An audit of short- and long-term outcomes after laparoscopic removal of common bile duct stones in Finland

Background and aim

To audit short- and long-term outcomes after laparoscopic common bile duct exploration (LCBDE) and factors influencing the success of the laparoscopic treatment.

Methods

From January 1999 to December 2011, 288 patients (93 males) underwent a single-stage laparoscopic cholecystectomy combined with LCBDE in two Finnish Hospitals. Short-term outcome data were collected prospectively. Long-term outcomes were examined retrospectively. The main measures of outcome were the success of laparoscopic CBD stone clearance and recurrence of CBD stones in the long-term, with 30-day mortality, morbidity, and the length of postoperative hospital stay as secondary outcome measures.

Results

CBD stones were successfully removed by one-stage laparoscopic procedure in 232 of the 279 patients (83.2 %) with verified CBD stones and after conversion to open surgery in additional 28 patients (93.2 %). Nineteen patients (6.8 %) having residual stones after surgery were successfully treated with postoperative ERCP. On multivariate analysis, the independent factors associated with a failed laparoscopic stone clearance were stone size over 7 mm [OR 3.51 (95 % CI 1.53–8.03), p = 0.003], difficult anatomy [OR 18.01 (5.03–64.49), p < 0.001] and transcholedochal approach [OR 2.98 (1.37–4.47), p = 0.006]. Laparoscopic stone clearance also failed in all 11 patients having impacted stones at the ampulla of Vater. Cumulative long-term recurrence rate was 3.6 % at 5 years and 6.0 % at 10 years. Thirty-day mortality was 0.3 % and morbidity 12.2 %. Postoperative hospital stay was median 2 (IQR 1–3) days after transcystic CBD removal and 4 (IQR 3–7) days after transcholedochal CBD removal, p < 0.001.

Conclusion

Our results show that one-stage LC combined with LCBDE stone clearance is safe and effective in most patients thus reducing the number of additional, potentially dangerous endoscopic procedures. Moreover, large or impacted stones are a risk factor for failed stone clearance.     

Differential aberrant connectivity of precuneus and anterior insula may underpin the diagnosis of schizophrenia and mood disorders

BACKGROUNDOver the past decade, resting-state functional magnetic resonance imaging (rs-fMRI) has concentrated on brain networks such as the default mode network (DMN), the salience network (SN), and the central executive network (CEN), allowing for a better understanding of cognitive deficits observed in mental disorders, as well as other characteristic psychopathological phenomena such as thought and behavior disorganization.AIMTo investigate differential patterns of effective connectivity across distributed brain networks involved in schizophrenia (SCH) and mood disorders. METHODSThe sample comprised 58 patients with either paranoid syndrome in the context of SCH (n = 26) or depressive syndrome (Ds) (n = 32), in the context of major depressive disorder or bipolar disorder. The methods used include rs-fMRI and subsequent dynamic causal modeling to determine the direction and strength of connections to and from various nodes in the DMN, SN and CEN.RESULTSA significant excitatory connection from the dorsal anterior cingulate cortex to the anterior insula (aI) was observed in the SCH patient group, whereas inhibitory connections from the precuneus to the ventrolateral prefrontal cortex and from the aI to the precuneus were observed in the Ds group. CONCLUSIONThe results delineate specific patterns associated with SCH and Ds and offer a better explanation of the underlying mechanisms of these disorders, and inform differential diagnosis and precise treatment targeting.     

Prevalence and incidence of dermatitis herpetiformis: a 40-year prospective study from Finland

Background Dermatitis herpetiformis (DH) is an external manifestation of coeliac disease presenting with blistering rash and pathognomonic cutaneous IgA deposits. Better knowledge of subclinical forms and serological testing has resulted in a sharp increase in the incidence and prevalence of coeliac disease. Objectives To investigate the prevalence of DH and analyse whether the incidence of DH changed when the occurrence of coeliac disease increased. Methods All 477 patients with DH diagnosed from 1970 onwards at the Tampere University Hospital were analysed for prevalence in 2009. The incidence of DH was calculated in three 10‐year periods from the year 1980. Results The prevalence of DH was 75·3 per 100 000 which is eight times lower than the prevalence of coeliac disease in our area. The annual incidence of DH in the whole period was 3·5 per 100 000, and in the three 10‐year periods 5·2, 2·9 and 2·7 per 100 000, respectively. The decrease in incidence between the first and second 10‐year period was significant (P < 0·001). The male to female ratio of DH was 1·1 : 1. The mean age at diagnosis increased significantly during the study, in men from 35·3 to 51·1 years and in women from 36·3 to 45·8 years. Conclusions The present study shows the highest prevalence of DH reported to date. Although the overall incidence of DH was also high, a significant decrease occurred in the 1990s, which is in contrast to the incidence of coeliac disease.     

香叶天竺葵挥发油的化学成分及抗瘤作用

用高分离效能的交联石英毛细管柱气相色谱法和气相色谱/质量选择检测器分离和鉴定了三种香叶油,并作了对比。结果表明这些香叶油的化学成分极为相似,但某些成分的含量却有明显差别。香茅醇、香叶醇、甲酸香茅酯和乙酸香茅酯均有一定的抗瘤活性。     

The effect of educational intervention on use of psychotropics in defined daily doses and related costs – a randomized controlled trial

ObjectiveTo investigate the effect of an educational intervention of nursing staff on change in psychotropic use and related costs among older long-term care residents.DesignA secondary analysis of a randomized controlled intervention study with 12 months of follow-up.SettingAssisted living facilities in Helsinki, Finland.SubjectsOlder (≥65 years) residents (N = 227) living in assisted living facility wards (N = 20) in Helsinki in 2011.InterventionThe wards were randomized into two groups. In one group, the nursing staff received training on appropriate medication therapy and guidance to recognize potentially harmful medications and adverse effects (intervention group); in the other group, the nursing staff did not receive any additional training (control group).Main outcome measuresChange of psychotropic use counted as relative proportions of WHO ATC-defined daily doses (rDDDs) among older long-term care residents. In addition, the change in drug costs was considered. Comparable assessments were performed at 0, 6, and 12 months.ResultsA significant decrease in both rDDDs and the cost of psychotropics was observed in the intervention group at 6 months follow-up. However, at 12 months, the difference between the intervention and control group had diminished.ConclusionsEducational training can be effective in reducing the doses and costs of psychotropics. Further studies are warranted to investigate whether long-term effects can also be achieved by various educational interventions.Registration numberACTRN 12611001078943

KEY POINTS

• We explored the effect of staff training on psychotropic use and associated costs among older long-term care residents.
• Educational training of nursing staff was beneficial as regards the actual drug doses of psychotropics, and cost savings in psychotropic medication were achieved.
• Educational training was efficient in the short-term, but further research is warranted to achieve long-term effects.

     

Assessment of Cartilage Repair Quality With the International Cartilage Repair Society Score and the Oswestry Arthroscopy Score

The International Cartilage Repair Society (ICRS) score and the Oswestry Arthroscopic Score (OAS) have been validated to evaluate repair tissue quality. However, the performance of these scores has not been studied in typical patients undergoing cartilage repair and who have lesions of varying sizes. In this study, we compared the performance of the ICRS and the OAS scores and analyzed the effect of lesion characteristics on the performance of these two scores. Cartilage repair quality was assessed in a total of 104 arthroscopic observations of cartilage repair sites of the knee in 62 patients after autologous chondrocyte implantation. Two observers scored the repair areas independently with the ICRS and the OAS scores. The performance of both scores was evaluated according to internal consistency and inter-rater reliability and correlation between the scores. The frequency and proportion of disagreements were analyzed according to the repair site area and the given score. The correlation between the scores was good (r = 0.91, 95% confidence interval [CI]: 0.87–0.94). Both scores showed moderate internal consistency and inter-rater reliability. Cronbach's α was 0.88 (95% CI: 0.80–0.92) for the ICRS score and 0.79 (95% CI: 0.70–0.86) for the OAS score. The intraclass correlation coefficient was 0.89 (95% CI: 0.84–0.92) for the ICRS and 0.81 (95% CI: 0.74–0.87) for the OAS scores. The frequency and proportion of disagreements were higher in larger repair sites. In arthroscopic use, both ICRS and OAS scores perform similarly, however, their reliability deteriorates as the lesion size increases. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:555–562, 2020