McDonnell, John G
The transversus abdominis plane (TAP) block is a novel approach for blocking the abdominal wall neural afferents via the bilateral lumbar triangles of Petit. We evaluated its analgesic efficacy in patients during the first 24 postoperative hours after abdominal surgery, in a randomized, controlled, double-blind clinical trial.
Sada, Fatos; Krasniqi, Avdyl; Hamza, Astrit; Gecaj-Gashi, Agreta; Bicaj, Besnik; Kavaja, Floren
Background Carbohydrate-rich liquid drinks (CRLDs) have been recommended to attenuate insulin resistance by shortening the preoperative fasting interval. The aim of our study the effect of preoperative oral administration of CRLDs on the well-being and clinical status of patients. Methods A randomized, double blind, prospective study of patients undergoing open colorectal operations (CR) and open cholecyctectomy (CH) was conducted. Patients were divided into three groups: study, placebo, and ...
Ya-Min Zheng; Fei Li; Ming-Ming Zhang; Xiao-Ting Wu
AIM: To assess the clinical and economical validity of glutamine dipeptide supplemented to parenteral nutrition(PN) in patients undergoing abdominal surgery.METHODS: A meta-analysis of all the relevant randomized controlled trials (RCTs) was performed. The trials compared the standard PN and PN supplemented with glutamine dipeptide in abdominal surgery. RCTs were identified from the following electronic databases:the Cochrane Library, MEDLINE, EMBASE and ISI web of knowledge (SCI). The search was undertaken in April 2006. Literature references were checked by computer or hand at the same time. Clinical trials were extracted and evaluated by two reviewers independently. Statistical analysis was performed by RevMan4.2 software from Cochrane Collaboration. A P value of ＜0.05 was considered statistically significant.RESULTS: Nine RCTs involving 373 patients were included. The combined results showed that glutamine dipeptide has a positive effect in improving postoperative cumulative nitrogen balance (weighted mean difference (WMD = 8.35, 95% CI [2.98, 13.71], P = 0.002),decreasing postoperative infectious morbidity (OR = 0.24,95% CI [0.06, 0.93], P = 0.04), shortening the length of hospital stay (WMD= -3.55, 95% CI [-5.26, -1.84], P＜0.00001). No serious adverse effects were found.CONCLUSION: Postoperative PN supplemented with glutamine dipeptide is effective and safe to decrease the infectious rate, reduce the length of hospital stay and improve nitrogen balance in patients undergoing abdominal surgery. Further high quality trials in children and severe patients are required, and mortality and hospital cost should be considered in future RCTs with sufficient size and rigorous design.
Legemate Dink A
Full Text Available Abstract Background Intravenous (IV fluid administration is an essential part of postoperative care. Some studies suggest that a restricted post-operative fluid regime reduces complications and postoperative hospital stay after surgery. We investigated the effects of postoperative fluid restriction in surgical patients undergoing major abdominal surgery. Methods In a blinded randomized trial, 62 patients (ASA I-III undergoing elective major abdominal surgical procedures in a university hospital were allocated either to a restricted (1.5 L/24 h or a standard postoperative IV fluid regime (2.5 L/24 h. Primary endpoint was length of postoperative hospital stay (PHS. Secondary endpoints included postoperative complications and time to restore gastric functions. Results After a 1-year inclusion period, an unplanned interim analysis was made because of many protocol violations due to patient deterioration. In the group with the restricted regime we found a significantly increased PHS (12.3 vs. 8.3 days; p = 0.049 and significantly more major complications: 12 in 30 (40% vs. 5 in 32 (16% patients (Absolute Risk Increase: 0.24 [95%CI: 0.03 to 0.46], i.e. a number needed to harm of 4 [95%CI: 2–33]. Therefore, the trial was stopped prematurely. Intention to treat analysis showed no differences in time to restore gastric functions between the groups. Conclusion Restricted postoperative IV fluid management, as performed in this trial, in patients undergoing major abdominal surgery appears harmful as it is accompanied by an increased risk of major postoperative complications and a prolonged postoperative hospital stay. Trial registration Current Controlled Trials ISRCTN16719551
Gefke, K; Schroeder, T V; Thisted, B; Olsen, P S; Perko, M J; Agerskov, Kim; Røder, O; Lorentzen, Jørgen Ewald
The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 55......, 78% stated that their quality of life had improved or was unchanged after surgery and had resumed working. These data justify a therapeutically aggressive approach, including ICU therapy following AAA surgery, despite failure of one or more organ systems.......The goal of this study was to identify patients who need longer care in the ICU (more than 48 hours) following abdominal aortic aneurysm (AAA) surgery and to evaluate the influence of perioperative complications on short- and long-term survival and quality of life. AAA surgery was performed in 553...
Full Text Available This was a randomized double-blinded study; in which 60 ASAI-II adult patients scheduled for major abdominal surgeries (colostomy, radical cystectomy, major gynecological surgery, and abdominal vascular surgery were received standard general anesthesia. Twenty minutes before the anticipated end of surgery, patients were randomized into two equal groups: dexmedetomidine group (group D and morphine group (group M. Group D received dexmedetomidine IV infusion 4µg/kg/h for 15 minutes (1µg/Kg followed by 0.4µg/kg/h for 3h. Group M received morphine sulfate IV (0.07mg/kg. All patients were given a morphine patient controlled analgesia (PCA pump in the post anesthesia care unit (PACU, delivering IV morphine 2mg with a lockout time of 5 minutes if pain score assessed through visual analog scale (VAS was more than 5 at any given 5-min assessment. During the PACU recovery period, morphine consumption; pain and sedation scores; hemodynamic variables (heart rate, mean arterial blood pressure, oxygen saturation and respiratory rate; and postoperative nausea, retching and vomiting (PONV were recorded every 30 min for 3h (study period by a member of staff blinded to the treatment. The study demonstrated that the use of dexmedetomidine led to significant decrease in the total amount of morphine consumed throughout the entire PACU recovery period (P0.05; significant decrease in mean arterial pressure (P0.05; without any significant changes in oxygen saturation (P<0.05 or respiratory rate (P<0.05. In conclusion, dexmedetomidine exhibited both analgesic and sedative properties. The associated cardiovascular protective pharmacological profile and the lack of respiratory depression made it potentially extremely interesting for postoperative analgesia after major abdominal surgeries.
Staehr Anne K
Full Text Available Abstract Background A high perioperative inspiratory oxygen fraction (FiO2 may reduce the frequency of surgical site infection. Perioperative atelectasis is caused by absorption, compression and reduced function of surfactant. It is well accepted, that ventilation with 100% oxygen for only a few minutes is associated with significant formation of atelectasis. However, it is still not clear if a longer period of 80% oxygen results in more atelectasis compared to a low FiO2. Our aim was to assess if a high FiO2 is associated with impaired oxygenation and decreased pulmonary functional residual capacity (FRC. Methods Thirty-five patients scheduled for laparotomy for ovarian cancer were randomized to receive either 30% oxygen (n = 15 or 80% oxygen (n = 20 during and for 2 h after surgery. The oxygenation index (PaO2/FiO2 was measured every 30 min during anesthesia and 90 min after extubation. FRC was measured the day before surgery and 2 h after extubation by a rebreathing method using the inert gas SF6. Results Five min after intubation, the median PaO2/FiO2 was 69 kPa [53-71] in the 30%-group vs. 60 kPa [47-69] in the 80%-group (P = 0.25. At the end of anesthesia, the PaO2/FiO2 was 58 kPa [40-70] vs. 57 kPa [46-67] in the 30%- and 80%-group, respectively (P = 0.10. The median FRC was 1993 mL [1610-2240] vs. 1875 mL [1545-2048] at baseline and 1615 mL [1375-2318] vs. 1633 mL [1343-1948] postoperatively in the 30%- and 80%-group, respectively (P = 0.70. Conclusion We found no significant difference in oxygenation index or functional residual capacity between patients given 80% and 30% oxygen for a period of approximately 5 hours. Trial registration ClinicalTrials.gov Identifier: NCT00637936.
Peter M Spieth; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J.; Pelosi, Paolo; Koch, Thea; Gama de Abreu, Marcelo
Background General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventila...
Vester-Andersen, M; Waldau, T; Wetterslev, J; Møller, M H; Rosenberg, J; Jørgensen, L N; Jakobsen, J C; Møller, Ann
BACKGROUND: Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was to evaluate the effect and feasibility of intermediate care compared with standard ward care in...
Full Text Available Abstract Background Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ventilation strategy with a conventional mechanical ventilation strategy during general anesthesia for abdominal non-laparoscopic surgery. Methods The PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure ("PROVHILO" trial is a worldwide investigator-initiated multicenter randomized controlled two-arm study. Nine hundred patients scheduled for non-laparoscopic abdominal surgery at high or intermediate risk for post-operative pulmonary complications are randomized to mechanical ventilation with the level of PEEP at 12 cmH2O with recruitment maneuvers (the lung-protective strategy or mechanical ventilation with the level of PEEP at maximum 2 cmH2O without recruitment maneuvers (the conventional strategy. The primary endpoint is any post-operative pulmonary complication. Discussion The PROVHILO trial is the first randomized controlled trial powered to investigate whether an open lung mechanical ventilation strategy in short-term mechanical ventilation prevents against postoperative pulmonary complications. Trial registration ISRCTN: ISRCTN70332574
Full Text Available Background: Perioperative pain is prevalent and poorly treated. Apart from that it makes the recovery from surgery unpleasent, pain often remains as a residual side effect of surgery, even though the tissue healing is complete. An essential observation is that tissue injury and the resulting nociceptor barrage initiates a cascade of events that can indelibly alter pain perception. Preemptive analgesia is the concept of initiating analgesic therapy before the onset of the noxious stimulus so as to prevent the nociceptor barrage and its consequences. However, anticipated clinical potency of preemptive analgesia, though has firmly grounded in the neurobiology of pain, has not been yet realized. As data accumulates, it has become clear that clinical studies emulating those from the laboratory and designed around a relatively narrow definition of preemptive analgesia have been largely unsupportive of its use. Nevertheless, preemptive analgesic interventions that recognize the intensity, duration, and somatotopic extent of major surgery can help reduce perioperative pain and its longer-term sequelae. surgeons spend a lot of time treating the pain of lower abdominal surgery. Methods: A total number of 48 consecutive patients who were going to undergo elective lower abdominal surgery. Were randomly assigned in two groups of 24 each. In one group the patients received an injection of 0.5 % bupivacaine in the planned skin for incision just before lower abdominal surgery, and in the other group, they received an equal amount of 0.5% bupivacaine after the surgery had been done. Pain was objectified by a numerical visual pain score, in the 24 hours following the lower abdominal surgery. Results: There were no differences in postoperative pain scores on the visual analog scale (VAS: In groups 1and 2, VAS at hour 4 were 6.37±1.13 versus 6.29±1.19; At hour 8 were 5.54 ± 1.17 versus 5.37±1.09; and at hour 12 were 4.5 ± 1.31 versus 4.45 ± 1
Full Text Available Background: Post-operative nausea and vomiting is one of the most common and distressing complications after anesthesia and surgery. It may lead to serious post-operative complications. Ramosetron is a newer 5-HT3 receptor antagonist and has more potent and longer duration of antiemetic effects compared to first generation 5HT3 receptor antagonists. The purpose of this study was to compare the efficacy of Ramosetron for the prevention of post-operative nausea and vomiting with that of Ondansetron in patients undergoing abdominal surgeries under general anesthesia. Methods: In this randomized, double-blind study, 60 patients, 18-60 years of both genders falling under ASA I-II category scheduled for abdominal surgery were included. Group I received I.V ramosetron 0.3 mg while group II received I.V Ondansetron 4 mg at the time of extubation. The standard general anesthetic technique was used throughout. Postoperatively the incidences of nausea, vomiting, and safety assessments were performed at 1, 2, 6, and 24 h during the first 24 h after surgery. Results: There were no differences between groups with respect to patient demographics. The percentage of patients who had complete response (no PONV, and no need for another rescue antiemetic from 0 to 24 h after anesthesia was 56% with ramosetron and 33% with ondansetron. The corresponding rates at 1, 2, 6, and 24 h after anesthesia were 76% and 63%, 76% and 50%, 100 and 83%, 100 and 93%, respectively. Safety profiles of the two drugs were comparable, as no clinically serious adverse effects caused by study drugs were observed in either of the groups. Conclusion: Our study concludes that prophylactic therapy with ramosetron is highly efficacious than ondansetron in preventing PONV in patients undergoing abdominal surgery under general anesthesia.
Full Text Available Background: Regional anesthetic techniques can be used to alleviate postoperative pain in patients undergoing major upper abdominal surgery. Our aim was to evaluate the efficacy of bilateral ultrasound (US-guided rectus sheath (RS and transversus abdominis plane (TAP blocks for better perioperative analgesia. Patients and Methods: It is a prospective, observer-blinded, randomized clinical study. 40 eligible patients undergoing elective liver resection or Whipple procedure were included. All patients received a standardized anesthetic technique. Group 1 (n = 20 received preincisional US-guided bilateral RS and TAP blocks using 20 ml volume of bupivacaine 0.25% for each, and group 2 (n = 20 received local wound infiltration at end of surgery with 40 ml of bupivacaine 0.25%. A standardized postoperative analgesic regimen composed of intravenous paracetamol and a morphine patient-controlled analgesia (PCA. The use of intraoperative fentanyl and recovery room morphine boluses, PCA-administered morphine, pain scores as well as number of patients′ experienced postoperative nausea and vomiting in the ward at 6 and 24 h were recorded. Results: Group 1 patients received a significantly lower cumulative intraoperative fentanyl, significantly lesser boluses of morphine in postanesthesia care unit, as well, significantly lower cumulative 24 h postoperative morphine dosage than the group 2 patients. Pain visual analog scale scores were significantly lower at both 6 and 24 h postoperatively in TAP group when compared with the no-TAP group. There were no complications related to the TAP block procedures. No signs or symptoms of local anesthetic systemic toxicity were detected. Conclusion: The combination of bilateral US-guided RS and TAP blocks provides excellent perioperative analgesia for major upper abdominal surgery.
Full Text Available Background: Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epidurally administered butorphanol and fentanyl combined with bupivacaine (B. Materials and Methods: A total of 75 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 20-60 years, undergoing lower abdominal under epidural anesthesia were enrolled into the study. Patients were randomly divided into three groups of 25 each: B, bupivacaine and butorphanol (BB and bupivacaine + fentanyl (BF. B (0.5% 20 ml was administered epidurally in all the three groups with the addition of 1 mg butorphanol in BB group and 100 μg fentanyl in the BF group. The hemodynamic parameters as well as various block characteristics including onset, completion, level and duration of sensory analgesia as well as onset, completion and regression of motor block were observed and compared. Adverse events and post-operative visual analgesia scale scores were also noted and compared. Data was analyzed using ANOVA with post-hoc significance, Chi-square test and Fisher′s exact test. Value of P < 0.05 was considered significant and P < 0.001 as highly significant. Results: The demographic profile of patients was comparable in all the three groups. Onset and completion of sensory analgesia was earliest in BF group, followed by BB and B group. The duration of analgesia was significantly prolonged in BB group followed by BF as compared with group B. Addition of butorphanol and fentanyl to B had no effect on the time of onset, completion and regression of motor block. No serious cardio-respiratory side effects were observed in any group. Conclusions: Butorphanol and fentanyl as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory
Full Text Available Background: The aim of this study was to compare the postoperative pain scores and morphine requirements between spinal anesthesia (SA with hyperbaric bupivacaine 0.5% and general anesthesia (GA with 1 Minimal alveolar concentration minimal alveolar concentration (MAC of isoflurane in 50% N 2 O and O 2 after elective lower abdominal surgery. Materials and Methods: In this randomized clinical trial, 68 patients with American Society of Anesthesiologists (ASA I or II undergoing lower abdominal surgery were randomly assigned to have elective lower abdominal surgery under SA (n = 34 or GA (n = 34. The SA group received 3 cc of 0.5% hyperbaric bupivacaine (15 mg, at L3-L4 interspace intrathecally and also 2 mic/kg fentanyl and 0.15 mg/kg morphine intravenously for intraoperative analgesia. In the GA group, induction of anesthesia was carried out with Na thiopental 6 mg/kg body weight, fentanyl 2 mic/kg body weight, morphine 0.15 mg/kg, and atracurium 0.6 mg/kg body weight, and then, trachea was intubated. The primary outcome was postoperative pain scores at rest and under stress on a visual analog scale and the secondary outcome was morphine requirement by the patients. Outcome measures were recorded at 2, 4, 6, 12, and 24 h postoperatively. The duration of postanesthesia care unit (PACU and hospital stay were recorded. Intraoperative parameters, postoperative pain scores, complications, recovery time, and the duration of hospital stay at follow up were compared between the two groups. Results: Patients in SA group had significantly lower scores of a postoperative pain at rest (3.4 ± 1.6 and 4.1 ± 1.2 at 2 and 4 h postoperatively vs. 5.2 ± 1.5 and 5.8 ± 0.9 in the GA group with P < 0.05, but there were no significant differences between both groups for scores of postoperative pain at 6, 12, and 24 h. The amount of morphine requirement in 6 h postoperatively was significantly lower in the SA group (10.2 ± 4.3 mg vs. 15.6 ± 5.6 mg in the GA group
Kahokehr, Arman Adam
The intraperitoneal wound is often forgotten after transperitoneal surgery. This review is a on the peritoneum and the implications of peritoneal injury after surgery. This review will focus on the intraperitoneal wound response after surgical injury.
Full Text Available BACKGROUND: Among all the spinal adjuvants, clonidine, an alpha - 2 agonist has the ability to alleviate both the somatic and visceral pain and is more potent at spinal site, favoring its neuraxial administration. OBJECTIVE: This study was done to compare the onset and duration of sensory and motor blocks, duration of analgesia, haemodynamic and adverse effects of Clonidine, buprenorhine and fentanyl used intrathecally with hyperbaric 0.5% bupuvacaine. SETTINGS & DESIGN: This prospective, randomized and comparative study included 90 ASA class 1 & 2 patients undergoing lower abdominal and lower limb surgeries under spinal anesthesia after approval from hospital ethics committee with written i nformed consent of patients. MATERIALS AND METHOD S: Patients were randomly allocated into three groups (n=30 and received 50μg of clonidine, 25μg of fentanyl and 75μg of buprenorphine respectively in group BC,BF and BB as adjuvants to 15mg of 0.5% hyperba ric bupivacaine (3.0ml. The onset time and duration of sensory and motor block, duration of analgesia, haemodynamic changes and side effects were recorded. RESULTS: The onset time of motor block and durations of sensory, motor blockade and analgesia were prolonged in - group BC as compared to group BF and BB (P.05. Group BC had lower heart rate and mean blood pressure and higher sedation score. CONCLUSION: Intr athecal Clonidine in a dose of 50μg is an effective adjuvant to local anesthetics in neuraxial blocks despite mild sedation and haemodynamic variations.
Hedenstierna Göran; Binnekade Jan M; Hollmann Markus W; Tschernko Edda M; Hiesmayr Michael; Wrigge Hermann; Canet Jaume; Jaber Samir; Severgnini Paolo; Hemmes Sabrine NT; Putensen Christian; Abreu Marcelo; Pelosi Paolo; Schultz Marcus J
Abstract Background Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP) and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ven...
Bodoky, A; Heberer, M; Iwatschenko, P; Harder, F
Needle catheter jejunostomy is used to a varying extent today. Therefore, the need for nutritional support was evaluated following elective abdominal surgery and compared to experiences with postoperative enteral feeding. Oesophagectomy, total gastrectomy and the Whipple procedure were identified as good indications for catheter jejunostomy, whereas with other types of operation an individual decision is required. PMID:3935397
Full Text Available Pulmonary complications encountered in 67 patients undergoing upper abdominal surgery in our unit in one year period are analysed. Pulmonary function tests and their post-operative reduction, as also the risk factors are discussed. Pathophysiology responsible for pulmonary complications is outlined.
Chen, Zhiqiang; Cao, Lixing; Wen, Zehuai; Cui, Naiqiang; Li, Naiqing; Xie, Jianxing; Tan, Zhijian; Luo, Zhenbin; Wang, Shusheng; Qin, You; Chen, Xiuhua; Xu, Zhenhua; Ou, Aihua; Shang, Wenfan; Jiang, Zhi
Background: The importance of postoperative gastrointestinal function recovery is being increasingly recognized. In this multi-center randomized controlled study, we evaluated the efficacy and safety of Evodia hot compress (ECS) plus electro-acupuncture (EA) for patients who developed postoperative gastrointestinal tract dysfunction after abdominal surgery. Methods: 1009 patients who developed postoperative gastrointestinal tract dysfunction after abdominal surgery were enrolled. All patients...
Analysis of the surgical criteria for reintervention in Abdominal Surgery led to the accentuation of a certain number of pictures of occlusion, general infectious syndromes, postoperative peritonitis, gastro-intestinal fistula and hemorrhagic syndrome. In all cases, the clinical examination can be misleading in particular in the case of peritonitis, and the history and non-surgical criteria must be strongly borne in mind. PMID:2036
Prospective controlled randomized trial on prevention of postoperative abdominal adhesions by Icodextrin 4% solution after laparotomic operation for small bowel obstruction caused by adherences [POPA study: Prevention of Postoperative Adhesions on behalf of the World Society of Emergency Surgery
Full Text Available Abstract Background Adhesive small intestine occlusion [ASIO] is an important cause of hospital admission placing a substantial burden on healthcare systems worldwide. Often times, ASIO is associated with significant morbidity and mortality. Icodextrin 4% solution [Adept, Shire Pharmaceuticals, UK] is a high-molecular-weight a-1,4 glucose polymer that is approved in Europe for use as an intra-operative lavage and a post-operative instillate to reduce the occurrence of post-surgery intra-abdominal adhesions. There are no randomized trials on the use of this solution to prevent adhesions after ASIO operation in current medical literature. The current clinical study evaluates the safety and effectiveness of Icodextrin 4% for decreasing the incidence, extent, and severity of adhesions in patients after abdominal surgery for ASIO. Design The study project is a prospective, randomized controlled investigation performed in the Department of Transplant, General and Emergency Surgery of St. Orsola-Malpighi University Hospital [Bologna, Italy]. The study is designed and conducted in compliance with the principles of Good Clinical Practice regulations. The study compares the results of Icodextrin 4% against a control group who does not receive anti-adhesion treatment. This randomized study uses a double-blind procedure to evaluate efficacy end points. In other words, designated third party individuals who are unaware of the treatment assigned to the patients to assess adhesion formation. Trial Registration Number ISRCTN22061989 Prospective controlled randomized trial on Prevention of Postoperative Abdominal Adhesions by Icodextrin 4% solution after laparotomic operation for small bowel obstruction caused by adherences [POPA study: Prevention of Postoperative Adhesions
Gopala Krishna Alaparthi; Alfred Joseph Augustine *; Anand R; Ajith Mahale
Objective:This study was designed to evaluate the efficacy of two types of incentive spirometer (flow andvolume) on pulmonary function and diaphragm excursion in patients who underwent laparoscopic surgery.Materials and Methods:Twenty sample sizes with eleven men and nine women who underwent laparoscopicsurgery were randomly divided as follows: 10 subjects performed flow oriented incentive spirometer group,and other 10 subjects performed volume oriented incentive spirometer group. (Other ther...
Haug, E S; Saether, O D; Odegaard, A; Johnsen, G; Myhre, H O
Two patients developed chylous complications following abdominal aortic aneurysm repair. One patient had chylous ascitis and was successfully treated by a peritoneo-caval shunt. The other patient developed a lymph cyst, which gradually resorbed after puncture. Chylous complications following aortic surgery are rare. Patients in bad a general condition should be treated by initial paracentesis and total parenteral nutrition, supplemented by medium-chain triglyceride and low-fat diet. If no improvement is observed on this regimen, the next step should be implementation of a peritoneo-venous shunt, whereas direct ligation of the leak should be reserved for those who are not responding to this treatment. PMID:10204656
Full Text Available Introduction. Kidney anomalies present a challenge even for the most experienced vascular surgeon in the reconstruction of the aortoilliac segment. The most significant anomalies described in the surgery of the aortoilliac segment are a horse-shoe and ectopic kidney. Objective. The aim of this retrospective study was to analyze experience on 40 patients with renal anomalies, who underwent surgery of the aortoilliac segment and to determine attitudes on conventional surgical treatment. Methods. In the period from 1992 to 2009, at the Clinic for Vascular Surgery of the Clinical Centre of Belgrade we operated on 40 patients with renal anomalies and aortic disease (aneurysmatic and obstructive. The retrospective analysis involved standard epidemiological data of each patient (gender, age, risk factors for atherosclerosis, type of anomaly, type of aortic disease, presurgical parameter values of renal function, type of surgical approach (laparatomy or retroperitoneal approach, classification of the renal isthmus, reimplantation of renal arteries and perioperative morbidity and mortality. Results. Twenty patients were males In 30 (70% patients we diagnosed a horse-shoe kidney and in 10 (30% ectopic kidney. In the cases of ruptured aneurysm of the abdominal aorta the diagnosis was made by ultrasound findings. Pre-surgically, renal anomalies were confirmed in all patients, except in those with a ruptured aneurysm who underwent urgent surgery. In all patients we applied medial laparatomy, except in those with a thoracoabdominal aneurysm type IV, when the retroperitonal approach was necessary. On average the patients were under follow-up for 6.2 years (from 6 months to 17 years. Conclusion. Under our conditions, the so-called double clamp technique with the preservation of the kidney gave best results in the patients with renal anomalies and aortic disease.
Cherry, Kevin M.; Wang, Shijun; Turkbey, Evrim B.; Summers, Ronald M.
We propose a new method for detecting abdominal lymphadenopathy by utilizing a random forest statistical classifier to create voxel-level lymph node predictions, i.e. initial detection of enlarged lymph nodes. The framework permits the combination of multiple statistical lymph node descriptors and appropriate feature selection in order to improve lesion detection beyond traditional enhancement filters. We show that Hessian blobness measurements alone are inadequate for detecting lymph nodes in the abdominal cavity. Of the features tested here, intensity proved to be the most important predictor for lymph node classification. For initial detection, candidate lesions were extracted from the 3D prediction map generated by random forest. Statistical features describing intensity distribution, shape, and texture were calculated from each enlarged lymph node candidate. In the last step, a support vector machine (SVM) was trained and tested based on the calculated features from candidates and labels determined by two experienced radiologists. The computer-aided detection (CAD) system was tested on a dataset containing 30 patients with 119 enlarged lymph nodes. Our method achieved an AUC of 0.762+/-0.022 and a sensitivity of 79.8% with 15 false positives suggesting it can aid radiologists in finding enlarged lymph nodes.
Slabach, Rachel; Suyderhoud, Johan P.
Anesthesia considerations for abdominal wall reconstruction (AWR) are numerous and depend upon the medical status of the patient and the projected procedure. Obesity, sleep apnea, hypertension, and cardiovascular disease are not uncommon in patients with abdominal wall defects; pulmonary functions and cardiac output can be affected by the surgical procedure. Patients with chronic obstructive pulmonary disease are also at a higher risk of coughing during the postoperative awakening process, wh...
N. I. Gabrielyan
Full Text Available This article provides an overview of new approaches to the prevention of infectious complications of bacterial nature after the high-technology operations in the abdominal surgery, first of all, after liver transplantation. At- tention is drawn to the first positive results of randomized studies on the use of biological preparations - probi- otics, prebiotics and synbiotics in patients after liver transplantation. The authors prove the prospects of further development of this subject based on successful model experiments on animals and various operational interven- tions in abdominal surgery.
SH Bassampour; A Nikbakht Nasrabadi; A Mehran; Z Poresmaeil; S Valiee
Background & Aim: Anxiety is one of the emotional conditions among patients scheduled for surgery that can result in increasing postoperative pain, increasing analgesic and anesthetic requirements and prolonging hospital stay. The aim of this study was to assess the effectiveness of acupressure (acupuncture without needle) in reducing patients' anxiety before abdominal surgeries. Methods & Materials: In this randomized, blinded, sham controlled trial, 70 patients who were...
Ringold, Forrest G.; Minkowitz, Harold S; Gan, Tong Joo; Aqua, Keith A.; Chiang, Yu-Kun; Evashenk, Mark A; Palmer, Pamela P
Background and Objectives This study evaluates the efficacy and safety of a sufentanil sublingual tablet system (SSTS) for the management of postoperative pain following open abdominal surgery. Methods At 13 hospital sites in the United States, patients following surgery with pain intensity of greater than 4 on an 11-point numerical rating scale were randomized to receive SSTS dispensing a 15-μg sufentanil tablet sublingually with a 20-minute lockout or an identical system dispensing a placeb...
Xing-Zhen Wang; Li-Hong Lu; Hui-Yan Deng
Objective:To study effect of nursing intervention on early rehabilitation of patients with abdominal surgery.Methods: A total of 90 patients with abdominal surgery were randomly divided into observation group and control group by half. Patients in the control group were given routine nursing care, observation group given conventional gum chewing training and anal contraction movements.Results:In the observation group anal exhaust time, indwelling gastric tube and catheter time defecate, eating time, hospitalization days were significantly reduced compared with controls (P 0.05). Conclusions: Strengthened perioperative nursing, gum chewing training and anal contraction movements can promote gastrointestinal functional recovery after abdominal surgery. It can shorten hospitalization time, reduce the patients' pain. It is safety, effective and worthy clinical application.
Mohammad Shariati; Masuod Yunesian; Iraj Harirchi; Ahmad Khosravi
Introduction: This study aims to clarify the effects of implementing a series of virtual patients in undergraduate surgery education on various dimensions of skills as applied to clinical problems. Methods: In a randomized controlled trial 48 surgery clerks were assigned to an intervention group who worked on 14 simulated cases of abdominal pain during 7 weeks in a computer lab and a control group without access to software. At the end of the intervention, both groups were tested by a structu...
Hovens, Iris B; van Leeuwen, Barbara L; Mariani, Massimo A; Kraneveld, Aletta D; Schoemaker, Regien G
Postoperative cognitive dysfunction (POCD) is a debilitating surgical complication, with cardiac surgery patients at particular risk. To gain insight in the mechanisms underlying the higher incidence of POCD after cardiac versus non-cardiac surgery, systemic and central inflammatory changes, alterations in intraneuronal pathways, and cognitive performance were studied after cardiac and abdominal surgery in rats. Male Wistar rats were subjected to ischemia reperfusion of the upper mesenteric artery (abdominal surgery) or the left coronary artery (cardiac surgery). Control rats remained naïve, received anesthesia only, or received thoracic sham surgery. Rats were subjected to affective and cognitive behavioral tests in postoperative week 2. Plasma concentrations of inflammatory factors, and markers for neuroinflammation (NGAL and microglial activity) and the BDNF pathway (BDNF, p38MAPK and DCX) were determined. Spatial memory was impaired after both abdominal and cardiac surgery, but only cardiac surgery impaired spatial learning and object recognition. While all surgical procedures elicited a pronounced acute systemic inflammatory response, NGAL and TNFα levels were particularly increased after abdominal surgery. Conversely, NGAL in plasma and the paraventricular nucleus of the hypothalamus and microglial activity in hippocampus and prefrontal cortex on postoperative day 14 were increased after cardiac, but not abdominal surgery. Both surgery types induced hippocampal alterations in BDNF signaling. These results suggest that POCD after cardiac surgery, compared to non-cardiac surgery, affects different cognitive domains and hence may be more extended rather than more severe. Moreover, while abdominal surgery effects seem limited to hippocampal brain regions, cardiac surgery seems associated with more wide spread alterations in the brain. PMID:26867718
The aim of this article is to expound on the crossing and influence each other of gastrointestinal surgery and abdominal wall hernia surgery. Although these two departments are independent respectively, but due to the existence of association among anatomy, physiology and pathology, so they are also overlapping. First of all, the abdominal wall and digestive tract are interdependent, and the abdominal wall provides "protection" for gut. In case of large abdominal wall defect, intra-abdominal viscera, breathing, circulation system and spine will change accordingly. In addition, when intra-abdominal pressure increases due to various reasons, laparotomy is an effective way. But laparotomy is not an easy case, but a crisis. One of the most difficult problems is "enteroatmospheric fistulae". Therefore, to avoid serious complications after laparotomy, the concept of planned ventral hernia is proposed. When life safety is threatened by inter-abdominal hypertension, planned abdominal wall hernia is the style to save life. This is a kind of concept of innovation, and is the concrete practice of the theory of damage control surgery. For a planned abdominal wall hernia patient, it is better to wait and watch, and after making a comprehensive assessment, multidisciplinary collaboration mode should be applied to ensure the safety of surgery. PMID:26616795
Maurice Ogaick,1 Guillaume Martel1,2 1Department of Surgery, 2Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada Abstract: There are several laparoscopic surgery abdominal wall access techniques. The most useful and well-established is the open Hasson technique. The Veress needle closed technique is another alternative, but its use is controversial owing to possibly higher rates of rare insertion complications. Optical trocars have been developed in an attempt to de...
Stengel, Andreas; Goebel, Miriam; Wang, Lixin; Taché, Yvette
Abdominal surgery-induced postoperative gastric ileus is well established to induce Fos expression in specific brain nuclei in rats within 2-h after surgery. However, the phenotype of activated neurons has not been thoroughly characterized. Nesfatin-1 was recently discovered in the rat hypothalamus as a new anorexigenic peptide that also inhibits gastric emptying and is widely distributed in rat brain autonomic nuclei suggesting an involvement in stress responses. Therefore, we investigated whether abdominal surgery activates nesfatin-1-immunoreactive (ir) neurons in the rat brain. Two hours after abdominal surgery with cecal palpation under short isoflurane anesthesia or anesthesia alone, rats were transcardially perfused and brains processed for double immunohistochemical labeling of Fos and nesfatin-1. Abdominal surgery, compared to anesthesia alone, induced Fos expression in neurons of the supraoptic nucleus (SON), paraventricular nucleus (PVN), locus coeruleus (LC), Edinger-Westphal nucleus (EW), rostral raphe pallidus (rRPa), nucleus of the solitary tract (NTS) and ventrolateral medulla (VLM). Double Fos/nesfatin-1 labeling showed that of the activated cells, 99% were nesfatin-1-immunoreactive in the SON, 91% in the LC, 82% in the rRPa, 74% in the EW and VLM, 71% in the anterior parvicellular PVN, 47% in the lateral magnocellular PVN, 41% in the medial magnocellular PVN, 14% in the NTS and 9% in the medial parvicellular PVN. These data established nesfatin-1 immunoreactive neurons in specific nuclei of the hypothalamus and brainstem as part of the neuronal response to abdominal surgery and suggest a possible implication of nesfatin-1 in the alterations of food intake and gastric transit associated with such a stressor. PMID:19944727
Full Text Available Purpose. Transversus abdominis plane (TAP blocks have been shown to reduce pain and opioid requirements after abdominal surgery. The aim of the present case series was to demonstrate the use of TAP catheter injections of bupivacaine after major abdominal surgery. Methods. Fifteen patients scheduled for open colonic resection surgery were included. After induction of anesthesia, bilateral TAP catheters were placed, and all patients received a bolus dose of 20 mL bupivacaine 2.5 mg/mL with epinephrine 5 μg/mL through each catheter. Additional bolus doses were injected bilaterally 12, 24, and 36 hrs after the first injections. Supplemental pain treatment consisted of paracetamol, ibuprofen, and gabapentin. Intravenous morphine was used as rescue analgesic. Postoperative pain was rated on a numeric rating scale (NRS, 0–10 at regular predefined intervals after surgery, and consumption of intravenous morphine was recorded. Results. The TAP catheters were placed without any technical difficulties. NRS scores were ≤3 at rest and ≤5 during cough at 4, 8, 12, 18, 24, and 36 hrs after surgery. Cumulative consumption of intravenous morphine was 28 (23–48 mg (median, IQR within the first 48 postoperative hours. Conclusion. TAP catheter bolus injections can be used to prolong analgesia after major abdominal surgery.
Gogenur, I.; Wildschiotz, G.; Rosenberg, J.
Background. It is believed that the severely disturbed night-time sleep architecture after surgery is associated with increased cardiovascular morbidity with rebound of rapid eye movement (REM). The daytime sleep pattern of patients after major general surgery has not been investigated before. We...... decided to study the circadian distribution of sleep phases before and after surgery. Methods. Eleven patients undergoing elective major abdominal surgery were included in the study. Continuous ambulatory polysomnographic monitoring was made 24 h before surgery and 36 h after surgery, thus including two...... nights after operation. Sleep was scored independently by two blinded observers and the recordings were reported as awake, light sleep (LS, stages I and II), slow wave sleep (SWS, stages III and IV), and REM sleep. Results. There was significantly increased REM sleep (P=0.046), LS (P=0.020), and reduced...
Full Text Available Maurice Ogaick,1 Guillaume Martel1,2 1Department of Surgery, 2Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada Abstract: There are several laparoscopic surgery abdominal wall access techniques. The most useful and well-established is the open Hasson technique. The Veress needle closed technique is another alternative, but its use is controversial owing to possibly higher rates of rare insertion complications. Optical trocars have been developed in an attempt to decrease complication rates even further, although the evidence base supporting their use is limited. Single-incision laparoscopic surgery (SILS is used in certain centers to carry out various abdominal surgeries, but most commonly appendectomy and cholecystectomy. To date, SILS appears safe and feasible, with possibly greater costs and operative time. Natural orifice translumenal endoscopic surgery (NOTES is an evolving area of incisionless surgery. While some progress has been made in achieving transgastric or transvaginal peritoneal endoscopic access, this technique remains largely unproven and best-suited for experimental or clinical trial protocols. Keywords: laparoscopy, Hasson, Veress, optical trocar, SILS, NOTES
BACKGROUND: Intra-abdominal pressure (IAP) is a harbinger of intra-abdominal mischief, and its measurement is cheap, simple to perform, and reproducible. Intra-abdominal hypertension (IAH), especially grades 3 and 4 (IAP > 18 mmHg), occurs in over a third of patients and is associated with an increase in intra-abdominal sepsis, bleeding, renal failure, and death. PATIENTS AND METHODS: Increased IAP reading may provide an objective bedside stimulus for surgeons to expedite diagnostic and therapeutic work-up of critically ill patients. One of the greatest challenges surgeons and intensivists face worldwide is lack of recognition of the known association between IAH, ACS, and intra-abdominal sepsis. This lack of awareness of IAH and its progression to ACS may delay timely intervention and contribute to excessive patient resuscitation. CONCLUSIONS: All patients entering the intensive care unit (ICU) after emergency general surgery or massive fluid resuscitation should have an IAP measurement performed every 6 h. Each ICU should have guidelines relating to techniques of IAP measurement and an algorithm for management of IAH.
Rada, Gabriel; Viñuela, José
This Living FRISBEE (Living FRIendly Summary of the Body of Evidence using Epistemonikos) is an update of the summary published in November 2014, based on four new systematic reviews published since then. Postoperative ileus is common condition that delays recovery after an abdominal surgery. Early use of sham feeding with chewing gum stimulates peristalsis and would allow an earlier nutrition. Searching in Epistemonikos database, which is maintained by screening 30 databases, we identified 18 systematic reviews including 81 randomized trials. We combined the evidence using meta-analysis and generated a summary of findings following the GRADE approach. We concluded that chewing gum probably reduces the length of hospital stay after an abdominal surgery. PMID:25627680
Gögenur, I; Rosenberg-Adamsen, S; Kiil, C;
BACKGROUND: The aim of this study was to examine subjective sleep quality before and after laparoscopic vs open abdominal surgery. METHODS: Twelve patients undergoing laparoscopic cholecystectomy and 15 patients undergoing laparotomy were evaluated with the aid of a sleep questionnaire from 4 days...... before until 4 weeks after surgery. RESULTS: Following laparoscopic surgery, total sleep time increased during the 1st week after the operation compared with preoperative values (p = 0.02), whereas sleep duration during weeks 2, 3, and 4 did not differ from the times reported preoperatively. Following...... laparotomy, sleep duration increased during the 1st, 3rd, and 4th weeks after the operation compared with preoperative values (p < 0.05). All patients experienced postoperative circadian sleep disturbance, with significantly more sleep during the daytime compared with preoperative values; the disturbance was...
Oka, T; Ozawa, Y; Sato, J
The present study was carried out to clarify the effects of chest deformation by upper abdominal retractor on respiratory system impedance during abdominal surgery. We measured the impedances of respiratory system (RS), lung, and chest wall (CW) in nine anesthetized paralyzed subjects employing a pseudorandom noise forced volume oscillation technique. These measurements were performed before and after the lifting chest wall by upper abdominal retractor. The effects of chest deformation was significant on the impedances of RS, lung, while no discernible effect was found in CW impedance. Lifting chest wall decreased RS resistance which was totally accounted for by the decrease in lung resistance, whereas the lifting did not affect reactance in either RS or lung. The mathematical modeling showed the significant lifting effect on the resistance of the parenchyma. In conclusion, change in RS mechanics produced by chest deformation by upper abdominal retractor is dominated in lung but not in CW. Among the lung mechanical components, parenchyma is the primary site of the lifting effect. PMID:10087819
Full Text Available Abstract Objective This study aimed to investigate clinical features of abdominal emergency surgery in elderly patients, and to determine factors predicting mortality in these patients. Methods The study population included 94 patients aged 80 years or older who underwent emergency surgery for acute abdominal diseases between 2000 and 2010. Thirty-six patients (38.3% were male and fifty-eight patients (61.7% were female (mean age, 85.6 years. Main outcome measures included background of the patient’s physical condition (concomitant medical disease, and performance status, cause of disease, morbidity and mortality, and disease scoring system (APACHE II, and POSSUM. Prognostic factors affecting mortality of the patient were also evaluated by univariate analysis using Fisher’s exact test and Mann–Whitney U–test, and by multivariate analysis using multiple logistic regression analysis. Results Of the 94 patients, 71 (75.5% had a co-existing medical disease; most patients had hypertension (46.8%. The most frequent surgical indications were acute cholecystitis in 23 patients (24.5%, followed by intestinal obstruction in 18 patients (19.1%. Forty-one patients (43.6% had complications during hospital stay; the most frequent were surgical site infection (SSI in 21 patients (22.3% and pneumonia in 12 patients (12.8%. Fifteen patients died (overall mortality, 16% within 1 month after operation. The most common causes of death were sepsis related to pan-peritonitis in 5 patients (5.3%, and pneumonia in 4 patients (4.3%. Multiple logistic regression analysis showed that time from onset of symptoms to hospital admission and the POSSUM scoring system could be prognostic factors for mortality. Conclusions Mortality in elderly patients who underwent emergency surgery for acute abdominal disease can be predicted using the disease scoring system (POSSUM and on the basis of delay in hospital admission.
Baskiran, Adil; Otan, Emrah; Aydin, Cemalettin; Kayaalp, Cuneyt
INTRODUCTION Discovery of abdominal masses often poses significant diagnostic difficulties. GISTs are mesenchymal masses, with specific histological features. Dimensions may vary from millimeters to giant tumours. We would like to present our case, which had an unexpectedly easy operative course which was easily handled with a simple surgical excision with a short operative duration. PRESENTATION OF CASE A 38 years old female patient was diagnosed to have an abdominal heterogen mass of 15 cm × 12 cm × 10 cm in dimension. Abdominal computed tomography revealed the solid mass between the stomach and pancreas corpus and tail, possibly orginating from the pancreas. With the preoperative diagnosis of locally invasive distal pancreas cancer the patient underwent laparotomy, following the dissection, the mass was observed to be originating from the posterior gastric Wall, extending exophytically with a peduncle of 5 cm in width, without any visual evidence for peritoneal invasion and metastasis. The tumour and the peduncle was resected with stapler device. Total operation time was 30 min. Postoperative course was uneventful. Pathologic diagnosis was gastrointestinal stromal tumour (GIST). DISCUSSION Pedunculated large GISTs are not frequent and they can enlarge as 15 cm in diameter and compress the neighbouring organs. When they were huge, it is difficult to differentiate the origin of the masses. GISTs should be considered in differential diagnosis of giant abdominal masses. CONCLUSION When GISTs are huge and pedunculated, it can be difficult to differentiate the origin of the masses. This case report presents unexpectedly ease surgery for a worrysome abdominal mass. PMID:23999120
Full Text Available Candida endocarditis is an emerging infectious disease, usually involving patients with intravascular prosthetic devices, and associated with substantial morbidity and mortality. A 28-year-old primigravida at 32 weeks of gestation was admitted with low-grade fever and lower abdominal pain for 2 weeks. She had undergone open appendicectomy 2 months before admission. Echocardiogram showed a pedunculated 24 mm × 21 mm mass attached to the undersurface of anterior mitral leaflet near the tip and moderate mitral regurgitation. Repeated blood cultures showed growth of nonalbicans candida. She was immediately started on liposomal amphotericin and was taken up for surgery, but despite all efforts she succumbed to her illness.
Jing Zhao; Ai-lun Luo; Li Xu; Yu-guang Huang
Objective To evaluate the effect of intraoperative combined forced-air warming and fluid warming system on patient's core temperature, blood loss, transfusion demand, extubation time, and incidence of postoperative shivering.Methods Forty patients with American Society of Anesthesiologists physical status Ⅰ and Ⅱ, aged 18-70 years, scheduled for elective abdominal surgery were randomly assigned to receive intraoperative warming from a forced-air blanket and fluid warming system or conventional cotton blanket, 20 in each group. The core temperature was recorded every 20 minutes during the operation, as well as the blood loss, blood transfusion, extubation time, and incidence of postoperative shivering.Results The core temperature at the end of the surgery in the wanning group was significantly different from that in the control group (36.4±0.4C vs. 35.3±0.5°C, P＜0.001). Application of intraoperative warming significantly shortened the time between the end of the surgery and extubation (P＜0.01). Postoperative shivering occurred in 30% of the patients in the control group compared to no patient in the warming group (P ＜0.01).Conclusion Active warming with air-forced blanket and fluid warming system provides sufficient heat to prevent hypothermia during abdominal surgery.
Hasegawa, Kenji; Negishi, Chiharu; Nakagawa, Fumitoshi; Ozaki, Makoto
Purpose It has been reported that recently developed circulating-water garments transfer more heat than a forced-air warming system. The authors evaluated the hypothesis that circulating-water leg wraps combined with a water mattress better maintain intraoperative core temperature ≥36°C than either forced-air warming or carbon-fiber resistive heating during major abdominal surgery. Methods Thirty-six patients undergoing open abdominal surgery were randomly assigned to warming with: (1) circul...
Hilsted, J; Wilken-Jensen, Charlotte; Birch, K;
Adrenaline-induced changes in heart rate, blood pressure, plasma adrenaline and noradrenaline, cortisol, glucagon, insulin, cAMP, glucose lactate, glycerol and beta-hydroxybutyrate were studied preoperatively and 4 and 24 h after skin incision in 8 patients undergoing elective cholecystectomy. Late...... postoperative responses of blood glucose, plasma cAMP, lactate and glycerol to adrenaline infusion were reduced, whereas other responses were unaffected. Blood glucose appearance and disappearance rate as assessed by [3H]3-glucose infusion was unchanged pre- and postoperatively. The increase in glucose...... appearance rate following adrenaline was similar pre- and postoperatively. These findings suggest that several beta-receptor-mediated responses to adrenaline are reduced after abdominal surgery....
Boshkoska, Biljana Mileva; Damij, Talib; Jelenc, Franc; Damij, Nadja
We provide a continuation of the existing Activity Table Modeling methodology with a modular spreadsheets simulation. The simulation model developed is comprised of 28 modeling elements for the abdominal surgery cycle process. The simulation of a two-week patient flow in an abdominal clinic with 75 beds demonstrates the applicability of the methodology. The simulation does not include macros, thus programming experience is not essential for replication or upgrading the model. Unlike the existing methods, the proposed solution employs a modular approach for modeling the activities that ensures better readability, the possibility of easily upgrading the model with other activities, and its easy extension and connectives with other similar models. We propose a first-in-first-served approach for simulation of servicing multiple patients. The uncertain time duration of the activities is modeled using the function "rand()". The patients movements from one activity to the next one is tracked with nested "if()" functions, thus allowing easy re-creation of the process without the need of complex programming. PMID:26004999
Demian, Atef D; Wahba, Ashraf M; Atia, Emad M; Hussein, Sami H
This randomized study was designed to compare the effectiveness of bilateral interpleural analgesia with lumbar epidural analgesia, on postoperative pain relief in upper abdominal surgery. The studied patients were randomely allocated into either interpleural group "IP" (n = 15) or epidural group "EP" (n = 15). In "IP" group, preanesthetic bilateral interpleural block was done using a mixture of bupivacaine 0.5% (0.8 mg/kg) and 2 mg morphine diluted to 50 ml saline for each side. In "EP" group, the same mixture-diluted in 20 ml saline-was injected in the epidural space (L2-3). The general anesthetic technique was the same in both groups. Hemodynamic, gasometric, verbal pain score (VPS) values and complications were compared in both techniques. Heart rate (HR) and mean arterial pressure (MAP) readings were in the accepted normal range in the perioperative period although significant lower readings were detected in "EP" group. No significant differences were displayed in blood gasometric variables between the two groups. There were considerable level of analgesia in both groups in the postoperative period although "EP" analgesia was superior to "IP". More pain free patients (9 versus 4) and significant lower consumption of nalbuphine were detected in "EP" group. The results of this study indicate that bilateral "IP" analgesia may offer a satisfactory analgesia for upper abdominal surgery when the use of other analgesic techniques may be contraindicated. PMID:14740589
Møller, Jacob; Jensen, Martin Bach; Frandsen, E.;
OBJECTIVE: To investigate the possible beneficial effects of growth hormone (GH) in catabolic patients we examined the impact of GH on body fluid distribution in patients with ulcerative colitis undergoing elective abdominal surgery. DESIGN AND MEASUREMENTS: Twenty-four patients (14 female, 10 male......) aged 19-47 years were in a double-blinded study randomly assigned to receive either placebo (n = 12) or GH (n = 12) 6 i.u. s.c. twice daily from 2 days before until 7 days after ileo-anal J pouch surgery. Extracellular and plasma volume (ECV, PV) were determined using 82Br and 125I albumin dilution at...... day -2 and at day 7, and body composition was estimated by dual X-ray absorptiometry and bioimpedance. Changes in body weight and fluid balance were recorded and hence intracellular volume was assessed. RESULTS: During placebo treatment body weight decreased 4.3 +/- 0.6 kg; during GH treatment body...
Rasmussen, Morten Schnack; Jørgensen, Lars Nannestad; Wille-Jørgensen, Peer
pulmonary embolism (PE)) as assessed by objective means (ascending bilateral venography, ultrasonography, pulmonary ventilation/perfusion scintigraphy, spiral CT scan or autopsy). Studies exclusively reporting on clinical diagnosis of VTE, without objective confirmation were excluded. DATA COLLECTION AND...... remains controversial. Some studies suggest that patients undergoing major abdominal surgery benefit from prolongation of the thromboprophylaxis to 1 month after surgery. No systematic review on prolonged thromboprophylaxis after major abdominal or pelvic surgery has been published. OBJECTIVES: To...
GENCER, Abdulhamit; Yavuz ÖZDEMİR; Sücüllü, İlker; Filiz, Ali İlker; YÜCEL, Ergün; AKIN, M. Levhi; Yıldız, Mehmet
Objective: We aimed to investigate the effects of enteral immunonutrition and Total Parenteral Nutrition (TPN) on the immune system and acute inflammatory response of patients who underwent major abdominal surgery. Material and Methods: Sixty gastric or colorectal cancer patients were randomized into two groups. Enteral immunonutrition was given to the first group and TPN was given to the second group. Albumin, prealbumin, retinol binding globulin (RBP), transferrin, IL-2, IL-6, CRP...
Li-Hua Dai; Bo Xu; Guang-Hui Zhu
AIM: To design a hand-assisted laparoscopic approach in an attempt to provide an option for laparoscopic resection of abdominal large viscera.METHODS: A 5-6 cm incision (for HandPort) and 2 trocars were employed. The main vessel of the target organ was taken as a "core", and all tissues around the core were taken as peripheral structures. The peripheral structures were dissected first, and the core vessels were treated last. Twenty-six patients underwent laparoscopic deroofing of the hepatic huge cysts, resection of the segments lying at the outer edge of the liver (segments 2 to 6), splenectomy, hemicolectomy, ileocecectomy and subtotal gastrectomy with HandPort device, harmonic scalpel, or Ligasure.RESULTS: The duration of the procedure was within 2 hours. Blood loss amounted to 8-120 mL. The conversion rate was 3.8% (1/26). All patients had uneventful postoperative courses with less pain, earlier oral intake,and faster recovery, compared with conventional surgery.CONCLUSION: This method combines the advantages of both open and laparoscopic techniques, achieving better hemostasis effect, shortening the operative time,and is beneficial to the patients.
Yue-ping Fan; Jian-chun Yu; Wei-ming Kang; Qun Zhang
Objective To evaluate the effects of supplementation of glutamine (GLN) on maintaining glutathione (GSH) level, immune system function, liver function, and clinical outcome of patients receiving abdominal operation. Methods Forty patients undergoing elective abdominal surgical treatment were randomly divided into 2 groups: study group (n = 20) and control group (n = 20). All patients received total parenteral nutrition (TPN) for up to 7 days during perioperative period. The study group received TPN supplemented with GLN dipeptide while the control group received TPN without GLN dipeptide. Patients in both groups received equivalent nitrogen and caloric intake. Blood sample was taken on preoperative day, and the 1st, 3rd, 6th postoperative day to measure GSH level, immune indexes, and liver function indexes. Results The decrease of GSH level in plasma and red blood cell (RBC) in study group was less than that in control group during postoperative period. Ratio of GSH/glutathione disulfide (GSSG) in plasma in study group was higher than that in control group on the 3rd postoperative day (52.53 ± 11.46 vs. 31.43 ± 7.27, P = 0.001). Albumin level in study group was higher than that in control group on the 3rd postoperative day (37.7 ± 3.8 g/L vs. 33.8 ± 4.2 g/L, P = 0.02). There was no significant difference in the levels of immunoglobin (IgG, IgM, IgA) or T lymphocyte subgroup (CD4, CD8, CD4/CD8) in both groups during postoperative period. There was one case with infectious complication in control group, while none in study group. A trend of shortened hospital stay was observed in study group compared with control group (22.3 ± 2.1 d vs. 24.9 ± 1.7 d, P = 0.32). Conclusions Supplementation of GLN-enriched TPN has beneficial effects on maintaining GSH levels in plasma and RBC, sustaining GSH/GSSG ratio and albumin level, and keeping antioxidant abilities during postoperative period in patients with abdominal operation, with the trends of decreasing incidence of
Zhi QIAO; Zhanliang LI; Jiye LI; Lianrong LU; Yi LV; Junyou LI
sely related with bacterial translocation. Intestinal bacterial translocation (most commonly E. coli) might occur at early stage (2 h) after ab-dominal surgery. Postoperative SIRS and infection might bear a close relationship with bacterial translocation.
Aliya Ahmed; Naveed Latif; Robyna Khan
Background: Post-operative pain is often inadequately treated. Optimal utilization of the available resources is essential for improving pain management. Aims: The aim of our study was to determine pain management strategies employed after major abdominal surgeries at our institute and their efficacy and safety. Settings and Design: Prospective observational study conducted at a tertiary care hospital. Materials and Methods: Patients undergoing elective major abdominal surgeries w...
Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim
The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described. PMID:24553513
Hall, J. C.; Tarala, R. A.; Tapper, J.; Hall, J L
OBJECTIVE--To evaluate the prevention of respiratory complications after abdominal surgery by a comparison of a global policy of incentive spirometry with a regimen consisting of deep breathing exercises for low risk patients and incentive spirometry plus physiotherapy for high risk patients. DESIGN--Stratified randomised trial. SETTING--General surgical service of an urban teaching hospital. PATIENTS--456 patients undergoing abdominal surgery. Patients less than 60 years of age with an Ameri...
In an open controlled study, 248 consecutive patients (age more than 40 yrs) admitted for major abdominal surgery were randomized to one of three prophylactic antithrombotic treatments. Eighty-five patients received subcutaneous heparin, 74 patients had graduated compression stockings to the knee (TED stockings), and 89 patients had both subcutaneous heparin and stockings. Treatment began on the evening before operation and continued to complete mobilization, or for not less than five days postoperatively. On the fourth or fifth postoperative day, the patients underwent a /sup 99m/Tc-plasmin test of the lower limbs as a test for deep vein thrombosis. There were 29.7% positive tests in the stocking group, 29.4% in the group with heparin prophylaxis, and 25.8% in the combined group. Differences between treatments were not statistically significant
A PROSPECTIVE, RANDOMIZED, DOUBLE BLIND, CONTROLLED CLINICAL STUDY OF ADJUVANT EFFECT OF FENTANYL (1 µg/kg OR CLONIDINE (2µg / kg TO ROPIVACAINE 0.2% 1ML/KG FOR CAUDAL ANALGESIA IN CHILDREN UNDERGOING LOWER ABDOMINAL SURGERIES
Full Text Available Ropivacaine having better safety profile and less motor blockade than bupivacaine is well suited for caudal analgesia. Since studies done regarding the effect of fentanyl and clonidine as adjuvants to ropivacaine for prolongation of caudal analgesia are scant and have shown conflicting results, the present study was conducted. METHODS: A total of 90 children aged between 3-6yrs belonging to ASA class I and II undergoing surgical procedures below the umbilicus were randomly allocated to one of two groups: Group R received ropivacaine 0.2%, 1 ml/kg with saline 0.02ml/kg and Group RF received ropivacaine 0.2%, 1 ml/kg with fentanyl 1 μg/kg (0.02ml/kg and Group RC (clonidine received 1ml/kg of 0.2% Ropivacaine plus clonidine 2µg / kg caudally after induction of general endotracheal anaesthesia. The pain score was evaluated using Hannallah pain scale, motor blockade using modified bromage scale and sedation assessed using 4 point sedation score at 30 minutes after extubation and at 1, 2, 4, 6, 12 and 24 h. The time to awakening, first analgesic requirement time, number of doses of rescue analgesic and side-effects in a 24 hours period were also recorded. The results were evaluated using SPSS 17 statistical method. RESULTS: There were no differences in demographic characteristics between the groups. However, mean duration of caudal analgesia was 659.5 minutes in group R, 784.5 minutes in group RF and 960.5 minutes in group RC which was statistically highly significant (P<0.01.The total dose of rescue analgesic in 24 hours was lower in groups RF and RC. Also the number of children receiving rescue analgesia at 12 hours was higher in placebo group than fentanyl group and clonidine group which was statistically highly significant (P<0.01. Increased incidence of urinary retention and pruritis was noted in group RF which was statistically not significant (P=0.366. CONCLUSION: Addition of inj. Fentanyl 1µg/kg or clonidine 2µg/kg to Ropivacaine 0.2% 1ml
Grantcharov, T P; Rosenberg, J
. SETTING: Teaching hospital, Denmark. SUBJECTS: Patients undergoing open abdominal operations. INTERVENTIONS: For some of the variables (burst abdomen and incisional hernia) it was considered adequate to include retrospective studies. Studies were identified through Medline, Cochrane library, Embase, and a......, and late complications (incisional hernia). RESULTS: Eleven randomised controlled trials and seven retrospective studies were identified. The transverse incision offers as good an access to most intra-abdominal structures as a vertical incision. The transverse incision results in significantly less...
Chosidow, D; Lesurtel, M; Sauvat, F; Paugam, C; Johanet, H; Marmuse, J P; Benhamou, G
Abbreviated laparotomy and planned reoperation(s) is a new concept in severely injured patients with multivisceral failure by hemorrhagic shock, coagulopathy and hypothermia. The aim of an abbreviated laparotomy is to control hemorrhage, prevent digestive contamination and close the abdominal wall without tension. After a delay for reanimation during 24 to 96 hours, discovery of unknown lesions and anatomic reconstruction will be possible through planned reoperation in better conditions. Emergency reoperation for hemorrhage and abdominal hyperpression severely worsens prognosis. PMID:10921187
Full Text Available AIM: Aim of our study was to compare the relative effectiveness of gabapentin and clonidine premedication on patients undergoing elective abdominal surgeries under G.A. OBJECTIVE: gabapentine and clonidine have anti-nociceptive properties .This study assess their efficacy in prolonging the analgesic effect intra-operative and postoperative analgesic requirement. MATERIAL AND METHOD: 225 patients of either sex of age between 20-60 years, ASA grade I & II, patient admitted to Hamidia hospital for elective abdominal surgeries under general anaesthesia were included in the study. The patients were randomly allocated into three groups 75 each group I : Control group (patients received placebo tablet at 90 min before the surgery,group II Gabapentin 300 mg tablet orally 90 min before surgery ,groupIII:clonidine150µg tablet orally given 90 min before surgery. Duration of postoperative analgesia, Degree of postoperative pain (VAS scoreand added rescue analgesia required in 24 hrs were recorded postoperatively. RESULT: Analysis reveled that there was no difference in the HR, SBP among the three group during the study. Duration of postoperative analgesia, observed from time of reversal to first demand of analgesia in the recovery room was more in group II compared to group I and group III (p-value <0.001, highly significant. Pain perception was highly blunted in groups II compared to group I & group III. Total rescue analgesic requirement during the postoperative 24hrs period was much lower in group II inj Diclofenac compared to group I and group III . ( p-value < 0.001, highly significant.CONCLUSION: Given 90 min before induction of GA oral gabapentin(300 mg or clonidine(150 µg preoperatively was effective in lowering postoperative VAS pain score and consumption of analgesics, it was also shows that gabapentin significantly decreases postoperative pain intensity and analgesic consumption after abdominal surgeries.
Full Text Available Background: Pregabalin is a potent ligand for alpha-2-delta subunit of voltage-gated calcium channels in the central nervous system, which exhibits potent anticonvulsant, analgesic and anxiolytic activity. The pharmacological activity of pregabalin is similar to that of gabapentin and shows possible advantages. Although it shows analgesic efficacy against neuropathic pain, very limited evidence supports its postoperative analgesic efficacy. We investigated its analgesic efficacy in patients experiencing acute pain after abdominal hysterectomy and compared it with gabapentin and placebo. Methods: A randomized, double-blind, placebo-controlled study was conducted in 90 women undergoing abdominal hysterectomy who were anaesthetized in a standardized fashion. Patients received 300 mg pregabalin, 900 mg gabapentin or placebo, 1-2 hours prior to surgery. Postoperative analgesia was administered at visual analogue scale (VAS ≥3. The primary outcome was analgesic consumption over 24 hours and patients were followed for pain scores, time to rescue analgesia and side effects as secondary outcomes. Results: The diclofenac consumption was statistically significant between pregabalin and control groups, and gabapentin and control groups; however, pregabalin and gabapentin groups were comparable. Moreover, the consumption of tramadol was statistically significant among all the groups. Patients in pregabalin and gabapentin groups had lower pain scores in the initial hour of recovery. However, pain scores were subsequently similar in all the groups. Time to first request for analgesia was longer in pregabalin group followed by gabapentin and control groups. Conclusion: A single dose of 300 mg pregabalin given 1-2 hours prior to surgery is superior to 900 mg gabapentin and placebo after abdominal hysterectomy. Both the drugs are better than placebo.
Full Text Available PURPOSE: The objectives of this study were to compare the effects of caudal dexmedetomidine combined with Ropivacaine to provide postoperative analgesia in children and also to establish its safety in the pediatric patients. METHODS: In a randomized, prospective, parallel group, double-blinded study, 80 children of 1 year to 6years posted for lower abdominal surgeries were recruited and allocated into two groups: Group RD (n=40 received 0.25% Ropivacaine 1 ml/kg with dexmedetomidine2 μg/kg, making the volume to 0.5 ml and Group R (n=40 received 0.25% Ropivacaine1 ml/kg + 0.5 ml normal saline. Induction of anesthesia was achieved with Inj. Ketamine 2mg/kg + Inj. Succinylcholine 2mg/kg. Intubated with appropriate-sized Endotracheal tube and caudal block was performed in all patients. Maintained with 66% nitrous oxide in Oxygen and isoflurane 0.2-0.4%.Post-operative pain assessed with FLACC score. RESULTS: The duration of postoperative analgesia recorded a mean of 339 minutes (5.6hrs ± 2.4 hrs. in Group R compared with 884 minutes (14.7 hrs. ±5hrs in Group RD, with a p value of <0.001. Group RD patients achieved a statistically significant higher FLACC score compared with Group RD patients. The peri-operative hemodynamics were stable among both the groups. CONCLUSION: Caudal dexmedetomidine (2 μg/kg with 0.25%Ropivacaine (1 ml/kg for pediatric lower abdominal surgeries provides significant postoperative pain relief and better quality of sleep and a prolonged duration of arousable sedation.
He, Xingying; Jiang, Jingjing; Liu, Yuli; Xu, Haitao; Zhou, Shuangqiong; Yang, Shibo; Shi, Xueyin; Yuan, Hongbin
The aim of the study is to utilize electrical impedance tomography (EIT) to guide positive end-expiratory pressure (PEEP) and to optimize oxygenation in patients undergoing laparoscopic abdominal surgery.Fifty patients were randomly assigned to the control (C) group and the EIT (E) group (n = 25 each). We set the fraction of inspired oxygen (FiO2) at 0.30. The PEEP was titrated and increased in a 2-cm H2O stepwise manner, from 6 to 14 cm H2O. Hemodynamic variables, respiratory mechanics, EIT images, analysis of blood gas, and regional cerebral oxygen saturation were recorded. The postoperative pulmonary complications within the first 5 days were also observed.We chose 10 cm H2O and 8 cm H2O as the "ideal" PEEP for the C and the E groups, respectively. EIT-guided PEEP titration led to a more dorsal shift of ventilation. The PaO2/FiO2 ratio in the E group was superior to that in the C group in the pneumoperitoneum period, though the difference was not significant (330 ± 10 vs 305.56 ± 4 mm Hg; P = 0.09). The C group patients experienced 8.7% postoperative pulmonary complications versus 5.3% among the E group patients (relative risk 1.27, 95% confidence interval 0.31-5.3, P = 0.75).Electrical impedance tomography represents a new promising technique that could enable anesthesiologists to assess regional ventilation of the lungs and optimize global oxygenation for patients undergoing laparoscopic abdominal surgery. PMID:27057904
Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel;
patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating......AIMS AND OBJECTIVES: To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery. BACKGROUND: Emergency abdominal surgery is common, but little is known about how...... postoperative intermediate care after emergency abdominal surgery, the InCare trial. DESIGN: A qualitative study with individual semi-structured interviews. METHODS: We analysed interviews using Systematic Text Condensation. RESULTS: Eighteen patients (nine intervention/nine controls) were strategically sampled...
Full Text Available The post - operative pain can be treated by various approaches. Aim of this randomised prospective study was to compare two drugs (Tramadol and Pentazocine . 100 adult patients of both sexes of ASA status 1 & 2 posted for elective upper abdominal surgery were randomly assigned into two groups of 50 each, where Group 1 received Tramadol intravenously and Group 2 received Pentazocine intravenously as post - opera tive pain management. The efficacy of the analgesic effect of intravenous Tramadol & Pentazocine was compared during post - operative pain management. It was observed that Tramadol has got more potent analgesic action compared to equianalgesic dose of Pentaz ocine.
Yıldız, Ramazan; Öztaş, Muharrem; Şahin, Mehmet Ali; Yağcı, Gökhan
Complications arising from lumbar intervertebral disc surgery are rare but fatal. Major vascular injury is one complication that may end in death unless it is diagnosed and treated immediately. Herein we report an abdominal aortic injury due to L3–L4 intervertebral disc surgery that was treated successfully and discuss it in light of current literature. Diagnosis and treatment of an abdominal aortic injury in a 31-year-old male patient operated on for L3–L4 intervertebral disc degeneration is...
Burcharth, J; Pommergaard, H-C; Klein, M;
used to evaluate the actively healing fascia. Such an animal model may promote future research in the prevention of IH. Methods: 86 male Sprague-Dawley rats were used to establish a model involving six experiments (experiments A-F). Mechanical testing of the breaking strength of the healed fascia was......Background: Incisional hernia (IH) is a well-known complication after abdominal surgical procedures. The exact etiology of IH is still unknown even though many risk factors have been suggested. The aim of this study was to create an animal model of a weakly healed abdominal fascia that could be...... performed by testing tissue strips from the healed fascia versus the unincised control fascia 7 and 28 days postoperatively. Results: During the six experiments a healing model was created that produced significantly weaker coherent fascia when compared with the control tissue measured in terms of...
Sørensen, Henrik; Grocott, Hilary P; Secher, Niels H
PURPOSE: Cerebral deoxygenation, as determined by near infrared spectroscopy (NIRS), seems to predict postoperative complications following cardiac surgery. We identify the type of non-vascular abdominal surgery associated with cerebral deoxygenation and/or hyperoxygenation, how such deviations......; mini-mental state examination) and reduced LOS (14 versus 23 days) were seen. Also, during liver transplantation (LTx), impaired cerebral autoregulation (25%), cerebral deoxygenation in the anhepatic phase (36%) and cerebral hyperoxygenation with reperfusion of the grafted liver (14%) were identified...
Antoniou, Stavros A; Antoniou, George A; Antoniou, Athanasios I; Granderath, Frank-Alexander
Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927-2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concept, having performed the first laparoscopic appendectomy, inspiring Erich Mühe and many other surgeons around the world to perform a wide spectrum of procedures by minimally invasive means. Laparoscopic cholecystectomy soon became the gold standard, and various laparoscopic procedures are now preferred over open approaches, in the light of emerging evidence that demonstrates less operative stress, reduced pain, and shorter convalescence. Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) may be considered further steps toward minimization of surgical trauma, although these methods have not yet been standardized. Laparoscopic surgery with the use of a robotic platform constitutes a promising field of investigation. New technologies are to be considered under the prism of the history of surgery; they seem to be a step toward further minimization of surgical trauma, but not definite therapeutic modalities. Patient safety and medical ethics must be the cornerstone of future investigation and implementation of new techniques. PMID:26508823
Peter M Spieth; Güldner, Andreas; Uhlig, Christopher; Bluth, Thomas; Kiss, Thomas; Schultz, Marcus J.; Pelosi, Paolo; Koch, Thea; Gamba de Abreu, Marcelo
Background: General anesthesia usually requires mechanical ventilation, which is traditionally accomplished with constant tidal volumes in volume- or pressure-controlled modes. Experimental studies suggest that the use of variable tidal volumes (variable ventilation) recruits lung tissue, improves pulmonary function and reduces systemic inflammatory response. However, it is currently not known whether patients undergoing open abdominal surgery might benefit from intraoperative variable ventil...
Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim
The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the imple...
Rosenberg, J; Dirkes, W E; Kehlet, H
In 20 patients undergoing elective major abdominal surgery, heart rate and arterial oxygen saturation were monitored continuously during the night 2 days before operation and during the first and second nights after operation (23:00 to 07:30). Mean heart rate increased by 16 beat min-1 (P less th...
Bisgaard, Thue; Kehlet, Henrik
This review analyzes the literature and the historical concerns (restrictions, traditions, nasogastric tube) and pathophysiologic factors (postoperative ileus, risk of anastomotic dehiscence, nausea and vomiting, loss of appetite) invoked for not instituting early oral feeding after major abdomin...... surgical programs in abdominal surgery provide a rational basis for future studies to investigate and facilitate enforced oral feeding after major abdominal procedures.......This review analyzes the literature and the historical concerns (restrictions, traditions, nasogastric tube) and pathophysiologic factors (postoperative ileus, risk of anastomotic dehiscence, nausea and vomiting, loss of appetite) invoked for not instituting early oral feeding after major abdominal...... procedures. It appears that several factors may promote postoperative oral feeding such as thoracic epidural analgesia, multimodal anti-emetic treatment, opioid-sparing analgesia, selective peripheral opioid antagonists, and enforced oral nutrition. Recent data from multimodal fast-track rehabilitation...
CONCLUSION: Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration.
Heberer, M; Bodoky, A; Iwatschenko, P; Harder, F
Needle catheter jejunostomy for postoperative nutritional support is now employed worldwide. However, there is a large discrepancy regarding indications for this technique which this study attempts to rectify. The need for nutritional support after elective abdominal procedures in 464 patients was analyzed and compared with the experience with needle catheter jejunostomy in 42 patients. The results show that needle catheter jejunostomy is indicated after extensive operations of the upper gastrointestinal tract, for example, esophagectomy, total gastrectomy, and the Whipple procedure. With minor upper gastrointestinal operations, or procedures of the lower gastrointestinal tract, needle catheter jejunostomy should be performed only in patients with poor nutritional status or in the presence of postoperative chemotherapy or radiotherapy. In an unclear situation, liberal insertion of the needle catheter jejunostomy and a postponed decision on enteral feeding is recommended, as there is no significant catheter-related morbidity. PMID:3109269
Olsen, P S; Schroeder, T; Agerskov, Kim; Røder, Ole Christian; Sørensen, Steffen; Perko, M; Lorentzen, J E
renal function or chronic pulmonary disease showed an increased perioperative mortality. Development of postoperative cardiac and renal complications could not be related to previous cardiac or renal diseases. The major postoperative complications were renal failure in 81 patients (12%), pulmonary......Between 1979 and 1988, 656 patients were operated upon for abdominal aortic aneurysm. Elective operation was performed in 287 patients (44%) and acute operation in 369 patients. A ruptured aneurysm was found in 218 patients (33%). Patients with arteriosclerotic heart disease, hypertension, impaired...... insufficiency in 77 patients (11%) and cardiac complications in 96 patients (13%). Failure of one or more organs occurred in 153 patients (23%) and the mortality rate for patients with multiorgan failure was 68%. Complications leading to reoperation occurred in 93 patients (14%). The perioperative mortality was...
A total of 18 patients suspected of inflammatory process or abcessus in the abdominal cavity have been studied by scintiscanning with autologous leukocytes labelled with 111In-oxine (10-12 MBq) or 99mTc-HMPAO (300 MBq). Evaluation of the process activity is done on the ground activity index adopted which is received after the computer processing of the results. Three levels of process activity are determined: 1) when the leukocyte accumulation (LA) corresponds to that in the bone marrow; 2) when the LA corresponds to that in the liver; 3) when the LA corresponds to that in the spleen. The recorded sensitivity, specificity and accuracy of the method amount to 87.5%, 100% and 92.9% respectively. The method allows localization of the inflammatory process and indicates the degree of affecting the intestines. 2 figs., 6 refs
Full Text Available Pseudozyma aphidis is an environmental Basidiomycete yeast, and has been involved in the ten past years in rare cases of invasive infection. Pseudozyma species are naturally resistant to caspofungin and often present decreased susceptibility or resistance to fluconazole. This fungus may be difficult to recognize and misidentifications are reported with conventional phenotypical methods. We report a case of P. aphidis invasive infection in an adult with a metastatic ampulloma who had gone through digestive surgery.
Herb, Agathe; Sabou, Marcela; Delhorme, Jean-Baptiste; Pessaux, Patrick; Mutter, Didier; Candolfi, Ermanno; Letscher-Bru, Valérie
Pseudozyma aphidis is an environmental Basidiomycete yeast, and has been involved in the ten past years in rare cases of invasive infection. Pseudozyma species are naturally resistant to caspofungin and often present decreased susceptibility or resistance to fluconazole. This fungus may be difficult to recognize and misidentifications are reported with conventional phenotypical methods. We report a case of P. aphidis invasive infection in an adult with a metastatic ampulloma who had gone through digestive surgery. PMID:25870786
Antoniou, Stavros A.; Antoniou, George A.; Antoniou, Athanasios I.; Granderath, Frank-Alexander
Laparoscopic surgery has generated a revolution in operative medicine during the past few decades. Although strongly criticized during its early years, minimization of surgical trauma and the benefits of minimization to the patient have been brought to our attention through the efforts and vision of a few pioneers in the recent history of medicine. The German gynecologist Kurt Semm (1927–2003) transformed the use of laparoscopy for diagnostic purposes into a modern therapeutic surgical concep...
Full Text Available Introduction. Preoperative malnutrition is a major risk factor for increased postoperative morbidity and mortality. Definition and diagnosis of malnutrition and its treatment is still subject for controversy. Furthermore, practical implementation of nutrition-related guidelines is unknown. Methods. A review of the available literature and of current guidelines on perioperative nutrition was conducted. We focused on nutritional screening and perioperative nutrition in patients undergoing digestive surgery, and we assessed translation of recent guidelines in clinical practice. Results and Conclusions. Malnutrition is a well-recognized risk factor for poor postoperative outcome. The prevalence of malnutrition depends largely on its definition; about 40% of patients undergoing major surgery fulfil current diagnostic criteria of being at nutritional risk. The Nutritional Risk Score is a pragmatic and validated tool to identify patients who should benefit from nutritional support. Adequate nutritional intervention entails reduced (infectious complications, hospital stay, and costs. Preoperative oral supplementation of a minimum of five days is preferable; depending on the patient and the type of surgery, immune-enhancing formulas are recommended. However, surgeons' compliance with evidence-based guidelines remains poor and efforts are necessary to implement routine nutritional screening and nutritional support.
Banke, A.B.; Andersen, Jakob Steen; Heslet, L.; Johansson, P.I.; Shahidi, S.
Care Unit's (ICU) Critical Information System, a blood bank and the database of a vascular surgery unit. RESULTS: The perioperative mortality was 8%, ICU mortality 22%, postoperative mortality 33% and 30-day mortality 39%. The ICU mortality for patients with renal failure and septic shock was...... significantly higher than the overall ICU mortality. The ICU mortality and morbidity increased with the amount of postoperative blood loss. Patients with an initial serum creatinine concentration of <0.100 mmol/l had a 30-day mortality that was lower than that of patients with a higher initial serum creatinine...... concentration. CONCLUSION: The treatment of patients with rAAA at RH is comparable to leading clinical practice results. Postoperative bleeding, septic shock and renal failure are identified as predictive factors for increased ICU mortality and morbidity, for which reason future monitoring and postoperative r...
Ashraf Abualhassan Abdellatif
Full Text Available Context: Supraglottic airway devices have been used as an alternative to tracheal intubation during laparoscopic surgery. Aims: The study was designed to compare the efficacy of Streamlined Liner of the Pharynx Airway (SLIPA for positive pressure ventilation and postoperative complications with the Laryngeal Mask Airway ProSeal (PLMA for patients undergoing lower abdominal laparoscopies under general anesthesia with controlled ventilation. Settings and Design: Prospective, crossover randomized controlled trial performed on patients undergoing lower abdominal laparoscopic surgeries. Methods: A total of 120 patients undergoing lower abdominal laparoscopic surgeries were randomly allocated into two equal groups; PLMA and SLIPA groups. Number of intubation attempts, insertion time, ease of insertion, and fiberoptic bronchoscopic view were recorded. Lung mechanics data were collected 5 minutes after securing the airway, then after abdominal insufflation. Blood traces and regurgitation were checked for; postoperative sore throat and other complications were recorded. Statistical Analysis: Arithmetic mean and standard deviation values were calculated and statistical analyses were performed for each group. Independent sample t-test was used to compare continuous variables exhibiting normal distribution, and Chi-squared test for noncontinuous variables. P value <0.05 was considered significant. Results: Insertion time, first insertion success rate, and ease of insertion were comparable in both groups. Fiberoptic bronchoscopic view was significantly better and epiglottic downfolding was significantly lower in SLIPA group. Sealing pressure and lung mechanics were similar. Gastric distension was not observed in both groups. Postoperative sore throat was significantly higher in PACU in PLMA group. Blood traces on the device were significantly more in SLIPA group. Conclusions: SLIPA can be used as a useful alternative to PLMA in patients undergoing lower
Gilberto L Galloso Cueto; Abel Lantigua Godoy; Libardo Castillo Lamas; Oriol Alfonso Moya; Raúl Bello Delgado
Urgent abdominal diseases of surgical treatment are still being a non despicable part of the general surgeon work. Video laparoscopic surgery is an advantageous and efficacious method in treatment the surgical urgency to determine the behaviour of surgical laparoscopy in abdominal urgency. We carried out a transversal descriptive study in the urgency service of the Teaching Military Hospital “Dr. Mario Muñoz Monroy”. The universe was formed by 201 patients urgently operated by vid...
Conclusion: Epidural, PCIA and opioid infusions are used for pain relief after major abdominal surgeries at our hospital. Although there is limited drug availability, regular assessments and appropriate dose adjustments by acute pain management service (APMS and use of multimodal analgesia led to a high level of patient satisfaction. We recommend that feedback to the primary anesthesiologists by APMS is of utmost importance to enable improvement in practice.
Pan, Wu; Cai, Shen-Yang; Luo, Hai-Long; Ouyang, Shu-Rui; Zhang, Wen-Duo; Wei, Zai-Rong; Wang, Da-Li
Background Chylous ascites is the pathologic leakage of triglycerides-rich lymphatic fluid into the peritoneal cavity. Chylous ascites is a rare complication in abdominal surgery. This study aimed to find a relatively better method for nutrition support in the treatment of chylous ascites after abdominal surgery. Methods This study was a retrospective study. This study retrospectively reviewed patients who underwent abdominal surgery and developed chylous ascites, from the year 2010 to 2014, at the West China Hospital of Sichuan University and the Affiliated Hospital of Zunyi Medical College. Fifty-eight patients who developed chylous ascites after abdominal surgery were included in the study. The clinical effect of somatostatin was evaluated. The differences in the curative efficacy among a daily diet, a low-fat diet supplemented with medium-chain triglyceride (MCT), and total parenteral nutrition (TPN) were also analyzed in this study. Results Complete clinical success was reached earlier in patients treated with somatostatin (P<0.001). The tube removal time, the time to resumption of an oral diet, and the length of hospital stay after chylous leakage were significantly different between patients treated with and without somatostatin. The curative efficacies of the enteral nutrition (EN) + MCT plan and the TPN plan were quite similar, with no significant difference, however, were significantly different from the MCT regime, which was the worst. However, using the EN + MCT plan was more cost-effective (P=0.038). Conclusion In treating chylous ascites, EN + MCT instead of TPN was the best nutrition support. Moreover, somatostatin or its analog octreotide should be used immediately. The treatment with somatostatin in combination with EN + MCT is recommended in the conservative treatment of postoperative chylous ascites. PMID:27143902
Hasselager, Rune; Gögenur, Ismail
systematically review the literature where core muscle size measurements have been used for risk assessment of patients undergoing major abdominal surgery. METHODS: PubMed and EMBASE databases were searched for studies that investigated core muscle size measured with abdominal CT scans and outcomes after major...... abdominal surgery. RESULTS: Eight studies were found. Four studies investigated postoperative complications related to core muscle area. Three of these studies found significantly increased risk of complications related to low core muscle area. Three studies investigated length of hospitalization, and two...... of these found significantly longer length of stay related to low core muscle area. Seven studies investigated 1-year and long-term mortality after surgery, whereof only one did not find significantly increased mortality related to low core muscle area. Furthermore, one study found increased short...
Andrea Horvath; Piotr Dziechciarz,; Hania Szajewska
AIM: To assess the efficacy of glucomannan (GNN) as the sole treatment for abdominal pain-related functional gastrointestinal disorders (FGIDs). METHODS: We conducted a double-blind, placebo-controlled, randomized trial. Patients were recruited among children referred to the Department of Paediatrics, Medical University of Warsaw. Included in the study were children aged 7-17 years with abdominal pain-related FGIDs classified according to the Rome III diagnostic criteria. The children were ra...
Konstantatos, A H; Imberger, G; Angliss, M;
The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia.......The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia....
Full Text Available Wu Pan,1 Shen-Yang Cai,2 Hai-Long Luo,2 Shu-Rui Ouyang,1 Wen-Duo Zhang,1 Zai-Rong Wei,1 Da-Li Wang1 1Department of Plastic & Vascular Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi, Guizhou, 2Department of Hepatopancreatobiliary Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China Background: Chylous ascites is the pathologic leakage of triglycerides-rich lymphatic fluid into the peritoneal cavity. Chylous ascites is a rare complication in abdominal surgery. This study aimed to find a relatively better method for nutrition support in the treatment of chylous ascites after abdominal surgery. Methods: This study was a retrospective study. This study retrospectively reviewed patients who underwent abdominal surgery and developed chylous ascites, from the year 2010 to 2014, at the West China Hospital of Sichuan University and the Affiliated Hospital of Zunyi Medical College. Fifty-eight patients who developed chylous ascites after abdominal surgery were included in the study. The clinical effect of somatostatin was evaluated. The differences in the curative efficacy among a daily diet, a low-fat diet supplemented with medium-chain triglyceride (MCT, and total parenteral nutrition (TPN were also analyzed in this study. Results: Complete clinical success was reached earlier in patients treated with somatostatin (P<0.001. The tube removal time, the time to resumption of an oral diet, and the length of hospital stay after chylous leakage were significantly different between patients treated with and without somatostatin. The curative efficacies of the enteral nutrition (EN + MCT plan and the TPN plan were quite similar, with no significant difference, however, were significantly different from the MCT regime, which was the worst. However, using the EN + MCT plan was more cost-effective (P=0.038. Conclusion: In treating chylous ascites, EN + MCT instead of TPN was the best nutrition support
Vester-Andersen, Morten; Waldau, Tina; Wetterslev, Jørn;
. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.Methods and design: The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing...... emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome...... measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. DISCUSSION: This trial evaluates the benefits and possible harm of intermediate care. The results may...
Godat, Laura; Kobayashi, Leslie; Costantini, Todd; Coimbra, Raul
Abstract Damage control laparotomy was first described by Dr. Harlan Stone in 1983 when he suggested that patients with severe trauma should have their primary procedures abbreviated when coagulopathy was encountered. He recommended temporizing patients with abdominal packing and temporary closure to allow restoration of normal physiology prior to returning to the operating room for definitive repair. The term damage control in the trauma setting was coined by Rotondo et al., in 1993. ...
Malavasi, Lais M; Greene, Stephen A; Gay, John M; Grubb, Tammy L
Lidocaine is commonly used in ruminants but has an anecdotal history of being toxic to goats. To evaluate lidocaine's effects on selected cardiopulmonary parameters. Isoflurane-anesthetized adult goats (n = 24) undergoing abdominal surgery received a loading dose of lidocaine (2.5 mg/kg) over 20 min followed by constant-rate infusion of lidocaine (100 μg/kg/min); control animals received saline instead of lidocaine. Data collected at predetermined time points during the 60-min surgery included heart rate, mean arterial blood pressure, pO2, and pCO2. According to Welch 2-sample t tests, cardiopulmonary variables did not differ between groups. For example, after administration of the loading dose, goats in the lidocaine group had a mean heart rate of 88 ± 28 bpm, mean arterial blood pressure of 70 ± 19 mm Hg, pCO2 of 65 ± 13 mm Hg, and pO2 of 212 ± 99 mm Hg; in the saline group, these values were 90 ± 16 bpm, 76 ± 12 mm Hg, 61 ± 9 mm Hg, and 209 ± 83 mm Hg, respectively. One goat in the saline group required an additional dose of butorphanol. Overall our findings indicate that, at the dose provided, intravenous lidocaine did not cause adverse cardiopulmonary effects in adult goats undergoing abdominal surgery. Adding lidocaine infusion during general anesthesia is an option for enhancing transoperative analgesia in goats. PMID:27423150
Chen, Yanqing; Wu, Weilan; Yao, Yusheng; Yang, Yang; Zhao, Qiuyan; Qiu, Liangcheng
Background: Transcutaneous electric acupoint stimulation (TEAS) at Jiaji acupuncture points has therapeutic potential for relieving viscera pain and opioid-related side effects. This prospective, randomized, triple-blinded, placebo-controlled trial was to investigate the efficacy of TEAS on abdominal pain after colonoscopy. Methods: Consecutive outpatients with American Society of Anesthesiologists (ASA) physical status I or II underwent selective colonoscopy were randomly assigned into two g...
de Jong, Myrthe A C; Ladha, Karim S; Melo, Marcos F Vidal;
odds of respiratory complications in patients undergoing major abdominal surgery (odds ratio 0.53, 95% confidence interval 0.39 - 0.72), effects that translated to deceased hospital length of stay [median hospital length of stay : 6 days (4-9 days), incidence rate ratios for each additional day: 0......OBJECTIVES: In this study, we examined whether (1) positive end-expiratory pressure (PEEP) has a protective effect on the risk of major postoperative respiratory complications in a cohort of patients undergoing major abdominal surgeries and craniotomies, and (2) the effect of PEEP is differed...... abdominal surgery patients and 5063 craniotomy patients. Analysis was performed using multivariable logistic regression. The primary outcome was a composite of major postoperative respiratory complications (respiratory failure, reintubation, pulmonary edema, and pneumonia) within 3 days of surgery. RESULTS...
Shapiro, Peter; Schroeck, Hedwig
We present the case of an otherwise healthy 12-month-old girl undergoing repair of a giant omphalocele, who experienced a postoperative seizure attributed to accumulation of bupivacaine from an epidural infusion. Whereas a standard dose was used, this patient experienced temporary liver dysfunction postoperatively, presumably from elevated intra-abdominal pressures, predisposing her to toxicity after a prolonged infusion. This case illustrates how the type of surgery can influence the margin of safety of routinely used neuraxial local anesthetic doses in infants and young children. PMID:26825992
Mans Christina M
Full Text Available Abstract Background In patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources. Adequate preoperative respiratory muscle strength may help protect against the development of postoperative pulmonary complications and therefore preoperative inspiratory muscle training has been suggested to be of potential value in improving postoperative outcomes. Methods/Design A systematic search of electronic databases will be undertaken to identify randomized trials of preoperative inspiratory muscle training in patients undergoing elective open cardiothoracic and upper abdominal surgery. From these trials, we will extract available data for a list of predefined outcomes, including postoperative pulmonary complications, hospital length of stay and respiratory muscle strength. We will meta-analyze comparable results where possible, and report a summary of the available pool of evidence. Discussion This review will provide the most comprehensive answer available to the question of whether preoperative inspiratory muscle training is clinically useful in improving postoperative outcomes in patients undergoing cardiothoracic and upper abdominal surgery. It will help inform clinicians working in the surgical arena of the likely effectiveness of instituting preoperative inspiratory muscle training programs to improve postoperative outcomes.
Crawford, M E; Møiniche, S; Orbæk, Janne; Bjerrum, H; Kehlet, H
Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...... postoperatively compared with preoperatively (P < or = 0.01). Epidural infusion was discontinued in three patients due to either persisting resting or orthostatic hypotension. There was no correlation between ASA classification, intraoperative bleeding, or postoperative dizziness and incidence of orthostatic...... hypotension. The results suggest that patients undergoing abdominal surgery and treated with continuous small-dose thoracic epidural bupivacaine-morphine are subjected to a decrease of BP at rest and during mobilization, but not to an extent that seriously impairs ambulation in most patients....
Kissmeyer-Nielsen, Peter; Jensen, Martin Bach; Laurberg, Søren
OBJECTIVE: To evaluate short- and long-term effects of perioperative human growth hormone (hGH) treatment on physical performance and fatigue in younger patients undergoing a major abdominal operation in a normal postoperative regimen with oral nutrition. SUMMARY BACKGROUND DATA: Muscle wasting and...... after surgery. RESULTS: The total muscle strength of four limb muscle groups was reduced by 7.6% in the hGH group and by 17.1% in the placebo group at postoperative day 10 compared with baseline values. There was also a significant difference between treatment groups in total muscle strength at day 30......, and at the 90-day follow-up total muscle strength was equal to baseline values in the hGH group, but still significantly 5.9% below in the placebo group. The work capacity decreased by approximately 20% at day 10 after surgery, with no significant difference between treatment groups. Both groups were...
Full Text Available Background and Aims: Advanced monitoring targeting haemodynamic and oxygenation variables can improve outcomes of surgery in high-risk patients. We aimed to assess the impact of goal directed therapy (GDT targeting cardiac index (CI and oxygen extraction ratio (O 2 ER on outcomes of high-risk patients undergoing abdominal surgery. Methods: In a prospective randomised trial, forty patients (American Society of Anaesthesiologists II and III undergoing major abdominal surgeries were randomised into two groups. In-Group A mean arterial pressure ≥ 65 mmHg, central venous pressure ≥ 8-10 mmHg, urine output ≥ 0.5 mL/kg/h and central venous oxygen saturation ≥ 70% were targeted intra-operatively and 12 h postoperatively. In-Group-B (enhanced GDT, in addition to the monitoring in-Group-A, CI ≥ 2.5 L/min/m 2 and O 2 ER ≤ 27% were targeted. The end-points were lactate levels and base deficit during and after surgery. The secondary end points were length of Intensive Care Unit (ICU and hospital stay and postoperative complications. Wilcoxon Mann Whitney and Chi-square tests were used for statistical assessment. Results: Lactate levels postoperatively at 4 and 8 h were lower in-Group-B (P < 0.05. The mean base deficit at 3, 4, 5 and 6 h intra-operatively and postoperatively after 4, 8 and 12 h were lower in-Group-B (P < 0.05. There were no significant differences in ICU stay (2.10 ± 1.52 vs. 2.90 ± 2.51 days or hospital stay (10.85 + 4.39 vs. 13.35 + 6.77 days between Group A and B. Conclusions: Implementation of enhanced GDT targeting CI and OER was associated with improved tissue oxygenation.
Full Text Available The study aims the influence of development of the acute postoperative pancreatitis at the early postoperative period; determine its influence at the frequency and spectrum of complications after abdominal surgery. Material and methods. The work is based on the results of the complex examination and surgical treatment of 1934 patients with various disorders of the digestive system (complicated duodenal ulcer and gastric ulcer, gastric cancer, the proximal and distal pancreatic cancer, colon cancer and postgastrectomy syndromes. The dependence of the overall incidence of postoperative complications, the number of complications per patient, and the number of infectious and inflammatory complications per patient, hospital mortality and length of postoperative hospital days for the development of acute postoperative pancreatitis were studied. Results. Acute postoperative pancreatitis is a leading cause of morbidity postoperative intra-abdominal operations. 97,8% of the cases of complicated early postoperative period of the operations on the organs of the abdominal cavity caused by the development of acute postoperative pancreatitis. Specific complications for the acute postoperative pancreatitis (satellite complications were identified. Satellite complication had a clearly defined correlation with the development of the acute postoperative pancreatitis. The negative effect of acute postoperative pancreatitis on the severity of the postoperative period, on the morbidity, on the number of complications per patient, on the number of the infectious and inflammatory complications per patient, hospital mortality and on the duration of the postoperative hospital stay were found.
HUANG Yuan; LIU Chao; LIN Jin-ling
Background Hepatic artery variations are frequent clinical occurrences.The aim of this study was to investigate the characteristic course of variant hepatic arteries originating from the superior mesenteric artery for the purpose of providing instructions for abdominal tumor surgery.Methods The course of variant hepatic arteries originating from the superior mesenteric artery was studied in 400 patients with liver cancer confirmed by digital subtraction angiography (DSA) and multi-slice spiral computed tomography angiography (MSCTA),and 86 patients with gastric cancer confirmed by preoperative MSCTA between June 2008 and June 2010 in the First Affiliated Hospital of Guangxi Medical University.Results Hepatic artery variations originating from the superior mesenteric artery were noticed in 49 liver cancer patients and 14 gastric cancer patients (total 63 cases),with a variation rate of 12.96％,including two cases (3.17％) where the hepatic arteries ran along the anterior pancreas,and 61 cases (96.83％) where the hepatic arteries ran along the posterior pancreas.Conclusions Hepatic artery variations originating from the superior mesenteric artery present as two types:the pre-pancreas type and the post-pancreas type with the latter predominating.This finding is of clinical significance in abdominal tumor surgeries where clearance of portal lymph nodes is needed.
Jang, Ji Young; Shim, Hongjin; Lee, Yun Jin; Lee, Seung Hwan; Lee, Jae Gil
Purpose Since the 1990's, negative pressure wound therapy (NPWT) has been used to treat soft tissue defects, burn wounds, and to achieve skin graft fixation. In the field of abdominal surgery, the application of NPWT is increasing in cases with an open abdominal wound requiring temporary wound closure and a second look operation. In the present study, the authors analyzed patients that underwent NPWT for postoperative wound dehiscence. Methods The computerized records of patients that had und...
Spadaro, S.; Karbing, Dan Stieper; Mauri, T.;
52 patients undergoing either laparotomy or laparoscopic surgery. Three levels of PEEP were applied in random order: (1) zero (ZEEP), (2) 5 cmH2O and (3) 10 cmH2O. Pulmonary shunt and ventilation/perfusion mismatch were assessed by the automatic lung parameter estimator system. RESULTS: Pulmonary......BACKGROUND: General anaesthesia decreases pulmonary compliance and increases pulmonary shunt due to the development of atelectasis. The presence of capnoperitoneum during laparoscopic surgery may further decrease functional residual capacity, promoting an increased amount of atelectasis compared...... of 10 cmH2O. Although laparoscopic surgery was associated with a lower pulmonary compliance, increasing levels of PEEP were able to ameliorate it in both groups. CONCLUSION: Both surgeries have similar negative effects on pulmonary shunt, while the presence of capnoperitoneum reduced only the...
Full Text Available CONTEXT: Various adjuvants such as opioids or α2 agonists are being used to improve the quality and duration of caudal analgesia with local anesthetics. Dexmedetomidine a α2 agonist is used frequently in adult patients to enhance the local anesthetic effect. However there is little literature regarding its effectiveness in pediatric caudal analgesia. The objective of this study was to assess the efficacy of dexmedetomidine when used as an adjuvant to bupivacaine in increasing the duration of caudal analgesia. AIM: The aim of this study was to investigate the effect of adding Dexmedetomidine to caudal Bupivacaine and observe the effect on the duration of analgesia in the post-operative period. SETTINGS AND DESIGN: One year hospital based Double Blind Randomized Controlled Trial. METHODS AND MATERIAL: Sixty children, aged 1-6 years, undergoing lower abdominal surgeries were included in this prospective randomized double-blind study. The patients were randomly divided into two groups: Group I received Bupivacaine (0.25% 1ml/kg plus 1 ml of normal saline in the caudal epidural space. Group II was administered Bupivacaine (0.25% 1ml/ with Dexmedetomidine 2 mcg/ ml diluted to 1 ml of normal saline in the caudal epidural space. All anesthetic and surgical techniques were standardized. Heart rate, blood pressure, oxygen saturation, respiratory rate were monitored continuously. Surgery was started 10-15 minutes after the injection and confirming adequacy of caudal block. Duration of analgesia was assessed using FLACC scale (Face, Legs, Activity, Cry, Consolability scale. The time from administration of caudal anesthesia to the first time the FLACC score equal or greater than 4 was considered as the duration of caudal analgesia. Paracetamol suppository was used as rescue analgesia with a loading dose of 40mg/kg. STATISTICAL ANALYSIS: Mann-Whitney test and Student ‘t’test was used to compare the data obtained in the two groups. RESULTS: The
Full Text Available Abdominal surgery inhibits food intake and induces c-Fos expression in the hypothalamic and medullary nuclei in rats. Rikkunshito (RKT, a Kampo medicine improves anorexia. We assessed the alterations in meal microstructure and c-Fos expression in brain nuclei induced by abdominal surgery and the modulation by RKT in mice. RKT or vehicle was gavaged daily for 1 week. On day 8 mice had no access to food for 6-7 h and were treated twice with RKT or vehicle. Abdominal surgery (laparotomy-cecum palpation was performed 1-2 h before the dark phase. The food intake and meal structures were monitored using an automated monitoring system for mice. Brain sections were processed for c-Fos immunoreactivity (ir 2-h after abdominal surgery. Abdominal surgery significantly reduced bouts, meal frequency, size and duration, and time spent on meals, and increased inter-meal interval and satiety ratio resulting in 92-86% suppression of food intake at 2-24 h post-surgery compared with control group (no surgery. RKT significantly increased bouts, meal duration and the cumulative 12-h food intake by 11%. Abdominal surgery increased c-Fos in the prelimbic, cingulate and insular cortexes, and autonomic nuclei, such as the bed nucleus of the stria terminalis, central amygdala, hypothalamic supraoptic (SON, paraventricular and arcuate nuclei, Edinger-Westphal nucleus (E-W, lateral periaqueduct gray (PAG, lateral parabrachial nucleus, locus coeruleus, ventrolateral medulla and nucleus tractus solitarius (NTS. RKT induced a small increase in c-Fos-ir neurons in the SON and E-W of control mice, and in mice with surgery there was an increase in the lateral PAG and a decrease in the NTS. These findings indicate that abdominal surgery inhibits food intake by increasing both satiation (meal duration and satiety (meal interval and activates brain circuits involved in pain, feeding behavior and stress that may underlie the alterations of meal pattern and food intake inhibition
Kim, Jin-seop; Oh, Duck-Won
[Purpose] The aim of this study was to determine the effects of high-frequency current therapy on the abdominal obesity levels of young women. [Subjects] Twenty-two women with abdominal obesity were randomly allocated to either an experimental group (n 1 = 10) or a control group (n 2 = 12). [Methods] The experimental group subjects received high-frequency current therapy for the abdominal region 3 times per week for 6 weeks (a total of 18 sessions). Outcome measures were waist circumference, ...
Jing Zhou,1 Hongying Pi,2 Yingying Zheng1 1General Surgery, 2Nursing Department, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China Background: Abdominal cavity drainage fluid can be used as an early diagnostic tool of postoperative complications, and observing its characteristics can help us to judge and handle postoperative complications. There is no accurate standard reference range on its characteristics after surgeries for gastroi...
Robert J Fraser; Paul Jury; John Dent; Marc Ritz; Addolorata C Di Matteo; Rosalie Vozzo; Monika Kwiatek; Robert Foreman; Brendan Stanley; Jack Walsh; Jim Burnett
AIM: To investigate distal small bowel motility and lipid absorption in patients following elective abdominal aortic aneurysm (AAA) repair surgery.METHODS: Nine patients (aged 35-78 years; body mass index (BMI) range: 23-36 kg/m2) post-surgery for AAA repair, and seven healthy control subjects (20-50 years;BMI range: 21-29 kg/m2) were studied. Continuous distal small bowel manometry was performed for up to 72 h, during periods of fasting and enteral feeding (Nutrison(R)). Recordings were analyzed for the frequency,origin, length of migration, and direction of small intestinal burst activity. Lipid absorption was assessed on the first day and the third day post surgery in a subset of patients using the 13C-triolein-breath test, and compared with healthy controls. Subjects received a 20-min intraduodenal infusion of 50 mL liquid feed mixed with 200 μL 13C-triolein. End-expiratory breath samples were collected for 6 h and analyzed for 13CO2 concentration.RESULTS: The frequency of burst activity in the proximal and distal small intestine was higher in patients than in healthy subjects, under both fasting and fed conditions (P＜0.005). In patients there was a higher proportion of abnormally propagated bursts (71% abnormal), which began to normalize by d 3 (25% abnormal) post-surgery.Lipid absorption data was available for seven patients on d 1 and four patients on d 3 post surgery. In patients,absorption on d 1 post-surgery was half that of healthy control subjects (AUC 13CO2 1323 ± 244 vs 2 646 ±365;P＜ 0.05, respectively), and was reduced to the one-fifth that of healthy controls by d 3 (AUC 13CO2 470 ± 832 vs 2646 ± 365; P＜ 0.05, respectively).CONCLUSION: Both proximal and distal small intestinal motor activity are transiently disrupted in critically ill patients immediately after major surgery,with abnormal motility patterns extending as far as the ileum. These motor disturbances may contribute to impaired absorption of enteral nutrition, especially when
VanderBrink, Brian A; Stock, Jeffrey A; Hanna, Moneer K
Long-term follow-up of patients born with classical bladder exstrophy-epispadias complex (EEC) reveals that many of them suffer from poor self-image, and the aesthetic aspects of the genitalia and lower abdomen acquire greater significance with age. In this article, we review the aesthetic outcomes in performing puboplasty, umbilicoplasty, and genitoplasty in patients born with EEC. Retrospective review of the cosmetic and functional outcomes in 116 patients born with EEC treated by puboplasty, umbilicoplasty, or genitoplasty was performed. Satisfaction with the cosmetic and functional outcomes of these three reconstructive surgeries was high following initial reconstructive efforts (> 90%). Attention to cosmesis during abdominal wall and genital reconstruction for EEC helps to improve a patient's perception of body image and self-esteem. Our experience with these procedures over the past 25 years demonstrated that the efforts directed toward aesthetics have been well worthwhile. PMID:16527001
YU Xiao; LI Yong-guo; CHEN Dao-jin; LI Xiao-rong; ZHANG Sheng-dao; LEI Ruo-qing; TANG Yao-qing
Objective To retrospectively analyze and compare conservative versus surgical treatment of patients with fulminant acute pancreatitis (FAP) plus abdominal compartment syndrome (ACS). Methods From January 1998 to September 2005, 21 patients with FAP plus ACS were retrospectively analyzed. Ten patients were conservatively treated by means of intensive care medicine without surgery, and 11 patients received open surgical management and suction drainage. Results Seven of the 10 non-surgical patients died, comprising one with mild, four with moderate and two with severe ACS (70% mortality rate). Of the 11 patients receiving open surgical management in the early phase (within 3 days of disease initiation), three died, comprising one with moderate and two with severe ACS (27.3% mortality rate). The difference in mortality rates was found to be statistically significant. Conclusion Our data indicate patients suffering FAP with severe ACS should be treated with open management of the abdomen in the early phase (within 3 days), even in the absence of infection. This approach appears superior to that of conservative management. Surgical treatment resulted in abdominal decompression and subsequently significantly decreased the mortality rate and improved overall prognosis.
Full Text Available Jeffrey Gadsden,1 Sabry Ayad,2 Jeffrey J Gonzales,3 Jaideep Mehta,4 Jan Boublik,5 Jacob Hutchins6,7 1Department of Anesthesiology, Duke University Medical Center, Durham, NC, 2Department of Anesthesiology and Pain Management, Cleveland Clinic, Cleveland, OH, 3Department of Anesthesiology, University of Colorado Hospital, Aurora, CO, 4Department of Anesthesiology, UT Health, The University of Texas Health Science Center at Houston, Houston, TX, 5Department of Anesthesiology, NYU Langone Medical Center – Hospital for Joint Diseases, New York, NY, 6Department of Anesthesiology, 7Department of Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Transversus abdominis plane (TAP infiltration is a regional anesthesia technique that has been demonstrated to be effective for management of postsurgical pain after abdominal surgery. There are several different clinical variations in the approaches used for achieving analgesia via TAP infiltration, and methods for identification of the TAP have evolved considerably since the landmark-guided technique was first described in 2001. There are many factors that impact the analgesic outcomes following TAP infiltration, and the various nuances of this technique have led to debate regarding procedural classification of TAP infiltration. Based on our current understanding of fascial and neuronal anatomy of the anterior abdominal wall, as well as available evidence from studies assessing local anesthetic spread and cutaneous sensory block following TAP infiltration, it is clear that TAP infiltration techniques are appropriately classified as field blocks. While the objective of peripheral nerve block and TAP infiltration are similar in that both approaches block sensory response in order to achieve analgesia, the technical components of the two procedures are different. Unlike peripheral nerve block, which involves identification or stimulation of a specific nerve or nerve plexus, followed by
Full Text Available The nutritional risk screening (NRS 2002 has been applied increasingly in patients who underwent abdominal surgery for nutritional risk assessment. However, the usefulness of the NRS 2002 for predicting is controversial. This meta-analysis was to examine whether a preoperative evaluation of nutritional risk by NRS 2002 provided prediction of postoperative outcomes in patients undergoing abdominal surgery.A systematic literature search for published papers was conducted using the following online databases: MEDLINE, EMBASE, the Cochrane library, EBSCO, CRD databases, Cinahl, PsycInfo and BIOSIS previews. The pooled odds ratio (OR or weight mean difference (WMD was calculated using a random-effect model or a fix-effect model.Eleven studies with a total of 3527 patients included in this study. Postoperative overall complications were more frequent in nutritional risk patients versus patients without nutritional risk (the pooled OR 3.13 [2.51, 3.90] p<0.00001. The pooled OR of mortality for the nutritional risk group and non-nutritional risk group was 3.61 [1.38, 9.47] (p = 0.009. Furthermore, the postoperative hospital stay was significant longer in the preoperative nutritional risk group than in the nutritional normal group (WMD 5.58 [4.21, 6.95] p<0.00001.The present study has demonstrated that patients at preoperative nutritional risk have increased complication rates, high mortality and prolonged hospital stay after surgery. However, NRS 2002 needs to be validated in larger samples of patients undergoing abdominal surgery by better reference method.
Moustafa, Ahmed A M; Abdelazim, Ibrahim A
To determine impact of obesity on recovery parameters and pulmonary functions of women undergoing major abdominal gynecological surgeries. Eighty women undergoing major gynecological surgeries were included in this study. Anesthesia was induced by remifentanil bolus, followed by propofol and cisatracurium to facilitate oro-tracheal intubation and was maintained by balanced anesthesia of remifentanil intravenous infusion and sevoflurane in oxygen and air. Time from discontinuation of maintenance anesthesia to fully awake were recorded at 1-min intervals and time from discontinuation of anesthesia until patient was transferred to post-anesthesia care unit (PACU) and discharged from PACU was also recorded. Pulmonary function tests were performed before surgery and repeated 4 h, days 1, 2 and 3 post-operative for evaluation of forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow rate. Occurrence of post-operative complications, re-admission to ICU, hospital stay and morbidities were also recorded. Induction of anesthesia using remifentanil bolus injection resulted in significant decrease of heart rate and arterial pressures compared to pre-operative and pre-induction values. Recovery times were significantly shorter in obese compared to morbidly obese women. Post-operative pulmonary function tests showed significant deterioration compared to pre-operative measures but showed progressive improvement through first 3 post-operative days. Hospital stay was significantly shorter for obese compared to morbid obese women. Obesity delays recovery from general anesthesia, adversely affects pulmonary functions and increases post-operative complications. Remifentanil infusion and sevoflurane could be appropriate combination for obese and morbidly obese women undergoing major surgeries. PMID:26072156
Efeitos de duas técnicas de incentivo respiratório na mobilidade toracoabdominal após cirurgia abdominal alta Effects of two respiratory incentive techniques on chest wall mobility after upper abdominal surgery
Maria Elaine Trevisan
Full Text Available A cirurgia abdominal alta está associada a um risco elevado de complicações pulmonares que podem ser reduzidas pelo uso criterioso de manobras terapêuticas visando a expansão pulmonar. O objetivo foi comparar duas técnicas de incentivo respiratório na recuperação da dinâmica toracoabdominal em pacientes submetidos à cirurgia abdominal alta. O grupo de estudo experimental foi constituído por 16 pacientes internados na Clínica Cirúrgica do Hospital Universitário de Santa Maria distribuídos aleatoriamente em dois grupos: o grupo 1 foi constituído por dez pacientes que usaram o dispositivo Voldyne e o grupo 2, por seis pacientes submetidos ao padrão ventilatório com inspiração fracionada em três tempos. A expansibilidade toracoabdominal foi avaliada por cirtometria antes da cirurgia e no 1º, 3º¸ e 5º dias do pós-operatório (PO. Observou-se redução significativa dos valores de cirtometria no 1º PO que, gradualmente, foram sendo recuperados, não mais havendo diferença significativa no 5o PO em relação aos valores pré-operatórios em ambos os grupos. O grupo 1 obteve significativamente melhores índices de recuperação da mobilidade toracoabdominal do que o grupo 2. Também o tempo de recuperação do grupo 1 atingiu médias mais elevadas durante todo o período de PO investigado. Embora ambas as técnicas utilizadas fossem efetivas, o incentivo inspiratório por meio do Voldyne mostrou melhores resultados na recuperação da expansibilidade pulmonar após cirurgia abdominal alta.Upper abdominal surgery is associated to increased risk of pulmonary complications, which may be lessened by judicious use of therapeutic maneuvers aimed at lung expansion. The purpose here was to compare two respiratory incentive techniques on recovery of thoracic-abdominal dynamics in patients having undergone upper abdominal surgery. Sixteen patients in such condition were randomly divided into group 1 (n=10, who did respiratory training
Full Text Available BACKGROUND This prospective randomized double-blind study was designed to compare the analgesic efficacy and safety of intrathecal midazolam and fentanyl as an additive agent to bupivacaine for lower abdominal elective surgeries. METHODS Sixty patients classified in American Society of Anesthesiologists (ASA classes I and II scheduled for lower abdominal surgeries were studied. Patients were randomly divided to receive either 12.5 mg hyperbaric bupivacaine plus 1mg midazolam (group BM, n=30 or 12.5 mg hyperbaric bupivacaine plus 25 μg fentanyl (group BF, n=30 intrathecal. RESULTS The time of onset and the duration of motor blockade were comparable among the groups while the time to sensory block regression was same in group BM and group BF. The duration of postoperative analgesia was similar in group BM and group BF. While it was same for group BM and BF. Symptoms of pruritus and vomiting was more in group BF. CONCLUSION We conclude that midazolam is as effective as fentanyl in prolonging the durations of both sensory block and analgesia with less side effects.
Full Text Available OBJECTIVES : We aimed to evaluate the preemptive analgesic properties of pregabalin, an anticonvulsant drug used in clinical practice for the treatment of neuropathic pain. METHOD S : This study was performed on 40 patients from ASA I - II risk group aged 18 - 60 years which underwent lower abdominal surgeries. Group I received 300 mg pregabalin and Group II was given a placebo in oral capsule form. Visual analog scale (VAS scores, morphine consumption and side effects of all patients were recorded at 1, 4, 8, 12 and 24 hour s postoperatively. When Aldrette recovery score reached 9, morphine 0.75mcg/kg was given as rescue analgesia. RESULTS : There was no difference observed in the first analgesic requirement time values between the two groups (p>0.05. A statistically signific ant decrease was observed in the VAS scores of the pregabalin group at 1, 4, 12 and 24 hours after surgery (p0.05. CONCLUSION : Our study demonstrated that a 300 mg pregabalin administered preoperatively is an ef ficient and safe agent for preemptive analgesia. Premedication with pregabalin reduces postoperative pain scores and total analgesic consumption without increasing sedation or other side effects in the postoperative period.
CHANG Ling-hua; MA Tso-chiang; TSAY Shiow-luan; JONG Gwo-ping
Background A link between postoperative pain intensity and heart rate variability (HRV) had not been well established.This study aimed to investigate the correlation between post-operative pain intensity and HRV.Methods The subjects in this cross-sectional correlation study comprised of patients who had undergone abdominal surgery in a regional teaching hospital in central Taiwan during the period July 2009-November 2009.The visual analogue scale (VAS) and the short-form McGill pain questionnaire (SF-MPQ) were used to measure post-operative pain.HRV was measured as the standard deviation of normal RR interval,and by power spectral analysis that included high frequency (HF),low frequency (LF),very low frequency power,and LF/HF ratio.Results Atotal of 34 subjects were included in this study.We found that the day after the surgery,the mean VAS score was 47.50±20.98 and the mean SF-MPQ score was 18.06±8.90,indicating a moderate degree of pain.Moderate to severe degrees of tenderness were reported by 70.6％ of the patients,moderate to severe degrees of gnawing pain were experienced by 67.7％ of the patients,moderate to severe degrees of tiring-exhaustion pain were reported by 64.7％ of the patients,and 41.2％ of the patients who experienced moderate to severe pain believed that the pain was punishing-cruel.The standard deviation of normal RR interval and high frequency values obtained from male patients or married patients were higher than female patients or unmarried (P ＜0.05).The correlation of the standard deviation of normal RR interval,high frequency,very low frequency value and patient's age were negative (p ＜0.05).The total SF-MPQ pain scores positively correlated with the LF/HF ratio (P ＜0.05).Conclusions The multidimensional pain assessment tool (SF-MPQ) reflects better the patients' post-operative pain than the single-dimensional assessment tool (VAS).HRV positively correlated with SF-MPQ scores in patients after abdominal surgery.
We investigated the effects of antithrombin on coagulation, fibrinolysis, and production of cytokines and adhesion molecules in abdominal aortic aneurysm repair surgery. Sixteen patients for Y-shaped graft replacement of abdominal aortic aneurysm were divided into an antithrombin group and a control group. In the antithrombin group, 3000 U antithrombin was infused over 30 min before heparin administration and 24 h later. White blood cell counts, platelet counts, prothrombin time ratio, and serum concentrations of antithrombin, polymorphonuclear leukocyte elastase, interleukin (IL)-1beta, IL-6, IL-8, tumor necrosis factor-alpha, and adhesion molecules, and variables of coagulation and fibrinolysis were measured before surgery, at the end of surgery, and 1 and 2 days after surgery. The antithrombin concentration decreased in the control group, whereas it increased in the antithrombin group with significant differences between the groups. Prothrombin time ratio, concentrations of d-dimer, thrombin-antithrombin complex, and intercellular adhesion molecule-1 increased only in the control group and polymorphonuclear leukocyte elastase, IL-6, tumor necrosis factor-alpha, and vascular cell adhesion molecule-1 increased in both groups. They were significantly less in the antithrombin group except for intercellular adhesion molecule-1. In conclusion, antithrombin could decrease hypercoagulation and inflammatory activation during abdominal aortic aneurysm surgery, which may decrease adverse events. PMID:16551889
Full Text Available Abstract Background Wound infection affects a considerable portion of patients after abdominal operations, increasing health care costs and postoperative morbidity and affecting quality of life. Antibacterial coating has been suggested as an effective measure to decrease postoperative wound infections after laparotomies. The INLINE metaanalysis has recently shown the superiority of a slowly absorbable continuous suture for abdominal closure; with PDS plus® such a suture has now been made available with triclosan antibacterial coating. Methods/Design The PROUD trial is designed as a randomised, controlled, observer, surgeon and patient blinded multicenter superiority trial with two parallel groups and a primary endpoint of wound infection during 30 days after surgery. The intervention group will receive triclosan coated polydioxanone sutures, whereas the control group will receive the standard polydioxanone sutures; abdominal closure will otherwise be standardized in both groups. Statistical analysis is based on intention-to-treat population via binary logistic regression analysis, the total sample size of n = 750 is sufficient to ensure alpha = 5% and power = 80%, an interim analysis will be carried out after data of 375 patients are available. Discussion The PROUD trial will yield robust data to determine the effectiveness of antibacterial coating in one of the standard sutures for abdominal closure and potentially lead to amendment of current guidelines. The exploration of clinically objective parameters as well as quality of life holds immediate relevance for clinical management and the pragmatic trial design ensures high external validity. Trial Registration The trial protocol has been registered with the German Clinical Trials Register (DRKS00000390.
Background and purpose: To quantify inter- and intrafraction prostate motion in a standard VacLok (VL) immobilization device or in the BodyFix (BF) system incorporating a compression element which may reduce abdominal movement. Materials and methods: Thirty-two patients were randomly assigned to VL or BF. Interfraction prostate motion >3 mm was corrected pre-treatment. EPIs were taken daily at the start and end of the first and last treatment beams. Interfraction and intrafraction prostate motion were measured for centre of mass (COM) and individual markers. Results: There were no significant differences in interfraction (p ≥ 0.002) or intrafraction (p ≥ 0.16) prostate motion with or without abdominal compression. Median intrafraction motion was slightly smaller than interfraction motion in the AP (7.0 mm vs. 7.6 mm) and SI direction (3.2 mm vs. 4.7 mm). The final image captured the maximal intrafraction displacement in only 40% of fractions. Our PTV incorporated >95% of total prostate motion. Conclusions: Intrafraction motion became the major source of error during radiotherapy after online correction of interfraction prostate motion. The addition of 120 mbar abdominal compression to custom pelvic immobilization influenced neither interfraction nor intrafraction prostate motion
This study evaluated the safety, feasibility, and clinical utility of transhepatic drainage of inaccessible abdominal abscesses retrospectively under real-time computed tomographic (CT) guidance. For abdominal abscesses, 12 consecutive patients received percutaneous transhepatic drainage. Abscesses were considered inaccessible using the usual access route because they were surrounded by the liver and other organs. The maximum diameters of abscesses were 4.6-9.5 cm (mean, 6.7 ± 1.4 cm). An 8-Fr catheter was advanced into the abscess cavity through the liver parenchyma using real-time CT fluoroscopic guidance. Safety, feasibility, procedure time, and clinical utility were evaluated. Drainage catheters were placed with no complications in abscess cavities through the liver parenchyma in all patients. The mean procedure time was 18.8 ± 9.2 min (range, 12-41 min). All abscesses were drained. They shrank immediately after catheter placement. In conclusions, this transhepatic approach under real-time CT fluoroscopic guidance is a safe, feasible, and useful technique for use of drainage of inaccessible abdominal abscesses.
Moore, E E; Jones, T N
Benefits of immediate postinjury nutritional support remain ill defined. Seventy-five consecutive patients undergoing emergent celiotomy with an abdominal trauma index (A.T.I.) greater than 15 were randomized prospectively to a control group (no supplemental nutrition during first 5 days) or enteral-fed group. The enteral patients had a needle catheter jejunostomy (N.C.J.) placed at laparotomy with the constant infusion of an elemental diet (Vivonex HN) begun at 18 hours and advanced to 3,000 ml/day (3,000 kcal, 20 gm N2) within 72 hours. Control and enteral-fed groups were comparable with respect to demographic features, trauma mechanism, shock, colon injury, splenectomy, A.T.I., and initial nutritional assessment. Twenty (63%) of the enteral patients were maintained on the elemental diet greater than 5 days; four (12%) needed total parenteral nutrition (T.P.N.). Nine (29%) of the control patients required T.P.N. Nitrogen balance was markedly improved (p less than 0.001) in the enteral-fed group. Although visceral protein markers and overall complication rate were not significantly different, septic morbidity was greater (p less than 0.025) in the control group (abdominal infection in seven and pneumonia in two) compared to the enteral-fed patients (abdominal abscess in three). Analysis of patients with A.T.I. 15-40 disclosed sepsis in seven (26%) of the control versus one (4%) of the enteral-fed group (p less than 0.01). Our clinical experience demonstrates the feasibility of immediate postoperative enteral feeding via N.C.J. after major abdominal trauma, and suggests this early nutrition reduces septic complications in critically injured patients. PMID:3095557
Dex medetomidine is a highly selective α2 agonist with anesthetic, analgesic and sympatholytic properties. Its neuromuscular effects in humans are unknown. This study evaluates the effect of dex medetomidine on neuromuscular block and hemodynamics during thiopental/ isoflurane anesthesia for patients with complex abdominal or pelvic surgery. Patients and methods: During thiopental/isoflurane anesthesia, the rocuronium infusion rate was adjusted in 20 complex surgery patients to maintain a stable first response (T1) in the train of four sequence of 50% ± 3 of the pre-rocuronium value. Dex medetomidine was then administered by infusion pump, targeting a plasma dex medetomidine concentration of 0.6 ng/dL for 45 min. The evoked mechanical responses of the adductor pollicis responses (T1 response and T4/T1 ratio), systolic blood pressure, diastolic blood pressure and heart rate (HR) were measured during the dex medetomidine infusion using repeated measures analysis of variance. Plasma levels ranged from 0.73 to 1.38 ng/mL. Results: T1 values decreased during the infusion from 55(ρ2 to 38±9 ((ρ< 0.05). T4/Tl values did not change during the infusion. Dex medetomidine increased SBP (ρ< 0.001) and decreased HR ((ρ< 0.05) (10 min median values) during the infusion compared with values before the infusion. This study demonstrated that dex medetomidine decreased T1, increased SBP and decreased HR during thiopental/isoflurane anesthesia. Conclusion: We conclude that dex medetomidine induced direct vasoconstriction may alter pharmacokinetics of rocuronium, therefore increasing plasma rocuronium concentration. Although these effects were statistically significant, further studies should be held for understanding and characterizing the peripheral vasoconstrictive effects of a2 agonists that allow better management and determination of drug dosing regimens
Full Text Available INTRODUCTION : One very important complication of abdominal surgeries is postoperative ileus which results in severe patient discomfort, prolonged hospitalization, and enhanced treatment cost. This study was conducted with an aim to analyze the clinical outcome of effe ct of chewing gum mainly to avoid post - operative paralytic ileus in post - operative patients of abdominal surgeries . MATERIAL AND METHODS : In this study total 200 patients were included, 100 were cases and remaining were controls. The cases were given chewing gum to chew after the surgery while the controls were allowed to heal without chewing gums in conventional style and both were observed hourly for clinical outcome. RESULTS : Among cases the mean duration of first sound heard was 26.3 hours while am ong controls this was 38.8 hours [p<0.001], the mean duration of first flatus passed among cases was 50.7 hours while that among controls was 68.5 hours, the mean duration of first Bowel passed among cases was 92.4 hours while that among controls was 128.3 hours [p<0.001]. On comparing cases of routine with emergency surgeries, gastric with small bowel surgeries, and traumatic with pathological bowel surgeries it was observed that the first bowel sound, first flatus and first bowel passed appears significan tly earlier in routine surgeries, gastric surgeries and traumatic surgeries respectively. CONCLUSIONS: It was observed that chewing gum has significant effect over bowel motility as bowel sounds appeared significantly earlier in cases than control and tim e for first flatus passed and first bowel passed were also noted significantly earlier in cases than controls. Hospital stay of cases were found significantly lesser than control hence simple intervention like chewing can decrease the burden of disease of paralytic ileus from community.
Full Text Available La urgencia abdominal también puede ser intervenida mediante abordaje laparoscópico: el planteamiento puede ser de laparoscopia diagnóstica, cirugía asistida por laparoscopia o laparotomía dirigida según los hallazgos de la laparoscopia. Las contraindicaciones generales se refieren sobre todo al estado de inestabilidad hemodinámica del paciente y a pacientes graves (ASA IV. En ausencia de contraindicación específica para el procedimiento laparoscópico concreto a realizar, muchas enfermedades abdominales que requieren cirugía urgente pueden realizarse con abordaje laparoscópico. Las indicaciones más frecuentes son la apendicitis, la colecistitis aguda, la perforación gastroduodenal, la oclusión de intestino delgado, y algunos traumas abdominales. Con una correcta selección de pacientes y la oportuna experiencia del cirujano, los resultados son excelentes, y mejoran la cirugía abierta (menos infección de herida, complicaciones, estancia hospitalaria y dolor postoperatorio. Se explican con detalle los aspectos básicos de la técnica quirúrgica en los procedimientos más frecuentes de laparoscopia de urgencia.Abdominal emergencies can also be operated on through the laparoscopic approach: the approach can be diagnostic laparoscopy, surgery assisted by laparoscopy or laparotomy directed according to the findings of the laparoscopy. The general contraindications refer above all to the state of haemodynamic instability of the patient and to seriously ill patients (ASA IV. In the absence of any specific counter-indications for the specific laparoscopic procedure to be carried out, many abdominal diseases requiring emergency surgery can be performed with the laparoscopic approach. The most frequent indications are appendicitis, acute colecistitis, gastroduodenal perforation, occlusion of the small intestine, and some abdominal traumas. With a correct selection of patients and the appropriate experience of the surgeon, the results are
The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery,...
Smith, Jason W; Nash, Nick; Procter, Levi; Benns, Matthew; Franklin, Glen A; Miller, Keith; Harbrecht, Brian G; Bernard, Andrew C
Damage control surgery (DCS) was developed to manage exsanguinating trauma patients, but is increasingly applied to the management of peritoneal sepsis and abdominal catastrophes. Few manuscripts compare the outcomes of these surgeries on disparate patient populations. A multi-institutional three group propensity score matched case cohort study comparing penetrating trauma (PT-DCS), blunt trauma (BT-DCS), and intraperitoneal sepsis (IPS-DCS) was performed comparing patients treated with DSC between 2008 and 2013. Propensity scoring was performed using demographic and presenting physiologic data. Four hundred and twelve patients were treated with DCS across two institutions. Propensity matching for age, gender, and initial Acute Physiology and Chronic Health Evaluation II score 80 identified 80 patients per group for comparison. Rate of primary fascial closure was lowest in the IPS-DCS group, and highest in the penetrating trauma DCS group. Intra-abdominal complication rates were highest in the IPS-DCS group. IPS-DCS had increased time to definitive closure compared with the other two groups (RR 1.8; 1.3-2.2; P eight days were more than twice the risk of death at 90 days across all groups. (RR 2.15; 1.2-3.5; P trauma and emergency general surgery are quite different. Despite this difference, prompt abdominal closure at the earliest possible opportunity afforded the best outcome in patients managed via DCS. PMID:27215724
Zhen Sun; Xin-Juan Kong; Xue Jing; Run-Jun Deng; Zi-Bin Tian
Background The nutritional risk screening (NRS 2002) has been applied increasingly in patients who underwent abdominal surgery for nutritional risk assessment. However, the usefulness of the NRS 2002 for predicting is controversial. This meta-analysis was to examine whether a preoperative evaluation of nutritional risk by NRS 2002 provided prediction of postoperative outcomes in patients undergoing abdominal surgery. Methods A systematic literature search for published papers was conducted us...
P. Di Carlo; GULOTTA, G.; Casuccio, A; Pantuso, G.; Raineri, SM; Airò Farulla, C; BONVENTRE, S.; Guadagnino, G; D Ingrassia; COCORULLO, G.; C. Mammina; Giarratano, A
Background Abdominal surgery carries significant morbidity and mortality, which is in turn associated with an enormous use of healthcare resources. We describe the clinical course of 30 Intensive Care Unit (ICU) patients who underwent abdominal surgery and showed severe infections caused by Klebsiella pneumoniae sequence type (ST) 258 producing K. pneumoniae carbapenemase (KPC-Kp). The aim was to evaluate risk factors for mortality and the impact of a combination therapy of colistin plus reco...
Prem Swarup Vampugalla
Conclusion: This study revealed that the intrathecal ropivacaine with fentanyl provided adequate anesthesia for lower abdominal and lower limb surgeries. Ropivacaine achieved a shorter duration of sensory and motor blockade, and a lesser degree of motor blockade when compared to L-bupivacaine. Thus, ropivacaine was justified for short duration ambulatory surgeries of lower abdominal and lower limb surgeries. Furthermore, fentanyl as an adjuvant to both ropivacaine and L-bupivacaine enhanced the duration of the sensory block. Hence, ropivacaine with fentanyl in spinal anesthesia for lower abdominal and lower limb surgeries is a better alternative compared to L-bupivacaine with fentanyl favoring day care ambulatory surgeries. [Int J Basic Clin Pharmacol 2015; 4(6.000: 1147-1155
... during sleep. They also occur normally for a short time after the use of certain medicines and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation. Increased ( hyperactive ) bowel sounds ...
Full Text Available Objective To explore the correlation between the perioperative risk factors and postoperative pulmonary complications(POPC in elder patients undergoing upper abdominal surgery.Methods A retrospective survey of 169 elder patients(age over 60 years,received elective upper abdominal surgery under general anesthesia from Jan.1,2006 to Jan.1,2010 was conducted.The perioperative factors influencing respiratory function were evaluated,including clinical manifestations,chest X-ray,pulmonary function,arterial blood gas analysis,duration of anesthesia,incision type,duration of nasogastric tube and ambulation time.Meanwhile,the relationship between POPC and the factors mentioned above was analyzed.Results POPC were seen to occur in 77 of the 169 patients(45.6%,and the most common complication was pneumonia(20 cases,followed by atelectasis(18 cases,tracheobronchitis or acute exacerbations of chronic bronchitis(17 cases,bronchospasm(15 cases,acute respiratory failure(5 cases and pulmonary embolism(2 cases.Multivariate logistic analysis showed that the postoperative nasogastric intubation,preoperative respiratory symptoms,decreased forced expiratory volume in 1st second/forced vital capacity(FEV1/FVC and longer duration of anesthesia were the valuable risk factors for prediction of POPC.Conclusions It is recommend that a detailed preoperative pulmonary examination and pulmonary function test in elder patients who are going to have upper abdominal surgery should be done to identify the risk for POPC.Preoperative intervention therapy may be helpful to improve pulmonary function,decrease the incidence of POPC and lower mortality of the patients.
Le Blanc-Louvry, Isabelle; Costaglioli, Bruno; Boulon, Catherine; Leroi, Anne-Marie; Ducrotte, Philippe
The aim of this study was to determine the effectiveness of mechanical abdominal massage on postoperative pain and ileus after colectomy. We hypothesized that parietal abdominal stimulation could counteract induced pain and postoperative ileus, through common spinal-sensitive pathways, with nociceptive visceral messages. After preoperative randomization, 25 patients (age 52 +/- 5 years) underwent active mechanical massage by intermittent negative pressure on the abdominal wall resulting in aspiration (Cellu M50 device, LPG, Valence, France), and 25 patients (age 60 +/- 6 years) did not receive active mechanical massage (placebo group). Massage sessions began the first day after colectomy and were performed daily until the seventh postoperative day. In the active-massage group, amplitude and frequency were used, which have been shown to be effective in reducing muscular pain, whereas in the placebo group, ineffective parameters were used. Visual analogue scale (VAS) pain scores, doses of analgesics (propacetamol), and delay between surgery and the time to first passage of flatus were assessed. Types and dosages of the anesthetic drugs and the duration of the surgical procedure did not differ between groups. From the second and third postoperative days, respectively, VAS pain scores (P < 0.001) and doses of analgesics (P < 0.05) were significantly lower in patients receiving active massage compared to the placebo group. Time to first passage of flatus was also significantly shorter in the active-massage group (1.8 +/- 0.3 days vs. 3.6 +/- 0.4 days, P < 0.01). No adverse effects were observed. These results suggest that mechanical massage of the abdominal wall may decrease postoperative pain and ileus after colectomy. PMID:11986017
Full Text Available Background and purpose: Despite progresss in the techniques of surgery, there is still a lot of controversy about selection of the best technique and suture material. Many post operation complications such as infection, wound dehiscence, pain and sinus formation are related to the type of the suture used. In this study we compared the complications due to the absorbent suture (PDS with a non absorbent suture (nylon in laparotomy operation.Materials and Methods: This clinical trial was performed on 120 patients referring to Imam Khomeini hospital, Sari, 2003-2005 for laparotomy. They were randomly divided in tow groups of equal number. The incision was repaired with PDS sutures in case and with nylon suture in control group. All patients under study were followed up for one year. Data about chronic pain,wound dehiscence, infection, hernia and sinus formation were recorded and analyzed using SPSS software and Chi- square test.Results: In this study 120 patients (60 in case and 60 in control groups were enrolled. After laparotomy, the incidence of chronic pain and sinus formation in case group was significantly less than the control group. There were no significant differences between the rate of infection, hernia and wound dehiscence in the two groups.Conclusion: No significant differences in the rate of infection, hernia and wound dehiscence between two types of suture materials were observed. However, application of PDS leads to less pain and sinus formation. Therefore, it can be a better choice in surgical incisions.
Samantha T. Grams
Full Text Available BACKGROUND: There is currently no consensus on the indication and benefits of breathing exercises for the prevention of postoperative pulmonary complications PPCs and for the recovery of pulmonary mechanics. OBJECTIVE: To undertake a systematic review of randomized and quasi-randomized studies that assessed the effects of breathing exercises on the recovery of pulmonary function and prevention of PCCs after upper abdominal surgery UAS. METHOD: Search Strategy: We searched the Physiotherapy Evidence Database PEDro, Scientific Electronic Library Online SciELO, MEDLINE, and Cochrane Central Register of Controlled Trials. Selection Criteria: We included randomized controlled trials and quasi-randomized controlled trials on pre- and postoperative UAS patients, in which the primary intervention was breathing exercises without the use of incentive inspirometers. Data Collection and Analysis: The methodological quality of the studies was rated according to the PEDro scale. Data on maximal respiratory pressures MIP and MEP, spirometry, diaphragm mobility, and postoperative complications were extracted and analyzed. Data were pooled in fixed-effect meta-analysis whenever possible. RESULTS: Six studies were used for analysis. Two meta-analyses including 66 participants each showed that, on the first day post-operative, the breathing exercises were likely to have induced MEP and MIP improvement treatment effects of 11.44 mmH2O (95%CI 0.88 to 22 and 11.78 mmH2O (95%CI 2.47 to 21.09, respectively. CONCLUSION: Breathing exercises are likely to have a beneficial effect on respiratory muscle strength in patients submitted to UAS, however the lack of good quality studies hinders a clear conclusion on the subject.
Tejaswini Arunachala Murthy
Full Text Available Background: Benefit of early enteral feeds in surgical patients admitted to Intensive Care Units (ICUs has been emphasized by several studies. Apprehensions about anastomotic leaks in gastrointestinal surgical patients prevent initiation of early enteral nutrition (EN. The impact of these practices on outcome in Indian scenario is less studied. Aims: This study compares the impact of early EN (within 48 h after surgery with late EN (48 h postsurgery on outcomes in abdominal surgical ICU patients. Settings and Design: Postabdominal surgery patients admitted to a tertiary referral hospital ICU over a 2-year period were analyzed. Methods: Only patients directly admitted to ICU after abdominal surgery were included in this study. ICU stay>3 days was considered as prolonged; with average ICU length of stay (LOS for this ICU being 3 days. The primary outcome was in-patient mortality. ICU LOS, hospital LOS, infection rates, and ventilator days were secondary outcome measures. Acute Physiology and Chronic Health Evaluation II scores were calculated. SPSS and Microsoft Excel were used for analysis. Results: Of 91 ICU patients included, 58 received early EN and 33 late EN. Hospital LOS and infection rates were less in early EN group. Use of parenteral nutrition (odds ratio [OR] 5.25, 95% confidence interval (CI; P = 0.003 and number of nil-per-oral days (OR 8.25, 95% CI; P ≤ 0.001 were other predictors of prolonged LOS. Conclusions: Early EN in postabdominal surgery ICU patients was associated with reduced hospital LOS and infection rates. ICU LOS, duration of mechanical ventilation and mortality rates did not vary.
Md. Jawed; Himadri; De, Abhijit; Rathindra; Deshmukh Md Saudmiya
BACKGROUND: Manual small incision cataract surgery (SICS) has given visual results almost equivalent to Phacoemulsification but limited studies are available regarding the efficacy of small incision cataract surgery in phaco suitable immature cataracts. OBJECTIVE: To compare manual small incision cataract surgery and Phacoemulsification in immature cataracts. MATERIALS AND METHODS: A single blind randomized controlled trial was conducted with 105 eyes each for small incisi...
Computed tomography prospective study of pleural-pulmonary changes after abdominal surgery : assessment of associated risk factors; Estudo prospectivo por tomografia computadorizada das alteracoes pleuro-pulmonares apos cirurgia abdominal: avaliacao dos fatores de risco associados
Rossi, Luis Antonio [Pontificia Univ. Catolica de Sao Paulo, SP (Brazil). Centro de Ciencias Medicas e Biologicas]. E-mail: email@example.com; Bromberg, Sansom Henrique [Instituto de Assistencia Medica ao Servidor Publico Estadual de Sao Paulo (IAMSPE), Sao Paulo, SP (Brazil). Curso de Pos-graduacao em Gastroenterologia Cirurgica
Postoperative pleural-pulmonary changes (PPC) are very common following elective abdominal surgery, resolving without clinical manifestations in most patients. The incidence and risk factors associated are unknown. Objective: to determine the incidence of PPC and possible association with risk factors using computerized tomography (CT). Material and method: thirty seven patients submitted to elective abdominal surgery were prospectively analyzed using CT performed in the preoperative period and 48 hours after surgery. The PPC was scored from 0 to III. The risk factors evaluated were: age, sex, obesity, smoking history, alcoholism, comorbid conditions, cancer, ASA classification, duration of surgery, surgical incision type and number of days of hospitalization. Results: Pleura effusion was detected by CT in 70.3% (26/37) of the patients and pulmonary atelectasis in 75.5% (28/37). Grade I and II PPC was found in 59.5% (22/37) of the patients and grade III in 21.6% (8/37). Two (5.4%) of these patients developed serious pulmonary complications whereas one patient died. Surgery due to cancer, class ASA >2, longitudinal incision and > 15 cm showed statistical significance and were associated with pleural effusion. The hospitalization was over 2.4 longer for patients with PPC. Conclusion: PPC is frequently seen in patients submitted to abdominal surgery. The use of the CT for the detection of pulmonary atelectasis and pleural effusion proved to be effective. Most cases of PPC are self-limited, resolving without symptoms. (author)
Berghmans Tim MP
Full Text Available Abstract Background Postoperative ileus (POI is a well-known complication of abdominal surgery and is considered to be caused by a local inflammation in the gut. Previously it has been shown that both local and systemic inflammation can be reduced by stimulation of the autonomic nervous system via lipid rich nutrition. Stimulation of the autonomic nervous system releases acetylcholine from efferent vagal nerve endings that binds to nicotinic receptors located on the inflammatory cells leading to a decrease of pro-inflammatory mediators. Besides administration of nutrition there are other ways of stimulating the autonomic nervous system such as gum chewing. Methods/design This prospective, placebo-controlled randomized trial will include 120 patients undergoing colorectal surgery which are randomized for gum chewing preoperatively and in the direct postoperative phase or a placebo. Postoperative ileus will be assessed both clinically by time to first flatus and time to first defecation and by determination of gastric motility using ultrasound to measure dimensions of the antrum. Furthermore the inflammatory response is quantified by analyzing pro-inflammatory mediators. Finally, markers of gut barrier integrity will be measured as well as occurrence of postoperative complications. Discussion We hypothesize that chewing gum preoperatively and in the direct postoperative phase in patients undergoing colorectal surgery dampens local and systematic inflammation, via activation of the autonomic nervous system. Down-regulation of the inflammatory cascade via stimulation of the vagus nerve will ameleriote POI and enhance postoperative recovery. Trial registration NTR2867
Winfield, Robert D; Reese, Stacey; Bochicchio, Kelly; Mazuski, John E; Bochicchio, Grant V
Obesity is a risk factor for surgical site infection (SSI) after abdominal procedures; however, data characterizing the risk of SSI in obese patients during abdominal procedures are lacking. We hypothesized that obesity is an independent risk factor for SSI across wound classes. We analyzed American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) data for 2011. We calculated body mass index (BMI), classifying patients according to National Institute of Health (NIH) BMI groups. We excluded records in which height/weight was not recorded and patients with BMI less than 18.5. We examined patients undergoing open abdominal procedures, performing univariate and multivariate analyses to assess the relative contribution of obesity to SSI. Study criteria were met by 89,148 patients. Obese and morbidly obese patients had significantly greater SSI rates in clean and clean-contaminated cases but not contaminated or dirty/infected cases. Logistic regression confirmed obesity and morbid obesity as being independently associated with the overall SSI development, specifically in clean [Obesity odds ratio (OR) = 1.757, morbid obesity OR = 2.544, P SSI overall, specifically in clean and clean-contaminated abdominal procedures; this is independent of diabetes mellitus. Novel techniques are needed to reduce SSI in this high-risk patient population. PMID:27097626
Elissa Epel; Lori Karan; Margaret Kemeny; Lustig, Robert H.; Margaret Kuwata; Jennifer Daubenmier; Nicole Maninger; Hecht, Frederick M.; Kinnari Jhaveri; Jean Kristeller
Psychological distress and elevated cortisol secretion promote abdominal fat, a feature of the Metabolic Syndrome. Effects of stress reduction interventions on abdominal fat are unknown. Forty-seven overweight/obese women (mean BMI = 31.2) were randomly assigned to a 4-month intervention or waitlist group to explore effects of a mindfulness program for stress eating. We assessed mindfulness, psychological distress, eating behavior, weight, cortisol awakening response (CAR), and abdominal fat ...
Marzouk, Tyseer M. F.; El-Nemer, Amina M. R.; Baraka, Hany N.
Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 (n = 48) received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond ...
Okumu, Gabriel; Makobore, Patson; Kaggwa, Sam; Kambugu, Andrew; Galukande, Moses
Background Surgery plays a key role in HIV palliative care, specifically in the diagnosis and treatment of HIV related and non-related conditions. Yet major surgery depresses the immune system. Whereas the surgical consequences of HIV infection are well described, there is a paucity of published data, in resource-limited settings, on the effects of major surgery on the immune system. The purpose of this study was to determine the effect of major abdominal surgery on CD4 count in HIV positive ...
Full Text Available Hamid Reza Faiz,1 Poupak Rahimzadeh,1 Ognjen Visnjevac,2 Behzad Behzadi,1 Mohammad Reza Ghodraty,1 Nader D Nader2 1Iran University of Medical Sciences, Tehran, Iran; 2VA Western NY Healthcare System, University at Buffalo, Buffalo, NY, USA Background: In recent years, intravenously (IV administered acetaminophen has become one of the most common perioperative analgesics. Despite its now-routine use, IV acetaminophen's analgesic comparative efficacy has never been compared with that of ketamine, a decades-old analgesic familiar to obstetricians, gynecologists, and anesthesiologists alike. This double-blind clinical trial aimed to evaluate the analgesic effects of ketamine and IV acetaminophen on postoperative pain after abdominal hysterectomy. Methods: Eighty women aged 25–70 years old and meeting inclusion and exclusion criteria were randomly allocated into two groups of 40 to receive either IV acetaminophen or ketamine intraoperatively. Postoperatively, each patient had patient-controlled analgesia. Pain and sedation (Ramsay Sedation Scale were documented based on the visual analog scale in the recovery room and at 4 hours, 6 hours, 12 hours, and 24 hours after the surgery. Hemodynamic changes, adverse medication effects, and the need for breakthrough meperidine were also recorded for both groups. Data were analyzed by repeated-measures analysis of variance. Results: Visual analog scale scores were significantly lower in the IV acetaminophen group at each time point (P<0.05, and this group required significantly fewer doses of breakthrough analgesics compared with the ketamine group (P=0.039. The two groups had no significant differences in terms of adverse effects. Conclusion: Compared with ketamine, IV acetaminophen significantly improved postoperative pain after abdominal hysterectomy. Keywords: intravenous acetaminophen, abdominal hysterectomy, ketamine, analgesia, postoperative pain
Wiebelitz KR; Beer AM
Karl Rüdiger Wiebelitz, André-Michael BeerDepartment of True Naturopathy, Blankenstein Hospital, Hattingen, GermanyAbstract: A patient with pancreatic carcinoma diagnosed in 2005 suffered from chronic abdominal pain 6 years later that did not respond to conventional pain treatment according to guidelines. Furthermore, several complementary medical approaches remained ineffective. In the long run, only an Iberis amara drug combination relieved pain sufficiently. The drug is...
Sillesen, H; Eldrup, N; Hultgren, R;
BACKGROUND: Abdominal aortic aneurysm (AAA) is thought to develop as a result of inflammatory processes in the aortic wall. In particular, mast cells are believed to play a central role. The AORTA trial was undertaken to investigate whether the mast cell inhibitor, pemirolast, could retard the...... surgery, diabetes mellitus, and severe concomitant disease with a life expectancy of less than 2 years. Included patients were treated with 10, 25 or 40 mg pemirolast, or matching placebo for 52 weeks. The primary endpoint was change in aortic diameter as measured from leading edge adventitia at the...
Full Text Available BACKGROUND In view of the wider application of regional anaesthetic procedures in modern anaesthesia practice, there is a need for local anaesthetic with desirable properties like long duration of sensory blockade and lesser duration of motor paralysis; α-2 adrenergic agonists have both analgesic and sedative properties when used as an adjuvant in regional anaesthesia.1-6 Dexmedetomidine is a highly selective α-2 adrenergic agonist with an affinity eight times greater than that of clonidine. AIM To evaluate the clinical efficacy of 0.5% ropivacaine with dexmedetomidine by epidural route compared to 0.5% bupivacaine with dexmedetomidine by epidural route in patients undergoing lower abdominal and lower limb surgeries. MATERIALS AND METHODS In this study, 60 patients aged between 18-60 yrs. of either sex, belonging to ASA-I and II undergoing elective lower abdominal and lower limb surgeries were randomly divided into two groups. Group RD comprises of patients in whom 20mL of 0.5% ropivacaine with 30mcg. Dexmedetomidine was administered single shot epidurally. Group BD comprises of patients in whom 20mL of 0.5% bupivacaine with 30mcg. Dexmedetomidine was administered single shot epidurally. RESULTS Addition of dexmedetomidine as an adjuvant to both the groups has shortened the mean time of onset of both sensory and motor blockade. The time for two segmental regression in ropivacaine dexmedetomidine (RD group is less than that of bupivacaine dexmedetomidine (BD group, which is statistically significant. The mean time of onset of motor blockade is longer in group RD than that of the group BD, which is statistically highly significant. Duration of motor blockade in group BD is longer than that of group RD, which is statistically significant. CONCLUSION Bupivacaine with dexmedetomidine group had early onset of motor and sensory blockade with longer duration of motor blockade than that of ropivacaine with dexmedetomidine group. Group ropivacaine with
Abdominal injury is an important cause of morbidity and mortality in childhood. Ten percent of trauma-related deaths are due to abdominal injury. Thousands of children are involved in auto accidents annually; many suffer severe internal injury. Child abuse is a second less frequent but equally serious cause of internal abdominal injury. The descriptions of McCort and Eisenstein and their associates in the 1960s first brought to attention the frequency and severity of visceral injury as important manifestations of the child abuse syndrome. Blunt abdominal trauma often causes multiple injuries; in the past, many children have been subjected to exploratory surgery to evaluate the extent of possible hidden injury. Since the advent of noninvasive radiologic imaging techniques including radionuclide scans and ultrasound and, especially, computed tomography (CT), the radiologist has been better able to assess (accurately) the extent of abdominal injury and thus allow conservative therapy in many cases. Penetrating abdominal trauma occurs following gunshot wounds, stabbing, and other similar injury. This is fortunately, a relatively uncommon occurrence in most pediatric centers and will not be discussed specifically here, although many principles of blunt trauma diagnosis are valid for evaluation of penetrating abdominal trauma. If there is any question that a wound has extended intraperitonelly, a sinogram with water-soluble contrast material allows quick, accurate diagnosis. The presence of large amounts of free intraperitoneal gas suggests penetrating injury to the colon or other gas-containing viscus and is generally considered an indication for surgery
Baron, Jean-François; Gourdin, Maximilien; Bertrand, Michèle,; Mercadier, Anne; Delort, Josée; Kieffer, Edouard; Coriat, Pierre
We evaluated, by using a before-and-after study, the influence of leukoreduction by filtration on postoperative infections and adverse outcomes in patients undergoing elective major aortic surgery. From January 1995 to October 2000, all patients who underwent elective abdominal aortic surgery were included in the analysis. Before the introduction of systematic leukodepletion of packed red blood cells (RBCs), on April 1, 1998, 192 patients received standard or buffy-coat-depleted packed RBCs. ...
Zhou J; Pi H; Zheng Y
Jing Zhou,1 Hongying Pi,2 Yingying Zheng1 1General Surgery, 2Nursing Department, Chinese People’s Liberation Army General Hospital, Beijing, People’s Republic of China Background: Abdominal cavity drainage fluid can be used as an early diagnostic tool of postoperative complications, and observing its characteristics can help us to judge and handle postoperative complications. There is no accurate standard reference range on its characteristics after surgeries for gastrointestina...
Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial.
Alaparthi, Gopala Krishna; Augustine, Alfred Joseph; Anand, R; Mahale, Ajith
Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow Rate (PEFR), and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity) and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of laparoscopic abdominal surgery. PMID:27525116
LI Yu-hong; XU Jian-hong; YANG Jian-jun; TIAN Jie; XU Jian-guo
Objective: To evaluate the predictive performance of'Diprifusor' TCI (target-controlled infusion) system for its better application in clinical anesthesia. Methods: The predictive performance of a ‘Diprifusor’ TCI system was investigated in 27Chinese patients (16 males and 11 females) during upper abdominal surgery under total intravenous anesthesia (TIVA) with propofol/fentanyl. Measured arterial propofol concentrations were compared with the values predicted by the TCI infusion system.Performance was determined by the median performance error (MDPE), the median absolute performance error (MDAPE), the divergence (the percentage change of the absolute PE with time), and the wobble (the median absolute deviation of each PE from the MDPE). Results: The median (range) values of 14.9% (-21.6%～42.9%) for MDPE, 23.3% (6.9%～62.5%) for MDAPE, -1.9%h-1 (-32.7%～23.0% h-1) for divergence, and 18.9% (4.2%～59.6%) for wobble were obtained from 227 samples from all patients.For the studied population, the PE did not increase with time but with increasing target propofol concentration, particularly following induction. Conclusions: The control of depth of anaesthesia was good in all patients undergoing upper abdominal surgical operation and the predictive performance of the ‘Diprifusor’ target controlled infusion system was considered acceptable for clinical purposes. But the relatively bigger wobble showed that the pharmacokinetic model is not so suitable and requires improvement.
After resection of parenchymal abdominal organs the developing scan tissue is characterised by fat (-30 to -50 H.U.) in connection with mesenchymal funicles. Differential diagnosis presents no problem. Atrophy and hypertrophy may sometimes be demonstrated in CT. This is valid for compensating hypertrophy of the remaining parts of the liver, splenic regeneration or an accessory spleen. Furthermore, involution of the tail of the pancreas after proximal duodenopancreatectomy could be shown in CT. One pancreatic calcification decreased after drainage of a pseudocyst. (orig.)
Nikul'nikov, P I; Liksunov, O V; Ratushniuk, A V; Lugovs'koĭ, E V; Kolesnikova, I M; Lytvynova, L M; Kostiuchenko, O P; Chernyshenko, T M; Hornyts'ka, O V; Platonova, T M
Basing on data of analysis of the hemostasis system state in the patients, suffering abdominal aorta aneurysm, a tendency for raising of postoperative soluble fibrin and D-dimer content in the blood plasm and reduction of these indices on the third day was noted. The abovementioned markers content depends on the aneurysm size, the fibrin deposits presence, the terms from clinical signs beginning to the certain therapy administration and anticoagulants application. Information about correlation between content of D-dimer and soluble fibrin in the treatment dynamics is important for determination of activation degree in the patients blood coagulation system and the thrombotic complications prognosis. PMID:23285650
In many patients, abdominal ultrasonography is an excellent diagnostic and prognostic tool. It aids in deciding whether the animal should undergo surgical or medical treatment or be slaughtered. This is particularly true in cattle with traumatic reticuloperitonitis (in combination with radiography of the reticulum) or with a tentative diagnosis of left or right displacement of the abomasum. Ultrasound also is an excellent aid for identification of ileus of the small and large intestine, liver abscesses, cholestasis, various urinary tract disorders, and the different forms of ascites. PMID:15718086
Gabriel Rada; José Viñuela
Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos) es una actualización del resumen publicado en Noviembre de 2014, basado en 4 nuevas revisiones sistemáticas aparecidas con posterioridad. El íleo postoperatorio es una condición común que retrasa la recuperación luego de una cirugía abdominal. El uso precoz de goma de mascar, como método de alimentación fingida, estimularía la peristalsis permitiendo una alimentación más precoz. ...
Full Text Available Este resumen Epistemonikos (Living FRISBEE: Living FRIendly Summary of the Body of Evidence using Epistemonikos es una actualización del resumen publicado en Noviembre de 2014, basado en 4 nuevas revisiones sistemáticas aparecidas con posterioridad. El íleo postoperatorio es una condición común que retrasa la recuperación luego de una cirugía abdominal. El uso precoz de goma de mascar, como método de alimentación fingida, estimularía la peristalsis permitiendo una alimentación más precoz. Utilizando la base de datos Epistemonikos, la cual es mantenida mediante búsquedas en 30 bases de datos, identificamos 18 revisiones sistemáticas que en conjunto incluyen 81 estudios aleatorizados. Realizamos un metanálisis y tablas de resumen de los resultados utilizando el método GRADE. Concluimos que la goma de mascar probablemente disminuye el tiempo de hospitalización luego de una cirugía abdominal.
Ehlers, Lars Holger; Laursen, Kathrine Bang; Berg Jensen, Morten
-VAS, but not with EQ-5D. A negative association between QoL and years following surgery was found with EQ-VAS and SF-12 (PCS), but not with the other instruments. Discussion: Factors such as selection bias because of mortality and non-response may have resulted in an over-estimate of the QoL in patients...
ten Broek, Richard P. G.; Stommel, Martijn W. J.; Strik, Chema; van Laarhoven, Cornelis J. H. M.; Keus, Frederik; van Goor, Harry
Background Formation of adhesions after peritoneal surgery results in high morbidity. Barriers to prevent adhesion are seldom applied, despite their ability to reduce the severity of adhesion formation. We evaluated the benefits and harms of four adhesion barriers that have been approved for clinica
Full Text Available The stress response is the name given to the hormonal and metabolic changes which follow injury or trauma. The systemic reactions to surgical injury encompass a wide range of endocrinological, immunological and haematological effects. The ability of anaesthetic agents modifies the endocrine and metabolic responses have been studied enthusiastically. This research describes the endocrine and metabolic changes which occur during different types of surgical techniques, effects of anaesthetic and analgesic regimens to modify their responses. OBJECTIVES: The present study aimed to evaluate the effects of stress response on blood glucose levels and hemodynamics in patients undergoing open Laparotomy surgeries v/s laparoscopic surgeries. METHODS: Sixty surgical patients were enrolled in this clinical trial. The pulse, BP records were taken and blood sugar levels were tested peri-operatively. RESULTS: The results were analyzed and found that raise pulse rate, blood pressure and blood sugar levels due to stress in proportionate to surgical trauma, and duration of surgery under anaesthesia. Blood sugar levels gradually increased 90.5±4.88 to 115±7.18 and at post op119.4±6.93 in laparotomy group when compared to 91.07±4.93 to 118.33±5.06 and at post-op120.1±4.51 in laparoscopy group. CONCLUSION: Lap surgery causes minimum tissue injury and less stress response more so during postoperative period.
Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.
Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a cy
Bulut, O; Aslak, K K; Levic, K;
BACKGROUND: Potential benefits of single-port laparoscopic surgery may include improved cosmetic results, less postoperative pain, surgical trauma and faster recovery. Results of randomized prospective studies with a focus on single-port rectal surgery have not yet been presented. The aim of the...
Jelenska, Maria Magdalena; Szmidt, Jacek; Bojakowski, Krzystof; Grzela, Tomasz; Palester-Chlebowczyk, Magorzata
Elective surgery of abdominal aortic aneurysm (AAA) sometimes leads to excessive bleeding and disseminated intravascular coagulation (DIC), even in patients with normal preoperative coagulation parameters. Coagulation screen, performed routinely before surgery is of limited value in the assessment of compensated activation of the haemostatic system. In this study, we used a number of additional tests (D-dimer, prothrombin fragment 1+2, antithrombin, and activation of fibrinolysis in the platelet poor plasma) for the diagnosis of compensated activation of the haemostatic system in AAA-patients. D-dimer and marker of thrombin generation (prothrombin fragment 1+2) positively correlated with each other (r = 0.768, P D-dimer and prothrombin fragment 1+2 decreased significantly) and resulted in the increase of platelet number and fibrinogen concentration, indicating their previous consumption. Despite differences in aneurysm diameters between the groups of 15 LMWH treated patients (mean 70.9 +/- 16 mm) and the reference group of 20 untreated AAA patients (mean 52.3 +/- 8.0 mm), intraoperative parameters (operation time, blood loss and transfusion demands) were similar. PMID:15543326
Full Text Available Epidural administration of various analgesics gained increasing popularity following the discovery of opioid receptors in the spinal cord capable of producing potent analgesia. This effect seems to be greatest when epidural anaesthesia in continued in the post - operative period as epidural analgesia . It is now clear that epidural administration of opioids. Ours was a comparative study between epidural bupivacaine with buprenorphine and epidural bupivacaine for post - operative analgesia in abdominal and lower limb surgery. METHODS: 60 patients undergoing lower abdominal and lower limb surgeries of either sex with ASA grade 1 and 2 a ged between 20 and 60 years for divided into two groups. After completion of the surgery and when the effect of local anaesthetic wears of and the patients complains of pain the intended study drugs were given when visual analogue pain score touched 5 cm m ark. Group – A: Patients received 8ml of 0.25% bupivacaine + 0.15mg of buprenorphine. Group – B: patients received 0.25% of bupivacaine alone. In the post - operative period the following parameters were studied , 1. Onset of analgesia , 2. Duration of analges ia , 3. Vital parameters such as heart beat , blood pressure , respiratory rate , sedation score and visual analogue score were recorded , 4. Side effects like nausea , vomiting , hypotension , respiratory depression , and pruritus allergic reaction were looked for . RESULTS: It is observed that onset of analgesia in Group A (0.25% bupivacaine + 0.15mg buprenorphine was 7.35 min. When compared to Group B which 15.5 min , which is statically significant (P<0.05. Duration of analgesia in Group A is 17.23 hrs compared to Group B , which is 5.2 hrs , this is statically significant (P<0.05. Visual analogue scale was reduced in Group A compared to Group B CONCLUSIONS: Addition of buprenorphine to bupivacaine by epidural injection for post - operative analgesia improves the on set , The duration and the
Abd Elwahab, Sami Medani
Somatoform disorders (SD) or medically unexplained physical symptoms (MUPS) are a group of disorders that represent a group of symptoms that cannot be explained by an organic or physical pathology. These disorders are widely prevalent, and, if unrecognised, SD may lead medical professionals to embark on tests or procedures which may inflict unnecessary iatrogenic complications. Despite the high prevalence, they are only poorly included in medical training curricula, at both undergraduate and postgraduate levels. In this article, we review the literature and present two cases. The first one presented with a recurrent acute abdomen had an unnecessary CT abdomen. The second case had laparoscopy for acute right-sided abdominal pain which turned out to be normal, and was readmitted again after a short period with acute urine retention which resolved spontaneously following discussion with the patient and family. Both cases were referred for psychiatric assessment and their family doctors were informed.
To determine which abdominal CT findings predict severe fibrosis and post-operative pain relief in chronic pancreatitis (CP). Pre-operative abdominal CTs of 66 patients (mean age 52 ± 12 years, 53 % males) with painful CP who underwent the Whipple procedure (n = 32), Frey procedure (n = 32) or pancreatic head biopsy (n = 2), between 1/2003-3/2014, were evaluated. CT was evaluated for parenchymal calcifications, intraductal calculi, main pancreatic duct dilation (>5 mm), main pancreatic duct stricture, and abnormal side branch(es). The surgical histopathology was graded for fibrosis. CT findings were evaluated as predictors of severe fibrosis and post-operative pain relief using regression and area under receiver operating curve (AUC) analysis. Thirty-eight (58 %) patients had severe fibrosis. Parenchymal calcification(s) were an independent predictor of severe fibrosis (p = 0.03), and post-operative pain relief over a mean follow-up of 1-year (p = 0.04). Presence of >10 parenchymal calcifications had higher predictive accuracy for severe fibrosis than 1-10 parenchymal calcification(s) (AUC 0.88 vs. 0.59, p = 0.003). The predictive accuracy of >10 versus 1-10 parenchymal calcifications increased after adjusting for all other CT findings (AUC 0.89 vs. 0.63, p = 0.01). Parenchymal calcification(s) independently predict severe fibrosis and are significantly associated with post-operative pain relief in CP. The presence of >10 parenchymal calcifications is a better predictor of severe fibrosis than 1-10 parenchymal calcification(s). (orig.)
Sinha, Amitasha; Afghani, Elham [Johns Hopkins Medical Institutions, Division of Gastroenterology, Baltimore, MD (United States); Singh, Vikesh K. [Johns Hopkins Medical Institutions, Division of Gastroenterology, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Pancreatitis Center, Baltimore, MD (United States); Cruise, Michael; Matsukuma, Karen [Johns Hopkins Medical Institutions, Department of Pathology, Baltimore, MD (United States); Ali, Sumera; Raman, Siva P.; Fishman, Elliot K. [Johns Hopkins Medical Institutions, The Russel H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Andersen, Dana K. [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (United States); Makary, Martin A. [Johns Hopkins Medical Institutions, Department of Surgery, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Pancreatitis Center, Baltimore, MD (United States); Zaheer, Atif [Johns Hopkins Medical Institutions, The Russel H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Pancreatitis Center, Baltimore, MD (United States); Johns Hopkins Medical Institutions, Baltimore, MD (United States)
To determine which abdominal CT findings predict severe fibrosis and post-operative pain relief in chronic pancreatitis (CP). Pre-operative abdominal CTs of 66 patients (mean age 52 ± 12 years, 53 % males) with painful CP who underwent the Whipple procedure (n = 32), Frey procedure (n = 32) or pancreatic head biopsy (n = 2), between 1/2003-3/2014, were evaluated. CT was evaluated for parenchymal calcifications, intraductal calculi, main pancreatic duct dilation (>5 mm), main pancreatic duct stricture, and abnormal side branch(es). The surgical histopathology was graded for fibrosis. CT findings were evaluated as predictors of severe fibrosis and post-operative pain relief using regression and area under receiver operating curve (AUC) analysis. Thirty-eight (58 %) patients had severe fibrosis. Parenchymal calcification(s) were an independent predictor of severe fibrosis (p = 0.03), and post-operative pain relief over a mean follow-up of 1-year (p = 0.04). Presence of >10 parenchymal calcifications had higher predictive accuracy for severe fibrosis than 1-10 parenchymal calcification(s) (AUC 0.88 vs. 0.59, p = 0.003). The predictive accuracy of >10 versus 1-10 parenchymal calcifications increased after adjusting for all other CT findings (AUC 0.89 vs. 0.63, p = 0.01). Parenchymal calcification(s) independently predict severe fibrosis and are significantly associated with post-operative pain relief in CP. The presence of >10 parenchymal calcifications is a better predictor of severe fibrosis than 1-10 parenchymal calcification(s). (orig.)
Acute pancreatitis clinically manifests various degrees of severity. In the present study, we performed a retrospective study on 39 cases of acute pancreatitis and examined the indications for surgery and infection as an aggravating factor in acute pancreatitis on the basis of CT in the early stage (about 48 hours after onset). CT in the early stage of acute pancreatitis permits objective determination of the extent of lesion enlargement. The cases could be classified into three grades: severe (CT score ≥ 6; surgical therapy), moderate (CT score = 5, 4; medical therapy possible), and mild (CT score ≤ 3; medical therapy) as determined by CT. Emergency surgery was performed in seven of 10 patients in whom pancreatitis was judged to be severe on the basis of CT and clinical findings. Of the seven, four had infection in the early stage (within 48 hours after onset). Three of the four had MOF complications and died. Two of the three patients without infection were relieved. The extent of inflammatory lesions of severe pancreatitis was severe by CT, and the CT scores were especially high in cases with infection. Infection in the early stage of acute pancreatitis was thus thought to be an serious aggravating factor. It was concluded, therefore, that, in the early stage, CT was very useful as a helpful guide to early judgement and an indicator for emergency surgery. (author)
Full Text Available Objectives: It was aimed to evaluate the effectivenessof combined use of ultrasonography (US and plain radiography(PR in the postoperative follow-up of patientsundergoing retrograde intrarenal surgery (RIRS.Materials and methods: The charts of 207 patients whounderwent RIRS for renal stones in a 3-years-periodwere retrospectively reviewed. Fifty-eight patients wereincluded to study who were evaluated with combinationof urinary US, PR and computed tomography (CT at 1month after surgery.Results: Of 58 procedures with perioperative completestone fragmentation, 49 were completely stone-free(84.4%, while fragments (≥ 3 mm were observed in 9patients and hydronephrosis was detected in 5 patients(8.6% on the CT. Of the 9 residual stones and 5 hydronephrosis,the radiologists truly diagnosed 6 stones (66.6%and 5 hydronephrosis (100% by using the combination ofUS and PR. The sensitivity, specificity, positive and negativepredictive values of US and PR for detecting presenceof residual stone and hydronephrosis were 66.6%and 100%, 98% and 98%, 85.7% and 83.3%, 94.2% and100%, respectively.Conclusions: A combination of urinary US and plain filmhas clear advantages about lack of radiation exposureover CT scan and it is a highly specific and sensitive testfor detecting hydronephrosis. However this procedurehas limited accuracy for detecting small residual stones,so we believe that CT scan is only necessary when patienthas persistent pain or sonographic evidence of hydronephrosisis present.Key words: Renal stone, plain abdominal film, retrogradeintrarenal surgery, ultrasonography
Nordkam, R.A.; Bluyssen, S.J.; Goor, H. van
Glove perforation frequently occurs during the course of surgical procedures, introducing risks for both surgeons and patients. The aim of this study was to compare the use of blunt tapered and "sharp" needles during abdominal wall closure with respect to the incidence of glove perforation and the c
Nestor González-Roldán; Constantino López-Macías; Armando Isibasi; Eduardo Ferat-Osorio; Rosalía Aduna-Vicente; Isabel Wong-Baeza; Noemí Esquivel-Callejas; Horacio Astudillo-de la Vega; Patricio Sánchez-Fernández; Lourdes Arriaga-Pizano; Miguel Angel Villasís Keever
AIM: To evaluate the surface expression of triggering receptor on myeloid cell 1 (TREM-1), class Ⅱ major histocompatibility complex molecules (HLA-DR), andthe expression of the splicing variant (svTREM-1) ofTREM-1 in septic patients and those subjected to major abdominal surgery.METHODS: Using flow cytometry, we examined the surface expression of TREM-1 and HLA-DR in peripheral blood monocytes from 11 septic patients, 7 elective gastrointestinal surgical patients, and 10 healthy volunteers. svTREM-1 levels were analyzed by RT-PCR. RESULTS: Basal expression of TREM-1 and HLA-DR in healthy volunteers was 35.91±14.75 MFI and75.8±18.3%, respectively. In septic patients, TREM-1 expression was 59.9±23.9 MFI and HLA-DR expression was 44.39±20.25%, with a significant differencebetween healthy and septic groups (P＜0.05) for bothmolecules. In the surgical patients, TREM-1 and HLA-DR expressions were 56.8±20.85 MFI and 71±13.8% before surgery and 72.65±29.92 MlFI and 72.82±22.55% after surgery. TREM-1 expression was significantly different(P = 0.0087) between the samples before and aftersurgery and svTREM-1 expression was 0.8590±0.1451 MF1, 0.8820±0.1460 MF1, and 2.210±0.7873MF1 in the healthy, surgical (after surgery) and septic groups, respectively. There was a significant difference (P = 0.048) in svTREM-1 expression between the healthy and surgical groups and the septic group.CONCLUSION: TREM-1 expression is increased during systemic inflammatory conditions such as sepsis and the postoperative phase. Simultaneous low expression of HLA-DR molecules correlates with the severity of illness and increases susceptibility to infection. Additionally, TREM-1 expression is distinctly different in surgical patients at different stages of the inflammatory response before and after surgery. Thus, surface TREM-1 appears to be an endogenous signal during the course of the inflammatory response. svTREM-1 expression is significantly increased during sepsis, appearing to be
Zhang, Haifeng; K. Tong, Tom; Qiu, Weifeng; Wang, Jingjing; Nie, Jinlei; He, Yuxiu
The objective of the study was to compare the whole-body and abdominal fat loss resulting from high-intensity interval training (HIIT) with that from moderate-intensity continuous training (MICT) with equivalent oxygen cost in overweight women. Forty-three overweight women with matched anthropometric characteristics were randomly assigned to participate in: (1) HIIT [4 x 4-minute running at 85–95% HRpeak, 10-minute recovery], (2) MICT [33-minute running at 60–70% HRpeak] with oxygen cost e...
The potential for multiple intraperitoneal and retroperitoneal organ injuries often makes accurate clinical evaluation of abdominal trauma patients difficult. Additionally, patients may be unresponsive, have unreliable abdominal physical examinations, or have concurrent serious head and cervical spine injuries which delay diagnosis of and attention to abdominal problems. In these situations radiologic abdominal imaging is often requested. To expedite patient evaluation, close cooperation between the emergency physician and the radiologist is essential. It is the clinical stability of the traumatized patient that dictates the extent of radiologic imaging. Life-threatening hypotension, positive peritoneal signs, or clear evidence of penetrating abdominal injury are indications for immediate surgery. Stable patients with signs suggesting intra-abdominal injury will benefit by further radiologic evaluation with appropriate imaging modalities. The selection of an appropriate modality in any one clinical situation depends upon many criteria including accessibility to diagnostic equipment, the sensitivity and specificity of each technique, and the expertise and preference of the attending radiologist. A suggested scheme for evaluating abdominal trauma patients is presented. Most aspects of this evaluation scheme will be discussed in depth
Purpose: To assess the feasibility and toxicity of consolidative intensity-modulated whole abdominal radiotherapy (WAR) after surgery and chemotherapy in high-risk patients with advanced ovarian cancer. Methods and Materials: Ten patients with optimally debulked ovarian cancer International Federation of Gynecology and Obstetrics Stage IIIc were treated in a Phase I study with intensity-modulated WAR up to a total dose of 30 Gy in 1.5-Gy fractions as consolidation therapy after adjuvant carboplatin/taxane chemotherapy. Treatment was delivered using intensity-modulated radiotherapy in a step-and-shoot technique (n = 3) or a helical tomotherapy technique (n = 7). The planning target volume included the entire peritoneal cavity and the pelvic and para-aortal node regions. Organs at risk were kidneys, liver, heart, vertebral bodies, and pelvic bones. Results: Intensity-modulated WAR resulted in an excellent coverage of the planning target volume and an effective sparing of the organs at risk. The treatment was well tolerated, and no severe Grade 4 acute side effects occurred. Common Toxicity Criteria Grade III toxicities were as follows: diarrhea (n = 1), thrombocytopenia (n = 1), and leukopenia (n = 3). Radiotherapy could be completed by all the patients without any toxicity-related interruption. Median follow-up was 23 months, and 4 patients had tumor recurrence (intraperitoneal progression, n = 3; hepatic metastasis, n = 1). Small bowel obstruction caused by adhesions occurred in 3 patients. Conclusions: The results of this Phase I study showed for the first time, to our knowledge, the clinical feasibility of intensity-modulated whole abdominal radiotherapy, which could offer a new therapeutic option for consolidation treatment of advanced ovarian carcinoma after adjuvant chemotherapy in selected subgroups of patients. We initiated a Phase II study to further evaluate the toxicity of this intensive multimodal treatment.
Gögenur, Ismail; Bisgaard, Thue; Burgdorf, Stefan;
BACKGROUND: Studies on the circadian variation in bodily functions and sleep are important for understanding the pathophysiological processes in the postoperative period. We aimed to investigate changes in the circadian variation in activity after minimally invasive surgery (laparoscopic cholecys......BACKGROUND: Studies on the circadian variation in bodily functions and sleep are important for understanding the pathophysiological processes in the postoperative period. We aimed to investigate changes in the circadian variation in activity after minimally invasive surgery (laparoscopic...... scale (sleep quality, general well-being and pain) and fatigue was measured by a ten-point fatigue scale. The activity levels of the patients were monitored by actigraphy (a wrist-worn device measuring patient activity). Measures of circadian activity level [interday stability (IS), intraday variability...... circadian activity parameters (IS, IV and AMP). CONCLUSION: Severely disturbed circadian activity parameters was found after both LC and MAS with worse changes after MAS. Measures of circadian activity pattern analyses correlated significantly with postoperative subjective recovery parameters....
Tessone, Ariel; Nava, Maurizio; Blondeel, Phillip; Spano, Andrea
Ever since its introduction, the transverse rectus abdominis myocutaneous flap has become the mainstay of autologous breast reconstruction. However, concerns regarding donor site morbidity due to the breach of abdominal wall musculature integrity soon followed. Muscle-sparing techniques, eventually eliminating the muscle from the flap all-together with the deep inferior epigastric artery perforator flap, did not eliminate the problem of abdominal wall weakness. This led to the conclusion that motor innervation might be at fault. Studies have shown that even in the presence of an intact rectus abdominis muscle, and an intact anterior rectus sheath, denervation of the rectus abdominis muscle results in significant abdominal wall weakness leading to superior and inferior abdominal bulges, and abdominal herniation. Our aim was to establish a mathematical model to predict the location of the motor innervation to the rectus abdominis muscle, and thus provide surgeons with a tool that will allow them to reduce abdominal morbidity during deep inferior epigastric artery perforator and free muscle-sparing transverse rectus abdominis myocutaneous surgery. We dissected 42 cadaveric hemiabdomens and mapped the course of the thoracolumbar nerves. We then standardized and analyzed our findings and presented them as a relative map which can be adjusted to body type and dimensions. Our dissections show that the motor innervation is closely related to the lateral vascular supply. Thus, when possible, we support the preferred utilization of the medial vascular supply, and the preservation of the lateral supply and motor innervation. PMID:26756600
Rasmussen, M L; Dierking, G; Lech, K;
BACKGROUND: Multimodal analgesia may be important for optimal postoperative pain treatment and facilitation of early mobilization and recovery. We investigated the analgesic effect of pregabalin and dexamethasone in combination with paracetamol after abdominal hysterectomy. METHODS: One hundred and...... sixteen patients were randomly assigned to either group A (paracetamol+placebo x 2), group B (paracetamol+pregabalin+placebo) or group C (paracetamol+pregabalin+dexamethasone). According to randomization and preoperatively, patients received paracetamol 1000 mg, pregabalin 300 mg, dexamethasone 8 mg or...... placebo. General anaesthesia was performed. Postoperative pain treatment was paracetamol 1000 mg x 4 and patient-controlled intravenous morphine, 2.5 mg bolus. Nausea was treated with ondansetron. Morphine consumption, pain score (visual analogue scale) at rest and during mobilization, nausea, sedation...
Ajani, Abbas ali; Singam, Amol Prakash; Chaudhari, Ashok; chandak, aruna vijay
Purpose: To compare the efficacy of ondansetron-dexamethasone combination with ondansetron alone for prevention of postoperative nausea and vomiting (PONV). Methods: This double blind, randomized, prospective, Placebo controlled study was carried out in 120 patients, aged 20-60 yr, ASA-I and II physical status posted for exploratory laparotomy for various clinical conditions under general anaesthesia The patients were divided into three groups of 40 each. Patients received one of the three r...
Francisco J. González-Álvarez
Full Text Available ABSTRACT Background Few studies have explored the effects of stretching techniques on diaphragm and spine kinematics. Objective To determine whether the application of diaphragm stretching resulted in changes in posterior chain muscle kinematics and ribcage and abdominal excursion in healthy subjects. Method Eighty healthy adults were included in this randomized clinical trial. Participants were randomized into two groups: the experimental group, which received a diaphragmatic stretching technique, or the placebo group, which received a sham-ultrasound procedure. The duration of the technique, the position of participants, and the therapist who applied the technique were the same for both treatments. Participant assessment (cervical range of movement, lumbar flexibility, flexibility of the posterior chain, and rib cage and abdominal excursion was performed at baseline and immediately after the intervention by a blinded assessor. Results The mean between-group difference [95% CI] for the ribcage excursion after technique at xiphoid level was 2.48 [0.97 to 3.99], which shows significant differences in this outcome. The remaining between-group analysis showed significant differences in cervical extension, right and left flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level (p<0.05 in favor of the experimental group. Conclusion Diaphragm stretching generates a significant improvement in cervical extension, right and left cervical flexion, flexibility of the posterior chain, and ribcage excursion at xiphoid level compared to a placebo technique in healthy adults.
Stavrou, George; Giamarellos-Bourboulis, Evangelos J; Kotzampassi, Katerina
Administration of probiotics has been proposed for various medical and surgical conditions. Their effect has been largely attributed to their ability to maintain the integrity of the intestinal mucosal barrier as well as to modulate the innate immune response. Multiple studies have demonstrated their effect in reducing infectious complications in critically ill patients, minimising bacterial translocation and increasing the secretion of anti-inflammatory cytokines. Furthermore, they have been shown to be effective in reducing infections following colorectal surgery, while at the same time preventing overgrowth of bacterial species such as Pseudomonas aeruginosa that has been implicated in the pathogenesis of anastomotic leak. Recent experimental studies have demonstrated that probiotics may decrease expression of the SOCS3 gene, which encodes the protein SOCS3 that suppresses cytokine production, implying a direct interaction of probiotics with the innate immune system. These results hold high promises for the development of new therapeutic strategies. PMID:26686273
Full Text Available BACKGROUND: Epidural anaesthesia is used extensively for both intra-operative and post-operative analgesia. This prospective randomized study was conducted using opioids epidurally for post-operative analgesia. Fentanyl is a pure opioid agonist. Butorphanol tartarate which is an agonist antagonist opioid is considered safer than pure opioid agonist. Hence, we compared epidural 4mg butorphanol and epidural 100 µg fentanyl for the relief of post-operative pain. AIMS AND OBJECTIVES: To compare the onset, duration, quality of analgesia, hemodynamic effects and side effects between the 2 study drugs. MATERIALS AND METHODS: 60 patients of either sex posted for elective lower abdominal and lower limb surgeries were randomly divided into 2 groups of 30 each. Group A received butorphanol 4mg epidurally. Group B received fentanyl 100 µg epidurally. All surgeries were done under lumbar epidural anaesthesia with catheter in situ. Post-operatively when patients complained of pain, intensity of pain was assessed using visual analogue scale [VAS]. When the VAS score was > 5, Group A received butorphanol 4mg diluted to 10 ml with NS or Group B received 100 µg fentanyl epidurally diluted to 10 ml with NS. Onset, duration, quality of analgesia, hemodynamic effects and incidence of side effects were compared between the two groups and treated accordingly. RESULTS: Demographic profile was comparable in both groups. Mean time of onset of analgesia was rapid (3.22 ±0.9 (S.D min in group B compared to group A (6.38± 1.26 (S.D min. Duration of analgesia was longer in group A (344.00 ±63.39 min compared to group B (227±38.12 min. Quality of analgesia was better with group A compared to group B. There was no significant difference in hemodynamic parameters in both groups. Sedation was the main side effect in group A. Incidence of pruritis, vomiting, hypotension and respiratory depression was more in group B. CONCLUSION: Epidural Butorphanol though has a delayed
de Wilde, R B P; de Wit, F; Geerts, B F; van Vliet, A L; Aarts, L P H J; Vuyk, J; Jansen, J R C
We compared the accuracy and precision of the non-invasive Nexfin(®) device for determining systolic, diastolic, mean arterial pressure and pulse pressure variation, with arterial blood pressure values measured from a radial artery catheter in 19 patients following upper abdominal surgery. Measurements were taken at baseline and following fluid loading. Pooled data results of the arterial blood pressures showed no difference between the two measurement modalities. Bland-Altman analysis of pulse pressure variation showed significant differences between values obtained from the radial artery catheter and Nexfin finger cuff technology (mean (SD) 1.49 (2.09)%, p agreement -2.71% to 5.69%). The effect of volume expansion on pulse pressure variation was identical between methods (concordance correlation coefficient 0.848). We consider the Nexfin monitor system to be acceptable for use in patients after major upper abdominal surgery without major cardiovascular compromise or haemodynamic support. PMID:27291598
S. F. González-Pérez
the spinal level in the same way as opioids (2 and non-competitive N-methyl-D-aspar-tate NMDA receptor antagonist (3. Purpose: To evaluate the efficacy of epidural ketamine for postoperative pain relief in lower abdominal procedures. Materials and Methods: 50 patients undergoing inguinal herniotomy were studied in a comparative propective trial. They were divided into two groups to receive epidural ketamine 50 mg or epidural morphine 2 mg. Results: Epidural ketamine in doses to 50 mg provide adequate analgesia during 6 hours. Morphine administered epidurally obtained analgesia more than 18 hours. Conclusion: Epidurally administered ketamine is less effective than epidural morphine for postoperative analgesia, but it playes an important role in morphine-induced analgesia and during the combination with local anaesthetic.
Introduction This systematic review was conducted to analyze the impact and describe simulation-based training and the acquisition of laparoscopic surgery skills during medical school and residency programs. Methods This systematic review focused on the published literature that used randomized controlled trials to examine the effectiveness of simulation-based training to develop laparoscopic surgery skills. Searching PubMed from the inception of the databases to May 1, 2014 and specific hand...
Xin, Wei; Wei, Wei; Lin, Zhiqin; Zhang, Xiaoxia; Yang, Hongxia; Zhang, Tao; Li, Bin; Mi, Shuhua
Background Influence of fish oil supplementation on postoperative atrial fibrillation (POAF) was inconsistent according to published clinical trials. The aim of the meta-analysis was to evaluate the effects of perioperative fish oil supplementation on the incidence of POAF after cardiac surgery. Methods Pubmed, Embase and the Cochrane Library databases were searched. Randomized controlled trials (RCTs) assessing perioperative fish oil supplementation for patients undergoing cardiac surgery we...
Full Text Available Postoperative complications frequently follow major abdominal surgery and are associated with increased morbidity and mortality. Early diagnosis and treatment of complications is associated with improved patient outcome. In this study we assessed the value of a step-up diagnosis plan by C-reactive protein and CT-scan (computed tomography-scan imaging for detection of postoperative complications following major abdominal surgery. An observational cohort study was conducted of 399 consecutive patients undergoing major abdominal surgery between January 2009 and January 2011. Indication for operation, type of surgery, postoperative morbidity, complications according to the Clavien-Dindo classification and mortality were recorded. Clinical parameters were recorded until 14 days postoperatively or until discharge. Regular C-reactive protein (CPR measurements in peripheral blood and on indication -enhanced CT-scans were performed. Eighty-three out of 399 (20.6 % patients developed a major complication in the postoperative course after a median of seven days (IQR 4-9 days. One hundred and thirty two patients received additional examination consisting of enhanced CT-scan imaging, and treatment by surgical reintervention or intensive care observation. CRP levels were significantly higher in patients with postoperative complications. On the second postoperative day CRP levels were on average 197.4 mg/L in the uncomplicated group, 220.9 mg/L in patients with a minor complication and 280.1 mg/L in patients with major complications (p < 0,001. CT-scan imaging showed a sensitivity of 91.7 % and specificity of 100 % in diagnosis of major complications. Based on clinical deterioration and the increase of CRP, an additional enhanced CT-scan offered clear discrimination between patients with major abdominal complications and uncomplicated patients. Adequate treatment could then be accomplished.
Boden, Ianthe; Browning, Laura; Skinner, Elizabeth H.; Reeve, Julie; El-Ansary, Doa; Robertson, Iain K; Denehy, Linda
Background Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised con...
de Graauw, J A; Mihály, S; Deme, O; Hofker, H S; Baranski, A G; Gobée, O P; Krikke, C; Fehérvari, I; Langer, R M; Ploeg, R J; Marazuela, R; Domínguez-Gil, B; Haase-Kromwijk, B J J M; Font-Sala, C
Considering the growing organ demand worldwide, it is crucial to optimize organ retrieval and training of surgeons to reduce the risk of injury during the procedure and increase the quality of organs to be transplanted. In the Netherlands, a national complete trajectory from training of surgeons in procurement surgery to the quality assessment of the procured organs was implemented in 2010. This mandatory trajectory comprises training and certification modules: E-learning, training on the job, and a practical session. Thanks to the ACCORD (Achieving Comprehensive Coordination in Organ Donation) Joint Action coordinated by Spain and co-funded under the European Commission Health Programme, 3 twinning activities (led by France) were set to exchange best practices between countries. The Dutch trajectory is being adapted and implemented in Hungary as one of these twinning activities. The E-learning platform was modified, tested by a panel of Hungarian and UK surgeons, and was awarded in July 2013 by the European Accreditation Council for Continuing Medical Education of the European Union of Medical Specialists. As a pilot phase for future national training, 6 Hungarian surgeons from Semmelweis University are being trained; E-learning platform was fulfilled, and practical sessions, training-on-the-job activities, and evaluations of technical skills are ongoing. The first national practical session was recently organized in Budapest, and the new series of nationwide selected candidates completed the E-learning platform before the practical. There is great potential for sharing best practices and for direct transfer of expertise at the European level, and especially to export this standardized training in organ retrieval to other European countries and even broader. The final goal was to not only provide a national training to all countries lacking such a program but also to improve the quality and safety criteria of organs to be transplanted. PMID:25131109
王美英; 卢智; 王润云
Objective:To explore clinical efficacy of acupuncture on abdominal distension following surgery. Methods:100 cases of abdominal distension following surgery were given acupuncture treatment. After treatment , the efficacy was determined according to the Chinese disease diagnosis and efficacy standards published by SDA. Results:After treatment, in 100 cases, 62 cases were cured, effective 35 cases, improvement 3 cases;the total efficiency was 100%. Conclusion:Acupuncture on abdominal distension following surgery shows an obvious efficacy.%目的：探讨应用温针灸治疗术后腹胀的临床疗效。方法：所选100例均为术后胀气患者，均给予温针灸治疗。治疗后根据中医药管理局颁发的《中医病症诊断疗效标准》判定疗效。结果：100例患者治疗后，治愈62例，显效35例，好转3例，有效率为100%。结论：温针灸治疗术后腹胀疗效显著。
KASAP, Elmas; BOR, Serhat; İLTER(), Tankut
Background/aim: It is known that abdominal region operations are more common in patients with irritable bowel syndrome. The aim of this study was to determine the frequency of abdominal region operations in patients with irritable bowel syndrome. Materials and methods: 116 patients hospitalized between January 1998 and December 2002 with irritable bowel syndrome were evaluated retrospectively for previous abdominal region operation. Control group was composed of 53 healthy people and p...
Kakkar, V V; Cohen, A T; Edmonson, R A; Phillips, M J; Cooper, D J; Das, S K; Maher, K T; Sanderson, R M; Ward, V P; Kakkar, S
Low-molecular-weight heparin (LMWH) is effective in the prevention of postoperative venous thromboembolism but does it have the safety advantages over standard heparin (SH) that have been claimed? In a multicentre randomised trial in 3809 patients undergoing major abdominal surgery (1894 LMWH, 1915 SH) heparin was given preoperatively and continued for at least 5 postoperative days. Patients were assessed in the postoperative period and were followed up for at least 4 weeks, the emphasis being on safety. Major bleeding events occurred in 69 (3.6%) patients in the LMWH group and 91 (4.8%) patients in the SH group (relative risk 0.77, 95% confidence interval 0.56-1.04; p = 0.10). 93 indices of major bleeding were observed in the 69 LMWH patients and 141 in the SH patients. (p = 0.058). Severe bleeding was less frequent in the LMWH group (1.0% vs 1.9%; p = 0.02), as was wound haematoma (1.4% vs 2.7%; p = 0.007). Bleeding episodes with LMWH were less likely to lead to further surgery to evacuate a haematoma or to control bleeding, and injection site bruising was also less common in the LMWH group. No significant differences were found in the efficacy of the two agents. Perioperative death rates were 3.3% in the LMWH group and 2.5% in the SH group; pulmonary emboli were detected in 0.7% and 0.7%; and deep-vein thrombosis was diagnosed in 0.6% of patients in each group. Follow-up was done on 91% of 3699 evaluable patients. There were 19 further deaths (10 LMWH, 9 SH group) and 25 patients with thromboembolic complications (15 and 10). Of the 3 patients with fatal pulmonary emboli during follow-up 2 had received LMWH and 1 SH. The two drugs were of similar efficacy. The primary end point, the frequency of major bleeding, showed a 23% reduction in the LMWH group, but this difference was not significant. The secondary safety end points revealed that LMWH was significantly better than SH. Fatal pulmonary embolism occurs rarely (0.09%) following discharge from hospital so the
WANG Si-wen; LIN Ying; YAO Chen; LIN Pei-liang; WANG Shen-ming
Objective To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.Study selection According to the inclusion criteria,76 articles were finally analyzed to compare patient characteristics,clinical success,complications,and prognosis.Results We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group).There was no significant difference in the success rate of the procedures.Operative time,length of ICU stay,fasting time,duration of total postoperative stay,blood loss,and blood transfusion requirements during the procedure were significantly lower in the EVAR group.A 30-day follow up revealed more cardiac,renal,pulmonary,and visceral complications in the OS group (P＜0.01).Low-limb ischemia,however,was more common in the EVAR group (P＜0.05).The 30-day mortality rate,including aorta-related and non-aorta related mortality,was significantly lower in the EVAR group (P＜0.01).In the follow-up period,there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P＜0.01).The overall late mortality rate was higher in the OS group (P ＜0.01),especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P＜0.01).Conclusions EVAR was safer and less invasive for AAA patients.Patients suffered fewer complications and recovered sooner.However,complications such as artificial vessel occlusion,low-limb ischemia,and endoleak were common in EVAR.Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.
Fischer, John P.; Basta, Marten N.; Mirzabeigi, Michael N.; Bauder, Andrew R.; Fox, Justin P.; Drebin, Jeffrey A.; Serletti, Joseph M.; Kovach, Stephen J.
Objectives: Incisional hernia (IH) remains a common, highly morbid, and costly complication. Modest progress has been realized in surgical technique and mesh technology; however, few advances have been achieved toward understanding risk and prevention. In light of the increasing emphasis on prevention in today's health care environment and the billions in costs for surgically treated IH, greater focus on predictive risk models is needed. Methods: All patients undergoing gastrointestinal or gynecologic procedures from January 1, 2005 to June 1, 2013, within the University of Pennsylvania Health System were identified. Comorbidities and operative characteristics were assessed. The primary outcome was surgically treated IH after index procedures. Patients with prior hernia, less than 1-year follow-up, or emergency surgical procedures were excluded. Cox hazard regression modeling with bootstrapped validation, risk factor stratification, and assessment of model performance were conducted. Results: A total of 12,373 patients with a 3.5% incidence of surgically treated IH (follow-up 32.2 ± 26.6 months) were identified. The cost of surgical treatment of IH and management of associated complications exceeded $17.5 million. Notable independent risk factors for IH were ostomy reversal (HR = 2.76), recent chemotherapy (HR = 2.04), bariatric surgery (HR = 1.78), smoking history (HR = 1.74), liver disease (HR = 1.60), and obesity (HR = 1.96). High-risk patients (20.6%) developed IH compared with 0.5% of low-risk patients (C-statistic = 0.78). Conclusions: This study demonstrates an internally validated preoperative risk model of surgically treated IH after 12,000 elective, intra-abdominal procedures to provide more individualized risk counseling and to better inform evidence-based algorithms for the role of prophylactic mesh. PMID:26465784
Full Text Available Abstract Background Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients. Methods and design The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power. Discussion This trial evaluates the benefits and possible harm of intermediate care. The results may potentially influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care. Trial registration Clinicaltrials.gov identifier: NCT01209663
Mendelow, A David; Gregson, Barbara A; Rowan, Elise N; Francis, Richard; McColl, Elaine; McNamee, Paul; Chambers, Iain R; Unterberg, Andreas; Boyers, Dwayne; Mitchell, Patrick M.
Abstract Intraparenchymal hemorrhages occur in a proportion of severe traumatic brain injury TBI patients, but the role of surgery in their treatment is unclear. This international multi-center, patient-randomized, parallel-group trial compared early surgery (hematoma evacuation within 12 h of randomization) with initial conservative treatment (subsequent evacuation allowed if deemed necessary). Patients were randomized using an independent randomization service within 48 h of TBI. Patients w...
Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial
Gopala Krishna Alaparthi
Full Text Available Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC, Forced Expiratory Volume in the first second (FEV1, Peak Expiratory Flow Rate (PEFR, and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p<0.05. Results. Pulmonary function and diaphragm excursion showed a significant decrease on the first postoperative day in all four groups (p<0.001 but was evident more in the control group than in the experimental groups. On the second postoperative day pulmonary function (Forced Vital Capacity and diaphragm excursion were found to be better preserved in volume incentive spirometry and diaphragmatic breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p<0.05 as compared to that flow incentive spirometry group and the control group. Conclusion. Volume incentive spirometry and diaphragmatic breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of
The efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery. A double blind randomized multicentre trail with venographic assesment
Bergkvist, A; Eldor, A; Thorlacius-Ussing, O.
three times daily. METHODS: Patients included were over 40 years of age and undergoing planned elective curative abdominal or pelvic surgery for cancer. The study was designed as a prospective double-blind randomized multicentre trial with participating departments from ten countries. Primary outcome...... was venous thromboembolism as detected by mandatory bilateral venography or pulmonary scintigraphy. Follow-up was at 3 months. RESULTS: Some 1115 patients were randomized into the study but venograms were inadequate in 460 (41.3 per cent). Of 631 evaluable patients, a total of 104 (16.5 per cent......) developed thromboembolic complications. The frequency was 18.2 per cent in the heparin group and 14.7 per cent in the enoxaparin group (95 per cent confidence interval of the difference -9.2-2.3 per cent). There were no differences in bleeding events or other complications. One patient in the heparin group...
Balasubramanian, Sabapathy P.; Wiener, Martin; Alshameeri, Zeiad; Tiruvoipati, Ravindranath; Elbourne, Diana; Reed, Malcolm W.
Objective: To evaluate the quality of reporting of surgical randomized controlled trials published in surgical and general medical journals using Jadad score, allocation concealment, and adherence to CONSORT guidelines and to identify factors associated with good quality. Summary Background Data: Randomized controlled trials (RCTs) provide the best evidence about the relative effectiveness of different interventions. Improper methodology and reporting of RCTs can lead to erroneous conclusions about treatment effects, which may mislead decision-making in health care at all levels. Methods: Information was obtained on RCTs published in 6 general surgical and 4 general medical journals in the year 2003. The quality of reporting of RCTs was assessed under masked conditions using allocation concealment, Jadad score, and a CONSORT checklist devised for the purpose. Results: Of the 69 RCTs analyzed, only 37.7% had a Jadad score of ≥3, and only 13% of the trials clearly explained allocation concealment. The modified CONSORT score of surgical trials reported in medical journals was significantly higher than those reported in surgical journals (Mann-Whitney U test, P < 0.001). Overall, the modified CONSORT score was higher in studies with higher author numbers (P = 0.03), multicenter studies (P = 0.002), and studies with a declared funding source (P = 0.022). Conclusion: The overall quality of reporting of surgical RCTs was suboptimal. There is a need for improving awareness of the CONSORT statement among authors, reviewers, and editors of surgical journals and better quality control measures for trial reporting and methodology. PMID:17060756
目的：探讨七氟醚联合骶管麻醉在患儿下腹部手术中的应用。方法收集2012年4月至2014年4月于本院行下腹部手术的患儿88例资料，将患儿按照随机数字表法分为两组，对照组患者应用七氟醚麻醉，观察组患者行七氟醚联合骶管麻醉，观察比较两组患者各时点平均动脉压（MAP）、心率（HR），诱导时间及苏醒时间比较情况。结果麻醉后观察组各时点MAP、HR均低于对照组，差异均有统计学意义（均P＜0.05）。结论小儿下腹部手术应用七氟醚联合骶管麻醉，获得明显效果。%Objective To investigate the sevoflurane combined caudal anesthesia in pediatric abdominal surgery applications.Methods Data selected at random from April 2012 to April 2014 to 88 cases in children under hospital abdominal surgery,according to a random number table is divided into two groups,the application of the patients in the control group sevoflurane anesthesia,patients in the observation group of seven desflurane combined caudal anesthesia,two groups were compared at each time point were observed in mean arterial pressure(MAP),heart rate (HR),the induction time and wake time comparison situation.Results Observation group at al time points after anesthesia MAP,HR values were lower than the control group,the difference was statisticaly significant(P<0.05). Conclusion Pediatric abdominal surgery under sevoflurane combined caudal anesthesia,achieve significant results.
Objective To compare the impact of postoperative extubation of Abdominal surgery compared rocuronium administration of different ways. Methods From January 2010 to June 2011, patients selectd under general anesthesia undergoing elective surgery 110 patients were randomly divided into intermittent administration of rocuronium group (control group) and the continuous infusion group (observation group), neuromuscular blockade were recorded time and the maximum block onset time, the recovery process, and record rocuronium dosage. Results In the treatment onset time, muscle Songwei holding time, the dosage, the average pumping rate, the difference between the two groups were statistically significant (P < 0.05); Observed after discontinuation of neuromuscular recovery group was significantly faster than the control group (P < 0.01). Conclusion Continuous infusion of muscle relaxants rocuronium surgery for abdominal muscle relaxant to provide satisfactory conditions, and neuromuscular recovery after treatment is significantly shorter abdominal surgery "fast track" the ideal anesthetic drug approach.%目的 比较腹部手术中罗库溴铵不同给药方式对术后拔管的影响.方法 2010年1月～2011年6月,选取我院全麻下行开腹手术的患者共110例,随机分成罗库溴铵间断给药组(对照组)和持续泵注组(观察组),分别记录神经肌肉阻滞的最大阻滞时间及起效时间、恢复过程,并记录罗库溴铵的用药量.结果 在用药后起效时间、肌松维持时间、用药量、平均泵注速率上,两组患者差异有统计学意义(P < 0.05);停药后观察组的肌松恢复过程明显快于对照组(P < 0.01).结论 持续泵注肌松药罗库溴铵可为腹部手术提供满意的肌松条件,且停药后肌松恢复过程明显缩短是腹部手术"快通道"麻醉的理想用药方式.
黄海涛; 郑盛惠; 冯军; 王曙辉; 任蓉; 姜健; 杨丽霞
目的:观察薄氏腹针治疗腰椎手术失败综合征的临床疗效及对血清前列腺素E2(PGE2)、白介素-1β(IL-1β)的影响.方法:将40例本病患者随机分为腹针组与常规针刺组各20例,另设正常组20例.腹针组采用腹针疗法,常规针刺组采用常规针刺疗法.观察两组的临床疗效并测定两组患者治疗前、后血清PGE2、IL-1β水平.结果:两组患者治疗后VAS评分均明显降低,腹针组优于常规针刺组,差异有统计学意义(P<0.05,P<0.01);腹针组总有效率为95.0%,常规针刺组为80.0%,两组比较,差异有统计学意义(P<0.05).两组患者治疗前血清PGE:、IL-1β水平较正常组升高,经治疗后均明显降低,以腹针组更加明显,差异有统计学意义(P<0.05,P<0.01).结论:腹针疗法治疗腰椎手术失败综合征疗效确切,能有效降低VAS评分及血清PCE2、IL-1β含量,可能为其作用机制之一.%Objective: To observe the clinical efficacy of abdominal acupuncture for treatment of thin's failed back surgery syndrome and serum prostaglandin E2 (PGE2), white interleukin-1 β (IL-1β). Methods: 40 cases the patients were randomly divided into 20 cases of abdominal acupuncture group and the routine acupuncture group, separate group of 20 cases. Abdominal acupuncture group were treated with abdominal acupuncture, routine acupuncture group with routine acupuncture. The clinical efficacy of the two groups were observed and measured the two groups of patients, serum PGE2, IL-1β levels. Results: After treatment, VAS scores were significantly lower abdominal acupuncture group was better than the routine acupuncture group, the difference was statistically significant(PP<0.05, <0.01); abdominal acupuncture group, the total effective rate was 95.0%, the conventional needle The acupuncture group was 80.0%, respectively, the difference was statistically significantP< 0.05). The two groups before treatment serum PGE2, IL-1β levels than the normal group increased
Standard abdominal wound edge protection with surgical dressings vs coverage with a sterile circular polyethylene drape for prevention of surgical site infections (BaFO: study protocol for a randomized controlled trial
Mihaljevic André L
Full Text Available Abstract Background Postoperative surgical site infections cause substantial morbidity, prolonged hospitalization, costs and even mortality and remain one of the most frequent surgical complications. Approximately 14% to 30% of all patients undergoing elective open abdominal surgery are affected and methods to reduce surgical site infection rates warrant further investigation and evaluation in randomized controlled trials. Methods/design To investigate whether the application of a circular plastic wound protector reduces the rate of surgical site infections in general and visceral surgical patients that undergo midline or transverse laparotomy by 50%. BaFO is a randomized, controlled, patient-blinded and observer-blinded multicenter clinical trial with two parallel surgical groups. The primary outcome measure will be the rate of surgical site infections within 45 days postoperative assessed according to the definition of the Center for Disease Control. Statistical analysis of the primary endpoint will be based on the intention-to-treat population. The global level of significance is set at 5% (2 sided and sample size (n = 258 per group is determined to assure a power of 80% with a planned interim analysis for the primary endpoint after the inclusion of 340 patients. Discussion The BaFO trial will explore if the rate of surgical site infections can be reduced by a single, simple, inexpensive intervention in patients undergoing open elective abdominal surgery. Its pragmatic design guarantees high external validity and clinical relevance. Trial registration http://www.clinicaltrials.gov NCT01181206. Date of registration: 11 August 2010; date of first patient randomized: 8 September 2010
Full Text Available Objective: To assess whether honey can accelerate the wound healing in women undergoing cesarean section. Methods: This was a triple blinded randomized prospective clinical trial. Women with cesarean section were randomly designated as drug (37 cases and placebo (38 cases groups. The drug group received local honey gel 25% while the placebo group received similar free-honey gel on abdominal cesarean incision twice a day for 14 days. REEDA scale (Redness, Edema, Ecchymosis, Discharge and Approximation of wound edges was used to assess wound healing. Results: The mean REEDA was 2.27 ± 2.46 and 3.91 ± 2.74 (p=0.008 on the 7th day and 0.47 ± 0.84 and 1.59± 1.95 (p=0.002 on the 14th day for the drug and placebo groups, respectively. Redness, edema and hematoma in the drug group were significantly lower on the 7th and 14th days. Conclusion: Honey was effective in healing the cesarean section incision. Using topical honey is suggested as a natural product with rare side effects in order to reduce the complications of cesarean wounds.
Full Text Available BACKGROUND : Gynecological cancer surgeries differ from non - cancer surgeries as the former involves extensive dissection , and tissue handling , which contributes to increased nociception perioperatively. Radical hysterectomy with pelvic lymph node dissection is one of the most commonly performed surgeries in gynecological oncological set up. Transversus abdominis plane (TAP block is one of the new promising regional anesthesia technique complementing multi modal analgesic regimen. This is a prospective randomized controlled trial. We evaluated the role of the TAP block in Radical hysterectomy with pelvic lymph node dissection for periope rative analgesia and reducing the requirement of opioid consumption . METHODS : 100 patients of ASA grade 1 and 2 undergoing radical hysterectomy and pelvic lymph node dissection with below umbilical incision were randomized as block group to undergo TAP blo ck with bupivacaine 0.25% 20ml on each side (n=50 , versus non - block group (n=50. All patients received general anesthethesia. Block was performed before surgical incision bilaterally by using blind double pop technique in patients who were randomized to the block group. Intra operative analgesic regimen was with inj fentanyl 1.5 mic/k.g , repeated with 0.5mic/k.g depending on the requirement as assessed by the anaesthe - siologist based on haemodynamic parameters and post operatively by pain scores on numeri c visual analogue scale with inj . paracetamol 1gm followed by tramadol 2mg/kg and fentany 0.5mic/kg . Each patient was assessed post operatively at 0 , 2 , 4 , 6 , 8 , 12 , 16 , 20 , 24 hours for pain , nausea , vomiting and sedation . The data recorded . Descriptive a nd inferential sta ti stical analysis has been carried out using student t test , chi square/ fisher exact test in the present study. RESULTS : We studied 100 patients , 50 patients in block group and 50 patients in non - block group. The block group had significantly less pain
Full Text Available Introduction : Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS approach with a standard paralimbal strabismus surgery (SPSS approach in terms of post-operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post-operative redness, congestion, chemosis, foreign body sensation (FBS, and drop intolerance (DI on a graded scale of 0 to 3 on post-operative day 1, at 2-3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS. Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon′s signed rank test. Results: On the first post-operative day, only FBS (P = 0.01 and TIS (P = 0.04 showed significant difference favoring MISS. At 2-3 weeks, redness (P = 0.04, congestion (P = 0.04, FBS (P = 0.02, and TIS (P = 0.04 were significantly less in MISS eye. At 6 weeks, only redness (P = 0.04 and TIS (P = 0.05 were significantly less. Conclusion: MISS is more comfortable in the immediate post-operative period and provides better cosmesis in the intermediate period.
Full Text Available A classification of intraoperative cardio-vascular complications (CVC was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA for CVC in noncardiac surgery. There were 370 intraoperative CVC registered, distributed as follows: groups with low risk (148, moderate risk (200, and high risk (22. Patient groups were formed, according to the CVC risk level, during the intraoperative period, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardiovascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. On the basis of these indices, a new distribution of the risk factors was implemented, into groups with different levels of risk of CVC during intraoperative period. This result is a solid argument, substantiating the proposal to introduce these adjustments for determining the severity of CVC in the specific conditions of emergency abdominal surgery.
Full Text Available The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil and control (water vapor conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromatherapy showed a greater reduction in preoperative anxiety than those in the control groups. Aromatherapy may be a useful part of a holistic approach to reducing preoperative anxiety before ambulatory surgery.
Bonjer, H Jaap; Deijen, Charlotte L; Abis, Gabor A; Cuesta, Miguel A; van der Pas, Martijn H G M; de Lange-de Klerk, Elly S M; Lacy, Antonio M; Bemelman, Willem A; Andersson, John; Angenete, Eva; Rosenberg, Jacob; Fuerst, Alois; Haglind, Eva
BACKGROUND: Laparoscopic resection of colorectal cancer is widely used. However, robust evidence to conclude that laparoscopic surgery and open surgery have similar outcomes in rectal cancer is lacking. A trial was designed to compare 3-year rates of cancer recurrence in the pelvic or perineal ar...... of locoregional recurrence and disease-free and overall survival similar to those for open surgery. (Funded by Ethicon Endo-Surgery Europe and others; COLOR II ClinicalTrials.gov number, NCT00297791.).......BACKGROUND: Laparoscopic resection of colorectal cancer is widely used. However, robust evidence to conclude that laparoscopic surgery and open surgery have similar outcomes in rectal cancer is lacking. A trial was designed to compare 3-year rates of cancer recurrence in the pelvic or perineal area...... (locoregional recurrence) and survival after laparoscopic and open resection of rectal cancer. METHODS: In this international trial conducted in 30 hospitals, we randomly assigned patients with a solitary adenocarcinoma of the rectum within 15 cm of the anal verge, not invading adjacent tissues, and without...
Noites, Andreia; Pinto, Joana; Freitas, Carla Patrícia; Melo, Cristina; Albuquerque, Aníbal; Teixeira, Madalena; Ribeiro, Fernando; Bastos, José Mesquita
Objectives: Coronary artery disease are associated with decreased levels of physical activity, contributing to increases in abdominal fat and consequently the metabolic risk. The use of microcurrents is an innovative and effective method to increase lipolytic rate of abdominal adipocytes. This study aims to investigate the effects of microcurrents with a homebased exercise program on total, subcutaneous and visceral abdominal adipose tissue in subjects with coronary artery disease. Meth...
ONDANSETRON FOR THE PREVENT OF POSTOPERATIVE NAUSEA AND VOMITING FOLLOWING UPPER ABDOMINAL SURGERY ONDANSETRON FOR THE PREVENT OF POSTOPERATIVE NAUSEA AND VOMITING FOLLOWING UPPER ABDOMINAL SURGERY%恩丹西酮预防全麻上腹部 手术后恶心呕吐的临床研究
赵双平; 郭曲练; 杨浩汉; 熊云川
探讨静脉注射恩丹西酮的时机和剂量对吸静复合全麻上腹部手术 患者术后恶心呕吐的预防效果。方法：150例ASAⅠ～Ⅲ级成人患者随机分成五组。A组：麻 醉诱导前静脉注射恩丹西酮4mg，B组：麻醉诱导前静脉注射恩丹西酮8mg，C组：术毕静脉 注射恩丹 西酮4mg，D组：术毕静脉注射恩丹西酮8mg，E组不用恩丹西酮。结果：A、B、C、D、E组患 者 术后恶心呕吐发生率分别为50.0%，40.0%，53.3%，16.7%，56.7%(P＜0.01)。结论 ：术毕静脉注射恩丹西酮8mg更能有效预防全麻上腹部术后恶心呕吐。%To evaluate the prophylactic effect of ondansetrom (OND) on postoperative nausea and vomiting (PONV).Methods: One hundred and fifty patients,scheduled for upper abdominal surgery und e r general anesthesia,were randomly allocated into five groups.Group A OND 4mg iv before anesthesia induction,Group B OND 8mg iv before anesthesia induction,Grou p C OND 4mg iv after operation,Group D OND 8mg iv after operation,and Group E without OND. Results:The incidences of nausea and vomiting in gr oup A,B,C,D,E were 50.0%,40.0%,53.3%,167%,56.7% respectively (P＜0.01).C onc lusions:Ondansetron 8mg iv after operation can be used effectively to pr event PONV in upper abdominal surgical patients.
Tyseer M. F. Marzouk
Full Text Available Dysmenorrhea is a common cause of sickness absenteeism from both classes and work. This study investigated the effect of aromatherapy massage on a group of nursing students who are suffering of primary dysmenorrhea. A randomized blind clinical trial of crossover design was used. In the first treatment phase, group 1 ( received aromatherapy abdominal massage once daily for seven days prior to menstruation using the essential oils (cinnamon, clove, rose, and lavender in a base of almond oil. Group 2 ( received the same intervention but with placebo oil (almond oil. In the second treatment phase, the two groups switched to alternate regimen. Level and duration of pain and the amount of menstrual bleeding were evaluated at the baseline and after each treatment phase. During both treatment phases, the level and duration of menstrual pain and the amount of menstrual bleeding were significantly lower in the aromatherapy group than in the placebo group. These results suggests that aromatherapy is effective in alleviating menstrual pain, its duration and excessive menstrual bleeding. Aromatherapy can be provided as a nonpharmacological pain relief measure and as a part of nursing care given to girls suffering of dysmenorrhea, or excessive menstrual bleeding.
Cheng-Hua Ni; Wen-Hsuan Hou; Ching-Chiu Kao; Ming-Li Chang; Lee-Fen Yu; Chia-Che Wu; Chiehfeng Chen
The aim of this study was to determine if aromatherapy could reduce preoperative anxiety in ambulatory surgery patients. A total of 109 preoperative patients were randomly assigned to experimental (bergamot essential oil) and control (water vapor) conditions and their responses to the State Trait Anxiety Inventory and vital signs were monitored. Patients were stratified by previous surgical experience, but that did not influence the results. All those exposed to bergamot essential oil aromath...
The transversus abdominis plane (TAP) block provides effective postoperative analgesia in adults undergoing major abdominal surgery. Its efficacy in children remains unclear, with no randomized clinical trials in this population. In this study, we evaluated its analgesic efficacy over the first 48 postoperative hours after appendectomy performed through an open abdominal incision, in a randomized, controlled, double-blind clinical trial.
Tsang, Derek S.; Voncken, Francine E.M.; Tse, Regina V. [Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto (Canada); Sykes, Jenna [Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto (Canada); Wong, Rebecca K.S.; Dinniwell, Rob E.; Kim, John; Ringash, Jolie; Brierley, James D.; Cummings, Bernard J.; Brade, Anthony [Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto (Canada); Dawson, Laura A., E-mail: firstname.lastname@example.org [Princess Margaret Cancer Centre, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto (Canada)
Purpose: Reduction of respiratory motion is desirable to reduce the volume of normal tissues irradiated, to improve concordance of planned and delivered doses, and to improve image guided radiation therapy (IGRT). We hypothesized that pretreatment lorazepam would lead to a measurable reduction of liver motion. Methods and Materials: Thirty-three patients receiving upper abdominal IGRT were recruited to a double-blinded randomized controlled crossover trial. Patients were randomized to 1 of 2 study arms: arm 1 received lorazepam 2 mg by mouth on day 1, followed by placebo 4 to 8 days later; arm 2 received placebo on day 1, followed by lorazepam 4 to 8 days later. After tablet ingestion and daily radiation therapy, amplitude of liver motion was measured on both study days. The primary outcomes were reduction in craniocaudal (CC) liver motion using 4-dimensional kV cone beam computed tomography (CBCT) and the proportion of patients with liver motion ≤5 mm. Secondary endpoints included motion measured with cine magnetic resonance imaging and kV fluoroscopy. Results: Mean relative and absolute reduction in CC amplitude with lorazepam was 21% and 2.5 mm respectively (95% confidence interval [CI] 1.1-3.9, P=.001), as assessed with CBCT. Reduction in CC amplitude to ≤5 mm residual liver motion was seen in 13% (95% CI 1%-25%) of patients receiving lorazepam (vs 10% receiving placebo, P=NS); 65% (95% CI 48%-81%) had reduction in residual CC liver motion to ≤10 mm (vs 52% with placebo, P=NS). Patients with large respiratory movement and patients who took lorazepam ≥60 minutes before imaging had greater reductions in liver CC motion. Mean reductions in liver CC amplitude on magnetic resonance imaging and fluoroscopy were nonsignificant. Conclusions: Lorazepam reduces liver motion in the CC direction; however, average magnitude of reduction is small, and most patients have residual motion >5 mm.
Full Text Available BACKGROUND: Manual small incision cataract surgery (SICS has given visual results almost equivalent to Phacoemulsification but limited studies are available regarding the efficacy of small incision cataract surgery in phaco suitable immature cataracts. OBJECTIVE: To compare manual small incision cataract surgery and Phacoemulsification in immature cataracts. MATERIALS AND METHODS: A single blind randomized controlled trial was conducted with 105 eyes each for small incision cataract surgery and Phacoemulsification. RESULT: Mean IOL power was similar in both Phacoemulsifications as well as SICS. Four cases of posterior capsular rupture occurred in Phacoemulsification while one case of zonular dialysis occurred in SICS. Uncorrected visual acuity was good (6/6-6/18 in 80.0 % of the phaco and 93.33 % of the SICS group. CONCLUSION: SICS surgical technique resulted in significantly better visual acuity on the 1st postoperative day in comparison with phaco. Hence, SICS with rigid PMMA IOL implantation being a cheaper, faster and easier technique, may be recommended for immature cataract surgery in the developing countries
Morbidade respiratória nos pacientes com e sem síndrome pulmonar obstrutiva submetidos a cirurgia abdominal alta Respiratory morbidity in patients with and without pulmonary obstrutive syndrome after upper abdominal surgery
Full Text Available OBJETIVO: Estudar a morbidade respiratória nos pacientes com síndrome pulmonar obstrutiva submetidos a cirurgia abdominal alta. CASUÍSTICA E MÉTODO: Durante o pré-operatório, 196 pacientes candidatos à cirurgia abdominal alta eletiva responderam a um questionário padronizado e logo em seguida realizaram espirometria. Houve acompanhamento no pós-operatório até a alta hospitalar ou óbito. Os pacientes foram divididos em quatro grupos: 27 pacientes com DPOC (diagnóstico de bronquite crônica ou enfisema e VEF1/CVFBACKGROUND: We wanted to determine the postoperative pulmonary complicatiosn after upper abdominal surgery in patients with pulmonary obstrutive syndrome. METHODS: We have studied 196 patients prospectively analyzed in preoperative period with spirometry and followed for observation of PPC. The patients were divided in four groups: COPD - those with chronic bronchitis or emphysema and VEF1/CVF 70% (23 patients. NORMAL - patients without pulmonary disease and normal spirometry (102 patients. RESULTS: Postoperative pulmonary complication was recognized when the patient presented atelectasis with clinical or gasometric alterations; bronchospasm that needed bronchodilator therapy; respiratory failure; mechanical ventilation or orotracheal entubation more than 48 hours in postosurgery period; tracheobronchitis characterized by the presence of purulent sputum with normal x-ray; pneumonia. Patients with pulmonary obstruction had experienced higher rates of pulmonar complications (32% vs 6%,p<0,05. The presence of obstuctive lung disease was associated with an increased number of ventilator days, but was not associeted with longer intensive care unit or hospital stay. CONCLUSIONS: The incidence of postoperative pulmonary complications was strongly associated with the presence of pulmonary obstrutive syndrome.
Full Text Available We conducted this meta-analysis to compare the outcomes of coaxial microincision cataract surgery (C-MICS and standard coaxial small incision cataract surgery (C-SICS.The outcomes of randomized controlled trials (RCTs reporting C-MICS and C-SICS were collected from PubMed, Web of Science, and The Cochrane Library in May 2015. The final meta-analysis was conducted on the following intraoperative and postoperative outcomes: ultrasound time (UST, effective phacoemulsification time (EPT, balanced salt solution use (BSS use, cumulative dissipated energy (CDE, mean surgery time, endothelial cell loss percentage (ECL%, best corrected visual acuity (BCVA, increased central corneal thickness (CCT, laser flare photometry values and surgically induced astigmatism (SIA.A total of 15 RCTs, involving 1136 eyes, were included in the final meta-analysis. No significant between-group differences were detected in EPT, BSS use, CDE, BCVA, laser flare photometry values or increased CCT. However, the C-MICS group showed less SIA (at postoperative day 7: p<0.01; at postoperative day 30 or more: p<0.01 and greater ECL% (at postoperative day 60 or more: p<0.01, whereas the C-SICS group required a shorter UST (p<0.01.The present meta-analysis suggested that the C-MICS technique was more advantageous than C-SICS in terms of SIA, but C-MICS required a longer UST and induced a higher ECL%. Further studies should be done to confirm our results.
Shentu, Xingchao; Zhang, Xin; Tang, Xiajing; Yu, Xiaoning
Background We conducted this meta-analysis to compare the outcomes of coaxial microincision cataract surgery (C-MICS) and standard coaxial small incision cataract surgery (C-SICS). Methods The outcomes of randomized controlled trials (RCTs) reporting C-MICS and C-SICS were collected from PubMed, Web of Science, and The Cochrane Library in May 2015. The final meta-analysis was conducted on the following intraoperative and postoperative outcomes: ultrasound time (UST), effective phacoemulsification time (EPT), balanced salt solution use (BSS use), cumulative dissipated energy (CDE), mean surgery time, endothelial cell loss percentage (ECL%), best corrected visual acuity (BCVA), increased central corneal thickness (CCT), laser flare photometry values and surgically induced astigmatism (SIA). Results A total of 15 RCTs, involving 1136 eyes, were included in the final meta-analysis. No significant between-group differences were detected in EPT, BSS use, CDE, BCVA, laser flare photometry values or increased CCT. However, the C-MICS group showed less SIA (at postoperative day 7: p<0.01; at postoperative day 30 or more: p<0.01) and greater ECL% (at postoperative day 60 or more: p<0.01), whereas the C-SICS group required a shorter UST (p<0.01). Conclusions The present meta-analysis suggested that the C-MICS technique was more advantageous than C-SICS in terms of SIA, but C-MICS required a longer UST and induced a higher ECL%. Further studies should be done to confirm our results. PMID:26745279
Moesgaard, F; Jensen, L S; Christiansen, P M;
TREATMENT: One hundred and ninety-four consecutive patients undergoing acute colorectal surgery for perforated and/or obstructed large bowel were randomized in a double-blind fashion to receive ranitidine 100 mg i.v. twice a day commencing at induction of anesthesia and continued for five days (group I) or...... patients were withdrawn from the study (for reasons such as other diagnosis, refused to continue, medication not given as prescribed). MAIN OUTCOME MEASURES: Patients were observed for signs of infectious complications; such as wound infection, intra-abdominal abscess, septicemia, and pneumonia. RESULTS...... < 0.05). Wound infection, intraabdominal abscess, septicemia, and pneumonia were 12.9%, 5.2%, 3.8% and 14%, respectively in group I. In group II, the infectious complications were 16.1%, 6.8%, 6.9% and 22%, respectively. Twelve patients (13.8%) in the placebo group developed more than one complication...
Thorup, J M; Cortes, Dina; Visfeldt, J
Laparoscopy is a well described modality that provides an accurate visual diagnosis upon which further management of intra-abdominal testes may be based. Laparoscopic ligation of spermatic vessels as stage 1 of the procedure is a natural extension of laparoscopy. A staged approach provides adequate...... viability of the intra-abdominal testis. However, it is uncertain whether the more sensitive germ cells survive this procedure in addition to the Sertoli and interstitial cells of the human testis. Survival of germ cells is a prerequisite of later fertility potential....
Full Text Available Background/Aim. Abdominal aorta aneurysm (AAA represents a pathological enlargment of infrarenal portion of aorta for over 50% of its lumen. The only treatment of AAA is a surgical reconstruction of the affected segment. Until the late XX century, surgical reconstruction implied explicit, open repair (OR of AAA, which was accompanied by a significant morbidity and mortality of the treated patients. Development of endovascular repair of (EVAR AAA, especially in the last decade, offered another possibility of surgical reconstruction of AAA. The preliminary results of world studies show that complications of such a procedure, as well as morbidity and mortality of patients, are significantly lower than with OR of AAA. The aim of this paper was to present results of comparative clinical prospective study of early inflammatory response after reconstruction of AAA between endovascular and open, conventional surgical technique. Methods. A comparative clinical prospective study included 39 patients, electively operated on for AAA within the period of December 2008 - February 2010, divided into two groups. The group I counted 21 (54% of the patients, 58-87 years old (mean 74.3 years, who had been submited to EVAR by the use of excluder stent graft. The group II consisted of 18 (46% of the patients, 49-82 (mean 66.8 years, operated on using OR technique. All of the treated patients in both groups had AAA larager than 50 mm. The study did not include patients who have been treated as urgent cases, due to the rupture or with simptomatic AAA. Clinical, biochemical and inflamatory parameters in early postoperative period were analyzed, in direct postoperative course (number of leucocytes, thrombocytes, serum circulating levels of cytokine - interleukine (IL-2, IL-4, IL-6 and IL-10. Parameters were monitored on the zero, first, second, third and seventh postoperative days. The study was approved by the Ethics Commitee of the Military Medical Academy. Results
Lindholt, Jes S.; Sørensen, J; Søgaard, R; Henneberg, E W
The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years.......The aim was to estimate long-term mortality benefits and cost-effectiveness of screening for abdominal aortic aneurysm (AAA) in men aged 64-73 years....
Full Text Available Intrauterine adhesions (IUAs are the most common complication after hysteroscopy in patients of reproductive age. Intra-abdominal anti-adhesion gel reduces the incidence of adhesions, but effects on fertility after uterine surgery are not known. The objective of our work was to evaluate the effect of intrauterine anti-adhesion gel on spontaneous fertility after repeated intrauterine surgery with induced experimental synechiae in the rabbit model.Twenty New Zealand White rabbits underwent a double uterine curettage 10 days apart and were randomized into two groups. Each rabbit served as its own control: one uterine tube was the treatment group (A, the second uterine tube was the control group (B to avoid bias through other causes of infertility. Group A received a post curettage intrauterine instillation of anti-adhesion gel whereas group B, the control group, underwent curettage without instillation of the gel. After a recovery period, the rabbits were mated. An abdominal ultrasound performed 21 days after mating allowed us to diagnose pregnancy and quantify the number of viable fetuses.There was a significant difference in total fetuses in favor of group A, with an average of 3.7 (range, 0-9 total fetuses per tube against 2.1 (0-7 in group B (p = .04. The number of viable fetuses shows a trend in favor of group A, with an average of 3.4 (0-7 viable fetuses per tube against 1.9 (0-6 viable fetuses per tube in group B (p = .05.The use of immediate postoperative anti-adhesion gel improved fertility in an animal model after intrauterine surgery likely to cause uterine synechiae. This experimental model will permit comparison of different anti-adhesion solutions, including assessment of their tolerance and potential mucosal toxicity on embryonic development.
Viscusi, Eugene R; Frenkl, Tara L; Hartrick, Craig T;
-blind, placebo-controlled, randomized clinical trial, we evaluated postoperative pain following total abdominal hysterectomy over 5 days in patients receiving placebo or etoricoxib administered 90 min prior to surgery and continuing postoperatively. Patients were randomly assigned to receive either placebo (n...
de Seigneux Sophie
Full Text Available Abstract Background Experimentally, erythropoietin (EPO has nephroprotective as well as immunomodulatory properties when administered after ischemic renal injury. We tested the hypothesis that different doses of recombinant human EPO administered to patients after cardiac surgery would minimize kidney lesions and the systemic inflammatory response, thereby decreasing acute kidney injury (AKI incidence. Methods In this double-blinded randomized control study, 80 patients admitted to the ICU post-cardiac surgery were randomized by computer to receive intravenously isotonic saline (n = 40 versus α-Epoetin (n = 40: either 40000 IU (n = 20 or 20000 IU (n = 20. The study lasted one year. The primary outcome was the change in urinary NGAL concentration from baseline and 48 h after EPO injection. Creatinine, cystatine C and urinary NGAL levels were measured on the day of randomization and 2–4 days after EPO injection. To assess acute inflammatory response, serum cytokines (IL6 and IL8 were measured at randomization and four days after r-HuEPO injection. Patients and care-takers were blinded for the assignment. Results No patient was excluded after randomization. Patient groups did not differ in terms of age, gender, comorbidities and renal function at randomization. The rate of AKI assessed by AKIN criteria was 22.5% in our population. EPO treatment did not significantly modify the difference in uNGAl between 48 hours and randomization compared to placebo [2.5 ng/ml (−17.3; 22.5 vs 0.7 ng/ml (−31.77; 25.15, p = 0.77] and the incidence of AKI was similar. Inflammatory cytokines levels were not influenced by EPO treatment. Mortality and hospital stays were similar between the groups and no adverse event was recorded. Conclusion In this randomized-controlled trial, α-Epoetin administrated after cardiac surgery, although safe, demonstrated neither nephroprotective nor anti-inflammatory properties. Trial registration number NCT
Estudo prospectivo do derrame pleural pós-cirurgia abdominal e dos fatores de risco associados: avalição por ultra-sonografia Pleural effusion following abdominal surgery and associated risk factors: ultrasound assessment
Luiz Antonio Rossi
ós-operatório de cirurgia abdominal eletiva é muito freqüente. A maioria dos DPPO é autolimitada, evoluindo de modo assintomático. A ecografia na constatação do DPPO mostrou-se efetiva e sua utilização merece ser difundida.BACKGROUND: Pleural effusion is frequently seen on imaging examinations following elective abdominal surgery and has no clinical significance in most patients. This condition should be distinguished from pulmonary complications that require treatment. OBJECTIVE: To prospectively determine the incidence of pleural effusion in patients submitted to elective abdominal surgery using ultrasound (US, and to assess the possible association with risk factors related to the patients and anesthetic-surgical procedures. MATERIALS AND METHODS: Thirty-seven patients, 21 (56.8% female, and 16 (43.2% male aged 29 to 76 years submitted to elective abdominal surgery were evaluated. US was performed preoperatively and 48 hours after surgery in all patients. Associated risk factors were also assessed - age > 60 years, sex, obesity, smoking history, alcoholism and associated diseases -, and anesthetic-surgical procedure - cancer resection, class ASA > 2, duration of surgery, longitudinal incision and incision > 15 cm. Biliar lithiasis (43.2% and gastrointestinal cancer (43.2% were the main causes leading to surgery. RESULTS: The incidence of postoperative pleural effusion (PPE detected by US was 70.3% (26/37. Two of these patients (5.4% developed pulmonary complications, and one died. The risk factors age > 60 years, smoking history, alcoholism, obesity and associated diseases had no influence on the development of the PPE whereas cancer resection, class ASA > 2, longitudinal incision and incision > 15 cm were significantly statistically associated with the presence of PPE. PPE developed even during antibiotic therapy. The duration of hospitalization was more than 2.4 longer in the patients with PPE. CONCLUSION: PPE is a very frequent condition observed in patients
Tripathi, M; A. Subedi; A Raimajhi; K Pokharel; Pandey, M.
Background: Abdominal sepsis is associated with varied degree of hypoxemia and atelactasis in the lung and can enhance the onset of desaturation of arterial blood during apnea. Aims : This study looked at methods to improve safety margin of apnea during induction of anesthesia in these high-risk patients. Settings and Design: It was a randomized, single blind study on adult patients presenting for emergency laparotomy due to peritonitis in a university teaching hospital setting. Materials and...
XU Guang-chuan; RONG Tie-hua; LIN Peng
Objective: To evaluate the efficacy of adjuvant chemotherapy after radical surgery for non-small cell lung cancer (NSCLC). Methods: Seventy patients with NSCLC (stage Ⅰ-Ⅲ) undergone radical surgery were randomized into two groups: 35 patients received adjuvant chemotherapy with cyclophosphamide (CTX)300 mg/m2, vincristine (VCR) 1.4% mg/m2, adriamycin (ADM) 50 mg/m2, lomustine (CCNU) 50 mg/m2 d1,cisplatin (DDP) 20 mg/m2, d1-5, for 4 cycles, and followed by oral Ftorafur (FT-207) 600-900 mg/d for 1year (adjuvant chemotherapy group). The other 35patients received surgical treatment only (surgery group). Results: The overall 5-year survival rate was 48.6% in the adjuvant chemotherapy group, and 31.4%in the surgery group, respectively. The difference between the two groups was not statistically significant (P＞0.05). The 5-year survival rate of patients in stage Ⅲwas 44.0% and 20.8% received surgery with and without adjuvant chemotherapy, respectively. The difference between the two groups was statistically significant (P＜0.025). The 5-year survival rate of patients in stage Ⅰ-Ⅱ in the two groups was 60.0% and 54.5%, respectively (P＞0.75). Conclusion: Postoperative adjuvant chemotherapy in NSCLC can improve survival, for those patients in stage Ⅲ, it suggests significantly 5-year survival rate in the adjuvant chemotherapy group was higher than that in the surgery alone group.
Full Text Available Abstract Background Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively. The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component (approximately 1 L rather than to the nutrients. Methods Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial, and randomly allocated to preoperative fasting, to oral ingestion of tap water, or to oral ingestion of a carbohydrate drink. An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery, in the postoperative ward, and on the day after surgery. Other parameters were stress (cortisol in plasma and urine, muscle catabolism (urinary 3-methylhistidine, and wellbeing. Results Fifty-seven patients completed the study. In the postoperative ward, the glucose clearance and the insulin response had decreased from the previous day by 23% and 36%, respectively. Insulin sensitivity did not decrease until the next morning (−48% and was due to an increased insulin response (+51%. Cortisol excretion was highest on the day of surgery, while 3-methylhistidine increased 1 day later. Follow-up on the third postoperative day showed an average of 1.5 complications per patient. Wellbeing was better 2 weeks after than before the surgery. None of the measured parameters differed significantly between the study groups. Conclusions Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance, insulin sensitivity, postoperative complications, or wellbeing in patients undergoing elective hip surgery. Trial registration Registration number: NCT 01211184 (http://www.clinicaltrials.gov
ISHIBASHI, KEIICHIRO; Ishida, Hideyuki; KUWABARA, KOUKI; OHSAWA, TOMONORI; OKADA, NORIMICHI; Yokoyama, Masaru; Kumamoto, Kensuke
Purpose To investigate the non-inferiority of postoperative single-dose intravenous antimicrobial prophylaxis to multiple-dose intravenous antimicrobial prophylaxis in terms of the incidence of surgical site infections (SSIs) in patients undergoing elective rectal cancer surgery by a prospective randomized study. Methods Patients undergoing elective surgery for rectal cancer were randomized to receive a single intravenous injection of flomoxef (group 1) or five additional doses (group 2) of f...
Amany S Ammar
Full Text Available Purpose: Different adjuvants have been used to improve the quality and increase the duration of local anesthetics during various nerve block techniques. The current study was aimed to evaluate the effect of adding dexamethasone to bupivacaine on the quality and duration of transversus abdominis plane (TAP block. Methods: Sixty adult patients undergoing elective open abdominal hysterectomy were randomly allocated to receive TAP block using 20 mL of bupivacaine hydrochloride 0.25% + 2 mL saline 0.9% (control group, n=30 or 20 mL of bupivacaine hydrochloride 0.25% + 2 mL dexamethasone "8 mg" (dexamethasone group, n=30. The primary outcome was postoperative pain, as evaluated by visual analog scale (VAS for pain scoring at 1, 2, 4, 12, 24 and 48 h postoperatively, whereas the secondary outcomes were time to first analgesia (TFA, morphine consumption and the occurrence of nausea, vomiting or somnolence. Results: The pain VAS score was significantly lower at the postoperative 2 h (4.9 vs. 28.1, P=0.01, 4 h (12.2 vs. 31.1, P=0.01 and 12 h (15.7 vs. 25.4, P=0.02. Furthermore, TFA was significantly longer in the dexamethasone group (459.8 vs. 325.4 min, P=0.002, with lesser morphine requirements in the postoperative 48 h (4.9 vs. 21.2 mg, P=0.003 and lower incidence of nausea and vomiting (6 vs. 14, P=0.03. No complications attributed to the block were recorded. Conclusion: Addition of dexamethasone to bupivacaine in TAP block prolonged the duration of the block and decreased the incidence of nausea and vomiting.
Casey, Murray Joseph; Colanta, Agnes B
More than 40 years ago Lynch et al. described several multigenerational breast cancer family pedigrees which demonstrated autosomal dominant inheritance of a trait(s) that increased risks for both breast and ovarian cancers. Mutation carriers in at least 90 % of these hereditary breast ovarian cancer (HBOC) syndrome families have been linked to cancer-associated mutations in the genes BRCA1 and BRCA2. This review focuses on the contributions of Lynch, colleagues and collaborators and pertinent literature, toward defining the HBOC syndrome, the cancer risks that the inherited adverse mutations convey, the gynecologic tissues and organs from which the malignancy may arise to disseminate throughout the pelvic and abdominal organs and peritoneum and how this information can be used to reduce the risk and morbidities of intra-abdominal carcinomatosis in effected individuals. PMID:26875157
Mika Yuki; Yoshinori Komazawa; Yoshiya Kobayashi; Maho Kusunoki; Yoshiko Takahashi; Sayaka Nakashima; Goichi Uno; Isao Ikuma; Toshihiro Shizuku; Yoshikazu Kinoshita
Background: Daikenchuto (DKT), a traditional Japanese herbal medicine, is widely used for treatment of gastrointestinal disorders. We evaluated the efficacy and safety of DKT for abdominal bloating in patients with chronic constipation. Objective: To evaluate the efficacy and safety of DKT for the treatment of abdominal bloating. Methods: After discontinuing as-needed use of laxatives, 10 patients received oral DKT for 14 days (15 g/d). To evaluate small intestinal bacteria overgrowth (...
Conclusions: The findings of this pilot study suggest that intraoperative use of Dexmedetomidine as an adjuvant in major surgery in elderly patients was not associated with significant protection against POCD.
Christoffersen, Mette; Olsen, B H; Rosenberg, J; Bisgaard, T
PURPOSE: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma-reducing ......PURPOSE: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects. The aim of the present study was to investigate the pain- and seroma...... abdominal binders during the first postoperative week. Standardized surgical technique, anaesthesia, and analgesic regimens were used and study observers were blinded towards the intervention. Postoperative pain (visual analogue score) on day 1 was the primary outcome. In addition, ultrasonographic...... the abdominal binder were found. CONCLUSIONS: There were no effects of an abdominal binder on pain, movement limitation, fatigue, seroma formation, general well-being, or quality of life. However, most patients claimed a subjective beneficial effect of using their abdominal binder....
Turner Judith A
Full Text Available Abstract Background Conservative treatment remains the standard of care for treating mild to moderate carpal tunnel syndrome despite a small number of well-controlled studies and limited objective evidence to support current treatment options. There is an increasing interest in the usefulness of wrist magnetic resonance imaging could play in predicting who will benefit for various treatments. Method and design Two hundred patients with mild to moderate symptoms will be recruited over 3 1/2 years from neurological surgery, primary care, electrodiagnostic clinics. We will exclude patients with clinical or electrodiagnostic evidence of denervation or thenar muscle atrophy. We will randomly assign patients to either a well-defined conservative care protocol or surgery. The conservative care treatment will include visits with a hand therapist, exercises, a self-care booklet, work modification/ activity restriction, B6 therapy, ultrasound and possible steroid injections. The surgical care would be left up to the surgeon (endoscopic vs. open with usual and customary follow-up. All patients will receive a wrist MRI at baseline. Patients will be contacted at 3, 6, 9 and 12 months after randomization to complete the Carpal Tunnel Syndrome Assessment Questionnaire (CTSAQ. In addition, we will compare disability (activity and work days lost and general well being as measured by the SF-36 version II. We will control for demographics and use psychological measures (SCL-90 somatization and depression scales as well as EDS and MRI predictors of outcomes. Discussion We have designed a randomized controlled trial which will assess the effectiveness of surgery for patients with mild to moderate carpal tunnel syndrome. An important secondary goal is to study the ability of MRI to predict patient outcomes.
Andersson, J; Abis, G; Gellerstedt, M; Angenete, E; Angerås, U; Cuesta, M A; Jess, P; Rosenberg, J; Bonjer, H J; Haglind, E
BACKGROUND: This article reports on patient-reported sexual dysfunction and micturition symptoms following a randomized trial of laparoscopic and open surgery for rectal cancer. METHODS: Patients in the COLOR II randomized trial, comparing laparoscopic and open surgery for rectal cancer, completed...... the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CR38 questionnaire before surgery, and after 4 weeks, 6, 12 and 24 months. Adjusted mean differences on a 100-point scale were calculated using changes from baseline value at the various time points in the domains of sexual...... functioning, sexual enjoyment, male and female sexual problems, and micturition symptoms. RESULTS: Of 617 randomized patients, 385 completed this phase of the trial. Their mean age was 67·1 years. Surgery caused an anticipated reduction in genitourinary function after 4 weeks, with no significant differences...
Takeda, Akihiro; Imoto, Sanae; Mori, Masahiko; Yamada, Junko; Nakamura, Hiromi
A 26-year-old primigravida patient was referred with suspicion of ectopic pregnancy 39 days after her last menstrual period. Her serum β-human chorionic gonadotropin value was 3812 mIU/mL. As we suspected the existence of ectopic pregnancy with bilateral dermoid cysts, laparoendoscopic single-site surgery was performed. After dissection of dense pelvic adhesion, cystectomy was performed for a left ovarian dermoid cyst. Although there was a right ovary at the correct position, a parasitic dermoid cyst firmly attached to the peritoneal surface of cul-de-sac was identified. After excision of the parasitic dermoid cyst, early abdominal pregnancy tissue implanted in the peritoneal hollow of right deep pararectal space was identified under the guidance of diffusion-weighted magnetic resonance imaging and was excised. With systemic administration of methotorexate, the postoperative course was uneventful. PMID:22935307
蒋军; 裘华森; 顾锡冬; 周济春; 张喜平; 张勤
Objective To approach the mechanism of the action of emodin on the ghrelin secretion from rats after abdominal surger-y. Methods Totally 120 SD rats after abdominal operation were randomly divided into five groups: as sham -operated, model control, emodin with low dosage (EL) , medium dosage (EM) and high dosage (EH) groups. Each group was divided into four subgroups randomly, and rats were treated with emodin after postoperation. The gastric remainder rates of Blue Dextron (BD) 2000, intestinal emptying rate, level of serum ghrelin, the pathological changes in intestinal canal, somatostatin (ss) and expression of ghrelin from gastric fundus were measured post - operatively on 3 ,6,12,24h after administration with fasted. Results ①The mortality of rats in all groups were 0. ②The contents of serum ss (at 6, 12 and 24h in EH groups, at 12 and 24h in EM groups) , the gastric remainder rates of BD 2000 (at 24h in EH groups, at 3h in EL groups) were significantly lower than those in the model control group (P <0. 05). The contents of serum ghrelin (at 12, 24h in HE groups, at 24h in EL groups) , the expression of ghrelin from gastric fundus (at 3h in EH groups, at 24h in EM groups, at 3h in EL groups) , the intestinal emptying rate (at 12h in EH groups, at 6, 12h in EM groups, at 6, 24h in EL groups) were significantly higher than those in the model control group (P < 0. 05). The pathological severity scores in intestinal canal in the Sham - operated groups, at 3h in EH groups, at 24h in EM groups and at 3h in EL groups were also significantly lower than those in the model control group (P < 0. 05 ) . The contents of serum ghrelin at 12h and the expression of ghrelin from gastric fundus at 3 , 6h in the Sham - operated groups were significantly higher than those in the model control group ( P < 0. 05). ③The expression of ghrelin from gastric fundus at 3h in EH groups were significantly higher than those in the EM group (P < 0. 05). The expression of ghrelin from
Peng, Yun-Hua; Wang, Xin-Xiu; Zhu, Jing-Song; Gao, Li
The aim of this study was to evaluate the efficacy and safety of neo-adjuvant chemotherapy (NACT) versus radical surgery (RS) for patients with cervical cancer. A meta-analysis of randomized controlled trials (RCT) of NACT + RS versus RS alone for patients with cervical cancer was performed according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The following electronic databases were searched from their inception to April 2015: PUBMED, EMBASE and Cochrane Library. Statistical analysis was done using REVIEW MANAGER 5.3. Five RCT involving 739 patients were studied. There were significant differences between the NACT + RS and the RS-alone groups for positive lymph nodes (OR, 0.45; 95%CI: 0.29-0.70) and parametrial infiltration (OR, 0.48; 95% CI: 0.25-0.92), while treatment efficacy did not differ significantly for 5-year overall survival rate (OR, 1.17; 95% CI: 0.85-1.61), 5-year disease-free survival rate (OR, 1.09; 95% CI: 0.77-1.56) or recurrence rate (OR, 1.17; 95% CI: 0.85-1.61). The results also indicated that chemotherapy-related toxicity was well tolerated. For patients with cervical cancer, NACT could significantly reduce the number of positive lymph nodes and the level of parametrial infiltration compared with RS alone, and be well tolerated. PMID:26807961
Søren Løvstad Christensen
Full Text Available Søren Løvstad Christensen1, Mette Kjoelby1,2, Lars Ehlers31Health Technology Assessment and Health Services Research, Centre for Public Health, Central Denmark Region, Denmark; 2School of Public Health, Aarhus University, Denmark; 3Health Economics and Management, Aalborg University, DenmarkObjective: The purpose of this study is to investigate if the Danish national diagnosis-related group (DRG tariffs for surgery for abdominal aortic aneurysm (AAA were good estimates of the actual costs in two local hospitals in the Central Region of Denmark.Methods: We collected clinical data for 178 AAA patients operated at Skejby Hospital and Viborg Hospital in the period 2005–2006 from the Danish National Vascular Registry and economic data from the administrative systems in the hospitals. We used bootstrap methods to calculate 95% confidence intervals (CIs for the mean costs of surgery for ruptured AAA, nonruptured AAA and AAA where the patient died within 30 days by applying a cost-trimming rule that the Danish National Board of Health uses in calculating national DRG tariffs.Results: The national DRG tariff lies within the calculated Danish Krone (DKK CIs (CI ruptured AAA, 98,178–195,327 [€13,196–€26,254]; CI nonruptured AAA, 79,039–98,178 [€10,624–€13,196]; CI dead, 42,023–111,685 [€5,648–€15,011], and thus national DRG tariffs could be a good estimate for the actual costs in the local hospitals.Conclusion: The bootstrap method is useful for testing the generalizability of national DRG tariffs as estimates of local surgical costs.Keywords: bootstrap method, costs, DRG, abdominal aortic aneurysm
Lifshits, Yu Z; Babayev, E; Afremov, M; Valetskiy, V L; Grigoruk, A V; Omelchenko, A N
Biophysical peculiarities of action on tissues of a two-strem low-frequency ultrasound (TSLFU) technology, elaborated by "Arobella Medical LLC" (USA) firm, were studied. Capacity of ultrasound to separate a pathologically-changed and healthy tissues, to divide the structures in accordance to their bioacoustical parameters constitutes the technology peculiarities. The presence of such a biophysical effect permits to achieve high resectability (R0) in patients with oncological diseases. Antibacterial effect and stimulation of intraorgan microcirculation with ultrasound irradiation were noted. Biophysical peculiarities of TSLFU were successfully applied in surgical treatment of 48 patients, suffering inflammatory and oncological diseases of the abdominal cavity organs. PMID:26817081
Full Text Available BACKGROUND: Influence of fish oil supplementation on postoperative atrial fibrillation (POAF was inconsistent according to published clinical trials. The aim of the meta-analysis was to evaluate the effects of perioperative fish oil supplementation on the incidence of POAF after cardiac surgery. METHODS: Pubmed, Embase and the Cochrane Library databases were searched. Randomized controlled trials (RCTs assessing perioperative fish oil supplementation for patients undergoing cardiac surgery were identified. Data concerning study design, patient characteristics, and outcomes were extracted. Risk ratio (RR and weighted mean differences (WMD were calculated using fixed or random effects models. RESULTS: Eight RCTs involving 2687 patients were included. Perioperative supplementation of fish oil did not significantly reduce the incidence of POAF (RR = 0.86, 95%CI 0.71 to 1.03, p = 0.11 or length of hospitalization after surgery (WMD = 0.10 days, 95% CI: 0.48 to 0.67 days, p = 0.75. Fish oil supplementation also did not affect the perioperative mortality, incidence of major bleeding or the length of stay in the intensive care unit. Meta-regression and subgroup analyses indicated mean DHA dose in the supplements may be a potential modifier for the effects of fish oil for POAF. For supplements with DHA >1 g/d, fish oil significantly reduced the incidence of POAF; while it did not for the supplements with a lower dose of DHA. CONCLUSIONS: Current evidence did not support a preventative role of fish oil for POAF. However, relative amounts of DHA and EPA in fish oil may be important for the prevention of POAF.