1,720,975 research outputs found
Subcostal Transversus Abdominis Plane Block for Laparoscopic Sleeve Gastrectomy, Is It Worth the Time?
No full textBackgroundObesity is a complex and multifactorial disease whose incidence has increased, making it a serious public health issue. Laparoscopic sleeve gastrectomy (LSG) is one of the most common surgical procedures that is chosen for bariatric surgery. Decreasing postoperative pain in these patients which will increase patients' compliance and quality of life will lead to better surgical results. This study aims to compare the effectiveness of trocar site infiltration versus bilateral subcostal transversus abdominis plane block (TAP) in controlling postoperative pain in patients.MethodsForty-five consecutive patients who have undergone LSG in xxx General Surgery Department have been enrolled in the study. Patients were divided into two groups according to the surgeon's choice. The first group underwent TAP block, while the second group underwent trocar site infiltration. Patients' pain was recorded via visual analogue scale (VAS) in postoperative periods.ResultsTwenty-nine female (69%) and 13 (31%) male patients were included in the study. Median age was 41 (18-58) and median BMI was 48 (41.1-68). When the VAS values were compared, in the TAPB group, 6th hour resting and coughing pain was statistically significantly less. Other VAS values measured while resting, coughing, and post-mobilization did not show significant differences. There were no significant differences between the groups' tramadol use.ConclusionsAfter LSG, TAP block and trocar site infiltration yield similar pain control. Due to the faster application and fewer side effects, we concluded that trocar site infiltration should be the intervention of choice in controlling postoperative pain in LSG
Intraoperative Endoscopic Assessment of the Pouch and Anastomosis During Laparoscopic Roux-en-Y Gastric Bypass
No full textAs an advanced surgical procedure, laparoscopic Roux-en-Y gastric bypass (LRYGB) is associated with considerable morbidity, especially in the learning curve period. The aim of this study was to evaluate the role of endoscopy during LRYGB surgery in assessing the gastric pouch and anastomosis for air leak, bleeding, and structure at the beginning of a bariatric surgery program. Patients who underwent LRYGB for morbid obesity between May 2008 and May 2009 were included in this study. After the completion of the anastomosis, an endoscopic examination was carried out. The transection line and anastomosis site were examined for bleeding and patency and inspected for air leak under laparoscopic vision. Thirteen morbidly obese patients (mean body mass index, 48.0 +/- 6.8 kg/m(2)) were evaluated by endoscopic examination during the LRYGB operation. None of the cases had bleeding at the transection line or anastomosis site. In two patients, air leak test was positive and the anastomosis was reinforced with additional sutures. All the patients, including those with positive air leak test, were discharged from the hospital with no leak complications. After a mean follow-up of 9.1 +/- 5.5 months, except for the patient who underwent balloon dilatation, no other patient had anastomotic stricture. Intraoperative endoscopy is invaluable in the assessment of bleeding, anastomotic patency, and air leak during LRYGB, and it might be a helpful auxiliary tool to decrease morbidity during the learning curve period. Also, it helps solve intraoperative problems during the surgery so that postoperative complications might be prevented
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Coagulation dynamics and platelet functions in obstructive jaundiced patients
No full textAll of the body systems are affected by increased levels of bilirubin. The aim of this study is to investigate the function of platelets and clotting dynamics in patients with obstructive jaundice. Liver function tests, serum CRP, PT, PTT and hemogram were measured in 23 patients with obstructive jaundice. Thromboelastography (TEG) was done for the evaluation of coagulation dynamics, while platelet function assay (PFA 100) was used to evaluate platelet functions. Blood samples were obtained at two occasions, before the drainage and 3 weeks after the relief of the obstruction. Hypercoagulation was detected in 80% of patients. Maximum strength, elasticity, coagulation indices of the clot were correlated with increased concentrations of direct bilirubin. Although maximum strength of coagulum usually represents increased activity of platelet function, membrane closure times with PFA 100 were found to be prolonged in 30% of patients, reduced values were determined in 17% of patients. No demonstrable effect on coagulation parameters and platelet function were detected after drainage procedures regardless of modality. Even though there is a general assumption about the increased bleeding tendency in obstructive jaundiced patients, we could not demonstrate reduced clotting activity by measuring with either PFA or TEG. On the contrary we observed tendency for hypercoagulation independent of increased prothrombin times. The most probable cause of this effect is the increased activity of fibrin polymers on platelet membrane
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Do not rush for surgery; stent placement may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP
No full textEndoscopically unextractable common bile duct stones may be challenging for the endoscopist. In this study, we investigated the rate of stone removal after the endoscopic insertion of a biliary stent in patients with common bile duct stones unextractable via ERCP. Records of patients with common bile duct stone/s who underwent ERCP at single center were retrospectively analyzed. Only patients with common bile duct stone/s who had a stent placed due to unyielding stone removal were eligible for inclusion into this study. Endoscopic biliary stents were placed in cases of unextractable stone. After a follow-up period, a second ERCP procedure was performed. Major outcomes were the rate of stent insertion because of unextractable bile duct stones, the rate of spontaneous stone passage and the rate of stone extraction after the endoscopic insertion of a biliary stent. A total of 66 (28 %) patients had a stent placed due to unyielding attempts for stone removal, and 43 patients were included in the study. The second ERCP procedure revealed that 10 patients (23 %) had spontaneous stone passage and 5 (12 %) had spontaneous passage of both the stone and the stent. In the second procedure, biliary balloon was used successfully to extract the retained stone in 22 (51 %) patients. Thus, a total of 37 patients (86 %) with retained stones had a successful stone extraction during the second ERCP procedure. Biliary stenting may be an effective step for definitive treatment of initially unextractable common bile duct stones with ERCP
Is Concomitant Cholecystectomy Necessary for Asymptomatic Cholelithiasis During Laparoscopic Sleeve Gastrectomy?
No full textBackground There is not any consensus on concomitant cholecystectomy for asymptomatic gallbladder stones during laparoscopic sleeve gastrectomy (LSG). The aim of this study was to evaluate the surveillance results of the LSG patients who have asymptomatic gallbladder stones and did not undergo cholecystectomy. Methods Patients who underwent laparoscopic sleeve gastrectomy with preoperatively detected gallbladder stones and completed at least 6 months follow-up were included in the study. Concomitant cholecystectomy was performed for symptomatic patients while it was not performed for asymptomatic subjects. At the end of the follow-up time, symptoms and signs related to gallbladder disease were recorded. Clinical and demographic characteristics were compared between symptomatic and asymptomatic patients. Results Between February 2012 and October 2016, 312 laparoscopic sleeve gastrectomies were performed. Among the patients, 24 were regarded as asymptomatic cholelithiasis, and cholecystectomy was not performed. The mean follow-up period was 27 (6-58) months. The mean preoperative BMI was 50.0 +/- 7.6 kg/m(2), and at the end of the follow-up time, it decreased to 35.6 +/- 8.8 kg/m(2). Five (20.8%) patients experienced biliary colic. Acute cholecystitis or obstructive jaundice was not observed in any of the patients. Characteristics of patients who developed symptomatic gallbladder disease (n = 5) were not significantly different from those of patients who remained asymptomatic (n = 19). Conclusions The risk of becoming symptomatic for asymptomatic cholelithiasis is very close to the healthy population after sleeve gastrectomy. Although further studies with a high number of cases are needed, we suggest only observation for asymptomatic gallbladder stones in patients who will undergo sleeve gastrectomy
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