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排序方式: 共有249条查询结果,搜索用时 15 毫秒
101.
Giles TD Oparil S Ofili EO Pitt B Purkayastha D Hilkert R Samuel R Sowers JR 《Blood pressure monitoring》2011,16(2):87-95
102.
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Jarral OA Purkayastha S Athanasiou T Zacharakis E 《Interactive Cardiovascular and Thoracic Surgery》2011,13(1):60-65
A best evidence topic was written according to a structured protocol. The question addressed was whether the thoracoscopic phase of three-stage minimally-invasive esophagectomy is best performed in the prone or left lateral decubitus position. A total of 31 papers were found using the reported searches, of which seven represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. We conclude that there is no convincing evidence that prone thoracoscopic esophagectomy is superior to left lateral decubitus positioning. Four papers retrospectively compared the prone and lateral techniques, and while the authors suggested that the prone position was associated with better surgical ergonomics due to the effects of gravity pooling blood outside the operative view and the reduced need for lung retraction, outcomes were not significantly different. All four studies had significant limitations, such as small patient populations and sequential operating with the possible effect of a learning curve. Two studies compared respiratory and haemodynamic changes associated with prone positioning and suggest that it is physiologically well tolerated and may offer better oxygenation, similar to that seen in the prone positioning of acute respiratory distress patients. The evidence for prone thoracoscopic esophagectomy is currently not mature enough to reach any significant conclusions, and randomized studies are required. 相似文献
104.
Tilney HS Lovegrove RE Heriot AG Purkayastha S Constantinides V Nicholls RJ Tekkis PP 《International journal of colorectal disease》2007,22(5):531-542
Aims The present meta-analysis compared short-term outcomes between patients undergoing laparoscopic and open restorative proctocolectomy.
Methods A literature search of Medical Literature Analysis and Retrieval System Online, Ovid, Excerpta Medica and Cochrane databases
was performed to identify studies published between 1990 and 2006 comparing laparoscopic and open restorative proctocolectomy.
A random-effect meta-analytical technique was used, and sensitivity analysis was performed on studies published since 2001,
higher-quality papers, those reporting on more than 30 patients and those with matching of patient characteristics.
Results Ten studies satisfied the selection criteria, including outcomes on 329 patients, 168 (51.1%) of whom underwent laparoscopic
resection. Operative time was significantly longer in the laparoscopic group by 86 min (p<0.001) and throughout the subgroup analysis, but this finding was associated with significant heterogeneity. Operative blood
loss was less in the laparoscopic group by 84 ml. There was no significant difference in post-operative adverse events between
the groups. A statistically significant reduction in length of post-operative stay was observed for laparoscopic patients
in high-quality studies and those reporting on more than 30 patients by 1.1 days (p=0.02 in both subgroups) and studies published in or since 2001 by 3.0 days (p=0.004) but not overall.
Conclusion Laparoscopic ileal pouch surgery was associated with longer operative time, lower blood loss, shorter length of hospital stay
and similar short-term adverse events compared with open surgery. Comparative data on quality of life and long-term outcomes
are currently unavailable. The potential advantage of laparoscopic ileal pouch surgery remains to be established.
This paper was presented as a podium presentation at the Annual Meeting of the Association of Surgeons of Great Britain and
Ireland, Edinburgh 2006 and as a poster at the 2006 Scientific Session of the Society of American Gastrointestinal and Endoscopic
Surgeons. 相似文献
105.
Laparoscopic skills suffer on the first shift of sequential night shifts: program directors beware and residents prepare 总被引:1,自引:0,他引:1
Leff DR Aggarwal R Rana M Nakhjavani B Purkayastha S Khullar V Darzi AW 《Annals of surgery》2008,247(3):530-539
OBJECTIVE: Research evaluating fatigue-induced skills decline has focused on acute sleep deprivation rather than the effects of circadian desynchronization associated with multiple shifts. As a result, the number of consecutive night shifts that residents can safely be on duty without detrimental effects to their technical skills remains unknown. A prospective observational cohort study was conducted to assess the impact of 7 successive night shifts on the technical surgical performance of junior residents. METHODS: The interventional strategy included training 21 residents from surgery and allied disciplines on a virtual reality surgical simulator, towards the achievement of preset benchmark scores, followed by 294 technical skills assessments conducted over 1764 manpower night shift hours. Primary outcomes comprised serial technical skills assessments on 2 tasks of a virtual reality surgical simulator. Secondary outcomes included assessments of introspective fatigue, duration of sleep, and prospective recordings of activity (number of "calls" received, steps walked, and patients evaluated). RESULTS: Maximal deterioration in performance was observed following the first night shift. Residents took significantly longer to complete the first (P = 0.002) and second tasks (P = 0.005) compared with baseline. They also committed significantly greater numbers of errors (P = 0.025) on the first task assessed. Improved performance was observed across subsequent shifts towards baseline levels. CONCLUSIONS: Newly acquired technical surgical skills deteriorate maximally after the first night shift, emphasizing the importance of adequate preparation for night rotas. Performance improvements across successive shifts may be due to ongoing learning or adaptation to chronic fatigue. Further research should focus on assessments of both technical procedural skills and cognitive abilities to determine the rotas that best minimize errors and maximize patient safety. 相似文献
106.
Zacharakis E Hettige R Purkayastha S Aggarwal R Athanasiou T Darzi A Ziprin P 《Surgical innovation》2008,15(2):85-89
In this study, the authors review their initial results with the laparoscopic approach for parastomal hernia repair. Between 2006 and 2007, 4 patients were treated laparoscopically at our institution. The hernia sac was not excised. A piece of Gore-Tex DualMesh with a central keyhole and a radial incision was cut so that it could provide at least 3 to 5 cm of overlap of the fascial defect. The mesh was secured to the margins of the hernia with circumferential metal tacking and trans-fascial sutures. No complications occurred in the postoperative period. After a median follow-up of 9 months, recurrence occurred in 1 patient. This was our first patient in whom mesh fixation was performed only with circumferential metal tacking. The laparoscopic repair of parastomal hernias seems to be a safe, feasible and promising technique offering the advantages of minimally-invasive surgery. The success of this approach depends on longer follow-up reports and standardization of the technical elements. 相似文献
107.
108.
109.
Fluoroscopic-guided balloon dilatation and stenting in tracheal stenosis with metallic self-expandable stents and long-term follow-up results 总被引:1,自引:0,他引:1
Bodhey NK Gupta AK Neelakandhan KS Neema PK Kapilamoorthy TR Purkayastha S Thomas B Krishnamoorthy T Kesavadas C 《Australasian radiology》2007,51(4):351-357
The purpose of this study was to assess the safety and long-term efficacy of self-expandable stents in the treatment of benign tracheal stenosis. Nine patients (seven men) with tracheal stenosis (including one with fistula) of varied cause were treated by fluoroscopically guided balloon dilatation and stenting with self-expandable metallic stents. The procedure was carried out under topical spray in eight patients and under general anaesthesia in one patient. The patients were followed up for a period ranging between 13 and 60 months. In eight of the nine patients, satisfactory positioning of the stent was achieved at the first instance, with immediate relief of dyspnoea. One patient with innominate artery aneurysm died 16 days after the procedure because of renal failure. At 1 month of follow up, six out of eight (75%) of our live patients were without any respiratory embarrassment. This dyspnoea-free result reached almost 90% by the end of 1 year especially so in the fibrous strictures. Four out of the eight live patients (50%) had cough for 2 months and two (25%) had mild blood-tinged sputum treated by inhalation and mucolytic agents. Secondary intervention was required in one patient at 1 month because of recurrent symptoms. The patient with tracheo-oesophageal fistula required surgical intervention because of fracture of the stent. Fluoroscopically guided balloon dilatation and stenting of the tracheal stenosis is an effective non-surgical therapy resulting in cure of fibrous strictures and palliation in cases of malignancy. 相似文献
110.
Trystan M. Lewis Emmanouil Zacharakis Jonathan Hoare Sanjay Purkayastha George B. Hanna 《Journal of gastrointestinal surgery》2010,14(8):1340-1342