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Sample records for cardiac surgical patients

  1. 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...

  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. 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...

  4. 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.

  5. 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...

  6. 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.

  7. Comparison of two ventilation modes in post-cardiac surgical patients

    Directory of Open Access Journals (Sweden)

    Aloka Samantaray

    2011-01-01

    Full Text Available 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 patients with a PaO 2 /FiO 2 (arterial oxygen tension/Fractional inspired oxygen < 300 after arrival to intensive care unit (ICU, (n = 34 were randomized to receive either PRVC or PCV. Air way pressure (Paw and arterial blood gases (ABG were measured at four time points [T1: After induction of anesthesia, T2: after CPB (in the ICU, T3: 1 h after intervention mode, T4: 1 h after T3]. Oxygenation index (OI = [PaO 2 / {FiO 2 × mean airway pressure (Pmean }] was calculated for each set of data and used as an indirect estimation for intrapulmonary shunt. Results: There is a steady and significant improvement in OI in both the groups at first hour [PCV, 27.5(3.6 to 43.0(7.5; PRVC, 26.7(2.8 to 47.6(8.2 (P = 0.001] and second hour [PCV, 53.8(6.4; PRVC, 65.8(7.4 (P = 0.001] of ventilation. However, the improvement in OI was more marked in PRVC at second hour of ventilation owing to significant low mean air way pressure compared to the PCV group [PCV, 8.6(0.8; PRVC, 7.7(0.5, P = 0.001]. Conclusions: PRVC may be useful in a certain group of patients to reduce intrapulmonary shunt and improve oxygenation after cardiopulmonary bypass-induced perfusion mismatch.

  8. 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...

  9. Ten Years Experiences With Preoperative Evaluation Clinic for Day Admission Cardiac and Major Vascular Surgical Patients: Model for "Perioperative Anesthesia and Surgical Home".

    Science.gov (United States)

    Silvay, George; Zafirova, Zdravka

    2016-06-01

    Admission on the day of surgery for elective cardiac and noncardiac surgery is the prevalent practice in North America and Canada. This approach realizes medical, psychological and logistical benefits, and its success is predicated on an effective outpatient preoperative evaluation. The establishment of a highly functional preoperative clinic with a comprehensive set up and efficient logistical pathways is invaluable. This notion in recent years has included the entire perioperative period, and the concept of a perioperative anesthesia/surgical home (PASH) is gaining popularity. The anesthesiologists as perioperative physicians can organize and lead the entire process from the preoperative evaluation, through the hosptial discharge. The functions of the PASH include preoperative optimization of medical conditions and psychological preparation of the patients and their support system; the care in the operating room and intensive care unit; pain management; respiratory therapy; cardiac rehabilitation; and specialized nutrition. Along with oversight of the medical issues, the preoperative visit is an opportune time for counseling, clarification of expectations and discussion of research, as well as for utilization of various informatics systems to consolidate the pertinent information and distribute it to relevant health care providers. We review the scientific foundation and practical applications of a preoperative visit and share our experience with the development of the preoperative evaluation clinic, designed specifically for cardiac and major vascular patients scheduled for day admission surgery. The ultimate goal of preoperative evaluation clinic is to ensure a safe, efficient, and cost-effective perioperative care for patients undergoing a complex type of surgery. PMID:26620138

  10. Preoperative intervention reduces postoperative pulmonary complications but not length of stay in cardiac surgical patients: a systematic review

    Directory of Open Access Journals (Sweden)

    David Snowdon

    2014-06-01

    cardiac surgical patients: a systematic review. Journal of Physiotherapy 60: 66–77].

  11. Comparative study between dexmedetomidine and fentanyl for sedation during mechanical ventilation in post-operative paediatric cardiac surgical patients

    Directory of Open Access Journals (Sweden)

    S R Prasad

    2012-01-01

    Full Text Available Aims and Objectives: To compare the efficacy of sedation and time taken for extubation using dexmedetomidine and fentanyl sedation in post-operative paediatric cardiac surgical patients. Methods: A prospective randomized double-blind study involving 60 children undergoing open heart surgery was conducted. The patients were divided into two groups, each involving 30 patients. One group received fentanyl at 1 μg/kg/h (Group A and the other received dexmedetomidine at 0.5 μg/kg/h (Group B for post-operative sedation with intermittent rescue fentanyl 0.5 μg/kg bolus in either group as per requirement during suctioning. The efficacy of sedation was assessed using the Ramsay sedation score, paediatric intensive care unit sedation score and the tracheal suction score. The time taken for extubation from the stoppage of infusion was noted. Results: Haemodynamic parameters between the two groups were comparable. All sedation scores were comparable in the fentanyl and dexmedetomidine groups. Average time (in minutes required for extubation was 131.0 (±51.06 SD in the dexmedetomidine group compared with 373.0 (±121.4 SD in the fentanyl group. The difference in mean time for extubation was statistically significant. Conclusions: Dexmedetomidine facilitates adequate sedation for mechanical ventilation and also early extubation as compared with fentanyl.

  12. Modified ultrafiltration for paediatric cardiac surgical patients:additional benefits and concerns

    Institute of Scientific and Technical Information of China (English)

    Shahzad G.Raja

    2004-01-01

    @@ To the Editor: Ⅰ read with great interest the article by Huang et al1 and have a few comments which I am sure will not only substantiate the findings of the authors but will also give the readers additional information on use of modified ultrafiltration after paediatric cardiac surgery.

  13. Diaphragmatic palsy after cardiac surgical procedures in patients with congenital heart

    Directory of Open Access Journals (Sweden)

    Talwar Sachin

    2010-01-01

    Full Text Available Paralysis of diaphragm on one or, exceptionally, both sides is a common cause of delayed recovery and excessive morbidity following pediatric cardiac surgery. The consequences of this complication after all forms of congenital heart surgery in newborns and young infants can be potentially serious. The impact of diaphragmatic palsy on the physiology after single ventricle palliations is particularly significant. It is necessary for all professionals taking care of children with heart disease to be familiar with the etiology, diagnosis, and management of this condition. Early recognition and prompt management of diaphragmatic palsy can potentially reduce the duration of mechanical ventilation and intensive care in those who develop this complication. This review summarizes the anatomy of the phrenic nerves, reasons behind the occurrence of diaphragmatic palsy, and suggests practical guidelines for management.

  14. Type of stress ulcer prophylaxis and risk of nosocomial pneumonia in cardiac surgical patients: cohort study

    OpenAIRE

    Bateman, Brian T.; Bykov, Katsiaryna; Choudhry, Niteesh K; Schneeweiss, Sebastian; Gagne, Joshua J.; Polinski, Jennifer M.; Franklin, Jessica M.; Doherty, Michael; Fischer, Michael A.; Rassen, Jeremy A.

    2013-01-01

    Objective: To examine the relation between the type of stress ulcer prophylaxis administered and the risk of postoperative pneumonia in patients undergoing coronary artery bypass grafting. Design: Retrospective cohort study. Setting: Premier Research Database. Participants:: 21 214 patients undergoing coronary artery bypass graft surgery between 2004 and 2010; 9830 (46.3%) started proton pump inhibitors and 11 384 (53.7%) started H2 receptor antagonists in the immediate postoperative period. ...

  15. A prospective study of paediatric cardiac surgical microsystems: assessing the relationships between non-routine events, teamwork and patient outcomes

    NARCIS (Netherlands)

    Schraagen, J.M.C.; Schouten, T.; Smit, M.; Haas, F.; Beek, D. van der; Ven, J. van der; Barach, P.

    2011-01-01

    Objective: Paediatric cardiac surgery has a low error tolerance and demands high levels of cognitive and technical performance. Growing evidence suggests that further improvements in patient outcomes depend on system factors, in particular, effective team skills. The hypotheses that small intraopera

  16. Identifying postoperative atrial fibrillation in cardiac surgical patients posthospital discharge, using iPhone ECG: a study protocol

    OpenAIRE

    Lowres, Nicole; Freedman, S. Ben; Gallagher, Robyn; Kirkness, Ann; Marshman, David; Orchard, Jessica; Neubeck, Lis

    2015-01-01

    Introduction Postoperative atrial fibrillation (AF) occurs in 30–40% of patients after cardiac surgery. Identification of recurrent postoperative AF is required to initiate evidence-based management to reduce the risk of subsequent stroke. However, as AF is often asymptomatic, recurrences may not be detected after discharge. This study determines feasibility and impact of a self-surveillance programme to identify recurrence of postoperative AF in the month of posthospital discharge. Methods a...

  17. Multiparameter Predictor of Fluid Responsiveness in Cardiac Surgical Patients Receiving Tidal Volumes Less Than 10 mL/kg.

    Science.gov (United States)

    Ikeda, Keita; Smith, Gregory; Renehan, John; Isbell, James; McMurry, Timothy; Rosner, Mitchell; Thiele, Robert

    2016-09-01

    Introduction We hypothesize that respiratory variation in the pulmonary artery tracing predicts fluid responsiveness (primary hypothesis) and that inclusion of multiple physiologic waveforms as well as ventilator settings in a predictive model of fluid responsiveness would lead to improvements in the clinical utility of this class of metrics (secondary hypothesis). Methods Blood pressure tracings were prospectively recorded in 35 patients immediately following cardiac surgery. Fluid bolus administration data, ventilator settings, and cardiac output were recorded prospectively before and after fluid boluses given at the discretion of the treating physician. Results We observed statistically significant but limited relationships between pulmonic (r(2) = .26, P = .0052) and systemic (r(2) = .13, P = .011) pulse pressure variation and changes in cardiac index. A multiparameter estimate of fluid responsiveness, which included respiratory variation in central venous pressure and pulmonary artery pressure, indexed tidal volumes, positive end-expiratory pressure, and mean airway pressure, was also correlated with change in cardiac index (r(2) = .42, P = .0056). Using the area under the curve (AUC) technique to compare specificity and sensitivity, dynamic indicators (AUC = 0.74, 0.67, and 0.81 for systemic arterial respiratory [pulse pressure] variation, pulmonic arterial respiratory [pulse pressure] variation, and the multiparameter estimate, respectively) outperformed static estimates (0.49 and 0.48 for central venous pressure and pulmonary artery diastolic pressure, respectively). Conclusion While integration of multiple physiologic waveforms as well as ventilator parameters improves the predictability of fluid responsive metrics in the setting of lung-protective ventilation, the composite index may still be of limited predictive value. PMID:27317553

  18. Design and Rationale of the PRAGUE-12 Trial: A Large, Prospective, Randomized, Multicenter Trial That Compares Cardiac Surgery With Left Atrial Surgical Ablation With Cardiac Surgery Without Ablation in Patients With Coronary and/or Valvular Heart Disease Plus Atrial Fibrillation

    OpenAIRE

    Straka, Zbyněk; Budera, Petr; Osmančík, Pavel; Vaněk, Tomáš; Hulman, Michal; Šmíd, Michal; Malý, Marek; Widimský, Petr

    2013-01-01

    Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has any impact on clinical outcomes. There is a need for a randomized trial with long-term follow-up to study the outcome of surgical ablation in patients with coronary and/or valve disease and AF. Patients are prospectively enrolled and randomized either to group A (cardiac surgery with left atrial ablation) or group B (cardiac su...

  19. Management of general surgical problems after cardiac transplantation.

    Science.gov (United States)

    Jones, M T; Menkis, A H; Kostuk, W J; McKenzie, F N

    1988-07-01

    Over a 6-year period at the University Hospital in London, Ont., 101 patients underwent heart transplantation and 5 heart-lung transplantation. The authors review the general surgical problems identified from the charts of 13 of these patients. In the early postoperative period (within 30 days), laparotomy was required for pancreatitis (one), perforated peptic ulcer (two), cholecystectomy (one), pancreatic cyst (one) and appendicitis (one). In addition, a spontaneous colocutaneous fistula and spontaneous pneumoperitoneum occurred; both were managed conservatively. Later, three patients required cholecystectomy; one underwent a below-knee and a Symes amputation for dry gangrene and one surgical correction of a lymphocele. The incidence of surgical problems (13%) indicates an increased susceptibility in this group of patients. Four of the 13 patients died. Pancreatitis is a well-recognized complication of cardiac surgery; it is frequently associated with a normal or only slightly elevated serum amylase level, making a definitive diagnosis without laparotomy almost impossible. Persistence of abdominal signs should signal the need for exploratory surgery. During the early postoperative period and in the absence of multiorgan failure, immediate operation for an acute abdomen is usually successful. Despite the additional risk, cardiac transplantation does not preclude later surgery, but immunosuppression must be continued and carefully monitored. PMID:3292032

  20. Evaluation of adjusted central venous blood gases versus arterial blood gases of patients in post-operative paediatric cardiac surgical intensive care unit

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    Naveen G Singh

    2015-01-01

    Full Text Available Background and Aims: Central venous catheters are in situ in most of the intensive care unit (ICU patients, which may be an alternative for determining acid-base status and can reduce complications from prolonged arterial cannulation. The aim of this study was to examine the reliability between adjusted central venous blood gas (aVBG and arterial blood gas (ABG samples for pH, partial pressure of carbon-di-oxide (pCO2, bicarbonate (HCO3−, base excess (BE and lactates in paediatric cardiac surgical ICU. Methods: We applied blood gas adjustment rule, that is aVBG pH = venous blood gas (VBG pH +0.05, aVBG CO2 = VBG pCO2 - 5 mm Hg from the prior studies. In this study, we validated this relationship with simultaneous arterial and central venous blood obtained from 30 patients with four blood sample pairs each in paediatric cardiac surgical ICU patients. Results: There was a strong correlation (R i.e., Pearson's correlation between ABG and aVBG for pH = 0.9544, pCO2 = 0.8738, lactate = 0.9741, HCO3− = 0.9650 and BE = 0.9778. Intraclass correlation co-efficients (ICCs for agreement improved after applying the adjustment rule to venous pH (0.7505 to 0.9454 and pCO2 (0.4354 to 0.741. Bland Altman showed bias (and limits of agreement for pH: 0.008 (−0.04 to + 0.057, pCO2: −3.52 (–9.68 to +2.65, lactate: −0.10 (−0.51 to +0.30, HCO3−: −2.3 (–5.11 to +0.50 and BE: −0.80 (−3.09 to +1.49. Conclusion: ABG and aVBG samples showed strong correlation, acceptable mean differences and improved agreement (high ICC after adjusting the VBG. Hence, it can be promising to use trend values of VBG instead of ABG in conjunction with a correction factor under stable haemodynamic conditions.

  1. Propensity-matched analysis of association between preoperative anemia and in-hospital mortality in cardiac surgical patients undergoing valvular heart surgeries

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2015-01-01

    Full Text Available Introduction: Anaemia is associated with increased post-operative morbidity and mortality. We retrospectively assess the relationship between preoperative anaemia and in-hospital mortality in valvular cardiac surgical population. Materials and Methods: Data from consecutive adult patients who underwent valvular repair/ replacement at our institute from January 2010 to April 2014 were collected from hospital records. Anaemia was defined according to WHO criteria (hemoglobin <13g/dl for males and <12g/dl for females. 1:1 matching was done for anemic and non-anemic patients based on propensity for potentially confounding variables. Logistic regression was used to evaluate the relationship between anaemia and in-hospital mortality. MatchIt package for R software was used for propensity matching and SPSS 16.0.0 was used for statistical analysis. Results: 2449 patients undergoing valvular surgery with or without coronary artery grafting were included. Anaemia was present in 37.1% (33.91% among males & 40.88% among females. Unadjusted OR for mortality was 1.6 in anemic group (95% Confidence Interval [95% CI] - 1.041-2.570; p=0.033. 1:1 matching was done on the basis of propensity score for anaemia (866 pairs. Balancing was confirmed using standardized differences. Anaemia had an OR of 1.8 for mortality (95% CI- 1.042 to 3.094, P=0.035. Hematocrit of < 20 on bypass was associated with higher mortality. Conclusion: Preoperative anaemia is an independent risk factor associated with in-hospital mortality in patients undergoing valvular heart surgery.

  2. Video recording of cardiac surgical procedures: what the surgeon needs to know.

    Science.gov (United States)

    Massetti, M; Neri, E; Banfi, C; Buklas, D; Gerard, J L; Vigano, M; Chitwood, R W

    2008-10-01

    In the past, rudimentary devices were used to record surgical operations. Currently, the introduction of technologic advances such as high-definition television and the miniaturization of high-resolution digital video cameras provides an opportunity for making significantly enhanced surgical records. These enhancements, coupled with the recent advances in telemedicine and surgical simulation, will improve cardiac surgery training and skill acquisition, decrease operative times and costs, minimize morbidity, and improve overall patient care. The present paper provides a discussion of the media technology offered to surgeons for recording a surgical procedure on video. Hardware technology, including different types of cameras and analogical or digital post processing methods, are reviewed with a surgical ''eye''. This ''how to'' paper provides practical suggestions to surgeons in order to enhance surgical video recording. PMID:18670389

  3. Mediastinal Bronchogenic Cyst With Acute Cardiac Dysfunction: Two-Stage Surgical Approach.

    Science.gov (United States)

    Smail, Hassiba; Baste, Jean Marc; Melki, Jean; Peillon, Christophe

    2015-10-01

    We describe a two-stage surgical approach in a patient with cardiac dysfunction and hemodynamic compromise resulting from a massive and compressive mediastinal bronchogenic cyst. To drain this cyst, video-assisted mediastinoscopy was performed as an emergency procedure, which immediately improved the patient's cardiac function. Five days later and under video thoracoscopy, resection of the cyst margins was impossible because the cyst was tightly adherent to the left atrium. We performed deroofing of this cyst through a right thoracotomy. The patient had an uncomplicated postoperative recovery, and no recurrence was observed at the long-term follow-up visit. PMID:26434484

  4. EVALUATION OF STAPLING TECHNIQUE IN SURGICAL TREATMENT OF ESOPHAGEALAND CARDIAC CANCER

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    To investigate an effective method to prevent anastomotic leakage and stenosis, evaluating the role of stapling technique in surgical treatment of esophageal and cardiac cancer. Methods: The stapling technique was used in end-to-side esophagogastromosis in surgical treatment of esophageal and cardiac cancer. Results: 128 patients were so treated. One patient died of superior mesenteric artery embolism, and the operative mortality was 0.78%. No anastomotic leakage or stenosis was found in this series. The other complications included postoperative thoracic cavity bleeding in 1 (0.78%), myocardial infarction in 2 (1.56%), stress ulcer of stomach in 1 (0.78%), and gastroparsis in 4 (3.12%). The overall morbidity rate was 4.7%. Conclusion: Using stapler to perform end-to-side esophagogastromosis has the advantages of being simple and safe, cutting short the operation time, and preventing leakage and stenosis. It is an ideal technique in the treatment of esophageal and cardiac cancer.

  5. [OPTIMIZATION OF THE SURGICAL TREATMENT RESULTS IN CONOTRUNCAL CARDIAC FAILURES IN LARGE AORTO-PULMONARY COLLATERAL ARTERIES].

    Science.gov (United States)

    Bablyak, O D

    2015-09-01

    The results of surgical treatment of 83 patients, suffering conotruncal cardiac failures and large aorto-pulmonary collateral arteries, were analyzed. In 2007 - 2014 yrs a radical correction of the failure (RCF) was performed in 53 (64%) of them. RCF was achieved, using three surgical approaches. The algorithm of a surgical approach choice was introduced, guaranteeing the operation time shortening and artificial blood circulation application, have improved the course of early postoperative period. It was proved, that improvement of surgical results is possible, if a correct surgical tactic choosed and surgical approaches rationally applied. PMID:26817084

  6. Cardiac surgical experience in northern Nigeria.

    Science.gov (United States)

    Nwiloh, J; Edaigbini, S; Danbauchi, S; Babaniyi, I; Aminu, M; Adamu, Y; Oyati, A

    2012-09-01

    A pilot study was undertaken to determine the feasibility of establishing a heart surgery programme in northern Nigeria. During three medical missions by a visiting US team, in partnership with local physicians, 18 patients with heart diseases underwent surgery at two referral hospitals in the region. Sixteen (88.9%) patients underwent the planned operative procedure with an observed 30-day mortality of 12.5% (2/16) and 0% morbidity. Late complications were anticoagulant related in mechanical heart valve patients and included a first-trimester abortion one year postoperatively, and a death at two years from haemorrhage during pregnancy. This has prompted us to now consider bioprosthetics as the valve of choice in women of childbearing age in this patient population. This preliminary result has further stimulated the interest of all stakeholders on the urgency to establish open-heart surgery as part of the armamentarium to combat the ravages of heart diseases in northern Nigeria. PMID:22453514

  7. Cardiac surgical experience in northern Nigeria

    OpenAIRE

    Nwiloh, J; Edaigbini, S; Danbauchi, S; Aminu, M.; Oyati, A; Babaniyi, I; Adamu, Y.

    2012-01-01

    Abstract A pilot study was undertaken to determine the feasibility of establishing a heart surgery programme in northern Nigeria. During three medical missions by a visiting US team, in partnership with local physicians, 18 patients with heart diseases underwent surgery at two referral hospitals in the region. Sixteen (88.9%) patients underwent the planned operative procedure with an observed 30-day mortality of 12.5% (2/16) and 0% morbidity. Late complications were anticoagulant related in m...

  8. LR-Spring Mass Model for Cardiac Surgical Simulation

    DEFF Research Database (Denmark)

    Mosegaard, Jesper

    2004-01-01

    The purpose of the research conducted was to develop a real-time surgical simulator for preoperative planning of surgery in congenital heart disease. The main problem simulating procedures on cardiac morphology is the need for a large degree of detail and simulation speed. In combination with a...... demand for physically realistic real-time behaviour this gives us tradeoffs not easily balanced. The LR-Spring Mass model handles these constraints by the use of domain specific knowledge....

  9. Perioperative evaluation of cardiac surgical risk: particularities in the emergency surgery – from the guidelines to the clinical practice

    OpenAIRE

    Andronescu, AM; Nechita, AC; Ittu, G; Delcea, C; Dumitrescu, G; Vintila, MM

    2013-01-01

    Rationale: Cardiac risk in patients undergoing surgery depends on many factors from the patient's cardiovascular history to the surgical procedure itself, with its particularities, the type of anesthesia, fluid exchanges and the supervision of the patient. Therefore, this risk must be carefully considered and it determines the endorsement of perioperative measures with important medical implications. Objective: Perioperative cardiac risk evaluation guidelines were published since 2010 and the...

  10. The cardiac patient in Ramadan.

    Science.gov (United States)

    Chamsi-Pasha, Majed; Chamsi-Pasha, Hassan

    2016-01-01

    Ramadan is one of the five fundamental pillars of Islam. During this month, the majority of the 1.6 billion Muslims worldwide observe an absolute fast from dawn to sunset without any drink or food. Our review shows that the impact of fasting during Ramadan on patients with stable cardiac disease is minimal and does not lead to any increase in acute events. Most patients with the stable cardiac disease can fast safely. Most of the drug doses and their regimen are easily manageable during this month and may need not to be changed. Ramadan fasting is a healthy nonpharmacological means for improving cardiovascular risk factors. Most of the Muslims, who suffer from chronic diseases, insist on fasting Ramadan despite being exempted by religion. The Holy Quran specifically exempts the sick from fasting. This is particularly relevant if fasting worsens one's illness or delays recovery. Patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting. PMID:27144139

  11. Surgical management of infected cardiac implantable electronic devices.

    Science.gov (United States)

    Chaudhry, Umar A R; Harling, Leanne; Ashrafian, Hutan; Athanasiou, Christina; Tsipas, Pantelis; Kokotsakis, John; Athanasiou, Thanos

    2016-01-15

    The growing use of cardiac implantable electronic devices (CIED) has led to infections requiring intervention. These are traditionally managed using a percutaneous transvenous approach to fully extract the culpable leads. Indications for such strategies are well-established and range from simple traction to the use of powered extraction tools including laser sheaths. Where such attempts fail, or if there are further complications, then there may be need for a cardiothoracic surgical approach. Limited evidence is currently available on the merits of individual strategies, and these are mainly drawn from case reports or series. Most utilise cardiopulmonary bypass, cardioplegic arrest and entry within the right atrium to allow direct visualisation of any vegetation and safely explant all CIED components whilst avoiding perforation, valvular and paravalvular damage. In this review, we describe a number of these and the unique challenges faced by surgeons when attempting to extract CIED. It is clear that future work should concentrate on creating clear consensus and guidelines on indications, risks and measures of efficacy outcomes for various surgical techniques. PMID:26590887

  12. Interdisciplinary preoperative patient education in cardiac surgery.

    OpenAIRE

    De Weert, J.; van Dulmen, S.; Bar, P.; Venus, E.

    2003-01-01

    Patient education in cardiac surgery is complicated by the fact that cardiac surgery patients meet a lot of different health care providers. Little is known about education processes in terms of interdisciplinary tuning. In this study, complete series of consecutive preoperative consultations of 51 cardiac surgery patients with different health care providers (physicians, nurses and health educators) were videotaped. The information exchange between patients and providers was analyzed directl...

  13. Relationship between cardiac output and effective renal plasma flow in patients with cardiac disease

    Energy Technology Data Exchange (ETDEWEB)

    McGriffin, D.; Tauxe, W.N.; Lewis, C.; Karp, R.; Mantle, J.

    1984-12-01

    The relationship between effective renal plasma flow (ERPF) and cardiac output was examined in 46 patients (22 with congestive heart failure and 24 following cardiac surgical procedures) by simultaneously measuring the global ERPF by the single-injection method and cardiac output by the thermodilution method. Of the patients in the heart-failure group, 21 also had pulmonary artery end diastolic pressure (PAEDP) recorded at the same time. ERPF and cardiac output were found to be related by the regression equations: cardiac output = 2.08 + 0.0065 ERPF (r, 080), with a SE of estimate of 0.81 l/min. ERPF and PAEDP were related by the regression equation: PAEDP = 42.02 - 0.0675 ERPF (r, 0.86), with a SE of estimate of 5.5 mm Hg. ERPF may be a useful noninvasive method of estimating cardiac output if it is known that no intrinsic kidney disease is present, and if the error of 0.81 l/min (1 SE of estimate) is within the range of clinical usefulness. The error is principally attributable to the determination of cardiac output by the thermodilution method.

  14. Intraoperative PaO2 is not related to the development of surgical site infections after major cardiac surgery

    Directory of Open Access Journals (Sweden)

    Fierro Inma

    2011-01-01

    Full Text Available Abstract Background The perioperative use of high inspired oxygen fraction (FIO2 for preventing surgical site infections (SSIs has demonstrated a reduction in their incidence in some types of surgery however there exist some discrepancies in this respect. The aim of this study was to analyze the relationship between PaO2 values and SSIs in cardiac patients. Methods We designed a prospective study in which 1,024 patients undergoing cardiac surgery were analyzed. Results SSIs were observed in 5.3% of patients. There was not significant difference in mortality at 30 days between patients with and without SSIs. In the uni and multivariate analysis no differences in function of the inspired oxygen fraction administrated were observed. Conclusions We observed that the PaO2 in adult cardiac surgery patients was not related to SSI rate.

  15. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.

    Science.gov (United States)

    Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero

    2011-10-01

    A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease. PMID:23804483

  16. Perioperative management of pediatric patients on mechanical cardiac support.

    Science.gov (United States)

    Mossad, Emad B; Motta, Pablo; Rossano, Joseph; Hale, Brittani; Morales, David L

    2011-05-01

    The population of children with end-stage heart failure requiring mechanical circulatory support is growing. These children present for diagnostic imaging studies, various interventions and noncardiac surgical procedures that require anesthetic care. This article is a review of the population demographics of children on mechanical cardiac support, the alternative devices available, and the important concepts for safe perioperative management of these patients. The discussion will be limited to devices for short- and long-term cardiac support, excluding extracorporeal membrane oxygenation (ECMO) for respiratory support. PMID:21332879

  17. Depression Detection in Hospitalized Cardiac Patients

    OpenAIRE

    Geddes, Martine S.

    2010-01-01

    Depression has been shown to increase an individual's risk for heart disease. Despite this finding, physicians are not identifying depression in their hospitalized cardiac patients. This study looked at hospitalized cardiac patients and determined whether their physicians were identifying depression in those that scored > 5 on the PHQ-9 depression inventory. Methods included assessing patient depression during their stay at an intensive care unit using the PHQ-9. Those patients scoring > ...

  18. Perioperative Education of Patient Undergoing Cardiac Surgery

    OpenAIRE

    Alexandros Zacharis; Aikaterini Kampourelli

    2011-01-01

    In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall po...

  19. Fontan procedure: imaging of normal post-surgical anatomy and the spectrum of cardiac and extracardiac complications

    International Nuclear Information System (INIS)

    Univentricular congenital heart diseases include a range of entities that result in a functionally single ventricular chamber. Although the only curative therapy is cardiac transplantation, there are several palliative surgical techniques that prevent ventricular volume overload, diverting part or all the systemic venous circulation into the pulmonary arteries. The modern Fontan procedure, which consists of anastomosing both the superior (SVC) and inferior vena cava (IVC) to the right pulmonary artery (RPA), is nowadays the last step before transplantation. The importance of imaging in these entities lies not only in the understanding of the new circuit established after surgical correction, but also in the early detection of the wide spectrum of cardiac and extracardiac complications that can occur due to the new physiological condition. Due to the increased survival of these patients, long-term complications are becoming more common. The main cardiac complications are atrial enlargement, ventricular dysfunction, and stenosis or thrombosis of the conduit. Pulmonary artery stenosis, pulmonary arteriovenous fistulae (PAVF), systemic-pulmonary veno venous shunts (VVS), hepatic congestion, cardiac cirrhosis, and protein-losing enteropathy are potential extracardiac complications. - Highlights: • Fontan procedure is the main palliative surgical procedure for univentricular heart correction. • Fontan procedure entails the anastomosis of SVC and IVC to the RPA. • Complications are becoming more common due to the increased survival of patients with Fontan

  20. Artificial aortic valve dysfunction due to pannus and thrombus – different methods of cardiac surgical management

    Science.gov (United States)

    Marcinkiewicz, Anna; Kośmider, Anna; Walczak, Andrzej; Zwoliński, Radosław; Jaszewski, Ryszard

    2015-01-01

    Introduction Approximately 60 000 prosthetic valves are implanted annually in the USA. The risk of prosthesis dysfunction ranges from 0.1% to 4% per year. Prosthesis valve dysfunction is usually caused by a thrombus obstructing the prosthetic discs. However, 10% of prosthetic valves are dysfunctional due to pannus formation, and 12% of prostheses are damaged by both fibrinous and thrombotic components. The authors present two patients with dysfunctional aortic prostheses who were referred for cardiac surgery. Different surgical solutions were used in the treatment of each case. Case study 1 The first patient was a 71-year-old woman whose medical history included arterial hypertension, stable coronary artery disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), and hypercholesterolemia; she had previously undergone left-sided mastectomy and radiotherapy. The patient was admitted to the Cardiac Surgery Department due to aortic prosthesis dysfunction. Transthoracic echocardiography revealed complete obstruction of one disc and a severe reduction in the mobility of the second. The mean transvalvular gradient was very high. During the operation, pannus covering the discs’ surface was found. A biological aortic prosthesis was reimplanted without complications. Case study 2 The second patient was an 87-year-old woman with arterial hypertension, persistent atrial fibrillation, and COPD, whose past medical history included gastric ulcer disease and ischemic stroke. As in the case of the first patient, she was admitted due to valvular prosthesis dysfunction. Preoperative transthoracic echocardiography revealed an obstruction of the posterior prosthetic disc and significant aortic regurgitation. Transesophageal echocardiography and fluoroscopy confirmed the prosthetic dysfunction. During the operation, a thrombus growing around a minor pannus was found. The thrombus and pannus were removed, and normal functionality of the prosthetic valve was restored

  1. 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

  2. Rheumatic heart disease- a study of surgically excised cardiac valves and biopsies

    International Nuclear Information System (INIS)

    Objective: To examine the prevalence, age, sex and topographical distribution of the rheumatic heart diseases and its morphology. Design: A cross sectional descriptive study. Place and Duration of Study: Pathology Department, Army Medical College, Rawalpindi between 1981-1990. Patients and Methods: Five hundred and twenty six surgically excised cardiac valves and biopsies were studied in the laboratory in the light of clinical data. Results: Carditis constituted 87.4 % of the cardiac valvular disease with 23.5% active and 71% healed rheumatic lesions. About 5.5% had morphological appearances consistent with RHD. The lesions affected mitral valves (37.0%), aortic valve (22.1%), mitral and aortic valves together (21.0%) and atrial appendages (19.0%). Presentation was mostly as mitral stenosis either isolated (49.2% ) or combined (31.0%), aortic stenosis (11.7% ) and aortic incompetence with regurgitation (7.3%). Conclusion: Rheumatic carditis constitutes a significant proportion of cardiac valvular disease and affects comparatively younger age, with slight male preponderance and primarily affects mitral valve. (author)

  3. Incidence of cardiac events in burned patients.

    Science.gov (United States)

    Meyers, David G; Hoestje, Sara M; Korentager, Richard A

    2003-06-01

    Given the increased level of adrenergic stimulation in burn patients, it would be expected that they would experience an increased incidence of cardiac arrhythmias and other cardiac events. We performed a retrospective chart review of 56 acute burn patients matched by age, length of hospital stay, and sex to 56 trauma patients, all of whom had been continuously monitored electrocardiographically. Burn and trauma patients were similar in injury severity, admission laboratory values, and prior history of cardiopulmonary diseases. Arrhythmias were noted in 34% of burn patients and 28% of trauma patients. One myocardial infarction and six deaths occurred in burn patients. No myocardial infarctions or deaths were observed in trauma patients. A past history of cardiopulmonary disease increased the risk of myocardial infarction or death by 6.6 times. Cardiac arrhythmias and other events are relatively infrequent and benign in burn patients and are similar to those experienced by other patients with acute injuries. PMID:12781616

  4. Patient-Specific Models of Cardiac Biomechanics

    OpenAIRE

    Krishnamurthy, Adarsh; Villongco, Christopher T.; Chuang, Joyce; Frank, Lawrence R.; Nigam, Vishal; Belezzuoli, Ernest; Stark, Paul; Krummen, David E; Narayan, Sanjiv; Omens, Jeffrey H.; McCulloch, Andrew D.; Kerckhoffs, Roy CP

    2012-01-01

    Patient-specific models of cardiac function have the potential to improve diagnosis and management of heart disease by integrating medical images with heterogeneous clinical measurements subject to constraints imposed by physical first principles and prior experimental knowledge. We describe new methods for creating three-dimensional patient-specific models of ventricular biomechanics in the failing heart. Three-dimensional bi-ventricular geometry is segmented from cardiac CT images at end-di...

  5. Paediatric and congenital cardiac surgery in emerging economies: surgical 'safari' versus educational programmes.

    Science.gov (United States)

    Corno, Antonio F

    2016-07-01

    To attract the interest of all people potentially involved in humanitarian activities in the emerging economies, in particular giving attention to the basic requirements of the organization of paediatric cardiac surgery activities, the requirements for a successful partnership with the local existing organizations and the basic elements of a patient-centred multidisciplinary integrated approach. Unfortunately, for many years, the interventions in the low and middle income countries were largely limited to short-term medical missions, not inappropriately nicknamed 'surgical safari', because of negative general and specific characteristics. The negative aspects and the limits of the short-term medical missions can be overcome only by long-term educational programmes. The most suitable and consistent models of long-term educational programmes have been combined and implemented with the personal experience to offer a proposal for a long-term educational project, with the following steps: (i) site selection; (ii) demographic research; (iii) site assessment; (iv) organization of surgical educational teams; (v) regular frequency of surgical educational missions; (vi) programme evolution and maturation; (vii) educational outreach and interactive support. Potential limits of a long-term educational surgical programme are: (i) financial affordability; (ii) basic legal needs; (iii) legal support; (iv) non-profit indemnification. The success should not be measured by the number of successful operations of any given mission, but by the successful operations that our colleagues perform after we leave. Considering that the children in need outnumber by far the people able to provide care, in this humanitarian medicine there should be plenty of room for cooperation rather than competition. The main goal should be to provide teaching to local staff and implement methods and techniques to support the improvement of the care of the patients in the long run. This review focuses on the

  6. 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.

  7. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomised controlled trial

    OpenAIRE

    Guo, Ping

    2012-01-01

    Background: Patients awaiting cardiac surgery typically experience physical and psychological stress. Although there is evidence that preoperative education can improve postoperative outcomes among general surgical patients, less is known about preoperative education for patients undergoing cardiac surgery, particularly in the context of healthcare delivered in China. Aim: The aim of this study was to evaluate whether a preoperative education intervention designed for Chinese cardiac pat...

  8. 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...

  9. The cardiac patient during Ramadan and Hajj.

    Science.gov (United States)

    Chamsi-Pasha, Hassan; Ahmed, Waqar H; Al-Shaibi, Khaled F

    2014-10-01

    The holy month of Ramadan is one of the five pillars of Islam. During this month, fasting Muslims refrain from eating, drinking, smoking, and sex from dawn until sunset. Although the Quran exempts sick people from the duty of fasting, it is not uncommon for many heart disease patients to fast during Ramadan. Despite the fact that more than a billion Muslims worldwide fast during Ramadan, there is no clear consensus on its effects on cardiac disease. Some studies have shown that the effects of fasting on stable patients with cardiac disease are minimal and the majority of patients with stable cardiac illness can endure Ramadan fasting with no clinical deterioration. Fasting during Ramadan does not seem to increase hospitalizations for congestive heart failure. However, patients with decompensated heart failure or those requiring large doses of diuretics are strongly advised not to fast, particularly when Ramadan falls in summer. Patients with controlled hypertension can safely fast. However, patients with resistant hypertension should be advised not to fast until their blood pressure is reasonably controlled. Patients with recent myocardial infarction, unstable angina, recent cardiac intervention or cardiac surgery should avoid fasting. Physician advice should be individualized and patients are encouraged to seek medical advice before fasting in order to adjust their medications, if required. The performance of the Hajj pilgrimage is another pillar of Islam and is obligatory once in the lifetime for all adult Muslims who are in good health and can afford to undertake the journey. Hajj is a physically, mentally, emotionally, and spiritually demanding experience. Medical checkups one or two months before leaving for Hajj is warranted, especially for those with chronic illnesses such as cardiovascular disease. Patients with heart failure, uncontrolled hypertension, serious arrhythmias, unstable angina, recent myocardial infarction, or cardiac surgery should be

  10. Surgical Planning by 3D Printing for Primary Cardiac Schwannoma Resection.

    Science.gov (United States)

    Son, Kuk Hui; Kim, Kun-Woo; Ahn, Chi Bum; Choi, Chang Hu; Park, Kook Yang; Park, Chul Hyun; Lee, Jae-Ik; Jeon, Yang Bin

    2015-11-01

    We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach. PMID:26446661

  11. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric;

    2009-01-01

    BACKGROUND: Heart transplantation remains the last treatment option for patients with end-stage cardiac disease. Such diseases include ischemic cardiomyopathy, nonischemic cardiomyopathy and other conditions such as arrhythmogenic right ventricular dysplasia, cardiac sarcoidosis and cardiac...... amyloidosis. OBJECTIVE: To review the changes that have occurred over time in the etiology of heart disease in patients requiring heart transplantation, and to compare the clinical and histological diagnoses of explanted hearts from patients with progressive cardiac disease. METHODS: The pathological findings...... of 296 surgically excised hearts over a 20-year period (January 1987 to July 2006) at one institution were examined. Patients were separated into groups based on year of heart transplantation. The tissue was examined to determine the underlying cardiac pathology leading to congestive heart failure...

  12. [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

  13. [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

  14. Cardiac Arrest in a Heart Transplant Patient Receiving Dexmedetomidine During Cardiac Catheterization.

    Science.gov (United States)

    Schwartz, Lawrence Israel; Miyamoto, Shelley D; Stenquist, Scott; Twite, Mark David

    2016-06-01

    Dexmedetomidine is an α-2 agonist with a sedative and cardiopulmonary profile that makes it an attractive anesthetic in pediatric cardiac patients. Cardiac transplant patients may suffer from acute cellular rejection of the cardiac conduction system and, therefore, are at an increased risk of the electrophysiological effect of dexmedetomidine. We present such a patient who had a cardiac arrest while receiving dexmedetomidine during cardiac catheterization. Because acute cellular rejection of the cardiac conduction system is difficult to diagnose, dexmedetomidine should be used with caution in pediatric heart transplant patients. PMID:26721807

  15. 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...

  16. Patient-specific models of cardiac biomechanics

    Science.gov (United States)

    Krishnamurthy, Adarsh; Villongco, Christopher T.; Chuang, Joyce; Frank, Lawrence R.; Nigam, Vishal; Belezzuoli, Ernest; Stark, Paul; Krummen, David E.; Narayan, Sanjiv; Omens, Jeffrey H.; McCulloch, Andrew D.; Kerckhoffs, Roy C. P.

    2013-07-01

    Patient-specific models of cardiac function have the potential to improve diagnosis and management of heart disease by integrating medical images with heterogeneous clinical measurements subject to constraints imposed by physical first principles and prior experimental knowledge. We describe new methods for creating three-dimensional patient-specific models of ventricular biomechanics in the failing heart. Three-dimensional bi-ventricular geometry is segmented from cardiac CT images at end-diastole from patients with heart failure. Human myofiber and sheet architecture is modeled using eigenvectors computed from diffusion tensor MR images from an isolated, fixed human organ-donor heart and transformed to the patient-specific geometric model using large deformation diffeomorphic mapping. Semi-automated methods were developed for optimizing the passive material properties while simultaneously computing the unloaded reference geometry of the ventricles for stress analysis. Material properties of active cardiac muscle contraction were optimized to match ventricular pressures measured by cardiac catheterization, and parameters of a lumped-parameter closed-loop model of the circulation were estimated with a circulatory adaptation algorithm making use of information derived from echocardiography. These components were then integrated to create a multi-scale model of the patient-specific heart. These methods were tested in five heart failure patients from the San Diego Veteran's Affairs Medical Center who gave informed consent. The simulation results showed good agreement with measured echocardiographic and global functional parameters such as ejection fraction and peak cavity pressures.

  17. Management of cardiac device infections: A retrospective survey of a non-surgical approach combining antibiotic therapy with transvenous removal.

    Science.gov (United States)

    Tascini, C; Bongiorni, M G; Gemignani, G; Soldati, E; Leonildi, A; Arena, G; Doria, R; Giannola, G; La Pira, F; Tagliaferri, E; Caravelli, P; Dell'Anna, R; Menichetti, F

    2006-04-01

    Pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) have become life-saving therapeutic tools for patients with cardiac arrhythmia. Complications include thrombosis, embolism and infections at a highly variable rate. Surgical removal of the infected device has been perceived as the only way to guarantee a successful outcome and to reduce the high risk of mortality. Recently, a transvenous extraction method has been developed to remove infected intracardiac leads without sternotomy. This survey was designed to evaluate the outcome of an approach combining antibiotic therapy with non-surgical transvenous complete removal for the management of cardiac device infections (CDIs). We reviewed case-histories of 121 patients (105 with PM and 16 with ICD infections). The aim of our retrospective survey was to ascertain that a non-invasive transvenous complete removal of the infected devices is safe and effective when associated with appropriate antibiotic therapy starting 10 days before the procedure and extending to at least three weeks after. The infected devices were successfully removed in all patients with a non-surgical transvenous technique. The infections were most frequently caused by coagulase-negative staphylococci (70%), Staphylococcus aureus (14%), and Gram-negative rods (12%). Polymicrobial infections were documented in 19 patients and represent 16% of all device-related infections. The removal of the devices was done during antibiotic therapy, administered for a median of 26 days (range 23 to 45 days). Neither fatalities nor relapse of infections were recorded in the patient population during the one-year follow-up visits. According to our experience, CDIs can be treated with antibiotic therapy and non-surgical removal of the entire infected device, thus allowing a successful reimplantation. This procedure prevents recurrent infections and operative mortality. PMID:16736884

  18. PSYCHIATRIC MORBIDITY AMONG PATIENTS ATTENDING CARDIAC OPD

    OpenAIRE

    Goyal, Ashok; Bhojak, M.M.; Verma, K. K.; Singhal, Ashok; Jhirwal, O.P.; Bhojak, Maneesh

    2001-01-01

    One hundred patients were selected from the cardiology outpatient department by non-probability purposive method. Each patient was evaluated by a psychiatrist and a consultant cardiologist The informations were recorded in a self designed proforma. The Hindi version of Goldberg′s General Health Questionnaire and modified adjective check list for type A and type B personality characteristics were administered. Seventy five percent of the patients were having psychiatric problems. The cardiac p...

  19. 心血管外科手术病人院内安全转运的护理措施%Nursing measures of safe intra-hospital transport of cardiac surgical patients

    Institute of Scientific and Technical Information of China (English)

    车萌

    2012-01-01

    It summarized the security risks existing in surgical patients during hospital transporter in department of cardiovascular surgery and factors of accident occurrence, and its own characteristics in our hospital, at the same time, refer to the relevant literature, it put forward the corresponding prevention and nursing standards of safe transporter, improved the process of hospital transporter,enhanced the security of hospital transporter of surgical patients,realized the no apparent errors occurred, and ensured the operation successful.%分析我院心血管外科手术病人院内转运过程中存在的安全隐患及发生意外的因素,并根据我院自身特点,同时参考相关文献,提出了相应的预防措施和安全转运护理规范,改进了院内转运流程,有效提高了手术病人院内转运的安全性,实现了无明显差错发生,保证了手术的顺利进行.

  20. Cardiac Rehabilitation in Patients with Heart Failure

    OpenAIRE

    Fu, Tieh-Cheng; Huang, Shu-Chun; Hsu, Chih-Chin; Wang, Chao-Hung; Wang, Jong-Shyan

    2014-01-01

    Reduced exercise capacity negatively affects the ability of patients with heart failure (HF) to perform activities required for daily life, further decreasing their independence and quality of life (QoL). Cardiac rehabilitation (CR) can effectively improve aerobic fitness and overall health status in patients with HF. Low referral rate is an important limitation that may impede successful CR, whereas the automatic referral and liaison strategies performed by some healthcare providers manifest...

  1. Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Sahu

    2016-01-01

    Full Text Available Background: Nosocomial infections (NIs in the postoperative period not only increase morbidity and mortality, but also impose a significant economic burden on the health care infrastructure. This retrospective study was undertaken to (a evaluate the incidence, characteristics, risk factors and outcomes of NIs and (b identify common microorganisms responsible for infection and their antibiotic resistance profile in our Cardiac Surgical Intensive Care Unit (CSICU. Patients and Methods: After ethics committee approval, the CSICU records of all patients who underwent cardiovascular surgery between January 2013 and December 2014 were reviewed retrospectively. The incidence of NI, distribution of NI sites, types of microorganisms and their antibiotic resistance, length of CSICU stay, and patient-outcome were determined. Results: Three hundred and nineteen of 6864 patients (4.6% developed NI after cardiac surgery. Lower respiratory tract infections (LRTIs accounted for most of the infections (44.2% followed by surgical-site infection (SSI, 11.6%, bloodstream infection (BSI, 7.5%, urinary tract infection (UTI, 6.9% and infections from combined sources (29.8%. Acinetobacter, Klebsiella, Escherichia coli, and Staphylococcus were the most frequent pathogens isolated in patients with LRTI, BSI, UTI, and SSI, respectively. The Gram-negative bacteria isolated from different sources were found to be highly resistant to commonly used antibiotics. Conclusion: The incidence of NI and sepsis-related mortality, in our CSICU, was 4.6% and 1.9%, respectively. Lower respiratory tract was the most common site of infection and Gram-negative bacilli, the most common pathogens after cardiac surgery. Antibiotic resistance was maximum with Acinetobacter spp.

  2. Sudden cardiac arrest in a patient with epilepsy induced by chronic inflammation on the cerebral surface

    Institute of Scientific and Technical Information of China (English)

    Yuxi Liu; Weicheng Hao; Xiaoming Yang; Yimin Wang; Yu Su

    2012-01-01

    The present study analyzed a patient with epilepsy due to chronic inflammation on the cerebral surface underwent sudden cardiac arrest. Paradoxical brain discharge, which occurred prior to epileptic seizures, induced a sudden cardiac arrest. However, when the focal brain pressure was relieved, cardiac arrest disappeared. A 27-year-old male patient underwent pre-surgical video-electroencephalogram monitoring for 160 hours. During monitoring, secondary tonic-clonic seizures occurred five times. A burst of paradoxical brain discharges occurred at 2-19 seconds (mean 8 seconds) prior to epileptic seizures. After 2-3 seconds, sudden cardiac arrest occurred and lasted for 12-22 seconds (average 16 seconds). The heart rate subsequently returned to a normal rate. Results revealed arachnoid pachymenia and adhesions, as well as mucus on the focal cerebral surface, combined with poor circulation and increased pressure. Intracranial electrodes were placed using surgical methods. Following removal of the arachnoid adhesions and mucus on the local cerebral surface, paradoxical brain discharge and epileptic seizures occurred three times, but sudden cardiac arrest was not recorded during 150-hour monitoring. Post-surgical histological examination indicated meningitis. Experimental findings suggested that paradoxical brain discharge led to cardiac arrest instead of epileptic seizures; the insult was associated with chronic inflammation on the cerebral surface, which subsequently led to hypertension and poor blood circulation in focal cerebral areas.

  3. 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...

  4. Patient education of cardiac patients : a nursing journal club

    OpenAIRE

    Aaltio, Laura; Huhtamaa, Iina

    2011-01-01

    Cardiovascular diseases affect many people in Finland. One way to support this patient group is patient education. Since the time spent in the inpatient settings is limited, treatment and education of cardiovascular patients is currently focused mainly on the outpatient settings. This creates pressure for the nurses due to the strict time-frame and high turnover of patients. The purpose of this final project was to find evidence-based knowledge on the patient education of a cardiac patie...

  5. 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...

  6. Patient doses in digital cardiac imaging

    International Nuclear Information System (INIS)

    In this pilot study, we obtained estimates of entrance skin doses and the corresponding effective doses to patients undergoing digital cardiac imaging procedures on a GE Advantx LC/LP Plus system. Data were obtained for six patients undergoing diagnostic examinations and six patients who had interventional procedures. For each patient examination, radiographic techniques for fluoroscopic and digital cine imaging were recorded, together with the irradiation geometry. The projection with the highest exposure resulted in an average skin dose of 0.64 ± 0.41 Gy (maximum of 1.6 Gy). The average patient skin doses taking into account overlapping projections was 1.1 ± 0.8 Gy (maximum of 3.0 Gy). The exposure area product (EAP) incident on the patient was converted into the energy imparted to the patient and the corresponding effective dose. The average patient effective dose was 28 ± 14 mSv (maximum 62 mSv), with the resultant average fatal cancer risk estimated to be of the order of 8x10-3 . Average doses for interventional procedures in cardiac imaging are higher than those associated with diagnostic examinations by approximately 50%. (author)

  7. Incidence and management of diaphragmatic palsy in patients after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mehta Yatin

    2008-01-01

    Full Text Available Background: Diaphragm is the most important part of the respiratory system. Diaphragmatic palsy following cardiac surgery is not uncommon and can cause deterioration of pulmonary functions and attendant pulmonary complications. Objectives: Aim of this study was to observe the incidence of diaphragmatic palsy after off pump coronary artery bypass grafting (OPCAB as compared to conventional CABG and to assess the efficacy of chest physiotherapy on diaphragmatic palsy in post cardiac surgical patients. Design and Setting: An observational prospective interventional study done at a tertiary care cardiac centre. Patients: 2280 consecutive adult patients who underwent cardiac surgery from February 2005 to august 2005. Results: 30 patients out of 2280 (1.31% developed diaphragmatic palsy. Patients were divided based on the presence or absence of symptoms viz. breathlessness at rest or exertion or with the change of posture along with hypoxemia and / or hypercapnia. Group I included 14 patients who were symptomatic (CABG n=13, post valve surgery n=1, While Group II included 16 asymptomatic patients (CABG n=12, post valve surgery n=4, 9 patients (64% from Group I (n=14 and 4 patients (25% from group II showed complete recovery from diaphragmatic palsy as demonstrated ultrasonographically. Conclusion: The incidence of diaphragmatic palsy was remarkably less in our adult cardiac surgical patients because most of the cardiac surgeries were performed off pump and intensive chest physiotherapy beginning shortly after extubation helped in complete or near complete recovery of diaphragmatic palsy. Chest Physiotherapy led to marked improvement in functional outcome following post cardiac surgery diaphragmatic palsy. We also conclude that ultrasonography is a simple valuable bed-side tool for rapid diagnosis of diaphragmatic palsy

  8. Depression and Uncertainty in Cardiac Patients

    OpenAIRE

    Batool Ahadi; Mohammad Narimani; Jamal Sooreh

    2012-01-01

    Background: The aim of this study was to comparison of depression and uncertainty in cardiac patient and normal persons. Materials and Methods: The present study has been done in a form of casual-comparative on 60 persons at the Bookan city hospital. In the present study, Beck Depression Inventory (1988), and Fristone Uncertainty Scale (1994) were employed to gather the required data. For data analysis, Manova, Pearson correlation coefficient and regression analysis methods by SPSS-19 was use...

  9. Sublingual Microcirculation is Impaired in Post-cardiac Arrest Patients

    DEFF Research Database (Denmark)

    G. Omar, Yasser; Massey, Michael; Wiuff Andersen, Lars; A. Giberson, Tyler; Berg, Katherine; N. Cocchi, Michael; I. Shapiro, Nathan; W. Donnino, Michael

    2013-01-01

    markers in the post-cardiac arrest state. METHODS: We prospectively evaluated the sublingual microcirculation in post-cardiac arrest patients, severe sepsis/septic shock patients, and healthy control patients using Sidestream Darkfield microscopy. Microcirculatory flow was assessed using the...... microcirculation flow index (MFI) at 6 and 24h in the cardiac arrest patients, and within 6h of emergency department admission in the sepsis and control patients. RESULTS: We evaluated 30 post-cardiac arrest patients, 16 severe sepsis/septic shock patients, and 9 healthy control patients. Sublingual...... microcirculatory blood flow was significantly impaired in post-cardiac arrest patients at 6h (MFI 2.6 [IQR: 2-2.9]) and 24h (2.7 [IQR: 2.3-2.9]) compared to controls (3.0 [IQR: 2.9-3.0]; p<0.01 and 0.02, respectively). After adjustment for initial APACHE II score, post-cardiac arrest patients had significantly...

  10. Remifentanil in critically ill cardiac patients

    Directory of Open Access Journals (Sweden)

    Ruggeri Laura

    2011-01-01

    Full Text Available Remifentanil has a unique pharmacokinetic profile, with a rapid onset and offset of action and a plasmatic metabolism. Its use can be recommended even in patients with renal impairment, hepatic dysfunction or poor cardiovascular function. A potential protective cardiac preconditioning effect has been suggested. Drug-related adverse effects seem to be comparable with other opioids. In cardiac surgery, many randomized controlled trials demonstrated that the potential benefits of the use of remifentanil not only include a profound protection against intraoperative stressful stimuli, but also rapid postoperative recovery, early weaning from mechanical ventilation, and extubation. Remifentanil shows ideal properties of sedative agents being often employed for minimally invasive cardiologic techniques, such as transcatheter aortic valve implantation and radio frequency treatment of atrial flutter, or diagnostic procedures such as transesophageal echocardiography. In intensive care units remifentanil is associated with a reduction in the time to tracheal extubation after cessation of the continuous infusion; other advantages could be more evident in patients with organ dysfunction. Effective and safe analgesia can be provided in case of short and painful procedures (i.e. chest drain removal. In conclusion, thanks to its peculiar properties, remifentanil will probably play a major role in critically ill cardiac patients.

  11. Stress Management Training May Help Cardiac Rehab Patients

    Science.gov (United States)

    ... nlm.nih.gov/medlineplus/news/fullstory_157876.html Stress Management Training May Help Cardiac Rehab Patients When added ... March 21, 2016 (HealthDay News) -- The addition of stress management training can make cardiac rehabilitation programs more effective, ...

  12. Cardiac arrest after anesthetic management in a patient with hereditary sensory autonomic neuropathy type IV

    Directory of Open Access Journals (Sweden)

    Ergül Yakup

    2011-01-01

    Full Text Available Hereditary sensory autonomic neuropathy type IV is a rare disorder with an autosomal recessive transmission and characterized by self-mutilation due to a lack in pain and heat sensation. Recurrent hyperpyrexia and anhydrosis are seen in patients as a result of a lack of sweat gland innervation. Self-mutilation and insensitivity to pain result in orthopedic complications and patients undergone recurrent surgical interventions with anesthesia. However, these patients are prone to perioperative complications such as hyperthermia, hypothermia, and cardiac complications like bradycardia and hypotension. We report a 5-year-old boy with hereditary sensory autonomic neuropathy type IV, developing hyperpyrexia and cardiac arrest after anesthesia.

  13. Perioperative Education of Patient Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alexandros Zacharis

    2011-04-01

    Full Text Available In recent years, the number of patients undergoing cardiac surgeries is steadily increasing. In Greece, approximately 10,500 patients per year are admitted to some kind of cardiac operation. Constant evolution of heart surgery techniques calls for adaptation of the perioperative nursing care given. Patient education, as an important part of the perioperative care, is directly related to the reduction of postoperative complications and stress management, thus promoting the patient's overall postoperative well-being. Aim: The aim of this review was to present the most important aspects of the patient's perioperative education and the role that the nurse has to play in it. Methods: Data from selected articles were extracted from Pubmed, Chinahl and Cohrane, as well as from non-electronically published scientific studies ranging from 1998-2010 and 2003-2008 respectively. Results: According to the literature, perioperative patient education can be implemented in various ways, such as through verbal updates, the use of audiovisual means and the provision of informative leaflets. The teaching topics can be divided into those of the preoperative and postoperative phase. Stress management prepares the patients psychologically and also enhances the therapeutic nurse-patient relationship. The teaching of breathing techniques and isometric exercises of the lower limbs, the cessation of smoking, the diet to be followed, as well as the management of medication, aim in the patients' physical preparation, in order to optimize their postoperative course. Conclusion: Perioperative patient education, regardless of how it is implemented, constitutes both an integral part of the nursing care and an independent nursing intervention per se, which strengthens the nurses' autonomy and improves the patient's postoperative course.

  14. Predictors for outcome among cardiac arrest patients

    DEFF Research Database (Denmark)

    Wibrandt, Ida; Norsted, Kristine; Schmidt, Henrik; Schierbeck, Jens

    for outcome among CA patients, we can improve the management of CA, in order to strengthen the leads in the chain of survival.MethodsA retrospective cohort study including 172 CA patients admitted to the intensive care unit (ICU) in Odense University Hospital (OUH) in a three-year period was conducted...... spontaneous circulation (ROSC).ResultsThe overall mortality was 44% and a favorable neurological outcome was seen among 52%. Strong predictors for survival and favorable neurological outcome were ventricular tachycardia/ventricular fibrillation (VT/VF) as initial rhythm, cardiac etiology and time to ROSC¿<¿20...

  15. Cardiac angioscintigraphy in patients with arrhytmias

    International Nuclear Information System (INIS)

    The time course of ventricular activation can be characterized by the Fourier analysis of a dynamic series of cardiac images. Bi-ventricular activation mapping and quantitative phase histogram analysis may be useful for evaluation of patients with arrhythmias. Three clinical problems can benefit from the method: localization of the site of pre-excitation in the Wolff-Parkinson-White syndrom, assessment of an ectopic activation focus responsible for premature contraction in patients with ventricular tachycardia and diagnosis of an underlying organic disease when arrhytmogenic right ventricular dysplasia is suspected

  16. Creation and Global Deployment of a Mobile, Application-Based Cognitive Simulator for Cardiac Surgical Procedures.

    Science.gov (United States)

    Brewer, Zachary E; Ogden, William David; Fann, James I; Burdon, Thomas A; Sheikh, Ahmad Y

    2016-01-01

    Several modern learning frameworks (eg, cognitive apprenticeship, anchored instruction, and situated cognition) posit the utility of nontraditional methods for effective experiential learning. Thus, development of novel educational tools emphasizing the cognitive framework of operative sequences may be of benefit to surgical trainees. We propose the development and global deployment of an effective, mobile cognitive cardiac surgical simulator. In methods, 16 preclinical medical students were assessed. Overall, 4 separate surgical modules (sternotomy, cannulation, decannulation, and sternal closure) were created utilizing the Touch Surgery (London, UK) platform. Modules were made available to download free of charge for use on mobile devices. Usage data were collected over a 6-month period. Educational efficacy of the modules was evaluated by randomizing a cohort of medical students to either module usage or traditional, reading-based self-study, followed by a multiple-choice learning assessment tool. In results, downloads of the simulator achieved global penetrance, with highest usage in the USA, Brazil, Italy, UK, and India. Overall, 5368 unique users conducted a total of 1971 hours of simulation. Evaluation of the medical student cohort revealed significantly higher assessment scores in those randomized to module use versus traditional reading (75% ± 9% vs 61% ± 7%, respectively; P < 0.05). In conclusion, this study represents the first effort to create a mobile, interactive cognitive simulator for cardiac surgery. Simulators of this type may be effective for the training and assessment of surgical students. We investigated whether an interactive, mobile-computing-based cognitive task simulator for cardiac surgery could be developed, deployed, and validated. Our findings suggest that such simulators may be a useful learning tool. PMID:27568126

  17. [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

  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. Music Therapy for Post Operative Cardiac Patients

    DEFF Research Database (Denmark)

    Schou, Karin

    Background This study is the first controlled research study undertaken in the early phase of rehabilitation after cardiac surgery investigating the effect of a receptive music therapy method. Various forms of music therapy interventions including both active and receptive methods were reported...... to be significantly more effective than music treatment with music medicine. Music listening and receptive music therapy (such as Guided Imagery and Music) have been proposed to help patients both before heart surgery and during the recovery phase. This study therefore intended to explore both a music therapy...

  20. The cardiac patient during Ramadan and Hajj

    OpenAIRE

    Chamsi-Pasha, Hassan; Ahmed, Waqar H.; Al-Shaibi, Khaled F.

    2014-01-01

    The holy month of Ramadan is one of the five pillars of Islam. During this month, fasting Muslims refrain from eating, drinking, smoking, and sex from dawn until sunset. Although the Quran exempts sick people from the duty of fasting, it is not uncommon for many heart disease patients to fast during Ramadan. Despite the fact that more than a billion Muslims worldwide fast during Ramadan, there is no clear consensus on its effects on cardiac disease. Some studies have shown that the effects of...

  1. Ischemic Stroke Due to Cardiac Involvement: Emery Dreifuss Patient

    Directory of Open Access Journals (Sweden)

    Ersin Kasım Ulusoy

    2015-08-01

    Full Text Available Emery-Dreifuss muscular dystrophy (EDMD is a hereditary disease. It is characterized by early-onset contractures, slowly progressive weakness, fatigue related to skapulo-humero-peroneal muscle weakness, cardiomyopathy which develops in adulthood and cardiac conduction system block. Cardiac involvement has a prognostic significance in patients with EDMD and even sudden cardiac death may be the first clinical presentation. In this article, an EDMD patient with ischemic stroke clinic who didn’t have regular cardiac follow-up was reported and the importance of the treatment of cardiac diseases which could play a role in ischemic stroke etiology and the implantation of pace-maker was mentioned.

  2. 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.

  3. 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.

  4. 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 ...

  5. Visualization of transcoronary ablation of septal hypertrophy in patients with hypertrophic obstructive cardiomyopathy: a comparison between cardiac MRI, invasive measurements and echocardiography

    OpenAIRE

    Sohns, Christian; Sossalla, Samuel; Schmitto, Jan D; Jacobshagen, Claudius; Raab, Björn; Obenauer, Silvia; Maier, Lars S.

    2010-01-01

    Objective Hypertrophic obstructive cardiomyopathy (HOCM) is treated by surgical myectomy or transcoronary ablation of septal hypertrophy (TASH). The aim of this study was to visualize the feasibility, success and short-term results of TASH on the basis of cardiac MRI (CMR) in comparison with cardiac catheterization and echocardiography. Methods In this in vivo study, nine patients with HOCM were treated with TASH. Patients were evaluated by transthoracic echocardiography, invasive cardiac ang...

  6. Congenital cardiac malformations in congenital hypothyroid patients in Isfahan

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Sabri

    2006-11-01

    Full Text Available BACKGROUND: Congenital hypothyroidism (CH often seems to be associated with other congenital abnormalities, mostly cardiac in nature. The aim of this study was to determine the prevalence of cardiac malformations in patients with CH diagnosed during CH screening program in Isfahan. METHODS: In this cross-sectional study, cardiac malformations were determined in CH patients were compared to controls using echocardiography. The association between cardiac malformations and mean T4 and TSH concentrations, etiology of CH according to radiologic findings and permanent and transient CH were studied in CH patients. RESULTS: Overall, 96 and 59 subjects were included in the case and control groups, respectively. Cardiac malformations were present in 30.2% (n = 29 and 15.2% (n = 9 of case and control groups, respectively; i.e. a higher prevalence in CH patients than in controls (P = 0.03. The prevalence of cardiac malformations without patent foramen oval was 6.25% (n = 6 in CH patients and 1.7% (n = 1 in control group (P = 0.1. There was no significant association between the presence of cardiac malformations and the aforementioned variables. CONCLUSIONS: High prevalence of cardiac malformations in CH patients strongly suggests the potential involvement of genetic factors in the pathogenesis of CH. This emphasizes on the necessity of genetic studies involving CH patients. KEY WORDS: Congenital hypothyroidism, cardiac malformations, genetics.

  7. Prevention of sudden cardiac death in patients with chronic kidney disease.

    Science.gov (United States)

    Franczyk-Skóra, Beata; Gluba, Anna; Banach, Maciej; Kozłowski, Dariusz; Małyszko, Jolanta; Rysz, Jacek

    2012-01-01

    Cardiovascular deaths account for about 40% of all deaths of patients with chronic kidney disease (CKD), particularly those on dialysis, while sudden cardiac death (SCD) might be responsible for as many as 60% of SCD in patients undergoing dialysis. Studies have demonstrated a number of factors occurring in hemodialysis (HD) that could lead to cardiac arrhythmias. Patients with CKD undergoing HD are at high risk of ventricular arrhythmia and SCD since changes associated with renal failure and hemodialysis-related disorders overlap. Antiarrhythmic therapy is much more difficult in patients with CKD, but the general principles are similar to those in patients with normal renal function - at first, the cause of arrhythmias should be found and eliminated. Also the choice of therapy is narrowed due to the altered pharmacokinetics of many drugs resulting from renal failure, neurotoxicity of certain drugs and their complex interactions. Cardiac pacing in elderly patients is a common method of treatment. Assessment of patients' prognosis is important when deciding whether to implant complex devices. There are reports concerning greater risk of surgical complications, which depends also on the extent of the surgical site. The decision concerning implantation of a pacing system in patients with CKD should be made on the basis of individual assessment of the patient. PMID:23206758

  8. Assessment of pulmonary function tests in cardiac patients

    OpenAIRE

    El-Sobkey, Salwa B.; Gomaa, Magdi

    2011-01-01

    This study was aimed to assess the pulmonary function tests (PFTs) in cardiac patients; with ischemic or rheumatic heart diseases as well as in patients who underwent coronary artery bypass graft (CABG) or valvular procedures. For the forty eligible participants, the pulmonary function was measured using the spirometry test before and after the cardiac surgery. Data collection sheet was used for the patient’s demographic and intra-operative information. Cardiac diseases and surgeries had rest...

  9. Ischemic Stroke Due to Cardiac Involvement: Emery Dreifuss Patient

    OpenAIRE

    Ersin Kasım Ulusoy; Tolga Kunak; Şule Bilen; Fikri Ak

    2015-01-01

    Emery-Dreifuss muscular dystrophy (EDMD) is a hereditary disease. It is characterized by early-onset contractures, slowly progressive weakness, fatigue related to skapulo-humero-peroneal muscle weakness, cardiomyopathy which develops in adulthood and cardiac conduction system block. Cardiac involvement has a prognostic significance in patients with EDMD and even sudden cardiac death may be the first clinical presentation. In this article, an EDMD patient with ischemic stroke clinic who didn’t...

  10. 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.

  11. Cardiac Surgery in Patients with Drug Eluting Stents:The Risk of Stopping Clopidogrel

    Directory of Open Access Journals (Sweden)

    Gorav Ailawadi

    2007-01-01

    Full Text Available Recommendations for the duration of clopidogrel (Plavix®, Bristol Meyers Squibb, New York, NY therapy following drug eluting stent (DES insertion have been subject to recent criticism. Suggested recommendations for the continuation of clopidogrel have been extended to one year following DES insertion. However, patients with a previously inserted DES who now require cardiac surgery are requested to stop clopidogrel perioperatively. The safety of this practice is unclear. We report two cases of elective cardiac surgical intervention after the insertion of DES complicated by perioperative or intraoperative acute coronary ischemia attributed to DES closure.

  12. Prevention of sudden cardiac death in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Franczyk-Skóra Beata

    2012-12-01

    Full Text Available Abstract Cardiovascular deaths account for about 40% of all deaths of patients with chronic kidney disease (CKD, particularly those on dialysis, while sudden cardiac death (SCD might be responsible for as many as 60% of SCD in patients undergoing dialysis. Studies have demonstrated a number of factors occurring in hemodialysis (HD that could lead to cardiac arrhythmias. Patients with CKD undergoing HD are at high risk of ventricular arrhythmia and SCD since changes associated with renal failure and hemodialysis-related disorders overlap. Antiarrhythmic therapy is much more difficult in patients with CKD, but the general principles are similar to those in patients with normal renal function - at first, the cause of arrhythmias should be found and eliminated. Also the choice of therapy is narrowed due to the altered pharmacokinetics of many drugs resulting from renal failure, neurotoxicity of certain drugs and their complex interactions. Cardiac pacing in elderly patients is a common method of treatment. Assessment of patients’ prognosis is important when deciding whether to implant complex devices. There are reports concerning greater risk of surgical complications, which depends also on the extent of the surgical site. The decision concerning implantation of a pacing system in patients with CKD should be made on the basis of individual assessment of the patient.

  13. Health status in patients treated with cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Denollet, Johan; Pedersen, Susanne S.; Broers, Herman; Widdershoven, Jos W

    2008-01-01

    Cardiac resynchronization therapy (CRT) is a promising treatment in chronic heart failure (CHF). However, a subgroup of patients still report impaired health status, cardiac symptoms, and feelings of disability following CRT. The aims of this study were to examine (1) whether CHF patients treated...

  14. The prognostic value of cardiac ultrasonography in patients with cardiac arrest

    Directory of Open Access Journals (Sweden)

    Ehsan Bolvardi

    2016-04-01

    Full Text Available Introduction: Echocardiography or cardiac imaging is proposed as a gold standard method for identifying high risk patients for cardiac arrest. In this systematic review, we studied the prognostic value of cardiac sonography in patients with cardiac arrest. Methods: PubMed was searched for the relevant articles. Case reports were not included. Inclusion criteria were all the studies applied transthorasic echocardiography in patients with cardiac arrest arrived at emergency department that studied the efficacy of this modality on patients survived to emergency discharge and returned to spontaneous circulation.Result: Overall, 870 articles were obtained through initial search and only nine articles were included after the evaluation of the title, abstract, and the full text. Echocardiography has high sensitivity and specificity in predicting the return of spontaneous circulation.Conclusion: Cardiac sonography is a fairly effective (not definitive modality in predicting death in patients with lack of cardiac activity during resuscitation. Echocardiography should not be the sole basis for the decision to cease resuscitative efforts.

  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. CARDIAC REHABILITATION PROGRAM (AEROBIC) AND QUALITY OF LIFE IN CARDIAC PATIENTS

    OpenAIRE

    Majid Gorgeh; Morad Jorgeh; Farzad Nazem; Ali Yelfani

    2011-01-01

    Cardiac rehabilitation is the effective method to improve quality of life; especially in heartdisease.The purpose of this study was to determine the effect of cardiac rehabilitation programson the quality of life of patients who had undergone coronary artery bypass grafting in Iran.Six weeks after CABG 60 patients ( 46 male and 14 female) participated in an 12-week cardiacrehabilitation program that consisted of formal supervised exercise training and educationalsessions in shahid beheshti re...

  17. Investigation and analysis of incidence of awareness in patients undergoing cardiac surgery in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    WANG Yun; YUE Yun; SUN Yong-hai; WU An-shi; WU Qi-wei; ZHANG Yong-qian; FENG Chun-sheng

    2005-01-01

    Background Awareness under general anesthesia is a serious complication which leads to psychiatric disorders. The incidence of awareness in patients undergoing cardiac surgery has been reported in as many as 1.5%-23% in foreign countries. But so far, medical literature about awareness during cardiac surgery is still rare in China. Therefore, we investigated the incidence of awareness in patients undergoing different kinds of cardiac surgery, the phases when awareness occured and the effect of cardiopulmonary bypass on the incidence of awareness in coronary artery bypass grafting in Beijing.Methods Patients' recall of awareness during cardiac surgery was assessed. One hundred patients undergoing coronary artery bypass grafting (CABG) in Chaoyang Hospital, Beijing, one hundred patients undergoing CABG and one hundred patients undergoing valve replacement or septal defect repair in Fuwai Hospital, Beijing, were interviewed 3-6 days after surgery. Every report obout patients on recall of awareness was recorded. An independent research team, blinded to patients' surgery and anesthesia, assessed every report of awareness.Results The incidence of awareness of patients received CABG under cardiopulmonary bypass (CPB), off -pump CABG, septal repair or valve replacement under CPB was 4.7% (5 of 106 cases), 9.6% (9 of 94 cases) and 4% (4 of 100 cases), respectively. CPB did not greatly affect the incidence of awareness during the period of CABG (P>0.05). The incidence of awareness of patients who received CABG under CPB did not increase significantly, in comparison with that of patients who received septal repair or valve replacement under CPB in Fuwai Hospital (P>0.05). Awareness easily occurred before bypass grafting or CPB.Conclusions Awareness mainly occurs before bypass grafting or CPB in cardiac surgery. Most cases with awareness have auditory perceptions. CPB is not a main factor which affects the incidence of awareness of CABG. Surgical types do not affect the

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

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    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

  19. 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

  20. 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.

  1. Assessing Depression in Cardiac Patients: What Measures Should Be Considered?

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    M. Ceccarini

    2014-01-01

    Full Text Available It is highly recommended to promptly assess depression in heart disease patients as it represents a crucial risk factor which may result in premature deaths following acute cardiac events and a more severe psychopathology, even in cases of subsequent nonfatal cardiac events. Patients and professionals often underestimate or misjudge depressive symptomatology as cardiac symptoms; hence, quick, reliable, and early mood changes assessments are warranted. Failing to detect depressive signals may have detrimental effects on these patients’ wellbeing and full recovery. Choosing gold-standard depression investigations in cardiac patients that fit a hospitalised cardiac setting well is fundamental. This paper will examine eight well established tools following Italian and international guidelines on mood disorders diagnosis in cardiac patients: the Hospital Anxiety and Depression Scale (HADS, the Cognitive Behavioural Assessment Hospital Form (CBA-H, the Beck Depression Inventory (BDI, the two and nine-item Patient Health Questionnaire (PHQ-2, PHQ-9, the Depression Interview and Structured Hamilton (DISH, the Hamilton Rating Scale for Depression (HAM-D/HRSD, and the Composite International Diagnostic Interview (CIDI. Though their strengths and weaknesses may appear to be homogeneous, the BDI-II and the PHQ are more efficient towards an early depression assessment within cardiac hospitalised patients.

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

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    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.

  3. 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,...

  4. Cardiac perioperative complications in noncardiac surgery

    OpenAIRE

    Radovanović Dragana; Kolak Radmila; Stokić Aleksandar; Radovanović Zoran; Jovanović Gordana

    2008-01-01

    Anesthesiologists are confronted with an increasing population of patients undergoing noncardiac surgery who are at risk for cardiac complications in the perioperative period. Perioperative cardiac complications are responsible for significant mortality and morbidity. The aim of the present study was to determine the incidence of perioperative (operative and postoperative) cardiac complications and correlations between the incidence of perioperative cardiac complications and type of surgical ...

  5. Perceptions of cardiac rehabilitation patients, specialists and rehabilitation programs regarding cardiac rehabilitation wait times

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    Grace Sherry L

    2012-08-01

    Full Text Available Abstract Background In 2006, the Canadian Cardiovascular Society (CCS Access to Care Working Group recommended a 30-day wait time benchmark for cardiac rehabilitation (CR. The objectives of the current study were to: (1 describe cardiac patient perceptions of actual and ideal CR wait times, (2 describe and compare cardiac specialist and CR program perceptions of wait times, as well as whether the recommendations are appropriate and feasible, and (3 investigate actual wait times and factors that CR programs perceive to affect these wait times. Methods Postal and online surveys to assess perceptions of CR wait times were administered to CR enrollees at intake into 1 of 8 programs, all CCS member cardiac specialists treating patients indicated for CR, and all CR programs listed in Canadian directories. Actual wait times were ascertained from the Canadian Cardiac Rehabilitation Registry. The design was cross-sectional. Responses were described and compared. Results Responses were received from 163 CR enrollees, 71 cardiac specialists (9.3% response rate, and 92 CR programs (61.7% response rate. Patients reported that their wait time from hospital discharge to CR initiation was 65.6 ± 88.4 days (median, 42 days, while their ideal median wait time was 28 days. Most patients (91.5% considered their wait to be acceptable, but ideal wait times varied significantly by the type of cardiac indication for CR. There were significant differences between specialist and program perceptions of the appropriate number of days to wait by most indications, with CR programs perceiving shorter waits as appropriate (p  Conclusions Wait times following access to cardiac rehabilitation are prolonged compared with consensus recommendations, and yet are generally acceptable to most patients. Wait times following percutaneous coronary intervention in particular may need to be shortened. Future research is required to provide an evidence base for wait time

  6. Cardiac computed tomography in patients with acute coronary syndrome

    International Nuclear Information System (INIS)

    Currently, cardiac computed tomography (CT) is increasingly being implemented into clinical algorithms, primarily due to substantial technical advances over the last decade. Its use in the setting of suspected acute coronary syndrome is of particular relevance, given the high degree of accumulating scientific evidence of improving patient outcomes. Performing cardiac CT requires specific knowledge on the available scan acquisitions and patient preparation. Also, expertise is required in order to interpret the coronary and extra-coronary findings adequately. The present article provides an overview of the different aspects on the use of cardiac CT in the setting of acute coronary syndrome.

  7. Cardiac asthma in elderly patients: incidence, clinical presentation and outcome

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    Ray Patrick

    2007-05-01

    Full Text Available Abstract Background Cardiac asthma is common, but has been poorly investigated. The objective was to compare the characteristics and outcome of cardiac asthma with that of classical congestive heart failure (CHF in elderly patients. Methods Prospective study in an 1,800-bed teaching hospital. Results Two hundred and twelve consecutive patients aged ≥ 65 years presenting with dyspnea due to CHF (mean age of 82 ± 8 years were included. Findings of cardiac echocardiography and natriuretic peptides levels were used to confirm CHF. Cardiac asthma patients were defined as a patient with CHF and wheezing reported by attending physician upon admission to the emergency department. The CHF group (n = 137 and the cardiac asthma group (n = 75, differed for tobacco use (34% vs. 59%, p 2 (47 ± 15 vs. 41 ± 11 mmHg, p Conclusion Patients with cardiac asthma represented one third of CHF in elderly patients. They were more hypercapnic and experienced more distal airway obstruction. However, outcomes were similar.

  8. Knowledge and meaning of cardiac catheterization from the perspective of cardiac patients

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    Yana Thalita Barros de Oliveira Castro

    2016-01-01

    Full Text Available Objective: to describe the knowledge and significance of cardiac catheterization from cardiac patients’ perspective. Methods: descriptive and qualitative study of patients undergoing cardiac catheterization. Five categories were identified through content analysis. Results: knowledge of patients on cardiac catheterization proved to be limited; the subject was surrounded by lack of knowledge. Cardiac catheterization means a treatment for unblocking coronary arteries and it is confused with therapeutic purposes. There were reports of symptoms related to heart disease such as fatigue and chest pain and related to the exams such as worry, anxiety, depression, fear and restlessness generated, mainly, by expectations of the unknown. The majority of the respondents proved to be satisfied with the results of the exam, due to the discovery and treatment of heart diseases. Conclusion: cardiac catheterization means treatment and clearance of coronary arteries and it is confused with therapeutic purposes. Feelings such as worry, anxiety, fear and restlessness are described when patients are subjected to examination, generated mainly by expectations of the unknown.

  9. Catheters, wires, tubes and drains on postoperative radiographs of pediatric cardiac patients: the whys and wherefores

    International Nuclear Information System (INIS)

    Surgical treatment of congenital heart disease has advanced dramatically since the first intracardiac repairs in the mid-20th century. Previously inoperable lesions have become the focus of routine surgery and patients are managed successfully in intensive care units around the world. As a result, increasing numbers of postoperative images are processed by departments of radiology in children's hospitals. It is important that the radiologist accurately documents and describes the catheters, wires, tubes and drains that are present on the chest radiograph. This article reviews the reasons for the placement and positioning of perioperative equipment in children who have surgical repair of atrial septal defect, ventricular septal defect or transposition of the great arteries. Also included are a brief synopsis of each cardiac anomaly, the surgical procedure for its correction, and an in-depth discussion of the postoperative chest radiograph including illustrations of catheters, wires, tubes and drains. (orig.)

  10. Prediction of cardiac risk in patients undergoing vascular surgery

    Energy Technology Data Exchange (ETDEWEB)

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.

    1987-03-01

    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  11. Cardiac inflammatory myofibroblastic tumor: does it recur after complete surgical resection in an adult?

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    Yang Xuedong

    2012-05-01

    Full Text Available Abstract Inflammatory myofibroblastic tumor is currently considered to be a low-grade neoplasm, and it rarely involves the heart. We reported a rare case of a 59-year-old female who received cardiac surgery for complete resection of inflammatory myofibroblastic tumor in the left atrium. Five months after surgery, the patient presented with acute cardiogenic pulmonary edema and subsequent sudden death due to a left atrial tumor which protruded into the left ventricle through mitral annulus during diastole. The recurrence of inflammatory myofibroblastic tumor in the left atrium was strongly suggested clinically.

  12. 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...

  13. The incidence and importance of anaemia in patients undergoing cardiac surgery in the UK - the first Association of Cardiothoracic Anaesthetists national audit.

    Science.gov (United States)

    Klein, A A; Collier, T J; Brar, M S; Evans, C; Hallward, G; Fletcher, S N; Richards, T

    2016-06-01

    The importance and variability of pre-operative anaemia in cardiac surgical patients across the UK is not known, and there is debate about its association with patient outcomes. The Association of Cardiothoracic Anaesthetists carried out its first national audit on anaemia and transfusion, and analysed data from 19,033 patients operated on in 12 cardiac surgical centres between 2010 and 2012; 5895 (31%) had pre-operative anaemia. Centre-specific prevalence of anaemia varied from 23% to 45%; anaemia was associated with older patients, diabetes and surgical risk (EuroSCORE). Nevertheless, controlling for these factors, regional variation remained an independent effect (p treatment before cardiac surgery is required; these data will assist in designing such trials. PMID:26993159

  14. 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.

  15. 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

  16. Successful surgical repair of a triple cardiac rupture using modified cohesive double patch technique.

    Science.gov (United States)

    Dorobantu, Lucian Florin; Stiru, Ovidiu; Iliescu, Vlad Anton

    2016-02-01

    Introduction The association between both left and right ventricular free wall ruptures (FWR) and post-infarction anterior ventricular septal defect (VSD) is an exceptional situation. Case report We present the case of a patient who developed a VSD and two FWRs (of the left and right ventricle, respectively) shortly after the onset of an anterior AMI. We surgically closed this complex rupture using the cohesive double patch technique with two Teflon patches combined with an infarct exclusion technique. The left and right ventricular patches were attached cohesively to the septal wall and the infarcted area was excluded without reducing the left ventricular cavity. Conclusion Association between post-infarction ventricular septal rupture and both left and right free wall ruptures are a very rare and dangerous situation. The modified cohesive double patch technique associated the modified Cooley technique seems to be the correct surgical solution. PMID:27385145

  17. Anemia in Intensive Cardiac Care Unit patients - An underestimated problem.

    Science.gov (United States)

    Uscinska, Ewa; Idzkowska, Ewelina; Sobkowicz, Bozena; Musial, Wlodzimierz J; Tycinska, Agnieszka M

    2015-09-01

    The heterogeneous group of patients admitted to Intensive Cardiac Care Unit (ICCU) as well as nonspecific complaints associated with anemia might be the reason for underdiagnosing or minimization of this problem. Because of this heterogeneity, there are no clear guidelines to follow. It is known that anemia is impairing the outcome. Thus, it is crucial to keep alert in the diagnosis and treatment of anemia, especially in critically ill cardiac patients. The greatest groups of patients admitted to ICCU are those with acute coronary syndromes (ACS), acute decompensated heart failure (ADHF), severe arrhythmias as well as individuals after cardiac operations. However, patients suffering other critical cardiac illnesses quite often become anemic during hospitalization in ICCU. It is because anemia is typed in the clinical features of heavy diseases or may be the consequence of treatment. The current review focuses on the incidence, complex etiology and predictive role of anemia in a diverse group of ICCU patients. It discusses clinical aspects of anemia treatment in particular groups of critically ill cardiac patients because proper treatment increases chances for recovery and improves the outcome in this severe group of patients. PMID:26149915

  18. Clinical features and MRI characteristics in patients with cardiac amyloidosis

    International Nuclear Information System (INIS)

    Objective: To observe the clinical features and cardiac magnetic resonance (CMR) imaging characteristics in patients with cardiac amyloidosis. Methods: A total of 5 patients (4 males and 1 female) with the diagnosis of cardiac amyloidosis (3 were proven by heart transplantation, 2 by endomyocardial biopsy) were evaluated by electrocardiogram, echocardiogram, chest X-ray and CMR with delayed Gadolinium enhancement. Results: Echocardiograms were abnormal in all five patients; chest X- ray showed pulmonary hemorrhage (3), cardiomegaly (5), pleural effusion (3); echocardiogram showed atrial enlargement, left ventricular wall thickening, limited ventricular wall motion, etc. CMR exhibited increased thickness of the left ventricular wall, mild to moderate depression of systolic function (mean ejection fraction: 32.5%±15.0%) and bilateral atrial enlargement with restriction of diastolic ventricular filling. In all patients, there were widespread enhancement of the thickened myocardium on delayed post- contrast studies. In 4 patients, global subendocardial delayed gadolinium enhancement was found, in papillary muscles, and interventricular septa with 'zebra-like' sign in 3 patients. Left ventricular transmural delayed gadolinium enhancement was found in 1 patient. Conclusions: CMR shows a characteristic pattern of global subendocardial delayed gadolinium enhancement in cardiac amyloidosis. The findings may be valuable in the diagnosis of cardiac amyloidosis. (authors)

  19. 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.

  20. Swedish ambulance nurses' experiences of nursing patients suffering cardiac arrest.

    Science.gov (United States)

    Larsson, Ricard; Engström, Åsa

    2013-04-01

    Effective pre-hospital treatment of a person suffering cardiac arrest is a challenging task for the ambulance nurses. The aim of this study was to describe ambulance nurses' experiences of nursing patients suffering cardiac arrest. Qualitative personal interviews were conducted during 2011 in Sweden with seven ambulance nurses with experience of nursing patients suffering cardiac arrests. The interview texts were analyzed using qualitative thematic content analysis, which resulted in the formulation of one theme with six categories. Mutual preparation, regular training and education were important factors in the nursing of patients suffering cardiac arrest. Ambulance nurses are placed in ethically demanding situations regarding if and for how long they should continue cardio-pulmonary resuscitation (CPR) to accord with pre-hospital cardiac guidelines and patients' wishes. When a cardiac arrest patient is nursed their relatives also need the attention of ambulance nurses. Reflection is one way for ambulance nurses to learn from, and talk about, their experiences. This study provides knowledge of ambulance nurses' experiences in the care of people with cardiac arrest. Better feedback about the care given by the ambulance nurses, and about the diagnosis and nursing care the patients received after they were admitted to the hospital are suggested as improvements that would allow ambulance nurses to learn more from their experience. Further development and research concerning the technical equipment might improve the situation for both the ambulance nurses and the patients. Ambulance nurses need regularly training and education to be prepared for saving people's lives and also to be able to make the right decisions. PMID:23577977

  1. 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

  2. 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.

  3. Milrinone for cardiac dysfunction in critically ill adult patients

    DEFF Research Database (Denmark)

    Koster, Geert; Bekema, Hanneke J; Wetterslev, Jørn;

    2016-01-01

    review was performed according to The Cochrane Handbook for Systematic Reviews of Interventions. Searches were conducted until November 2015. Patients with cardiac dysfunction were included. The primary outcome was serious adverse events (SAE) including mortality at maximum follow-up. The risk of bias...... analyses displayed statistical and/or clinical heterogeneity of patients, interventions, comparators, outcomes, and/or settings and all featured missing data. DISCUSSION: The current evidence on the use of milrinone in critically ill adult patients with cardiac dysfunction suffers from considerable risks...

  4. 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.

  5. 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

  6. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    analysis, namely the Finometer monitor (FNM) for further use on patients dialyzing on a central vascular catheter. Fifty simultaneous cardiac output measurements were obtained during hemodialysis sessions in 25 patients. The internal variability of the FNM measurements was assessed by comparing 24 pairs of...

  7. Utilizing FEM-Software to quantify pre- and post-interventional cardiac reconstruction data based on modelling data sets from surgical ventricular repair therapy (SVRT and cardiac resynchronisation therapy (CRT

    Directory of Open Access Journals (Sweden)

    Verhey Janko F

    2006-10-01

    Full Text Available Abstract Background Left ventricle (LV 3D structural data can be easily obtained using standard transesophageal echocardiography (TEE devices but quantitative pre- and intraoperative volumetry and geometry analysis of the LV is presently not feasible in the cardiac operation room (OR. Finite element method (FEM modelling is necessary to carry out precise and individual volume analysis and in the future will form the basis for simulation of cardiac interventions. Method A Philips/HP Sonos 5500 ultrasound device stores volume data as time-resolved 4D volume data sets. In this prospective study TomTec LV Analysis TEE© Software was used for semi-automatic endocardial border detection, reconstruction, and volume-rendering of the clinical 3D echocardiographic data. With the software FemCoGen© a quantification of partial volumes and surface directions of the LV was carried out for two patients data sets. One patient underwent surgical ventricular repair therapy (SVR and the other a cardiac resynchronisation therapy (CRT. Results For both patients a detailed volume and surface direction analysis is provided. Partial volumes as well as normal directions to the LV surface are pre- and post-interventionally compared. Conclusion The operation results for both patients are quantified. The quantification shows treatment details for both interventions (e.g. the elimination of the discontinuities for CRT intervention and the segments treated for SVR intervention. The LV quantification is feasible in the cardiac OR and it gives a detailed and immediate quantitative feedback of the quality of the intervention to the medical.

  8. 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.

  9. 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...

  10. 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

  11. Preoperative cardiac risk management

    OpenAIRE

    Vidaković Radosav; Poldermans Don; Nešković Aleksandar N.

    2011-01-01

    Approximately 100 million people undergo noncardiac surgery annually worldwide. It is estimated that around 3% of patients undergoing noncardiac surgery experience a major adverse cardiac event. Although cardiac events, like myocardial infarction, are major cause of perioperative morbidity or mortality, its true incidence is difficult to assess. The risk of perioperative cardiac complications depends mainly on two conditions: 1) identified risk factors, and 2) the type of the surgical p...

  12. [Selection criteria for patient admission to cardiac rehabilitation centers].

    Science.gov (United States)

    Greco, Cesare; Cacciatore, Giuseppe; Gulizia, Michele; Martinelli, Luigi; Oliva, Fabrizio; Olivari, Zoran; Seccareccia, Fulvia; Temporelli, Pier Luigi; Urbinati, Stefano

    2011-03-01

    Current guidelines state that cardiac rehabilitation is indicated after the acute phase of major cardiovascular diseases and interventions; on the other hand implementation of these indications is difficult because of several barriers, i.e. the number of patients per year with an indication exceeds by far the accommodation offer of cardiac rehabilitation centers; the demand for access to cardiac rehabilitation from acute cardiac care hospitals is low because the attention is focused on the acute phase of cardiac diseases. The present Consensus Document describes the changes in clinical epidemiology of the main cardiovascular diseases, showing that complications are increasingly more frequent in the post-acute phase, especially in the setting of myocardial infarction. The Joint ANMCO/IACPR-GICR Committee defines priority criteria based on clinical risk for admission to cardiac rehabilitation centers as inpatients. This Consensus Document represents, therefore, an important step forward in the search for continuity of care in high-risk patients during the post-acute phase. PMID:21560480

  13. Cardiac Rehabilitation Patient and Organizational Factors: What Keeps Patients in Programs?

    OpenAIRE

    Turk‐Adawi, Karam I.; Oldridge, Neil B; Tarima, Sergey S.; Stason, William B.; Shepard, Donald S.

    2013-01-01

    Background Despite documented benefits of cardiac rehabilitation, adherence to programs is suboptimal with an average dropout rate of between 24% and 50%. The goal of this study was to identify organizational and patient factors associated with cardiac rehabilitation adherence. Methods and Results Facilities of the Wisconsin Cardiac Rehabilitation Outcomes Registry Project (N=38) were surveyed and records of 4412 enrolled patients were analyzed. Generalized estimating equations were used to a...

  14. Cardiac surgery in patients on hemodialysis: Eight years experience of the Tunisian military hospital

    Directory of Open Access Journals (Sweden)

    Gharsallah Hedi

    2010-01-01

    Full Text Available End-stage renal disease (ESRD is known to be an important risk factor for cardiac operations performed with cardiopulmonary bypass. We investigated the influence of preoperative status on perioperative mortality and morbidity. We retrospectively analyzed data from 26 patients with ESRD, who were on maintenance dialysis and underwent a cardiac surgical procedure bet-ween 2000 and 2007. Of them, 61.5% of the patients had isolated coronary artery bypass grafting (CABG and 38.5% had replacement or reconstruction of one or two valves. The perioperative mortality rate was 26% with five deaths occurring in patients undergoing CABG procedure. We found CABG procedure, being female and left ventricular (LV function < 30% to be associated with a higher relative risk for perioperative death. In conclusion, our data suggest that both indi-cations and referral for surgical intervention for coronary artery disease may be delayed in pa-tients who have ESRD, contributing to the relatively high perioperative mortality.

  15. Rationale and design of a proof-of-concept trial investigating the effect of uninterrupted perioperative (par)enteral nutrition on amino acid profile, cardiomyocytes structure, and cardiac perfusion and metabolism of patients undergoing coronary artery bypass grafting

    OpenAIRE

    Cocchieri Riccardo; van Venrooij Lenny MW; Niessen Hans WM; Kok Wouter EM; Verberne Hein J; Davids Mariska; Visser Marlieke; Wisselink Willem; de Mol Bas AJM; van Leeuwen Paul AM

    2011-01-01

    Abstract Background Malnutrition is very common in patients undergoing cardiac surgery. Malnutrition can change myocardial substrate utilization which can induce adverse effects on myocardial metabolism and function. We aim to investigate the hypothesis that there is a disturbed amino acids profile in the cardiac surgical patient which can be normalized by (par)enteral nutrition before, during and after surgery, subsequently improving cardiomyocyte structure, cardiac perfusion and glucose met...

  16. Pathways to postoperative hostility in cardiac patients: mediation of coping, spiritual struggle and interleukin-6.

    Science.gov (United States)

    Ai, Amy Lee; Pargament, Kenneth; Kronfol, Ziad; Tice, Terrence N; Appel, Hoa

    2010-03-01

    Using structural equation modeling, we estimated major pathways from preoperative distress, indicated by anxiety and other factors, to postoperative hostility in cardiac patients. Sequential interviews were conducted before and after surgery. Standardized medical and surgical indices were selected from a national database. Results showed that preoperative spiritual struggle mediated indirect effects of anxiety and anger coping on Interleukin-6 (IL-6) immediately before surgery. The link between spiritual struggle and IL-6 further mediated the indirect effects of anxiety and anger coping on postoperative hostility. Anger coping mediated the harmful influence of anxiety and counteracted the protection of positive religious coping on adjustment. PMID:20207662

  17. Successful treatment of 54 patients with acute renal failure after cardiac surgery

    Directory of Open Access Journals (Sweden)

    Lei CHEN

    2015-06-01

    Full Text Available Objectives To evaluate the result of treatment of acute renal failure (ARF in patients after cardiac surgery. Methods The clinical data of 54 cases admitted to the hospital from Jan. 2004 to Jan. 2014 and suffered from ARF after cardiac surgery were retrospectively analyzed. Among 54 cases, there were 35 males and 19 females, aged from one month to 79 years with a median of 52 years. The surgical procedures included coronary artery bypass grafting (CABG, 10 cases, valve surgery (22 cases, combined CABG and valve surgery (4 cases, operation on aorta (14 case, and radical correction of Fallot tetralogy (4 cases. After the operations mentioned above, 50 patients received continuous renal replacement therapy (CRRT, and 4 patients received peritoneal dialysis. Results Nine patients died, the mortality rate was 16.7%. Exploratory hemostasis by thoracotomy was performed in 8 patients, and extubation failure occurred in 4 cases. Of the 9 non-survivors, 6 died from multiple organ failure (MOF, 2 died from cerebral hemorrhage, and one died from acute respiratory failure. Serum creatinine (SCr and blood urea nitrogen (BUN levels declined obviously after CRRT and peritoneal dialysis (P<0.05, and all the patients were shown to have stable hemodynamics in the course of treatment, and no hemorrhage or embolism occurred. Conclusions ARF after cardiac surgery should be detected early and treated in time. CRRT and peritoneal dialysis are safe, convenient and effective procedures, and may decrease the mortality rate in patients with ARF after cardiac surgery. DOI: 10.11855/j.issn.0557-7402.2015.04.13

  18. [Perioperative management of patients equipped with cardiac implanted electronic devices].

    Science.gov (United States)

    Booke, Michael; Casu, Sebastian

    2016-04-01

    Anaesthetists are in increasing frequency confronted with patients equipped with cardiac implantable electrical devices. A consensus conference standardized the handling of such patients for elective cases. However, this multidisciplinary approach is characterized by a complexity, which is hard to handle in emergency cases and even in nowadays clinical routine. However, risks associated with electrocautery or electromagnetic interference can be easily handled applying a significantly easier approach. Telemetric reprogramming and/or postoperative interrogation of the cardiac implanted eletronical device can be avoided in most cases. PMID:27070514

  19. A Record Book of Open Heart Surgical Cases between 1959 and 1982, Hand-Written by a Cardiac Surgeon.

    Science.gov (United States)

    Kim, Won-Gon

    2016-08-01

    A book of brief records of open heart surgery underwent between 1959 and 1982 at Seoul National University Hospital was recently found. The book was hand-written by the late professor and cardiac surgeon Yung Kyoon Lee (1921-1994). This book contains valuable information about cardiac patients and surgery at the early stages of the establishment of open heart surgery in Korea, and at Seoul National University Hospital. This report is intended to analyze the content of the book. PMID:27525246

  20. 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...

  1. Non-cardiac issues in patients with heterotaxy syndrome

    Directory of Open Access Journals (Sweden)

    Shyam S Kothari

    2014-01-01

    Full Text Available Management of complex congenital heart disease in patients with Heterotaxy syndrome (HS has steadily improved. However, there is an insufficient appreciation of various non-cardiac issues that might impact the overall status of these patients. This article briefly reviews the implications of gastrointestinal, immunologic, genitourinary, respiratory, and central nervous system involvement in HS patients with a view to aid in their comprehensive clinical management.

  2. Management of Infection in the Post-Cardiac-Transplant Patient

    OpenAIRE

    Zeluff, Barry; Gentry, Layne O.

    1987-01-01

    In reviewing our post-transplant experience with infection in 192 cardiac transplant patients, * we have noticed a pattern. During the first month following transplantation, the patient seldom has an opportunistic infection, but is in danger of nosocomial infection (84 episodes in 57 patients). These include wound infection, and infections of the lungs, blood, and urinary tract. After the first month, and for the duration of the first year following transplantation, nosocomial infections beco...

  3. 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.

  4. Myocardial ischemia during intravenous DSA in patients with cardiac disease

    International Nuclear Information System (INIS)

    A prospective study was performed for 48 patients who had histories of angina and were referred for digital subtraction angiography (DSA). Cardiac disease was graded according to the American Heart Association (AHA) functional classification system. Each patient received 2-5 injections of 40-ml diatrizoate meglumine and diatrizoate sodium at 15 ml per second in the superior vena cava. Of the 28 patients in functional Classes I or II, 11% had angina and 32% had definite ischemic ECG changes after the DSA injections. Of the patients in functional Class III 63% had angina, and 58% had definite ischemic ECG changes after the injections. These observed cardiac effects following bolus injections of hypertonic ionic contrast media indicate that special precautions are necessary when performing intravenous DSA examinations on this group of high risk patients

  5. 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.

  6. 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.

  7. Sudden chest pain and cardiac emergencies in the obstetric patient.

    Science.gov (United States)

    Mabie, W C; Freire, C M

    1995-03-01

    The differential diagnosis and work-up of a patient with chest pain during pregnancy is presented in this article. This is followed by discussions of cardiac emergencies including hypertensive crisis, pulmonary edema, arrhythmias, cardiopulmonary resuscitation, myocardial infarction, and aortic dissection. PMID:7784039

  8. Exercise-based cardiac rehabilitation in patients with heart failure

    DEFF Research Database (Denmark)

    Lewinter, Christian; Doherty, Patrick; Gale, Christopher P;

    2015-01-01

    BACKGROUND: Guidelines recommend exercise-based cardiac rehabilitation (EBCR) for patients with heart failure (HF). However, established research has not investigated the longer-term outcomes including mortality and hospitalisation in light of the contemporary management of HF. METHODS: This was a...

  9. Long-term postoperative mortality in diabetic patients undergoing major non-cardiac surgery

    DEFF Research Database (Denmark)

    Juul, A B; Wetterslev, J; Kofoed-Enevoldsen, A

    2004-01-01

    a major risk factor for both short-term ( 30 days) patients especially after major cardiac surgery. We examined the long-term postoperative mortality of diabetic patients undergoing major non-cardiac surgery to identify possible perioperative risk factors....

  10. 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

  11. Coagulation Parameter Thresholds Associated with Non-Bleeding in the Eighth Hour of Adult Cardiac Surgical Post-Cardiotomy Extracorporeal Membrane Oxygenation.

    Science.gov (United States)

    Riley, Jeffrey B; Schears, Gregory J; Nuttall, Gregory A; Oliver, William C; Ereth, Mark H; Dearani, Joseph A

    2016-06-01

    Excessive bleeding and allogeneic transfusion during adult post-cardiotomy venoarterial extracorporeal membrane oxygenation (ECMO) are potentially harmful and expensive. Balancing the inhibition of clotting and distinguishing surgical from non-surgical bleeding in post-operative period is difficult. The sensitivity of coagulation tests including Thromboelastography(®) (TEG) to predict chest tube drainage in the early hours of ECMO was examined with the use of receiver-operating characteristics (ROC). The results are useful to incorporate in clinical evidence-based algorithms to guide management decisions. In the eighth hour of ECMO, 26 of the 53 adult patients (49%) studied were identified as non-bleeders (less than 2.0 mL/kg/h). All had experienced various types of cardiac surgical procedures. Fifty-two percent were female and the group was 54 ± 19 (mean ± 1 SD) years old. The coagulation parameter threshold with the maximum sensitivity and specificity to predict non-bleeding at 8 hours on ECMO was the kaolin plus heparinase TEG maximum amplitude (KH-TEG MA) at a significant ROC threshold (t) > 50 mm. The activated partial thromboplastin time (aPTT) t 51°, and the kaolin activated clotting time (ACT) t < 148 seconds were sensitive predictors of non-bleeders. The whole-blood KH-TEG MA was superior to the plasma-based aPTT or International Normalization Ratio (INR) to predict bleeding in the eighth hour of ECMO. Using coagulation laboratory thresholds that predict non-bleeding can begin a process of identifying patients earlier that are likely to bleed. Awareness of these parameter thresholds may improve care through patient protection from unnecessary transfusion and prolonging the life of the ECMO circuit. An algorithm incorporating the ROC thresholds was created to help recognize surgical bleeding to minimize unnecessary transfusions. PMID:27578897

  12. Radiographic findings in the chest of patients following cardiac transplantation

    International Nuclear Information System (INIS)

    The postoperative chest radiographic findings in 38 patients undergoing orthotopic (37 patients) and heterotopic (1 patient) cardiac transplantation were evaluated. Findings were correlated with those of echocardiograms, sputum and blood cultures, and lung and heart biopsies. The radiographic manifestations in the chest of these patients are classified in the following three main categories: 1) newly formed cardiac silhouette findings due to the transplanted heart itself, i.e., changes in size and shape of the new heart and pericardial effusion resulting from the placement of a smaller heart in a larger pericardial sac. 2) infectious complications due to bacteria, fungal, and other opportunistic agents secondary to immunosuppressive therapy, and 3) usual postoperatice complications following thoracomoty and open-heart surgery. (orig.)

  13. 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.

  14. Assessment of Patient and Relatives Satisfaction in a Cardiac Surgery ICU Model

    Directory of Open Access Journals (Sweden)

    Kamran Shadvar

    2015-10-01

    Full Text Available Introduction: Evaluation of patients’ and their families’ satisfaction regarding the quality of care in the ICU is an important concern that can identify deficiencies of this field and help to improve satisfaction of both patients and their families. Considering the fact that problems related to cardiac surgery ICUs differ from other ICUs, recognition of these problems and the factors that lead to patient or family dissatisfaction can not only improve the quality and quantity of services provided in this section but also lead to increased satisfaction in these groups and promote scientific and practical knowledge related to sectors at regional levels. The aim of this study was to evaluate the satisfaction of patients and their families from the quantity and quality of services provided in the cardiac surgical ICU of Madani hospital, Tabriz, Iran. Materials and Methods: In this descriptive study, satisfaction of patients and their relatives from cardiac surgery ICU of Shahid Madani Hospital was evaluated using Modified MISS questionnaire for patients and CCMFNA questionnaires for their relatives during one year (1391-1390. The obtained data were statistically analyzed using descriptive statistics (frequency, percentage, mean ± SD and SPSS ver. 15. Results: Majority of patients expressed moderate to high satisfaction. The overall satisfaction of doctors was higher than nurses (27% vs. 22%. The lowest level of satisfaction related to the possibility of meeting relatives (14.3%. Most relatives were spouses of patients who contributed to the highest rate of satisfaction; however, the location and meets expectations were less satisfactory. Conclusion: Improving waiting room quality, increasing duration of family meetings and increasing nursing attention are the factors that could be associated with further satisfaction. Keywords: ICU; Patient satisfaction; Family satisfaction

  15. Evolution of elderly patients who underwent cardiac surgery with cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Alain Moré Duarte

    2016-01-01

    Full Text Available Introduction: There is a steady increase in the number of elderly patients with severe cardiovascular diseases who require a surgical procedure to recover some quality of life that allows them a socially meaningful existence, despite the risks.Objectives: To analyze the behavior of elderly patients who underwent cardiac surgery with cardiopulmonary bypass.Method: A descriptive, retrospective, cross-sectional study was conducted with patients over 65 years of age who underwent surgery at the Cardiocentro Ernesto Che Guevara, in Santa Clara, from January 2013 to March 2014.Results: In the study, 73.1% of patients were men; and there was a predominance of subjects between 65 and 70 years of age, accounting for 67.3%. Coronary artery bypass graft was the most prevalent type of surgery and had the longest cardiopulmonary bypass times. Hypertension was present in 98.1% of patients. The most frequent postoperative complications were renal dysfunction and severe low cardiac output, with 44.2% and 34.6% respectively.Conclusions: There was a predominance of men, the age group of 65 to 70 years, hypertension, and patients who underwent coronary artery bypass graft with prolonged cardiopulmonary bypass. Renal dysfunction was the most frequent complication.

  16. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

    OpenAIRE

    Hann Christopher E; Chase J; Sundaresan Ashwath; Shaw Geoffrey M

    2010-01-01

    Abstract The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines...

  17. Management of Pregnancy in the Post-Cardiac Transplant Patient

    OpenAIRE

    Abdalla, Marwah; Mancini, Donna M.

    2014-01-01

    Over the past 10 years, heart transplantation survival has increased among transplant recipients. Because of improved outcomes in both congenital and adult transplant recipients, the number of male and female patients of childbearing age who desire pregnancy has also increased within this population. While there have been many successful pregnancies in post-cardiac transplant patients reported in the literature, long-term outcome data is limited. Decisions regarding the optimal timing and man...

  18. Benefit of cardiac rehabilitation programme in revascularized coronary patient

    OpenAIRE

    Laura Crăciun; Claudiu Avram; Adina Avram; Stela Iurciuc; Dan Gaiţă

    2009-01-01

    Objective: Evaluating the cardiovascular risk profile in revascularized coronary patients at 16 months after revascularization(PCI+CABG). Material and method: We evaluated the cardiovascular risk profile, compliance to the secondary preventionmeasures and reaching guideline targets in revascularized coronary patients included in EuroASpire III Romania. The patientswere divided in two groups: the selection criteria was the adherence to cardiac rehabilitation programme (CRP+/CRP-). Result:The p...

  19. Data analysis on patient exposures in cardiac angiography

    Energy Technology Data Exchange (ETDEWEB)

    Huyskens, C.J.; Hummel, W.A. [Eindhoven University of Technology (Netherlands). Radiation Protection Dept.

    1995-12-31

    In cardiac interventional radiology the fluoroscopy time and the film length are dominating factors for the resulting exposure of patients. From experiments in laboratory conditions and from measurements in actual practice an empirical formula has been derived to calculate the kerma-exposure product as a function of fluoroscopy time and film length. to simulate actual medical practice as closely as possible during the experiments, reference procedures were composed for fluoroscopy and cine-angiography. Over a period of two years, data on fluoroscopy time and cine film length were collected in the clinical practice of a large cardiology department in a major hospital in the Netherlands. The data refer to nearly 3000 cardiac intervention procedures, 50/50 divided between cardio-angiography (CAG) and percutaneous transluminal coronary angiography (PTCA). The mean value for the kerma-area product over all cardiac procedures is approx. 40 Gy cm{sup 2}. The relative standard deviation is 60%. From the distribution measured, it follows that about 20 % of all cardiac procedures account for approximately half the collective dose for patients. The empirically derived fit-function to calculate the kerma-area product provides a useful method to analyse patient exposures in interventional radiology as an aid in the context of quality assurance of medical practice and ALARA programmes in radiological protection. (Author).

  20. 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

  1. Cardiac evaluation in pediatric patients waiting for liver transplantation

    Directory of Open Access Journals (Sweden)

    Seyed Mohsen Dehghani, Naser Honar, Hamid Amoozegar, Ahad Eshraghian, Mohammad Borzooei, Mohammad Hadi Imanieh, Seyed Ali Malek-Hosseini

    2010-01-01

    Full Text Available Background: Cardiovascular abnormalities are among common complication in patients with cirrhosis waiting for liver transplantation (LT. The aim of the present study was to investigate cardiac abnormalities among pediatric liver transplant candidates.Methods: We prospectively evaluated the pediatric patient aged less than 18 years listed for LT between 2006 and 2008. Besides history taking and physical examination all the patients underwent electrocardiogram, chest radiograph, contrast echocardiography and color Doppler echocardiography, as well as arterial blood gas analyses.Results: Totally 89 patients with mean age of 8.1±4.6 years were included in the study. The most common causes for liver disease were cryptogenic cirrhosis followed by biliary atresia and autoimmune cirrhosis. Clubbing was found in 27 out of 89 patients and was the most common abnormalities in physical examination. In 22 patients (24.7% heart murmur was heard by a pediatric cardiologist. Sixty nine patients (77.5% had normal cardiac findings in chest radiograph. Cardiomegaly was found in 17 (19.1% patients as the most common abnormal finding in chest radiograph. Electrocardiogram showed sinus tachycardia in 16 (18% patients. Eleven patients (12.4% had tricuspid regurgitation as the most common abnormal findings in echocardiography. Thirteen (14.6% patients had positive contrast echocardiography in favor of intrapulmonary shunt.Conclusion: As the leading cause of post transplant death after graft rejection are cardiovascular complications cardiac evaluation should be considered in all pediatric patients before LT to lower morbidity and mortality during and after transplantation.

  2. Focused cardiac ultrasound in the emergency department for patients admitted with respiratory symptoms

    DEFF Research Database (Denmark)

    Laursen, C. B.

    2015-01-01

    In patients admitted with respiratory failure, a large proportion is diagnosed incorrectly in the emergency department and an even larger proportion seems to receive inappropriate treatment. Inappropriate initial treatment of these patients in the emergency department is associated with increased...... triage, patients with cardiac arrest, patients with undifferentiated shock, patients with cardiopulmonary instability, patients with respiratory symptoms, trauma patients with suspected cardiac injuries, and assessment of the fluid status before fluid loading. When using focused cardiac ultrasound (US...

  3. 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.

  4. Benefit of cardiac rehabilitation programme in revascularized coronary patient

    Directory of Open Access Journals (Sweden)

    Laura Crăciun

    2009-06-01

    Full Text Available Objective: Evaluating the cardiovascular risk profile in revascularized coronary patients at 16 months after revascularization(PCI+CABG. Material and method: We evaluated the cardiovascular risk profile, compliance to the secondary preventionmeasures and reaching guideline targets in revascularized coronary patients included in EuroASpire III Romania. The patientswere divided in two groups: the selection criteria was the adherence to cardiac rehabilitation programme (CRP+/CRP-. Result:The prevelence of cardiovascular risk factors was about 76%, with an increased significance in CRP- group (p0.05, OR>1. Conclusion: At 16 months after revascularisation, the patientsstill present a high risk. The level of cardio-metabolic and hemodynamic risk are maintained the same by unreaching thetargeted values recomended by ESC prevention guideline. The patients in CPR+ group had a significant improvement ofcardiovascular risk factors. Indication but also compliance to structured cardiac rehabilitation programme after myocardialrevascularisation remains at a suboptimal level.

  5. 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

  6. Simultaneous surgery in patients with both cardiac and noncardiac diseases

    Directory of Open Access Journals (Sweden)

    Yang Y

    2016-07-01

    Full Text Available Yang Yang,1 Feng Xiao,1 Jin Wang,1 Bo Song,1 Xi-Hui Li,1 Jian Li,2 Zhi-Song He,3 Huan Zhang,4 Ling Yin5 1Department of Cardiac Surgery, 2Department of Thoracic Surgery, 3Department of Urology Surgery, 4Department of General Surgery, 5Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, People’s Republic of China Background: To investigate the possibility and feasibility of simultaneous cardiac and noncardiac surgery.Methods: From August 2000 to March 2015, 64 patients suffering from cardiac and noncardiac diseases have been treated by simultaneous surgeries.Results: Two patients died after operations in hospital; thus, the hospital mortality rate was 3.1%. One patient with coronary heart disease, acute myocardial infarction, and a recurrence of bladder cancer accepted emergency simultaneous coronary artery bypass grafting (CABG, bladder cystectomy, and ureterostomy. He died of acute cerebral infarction complicated with multiple organ failure on the 153rd day after operation. The other patient with chronic constrictive pericarditis and right lung cancer underwent pericardial stripping and right lung lower lobectomy, which resulted in multiple organ failure, and the patient died on the tenth day postoperatively. The remaining 62 patients recovered and were discharged. The total operative morbidity was 17.2%: postoperative hemorrhage (n, % [1, 1.6%], pulmonary infection and hypoxemia (2, 3.1%, hemorrhage of upper digestive tract (1, 1.6%, incisional infection (3, 4.7%, subphrenic abscess (1, 1.6%, and postoperative acute renal failure and hemofiltration (3, 4.7%. Of the 62 patients discharged, 61 patients were followed up. Eleven patients died with 10 months to 10 years during the follow-up. The mean survival time is 116.2±12.4 months. The cumulative survival rate is 50.8%.Conclusion: Simultaneous surgeries in patients suffering from both cardiac and noncardiac benign or malignant diseases are safe and possible

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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

  12. Impact of bleeding-related complications and/or blood product transfusions on hospital costs in inpatient surgical patients

    Directory of Open Access Journals (Sweden)

    Reynolds Matthew W

    2011-05-01

    Full Text Available Abstract Background Inadequate surgical hemostasis may lead to transfusion and/or other bleeding-related complications. This study examines the incidence and costs of bleeding-related complications and/or blood product transfusions occurring as a consequence of surgery in various inpatient surgical cohorts. Methods A retrospective analysis was conducted using Premier's Perspective™ hospital database. Patients who had an inpatient procedure within a specialty of interest (cardiac, vascular, non-cardiac thoracic, solid organ, general, reproductive organ, knee/hip replacement, or spinal surgery during 2006-2007 were identified. For each specialty, the rate of bleeding-related complications (including bleeding event, intervention to control for bleeding, and blood product transfusions was examined, and hospital costs and length of stay (LOS were compared between surgeries with and without bleeding-related complications. Incremental costs and ratios of average total hospital costs for patients with bleeding-related complications vs. those without complications were estimated using ordinary least squares (OLS regression, adjusting for demographics, hospital characteristics, and other baseline characteristics. Models using generalized estimating equations (GEE were also used to measure the impact of bleeding-related complications on costs while accounting for the effects related to the clustering of patients receiving care from the same hospitals. Results A total of 103,829 cardiac, 216,199 vascular, 142,562 non-cardiac thoracic, 45,687 solid organ, 362,512 general, 384,132 reproductive organ, 246,815 knee/hip replacement, and 107,187 spinal surgeries were identified. Overall, the rate of bleeding-related complications was 29.9% and ranged from 7.5% to 47.4% for reproductive organ and cardiac, respectively. Overall, incremental LOS associated with bleeding-related complications or transfusions (unadjusted for covariates was 6.0 days and ranged from 1

  13. Radiation Dose Estimation for Pediatric Patients Undergoing Cardiac Catheterization

    Science.gov (United States)

    Wang, Chu

    Patients undergoing cardiac catheterization are potentially at risk of radiation-induced health effects from the interventional fluoroscopic X-ray imaging used throughout the clinical procedure. The amount of radiation exposure is highly dependent on the complexity of the procedure and the level of optimization in imaging parameters applied by the clinician. For cardiac catheterization, patient radiation dosimetry, for key organs as well as whole-body effective, is challenging due to the lack of fixed imaging protocols, unlike other common X-ray based imaging modalities. Pediatric patients are at a greater risk compared to adults due to their greater cellular radio-sensitivities as well as longer remaining life-expectancy following the radiation exposure. In terms of radiation dosimetry, they are often more challenging due to greater variation in body size, which often triggers a wider range of imaging parameters in modern imaging systems with automatic dose rate modulation. The overall objective of this dissertation was to develop a comprehensive method of radiation dose estimation for pediatric patients undergoing cardiac catheterization. In this dissertation, the research is divided into two main parts: the Physics Component and the Clinical Component. A proof-of-principle study focused on two patient age groups (Newborn and Five-year-old), one popular biplane imaging system, and the clinical practice of two pediatric cardiologists at one large academic medical center. The Physics Component includes experiments relevant to the physical measurement of patient organ dose using high-sensitivity MOSFET dosimeters placed in anthropomorphic pediatric phantoms. First, the three-dimensional angular dependence of MOSFET detectors in scatter medium under fluoroscopic irradiation was characterized. A custom-made spherical scatter phantom was used to measure response variations in three-dimensional angular orientations. The results were to be used as angular dependence

  14. 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

  15. Cardiac rhabdomyosarcoma

    OpenAIRE

    Chlumský, Jaromír; Holá, Dana; Hlaváček, Karel; Michal, Michal; Švec, Alexander; Špatenka, Jaroslav; Dušek, Jan

    2001-01-01

    Cardiac sarcoma is a very rare neoplasm and is difficult to diagnose. The case of a 51-year-old man with a left atrial tumour, locally recurrent three months after its surgical removal, is presented. Computed tomography showed metastatic spread to the lung parenchyma. On revised histology, the mass extirpated was a sarcoma. Because of the metastatic spread, further therapy was symptomatic only; the patient died 15 months after the first manifestation of his problems. Immunohistochemical stain...

  16. Brain Embolism Secondary to Cardiac Myxoma in Fifteen Chinese Patients

    Directory of Open Access Journals (Sweden)

    Youming Long

    2014-01-01

    Full Text Available Background. Heart myxoma-related embolisms commonly involve the central nervous system, but data are lacking in Chinese patients. Methods. 27 patients diagnosed with myxoma were reviewed retrospectively. Results. Among 27 patients, fourteen (51.9% patients were women. Fifteen (55.6% patients had brain embolisms. Rarely, patients were misdiagnosed with central nervous system vasculitis (n = 2, moyamoya disease (n = 1, and neuromyelitis optica (n = 1. We found positive associations between mRS (>3 and female gender (r = 0.873, P10 × 109/L (r = 0.722, P = 0.002, tumour size (r = 0.866, P0.05. Conclusions. Neurologic manifestations in Chinese patients with cardiac myxoma-related stroke were complicated and multifarious. Female gender, infection, other severe complications, low SBP, tumour size, bilateral brain lesions, TACI, and high WBC counts could be associated with a poor prognosis.

  17. Identification of patient specific parameters for a minimal cardiac model.

    Science.gov (United States)

    Hann, C E; Chase, J G; Shaw, G M; Smith, B W

    2004-01-01

    A minimal cardiac model has been developed which accurately captures the essential dynamics of the cardiovascular system (CVS). This paper develops an integral based parameter identification method for fast and accurate identification of patient specific parameters for this minimal model. The integral method is implemented using a single chamber model to prove the concept, and turns a previously nonlinear and nonconvex optimization problem into a linear and convex problem. The method can be readily extended to the full minimal cardiac model and enables rapid identification of model parameters to match a particular patient condition in clinical real time (3-5 minutes). This information can then be used to assist medical staff in understanding, diagnosis and treatment selection. PMID:17271801

  18. Cardiac tumours in children

    Directory of Open Access Journals (Sweden)

    Parsons Jonathan M

    2007-03-01

    Full Text Available Abstract Cardiac tumours are benign or malignant neoplasms arising primarily in the inner lining, muscle layer, or the surrounding pericardium of the heart. They can be primary or metastatic. Primary cardiac tumours are rare in paediatric practice with a prevalence of 0.0017 to 0.28 in autopsy series. In contrast, the incidence of cardiac tumours during foetal life has been reported to be approximately 0.14%. The vast majority of primary cardiac tumours in children are benign, whilst approximately 10% are malignant. Secondary malignant tumours are 10–20 times more prevalent than primary malignant tumours. Rhabdomyoma is the most common cardiac tumour during foetal life and childhood. It accounts for more than 60% of all primary cardiac tumours. The frequency and type of cardiac tumours in adults differ from those in children with 75% being benign and 25% being malignant. Myxomas are the most common primary tumours in adults constituting 40% of benign tumours. Sarcomas make up 75% of malignant cardiac masses. Echocardiography, Computing Tomography (CT and Magnetic Resonance Imaging (MRI of the heart are the main non-invasive diagnostic tools. Cardiac catheterisation is seldom necessary. Tumour biopsy with histological assessment remains the gold standard for confirmation of the diagnosis. Surgical resection of primary cardiac tumours should be considered to relieve symptoms and mechanical obstruction to blood flow. The outcome of surgical resection in symptomatic, non-myxomatous benign cardiac tumours is favourable. Patients with primary cardiac malignancies may benefit from palliative surgery but this approach should not be recommended for patients with metastatic cardiac tumours. Surgery, chemotherapy and radiotherapy may prolong survival. The prognosis for malignant primary cardiac tumours is generally extremely poor.

  19. Automated segmentation and reconstruction of patient-specific cardiac anatomy and pathology from in vivo MRI

    International Nuclear Information System (INIS)

    This paper presents an automated method to segment left ventricle (LV) tissues from functional and delayed-enhancement (DE) cardiac magnetic resonance imaging (MRI) scans using a sequential multi-step approach. First, a region of interest (ROI) is computed to create a subvolume around the LV using morphological operations and image arithmetic. From the subvolume, the myocardial contours are automatically delineated using difference of Gaussians (DoG) filters and GSV snakes. These contours are used as a mask to identify pathological tissues, such as fibrosis or scar, within the DE-MRI. The presented automated technique is able to accurately delineate the myocardium and identify the pathological tissue in patient sets. The results were validated by two expert cardiologists, and in one set the automated results are quantitatively and qualitatively compared with expert manual delineation. Furthermore, the method is patient-specific, performed on an entire patient MRI series. Thus, in addition to providing a quick analysis of individual MRI scans, the fully automated segmentation method is used for effectively tagging regions in order to reconstruct computerized patient-specific 3D cardiac models. These models can then be used in electrophysiological studies and surgical strategy planning. (paper)

  20. Automated segmentation and reconstruction of patient-specific cardiac anatomy and pathology from in vivo MRI*

    Science.gov (United States)

    Ringenberg, Jordan; Deo, Makarand; Devabhaktuni, Vijay; Filgueiras-Rama, David; Pizarro, Gonzalo; Ibañez, Borja; Berenfeld, Omer; Boyers, Pamela; Gold, Jeffrey

    2012-12-01

    This paper presents an automated method to segment left ventricle (LV) tissues from functional and delayed-enhancement (DE) cardiac magnetic resonance imaging (MRI) scans using a sequential multi-step approach. First, a region of interest (ROI) is computed to create a subvolume around the LV using morphological operations and image arithmetic. From the subvolume, the myocardial contours are automatically delineated using difference of Gaussians (DoG) filters and GSV snakes. These contours are used as a mask to identify pathological tissues, such as fibrosis or scar, within the DE-MRI. The presented automated technique is able to accurately delineate the myocardium and identify the pathological tissue in patient sets. The results were validated by two expert cardiologists, and in one set the automated results are quantitatively and qualitatively compared with expert manual delineation. Furthermore, the method is patient-specific, performed on an entire patient MRI series. Thus, in addition to providing a quick analysis of individual MRI scans, the fully automated segmentation method is used for effectively tagging regions in order to reconstruct computerized patient-specific 3D cardiac models. These models can then be used in electrophysiological studies and surgical strategy planning.

  1. Patient doses from fluoroscopically guided cardiac procedures in pediatrics

    Science.gov (United States)

    Martinez, L. C.; Vano, E.; Gutierrez, F.; Rodriguez, C.; Gilarranz, R.; Manzanas, M. J.

    2007-08-01

    Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for <1 year; 52 for 1-<5 years; 25 for 5-<10 years and 13 for 10-<16 years. Median values of KAP were 1.9, 2.9, 4.5 and 15.4 Gy cm2 respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers.

  2. Overhydration, cardiac function and survival in hemodialysis patients

    OpenAIRE

    Mihai Onofriescu; Dimitrie Siriopol; Luminita Voroneanu; Simona Hogas; Ionut Nistor; Mugurel Apetrii; Laura Florea; Gabriel Veisa; Irina Mititiuc; Mehmet Kanbay; Radu Sascau; Adrian Covic

    2015-01-01

    RESEARCH ARTICLE Overhydration, Cardiac Function and Survival in Hemodialysis Patients Mihai Onofriescu1☯, Dimitrie Siriopol1☯, Luminita Voroneanu1, Simona Hogas1, Ionut Nistor1, Mugurel Apetrii1, Laura Florea1, Gabriel Veisa1, Irina Mititiuc1, Mehmet Kanbay3, Radu Sascau2, Adrian Covic1* 1 Department of Nephrology, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania, 2 Department of Cardiology, University of Medicine and Pharmacy “Gr. T. Popa”, Iasi, Romania...

  3. Cardiac stem cells in patients with heart disease

    OpenAIRE

    Zhao, Xiaohui; Huang, Lan

    2013-01-01

    The heart has been regarded as a terminally differentiated organ for decades. There are numerous indicators for the potency of myocardial regeneration, which opens up new avenues for the treatment of heart disease. Cardiac stem cells (CSCs) have been discovered in the human heart and they play a vital role in myocardial regeneration. This review discusses the distribution, properties and proliferation of CSCs in the myocardium of patients with heart disease. Additionally, the potency of myoca...

  4. Anxiety, Depression and Psychosocial Stress in Patients with Cardiac Events

    OpenAIRE

    Michael, Anne John; Krishnaswamy, Saroja; Muthusamy, Tamil Selvan; Yusuf, Khalid; Mohamed, Jamaludin

    2005-01-01

    Stress tends to worsen the prognosis of patients with coronary heart disease. The aim of the study is to determine the relationship between stress related psychosocial factors like anxiety, depression and life events and temporally cardiac events specified as acute myocardial infarction and unstable angina 65 subjects with confirmed myocardial infarction or unstable angina were interviewed using 2 sets of questionnaire, the Hospital Anxiety and Depression Scale (HADS) and Life Changes Stress ...

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

    Directory of Open Access Journals (Sweden)

    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.

  6. 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

  7. 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.

  8. 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

  9. 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

  10. 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

  11. The cardiac phenotype in patients with a CHD7 mutation

    DEFF Research Database (Denmark)

    Corsten-Janssen, Nicole; Kerstjens-Frederikse, Wilhelmina S; du Marchie Sarvaas, Gideon J;

    2013-01-01

    Loss-of-function mutations in CHD7 cause Coloboma, Heart Disease, Atresia of Choanae, Retardation of Growth and/or Development, Genital Hypoplasia, and Ear Abnormalities With or Without Deafness (CHARGE) syndrome, a variable combination of multiple congenital malformations including heart defects....... Heart defects are reported in 70% to 92% of patients with a CHD7 mutation, but most studies are small and do not provide a detailed classification of the defects. We present the first, detailed, descriptive study on the cardiac phenotype of 299 patients with a CHD7 mutation and discuss the role of CHD7...

  12. 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...

  13. Radiation Therapy, Cardiac Risk Factors, and Cardiac Toxicity in Early-Stage Breast Cancer Patients

    International Nuclear Information System (INIS)

    Purpose: The benefits of adjuvant radiation therapy (RT) for breast cancer may be counterbalanced by the risk of cardiac toxicity. We studied the cardiac effects of RT and the impact of pre-existing cardiac risk factors (CRFs) in a population-based sample of older patients with breast cancer. Methods and Materials: In the Surveillance, Epidemiology and End-Results (SEER)-Medicare database of women ≥65 years diagnosed with Stages I to III breast cancer from January 1, 1992 to December 31, 2000, we used multivariable logistic regression to model the associations of demographic and clinical variables with postmastectomy and postlumpectomy RT. Using Cox proportional hazards regression, we then modeled the association between treatment and myocardial infarction (MI) and ischemia in the 10 or more years after diagnosis, taking the predictors of treatment into account. Results: Among 48,353 women with breast cancer; 19,897 (42%) were treated with lumpectomy and 26,534 (55%) with mastectomy; the remainder had unknown surgery type (3%). Receipt of RT was associated with later year of diagnosis, younger age, fewer comorbidities, nonrural residence, and chemotherapy. Postlumpectomy RT was also associated with white ethnicity and no prior history of heart disease (HD). The RT did not increase the risk of MI. Presence of MI was associated with age, African American ethnicity, advanced stage, nonrural residence, more than one comorbid condition, a hormone receptor-negative tumor, CRFs and HD. Among patients who received RT, tumor laterality was not associated with MI outcome. The effect of RT on the heart was not influenced by HD or CRFs. Conclusion: It appears unlikely that RT would increase the risk of MI in elderly women with breast cancer, regardless of type of surgery, tumor laterality, or history of CRFs or HD, for at least 10 years

  14. A Retrospective Study of Congenital Cardiac Abnormality Associated with Scoliosis

    OpenAIRE

    Bozcali, Evin; Ucpunar, Hanifi; Sevencan, Ahmet; Balioglu, Mehmet Bulent; Albayrak, Akif; Polat, Veli

    2016-01-01

    Study Design Retrospective study. Purpose To identify the incidence of congenital cardiac abnormalities in patients who had scoliosis and underwent surgical treatment for scoliosis. Overview of Literature Congenital and idiopathic scoliosis (IS) are associated with cardiac abnormalities. We sought to establish and compare the incidence of congenital cardiac abnormalities in patients with idiopathic and congenital scoliosis (CS) who underwent surgical treatment for scoliosis. Methods Ninety co...

  15. 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.

  16. 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

  17. Patient specific fluid-structure ventricular modelling for integrated cardiac care.

    Science.gov (United States)

    de Vecchi, A; Nordsletten, D A; Razavi, R; Greil, G; Smith, N P

    2013-11-01

    Cardiac diseases represent one of the primary causes of mortality and result in a substantial decrease in quality of life. Optimal surgical planning and long-term treatment are crucial for a successful and cost-effective patient care. Recently developed state-of-the-art imaging techniques supply a wealth of detailed data to support diagnosis. This provides the foundations for a novel approach to clinical planning based on personalisation, which can lead to more tailored treatment plans when compared to strategies based on standard population metrics. The goal of this study is to develop and apply a methodology for creating personalised ventricular models of blood and tissue mechanics to assess patient-specific metrics. Fluid-structure interaction simulations are performed to analyse the diastolic function in hypoplastic left heart patients, who underwent the first stage of a three-step surgical palliation and whose condition must be accurately evaluated to plan further intervention. The kinetic energy changes generated by the blood propagation in early diastole are found to reflect the intraventricular pressure gradient, giving indications on the filling efficiency. This suggests good agreement between the 3D model and the Euler equation, which provides a simplified relationship between pressure and kinetic energy and could, therefore, be applied in the clinical context. PMID:23340962

  18. 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

  19. Cardiac echinococcosis

    Directory of Open Access Journals (Sweden)

    Ivanović-Krstić Branislava A.

    2002-01-01

    Full Text Available Cardiac hydatid disease is rare. We report on an uncommon hydatid cyst localized in the right ventricular wall, right atrial wall tricuspid valve left atrium and pericard. A 33-year-old woman was treated for cough, fever and chest pain. Cardiac echocardiograpic examination revealed a round tumor (5.8 x 4 cm in the right ventricular free wall and two smaller cysts behind that tumor. There were cysts in right atrial wall and tricuspidal valve as well. Serologic tests for hydatidosis were positive. Computed tomography finding was consistent with diagnosis of hydatid cyst in lungs and right hylar part. Surgical treatment was rejected due to great risk of cardiac perforation. Medical treatment with albendazole was unsuccessful and the patient died due to systemic hydatid involvement of the lungs, liver and central nervous system.

  20. 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 ...

  1. 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...

  2. Incidence and risk factors of delirium in critically ill patients after non-cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    SHI Cheng-mei; WANG Dong-xin; CHEN Kai-sheng; GU Xiu-e

    2010-01-01

    Background Delirium is a common and deleterious complication in critically ill patients after surgery. The purpose of this study was to determine the incidence and risk factors of delirium in critically ill patients after non-cardiac surgery, and to investigate the relationship between the serum cortisol level and the occurrence of postoperative delirium. Methods In a prospective cohort study, 164 consecutive patients who were admitted to the surgical intensive care unit after non-cardiac surgery were enrolled. Baseline characteristics and perioperative variables were collected. Blood samples were obtained on the first postoperative day and serum cortisol concentrations were measured. Delirium was assessed using the Nursing Delirium Screening Scale until the seventh postoperative day or the disappearance of delirious symptoms.Results Postoperative delirium occurred in 44.5% of patients (73 of 164). The median time to first onset of delirium is 0 (range 0 to 5 days) and the median duration of delirium is 3 (1 to 13) days. Independent risk factors of postoperative delirium included increasing age (odds ratio (OR) 2.646, 95% confidence interval (CI) 1.431 to 4.890, P=0.002), a history of previous stroke (OR 4.499, 95%CI 1.228 to 16.481, P=0.023), high Acute Physiology and Chronic Health Evaluation Ⅱ score on surgical intensive care unite admission (OR 1.391, 95%CI 1.201 to 1.612, P<0.001), and high serum cortisol level on the 1 st postoperative day (OR 3.381, 95%CI 1.690 to 6.765, P=0.001). The development of delirium was linked to higher incidence of postoperative complications (28.8% vs. 7.7%, P<0.001), and longer duration of hospitalization (18 (7 to 74) days vs. 13 (3 to 48) days, P <0.001).Conclusions Delirium was a frequent complication in critically ill patients after non-cardiac surgery. High serum cortisol level was associated with increased incidence of postoperative delirium.

  3. Cardiac magnetic resonance imaging in patients with congenital heart disease

    International Nuclear Information System (INIS)

    The prevalence of congenital heart disease (CHD) is around 10 per 1000 live births in Germany. More than 90 % of these patients will survive into adulthood due to improvements in therapy. The classification of CHD may be based according to the anatomic structures involved, to the presence of an intracardiac shunt, the presence of a cyanosis and the intensity of therapy and complexity of the disease. Nearly half of all patients with CHD suffer from an intracardiac shunt, whereas complex cases such as patients with a tetralogy of Fallot or transposition of the great arteries are much more rare. Cardiac magnetic resonance imaging plays an important role in the work-up and follow-up of patients with CHD, especially after infancy and childhood. Depending on the abnormality in question, a multiparametric examination protocol is mandatory. Knowledge of operative procedures and findings of other imaging modalities help to optimize examination and time needed for it.

  4. Hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    Mahdi; Najafi; David; Faraoni

    2015-01-01

    Although red blood cells(RBCs) transfusion is sometimes associated with adverse reactions,anemia could also lead to increased morbidity and mortality in highrisk patients. For these reasons,the definition of perioperative strategies that aims to detect and treat preoperative anemia,prevent excessive blood loss,and define "optimal" transfusion algorithms is crucial. Although the treatment with preoperative iron and erythropoietin has been recommended in some specific conditions,several controversies exist regarding the benefit-to-risk balance associated with these treatments. Further studies are needed to better define the indications,dosage,and route of administration for preoperative iron with or without erythropoietin supplementation. Although restrictive transfusion strategies in patients undergoing cardiac surgery have been shown to effectively reduce the incidence and the amount of RBCs transfusion without increase in side effects,some high-risk patients(e.g.,symptomatic acute coronary syndrome) could benefit from higher hemoglobin concentrations. Despite all efforts made last decade,a significant amount of work remains to be done to improve hemoglobin optimization and transfusion strategies in patients undergoing cardiac surgery.

  5. Implanted Cardiac Defibrillator Care in Radiation Oncology Patient Population

    International Nuclear Information System (INIS)

    Purpose: To review the experience of a large cancer center with radiotherapy (RT) patients bearing implantable cardiac defibrillators (ICDs) to propose some preliminary care guidelines as we learn more about the devices and their interaction with the therapeutic radiation environment. Methods and Materials: We collected data on patients with implanted ICDs treated with RT during a 2.5-year period at any of the five Memorial Sloan-Kettering clinical campuses. Information regarding the model, location, and dose detected from the device, as well as the treatment fields, fraction size, and treatment energy was collected. During this time, a new management policy for these patients had been implemented requiring treatment with low-energy beams (6 MV) and close surveillance of the patients in partnership with their electrophysiologist, as they received RT. Results: During the study period, 33 patients were treated with an ICD in place. One patient experienced a default of the device to its initial factory setting that was detected by the patient hearing an auditory signal from the device. This patient had initially been treated with a 15-MV beam. After this episode, his treatment was replanned to be completed with 6-MV photons, and he experienced no further events. Conclusion: Patients with ICDs and other implanted computer-controlled devices will be encountered more frequently in the RT department, and proper management is important. We present a policy for the safe treatment of these patients in the radiation oncology environment.

  6. Mutations in the Kv1.5 channel gene KCNA5 in cardiac arrest patients

    DEFF Research Database (Denmark)

    Nielsen, Nathalie H; Winkel, Bo G; Kanters, Jørgen K; Schmitt, Nicole; Hofman-Bang, Jacob; Jensen, Henrik S; Bentzen, Bo H; Sigurd, Bjarne; Larsen, Lars Allan; Andersen, Paal S; Kjeldsen, Keld; Grunnet, Morten; Christiansen, Michael; Olesen, Søren-Peter; Haunsø, Stig

    2007-01-01

    Mutations in one of the ion channels shaping the cardiac action potential can lead to action potential prolongation. However, only in a minority of cardiac arrest cases mutations in the known arrhythmia-related genes can be identified. In two patients with arrhythmia and cardiac arrest, we identi...

  7. 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.

  8. 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

  9. 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

  10. Cardiac Biomarkers and Left Ventricular Hypertrophy in Asymptomatic Hemodialysis Patients

    Directory of Open Access Journals (Sweden)

    Reneta Yovcheva Koycheva

    2015-12-01

    Full Text Available BACKGROUND: Cardiac biomarkers are often elevated in dialysis patients showing the presence of left ventricular dysfunction. The aim of the study is to establish the plasma levels of high-sensitivity cardiac troponin T (hs TnT, precursor of B-natriuretic peptide (NT-proBNP and high sensitivity C-reactive protein (hs CRP and their relation to the presence of left ventricular hypertrophy (LVH in patients undergoing hemodialysis without signs of acute coronary syndrome or heart failure. MATERIAL AND METHODS: Were studied 48 patients - 26 men and 22 women. Pre and postdialysis levels of hs cTnT, NT-proBNP and hs CRP were measured at week interim procedure. Patients were divided in two groups according to the presence of echocardiographic evidence of LVH - gr A - 40 patients (with LVH, and gr B - 8 patients (without LVH. RESULTS: In the whole group of patients was found elevated predialysis levels of all three biomarkers with significant increase (p < 0.05 after dialysis with low-flux dialyzers. Predialysis values of NT-proBNP show moderate positive correlation with hs cTnT (r = 0.47 and weaker with hs CRP (r = 0.163. Such dependence is observed in postdialysis values of these biomarkers. There is a strong positive correlation between the pre and postdialysis levels: for hs cTnT (r = 0.966, for NT-proBNP (r = 0.918 and for hs CRP (r = 0.859. It was found a significant difference in the mean values of hs cTnT in gr. A and gr. B (0.07 ± 0.01 versus 0.03 ± 0.01 ng /mL, p < 0.05 and NT-proBNP (15,605.8 ± 2,072.5 versus 2,745.5 ± 533.55 pg /mL, p < 0.05. Not find a significant difference in hs CRP in both groups. CONCLUSIONS: The results indicate the relationship of the studied cardiac biomarkers with LVH in asymptomatic patients undergoing hemodialysis treatment.

  11. Baseline cerebral oximetry values in cardiac and vascular surgery patients: a prospective observational study

    Directory of Open Access Journals (Sweden)

    Matsagas Miltiadis

    2010-05-01

    Full Text Available Abstract Aim This study was conducted to evaluate baseline INVOS values and identify factors influencing preoperative baseline INVOS values in carotid endarterectomy and cardiac surgery patients. Methods This is a prospective observational study on 157 patients (100 cardiac surgery patients, 57 carotid endarterectomy patients. Data were collected on factors potentially related to baseline INVOS values. Data were analyzed with student's t-test, Chi-square, Pearson's correlation or Linear Regression as appropriate. Results 100 cardiac surgery patients and 57 carotid surgery patients enrolled. Compared to cardiac surgery, carotid endarterectomy patients were older (71.05 ± 8.69 vs. 65.72 ± 11.04, P Conclusion Compared to cardiac surgery, carotid endarterectomy patients are older, with higher baseline INVOS values and greater stroke frequency. Diabetes and high cholesterol are associated with lower baseline INVOS values in carotid surgery. Right and left side INVOS values are strongly correlated in both patient groups.

  12. Radiation Dose to the Thyroid and Gonads in Patients Undergoing Cardiac CT Angiography

    OpenAIRE

    Behroozi, Hamid; Davoodi, Mohammad; Aghasi, Shahriar

    2015-01-01

    Background: The present data show a global increase in the rate of cardiovascular disease. Cardiac CT angiography has developed as a fast and non-invasive cardiac imaging modality following the introduction of multi-slice computed tomogaraphy. Objectives: The aim of this study was to measure the radiation dose to the thyroid and pelvis regions in patients undergoing cardiac CT angiography using the Care Dose 4D method of 64-slice scanner. Patients and Methods: Eighty-one patients (41 males an...

  13. Cardiac sarcoidosis: Recurrent disease in a heart transplant patient following pulmonary tuberculosis infection

    OpenAIRE

    Luk, Adriana; Lee, Andrew; Ahn, Eric; Soor, Gursharan S.; Ross, Heather J.; Butany, Jagdish

    2010-01-01

    Cardiac transplantation is indicated for patients with end-stage cardiomyopathy secondary to cardiac sarcoidosis. Although rare, recurrent disease has been reported in two cases. The current report presents a case of recurrent cardiac sarcoidosis in a patient 45 months postorthotopic heart transplantation and 40 months following reactivation of latent Mycobacterium tuberculosis infection. The patient was the first to have recurrent disease following an infection that has been proposed to be i...

  14. Early goal-directed therapy in moderate to high-risk cardiac surgery patients

    OpenAIRE

    Kapoor Poonam; Kakani Madhava; Chowdhury Ujjwal; Choudhury Minati; Lakshmy R; Kiran Usha

    2008-01-01

    Early goal-directed therapy is a term used to describe the guidance of intravenous fluid and vasopressor/inotropic therapy by using cardiac output or similar parameters in the immediate post-cardiopulmonary bypass in cardiac surgery patients. Early recognition and therapy during this period may result in better outcome. In keeping with this aim in the cardiac surgery patients, we conducted the present study. The study included 30 patients of both sexes, with EuroSCORE ≥3 undergoing coro...

  15. A comparison of genetic findings in sudden cardiac death victims and cardiac patients

    DEFF Research Database (Denmark)

    Hertz, Christin L; Ferrero-Miliani, Laura; Frank-Hansen, Rune;

    2015-01-01

    Sudden cardiac death (SCD) is responsible for a large proportion of non-traumatic, sudden and unexpected deaths in young individuals. Sudden cardiac death is a known manifestation of several inherited cardiac diseases. In post-mortem examinations, about two-thirds of the SCD cases show structural...

  16. 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...

  17. 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...

  18. Prevention of sudden cardiac death in hemodialysis patients.

    Science.gov (United States)

    O'Shaughnessy, Michelle M; O'Regan, John A; Lavin, Peter J

    2014-01-01

    One quarter of all hemodialysis patients will succumb to sudden cardiac death (SCD), a rate far exceeding that observed in the general population. A high prevalence of atherosclerotic coronary artery disease amongst patients with end-stage kidney disease (ESKD) partly explains this exaggerated risk. However, uremia and dialysis related factors are also of critical importance. Interventions aimed at preventing SCD have been inadequately studied in patients with ESKD. Data extrapolated from non-renal populations cannot necessarily be applied to hemodialysis patients, who possess relatively unique risk factors for SCD including "uremic cardiomyopathy", electrolyte shifts, fluctuations in intravascular volume and derangements of mineral and bone metabolism. Pending data derived from proposed randomized controlled clinical trials, critical appraisal of existing evidence and the selective application of guidelines developed for the general population to dialysis patients are required if therapeutic nihilism, or excessive intervention, are to be avoided. We discuss the evidence supporting a role for medical therapies, dialysis prescription refinements, revascularization procedures and electrical therapies as potential interventions to prevent SCD amongst hemodialysis patients. Based on current best available evidence, we present suggested strategies for the prevention of arrhythmia-mediated death in this highly vulnerable patient population. PMID:24720456

  19. A prospective study to evaluate the accuracy of pulse power analysis to monitor cardiac output in critically ill patients

    Directory of Open Access Journals (Sweden)

    Grounds R Michael

    2008-02-01

    Full Text Available Abstract Background Intermittent measurement of cardiac output may be performed using a lithium dilution technique (LiDCO. This can then be used to calibrate a pulse power algorithm of the arterial waveform which provides a continuous estimate of this variable. The purpose of this study was to examine the duration of accuracy of the pulse power algorithm in critically ill patients with respect to time when compared to measurements of cardiac output by an independent technique. Methods Pulse power analysis was performed on critically ill patients using a proprietary commercial monitor (PulseCO. All measurements were made using an in-dwelling radial artery line and according to manufacturers instructions. Intermittent measurements of cardiac output were made with LiDCO in order to validate the pulse power measurements. These were made at baseline and then following 1, 2, 4 and 8 hours. The LiDCO measurement was considered the reference for comparison in this study. The two methods of measuring cardiac output were then compared by linear regression and a Bland Altman analysis. An error rate for the limits of agreement (LOA between the two techniques of less than 30% was defined as being acceptable for this study. Results 14 critically ill medical and surgical patients were enrolled over a three month period. At baseline patients showed a wide range of cardiac output (median 7.5 L/min, IQR 5.1 -9.0 L/min. The bias and limits of agreement between the two techniques was deemed acceptable for the first four hours of the study with percentage errors being 29%, 22%, and 285 respectively. The percentage error at eight hours following calibration increased to 36%. The ability of the PulseCo to detect changes in cardiac output was assessed with a similar analysis. The PulseCO tracked the changes in cardiac output with adequate accuracy for the first four hours with percentage errors being 20%, 24% and 25%. However at eight hours the error had increased to

  20. Cardiac Autonomic Function in Patients With Ankylosing Spondylitis

    Science.gov (United States)

    Wei, Cheng-Yu; Kung, Woon-Man; Chou, Yi-Sheng; Wang, Yao-Chin; Tai, Hsu-Chih; Wei, James Cheng-Chung

    2016-01-01

    Abstract Ankylosing spondylitis (AS) is a chronic inflammatory disease involing spine and enthesis. The primary aim of this study is to investigate the autonomic nervous system (ANS) function and the association between ANS and the functional status or disease activity in AS. The study included 42 AS patients, all fulfilling the modified New York criteria. All the patients are totally symptom free for ANS involvement and had normal neurological findings. These AS patients and 230 healthy volunteers receive analysis of 5 minutes heart rate variability (HRV) in lying posture. In addition, disease activity and functional status of these AS patients are assessed by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), and Bath Ankylosing Spondylitis Global Score (BAS-G). Both groups were age and sex-matched. Although the HRV analysis indicates that the peaks of total power (TP, 0–0.5 Hz) and high-frequency power (HF, 0.15–0.40 Hz) are similar in both groups, the activities of low-frequency power (LF, 0.04–0.15 Hz), LF in normalized units (LF%), and the ratio of LF to HF (LF/HF) in AS patients are obviously lower than healthy controls. The erythrocyte sedimentation rate and C-reactive protein revealed negative relationship with HF. The AS patients without peripheral joint disease have higher LF, TP, variance, LF%, and HF than the patients with peripheral joint disease. The AS patients without uvetis have higher HF than the patients with uvetis. The total scores of BASDI, BASFI, and BAS-G do not show any association to HRV parameters. AS patients have significantly abnormal cardiac autonomic regulation. This is closely related with some inflammatory activities. Reduced autonomic function may be one of the factors of high cardiovascular risk in AS patients. PMID:27227940

  1. 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

  2. Blunt Cardiac Injury in Trauma Patients with Thoracic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Rathachai Kaewlai

    2011-01-01

    Full Text Available Trauma patients with thoracic aortic injury (TAI suffer blunt cardiac injury (BCI at variable frequencies. This investigation aimed to determine the frequency of BCI in trauma patients with TAI and compare with those without TAI. All trauma patients with TAI who had admission electrocardiography (ECG and serum creatine kinase-MB (CK-MB from January 1999 to May 2009 were included as a study group at a level I trauma center. BCI was diagnosed if there was a positive ECG with either an elevated CK-MB or abnormal echocardiography. There were 26 patients (19 men, mean age 45.1 years, mean ISS 34.4 in the study group; 20 had evidence of BCI. Of 52 patients in the control group (38 men, mean age 46.9 years, mean ISS 38.7, eighteen had evidence of BCI. There was a significantly higher rate of BCI in trauma patients with TAI versus those without TAI (77% versus 35%, P<0.001.

  3. Effect of perioperative beta blockade in patients with diabetes undergoing major non-cardiac surgery: randomised placebo controlled, blinded multicentre trial

    DEFF Research Database (Denmark)

    Juul, Anne Benedicte; Wetterslev, Jørn; Gluud, Christian;

    2006-01-01

    Objectives To evaluate the long term effects of perioperative blockade on mortality and cardiac morbidity in patients with diabetes undergoing major non-cardiac surgery. Design Randomised placebo controlled and blinded multicentre trial. Analyses were by intention to treat. Setting University...... anaesthesia and surgical centres and one coordinating centre. Participants 921 patients aged > 39 scheduled for major non-cardiac surgery. Interventions 100 mg metoprolol controlled and extended release or placebo administered from the day before surgery to a maximum of eight perioperative days. Main outcome...... was 4.6 days in the metoprolol group and 4.9 days in the placebo group. Metoprolol significantly reduced the mean heart rate by 11% (95% confidence interval 9% to 13%) and mean blood pressure by 3% (1% to 5%). The primary outcome occurred in 99 of 462 patients in the metoprolol group (21%) and 93 of...

  4. Cardiac I-metaiodobenzylguanidine Scintigraphy in a Patient with Familial Parkinsonism with Gene Mutation

    Directory of Open Access Journals (Sweden)

    Young-Do Kim

    2010-10-01

    Full Text Available A decreased cardiac 123I-metaiodobenzylguanidine (123I-MIBG uptake has been used as a powerful tool to identify Lewy body disease, such as idiopathic parkinson’s disease (IPD. We performed cardiac 123I-MIBG scintigraphy in patient with autosomal recessive juvenile parkinsonism (ARJP with parkin gene mutation (PARK2. The findings showed normal cardiac 123I-MIBG uptake. Therefore, although the clinical features of ARJP are sometimes quite similar to those of late-onset IPD, cardiac 123I-MIBG scintigraphy may be used as a valuable tool to identify patients with IPD and to distinguish them from patients with other parkinsonian syndromes.

  5. Optimizing preoperative expectations in cardiac surgery patients is moderated by level of disability: the successful development of a brief psychological intervention.

    Science.gov (United States)

    Laferton, Johannes A C; Auer, Charlotte J; Shedden-Mora, Meike C; Moosdorf, Rainer; Rief, Winfried

    2016-04-01

    Patients' expectations have shown to be a major psychological predictor of health outcome in cardiac surgery patients. However, it is unclear whether patients' expectations can be optimized prior to surgery. This study evaluates the development of a brief psychological intervention focusing on the optimization of expectations and its effect on change in patients' expectations prior to cardiac surgery. Ninety patients scheduled for coronary artery bypass graft were randomly assigned to (1) standard medical care, (2) additional expectation manipulation intervention (EMI), and (3) additional attention control group. Therapists' fidelity to intervention manuals and patients satisfaction with the intervention were assessed for both active intervention conditions. Patients' expectations about post-surgical disability, treatment control, personal control, and disease duration were assessed before and after the psychological intervention. Demographical, medical, and psychosocial characteristics and disability were assessed at baseline. Treatment fidelity and patient satisfaction was very high in both intervention conditions. Only patients receiving EMI developed higher personal control expectations and longer (more realistic) expectations of disease duration. The effect of intervention group on patients' disability expectations and patients' personal control expectations was moderated by patient's level of disability. EMI patients with low to moderate disability developed positive expectations whereas patients with high disability did not. This study shows the successful development of a short psychological intervention that was able to modify patients' expectations, especially in those with low to moderate disability. Given the robust association of expectations and surgery outcome, such an intervention might offer the opportunity to enhance patients' health following cardiac surgery. PMID:26042657

  6. Recurrent cardiac events in patients with idiopathic ventricular fibrillation, excluding patients with the Brugada syndrome

    Directory of Open Access Journals (Sweden)

    Philippon François

    2005-01-01

    Full Text Available Abstract Background The recurrence of cardiac events in patients with idiopathic ventricular fibrillation (VF excluding patients with the Brugada syndrome is unclear since this entity remains present in previous studies. Methods Since 1992, 18 patients (72% male with idiopathic VF out of 455 ICD implants were treated with an implantable cardioverter defibrillator (ICD. The mean age at first ICD implantation was 42 ± 14 years. Brugada syndrome, as well as other primary electrical diseases (e.g. long QT, were systematically excluded in all patients by the absence of the typical electrocardiogram (ST elevation in the right precordial leads at rest and/or after pharmacological tests (ajmaline, flecainide, or procainamide. Recurrence of cardiac events was prospectively assessed. Results During a mean follow-up period of 41 ± 27 months, VF recurrence with appropriate shock occurred in 7 patients (39% covering a total of 27 shocks. The median time to first appropriate shock was 12 ± 9 months. There were no deaths. In the electrophysiological study, 39% of patients were inducible, but inducibility failed to predict subsequent arrhythmic events. Forty-four percent of patients suffered 21 inappropriate shocks, which were caused by sinus tachycardia, atrial arrhythmias or lead malfunction. Conclusion Idiopathic ventricular fibrillation patients have a high recurrence rate of potentially fatal ventricular arrhythmias, excluding patients with the Brugada syndrome or other known causes. ICD prevents sudden cardiac death but inappropriate shocks remained a major issue in this young and active population.

  7. Autonomic Dysfunction Predicts Early Cardiac Affection in Patients with Systemic Sclerosis

    OpenAIRE

    Othman, Khaled M.; Naglaa Youssef Assaf; Hanan Mohamed Farouk; Iman M. Aly Hassan

    2010-01-01

    Objective: To detect the early preclinical alterations in cardiac autonomic control as well as altered cardiac function in systemic sclerosis (SSc) patients and their relevance to the clinical features of the disease using noninvasive methods. Methods: 30 SSc patients and 15 healthy controls matched for age and sex underwent clinical examination, serological analysis, and echocardiographic assessment including Doppler flow imaging to evaluate cardiac function, and 24-hour Holter monitoring an...

  8. 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.

  9. 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...

  10. 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...

  11. 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...

  12. 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

  13. Radiation dose measurement for patients and staff during cardiac catheterization

    International Nuclear Information System (INIS)

    The primary objective of this study was to determine the patient and staff dose during cardiac catheterization procedures in Ahmed Gasim Hospital, Khartoum Bahry. A survey of patient and staff exposure was performed covered 2 Cath Lab units from 2 manufacturers. The measurements involved 50 operations. The medical staff was monitored using TLD chips (LiF: Mg, Cu, P). The main operator who was closer to the patient and the x-ray tube, was monitored at six positions (forehead, neck chest - over the lead apron, waist - under the lead apron, leg, and hand), while the exposure to the assistant was measured at two positions (chest - over the lead apron, and hand), where the technologist and the circulator were monitored at one position (chest - over the lead apron). patient exposure was measured using the DAP meter. The main operator and the rest of the staff received 0.14, 0.01 mSv/y respectively. The estimated patient dose rate was found to be 125 mGy/min which considered higher than the recommended DRL for the continuous high mode fluoroscopy used in interventional radiology (100 mGy/min). The study concluded to the fact that the main operator received relatively high dose which is a direct result to the poor radiation protection in the department. (Author)

  14. Preoperative physical therapy for elective cardiac surgery patients

    NARCIS (Netherlands)

    Hulzebos, E.H.J.; Smit, Y.; Helders, P.P.J.M.; Meeteren, N.L.U. van

    2012-01-01

    BACKGROUND: After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications. OBJECTIVES: To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac sur

  15. 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

  16. 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)....

  17. Coagulopathy and hemostatic monitoring in cardiac surgery

    DEFF Research Database (Denmark)

    Johansson, Pär I; Sølbeck, Sacha; Genet, Gustav; Stensballe, Jakob; Ostrowski, Sisse R

    2012-01-01

    Cardiac surgery with cardiopulmonary bypass (CPB) causes severe derangements in the hemostatic system, which in turn puts the patient at risks of microvascular bleeding. Excessive transfusion and surgical re-exploration after cardiac surgery are potentially associated with a number of adverse...

  18. Preoperative respiratory physical therapy in cardiac surgery

    NARCIS (Netherlands)

    Hulzebos, H.J.

    2006-01-01

    Cardiac surgery is one of the most common surgical procedures and accounts for more resources expended in cardiovascular medicine than any other single procedure. Because cardiac surgery involves sternal incision and cardiopulmonary bypass, patients usually have a restricted respiratory function in

  19. Cardiac imaging in patients with chronic liver disease

    DEFF Research Database (Denmark)

    Wiese, Signe; Hove, Jens D; Møller, Søren

    2016-01-01

    dysfunction at rest by application of new myocardial strain techniques. Experience with other modalities such as cardiac magnetic resonance imaging and cardiac computed tomography is limited. Future studies exploring these imaging modalities are necessary to characterize and monitor the cardiac changes in...... involved in the development of hepatic nephropathy and is associated with an impaired survival. In the field of cardiac imaging, CCM is not yet a well-characterized entity, hence various modalities of cardiac imaging have been applied. Stress testing with either physiologically or pharmacologically induced...

  20. Type D patients report poorer health status prior to and after cardiac rehabilitation compared to non-type D patients

    DEFF Research Database (Denmark)

    Pelle, Aline J; Erdman, Ruud A M; van Domburg, Ron T; Spiering, Marquita; Kazemier, Marten; Pedersen, Susanne S.

    2008-01-01

    Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients.......Type D personality is an emerging risk factor in coronary artery disease (CAD). Cardiac rehabilitation (CR) improves outcomes, but little is known about the effects of CR on Type D patients....

  1. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients

    Directory of Open Access Journals (Sweden)

    Hann Christopher E

    2010-11-01

    Full Text Available Abstract The application of positive end expiratory pressure (PEEP in mechanically ventilated (MV patients with acute respiratory distress syndrome (ARDS decreases cardiac output (CO. Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness. This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model. The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management.

  2. Cardiac output estimation using pulmonary mechanics in mechanically ventilated patients.

    Science.gov (United States)

    Sundaresan, Ashwath; Chase, J Geoffrey; Hann, Christopher E; Shaw, Geoffrey M

    2010-01-01

    The application of positive end expiratory pressure (PEEP) in mechanically ventilated (MV) patients with acute respiratory distress syndrome (ARDS) decreases cardiac output (CO). Accurate measurement of CO is highly invasive and is not ideal for all MV critically ill patients. However, the link between the PEEP used in MV, and CO provides an opportunity to assess CO via MV therapy and other existing measurements, creating a CO measure without further invasiveness.This paper examines combining models of diffusion resistance and lung mechanics, to help predict CO changes due to PEEP. The CO estimator uses an initial measurement of pulmonary shunt, and estimations of shunt changes due to PEEP to predict CO at different levels of PEEP. Inputs to the cardiac model are the PV loops from the ventilator, as well as the oxygen saturation values using known respiratory inspired oxygen content. The outputs are estimates of pulmonary shunt and CO changes due to changes in applied PEEP. Data from two published studies are used to assess and initially validate this model.The model shows the effect on oxygenation due to decreased CO and decreased shunt, resulting from increased PEEP. It concludes that there is a trade off on oxygenation parameters. More clinically importantly, the model also examines how the rate of CO drop with increased PEEP can be used as a method to determine optimal PEEP, which may be used to optimise MV therapy with respect to the gas exchange achieved, as well as accounting for the impact on the cardiovascular system and its management. PMID:21108836

  3. 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

  4. Preoperative respiratory physical therapy in cardiac surgery

    OpenAIRE

    Hulzebos, H.J.

    2006-01-01

    Cardiac surgery is one of the most common surgical procedures and accounts for more resources expended in cardiovascular medicine than any other single procedure. Because cardiac surgery involves sternal incision and cardiopulmonary bypass, patients usually have a restricted respiratory function in the postoperative period. Moreover, anesthesia and analgesia affect respiratory function during and after the surgical intervention, causing changes in lung volume, diaphragmatic dysfunction, respi...

  5. Cardiac Rehabilitation Enhancing Programs in Patients with Myocardial Infarction: A literature Review

    Directory of Open Access Journals (Sweden)

    Ahyana Ahyana

    2013-01-01

    Full Text Available Background: Cardiac rehabilitation (CR is a process that involves a multidisciplinary team of health professionals in order to optimize the status of patients’ physical, psychological, social, and vocational well being. The CR program has been proven to influence health outcomes in patients with cardiac diseases, particularly myocardial infarction (MI and stable angina. However, patients’ compliance with cardiac rehabilitation programs remains a challenge.Purpose: The purpose of this study is to review and identify interventions that enhance cardiac rehabilitation behaviors in MI patients.Method: A literature review was conducted by analyzing related research reports published since 2000 to 2012. Only English language articles were included.Result: There were 10 experimental studies and 2 meta-analysis studies. Interventions widely used to enhance cardiac rehabilitation behaviors in MI patients were self-efficacy and self management derived programs. These programs involved interventions that enhance cardiac rehabilitation behaviors, including training exercise, behavioral change, education and psychological support, and lifestyle changing strategies. None have reported the use of culturally tailored intervention. Four phases of cardiac rehabilitation were accepted as each phase represents a different aspect of care: inpatient care, early post discharge period, exercise training, and long term follow up. Critical factors for patients in maintaining an optimum health condition after a cardiac event are, in order, status of patient’s physical, psychological, social, and vocational well being.Conclusion: Cardiac Rehabilitation program has been shown to improve quality of life and decrease mortality in MI patients. The development of culturally specific interventions to increase cardiac rehabilitation behaviors will provide a significant improvement for cardiac patient’s care that ultimately results in better health outcomes. Health care

  6. RELATION OF PERIOPERATIVE SERUM THYROID HORMONE CHANGES TO HEART DYSFUNCTION IN PATIENTS UNDERGONE CARDIAC VALVE REPLACEMENT

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objective To explore the relationship between perioperative serum thyroid hormone changes and heart dysfunction in patients undergone cardiac valve replacement. Methods The serum concentrations of free tri- iodothyronine (),free thyroxine (),total total reverse and thyroid-stimulating hor- mone (TSH) in 20 patients undergone routine rheumatic mitral valve replacement were determined by radioim- munoassay at preoperation, the end of myocardial ischemia, and 2,6,12,24 and 48h postoperation, respectively. The alteration hormones above mentioned were comparatively analysed of the normal heart function group (group I,n = 14) and heart dysfunction group (group I ,n=6) after surgery. Results In comparing group I with group I , the more severe the chronic congestive heart failure, the lower the thyroid hormone level before operation;and subse- quently both progressively lowered T3 level and acute heart dysfunction emerged after operation. The decreased extent of serum thyroid hormone was closely parallel to the severity of heart dysfunction. Gonclusion Perioperatively, de- creased serum FT3 and TT3 concentrations are at least an important humoral factor aggravating heart dysfunction, and the patients with preoperative low T3 should be considered as high-risk valvular surgical cases.

  7. Early and late rehabilitation and physical training in elderly patients after cardiac surgery

    OpenAIRE

    C. Macchi; Fattirolli, F; RM.Lova; AA Conti.; ML.Luisi; R.Intini; R.Zipoli; C.Burgisser; L. Guarducci; G. Masotti; Gensini GF

    2007-01-01

    OBJECTIVE: Few randomized trials have enrolled patients who have undergone cardiac surgery, and even fewer have included patients aged 75 yrs or more. Furthermore, the optimal timing of cardiac rehabilitation for postsurgical patients has not yet been codified. The aim of this study was to verify whether rehabilitation outcomes are also favorable in postsurgical patients aged 75 yrs or more and whether an early rehabilitation program is as effective and safe as a late one. DESIGN: Th...

  8. Right ventricular 18F-FDG uptake is an important indicator for cardiac involvement in patients with suspected cardiac sarcoidosis

    International Nuclear Information System (INIS)

    Cardiac sarcoidosis is most commonly found in the left ventricular (LV) free wall. Presence in the right ventricle (RV) is less common but might be useful for detecting cardiac involvement of sarcoidosis. 18F-fluoro-deoxyglucose (18F-FDG) PET has been used to detect LV regions with cardiac sarcoidosis. However, the same has not been done for RV involvement. The aims of the current study were to evaluate RV 18F-FDG uptake and its relationship to the distribution of LV wall 18F-FDG-positive segments in the LV, and to evaluate whether patients with positive RV 18F-FDG uptake met the 1993 diagnostic criteria of the Japanese Ministry of Health and Welfare (JMHW) guidelines regarding sarcoidosis with suspected cardiac involvement. Fifty-nine biopsy-proven extra-cardiac sarcoidosis patients (age 56.1 ± 14.7 years) with suspected cardiac involvement based on abnormal electrocardiography or echocardiography findings underwent fasting 18F-FDG PET or PET/CT. The LV wall was divided into 17 segments and RV uptake was also evaluated. Among 59 patients, 35 (59.3%) showed some abnormal 18F-FDG uptake in the RV and/or LV wall. With respect to the RV wall, 13 (22.0%) showed abnormal 18F-FDG uptake. The number of LV-involved segments was 4.8 ± 2.4 in the patients with RV 18F-FDG uptake, which was significantly higher than in the patients without RV uptake, 1.8 ± 2.2 (P < 0.0001). Patients with RV uptake more frequently met the diagnostic criteria of the 1993 JMHW guidelines (n=27), than did those without RV uptake (84.6 vs. 34.8%, P=0.0033). 18F-FDG PET identified RV involvement less frequently than LV involvement in this study population. However, patients who had RV uptake showed a greater number of LV-involved segments and met the JMHW diagnostic criteria more frequently. Although RV uptake is less frequent, 18F-FDG RV uptake may be useful in diagnosing cardiac involvement in sarcoidosis. (author)

  9. Cardiac magnetic resonance imaging of a patient with an magnetic resonance imaging conditional permanent pacemaker

    OpenAIRE

    Chris B. Pepper; Mohan Sivananthan; Artis, Nigel J.; Hogarth, Andrew J.

    2011-01-01

    Cardiac Magnetic Resonance Imaging (MRI) is increasingly used as the optimum modality for cardiac imaging. An aging population and rising numbers of patients with permanent pacemakers means many such individuals may require cardiac MRI scanning in the future. Whilst the presence of a permanent pacemaker is historically regarded as a contra-indication to MRI scanning, pacemaker systems have been developed to limit any associated risks. No reports have been published regarding the use of such d...

  10. Cardiac amyloidosis in a heart transplant patient - A case report and retrospective analysis of amyloidosis evolution

    OpenAIRE

    Kintsler, Svetlana; Jäkel, Jörg; Brandenburg, Vincent; Kersten, Katrin; Knuechel, Ruth; Röcken, Christoph

    2015-01-01

    Cardiac amyloidosis is a very rare cause of heart failure in heart transplant recipients but an important differential diagnosis in cases of progressive cardiac failure. We report a 72-year-old male patient with the diagnosis of senile systemic amyloidosis (SSA) in a transplanted heart 15 years after transplantation by the initial diagnosis of the dilated cardiomyopathy. Additionally performed immunohistochemical analysis with anti-transthyretin antibody of the cardiac biopsies of the last 15...

  11. 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...

  12. 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...

  13. 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)

  14. Cardiac insufficiency in elderly patients. A non-solve problem.

    OpenAIRE

    Angel Julio Romero Cabrera

    2004-01-01

    Cardiac insufficiency is a clinical syndrome that is known since ancient times – more than 2000 years – in the pre Christian civilisation as Egypt, Greece and Old Rome where the digital plant was used as a remedy for this disease. As a syndrome it constitutes a point of convergence and many times the final stage of cardiac diseases but as it is known, cardiac insufficiency can be produced by non- cardiac disorders. This review is developed due to the necessity to update the guides about an un...

  15. 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.

  16. 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...

  17. Apathy and Cognitive Test Performance in Patients Undergoing Cardiac Testing

    Directory of Open Access Journals (Sweden)

    Lynn Reese Kakos

    2013-01-01

    Full Text Available Background. Psychiatric comorbidity is common in patients with cardiovascular disease, with the literature indicating that this population may be at risk for apathy. The current study examined the prevalence of apathy in patients with cardiovascular disease and its relation to aspects of cognitive function. Methods. 123 participants from an outpatient cardiology clinic completed a brief neuropsychological battery, a cardiac stress test, and demographic information, medical history, and depression symptomatology self-report measures. Participants also completed the Apathy Evaluation Scale to quantify apathy. Results. These subjects reported limited levels of apathy and depression. Increased depressive symptomatology, history of heart attack, and metabolic equivalents were significantly correlated with apathy (P<0.05. Partial correlations adjusting for these factors revealed significant correlations between behavioral apathy and a measure of executive function and the other apathy subscale with a measure of attention. Conclusion. Findings revealed that apathy was not prevalent in this sample though associated with medical variables. Apathy was largely unrelated to cognitive function. This pattern may be a result of the mild levels of cardiovascular disease and cognitive dysfunction in the current sample. Future studies in samples with severe cardiovascular disease or neuropsychological impairment may provide insight into these associations.

  18. Effective dose to patient during cardiac interventional procedures (Prague workplaces)

    International Nuclear Information System (INIS)

    The aim of this study was to assess effective dose to a patient during cardiac procedures, such as coronary angiography (CA) and percutaneous transluminal angioplasty (PTCA). Measurements were performed on 185 patients in four catheterisation laboratories in three hospitals in Prague using the dose area product (DAP) meter. Calculations of surface and effective dose were performed with Monte-Carlo-based program PCXMC. The mean DAP value per procedure determined in all workplaces ranged between 25.0 and 54.5 Gy cm2 for CA and 43.0-104.5 Gy cm2 for PTCA. In three cases, the surface dose exceeded the 2 Gy level for occurrence of transient erythema. The mean effective dose per procedure in an workplaces was determined to be in the range of 2.7-8.8 mSv for CA and 5.7-15.3 mSv for CA + PTCA combined. The results presented are comparable with those published by other authors. (authors)

  19. Acute Renal Failure and the Critically Ill Surgical Patient

    OpenAIRE

    Sykes, Eliot; Cosgrove, Joseph F

    2007-01-01

    Acute renal failure can occur following major surgery. Predisposing factors include massive haemorrhage, sepsis, diabetes, hypertension, cardiac disease, peripheral vascular disease, chronic renal impairment and age. Understanding epidemiology, aetiology and pathophysiology can aid effective diagnosis and management. A consensus definition for acute renal failure has recently been developed. It relates to deteriorating urine output, serum creatinine and glomerular filtration rate. In the surg...

  20. Cardiac and Liver T2* Measurement in 2000 Thalassemia Patients

    Directory of Open Access Journals (Sweden)

    Shahram Akhlaghpoor

    2009-01-01

    Full Text Available "nIntroduction: Although several studies have been published for the evaluation of  myocardial and hepatic iron loads and serum ferritin levels in beta - thalassemia major patients, most of them are reported in small series. The purpose of this study is to evaluate these parameters in a larger group of patients. "nMaterial and Methods: One thousand and five hundred and eighty eight beta thalassemia major patients with the mean age of 23.5 (SD=9.4 years were enrolled in this study and T2* images were obtained from their heart and liver by 1.5 Tesla MRI scanner using respiratory and cardiac gating. Quantitative T2* were calculated for myocardium and liver parenchyma by a dedicated well known software. Serum ferritin concentration was also recorded for all patients and correlations were calculated. "nResults: There was no correlation found between myocardial and serum ferritin and hepatic iron loads and serum ferritin. There was no correlation between organs’ iron load and the patients’ age. Mild correlation was observed between hepatic iron loads and serum ferritin (r=-0.37 which was slightly improved using non-linear correlation (r=- 0.49. "nConclusion: Iron accumulation in different organs is independent and direct iron load measurement is the best way for organ iron deposition risk evaluation especially in the heart and liver. Serum ferritin is not a good indicator of organ iron load and clinical decision could not be made on this parameter alone.  

  1. Effects of a brief intervention on retention of patients in a cardiac rehabilitation program.

    Science.gov (United States)

    McGrady, Angele; Burkes, Robert; Badenhop, Dalynn; McGinnis, Ron

    2014-12-01

    This intervention assessed the effects of a brief intervention on dropout rate in a cardiac rehabilitation program. One hundred thirty five patients were recruited from a cardiac rehabilitation program and randomized to either a control or intervention group. The intervention group participated in four sessions of motivational interviewing and stress management-relaxation in addition to standard cardiac rehabilitation. The control group underwent cardiac rehabilitation alone. Patients who completed the intervention completed an average of 30 sessions while those who dropped out of the intervention completed about six (p Anxiety and depression measured at baseline were the primary predictors of dropout. Patients in both the intervention and controls groups who completed cardiac rehabilitation improved the distance walked, quality of life and decreased anxiety. PMID:25150038

  2. Comparison of topical use of protamine and tranexamic acid in surgical patients requiring cardio-pulmonary bypass

    International Nuclear Information System (INIS)

    To determine the effectiveness of local protamine in reducing post-operative blood loss compared to local tranexamic acid. Study Design: Randomized controlled trial. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi from January 2011 to September 2011. Patients and Methods: One hundred and twenty cardiac surgical patients were randomly divided into two equal groups, one receiving local protamine while the other group receiving local tranexamic acid before chest closure. The efficiency was measured as post-operative blood loss and requirement of blood and blood products in the post-surgical ICU. Results: Average blood loss in protamine group was significantly less (252.97 ml) compared to tranexamic acid group (680.67 ml). Number of patients requiring no post-operative blood transfusion was significantly higher in protamine group (76.7%) compared to tranexamic acid group (53.3%). Conclusion: Local protamine is more effective in reducing post-operative blood loss than local tranexamic acid. (author)

  3. Patient with Recent Coronary Artery Stent Requiring Major Non Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Usha Kiran

    2009-01-01

    Full Text Available Anaesthesiologists are increasingly confronted with patients who had a recent coronary artery stent implanta-tion and are on dual anti-platelet medication. Non cardiac surgery and most invasive procedures increase the risk of stent thrombosis especially when procedure is performed early after stent implantation. Anaesthesiologist faces the dilemma of stopping the antiplatelet therapy before surgery to avoid bleeding versus perioperative stent thrombosis. Individualized approach should be adopted with following precautions. i In a surgical patient with a history of percu-taneous coronary intervention (PCI and coronary stent, determine the date of the procedure, the kind of the stent inserted and the possibility of complications during the procedure. ii Consider all patents with a recent stent implan-tation (e.g. less than three months for bare metal stents and less than one year for brachytherapy or drug eluting stents as high risk and consult an interventional cardiologist. iii Any decision to postpone surgery, continue, modify or discontinue antiplatelet regimes must involve the cardiologist, anaesthesiologist, surgeon, haematologist and the intensivist to balance the risk and benefit of each decision.

  4. 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

  5. Evaluation of exercise tolerance patients in cardiac rehabilitation D model based on 6 Minute Walk Test

    OpenAIRE

    Bielawa Lukasz.; Prusik Katarzyna; Ossowski Zbigniew; Kortas Jakub.; Wiech Monika; Prusik Krzysztof

    2012-01-01

    Evaluation of the results of 6-minute walk test depending on gender, age, left ventricular ejection fraction, the primary disease and BMI. Patients underwent assessment of Cardiac Rehabilitation Department in Szymbark in 2012 (80 people). Duration of rehabilitation for all patients was 21 days. The test was performed at the beginning and end of the cycle. Following the 3-week cardiac rehabilitation in the model D in a group of 80 patients with a mean age of 72 years achieved a statistically s...

  6. Cost and effectiveness assessment of cardiac rehabilitation for dialysis patients following coronary bypass

    OpenAIRE

    Huang, Yijian; Zhang, Rebecca; Culler, Steven; Kutner, Nancy

    2008-01-01

    Dialysis patients have a high risk of cardiovascular disease. In the general population, cardiac rehabilitation is recommended as a standard component of care and is covered by Medicare for patients who have undergone coronary artery bypass grafting (CABG). Previous investigation demonstrated survival benefit of cardiac rehabilitation in dialysis patients. This study investigated its impact on Medicare expenditure and its cost effectiveness. A cohort of 4,324 end-stage renal disease (ESRD) pa...

  7. Kredsløbsmonitorering af kritisk syge patienter med "pulse contour cardiac output"-systemet

    DEFF Research Database (Denmark)

    Afshari, Arash; Perner, Anders; Bonde, Jan

    2006-01-01

    The Pulse Contour Cardiac Output (PiCCO) monitoring system measures cardiac output with high precision and accuracy. The system may replace the pulmonary artery catheter in most critically ill patients because the rate of serious complications may be lower. Whether the use of dynamic or static fl...

  8. Serum TnT concentration in post-operative children patients with congenital cardiac disease

    International Nuclear Information System (INIS)

    The TnT (troponin) concentration in 31 children patients with congenital cardiac disease both before and after operation was measured. The result shows that the TnT concentrations increase remarkably after operation and become normal gradually. The TnT concentration can indicate recovery process of the cardiac muscles after surgery

  9. Conservative Management of Cardiac Hemangioma for 11 Years.

    Science.gov (United States)

    Gribaa, Rym; Slim, Mehdi; Neffati, Elyes; Boughzela, Essia

    2015-10-01

    Cardiac hemangiomas are benign tumors with an unpredictable natural history. Surgical resection is the treatment of choice; however, conservative management can be an alternative in some patients. We report a case of a left-sided cardiac hemangioma that we managed conservatively for 11 years without obvious major complications in the patient, an adult woman. PMID:26504439

  10. Early and long-term results of combined cardiac surgery and neoplastic resection in patients with concomitant severe heart disease and neoplasms

    Institute of Scientific and Technical Information of China (English)

    FU Qiang; LI Quan-zheng; LIANG De-gang; RUAN Xin-hua; WANG Zan-xin; WEI Min-xin

    2011-01-01

    Background It is a surgical dilemma when patients present with both severe heart disease and neoplasms. The best surgical treatment remains controversial. This study aimed to analyze the early and long-term results of simultaneous surgical treatment of severe heart disease and neoplasms.Methods We reviewed the clinical records of 15 patients who underwent simultaneous neoplastic resection and cardiac surgery between September 2006 and January 2011. There were 5 male and 10 female patients. The mean age was (59.2±12.5) years and the mean left ventricular ejection fraction was (57.4±11.0)%. All patients were followed up completely for a period of 12 to 51 months (mean, (33.1±11.2) months).Results Fifteen patients underwent simultaneous cardiac surgery and neoplastic resection. Cardiac procedures consisted of off pump coronary artery bypass grafting (n=7), aortic valve replacement (n=3), mitral valve replacement (n=3), mitral valve replacement with coronary artery bypass grafting (n=1) and left atrial myxoma resection (n=1). Neoplastic resection consisted of lung cancer resection (n=5). colonic cancer resection (n=3), gallbladder resection (n=1), colonic cancer resection with gallbladder resection (n=1), hysterectomy (n=2), hysterectomy with bilateral salpingo-oophorectomy (n=2) and left ovariectomy (n=1). Pathological examination confirmed malignant disease in 10 patients and benign disease in 5 patients. There were no perioperative myocardial infarctions, stroke, pericardial tamponade, renal failure or hospital deaths. The most frequent complications were atrial fibrillation (33.3%), pneumonia (26.7%), low cardiac output syndrome (6.7%) and delayed healing of surgical wounds (6.7%). There was 1 late death 42 months after surgery for recurrent malignant disease. At 1 and 3 years, survival rates were 100% (Kaplan-Meier method).Conclusions Simultaneous cardiac surgery and neoplastic resection was not associated with increased early or late morbidity or mortality

  11. Cardiac insufficiency in elderly patients. A non-solve problem.

    Directory of Open Access Journals (Sweden)

    Angel Julio Romero Cabrera

    2004-04-01

    Full Text Available Cardiac insufficiency is a clinical syndrome that is known since ancient times – more than 2000 years – in the pre Christian civilisation as Egypt, Greece and Old Rome where the digital plant was used as a remedy for this disease. As a syndrome it constitutes a point of convergence and many times the final stage of cardiac diseases but as it is known, cardiac insufficiency can be produced by non- cardiac disorders. This review is developed due to the necessity to update the guides about an unsolved problem of high frequency and a bad prognosis as well as to join the clinical practice with updated clinical evidence and to inform the most relevant aspects about cardiac insufficiency in the last few years.

  12. Incidental Papillary Fibroelastoma Multimodal: Imaging and Surgical Decisions in 2 Patients

    OpenAIRE

    Bouhzam, Najime; Kurtz, Baptiste; Doguet, Fabien; Eltchaninoff, Helene; Bauer, Fabrice

    2012-01-01

    Papillary fibroelastoma is a rare, benign cardiac tumor typically found on the heart valves. It is usually discovered incidentally on echocardiography. The clinical presentation of cardiac papillary fibroelastoma varies from no symptoms to severe embolic sequelae. We report the incidental finding of papillary fibroelastoma in 2 patients. In each, we chose to excise the tumor. The relevant medical literature provides little guidance regarding whether to excise a small papillary fibroelastoma i...

  13. Biatrial Cardiac Metastases in a Patient with Uterine Cervix Malignant Melanoma

    Directory of Open Access Journals (Sweden)

    Caglayan Geredeli

    2015-01-01

    Full Text Available Primary malignant melanomas of uterine cervix are quite rarely seen neoplasms, and long-life prognosis of patients with this disease is poor. Immunohistochemical methods and exclusion of other primary melanoma sites are used to confirm the diagnosis. As with other melanomas, cervix malignant melanomas may also cause cardiac metastases. Cardiac metastases are among rarely seen but more commonly encountered cases, compared to primary cardiac tumors. Here, we present a case of biatrial cardiac metastases in a 73-year-old patient with uterine cervix malignant melanomas. The patient underwent echocardiography, cardiac magnetic resonance imaging, and computed tomography. Our report shows the importance of advanced diagnostic techniques, such as cardiac magnetic resonance, not only for the detection of cardiac masses, but for a better anatomic definition and tissue characterization. Although the cases of malignant melanomas leading to multiple cardiac metastasis were reported in literature, the metastatic concurrence of malignant melanomas in both right and left atriums is quite rarely encountered as metastatic malignant melanomas. Also, another intriguing point in our case is that the primary lesion of our case was stemmed from uterine cervix, but not skin.

  14. Echocardiographic abnormalities in the assessment of cardiac organ damage in never-treated hypertensive patients.

    Science.gov (United States)

    Milan, Alberto; Avenatti, Eleonora; Puglisi, Elisabetta; Abram, Sara; Magnino, Corrado; Naso, Diego; Tosello, Francesco; Fabbri, Ambra; Vairo, Alessandro; Mulatero, Paolo; Rabbia, Franco; Veglio, Franco

    2012-01-01

    Hypertension-related cardiac organ damage, other than left ventricular (LV) hypertrophy (LVH), has been described: in particular, concentric remodeling, LV diastolic dysfunction (DD), and left atrial (LA) enlargement are significantly associated with cardiovascular morbility and mortality in different populations. This study evaluated the prevalence of these latter morphofunctional abnormalities, in never-treated essential hypertensive patients and the role of such a serial assessment of hypertensive cardiac damage in improving cardiovascular risk stratification in these patients. A total of 100 never-treated essential hypertensive subjects underwent a complete clinical and echocardiographic evaluation. Left ventricular morphology, systolic and diastolic function, and LA dimension (linear and volume) were evaluated by echocardiography. Left ventricular hypertrophy was present in 14% of the patients, whereas concentric remodeling was present in 25% of the subjects. Among patients free from LV morphology abnormalities, the most frequent abnormality was LA enlargement (global prevalence 57%); the percentage of patients with at least one parameter consistent with DD was 22% in the entire population, but DD was present as the only cardiac abnormality in 1% of our patient. Left atrial volume indexed for body surface area was the most sensitive parameter in identifying hypertension-related cardiac modification. The global prevalence of cardiac alteration reached 73% in never-treated hypertensive patients. Left ventricular remodeling and LA enlargement evaluation may grant a better assessment of cardiac organ damage and cardiovascular risk stratification of hypertensive patients without evidence of LVH after routine examination. PMID:22738434

  15. 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.

  16. 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

  17. Prediction of morbidity and mortality in middle and old aged surgical patients-comparison of standard scoring system and addition of echocardiography with hemodynamic indices

    Directory of Open Access Journals (Sweden)

    Amit K. Singh

    2015-10-01

    Conclusions: In conclusion preoperative TTE before non-cardiac surgery can predict the risk of perioperative cardiac complications in known or suspected cases of cardiac disease patients. [Int J Res Med Sci 2015; 3(10.000: 2543-2548

  18. 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)

  19. Surgical technique of double valve replacement in a patient with osteogenesis imperfecta.

    Science.gov (United States)

    Sumi, Mizuki; Ariyoshi, Tsuneo; Matsukuma, Seiji; Nakaji, Shun; Hashizume, Koji; Kinoshita, Naoe; Eishi, Kiyoyuki

    2016-04-01

    Osteogenesis imperfecta (OI) is an inherited connective tissue disorder. Left ventricle dilation and valve insufficiency are complications in patients with OI and such patients are at high risk of mortality and complications related to bleeding and tissue friability during cardiac surgery. Valve dehiscence due to extreme friability of the annulus is a major complication of cardiac valve replacement with OI. We describe OI in a male patient who underwent double valve replacement with mechanical valves using a tissue protective method to prevent valve dehiscence. PMID:25028093

  20. Prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest

    DEFF Research Database (Denmark)

    Ottesen, Michael Mundt; Dixen, Ulrik; Torp-Pedersen, Christian; Køber, Lars

    2003-01-01

    OBJECTIVE: To study prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest. DESIGN: Structured interview of 250 consecutive patients with acute coronary syndrome and relatives of 48 patients with witnessed cardiac arrest. The following courses of action...... hundred and thirteen patients (45%) knew of thrombolytic therapy. Twenty-seven of 75 patients with knowledge of the benefit of prompt treatment with thrombolysis, acted in accordance with this awareness. CONCLUSION: Patients misinterpret symptoms of acute coronary syndrome and are misguided when calling...

  1. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization

    Energy Technology Data Exchange (ETDEWEB)

    El Demerdash, Salah [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Khorshid, Hazem, E-mail: hazemkhorshid@yahoo.com [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Salah, Iman; Abdel-Rahman, Mohamed A. [Department of Cardiology, Ain Shams University Hospital, Cairo (Egypt); Salem, Alaa M. [Department of Internal Medicine, Medical Division, National Research Centre, Cairo (Egypt)

    2015-07-15

    Background: Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. Aim: We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. Methods: The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient’s symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3 months after the end of the study. Results: The mean age was 56.8 ± 3.1 years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3 months after completion of CRP, there was a significant decrease in BMI (30.3 ± 2.9 vs. 31.2 ± 1.9, p < 0.001), and mean blood pressure (93.4 ± 11 vs. 105 ± 10.6 mmHg, p < 0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1 ± 0.62 vs. 1.4 ± 0.6, p < 0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7 ± 7.8 vs. 54.5 ± 6.3 %, p = 0.06) and significant improvement of Canadian cardiovascular class (1.42 ± 0.6 vs. 1.95 ± 0.5, p < 0.001) post CRP. Importantly, the difference between the SPECT

  2. Cardiac rehabilitation improves the ischemic burden in patients with ischemic heart disease who are not suitable for revascularization

    International Nuclear Information System (INIS)

    Background: Ischemic heart diseases including stable angina & acute events, represent a huge burden on both the individual & the society and represent an important source of disability. Aim: We aimed to identify the effect of cardiac rehabilitation program (CRP) on the ischemic burden in patients with ischemic heart disease (IHD) unsuitable for coronary revascularization. Methods: The study included 40 patients with IHD who were not suitable for coronary revascularization either by PCI or CABG (due to unsuitable coronary anatomy, co morbidities, high surgical/procedural risk or patient preference). All patients were subjected to sophisticated CRP protocols, including patient education, nutritional, medical, psychological and sexual counseling and group smoking cessation. All patients participated in low intensity exercise program twice weekly. The patient’s symptoms, vitals and medications were evaluated at each visit and clinical and laboratory data, echocardiography and stress myocardial perfusion imaging (SPECT) were evaluated before and 3 months after the end of the study. Results: The mean age was 56.8 ± 3.1 years and only 2 patients (5%) were females. 22 (55%) patients were diabetic, 21 (53%) were hypertensive and 30 (75%) were smokers. It was found that 3 months after completion of CRP, there was a significant decrease in BMI (30.3 ± 2.9 vs. 31.2 ± 1.9, p < 0.001), and mean blood pressure (93.4 ± 11 vs. 105 ± 10.6 mmHg, p < 0.001). There was also a favorable effect on lipid profile and a significant improvement of the functional capacity in terms of NYHA functional class (2.1 ± 0.62 vs. 1.4 ± 0.6, p < 0.001). Despite that wall motion score index did not significantly change after CRP, there was a strong trend toward a better ejection fraction (53.7 ± 7.8 vs. 54.5 ± 6.3 %, p = 0.06) and significant improvement of Canadian cardiovascular class (1.42 ± 0.6 vs. 1.95 ± 0.5, p < 0.001) post CRP. Importantly, the difference between the SPECT

  3. 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 ...

  4. 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...

  5. 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...

  6. 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, ...

  7. [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

  8. 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...

  9. 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...

  10. [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

  11. Genomic Stability of Legionella pneumophila Isolates Recovered from Two Cardiac Transplant Patients with Nosocomial Legionnaires' Disease

    OpenAIRE

    Marrie, Thomas J; Johnson, Wendy M; Tyler, Shaun D.; Bezanson, Gregory S.; Burbridge, Susan

    1994-01-01

    Pulsed-field gel electrophoresis revealed that multiple consecutive isolates of Legionella pneumophila from two cardiac transplant patients remained genomically stable, despite exposure to host defenses and antimicrobial agents.

  12. Collaborative Cardiac Care Service: A Multidisciplinary Approach to Caring for Patients with Coronary Artery Disease

    OpenAIRE

    Sandhoff, Brian G; Kuca, Susan; Rasmussen, Jon; Merenich, John A

    2008-01-01

    Background: Coronary artery disease (CAD) remains the leading cause of death in the US. In 1996, Kaiser Permanente of Colorado (KPCO) developed the Collaborative Cardiac Care Service (CCCS) with the goal of improving the health of patients with CAD.

  13. Pre-operative echocardiogram in hip fracture patients with cardiac murmur- an audit

    Directory of Open Access Journals (Sweden)

    Talkhani Imtiyaz

    2011-09-01

    Full Text Available Abstract Background All hip fracture patients with a cardiac murmur have an echocardiogram as a part of their preoperative work-up in our unit. We performed a retrospective audit to assess the impact of obtaining a pre-operative echocardiogram on the management of hip fracture patients. Methods All hip fracture patients (N = 349 between 01/06/08 and 01/06/09 were included in the study. 29 patients had pre-operative echocardiogram (echo group. A computer generated randomised sample of 40 patients was generated from N, 'non-echo' group. Data was obtained from medical records and the Hospital Information Support System (HISS. The groups were compared using Student's t test. Approval was obtained locally from the clinical governance department for this project. Results Age and gender distribution were similar in both groups. Indication for echo was an acute cardiac abnormality in 4 cases. 25 patients had echo for no new cardiac problem (indication being cardiac murmur in 23 patients and extensive cardiac history in 2 cases. Cardiology opinion was sought in 5 cases. No patient required cardiac surgery or balloon angioplasty preoperatively. Patients having pre-operative echo had significant delay to surgery (average 2.7 days, range 0-6 days compared to 'non-echo' group (average 1.1 days, range 0-3 days, (p Conclusion We have developed departmental guidelines for expediting echo requests in hip fracture patients with cardiac murmur. A liaison has been established with our cardiology department to prioritise such patients on the Echocardiography waiting list, to prevent unnecessary avoidable delay. Careful patient selection for pre-operative echocardiography is important to avoid unnecessary delay to surgery.

  14. 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

  15. DIAGNOSTIC EFFICACY OF CARDIAC TROPONIN-T IN ACUTE MYOCARDIAL INFARCTION PATIENTS ADMITTED IN INTENSIVE CARDIAC CARE UNIT

    Directory of Open Access Journals (Sweden)

    Tapan

    2016-03-01

    Full Text Available INTRODUCTION Myocardial infarction is a common and severe manifestation of ischaemic heart disease (IHD. Acute myocardial infarction (AMI is the result of death of heart muscle cells following either from a prolonged or severe ischaemia. The World Health Organisation emphasises IHD as our "Modern Epidemic" and AMI as common cause of sudden death. AIM The present study has been undertaken with the aim to assess the role of cardiac Troponin-T in early diagnosis of AMI and to evaluate its positive roles over CK-MB and LDH enzyme assays. The study also aims to find out the role of cardiac Troponin-T test, where ECG changes are nondiagnostic and inconclusive for AMI. MATERIAL & METHOD One hundred cases of provisionally diagnosed AMI, who were admitted during June 2012 to July 2015 in ICC Unit of TMC & Dr. BRAM Teaching Hospital, formed the subjects for the study. Those patients reported 2 to 10 hours after onset of chest pain were included in this study. Patients reported beyond 10 hours after onset of chest pain of AMI cases and patients having chest pain of non-AMI causes are excluded from the study. The provisional diagnosis of AMI was done on the basis of the history, chest pain, clinical findings and ECG changes. Trop-T test (Troponin-T sensitive rapid test by Muller Bardoff, et al, 1991 as well as CK-MB (creatine kinase-MB isoenzymeassays were performed immediately for each and every patient. Trop-T test was repeated in some selective cases where the early changes were insignificant and the results were compared with those of CK-MB, at different period of the disease onset. RESULTS The rapid cardiac Troponin-T test (CTn-T has 100% specificity for AMI whereas CK-MB and LDH have specificities of 80% and 60% respectively. The CTn-T has diagnostic efficiency of 92% for AMI but ECG has only 69% sensitivity and 80% specificity. The overall diagnostic efficacy of cardiac Troponin-T is higher than that of CK-MB, LDH and ECG (94% versus 92%, 91 % and 72

  16. Cardiac computed tomography in patients with acute coronary syndrome; Kardiale CT beim akuten Koronarsyndrom

    Energy Technology Data Exchange (ETDEWEB)

    Schlett, C.L. [Universitaetsklinikum, Heidelberg (Germany). Abt. fuer Diagnostische und Interventionelle Radiologie; Alkadhi, H. [Universitaetsspital, Zuerich (Switzerland); Bamberg, F. [Universitaetsklinikum, Tuebingen (Germany). Diagnostische und Interventionelle Radiologie

    2014-09-15

    Currently, cardiac computed tomography (CT) is increasingly being implemented into clinical algorithms, primarily due to substantial technical advances over the last decade. Its use in the setting of suspected acute coronary syndrome is of particular relevance, given the high degree of accumulating scientific evidence of improving patient outcomes. Performing cardiac CT requires specific knowledge on the available scan acquisitions and patient preparation. Also, expertise is required in order to interpret the coronary and extra-coronary findings adequately. The present article provides an overview of the different aspects on the use of cardiac CT in the setting of acute coronary syndrome.

  17. Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program

    OpenAIRE

    Jyotsna, Viveka P.; Smita Ambekar; Rajiv Singla; Ansumali Joshi; Anju Dhawan; Neeta Kumar; Deepak, K. K.; Sreenivas, V.

    2013-01-01

    Background: The aim of this study was to observe the effect comprehensive yogic breathing (Sudarshan Kriya Yoga [SKY] and Pranayam) had on cardiac autonomic functions in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 64 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes and the other group receiving standard therapy for diabetes and c...

  18. Increased anxiety and depression in Danish cardiac patients with a type D personality

    DEFF Research Database (Denmark)

    Spindler, Helle; Kruse, Charlotte; Zwisler, Ann-Dorthe;

    2009-01-01

    Type D personality is an emerging risk factor in cardiovascular disease. We examined the psychometric properties of the Danish version of the Type D Scale (DS14) and the impact of Type D on anxiety and depression in cardiac patients.......Type D personality is an emerging risk factor in cardiovascular disease. We examined the psychometric properties of the Danish version of the Type D Scale (DS14) and the impact of Type D on anxiety and depression in cardiac patients....

  19. The Effect of a Self Exercise Program in Cardiac Rehabilitation for Patients with Coronary Artery Disease

    OpenAIRE

    Kim, Chul; Youn, Jo Eun; Choi, Hee Eun

    2011-01-01

    Objective To investigate the effect of self exercise in cardiac rehabilitation on cardiopulmonary exercise capacity for selected patients with coronary artery disease. Method The subjects of this study were patients who received percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery and who participated in a cardiac rehabilitation program. The supervised exercise group participated in 6-8 weeks of aerobic exercise training with telemetry ECG monitoring in hosp...

  20. Cardiac rehabilitation for patients after coronary artery bypass graft surgery Nursing Interventions

    OpenAIRE

    Tsaloglidou A.; Lavdaniti M.; Ioannidis T.

    2010-01-01

    Purpose: To describe the way by which the rehabilitation of the patients that have undergone cardiac surgery is performed, to present the content of the cardiac rehabilitation programs and to determine the nursing role in the whole process. Methodology: Literature review of the relevant articles in the databases pubmed and scopus. Results: The patients with coronary heart disease usually face a lot of problems in their everyday life. Coronary artery bypass graft surgery (CABG) is commonly per...

  1. Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients

    OpenAIRE

    Lee, Sang Hyun; Chun, Kook Jin; Lee, Dae Sung; Lee, Soo Yong; Hwang, Jongmin; Chon, Min Ku; Hwang, Ki Won; Kim, Jeong Su; Park, Yong Huyn; Kim, June Hong

    2016-01-01

    Background and Objectives Right heart catheterization is traditionally performed using a femoral vein approach that involves admission, bed rest, and risks of bleeding and hematoma. Recent studies have confirmed safety of the use of forearm vein for right cardiac catheterization. In the present study, we evaluated the feasibility of right cardiac catheterization via the antecubital fossa vein in Korean patients. Subjects and Methods The medical records of all patients who underwent right hear...

  2. The therapeutic use of music as experienced by cardiac surgery patients of an intensive care unit

    OpenAIRE

    Varshika M. Bhana; Annali D.H. Botha

    2014-01-01

    Patients perceive the intensive care unit (ICU) as being a stressful and anxiety-provoking environment. The physiological effects of stress and anxiety are found to be harmful and therefore should be avoided in cardiac surgery patients. The aim of the study on which this article is based was to describe cardiac surgery patients’ experiences of music as a therapeutic intervention in the ICU of a public hospital. The objectives of this article were to introduce and then expo...

  3. 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

  4. Blunt cardiac rupture in patient with liver laceration

    Institute of Scientific and Technical Information of China (English)

    王文林; 曾伟生; 蒋仁超

    2003-01-01

    The early diagnosis of cardiac rupture is one of the key factors for a successful outcome. However, the accurate diagnosis is often difficult in the early stage of injury, especially when some obvious severe wounds are found in other regions of the body,1,2 for they are easy to disguise the symptom of the heart. We report a case with cardiac rupture and liver trauma caused by traffic accident.

  5. Clinical Features and Mid-Term and Long-Term Outcomes of Surgical Treatment of 8 Patients with Primary Ventricular Tumors

    Institute of Scientific and Technical Information of China (English)

    JianminYao; QingrenJia; QirenCheng; NingLu; XiangdongZhao; ZhibinXiao; XiaomengZhang

    2004-01-01

    OBJECTIVE To summarize the clinical features and surgical treatment of primary ventricular tumors. METHODS Eight patients with primary ventricular tumor, aged 3 to 52 years, underwent surgical treatment. There were 6 males and 2 females. The pathological diagnoses were as follows: multiple left ventricular myxomas in 2 cases; left ventricular rhabclomyoma, fibroma and malignant neurolemmoma in 1 case for each; right ventricular myxoma and malignant neurolemmoma in 1 case for each; intraseptal fibroma in 1 case. The operations were performed through median sternotomy with moderate hypothermic cardiopulmonary bypass in 7 cases; via left anterolateral thoracotomy without extracorporeal circulation in 1 case. Tumors were totally removed in 7 cases and subtotally resectecl in 1 case. RESULTS Cardiac arrest after anaesthetization occurred in 1 case with postoperative coma for 10 days. One case died of massive gastro-intestinal hemorrhage postoperatively. Seven cases survived, During a follow-up period of 1 to 21 years, there was no recurrence or metastasis in the 6 cases who received complete tumor resection including 2 cases with malignant tumor. One case of partial tumor removal had a mild heart murmur without tumor progression. All patients were asymptomatic with cardiac functiongrade I. CONCLUSION Primary ventricular tumors showed diversity in their histological characteristics. The mid- and long-term outcomes of surgical treatment for primary ventricular tumors appear to be satisfactory.

  6. Comparison of Cardiac Status in Thalassemic Patients with That of Non-Thalassemic Children

    Directory of Open Access Journals (Sweden)

    Z Kamali

    2002-08-01

    Full Text Available Cardiac siderosis from transfused iron remained, despite iron chelation therapy with desferioxamine (DFO, the major cause of death in Thalassemia major. In a retrospective study, we reviewed 67 patients with Thalassemia major and the same number of non-thalassemic children and analyzed factors affecting cardiac involvement. Ejection fraction (EF and shortening fraction (SF of Thalassemic group was lower than that of non-thalassemic and difference was significant (P<0.001. In Thalassemic patients there was inverse relationship between serum ferritin and cardiac OF and SF. Patients with optimal compliance had lower serum ferritin (P<0.001. 16 patients showed some kind of cardiac involvement. Older (P<0.001, had lower SF (P<0.05 and late onset of DFO therapy (P<0.001. We concluded that patients with Thalassemia major, despite iron chelation therapy with DFO, had weaker cardiac performance compared to non-thalassemic children. In these patients cardiac complications occurred in older age group with late onset of DFO treatment. Echocardiographic measurement of SF has prognostic value.

  7. Invasive and non-invasive methods for cardiac output measurement

    OpenAIRE

    Lavdaniti M.

    2008-01-01

    The hemodynamic status monitoring of high-risk surgical patients and critically ill patients inIntensive Care Units is one of the main objectives of their therapeutic management. Cardiac output is one of the mostimportant parameters for cardiac function monitoring, providing an estimate of whole body perfusion oxygen deliveryand allowing for an understanding of the causes of high blood pressure. The purpose of the present review is thedescription of cardiac output measurement methods as prese...

  8. 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.

  9. Cardiac involvement in patients with limb-girdle muscular dystrophy type 2 and Becker muscular dystrophy

    DEFF Research Database (Denmark)

    Sveen, Marie-Louise; Thune, Jens Jakob; Køber, Lars;

    2008-01-01

    Rigshospitalet. Patients One hundred one patients with LGMD2A-I and BMD and 29 patients with LGMD2 and no molecular diagnosis. MAIN OUTCOME MEASURES: Clinical investigation, echocardiography, and electrocardiographic findings. RESULTS: Cardiac involvement was present in 24 of 100 patients (24%) with LGMD2A-I and......OBJECTIVE: To investigate the extent of cardiac involvement in patients with 1 of the 12 groups of recessively inherited limb-girdle muscular dystrophy type 2 (LGMD2A-L) and Becker muscular dystrophy (BMD). DESIGN: Prospective screening. SETTING: Neuromuscular Clinic and Department of Cardiology at...

  10. PATIENTS OVERCOME ANXIETY AND ARE ENCOURAGED TO BE PHYSICAL ACTIVE THROUGH EXERCISE-BASED CARDIAC REHABILITATION

    DEFF Research Database (Denmark)

    Simonÿ, Charlotte; Dreyer, Pia; Pedersen, Birthe D.;

    , and it seems to be crucial to further emphasise the individuals lived experiences when exercise-based cardiac rehabilitation is followed. Hence this study aims to investigate how patients experience exercise-based cardiac rehabilitation in a hospital setting. Methods. This study, which included nine...... other to begin exercising; and growing confidence in the heart, whereby the patients overcome anxiety and dare to be physically active. Conclusions. Exercise-based cardiac rehabilitation provides a comfort-giving setting that offers peer support and a positive physical perception leading to confidence...... into that the heart endures physical activity. In addition to serving as physical guidance, exercise-based cardiac rehabilitation offers valuable mental support. The patients find help to overcome an initial anxiety and move forward towards a physically active life featuring a feeling of improved...

  11. High prevalence of cardiac involvement in patients with myotonic dystrophy type 1

    DEFF Research Database (Denmark)

    Petri, Helle; Witting, Nanna; Ersbøll, Mads Kristian;

    2014-01-01

    of controls. Thus, the optimal strategy for assessing cardiac involvement in DM1 is unclear. METHOD: In this large single-centre study, we evaluated 129 unselected DM1 patients (49.6% men), mean (SD) age 44 (14.7) years with family history, physical examination, electrocardiogram (ECG......BACKGROUND: Patients with myotonic dystrophy type 1 (DM1) have a three-fold higher risk of sudden cardiac death (SCD) than age-matched healthy controls. Despite numerous attempts to define the cardiac phenotype and natural history, existing literature suffers from low power, selection-bias and lack......), echocardiography, Holter-monitoring and muscle strength testing. RESULTS: Cardiac involvement was found in 71 patients (55%) and included: 1) Conduction abnormalities: atrio-ventricular block grade I (AVB grade I) (23.6%), AVB grade II (5.6%), right/left bundle branch block (5.5/3.2%) and prolonged QTc (7.2%); 2...

  12. Reentrant Supraventricular Tachycardia in a Pediatric Trauma Patient Masquerading as a Cardiac Contusion

    Directory of Open Access Journals (Sweden)

    Bradbum, Christopher

    2005-01-01

    Full Text Available Establishing the etiology of tachycardia in a trauma patient is often difficult. Pediatric trauma patients present an even tougher challenge. Cardiac contusion should be suspected when other more common traumatic injuries that produce hypoxia and blood loss are excluded. The diagnosis of cardiac contusion is notoriously difficult to make largely due to the controversy over the definition of the disease, and the lack of a true gold standard confirmatory test. Atrioventricular nodal reentrant tachycardia (AVNRT is a common form of supraventricular tachycardia (SVT that can also present a diagnostic challenge to emergency physicians. While electrophysiologic studies are the gold standard for confirming the diagnosis, there are certain aspects of the history, electrocardiogram (ECG, and responses to cardiac maneuvers that strongly suggest the diagnosis. We present the case of a pediatric trauma patient that presented with new onset AVNRT masquerading as cardiac contusion.

  13. 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

  14. 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...

  15. 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.

  16. 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

  17. 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.

  18. Long QT Syndrome Leading to Multiple Cardiac Arrests After Posaconazole Administration in an Immune-Compromised Patient with Sepsis: An Unusual Case Report.

    Science.gov (United States)

    Panos, George; Velissaris, Dimitrios; Karamouzos, Vasilios; Matzaroglou, Charalampos; Tylianakis, Minos

    2016-01-01

    BACKGROUND We present the case of a septic patient with severe immunodeficiency, who developed QT interval prolongation followed by episodes of lethal cardiac arrhythmia. Cardiac events occurred after posaconazole administration, incriminating posaconazole use, alone or in combination with voriconazole, as the culpable agent. CASE REPORT A 26-year-old female patient underwent orthopedic surgery to remove ectopic calcifications in her left hip joint. On the first post-operative day she became septic due to a surgical wound infection. Despite being treated according to the therapeutic protocols for sepsis, no clinical improvement was noticed and further assessment revealed an underlying immunodeficiency. Considering the underlying immunodeficiency and to that point poor clinical response, an antifungal agent was added to the antibiotic regiment. Following discontinuation of multiple antifungal agents due to adverse effects, posaconazole was administered. Posaconazole oral intake was followed by episodes of bradycardia and QT interval prolongation. The patient suffered continuous incidents of cardiac arrest due to polymorphic ventricular tachycardia (torsades des pointes) that degenerated to lethal ventricular fibrillation. Posaconazole was immediately discontinued and a temporary pacemaker was installed. The patient finally recovered without any neurological deficit, and was discharged in a good clinical status. CONCLUSIONS Close cardiac monitoring is recommended in cases where posaconazole administration is combined with coexisting risk factors, as they may lead to severe ECG abnormalities and cardiac arrhythmias such as long QT interval syndrome and torsades de pointes. Posaconazole interactions with medications metabolized via the CYP3A4 pathway should be considered an additional risk factor for lethal cardiac incidents. PMID:27125217

  19. MULTIPLE FACETS OF REHABILITATION IN ELDERLY PATIENTS AFTER CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    Maura Gabriela FELEA

    2014-11-01

    Full Text Available The elderly rehabilitation program after coronary artery bypass graft (CABG encompasses endurance training performed on a cycloergometer and physical rehabilitation, the results being exceeded by adding strength and balance exercises. Early initiation of mobilization exercises can prevent problems of posture, as well as thoraco-pulmonary and scapular-humeral articulation conditions often encountered after cardiac surgery. The results of special functional training in elderly can be assessed by six minute walk perimeter and quality of life questionnaire. This article describes the extents of multiple dimensions facets of cardiac rehabilitation program, like effort capacity and psycho-social benefits, morbi-mortality and cost-effectiveness. Referral to cardiac rehabilitation for primary and secondary prevention programs remains low in developing countries. There is a need for a network intelligence schema in order to address patients’ needs and to improve health care professionals’ education.

  20. Cardiac Operations for North American Children with Rheumatic Diseases: 1985–2005

    OpenAIRE

    Stingl, Cory; Moller, James H.; Binstadt, Bryce A

    2009-01-01

    Certain pediatric rheumatic diseases are known to affect the heart, sometimes requiring surgical intervention. The Pediatric Cardiac Care Consortium database was used to characterize cardiac surgical intervention among children with rheumatic diseases from 1985 to 2005. From this large database, the records for patients younger than 21 years who underwent cardiac surgery for any rheumatic disorder were extracted. The data collected included the type of procedure performed, the age at the time...

  1. Factors influencing health care utilisation among Aboriginal cardiac patients in central Australia: a qualitative study

    Science.gov (United States)

    2013-01-01

    Background Aboriginal Australians suffer from poorer overall health compared to the general Australian population, particularly in terms of cardiovascular disease and prognosis following a cardiac event. Despite such disparities, Aboriginal Australians utilise health care services at much lower rates than the general population. Improving health care utilisation (HCU) among Aboriginal cardiac patients requires a better understanding of the factors that constrain or facilitate use. The study aimed to identify ecological factors influencing health care utilisation (HCU) for Aboriginal cardiac patients, from the time of their cardiac event to 6–12 months post-event, in central Australia. Methods This qualitative descriptive study was guided by an ecological framework. A culturally-sensitive illness narrative focusing on Aboriginal cardiac patients’ “typical” journey guided focus groups and semi-structured interviews with Aboriginal cardiac patients, non-cardiac community members, health care providers and community researchers. Analysis utilised a thematic conceptual matrix and mixed coding method. Themes were categorised into Predisposing, Enabling, Need and Reinforcing factors and identified at Individual, Interpersonal, Primary Care and Hospital System levels. Results Compelling barriers to HCU identified at the Primary Care and Hospital System levels included communication, organisation and racism. Individual level factors related to HCU included language, knowledge of illness, perceived need and past experiences. Given these individual and health system barriers patients were reliant on utilising alternate family-level supports at the Interpersonal level to enable their journey. Conclusion Aboriginal cardiac patients face significant barriers to HCU, resulting in sub-optimal quality of care, placing them at risk for subsequent cardiovascular events and negative health outcomes. To facilitate HCU amongst Aboriginal people, strategies must be implemented

  2. 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

  3. Feasibility of Rapid-Sequence 31P Magnetic Resonance Spectroscopy in Cardiac Patients

    International Nuclear Information System (INIS)

    Purpose: To determine the clinical feasibility of rapid-sequence phosphorus-31 magnetic resonance spectroscopy (31P -MRS) of the heart with cardiac patients using a 5T clinical MR system. Material and Methods: Twenty cardiac patients, i.e. dilated cardiomyopathy (DCM)3 cases, hypertrophic cardiomyopathy (HCM) 3 cases, hypertensive heart diseases (HHD) 3 cases, and aortic regurgitation (AR) case were examined using rapid cardiac 31P-MRS. Complete three-dimensional localization was performed using a two-dimensional phosphorus chemical-shift imaging sequence in combination with 30-mm axial slice-selective excitation. The rapid-sequence 31P-MRS procedure was phase encoded in arrays of 8x8 steps with an average of 4 acquisitions. The total examination time, including proton imaging and shimming, for the rapid cardiac 31P-MRS procedure, ranged from 0 to 5 min, depending on the heart rate. Student's t test was used to compare creatine phosphate (PCr)/adenosine triphosphate (ATP) ratios from the cardiac patients with those of the control subjects (n≅13). Results: The myocardial PCr/ATP ratio obtained by rapid 31P-MRS was significantly lower (P 31P-MRS may be a valid diagnostic tool for patients with cardiac disease

  4. CARDIAC AMYLOIDOSIS IN A PATIENT WITH MULTIPLE MYELOMA

    Directory of Open Access Journals (Sweden)

    Parathan

    2015-10-01

    Full Text Available Cardiac amyloidosis is a rare disorder, which is characterised by the extra cellular deposition of amyloid, a protein polysaccharide complex in the heart. This infiltrative cardiomyopathy presents with restrictive heart failure. We report a 58 year old male who pr esented with macroglossia, proteinuria and heart failure. His detailed evaluation revealed multiple myeloma with concurrent Primary (AL amyloidosis. This case report is to highlight the occurrence of cardiac amyloidosis and multiple myeloma which are two separate plasma cell dyscrasias which have presented together.

  5. 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

  6. 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...

  7. 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 ...

  8. [Manifestations of polymorphism of β1-adrenoreceptors in patients with newly diagnosed cardiac rhythm disorders].

    Science.gov (United States)

    Afanas'ev, S A; Rebrova, T Iu; Batalov, R E; Muslimova, É F; Borisova, E V; Popov, S V

    2013-01-01

    Individual peculiarities of the receptor apparatus of cardiomyocytes may determine pathological features of heart activity and susceptibility to pharmaceuticals. The possible role of beta-adrenoreceptor polymorphism in the development of cardiac rhythm disturbances is assessed by PCR. Special attention is given to A145G polymorphism of the ADRB1 gene in 127 patients with primary cardiac rhythm disorders. It was shown that AJ45G polymorphism (Ser49Gly) at DNA sites encoding for the amino acid sequence of beta-1 adrenoreceptors can influence the development of sex-specific cardiac rhythm disorders. PMID:24437165

  9. 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.

  10. 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...

  11. An unusual case of mesenteric ischemia in a patient with cardiac myxoma.

    Science.gov (United States)

    Pérez Baztarrica, Gabriel; Bornancini, Norberto; Salvaggio, Flavio; Porcile, Rafael

    2013-01-01

    Symptoms related to peripheral embolism are experienced in 2%-15% of cases of cardiac myxoma. We present a rare case of a 54-year-old man admitted due to sudden abdominal pain. A computed tomography (CT) scan showed occlusion of the superior mesenteric artery (SMA). As the patient's response to support treatment was favorable, a non-invasive approach was adopted, with prescription of oral anticoagulation (OAC) therapy. Transesophageal echocardiography revealed a tumor in the left atrium. The cardiac mass was completely removed and diagnosed as myxoma by histopathological analysis. As periodic CT scans showed progressive improvement of blood flow through the SMA, OAC was continued. OAC may have been beneficial due to the nature of emboli originating from a cardiac myxoma: thrombi covering the surface of the tumor. At present, there is no explanation in the literature for the benefits of OAC in patients with embolism associated with cardiac myxoma. PMID:23890757

  12. Dependency of blood pressure upon cardiac filling in patients with severe postural hypotension

    DEFF Research Database (Denmark)

    Mehlsen, J; Haedersdal, C; Stokholm, K H

    1994-01-01

    vasoconstriction. The reduction in cardiac output resulted from reductions in left ventricular end-diastolic volumes with unchanged left ventricular ejection fractions and only moderate increments in heart rate. The study was demonstrated that blood pressure is strongly dependent upon cardiac filling in severe......Autonomic denervation of the vascular bed results theoretically in a stronger dependency of blood pressure upon intravascular volume, and the study described aimed at an investigation of the relation between cardiac filling and arterial blood pressure in patients with severe postural hypotension....... Seven patients were studied during head-up tilt at three different tilt angles using intra-arterial blood pressure recordings and estimates of left ventricular volumes by radioisotope ventriculography. Blood pressure fell dramatically during head-up tilt due to reductions in cardiac output unopposed by...

  13. 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...

  14. 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...

  15. 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...

  16. 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...

  17. Short-term effect of cardiac resynchronization therapy in patients with ischaemic or nonischaemic cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    HUA Wei; NIU Hong-xia; WANG Fang-zheng; ZHANG Shu; CHEN Ke-ping; CHEN Xin

    2006-01-01

    Background Patients with heart failure were candidates for cardiac resynchronization therapy (CRT)regardless of underlying aetiology. This study observed the effect of CRT in patients with ischaemic or nonischaemic cardiomyopathy.Methods One hundred and forty-two patients with refractory chronic heart failure and left bundle branch block received cardiac resynchronization therapy, 91 men and 51 women, average age 60 years. Left ventricular ejection fraction (LVEF) was severely depressed (mean 29%), left ventricular end diastolic diameter (LVEDD)enlarged (mean 72 mm) and QRS width was lengthened (mean 147 ms). Ninety-eight had nonischaemic cardiomyopathy and 44 had ischaemic cardiomyopathy.Results After cardiac resynchronization therapy, the heart function was significantly improved. The mean LVEF increased from 29% to 36% after pacing. In patients with nonischaemic cardiomyopathy, the LVEF was improved from 28% to 37%, and in patients with ischaemic cardiomyopathy, the LVEF was improved from 30% to 36%. No significant difference of the improvement was found between the two groups (P>0.05).Conclusions Cardiac resynchronization therapy could significantly improve cardiac function in patients with chronic heart failure regardless of the underlying heart disease.

  18. Physical conditioning and mental stress reduction - a randomised trial in patients undergoing cardiac surgery

    OpenAIRE

    van der Merwe Juliana; Bailey Michael; Shepherd Judy; Bradley Scott; Spitzer Ondine; Braun Lesley; Rosenfeldt Franklin; Leong Jee; Esmore Donald

    2011-01-01

    Abstract Background Preoperative anxiety and physical unfitness have been shown to have adverse effects on recovery from cardiac surgery. This study involving cardiac surgery patients was primarily aimed at assessing the feasibility of delivering physical conditioning and stress reduction programs within the public hospital setting. Secondary aims were to evaluate the effect of these programs on quality of life (QOL), rates of postoperative atrial fibrillation (AF) and length of stay (LOS) in...

  19. Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

    OpenAIRE

    Kelli Maria Souza Santos; Manoel Luiz de Cerqueira Neto; Vitor Oliveira Carvalho; Valter Joviniano Santana Filho; Walderi Monteiro da Silva Junior; Amaro Afrânio Araújo Filho; Telma Cristina Fontes Cerqueira; Lucas de Assis Pereira Cacau

    2014-01-01

    Introduction: Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective: To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods: This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors) at three different times: preoperatively (M1), the day of discharge (M2) and hospital discharge (M...

  20. GATED SPECT IN PATIENTS WITH BIOPSY-NEGATIVE CARDIAC TRANSPLANT REJECTION

    OpenAIRE

    E. N. Ostroumov; V. M. Zakharevich; E. D. Kotina; N. N. Mojeiko; A. G. Kupriyanova; E. I. Ryaboshtanova; B. N. Morozov; N.Z. Meboniya; Mironov, S. V.; A. Y. Kormer; I. M. Ilynsky; L. V. Beletskaya; E. N. Kazakov

    2009-01-01

    Humoral rejection of the cardiac allograft is still a challenging problem associated with high incidence of graft loss and patient mortality. These episodes of rejection are often more severe, and more difficult to treat, than classical acute cellular rejection. Hemodynamic compromise, in the absence of acute cellular rejection, called biopsy-negative rejection occurs in 10 to 20% of cardiac allograft recipients. The assessment of hemodynamic compromise can provide functional data in transpla...

  1. 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 ...

  2. Pulse contour-derived cardiac output in hemodialysis patients

    DEFF Research Database (Denmark)

    Cordtz, Joakim; Ladefoged, Soeren D

    2010-01-01

    Reliable methods for cardiac output determination are essential for studying the pathophysiology of intradialytic hypotension. Use of the current gold standard, the Transonic monitor, requires an arteriovenous fistula. We wished to verify the accuracy of a method based on finger pulse contour...

  3. Perioperative beta blockers in patients having non-cardiac surgery

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi;

    2008-01-01

    American College of Cardiology and American Heart Association (ACC/AHA) guidelines on perioperative assessment recommend perioperative beta blockers for non-cardiac surgery, although results of some clinical trials seem not to support this recommendation. We aimed to critically review the evidenc...

  4. 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

  5. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia

    Directory of Open Access Journals (Sweden)

    Ana Carla Pereira de Araujo

    2014-11-01

    Full Text Available Background: Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective: To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods: This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1 or positive (G2 for myocardial ischemia. The endpoints analyzed were all-cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results: G2 comprised 205 patients (23.7%. During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 - 6.01; p = 0.016. The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 - 6.53; p = 0.022 and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively. Conclusion: Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.

  6. Autonomic Dysfunction Predicts Early Cardiac Affection in Patients with Systemic Sclerosis

    Directory of Open Access Journals (Sweden)

    Khaled M. Othman

    2010-05-01

    Full Text Available Objective: To detect the early preclinical alterations in cardiac autonomic control as well as altered cardiac function in systemic sclerosis (SSc patients and their relevance to the clinical features of the disease using noninvasive methods. Methods: 30 SSc patients and 15 healthy controls matched for age and sex underwent clinical examination, serological analysis, and echocardiographic assessment including Doppler flow imaging to evaluate cardiac function, and 24-hour Holter monitoring analyzed for arrhythmia and heart rate variability (HRV in the time and frequency domains. Results: The trans-mitral Doppler of early to atrial wave (E/A ratio was reversed in five patients (16.6% and the tricuspid E/A ratio was reversed in 10 patients (33.3%. Holter analysis for SSc patients revealed an increased prevalence of premature ventricular contractions (PVC $ 10/h (P = 0.02, supra-ventricular tachycardias (SVTs (P = 0.2, and total PVC count (P = 0.0000. Highly significant (P = 0.000 impairment in all HRV parameters was demonstrated in the SSc patients. Total skin thickness score (TSS, Raynaud’s phenomenon and anti-scleroderma 70 (anti-SCL70 showed significant positive correlations with all arrhythmia parameters, while showing a significant negative correlation with the impaired ventricular diastolic function and various HRV parameters. No correlation was found between arrhythmia and HRV parameters and disease duration, disease type, or presence of anti-centromere antibodies. Conclusion: Low heart rate variability, increased TSS and the presence of anti-SCL70 are correlated with preclinical cardiac involvement in SSc patients and may predict the likelihood of malignant arrhythmia and sudden cardiac death. Therefore, noninvasive HRV evaluation before clinical cardiac involvement in these patients might be beneficial when added to the clinical and laboratory assessments in detecting high-risk patients, and may allow for implementation of preventive

  7. 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.)

  8. 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.)

  9. 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...

  10. [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

  11. Personality and the physician-patient relationship as predictors of quality of life of cardiac patients after rehabilitation

    OpenAIRE

    Farin Erik; Meder Milena

    2010-01-01

    Abstract Background Numerous studies document the influence of psychosocial variables on the course of coronary heart disease. This study examines the influence of personality traits (trait anger, cynicism) and aspects of the physician-patient relationship (promoting patient participation by the physician, active communication behavior of the patient, trust in the physician) on the health related quality of life (HRQOL) of cardiac patients after rehabilitation. Methods N = 331 patients with c...

  12. Impact of hospital infections on patients outcomes undergoing cardiac surgery at Santa Casa de Misericórdia de Marília

    Directory of Open Access Journals (Sweden)

    Lucieni Oliveira Conterno

    2014-04-01

    Full Text Available Objective: this study aimed to determine the incidence of nosocomial infections, the risk factors and the impact of these infections on mortality among patients undergoing to cardiac surgery. Methods: Retrospective cohort study of 2060 consecutive patients from 2006 to 2012 at the Santa Casa de Misericórdia de Marília. Results: 351 nosocomial infections were diagnosed (17%, 227 non-surgical infections and 124 surgical wound infections. Major infections were mediastinitis (2.0%, urinary tract infection (2.8%, pneumonia (2.3%, and bloodstream infection (1.7%. The in-hospital mortality was 6.4%. Independent variables associated with non-surgical infections were age > 60 years (OR 1.59, 95% CI 1.09 to 2.31, ICU stay > 2 days (OR 5, 49, 95% CI 2.98 to 10, 09, mechanical ventilation > 2 days (OR11, 93, 95% CI 6.1 to 23.08, use of urinary catheter > 3 days (OR 4.85 95% CI 2.95 -7.99. Non-surgical nosocomial infections were more frequent in patients with surgical wound infection (32.3% versus 7.2%, OR 6.1, 95% CI 4.03 to 9.24. Independent variables associated with mortality were age greater than 60 years (OR 2.0; 95% CI 1.4 to3.0, use of vasoactive drugs (OR 3.4, 95% CI 1.9 to 6, 0, insulin use (OR 1.8; 95% CI 1.2 to 2.8, surgical reintervention (OR 4.4; 95% CI 2.1 to 9.0 pneumonia (OR 4.3; 95% CI 2.1 to 8.9 and bloodstream infection (OR = 4.7, 95% CI 2.0 to 11.2. Conclusion: Non-surgical hospital infections are common in patients undergoing cardiac surgery; they increase the chance of surgical wound infection and mortality.

  13. 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.

  14. Cardiac output determined by echocardiography in patients with cirrhosis: comparison with the indicator dilution technique

    DEFF Research Database (Denmark)

    Andersen, Ulrik B; Møller, Søren; Bendtsen, Flemming; Henriksen, Jens H

    2003-01-01

    technique (CO(I)). METHODS: Twelve patients with cirrhosis were studied. CO(d) was measured as the spatial mean velocity of the left ventricular outflow tract, multiplied by the cross-sectional area and the heart rate. CO(I) was determined by the standard indicator dilution technique after injection of 125I......BACKGROUND/AIMS: Measurement of cardiac output in hyperkinetic patients with cirrhosis by Doppler echocardiography is increasingly reported, but has not been validated. We have compared simultaneous measurements of cardiac output by Doppler echocardiography (CO(d)) and by the indicator dilution...... with the Doppler technique. CONCLUSION: Doppler measurements of cardiac output in groups of patients with cirrhosis are accurate with respect to the group mean, but marked disagreements of over- and underestimation were seen in individual patients. The reproducibility of the Doppler technique is...

  15. Radiation exposure of patients from paediatric cardiac catheterizations. Part 2. Results of patient related measurements

    International Nuclear Information System (INIS)

    Age, entire exposure duration and dose-area products for pa and lat beam as well as the number of angiographies have been recorded for 2114 pediatric cardiac catheterizations within the time period 1982 to 1996. Furthermore, the average field dimensions and sizes at the patient entrance surface for pa and lat beams and the frequency distributions for dose-area product rates, the entire dose-area products and the effective doses, calculated by means of age class dependent conversion factors, are given for all patients. The effective doses for new-borns are higher by about a factor 2 (Q50=6.5 mSv compared to 3.0 mSv) compared to children of higher age class, despite of the quite smaller body dimensions and thus smaller dose-area product rates. Cancer risks by radiation exposure are significantly higher for new-borns than for elder children for the same effective dose. Although no age specific factor can be given it is possible to derive from literature data, that cardiac catheterizations cause radiation risks, which are larger at least by a factor 2 to 4 with decreasing age, especially for thyroid and breast cancer (the latter more for girls). (orig.)

  16. GATED SPECT IN PATIENTS WITH BIOPSY-NEGATIVE CARDIAC TRANSPLANT REJECTION

    Directory of Open Access Journals (Sweden)

    E. N. Ostroumov

    2009-05-01

    Full Text Available Humoral rejection of the cardiac allograft is still a challenging problem associated with high incidence of graft loss and patient mortality. These episodes of rejection are often more severe, and more difficult to treat, than classical acute cellular rejection. Hemodynamic compromise, in the absence of acute cellular rejection, called biopsy-negative rejection occurs in 10 to 20% of cardiac allograft recipients. The assessment of hemodynamic compromise can provide functional data in transplant patients that is complementary to myocardial biopsies if the biopsy can miss significant rejection. We present three cases of the biopsy-negative rejection. All patients have studied with gated SPECT phase analysis. 

  17. Heart shaking transitions - A phenomenological-hermeneutic study of patients´ experiences in cardiac rehabilitation

    DEFF Research Database (Denmark)

    Simonÿ, Charlotte; Dreyer, Pia; Pedersen, Birthe D.;

    enrolled in the cardiac rehabilitation programme. The data underwent interpretation consisting of three phases: naïve reading, structural analysis and comprehensive interpretation. Results. The preliminary findings are that the patients go through a Heart Shaking Journey in Cardiac Rehabilitation. Three...... themes emerged: Hard to accept the disease: facing the disease is a difficult surrender to the patients, leading to vulnerability and helplessness; Understanding that life has become frail: patients feel shaken in an existential way as they realize that the disease is chronical and life-threatening; An...

  18. Cardiac abnormalities in adult patients with polymyositis or dermatomyositis as assessed by non-invasive modatities

    DEFF Research Database (Denmark)

    Christensen, Anne Friesgaard

    2016-01-01

    , factors associated with LVDD were age (P = 0.001), disease duration (P = 0.004), presence of myositis specific/associated autoantibodies (P = 0.05), and high cardiac (99m) Tc-PYP uptake (P = 0.006). In multivariate analysis of the pooled data for patients and HCs, a diagnosis of PM/DM (P < 0.0001) was...... associated with LVDD. Conclusions Patients with PM or DM had an increased prevalence of cardiac abnormalities compared to HCs. LVDD was a common occurrence in PM/DM patients and correlated to disease duration. In addition, the association of LVDD with myositis specific/associated autoantibodies and high...

  19. Cardiac sarcoidosis and heart transplantation: a report of four consecutive patients

    DEFF Research Database (Denmark)

    Milman, N.; Andersen, Claus Bøgelund; Mortensen, Sven Aage;

    2008-01-01

    Heart transplantation (HTx) is a well-established treatment for severe cardiac failure. However, HTx for cardiac sarcoidosis is rare; less than 80 patients have been reported worldwide. In many patients, the diagnosis was not made prior to HTx. The aim of this study was to describe the use of HTx...... proven prior to HTx. In three patients, all with dilated cardiomyopathy due to myocardial sarcoidosis, the final diagnosis was obtained by examination of the explanted heart. Arrythmias (supraventricular and ventricular), heart block, mitral valve insufficiency and dilated cardiomyopathy were prominent...

  20. [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

  1. 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.

  2. Functional Status, Anxiety, Cardiac Self-Efficacy, and Health Beliefs of Patients with Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Hamid Allahverdipour

    2013-12-01

    Full Text Available Background: Beliefs and emotions could effect on functional status, quality of life, and mortality amongst patients who are suffering coronary heart disease (CHD. Current study examined the role of anxiety: trait/ state, self-efficacy, health beliefs, and functional status among patient with history of CHD. Method: In this correlational study, 105 hospitalized and outpatients patients suffering CHD in Tehran Heart Center Hospital participated by using convenience sampling method in 2012. Cardiac self-efficacy, Seattle Angina, and research- designed health beliefs questionnaires were used to gather data. Results: The functional status in CHD patients showed significant relationships with gender, job, and type of medical insurance of the participants (All ps<0.05. In addition , perceived vulnerability to face again cardiac attack in the future, perceived severity of next cardiac attack, anxiety, state anxiety and trait anxiety (All ps<0.05 had significant and negative relationships with functional status. Conversely, the cardiac self-efficacy had a positive and significant relationship (P<0.001 with functional status. Conclusion: Psychological factors have important role in functional status and quality of life of patients who suffering CHD. Therefore, it is necessary to emphasize on supportive and complementary programs to promote Cardiac Rehabilitation Programs.

  3. Serial measurements of cardiac biomarkers in patients after allogeneic hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Roziakova Lubica

    2012-02-01

    Full Text Available Abstract Background Previous therapy with anthracyclines (ANT and conditioning regimen followed by hematopoietic stem cell transplantation (HSCT represents a high risk for development of cardiotoxicity. The aim of this study was to assess subclinical myocardial damage after HSCT using echocardiography and cardiac biomarkers - high sensitive cardiac troponin T (hs-cTnT and N-terminal pro-B-type natriuretic peptide (NT-proBNP and to identify patients at risk of developing clinical cardiotoxicity. Patients and methods Thirty-seven patients who were treated with allogeneic HSCT for hematologic diseases at median age of 28 years at time of HSCT were studied. Conditioning regimen included either chemotherapy without total body irradiation (TBI or combination of chemotherapy with TBI. Twenty-nine (78,3% patients were pretreated with ANT therapy. Cardiac biomarkers were serially measured before conditioning regimen and at days 1, 14 and 30 after HSCT. Cardiac systolic and diastolic functions were assessed before conditioning regimen and 1 month after HSCT by echocardiography. Results The changes in plasma NT-proBNP and hs-cTnT levels during the 30 days following the HSCT were statistically significant (P P Conclusions Elevations in both cardiac biomarkers were found before clinical signs of cardiotoxicity developed. Persistent elevations in NT-pro-BNP and hs-cTnT concentrations simultaneously for a period exceeding 14 days might be used for identification of patients at risk of developing cardiotoxicity and requiring further cardiological follow up.

  4. 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

  5. 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

  6. Collaborative Cardiac Care Service: A Multidisciplinary Approach to Caring for Patients with Coronary Artery Disease

    Science.gov (United States)

    Sandhoff, Brian G; Kuca, Susan; Rasmussen, Jon; Merenich, John A

    2008-01-01

    Background: Coronary artery disease (CAD) remains the leading cause of death in the US. In 1996, Kaiser Permanente of Colorado (KPCO) developed the Collaborative Cardiac Care Service (CCCS) with the goal of improving the health of patients with CAD. Description: CCCS consists of a nursing team (the KP Cardiac Rehabilitation program) and a pharmacy team (the Clinical Pharmacy Cardiac Risk Service). CCCS works collaboratively with patients, primary care physicians, cardiologists, and other health care professionals to coordinate proven cardiac risk reduction strategies for patients with CAD. Activities such as lifestyle modification, medication initiation and adjustment, patient education, laboratory monitoring, and management of adverse events are all coordinated through CCCS. The CCCS uses an electronic medical record and patient-tracking software to document all interactions with patients, track patient appointments, and collect data for evaluation of both short- and long-term outcomes. Outcomes: The CCCS currently follows over 12,000 patients with CAD. The CCCS has demonstrated improvement in surrogate outcomes including: cholesterol screening (55% to 96.3%), the proportion of patients with a goal of low-density lipoprotein cholesterol (LDL-c) <100 mg/dL (22% to 76.9%), and has reduced the average LDL-c to 78.3 mg/dL for the CAD population it follows. The CCCS has shown a reduction in all-cause mortality associated with CAD by 76% in the patients followed by the service. Patient and physician satisfaction have been high with CCCS. Conclusion: The CCCS coordinates many aspects of cardiac risk reduction care resulting in excellent continuity of care. The CCCS has continued to grow and expand the number of patients enrolled by using innovative strategies and technology and has resulted in excellent care and improved outcomes of the CAD population at KPCO. PMID:21331203

  7. 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

  8. 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.

  9. Cardiac function in patients with early cirrhosis during maximal beta-adrenergic drive

    DEFF Research Database (Denmark)

    Krag, Aleksander; Bendtsen, Flemming; Dahl, Emilie Kristine;

    2014-01-01

    BACKGROUND AND AIM: Cardiac dysfunction in patients with early cirrhosis is debated. We investigated potential cardiac dysfunction by assessing left ventricular systolic performance during a dobutamine stress test in patients with early cirrhosis. PATIENTS AND METHODS: Nineteen patients with Child......: Patients with cirrhosis and controls had an equal stress response, the heart rate and ejection fraction increased similarly and maximal heart rate was reached in all. At rest CO was higher in Child B patients than controls. During maximal stress, Child B patients had higher CO (10.6±2.7 vs. 8.0±1.8 L...... ventricle mass increased by 5.6 gram per model for end stage liver disease (MELD) point. MELD score correlated with the end diastolic and systolic volume, CO, and stroke volume at rest and at stress (all p<0.05). CONCLUSION: In patients with early cirrhosis the chronotropoic and inotropic response to...

  10. Surveillance and follow-up of patients with implanted cardiac pacemaker by telephone transmission.

    Science.gov (United States)

    Sakurai, T; Tokutsu, S; Nishimura, O; Tagami, Y; Takimoto, M; Ohta, H; Yamaoka, Y; Okada, K; Suzuki, Y; Yokoi, H; Enomoto, K; Okada, N; Tanaka, H; Murakami, K

    1978-11-01

    A follow-up study on pacemaker function in 15 patients with implanted cardiac pacemaker has been performed by telephone transmission. The transmitting set consisting of electrocardiograph, pacemaker pulse modulator and acoustic coupler was manipulated by the patients themselves. ECG, pacemaker pulse, and pulse rate were simultaneously transmitted through 1 channel to the receiver in our clinic. Of 56 patients with pacemaker, 15 patients were surveyed by telephone transmission. In these patients battery exhaustion was detected in 3, competition in 2, and lead fracture in 1. The fact that surveillance and follow-up of the patients with implanted cardiac pacemaker could be carried out by telephone transmission as well as by clinic visitation tells us that the telephone transmission is a useful method and plays an important role in a pacemaker clinic. Moreover our study established its further usefulness in the patient's preference due to difficulties in travelling to the pacemaker clinic and in reducing patient's anxiety. PMID:750667

  11. 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)

  12. [Cardiac evaluation before non-cardiac surgery].

    Science.gov (United States)

    Menzenbach, Jan; Boehm, Olaf

    2016-07-01

    Before non-cardiac surgery, evaluation of cardiac function is no frequent part of surgical treatment. European societies of anesthesiology and cardiology published consensus-guidelines in 2014 to present a reasonable approach for preoperative evaluation. This paper intends to differentiate the composite of perioperative risk and to display the guidelines methodical approach to handle it. Features to identify patients at risk from an ageing population with comorbidities, are the classification of surgical risk, functional capacity and risk indices. Application of diagnostic means, should be used adjusted to this risk estimation. Cardiac biomarkers are useful to discover risk of complications or mortality, that cannot be assessed by clinical signs. After preoperative optimization and perioperative cardiac protection, the observation of the postoperative period remains, to prohibit complications or even death. In consideration of limited resources of intensive care department, postoperative ward rounds beyond intensive care units are considered to be an appropriate instrument to avoid or recognize complications early to reduce postoperative mortality. PMID:27479258

  13. 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

  14. 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. ...

  15. 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...

  16. 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

  17. 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.

  18. Neurohormonal activation and diagnostic value of cardiac peptides in patients with suspected mild heart failure

    DEFF Research Database (Denmark)

    Mikkelsen, Kirsten V.; Bie, Peter; Møller, Jacob E.; Videbæk, Lars; Villadsen, Henrik D.; Haghfelt, Torben

    2006-01-01

    accuracy of cardiac peptides to detect any left ventricular dysfunction (LVD) in patients referred from primary care with suspected HF before institution of medical therapy. METHODS: Of 166 referred patients 150 were consecutively included (14 were excluded and two refused consent). Echocardiography and...

  19. Determinants of Left Ventricular Mass and Hypertrophy in Hemodialysis Patients Assessed by Cardiac Magnetic Resonance Imaging

    OpenAIRE

    Patel, Rajan K.; Oliver, Scott; Patrick B. Mark; Powell, Joanna R.; McQuarrie, Emily P.; Traynor, James P.; Dargie, Henry J; Jardine, Alan G

    2009-01-01

    Background and objectives: Left ventricular hypertrophy (LVH) is an independent risk factor for premature cardiovascular death in hemodialysis (HD) patients and one of the three forms of uremic cardiomyopathy. Cardiovascular magnetic resonance (CMR) is a volume-independent technique to assess cardiac structure. We used CMR to assess the determinants of left ventricular mass (LVM) and LVH in HD patients.

  20. Predicting non-return to work in patients attending cardiac rehabilitation

    DEFF Research Database (Denmark)

    Samkange-Zeeb, Florence; Altenhöner, Thomas; Berg, Gabriele;

    2006-01-01

    Return to work (RTW) is the primary goal in the rehabilitation of patients suffering from coronary heart diseases. However, in spite of expensive rehabilitative efforts, many patients do not resume work following cardiac rehabilitation. To increase cost-effectiveness, predictive tests for non-RTW...... concerning RTW and level of depression were significant predictors of RTW. Gender and anxiety were not significant predictors....

  1. Progression of cardiac involvement in patients with limb-girdle type 2 and Becker muscular dystrophies

    DEFF Research Database (Denmark)

    Petri, Helle; Sveen, Marie-Louise; Thune, Jens Jakob;

    2015-01-01

    AIM: To assess the degree and progression of cardiac involvement in patients with limb-girdle type 2 (LGMD2) and Becker muscular dystrophies (BMD). METHODS: A follow-up study of 100 LGMD2 (types A-L) and 30 BMD patients assessed by electrocardiogram (ECG) and echocardiography, supplemented by...

  2. Cardiac Responses during Picture Viewing in Young Male Patients with Schizophrenia

    Directory of Open Access Journals (Sweden)

    Roelie J. Hempel

    2012-01-01

    Full Text Available Previous research investigating the emotion recognition ability in patients with schizophrenia has mainly focused on the recognition of facial expressions. To broaden our understanding of emotional processes in patients with schizophrenia, this study aimed to investigate whether these patients experience and process other emotionally evocative stimuli differently from healthy participants. To investigate this, we measured the cardiac and subjective responses of 33 male patients (9 with and 24 without antipsychotic medication and 40 male control subjects to emotion-eliciting pictures. Cardiac responses were chosen as an outcome measure because previous research has indicated that these are linked with attentional and emotional processes and provide a more objective measure than self-report measures alone. The differences in cardiac responses between patients and controls were limited to medicated patients: only the medicated patients showed significantly decreased cardiac orienting responses compared with control subjects, regardless of picture contents. These results indicate that medicated patients directed less attention towards emotion-eliciting pictures than controls. Decreased attentional resources while processing emotional evocative stimuli could lead to incorrect appraisals of the environment and may have detrimental emotional and social consequences, contributing to chronic stress levels and an increased risk for cardiovascular disease.

  3. Value of plasma ADMA in predicting cardiac structure and function of patients with chronic kidney diseases

    Institute of Scientific and Technical Information of China (English)

    叶建华

    2012-01-01

    Objective To explore the predicting value of plasma asymmetric dimethylarginine (ADMA) in cardiac structure and function of patients with chronic kidney diseases(CKD). Methods A total of 100 CKD patients were enrolled in this cross-sectional study. According to staging of the

  4. Comprehensive cardiac rehabilitation improves outcome for patients with implantable cardioverter defibrillator

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Pedersen, Preben Ulrich; Zwisler, Ann-Dorthe;

    2015-01-01

    Aims:The aim of this randomised clinical trial was to assess a comprehensive cardiac rehabilitation intervention including exercise training and psycho-education vs 'treatment as usual' in patients treated with an implantable cardioverter defibrillator (ICD).Methods:In this study 196 patients with...

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

    Directory of Open Access Journals (Sweden)

    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.

  6. Pre-ICU characteristics in cardiac surgery patients with CPB developing AKI

    OpenAIRE

    Mertens, K.; Pennemans, Valerie; Penders, Joris; Swennen, Quirine; Vander Laenen, M.; Vanelderen, P.; Boer, Willem

    2014-01-01

    Aims. AKI is common after cardiac surgery involving CPB. Lack of reliable early detection methods for post-op AKI limits timely therapeutic intervention. A number of new biomarkers for AKI await validation in this setting. Analysis of a database was performed to define baseline patient and biomarker characteristics in patients developing AKI. Methods. 259 patients were enrolled. Patients with severe pre-existing renal insufficiency were excluded (eGFR

  7. Prevalence of hospital malnutrition among cardiac patients: results from six nutrition screening tools

    OpenAIRE

    Pathirana, Anidu K; Lokunarangoda, Niroshan; Ranathunga, Ishara; Santharaj, Wijeyasingam Samuel; Ekanayake, Ruwan; Jayawardena, Ranil

    2014-01-01

    Malnutrition is highly prevalent among hospitalized patients, ranging from 30% to 50% depending on the patient population and the criteria used for diagnosis. Identifying early those who are malnourished and at risk of malnutrition and intervening at an early stage will improve patients overall prognosis and will reduce the costs to the state. Even though cardiac patients are at risk of malnutrition, data on the prevalence of malnutrition among cardiology inpatients is limited. The aim of the...

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

    Directory of Open Access Journals (Sweden)

    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

  9. 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

  10. Cardiac Repolarization Abnormalities and Potential Evidence for Loss of Cardiac Sodium Currents on ECGs of Patients with Chagas' Heart Disease

    Science.gov (United States)

    Schlegel, T. T.; Medina, R.; Jugo, D.; Nunez, T. J.; Borrego, A.; Arellano, E.; Arenare, B.; DePalma, J. L.; Greco, E. C.; Starc, V.

    2007-01-01

    Some individuals with Chagas disease develop right precordial lead ST segment elevation in response to an ajmaline challenge test, and the prevalence of right bundle branch block (RBBB) is also high in Chagas disease. Because these same electrocardiographic abnormalities occur in the Brugada syndrome, which involves genetically defective cardiac sodium channels, acquired damage to cardiac sodium channels may also occur in Chagas disease. We studied several conventional and advanced resting 12-lead/derived Frank-lead ECG parameters in 34 patients with Chagas -related heart disease (mean age 39 14 years) and in 34 age-/gender-matched healthy controls. All ECG recordings were of 5-10 min duration, obtained in the supine position using high fidelity hardware/software (CardioSoft, Houston, TX). Even after excluding those Chagas patients who had resting BBBs, tachycardia and/or pathologic arrhythmia (n=8), significant differences remained in multiple conventional and advanced ECG parameters between the Chagas and control groups (n=26/group), especially in their respective QT interval variability indices, maximal spatial QRS-T angles and low frequency HRV powers (p=0.0006, p=0.0015 and p=0.0314 respectively). In relation to the issue of potential damage to cardiac sodium channels, the Chagas patients had: 1) greater than or equal to twice the incidence of resting ST segment elevation in leads V1-V3 (n=10/26 vs. n=5/26) and of both leftward (n=5/26 versus n=0/26) and rightward (n=7/26 versus n=3/26) QRS axis deviation than controls; 2) significantly increased filtered (40-250 Hz) QRS interval durations (92.1 8.5 versus 85.3 plus or minus 9.0 ms, p=0.022) versus controls; and 3) significantly decreased QT and especially JT interval durations versus controls (QT interval: 387.5 plus or minus 26.4 versus 408.9 plus or minus 34.6 ms, p=0.013; JT interval: 290.5 plus or minus 26.3 versus 314.8 plus or minus 31.3 ms; p=0.0029). Heart rates and Bazett-corrected QTc/JTc intervals

  11. Cardiac disease in patients with mucopolysaccharidosis: presentation, diagnosis and management

    OpenAIRE

    Braunlin, Elizabeth A.; Harmatz, Paul R.; Scarpa, Maurizio; Furlanetto, Beatriz; Kampmann, Christoph; Loehr, James P.; Ponder, Katherine P.; Roberts, William C.; Rosenfeld, Howard M.; Giugliani, Roberto

    2011-01-01

    The mucopolysaccharidoses (MPSs) are inherited lysosomal storage disorders caused by the absence of functional enzymes that contribute to the degradation of glycosaminoglycans (GAGs). The progressive systemic deposition of GAGs results in multi-organ system dysfunction that varies with the particular GAG deposited and the specific enzyme mutation(s) present. Cardiac involvement has been reported in all MPS syndromes and is a common and early feature, particularly for those with MPS I, II, and...

  12. Cardiac Output Measurement in Patients with an Implanted Pacemaker

    Czech Academy of Sciences Publication Activity Database

    Vondra, Vlastimil; Halámek, Josef; Viščor, Ivo; Jurák, Pavel; Novák, M.

    Danvers : Institute of Electrical and Electronics Engineers, Inc., 2007, s. 916-918. ISBN 978-1-4244-0787-3. ISSN 1557-170X. [Annual International Conference of the IEEE Engineering in Medicine and Biology Society /29./. Lyon (FR), 23.08.2007-26.08.2007] R&D Projects: GA ČR GA102/06/0136 Institutional research plan: CEZ:AV0Z20650511 Keywords : cardiac output measurement * implanted pacemaker Subject RIV: FA - Cardiovascular Diseases incl. Cardiotharic Surgery

  13. MULTIPLE FACETS OF REHABILITATION IN ELDERLY PATIENTS AFTER CARDIAC SURGERY

    OpenAIRE

    Maura Gabriela FELEA; Florin MITU; Maria M. LEON

    2014-01-01

    The elderly rehabilitation program after coronary artery bypass graft (CABG) encompasses endurance training performed on a cycloergometer and physical rehabilitation, the results being exceeded by adding strength and balance exercises. Early initiation of mobilization exercises can prevent problems of posture, as well as thoraco-pulmonary and scapular-humeral articulation conditions often encountered after cardiac surgery. The results of special functional training in elderly can be assessed ...

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

    Directory of Open Access Journals (Sweden)

    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.

  15. Feasibility of Rapid-Sequence {sup 31}P Magnetic Resonance Spectroscopy in Cardiac Patients

    Energy Technology Data Exchange (ETDEWEB)

    Chida, K.; Otani, H.; Saito, H.; Nagasaka, T.; Kagaya, Y.; Kohzuki, M.; Zuguchi, M.; Shirato, K. [Tohoku Univ., School of Health Sciences, Sendai (Japan). Dept. of Radiological Technology

    2005-07-01

    Purpose: To determine the clinical feasibility of rapid-sequence phosphorus-31 magnetic resonance spectroscopy ({sup 31}P -MRS) of the heart with cardiac patients using a 5T clinical MR system. Material and Methods: Twenty cardiac patients, i.e. dilated cardiomyopathy (DCM)3 cases, hypertrophic cardiomyopathy (HCM) 3 cases, hypertensive heart diseases (HHD) 3 cases, and aortic regurgitation (AR) case were examined using rapid cardiac {sup 31}P-MRS. Complete three-dimensional localization was performed using a two-dimensional phosphorus chemical-shift imaging sequence in combination with 30-mm axial slice-selective excitation. The rapid-sequence {sup 31}P-MRS procedure was phase encoded in arrays of 8x8 steps with an average of 4 acquisitions. The total examination time, including proton imaging and shimming, for the rapid cardiac {sup 31}P-MRS procedure, ranged from 0 to 5 min, depending on the heart rate. Student's t test was used to compare creatine phosphate (PCr)/adenosine triphosphate (ATP) ratios from the cardiac patients with those of the control subjects (n{approx_equal}13). Results: The myocardial PCr/ATP ratio obtained by rapid {sup 31}P-MRS was significantly lower (P <0.001) in DCM patients (1.82{+-}0.33, mean{+-}SD), and in patients with global myocardial dysfunction (combined data for 20 patients:.89{+-}0.32) than in normal volunteers (2.96{+-}0.59). These results are similar to previous studies. Conclusion: Rapid-sequence {sup 31}P-MRS may be a valid diagnostic tool for patients with cardiac disease.

  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.

    Directory of Open Access Journals (Sweden)

    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. Cirurgia cardíaca no idoso Cardiac surgery in elderly patients

    Directory of Open Access Journals (Sweden)

    Danton R. da Rocha LOURES

    2000-03-01

    -five patients, 70 years of age or older, who underwent cardiac surgery in the HC-UFPR, between 1995 and 1999 were studied. The purpose of this study was to analyze early and long-term results. Ages from 70 to 88 years, with 34 females (46.7% and 41 males (53.3%. Symptoms included angina (81.3%, dyspnea (42.6% and syncope (16%. There was 57.3% of patients in NYHA class I, 17.3% in class II, 18.6% in class III and 6.6% in class IV. The main risk factors listed were high blood pressure (61.3%, smoke (48%, diabetes mellitus (28% and 9.3% had already had cardiac operations. Surgical procedures included 50 coronary artery bypass grafts - CABG (66.6%, 9 aortic valve replacements (12%, 5 aortic operations (6.6%, 4 CABG + valve replacement (5.2% and other procedures (7%. The main postoperative complications were cardiovascular - ventricular arrhythmias (22.6%, supraventricular arrhythmias (21.3%, low cardiac output (16% - infections (16% and pulmonary problems (9.3%. The median stay in the ICU was 5 days. RESULTS: Sixty-five (78.4% survivors had complete follow-up. The mean follow-up time was 20.7 months and long-term survival was 92%. Only one of the late deaths was cardiac related. CONCLUSION: Although this subgroup is associated with chronic diseases compromising other organs, advances in cardiac surgery and intensive care have made possible an intervention with safety and low morbidity and mortality.

  1. Has Microsoft® Left Behind Risk Modeling in Cardiac and Thoracic Surgery?

    OpenAIRE

    Poullis, Mike

    2011-01-01

    This concept paper examines a number of key areas central to quality and risk assessment in cardiac surgery. The effect of surgeon and institutional factors with regard to outcomes in cardiac surgery is utilized to demonstrate the need to sub analyze cardiac surgeons performance in a more sophisticated manner than just operation type and patient risk factors, as in current risk models. By utilizing the mathematical/engineering concept of Fourier analysis in the breakdown of cardiac surgical r...

  2. Cardiac Magnetic Resonance In Adults With Congenital Heart Disease

    OpenAIRE

    Partington, Sara L.; Valente, Anne Marie

    2013-01-01

    Increasing numbers of adults with congenital heart disease are referred for cardiac magnetic resonance imaging. Knowledge of the congenital heart anatomy, prior surgical interventions, and the development of an imaging focus for each individual patient plays a crucial role when performing a successful cardiac magnetic resonance imaging examination. The following manuscript focuses on cardiac magnetic resonance imaging considerations of three specific conotruncal congenital heart lesions: tetr...

  3. Evaluation of effective dose received by patients undergoing Cardiac Angiography Computed Tomography (CT) and Conventional Angiography

    International Nuclear Information System (INIS)

    Cardiac Angiography is a field of studies that utilizes the energy of radiation to study the coronary arteries of the heart. Patients undergoing this procedure has a probability of receiving an over dose of radiation that may further cause stochastic effect. The main objective of this research is to compare and clarify an approach for minimal effective dose receive by patients between procedures of Cardiac Angiography Computerized Tomography (CT) and Conventional Angiography. Based on this study, the patients recorded are based in Hospital University Sains Malaysia, Kubang Kerian, Kelantan. The Dose-Length-Product (DLP) was extracted from the Computed Tomography Dose Index (CTDI); meanwhile the Dose-Area-Product (DAP) was extracted from the modalities console screen. These relevant data are the means to clarify the effective dose receive by patients. The result shows that patients who undergo Conventional Angiography had a mean effective dose of 8.50 ± 6.41 mSv. Meanwhile, as for Cardiac Angiography Computerized Tomography, the patients had a mean effective dose of 7.08 ± 2.42 mSv. A significant difference in effective dose was seen between the two procedures. Cardiac Angiography CT provides high accurate diagnostic information with less radiation dose to patients compared to Conventional Angiography. (author)

  4. Pseudoxanthoma elasticum: cardiac findings in patients and Abcc6-deficient mouse model.

    Directory of Open Access Journals (Sweden)

    Fabrice Prunier

    Full Text Available BACKGROUND: Pseudoxanthoma elasticum (PXE, caused by mutations in the ABCC6 gene, is a rare multiorgan disease characterized by the mineralization and fragmentation of elastic fibers in connective tissue. Cardiac complications reportedly associated with PXE are mainly based on case reports. METHODS: A cohort of 67 PXE patients was prospectively assessed. Patients underwent physical examination, electrocardiogram, transthoracic echocardiography, cardiac magnetic resonance imaging (CMR, treadmill testing, and perfusion myocardial scintigraphy (SPECT. Additionally, the hearts of a PXE mouse models (Abcc6(-/- and wild-type controls (WT were analyzed. RESULTS: Three patients had a history of proven coronary artery disease. In total, 40 patients underwent exercise treadmill tests, and 28 SPECT. The treadmill tests were all negative. SPECT showed mild perfusion abnormalities in two patients. Mean left ventricular (LV dimension and function values were within the normal range. LV hypertrophy was found in 7 (10.4% patients, though the hypertrophy etiology was unknown for 3 of those patients. Echocardiography revealed frequent but insignificant mitral and tricuspid valvulopathies. Mitral valve prolapse was present in 3 patients (4.5%. Two patients exhibited significant aortic stenosis (3.0%. While none of the functional and histological parameters diverged significantly between the Abcc6(-/- and WT mice groups at age of 6 and 12 months, the 24-month-old Abcc6(-/- mice developed cardiac hypertrophy without contractile dysfunction. CONCLUSIONS: Despite sporadic cases, PXE does not appear to be associated with frequent cardiac complications. However, the development of cardiac hypertrophy in the 24-month-old Abcc6(-/- mice suggests that old PXE patients might be prone to developing late cardiopathy.

  5. 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.

  6. 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.

  7. 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.

  8. 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

  9. Cardiac Iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy parameter predicts cardiac and cerebrovascular events in type 2 diabetic patients without structural heart disease

    International Nuclear Information System (INIS)

    Cardiac iodine-123 metaiodobenzylguanidine (123I-MIBG) scintigraphy is an established method of assessment of cardiovascular sympathetic function. The aim of the present study was to investigate the long-term cardiovascular predictive value of cardiac 123I-MIBG scintigraphy parameters in Japanese type 2 diabetic patients without structural heart disease. Cardiac 123I-MIBG scintigraphy in 108 patients with type 2 diabetes who did not have structural heart disease, was evaluated. The washout rate (WR) was considered enhanced if it was ≥40%. Accurate follow-up information for 4.6 years was obtained in 54 enhanced WR patients (27 male; mean age, 61±11 years) and in 54 sex- and age-matched preserved WR patients (27 male; mean age, 61±10 years). Major adverse cardiac and cerebrovascular events (MACCE) were investigated. During follow-up, 10 enhanced WR patients developed MACCE including cardiac death, coronary revascularization, stroke, and congestive heart failure, while MACCE occurred in only 3 male patients. The Kaplan-Meier curves indicated that enhanced WR patients had higher incidence of MACCE than those with preserved WR (P123I-MIBG scintigraphy at baseline has long-term cardiovascular predictive value in Japanese patients with type 2 diabetes without structural heart disease. (author)

  10. 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

  11. 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...

  12. 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...

  13. The Role of Imaging with Cardiac Computed Tomography in Cardio-Oncology Patients.

    Science.gov (United States)

    Pitekova, Barbora; Ravi, Sriram; Shah, Shimoli V; Mladosievicova, Beata; Heitner, Stephen; Ferencik, Maros

    2016-09-01

    Cardiovascular diseases and cancer represent the two most common causes of morbidity and mortality in industrialized countries. With the increase in long-term survival of cancer patients, cardiovascular diseases are the leading cause of mortality for many cancer survivors. In this article, we will review the most common cardiovascular toxicities of cancer therapies and will describe the role of cardiac CT in the detection and monitoring of cardiovascular disease. While there is limited evidence for the use of CT imaging in cancer patients, we will discuss the utility of cardiac CT in the detection and management of coronary artery disease, pericardial and valvular heart disease. PMID:27443383

  14. Developing a visualized patient-centered, flow-based and objective-oriented care path of cardiac catheterization examination.

    Science.gov (United States)

    Kuo, Ming Chuan; Chang, Polun

    2009-01-01

    It has been known that visualization is a user-preferred and more meaningful interface of information systems. To reduce the anxiety and uncertainty of patients, we transformed the sophisticated process of cardiac catheterization into visualized information. The Microsoft Visio 2003 and Excel 2003 with the VBA automation tool were used to design a process flow of Cardiac Catheterization. The results show the technical feasibility and potentials helpful for patient to realize the nursing process of cardiac catheterization. PMID:19593031

  15. 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.

  16. Dipyridamole thallium imaging for detecting cardiac involvement in patients with systemic sclerosis (scleroderma)

    Energy Technology Data Exchange (ETDEWEB)

    Ishida, Yoshio; Matsubara, Noboru; Tani, Akihiro; Morozumi, Takakazu; Hori, Masatsugu; Kitabatake, Akira; Kamada, Takenobu; Kimura, Kazufumi; Kozuka, Takahiro (Osaka Univ. (Japan). Faculty of Medicine)

    1990-02-01

    Dipyridamole thallium-201 imaging was carried out in 21 patients with progressive systemic sclerosis (PSS) to assess its value in detecting impaired myocardium and coronary microcirculation associated with PSS. Depending upon the degree of cardiac function, the patients were classified as having either ejection fraction of 50% or more (Group I, n=17) or less than 50% (Group II, n=4). In Group I, four patients had transient defect in which perfusion defects were seen on early images but not seen on delayed images; three had reverse redistribution in which defects were not seen on early images but seen on delayed images; and three had persistent defects which were seen on both early and delayed images. A decreased washout of thallium-201 was seen in 9 patients. In an analysis of both perfusion defects and washout rate, 13 patients (76%) in Group I were found to have abnormal findings. This suggests that disturbed coronary microcirculation or impaired myocardium may frequently develop even when EF is normal. All of the patients categorized as having a decreased cardiac function (Group II) had perfusion defect, suggesting the presence of myocardial fibrosis. In PSS, deterioration of cardiac function seemed to be associated with progression of myocardial fibrosis. Dipyridamole thallium imaging may be a sensitive method for detecting cardiac lesions in PSS. It also has the potential for detecting decreased coronary flow reserve or slightly impaired myocardium even without decreased EF. (N.K.).

  17. Major depressive disorder predicts cardiac events in patients with coronary artery disease.

    Science.gov (United States)

    Carney, R M; Rich, M W; Freedland, K E; Saini, J; teVelde, A; Simeone, C; Clark, K

    1988-01-01

    Fifty-two patients undergoing cardiac catheterization and subsequently found to have significant coronary artery disease (CAD) were given structured psychiatric interviews before catheterization. Nine of these patients met criteria for major depressive disorder. All 52 patients were contacted 12 months after catheterization, and the occurrence of myocardial infarction, angioplasty, coronary bypass surgery and death was determined. Results of the study show that major depressive disorder was the best predictor of these major cardiac events during the 12 months following catheterization. The predictive effect was independent of the severity of CAD, left ventricular ejection fraction, and the presence of smoking. Furthermore, with the exception of smoking, there were no statistically significant differences between those patients with major depressive disorder and the remaining patients on any variable studied. The possible mechanisms relating major depressive disorder to subsequent cardiac events are discussed. It is concluded that major depressive disorder is an important independent risk factor for the occurrence of major cardiac events in patients with CAD. PMID:2976950

  18. 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

  19. 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.

  20. 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

  1. 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...

  2. Role of 18F-FDG PET/CT in the diagnosis of infective endocarditis in patients with an implanted cardiac device: a prospective study

    International Nuclear Information System (INIS)

    Infective endocarditis (IE) is widely underdiagnosed or diagnosed after a major delay. The diagnosis is currently based on the modified DUKE criteria, where the only validated imaging technique is echocardiography, and remains challenging especially in patients with an implantable cardiac device. The aim of this study was to assess the incremental diagnostic role of 18F-FDG PET/CT in patients with an implanted cardiac device and suspected IE. We prospectively analysed 27 consecutive patients with an implantable device evaluated for suspected device-related IE between January 2011 and June 2013. The diagnostic probability of IE was defined at presentation according to the modified DUKE criteria. PET/CT was performed as soon as possible following the clinical suspicion of IE. Patients then underwent medical or surgical treatment based on the overall clinical evaluation. During follow-up, we considered: lead cultures in patients who underwent extraction, direct inspection and lead cultures in those who underwent surgery, and a clinical/instrumental reevaluation after at least 6 months in patients who received antimicrobial treatment or had an alternative diagnosis and were not treated for IE. After the follow-up period, the diagnosis was systematically reviewed by the multidisciplinary team using the modified DUKE criteria and considering the new findings. Among the ten patients with a positive PET/CT scan, seven received a final diagnosis of ''definite IE'', one of ''possible IE'' and two of ''IE rejected''. Among the 17 patients with a negative PET/CT scan, four were false-negative and received a final diagnosis of definite IE. These patients underwent PET/CT after having started antibiotic therapy (≥48 h) or had a technically suboptimal examination. In patients with a cardiac device, PET/CT increases the diagnostic accuracy of the modified Duke criteria for IE, particularly in the subset of patients with possible IE in whom it may help the clinician manage a

  3. Shared Care Contributions to Self-Care and Quality of Life in Chronic Cardiac Patients.

    Science.gov (United States)

    Sebern, Margaret; Brown, Roger; Flatley-Brennan, Patricia

    2016-07-01

    Shared care is an interpersonal interaction system composed of communication, decision making, and reciprocity; it is used by patients and family caregivers (care dyads) to exchange social support. This study's purpose was to describe the contributions of shared care to outcomes for individuals with cardiac disease. A secondary data analysis was used to answer the following questions. What is the association between elements of shared care and patient outcomes? Do dyad perceptions of shared care differentially contribute to patient outcomes? Participants in this study were 93 individuals with a cardiac disease and 93 family caregivers. Composite index structured equation modeling was the analytic tool. Caregiver communication and reciprocity were related to patient mental quality of life. Patient communication and reciprocity were related to their own mental and physical quality of life and self-care confidence. Findings from this study contribute a better understanding of how care dyads are integral to patient outcomes. PMID:26864996

  4. Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program

    Directory of Open Access Journals (Sweden)

    Viveka P Jyotsna

    2013-01-01

    Full Text Available Background: The aim of this study was to observe the effect comprehensive yogic breathing (Sudarshan Kriya Yoga [SKY] and Pranayam had on cardiac autonomic functions in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 64 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program. Standard therapy included dietary advice, brisk walking for 45 min daily, and administration of oral antidiabetic drugs. Comprehensive yogic breathing program was introduced to the participants through a course of 12 h spread over 3 days. It was an interactive session in which SKY, a rhythmic cyclical breathing, preceded by Pranayam is taught under the guidance of a certified teacher. Cardiac autonomic function tests were done before and after 6 months of intervention. Results: In the intervention group, after practicing the breathing techniques for 6 months, the improvement in sympathetic functions was statistically significant (P 0.04. The change in sympathetic functions in the standard therapy group was not significant (P 0.75.Parasympathetic functions did not show any significant change in either group. When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P 0.06. In the standard therapy group, no change in cardiac autonomic functions was noted (P 0.99. Conclusion: Cardiac autonomic functions improved in patients with diabetes on standard treatment who followed the comprehensive yogic breathing program compared to patients who were on standard therapy alone.

  5. Visual Analogue Scale for Anxiety and Amsterdam Preoperative Anxiety Scale Provide a Simple and Reliable Measurement of Preoperative Anxiety in Patients Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Joaquín Hernández-Palazón

    2015-03-01

    Full Text Available Background: Anxiety is an emotional state characterized by apprehension and fear resulting from anticipation of a threatening event. Objectives: The present study aimed to analyze the incidence and level of preoperative anxiety in the patients scheduled for cardiac surgery by using a Visual Analogue Scale for Anxiety (VAS-A and Amsterdam Preoperative Anxiety and Information Scale (APAIS and to identify the influencing clinical factors. Patients and Methods: This prospective, longitudinal study was performed on 300 cardiac surgery patients in a single university hospital. The patients were assessed regarding their preoperative anxiety level using VAS-A, APAIS, and a set of specific anxiety-related questions. Their demographic features as well as their anesthetic and surgical characteristics (ASA physical status, EuroSCORE, preoperative Length of Stay (LoS, and surgical history were recorded, as well. Then, one-way ANOVA and t-test were applied along with odds ratio for risk assessment. Results: According to the results, 94% of the patients presented preoperative anxiety, with 37% developing high anxiety (VAS-A ≥ 7. Preoperative LoS > 2 days was the only significant risk factor for preoperative anxiety (odds ratio = 2.5, CI 95%, 1.3 - 5.1, P = 0.009. Besides, a positive correlation was found between anxiety level (APAISa and requirement of knowledge (APAISk. APAISa and APAISk scores were greater for surgery than for anesthesia. Moreover, the results showed that the most common anxieties resulted from the operation, waiting for surgery, not knowing what is happening, postoperative pain, awareness during anesthesia, and not awakening from anesthesia. Conclusions: APAIS and VAS-A provided a quantitative assessment of anxiety and a specific qualitative questionnaire for preoperative anxiety in cardiac surgery. According to the results, preoperative LoS > 2 days and lack of information related to surgery were the risk factors for high anxiety levels.

  6. Surgical optimization and characterization of a minimally invasive aortic banding procedure to induce cardiac hypertrophy in mice.

    Science.gov (United States)

    Martin, Tamara P; Robinson, Emma; Harvey, Adam P; MacDonald, Margaret; Grieve, David J; Paul, Andrew; Currie, Susan

    2012-07-01

    Left ventricular pressure overload in response to aortic banding is an invaluable model for studying progression of cardiac hypertrophy and transition to heart failure. Traditional aortic banding has recently been superceded by minimally invasive transverse aortic banding (MTAB), which does not require ventilation so is less technically challenging. Although the MTAB approach is superior, few laboratories have documented success, and minimal information on the model is available. The aim of this study was to optimize conditions for MTAB and to characterize the development and progression of cardiac hypertrophy. Isofluorane proved the most suitable anaesthetic for MTAB surgery in mice, and 1 week after surgery the MTAB animals showed significant increases in systolic blood pressure (MTAB 110 ± 6 mmHg versus sham 78 ± 3 mmHg, n = 7, P MTAB 6.2 ± 0.2 versus sham 5.1 ± 0.1, n = 12, P MTAB 31.7 ± 1% versus sham 36.6 ± 1.4%, P = 0.01) and diastolic dysfunction (e.g. left ventricular end-diastolic pressure, MTAB 12.7 ± 1.0 mmHg versus sham 6.7 ± 0.8 mmHg, P MTAB hearts, signifying an inflammatory response. More pronounced remodelling was observed 4 weeks postsurgery (heart weight to body weight ratio, MTAB 9.1 ± 0.6 versus sham 4.6 ± 0.04, n = 10, P MTAB 24.3 ± 2.5% versus sham 43.6 ± 1.7%, n = 10, P = 0.003), together with a significant increase in cardiac fibrosis and further cardiac inflammation. Our findings demonstrate that MTAB is a relevant experimental model for studying development and progression of cardiac hypertrophy, which will be highly valuable for future studies examining potential novel therapeutic interventions in this setting. PMID:22447975

  7. 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.

  8. 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...

  9. 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

  10. 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

  11. 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.

  12. 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)

  13. Possible transfusion-related acute lung injury (TRALI) in cardiac surgery patients

    OpenAIRE

    Zah-Bogović, Tajana; Mesarić, Jasna; Hrabač, Pero; Majerić-Kogler, Višnja

    2014-01-01

    Aim To determine the incidence of possible transfusion-related acute lung injury (TRALI) and related risk factors in cardiac surgery patients. Methods A single-center prospective cohort study was conducted from January 2009 to March 2010 at the Zagreb University Hospital Center, Croatia. Patient-, transfusion-, and surgery-related data were collected. The study included 262 patients who were observed for respiratory worsening including measurements of arterial oxygen saturation (SaO 2), fract...

  14. Cardiac involvement in myotonic muscular dystrophy (Steinert's disease): a prospective study of 25 patients

    International Nuclear Information System (INIS)

    The presence, degree and frequency of disorders of cardiac conduction and rhythm and of regional or global myocardial dystrophy or myotonia have not previously been studied prospectively and systematically in the same population of patients with myotonic dystrophy. Accordingly, 25 adults with classic Steinert's disease underwent electrocardiography, 24-hour ambulatory electrocardiography, vectorcardiography, chest x-rays, echocardiography, electrophysiologic studies, and technetium-99m angiography. Clinically important cardiac manifestations of myotonic dystrophy reside in specialized tissues rather than in myocardium. Involvement is relatively specific, primarily assigned to the His-Purkinje system. The cardiac muscle disorder takes the form of dystrophy rather than myotonia, and is not selective, appearing with approximately equal distribution in all 4 chambers. Myocardial dystrophy seldom results in clinically overt ventricular failure, but may be responsible for atrial and ventricular arrhythmias. Since myotonic dystrophy is genetically transmitted, a primary biochemical defect has been proposed with complete expression of the gene toward striated muscle tissue, whether skeletal or cardiac. Specialized cardiac tissue and myocardium have close, if not identical, embryologic origins, so it is not surprising that the genetic marker affects both. Cardiac involvement is therefore an integral part of myotonic dystrophy, targeting particularly the infranodal conduction system, to a lesser extent the sinus node, and still less specifically, the myocardium

  15. 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

  16. 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.)

  17. The cardiac safety of aripiprazole treatment in patients at high risk for torsade

    DEFF Research Database (Denmark)

    Polcwiartek, Christoffer; Sneider, Benjamin; Graff, Claus;

    2015-01-01

    reviewed and cardiac safety data were extracted. Continuous and dichotomous QTc data were used in the meta-analysis. RESULTS: Preclinical studies suggested that aripiprazole has limited affinity for the delayed rectifier potassium current. TdP was reported in two case reports and SCD was reported in one...... case report and one case series. No clinical studies assessing aripiprazole's cardiac safety in patients at high risk for torsade were found. No thorough QT (TQT) study with aripiprazole was found. The meta-analysis revealed that the mean ΔQTc interval was decreased with aripiprazole and QTc...... factors. OBJECTIVES: Aripiprazole's cardiac safety has not been assessed in patients at high risk for torsade, where QTc prolongation risk is highly increased. METHODS: MEDLINE, Embase, and The Cochrane Library were searched for preclinical, clinical, and epidemiological studies. Eligible studies were...

  18. 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. 

  19. 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.

  20. 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

  1. 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.

  2. 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.

  3. 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...

  4. Efficacy analysis of intravenous thrombolysis after cardiopulmonary resuscitation for patients with acute myocardial infarction and cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    张晓丽

    2014-01-01

    Objective To explore the clinical value of intravenous thrombolysis in the treatment of patients with acute myocardial infarction(AMI)and cardiac arrest after cardiopulmonary resuscitation.Methods 120 patients with AMI and cardiac arrest admitted in our hospital from Mar2009 to Mar 2013 were divided into thrombolytic group(n=50)and control group(n=70)according to the

  5. Impaired cardiac sympathetic innervation in symptomatic patients with long QT syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Kies, Peter; Stegger, Lars; Schober, Otmar [University Hospital Muenster, Department of Nuclear Medicine, Muenster (Germany); Paul, Matthias; Moennig, Gerold [University Hospital Muenster, Department for Cardiology and Angiology, Muenster (Germany); Gerss, Joachim [University of Muenster, Institute of Biostatistics and Clinical Research, Muenster (Germany); Wichter, Thomas [Marienhospital Osnabrueck, Department of Cardiology, Niels-Stensen-Kliniken, Osnabrueck (Germany); Schaefers, Michael [University of Muenster, European Institute of Molecular Imaging - EIMI, Muenster (Germany); Schulze-Bahr, Eric [University Hospital Muenster, Department for Cardiology and Angiology, Muenster (Germany); University Hospital Muenster, Institute for Genetics of Heart Diseases, Muenster (Germany)

    2011-10-15

    Increased sympathetic activation is a key modifier for arrhythmogenesis in patients with long QT syndrome (LQTS), a congenital channelopathy. Therefore, we investigated cardiac sympathetic function using {sup 123}I-metaiodobenzylguanidine (MIBG) single photon emission computed tomography (SPECT) in a cohort of symptomatic LQTS patients and correlated these findings with the underlying genotype. [{sup 123}I]MIBG SPECT was performed in 28 LQTS patients. Among these, 18 patients (64%) had a previous syncope and 10 patients (36%) survived sudden cardiac arrest. Patients were characterized in terms of genetic subtypes and QTc interval on surface ECGs. SPECT images were analysed for regional [{sup 123}I]MIBG uptake in a 33-segment bullseye scheme and compared to those obtained from 10 age-matched healthy control subjects (43 {+-} 12 years). An abnormal {sup 123}I-MIBG scan was found in 17 of 28 LQTS patients (61%) with a tracer reduction mainly located in the anteroseptal segments of the left ventricle. This finding was independent of the genetic LQTS subtype. In addition, no differences were found between LQTS patients with a QTc >500 ms vs <500 ms or those suffering from syncope vs VF (p > 0.05). A distinct regional pattern of impaired cardiac sympathetic function was identified in the majority of symptomatic LQTS patients. This innervation defect was independent of the underlying genotype and clinical disease expression. (orig.)

  6. Impaired cardiac sympathetic innervation in symptomatic patients with long QT syndrome

    International Nuclear Information System (INIS)

    Increased sympathetic activation is a key modifier for arrhythmogenesis in patients with long QT syndrome (LQTS), a congenital channelopathy. Therefore, we investigated cardiac sympathetic function using 123I-metaiodobenzylguanidine (MIBG) single photon emission computed tomography (SPECT) in a cohort of symptomatic LQTS patients and correlated these findings with the underlying genotype. [123I]MIBG SPECT was performed in 28 LQTS patients. Among these, 18 patients (64%) had a previous syncope and 10 patients (36%) survived sudden cardiac arrest. Patients were characterized in terms of genetic subtypes and QTc interval on surface ECGs. SPECT images were analysed for regional [123I]MIBG uptake in a 33-segment bullseye scheme and compared to those obtained from 10 age-matched healthy control subjects (43 ± 12 years). An abnormal 123I-MIBG scan was found in 17 of 28 LQTS patients (61%) with a tracer reduction mainly located in the anteroseptal segments of the left ventricle. This finding was independent of the genetic LQTS subtype. In addition, no differences were found between LQTS patients with a QTc >500 ms vs 0.05). A distinct regional pattern of impaired cardiac sympathetic function was identified in the majority of symptomatic LQTS patients. This innervation defect was independent of the underlying genotype and clinical disease expression. (orig.)

  7. Prognostic factors for death and survival with or without complications in cardiac arrest patients receiving CPR within 24 hours of anesthesia for emergency surgery

    Directory of Open Access Journals (Sweden)

    Siriphuwanun V

    2014-10-01

    Full Text Available Visith Siriphuwanun,1 Yodying Punjasawadwong,1 Worawut Lapisatepun,1 Somrat Charuluxananan,2 Ketchada Uerpairojkit2 1Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Department of Anesthesiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Purpose: To determine prognostic factors for death and survival with or without complications in cardiac arrest patients who received cardiopulmonary resuscitation (CPR within 24 hours of receiving anesthesia for emergency surgery. Patients and methods: A retrospective cohort study approved by the Maharaj Nakorn Chiang Mai University Hospital Ethical Committee. Data used were taken from records of 751 cardiac arrest patients who received their first CPR within 24 hours of anesthesia for emergency surgery between January 1, 2003 and October 31, 2011. The reviewed data included patient characteristics, surgical procedures, American Society of Anesthesiologist (ASA physical status classification, anesthesia information, the timing of cardiac arrest, CPR details, and outcomes at 24 hours after CPR. Univariate and polytomous logistic regression analyses were used to determine prognostic factors associated with the outcome variable. P-values of less than 0.05 were considered statistically significant. Results: The outcomes at 24 hours were death (638/751, 85.0%, survival with complications (73/751, 9.7%, and survival without complications (40/751, 5.3%. The prognostic factors associated with death were: age between 13–34 years (OR =3.08, 95% CI =1.03–9.19; ASA physical status three and higher (OR =6.60, 95% CI =2.17–20.13; precardiopulmonary comorbidity (OR =3.28, 95% CI =1.09–9.90; the condition of patients who were on mechanical ventilation prior to receiving anesthesia (OR =4.11, 95% CI =1.17–14.38; surgery in the upper abdominal site (OR =14.64, 95% CI =2.83–75.82; shock prior to cardiac arrest (OR =6.24, 95% CI =2.53–15

  8. Evaluation of cardiac ischaemia in cardiac asymptomatic newly diagnosed untreated patients with primary hypothyroidism

    NARCIS (Netherlands)

    A. Roos; S.K. Zoet-Nugteren; A. Berghout (Arie)

    2005-01-01

    textabstractBACKGROUND: Hypothyroidism is regarded as a risk factor for coronary artery disease. Possible factors involved in this association are hyperlipidaemia and hypertension, both occurring with increased frequency in hypothyroid patients. The aim of our study was to evaluate

  9. 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

  10. 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...

  11. 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.

  12. 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 ...

  13. 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 ...

  14. 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

  15. 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...

  16. Potential risk factors for surgical site infection after isolated coronary artery bypass grafting in a Bahrain Cardiac Centre: A retrospective, case-controlled study

    Directory of Open Access Journals (Sweden)

    Ahmed Abdulaziz Abuzaid

    2015-01-01

    Conclusions: Patients with comorbidities of impaired renal function and/or impaired left ventricular systolic function are at high risk of developing SSI. There appears to be a relationship between SSIs in CABG patients and impaired renal or LV function (low ejection fraction. CABG with BIMA grafting could be performed safely even in diabetics. Future studies should consider further scrutiny of these and other factors in relation to SSIs in a larger surgical population.

  17. Fast tracking in paediatric cardiac anaesthesia : an update.

    OpenAIRE

    Lake Carol

    2002-01-01

    A care plan in which cardiac surgical patients progress quickly through the perioperative course to hospital discharge is often referred to as a Fast Track. Such care plans have been used extensively in adult cardiac patients but are also applicable to paediatric patients. Although no randomised controlled trials are available to document a reduction in hospital costs and avoidance of iatrogenic complications with paediatric fast tracks, many healthcare administrators encourage their use. Fas...

  18. Beta-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Shilane, David; Go, Alan S;

    2014-01-01

    BACKGROUND: The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI). OBJECTIVES: The purpose of this study was to assess the association of beta-blockers with outcomes among...... patients with new-onset CHD. METHODS: We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time......-blockers among patients with new-onset CHD was associated with a lower risk of cardiac events only among patients with a recent MI....

  19. CT and MRI evaluation of cardiac complications in patients with hematologic diseases: a pictorial review.

    Science.gov (United States)

    Kim, Tae Yun; Jung, Jung Im; Kim, Yoo Jin; Kim, Hwan Wook; Lee, Hae Giu

    2015-12-01

    Cardiac complications with hematologic diseases are not uncommon but it is difficult to diagnose, due to non-specific clinical symptoms. Prompt recognition of these potentially fatal complications by cardiac computed tomography (CT) or cardiac magnetic resonance imaging (MRI) may help to direct clinicians to specific treatments according to causes. Thrombosis is often related to central venous catheter use and is usually located at the catheter tip near the atrial wall. Differentiation of thrombosis from normal structure is possible with CT and, distinction of a thrombus from a tumor is possible on a delayed enhancement MRI with a long inversion time (500-600 ms). Granulocytic sarcoma of the heart is indicated by an infiltrative nature with involvement of whole layers of myocardium on CT and MRI. MRI with T2* mapping is useful in evaluating myocardial iron content in patients with hemochromatosis. Diffuse subendocardial enhancement is typically observed on delayed MRIs in patients with cardiac amyloidosis. T1 mapping is an emerging tool to diagnose amyloidosis. Myocardial abscess can occur due to an immunocompromised status. CT and MRI show loculated lesions with fluid density and concomitant rim-like contrast enhancement. Awareness of CT and MRI findings of cardiac complications of hematologic diseases can be helpful to physicians for clinical decision making and treatment. PMID:25651878

  20. 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

  1. 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.

  2. Alterations of left ventricular deformation and cardiac sympathetic derangement in patients with systolic heart failure: a 3D speckle tracking echocardiography and cardiac 123I-MIBG study

    International Nuclear Information System (INIS)

    Myocardial contractile function is under the control of cardiac sympathetic activity. Three-dimensional speckle tracking echocardiography (3D-STE) and cardiac imaging with 123I-metaiodobenzylguanidine (123I-MIBG) are two sophisticated techniques for the assessment of left ventricular (LV) deformation and sympathetic innervation, respectively, which offer important prognostic information in patients with heart failure (HF). The purpose of this investigation was to explore, in patients with systolic HF, the relationship between LV deformation assessed by 3D-STE and cardiac sympathetic derangement evaluated by 123I-MIBG imaging. We prospectively studied 75 patients with systolic HF. All patients underwent a 3D-STE study (longitudinal, circumferential, area and radial) and 123I-MIBG planar and SPECT cardiac imaging. 3D-STE longitudinal, circumferential and area strain values were correlated with 123I-MIBG late heart to mediastinum (H/M) ratio and late SPECT total defect score. After stratification of the patients according to ischaemic or nonischaemic HF aetiology, we observed a good correlation of all 3D-STE measurements with late H/M ratio and SPECT data in the ischaemic group, but in patients with HF of nonischaemic aetiology, no correlation was found between LV deformation and cardiac sympathetic activity. At the regional level, the strongest correlation between LV deformation and adrenergic innervation was found for the left anterior descending coronary artery distribution territory for all four 3D-STE values. In multivariate linear regression analyses, including age, gender, LV ejection fraction, NYHA class, body mass index, heart rate and HF aetiology, only 3D-STE area and radial strain values significantly predicted cardiac sympathetic derangement on 123I-MIBG late SPECT. This study indicated that 3D-STE measurements are correlated with 123I-MIBG planar and SPECT data. Furthermore, 3D-STE area and radial strain values, but not LVEF, predict cardiac sympathetic

  3. 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.

  4. EVALUATION CARDIAC RESYNCHRONIZATION THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    A. J. Fishman

    2011-01-01

    Full Text Available Objective — studying dyssynchrony characteristics and evaluation correction effectiveness in patients with chronic heart failure (CHF of ischemic origin.Materials and methods. The study included 125 patients with chronic heart failure of ischemic etiology, 28 of them — with coronary heart disease (CHD who had undergone aorto-and / or mammarokoronary bypass and / or percutaneous coronary intervention, 42 — with coronary artery disease and postinfarction cardiosclerosis, 32 — with arrhythmic variant of coronary artery disease, 23 — with stable angina without evidence of arrhythmia. Among included patients, biventricular pacemakers were implanted for 17 patients. All patients underwent echocardiography with determination of the parameters of dyssynchrony.Results and conclusion. Among patients with CHF ischemic symptoms dyssynchrony was diagnosed in 36 (28.8 % cases. Statistically significant association between patients with cardiac arrhythmias and dyssynchrony was determined. At the same time the incidence of dyssynchrony was not associated with various forms of ischemic heart disease, and did not depend on the anamnesis of cardiac surgery. Dependence of the frequency of occurrence of dyssynchrony on the severity of CHF was revealed. Patients selected for implantation of biventricular pacemakers, especially in view of echocardiographic signs of dyssynchrony had significant improvement after providing cardiac resynchronization therapy. Effect of the treatment does not depend on the atrial fibrillation rhythm presence.

  5. 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.

  6. Prophylactic cerebrovascular reconstructive surgery for occlusive cerebrovascular disease in patients with cardiac surgery

    International Nuclear Information System (INIS)

    We report the outcomes of prophylactic cerebral reconstructive surgery aimed at reducing the incidence of perioperative cerebral infarction in patients with intracranial or extracranial occlusive cerebrovascular disease who were scheduled to undergo cardiac surgery. Before the surgery, carotid artery ultrasonography, magnetic resonance angiography (MRA) of the carotid artery, and magnetic resonance imaging (MRI) and MRA of the brain were performed on 875 patients. The high-risk group was defined as: patients with cervical carotid artery stenosis of at least 90%, those with a reduced cerebral perfusion reserve because of occlusion of the internal carotid or middle cerebral artery, and those with a reduced cerebral perfusion reserve because of major intracranial artery stenosis of at least 75%. According to the degree of cardiac reserve, patients in the high-risk group underwent carotid artery stenting (CAS), carotid endarterectomy (CEA), superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis, or percutaneous transluminal angioplasty (PTA). Of the 875 patients, 29 (3.3%) were classified in the high-risk group, and 16 underwent prophylactic revascularization and cardiac surgery. Prophylactic revascularization included CAS in 7 patients (including stenting of the intracranial internal carotid artery in 1 patient), CEA in 4, STA-MCA in 4 and PTA in 1. Cardiac surgery was performed on 870 of the 875 patients, and perioperative cerebral infarction occurred in 11 (1.3%). It is uncertain whether our treatment strategy significantly reduced the incidence of perioperative cerebral infarction because of the lack of accurate information on the number of patients with this condition before the present study. However, 73% of patients had a score of 1 or 2 on the modified Rankin Scale 1 month after the onset of cerebral infarction, suggesting that our strategy improved the outcome. (author)

  7. Echocardiography integrated ACLS protocol versus conventional cardiopulmonary resuscitation in patients with pulseless electrical activity cardiac arrest

    Institute of Scientific and Technical Information of China (English)

    Mojtaba Chardoli; Farhad Heidari; Helaleh Rabiee; Mahdi Sharif-Alhoseini; Hamid Shokoohi; Vafa Rahimi-Movaghar

    2012-01-01

    Objective: To examine the utility of bedside echocardiography in detecting the reversible causes of pulseless electrical activity (PEA) cardiac arrest and predicting the resuscitation outcomes.Methods: In this prospective interventional study,patients presenting with PEA cardiac arrest were randomized into two groups.In Group A,ultrasound trained emergency physicians performed echocardiography evaluating cardiac activity,right ventricle dilation,left ventricle function,pericardial effusion/tamponade and ⅣC size along with the advanced cardiac life support (ACLS) protocol.Patients in Group B solely underwent ACLS protocol without applying echocardiography.The presence or absence of mechanical ventricular activity (MVA) and evidences of PEA reversible causes were recorded.The return of spontaneous circulation (ROSC) and death were evaluated in both groups.Results: One hundred patients with the mean age of (58±6.1) years were enrolled in this study.Fifty patients (Group A) had echocardiography detected in parallel with cardiopulmonary resuscitation (CPR).Among them,7 patients (14%) had pericardial effusion,11 (22%) had hypovolemia,and 39 (78%) were revealed the presence of MVA.In the pseudo PEA subgroup (presence of MVA),43% had ROSC (positive predictive value) and in the true PEA subgroup with cardiac standstill (absence of MVA),there was no recorded ROSC (negative predictive value).Among patients in Group B,no reversible etiology was detected.There was no significant difference in resuscitation results between Groups A and B observed (P=0.52).Conclusion: Bedside echocardiography can identify some reversible causes of PEA.However,there are no significant changes in survival outcome between the echo group and those with traditional CPR.

  8. 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

  9. 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

  10. Incidence of cardiac conduction disorders in patients with rheumatic disease receiving hydroxychloroquine

    Directory of Open Access Journals (Sweden)

    Vijaya Prasanna Parimi

    2015-06-01

    Conclusion: This study highlights need for periodic cardiac evaluation of patients receiving long-term antimalarials. Reversibility of antimalarial toxicity is also highlighted in this study. Conduction disorders observed were similar to that expected in general population thus adding further evidence on safety of HCQ. [Int J Basic Clin Pharmacol 2015; 4(3.000: 565-567

  11. Patient Positioning and Skin Sequelae: Ischemic Epidermal Necrosis from Tight Padding During Cardiac Surgery.

    Science.gov (United States)

    Sadeghpour, Mona; Au, Jeremiah; Ho, Jonhan; Hyman, Jaime; Patton, Timothy

    2016-05-15

    Careful positioning and padding of pressure points during surgery are recommended to prevent pressure ulcers, vascular injury, and nerve damage in an immobilized patient. However, overpadding may have unintended consequences. We report a case of ischemia-induced full-thickness epidermal necrosis secondary to tight foam padding during a cardiac surgery. PMID:26934606

  12. Cardiac abnormalities assessed by non-invasive techniques in patients with newly diagnosed idiopathic inflammatory myopathies

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Simonsen, Jane Angel; Diederichsen, Axel Cosmus Pyndt;

    2015-01-01

    inflammatory myopathies (IIM) by means of non-invasive techniques. METHODS: Fourteen patients with IIM (8 polymyositis, 4 dermatomyositis, 2 cancer-associated dermatomyositis) and 14 gender- and age- matched healthy control subjects were investigated. Participant assessments included a cardiac questionnaire...

  13. Effects of levosimendan for low cardiac output syndrome in critically ill patients

    DEFF Research Database (Denmark)

    Koster, Geert; Wetterslev, Jørn; Gluud, Christian;

    2015-01-01

    PURPOSE: To assess the benefits and harms of levosimendan for low cardiac output syndrome in critically ill patients. METHODS: We conducted a systematic review with meta-analyses and trial sequential analyses (TSA) of randomised clinical trials comparing levosimendan with any type of control. Two...

  14. Type D personality and cardiac mortality in patients with chronic heart failure

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Smith, Otto R F; Pedersen, Susanne S.;

    2010-01-01

    Clinical predictors of cardiac mortality in chronic heart failure (CHF) are established, but less is known about chronic psychological predictors. Therefore, we examined the prognostic value of Type D personality (tendency to experience negative feelings and inhibit self-expression) in CHF patients....

  15. Predictors of arrhythmic sudden cardiac death in heart failure patients in the CARE-HF study

    DEFF Research Database (Denmark)

    Uretsky, B.; Cleland, J.G.F.; Freemantle, N.; Daubert, J.C.; Gras, D.; Kappenberger, L.; Tavazzi, L.; Thygesen, Kristian Anton

    2006-01-01

    Topic(s):Rsynchronisation therapy   Cardiac resynchronization therapy (CRT) has become an important modality to improve symptoms, exercise performance, and survival in patients with severe heart failure and left ventricular dyssynchrony. The CARE-HF study showed that CRT reduced mortality in syst...

  16. Correlation between antiplatelet resistance and recurrent cardiac ischemic events of patients with acute myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    李蕾

    2012-01-01

    Objective To evaluate the predictive value of anti-platelet resistance assessed by whole blood electronic impedance aggregometry(EIA) for the risk of recurrent cardiac ischemic events in patients with acute myocardial infarction(AMI) who underwent coronary stenting. Methods We enrolled

  17. Network representation of cardiac interbeat intervals for monitoring restitution of autonomic control for heart transplant patients

    CERN Document Server

    Makowiec, Danuta; Graff, Beata; Makowiec, Joanna Danuta; Kryszewski, Stanislaw; Graff, Beata; Wdowczyk-Szulc, Joanna; Buchnowiecka, Marta Zarczynska-; Gruchala, Marcin; Rynkiewicz, Andrzej

    2013-01-01

    The aim is to present the ability of a network of transitions as a nonlinear tool providing a graphical representation of a time series. This representation is used for cardiac RR-intervals in follow-up observation of changes in heart rhythm of patients recovering after heart transplant.

  18. First reported case of Aspergillus granulosus infection in a cardiac transplant patient.

    OpenAIRE

    Fakih, M G; Barden, G E; Oakes, C A; Berenson, C. S.

    1995-01-01

    We report a case of disseminated infection with Aspergillus granulosus in a cardiac transplant recipient on immunosuppressive therapy. This is the first reported case in which this organism has been described as a pathogen. This organism bears morphological features different from those of more common Aspergillus species and should be considered a potential pathogen in immunocompromised patients.

  19. Cardiac rehabilitation for patients after coronary artery bypass graft surgery Nursing Interventions

    Directory of Open Access Journals (Sweden)

    Tsaloglidou A.

    2010-07-01

    Full Text Available Purpose: To describe the way by which the rehabilitation of the patients that have undergone cardiac surgery is performed, to present the content of the cardiac rehabilitation programs and to determine the nursing role in the whole process. Methodology: Literature review of the relevant articles in the databases pubmed and scopus. Results: The patients with coronary heart disease usually face a lot of problems in their everyday life. Coronary artery bypass graft surgery (CABG is commonly performed to improve the quality of patients’ life and to extend their survival. Ιn order for the positive results of the surgery to be maintained and the quality of patients’ life to be improved, it is essential that the patients participate after the surgery in programs of cardiac rehabilitation. The cardiac rehabilitation programs are usually consisted of four phases and they involve a variety of interventions including exercise training, suitable drug therapy, psychological input, risk factor education, as well as teaching for the rules of a healthy diet. Conclusions: Nurses and other health care professionals have to inform the patients of the existing rehabilitation programs and instruct to participate in them as well as to return in the daily life activities.

  20. Heart rate variability characterized by refined multiscale entropy applied to cardiac death in ischemic cardiomyopathy patients

    OpenAIRE

    Caminal Magrans, Pere; Valencia Murillo, José Fernando; Vallverdú Ferrer, Montserrat; Schroeder, Rico; Cygankiewicz, I.; Vázquez, Rafael; Bayes de Luna, Antonio; Porta, Alberto; Voss, Andreas

    2010-01-01

    In this work, Refined Multiscale Entropy (RMSE) was applied to characterize risk of cardiac death in ischemic cardiomyopathy patients, analyzing heart rate variability (HRV) by means of RR series during daytime and nighttime. RMSE approach measures an entropy rate in different time scales of a series, giving a multiscale characterization of complexity of that series. RMSE showed statistically significant differences (p

  1. Private Prayer and Optimism in Middle-Aged and Older Patients Awaiting Cardiac Surgery

    Science.gov (United States)

    Ai, Amy L.; Peterson, Christopher; Bolling, Steven F.; Koenig, Harold

    2002-01-01

    Purpose: This study investigated the use of private prayer among middle-aged and older patients as a way of coping with cardiac surgery and prayer's relationship to optimism. Design and Methods: The measure of prayer included three aspects: (a) belief in the importance of private prayer, (b) faith in the efficacy of prayer on the basis of previous…

  2. Sexual Problems in Cardiac Patients How to Assess, When to Refer

    NARCIS (Netherlands)

    Jaarsma, Tiny; Steinke, Elaine E.; Gianotten, Woet L.

    2010-01-01

    It is increasingly realized that discussing sexuality is an important issue in the holistic care for cardiac patients. In this review article, the conditions of a good assessment of sexual problems are identified such as creating an appropriate environment, ensuring confidentiality, and using approp

  3. The incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery

    Directory of Open Access Journals (Sweden)

    Wei WANG

    2011-06-01

    Full Text Available Objective To identify the incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery.Methods One hundred and twenty-five elderly patients who were admitted to the surgical intensive care unit(SICU after non-cardiac surgery were involved in the present study.Baseline and the perioperative variables of patients were collected.Postoperative delirium was diagnosed using the Confusion Assessment Method for Intensive Care Unit(CAM-ICU.Delirium assessment was performed once daily during the first five days after surgery.Results Postoperative evaluations of delirium were completed in 124 patients.Postoperative delirium occurred in 42 patients(33.87%,among them delirium occurred within the first 2 postoperative days in 92.86%(39/42(4.76% in the operative day,50.00% in the first postoperative day,and 38.10% in the second postoperative day,respectively.When compared with the non-delirious patients,the delirious patients had longer duration of ICU stay [39.75(21.00-65.63h vs 19.63(17.77-22.31h,P=0.000],higher incidence of postoperative complications [(38.1%(16/42 vs 13.4%(11/82,P=0.000],and higher mortality [11.9%(5/42 vs 1.2%(1/82,P=0.000].Multivariate logistic regression analysis demonstrated that the following risk factors predicted the occurrence of postoperative delirium: preoperative history of cerebral accident(OR=3.051,95%CI 1.032-8.370,high APACHE Ⅱ score at admission to the SICU(OR=1.664,95%CI 1.268-2.184,and high pain score at 24 hours after operation(OR=1.043,95%CI 1.021-1.086.Conclusions Delirium is a common complication after surgery.The prognosis is significantly worse in the delirious patients than in the non-delirious patients.Risk factors of postoperative delirium include history of preoperative cerebral accident,high APACHE Ⅱ score at admission to the SICU,and high pain score at 24 hours after operation.

  4. 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

  5. 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.

  6. The Emory University Perioperative Algorithm for the Management of Hyperglycemia and Diabetes in Non-cardiac Surgery Patients.

    Science.gov (United States)

    Duggan, Elizabeth W; Klopman, Matthew A; Berry, Arnold J; Umpierrez, Guillermo

    2016-03-01

    Hyperglycemia is a frequent manifestation of critical and surgical illness, resulting from the acute metabolic and hormonal changes associated with the response to injury and stress (Umpierrez and Kitabchi, Curr Opin Endocrinol. 11:75-81, 2004; McCowen et al., Crit Care Clin. 17(1):107-24, 2001). The exact prevalence of hospital hyperglycemia is not known, but observational studies have reported a prevalence of hyperglycemia ranging from 32 to 60 % in community hospitals (Umpierrez et al., J Clin Endocrinol Metab. 87(3):978-82, 2002; Cook et al., J Hosp Med. 4(9):E7-14, 2009; Farrokhi et al., Best Pract Res Clin Endocrinol Metab. 25(5):813-24, 2011), and 80 % of patients after cardiac surgery (Schmeltz et al., Diabetes Care 30(4):823-8, 2007; van den Berghe et al., N Engl J Med. 345(19):1359-67, 2001). Retrospective and randomized controlled trials in surgical populations have reported that hyperglycemia and diabetes are associated with increased length of stay, hospital complications, resource utilization, and mortality (Frisch et al., Diabetes Care 33(8):1783-8, 2010; Kwon et al., Ann Surg. 257(1):8-14, 2013; Bower et al., Surgery 147(5):670-5, 2010; Noordzij et al., Eur J Endocrinol. 156(1):137-42, 2007; Mraovic et al., J Arthroplasty 25(1):64-70, 2010). Substantial evidence indicates that correction of hyperglycemia reduces complications in critically ill, as well as in general surgery patients (Umpierrez et al., J Clin Endocrinol Metab. 87(3):978-82, 2002; Clement et al., Diabetes Care 27(2):553-97, 2004; Pomposelli et al., JPEN J Parented Enteral Nutr. 22(2):77-81, 1998). This manuscript reviews the pathophysiology of stress hyperglycemia during anesthesia and the perioperative period. We provide a practical outline for the diagnosis and management of preoperative, intraoperative, and postoperative care of patients with diabetes and hyperglycemia. PMID:26971119

  7. Multimodality assessment of cardiac involvement in Churg-Strauss syndrome patients in clinical remission

    International Nuclear Information System (INIS)

    Cardiac involvement in Churg-Strauss syndrome (CSS) is not uncommon, but its frequency varies widely and may depend on the activity of the disease. Therefore, the cardiac involvement in CSS patients in clinical remission was assessed in the present study. In 20 CSS patients in remission and 20 sex- and age-matched healthy controls, an electrocardiogram (ECG) stress test, echocardiography, and 24-h ECG Holter monitoring were performed, together with cardiac magnetic resonance imaging (cMRI). Cardiac involvement was present in 90% (18/20) of CSS patients. Left ventricular ejection fraction (LVEF) was on average lower in the CSS group than in controls (P<0.05), with 7 patients showing systolic heart failure (LVEF <50%). cMRI changes included late gadolinium enhancement lesions in the LV in 89% of patients (17/19), present in all layers of the myocardium. Signs of ongoing inflammation (early gadolinium enhancement) and edema (T2-weighted imaging) were present in 6/19 patients. Holter monitoring revealed both supraventricular and ventricular arrhythmias more frequently in CSS patients when compared with controls (P<0.05). Absolute eosinophil count before the initiation of treatment was higher in rhythm disturbances (P<0.05), and inversely correlated with LV systolic function (rho -0.65). Heart involvement in CSS patients who are in clinical remission is very common. It is characterized not only by fibrosis, but also by an active inflammatory process. The latter finding might influence therapeutic decisions in CSS patients in full clinical remission. (author)

  8. PHARMACOECONOMIC ASPECTS OF NICOTINE ADDICTION TREATMENT IN PATIENTS WITH ANGINA REQUIRING CARDIAC SURGERY

    Directory of Open Access Journals (Sweden)

    A. V. Rudakova

    2015-12-01

    Full Text Available Smoking is a major risk factor in patients with angina pectoris. Interventions that facilitate the rejection of it are an important part of the treatment. Aim. To analyze the cost effectiveness of the partial agonist of nicotinic receptors, varenicline, in patients with angina who require cardiac interventions. Material and methods. The estimation was conducted using a Markov model based on the results of clinical trials and epidemiological studies. The cost of treatment of complications were calculated on the basis of compulsory medical insurance rates for St. Petersburg in 2011. Results. The varenicline therapy in 70-year-old patients before cardiac surgery reduces hospital mortality at an extremely high cost-effectiveness (the cost of preventing one death - 148.8 thousand rubles. The cost/effectiveness ratio in the analysis for the period of survival of patients in this situation was 31.3 thousand rubles for 1 additional year of life. Life expectancy will be increased by an average of 0.147 years. Analysis for the period of survival of 50-year-old patients has shown that in patients after cardiac surgery cost-effectiveness of varenicline is extremely high (in the analysis from the perspective of the health care system the cost/effectiveness ratio was 36.0 thousand rubles for 1 additional year of life, in the analysis, taking into account the social perspective – 17.9 thousand rubles for 1 additional year of life. Increase in the life expectancy of 50 year-old patients will be 0.291 year in average. Conclusion. Varenicline therapy of patients with angina pectoris is the economy before cardiac surgery , and after their execution, and this applies not only young, but older patients. The desirability of varenicline including to federal and regional programs to reduce cardiovascular morbidity and mortality is shown.

  9. Predicted risks of radiogenic cardiac toxicity in two pediatric patients undergoing photon or proton radiotherapy

    International Nuclear Information System (INIS)

    Hodgkin disease (HD) and medulloblastoma (MB) are common malignancies found in children and young adults, and radiotherapy is part of the standard treatment. It was reported that these patients who received radiation therapy have an increased risk of cardiovascular late effects. We compared the predicted risk of developing radiogenic cardiac toxicity after photon versus proton radiotherapies for a pediatric patient with HD and a pediatric patient with MB. In the treatment plans, each patient’s heart was contoured in fine detail, including substructures of the pericardium and myocardium. Risk calculations took into account both therapeutic and stray radiation doses. We calculated the relative risk (RR) of cardiac toxicity using a linear risk model and the normal tissue complication probability (NTCP) values using relative seriality and Lyman models. Uncertainty analyses were also performed. The RR values of cardiac toxicity for the HD patient were 7.27 (proton) and 8.37 (photon), respectively; the RR values for the MB patient were 1.28 (proton) and 8.39 (photon), respectively. The predicted NTCP values for the HD patient were 2.17% (proton) and 2.67% (photon) for the myocardium, and were 2.11% (proton) and 1.92% (photon) for the whole heart. The predicted ratios of NTCP values (proton/photon) for the MB patient were much less than unity. Uncertainty analyses revealed that the predicted ratio of risk between proton and photon therapies was sensitive to uncertainties in the NTCP model parameters and the mean radiation weighting factor for neutrons, but was not sensitive to heart structure contours. The qualitative findings of the study were not sensitive to uncertainties in these factors. We conclude that proton and photon radiotherapies confer similar predicted risks of cardiac toxicity for the HD patient in this study, and that proton therapy reduced the predicted risk for the MB patient in this study

  10. 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.

  11. 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.

  12. 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

  13. Adapted cardiac rehabilitation programme to improve uptake in patients of Moroccan and Turkish origin in The Netherlands: a qualitative study

    OpenAIRE

    Sloots, Maurits; Bartels, Edien A. C.; Angenot, Edmond L. D.; Geertzen, Jan H. B.; Dekker, Joost

    2012-01-01

    Aim. To explore the treatment experiences in patients of Moroccan and Turkish origin and their rehabilitation therapists regarding an adapted outpatient cardiac rehabilitation programme. Background. Non-native patients who participated in a cardiac rehabilitation programme at a Dutch rehabilitation centre had more difficulties to achieve the treatment aims than native Dutch patients. Therefore, an adapted programme for non-native patients, lacking proficiency in Dutch, has been instigated. Th...

  14. A STUDY ON ASYMPTOMATIC CARDIAC CHANGES IN TYPE 2 DIABETES PATIENTS

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    Ramchandra Rao

    2015-06-01

    Full Text Available INTRODUCTION: Majority of the time the patient of Diabetes presents with complications like Myocardial infarction, heart failure, being end stages of cardiovascular 2 disease associated with other macro and microvascular complications. If patients are screened at an early stage of Diabetes before the onset of symptoms the cardiovascular complications can be delayed and mortality can be reduced . There are only few studies in India done to screen asymptomatic diabetic individuals for cardiovascular compli cations. This study is done in view of screening the asymptomatic individuals in our area to prevent complications. With the available infrastructure, ECG, 2D ECHO were done in 50 patients who met inclusion, exclusion criterias, the changes were noted and the cardiac status was evaluated. AIM AND OBJECTIVES : “To study the asymptomatic cardiac changes in type2 Diabetes patients”. To observe the ECG changes in patients of type2 Diabetes without any symptoms of cardiac disease. To evaluate the ECG changes along with 2DECHO findings in asymptomatic cardiac patients of type 2 Diabetes. To study the correlation between these two investigations and evaluate the cardiac status of the individual. CONCLUSIONS : M ost of the patients in study group belong to 5 th decade , Males with Diabetes were almost double that of females , Most of the patients had duration of Diabetes as 5yrs , Less than half of patients had family history of Diabetes , Half of the group had alcohol, smoking habits , More than half of patients were overweight , Only 20% had good control of Diabetes , Total cholesterol is above normal in almost all of the patients, LDL is elevated in half of the patients, triglycerides in most of them, there is significant dyslipidemia in patients of Diabetes , Only 6 had normal ECG. Rest of them have LVH, ischemia , 18 patients had changes in echo including LVD, regional and global hypokinesias , t hus the present study shows patients with type 2

  15. Influence of water immersion, water gymnastics and swimming on cardiac output in patients with heart failure

    Science.gov (United States)

    Schmid, Jean‐Paul; Noveanu, Markus; Morger, Cyrill; Gaillet, Raymond; Capoferri, Mauro; Anderegg, Matthias; Saner, Hugo

    2007-01-01

    Background Whole‐body water immersion leads to a significant shift of blood from the periphery to the intrathoracic circulation, followed by an increase in central venous pressure and heart volume. In patients with severely reduced left ventricular function, this hydrostatically induced volume shift might overstrain the cardiovascular adaptive mechanisms and lead to cardiac decompensation. Aim To assess the haemodynamic response to water immersion, gymnastics and swimming in patients with chronic heart failure (CHF). Methods 10 patients with compensated CHF (62.9 (6.3) years, ejection fraction 31.5% (4.1%), peak oxygen consumption (V̇o2) 19.4 (2.8) ml/kg/min), 10 patients with coronary artery disease (CAD) but preserved left ventricular function (57.2 (5.6) years, ejection fraction 63.9% (5.5%), peak V̇o2 28 (6.3) ml/kg/min), and 10 healthy controls (32.8 (7.2) years, peak V̇o2 45.6 (6) ml/kg/min) were examined. Haemodynamic response to thermoneutral (32°C) water immersion and exercise was measured using a non‐invasive foreign gas rebreathing method during stepwise water immersion, water gymnastics and swimming. Results Water immersion up to the chest increased cardiac index by 19% in controls, by 21% in patients with CAD and by 16% in patients with CHF. Although some patients with CHF showed a decrease of stroke volume during immersion, all subjects were able to increase cardiac index (by 87% in healthy subjects, by 77% in patients with CAD and by 53% in patients with CHF). V̇o2 during swimming was 9.7 (3.3) ml/kg/min in patients with CHF, 12.4 (3.5) ml/kg/min in patients with CAD and 13.9 (4) ml/kg/min in controls. Conclusions Patients with severely reduced left ventricular function but stable clinical conditions and a minimal peak V̇o2 of at least 15 ml/kg/min during a symptom‐limited exercise stress test tolerate water immersion and swimming in thermoneutral water well. Although cardiac index and V̇o2 are lower than in patients

  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. Cardiac output response to changes of the atrioventricular delay in different body positions and during exercise in patients receiving cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Ståhlberg, Marcus; Damgaard, Morten; Norsk, Peter; Gabrielsen, Anders; Sahlén, Anders; Linde, Cecilia; Braunschweig, Frieder

    2009-01-01

    prolonged by 40 ms in 27 CRT patients and 9 controls without heart failure. Cardiac output (CO) was measured by inert gas rebreathing (Innocor) as the average over different body positions (left-lateral, supine, sitting, standing, and exercise). In eight CRT patients with an implantable haemodynamic monitor...

  18. Could Recurrent Anxiety be a New Surgical Indication for Patients with Spontaneous Pneumothorax?

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    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.

  19. Effects of Obstructive Sleep Apnea on Cardiac Function and Clinical Outcomes in Chinese Patients with ST-Elevation Myocardial Infarction

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    Baoxin Liu

    2014-01-01

    Full Text Available Aim. The objective of this study was to investigate the influence of OSA on cardiac function in Chinese patients with ST-elevation myocardial infarction (STEMI and determine the prognostic impact of OSA among these patients. Methods. In this retrospective study, 198 STEMI patients were enrolled. Doppler echocardiography was performed to detect the effect of OSA on cardiac function. Major adverse cardiac events (MACE and cardiac mortality were analyzed to determine whether OSA was a clinical prognostic factor; its prognostic impact was then assessed adjusting for other covariates. Results. The echocardiographic results showed that the myocardium of STEMI patients with OSA appeared to be more hypertrophic and with a poorer cardiac function compared with non-OSA STEMI patients. A Kaplan-Meier survival analysis revealed significantly higher cumulative incidence of MACE and cardiac mortality in the OSA group compared with that in the non-OSA group during a mean follow-up of 24 months. Multivariate Cox regression analysis revealed that OSA was an independent risk factor for MACE and cardiac mortality. Conclusion. These results indicate that the OSA is a powerful predictor of decreased survival and exerts negative prognostic impact on cardiac function in STEMI patients.

  20. 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