The R-S technique is the most promising open technique, with low recurrence rates, excellent long-time results, and minimal serious morbidity. Age might be an important factor in recurrence rate.
Weight gain after cholecystectomy is one of the major surgical problems consistent with morbidities and long-term mortalities. Here, we aimed to study the impact of palliative cholecystectomy on weight gain and nutritional status of the patients before and in 1, 4 and 6 months after surgery. We performed a prospective survey on a cohort of 48 patients undergoing elective cholecystectomy. The nutritional status of the patients was collected by nutrition nurse and analysed by NutriBase software. There were 13 (16%) females and 35 (84%) males with the mean age of 51.8 ± 1.97. In 6 months after surgery, patients had higher values of BMI, daily energy expenditure, carbohydrate and lipid consumption and a decreased level of protein consumption. Weight gain after surgery was caused by an increase in fat consumption which resulted in the weight gain and worsening of lipid profile. Dietary consultation, shortly after surgery, would improve patient outcome after cholecystectomy.
Background Breast cancer-related lymphedema is one of the most important complications that adversely affect patients' quality of life. Lymphedema can be managed if its risk factors are known and can be modified. This study aimed to select an appropriate model to predict the risk of lymphedema and determine the factors affecting lymphedema. Method This study was conducted on data of 970 breast cancer patients with lymphedema referred to a lymphedema clinic. This study was designed in two phases: developing an appropriate model to predict the risk of lymphedema and identifying the risk factors. The first phase included data preprocessing, optimizing feature selection for each base learner by the Genetic algorithm, optimizing the combined ensemble learning method, and estimating fitness function for evaluating an appropriate model. In the second phase, the influential variables were assessed and introduced based on the average number of variables in the output of the proposed algorithm. Result Once the sensitivity and accuracy of the algorithms were evaluated and compared, the Support Vector Machine algorithm showed the highest sensitivity and was found to be the superior model for predicting lymphedema. Meanwhile, the combined method had an accuracy coefficient of 91%. The extracted significant features in the proposed model were the number of lymph nodes to the number of removed lymph nodes ratio (68%), feeling of heaviness (67%), limited range of motion in the affected limb (65%), the number of the removed lymph nodes ( 64%), receiving radiotherapy (63%), misalignment of the dominant and the involved limb (62%), presence of fibrotic tissue (62%), type of surgery (62%), tingling sensation (62%), the number of the involved lymph nodes (61%), body mass index (61%), the number of chemotherapy sessions (60%), age (58%), limb injury (53%), chemotherapy regimen (53%), and occupation (50%). Conclusion Applying a combination of ensemble learning approach with the selected classification algorithms, feature selection, and optimization by Genetic algorithm, Lymphedema can be predicted with appropriate accuracy. Developing applications by effective variables to determine the risk of lymphedema can help lymphedema clinics choose the proper preventive and therapeutic method.
Background: Hemorrhoidectomy is commonly associated with post-operative perianal pain. Local botulinum toxin injection by relaxing the smooth muscles of the perianal sphincter and reducing anal pressure can be effective in decreasing post-operative pain. This study evaluates the effectiveness of local botulinum toxin injection in controlling pain after hemorrhoidectomy. Methods: This study was a double-blind, randomized clinical trial. A total of 40 patients undergoing hemorrhoidectomy who were referred to Shariati Hospital in 2019- 2020 were enrolled as participants and divided into two groups. In one group, injection of botulinum toxin was done in intersphincteric area, and in the other group, there was no intervention after hemorrhoidectomy. SPSS software version 24 was used to analyze the data. Results: Local botulinum toxin injection (MASPORT® 500) significantly reduced post-operative perianal pain on the first, third, fifth, and seventh days after the operation compared with the second group (P<0.05). The mean pain scores in the first, third, fifth, and seventh days in the first and second groups were 7.60 (±0.88) versus 8.25 (±1.16), 40.5 (±0.88) versus 6.05 (±0.99), 2.45 (±0.51) versus 3.05 (±0.68), and 2.05 (±0.39) versus 1.70 (±0.57), respectively. Furthermore, pain during defecation was significantly lower for the experimental group (P<0.05). Conclusion: Local botulinum toxin injection effectively improves post-operative pain after hemorrhoidectomy. Further studies are needed to prove the clinical value of local botulinum toxin injection.
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