Safe Without Suction: Double-Blind Randomized Controlled Trial Challenges Routine Gastric Decompression in Laparoscopy.

To compare intraocular pressure (IOP) control in eyes with or without clear corneal phacoemulsification following trabeculectomy. The study group included 30 eyes that underwent uneventful clear corneal phacoemulsification and foldable intraocular lens implantation following trabeculectomy without antimetabolites. Thirty eyes that had undergone filtering surgery without cataract extraction were selected as controls. Case and control groups were matched with respect to age, gender, IOP, number of glaucoma medications, glaucoma type (primary open-angle glaucoma/pseudoexfoliative glaucoma), trabeculectomy time and follow-up. Comparisons between the study and control groups (intergroup) and within the same group at different time-points (intragroup) were performed for IOP, glaucoma medications and bleb morphology. Success rates were investigated by Kaplan-Meier survival analysis and the factors influencing final success by logistic regression. Intraocular pressure (p = 0.04) and glaucoma medications (p = 0.001) increased during an average follow-up of 26.1 +/- 9.9 months in both groups. Intragroup differences became statistically significant after the 6-month visit, but intergroup differences remained insignificant. Bleb height decreased significantly following phacoemulsification in the study group (p = 0.017). Success rates decreased with time in both groups, with no intergroup difference (p = 0.46). The final success rate was negatively correlated with IOP and number of glaucoma medications used at the study entry, while there was a positive correlation between the baseline and final success rates. Trabeculectomy success decreased in a time-dependent manner in eyes with and without subsequent phacoemulsification. Uncomplicated clear corneal phacoemulsification was not found to have any additional unfavorable influence on IOP control in eyes with filtering blebs.

Objective: Confirmation of nasogastric tube (NGT) placement is sometimes difficult in clinical practice. Hence, the purpose of this study is to validate the accuracy of manometry for intragastric NGT placement confirmation in intubated, mechanically ventilated patients. Methods: A total of 100 adult patients who underwent elective open abdominal surgery and required gastric decompression were enrolled in this prospective descriptive study at a university-affiliated teaching hospital. The position of NGTs was verified by two blinded investigators, of whom the first investigator used the manometric technique and the second investigator used a fiberscope for verification. The manometric technique involved using a cuff pressure manometer to verify NGT placement. The primary measurements, sensitivity and specificity of the manometric technique in verifying NGT placement were calculated according to the standard findings of fiberoptic inspection. Results: In 81 of 100 NGT placements, intragastric placement was interpreted by the manometric technique. All of these 81 placements were confirmed by fiberoptic inspection. The manometric technique was therefore 100% sensitive. The 19 placements interpreted as extragastric placement by the manometric technique were confirmed by fiberscopy as being in the oral cavity, trachea, or esophagus, indicating 100% specificity. These results revealed 100% accuracy of the manometric technique in verifying intragastric placement of NGTs in intubated, mechanically ventilated patients. Conclusions: The manometric technique is a convenient, inexpensive, and highly accurate method for verifying NGT placement. This technique may be used to verify correct NGT placement for the purpose of gastric decompression and in those environments where a roentgenogram is not available.

Orogastric (OG) tube insertion is a frequent practice performed by nurses in the neonatal intensive care unit (NICU). Combining the nose-ear-mid-umbilicus (NEMU) method with a birth weight (BW)-based method to determine optimal insertion length of OG tubes could reduce misplacement in extremely low birth-weight (ELBW) infants. The objective of this study was to determine whether combining the NEMU method with a BW-based method to determine insertion length of OG tubes reduces misplacement of OG tubes in ELBW infants younger than 6 hours. The study included 129 ELBW infants in the NICU younger than 6 hours. We compared the frequency of OG tube misplacements in ELBW infants during 2 different time periods. In period I, the insertion length of OG tubes was estimated with the NEMU method alone. In period II, the insertion length of OG tubes was estimated by combining the NEMU method with a BW-based method. OG tubes were considered misplaced if the tip was above the diaphragm (high) or near the pylorus (low) in radiographs obtained after placement. Infants who had OG tubes placed by combining both methods were less likely to have low OG tubes (53% in period I vs 34% in period II; P < .05). The BW-based method alone predicted optimal OG tube insertion length in 57 of 89 infants (64%). Combining the NEMU method with the BW-based method increases the probability of optimal OG tube placement in ELBW infants. Additional studies across multiple centers would validate the diagnostic accuracy of this method.Video abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx .

ObjectiveStress ulcers occur frequently in neurosurgical intensive care patients and can pose serious risks. We summarized the clinical experience of the combined application of nasointestinal tubes for early restoration of enteral nutrition and of nasogastric (NG) tubes for stress ulceration treatment in patients hospitalized in a neurosurgical intensive care unit.MethodsFrom January 2011 to June 2011, a series of 67 patients with stress ulceration hospitalized in a neurosurgical intensive care unit were randomized to two groups. The control group (33 patients) received treatment with NG tube decompression and drainage according to international guidelines, and parenteral nutrition was changed to enteral feeding until there was no grossly visible blood in the NG tube. The nasointestinal tube group (34 patients) received treatment combining application of NG tubes and nasointestinal tubes. Drainage was performed with NG tubes as in the control group, with concurrent placement of nasointestinal tubes. Duration until resolution of stress ulceration and days until start of enteral nutrition were compared between the two groups.ResultsDuration until resolution of stress ulceration was 4.5 days in the control group and 4.3 days in the nasointestinal tube group. There was no difference between the two groups (P > 0.05). Duration until start of enteral nutrition was 4.5 days in the control group and 1 day in the nasointestinal tube group. There was an obvious difference between the two groups (P < 0.01).ConclusionsThe combined application of NG tubes and nasointestinal tubes in neurosurgical intensive care patients with stress ulceration is an effective means of treating stress ulceration and restoring early enteral nutrition.

Background: The reduction of shoulder pain and postoperative nausea and vomiting (PONV), causing great discomfort for patients after gynecological laparoscopy, requires preventive or treatment strategies. Objectives: The present study aimed to determine the efficacy of intraperitoneal (IP) dexamethasone in the reduction of shoulder pain and PONV after gynecological laparoscopy. Methods: In this double-blind, randomized clinical trial, 130 consecutive patients undergoing gynecological laparoscopy were randomly assigned to two groups of 65 patients within May 2015 to May 2016. One group received 16 mg IP dexamethasone before the end of the surgery, and the other group received the placebo (i.e., the IP infusion of distilled water). Patients' age and body mass index (BMI), and surgery duration were recorded in this study. The severity of shoulder pain was evaluated by the visual analog scale (VAS) at recovery and 2, 6, 12, and 24 h after the surgery. Moreover, the need for opioid use and PONV were recorded within the first 24 h after the surgery. The study outcomes were compared between the two study groups and among the different intervals using SPSS software (version 21). Results: The groups had similar demographics (i.e., age and BMI) and mean surgery duration (P &gt; 0.05). The mean values of VAS scores of the intervention group were lower than those of the placebo group at five intervals (P = 0.001). The frequency of opioid use was significantly lower in the dexamethasone group (P = 0.010). In addition, 20% and 60% of the patients in the dexamethasone and placebo groups had PONV, respectively (P &lt; 0.001). Conclusions: The IP dexamethasone is effective in the reduction of shoulder pain and nausea/vomiting after gynecological laparoscopy and can significantly reduce opioid requirement within the first 24 h after surgery; however, IP dexamethasone does not increase surgery duration. Therefore, it is recommended to use this technique during gynecological laparoscopy.

Intraventricular haemorrhage by nasogastric tube insertion into the brain after transsphenoidal surgery. A case report and review of the literature

Objective To investigate effect of early enteral nutrition supplemented with probiotics on gastrointestinal motility disturbance and nutritional status in patients with severe craniocerebral trauma.Methods Forty patients with severe craniocerebral trauma were randomized into study group (18patients) and control group (22 patients).Patients of both groups received enteral nutrition via nasogastric tube at 24-72 hours after admission,but the patients of study group were also supplemented with probiotics simultaneously.Rate of abdominal distention,vomiting,gastro-oesophageal reflux,gastric retention,constipation and diarrhea were recorded during the whole study.Time to first defecation and time to targeted nutritional goals were also recorded.Prealbumin and transferrin in serum were detected at days 0,4,7,and 15 after the beginning of enteral nutrition.Length of ICU stay was compared between groups.Results There were no significant differences of the two groups in terms of rate of abdominal distention,vomiting,gastric retention and diarrhea.However,less gastro-oesophageal reflux or constipation patients were observed in study group,as compared with control group (P ＜ 0.05).Time to first defecation and time to targeted nutritional goals were shorter in study group,as compared with control group (P ＜ 0.05).Levels of prealbumin and transferrin had no significant differences between the two groups at days 0,4,and 7,but study group showed both were higher than control group at day 15 (P＜0.05).Moreover,length of ICU stay showed no significant difference between the two groups.Conclusions Compared with simple enteral nutrition,early enteral nutrition with probiotics improves gastrointestinal motility,facilitates the delivery of enteral nutrition,and further ameliorates nutritional status in patients with severe craniocerebral trauma. Key words: Craniocerebral trauma; Prebiotics; Enteral nutrition; Nutritional status ; Gastrointestinal motility

Increased monocyte chemoattractant protein-1 levels indicating early vascular damage in lean young PCOS patients

Inherited thrombophilia in infertile women: implication in unexplained infertility

Background: Nasogastric (NG) decompression and delayed oral feeding after bowel anastomosis is conventional and years old practice. The aim of the present study was to evaluate the advantages and disadvantages of early removal of naso gastric tube (&lt;24 hrs) and delayed feeding, compared with delayed removal and delayed enteral feeding in patients undergoing bowel anastomosis.Methods: It is a single blind, prospective randomized study involving patients with bowel anastomosis from December 2016- November 2018 at a tertiary care hospital. In study group naso gastric tube was removed within 24 hours. After 12 hours of surgery patients were allowed sips of water, then free liquids followed by semisolid and normal diet in calculated way. In control group naso gastric tube was retained till passage of flatus and orally allowed only after passage of stool.Results: A total of 241 patients were enrolled. In study group bowel sound returned after 30.57±31.19 hours of surgery and in control group 46.90±48.65 hours and this difference was significant (p&lt;0.002). In study group first free liquid was allowed on 38.14±38.50 hours in post operative period, as compared to the control group where free liquids were allowed after 50.09±51.80 hours this difference was significant (p&lt;0.04). Total hospital stay in the study group was significant (p&lt;0.02).Conclusions: Early removal of naso gastric tube and early feeding is better than the conventional practice.

Background/AimsTo evaluate the efficacy and safety of a controlled release, once-daily formulation of mosapride (UI05MSP015CT) in patients with functional dyspepsia (FD).MethodsPatients with FD were randomly assigned (1:1) to receive either UI05MSP015CT (15 mg once a day, study group) or mosapride (5 mg three times a day, control group) and corresponding placebo for 4 weeks. The primary endpoint was a change in the gastrointestinal symptom score (GIS) evaluated at enrollment and after 4 weeks. Secondary endpoints were changes in the Nepean Dyspepsia Index-Korean version (NDI-K), rate of satisfactory symptom relief, and rate of adverse events.ResultsA total of 138 patients were enrolled (female, 73.9%; mean age, 44.0±15.4 years). After excluding patients who violated the study protocol, 59 and 58 patients from the study and control groups, respectively, were included in the per-protocol analysis. No difference was observed in drug compliance between the control and study groups (97.07%±4.52% vs 96.85%±6.05%, p=0.870). Changes in GIS scores were 9.69±6.44 and 10.01±5.92 in the study and control groups. The mean difference in GIS change between groups was 0.33 (95% confidence interval, 1.75 to 2.41), demonstrating non-inferiority of UI-05MSP015CT (p=0.755). The rate of satisfactory symptom relief was not different between the study and control groups (39.0% vs 56.9%, p=0.053). No differences in change in NDI-K score (14.3 vs 16.9, p=0.263) or rates of adverse events (12.9% vs. 4.4%, p=0.062) were observed between the study and control groups.ConclusionsOnce-daily mosapride is not inferior to conventional mosapride in efficacy and is safe in patients with FD.

Do nondiabetic patients undergoing coronary artery bypass grafting surgery require intraoperative management of hyperglycemia?

Objective To investigate clinical results of improved pelvic floor reconstruction and vaginal paravaginal repair plus vaginal bridge repair in the treatment of female pelvic organ prolapse (POP). Methods From January 2009 to December 2010, a total of 50 women with POP were included into this study. They were divided into two groups randomly according to different operation methods, study group (n=25) received improved pelvic floor reconstruction and control group (n=25) received vaginal paravaginal repair plus vaginal bridge repair. Informed consent was obtained from all participates. There had no significant difference between two groups among ages, body mass index (BMI), parities, length of vagina and POP quantitative examination(POP-Q)(P>0.05). Results ① No significant difference was found of average operation time between two groups (P>0.05). ② The blood bleeding volume during operation in study group was slightly more than that in control group with no significant difference (P>0.05). ③ The average length of stay in study group was significantly shorter than that in control group (P<0.01). ④ Vaginal length after the operation was significantly shorter than that before operation in control group, but no difference was found in study group before and after the operation. There had significant difference of vaginal length between study and control group (P<0.05). ⑤ No recurrence was found in study group in follow-up, there had two cases in control group. ⑥ The study group had less impact on postoperative sexual life than that of control group (P<0.001). Conclusion The improved pelvic floor reconstruction is an effective surgical method in the treatment of female POP, which can strengthen the pelvic organ. Key words: pelvic organ prolapse; improved pelvic floor reconstruction; mesh

Effect of a Nasogastric Tube on Esophageal Pressure Measurement in Normal Adults

Aims NICE provide clear guidelines on confirming correct nasogastric (NG) tube siting using pH testing of aspirates or with X-rays where indeterminate samples are drawn. We aimed to audit documentation following nasogastric tube insertion to ascertain adherence to NICE guidelines. Methods A single-cycle snapshot audit was conducted on all surgical inpatients who had nasogastric tubes inserted over their admission across a single-centre district general hospital general surgery department. Data was collected on indication for NG tube insertion (drainage or feeding), length of initial tube insertion, whether pH testing was used to confirm position, and whether correct tube placement has been confirmed by a competent person through x-ray where indeterminate samples were tested from NG aspirate (pH &amp;gt; 5.5). Results A total of 15 patients had an NG tube inserted over their admission with mean age 77.3 years (range 47-97). 60% of patients had correctly documented confirmation of NG tube siting. 4/15 NG tubes were inserted for feeding purposes (26.7%), all of which were documented correctly. Only 45.5% of NG tubes for drainage were documented correctly and only 33.3% of all NG tubes had length of insertion documented. Where pH testing was inconclusive, a chest X-ray was requested for all patients and sufficiently documented by a doctor qualified to confirm position. No complications relating to NG tubes occurred across the audit study. Conclusions Implementation of improvement measures are warranted to improve overall adherence with NICE guidelines and prevent risk of incorrect confirmation of NG tube siting.