El-Hossamy H.,Dudley Hospitals NHS Foundation Trust |
Morsi H.,Dudley Hospitals NHS Foundation Trust |
Morsi H.,Russells Hall Hospital |
Morsi H.,University of Birmingham
Journal of Gynecologic Surgery | Year: 2014
Background: Laparoscopy is becoming an increasingly essential "tool" for gynecologists. It has rapidly gained popularity because of laparoscopy's advantages over laparotomy. In any event, immediate recognition of complications is essential for reducing morbidity and potential mortality. Most complications occur during entry. This article presents a case of gastric injury caused by a Veress needle during an operative laparoscopy. Case: A postmenopausal woman sustained a gastric injury during insertion of a Veress needle. After the injury was recognized, the patient underwent laparoscopic primary repair of three small serosal puncture wounds. Results: The patient had an uneventful postoperative recovery. Conclusions: Gastric injury is a rare complication of gynecologic laparoscopy. Identification of risk factors, using a nasogastric or orogastric tube to relieve any gastric dilatation before initiation of the procedure, and using proper surgical technique may minimize such injuries. (J GYNECOL SURG 30:181) © Copyright 2014, Mary Ann Liebert, Inc. 2014.
Morsi H.,Dudley Hospitals NHS Foundation Trust |
Nightingale P.,University of Birmingham |
De Silva M.S.,Dudley Hospitals NHS Foundation Trust
Journal of Gynecologic Surgery | Year: 2013
Objective: The aim of this study was to determine whether obese women undergoing minimally invasive hysterectomy are at increased risk of complications or conversions to open surgery. Design: This study was designed as a retrospective cohort study. Materials and Methods: All laparoscopic hysterectomies performed between 2008 and 2012 for benign pathology were included. The main outcomes analyzed, across the three body mass index (BMI) groups (normal, overweight, and obese), were operative time; hemoglobin drop; conversion to open hysterectomy; bleeding requiring blood transfusion; damage to the bladder, ureter, bowel, or vessels; return to the operating theater; readmission to hospital; and length of postoperative stay. Results: There were 186 women (124 laparoscopic hysterectomies, 62 laparoscopic-assisted vaginal hysterectomies). Of these women, 62 (33.3%) were obese, 77 (41.4%) were overweight, and 47 (25.3%) had normal BMIs. The rate of major complications was 11.3% (21/186), with conversion to open surgery being the most common (17/186; 9.1%). There were no significant differences in any of the main outcomes among the BMI categories - except for the duration of surgery, which was significantly longer for patients in the obese than for those in the overweight category (p=0.015). Odds ratio analysis did not show that there were higher odds of complications or conversions in the obese group. The obese group was compared with the nonobese groups (overweight+normal BMI pooled together to form a "nonobese group" in this analysis), and the only difference was that the operative time was significantly longer (p=0.009) in the obese group. Conclusions: The findings in this study suggest that minimally invasive hysterectomy does not increase the risk of complications or conversions, but operative time appears to be longer, in obese women. (J GYNECOL SURG 29:190) © Copyright 2013, Mary Ann Liebert, Inc. 2013.
Stavropoulos-Kalinoglou A.,Dudley Hospitals NHS Foundation Trust |
Stavropoulos-Kalinoglou A.,University of Thessaly |
Stavropoulos-Kalinoglou A.,Performance Technology |
Metsios G.S.,Dudley Hospitals NHS Foundation Trust |
And 9 more authors.
Annals of the Rheumatic Diseases | Year: 2013
Background and objectives: Low cardiorespiratory fitness (CRF) is a significant predictor of cardiovascular disease (CVD), and interventions aiming at increasing CRF are known to reduce CVD risk. The effects of such interventions on CVD risk have not been studied in patients with rheumatoid arthritis (RA). Methods: 40 age, gender, body mass index (BMI) and disease duration matched RA patients were allocated to either an exercise (receiving 6 months individualised aerobic and resistance high intensity exercise intervention, three times per week), or control (receiving advice on exercise benefits and lifestyle changes) arm. Participants were assessed at baseline, 3 and 6 months for aerobic capacity (VO2max), individual CVD risk factors (blood pressure, lipids, insulin resistance, body composition), 10-year CVD event probability and RA characteristics (C-reactive protein (CRP), Disease Activity Score 28 (DAS28) and Health Assessment Questionnaire (HAQ)). Results: There were no differences between groups at baseline in any of the assessed variables. VO2max (p=0.001), blood pressure (systolic: p<0.001; diastolic: p=0.003), triglycerides (p=0.030), high density lipoprotein (HDL; p=0.042), total cholesterol:HDL ratio (p=0.005), BMI (p=0.001), body fat (p=0.026), 10- year CVD event probability (p=0.012), CRP (p=0.042), DAS28 (p=0.008) and HAQ (p=0.003) were all significantly improved in the exercise versus the control group. The change in VO2max was the strongest predictor for the observed improvements in all of the assessed CVD risk factors and disease characteristics. Conclusions: Individualised aerobic and resistance exercise intervention can lead to significantly improved CRF, individual CVD risk factors, composite CVD risk, and disease activity and severity in RA patients.