European Community Multi-Center Trial "Fetal ECG Analysis During Labor": ST plus CTG analysis

This report form part of the European Community Multi-Center Trial "Fetal ECG Analysis during Labor". Aim of this prospective trial was to identify changes in the fetal ECG waveform with cases of verified fetal hypoxia. In this paper we also report on the use of a newly developed automatic system for identification of ST waveform changes (ST Log). All ECG were recorded with the STAN recorder (Neoventa Medical AB, Gothenburg, Sweden). The ECG information was not displayed during labor in order not to influence the clinical management. This report includes data from 320 cases and include six cases of fetal intrapartum hypoxia. Twenty seven cases showed changes in ST waveform. All five cases with the most marked ST change (a rise in T/QRS of >0.10 units and lasting more then 10 minutes) had signs of ongoing intrapartum hypoxia. Six out of six cases with evidence of intrapartum asphyxia, showed ST changes. On the basis of our multi-center trial it appears that the combined analysis of CTG and ST waveform changes provides an accurate way to identify adverse events during labor. The work is continuing with a new STAN recorder developed by Neoventa Medical in Goteborg and currently being tested in a Swedish randomized, controlled multi-center trial

Dual energy CT (DECT) of the liver: Conventional versus virtual unenhanced images

OBJECTIVE: To compare image quality and noise of conventional unenhanced (CU) and virtual unenhanced (VU) images in patients who underwent hepatic dual energy computed tomography (DECT) and to assess potential radiation dose reduction. MATERIALS AND METHODS: Forty consecutive patients were studied. Mean CU and VU image quality and noise were analyzed by two blinded radiologists using a five-point grade scale. The effective radiation dose of a triple-phase protocol (CU, arterial and DE portal phases) were compared with that of a dual-phase protocol (arterial and DE portal phases). RESULTS: No significant difference in mean image quality was observed between VU (3.92 ± 0.85) and CU images (4.20 ± 0.72). A significant difference in mean image noise was observed between VU and CU (P < 0.01). The dose reduction achieved by omitting the unenhanced acquisition was 30.47 ± 7.07% (P < 0.01). In 6 patients, a complete VU liver image was not obtained. CONCLUSIONS: VU images can be obtained with similar image quality as CU. This approach favors a reduction in patient's radiation exposure. Nevertheless, a complete abdominal DECT is possible only in patients with a low body mass index, due technical limitations of the present DECT systems

A prospective cohort analysis of the prevalence and predictive factors of delayed discharge after laparoscopic cholecystectomy in Italy: the DeDiLaCo Study

Background: The concept of early discharge ≤24 hours after Laparoscopic Cholecystectomy (LC) is still doubted in Italy. This prospective multicentre study aims to analyze the prevalence of patients undergoing elective LC who experienced a delayed discharge &gt;24 hours in an extensive Italian national database and identify potential limiting factors of early discharge after LC. Methods: This is a prospective observational multicentre study performed from January 1, 2021 to December 31, 2021 by 90 Italian surgical units. Results: A total of 4664 patients were included in the study. Clinical reasons were found only for 850 patients (37.7%) discharged &gt;24 hours after LC. After excluding patients with nonclinical reasons for delayed discharge &gt;24 hours, 2 groups based on the length of hospitalization were created: the Early group (≤24 h; 2414 patients, 73.9%) and the Delayed group (&gt;24 h; 850 patients, 26.1%). At the multivariate analysis, ASA III class ( P &lt;0.0001), Charlson's Comorbidity Index (P=0.001), history of choledocholithiasis (P=0.03), presence of peritoneal adhesions (P&lt;0.0001), operative time &gt;60 min (P&lt;0.0001), drain placement (P&lt;0.0001), pain ( P =0.001), postoperative vomiting (P=0.001) and complications (P&lt;0.0001) were independent predictors of delayed discharge &gt;24 hours. Conclusions: The majority of delayed discharges &gt;24 hours after LC in our study were unrelated to the surgery itself. ASA class &gt;II, advanced comorbidity, the presence of peritoneal adhesions, prolonged operative time, and placement of abdominal drainage were intraoperative variables independently associated with failure of early discharge