Inguinal hernia repair with or without mesh in late adolescent males

Purpose@#Inguinal hernia repair is one of the most common treatments worldwide, but there are few studies about the use of mesh in late adolescent patients because hernias are rare in this group. This study aimed to evaluate the postoperative outcomes of hernia repair with and without mesh in late adolescent patients. @*Methods@#We retrospectively reviewed the data of 243 male patients aged between 18 and 21 years who underwent inguinal hernia repair at a single institution from January 2013 to December 2017. We distinguished 2 groups depending on the repair method; mesh (n = 121) and no-mesh (n = 122) groups. We compared the baseline characteristics, immediate postoperative outcomes, and recurrence and chronic pain rates between the 2 groups. @*Results@#There were no significant differences between the mesh and no-mesh groups on immediate postoperative outcomes (length of stay: 18.5 ± 8.9 days vs. 17.0 ± 6.0 days, P = 0.139; postoperative complications: 8.2% vs. 6.6%, P = 0.821) and 2-year recurrence rate (0.8% vs. 2.6%, P = 0.194). There was a significant difference in the chronic pain rate (9.0% vs.1.7%, P = 0.023). @*Conclusion@#Using mesh for inguinal hernia repair in late adolescent male patients increases chronic postoperative inguinal pain.

Inguinal hernia repair with or without mesh in late adolescent males

Purpose@#Inguinal hernia repair is one of the most common treatments worldwide, but there are few studies about the use of mesh in late adolescent patients because hernias are rare in this group. This study aimed to evaluate the postoperative outcomes of hernia repair with and without mesh in late adolescent patients. @*Methods@#We retrospectively reviewed the data of 243 male patients aged between 18 and 21 years who underwent inguinal hernia repair at a single institution from January 2013 to December 2017. We distinguished 2 groups depending on the repair method; mesh (n = 121) and no-mesh (n = 122) groups. We compared the baseline characteristics, immediate postoperative outcomes, and recurrence and chronic pain rates between the 2 groups. @*Results@#There were no significant differences between the mesh and no-mesh groups on immediate postoperative outcomes (length of stay: 18.5 ± 8.9 days vs. 17.0 ± 6.0 days, P = 0.139; postoperative complications: 8.2% vs. 6.6%, P = 0.821) and 2-year recurrence rate (0.8% vs. 2.6%, P = 0.194). There was a significant difference in the chronic pain rate (9.0% vs.1.7%, P = 0.023). @*Conclusion@#Using mesh for inguinal hernia repair in late adolescent male patients increases chronic postoperative inguinal pain.

Vascular Complications Related to Posterior Lumbar Disc Surgery

PURPOSE: To evaluate patients who underwent surgical or endovascular treatment after vascular injury related to posterior lumbar disc surgery. MATERIALS AND METHODS: We retrospectively reviewed seven cases of vascular injuries (four lacerations, one arteriovenous fistula [AVF], and two pseudoaneurysms) related to lumbar disc surgery by a posterior approach from January 1997 to December 2016 at Chonnam National University Hospital. Information of patient characteristics, diagnosis, treatment strategies, and outcomes were analyzed. RESULTS: Five out of seven cases were inhospital cases. In three laceration cases, each patient instantly became hypotensive and a life-threatening arterial injury was suspected. Therefore, the patient was immediately turned to the supine position and surgical repair was performed. The patients with pseudoaneurysm and AVF were treated by endovascular intervention. Remaining two were referred cases under the impression of vascular injuries. One laceration case of them was in preshock condition, and the left common iliac artery was surgically repaired. The other referred patient showed pseudoaneurysm which was treated with stent graft insertion. There was no surgery or endovascular intervention related death and none of the patients suffered any sequela related to vascular injury. CONCLUSION: Vascular injury associated with posterior lumbar disc surgery is not common, but can be fatal. Early recognition, diagnosis, and prompt treatment are essential to prevent fatal outcomes. Recently, endovascular intervention is increasingly and preferably used because of its low morbidity and mortality. However surgery is still the best option for the patients with unstable vital sign and endovascular approach can be applied to stable patients.

Colon perforation due to embolization coil for internal iliac aneurysm

Coil migration is an extremely rare but hazardous complication of aneurysmal coil embolization. Only 1 case report has described coil migration following endovascular exclusion to gastrointestinal (GI) tract. We report the experience of a case of colon penetration caused by embolization coil placed for internal iliac aneurysm. A 66-year-old man visited the Emergency Department for hematochezia that had persisted for 3 months. Stent insertion and coil embolization of left internal iliac artery aneurysm had been performed on the patient 18 months ago. Colonoscopy was performed. It suggested penetration of sigmoid colon by embolization coil and diverticulum. Angiography revealed extravasation of contrast media at left internal iliac artery. Covered stent deployment was done in the left internal iliac artery. One week after the stent insertion, the patient underwent anterior resection, aneurysm resection, and coil removal. The patient recovered without complications. He was discharged at 2 weeks after the operation.

Laparoscopic Total Gastrectomy in Elderly Patients (> or =70 Years) with Gastric Carcinoma: A Retrospective Study

PURPOSE: To compare the surgical outcomes of laparoscopic total gastrectomy between elderly and non-elderly patients. MATERIALS AND METHODS: Between 2008 and 2015, a total of 273 patients undergoing laparoscopic total gastrectomy for gastric carcinoma were divided into two age groups: elderly (> or =70 years, n=71) vs. non-elderly ( or =70 years) was an independent risk factor (odds ratio=4.42, 95% confidence interval=1.50~13.01) for postoperative complications of grade III and above. CONCLUSIONS: Elderly patients are more vulnerable to grade III and above complications after laparoscopic total gastrectomy than non-elderly patients. Great care should be taken to prevent and monitor the development of anastomosis leakage in elderly patients after laparoscopic total gastrectomy.

Effect of evidence-based postoperative pain guidelines via web for patients undergoing abdominal surgery in South Korea.

PURPOSE: The purpose of this study was to develop evidence-based guidelines on postoperative pain management via the web and to examine the effects in terms of pain level of patients undergoing abdominal surgery and nurses' knowledge of postoperative pain management. METHODS: First, evidence-based pain guidelines were developed via the web in a tertiary hospital. Second, a special educational program on evidence-based pain guidelines for nurses was developed after validation of content by experts. Third, diverse strategies were adopted in order to facilitate incorporation of evidence-based pain guidelines in practice. Fourth, nurses in the study units were educated on evidence-based guidelines using the developed educational program for 3 weeks before their implementation of evidence-based pain guidelines to patients. Patients were assigned to the control group (from July 29 to August 20, 2011) and the experimental group (from September 24 to October 25, 2011) according to interrupted time interval. The data were analyzed using chi-square test, analysis of variance test with Scheffé's test as a post hoc and repeated measure of analysis of variance. RESULTS: Patients in the experimental group showed a significantly lower level of pain. Nurses' knowledge of management of postoperative pain showed a significant increase after installation of evidence-based guidelines. CONCLUSION: Evidence-based pain guidelines were effective in reducing the pain level of patients as well as improving nurses' knowledge of pain management.

Korean hospice nursing interventions using the Nursing Interventions Classification system: a comparison with the USA.

In this study, nursing interventions used by hospice nurses in Korea were identified and compared with core interventions selected by US end-of-life care nurses in order to determine similarities and differences between the two nations regarding such care. Data were collected from the electronic medical records of 353 hospice patients admitted to a tertiary hospital in Korea over a period of two years. First, extracted narrative interventions were mapped onto the Nursing Interventions Classification for comparison with interventions selected by nurses in the USA. A total of 56,712 intervention statements were mapped onto 147 Nursing Interventions Classification interventions. Hospice nurses in Korea performed more nursing interventions in the physiological basic domain, compared to nurses in the USA. The most frequently-used interventions in Korea were related to patient pain management. Among 47 core Nursing Interventions Classification interventions used in the USA, only 18 were used by Korean nurses in this study. This study highlights cultural differences in hospice care nursing interventions between the two countries.

Comparing effects of intravenous patient-controlled analgesia and intravenous injection in patients who have undergone total hysterectomy.

AIMS AND OBJECTIVES: To compare the effects of two pain management methods, intravenous patient-controlled analgesia and conventional intravenous injection, in terms of pain level, adverse reactions experienced, nursing care time spent for pain management, satisfaction with pain management and total cost of pain management for patients who underwent total abdominal hysterectomy. BACKGROUND: Patient-controlled intravenous analgesia has been used most commonly for management of postoperative pain. Although it can be very effective in management of postoperative pain, patients still complained of many adverse reactions. DESIGN: A quasi-experimental study design was used. METHODS: Seventy female participants were recruited for each group and were randomly assigned to one of the pain management methods. Data regarding pain level, adverse reactions experienced and level of satisfaction with pain management methods during a 48-hour postoperative period were collected. Calculation of cost for each pain management method was based on the cost of the device, drugs for both analgesics and antiemetics, and time spent by nurses for both pain management methods. Frequencies, percentages and means of the data were calculated, and chi-squared test and t-test were performed for homogeneity. RESULTS: Mean postoperative pain levels at 2, 6 and 12 hour were significantly lower in patients who used patient-controlled analgesic compared with patients who received intravenous injection; however, after that, there was no significant difference between the two methods. The cost for pain management was much higher for patients who used patient-controlled analgesic; however, satisfaction level with pain control was lower than that for patients who received intravenous injection. CONCLUSIONS: For patients who underwent total hysterectomy, patient-controlled analgesia was not cost-effective for management of postoperative pain for 48 hour, compared with conventional intravenous injection. RELEVANCE TO CLINICAL PRACTICE: For nurses caring for patients with pain, adaptation of diverse methods of pain management that will increase patients' satisfaction with pain management as well as lower the cost and occurrence of adverse reactions should be considered.

Effects of a structured educational programme on patient-controlled analgesia (PCA) for gynaecological patients in South Korea.

AIMS AND OBJECTIVES: The purpose of the study was to evaluate the effects of a structured educational programme on the patient-controlled analgesia device in terms of postoperative pain, dose of analgesics used, adverse reactions, patient knowledge and attitudes of patient-controlled analgesia and patient satisfaction with postoperative pain management among gynaecological patients in South Korea. BACKGROUND: Patient-controlled intravenous analgesia has become the most common method to manage postoperative pain. Although the patient-controlled analgesia device can be very effective in managing pain, patients using external pump delivery have several problems because of their lack of knowledge of patient-controlled analgesia. To minimise these problems, nursing interventions that may decrease the number of problems should be developed and adopted into clinical practice. DESIGN: A non-equivalent control group, non-synchronised design. METHODS: The participants were 79 patients who had gynaecological surgery under general anaesthesia. Of the 79 patients, 39 were assigned to the experimental group and 40 to the control group. A day before surgery, 40 minutes of structured education on the patient-controlled analgesia device was provided individually to the patients in the experimental group using both a CD-ROM and brochure. RESULTS: Pain level and adverse reactions were significantly lower in the experimental group than in the control group. Furthermore, the analgesic dose administered and the level of patient satisfaction with postoperative pain management increased significantly in the experimental group compared with the control group. CONCLUSION: A structured educational programme on the patient-controlled analgesia can be an effective nursing intervention for pain management in gynaecological patients. RELEVANCE TO CLINICAL PRACTICE: Nurses caring for the patients who are using the patient-controlled analgesia should provide a structured educational programme to increase knowledge of pain management with patient-controlled analgesia, patient satisfaction with pain management, as well as more effective management of the pain and adverse reaction caused by patient-controlled analgesia.

The effect of lavender oil on stress, bispectral index values, and needle insertion pain in volunteers.

OBJECTIVES: The purpose of this study was to investigate whether lavender oil aromatherapy can reduce the bispectral index (BIS) values and stress and decrease the pain of needle insertion in 30 volunteers. SUBJECTS AND METHODS: Thirty (30) healthy volunteers were randomly allocated to 2 groups: the experimental group received oxygen with a face mask coated with lavender oil for 5 minutes, and the control group received oxygen through a face mask with no lavender oil for 5 minutes. The stress level (0=no stress, 10=maximum stress), BIS value, and pain intensity of needle insertion (0=no pain, 10=worst pain imaginable) were measured. RESULTS: There were no significant differences in age, sex, height, and weight between the two groups. Stress level, BIS value, and pain intensity of needle insertion before aromatherapy were similar between the two groups. However, the stress values (p<0.001) and BIS value (p<0.001) after aromatherapy were significantly reduced compared with the control. In addition, the pain intensity of needle insertion was significantly decreased after aromatherapy compared with the control (p<0.001). CONCLUSIONS: Lavender aromatherapy in volunteers provided a significant decrease in the stress levels and in the BIS values. In addition, it significantly reduced the pain intensity of needle insertion.

Analysis of Nursing Interventions Performed by Gynecological Nursing Unit Nurses Using the Nursing Interventions Classification.

PURPOSE: The purpose of this study was to identify nursing intervention performed by nurses on gynecological nursing units. METHODS: The instrument in this study is based on the fifth edition of Nursing Interventions Classification (NIC) (2008). Data was collected by Electronic Medical record from August, 2010 to October, 2010 at one hospital and analyzed by using frequencies in the Microsoft Excel 2010 program. RESULTS: Of a total of 82 NIC, domains of the nursing interventions showed higher percentages for physiological: basic (36.3%) and physiological: complex (34.5%). The classes of nursing interventions showed higher percentage for health system mediation (12.1%), perioperative care (10.0%), and drug management (8.6%). The most frequently used top interventions were Discharge Planning. The thirty least used interventions was environmental management. Top thirty most frequently used interventions belonged to the domain of physiological: basic (37.9%), physiological: complex (31.1%), and behavioral (5.4%). CONCLUSION: These findings will help in the establishment of a standardized language for gynecological nursing units and enhance the quality of nursing care.

Selective fluorogenic derivatization of 3-nitrotyrosine and 3,4-dihydroxyphenylalanine in peptides: a method designed for quantitative proteomic analysis.

There is a need for the selective derivatization and enrichment of posttranslational protein modifications from tissue samples. This chapter describes a method for the selective derivatization of 3-nitrotyrosine (after reduction to 3-amino-tyrosine) and 3,4-dihydroxyphenylalanine with benzylamine derivatives to yield 6-amino- and 6-benzylamine-substituted benzoxazoles, which display characteristic fluorescence properties. The methodology can be expanded to other substituted benzylamines, which carry functional groups for affinity enrichment.

Proteomic analysis of age dependent nitration of rat cardiac proteins by solution isoelectric focusing coupled to nanoHPLC tandem mass spectrometry.

Protein nitration occurs as a result of oxidative stress induced by reactive oxygen (ROS) and reactive nitrogen species (RNS). Therefore, protein nitration serves as a hallmark for protein oxidation in vivo. We have previously reported on age dependent protein nitration in cardiac tissue of Fisher 344 BN-F1 rats analyzed by two-dimensional gel electrophoresis; however, only one specific nitration site was identified [Kanski, J., Behring, A., Pelling, J., Schöneich, C., 2005a. Proteomic identification of 3-nitrotyrosine-containing rat cardiac proteins: effects of biological aging. Am. J. Physiol. Heart Circ. Physiol. 288, H371-381]. In the present report, we used solution phase isoelectric focusing (IEF) followed by nanoHPLC-ESI-MS/MS that allowed us to obtain good MS/MS data to identify specific sites of protein nitration in cardiac tissue. As expected, more nitrated proteins were detected in cardiac tissue of old rats, including myosin heavy chain, neurofibromin, tropomyosin and nebulin-related anchoring protein. The post-translational modification of these cytoskeletal proteins may provide some rationale for the age-dependent functional decline of the heart.