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Sample records for bariatric surgical patients

  1. Perioperative Optimization of Patients Undergoing Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    C. E. Owers

    2012-01-01

    Full Text Available Bariatric surgery is fast becoming an efficient and safe method of weight reduction, especially for patients in whom conservative measures have failed. As the obese population of the world increases, so will the number of patients requesting or requiring surgical weight loss methods. Bariatric patients however have numerous co-morbidities that make their operative course more difficult, and therefore is important to have a good understanding of the important issues surrounding their pre, peri and post operative management. This article aims to educate the reader about optimal management of the bariatric surgical patient.

  2. Benefits of Bariatric Surgery and Perioperative Surgical Safety

    Directory of Open Access Journals (Sweden)

    Ji Chung Tham

    2015-11-01

    Full Text Available Obesity is a worldwide problem with numerous associated health problems. The number of patients eligible for surgery outnumber surgical capacity and so patients need to be prioritised based on their obesity- related health burden and comorbidities. Weight loss as a result of bariatric surgery is significant and maintained in the long term. In addition to weight loss, patient health improves in terms of metabolic, macrovascular, and microvascular disease. As a result, quality of life is better, along with psychosocial wellbeing. Bariatric surgery is associated with a relatively low number of complications and appears to result in a reduction in mortality risk due to the resolution of comorbidities. Hence, surgery can now be routinely considered as an adjunct to medical therapy in the management of obesity.

  3. [Dealing with surgical complications after bariatric gastric bypass surgery].

    Science.gov (United States)

    Schlesinger, Nis Hallundbæk; Naver, Lars

    2013-11-25

    The subject of this article is surgical complications to Roux-en-Y-gastric bypass and how to deal with them. The article addresses doctors, who are on duty in hospitals without bariatric surgery and who often deal with this patient category in the acute situation. Managing complications is challenging due to both the patient's physiognomy and the wide-ranged change in anatomy. The article gives a review of the literature and hands-on-recommendations for treating anastomotic leak, post-operative bleeding, internal herniation, bowel obstruction and biliary complications. PMID:24629437

  4. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    OpenAIRE

    Bartlett MA; Mauck KF; Daniels PR

    2015-01-01

    Matthew A Bartlett, Karen F Mauck, Paul R Daniels Division of General Internal Medicine, Mayo Clinic Thrombophilia Center, Department of Medicine, Mayo Clinic, Rochester, MN, USA Abstract: Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due t...

  5. Metabolic Bone Disease in the Bariatric Surgery Patient

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    Susan E. Williams

    2011-01-01

    Full Text Available Bariatric surgery has proven to be a life-saving measure for some, but for others it has precipitated a plethora of metabolic complications ranging from mild to life-threatening, sometimes to the point of requiring surgical revision. Obesity was previously thought to be bone protective, but this is indeed not the case. Morbidly obese individuals are at risk for metabolic bone disease (MBD due to chronic vitamin D deficiency, inadequate calcium intake, sedentary lifestyle, chronic dieting, underlying chronic diseases, and the use of certain medications used to treat those diseases. After bariatric surgery, the risk for bone-related problems is even greater, owing to severely restricted intake, malabsorption, poor compliance with prescribed supplements, and dramatic weight loss. Patients presenting for bariatric surgery should be evaluated for MBD and receive appropriate presurgical interventions. Furthermore, every patient who has undergone bariatric surgery should receive meticulous lifetime monitoring, as the risk for developing MBD remains ever present.

  6. Endocrine and metabolic aspects of the management of patients undergoing bariatric surgery. Review of clinical recommendations.

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    N V Mazurina

    2012-03-01

    Full Text Available The incidence of morbid obesity increases worldwide. Therefore surgical methods of treatment are widely applied. A lot of patients after bariatric surgery requires lifelong control and therapy. The Endocrine Society offered detailed guideline for the management of boost-bariatric surgery patients. The basic recommendations are reviewed in this article.

  7. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    Science.gov (United States)

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  8. Medical management of patients after bariatric surgery: Principles and guidelines

    Institute of Scientific and Technical Information of China (English)

    Abd; Elrazek; Mohammad; Ali; Abd; Elrazek; Abduh; Elsayed; Mohamed; Elbanna; Shymaa; E; Bilasy

    2014-01-01

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index(BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients(BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  9. The bariatric patient: an overview of perioperative care.

    Science.gov (United States)

    Fencl, Jennifer L; Walsh, Angela; Vocke, Dawn

    2015-08-01

    Obesity (ie, a body mass index of ≥30 kg/m(2)) is increasing in the United States. As a result, more overweight individuals are being surgically treated for weight loss, thus making it imperative for perioperative RNs to understand obesity's effects on patients' health, its contribution to significant comorbidities (eg, diabetes, cardiovascular disease, hypertension, sleep apnea, musculoskeletal issues, stroke), the perioperative care requirements (eg, specialized instruments and equipment, positioning and lifting aids), and unique needs of these patients (eg, diet, counseling). It is vital that the perioperative nurse accurately assesses the patient undergoing bariatric surgery to provide safe and appropriate nursing interventions during the perioperative continuum of care. PMID:26227516

  10. New devices for the bariatric patient.

    Science.gov (United States)

    Debergh, Isabelle; Snauwaert, Christophe; Dillemans, Bruno

    2016-04-01

    Over the past years, the global prevalence of obesity has risen dramatically. This generates enormous costs for the health care system, since obesity is associated with hypertension, diabetes mellitus type 2, coronary heart diseases, stroke, dyslipidemia, psychological problems, and cancer. Bariatric surgery has demonstrated to be the most effective and durable treatment option in the morbidly obese patient. Despite its evidence based efficacy, less than 1% of obese patients will undergo surgery. The role of new, less-invasive devices for the bariatric patient needs to be defined. Are they situated in the gap between lifestyle modification and surgery for the obese patient, in the preoperative work-up of the super-obese patient, in patient groups that are currently excluded for surgery, and/or in the routine treatment of obesity as a chronic disease? This review will focus on emerging technologies for the bariatric patient that are currently in clinical practice or in an advanced development stage, with different modes of action: inducing stretch on the gastric wall (space-occupying or stitching devices), vagal neuromodulation, altering the absorption, or exclusion of the duodenum and proximal jejunum. Exploring the evidence and the indication of different therapeutic approaches and innovations will be an interesting field of research in the near future. PMID:26923812

  11. Imaging of patients treated with bariatric surgery

    International Nuclear Information System (INIS)

    Over the past few years, obesity has become a major clinical and population concern in the majority of developed countries. Obesity leads to significant systemic disorders, such as hypertension, hypercholesterolemia, hypertriglyceridemia and insulin resistance, and also increases the risk of developing cardiovascular diseases (ischemic heart disease, ischemic stroke), metabolic diseases (type 2 diabetes), certain types of cancer, and degenerative bone disorders (osteoarthritis). Health hazards associated with epidemic of obesity and potential benefits of weight loss have spurred interest in new treatment methods. Bariatric surgical procedures constitute a recognized alternative in cases where conservative management of obesity fails. Several bariatric operations can be distinguished: restrictive procedures, such as adjustable gastric band (AGB) and vertical banded gastroplasty (VBG); predominantly malabsorptive procedures, such as biliopancreatic diversion (BPD), and a combination of both methods, such as Roux-en-Y gastric bypass. The adverse consequences of surgical treatment of obesity include i.a.: intestinal anastomotic leakage, impaired intestinal permeability and internal hernia, dilatation of the stomach, gastrointestinal anastomotic stenosis, marginal ulceration, incisional hernia. Basic knowledge of procedures in the surgical treatment of obesity is of vital importance for the radiologist during evaluation of upper gastrointestinal tract in the early and late postoperative period, allowing correct interpretation of acquired images as well as recognition of typical complications

  12. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    OpenAIRE

    M. Cerci; Bellini, M. I.; Russo, F.; Benavoli, D.; Capperucci, M.; Gaspari, A. L.; Gentileschi, P.

    2013-01-01

    Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative m...

  13. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

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    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  14. FUNCTIONAL ASSESSMENT OF OLDER OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY

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    Denis PAJECKI

    2014-03-01

    Full Text Available Context Obesity in the elderly is associated with exacerbation of functional decline (dependency, that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years. Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72 and 75% were women. They had an average weight of 121.1 kg (72.7-204 and a mean BMI of 47.2 kg/m2 (35.8-68.9. 16 patients (40% have shown dependency for activities of daily living, 19 (47,5% for instrumental activities of daily living and 20 patients (50% had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression has shown

  15. Assessing the obese diabetic patient for bariatric surgery: which candidate do I choose?

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    Raffaelli M

    2015-06-01

    Full Text Available Marco Raffaelli,1 Luca Sessa,1 Geltrude Mingrone,2 Rocco Bellantone1 1Division of Endocrine and Metabolic Surgery, 2Division of Obesity Diseases, Università Cattolica del Sacro Cuore, Rome, Italy Abstract: The worldwide prevalence of type 2 diabetes is rising in association with an increasing frequency of overweight and obesity. Bariatric-metabolic procedures are considered as additional therapeutic options, allowing improved diabetes control in most patients. Multiple factors play in concert to achieve the improvements in diabetic remission observed after bariatric-metabolic surgery. Several studies have demonstrated that bariatric-metabolic surgery is an effective treatment for type 2 diabetes when compared with conventional nonsurgical medical treatment. Because the best results are achievable in patients with a relatively short history of diabetes and less advanced controlled disease, the surgical option could be considered early, especially in morbid obese subjects (BMI ≥35 kg/m2 after failure of medical treatment. Patients with extensive weight loss are more likely to achieve type 2 diabetes remission after bariatric surgery. At present, Roux-en-Y gastric bypass seems the surgical procedure of choice because it has fewer risks than biliopancreatic diversion, and it is associated with higher weight loss and metabolic improvements compared with adjustable gastric banding. Recent evidences regarding the effectiveness of sleeve gastrectomy in diabetes remission have to be confirmed by controlled trials with longer follow-up. Keywords: bariatric surgery, metabolic surgery, diabetes, morbid obesity

  16. Guidelines for the follow-up of patients undergoing bariatric surgery.

    Science.gov (United States)

    O'Kane, Mary; Parretti, Helen M; Hughes, Carly A; Sharma, Manisha; Woodcock, Sean; Puplampu, Tamara; Blakemore, Alexandra I; Clare, Kenneth; MacMillan, Iris; Joyce, Jacqueline; Sethi, Su; Barth, Julian H

    2016-06-01

    Bariatric surgery can facilitate weight loss and improvement in medical comorbidities. It has a profound impact on nutrition, and patients need access to follow-up and aftercare. NICE CG189 Obesity emphasized the importance of a minimum of 2 years follow-up in the bariatric surgical service and recommended that following discharge from the surgical service, there should be annual monitoring as part of a shared care model of chronic disease management. NHS England Obesity Clinical Reference Group commissioned a multi-professional subgroup, which included patient representatives, to develop bariatric surgery follow-up guidelines. Terms of reference and scope were agreed upon. The group members took responsibility for different sections of the guidelines depending on their areas of expertise and experience. The quality of the evidence was rated and strength graded. Four different shared care models were proposed, taking into account the variation in access to bariatric surgical services and specialist teams across the country. The common features include annual review, ability for a GP to refer back to specialist centre, submission of follow-up data to the national data base to NBSR. Clinical commissioning groups need to ensure that a shared care model is implemented as patient safety and long-term follow-up are important. PMID:27166136

  17. Defining the role of bariatric surgery in polycystic ovarian syndrome patients

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    Shaveta M Malik

    2012-01-01

    Full Text Available Polycystic ovarian syndrome (PCOS is the most common endocrine disorder in women. To meet PCOS criteria, women must have a combination of hyperandrogenism, anovulation and ultrasound findings. Almost 10% of all reproductive age women worldwide show signs of PCOS. Although women often seek care for gynecological or body image concerns, many PCOS women are at risk for metabolic syndrome (MS. Many of the metabolic consequences are overlooked and undertreated by physicians because these patients tend to be young, reproductive age women. MS and obesity coexist commonly with PCOS. These young women are predisposed to glucose abnormalities and ultimately diabetes mellitus, dyslipidemia and eventually cardiovascular disease. Bariatric surgery can be an effective means of weight loss in PCOS women. Surgical techniques have become safer and less invasive over time and have been found to be effective in achieving significant weight loss. Surgical options have also increased, giving patients more choices. Bariatric surgery may prevent or reverse metabolic syndrome. Bariatric surgery may also have reproductive benefits in PCOS patients. Although bariatric surgery has historically been performed in older, reproductive aged women, it has recently gained favor in adolescents as well. This is of particular importance due to the prevalence of both PCOS and MS in adolescents. Treatment of PCOS and MS certainly requires a combination of medical therapy, psychological support and lifestyle modifications. These treatments are difficult and often frustrating for patients and physicians. Bariatric surgery can be effective in achieving significant weight loss, restoration of the hypothalamic pituitary axis, reduction of cardiovascular risk and even in improving pregnancy outcomes. Ultimately, bariatric surgery should be considered part of the treatment in PCOS women, especially in those with MS.

  18. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

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    Carlene Johnson Stoklossa

    2013-01-01

    Full Text Available Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews several factors that influence weight regain after bariatric surgery, including type of surgery, food tolerance, energy requirements, drivers to eat, errors in estimating intake, adherence, food and beverage choices, and patient knowledge. A comprehensive multidisciplinary approach can provide the best care for patients with weight regain. Nutrition care by a registered dietitian is recommended for all bariatric surgery patients. Nutrition diagnoses and interventions are discussed. Regular monitoring of weight status and early intervention may help prevent significant weight regain.

  19. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

    Science.gov (United States)

    Wharton, S; Serodio, K J; Kuk, J L; Sivapalan, N; Craik, A; Aarts, M-A

    2016-04-01

    The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P effectiveness of bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature. PMID:26910303

  20. A psychiatric perspective view of bariatric surgery patients

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    Isabel Brandão

    2015-10-01

    Full Text Available Abstract Background Bariatric surgery is the only procedure that has significant results in weight loss and improvements in medical comorbidities in morbid obese patients. Severely obese patients are also associated with a higher prevalence of psychiatric disorders and poor quality of life. Objective To evaluate specific areas of psychopathology in individuals undergoing bariatric surgery. Methods A review of the literature was conducted from January 2002 to March 2014 by researching PubMed database using the following query: “morbid AND obesity AND bariatric AND surgery AND (psychiatry OR psychology”. Results Overall improvements in eating behaviors, mood disorders and body image are reported after bariatric surgery, and the mechanism is not enlightened. Risk of suicide and consumption of substances of abuse, especially alcohol, after gastric bypass surgery are problems that clinicians must be aware. Discussion Bariatric patients should be monitored after surgery to identify who did not show the expected benefits postoperatively and the ones who develop psychiatric symptoms after an initial positive response.

  1. Bariatric surgery in elderly patients: a systematic review

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    Giordano S

    2015-10-01

    Full Text Available Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (% with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I2 test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone. Keywords: morbid obesity, bariatric surgery, elderly, gastric bypass, weight loss, laparoscopy

  2. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study.

    Science.gov (United States)

    Sarosiek, Konrad; Pappan, Kirk L; Gandhi, Ankit V; Saxena, Shivam; Kang, Christopher Y; McMahon, Heather; Chipitsyna, Galina I; Tichansky, David S; Arafat, Hwyda A

    2016-01-01

    The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D) patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery. PMID:26881244

  3. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study

    Directory of Open Access Journals (Sweden)

    Konrad Sarosiek

    2016-01-01

    Full Text Available The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery.

  4. The Anatomy of a Weight Recidivism and Revision Bariatric Surgical Clinic

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    C. J. de Gara

    2014-01-01

    Full Text Available Abstract. Weight recidivism in bariatric surgery failure is multifactorial. It ranges from inappropriate patient selection for primary surgery to technical/anatomic issues related to the original surgery. Most bariatric surgeons and centers focus on primary bariatric surgery while weight recidivism and its complications are very much secondary concerns. Methods. We report on our initial experience having established a dedicated weight recidivism and revisional bariatric surgery clinic. A single surgeon, dedicated nursing, dieticians, and psychologist developed care maps, goals of care, nonsurgical candidate rules, and discharge planning strategies. Results. A single year audit (2012 of clinical activity revealed 137 patients, with a mean age 49 ± 10.1 years (6 years older on average than in our primary clinic, 75% of whom were women with BMI 47 ± 11.5. Over three quarters had undergone a vertical band gastroplasty while 15% had had a laparoscopic adjustable gastric band. Only 27% of those attending clinic required further surgery. As for primary surgery, the role of the obesity expert clinical psychologist was a key component to achieving successful revision outcomes. Conclusion. With an exponential rise in obesity and a concomitant major increase in bariatric surgery, an inevitable increase in revisional surgery is becoming a reality. Anticipating this increase in activity, Alberta Health Services, Alberta, Canada, has established a unique and dedicated clinic whose early results are promising.

  5. A Cognitive-Behavioral Mindfulness Group Therapy Intervention for the Treatment of Binge Eating in Bariatric Surgery Patients

    Science.gov (United States)

    Leahey, Tricia M.; Crowther, Janis H.; Irwin, Sharon R.

    2008-01-01

    Binge eating is a negative indicator of post-surgical weight loss and health outcome in bariatric surgery patients (Hsu, Bentancourt, Sullivan, 1996). Cognitive-behavioral techniques and mindfulness-based practices have been shown to successfully treat binge eating (Agras, Telch, Arnow, Eldredge, & Marnell, 1997; Kristeller & Hallett, 1999). This…

  6. Effects of Bariatric Surgery on Facial Features

    OpenAIRE

    Papoian, Vardan; Mardirossian, Vartan; Hess, Donald Thomas; Spiegel, Jeffrey H.

    2015-01-01

    Background Bariatric surgeries performed in the USA has increased twelve-fold in the past two decades. The effects of rapid weight loss on facial features has not been previously studied. We hypothesized that bariatric surgery will mimic the effects of aging thus giving the patient an older and less attractive appearance. Methods Consecutive patients were enrolled from the bariatric surgical clinic at our institution. Pre and post weight loss photographs were taken and used to generate two su...

  7. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

    OpenAIRE

    Carlene Johnson Stoklossa; Suneet Atwal

    2013-01-01

    Achieving optimal weight outcomes for patients with obesity is important to the management of their chronic disease. All interventions present risks for weight regain. Bariatric surgery is the most efficacious treatment, producing greater weight losses that are sustained over more time compared to lifestyle interventions. However, approximately 20–30% of patients do not achieve successful weight outcomes, and patients may experience a regain of 20–25% of their lost weight. This paper reviews ...

  8. Bariatric surgery in elderly patients: a systematic review

    OpenAIRE

    Giordano S; Victorzon M

    2015-01-01

    Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google ...

  9. Bariatric surgery in elderly patients: a systematic review

    OpenAIRE

    Victorzon, Mikael

    2015-01-01

    Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and...

  10. Eating Disorders in obese patients seeking bariatric surgery: aspects of mental health before and afterweight-loss treatment

    OpenAIRE

    Dahl, Jens Kornelius

    2014-01-01

    Background: An increasing number of obese patients are seeking surgical weight-loss treatments. Health-care workers need more knowledge about the various characteristics of these patients, and how they should be treated. Prior to bariatric surgery, those with Eating Disorders (EDs) showed impaired psychological functioning in several areas when compared with those without EDs. Some studies have shown that patients with EDs also have less success in the weight loss interventions. The present t...

  11. The psychological profile of bariatric patients with and without type 2 diabetes

    DEFF Research Database (Denmark)

    Wimmelmann, Cathrine L; Smith, Evelyn; Lund, Michael T;

    2015-01-01

    BACKGROUND: Some bariatric patients are referred for surgery with a diagnosis of type 2 diabetes while others are referred without co-morbid diabetes, but psychological differences between patients with and without type 2 diabetes undergoing bariatric surgery have not yet been investigated. The...... objective of this study was to present the baseline results of the longitudinal GASMITO-PSYC study, and to evaluate the psychological differences between bariatric patients with and without type 2 diabetes. METHODS: A total of 129 Roux-en- Y gastric bypass patients were recruited from the bariatric clinic...... sex and age. The total study sample differed significantly from Danish test norms reporting higher neuroticism (P = .000), more mental symptoms (P = .000), lower HRQOL (P = .000), and less positive weight-related body image (P = .000). CONCLUSION: Patients with type 2 diabetes had better physical...

  12. Employment and Professional Outcomes in 803 Patients Undergoing Bariatric Surgery in a French Reference Center for Obesity

    Directory of Open Access Journals (Sweden)

    Q Durand-Moreau

    2015-03-01

    Full Text Available Background: Very few studies have been performed on small populations about the links between employment and bariatric surgery.Objective: To determine if rates of employment are increased among patients who have undergone bariatric surgery, to assess their post-operative health consequences (post-prandial weakness, diarrhea, and patients' ability to maintain post-operative advice (ie, 30 minutes of daily physical activity, 6 small meals daily compared to non-employed post-surgical patients.Methods: This cross-sectional study was performed in the Regional Reference Centre for Obesity, which is a partnership between the University Hospital and a clinic in Angers, France during 2012 using a self-administrated questionnaire completed by patients hospitalized for post-operative follow-ups after bariatric surgery. Issues investigated were their professional situation before and after the surgery, compliancy to post-operative advice, and any postoperative side effects.Results: Employment rates were 64.4% before and 64.7% after the surgery (p=0.94. Of these, 30.6% maintained 30 minutes of daily physical activity vs. 41.0% of non-workers (p=0.02. 50.5% of employed patients and 57.3% of non-workers maintained 6 small meals a day after surgery (p=0.09. 8% of working patients reported post-prandial weaknesses and 8% reported diarrhea that caused problems at work.Conclusion: Employment rate remained stable after surgery. Having a job seemed to be an obstacle to managing 30 minutes of daily exercise, especially among women, but not maintaining 6 small meals a day. Therefore, working environment needs to be assessed to improve job quality and retention for patients who have undergone bariatric surgery.

  13. Psychiatric and Psychosocial Aspects of Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Guzin Mukaddes Sevincer

    2014-02-01

    Full Text Available Bariatric surgery is a treatment modality which is becoming increasingly popular in the last decade in our country and around the world. Patients who treated with a conventional methods are unable to loose sufficient weight and even they regained most of their lost weight easily. The number of patients undergoing bariatric surgery are increasing day by day considering the success of bariatric surgery with regard to lose weight fast and the improvement in co-morbid conditions. Obesity and bariatric surgery are in a reciprocal relationship both with psychiatric disorders and psychosocial variables. Relations are begin with the evaluation of a patients eligibility for surgery in terms of psychiatric and psychosocial issues at a very early stage of the process. Presence of psychopathology, level of knowledge related to the surgical procedure and patients expectations about physical, psychological and social changes that may occur after surgery are the significant parts of the evaluation of bariatric surgery patients. These components should be considered in assessing capacity of patients to comply with medical advice in post-operative stage. In this article the needs for assesment of psychiatric and psychosocial aspects of obese patients who will undergo bariatric surgery is reviewed in the light of current literature . Possible medical, psychiatric and psychosocial complications of bariatric surgery and related issues are reviewed and psycosocial factors that may be predictors of the successful outcome of bariatric surgery are discussed.Discussions around the nature of specific eating disorders seen frequently in bariatric surgery patients, wheter it is a separate entities from well known eating disorders and controversial issues such as presence or absence of psychopathology like suicide as directly consequence of the surgical procedures are summarized. Discussions about performing of psychiatric and psychosocial assesment (i.e by whom, how and

  14. News media reports of patient deaths following 'medical tourism' for cosmetic surgery and bariatric surgery.

    Science.gov (United States)

    Turner, Leigh

    2012-04-01

    Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer-reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article identifies and describes twenty-six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer-reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of 'medical tourism' will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. PMID:22420449

  15. Mental and Physical Impact of Body Contouring Procedures on Post–Bariatric Surgery Patients

    OpenAIRE

    Singh, Devinder; Zahiri, Hamid R.; Janes, Lindsay E; Sabino, Jennifer; Matthews, Jamil A; Bell, Robert L.; Thomson, J. Grant

    2012-01-01

    Objective: The rapid rate of weight loss following bariatric surgery leads to areas of excessive skin that can cause physical ailments and distortion of body image. Dissatisfaction with the excessive skin can lead patients to seek plastic surgery. This study aims to assess the changes in mental and physical quality of life after body contouring procedures in the post–bariatric surgery population. Methods: In this cross-sectional study, the 36-Item Short Form Health Survey was given to 104 pat...

  16. Providing quality skin and wound care for the bariatric patient: an overview of clinical challenges.

    Science.gov (United States)

    Beitz, Janice M

    2014-01-01

    Obesity, (defined as body mass index [BMI] ≥30), and especially morbid obesity (defined as BMI ≥40), has a profound impact on the health and integrity of the patient's integumentary system and on the caregivers who strive to provide care for larger, heavy patients. The purpose of this overview is to address some common skin and wound care issues faced by bariatric patients in order to inform clinicians, patients, and caregivers and enable them to optimize care. For bariatric patients, extra attention must be paid to skin care, cleanliness, skin fold management, perigenital care, odor management, and effective pressure redistribution. Despite these interventions, the multifactorial challenges presented by morbid obesity increase patient risk for serious skin diseases and wound conditions. Implications for practice include how best to educate patients and caregivers for optimal problem prevention. Future research should target improving bariatric care equipment and decreasing risk indices. PMID:24434162

  17. PS1-48: A Patient-centered Electronic Education Tool for Establishing Weight Loss Expectations after Bariatric Surgery

    Science.gov (United States)

    Wood, G. Craig; Benotti, Peter; Gerhard, Glenn; Zaccone, Richard; Zhang, Yushan; Miller, Elaina; Still, Christopher

    2014-01-01

    Background/Aims Bariatric surgery candidates often struggle when deciding between intensive lifestyle therapy, pharmacological therapy, and/or bariatric surgery for achieving their long-term weight loss (WL) goals. Moreover, they often have unrealistic WL expectations prior to surgery. Despite huge individual variation in surgically induced WL, patient education is currently based on average WL results derived from program experience or published literature. Improved patient education tools are needed to provide realistic individual expectations for surgical WL. The purpose of this study was to develop an electronic application for patient education that can aid in surgical decisions, establishing realistic WL goals, and monitoring WL success. Methods Post-operative weight measurements from 2608 Roux-en-Y gastric bypass patients at Geisinger Clinic were collected over an eight year period. While accounting for surgical BMI and age, quantile regression was used to create expected WL curves (10th, 25th, 50th, 75th, and 90th %tile) for the 36 month post-operative period. Results A mobile application (Get-2-Goal) was designed to provide a simple, personalized interface that allows patients to track their WL and compare their WL results to their expected WL curves. Get-2-Goal was made publicly available at no cost on a popular Apps store and is compatible with current smartphone and tablet technology (>1000 downloads to date). Get-2-Goal allows patients to input their personal profile (e.g. age, BMI), review their expected WL, and track their WL post-operatively. Patients have the option of saving a graphic containing their personalized WL curves and e-mailing a tabular form of their WL results to family, friends, and/or care providers. Conclusions Get-2-Goal is a simple tool that may be used by Bariatric Surgery Programs to facilitate electronic patient education. This tool may assist patients in deciding to proceed to WL surgery, and will facilitate early

  18. Quality of Life, Body Image and Sexual Functioning in Bariatric Surgery Patients.

    Science.gov (United States)

    Sarwer, David B; Steffen, Kristine J

    2015-11-01

    This article provides an overview of the literature on quality of life, body image and sexual behaviour in individuals with extreme obesity and who undergo bariatric surgery. Quality of life is a psychosocial construct that includes multiple domains, including health-related quality of life, weight-related quality of life, as well as other psychological constructs such as body image and sexual functioning. A large literature has documented the impairments in quality of life and these other domains in persons with obesity and extreme obesity in particular. These impairments are believed to play an influential role in the decision to undergo bariatric surgery. Individuals who undergo bariatric surgery typically report significant improvements in these and other areas of psychosocial functioning, often before they reach their maximum weight loss. The durability of these changes as patients maintain or regain weight, however, is largely unknown. PMID:26608946

  19. The Night Eating Syndrome (NES) in Bariatric Surgery Patients.

    Science.gov (United States)

    de Zwaan, Martina; Marschollek, Michael; Allison, Kelly C

    2015-11-01

    The night eating syndrome (NES) has been included into the Diagnostic and Statistical Manual of Mental Disorders 5 as an example of an 'other-specified feeding or eating disorder'. The prevalence of NES has found to be higher in obese populations than in the general population and seems to rise with increasing body mass index. Recent studies suggest a prevalence of 2%-20% in bariatric surgery samples. Given that the core feature of this eating disorder may involve a shift in the circadian pattern of eating that disrupts sleep, and not the ingestion of objectively large amounts of food, it is a pattern that can continue after bariatric surgery. Nonetheless, symptoms of NES appear to decrease after weight loss surgery, and there is no evidence that pre-surgery NES negatively impacts weight loss following surgery. Prospective and longitudinal studies of the course of night eating symptoms are warranted using clear criteria and standardized assessment instruments. PMID:26395455

  20. Psychological Assessment of the Patient Undergoing Bariatric Surgery

    OpenAIRE

    Snyder, Allison G.

    2009-01-01

    The purpose of this article is to provide an overview of the critical domains assessed during the psychological evaluation of candidates for bariatric surgery. Although no formal standard exists in the literature, there is growing recognition of the important elements to be addressed and the appropriate means for collecting the necessary data to determine psychological readiness for these procedures. Information regarding the components of the clinical interview and the specific measures used...

  1. Effective Ventilation Strategies for Obese Patients Undergoing Bariatric Surgery: A Literature Review.

    Science.gov (United States)

    Hu, Xin Yan

    2016-02-01

    Obesity causes major alterations in pulmonary mechanics. Obese patients undergoing bariatric surgery present mechanical ventilation-related challenges that may lead to perioperative complications. Databases were systematically searched for clinical trials of ventilation maneuvers for obese patients and bariatric surgery. Thirteen randomized controlled trials were selected. The quality of the studies was evaluated with the Critical Appraisal Skills Programme tool, and a matrix was developed to present the essential components of the studies. Eight strategies of ventilation maneuvers were identified. Recruitment maneuvers followed by positive end-expiratory pressure (PEEP) consistently demonstrated effectiveness in obese patients undergoing bariatric surgery. Pressure-controlled ventilation and volume-controlled ventilation did not differ significantly in their efficacy. Noninvasive positive pressure ventilation (NIPPV) during induction was effective in preventing atelectasis and increasing the duration of safe apnea. Equal ratio ventilation can be a useful ventilation strategy. Recruitment maneuvers followed by PEEP are effective ventilation strategies for obese patients undergoing bariatric surgery. During induction, NIPPV provides further benefit. Future studies are needed to examine the postoperative effects of recruitment maneuvers with PEEP as well as the efficacy and safety of equal ratio ventilation. PMID:26939387

  2. Bariatric surgery for type 2 diabetes: Weighing the impact for obese patients

    OpenAIRE

    Kashyap, Sangeeta R.; GATMAITAN, PATRICK; Brethauer, Stacy; Schauer, Philip

    2010-01-01

    Obesity is a potent risk factor for the development and progression of type 2 diabetes, and weight loss is a key component of diabetes management. Bariatric surgery results in significant weight loss and remission of diabetes in most patients. After surgery, glycemic control is restored by a combination of enforced caloric restriction, enhanced insulin sensitivity, and increased insulin secretion.

  3. Bariatric surgery as a treatment option in patients with type 2 diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Marianna Spanou

    2013-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM is a leading cause of blindness, non-traumatic amputation and end-stage renal disease as well as a major cardiovascular risk factor. Tight glycemic control reduces the incidence of microvascular complications of T2DM whereas its effects on macrovascular complication are more controversial. However, glycemic targets are achieved by a minority of diabetic patients despite the availability of several antidiabetic agents. In the present commentary, we discuss the findings of two recent randomized studies that compared bariatric surgery with medical treatment in patients with uncontrolled T2DM. Both studies showed that bariatric surgery results in remission of T2DM in the majority of patients. However, both studies were limited to relatively young patients without comorbidities, had relatively short follow-up and did not assess the effects of surgery on T2DM complications. Moreover, the perioperative complications of bariatric surgery and its limited availability in some areas are additional barriers to the wider implementation of this therapeutic approach. On the other hand, the elucidation of the mechanisms underpinning the resolution of T2DM following bariatric surgery might result in the development of novel, more effective pharmacotherapies for this common disease.

  4. IVF after bariatric surgery

    OpenAIRE

    Doblado, Manuel A.; Lewkowksi, Beth M.; Odem, Randall R.; Jungheim, Emily S.

    2010-01-01

    Little data exist regarding in vitro fertilization in women who have undergone bariatric surgery. Our experience with five patients suggests IVF is a safe and effective fertility treatment for these women although special considerations should be made including the type of bariatric procedure the patient underwent and relating this knowledge to symptoms the patient may experience during their IVF cycle.

  5. The Pharmacokinetics of the CYP3A Substrate Midazolam in Morbidly Obese Patients Before and One Year After Bariatric Surgery

    OpenAIRE

    Brill, Margreke J.; van Rongen, Anne; van Dongen, Eric P.; van Ramshorst, Bert; Hazebroek, Eric J; Darwich, Adam S; Rostami-Hodjegan, Amin; Knibbe, Catherijne A.

    2015-01-01

    Purpose Bariatric surgery is nowadays commonly applied as treatment for morbid obesity (BMI > 40 kg/m2). As information about the effects of this procedure on a drug’s pharmacokinetics is limited, we aimed to evaluate the pharmacokinetics of CYP3A probe substrate midazolam after oral and intravenous administration in a cohort of morbidly obese patients that was studied before and 1 year post bariatric surgery. Methods Twenty morbidly obese patients (aged 26–58 years) undergoing bariatric surg...

  6. Defining the Role of Bariatric Surgery in Polycystic Ovarian Syndrome Patients%减重手术在多囊卵巢综合征治疗中的作用

    Institute of Scientific and Technical Information of China (English)

    Shaveta M. Malik; Michael L. Traub; 王恺京; 徐安安

    2013-01-01

    Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. To meet PCOS criteria, women must have a combination of hyperandrogenism, anovulation and ultrasound findings. Almost 10% of all reproductive age women worldwide show signs of PCOS. Although women often seek care for gynecological or body image concerns, many PCOS women are at risk for metabolic syndrome (MS). Many of the metabolic consequences are overlooked and undertreated by physicians because these patients tend to be young, reproductive age women. MS and obesity coexist commonly with PCOS. These young women are predisposed to glucose abnormalities and ultimately diabetes mellitus, dyslipidemia and eventually cardiovascular disease. Bariatric surgery can be an effective means of weight loss in PCOS women. Surgical techniques have become safer and less invasive over time and have been found to be effective in achieving significant weight loss. Surgical options have also increased, giving patients more choices. Bariatric surgery may prevent or reverse metabolic syndrome. Bariatric surgery may also have reproductive benefits in PCOS patients. Although bariatric surgery has historically been performed in older, reproductive aged women, it has recently gained favor in adolescents as well. This is of particular importance due to the prevalence of both PCOS and MS in adolescents. Treatment of PCOS and MS certainly requires a combination of medical therapy, psychological support and lifestyle modifications. These treatments are difficult and often frustrating for patients and physicians. Bariatric surgery can be effective in achieving significant weight loss, restoration of the hypothalamic pituitary axis, reduction of cardiovascular risk and even in improving pregnancy outcomes. Ultimately, bariatric surgery should be considered part of the treatment in PCOS women, especially in those with MS.

  7. The Bariatric Patient in the Intensive Care Unit: Pitfalls and Management.

    Science.gov (United States)

    Pompilio, Carlos E; Pelosi, Paolo; Castro, Melina G

    2016-09-01

    The increasing number of bariatric/metabolic operations as important alternatives for the treatment of obesity and type 2 diabetes brought several concerns about the intensive care of patients undergoing those procedures. Intensive Care Unit admission criteria are needed in order to better allocate resources and avoid unnecessary interventions. Furthermore, well-established protocols, helpful in many clinical situations, are not directly applicable to obese patients. Indeed, difficult airway management, mechanical ventilation, fluid therapy protocols, prophylaxis, and treatment of venous thromboembolic events have unique aspects that should be taken into consideration. Finally, new data related to planning nutrition therapy of the critically obese have been highlighted and deserve consideration. In this review, we provide an outline of recent studies related to those important aspects of the care of the bariatric/metabolic patients in critical conditions. PMID:27464648

  8. Does bariatric surgery improve the patient´s quality of life?

    Directory of Open Access Journals (Sweden)

    Y. Martínez

    2010-12-01

    Full Text Available Objective: The aim of this investigation was to assess the effect of malabsorptive bariatric surgery (BS on the quality of life (QoL, applying the Nottingham Health Profile (NHP and the bariatric analysis and reporting outcome system (BAROS. Design: A prospective cohort study was performed in 100 adult patients (> 18 years undergoing bariatric surgery by malabsorptive technique for one year. Research methods and procedures: Patients were monitored from the beginning of the BS program until a year after the intervention, applying the NHP and the BAROS test. At baseline, the mean weight of the women was 132 ± 22 kg and the Body Mass Index (BMI was 50.7 kg/m². Results: The values obtained from different areas applying the NHP questionnaire showed statistical significant differences (p < 0.001 with respect to baseline values. According to the BAROS test, 48% of patients lost 25-49% of weight excess and 80.8% had resolved major comorbidities at 1 yr. According to the Moorehead-Ardelt QoL score, there were major improvements in employment and self-esteem in 89% and 87% of patients, respectively, and improvements in physical activity, sexual and social relationships. According to the total mean BAROS score, the outcome was considered "very good". Conclusion: NHP and BAROS questionnaires appear to be useful and easily applicable tools to assess the QoL of obese patients.

  9. Stone formation and management after bariatric surgery.

    Science.gov (United States)

    Tarplin, Sarah; Ganesan, Vishnu; Monga, Manoj

    2015-05-01

    Obesity is a significant health concern and is associated with an increased risk of nephrolithiasis, particularly in women. The underlying pathophysiology of stone formation in obese patients is thought to be related to insulin resistance, dietary factors, and a lithogenic urinary profile. Uric acid stones and calcium oxalate stones are common in these patients. Use of surgical procedures for obesity (bariatric surgery) has risen over the past two decades. Although such procedures effectively manage obesity-dependent comorbidities, several large, controlled studies have revealed that modern bariatric surgeries increase the risk of nephrolithiasis by approximately twofold. In patients who have undergone bariatric surgery, fat malabsorption leads to hyperabsorption of oxalate, which is exacerbated by an increased permeability of the gut to oxalate. Patients who have undergone bariatric surgery show characteristic 24 h urine parameters including low urine volume, low urinary pH, hypocitraturia, hyperoxaluria and hyperuricosuria. Prevention of stones with dietary limitation of oxalate and sodium and a high intake of fluids is critical, and calcium supplementation with calcium citrate is typically required. Potassium citrate is valuable for treating the common metabolic derangements as it raises urinary pH, enhances the activity of stone inhibitors, reduces the supersaturation of calcium oxalate, and corrects hypokalaemia. Both pyridoxine and probiotics have been shown in small studies to reduce hyperoxaluria, but further study is necessary to clarify their effects on stone morbidity in the bariatric surgery population. PMID:25850790

  10. Nursing care in the perioperative period for patients undergoing bariatric surgery

    OpenAIRE

    Maria Beatriz Guimarães Ferreira; Márcia Marques dos Santos Felix; Cristina Maria Galvão

    2014-01-01

    This integrative review aimed to analyze the available evidence in the literature regarding nursing care in the perioperative period for patients who underwent bariatric surgery. The search for primary studies was carried out in the US National Library of Medicine National Institutes of Health, Cumulative Index to Nursing and Allied Health Literature and Latin American and Caribbean Health Sciences Literature databases. The sample was comprised of 11 primary studies, published between January...

  11. Bariatric Surgery in Youth.

    Science.gov (United States)

    Mirensky, Tamar L

    2016-06-01

    Bariatric surgery provides a clinically effective and cost-effective means of achieving sustained weight reduction and management of associated comorbidities and has been met with increasing enthusiasm for application in obese youth. Following trends seen among obese adults, carefully selected obese youth are now undergoing bariatric surgical procedures with excellent short-term and intermediate-term outcomes. Although long-term data are not yet available, the results thus far hold great promise in the management of this population. PMID:27241972

  12. Does bariatric surgery improve the patient´s quality of life? ¿La cirugía bariatrica mejora sensiblemente la calidad de vida del paciente?

    OpenAIRE

    Y. Martínez; M. D. Ruiz-López; Giménez, R.; A. J. Pérez de la Cruz; R. Orduña

    2010-01-01

    Objective: The aim of this investigation was to assess the effect of malabsorptive bariatric surgery (BS) on the quality of life (QoL), applying the Nottingham Health Profile (NHP) and the bariatric analysis and reporting outcome system (BAROS). Design: A prospective cohort study was performed in 100 adult patients (> 18 years) undergoing bariatric surgery by malabsorptive technique for one year. Research methods and procedures: Patients were monitored from the beginning of the BS program unt...

  13. Pregnancy after Bariatric Surgery: A Review

    OpenAIRE

    Eugene Oteng-Ntim; Hezelgrave, N. L.

    2011-01-01

    Maternal obesity is a major cause of obstetric morbidity and mortality. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. This paper aims to synthesize the current evidence regarding pregnancy outcomes after bariatric surgery. It concludes that bariatric surgery appears to ...

  14. Inferior vena cava filters and postoperative outcomes in patients undergoing bariatric surgery: a meta-analysis.

    Science.gov (United States)

    Kaw, Roop; Pasupuleti, Vinay; Wayne Overby, D; Deshpande, Abhishek; Coleman, Craig I; Ioannidis, John P A; Hernandez, Adrian V

    2014-01-01

    Background: Pulmonary embolism(PE)accounts for almost 40% of perioperative deaths after bariatric surgery.Placement of prophylactic inferior vena cava(IVC) filter before bariatric surgery to improve outcomes has shown varied results. We performed a meta-analysis to evaluate post- operative outcomes associated with the preoperative placement of IVC filters in these patients. Methods: A systematic review was conducted by three investigators independently in PubMed, EMBASE, the Web of Science and Scopus until February 28,2013.Our search was restricted to studies in adult patients undergoing bariatric surgery with and without IVC filters. Primary outcomes were postoperative deep vein thrombosis(DVT),pulmonary embolism (PE),and postoperative mortality. Meta-analysis used random effects models to account for heterogeneity,and Sidik- Jonkman method to account for scarcity of outcomes and studies. Associations are shown as Relative Risks(RR) and 95% Confidence Intervals(CI). Results: Seven observational studies were identified (n=102,767), with weighted average inci- dences of DVT(0.9%),PE(1.6%),and mortality(1.0%)for a follow-up ranging from 3 weeks to 3 months. Use of IVC filters was associated with an approximately 3-fold higher risk of DVT and death that was nominally significant for the former outcome, but not the latter (RR2.81,95%CI 1.33-5.97, p=0.007; and RR 3.27,95%CI0.78-13.64, p=0.1, respectively);there was no difference in the risk of PE(RR1.02,95%CI0.31-3.77,p=0.9). Moderate to high heterogeneity of effects was noted across studies. Conclusions: Placement of IVC filter before bariatric surgery Is associated with higher risk of postoperative DVT and mortality. A similar risk of PE inpatients with and without IVC filter placement cannot exclude a benefit, given the potential large imbalance in risk at baseline.Ran- domized trials are needed before IVC placement can be recommended. (SurgObesRelatDis 2015;11:268-269.) r 2015 American Society for Metabolic and

  15. Treatment of Adult Obesity with Bariatric Surgery.

    Science.gov (United States)

    Schroeder, Robin; Harrison, T Daniel; McGraw, Shaniqua L

    2016-01-01

    In 2013, approximately 179,000 bariatric surgery procedures were performed in the United States, including the laparoscopic sleeve gastrectomy (42.1%), Roux-en-Y gastric bypass (34.2%), and laparoscopic adjustable gastric banding (14.0%). Choice of procedure depends on the medical conditions of the patient, patient preference, and expertise of the surgeon. On average, weight loss of 60% to 70% of excess body weight is achieved in the short term, and up to 50% at 10 years. Remission of type 2 diabetes mellitus occurs in 60% to 80% of patients two years after surgery and persists in about 30% of patients 15 years after Roux-en-Y gastric bypass. Other obesity-related comorbidities are greatly reduced, and health-related quality of life improves. The Roux-en-Y procedure carries an increased risk of malabsorption sequelae, which can be minimized with nutritional supplementation and surveillance. Overall, these procedures have a mortality risk of less than 0.5%. Cohort studies show that bariatric surgery reduces all-cause mortality by 30% to 50% at seven to 15 years postsurgery compared with patients with obesity who did not have surgery. Dietary changes, such as consuming protein first at every meal, and regular physical activity are critical for patient success after bariatric surgery. The family physician is well positioned to counsel patients about bariatric surgical options, the risks and benefits of surgery, and to provide long-term support and medical management postsurgery. PMID:26760838

  16. Post-Bariatric Buttock Contouring with Autogenous Tissue Augmentation

    OpenAIRE

    Gerut, Zachary E.

    2006-01-01

    There are many established plastic surgical techniques to address effectively the lax, redundant tissue of the post–weight loss patient. Surgeons who are beginning their involvement in treating these patients are discovering that standard techniques are not always applicable to this rapidly growing group of patients and their extraordinary surgical challenges. Unique to the buttocks and the post-bariatric female breast is a tendency for these areas not only to become loose and ptotic but also...

  17. Timing of food intake is associated with weight loss evolution in severe obese patients after bariatric surgery

    OpenAIRE

    Ruíz-Lozano, T.; Vidal i Cortada, Josep; de Hollanda, A.; Scheer, F.A.J.L.; Garaulet, M.; Izquierdo Pulido, María Luz

    2016-01-01

    Background Recent research has demonstrated a relationship between the timing of food intake and weight loss in humans. However, whether the meal timing can be associated with weight loss in patients treated with bariatric surgery is unknown. Objective To evaluate the role of food-timing in the evolution of weight loss in a sample of 270 patients that underwent bariatric surgery with a follow-up of 6 years. Methods Participants (79% women; age [mean ± SD]: 52 ± 11 years; BMI: 46.5 ± 6.0 kg/m2...

  18. Cirugía Bariátrica, Cirugía Colorrectal e Internet: ¿Pacientes (desinformados? Bariatric surgery, colorectal surgery and the internet: (Uninformed patients?

    Directory of Open Access Journals (Sweden)

    M. Elisa De Castro Peraza

    2009-12-01

    Full Text Available Introducción: El uso de Internet por los pacientes se incrementa buscando información. Evaluamos una cohorte de pacientes de cirugía bariátrica y otra de colorrectal. Objetivo: Conocer patrones de uso de Internet de pacientes bariátricos y colorrectales. Método: Preguntas a 60 pacientes de bariátrica recogiendo edad, género, nivel académico y patrones de uso de Internet comparados con 61 pacientes de colorrecto. Resultados principales: Los pacientes de bariátrica usan más Internet para informarse, destacando universitarios y mujeres. Los pacientes afirman que la información encontrada les resulta útil para el conocimiento y la toma de decisiones aunque refieran como dudosa y hasta peligrosa alguna información encontrada. Conclusiones: El uso incrementado de Internet favorece a la comunidad quirúrgica permitiendo llegar a más pacientes pero puede ser una fuente de desinformación, creando perspectivas erróneas. Un mejor entendimiento del uso que el paciente hace de Internet y de la información que encuentra permitirá mejorar el cuidado.Introduction: Internet use by patients seeking information increases. We evaluated a cohort of patients for bariatric surgery and another of colorectal. Aim: Knowing patterns of Internet use in colorectal and bariatric patients. Method: 60 questions to gather bariatric patients age, gender, educational level and patterns of Internet use compared with 61 patients of colorectum. Main results: Bariatric patients used the Internet to learn more, leading academics and women. Patients say that they found the information useful for understanding and decision making as suspect and even relate to any dangerous information found. Conclusions: The increased use of the Internet favors the surgical community to reach more patients but can be a source of misinformation, creating prospects wrong. A better understanding of the patient makes use of the Internet and found information that will improve care.

  19. American Society for Metabolic and Bariatric Surgery

    Science.gov (United States)

    ... Education CBN CME Policies Meetings of Interest Online Education Directory Search Patient Learning Center Bariatric Surgery FAQs Bariatric Surgery Procedures BMI Calculator Childhood and Adolescent Obesity 100 SW 75th Street, Suite 201, Gainesville, FL, ...

  20. Moxifloxacin dosing in post-bariatric surgery patients

    NARCIS (Netherlands)

    Colin, Pieter; Eleveld, Douglas J.; Struys, Michel M. R. F.; T'Jollyn, Huybrecht; Van Bortel, Luc M.; Ruige, Johannes; De Waele, Jan; Van Bocxlaer, Jan; Boussery, Koen

    2014-01-01

    Introduction Given the ever increasing number of obese patients and obesity related bypass surgery, dosing recommendations in the post-bypass population are needed. Using a population pharmacokinetic (PK) analysis and PK-pharmacodynamic (PD) simulations, we investigated whether adequate moxifloxacin

  1. Evaluation of medical and health economic effectiveness of bariatric surgery (obesity surgery versus conservative strategies in adult patients with morbid obesity

    Directory of Open Access Journals (Sweden)

    von der Schulenburg, Johann-Matthias

    2008-07-01

    Full Text Available Background: Obesity with its associated medical, psychological, social, and economic complications is considered a chronic, multifactorial disorder. Given the magnitude of the challenge obesity, there is a clear need for preventive as well as therapeutic measures and strategies on an individual and a public health level. Objectives: The goal of this health technology assessment (HTA-report is to summarise the current literature on bariatric surgery, to evaluate their medical effectiveness/efficacy and cost-effectiveness as well as the ethical, social and legal implications of these procedures in comparison to conventional therapies and compared to each other. Methods: Relevant publications are identified by means of a structured search of databases accessed on 13.11.2006 and an update conducted on 12.11.2007. In addition, a manual search of identified reference lists is conducted. The present report includes German and English literature published since 2001 and targeting adult subjects with morbid obesity (body mass index (BMI >=40 kg/m² or BMI >=35 kg/m² with severe comorbidities. The methodological quality of studies included is assessed according to pre-defined quality criteria by two independent scientists. Results: Among 5910 retrieved publications, 25 medical articles, as well as seven health economic studies meet the inclusion criteria. The medical studies show a superior weight loss following bariatric surgery compared to conventional therapy. Malabsorptive procedures lead to a more profound weight loss than purely restrictive procedures. Weight reduction in general is accompanied by a reduced frequency of comorbidities (mostly diabetes type 2. The evidence is not sufficient to quantify these effects for individual procedures or to assess long-term outcomes. However, recent studies show a profound survival benefit for surgically treated patients up to a period of eleven years. The economic studies illustrate that bariatric surgery is

  2. Restoration of Glycemic Control in Patients with Type 2 Diabetes Following Bariatric Surgery is Associated with Reduction in Microparticles

    Science.gov (United States)

    Cheng, V.; Kashyap, S.R.; Schauer, P.R.; Kirwan, J.P.; McCrae, K.R.

    2011-01-01

    Background Microparticles bud from cellular elements during inflammation and are associated with vascular dysfunction related to type 2 diabetes. Although weight loss is known to reduce inflammation, the metabolic effects of bariatric surgery on microparticle concentration and composition are not known. Objectives To determine the effect of bariatric surgery on microparticle concentration and correlate these changes with clinical parameters. Setting Multispecialty group practice Methods We studied 14 obese subjects with type 2 diabetes two weeks before and at one and 12 months following bariatric surgery. Nine of the patients underwent Roux-en-Y gastric bypass and 5 received gastric restrictive surgery. Results One month following surgery, body mass index was reduced by ~10%, glycemic control improved dramatically (P 60% reduction in endothelial, platelet microparticles and CRP levels (P 50% reduction in monocyte microparticles compared to pre-surgery. The reduction in monocyte microparticles one month after surgery was strongly associated with the reduction in hemoglobin A1c (P < 0.05). The reduction in monocyte microparticles 12 months following surgery correlated strongly with the reduction in body mass index (P < 0.05). Conclusion The reduction in microparticles after bariatric surgery in patients with type 2 diabetes reflects an attenuation of inflammation and this mechanism may contribute to normalization of glycemic control. PMID:22093380

  3. Techniques, assessment, and effectiveness of bariatric surgery in combating obesity

    Directory of Open Access Journals (Sweden)

    Dimitrios K Papamargaritis

    2010-10-01

    Full Text Available Dimitrios K Papamargaritis, Dimitrios J Pournaras, Carel W Le RouxImperial Weight Centre, Imperial College London, London, UKAbstract: Obesity is an epidemic disease, and its prevalence is predicted to rise in the future. Many health and social comorbidities, such as cardiovascular disease, type 2 diabetes mellitus, cancer, nonalcoholic fatty liver disease, arthritis, infertility, eating disorders, unemployment, and low quality of life, have been associated with obesity. Nowadays, bariatric surgery is the only effective treatment for severe obesity. An increasing body of literature demonstrates significant remission of obesity-related comorbidities and an increase in life expectancy after surgical treatment. Unfortunately, serious complications can appear after surgery, and the careful preoperative assessment of patients is necessary to estimate the indications and contraindications of bariatric surgery. Recent studies report the lower complication and mortality rates when bariatric procedures are performed in high-volume centers. The purpose of this review is to describe the techniques of the currently used surgical procedures and the clinical effectiveness of bariatric surgery. Additionally, the possible complications and mortality rates after bariatric surgery are discussed.Keywords: obesity, surgery, assessment, clinical effectiveness, complications

  4. Post-bariatric abdominoplasty: our experience.

    Science.gov (United States)

    Grignaffini, Eugenio; Grieco, Michele P; Bertozzi, Nicolo'; Gandolfi, Marco; Palli, Dante; Cinieri, Francesco Giovanni; Gardani, Marco; Raposio, Edoardo

    2015-01-01

    The fast increase in obesity has been followed by the growth in the demand for plastic surgery in formerly obese patients. The weight loss is accompanied by new dysfunctions and disorders of the outline of the body that affects the quality of life of the patient. Abdominoplasty is a cosmetic surgery procedure that aims to remove the excess of skin and the redundant fat. The aim of this paper was to analyze our experience in this field and to test how functional abdominoplasty improved quality of life in the operated patients. In our Unit from January 2012 to December 2014, 25 patients (18 women and 7 men, age: 24 - 79 years, mean: 51 years) underwent abdominoplastic surgery. Only at least six months after bariatric surgery the patients were eligible for functional abdominoplasty. Average weight of the patients before surgery was 83.5 kg (range 58 - 163 Kg); averege BMI was 31 (range 24.77 - 57). The average quantity of tissue removed was 1.765 Kg (range 250 g - 11,5 Kg). Minor complications rate was in agreement with the percentages reported in literature. No mortality and major complications have occurred in our series. The majority of patients undergoing post-bariatric abdominoplasty reported an improvement in the quality of life and psychological well-being. In our opinion, however, only a multidisciplinary (surgical, psychological, dietological) approach of the post-bariatric patient allows to maintain long-term aesthetic and functional results. PMID:26694156

  5. Relevance of Adipose Tissue Stiffness Evaluated by Transient Elastography (AdipoScan™) in Morbidly Obese Patients before Bariatric Surgery

    Science.gov (United States)

    Sasso, Magali; Abdennour, Meriem; Liu, Yuejun; Hazrak, Hecham; Aron-Wisnewsky, Judith; Bouillot, Jean-Luc; Le Naour, Gilles; Bedossa, Pierre; Torjman, Joan; Clément, Karine; Miette, Véronique

    Subcutaneous adipose tissue (scAT) in human obesity undergoes severe alteration such as fibrosis which is related to metabolic alterations and to less efficiency in losing weight after bariatric surgery. There is currently no non-invasive tool to assess fibrosis in scAT. Vibration Controlled Transient Elastography (VCTE) using FibroScan® is widely used to assess liver fibrosis in clinical practice. A novel device named AdipoScan™ which is based on VCTE has been developed by Echosens (Paris) so as to assess scAT. The objective of this study is to show the first AdipoScan clinical results. AdipoScan™ was assessed in vivo on 73 morbidly obese patients candidate for bariatric surgery who were enrolled in the Pitié Salpêtrière hospital. scAT shear wave speed measured by AdipoScan™ is significantly associated with scAT fibrosis, gender, hypertension status, total body fat mass assessed by DXA, hypertension status, glycemic, lipid, hepatic parameters and adiponectin. Results suggest that scAT evaluation before bariatric surgery can be useful in clinical practice since it is related to scAT fibrosis -who plays in role in weight loss resistance after bariatric surgery- and to obesity induced co-morbidities such as diabetes, hypertension liver dysfunction.

  6. Cardiac dual-source CT for the preoperative assessment of patients undergoing bariatric surgery

    International Nuclear Information System (INIS)

    Aim: To assess the diagnostic value of coronary dual-source computed tomography (DSCT) as a comprehensive, non-invasive tool in the preoperative cardiac evaluation of patients undergoing bariatric surgery. Materials and methods: Thirty consecutive obese [average body mass index (BMI): 45 ± 7.6, range: 35–59] patients (24 women; six men; median age: 52 ± 15 years) were enrolled in this institutional review board (IRB)-approved, Health Insurance Portability and Accountability Act of 1996 (HIPAA)-compliant prospective study. Calcium scoring (CaS) and electrocardiography (ECG)-gated images of the coronary arteries were obtained with a large body habitus protocol (120 kV; 430 mAs; 100 ml iodinated contrast medium at 7 ml/s injection rate) on a DSCT machine. Qualitative (four-point: 1 = excellent to 4 = not delineable) coronary segmental analysis, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) measurements were performed. The presence and degree of vascular disease (four-grade scale: mild to severe) was correlated with CaS and cardiovascular (CV) risk stratification blood tests. In patients with severe stenosis (>70%), findings were compared with cardiac nuclear medicine imaging (single photon-emission computed tomography; SPECT) imaging. Results: The average HR, enhancement, and quality score were 64 ± 7 beats/min, 288 ± 66 HU and 1.8 ± .5, respectively. Ninety-three percent (417/450) of the coronary segments were rated diagnostic. The SNRs and CNRs were 17 ± 9 and 12 ± 7 for the right coronary artery; 17 ± 8 and 12 ± 7 for the left main coronary artery; 16 ± 9 and 11 ± 7 for the left anterior descending coronary artery; and 15 ± 7 and 10 ± 6 for the left circumflex coronary artery. Ten of the 30 patients (33%) demonstrated coronary artery disease (CAD) of which two (6%) showed three-vessel disease. Four (13%) patients showed severe disease: in three of which the presence of significant stenosis was confirmed by SPECT and by catheter

  7. Pregnancy after Bariatric Surgery: A Review

    Directory of Open Access Journals (Sweden)

    N. L. Hezelgrave

    2011-01-01

    Full Text Available Maternal obesity is a major cause of obstetric morbidity and mortality. With surgical procedures to facilitate weight loss becoming more widely available and demanded and increasing number of women becoming pregnant after undergoing bariatric surgery, it is important and timely to consider the outcome of pregnancy following bariatric surgery. This paper aims to synthesize the current evidence regarding pregnancy outcomes after bariatric surgery. It concludes that bariatric surgery appears to have positive effects on fertility and reduces the risk of gestational diabetes and preeclampsia. Moreover, there appears to be a reduced incidence of fetal macrosomia post-bariatric procedure, although there remains uncertainty about the increased rates of small-for-gestational age and intrauterine growth restricted infants, as well as premature rupture of membranes in this group. A number of case reports highlight that pregnancy following bariatric surgery is not without complications and it must be managed as high risk by the multidisciplinary team.

  8. Patient dose during radiological examination in the follow-up of bariatric surgery

    International Nuclear Information System (INIS)

    A patient dose survey was carried out measuring the kerma-area product (KAP) values during radiological evaluation in the follow-up of bariatric surgery. The procedures were performed by three radiologists to adjust laparoscopic gastric bands and to detect postoperative complications after Roux-en-Y gastric bypass procedures to treat morbid obesity. Total fluoroscopy time, exposure factors and the overall contribution of fluoroscopy to the accumulated KAP value were recorded. The median KAP values were used to estimate organ doses and effective dose to a standard patient; the radiation risk associated with the procedures was also evaluated. The doses were smaller for one of the three radiologists, owing to a more appropriate beam collimation and a reduction of the screening time. The KAP values ranged from 1.6 to 7.1 Gy cm2 for the laparoscopic adjustable gastric banding management, and from 3.0 and 8.3 Gy cm2 for the radiological examinations after gastric bypass. As a whole, the effective doses associated to these procedures were between 0.5 and 2.7 mSv. The organs receiving the highest doses were not only breast, stomach, pancreas and liver, but also lungs, owing to of their high radiosensitivity, significantly contributed to the effective dose. (authors)

  9. Prevalence of Helicobacter pylori infection in a group of morbidly obese Saudi patients undergoing bariatric surgery: A preliminary report

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    Al-Akwaa Ahmad

    2010-01-01

    Full Text Available Background/Aim: Earlier reports from Saudi Arabia have shown high prevalence of Helicobacter pylori infection. However, recent studies have documented a reduction in the infection prevalence. No prior study has assessed the prevalence in morbidly obese Saudi patients. We aimed to study the prevalence of H. pylori infection in a group morbidly obese Saudi patients referred for endoscopy prior to bariatric surgery. Materials and Methods: We retrospectively reviewed the medical records of all patients who were referred for upper endoscopy prior to bariatric surgery from June 2006 to September 2008. All data were recorded including patient′s demographics, comorbid conditions, endoscopic and histological findings. Results: There were 62 patients included, 20 males and 42 females. The mean age was 34 years (range 18 - 51 with a mean BMI of 55 Kg/m 2 (range 35 -92. H. pylori were present in 53 patients (85.5% with chronic active gastritis. All patients with positive H. pylori had chronic gastritis of variable severity. Intestinal metaplasia was present in 5%. The prevalence of H. pylori infection was similar in patients with and without co-morbid conditions. Main endoscopic findings were gastritis in 67.7%, hiatus hernia in 13%, and gastric erosions in 13%. No patient had duodenal or gastric ulcer. Conclusions: There is a high prevalence of H. pylori infection in morbidly obese Saudi patients undergoing bariatric surgery being referred for upper GI endoscopy. Further prospective studies are needed to evaluate the clinical implication and benefit of eradication treatment of infection in these patients.

  10. A Prospective Assessment of Psychosocial Factors Among Bariatric Versus Non-bariatric Surgery Candidates

    OpenAIRE

    Rutledge, Thomas; Adler, Sarah; Friedman, Raquel

    2010-01-01

    Background Psychological factors are considered potential contraindicators to bariatric surgery, but inconsistently predict surgical outcomes. We examined biomedical and psychosocial predictors of future bariatric candidacy in a population of veterans enrolling in a multidisciplinary weight management program. Methods Ninety-five obese veterans meeting bariatric surgery eligibility criteria participating in a weight control intake class from 2007 to 2008 completed the MOVE!23 questionnaire to...

  11. INSTANT REMEDY OR TOTAL SALVATION? MERITS AND DEMERITS OF BARIATRIC SURGERY

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    Randhawa

    2014-12-01

    Full Text Available Bariatric surgery as it is called now is not a new thing. First bariatric surgery was performed in 1954. Later the surgical remedy for bariatric surgery remained dormant till the popularity of laparoscopic surgery. Past decade has seen a tremendous increase in the number of bariatric or metabolic surgical procedures. This trend may continue because of the epidemic of obesity throughout globe and its rising prevalence among children. Advocates of bariatric surgery consider it the most effective and only treatment for morbid obesity and its co morbidities. To simplify; two types of procedures are performed. 1. Restrictive- where the intake of calories are prevented by restricting food intake. 2. The other one is malabsorptive- where food rich in calories is prevented to get absorbed. Operations based on these principles are-Laparoscopic adjustable gastric band and Vertical sleeve resection of stomach; for restrictive surgery and Laparoscopic biliopancreatic diversion with or without duodenal switch; for malabsorptive procedures. Both types have their own merits and demerits, many of which are almost unacceptable. To counter each other’s’ demerits certain combinations of both types are evolved like Roux-en-Y gastric bypass; it combines both restrictive and malabsorptive components. Each operation has its own merits and demerits. Important points for the patient and surgeon alike in the decision to proceed with bariatric operation include – the technical aspects of operation, post-operative complications including long term nutritional problems, Magnitude of initial and later steady weight loss over the period and correction of obesity related comorbidities. Here, the merits and demerits of present day laparoscopic bariatric surgical procedures are reviewed and related controversial aspects related to them are discussed. Right patient selection; right selection of operative procedure for an individual patient and more importantly right

  12. Endoscopic Bariatric Therapies.

    Science.gov (United States)

    Goyal, Deepinder; Watson, Rabindra R

    2016-06-01

    Obesity and its associated cardio-metabolic comorbidities have emerged as a global pandemic. The efficacy of various hypo-caloric diets and prescription drugs has been poor with respect to sustained weight loss. Recent advancements in endoscopic technology and techniques have opened a new field of minimally invasive endoscopic treatment options for combatting obesity both as a first line and adjunctive therapy. Presently, two endoscopic space-occupying devices in the form of intragastric balloons have received FDA approval for 6-month implantation in patients within a BMI range of 30-40 kg/m(2). Furthermore, full-thickness suturing has led to the development of primary endoscopic sleeve gastroplasty and Roux-en-Y gastric bypass revision as viable endoscopic alternatives to surgical approaches. These techniques have the potential to reduce adverse events, cost, and recovery times. Looking forward, a variety of promising and novel medical devices and endoscopic platforms that target obesity and diabetes are in various phases of development and investigation. The present review aims to discuss the current and forthcoming endoscopic bariatric therapies with emphasis on relevant procedural technique and review of available evidence. PMID:27098813

  13. The Application of Transcutaneous CO2 Pressure Monitoring in the Anesthesia of Obese Patients Undergoing Laparoscopic Bariatric Surgery

    OpenAIRE

    Liu, Shijiang; Sun, Jie; Chen, Xing; Yu, Yingying; Liu, Xuan; Liu, Cunming

    2014-01-01

    To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m2 were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. ...

  14. NONALCOHOLIC FATTY LIVER DISEASE IN SEVERE OBESE PATIENTS, SUBJECTED TO BARIATRIC SURGERY

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    Alexandre LOSEKANN

    2013-12-01

    Full Text Available Context Nonalcoholic fatty liver disease encompasses a spectrum of histopathological changes that range from simple steatosis to nonalcoholic steatohepatitis. Works suggest that iron (Fe deposits in the liver are involved in the physiopathology of nonalcoholic steatohepatitis. Objective The aim of this study was to determine the prevalence of simple steatosis and nonalcoholic steatohepatitis in patients with morbid obesity, subjected to bariatric surgery and to establish a correlation of the anatomopathological findings with the presence of liver fibrosis. Methods A total of 250 liver biopsies were conducted in the transoperation of the surgeries. Results Steatosis was present in 226 (90.4% of the samples, 76 (30.4% being classified as mild; 71 (28.4% as moderate and 79 (31.6% as intense. Nonalcoholic steatohepatitis was diagnosed in 176 (70.4% cases, where 120 (48.4% were mild; 50 (20% were moderate, and 6 (2.4% cases were intense. Fibrosis was referred to in 108 (43.2% biopsies, 95 of which (38% were mild; 2 (0.8% were moderate; 7 (2.8% were intense, and cirrhosis was diagnosed in 4 (1.6% cases. There was a correlation between the degree of steatosis and the level of inflammatory activity (rs = 0.460; P<0.001 and between the degree of this activity and the degree of fibrosis (rs = 0.583; P<0.001. Only 13 (5.2% samples showed Fe deposits. Conclusion There is a high prevalence of nonalcoholic steatohepatitis in these patients and a positive correlation of the degrees of nonalcoholic steatohepatitis with the intensity of fibrosis. The low prevalence of Fe deposits found makes it questionable that the presence of this ion has any participation in the physiopathogeny of nonalcoholic fatty liver disease.

  15. A review of psychological assessment instruments for use in bariatric surgery evaluations.

    Science.gov (United States)

    Marek, Ryan J; Heinberg, Leslie J; Lavery, Megan; Merrell Rish, Julie; Ashton, Kathleen

    2016-09-01

    Bariatric surgery is a viable treatment option for patients with extreme obesity and associated medical comorbidities; however, optimal surgical outcomes are not universal. Surgical societies, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), recommend that patients undergo a presurgical psychological evaluation that includes reviewing patients' medical charts, conducting a comprehensive clinical interview, and employing some form of objective psychometric testing. Despite numerous societies recommending the inclusion of self-report assessments, only about 2/3 of clinics actively use psychological testing-some of which have limited empirical support to justify their use. This review aims to critically evaluate the psychometric properties of self-report measures when used in bariatric surgery settings and provide recommendations to help guide clinicians in selecting instruments to use in bariatric surgery evaluations. Recommended assessment batteries include use of a broadband instrument along with a narrowband eating measure. Suggestions for self-report measures to include in a presurgical psychological evaluation in bariatric surgery settings are also provided. (PsycINFO Database Record PMID:27537008

  16. Quality of life of obese patients submitted to bariatric surgery Calidad de vida en pacientes obesos sometidos a cirugía bariátrica

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    N. Barreto Villela

    2004-11-01

    Full Text Available Introduction: The quality of life (QOL of patients with morbid obesity (MO is reduced given the restrictions it imposes. Bariatric surgery is considered an efficient treatment for MO as it leads to marked and progressive weight reduction. Weight loss, appropriate nutritional advice and follow up may induce significant improvement in QOL. Aim: To evaluate the degree of QOL in patients with MO before and after bariatric, surgery (Fobi-Capella reducing gastroplasty. Cases. Material and Methods: 95 morbidly obese(BMI > 40 kg/m² or moderately obese (BNI 35 - 39 kg/m² patients with co-morbidities were seen, followed up and given advice by the Nutrition, Psychology, Endocrinology and Surgery staff at the Federal University of Bahia Hospital. Group I included 66 subjects at the pre-surgical stage and Group II was composed of 29 other patients in a late postsurgical phase. Group II patients were seen at 6, 12 and more months after bariatric surgery. The medical outcomes study Short-Form Health Survey (SF-36 was the instrument used to evaluate QOL in this study. Data were analyzed using the Mann-Whitney non-parametric method and the SPSS program. Results: A statistically significant improvement in QOL was detected in the aspects of general health, functional ability and vitality. A progressive improvement in physical conditioning was particularly observed in the patients who had had bariatric surgery less than 6 months before, between 6 and 12 months and more than 12 months before. Small changes in subjective features were seen. An improvement in social aspects was observed after a post surgical fall. This explains why do not changes appear when pre and post surgical patients are compared. Conclusions: Fobi-Capella bariatric surgery for our patients with MO or with co-morbidities associated moderate obesity resulted in QOL improvement, and gradual but marked improvements in physical condition over time.Introducción: La calidad de vida (QOL de los

  17. Effectiveness of a Cognitive Behavioral Therapy for Dysfunctional Eating among Patients Admitted for Bariatric Surgery: A Randomized Controlled Trial

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    Hege Gade

    2014-01-01

    Full Text Available Objective. To examine whether cognitive behavioral therapy (CBT alleviates dysfunctional eating (DE patterns and symptoms of anxiety and depression in morbidly obese patients planned for bariatric surgery. Design and Methods. A total of 98 (68 females patients with a mean (SD age of 43 (10 years and BMI 43.5 (4.9 kg/m2 were randomly assigned to a CBT-group or a control group receiving usual care (i.e., nutritional support and education. The CBT-group received ten weekly intervention sessions. DE, anxiety, and depression were assessed by the TFEQ R-21 and HADS, respectively. Results. Compared with controls, the CBT-patients showed significantly less DE, affective symptoms, and a larger weight loss at follow-up. The effect sizes were large (DE-cognitive restraint, g=-.92, P≤.001; DE-uncontrolled eating, g=-.90, P≤.001, moderate (HADS-depression, g=-.73, P≤.001; DE-emotional eating, g=-.67, P≤.001; HADS-anxiety, g=-.62, P=.003, and low (BMI, g=-.24, P=.004. Conclusion. This study supports the use of CBT in helping patients preparing for bariatric surgery to reduce DE and to improve mental health. This clinical trial is registered with NCT01403558.

  18. Prevalence and Predictors of Self-Reported Sexual Abuse in Severely Obese Patients in a Population-Based Bariatric Program

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    Danielle L. Gabert

    2013-01-01

    Full Text Available Background. Sexual abuse may be associated with poorer weight loss outcomes following bariatric treatment. Identifying predictors of abuse would enable focused screening and may increase weight management success. Methods. We analyzed data from 500 consecutively recruited obese subjects from a population-based, regional bariatric program. The prevalence of self-reported sexual abuse was ascertained using a single interview question. Health status was measured using a visual analogue scale (VAS. Multivariable logistic regression was performed to identify sexual abuse predictors. Results. The mean age was 43.7 y (SD 9.6, 441 (88.2% were females, 458 (91.8% were white, and the mean body mass index (BMI was 47.9 kg/m2 (SD 8.1. The self-reported prevalence of past abuse was 21.8% (95% CI 18.4–25.4%. Abused subjects had worse health status (VAS score 53.1 (SD 21.2 versus 58.0 (SD 20.1, P=0.03. BMI was not associated with abuse (P>0.5. Age, sex, BMI, and covariate-adjusted independent predictors of abuse included alcohol addiction (adjusted odds ratio 15.8; 95% CI 4.0–62.8, posttraumatic stress disorder (4.9; 2.5–9.5, borderline personality (3.8; 1.0–13.8, depression (2.4; 1.3–4.3, and lower household income (3.4; 1.6–7.0. Conclusions. Abuse was common amongst obese patients managed in a population-based bariatric program; alcohol addiction, psychiatric comorbidities, and low-income status were highly associated with sexual abuse.

  19. Revisional Bariatric/Metabolic Surgery: What Dictates Its Indications?

    Science.gov (United States)

    Ma, Pearl; Reddy, Subhash; Higa, Kelvin D

    2016-07-01

    Bariatric/metabolic surgery is currently the only effective long-term treatment for morbid obesity- and obesity-related diseases such as diabetes, heart disease, hypertension, obstructive sleep apnea, and dyslipidemia. In addition, bariatric/metabolic surgery has been shown to significantly reduce the incidence of diabetes and cancer and prolong life when compared to non-surgical therapies. However, as obesity is a chronic disease, recidivism of weight and comorbid conditions can occur. In addition, the surgical construct can lead to long-term consequences such as marginal ulceration, bowel obstruction, reflux, and nutritional deficiencies. Despite these drawbacks, prospective randomized controlled studies and long-term longitudinal population-based comparative studies greatly favor surgical intervention as opposed to traditional lifestyle, diet, and exercise programs. Revisional surgery can be quite complex and technically challenging and may offer the patient a wide variety of solutions for treatment of weight recidivism and complications after primary operations. Given the paucity of high quality published data, we have endeavored to provide indications for revisions after bariatric surgery. PMID:27221504

  20. ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

    OpenAIRE

    2015-01-01

    Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The stud...

  1. Bariatric surgery complications. Internal hernia: A potentially fatal condition. A case report and literature review

    International Nuclear Information System (INIS)

    In recent years, Obesity (defined as Body Mass Index > 30 kg/m2) has increased its prevalence reaching epidemic levels in countries such as The United States where it has became a national health issue. In Colombia the Obesity prevalence is figured around 14%. Treatment options for Obesity include life style modifications, pharmacologist management and surgical approach (Bariatric Surgery). This article describes a patient with previous bariatric surgery, who presents abdominal pain and melena owed to isquemic process of the alimentary limb caused by an internal hernia which is a potentially lethal condition if it is not highly suspected allowing its early diagnosis and treatment

  2. A Systematic Review and Meta-Analysis of Outcomes for Type 1 Diabetes after Bariatric Surgery

    Science.gov (United States)

    Chow, Alexandra; Switzer, Noah J.; Dang, Jerry; Shi, Xinzhe; de Gara, Christopher; Birch, Daniel W.; Gill, Richdeep S.; Karmali, Shahzeer

    2016-01-01

    Background. The utility of bariatric surgery in type 1 diabetes remains controversial. The aim of the present study is to evaluate glycemic control outcomes in obese patients with type 1 diabetes after bariatric surgery. Methods. A comprehensive search of electronic databases was completed. Inclusion criteria included human adult subjects with BMI ≥35 kg/m2 and a confirmed diagnosis of type 1 diabetes who underwent a bariatric surgical procedure. Results. Thirteen primary studies (86 patients) were included. Subjects had a mean age of 41.16 ± 6.76 years with a mean BMI of 42.50 ± 2.65 kg/m2. There was a marked reduction in BMI postoperatively at 12 months and at study endpoint to 29.55 ± 1.76 kg/m2 (P diabetes leads to significant reductions in BMI and improvements in glycemic control.

  3. Bariatric surgery in hypothalamic obesity

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    Nathan eBingham

    2012-02-01

    Full Text Available Craniopharyngiomas (CP are epithelial neoplasms generally found in the area of the pituitary and hypothalamus. Despite benign histology, these tumors and/or their treatment often result in significant, debilitating disorders of endocrine, neurological, behavioral, and metabolic systems. Severe obesity is observed in a high percentage of patients with CP resulting in significant comorbidities and negatively impacting quality of life. Obesity occurs as a result of hypothalamic damage and disruption of normal homeostatic mechanisms regulating energy balance. Such pathological weight gain, termed hypothalamic obesity (HyOb, is often severe and refractory to therapy.Unfortunately, neither lifestyle intervention nor pharmacotherapy has proven truly effective in the treatment of CP-HyOb. Given the limited choices and poor results of these treatments, several groups have examined bariatric surgery as a treatment alternative for patients with CP-HyOb. While a large body of evidence exists supporting the use of bariatric surgery in the treatment of exogenous obesity and its comorbidities, its role in the treatment of HyOb has yet to be well defined. To date, the existing literature on bariatric surgery in CP-HyOb is largely limited to case reports and series with short term follow-up. Here we review the current reports on the use of bariatric surgery in the treatment of CP-HyOb. We also compare these results to those reported for other populations of HyOb, including Prader-Willi Syndrome and patients with melanocortin signaling defects. While initial reports of bariatric surgery in CP-HyOb are promising, their limited scope makes it difficult to draw any substantial conclusions as to the long term safety and efficacy of bariatric surgery in CP-HyOb. There continues to be a need for more robust, controlled, prospective trials with long term follow-up in order to better define the role of bariatric surgery in the treatment of all types of hypothalamic

  4. Post-operative bariatric surgery complications: Deficiency of nutrients

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    Syed Abdul Majid Mufaqam1, Soni Dhwani Satishkumar2, Patel Palak Arvindkumar2

    2013-08-01

    Full Text Available Since more than half of the population in America falls under the category of obesity, scientists have discovered a surgical technique to reduce the weight of the obese patients. Bariatric surgery or gastric bypass surgery is a procedure that has been successful in reducing the weight for obese people. This technique requires a permanent gastric bypass (Roux-en-Y where part of the stomach and duodenum is removed. Since the size of the stomach is reduced to 20% of its original size along with the removal of duodenum – this may lead to improper absorption of several vitamins and minerals. This review showed that several vitamins and mineral deficiencies are observed in patients, post-operative bariatric surgery. Thiamin, folate, and B12 deficiencies were most commonly observed, and Vitamin A, D, C and B6 deficiencies were also seen in some cases. Iron and calcium deficiencies were also reported by some of the studies.

  5. O impacto emocional da cirurgia bariátrica em pacientes com obesidade mórbida The emotional impact of bariatric surgery in patients with morbid obesity

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    Cristiano Waihrich Leal

    2007-12-01

    his new physical and chemical state. This study aimed at analyzing hopes, fantasies, results, difficulties, and frustrations present after a surgical procedure. This case report resulted from the data collected from six patients being followed at a public hospital in Santa Catarina, Brazil, who developed symptoms of psychic suffering after the bariatric surgery. Each patient participated in two sessions of semi-structured interviews. This research was approved by the ethics committee of Universidade de Joinville. Results show that psychological changes resulting from the bariatric surgery were remarkable. In some cases, patients expressed expectations beyond weight loss, such as resolution of marital and interpersonal conflicts, as well as changes in stable personality traits. Use of substances (alcohol and tobacco associated with risk behavior (extra-marital relationships and dangerous driving was also detected. The problem of obesity was evidenced as part of a complex situation that involves both physical and mental status, and its solution sometimes exposes the patient's difficulties and psychological limitations.

  6. Percentage of Surgical Patients Receiving Recommended Care

    Science.gov (United States)

    ... view charts and maps. State Percentage of Surgical Patients Receiving Recommended Care by ... U.S. Department of Health & Human Services — 200 Independence Avenue, S.W. — Washington, D.C. 20201

  7. The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery.

    Science.gov (United States)

    Liu, Shijiang; Sun, Jie; Chen, Xing; Yu, Yingying; Liu, Xuan; Liu, Cunming

    2014-01-01

    To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2) with regard to arterial carbon dioxide partial pressure (PaCO2) in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2) were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2), as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2) and. (PTCCO2-PaCO2) were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2), mean 42.1,SD 5.4 kg/m(2)) were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD). And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD). The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2) = 0.64, Ptranscutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery. PMID:24699267

  8. Complications of bariatric surgery: Presentation and emergency management.

    Science.gov (United States)

    Kassir, Radwan; Debs, Tarek; Blanc, Pierre; Gugenheim, Jean; Ben Amor, Imed; Boutet, Claire; Tiffet, Olivier

    2016-03-01

    The epidemic in obesity has led to an increase in number of so called bariatric procedures. Doctors are less comfortable managing an obese patient after bariatric surgery. Peri-operative mortality is less than 1%. The specific feature in the obese patient is that the classical signs of peritoneal irritation are never present as there is no abdominal wall and therefore no guarding or rigidity. Simple post-operative tachycardia in obese patients should be taken seriously as it is a WARNING SIGNAL. The most common complication after surgery is peritonitis due to anastomotic fistula formation. This occurs typically as an early complication within the first 10 days post-operatively and has an incidence of 1-6% after gastric bypass and 3-7% after sleeve gastrectomy. Post-operative malnutrition is extremely rare after restrictive surgery (ring, sleeve gastrectomy) although may occur after malabsorbative surgery (bypass, biliary pancreatic shunt) and is due to the restriction and change in absorption. Prophylactic cholecystectomy is not routinely carried out during the same procedure as the bypass. Superior mesenteric vein thrombosis after bariatric surgery is a diagnosis which should be considered in the presence of any postoperative abdominal pain. Initially a first etiological assessment is performed (measurement of antithrombin III and of protein C and protein S, testing for activated protein C resistance). If the least doubt is present, a medical or surgical consultation should be requested with a specialist practitioner in the management of obese patients as death rates increase with delayed diagnosis. PMID:26808323

  9. Bariatric Surgery Misconceptions

    Science.gov (United States)

    ... from depression or anxiety and to have lower self-esteem and overall quality of life than someone who ... is a Candidate for Bariatric Surgery? Childhood and Adolescent Obesity Find a Provider Benefits of Bariatric Surgery ...

  10. Preoperative and Postoperative (1st and 3rd Month Metabolic Data of Patients Who Underwent Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Nilüfer Özdemir Kutbay

    2015-03-01

    Full Text Available Purpose: The growing prevalence of obesity has become a major concern. The efficacy of medical treatment, diet and behavior therapy in morbidly obese patients is limited. Obesity surgery is a treatment option for selected morbidly obese patients. Material and Method: Data of 47 patients (n=39 women, 8 men who underwent bariatric surgery were investigated. Results: Out of 47 patients, 20 underwent Roux-en-Y gastric bypass (RYGB (43% and 27 had sleeve gastrectomy (SG (57%. The mean age of the patients was 37±9.5 (19-59 years. 17% of patients were men and 83% were women. In the analysis of data on weight that could be found for 31 out of 47 patients, we detected preoperative and postoperative (1st and 3rd month mean weight values as 125.4±15.9 kg, 112.7±13.2 kg (p<0.001 and 100.9±17.5 kg (p<0.001, respectively. In addition, the analysis of the data on mean fasting plasma glucose (FPG levels which could be found for 23 out of 47 patients, showed us that preoperative and postoperative (1st and 3rd month FPG levels were 100.9±17.5 mg/dL, 91.6±10.9 mg/dL (p=0.03 and 87.3±2.0 mg/dL, respectively. Only 1 patient had diabetes before the surgery. In the RYGB group, the mean change in weight was 12.4±5.5 kg in the 1st month and 22.2±8.6 kg in the 3rd month (compared to the weights in the preoperative period. Moreover, in the SG group, the mean change in weight was 13.7±4.5 kg in the 1st month and 23.4±5.8 kg in the 3rd month. No statistically significant difference was found between the weight changes in the 1st and the 3rd month as for surgery types. Discussion: After bariatric surgery, significant loss in weight and reduction in FPG occurred in short-term.

  11. Surgical acute abdomen in elderly patients.

    Directory of Open Access Journals (Sweden)

    Itengré Ouédraogo

    2004-08-01

    Full Text Available Fundaments : The surgical acute abdomen usually is the most frequent cause of abdominal surgery of urgency in t he old one, with the high mortality in spite of the modern surgical technologies. Objective: To evaluate the surgery of the surgical acute abdomen in the old one. Method: Appears a prospectivo descriptive study that includes 102 patients of 60 years or more who underwent surgery at the ¨Dr Gustavo Aldereguía Lima¨ University Hospital of Cienfuegos with this diagnostic. The primary data were obtained from clinical cards of the patients and the daily clinical observation until the debit. Results: The patients presented an average age of 74 years, being the most frequent causes of the syndrome intestinal obstruction (32,4%, the biliary tract affections (22,5%, and acute appendicitis (21,6%. The most frequent symptom was abdominal pain (96,08%, and we noticed tachycardia in 80,4%. Postoperating complications in 47,06% of the patients appeared and was observed a mortality of 26,5% with statistically significant relation with the age, ASA classification, surgical risk, time of evolution and the surgical time. The peritonitis heads the direct causes of death.

  12. A role for exercise after bariatric surgery?

    Science.gov (United States)

    Coen, Paul M; Goodpaster, Bret H

    2016-01-01

    Obesity predisposes an individual to develop numerous comorbidities, including type 2 diabetes, and represents a major healthcare issue in many countries worldwide. Bariatric surgery can be an effective treatment option, resulting in profound weight loss and improvements in metabolic health; however, not all patients achieve similar weight loss or metabolic improvements. Exercise is an excellent way to improve health, with well-characterized physiological and psychological benefits. In the present paper we review the evidence to determine whether there may be a role for exercise as a complementary adjunct therapy to bariatric surgery. Objectively measured physical activity data indicate that most patients who undergo bariatric surgery do not exercise enough to reap the health benefits of exercise. While there is a dearth of data on the effects of exercise on weight loss and weight loss maintenance after surgery, evidence from studies of caloric restriction and exercise suggest that similar adjunctive benefits may be extended to patients who perform exercise after bariatric surgery. Recent evidence from exercise interventions after bariatric surgery suggests that exercise may provide further improvements in metabolic health compared with surgery-induced weight loss alone. Additional randomized controlled exercise trials are now needed as the next step to more clearly define the potential for exercise to provide additional health benefits after bariatric surgery. This valuable evidence will inform clinical practice regarding much-needed guidelines for exercise after bariatric surgery. PMID:26228356

  13. Coping strategies in anxious surgical patients

    OpenAIRE

    Aust, Hansjoerg; Rüsch, Dirk; Schuster, Maike; Sturm, Theresa; Brehm, Felix; Nestoriuc, Yvonne

    2016-01-01

    Background Anaesthesia and surgery provoke preoperative anxiety and stress. Patients try to regain control of their emotions by using coping efforts. Coping may be more effective if supported by specific strategies or external utilities. This study is the first to analyse coping strategies in a large population of patients with high preoperative anxiety. Methods We assessed preoperative anxiety and coping preferences in a consecutive sample of 3087 surgical patients using validated scales (Am...

  14. Post-bariatric abdominoplasty resulting in wound infection and dehiscence—Conservative treatment with medical grade honey: A case report and review of literature

    Science.gov (United States)

    Dina Jarjis, Reem; Thomas Crewe, Bjørn; Henrik Matzen, Steen

    2016-01-01

    Introduction Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times. Methods This case report has been reported in line with the CARE criteria. Presentation of case A 40 year-old female suffered wound infection and dehiscence after undergoing post-bariatric abdominoplasty. The patient was not interested in surgical revision and split skin grafting. Therefore, conservative wound treatment with topical Manuka honey was instituted resulting in significant clinical improvement and effective healing concurrently with good patient satisfaction. Discussion Surgical wound complications in post-bariatric patients undergoing abdominoplasty are common and often require surgical revision or conservative wound treatment. No previous publication has addressed outpatient treatment of post-bariatric abdominoplasty wound complications with medical grade honey. Conclusion Although more research is needed for definitive conclusions of honey’s efficacy, it is safe and as presented in our case, it may under certain circumstances reduce the need of surgical wound debridement and serve as a remedy for conservative treatment. PMID:26773204

  15. Macrophage activation marker soluble CD163 and non-alcoholic fatty liver disease in morbidly obese patients undergoing bariatric surgery

    DEFF Research Database (Denmark)

    Kazankov, Konstantin; Tordjman, Joan; Møller, Holger Jon; Vilstrup, Hendrik; Poitou, Christine; Bedossa, Pierre; Bouillot, Jean-Luc; Clement, Karine; Grønbaek, Henning

    2015-01-01

    BACKGROUND AND AIMS: Macrophages play an important role in non-alcoholic fatty liver disease (NAFLD). Soluble CD163 (sCD163) is a specific marker of macrophage activation. We aimed to measure sCD163 in morbidly obese patients with varying degrees of NAFLD before and after bariatric surgery (BS...... decreased after BS and was greatly reduced after 12 months, more rapidly so in patients with NAS ≥ 5 (P < 0.001) and non-alcoholic steatohepatitis (NASH) according to the FLIP algorithm (P = 0.03). Immunohistochemistry showed CD163-positive macrophages aligning fat-laden hepatocytes and forming...... microgranulomas in patients with NASH. CD163 mRNA expression did not vary with NAS. CONCLUSION: sCD163 increased in parallel with the severity of NAFLD in morbid obesity, indicating macrophage activation. BS reduced sCD163 even in patients with severe liver injury and fibrosis, suggesting full reversibility of...

  16. Physiologically-based pharmacokinetic modelling and simulation of oral drug bioavailability: Focus on bariatric surgery patients and mechanism-based inhibition of gut wall metabolism

    OpenAIRE

    Darwich, Adam Saed

    2014-01-01

    AbstractTHE UNIVERSITY OF MANCHESTER,Abstract of thesis submitted by Adam S. Darwich, for the degree of PhD and entitled: "Physiologically-based pharmacokinetic modelling and simulation of oral drug bioavailability: Focus on bariatric surgery patients and mechanism-based inhibition of gut wall metabolism"Month and year of submission: November 2013.Understanding the processes that govern pre-systemic drug absorption and elimination is of high importance in pharmaceutical research and developme...

  17. The application of transcutaneous CO2 pressure monitoring in the anesthesia of obese patients undergoing laparoscopic bariatric surgery.

    Directory of Open Access Journals (Sweden)

    Shijiang Liu

    Full Text Available To investigate the correlation and accuracy of transcutaneous carbon dioxide partial pressure (PTCCO2 with regard to arterial carbon dioxide partial pressure (PaCO2 in severe obese patients undergoing laparoscopic bariatric surgery. Twenty-one patients with BMI>35 kg/m(2 were enrolled in our study. Their PaCO2, end-tidal carbon dioxide partial pressure (PetCO2, as well as PTCCO2 values were measured at before pneumoperitoneum and 30 min, 60 min, 120 min after pneumoperitoneum respectively. Then the differences between each pair of values (PetCO2-PaCO2 and. (PTCCO2-PaCO2 were calculated. Bland-Altman method, correlation and regression analysis, as well as exact probability method and two way contingency table were employed for the data analysis. 21 adults (aged 19-54 yr, mean 29, SD 9 yr; weight 86-160 kg, mean 119.3, SD 22.1 kg; BMI 35.3-51.1 kg/m(2, mean 42.1,SD 5.4 kg/m(2 were finally included in this study. One patient was eliminated due to the use of vaso-excitor material phenylephrine during anesthesia induction. Eighty-four sample sets were obtained. The average PaCO2-PTCCO2 difference was 0.9 ± 1.3 mmHg (mean ± SD. And the average PaCO2-PetCO2 difference was 10.3 ± 2.3 mmHg (mean ± SD. The linear regression equation of PaCO2-PetCO2 is PetCO2 = 11.58+0.57 × PaCO2 (r(2 = 0.64, P<0.01, whereas the one of PaCO2-PTCCO2 is PTCCO2 = 0.60 + 0.97 × PaCO2 (r(2 = 0.89. The LOA (limits of agreement of 95% average PaCO2-PetCO2 difference is 10.3 ± 4.6 mmHg (mean ± 1.96 SD, while the LOA of 95% average PaCO2-PTCCO2 difference is 0.9 ± 2.6 mmHg (mean ± 1.96 SD. In conclusion, transcutaneous carbon dioxide monitoring provides a better estimate of PaCO2 than PetCO2 in severe obese patients undergoing laparoscopic bariatric surgery.

  18. [Patients' Rights Act - Relevance for surgical disciplines].

    Science.gov (United States)

    Haier, J

    2014-01-01

    The new Patients' Rights Act does not reflect rights of patients as professional obligations of physicians for the first time. It adopted common longtime jurisdiction, but in some respects it is going beyond. This law clearly extends the documentation requirements of physicians, especially concerning the extent of documentation. In surgical fields the requirements for enlightening physicians were more strongly worded than in previous jurisdiction. In medical facilities it is now mandatory to establish an internal quality management system. PMID:24390850

  19. [Surgical treatment of bronchiectases in elderly patients].

    Science.gov (United States)

    Danilov, G P; Makeeva, R P; Shornikov, V A; Zil'ber, E K; Akopov, A L

    2010-01-01

    The authors present experiences with surgical treatment of 29 patients (aged 50-64 years) with bronchiectases. Early and late results were analyzed. It was shown that complex approach to the estimation of the findings of radiography, spiral computed tomography, investigation of the external respiration function, fibrobronchoscopy and bronchoscopy, if necessary, allowed operating the patients older than 50 years with local forms of bronchiectases which gave good results. PMID:21137257

  20. Prevalence and Predictors of Self-Reported Sexual Abuse in Severely Obese Patients in a Population-Based Bariatric Program

    OpenAIRE

    Gabert, Danielle L.; Majumdar, Sumit R; Sharma, Arya M; Rueda-Clausen, Christian F; Klarenbach, Scott W.; Birch, Daniel W; Shahzeer Karmali; Linda McCargar; Konrad Fassbender; Padwal, Raj S

    2013-01-01

    Background. Sexual abuse may be associated with poorer weight loss outcomes following bariatric treatment. Identifying predictors of abuse would enable focused screening and may increase weight management success. Methods. We analyzed data from 500 consecutively recruited obese subjects from a population-based, regional bariatric program. The prevalence of self-reported sexual abuse was ascertained using a single interview question. Health status was measured using a visual analogue scale (VA...

  1. Methylation and Expression of Immune and Inflammatory Genes in the Offspring of Bariatric Bypass Surgery Patients

    Directory of Open Access Journals (Sweden)

    Frédéric Guénard

    2013-01-01

    Full Text Available Background. Maternal obesity, excess weight gain and overnutrition during pregnancy increase risks of obesity, type 2 diabetes mellitus, and cardiovascular disease in the offspring. Maternal biliopancreatic diversion is an effective treatment for severe obesity and is beneficial for offspring born after maternal surgery (AMS. These offspring exhibit lower severe obesity prevalence and improved cardiometabolic risk factors including inflammatory marker compared to siblings born before maternal surgery (BMS. Objective. To assess relationships between maternal bariatric surgery and the methylation/expression of genes involved in the immune and inflammatory pathways. Methods. A differential gene methylation analysis was conducted in a sibling cohort of 25 BMS and 25 AMS offspring from 20 mothers. Following differential gene expression analysis (23 BMS and 23 AMS, pathway analysis was conducted. Correlations between gene methylation/expression and circulating inflammatory markers were computed. Results. Five immune and inflammatory pathways with significant overrepresentation of both differential gene methylation and expression were identified. In the IL-8 pathway, gene methylation correlated with both gene expression and plasma C-reactive protein levels. Conclusion. These results suggest that improvements in cardiometabolic risk markers in AMS compared to BMS offspring may be mediated through differential methylation of genes involved in immune and inflammatory pathways.

  2. Ethical issues in the psychosocial assessment of bariatric surgery candidates.

    Science.gov (United States)

    Rouleau, Codie R; Rash, Joshua A; Mothersill, Kerry J

    2016-07-01

    Psychosocial evaluation is recommended prior to bariatric surgery. Practice guidelines have been published on assessment methods for bariatric surgery candidates, but they have not emphasized ethical issues with this population. This review outlines ethical and professional considerations for behavioral healthcare providers who conduct pre-surgical assessments of bariatric surgery candidates by merging ethical principles for mental health professionals with current practices in pre-surgical assessments. Issues discussed include the following: (a) establishing and maintaining competence, (b) obtaining informed consent, (c) respecting confidentiality, (d) avoiding bias and discrimination, (e) avoiding and addressing dual roles, (f) selecting and using psychological tests, and (g) acknowledging limitations of psychosocial assessments. PMID:25411197

  3. Imaging in bariatric surgery: service set-up, post-operative anatomy and complications

    OpenAIRE

    Shah, S.; Shah, V.; Ahmed, A.R; Blunt, D M

    2011-01-01

    Obesity is an increasingly prevalent and costly problem faced by the healthcare system. The role of bariatric surgery in managing obesity has also increased with evidence showing a reduction in long-term morbidity and mortality. There are unique challenges faced by the radiology department in providing an imaging service for this population of patients, from technical and staffing requirements through to the interpretation of challenging post-surgical images. We describe these challenges and ...

  4. Improved patient selection by stratified surgical intervention

    DEFF Research Database (Denmark)

    Wang, Miao; Bünger, Cody E; Li, Haisheng;

    2015-01-01

    anatomical classification of the spinal metastases. This algorithm could help spine surgeons to discriminate the risks of surgeries. The ASMA provides a tool to guild surgeons to evaluate the spinal metastases patients, select potential optimal surgery, and avoid life-threatening risks.......BACKGROUND CONTEXT: Choosing the best surgical treatment for patients with spinal metastases remains a significant challenge for spine surgeons. There is currently no gold standard for surgical treatments. The Aarhus Spinal Metastases Algorithm (ASMA) was established to help surgeons choose the...... included prospectively and analyzed in detail retrospectively. OUTCOME MEASURES: Survival time after surgery was determined for all patients. Neurological function was assessed using the Frankel score preoperatively and postoperatively (at the time of discharge). Complete outcome data were retrieved in 97...

  5. Kidney Stone Risk Following Modern Bariatric Surgery

    OpenAIRE

    Gonzalez, Ricardo D.; Canales, Benjamin K.

    2014-01-01

    Over the past 10 years, a variety of reports have linked bariatric surgery to metabolic changes that alter kidney stone risk. Most of these studies were retrospective, lacked appropriate controls, or involved bariatric patients with a variety of inclusion criteria. Despite these limitations, recent clinical and experimental research has contributed to our understanding of the pathophysiology of stone disease in this high-risk population. This review summarizes the urinary chemistry profiles t...

  6. Iron Deficiency and Bariatric Surgery

    OpenAIRE

    Ignacio Jáuregui-Lobera

    2013-01-01

    It is estimated that the prevalence of anaemia in patients scheduled for bariatric surgery is higher than in the general population and the prevalence of iron deficiencies (with or without anaemia) may be higher as well. After surgery, iron deficiencies and anaemia may occur in a higher percentage of patients, mainly as a consequence of nutrient deficiencies. In addition, perioperative anaemia has been related with increased postoperative morbidity and mortality and poorer quality of life aft...

  7. Esophagogastric pathology in morbid obese patient: preoperative diagnosis and influence in the selection of surgical technique

    Directory of Open Access Journals (Sweden)

    Sergio Estévez-Fernández

    2015-07-01

    Full Text Available Introduction: Given the difficulty in accessing to the excluded stomach after gastric bypass and the increase in gastroesophageal reflux after sleeve gastrectomy, it is justified to perform a preoperative fibrogastroscopy. The influence of the fibrogastroscopy (FGS findings in the therapeutic approach is analyzed. Patients and methods: A retrospective study of preoperative FGS findings is performed, from 04/06 to 12/12. The influence of the FGS results on the surgical technique selection, in the endoscopic or medical treatment and its relation to gastric fistula is analyzed by means of multivariate regression (confounding factors: Age, body mass index, arterial hypertension, diabetes mellitus, antiplatelet therapy, surgical technique (bariatric surgery, sleeve gastrectomy. Results: Three hundred thirty one patients are included: 32.6% biopsy of gastric lesion; 27% gastritis; 18.1% hiatal hernia; 3% metaplasia; 0.6% Barrett esophagus; 2.1% esophagitis; 0.3% dysplasia; 0.3 Schatzky's ring; 1.5% incompetent cardia; 2.4% duodenitis; 0.3% gastric erosions; 0.6% gastric xanthoma; 1.8%, gastric polyp; 1.6% duodenal ulcer; 0.6% papulo-erosive gastritis; 0.6% esophageal papilloma; 0.3% submucosal tumor. Helicobacter pylori+ 30.2% (triple therapy eradication in all patients. The FGS findings led to a variation in the surgical technique or to the completion of endoscopic treatment in 22.2% of cases. The gastric lesions did not influence the development of gastric fistula. Independent prognostic factors of fistula: Sleeve gastrectomy (7.9% vs. 2.7%; p = 0.02; OR: 1.38 IC95: 1.01-1.87 and the body mass index > 50 kg/m² (6.7% vs. 2.2%; p = 0.04; OR: 3.7 IC95: 1.12-12.4. Conclusions: The diagnosis of gastroesophageal disease through preoperative FGS motivated variations in the therapeutic approach in 52% of patients, so we consider essential to include the preoperative FGS in bariatric surgery.

  8. Mandatory weight loss during the wait for bariatric surgery.

    Science.gov (United States)

    Glenn, Nicole M; Raine, Kim D; Spence, John C

    2015-01-01

    Mandatory presurgical, behavior-induced weight loss, although not standard, is a relatively common practice among bariatric surgical clinics. We explore the patient's experience of this practice using phenomenology. We gathered experiential accounts from 7 individuals waiting to have the procedure at a large publically funded clinic in western Canada. In writing this article, we focused on four phenomenological themes: "just nod your head and carry on"-silencing through the ideal; waiting and weighing-promoting weight consciousness to the weight conscious; paying for surgical approval through weight loss; and presurgical weight loss and questioning the need for weight loss surgery altogether. We contrast the experiential findings with the clinical literature to question the impact and possible (unintended or unexpected) effects the practice might have, particularly on patients' lives. We situate this article within a larger discussion about the possible contribution of experiential knowledge to clinical guidelines, practices, and pedagogies. PMID:25185162

  9. Measures of surgical quality: what will patients know by 2005?

    OpenAIRE

    Michael S. Broder; Payne-Simon, L; Brook, R H

    2005-01-01

    Rationale, aims and objectives Many objective measures rating quality of doctors, hospitals, and medical groups are publicly reported. Surgical patients may have more opportunity to use quality measures than other types of patients to guide their choice of provider. If surgical patients are able to choose higher quality providers, overall surgical quality might increase. Objective To determine what procedure-specific measures of surgical quality are available to consumers facing surgery in Ca...

  10. Bariatric surgery: assessing opportunities for value innovation.

    Science.gov (United States)

    Tarantino, David P; Smith, Darlene B

    2005-03-01

    Obesity has been increasing over the past two decades, and the amount of medical and media attention given to bariatric surgery as a promising option for morbidly obese individuals is growing. The growth of bariatric surgery also has been attributed to improved surgical technique, the increase in surgeons trained in laparoscopic procedures, as well increased public awareness with celebrities having successfully undergone surgery. The number of surgeons and hospitals offering bariatric services is increasing. How then does a surgeon or a hospital develop a competitive strategy? The first step is to understand the health-care industry. The key forces are rivalry among present competitors, and the bargaining power of suppliers and buyers. While bariatric surgery currently is in a growth phase, time and competition will force practitioners to compete on the basis of price, unless they find true competitive advantage. Value innovation, is a means of creating new marketing space by looking across the conventionally defined boundaries of business--across substitute industries, across strategic groups, across buyer groups, across complementary product and service offerings, and across the functional-emotional orientation of an industry. One can compete by offering similar services focusing primarily on cost efficiencies as the key to profitability. Alternatively, one can break free from the pack by innovating and focusing on delivering superior value to the customer. As the market for bariatric surgery becomes increasingly overcrowded, profitable growth is not sustainable without developing a clear differential advantage in the market. Value innovation allows you to develop that advantage. PMID:15846452

  11. [Bariatric surgery in Denmark.

    DEFF Research Database (Denmark)

    Funch-Jensen, P.; Iversen, M.G.; Kehlet, H.

    2008-01-01

    private centres that have entered into an agreement with Danish Regions. Since the operative access and selection of procedures varies between departments we conclude that research should be a firm requirement for all centres, and that research efforts should comprise cooperation concerning the database...... data from the National Patient Registry in the period from 2005 through 2007: annual number of operations, type of operation, laparoscopic versus open procedure. Furthermore, the centres were compared. RESULTS: A total of 2,098 bariatric procedures were performed in the years 2005 to 2007. Apart from a...... departments fulfilled the recommendation from the NBH of a minimum of 100 annual operations. The proportion of banding procedures performed at private clinics was significantly lower than the proportion performed at public hospitals. Significantly more open operations were performed at private clinics, a...

  12. Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging

    Energy Technology Data Exchange (ETDEWEB)

    Guzman-Aroca, F.; Reus, M.; Dios Berna-Serna, Juan de [Virgen de la Arrixaca University Hospital, Department of of Radiology, El Palmar, Murcia (Spain); Frutos-Bernal, M.D.; Lujan-Mompean, J.A.; Parrilla, P. [Virgen de la Arrixaca University Hospital, Department of Surgery, El Palmar, Murcia (Spain); Bas, A. [Virgen de la Arrixaca University Hospital, Department of Pathology, El Palmar, Murcia (Spain)

    2012-11-15

    To investigate the utility of acoustic radiation force impulse (ARFI) imaging, with the determination of shear wave velocity (SWV), to differentiate non-alcoholic fatty liver disease (NAFLD) from non-alcoholic steatohepatitis (NASH) in patients with morbid obesity before bariatric surgery. Thirty-two patients with morbid obesity were evaluated with ARFI and conventional ultrasound before bariatric surgery. The ARFI and ultrasound results were compared with liver biopsy findings, which is the reference standard. The patients were classed according to their histological findings into three groups: group A, simple steatosis; group B, inflammation; and group C, fibrosis. The median SWV was 1.57 {+-} 0.79 m/s. Hepatic alterations were observed in the histopathological findings for all the patients in the study (100 %), with the results of the laboratory tests proving normal. Differences in SWV were also observed between groups A, B and C: 1.34 {+-} 0.90 m/s, 1.55 {+-} 0.79 m/s and 1.86 {+-} 0.75 m/s (P < 0.001), respectively. The Az for differentiating NAFLD from NASH or fibrosis was 0.899 (optimal cut-off value 1.3 m/s; sensitivity 85 %; specificity 83.3 %). The ARFI technique is a useful diagnostic tool for differentiating NAFLD from NASH in asymptomatic patients with morbid obesity. (orig.)

  13. Detection of non-alcoholic steatohepatitis in patients with morbid obesity before bariatric surgery: preliminary evaluation with acoustic radiation force impulse imaging

    International Nuclear Information System (INIS)

    To investigate the utility of acoustic radiation force impulse (ARFI) imaging, with the determination of shear wave velocity (SWV), to differentiate non-alcoholic fatty liver disease (NAFLD) from non-alcoholic steatohepatitis (NASH) in patients with morbid obesity before bariatric surgery. Thirty-two patients with morbid obesity were evaluated with ARFI and conventional ultrasound before bariatric surgery. The ARFI and ultrasound results were compared with liver biopsy findings, which is the reference standard. The patients were classed according to their histological findings into three groups: group A, simple steatosis; group B, inflammation; and group C, fibrosis. The median SWV was 1.57 ± 0.79 m/s. Hepatic alterations were observed in the histopathological findings for all the patients in the study (100 %), with the results of the laboratory tests proving normal. Differences in SWV were also observed between groups A, B and C: 1.34 ± 0.90 m/s, 1.55 ± 0.79 m/s and 1.86 ± 0.75 m/s (P < 0.001), respectively. The Az for differentiating NAFLD from NASH or fibrosis was 0.899 (optimal cut-off value 1.3 m/s; sensitivity 85 %; specificity 83.3 %). The ARFI technique is a useful diagnostic tool for differentiating NAFLD from NASH in asymptomatic patients with morbid obesity. (orig.)

  14. Liposuction-assisted medial thigh lift in non bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    Abdelmohsen K. Aboueldahab

    2014-03-01

    Results: All patients recovered well in two weeks and showed improvement of thigh contour. Scar downward displacement occurred in one patient. No skin necrosis or seroma was encountered. One patient developed superficial thrombophlebitis and required hospital stay for 5 days and anticoagulant treatment. No labial distortion or separation was encountered.

  15. Effects of bariatric surgery on the body composition of adults

    Directory of Open Access Journals (Sweden)

    Tiago Wally Hartwig

    2013-09-01

    Full Text Available The most alarming cases are known as morbidly obese. An effective method to change the anthropometric characteristics of this population with excess body weight and high fat mass is bariatric surgery. The objective of this study was to analyze the body composition of morbidly obese patients undergoing bariatric surgery in the city of Pelotas, Southern Brazil. In a prospective cohort study, a group of morbidly obese patients was followed up 30 days before and 30 days after surgery. The sample consisted of 123 patients who underwent vertical banded Roux-en-Y gastroplasty between April 2003 and May 2010. Body composition (fat percentage was determined by bioelectrical impedance analysis. The mean age of the patients was 36.1 ± 8.8 years and mean body weight loss was 14.1 ± 6.0 kg (p<0.001. The mean reduction in body mass index (BMI was 5.2 ± 2.1 kg/m2 (p<0.001. Body fat percentage and fat mass were reduced by 2.8% (p<0.001 and 9.7 ± 4.9 kg (p<0.001, respectively. In addition, there was a reduction of 4.4 ± 3.4 kg (p<0.001 in lean mass. We concluded that the surgical procedure significantly reduced body weight, BMI, fat percentage and fat mass and is an alternative when conventional treatments appear ineffective.

  16. Surgical stapling device–tissue interactions: what surgeons need to know to improve patient outcomes

    Directory of Open Access Journals (Sweden)

    Chekan E

    2014-09-01

    Full Text Available Edward Chekan,1 Richard L Whelan2 1Ethicon Inc., Cincinnati, OH, USA; 2St Luke’s Roosevelt Hospital, New York, NY, USA Abstract: The introduction of both new surgical devices and reengineered existing devices leads to modifications in the way traditional tasks are carried out and allows for the development of new surgical techniques. Each new device has benefits and limitations in regards to tissue interactions that, if known, allow for optimal use. However, most surgeons are unaware of these attributes and, therefore, new device introduction creates a “knowledge gap” that is potentially dangerous. The goal of this review is to present a framework for the study of device–tissue interactions and to initiate the process of “filling in” the knowledge gap via the available literature. Surgical staplers, which are continually being developed, are the focus of this piece. The integrity of the staple line, which depends on adequate tissue compression, is the primary factor in creating a stable anastomosis. This review focuses on published studies that evaluated the creation of stable anastomoses in bariatric, thoracic, and colorectal procedures. Understanding how staplers interact with target tissues is key to improving patient outcomes. It is clear from this review that each tissue type presents unique challenges. The thickness of each tissue varies as do the intrinsic biomechanical properties that determine the ideal compressive force and prefiring compression time for each tissue type. The correct staple height will vary depending on these tissue-specific properties and the tissue pathology. These studies reinforce the universal theme that compression, staple height, tissue thickness, tissue compressibility, and tissue type must all be considered by the surgeon prior to choosing a stapler and cartridge. The surgeon's experience, therefore, is a critical factor. Educational programs need to be established to inform and update surgeons on

  17. Single-incision laparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Huang Chih-Kun

    2011-01-01

    Full Text Available Background: Bariatric surgery has been established as the best option of treatment for morbid obesity. In recent years single-incision laparoscopic surgery (SILS has emerged as another modality of carrying out the bariatric procedures. While SILS represents an advance, its application in morbid obesity at present is limited. In this article, we review the technique and results of SILS in bariatric surgery. Methods: The PubMed database was searched and totally 11 series reporting SILS in bariatric surgery were identified and analyzed. The case reports were excluded. Since 2008, 114 morbidly obese patients receiving SILS bariatric surgeries were reported. Results: The procedures performed included SILS gastric banding, sleeve gastrectomy and gastric bypass. No mortality was reported in the literatures. Sixteen patients (14.05% needed an additional incision for a liver retractor, a trocar or for conversion. Only one complication of wound infection was reported in these series. All the surgeons reported that the patients were highly satisfied with the scar. Conclusion: Because of abundant visceral and subcutaneous fat and multiple comorbidities in morbid obesity, it is more challenging for surgeons to perform the procedures with SILS. It is clear that extensive development of new instruments and technical aspects of these procedures as well as randomized studies to compare them with traditional laparoscopy are essential before these procedures can be utilized in day-to-day clinical practice.

  18. [Surgical approach to posthepatitic cirrhotic patient today].

    Science.gov (United States)

    Meriggi, F; Forni, E

    1996-01-01

    A posthepatitic cirrhotic patient may undergo elective or urgent abdominal operation for an extra-hepatic or hepatic disease. According to the high postoperative morbidity (61%), surgery is indicated only for symptomatic or complicated cholelithiasis. A surgical procedure for refractory ascites has been devised to create a permanent peritoneo-venous shunt by a one way pressure-sensitive valve (Leveen). The procedure is simple and brings a long lasting relief with recovery in strength and nutrition and improved kidney function. Sclerotherapy is widely used to treat acute variceal bleeding while repeated sclerotherapy is used in the long-term management to eradicate varices. When indicated, liver transplantation is the best treatment to prevent variceal bleeding recurrence. Also portosystemic shunts effectively prevent recurrent variceal bleeding. They are, however, major operations with an important morbidity and mortality, particularly in poor risk patients. The most advocated shunts today are the Warren distal splenorenal shunt and the Sarfeh portacaval shunt using a small diameter prosthetic H-graft. The transjugular intrahepatic portosystemic stent-shunt (TIPSS) is a new treatment for portal hypertension and its complications. From a haemodynamic point of view it allows balanced hepatic perfusion. Postoperative mortality is rare; further bleeding and encephalopathy are reasonably acceptable. The most relevant complications concern dislocation of the prosthesis, stenosis and thrombosis of the shunt, which can be corrected by non-invasive dilatation. Encephalopathy is the main complication of surgical portosystemic shunts. It is usually controlled by protein diet restriction, and administration of lactulose or oral antibiotics. In severe forms the patients may be treated by an oesophageal transection with oesophagogastric devascularization, and by a postoperative suppression of the portosystemic shunt using external maneuvers. Posthepatitic liver cirrhosis is

  19. Características psicológicas de pacientes submetidos a cirurgia bariátrica Psychological characteristics of patients submitted to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ronis Magdaleno Jr.

    2009-01-01

    terapêutico específico.INTRODUCTION: The great number of patients submitted bariatric surgery who have psychological and psychiatric complications during the postoperative period require a thorough preoperative investigation and a categorization with the purpose of predicting possible complications and personalizing psychological care that might favor patient compliance. Psychodynamic assessment may provide data for such categorization and, thus, suggest effective pre- and postoperative approach strategies. Therefore, the objective of this study was to identify personality structures that may be useful in the postoperative follow-up, as well as additional inclusion and exclusion criteria for the surgical procedure. METHOD: Report of empirical survey conducted during psychotherapy sessions with an open group of patients who underwent bariatric surgery. DISCUSSION: After surgery, patients may experience phases of emotional restructuring, such as an initial phase of feeling triumphant, followed by a phase when there is risk of melancholic behavior and new addictions. We identified three categories of psychological structures: melancholic structure (patients seem to be more likely to develop other postoperative addictive behaviors, mainly eating disorders, since they cannot tolerate the frustration of the loss; dementalized structure (due to the lack of elaborative capacity, patients are unable to reorganize themselves in face of the challenge of keeping their weight under control; and perverse structure (patients comply with the scheduled weight loss; however, their behavior makes the health team experience uncomfortable situations. Establishing psychological categories may be crucial in order to suggest postoperative management strategies, including referral to a psychotherapist with the purpose of providing personalized care, thus increasing specific therapeutic success.

  20. Bariatric surgery in an obese patient with Albright hereditary osteodystrophy: a case report

    OpenAIRE

    Ferrario, Chiara; Gastaldi, Giacomo; Portmann, Luc; Giusti, Vittorio

    2013-01-01

    Introduction We report for the first time the case of a patient with Albright hereditary osteodystrophy and pseudopseudohypoparathyroidism who underwent a Roux-en-Y gastric bypass. Case presentation A 26-year-old obese Caucasian woman with Albright hereditary osteodystrophy with pseudopseudohypoparathyroidism (heterozygous mutation (L272F) in GNAS1 exon 10 on molecular analysis) was treated with gastric bypass. She had the classical features of Albright hereditary osteodystrophy: short statur...

  1. Defining the role of bariatric surgery in polycystic ovarian syndrome patients

    OpenAIRE

    Malik, Shaveta M; Traub, Michael L

    2012-01-01

    Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women. To meet PCOS criteria, women must have a combination of hyperandrogenism, anovulation and ultrasound findings. Almost 10% of all reproductive age women worldwide show signs of PCOS. Although women often seek care for gynecological or body image concerns, many PCOS women are at risk for metabolic syndrome (MS). Many of the metabolic consequences are overlooked and undertreated by physicians because these patient...

  2. Quality of life of diabetic patients with medical or surgical treatment

    Directory of Open Access Journals (Sweden)

    S. Weiner

    2013-01-01

    Full Text Available Introduction: In general, most of the studies agree in that the quality of life (QoL of patients with diabetes is worse than that of the general population. Furthermore, these same studies have also described very positive effects on quality of life after bariatric surgery. The aim of this study was to analyze whether the impact on quality of life of diabetic patients after being submitted to bariatric surgery is the one supposed to be. Methods: We prospectively analyzed our data on 524 diabetic patients submitted to bariatric surgery between 2001 and 2005. All the patients filled up three QoL questionnaires before the surgery and at 1, 3, 6, and 12 months after the surgery. The answers were gathered from an annual database. All patients were submitted to adjustable gastric band surgery, Y-Roux gastric bypass, or BPD-Scopinaro. Results: We obtained complete data on 89 patients that were included into the study. One year after the surgery, the QoL had significantly improved independent of disease remission and weight loss. Diabetes got improved in all the cases. The improvement on the quality of life was higher in the patients with total remission of the disease than in those only improving their health status, although it was lower than that of those patients without diabetes before the surgery. Conclusions: After a literature review and with our own prospective data, we may conclude that the benefits obtained by diabetic patients from bariatric surgery are mainly due to improvement of their diabetes, irrespective of their initial BMI and the BMI decrease after the intervention. Further studies are needed to investigate the results of the QoL test in diabetics with low BMI after bariatric surgery and in the long run.

  3. Surgical treatment of patients with bilateral cataracts

    Directory of Open Access Journals (Sweden)

    I.E. Ioshin

    2013-02-01

    Full Text Available ABSTRACT The Determination of the tactics for surgical cataract treatment in the fellow eye in patients with bilateral cataracts did not received any unambiguous solution till now and the periods of operation performance are interpreted differently. The authors analyzed the results of treatment in 486 patients with bilateral cataracts. The authors identified a possible favorable interval between first and second operations in case of bilateral cataract, which was based on the clinical, functional and immunological parameters. Phacoemulsifications with peri-operative antibiotic prophylaxis were carried out not later than 4 days after the operation on the first eye, if there were no complications intra-operatively and in post-operative period in the first eye. Recommended time of surgery in the fellow eye in 114 patients of the main group allowed to reveal high functional results (0.7-1.0 in 90.4% in the first eye and in 85.1% of cases in the fellow eye, that promoted the restoration of binocular functions in 98 % of cases after surgery in the shortest possible time. In all patients of the main group the clear vision at different distances were achieved after surgery with bilateral implantation of multifocal IOLs in both eyes in the maximum shortest time. Selected dates of cataract surgery in both eyes taking into account the general and associated ocular pathology allows to reduce the emotional cost, time and organizational problems in preparation for the operation, adding the benefits of quality of early rehabilitation after surgery in both eyes.

  4. Cooling in Surgical Patients: Two Case Reports

    Directory of Open Access Journals (Sweden)

    Bibi F. Gurreebun

    2014-01-01

    Full Text Available Moderate induced hypothermia has become standard of care for children with peripartum hypoxic ischaemic encephalopathy. However, children with congenital abnormalities and conditions requiring surgical intervention have been excluded from randomised controlled trials investigating this, in view of concerns regarding the potential side effects of cooling that can affect surgery. We report two cases of children, born with congenital conditions requiring surgery, who were successfully cooled and stabilised medically before undergoing surgery. Our first patient was diagnosed after birth with duodenal atresia after prolonged resuscitation, while the second had an antenatal diagnosis of left-sided congenital diaphragmatic hernia and suffered an episode of hypoxia at birth. They both met the criteria for cooling and after weighing the pros and cons, this was initiated. Both patients were medically stabilised and successfully underwent therapeutic hypothermia. Potential complications were investigated for and treated as required before they both underwent surgery successfully. We review the potential side effects of cooling, especially regarding coagulation defects. We conclude that newborns with conditions requiring surgery need not be excluded from therapeutic hypothermia if they might benefit from it.

  5. Acompanhamento psicológico tardio em pacientes submetidos à cirurgia bariátrica Late psychological follow-up on patients submitted to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Simone Dallegrave Marchesini

    2010-06-01

    a prevenção às recaídas possa ser foco terapêutico.BACKGROUND: The human being is not alone; he is always compared to their peers and the environment. Every change corresponds to a social reaction and a response issued in the form of behavior. AIM: To evaluate some of the postoperative psychological conditions and life style in a short and in a long term follow-up. METHOD: A 26 item evaluation questionnaire was sent to post bariatric patients concerning to motivation and compliance to the treatment, behavioral changes, humor alterations, reaching of expectancies among others. RESULTS: The majority of this group of patients felt prepared for surgery during the first office interview, but didn't know the method of treatment that they were about to be submitted to. The majority also had not been treated for their psychological and/or psychiatric conditions and didn't change their life style after the operation. Compliance to nutrition orientation was partial and there were evident emotional manifestations. The weight regain complaint was small compared with the satisfaction of the weight loss. Most of these patients would be submitted again to the operation, and half of them stated the need for support groups. Patients wanted the operation, but didn't realize the need of better preparation and didn't change the behavioral patterns necessary to reach the success in a long term follow-up. They usually abandon the postoperative treatment. CONCLUSION: It can be inferred that the motivations that lead individuals to seek bariatric surgery are predicated on social returns, in the aesthetic standards and the psychological desire for life change. Once implemented the change of life, motivation is over, but does not guarantee the existential satisfaction. It is also possible to infer that the preparation for the care of spouses and family claims a space in training professionals in the area of surgical treatment of obesity, for the prevention of relapses can be therapeutic

  6. Factors Influencing the Surgical Success in Patients with Infantile Esotropia

    OpenAIRE

    Fatma Gül Yılmaz Çınar; Deniz Somer; Ayşe Burcu; Züleyha Yalnız Akkaya; Firdevs Örnek

    2013-01-01

    Purpose: To determine the factors that influence the surgical success in patients with infantile esotropia and to evaluate the relationship between amount of bilateral medial rectus recession and convergence. Material and Method: We retrospectively investigated the records of 188 patients with infantile esotropia who were operated on. The surgical success rate, the factors that influence the surgical success, and the relationship between amount of bilateral medial rectus recession ...

  7. Beyond consent--improving understanding in surgical patients.

    LENUS (Irish Health Repository)

    Mulsow, Jürgen J W

    2012-01-01

    Little is known of the actual understanding that underlies patient choices with regard to their surgical treatment. This review explores current knowledge of patient understanding and techniques that may be used to improve this understanding.

  8. Carbon dioxide monitoring during laparoscopic-assisted bariatric surgery in severely obese patients: transcutaneous versus end-tidal techniques.

    Science.gov (United States)

    Dion, Joanna M; McKee, Chris; Tobias, Joseph D; Herz, Daniel; Sohner, Paul; Teich, Steven; Michalsky, Marc

    2015-02-01

    Various factors including severe obesity or increases in intra-abdominal pressure during laparoscopy can lead to inaccuracies in end-tidal carbon dioxide (PETCO2) monitoring. The current study prospectively compares ET and transcutaneous (TC) CO2 monitoring in severely obese adolescents and young adults during laparoscopic-assisted bariatric surgery. Carbon dioxide was measured with both ET and TC devices during insufflation and laparoscopic bariatric surgery. The differences between each measure (PETCO2 and TC-CO2) and the PaCO2 were compared using a non-paired t test, Fisher's exact test, and a Bland-Altman analysis. The study cohort included 25 adolescents with a mean body mass index of 50.2 kg/m2 undergoing laparoscopic bariatric surgery. There was no difference in the absolute difference between the TC-CO2 and PaCO2 (3.2±3.0 mmHg) and the absolute difference between the PETCO2 and PaCO2 (3.7±2.5 mmHg). The bias and precision were 0.3 and 4.3 mmHg for TC monitoring versus PaCO2 and 3.2 and 3.2 mmHg for ET monitoring versus PaCO2. In the young severely obese population both TC and PETCO2 monitoring can be used to effectively estimate PaCO2. The correlation of PaCO2 to TC-CO2 is good, and similar to the correlation of PaCO2 to PETCO2. In this population, both of these non-invasive measures of PaCO2 can be used to monitor ventilation and minimize arterial blood gas sampling. PMID:24916514

  9. ANTIBIOTIC PROPHYLAXIS IN BARIATRIC SURGERY: a continuous infusion of cefazolin versus ampicillin/sulbactam and ertapenem

    Directory of Open Access Journals (Sweden)

    Álvaro Antônio Bandeira FERRAZ

    2015-06-01

    Full Text Available Background The incidence of surgical site infection in bariatric patients is significant and the current recommendations for antibiotic prophylaxis are sometimes inadequate. Objective The aim of this study was to analyze the effect of three prophylactic antibiotic regimens on the incidence of surgical site infection. Methods A prospective, cross-sectional study was conducted between January 2009 and January 2013 in which 896 Roux-en-Y gastric bypasses were performed to treat obesity. The study compared three groups of patients according to the perioperative antibiotic prophylaxis administered intravenously and beginning at anesthesia induction: Group I consisting of 194 patients treated with two 3-g doses of ampicillin/sulbactam; Group II with 303 patients treated with a single 1-g dose of ertapenem; and Group III with 399 patients treated with a 2-g dose of cefazolin at anesthesia induction followed by a continuous infusion of cefazolin 1g throughout the surgical procedure. The rate of surgical site infection was analyzed, as well as its association with age, sex, preoperative weight, body mass index and comorbidities. Results The rates of surgical site infection were 4.16% in the group treated prophylactically with ampicillin/sulbactam, 1.98% in the ertapenem group and 1.55% in the continuous cefazolin group. Conclusion The prophylactic use of continuous cefazolin in surgeries for morbid obesity shows very promising results. These findings suggest that some prophylactic regimens need to be reconsidered and even substituted by more effective therapies for the prevention of surgical site infections in bariatric patients.

  10. Bariatric Surgery in University Clinic Center Tuzla - Results After 30 Operations

    Science.gov (United States)

    Ahmetasevic, Emir; Pasic, Fuad; Beslin, Miroslav Bekavac; Ilic, Miroslav; Ahmetasevic, Dzenita; Mesic, Mirza

    2016-01-01

    Introduction: Project of Bariatric surgery in University clinic center (UCC) Tuzla has been initiated in 2009 as an idea of professor Dešo Mešić and soon after that Bariatric surgical team led by doctor Fuad Pasic has been created. Material and methods: Practical team education was realized in Croatia in hospital „Sisters of Mercy” under supervision of professor Miroslav-Bekavac Beslin. First bariatric operations in UCC Tuzla has been done in 2011 and it was biliopancreatic diversion (BPD) Scopinaro. Results and discussion: So far there has been done 30 operations and among them there have been used almost all operative modalities - restrictive, malabsorptive and combined (laparoscopic gastric banding-LAPGB, Roux-y mini gastric bypass, open and laparoscopic gastric sleeve resection, and over mentioned Scopinaro’s BPD). Beginning results are very promising according to the fact that almost all operated patients after one year stopped using antihypertensive, antidiabetic and antidepressant therapy, that average year’s weight loss is 35-100 kilograms and total satisfactions of patients after surgeries is obvious. PMID:27147808

  11. General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery

    Directory of Open Access Journals (Sweden)

    Adriano Fernandes

    2014-12-01

    Full Text Available OBJECTIVES: Video laparoscopic bariatric surgery is the preferred surgical technique for treating morbid obesity. However, pneumoperitoneum can pose risks to the kidneys by causing a decrease in renal blood flow. Furthermore, as in other surgical procedures, laparoscopic bariatric surgery triggers an acute inflammatory response. Neutrophil gelatinase-associated lipocalin is an early and accurate biomarker of renal injury, as well as of the inflammatory response. Anesthetic drugs could offer some protection for the kidneys and could attenuate the acute inflammatory response from surgical trauma. The objective of this study was to compare the effects of two types of anesthetics, propofol and sevoflurane, on the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in laparoscopic bariatric surgery. METHODS: Sixty-four patients scheduled for laparoscopic bariatric surgery were randomized into two anesthesia groups and were administered either total intravenous anesthesia (propofol or inhalation anesthesia (sevoflurane. In the perioperative period, blood samples were collected at three time points (before anesthesia, 6 hours after pneumoperitoneum and 24 hours after pneumoperitoneum and urine output was measured for 24 hours. Acute kidney injuries were evaluated by examining both the clinical and laboratory parameters during the postoperative period. The differences between the groups were compared using non-parametric tests. ReBEC (http://www.ensaiosclinicos.gov.br/rg/recruiting/: RBR-8wt2fy RESULTS: None of the patients developed an acute kidney injury during the study and no significant differences were found between the serum neutrophil gelatinase-associated lipocalin levels of the groups during the perioperative period. CONCLUSION: The choice of anesthetic drug, either propofol or sevoflurane, did not affect the serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in

  12. [Assessment of bariatric surgery results].

    Science.gov (United States)

    Barros, Lívia Moreira; Frota, Natasha Marques; Moreira, Rosa Aparecida Nogueira; de Araújo, Thiago Moura; Caetano, Joselany Áfio

    2015-03-01

    The objective was to evaluate the results of bariatric surgery in patients in the late postoperative period using the Bariatric Analysis and Reporting Outcome System (BAROS). This cross-sectional study was conducted from November 2011 to June 2012 at a hospital in the state of Ceará, Brazil. Data were collected from 92 patients using the BAROS protocol, which analyzes weight loss, improved comorbidities, complications, reoperations and Quality of Life (QoL). Data were analysed using the chi-squared test, Fischer's exact test and the Mann-Whitney test. There was a reduction in the Body Mass Index (47.2±6.8 kg/m2 in the pre-operatory and 31.3±5.0 kg/m2 after surgery, p<0.001). The comorbidity with the highest resolution was arterial hypertension (p<0.001), and QV improved in 94.6% of patients. The main complications were hair loss, incisional hernia and cholelithiasis. The surgery provided satisfactory weight loss and improvements in the comorbidities associated to a better QL. Use of the BAROS protocol allows nurses to plan interventions and maintain the good results. PMID:26098798

  13. Sarcina, a new threat in the bariatric era.

    Science.gov (United States)

    Sopha, Sabrina C; Manejwala, Alif; Boutros, Cherif N

    2015-09-01

    First identified in humans by Goodsir in 1842, Sarcina were already known to cause fatal abomasal bloat in animals. Their pathogenicity in humans has only recently been characterized. Sarcina is not inherently pathogenic but, with a gastric ulcer and delayed gastric emptying, can result in perforation. We present a case report of a 32-year-old woman status post-gastric banding presenting with epigastric pain. Upper endoscopy revealed a gastric ulcer near the band. After deflation, upper gastrointestinal series showed passage of contrast and no perforation. Ulcer biopsy showed gastric contents composed of Sarcina. Proton pump inhibitors and antibiotics were administered. Follow-up endoscopy at an outside institution resulted in perforation. This case report supports a growing body of literature that Sarcina organisms contribute to ulcers and perforation. This is the first report of Sarcina in elective bariatric surgery patients, highlighting the high suspicion needed among pathologists evaluating ulcers in this unique surgical population. PMID:26198746

  14. Factors Influencing the Surgical Success in Patients with Infantile Esotropia

    Directory of Open Access Journals (Sweden)

    Fatma Gül Yılmaz Çınar

    2013-12-01

    Full Text Available Purpose: To determine the factors that influence the surgical success in patients with infantile esotropia and to evaluate the relationship between amount of bilateral medial rectus recession and convergence. Material and Method: We retrospectively investigated the records of 188 patients with infantile esotropia who were operated on. The surgical success rate, the factors that influence the surgical success, and the relationship between amount of bilateral medial rectus recession and convergence deficiency were evaluated. Successful outcome was defined as deviation amount lower than 10 prism diopters postoperatively. Results: The mean age of the 188 patients included in the study at presentation was 54.9±56.8 (5-276 months, and the mean surgical age was 60.7±54.8 (7-276 months. Success was provided in 70.7% of patients after the first surgery and in 86.7% of patients after repeated surgeries. It was seen that gender, surgical age, refractive error, surgical procedure and the presence of fusion before surgery did not affect surgical success. Residual esotropia was found more frequently in patients with large-angle preoperative deviation, whilst both residual esotropia and consecutive exotropia were found more frequently in patients with amblyopia. It was observed that augmented bilateral medial rectus recession did not cause an increase in postoperative convergence deficiency. Discussion: Since the presence of amblyopia affects the surgical success negatively, it must be identified and treated preoperative. Residual esotropia is more frequently seen in patients with large-angle deviation preoperative, and more than one surgery may be required to provide orthophoria. In these cases, augmented bilateral medial rectus recession is a safe and effective method that rescues the patient from repeated surgeries and may be preferred to three-or four-muscle surgeries. (Turk J Ophthalmol 2013; 43: 413-8

  15. Post-bariatric abdominoplasty resulting in wound infection and dehiscence—Conservative treatment with medical grade honey: A case report and review of literature

    OpenAIRE

    Reem Dina Jarjis; Bjørn Thomas Crewe; Steen Henrik Matzen

    2016-01-01

    Introduction: Wound complications in post-bariatric patients undergoing body-contouring surgery after massive weight loss are not uncommon and often, surgical debridement or conservative management is necessary. Honey is one of the most ancient remedies for wound care and it is also considered to possess debriding effects. Current research has demonstrated promising results showing that honey can improve wound granulation and epithelialization, reduce exudate and shorten healing times. Met...

  16. Providing care for critically ill surgical patients: challenges and recommendations.

    Science.gov (United States)

    Tisherman, Samuel A; Kaplan, Lewis; Gracias, Vicente H; Beilman, Gregory J; Toevs, Christine; Byrnes, Matthew C; Coopersmith, Craig M

    2013-07-01

    Providing optimal care for critically ill and injured surgical patients will become more challenging with staff shortages for surgeons and intensivists. This white paper addresses the historical issues behind the present situation, the need for all intensivists to engage in dedicated critical care per the intensivist model, and the recognition that intensivists from all specialties can provide optimal care for the critically ill surgical patient, particularly with continuing involvement by the surgeon of record. The new acute care surgery training paradigm (including trauma, surgical critical care, and emergency general surgery) has been developed to increase interest in trauma and surgical critical care, but the number of interested trainees remains too few. Recommendations are made for broadening the multidisciplinary training and practice opportunities in surgical critical care for intensivists from all base specialties and for maintaining the intensivist model within acute care surgery practice. Support from academic and administrative leadership, as well as national organizations, will be needed. PMID:23754675

  17. Self-determination and motivation for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Park, Juyeon

    2016-10-01

    This study examined how obese individuals acquire their motivation to undergo weight loss surgery and characterized the motivations within the framework of the self-determination theory (SDT). Participants expecting to have bariatric surgery were recruited and participated in semi-structured interviews. Interview accounts characterized different types of motivation for individuals seeking surgical weight loss treatments on the SDT continuum of relative autonomy. This study demonstrated that the more one's motivation was internally regulated, related to one's personal life and supported for competency, the more personal and hopeful were the anecdotes participants mentioned in accounts, thus the more positive the surgical outcomes were anticipated. Study limitations and future research were discussed as was the need for a systematic scheme to categorize types of motivation within the SDT, a longitudinal approach to measure actual weight loss outcomes based on the patient's pre-surgical motivation, and a further investigation with a larger sample size and balanced gender ratio. Practical implications of the study findings were also discussed as a novel strategy to internalize bariatric patients' motivation, further helping to improve their long-term quality of life post-surgery. PMID:26708344

  18. Postoperative Acute Respiratory Failure In Patients Treated Surgically For Goiters

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    Buła Grzegorz

    2015-07-01

    Full Text Available The aim of the study was to present a clinical picture, treatment and prognosis regarding patients who developed acute respiratory failure (ARF while treated surgically for a goiter.

  19. Surgical dislocation of the hip in patients with femoroacetabular impingement: Surgical techniques and our experience

    Directory of Open Access Journals (Sweden)

    Mladenović Marko

    2015-01-01

    Full Text Available Background/Aim. Arthrosis of the hip is the most common cause of a hip joint disorders. The aim of this study was to present our experience in the application of a safe surgical dislocation of the hip in patients with minor morphological changes in the hip joint, which, through the mechanism of femoroacetabular impingement, cause damage to the acetabular labrum and adjacent cartilage as an early sign of the hip arthrosis. Methods. We have operated 51 patients with different morphological bone changes in the hip area and resultant soft tissue damage of the acetabular labrum and its adjacent cartilage. Surgical technique that we applied in this group of patients, was adapted to our needs and capabilities and it was minimaly modified compared to the original procedure. Results. The surgical technique presented in this paper, proved to be a good method of treatment of bone and soft tissue pathomorphological changes of the hip in patients with femoroacetabular impingement. We had no cases with avascular necrosis of the femoral head, and two patients had nonunion of the greater trochanter, 9 patients developed paraarticular ossification, without subjective symptoms, while 3 patients suffered from postoperative pain in the groin during more energetic physical activities. Conclusion. Utilization of our partly modified surgical technique of controlled and safe dislocation of the hip can solve all the bone and soft tissue problems in patients with femoroacetibular impingement to stop already developed osteoarthritis of the hip or to prevent mild form of it.

  20. Quality of life in patients with ulcerative colitis treated surgically

    OpenAIRE

    Kozłowska, Katarzyna A.; Bączyk, Grażyna; Krokowicz, Piotr

    2014-01-01

    Introduction Ulcerative colitis belongs to the group of inflammatory bowel diseases. The specific symptoms and chronic nature of the disease significantly affect the quality of patients’ lives. Quality-of-life assessment helps to define its determining factors as well as the efficiency of surgical procedures. Aim Quality-of-life evaluation of patients with ulcerative colitis treated surgically. Material and methods A retrospective review was carried out on 35 patients with ulcerative colitis,...

  1. Psychological predictors of weight loss after bariatric surgery

    DEFF Research Database (Denmark)

    Wimmelmann, Cathrine Lawaetz; Dela, Flemming; Mortensen, Erik Lykke

    2014-01-01

    of surgical weight loss.Methods: We searched PubMed, PsycInfo and Web of Science, for original prospectivestudies with a sample size >30 and at least one year follow-up, using a combina-tion of search terms such as ‘bariatric surgery’, ‘morbid obesity’, ‘psychologicalpredictors’, and ‘weight loss’. Only...

  2. Self-reported problems and wishes for plastic surgery after bariatric surgery

    DEFF Research Database (Denmark)

    Wagenblast, Lene; Laessoe, Line; Printzlau, Andreas

    2014-01-01

    , since some of the patients will experience problems due to excess skin. Foreign studies estimate that ∼30% of all bariatric surgery patients will at some point seek plastic surgical correction of excess skin. The aim of this study is to investigate to what extent the GB patients themselves consider...... plastic surgery for removal of excess skin, and their reasons and motivations for this. The investigation was performed as an anonymous questionnaire handed out to 150 patients at the 1-year standard consultation for GB patients at a private hospital. The questionnaire contained information about...... demographic data, patient habits, earlier or present comorbidity, physical problems, psychological problems, and cosmetic problems due to excess skin. Also, it contained information about what anatomical area bothered the patient the most. One hundred and thirty-eight patients responded to the questionnaire...

  3. Pregnancy management following bariatric surgery.

    Science.gov (United States)

    Uzoma, A; Keriakos, R

    2013-02-01

    Bariatric surgery is gaining in popularity, due to globally increasing rates of obesity. In the UK, this has manifested as a 14-fold increase in bariatric surgery between 2004 and 2010, making it necessary to develop strategies to manage women who become pregnant following bariatric surgery. This review paper has explored all the current evidence in the literature and provided a comprehensive management strategy for pregnant women following bariatric surgery. The emphasis is on a multidisciplinary team approach to all aspects of care. Adequate pre-conception and antenatal and postnatal care is essential to good pregnancy outcomes with emphasis on appropriate nutritional supplementation. This is especially important following malabsorptive procedures. There is no evidence to suggest that pregnancy outcome is worse after bariatric surgery, though women who remain obese are prone to obesity-related risks in pregnancy. Neonatal outcome post-bariatric surgery is no different from the general population. PMID:23445128

  4. Treatment of adolescents with morbid obesity with bariatric procedures and anti-obesity pharmacological agents

    Directory of Open Access Journals (Sweden)

    Um SS

    2011-12-01

    Full Text Available Scott S Um1, Wendelin Slusser2, Daniel A DeUgarte11Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; 2Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USAAbstract: Adolescent obesity is a growing health concern that can have immense physical and psychological impact. Treatment of morbidly obese adolescents should include a multidisciplinary team to address medical comorbidities, diet, physical activity, mental health, and behavior modification. Anti-obesity pharmacologic agents have a limited role in the treatment of adolescents because of concerns with side effects, safety, and efficacy. Orlistat (GlaxoSmithKline, Moon Township, PA is the only approved medication for weight-loss in adolescents. However, it is associated with gastrointestinal side effects and its long-term efficacy is unknown. Bariatric surgery is the most effective therapy to treat morbid obesity. However, adolescents must meet rigorous criteria and have appropriate cognitive, psychological, and social clearance before being considered for surgical intervention. Gastric bypass remains the gold standard bariatric operation. The adjustable gastric band is not FDA-approved for use in patients under 18 years of age. Sleeve gastrectomy is a promising procedure for adolescents because it avoids an intestinal bypass and the implantation of a foreign body. Prospective longitudinal assessment of bariatric surgery procedures is required to determine long-term outcomes. In this manuscript, we review the treatment options, efficacy, and impact on quality of life for morbidly obese adolescents.Keywords: bariatric surgery, morbid obesity, weight loss, adolescent

  5. A rare case of small bowel volvulus after jenjunoileal bariatric bypass requiring emergency surgery: a case report

    Directory of Open Access Journals (Sweden)

    Patel Pranav H

    2012-03-01

    Full Text Available Abstract Introduction Bariatric surgery is on the increase throughout the world. Jejunoileal bypass bariatric procedures have fallen out of favor in western surgical centers due to the high rate of associated complications. They are, however, performed routinely in other centers and as a consequence of health tourism, management of complications related to these procedures may still be encountered. Case presentation We describe a rare case of small bowel obstruction in a 45-year-old British Caucasian woman, secondary to a volvulus of the jejunoileal anastomosis following bariatric bypass surgery. The pre-operative diagnosis was confirmed by radiology. We describe a successful surgical technique for this rare complication. Conclusions Bariatric surgery may be complicated by bowel obstruction. Early imaging is vital for diagnosis and effective management. The use of our surgical technique provides a simple and effective approach for the successful management of this bariatric complication.

  6. COMPLICATIONS REQUIRING HOSPITAL MANAGEMENT AFTER BARIATRIC SURGERY

    OpenAIRE

    WRZESINSKI, Aline; CORRÊA, Jéssica Moraes; FERNANDES, Tainiely Müller Barbosa; MONTEIRO, Letícia Fernandes; TREVISOL, Fabiana Schuelter; do NASCIMENTO, Ricardo Reis

    2015-01-01

    Background: The actual gold standard technique for obesity treatment is the Roux-en-Y gastric bypass. However, complications may occur and the surgeon must be prepared for them. Aim: To evaluate retrospectively the complications occurrence and associated factors in patients who underwent bariatric surgery. Methods: In this study, 469 medical charts were considered, from patients and from data collected during outpatient consultations. The variables considered were gender, age, height, pre-ope...

  7. Evaluation of surgical nurses’ attitudes concerning patient safety

    OpenAIRE

    Ali Şahin; Fatma Ayhan; Şerife Kurşun

    2015-01-01

    The present study was designed as a descriptive study to evaluate the attitudes of surgical nurses concerning patient safety. The study included 123 nurses, who have been working in the operating rooms of the hospitals in Karaman, Konya for at least one year and were voluntary to participate in the study. Data collection tools included a questionnaire to inquire demographic characteristics of surgical nurses, and “Safety Attitudes Questionnaire (SAQ) -Operating Room Version” to evaluate their...

  8. Bariatric Surgery in Women: A Boon Needs Special Care During Pregnancy.

    Science.gov (United States)

    Kumari, Archana; Nigam, Aruna

    2015-11-01

    Obesity is one of the leading causes of health related disorder and has reached epidemic proportions not only in developed nations but also in developing countries like India. Bariatric surgery has become a popular alternative for obese women planning pregnancy. A multidisciplinary approach involving the obstetrician, the bariatric surgeon and the nutritionist is required to manage pregnancy following bariatric surgery. Early consultation should be done to determine baseline nutritional status and the importance of regular check-ups must be explained. Nutritional supplementation should be tailored to the patient's status and the type of bariatric surgery performed. PMID:26672514

  9. Systemic inflammatory response syndrome in surgical patients with sepsis

    OpenAIRE

    Milić Dragan J.; Pejić Miljko A.; Živić Saša S.; Karanikolić Aleksandar D.; Jovanović Slobodan; Radojković Milan

    2004-01-01

    Systemic inflammatory response syndrome and sepsis are common in surgically treated patients. Systemic inflammatory response syndrome represents a major factor of morbidity and mortality in these patients. The pathogenesis of these syndromes has been increasingly clarified. The objective of this review is to present an overview of our current understanding of the physiology underlying these conditions.

  10. Obesity and Readmission in Elderly Surgical Patients

    Science.gov (United States)

    Reinke, Caroline E.; Kelz, Rachel R.; Zubizarreta, Jose R.; Mi, Lanyu; Saynisch, Philip; Kyle, Fabienne A.; Even-Shoshan, Orit; Fleisher, Lee A.; Silber, Jeffrey H.

    2013-01-01

    Introduction Reducing readmissions has become a focus in efforts by Medicare to improve healthcare quality and reduce costs. This study aimed to determine whether causes for readmission differed between obese and non-obese patients, possibly allowing for targeted interventions. Methods A matched case-control study of Medicare patients admitted between 2002–2006 who were readmitted following hip or knee surgery, colectomy, or thoracotomy was performed. Patients were matched exactly for procedure, while also balancing on hospital, age and sex. Conditional logistic regression was used to study the odds of readmission for very obese cases (BMI > 35kg/m2) versus normal weight patients (BMI of 20–30kg/m2) after further controlling for race, transfer-in and emergency status, and comorbidities. Results Among 15,914 patient admissions we identified 1,380 readmitted patients and 2,760 controls. Risk of readmission was increased for obese vs. non-obese patients, before and after controlling for comorbidities (OR=1.35, P=0.003; OR=1.25, P=0.04). Reasons for readmission varied by procedure but were not different by BMI category. Conclusions Obese patients have an increased risk of readmission, yet reasons for readmission in obese patients appear similar to the non-obese, suggesting that improved post-discharge management for the obese cannot focus on a few specific causes of readmission, but must provide a broad range of interventions. PMID:22938896

  11. Insulinoma After Bariatric Surgery: Diagnostic Dilemma and Therapeutic Approaches.

    Science.gov (United States)

    Mulla, Christopher M; Storino, Alessandra; Yee, Eric U; Lautz, David; Sawnhey, Mandeep S; Moser, A James; Patti, Mary-Elizabeth

    2016-04-01

    Hypoglycemia is increasingly recognized as a complication of bariatric surgery. Typically, hypoglycemia does not appear immediately postoperatively, but rather more than 1 year later, and usually occurs 1-3 h after meals. While rare, insulinoma has been reported after bariatric surgery. Clinical factors which should raise suspicion for insulinoma and the need for comprehensive clinical and biochemical evaluation include hypoglycemia occurring in the fasting state, predating bariatric surgery, and/or worsening immediately postoperatively, and lack of response to conservative therapy. Localization and successful resection of insulinoma can be achieved using novel endoscopic ultrasound and surgical approaches. In summary, hypoglycemia presenting shortly after gastric bypass or with a dominant fasting pattern should be fully evaluated to exclude insulinoma. Additionally, evaluation prior to gastric bypass should include screening for history of hypoglycemia symptoms. PMID:26846121

  12. Quality of life of patients surgically treated for ameloblastoma

    Science.gov (United States)

    Lawal, Hammed Sikiru; Adebola, Rafel Adetokunbo; Arotiba, Juwon Tunde; Amole, Ibiyinka Olushola; Efunkoya, Akinwale Adeyemi; Omeje, Uchenna Kelvin; Amole, Taiwo Gboluwaga; Adeoye, Joshua Biodun

    2016-01-01

    Background: The surgical management of ameloblastoma can have a profound functional and psychological effect on a patient's quality of life (QoL). The aim of this study was to compare the pre- and post-operative QoL outcomes of patients requiring surgical treatment for ameloblastoma. Patients and Methods: A total number of 30 patients were identified as fulfilling the criteria for this study. They included 18 males and 12 females, aged between 14 and 47 years with a mean of 27.3 years (standard deviation 10.2). Each patient completed a modified version of the University of Washington QoL questionnaire version 4, a day to surgery and postoperatively on the 7th day, 3 months, and 6 months. Results: Following surgical treatment of patients for ameloblastoma, the QoL decreased immediately after surgery. It then gradually improved over time and exceeded the preoperative value at 6 months postoperatively. When analyzed with respect to location, posteriorly placed tumors had the best postoperative QoL outcome. Patients expressed concern more about their appearance preoperatively while postoperative concerns were mostly focused on their ability to chew. Conclusion: Significant improvement occurred in QoL scores following surgical management of ameloblastoma. The small sample size utilized in this study limits a definitive conclusion. A larger multicenter study is therefore recommended.

  13. Bariatric Surgery for Severe Obesity

    Science.gov (United States)

    ... switch, less often. Each type of surgery has advantages and disadvantages. ​ ​​​​ Bariatric Surgery Benefits Bariatric surgery can ... basic and clinical research into many disorders. ​ Additional Reading Active at Any Size! Binge Eating Disorder Dieting ...

  14. Estudo da correlação do IMC e comprimento do intestino delgado em pacientes obesos submetidos à cirurgia bariátrica Correlation study of BMI and small intestine length in obese patients subjected to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Paulo Afonso Nunes Nassif

    2009-09-01

    between the intestine size and Body Mass Index (BMI. METHODS: The sample was composed of 30 patients of Hospital Universitário Evangélico de Curitiba, Obesity Service, which had been submitted to bariatric surgery in the period between March and June, 2009. These patients previously had been evaluated, according to their weight, height and BMI. The surgical technique was Fobi-Capella. The measurement of small bowel was carried through the Treitz angle towards the ileocecal junction, during the operation. The instrument used was an intestinal manipulation clamp, which was marked with the measure of 10 cm. The intestinal handles had been measured in the anti-mesenteric edge, applying minimum tension necessary to rectify them. The data were statistically correlated and automatically tabulated, using the Pearson correlation method. RESULTS: The average intestinal length for males was 582,5 cm and for 509,1 cm, medium length 528,7 cm. Pearson correlation coefficient, confirmed the absence of correlation between BMI and the intestinal length. CONCLUSION: The medium length of small intestine was 528,7 cm and it did not have correspondence to BMI.

  15. Safety of surgical treatment of hemorrhoids in elderly patients

    Directory of Open Access Journals (Sweden)

    Mustafa Cellalettin Haksal

    2015-12-01

    Full Text Available Introduction: The aim of this study was to compare the outcomes following surgical treatment of hemorrhoids between elderly (≥60 years old and young patients (<60 years old.Methods: A total of 365 patients who underwent surgical procedures for the treatment of third or fourth degree hemorrhoids between January 01, 2009 and January 31, 2014 were retrospectively screened.Results: Among the 365 participants, 316 and 49 patients were younger and older than 60 years of age, respectively. No statistically significant differences with regard to the gender, operative duration, hospitalization time, incapacity to work, hemoglobin levels at admission or discharge, number of hemorrhoid packages, presence of thrombosis prior to the surgery, reoperation requirement, or the number of patients complaining of long-term pain were observed between the groups. Moreover, there was no statistically significant difference in the rate of early or late postoperative complications between the groups.Conclusions: In conclusion, we found that the surgical treatment of hemorrhoids is equally safe in the younger and elderly patients. Therefore, surgeons can be confident in performing surgical treatment of hemorrhoids in elderly patients.

  16. Surgical treatment of nonalcoholic fatty liver disease in severely obese patients

    Directory of Open Access Journals (Sweden)

    Vander Naalt SJ

    2014-10-01

    Full Text Available Steven J Vander Naalt, Juan P Gurria, AiXuan L HoltermanUniversity of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Department of Surgery/Pediatric Surgery, Peoria, IL, USAAbstract: Obesity is a multi-organ system disease with underlying metabolic abnormalities and chronic systemic inflammation. Nonalcoholic fatty liver disease (NAFLD is a hepatic manifestation of obesity metabolic dysfunction and its associated cardiovascular- and liver-related morbidities and mortality. Our current understanding of NAFLD pathogenesis, disease characteristics, the role of insulin resistance, chronic inflammation, gut–liver and gut–brain crosstalk and the effectiveness of pharmacotherapy is still evolving. Bariatric surgery significantly improves metabolic and NAFLD histology in severely obese patients, although its positive effects on fibrosis are not universal. Bariatric surgery benefits NAFLD through its metabolic effect on insulin resistance, inflammation, and insulinotropic and anorexinogenic gastrointestinal hormones. Further studies are needed to understand the natural course of NAFLD in severely obese patients and the role of weight loss surgery as a primary treatment for NAFLD.Keywords: NAFLD, severe obesity, bariatric surgery

  17. ProSeal laryngeal mask airway improves oxygenation when used as a conduit prior to laryngoscope guided intubation in bariatric patients

    Directory of Open Access Journals (Sweden)

    Aparna Sinha

    2013-01-01

    Full Text Available Background: The primary objective of this study was to compare the effect of ventilation using the ProSeal TM laryngeal mask airway (PLMA with facemask and oropharyngeal airway (FM, prior to laryngoscopy, on arterial oxygenation in morbidly obese patients undergoing bariatric surgery. Methods: Forty morbidly obese patients were randomly recruited to either PLMA or FM. After pre-oxygenation (FiO 2 1.0 in the ramp position with continuous positive airway pressure of 10 cm H 2 O for 5 min, anaesthesia was induced. Following loss of jaw thrust oropharyngeal airway, the FM and PLMA were inserted. On achieving paralysis, volume control ventilation with PEEP (5 cm H 2 O was initiated. The difficulty in mask ventilation (DMV in FM, number of attempts at PLMA and laryngoscopy were graded (Cormack and Lehane in all patients. Time from onset of laryngoscopy to endotracheal tube confirmation was recorded. Hypoxia was defined as mild (SpO 2 ≤95%, moderate (SpO 2 ≤90% and severe (SpO 2 ≤85%. Results: Significant rise in pO 2 was observed within both groups ( P=0.001, and this was significantly higher in the PLMA ( P=0.0001 when compared between the groups. SpO 2 ≥ 90% ( P=0.018 was seen in 19/20 (95% patients in PLMA and 13/20 (65% in FM at confirmation of tracheal tube. A strong association was found between DMV and Cormack Lehane in the FM group and with number of attempts in the PLMA group. No adverse events were observed. Conclusion: ProSeal TM laryngeal mask airway as conduit prior to laryngoscopy in morbidly obese patients seems effective in increasing oxygen reserves, and can be suggested as a routine airway management technique when managing the airway in the morbidly obese.

  18. Use of positive pressure in preoperative and intraoperative of bariatric surgery and its effect on the time of extubation

    Directory of Open Access Journals (Sweden)

    Letícia Baltieri

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVE: To investigate the influence of intraoperative and preoperative positive pressure in the time of extubation in patients undergoing bariatric surgery. METHOD: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55 kg/m2, age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10: individuals who received treatment with noninvasive positive pressure before surgery for 1 h; G-intra (n = 10: individuals who received positive end-expiratory pressure of 10 cm H2O throughout the surgical procedure; and G-control (n = 20: not received any preoperative or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the post-anesthetic recovery. RESULTS: There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10 cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. CONCLUSION: The use of positive end-expiratory pressure of 10 cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.

  19. Surgical treatment strategy for multiple injury patients in ICU

    Institute of Scientific and Technical Information of China (English)

    ZHANG Lian-yang; YAO Yuan-zhang; JIANG Dong-po; ZHOU Jian; HUANG Xian-kai; SHEN Yue; HUANG Jian

    2011-01-01

    Objective: To investigate the surgical treatment for patients with multiple injuries in ICU.Methods: Clinical data of 163 multiple injury patients admitted to ICU of our hospital from January 2006 to January 2009 were retrospectively studied, including 118 males and 45 females, with the mean age of 36.2 years (range, 5-67 years). The injury regions included head and neck (29 cases),face (32 cases), chest (89 cases), abdomen (77 cases), pelvis and limbs (91 cases) and body surface (83 cases). There were 57 cases combined with shock. ISS values varied from 10 to 54, 18.42 on average. Patients received surgical treatments in ICU within respectively 24 hours (10 cases), 24-48 hours (8 cases), 3-7 days (7 cases) and 8-14 days (23 cases).Results: Forthe 163 patients, the duration of ICU stay ranged from 2 to 29 days, with the average value of 7.56 days. Among them, 143 were cured (87.73%), 11 died in the hospital (6.75%) due to severe hemorrhagic shock (6 cases),craniocerebral injury (3 cases) and multiple organ failure (2 cases), and 9 died after voluntarily discharging from hospital (5.52%). The total mortality rate was 12.27%.Conclusions: The damage control principle should be followed when multiple injury patients are resuscitated in ICU. Surgical treatment strategies include actively controlling hemorrhage, treating the previously missed injuries and related wounds or surgical complications and performing planned staging operations.

  20. Obesity-related insulin resistance: implications for the surgical patient.

    Science.gov (United States)

    Tewari, N; Awad, S; Macdonald, I A; Lobo, D N

    2015-11-01

    In healthy surgical patients, preoperative fasting and major surgery induce development of insulin resistance (IR). IR can be present in up to 41% of obese patients without diabetes and this can rise in the postoperative period, leading to an increased risk of postoperative complications. Inflammation is implicated in the aetiology of IR. This review examines obesity-associated IR and its implications for the surgical patient. Searches of the Medline and Science Citation Index databases were performed using various key words in combinations with the Boolean operators AND, OR and NOT. Key journals, nutrition and metabolism textbooks and the reference lists of key articles were also hand searched. Adipose tissue has been identified as an active endocrine organ and the chemokines secreted as a result of macrophage infiltration have a role in the pathogenesis of IR. Visceral adipose tissue appears to be the most metabolically active, although results across studies are not consistent. Results from animal and human studies often provide conflicting results, which has rendered the pursuit of a common mechanistic pathway challenging. Obesity-associated IR appears, in part, to be related to inflammatory changes associated with increased adiposity. Postoperatively, the surgical patient is in a proinflammatory state, so this finding has important implications for the obese surgical patient. PMID:26028059

  1. Surgical Treatment for Refractory Epilepsy: Review of Patient Evaluation and Surgical Options

    Directory of Open Access Journals (Sweden)

    Kristen M. Kelly

    2011-01-01

    Full Text Available Treatment of epilepsy often imposes an exposure to various antiepileptic drugs and requires long-term commitment and compliance from the patient. Although many new medications are now available for the treatment of epilepsy, approximately 30% of epilepsy patients still experience recurrent seizures and many experience undesirable side effects. Treatment of epilepsy requires a multidisciplinary approach. For those patients with medically refractory seizures, surgical treatment has increased in prevalence as techniques and devices improve. With increased utilization, proper patient selection has become crucial in evaluating appropriateness of surgical intervention. Epilepsy syndromes in which surgery has shown to be effective include mesial temporal sclerosis, cortical dysplasia, many pediatric epilepsy syndromes, and vascular malformations. Monitoring in an epilepsy monitoring unit with continuous scalp or intracranial EEG is an important step in localization of seizure focus. MRI is the standard imaging technique for evaluation of anatomy. However, other imaging studies including SPECT and PET have become more widespread, often offering increased diagnostic value in select situations. In addition, as an alternative or adjunct to surgical resection, implantable devices such as vagus nerve stimulators, deep brain stimulators, and direct brain stimulators could be useful in seizure treatment.

  2. Applying Mathematical Models to Surgical Patient Planning

    OpenAIRE

    Oostrum, Jeroen

    2009-01-01

    textabstractOn a daily basis surgeons, nurses, and managers face cancellation of surgery, peak demands on wards, and overtime in operating rooms. Moreover, the lack of an integral planning approach for operating rooms, wards, and intensive care units causes low resource utilization and makes patient flows unpredictable. An ageing population and advances in medicine are putting the available healthcare budget under great pressure. Under these circumstances, hospitals are seeking innovative way...

  3. KIDNEY STONE INCIDENCE AND METABOLIC URINARY CHANGES AFTER MODERN BARIATRIC SURGERY: REVIEW OF CLINICAL STUDIES, EXPERIMENTAL MODELS, AND PREVENTION STRATEGIES

    OpenAIRE

    Canales, Benjamin K.; Hatch, Marguerite

    2014-01-01

    Bariatric surgery has been associated with increased metabolic kidney stone risk and post-operative stone formation. A MEDLINE search, performed for articles published between January 2005 and November 2013, identified 24 pertinent studies containing 683 bariatric patients with 24-hour urine profiles, 6,777 bariatric patients with kidney stone incidence, and 7,089 non-stone forming controls. Of all procedures reviewed, only Roux-en-Y gastric bypass (RYGB) was linked to post-...

  4. Obesity and co-morbid psychiatric disorders as contraindications for bariatric surgery?—A case study

    OpenAIRE

    Peterhänsel, C; Wagner, B.; Dietrich, A; A. Kersting

    2014-01-01

    INTRODUCTION: Many patients undergoing bariatric surgery report current or past psychiatric disorders and controversy exists regarding their outcome after bariatric surgery. PRESENTATION OF CASE: We present a case of an obese patient with a borderline personality disorder, a recurrent depressive disorder, post-traumatic stress symptoms and binge eating episodes who underwent bariatric surgery. DISCUSSION: Although the psychiatric disorders remained, the procedure contributed to an impro...

  5. Bariatric surgery - effects on obesity and related co-morbidities

    DEFF Research Database (Denmark)

    Svane, Maria Saur; Madsbad, Sten

    2014-01-01

    Laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) are the three most commonly performed bariatric procedures. Obesity responds well to bariatric surgery, with major long-lasting weight loss that is most pronounced...... vitamins and minerals, and anemia. Some patients have dumping after meals, and a few patients will develop postprandial hypoglycemia after RYGB. About 25% of patients require plastic surgery to provide relief from excessive skin tissue.......Laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (SG) are the three most commonly performed bariatric procedures. Obesity responds well to bariatric surgery, with major long-lasting weight loss that is most pronounced...... hormone responses, especially a 10-fold increase in glucagon-like peptide-1 (GLP-1), which improves insulin secretion. After gastric banding, the remission of diabetes depends more on weight loss. Bariatric surgery reduces cardiovascular risk factors including hypertension, lipid disturbances, non...

  6. Exploring challenges and solutions in the preparation of surgical patients

    DEFF Research Database (Denmark)

    Møller, Thea Palsgaard; Münter, Kristine Husum; Østergaard, Doris;

    2015-01-01

    management system tasks, 26% of anaesthesia record tasks, 24% of medication tasks, 14% of blood test tasks and 12% of patient record tasks. In two workshops held for each of four specialties, a total of 21 participants mapped the preoperative patient journey with related responsibilities, tasks and written...... documentation. Furthermore, challenges and suggestions for solutions were identified. CONCLUSIONS: Completion of mandatory tasks for surgical patient preparation was poor. Workshops with table simulations actively involved the stakeholders from various professions and specialties in describing the patient...

  7. BRUCELLA ENDOCARDITIS IN IRANIAN PATIENTS: COMBINED MEDICAL AND SURGICAL TREATMENT

    Directory of Open Access Journals (Sweden)

    Ebrahim Nematipour

    1995-06-01

    Full Text Available Brucella endocarditis is a Tare but serious complication ofbrucellosis and is the main cause of death reuuedto thisdisease: Itis not rare in the endemic areas and aaualiy accounts for up to 8~lO% ofendocarditis infections: We report seven adult cases of brucella endocarditis in lmam-Khorneini Hospual: Contrary to previous independent reports, female patients were not rare in this study and accountedfor three out ofseven. Four patients were cared for by combined medical and surgical treatment and were recovered Three of the patients that did not receive the combined theraPl could not he saved This report confirms the necessity of prompt combined medical and surgical treatment ofbrucella endocarditis.

  8. Glucose Regulation and Cognitive Function after Bariatric Surgery

    Science.gov (United States)

    Galioto, Rachel; Alosco, Michael L.; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D.; Mitchell, James E.; Gunstad, John

    2016-01-01

    Introduction Obesity is associated with cognitive impairment and bariatric surgery has been shown to improve cognitive functioning. Rapid improvements in glycemic control are common after bariatric surgery and likely contribute to these cognitive gains. We examined whether improvements in glucose regulation are associated with better cognitive function following bariatric surgery. Method A total of 85 adult bariatric surgery patients underwent computerized cognitive testing and fasting blood draw for glucose, insulin, and glycated hemoglobin (HbA1c) at baseline and 12 month post-operatively. Results Significant improvements in both cognitive function and glycemic control were observed among patients. After controlling for and baseline factors, 12-month homeostatic model assessment of insulin resistance HOMA-IR predicted 12-month digits backward (β = −.253, p < .05), switching of attention- A (β = .156, p < .05), and switching of attention-B (β = −.181, p < .05). Specifically, as HOMA-IR decreased over time, working memory, psychomotor speed, and cognitive flexibility improved. Decreases in HbA1c were not associated with post-operative cognitive improvements. After controlling for baseline cognitive test performance, changes in BMI were also not associated with 12-month cognitive function. Conclusions Small effects of improved glycemic control on improved aspects of attention and executive function were observed following bariatric surgery among severely obese individuals. Future research is needed to identify the underlying mechanisms for the neurocognitive benefits of these procedures. PMID:25875124

  9. Acute limb ischemia in cancer patients: should we surgically intervene?

    LENUS (Irish Health Repository)

    Tsang, Julian S

    2012-02-01

    BACKGROUND: Cancer patients have an increased risk of venous thromboembolic events. Certain chemotherapeutic agents have also been associated with the development of thrombosis. Reported cases of acute arterial ischemic episodes in cancer patients are rare. METHODS: Patients who underwent surgery for acute limb ischemia associated with malignancy in a university teaching hospital over a 10-year period were identified. Patient demographics, cancer type, chemotherapy use, site of thromboembolism, treatment and outcome were recorded. RESULTS: Four hundred nineteen patients underwent surgical intervention for acute arterial ischemia, 16 of these patients (3.8%) had associated cancer. Commonest cancer sites were the urogenital tract (n = 5) and the lungs (n = 5). Eight patients (50%) had been recently diagnosed with cancer, and four (25%) of these cancers were incidental findings after presentation with acute limb ischemia. Four patients (25%) developed acute ischemia during chemotherapy. The superficial femoral artery was the most frequent site of occlusion (50%), followed by the brachial (18%) and popliteal (12%) arteries. All patients underwent thromboembolectomy, but two (12%) patients subsequently required a bypass procedure. Six patients (37%) had limb loss, and in-patient mortality was 12%. Histology revealed that all occlusions were due to thromboembolism, with no tumor cells identified. At follow-up, 44% of patients were found to be alive after 1 year. CONCLUSION: Cancer and chemotherapy can predispose patients to acute arterial ischemia. Unlike other reports that view this finding as a preterminal event most appropriately treated by palliative measures, in this series, early diagnosis and surgical intervention enabled limb salvage and patient survival.

  10. KYPHECTOMY IN PATIENTS WITH MYELOMENINGOCELE: SURGICAL RESULTS AND COMPLICATIONS

    Directory of Open Access Journals (Sweden)

    Pedro Araujo Petersen

    2015-09-01

    Full Text Available Objectives:The lumbar kyphosis in patients with myelomeningocele is a complex deformity whose treatment is mainly surgical. The objective of this study is to summarize the results and complications obtained by the group in 2012 with respect to this group of patients.Method:Performed a retrospective analysis of the medical records and radiographs of patients consecutively operated in 2012. The technique was originally described by Dunn-McCarthy and consists of kyphectomy and posterior fixation using S-shaped Luque rods through the foramina of S1 associated with pedicle screws in the thoracic spine.Results:Six patients were included in the study. The age at surgery was 11 years and 7±22 months and the weight was 29.1±11.9 kg. The procedure lasted 271±87 minutes, with the removal of one or two (mean 1.5 vertebrae from the apex of the kyphosis. Hospitalization time was 10±9 days. The lumbar kyphosis measuring 116.3±37 degrees preoperatively was reduced to 62.5±21 degrees. All patients began to sit without support and to lie in the supine position. Four patients developed postoperative infection and required surgical debridement at the follow-up. One patient had the implant removed after a year due to loosening of the rod in the sacrum.Conclusion:The surgical technique allows excellent functional results in the correction of lumbar kyphosis in patients with myelomeningocele despite high complication rates. It is necessary to conduct studies with a larger number of patients and duration of follow-up to assess whether the use of pedicle screws will decrease the rate of loosening and pseudoarthrosis.

  11. The impact of surgical outcome after pancreaticoduodenectomy in elderly patients

    Directory of Open Access Journals (Sweden)

    Nagashima Atsushi

    2011-09-01

    Full Text Available Abstract Background The elderly population has increased in many countries. Indications for cancer treatment in elderly patients have expanded, because surgical techniques and medical management have improved remarkably. Pancreaticoduodenectomy (PD requires high-quality techniques and perioperative management methods. If it is possible for elderly patients to withstand an aggressive surgery, age should not be considered a contraindication for PD. Appropriate preoperative evaluation of elderly patients will lead to their safer management. The purpose of the present study was to evaluate the safety of PD in patients older than 75 years and to show the influence of advanced age on the morbidity and mortality associated with this operation. Patients and methods Subjects were 98 patients who underwent PD during the time period from April 2005 to April 2011. During this study, 31 patients were 75 years of age or older (group A, and the other 67 patients were less than 75 years old (group B. Preoperative demographic and clinical data, surgical procedure, pathologic diagnosis, postoperative course and complication details were collected prospectively and they were analyzed in two group. Results There was no statistical difference between patient groups in terms of gender, comorbidity, preoperative drainage, diagnosis, or laboratory data. Preoperative albumin values were lower in group A (P = 0.04. The mean surgical time in group A was 408.1 ± 73.47 min. Blood loss and blood transfusion were not significantly different between both groups. There was no statistical differences in mortality rate (P = 0.14, morbidity rate (P = 0.43, and mean length of hospital stay (P = 0.22 between both groups. Long-term survival was also no statistically significant difference between the two groups using the log-rank test (P = 0.10. Conclusion It cannot be ignored that the elderly population is getting larger. We must investigate the management of elderly patients after

  12. Prediction of Exercise in Patients across Various Stages of Bariatric Surgery: A Comparison of the Merits of the Theory of Reasoned Action versus the Theory of Planned Behavior

    Science.gov (United States)

    Hunt, Hillary R.; Gross, Alan M.

    2009-01-01

    Obesity is a world-wide health concern approaching epidemic proportions. Successful long-term treatment involves a combination of bariatric surgery, diet, and exercise. Social cognitive models, such as the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB), are among the most commonly tested theories utilized in the…

  13. Over-drainage and persistent shunt-dependency in patients with idiopathic intracranial hypertension treated with shunts and bariatric surgery

    Directory of Open Access Journals (Sweden)

    Jonathan Roth

    2015-01-01

    Conclusions: Patients with IIH that undergo shunt surgery and BS (not concomitantly may suffer from OD symptoms, necessitating multiple shunt revisions, and valve upgrades. Despite BS being a valid primary treatment for some patients with IIH, among shunted patients, BS may not lead to resolution of IIH-related symptoms and patients may remain shunt-dependent.

  14. Nefrolitotomía percutánea en pacientes con cirugía bariátrica: ¿mayor riesgo de complicación? Percutaneous nephrolitotomy in bariatric surgery patients: Is there an increased risk of complications

    Directory of Open Access Journals (Sweden)

    Gastón López-Fontana

    2012-10-01

    Full Text Available Objetivo: Presentar el caso de un paciente con antecedente de cirugía bariátrica y litiasis renal coraliforme, el cual presentó una perforación colónica luego de una nefrolitectomía percutánea. Material y Métodos: Paciente hombre de 38 años de edad con antecedente de bypass gástrico. Fue sometido a una nefrolitectomía percutánea por litiasis renal izquierda coraliforme, complicada de una perforación colónica no reconocida en forma precoz. Resultados: El paciente evolucionó con cuadro séptico y presencia de material fecaloídeo en la zona de la nefrostomía, por lo que requirió colostomía transversa, con resolución de la complicación séptica y resolución de la fístula nefrocólica. Conclusión: Es sabido que la cirugía bariátrica se asocia a litogénesis urinaria y cambios anatómicos de las relaciones de los órganos abdominales. El estudio radiológico y la adecuada estrategia quirúrgica evitará complicaciones graves en la cirugía de la litiasis renal.Introduction: To report a patient with a history of bariatric surgery and staghorn calculi of the left kidney, who had a colonic perforation after percutaneous renal surgery. Material and Methods: A 38 years old male patient, with a history of gastric bypass, underwent a left percutaneous nephrolithotomy due to staghorn renal calculi. In the procedure, the colon was incidentally perforated during the percutaneous access. Results: The patient developed a sepsis and fecal material appeared surrounding the nephrostomy tube. A transverse colostomy was performed, with improvement of the sepsis and a spontaneous resolution of the nephro-colonic fistula. Conclusion: Is known that bariatric surgery is associated with the novo urinary lithiasis. Besides, there are anatomical changes in between intraabdominal viscera. Radiological studies and a adequate surgical strategy are fundamental to avoid severe surgical complications in kidney stone disease.

  15. Surgical treatment of patients with intermediate-terminal pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Yu-Bin Liu; Liang Huang; Zhi-Yong Xian; Zhi-Xiang Jian; Jin-Rui Ou; Zi-Xian Liu

    2006-01-01

    AIM: To investigate the surgical treatment of patients with intermediate-terminal pancreatic cancer.METHODS: A retrospective analysis was made of the clinical data of 163 patients with intermediate-terminal pancreatic cancer who were surgically treated between August 1994 and August 2003.RESULTS: A total of 149 patients underwent palliative surgery. The mortality rate of those who underwent cholecystojejunostomy alone was 14.2%, the icterus or cholangitis recurrence rate was 61.9% with an average survival period of 7.1 mo. The mortality rate for those who received hepatic duct-jejunostomy (HDJS) was 5.7%,the icterus or cholangitis recurrence rate was 6.8% with an average survival period of 7.1 mo. But 31.8% of the patients developed duodenum obstruction within 6 mo after the surgery, six of seven patients with severe pain were given peri-abdominal aorta injection with absolute alcohol and their pain was alleviated. The other patients underwent percutaneous transhepatic cholangial drainage (PTCD) and their icterus index returned to normal level within 40 d with an average survival period of 7.5 mo.CONCLUSION: Roux-en-y HDJS combined withprophylactic gastrojejunostomy is recommended for patients with intermediate-terminal pancreatic cancer, and biliary prosthesis can partly relieve biliary obstruction in a short term.

  16. The Alberta population-based prospective evaluation of the quality of life outcomes and economic impact of bariatric surgery (APPLES study: background, design and rationale

    Directory of Open Access Journals (Sweden)

    McCargar Linda

    2010-10-01

    Full Text Available Abstract Background Extreme obesity affects nearly 8% of Canadians, and is debilitating, costly and ultimately lethal. Bariatric surgery is currently the most effective treatment available; is associated with reductions in morbidity/mortality, improvements in quality of life; and appears cost-effective. However, current demand for surgery in Canada outstrips capacity by at least 1000-fold, causing exponential increases in already protracted, multi-year wait-times. The objectives and hypotheses of this study were as follows: 1. To serially assess the clinical, economic and humanistic outcomes in patients wait-listed for bariatric care over a 2-year period. We hypothesize deterioration in these outcomes over time; 2. To determine the clinical effectiveness and changes in quality of life associated with modern bariatric procedures compared with medically treated and wait-listed controls over 2 years. We hypothesize that surgery will markedly reduce weight, decrease the need for unplanned medical care, and increase quality of life; 3. To conduct a 3-year (1 year retrospective and 2 year prospective economic assessment of bariatric surgery compared to medical and wait-listed controls from the societal, public payor, and health-care payor perspectives. We hypothesize that lower indirect, out of pocket and productivity costs will offset increased direct health-care costs resulting in lower total costs for bariatric surgery. Methods/design Population-based prospective cohort study of 500 consecutive, consenting adults, including 150 surgically treated patients, 200 medically treated patients and 150 wait-listed patients. Subjects will be enrolled from the Edmonton Weight Wise Regional Obesity Program (Edmonton, Alberta, Canada, with prospective bi-annual follow-up for 2 years. Mixed methods data collection, linking primary data to provincial administrative databases will be employed. Major outcomes include generic, obesity-specific and preference

  17. Frequency of RBC Alloantibodies in Chinese Surgical Patients.

    Science.gov (United States)

    Wang, Qiushi; Yang, Qiaoni; Bai, Yingzhe; Zhang, Chengxin; Diao, Yanni; Fang, Deqiang

    2012-08-01

    BACKGROUND: The aim of this study was to evaluate the frequency of red blood cell (RBC) alloantibodies in surgical patients. METHODS: Blood samples of 18,980 Chinese surgical patients were collected and tested between January 2009 and September 2010. For patients with RBC alloantibodies, sequences of antibodies were identified with the DiaMed Asia antibody screening system. Data regarding sex, age, transfusion history, pregnancy history, and alloantibody specificity were collected. RESULTS: 39 alloantibodies were identified from 18,980 samples, yielding a prevalence of 0.21%. The most frequently identified alloantibodies were Rhesus system antibodies (28/39, 71.8%), including anti-E (17/39; 1 anti-E accompanied by anti-Fy(b)), anti-c (5/39), anti-cE (2/39), anti-C(w) (1/39), anti-D (1/39), and anti-e (1/39). Other antibodies included anti-M (5/39), anti-Le(a) (2/39), anti-Le(b) (1/39), anti-K+S (1/39), anti-JK(a) (1/39), and anti-JS(a) (1/39). The frequency of alloantibodies was greater in females than in males (31 vs. 8). CONCLUSION: The results show a higher prevalence of RBC alloantibodies in females than in males. Anti-E was the most common alloantibody identified in this Chinese surgical population and was also more frequent in females compared to males. PMID:22969699

  18. Influence of Bariatric Surgery on Remission of Type 2 Diabetes

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    Paweł Nalepa

    2011-12-01

    Full Text Available The plague of obesity afflicts an increasing group of people. Moreover type 2 diabetes, which is the most serious illness accompanying excessive weight, is becoming more and more common. Traditional methods of obesity treatment, such as diet and physical exercise, fail. This applies especially to people with class III obesity. The only successful way of treating obesity in their case is bariatric surgery. There are three types of bariatric surgery: restrictive procedures (reducing stomach volume, malabsorptive procedures, and mixed procedures, which combine both methods. In spite of the risk connected with the surgery and complications after it, bariatric procedures are advised to patients with class III obesity and class II with an accompanying illness which increases the probability of death. It has been proved that bariatric surgery not only eliminates obesity but also very frequently (in 90�0of cases leads to the remission of type 2 diabetes. Moreover, the remission occurs very fast – it takes place a long time before the patients reduce their weight, even within a few days after surgery. Detailed studies have shown that the remission of diabetes is caused mostly by the change of the gastro-intestinal hormones’ profile, resulting from the surgery. These hormones include GLP-1, GIP, peptide YY, ghrelin and oxyntomodulin. Additionally, the change of the amount of adipose tissue after the surgery influences the level of adipokines, i.e. the hormones of the adipose tissue, among which the most important are leptin, adiponectin and resistin. Thus, bariatric surgery not only changes the shape of the gastrointestinal tract but it also modulates the hormonal activity. Bariatric surgery is considered as therapy not only for the obese but also for diabetic patients.

  19. Generating patient-specific pulmonary vascular models for surgical planning

    Science.gov (United States)

    Murff, Daniel; Co-Vu, Jennifer; O'Dell, Walter G.

    2015-03-01

    Each year in the U.S., 7.4 million surgical procedures involving the major vessels are performed. Many of our patients require multiple surgeries, and many of the procedures include "surgical exploration". Procedures of this kind come with a significant amount of risk, carrying up to a 17.4% predicted mortality rate. This is especially concerning for our target population of pediatric patients with congenital abnormalities of the heart and major pulmonary vessels. This paper offers a novel approach to surgical planning which includes studying virtual and physical models of pulmonary vasculature of an individual patient before operation obtained from conventional 3D X-ray computed tomography (CT) scans of the chest. These models would provide clinicians with a non-invasive, intricately detailed representation of patient anatomy, and could reduce the need for invasive planning procedures such as exploratory surgery. Researchers involved in the AirPROM project have already demonstrated the utility of virtual and physical models in treatment planning of the airways of the chest. Clinicians have acknowledged the potential benefit from such a technology. A method for creating patient-derived physical models is demonstrated on pulmonary vasculature extracted from a CT scan with contrast of an adult human. Using a modified version of the NIH ImageJ program, a series of image processing functions are used to extract and mathematically reconstruct the vasculature tree structures of interest. An auto-generated STL file is sent to a 3D printer to create a physical model of the major pulmonary vasculature generated from 3D CT scans of patients.

  20. The eating-related behaviours, disorders and expectations of candidates for bariatric surgery.

    Science.gov (United States)

    Opolski, M; Chur-Hansen, A; Wittert, G

    2015-08-01

    It is important that clinicians and researchers understand the possible eating-related difficulties experienced by pre-bariatric surgery candidates, as well as their expectations of how their eating and hunger will change after surgery. This review examines English-language publications related to the eating-related behaviours, disorders and expectations of bariatric candidates. Seventy-five articles related to binge eating disorder, grazing, night eating syndrome, emotional eating, food cravings and addiction, and pre-surgical expectations of post-surgical eating in this population were critically reviewed. A variety of often problematic eating behaviours appear more common in bariatric candidates than in non-obese populations. The literature suggests that 4-45% of candidates may have binge eating disorder, 20-60% may graze, 2-42% may have night eating syndrome, 38-59% may engage in emotional eating and 17-54% may fit criteria for food addiction. Binge eating may also be more prevalent in bariatric candidates than in similarly obese non-surgical individuals. Expectations of surgery are high, with pre-surgical candidates believing their bariatric procedure will virtually guarantee significantly improved eating behaviours. Study replications are needed, and further investigation into prevalence, impacts and candidate characteristics related to disordered eating behaviours, as well as candidates' expectations of eating after surgery, will be important. Further comparisons of bariatric candidates to similarly obese non-bariatric populations will be important to understand eating-related characteristics of candidates beyond those related to their weight. Future research may be improved by the use of validated measures, replicable methodologies, minimization of data collected in circumstances where respondents may been motivated to 'fake good', use of prospective data and consistent definitions of key terminology. PMID:26173752

  1. Managing Opioid-Tolerant Patients in the Perioperative Surgical Home.

    Science.gov (United States)

    Wenzel, John T; Schwenk, Eric S; Baratta, Jaime L; Viscusi, Eugene R

    2016-06-01

    Management of acute postoperative pain is important to decrease perioperative morbidity and improve patient satisfaction. Opioids are associated with potential adverse events that may lead to significant risk. Uncontrolled pain is a risk factor in the transformation of acute pain to chronic pain. Balancing these issues can be especially challenging in opioid-tolerant patients undergoing surgery, for whom rapidly escalating opioid doses in an effort to control pain can be associated with increased complications. In the perioperative surgical home model, anesthesiologists are positioned to coordinate a comprehensive perioperative analgesic plan that begins with the preoperative assessment and continues through discharge. PMID:27208711

  2. Bariatric diagnostic CT scanning: A radiotherapy perspective

    International Nuclear Information System (INIS)

    Obesity is increasing in the United Kingdom. Equipment available for this patient group including wheelchairs, beds and hoists is becoming more common in the hospital environment; diagnostic imaging equipment that can accommodate bariatric patients has not increased at the same rate. Subsequently these service-users are often unable to receive “gold-standard” cross-sectional imaging within their patient-pathway. This paper highlights how a diagnostic imaging department has utilised wide-bore CT scanning equipment within the radiotherapy setting to ensure an equitable service for all service users. Through literature review and local experience, a standard operating procedure and scanning service has been developed. Areas explored include technical consideration of scanner design; patient positioning; image artefacts and intravenous contrast administration. Also investigated is patient wellbeing incorporating manual handling, respiration and psycho-social needs. Additionally, demonstration of how interprofessional collaboration by diagnostic and radiotherapy radiographers can ensure the best imaging experience and outcome for this patient group. - Highlights: • Rising obesity in the UK has highlighted a shortage of diagnostic imaging facilities. • Large bore CT scanners are the scanner of choice for radiotherapy planning. • Technical capability, manual handling and psycho-social issues have been explored. • Bariatric diagnostic imaging facilitated by inter-professional collaboration

  3. Thoracic wall defects: surgical management of 205 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Pairolero, P.C.; Arnold, P.G.

    1986-07-01

    In this article, we review our experience during the past 9 years with 205 consecutive thoracic wall reconstructions. The 100 female and 105 male patients ranged in age from 12 to 85 years (mean, 53.4 years). One hundred fourteen patients had thoracic wall tumors, 56 had radiation necrosis, 56 had infected median sternotomy wounds, and 8 had costochondritis. Twenty-nine of these patients had combinations of the aforementioned conditions. One hundred seventy-eight patients underwent skeletal resection. A mean of 5.4 ribs were resected in 142 patients. Total or partial sternectomies were performed in 60. Skeletal defects were closed with prosthetic material in 66 patients and with autogenous ribs in 12. One hundred sixty-eight patients underwent 244 muscle flap procedures: 149 pectoralis major, 56 latissimus dorsi, 14 rectus abdominis, 13 serratus anterior, 8 external oblique, 2 trapezius, and 2 advancement of diaphragm. The omentum was transposed in 20 patients. The mean number of operations per patient was 1.9 (range, 1 to 8). The mean duration of hospitalization was 16.5 days. One perioperative death occurred (at 29 days). Four patients required tracheostomy. During a mean follow-up of 32.4 months, there were 49 late deaths, predominantly due to malignant disease. All 204 patients who were alive 30 days after operation had excellent surgical results at last follow-up examination or at the time of death due to causes unrelated to the reconstructive procedure.

  4. Evaluation of surgical nurses’ attitudes concerning patient safety

    Directory of Open Access Journals (Sweden)

    Ali Şahin

    2015-06-01

    Full Text Available The present study was designed as a descriptive study to evaluate the attitudes of surgical nurses concerning patient safety. The study included 123 nurses, who have been working in the operating rooms of the hospitals in Karaman, Konya for at least one year and were voluntary to participate in the study. Data collection tools included a questionnaire to inquire demographic characteristics of surgical nurses, and “Safety Attitudes Questionnaire (SAQ -Operating Room Version” to evaluate their attitudes concerning patient safety. The mean scores obtained from SAQ sub-dimensions were between 42.12 ±16.82 and 69.07±24.44, whereas the mean score of SAQ total was 59.11 ±13.29. Statistically significant difference was determined between the mean SAQ total score and age, weekly working hours, duration of working in the operating room, resting status, receiving in service training, and training about patient safety. The present study will enhance patient safety in operating rooms by providing an improvement in communication among health workers and in team collaboration, regulating working hours, and scheduling training programs to establish an opinion about worker safety and patient safety.

  5. Long-term prognosis of patients with surgical wound infections.

    Science.gov (United States)

    Poulsen, K B; Gottschau, A

    1997-10-01

    This study examined if surgical wound infections (SWI) result in a severe prognosis regarding general health and increase the consumption of social resources. A group of 1301 patients were interviewed by self-administered questionnaires during 1993-1994, while operated during hospitalization in seven Danish hospitals. These patients were followed up at least once by similar questionnaires at a median time of 5.5 and 10.0 months postoperatively. The consequences of surgically diagnosed SWI were analyzed in a hospital cohort of 58 infected patients and 648 controls. Postdischarge infections were analyzed in a patient cohort of 263 cases and 767 controls. Changes in health was measured by the General Health Questionnaire, Activities of Daily Living index, and self-assessed health. Consumption of resources were estimated by reliance on assistance from family and friends, use of home services, and contacts to doctors. It was found that the long-term prognosis of general health was unaffected by SWIs. However significantly increased social dependence was found for patients with SWIs compared to uninfected patients. Almost one-fourth of the operations were complicated by an SWI. Most of the infections were recognized only after discharge and were thought to be of minor importance, which may explain why no chronic impairment of the health was found for patients with an SWI. A bias toward no-effect may have been introduced if patients with severe SWIs abstained from participation. The societal cost of care for patients with minor infections seems to be large. The causal relation between outcome and SWI needs to be further investigated. PMID:9327669

  6. Results of Surgical Therapy in Patients with Medullary Thyroid Carcinoma.

    Science.gov (United States)

    Vlad, Mihaela; Zosin, Ioana; Timar, Bogdan; Lazar, Fulger; Vlad, Adrian; Timar, Romulus; Cornianu, Marioara

    2016-08-01

    Medullary thyroid carcinoma (MTC) is a rare form of malignancy, having an intermediate prognosis. Controversies exist regarding the best surgical approach. The aim of the study was to analyze the outcome in a group of patients with MTC, diagnosed and followed up in a single care center. We performed a retrospective analysis of all the patients diagnosed with MTC in the Department of Endocrinology from the County Emergency Hospital Timisoara between 1992 and 2012. The study group included 19 patients, 6 men (31.6 %), mean age 41.2 ± 12.5 years (20-72 years). The preoperative diagnosis was based on the protocol for nodular thyroid disease. Total or near-total thyroidectomy was performed in 10 out of 16 patients who could be operated. Postoperative follow-up included repeated measurements of serum calcitonin and imaging investigations. Nine out of the total of 19 (47.3 %) patients had hereditary forms of MTC. Most of the cases (84.2 %) were submitted to surgery. The median duration of follow-up was 84 months. The pTNM staging indicated that the majority of the patients with hereditary MTC were diagnosed in an earlier stage. Disease remission was achieved in 7 cases (43.8 %). Four patients, all with sporadic forms, died. Survival rates at 1, 5 and 10 years were significantly higher (p = 0.048) in patients with hereditary MTC. An early diagnosis of MTC allows a better surgical approach and an improved survival rate. We support the general recommendation that modified radical neck dissection is not necessary for all the patients with MTC. PMID:27574350

  7. A Prior History of Substance Abuse in Veterans Undergoing Bariatric Surgery

    OpenAIRE

    Maureen Tedesco; William Q. Hua; Lohnberg, Jessica A.; Nina Bellatorre; Dan Eisenberg

    2013-01-01

    Background. The rates of obesity and substance abuse are high among US veterans. Objective. To examine weight loss and substance abuse rates following bariatric surgery in veterans with a history of substance abuse (SA). Methods. A prospective database of consecutive bariatric operations was reviewed. Data for SA patients were compared to patients without a substance abuse history (NA). Behavioral medicine staff followed patients throughout the pre- and postoperative courses. Results. Of 205 ...

  8. Violent Behavior among hospitalized medical and surgical patients.

    Science.gov (United States)

    Ochitill, H N; Krieger, M

    1982-02-01

    To characterize violent behavior in hospitalized medical and surgical patients, we reviewed documented violent incidents at the San Francisco General Hospital during a two-year period. Twenty-nine incidents of verbal and physical violence occurred. One patient was gravely ill and three were delirious. All the incidents were associated with increased levels of tension and loss of impulse control. In most cases, contention with the staff regarding pain medication or ward regulations was a precipitating event. Of the 28 patients with mental disorders, 19 were substance abusers, six had organic brain syndrome, tw had neurosis, and one had schizophrenia. The findings suggest that physicians should be more sensitive to patient characteristics and to the situational characteristics of the violent incident. Explicit measures that anticipate and reduce violent behavior are reviewed. PMID:7058353

  9. Feasibility and analgesic efficacy of the transversus abdominis plane block after single-port laparoscopy in patients having bariatric surgery

    Directory of Open Access Journals (Sweden)

    Wassef M

    2013-11-01

    Full Text Available Michael Wassef, David Y Lee, Jun L Levine, Ronald E Ross, Hamza Guend, Catherine Vandepitte, Admir Hadzic, Julio TeixeiraDepartment of Anesthesiology, St Luke's-Roosevelt Hospital Center, New York, NY, USAPurpose: The transversus abdominis plane (TAP block is a technique increasingly used for analgesia after surgery on the anterior abdominal wall. We undertook this study to determine the feasibility and analgesic efficacy of ultrasound-guided TAP blocks in morbidly obese patients. We describe the dermatomal spread of local anesthetic in TAP blocks administered, and test the hypothesis that TAP blocks decrease visual analog scale (VAS scores.Patients and methods: After ethics committee approval and informed consent, 35 patients with body mass index >35 undergoing single-port sleeve gastrectomy (SPSG were enrolled. All patients received balanced general anesthesia, followed by intravenous patient-controlled analgesia (IV-PCA; hydromorphone postoperatively; all reported VAS >3 upon arrival to the recovery room. From the cohort of 35 patients having single-port laparoscopy (SPL, a sealed envelope method was used to randomly select ten patients to the TAP group and 25 patients to the control group. The ten patients in the TAP group received ultrasound-guided TAP blocks with 30 mL of 0.2% Ropivacaine injected bilaterally. The dermatomal distribution of the sensory block (by pinprick test was recorded. VAS scores for the first 24 hours after surgery and opioid use were compared between the IV-PCA+TAP block and IV-PCA only groups.Results: Sensory block ranged from T5–L1. Mean VAS pain scores decreased from 8 ± 2 to 4 ± 3 (P=0.04 within 30 minutes of TAP block administration. Compared with patients given IV-PCA only, significantly fewer patients who received TAP block had moderate or severe pain (VAS 4–10 after block administration at 6 hours and 12 hours post-surgery. However, cumulative consumption of hydromorphone at 24 hours after SPSG surgery

  10. Evaluation surgical treatment results of scoliosis in patients with neurofibromatosis

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    Hojjat Hossein-Pourfeizi

    2014-08-01

    Full Text Available Introduction: Surgical treatment of spinal deformity resulting from neurofibromatosis (NF is a major challenge for orthopedic spine surgeons. There are several problems and complications including pseudoarthrosis and cure progress despite treatment. Progressive kyphoscoliosis is the most important spinal deformity. The present study aims to evaluate surgical treatment results in severe spinal involvement cases. Methods: This analytical a-descriptive study evaluated 20 patients with NF, severe scoliosis and kyphosis (up to 50° hospitalized and treated at our center during the past 10 years. The treatment failure rate and complications were studied. Results: In this study, 20 cases with NF and kyphoscoliosis with the mean age of 13.00 ± 7.18 years were studied. These case series were consisted of 13 (65% males and 7 (35% females. Overall treatment failure was 45%. However, it was 55% of failure happened in posterior fusion alone. Failure rate was reported 36% in the combined anterior and posterior fusion and mainly seen in younger than 8-years children. Surgical complications were found in 20% with pseudoarthrosis as the most common one. There were no infections and neurological complications. Statistically, there was a significant negative relation between age and curve progression in scoliosis and kyphosis during the 2 years follow-up period. There was not any significant difference between genders considering curvature progress. Conclusion: The combined anterior and posterior fusion is probably more effective treatment, especially at early ages when more aggressive treatment is required since it reduces the treatment failure possibility.

  11. Bariatric surgery and pregnancy: literature review

    Directory of Open Access Journals (Sweden)

    Pedro Ferrand Miranda

    2014-01-01

    Full Text Available Obesity has currently reached epidemic proportions, both in Chile and in the world. This condition is associated to a variety of maternal complications in all stages of the vital cycle and during pregnancy. Medical treatment has not proved successful thus resulting in an increase in bariatric surgery in recent years, even when it is not first line treatment. This literature review aims to report updated results of surgical treatment for obesity before and during pregnancy with respect to fertility, gestational diabetes, pre-eclampsia and pregnancy-induced hypertension. It also looks into the possible effects of surgery on fetal development, and its relation to premature delivery, fetal macrosomy, low birth weight and neural tube defects, as well as effects on maternal and fetal outcomes, mainly in nutrition. Lastly, we suggest some recommendations that arise from this review on the role of contraception, nutrition and time between surgery and pregnancy.

  12. Neural network adapted to wound cell analysis in surgical patients.

    Science.gov (United States)

    Viljanto, Jouko; Koski, Antti

    2011-01-01

    Assessment of the real state of wound healing of closed surgical wounds is uncertain both clinically and from conventional laboratory tests. Therefore, a novel approach based on early analysis of exactly timed wound cells, computerized further with an artificial neural network, was developed. At the end of routine surgery performed on 481 children under 18 years of age, a specific wound drain Cellstick™ was inserted subcutaneously between the wound edges to harvest wound cells. The Cellsticks™ were removed from 1 to 50 hours, mainly at hour 3 or 24 postsurgery. Immediately, the cellular contents were washed out using a pump constructed for the purpose. After cytocentrifugation, the cells were stained and counted differentially. Based on their relative proportions at selected time intervals, an artificial self-organizing neural map was developed. This was further transformed to a unidirectional linear graph where each node represents one set of relative cell quantities. As early as 3 hours, but more precisely 24 hours after surgery, the location of the nodes on this graph showed individually the patients' initial speed of wound inflammatory cell response. Similarly, timed Cellstick™ specimens from new surgical patients could be analyzed, computerized, and compared with these node values to assess their initial speed in wound inflammatory cell response. Location of the node on the graph does not express the time lapse after surgery but the speed of wound inflammatory cell response in relation to that of other patients. PMID:21362082

  13. Cataract surgical outcomes in diabetic patients: Case control study

    Directory of Open Access Journals (Sweden)

    Onakpoya Oluwatoyin

    2009-01-01

    Full Text Available Purpose: To determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria. Design: A retrospective case control study conducted at the University College Hospital, Ibadan Nigeria. Subjects: Twenty three consecutive patients with diabetes and 23 age and sex matched non-diabetic control patients who had extracapsular cataract extraction for advanced cataract between 2002-2005. Main outcome: Mean post operative visual acuity and surgical complications. Results: Twenty three patients with diabetes mellitus and 23 non diabetic controls were studied; mean duration of diabetes was 8.1 ± 7.2 years. The mean post operative visual acuity in diabetics was 0.11±0.38, 0.33±0.57 and 0.38±0.49 at one week, two months and six months compared with 0.23±0.19, 0.46±0.37 and 0.48±0.31 in non diabetics. (p=0.207, 0.403 and 0.465 respectively. Improvement in preoperative visual acuity was noted in 84.2% and 90% in diabetics and non-diabetics respectively. Poor visual outcome in diabetics was mainly due to diabetic retinopathy, maculopathy or diabetes related surgical complications. Conclusion: Visual improvement was seen following surgery for advanced cataract in diabetics in this study population. Post operative monitoring for treatment of diabetic retinopathy may enhance visual outcome.

  14. Orthodontic and surgical treatment of a patient with hemifacial microsomia.

    Science.gov (United States)

    Zanardi, Gustavo; Parente, Eduardo Varela; Esteves, Lucas Senhorinho; Louro, Rafael Seabra; Capelli, Jonas

    2012-04-01

    This article describes the surgical and orthodontic treatment of a 12-year-old boy with a significant deformity and functional involvement caused by hemifacial microsomia. The left mandibular ramus and condyle were hypoplastic and abnormal in form and location. The lower third of the face was increased, with mandibular retrusion and significant facial asymmetry. He had difficulties in speaking and chewing and problems related to his facial appearance, which caused severe psychosocial disturbances. The patient received orthodontic treatment and temporomandibular joint reconstruction with a costochondral graft on the left side while he was still growing. Three-year follow-up records are presented. PMID:22449593

  15. Surgical management of cleft lip in pedo-patients.

    Science.gov (United States)

    Taware, C P; Kulkarni, S R

    1991-01-01

    The Present article describes in short etiology of cleft lip and cleft palate. With this in-born defect, patient develops crucial problems with feeding, phonation, overall growth and development of affected and allied soft and hard tissue structures. This in turn results in deformity and asymmetry which is going to affect functional requirements as well as aesthetic outlook. Hence it really becomes mandatory to correct this defect surgically as early as possible, at stipulated timings so as to avoid present and future anticipated problems. PMID:1820390

  16. Long-term effects of bariatric surgery on meal disposal and β-cell function in diabetic and nondiabetic patients

    DEFF Research Database (Denmark)

    Camastra, Stefania; Muscelli, Elza; Gastaldelli, Amalia;

    2013-01-01

    patients and 15 obese nondiabetic (ND) subjects before and 1 year after surgery (10 T2D and 11 ND) using the double-tracer technique and modeling of β-cell function. In both groups postsurgery, tracer-derived appearance of oral glucose was biphasic, a rapid increase followed by a sharp drop, a pattern......Gastric bypass surgery leads to marked improvements in glucose tolerance and insulin sensitivity in obese type 2 diabetes (T2D); the impact on glucose fluxes in response to a physiological stimulus, such as a mixed meal test (MTT), has not been determined. We administered an MTT to 12 obese T2D...... that was mirrored by postprandial glucose levels and insulin secretion. In diabetic patients, surgery lowered fasting and postprandial glucose levels, peripheral insulin sensitivity increased in proportion to weight loss (~30%), and β-cell glucose sensitivity doubled but did not normalize (compared with 21...

  17. Surgical outcome after spinal fractures in patients with ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Brilakis Emmanuel

    2009-08-01

    Full Text Available Abstract Background Ankylosing spondylitis is a rheumatic disease in which spinal and sacroiliac joints are mainly affected. There is a gradual bone formation in the spinal ligaments and ankylosis of the spinal diarthroses which lead to stiffness of the spine. The diffuse paraspinal ossification and inflammatory osteitis of advanced Ankylosing spondylitis creates a fused, brittle spine that is susceptible to fracture. The aim of this study is to present the surgical experience of spinal fractures occurring in patients suffering from ankylosing spondylitis and to highlight the difficulties that exist as far as both diagnosis and surgical management are concerned. Methods Twenty patients suffering from ankylosing spondylitis were operated due to a spinal fracture. The fracture was located at the cervical spine in 7 cases, at the thoracic spine in 9, at the thoracolumbar junction in 3 and at the lumbar spine in one case. Neurological defects were revealed in 10 patients. In four of them, neurological signs were progressively developed after a time period of 4 to 15 days. The initial radiological study was negative for a spinal fracture in twelve patients. Every patient was assessed at the time of admission and daily until the day of surgery, then postoperatively upon discharge. Results Combined anterior and posterior approaches were performed in three patients with only posterior approaches performed on the rest. Spinal fusion was seen in 100% of the cases. No intra-operative complications occurred. There was one case in which superficial wound inflammation occurred. Loosening of posterior screws without loss of stability appeared in two patients with cervical injuries. Frankel neurological classification was used in order to evaluate the neurological status of the patients. There was statistically significant improvement of Frankel neurological classification between the preoperative and postoperative evaluation. 35% of patients showed improvement

  18. Dietary intake in the postoperative bariatric surgery at a university hospital in Rio de Janeiro

    OpenAIRE

    Louise Crovesy-de-Oliveira; Gigliane Cosendey-Menegati; Eliane Lopes-Rosado

    2014-01-01

    Introduction: bariatric surgery is a treatment for morbid obesity that besides result in high weight loss promotes improvements in laboratory tests and in the pressure reduction. However the surgery can cause bad effects as deficiency some nutrients. This fact become more important evaluates the adequacy of dietary intake of these patients. The objective this study was evaluates the adequacy dietetic of patients after bariatric surgery.Material and methods: we select forty women who underwent...

  19. The effects of bariatric surgeries on type 2 diabetes mellitus

    Science.gov (United States)

    Lerd Ng, Jia; Ortiz, Roberto; Hughes, Tyler; Abou Ghantous, Michel; Bouhali, Othmane; Arredouani, Abdelilah; Allen, Roland

    2012-10-01

    We consider a scientific mystery which is of central importance in treating the most rapidly emerging national and global health threat: type 2 diabetes mellitus. The mystery involves a surprising effect of certain bariatric surgeries, and specifically Roux-en-Y gastric bypass (RYGB), a procedure which bypasses most of the stomach and upper intestine. An unanticipated result is that RYGB is usually found to contribute within only a few days to glucose homeostasis. This means the surgery can immediately cure patients even before they start losing weight. We are investigating this wondrous biochemical response with a quantitative model which includes the most important mechanisms. One of the major contributors is glucagon-like peptide 1 (GLP-1), an incretin whose concentration is found to increase by a large amount right after the RYGB surgical procedure. However, our results, in conjunction with the experimental and medical data, indicate that other substances must also contribute. If these substances can be definitively identified, it may be possible to replace the surgery with pharmaceuticals as the preferred treatment for type 2 diabetes.

  20. Endoscopic extraction of adjustable gastric bands after intragastric migration as a complication of bariatric surgery: technique and advice

    Science.gov (United States)

    Collado-Pacheco, David; Rábago-Torre, Luis Ramon; Arias-Rivera, Maria; Ortega-Carbonel, Alejandro; Olivares-Valles, Ana; Alonso-Prada, Alicia; Vázquez-Echarri, Jaime; Herrera-Merino, Norberto

    2016-01-01

    Background: Surgery has been the method most widely used to manage the extraction of gastric bands with inclusion as a late complication of bariatric surgery; however, surgical extraction entails morbidity and limits future surgical procedures. The development of endoscopic techniques has provided an important means of improving the treatment of this complication, enabling minimally invasive and safe procedures that have a high success rate. Methods: A retrospective analysis was conducted of patients who had laparoscopic gastric banding complicated by intragastric migration and were treated endoscopically. A technique already described for managing this complication was employed. An MTW Endoskopie Dormia basket for mechanical lithotripsy or a standard 0.0035-in guidewire was placed around the band, and an MTW Endoskopie emergency lithotripter was used to section it, after which the band was extracted with a standard polypectomy snare. Also analyzed were the initial symptoms of patients with this complication, the mean time from surgery to development of the event, the success rate of endoscopic treatment, and complications, Results: A total of 127 patients had undergone gastric banding surgery in our Bariatric Surgery Center; of these, 12 patients (9.4 %) developed a complication such as intragastric migration of the band. Weight gain and pain were the main symptoms in 11 patients (92 %), and the mean time to the development of symptoms was 51.3 months. A single endoscopic treatment was successful in 7 of 9 patients (78 %). Only 1 complication, involving ventilation during anesthesia, occurred; no other adverse events were recorded. Conclusions: The endoscopic extraction of bands with inclusion is feasible and can be performed easily and successfully. The procedure is available in all hospitals and has a low incidence of related complications, so that unnecessary surgical procedures can be avoided.

  1. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients

    DEFF Research Database (Denmark)

    Schulman, S; Angerås, U; Bergqvist, D;

    2010-01-01

    The definition of major bleeding varies between studies on surgical patients, particularly regarding the criteria for surgical wound-related bleeding. This diversity contributes to the difficulties in comparing data between trials. The Scientific and Standardization Committee (SSC), through its...

  2. Gastrointestinal changes after bariatric surgery.

    Science.gov (United States)

    Quercia, I; Dutia, R; Kotler, D P; Belsley, S; Laferrère, B

    2014-04-01

    Severe obesity is a preeminent health care problem that impacts overall health and survival. The most effective treatment for severe obesity is bariatric surgery, an intervention that not only maintains long-term weight loss but also is associated with improvement or remission of several comorbidies including type 2 diabetes mellitus. Some weight loss surgeries modify the gastrointestinal anatomy and physiology, including the secretions and actions of gut peptides. This review describes how bariatric surgery alters the patterns of gastrointestinal motility, nutrient digestion and absorption, gut peptide release, bile acids and the gut microflora, and how these changes alter energy homeostasis and glucose metabolism. PMID:24359701

  3. Potential mechanisms mediating improved glycemic control after bariatric/metabolic surgery.

    Science.gov (United States)

    Yamamoto, Hiroshi; Kaida, Sachiko; Yamaguchi, Tsuyoshi; Murata, Satoshi; Tani, Masaji; Tani, Tohru

    2016-03-01

    Conservative medical treatment for morbid obesity generally fails to sustain weight loss. On the other hand, surgical operations, so-called bariatric surgery, have evolved due to their long-term effects. The global increase in the overweight population and the introduction of laparoscopic surgery have resulted in the use of bariatric surgery spreading quickly worldwide in recent years. Recent clinical evidence suggests that bariatric surgery not only reduces body weight, but also improves secondary serious diseases, including type 2 diabetes mellitus, in so-called metabolic surgery. Moreover, several potential mechanisms mediating the improvement in glycemic control after bariatric/metabolic surgery have been proposed based on the animal and human studies. These mechanisms include changes in the levels of gastrointestinal hormones, bacterial flora, bile acids, intestinal gluconeogenesis and gastrointestinal motility as well as adipose tissue and inflammatory mediators after surgery. The mechanisms underlying improved glycemic control are expected to accelerate the promotion of both metabolic and bariatric surgery. This article describes the current status of bariatric surgery worldwide and in Japan, reviews the accumulated data for weight loss and diabetic improvements after surgery and discusses the potential mechanisms mediating improved glycemic control. PMID:25700844

  4. Using lifestyle medicine in U.S. health care to treat obesity: too many bariatric surgeries?

    Science.gov (United States)

    Trilk, Jennifer L; Kennedy, Ann Blair

    2015-01-01

    More than one-third of Americans are classified as obese. Many clinicians perform bariatric surgery (BSx) when it is said that lifestyle intervention failed. However, BSx is medically complex, with extremely variable success, certain failures, major complications, and sometimes death. Although many studies declare BSx as more effective for producing weight loss than nonsurgical lifestyle management, these conclusions are flawed when lifestyle management between cohorts are not identical. Lifestyle behavior change is essential to success for both surgical and nonsurgical weight loss, as over 50% of BSx patients regain weight without lifestyle modification. Indeed, programs that include self-reward and reinforcement are extremely effective. It is therefore possible that successful BSx is simply an intrinsic reward for an intensive change in lifestyle behavior. Accounting for the costs and risks associated with BSx, providing state and federal resources for lifestyle behavior change programs could provide a key opportunity for the war against obesity. PMID:25757003

  5. Genital Reconstruction After Weight Loss in Adipose Male Patients: A Case report

    OpenAIRE

    Sattler, Daniel Robert Arno; Altmann, Silke; Infanger, Manfred; Abuagela, Nauras; Schneegans, Sarah Maj; Damert, Hans-Georg; Kraus, Armin

    2014-01-01

    Objective: We introduce our surgical technique in two male genital reconstruction cases out of 15 post-bariatric patients. Methods: At our Department for Plastic Surgery at the University Hospital Magdeburg, 15 patients, 6 male and 9 female, underwent a surgical abdominoplasty after weight loss in 2009. Results: The average weight of the 15 patients was preoperatively 197.2 kg and the average hospital stay was of 14 days. In 2 cases, a second procedure for male genital reconstruction was nece...

  6. Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients

    Science.gov (United States)

    Petrick, Anthony; Wood, G. Craig; Still, Christopher D.; Strodel, William E.; Gabrielsen, John; Rolston, David; Chu, Xin; Argyropoulos, George; Ibele, Anna; Gerhard, Glenn S.

    2016-01-01

    Background Nonalcoholic fatty liver disease (NAFLD) is common in adults with extreme obesity and can impact long-term health and survival. Liver biopsy is the only accurate test for diagnosis and staging, but is invasive and costly. Non-invasive testing offers an attractive alternate, but the overall accuracy remains a significant issue. This study was conducted to determine the accuracy and clinical utility of preoperative ultrasound and liver transaminase levels, as well as intra-operative hepatic visual inspection, for assessing presence of NAFLD as confirmed by hepatic histology. Methods Data was collected prospectively from 580 morbidly obese adult patients who underwent Roux-en-Y gastric bypass surgery with intraoperative wedge biopsy between January 2004 and February 2009. Complete data for ultrasound, ALT and AST levels, and documented visual inspection was available for 513 patients. Results The prevalence of NAFLD was 69 % and that of NASH was 32 %. The individual non-invasive clinical assessments demonstrated low sensitivity, specificity, and accuracy for detecting the presence of steatosis, steatohepatitis, or fibrosis. The combination of normal or abnormal results for all tests improved predictive utility. Abnormal tests with all three assessments had a sensitivity of 95–98 % and a specificity of 28–48 % for major histologic findings in NAFLD/NASH. Normal tests with all three assessments had a sensitivity of 12–22 % and a specificity of 89–97 % for major histologic findings in NAFLD/NASH. Conclusions Although individual clinical tests for NAFLD have limited accuracy, the use of combined clinical tests may prove useful. PMID:26003548

  7. Patient Participation in Surgical Treatment Decision Making from the Patients' Perspective: Validation of an Instrument

    Directory of Open Access Journals (Sweden)

    Liv-Helen Heggland

    2012-01-01

    Full Text Available The aim of this paper is to describe the development of a new, brief, easy-to-administer self-reported instrument designed to assess patient participation in decision making in surgical treatment. We describe item generation, psychometric testing, and validity of the instrument. The final scale consisted of four factors: information dissemination (5 items, formulation of options (4 items, integration of information (4 items, and control (3 items. The analysis demonstrated a reasonable level of construct validity and reliability. The instrument applies to patients in surgical wards and can be used to identify the health services that are being provided and the areas that could strengthen patient participation.

  8. Patient Participation in Surgical Treatment Decision Making from the Patients' Perspective: Validation of an Instrument

    Science.gov (United States)

    Heggland, Liv-Helen; Øgaard, Torvald; Mikkelsen, Aslaug; Hausken, Kjell

    2012-01-01

    The aim of this paper is to describe the development of a new, brief, easy-to-administer self-reported instrument designed to assess patient participation in decision making in surgical treatment. We describe item generation, psychometric testing, and validity of the instrument. The final scale consisted of four factors: information dissemination (5 items), formulation of options (4 items), integration of information (4 items), and control (3 items). The analysis demonstrated a reasonable level of construct validity and reliability. The instrument applies to patients in surgical wards and can be used to identify the health services that are being provided and the areas that could strengthen patient participation. PMID:22830010

  9. A systematic review of risk factors associated with surgical site infections among surgical patients.

    Directory of Open Access Journals (Sweden)

    Ellen Korol

    Full Text Available IMPORTANCE: Surgical site infection (SSI complicates 2-5% of surgeries in the United States. Severity of SSI ranges from superficial skin infection to life-threatening conditions such as severe sepsis, and SSIs are responsible for increased morbidity, mortality, and economic burden associated with surgery. Staphylococcus aureus (S. aureus is a commonly-isolated organism for SSI, and methicillin-resistant S. aureus SSI incidence is increasing globally. OBJECTIVE: The objective of this systematic review was to characterize risk factors for SSI within observational studies describing incidence of SSI in a real-world setting. EVIDENCE REVIEW: An initial search identified 328 titles published in 2002-2012; 57 were identified as relevant for data extraction. Extracted information included study design and methodology, reported cumulative incidence and post-surgical time until onset of SSI, and odds ratios and associated variability for all factors considered in univariate and/or multivariable analyses. FINDINGS: Median SSI incidence was 3.7%, ranging from 0.1% to 50.4%. Incidence of overall SSI and S. aureus SSI were both highest in tumor-related and transplant surgeries. Median time until SSI onset was 17.0 days, with longer time-to-onset for orthopedic and transplant surgeries. Risk factors consistently identified as associated with SSI included co-morbidities, advanced age, risk indices, patient frailty, and surgery complexity. Thirteen studies considered diabetes as a risk factor in multivariable analysis; 85% found a significant association with SSI, with odds ratios ranging from 1.5-24.3. Longer surgeries were associated with increased SSI risk, with a median odds ratio of 2.3 across 11 studies reporting significant results. CONCLUSIONS AND RELEVANCE: In a broad review of published literature, risk factors for SSI were characterized as describing reduced fitness, patient frailty, surgery duration, and complexity. Recognition of risk factors

  10. Colorectal patients and cardiac arrhythmias detected on the surgical high dependency unit.

    OpenAIRE

    Batra, G. S.; Molyneux, J.; N. A. Scott

    2001-01-01

    INTRODUCTION: Surgical high dependency unit (SHDU) care is becoming an integral feature of colorectal surgical practice. Routine ECG monitoring is a feature of surgical care in this setting. The aim of this study was to determine the incidence and outcome of cardiac arrhythmias detected in an SHDU population of colorectal patients. PATIENTS AND METHODS: 226 patients over a 12 month period were admitted to a 6-bedded SHDU under the care of 3 colorectal surgeons. A total of 29 patients (13%) ha...

  11. Prevalence and Determinants of Depression and Anxiety Symptoms in Surgical Patients

    OpenAIRE

    Saeed Shoar; Mohammad Naderan; Motahareh Aghajani; Elaheh Sahimi-Izadian; Negin Hosseini-Araghi; Zhamak Khorgami

    2016-01-01

    Objectives: Mood disorders are prevalent in hospitalized patients. However, risk factors for early diagnosis have not been studied exclusively in surgical patients. Our study aimed to investigate the prevalence and determinants of depression and anxiety symptoms in surgical patients. Methods: We included 392 surgical patients in this prospective cross-sectional study, which took place between June 2011 and June 2012. The Hospital Anxiety and Depression Scale (HADS) was used to screen for ...

  12. A Prospective Cohort Study of Patients Treated Surgically or Non-Surgically for Full-thickness Rotator Cuff Tears

    OpenAIRE

    Gagnier, Joel Joseph; Robbins, Christopher; Carpenter, James E; Bedi, Asheesh; Miller, Bruce

    2014-01-01

    Objectives: The objectives of this project are: (1) to compare the efficacy of surgical versus non-surgical management of full-thickness rotator cuff tears, and (2) to detect variables that predict success within each treatment group. Methods: Adult patients presenting at MedSport, University of Michigan, with full thickness rotator cuff tears diagnosed by MRI or ultrasound and no history of shoulder surgery were recruited for inclusion in the study. Consenting subjects were given baseline wr...

  13. General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery

    OpenAIRE

    Adriano Fernandes; João Ettinger; Fabiano Amaral; Maria José Ramalho; Rodrigo Alves; Norma Sueli Pinheiro Módolo

    2014-01-01

    OBJECTIVES: Video laparoscopic bariatric surgery is the preferred surgical technique for treating morbid obesity. However, pneumoperitoneum can pose risks to the kidneys by causing a decrease in renal blood flow. Furthermore, as in other surgical procedures, laparoscopic bariatric surgery triggers an acute inflammatory response. Neutrophil gelatinase-associated lipocalin is an early and accurate biomarker of renal injury, as well as of the inflammatory response. Anesthetic drugs could offer s...

  14. The risk of kidney stones following bariatric surgery: a systematic review and meta-analysis.

    Science.gov (United States)

    Thongprayoon, Charat; Cheungpasitporn, Wisit; Vijayvargiya, Priya; Anthanont, Pimjai; Erickson, Stephen B

    2016-04-01

    Background With rising prevalence of morbid obesity, the number of bariatric surgeries performed each year has been increasing worldwide. The objective of this meta-analysis was to assess the risk of kidney stones following bariatric surgery. Methods A literature search was performed using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from inception through July 2015. Only studies reporting relative risks, odd ratios or hazard ratios (HRs) to compare risk of kidney stones in patients who underwent bariatric surgery versus no surgery were included. Pooled risk ratios (RR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Results Four studies (One randomized controlled trial and three cohort studies) with 11,348 patients were included in analysis to assess the risk of kidney stones following bariatric surgery. The pooled RR of kidney stones in patients undergoing bariatric surgery was 1.22 (95% CI, 0.63-2.35). The type of bariatric surgery subgroup analysis demonstrated an increased risk of kidney stones in patients following Roux-en-Y gastric bypass (RYGB) with the pooled RR of 1.73 (95% CI, 1.30-2.30) and a decreased risk of kidney stones in patients following restrictive procedures including laparoscopic banding or sleeve gastrectomy with the pooled RR of 0.37 (95% CI, 0.16-0.85). Conclusions Our meta-analysis demonstrates an association between RYGB and increased risk of kidney stones. Restrictive bariatric surgery, on the other hand, may decrease kidney stone risk. Future study with long-term follow-up data is needed to confirm this potential benefit of restrictive bariatric surgery. PMID:26803902

  15. Surgical transposition of the ovaries: Imaging findings in 14 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kier, R.; Chambers, S.K. (Yale Univ. School of Medicine, New Haven, CT (USA))

    1989-11-01

    Pelvic radiation therapy for cervical or vaginal cancer often leads to ovarian failure. To remove the ovaries from the radiation portal and preserve their function, they can be transposed to the lateral abdomen. Serial imaging studies in 14 patients who had undergone ovarian transposition (five bilateral, nine unilateral) were reviewed. Images obtained included 32 CT scans, 20 sonograms, and one MR image. Most transposed ovaries were located along the paracolic gutters near the iliac crests, creating an extrinsic mass effect on adjacent bowel. Detection of surgical clips on the ovary on CT scans allowed confident recognition of all 19 transposed ovaries. Cysts in the transposed ovaries, noted on most imaging studies, did not correlate with complications of pain or hormonal dysfunction. In one case, a large physiologic cyst in a transposed ovary distorted the cecum and was mistaken for a mucocele of the appendix. In another case, a large ovarian cyst was thought to be tumor recurrence or a lymphocele. These findings indicate that although the transposed ovaries can be recognized on CT scans by the surgical clips attached to the ovaries, the appearance of the ovary does not predict reliably the development of complications.

  16. Surgical transposition of the ovaries: Imaging findings in 14 patients

    International Nuclear Information System (INIS)

    Pelvic radiation therapy for cervical or vaginal cancer often leads to ovarian failure. To remove the ovaries from the radiation portal and preserve their function, they can be transposed to the lateral abdomen. Serial imaging studies in 14 patients who had undergone ovarian transposition (five bilateral, nine unilateral) were reviewed. Images obtained included 32 CT scans, 20 sonograms, and one MR image. Most transposed ovaries were located along the paracolic gutters near the iliac crests, creating an extrinsic mass effect on adjacent bowel. Detection of surgical clips on the ovary on CT scans allowed confident recognition of all 19 transposed ovaries. Cysts in the transposed ovaries, noted on most imaging studies, did not correlate with complications of pain or hormonal dysfunction. In one case, a large physiologic cyst in a transposed ovary distorted the cecum and was mistaken for a mucocele of the appendix. In another case, a large ovarian cyst was thought to be tumor recurrence or a lymphocele. These findings indicate that although the transposed ovaries can be recognized on CT scans by the surgical clips attached to the ovaries, the appearance of the ovary does not predict reliably the development of complications

  17. Futility and the care of surgical patients: ethical dilemmas.

    Science.gov (United States)

    Grant, Scott B; Modi, Parth K; Singer, Eric A

    2014-07-01

    Futility has been a contentious topic in medicine for several decades. Surgery in critical or end-of-life situations often raises difficult questions about futility. In this article, we discuss the definition of futility, methods for resolving futility disputes, and some ways to reframe the futility debate to a more fruitful discussion about the goals of care, better communication between surgeon and patient/surrogate, and palliative surgical care. Many definitions of futile therapy have been discussed. The most controversial of these is "qualitative futility" which describes a situation in which the treatment provided is likely to result in an unacceptable quality of life. This is an area of continued controversy because it has been impossible to identify universally held beliefs about acceptable quality of life. Many authors have described methods for resolving futility disputes, including community standards and legalistic multi-step due process protocols. Others, however, have abandoned the concept of futility altogether as an unhelpful term. Reframing the issue of futility as one of inadequate physician-patient communication, these authors have advocated for methods of improving communication and strengthening the patient-physician relationship. Finally, we discuss the utilization of consultants who may be of use in resolving futility disputes: ethics committees, palliative care specialists, pastoral care teams, and dedicated patient advocates. Involving these specialists in a futility conflict can help improve communication and provide invaluable assistance in arriving at the appropriate treatment decision. PMID:24849199

  18. Bariatric surgery and nonalcoholic fatty liver disease: current and potential future treatments

    Directory of Open Access Journals (Sweden)

    Akira eSasaki

    2014-10-01

    Full Text Available Nonalcoholic fatty liver disease (NAFLD and nonalcoholic steatohepatitis (NASH are increasingly common cause of chronic liver disease worldwide. The diagnosis of NASH is challenging as most affected patients are symptom-free and the role of routine screening is not clearly established. Most patients with severe obesity who undergo bariatric surgery have NAFLD, which is associated insulin resistance, type 2 diabetes mellitus (T2DM, hypertension, and obesity-related dyslipidemia. The effective treatment for NAFLD is weight reduction through lifestyle modifications, antiobesity medication, or bariatric surgery. Among these treatments, bariatric surgery is the most reliable method for achieving substantial, sustained weight loss. This procedure is safe when performed by a skilled surgeon, and the benefits include reduced weight, improved quality of life, decreased obesity-related comorbidities, and increased life expectancy. Further research is urgently needed to determine the best use of bariatric surgery with NAFLD patients at high risk of developing liver cirrhosis and its role in modulating complications of NAFLD, such as T2DM and cardiovascular disease. The current evidence suggests that bariatric surgery for patients with severe obesity decreases the grade of steatosis, hepatic inflammation, and fibrosis. However, further long-term studies are required to confirm the true effects before recommending bariatric surgery as a potential treatment for nonalcoholic steatohepatitis.

  19. Metabolic bariatric surgery and type 2 diabetes mellitus: an endocrinologist's perspective

    Institute of Scientific and Technical Information of China (English)

    Sonali Ganguly; Hong Chang Tan; Phong Ching Lee; Kwang Wei Tham

    2015-01-01

    Traditional treatment of T2DM consisting of modification of diet,an exercise regimen,and pharmacotherapy has problems of poor lifestyle modifications and fail tend of treatment over time,now bariatric surgery is recommended for treatment of obese patients with T2DM because its great improvements on weight loss and metabolic.In this article,effects of bariatric surgery on diabetes and diabetes-related complications are reviewed.

  20. Improved Serum Leptin and Ghrelin Following Bariatric Surgery Predict Better Postoperative Cognitive Function

    OpenAIRE

    Alosco, Michael L.; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D.; Mitchell, James E; Gunstad, John

    2015-01-01

    Background and Purpose Bariatric surgery is associated with improved cognitive function, but the mechanisms underlying these gains remain poorly understood. Disturbed leptin and ghrelin systems are common in obese individuals and are associated with impaired cognitive function in other samples. Bariatric surgery has been shown to improve serum leptin and ghrelin levels, and these changes may underlie postoperative cognitive improvements. Methods Eighty-four patients completed a computerized c...

  1. Non-invasive ventilation for surgical patients with acute respiratory failure

    OpenAIRE

    Lee, Byoung Chul; Kyoung, Kyu Hyouck; Kim, Young Hwan; Hong, Suk-Kyung

    2011-01-01

    Purpose Acute respiratory failure is a relatively common complication in surgical patients, especially after abdominal surgery. Non-invasive ventilation (NIV) is increasingly used in the treatment of acute respiratory failure. We have assessed the usefulness of NIV in surgical patients with acute respiratory failure. Methods We retrospectively reviewed the medical charts of patients who were admitted to a surgical intensive care unit between March 2007 and February 2008 with acute respiratory...

  2. Could the mechanisms of bariatric surgery hold the key for novel therapies?

    DEFF Research Database (Denmark)

    Tam, C S; Berthoud, H-R; Bueter, M;

    2011-01-01

    in energy metabolism, gut peptides and food preference. The goal of this meeting was to review the latest research to better understand the mechanisms behind the 'magic' of bariatric surgery. Replication of these effects in a non-surgical manner remains one of the ultimate challenges for the...

  3. Postoperative intravenously administered iron sucrose versus postoperative orally administered iron to treat post-bariatric abdominoplasty anaemia (ISAPA): the study protocol for a randomised controlled trial

    OpenAIRE

    Montano-Pedroso, Juan Carlos; Garcia, Elvio Bueno; Novo, Neil Ferreira; Veiga, Daniela Francescato; Ferreira, Lydia Masako

    2016-01-01

    Background Anaemia and iron deficiency are common complications following post-bariatric abdominoplasty. Given the low oral absorbability of iron resulting from bariatric surgery, it has been hypothesised that postoperative intravenously administered iron supplementation could be used to treat anaemia and to prevent the development of iron deficiency in these patients. Methods/Design In this multicentre open-label randomised clinical trial, 56 adult women undergoing post-bariatric anchor-line...

  4. Effect of an Office-Based Surgical Safety System on Patient Outcomes

    OpenAIRE

    Rosenberg, Noah M.; Urman, Richard Dennis; Gallagher, Sean; Stenglein, John Joseph; Xiaoxia LIU; Shapiro, Fred E.

    2012-01-01

    Objective: To implement a customizable checklist in an interdisciplinary, team-based plastic surgery setting to reduce surgical complications. Methods: We examined the effects on patient outcomes and documentation of a customizable, office-based surgical safety checklist. On the basis of the World Health Organization Surgical Safety Checklist, we developed a 28-element, perioperative checklist for use in the office-based surgical setting. The checklist was implemented in an office-based plast...

  5. 3-D Storybook: Effects on Surgical Knowledge and Anxiety Among Four- to Six-Year-Old Surgical Patients.

    Science.gov (United States)

    Macindo, John Rey B; Macabuag, Katherine R; Macadangdang, Carlo Miguel P; Macaranas, Margaux Valerie S; Macarilay, Marianne Jezelle Jem T; Madriñan, Natasha Nikki M; Villarama, Rouena S

    2015-07-01

    Inadequate surgical knowledge potentiates anxiety; however, no methodology simultaneously addresses anxiety and surgical knowledge. Our quasi-experimental study determined the effectiveness of a three-dimensional (3-D) storybook in increasing surgical knowledge and decreasing anxiety among young children scheduled for planned or required major surgeries. We studied 20 randomly assigned participants who received either the 3-D storybook or traditional health teaching. A presurgical knowledge questionnaire and modified Yale Preoperative Anxiety Scale assessed surgical knowledge and anxiety. Data were analyzed with one-way and repeated-measures multivariate analysis of variance. Results showed that both groups had higher knowledge scores (F = 8.94; P = .008) and lower anxiety scores (F = 5.13; P = .036) after the intervention. The children who received information from the 3-D storybook exhibited a significantly higher posttest knowledge score (F = 11.71; P = .003) and lower anxiety score (F = 10.05; P = .005) than the traditionally educated group of children. The 3-D storybook effectively increased surgical knowledge and decreased anxiety and could be used as an alternative method to prepare pediatric surgical patients. PMID:26119618

  6. Surgical complications associated with primary closure in patients with diabetic foot osteomyelitis

    Directory of Open Access Journals (Sweden)

    Esther García-Morales

    2012-09-01

    Full Text Available Background: The aim of this study was to determine the incidence of complications associated with primary closure in surgical procedures performed for diabetic foot osteomyelitis compared to those healed by secondary intention. In addition, further evaluation of the surgical digital debridement for osteomyelitis with primary closure as an alternative to patients with digital amputation was also examined in our study. Methods: Comparative study that included 46 patients with diabetic foot ulcerations. Surgical debridement of the infected bone was performed on all patients. Depending on the surgical technique used, primary surgical closure was performed on 34 patients (73.9%, Group 1 while the rest of the 12 patients were allowed to heal by secondary intention (26.1%, Group 2. During surgical intervention, bone samples were collected for both microbiological and histopathological analyses. Post-surgical complications were recorded in both groups during the recovery period. Results: The average healing time was 9.9±SD 8.4 weeks in Group 1 and 19.1±SD 16.9 weeks in Group 2 (p=0.008. The percentage of complications was 61.8% in Group 1 and 58.3% in Group 2 (p=0.834. In all patients with digital ulcerations that were necessary for an amputation, a primary surgical closure was performed with successful outcomes. Discussion: Primary surgical closure was not associated with a greater number of complications. Patients who received primary surgical closure had faster healing rates and experienced a lower percentage of exudation (p=0.05, edema (p<0.001 and reinfection, factors that determine the delay in wound healing and affect the prognosis of the surgical outcome. Further research with a greater number of patients is required to better define the cases for which primary surgical closure may be indicated at different levels of the diabetic foot.

  7. Outcomes of early physiotherapy in patients with cerebral aneurysms treated by surgical clipping or endovascular embolization☆

    OpenAIRE

    Guclu-Gunduz, Arzu; Bilgin, Sevil; KÖSE, Nezire; Oruckaptan, Hakan

    2012-01-01

    Early physiotherapy was given to 124 patients with ruptured or unruptured cerebral aneurysms who were treated by surgical clipping or endovascular embolization. Patients were divided into four groups according to their Hunt and Hess grade at admission and aneurysm treatment modality: Group 1, Hunt and Hess grade ≤ II and surgical clipping; Group 2, Hunt and Hess grade ≤ II and endovascular embolization; Group 3, Hunt and Hess grade ≥ III and surgical clipping; Group 4, Hunt and Hess grade ≥ I...

  8. Assessment of surgical risk in colo-rectal cancer patients: POSSUM or ACPGBI?

    OpenAIRE

    Goulart, A; Martins, S

    2013-01-01

    Introduction: Several models have been developed with the purpose of predicting surgical risk of patients submitted to colorectal cancer surgery. However, to date, there isn’t any model that fulfills this purpose in a satisfactory manner. Methods: We consulted the clinical processes of 345 patients, who were submitted to surgical colorectal cancer treatment at the General Surgery department in Hospital de Braga, and calculated surgical risk based on the following risk assessment scal...

  9. Clinicopathological Parameters Associated with Surgical Site Infections in Patients who Underwent Pancreatic Resection

    OpenAIRE

    Nanashima, Atsushi; Abo, Takafumi; Arai, Junichi; Oyama, Shousaburo; Mochinaga, Koji; Matsumoto, Hirofumi; Takagi, Katsunori; Kunizaki, Masaki; To, Kazuo; Takeshita, Hiroaki; HIDAKA, SHIGEKAZU; Nagayasu, Takeshi

    2014-01-01

    Background/Aims: To clarify parameters associated with postoperative surgical site infection (SSI) after pancreatectomy, we examined clinicopathological and surgical records in 186 patients who underwent pancreatectomy at a single academic institute. Methodology: Patient demographics, liver functional parameters, histological findings, surgical records and post-hepatectomy outcomes during hospitalization were compared between the non-SSI and SSI group, in which SSIs included superficial and d...

  10. Non-invasive ventilation in surgical patients in a district general hospital.

    Science.gov (United States)

    Badiger, R; Green, M; Hackwood, H; Palin, C; Shee, C D

    2004-10-01

    We have retrospectively audited the use of non-invasive ventilation (NIV) in surgical patients. We analysed the case notes of 38 surgical patients who received NIV over a 9-month period. Twenty-three patients received NIV following emergency surgery, eight after elective surgery, and seven did not have an operation. Co-morbidity was common. The commonest reasons for starting NIV were chest infection, acute respiratory distress syndrome and pulmonary oedema. NIV was often only one aspect of treatment in surgical patients with complex medical problems. With intensive support from the critical care outreach team, NIV can be safely delivered on a surgical ward, and may sometimes prevent intensive care unit admission. Use of NIV on the intensive care unit may obviate the need for tracheal intubation in some patients. In very ill surgical patients with a poor prognosis, NIV was frequently used as the ceiling of respiratory support. PMID:15488054

  11. Predictive Score Card in Lumbar Disc Herniation: Is It Reflective of Patient Surgical Success after Discectomy?

    Science.gov (United States)

    Azimi, Parisa; Benzel, Edward C; Montazeri, Ali

    2016-01-01

    Does the Finneson-Cooper score reflect the true value of predicting surgical success before discectomy? The aim of this study was to identify reliable predictors for surgical success two year after surgery for patients with LDH. Prospective analysis of 154 patients with LDH who underwent single-level lumbar discectomy was performed. Pre- and post-surgical success was assessed by the Oswestry Disability Index (ODI) over a 2-year period. The Finneson-Cooper score also was used for evaluation of the clinical results. Using the ODI, surgical success was defined as a 30% (or more) improvement on the ODI score from the baseline. The ODI was considered the gold standard in this study. Finally, the sensitivity, specificity, and positive and negative predictive power of the Finneson-Cooper score in predicting surgical success were calculated. The mean age of the patients was 49.6 (SD = 9.3) years and 47.4% were male. Significant improvement from the pre- to post-operative ODI scores was observed (P < 0.001). Post-surgical success was 76.0% (n = 117). The patients' rating on surgical success assessments by the ODI discriminated well between sub-groups of patients who differed with respect to the Finneson-Cooper score. Regarding patients' surgical success, the sensitivity, specificity, and accuracy of the Finneson-Cooper ratings correlated with success rate. The findings indicated that the Finneson-Cooper score was reflective of surgical success before discectomy. PMID:27100287

  12. Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk

    DEFF Research Database (Denmark)

    Jie, Bin; Jiang, Zhu-Ming; Nolan, Marie T;

    2012-01-01

    This multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002).......This multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002)....

  13. Radioisotopic monitoring of esophageal motility in patients with achalasia cardiae after surgical treatment

    International Nuclear Information System (INIS)

    Results of the radioisotope esophageal motility studies in patients after surgical treatment of achalasia are presented. 28 patients were studied. In both group of the patients (after Belsey-Mark and modified Nissen antireflux surgical techniques) slightly delayed esophageal transit time was found. Mean transit time of the esophagus proved to be a useful practical parameter. This simple, noninvasive, physiological radioisotope technique is recommended for follow-up studies of patients after gastroesophageal surgery. (N.T.). 10 refs., 2 figs

  14. A comparative analysis of Type 2 diabetes and binge eating disorder in a bariatric sample.

    Science.gov (United States)

    Webb, Jennifer B; Applegate, Katherine L; Grant, John P

    2011-08-01

    An emerging literature has illuminated an important link between Type 2 diabetes mellitus (DM) and binge eating disorder (BED) within obese cohorts. However, prior work has not examined this relationship specifically in a weight loss surgery (WLS) sample or fully explored potential psychosocial factors associated with this co-occurrence. Therefore, the present investigation sought to identify socio-demographic (i.e. age, education, BMI, ethnicity, gender, age of obesity onset) and psychological (i.e. depressive symptoms, hedonic hunger/food locus of control beliefs, severity of binge eating-related cognitions) correlates of the co-occurrence of Type 2 DM and BED among bariatric surgery candidates. An archival sample of 488 patients seeking surgical treatment for clinical obesity completed a standard battery of pre-operative psychosocial measures. The presence of BED was evaluated using a semi-structured clinical interview based on the DSM-IV TR (APA, 2000) and was further corroborated by responses on the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R; Spitzer, Yanovski, & Marcus, 1993). Results indicated that 8.2% of the sample was classified as having both Type 2 DM and BED concurrently. A multivariate logistic regression model revealed that in addition to other psychological (e.g., binge eating-related cognitions, hedonic hunger) and demographic variables (i.e. male gender), African American ethnicity (OR=3.3: 1.41-7.73) was a particularly robust indicator of comorbid status. Findings support and extend previous health disparity research urging greater attention to the needs of traditionally underserved, at-risk populations seeking treatment for obesity complicated by dysregulated eating and metabolism. Additionally, these preliminary results underscore the relevance of considering the potential benefits of providing quality comprehensive pre- and post-operative psychological care among bariatric patients towards optimizing both short- and long

  15. A Systematic Review of Risk Factors Associated with Surgical Site Infections among Surgical Patients

    OpenAIRE

    Korol, Ellen; Johnston, Karissa; Waser, Nathalie; Sifakis, Frangiscos; Jafri, Hasan S.; Lo, Mathew; Moe H. Kyaw

    2013-01-01

    Importance Surgical site infection (SSI) complicates 2-5% of surgeries in the United States. Severity of SSI ranges from superficial skin infection to life-threatening conditions such as severe sepsis, and SSIs are responsible for increased morbidity, mortality, and economic burden associated with surgery. Staphylococcus aureus (S. aureus) is a commonly-isolated organism for SSI, and methicillin-resistant S. aureus SSI incidence is increasing globally. Objective The objective of this systemat...

  16. Surgical acute abdomen in elderly patients. Abdomen agudo quirúrgico en el anciano.

    OpenAIRE

    Lidia Torres Ajá; Angel Delfín Rodríguez Sarria; Julio Pablo Miñoso Andina; Itengré Ouédraogo

    2004-01-01

    Fundaments : The surgical acute abdomen usually is the most frequent cause of abdominal surgery of urgency in t he old one, with the high mortality in spite of the modern surgical technologies. Objective: To evaluate the surgery of the surgical acute abdomen in the old one. Method: Appears a prospectivo descriptive study that includes 102 patients of 60 years or more who underwent surgery at the ¨Dr Gustavo...

  17. Initial Weight Loss after Restrictive Bariatric Procedures May Predict Mid-Term Weight Maintenance: Results From a 12-Month Pilot Trial

    OpenAIRE

    Nikolić, Marko; Kruljac, Ivan; Kirigin, Lora; Mirošević, Gorana; Ljubičić, Neven; Nikolić, Borka Pezo; Bekavac-Bešlin, Miroslav; Budimir, Ivan; Vrkljan, Milan

    2015-01-01

    Background: Bariatric procedures are effective options for weight loss (WL) in the morbidly obese. However, some patients fail to lose any weight after bariatric surgery, and mid-term weight maintenance is variable. The aim of this study was to investigate whether initial WL could predict mid-term weight maintenance.

  18. Economic considerations for bariatric surgery and morbid obesity.

    Science.gov (United States)

    Frezza, Eldo E; Wacthell, Mitchell; Ewing, Bradley

    2009-01-01

    The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years. PMID:21935309

  19. Management experience of surgical complications of dengue fever patients at hameed latif hospital, Lahore

    International Nuclear Information System (INIS)

    Objective: This study was designed to determine the frequency, pattern and management of surgical complications among patients with dengue fever. Design: Cross sectional study design was used. Settings: Hameed Latif Hospital, Lahore. Methods: From March - 2009 to December - 2011 total of 875 patients of dengue fever with positive anti-dengue immunoglobulin M (IgM) serology were included in this study. Complete blood count, liver function test, blood urea, serum creatinin, serum amylase were determined in all patients admitted with the diagnosis of dengue fever. All the patients were evaluated for the presence of surgical complications by physical examination and real time ultrasound abdomen. Patient had CT - abdomen and brain where it was required. Patients having surgical complications were managed in dengue ward and ICU with multidisciplinary approach. Data entry and analysis was done by using SPSS 16. Results: Among 875 patients with dengue fever, 491 (43.9%) patients were men and 384 (48.9%) were women with age range (18 - 70) years. Surgical complications were detected in 121 (13.8%) patients: acute cholecystitis in 46 (5.26%); acute pancreatitis in 19 (2.17%); injection abscess in 14 (1.6%); gastrointestinal bleed in 24 (2.74%); forearm compartment syndrome in 3 (0.34%); abdominal compartment syndrome in 2 (0.23%) and acute appendicitis, 4 (0.46%) patients. Cerebral bleed, retroperitoneal hematoma, abdominal wall hematoma and splenic rupture was seen among 3 (0.34%), 2 (0.23%), 3 (0.34%), and 1 (0.11%) patients, respectively. Out of 121 patients surgery was done in 20 (16.5%) patients while rest of 101 (83.5%) patients were managed conservatively. Two patients died. Conclusion: Surgical complications are common and should be suspected in every patient with dengue fever. Majority of surgical manifestations of dengue fever were managed conservatively however surgical intervention was done in certain cases with favorable outcome. (author)

  20. Psychological and health comorbidities before and after bariatric surgery: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Susana Sofia Pereira da Silva

    2013-12-01

    Full Text Available INTRODUCTION: Morbid obesity has multiple implications for psychological and physical health. Bariatric surgery has been selected as the treatment of choice for this chronic disease, despite the controversial impact of the surgery on psychosocial health. The objective of this study was to describe candidates for bariatric surgery and analyze changes in weight, psychopathology, personality, and health problems and complaints at 6- and 12- month follow-up assessments. METHODS: Thirty obese patients (20 women and 10 men with a mean age of 39.17±8.81 years were evaluated in different dimensions before surgery and 6 and 12 months after the procedure. RESULTS: Six and 12 months after bariatric surgery, patients reported significant weight loss and a significant reduction in the number of health problems and complaints. The rates of self-reported psychopathology were low before surgery, and there were no statistically significant changes over time. The conscientiousness, extraversion, and agreeableness dimensions increased, but neuroticism and openness remained unchanged. All changes had a medium effect size. CONCLUSIONS: Our results suggest that patients experience significant health improvements and some positive personality changes after bariatric surgery. Even though these findings underscore the role of bariatric surgery as a relevant treatment for morbid obesity, more in-depth longitudinal studies are needed to elucidate the evolution of patients after the procedure.

  1. Results of surgical treatment in patients with local recurrences of uterine sarcomas

    Directory of Open Access Journals (Sweden)

    I. V. Matrosova

    2011-01-01

    Full Text Available The results of treatment were studied in 95 patients with local recurrences of uterine sarcomas, who had been treated at the N.N. Blokhin Russian Cancer Research Center in 1972 to 2010. Two patient groups were comparatively analyzed after surgical and conservative (chemo- and radiotherapy treatments. Overall survival was found to be significantly higher in the group of patients who had undergone surgical treatment.

  2. Triaging early-stage lung cancer patients into non-surgical pathways: who, when, and what?

    OpenAIRE

    Sroufe, Rameses; Kong, Feng-Ming

    2015-01-01

    More lung cancer patients are being diagnosed at an earlier stage due to improved diagnostic imaging techniques, a trend that is expected to accelerate with the dissemination of lung cancer screening. Surgical resection has always been considered the standard treatment for patients with early-stage non-small cell lung cancer (NSCLC). However, non-surgical treatment options for patients with early-stage NSCLC have evolved significantly over the past decade with many new and exciting alternativ...

  3. Imagem corporal, ansiedade e depressão em pacientes obesos submetidos à cirurgia bariátrica Body image, anxiety and depression in obese patients submitted to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Sebastião Sousa Almeida

    2012-04-01

    Full Text Available Pacientes obesos mórbidos têm recorrido à cirurgia bariátrica como um recurso eficaz para perder peso. Entretanto, este procedimento pode causar alterações comportamentais significativas. O objetivo deste trabalho foi investigar os níveis de ansiedade e depressão, assim como as mudanças sofridas na percepção da imagem corporal em pacientes obesos submetidos à cirurgia bariátrica em três momentos: pré-operatório, 6 meses e 12 meses após a cirurgia. Trata-se de um estudo do tipo prospectivo longitudinal, de abordagem quantitativa. No estudo foram aplicados os Inventários de Depressão e Ansiedade de Beck e a Escala Brasileira de Figuras de Silhuetas para Adultos. A cirurgia diminuiu significativamente tanto o índice de massa corporal dos pacientes quanto a insatisfação com a sua imagem corporal. Essa perda de peso e diminuição da insatisfação com a imagem corporal foi acompanhada de redução nos níveis de ansiedade e depressão, o que sugere que estes são fatores importantes no quadro obesidade.Morbidly obese patients often have resorted to bariatric surgery as an effective resource to be used for weight loss. However, this procedure can cause significant behavioral changes. The objective of this study was to investigate levels of anxiety and depression, as well as the changes suffered in the perception of body image in obese patients undergoing bariatric surgery at three different times: preoperatively, 6 months and 12 months after surgery. This is a prospective longitudinal study of a quantitative approach. The study used the Beck Depression Inventory, the Beck Anxiety Inventory and the Brazilian Scale of Figures Silhouettes for Adults. Surgery significantly decreased both the body mass index of patients and dissatisfaction with their body image. This weight loss and decreased body image dissatisfaction was accompanied by reduced levels of anxiety and depression, suggesting that these are important factors in the

  4. Effects of Bariatric Surgery on Human Small Artery Function

    Science.gov (United States)

    Aghamohammadzadeh, Reza; Greenstein, Adam S.; Yadav, Rahul; Jeziorska, Maria; Hama, Salam; Soltani, Fardad; Pemberton, Phil W.; Ammori, Basil; Malik, Rayaz A.; Soran, Handrean; Heagerty, Anthony M.

    2013-01-01

    Objectives The aim of this study was to investigate the effects of bariatric surgery on small artery function and the mechanisms underlying this. Background In lean healthy humans, perivascular adipose tissue (PVAT) exerts an anticontractile effect on adjacent small arteries, but this is lost in obesity-associated conditions such as the metabolic syndrome and type II diabetes where there is evidence of adipocyte inflammation and increased oxidative stress. Methods Segments of small subcutaneous artery and perivascular fat were harvested from severely obese individuals before (n = 20) and 6 months after bariatric surgery (n = 15). Small artery contractile function was examined in vitro with wire myography, and perivascular adipose tissue (PVAT) morphology was assessed with immunohistochemistry. Results The anticontractile activity of PVAT was lost in obese patients before surgery when compared with healthy volunteers and was restored 6 months after bariatric surgery. In vitro protocols with superoxide dismutase and catalase rescued PVAT anticontractile function in tissue from obese individuals before surgery. The improvement in anticontractile function after surgery was accompanied by improvements in insulin sensitivity, serum glycemic indexes, inflammatory cytokines, adipokine profile, and systolic blood pressure together with increased PVAT adiponectin and nitric oxide bioavailability and reduced macrophage infiltration and inflammation. These changes were observed despite the patients remaining severely obese. Conclusions Bariatric surgery and its attendant improvements in weight, blood pressure, inflammation, and metabolism collectively reverse the obesity-induced alteration to PVAT anticontractile function. This reversal is attributable to reductions in local adipose inflammation and oxidative stress with improved adiponectin and nitric oxide bioavailability. PMID:23665100

  5. Radioisotope monitoring of gastro-esophageal reflux in patients with achalasia cardiae after surgical treatment

    International Nuclear Information System (INIS)

    Results of a radioisotope method of the gastro-esophageal reflux are presented in patients with achalasia cardiae after different types of surgical treatment. Both Belsey-Mark and modified Nissen techniques are effective in preventing spontaneous gastroesophageal reflux, however 2 patients after Nissen fundoplication demonstrated gastro-esophageal reflux provoked by abdominal compression. This simple, noninvasive and physiologic method is an appropriate diagnostic tool for evaluating the efficiency of different anti reflux surgical techniques and is recommended for follow-up studies of patients after gastro-esophageal surgical intervention. (N.T.). 8 refs., 1 fig

  6. Bariatric surgery in type 1 diabetes mellitus: long-term experience in two cases

    Directory of Open Access Journals (Sweden)

    Nuria Fuertes-Zamorano

    2013-08-01

    Full Text Available In patients with obesity and type 2 diabetes, recommendations for bariatric surgery are well established. However, no consensus exists regarding its role for the management of patients with type 1 diabetes and morbid obesity. We present the long-term follow-up of two women with type 1 diabetes, morbid obesity and associated comorbidities, who underwent malabsorptive bariatric surgery. More than four years after the procedure, both have a body mass index (BMI within the normal range and HbA1c levels below 7%. Also, they have been able to reduce their insulin requirements in more than 50%, their associated comorbidities have disappeared, and their overall quality of life has significantly improved. We compare our results with other recently published ones, emphasizing potential indications of bariatric surgery for patients with type 1 diabetes.

  7. Evaluation of 30 patients with gynecomastia surgically treated

    Directory of Open Access Journals (Sweden)

    Nurettin Yiyit

    2013-10-01

    Conclusions; Surgery is the most effective  treatment of gynecomastia. The most suitable surgical tecnique should be selected according to the skin redundancy. The target always must be breast reduction by the tecnique to provide the best symmetry and leave at least scar.

  8. Economic considerations for bariatric surgery and morbid obesity

    Directory of Open Access Journals (Sweden)

    Eldo E Frezza

    2009-12-01

    Full Text Available Eldo E Frezza, Mitchell Wacthell1, Bradley Ewing21Center for Metabolic Disease and Texas Tech University, Department of Pathology, 2Rawls Business School, Texas Tech University, Lubbock, TX, USAAbstract: The obesity epidemic is also an economic tragedy. This analysis evaluates the economic effects and the potential to improve the well-being of both individual and societal wealth. Econometric techniques should carefully assess the degree to which obesity affects declines in business output, employment, income, and tax revenues at the regional and national levels. Microeconomics assesses lost productivity and associated wages and profit. Macroeconomics assesses trends associated with employment, inflation, interest rates, money supply, and output. To decrease the adverse economic consequences of the obesity epidemic, policy makers must emphasize bariatric surgery as a cost-effective option for qualified patients. Early intervention, education, and tax rebates for obese individuals who undergo bariatric surgery and for medical centers and doctors would likely have positive economic effects on the whole economy in a few years.Keywords: bariatric surgery, morbid obesity, economics

  9. Surgical treatment of Peyronie's disease: choosing the best approach to improve patient satisfaction

    Institute of Scientific and Technical Information of China (English)

    Paulo H. Egydio

    2008-01-01

    Aim: To discuss important points on medical history, preoperative evaluation, real expectations, and selection of the appropriate surgical procedure to improve patient satisfaction after surgical procedures for Peyronie's disease. Methods:Recent advances in approaches to Peyronie's disease are discussed based on the literature and personal experiences.Issues concerning surgical indication, patient selection, surgical techniques, and grafting are discussed. Lengthening procedures on the convex side of the penile curvature by means of grafting offer the best possible gain from a reconstruction standpoint. Penile rectification and rigidity are required to achieve a completely functional penis. Most patients experience associated erectile dysfunction (ED), and penile straightening alone may not be enough to restore complete function. Twenty-five patients were submitted to total penile reconstruction on length and girth with concomitant penile prosthesis implant. The maximum length restoration was possible and limited by the length of the maintained the penis straight. No infections occurred. Sexual intercourse was restored in all patients and all reported recovered self-esteem. Conclusion: Improving patient satisfaction with the surgical treatment includes proper preoperative evaluation on stable disease, penile shortening, vascular and erectile status, patient decision and selection as well as extensive discussion on surgical technique for restoring functional penis (length and rigidity). Length and girth

  10. Patient effective dose and radiogenic risks from fluoroscopically assisted surgical reconstruction of femoral fractures

    International Nuclear Information System (INIS)

    The objectives were to assess patient effective radiation dose from fluoroscopically guided surgical reconstruction of femoral fractures and provide normalized data for the estimation of patient effective dose and risks associated with such procedures performed in any laboratory. The fluoroscopic control required during surgical reconstruction of femoral fractures was classified into two types identified by beam orientation, i.e., posterior-anterior (PA) and lateral cross-table (LC) exposures. The duration and the dose area product (DAP) of each exposure were monitored in 24 patients with femoral fractures. Patient dose per DAP unit and per minute of fluoroscopy were measured at 14 radiosensitive organs/tissues using an anthropomorphic phantom and thermoluminescence dosimetry. The typical effective dose to patients with femoral fracture treated surgically in our institution was 11.6-21.7 μSv. This effective dose is estimated to cause an excess of 1.4 fatal cancers per million patients treated, and an excess of 0.4 hereditary disorders per million of births. Induction of deterministic skin injuries to treated patients is highly improbable at the dose levels found in this study. Patient effective dose and associated risks from a typical fluoroscopically guided surgical fixation of femoral fracture are low. However, they may be significantly elevated if treated patients are young individuals and/or the fluoroscopic exposure is prolonged. The present data may be used to determine effective dose to patients undergoing surgical reconstruction of femoral fracture in any institution. (authors)

  11. Surgical outcome in patients with cervical ossified posterior longitudinal ligament: A single institutional experience

    OpenAIRE

    Kommu, Rao; B P Sahu; Purohit, A. K.

    2014-01-01

    Objective: Ossification of the posterior longitudinal ligament (OPLL) is a complex multi-factorial disease process having both metabolic and biomechanical factors. The role of surgical intervention as well as the choice of approach weather anterior or posterior is ambiguous. The objective of this study was to assess the surgical out come and post operative functional improvement in patients with cervical OPLL at a tertiary care centre. Patients and Methods: This prospective study included 63 ...

  12. Surgical complications associated with primary closure in patients with diabetic foot osteomyelitis

    OpenAIRE

    García-Morales, Esther; Lázaro-Martínez, Jose Luis; Aragón-Sánchez, Javier; Almudena, Cecilia-Matilla; García-Álvarez, Yolanda; Beneit-Montesinos, Juan Vicente

    2012-01-01

    Background: The aim of this study was to determine the incidence of complications associated with primaryclosure in surgical procedures performed for diabetic foot osteomyelitis compared to those healed bysecondary intention. In addition, further evaluation of the surgical digital debridement for osteomyelitis withprimary closure as an alternative to patients with digital amputation was also examined in our study.Methods: Comparative study that included 46 patients with diabetic foot ulcerati...

  13. Management of asymptomatic carotid stenosis in patients undergoing general and vascular surgical procedures

    OpenAIRE

    Paciaroni, M; Caso, V; Acciarresi, M; Baumgartner, R.; Agnelli, G.

    2005-01-01

    Current available data do not seem to support the strategy for carotid endarterectomy prior to surgical intervention in patients with asymptomatic carotid stenosis. However, in patients with coronary artery disease, synchronous carotid endarterectomy and coronary artery bypass grafting should be considered where there is a proven surgical risk of 60% or bilateral carotid stenosis >75% on the same side as the most severe stenosis. Clarification of the optimal strategy requires an adequately po...

  14. Results of surgical treatment of massive localized lymphedema in severely obese patients

    OpenAIRE

    Wilson Cintra Júnior; Miguel Luiz Antonio Modolin; Rodrigo Itocazo Rocha; Thadeu Rangel Fernandes; Ariel Barreto Nogueira; Rolf Gemperli

    2014-01-01

    OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL) in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, ...

  15. [Lipid peroxidation and its interrelation with the personality characteristics of surgical patients].

    Science.gov (United States)

    Man'kov, Iu U; Sharapov, G N; Khyshov, V B; Pal'chikov, V P; Alekseenko, G M

    1991-04-01

    The article deals with the exam results of 42 pre- and postoperative surgical patients. The reactivity of peroxide oxidation of lipids plays an important role in regulation of adaptive process of surgical patients. The authors emphasize the role of anxiety state as one of the most intimate and obligate mechanisms of psychologic stress. The anxiety rising process influences upon the formation of typical psychophysiological correlations that lead to the intensification of lipid oxidation. PMID:1887607

  16. Psycho-social and general health status after surgical treatment in cancer patients: An Indian prospect

    OpenAIRE

    Alay P Brahmbhatt; Bothara, Sunil B.; Ashish M Kaushal

    2012-01-01

    Objective : The objective of this study was to evaluate the psychological, social well-being and general state of health in patients suffering from cancer, before and after surgical treatment. Experimental/Computational Work Done: Subjects were selected from HCG MEDI-SURGE Hospital, India, who had undertaken surgical treatment for various cancers. The present study consists of a single centered, behavioral, prospective study designed to evaluate 100 cancer patients with their psycho-social an...

  17. Endoscopic Evaluation of Surgically Altered Bowel in Patients with Inflammatory Bowel Diseases

    OpenAIRE

    Sinh, Preetika; Shen, Bo

    2015-01-01

    Abstract: Patients with inflammatory bowel diseases often undergo surgical procedures for medically refractory disease or colitis associated dysplasia. Endoscopic evaluation of the surgically altered bowel is often needed to assess for disease recurrence, its severity, and for therapy. It is important to obtain and review the operative report and abdominal imaging before performing the endoscopy. Diagnostic and therapeutic endoscopy can be safely performed in most patients with inflammatory b...

  18. [Surgical treatment of patients with cancer of the larynx with lesions of the anterior commissure].

    Science.gov (United States)

    Bariliak, Iu R

    1990-01-01

    Eighty two patients with glottic tumors extending to the anterior commissure underwent surgical treatment: 11 patients for cordectomy in its classic form, 11 patients for fronto-lateral cordectomy, 59 patients for extended cordectomy, and 1 patient for hemilaryngectomy according to Otan. Analysis of the postoperative clinical state of the patients suggests that surgery for vocal cord carcinoma involving the anterior commissure should not necessarily include tracheostomy and laryngeal tamponade. PMID:2316118

  19. Association between nutrient adequacy and psychosocial factors with overall rate of weight loss after bariatric surgery.

    Science.gov (United States)

    Vanoh, Divya; Shahar, Suzana; Mahmood, Nik Ritza Kosai Nik

    2015-01-01

    This was a cross-sectional study that investigated the relationship between nutrient intake and psychosocial factors with the overall rate of weight loss after bariatric surgery among patients who had undergone sleeve gastrectomy in University Kebangsaan Malaysia Medical Centre (UKMMC). Forty-three subjects (15 men and 28 women) were recruited for this study. Subjects completed assessment questionnaires including the Binge Eating Scale (BES), Beck Depression Inventory (BECK), Family Support Questionnaires, and the Index of Peer Relation (IPR). Results showed that the median overall rate of weight loss was 4.3±5.5 kg/month, which was lower when compared to the rate of weight loss at three months which was 5.0±5.6 kg/month. Pre-operative weight was the predictor of overall rate of weight loss (peating disorder (BED) and depression were also closely associated with each other after bariatric surgery (peating scale. The mean caloric and protein intake was very low, only 562±310 kcal/day and 29.6±16.1 g/day. The intake of vitamin A, B-1, B-2, B-3, B-12, C, folate, and iron met the Malaysian Recommended Nutrient Intake (RNI). However, the RNI for calcium, zinc, selenium, vitamin D, and vitamin E was not met. In conclusion, although bariatric surgery had many health benefits, several factors hindered weight loss after bariatric surgery. Health care professionals should closely monitor patients after bariatric surgery. PMID:26693745

  20. Endovascular stenting of carotid stenosis in patients at high surgical risk

    International Nuclear Information System (INIS)

    Objective: To evaluated the safety and complications of endovascular stenting for symptomatic carotid stenosis with surgical high risk. Methods: A series of 11 vessels in 9 patients at surgical high risk were treated by endovascular stenting. The complications during the procedures and postoperative periods were analyzed within one to five months. Results: All of the operations were successfully performed without any serious complications. During the follow-up period (averaging 6 months), there were no complications of TIAs, stokes and re-stenoses. Conclusions: The study suggests that endovascular stenting may be safe and effective for patients as surgical high risk, but further more study is needed

  1. The impact of a bariatric rehabilitation service on weight loss and psychological adjustment - study protocol

    Directory of Open Access Journals (Sweden)

    Hollywood Amelia

    2012-04-01

    Full Text Available Abstract Background Bariatric surgery is currently the most effective form of obesity management for those whose BMI is greater than 40 (or 35 with co morbidities. A minority of patients, however, either do not show the desired loss of excess weight or show weight regain by follow up. Research highlights some of the reasons for this variability, most of which centres on the absence of any psychological support with patients describing how although surgery fixes their body, psychological issues relating to dietary control, self esteem, coping and emotional eating remain neglected. The present study aims to evaluate the impact of a health psychology led bariatric rehabilitation service (BRS on patient health outcomes. The bariatric rehabilitation service will provide information, support and mentoring pre and post surgery and will address psychological issues such as dietary control, self esteem, coping and emotional eating. The package reflects the rehabilitation services now common place for patients post heart attack and stroke which have been shown to improve patient health outcomes. Methods/Design The study is a randomised control trial and patients will be allocated to receive either usual care or the bariatric rehabilitation service pre and post bariatric surgery. Follow up measures of weight loss and psychological issues will be taken at baseline (2 weeks preoperatively, 3, 6 and 12 months postoperatively. The contents of the bariatric service and the follow up measures are based on previous pilot work and have been developed further by the research team working closely with two patient support groups (BOSPA & WLSinfo. This study will take place in St Richard's Hospital in Chichester in the UK. Discussion It is predicted that a bariatric rehabilitation service will improve weight loss following surgery and will also facilitate changes in other psychological variables such as quality of life, dietary control, self esteem, coping and

  2. Barriers and Facilitators Associated with Non-Surgical Treatment Use for Osteoarthritis Patients in Orthopaedic Practice.

    Directory of Open Access Journals (Sweden)

    Stefanie N Hofstede

    Full Text Available International evidence-based guidelines for the management of patients with hip and knee osteoarthritis (OA recommend to start with (a combination of non-surgical treatments, and using surgical intervention only if a patient does not respond sufficiently to non-surgical treatment options. Despite these recommendations, there are strong indications that non-surgical treatments are not optimally used in orthopaedic practice. To improve the adoption of non-surgical treatments, more insight is needed into barriers and facilitators of these treatments. Therefore, this study assessed which barriers and facilitators are associated with the use and prescription of different non-surgical treatments before hip and knee OA in orthopaedic practice among patients and orthopaedic surgeons in the Netherlands.We performed two internet-based surveys among 172 orthopaedic surgeons and 174 OA patients. Univariate association and multivariable regression techniques are used to identify barriers and facilitators associated with the use of non-surgical treatments.Most barriers and facilitators among patients were associated with the use of physical therapy, lifestyle advice and dietary therapy. Among orthopaedic surgeons, most were associated with prescription of acetaminophen, dietary therapy and physical therapy. Examples of barriers and facilitators among patients included "People in my environment had positive experiences with a surgery" (facilitator for education about OA, and "Advice of people in my environment to keep on moving" (facilitator for lifestyle and dietary advice. For orthopaedic surgeons, examples were "Lack of knowledge about guideline" (barrier for lifestyle advice, "Agreements/ deliberations with primary care" and "Easy communication with a dietician" (facilitators for dietary therapy. Also the belief in the efficacy of these treatments was associated with increased prescription.Strategies to improve non-surgical treatment use in orthopaedic

  3. Ectopic adrenal tissue in the spermatic cord in pediatric patients: surgical implications

    Directory of Open Access Journals (Sweden)

    Roberto Mendez

    2006-04-01

    Full Text Available OBJECTIVE: To study the incidence and relevance of ectopic adrenal tissue in pediatric patients who underwent groin surgical explorations. MATERIALS AND METHODS: We studied 1120 patients with groin surgical explorations during a period of 8 consecutive years. Patients’ clinical data and histological findings were analyzed. RESULTS: We found ectopic adrenal tissue in 13 patients in 1120 groin surgical exploration (1.16%. Of the 13 cases, 5 were diagnosed as having undescended testes, 6 inguinal hernia and 2 communicating hydrocele. Median age at diagnosis was 5.6 years. Histological sections showed adrenal cortical tissue with no medulla present. CONCLUSION: Based on the clinical implications of those adrenal rests it is mandatory the removal of this ectopic tissue whenever encountered during surgical interventions in the groin region in children.

  4. Aortic rupture during reoperative bariatric surgery

    Directory of Open Access Journals (Sweden)

    Sorin Hostiuc

    2015-08-01

    Full Text Available Abstract Morbid obesity has become a very common problem worldwide, causing severe health-related consequences including cardiovascular or metabolic diseases, arthritis, sleep apnea, or an increased risk of cancer. Bariatric surgery was shown to be the only way to achieve sustainable weight loss and to decrease the frequency and severity of metabolic and cardiovascular comorbidities. The purpose of this article is to present a case of bariatric surgery complicated with lesion of the aorta with a lethal outcome.

  5. Pregnancy following bariatric requires special attention

    DEFF Research Database (Denmark)

    Renault, Kristina; Andersen, Lise Lotte Fischer; Kjær, Mette Karie Mandrup;

    2012-01-01

    In the latest years the number of pregnant women having undergone bariatric surgery before pregnancy has increased rapidly. In pregnancy, they seem to have a reduced risk of obesity-related complications but an increased risk of mechanical complications causing small bowel obstruction and...... complications due to malabsorption. This article reviews the effect of bariatric surgery before pregnancy on obstetric and neonatal outcomes and provides, based on the limited available evidence, recommendations for the management of pregnancy in these women....

  6. Maintaining weight loss after bariatric surgery: when the spectator role is no longer enough.

    Science.gov (United States)

    Jones, L; Cleator, J; Yorke, J

    2016-08-01

    Bariatric (weight loss) surgery is the gold standard treatment for severe obesity. Concern exists that patients are regaining weight in the longer term. Success and cost-effectiveness of surgery are threatened due to the re-emergence of related conditions such as diabetes. This exploratory qualitative study investigates patients' expectations and experiences of weight regain (WR) 2 years or more after Roux-en-Y gastric bypass (RYGB). Ten participants (two men and eight women) who experienced WR were interviewed between 2 and 6 years following surgery. Findings highlight that participants reacted to initial weight loss as passive spectators and were unprepared for subsequent WR. Their tolerability of WR reduced as the amount of regain increased, suggesting a 'line of tolerance' for WR. WR was influenced by a new vulnerability arising from weight loss over time, and participants struggled to manage their own weight actively as surgical effects waned. They considered self-management skills, and carer and professional support to be limited at the time when WR was most likely to occur. Degrees of tolerability are noted in individuals regaining weight after RYGB. More studies are needed to further understand these problems. Pre- and post-operative support and teaching patients self-management skills may be helpful to minimize WR. PMID:27273813

  7. Financial costs and patients’ perceptions of medical tourism in bariatric surgery

    Science.gov (United States)

    Kim, David H.; Sheppard, Caroline E.; de Gara, Christopher J.; Karmali, Shahzeer; Birch, Daniel W.

    2016-01-01

    Summary Many Canadians pursue surgical treatment for severe obesity outside of their province or country — so-called “medical tourism.” We have managed many complications related to this evolving phenomenon. The costs associated with this care seem substantial but have not been previously quantified. We surveyed Alberta general surgeons and postoperative medical tourists to estimate costs of treating complications related to medical tourism in bariatric surgery and to understand patients’ motivations for pursuing medical tourism. Our analysis suggests more than $560 000 was spent treating 59 bariatric medical tourists by 25 surgeons between 2012 and 2013. Responses from medical tourists suggest that they believe their surgeries were successful despite some having postoperative complications and lacking support from medical or surgical teams. We believe that the financial cost of treating complications related to medical tourism in Alberta is substantial and impacts existing limited resources. PMID:26574702

  8. Facial aesthetic surgical goals in patients of different cultures.

    Science.gov (United States)

    Rowe-Jones, Julian M

    2014-08-01

    The purpose of facial aesthetic surgery is to improve the patient's psychological well-being. To achieve this, the surgeon must understand the patient's body image and their aesthetic and psychological expectations. These factors must be judged in the context of their cultural background. The patient's cultural values must also be understood to optimize the doctor-patient relationship. PMID:25049120

  9. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients

    DEFF Research Database (Denmark)

    Schulman, S; Angerås, U; Bergqvist, D;

    2010-01-01

    The definition of major bleeding varies between studies on surgical patients, particularly regarding the criteria for surgical wound-related bleeding. This diversity contributes to the difficulties in comparing data between trials. The Scientific and Standardization Committee (SSC), through its...... subcommittee on Control of Anticoagulation, of the International Society on Thrombosis and Haemostasis has previously published a recommendation for a harmonized definition of major bleeding in non-surgical studies. That definition has been adopted by the European Medicines Agency and is currently used in...... several non-surgical trials. A preliminary proposal for a parallel definition for surgical studies was presented at the 54(th) Annual Meeting of the SSC in Vienna, July 2008. Based on those discussions and further consultations with European and North American surgeons with experience from clinical trials...

  10. Oral surgical treatment by erbium laser application in patients with the risk of bleeding

    Directory of Open Access Journals (Sweden)

    Tarasenko S.V.

    2013-09-01

    Full Text Available Aim: to analyze the erbium laser effects in oral surgery in patients with the risk of bleeding. There were selected 2 groups of patients for oral surgery treatment. Materials and methods. The first group included 31 patients with bleeding risk. In this group erbium laser radiation was used for the cut and tooth socket conditioning after tooth extraction. The second (control group of 43 patients without concomitant pathology was determined for conventional surgical treatment. Results. In the first group there was no postoperative bleeding, post-surgical pain and infection were prevented with no need for analgesics, and the wounds epithelization took 1-3 days. It takes less time than in control group. Conclusion. Application of erbium laser is a modern method which can be successfully used in surgical treatment of patients with the risk of bleeding.

  11. Surgical management of osteonecrosis of the femoral head in patients with sickle cell disease.

    Science.gov (United States)

    Kamath, Atul F; McGraw, Michael H; Israelite, Craig L

    2015-11-18

    Sickle cell disease is a known risk factor for osteonecrosis of the hip. Necrosis within the femoral head may cause severe pain, functional limitations, and compromise quality of life in this patient population. Early stages of avascular necrosis of the hip may be managed surgically with core decompression with or without autologous bone grafting. Total hip arthroplasty is the mainstay of treatment of advanced stages of the disease in patients who have intractable pain and are medically fit to undergo the procedure. The management of hip pathology in sickle cell disease presents numerous medical and surgical challenges, and the careful perioperative management of patients is mandatory. Although there is an increased risk of medical and surgical complications in patients with sickle cell disease, total hip arthroplasty can provide substantial relief of pain and improvement of function in the appropriately selected patient. PMID:26601059

  12. Bariatric support line: a prospective study of support line activity.

    Science.gov (United States)

    McDougall, Kirsten; Segaran, Ella; Sufi, Pratik; Heath, Dugal I

    2010-03-01

    In this prospective study, we examine the workload of the North London Obesity Surgery Service Bariatric telephone support line (BTSL) and its effects on service provision. Over a 3-month period (June to August 2008), a prospective record was kept of all calls, who they were from, whether the patient was presurgery or postsurgery, the type of procedure planned or undertaken, the nature of the enquiry, and the time taken to answer the query. Seventy-five (72%) calls were related to patients who were postsurgery and 29 (28%) presurgery. Patients scheduled for or having undergone Roux-en-Y gastric bypass accounted for 46 (44%) calls; 24 (23%) were preprocedure and 22 (21%) postprocedure. Patients scheduled for or having undergone gastric banding accounted for 56 (54%) calls; five (0.5%) were preprocedure and 51 (49%) postprocedure. Patients undergoing sleeve gastrectomy accounted for two (<1%) calls. Both calls were postprocedure. The reason for the support line enquiry was psychological support in 15 (14%) patients, questions postsurgery in 26 (25%), general enquiries in 27 (26%), and clinical enquiries in 36 (36%). This study of the BTSL has allowed us to identify areas of need within our bariatric population and improve the service we deliver. The changes we have made should lead to a better use of the team's time, greater patient compliance, and satisfaction as well as reduced complaints and litigation. PMID:19711140

  13. Resting State Brain Connectivity After Surgical and Behavioral Weight Loss

    Science.gov (United States)

    Lepping, Rebecca J.; Bruce, Amanda S.; Francisco, Alex; Yeh, Hung-Wen; Martin, Laura E.; Powell, Joshua N.; Hancock, Laura; Patrician, Trisha M.; Breslin, Florence J.; Selim, Niazy; Donnelly, Joseph E.; Brooks, William M.; Savage, Cary R.; Simmons, W. Kyle; Bruce, Jared M.

    2015-01-01

    OBJECTIVE We previously reported changes in food-cue neural reactivity associated with behavioral and surgical weight loss interventions. Resting functional connectivity represents tonic neural activity that may contribute to weight loss success. Here we explore whether intervention type is associated with differences in functional connectivity after weight loss. METHODS Fifteen obese participants were recruited prior to adjustable gastric banding surgery. Thirteen demographically matched obese participants were selected from a separate behavioral diet intervention. Resting state fMRI was collected three months after surgery/behavioral intervention. ANOVA was used to examine post-weight loss differences between the two groups in connectivity to seed regions previously identified as showing differential cue-reactivity after weight loss. RESULTS Following weight loss, behavioral dieters exhibited increased connectivity between left precuneus/superior parietal lobule (SPL) and bilateral insula pre- to post-meal and bariatric patients exhibited decreased connectivity between these regions pre- to post-meal (pcorrected<.05). CONCLUSIONS Behavioral dieters showed increased connectivity pre- to post-meal between a region associated with processing of self-referent information (precuneus/SPL) and a region associated with interoception (insula) whereas bariatric patients showed decreased connectivity between these regions. This may reflect increased attention to hunger signals following surgical procedures, and increased attention to satiety signals following behavioral diet interventions. PMID:26053145

  14. Improved patient specific seizure detection during pre-surgical evaluation.

    LENUS (Irish Health Repository)

    Chua, Eric C-P

    2011-04-01

    There is considerable interest in improved off-line automated seizure detection methods that will decrease the workload of EEG monitoring units. Subject-specific approaches have been demonstrated to perform better than subject-independent ones. However, for pre-surgical diagnostics, the traditional method of obtaining a priori data to train subject-specific classifiers is not practical. We present an alternative method that works by adapting the threshold of a subject-independent to a specific subject based on feedback from the user.

  15. Surgical approaches towards fertility preservation in young patients with early invasive cervical carcinoma.

    Science.gov (United States)

    Mandic, A; Novakovic, P; Nincic, D

    2009-01-01

    Cervical cancer still remains one of the major problems in developing countries. The last decade of 20th century has seen a trend towards more conservative surgical approaches in the treatment of early-stage disease in young patients. The trend of delaying childbearing, nowadays, increases preservation of fertility, and reproductive function is a major concern when counseling these young women with regard to the effects of treatment for cervical cancer. Radical trachelectomy, either with abdominal or vaginal surgical approach, showed promise as treatment option in young patients with early cervical cancer. The basic principle of such a surgical approach is an operation aiming at preserving the uterine body and removing the cervix, parametrium, with bilateral pelvic lymphadenectomy, and creating a utero-vaginal anastomosis, either laparoscopically or by laparotomy. Both surgical approaches are evaluated after a search of the relevant literature in Pub Med or Medline. PMID:20148446

  16. Lymphedema surgery: Patient selection and an overview of surgical techniques.

    Science.gov (United States)

    Allen, Robert J; Cheng, Ming-Huei

    2016-06-01

    Evaluation of the lymphedema patients with appropriate staging is fundamental for further treatment. Treatment includes compressive decongestive therapy for stage 0 and 1 patients, lymphovenous anastomosis for stage 1 and 2 patients, vascularized lymph node transfer for stage 2 and above patients. Wedge resection, liposuction, and the Charles procedure are alternatives or additions to physiological procedures. The selection of donor lymph node flap and recipient site depends on the patient's lymphedema status and surgeon's expertise. J. Surg. Oncol. 2016;113:923-931. © 2016 Wiley Periodicals, Inc. PMID:26846615

  17. EARLY COMPLICATIONS IN BARIATRIC SURGERY: incidence, diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Marco Aurelio SANTO

    2013-03-01

    Full Text Available Context Bariatric surgery has proven to be the most effective method of treating severe obesity. Nevertheless, the acceptance of bariatric surgery is still questioned. The surgical complications observed in the early postoperative period following surgeries performed to treat severe obesity are similar to those associated with other major surgeries of the gastrointestinal tract. However, given the more frequent occurrence of medical comorbidities, these patients require special attention in the early postoperative follow-up. Early diagnosis and appropriate treatment of these complications are directly associated with a greater probability of control. Method The medical records of 538 morbidly obese patients who underwent surgical treatment (Roux-en-Y gastric bypass surgery were reviewed. Ninety-three (17.2% patients were male and 445 (82.8% were female. The ages of the patients ranged from 18 to 70 years (average = 46, and their body mass indices ranged from 34.6 to 77 kg/m2. Results Early complications occurred in 9.6% and were distributed as follows: 2.6% presented bleeding, intestinal obstruction occurred in 1.1%, peritoneal infections occurred in 3.2%, and 2.2% developed abdominal wall infections that required hospitalization. Three (0.5% patients experienced pulmonary thromboembolism. The mortality rate was 0,55%. Conclusion The incidence of early complications was low. The diagnosis of these complications was mostly clinical, based on the presence of signs and symptoms. The value of the clinical signs and early treatment, specially in cases of sepsis, were essential to the favorable surgical outcome. The mortality was mainly related to thromboembolism and advanced age, over 65 years. Contexto A cirurgia bariátrica tem mostrado ser o método mais eficaz de tratamento da obesidade grave. No entanto, sua aceitação como terapia padrão-ouro ainda é questionada. As complicações cirúrgicas observadas no início do período p

  18. Surgical management of aneurysms of arteriovenous fistulae in hemodialysis patients: A case series

    OpenAIRE

    Valentine,

    2010-01-01

    Christopher SP Valentine, Olugbenga AworantiDepartment of Surgery, Cornwall Regional Hospital, Montego Bay, JamaicaBackground: One of the complications of arteriovenous (AV) fistulae used for hemodialysis is aneurysm formation and subsequent risk for rupture. Surgery is one of the modalities utilised to treat this condition.Methods: A retrospective review of medical records was done to identify patients managed surgically at our institution over a four-year period. The surgical procedures var...

  19. Lived experiences and challenges of older surgical patients during hospitalization for cancer: An ethnographic fieldwork

    OpenAIRE

    Uhrenfeldt, Lisbeth; Høybye, Mette Terp

    2014-01-01

    This paper explores the lived experiences of older surgical patients’ (aged 74 years and older) experienced challenges during a brief admission to hospital. Age, gender, polypharmacy, and the severity of illness are also factors known to affect the hospitalization process. For an ethnographic study using participant observation and interviews, surgical cancer patients (n9, aged 74 years and older) were recruited during admission to a Danish teaching hospital. Using ethnographic strategies of ...

  20. Development of an adhesive surgical ward round checklist: a technique to improve patient safety.

    LENUS (Irish Health Repository)

    Dhillon, P

    2012-02-01

    Checklists have been shown to improve patient outcomes. Checklist use is seen in the pre-operative to post-operative phases of the patient pathway. An adhesive checklist was developed for ward rounds due to the positive impact it could have on improving patient safety. Over an eight day period data were collected from five consultant-led teams that were randomly selected from the surgical department and divided into sticker groups and control groups. Across the board percentage adherence to the Good Surgical Practice Guidelines (GSPG) was markedly higher in the sticker study group, 1186 (91%) in comparison with the control group 718 (55%). There was significant improvement of documentation across all areas measured. An adhesive checklist for ward round note taking is a simple and cost-effective way to improve documentation, communication, hand-over, and patient safety. Successfully implemented in a tertiary level centre in Dublin, Ireland it is easily transferable to other surgical departments globally.

  1. Clinical Assessment of Fluid Balance is Incomplete for Colorectal Surgical Patients

    DEFF Research Database (Denmark)

    Tolstrup, J; Brandstrup, B

    2015-01-01

    BACKGROUND AND AIMS: Fluid balance for the surgical patient has been proven very important for the postoperative outcome and development of complications. The aim of this study was to evaluate, for the first time in modern times, the accordance between nurse-based fluid charting (cumulated fluid...... balance) and body weight change for general surgical patients. MATERIAL AND METHODS: This was a descriptive study with prospectively collected data from two clinical randomized multicenter trials. A total of 113 patients from American Society of Anesthesiology group I-III undergoing elective colorectal...... cumulated fluid balance and body weight change for colorectal surgical patients is relatively good for the first four postoperative days, however, with large uncertainty, whereas on the fifth and sixth postoperative day, the discrepancy is statistically and clinically significant. The fluid chart cannot...

  2. Effects of sedation with low-dosage dexmedetomidine on cardiac function in elderly surgical patients

    OpenAIRE

    Yu LANG; Tian-long WANG

    2011-01-01

    Objective To investigate the influence of continuous infusion of low-dose dexmedetomidine(DEX) for sedation on cardiac function index in elderly surgical patients,and assess the impacts on circulation.Methods Sixty elderly surgical patients were randomized into DEX group and control group(30 each).The sex ratio of the patients was 24/36(male/female),and age from 65 to 89 years.After the cannulation of left radial artery,the arterial pressure continuous cardiac output(APCO) monitor(Edwards,USA...

  3. Patient attitudes toward the use of surgical scrubs in a military hospital clinic

    OpenAIRE

    Lund, Jon D; Rohrer, James E; Goldfarb, Susana

    2008-01-01

    Objective To determine whether obstetrics and gynecology (ob/gyn) patients in a large military teaching hospital have a negative attitude toward the wearing of surgical scrubs by ob/gyn providers. Methods A convenience sample questionnaire on patient preferences, including two questions relating independently to military and civilian staff attire, was offered to clinic patients over a 2 month period. Univariate and multiple logistic regression analyses were used to identify patient groups les...

  4. Impact of Cosmetic Result on Selection of Surgical Treatment in Patients With Localized Prostate Cancer

    OpenAIRE

    Rojo, María Alejandra Egui; Martinez-Salamanca, Juan Ignacio; Maestro, Mario Alvarez; Galarza, Ignacio Sola; Rodriguez, Joaquin Carballido

    2014-01-01

    Objectives: To analyze the effect of cosmetic outcome as an isolated variable in patients undergoing surgical treatment based on the incision used in the 3 variants of radical prostatectomy: open (infraumbilical incision and Pfannestiel incision) and laparoscopic, or robotic (6 ports) surgery. Patients and methods: 612 male patients 40 to 70 years of age with a negative history of prostate disease were invited to participate. Each patient was evaluated by questionnaire accompanied by a set of...

  5. Clinical and surgical outcomes after lumbar laminectomy: An analysis of 500 patients

    OpenAIRE

    Mohamad Bydon; Mohamed Macki; Abt, Nicholas B.; Sciubba, Daniel M.; Jean-Paul Wolinsky; Timothy F Witham; Gokaslan, Ziya L.; Ali Bydon

    2015-01-01

    Background: The objective of this study is to determine the clinical and surgical outcomes following lumbar laminectomy. Methods: We retrospectively reviewed medical records of neurosurgical patients who underwent first-time, bilateral, 1-3 level laminectomies for degenerative lumbar disease. Patients with discectomy, complete facetectomy, and fusion were excluded. Results: Five hundred patients were followed for an average of 46.79 months. Following lumbar laminectomy, patients exper...

  6. Clinical review: How to optimize management of high-risk surgical patients

    OpenAIRE

    Pearse, Rupert M.; Rhodes, Andrew; Grounds, R Michael

    2004-01-01

    For many patients optimal perioperative care may require little or no additional medical management beyond that given by the anaesthetist and surgeon. However, the continued existence of a group of surgical patients at high risk for morbidity and mortality indicates an ongoing need to identify such patients and deliver optimal care throughout the perioperative period. A group of patients exists in whom the risk for death and serious complications after major surgery is in excess of 20%. The r...

  7. Cardiac surgery in grown-up congenital heart patients. Will the surgical workload increase?

    DEFF Research Database (Denmark)

    Klcovansky, J.; Søndergård, Lars; Helvind, M.; Andersen, H.O.

    2008-01-01

    The number of patients with grown-up congenital heart (GUCH) disease is steadily increasing. Although there is agreement that the medical service for GUCH patients should be expanded in coming years, it is still unknown whether this should also include the surgical service. In an attempt to...

  8. Lower Vitamin D Levels in Surgical Hyperparathyroidism versus Thyroid Patients

    OpenAIRE

    LINDEMAN, BRENESSA M.; PESCE, CATHERINE E.; Tsai, Hua-Ling; Somervell, Helina; UMBRICHT, CHRISTOPHER B.; Kowalski, Jeanne; Zeiger, Martha A.

    2014-01-01

    Low vitamin D levels have been shown to be associated with primary hyperparathyroidism, but it is unclear whether vitamin D deficiency may be an etiologic factor in the development of primary hyperparathyroidism. To investigate this, we compared preoperative vitamin D levels of patients undergoing surgery for primary hyperparathyroidism with those of patients undergoing surgery for benign thyroid disease. With Institutional Review Board approval, data were collected prospectively on patients ...

  9. Rapid prototyping for patient-specific surgical orthopaedics guides: A systematic literature review.

    Science.gov (United States)

    Popescu, Diana; Laptoiu, Dan

    2016-06-01

    There has been a lot of hype surrounding the advantages to be gained from rapid prototyping processes in a number of fields, including medicine. Our literature review aims objectively to assess how effective patient-specific surgical guides manufactured using rapid prototyping are in a number of orthopaedic surgical applications. To this end, we carried out a systematic review to identify and analyse clinical and experimental literature studies in which rapid prototyping patient-specific surgical guides are used, focusing especially on those that entail quantifiable outcomes and, at the same time, providing details on the guides' design and type of manufacturing process. Here, it should be mentioned that in this field there are not yet medium- or long-term data, and no information on revisions. In the reviewed studies, the reported positive opinions on the use of rapid prototyping patient-specific surgical guides relate to the following main advantages: reduction in operating times, low costs and improvements in the accuracy of surgical interventions thanks to guides' personalisation. However, disadvantages and sources of errors which can cause patient-specific surgical guide failures are as well discussed by authors. Stereolithography is the main rapid prototyping process employed in these applications although fused deposition modelling or selective laser sintering processes can also satisfy the requirements of these applications in terms of material properties, manufacturing accuracy and construction time. Another of our findings was that individualised drill guides for spinal surgery are currently the favourite candidates for manufacture using rapid prototyping. Other emerging applications relate to complex orthopaedic surgery of the extremities: the forearm and foot. Several procedures such as osteotomies for radius malunions or tarsal coalition could become standard, thanks to the significant assistance provided by rapid prototyping patient-specific surgical

  10. Clinical, magnetic-resonance imaging and surgical findings in patients with temporomandibular joint disorders - a survey of 47 patients

    Energy Technology Data Exchange (ETDEWEB)

    Raustia, A.M. (Dept. of Prosthodontics and Stomatognathic Physiology, Inst. of Dentistry, Oulu Univ., Aapistie (Finland)); Pyhtinen, J. (Dept. of Diagnostic Radiology, University Central Hospital, Oulu (Finland)); Pernu, H. (Dept. of Oral and Maxillofacial Surgery, Inst. of Dentistry, Oulu Univ. (Finland))

    1994-05-01

    The purpose of this study was to evaluate and correlate the clinical, magnetic-resonance imaging (MRI), and surgical findings in 47 patients with temporomandibular joint (TMJ) disorders. 51 TMJs (24 right, 27 left) were operated on, because 4 patients underwent treatment of both TMJs. The best correlation between MRI and surgical findings was noted in connection with position of the disk. This was surgically confirmed altogether in 88% of cases (45/51). The clinical diagnosis was confirmed by surgical findings in 75% of cases of anterior dislocation of the disk with reduction and 89% of cases of anterior dislocation of the disk without reduction. Bone changes noted by MRI were confirmed by surgery in 71% of cases. MRI was excellent especially relating to disk position and changes in disk morphology. The results show also that there are findings using MRI, e.g. of joint effusion, which cannot be confirmed during surgery. (orig.)

  11. Clinical, magnetic-resonance imaging and surgical findings in patients with temporomandibular joint disorders - a survey of 47 patients

    International Nuclear Information System (INIS)

    The purpose of this study was to evaluate and correlate the clinical, magnetic-resonance imaging (MRI), and surgical findings in 47 patients with temporomandibular joint (TMJ) disorders. 51 TMJs (24 right, 27 left) were operated on, because 4 patients underwent treatment of both TMJs. The best correlation between MRI and surgical findings was noted in connection with position of the disk. This was surgically confirmed altogether in 88% of cases (45/51). The clinical diagnosis was confirmed by surgical findings in 75% of cases of anterior dislocation of the disk with reduction and 89% of cases of anterior dislocation of the disk without reduction. Bone changes noted by MRI were confirmed by surgery in 71% of cases. MRI was excellent especially relating to disk position and changes in disk morphology. The results show also that there are findings using MRI, e.g. of joint effusion, which cannot be confirmed during surgery. (orig.)

  12. Acute hypothyroidism in a severely ill surgical patient

    DEFF Research Database (Denmark)

    Mogensen, T; Hjortsø, N C

    1988-01-01

    A case of acute postoperative hypothyroidism in a 62-year old woman is presented. One month before emergency admission because of a perforated gastric ulcer the patient had normal thyroid function, despite removal of a thyroid adenoma 20 years earlier. Following surgery the patient developed...

  13. [Low-flow xenon anesthesia in surgical patients with hypertension].

    Science.gov (United States)

    Rashchupkin, A B; Burov, N E

    2011-01-01

    A comparative study of central hemodynamics in 60 patients with essential hypertension during low flow anesthesia with xenon and nitrous oxide is carried out. The main group consisted of 30 patients, 22 male and 8 female, in the median age of 45.9 +/- 23 years. 22 patients out of those had 2nd stage essential hypertension, while the other 8 had 3rd stage. The control group consisted of 30 patients, 20 male and 10 female, in the median age of 45.1 + 1.3 years. 4 patients had 3rd stage essential hypertension, 26 patients had 2nd stage. The both groups were clinically comparable by the character and severity of the main disease, the carried out surgery (open cholecystectomy) and the qualification of surgeons. Results of the research showed, that low flow monoanesthesia with xenon abruptly eradicated the unfavourable consequences of induction of anesthesia (3-5 mg/kg of sodium thiopental or 2-2.5 mg/kg of propofol) and had a positive effect on the parameters of central hemodynamics of patients with essential hypertension. Xenon anesthesia, compared to nitrous oxide, rapidly stabilized the parameters of blood pressure and heart rate and can be recommended as a method of choice in patients with essential hypertension and compromised myocarium. Nitrous oxide with bolus of regular fentanyl doses doesn't reliable anesthesiological protection during open cholecystectomy and shows signs of toxicity. PMID:21692217

  14. Dose surgical sub-specialization influence survival in patients with colorectal cancer?

    Institute of Scientific and Technical Information of China (English)

    Cameron Platell; Daniel Lim; Nazreen Tajudeen; Ji-Li Tan; Karen Wong

    2003-01-01

    AIM: To perform a review of patients with colorectal cancer to a community hospital and to compare the risk-adjusted survival between patients managed in general surgical units versus a colorectal unit.METHODS: The study evaluated all patients with colorectal cancer referred to either general surgical units or a colorectal unit from 1/1996 to 6/2001.These results were compared to a historical control group treated within general surgical units at the same hospital from 1/1989 to 12/1994. A KaplanMeier survival analysis compared the overall survivals (allcause mortality) between the groups. A Cox proportional hazards model was used to determine the influence of a number of independent variables on survival. These variables included age, ASA score, disease stage, emergency surgery,adjuvant chemotherapy and/or radiotherapy, disease location, and surgical unit.RESULTS: There were 974 patients involved in this study.There were no significant differences in the demographic details for the three groups. Patients in the colorectal group were more likely to have rectal cancer and Stage T cancers,and less likely to have Stage Ⅱ cancers. Patients treated in the colorectal group had a significantly higher overall 5-year survival when compared with the general surgical group and the historical control group (56 % versus 45 % and 40 % respectively, P<0.01). Survival regression analysis identified age, ASA score, disease stage, adjuvant chemotherapy, and treatment in a colorectal unit (Hazards ratio: 0.67; 95 % CI: 0.53 to 0.84, P =0.0005), as significant independent predictors of survival.CONCLUSION: The results suggest that there may be a survival advantage for patients with colon and rectal cancers being treated within a specialist colorectal surgical unit.

  15. Prevalence of deep vein thrombosis (DVT) in non-surgical patients at hospital admission.

    Science.gov (United States)

    Lawall, Holger; Hoffmanns, Wibke; Hoffmanns, Phillip; Rapp, Uli; Ames, Michael; Pira, Alessandro; Paar, W Dieter; Bramlage, Peter; Diehm, Curt

    2007-10-01

    Venous thromboembolism (VTE) is known as a common complication in surgical and non-surgical patients. We hypothesized that according to the underlying risk factors and the acute illness, the prevalence ofVTE in non-surgical patients admitted to hospital is widely underestimated. For three months each patient admitted to the department of internal medicine with an acute illness, but without known deep venous thrombosis (DVT) was investigated by ultrasound compression sonography. Patients' history, risk factors and extent of immobilisation were documented. In patients with newly detected DVT D-dimer and fibrinogen were measured as well as computer tomography scans performed. Follow-up investigations of the DVT population were performed at four weeks and three months. Six hundred seventeen patients (49.3% men) were included. In 16 patients (men = 7) a previously unknown thrombosis (2.6%) was detected, mainly in patients with acute cardio-pulmonary disease (56%) and the elderly (mean age 75.6 years). Eight patients had femoro-popliteal (50.0%), four a femoral (25.0%), and four a popliteal vein thrombosis (25.0%). Five had pulmonary embolism (31.3%). In patients with DVT D-dimer was 875 +/- 1,228 mg/l, fibrinogen 568 +/- 215 mg/dl and C-reactive-protein 58.54 +/- 73.65 mg/dl. One patient died from sepsis during hospitalisation, one died from sudden cardiac death at home. None of the other 14 surviving patients relapsed. The study shows a 2.6% risk for DVT in outpatients with acute illness admitted to the department of internal medicine. These data demonstrate the high risk of DVT is in non-surgical patients. Early prophylaxis has to be considered in internal medicine patients especially in the elderly. PMID:17938799

  16. [Late deficiency states in patients with a surgically treated stomach].

    Science.gov (United States)

    Popova, D; Daskalov, M; Kostadinova, I

    1988-01-01

    37 patients with partial stomach resection because of peptic ulcer, performed 5 to 28 years before, were studied. In 29 patients the serum vitamin B12 and folic acid levels were determined by radioimmunoassay. In 19 patients several hematologic indices--hemoglobin, serum iron, erythrocyte morphology, proteinogram--were determined, too. The mean serum vit. B12 level was significantly lower than that of the control group of healthy persons. In 1/3 of these patients the low serum vit. B12 level was accompanied by manifested neurologic complications-myelopathy and polyneuropathy. The mean folic acid level was also low but statistically insignificantly and in patients the value was subnormal. In half of the patients a low degree hypochromic anemia was found. The role of vit. B12 deficiency in the pathogenesis of the neurologic manifestations is discussed and the determination of vit. B12 and folic acid levels is recommended in patients who had undergone gastric resection, especially after 5 years following the resection. PMID:3414095

  17. Surgical resection of lung metastases: results from 529 patients

    Directory of Open Access Journals (Sweden)

    Riad N. Younes

    2009-06-01

    Full Text Available OBJECTIVE: The aim of this study is to determine clinical, pathological, and treatment-relevant variables associated with long-term (90-month overall survival in patients with lung metastases undergoing pulmonary metastasectomy. METHODS: A retrospective review was performed of patients who were admitted with lung metastases, and who underwent thoracotomy for resection, after treatment of a primary tumor. Data were collected regarding demographics, tumor features, treatment, and outcome. RESULTS: Patients (n = 529 were submitted to a total of 776 thoracotomies. Median follow-up time across all patients was 21.6 months (range: 0-192 months. The postoperative complication rate was 9.3%, and the 30-day mortality rate was 0.2%. The ninety-month overall survival rate for all patients was 30.4%. Multivariate analysis identified the number of pulmonary nodules detected on preoperative CT-scan, the number of malignant nodules resected, and complete resection as the independent prognostic factors for overall survival. CONCLUSION: These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors. A select group of patients can achieve long-term survival after resection.

  18. Transfusion and management of surgical patients with hematologic disorders.

    Science.gov (United States)

    Douglas, Wade G; Uffort, Ekong; Denning, David

    2015-04-01

    Clinical trials have provided guidance in developing triggers for transfusing in the hemodynamically stable patient. These studies have identified that improved outcomes can be obtained in the massively transfused patient when platelets and fresh frozen plasma are transfused with packed red blood cells. Studies that characterize the complications of transfusions, such as transfusion-related acute lung injury and poor cancer-related outcomes, are discussed. Emerging data that characterize the risk factors associated with transfusion-related acute lung injury and suggest metastasis and local recurrence occur at a higher rate in the transfused patient are discussed. Hematologic disorders commonly encountered by surgeons are discussed. PMID:25814112

  19. Systematic review and meta-analysis of the association between frailty and outcome in surgical patients.

    Science.gov (United States)

    Oakland, K; Nadler, R; Cresswell, L; Jackson, D; Coughlin, P A

    2016-02-01

    Introduction Frailty is becoming increasingly prevalent in the elderly population although a lack of consensus regarding a clinical definition hampers comparison of clinical studies. More elderly patients are being assessed for surgical intervention but the effect of frailty on surgical related outcomes is still not clear. Methods A systematic literature search for studies prospectively reporting frailty and postoperative outcomes in patients undergoing surgical intervention was performed with data collated from a total of 12 studies. Random effects meta-analysis modelling was undertaken to estimate the association between frailty and mortality rates (in-hospital and one-year), length of hospital stay and the need for step-down care for further rehabilitation/nursing home placement. Results Frailty was associated with a higher in-hospital mortality rate (pooled odds ratio [OR]: 2.77, 95% confidence interval [CI]: 1.62-4.73), a higher one-year mortality rate (pooled OR: 1.99, 95% CI: 1.49-2.66), a longer hospital stay (pooled mean difference: 1.05 days, 95% CI: 0.02-2.07 days) and a higher discharge rate to further rehabilitation/step-down care (pooled OR: 5.71, 95% CI: 3.41-9.55). Conclusions The presence of frailty in patients undergoing surgical intervention is associated with poorer outcomes with regard to mortality and return to independence. Further in-depth studies are required to identify factors that can be optimised to reduce the burden of frailty in surgical patients. PMID:26741674

  20. Muscle chemistry of critically ill surgical patients and the effects of a course of intravenous nutrition.

    Science.gov (United States)

    King, R F; Collins, J P; Morgan, D B; Hill, G L

    1978-07-01

    The water, electrolyte and nitrogen contents of muscle were measured in 15 critically ill surgical patients before and after a course (approximately 2 weeks) of intravenous nutrition and in 8 normal individuals. The muscle from the surgical patients contained a significantly increased ratio of water to fat-free dry weight (P less than 0.01) due to an increase in the proportion of extracellular to intracellular water, and this was not corrected by intravenous nutrition. These changes could be due to an accumulation of extracellular fluid alone or to a loss of cell cytoplasm or a loss of whole muscle fibres. Intracellular chemistry was normal in the ill surgical patients and was not changed by intravenous nutrition. PMID:96905

  1. Physical rehabilitation modern tendencies in patients with lumbar disc degenerative diseases after surgical treatment.

    Directory of Open Access Journals (Sweden)

    Kolesnichenko V.A.

    2012-12-01

    Full Text Available Purpose of work - to define the modern state and perspective directions of researches in area of physical rehabilitation of patients by a lumbar osteochondrosis after surgical treatment. Material for researches is the articles in the specialized magazines and abstracts of database the National medical library of USA "Medline" for the last 15 years. Informative research allowed to set general conformities to the law of orthopaedic status of patients a lumbar osteochondrosis, subject surgical treatment and to expose the volume of facilities of their physical rehabilitation in a perioperative period. It is rotined that the state of locomotorium of patients is characterized the presence of cross muscular syndromes and change of positional parameters vertebral-pelvic balance. It is marked that selectivity and specificity of the existent programs of medical physical culture after lumbar spondylosyndesis does not provide valuable renewal of functional possibilities and reduces efficiency of surgical treatment.

  2. Answers to Clinical Questions in the Primary Care Management of People with Obesity: Bariatric Surgery.

    Science.gov (United States)

    Braverman-Panza, Jill; Horn, Deborah Bade

    2016-07-01

    The role of bariatric surgery in the management of patients with obesity is expanding owing to the amount of data that are accumulating; these data demonstrate significant short- and long-term health benefits, including control or remission of obesity-related complications, as well as acceptable long-term safety. PMID:27565108

  3. Prevalence of hepatitis B and C virus in surgical patients

    International Nuclear Information System (INIS)

    To assess the current prevalence of Hepatitis B and C virus in our set up. All patients who were operated during the study period. The detailed information about each patient was entered on a pre-designed questionnaire, including age, sex, type of operation, HBV and HCV screening test results, and presence of risk factors like: history of drug addiction, blood transfusion, family history of hepatitis, tattooing, viral vaccination, hospitalization, previous surgery, haemodialysis, etc. Amongst the total 275 patients, 27 (9.8%) had the Hepatitis virus: HBV-10, HCV-14 and HBV and HCV-3. Infection was more common among male patients and those between the ages of 41-50 years. Knowledge about Hepatitis risk factors is deficient, hence there should be more emphasis on public mass education programmes. Besides HBV vaccination should be carried out to reduce Hepatitis transmission. (author)

  4. Surgical treatment of jaw osteonecrosis in "Krokodil" drug addicted patients.

    Science.gov (United States)

    Poghosyan, Yuri M; Hakobyan, Koryun A; Poghosyan, Anna Yu; Avetisyan, Eduard K

    2014-12-01

    Retrospective study of jaw osteonecrosis treatment in patients using the "Krokodil" drug from 2009 to 2013. On the territory of the former USSR countries there is widespread use of a self-produced drug called "Krokodil". Codeine containing analgesics ("Sedalgin", "Pentalgin" etc), red phosphorus (from match boxes) and other easily acquired chemical components are used for synthesis of this drug, which used intravenously. Jaw osteonecrosis develops as a complication in patients who use "Krokodil". The main feature of this disease is jawbone exposure in the oral cavity. Surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". 40 "Krokodil" drug addict patients with jaw osteonecrosis were treated. Involvement of maxilla was found in 11 patients (27.5%), mandible in 21 (52.5%), both jaws in 8 (20%) patients. 35 Lesions were found in 29 mandibles and 21 lesions in 19 maxillas. Main factors of treatment success are: cessation of "Krokodil" use in the pre- (minimum 1 month) and postoperative period and osteonecrosis area resection of a minimum of 0.5 cm beyond the visible borders of osteonecrosis towards the healthy tissues. Surgery was not delayed until sequestrum formation. In the mandible marginal or segmental resection (with or without TMJ exarticulation) was performed. After surgery recurrence of disease was seen in 8 (23%) cases in the mandible, with no cases of recurrence in the maxilla. According to our experience in this case series, surgery is the main method for the treatment of jaw osteonecrosis in patients using "Krokodil". Cessation of drug use and jaw resection minimize the rate of recurrences in such patients. PMID:24969764

  5. Surgical Treatment of Pathologic Fractures in Patients with Metastatic Tumors

    OpenAIRE

    Zore, Zvonimir; Filipović Zore, Irina; Matejčić, Aljoša; Kamal, Mohamed; Arslani, Nuhi; Knezović Zlatarić, Dubravka

    2009-01-01

    The study presents results in treatment of pathologic fractures of long bones of all patients who underwent surgery in the last 10 years in our hospital. The study cohort comprised 133 consecutive patients divided in two groups who underwent surgery of long bone fractures caused by metastatic tumor or trauma. We used resection, open reduction and plating with bone cement application for pathologic fracture and some cases of femoral shaft fractures were stabilized with intramedullary nailing. ...

  6. Cataract Surgical Outcomes In Diabetic Patients: Case Control Study

    OpenAIRE

    Onakpoya Oluwatoyin; Bekibele Charles; Adegbehingbe Stella

    2009-01-01

    Purpose: To determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria. Design: A retrospective case control study conducted at the University College Hospital, Ibadan Nigeria. Subjects: Twenty three consecutive patients with diabetes and 23 age and sex matched non-diabetic control patients who had extracapsular cataract extraction for advanced cataract between 2002-2005. Main outcome: Mean post operative visual acu...

  7. Conservative Surgical Treatment of Infected Ulceration of the First Metatarsophalangeal Joint With Osteomyelitis in Diabetic Patients.

    Science.gov (United States)

    Dalla Paola, Luca; Carone, Anna; Morisi, Claudio; Cardillo, Sara; Pattavina, Marco

    2015-01-01

    Ulceration of the plantar aspect of the first metatarsophalangeal joint is a common localization in the diabetic foot. Conservative treatment of this lesion is a challenging problem, performed through the soft tissues and osseous debridement. The present study included a cohort of 28 patients affected by diabetes mellitus and a first ray lesion penetrating the bone. After surgical debridement with removal of the infected bone, we positioned antibiotic-loaded bone cement and stabilized the treated area with an external fixator. All patients with critical limb ischemia had their vascular disease treated before the procedure. The mean follow-up was 12.2 ± 6.9 months. Four patients developed a relapse of the ulceration after the procedure. In the postoperative period, 1 patient (3.57%) developed dehiscence of the surgical site and underwent a second procedure. In the follow-up period, 2 patients (7.14%) experienced bone cement dislocation. In 1 of these patients, a new ulceration was observed dorsally to the surgical site. The approach was surgical revision with bone cement replacement and stabilization with a new external fixator. In the other patient, given the absence of ulcerations, the cement was removed, and arthrodesis with internal stabilization using 2 cannulated screws was performed. One patient (3.57%), who had developed a relapse of ulceration after recurrent critical ischemia, underwent a percutaneous revascularization procedure and transmetatarsal amputation. During the follow-up period, no ulceration recurrences, transfer ulcerations, shoe fit problems, or gait abnormalities were detected in the other 24 patients. Our study presents the results of a technique requiring a 1-stage surgical approach to a relatively common problem, which is often difficult to solve. PMID:25249400

  8. Psycho-social and general health status after surgical treatment in cancer patients: An Indian prospect

    Directory of Open Access Journals (Sweden)

    Alay P Brahmbhatt

    2012-01-01

    Full Text Available Objective : The objective of this study was to evaluate the psychological, social well-being and general state of health in patients suffering from cancer, before and after surgical treatment. Experimental/Computational Work Done: Subjects were selected from HCG MEDI-SURGE Hospital, India, who had undertaken surgical treatment for various cancers. The present study consists of a single centered, behavioral, prospective study designed to evaluate 100 cancer patients with their psycho-social and general health status. The population of patients chosen for the study contained patients of both sexes. Data were obtained by using two questionnaires, i.e., General Health Questionnaire (GHQ-28 and Hospital Anxiety and Depression Scale (HADS. Obtained data were evaluated for correlation of incidence of psycho-sociological aspect with gender, age, and family background history. Statistical analysis was carried out by using the Student t-test and ANOVA. Results and Discussion: Higher percentage of depression and anxiety were observed after surgical treatment among breast cancer patients and head and neck cancer (HNC patients. Stage I and III colorectal cancer, stage I-IV breast and HNC cancer patients did not show significant change in GHQ-28 and HADS scores after surgical treatment. The female patients of colorectal and HNC cancer showed higher total GHQ-28 and HADS scores compared to male. Conclusions: From this study it can be concluded that cancer patients after surgical treatment show an increase in the prevalence of psychiatric morbidity. Depression and anxiety disorders are especially common and detection of these disorders is an important in the overall disease management in India.

  9. TYPE II DIABETES MELLITUS: MEDICAL OR SURGICAL DISEASE ?

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    G. Silecchia

    2009-02-01

    Full Text Available The incidence of type II diabetes mellitus (T2DM is increasing in all the world. In this way the comorbidities and complications of the T2DM as well as death related T2DM are also increasing. It was demonstrated by many studies that T2DM is a medically incurable disease, chronic and progressive, and despite all the medical therapy and life style changing, more than 20% from the patients have a poor glycemic control. On the other hand, some surgical procedures, initially performed for morbid obesity (bariatric surgery revealed good results to control the diabetes and even the metabolic syndrome. This paper presents the advantages and disadvantages of three main surgical procedures: gastric by-pass, sleeve gastrectomy and gastric banding. All of these procedures are very effectiveness to control the diabetes and metabolic syndrome. Further studies are necessary to establish the guidelines for the treatment (and even prophylaxis of T2DM.

  10. Surgical treatment options for cerebral alveolar echinococcosis: Experience in six patients

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    Wang Junyi

    2009-01-01

    Full Text Available Background: Cerebral alveolar echinococcosis (AE is a rare but lethal parasitic disease. Its pathogenesis remains poorly understood. Currently there is no widely accepted methods for its surgical treatment. Aims: To discuss the surgical treatment options. Settings and Design: Hospital-based observational study. Materials and Methods: Patients who had surgery for cerebral AE during 2001 and 2007 were the subjects of the study. According to the lesion location and volume, patients have been allocated to either massive resection group or radical piecemeal resection group. Postoperatively, all patients received long-term aldendazole therapy in view of the associated hepatic involvement and were follow-up in the clinic. Results: Of the six patients with cerebral AE who were operated during the study period, four had massive resection and two had radical piece meal resection. None of the patients had postoperative neurological worsening and there was improvement in the neurological status in all the patients except for the patient with blindness. Of the 4 patients in massive resection group, two patients died during the follow-up, one because of liver failure and the other due to hydrocephalus. The remaining four patients were back to their normal activities and none had recurrence of the disease during the follow-up. Conclusions: Although radical massive resection is generally regarded as the surgical method treatment for cerebral AE, radical piecemeal resection can be a reasonable, effective alternative management option, especially when massive resection might result in unavoidable morbidity and mortality.

  11. Tissue-Specific Effects of Bariatric Surgery Including Mitochondrial Function

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    Simon N. Dankel

    2011-01-01

    Full Text Available A better understanding of the molecular links between obesity and disease is potentially of great benefit for society. In this paper we discuss proposed mechanisms whereby bariatric surgery improves metabolic health, including acute effects on glucose metabolism and long-term effects on metabolic tissues (adipose tissue, skeletal muscle, and liver and mitochondrial function. More short-term randomized controlled trials should be performed that include simultaneous measurement of metabolic parameters in different tissues, such as tissue gene expression, protein profile, and lipid content. By directly comparing different surgical procedures using a wider array of metabolic parameters, one may further unravel the mechanisms of aberrant metabolic regulation in obesity and related disorders.

  12. NEWS ON THE SURGICAL TREATMENT OF OBESITY

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    Laura Curic

    2012-02-01

    Full Text Available BACKGROUND:Liposuction is one of the most common elective surgical procedures in the U.S. and is supposed to be on the increase. AIM: The present study analyzes the effects of the surgical removal of subcutaneous adipose tissue by ultrasound-assisted megalipoplasty (UAM on BMI (body mass index, weight variation and anthropometric measurements in obese people. METHODS: Thirty premenopausal obese women underwent UAM, superwet technique. The mean aspirate volume was 17.5 L (range 9.2-26.3l. BMI, weight and anthropometric measurements were determined before and 1 day, 3 days, 6 months and 1year after the procedure. RESULTS: UAM reduced all parameters in the first six months after surgery, without further important changes in thefollowing six months. No major complications were noted in our study. Minor complications were present in 13 patients: seroma (10 patients, skin necrosis (2 patients, burns (1patient whichwere solved favorably. CONCLUSIONS: Our study demonstrates that UAM is safe andrepresents a reliable alternative to bariatric surgery, universally accepted in the treatment of obesity. It should be considered only if a dedicated team for the treatment of obesity exists (nutritionist, plastic surgeon, general surgeon, anesthesiologist and psychologist. UAM, by aesthetic benefits to patients (removing a large amount of fat with minimal blood loss, restored all patients satisfaction and esteem.

  13. Early clinical results of surgical treatment of patients with femoroacetabular impingement

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    Mladenović Desimir

    2014-01-01

    Full Text Available Introduction. Surgical treatment is the treatment of choice in patients with symptoms and radiological signs of femoroacetabular impingement. Objective. Our experience and early results of surgical treatment of patients with signs of femoroacetabular impingement and early hip osteoarthritis are reported. Methods. The results of treatment of 21 patients aged 23-54 years with different types of femoroacetabular impingement are presented. Safe open surgical dislocation of the hip was performed in all patients. Before and after surgery, the WOMAC score was performed, clinical and radiographic data of the operated hips were evaluated and t-tests were used for statistical analyzes of data. Results. The WOMAC score improved from 70.5 points ( range 56.3 to 89.8 points to 90.3 points (range 70.3 to 100 points at one year of follow-up (p<0.0001, anterior impingement test was negative in all operated cases, average hip internal rotation improved significantly, no complications were found, except trochanteric nonunion at the site of osteotomy, which was reaffixed. Conclusion. Postoperative results have shown that the surgical approach to treating patients with femoroacetabular impingement is the method of choice. Three operated patients, with advanced osteoarthritis of the hip, had to be converted to total hip replacement. [Projekat Ministarstva nauke Republike Srbije, br. III 41017 i br. III 41004

  14. Natural history and surgical results in patients with unruptured intracranial aneurysms

    International Nuclear Information System (INIS)

    The management of patients with unruptured intracranial aneurysms (UIAs) is controversial. We aimed to assess the natural history of UIAs and evaluate the surgical results. We analyzed 154 patients (181 saccular UIAs) with no history of subarachnoid hemorrhage (SAH) from a different aneurysm. Aneurysms were detected by magnetic resonance angiography (MRA) or by 3-dimensional CT angiography. Although the most frequent reason for the diagnosis was routine brain examinations of healthy patients or a vague symptom such as headache or dizziness, 15 patients were symptomatic. The natural history in patients who did not have surgery (follow-up group: 76 cases, 95 aneurysms) was assessed, and the surgical outcome of UIAs (surgical group: 78 cases, 86 aneurysms) was evaluated. Among 76 patients in the follow-up group, 7 had SAH. The mean latency period to aneurysm rupture was 3.2 months. The aneurysms with subsequent bleeding ranged from 5 to 25 mm (19.3 mm on average), whereas those without ranged from 1 to 28 mm (4.5 mm on average). The rupture rates of UIAs in anterior and posterior circulation were 6.2% and 14.3%, respectively. All ruptured cases were females. Mortality and morbidity associated with UIAs in the follow-up group were 3.9% and 3.9%, respectively. In the surgical group, no mortality was noted. Permanent morbidity associated with prospective repair of UIAs was 5.1%, although the morbidity of the patients with preoperative Rankin scores of 0 or 1 was 1.3%. Transient morbidity was observed in 6 patients (7.7%) with the size of the aneurysm 19.8 mm on average. The natural history and surgical results in patients with UIAs are modified by several factors including aneurysm size and location, the patient's age and gender, the medical status and the patient's preoperative Rankin score. The present results indicated that these factors should be considered in deciding whether to treat UIAs, and that careful assessment of the surgical benefits might be essential

  15. Pre: Surgical orthopedic pre-maxillary alignment in bilateral cleft lip and palate patient

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    Vijaya Prasad Kamavaram Ellore

    2012-01-01

    Full Text Available Pre-surgical orthopedic appliances are mainly used to retract and align the protruded and deviated pre-maxilla and to facilitate initial lip repair. This article presents a case report of a five year old male child patient with bilateral cleft lip and palate in whom a special custom made pre-surgical orthopedic appliance was delivered. Use of a special custom made presurgical orthopedic appliance for repositioning pre-maxilla in bilateral cleft lip and palate patient is discussed in this article.

  16. Post-operative care to promote recovery for thoracic surgical patients: a nursing perspective

    OpenAIRE

    Yeung, Wilfred Wai Kit

    2016-01-01

    The change in patient population leads to an inevitable transformation among the healthcare system. Over the past decades, thoracic surgical technique has been evolving from conventional open thoracotomy to minimally invasive video assisted thoracoscopic surgery (VATS). Thoracic nursing team of Prince of Wales Hospital (PWH) grows together with the evolution and aims at providing holistic and quality care to patients require thoracic operation. In order to enhance patient post-operative recov...

  17. Predictors of Multidrug Resistant Acinetobacter Baumannii Infections in Surgical Intensive Care Patients: A Retrospective Analysis

    OpenAIRE

    Aynur Camkıran; Aycan Kundakcı; Coşkun Araz; Arash Pirat; Pınar Zeyneloğlu; Hande Arslan; Gülnaz Arslan

    2011-01-01

    Objective: Multidrug resistant Acinetobacter baumannii (MRAB) is an important cause of hospital acquired infection and leads to an increasing morbidity and mortality in intensive care units (ICU). The aim of this study was to investigate the predictors of MRAB infection in surgical ICU patients. Material and Method: The charts of the patients who were admitted to the ICU between January 2008 and August 2010 were reviewed to identify patients with MRAB infection. Recorded data were as fo...

  18. Surgical Treatment for Non-small Cell Lung Cancer Patients with Synchronous Solitary Brain Metastasis

    OpenAIRE

    Bai, Hao; Han, Baohui

    2013-01-01

    Background and objective Brain metastases are common in non-small cell lung cancer. Usual treatments include radiotherapy and chemotherapy. However, these methods result in poor patient prognosis. The aim of this study is to assess the effectiveness of surgical resection in the multimodality management of non-small cell lung cancer patients with synchronous solitary brain metastasis. Methods The clinical data of 46 non-small cell lung cancer patients with synchronous solitary brain metastasis...

  19. Surgical management for early-stage bilateral breast cancer patients in China.

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    Jia-jian Chen

    Full Text Available The aim of this study was to investigate the current surgical management strategy for bilateral breast cancer (BBC patients and to assess the changes in this strategy in China.This is a retrospective review of all patients with early-stage BBC who underwent surgical treatment at the Fudan University Shanghai Cancer Center between June 2007 and June 2014.A total of 15,337 patients with primary breast cancer were identified. Of these patients, 218 (1.5% suffered from synchronous bilateral breast cancer (sBBC, and 296 (2.0% suffered from metachronous bilateral breast cancer (mBBC. Patients with a lobular carcinoma component, those with estrogen receptor-positive cancer, and those with an accompanying sclerosing adenosis in the affected breast tended to develop BBC. The rates of bilateral mastectomy, breast conserving therapy, reconstruction, and combined surgeries were 86.2%, 6.4%, 3.7%, and 3.7%, respectively, for patients with sBBC and 81.1%, 4.4%, 3.0%, and 11.5%, respectively, for patients with mBBC. The interval between bilateral cancers, age at first diagnosis of breast cancer, histopathological type, and stage have significant impacts on the choice of surgery for patients with BBC.Bilateral mastectomy was the dominant surgical management for patients with BBC in China, despite the increased application of breast reconstruction surgery observed in recent years. Bilateral prosthetic breast reconstruction was the ideal choice for patients with sBBC. Chinese surgeons should take responsibility for patient education and inform their patients about their surgical options.

  20. A comparison of androgen deprivation therapy versus surgical castration for patients with advanced prostatic carcinoma

    Institute of Scientific and Technical Information of China (English)

    Yu-hsiang LIN; Chien-lun CHEN; Chen-pang HOU; Phei-lang CHANG; Ke-hung TSUI

    2011-01-01

    Airn:To examine the outcomes of patients with advanced prostate carcinoma who underwent medical or surgical castration.Methods:A hundred twenty one consecutive cases of patients with advanced prostate carcinoma who underwent medicaI or surgical castration between 2001 and 2006 were retrospectively reviewed.Associations between clinicaI outcomes and prognostic scoring factors were determined based on the Reijke study.In the surgical and medical castration groups.the impact on the prostate-specific antigen(PSA)normalization rate,the rebound rate and the disease-free survivaI rate were evaluated.The mean foIlow-up was 36.1months.Results:In the initial 12 months.there were no statisticaI differences in the PSA normalization rate and the PSA rebound rate between the two groups.However,the PSA rebound rate after the 12th month(20.90%vs 40.74%.P=-0.0175)and the 18th month PSA normalization rate(59.70%vs 37.04%.P=0.0217)differed significantly between the two groups,and these differences were maintained to the end of the study.When comparing patients grouped according to Reijke prognosis scores.there was no difference between medical and surgical castration for the good prognosis group.However, among the patients given a poor prognosis,surgical castration was superior in terms of the PSA normalization rate,the PSA rebound rate.the tumor progression-free survival rate(P<0.001)and the overalI survivaI rate (P<0.001).Conclusion:Advanced prostate carcinoma patients with poor pretreatment prognosis scores should undergo surgical castration rather than medical castration for better PSA rebound rates and overaII survival.

  1. Flow Simulation to Enable Patient Specific Virtual Surgical Planning

    Science.gov (United States)

    Jansen, Kenneth; Taylor, Charles; Mueller, Jens

    2003-11-01

    The current paradigm for interventional and surgery planning for the treatment of cardiovascular disease relies exclusively on diagnostic imaging data to define the present state of the patient, empirical data to evaluate the efficacy of prior treatments for similar patients, and the judgement of the surgeon to decide on a preferred treatment. The individual variability and inherent complexity of human biological systems is such that diagnostic imaging and empirical data alone are insufficient to predict the outcome of a given treatment for an individual patient. We have proposed a new paradigm of predictive medicine in which the physician utilizes computational tools to construct and evaluate a combined anatomic/physiologic model to predict differential changes in blood flow for alternative treatment plans for an individual patient. Ideally, these systems would provide an integrated set of image segmentation, geometric solid modeling, automatic finite element mesh generation, computational mechanics and scientific visualization tools accessible through an intuitive human-computer interface. In this talk we focus on the flow simulation aspects of this project. Error estimators for transient flow analyses have been developed and implemented to focus computational resources on the areas where they may have provide the greatest improvement. We will describe these error estimators and apply them to adaptive as well as uniform refinement simulations and compare the accuracy and performance to available experimental data in porcine bypass models that have been carried out specifically for this purpose.

  2. SURGICAL TREATMENT IMPROVEMENT IN PATIENTS WITH NEOPLASTIC OBSTRUCTIVE JAUNDICE

    OpenAIRE

    Bazilevich, F.; Abashidze, Z.; Klimov, A.; Gaboyan, A.

    2003-01-01

    In the article we represent our experience of 138 patients treatment with malignant obstructive jaundice. The special place in the claude is given to the decompressive methods usage in a preoperative period and it's influence to the development and the outcome of disease.

  3. Interfaces between bariatric surgery and oral health: a longitudinal survey Interface entre cirurgia bariátrica e saúde bucal: estudo longitudinal

    OpenAIRE

    Juliane Avansini Marsicano; Patrícia Garcia de Moura Grec; Lídia Barbieri Belarmino; Reginaldo Ceneviva; Sílvia Helena de Carvalho Sales Peres

    2011-01-01

    PURPOSE: To evaluate oral changes, such as dental caries, periodontal disease, dental wear and salivary flow in bariatric patients. Fifty four obese patients who underwent bariatric surgery were studied before (n=54), up after 3 months (n=24) and 6 months (n=16). METHODS: Indices for evaluating oral conditions were: DMFT, CPI, DWI and salivary flow. OIDP questionnaire was used to assess the impact of oral health on quality of life. ANOVA and Spearman correlation were used (p0.05), presence of...

  4. Triaging early-stage lung cancer patients into non-surgical pathways: who, when, and what?

    Science.gov (United States)

    Sroufe, Rameses; Kong, Feng-Ming Spring

    2015-08-01

    More lung cancer patients are being diagnosed at an earlier stage due to improved diagnostic imaging techniques, a trend that is expected to accelerate with the dissemination of lung cancer screening. Surgical resection has always been considered the standard treatment for patients with early-stage non-small cell lung cancer (NSCLC). However, non-surgical treatment options for patients with early-stage NSCLC have evolved significantly over the past decade with many new and exciting alternative treatments now available. These alternative treatments include radiofrequency ablation (RFA), microwave ablation (MWA), percutaneous cryoablation therapy (PCT), photodynamic therapy (PDT) and external beam radiation therapy (EBRT), including stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy. We describe the established alternatives to surgical resection, their advantages and disadvantages, potential complications and efficacy. We then describe the optimal treatment approach for patients with early-stage NSCLC based on tumor operability, size and location. Finally, we discuss future directions and whether any alternative therapies will challenge surgical resection as the treatment of choice for patients with operable early-stage lung cancer. PMID:26380185

  5. Psychological evaluation of patients with a thyroid nodule before and after surgical treatment

    Directory of Open Access Journals (Sweden)

    Čaparević Zorica

    2002-01-01

    Full Text Available Introduction Association between endocrine and mental disorders has been recognized a long time ago, as well as their mutual dependence. The aim of this study was to evaluate the psychological structure of patients with thyroid nodule before and after surgical treatment. Material and methods In order to establish the type and degree of psychological disorders, we have examined 60 patients with thyroid nodule before and after surgical treatment by using DSM-IV classification of mental disorders and psychological instruments: semi structured psychiatric interview, MMPI, Zung Depression Scale and a list of panic symptoms. Patients with nonautonomous ("cold" nodules presented as euthyroid, and those with autonomous ("hot" nodules (after a period of drug therapy if they were hyperthyroid, required surgery. After a period of drug therapy two groups of patients were compared: group 1- euthyroid with "cold" nodules and group 2 - euthyroid with "hot" nodules. Before surgical treatment both groups under went psychological evaluation. Group 2 presented with: anxiety, depression and panic disorder with or without agoraphobia (72%, 46%, 28% while group 1 presented with following results: 48%, 23%, 14% respectively. After surgical treatment patients from group 1 presented with psychologic disorders in less than 1%. Discussion and conclusion In some physical disorders, psychologic factors contribute directly or indirectly to the etiology, in others, psychologic symptoms are the direct results of a lesion affecting neural or endocrine organs. One of the key etiological factors is often a short-time or long-time stress and its direct consequence is altered functioning of various hormonal systems. Unexpected high percentage of psychological disorders in patients with thyroid disorders suggests that psychological evaluation before and after surgical treatment is unavoidable for good assessment and choice of treatment. These patients need psychotherapeutic and

  6. Risk factors in patients surgically treated for peptic ulcer perforation

    DEFF Research Database (Denmark)

    Møller, Morten Hylander; Shah, Kamran; Bendix, Jørgen;

    2009-01-01

    Society of Anaesthesiologists) class, age, shock upon admission, preoperative metabolic acidosis, elevated concentration of creatinine upon admission, subnormal concentration of albumin upon admission and insufficient postoperative nutrition. CONCLUSIONS: Thus, preoperative metabolic acidosis, renal...... admission and preoperative metabolic acidosis are independently related to 30-day mortality could indicate that patients with peptic ulcer perforation are septic upon admission, and thus might benefit from a perioperative care protocol with early source control and early goal-directed therapy according to...

  7. The role of trimetazidine in patients subjected to surgical revascularization

    OpenAIRE

    Banach, M.; Goch, A.; Rysz, J.; Ugurlucan, M.; Mikhailidis, D P; Goch, J. H.

    2007-01-01

    In recent years methods interfering with cellular metabolism to prevent and treat heart diseases have become available. Metabolic treatment involves the use of drugs to improve the function of cardiomyocytes. Trimetazidine (TMZ) is one of the drugs in this group. The ESC 2006 guidelines on the management of patients with stable angina indicated the efficacy of metabolic treatment in improving the physical efficiency and decreasing the recurrence of pain. The available data suggest that a comb...

  8. Double-balloon-enteroscopy-based endoscopic retrograde cholangiopancreatography in post-surgical patients

    Institute of Scientific and Technical Information of China (English)

    Martin Raithel; Harald Dormann; Andreas Naegel; Frank Boxberger; Eckhart G Hahn; Markus F Neurath; Juergen Maiss

    2011-01-01

    AIM: To evaluate double balloon enteroscopy (DBE) in post-surgical patients to perform endoscopic retrograde cholangiopancreatography (ERCP) and interventions. METHODS: In 37 post-surgical patients, a stepwise approach was performed to reach normal papilla or enteral anastomoses of the biliary tract/pancreas. When conventional endoscopy failed, DBE-based ERCP was performed and standard parameters for DBE, ERCP and interventions were recorded.RESULTS: Push-enteroscopy (overall, 16 procedures) reached enteral anastomoses only in six out of 37 post-surgical patients (16.2%). DBE achieved a high rate of luminal access to the biliary tract in 23 of the remaining 31 patients (74.1%) and to the pancreatic duct (three patients). Among all DBE-based ERCPs (86 procedures), 21/23 patients (91.3%) were successfully treated. Interventions included ostium incision or papillotomy in 6/23 (26%) and 7/23 patients (30.4%),respectively. Biliary endoprosthesis insertion and regular exchange was achieved in 17/23 (73.9%) and 7/23 patients (30.4%), respectively. Furthermore, bile duct stone extraction as well as ostium and papillary dilation were performed in 5/23 (21.7%) and 3/23 patients (13.0%), respectively. Complications during DBE-based procedures were bleeding (1.1%), perforation (2.3%) and pancreatitis (2.3%), and minor complications occurred in up to 19.1%.CONCLUSION: The appropriate use of DBE yields a high rate of luminal access to papilla or enteral anastomoses in more than two-thirds of post-surgical patients, allowing important successful endoscopic therapeutic interventions.

  9. Bariatric surgery and diabetes remission: Who would have thought it?

    Directory of Open Access Journals (Sweden)

    Awadhesh Kumar Singh

    2015-01-01

    Full Text Available Type 2 diabetes mellitus (T2DM and obesity are increasingly common and major global health problems. The Edmonton obesity staging system clearly pointed towards increased mortality proportionate to the severity of obesity. Obesity itself triggers insulin resistance and thereby poses the risk of T2DM. Both obesity and T2DM have been associated with higher morbidity and mortality and this calls for institution of effective therapies to deal with the rising trend of complications arising out of this dual menace. Although lifestyle changes form the cornerstone of therapy for both the ailments, sustained results from this modalities is far from satisfactory. While Look AHEAD (action for HEAalth in diabetes study showed significant weight loss, reduction in glycated hemoglobin and higher remission rate of T2DM at 1 st year following intensive lifestyle measures; recurrence and relapse rate bounced back in half of subjects at 4 years, thereby indicating that weight loss and glycemic control is difficult to maintain in the long term with lifestyle interventions. Same recurrence phenomenon was also observed with pharmacotherapy with rimonabant, sibutramine and orlistat. Bariatric surgery has been seen to associate with substantial and sustained weight loss in morbidly obese patients. Interestingly, bariatric surgeries also induce higher rates of short and long-term diabetes remission. Although the exact mechanism behinds this diabetes remission are not well understood; improved insulin action, beta-cell function and complex interplay of hormones in the entero-insular axis appears to play a major role. This article reviews the effectiveness of bariatric procedures on remission or improvement in diabetes and put a perspective on its implicated mechanisms.

  10. Charcot Neuroarthropathy in Patients With Diabetes: An Updated Systematic Review of Surgical Management.

    Science.gov (United States)

    Schneekloth, Brian J; Lowery, Nicholas J; Wukich, Dane K

    2016-01-01

    Charcot neuroarthropathy (CN) of the foot and ankle is a demanding clinical dilemma, and surgical management can be very complicated. Historically, the evidence guiding surgical management of CN has been small retrospective case series and expert opinions. The purpose of the present report was to provide a systematic review of studies published from 2009 to 2014 and to review the indications for surgery. A Medline search was performed, and a systematic review of studies discussing the surgical management of CN was undertaken. Thirty reports fit the inclusion criteria for our study, including 860 patients who had undergone a surgical procedure for the treatment of CN. The surgical procedures included amputation, arthrodesis, debridement of ulcers, drainage of infections, and exostectomy. The midfoot was addressed in 26.9% of cases, the hindfoot in 41.6%, and the ankle in 38.4%. Of the 30 studies, 24 were retrospective case series (level 4), 4 were controlled retrospective studies (level 3), and 2 were level II studies. The overall amputation rate was 8.9%. The quality of the published data on the surgical management of CN has improved during the past several years. Evidence concerning the timing of treatment and the use of different fixation methods remains inconclusive. PMID:26810129

  11. Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy

    Directory of Open Access Journals (Sweden)

    Francesco Tonelli

    2012-01-01

    Full Text Available Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1 correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2 avoid persistent hypoparathyroidism; and 3 facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1 subtotal parathyroidectomy with removal of at least 3-3 K glands; and 2 total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1 the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2 the surgeon's experience; 3 the timing of surgery; 4 the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay of the curative potential of the surgical procedure; and, 5 the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence.

  12. Surgical treatment results of hand deformities in patients with Apert syndrome

    Directory of Open Access Journals (Sweden)

    Ufuk Nalbantoglu

    2015-12-01

    Results: The mean age at the first operation was 2.7 years and the mean number of operations was 3 per patient. No patient developed graft-flap necrosis and no patients required amputations. All patients were able to perform grasping and pinching functions and families were satisfied with the cosmetic results. Conclusion: Using a two-stage surgical protocol, achieving satisfactory results with a minimal number of operations is possible in patients with Apert Syndrome. [Hand Microsurg 2015; 4(3.000: 53-57

  13. Mortality in asymptomatic vs. symptomatic patients surgically treated for non-small cell lung cancer (NSCLC)

    DEFF Research Database (Denmark)

    Madsen, Kirsten Riis; Bødtger, Uffe

    Introduction: Compared to incidentally found lung cancer, the presence of symptoms (eg. cough, haemoptysis, pain, weight loss) at diagnosis is associated with a 50% reduction in median survival. In surgically treated patients, it is unknown whether presence of symptoms has prognostic significance...... higher in asymptomatic than symptomatic subjects (23% vs. 12%), and in patients with former malignancy compared to patients with no former cancer (17% vs. 16%). Discussion: Symptoms at diagnosis per se appear unrelated to mortality in patients with NSCLC referred for surgery. Asymptomatic patients were...

  14. Surgical risk for patients with Chagasic achalasia and its correlation with the degree of esophageal dilation

    Institute of Scientific and Technical Information of China (English)

    José Garcia Neto; Roberto de Cleva; Bruno Zilberstein; Joaquim José Gama-Rodrigues

    2005-01-01

    AIM: To analyze the risk of cardiovascular complications in patients with indication for surgical treatment of Chagasic esophageal achalasia and to correlate the surgical risks with the degree of esophageal dilation,thereby proposing a risk scale index.METHODS: One hundred and twenty-four patients with Chagasic esophageal achalasia, who received surgical treatment at the Hospital das Clinicas of the Federal patients were mostly related to the postoperative complications due to the cardiovascular system. All the patients were submitted to: (1) clinical history to define the cardiac functional class (New York Heart Association);(2) conventional 12-lead electrocardiogram at rest; and (3) contrast imaging of the esophagus to determine esophageal dilatation according to Rezende's classification of Chagasic megaesophagus.RESULTS: An assessment of the functional classification (FC) of heart failure during the preoperative period determined that 67 patients (54.03%) were assigned functional class Ⅰ (FC Ⅰ), 46 patients (37.09%) were assigned functional class Ⅱ (FC Ⅱ), and 11 patients (8.87%) were assigned functional class Ⅲ (FC Ⅲ). None of the patients were assigned to functional class Ⅳ (FC Ⅳ). There was a positive correlation between the functional class and the postoperative complications (FC ⅠxFC Ⅱ: P<0.001; FC ⅠxFC Ⅲ: P<0.001). The ECG was normal in 44 patients (35.48%) and presented abnormalities in 80 patients (64.52%). There was a significant statistical correlation between abnormal ECG (arrhythmias and primary change in ventricular repolarization) and postoperative complications (P<0.001).With regard to the classification of the Chagasic esophageal achalasia, the following distribution was observed: group Ⅱ, 53 patients (42.74%); group Ⅲ, 37 patients (29.83%);and group Ⅳ, 34 patients (27.41%). There was a positive correlation between the degree of esophageal dilation and the increase in postoperative complications (grade

  15. EFFICACY OF BARIATRIC SURGERY IN OBESE INDIAN WITH TYPE 2 DIABETES MELLITUS

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    Subodh

    2013-01-01

    Full Text Available ABSTRACT: CONTEXT: Individuals with morbid obesity and type 2 diabetes benefit from weight loss, as this allows better glycemic control and modifies the coexisting risk factors for coronary heart disease, namely hypertension, dyslipid emia, insulin resistance, sleep apnea, and other comorbidities that constitute the metabolic s yndrome. AIMS: The purpose of the present study was to investigate whether weight loss after bariatric surgery can correct glycemic control and reduces the need of anti-diabetic treat ment in morbidly obese patients with type 2 diabetes. SETTINGS AND DESIGN: This is a prospective cohort study performed in Sri Aurobindo Medical College & PG Institute, Indore. S ampling done was nonrandom and purposive. METHODS AND MATERIAL: Forty patients with body mass index (BMI > 35 and had known type 2 diabetes were enrolled in study, al l these patient undergone bariatric surgery. Their obesity status in terms of height, weight and BMI, Glycemic status in terms of fasting blood sugar (FBS, postprandial blood sugar (PPBS and glycosylated haemoglobin (HbA1c, and treatment status in terms of oral hypoglycemic a gents and insulin were noted in details preoperatively Statistical analysis used: Quantitative variables w ere tested using Chi square test and p values were calculated between two groups. p val ue of ≤ 0.05 was considered statistically significant. Averages were expressed between groups a s mean ± standard deviation or percentage. RESULTS: Our study shows good control of glycemic status af ter bariatric surgery with mean HbA1c within desired level after 6 months of bariatric surgery. CONCLUSIONS: In conclusion, our study shows that bariatric surgery is an effective option for morbidly obese patients with type 2 diabetes mellitus. Weight loss d ue to surgery is strongly associated with good glycemic control and improved treatment efficac y.

  16. Comparison between surgical outcomes of colorectal cancer in younger and elderly patients

    Institute of Scientific and Technical Information of China (English)

    Longxue Jin; Katsutoshi Kaneko; Norio Inoue; Naoki Sato; Susumu Matsumoto; Hitoshi Kanno; Yuko Hashimoto; Kazuhiro Tasaki; Kinya Sato; Shun Sato

    2011-01-01

    AIM: To compare the outcome of surgical treatment of colorectal adenocarcinoma in elderly and younger patients. METHODS: The outcomes of 122 patients with colorectal adenocarcinoma who underwent surgical treatment between January 2004 and June 2009 were analyzed. The clinicopathological and blood biochemistry data of the younger group (< 75 years) and the elderly group (≥ 75 years) were compared. RESULTS: There were no significant differences between the two groups in operation time, intraoperative blood loss, hospital stay, time to resumption of oral intake, or morbidity. The elderly group had a significantly higher rate of hypertension and cardiovascular disease. levels were significantly lower in the elderly than in the younger group. The serum carcinoembryonic antigen level was lower in the elderly than in the younger group, and there was a significant decreasing trend after the operation in the elderly group. CONCLUSION: The short-term outcomes of surgical treatment in elderly patients with colorectal adenocarcinoma were acceptable. Surgical treatment in elderly patients was considered a selectively effective approach.

  17. Oral nutritional support of older (65 years+) medical and surgical patients after discharge from hospital

    DEFF Research Database (Denmark)

    Beck, Anne Marie; Holst, Mette; Rasmussen, Henrik Højgaard

    2013-01-01

    To estimate the effectiveness of oral nutritional support compared to placebo or usual care in improving clinical outcome in older (65 years+) medical and surgical patients after discharge from hospital. Outcome goals were: re-admissions, survival, nutritional and functional status, quality of life...

  18. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than ty

  19. The effects of surgical stress and psychological stress on the immune function of operative cancer patients

    NARCIS (Netherlands)

    Van der Pompe, G; Antoni, MH; Heijnen, CJ

    1998-01-01

    Surgical resection of solid tumors provides a major opportunity for cure in many patients, but unfortunately can also increase the risk of metastases by spilling of tumor cells into the circulation. Moreover, surgery has been shown to result in immunological changes including an impaired natural kil

  20. Correlation between pulmonary regurgitation and right ventricular myocardial performance index in TOF patients after surgical repair

    Directory of Open Access Journals (Sweden)

    Lamiaa Abdel Rahman Ibrahim

    2014-03-01

    Conclusion: Tissue Doppler RVMPI in patients after surgical repair of Fallot tetralogy is not correlated to the degree of PR measured by two indices: PR index and DSTVI, a new index that can assess severity of PR and correlate to RV functions is required.

  1. Mild trigonocephaly in patients with microcephaly. Surgical results in 12 cases

    International Nuclear Information System (INIS)

    We have recently diagnosed several cases of mild trigonocephaly associated with microcephaly. The surgical approach is often difficult to decide for such cases. Surgical treatment is often attempted if neuroradiological studies show evidence of increased intracranial pressure. Twelve patients (9 girls and 3 boys) were found to microcephaly during infancy. All patients had symptoms, including varying degrees of mental retardation, delayed language, hyperactivity, motor dysfunctions, and self-mutilation (head banging). Most patients had mild trigonocephaly with microcephaly and tended to be of short stature. Head circumferences were at least 2 standard deviations below the mean for age at the time of surgery. Mild trigonocephaly was diagnosed in all patients by means of 3-dimensional computed tomography. Magnetic resonance of the brain showed no abnormalities in any patient. Plain skull X-ray films showed marked digital markings in 8 patients. Intracranial pressure was measured under normocapnia: results were obtained in 9 patients, and intracranial pressure was increased in 8 patients. Decompressive cranioplasty was performed in all patients. After surgery, chronological measurements showed tendencies for head circumferences to increase in 7 patients. Cognitive impairment showed no change, but other symptoms showed some improvement in all patients. These results suggest that surgery is indicated for patients with mild trigonocephaly associated with microcephaly if intracranial pressure is increased and if magnetic resonance of the brain shows no abnormalities. (author)

  2. Surgical treatment of pathological obesity

    International Nuclear Information System (INIS)

    The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)

  3. Surgonomics as a health care financing policy for hospitalized surgical patients.

    Science.gov (United States)

    Muñoz, E; Goldstein, J; Benacquista, T; Mulloy, K; Wise, L

    1989-05-01

    The Medicare system of prospective payment to hospitals based on diagnostic related groups (DRG) has been severely criticized at a number of levels. Many states are using DRG prospective "All Payor Systems" for reimbursement to hospitals with the federal DRG system as a model. In All Payor Systems, Medicare, Medicaid, Blue Cross and other commercial insurers pay by the DRG mode; the state of New York has been All Payor since 1 January 1988. This study simulated DRG All Payor methods on a large sample (N = 17,560) of surgical patients for a two year period, using both federal and New York DRG reimbursement methods currently in effect. Both Medicare and Medicaid patients had, on average, a longer length of stay in the hospital and higher total cost of hospitalization compared with patients from Blue Cross and other commercial payors. Medicare and Medicaid patients also had a greater severity of illness compared with patients from Blue Cross or other payors. All except commercial insurors (that is, Medicaid, Blue Cross and Medicare) had greater financial risk under the DRG All Payor scheme. Results from our study suggest that federal, state and private payors may not be adequately reimbursing health care providers for the care of the hospitalized surgical patient under the DRG prospective scheme of hospital payment. It appears that the financing policy for health care, especially at the federal and state level, could limit both the access and quality of care for surgical patients. PMID:2496483

  4. Analysis of 33 patients with nasopharyngeal carcinoma. Surgical management for persistent tumor after radiation therapy

    International Nuclear Information System (INIS)

    We report thirty-three patients treated for nasopharyngeal carcinoma (NPC) in our clinic from 1976 to 1997. They consisted of 24 males and 9 females, and their ages ranged from 17 to 76 years with an average of 56 years. Radiation therapy is a mainstay of treatment of NPC because of anatomic restrictions and a high degree of radiosensitivity. An average of total radiation dose was 63.9 Gy for the primary site except in one patient (28 Gy followed by surgery due to poor response to radiation). In two patients, high-dose intracavity radiation by remote afterloading system was performed. They have been free from disease since then for more than 3 years. Radiation therapy was combined with 5-fluorouracil and vitamin A, or a low-dose of cisplatin in 2 and 5 patients, respectively. Local recurrence was detected in none of these patients and this combined therapy seemed to be effective in controlling the primary lesion. The overall 5-year survival rate was 56.9%, however, that of patients with stage IV was still poor; 33.2%. This emphasizes the importance of an early diagnosis of NPC. Twelve patients underwent surgical resection of the residual tumor at the primary site after radiotherapy. As a surgical approach to the nasopharynx, the transmandibular transpterygoid approach was employed in five patients. This procedure offers a wider exposure of the nasopharynx than either the transmaxillary or the transpalatal approaches. Although distant metastasis was detected in three of the five patients, none of them developed local recurrence. The 5-year survival rate in 12 patients with surgery was 65.6%, which was better than 49.2% in 21 patients without surgery. Neck dissection was performed on 14 patients after radiotherapy. None had cervical recurrence postoperatively. The surgical treatments are recommended for patients with postradiation residual primary tumor and/or cervical metastasis. (K.H.)

  5. Change in fracture risk and fracture pattern after bariatric surgery: nested case-control study

    Science.gov (United States)

    Rousseau, Catherine; Jean, Sonia; Gamache, Philippe; Lebel, Stéfane; Mac-Way, Fabrice; Biertho, Laurent; Michou, Laëtitia

    2016-01-01

    Objective To investigate whether bariatric surgery increases the risk of fracture. Design Retrospective nested case-control study. Setting Patients who underwent bariatric surgery in the province of Quebec, Canada, between 2001 and 2014, selected using healthcare administrative databases. Participants 12 676 patients who underwent bariatric surgery, age and sex matched with 38 028 obese and 126 760 non-obese controls. Main outcome measures Incidence and sites of fracture in patients who had undergone bariatric surgery compared with obese and non-obese controls. Fracture risk was also compared before and after surgery (index date) within each group and by type of surgery from 2006 to 2014. Multivariate conditional Poisson regression models were adjusted for fracture history, number of comorbidities, sociomaterial deprivation, and area of residence. Results Before surgery, patients undergoing bariatric surgery (9169 (72.3%) women; mean age 42 (SD 11) years) were more likely to fracture (1326; 10.5%) than were obese (3065; 8.1%) or non-obese (8329; 6.6%) controls. A mean of 4.4 years after surgery, bariatric patients were more susceptible to fracture (514; 4.1%) than were obese (1013; 2.7%) and non-obese (3008; 2.4%) controls. Postoperative adjusted fracture risk was higher in the bariatric group than in the obese (relative risk 1.38, 95% confidence interval 1.23 to 1.55) and non-obese (1.44, 1.29 to 1.59) groups. Before surgery, the risk of distal lower limb fracture was higher, upper limb fracture risk was lower, and risk of clinical spine, hip, femur, or pelvic fractures was similar in the bariatric and obese groups compared with the non-obese group. After surgery, risk of distal lower limb fracture decreased (relative risk 0.66, 0.56 to 0.78), whereas risk of upper limb (1.64, 1.40 to 1.93), clinical spine (1.78, 1.08 to 2.93), pelvic, hip, or femur (2.52, 1.78 to 3.59) fractures increased. The increase in risk of fracture reached significance only for

  6. SURGICAL TREATMENT OF PATIENTS WITH PROSTATE CANCER AT HIGH RISK OF PROGRESSION

    Directory of Open Access Journals (Sweden)

    K. M. Nyushko

    2014-07-01

    Full Text Available Prostate cancer (PC is one of the most burning problems of modern urologic oncology. Patients at its high risk are characterized by a more aggressive course of the disease and significantly lower tumor-specific and relapse-free survival rates. Hormone therapy and radiotherapy are one of the conventional treatments in patients with PC at high risk of progression. Nonetheless, more and more publications demonstrating the efficiency and safety of surgical therapy in this contingent of patients are recently appearing. This paper presents the results of surgical treat-ment in 499 patients with PC at high risk of progression, who have undergone radical prostatectomy with extended pelvic lymphadenectomy at the Department of Urologic Oncology, P.A. Herzen Moscow Oncology Research Institute. 

  7. Triple pathological findings in a surgically amenable patient with mesial temporal lobe epilepsy

    Directory of Open Access Journals (Sweden)

    Fumin Tong

    2015-01-01

    Full Text Available Mesial temporal sclerosis (MTS is a well-recognized cause of intractable epilepsy; however, coexistence with focal cortical dysplasia (FCD is less common. Middle fossa epidermoid cysts are rare and may involve the temporal lobe. Most epidermoids are clinically silent, slow-growing, and seldom associated with overt symptomatology, including seizures. We describe a patient with multiple comorbidities including left MTS and a large epidermoid cyst involving the left quadrigeminal plate cistern compressing upon the cerebellar vermis and tail of the left hippocampus, resulting in refractory left temporal lobe epilepsy. The patient underwent left anterior temporal lobectomy. The surgical pathology demonstrated a third pathological finding of left temporal FCD type Ia. The patient has been seizure-free since the surgery. This case provides additional information with regard to the understanding of epileptogenicity and surgical planning in patients with MTS and epidermoid cysts.

  8. Coordinating perioperative care for the 'high risk' general surgical patient using risk prediction scoring.

    Science.gov (United States)

    Hafiz, Shaziz; Lees, Nicholas Peter

    2016-01-01

    Identifying 'high risk' (> 5% mortality score) emergency general surgical patients early, allows appropriate perioperative care to be allocated by securing critical care beds and ensuring the presence of senior surgeons and senior anesthetists intraoperatively. Scoring systems can be used to predict perioperative risk and coordinate resources perioperatively. Currently it is unclear which estimate of risk correlates with current resource deployment. A retrospective study was undertaken assessing the relationship between deployment of perioperative resources: senior surgeon, senior anesthetist and critical care bed. The study concluded that almost all high risk patients with high POSSUM mortality and morbidity scores had a consultant senior surgeon present intraoperatively. Critically unwell patients with higher operative severity and perioperative morbidity scores received higher care (HDU/ICU) beds postoperatively, ensuring that they received appropriate care if their condition deteriorated. Therefore POSSUM scoring should be used perioperatively in emergency cases to coordinate appropriate perioperative care for high risk general surgical patients. PMID:26901929

  9. An outcome analysis of seventeen patients treated surgically for intractable extratemporal epilepsy.

    LENUS (Irish Health Repository)

    Mulholland, D

    2010-07-01

    We studied the outcomes of seventeen patients treated surgically for extratemporal lobe epilepsy. A retrospective case review of medical charts was performed. Seizure freedom post surgery was appraised using the Engel classification system. Post-operatively seven patients (41%) were seizure free (Engel class I), four patients were class II (23.5%), two in class III (11.76%) and four in class IV (23.5%). Three patients (17.6%) suffered traumatic injuries due to seizures. The mean duration of epilepsy prior to surgery was 12.2 years and the mean number of anti-epileptic medications given was 6.5. Seizure freedom rates for surgical treatment of extratemporal epilepsy in this centre are similar to those of other centres. Post-operative morbidity in this centre was similar to other centres. Any complications resolved with no lasting impairment.

  10. Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

    Directory of Open Access Journals (Sweden)

    Adriana Estela Biasotti Gomes

    2014-05-01

    Full Text Available Introduction Surgical site infections (SSIs often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4% acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance.

  11. Chronobiology, cognitive function and depressive symptoms in surgical patients

    DEFF Research Database (Denmark)

    Hansen, Melissa Voigt

    2014-01-01

    disorders, such as anxiety and depression, are common problems arising around the time of surgery or in the course of a cancer diagnosis and subsequent treatment period. The importance of investigating prevention or treatment possibilities in these populations is significant due to the extent...... of the problems and the derived consequences on morbidity and mortality. Genetic predisposition to these problems is also an issue in focus. In this thesis we initially investigated whether the specific clock gene genotype PER(5/5) was associated with the development of postoperative cognitive dysfunction one...... investigated the effect of 6 mg oral melatonin on depressive symptoms, anxiety, sleep, cognitive function and fatigue in patients with breast cancer in a three month time period after surgery. Melatonin had an effect on reducing the risk of developing depressive symptoms and also increased sleep efficiency...

  12. Ménage-à-trois of bariatric surgery, bile acids and the gutmicrobiome

    Institute of Scientific and Technical Information of China (English)

    Rajendra Raghow

    2015-01-01

    Bariatric surgeries have emerged as highly effectivetreatments for obesity associated type-2 diabetesmellitus. Evidently, the desired therapeutic endpointssuch as rates of weight loss, lower levels of glycatedhemoglobin and remission of diabetes are achievedmore rapidly and last longer following bariatric surgery,as opposed to drug therapies alone. In light of thesefindings, it has been suspected that in addition tocausing weight loss dependent glucose intolerance,bariatric surgery induces other physiological changesthat contribute to the alleviation of diabetes. However,the putative post-surgical neuro-hormonal pathwaysthat underpin the therapeutic benefits of bariatricsurgery remain undefined. In a recent report, Ryan andcolleagues shed new light on the potential mechanismsthat determine the salutary effects of bariatric surgeryin mice. The authors demonstrated that the improvedglucose tolerance and weight loss in mice after verticalsleeve gastrectomy (VSG) surgery were likely to becaused by post-surgical changes in circulating bileacids and farnesoid-X receptor (FXR) signaling, both ofwhich were also mechanistically linked to changes inthe microbial ecology of the gut. The authors arrivedat this conclusion from a comparison of genome-wide,metabolic consequences of VSG surgery in obese wildtype (WT) and FXR knockout mice. Gene expressionin the distal small intestines of WT and FXR knockoutmice revealed that the pathways regulating bile acidcomposition, nutrient metabolism and anti-oxidantdefense were differentially altered by VSG surgeryin WT and FXR-/- mice. Based on these data Ryanet al , hypothesized that bile acid homeostasis andFXR signaling were mechanistically linked to the gutmicrobiota that played a role in modulating post-surgicalchanges in total body mass and glucose tolerance.The authors' data provide a plausible explanation forputative weight loss-independent benefits of bariatricsurgery and its relationship with metabolism of bileacids.

  13. STUDY ON THE APPLICABILITY OF THE MODIFIED TOKUHASHI SCORE IN PATIENTS WITH SURGICALLY TREATED VERTEBRAL METASTASIS

    Science.gov (United States)

    Mattana, Jeferson Luis; Freitas, Rosyane Rena de; Mello, Glauco José Pauka; Neto, Mário Armani; Freitas Filho, Geraldo de; Ferreira, Carolina Bega; Novaes, Carolina

    2015-01-01

    To present the results obtained from surgical treatment of patients with vertebral metastases, comparing them with the modified Tokuhashi score in order to validate the applicability of this score for prognostic predictions and for choosing surgical treatments. Methods: This was a retrospective study on 157 patients treated surgically for spinal metastasis in Erastus Gaertner Hospital in Curitiba. The Tokuhashi score was applied retrospectively to all the patients. The patients' actual survival time was compared with the expected survival time using the Tokuhashi score. Results: There were 82 females and 75 males. The most frequent location of the primary tumor was the breast. The thoracic region was involved in 66.2%, lumbar region in 65.6%, cervical region in 15.9% and sacral region in 12.7%. All the patients underwent surgical treatment. The most frequent indication for treatment was intractable pain (89.2%). There was partial or complete improvement in a majority of the cases (52.2%). Out of 157 cases studied, 86.6% died. The maximum survival time was 13.6 years, the minimum was 3 days and the mean was 13.2 months. The following frequencies of Tokuhashi scores were found among the operated cases: up to 8 points, 111 cases; 9-11 points, 43 cases; and 12-15 points, three cases. The mean survival time in months for all 157 patients according to the Tokuhashi score was: 0-8 points, 15.4 months; 9-11 points, 11.4 months; and 12-15 points, 12 months. Conclusion: Unlike the nonsurgical approach recommended by Tokuhashi for patients with lower scores, this group in our study was sent for surgery, with better results than those of non-operated patients reported by Tokuhashi. PMID:27027033

  14. The Effects of Psychological Desensitization on Levels of Patient Comfort During Oral Surgical Procedures

    OpenAIRE

    Long, David H.

    1987-01-01

    The efficacy of psychological desensitization to reduce clinical pain associated with oral surgery was compared to diazepam plus meperidine I.V. Premedication. A visual analog scale was used to rate pain during local anesthesia administration and oral surgery. Psychological desensitization of patients who are to receive only local anesthesia during oral surgical procedures appears to be a significantly effective means of controlling patient pain perception. Such desensitization does not appea...

  15. Could Recurrent Anxiety Be a New Surgical Indication for Patients with Spontaneous Pneumothorax?

    Directory of Open Access Journals (Sweden)

    Mahmut Tokur

    2013-10-01

    Full Text Available This article should be a reference perspective for further research on this rarely studied subject. As authors mentioned limited number and non-homogenous distribution of patients are disabilities of the article and it is insufficient for making an accurate judgment like “for dealing with recurrence anxiety in spontaneous pneumothorax patients, initial choice of treatment in first attack should be surgical therapy”. Further studies with larger subject groups should be done.

  16. Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation

    OpenAIRE

    Arya Satyavrat; Singh Tanveer; Mohil Ravindra; Bhatnagar Dinesh

    2008-01-01

    Abstract Background Using crude mortality and morbidity rates for comparing outcomes can be misleading. The aim of the present study was to compare the outcome of various surgical modalities without and with risk adjustment using Physiologic and Operative Severity Scoring for the enUmeration of Mortality and morbidity (POSSUM) score in cases of ileal perforations. Methods Prospective study on 125 patients of ileal perforations. Resection anastamosis (Group I) was done in 38 patients, primary ...

  17. Postoperative intubation time is associated with acute kidney injury in cardiac surgical patients

    OpenAIRE

    Heringlake, Matthias; Nowak, Yvonne; Schön, Julika; Trautmann, Jens; Berggreen, Astrid Ellen; Charitos, Efstratios I.; Paarmann, Hauke

    2014-01-01

    Introduction Acute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with a poor prognosis. Mechanical ventilation is an important risk factor for developing AKI in critically ill patients. Ventilation with high tidal volumes has been associated with postoperative organ dysfunction in cardiac surgical patients. No data are available about the effects of the duration of postoperative respiratory support in the immediate postoperative period on the incidence...

  18. Evaluation of spinopelvic balance among patients undergoing surgical treatment for lumbar disk hernia☆☆☆

    OpenAIRE

    Rafael de Paiva Oliveira; Vinícius Gonçalves Coimbra; Yuri Lubiana Chisté; José Lucas Batista Junior; Charbel Jacob Junior; Igor Machado Cardoso; Rodrigo Rezende

    2014-01-01

    OBJECTIVE: to evaluate spinopelvic balance using the pelvic incidence, sacral slope and pelvic tilt among patients with lumbar disk hernias who underwent surgical treatment.METHODS: thirty patients at the spinal services of Hospital Santa Casa de Misericórdia de Vitória and Hospital Vila Velha were evaluated by measuring their spinopelvic balance from the angles of pelvic tilt, sacral slope and pelvic incidence, with their respective means, on simple lateral-view lumbopelvic radiographs that ...

  19. Surgical Treatment of Anomalous Origin of Right Coronary Artery in a Patient with Mitral Stenosis

    OpenAIRE

    Ali Refatllari; Ermal Likaj; Selman Dumani; Endri Hasimi; Artan Goda

    2015-01-01

    BACKGROUND: An anomalous origin of the right coronary artery is rarely observed, with a reported incidence between 0.026% and 0.25%. This condition is often completely asymptomatic and is found incidentally during angiographic evaluation for other cardiac diseases. However some patients present with exertion angina or sudden death. Surgical treatment in patients with anomalous RCA is still controversial. Treatment can be conservative, angioplasty or surgery. CASE PRESENTATION: A 59-year-o...

  20. Pseudoangiomatous stromal hyperplasia (PASH) tumour at the surgical scar site in a patient of carcinoma breast.

    Science.gov (United States)

    Abrari, Andleeb

    2011-01-01

    A patient on follow-up post surgery for carcinoma breast, presented with a nodule under the surgical scar. The sinister eventuality of recurrent carcinoma was clinically considered first. The lesion was biopsied and the histopathology was diagnostic of pseudoangiomatous stromal hyperplasia tumour. The nodule was excised and the patient's clinical denouement has been uneventful in the 4 months which have elapsed after this event. PMID:22688488

  1. OPTIMIZATION OF SURGICAL TREATMENT OF CATARACT IN PATIENTS WITH DIABETES MELLITUS

    OpenAIRE

    Dmitriy Valentinovich Lipatov; Timofey Aleksandrovich Chistyakov; Anatoliy Gennad'evich Kuz'min

    2010-01-01

    Aim. To compare different methods for surgical treatment of cataract in patients with diabetes melli-tus (DM) and substantiate the choice of its optimal modality. Materials and methods. Analysis included data on 209 patients (221 eyes) treated from January 2008 to December 2009 in the Department of Retinopathy and Ophthalmosurgey, Endocrinological Research Centre. Diabetic cataract was managed using UNIVERSAL-II, LEGACY EVEREST, and INFINITI phacoemulsifiers. Parameters studied in...

  2. Through Thick and Thin: Identifying Barriers to Bariatric Surgery, Weight Loss Maintenance, and Tailoring Obesity Treatment for the Future

    Science.gov (United States)

    Westerveld, Donevan; Yang, Dennis

    2016-01-01

    More than one-third of the adults in the United States are obese. This complex metabolic disorder is associated with multiple comorbidities and increased all-cause mortality. Bariatric surgery has been shown to be more effective than medical therapy and has been associated with weight loss maintenance and decreased mortality. In spite of these well-established benefits, less than 1% of candidates undergo surgery due to multiple factors, such as patient and physician perceptions and attitudes, patient-physician interaction, lack of resources, and cost burden. Furthermore, even in patients who do undergo bariatric surgery and/or alternate weight loss interventions, long-term weight control is associated with high-risk failure and weight regain. In this review, we highlight some of the current barriers to bariatric surgery and long-term weight loss maintenance and underscore the importance of an individualized multidisciplinary longitudinal strategy for the treatment of obesity.

  3. The trans-sphenoidal resection of pituitary adenomas in elderly patients and surgical risk.

    Science.gov (United States)

    Locatelli, M; Bertani, G; Carrabba, G; Rampini, P; Zavanone, M; Caroli, M; Sala, E; Ferrante, E; Gaini, S M; Spada, A; Mantovani, G; Lania, A

    2013-06-01

    In western countries, the process of "ageing of the population" is increasingly forcing clinical medicine to find answers for pathologies affecting the elder segments of our community. In this respect, pituitary adenomas often raise difficult questions on surgical indications, since little is known about postoperative morbidity and mortality in elderly patients. The transsphenoidal endonasal approach (TNS), which is considered the gold standard for surgical resection of the majority of functioning and non-functioning pituitary adenomas, is supposed to be a low morbidity and mortality procedure in adult patients. However, only a few contradicting data are available in the literature about elderly patients. In this paper we retrospectively analyze a cohort of 43 consecutive patients aged more than 65 years, operated on for pituitary adenomas at our Institution in the years 1998-2007. These patients were treated by transsphenoidal endonasal approach (TNS) for resection of non-functioning pituitary adenomas (n = 31), GH-secreting adenomas (n = 4) and ACTH-secreting adenomas (n = 8). Clinical records reported a macroadenoma with tumour-related mass symptoms in about 80 % of patients; single or multiple pituitary deficits were present in 44 % of patients. Regarding comorbidities, cardiac disease was the most frequently observed (86 %); assessment of anaesthesiological risk indicated a moderate to severe ASA score in most patients, 11 % showing a 4-5 score. On the basis of current criteria, our retrospective analysis revealed that cure was achieved in 54 % of patients. The outcome was similar to that observed in the general population of patients undergoing transphenoidal surgery in our centre, without differences in the rate of surgical and endocrinological cure, minor and major surgical complications and hospitalization duration. In particular, no significant anaesthesiological complications were observed and no patient developed either permanent diabetes

  4. Prosthetic Rehabilitation of Maxillectomy Patient with Post-Surgical Obturator: A Case Report

    Directory of Open Access Journals (Sweden)

    Meena Kumari Mishra

    2015-07-01

    Full Text Available Case description: A 60 year old female patient presented to Department of Prosthodontics, CODS, BPKIHS, Dharan with a chief complain of loose obturator. History revealed that patient had undergone partial maxillectomy for squamous cell carcinoma 7 years back. The patient also has been wearing obturator which was loose when the patient reported to the department. On examination, the site of surgery was the maxillary right buccal sulcus area and a part of the hard palate including teeth number 11, 12, 13, 14, 15, 16, 17. The presented defect situation corresponded to a Class I situation (resection performed along the palatalmidline according to the Aramany classification of defects. The surgical site showed complete healing. A hollow-bulb obturator was fabricated for rehabilitation of the defect. Conclusion: The extensive surgical procedures necessary to eradicate cancer of the head and neck and to prevent local recurrence or regional metastasis often leave extremely large physical defects which present almost insurmountable surgical difficulties in restoring acceptable function or esthetics. The prosthesis rehabilitated the patient in terms of function by providing better masticatory efficiency, phonetics by adding resonance to the voice, hence improving the clarity of speech and also improved the esthetics of the patient. DOI: http://dx.doi.org/10.3126/jcmsn.v10i4.12976 JCMS Nepal 2014; 10(4:32-36

  5. Surgical treatment of a chronically fixed lateral patella dislocation in an adolescent patient

    Directory of Open Access Journals (Sweden)

    Xinning Li

    2013-06-01

    Full Text Available Acute patellar dislocation or subluxation is a common cause for knee injuries in the United States and accounts for 2% to 3% of all injuries. Up to 49% of patients will have recurrent subluxations or dislocations. Importance of both soft tissue\t(predominantly,\tthe medial patellofemoral ligament, MPFL, which is responsible for 60% of the resistance to lateral dislocation and bony constraint of femoral trochlea in preventing subluxation and dislocation is well documented. Acute patella dislocation will require closed reduction and management typically consist of conservative or surgical treatment depending on the symptoms and recurrence of instability. Most patients are diagnosed and treated in a timely manner. We present a 15 years old male with a missed traumatic lateral patella dislocation during childhood. The patient presented as an adolescent with a chronically fixed lateral patella dislocation and was management with surgery. The key steps in the surgical reconstruction of this patient required first mobilizing the patella with a lateral retinacular release and V-Y lengthening of the shortened or contracted quadriceps tendon. Then a combination of MPFL reconstruction using the semi-tendinosis autograft, tibial tubercle osteotomy with anterio-medialization, and lateral facetectomy was performed. At the one-year follow-up, our patient had improved knee range of motion and decrease in pain. Chronically fixed lateral dislocated patella is a rare and complex problem to manage in older patients that will require a thorough work-up and appropriate surgical planning along with reconstruction.

  6. Bariatric surgery versus medications in the treatment of type 2 diabetes.

    Science.gov (United States)

    Fanin, A; Benetti, A; Ceriani, V; Pontiroli, A E

    2015-12-01

    Type 2 diabetes mellitus (T2DM) is associated with increased risk of severe comorbidities and mortality; its prevalence is increasing worldwide, linked with the increasing prevalence of obesity. Weight loss prevents the development of T2DM in obese subjects, and can reverse T2DM in morbid obesity. This paper reviews bariatric surgery as a means for prevention and treatment of T2DM and its complications, in comparison with medical treatment, and analyzes the possible mechanisms involved. In morbidly obese patients bariatric surgery results in stable weight loss and long-term reduction in incidence and prevalence of obesity-related comorbidities, especially T2DM. The efficacy of bariatric surgery in improving and normalizing glucose levels has been confirmed by a large number of studies, comparing surgery with medical therapy. When compared to each other, malabsorptive and mixed malabsorptive/restrictive surgery techniques have shown better outcomes than restrictive techniques in terms of T2DM remission. However it is demonstrated that T2DM can reappear in the following years, especially in patients with advanced age, female sex, longer duration of T2DM, poorer glycemic control, use of insulin before surgery and weight regain. Bariatric surgery is superior to conventional medical therapy in inducing significant weight loss and control of T2DM. Weight loss has pleiotropic effects: T2DM can disappear and then re-appear as a result of persistent beta-cells impairment, while other effects last much longer, as reduction of blood pressure and improvement of lipids and of kidney function. This is probably the reason for long-term prevention of cardiovascular events and of mortality in obese and in obese-diabetic patients. The effect of bariatric surgery on diabetic retinopathy is still controversial. PMID:26365477

  7. CLINICAL PROFILE OF DIABETIC FOOT ULCERS OF PATIENTS ATTENDING SURGICAL OPD IN RURAL MEDICAL COLLEGE

    Directory of Open Access Journals (Sweden)

    Sanjeev

    2015-12-01

    Full Text Available OBJECTIVE To study the clinical profile of dibetic foot ulcers of patients attending surgical OPD in rural medical college. MATERIAL AND METHODS Clinical profile of 40 patients of diabetic foot ulcers was studied. All the patients were subjected to complete haemogram, fasting and PP blood sugar, LFT, KFT, lipid profile, urine R/E, pus c/s, colour doppler of lower limb and x-ray foot. RESULTS Majority of patients with diabetic foot ulcers were of age group 41–70, male, diabetes mellitus of duration more than 6 years, had intermittent claudication and single ulcer.

  8. Results of surgical treatment of massive localized lymphedema in severely obese patients

    Directory of Open Access Journals (Sweden)

    Wilson Cintra Júnior

    2014-01-01

    Full Text Available OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, with greater range of motion, ambulation with ease and more effective hygiene. Histological analysis demonstrated the existence of a chronic inflammatory process marked by lymphomonocitary infiltrate and severe tissue edema. We observed foci of necrosis, formation of microabscesses, points of suppuration and local fibrosis organization, and pachydermia. The lymphatic vessels and some blood capillaries were increased, depicting a framework of linfangiectasias. CONCLUSION: surgical treatment of MLL proved to be important for improving patients' quality of life, functionally rehabilitating them and optimizing multidisciplinary follow-up of morbid obesity, with satisfactory surgical results and acceptable complication rates, demonstrating the importance of treatment and awareness about the disease.

  9. Prevention of bleeding and hemorrhagic complications in surgical patients with inherited factor VII deficiency.

    Science.gov (United States)

    Wiszniewski, Adam; Szczepanik, Andrzej; Misiak, Andrzej; Bykowska, Ksenia; Szopiński, Piotr

    2015-04-01

    Inherited factor VII (FVII) deficiency is a rare autosomal recessive hemorrhagic disorder. The major clinical symptoms include: bleeding from the oral cavity, epistaxis, menorrhagia, spontaneous hemarthros, bleeding to the gastrointestinal tract and central nervous system, and perioperative bleeding. The aim of this study was to present our experience in preventing bleeding and hemorrhagic disorders in surgical patients with inherited FVII deficiency by using recombinant activated FVIIa (rFVIIa), and with prothrombin complex concentrates (PCCs). In 2002-2011, 17 patients with inherited FVII deficiency underwent surgery. Thirteen patients had isolated FVII deficiency below 10%, and four patients 10-25. To prevent bleeding and hemorrhagic complications, we administered small single doses of rFVIIa (Novo-Seven) at 12-h intervals to 15 patients on surgery day and on day 1 following surgery, then every 24 h; PCCs were administered (Prothromplex, Beriplex) to two patients. No symptoms of bleeding, hemorrhagic or thromboembolic complications were observed in the perioperative and 1-month observation period in surgical patients treated with rFVIIa. One patient treated with PCC (Prothromplex) developed distal deep vein thrombosis on postoperative day 7. The results suggest that small, single, every 12-h doses of rFVIIa (NovoSeven) and in next days after surgery one time every 24 h are well tolerated and effective for prevention of thromboembolic, bleeding and hemorrhagic complications in FVII-deficient patients. Antithrombotic prophylaxis with low-molecular-weight heparin should be applied in patients using PCCs. PMID:25688458

  10. Clinical effect of a positive surgical margin after hepatectomy on survival of patients with intrahepatic cholangiocarcinoma

    Science.gov (United States)

    Yeh, Chun-Nan; Hsieh, Feng-Jen; Chiang, Kun-Chun; Chen, Jen-Shi; Yeh, Ta-Sen; Jan, Yi-Yin; Chen, Miin-Fu

    2015-01-01

    Background Several unfavorable prognostic factors have been proposed for peripheral cholangiocarcinoma (PCC) in patients undergoing hepatectomy, including gross type of tumor, vascular invasion, lymph node metastasis, a high carbohydrate antigen 19-9 level, and a positive resection margin. However, the clinical effect of a positive surgical margin on the survival of patients with PCC after hepatectomy still needs to be clarified due to conflicting results. Methods A total of 224 PCC patients who underwent hepatic resection with curative intent between 1977 and 2007 were retrospectively reviewed. Eighty-nine patients had a positive resection margin, with 62 having a microscopically positive margin and 27 a grossly positive margin (R2). The clinicopathological features, outcomes, and recurrence pattern were compared with patients with curative hepatectomy. Results PCC patients with hepatolithiasis, periductal infiltrative or periductal infiltrative mixed with mass-forming growth, higher T stage, and more advanced stage tended to have higher positive resection margin rates after hepatectomy. PCC patients who underwent curative hepatectomy had a significantly higher survival rate than did those with a positive surgical margin. When PCC patients underwent hepatectomy with a positive resection margin, the histological grade of the tumor, nodal positivity, and chemotherapy significantly affected overall survival. Locoregional recurrence was the most common pattern of recurrence. Conclusion A positive resection margin had an unfavorable effect on overall survival in PCC patients undergoing hepatectomy. In these patients, the prognosis was determined by the biology of the tumor, including differentiation and nodal positivity, and chemotherapy increased overall survival. PMID:25552905

  11. Suprastomal tracheal stenosis after dilational and surgical tracheostomy in critically ill patients.

    Science.gov (United States)

    Koitschev, A; Simon, C; Blumenstock, G; Mach, H; Graumüller, S

    2006-09-01

    We have previously reported cases of severe suprastomal stenosis after tracheostomy. In this observational study we investigated the occurrence of suprastomal stenosis as a late complication. Patients with persistent tracheostomy after intensive care underwent an endoscopic examination of tracheostoma, larynx and trachea. A percutaneous dilational tracheostomy was employed in 105 (71.9%) and surgical tracheostomy in 41 (28.1%) of the cases (n = 146). The incidence of severe suprastomal stenosis (grade II > 50% of the lumen) was 23.8% (25 of 105) after dilational tracheostomy and 7.3% (3 of 41) after surgical tracheostomy (p = 0.033). Age, gender, underlying disease, ventilation time, and swallowing ability were not significantly associated with the tracheal pathology. This study suggests that dilational tracheostomy is associated with an increased risk of severe suprastomal tracheal stenosis compared to the surgical technique. PMID:16922748

  12. INCREMENTAL DYNAMIC COMPUTER TOMOGRAPHY IN SURGICAL TREATMENT OF PATIENTS WITH SOLITARY PULMONARY NODULES

    Institute of Scientific and Technical Information of China (English)

    ZHU Ya-bing; CHU Cheng-feng; LIU Zhi-yong; YANG Dan-ning; XU Qiu-zhen; YANG Ming

    2006-01-01

    Objective The purpose of this study is to appraise the value of incremental dynamic enhanced computed tomography in surgical treatment of patients with solitary pulmonary nodules (SPNs). Methods The data of 42 cases with solitary pulmonary nodules who underwent surgical treatment from May 2002 to June 2003 in our hospital were collected to find the relationship between preoperative dynamic enhanced CT image and postoperative pathology. Result All bronchogenic carcinoma showed significant enhancement after intravenous 100 mL iodinated contrast material. The average degree of enhancement of bronchogenic carcinoma was significantly different from that of tuberculoma and other benign lesions. Conclusion Dynamic enhanced computed tomography is very valuable in distinguishing between malignant nodules and benign ones. Emphasis should be paid to lymph nodes in the dynamic enhanced computed tomography, which is useful both to the diagnosis of SPN and for surgical treatment.

  13. General anesthesia-associatedDNA damage in peripheral blood mononuclear cells of surgical patients

    Institute of Scientific and Technical Information of China (English)

    Wang Haiyan; Zhou Qi; Fu Huo

    2011-01-01

    Objective:To evaluate retrospectively the effect of general anesthesia onDNA damage in the blood mononuclear cells (PBMCs) of surgical patients in order to provide evidence for a better nursing care during the procedure.Methods: Clinical charts of76 patients who underwent operation under general anesthesia and76 healthy control subjects with documented results of DNA damage extent inPBMCs from the single-cell gel electrophoresis(SCGE) or comet assay and serum contents of superoxide dismutase(SOD) and malondialdehyde(MDA)from biochemical analyses were reviewed. The percentage of comet PBMCs and tailDNAand serum contents of SOD and MAD were analyzed by student t-test.Results: Compared with healthy control subjects, generally anesthetized surgical patients had significantly higher % cometPBMCs and % tail DNA(P<0.05) and significantly lower serum concentrations ofSOD (P<0.05) and significantly higher serum concentrations ofMAD (P<0.05). Compared with levels before general anesthesia in surgical patients, % cometPBMCs, % tailDNA, and serum levels ofMADwere significantly higher (P<0.05 or0.01), and serum levels ofSOD were significantly lower (P<0.05), after general anesthesia.Conclusions: General anesthesia during surgery causes a certain degree of hypoxia and PBMC damage. Particular attention should be paid to monitoring and maintenance of blood oxygen saturation in patients undergoing surgery under general anesthesia.

  14. Effect of non-surgical periodontal treatment on chronic kidney disease patients

    Directory of Open Access Journals (Sweden)

    Hilana Paula Carillo Artese

    2010-12-01

    Full Text Available Chronic kidney disease (CKD is a debilitating systemic condition. Our working hypothesis is that CKD predialysis patients with periodontitis would respond poorly to periodontal treatment owing to immunologic compromise. Twenty-one predialysis patients (group 1 and 19 individuals without clinical evidence of kidney disease (group 2 with chronic periodontitis were subjected to non-surgical periodontal treatment with no antibiotics. Clinical periodontal and systemic parameters were evaluated at baseline and 3 months after treatment. Both groups showed significant and similar post-treatment improvements in all periodontal parameters examined. Most interestingly, periodontal treatment had a statistically significant positive effect on the glomerular filtration rate of each individual (group 1, p = 0.04; group 2, p = 0.002. Our results indicate that chronic periodontitis in predialysis kidney disease patients improved similarly in patients with chronic periodontitis and no history of CKD after receiving non-surgical periodontal therapy. This study demonstrates that CKD predialysis patients show a good response to non-surgical periodontal treatment.

  15. Clinical effect of a positive surgical margin after hepatectomy on survival of patients with intrahepatic cholangiocarcinoma

    Directory of Open Access Journals (Sweden)

    Yeh CN

    2014-12-01

    Full Text Available Chun-Nan Yeh,1 Feng-Jen Hsieh,1 Kun-Chun Chiang,1 Jen-Shi Chen,2 Ta-Sen Yeh,1 Yi-Yin Jan,1 Miin-Fu Chen1 1Department of General Surgery, 2Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan Background: Several unfavorable prognostic factors have been proposed for peripheral cholangiocarcinoma (PCC in patients undergoing hepatectomy, including gross type of tumor, vascular invasion, lymph node metastasis, a high carbohydrate antigen 19-9 level, and a positive resection margin. However, the clinical effect of a positive surgical margin on the survival of patients with PCC after hepatectomy still needs to be clarified due to conflicting results. Methods: A total of 224 PCC patients who underwent hepatic resection with curative intent between 1977 and 2007 were retrospectively reviewed. Eighty-nine patients had a positive resection margin, with 62 having a microscopically positive margin and 27 a grossly positive margin (R2. The clinicopathological features, outcomes, and recurrence pattern were compared with patients with curative hepatectomy. Results: PCC patients with hepatolithiasis, periductal infiltrative or periductal infiltrative mixed with mass-forming growth, higher T stage, and more advanced stage tended to have higher positive resection margin rates after hepatectomy. PCC patients who underwent curative hepatectomy had a significantly higher survival rate than did those with a positive surgical margin. When PCC patients underwent hepatectomy with a positive resection margin, the histological grade of the tumor, nodal positivity, and chemotherapy significantly affected overall survival. Locoregional recurrence was the most common pattern of recurrence. Conclusion: A positive resection margin had an unfavorable effect on overall survival in PCC patients undergoing hepatectomy. In these patients, the prognosis was determined by the biology of the tumor, including differentiation and nodal

  16. Effect of surgical delay on outcome in hip fracture patients: a retrospective multivariate analysis of 192 patients

    OpenAIRE

    Verbeek, D. O.F.; Ponsen, K.J.; Goslings, J.C.; Heetveld, M.J.

    2007-01-01

    Previous studies have not demonstrated consistent results on the effect of surgical delay on outcome. This study investigated the association between the delay to surgery and the development of postoperative complications, length of hospital stay (LOS) and one-year mortality. Patients that underwent surgery for a hip fracture in a two-year period were included in a retrospective study. Uni- and multivariate regression analysis was performed in 192 hip fracture patients. There was a trend towa...

  17. Could Recurrent Anxiety be a New Surgical Indication for Patients with Spontaneous Pneumothorax?

    Directory of Open Access Journals (Sweden)

    Rasih Yazkan

    2013-03-01

    Full Text Available    Aim: Anxiety is a psychological and physiological clinical state characterized by somatic, emotional, cognitive, and behavioral components. This disturbance may causes clinically significant distress or impairment in social, occupational or other important areas of functioning. Recurrent anxiety is a serious clinical entity in patients with spontaneous pneumothorax, and some patients may have strong anxiety and avoid risky activities. In this study, we searched for answer to the question “could recurrent anxiety be a new surgical indication for patients with spontaneous pneumothorax?”. Material and Method: A total 36 patients with spontaneous pneumothorax were evaluated, the data of frequency of admission without any recurrence due to the recurrent anxiety were collected, and the patients were evaluated with chest radiography in each admission. Results: In preoperative period 19 (52.8% patients, in postoperative period 2 (5.6% patients admitted to the hospital due to their recurrent anxiety in follow-up period. There were approximately 9.5-fold difference between the frequency of admission to the hospital in preoperative and postoperative period. Discussion: Surgical approach may be preferred in post episode whose have declining quality of life and serious recurrent anxiety in patients with spontaneous pneumothorax.  Especially  thoracoscopic surgery must be the preferred in the first episode of  spontaneous pneumothorax in young and healthy patients.

  18. Non surgical predicting factors for patient satisfaction after third molar surgery

    Science.gov (United States)

    Balaguer-Martí, José-Carlos; Aloy-Prósper, Amparo; Peñarrocha-Oltra, David

    2016-01-01

    Background In the third molar surgery, it is important to focus not only on surgical skills, but also on patient satisfaction. Classically studies have been focused on surgery and surgeon’s empathy, but there are non-surgical factors that may influence patient satisfaction. Material and Methods A cross-sectional study was performed on 100 patients undergoing surgical extractions of impacted mandibular third molars treated from October 2013 to July 2014 in the Oral Surgery Unit of the University of Valencia. A questionnaire (20 questions) with a 10-point Likert scale was provided. The questionnaire assessed the ease to find the center, the ease to get oriented within the center, the burocratic procedures, the time from the first visit to the date of surgical intervention, waiting time in the waiting room, the comfort at the waiting room, the administrative staff (kindness and efficiency to solve formalities), medical staff (kindness, efficiency, reliability, dedication), personal data care, clarity in the information received (about the surgery, postoperative care and resolution of the doubts), available means and state of facilities. Outcome variables were overall satisfaction, and recommendation of the center. Statistical analysis was made using the multiple linear regression analysis. Results Significant correlations were found between all variables and overall satisfaction. The multiple regression model showed that the efficiency of the surgeon and the clarity of the information were statistically significant to overall satisfaction and recommendation of the center. The kindness of the administrative staff, available means, the state of facilities and the comfort at the waiting room were statistically significant to the recommendation of the center. Conclusions Patient satisfaction directly depends on the efficiency of the surgeon and clarity of the clinical information received about the procedure. Appreciation of these predictive factors may help clinicians

  19. [Surgical treatment of respiratory failure in young patients with diffuse lung emphysema].

    Science.gov (United States)

    Gorbunkov, S D; Chernyĭ, S M; Akopov, A L; Varlamov, V V; Lukina, O V; Kiriukhina, L D; Agishev, A S; Gembitskaia, T E

    2012-01-01

    An analysis of results of examination and treatment of 8 young patients (from 25 to 17 years of age) with generalized emphysema of the lungs, pulmonary failure of the II and III degrees was made. The functional examination of the patients before operation has revealed changed respiration by obstructive type. Symptoms of dysplasia of the connective tissue were found in 4 patients. Surgical reduction of the lung volume was performed in 5 patients for correction of respiratory failure. There were neither serious complications nor lethality. Dyspnea by MMRC scale decreased in all the patients at minimum by 1 point during the first months after operation. Three years later 4 out of the operated patients (80%) had retained positive effect of operation. In patients who had no operative treatment the frequency of infectious complications, level of dyspnea during three years of follow-up remained at the same level, while functional indices continued worsening. The surgical method of treatment of severe respiratory failure allowed tolerance of physical exercise to be increased and quality of life of patients with diffuse lung emphysema to be improved. PMID:23488258

  20. A comparative study to evaluate the effect of intranasal dexmedetomidine versus oral alprazolam as a premedication agent in morbidly obese patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Lakshmi Jayaraman

    2013-01-01

    Full Text Available Background: Morbidly obese patients with obstructive sleep apnea are extremely sensitive to sedative premedication. Intranasal dexmedetomidine is painless and quick acting. Intranasal dexmedetomidine can be used for premedication as it produces adequate sedation and also obtund hemodynamic response to laryngoscopy and tracheal intubation. Materials and Methods: Forty morbidly obese patients with BMI > 35 were chosen and divided into two groups. Group DEX received intranasal dexmedetomidine 1 mcg/kg (ideal body weight while other group (AZ received oral alprazolam 0.5 mg. Sedation scale, heart rate and the mean arterial pressure was assessed in both the groups at 0 hour, 45 minutes, during laryngoscopy and tracheal intubation. Results: The demographic profile, baseline heart rate, means arterial pressure, oxygen saturation and sedation scale was comparable between the two groups. The sedation scores, after 45 min, were statistically significant between the two groups i.e., 2.40 ± 1.09 in the AZ group as compared to 3.20 ± 1.79 in DEX group P value 0.034. The heart rate, mean arterial pressure and oxygen saturation were statistically similar between the two groups, after 45 min. The heart rate was significantly lower in the DEX group as compared to the AZ group. There was no statistical difference in the mean arterial pressure between the two groups either during laryngoscopy or tracheal intubation. Conclusion: Intranasal dexmedetomidine is a better premedication agent in morbidly obese patients than oral alprazolam.

  1. Surgical treatment in patients with kidney cancer metastasizing to the spine

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    S. V. Kostritsky

    2014-01-01

    Full Text Available The data of 60 patients with metastatic kidney cancer involving the vertebrae who had undergone different-volume surgery were retrospectively analyzed. The role of surgical volume was assessed. In patients with solitary spinal metastases, their radical removal was found to lead to better quality of life and longer survival. Puncture vertebroplasty with bone cement in patients with spinal metastatic involvement permits one to avoid traumatic fixing operations, without reducing the median survival at the same time.

  2. Optimization of the extent of surgical treatment in patients with stage I in cervical cancer

    Science.gov (United States)

    Chernyshova, A. L.; Kolomiets, L. A.; Sinilkin, I. G.; Chernov, V. I.; Lyapunov, A. Yu.

    2016-08-01

    The study included 26 patients with FIGO stage Ia1-Ib1 cervical cancer who underwent fertility-sparing surgery (transabdominaltrachelectomy). To visualize sentinel lymph nodes, lymphoscintigraphy with injection of 99mTc-labelled nanocolloid was performed the day before surgery. Intraoperative identification of sentinel lymph nodes using hand-held gamma probe was carried out to determine the radioactive counts over the draining lymph node basin. The sentinel lymph node detection in cervical cancer patients contributes to the accurate clinical assessment of the pelvic lymph node status, precise staging of the disease and tailoring of surgical treatment to individual patient.

  3. Surgical Treatment and Recurrence of Cutaneous Nasal Malignancies: A 26-Year Retrospective Review of 1795 Patients.

    Science.gov (United States)

    Christopoulos, George; Sergentanis, Theodoros N; Karantonis, Fotis; Karypidis, Dimitrios; Hampsas, Grigoris; Kostopoulos, Epaminondas; Kostaki, Maria; Papadopoulos, Othon

    2016-08-01

    Frequent localization of facial malignancies in the nasal area and their required complete surgical extirpation pose a significant challenge to the plastic surgeon, who is called to perform a suitable delicate reconstruction of produced nasal skin defects. The present study was aimed to examine the role of tumor characteristics in the prognosis of patients with nasal skin cancer undergoing surgical management.A retrospective review of 1795 patients operated on for nasal cutaneous neoplasms during a 26-year period is presented in our study. Descriptive statistics were appropriately calculated; multivariate Cox regression analysis was performed regarding the possible risk factors for recurrence. Only those with a complete follow-up were included in the study. The mean age of our study population was 66.7 years with a male majority (52.4%). Basal cell carcinoma appeared as the most common histological type (87.7%), followed by squamous cell carcinoma (7.9%); the latter correlated with poor prognosis.The nasal sidewalls were the most frequent lesion location (29.8%), followed by the alae (27.8%), dorsum (21.7%), and tip (19.3%). The columella was very rarely affected (0.5%) but was associated with increased recurrence [hazard ratio, 4.74; 95% confidence interval (CI), 1.12-20.00; P = 0.034]. Most patients were treated with elliptical excision and direct closure (58.7%). Local flaps (31.0%) and skin grafting (9.0%) proved very reliable surgical options, especially for larger, high-risk lesions. Recurrence transpired in 46 patients (2.6%) and 4 skin cancer-related deaths occurred.Surgical modality of choice should be individualized and carefully adjusted to patients' needs. Moreover, more elective techniques, such as Mohs micrographic surgery or cumulative therapeutic approaches, like irradiation, should be examined as a beneficial aid to confront high-risk malignancies. PMID:26207539

  4. Lived experiences and challenges of older surgical patients during hospitalization for cancer: An ethnographic fieldwork

    Directory of Open Access Journals (Sweden)

    Lisbeth Uhrenfeldt

    2014-02-01

    Full Text Available This paper explores the lived experiences of older surgical patients’ (aged 74 years and older experienced challenges during a brief admission to hospital. Age, gender, polypharmacy, and the severity of illness are also factors known to affect the hospitalization process. For an ethnographic study using participant observation and interviews, surgical cancer patients (n = 9, aged 74 years and older were recruited during admission to a Danish teaching hospital. Using ethnographic strategies of participant observation and interviews, each patient was followed through the course of 1 day during their stay at the hospital. Interviews were carried out with all patients during this time. Three areas of concern were identified as prominent in the patients’ experiences and challenges during their short hospital stay: teeth and oral cavity, eating in a hospital setting, and medication during hospitalization. Short-term hospitalization requires focused collaboration between staff and patient concerning individual challenges from their teeth and oral cavity as support of nutritional needs during surgical treatment for cancer.

  5. Pain experience and satisfaction with postoperative pain control among surgical patients.

    Science.gov (United States)

    Subramanian, Pathmawathi; Ramasamy, Suguna; Ng, Kwan Hoong; Chinna, Karuthan; Rosli, Roshaslina

    2016-06-01

    Alleviating acute pain and providing pain relief are central to caring for surgical patients as pain can lead to many adverse medical consequences. This study aimed to explore patients' experience of pain and satisfaction with postoperative pain control. A cross-sectional survey was carried out among 107 respondents who had undergone abdominal surgery in the surgical ward of an urban hospital using the Revised American Pain Society's Patient Outcome and Satisfaction Survey Questionnaires (APS-POQ-R). Data were analysed using descriptive statistics and chi-square test. Chi-square test showed significant association between race (P = 0.038), education level (P ≤ 0.001), previous operation status (P = 0.032) and operation status (P ≤ 0.001). Further analysis on nominal regression, association between dissatisfaction with factors of operation status (46.09 (95% CI 7.456, 284.947)) and previous operation status (13.38 (95% CI 1.39, 128.74)) was found to be significant. Moderate to high levels of pain intensity in the last 24 h after surgery, as well as moderate to high rates of pain-related interference with care activities were most reported. Pain still remains an issue among surgical patients, and effective pain management and health education are needed to manage pain more effectively after surgery. PMID:25355297

  6. Bariatric Surgery and Non-Alcoholic Fatty Liver Disease: Current and Potential Future Treatments

    OpenAIRE

    Sasaki, Akira; Nitta, Hiroyuki; Otsuka, Koki; Umemura, Akira; Baba, Shigeaki; Obuchi, Toru; WAKABAYASHI, GO

    2014-01-01

    Non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) are increasingly common cause of chronic liver disease worldwide. The diagnosis of NASH is challenging as most affected patients are symptom-free and the role of routine screening is not clearly established. Most patients with severe obesity who undergo bariatric surgery have NAFLD, which is associated insulin resistance, type 2 diabetes mellitus (T2DM), hypertension, and obesity-related dyslipidemia. The effec...

  7. Retrospective patient-reported assessment of quality of life after surgical release for de Quervain tenosynovitis

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    Sorg, Heiko

    2015-03-01

    Full Text Available Background: Evaluation of the quality of life following surgical release of the first extensor compartment in adult patients with de Quervain disease. Patients and methods: This retrospective study included hospital chart review and patient-reported outcome assessment using the German version of the Disabilities of the Arm, Shoulder and Hand (DASH Outcome Measure and the validated German Michigan Hand Outcomes Questionnaire (MHQ. Results: A total of 46 patients underwent a surgical release of the first extensor compartment for de Quervain disease. Postoperative German MHQ was 78±4. Postoperative DASH score was 19±5. Satisfaction with surgery was rated positive in 85%, and 89% would undergo the procedure again. Patients with a transversal incision line had a DASH result of 11±6 and a German MHQ score of 83±7, patients with a longitudinal incision had a DASH score of 22±9 and a German MHQ score of 80±6. The patients pain level after transversal incision was markedly lower (resting pain=0.4±0.3; stress pain=1.0±0.6 than in patients operated with a longitudinal incision (resting pain=2.4±0.9; stress pain=3.1±1.1. Conclusion: The surgical approach for the treatment of de Quervain disease is associated with a high postoperative quality of life, a low postoperative morbidity and a low level of postoperative pain. A transversal incision is associated with better postoperative results than the longitudinal approach.

  8. Bariatric surgery for obesity and metabolic conditions in adults

    OpenAIRE

    Arterburn, David E; Courcoulas, Anita P.

    2014-01-01

    This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and q...

  9. The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches

    OpenAIRE

    Alshameeri, Zeiad A.; Krishnaiah Katam; Mohammed Alsamaq; Paresh Sonsale

    2012-01-01

    Introduction: Clavicle fractures represent 2.5% of fractures in adults and almost 44% of shoulder injuries. The treatment is usually non-surgical with good results; however, significantly displaced fractures can be associated with high non-union rate and therefore many would advocate surgical fixation. This is traditionally carried out by direct approach over the clavicle but an infraclavicular approach has also been used for clavicular fixation. The aim of this study was to identify the main...

  10. Experimental Bariatric Surgery in Rats Generates a Cytotoxic Chemical Environment in the Gut Contents.

    Directory of Open Access Journals (Sweden)

    Jia eLi

    2011-09-01

    Full Text Available Bariatric surgery, also known as metabolic surgery, is an effective treatment for morbid obesity which also offers pronounced metabolic effects including the resolution of type 2 diabetes and a decrease in cardiovascular disease and long-term cancer risk. However, the mechanisms of surgical weight loss and the long term consequences of bariatric surgery remain unclear. Bariatric surgery has been demonstrated to alter the composition of both the microbiome and the metabolic phenotype. We observed a marked shift towards Gammaproteobacteria, particularly Enterobacter hormaechei, following Roux-en-Y gastric bypass (RYGB surgery in a rat model compared with sham operated controls. Fecal water from RYGB surgery rats was highly cytotoxic to rodent cells (mouse lymphoma cell line, although In contrast, fecal water from sham operated animals showed no/very low cytotoxicity. This shift in the gross structure of the microbiome correlated with greatly increased cytotoxicity in a regulatory acceptable mouse lymphoma assay. Urinary phenylacetylglycine and indoxyl sulfate and fecal GABA, putrescine, tyramine and uracil were found to be inversely correlated with cell survival rate. This profound co-dependent response of mammalian and microbial metabolism to RYGB surgery and the impact on the cytotoxicity of the gut luminal environment suggests that RYGB exerts local and global metabolic effects which may have an influence on long term cancer risk and cytotoxic load.

  11. Becoming a normal guy: Men making sense of long-term bodily changes following bariatric surgery

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    Karen Synne Groven

    2015-12-01

    Full Text Available Background: To date, research on bodily changes following bariatric surgery has focused predominantly on women, leaving the long-term experience of men relatively unexplored. In this paper, we draw on interviews with men who have undergone an irreversible gastric bypass procedure to explore their bodily changes more than 4 years post-surgery. We apply a phenomenological framework that draws on Leder's perspectives on the “disappearing” and “dys-appearing” body, combined with a gender-sensitive lens that draws on Connell's theory of hegemonic masculinity and Robertson's conceptions of embodied masculinity. Findings: Our principal finding was that the men negotiated their bodily changes following bariatric surgery in profoundly ambivalent ways. Although they enthusiastically praised the surgery for improving their health, self-esteem, and social functioning, they also emphasized their efforts to cope with post-surgical side effects and life-threatening complications. Our analysis elaborates on their efforts to adjust to and come to terms with these changes, focusing on episodes of hypoglycemia, severe pain and internal herniation, and the significance of physical activity and exercise. Conclusions: Our findings point to the need to acknowledge men's ways of making sense of profound and ongoing bodily changes following bariatric surgery and how these negotiations are closely intertwined with masculine ideals of embodiment and social value.

  12. Results of surgical treatment of cervical cancer patients of childbearing age

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    V. S. Navruzova

    2015-09-01

    Full Text Available The world marked increase in the incidence of cervical cancer in young women, especially from 29 to 45 years old. Analysis showed that in patients with preserved ovarian function, not only the effectiveness of the treatment, but also the quality of life. It is associated with the acceleration, earlier puberty and the onset of sexual activity. In recent years more and more widely used radical surgery with preservation of the ovaries and the abduction of the radiation castration and preservation of reproductive function. In the National Cancer Research Centre of the Ministry of Health of the Republic of Uzbekistan analyzed the results of surgical treatment of 204 patients with cervical cancer younger. Age of patients from 23 to 45 years, that is, in the most hard-working, reproductive period. In our study patients met principally with exophytic – 82 (40.2 % and 68 (33.3 % еndophytic growth cervical tumors. Histological in 197 (96.6 % patients with squamous cervical cancer patients with 7 (3.4%. Adenocarcinoma of cervical cancer. Handard examination of the patient are further adapted to determine the level of sex hormones (estradiol, progesterone, determination of the tumor marter CA-125 levels of calcium and phosphate in the blood. 112 patients from the main group and the combined complex therapy surgical treatment with organ-component (conservation and ovarian transposition. The first group included 112 (55.1 % patients, who as part of combination therapy was performed and complex surgical treatment of ovarian transposition. The second group included 92 (44.9% patients who as part of combination therapy and complex surgery performed without ovarian transposition. Each group was divided into 3 subgroup included patients with stage process T1b–2aN0M0. Which performs the combined radiotherapy. The second subgroups included patients with stage process that runs systemic chemotherapy, surgery, combined radiotherapy. The third group included

  13. Long-term patient satisfaction after surgical correction of penile curvature via tunical plication

    OpenAIRE

    Alvaro Paez; Juan Mejias; Jorge Vallejo; Ignacio Romero; Miguel Castro; Fernando Gimeno

    2007-01-01

    OBJECTIVE: To assess patient satisfaction and functional results at long term follow-up after surgical correction for Peyronie's disease (PD) and congenital penile curvature (CPC) with the technique of tunical plication. MATERIALS AND METHODS: One hundred and two men operated for PD (n = 76) or CPC (n = 26) in four different departments of urology in public hospitals agreed to answer a six-question telephone questionnaire about treatment satisfaction. Tunica albuginea plication procedures rep...

  14. Molecular characteristics of community-associated methicillin-resistant Staphylococcus aureus colonizing surgical patients in Greece.

    Science.gov (United States)

    Hadjihannas, Linos; Psichogiou, Mina; Empel, Joanna; Kosmidis, Chris; Goukos, Dimitrios; Bouzala, Jina; Georgopoulos, Sotirios; Malhotra-Kumar, Surbhi; Harbarth, Stephan; Daikos, George L

    2012-12-01

    Fifty-one of 925 patients screened for methicillin-resistant Staphylococcus aureus (MRSA) upon admission to a surgical unit were MRSA carriers; 15 were classified as community- and 36 as hospital-associated-MRSA. Fourteen of 22 isolates typed by molecular methods belonged to the European clone ST80-IVc, 3 of which exhibited resistance to ≥3 non-β-lactam antibiotics. PMID:23021063

  15. Surgical Correction of Scoliosis in Children with Spastic Quadriplegia: Benefits, Adverse Effects, and Patient Selection

    OpenAIRE

    Legg, Julian; Davies, Evan; Raich, Annie L.; Dettori, Joseph R.; Sherry, Ned

    2014-01-01

    Study Rationale Cerebral palsy (CP) is a group of nonprogressive syndromes of posture and motor impairment associated with lesions of the immature brain. Spastic quadriplegia is the most severe form with a high incidence of scoliosis, back pain, respiratory compromise, pelvic obliquity, and poor sitting balance. Surgical stabilization of the spine is an effective technique for correcting deformity and restoring sitting posture. The decision to operate in this group of patients is challenging....

  16. New method of surgical treatment of patients with recurrent ingrown nail

    Directory of Open Access Journals (Sweden)

    Kondulukov A.N.

    2011-12-01

    Full Text Available The article discusses the surgical treatment of ingrown nail in patients with recurrent disease. The advantages of a new method of operation have been explained in the article. It gives a detailed description of the operation. The clinical and additional methods of research have confirmed the fact that a new operation reduces the wound healing period and the number of ingrown nail recurrences

  17. Surgical Treatments on Patients with Anterior Cervical Hyperostosis-Derived Dysphagia

    OpenAIRE

    Song, Ah Rom; Yang, Hee Seung; Byun, Eunjin; Kim, Youngbae; Park, Kwan Ho; Kim, Kyung Lyul

    2012-01-01

    Anterior cervical hyperostosis may be a cause of dysphagia. For anterior cervical hyperostosis, medical or surgical treatments can be adhibited in view of the causative mechanisms and intensities of dysphagia. We report 3 cases of cervical hyperostosis-derived progressive dysphagia that underwent operation. Radiologic diagnosis and Video Fluoroscopic Swallowing Study were performed on the three patients for evaluation. One had history of recurrent aspiration pneumonia accompanied by weight lo...

  18. The results of surgical treatment of atrial fibrillation in patients with heart disease

    OpenAIRE

    Bockeria L. А.; Revishvili А. Sh.; Shmul' А. V.; Dzhordzhikiya T. R.; Kvasha B.I.; Matsonashvili G.R.; Pronicheva I. V.; Serguladze S. Yu.

    2012-01-01

    For two decades the Maze III procedure is considered to be a gold standard in surgical treatment of atrial fibrillation. This method has also proved its efficacy in patients with concomitant heart disease. With the development of new modifications of the Maze III procedure and invention of alternative energy source to make lesions on the atria (cryo, radiofrequency), more and more cardiac surgeons prefer to perform these less complicated operations. Aim of this study was to assess long-term r...

  19. Corneal-Based Surgical Presbyopic Therapies and Their Application in Pseudophakic Patients

    OpenAIRE

    Paley, Grace l.; Chuck, Roy S.; Tsai, Linda M.

    2016-01-01

    Purpose. The purpose of this review is to provide a summary of laser refractive surgery and corneal inlay approaches to treat presbyopia in patients after cataract surgery. Summary. The presbyopic population is growing rapidly along with increasing demands for spectacle independence. This review will focus on the corneal-based surgical options to address presbyopia including various types of corneal intrastromal inlays and laser ablation techniques to generate either a multifocal cornea (“Pre...

  20. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk

    OpenAIRE

    Pull ter Gunne, Albert F.; Laarhoven, C.J.H.M. van; Cohen, David B.

    2010-01-01

    Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than typical spinal procedures. Previous research has identified risk factors for SSI in spinal surgery, but few studies have looked at adult deformity surgeries. We retrospectively performed a large case...

  1. Comparison of two ventilation modes in post-cardiac surgical patients

    OpenAIRE

    Aloka Samantaray; Nathan Hemanth

    2011-01-01

    Background: The cardiopulmonary bypass (CPB)-associated atelectasis accounted for most of the marked post-CPB increase in shunt and hypoxemia. We hypothesized that pressure-regulated volume-control (PRVC) modes having a distinct theoretical advantage over pressure-controlled ventilation (PCV) by providing the target tidal volume at the minimum available pressure may prove advantageous while ventilating these atelactic lungs. Methods: In this prospective study, 36 post-cardiac surgical patient...

  2. The preventive surgical site infection bundle in patients with colorectal perforation

    OpenAIRE

    Yamamoto, Takehito; MORIMOTO, TAKESHI; Kita, Ryosuke; Masui, Hideyuki; Kinoshita, Hiromitsu; Sakamoto, Yusuke; Okada, Kazuyuki; Komori, Junji; Miki, Akira; Kondo, Masato; Uryuhara, Kenji; Kobayashi, Hiroyuki; Hashida, Hiroki; Kaihara, Satoshi; Hosotani, Ryo

    2015-01-01

    Background Incisional surgical site infection (SSI) is one of the most frequent complications that occur after colorectal surgery. Surgery for colorectal perforation carries an especially high risk of incisional SSI because fecal ascites contaminates the incision intraoperatively, and in patients who underwent stoma creation, the incision is located near the infective origin and is subject to infection postoperatively. Although effectiveness of the preventive SSI bundle of elective colorectal...

  3. Essential Oils for Complementary Treatment of Surgical Patients: State of the Art

    OpenAIRE

    Susanna Stea; Alina Beraudi; Dalila De Pasquale

    2014-01-01

    Aromatherapy is the controlled use of plant essences for therapeutic purposes. Its applications are numerous (i.e., wellbeing, labour, infections, dementia, and anxiety treatment) but often they have not been scientifically validated. The aim of the present study is to review the available literature to determine if there is evidence for effectiveness of aromatherapy in surgical patients to treat anxiety and insomnia, to control pain and nausea, and to dress wound. Efficacy studies of lavende...

  4. MR spectroscopy in patients after surgical clipping and endovascular embolisation of intracranial aneurysms

    International Nuclear Information System (INIS)

    In MR spectroscopy, we evaluated cerebral metabolic changes in patients 2–4 years after clipping or endovascular therapy of intracranial aneurysms. A prospective study was conducted in 36 patients after SAH, treated surgically (n=23) or by endovascular embolisation (n=13). Control group consisted of 20 healthy volunteers. The clinical evaluation was based on the Glasgow Coma Scale, Hunt and Hess grade, and Glasgow Outcome Scale. MR spectroscopy was performed with 1.5T system with PRESS sequence, at echo time of 35 ms, in frontal lobes unchanged in MR examination. Ratios of N-acetylaspartate (NAA), choline (Cho), myo-inositol (mI) and glutamine/glutamate complex (Glx) to creatine were assessed. Only a slight, statistically insignificant reduction of NAA/Cr and an insignificant increase of mI/Cr were noted; other metabolite ratios were close to the ones in the control group. Similar results were obtained in patients after surgical clipping and after endovascular therapy. Only in patients with aneurysms of anterior communicating artery complex (AcoA), the NAA/Cr ratio showed a significant reduction as compared to that of non-AcoA patients and of the control group. No significant changes of metabolite ratios were found in patients with internal carotid artery (ICA) and middle cerebral artery (MCA) aneurysms, with regard to aneurysm lateralisation. Surgical clipping and endovascular embolisation of ICA, MCA and posterior circulatory aneurysms do not induce changes in metabolite concentration in frontal lobes assessed in MR spectroscopy. In patients with AcoA aneurysms, 2–4 years after obliteration, there were found persistent metabolic changes in unchanged brain tissue of the frontal lobes, corresponding to neuronal damage (dysfunction)

  5. Clinical characteristics and surgical treatment of patients with giant intracranial aneurysms

    Institute of Scientific and Technical Information of China (English)

    QI Wei; WANG Shuo; ZHAO Yuan-li; YANG Hai-bo; ZHAO Ji-zong

    2008-01-01

    Background Compared with smaller aneurysms,giant intracranial aneurysms (GICAs) have a poorer prognosis and require more meticulous surgical planning and techniques to exclude them from the circulation.GICAs continue to challenge the limits of neurosurgical techniques.A series of 170 patients with GICAs were reviewed for understanding the clinical characteristics.surgical treatment and outcomes of patients with GICAs.Methods Collected data of 170 consecutive patients with GICAs from January 1995 to July 2007 were analyzed.The clinicaI Characteristics in this study included age,sex,intracranial aneurysms size,the first presentations,locations and Hunt & Hess grade.Surgical methods included direct clipping of the aneurysm neck,parent artery reconstruction,proximal artery ligation,trapping and wrapping.Surgical results were evaluated postOperatively by the Glasgow Outcome Scale (GOS).Results GICAs were more commonly diagnosed at age 30 to 50 years with a mean age of 39.3 years and without obvious gender preponderance in our study (88 male and 82 female patients).The size of the GlCAs ranged from 2.5 cm to 8.0 cm(mean,2.9 cm).Hemorrhage (41%),mass effect (34%) and headache (12%) were the first 3 most common presentations.Regarding the Hunt & Hess classification,at admission there were 1 00 cases in grade 0,24 in grade 1,21 in grade 2,16 in grade 3,8 in grade 4 and 1 in grade 5.There were 84 cases of GICAs treated by direct neck-clipping,47 by parent artery reconstruction,19 by proximal artery occlusion(with 4 combined with reVascuIarization),18 by trapping and 2 by wrapping.The follow-up study (ranging from 6 to 115 months,mean 32 months)showed good results in 108 cases.moderate disability in 26 and severe disability in 15 according to GOS.Six cases died.Conclusions Surgical treatment is an effective treatment for GICAs.SurgicaI strategies should be made carefully and individually.Doppler ultrasonography,neuroendoscope and intraoperative angiography are useful to

  6. Anesthesia management in laparoscopic bariatric surgery: Perioperative complications and outcomes in the third year of practice

    Directory of Open Access Journals (Sweden)

    Serkan Karaman

    2014-06-01

    Full Text Available Objective: In this study, we aimed to assess the perioperative and postoperative results of the patients who underwent bariatric surgery. Methods: After obtaining approval, a retrospectively designed observational study was conducted. All adult patients who underwent laparoscopic gastric plication, sleeve gastrectomy, or roux-en-Y anastomosis between January 2011 and May 2013 were included. Results: A total of 104 patients were included in the study period: 49 (47.1% underwent laparoscopic roux-en-Y anastomosis, 44 (42.3% underwent laparoscopic sleeve gastrectomy, and 11 (10.6% underwent laparoscopic gastric plication. The present study showed a mortality rate of 1.9% (n = 2, one after Roux-en-Y anastomosis operation, and the other one after gastric plication. Conclusion: The anesthesia methods and approaches have no association with morbidity and mortality in such procedures of bariatric surgery indicated in the present study. J Clin Exp Invest 2014; 5 (2: 200-205

  7. Incidence and Predicted Risk Factors of Pressure Ulcers in Surgical Patients: Experience at a Medical Center in Taipei, Taiwan

    OpenAIRE

    Ling Fu Shaw; Pao-Chu Chang; Jung-Fen Lee; Huei-Yu Kung; Tao-Hsin Tung

    2014-01-01

    Purpose. To explore the context of incidence of and associated risk factors for pressure ulcers amongst the population of surgical patients. Methods. The initial study cohort was conducted with a total of 297 patients admitted to a teaching hospital for a surgical operation from November 14th to 27th 2006 in Taipei, Taiwan. The Braden scale, pressure ulcers record sheet, and perioperative patient outcomes free from signs and symptoms of injury related to positioning and related nursing interv...

  8. Prevalence of obstructive sleep apnea in surgical patients presenting to a tertiary care teaching hospital in India: A preliminary study

    OpenAIRE

    Sanjay Agrawal; Ravi Gupta; Vivekanand Lahan; Ghulam Mustafa; Uttamjot Kaur

    2013-01-01

    Background: Obstructive sleep apnea (OSA) is often not diagnosed in patients presenting for surgical procedures thereby increasing the incidence of adverse perioperative course. Early diagnosis of this disease is important in modifying anesthetic management as well as utilizing specific means which may decrease the complications and improve the patient outcome. Methods: Patients greater than eighteen years of age, ASA I-III scheduled for elective surgical procedures under anesthesia were rand...

  9. SURGICAL TREATMENT OF PRONATION CONTRACTURE OF THE FOREARM IN PATIENTS WITH INFANTILE CEREBRAL PALSY

    Directory of Open Access Journals (Sweden)

    Vladimir Alexandrovich Novikov

    2014-03-01

    Full Text Available The objective of the work was to evaluate the efficiency of the existing methods of surgical treatment of pronation contracture of the forearm, the modification of the existing methods of treatment, the development of the indications for each specific method of treatment. Materials and methods. This study is based on a survey of children suffering from infantile cerebral palsy affecting the upper limbs. The main criterion for the patient selection was the presence of a fixed pronation contracture of the forearm, both isolated and combined with other contractures of the joints of the upper limb. Total 42 patients with spastic forms of cerebral palsy were examined. Results and conclusions. With age of the patient, the pronation contracture is usually increased, the contractures of the elbow and wrist joints may develop, which leads to the necessity for more and more radical operative techniques. Therefore, the early surgical treatment allows obtaining optimal results with its minimum scope. The investigation data gave an option to simplify, but to increase the efficiency of surgical treatment methods of pronation contractures in children with infantile cerebral palsy.

  10. Overview of current surgical strategies for aortic disease in patients with Marfan syndrome.

    Science.gov (United States)

    Miyahara, Shunsuke; Okita, Yutaka

    2016-09-01

    Marfan syndrome is a heritable, systemic disorder of the connective tissue with a high penetrance, named after Dr. Antoine Marfan. The most clinically important manifestations of this syndrome are cardiovascular pathologies which cause life-threatening events, such as acute aortic dissections, aortic rupture and regurgitation of the aortic valve or other artrioventricular valves leading to heart failure. These events play important roles in the life expectancy of patients with this disorder, especially prior to the development of effective surgical approaches for proximal ascending aortic disease. To prevent such catastrophic aortic events, a lower threshold has been recommended for prophylactic interventions on the aortic root. After prophylactic root replacement, disease in the aorta beyond the root and distal to the arch remains a cause for concern. Multiple surgeries are required throughout a patient's lifetime that can be problematic due to distal lesions complicated by dissection. Many controversies in surgical strategies remain, such as endovascular repair, to manage such complex cases. This review examines the trends in surgical strategies for the treatment of cardiovascular disease in patients with Marfan syndrome, and current perspectives in this field. PMID:26586198

  11. The effects of high perioperative inspiratory oxygen fraction for adult surgical patients

    DEFF Research Database (Denmark)

    Wetterslev, Jørn; Meyhoff, Christian S; Jørgensen, Lars N;

    2015-01-01

    .99), serious adverse events (RR 0.96, 95% CI 0.65 to 1.43) or length of stay (mean difference -0.06 days, 95% CI -0.44 to 0.32 days).In subgroup analyses of nine trials using preoperative antibiotics, a high fraction of inspired oxygen was associated with a decrease in surgical site infections (RR 0.76, 95% CI......BACKGROUND: Available evidence on the effects of a high fraction of inspired oxygen (FIO2) of 60% to 90% compared with a routine fraction of inspired oxygen of 30% to 40%, during anaesthesia and surgery, on mortality and surgical site infection has been inconclusive. Previous trials and meta......-analyses have led to different conclusions on whether a high fraction of supplemental inspired oxygen during anaesthesia may decrease or increase mortality and surgical site infections in surgical patients. OBJECTIVES: To assess the benefits and harms of an FIO2 equal to or greater than 60% compared with a...

  12. Radiation therapy for patients of malignant salivary gland tumors with positive surgical margins

    International Nuclear Information System (INIS)

    Purpose: Surgery is an essential part of treatment for tumors of the salivary gland, yet there is increasing evidence in the literature supporting the necessity of adjuvant radiation therapy. The patients described in this report were selected to receive postoperative radiation therapy because they were found to have positive margins. A total of 17 patients with malignant tumors originating from the major salivary glands seen between 1970 and 1988 who were treated with surgery and postoperative radiation therapy were reviewed. All patients had positive surgical margins and the overall local control at five years was 65%. Classified by T-stage, local control was obtained in all two patients for T1 disease, in five of six for T2, in four of six for T3, and in none of three for T4. At five years, the ratio of patients free of distant metastases was two of two for T1 lesion, four of six for T2, three of six for T3, and none of three for T4. Five-year survival was obtained in all eight patients with T1 and T2 lesions, four of six for T3, and one of three for T4. Patients with neck nodal metastases present in the neck at admission did worse than those with negative nodes, with 0% (none of three patients) free of locoregional recurrence vs. 71% (eleven of 14), 0% (none of three) free of distant metastases vs. 63% (nine of 14), and 0% (none of three) survival at five years vs. 93% (13 of 14). It was concluded that postoperative radiation therapy for patients with positive surgical margins was effective for T1 and T2 disease. However, patients with T3 and T4 disease require more aggressive therapy. Patients with nodal metastases in the neck at admission tended to have distant metastases and had poor prognoses

  13. Surgical risks and perioperative complications of instrumented lumbar surgery in patients with liver cirrhosis

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    Tung-Yi Lin

    2014-02-01

    Full Text Available Background: Patients with liver cirrhosis have high surgical risks due to malnutrition, impaired immunity, coagulopathy, and encephalopathy. However, there is no information in English literature about the results of liver cirrhotic patients who underwent instrumented lumbar surgery. The purpose of this study is to report the perioperative complications, clinical outcomes and determine the surgical risk factors in cirrhotic patients. Methods: We retrospectively reviewed 29 patients with liver cirrhosis who underwent instrumented lumbar surgery between 1997 and 2009. The hepatic functional reserves of the patients were recorded according to the Child-Turcotte-Pugh scoring system. Besides, fourteen other variables and perioperative complications were also collected. To determine the risks, we divided the patients into two groups according to whether or not perioperative complications developed. Results: Of the 29 patients, 22 (76% belonged to Child class A and 7 (24% belonged to Child class B. Twelve patients developed one or more complications. Patients with Child class B carried a significantly higher incidence of complications than those with Child class A (p = 0.011. In the Child class A group, patients with 6 points had a significantly higher incidence of complications than those with 5 points (p = 0.025. A low level of albumin was significantly associated with higher risk, and a similar trend was also noted for the presence of ascites although statistical difference was not reached. Conclusion: The study concludes that patients with liver cirrhosis who have undergone instrumented lumbar surgery carry a high risk of developing perioperative complications, especially in those with a Child-Turcotte-Pugh score of 6 or more.

  14. The results of surgical treatment of thyroid pathology in adult patients exposed due Chernobyl disaster

    International Nuclear Information System (INIS)

    Comparative results of consequently operated within the period 1995-2000 adult patients with thyroid pathology are presented. All the patients were divided into 3 groups: 1 - liquidators of consequences of the Chernobyl disaster (70 patients), 2 - other persons exposed due to the Chernobyl accident (271 ones) and control group consisted of 2730 patients without any history of irradiation from the same birth cohort (1923-1967). Detected trends depended upon the approximate severity estimation of irradiation being reflected in the categories of observation of the exposed patients i.e. the worst findings were found among liquidators of the Chernobyl accident consequences. A greater number of surgery for hypertrophied form of autoimmune thyroiditis was also typical for all the categories of exposed people. According to detected clinical and morphological peculiarities of the surgical thyroid pathology in the exposed patients we strongly recommend radical surgical treatment - total thyroidectomy with modified neck dissection followed by radioiodine treatment and suppressive therapy for those with thyroid carcinoma

  15. Health-related quality of life and expectations of patients before surgical treatment of lumbar stenosis

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    Lílian Maria Pacola

    2014-03-01

    Full Text Available OBJECTIVE: To evaluate the expectations of patients awaiting surgical treatment of lumbar canal stenosis and the association of Health-Related Quality of Life (HRQoL with symptoms of anxiety and depression. METHODS: The sample included 49 patients from a university hospital. HRQoL was assessed by the Oswestry Disability Index (ODI and 36-item Medical Outcomes Survey Short Form (SF-36 and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale (HADS. Expectations were investigated by means of questions used in international studies. Data were analyzed descriptively and by Student's t test. RESULTS: The mean time of disease progression was 34.5 months, the mean age was 58.8 years and 55.1% of the patients were women. Most patients had the expectation of improving with surgical treatment and 46.9% expected to be "much better" with regard to leg pain, walking ability, independence in activities and mental well being. The scores of anxiety and depression were respectively, 34.7% and 12.2%. We observed statistically significant differences between the groups with and without anxiety in the domains: General Health, Mental Health, and Vitality. Between the groups with and without depression there were statistically significant differences in the General Health and Mental Health domains. CONCLUSION: Patients showed great expectation to surgical treatment and the symptoms of anxiety and depression were related to some domains of HRQoL. Thus, the study contributes to broaden our knowledge and we can therefore guide the patients as to their expectations with respect to the real possibilities arising from surgery.

  16. Surgical revascularization versus amputation for peripheral vascular disease in dialysis patients: a cohort study

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    Ramkumar Nirupama

    2005-03-01

    Full Text Available Abstract Background Surgical treatment of peripheral vascular disease (PVD in dialysis patients is controversial. Methods We examined the post-operative morbidity and mortality of surgical revascularization or amputation for PVD in a retrospective analysis of United States Renal Data System. Propensity scores for undergoing amputation were derived from a multivariable logistic regression model of amputation. Results Of the Medicare patients initiated on dialysis from Jan 1, 1995 to Dec 31, 1999, patients underwent surgical revascularization (n = 1,896 or amputation (n = 2,046 in the first 6 months following initiation of dialysis were studied. In the logistic regression model, compared to claudication, presence of gangrene had a strong association with amputation [odds ratio (OR 19.0, 95% CI (confidence interval 13.86–25.95]. The odds of dying within 30 days and within1 year were higher (30 day OR: 1.85, 95% CI: 1.45–2.36; 1 yr OR: 1.46, 95% CI: 1.25–1.71 in the amputation group in logistic regression model adjusted for propensity scores and other baseline factors. Amputation was associated with increased odds of death in patients with low likelihood of amputation (rd percentile of propensity score and moderate likelihood of amputation (33rd to 66th percentile but not in high likelihood group (>66th percentile. The number of hospital days in the amputation and revascularization groups was not different. Conclusion Amputation might be associated with higher mortality in dialysis patients. Where feasible, revascularization might be preferable over amputation in dialysis patients.

  17. Orbital and Maxillofacial Computer Aided Surgery: Patient-Specific Finite Element Models To Predict Surgical Outcomes

    CERN Document Server

    Luboz, V; Swider, P; Payan, Y; Luboz, Vincent; Chabanas, Matthieu; Swider, Pascal; Payan, Yohan

    2005-01-01

    This paper addresses an important issue raised for the clinical relevance of Computer-Assisted Surgical applications, namely the methodology used to automatically build patient-specific Finite Element (FE) models of anatomical structures. From this perspective, a method is proposed, based on a technique called the Mesh-Matching method, followed by a process that corrects mesh irregularities. The Mesh-Matching algorithm generates patient-specific volume meshes from an existing generic model. The mesh regularization process is based on the Jacobian matrix transform related to the FE reference element and the current element. This method for generating patient-specific FE models is first applied to Computer-Assisted maxillofacial surgery, and more precisely to the FE elastic modelling of patient facial soft tissues. For each patient, the planned bone osteotomies (mandible, maxilla, chin) are used as boundary conditions to deform the FE face model, in order to predict the aesthetic outcome of the surgery. Seven F...

  18. Comparison of surgical complications of intertrochanteric hip fractures between non-osteoporotic and osteoporotic patients

    International Nuclear Information System (INIS)

    Objective: To determine the role of bone quality in post-treatment complications among patients of intertrochanteric fracture. Methods: The cross-sectional descriptive study was done on 61 patients who presented with intertrochanteric hip fractures to two affiliated hospitals of Mazandaran University of Medical Science, Sari, Iran between February 2009 and December 2010. All the patients went through open reduction and internal fixation using 4-hole dynamic hip screw. The patients were followed up from 2 to 60 months. Data was analysed using SPSS 18. Results: The final rate of malunion, nail protrusion and mortality was 8.3% (n=3), 5.6% (n=2) and 8.4% (n=3) respectively. There was no significant difference between osteoporatic (n=36; 59%) and non-osteoporatic (n=25; 41%) groups regarding the surgical complications of intertrochanteric hip fracture. Conclusion: The quality of bone made no significant difference among patients who were treated for intertrochanteric fracture. (author)

  19. A Novel Prevention Bundle to Reduce Surgical Site Infections in Pediatric Spinal Fusion Patients.

    Science.gov (United States)

    Gould, Jane M; Hennessey, Patricia; Kiernan, Andrea; Safier, Shannon; Herman, Martin

    2016-05-01

    BACKGROUND The Surgical Care Improvement Project bundle emphasizes operative infection prevention practices. Despite implementing the Surgical Care Improvement Project bundle in 2008, spinal fusion surgical site infections (SF-SSI) continued to be prevalent for this low-volume, high-risk surgery. OBJECTIVE To design a combined pre-, peri-, and postoperative bundle (PPPB) that would lead to sustained reductions in SF-SSI rates. DESIGN Quality improvement project, before-after trial with cost-effectiveness analysis. SETTING Children's hospital. PATIENTS All spinal fusion patients, 2008-2015. INTERVENTION A multidisciplinary team developed the PPPB composed of Surgical Care Improvement Project elements plus improved wound care practices, nursing standard of care, dedicated nursing unit, dermatology assessment tool and consultation, nursing education tool using "teach back" technique, and a "Back Home" kit. SF-SSI rates were compared before (2008-2010) and after (2011-February 2015) implementation of PPPB. PPPB compliance was monitored. RESULTS A total of 224 SF surgeries were performed from 2008 to February 2015. Pre-PPPB analysis revealed median time to SF-SSI of 28 days, secondary to skin and bowel flora. Mean 3-year pre-PPPB SF-SSI rate per 100 SF surgeries was 8.2 (8/98) (2008: 13.3 [4/30], 2009: 2.7 [1/37], 2010: 9.7 [3/31]). Mean SF-SSI rate after PPPB was 2.4 (3/126) (January 2011-February 2015); there was a 71% reduction in mean SSI rate (P=.0695). No SF-SSI occurred in neuromuscular patients (P=.008) after PPPB. Compliance with PPPB elements has been 100%. CONCLUSIONS PPPB led to sustained improvement in SF-SSI rates over 50 months. The PPPB could be reproduced for other surgeries. Infect Control Hosp Epidemiol 2016;37:527-534. PMID:26818613

  20. Methodology of research of quality of life of surgical patients in the process of physical rehabilitation.

    Directory of Open Access Journals (Sweden)

    Romanenko Y.N.

    2011-04-01

    Full Text Available The methodological characteristics of research of quality of life of surgical patients are considered in the article. The main requirements to records keeping, collection and statistical processing of data are argued during research of quality of life in the process of physical rehabilitation. The main characteristics and quality of life research tools requirements were pointed out. We have chosen The Short Form (36 Health Survey (SF-36 for our research, which studies the life quality index according to 8 criterions. The additional methods of functional state research of patients after abdominoanterior wall hernia surgery were suggested.

  1. Urinary neutrophil gelatinase-associated lipocalin in critically ill surgical cancer patients

    OpenAIRE

    Pericles Almeida Delfino Duarte; Andreia Cristina Fumagalli; Vanessa Wandeur; Delmiro Becker

    2015-01-01

    Background and Aims: Neutrophil gelatinase-associated lipocalin (N-GAL) is an early biomarker of acute kidney injury (AKI) due to various etiologies. On the other hand, N-GAL is also elevated in patients with acute inflammatory conditions and in several solid neoplasms. The goal of this study was to assess the efficacy of N-GAL as a predictor of AKI and mortality in oncological surgical patients postoperatively in the intensive care unit (ICU). Methods: This was a prospective cohort observati...

  2. Assessment of thyroid function in patients with laryngeal carcinoma treated surgically and with radiotherapy

    International Nuclear Information System (INIS)

    In 40 patients with laryngeal carcinoma after total laryngectomy and radiotherapy the triiodotyronine binding index, total thyroxine level, serum free thyroxine index were determined before, during and after treatment. At the same time thyroid iodine uptake was determined by the routine method. Surgical treatment as well as radiotherapy caused lowering of thyroid functions. These changes had a high tendency for return to normal values, not earlier, however, than 6 months after treatment. The authors stress that endocrine thyroid disturbances may have an important influence on delay of psychic rehabilitation and speech training in laryngectomized patients. (author)

  3. Anesthetic issues and perioperative blood pressure management in patients who have cerebrovascular diseases undergoing surgical procedures.

    Science.gov (United States)

    Jellish, W Scott

    2006-11-01

    Patients who have cerebrovascular disease and vascular insufficiency routinely have neurosurgical and nonneurosurgical procedures. Anesthetic priorities must provide a still bloodless operative field while maintaining cardiovascular stability and renal function. Patients who have symptoms or a history of cerebrovascular disease are at increased risk for stroke, cerebral hypoperfusion, and cerebral anoxia. Type of surgery and cardiovascular status are key concerns when considering neuroprotective strategies. Optimization of current condition is important for a good outcome; risks must be weighed against perceived benefits in protecting neurons. Anesthetic use and physiologic manipulations can reduce neurologic injury and assure safe and effective surgical care when cerebral hypoperfusion is a real and significant risk. PMID:16935193

  4. Curative effect of parenteral nutrition and glutamine on post-surgical patients

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    Bangash TA

    2012-03-01

    Full Text Available Background: To evaluate the influence of parenteral nutrition and glutamine on nutritional status and prognosis of surgical critically ill patients. Methods: 32 cases were treated by parenteral nutrition plus alanyl-glutamine injection. The differences in liver function, weight and nutritional status were compared between, before and after medication. Results: Patients were either cured or relieved, and no complication including infection appeared. Total protein. Albumin, ferrohemoglobin and weight increased after medication, respectively. Conclusions: The use of parenteral nutrition plus glutamine is beneficial for ameliorating malnutrition and negative nitrogen balance caused by hypermetabolism, inhibiting bacterial translocation, preventing the complication, and increasing healing rate of disease.

  5. Prevention and treatment of surgical site infection in HIV-infected patients

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    Zhang Lei

    2012-05-01

    Full Text Available Abstract Background Surgical site infection (SSI are the third most frequently reported nosocomial infection, and the most common on surgical wards. HIV-infected patients may increase the possibility of developing SSI after surgery. There are few reported date on incidence and the preventive measures of SSI in HIV-infected patients. This study was to determine the incidence and the associated risk factors for SSI in HIV-infected patients. And we also explored the preventive measures. Methods A retrospective study of SSI was conducted in 242 HIV-infected patients including 17 patients who combined with hemophilia from October 2008 to September 2011 in Shanghai Public Health Clinical Center. SSI were classified according to Centers for Disease Control and Prevention (CDC criteria and identified by bedside surveillance and post-discharge follow-up. Data were analyzed using SPSS 16.0 statistical software (SPSS Inc., Chicago, IL. Results The SSI incidence rate was 47.5% (115 of 242; 38.4% incisional SSIs, 5.4% deep incisional SSIs and 3.7% organ/space SSIs. The SSI incidence rate was 37.9% in HIV-infected patients undergoing abdominal operation. Patients undergoing abdominal surgery with lower preoperative CD4 counts were more likely to develop SSIs. The incidence increased from 2.6% in clean wounds to 100% in dirty wounds. In the HIV-infected patients combined with hemophilia, the mean preoperative albumin and postoperative hemoglobin were found significantly lower than those in no-SSIs group (P Conclusions SSI is frequent in HIV-infected patients. And suitable perioperative management may decrease the SSIs incidence rate of HIV-infected patients.

  6. Brain spect in the pre-surgical evaluation of epileptic patients preliminary results

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    Carlos A. Buchpiguel

    1992-03-01

    Full Text Available Pre-surgical evaluation of epileptic patients consists of neurological examination, intensive electroencephalographic (EEG monitoring and anatomical studies (CT and MRI. Functional methods such as PET and SPECT imaging are now used more frequently. We have studied pre-operatively 15 adult epileptic patients (8 female, 7 male using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99mTc_HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas. In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions. Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hyperperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: (a in 4, SPECT findings correlated well with the anatomical findings; (b in 5 instances, SPECT was able to disclose additional functional deficits; (c in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n=10 SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and hete-rogenicity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic patients who are candidates for epilepsy surgery.

  7. Mineral Malnutrition Following Bariatric Surgery12

    OpenAIRE

    Gletsu-Miller, Nana; Wright, Breanne N.

    2013-01-01

    Moderate/severe obesity is on the rise in the United States. Weight management includes bariatric surgery, which is effective and can alleviate morbidity and mortality from obesity-associated diseases. However, many individuals are dealing with nutritional complications. Risk factors include: 1) preoperative malnutrition (e.g., vitamin D, iron); 2) decreased food intake (due to reduced hunger and increased satiety, food intolerances, frequent vomiting); 3) inadequate nutrient supplementation ...

  8. Surgical Exposure

    OpenAIRE

    Hendra Chandra

    2015-01-01

    Surgical exposure is a surgical method to expose mucous or bone which prevent delayed or unerupted permanent crown teeth, in order to provide normal eruption and to prevent malocclusion. Surgical exposure is usually carried out on maxillary caninces as they have higher incidence of delayed eruption. Nevertheless, this procedure can also be performed on other teeth. For patient management, this procedure need cooperation betweent oral surgeon and orthodontist.

  9. Use of alcohol before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ana Carolina Ribeiro de Amorim

    2015-02-01

    Full Text Available OBJECTIVE: to assess alcohol intake in the bariatric surgery pre and postoperative periods. METHODS: Patients were interviewed atSurgery Clinic of the Hospital das Clínicas da Universidade Federal de Pernambuco - HC/UFPE (Brazil from July 2011 to March 2012. We analyzed socioeconomic, anthropometric and clinical variables. We used the Alcohol Use Disorders Identification Test (AUDIT C. RESULTS: One hundred nineteen patients were enrolled (mean age: 41.23+11.30 years, with a predominance of the female gender (83.2%, non-Caucasian race (55%, married individuals or in a stable union (65.5%, with a high school education (40.3%and active in the job market (37%. Weight and body mass index (BMI were 128.77+25.28Kg and 49.09+9.26Kg/m2,respectively in the preoperative period (class II obesity and 87.19+19.16Kg and 33.04+6.21Kg/m2, respectively in the postoperative period (class I obesity (p<0.001. Hypertension was the most frequent disease in the pre (66.6% and postoperative (36.5% periods. The prevalence of alcohol use was 26.6% in the preoperative period, of which 2.2% of high risk, and 35.1% in the postoperative period, of which 1.4% of probable dependence; this difference did not achieve statistical significance (p=0.337. CONCLUSION: The prevalence of abusive alcohol intake and/or probable dependence was low in both the pre and postoperative periods, with little evidence of risky consumption among the patients submitted to bariatric surgery.

  10. [Immediate and long-term results of surgical treatment of patients for traumatic mandibular fracture].

    Science.gov (United States)

    Kopchak, A V

    2014-01-01

    The analysis of immediate and long-term results of the surgical treatment of 286 patients, operated for traumatic mandibular fractures in the Department of Oral and Maxillofacial Surgery, National O. O. Bogomolets Medical University. In 67% of patients the anatomical shape of the bone was adequately restored. The presence of residual displacements in other cases was determined by the fracture type and localization, the technical complexity of the surgical intervention, lack of fixation rigidity under certain functional load conditions. In long terms of observation the infection and inflammatory complications were observed in 13.4% of patients, delayed unition and non-unition of bone fragments occurred--in 4.7%, arthosis with persistent dysfunction of the temporomandibular joint--in 6.7%, fibrous ankylosis--in 1.3%. Secondary displacement of fragments was observed in 23.5% of patients due to insufficient stiffness and reliaability of the bone-fixatorsystem. The non-precise reposition of fragments and secondary displacements in the early and late postoperative period were the main cause of occlusal disturbances of various severities, noted in 28% of operated patients, limitation of mouth opening (10%), TMJ disorders and changes in masticatory stereotype (33%), the sensation of pain and discomfort in tough food chewing (35%). A statistical analysis of the effectiveness of different osteosynthesis methods depending on the type and localization of the fracture was carried out and recommendations for usage of fixation devices in clinical practice were given. PMID:24923155

  11. Surgical management of oral submucous fibrosis in an edentulous patient: A procedural challenge

    Science.gov (United States)

    Mahajan, Amit D.; Tatu, Rohit J.; Shenoy, Nithin A.; Sharma, Vaibhav S.

    2010-01-01

    Prosthetic rehabilitation of patients with oral submucous fibrosis (OSMF) offers a formidable challenge due to restricted mouth opening. Physiotherapy via interocclusal force application is the mainstay for surgical treatment. Herein, we report a case of a man with OSMF requiring construction of dentures. The main objective was to deliver intra-operative and post operative inter occlusal forces without fracturing the mandible and thus providing rehabilitation to the patient prosthetically. An edentulous male patient reported with grade IVA OSMF to our department to improve his mouth opening for denture construction. The patient was managed successfully using surgical sectioning of the fibrous bands. Inter occlusal force application for mouth opening during the operation and post operative physiotherapy were facilitated using custom-made occlusal splints. Satisfactory mouth opening was achieved, with good healing and no event of infection or fracture. Here, we propose an easy method to achieve adequate mouth opening in an edentulous patient of OSMF, with atrophic ridges; without the chances of fracture of either jaw. PMID:22442590

  12. Suppression of natural killer cell activity by surgical stress in cancer patients and the underlying mechanisms.

    Directory of Open Access Journals (Sweden)

    Yoshihara,Hisashi

    1986-04-01

    Full Text Available The influence of surgical stress on the natural killer (NK activity of peripheral blood lymphocytes in patients with carcinoma of the lung or gastrointestinal system was studied. The peripheral blood lymphocytes of the patients showed a marked decrease in NK activity against K-562 cells as target cells 1-2 days after surgery. The activity remained lowered for 2 weeks after thoractomy and for 1 week after laparotomy. No appreciable suppression of NK activity was observed with normal human peripheral blood lymphocytes preincubated with postoperative patient sera. Peripheral blood mononuclear cells obtained postoperatively from patients lost NK activity after ultraviolet irradiation, without any detectable loss of viability. Such irradiated mononuclear cells showed inhibition of NK activity after a 24-hour preincubation with peripheral blood lymphocytes from normal subjects. Similar suppressive activity was demonstrable in a fraction of mononuclear cells with adhesiveness to plastic petri dishes, while non-adherent cells had no such activity. When added immediately to the cytotoxicity assay system without the 24-hour preincubation, patient mononuclear cells caused no inhibition of NK activity, whereas adherent cells from normal subjects enhanced NK activity. The findings seems to indicate that, following surgical stress, plastic dish-adherent peripheral blood mononuclear cells become deprived of NK helper activity and exert suppression, thus causing postoperative depression of NK activity.

  13. Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

    OpenAIRE

    Menachem M. Meller; Courville, Amber B; Sumner, Anne E.

    2014-01-01

    The prevalence of class III obesity (BMI ≥ 40 kg/m2) in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was success...

  14. Surgical and functional outcomes of sigmoid vaginoplasty among patients with variants of disorders of sex development

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    A Nowier

    2012-06-01

    Full Text Available PURPOSE:To assess the use of sigmoid colon in vaginal reconstruction of some patients with disorders of sex development. MATERIALS AND METHODS: The study included 31 patients with disorders of sex development of various causes. All were reared as females. Female gender was decided for all cases after complete medical assessment. All patients underwent sigmoid vaginoplasty. Assessment of surgical and functional outcomes was carried out in a follow up period of up to 6 years. RESULTS: The preoperative diagnoses included mullerian aplasia (16 cases, androgen insensitivity syndrome (12 cases and previous failed vaginoplasty (3 cases. Associated surgical procedures were gonadectomy in 5 cases and gonadectomy combined with clitoroplasty and vulvoplasty in 7 cases. No intra-operative or early postoperative complications occurred. A cosmetic neovagina with adequate size was achieved in all cases. Long term follow up showed introital stenosis in 4 cases (12.9 %. Two of them responded to vaginal dilatation. The third one needed y-v plasty while the fourth one presented by acute abdomen secondary to ruptured vagina and was submitted to urgent laparotomy. Mucosal prolapse occurred in 1 case (3.2%. Reoperation rate was 9.6%. Sexual satisfaction was achieved among 9 sexually active cases. The subjective satisfaction score of the surgical outcome was 8.03. CONCLUSIONS: For patients with disorders of sex development of various etiologies, sigmoid vaginoplasty is the preferred technique for vaginal replacement. It is a safe technique that provides the patient with a cosmetic neovagina of adequate caliber and a satisfactory functional outcome.

  15. Effects of sedation with low-dosage dexmedetomidine on cardiac function in elderly surgical patients

    Directory of Open Access Journals (Sweden)

    Yu LANG

    2011-09-01

    Full Text Available Objective To investigate the influence of continuous infusion of low-dose dexmedetomidine(DEX for sedation on cardiac function index in elderly surgical patients,and assess the impacts on circulation.Methods Sixty elderly surgical patients were randomized into DEX group and control group(30 each.The sex ratio of the patients was 24/36(male/female,and age from 65 to 89 years.After the cannulation of left radial artery,the arterial pressure continuous cardiac output(APCO monitor(Edwards,USA was connected,and the cardiac function index was continuously monitored,including cardiac output index(CI,stroke volume index(SVI,heart rate(HR and mean arterial pressure(MAP.The patients in DEX group were infused with DEX at 0.4μg(kg·h for 10min following intrathecal anesthesia,then the infusion rate was adjusted from 0.2 to 0.4μg(kg·h to keep the bispectral index values(BIS maintained between 75 and 85.Normal saline was administered with an equal volume in control group.The MAP,HR,respiration rate(RR,pulse oxygen saturation(SpO2,the partial pressure of end-tidal carbon dioxide(PETCO2 and BIS were recorded immediately at the DEX infusion(T0,and 10min(T1,20min(T2,30min(T3,60min(T4 after DEX infusion,and the end of surgery(T5.All cardiac function data were statistically analyzed,and P 0.05.Conclusion The sedation with continuous infusion of small-dosage DEX during intrathecal anesthesia in elderly surgical patients may have little impact on cardiac function index,but the conclusion remains to be verified with large sample and multicenter research.

  16. Surgical Guides (Patient-Specific Instruments for Pediatric Tibial Bone Sarcoma Resection and Allograft Reconstruction

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    Laura Bellanova

    2013-01-01

    Full Text Available To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI and computerized tomography (CT were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis.

  17. Scoliosis in patients with Prader Willi Syndrome – comparisons of conservative and surgical treatment

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    Goodall Deborah

    2009-05-01

    Full Text Available Abstract In children with Prader Willi syndrome (PWS, besides growth hormone (GH therapy, control of the food environment and regular exercise, surgical treatment of scoliosis deformities seems the treatment of choice, even though the risks of spinal surgery in this specific population is very high. Therefore the question arises as to whether the risks of spinal surgery outweigh the benefits in a condition, which bears significant risks per se. The purpose of this systematic review of the Pub Med literature was to find mid or long-term results of spinal fusion surgery in patients with PWS, and to present the conservative treatment in a case study of nine patients with this condition. Methods Types of studies included; all kinds of studies; retrospective and prospective ones, which reported upon the outcome of scoliosis surgery in patients with PWS. Types of participants included: patients with scoliosis and PWS. Type of intervention: surgery. Search strategy for identification of the studies; Pub Med; limited to English language and bibliographies of all reviewed articles. Nine patients with PWS from our data-base treated conservatively have been found, being 19 years or over at the time this study has been performed. The results of conservative management are described and related to the natural history and treatment results found in the Pub Med review. Results From 2210 titles displayed in the Pub Med database with the key word being "Prader Willi syndrome", 5 different papers were displayed at the date of the search containing some information on the outcome of surgery and none appeared to contain a mid or long-term follow-up. The PWS patients treated conservatively from our series all stayed below 70° and some of which improved. Discussion If the curve of scoliosis patients with PWS can be kept within certain limits (usually below 70 degrees conservatively, this treatment seems to have fewer complications than surgical treatments. The

  18. Early Surgical Treatment of Penile Fracture: Our Experience with 19 Patients

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    Ozer Guzel

    2014-03-01

    Full Text Available Aim: We aimed to evaluate the outcomes of patients who underwent surgical treatment due to penile fracture. Material and Method: Between 2007 and 2013, a total of 19 patients admitted to our hospital for penile fracture treated with early surgical repair were included in the study. In the pre-operative period, Age, first-five questions version of International Index of Erectile Function (IIEF-5 scores, penile fracture etiology, penile fracture formation, duration until referred to our hospital and duration of hospitalization were retrospectively obtained from medical data of patients. In the post-operative period, IIEF-5 scores, loss of penile sensation, painful erection and penile curvature development were evaluated. Results: The mean age of patients was 37.8 years. The mean follow-up time was 33.4 months. The mean time until the surgery and pre-operative IIEF-5 score were 11.1 hours and 22.7, respectively. In pre-operative period, 1 patient had mild-moderate degree erectile dysfunction (ED, 3 patients had mild degree ED. Fifteen patients had no ED. The mean of post-operative IIEF-5 score was 19.3. There was a significant difference between pre-operative and post-operative IIEF-5 scores (p=0.01. In the post-operative period, penile curvature was detected in 5 (26.3%, painful penile erection in 4 (21% and loss of penile sensation in 2 (%10.5 patients. Discussion: In light of our results, we believe that patients who undergo early penil fracture surgery should be well informed in terms of possible penile curvature, painful erections and ED development.

  19. Salt taste after bariatric surgery and weight loss in obese persons.

    Science.gov (United States)

    Ekmekcioglu, Cem; Maedge, Julia; Lam, Linda; Blasche, Gerhard; Shakeri-Leidenmühler, Soheila; Kundi, Michael; Ludvik, Bernhard; Langer, Felix B; Prager, Gerhard; Schindler, Karin; Dürrschmid, Klaus

    2016-01-01

    Background. Little is known about the perception of salty taste in obese patients, especially after bariatric surgery. Therefore, the aim of this study was to analyse possible differences in salt detection thresholds and preferences for foods differing in salt content in obese persons before and after bariatric surgery with weight loss compared to non-obese individuals. Methods. Sodium chloride detection thresholds and liking for cream soups with different salt concentrations were studied with established tests. Moreover, a brief salt food questionnaire was assessed to identify the usage and awareness of salt in food. Results. The results showed similar mean sodium chloride detection thresholds between non-obese and obese participants. After bariatric surgery a non-significant increase in the salt detection threshold was observed in the obese patients (mean ± SD: 0.44 ± 0.24 g NaCl/L before OP vs. 0.64 ± 0.47 g NaCl/L after OP, p = 0.069). Cream soup liking between controls and obese patients were not significantly different. However, significant sex specific differences were detected with the tested women not liking the soups (p < 0.001). Results from the food questionnaire were similar between the groups. Conclusion. No differences between non-obese persons and obese patients were shown regarding the salt detection threshold. However, due to highly significant differences in soup liking, sex should be taken into consideration when conducting similar sensory studies. PMID:27330856

  20. Thinking in three's: Changing surgical patient safety practices in the complex modern operating room

    Institute of Scientific and Technical Information of China (English)

    Verna C Gibbs

    2012-01-01

    The three surgical patient safety events,wrong site surgery,retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study.The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined.Many providers may never have a personal experience with one of these events and training and education on these topics are sparse.These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do.Surgeons are not preoccupied with failure and tend to usually consider good outcomes,which leads them to ignore or diminish the importance of implementing and following simple safety practices.These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions.Individual facilities rarely have the time or talent to understand these events and develop lasting solutions.More often than not,even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate.This approach routinely fails and is another reason why these problems are so persistent.Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment.This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery,RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists,surgeons and nurses.A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team

  1. The outcome of surgical fixation of mid shaft clavicle fractures; looking at patient satisfaction and comparing surgical approaches

    Directory of Open Access Journals (Sweden)

    Zeiad A Alshameeri

    2012-01-01

    Conclusion : Our study showed excellent surgical outcome for displaced clavicle fractures supported by the high union rate, good oxford shoulder score, high return to work rate, and good patient′s satisfaction. The number of minor complications and symptomatic metal work removal was less in the infraclavicular approach.

  2. Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Vester-Andersen, Morten; Nielsen, Martin Vedel;

    2015-01-01

    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...

  3. Corneal-Based Surgical Presbyopic Therapies and Their Application in Pseudophakic Patients

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    Grace L. Paley

    2016-01-01

    Full Text Available Purpose. The purpose of this review is to provide a summary of laser refractive surgery and corneal inlay approaches to treat presbyopia in patients after cataract surgery. Summary. The presbyopic population is growing rapidly along with increasing demands for spectacle independence. This review will focus on the corneal-based surgical options to address presbyopia including various types of corneal intrastromal inlays and laser ablation techniques to generate either a multifocal cornea (“PresbyLASIK” or monovision. The natural history of presbyopia develops prior to cataracts, and these presbyopic surgeries have been largely studied in phakic patients. Nevertheless, pseudophakic patients may also undergo these presbyopia-compensating procedures for enhanced quality of life. This review examines the published reports that apply these technologies to patients after cataract surgery and discusses unique considerations for this population.

  4. Corneal-Based Surgical Presbyopic Therapies and Their Application in Pseudophakic Patients

    Science.gov (United States)

    Paley, Grace L.; Chuck, Roy S.

    2016-01-01

    Purpose. The purpose of this review is to provide a summary of laser refractive surgery and corneal inlay approaches to treat presbyopia in patients after cataract surgery. Summary. The presbyopic population is growing rapidly along with increasing demands for spectacle independence. This review will focus on the corneal-based surgical options to address presbyopia including various types of corneal intrastromal inlays and laser ablation techniques to generate either a multifocal cornea (“PresbyLASIK”) or monovision. The natural history of presbyopia develops prior to cataracts, and these presbyopic surgeries have been largely studied in phakic patients. Nevertheless, pseudophakic patients may also undergo these presbyopia-compensating procedures for enhanced quality of life. This review examines the published reports that apply these technologies to patients after cataract surgery and discusses unique considerations for this population. PMID:27051527

  5. Corneal-Based Surgical Presbyopic Therapies and Their Application in Pseudophakic Patients.

    Science.gov (United States)

    Paley, Grace L; Chuck, Roy S; Tsai, Linda M

    2016-01-01

    Purpose. The purpose of this review is to provide a summary of laser refractive surgery and corneal inlay approaches to treat presbyopia in patients after cataract surgery. Summary. The presbyopic population is growing rapidly along with increasing demands for spectacle independence. This review will focus on the corneal-based surgical options to address presbyopia including various types of corneal intrastromal inlays and laser ablation techniques to generate either a multifocal cornea ("PresbyLASIK") or monovision. The natural history of presbyopia develops prior to cataracts, and these presbyopic surgeries have been largely studied in phakic patients. Nevertheless, pseudophakic patients may also undergo these presbyopia-compensating procedures for enhanced quality of life. This review examines the published reports that apply these technologies to patients after cataract surgery and discusses unique considerations for this population. PMID:27051527

  6. Predictors of Multidrug Resistant Acinetobacter Baumannii Infections in Surgical Intensive Care Patients: A Retrospective Analysis

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    Aynur Camkıran

    2011-08-01

    Full Text Available Objective: Multidrug resistant Acinetobacter baumannii (MRAB is an important cause of hospital acquired infection and leads to an increasing morbidity and mortality in intensive care units (ICU. The aim of this study was to investigate the predictors of MRAB infection in surgical ICU patients. Material and Method: The charts of the patients who were admitted to the ICU between January 2008 and August 2010 were reviewed to identify patients with MRAB infection. Recorded data were as follows: age, sex, medical history, underlying surgical pathology, Acute Physiology and Chronic Health Evaluation II score (APACHE II and Glasgow Coma Score on ICU admission,presence of invasive procedures (intubation, arterial, central venous lines, urinary catheters, and renal replacement therapy, days in ICU and white blood cells (WBC and lactate count on infection day, infection site, complications (such as organ/system failure, length of stay (LOS in the ICU and hospital, and final outcome. Results: During the study period 25 patients with MRAB infection were identified. When compared with their matched control group (n=25, patients with MRAB infection had a significantly higher mean APACHE II score (p=0.001 and more frequently had an open wound (p=0.002 or required mechanical ventilation (p=0.005, with respiratory system disease (p=0.03, arterial catheterization (p=0.006, and central venous catheterization (p=0.004. Multivariate logistic regression revealed that APACHE II score (OR,1.155; CI, 1.008-1.324; p= 0.038 and open wound (OR, 27.77; CI, 2.020-333.333; p=0.018 were predictors of MRAB infection in these patients. Compared to their controls, patients with MRAB infection hand a longer LOS in ICU (36.44±30.44 days vs 7.80±8.13 days, p<0.000 and hospital (55.12±40.81 days vs 19.04±13.44 days, p<0.000. In hospital mortality rates for patients with MRAB infection and their controls were 56% and 32%, respectively (p=0.154. Conclusion: Our results indicate

  7. Nutritional Optic Neuropathy Caused by Copper Deficiency After Bariatric Surgery.

    Science.gov (United States)

    Rapoport, Yuna; Lavin, Patrick J M

    2016-06-01

    A 47-year-old woman developed severe bilateral visual loss 4 years after a Roux-en-Y gastric bypass and 24 years after vertical banded gastroplasty. Her serum copper level was 35 μg/dL (normal, 80-155 μg/dL). She was prescribed elemental copper tablets. Because her methylmalonic acid was slightly elevated, she received vitamin B12 injections as well. Five weeks later, she reported that her vision had improved and, at 10 months, her vision had recovered from 20/400 bilaterally to 20/25 in each eye. This case highlights the importance of checking copper levels in addition to the "more routine" vitamin levels, such as B1, B6, B12, E, and serum folate in patients with suspected nutritional optic neuropathy after bariatric surgery, particularly if it involved a bypass procedure. PMID:26828841

  8. Central and peripheral venous lines-associated blood stream infections in the critically ill surgical patients

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    Ugas Mohamed

    2012-09-01

    Full Text Available Abstract Critically ill surgical patients are always at increased risk of actual or potentially life-threatening health complications. Central/peripheral venous lines form a key part of their care. We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention. An extensive systematic electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonisation and catheter-related bloodstream infection. Two independent reviewers engaged in selecting the appropriate articles in line with our protocol retrieved 8 articles published from 1999 to 2011. Outcomes on CVC colonisation and infections were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomised trial. We identified only one study that compared CVC- and PICC-related complications in surgical intensive care units. Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature, namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations. In summary, the diverse definitions for the diagnosis of central and peripheral venous catheter-related bloodstream infections along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance remains inconclusive.

  9. Surgical correction of severe cervical kyphosis in patients with neurofibromatosis Type 1.

    Science.gov (United States)

    Kawabata, Soya; Watanabe, Kota; Hosogane, Naobumi; Ishii, Ken; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

    2013-03-01

    Severe cervical kyphosis requiring surgical treatment is rare in patients with neurofibromatosis Type 1 (NF1). When it occurs, however, dystrophic changes in the vertebrae make surgical correction and fusion of the deformity extremely difficult. The authors report on 3 cases of severe cervical kyphosis associated with NF1 that were successfully treated with combined anterior and posterior correction and fusion. All patients underwent halo-gravity traction for approximately 1 month prior to surgery to correct the deformity gradually. Posterior correction and fusion were performed with segmental spinal instrumentation consisting of lateral mass screws, lamina screws, pedicle screws, and polyethylene tape for sublaminar wiring. Anterior spinal fusion was performed using a fibula strut to induce solid bone fusion. All patients used a halo vest for postoperative external fixation. Preoperative CT scans showed dystrophic cervical spine changes, and MR images demonstrated extensive neurofibromas outside the cervical spine in all 3 patients. The preoperative kyphotic angles were as follows: Case 1, 140°; Case 2, 81°; and Case 3, 72°; after halo-gravity traction, the kyphosis angles improved to 50°, 55°, and 51°, respectively; and after surgery, they were 50°, 15°, and 27°, respectively. Solid bone union was observed in all patients at the latest follow-up. All three patients experienced postoperative complications consisting of superficial infection, severe pneumonia, and partial dislocation of the distal fibula graft after removing the halo vest, in one patient each. Although dystrophic cervical vertebral changes in these patients with NF1 complicated the correction of severe cervical kyphosis, the use of preoperative halo-gravity traction, a combination of spinal instrumentations, an anterior strut bone graft, and postoperative halo-vest fixation made it possible to correct the kyphosis, maintain the correction, and achieve solid bone fusion. PMID:23289507

  10. Chronic Renin-Angiotensin System (RAS) Blockade May Not Induce Hypotension During Anaesthesia for Bariatric Surgery.

    Science.gov (United States)

    Salvetti, Guido; Di Salvo, Claudio; Ceccarini, Giovanni; Abramo, Antonio; Fierabracci, Paola; Magno, Silvia; Piaggi, Paolo; Vitti, Paolo; Santini, Ferruccio

    2016-06-01

    The use of angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin II receptor blockers (ARB) for the treatment of hypertensive obese patients is steadily increasing. Some studies have reported that the use of these drugs was associated with an increased risk of hypotensive episodes, during general anaesthesia. The number of bariatric procedures is also increasing worldwide, but there is a lack of studies investigating the hypotensive effect of renin-angiotensin system (RAS) blockers in severely obese patients during general anaesthesia for bariatric surgery. The aim of this pilot study was to evaluate hemodynamic changes induced by general anaesthesia in obese patients chronically treated with ACE-I or ARB compared to a control group not treated with antihypertensive therapy. Fourteen obese subjects (mean body mass index (BMI) 47.5 kg/m(2)) treated with ACE-I or ARB and twelve obese (mean BMI 45.7 kg/m2) controls not treated with antihypertensive therapy underwent general anaesthesia to perform laparoscopic bariatric surgery. Systolic blood pressure, diastolic blood pressure, and heart rate were monitored continuously and registered at different time points: T0 before induction, then at 2, 5, 7, 10, 15, 20, 30, 60, 90, 120, and 150 min after induction, and the last time point taken following recovery from anaesthesia. A progressive reduction of both systolic and diastolic blood pressure values was observed without significant differences between the two groups. A similar trend of heart rate values was observed. In conclusion, our pilot study suggests that RAS blockers may be continued during the perioperative period in patients undergoing bariatric surgery, without increasing the risk of hypotensive episodes. PMID:26328531

  11. Bariatric surgery decreases carotid intima-media thickness in obese subjects

    Directory of Open Access Journals (Sweden)

    Gonzalo García

    2013-08-01

    Full Text Available Background: Obesity has long been associated with an increased risk of cardiovascular disease (CVD. The aim of this study was to evaluate the impact of substantial weight loss induced by bariatric surgery on carotid intima media thickness (C-IMT (surrogate marker of early atherosclerosis and classic factors of cardiovascular risk (CVRFs. Methods: thirty-one obesity patients were evaluated for bariatric surgery. Twenty-seven were undergone surgery, 14 Roux-en-Y gastric bypass surgery (GBS and 13 sleeve gastrectomy. The four obese patients who did not undergo surgery, were performed the same evaluations. Measurements: Body weight, BMI, blood pressure, total cholesterol, TC levels, LDL-C, HDL-C, TG, fasting plasma glucose and insulin, HOMA IR, and US B-mode C-IMT was measured. Results: After 354 ± 92 days follow up, 27 patients that underwent bariatric surgery evidenced a mean body mass index decrease from 38 to 27 k/m² (p < 0.001, simultaneously was observed improvement in CVRFs, 10 years Framingham risk and a significant reduction of therapeutic requirements. C-IMT diminished from a mean of 0.58 ± 0.14 mm to 0.49 ± 0.09 mm (p = 0.0001. Four patients that did not undergo surgery increased C-IMT from 0.52 ± 0.12 to 0.58 ± 0.13 mm (p = 0.03 with no significant changes in CVRFs. Conclusion: Weight loss, one year after bariatric surgery, GBS and sleeve gastrectomy, decreases C-IMT; improve CVRFs and 10 years Framingham risk.

  12. Equal ratio ventilation (1:1 improves arterial oxygenation during laparoscopic bariatric surgery: A crossover study

    Directory of Open Access Journals (Sweden)

    Wesam Farid Mousa

    2013-01-01

    Full Text Available Background: Hypoxaemia and high peak airway pressure (Ppeak are common anesthetic problems during laparoscopic bariatric surgery. Several publications have reported the successful improvement in arterial oxygenation using positive end expiratory pressure and alveolar recruitment maneuver, however, high peak airway pressure during laparoscopic bariatric surgery may limit the use of both techniques. This study was designed to determine whether equal I:E (inspiratory-to-expiratory ratio ventilation (1:1 improves arterial oxygenation with parallel decrease in the Ppeak values. Methods: Thirty patients with a body mass index ≥40 kg/m 2 scheduled for laparoscopic bariatric surgery were randomized, after creation of pneumoperitoneum, to receive I:E ratio either 1:1 (group 1, 15 patients or 1:2 (group 2, 15 patients. After a stabilization period of 30 min, patients were crossed over to the other studied I:E ratio. Ppeak, mean airway pressure (Pmean, dynamic compliance (Cdyn, arterial blood gases and hemodynamic data were collected at the end of each stabilization period. Results: Ventilation with I: E ratio of 1:1 significantly increased partial pressure of O 2 in the arterial blood (PaO 2 , Pmean and Cdyn with concomitant significant decrease in Ppeak compared to ventilation with I: E ratio of 1:2. There were no statistical differences between the two groups regarding the mean arterial pressure, heart rate, respiratory rate, end tidal CO 2 or partial pressure of CO 2 in the arterial blood. Conclusion: Equal ratio ventilation (1:1 is an effective technique in increase PaO 2 during laparoscopic bariatric surgery. It increases Pmean and Cdyn while decreasing Ppeak without adverse respiratory or hemodynamic effects.

  13. Post-Bariatric Surgery Satisfaction and Body-Contouring Consideration after Massive Weight Loss

    OpenAIRE

    Saleh M Aldaqal; Ahmad M Makhdoum; Ali M Turki; Awan, Basim A; Osama A Samargandi; Hytham Jamjom

    2013-01-01

    Background: Following a bariatric surgery and massive weight-loss, the outcome is usually sullied by consequences on the body′s contour and redundant skin. Aims: We aimed to record the frequency of contour irregularities and quantify patients′ satisfaction with appearance and anticipations from body contouring surgery. Materials and Methods: The ethical committee at King Abdulaziz University Hospital approved the study, and patients were consented. A cross-sectional study targeting the post-b...

  14. Surgical Approach and Laser Applications in BRONJ Osteoporotic and Cancer Patients

    Directory of Open Access Journals (Sweden)

    Paolo Vescovi

    2012-01-01

    Full Text Available Bisphosphonates-related Osteonecrosis of the Jaw (BRONJ has been reported with increasing frequency in literature over last years, but its therapy is still a dilemma. One hundred ninety patients affected by BRONJ were observed between January 2004 and November 2011 and 166 treated sites were subdivided in five groups on the basis of the therapeutical approach (medical or surgical, traditional or laser-assisted approach, with or without Low Level Laser Therapy (LLLT. Clinical success has been defined for each treatment performed as clinical improvement or complete mucosal healing. Combination of antibiotic therapy, conservative surgery performed with Er:YAG laser and LLLT applications showed best results for cancer and noncancer patients. Nonsurgical approach performed on 69 sites induced an improvement in 35 sites (50.7% and the complete healing in 19 sites (27.5%, while surgical approach on 97 sites induced an improvement in 84 sites (86.6% and the complete healing in 78 sites (80.41%. Improvement and healing were recorded in 31 (81.5% and 27 (71.5% out of the 38 BRONJ sites treated in noncancer patients and in 88 (68.75% and in 69 (53.9% out of the 128 in cancer patients.

  15. [Hybrid surgical intervention in a patient with an aortic arch aneurysm and coronary artery disease].

    Science.gov (United States)

    Charchan, E R; Abugov, S A; Puretsky, M V; Kim, S Yu; Skvortsov, A A; Khachatryan, Z R

    2015-01-01

    Presented herein is a clinical case report regarding the use of hybrid technology in surgical treatment of a patient with an aneurysm of the distal portion of the aortic arch and coronary artery disease. The patient underwent a hybrid operation, i.e. debranching of the aortic arch branches, exoprosthetic repair of the ascending aorta, autovenous prosthetic coronary bypass grafting of the branch of the blunt edge of the anterior interventricular artery, stenting of the ascending portion, arch and descending portion of the aorta (stent graft "Medtronic Valiant"). In doing so, we used a non-standard approach to connecting the artificial circulation unit and to choosing the place for establishing proximal anastomoses of autovenous coronary bypass grafts. The early postoperative period was complicated by the development of respiratory insufficiency requiring continuation artificial pulmonary ventilation. The duration of the hospital stay of the patient amounted to 15 days. The check-up multispiral computed tomography showed normal functioning of the reconstruction zones, the stent graft is expanded, with no leak observed. The conclusion was made that hybrid interventions may be considered as an alternative to the classical surgical treatment associated in patients of older age group with a severe course of the postoperative period and high lethality. PMID:26035581

  16. Functional improvements after orthodontic-surgical reconstruction in a patient with multiple maxillofacial fractures.

    Science.gov (United States)

    Ishihara, Yoshihito; Kuroda, Shingo; Nishiyama, Akiyoshi; Sasaki, Akira; Takano-Yamamoto, Teruko; Yamashiro, Takashi

    2012-10-01

    Patients with multiple craniofacial fractures often suffer from stomatognathic problems after their primary treatment, because administering emergency care is the clinician's highest priority. Therefore, optimal bone repositioning is sometimes difficult because bone fixation is delayed. Moreover, neither an adequate radiographic examination nor an evaluation of primary occlusion is available during the repair of fractured bones. The lack of these assessments can also lead to occlusal dysfunction after bone fixation. As a result, patients with craniofacial fractures often require occlusal reconstruction. This report describes the successful occlusal reconstruction with orthodontic-surgical treatment of a patient with multiple maxillofacial bone fractures. Combined surgery, including an intraoral vertical ramus osteotomy and a mandibular body osteotomy, was performed to reposition the deviated mandible after 3 months of preoperative orthodontic treatment. The total active treatment period was 25 months. After treatment, both the facial asymmetry and the anterior open bite caused by the skeletal disharmony were significantly improved. Additionally, the range of condylar motion, maximum occlusal force, and occlusal contact area during maximum clenching were also increased. These stomatognathic functions were further enhanced by 2 years of retention. Orthodontic-surgical reconstruction appears to improve both facial esthetics and occlusal function in patients with facial asymmetry caused by severe traumatic maxillofacial fractures. PMID:22999677

  17. Patient-specific system for prognosis of surgical treatment outcomes of human cardiovascular system

    Science.gov (United States)

    Golyadkina, Anastasiya A.; Kalinin, Aleksey A.; Kirillova, Irina V.; Kossovich, Elena L.; Kossovich, Leonid Y.; Menishova, Liyana R.; Polienko, Asel V.

    2015-03-01

    Object of study: Improvement of life quality of patients with high stroke risk ia the main goal for development of system for patient-specific modeling of cardiovascular system. This work is dedicated at increase of safety outcomes for surgical treatment of brain blood supply alterations. The objects of study are common carotid artery, internal and external carotid arteries and bulb. Methods: We estimated mechanical properties of carotid arteries tissues and patching materials utilized at angioplasty. We studied angioarchitecture features of arteries. We developed and clinically adapted computer biomechanical models, which are characterized by geometrical, physical and mechanical similarity with carotid artery in norm and with pathology (atherosclerosis, pathological tortuosity, and their combination). Results: Collaboration of practicing cardiovascular surgeons and specialists in the area of Mathematics and Mechanics allowed to successfully conduct finite-element modeling of surgical treatment taking into account various features of operation techniques and patching materials for a specific patient. Numerical experiment allowed to reveal factors leading to brain blood supply decrease and atherosclerosis development. Modeling of carotid artery reconstruction surgery for a specific patient on the basis of the constructed biomechanical model demonstrated the possibility of its application in clinical practice at approximation of numerical experiment to the real conditions.

  18. Clinical characteristics and surgical outcome of patients with temporal lobe tumors and epilepsy

    Directory of Open Access Journals (Sweden)

    JORGE CARMEN LISA

    2000-01-01

    Full Text Available This is a retrospective study of 21 surgically treated patients with temporal lobe tumors and epilepsy. Evaluation included clinical data, EEG findings, structural scans, pathological diagnosis and post-surgical follow-up. There were 9 cases of ganglioglioma, 5 pilocytic astrocytoma, 3 ganglioneuroma, 2 dysembryoplastic neuroepithelial tumor, 1 pleomorphic xantoastrocytoma, and 1 meningioangiomatosis. Mean follow-up time was 22 months and outcome was evaluated according to Engel's classification; 76.2% were classified in class I and 23.8% in II and III. All patients classes II and III had been submitted to mesial and neocortical resections. There were no differences related to clinical characteristics, pathological diagnosis or duration of follow-up in patients seizure-free or not. All patients had abnormal MRI and ten of these had normal CT; the MRI characteristics were compared to pathological diagnosis and specific histological characteristics of the tumors were not discernible by MRI. We concluded that MRI was essential for the diagnosis and precise location of TL tumors. Ganglioglioma was the most frequent tumor and lesionectomy associated to mesial resection doesn't guarantee a better prognosis.

  19. Adherence to vitamin supplementation following adolescent bariatric surgery

    OpenAIRE

    Modi, Avani C.; Zeller, Meg H.; Xanthakos, Stavra A.; Jenkins, Todd M.; Inge, Thomas H.

    2013-01-01

    Adolescents with extreme obesity, who have undergone bariatric surgery, must adhere to many lifestyle and nutritional recommendations, including multivitamin therapy. Little is know about multivitamin adherence following adolescent bariatric surgery. The present study aims to document self-reported and electronically-monitored adherence to multivitamins, determine convergence between self-report and electronic monitoring adherence for multivitamins, and identify barriers to multivitamin adher...

  20. Demographics of Patients with Double-headed Pterygium and Surgical Outcomes

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    Fulya Duman

    2015-12-01

    Full Text Available Objectives: To analyze demographic and ophthalmologic characteristics of patients with double-headed pterygium in the Mediterranean region of Turkey and to evaluate their surgical outcomes. Materials and Methods: Records of all patients who underwent surgery for pterygium in Antalya Atatürk State Hospital between November 2012 and March 2014 were retrospectively reviewed. Patients with pterygia on both sides of the cornea (nasal and temporal were included in the study. Patients with less than six months of follow-up were excluded. Age, occupation and smoking status of patients, recurrence of pterygium and any existing complications in records were evaluated. Fibrovascular proliferation more than 0.5 mm over the cornea was accepted as recurrence. Results: Eight (5% of 158 patients who underwent pterygium surgery were diagnosed with double-headed pterygium. Six (75% of the patients were male and two (25% were female. Mean age was 42.63 (26-71 years. It was recorded that all patients had worked under the sun for at least 5 hours a day. No intra-operative or post-operative complications were found. Mean follow-up time after surgery was 12 (6-21 months and no recurrence was detected. Conclusion: Pterygium, especially double-headed pterygium is mostly seen in warm climates and individuals who work outdoors. Dividing the free conjunctival autograft into two and suturing in place of the excised pterygium on both sides of the cornea is a good choice in these patients.

  1. Patient-Specific Surgical Planning, Where Do We Stand? The Example of the Fontan Procedure.

    Science.gov (United States)

    de Zélicourt, Diane A; Kurtcuoglu, Vartan

    2016-01-01

    The Fontan surgery for single ventricle heart defects is a typical example of a clinical intervention in which patient-specific computational modeling can improve patient outcome: with the functional heterogeneity of the presenting patients, which precludes generic solutions, and the clear influence of the surgically-created Fontan connection on hemodynamics, it is acknowledged that individualized computational optimization of the post-operative hemodynamics can be of clinical value. A large body of literature has thus emerged seeking to provide clinically relevant answers and innovative solutions, with an increasing emphasis on patient-specific approaches. In this review we discuss the benefits and challenges of patient-specific simulations for the Fontan surgery, reviewing state of the art solutions and avenues for future development. We first discuss the clinical impact of patient-specific simulations, notably how they have contributed to our understanding of the link between Fontan hemodynamics and patient outcome. This is followed by a survey of methodologies for capturing patient-specific hemodynamics, with an emphasis on the challenges of defining patient-specific boundary conditions and their extension for prediction of post-operative outcome. We conclude with insights into potential future directions, noting that one of the most pressing issues might be the validation of the predictive capabilities of the developed framework. PMID:26183962

  2. Efficacy of external warming in attenuation of hypothermia in surgical patients

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    Zeba Snježana

    2016-01-01

    Full Text Available Background/Aim. Hypothermia in surgical patients can be the consequence of long duration of surgical intervention, general anaesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, and prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition. The aim of this study was to evaluate the efficiency of external warming system in alleviation of cold stress and hypothermia in patients who underwent major surgical procedures. Methods. The study was conducted in the Military Medical Academy in Belgrade. A total of 30 patients of both genders underwent abdominal surgical procedures, randomly divided into two equal groups: the one was externally warmed using warm air mattress (W, while in the control group (C surgical procedure was performed in regular conditions, without additional warming. Oesophageal temperature (Te was used as indicator of changes in core temperature, during surgery and awakening postoperative period, and temperature of control sites on the right hand (Th and the right foot (Tf reflected the changes in skin temperatures during surgery. Te and skin temperatures were monitored during the intraoperative period, with continuous measurement of Te during the following 90 minutes of the postoperative period. Heart rates and blood pressures were monitored continuously during the intraoperative and awakening period. Results. In the W group, the average Te, Tf and Th did not change significantly during the intraoperative as well as the postoperative period. In the controls, the average Te significantly decreased during the intraoperative period (from 35.61 ± 0.35ºC at 0 minute to 33.86 ± 0.51ºC at 120th minute. Compared to the W group, Te in the C group was significantly lower in all the observed periods. Average values of Tf and

  3. Embarazo posterior a cirugía bariátrica: complicaciones maternas y fetales Maternal and foetal complications in pregnancy following bariatric (weight-loss surgery

    Directory of Open Access Journals (Sweden)

    Jairo Hernández-Pinzón

    2008-09-01

    Full Text Available Objetivo: utilizando herramientas de revisiones sistemáticas, describir los efectos de la obesidad en el embarazo para la madre y el feto, así como describir las complicaciones perinatales, intraparto y posnatales en pacientes a las que se les ha practicado cirugía bariátrica. Metodología: se utilizó la base de datos Pubmed/Medline, los términos de búsqueda fueron: bariatric surgery AND/OR obstetric complications, pregnance, abortion, pregnancy outcomes, adverse pregnancy outcomes. Se hizo énfasis en guías de práctica clínica, se realizó búsqueda en sitios de sinopsis de la literatura médica del Database of Abstracts or Reviews of Effectiveness (DARE. Resultados: se seleccionaron 50 artículos, los cuales fueron sintetizados en la sección de resultados de la revisión. La cirugía bariátrica predispone a la isquemia intestinal y formación de hernias en los embarazos posteriores. También se han descrito deficiencias específicas de micronutrientes. Por otra parte, existen informes contradictorios sobre el efecto en el peso fetal. Conclusiones: el seguimiento de los embarazos después del primer año de la cirugía para pérdida de peso no informa episodios importantes de malnutrición materna o fetal. La evidencia muestra que los resultados del embarazo después de la cirugía bariátrica son favorables, en comparación con los resultados en los obesos no tratados quirúrgicamente, se necesitan más estudios prospectivos diseñados cuidadosamente para evaluar áreas de incertidumbre en este campo.Objective: using systematic review tools for describing the effects of obesity on pregnancy for the mother and the foetus, as well as describing perinatal, intrapartum and postnatal complications in patients who have undergone bariatric (weigh-loss surgery. Methodology: the PUBMED/MEDLINE database was searched using the following search terms: bariatric surgery AND/OR obstetric complications, pregnancy, abortion, pregnancy outcome

  4. Carbohydrate metabolism and quality of life in patients after surgical treatment of insulinoma

    Directory of Open Access Journals (Sweden)

    Ivan Ivanovich Dedov

    2014-08-01

    Full Text Available Objectives. T study the quality of life and status of carbohydrate metabolism in patients after surgical treatment insulinoma. Methods: The study involved 20 patients divided in two groups: the first group with a catamnesis duration of up to five years; the second group with a catamnesis duration of more than five years. We studied anthropometric parameters and carbohydrate metabolism as well as psychological questioning of patients using SF-36 questionnaire, the data was considered statistically significant at p<0.05. Results. severe combined postoperative complications were more frequent in the first group (63.6% vs. 22.2%, p=0.07, due to extend of the performed surgery. Adrenergic symptoms prior to the surgery were detected in 90.9% of cases in the first group and in 77.7% of cases in the second group. After treatment these numbers decreased to 36.4% and 11.1% respectively (p=0.039 and 0.026. Neuroglycopeniс symptoms before treatment were detected in 90.9% of cases in the first group and for all patients in the second, while after treatment persisted only in 45.5% and 33.3% of cases respectively (p=0.045 and 0.036. Carbohydrate metabolism have normalized for the majority of patients. Two patients (18.2% of the first group showed impaired glucose tolerance. Improved carbohydrate metabolism was associated with a decrease in body weight in both groups. Results of psychological questionnaires were comparable with the survey data obtained in general population in the Russian Federation. Conclusion. Surgical treatment of insulinomas is highly effective. Physical and psychological status of patients in most cases corresponds with those typical for this age-sex group of the population of the Russian Federation. Long-term treatment results do not depend on duration of the catamnesis. Complications that developed from surgical treatment have the main influence on the health of patients.

  5. Brain SPECT in the pre-surgical evaluation of epileptic patients

    International Nuclear Information System (INIS)

    Fifteen adult epileptic patients were studied pre-operatively using a rotational scintillation camera interfaced to a dedicated computer. The tomographic images were obtained 15 minutes after intravenous injection of 99 m Tc-HMPAO. All had MRI scanning and intensive EEG monitoring which generally included seizure recording. Five patients had progressive lesions (3 meningiomas, 2 astrocytomas). In 10 patients, neuroradiological studies did not show the presence of progressive lesions (2 normal scans and 8 cases with inactive lesions). Two patients with meningioma showed hypoperfusion at the lesion site while the third patient had a marked hypoperfusion which might correlate with the clinical diagnosis of epilepsia partialis continua. In the astrocytoma patients SPECT scans showed hypoperfusion at the lesion site. Data obtained from the 10 patients without progressive CNS lesions showed: in 4, SPECT findings correlated well with the anatomical findings; in 5 instances, SPECT was able to disclose additional functional deficits; in one case, there was no SPECT correlate of a discrete anatomical lesion. In 5 of these cases with no progressive lesions (n=10) SPECT findings were useful as a complementary tool in determining the clinical or surgical management of these patients. Despite the small number and heterogeneity of the present sample, SPECT seems to be an useful tool as part of the clinical workup of epileptic who are candidates for epilepsy surgery. (author)

  6. Confidentiality and the physician-patient relationship -- ethical reflections from a surgical waiting room.

    Science.gov (United States)

    Clark, Peter A

    2002-11-01

    The physician-patient relationship is the primary focus of ethics in medicine. It is both a personal and a professional relationship that is founded on trust, confidence, dignity and mutual respect. Trust is the bridge to the physician-patient relationship, and the burden is on the physician not only to expect the patient's trust but also to build a solid foundation upon which the patient can place his or her trust. Great strides have been made by physicians in refining the physician-patient relationship especially in understanding and respecting the patients' right of self-determination regarding medical decision-making and protecting their rights of privacy and confidentiality. However, further refinements are needed on both sides regarding this relationship. Breaches of confidentiality are occurring in places like surgical waiting rooms and as a result, the physician-patient relationship is being damaged. This article identifies some legitimate concerns and offers some concrete solutions so that the physician-patient relationship can be further refined and the virtues and rights that support it can be reinforced. PMID:12444393

  7. Digital multimedia books produced using iBooks Author for pre-operative surgical patient information.

    Science.gov (United States)

    Briggs, Matthew; Wilkinson, Caroline; Golash, Aprajay

    2014-10-01

    Presenting patients with medical information and ensuring informed consent can be difficult due to patients with varying levels of literacy, physical and mental disabilities and spoken languages. Patients obtaining information from external sources, such as the internet, can also be problematic as the information can be irrelevant, inaccurate or misleading. A patient satisfaction study was performed in order to assess the effectiveness of using ebooks in order to communicate pre and post surgical information to neurosurgical patients. 3 digital books were produced using iBooks Author (a free desktop publishing program designed by Apple) including ACDF (anterior cervical discectomy and fusion), lumbar laminectomy and lumbar discectomy. Each book contained written information organised into sections and chapters along with an array of multimedia elements including 3D animations, interactive diagrams, 3D models of anatomy and patient experience videos. 32 volunteer patients were then presented with the digital books via an iPad during their preoperative assessment and then asked to complete a questionnaire. The results demonstrated a demand for this type of digital presentation of medical information and also showed patients no longer felt the need to seek further information from external sources. PMID:25390936

  8. Using the Statecharts paradigm for simulation of patient flow in surgical care.

    Science.gov (United States)

    Sobolev, Boris; Harel, David; Vasilakis, Christos; Levy, Adrian

    2008-03-01

    Computer simulation of patient flow has been used extensively to assess the impacts of changes in the management of surgical care. However, little research is available on the utility of existing modeling techniques. The purpose of this paper is to examine the capacity of Statecharts, a system of graphical specification, for constructing a discrete-event simulation model of the perioperative process. The Statecharts specification paradigm was originally developed for representing reactive systems by extending the formalism of finite-state machines through notions of hierarchy, parallelism, and event broadcasting. Hierarchy permits subordination between states so that one state may contain other states. Parallelism permits more than one state to be active at any given time. Broadcasting of events allows one state to detect changes in another state. In the context of the peri-operative process, hierarchy provides the means to describe steps within activities and to cluster related activities, parallelism provides the means to specify concurrent activities, and event broadcasting provides the means to trigger a series of actions in one activity according to transitions that occur in another activity. Combined with hierarchy and parallelism, event broadcasting offers a convenient way to describe the interaction of concurrent activities. We applied the Statecharts formalism to describe the progress of individual patients through surgical care as a series of asynchronous updates in patient records generated in reaction to events produced by parallel finite-state machines representing concurrent clinical and managerial activities. We conclude that Statecharts capture successfully the behavioral aspects of surgical care delivery by specifying permissible chronology of events, conditions, and actions. PMID:18390170

  9. Comparing patients with Apert and Crouzon syndromes--clinical features and cranio-maxillofacial surgical reconstruction.

    Science.gov (United States)

    Stavropoulos, Dimitrios; Tarnow, Peter; Mohlin, Bengt; Kahnberg, Karl-Erik; Hagberg, Catharina

    2012-01-01

    Cranio-maxillofacial malformations, as seen in Crouzon and Apert syndromes, may impose an immense distress on both function and aesthetics of the person affected. The aims of this study were to describe and compare the main facial and intraoral features of patients with Apert and Crouzon syndromes, the clinical manifestations that may be present, additionally to the main syndromic traits, as well as the cranio-maxillofacial surgical treatment protocols followed.Twenty-three patients with Apert syndrome (6 males, 17 females), and 28 patients with Crouzon syndrome (20 males, 8 females) were evaluated for general medical aspects, craniofacial characteristics, dentoalveolar traits before and after the final orthognathic surgery, and types and timing of cranio-maxillofacial operations. Mental retardation, associated additional malformations, cleft palate, and extensive lateral palatal soft tissue swellings were more common in children with Apert syndrome. In both syndromes, clinical findings included concave profile, negative overjet, posterior crossbites, anterior openbite, and dental midline deviation, which were corrected in almost all cases with the final orthognathic surgery, with the exception of the lateral crossbites, including more than one tooth pair, which were persisting in about half of the cases. Cranial vault decompression and/or reshaping, midfacial and orbital advancement procedures, often in conjunction with a mandibular setback, were the most frequent cranio-maxillofacial operations performed. In conclusion, Apert syndrome is more asymmetric in nature and a more severe clinical entity than Crouzon syndrome. The syndromic dentofacial features of both conditions could be significantly improved after a series of surgical procedures in almost all cases with the exception of the posterior crossbites, with haIf of them persisting post-surgically. PMID:22611902

  10. Surgical Results of Symmetric and Asymmetric Surgeries and Dose-Response in Patients with Infantile Esotropia

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    Nazife Sefi Yurdakul

    2015-10-01

    Full Text Available Objectives: To evaluate the results of symmetric and asymmetric surgery and responses to surgical amounts in patients with infantile esotropia. Materials and Methods: The records of patients with infantile esotropia who underwent bilateral medial rectus recession (symmetric surgery and unilateral medial rectus recession with lateral rectus resection (asymmetric surgery were analyzed. The results of the cases with symmetric (group 1 and asymmetric (group 2, successful (group 3 and failed (group 4 surgeries were compared, and responses to the amount of surgery were investigated. Results: There were no significant differences between group 1 (n=71 and group 2 (n=13 cases in terms of gender, refraction, preoperative distance deviation, anisometropia and postoperative deviation angles, binocular vision, surgical success or follow-up period (p>0.05. The rate of amblyopia, near deviation and amount of surgery were higher in group 2 cases (p0.05. The average postoperative follow-up period was 15.41±19.93 months (range, 6-98 months in group 3 cases and 40.45±40.06 months (range, 6-143 months in group 4 cases (p=0.000. No significant difference was detected in the amount of deviation corrected per 1 mm of surgical procedure between the successful cases in the symmetric and asymmetric groups (p>0.05. Conclusion: Symmetric or asymmetric surgery may be preferable in patients with infantile esotropia according to the clinical features. It is necessary for every clinic to review its own dose-response results. (Turk J Ophthalmol 2015; 45: 197-202

  11. ["Incidental" thyroid carcinoma among patients in surgical treatment for nontumors thyroid desease].

    Science.gov (United States)

    Nechaĭ, O P; Larin, O S; Cheren'ko, S M; Sheptukha, S A; Smoliar, V A; Zolotar'ov, P O

    2012-07-01

    Incidence of unexpected diagnosis of thyroid carcinoma among operations on benign thyroid surgical diseases (nodular goiter and Graves' disease) was studied in 608 patients within 2008-2009 years in specialized clinic of endocrine surgery. In 56 (9.2%) patients the "incidental" thyroid carcinoma including 43 (77%) - papillary microcarcinoma were diagnosed in histological investigations. In 10 (18%) patients which were performed within the first postoperative week. Repeated surgery demonstrates increased risk of complication (damage of parathyroid glands, recurrent laryngeal nerves and other anatomic structures of neck) considering less favoring conditions for secondary operations, it is worth to implement wider indications to frozen section, radical primary operation (total thyroidectomy at multi-nodular bilateral goiter and Graves' disease), and also maximal complete examination prior to surgery. PMID:23033769

  12. Nutritional survey of patients in a general surgical ward: is there an effective predictor of malnutrition?

    Science.gov (United States)

    Neithercut, W D; Smith, A D; McAllister, J; La Ferla, G

    1987-01-01

    A survey of patients in a general surgical ward was undertaken to establish biochemical and anthropometric standards which could be used to detect malnourished patients in hospital. Results of biochemical and anthropometric tests of nutritional status were compared with assessment by a clinician and the quick nutritional index of Seltzer. Triceps skinfold thickness and serum albumin concentrations indicated that 29% and 35% of patients, respectively, were undernourished compared with 16% by clinical assessment and 17% by the quick nutritional index. Significant correlations (p less than 0.001) between serum albumin and transferrin concentrations and arm muscle area were found for men but not for women. Poor nutritional specificity and sensitivity of some anthropometric and biochemical tests may account for the difference in the level of undernutrition found by these tests and clinical assessment. This shows the importance of the choice of test in influencing the level of undernutrition detected. PMID:3624502

  13. Anatomical Authorities: On the Epistemological Exclusion of Trans-Surgical Patients.

    Science.gov (United States)

    Plemons, Eric

    2015-01-01

    American feminist health activists in the 1970s created representations of genital anatomy intended to replace the abstracted images of biomedicine's 'modest witness,' with what Michelle Murphy has called the 'immodest witness,' authority explicitly derived from personal and embodied experience. Decades later, a feminist publication in the tradition of the immodest witness called Femalia was adopted into the practice of an American surgeon specializing in trans- genital sex reassignment surgery (GSRS). Based on ethnographic and textual research, I show how oppositional claims to represent the 'natural' female body-one valued for its medical objectivity and the other for its feminist subjectivity-effectively foreclosed these as modes of authority through which the trans- patient might contribute to her surgical care. I argue that trans- patients' double epistemological exclusion contributes to a broader asymmetry in the use of patients' subjective reports in the everyday practice of GSRS and the clinical research by which it is evaluated. PMID:25849147

  14. Electronic data collection for the analysis of surgical maneuvers on patients submitted to rhinoplasty

    Science.gov (United States)

    Berger, Cezar; Freitas, Renato; Malafaia, Osvaldo; Pinto, José Simão de Paula; Mocellin, Marcos; Macedo, Evaldo; Fagundes, Marina Serrato Coelho

    2012-01-01

    Summary Introduction: In the health field, computerization has become increasingly necessary in professional practice, since it facilitates data recovery and assists in the development of research with greater scientific rigor. Objective: the present work aimed to develop, apply, and validate specific electronic protocols for patients referred for rhinoplasty. Methods: The prospective research had 3 stages: (1) preparation of theoretical data bases; (2) creation of a master protocol using Integrated System of Electronic Protocol (SINPE©); and (3) elaboration, application, and validation of a specific protocol for the nose and sinuses regarding rhinoplasty. Results: After the preparation of the master protocol, which dealt with the entire field of otorhinolaryngology, we idealized a specific protocol containing all matters related to the patient. In particular, the aesthetic and functional nasal complaints referred for surgical treatment (i.e., rhinoplasty) were organized into 6 main hierarchical categories: anamnesis, physical examination, complementary exams, diagnosis, treatment, and outcome. This protocol utilized these categories and their sub-items: finality; access; surgical maneuvers on the nasal dorsum, tip, and base; clinical evolution after 3, 6, and 12 months; revisional surgery; and quantitative and qualitative evaluations. Conclusion: The developed electronic-specific protocol is feasible and important for information registration from patients referred to rhinoplasty. PMID:25991979

  15. Extraocular Surgical Approach for Placement of Subretinal Implants in Blind Patients: Lessons from Cochlear-Implants

    Directory of Open Access Journals (Sweden)

    Assen Koitschev

    2015-01-01

    Full Text Available In hereditary retinal diseases photoreceptors progressively degenerate, often causing blindness without therapy being available. Newly developed subretinal implants can substitute functions of photoreceptors. Retina implant extraocular surgical technique relies strongly on cochlear-implant know-how. However, a completely new surgical approach providing safe handling of the photosensor array had to be developed. The Retina Implant Alpha IMS consisting of a subretinal microphotodiode array and cable linked to a cochlear-implant-like ceramic housing was introduced via a retroauricular incision through a subperiosteal tunnel above the zygoma into the orbit using a specially designed trocar. Implant housing was fixed in a bony bed within a tight subperiosteal pocket in all patients. Primary outcomes were patient short term safety as well as effectiveness. Nine patients participated in the first part of the multicenter trial and received the subretinal visual implant in one eye. In all cases microphotodiode array pull-through procedure and stable positioning were possible without affecting the device function. No intraoperative complications were encountered. The minimally invasive suprazygomatic tunneling technique for the sensor unit as well as a subperiosteal pocket fixation of the implant housing provides a safe extraocular implantation approach of a subretinal device with a transcutaneous extracorporeal power supply.

  16. Extraocular Surgical Approach for Placement of Subretinal Implants in Blind Patients: Lessons from Cochlear-Implants.

    Science.gov (United States)

    Koitschev, Assen; Stingl, Katarina; Bartz-Schmidt, Karl Ulrich; Braun, Angelika; Gekeler, Florian; Greppmaier, Udo; Sachs, Helmut; Peters, Tobias; Wilhelm, Barbara; Zrenner, Eberhart; Besch, Dorothea

    2015-01-01

    In hereditary retinal diseases photoreceptors progressively degenerate, often causing blindness without therapy being available. Newly developed subretinal implants can substitute functions of photoreceptors. Retina implant extraocular surgical technique relies strongly on cochlear-implant know-how. However, a completely new surgical approach providing safe handling of the photosensor array had to be developed. The Retina Implant Alpha IMS consisting of a subretinal microphotodiode array and cable linked to a cochlear-implant-like ceramic housing was introduced via a retroauricular incision through a subperiosteal tunnel above the zygoma into the orbit using a specially designed trocar. Implant housing was fixed in a bony bed within a tight subperiosteal pocket in all patients. Primary outcomes were patient short term safety as well as effectiveness. Nine patients participated in the first part of the multicenter trial and received the subretinal visual implant in one eye. In all cases microphotodiode array pull-through procedure and stable positioning were possible without affecting the device function. No intraoperative complications were encountered. The minimally invasive suprazygomatic tunneling technique for the sensor unit as well as a subperiosteal pocket fixation of the implant housing provides a safe extraocular implantation approach of a subretinal device with a transcutaneous extracorporeal power supply. PMID:26783453

  17. Extraocular Surgical Approach for Placement of Subretinal Implants in Blind Patients: Lessons from Cochlear-Implants

    Science.gov (United States)

    Koitschev, Assen; Stingl, Katarina; Bartz-Schmidt, Karl Ulrich; Braun, Angelika; Gekeler, Florian; Greppmaier, Udo; Sachs, Helmut; Peters, Tobias; Wilhelm, Barbara; Zrenner, Eberhart; Besch, Dorothea

    2015-01-01

    In hereditary retinal diseases photoreceptors progressively degenerate, often causing blindness without therapy being available. Newly developed subretinal implants can substitute functions of photoreceptors. Retina implant extraocular surgical technique relies strongly on cochlear-implant know-how. However, a completely new surgical approach providing safe handling of the photosensor array had to be developed. The Retina Implant Alpha IMS consisting of a subretinal microphotodiode array and cable linked to a cochlear-implant-like ceramic housing was introduced via a retroauricular incision through a subperiosteal tunnel above the zygoma into the orbit using a specially designed trocar. Implant housing was fixed in a bony bed within a tight subperiosteal pocket in all patients. Primary outcomes were patient short term safety as well as effectiveness. Nine patients participated in the first part of the multicenter trial and received the subretinal visual implant in one eye. In all cases microphotodiode array pull-through procedure and stable positioning were possible without affecting the device function. No intraoperative complications were encountered. The minimally invasive suprazygomatic tunneling technique for the sensor unit as well as a subperiosteal pocket fixation of the implant housing provides a safe extraocular implantation approach of a subretinal device with a transcutaneous extracorporeal power supply. PMID:26783453

  18. Perioperative ω-3 Polyunsaturated Fatty Acid Nutritional Support in Gastrointestinal Cancer Surgical Patients: A Systematic Evaluation.

    Science.gov (United States)

    Ma, Ying-Jie; Liu, Lian; Xiao, Jing; Cao, Bang-Wei

    2016-01-01

    This study was a systematic evaluation of the beneficial effects of n-3 polyunsaturated fatty acid (PUFA) in abdominal cancer surgical patients. A literature search of the databases PubMed, Medline, Cochrane, and EMBASE was conducted for studies published up to November 2014 in English language journals. Randomized controlled trials (RCTs) examining the effects of n-3 PUFA intake relative to conventional nutrition in surgical patients were included. The main outcomes were the duration of systemic inflammatory response syndrome (SIRS), length of hospital stay (LOS), serum C-reactive protein (CRP) levels, and postoperative complications. We identified 15 RCTs among 158 relevant trials. The results indicated the associations between n-3 PUFA intake and reduced LOS [mean differences (MDs), -2.47 d; 95% confidence intervals (CIs), -3.25 to -1.69], duration of SIRS (MD, -0.57 d; 95% CI, -0.92 to -0.22), and serum CRP levels (MD, -3.97 mg/l; 95% CI, -7.88 to -0.07) compared with consumption of conventional nutrition, as well as reduced incidence of postoperative infectious complications (risk ratio, 0.66; 95% CI, 0.49-0.87). This systematic evaluation suggests that n-3 PUFA significantly reduces the postoperative infectious complication rate, and shortens hospitalization and SIRS duration, particularly in malnourished gastrointestinal cancer patients. PMID:27115734

  19. Evaluation of spinopelvic balance among patients undergoing surgical treatment for lumbar disk hernia

    Directory of Open Access Journals (Sweden)

    Rafael de Paiva Oliveira

    2014-04-01

    Full Text Available OBJECTIVE: to evaluate spinopelvic balance using the pelvic incidence, sacral slope and pelvic tilt among patients with lumbar disk hernias who underwent surgical treatment.METHODS: thirty patients at the spinal services of Hospital Santa Casa de Misericórdia de Vitória and Hospital Vila Velha were evaluated by measuring their spinopelvic balance from the angles of pelvic tilt, sacral slope and pelvic incidence, with their respective means, on simple lateral-view lumbopelvic radiographs that needed to encompass the lumbar spine, sacrum and proximal third of the femur.RESULTS: the spinopelvic balance measurements obtained from the mean angles of the population studied, for pelvic incidence, sacral slope and pelvic tilt, were 45◦ , 36.9◦ and 8.1◦ , respectively. The confidence interval for the mean pelvic incidence was from 41.9 to 48.1 (95% CI, thus including a reference value that characterized it as low, for an asymptomatic population, thus confirming that the sample was extracted from a population with this characteristic.CONCLUSION: among these patients with lumbar disk hernias who underwent surgical treatment, the average spinopelvic balance was found to have pelvic incidence lower than what has been reported in the literature for an asymptomatic population.

  20. Post-surgical treatment and rehabilitation of the thyroid cancer patients

    International Nuclear Information System (INIS)

    There are 1232 patients opened on for thyroid cancer (TCP) had been examined after surgical treatment in compare with 55 persons without thyroid gland disorder. Desadaptation of TCP just after surgery had been dell with parathyroid insufficiency, disturbances of VII, IX-XII nervure. Increasing of arterial hypotension, chronic gastritis, myome in women, depressive reaction with decreasing of quality of life had been marked in thyroid cancer patients after 4,5±0,2 of treatment stating. In TCP more frequently suffered from neoplastic diseases of localization. Average parameters' level of pulmonary volume, immunology status, antioxidative activity was lover in TCP then it was in control group. Recurrence of thyroid cancer was deal with type of surgical treatment, TSH- suppression and compliments of TCP. It was revealed that thyroxin suppressive dose is deal from body mass index, higher in men then in women and in patients' group after radiotherapy. Disability of TCP related with postoperative complication and cardio-respiratory system status. These come to decreasing in work participation, mobility and communication. System of rehabilitation of TCP had been provided

  1. Effects of general anaesthesia on endocrine system of body in paediatric patients during surgical intervention

    International Nuclear Information System (INIS)

    A total of 50 children (mean age 7, range 2-12 years), undergoing minor to major surgical operations were evaluated for hormonal changes induced by anaesthesia 15 hormones i.e. GH, ACTH, OH, FISH, TSH, PTH, FT4, T3, prolactin, insulin estradiol, testosterone, aldosterone, progesterone, and cortisol were studies results obtained showed significant increase in the levels of GH, cortisol, aldosterone, prolactin, progesterone, and PTH at the time of induction of anaesthesia. Of these GH, prolactin and aldosterone levels showed further increase during surgery (maintenance of anaesthesia). Values of TSH, LH, FSH, FT4 and testosterone levels remained essentially unaffected at induction of anaesthesia, but showed significant rise during surgery (maintenance of anaesthesia). Serum levels of ACTH, insulin, estradiol, and T3 were basically unaffected by anaesthesia and surgery. Furthermore, increase in cortisol and PTH levels was more prominent in patients anaesthetized with halothane alone. In this group ACTH level recorded a decrease while in thiopentone, halothane+nitrous oxide anaesthesia group ACTH showed a significantly rise. Growth hormone and insulin response was significantly more prominent in patients undergoing major surgery as compared to others. These findings under score the importance of stress response resulting from general anaesthesia and surgical trauma in children, and brings into focus the need of careful pre and post operative monitoring of patients in this age group. (author)

  2. Electronic data collection for the analysis of surgical maneuvers on patients submitted to rhinoplasty

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    Berger, Cezar

    2012-01-01

    Full Text Available Introduction: In the health field, computerization has become increasingly necessary in professional practice, since it facilitates data recovery and assists in the development of research with greater scientific rigor. Objective: the present work aimed to develop, apply, and validate specific electronic protocols for patients referred for rhinoplasty. Methods: The prospective research had 3 stages: (1 preparation of theoretical data bases; (2 creation of a master protocol using Integrated System of Electronic Protocol (SINPE©; and (3 elaboration, application, and validation of a specific protocol for the nose and sinuses regarding rhinoplasty. Results: After the preparation of the master protocol, which dealt with the entire field of otorhinolaryngology, we idealized a specific protocol containing all matters related to the patient. In particular, the aesthetic and functional nasal complaints referred for surgical treatment (i.e., rhinoplasty were organized into 6 main hierarchical categories: anamnesis, physical examination, complementary exams, diagnosis, treatment, and outcome. This protocol utilized these categories and their sub-items: finality; access; surgical maneuvers on the nasal dorsum, tip, and base; clinical evolution after 3, 6, and 12 months; revisional surgery; and quantitative and qualitative evaluations. Conclusion: The developed electronic-specific protocol is feasible and important for information registration from patients referred to rhinoplasty.

  3. Influence of perioperative administration of amino acids on thermoregulation response in patients underwent colorectal surgical procedures

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    Zeba Snježana

    2007-01-01

    Full Text Available Background. Hypothermia in the surgical patients can be the consequence of long duration of surgical intervention, general anesthesia and low temperature in operating room. Postoperative hypothermia contributes to a number of postoperative complications such as arrhythmia, myocardial ischemia, hypertension, bleeding, wound infection, coagulopathy, prolonged effect of muscle relaxants. External heating procedures are used to prevent this condition, but some investigations reported that infusion of aminoacids during surgery can induce thermogenesis and prevent postoperative hypothermia. Case report. We reported two males who underwent major colorectal surgery for rectal carcinoma. One patient received Aminosol 15% solution, 125 ml/h, while the other did not. The esophageal temperatures in both cases were measured every 30 minutes during the operation and 60 minutes after in Intensive Care Unit. We were monitoring blood pressure, heart rate, ECG, and shivering. Patient who received aminoacids showed ameliorated postoperative hypothermia without hypertension, arrhythmia, or shivering, while the other showed all symptoms mentioned above. Conclusion. According to literature data, as well as our findings, we can conclude that intraoperative intravenous treatment with amino acid solution ameliorates postoperative hypothermia along with its complications. .

  4. Patient attitudes toward the use of surgical scrubs in a military hospital clinic

    OpenAIRE

    Lund, Jon

    2008-01-01

    Jon D Lund1,2, James E Rohrer3,4, Susana Goldfarb11Department of Ob/Gyn, Naval Medical Center, San Diego, CA, USA; 2Department of Ob/Gyn, 3Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Amarillo, TX, USA; 4Department of Family Medicine, Mayo Clinic, Rochester, MN, USAObjective: To determine whether obstetrics and gynecology (ob/gyn) patients in a large military teaching hospital have a negative attitude toward the wearing of surgical scrubs by ob/gy...

  5. A review of surgical strategies for penile prosthesis implantation in patients with Peyronie’s disease

    Science.gov (United States)

    Anaissie, James

    2016-01-01

    The introduction of the inflatable penile prosthesis (IPP) has revolutionized the treatment of patients with both Peyronie’s disease (PD) and erectile dysfunction (ED). A thorough literature review was performed in order to review the surgical strategies used to treat PD, using the PubMed online database with the keywords “penile prosthesis”, “surgical management” and “Peyronie’s disease”. Patient satisfaction rates of 72–100% and partner satisfaction rates of 89% have been reported in the literature, although strong preoperative education may be needed to prepare patients for risks such as penile shortening, seen in up to 54% of patients. Three-piece IPPs are most commonly used, and when comparing the two most popular models (AMS 700 CX vs. Coloplast Titan), no significant differences were seen in functional outcomes or patient satisfaction. Simple insertion of an IPP has been shown to resolve curvature in 33–90% of patients, but surgeons may often need to also utilize ancillary straightening procedures for residual curvatures. Manual modeling can correct residual curvature with an 86–100% success rate, but with a 4% risk of urethral injury. When the post-modeling residual curvature exceeds 30 degrees, a plaque-releasing incision or plication is recommended to further reduce curvature. Grafting is recommended if the resulting incisional defect is larger than two centimeters. Alternative straightening techniques such as plication prior to IPP insertion, endoscopic plaque resection, the “scratch technique” and bone saw plaque incision have also been described. PMID:27298781

  6. Intensive medical student involvement in short-term surgical trips provides safe and effective patient care: a case review

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    Macleod Jana B

    2011-09-01

    Full Text Available Abstract Background The hierarchical nature of medical education has been thought necessary for the safe care of patients. In this setting, medical students in particular have limited opportunities for experiential learning. We report on a student-faculty collaboration that has successfully operated an annual, short-term surgical intervention in Haiti for the last three years. Medical students were responsible for logistics and were overseen by faculty members for patient care. Substantial planning with local partners ensured that trip activities supplemented existing surgical services. A case review was performed hypothesizing that such trips could provide effective surgical care while also providing a suitable educational experience. Findings Over three week-long trips, 64 cases were performed without any reported complications, and no immediate perioperative morbidity or mortality. A plurality of cases were complex urological procedures that required surgical skills that were locally unavailable (43%. Surgical productivity was twice that of comparable peer institutions in the region. Student roles in patient care were greatly expanded in comparison to those at U.S. academic medical centers and appropriate supervision was maintained. Discussion This demonstration project suggests that a properly designed surgical trip model can effectively balance the surgical needs of the community with an opportunity to expose young trainees to a clinical and cross-cultural experience rarely provided at this early stage of medical education. Few formalized programs currently exist although the experience above suggests the rewarding potential for broad-based adoption.

  7. A Seven-year Experience for The Surgical Radiofrequency Ablation in Patients With Atrial Fibrillation

    Institute of Scientific and Technical Information of China (English)

    Bin XIE; Hui-ming GUO; Ruo-bin WU; Cong LU

    2009-01-01

    Objective A 7-year experience for the treatment strategy using mono- and bi-polar radiofrequency (RF) ablation procedures in a heterogeneous group of patients was reported. Methods Between July 2003 and May 2009, the data of 314 consecutive patients aged 13 -75 (48. 70 + 11.09)undergone the radiofrequency ablation procedure for atrial fibrillation (AF) associated with concomitant cardiac surgery were analyzed. Monopolar was used for 91 patients; Medtronic bi-polar RF ablation procedure for 92 patients and Atricure RF ablation procedure for 131 patients. All patients were combined with valve surgery. Regular follow-ups were performed at 3, 6 month after surgery. Results Hospital mortality after combined open heart and surgical RF ablation was 0 %. The success rates for sinus rhythm con-version with monopolar RF were 73.6 % immediately, 74. 7 % at 3 months, 79. 1% at 6 months; with Medtronic bi-polar RF, the rates were 78.3 % immediately, 82. 8 % at 3 months, 84 % at 6 months; with Atricure bi-polar RF, the rates were 82. 4 % immediately, 84. 1% at 3 months, 83.9 % at 6 months. Conclusions The use of RF ablation pro-cedures is a safe and efficient option to cure AF during open heart surgery in a selective group of patients.

  8. Surgical outcome after decompressive craniectomy in patients with extensive cerebral infarction

    International Nuclear Information System (INIS)

    Extensive cerebral hemispheric infarction is a devastating condition leading to early death in nearly 80% of cases due to the rapid rise of intracranial pressure in spite of maximum medical treatment for brain edema and swelling. Recently, decompressive craniectomy has been reevaluated to prevent the brain herniation caused by extensive hemispheric cerebral infarction. We studied the surgical results after decompressive craniectomy for extensive cerebral infarction. Between December 1997 and August 2006, 13 consecutive patients (7 males and 6 females aged from 39 to 73 with a mean age of 59 years) with massive cerebral infarction of internal carotid (IC) (11 patients) and middle cerebral artery (MCA) (2 patients) territory were treated with decompressive craniectomy and dural plasty. Five patients had a left-sided stroke with severe aphasia. The cardioembolic source of stroke was seen in 5 patients. Surgery was performed at the point of neurological deterioration, anisocoria, and effacement of perimesencephalic cistern on CT findings. The mean time between stroke onset and surgery was 39.8 hr and ranged from 13 to 102 hr. Glasgow outcome scale (GOS) on discharge was moderately disabled (MD) 1, severe disabled (SD) 5, vegetative state (VS) 1, and dead (D) 3 (mortality rate 30.8%). Severe pneumoniae were the causes of death. All survivors underwent cranioplasty and were transferred with the aim of rehabilitation. In this study, we showed that the decompressive craniectomy reduced mortality after extensive cerebral infarction. However, the functional outcome and level of independence are poor. It seems that the early decompressive craniectomy should be aggressively performed for extensive cerebral infarction before neurological deterioration such as worsening of consciousness disturbance or pupil abnormalities. Further investigations will be needed to clarify the surgical indications, timing, and functional outcomes. (author)

  9. Surgical Clipping versus Endovascular Intervention for the Treatment of Subarachnoid Hemorrhage Patients in New York State.

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    Kimon Bekelis

    Full Text Available Randomized trials have demonstrated a survival benefit for endovascular treatment of ruptured cerebral aneurysms. We investigated the association of surgical clipping and endovascular coiling with outcomes in subarachnoid hemorrhage (SAH patients in a real-world regional cohort.We performed a cohort study involving patients with ruptured cerebral aneurysms, who underwent surgical clipping, or endovascular coiling from 2009-2013 and were registered in the Statewide Planning and Research Cooperative System (SPARCS database. An instrumental variable analysis was used to investigate the association of treatment technique with outcomes.Of the 4,098 patients undergoing treatment, 2,585 (63.1% underwent coiling, and 1,513 (36.9% underwent clipping. Using an instrumental variable analysis, we did not identify a difference in inpatient mortality [marginal effect (ME, -0.56; 95% CI, -1.03 to 0.02], length of stay (LOS (ME, 1.72; 95% CI, -3.39 to 6.84, or the rate of 30-day readmissions (ME, -0.30; 95% CI, -0.82 to 0.22 between the two treatment techniques for patients with SAH. Clipping was associated with a higher rate of discharge to rehabilitation (ME, 0.63; 95% CI, 0.24 to 1.01. In sensitivity analysis, mixed effect regression, and propensity score adjusted regression models demonstrated identical results.Using a comprehensive all-payer cohort of patients in New York State presenting with aneurysmal SAH we did not identify an association of treatment method with mortality, LOS or 30-day readmission. Clipping was associated with a higher rate of discharge to rehabilitation.

  10. AN ANALYSIS OF CLINICOPATHOLOGICAL AND SURGICAL OUTCOME IN SALIVARY GLAND TUMORS OF 178 PATIENTS OF TELANGANA

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    Boda

    2015-10-01

    Full Text Available INTRODUCTION: The incidence of tumors of Salivary glands is not uncommon in the surgical practice in Telangana state. In the present study 178 patients with a clinical diagnosis of salivary gland tumors between 2006 and 2014 at Warangal, Telangan a were analyzed both retrospectively (2006 - 2010 and prospectively (2011 - 2014. Demographic data like age, sex and clinical features like tumor location, FNAC reports, CT scan findings, nature of growth and predisposing factors were recorded. All the patie nts with benign tumors were managed by surgical excision and malignant lesions with surgery in combination with Radiotherapy. Cervical lymph node metastases were managed by RT and neck dissection. AIM : This study aims at analyzing the clinical, pathological, Surgical and RT outcome of Salivary gland Tumors in patients attending a large tertiary Hospital at Warangal, rendering services to four districts of Telangana. STUDY DESIGN: 178 patients diagnosed as SGTs retrospectively and prospectively and undergoing surgical treatment were analyzed with respect to their clinical, cytological and surgical outcome. RESULTS: There were 143 patients with benign tumors and 35 patients with malignant tumors. The mean age was 41.3±2.6 years for benign tumors and 65.4±1.8 for the malignant tumors. Parotid gland was commonly involved 75(42.13% followed minor sal ivary glands of Hard palate 29 (16.29% and Submandibular gland 23(12.92%. Remaining 51(28.65% patients presen ted with tumors involving cheek, lips and floor of the mouth. Among the benign tumors Pleomorphic adenoma accounted for 94(52.80% and warthin’s tumor for 23(12.92%. Among malignant tumors Mucoepidermoid carcinomas were 12(6.74%, adenocarcinomas 9(5.05% , adenoid cystic carcinomas 6(3.37% and Acinic cell carcinomas 5(2.80%, EMC 2(1.12% and Myoepiothelial carcinoma 1(0.56%. CT scan, MRI studies were helpful in deciding the route of approach and risk of involvement of deeper vascular structures

  11. Risk adjustment is crucial in comparing outcomes of various surgical modalities in patients with ileal perforation

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    Arya Satyavrat

    2008-11-01

    Full Text Available Abstract Background Using crude mortality and morbidity rates for comparing outcomes can be misleading. The aim of the present study was to compare the outcome of various surgical modalities without and with risk adjustment using Physiologic and Operative Severity Scoring for the enUmeration of Mortality and morbidity (POSSUM score in cases of ileal perforations. Methods Prospective study on 125 patients of ileal perforations. Resection anastamosis (Group I was done in 38 patients, primary repair (Group II in 42 patients and 45 patients had an ileostomy (Group III. The disease severity was assessed in all patients using POSSUM score. The odds of death without and with risk adjustment using POSSUM mortality score were calculated for all groups Results Seventeen patients (14% patients died and 99 (79% developed postoperative complications. Using crude mortality rates Group I appeared to be the best treatment option with only 2 (5% deaths followed by Group II with 5 (12% deaths where as Group III had the worst outcome with 10 deaths (22%. However, Group III (ileostomy patients had higher mean POSSUM mortality and morbidity score (55.55%, 91.33% than Group I (28%, 75.26% and Group II (27%, 73.59%. Taking Group I as the reference (odds ratio, OR1 odds of death were greatest in Group III (OR 5.14, p = 0.043 followed by Group II (OR 2.43, p = 0.306. With risk adjustment using POSSUM mortality score the odds of death decreased in Group III (OR 1.16 p = 0.875. For the whole group, there was a significant association between the POSSUM score and postoperative complications and deaths. Mean POSSUM mortality and morbidity score of those who died (63.40 vs.33.68, p = 0.001 and developed complications (66.32 vs.84.20, p = 0.001 was significantly higher. For every percent increase in severity score the risk of postoperative complications and death increased by 1.10 (p = 0.001 and1.06 (p = 0.001 respectively. Conclusion Despite ileostomy patients having highest

  12. Predictive / Reactive Planning and Scheduling of a Surgical Suite with Emergency Patient Arrival.

    Science.gov (United States)

    Heydari, Mehdi; Soudi, Asie

    2016-01-01

    This paper surveys the problem of predictive / reactive scheduling of an integrated operating theatre with two types of demand for surgery: 1) elective or known demand; 2) emergency or uncertain demand. The stochastic arrival of emergency patients with uncertain surgery time enforces the scheduler to react to disruption and modify scheduling plan of elective patients. We focus on this predictive / reactive scheduling problem which has not been investigated in such way before. As in hospitals, at the time of occurrence a disruption in a surgical suite, the scheduler has not enough time to make the best decision; we propose a new approach based on two-stage stochastic programming model with recourse which determines the best recourse strategy in advance of any disruption occurrence. Using the proposed approach, the primary schedule is generated in such a way that it can absorb disruption with minimum effect on planned elective surgeries. For the first time in operating theatre planning, two new significant sets of performance measures comprising "robustness" and "stability" measures are considered in generation of primary schedule which will be shown to be of great importance in efficiency of surgical suite planning. Computational experiments performed on sets of generated problem based on the data obtained from a non-profit hospital. In order to demonstrate efficiency of the proposed method, computational results of the proposed approach are compared with classic approach. PMID:26547850

  13. The status of oral hygiene in cleft lip, palate patients after surgical correction

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    Pandey S

    2005-01-01

    Full Text Available The cleft lip and palate patients usually present a number of problems viz. altered oral anatomy leading to changes in oral physiology diminishing the self-cleansing ability of individual. The handicapped children are unable to maintain their oral hygiene properly. The present study was formulated with the aim that does normalization of oral anatomy have its effect on improvement of oral hygiene? An assessment of oral hygiene index-simplified was performed between preoperative and postoperative values in the same patient at KGMU and KGDU. A total of 50 cases were recorded in two groups of 25 each: (i < 6 years old and (ii > 6 years. The observations are statistically analyzed by paired ′t′ test to get the significance of results. Results: The data analyzed showed the significant decrease in oral hygiene indices observed in both groups. A relative significance in oral hygiene status following surgery was observed. Both groups expressed greater significance when compared pre and postoperatively which is indicative of considerable improvement of oral hygiene after surgical correction. The study concludes that oral hygiene improves more in older cleft lip-palate cases following reconstruction of palatal vault, premaxilla and anterior lip seal by secondary bone grafting method when compared with oral hygiene indices results in primary periosteoplasty cases. The surgical correction of cleft lip palate enhances self-cleaning ability and better compliance to maintain oral hygiene in children as the age advances.

  14. Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?

    International Nuclear Information System (INIS)

    Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia in outpatients. It is more common in females, after menopause, and the prevalence is 1 to 4:1000 in the general population. Patients with PHPT have abnormal regulation of PTH secretion, resulting in elevated serum calcium and inappropriately high or normal PTH in relation to the calcium value. Sporadic PTH-secreting adenoma alone accounts for 90% of cases of PHPT, while multiglandular hyperplasia is more common in familial hyperparathyroidism syndromes (5%) and parathyroid carcinomas represent less than 1% of cases. Only after making sure there is functional autonomy of one or more parathyroid glands, localization imaging tests should be performed to guide a possible surgical procedure. It is important to highlight that these tests have limitations and can yield false-positive and false-negative results. There are cases in which the parathyroid gland is difficult to be located, requiring a combination of imaging methods for pre-operative localization, such as 99mTc-pertechnetate, SPECT, SPECT/CT, and US. We describe the case of a 50-year-old female patient diagnosed with PHPT, who underwent a surgical procedure without success, with maintenance of hypercalcaemia and hyperparathyroidism. In this case, the hyper functioning parathyroid was located in the retrotracheal region only after scintigraphy combined with SPECT/CT were used. (author)

  15. [Hepatic hydatidosis. Review of a series of 677 surgically treated patients].

    Science.gov (United States)

    Hernando, E; García Calleja, J L; Córdoba, E; Lahuerta, L; del Río, F; Ferreira, V

    1996-03-01

    A retrospective study of 677 patients who underwent surgery for hepatic hidatidosis in the Department of Surgery A and B of the Hospital Miguel Servet in Zaragoza, Spain, over the last 21 years is presented. The frequency was analyzed in regards to sex, age, symptomatology, cyst data, surgical techniques performed and postoperative morbidity. The mean age of the patients was 39 years with the incidence being practically equal in both sexes. Dyspeptic symptoms (60%), hepatomegaly and/or palpable mass in the right hypochondria (58%) and pain (46%) were the most frequent clinical signs and symptoms observed. Radical surgery was performed in 21% of all the surgical treatments, while conservative surgery was undergone in 79%. Solitary cysts were most frequent (65.7%) with localization in the right hepatic lobe (65.4%). The most frequent postoperative complication was biliary fistula (72 cases). The rate of reintervention was 18% and operative mortality 1.6% with a mean hospitalization period of 25 days. PMID:8991656

  16. Nutrition for the pediatric surgical patient: approach in the peri-operative period

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    Falcão Mário Cícero

    2002-01-01

    Full Text Available Nutrition is essential for maintenance of physiologic homeostasis and growth. Hypermetabolic states lead to a depletion of body stores, with decreased immunocompetence and increased morbidity and mortality. The purpose of this paper is to provide an update regarding the provision of appropriate nutrition for the pediatric surgical patient, emphasizing the preoperative and postoperative periods. Modern nutritional support for the surgical patient comprises numerous stages, including assessment of nutritional status, nutritional requirements, and nutritional therapy. Nutritional assessment is performed utilizing the clinical history, clinical examination, anthropometry, and biochemical evaluation. Anthropometric parameters include body weight, height, arm and head circumference, and skinfold thickness measurements. The biochemical evaluation is conducted using determinations of plasma levels of proteins, including album, pre-albumin, transferrin, and retinol-binding protein. These parameters are subject to error and are influenced by the rapid changes in body composition in the peri-operative period. Nutritional therapy includes enteral and/or parenteral nutrition. Enteral feeding is the first choice for nutritional therapy. If enteral feeding is not indicated, parenteral nutrition must be utilized. In all cases, an individualized, adequate diet (enteral formula or parenteral solution is obligatory to decrease the occurrence of overfeeding and its undesirable consequences.

  17. Can SPECT change the surgical strategy in patients with primary hyperparathyroidism?

    Energy Technology Data Exchange (ETDEWEB)

    Iervolino, Leticia; Scalisse, Nilza Maria; Maeda, Sergio Setsuo, E-mail: leiervolino@hotmail.com [Discipline of Endocrinology, Department of Medicine, Faculdade de Medicina da Santa Casa de Sao Paulo (FMSCSP), Sao Paulo, SP (Brazil)

    2012-06-15

    Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcaemia in outpatients. It is more common in females, after menopause, and the prevalence is 1 to 4:1000 in the general population. Patients with PHPT have abnormal regulation of PTH secretion, resulting in elevated serum calcium and inappropriately high or normal PTH in relation to the calcium value. Sporadic PTH-secreting adenoma alone accounts for 90% of cases of PHPT, while multiglandular hyperplasia is more common in familial hyperparathyroidism syndromes (5%) and parathyroid carcinomas represent less than 1% of cases. Only after making sure there is functional autonomy of one or more parathyroid glands, localization imaging tests should be performed to guide a possible surgical procedure. It is important to highlight that these tests have limitations and can yield false-positive and false-negative results. There are cases in which the parathyroid gland is difficult to be located, requiring a combination of imaging methods for pre-operative localization, such as {sup 99m}Tc-pertechnetate, SPECT, SPECT/CT, and US. We describe the case of a 50-year-old female patient diagnosed with PHPT, who underwent a surgical procedure without success, with maintenance of hypercalcaemia and hyperparathyroidism. In this case, the hyper functioning parathyroid was located in the retrotracheal region only after scintigraphy combined with SPECT/CT were used. (author)

  18. Cardio-thoracic surgical patients' experience on bedside nursing handovers: Findings from a qualitative study.

    Science.gov (United States)

    Lupieri, Giulia; Creatti, Chiara; Palese, Alvisa

    2016-08-01

    The purpose of this study was to describe the experiences of postoperative cardio-thoracic surgical patients experiencing nursing bedside handover. A descriptive qualitative approach was undertaken. A purposeful sampling technique was adopted, including 14 patients who went through cardio-thoracic surgery and witnessed at least two bedside handovers. The study was performed in a Cardio-thoracic ICU localised in a Joint Commission International accredited Academic Hospital in north-eastern Italy from August to November 2014. The experience of patients participating at the bedside handover is based on four main themes: (1) 'discovering a new nursing identity', (2) 'being apparently engaged in a bedside handover', (3) 'experiencing the paradox of confidentiality' and (4) 'having the situation under control'. With the handover performed at the bedside in a postoperative setting, two interconnected potential effects may be achieved with regard to patients, nurses and the nursing profession. Nurses have a great opportunity to express their closeness to patients and to promote awareness of the important growth that nursing has achieved over the years as a profession and discipline. Therefore, patients may better perceive nursing competence and feel safer during the postoperative care pathway. They can appreciate nurses' humanity in caring and trust their competence and professionalism. PMID:27080568

  19. Elevated postoperative serum procalcitonin is not indicative of bacterial infection in cardiac surgical patients

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    Murali Chakravarthy

    2015-01-01

    Full Text Available Background: Identifying infections early, commencing appropriate empiric antibiotic not only helps gain control early, but also reduces mortality and morbidity. Conventional cultures take about 5 days to identify infections. To identify the infections early biomarker like serum procalcitonin (SPC. Aims: We studied the correlation of an elevated level of SPC and positive culture in elective adult patients undergoing cardiac surgery. Methods: This prospective study was conducted from January to December 2013. SPC was checked in patients showing evidence of sepsis. Simultaneously, relevant culture was also undertaken. Correlation, specificity, and sensitivity of elevated SPC were checked. Results: A total of 819 adult patients were included in the study. 43 of them had signs of infection and SPC levels were checked. Based on the level of SPC criteria, 10 patients were diagnosed as "nil", out of them, 4 had culture-positive infections, 17 were suggested to have "mild infection," 3 out those had culture positivity. None among the eleven patients suggested to have "moderate infection," had a positive culture, and one among the five suggested to have a severe infection had a positive culture. The sensitivity was 50% and the specificity 17%. The positive predictive value was 12% and the negative predictive value 60%. Conclusions: We failed to elicit positive correlation between elevated SPC levels and postoperative infection in cardio surgical patients.

  20. Pyramidal Lobe of the Thyroid Gland: Surgical Anatomy in Patients Undergoing Total Thyroidectomy

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    Emin Gurleyik

    2015-01-01

    Full Text Available Background. Anatomic variations, the presence of the pyramidal lobe (PL, may impact completeness of thyroidectomy and effect of surgical treatment. Method. This study included 166 patients who underwent total thyroidectomy. The anterior cervical region between the thyroid isthmus and the hyoid bone was dissected during thyroid surgery. The incidence, size, and anatomical features of the PL were established in these patients. Results. The incidence of PL was 65.7%. No gender difference was found for PL incidence. The base of the PL was located at the isthmus in 52.3%, the left lobe in 29.4%, and the right lobe in 18.3% of patients. The mean length of the PL was 22.7 (range, 5–59 mm. The PL was longer than 30 mm in 23% of patients. One-third of the patients with short PL were men whereas women accounted for 80% of patients with long PL. Conclusions. The high incidence indicates that the PL is a common part of the thyroid. The PL generally originates from the isthmus near midline and is of variable length, extending from the isthmus up to the hyoid bone. Considering that the PL is a common structure, the prelaryngeal region should be dissected to achieve the completeness of thyroidectomy.