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PubMed1999

Short convalescence after inguinal herniorrhaphy with standardised recommendations: duration and reasons for delayed return to work.

OBJECTIVE: To provide a detailed description of post-herniorrhaphy convalescence. DESIGN: Prospective, descriptive, consecutive questionnaire case series. SETTING: Public university hospital, Denmark. PATIENTS: 100 consecutive patients treated for inguinal hernia. INTERVENTION: Elective open inguinal herniorrhaphy under local anaesthesia. One day convalescence for light/moderate and three weeks for strenuous physical activity was recommended. MAIN OUTCOME MEASURE: Duration of absence from work or main recreational activity. RESULTS: Overall median absence (including the day of operation) was 6 days (interquartile range 1-16). For unemployed patients it was 1 day (0-7), for patients with a light or moderate workload 6 days (3-12), and for those with a heavy workload 25 days (21-37). Among the 64 patients, who did not follow the recommendations, pain was contributory in 33 and advice from the general practitioner in 12. Pain was the main cause of impairment of activities of daily living. CONCLUSION: Well-defined recommendations for convalescence may, together with improved management of postoperative pain, shorten convalescence; they are essential in the evaluation of effects of different surgical techniques of herniorrhaphy on convalescence.

Absenteeism↗

PubMed1989

[Measurement of MEFV in 66 cases of asthma in the convalescent stage and after treatment with Chinese herbs].

This paper reported the measurement of maximal expiratory flow-volume curve (MEFV) for 66 cases of asthmatics in the convalescent stage. Among which the data of FEV, PEF, V75, V50, V25 in 35 cases (53.03% of the total) gave different abnormal as compared with healthy persons. It showed that in the convalescent stage, most of the asthmatics still possessed obstruction of airways and chiefly of small airways. 35 cases of asthmatics in the convalescent stage was given the Chinese herbal decoction of chiefly invigorating Kidney (Viscum coloratum 15g, Psoralea corylifolia 15g, Eucommia ulmoides 15g, Lycium chinense 9g, Tussilago farfara 15g, Artemisia capillaris 9g, and Pogostemon cablin 9g as daily dosage) for treatment of 10 weeks and measuring MEFV curves to observe their changes before and after treatment. The results showed that different parameters of MEFV was improved in some extent which suggested that the airway obstruction of asthmatics in the convalescent stage was reversible. In discussion, the authors indicated that the prompt treatment for asthmatics in the convalescent stage was conductive early to prevent emphysema and confirmed that the treatment with Chinese herbs of chiefly invigorating Kidney deserved to be propagated.

Adolescent↗

PubMed1986

[Time periods of antibody preservation in patients convalescing from hemorrhagic fever with renal syndrome in European foci of the infection].

The radioimmunoassay of serum samples from 76 convalescents after hemorrhagic fever with the renal syndrome (HFRS), that took place in 1964 in Ufa, revealed the presence of specific antibodies in 75% of the convalescents. The absence of antibodies may be attributed both to their loss in some of the convalescents and to mistakes in the clinical diagnosis. The study of serum samples from 19 convalescents who had the infection in 1960 during the laboratory outbreak of HFRS at the Gamaleya Institute of Epidemiology and Microbiology (Moscow) showed the presence of antibodies in all convalescents. In both groups the infection was linked with common red-backed voles (the Western serological variant of the virus).

Adult↗

PubMed1994

Determinants of frequency domain measures of heart rate variability in the acute and convalescent phases of myocardial infarction.

OBJECTIVE: Low heart rate variability after acute myocardial infarction is associated with an increased risk of cardiac mortality. The aim of this study was to investigate the determinants of frequency domain measures of heart rate variability in acute myocardial infarction. METHODS: Heart rate variability in the frequency domain was compared in 43 patients in the early (0-12 h from the onset of pain) and convalescent (1 week after) phases of myocardial infarction and related to location (22 patients with anterior infarction and 21 patients with inferior infarction) and size of the infarct, occurrence of ventricular ectopic activity, and thrombolytic therapy. RESULTS: In the early phase of infarction all the power spectral components of heart variability were significantly lower in the patients with anterior infarcts than in those with inferior infarcts (p < 0.05 for all), but heart rate variability did not differ significantly between anterior and inferior infarct groups in the convalescent phase. High frequency power of heart rate variability was significantly lower in the convalescent phase than in the early phase in both the anterior and inferior infarction groups (p < 0.05 and p = 0.001, respectively), but other measures of variability did not change significantly. The ejection fraction was correlated with total power (p < 0.05), low frequency power (p < 0.01), and very low frequency power of heart rate variability (p < 0.05), and the low frequency and high frequency power components were significantly lower in the patients with non-sustained ventricular tachycardia than in those without repetitive ventricular activity in the convalescent phase of myocardial infarction (p < 0.05). Thrombolytic therapy had no influence on the measures of heart rate variability. CONCLUSIONS: The frequency domain measures of heart rate variability are mostly determined by the location of myocardial infarction in the early phase, whereas a correlation between heart rate variability and left ventricular function and arrhythmic propensity is more obvious in the convalescent phase.

Arrhythmias, Cardiac↗

PubMed2002

Concentrations of cytokines, soluble interleukin-2 receptor, and soluble CD30 in sera of patients with hepatitis B virus infection during acute and convalescent phases.

The immunoregulatory roles of interleukin-2 (IL-2), IL-4, IL-10, gamma interferon (IFN-gamma), tumor necrosis factor alpha (TNF-alpha), the soluble form of the IL-2 receptor (sIL-2R), and the soluble form of CD30 (sCD30) were evaluated in patients with hepatitis B virus (HBV) infection. Two groups of subjects were studied: 15 healthy individuals without hepatitis antecedents and 15 patients with HBV infection. Blood samples were taken during the acute and convalescent phases. The analysis of the samples was done by the enzyme-linked immunosorbent assay technique. IFN-gamma and TNF-alpha levels decreased in the convalescent phase. IL-10, IL-2, and sIL-2R levels increased in the acute and convalescent phases, while sCD30 levels increased during the acute phase. The IL-4 concentrations decreased in both phases. During the acute phase, IFN-gamma and TNF-alpha induced increases in IL-2, sIL-2R, IL-10, and sCD30 levels in serum, which allowed the development of immunity characterized by the nonreactivity of the HBV surface antigen, the onset of antibodies to the HBV surface antigen (anti-HBs), and normal alanine aminotransferase levels during the convalescent phase. Increased IL-2 levels during the acute phase would stimulate the activities of NK cells and CD8(+) lymphocytes, which are responsible for viral clearing. The raised sIL-2R levels reveal activation of T lymphocytes and control of the IL-2-dependent immune response. The sCD30 increment during the acute phase reflects the greater activation of the Th2 cellular phenotype. Its decrease in the convalescent phase points out the decrease in the level of HBV replication. The increase in IL-10 levels could result in a decrease in IL-4 levels and modulate IFN-gamma and TNF-alpha levels during both phases of disease, allowing the maintenance of anti-HBs concentrations.

Adult↗

PubMed1994

Serum antibody immunoglobulin G of mice convalescent from Plasmodium yoelii infection inhibits growth of Plasmodium falciparum in vitro: blood stage antigens of P. falciparum involved in interspecies cross-reactive inhibition of parasite growth.

We demonstrated that antibodies in the serum of BALB/c mice convalescent from Plasmodium yoelii infection inhibit the in vitro growth of Plasmodium falciparum. Blood stage P. falciparum antigens that cross-react with the convalescent-phase mouse serum antibodies were identified and partially characterized. Convalescent-phase mouse serum immunoglobulin G (IgG) reacted with P. falciparum lysates at up to a 1:15,000 dilution of the immune sera and bound to P. falciparum-parasitized erythrocytes at up to a 1:5,000 dilution of the sera. The cross-reactive moieties of antigens in parasite lysates were resistant to oxidation by periodate but sensitive to trypsinization. About 15 polypeptides (M(r)s of 15,000 to 110,000) of P. falciparum blood stages were recognized by the convalescent-phase mouse anti-P. yoelii sera; many of these antigens were metabolically 35S labeled and specifically immunoprecipitated. Also, virtually all of the cross-reactive antigens were recognized by human malaria-immune sera. The anti-P. yoelii serum antibodies bound, with high affinity, to at least five of the cross-reactive antigens (M(r)s of 107,000, 84,000, 53,000, 36,000, and 30,000). By phase separation in Triton X-114, eight interspecies cross-reactive antigens (M(r)s of 84,000, 76,000, 51,000, 31,000, 29,000, 28,000, 23,000, and 22,000) were found to be integral membrane proteins. Convalescent-phase mouse serum IgG strongly inhibited the differentiation of P. falciparum from schizonts to rings; 75 micrograms of IgG per ml caused 80% inhibition of release of merozoites and their invasion into erythrocytes. On the other hand, the anti-P. yoelii serum antibodies also inhibited intracellular development of P. falciparum from rings to schizonts; 25 micrograms of IgG per ml caused 50% inhibition. Inhibition of P. falciparum growth by anti-P. yoelii serum IgG suggests that some of the interspecies cross-reactive antigens contain important conserved epitopes and induce protective antibodies against P. falciparum.

Animals↗

PubMed1980

Antibody-dependent mononuclear cell-mediated antimeningococcal activity. Comparison of the effects of convalescent and postimmunization immunoglobulins G, M, and A.

We have compared the abilities of immunoglobulin (Ig)G, IgM, and IgA to induce either mononuclear cell-mediated (complement-independent) or complement-mediated (cell-free) antibacterial activity against group C meningococci. In each of these assays, immunoglobulins purified from the sera of individuals immunized with meningococcal group C polysaccharide were compared with those purified from sera of patients convalescing from disseminated meningococcal disease. Our data support three conclusions. First, although nonbactericidal in cooperation with complement, IgA can induce cell-mediated antibacterial activity as well as IgG. Second, the amount of IgG required to induce cell-mediated antibacterial activity is similar to the amount required for complement-mediated killing. Third, although the amount of either postimmunization or convalescent IgM required to induce complement-mediated killing is 16- to 20-fold less than the amount of respective IgG required, IgM is inferior to IgG in its ability to induce cell-mediated antibacterial activity because in the cell-mediated system (a) postimmunization IgM is ineffective; (b) the amount of convalescent IgM required for minimal activity is eightfold more than the amount of convalescent IgG required; and (c) the maximal antibacterial index induced by convalescent IgM is 50% less than that which can be induced by IgG. These data suggest that IgG and IgA may play a greater role than IgM in mononuclear cell-mediated antibacterial host immune defense.

Antibodies, Bacterial↗

PubMed1984

Histopathological findings of acute and convalescent myocarditis obtained by serial endomyocardial biopsy.

Serial endomyocardial biopsy findings in 20 cases with acute myocarditis of possible viral origin were analyzed. The histopathological findings were analyzed during the acute (0-10 days after the onset: 8.3 +/- 1.9 days; 6 cases), the subacute (11-21 days: 18.2 +/- 2.2 days, 6 cases), and the convalescent stages (22-167 days: 54.5 +/- 45.4 days; 8 cases). The incidence and severity of various changes of the cardiac myocytes and interstitial changes were analyzed and compared at each stage of the disease. In the acute stage, interstitial cell infiltrations were composed of fibroblasts, macrophages and lymphocytes, taken out in descending order. In the convalescent stage, interstitial cell infiltration showed a marked increase and was replaced by fibrocytes. In the subacute stage, transitional changes between the acute and convalescent stages were observable. A controlled myocardium in 21 cases with myocardial infarction which were compared at various stages revealed that in the acute stage, neutrophils were most prominent, and in the subacute and convalescent stages, macrophages were most prominent and plasma cells were most often observed. The time course changes of the histopathological findings in acute myocarditis were as follows: In the acute stage, Interstitial cell infiltration which is composed of fibroblasts, macrophages and lymphocytes, fragmentation of the muscle bundles, myocytolytic changes, swelling and scarcity of the cytoplasm and swelling of nuclei, variation in size of the myocytes, disarrangement of the muscle bundles, interstitial edema, increased glycogen deposition in the myocytes, abnormal branching of the myocytes, and interstitial fibrosis were observable. In the convalescent stage, most of the above described findings were still observable except for the myocytolytic change, swelling of myocytes and interstitial edema.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗

PubMed1981

Shedding of Treponema hyodysenteriae, transmission of disease, and agglutinin response to pigs convalescent from swine dysentery.

Fecal shedding of Treponema hyodysenteriae, transmission of disease, and humoral antibody production against the large spirochete were evaluated in pigs convalescent from experimentally induced swine dysentery. Untreated pigs (n = 21) and 5 pigs that had been treated with virginiamycin were included in the study. Treponema organisms were culturally detected in the feces of 2 untreated pigs as long as 70 and 71 days, and in the feces of 1 treated pig as long as 83 days after the last clinical evidence of disease. Of 8 convalescent pigs that intermittently discharged T hyodysenteriae in their feces, 4 transmitted clinical disease to exposed susceptible pigs. One of the convalescent animals has been free of clinical signs of disease for 57 days before introduction of the susceptible pigs. Treated and untreated convalescent pigs developed similarly elevated agglutinin titers that were maintained as long as 150 days after infection. There was no apparent correlation between the frequency or duration of fecal shedding of the spirochetes and the magnitude of the agglutinin titers of the convalescent pigs.

Agglutination Tests↗

PubMed1985

Histopathologic and ultrastructural observations of acute and convalescent myocarditis: a serial endomyocardial biopsy study.

Serial endomyocardial biopsy findings were analyzed in ten cases with acute myocarditis of possible viral origin. The histopathologic findings were analyzed at the acute (0-10 days after the onset), subacute (11-21 days), and convalescent stages (22-167 days). The incidence and severity of various cardiac myocyte and interstitial changes were compared at each stage of the disease. The time-course changes of the histopathologic findings in acute myocarditis were as follows. At the acute stage, we observed: interstitial cell infiltration composed of fibroblasts, macrophages, and lymphocytes, fragmentation of the muscle bundles, myocytolytic changes, swelling and scarcity of the cytoplasm and swelling of nuclei, variation in size of the myocytes, disarrangement of the muscle bundles, interstitial edema, increased glycogen deposition in the myocytes, abnormal branching of the myocytes, and interstitial fibrosis. At the convalescent stage, most of the above findings could still be seen except for myocytolytic changes, swelling of myocytes, and interstitial edema. At the subacute and convalescent stages, an increase in abnormal branching and in double nuclei in the myocytes and nuclear degeneration became observable. A further control study comparing the changes at the convalescent stage of myocarditis and the myocardial changes in cases with chronic right ventricular overload in 58 cases revealed that in the former fragmentation of the muscle bundles, abnormal branching, size variation, glycogen deposition, and large mononuclear cell infiltrations were significantly more frequent. Ultrastructural observation of the myocytes revealed that they have a great potentiality for regeneration; myocytes showing severe myocytolytic changes may recover to regain an architecture of almost normal appearance.

Acute Disease↗

PubMed2001

Pain and convalescence after laparoscopic cholecystectomy.

Pain and speed of convalescence are the two main problems after uncomplicated laparoscopic cholecystectomy. We therefore identified interventional and descriptive studies in electronic databases and supplemented them with manual searches. Pain and interventional analgesic studies were analysed with reference to the effects on specific pain components after laparoscopic cholecystectomy. Convalescence and factors associated with early recovery were also analysed. Pain after cholecystectomy is most intense for the first 2-3 days with a high interindividual variability and dominated by incisional pain rather than other pain components. Early pain after cholecystectomy is reduced by minimising residual pneumoperitoneum and by giving incisional local anaesthetics, epidural analgesia, and non-steroidal anti-inflammatory drugs. There are inconclusive data about type and pressure of pneumoperitoneum, the use of intraperitoneal local anaesthetics, and the type of general anaesthesia. Pain and medico-cultural traditions are the main factors responsible for prolonged convalescence after laparoscopic cholecystectomy. To minimise pain and the duration of convalescence, we recommend multi-modal analgesic treatment in combination with short, standardised instructions to resume work and normal activity.

Analgesics↗

PubMed1992

Doppler assessment of left ventricular diastolic filling pattern during the convalescent stage of acute myocardial infarction. Effects of infarct size and coronary thrombolysis.

Pulsed Doppler echocardiography was used to study left ventricular diastolic filling pattern (LVDFP) over the convalescent stage of acute myocardial infarction (AMI) in 25 patients. Twelve normal subjects served as a control group. The patients were divided on the basis of enzymatically estimated infarct size into 2 groups: 7 as the large AMI group, and the other 18 as the small AMI group. Peak early diastolic filling velocity (E) and the ratio of E to peak filling velocity at atrial contraction (E/A ratio) were determined from the Doppler transmitral flow velocity recordings at 1 and 4 weeks after the onset of AMI. At 1 week E and E/A ratio were significantly lower in the small AMI group compared to the control and the large AMI groups, however, there was no significant difference in E and E/A ratio between the control and the large AMI groups. E/A increased with cumulative CK release among the patients (r = 0.54, p < 0.01). In the following 3 weeks E and E/A ratio decreased only in the large AMI group, and E and E/A ratio at 4 weeks weakly correlated with pulmonary capillary wedge pressure (r = 0.63, p < 0.01 and r = 0.65, p < 0.01) and ejection fraction (r = 0.50, p < 0.05 and r = 0.62, p < 0.01) among the patients. There was no significant difference in E or E/A ratio between patients with and without coronary thrombolysis. Thus, LVDFP in the early convalescent stage of AMI was characterized by low E and E/A ratio in patients with small AMI, however, a "pseudonormalized" pattern was observed in patients with large AMI. The effect of the infarct size on LVDFP diminished in the late convalescent stage of AMI. LVDFP in patients with AMI appears to be influenced by the infarct size and by the time of study. The effect of coronary thrombolysis on LVDFP was not evident throughout the convalescent stage of AMI in this study.

Convalescence↗

PubMedDate not supplied

[Use of natural vitamin supplements in children during convalescence and in children with athletic activities].

BACKGROUND AND AIMS: Sporting activities and periods of convalescence call for an added intake of nutrients in children. This study aimed to evaluate the effect of a natural vitamin supplement on diet, food intake, body composition and muscular strength in children during convalescence and in children practising sports. METHODS: A comparative study was performed in two different groups of subjects: 20 children aged between 6 and 12 years old during convalescence following infections of upper airways, and 20 9-year-old children forming part of a football team. All subjects were randomly subdivided into two groups who were respectively given a vitamin supplement (Vitality Roeder 2000 Junior) or a placebo for 4 weeks. Weight, body composition using and muscolar strength using dynamometer measured before and after the study and a food diary was kept for 3 days before each visit. RESULTS: No significant differences in body mass and strength emerged from the data collected in the athletic group, whereas an increase was observed in appetite, calorie intake, weight and muscular strength in the convalescent group (p < 0.05). A significant increase in vitamin B12, B3, B5 and D levels was observed in both groups. CONCLUSIONS: The supplement to provides an adequate intake for those categories at risk of vitamin deficiency or in conditions of increased requirements.

Child↗

PubMed1999

[Cardiovascular function in leptospirosis convalescents].

AIM: To study mechanisms of cardiovascular damage in leprospirosis convalescents. MATERIALS AND METHODS: Cardiovascular system was investigated in 121 leptospirosis convalescents at the age 17-58 years clinically, electrocardiographically and measuring troponin-T in blood serum. RESULTS: 6-12 months after leptospirosis 42.1% of patients who had leptospiral jaundice (88.4%) and bovine leptospirosis (21.6%) myocardial damages were revealed. In spite of disappearance of cardiac pain ECG readings did not return to normal. The myocardial damage has developed in the advanced stage of leptospirosis due to rhandomyolis: high concentration of myoglobin and troponin-T in the blood serum confirms this suggestion. CONCLUSION: Clinical ECG readings as well as the level of troponin-T in the blood serum may be considered as the index of rehabilitation level in leptospirosis convalescents. It should be taken into consideration that 19.8% of the convalescents develop hypertension of renal genesis. This should be accounted for when planning prophylaxis and rehabilitation programs for young patients living in the North Caucasus--natural source of leptospirosis.

Adolescent↗

PubMed2003

[Outcome and tendency of late convalescence in icterohemorrhagic leptospirosis].

To elucidate the time of onset and duration of complications of icterohemorrhagic leptospirosis (IL), a clinical course of early and late convalescence was analysed in 170 patients who were followed up for 1.5-9 years. It was found that affection of hepatobiliary, urinary, cardiovascular and nervous systems persisted for a year after the acute disease in 65.3, 67.6, 31.8 and 13.5% patients, respectively. The organ of vision was affected for 1 year in 7.1% patients. A total of 86% patients retained the above disorders in early convalescence (for a year). In early convalescence the author observed development of such diseases as chronic hepatitis, a latent stage of chronic renal failure, myocardiac myocardiodystrophy. Nervous and ocular complications manifested both in early and late convalescence (4-18 months). The complications combined in 66.0% cases, renal dysfunction + hepatic dysfunction being most frequent. Endogenic infection foci activated within 6 months after IL. In 19.4% patients, the pathological process prolonged up to 1.5 years. In 5.3% patients it can last for several years. It is concluded that IL patients should be followed up for 1.5 years, combined pattern of organ affection typical for IL should be taken into account.

Adolescent↗

PubMed1992

Potential for hepatic and renal dysfunction during influenza B infection, convalescence, and after induction of secondary viremia.

Whether infection with influenza B virus alters hepatic function was examined in the ferret. Also, the possibility that viral-specific antibodies (Ab) could be produced well before their detection in serum was explored. During the febrile period of influenza, reductions in the serum potassium, anion gap, ammonia, albumin and CPK and elevations of the BUN, creatinine and the GGTP levels occurred. With convalescence, the electrolytes, BUN and creatinine normalized, FFA, SGPT and CPK levels rose and the serum GGTP rose even further. Hepatic fatty acid (FA) oxidation, ornithine transcarbamylase (OTC) and carnitine palmitoyltransferase (CPT) activities were minimally altered and liver ATP and total lipid content remained normal. Following experimental secondary viremia, serum FFA continued to rise, TG decreased and CPK remained elevated while SGPT and GGTP levels normalized. In the liver, FA oxidation and OTC rates remained unchanged but CPT activity was inhibited and the liver content of ATP was significantly reduced. Immune complex (IC) protein recovered from postmicrosomal supernatant fractions by polyethylene glycol precipitation was progressively increased in livers from convalescent and viremic animals. While the amount of IC protein recovered in the spleen also increases during convalescence, this is not the case after viremia when the IC formed seem to be processed largely by the liver. By SDS/PAGE, the major proteins identified in the IC were IgM and other viral proteins. However, the viral proteins could not be validated by immunoblot with Ab produced against purified influenza B hemagglutinin (HA) and neuraminidase (NA) most probably due to phagocytic alterations of glycoprotein immunodeterminants. These findings indicate that during influenza, convalescence and post viremia changes in the concentrations of several serum and liver components occur that reflect hepatic involvement. Also, antiviral Ab, largely IgM, appears to be produced early, complexes with Ag and can be found sequestered in both the liver and spleen at a time when Ab is not detectable in the serum.

Adenosine Triphosphate↗

PubMed1988

Convalescent phase of bipolar disorder.

The interepisode interval in bipolar disorder has been relatively unstudied, in part because patients are generally considered to be well during that period. The author proposes that a symptomatic convalescent phase follows acute episodes of mania and depression and precedes the return to the entirely well state. A case is presented of a 15-month convalescence that followed a manic episode. The most prominent features of the convalescence were its long duration, its saw-toothed pattern of remitting and recurring symptoms, and the presence of dysphoria. The fluctuation of dysphoric symptoms was at times associated with and at times independent of life events and was independent of lithium levels. Supportive psychotherapy is apparently a critical element in the management of this phase. Questions about the nature and optimal management of the convalescent period are raised.

Bipolar Disorder↗

PubMed1995

Smaller ports result in shorter convalescence after laparoscopic varicocelectomy.

Minimal postoperative pain and a shorter convalescence after laparoscopic surgery are attributable to the small puncture wounds produced to accommodate trocars. We investigated the effects of trocar size on convalescence after 37 laparoscopic varicocelectomies. The initial 21 patients underwent the procedure with 2, 10 mm. ports and 1, 5 mm. port, while the last 16 underwent surgery with 3, 5 mm. ports. Postoperative convalescence was evaluated by a questionnaire. The patients who underwent the 5 mm. port technique achieved complete pain relief, returned to work and could resume work at preoperative levels significantly earlier than those who underwent the 10 mm. port technique (2.4 +/- 1.5 days versus 5.9 +/- 4.8 days, p < 0.03; 8.2 +/- 3.1 days versus 10.0 +/- 2.5 days, p < 0.03, and 10.2 +/- 4.4 days versus 14.3 +/- 6.5 days, p < 0.03, respectively). Our study showed that laparoscopic surgery with smaller ports resulted in less postoperative pain and a shorter convalescence than when larger 10 mm. ports were used.

Adolescent↗