Top PDF A clinical study of the factors affecting the outcome of intestinal resection and anastomosis

A clinical study of the factors affecting the outcome of intestinal resection and anastomosis

A clinical study of the factors affecting the outcome of intestinal resection and anastomosis

like gastropexy where they reduce the size of the available stomach, and also to close the rectum below the tumor during anterior resection. Linear staplers with a cutting blade These devices deliver four rows of parallel staples and cut between the middle two rows. Hence they are extremely useful in cutting and sealing the cut ends at the same time. Hence these devices are very much helpful in reducing the operating time, especially in elderly patients with co morbidities. They also reduce the contamination of the abdomen while operating on unprepared bowel. Duodenal division during gastrectomy is another surgery where they play a useful role.
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EVALUATION OF PROGNOSTIC FACTORS IN OUTCOME OF BOWEL ANASTOMOSIS

EVALUATION OF PROGNOSTIC FACTORS IN OUTCOME OF BOWEL ANASTOMOSIS

Background and objective: Bowel anastomosis is the surgical procedure done in order to establish communication between two formerly distant portions of the bowel. This surgical procedure restores bowel continuity after the removal of a pathological condition affecting the intestines. A dangerous complication of bowel anastomosis is anastomotic leak causing peritonitis, which is related with a high morbidity and mortality. Good surgical technique and obedience to fundamental principles is vital to ensure successful outcome after bowel anastomosis. Safety in the gastrointestinal surgery may therefore depends to a great extent on the factors that affect the healing of anastomosis. Our information of the gastrointestinal surgery has developed slowly over centuries from a mystical to a scientific level over many eras. Today, surgeries on the gastrointestinal tract are among the most frequent surgical procedures. Our information of the gastrointestinal healing has progressed and we have better understanding of the influence of local and systemic factors on anastomotic healing. Nonetheless, anastomotic leak and dehiscence continue to be recurrent and serious difficulties related with high morbidity and mortality. This study was designed to identify risk factors for anastomotic leakage following bowel anastomosis, to study the incidence of early complications after bowel anastomosis and to study mortality rates for bowel anastomosis. Methods: This study is the prospective hospital based time bound study concerning all patients undergoing Intestinal Resection and Anastomosis at Krishna Institute of Medical Sciences from 1 st December of 2016 to 30 th June of 2018. Information was collected from detailed history, clinical examination and investigations (both hematological and radiological investigations) on the patients. A total of 50 patients undergoing resection and anastomosis for different diseases were studied. Results: In present study, there were 30 male patients (60%) and 20(40%) female patients. The age of the patients in this study ranged from 18 to 85 years. 43(86%) patients underwent anastomosis in the emergency setting and 7(14%) underwent anastomosis in elective setting. In this study out of 50 total patients, 46 patients (92%) underwent end to end anastomosis, 2 patients (4%) underwent end to side anastomosis and 2 patients (4%) underwent side to side anastomosis. The risk factors which are known to influence the outcome of bowel anastomosis particularly the occurrence of the anastomotic leak were observed and recorded including age, anaemia, hypoalbuminaemia, emergency surgery, peri-operative use of steroids, and intra- abdominal sepsis. The anastomotic leak rate was 27.77%, 40%, 40%, 23.25%, 42.85% and 37.5% respectively.
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A Comprehensive Study on Factors Influencing Morbidity and Mortality in Patients Undergoing Bowel Resection and Anastomosis

A Comprehensive Study on Factors Influencing Morbidity and Mortality in Patients Undergoing Bowel Resection and Anastomosis

18 The high incidence of leakage and obstruction that resulted soon led the barbers to abandon intestinal procedures, except for repair of partial transverse or colonic wounds. Attempts were made to close bowel injuries and to approximate the repaired area to the abdominal wall or to other organs with the goal of imitating natural adhesion formation. In the 1700s, Palfyn and Peyronie brought the closed intestinal injury out into the wound so that if primary healing failed to occur, an enterocutaneous fistula would develop; this was the first description of a rudimentary stoma. Verduc and von de Wyl carried this principle to its logical conclusion and developed the so-called artificial anus for use in cases of complete transection. In 1730, Ramdohr intussuscepted one segment of bowel into another, fixing it in place with a single transfixing suture. The resultant mucosa-to-serosa coaptation healed poorly and exhibited a high leakage rate.
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Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease: analysis from the PRACTICROHN study

Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease: analysis from the PRACTICROHN study

Patient selection We identified patients from IBD outpatient clinics aged more than 18 years who underwent ileocolonic resection with ileocolonic anastomosis for CD between January 2007 and December 2010. Those who signed an informed consent autho- rizing the use of their clinical data for research were included. For this analysis, patients’ data from diagnosis of CD to the in- dex surgery and until 5 years after the index surgery were col- lected from medical records. All surgeries were performed with anastomosis; no surgeries with stomas were included. When the patient had undergone more than one procedure, the index surgery was considered that closest to December 2010. Data col- lected from the medical records included demographic data (age, sex, smoking status and family history) and clinical data (date of diagnosis, Montreal classification at diagnosis and at time of surgery [ 13 ], extra-intestinal manifestations, immune- mediated inflammatory diseases, IBD-related treatments re- ceived before surgery [from diagnosis to surgery] and at the time of surgery, approach [open or laparoscopic], previous surgeries, reason for current surgery [penetrating or stricturing disease or resistance to treatment], length of resection and hos- pital stay). We evaluated the rate of ePOCs during the 30 days after surgery, including death, ileus, anastomotic leak, digestive bleeding, abscess, wound infection, catheter-related infection and other extra-abdominal infections. We performed a separate analysis of infectious complications (wound infections, intra- abdominal abscesses, extra-abdominal infections and catheter- related infections). Finally, we analyzed the number of surgeries performed at each site during the study period and the influ- ence of IBD drugs on ePOCs at the time of surgery. The rate of post-operative recurrence in this sample of patients has been reported elsewhere [ 10 ].
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Virus and Host Factors Affecting the Clinical Outcome of Bluetongue Virus Infection

Virus and Host Factors Affecting the Clinical Outcome of Bluetongue Virus Infection

In this study, we dissected both host and virus factors that can affect the clinical outcome of BTV infection. The use of a uniform experimental framework has allowed us to rigorously interrogate both experimental questions addressed in past studies (55), as well as to explore hitherto unanswered questions. First of all, as sug- gested previously (24, 32–36), we confirmed that while both sheep and goats are fully susceptible to BTV (in this case BTV-8) infec- tion, the former are more susceptible than goats and more likely to develop clinical disease. The levels of viremia in BTV-infected goats were not different from (if anything, higher than) those observed in infected sheep. These data confirm that BTV is able to replicate to high levels in goat tissues but cellular damage, either induced by the virus or the host immune responses, does not likely occur. We do not know if goats would be more susceptible to disease if we had used higher infectious doses. We have used 2 ⫻ 10 6 PFU of BTV in our experimental infections, and this is likely far more infectious virus than is transmitted in nature by infected midges. In addition, studies in sheep using as little as 10 1.4 TCID 50
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A study of predictors and factors affecting outcome in diabetic ketoacidosis patients

A study of predictors and factors affecting outcome in diabetic ketoacidosis patients

DKA presents with various clinical manifestations . One such manifestation is altered sensorium which occurred in 20% of the study population and was the commonest manifestation following vomiting which occured in 26% of DKA population studied. The initial GCS calculated significantly affected the outcome. The worst outcomes were documented in individuals with less than 8 score. The previous studies did not show constant association of outcome with GCS. In study by Otieno et al., 173 altered level of consciousness was a major predictor of mortality in DKA patients whereas Agarwal et al. dID not show such association. 9
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Clinical presentation, risk factors and factors affecting short term outcome in patients with cerebral venous thrombosis

Clinical presentation, risk factors and factors affecting short term outcome in patients with cerebral venous thrombosis

Exclusion criteria Patient less than 18 years. Study had written consent from the patient and approval of Institutional Review Board. Baseline details were collected regarding the name, age, time of hospital admission from the onset of symptoms, mode of onset and duration of hospital stay. Detailed history and clinical examination of the patients were done to obtain the following details. Symptoms and signs - presence of headache, visual loss, diplopia, aphasia, history of seizures, either focal or generalised tonic clonic were taken. Patients were checked for signs such as papilledema, stupor/coma, left/right hemiplegia, cranial nerve palsy and anisocoria. Glasgow coma scale score was also noted. Patients were asked for a past history of diabetes mellitus, hypertension, coronary artery disease, dyslipidaemia, deep vein thrombosis, connective tissue disorders, thyroid disorders and any malignancy. Personal habits such as alcohol intake and smoking and drug history such as use of OCP, steroids and chemotherapy were also looked into.
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A PROSPECTIVE STUDY OF DETERMINANTS OF FACTORS AFFECTING OUTCOME OF PERFORATED PEPTIC ULCER DISEASE

A PROSPECTIVE STUDY OF DETERMINANTS OF FACTORS AFFECTING OUTCOME OF PERFORATED PEPTIC ULCER DISEASE

3 Senior registrar, dept of surgery. lokmanya tilak municipal general hospital and lokmanya tilak municipal medical college, sion Mumbai -400022. Peptic ulcer perforation is one of the most common perforation in asian countries and is still in era of proton pump inhibitors. peptic ulcer disease can be divided into gastric and duodenal ulcers peptic ulcer perforation the bacteria released into the peritoneal cavity following perforation of a hollow viscus cause secondary peritonitis the morbidity and mortality associated with the presence of enterococcus. the prospective factors determining the outcome were studied such as age, sex, stage of presentation, co morbities, renal failure, use of nsaids ,multiple addiction and physical factors such as heart rate ,blood pressure, size and site of perforation ,amount of contamination and investigations ,days stay and complications were evaluated. Assessment of these factors at presentation can lead to identification of patients in need of intensive care and early aggressive surgical steps to decrease morbidity and mortlity were studied.60 patients with perforative peritonitis presented to the emergency department were included and studied. detailed history & clinical examination performed, routine blood investigation were done followed by the use of appropriate diagnostic procedures such as x-ray erect abdomen, with additional help of abdominal ultrasound and abdominal ct scan. this study concluded that factors causing adverse outcome in patients were identified as pre operative renal failure, multiple addictions ,peritoneal contamination, ,size of perforation were known to cause significant mortality and morbidity in this study.
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Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma in the major salivary gland

Prognostic factors affecting the clinical outcome of carcinoma ex pleomorphic adenoma in the major salivary gland

management strategy [9,10]. Presently, no evidence sug- gests that adjuvant chemotherapy can improve CXPA prognosis. This is a retrospective review of a single institution’s experience. Unlike previous reports that included CXPA in both major and minor salivary glands, which may in- fluence the interpretation of results, our study focused only on the major salivary glands, in which surgery was used as the main curative-intention treatment for all pa- tients. In addition, we had a relatively large series for this uncommon disease. Our goal was to identify prognostic variables that could help to better guide CXPA therapy.
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Factors Affecting Functional Outcomes after Clavicle Fracture- A Clinical Study

Factors Affecting Functional Outcomes after Clavicle Fracture- A Clinical Study

ABSTRACT :) Background: The clavicle is one of the most frequently fractured bones in the body, the fracture most often resulting from a direct blow or a fall on an outstretched hand. The present study was conducted to assess functional outcome in patients undergoing treatment for clavicle fractures. Materials & Methods: The present study consisted of 50 cases of clavicle fracture in adults of either sex in the Department of Orthopaedics, Guru Nanak Dev Hospital, Amritsar. All were treated by following methods; Conservative management which included webbing and ring in children, figure of 8 bandage, broad arm sling and K wire fixation. For lateral 1/3 rd clavicular fracture, two K wires introduced through acromion into lateral end clavicle after reduction of fracture. Open reduction and internal fixation with plating was done wherever necessary. American shoulder & elbow surgeon (ASES) score were used to access function on scale of 100 points, with higher score indicating better function and low score meaning greater pain and disability. Results: Males were 39 (78%), male child were 3 (6%) and females were 8 (16%) in number. The difference was significant (P< 0.05). The mean score for difficulty on putting coat was 2.89, difficult sleeping affected side was 2.15, difficult washing back was 2.88, manage toileting was 2.18, comb hair was 2.56, reach high shelf was 2.48, lift 10 lbs above shoulder was 2.80, throw a ball overhand was 2.72, difficult doing usual work was 2.94 and difficult doing sport/ leisure activity was 2.64. The mechanism of injury was fall seen in 19 (38%), road side accident in 28 (56%), physical assault in 3 (6%). The difference was significant (P< 0.05). Conclusion: We can conclude that clavicle fractures can be managed both conservatively and surgically. Type of fracture and type of treatment are factors affecting outcome of clavicle fracture management.
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Factors Affecting the Surgical Outcome of Primary Exotropia in Children

Factors Affecting the Surgical Outcome of Primary Exotropia in Children

Study Design: Retrospective Clinical Study. Place and Duration of Study: Hamad Medical Corporation –Tertiary Hospital in Qatar, study done over six months. Methods: Medical records of patients who underwent surgical correction of primary exotropia procedures between the years 2008 and 2013 were retrospectively reviewed. Patients less than 15 years of age were included in the study and the following data were collected: onset age of squint, age at surgery, type of exotropia, visual acuity, presence of amblyopia, anisometropia, refractive error (spherical equivalent), preoperative deviation, AV pattern, stereopsis, type of surgery and analysis using descriptive statistics, unpaired t- and chi-square statistical tests.
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A Study on Early Enteral Feeding in cases of Intestinal Anastomosis

A Study on Early Enteral Feeding in cases of Intestinal Anastomosis

After intestinal anastomosis, conventional feeding protocol is to keep the patient nil per oral till the patient shows signs and symptoms of gut motility, thereby preventing signs and symptoms of post-operative ileus and to reduce the incidence of anastomotic leak. After major gastrointestinal surgeries, the small intestine (jejunum) will shows normal motility 4 – 8 hrs after surgery. Postoperative ileus is usually transient and feeding within 24 hours after intestinal anastomosis is well tolerated by the patients. There are studies which has shown that early enteral feeds have a positive effect on gut motility thereby reducing post-operative ileus and increasing patient compliance.
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Factors affecting outcome of cochlear implant: an observational study

Factors affecting outcome of cochlear implant: an observational study

Approximately 74% of the study population had normal inner ear anatomy and 26% had cochleovestibular anomaly on radiological imaging. Out of thirteen, four had features suggestive of TORCH Infections, two had Mondini’s deformity, and one had absent modiolus, one had labyrinthitis ossificans sequelae, one had dysplasia/hypoplasia. On comparison of the CAP, SIR, MAIS score at various intervals between the two groups, it showed that the CAP, SIR and MAIS score is higher in Normal group with greater t value in each interval and is statistically not significant. Similar results were seen in a study done by Jansen et al in 1969 where they reported abnormalities of inner ear in 20% patients with congenital sensorineural hearing loss. 15 We observed that both groups performed similar in CAP, SIR, AND MAIS score over various intervals. This may be due to better understanding of cochlear anatomy preoperatively by extensively discussing the surgical approaches, Intraoperative NRT and Check X-ray and confirming the position of electrodes.
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Study of uveitis in children and factors affecting visual outcome.

Study of uveitis in children and factors affecting visual outcome.

CERTIFICATE This is to certify that Dr. A. Nandhini, MS. Post Graduate Student in Ophthalmology, Regional Institute of Ophthalmology, Government Ophthalmic Hospital, Madras Medical College, carried out this dissertation titled Study of Uveitis in Children and Factors Affecting Visual Outcome by herself under my guidance and direct supervision during the period of May 2004 to March 2007. This dissertation is submitted to Tamil Nadu Dr. MGR Medical University, Chennai in partial fulfillment of the award of MS Degree (Ophthalmology).
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Primary Resection and Anastomosis in Gangrenous Sigmoid Volvulus- A Prospective Study

Primary Resection and Anastomosis in Gangrenous Sigmoid Volvulus- A Prospective Study

Rapid resection with colostomy fashioning has been done over time for gangrenous volvulus. However resection and primary anastomosis has also been described with less complications and a shorter hospital stay. Our aim was to study the safety and efficacy of emergency resection and primary anastomosis in gangrenous sigmoid volvulus without a proximal colostomy.

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Chylous ascites associated with abdominal trauma and intestinal resection-anastomosis in a pet ferret (Mustela putorius furo).

Chylous ascites associated with abdominal trauma and intestinal resection-anastomosis in a pet ferret (Mustela putorius furo).

Conservative treatment successfully resolved clin- ical signs of chyloabdomen after 48 hours in the ferret described in the present report. In humans, medical management is the initial therapeutic approach for chylous effusions, 32,33,35 with nutritional support being an important component to maintain the patient’s nu- tritional status and influence chyle formation and flow through the thoracic duct. Total parenteral nutrition is generally advocated, although provision of a high- protein, low-fat diet with medium-chain triglycerides is an alternative. 33 Medium-chain triglycerides are ab- sorbed directly by intestinal cells and then transported as glycerol and free fatty acids directly to the liver via the portal vein, unlike long-chain triglycerides, which are converted into monoglycerides and free fatty acids, and then transported as chylomicrons to the intestinal lymph ducts. 33 Such diets reduce the production and flow of chyle in humans 33 but do not seem to influence
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Maternal and perinatal outcome in eclampsia and factors affecting the outcome: a study in North Indian population

Maternal and perinatal outcome in eclampsia and factors affecting the outcome: a study in North Indian population

Morbidity and mortality observed in patients of eclampsia in our study is similar to that observed in studies from other regions of our country and other developing countries. Case fatality rate observed in our study i.e. 8.4% is similar to studies from Tanzania (7.89%) and Benin (10.7%). 4,11 It is slightly higher than that reported from Eastern India (4.4%). 9 However the case fatality rate is much higher than reported from developed countries (0.5% to 1.8%). 6,12,13 The difference in case fatality rate may be due to critical condition at arrival, more time taken to reach adequate health care facility, delayed referral, poor transport facilities for the patients and nonspecific and inadequate management given at peripheral centers. For all the 7 maternal deaths, many of the responsible factors were found which could have been avoided. Six out of seven of these patients did not seek any antenatal care; they took much long to reach adequate health care facility and 4 women suffered from recurrent convulsions during the transport. Three of these four women did not get MgSO 4 from the peripheral health centers.
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Analysis of pregnancy outcome after anastomosis of oviduct and its influencing factors

Analysis of pregnancy outcome after anastomosis of oviduct and its influencing factors

Our strengths are that the sample size was not small, thus the result was convincing, and we found out some factors that can affect the effects of laparoscopic oviduct anastomosis, for example, ligation duration and length of oviduct. However, age per se can affect fertility rates, but we did not compare the data in our study with the data of the patients that are at the same age range of the patients in our study, but did not do laparoscopic oviduct anasto- mosis, which should be addressed in future studies. In addition, we did not compare the effects of laparoscopic oviduct anastomosis with in-vitro fertilization (IVF). Also, we did not evaluate the postoperative complications, which can be discussed in future studies. In addition, due to the long duration of pregnancy and limited trial time, the pregnancy outcomes of patients after fallopian tube anastomosis are still being followed up and no systematic data have been obtained, which can be mainly discussed in future studies. We have added it as a limitation of our study in the discussion section.
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A Comparative study between Single Versus Double Layered Intestinal Anastomosis

A Comparative study between Single Versus Double Layered Intestinal Anastomosis

bowel, anastomosis involving disease-affected bowel, and inadequate blood flow are associated with delayed healing and contributes to anastomotic leak. Anastomotic leak presenting on postoperative day 1 or 2 is invariably due to technical reasons. Anastomotic leak secondary to interference in the normal healing mechanism usually presents around the end of the first postoperative week. Anastomotic leak can present either as frank peritonitis when the leak is uncontrolled or as localized intra-abdominal collection/abscess if the leak is controlled. An uncontrolled leak with diffuse peritonitis is associated with high morbidity and mortality and requires re-exploration. During relaparotomy, a thorough lavage of the peritoneal cavity should be carried out. In most circumstances, it is better to dismantle the anastomosis and bring the bowel loops as stoma. A controlled leak presenting with a localized intra-abdominal abscess can effectively managed conservatively by means of percutaneous drainage of the abscess under imaging guidance and antibiotics.
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A study of risk factors and clinical outcome of stroke in children

A study of risk factors and clinical outcome of stroke in children

Correlating outcome with individual risk factors of stroke, authors found that recurrence was more common in those with vasculopathy due to Moyamoya disease, which was also demonstrated in a study conducted in 2006 by Ganesan V et al, Two of four children who had a recurrent stroke had moyamoya disease. 22 One of these also had hypercoagulability as an additional risk factor. A prospective study conducted by Strater R et al, showed that a vascular origin and protein C deficiency was the risk factor for recurrence. 23 Kim SK et al, have demonstrated that young patients with moyamoya disease have rapid disease progression and poor clinical outcome. 24 In a Korean study conducted by Lee EH et al, it was found that cardiac disease was associated with poor outcome. 17 In present study also, risk factors predominantly cardiac diseases followed by hypercoagulability, vasculopathy and vasculitis were associated with high mortality, children with multiple risk
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