Current Issue : April - June Volume : 2015 Issue Number : 2 Articles : 9 Articles
Gastric gastrointestinal stromal tumors (GISTs) are the most common\nsarcoma of the gastrointestinal tract, and surgical resection is\nthe primary treatment of early disease. Limited data exist concerning\nlaparoscopic resections of these neoplasms. This systematic review\nwas designed to evaluate the literature comparing laparoscopic and\nopen surgical resection of gastric GISTs and to assess the effectiveness\nand safety of this minimally invasive technique. We performed\na systematic search of MEDLINE, the Cochrane Library, PubMed,\nEmbase, Scopus, Web of Science, Google Scholar, the clinical trials\ndatabase and ProQuest Dissertations and Theses as well as the\npast 3 years of conference abstracts from the Society of American\nGastrointestinal and Endoscopic Surgeons Annual Meetings. Studies\ncomparing the open and the laparoscopic approaches to the resection\nof gastric GISTs were included in this systematic review. Two reviewers\nindependently performed the screen of titles and abstracts, the full\nmanuscript review, the data extraction and the risk of bias assessment.\nA quantitative analysis was performed. Of the 189 studies identi�¿ed,\nseven studies were included. The laparoscopic approach was associated\nwith a signi�¿ cantly lower length of hospital stay (3.82 days (2.14\n- 5.49)). There was no observed difference in operative time, adverse\nevents, estimated blood loss, overall survival and recurrence rates.\nThis study supports that laparoscopic resection is safe and effective\nfor gastric GISTs and is associated with a signi�¿ cantly lower length of\nhospital stay. Further trials are needed for cost analysis and to rigorously\nassess oncologic outcomes....
Background\n\nSuperior canal dehiscence (SCD) is a benign condition in which a surgical treatment may be considered depending on the patients� tolerance of their symptoms. In this study, we aim to identify driving factors behind the patients� choice of a surgical management over watchful waiting.\n\nMethods\n\nSixty-two patients with cochlear and/or vestibular symptoms and a temporal bone high-resolution CT (HRCT) scan showing SCD were included in the study. All patients have been offered either surgical management or watchful waiting.\n\nResults\n\nOf these, 28 elected surgery and 34 declined it. The operated group showed more cochlear (6.6 vs. 2.4) symptoms than the non-operated group (P < 0.001) except for hypoacousis, but no significant difference (P = 0.059) was found for the number of vestibular symptoms between both groups (3.4 vs. 1.1). Footstep and eating hyperacousis were both present in 57.1% of operated vs. 3% of non-operated patients (P < 0.001). Oscillopsia with effort and with walking was found in 50% and 35.7% of operated patients, respectively, but none in the non-operated group (P < 0.001). Hearing tuning fork at malleolus and Valsalva and pneumatic speculum induced vertigo showed a statistically significant difference between the two groups (P = 0.003, P < 0.001, P = 0.010 respectively). Cervical vestibular-evoked myogenic potential (cVEMP) thresholds, air and bone conduction thresholds, and mean air-bone gap (ABG) were similar in the two populations (P > 0.05). The average dehiscence size was 4.7 mm (2.0 - 8.0 mm) and 3.8 mm (1.3 - 7.7 mm) in the operated and non-operated patients, respectively (P = 0.421).\n\nConclusions\n\nThe natures of cochleovestibular signs and symptoms were shown to be key factors in patients� choice of a surgical management whereas paraclinical tests seem to be less significant in the patients� decision for a surgical treatment....
Background\n\nAlthough statin therapy significantly reduces cardiovascular morbidity and mortality, atherosclerotic plaque progresses in some patients taking statins. This study investigated the factors associated with onset of acute coronary syndrome (ACS) early after the initiation of statin therapy.\n\nMethods\n\nConsecutive patients taking statins who presented with ACS (n = 64) were divided into < 1-year and > 1-year groups based on the duration of statin therapy. Patient characteristics, coronary risk factors, lesion locations, and percutaneous intervention procedures were compared between groups.\n\nResults\n\nThe < 1-year group was significantly younger (57.6 �± 11.9 years vs. 76.6 �± 9.1 years, P < 0.01), had significantly higher body mass index (27.22 �± 4.20 kg/m2 vs. 24.60 �± 4.65 kg/m2, P < 0.05), higher proportion of males (94% vs. 70%, P < 0.05), higher proportion of current smokers (61% vs. 17%, P < 0.01), and lower proportions taking aspirin and calcium antagonists (both 17% vs. 57%, P < 0.05) than the > 1-year group. In the < 1-year group, there were significant correlations between the low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels (r = 0.649, P = 0.004) and between the TG and hemoglobin (Hb)A1c levels (r = 0.552, P = 0.018), but these correlations were not observed a year before admission. TG level was the only parameter associated with LDL-C and HbA1c levels.\n\nConclusions\n\nA linear correlation between the LDL-C and TG levels, obesity, older age, male sex, and smoking may be associated with increased risk of onset of ACS early after the initiation of statin therapy. Prospective cohort studies are needed to further explore these interactions....
BACKGROUND:\nThe aim of the current study was to test the effectiveness of a physical activity and exercise-based program in a clinical context to reduce cardiovascular risk factors in children and adolescents.\nMETHODS:\nA randomized clinical trial was conducted in a pediatric preventive outpatient clinic. Intervention was 14 weeks of exercise for the intervention group or general health advice for the control group. The primary and the secondary outcomes were reduction of cardiovascular risk factors and the feasibility and the effectiveness of clinical advice plan to practice physical exercises at home.\nRESULTS:\nA total of 134 children were screened; 26 met eligibility criteria. Of these, 10 were allocated in the exercise intervention group and nine were included in the control group until the end of the intervention. Those patients who discontinued the intervention had the lowest scores of z-BMI (P = 0.033) and subscapular skin fold (P = 0.048). After 14 weeks of intervention, no statistical differences were found between the groups. High-density lipoprotein cholesterol (HDL-C) was higher in the exercise group, with a mild tendency to be significant (P = 0.066). Patients who adhere to treatment had diastolic blood pressure decreased from baseline to the end of the follow-up period in the control group (P = 0.013). Regardless of this result, the other comparisons within the group were not statistically different between T0 and T14.\nCONCLUSION:\nA low-cost physical activity advice intervention presented many barriers for implementation in routine clinical care, limiting its feasibility and evaluation of effectiveness to reduce cardiovascular risk factors....
Background: Emergency room nurses were trained to provide a short-term psychological intervention in physically injured patients with Impact of Event Scale (IES) scores > 20. The aims were to study the effects of the psychological intervention relative to usual care (UC).\n\nMethods: In a randomized controlled trial, psychological distress, daily functioning and the personality traits optimism/pessimism were compared with patients who received the UC. The interventions were provided 1 - 3 months after discharge.\n\nResults: The IES scores were significantly reduced in both groups at 3 months (intervention: 41.1 - 28.6, P < 0.001 vs. UC: 35.4 - 26.2, P < 0.001), but not significantly different between groups. Baseline IES score was a significant predictor of IES scores at 3 (? = 0.4, P < 0.05) and 12 months (? = 0.3, P < 0.05), whereas overall daily functioning at 3 months predicted IES scores at 12 months (? = -0.5, P < 0.001). Patients receiving intervention became significantly more optimistic during the year, and had an increase in overall daily functioning from 3 to 12 months (P < 0.001). Patients declining intervention were more pessimistic and had lower daily functioning. Patients who talked with nurses with more training in psychological processing had a larger reduction in IES symptoms at 3 months (? = -0.3, P = 0.081).\n\nConclusion: The nurse-led intervention had a significant effect on optimism and overall daily functioning. Nurses may become a low-cost option to perform short-term psychological interventions with physically injured hospitalized patients....
Objective of this study was to find out pregnancy outcome of open field tuboplasty (naked eye surgery). Retrospective study of 50 tubectomy patients was done who underwent tubal recanalization by open field surgery from February 2006 to December 2013 in the department of obstetrics and gynecology at R. D. Gardi Medical College Ujjain (M.P). 90% cases were of 20 to 30 years. Death of male or both children and remarriage were indication for tuboplasty. Pregnancy rate was 75% within 6 months after surgery. 15 cases reached to term pregnancy and delivered. 5 cases aborted. Ectopic pregnancy was noted in 12% of cases. Tubal regret was mostly sought due to loss of male child or both children in 2 children family norm or in case of remarriage. Better result can be found in under bed of previous laparoscopic surgery than in conventional tube ligation (pomoroy method). The optimum pregnancies were seen within first six months of isthmo – isthmic tubal anastomosis. Open field method was quite effective procedural choice in deprived and developing circumstances....
Background. Primary goal of this randomized, double-blind, placebo-controlled crossover study of Renadyl in end-stage renal\ndisease patients was to assess the safety and efficacy of Renadyl measured through improvement in quality of life or reduction in\nlevels of known uremic toxins. Secondary goal was to investigate the effects on several biomarkers of inflammation and oxidative\nstress. Methods. Two 2-month treatment periods separated by 2-month washout and crossover, with physical examinations, venous\nblood testing, and quality of life questionnaires completed at each visit. Datawere analyzed with SAS V9.2. Results. 22 subjects (79%)\ncompleted the study. Observed trends were as follows (none reaching statistical significance): decline inWBC count (?0.51Ã?â??109/L,\nP = 0.057) and reductions in levels of C-reactive protein (?8.61mg/L, P = 0.071) and total indoxyl glucuronide (?0.11mg%, P =\n0.058). No statistically significant changes were observed in other uremic toxin levels or measures of QOL. Conclusions. Renadyl\nappeared to be safe to administer to ESRD patients on hemodialysis. Stability in QOL assessment is an encouraging result for a\npatient cohort in such advanced stage of kidney disease. Efficacy could not be confirmed definitively, primarily due to small sample\nsize and low statistical powerââ?¬â?further studies are warranted....
BACKGROUND:\nEvidence now suggests the role of neural effect on bone mass control. The effect of small vessel disease of the brain on osteoporosis has not been studied. The aim of this study was to investigate the association of white matter disease (WMD) of the brain with osteoporosis in the elderly.\nMETHODS:\nIn this retrospective cross-sectional study, 780 consecutive patient charts between 2010 and 2011 were reviewed in the Senior's Outpatient Clinic at the University of Alberta Hospital. Subjects with brain computerized tomography (CT) were included in the study. Subjects with incomplete information, intracranial hemorrhage, acute stroke, cerebral edema, and/or normal pressure hydrocephalus on the CT were excluded. WMD was quantified on CT using Wahlund's scoring protocol. Osteoporosis information was obtained from the chart, which has been diagnosed based on bone mineral density (BMD) information. Logistic regression analysis was done to determine the association of WMD severity with osteoporosis after controlling for confounding vascular risk factors.\nRESULTS:\nOf the 505 subjects who were included in the study, 188 (37%) had osteoporosis and 171 (91%) of these osteoporotic subjects were females. The mean age was 79.8 �± 7.04 years. The prevalence of WMD in osteoporosis subjects was 73%. In the unadjusted logistic regression analysis, there was a significant association between WMD severity and osteoporosis (odds ratio (OR): 1.10; 95% confidence interval (CI): 1.05 - 1.14; P < 0.001) and the significance remained in the adjusted model, after correcting for age, sex and all vascular risk factors (OR: 1.11; 95% CI: 1.05 - 1.18; P < 0.001).\nCONCLUSION:\nWMD severity of the brain was associated with osteoporosis in the elderly....
BACKGROUND:\nIn Japan, dipeptidyl peptidase 4 (DPP4) inhibitors have become standard therapeutic agents for type 2 diabetes, and numbers of patients receiving insulin therapy combined with DPP4 inhibitors, which is a highly effective regimen, are increasing.\nMETHODS:\nIn this study, we evaluated the efficacy of vildagliptin administered at the dose of 100 mg twice daily in 57 patients with type 2 diabetes already receiving insulin treatment.\nRESULTS:\nThe 36 patients who simply received add-on vildagliptin showed a 0.6% decrease in HbA1c levels, despite a marked insulin dose reduction, mainly bolus insulin, of approximately 8.3 units. In addition, body mass index exhibited a significant negative correlation with the efficacy of vildagliptin, i.e., ?HbA1c. On the other hand, the 21 patients switched from 50 mg of sitagliptin to vildagliptin showed HbA1c decreases approaching 0.7%.\nCONCLUSION:\nTaking into consideration that twice-daily oral vildagliptin has already been reported to be advantageous in reducing postprandial hyperglycemia, this drug was suggested to be more effective in reducing HbA1c than sitagliptin under conditions in which it is used as a supplement to basal insulin, as in this study....
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