1
|
Yeung C, Al-Turki M, Baranchuk A. The Value of the Surface ECG for the Diagnosis and Management of Lyme Carditis: A Case Report. Curr Cardiol Rev 2021; 17:5-9. [PMID: 32164515 PMCID: PMC8142371 DOI: 10.2174/1573403x16666200312101751] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 01/13/2023] Open
Abstract
Lyme carditis (LC) is an early-disseminated manifestation of Lyme disease, most commonly presenting as a high-degree atrioventricular block (AVB). The degree of AVB can fluctuate rapidly within minutes, and progression to third-degree AVB is potentially fatal if not recognized and managed promptly. However, the AVB in LC is often transient and usually resolves with appropriate antibiotic therapy. LC should be on the differential diagnosis in young patients presenting with new high-degree AVB and factors that increase the index of suspicion for Lyme disease. The Suspicious Index in Lyme Carditis (SILC) score helps clinicians risk-stratify for LC. A systematic approach to the diagnosis and treatment of LC minimizes the unnecessary implantation of permanent pacemakers.
Collapse
Affiliation(s)
- Cynthia Yeung
- Department of Medicine, Queen's University, Kingston, ON K7L 2V7, Ontorio, Canada
| | - Mohammed Al-Turki
- Department of Medicine, Queen's University, Kingston, ON K7L 2V7, Ontorio, Canada
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston, ON K7L 2V7, Ontorio, Canada
| |
Collapse
|
2
|
Abstract
Entitlements for social security and occupational pensions present a major wealth component and play a central role for financial security. However, most individual-level data lacks information on pension wealth. By linking various data sources, this contribution estimates the present value of future pension entitlements in Switzerland for statutory pensions, occupational pensions and third pillar accounts and analyses the distribution of augmented wealth, which combines pension wealth and net worth. The CH-SILC survey from 2015 is used to estimate real assets, financial assets and pension wealth of retired individuals. The pension entitlements of non-retired individuals are simulated on the basis of their earning history from administrative records following the accrual method and assuming a real discount rate of 2%. When pension wealth is added to net worth, average wealth doubles, and the Gini-coefficient declines by 26%. The equalising effect is particularly strong for social security pensions. The wealth distribution differs strongly between the three pillars of the pension system; there are also strong differences between gender and age groups. In Switzerland, wealth accumulation continues after retirement age.
Collapse
Affiliation(s)
- Ursina Kuhn
- Swiss Centre of Expertise in the Social Sciences (FORS), C/o Université de Lausanne, Bâtiment Géopolis, 1015 Lausanne, Switzerland
| |
Collapse
|
3
|
Shaikh AR, Ali SA, Munir A, Shaikh AA. Single incision laparoscopic cholecystectomy with conventional instruments and ports: Initial experience at tertiary care public sector Hospital. Pak J Med Sci 2017; 33:654-658. [PMID: 28811789 PMCID: PMC5510121 DOI: 10.12669/pjms.333.12930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To find out safety and feasibility of single incision laparoscopic cholecystectomy (SLIC) using conventional instruments. Methods: This study was conducted at surgical department of LUMHS Jamshoro Pakistan from Jan: 2014 to Dec: 2015. All cases of symptomatic cholelithiasis that consented for laparoscopic surgery were included. The exclusion criteria were acute cholecystitis, acute gall stone pancreatitis, common bile duct stones and patients with co-morbid. A midline 3cm incision made supraumbilically and 10mm port placed. Two 5mm ports placed on either side of umbilicus slightly superior and laterally in or-der to triangulate. A 2/0 prolene suture placed through the infundibulum of the gall bladder to achieve retraction. The rest of the procedure is like standard 4 ports laparoscopic cholecystectomy. Results: Total no of cases were 50. The age ranged from 30-59 years (mean 35.20 years ±4.886.) There were 43(86%) females and 07(14%) males. The mean operating time was 80 minutes (range 50-120 ±16.020). Four (8%) cases were converted to standard four ports laparoscopic cholecystectomy due to bleeding and difficult dissection in Calot’s triangle. Minimal blood loss was observed during the procedure with no postoperative complications. The range of hospital stay was 1-2 days (mean 1.08 ±0.274). Conclusion: SILC is a safe and feasible procedure with conventional laparoscopic instruments without additional cost of single port and articulated instruments. The cosmetic results are excellent with minimal increase in the operating time.
Collapse
Affiliation(s)
- Abdul Razaque Shaikh
- Abdul Razaque Shaikh, Professor & Dean Surgery Department of Surgery, Liaquat University of Medical &Health Sciences, Jamshoro, Sindh, Pakistan
| | - Syed Asad Ali
- Syed Asad Ali Associate Professor, Department of Surgery, Liaquat University of Medical &Health Sciences, Jamshoro, Sindh, Pakistan
| | - Ambreen Munir
- Ambreen Munir Associate Professor, Department of Surgery, Liaquat University of Medical &Health Sciences, Jamshoro, Sindh, Pakistan
| | - Aijaz Ali Shaikh
- Aijaz Ali Shaikh Assistant Professor, Department of Surgery, Liaquat University of Medical &Health Sciences, Jamshoro, Sindh, Pakistan
| |
Collapse
|
4
|
Abaid RA, Zilberstein B. Two-Incision Laparoscopic Cholecystectomy: Reducing Scars in a Simple Way. J Laparoendosc Adv Surg Tech A 2017; 28:7-12. [PMID: 28514179 DOI: 10.1089/lap.2017.0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND About 20% of the population has cholelithiasis and this is the main abdominal cause of hospitalization in developed countries. Considering that only in the United States about 700,000 cholecystectomies are done each year, it is possible to estimate the importance of the problem for public health. OBJECTIVE To describe a two-incision laparoscopic cholecystectomy (TILC) technique using only conventional material, without increasing complications or operative time. MATERIALS AND METHODS A consecutive and prospective case series compared to another historical operated by conventional laparoscopic cholecystectomy (LC). The TILC was performed with three trocars in two incisions, two trocars in umbilical incision, and one in epigastrium. RESULTS A total of 72 patients were operated on by the same surgeon (36 in each group). There were no significant differences between groups for gender, mean age, body mass index, or length of hospital stay. The procedures were classified by the surgeon according to surgical difficulty and 58.3% (n = 42) were considered low grade, 9.7% (n = 7) difficult, and the other were intermediaries, with no difference between the series (P < .05). There were minor complications in 6.94% (n = 5) procedures. There were no differences between mean operative time (P = .989), which was 49 (95% confidence interval [CI] 42-56) minutes in LC and 40 (95% CI 35-44) min in TILC. There was no need for additional trocars in any case or for conversion to open surgery. CONCLUSIONS TILC is feasible, safe, and with good aesthetic result, using the same instruments of LC, without increasing operative time.
Collapse
Affiliation(s)
- Rafael Antoniazzi Abaid
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine , Sao Paulo, Brazil
| | - Bruno Zilberstein
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine , Sao Paulo, Brazil
| |
Collapse
|
5
|
Rizzuto A, Serra R, Mignogna C, Palaia I, Zittel FU, Sacco R. Single incision laparoscopic cholecystectomy in geriatric patients. Int J Surg 2016; 35:83-87. [PMID: 27663087 DOI: 10.1016/j.ijsu.2016.09.075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/31/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Laparoscopy is a surgical approach recommended for the treatment of gall bladder disease. It is recommended also in geriatric patients. Recently Single Incision Laparoscopic Cholecystectomy (SILC) has been proposed to minimize surgical trauma, recovery and hospitalization time. However, the results and advantages of SILC in the geriatric population have received minimal attention. This case series review is focused on the results of SILC in the geriatric population. METHODS The records of 355 patients who had undergone SILC were reviewed. This report identifies, in the entire cohort, 40 patients aged 65 years or older at the time of surgery who will be the object of this study (geriatric series). Clinical outcomes and results were evaluated. Moreover, post-operative pain of the geriatric cohort was compared to that of the entire series. RESULTS SILC was successfully completed for 347 out of 355 patients of the entire series, with no mortality reported. In total SILC was converted to standard laparoscopy in 10 patients (2.2%) but never to open procedure. No significant difference was found between the total cohort and the geriatric series in terms of median time of operation (61.20 min vs 68.38 min). Post-operative pain was significantly lower in geriatric patients. CONCLUSION SILC is an effective and safe procedure for the treatment of gallbladder disease of elderly, also in terms of post-operative pain and it represents an alternative to the standard laparoscopic approach on a routine basis.
Collapse
Affiliation(s)
- Antonia Rizzuto
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy.
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | - Chiara Mignogna
- Department of Health Science, University Magna Græcia of Catanzaro, Italy
| | - Ilaria Palaia
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| | | | - Rosario Sacco
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Italy
| |
Collapse
|
6
|
Wani M, Shahdhar M, Sheikh U. Transumbilical SILC Using Conventional Laparoscopic Instruments-Initial Experience in a Resource-Limited Setting. Indian J Surg 2016; 77:624-7. [PMID: 26730076 DOI: 10.1007/s12262-013-0946-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 06/28/2013] [Indexed: 12/01/2022] Open
Abstract
In the era of minimal access, single-incision laparoscopic surgery is gaining popularity. Expensive ports, disposable hand instruments and flexible endoscopes have been utilised, but they increase the cost of operation. We report our initial experience of two-trocar single-incision laparoscopic cholecystectomy (SILC) in 70 patients using conventional instruments that can be adapted as a novel technique in achieving minimal trauma and aesthetic results in resource-limited hospitals. Between September 2011 and September 2012, 70 consecutive patients underwent an attempted SILC in a single centre. The mean age of the patients was 42 years (range 18-65 years). There were 12 males and 58 females with a male-to-female ratio of 1:4.8. Transumbilical incision was used to access the abdomen, and two 10-mm ports/trocars were placed through the single incision side by side, maintaining a facial bridge of 5-8 mm in between. Gall bladder was manipulated through two strategically placed traction sutures to expose the Callot's triangle. Mean operation time in our series was 42.12 min (range 22-90 min). There was no need of additional sutures. Bleeding was minimal in nearly all cases. The mean hospital stay was 1.06 days (range 1-4 days). The post-operative analgesic requirement was one dose in 60.4 % patients. Additional port was required in two of our patients. Two patients needed conversion to open surgery. There was no major complication or mortality in our series. This technique of two-trocar SILC using conventional instruments can be adapted as a less invasive surgical procedure in resource-limited hospitals in selected group of patients. Cosmetic result, reduced pain, short hospital stay and the degree of satisfaction appear to be significant with this technique.
Collapse
Affiliation(s)
- Mumtaz Wani
- Department of Surgery, SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir India
| | - Muddassir Shahdhar
- Department of Surgery, SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir India
| | - Umar Sheikh
- Department of Surgery, SMHS Hospital Srinagar, Srinagar, Jammu and Kashmir India
| |
Collapse
|
7
|
Abdelrahman AM, Bingener J, Yu D, Lowndes BR, Mohamed A, McConico AL, Hallbeck MS. Impact of single-incision laparoscopic cholecystectomy ( SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload: a randomized controlled trial. Surg Endosc 2015; 30:1205-11. [PMID: 26194249 PMCID: PMC4721929 DOI: 10.1007/s00464-015-4332-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/09/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Single-incision laparoscopic cholecystectomy (SILC) may lead to higher patient satisfaction; however, SILC may expose the surgeon to increased workload. The goal of this study was to compare surgeon stress and workload between SILC and conventional laparoscopic cholecystectomy (CLC). METHODS During a double-blind randomized controlled trial comparing patient outcomes for SILC versus CLC (NCT0148943), surgeon workload was assessed by four measures: surgery task load index questionnaire (Surg-TLX), maximum heart rate, salivary cortisol level, and instruments usability survey. The maximum heart rate and salivary cortisol levels were sampled from the surgeon before the random assignment of the surgical procedure, intraoperatively after the cystic duct was clipped, and at skin closure. After each procedure, the surgeon completed the Surg-TLX and an instrument usability survey. Student's t tests, Wilcoxon rank sum test, and Kruskal-Wallis nonparametric ANOVAs on the dependent variables by the technique (SILC vs. CLC) were performed with α = 0.05. RESULTS Twenty-three SILC and 25 CLC procedures were included in the intent-to-treat analysis. No significant differences were observed between SILC and CLC for patient demographics and procedure duration. SILC had significantly higher post-surgery surgeon maximum heart rates than CLC (p < 0.05). SILC also had significantly higher mean change in the maximum heart rate between during and post-procedure (p < 0.05) than CLC. Salivary cortisol level was significantly higher during SILC than CLC (p < 0.01). Awkward manipulation of the instruments and limited fine motions were reported significantly more frequently with SILC than CLC (p < 0.01). In the surgeon-reported Surg-TLX, subscale of physical demand was significantly more demanding for SILC than CLC (p < 0.05). CONCLUSIONS Surgeon heart rate, salivary cortisol level, instrument usability, and Surg-TLX ratings indicate that SILC is significantly more stressful and physically demanding than the CLC. Surgeon stress and workload may impact patients' outcomes; thus, ergonomic improvement on SILC is necessary.
Collapse
Affiliation(s)
- Amro M Abdelrahman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Denny Yu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bethany R Lowndes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amani Mohamed
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| |
Collapse
|
8
|
Downes RO, McFarlane M, Diggiss C, Iferenta J. Single incision cholecystectomy using a clipless technique with LigaSure in a resource limited environment: The Bahamas experience. Int J Surg Case Rep 2015; 11:104-9. [PMID: 25958050 DOI: 10.1016/j.ijscr.2015.04.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/23/2015] [Accepted: 04/23/2015] [Indexed: 01/24/2023] Open
Abstract
SILC in the third world. The addition of LigaSure to enhance procedure. Look at feasibility. Look at cost different.
Background Scarless/single-incision laparoscopic cholecystectomy (SILC) is a new procedure. It affords a superior cosmetic outcome when compared to conventional laparoscopic cholecystectomy. We examine the application of this technique using LigaSure via a clipless method. The present study looks at the experience of a single surgeon using this method with initial evaluation of the safety, feasibility, affordability, and benefits of this procedure. Methods Twenty-eight patients underwent transumbilical SILC at Doctors Hospital from January to December, 2014. The cohort included both emergency and elective patients. There was no difference in the preoperative work-up as indicated. To perform the operation, a 2–2.5-cm linear incision was made through the umbilicus and the single port platform utilized. A 10 mm 30-degree laparoscope, a 5 mm LigaSure and straight instruments were used to perform the laparoscopic cholecystectomy procedure. Results All patients except two were operated on successfully. Conversion was considered the placement of an additional epigastric/Right upper quadrant (RUQ) port. The conversion rate to standard LC was 7%. No patient was converted to open cholecystectomy. In the 28 successfully completed patients, the median duration of the operation was 38.5 min and estimated operative blood loss was 24 ml. Patients were commenced on liquid diet immediately on being fully conscious and after return to the ward with an estimated time of 6 h. The mean postoperative hospital stay was 1.4 days. Follow-up visits were conducted for all patients at 2-weeks intervals and continued for 6 weeks after surgery where possible. Two patients developed wound infections. All patients were satisfied with the good cosmetic effect of the surgery. The total satisfaction rate was 100%. Conclusions SILC is a safe and feasible technique for operating with scarless outcomes and reducing perioperative discomfort at the same time. The GelPOINTTM is a safe and feasible platform to be used. The procedure can be accomplished using regular instruments and laparoscope. Curved instruments and a bariatric length laparoscope may make the procedure easier and result in greater time saving. The addition of LigaSure™ decreases the complexity of the operation, decreases operative time and blood loss. The technique is economical in a resource-limited environment.
Collapse
|
9
|
Borle FR, Mehra B, Ranjan Singh A. Comparison of Cosmetic Outcome Between Single-Incision Laparoscopic Cholecystectomy and Conventional Laparoscopic Cholecystectomy in Rural Indian Population: A Randomized Clinical Trial. Indian J Surg 2015; 77:877-80. [PMID: 27011474 DOI: 10.1007/s12262-014-1044-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 02/10/2014] [Indexed: 12/26/2022] Open
Abstract
Persistent efforts are being made to reduce operative trauma and morbidity and to improve cosmesis following laparoscopic cholecystectomy. The trend is to reduce the number of incisions, and thus single-incision laparoscopic cholecystectomy (SILC) and natural orifice endoscopic surgery (NOTES) are becoming popular. There is a paucity of studies pertaining to cosmetic outcome after SILC and conventional laparoscopic cholecystectomy in rural Indian population. In the present study, the cosmetic outcome of SILC versus conventional laparoscopic cholecystectomy (CLC) in rural Indian population was evaluated. Sixty patients with gallstone disease were randomly assigned to two groups. In group A (n = 30), CLC was performed, while group B (n = 30) was subjected to SILC. The cosmetic outcome was evaluated using a body image questionnaire on the 7th and 30th postoperative days. On the 7th postoperative day, the body image score for SILC was 6.23 ± 0.89 and for CLC, 8.26 ± 1.08 (p < 0.0001), while the cosmetic score for SILC was 19.56 ± 1.07 and for CLC, 15 ± 1.20 (p < 0.0001). On the 30th postoperative day, the body image score for SILC was 5.50 ± 0.68 and for CLC, 8 ± 1.31 (p < 0.0001), while the cosmetic score for SILC was 21.13 ± 0.57 and for CLC, 15.63 ± 1.06 (p < 0.0001), which favored SILC over CLC. The patient perception and acceptance of SILC was better than that of CLC in terms of cosmetic outcome.
Collapse
|
10
|
Borle FR, Mehra BK, Jain S. Evaluation of pain scores after single-incision and conventional laparoscopic cholecystectomy: a randomized control trial in a rural Indian population. Asian J Endosc Surg 2014; 7:38-42. [PMID: 24450342 DOI: 10.1111/ases.12071] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/17/2013] [Accepted: 09/29/2013] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Single-incision laparoscopic cholecystectomy (SILC) is considered to be less invasive and have less morbidity than conventional laparoscopic cholecystectomy (CLC). However, there is a relative paucity of data regarding postoperative pain scores in rural Indian populations following SILC. Also, data pertaining to the applicability of SILC in rural Indian population are scant. METHODS In the present randomized control trial, pain scores after SILC and CLC were evaluated. Sixty patients with gallstone disease were randomly assigned to one of two groups with 30 patients each: the CLC group and the SILC group. Postoperative pain scores were recorded on the visual analog scale at 8 hours, 24 hours and 7 days after surgery. RESULTS The patients were comparable with respect to age, sex and BMI. Operative time was longer for the SILC group (47.73 ± 5.57 min vs 69.53 ± 8.96 min; P < 0.0001).The pain scores were similar in both groups at 8 hours (3.61 ± 0.41 vs 3.50 ± 0.51; P = 0.36) and 24 hours (3.30 ± 0.59 vs 3.20 ± 0.40; P = 0.44) postoperatively. On day 7, the SILC group had lower pain scores than the CLC group (2.56 ± 0.56 vs 1.16 ± 0.37; P < 0.01). CONCLUSION There was no distinct advantage to SILC with regard to immediate postoperative pain. Pain was significantly less (P < 0.01) in the SILC group on postoperative day 7.
Collapse
Affiliation(s)
- Firoz R Borle
- Department of General Surgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, India
| | | | | |
Collapse
|