperative pain and shorter length of hospital stay. Since only a simple umbilical incision is used, LESS surgery can be completed with segmental epidural anesthesia. This study describes the evolution of our technique of LESS cholecystectomy from a combination of spinal and epidural anesthesia to thoracic epidural alone and presents our experience with its safety, the observed morbidity, and the reported patient satisfaction. In August 2009, a prospective evaluation of LESS cholecystectomy with regional anesthesia was undertaken. We recruited patients with chronic cholecystitis or symptomatic cholelithasis. Blood loss, operative time, complications, and length of hospital stay were measured. Preoperatively and 14 days postoperatively, outcome and symptom resolution were scored. Fifteen consecutive patients underwent LESS cholecystectomy; first with combined spinal-epidural (CSE), and then with thoracic epidural anesthesia alone. Immediate postoperative pain and discomfort were well tolerated. VAS scores upon admission to PACU were 0.4 (1.7±2.2). At postoperative day 14, the patients scored high values for "Satisfaction", 10 (10±1.0) and "Cosmesis", 10 (9.3±1.5). LESS cholecystectomy with epidural anesthesia can be undertaken safely. Patient satisfaction and cosmesis are particularly prominent amongst our patients. Our experience supports further utilization of epidural anesthesia for selected patients undergoing LESS cholecystectomy.
Escarce, J J; Bloom, B S; Hillman, A L; Shea, J A; Schwartz, J S
Introduced in 1989, laparoscopic cholecystectomy has rapidly become the treatment of choice for symptomatic gallstones. This study describes the diffusion of laparoscopic cholecystectomy among general surgeons; assesses the importance of various reasons for surgeons adopting the procedure; and examine the influence of surgeon, practice, and health care market characteristics on the timing of adoption. The data were obtained from a survey of a national sample of surgeons. Most surgeons (81%) adopted laparoscopic cholecystectomy by early 1992. More than three fourths of adopters identified the desire to keep up with the state-of-the-art and improved patient outcomes as very or extremely important reasons for adoption. Results of proportional hazards regression analysis indicate that individual surgeons' adoption behavior generally was consistent with expected utility maximization in an uncertain new technological environment. Of particular interest, fee-for-service payment and more competitive practice settings and markets were associated with earlier adoption. These findings suggest that the "technological imperative" and surgeons' perception of the relative clinical and financial advantages of laparoscopic cholecystectomy were important reasons for the rapid diffusion of laparoscopic cholecystectomy. Policies that accelerate current trends toward payment of physicians based on salary or capitation and promote the growth of multispecialty group practice could slow the diffusion of new physician-based product innovations in health care.
Full Text Available Background As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain compared how their Diagnosis-Related Groups (DRG systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. Results European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England. The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Conclusion Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries’ DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.
Paat-Ahi, Gerli; Aaviksoo, Ain; Swiderek, Maria
As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. National or regional databases were used to identify hospital cases with a procedure of cholecystectomy. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually contained at least 1% of cases. Six standardised case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained and compared to an index case. European DRG systems vary widely: they classify cholecystectomy patients according to different sets of variables into diverging numbers of DRGs (between two DRGs in Austria and Poland to nine DRGs in England). The most complex DRG is valued at four times more resource intensive than the index case in Ireland but only 1.3 times more resource intensive than the index case in Austria. Large variations in the classification of cholecystectomy patients raise concerns whether all systems rely on the most appropriate classification variables. Surgeons, hospital managers and national DRG authorities should consider how other countries' DRG systems classify cholecystectomy patients in order to optimize their DRG systems and to ensure fair and appropriate reimbursement.
Biétry, Fabienne A; Reich, Oliver; Schwenkglenks, Matthias; Meier, Christoph R
Using claims data from the Helsana Group, a large Swiss health insurance provider, we examined the association between statin use and the risk of cholecystectomy in a case-control analysis. We identified 2,200 cholecystectomy cases between 2013 and 2014 and matched 4 controls to each case on age, sex, index date and canton. We categorized statin users into current or past users (last prescription ≤ 180 or > 180 days before the index date, respectively) and classified medication use by duration based on number of prescriptions before the index date. We applied conditional logistic regression analyses to calculate odds ratios (ORs) with 95% confidence intervals (CIs) and adjusted the analyses for history of cardiovascular diseases and for use of estrogens, fibrates and other lipid-lowering agents. The adjusted OR (aOR) for cholecystectomy was 0.85 (95% CI: 0.74, 0.99) for current statin users compared to non-users. Long-term current statin use (5-19 prescriptions) was associated with a reduced OR (aOR 0.77, 95% CI: 0.65, 0.92). However, neither short-term current use nor past statin use affected the risk of cholecystectomy. The study supports the previously raised hypothesis that long-term statin use reduces the risk of cholecystectomy.
Liu, Yu-Yin; Yeh, Chun-Nan; Lee, Hsiang-Lin; Wang, Shang-Yu; Tsai, Chun-Yi; Lin, Chih-Chung; Chao, Tzu-Chieh; Yeh, Ta-Sen; Jan, Yi-Yin
AIM: To investigate the effect of pain relief after infusion of ropivacaine at port sites at the end of surgery. METHODS: From October 2006 to September 2007, 72 patients undergoing laparoscopic cholecystectomy (LC) were randomized into two groups of 36 patients. One group received ropivacaine infusion at the port sites at the end of LC and the other received normal saline. A visual analog scale was used to assess postoperative pain when the patient awakened in the operating room, 6 and 24 h after surgery, and before discharge. The amount of analgesics use was also recorded. The demographics, laboratory data, hospital stay, and perioperative complications were compared between the two groups. RESULTS: There was no difference between the two groups preoperatively in terms of demographic and laboratory data. After surgery, similar operation time, blood loss, and no postoperative morbidity and mortality were observed in the two groups. However, a significantly lower pain score was observed in the patients undergoing LC with local anesthesia infusion at 1 h after LC and at discharge. Regarding analgesic use, the amount of meperidine used 1 h after LC and the total used during admission were lower in patients undergoing LC with local anesthesia infusion. This group also had a shorter hospital stay. CONCLUSION: Local anesthesia with ropivacaine at the port site in LC patients significantly decreased postoperative pain immediately. This explains the lower meperidine use and earlier discharge for these patients. PMID:19452582
Pandian, T K; Ubl, Daniel S; Habermann, Elizabeth B; Moir, Christopher R; Ishitani, Michael B
Few studies have assessed the impact of obesity on laparoscopic cholecystectomy (LC) in pediatric patients. Children who underwent LC were identified from the 2012 to 2013 American College of Surgeons' National Surgical Quality Improvement Program Pediatrics data. Patient characteristics, operative details, and outcomes were compared. Multivariable logistic regression was utilized to identify predictors of increased operative time (OT) and duration of anesthesia (DOAn). In total, 1757 patients were identified. Due to low rates of obesity in children obese). Among obese children, 80.6% were girls. A higher proportion of obese patients had diabetes (3.0% versus 1.0%, P obesity was an independent predictor of OT >90 (odds ratio [OR] 2.02; 95% confidence interval [95% CI] 1.55-2.63), and DOAn >140 minutes (OR 1.86; 95% CI 1.42-2.43). Obesity is an independent risk factor for increased OT in children undergoing LC. Pediatric surgeons and anesthesiologists should be prepared for the technical and physiological challenges that obesity may pose in this patient population.
Daradkeh, S S; Suwan, Z; Abu-Khalaf, M
A prospective study was carried out to investigate the value of preoperative ultrasound findings for predicting difficulties encountered during laparoscopic cholecystectomy (LC). Altogether 160 consecutive patients with symptomatic gallbladder (GB) disease (130 females, 30 males) referred to the Jordan University Hospital were recruited for the purpose of this study. All patients underwent detailed ultrasound examination 24 hours prior to LC. The overall difficulty score (ODS), as a dependent variable, was based on the following operative parameters: duration of surgery, bleeding, dissection of Calot's triangle, dissection of gallbladder wall, adhesions, spillage of bile, spillage of stone, and difficulty of gallbladder extraction. Multiple regression analysis was used to assess the significance of the following preoperative ultrasound variables (independent) for predicting the variation in the ODS: size of the GB, number of GB stones, size of stones, location of GB stones, thickness of GB wall, common bile duct (CBD) diameter, and liver size. Only thickness of GB wall and CBD diameter were found to be significant predictors of the variation in the ODS (adjusted R2 = 0.25). We conclude that the preoperative ultrasound examination is of value for predicting difficulties encountered during LC, but it is not the sole predictor.
Terhaar, O.A.; Abbas, S.; Thornton, F.J.; Duke, D.; O'Kelly, P.; Abdullah, K.; Varghese, J.C.; Lee, M.J.
AIM: To assess the role of ultrasound (US), magnetic resonance cholangiopancreatography (MRCP) and liver function tests (LFTs) in the evaluation of selected patients presenting with late post-cholecystectomy syndrome (PCS) who were referred for endoscopic retrograde cholangiopancreatography (ERCP) MATERIALS AND METHODS: In a retrospective study a final group of 42 patients with PCS referred for diagnostic ERCP underwent MRCP and abdominal US. ERCP and MRCP images were assessed for bile duct diameters and the presence of strictures and stones. A common bile duct (CBD) diameter of <10 mm was considered normal, whereas ≥10 mm was considered abnormal on US. Findings were correlated to LFTs with contingency table results performed for single techniques and combination of methods. RESULTS: In total 14 stones and one stricture were seen. US had a high negative predictive value (86.4%). MRCP had a sensitivity of 100% and specificity of 88.0%. ERCP is the most accurate test but failed in 11 patients, five of whom had a stone. The accuracy of US and LFTs increases to 93.8% if test results agree in either negative or positive outcome. CONCLUSION: US and LFTs are first-line tests in PCS. If the CBD on US is ≥10 mm, but no cause is identified, MRCP should be performed. If US and LFTs are normal then MRCP is not necessary. The availability of LFTs raises the diagnostic value of imaging
Tayeb, M.; Khan, Muhammad R.; Riaz, N.
Although laparoscopic cholecystectomy (LC) has become the procedure ofchoice for cholelithiasis in the general population, many consider cirrhosisas a relative or absolute contraindication for laparoscopic surgery. The aimof this study was to confirm the safety of LC in cirrhotic patients in ourset-up. This is a retrospective case series including all patients withcirrhosis who underwent LC for gallstones from January 2000 to December2006at our institution. Data were analyzed for Child class, indication forsurgery, hospital stay and procedure-related morbidity and mortality. Resultsare given as +- standard deviation. Thirty patients, including 21 females(median age: 42 years) underwent LC during the study period. There was nooperative mortality. Twenty-four patients belonged to Child class A and 6belonged to Child class B. Mean operative time was 80+-26 min. There was noincident of bile duct injury, but two patients (6.7%) required conversion toopen procedure. Mean hospital stay was 3+-2.7 days. Postoperative morbiditywas observed in 7 patients, including postoperative deterioration of liverfunction in 2, worsening of ascites in 2 and pneumonia and port-siteinfection in 1. Two patients had significant in hemoglobin requiring bloodtransfusion. Cirrhosis is not a contraindication for LC and it can beperformed safely in compensated cirrhotic patients with acceptable morbidityand mortality. (author)
Bialkowski, Jedrzej; Gottschalk, Katrin; Wisniewski, Tomasz
This paper investigates a sample of 27 OECD countries to test whether national elections induce higher stock market volatility. It is found that the country-specific component of index return variance can easily double during the week around an Election Day, which shows that investors are surprised by the election outcome. Several factors, such as a narrow margin of victory, lack of compulsory voting laws, change in the political orientation of the government, or the failure to form a coaliti...
Bialkowski, Jedrzej; Gottschalk, Katrin; Wisniewski, Tomasz Piotr
This paper investigates a sample of 27 OECD countries to test whether national elections induce higher stock market volatility. It is found that the countryspecific component of index return variance can easily double during the week around an Election Day, which shows that investors are surprised by the election outcome. Several factors, such as a narrow margin of victory, lack of compulsory voting laws, change in the political orientation of the government, or the failure to form a coalitio...
F. Xavier Peytibi
Full Text Available
The last elections, on 9 March 2008, were the first Spanish general elections where the Internet played a major role in the electoral campaign. It entered in the campaign in a way different from how it had done up until then, not just in general elections, but in any election in Spain.
Even though political parties continued to have their web pages, with news, biographies of the candidates, planned events, electoral programme, etc., five clear changes were observed in how the campaigns were run online, changes which have also been observed in other countries.
Election Assistance Commission — This dataset contains data about domestic absentee voting, provisional balloting, poll books, polling place, precincts, poll workers, and voting technology used in...
Election Assistance Commission — This dataset contains data about domestic absentee voting, provisional balloting, poll books, polling place, precincts, poll workers, and voting technology used in...
Bouwense Stefan A
Full Text Available Abstract Background After an initial attack of biliary pancreatitis, cholecystectomy minimizes the risk of recurrent biliary pancreatitis and other gallstone-related complications. Guidelines advocate performing cholecystectomy within 2 to 4 weeks after discharge for mild biliary pancreatitis. During this waiting period, the patient is at risk of recurrent biliary events. In current clinical practice, surgeons usually postpone cholecystectomy for 6 weeks due to a perceived risk of a more difficult dissection in the early days following pancreatitis and for logistical reasons. We hypothesize that early laparoscopic cholecystectomy minimizes the risk of recurrent biliary pancreatitis or other complications of gallstone disease in patients with mild biliary pancreatitis without increasing the difficulty of dissection and the surgical complication rate compared with interval laparoscopic cholecystectomy. Methods/Design PONCHO is a randomized controlled, parallel-group, assessor-blinded, superiority multicenter trial. Patients are randomly allocated to undergo early laparoscopic cholecystectomy, within 72 hours after randomization, or interval laparoscopic cholecystectomy, 25 to 30 days after randomization. During a 30-month period, 266 patients will be enrolled from 18 hospitals of the Dutch Pancreatitis Study Group. The primary endpoint is a composite endpoint of mortality and acute re-admissions for biliary events (that is, recurrent biliary pancreatitis, acute cholecystitis, symptomatic/obstructive choledocholithiasis requiring endoscopic retrograde cholangiopancreaticography including cholangitis (with/without endoscopic sphincterotomy, and uncomplicated biliary colics occurring within 6 months following randomization. Secondary endpoints include the individual endpoints of the composite endpoint, surgical and other complications, technical difficulty of cholecystectomy and costs. Discussion The PONCHO trial is designed to show that early
Full Text Available ObjectiveTo investigate the identification and treatment of variation of extrahepatic bile duct in laparoscopic cholecystectomy (LC, and to reduce the occurrence of bile duct injury. MethodsThis study included 60 patients who received LC in the People′s Hospital of Caidian District in Wuhan and had structural variation of extrahepatic bile duct found during the operation from January 2012 to January 2014. The clinical data were retrospectively analyzed, and the intraoperative and postoperative conditions were summarized. ResultsDuring operation, cystic duct variation was found in 32 cases, abnormal position of the point where the cystic duct joins the extrahepatic bile duct in 20 cases, the cystic duct and the common hepatic duct having the common wall before joining the common bile duct in 2 cases, aberrant bile duct in the gallbladder bed in 2 cases, and accessory hepatic duct in 4 cases. Fifty-one patients (85% successfully underwent LC; 9 patients (15% were converted to open surgery. All patients finished surgery successfully. There were 2 cases of postoperative complications; one patient developed residual stones in the bile duct, and bile leakage occurred in the other patient at one week after LC, who recovered after reoperation. All patients were cured and discharged, without severe complications such as intraperitoneal hemorrhage, infection, and intestinal injury. ConclusionIdentifying the structural variation of extrahepatic bile duct, dissecting the Calot′s triangle meticulously, and determining the type of variation of extrahepatic bile duct play important roles in LC and significantly reduce the incidence of bile duct injury.
Full Text Available Objectives: It is still controversial to perform a laparoscopic cholecystectomy (LC for the management of acute biliary pancreatitis (ABP at the early hospitalization period, because of adhesions and dissection difficulties. The aim of this study was to evaluate the outcome of the patients with ABP who underwent LC prior to hospital discharge.Methods: A total of 43 patients with ABP, that underwent LC after clinical and laboratory improvement, were retrospectively evaluated. Patient’s age, gender, laboratory findings; ultrasonography (USG, magnetic resonance and other imaging results, surgical operation duration, complications, mortality and postoperative hospital stay days were recorded and statistically analyzed.Results: The median age of patients was 51.8 (20-83 years. A total of 29 (67.4% patients were women and 14 (32.6% were male. The cause was gallstone in all patients. In addition, hyperparathyroidism was found in one patient and hyperlipidemia was present in the other one. Gallbladder stones were determined in all patients. Common bile duct enlargement and stones were detected in 7 patients. Three patients underwent sphyncterectomy and stone extraction according to clinical status. Operations were performed at the mean hospitalization day of 11.4 (3-23. LC was performed to 39 (%90.6 of patients. However, 4 (9.4% patients had intra-abdominal adhesions secondary to infection and were switched to open surgery. The mean operation time was 70 (25-160 minutes and the mean duration of postoperative hospital stay was 3 (1-6 days. In a patient who underwent LC and ERCP preoperatively complication occurred. A second drainage operation was performed and due to development of necrotizing pancreatitis, the patient was lost at the postoperative 7th day secondary to adult type respiratory distress syndrome.Conclusions: In patients with ABP whose clinical and laboratory findings were improved, late LC can be performed safely during their first
Bisgaard, T; Klarskov, B; Trap, R
cholecystectomy using two 10-mm and two 5-mm trocars (LC). Incisional pain at each port incision and overall pain were recorded for 1 week after the operation. Fatigue, nausea and vomiting, pulmonary function, and cosmetic results were also measured. RESULTS: Data from 52 patients were analyzed; eight patients......BACKGROUND: Downsizing the port incisions may reduce pain after laparoscopic cholecystectomy. METHODS: In a double-blind controlled study, 60 patients were randomized to undergo either microlaparoscopic cholecystectomy using one 10-mm and three 3.5-mm trocars (3.5-mm LC) or traditional laparoscopic.......01). In both groups, pain scores at the supraumbilical 10-mm port were significantly higher compared with other port sites (p
Kimura, T; Goto, H; Takeuchi, Y; Yoshida, M; Kobayashi, T; Sakuramachi, S; Harada, Y
Gallbladder perforation often occurs during laparoscopic cholecystectomy. The frequency and causes of gallbladder perforation as well as the relevant clinical background factors were investigated in 110 patients undergoing laparoscopic cholecystectomy. We also evaluated intraperitoneal contamination by bacteria and gallstones at the time of gallbladder perforation and investigated whether perforation caused early or late postoperative complications. Intraoperative gallbladder perforation occurred in 29 of the 110 patients (26.3%). It was caused by injury with an electric knife during dissection of the gallbladder bed, injury during gallbladder retraction with grasping forceps, injury during gallbladder extraction from the abdomen, and slippage of cystic duct clips (potentially causing bile and stone spillage). Perforation was more frequent in patients with positive bile cultures and in those with pigment stones (p gallbladder perforation is sometimes unavoidable during laparoscopic cholecystectomy, the risk of severe complications appears to be minimized by early closure of perforation, retrieval of as many of the spilled stones as possible, and intraperitoneal lavage.
Ciulla, A; Romeo, G; Genova, G; Tomasello, G; Agnello, G; Cstronovo, Gaetano
A potentially serious complication of laparoscopic cholecystectomy is the inadvertent dissemination of unsuspected gallbladder carcinoma. There are increasing reports of seeding of tumor at the trocar sites following laparoscopic cholecystectomy in patients with unexpected or inapparent gallbladder carcinoma. Although the mechanism of the abdominal wall recurrence is still unclear, laparoscopic handling of the tumor, perforation of the gallbladder, and extraction of the specimen without an endobag may be risk factors for the spreading of malignant cells. The Authors report the case of late development of umbilical metastasis after laparoscopic cholecystectomy; the presence of an incisional hernia and the finding of a stone in subcutaneous tissue demonstrate the diffusion of tumor cells into subcutaneous tissue during the extraction of gallbladder. The patient underwent an excision of the metastases. She is disease free two years after surgical treatment.
The elections to renew the Staff Council for the period 2012–2013 are now behind us and we welcome the turnout for the vote was 63.6%, This clearly shows the interest that members of the Staff Association attach to the work and dedication of their delegates and expresses their full support for the candidates of their college and department. We also thank all candidates who committed themselves to actively defend the interests of the staff. This newly-elected Staff Council (see its composition on the following page) is meant to be truly representative of all sectors and professions of the Organization, and this will be a major asset when representatives of the Staff Association will have discussions with Management and Member States on issues we have will have to treat the next two years. Armed with this vote of confidence, we are certain that we can count on your active and ongoing support in the future. We know there will be no shortage of challenges. Together we will be stronger to take them o...
The elections to renew the Staff Council for the period 2016-2017 are now behind us and we welcome the turnout for the vote of 55.9 %, which was considerably higher than that of last time. This clearly shows the interest that members of the Staff Association attach to the work and dedication of their delegates and expresses their full support for the candidates of their department. We also thank all candidates who committed themselves to actively defend the interests of the staff. This newly-elected Staff Council (see its composition below) is meant to be truly representative of all sectors and professions of the Organization. This will be a major asset when representatives of the Staff Association will have discussions with Management and Member States on issues which we will have to address the next two years. Strong with this vote of confidence, we are certain that we can count on your active and ongoing support in the future. We know there will be no shortage of challenges. Together we will be stronger t...
Schreuder, Anne Marthe; Booij, Klaske A C; de Reuver, Philip R; van Delden, Otto M; van Lienden, Krijn P; Besselink, Marc G; Busch, Olivier R; Gouma, Dirk J; Rauws, Erik A J; van Gulik, Thomas M
Bile duct injury (BDI) remains a daunting complication of laparoscopic cholecystectomy. In patients with complex BDI, a percutaneous-endoscopic rendezvous procedure may be required to establish bile duct continuity. The aim of this study was to assess short- and long-term outcomes of the rendezvous procedure. All consecutive patients with BDI referred to our tertiary referral center between 1995 and 2016 were analyzed. A rendezvous procedure was performed when endoscopic or radiologic intervention failed, and when deemed feasible by a dedicated multidisciplinary team including hepatopancreaticobiliary surgeons, gastrointestinal endoscopists, and interventional radiologists. Classification of BDI, technical success of the rendezvous procedure, procedure-related adverse events, and outcomes were assessed. Among a total of 812 patients, rendezvous was performed in 47 (6 %), 31 (66 %) of whom were diagnosed with complete transection of the bile duct (Amsterdam type D/Strasberg type E injury). The primary success rate of rendezvous was 94 % (44 /47 patients). Overall morbidity was 18 % (10 /55 procedures). No life-threatening adverse events or 90-day mortality occurred. After a median follow-up of 40 months (interquartile range 23 - 54 months), rendezvous was the final successful treatment in 26 /47 patients (55 %). In 14 /47 patients (30 %), rendezvous acted as a bridge to surgery, with hepaticojejunostomy being chosen either primarily or secondarily to treat refractory or relapsing stenosis. In experienced hands, rendezvous was a safe procedure, with a long-term success rate of 55 %. When endoscopic or transhepatic interventions fail to restore bile duct continuity in patients with BDI, rendezvous should be considered, either as definitive treatment or as a bridge to elective surgery. © Georg Thieme Verlag KG Stuttgart · New York.
Sulz, Michael C; Zerz, Andreas; Sagmeister, Markus; Roll, Thomas; Meyenberger, Christa
Few data are available regarding patients' perceptions of new cholecystectomy (CC) techniques, in the context of the patients' risk behaviours. We investigated patients' preferences for transgastric pure natural orifice translumenal endoscopic surgery (NOTES; transgastric NCC) and rigid-hybrid transvaginal NOTES CC (tvNCC) compared with the standard laparoscopic CC (SL-CC), and patients' risk behaviours. A total of 140 inpatients scheduled for elective laparoscopic CC were enrolled in this prospective single-centre study, from January 2009 to January 2010. Patients judged the potential advantages and disadvantages of transgastric NCC and tvNCC compared with SL-CC. The individual's risk behaviour was analysed by means of the validated 40-item Domain-Specific Risk Attitude Scale (DOSPERT). Of the 140 recruited patients, 57 (65% females; mean age 51.5 years) were analysed. Twenty-five percent of males opted for transgastric NCC and 75% opted for SL-CC. Among females, 10.8%, 37.8% and 51.4% opted for transgastric NCC, tvNCC and SL-CC, respectively. Faster convalescence was graded as the primary potential advantage of transgastric NCC, whereas the potential risk of long-term stomach injuries was considered a primary disadvantage. Females graded the reduction of hospital-acquired morbidity as the primary advantage of tvNCC. The risk assessment showed significantly more risk-taking behaviour in the recreational domain of life among patients who opted for innovative surgical techniques than among those opting for conventional surgery. Transgastric NCC is rarely accepted by females but accepted by a quarter of males. Females consider rigid-hybrid tvNCC and SL-CC similarly attractive. Despite promising new techniques, three-quarters of male and one half of female patients still prefer the standard laparoscopic CC.
Full Text Available Duodenal injury following laparoscopic cholecystectomy is rare complications with catastrophic sequelae. Most injuries are attributed to thermal burns with electrocautery following adhesiolysis and have a delayed presentation requiring surgical intervention. We present a case of a 47-year-old gentleman operated on for laparoscopic cholecystectomy with a bilious drain postoperatively; for which an ERC was done showing choledocholithiasis with cystic duct stump blow-out and a drain in the duodenum suggestive of an iatrogenic duodenal injury. He was managed conservatively like a duodenal fistula and recovered without undergoing any intervention.
Sangrasi, Ahmed Khan; Syed, Bm; Memon, Amir Iqbal; Laghari, Abdul Aziz; Talpur, K Altaf Hussain; Qureshi, Jawaid Naeem
Acute gallstone pancreatitis is quite common throughout the globe. Conventionally definitive cholecystectomy has been delayed in index hospital admission. Since the last decade timing of cholecystectomy is gradually shifting towards the earlier phase of disease and currently gallstone pancreatitis is being evaluated as a further indication for laparoscopic cholecystectomy. There is also great concern regarding compliance of patients for definitive surgery due to poverty, ignorance and illiteracy in developing countries. The aim of this study was to assess the feasibility and safety of laparoscopic cholecystectomy as a definitive treatment in patients with mild and resolving gall stone pancreatitis. This was a prospective study from July 2009 to June 2012. Patients were diagnosed by clinical examination, biochemical tests, ultrasonography and contrast enhanced CT. Patients with mild form of the disease (Ranson Score ≤3) and who showed clinical improvement were offered laparoscopic cholecystectomy in index hospital admission. Those who were unfit for surgery were referred for endoscopic sphincterotomy. Common bile duct stones were excluded preoperatively. A total of 38 patients were admitted with acute gallstone pancreatitis in the study period. The mean age of patients was 46.3 years with male to female ratio of 11/27. 22 (57.8%) patients were selected for laparoscopic cholecystectomy and procedure was completed successfully. Ten (26.3%) patients were referred for ERCP and endoscopic sphincterotomy and 11 (28.9%) were managed by conservative treatment and went without any definitive treatment. Mean duration of time from onset of symptoms and laparoscopic cholecystectomy was 7 days (range 4-10). Mean duration of operative time was 45 minutes and hospital stay was 7 days. There was no operative mortality. No major intra-operative or post-operative complication was recorded. two patients (9%) had minor complications. Laparoscopic cholecystectomy can be safely
Full Text Available This study aimed to elucidate the effects of cholecystectomy on the risk of colorectal cancer (CRC by conducting a meta-analysis of 10 cohort studies.The eligible cohort studies were selected by searching the PubMed and EMBASE databases from their origination to June 30, 2016, as well as by consulting the reference lists of the selected articles. Two authors individually collected the data from the 10 papers. When the data showed marked heterogeneity, we used a random-effects model to estimate the overall pooled risk; otherwise, a fixed effects model was employed.The final analysis included ten cohort studies. According to the Newcastle-Ottawa Scale (NOS, nine papers were considered high quality. After the data of these 9 studies were combined, an increased risk of CRC was found among the individuals who had undergone cholecystectomy (risk ratio (RR 1.22; 95% confidence interval (CI 1.08-1.38. In addition, we also found a promising increased risk for colon cancer (CC (RR 1.30, 95% CI 1.07-1.58, but no relationship between cholecystectomy and rectum cancer (RC (RR 1.09; 95% CI 0.89-1.34 was observed. Additionally, in the sub-group analysis of the tumor location in the colon, a positive risk for ascending colon cancer (ACC was found (RR 1.18, 95% CI 1.11-1.26. After combining the ACC, transverse colon cancer (TCC, sigmoid colon cancer (SCC and descending colon cancer (DCC patients, we found a positive relationship with cholecystectomy (RR 1.18, 95% CI 1.11-1.26. Furthermore, after combining the ACC and DCC patients, we also found a positive relationship with cholecystectomy (RR 1.28; 95% CI 1.11-1.26 in the sub-group analysis. In an additional sub-group analysis of patients from Western countries, there was a positive relationship between cholecystectomy and the risk of CRC (RR 1.20; 95% CI 1.05-1.36. Furthermore, a positive relationship between female gender and CRC was also found (RR 1.17; 95% CI 1.03-1.34. However, there was no relationship
Full Text Available How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants' inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the
Lin, Chujun; Adolphs, Ralph; Alvarez, R Michael
How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants' inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures) correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the difficult question of
Adolphs, Ralph; Alvarez, R. Michael
How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants’ inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures) correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the difficult question of
Newland, P E; Pastoriza-Pinol, J; McMillan, J; Smith, B F; Stirling, G R
Open heart surgery has previously been associated with the use of large volumes of blood products. This paper describes methods of blood conservation and a simple method of intraoperative autotransfusion that together have resulted in minimal blood product usage in elective open heart surgery cases. This has reduced our dependence on blood bank supplies for the performance of elective open heart surgery.
Binstock, Robert H.
Examines what is known about one element of the politics of aging--the voting behavior of older persons in recent presidential elections--and suggests areas of research on the 1992 election that may tell something about how far, and how soon, proponents of generational equity will be able to move toward dismantling policies that benefit older…
J.M.T. Romijn (Judi)
textabstractThe HAVi specification proposes an architecture for audio/video interoperability in home networks. Part of the HAVi specification is a distributed leader election protocol. We have modelled this leader election protocol in Promela and Lotos and have checked several properties with the
However, in conditions where such elections are shrouded in constitutional manipulation, political opaqueness, greed and consolidation of personal rule, they may instead, entrench an authoritarian regime. This article looks at the effects of the recent multiparty elections on the process of democratization and peace building ...
... organization must accept without restriction (except for an MA RFB plan as provided by § 422.57) individuals... election mechanisms. (1) The election must comply with CMS instructions regarding content and format and be... may be retroactive. Consistent with § 422.308(f)(2), payment adjustments based on a retroactive...
Hoff, David J.
This article reports on two national teachers' unions' different approaches to the 2008 U.S. election campaign. The National Education Association is ready to spend $40 million this election year, but it is not ready to endorse a candidate for president. The American Federation Teachers, by contrast, is working aggressively for U.S. Sen. Hillary…
Nickel, Felix; Brzoska, Julia A.; Gondan, Matthias; Rangnick, Henriette M.; Chu, Jackson; Kenngott, Hannes G.; Linke, Georg R.; Kadmon, Martina; Fischer, Lars; Müller-Stich, Beat P.
Abstract This study compared virtual reality (VR) training with low cost-blended learning (BL) in a structured training program. Training of laparoscopic skills outside the operating room is mandatory to reduce operative times and risks. Laparoscopy-naïve medical students were randomized in 2 groups stratified for sex. The BL group (n = 42) used E-learning for laparoscopic cholecystectomy (LC) and practiced basic skills with box trainers. The VR group (n = 42) trained basic skills and LC on the LAP Mentor II (Simbionix, Cleveland, OH). Each group trained 3 × 4 hours followed by a knowledge test concerning LC. Blinded raters assessed the operative performance of cadaveric porcine LC using the Objective Structured Assessment of Technical Skills (OSATS). The LC was discontinued when it was not completed within 80 min. Students evaluated their training modality with questionnaires. The VR group completed the LC significantly faster and more often within 80 min than BL (45% v 21%, P = .02). The BL group scored higher than the VR group in the knowledge test (13.3 ± 1.3 vs 11.0 ± 1.7, P training and felt well prepared for assisting in laparoscopic surgery. The efficiency of the training was judged higher by the VR group than by the BL group. VR and BL can both be applied for training the basics of LC. Multimodality training programs should be developed that combine the advantages of both approaches. PMID:25997044
Li, Jinshan; Elklit, Jørgen
The parliamentary eklection in singapore in January 1997 is examined, as is the particular electoral system ('the party block vote') which is found to be a central element in the electoral strategy of the ruling party, PAP. the functioning of this rare electoral system is, however, only one eleme...... in explaining how PAP has been able to win comfortable majorities in the House. The analysis contributes to the understandi9ng of how a semi-democratic regime can stay in power. The political and electoral process in relation to the 1997 election is also analysed......The parliamentary eklection in singapore in January 1997 is examined, as is the particular electoral system ('the party block vote') which is found to be a central element in the electoral strategy of the ruling party, PAP. the functioning of this rare electoral system is, however, only one element...
Prado, C G
Moral individualism (Brooks, 2011; Smith, 2011) is a contemporary interpretation of morality as entirely a matter of personal choice. It is a popular rather than theory-based interpretation and has a number of social generative sources related to present-day preoccupation with individuality and personal distinctiveness. A key generative source is popularization of postmodernism, which prioritizes self-reinvention and provides moral individualism with the appearance of intellectual legitimacy. Moral individualism is a deeply flawed misconception of morality because it abolishes moral communality. My concern in this paper is that in doing so, it seriously jeopardizes productive discussion of the moral permissibility of elective death or choosing to die in despairingly and dire circumstances. Copyright © 2013 Elsevier Ltd. All rights reserved.
In March 2013, Kenya held its first election after the post-election violence (PEV) in 2008, which media were blamed for contributing to by partisan reporting and hate speech. Prior to the 2013 election, several organizations worked to raise awareness of the negative consequences of hate speech...... and the need of responsible journalism. This article sheds light on how Kenyan journalists perceived their role and evaluated their own reporting of the 2013 election and whether they were influenced by the experience of the PEV. The article shows how the experience of the PEV became a reference point when...... discussing the election reporting and the role of journalists. Several journalists admitted that important issues were avoided due to fear of steering up emotions....
Vadgård, Anne Kathrine Pihl
In this paper I explore the role of the Danish election law in the conduct of elections. Based on 9 months of ethnographic fieldwork in an election office in a Danish municipality, I focus on the conflicting relation between the legal framework and deviating election practices. I argue that handl......In this paper I explore the role of the Danish election law in the conduct of elections. Based on 9 months of ethnographic fieldwork in an election office in a Danish municipality, I focus on the conflicting relation between the legal framework and deviating election practices. I argue...... that handling of such election practices requires thoughtful and vigorous bureaucratic work. Thus the election law may be said to act as a navigational tool throughout the complex bureaucratic practices of planning an election. Yet exceptions to the law inevitably occur on Election Day, requiring bending...
Lechowicz, Martin J
Electivity indices measure the utilization of food types (r) in relation to their abundance or availability in the environment (p). Foods that constitute a larger proportion of the diet than of the available foods are considered preferred; conversely those proportionately underrepresented in the diet are avoided. A food is eaten at random if its proportion in the diet equals its proportion in the environment. A family of electivity indices stemming from Ivlev's (1961) classic monograph exist and differ only in the particular algorithm used to calculate electivity from r and p.For each available index I graphed the values of electivity as contours for all combinations of r and p. These graphs are compared to illustrate the strengths and weaknesses of each index on the basis of the following criteria: 1) the value of the index when r=p for a food, 2) the symmetry of the electivity value as feeding deviates from random, 3) the possible range of index values, 4) the linearity of changes in electivity over the full range of r and p, 5) the sensitivity of the index to sampling errors, 6) the statistical testability of the electivity, and 7) the stability of the electivity value for a food type that changes relative abundance or occurs in combination with different food types. No one index ideally satisfies all the criteria.The host preferences of gypsy moth, Lymantria dispar, feeding on tree foliage in an undisturbed deciduous forest in southwestern Quebec, Canada were used to compare the available indices: Ivlev's electivity, E; Ivlev's forage ratio, E'; Jacob's modified electivity, D; Jacob's modified forage ratio, log Q; Chesson's alpha; Strauss' linear index, L; and Vanderploeg and Scavia's relativized electivity, E * . The electivity values calculated by each index differ one from another; host trees shown as preferred by one index will frequently appear avoided according to an alternative index. The rank order electivities for the 19 available host trees, however
Full Text Available Introduction. Early laparoscopic cholecystectomy is usually associated with reduced hospital stay, sick leave, and health care expenditures. Early diagnosis and treatment of acute cholecystitis reduce both mortality and morbidity and the accurate diagnosis requires specific diagnostic criteria of clinical data and imaging studies. Objectives. To compare early versus delayed laparoscopic cholecystectomy regarding the operative outcome and patient satisfaction. Patients and Methods. Patients with acute cholecystitis were divided into two groups, early (A and delayed (B cholecystectomy. Diagnosis of acute cholecystitis was confirmed by clinical examination, laboratory data, and ultrasound study. The primary end point was operative and postoperative outcome and the secondary was patient’s satisfaction. Results. The number of readmissions in delayed treatment group B was three times in 10% of patients, twice in 23.3%, and once in 66.7% while the number of readmissions was once only in patients in group A and the mean total hospital stays were higher in group B than in group A. The overall patient’s satisfaction was 92.66±6.8 in group A compared with 75.34±12.85 in group B. Conclusion. Early laparoscopic cholecystectomy resulted in significant reduction in length of hospital stay and accepted rate of operative complications and conversion rates when compared with delayed techniques.
Booij, Klaske A. C.; de Reuver, Philip R.; Yap, Kenneth; van Dieren, Susan; van Delden, Otto M.; Rauws, Erik A.; Gouma, Dirk J.
Cystic duct and Luschka duct leakage after laparoscopic cholecystectomy are often classified as minor injuries because the outcome of endoscopic stenting and percutaneous drainage is generally reported to be good. However, the potential associated early mortality and risk factors for mortality are
Ndoye, M Diop; Bah, M Diao; Pape, I Ndiaye; Diouf, E; Kane, O; Bèye, M; Fall, B; Ka-Sall, B
Sickle cell disease is a public health problem in Africa. The aim of this prospective study was to evaluate per and post-operative complications of laparoscopic cholecystectomy in sickle cell children in Senegal. from January 1999 to December 2006, an anesthetic protocol was applied to 39 sickle cell children undergoing a cholecystectomy. Among them, 20 experienced laparoscopic cholecystectomy. All these 20 patients had previously suffered from sickle cell visceral complications and were classified as ASA II (11 cases) and as ASA III (9 cases). Blood transfusion program aimed at sustaining haemoglobin level between 10 and 12 g/dl was implemented. The preoperative monitoring and anesthesia management were the same for these patients. During perioperative period, the prevention of pain, hypovolemia, hypothermia and acidosis was achieved. The mean insufflation duration of laparoscopy was 23 min (17-60 min), the mean surgery duration was 55 min (40-110 min), and the mean anesthesia duration was 78 min (88-135 min). Postoperative complications occurred in 9 patients: acute chest syndrome (n=2), postoperative hemolysis (n=5), vaso-occlusive crisis (n=2). Laparoscopic cholecystectomy can be carried out in sickle cell children affected with gallstones, provided that general anaesthetic rules were respected. An appropriate pre-, per- and postoperative anaesthesia is mandatory to reduce postoperative complications in children with sickle cell disease. Searching for early diagnosis of gallstones before occurrence of visceral complications should allow further optimal laparoscopic surgery.
Pasmans, H. L.; Go, P. M.; Gouma, D. J.; Heidendal, G. A.; van Engelshoven, J. M.; van Kroonenburgh, M. J.
To assess the role of Tc-99m IDA cholescintigraphy in diagnosing bile leakage and bile obstruction after laparoscopic cholecystectomy, 51 studies were performed in 51 patients on the first postoperative day. Two different radioactive bile acid analogs were used, Tc-99m HIDA and Tc-99m trimethylbromo
Rangarajan, M.; Palanivelu, C.; Madankumar, M.V.
This report describes a pregnant patient on whom emergency laparoscopic cholecystectomy was performed for empyema gallbladder. The patient was in her second trimester of pregnancy. The distended gallbladder was decompressed before dissection was commenced. There was no mortality, morbidity or conversion. There were no complications for either mother or child related to general anesthesia. (author)
Janssen, I.M.; Swank, D.J.; Boonstra, O.; Knipscheer, B.C.; Klinkenbijl, J.H.G.; Goor, H. van
BACKGROUND: Laparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and
Janssen, I. M. C.; Swank, D. J.; Boonstra, O.; Knipscheer, B. C.; Klinkenbijl, J. H. G.; van Goor, H.
Laparoscopic cholecystectomy is frequently complicated by gallbladder perforation and loss of bile or stones into the peritoneal cavity. The aim of this study was to compare the use of ultrasonic dissection and electrocautery with respect to the incidence of gallbladder perforation and
O. V. Lebedeva
Full Text Available Rationale: At present, the metabolic syndrome and pathophysiology of non-alcoholic fatty liver disease, as well as identification of factors that may influence the rate of development of dystrophy and fibrosis in the liver are in the focus of investigators' attention. This study represents an attempt to detail metabolic derangements and liver tissue abnormalities after cholecystectomy in patients with metabolic syndrome at baseline.Aim: To study the influence of cholecystectomy performed at younger age on the course of metabolic syndrome in women.Materials and methods: This was a retrospective analytical study in a sample of 57 female patients with metabolic syndrome (International Diabetes Federation criteria 2005 aged from 18 to 44 years (young age according to the World Health Organization definition. From those, 30 patients with cholelithiasis were included into the control group and 27 patients who had undergone cholecystectomy in this age range were included into the comparison group. We analyzed their past history, results of clinical examination, laboratory tests, abdominal ultrasound examination, esophagogastroduodenoscopy, hydrogen respiration test with lactulose, as well as the results of needle liver biopsy.Results: Non-alcoholic steatohepatitis after cholecystectomy was associated with the excessive bacterial growth in the small intestine (р = 0.026, ultrasound signs of cholangitis (р = 0.041, and diarrhea syndrome (р = 0.027. Liver fibrosis was significantly more frequent in association with chronic diarrhea (р = 0.034 and past clinical signs of post-cholecystectomy syndrome (р = 0.044. There was a strong direct correlation between the grade of fibrosis and the time since cholecystectomy (r = 0.77; р = 0.047.Conclusion: Cholecystectomy performed at young age predicts progression of metabolic
Full Text Available BACKGROUND Laparoscopic cholecystectomy is now the gold standard procedure and with over 5,00,000 procedures being done annually, laparoscopic cholecystectomy assumes a great significance in general surgical specialty. This study aims to study the effects of carbon dioxide pneumoperitoneum on the coagulation system of patients undergoing laparoscopic cholecystectomy and make the surgeon aware of the detrimental effects. MATERIALS AND METHODS A prospective clinical observational study of 50 patients selected by systematic sampling method from January 2015 to September 2015 at our institution was conducted to determine the results of changes in coagulation profile of patients undergoing laparoscopic cholecystectomy using carbon dioxide pneumoperitoneum. RESULTS The mean prothrombin time of the patients before surgery is 11.83 seconds. The standard deviation was 1.008 and standard error of mean was 0.143. The mean of prothrombin time 6 hours after surgery was 11.7 seconds. The standard deviation was 0.898 and the standard error of mean being 0.127. The difference in the mean between the two groups was 0.130. The p-value was 0.0109 (<0.05. Hence, the value was statistically extremely significant. The values for D-dimer were analysed. The mean value of D-dimer before surgery is 129.78. The standard deviation was 21.01 and standard error of mean was at 2.97. In the D-dimer values after surgery, mean was calculated to be 350.22 with the standard deviation at 73.21 and standard error of mean at 10.35. CONCLUSION Our study concluded that there is activation of both coagulation and fibrinolytic systems post laparoscopic cholecystectomy.
Full Text Available Whether low-concentration desflurane reinforces propofol-based intravenous anesthesia on maintenance of anesthesia for patients undergoing laparoscopic cholecystectomy is to be determined. The aim of this study was to investigate whether propofol-based anesthesia adding low-concentration desflurane is feasible for laparoscopic cholecystectomy. Fifty-two patients undergoing laparoscopic cholecystectomy were enrolled in the prospective, randomized, clinical trial. Induction of anesthesia was achieved in all patients with fentanyl 2 μg/kg, lidocaine 1 mg/kg, propofol 2 mg/kg, and rocuronium 0.8 mg/kg to facilitate tracheal intubation and to initiate propofol target-controlled infusion (TCI to effect site concentration (Ce: 4 μg/mL with infusion rate 400 mL/h. The patients were then allocated into either propofol TCI based (group P or propofol TCI adding low-concentration desflurane (group PD for maintenance of anesthesia. The peri-anesthesia hemodynamic responses to stimuli were measured. The perioperative psychomotor test included p-deletion test, minus calculation, orientation, and alert/sedation scales. Group PD showed stable hemodynamic responses at CO2 inflation, initial 15 minutes of operation, and recovery from general anesthesia as compared with group P. There is no significant difference between the groups in operation time and anesthesia time, perioperative psychomotor functional tests, postoperative vomiting, and pain score. Based on our findings, the anesthetic technique combination propofol and desflurane for the maintenance of general anesthesia for laparoscopic cholecystectomy provided more stable hemodynamic responses than propofol alone. The combined regimen is recommended for patients undergoing laparoscopic cholecystectomy.
Madani, Amin; Watanabe, Yusuke; Feldman, Liane S; Vassiliou, Melina C; Barkun, Jeffrey S; Fried, Gerald M; Aggarwal, Rajesh
Bile duct injuries from laparoscopic cholecystectomy remain a significant source of morbidity and are often the result of intraoperative errors in perception, judgment, and decision-making. This qualitative study aimed to define and characterize higher-order cognitive competencies required to safely perform a laparoscopic cholecystectomy. Hierarchical and cognitive task analyses for establishing a critical view of safety during laparoscopic cholecystectomy were performed using qualitative methods to map the thoughts and practices that characterize expert performance. Experts with more than 5 years of experience, and who have performed at least 100 laparoscopic cholecystectomies, participated in semi-structured interviews and field observations. Verbal data were transcribed verbatim, supplemented with content from published literature, coded, thematically analyzed using grounded-theory by 2 independent reviewers, and synthesized into a list of items. A conceptual framework was created based on 10 interviews with experts, 9 procedures, and 18 literary sources. Experts included 6 minimally invasive surgeons, 2 hepato-pancreatico-biliary surgeons, and 2 acute care general surgeons (median years in practice, 11 [range 8 to 14]). One hundred eight cognitive elements (35 [32%] related to situation awareness, 47 [44%] involving decision-making, and 26 [24%] action-oriented subtasks) and 75 potential errors were identified and categorized into 6 general themes and 14 procedural tasks. Of the 75 potential errors, root causes were mapped to errors in situation awareness (24 [32%]), decision-making (49 [65%]), or either one (61 [81%]). This study defines the competencies that are essential to establishing a critical view of safety and avoiding bile duct injuries during laparoscopic cholecystectomy. This framework may serve as the basis for instructional design, assessment tools, and quality-control metrics to prevent injuries and promote a culture of patient safety. Copyright
Kamila Rafaela Alves
Full Text Available ABSTRACT: CONTEXT AND OBJECTIVE: There are few data in the literature on the frequency of cholecystectomy in Brazil. The frequency of cholecystectomy and associated risk factors were evaluated in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil. DESIGN AND SETTING: Cross-sectional study using baseline data on 5061 participants in São Paulo. METHODS: The frequency of cholecystectomy and associated risk factors were evaluated over the first two years of follow-up of the study and over the course of life. A multivariate regression analysis was presented: odds ratio (OR and 95% confidence interval (95% CI. RESULTS: A total of 4716 individuals (93.2% with information about cholecystectomy were included. After two years of follow-up, 56 had undergone surgery (1.2%: 1.7% of the women; 0.6% of the men. A total of 188 participants underwent cholecystectomy during their lifetime. The risk factors associated with surgery after the two-year follow-up period were female sex (OR, 2.85; 95% CI, 1.53-5.32, indigenous ethnicity (OR, 2.1; 95% CI, 2.28-15.85 and body mass index (BMI (OR, 1.10; 95% CI, 1.01-1.19 per 1 kg/m2 increase. The risk factors associated over the lifetime were age (OR, 1.03; 95% CI, 1.02-1.05 per one year increase, diabetes (OR, 1.92; 95% CI, 1.34-2.76 and previous bariatric surgery (OR, 5.37; 95% CI, 1.53-18.82. No association was found with parity or fertile age. CONCLUSION: Female sex and high BMI remained as associated risk factors while parity and fertile age lost significance. New factors such as bariatric surgery and indigenous ethnicity have gained importance in this country.
Firouzian, Abolfazl; Kiasari, Alieh Zamani; Godazandeh, Gholamali; Baradari, Afshin Gholipour; Alipour, Abbas; Taheri, Arman; Emami Zeydi, Amir; Montazemi, Maryam
Post-operative nausea and vomiting (PONV) is a common and distressing complication after laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the effect of intravenous (IV) dextrose administration for the prophylaxis of PONV after LC. In a double-blind, randomised controlled trial, a total of 150 female patients who were scheduled for elective LC were randomly assigned into two groups (A and B). Thirty minutes before induction of anaesthesia, patients received an infusion of 500 cc lactated Ringer's solution (Group A) and 5% dextrose in lactated Ringer's solution (Group B) and over a period of 30 min. All patients rated their nausea and vomiting intensity using the verbal rating scale immediately at post-anaesthesia care unit (PACU) arrival; 30, 60, 90 and 120 min after arriving at the PACU and 6, 12 and 24 h after surgery. There was a statistically significant time trend and group effect along with significant differences in time/group interaction effect in both groups for nausea and vomiting scores ( P Dextrose administration reduced the odds of vomiting events compared to placebo (estimate: -0.87, odds ratio = 0.42, 95% confidence interval: 0.28-0.64). Administration of IV dextrose before anaesthesia induction may be recommended as an effective, and safe method for the prophylaxis of PONV after LC.
CERN - EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH PENSION FUND This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate: Name: SEIS First Name : Irene Our Pension Fund (that of CERN and ESO personnel) is for most of us the only social protection when we retire. Its purpose is to give us a pension, which permits to maintain a certain standard of living for us, and for our dependants. I have worked in the Governing Board of the Pension Fund, as well as in numerous working groups on pension matters, since 11 years, either in my role as a Staff Association delegate, or as a member of the Governing Board. In both environments, I defend the principles of solidarity, which are part of our social security system, and I stand up for maintaining its primary principle, being a defined benefit scheme. Another of my preoccupations is the long-term future of the fund, including the gu...
van den Broek, W E Sjoukje; Wijnen-Meijer, Marjo; Ten Cate, Olle; van Dijk, Marijke
Objectives: This study adds to the ongoing discussion on how to ease the transition from undergraduate medical training to postgraduate training. In the Netherlands there is no central matching system for admission to residency. Medical school graduates just apply for a position in an open job market. Many choose to acquire general or specialty-specific clinical experiences after the medical degree before residency, to further explore career opportunities and to increase their chances to get into their preferred specialty. To shorten this gap between undergraduate and the start of postgraduate training, the sixth and final year of most Dutch medical schools is designed as a "transitional year". Students work with more clinical responsibilities than in the earlier clerkships, and this year includes many elective options. Our study focuses on these elective options and explores how medical students use these transitional year electives to prepare for transition to postgraduate training. Methods: In 2012-2013 we asked all 274 graduating students at one Dutch medical school to complete an open-answer questionnaire with the following topics: their preferred specialty at the start of the transitional year, electives they chose during this year and reasons for these choices, and whether the transitional year electives changed their career considerations. Questionnaire results were coded by two researchers and were discussed with all members of the research team. Results: A total of 235 students responded (86%). Answers about motivation for choices revealed that most electives where chosen for career orientation and to optimize chances to get into a residency program. Students also focused on additional experiences in specialties related to their preferred specialty. Many students chose electives logically related to each other, e.g. combinations of surgery and radiology. About two-thirds of the respondents stated that their elective experiences did confirm their specialty
Full Text Available Laparoscopic cholecystectomy has become the standard procedure for the surgical management of symptomatic cholelithiasis. Laparoscopic cholecystectomy is generally considered a safe procedure although a few complications such as major bleeding, wound infection, bile leakage, biliary and bowel injury are well known. We are reporting a case of a thirty-seven year old male who presented with abdominal pain, three weeks after laparoscopic cholecystectomy. Abdominal ultrasound revealed a filling defect in common bile duct with deranged liver function tests. With an impression of choledocholithiasis, his endoscopic retrograde cholangiopancreatography (ERCP was done which revealed a surgical clip impacted in the ampulla. The surgical clip was retrieved successfully by ERCP. Intraductal clip migration is a rarely encountered complication after laparoscopic cholecystectomy. Appropriate management requires timely identification and retrieval during ERCP.
de Vries, A.; Donkervoort, S. C.; van Geloven, A. A. W.; Pierik, E. G. J. M.
Background: Preceding endoscopic retrograde cholangiography (ERC) in patients with choledochocystolithiasis impedes laparoscopic cholecystectomy (LC) and increases risk of conversion. We studied the influence of time interval between ERC and LC on the course of LC. Methods: All patients treated for
Antibiotic prophylaxis for patients undergoing elective endoscopic retrograde cholangiopancreatography. M Brand, D Bisoz. Abstract. Background. Antibiotic prophylaxis for endoscopic retrograde cholangiopancreatography (ERCP) is controversial. We set out to assess the current antibiotic prescribing practice among ...
Dr Tanya du Plessis
in electoral events by political parties, the electorate and civil society organisations. 2 ... the independent model, elections are managed by an EMB which is institutionally .... entrenched ethnic or racially exclusive interests. In a country with a ...
Korst, Lisa M; Fridman, Moshe; Lu, Michael C; Fleege, Laura; Mitchell, Connie; Gregory, Kimberly D
We propose a methodology for identifying and analysing 'elective' preterm births (PTBs) using administrative data, and apply this methodology to California data with the objective of providing a framework to further explore the potential rationales for early delivery. Using the California linked birth cohorts for 1999, 2002 and 2005, singleton PTBs were identified using birth certificate gestational age ≥ 24 and PTBs increased 27.7% over the 6-year study period, with nearly all cases confined to the late PTB stratum; elective late PTB rates rose from 10.5% to 13.5% of all late PTBs (P PTBs that is 'elective'. This method can be used to explore and monitor potential strategies for the prevention of elective PTB. © 2012 Blackwell Publishing Ltd.
Sep 16, 2006 ... section of the presidential and National Assembly Elections Act. The change .... of its functions, such as registering voters and supervising the conduct of ..... civil rights as well as civic duties, including the need to contest ...
Johnston, R.; Pattie, C.
The first elections to the newly created 41 posts of Police and Crime Commissioner in England and Wales were held in November 2012. The results show all the main characteristics of second-order elections. Turnout was low. The two unpopular coalition parties in the national government lost vote share compared to the outcome of the most recent general election, whereas the main opposition party's share increased substantially-as did that of a minor party (UKIP). Labour, Liberal Democrat and UKI...
Situngkir, Hokky; Mauludy, Rolan
The short paper presents interesting discussions related to specific Indonesian legislative election system. We build algorithmic steps in computational geometry that employ the basic patterns that emerged from the legal decisions of Indonesian General Election Commission about the election district. Some interesting facts are observed and tried to be analyzed and concerning them to the democratization processes in the country. The further implementation of the model can be utilized as a tool...
Iwata, Masato; Kuzumoto, Naoya; Akasaki, Yuka; Morioka, Masayo; Nakayama, Kana; Matsuzawa, Nobuyoshi; Kimoto, Katsuhiro; Shimomura, Toshiyuki
Becker muscular dystrophy (BMD) is a progressive neuromuscular disorder caused by mutations in the dystrophin gene. The sensitivity to non-depolarizing muscle relaxant in a patient with muscle dystrophy is reportedly higher than that in normal individuals, and the duration of the effect is known to be prolonged. In this report, we present the case of a 58-year-old man with BMD who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis under total intravenous anesthesia without the use of muscle-relaxant drugs and supplemented with regional anesthesia. Anesthesia was induced and maintained with propofol, remifentanil, and fentanyl; ultrasound-guided bilateral rectus sheath block (RSB) and right-sided subcostal transversus abdominis plane block (TAP) were performed. The procedure required conversion to open surgery because of hard conglutination; intraoperative and postoperative periods were uneventful. Adequate analgesia was maintained after extubation because of the effect of RSB and TAP.
The document gives information about the election of 11 Member States to the IAEA Board of Governors, the 35-member policy-making body, during the 44th regular session of the IAEA's General Conference (18 - 22 September 2000, Austria Center, Vienna). The newly elected Member States are: Argentina, Egypt, Ghana, Ireland, Libyan Arab Jamahiriya, Mexico, Pakistan, Peru, Switzerland, Thailand, Ukraine. The other 24 Member States of the Board are also given
Chaum, D; Ryan, PYA; Schneider, SA
We present an election scheme designed to allow voters to verify that their vote is accurately included in the count. The scheme provides a high degree of transparency whilst ensuring the secrecy of votes. Assurance is derived from close auditing of all the steps of the vote recording and counting process with minimal dependence on the system components. Thus, assurance arises from verification of the election rather than having to place trust in the correct behaviour of components of the vot...
The document gives information about the election of 11 Member States to the IAEA Board of Governors, the 35-member policy-making body, during the 45th regular session of the IAEA's General Conference (17-21 September 2001, Austria Center, Vienna). The newly elected Member States are: Bulgaria, Burkina Faso, Chile, Colombia, Islamic Republic of Iran, Kuwait, Morocco, Philippines, Romania, Spain, and Turkey. The other 24 Member States of the Board are also given
Blom, Rianne M; Guglielmi, Valeria; Denys, Damiaan
Patients with body integrity identity disorder (BIID) experience a strong desire for amputation from very early on. BIID patients are often dismissed when they share their wish for amputation with surgeons. Consequently, patients resort to self-amputation, including complications and sometimes death. BIID patients are not psychotic and are mentally competent to oversee the consequences of an elective amputation. The authors offer arguments in favor of elective amputation.
Full Text Available ObjectiveTo investigate whether blood lipid control can delay the progression of asymptomatic gallstones and reduce the risk of cholecystectomy in patients with gallstones and hyperlipidemia, as well as the influence of hyperlipidemia on postoperative pain after cholecystectomy. MethodsA total of 153 patients with asymptomatic gallstones and hyperlipidemia who underwent physical examination from February 2013 to February 2015 were enrolled and randomly divided into experimental group with 72 patients and control group with 81 patients. The patients in the experimental group were given blood lipid control via diet, exercise, and drugs, and according to fasting triglyceride (TG and total cholesterol (TC after 3 months, these patients were further divided into normal blood lipid group with 47 patients and abnormal blood lipid group with 25 patients. All the patients were followed up for 2 years with an interval of 3 months. The surgical indications for laparoscopic cholecystectomy were persistent pain in the gallbladder or more than 3 times of gallbladder discomfort within the past one month. A subgroup analysis was performed based on the number and size of gallstones to evaluate the risk of cholecystectomy. A numerical pain scale was used to assess the improvement in pain during hospitalization and at 3 and 6 months after surgery. The t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between three groups, and the Bonferroni test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups. ResultsThe normal blood lipid group had a significantly lower rate of cholecystectomy than the abnormal blood lipid group and the control group (23.4% vs 68.8%/70.4%, χ2=2772, P＜0.01. The patients in the normal blood lipid group had moderate pain during hospitalization, while those in the abnormal blood lipid
Full Text Available Abstract Background Widespread literature on inequity in healthcare access and utilization has been published, but research on socioeconomic differences in waiting times is sparse and the evidence is fragmentary and controversial. The objective of the present study is the analysis of the relationship between individual socioeconomic level and waiting times for in-hospital elective surgery. Methods We retrospectively studied the waiting times experienced by patients registered on hospital waiting lists for 6 important surgical procedures by using the Hospital Discharge Database (HDD of the Piedmont Region (4,000,000 inhabitants in the North West of Italy from 2006 to 2008. The surgical procedures analyzed were: coronary artery by-pass (CABG, angioplasty, coronarography, endarterectomy, hip replacement and cholecystectomy. Cox regression models were estimated to study the relationship between waiting times and educational level taking into account the confounding effect of the following factors: sex, age, comorbidity, registration period, and Local Health Authorities (LHA as a proxy of supply. Results Median waiting times for low educational level were higher than for high educational level for all the selected procedures. Differences were particularly high for endarterectomy and hip replacement. For all considered procedures, except CABG, an inverse gradient between waiting times and educational level was observed: the conditional probabilities of undergoing surgery were lower among individuals with a low to middle level education than for individuals with a higher level of education after adjustment for sex, age, comorbidities, registration period, and LHAs. For most procedures the effect decreases over the follow up period. Conclusions The results of the study show evidence of inequalities in access to elective surgery in Italy. Implementation of policies aimed to promote national information initiatives that guarantee wider access to those
... 26 Internal Revenue 20 2010-04-01 2010-04-01 false Presidential Election Campaign Fund. 701.9006-1...) INTERNAL REVENUE PRACTICE PRESIDENTIAL ELECTION CAMPAIGN FUND § 701.9006-1 Presidential Election Campaign Fund. (a) Transfer of amounts to the Presidential Election Campaign Fund. The Secretary shall determine...
... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Election of insurable interest rate. 842... Election of insurable interest rate. (a) At the time of retirement, an employee or Member in good health and who is applying for a non-disability annuity may elect an insurable interest rate. An election...
..., Assistant General Counsel, or Attorney Mr. David C. Adkins or Attorney Mr. Neven F. Stipanovic, 999 E Street... FEDERAL ELECTION COMMISSION 11 CFR Part 100 [Notice 2010-18] Definition of Federal Election Activity AGENCY: Federal Election Commission. ACTION: Final rules. SUMMARY: The Federal Election Commission...
boycotted by the appellant in protest. Nevertheless, the commission carried on with the election and thereafter declared the 1st respondent as elected/returned. The Court of Appeal sitting over the decision of the elections petition tribunal held that it was wrong of the Commission to have conducted elections in the 5 wards of ...
Robi Cahyadi Kurniawan
Full Text Available Vote buying in elections, both general elections and local elections is a phenomenon in Indonesian politics. Lampung Province has implemented direct elections simultaneously in December 2015 and February 2017. This study explains that vote buying can change voter choice in three regional head elections in Lampung Province. This study was conducted with the object of research residing in Way Kanan District on July 2014, Pringsewu District on February 2016 and Bandar Lampung City on November 2015. This study used a survey approach, using stratified random sampling method. The survey conducted on 662 respondents in each county or district and city object being studied. The results show that voters believe that vote buying will happen in local elections.Voters may be influenced their choice if given relief goods, gifts of money or the provision of project. The thesis in this study is vote buying can change voting choice of voters.
Muench, J; Albrink, M; Serafini, F; Rosemurgy, A; Carey, L; Murr, M M
Recent reports indicate that laparoscopic cholecystectomy in pregnancy is safe. The aim of this study was to evaluate whether delays in definitive treatment of symptomatic cholelithiasis increase morbidity. We reviewed the records of 16 women who underwent laparoscopic cholecystectomy during pregnancy between 1992 and 1999. Mean age was 24 +/- 5 years (mean +/- standard error). Symptom onset was during the first trimester in nine patients, second trimester in six patients, and third trimester in one patient. Patients had abdominal pain (93%), nausea (93%), emesis (80%), and fever (66%) for a median of 45 days (range 1-195 days) before cholecystectomy. Nine of 11 women who underwent cholecystectomy more than 5 weeks after onset of symptoms experienced recurrent attacks necessitating 15 hospital admissions and four emergency room visits. Moreover four women who developed symptoms in the first and second trimesters but whose operations were delayed to the third trimester had 11 hospital admissions and four emergency room visits; three of those four (75%) women developed premature contractions necessitating tocolytics. Cholecystectomy was completed laparoscopically in 14 women. There was no hospital infant or maternal mortality or morbidity. We recommend prompt laparoscopic cholecystectomy in pregnant women with symptomatic biliary disease because it is safe and it reduces hospital admissions and frequency of premature labor.
Juergen Huber; Michael Kirchler
In the U.S. campaign contributions by companies play a major role in financing election campaigns. We analyze contributions by companies before an election and stock market performance after the election for the presidential elections from 1992 until 2004. We find that (i) the percentage of contributions given to the winner in a presidential election and (ii) the total contribution (divided by market capitalization) have a significant positive impact on a company's stock market performance af...
de Vreese, C.H.
The literature on professionalization of political campaigns is strongly biased toward first-order (national) elections and the U.S. and U.K. contexts. This study expands that scope. Based on a survey of candidates for the 2004 European elections in eight European Union countries, we tested whether
Yildiz, Huseyin; Gunal, Solmaz Eruyar; Yilmaz, Gulsen; Yucel, Safak
The aim of this study was to investigate the effects of oral carbohydrate solution (CHO) on perioperative discomfort, biochemistry, hemodynamics, and patient satisfaction in elective surgery patients under general anesthesia. Sixty cases in ASA I-II group who were planned to have operation under general anesthesia were included in the study. The cases were randomly divided into two groups having 30 subjects in each. The patients in the study group were given CHO in the evening prior to the surgery and 2-3 hr before the anesthesia while routine fasting was applied in the control group. In the study group; 2-3 hr before the surgery; malaise, thirst, hunger, and weakness; just before the surgery malaise, thirst, hunger, and fatigue; 2 hr after the operation thirst, hunger, weakness, and concentration difficulty; 24 hr after the operation malaise and weakness were found significantly lower. Fasting blood glucose (FBG) level was found to be higher in the control group at the 90th min of the operation. Gastric volumes were higher in the control group; gastric pH values were found significantly higher in the study group. The level of anxiety and depression risk rate were found lower in the study group. In conclusion, preoperative CHO reduces perioperative discomfort and improves perioperative well being when compared to overnight fasting.
Ye, Jian; Liu, Guanghui; Liu, Peng; Zhang, Shiwu; Shao, Pengfei; Smith, Zachary J.; Liu, Chenhai; Xu, Ronald X.
We propose a portable fluorescence microscopic imaging system (PFMS) for intraoperative display of biliary structure and prevention of iatrogenic injuries during cholecystectomy. The system consists of a light source module, a camera module, and a Raspberry Pi computer with an LCD. Indocyanine green (ICG) is used as a fluorescent contrast agent for experimental validation of the system. Fluorescence intensities of the ICG aqueous solution at different concentration levels are acquired by our PFMS and compared with those of a commercial Xenogen IVIS system. We study the fluorescence detection depth by superposing different thicknesses of chicken breast on an ICG-loaded agar phantom. We verify the technical feasibility for identifying potential iatrogenic injury in cholecystectomy using a rat model in vivo. The proposed PFMS system is portable, inexpensive, and suitable for deployment in resource-limited settings.
Morita, Kiyomi; Ishizawa, Takeaki; Tani, Keigo; Harada, Nobuhiro; Shimizu, Atsushi; Yamamoto, Satoshi; Takemura, Nobuyuki; Kaneko, Junichi; Aoki, Taku; Sakamoto, Yoshihiro; Sugawara, Yasuhiko; Hasegawa, Kiyoshi; Kokudo, Norihiro
Fluorescence imaging using indocyanine green (ICG) has recently been applied to laparoscopic surgery to identify cancerous tissues, lymph nodes, and vascular anatomy. Here we report the application of ICG-fluorescence imaging to visualize the boundary between the liver and subserosal tissues of the gallbladder during laparoscopic full-thickness cholecystectomy. A patient with a potentially malignant gallbladder lesion was administered 2.5-mg intravenous ICG just before laparoscopic full-thickness cholecystectomy. Intraoperative fluorescence imaging enabled the real-time delineation of both extrahepatic bile duct anatomy and hepatic parenchyma throughout the procedure, which resulted in complete removal of subserosal tissues between liver and gallbladder. Safe and feasible ICG-fluorescence imaging can be widely applied to laparoscopic hepatobiliary surgery by utilizing a biliary excretion property of ICG. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
Sanawan, Ejaz; Qureshi, Ahmad Uzair; Qureshi, Sidra Shoaib; Cheema, Khalid M; Cheema, Muhammad Arshad
To determine the efficacy of ultrasound shear in laparoscopic cholecystectomy in terms of total operative time, postoperative bile leaks, gall bladder perforation rate, and postoperative bleeding from cystic artery and collateral injury to bowel and duodenum. Comparative study. Mayo Hospital, Lahore, from June 2013 to May 2014. 150 cases (75 in each group) were randomized into two groups, i.e. harmonic scalpel clipless group (HSG) versus conventional laparoscopic cholecystectomy (CLC) with electrocautery group. The above stated variables were documented. The data for age, blood loss, and drain output were positively skewed as calculated using the Shapiro-Wilk test. The histograms, Q-Q plots and box plots were analyzed for all the dependent variables. Skewed qualitative continuous data was analyzed using the Mann-Whitney U-Test. Operative time was significantly lower in HSG as compared to CLC. Median operative times were 30 minutes (IQR 10) versus 35 minutes (IQR 10) (pelectrocautery.
Bisgaard, T; Kristiansen, V B; Hjortsø, N C
BACKGROUND: Preoperative oral carbohydrate can attenuate postoperative insulin resistance and catabolism, and may have the potential to improve postoperative recovery. There are no data from randomized studies on postoperative clinical outcome after specific surgical procedures. This study...... evaluated the clinical effects of a preoperative carbohydrate beverage in patients undergoing laparoscopic cholecystectomy. METHODS: Ninety-four patients undergoing laparoscopic cholecystectomy were included in a randomized clinical trial. Patients were randomized to receive 800 ml of an iso-osmolar 12.......5 per cent carbohydrate-rich beverage the evening before operation (100 g carbohydrate) and another 400 ml (50 g carbohydrate) 2 h before initiation of anaesthesia, or the same volume of a placebo beverage. The primary endpoint was general well-being the day after operation. Patients were evaluated from...
Dwyer, Tim; Henry, Patrick D G; Cholvisudhi, Phantila; Chan, Vincent W S; Theodoropoulos, John S; Brull, Richard
Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic-based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.
Sudeep S Gill
Full Text Available Following initial regulatory approval of prescription drugs, many factors may influence insurers and health systems when they decide whether to add these drugs to their formularies. The role of political pressures on drug funding announcements has received relatively little attention, and elections represent an especially powerful form of political pressure. We examined the temporal relationship between decisions to add one class of drugs to publicly funded formularies in Canada's ten provinces and elections in these jurisdictions.Dates of provincial formulary listings for cholinesterase inhibitors, which are drugs used to treat Alzheimer's disease and related dementias, were compared to the dates of provincial elections. Medical journal articles, media reports, and proceedings from provincial legislatures were reviewed to assemble information on the chronology of events. We tested whether there was a statistically significant increase in the probability of drug funding announcements within the 60-day intervals preceding provincial elections.Decisions to fund the cholinesterase inhibitors were made over a nine-year span from 1999 to 2007 in the ten provinces. In four of ten provinces, the drugs were added to formularies in a time period closely preceding a provincial election (P = 0.032; funding announcements in these provinces were made between 2 and 47 days prior to elections. Statements made in provincial legislatures highlight the key role of political pressures in these funding announcements.Impending elections appeared to affect the timing of drug funding announcements in this case study. Despite an established structure for evidence-based decision-making, drug funding remains a complex process open to influence from many sources. Awareness of such influences is critical to maintain effective drug policy and public health decision-making.
Gill, Sudeep S; Gupta, Neeraj; Bell, Chaim M; Rochon, Paula A; Austin, Peter C; Laupacis, Andreas
Following initial regulatory approval of prescription drugs, many factors may influence insurers and health systems when they decide whether to add these drugs to their formularies. The role of political pressures on drug funding announcements has received relatively little attention, and elections represent an especially powerful form of political pressure. We examined the temporal relationship between decisions to add one class of drugs to publicly funded formularies in Canada's ten provinces and elections in these jurisdictions. Dates of provincial formulary listings for cholinesterase inhibitors, which are drugs used to treat Alzheimer's disease and related dementias, were compared to the dates of provincial elections. Medical journal articles, media reports, and proceedings from provincial legislatures were reviewed to assemble information on the chronology of events. We tested whether there was a statistically significant increase in the probability of drug funding announcements within the 60-day intervals preceding provincial elections. Decisions to fund the cholinesterase inhibitors were made over a nine-year span from 1999 to 2007 in the ten provinces. In four of ten provinces, the drugs were added to formularies in a time period closely preceding a provincial election (P = 0.032); funding announcements in these provinces were made between 2 and 47 days prior to elections. Statements made in provincial legislatures highlight the key role of political pressures in these funding announcements. Impending elections appeared to affect the timing of drug funding announcements in this case study. Despite an established structure for evidence-based decision-making, drug funding remains a complex process open to influence from many sources. Awareness of such influences is critical to maintain effective drug policy and public health decision-making.
Full Text Available Taiwan held its first combined national elections on 14 January 2012. Though the Democratic Progressive Party (DPP, the largest opposition party, fared much better in the Legislative Yuan elections than it did in 2008, DPP presidential contender Tsai Ying-wen’s (Cai Yingwen clear defeat at the hands of the Kuomintang (KMT, Guomindang incumbent, Ma Ying-jeou (Ma Yingjiu, in the presidential race came as a surprise. The article examines the election campaigns of both Tsai and Ma, summarizes the election results, and analyses the reasons why the DPP failed to retake the presidency. It then discusses the post-election debate within the DPP on the future of its China policy and ponders what can be expected from the second Ma administration.
Barrio, Javier; Errando, Carlos L; García-Ramón, Jaime; Sellés, Rafael; San Miguel, Guillermo; Gallego, Juan
To evaluate the influence of neuromuscular blockade (NMB) on surgical conditions during low-pressure pneumoperitoneum (8mmHg) laparoscopic cholecystectomy (LC), while comparing moderate and deep NMB. Secondary objective was to evaluate if surgical conditions during low-pressure pneumoperitoneum LC performed with deep NMB could be comparable to those provided during standard-pressure pneumoperitoneum (12mmHg) LC. Prospective, randomized, blinded clinical trial. Operating room. Ninety ASA 1-2 patients scheduled for elective LC. Patients were allocated into 3 groups: Group 1: low-pressure pneumoperitoneum with moderate-NMB (1-3 TOF), Group 2: low-pressure pneumoperitoneum with deep-NMB (1-5 PTC) and Group 3: standard pneumoperitoneum (12mmHg). Rocuronium was used to induce NMB and acceleromiography was used for NMB monitoring (TOF-Watch-SX). Three experienced surgeons evaluated surgical conditions using a four-step scale at three time-points: surgical field exposure, dissection of the gallbladder and extraction/closure. Low-pressure pneumoperitoneum (Group 1 vs. 2): good conditions: 96.7 vs. 96.7%, 90 vs. 80% and 89.6 vs. 92.3%, respectively for the time-points, p>0.05. No differences in optimal surgical conditions were observed between the groups. Surgery completion at 8mmHg pneumoperitoneum: 96.7 vs. 86.7%, p=0.353. Standard-pressure pneumoperitoneum vs. low-pressure pneumoperitoneum with deep NMB (Group 3 vs. 2): good conditions: 100% in Group 3 for the three time-points (p=0.024 vs. Group 2 at dissection of the gallbladder). Significantly greater percentage of optimal conditions during standard-pressure pneumoperitoneum LC at the three time points of evaluation. The depth of NMB was found not to be decisive neither in the improvement of surgical conditions nor in the completion of low-pressure pneumoperitoneum LC performed by experienced surgeons. Surgical conditions were considered better with a standard-pressure pneumoperitoneum, regardless of the depth of NMB
Van Bruwaene, Siska; Schijven, Marlies P; Napolitano, Daniel; De Win, Gunter; Miserez, Marc
As conventional laparoscopic procedural training requires live animals or cadaver organs, virtual simulation seems an attractive alternative. Therefore, we compared the transfer of training for the laparoscopic cholecystectomy from porcine cadaver organs vs virtual simulation to surgery in a live animal model in a prospective randomized trial. After completing an intensive training in basic laparoscopic skills, 3 groups of 10 participants proceeded with no additional training (control group), 5 hours of cholecystectomy training on cadaver organs (= organ training) or proficiency-based cholecystectomy training on the LapMentor (= virtual-reality training). Participants were evaluated on time and quality during a laparoscopic cholecystectomy on a live anaesthetized pig at baseline, 1 week (= post) and 4 months (= retention) after training. All research was performed in the Center for Surgical Technologies, Leuven, Belgium. In total, 30 volunteering medical students without prior experience in laparoscopy or minimally invasive surgery from the University of Leuven (Belgium). The organ training group performed the procedure significantly faster than the virtual trainer and borderline significantly faster than control group at posttesting. Only 1 of 3 expert raters suggested significantly better quality of performance of the organ training group compared with both the other groups at posttesting (p virtual trainer group did not outperform the control group at any time. For trainees who are proficient in basic laparoscopic skills, the long-term advantage of additional procedural training, especially on a virtual but also on the conventional organ training model, remains to be proven. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
YİĞİTLER, Cengizhan; DUMAN, Kazım; ÖZCAN, Ali
We aim to report a case of abdominal wall mass formation secondary to gallbladder perforation and stone spillage occurring during laparoscopic cholecystectomy (LC). A 73-year-old women presented with purulent discharge from one of her previous port sites one year after she underwent LC. The latter revealed a round opaque mass in an abscess like cavity, and subsequently an ultrasonography showed a round echogenity with acoustic shadow posteriorly. Axial CT images verified the presence of a wel...
Borello Alessandro; Ferrarese Alessia; Passera Roberto; Surace Alessandra; Marola Silvia; Buccelli Claudio; Niola Massimo; Di Lorenzo Pierpaolo; Amato Maurizio; Di Domenico Lorenza; Solej Mario; Martino Valter
Abstract Background Surgical informed consent forms can be complicated for patients to read and understand. We created a consent form with key information presented in bulleted texts and diagrams combined in a graphical format to facilitate the understanding of information during the verbal consent discussion. Methods This prospective, randomized study involved 70 adult patients awaiting cholecystectomy for gallstones. Consent was obtained after standard verbal explanation using either a grap...
Gerli Paat-Ahi; Ain Aaviksoo; Maria Świderek
Background As part of the EuroDRG project, researchers from eleven countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Sweden, and Spain) compared how their Diagnosis-Related Groups (DRG) systems deal with cholecystectomy patients. The study aims to assist surgeons and national authorities to optimize their DRG systems. Methods National or regional databases were used to identify hospital cases with a procedure of cholecystectom...
Zaorska-Rajca, J.; Piecinska, T.; Samojlow, R.; Dudzik, M.; Wnuk, W.
Cholescintigraphy was made in 42 patients with postcholecystectomy syndrome and 8 asymptomatic volunteers. In 7 cases organic disorders were diagnosed. Among the remaining 35, in 11 patients sphincter Oddi dysfunction and in 12 duodenogastric reflux were diagnosis. The others had normal results of cholescintigraphy. This study shows that cholescintigraphy is useful in diagnosis of functional disorders of bile in patients after cholecystectomy. (author). 21 refs, 4 figs, 2 tabs
Lima Junior Olavo Brasil de
Full Text Available The author argues that the conjugation of certain democratic, socioeconomic and political factors has led to the "nationalization" of presidential elections in Brazil since 1960. The expansion of the electoral market resulting from urbanization and the growth of the electorate, together with the progressive removal of the obstacles to voting - due to income, gender, age, and education - has democratized the electoral process by diversifying the social structure of the electorate. Since then, the president's election has ceased to depend solely upon rural political forces and now involves multiple combinations of rural and urban political forces. Candidates can no longer count on specific social groups in order to guarantee their election, and need to widen their appeal. Based on the results of the direct presidential elections of 1960, 1989, 1994 and 1998, the author contends that the "nationalization" of the vote is part of the political integration of Brazilian society and that this, together with the social complexity of the electorate, means that the candidate's appeal and political stance need to be more wide-ranging in order to prevent potential conflicts from arising during the election campaign.
Borzellino, Giuseppe; Rodella, Luca; Saladino, Edoardo; Catalano, Filippo; Politi, Leonardo; Minicozzi, Annamaria; Cordiano, Claudio
To determine the feasibility and efficacy of the laparoscopic intraoperative rendezvous technique for common bile duct stones (CBDS). Case series. Verona University Hospital, Verona, Italy. A total of 110 patients were enrolled in the study; 47 had biliary colic; 39, acute cholecystitis; 19, acute biliary pancreatitis; and 5, acute biliary pancreatitis with associated acute cholecystitis. In all patients, CBDS diagnosis was reached by intraoperative cholangiography. Intraoperative endoscopy with rendezvous performed during laparascopic cholecystectomy for confirmed CBDS; for such a procedure, a transcystic guide wire was positioned into the duodenum. Intraoperative endoscopy with rendezvous was performed for retrieved CBDS during a laparoscopic cholecystectomy. Laparoscopic rendezvous feasibility, morbidity, postprocedure pancreatitis, and mortality. The laparoscopic rendezvous proved to be feasible in 95.5% (105 of 110 patients). The rendezvous failed in 3 cases of successfully performed laparoscopic cholecystectomy, and a conversion of the laparoscopy was needed in 2 cases of successful rendezvous. Two major complications and 2 cases of bleeding were registered after sphincterotomy was successfully performed with rendezvous, and severe acute pancreatitis complicated a traditional sphincterotomy performed after a failed rendezvous. Rendezvous is a feasible option for treatment of CBDS; it allows one to perform only 1 stage of treatment, even in acute cases such as cholecystitis and pancreatitis. Positioning of the guide wire may allow reduced complications secondary to papilla cannulation but not those of the endoscopic sphincterotomy.
Full Text Available Background. Situs inversus viscerum totalis (reciprocally reversed position of internal organs is a rare case with genetic predisposition, inherited autosomnously recessive. The presented case involves an older patient with complete transposition of internal organs having acute calculous cholecystitis, which was successfully performed the laparoscopic cholecystectomy. Whilst the production of biliary stones in a case of transposed internal organs is very rare, it may well represent a diagnostic problem. It is not, however, the contraindication for laparoscopic surgery.Patients and methods. The case presents a 64-year-old patient, whose persistent biliary colic trouble eventually resulted in acute cholecystitis. Following routine diagnostics, a laparoscopic cholecystectomy was performed and the patient was released in domestic care after three day hospitalization.Conclusions. The laparoscopic cholecystectomy may also be safely performed in a patient with reciprocal transposition of all internal organs, but it is imperative to consider the fact that the extra-hepatic anatomy of gall bladder and vascular system is the mirror image of normal, right-hand positioned liver.
Materials and Methods: In a private rural medical college, 150 patients were selected prospectively for laparoscopic cholecystectomy, under low-pressure (8mmHg pneumoperitoneum and under spinal anesthesia over a span of one and a half years. Injection bupivacaine (0.5% was used for spinal anesthesia. All ports were made in a head-down position to avoid hypotension. Shoulder pain was managed by reassurance as well as by diverting the attention and sedation in a few cases. Results: We successfully performed the operations in 145 patients without major complications. Spinal anesthesia was converted to general anesthesia in five patients due to severe shoulder pain. Age varied between 21 and 75 years. Duration of operation time (skin to skin was between 40 and 80 minutes. Twenty-nine patients complained of right shoulder pain. Most of them were managed by reassurance from the anesthetist and a few needed an injection of fentanyl along with midazolam. Conclusion: Laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum is feasible and safe under spinal anesthesia. Incidence of postoperative shoulder pain and complications are comparable with laparoscopic cholecystectomy under general anesthesia. [Arch Clin Exp Surg 2012; 1(4.000: 224-228
Butt, U. I.; Khan, A.; Nawaz, A.; Mansoor, R.; Malik, A. A.; Sher, F.; Ayyaz, M.
Objective: To compare the frequency of surgical site infections in patients with type II diabetes undergoing laparoscopic cholecystectomy as compared with non-diabetic patients. Study Design: Cohort study. Place and Duration of Study: Surgical Unit 2, Services Hospital, Lahore, from May to October 2012. Methodology: Patients were divided into two groups of 60 each, undergoing laparoscopic cholecystectomy. Group A comprised non-diabetic patients and group B comprised type II diabetic patients. Patients were followed postoperatively upto one month for the development of SSIs. Proportion of patients with surgical site infections or otherwise was compared between the groups using chi-square test with significance of p < 0.05. Results: In group A, 35 patients were above the age of 40 years. In group B, 38 patients were above the age of 40 years. Four patients in group A developed a surgical site infection. Seven patients in group B developed SSIs (p = 0.07). Conclusion: Presence of diabetes mellitus did not significantly affect the onset of surgical site infection in patients undergoing laparoscopic cholecystectomy. (author)
Full Text Available BACKGROUND AND OBJECTIVE: One of the complications of laparoscopic cholecystectomy is trocar incision hernia (TSIH: Trocar Site Incisional Hernia, which occurs almost exclusively in the navel area and could cause significant problems. The aim of this study was to evaluate the prevalence of hiatal hernia in laparoscopic cholecystectomy and identify the associated risk factors. METHODS: This cross sectional study was done on patients who underwent laparoscopic cholecystectomy during one year in different hospitals of Babol. Information including age, gender, BMI, diagnosis prior to surgery, duration of hospitalization, duration of surgery, the thickness of the lining of the gallbladder, surgical site infection and umbilical hernia during 12 months follow-up for patients were confirmed and examined. FINDINGS: Among 270 studied patients, there were 236 women (87.4% and 34 men (12.59 %. Eleven patients (4.07% during the 12-month follow-up; they had a hiatal hernia surgical site infection in the navel area (223.82-4.33: CI-95%, OR: 31.14 and BMI (60.18-1.72 CI-95%; OR: 10.21 were associated with increased incidence of inguinal hernias. There was no relationship between other variables and umbilical hernia. CONCLUSION: According to the results of this study obesity and surgical site infections have been linked with an increased incidence of inguinal hernias.
Bordelon, B M; Hobday, K A; Hunter, J G
An unsolved problem of laparoscopic cholecystectomy is the optimal method of removing the gallbladder with thick walls and a large stone burden. Proposed solutions include fascial dilatation, stone crushing, and ultrasonic, high-speed rotary, or laser lithotripsy. Our observation was that extension of the fascial incision to remove the impacted gallbladder was time efficient and did not increase postoperative pain. We reviewed the narcotic requirements of 107 consecutive patients undergoing laparoscopic cholecystectomy. Fifty-two patients required extension of the umbilical incision, and 55 patients did not have their fascial incision enlarged. Parenteral meperidine use was 39.5 +/- 63.6 mg in the patients requiring fascial incision extension and 66.3 +/- 79.2 mg in those not requiring fascial incision extension (mean +/- standard deviation). Oral narcotic requirements were 1.1 +/- 1.5 doses vs 1.3 +/- 1.7 doses in patients with and without incision extension, respectively. The wide range of narcotic use in both groups makes these apparent differences not statistically significant. We conclude that protracted attempts at stone crushing or expensive stone fragmentation devices are unnecessary for the extraction of a difficult gallbladder during laparoscopic cholecystectomy.
Pavlidis, T E; Papaziogas, B T; Koutelidakis, I M; Papaziogas, T B
During laparoscopic cholecystectomy, perforation of the gallbladder can occurs in extraction of the gallbladder. The fate of such lost gallstones, which can lead to the formation of an abscess, an abdominal wall mass, or a persistent sinus, has not been studied adequately. Herein we report the case of a persistent sinus of the abdominal wall after an emergent laparoscopic cholecystectomy in an 82-year-old woman with gangrenous cholecystitis and perforation of the friable wall in association with an empyema of the gallbladder. The culture of the obtained pus was positive for Escherichia coli. After a small leak of dirty fluid from the wound of the epigastric port site of 4 months' duration, surgical exploration under local anesthesia revealed that the sinus was caused by spilled gallstones impacting into the abdominal wall between the posterior sheath and left rectus abdominalis muscle. The removal of the stones resulted in complete healing. Long-term complications after laparoscopic cholecystectomy involving the abdominal wall are rare but important possible consequences that could be avoided.
Full Text Available Aim: Notwithstanding cholecystectomy’s being the standard cure for symptomatic gallbladder stones, it might as well trigger changes that result in the increase of duodenogastric reflux and the emergence of relevant clinic and laboratorial data. The aim of this thesis is to explore the effect of cholecystectomy on the duodenogastric reflux, histopathologic changes in the antral mucosa and Helicobacter pylori colonization. Material and Method: This prospective research is based upon data collected from 45 patients (28 of them being female and 17 of them being male patients with an average age of 50.9, who would undergo cholecystectomic surgery. Upper gastrointestinal endoscopy has been performed on patients before the operation and at least two months after the operation in order to examine the existence of bile in the stomach. The tissues removed from the antrum during these endoscopic biopsies have been examined to spot the histopathologic changes and the existence of Helicobacter pylori in the mucosa (chronic gastritis, activation findings, and intestinal metaplasia. Results: Duodenogastric reflux, chronic gastritis, and intestinal metaplasia have been observed to increase significantly after cholecystectomy (p<0.001 for duodenogastric reflux and chronic gastritis, p<0.05 for intestinal metaplasia. On the other hand, no significant data have been attained in terms of activation findings and the existence of H.pylori before and after the operation. Discussion: Although cholecystectomy cause duodenogastric reflux and histopathologic changes in the antrum, it does not affect H.pylori colonization.
Santarelli, Luca; Gabrielli, Maurizio; Candelli, Marcello; Cremonini, Filippo; Nista, Enrico C; Cammarota, Giovanni; Gasbarrini, Giovanni; Gasbarrini, Antonio
At present there are no well-established pharmacological approaches in the management of post-cholecystectomy alkaline reactive gastritis. The aim of this study was to assess the effect of sucralfate versus rabeprazole or no treatment on dyspeptic symptoms and endoscopic/histological signs in a population of patients with a history of cholecystectomy and evidence of alkaline reactive gastritis. Sixty dyspeptic patients fulfilling the following criteria of inclusion took part in this study: (1) a history of cholecystectomy; (2) no use of anti-inflammatory steroidal and non-steroidal drugs, or abuse of alcohol; (3) evidence of abundant gastric bile reflux at endoscopy; (4) endoscopic signs of chronic gastritis; (5) histological signs of chronic gastritis; and (6) absence of Helicobacter pylori infection. Dyspeptic symptoms were evaluated by means of a self-administered validated questionnaire. Patients included in the study were randomly assigned to one of three treatment groups for 3 months: sucralfate, rabeprazole, observation. Patients were re-evaluated at the end of the treatment. Sucralfate and rabeprazole therapies were both able to significantly reduce epigastric pain, heartburn, bloating and halitosis. Endoscopic/histological signs were lower in both treatment groups compared to the observation group. Both sucralfate and rabeprazole therapies are effective treatment options in the patients with alkaline gastritis when compared with observation.
Wanjura, Viktor; Sandblom, Gabriel
Previous studies have indicated a correlation between indication for cholecystectomy and long-term gastrointestinal quality-of-life (QoL). The aim of the present study was to compare QoL in a post-cholecystectomy cohort with the background population and with historical controls. A post-cholecystectomy study group (on average 4 years after cholecystectomy) was compared with a control group from the background population using the Gastrointestinal Quality-of-Life Index (GIQLI). EQ-5D scores were compared with expected scores derived from recent historical data. The post-cholecystectomy study group (N = 451) had better QoL measured by the EQ-5D compared with historical controls (p < 0.001), similar total GIQLI scores as the control group (N = 390), but scored worse on the GIQLI gastrointestinal symptoms subscale score (p < 0.001). The results include an item-by-item breakdown of the GIQLI questionnaire where the scores for diarrhea, bowel urgency, bloating, regurgitation, abdominal pain, flatus, fullness, nausea, uncontrolled stools, belching, heartburn, restricted eating, and bowel frequency were found to be significantly lower (i.e. worse) in the post-cholecystectomy cohort than in the control group. The opposite was true for relationships, endurance, sexual life, physical strength, feeling fit, not being frustrated by illness, and being able to carry out leisure activities, i.e. items related to general performance and well-being. In this study, QoL after cholecystectomy was good, but there was an increased prevalence of gastrointestinal symptoms compared to the background population.
Albrecht, R; Haase, D; Zippel, R; Koch, H; Settmacher, U
By means of a matched-pair analysis comparing data obtained from laparoscopic cholecystectomy (LC) and robot-assisted laparoscopic cholecystectomy (RAC), the value of both methods as well as the advantages and disadvantages of both approaches were elucidated. The consideration was carried out by evaluation of postoperative surgical results, a cost analysis and a subjective survey of the patients using a questionnaire. Thus, from the 35 consecutive RAC, 35 (parallel) retrospectively matched pairs were established. Postoperative surgical results did not show any significant differences between LC and RAC. In the individual assessment by each patient, there were also no significant differences; however, there was a tendency towards the assessment of the RAC to be slightly worse. A striking difference was found with respect to the cost analysis at the time of surgery. The RAC operation alone is significantly more expensive compared to LC with respect to maintenance and acquisition costs. In addition, RAC can at present not be completely reimbursed under the current German diagnosis-related system. The postulated advantages of RAC comprise mainly the precise preparation within narrow confinements and the favorable ergonomic handling for the surgeon. The basic prerequisites are control of the costs and a reasonable reflection in the current reimbursement system.
ORGANISATION EUROPEENNE POUR LA RECHERCHE NUCLEAIRE CERN EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH CAISSE DE PENSIONS / PENSION FUND Caisse de Pensions - ELECTIONS - Pension Fund This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate : Name : Hauviller First Name : Claude Dear colleague of CERN and ESO, For the first time, I am standing and requesting your support to become a member of the Governing Board of our Pension Fund. CERN staff member since 1974, I have already carried elective mandates: I have been Delegate to the Staff Council and Member of the Senior Staff Consultative Committee (the Nine). For the majority of us, our Pension Fund is our only social provident scheme and source of retirement income; I believe I can usefully contribute to its successful management and help ensure its balance. Our Fund reaches its majority: soon, there will be more beneficiaries tha...
ORGANISATION EUROPEENNE POUR LA RECHERCHE NUCLEAIRE CERN EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH CAISSE DE PENSIONS / PENSION FUND Caisse de Pensions - ELECTIONS - Pension Fund This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate : Name : HAUVILLER First Name : Claude Dear colleague of CERN and ESO, For the first time, I am standing and requesting your support to become a member of the Governing Board of our Pension Fund. CERN staff member since 1974, I have already carried elective mandates: I have been Delegate to the Staff Council and Member of the Senior Staff Consultative Committee (the Nine). For the majority of us, our Pension Fund is our only social provident scheme and source of retirement income; I believe I can usefully contribute to its successful management and help ensure its balance. Our Fund reaches its majority: soon, there will be more beneficiaries tha...
ORGANISATION EUROPEENNE POUR LA RECHERCHE NUCLEAIRE CERN EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH CAISSE DE PENSIONS / PENSION FUND Caisse de Pensions - ELECTIONS - Pension Fund This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate : Name : MYERS First Name : Stephen I have been at CERN since 1972, and was elected member of the Governing Board for the first time in 1998. The Governing Board then nominated me to the Investments Committee where I have been a member since the beginning of 1999. Since then I have actively participated in redefining and transforming the investment portfolio in order to improve the overall return and where possible reduce the risk. The portfolio has recently been greatly improved and now allows much simpler more transparent monitoring of our investment. I have also actively participated and hopefully made useful contributions in discussions conc...
ORGANISATION EUROPEENNE POUR LA RECHERCHE NUCLEAIRE CERN EUROPEAN ORGANIZATION FOR NUCLEAR RESEARCH CAISSE DE PENSIONS / PENSION FUND Caisse de Pensions - ELECTIONS - Pension Fund This candidature has been duly registered and is hereby presented in accordance with paragraph 6.h of the Regulations for Elections to the Governing Board of the Pension Fund. Candidate : Name : MYERS First Name : Stephen I have been at CERN since 1972, and was elected member of the Governing Board for the first time in 1998. The Governing Board then nominated me to the Investments Committee where I have been a member since the beginning of 1999. Since then I have actively participated in redefining and transforming the investment portfolio in order to improve the overall return and where possible reduce the risk. The portfolio has recently been greatly improved and now allows much simpler more transparent monitoring of our investment. I have also actively participated and hopefully made useful contributions in discussions conc...
Hakeem, Abdul R; Birks, Theodore; Azeem, Qasim; Di Franco, Filippo; Gergely, Szabolcs; Harris, Adrian M
There is conflicting evidence for the use of warmed, humidified carbon dioxide (CO2) for creating pneumoperitoneum during laparoscopic cholecystectomy. Few studies have reported less post-operative pain and analgesic requirement when warmed CO2 was used. This systematic review and meta-analysis aims to analyse the literature on the use of warmed CO2 in comparison to standard temperature CO2 during laparoscopic cholecystectomy. Systematic review and meta-analysis carried out in line with the PRISMA guidelines. Primary outcomes of interest were post-operative pain at 6 h, day 1 and day 2 following laparoscopic cholecystectomy. Secondary outcomes were analgesic usage and drop in intra-operative core body temperature. Standard Mean Difference (SMD) was calculated for continuous variables. Six randomised controlled trials (RCTs) met the inclusion criteria (n = 369). There was no significant difference in post-operative pain at 6 h [3 RCTs; SMD = -0.66 (-1.33, 0.02) (Z = 1.89) (P = 0.06)], day 1 [4 RCTs; SMD = -0.51 (-1.47, 0.44) (Z = 1.05) (P = 0.29)] and day 2 [2 RCTs; SMD = -0.96 (-2.30, 0.37) (Z = 1.42) (P = 0.16)] between the warmed CO2 and standard CO2 group. There was no difference in analgesic usage between the two groups, but pooled analysis was not possible. Two RCTs reported significant drop in intra-operative core body temperature, but there were no adverse events related to this. This review showed no difference in post-operative pain and analgesic requirements between the warmed and standard CO2 insufflation during laparoscopic cholecystectomy. Currently there is not enough high quality evidence to suggest routine usage of warmed CO2 for creating pneumoperitoneum during laparoscopic cholecystectomy. Copyright © 2015 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
Klug, Tejs Ehlers; Henriksen, Jens-Jacob; Rusan, Maria
for each isolate obtained from elective tonsillectomy cases compared to quinsy tonsillectomy cases (P bacterial endocarditis...... prophylaxis recommendations to patients at high risk of infective endocarditis who are undergoing tonsillectomy. Methods: A prospective study was conducted on 80 patients undergoing elective tonsillectomy and 36 patients undergoing acute tonsillectomy due to peritonsillar abscess. Blood cultures, tonsillar...... prophylaxis recommendation only to patients undergoing procedures to treat an established infection. To provide full empiric coverage, including coverage for Staphylococcus aureus, we advocate the use of amoxicillin with clavulanic acid in patients at high risk of infective endocarditis....
What you see above is a graphic representation of something anyone who followed the campaign that led to the re-election of Dilma Rousseff as Brazil’s president on October 26 already knows: the election was the most polarised in the country’s history. Brasil was split down the middle, not only numerically (Dilma got 52 per cent, Aécio Neves 48) and geographically (Dilma won in the less developed north, Aécio in the more prosperous south). The twitterspere, too, was divided into two camps....
Full Text Available The article represents an analysis of the 2012 general elections and their consequences on the Romanian political system. The variables analysed in the study are: the effective number of parties (N, the level of electoral disproportionality (G and the nature of bicameralism. Although measured indicators appear to call for an institutional approach and a formal analysis, the article tries to capture and simultaneously takes into account the functional dimension of the political system too. Thus, the consequences of the 2012 parliamentary elections reveal not necessarily the imbalance in the party system or the improvisation of a delegitimized electoral formula, but rather the current makeshift relationships between actors.
Bock Segaard, Signe; Agger Nielsen, Jeppe
candidates, content registration of local blogs, and log file data of local blogs through Google Analytics). In contrast to the democratic vision for social media the analysis demonstrates that the election blogs primarily are used by those who are most politically active in advance. The analysis also shows...... and their actual behavior in social media. The experiences from the Norwegian local elections indicate that the usage of social media has not yet constituted a vital democratic frontier. The myth that the “tone" in online debates always is hard, concise and person fixed has also been disproved....
Full Text Available The recent parliamentary elections which took place in The Slovak Republic in March 2016 opened for many national and international commentators the bottled of demons from the past history of Slovakia. For the first time a Far right extremist political party entered into parliament and held seats there. They gained more than some standard political parties and also were not dubbed as the “black” horse of this election. As they were not measured by public opinion. The main purpose of this article is to analyze the fundamental purpose of voters that had elected this political party and on the other hand the main reason that has opened the parliamentary door to such a political entity that was not visible in the previous electoral periods or played any important role in the independence of Slovak republic. Our main assumption will be that which is taken from the media analysis before the parliamentary election and public opinion research. Our main variable from the external environment will be the migration refugee crisis and the rhetoric of political parties acting at national level. We can assume that this was one of the main reason for the entry of this political party within others which were “hidden” or covered by this crisis and were not mediatized in the media.
Stenlund Hans C
Full Text Available Abstract Background Gallstones represent the most common cause of acute pancreatitis in Sweden. Epidemiological data concerning timing of cholecystectomy and sphincterotomy in patients with first attack of mild acute biliary pancreatitis (MABP are scarce. Our aim was to analyse readmissions for biliary disease, cholecystectomy within one year, and mortality within 90 days of index admission for MABP. Methods Hospital discharge and death certificate data were linked for patients with first attack acute pancreatitis in Sweden 1988-2003. Mortality was calculated as case fatality rate (CFR and standardized mortality ratio (SMR. MABP was defined as acute pancreatitis of biliary aetiology without mortality during an index stay of 10 days or shorter. Patients were analysed according to four different treatment policies: Cholecystectomy during index stay (group 1, no cholecystectomy during index stay but within 30 days of index admission (group 2, sphincterotomy but not cholecystectomy within 30 days of index admission (group 3, and neither cholecystectomy nor sphincterotomy within 30 days of index admission (group 4. Results Of 11636 patients with acute biliary pancreatitis, 8631 patients (74% met the criteria for MABP. After exclusion of those with cholecystectomy or sphincterotomy during the year before index admission (N = 212, 8419 patients with MABP remained for analysis. Patients in group 1 and 2 were significantly younger than patients in group 3 and 4. Length of index stay differed significantly between the groups, from 4 (3-6 days, (representing median, 25 and 75 percentiles in group 2 to 7 (5-8 days in groups 1. In group 1, 4.9% of patients were readmitted at least once for biliary disease within one year after index admission, compared to 100% in group 2, 62.5% in group 3, and 76.3% in group 4. One year after index admission, 30.8% of patients in group 3 and 47.7% of patients in group 4 had undergone cholecystectomy. SMR did not differ
van den Broek, W. E. Sjoukje
Full Text Available Objectives: This study adds to the ongoing discussion on how to ease the transition from undergraduate medical training to postgraduate training. In the Netherlands there is no central matching system for admission to residency. Medical school graduates just apply for a position in an open job market. Many choose to acquire general or specialty-specific clinical experiences after the medical degree before residency, to further explore career opportunities and to increase their chances to get into their preferred specialty. To shorten this gap between undergraduate and the start of postgraduate training, the sixth and final year of most Dutch medical schools is designed as a “transitional year”. Students work with more clinical responsibilities than in the earlier clerkships, and this year includes many elective options. Our study focuses on these elective options and explores how medical students use these transitional year electives to prepare for transition to postgraduate training.Methods: In 2012-2013 we asked all 274 graduating students at one Dutch medical school to complete an open-answer questionnaire with the following topics: Questionnaire results were coded by two researchers and were discussed with all members of the research team. Results: A total of 235 students responded (86%. Answers about motivation for choices revealed that most electives where chosen for career orientation and to optimize chances to get into a residency program. Students also focused on additional experiences in specialties related to their preferred specialty. Many students chose electives logically related to each other, e.g. combinations of surgery and radiology. About two-thirds of the respondents stated that their elective experiences did confirm their specialty preferences or resulted in a more clear insight.Conclusion: We conclude that students use the transitional year electives to focus on their future postgraduate training program, i.e. for
This study was aimed at comparing the effect of Acute Isovolemic Haemodilution (AIH) with use of Homologous Blood Transfusion during elective major surgery. Methods: This was a study prospective undertaken in the sub regional hospital at ArbaMinch, Ethiopia over a 15 month period and involved 34 patients admitted ...
Lichtman, Allan J.
Asserts that Vice President Al Gore will be elected in 2000 based on the performance of the Clinton administration. Utilizes the key to the White House, 13 true-or-false diagnostic questions stated as propositions. If five or less are false then the party in power wins. (CMK)
After the defeat of the Panhellenic Socialist Movement (PASOK) in the 2004 election, the party of Nea Dimokratia (New Democracy, ND) begun its first term in government since 1993 on a platform promising to fight rising prices and corruption and ‘reconstruct’ the state. ND’s term begun with the
Rothwell, Jennifer Truran
Explores the role of television in politics providing historical examples of the use of television and its possible effects on elections. Focuses on television as the dominant medium for politics, the connections among television, advertising, and political money, and ideas for reforming the electoral process. Includes a teaching activity on…
Full Text Available Department of Political Science at Alexander Dubcek University in Trencin prepared its own exit poll during election day on March 5, 2016. The survey asked seven questions that were aimed at determining the preferences of the respondents concerning not only the current but also past general elections. Interviewers surveyed the choice of political party or movement in parliamentary elections in 2016 as well as preferences in past elections. Followed by questions concerning motivation to vote - when did the respondents decide to go to vote and what or who inspired this decision. The survey also tried to found out how many preferential votes did the voters give to the candidates of political parties and movements. Final question asked about expectations for the future of individual respondents. This article is the information output of the survey. The interviewers were 124 university students and its return was 1,612 sheets. The aim of this paper is to communicate the findings of this unique survey, which is unprecedented in the Slovak political science.
In the US, fifty percent of the citizens do not take part in the elections -an outcome of a long tradition of two candidates, identical in deeds though different in style. Both represent the same "market forces" but the Democrats have more respect to the liberal values of the west: the
of hysterectomy did not occur until the 19th century, earlier attempts are known. Some references to hysterectomy date back to 5th century BC, in the time of Hippocrates. In. 1600, Schenck of Grabenberg cataloged 26 cases of vaginal hysterectomy in Europe.. Elective abdominal hysterectomy: Appraisal of indications and.
Hill, Linda; Scull, John
Effective treatment procedures for a nine-year-old boy with elective mutism and selective inactivity included increasing the frequency of situations in which he could already speak and decreasing the frequency of those in which he seldom spoke (specifically coercive situations). (CL)
Full Text Available representation. In cases where municipalities fall within districts, there is a third vote for candidates to be elected for district councils. As predictions are computed, these need to be shared through the national public broadcast system, including radio...
Moore, Martin John Edwards; Ramsay, Gordon Neil
UK election 2015: setting the agenda builds on innovativework by Dr Martin Moore and Dr Gordon Ramsaystarted in January 2015. Using new methods forcollecting and analysing news and social media content,the report provides a fresh perspective on how politicalcommunication is changing in the digital era.
... Representation Election Procedure AGENCY: National Mediation Board. ACTION: Final rule; delay of effective date. SUMMARY: The National Mediation Board (NMB) is delaying the effective date of its rule regarding... participants under the Railway Labor Act (RLA) that the rule will apply to applications filed on or after June...
Dr Tanya du Plessis
material or documents which have a bearing on elections. A legal ..... This enabled us to announce the results in three days after voting day compared to six days in 1999. ... Attempts to build a democracy without viable political parties have failed. Political parties play a vital role in the market place of political ideas and.
Bochsler, Daniel; Gerber, Marlène; Zumbach, David
The 2015 election to the Swiss Parliament marks a return to an already observed trend that was only interrupted in 2011: a shift to the right and an increase in polarization. The vote share of the nationalist-conservative Swiss People's Party (SVP) has now reached a historical height of 29.4% (+2...
Honawar, Vaishali; Keller, Bess
The National Education Association is poised for a change in leadership this year as its president of six years, Reg Weaver, bumps up against term limits. Now, speculation is widespread that Edward J. McElroy, his counterpart at the American Federation of Teachers, might not seek re-election in July. The possible exit of Mr. McElroy--and the…
Purpose: To identify the level of malnutrition and complications observed in Malaysia. Methods: A prospective, observational study was conducted with the objectives of identifying the degree of malnutrition, complications and the need for nutritional support in elective surgical patients. Collection of data was performed in ...
Perslev, Anette; Jørgensen, Finn Stener; Nielsen, Leif Kofoed
OBJECTIVE: To investigate the degree of fetomaternal hemorrhage (FMH) caused by elective cesarean section. DESIGN: Descriptive study. SETTINGS: University Hospitals in Copenhagen, Denmark. POPULATION: Women scheduled for elective cesarean section, in the period September 2007 to January 2009, at ...