We describe a one-port laparoscopic technique for assisting in Tenchkoff catheter placement and salvaging obstructed ones in patients requiring continuous ambulatory peritoneal dialysis (CAPD). This unique technique enables diagnostic laparoscopy, adhesiolysis, repositioning of catheters, and omentectomy to be performed without laparotomy. Six patients were treated. Only one 10-mm port was required, using an operating laparoscope and an instrument introduced through the working channel of the laparoscope. Adhesiolysis was performed under laparoscopic vision; omentectomy and flushing of blocked catheters were carried out extracorporeally. The catheters were then repositioned to the pelvic cavity under laparoscopic vision. All patients were followed up for 6-10 months. No mechanical problem was noticed. Our one-port laparoscopic technique is a simple and effective method for treating patients who have mechanical problems with their peritoneal dialysis catheters.
BACKGROUND: Hip fracture is a challenging geriatric problem for the health care professionals, especially in patients with multiple comorbidities. In patients with inoperable hip fracture secondary to severe comorbid conditions, the pain can lead to significant challenges in nursing care. With the current understanding of the innervation of hip joint, we are now able to perform selective chemical denervation of the articular branches of femoral and obturator nerves to manage the pain associated with inoperable hip fracture. METHODS: In this retrospective case series, we analyzed 20 consecutive patients with inoperable hip fracture who received chemical denervation and examined the effect of the denervation on pain and functional outcomes, including the maximally tolerable hip flexion and the ability to sit during their hospital stay. We also assessed the likelihood of being ambulatory as a long-term outcome. RESULTS: The movement-related pain was significantly reduced at 10 minutes postprocedure, on postintervention days 1 and 5 (P values of <.001), and the degree of maximally tolerable hip flexion was doubled at the same time points (P values of <.001, .003, and .002, respectively). Fifty percent of the patients managed to sit within the first 5 days after procedure, and 3 of them managed to walk with aid 4 months after hip denervation. No procedural adverse event was noted. CONCLUSIONS: We concluded that this chemical hip denervation could be a safe and effective measure to handle the pain-related and rehabilitation-related challenges as a result of inoperable hip fracture.
BackgroundThe development of anterior hip neurolysis has made an appreciable impact on the management of patients with inoperable hip fracture. Nonetheless, suboptimal analgesic benefit was still observed in some patients. We therefore developed a novel posterior hip pericapsular neurolysis (PHPN) to complement anterior hip neurolysis in inoperable hip fracture.MethodsIn this retrospective review, we analyzed patients who responded suboptimally (defined as composite pain score moderate or higher on hip flexion 80°) to the anterior hip neurolysis from July 2019 to March 2021. The patients received additional PHPN if the composite pain score was suboptimal. The percentage of patients with dynamic composite pain scores on hip flexion to 80° and on gentle hip external and internal rotation on post-intervention day 5 was then evaluated.ResultsAmong the 70 patients who were reviewed in the study period, 20 patients who partially responded to anterior hip neurolysis received an addition of diagnostic posterior hip pericapsular block. Eighteen patients were the positive responders and PHPN was then performed. Among the PHPN recipients, a high percentage with satisfactory dynamic pain control was observed with 78% on hip flexion 80° and 83% on hip external/internal rotation on day 5 following the intervention. No procedural adverse event was noted.ConclusionsWhile most patients responded satisfactorily to anterior hip neurolysis, we concluded PHPN could be an effective adjunct to manage suboptimal pain control after anterior hip neurolysis in inoperable hip fracture.Trial registration numberNTWC/REC/21061.
Objectives: We report our results of an audit on extracorporeal shockwave lithotripsy (ESWL) of renal and ureteric stones using the Dornier Lithotripter S (Dornier MedTech, Wessling, Germany). Materials and Methods:We retrospectively reviewed the outcome of ESWL for patients treated between March and December 2003 (pilot). Prospective collection of data was performed for patients treated between October 2004 and March 2005 (re-audit) after an upgrade to the power unit of our shockwave emitter by the manufacturer in September 2004. Patient demographic data, target stone characteristics and treatment outcome were recorded. Analysis of the results between the two periods was made. Results: ESWL was performed on 232 and 220 target stones in the pilot and re-audit periods, respectively. Patient demographic data and stone characteristics were similar between the two periods. Clinical success (stone fragments less than 4 mm in size after one session of ESWL) was achieved in 31% and 61% (stonefree 19% and 38%) of patients in the pilot and re-audit periods, respectively (P < 0.0001, χ 2 test). Patients requiring re-treatment with ESWL to achieve success and auxiliary procedure reduced to 8% and 5%, respectively, in the re-audit period (pilot: 14% and 14%, respectively). The overall complication rate was reduced from 6.2% (pilot) to 3.3% (re-audit). Obstructive complications significantly reduced from 4.8% to 0.5% (pilot vs re-audit, Fisher's exact test, P = 0.012). Conclusion: Effectiveness of our lithotripter was significantly improved and obstructive complications were significantly reduced after an upgrade to the power unit of the electromagnetic shockwave emitter of our lithotripter.
Introduction: Owing to the severe shortage of organ donation in our locality, large number of end‐stage renal failure (ESRF) patients have to consider the option of renal transplant in mainland China. The objective of this study is to assess the complication rate of patients having renal transplantation done in China. Patients and Method: Medical record of 119 patients with renal transplant done in China since 1/1/1990 were reviewed with particular attention to surgically related complications. Results were compared with some oversea series. Results: 109 out of 119 patients who had received renal transplant in China are being followed up at the time of review (nine died and one dropped out for unknown reason). The mean follow time was 32 months (1–123). Surgical complications occurred in 32 patients (26%). Four graft lost due to rupture arterial anastomosis, arterial thrombosis, venous thrombosis and anastomotic pseudoaneurysm. Ten patients(8%) had renal artery stenosis requiring angioplasty. nine patients (7.5%) had wound related problems (three gapped wound, four wound infection and two incisional hernia). Two patients (1.6%) with urinary leakage. Three patients (2.5%) with ureteric stricture. six patients (5%) had perinephric collection. One patient with wound haematoma in early postop period requiring clot evacuation. Discussion: The complications rate in our group is similar to oversea series. Renal transplantarion is the most cost‐effective treatment of ESRF. More and more patient had transplantation done in China. Patients frequently ask about the safety and results of having operation in China. Our result provide an insight into this question though more solid conclusion is required by gathering more results from other hospitals.
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