In Ontario, bariatric surgery is publicly funded and is performed only in accredited tertiary care hospitals. The purpose of our study was to report on the safety and outcomes of performing bariatric ...surgery at an ambulatory site of a tertiary care hospital in southern Ontario.
We conducted a retrospective cohort study of all adult (age ≥ 18 yr) patients who underwent primary laparoscopic Roux-en-Y gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) at the ambulatory site of our tertiary care hospital between September 2016 and August 2018. The 2 sites are 1.4 km apart. Patient demographic characteristics, duration of surgery, intraoperative and 90-day postoperative complications, number of transfers and readmission to the tertiary care hospital, and emergency department visits were collected.
A total of 314 patients (285 women 90.8% and 29 men 9.2% with a mean age of 41.8 yr standard deviation (SD) 8.9 yr) underwent surgery: LRYGB in 295 cases (93.9%) and LSG in 19 (6.0%). The mean body mass index was 45.3 (SD 5.1), the median American Society of Anesthesiologists score was 3 (range 2-4), and the median Edmonton Obesity Staging System score was 2 (range 0-4). The mean operative time was 119.8 (SD 23.1) minutes for LRYGB and 96.2 (SD 22.0) minutes for LSG, and the mean length of stay was 2.1 (SD 0.6) days and 2.1 (SD 0.2) days, respectively. Thirteen patients (4.1%) required transfer to the tertiary care hospital for a postoperative complication. Of 312 patients, 29 (9.3%) presented to emergency department within 90 days after surgery, and 8 (2.6%) required readmission to hospital; no deaths were reported.
The findings suggest that LRYGB and LSG can be performed safely at an ambulatory site of a tertiary care hospital. However, caution should be exercised in performing these procedures at an ambulatory site without a tertiary care hospital affiliation, as patients may require urgent transfer for a serious postoperative complication.
Intra-aortic balloon pump (IABP) insertion in critically ill patients has been associated with both vascular and nonvascular complications, which have restricted its use. The primary objective for ...this study was to determine the frequency and predictors of vascular complication in our centre.
We conducted a retrospective cohort study of consecutive patients treated with an IABP between January 2014 and June 2018. Baseline clinical characteristics, cannulation details, duration of treatment and management, overall mortality, and complications were extracted from electronic and paper medical records.
A total of 187 patients required an IABP; of these, 146 were male (78.1%), the average age was 65.2 ± 11.5 years, and body mass index was 26.8 ± 6.2 kg/m2. A majority of the patients had an IABP inserted in either the cardiac catheterization laboratory (54.5%) or an outside hospital (26.7%). The main indications for insertion were acute decompensated heart failure-cardiogenic shock (58.3%), followed by acute myocardial infarction and cardiogenic shock (26.2%). From the documented cannulation site, the right femoral artery was cannulated in 61.6% of patients, with a median size of 7.5 Fr (range: 5 -12 Fr). Mortality for in-hospital, 30-day, and 1-year mortality was calculated at 37.4%, 40.6%, and 41.7%, respectively. Limb ischemia (3.2%), bleeding (1.6%), mesenteric ischemia (0.5%), compartment syndrome (0.5%), and fasciotomy (0.5%), were rare occurrences. No records indicated amputation, aortoiliac dissection, thrombectomy, or infection at the site of insertion.
This single-centre retrospective study demonstrated that more than one third of this patient population died secondary to their primary diagnosis. The incidence of vascular complications secondary to IABP insertion remained low, with less than 3% developing an ischemic limb.
L’insertion d’un ballon de contrepulsion intra-aortique (BCPIA) chez les patients dont l’état est critique est associée à des complications à la fois vasculaires et non vasculaires, ce qui limite son utilisation. L’objectif principal de cette étude était de déterminer la fréquence des complications vasculaires dans notre centre ainsi que les facteurs prédictifs de ces complications.
Nous avons mené une étude de cohorte rétrospective auprès de patients traités consécutivement par BCPIA entre janvier 2014 et juin 2018. Les caractéristiques cliniques initiales, les détails sur la canulation, la durée du traitement et de la prise en charge, la mortalité globale et les complications ont été extraits des dossiers médicaux électroniques et en format papier.
Au total, un BCPIA a été nécessaire chez 187 patients; 146 d’entre eux étaient des hommes (78,1 %), l’âge moyen était de 65,2 ± 11,5 ans, et l’indice de masse corporelle moyen était de 26,8 ± 6,2 kg/m2. La majorité des insertions de BCPIA s’étaient déroulées soit dans le laboratoire de cathétérisme (54,5 %) ou dans un hôpital externe (26,7 %). Les principales indications pour lesquelles ces insertions ont été effectuées étaient l’insuffisance cardiaque aiguë décompensée avec choc cardiogénique (58,3 %), suivie de l’infarctus du myocarde aigu avec choc cardiogénique (26,2 %). Selon les sites de canulation documentés, l’artère fémorale droite avait été canulée chez 61,6 % des patients, avec un calibre médian de 7,5 Fr (de 5 à 12 Fr). Les valeurs de mortalité à l’hôpital, à 30 jours et à un an, ont été établies à 37,4 %, 40,6 % et 41,7 %, respectivement. L’ischémie d’un membre (3,2 %), l’hémorragie (1,6 %), l’ischémie mésentérique (0,5 %), le syndrome des loges (0,5 %) et la fasciotomie (0,5 %) ont été constatés dans quelques rares cas. Aucun dossier n’indiquait d’amputation, de dissection aorto-iliaque, de thrombectomie ou d’infection au point d’insertion.
Cette étude de cohorte rétrospective unicentrique a permis de démontrer que plus d’un tiers des patients de la population à l’étude sont décédés des suites de leur diagnostic primaire. L’incidence de complications vasculaires secondaires à l’insertion d’un BCPIA est demeurée faible, avec moins de 3 % des patients présentant une ischémie d’un membre.
Background
Carboplatin-based chemotherapy offers high response rates and improved overall survival for women with epithelial ovarian cancer, but its use is limited by the occurrence of ...hypersensitivity reactions. To evaluate the efficacy of prophylactic diphenhydramine for hypersensitivity reaction prevention, we reviewed the incidence of hypersensitivity reactions and identified patients at high risk of hypersensitivity reactions.
Methods
Women receiving ≥6 cycles of carboplatin-based chemotherapy for epithelial ovarian cancer were identified from our institutional database at the Princess Margaret Cancer Centre. Institutional policy was changed in 2009 to introduce diphenhydramine prophylaxis for patients receiving ≥6 cycles of carboplatin. Additional clinical data were abstracted from the patient record.
Results
Between 2006 and 2012, 450 women received ≥6 cycles of carboplatin-based chemotherapy for epithelial ovarian cancer. Two hundred and ninety-one women received prophylaxis with diphenhydramine. Carboplatin-induced hypersensitivity reactions occurred in 41 of 449 patients (9%). Univariable predictors of carboplatin-induced hypersensitivity reactions included administration of 8 to 10 cycles of carboplatin, history of other drug allergies and a platinum-free interval >12 months. BRCA mutational status was not predictive. In a multivariable analysis, the number of cycles of carboplatin and a platinum-free interval >12 months were independent predictors of hypersensitivity reactions. There was a trend towards diphenhydramine prophylaxis reducing the incidence of hypersensitivity reactions in women with a platinum-free interval compared to continuous delivery; this was most marked when the platinum-free interval was >12 months (n = 64) (OR: 0.2 (95% CI: 0.046–0.83), p = 0.03).
Conclusions
The administration of diphenhydramine to women who have a platinum-free interval may reduce the risk of hypersensitivity reaction, but prospective evaluation is required.
Background and Objectives: Diastasis recti is a common problem after delivery, which occurs due to stretch of fascia between two sides of rectus abdominis muscle. The present study was conducted with ...the purpose of determining the immediate effect of contraction of the abdominal muscles on inter-recti distance. Methods: This case-control study was performed on 40 women in 2 groups of diastasis (n=20) and normal (n=20). Inter-recti distance was assessed by solography (before and during the contraction). Data were analyzed using Kolmogorov-Smirnov, independent t-, and paired t-tests. Results: In both groups, a significant decrease was observed between two sides of rectus abdominis muscle during each maneuver, except abdominal hollowing maneuver, in healthy group compared to the resting position (p<0/05). In both groups, maximum decrease in the distance between two sides of rectus abdominis muscle, was seen during partial sit-up maneuver towards both sides (p<0/05). Conclusion: According to the findings of the present study, the maximum decrease in distance between two sides of rectus abdominis muscle, was happened during partial sit-up maneuver towards both sides and the minimum decrease was happened during abdominal hallowing maneuver.
Folate intake in North America has drastically increased over the past decade due to folic acid fortification and widespread supplemental use. The role of folate in breast cancer is highly ...controversial and the effects of folic acid supplementation on breast cancer patients are currently unknown. An animal study was performed to determine the effects of folic acid supplementation on the progression of the mammary tumors in the DMBA-carcinogen model. Folic acid supplementation was associated with more rapid sentinel tumor progression and with higher sentinel tumor weight, volume, and area, although no clear dose-responsive relationship was observed. Folic acid supplementation was associated with an increased expression of proapoptotic protein PARP and decreased expression of proliferation protein PCNA. These data suggest that folic acid supplementation may promote the progression of established mammary tumors. Whether or not folic acid supplementation may adversely affect the outcome of patients with breast cancer warrants further studies.
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