The Parkland Grading Scale for Cholecystitis (PGS) was developed as an intraoperative grading scale to stratify gallbladder (GB) disease severity during laparoscopic cholecystectomy (LC). We aimed to prospectively validate this scale as a measure of LC outcomes.
Methods
Eleven surgeons took pictures of and prospectively graded the initial view of 317?GBs using PGS while performing LC (LIVE) between 9/2016 and 3/2017. Three independent surgeon raters retrospectively graded these saved GB images (STORED). The Intraclass Correlation Coefficient (ICC) statistic assessed rater reliability. Fisher's Exact, Jonckheere-Terpstra, or ANOVA tested association between peri-operative data and gallbladder grade.
Results
ICC between LIVE and STORED PGS grades demonstrated excellent reliability (ICC?=?0.8210). Diagnosis of acute cholecystitis, difficulty of surgery, incidence of partial and open cholecystectomy rates, pre-op WBC, length of operation, and bile leak rates all significantly increased with increasing grade.
Conclusions
PGS is a highly reliable, simple, operative based scale that can accurately predict outcomes after LC.
Table of contents summary
The Parkland Grading Scale for Cholecystitis was found to be a reliable and accurate predictor of laparoscopic cholecystectomy outcomes. Diagnosis of acute cholecystitis, surgical difficulty, incidence of partial and open cholecystectomy rates, pre-op WBC, operation length, and bile leak rates all significantly increased with increasing grade. 相似文献
Visible light spectroscopy (VLS) represents a sensitive, non-invasive method to quantify tissue oxygen levels and detect hypoxemia. The aim of this study was to assess the microperfusion patterns of the gastric pouch during laparoscopic Roux-en-Y gastric bypass (LRYGB) using the VLS technique.
Methods
Twenty patients were enrolled. Tissue oxygenation (StO2%) measurements were performed at three different localizations of the gastric wall, prior and after the creation of the gastric pouch, and after the creation of the gastro-jejunostomy.
Results
Prior to the creation of the gastric pouch, the lowest StO2% levels were observed at the level of the distal esophagus with a median StO2% of 43 (IQR 40.8–49.5). After the creation of the gastric pouch and after the creation of the gastro-jejunostomy, the lowest StO2% levels were recorded at the level of the His angle with median values of 29% (IQR 20–38.5) and 34.5% (IQR 19–39), respectively. The highest mean StO2 reduction was recorded at the level of the His angle after the creation of the gastric pouch, and it was 18.3% (SD ± 18.1%, p < 0.001). A reduction of StO2% was recorded at all localizations after the formation of the gastro-jejunostomy compared to the beginning of the operation, but the mean differences of the StO2% levels were statistically significant only at the resection line of the pouch and at the His angle (p = 0.044 and p < 0.001, respectively).
Conclusion
Gastric pouch demonstrates reduction of StO2% during LRYGB. VLS is a useful technique to assess microperfusion patterns of the stomach during LRYGB.
STATEMENT OF PROBLEM: The failure of adhesion between a silicone-based resilient liner and a denture base is a significant clinical problem. PURPOSE: The purpose of this study was to examine the effects of denture base resin surface pretreatments with different chemical etchants preceding the silicone-based resilient liner application on microleakage and bond strength. The initial effects of chemical etchants on the denture base resin in terms of microstructural changes and flexural strength were also examined. MATERIAL AND METHODS: Forty-two polymethyl methacrylate (PMMA) denture base resin (Meliodent) specimens consisting of 2 plates measuring 30 x 30 x 2 mm were prepared and divided into 7 groups (n = 6). Specimen groups were treated by immersion in acetone for 30 (A30) or 45 (A45) seconds, methyl methacrylate monomer for 180 (M180) seconds, and methylene chloride for 5 (MC5), 15 (MC15) or 30 (MC30) seconds. Group C had no surface treatment and served as the control. Subsequently, an adhesive (Mollosil) and a silicone-based resilient denture liner (Mollosil) were applied to the treated surfaces, and all specimens were immersed in the radiotracer solution (thalium-201 chloride) for 24 hours. Tracer activity (x-ray counts), as a parameter of microleakage, was measured using a gamma camera. For bond-strength measurement, 84 rectangular PMMA specimens (10 x 10 x 40 mm) were surface-smoothed for bonding and treated with the different chemical etchants using the same previously described group configurations. The adhesive and the silicone-based denture liner were applied to the treated surfaces. Tensile bond-strength (MPa) was measured in a universal testing machine. Flexural strength measurement was performed with 49 PMMA specimens (65 x 10 x 3.3 mm according to ISO standard 1567) in 7 groups (n = 7), with 1 flat surface of each treated with 1 of the chemical etchants preceding adhesive application. The flexural strength (MPa) was measured using a 3-point bending test in a universal testing machine. The data were analyzed by 1-way analysis of variance and the Tukey HSD test (alpha = .05). RESULTS: Significant differences were found between the groups in terms of microleakage (P < .0001). The lowest microleakage was observed in group M180 (30,000 x-ray counts) and the highest in the control group (44,000 x-ray counts). The mean bond strength to PMMA resin ranged from 1.44 to 2.22 MPa. All treated specimens showed significantly higher bond strength than controls (P < .01). The flexural strength values all significantly differed (P < .05). All experimental specimens that had chemical surface treatments showed lower flexural strength than controls (P < .05). CONCLUSION: Treating the denture base resin surface with chemical etchants increased the bond strength of silicone-based resilient denture liner to denture base and decreased the microleakage between the 2 materials. Considering the results of both tests together, the use of methyl methacrylate monomer for 180 seconds was found to be the most effective chemical treatment. 相似文献
Objectives:To determine the relationship between fear of falling (FOF) and upper extremity muscle strength.Methods:This cross-sectional study included 112 hospitalized, mobile patients. Forty-seven (42%) were males and 65 (58%) were females, and the mean age was 72.3. The study was carried out between September 2018 and September 2019 at Balikli Rum Hospital Nursing Homes, Istanbul, Turkey. Patients were tested using geriatric tools (such as Mini-Mental State Examination) and physical tests such as handgrip, key pinch and 6-meter up and go tests.Results:The average annual falling number of elderly people with FOF was statistically significantly higher than that in those without FOF (p=0.001). Right handgrip, left handgrip, right key pinch, and left key-pinch mean values in elderly individuals with FOF were statistically significantly lower than those without FOF (p< 0.001, p< 0.001, p< 0.001, p< 0.001, respectively).Conclusion:The measurement of upper extremity strength could be a predicting parameter of FOF. 相似文献
Little information is available on the effects of concomitant vaginal prolapse repair on the outcomes of the transobturator tape (TOT) procedure. The purpose of this study is to assess the results and complications of TOT when combined with vaginal prolapse repair with a long-term follow-up.
Methods
We conducted a retrospective cohort study of 232 female patients who underwent the TOT procedure at two institutions. There were two groups: group 1 consisted of patients who had undergone TOT alone and group 2 consisted of patients who had undergone concomitant vaginal prolapse repair. The outcomes were analyzed considering four postoperative parameters: objective cure, subjective cure, resolution of urgency urinary incontinence (UUI), and patient satisfaction. The mean follow-up was 66.3 months (range 60–85).
Results
A total of 117 patients in group 1 and 104 patients in group 2 were documented in this study. The subjective and objective cure rates were 87.17 %, 64.95 % in group 1 and 89.42 %, 68.26 % in group 2. Patient satisfaction rates (visual analog scale [VAS] score ≥80) were 71.79 and 83.65 % in groups 1 and 2 respectively (p?=?0.035). Complications were reported according to the Clavien–Dindo classification with grade I 7.7 %, grade II 69.2 %, grade IIIa 7.7 %, and grade IIIb 15.4 %, and grade I 9.5 %, grade II 47.6 %, grade IIIa 42.8 %, and grade IIIb 0 % in groups 1 and 2 respectively.
Conclusions
Concomitant vaginal prolapse repair with TOT does not have any negative effects on continence outcomes; on the contrary, it increases patient satisfaction. 相似文献