Meeting the difficulties regarding Immunizing Older people

Seven of the 13 with major bleeding had pseudoaneurysms-4 were embolized, 4 needed surgery including 1 embolization failure. Seven with intraabdominal bleeding required surgical intervention, 2 had successful embolization and 3 had expectant management. CT severity index and surgical intervention, were significantly associated with intraabdominal bleeding. Organ failure, presence of pseudoaneurysm and surgical intervention were associated with major bleeding.
Hemorrhage in SAP was associated with increased morbidity and mortality. Infected necrosis accentuated the degradation of the vessel wall, which predispose to hemorrhage. Luminal bleeding may be indicative of erosion into the adjacent viscera by the pseudoaneurysm.
Hemorrhage in SAP was associated with increased morbidity and mortality. Infected necrosis accentuated the degradation of the vessel wall, which predispose to hemorrhage. Luminal bleeding may be indicative of erosion into the adjacent viscera by the pseudoaneurysm.
This study aims to describe our experience with minimally-invasive distal pancreatectomies, with emphasis on the comparison between robotic distal pancreatectomy (RDP) and laparoscopic distal pancreatectomy (LDP).
Retrospective review of 102 consecutive RDP and LDP from 2006 to 2019 was performed.
There were 27 and 75 patients who underwent RDP and LDP, respectively. There were 12 (11.8%) open conversions and 16 (15.7%) patients had major (＞grade 2) morbidities. Patients who underwent RDP had significantly higher rates of splenic preservation (44.4% vs. 13.3%, p=0.002), higher rates of splenic-vessel preservation (40.7% vs. 9.3%, p=0.001), higher median difficulty score (5 vs. 3, p=0.002) but longer operation time (385 vs. 245 minutes, p＜0.001). The rate of open conversion tended to be lower with RDP (3.7% vs. 14.7%, p=0.175).
In our institution practice, both RDP and LDP were safe and effective. The use of RDP appeared to be complementary to LDP, allowing us to perform more difficult procedures with comparable postoperative outcomes.
In our institution practice, both RDP and LDP were safe and effective. The use of RDP appeared to be complementary to LDP, allowing us to perform more difficult procedures with comparable postoperative outcomes.
Pancreaticoduodenectomy is the only potentially curative treatment for pancreatic cancer. The identification of the first nodal drainage site (sentinel node) may improve the detection of metastatic nodes and can contribute to a less invasive surgery. We aimed to determine the accuracy of sentinel node mapping in patients with pancreatic cancer using intraoperative radiotracer injection technique.
At surgical exposure, peritumoral injection of 0.4-0.5 mci/0.5 ml of 99mTc- sodium phytate was performed. After tumor resection, sentinel nodes were investigated in the most common areas using a hand-held gamma probe. Any lymph node with in vivo count twice the background was considered as sentinel node, thus, it was removed and sent for pathological assessment. Then a standard lymph node dissection was performed for all patients.
Fourteen patients with cancer in the head of the pancreas were included in this study. Overall, 180 lymph nodes were harvested with a mean of 11.6±4.7 lymph nodes per patient. In eight patients, at least one sentinel node could be identified (detection rate about 64%). False negative rate of the study was 3/5 (60%).
Our study revealed insufficient diagnostic accuracy and high false negative rate for sentinel lymph node mapping with 99mTc- sodium phytate in pancreatic cancer.
Our study revealed insufficient diagnostic accuracy and high false negative rate for sentinel lymph node mapping with 99mTc- sodium phytate in pancreatic cancer.
The comparative effectiveness of pylorus-resecting pancreaticoduodenectomy (PRPD) and pylorus- preserving pancreaticoduodenectomy (PPPD) in pancreatic head cancer is still disputed. The aim of this study was to analyze the data obtained from a large, single center with PPPD compared with PRPD in terms of postoperative outcomes, including blood glucose levels and survival in patients with pancreatic head cancer.
Between January 2007 and December 2016, a total of 556 patients with pancreatic head cancer underwent either PPPD or PRPD. We analyzed the clinicopathologic data to assess short- and long-term outcomes retrospectively.
For underlying disease, patients with DM in PPPD were fewer than in PRPD (33.0% vs. 46.2%,
=0.002). The median value of CA19-9 was significantly higher in PRPD than in PPPD (129.36 vs. 86.47,
=0.037). The incidence of Clavien-Dindo grade III to V major complications in PPPD was significantly higher than in PRPD (20.4% vs. 13.4%,
=0.032). Resection of pylorus was shown to reduce complications in univariate and multivariate analyses (
=0.032 and = 0.021, respectively). The 5-year survival rates were 27.6% in the PPPD group and 22.4% in the PRPD group (
=0.015).
The results of PPPD and PRPD showed no significant differences from those reported conventionally in previous studies. selleck kinase inhibitor Although further well-designed studies are needed, it is more important to select the range of surgical resection for the patient's disease regardless of resection of pylorus.
The results of PPPD and PRPD showed no significant differences from those reported conventionally in previous studies. Although further well-designed studies are needed, it is more important to select the range of surgical resection for the patient's disease regardless of resection of pylorus.
Acute pancreatitis is the most widespread complication of endoscopic retrograde cholangiopancreatography. Here, we investigated the efficacy of rectal suppository naproxen, sublingual isosorbide dinitrate and their co-administration in the prevention of post-ERCP pancreatitis.
This double-blind randomized clinical trial carried out from June 2015 to February 2016 at the Gastrointestinal and Liver Diseases Research Center in Rasht, Iran. A total of 585 patients were selected from candidates for diagnostic or therapeutic ERCP by using the simple sampling method. Patients divided into three groups. Group A received 500 mg naproxen, group B took 5 mg isosorbide dinitrate, and group C was co-administrated both agents before ERCP. The primary outcome measure was the development of pancreatitis onset of pain in the upper abdomen and increase of serum amylase activity more than 3 times over the upper normal limit (60-100 IU/L) within first the 24 h post-ERCP.
Totally, 80 patients developed PEP included 29 (4.9%ndoscopist's skills can be effective. Departments and educational hospitals should develop their assessment and quality assurance measures for the training of fellows' not only technical training but also an understanding of the diagnostic and therapeutic roles of the procedure.
The Pringle maneuver is generally performed to reduce the amount of blood loss during hepatic resection. During laparoscopic liver resection, the Pringle maneuver can be used in several ways. We have developed a new Pringle maneuver (PM) with Penrose drain tube to sufficiently control blood loss during laparoscopic liver resection. This study was performed to determine the safety and outcome during laparoscopic left-sided hepatectomy performed using this new method.
We describe the technique and results of the left-sided liver resection with totally intracorporeal PM with Penrose drain tube. We performed 37 laparoscopic left-sided hepatic resections with (PM group) or without the Penrose PM (No PM group). We retrospectively compared the short-term operative outcome between the No PM group (n=12) and the PM group (n=25) during laparoscopic left-sided liver resection.
Median PM duration was 34.3 min. The median duration of the surgery using the totally intracorporeal PM with Penrose drain tube was 174 min, while the surgical duration required for resection without the PM was 156 min. The median volume of operative blood loss was lower in the PM group than in the No PM group (No PM group (341 ml) vs. PM group (165 ml)). There was no postoperative mortality and no open conversion.
The totally intracorporeal PM with Penrose drain tube for laparoscopic hepatectomy is safe, reproducible, and can facilitate liver dissection during left-sided liver resection.
The totally intracorporeal PM with Penrose drain tube for laparoscopic hepatectomy is safe, reproducible, and can facilitate liver dissection during left-sided liver resection.
Although systemic therapy is recommended in advanced hepatocellular carcinoma (HCC), treatment options for advanced HCC with portal vein tumor thrombosis (PVTT) are debatable. Recent studies have recommended other treatments, such as surgical resection (SR) and transarterial chemoembolization (TACE). Therefore, we performed a meta-analysis of hazard ratio (HR) for overall survival (OS) between the two modalities using previous reports in order to compare the two treatment options.
A systematic review was performed on previously reported data that compared the survival benefits of SR and TACE in patients with advanced HCC with PVTT. Thereafter, the meta-analysis was performed to determine the cumulative HR between the two different treatment groups. We used the HR and 95% CI directly from the original data, when available; however, if these data were unavailable, reconstruction was performed with the secondary data from the original Kaplan-Meier survival curve.
A total of seven studies were eligible; however, 2 were excluded from the meta-analysis. The remaining 5 studies that included 1422 patients (SR group=559, TACE group=863) were studied for the meta-analysis. The median OS was longer in the SR group (8.2-64 months in SR vs. 6.6-32 months in TACE), proving that SR offered survival benefits. Moreover, the HR for the OS in the TACE group was 1.64 (95% CI, 1.43-1.88) compared to SR group, depicting that TACE was a less favorable option compared to SR.
There is evidence that SR may be a better viable option for advanced HCC with PVTT.
There is evidence that SR may be a better viable option for advanced HCC with PVTT.Enhancing motivation is a crucial issue in pediatric obesity interventions, as behavioral changes related to food intake and physical exercise are difficult to carry out with an insufficient level of motivation. In the treatment setting, low motivation towards change may lead to early termination or inadequate treatment outcomes. This paper reviews widely-used models of motivation, including the transtheoretical model of change, self-determination theory, and motivational interviewing (MI). We introduce useful strategies based on each theoretical model to enhance motivation, such as an importance and confidence scale and a decisional balance technique. A review of recent MI interventions in children and adolescents is presented to discuss the efficacy of MI-based interventions and considerations for applying MI in pediatric obesity.Chronic diseases in postmenopausal women are caused by rapid changes in hormones and are accompanied by rapid changes in body composition (muscle, bone, and fat). In an aging society, the health of postmenopausal women is a social issue, and people's interest in ingesting high-quality protein is increasing in order to maintain a healthy body composition. This review aims to summarize the efficacy of soy foods and their impact on body composition. The soy protein and isoflavones contained in soy foods can improve muscle and bone density quality and reduce body weight. It is considered a breakthrough in preventing osteosarcopenia and obesity that may occur after menopause.