Context: Condyloma acuminatum is a common morbidity caused by human papillomavirus infection. Objective: To compare the recurrence rate after surgical excision with or without podophyllin cautery. Design, Setting, Par...Context: Condyloma acuminatum is a common morbidity caused by human papillomavirus infection. Objective: To compare the recurrence rate after surgical excision with or without podophyllin cautery. Design, Setting, Participants: Sixty women were enrolled in a study that was conducted in Cairo from Jan-2017 to Mar-2018. Interventions: All women received the same preparations. After randomization;in the study group (N = 30), podophyllin cautery was added to surgical removal in the follow-up period. In the control group (N = 30), only surgical removal was used. Main Outcome Measure: The main outcome measure was the estimation of the recurrence of the lesion during the follow-up period. The secondary outcome measures were the incidence of adverse events. Results: Both groups were comparable (p-value > 0.05) with regard to the age and BMI. Recurrence was significantly lower (P = 0.001) in the study group than the control group. In the study group, five cases (17.2%) have recurrence whereas, in the control group, 18 (60.0%) had suffered recurrence. The ARR was 42.8% (CI 95%: 18% - 60.9%) with RR of 0.29 (CI 95%: 0.12% - 0.67%) and NNT2 (CI 95%: 6% - 2%). During the follow-up period, 19 cases (65.5%) of the study group experienced pain versus only eight cases (26.7%) in the control group (p = 0.003). However, the development of scars was less in the study group 7 (24.1%) than in the control group 19 (63.3%), (p = 0.002). Conclusion: Podophyllin cautery, when added to surgical removal, is effective in decreasing the incidence recurrence in cases with condylomata acuminata.展开更多
To evaluate the efficacy of a newly developed dilator for endoscopic ultrasound (EUS)-guided drainage (ES Dilator). METHODSFourteen consecutive patients who had undergone EUS-guided choledochoduodenostomy (EUS-CDS) wi...To evaluate the efficacy of a newly developed dilator for endoscopic ultrasound (EUS)-guided drainage (ES Dilator). METHODSFourteen consecutive patients who had undergone EUS-guided choledochoduodenostomy (EUS-CDS) with the ES Dilator were identified from a prospectively maintained database and enrolled in the study group. Fourteen other patients who had undergone EUS-CDS without the dilator just prior to its introduction were analyzed as the control group. A historical cohort study was carried out comparing the two groups. The main outcome measurement was the procedure time. The technical success rate and early AE rate were also compared between the two groups. RESULTSThere were no significant differences in age, sex and etiology of biliary obstruction. The utilization rate of a plastic stent was higher in the control group (36% vs 0%). The technical success rate was 100% in both groups. The mean procedure time was significantly shorter in the study group than in the control group (27 ± 7 min vs 44 ± 26 min, P = 0.026). Additionally, there were no patients who required more than 40 min for the procedure in the study group. Early adverse events occurred in 29% (4/14) of the control group whereas none in the study group. The adverse events in all 4 patients was bile peritonitis, including pan-peritonitis in one patient. All patients recovered with conservative treatment by medication. CONCLUSIONThe newly developed dilator was found to be useful for shortening procedure time and would prevent adverse events related to bile leakage in EUS-CDS.展开更多
This article provides the efficacy of the new device, Ligasure Vessel Sealing System（LVSS） for achieving hemostasis. LVSS is an alternative to suture ligatures, hemoclips, staplers, for ligating vessels and tissue b...This article provides the efficacy of the new device, Ligasure Vessel Sealing System（LVSS） for achieving hemostasis. LVSS is an alternative to suture ligatures, hemoclips, staplers, for ligating vessels and tissue bundles. This new device seals the vessels up to 7 mm in diameter by denaturing collagen and elastin within vessel wall and surrounding connective tissue.展开更多
Kaiy(medieval cautery)is an ancient method of heat therapy in traditional Persian medicine(TPM).Some of its important applications have been neglected during the medical revolution.Meanwhile,different treatment modali...Kaiy(medieval cautery)is an ancient method of heat therapy in traditional Persian medicine(TPM).Some of its important applications have been neglected during the medical revolution.Meanwhile,different treatment modalities that incorporate heat,including moxibustion,have progressed in traditional Chinese medicine.In this study,we reviewed the main TPM textbooks that were written specifically in the field of kaiy.We considered the traditional teachings in the context of contemporary information,gathered from the scientific literature about moxibustion and modern cauterization.Some surgical therapeutic indications of kaiy(e.g.,debridement and coagulative procedures)have been advanced by the innovation of electro-cauterization.However,those therapeutic applications that were based on the TPM humoral theory for relieving body coldness or myofascial pains—which are similar to moxibustion usages—have not received the same attention.Apart from the broad similarities of kaiy and moxibustion as thermal therapies with similar indications,there is a striking correspondence between kaiy point mapping and acupoints.Therefore,further research on different kaiy aspects is recommended.展开更多
BACKGROUND Gastrointestinal(GI)bleeding accounts for over half a million admissions annually and is the most common GI diagnosis requiring hospitalization in the United States.Bipolar electrocoagulation devices are us...BACKGROUND Gastrointestinal(GI)bleeding accounts for over half a million admissions annually and is the most common GI diagnosis requiring hospitalization in the United States.Bipolar electrocoagulation devices are used for the management of gastrointestinal bleeding.There is no data on device-related adverse events for gold probe(GP)and injection gold probe(IGP).AIM To analyze this using the Food and Drug Administration(FDA’s)Manufacturer and User Facility Device Experience(MAUDE)database from 2013 to 2023.METHODS We examined post-marketing surveillance data on GP and IGP from the FDA MAUDE database to report devicerelated and patient-related adverse events between 2013-2023.The MAUDE database is a publicly available resource providing over 4 million records relating to medical device safety.Statistical analyses were performed using IBM SPSS Statistics V.27.0(IBM Corp.,Armonk,NY,United States).RESULTS Our search elicited 140 reports for GP and 202 reports for IGP,respec-tively,during the study period from January 2013 to August 2023.Malfunctions reportedly occurred in 130 cases for GP,and actual patient injury or event occurred in 10 patients.A total of 149 patients(74%)reported with Injection GP events suffered no significant consequences due to the device failure,but 53 patients(26%)were affected by an event.CONCLUSION GP and IGP are critical in managing gastrointestinal bleeding.This study of the FDA MAUDE database revealed the type,number,and trends of reported device-related adverse events.The endoscopist and support staff must be aware of these device-related events and be equipped to manage them if they occur.展开更多
BACKGROUND Endoscopic ultrasound guided gallbladder drainage(EUS-GBD)is being increasingly used in practice(either as a bridge to cholecystectomy in high-risk patients or as destination therapy in non-surgical patient...BACKGROUND Endoscopic ultrasound guided gallbladder drainage(EUS-GBD)is being increasingly used in practice(either as a bridge to cholecystectomy in high-risk patients or as destination therapy in non-surgical patients).Stents are used to create a conduit between the lumen of the gallbladder(GB)and the intestinal lumen through the gastric or enteric routes.Among the various types of stents used,cautery-enhanced lumen apposing metallic stents(LAMS)may be associated with fewer adverse events(AEs).AIM To compare the clinical success,technical success,and rate of AEs between transgastric(TG)and trans-enteric[transduodenal(TD)/transjejunal(TJ)]approach to GB drainage.Further,we analyzed whether using cautery enhanced stents during EUS-GBD impacts the above parameters.METHODS Study was registered in PROSPERO(CRD42022319019)and comprehensive literature review was conducted.Manuscripts were reviewed for the data collection:Rate of AEs,clinical success,and technical success.Random effects model was utilized for the analysis.RESULTS No statistically significant difference in clinical and technical success between the TD/TJ and TG approaches(P>0.05)were noted.There was no statistically significant difference in the rate of AEs when comparing two-arm studies only.However,when all studies were included in the analysis difference was almost significant favoring the TD/TJ approach.When comparing cautery-enhanced LAMS with non-cautery enhanced LAMS,a statistically significant difference in the rate of AEs was observed when all the studies were included,with the rate being higher in non-cautery enhanced stents(14.0%vs 37.8%;P<0.01).CONCLUSION As per our study results,TD/TJ approach appears to be associated with lower rate of adverse events and comparable efficacy when compared to the TG approach for the EUS-GBD.Additionally,use of cautery-enhanced LAMS for EUS-GBD is associated with a more favorable adverse event profile compared to cold LAMS.Though the approach chosen depends on several patient and physician factors,the above findings could help in deciding the ideal drainage route when both TG and TD/TJ approaches are feasible.展开更多
Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.Material and methods:A cost analysis was conducted based on a retrospective revie...Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.Material and methods:A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014.A consecutive sample of adult patients with a diagnosis of anterior epistaxis was included.Anterior epistaxis was managed via one of:Nasal clip,Merocel(R),Silver Nitrate cautery,Vaseline packing,other treatment or no treatment.Both the direct and indirect hospital costs(SCDN)for anterior epistaxis treatment were calculated from the hospital's perspective.Generalized linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding factors.Results:Three hundred and fifty-three patients(49%female)with a mean age of(69.9±18.5)years were included in the analysis.The median(interquartile ranges)costs of treatment ranged from CS227.83(CS167.96,CS328.69)for observation to CS763.98(CS632.25,CS830.23)for Merocel(R).The overall median total hospital costs incurred across all modalities was CS566.24(CS459.61,CS753.46)for the management of anterior epistaxis.Silver Nitrate,nasal clip,and observation were statistically associated with a lower cost when compared to Merocel(R)(P<0.001)even after potential confounding factors were controlled.Conclusions:Our results show wide difference in the hospital cost of epistaxis across treatment modalities.These cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.展开更多
文摘Context: Condyloma acuminatum is a common morbidity caused by human papillomavirus infection. Objective: To compare the recurrence rate after surgical excision with or without podophyllin cautery. Design, Setting, Participants: Sixty women were enrolled in a study that was conducted in Cairo from Jan-2017 to Mar-2018. Interventions: All women received the same preparations. After randomization;in the study group (N = 30), podophyllin cautery was added to surgical removal in the follow-up period. In the control group (N = 30), only surgical removal was used. Main Outcome Measure: The main outcome measure was the estimation of the recurrence of the lesion during the follow-up period. The secondary outcome measures were the incidence of adverse events. Results: Both groups were comparable (p-value > 0.05) with regard to the age and BMI. Recurrence was significantly lower (P = 0.001) in the study group than the control group. In the study group, five cases (17.2%) have recurrence whereas, in the control group, 18 (60.0%) had suffered recurrence. The ARR was 42.8% (CI 95%: 18% - 60.9%) with RR of 0.29 (CI 95%: 0.12% - 0.67%) and NNT2 (CI 95%: 6% - 2%). During the follow-up period, 19 cases (65.5%) of the study group experienced pain versus only eight cases (26.7%) in the control group (p = 0.003). However, the development of scars was less in the study group 7 (24.1%) than in the control group 19 (63.3%), (p = 0.002). Conclusion: Podophyllin cautery, when added to surgical removal, is effective in decreasing the incidence recurrence in cases with condylomata acuminata.
文摘To evaluate the efficacy of a newly developed dilator for endoscopic ultrasound (EUS)-guided drainage (ES Dilator). METHODSFourteen consecutive patients who had undergone EUS-guided choledochoduodenostomy (EUS-CDS) with the ES Dilator were identified from a prospectively maintained database and enrolled in the study group. Fourteen other patients who had undergone EUS-CDS without the dilator just prior to its introduction were analyzed as the control group. A historical cohort study was carried out comparing the two groups. The main outcome measurement was the procedure time. The technical success rate and early AE rate were also compared between the two groups. RESULTSThere were no significant differences in age, sex and etiology of biliary obstruction. The utilization rate of a plastic stent was higher in the control group (36% vs 0%). The technical success rate was 100% in both groups. The mean procedure time was significantly shorter in the study group than in the control group (27 ± 7 min vs 44 ± 26 min, P = 0.026). Additionally, there were no patients who required more than 40 min for the procedure in the study group. Early adverse events occurred in 29% (4/14) of the control group whereas none in the study group. The adverse events in all 4 patients was bile peritonitis, including pan-peritonitis in one patient. All patients recovered with conservative treatment by medication. CONCLUSIONThe newly developed dilator was found to be useful for shortening procedure time and would prevent adverse events related to bile leakage in EUS-CDS.
文摘This article provides the efficacy of the new device, Ligasure Vessel Sealing System（LVSS） for achieving hemostasis. LVSS is an alternative to suture ligatures, hemoclips, staplers, for ligating vessels and tissue bundles. This new device seals the vessels up to 7 mm in diameter by denaturing collagen and elastin within vessel wall and surrounding connective tissue.
基金Shiraz University of Medical Sciences(No.26803).
文摘Kaiy(medieval cautery)is an ancient method of heat therapy in traditional Persian medicine(TPM).Some of its important applications have been neglected during the medical revolution.Meanwhile,different treatment modalities that incorporate heat,including moxibustion,have progressed in traditional Chinese medicine.In this study,we reviewed the main TPM textbooks that were written specifically in the field of kaiy.We considered the traditional teachings in the context of contemporary information,gathered from the scientific literature about moxibustion and modern cauterization.Some surgical therapeutic indications of kaiy(e.g.,debridement and coagulative procedures)have been advanced by the innovation of electro-cauterization.However,those therapeutic applications that were based on the TPM humoral theory for relieving body coldness or myofascial pains—which are similar to moxibustion usages—have not received the same attention.Apart from the broad similarities of kaiy and moxibustion as thermal therapies with similar indications,there is a striking correspondence between kaiy point mapping and acupoints.Therefore,further research on different kaiy aspects is recommended.
文摘BACKGROUND Gastrointestinal(GI)bleeding accounts for over half a million admissions annually and is the most common GI diagnosis requiring hospitalization in the United States.Bipolar electrocoagulation devices are used for the management of gastrointestinal bleeding.There is no data on device-related adverse events for gold probe(GP)and injection gold probe(IGP).AIM To analyze this using the Food and Drug Administration(FDA’s)Manufacturer and User Facility Device Experience(MAUDE)database from 2013 to 2023.METHODS We examined post-marketing surveillance data on GP and IGP from the FDA MAUDE database to report devicerelated and patient-related adverse events between 2013-2023.The MAUDE database is a publicly available resource providing over 4 million records relating to medical device safety.Statistical analyses were performed using IBM SPSS Statistics V.27.0(IBM Corp.,Armonk,NY,United States).RESULTS Our search elicited 140 reports for GP and 202 reports for IGP,respec-tively,during the study period from January 2013 to August 2023.Malfunctions reportedly occurred in 130 cases for GP,and actual patient injury or event occurred in 10 patients.A total of 149 patients(74%)reported with Injection GP events suffered no significant consequences due to the device failure,but 53 patients(26%)were affected by an event.CONCLUSION GP and IGP are critical in managing gastrointestinal bleeding.This study of the FDA MAUDE database revealed the type,number,and trends of reported device-related adverse events.The endoscopist and support staff must be aware of these device-related events and be equipped to manage them if they occur.
基金The authors have read the PRISMA 2009 Checklist,and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
文摘BACKGROUND Endoscopic ultrasound guided gallbladder drainage(EUS-GBD)is being increasingly used in practice(either as a bridge to cholecystectomy in high-risk patients or as destination therapy in non-surgical patients).Stents are used to create a conduit between the lumen of the gallbladder(GB)and the intestinal lumen through the gastric or enteric routes.Among the various types of stents used,cautery-enhanced lumen apposing metallic stents(LAMS)may be associated with fewer adverse events(AEs).AIM To compare the clinical success,technical success,and rate of AEs between transgastric(TG)and trans-enteric[transduodenal(TD)/transjejunal(TJ)]approach to GB drainage.Further,we analyzed whether using cautery enhanced stents during EUS-GBD impacts the above parameters.METHODS Study was registered in PROSPERO(CRD42022319019)and comprehensive literature review was conducted.Manuscripts were reviewed for the data collection:Rate of AEs,clinical success,and technical success.Random effects model was utilized for the analysis.RESULTS No statistically significant difference in clinical and technical success between the TD/TJ and TG approaches(P>0.05)were noted.There was no statistically significant difference in the rate of AEs when comparing two-arm studies only.However,when all studies were included in the analysis difference was almost significant favoring the TD/TJ approach.When comparing cautery-enhanced LAMS with non-cautery enhanced LAMS,a statistically significant difference in the rate of AEs was observed when all the studies were included,with the rate being higher in non-cautery enhanced stents(14.0%vs 37.8%;P<0.01).CONCLUSION As per our study results,TD/TJ approach appears to be associated with lower rate of adverse events and comparable efficacy when compared to the TG approach for the EUS-GBD.Additionally,use of cautery-enhanced LAMS for EUS-GBD is associated with a more favorable adverse event profile compared to cold LAMS.Though the approach chosen depends on several patient and physician factors,the above findings could help in deciding the ideal drainage route when both TG and TD/TJ approaches are feasible.
文摘Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.Material and methods:A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014.A consecutive sample of adult patients with a diagnosis of anterior epistaxis was included.Anterior epistaxis was managed via one of:Nasal clip,Merocel(R),Silver Nitrate cautery,Vaseline packing,other treatment or no treatment.Both the direct and indirect hospital costs(SCDN)for anterior epistaxis treatment were calculated from the hospital's perspective.Generalized linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding factors.Results:Three hundred and fifty-three patients(49%female)with a mean age of(69.9±18.5)years were included in the analysis.The median(interquartile ranges)costs of treatment ranged from CS227.83(CS167.96,CS328.69)for observation to CS763.98(CS632.25,CS830.23)for Merocel(R).The overall median total hospital costs incurred across all modalities was CS566.24(CS459.61,CS753.46)for the management of anterior epistaxis.Silver Nitrate,nasal clip,and observation were statistically associated with a lower cost when compared to Merocel(R)(P<0.001)even after potential confounding factors were controlled.Conclusions:Our results show wide difference in the hospital cost of epistaxis across treatment modalities.These cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.
