- Randomized controlled trial of probiotic use for post-colonoscopy symptoms. [Journal Article]
- AJANZ J Surg 2019; 89(3):234-238
- CONCLUSIONS: There may be a role for the use of probiotics in the subgroup of patients with preexisting symptoms; however, routine use of probiotics to ameliorate post-procedural symptoms of carbon dioxide insufflation colonoscopy cannot be advocated.
- Additional Thirty Seconds Observation with Linked Color Imaging Improves Detection of Missed Polyps in the Right-Sided Colon. [Journal Article]
- GRGastroenterol Res Pract 2018; 2018:5059834
- CONCLUSIONS: The 30 seconds additional observation with LCI improved the detection of adenoma and SSA/P in the right-sided colon.
- Role of Routine Subhepatic Abdominal Drain Placement following Uncomplicated Laparoscopic Cholecystectomy: A Prospective Randomised Study. [Journal Article]
- JCJ Clin Diagn Res 2016; 10(12):PC03-PC05
- CONCLUSIONS: Use of drains in uncomplicated laparoscopic cholecystectomy is not advantageous; its role in reducing post-operative nausea/vomiting is insignificant. It increases post-operative shoulder tip pain and hospital stay. Therefore, routine use of drains cannot be justified as it increases morbidity without significant advantage.
- The Association of Valsalva Status With Smoking and Its Impact on Ossiculoplasty Outcomes and Complications. [Journal Article]
- ONOtol Neurotol 2016; 37(7):914-8
- CONCLUSIONS: A patient's inability to perform the Valsalva maneuver is not significantly associated with smoking; however, negative Valsalva status is associated with an increased incidence of significant complications after ossiculoplasty.
- Colonoscopy Comfort: An Evidence-Based Practice Project. [Journal Article]
- GNGastroenterol Nurs 2016 May-Jun; 39(3):212-5
- Decreased discomfort after colonoscopy is a high priority for patients. Typically, air is used to insufflate the bowel during colonoscopy, but emerging literature shows that carbon dioxide insufflati…
Decreased discomfort after colonoscopy is a high priority for patients. Typically, air is used to insufflate the bowel during colonoscopy, but emerging literature shows that carbon dioxide insufflation decreases postoperative discomfort and flatus. An evidence-based practice project was developed and implemented by a surgical department at a community hospital. The Director of Surgical Services brought the evidence to the staff, secured agreement from a physician champion, and the new process was quickly adopted. Patients experienced less discomfort and flatus postprocedure with carbon dioxide insufflation, and were able to be discharged expediently. These patient outcomes validated the literature and confirmed the success of the practice change.
- Therapeutic Pneumoperitoneum: Relevant or Obsolete in 2015? [Journal Article]
- TCThorac Cardiovasc Surg 2017; 65(5):375-381
- Background Therapeutic pneumoperitoneum (TP) is one alternative to manage pleural space problems. We describe our technique and experience. Materials and Methods Medical records of all patients who u…
Background Therapeutic pneumoperitoneum (TP) is one alternative to manage pleural space problems. We describe our technique and experience. Materials and Methods Medical records of all patients who underwent TP from January 1, 2007, to January 1, 2015, were reviewed after Institutional Review Board approval. We report indication, preprocedure pulmonary function tests, volume of insufflated air, time to chest tube removal, and complications. We place a red rubber catheter into the peritoneal space through the diaphragm or a small abdominal incision, insufflate with room air, record volume (liters), intraperitoneal pressure (goal 9-10 mm Hg), and monitor vital signs, airway pressures, and urine output. Results We performed TP in 32 patients. Follow-up was available for 31 patients. Indications were prevention of pleural space problems in bilobectomy patients (n = 11), following decortication for empyema (n = 11), prevention of prolonged air leak (n = 3), prevention of postresection space (n = 4), and spontaneous chylothorax (n = 2). TP was done postoperatively in three patients. Median air volume used was 3.5 L (3-6 L). Time to chest tube removal overall was 7.8 days (3-20 days) and to discharge 10.2 days (4-32 days). No patient developed respiratory failure, renal failure, or required evacuation of TP. Conclusion TP is a simple, safe, and effective technique to manage pleural space problems. Proper patient selection and meticulous technique are imperative for the successful clinical application of TP. We believe that TP is an underutilized tool for the management of pleural space problems and merits wider application in thoracic surgical practice.
- Capsule endoscopy: The road ahead. [Review]
- WJWorld J Gastroenterol 2016 Jan 07; 22(1):369-78
- Since its introduction into clinical practice 15 years ago, capsule endoscopy (CE) has become the first-line investigation procedure in some small bowel pathologies, and more recently, dedicated esop…
Since its introduction into clinical practice 15 years ago, capsule endoscopy (CE) has become the first-line investigation procedure in some small bowel pathologies, and more recently, dedicated esophageal and colon CE have expanded the fields of application to include the upper and lower gastrointestinal disorders. During this time, CE has become increasingly popular among gastroenterologists, with more than 2 million capsule examinations performed worldwide, and nearly 3000 PubMed-listed studies on its different aspects published. This huge interest in CE may be explained by its non-invasive nature, patient comfort, safety, and access to anatomical regions unattainable via conventional endoscopy. However, CE has several limitations which impede its wider clinical applications, including the lack of therapeutic capabilities, inability to obtain biopsies and control its locomotion. Several research groups are currently working to overcome these limitations, while novel devices able to control capsule movement, obtain high quality images, insufflate the gut lumen, perform chromoendoscopy, biopsy of suspect lesions, or even deliver targeted drugs directly to specific sites are under development. Overlooking current limitations, especially as some of them have already been successfully surmounted, and based on the tremendous progress in technology, it is expected that, by the end of next 15 years, CE able to perform both diagnostic and therapeutic procedures will remain the major form of digestive endoscopy. This review summarizes the literature that prognosticates about the future developments of CE.
- Single Port Laparoscopic Gastrostomy: description of a technique and initial experience. [Journal Article]
- AGActa Gastroenterol Latinoam 2015; 45(4):280-7
- CONCLUSIONS: The diametercreated is the same as the one performed with an open technique, but in this case, with a minimally invasive approach, that allows us to start feeding the patient with a high quality of feeding, because of the wider lumen.
- A new technique for avoiding barotrauma-induced complications in apnea testing for brain death. [Journal Article]
- JCJ Clin Neurosci 2015; 22(6):1021-4
- Prompted by our experience with complications occurring with apnea testing (AT), we discuss complications reported in the literature. AT is an integral part of brain death assessment. Many complicati…
Prompted by our experience with complications occurring with apnea testing (AT), we discuss complications reported in the literature. AT is an integral part of brain death assessment. Many complications of AT have been described, including hypoxemia, arterial hypotension, tension pneumothorax and cardiac arrest. We conclude that a commonly used technique in conducting AT can create auto-positive end expiratory pressure (PEEP) and contributes to many complications. The mechanism of occult auto-PEEP in AT is discussed. Intensive care unit patients may have a compensated and asymptomatic relative hypovolemia that can be decompensated by a small amount of auto-PEEP produced by air trapping during insufflating oxygen (O2) through a 7.0 endotracheal tube (ETT). It could then lead to decreased preload, decreased stroke volume, decreased cardiac output and thus, to hypotension and a compensatory tachycardia. The placement of the standard O2 tubing (6mm outside diameter [OD]) inside the 7.0 ETT (7mm inside diameter [ID]) greatly decreased the ETT lumen (73%). We changed our practice to instead use readily available small pressure tubing to insufflate O2 for AT to avoid excessive reduction in the ETT lumen. The change from standard O2 tubing (6mm OD) to pressure tubing (3mm OD) will greatly decrease the reduction in cross-sectional area of 7.0 ETT lumen from 73 to 18% and avoid potential complications of air trapping, auto-PEEP and barotrauma. We have successfully used this new simple technique with readily available equipment to eliminate auto-PEEP in AT while preserving oxygenation.
New Search Next
- Pneumatic colon injury following high pressure blow gun dust cleaner spray to the perineum. [Journal Article]
- IJInt J Surg Case Rep 2015; 6C:218-21
- CONCLUSIONS: Air from pneumatic tools produces column of air at pressure of 3.5-8.8kg/cm(2) and pressure greater than the resting anal pressure of 0.109kg/cm(2) force air to enter the colon when the perineum is sprayed. Different degree of colon injury results when airflow is greater than 1.46L/m, and/or intraluminal pressure greater than 0.109kg/cm(2). In most children, initial anxiety to tell the truth result in difficulty to obtain good history.Spraying of the perianal with excessive pneumatic force of greater than the resting anal pressure and high air flow rate causes multiple site colon injury and tension pneumoperitoneum due to colon perforation. Parent should be caution in children playing with high pressure pneumatic tool, and the importance of history is emphases for early correct diagnosis.