WorldWideScience

Sample records for factors influencing postoperative

  1. Post-operative sleep disturbance: causes, factors and effects on outcome

    DEFF Research Database (Denmark)

    Rosenberg, J; Rosenberg-Adamsen, S; Kehlet, H

    1995-01-01

    Post-operative sleep disturbance, with suppression of rapid eye movement sleep and slow wave sleep followed by a subsequent rebound, seems to be related to the magnitude of trauma and thereby to the surgical stress response. In this context, cortisol, autonomic stimulation, and certain cytokines...... may lead to abnormal sleep. Furthermore, the environment, pain and the administration of analgesics seem to be important factors in the precipitation of sleep abnormalities. Post-operative sleep disturbance may contribute to the development of episodic hypoxaemia, haemodynamic instability and altered...... mental status, all of which have an influence on post-operative morbidity and mortality. Prevention or reduction of the post-operative sleep disturbance may be achieved by minimizing surgical trauma, changing the conventional nursing procedures, avoiding opioids and treating pain with non...

  2. Postoperative weight gain after standard Whipple's procedure versus pylorus-preserving pancreatoduodenectomy: the influence of tumour status

    NARCIS (Netherlands)

    van Berge Henegouwen, M. I.; Moojen, T. M.; van Gulik, T. M.; Rauws, E. A.; Obertop, H.; Gouma, D. J.

    1998-01-01

    BACKGROUND: Recent reports suggest a better postoperative weight gain after pylorus-preserving pancreatoduodenectomy (PPPD) compared with standard pancreatoduodenectomy (PD). Factors that could also influence postoperative weight gain, such as tumour-positive resection margins and tumour recurrence,

  3. Does Histologic Subtype Influence the Post-Operative Outcome in Spinal Meningioma?

    Science.gov (United States)

    Zham, Hanieh; Moradi, Afshin; Rakhshan, Azadeh; Zali, Alireza; Rahbari, Ali; Raee, Mohammadreza; Ashrafi, Farzad; Ahadi, Mahsa; Larijani, Leila; Baikpour, Masoud; Khayamzadeh, Maryam

    2016-04-01

    Postoperative outcome of spinal meningiomas is an important issue in surgery decision-making. There are limited and conflicting data in the literature about the prognostic factors influencing recovery, especially about the histopathologic subtypes. This study was carried out to evaluate the effect of some of these factors on postoperative outcome. This study was performed on 39 patients operated for spinal meningioma between October 1998 and January 2012; their histopathologic subtype was determined according to WHO criteria. The follow up period ranged between 8 - 120 months. The influence of histopathologic subtype, grade, age, sex, surgical approach, local adhesion and anatomical location was assessed according to Frankel classification of neurologic deficit. From a total number of 39 spinal meningiomas, 34 cases were WHO grade I, from which 15 cases were psammomatous, 7 cases were meningothelial, 9 cases were transitional and 3 cases were fibroblastic. Five cases were grade II, 3 of which had clear cell appearance and the remaining 2 had chordoid appearance. The mean age was 51.6 (22 to 76) years; 25 cases were female and 14 cases were male. This study revealed that grade II meningioma cases had poor prognosis in all 5 cases and psammomatous subtype had poor postoperative outcome in 40% of cases while the other subtypes had good outcome in all cases (P = 0.026). Cervical location of the tumor was also related with poor outcome in 37.5% of the cases, while 22.5% had poor outcome in other locations (P = 0.029). Age below and above 45 years and sex had no significant influence on the outcome. Spinal meningiomas of psammomatous type and grade II spinal meningiomas are associated with less favorable postoperative neurologic outcome. Cervical location has also a negative correlation with a good outcome.

  4. Risk factors for postoperative complications in robotic general surgery.

    Science.gov (United States)

    Fantola, Giovanni; Brunaud, Laurent; Nguyen-Thi, Phi-Linh; Germain, Adeline; Ayav, Ahmet; Bresler, Laurent

    2017-03-01

    The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (Clavien >III) rates were 20.4 and 6 %, respectively. This included a conversion rate of 4.4 %, reoperation rate of 4.5 %, and mortality rate of 0.2 %. Multivariate analysis showed that ASA score >3 [OR 1.7; 95 % CI (1.2-2.4)], hematocrit value surgery [OR 1.5; 95 % CI (1-2)], advanced dissection [OR 5.8; 95 % CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95 % CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95 % CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95 % CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (Clavien >III). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.

  5. Is age a predisposing factor of postoperative complications after lung resection for primary pulmonary neoplasms?

    Science.gov (United States)

    Cañizares Carretero, Miguel-Ángel; García Fontán, Eva-María; Blanco Ramos, Montserrat; Soro García, José; Carrasco Rodríguez, Rommel; Peña González, Emilio; Cueto Ladrón de Guevara, Antonio

    2017-03-01

    Age has been classically considered as a determining factor for the development of postoperative complications related to lung resection for bronchogenic carcinoma. The Postoperative Complications Study Group of the Spanish Society of Thoracic Surgery has promoted a registry to analyze this factor. A total of 3,307 patients who underwent any type of surgical resection for bronchogenic carcinoma have been systematically and prospectively recorded in any of the 24 units that are part of the group. Several variables related to comorbidity and age, as well as postoperative complications, were analyzed. The mean age of patients was 65,44. Men were significantly more common than female. The most frequent complication was prolonged air leak, which was observed in more than one third of patients. In a univariant analysis, air leak presence and postsurgical atelectasis showed statistical association with patient age, when stratified in age groups. In a multivariate analysis, age was recognized as an independent prognostic factor in relation to air leak onset. However, this could not be confirmed for postoperative atelectasis. Age is a predisposing factor for the development of postoperative complications after lung resection. Other associated factors also influence the occurrence of these complications. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Postoperative mortality after inpatient surgery: Incidence and risk factors

    Directory of Open Access Journals (Sweden)

    Karamarie Fecho

    2008-09-01

    Full Text Available Karamarie Fecho1, Anne T Lunney1, Philip G Boysen1, Peter Rock2, Edward A Norfleet11Department of Anesthesiology, School of Medicine, University of North Carolina, Chapel Hill, NC, USA; 2Department of Anesthesiology, University of Maryland, Baltimore, MD, USAPurpose: This study determined the incidence of and identified risk factors for 48 hour (h and 30 day (d postoperative mortality after inpatient operations.Methods: A retrospective cohort study was conducted using Anesthesiology’s Quality Indicator database as the main data source. The database was queried for data related to the surgical procedure, anesthetic care, perioperative adverse events, and birth/death/operation dates. The 48 h and 30 d cumulative incidence of postoperative mortality was calculated and data were analyzed using Chi-square or Fisher’s exact test and generalized estimating equations.Results: The 48 h and 30 d incidence of postoperative mortality was 0.57% and 2.1%, respectively. Higher American Society of Anesthesiologists physical status scores, extremes of age, emergencies, perioperative adverse events and postoperative Intensive Care Unit admission were identified as risk factors. The use of monitored anesthesia care or general anesthesia versus regional or combined anesthesia was a risk factor for 30 d postoperative mortality only. Time under anesthesia care, perioperative hypothermia, trauma, deliberate hypotension and invasive monitoring via arterial, pulmonary artery or cardiovascular catheters were not identified as risk factors.Conclusions: Our findings can be used to track postoperative mortality rates and to test preventative interventions at our institution and elsewhere.Keywords: postoperative mortality, risk factors, operations, anesthesia, inpatient surgery

  7. Influence of Postoperative Hypertension on the Development of Spinal Epidural Hematoma.

    Science.gov (United States)

    Ohba, Tetsuro; Ebata, Shigeto; Haro, Hirotaka

    2017-11-01

    Spinal epidural hematoma (SEH) is a rare postoperative complication but can result in catastrophic neurological deficits requiring immediate surgical evacuation of the hematoma. Knowing the risk factors for postoperative SEH can help surgeons stratify patients. Therefore, to identify possible risk factors for postoperative SEH, we reviewed 6 clinical cases and examined the relation between postoperative hypertension and the risk of developing SEH. A retrospective review was conducted of 1282 consecutive patients who underwent spinal surgery at a single institution between 2010 and 2015. Of this cohort, 6 patients developed symptomatic SEH and underwent emergency hematoma evacuation. The 6 SEH patients were evaluated for previously described risk factors of postoperative hematoma formation. In particular, postoperative blood pressure measurements were reviewed. The incidence of postoperative symptomatic SEH was 0.468%. Two patients developed SEH secondary to a nonfunctional surgical drain in the early postoperative period (5 or 12 h post-surgery). Preoperative and postoperative hypertension was observed in 4 patients who developed SEH at greater than or equal to 48 h following surgery. Our findings suggest that rigorous postoperative blood pressure control may decrease the risk of SEH. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  8. The incidence of postoperative radiotherapy-induced acute dermatitis in breast cancer and its influencing factors for Chinese women

    Directory of Open Access Journals (Sweden)

    Ding J

    2018-03-01

    Full Text Available Jingxian Ding,1,2,* Yonghong Guo,3,* Qingge Li,1 Jun Chen,4 Pinghua Hu,4 Qiuming Liu,4 Yali Cao,4 Jiong Wu5,6 1Department of Radiation Oncology, The Third Hospital of Nanchang, Nanchang, China; 2Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China; 3Department of Radiation Oncology, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China; 4Department of Breast Surgery, The Third Hospital of Nanchang, Nanchang, China; 5Department of Breast Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; 6Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China *These authors contributed equally to this work Purpose: To investigate the incidence of skin acute reaction and its influencing factors in postoperative breast cancer radiotherapy patients. Methods: One hundred and seventy three cases of breast cancer patients treated with postoperative radiotherapy were consecutively enrolled from June 1, 2016 to July 31, 2017 in our breast cancer center. Irradiation technology includes conformal intensity-modulated radiotherapy and a conventional two-dimensional one with conventional fraction. Any acute radiation dermatitis was recorded and the influencing factors were analyzed at the end of the radiation treatment. Results: Radiotherapy-induced acute dermatitis in patients with breast-conserving surgery was relatively mild. Among the 173 patients, 33 cases had no obvious changes in the skin (grade 0; 121 cases had grade 1 skin reactions, manifested as local dark erythema and dry peeling; 29 cases had grade 2 skin reactions, characterized by edema, hyperemia, or erosion part; no grade 3 cases of skin reactions were observed. The incidence of grade 0, grade 1, and grade 2 reactions in all patients was 19.1%, 69.9%, and 11.0%, respectively. The severity of skin acute reaction is independent of the tumor sites, molecular subtypes, patients’ age, and irradiation modalities, but it

  9. Risk factors for postoperative liver failure after hepatectomy for hepatocellular carcinoma.

    Science.gov (United States)

    Maeda, Yoshitaka; Nishida, Minekatsu; Takao, Takashi; Mori, Naohide; Tamesa, Takao; Tangoku, Akira; Oka, Masaaki

    2004-01-01

    Selection of patients for hepatectomy for hepatocellular carcinoma conventionally has been based upon Child-Pugh grading. However, postoperative liver failure after hepatectomy is a major cause of hospital mortality. A new predictor of postoperative liver failure is required. The objective of this study was to identify risk factors for postoperative liver failure after hepatectomy. Perioperative risk factors for liver failure after hepatectomy were analyzed in 112 patients with hepatocellular carcinoma Eight of these patients died of liver failure. Stepwise multivariate logistic regression was performed to investigate significant independent factors among 17 variables, including the serum alkaline phosphatase ratio (ALPR) on the first day after hepatectomy. ALPR was calculated as the postoperative ALP level divided by the ALP level before surgery. Significant risk factors of postoperative liver failure were ALPR on postoperative day 1 (ALPR1), sex, operative blood loss, and operative procedure. As an indicator of liver failure, the diagnostic accuracy of the ALPR1 was 93.7% when the ALPR was less than 0.4 on the first postoperative day. The ALPR and the serum total bilirubin concentration after hepatectomy were uncorrelated. ALPR1 is a useful predictor of liver failure after hepatectomy.

  10. Metastatic spine tumor surgery: does perioperative blood transfusion influence postoperative complications?

    Science.gov (United States)

    Zaw, Aye Sandar; Kantharajanna, Shashidhar B; Maharajan, Karthikeyan; Tan, Barry; Saparamadu, Amarasinghe A; Kumar, Naresh

    2017-11-01

    The question of independent association between allogeneic blood transfusion (ABT) and postoperative complications in cancer surgeries has been controversial and remains so. In metastatic spine tumor surgery (MSTS), previous studies investigated the influence of ABT on survival, but not on postoperative complications. We aimed to evaluate the influence of perioperative ABT on postoperative complications and infections in patients undergoing MSTS. This retrospective study included 247 patients who underwent MSTS at a single tertiary institution between 2005 and 2014. The outcome measures were postoperative complications and infections within 30 days after MSTS. Multivariate logistic regression analyses were performed to assess influence of blood transfusion on the outcomes after adjusting for potential confounders. Of 247 patients, 133 (54%) received ABT with overall median (range) of 2 (0-10) units. The adjusted odds of developing any postoperative complication was 2.27 times higher in patients with transfusion (95% confidence interval [CI], 1.17-4.38; p = 0.01) and 1.24 times higher odds per every unit increase in blood transfusion (95% CI, 1.05-1.46; p blood transfusion also increased the odds of having overall postoperative infections (odds ratio, 3.58; 95% CI, 1.15-11.11; p = 0.02) and there were 1.24 times higher odds per every unit increase in transfusion (95% CI, 1.01-1.54; p = 0.04). This study adds evidence to the literature implicating ABT to be influential on postoperative complications and infections in patients undergoing MSTS. Appropriate blood management measures should, therefore, be given a crucial place in the care of these patients so as to reduce any putative effect of blood transfusion. © 2017 AABB.

  11. Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes.

    Science.gov (United States)

    Nakagawa, Shigeto; Mae, Tatsuo; Sato, Seira; Okimura, Shinichiro; Kuroda, Miki

    2017-09-01

    Several risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair have been reported, but there have been few detailed investigations of the specific risk factors in relation to the type of sport. This study investigated the postoperative recurrence of instability after arthroscopic Bankart repair without additional reinforcement procedures in competitive athletes, including athletes with a large glenoid defect. The purpose of this study was to investigate risk factors related to the postoperative recurrence of instability in athletes. Case-control study; Level of evidence, 3. A total of 115 athletes (123 shoulders) were classified into 5 groups according to type of sport: rugby (41 shoulders), American football (32 shoulders), other collision sports (18 shoulders), contact sports (15 shoulders), and overhead sports (17 shoulders). First, the recurrence rate in each sporting category was investigated, with 113 shoulders followed up for a minimum of 2 years. Then, factors related to postoperative recurrence were investigated in relation to the type of sport. Postoperative recurrence of instability was noted in 23 of 113 shoulders (20.4%). The recurrence rate was 33.3% in rugby, 17.2% in American football, 11.1% in other collision sports, 14.3% in contact sports, and 12.5% in overhead sports. The most frequent cause of recurrence was tackling, and recurrence occurred with tackling in 12 of 16 athletes playing rugby or American football. Reoperation was completed in 11 shoulders. By univariate analysis, significant risk factors for postoperative recurrence of instability included playing rugby, age between 10 and 19 years at surgery, preoperative glenoid defect, small bone fragment of bony Bankart lesion, and capsular tear. However, by multivariate analysis, the most significant factor was not the type of sport but younger age at operation and a preoperative glenoid defect with small or no bone fragment. Compared with the other

  12. The influence of dexamethasone and ketolgan on postoperative nausea and vomiting and estimation of risk factors in women undergoing gynecologic laparoscopic surgeries.

    Science.gov (United States)

    Rimaitis, Kestutis; Svitojūte, Asta; Macas, Andrius

    2010-01-01

    The aim of this study was to determine the effect of dexamethasone and ketolgan on postoperative nausea and vomiting and to evaluate risk factors for postoperative nausea and vomiting. A prospective, double-blind, randomized clinical study was carried out. One hundred fifty-three ASA I-II women undergoing laparoscopic gynecologic operations were randomized into three groups: dexamethasone group (n=51), ketolgan group (n=51), and control group (n=51). Patients in the dexamethasone group were given 4 mg of dexamethasone intravenously before the induction of general anesthesia, the ketolgan group received 30-mg ketolgan intravenously, and control group did not receive any medication. The incidence and severity of postoperative nausea and vomiting were registered 24 hours after the surgery. The incidence of postoperative nausea and vomiting in the dexamethasone group was 13.8%; in the ketolgan group, 37.3%, and in the control group, 58.9% (P=0.026). Patients with a history of migraine suffered from postoperative nausea and vomiting in 70.3% of cases and migraine-free patients in 25.8% of cases (P=0.015). Opioids for postoperative analgesia increased the incidence of postoperative nausea and vomiting as compared with nonsteroidal anti-inflammatory drugs (P=0.00002). Preoperative medication with dexamethasone significantly reduces the incidence of postoperative nausea and vomiting. Avoidance of opioids for postoperative analgesia reduces the incidence of postoperative nausea and vomiting. Migraine and motion sickness are independent risk factors for postoperative nausea and vomiting.

  13. Effect of postoperative adjuvant transarterial chemoembolization on postoperative survival of patients with liver cancer and related influencing factors for prognosis

    Directory of Open Access Journals (Sweden)

    XING Zhixiang

    2017-12-01

    Full Text Available ObjectiveTo investigate the effect of postoperative adjuvant transarterial chemoembolization (TACE on the survival of patients with hepatocellular carcinoma (HCC, as well as influencing factors for prognosis. MethodsA retrospective analysis was performed for the clinical data of 215 HCC patients who were admitted to Renmin Hospital of Wuhan University from January 2007 to December 2012. According to whether TACE was given after hepatectomy, these patients were divided into single group with 95 patients and combination group with 120 patients. A comparative analysis was performed for the two groups. The patients in the single group were given hepatectomy alone, and those in the combination group were given hepatectomy followed by TACE at one month after surgery. General status, treatment condition, and related clinical indices were recorded for both groups, and the two groups were compared in terms of the 1-, 3-, and 5-year survival rates and disease-free survival rates after surgery. The independent samples t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The Kaplan-Meier method was used for comparison of survival rates between groups, and univariate analysis and Cox multivariate regression analysis were used to investigate the influencing factors for prognosis after hepatectomy. ResultsIn the combination group, the 1-, 3-, and 5-year survival rates were 96.5%, 67.0%, and 51.0%, respectively, with a median survival time of 51 months; in the single group, the 1-, 3-, and 5-year survival rates were 84.0%,49.5%, and 36.5%, respectively, with a median survival time of 39 months; there was a significant difference in survival rates between the two groups (χ2=5.540, P=0.018. The 1-, 3-, and 5-year disease-free survival rates were 91.7%, 62.5%, and 37.5%, respectively, in the combination group and 84.0%, 42.1%, and 26.3%, respectively, in the single

  14. Risk factors for postoperative complications following oral surgery

    Directory of Open Access Journals (Sweden)

    Hideo SHIGEISHI

    2015-08-01

    Full Text Available AbstractObjective The objective of this study was to clarify significant risk factors for postoperative complications in the oral cavity in patients who underwent oral surgery, excluding those with oral cancer.Material and Methods This study reviewed the records of 324 patients who underwent mildly to moderately invasive oral surgery (e.g., impacted tooth extraction, cyst excision, fixation of mandibular and maxillary fractures, osteotomy, resection of a benign tumor, sinus lifting, bone grafting, removal of a sialolith, among others under general anesthesia or intravenous sedation from 2012 to 2014 at the Department of Oral and Maxillofacial Reconstructive Surgery, Hiroshima University Hospital.Results Univariate analysis showed a statistical relationship between postoperative complications (i.e., surgical site infection, anastomotic leak and diabetes (p=0.033, preoperative serum albumin level (p=0.009, and operation duration (p=0.0093. Furthermore, preoperative serum albumin level (<4.0 g/dL and operation time (≥120 minutes were found to be independent factors affecting postoperative complications in multiple logistic regression analysis results (odds ratio 3.82, p=0.0074; odds ratio 2.83, p=0.0086, respectively.Conclusion Our results indicate that a low level of albumin in serum and prolonged operation duration are important risk factors for postoperative complications occurring in the oral cavity following oral surgery.

  15. Risk Factors for Postoperative Fibrinogen Deficiency after Surgical Removal of Intracranial Tumors.

    Directory of Open Access Journals (Sweden)

    Naili Wei

    Full Text Available Higher levels of fibrinogen, a critical element in hemostasis, are associated with increased postoperative survival rates, especially for patients with massive operative blood loss. Fibrinogen deficiency after surgical management of intracranial tumors may result in postoperative intracranial bleeding and severely worsen patient outcomes. However, no previous studies have systematically identified factors associated with postoperative fibrinogen deficiency. In this study, we retrospectively analyzed data from patients who underwent surgical removal of intracranial tumors in Beijing Tiantan Hospital date from 1/1/2013to12/31/2013. The present study found that patients with postoperative fibrinogen deficiency experienced more operative blood loss and a higher rate of postoperative intracranial hematoma, and they were given more blood transfusions, more plasma transfusions, and were administered larger doses of hemocoagulase compared with patients without postoperative fibrinogen deficiency. Likewise, patients with postoperative fibrinogen deficiency had poorer extended Glasgow Outcome Scale (GOSe, longer hospital stays, and greater hospital expenses than patients without postoperative fibrinogen deficiency. Further, we assessed a comprehensive set of risk factors associated with postoperative fibrinogen deficiency via multiple linear regression. We found that body mass index (BMI, the occurrence of postoperative intracranial hematoma, and administration of hemocoagulasewere positively associated with preoperative-to-postoperative plasma fibrinogen consumption; presenting with a malignant tumor was negatively associated with fibrinogen consumption. Contrary to what might be expected, intraoperative blood loss, the need for blood transfusion, and the need for plasma transfusion were not associated with plasma fibrinogen consumption. Considering our findings together, we concluded that postoperative fibrinogen deficiency is closely associated with

  16. [Analysis on influencing factor of the complications of percutaneous dilational tracheotomy].

    Science.gov (United States)

    Zhai, Xiang; Zhang, Jinling; Hang, Wei; Wang, Ming; Shi, Zhan; Mi, Yue; Hu, Yunlei; Liu, Gang

    2015-01-01

    To Analyze the influence factors on the complications of percutaneous dilational tracheotomy. Between August 2008 and February 2014, there were 3 450 patients with the indications of tracheotomy accepted percutaneous dilational tracheostomy, mainly using percutaneous dilational and percutaneous guide wire forceps in these cases. Statistical analysis was performed by SPSS 19.0 software on postoperative complications, the possible influence factors including age, gender, etiology, preoperative hypoxia, obesity, preoperative pulmonary infection, state of consciousness, operation method, operation doctor and whether with tracheal intubation. Among 3 450 patients, there were 164 cases with intraoperative or postoperative complications, including postoperative bleeding in 74 cases (2.14%), subcutaneous emphysema in 54 cases (1.57%), wound infection in 16 cases (0.46%), pneumothorax in 6 cases (0.17%), mediastinal emphysema in 5 cases (0.14%), operation failed and change to conventional incision in 4 cases (0.12%), tracheoesophageal fistula in 2 cases (0.06%), death in 3 cases(0.09%).Obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method were the main influence factors, with significant statistical difference (χ(2) value was 0.010, 0.000, 0.002, 0.000, 0.000, 0.000, all P Gender, age, operation doctor and whether there was the endotracheal intubation were not the main influence factors. There was no significant statistical difference (P > 0.05). Although percutaneous dilational tracheostomy is safe, but the complications can also happen. In order to reduce the complications, it is need to pay attention to the factors of obesity, etiology, preoperative hypoxia, preoperative pulmonary infection, state of consciousness and operation method.

  17. Factors associated with postoperative complications and mortality in perforated peptic ulcer.

    Science.gov (United States)

    Montalvo-Javé, Eduardo Esteban; Corres-Sillas, Omar; Athié-Gutiérrez, César

    2011-01-01

    Elective surgery for uncomplicated peptic ulcer has shown a significant decrease; however, complications such as perforation and obstruction persist and require urgent surgical management. The aim of this study was to identify factors associated with early postoperative complications and mortality of patients admitted to the emergency department with perforated peptic ulcer. We performed a clinical, retrospective, cross-sectional and descriptive study of patients who were treated at the General Hospital of Mexico with a diagnosis of perforated peptic ulcer from January 2006 to December 2008. Thirty patients were included in the study. We studied several clinical findings upon admission to the emergency department and intraoperative patient findings in order to determine the association of those with early postoperative complications and mortality. We studied 30 patients with an average age of 57.07 years (± 14.2 years). The male:female ratio was 2:1. We found that the risk of developing postoperative complications was 66.7% and is significantly influenced by time of onset of abdominal pain prior to admission, bloating, septic shock and blood type O positive. Mortality was 16.7% and was correlated with the presence of septic shock on admission. The surgical procedure performed was primary closure with Graham patch in 86.6%. Average hospital stay was 12.8 days. The presence of early postoperative complications is associated with time of onset of abdominal pain before admission, abdominal distension, blood type O positive and the presence of septic shock on admission.

  18. Preoperative factors influencing mortality and morbidity in peptic ulcer perforation.

    Science.gov (United States)

    Sivaram, P; Sreekumar, A

    2018-04-01

    Perforated peptic ulcer is one of the most common surgical emergencies worldwide. With the improvement in medical therapy for peptic ulcers, the number of elective surgical procedures has come down. However, the incidence of perforated peptic ulcer is still increasing and remains as a substantial health problem with significant postoperative morbidity and mortality. This study aimed to find out the association between various preoperative and intraoperative factors with the postoperative mortality and morbidity in patients operated for peptic ulcer perforation. This prospective observational study had a time based sample of 101 perforation peritonitis cases admitted to the surgical wards of a tertiary care center from February 2015 to January 2016 who underwent laparotomy, diagnosed to have peptic ulcer perforation and underwent simple closure with an omental patch. Data regarding age, gender, presenting complaints, time elapsed from the onset of symptoms to surgery, physical examination findings, comorbid diseases, laboratory and imaging findings, intraoperative findings, length of hospital stay, postoperative morbidity, and mortality were recorded and analyzed. Female gender, older age group, perforation surgery interval more than 36 h, and size of perforation more than 1 cm 2 were found to be significant factors influencing postoperative mortality and morbidity. Postoperative morbidity was also associated with comorbid diseases. Abnormal renal function on presentation was identified as an additional risk factor for postoperative morbidity and longer hospital stay. An understanding of these factors, identification of patients at risk and early intervention can help in reducing the postoperative morbidity and mortality in peptic ulcer perforation.

  19. Postoperative influences of the torsional phacoemulsification on foveal thickness and corneal edema

    Directory of Open Access Journals (Sweden)

    Lei Li

    2014-05-01

    Full Text Available AIM: To report the influences onfoveal thickness and corneal edema after torsional phacoemulsification.METHODS: Totally 52 patients(52 eyeswith age-related cataract were randomly assigned to phacoemulsification using torsional mode(26 eyesor conventional ultrasound mode(26 eyes. The foveal thickness examined by optical coherence tomography(OCTafter surgery at 1, 4 and 12wk and corneal edema was examined by slit lamp after surgery at 1d.RESULTS: The postoperative averagefoveal thickness datas of the two groups, comparing with corresponding preoperative datas, were significantly augmented at 1, 4 and 12wk(PPP>0.05. The effects of corneal edema in torsional group were slighter(PCONCLUSION: The postoperative influences onfoveal thickness and corneal edema with torsional mode are slighter than that with ultrasound mode, and the postoperative reactions with torsional mode are efficiently reduced.

  20. Risk Factors for Postoperative Cognitive Dysfunctions in Elderly Patients

    Directory of Open Access Journals (Sweden)

    N. Yu. Ibragimov

    2008-01-01

    Full Text Available Objective: to study the impact of a wide spectrum of factors on the development of postoperative delirium in elderly patients in relation to the changes in their cognitive functions depending on the type of anesthesia and period after surgery. Subjects and methods. The study covered 100 patients aged 65—90 years who had been electively operated on under general, regional, and combined anesthesia. Their cognitive status was elevated before and 1, 4, and 7 days after surgery, by using the Mini-Mental State Examination (MMSE schedule. The diagnosis was postoperatively established on the basis of interviews, by applying the diagnostic criteria of ICD-10 and DSM-IV (American Psychiatric Association, 1994 and verified by a psychiatrist’s consultation. Results. Seventeen patients developed delirium within the first two days following surgery. Elevated plasma sodium (p<0.000001, leukocytosis (p<0.00002, and postoperative analgesia mode (p<0.02 proved to be statistically significant risk factors for delirium. Worse results of MMSE tests at all postoperative stages than those obtained prior to surgery were significant (p<0.05. Comparing the results obtained on days 1, 4, and 7 showed a significant cognitive improvement. Analysis indicated no significant differences in MMSE changes between the groups of general, regional, and combined anesthesia at all study stages. Conclusion. In elderly patients, surgery and anesthesia lead to a considerable deterioration of cognitive functions even if the development of delirium can be avoided. There is a significant correlation of the development of delirium with leukocytosis, hypernatremia, and postoperative analgesia mode. Key words: anesthesia, postoperative delirium, cognitive status, MMSE, elderly age.

  1. Postoperative complications do not influence the pattern of early lung function recovery after lung resection for lung cancer in patients at risk.

    Science.gov (United States)

    Ercegovac, Maja; Subotic, Dragan; Zugic, Vladimir; Jakovic, Radoslav; Moskovljevic, Dejan; Bascarevic, Slavisa; Mujovic, Natasa

    2014-05-19

    The pattern and factors influencing the lung function recovery in the first postoperative days are still not fully elucidated, especially in patients at increased risk. Prospective study on 60 patients at increased risk, who underwent a lung resection for primary lung cancer. complete resection and one or more known risk factors in form of COPD, cardiovascular disorders, advanced age or other comorbidities. Previous myocardial infarction, myocardial revascularization or stenting, cardiac rhythm disorders, arterial hypertension and myocardiopathy determined the increased cardiac risk. The severity of COPD was graded according to GOLD criteria. The trend of the postoperative lung function recovery was assessed by performing spirometry with a portable spirometer. Cardiac comorbidity existed in 55%, mild and moderate COPD in 20% and 35% of patients respectively. Measured values of FVC% and FEV1% on postoperative days one, three and seven, showed continuous improvement, with significant difference between the days of measurement, especially between days three and seven. There was no difference in the trend of the lung function recovery between patients with and without postoperative complications. Whilst pO2 was decreasing during the first three days in a roughly parallel fashion in patients with respiratory, surgical complications and in patients without complications, a slight hypercapnia registered on the first postoperative day was gradually abolished in all groups except in patients with cardiac complications. Extent of the lung resection and postoperative complications do not significantly influence the trend of the lung function recovery after lung resection for lung cancer.

  2. [Risk factors of postoperative meningitis in patients with chiasm-sellar tumors].

    Science.gov (United States)

    Popugaev, K A; Savin, I A; Ershova, O N; Kurdyumova, N V; Tabasaransky, T F; Oshorov, A V; Kadashev, B A; Kalinin, P L; Kutin, M A

    2014-01-01

    Postoperative intracranial infectious complications are one of the most topical problems of neurosurgical intensive care due to theirs significant capability to impair outcomes of the main disease. To define the risk factors of postoperative meningitis in patients with chiasm-sellar tumors. 1. to define the effect of somatic and intracranial risk factors on occurrence of postoperative meningitis in patients after transsphenoidal and transcranial approaches to the tumor. 2. To define the effect of postoperative meningitis on outcomes of treatment in patients after transsphenoidal and transcranial approaches to the tumor. Somatic and intracranial risk factors of occurrence of postoperative meningitis (pneumonia, urinary tract infection, sepsis, intra-abdominal hypertension, the presence of external ventricular and lumbar drainage, monitoring of intracranial pressure, cerebrospinal fluid, and reoperation) were fixed every day. The study was conducted in the ICU of the Burdenko from October, 2010 to July, 2012. The 34 patients (19 males, 15 females) were included in the study (average age 47.5 years). The patients were divided into two groups; 17 patients each group. The group-1 included patients after transcranial approach to the tumor and the group-2 included patients after transsphenoidal approach. In the group-1 a meningitis occurred in 3 patients (17.6% +/- 9.2%, DI [-0.4 - 35.6]). In the group-2 a meningitis occurred in 7 patients (41.2% +/- 11.9) DI 95% [17.8 - 64.4]. Accumulation of cerebrospinal fluid under the skin flap authentically increased a risk of a meningitis occurrence in patients after transcranial approach to the tumor (p = 0.031). There was no defined statistical significance of other risk factors. But there was defined a trend of the increasing of meningitis occurrence in patients after transsphenoidal approach in case of lumbar drainage or reoperation. Duration of mechanical ventilation and ICU stay in patients with meningitis was authentically

  3. Extrinsic Factors as Component Positions to Bone and Intrinsic Factors Affecting Postoperative Rotational Limb Alignment in Total Knee Arthroplasty.

    Science.gov (United States)

    Mochizuki, Tomoharu; Sato, Takashi; Tanifuji, Osamu; Watanabe, Satoshi; Kobayashi, Koichi; Endo, Naoto

    2018-02-13

    This study aimed to identify the factors affecting postoperative rotational limb alignment of the tibia relative to the femur. We hypothesized that not only component positions but also several intrinsic factors were associated with postoperative rotational limb alignment. This study included 99 knees (90 women and 9 men) with a mean age of 77 ± 6 years. A three-dimensional (3D) assessment system was applied under weight-bearing conditions to biplanar long-leg radiographs using 3D-to-2D image registration technique. The evaluation parameters were (1) component position; (2) preoperative and postoperative coronal, sagittal, and rotational limb alignment; (3) preoperative bony deformity, including femoral torsion, condylar twist angle, and tibial torsion; and (4) preoperative and postoperative range of motion (ROM). In multiple linear regression analysis using a stepwise procedure, postoperative rotational limb alignment was associated with the following: (1) rotation of the component position (tibia: β = 0.371, P intrinsic factors, such as preoperative rotational limb alignment, ROM, and tibial torsion, affected postoperative rotational limb alignment. On a premise of correct component positions, the intrinsic factors that can be controlled by surgeons should be taken care. In particular, ROM is necessary to be improved within the possible range to acquire better postoperative rotational limb alignment. Copyright © 2018 Elsevier Inc. All rights reserved.

  4. Influence of Modest Endotoxemia on Postoperative Antithrombin Deficiency and Circulating Secretory Immunoglobulin A Levels

    Science.gov (United States)

    Fujita, Tetsuji; Imai, Takashi; Anazawa, Sadao

    2003-01-01

    Objective: To evaluate the influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis. Summary Background Data: It has not been determined whether endotoxin translocation in small amounts is a physiological phenomenon or whether it is a potential health hazard. Methods: Blood endotoxin, antithrombin III (ATIII), secretory immunoglobulin A (sIgA), which was selected as a marker of cholestasis, C-reactive protein (CRP), and α-1-antitrypsin (AAT) concentrations were measured from the 20 patients undergoing curative gastrectomy for gastric cancer preoperatively and postoperatively. Portal and systemic blood samples were taken for the analysis of endotoxin and interleukin-6 (IL-6) concentrations during surgery in these patients. Results: Although plasma endotoxin levels showed a significant increase during surgery, we did not find a correlation with ATIII, sIgA, CRP, and IL-6 levels. Systemic blood endotoxin levels during surgery correlated with a postoperative rise of serum AAT levels. Plasma ATIII levels transiently decreased on the first and third postoperative day, and sIgA levels were shown to increase on the seventh postoperative day. There was a weak relationship between the extent of postoperative endotoxemia and a reduction in ATIII concentrations. Conclusions: The influence of modest endotoxemia on postoperative antithrombin deficiency and cholestasis was limited, and increased translocational endotoxemia during abdominal surgery may be a physiological phenomenon to trigger off an acute-phase protein response. PMID:12894020

  5. Postoperative irradiation of incompletely excised gemistocytic astrocytomas. Clinical outcome and prognostic factors

    International Nuclear Information System (INIS)

    Nowak-Sadzikowska, J.; Glinski, B.; Szpytma, T.; Pluta, E.

    2005-01-01

    Background and purpose: although gemistocytic astrocytomas are considered slow-growing tumors, they often behave aggressively and carry the least favorable prognosis among low-grade astrocytomas. The aim of this study is to evaluate the outcomes and prognostic factors of patients with incompletely excised gemistocytic astrocytomas irradiated postoperatively. Patients and methods: records of 48 patients with incompletely excised gemistocytic astrocytoma, irradiated between 1976 and 1998 at the department of radiation oncology, Maria Sklodowska-curie Memorial Cancer Center, Cracow, Poland, were reviewed. The total dose ranged from 50 to 60 Gy (mean: 59.35, median: 60 Gy) delivered in daily fractions of 2 Gy, 5 days a week. The treatment volume covered the residual tumor with a margin of 1-2 cm. Results: toxicity was acceptable. The overall actuarial survival rates at 5 and 10 years were 30% and 17%, respectively. Age and gender had an influence on overall survival by univariate and multivariate analysis (p < 0.05). Patients ≤ 35 years of age and female patients carried the best prognosis. Conclusion: in most patients with gemistocytic astrocytoma, combined surgery and postoperative radiotherapy result in only short-term survival. Older age is the most important unfavorable prognostic factor in patients with gemistocytic astrocytoma. (orig.)

  6. Factors related to postoperative pain among patients who underwent radiofrequency ablation of hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Hsieh, Y.-C.; Yap, Y.-S.; Hung, C.-H.; Chen, C.-H.; Lu, S.-N.; Wang, J.-H.

    2013-01-01

    Aim: To evaluate the incidence and associated factors of postoperative intense pain and haemodynamic changes during radiofrequency ablation of hepatocellular carcinoma. Materials and methods: A total of 123 consecutive hepatocellular carcinoma patients who underwent radiofrequency ablation were prospectively recruited. Patient factors, tumour characteristics, procedural factors, intraoperative haemodynamic changes, complications, postoperative events, laboratory values before and after ablation, and postoperative pain were evaluated. Postoperative pain was scored using a visual analogue scale after the procedure. Results: The mean age of the patients was 65.6 ± 9.6 years. In multiple logistic regression analysis, patients who underwent general anaesthesia [odds ratio (95% CI): 2.68 (1.23–5.81); p = 0.013] and had more postoperative nausea and vomiting episodes [3.10 (1.11–8.63); p = 0.036] were associated with intense pain. These findings remain robust after propensity score matching. For mean difference values between before and after RFA, higher in change in aspartate transaminase (p = 0.026), alanine transaminase (p = 0.016) and white blood cell count (p = 0.015), and lower in change in haemoglobin (p = 0.009) were also correlated with intense pain. There was no significant difference in haemodynamic changes between the general anaesthesia and local anaesthesia group during ablation. Conclusion: General anaesthesia, postoperative nausea and vomiting, and laboratory factors were associated with postoperative intense pain in patients who underwent radiofrequency ablation. Counselling and modification of analgesics should be considered in patients with related factors for intense pain

  7. A retrospective study of factors influencing survival following surgery for gastric dilatation-volvulus syndrome in 306 dogs.

    Science.gov (United States)

    Mackenzie, George; Barnhart, Mathew; Kennedy, Shawn; DeHoff, William; Schertel, Eric

    2010-01-01

    Gastric dilatation-volvulus (GDV) is a life-threatening condition in dogs that has been associated with high mortality rates in previous studies. Factors were evaluated in this study for their influence on overall and postoperative mortality in 306 confirmed cases of GDV between 2000 and 2004. The overall mortality rate was 10%, and the postoperative mortality rate was 6.1%. The factor that was associated with a significant increase in overall mortality was the presence of preoperative cardiac arrhythmias. Factors that were associated with a significant increase in postoperative mortality were postoperative cardiac arrhythmias, splenectomy, or splenectomy with partial gastric resection. The factor that was associated with a significant decrease in the overall mortality rate was time from presentation to surgery. This study documents that certain factors continue to affect the overall and postoperative mortality rates associated with GDV, but these mortality rates have decreased compared to previously reported rates.

  8. Identification of risk factors for postoperative dysphagia after primary anti-reflux surgery.

    Science.gov (United States)

    Tsuboi, Kazuto; Lee, Tommy H; Legner, András; Yano, Fumiaki; Dworak, Thomas; Mittal, Sumeet K

    2011-03-01

    Transient postoperative dysphagia is not uncommon after antireflux surgery and usually runs a self-limiting course. However, a subset of patients report long-term dysphagia. The purpose of this study was to determine the risk factors for persistent postoperative dysphagia at 1 year after surgery. All patients who underwent antireflux surgery were entered into a prospectively maintained database. After obtaining institutional review board approval, the database was queried to identify patients who underwent primary antireflux surgery and were at least 1 year from surgery. Postoperative severity of dysphagia was evaluated using a standardized questionnaire (scale 0-3). Patients with scores of 2 or 3 were defined as having significant dysphagia. A total of 316 consecutive patients underwent primary antireflux surgery by a single surgeon. Of these, 219 patients had 1 year postoperative symptom data. Significant postoperative dysphagia at 1 year was reported by 19 (9.1%) patients. Thirty-eight patients (18.3%) required postoperative dilation for dysphagia. Multivariate logistic regression analysis identified preoperative dysphagia (odds ratio (OR), 4.4; 95% confidence interval (CI), 1.2-15.5; p = 0.023) and preoperative delayed esophageal transit by barium swallow (OR, 8.2; 95% CI, 1.6-42.2; p = 0.012) as risk factors for postoperative dysphagia. Female gender was a risk factor for requiring dilation during the early postoperative period (OR, 3.6; 95% CI, 1.3-10.2; p = 0.016). No correlations were found with preoperative manometry. There also was no correlation between a need for early dilation and persistent dysphagia at 1 year of follow-up (p = 0.109). Patients with preoperative dysphagia and delayed esophageal transit on preoperative contrast study were significantly more likely to report moderate to severe postoperative dysphagia 1 year after antireflux surgery. This study confirms that the manometric criteria used to define esophageal dysmotility are not reliable

  9. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy.

    Science.gov (United States)

    Kim, Sun Woo; Ahn, Ji Hoon; Yim, Sang Un; Cho, Yang Hyun; Shin, Bo Sung; Chung, Ho Seok; Hwang, Eu Chang; Yu, Ho Song; Oh, Kyung Jin; Kim, Sun-Ouck; Jung, Seung Il; Kang, Taek Won; Kwon, Dong Deuk; Park, Kwangsung

    2016-09-01

    This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL) were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1%) had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, phydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis.

  10. Risk Factors in Development of Postoperative Empyema

    Directory of Open Access Journals (Sweden)

    Serdar Ozkan

    2013-10-01

    Full Text Available Aim: Many etiological factors play a role in the occurrence of postoperative empyema. We aimed to define the effects of these factors on the development of empyema. Material and Method: Two hundred and eighty-eight cases from our clinic who underwent tube thoracostomy and/or were operated due to any cause out of the primary empyema  between August 2009 and May 2010 were prospectively studied in terms of empyema development. Data comprised gender, age, chemoradiotherapy, surgical procedure, intraoperative thoracic lavage with povidone-iodine, emergency surgery status, sharing the same room with other cases with empyema, primary disease, additional comorbidity, operation duration, drain number, complication, number of patients in the room, and drain discontinuation and hospitalization duration. Blood leukocyte-neutrophil count was ordered in all cases at 3-day intervals, and fluid culture specimens were simultaneously collected from cases with drains. Drainage fluid culture specimens were evaluated with “Automated Identification and Antibiotic Susceptibility Testing” using standard procedures. Empyema cases who developed clinical manifestation and/or with bacterial growth in culture specimens were studied in terms of risk factors. The findings were analyzed using SPSS (version 16. Results: The results showed that gender, age, chemoradiotherapy, surgical procedure, intraoperative thoracic lavage with povidone-iodine, emergency surgery status, and sharing a same room with other empyema cases were not significantly correlated with the risk of empyema development. Contribution of the primary disease (p<0.05, additional comorbidity (p<0.05, operation duration (p<0.05, drain number (p<0.05, complication (p<0.05, number of people in the room (p<0.05, drain discontinuation time (p<0.05 and hospitalization duration (p<0.05 were found to be significant in the development of postoperative empyema. Discussion: Postoperative development of empyema is one

  11. FACTORS INFLUENCING THE OCCURRENCE OF HYPERTROPHIC SCARS AMONG POSTOPERATIVE PATIENTS IN GARUT, INDONESIA

    Directory of Open Access Journals (Sweden)

    Andri Nugraha

    2017-02-01

    Full Text Available Background: Hypertrophic scar causes physical and psychological problems. Thus understanding the factors related to the occurrence of hypertrophic scar tissue is needed. Little is known about its influencing factors in Indonesia, especially in Garut. Objective: This study aims to examine the relationships between hypertrophic scar and its influencing factors, and identify the most dominant factor of the occurrence of hypertrophic scars. Methods: This was an observational case control study using retrospective approach in Polyclinic of Surgery of Regional Public Hospital of dr. Slamet of Garut Regency. There were 40 samples recruited in this study by purposive sampling, which was divided to be case group (20 patients and control group (20 patients. Data were collected using Stony Brook Scar Evaluation Scale by observation and documentation of the medical records of patients. Data were analyzed using logistic regression analysis Results: Findings indicated that there were significant relationships between the surgical wound infection (p = 0.02, family history (p = 0.026, and type of suture (p = 0.043 with the occurrence of hypertrophic scars. The most dominant factor on the occurrence of hypertrophic scars was type of suture, acid polyglactin 910. The variables that had no significant relationships with the occurrence of hypertrophic scar tissue were age (p = 0.34, area of surgical wound (p = 0.177, and smoking habit (p = 0.479. Conclusion: There were significant relationships between infection of surgical wound, genetic history, the type of suture, and the occurrence of hypertrophic scar tissue. The most dominant factor that influenced the occurrence of hypertrophic scar tissue was the type of suture. Therefore, it is suggested to health professionals to modify the using of acid polyglactin 910 sutures, and nurses particularly need to provide the information regarding the family history and genetic-related hypertrophic scar, and prevent the

  12. Can Surgeon Demographic Factors Predict Postoperative Complication Rates After Elective Spinal Fusion?

    Science.gov (United States)

    Chun, Danielle S; Cook, Ralph W; Weiner, Joseph A; Schallmo, Michael S; Barth, Kathryn A; Singh, Sameer K; Freshman, Ryan D; Patel, Alpesh A; Hsu, Wellington K

    2018-03-01

    Retrospective cohort. Determine whether surgeon demographic factors influence postoperative complication rates after elective spine fusion procedures. Surgeon demographic factors have been shown to impact decision making in the management of degenerative disease of the lumbar spine. Complication rates are frequently reported outcome measurements used to evaluate surgical treatments, quality-of-care, and determine health care reimbursements. However, there are few studies investigating the association between surgeon demographic factors and complication outcomes after elective spine fusions. A database of US spine surgeons with corresponding postoperative complications data after elective spine fusions was compiled utilizing public data provided by the Centers for Medicare and Medicaid Services (2011-2013) and ProPublica Surgeon Scorecard (2009-2013). Demographic data for each surgeon was collected and consisted of: surgical specialty (orthopedic vs. neurosurgery), years in practice, practice setting (private vs. academic), type of medical degree (MD vs. DO), medical school location (United States vs. foreign), sex, and geographic region of practice. General linear mixed models using a Beta distribution with a logit link and pairwise comparison with post hoc Tukey-Kramer were used to assess the relationship between surgeon demographics and complication rates. 2110 US-practicing spine surgeons who performed spine fusions on 125,787 Medicare patients from 2011 to 2013 met inclusion criteria for this study. None of the surgeon demographic factors analyzed were found to significantly affect overall complication rates in lumbar (posterior approach) or cervical spine fusion. Publicly available complication rates for individual spine surgeons are being utilized by hospital systems and patients to assess aptitude and gauge expectations. The increasing demand for transparency will likely lead to emphasis of these statistics to improve outcomes. We conclude that none of the

  13. Does smoking have an influence on postoperative nausea and ...

    African Journals Online (AJOL)

    Background Smoking is considered a risk factor not only for anaesthesia, but for general health. On the other hand, it was demonstrated that smoking reduces postoperative nausea and vomiting. In our study, we have investigated this effect in patients undergoing laparoscopic cholecystectomy. Moreover, we have looked to ...

  14. Clinical factors associated with postoperative hydronephrosis after ureteroscopic lithotripsy

    Directory of Open Access Journals (Sweden)

    Sun Woo Kim

    2016-09-01

    Full Text Available Purpose: This study aimed to determine the predictors of ipsilateral hydronephrosis after ureteroscopic lithotripsy for ureteral calculi. Materials and Methods: From January 2010 to December 2014, a total of 204 patients with ureteral calculi who underwent ureteroscopic lithotripsy were reviewed. Patients with lack of clinical data, presence of ureteral rupture, and who underwent simultaneous percutaneous nephrolithotomy (PNL were excluded. Postoperative hydronephrosis was determined via computed tomographic scan or renal ultrasonography, at 6 months after ureteroscopic lithotripsy. Multivariable analysis was performed to determine clinical factors associated with ipsilateral hydronephrosis. Results: A total of 137 patients were enrolled in this study. The mean age of the patients was 58.8±14.2 years and the mean stone size was 10.0±4.6 mm. The stone-free rate was 85.4%. Overall, 44 of the 137 patients (32.1% had postoperative hydronephrosis. Significant differences between the hydronephrosis and nonhydronephrosis groups were noted in terms of stone location, preoperative hydronephrosis, impacted stone, operation time, and ureteral stent duration (all, p<0.05. On multivariable analysis, increasing preoperative diameter of the hydronephrotic kidney (adjusted odds ratio [OR], 1.21; 95% confidence interval [CI], 1.12–1.31; p=0.001 and impacted stone (adjusted OR, 3.01; 95% CI, 1.15–7.61; p=0.031 independently predicted the occurrence of postoperative hydronpehrosis. Conclusions: Large preoperative diameter of the hydronephrotic kidney and presence of impacted stones were associated with hydronephrosis after ureteroscopic stone removal. Therefore, patients with these predictive factors undergo more intensive imaging follow-up in order to prevent renal deterioration due to postoperative hydronephrosis.

  15. Influence factors of visual quality after phacoemulsification for cataract

    Directory of Open Access Journals (Sweden)

    Zhen-Lin Lin

    2017-12-01

    Full Text Available Cataract refers to the degenerative changes in lens quality caused by various causes of reduced transparency or color change. Surgical treatment is the main treatment modality at present. Among them, phacoemulsification has become the main surgical treatment for cataract because of its advantages such as short operation time, small incision and quicker healing. Today, cataract surgery has gradually shift to refractive surgery, and is no longer simply as cataract surgery. But after cataract phacoemulsification, the symptoms and visual quality are different. The main causes include refractive error, postoperative dry eyes and postoperative corneal astigmatism. This article reviews the factors that influence the visual quality of cataract phacoemulsification and its future trends.

  16. Postoperative nausea and vomiting: incidence, characteristics and risk factors--a prospective cohort study.

    Science.gov (United States)

    Moreno, C; Veiga, D; Pereira, H; Martinho, C; Abelha, F

    2013-05-01

    Postoperative nausea and vomiting are a common complication after surgery. The objective of the study was to identify risk factors, and to determine the incidence of postoperative nausea and vomiting in a cohort of patients in a tertiary university hospital. Prospective cohort study was conducted in a Post Anesthetic Care Unit during a period of 3 weeks. One hundred and fifty-seven adult patients subjected to scheduled non-cardiac and non-intracranial surgery were eligible for the study. Patient perioperative characteristics data were analyzed. The postoperative nausea and vomiting intensity scale and nausea visual analog scale were applied to measure postoperative nausea and vomiting at 6h and 24h after surgery. Descriptive analysis was performed and the Mann-Whitney U, Fisher's exact, or Chi-square tests were applied. A univariate and multivariate logistic binary regressions with calculation of odds ratio (OR) and its 95% confidence interval (95% CI) were performed. Thirty-nine (25%) patients and 54 (34%) patients had postoperative nausea and vomiting at 6h and 24h, respectively. Of the patients who experienced postoperative nausea and vomiting, 6 (15%) had clinically significant postoperative nausea and vomiting (postoperative nausea and vomiting intensity scale>50) at 6h and 9 (23%) at 24h. The majority of patients classified nausea as mild at 6h (57%) and 24h (56%). At 6h, 3 (10%) patients classified nausea as severe, and at 24h 5 (9%) patients reported the same. The median and interquartile ranges for nausea visual analog scale were 40 (20-60) at 6h and 50 (20-60) at 24h. Six patients (14%) at 6h, and 7 (18%) at 24h had a nausea visual analog scale score>75. Patients with postoperative nausea and vomiting intensity scale>50 had higher scores in the nausea visual analog scale at 6h (75 versus 30, P2 (OR 3.2, 95% CI 1.6-6.4, P=.001), previous history of postoperative nausea and vomiting (OR 2.9 95% CI 1.3-6.5, P=.009) and female patients (OR 2.7, 95% CI 1

  17. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study.

    Science.gov (United States)

    Koorevaar, Rinco C T; Van't Riet, Esther; Ipskamp, Marcel; Bulstra, Sjoerd K

    2017-03-01

    Frozen shoulder is a potential complication after shoulder surgery. It is a clinical condition that is often associated with marked disability and can have a profound effect on the patient's quality of life. The incidence, etiology, pathology and prognostic factors of postoperative frozen shoulder after shoulder surgery are not known. The purpose of this explorative study was to determine the incidence of postoperative frozen shoulder after various operative shoulder procedures. A second aim was to identify prognostic factors for postoperative frozen shoulder after shoulder surgery. 505 consecutive patients undergoing elective shoulder surgery were included in this prospective cohort study. Follow-up was 6 months after surgery. A prediction model was developed to identify prognostic factors for postoperative frozen shoulder after shoulder surgery using the TRIPOD guidelines. We nominated five potential predictors: gender, diabetes mellitus, type of physiotherapy, arthroscopic surgery and DASH score. Frozen shoulder was identified in 11% of the patients after shoulder surgery and was more common in females (15%) than in males (8%). Frozen shoulder was encountered after all types of operative procedures. A prediction model based on four variables (diabetes mellitus, specialized shoulder physiotherapy, arthroscopic surgery and DASH score) discriminated reasonably well with an AUC of 0.712. Postoperative frozen shoulder is a serious complication after shoulder surgery, with an incidence of 11%. Four prognostic factors were identified for postoperative frozen shoulder: diabetes mellitus, arthroscopic surgery, specialized shoulder physiotherapy and DASH score. The combination of these four variables provided a prediction rule for postoperative frozen shoulder with reasonable fit. Level II, prospective cohort study.

  18. Psychological stress as a risk factor for postoperative keloid recurrence.

    Science.gov (United States)

    Furtado, Fabianne; Hochman, Bernardo; Farber, Paulo Luiz; Muller, Marisa Campio; Hayashi, Lilian Fukusima; Ferreira, Lydia Masako

    2012-04-01

    To investigate psychological stress on the prognosis of the postoperative recurrence of keloids. Patients with keloids (n=25), candidates for surgical resection and postoperative radiotherapy, had their psychological stress evaluated on the day before the surgical procedure. The parameters evaluated were pain and itching (Visual Numerical Scale), quality of life (Questionnaire QualiFibro/Cirurgia Plástica-UNIFESP), perceived stress (Perceived Stress Scale), depression and anxiety (Hospital Depression and Anxiety Scale), salivary cortisol and minimum and maximum galvanic skin responses (GSR) at rest and under stress (i.e., while the questionnaires were being filled out). Patients were evaluated during the 3rd, 6th, 9th and 12th months of postoperative care. During each return visit, two experts classified the lesions as non-recurrent and recurrent. The recurrence group presented the greatest values in GSR during a stressful situation. The chance of recurrence increased by 34% at each increase of 1000 arbitrary units in maximum GSR during stress. Psychological stress influenced the recurrence of keloids. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Risk factors for postoperative complications following oral surgery.

    Science.gov (United States)

    Shigeishi, Hideo; Ohta, Kouji; Takechi, Masaaki

    2015-01-01

    The objective of this study was to clarify significant risk factors for postoperative complications in the oral cavity in patients who underwent oral surgery, excluding those with oral cancer. This study reviewed the records of 324 patients who underwent mildly to moderately invasive oral surgery (e.g., impacted tooth extraction, cyst excision, fixation of mandibular and maxillary fractures, osteotomy, resection of a benign tumor, sinus lifting, bone grafting, removal of a sialolith, among others) under general anesthesia or intravenous sedation from 2012 to 2014 at the Department of Oral and Maxillofacial Reconstructive Surgery, Hiroshima University Hospital. Univariate analysis showed a statistical relationship between postoperative complications (i.e., surgical site infection, anastomotic leak) and diabetes (p=0.033), preoperative serum albumin level (p=0.009), and operation duration (p=0.0093). Furthermore, preoperative serum albumin level (oral cavity following oral surgery.

  20. Clinical Factors and Postoperative Impact of Bile Leak After Liver Resection.

    Science.gov (United States)

    Martin, Allison N; Narayanan, Sowmya; Turrentine, Florence E; Bauer, Todd W; Adams, Reid B; Stukenborg, George J; Zaydfudim, Victor M

    2018-04-01

    Despite technical advances, bile leak remains a significant complication after hepatectomy. The current study uses a targeted multi-institutional dataset to characterize perioperative factors that are associated with bile leakage after hepatectomy to better understand the impact of bile leak on morbidity and mortality. Adult patients in the 2014-2015 ACS NSQIP targeted hepatectomy dataset were linked to the ACS NSQIP PUF dataset. Bivariable and multivariable regression analyses were used to assess the associations between clinical factors and post-hepatectomy bile leak. Of 6859 patients, 530 (7.7%) had a postoperative bile leak. Proportion of bile leaks was significantly greater in patients after major compared to minor hepatectomy (12.6 vs. 5.1%, p leak was significantly greater in patients after major hepatectomy who had concomitant enterohepatic reconstruction (31.8 vs. 10.1%, p leaks (6.0 vs. 1.7%, p leak was independently associated with increased risk of postoperative morbidity (OR = 4.55; 95% CI 3.72-5.56; p leak was not independently associated with increased risk of postoperative mortality (p = 0.262). Major hepatectomy and enterohepatic biliary reconstruction are associated with significantly greater rates of bile leak after liver resection. Bile leak is independently associated with significant postoperative morbidity. Mitigation of bile leak is critical in reducing morbidity and mortality after liver resection.

  1. [Influencing factors of reproduction status of patients undergoing laparoscopic myomectomy].

    Science.gov (United States)

    Song, Guang-hui; Zhang, Song-ying; Li, Bai-jia; Wei, Wei; Huang, Dong; Lin, Xiao-na; Lou, Hong-ying

    2013-09-17

    To explore the influencing factors of reproduction status in women undergoing laparoscopic myomectomy (LM). A total of 278 LM patients were recruited.We retrospectively reviewed the reproduction status of 87 pregnant cases after LM. The correlations of their pregnancy outcomes and such clinical profiles as age, operative techniques, biological characteristics of fibroids (number, type, size and location) were analyzed.No uterine rupture occurred during the gestation period. None of them switched to open surgery due to laparoscopic difficulties. However, one patient had a laparoscopic suture for secondary bleeding of uterine incision. At 3 months post-operation, sonography showed no heterogeneous echo, effusion and hematoma in uterine incision.Incision through uterine cavity occurred intraoperatively in 8 cases, but no intrauterine adhesion was found on hysteroscopy 3 months later. And 87 women became pregnant and the postoperative fertilization time was from 2 months to 5 years. Age influenced the postoperative pregnancy rate.Other factors such as location, number and size of fibroid had no impact on fertility. For achieving a high conception rate and guaranteeing the safety of pregnant women, a clinician should select reasonable surgical approaches, perform accurate anatomical restoration, apply strict hemostasis and choose a right time of conception.

  2. Prevalence and risk factors for postoperative delirium in total joint arthroplasty patients: A prospective study.

    Science.gov (United States)

    Chen, Wenliang; Ke, Xiurong; Wang, Xiaoqing; Sun, Xiaoliang; Wang, Juncheng; Yang, Guojing; Xia, Haijie; Zhang, Lei

    2017-05-01

    The aim of this prospective study was to investigate the incidence and clinical features of delirium after total joint arthroplasty, and to establish the potential risk factors for postoperative delirium. A total of 212 consecutive patients undergoing hip or knee arthroplasty, who met the inclusion and exclusive criteria were enrolled. The general characteristics, preoperative and postoperative hematological variables were documented respectively. According to the presence of delirium, all patients were divided into the delirium group and non-delirium group. Univariate and multivariate logistic regression were performed to identify the possible predictors for postoperative delirium. At a minimum of 6months of follow-up, 35 patients were observed with postoperative delirium at an estimated total incidence of 16.5%. The incidence of delirium was statistically higher in hip arthroplasty (22.8%) than that in knee arthroplasty (7.1%). The multivariate regression analysis identified older age (OR=1.590, P=0.023), a history of stroke (OR=190.23, P=0.036), preoperative PaO 2 (OR=1.277, P=0.018) and equivalent fentanyl dose (OR=1.010, P=0.012) as the predictive factors for postoperative delirium after total joint arthroplasty. The incidence of postoperative delirium after total joint arthroplasty is higher than expected. Based on our findings, we suggest that the surgeons should focus on those patients who have these risk factors and ensure the appropriate management to avoid postoperative delirium. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Effects of living environment on the postoperative Scoliosis Research Society-24 results in females with adolescent idiopathic scoliosis

    OpenAIRE

    Misterska, Ewa; G?owacki, Maciej; Panek, S?awomir; Igny?-O?Byrne, Anna; G?owacki, Jakub; Igny?, Iwona; Krauss, Hanna; Pi?tek, Jacek

    2012-01-01

    Summary Background There are many factors influencing postoperative health-related quality of life of adolescent idiopathic scoliosis patients, including the degree of the deformity, culture, differences in geography, rural versus urban living environments, and social factors. The objective of this study was to analyze the significance of geographic factors and their differences influencing the postoperative quality of life in females with adolescent idiopathic scoliosis residing in urban and...

  4. Risk Factors for the Postoperative Recurrence of Instability After Arthroscopic Bankart Repair in Athletes

    OpenAIRE

    Nakagawa, Shigeto; Mae, Tatsuo; Sato, Seira; Okimura, Shinichiro; Kuroda, Miki

    2017-01-01

    Background: Several risk factors for the postoperative recurrence of instability after arthroscopic Bankart repair have been reported, but there have been few detailed investigations of the specific risk factors in relation to the type of sport. Purpose: This study investigated the postoperative recurrence of instability after arthroscopic Bankart repair without additional reinforcement procedures in competitive athletes, including athletes with a large glenoid defect. The purpose of this stu...

  5. Preoperative physical therapy treatment did not influence postoperative pain and disability outcomes in patients undergoing shoulder arthroscopy: a prospective study

    Directory of Open Access Journals (Sweden)

    Valencia C

    2016-07-01

    contrast, age, pain intensity, disability, and pain-associated psychological factors did not differ between pre-op PT treatment groups (P>0.05. Subacromial bursectomies were more commonly performed in patients having pre-op PT treatment (P<0.05. Pre-op PT treatment did not influence length of post-op PT treatment and did not affect 3-month and 6-month pain intensity and disability outcomes. Differences in distribution of pre-op PT for males and females and subacromial bursectomy did not influence 3-month or 6-month postsurgical outcomes. Conclusion: Receiving pre-op PT treatment did not influence post-op PT treatment or pain and disability outcomes at 3 months and 6 months. This prospective cohort study provides no evidence of benefit for pre-op PT on post-op PT treatment or postsurgical outcomes. Females or patients receiving certain surgical procedures are more likely to undergo pre-op PT treatment. However, these differences did not influence postoperative outcomes in this cohort. Keywords: preoperative physical therapy, postoperative pain, postoperative disability, shoulder arthroscopy

  6. Risk factors for postoperative urinary tract infection following midurethral sling procedures.

    Science.gov (United States)

    Doganay, Melike; Cavkaytar, Sabri; Kokanali, Mahmut Kuntay; Ozer, Irfan; Aksakal, Orhan Seyfi; Erkaya, Salim

    2017-04-01

    To identify the potential risk factors for urinary tract infections following midurethral sling procedures. 556 women who underwent midurethral sling procedure due to stress urinary incontinence over a four-year period were reviewed in this retrospective study. Of the study population, 280 women underwent TVT procedures and 276 women underwent TOT procedures. Patients were evaluated at 4-8 weeks postoperatively and were investigated for the occurrence of a urinary tract infection. Patients who experienced urinary tract infection were defined as cases, and patients who didn't were defined as controls. All data were collected from medical records. Multivariate logistic regression model was used to identify the risk factors for urinary tract infection. Of 556 women, 58 (10.4%) were defined as cases while 498 (89.6%) were controls. The mean age of women in cases (57.8±12.9years) was significantly greater than in controls (51.8±11.2years) (purinary tract infection, concomitant vaginal hysterectomy and cystocele repair, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml were more common in cases than in controls. However, in multivariate regression analysis model presence of preoperative urinary tract infection [OR (95% CI)=0.1 (0.1-0.7); p=0.013], TVT procedure [OR (95% CI)=8.4 (3.1-22.3); p=0.000] and postoperative postvoiding residual bladder volume ≥100ml [OR (95% CI)=4.6 (1.1-19.2); p=0.036] were significant independent risk factors for urinary tract infection following midurethral slings CONCLUSION: Urinary tract infection after midurethral sling procedures is a relatively common complication. The presence of preoperative urinary tract infection, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml may increase the risk of this complication. Identification of these factors could help surgeons to minimize this complicationby developing effective strategies. Copyright © 2017. Published by Elsevier B.V.

  7. Study on the related factors influencing the formation of intra-aneurysmal thrombosis in the established side-wall aneurysmal model in canine

    International Nuclear Information System (INIS)

    Zhou Bing; Li Minghua; Wang Jianbo; Zhu Yueqi; Yuan Jianhua; Yu Wenqiang

    2011-01-01

    Objective: To analyze the related factors influencing the formation of intra-aneurysmal thrombosis (IAT) in the established side-wall aneurysmal model in canine, and to discuss the measures to prevent the occurrence of IAT. Methods: Twenty canines were randomly divided into 4 groups for building side-wall aneurysmal model: group A, vertical aneurysm without use of postoperative anticoagulation medication; group B, vertical aneurysm with use of postoperative anticoagulation medication; group C, oblique aneurysm without use of postoperative anticoagulation medication; and group D, oblique aneurysm with use of postoperative anticoagulation medication. Angiography was performed to evaluate the IAT. The potential related factors influencing the formation of IAT, including sex, age, operative time, aneurysmal morphology, postoperative anticoagulation medication and cervical hematoma, were statistically analysed with emphasis on aneurysmal morphology and the use of postoperative anticoagulation medication. The statistical software SPSS 12.0 was employed. Results: A total of 40 aneurysms were successfully established in 20 canines. Cervical hematoma occurred in 7 canines and IAT developed in 8 aneurysms. The univariate analysis showed that the formation of IAT was significantly influenced by the aneurysmal morphology and cervical hematoma. Surprisingly, the formation of IAT bore no relation to the postoperative anticoagulation, whether the medication was employed or not, which was further confirmed by stratified analysis. Conclusion: To establish oblique aneurysm and to reduce the occurrence of cervical hematoma can effectively decrease the incidence of IAT in established side-wall aneurysmal model in canine. The postoperative anticoagulation medication can not decrease the incidence of IAT. (authors)

  8. Radiographic sarcopenia predicts postoperative infectious complications in patients undergoing pancreaticoduodenectomy.

    Science.gov (United States)

    Takagi, Kosei; Yoshida, Ryuichi; Yagi, Takahito; Umeda, Yuzo; Nobuoka, Daisuke; Kuise, Takashi; Fujiwara, Toshiyoshi

    2017-05-26

    Recently, skeletal muscle depletion (sarcopenia) has been reported to influence postoperative outcomes after certain procedures. This study investigated the impact of sarcopenia on postoperative outcomes following pancreaticoduodenectomy (PD). We performed a retrospective study of consecutive patients (n = 219) who underwent PD at our institution between January 2007 and May 2013. Sarcopenia was evaluated using preoperative computed tomography. We evaluated postoperative outcomes and the influence of sarcopenia on short-term outcomes, especially infectious complications. Subsequently, multivariate analysis was used to assess the impact of prognostic factors (including sarcopenia) on postoperative infections. The mortality, major complication, and infectious complication rates for all patients were 1.4%, 16.4%, and 47.0%, respectively. Fifty-five patients met the criteria for sarcopenia. Sarcopenia was significantly associated with a higher incidence of in-hospital mortality (P = 0.004) and infectious complications (P sarcopenia (odds ratio = 3.43; P Sarcopenia is an independent preoperative predictor of infectious complications after PD. Clinical assessment combined with sarcopenia may be helpful for understanding the risk of postoperative outcomes and determining perioperative management strategies.

  9. Postoperative cognitive dysfunction : Involvement of neuroinflammation and neuronal functioning

    NARCIS (Netherlands)

    Hovens, Iris B.; Schoemaker, Regien G.; van der Zee, Eddy A.; Absalom, Anthony R.; Heineman, Erik; van Leeuwen, Barbara L.

    Postoperative cognitive dysfunction (POCD) has been hypothesized to be mediated by surgery-induced inflammatory processes, which may influence neuronal functioning either directly or through modulation of intraneuronal pathways, such as the brain derived neurotrophic factor (BDNF) mediated pathway.

  10. Classical prognostic factors in patients with non-advanced endometrial cancer treated with postoperative radiotherapy

    International Nuclear Information System (INIS)

    Karolewski, K.; Kojs, Z.; Jakubowicz, J.; Urbanski, K.; Michalak, A.

    2006-01-01

    Aim: Analysis of classical prognostic factors in patients with non-advanced endometrial cancer treated with postoperative radiotherapy. Materials/Methods: In the years 1985 - 1999, 705 patients underwent postoperative radiotherapy due to endometrial cancer: 529 patients with FIGO stage I and 176 with FIGO stage II cancer. Mean age was 58 years. In 96% of patients endometrioid adenocarcinoma was found. In 49.9% the cancer had a high, in 27.9% a medium, and in 22.2% a low degree of differentiation. Results: 82% of patients had 5-year disease-free survival. In univariate analysis a significantly higher rate of disease-free survival was observed in: patients younger than 60, with moderately and well differentiated cancers, with stage I endometrioid adenocarcinoma with less than 50% myometrial invasion. In multivariate analysis degree of cancer differentiation was the only independent prognostic factor. Conclusions: In a group of patients with non-advanced endometrial cancer treated with postoperative radiotherapy, degree of cancer differentiation is the primary prognostic factor. (authors)

  11. Clinical efficacy analysis of Ahmed glaucoma valve implantation in neovascular glaucoma and influencing factors

    Science.gov (United States)

    He, Ye; Tian, Ying; Song, Weitao; Su, Ting; Jiang, Haibo; Xia, Xiaobo

    2017-01-01

    Abstract This study aimed to evaluate the efficacy of Ahmed glaucoma valve (AGV) implantation in treating neovascular glaucoma (NVG) and to analyze the factors influencing the surgical success rate. This is a retrospective review of 40 eyes of 40 NVG patients who underwent AGV implantation at Xiangya Hospital of Central South University, China, between January 2014 and December 2016. Pre- and postoperative intraocular pressure (IOP), visual acuity, surgical success rate, medications, and complications were observed. Surgical success criteria were defined as IOP ≤21 and >6 mm Hg with or without additional medications. Kaplan–Meier survival curves and Multivariate cox regression analysis were used to examine success rates and risk factors for surgical outcomes. The mean follow-up period was 8.88 ± 3.12 months (range: 3–17). IOP declined at each visit postoperatively and it was statistically significant (P < .001). An average of 3.55 ± 0.86 drugs was applied preoperatively, while an average of 0.64 ± 0.90 drugs was used postoperatively, with the difference being of statistical significance (P < .05). The complete surgical success rate of 3, 6, and 12 months after the operation was 85%, 75%, and 65%, respectively. Meanwhile, the qualified success rate of 3, 6, and 12 months after the operation was 85%, 80%, and 77.5%, respectively. The multivariate cox regression analysis showed that age (hazard ratio: 3.717, 7.246; 95% confidence interval: 1.149–12.048, 1.349–38.461; P = .028, .021) was influencing factors for complete success rate and qualified success rate among all NVG patients. Gender, previous operation history, primary disease, and preoperative IOP were found to be not significant. AGV implantation is an effective and safe surgical method to treat NVG. Age is an important factor influencing the surgical success rate. PMID:29049253

  12. Thromboembolic prophylaxis as a risk factor for postoperative complications after breast cancer surgery

    DEFF Research Database (Denmark)

    Friis, Esbern; Hørby, John; Sørensen, Lars Tue

    2004-01-01

    Hematoma and bruising (sugillation) are frequent problems after operations for primary breast cancer. In the present study we evaluated the influence of various methods of perioperative thromboembolic prophylaxis on the postoperative incidence of hematoma and suggilation. From June 1994 through A...

  13. Management of Postoperative Respiratory Failure.

    Science.gov (United States)

    Mulligan, Michael S; Berfield, Kathleen S; Abbaszadeh, Ryan V

    2015-11-01

    Despite best efforts, postoperative complications such as postoperative respiratory failure may occur and prompt recognition of the process and management is required. Postoperative respiratory failure, such as postoperative pneumonia, postpneumonectomy pulmonary edema, acute respiratory distress-like syndromes, and pulmonary embolism, are associated with high morbidity and mortality. The causes of these complications are multifactorial and depend on preoperative, intraoperative, and postoperative factors, some of which are modifiable. The article identifies some of the risk factors, causes, and treatment strategies for successful management of the patient with postoperative respiratory failure. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Postoperative Paralysis From Thoracic Ossification of Posterior Longitudinal Ligament Surgery Risk Factor of Neurologic Injury: Nationwide Multiinstitution Survey.

    Science.gov (United States)

    Ito, Zenya; Matsuyama, Yukihiro; Ando, Muneharu; Kawabata, Shigenori; Kanchiku, Tsukasa; Kida, Kazunobu; Fujiwara, Yasushi; Yamada, Kei; Yamamoto, Naoya; Kobayashi, Sho; Saito, Takanori; Wada, Kanichiro; Tadokoro, Nobuaki; Takahashi, Masato; Satomi, Kazuhiko; Shinomiya, Kenichi; Tani, Toshikazu

    2016-10-01

    Retrospective case-control study. The purpose of this study was to examine the factors of postoperative paralysis in patients who have undergone thoracic ossification of posterior longitudinal ligament (OPLL) surgery. A higher percentage of thoracic OPLL patients experience postoperative aggravation of paralysis than cervical OPLL patients, including patients that presented great difficulties in treatment. However, there were a few reports to prevent paralysis thoracic OPLL. The 156 patients who had received thoracic OPLL surgery were selected as the subjects of this study. The items for review were the duration of disease; the preoperative muscle strength (Muscle Manual Testing); OPLL levels (T1/2-4/5: high, T5/6-8/9: middle, and T9/10-11/12: low); the spinal canal occupancy ratio; the ratio of yellow ligament ossification as a complication; the ratio of transcranial-motor evoked potential (Tc-MEP) derivation; the preoperative/postoperative kyphotic angles in the thoracic vertebrae; the correction angle of kyphosis; the duration of surgery; and the amount of bleeding. The subjects were divided into two groups based on the absence or presence of postoperative paralysis to determine the factors of postoperative paralysis. Twenty-three patients (14.7%) exhibited postoperative paralysis. Multivariate analysis identified factors associated with postoperative paralysis: the duration of disease (odds ratio, OR = 3.3); the correction angle of kyphosis (OR = 2.4); and the ratio of Tc-MEP derivation (OR = 2.2). The risk factors of postoperative paralysis are a short duration of disease and a small correction angle of kyphosis. In addition, ratios of Tc-MEP derivation below 50% may anticipate paralysis. 4.

  15. Risk factors for development of postoperative cerebellar mutism syndrome in children after medulloblastoma surgery.

    Science.gov (United States)

    Pols, San Y C V; van Veelen, Marie Lise C; Aarsen, Femke K; Gonzalez Candel, Antonia; Catsman-Berrevoets, Coriene E

    2017-07-01

    OBJECTIVE Postoperative cerebellar mutism syndrome (pCMS) occurs in 7%-50% of children after cerebellar tumor surgery. Typical features include a latent onset of 1-2 days after surgery, transient mutism, emotional lability, and a wide variety of motor and neurobehavioral abnormalities. Sequelae of this syndrome usually persist long term. The principal causal factor is bilateral surgical damage (regardless of tumor location) to any component of the proximal efferent cerebellar pathway, which leads to temporary dysfunction of cerebral cortical regions as a result of diaschisis. Tumor type, cerebellar midline location, and brainstem involvement are risk factors for pCMS that have been identified repeatedly, but they do not explain its latent onset. Ambiguous or negative results for other factors, such as hydrocephalus, postoperative meningitis, length of vermian incision, and tumor size, have been reached. The aim of this study was to identify perioperative clinical, radiological, and laboratory factors that also increase risk for the development of pCMS. The focus was on factors that might explain the delayed onset of pCMS and thus might provide a time window for taking precautionary measures to prevent pCMS or reduce its severity. The study was focused specifically on children who had undergone surgery for medulloblastoma. METHODS In this single-center retrospective cohort study, the authors included 71 children with medulloblastoma, 28 of whom developed pCMS after primary resection. Clinical and laboratory data were collected prospectively and analyzed systematically. Variables were included for univariate and multivariate analysis. RESULTS Univariate regression analysis revealed 7 variables that had a significant influence on pCMS onset, namely, tumor size, maximum tumor diameter > 5 cm, tumor infiltration or compression of the brainstem, significantly larger decreases in hemoglobin (p = 0.010) and hematocrit (p = 0.003) in the pCMS group after surgery than in the

  16. Risk factors for postoperative complications after total laryngectomy following radiotherapy or chemoradiation

    DEFF Research Database (Denmark)

    Wulff, N B; Kristensen, C.A.; Andersen, E

    2015-01-01

    OBJECTIVES: To determine the rates of and risk factors for postoperative complications following total laryngectomy in patients treated with radiotherapy or chemoradiation. DESIGN: Retrospective longitudinal study. SETTING: Tertiary medical centres. PARTICIPANTS: A total of 143 patients undergoin...

  17. Influence of intravenous opioid dose on postoperative ileus.

    Science.gov (United States)

    Barletta, Jeffrey F; Asgeirsson, Theodor; Senagore, Anthony J

    2011-07-01

    Intravenous opioids represent a major component in the pathophysiology of postoperative ileus (POI). However, the most appropriate measure and threshold to quantify the association between opioid dose (eg, average daily, cumulative, maximum daily) and POI remains unknown. To evaluate the relationship between opioid dose, POI, and length of stay (LOS) and identify the opioid measure that was most strongly associated with POI. Consecutive patients admitted to a community teaching hospital who underwent elective colorectal surgery by any technique with an enhanced-recovery protocol postoperatively were retrospectively identified. Patients were excluded if they received epidural analgesia, developed a major intraabdominal complication or medical complication, or had a prolonged workup prior to surgery. Intravenous opioid doses were quantified and converted to hydromorphone equivalents. Classification and regression tree (CART) analysis was used to determine the dosing threshold for the opioid measure most associated with POI and define high versus low use of opioids. Risk factors for POI and prolonged LOS were determined through multivariate analysis. The incidence of POI in 279 patients was 8.6%. CART analysis identified a maximum daily intravenous hydromorphone dose of 2 mg or more as the opioid measure most associated with POI. Multivariate analysis revealed maximum daily hydromorphone dose of 2 mg or more (p = 0.034), open surgical technique (p = 0.045), and days of intravenous narcotic therapy (p = 0.003) as significant risk factors for POI. Variables associated with increased LOS were POI (p POI and prolonged LOS, particularly when the maximum hydromorphone dose per day exceeds 2 mg. Clinicians should consider alternative, nonopioid-based pain management options when this occurs.

  18. Preoperative factors influencing success in pterygium surgery.

    Science.gov (United States)

    Torres-Gimeno, Ana; Martínez-Costa, Lucía; Ayala, Guillermo

    2012-08-08

    To identify preoperative, perioperative and postoperative risk factors that influence the success of pterygium surgery. This is a prospective study of thirty-six patients with primary or recurrent pterygia. A detailed anamnesis and an ophthalmological examination were performed looking for the following factors: age, race, latitude and altitude of the main place of residence, hours of exposure to the sun, use of protective measures against UV-radiation, classification of pterygium, width of the pterygium at limbus, surgical technique (conjunctival autograft plus suturing versus tissue glue), graft alterations (misapposition, granuloma, haemorrhage, oedema, retraction or necrosis), and postoperative symptoms (foreign-body sensation, pain). The examinations were performed 2 and 7 days and 2, 6 and 12 months after surgery. In addition, recurrence was defined as any growth of conjunctiva into the cornea. A logistic regression and a survival analysis have been used to perform data analysis. A total number of 36 patients completed a one year follow-up. A total of 13 patients were born and lived in Spain, and 26 came from other countries, mostly Latin America. A total number of 8 males (no women) presented a recurrence, mainly between 2 and 6 months. The hours of sun exposure through their life was independently related to surgical success. Pterygia of less than 5 mm of base width showed a weak positive correlation with recurrence. None of the other factors considered were significantly related to recurrence. Male gender and high sun exposure are strongly and independently related to surgical success after the removal of pterygia.

  19. Preoperative factors influencing success in pterygium surgery

    Directory of Open Access Journals (Sweden)

    Torres-Gimeno Ana

    2012-08-01

    Full Text Available Abstract Background To identify preoperative, perioperative and postoperative risk factors that influence the success of pterygium surgery. Methods This is a prospective study of thirty-six patients with primary or recurrent pterygia. A detailed anamnesis and an ophthalmological examination were performed looking for the following factors: age, race, latitude and altitude of the main place of residence, hours of exposure to the sun, use of protective measures against UV-radiation, classification of pterygium, width of the pterygium at limbus, surgical technique (conjunctival autograft plus suturing versus tissue glue, graft alterations (misapposition, granuloma, haemorrhage, oedema, retraction or necrosis, and postoperative symptoms (foreign-body sensation, pain. The examinations were performed 2 and 7 days and 2, 6 and 12 months after surgery. In addition, recurrence was defined as any growth of conjunctiva into the cornea. Results A logistic regression and a survival analysis have been used to perform data analysis. A total number of 36 patients completed a one year follow-up. A total of 13 patients were born and lived in Spain, and 26 came from other countries, mostly Latin America. A total number of 8 males (no women presented a recurrence, mainly between 2 and 6 months. The hours of sun exposure through their life was independently related to surgical success. Pterygia of less than 5 mm of base width showed a weak positive correlation with recurrence. None of the other factors considered were significantly related to recurrence. Conclusions Male gender and high sun exposure are strongly and independently related to surgical success after the removal of pterygia.

  20. Postoperative persistent chronic pain: what do we know about prevention, risk factors, and treatment

    Directory of Open Access Journals (Sweden)

    Durval Campos Kraychete

    Full Text Available Abstract Background and objectives: Postoperative persistent chronic pain (POCP is a serious health problem, disabling, undermining the quality of life of affected patients. Although more studies and research have addressed the possible mechanisms of the evolution from acute pain to chronic postoperatively, there are still no consistent data about the risk factors and prevention. This article aims to bring what is in the panorama of the current literature available. Content: This review describes the definition, risk factors, and mechanisms of POCD, its prevention and treatment. The main drugs and techniques are exposed comprehensively. Conclusion: Postoperative persistent chronic pain is a complex and still unclear etiology entity, which interferes heavily in the life of the subject. Neuropathic pain resulting from surgical trauma is still the most common expression of this entity. Techniques to prevent nerve injury are recommended and should be used whenever possible. Despite efforts to understand and select risk patients, the management and prevention of this syndrome remain challenging and inappropriate.

  1. [Postoperative cognitive deficits].

    Science.gov (United States)

    Kalezić, Nevena; Dimitrijević, Ivan; Leposavić, Ljubica; Kocica, Mladen; Bumbasirević, Vesna; Vucetić, Cedomir; Paunović, Ivan; Slavković, Nemanja; Filimonović, Jelena

    2006-01-01

    Cognitive dysfunctions are relatively common in postoperative and critically ill patients. This complication not only compromises recovery after surgery, but, if persistent, it minimizes and compromises surgery itself. Risk factors of postoperative cognitive disorders can be divided into age and comorbidity dependent, and those related to anesthesia and surgery. Cardiovascular, orthopedic and urologic surgery carries high risk of postoperative cognitive dysfunction. It can also occur in other types of surgical treatment, especially in elderly. Among risk factors of cognitive disorders, associated with comorbidity, underlying psychiatric and neurological disorders, substance abuse and conditions with elevation of intracranial pressure are in the first place in postoperative patients. Preoperative and perioperative predisposing conditions for cognitive dysfunction and their incidence were described in our paper. These are: geriatric patients, patients with substance abuse, preexisting psychiatric or cognitive disorders, neurologic disease with high intracranial pressure, cerebrovascular insufficiency, epilepsia, preeclampsia, acute intermittent porphyria, operation type, brain hypoxia, changes in blood glucose level, electrolyte imbalance, anesthetic agents, adjuvant medication and intraoperative awareness. For each of these factors, evaluation, prevention and treatment strategies were suggested, with special regard on anesthetic technique.

  2. Predictive risk factors of postoperative urinary incontinence following holmium laser enucleation of the prostate during the initial learning period

    Directory of Open Access Journals (Sweden)

    Shuichiro Kobayashi

    Full Text Available ABSTRACT Purpose: To determine the predictive factors for postoperative urinary incontinence (UI following holmium laser enucleation of the prostate (HoLEP during the initial learning period. Patients and Methods: We evaluated 127 patients with benign prostatic hyperplasia who underwent HoLEP between January 2011 and December 2013. We recorded clinical variables, including blood loss, serum prostate-specific antigen levels, and the presence or absence of UI. Blood loss was estimated as a decline in postoperative hemoglobin levels. The predictive factors for postoperative UI were determined using a multivariable logistic regression analysis. Results: Postoperative UI occurred in 31 patients (24.4%, but it cured in 29 patients (93.5% after a mean duration of 12 weeks. Enucleation time >100 min (p=0.043 and blood loss >2.5g/dL (p=0.032 were identified as significant and independent risk factors for postoperative UI. Conclusions: Longer enucleation time and increased blood loss were independent predictors of postoperative UI in patients who underwent HoLEP during the initial learning period. Surgeons in training should take care to perform speedy enucleation maneuver with hemostasis.

  3. Postoperative spine infections

    Directory of Open Access Journals (Sweden)

    Paolo Domenico Parchi

    2015-09-01

    Full Text Available Postoperative spinal wound infection is a potentially devastating complication after operative spinal procedures. Despite the utilization of perioperative prophylactic antibiotics in recent years and improvements in surgical technique and postoperative care, wound infection continues to compromise patients’ outcome after spinal surgery. In the modern era of pending health care reform with increasing financial constraints, the financial burden of post-operative spinal infections also deserves consideration. The aim of our work is to give to the reader an updated review of the latest achievements in prevention, risk factors, diagnosis, microbiology and treatment of post-operative spinal wound infections. A review of the scientific literature was carried out using electronic medical databases Pubmed, Google Scholar, Web of Science and Scopus for the years 1973-2012 to obtain access to all publications involving the incidence, risk factors, prevention, diagnosis, treatment of postoperative spinal wound infections. We initially identified 119 studies; of these 60 were selected. Despite all the measures intended to reduce the incidence of surgical site infections in spine surgery, these remain a common and potentially dangerous complication.

  4. The Influence of a New Clinical Motion for Endodontic Instruments on the Incidence of Postoperative Pain.

    Science.gov (United States)

    Gambarini, G; Di Nardo, D; Miccoli, G; Guerra, F; Di Giorgio, R; Di Giorgio, G; Glassman, G; Piasecki, L; Testarelli, L

    2017-01-01

    Previous studies showed that motor motions play an important role in determining apical extrusion of debris. Therefore a new clinical motion (MIMERACI) has been proposed. The basic idea is to progress slowly (1mm advancement), and after each 1mm, to remove the instrument from the canal, clean flutes and irrigate. The aim of the study was to prove whether the clinical use of MIMERACI technique would influence or not postoperative pain. 100 teeth requesting endodontic treatment were selected for the study and divided into two similar groups based on anatomy, pre-operative symptoms and vitality, presence or absence of periapical lesion. All teeth were shaped, cleaned and obturated by the same operator, using the same NiTi instruments. The only difference between the two groups was the instrumentation technique: tradional (group A) vs MIMERACI (group B). Assessment of postoperative pain was performed 3 days after treatment. Presence, absence and degree of pain were recorded with a visual analogue scale (VAS), validated in previous studies. Collected data statistically analyzed using one-way ANOVA post hoc Tukey test. For VAS pain scores MIMERACI technique showed significantly better results than group A (p=0,031). Overall, both incidence and intensity of symptoms were significantly lower. Flare ups occurred in 3 patients, but none treated with the MIMERACI Technique. Since extruded debris can elicit more postoperative pain, results obtained by using MIMERACI technique are probably due to many factors: better mechanical removal and less production of debris and more efficient irrigation during instrumentation.

  5. Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases.

    Science.gov (United States)

    Xu, Jieyun; Hu, Jing; Yu, Pei; Wang, Weiwang; Hu, Xingxue; Hou, Jinsong; Fang, Silian; Liu, Xiqiang

    2017-01-01

    Postoperative pneumonia (POP) is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC) surgery. Perioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later. The incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP. Several perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care.

  6. Factors Associated with Postoperative Prolonged Mechanical Ventilation in Pediatric Liver Transplant Recipients

    Directory of Open Access Journals (Sweden)

    Olubukola O. Nafiu

    2017-01-01

    Full Text Available Introduction. Almost all pediatric orthotopic liver transplant (OLT recipients require mechanical ventilation in the early postoperative period. Prolonged postoperative mechanical ventilation (PPMV may be a marker of severe disease and may be associated with morbidity and mortality. We determined the incidence and risk factors for PPMV in children who underwent OLT. Methods. This was a retrospective analysis of data collected on 128 pediatric OLT recipients. PPMV was defined as postoperative ventilation ≥ 4 days. Perioperative characteristics were compared between cases and control groups. Multivariable logistic regression analysis was used to calculate odds ratios for PPMV after controlling for relevant cofactors. Results. An estimated 25% (95% CI, 17.4%–32.6% required PPMV. The overall incidence of PPMV varied significantly by age group with the highest incidence among infants. PPMV was associated with higher postoperative mortality (p=0.004 and longer intensive care unit (p<0.001 and hospital length of stay (p<0.001. Multivariable analysis identified young patient age, preoperative hypocalcemia, and increasing duration of surgery as independent predictors of PPMV following OLT. Conclusion. The incidence of PPMV is high and it was associated with prolonged ICU and hospital LOS and higher posttransplant mortality. Surgery duration appears to be the only modifiable predictor of PPMV.

  7. Sleep Disruption at Home As an Independent Risk Factor for Postoperative Delirium.

    Science.gov (United States)

    Todd, Oliver M; Gelrich, Lisa; MacLullich, Alasdair M; Driessen, Martin; Thomas, Christine; Kreisel, Stefan H

    2017-05-01

    To determine whether sleep disruption at home or in hospital is an independent risk factor for postoperative delirium in older adults undergoing elective surgery. Prospective cohort study. German teaching hospital. Individuals aged 65 and older undergoing elective arthroplasty (N = 101). Preoperative questionnaires were used to assess sleep disruption at home (Pittsburgh Sleep Quality Index). Actigraphy was used to objectively measure sleep disruption in the hospital before and after surgery. Delirium was assessed daily after surgery using the Confusion Assessment Method and, if there was uncertainty, validated according to International Classification of Diseases, Tenth Revision (ICD-10), criteria. Twenty-seven participants developed postoperative delirium. Those with sleep disruption at home were 3.26 times as likely to develop postoperative delirium as those without (95% confidence interval (CI) = 1.34-7.92, P = .009). Participants with sleep disruption in hospital were 1.21 times as likely to develop postoperative delirium as those without (95% CI = 1.03-1.41, P = .02). When adjusting for other variables, risk remained significant for sleep disruption at home (risk ratio (RR) = 3.90, 95% CI = 2.14-7.11, P delirium than those without. Sleep disruption in the hospital may further heighten this risk. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  8. Multimodal approach to postoperative recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik

    2009-01-01

    PURPOSE OF REVIEW: To provide updated information on recent developments within individual components of multimodal interventions to improve postoperative outcome (fast-track methodology). RECENT FINDINGS: The value of the fast-track methodology to improve recovery and decrease hospital stay...... and morbidity has been firmly consolidated, especially in colorectal procedures. An increasing amount of data from other procedures supports the value of the fast-track concept across procedures. Fast-track programs should be based on the analysis of procedure-specific factors that may influence outcome...

  9. Ethnicity and parental report of postoperative behavioral changes in children.

    Science.gov (United States)

    Fortier, Michelle A; Tan, Edwin T; Mayes, Linda C; Wahi, Aditi; Rosenbaum, Abraham; Strom, Suzanne; Santistevan, Ricci; Kain, Zeev N

    2013-05-01

    To examine the role of ethnicity and language in parent report of children's postoperative behavioral recovery. To compare incidence of new onset negative behavior change in English- and Spanish-speaking White and Hispanic children following outpatient surgery. Postoperative behavioral change in children is common; however, it is unknown whether cultural variables including ethnicity and language may influence parent report of children's behavioral recovery. Participants included 288 parents (English-speaking White, English-speaking Hispanic, Spanish-speaking Hispanic parents) of children undergoing outpatient elective surgery. Parents completed the post-hospitalization behavior questionnaire (PHBQ) and parents' postoperative pain measure (PPPM) on postoperative days one, three, and seven at home. Most parents (83%) reported onset of new negative behavioral change in children postoperatively. Generalized estimating equations revealed significant group differences in overall behavior change [Wald χ(2)(12) = 375.69, P children compared to English-speaking White (ESW) parents (day 1: P children's postoperative behavioral recovery may be influenced by cultural variables, such as ethnicity and language. The present results contribute to a growing body of evidence that highlights the need for culturally sensitive assessment and care of families in the medical setting. The findings may reflect differences in cultural values such as stoicism; however, future studies would benefit from examination of the factors that may account for the differences in reported behavior change after surgery (i.e., report bias, cultural values). © 2012 Blackwell Publishing Ltd.

  10. Post-operative cognitive dysfunction in the elderly: A prospective clinical study

    Directory of Open Access Journals (Sweden)

    Nalini Kotekar

    2014-01-01

    Full Text Available Background and Aims: Aging population is a major demographic trend worldwide. Globally, 50% of all the elderly individuals are estimated to undergo atleast one surgical procedure and post-operative cognitive dysfunction (POCD is one of the most common and often poorly understood post-operative complications in this section of the population. This randomised prospective study was conducted to assess the post-operative cognitive status in the elderly undergoing non-cardiac surgery, evaluate the cognitive parameters affected, evaluate the potential risk factors and thereby analyse the potential for implementation of preventive strategies. Methods: This study was conducted on 200 patients aged 60 years or older scheduled for elective non-cardiac surgeries. The baseline cognitive status of the patients was assessed 2 days prior to the date of the surgery. The post-operative cognitive status was assessed on the 3 rd day, 7 th day and after 1 month. Statistical analysis was performed using SAS and SPSS. Results: The incidence of POCD showed a gradual decline from postoperative day 3 to 30. Females were found to be at significant risk in developing POCD. Advancing age and level of education emerged as dominant factors, while type of anaesthesia, duration of surgery, and presence of coexisting comorbidities had no influence on the incidence of cognitive dysfunction. Conclusion: POCD is a definite complication after surgery and anaesthesia in the elderly population. Gender emerged as a significant risk factor with increasing age as a dominating factor contributing to POCD.

  11. An exploration of Singaporean parental experiences in managing school-aged children's postoperative pain: a descriptive qualitative approach.

    Science.gov (United States)

    Lim, Siew Hoon; Mackey, Sandra; Liam, Joanne Li Wee; He, Hong-Gu

    2012-03-01

    To enhance understanding of the experience of parents in managing their children's postoperative pain in Singapore. Parents play a significant role in their hospitalised child's postoperative pain care. Their active involvement may contribute to accurate pain assessment and effective pain management for their child. However, there is a lack of in-depth research exploring the experience of parents involved in their children's postoperative pain management. This study adopted a descriptive qualitative approach, which is situated in the interpretive paradigm. Semi-structured interviews were conducted to collect data from 14 parents whose children were hospitalised in one of the three paediatric surgical wards in a hospital in Singapore in December 2009. Thematic analysis was used to analyse the data. Three themes were identified: 'Actions used by parents to alleviate their child's postoperative pain', 'Factors influencing parents' management of their child's postoperative pain' and 'Parents' needs in the process of caring for their child's postoperative pain'. Parents used a range of non-pharmacological pain relief interventions for their child. Parental roles and expectations, bond between parent and child, support from nurses, family and own religious beliefs, as well as children's age and maturity level were factors which promoted parental participation, whereas parents' negative feelings, knowledge deficit and nurses' busy schedule were hindering factors. Parents expressed needs for more involvement in their child's care, adequate rest and information support from nurses. This study highlights the importance of involving parents in their child's postoperative pain management. It provides evidence for health care professionals to pay attention to factors that may influence parental participation and, therefore, guide their practice. Nurses need to provide parents with support and education to facilitate their roles and improve their child's postoperative pain

  12. Significant Risk Factors for Postoperative Enlargement of Basal Ganglia Hematoma after Frameless Stereotactic Aspiration: Antiplatelet Medication and Concomitant IVH.

    Science.gov (United States)

    Son, Wonsoo; Park, Jaechan

    2017-09-01

    Frameless stereotactic aspiration of a hematoma can be the one of the treatment options for spontaneous intracerebral hemorrhage in the basal ganglia. Postoperative hematoma enlargement, however, can be a serious complication of intracranial surgery that frequently results in severe neurological deficit and even death. Therefore, it is important to identify the risk factors of postoperative hematoma growth. During a 13-year period, 101 patients underwent minimally invasive frameless stereotactic aspiration for basal ganglia hematoma. Patients were classified into two groups according to whether or not they had postoperative hematoma enlargement in a computed tomography scan. Baseline demographic data and several risk factors, such as hypertension, preoperative hematoma growth, antiplatelet medication, presence of concomitant intraventricular hemorrhage (IVH), were analysed via a univariate statistical study. Nine of 101 patients (8.9%) showed hematoma enlargement after frameless stereotactic aspiration. Among the various risk factors, concomitant IVH and antiplatelet medication were found to be significantly associated with postoperative enlargement of hematomas. In conclusion, our study revealed that aspirin use and concomitant IVH are factors associated with hematoma enlargement subsequent to frameless stereotactic aspiration for basal ganglia hematoma.

  13. Perioperative risk factors for postoperative pneumonia after major oral cancer surgery: A retrospective analysis of 331 cases.

    Directory of Open Access Journals (Sweden)

    Jieyun Xu

    Full Text Available Postoperative pneumonia (POP is common and results in prolonged hospital stays, higher costs, increased morbidity and mortality. However, data on the incidence and risk factors of POP after oral and maxillofacial surgery are rare. This study aims to identify perioperative risk factors for POP after major oral cancer (OC surgery.Perioperative data and patient records of 331 consecutive subjects were analyzed in the period of April 2014 to March 2016. We individually traced each OC patient for a period to discharge from the hospital or 45 days after surgery, whichever occur later.The incidence of POP after major OC surgery with free flap construction or major OC surgery was 11.6% or 4.5%, respectively. Patient-related risk factors for POP were male sex, T stage, N stage, clinical stage and preoperative serum albumin level. Among the investigated procedure-related variables, incision grade, mandibulectomy, free flap reconstruction, tracheotomy, intraoperative blood loss, and the length of the operation were shown to be associated with the development of POP. Postoperative hospital stay was also significantly related to increased incidence of POP. Using a multivariable logistic regression model, we identified male sex, preoperative serum albumin level, operation time and postoperative hospital stay as independent risk factors for POP.Several perioperative risk factors can be identified that are associated with POP. At-risk oral cancer patients should be subjected to intensified postoperative pulmonary care.

  14. Is peri-operative cortisol secretion related to post-operative cognitive dysfunction?

    NARCIS (Netherlands)

    Rasmussen, L.S.; O'Brien, J.T.; Silverstein, J.H.; Johnson, T.; Siersma, V.D.; Canet, J.; Jolles, J.; Hanning, C.D.; Kuipers, H.M.; Abildstrom, H.; Papaioannou, A.; Raeder, J.; Yli-Hankala, A.; Sneyd, J.R.; Munoz, L.; Moller, J.T.

    2005-01-01

    Background: The pattern of cortisol secretion is influenced by surgery. As cortisol can adversely affect neuronal function, this may be an important factor in the development of post-operative cognitive dysfunction (POCD). We hypothesized that the incidence of POCD would be related to changes in

  15. Logistic regression analysis of risk factors for postoperative recurrence of spinal tumors and analysis of prognostic factors.

    Science.gov (United States)

    Zhang, Shanyong; Yang, Lili; Peng, Chuangang; Wu, Minfei

    2018-02-01

    The aim of the present study was to investigate the risk factors for postoperative recurrence of spinal tumors by logistic regression analysis and analysis of prognostic factors. In total, 77 male and 48 female patients with spinal tumor were selected in our hospital from January, 2010 to December, 2015 and divided into the benign (n=76) and malignant groups (n=49). All the patients underwent microsurgical resection of spinal tumors and were reviewed regularly 3 months after operation. The McCormick grading system was used to evaluate the postoperative spinal cord function. Data were subjected to statistical analysis. Of the 125 cases, 63 cases showed improvement after operation, 50 cases were stable, and deterioration was found in 12 cases. The improvement rate of patients with cervical spine tumor, which reached 56.3%, was the highest. Fifty-two cases of sensory disturbance, 34 cases of pain, 30 cases of inability to exercise, 26 cases of ataxia, and 12 cases of sphincter disorders were found after operation. Seventy-two cases (57.6%) underwent total resection, 18 cases (14.4%) received subtotal resection, 23 cases (18.4%) received partial resection, and 12 cases (9.6%) were only treated with biopsy/decompression. Postoperative recurrence was found in 57 cases (45.6%). The mean recurrence time of patients in the malignant group was 27.49±6.09 months, and the mean recurrence time of patients in the benign group was 40.62±4.34. The results were significantly different (Pregression analysis of total resection-related factors showed that total resection should be the preferred treatment for patients with benign tumors, thoracic and lumbosacral tumors, and lower McCormick grade, as well as patients without syringomyelia and intramedullary tumors. Logistic regression analysis of recurrence-related factors revealed that the recurrence rate was relatively higher in patients with malignant, cervical, thoracic and lumbosacral, intramedullary tumors, and higher Mc

  16. Age and other perioperative risk factors for postoperative systemic inflammatory response syndrome after cardiac surgery

    NARCIS (Netherlands)

    Dieleman, J. M.; Peelen, L. M.; Coulson, T. G.; Tran, L.; Reid, C. M.; Smith, Jennifer A.; Myles, P. S.; Pilcher, C.D.

    2017-01-01

    Background The inflammatory response to surgery varies considerably between individual patients. Age might be a substantial factor in this variability. Our objective was to examine the association of patient age and other potential risk factors with the occurrence of a postoperative systemic

  17. Influence on ocular surface after cataract surgery and effect of topical diquafosol on postoperative dry eye: a multicenter prospective randomized study

    Science.gov (United States)

    Miyake, Kensaku; Yokoi, Norihiko

    2017-01-01

    Purpose To investigate influences of 3% diquafosol sodium ophthalmic solution (DQS) on ocular surface after cataract surgery and effects on postoperative dry eye. Design This study had two consecutive prospective study phases. The former was an observational study from before cataract surgery to 4 weeks after surgery and the latter was a randomized open-label study from 4 to 8 weeks after surgery. Methods Subjects were 433 eyes of 433 patients undergoing cataract surgery with intraocular lens implantation. Dry eye examination of tear breakup time (BUT), corneal and conjunctival fluorescein staining scores, total subjective symptom score (12 symptoms), and Schirmer I test were conducted before surgery and 4 weeks after surgery. Patient demographics and these examination results were used to analyze risk factors to predict postoperative dry eye. In a randomized study, 154 eyes diagnosed with dry eye postoperatively were applied either DQS or artificial tears (AT) six times daily for 4 weeks. The data of the examinations were compared. Results At 4 weeks after surgery, BUT was shortened significantly (P=0.036), fluorescein staining score increased significantly (P=0.012), but total subjective symptom score was significantly improved (Pdry eye was shortened BUT type (53.1%). The dry eye prevalence after surgery decreased (55.7%) compared with before surgery (69.7%). Females and the patient with dry eye symptoms before surgery had significant risk factors for postoperative dry eye. In a randomized study, BUT was significantly prolonged in the DQS group (P=0.015), but not in the AT group. Fluorescein staining score was significantly improved in both groups (P<0.001). Total subjective symptom score was significantly decreased in the AT group (P<0.001), but not in the DQS group. Conclusion Our study suggests that cataract surgery has harmful effects on tear film stability and ocular surface, and DQS has a capability to improve them. PMID:28360509

  18. [Quality of Outcome after Primary Total Hip Replacement at a Maximum Care Hospital in Relation to Preoperative Influencing Factors].

    Science.gov (United States)

    Osmanski-Zenk, K; Steinig, N S; Glass, Ä; Mittelmeier, W; Bader, R

    2015-12-01

    As the need for joint replacements will continue to rise, the outcome of primary total hip replacement (THR) must be improved and stabilised at a high level. In this study, we investigated whether pre-operative risk factors, such as gender, age and body weight at the time of the surgery or a restricted physical status (ASA-Status > 2 or Kellgren and Lawrence grade > 2) have a negative influence on the post-operative results or on patient satisfaction. Retrospective data collection and a prospective interview were performed with 486 patients who underwent primary total hip replacement between January 2007 and December 2010 in our hospital. The patients' satisfaction and quality of life were surveyed with the WOMAC-Score, SF-36 and EuroQol-5. Differences between more than two independent spot tests were tested with the non-parametric Kruskal-Wallis test. Differences between two independent spot tests were tested with the non-parametric Mann-Whitney U test. The frequencies were reported and odds ratios calculated. The confidence interval was set at 95 %. The level of significance was p total score of the SF-36 was 66.9 points. The patients declared an average EuroQol Index of 0.81. Our data show that the patients' gender did not influence the duration of surgery or the scores. However, female patients tended to exhibit more postoperative complications. However, increased patient age at the time of surgery was associated with an increased OR for duration of surgery, length of stay and risk of complications. Patients who had a normal body weight at time of the surgery showed better peri- and post-operative results. We showed that the preoperative estimated Kellgren and Lawrence grade had a significant influence on the duration of surgery. The ASA classification influenced the duration of surgery as well the length of stay and the rate of complications. The quality of results after primary THR depends on preoperative factors. Existing comorbidities have a

  19. Postoperative radiation for cervical cancer with pathologic risk factors

    International Nuclear Information System (INIS)

    Hart, Kimberly; Han, Ihn; Deppe, Gunter; Malviya, Vinay; Malone, John; Christensen, Carl; Chuba, Paul; Porter, Arthur

    1997-01-01

    Purpose: To examine the efficacy of postoperative radiation therapy for early-stage cervical cancer with pathologic risk factors. Methods and Materials: We reviewed the charts of 83 patients who received postoperative radiation therapy at our facility from March 1980 to November 1993 for early stage cervix cancer with positive surgical margins, positive pelvic or periaortic lymph nodes, lymphovascular space invasion, deep invasion, or for disease discovered incidentally at simple hysterectomy. Twenty-eight patients received low dose rate (LDR) intracavitary radiation with or without external beam pelvic irradiation and 55 patients received external beam pelvic irradiation with high dose rate (HDR) intracavitary implants. Of these 83 patients, 66 were evaluable--20 LDR and 46 HDR patients. All patients received 45-50 Gy external beam irradiation and 20 Gy LDR equivalent intracavitary irradiation prescribed to 0.5 cm below the mucosa. Ninety percent of the LDR group and 92% of the HDR group completed treatment within < 56 days. Treatment-related toxicities were scored according to the GOG toxicity scale. Mean and median follow-up times were 101 months and 111 months (3-172 months) for the LDR group and 42 and 40 months (3-98 months) for the HDR group. Results: The 5-year disease-free survival was 89% for the LDR group and 72% for the HDR group. Local control was observed in 90% (18 out of 20) of the LDR patients and 89% (41 out of 46) of the HDR patients for an overall local control rate of 89.5%. Two of 20 LDR patients (10%) experienced recurrence (two pelvic with distant metastasis). Nine of 46 HDR patients (22%) had recurrence of disease (three pelvic, four distant metastasis, and two pelvic with distant metastasis). In the HDR group, 6 out of 16 (38%) with positive lymph nodes died of disease whereas, 27 out of 30 (90%) of the patients with negative lymph nodes remain free of disease. Three of 20 (15%) LDR patients and 4 out of 46 (9%) HDR patients experienced

  20. Influence of fragment size and postoperative joint congruency on long-term outcome of posterior malleolar fractures.

    Science.gov (United States)

    Drijfhout van Hooff, Cornelis Christiaan; Verhage, Samuel Marinus; Hoogendoorn, Jochem Maarten

    2015-06-01

    One of the factors contributing to long-term outcome of posterior malleolar fractures is the development of osteoarthritis. Based on biomechanical, cadaveric, and small population studies, fixation of posterior malleolar fracture fragments (PMFFs) is usually performed when fragment size exceeds 25-33%. However, the influence of fragment size on long-term clinical and radiological outcome size remains unclear. A retrospective cohort study of 131 patients treated for an isolated ankle fracture with involvement of the posterior malleolus was performed. Mean follow-up was 6.9 (range, 2.5-15.9) years. Patients were divided into groups depending on size of the fragment, small (25%, n = 25), and presence of step-off after operative treatment. We have compared functional outcome measures (AOFAS, AAOS), pain (VAS), and dorsiflexion restriction compared to the contralateral ankle and the incidence of osteoarthritis on X-ray. There were no nonunions, 56% of patients had no radiographic osteoarthritis, VAS was 10 of 100, and median clinical score was 90 of 100. More osteoarthritis occurred in ankle fractures with medium and large PMFFs compared to small fragments (small 16%, medium 48%, large 54%; P = .006). Also when comparing small with medium-sized fragments (P = .02), larger fragment size did not lead to a significantly decreased function (median AOFAS 95 vs 88, P = .16). If the PMFF size was >5%, osteoarthritis occurred more frequently when there was a postoperative step-off ≥1 mm in the tibiotalar joint surface (41% vs 61%, P = .02) (whether the posterior fragment had been fixed or not). In this group, fixing the PMFF did not influence development of osteoarthritis. However, in 42% of the cases with fixation of the fragment a postoperative step-off remained (vs 45% in the group without fixation). Osteoarthritis is 1 component of long-term outcome of malleolar fractures, and the results of this study demonstrate that there was more radiographic osteoarthritis in

  1. Effect of immune nutritional support on immune function and inflammatory factor in postoperative patients with gastric cancer

    Directory of Open Access Journals (Sweden)

    Hua-Jia Dai

    2016-05-01

    Full Text Available Objective: To investigate the effect of immune nutritional support on immune function and inflammatory factor in postoperative patients with gastric cancer. Methods: A total of 100 patients with gastric cancer were selected and randomly divided into the observation group and the control group with 50 cases in each group. The control group received routine perioperative enteral and parenteral nutrition, on the basis of conventional nutritional support, and the observation group was given enteral nutrition emulsion immune support. Then, the immune function and the inflammatory factor of postoperative day 1 and day 7 were compared between the two groups. Results: (1 With the preoperative data as the basis, the levels of serum IgG, IgA, C3 and C4 decreased at the postoperative day 1 and then increased at the postoperative day 7, while the level of IgM showed an increasing trend and then a decreasing trend in the two groups, and the corresponding figures for the postoperative day 1 and day 7 were statistically different between the two groups. In the observation group, the levels of IgG, IgA, C3 and C4 were higher, while the level of IgM was lower at the postoperative day 1 and day 7 than that in the control group, and the differences were statistically significant; (2 With the preoperative data as the basis, the levels of serum TNF-α, IL-6 and CRP significantly increased at the postoperative day 1 and then decreased at the postoperative day 7 in the two groups, and the corresponding figures for the postoperative day 1 and day 7 in the observation group were lower than those in the control group, and the differences were statistically significant. Conclusion: Immune nutritional support can help to reduce the damage of immune function and the inflammatory response induced by surgery in patients with gastric cancer, which is worthy of clinical application.

  2. Factors associated with acute postoperative pain following breast reconstruction

    Directory of Open Access Journals (Sweden)

    Anita R. Kulkarni

    2017-03-01

    Conclusions: This study identifies patients at risk for severe acute postoperative pain following breast reconstruction. These findings will allow plastic surgeons to better tailor postoperative care to improve patient comfort, reduce clinical morbidity, and enhance patient satisfaction with their surgical outcome.

  3. Study on effectiveness and tolerance of pre-and postoperative radiochemotherapy for patients with stomach cancer

    International Nuclear Information System (INIS)

    Wydmanski, J.

    2008-01-01

    Postoperative radiochemotherapy was included to the therapeutic scheme of stomach cancer. The effectiveness and tolerance of pre- and postoperative radiochemotherapy were studied. A Range Scale Risk reflecting the risk of treatment failure , selecting patients with bad prognosis to intensive therapy was established on the base of identified predictive and prognostic factors. 426 patients with stomach cancer were undergone radiochemotherapy between 1999 and 2005. The therapeutic schemes with operation followed by adjuvant radiochemotherapy or pre-and postoperative radiochemotherapy were arranged.The overall survival was better in the second group. Body weight loss, age and performance status of patients, location of tumor, cancer stage evaluation, resected lymph nodes, operation radicality were identified as the independent prognostic factors. In conclusions, combined modality approaches in treatment of stomach cancer were shown as more effective than surgery alone. Neoadjuvant chemotherapy may be more effective than postoperative one. Postoperative radiochemotherapy started and completed within 5 weeks positively influenced all prognostic factors. 5-year overall survival rate was 66% and risk of local recurrence less than 15%. 4 prognostics groups of patients selected in 10 points scale of range scale risk by careful evaluation using hazard model were established and detailed results have been presented. (author)

  4. Post-Operative Infection Is an Independent Risk Factor for Worse Long-Term Survival after Colorectal Cancer Surgery.

    Science.gov (United States)

    Kerin Povšič, Milena; Ihan, Alojz; Beovič, Bojana

    2016-12-01

    Colorectal cancer surgery is associated with a high incidence of post-operative infections, the outcome of which may be improved if diagnosed and treated early enough. We compared white blood cell (WBC) count, C-reactive protein (CRP), and procalcitonin (PCT) as predictors of post-operative infections and analyzed their impact on long-term survival. This retrospective study included 186 patients undergoing colorectal surgery. Post-operative values of WBC, CRP, and PCT were analyzed by the receiver operating characteristic (ROC) analysis. We followed infections 30 d after the surgery. A five-year survival was analyzed by Kaplan-Meier method and prognostic factors by Cox regression model. Fifty-five patients (29.5%) developed post-operative infection, the most frequent of which was surgical site infection (SSI). C-reactive protein on post-operative day three and PCT on post-operative day two demonstrated the highest diagnostic accuracy for infection (area under the curve [AUC] 0.739 and 0.735). C-reactive protein on post-operative day three was an independent predictor of infection. Five-year survival was higher in the non-infected group (70.8%), compared with the infected group (52.1%). The worst survival (40.9%) was identified in patients with organ/space SSI. Post-operative infection and tumor stage III-IV were independent predictors of a worse five-year survival. C-reactive protein on post-operative day three and PCT on post-operative day two may be early predictors of infection after colorectal cancer surgery. Post-operative infections in particular organ/space SSI have a negative impact on long-term survival.

  5. Factors Influencing the Recurrence Potential of Benign Endometrial Polyps after Hysteroscopic Polypectomy.

    Directory of Open Access Journals (Sweden)

    Jehn-Hsiahn Yang

    Full Text Available An endometrial polyp is a frequently encountered gynecologic disease with abnormal uterine bleeding and infertility being the two common presenting problems, and hysteroscopic polypectomy is an effective method to remove them. The postoperative polyp recurrence might result in reappearance of abnormal uterine bleeding or infertility, whereas factors influencing the postoperative recurrence potential have limited data.This case-series report included 168 premenopausal women who suffered from endometrial polyps and underwent hysteroscopic polypectomy. All of them were awaiting a future pregnancy. Office hysteroscopy was done before and after hysteroscopic polypectomy, in which preoperative hysteroscopy examined the number, type, and location of endometrial polyps, and postoperative hysteroscopy checked the polyp recurrence. Surgical indications, either infertility or the presentation of abnormal uterine bleeding, and follow-up duration were recorded.Seventy-three out of 168 (43% women had polyp recurrence after hysteroscopic polypectomy. Multivariate logistic regression analysis revealed that more endometrial polyps (P = 0.015 and longer duration of follow-up (P = 0.004 were significantly associated with an increased risk of postoperative polyp recurrence. The type of endometrial polyps was not correlated with polyp recurrence potential, whereas pedunculated type endometrial polyps were closely related to the presentation of abnormal uterine bleeding (P = 0.001.A higher number of endometrial polyps and longer follow-up duration are associated with a greater potential of polyp recurrence after hysteroscopic polypectomy.

  6. Risk factors for postoperative recurrence of spontaneous pneumothorax treated by video-assisted thoracoscopic surgery†.

    Science.gov (United States)

    Imperatori, Andrea; Rotolo, Nicola; Spagnoletti, Marco; Festi, Luigi; Berizzi, Fabio; Di Natale, Davide; Nardecchia, Elisa; Dominioni, Lorenzo

    2015-05-01

    Over the past two decades, video-assisted thoracoscopic blebectomy and pleurodesis have been used as a safe and reliable option for treatment of spontaneous pneumothorax. The aim of this study is to evaluate the long-term outcome of video-assisted thoracoscopic surgery (VATS) treatment of spontaneous pneumothorax in young patients, and to identify risk factors for postoperative recurrence. We retrospectively analysed the outcome of VATS treatment of spontaneous pneumothorax in our institution in 150 consecutive young patients (age ≤ 40 years) in the years 1997-2010. Treatment consisted of stapling blebectomy and partial parietal pleurectomy. After excluding 16 patients lost to follow-up, in 134 cases [110 men, 24 women; mean age, 25 ± 7 standard deviation years; median follow-up, 79 months (range: 36-187 months)], we evaluated postoperative complications, focusing on pneumothorax recurrence, thoracic dysaesthesia and chronic chest pain. Risk factors for postoperative pneumothorax recurrence were analysed by logistic regression. Of 134 treated patients, 3 (2.2%) required early reoperation (2 for bleeding; 1 for persistent air leaks). Postoperative (90-day) mortality was nil. Ipsilateral pneumothorax recurred in 8 cases (6.0%) [median time of recurrence, 43 months (range: 1-71 months)]. At univariate analysis, the recurrence rate was significantly higher in women (4/24) than in men (4/110; P = 0.026) and in patients with >7-day postoperative air leaks (P = 0.021). Multivariate analysis confirmed that pneumothorax recurrence correlated independently with prolonged air leaks (P = 0.037) and with female gender (P = 0.045). Chronic chest wall dysaesthesia was reported by 13 patients (9.7%). In 3 patients, (2.2%) chronic thoracic pain (analogical score >4) was recorded, but only 1 patient required analgesics more than once a month. VATS blebectomy and parietal pleurectomy is a safe procedure for treatment of spontaneous pneumothorax in young patients, with a 6% long

  7. Factors influencing bowel sparing in intensity modulated whole pelvic radiotherapy for gynaecological malignancies

    International Nuclear Information System (INIS)

    Georg, Petra; Georg, Dietmar; Hillbrand, Martin; Kirisits, Christian; Poetter, Richard

    2006-01-01

    Background and purpose: To evaluate the influence of uterus and bladder size on large and small bowel sparing with intensity modulated whole pelvic radiotherapy (IM-WPRT) in gynecologic patients. Patients and methods: Twenty patients were selected; 10 women with cervical cancer treated with definitive radiotherapy (group 'DEF') and 10 endometrial cancer patients treated postoperatively (group 'POST'). Bladder, rectal wall, small (SB) and large bowel (LB) were delineated as organs at risk. A conformal four field technique and a seven field IMRT plan (prescription dose 50.4 Gy) were compared in terms of DVH and various target parameters. Results: At doses between 40 and 50.4 Gy statistically significant improvements (P<0.05) were observed for IM-WPRT for irradiated volume of rectal wall and bladder. In both patient groups, with IMRT the average irradiated volume of SB was reduced by a factor of 6 at 50.4 Gy. This ratio was 2 for LB. In the DEF group the effect of SB-sparing with IMRT correlated with bladder size (correlation coefficient 0.70) while it did not correlate in the postoperative group. The effect of LB-sparing decreased with increasing bladder size in both groups but the impact of IMRT was larger for postoperative patients. Conclusions: IMRT significantly reduced the absolute volume of rectal wall, bladder and bowel irradiated at the prescribed dose level in gynaecologic patients. Main differences between POST and DEF patients receiving IM-WPRT were absolute volumes of LB irradiated to doses between 35 and 50 Gy, suggesting an impact of intact uterus on LB volume in the pelvis. POST patients seem to benefit most from elective nodal IMRT. Bladder filling is an important co-factor influencing the benefit of IMRT with respect to OAR sparing

  8. Clinical Characteristics and Risk Factors for the Development of Postoperative Hepatic Steatosis After Total Pancreatectomy.

    Science.gov (United States)

    Hata, Tatsuo; Ishida, Masaharu; Motoi, Fuyuhiko; Sakata, Naoaki; Yoshimatsu, Gumpei; Naitoh, Takeshi; Katayose, Yu; Egawa, Shinichi; Unno, Michiaki

    2016-03-01

    The occurrence of hepatic steatosis after pancreatectomy is known to be associated with the remnant pancreatic function. However, other risk factors for hepatic steatosis after pancreatectomy remain unknown. The aims of this study were to identify other risk factors in addition to the remnant pancreatic function and elucidate the relationship between postoperative hepatic steatosis and pancreatic exocrine insufficiency in totally pancreatomized patients. Forty-three patients who underwent total pancreatectomy were analyzed. Hepatic steatosis was defined as the attenuation of unenhanced computed tomography values. Clinical findings and laboratory data were compared between patients with and without hepatic steatosis. Sixteen (37.2%) patients developed hepatic steatosis after total pancreatectomy, with marked declines in the Controlling Nutritional Status score and body mass index. Multiple linear regression analysis revealed that the attenuation of computed tomography values was correlated with female sex (P = 0.002), early postoperative serum albumin levels (P = 0.003), and pancreatic enzyme replacement therapy with high-dose pancrelipase (P = 0.032). Postoperative hepatic steatosis after pancreatectomy is associated with sex, malnutrition, and pancreatic exocrine insufficiency. High-dose pancreatic enzyme replacement therapy may have preventive effects on hepatic steatosis occurring after pancreatectomy.

  9. Influence on ocular surface after cataract surgery and effect of topical diquafosol on postoperative dry eye: a multicenter prospective randomized study

    Directory of Open Access Journals (Sweden)

    Miyake K

    2017-03-01

    Full Text Available Kensaku Miyake,1 Norihiko Yokoi2 On behalf of Dry Eye After Cataract Surgery Investigational Study Group (DASIS group 1Miyake Eye Hospital, Nagoya, 2Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan Purpose: To investigate influences of 3% diquafosol sodium ophthalmic solution (DQS on ocular surface after cataract surgery and effects on postoperative dry eye. Design: This study had two consecutive prospective study phases. The former was an observational study from before cataract surgery to 4 weeks after surgery and the latter was a randomized open-label study from 4 to 8 weeks after surgery. Methods: Subjects were 433 eyes of 433 patients undergoing cataract surgery with intraocular lens implantation. Dry eye examination of tear breakup time (BUT, corneal and conjunctival fluorescein staining scores, total subjective symptom score (12 symptoms, and Schirmer I test were conducted before surgery and 4 weeks after surgery. Patient demographics and these examination results were used to analyze risk factors to predict postoperative dry eye. In a randomized study, 154 eyes diagnosed with dry eye postoperatively were applied either DQS or artificial tears (AT six times daily for 4 weeks. The data of the examinations were compared. Results: At 4 weeks after surgery, BUT was shortened significantly (P=0.036, fluorescein staining score increased significantly (P=0.012, but total subjective symptom score was significantly improved (P<0.001. The majority of postoperative dry eye was shortened BUT type (53.1%. The dry eye prevalence after surgery decreased (55.7% compared with before surgery (69.7%. Females and the patient with dry eye symptoms before surgery had significant risk factors for postoperative dry eye. In a randomized study, BUT was significantly prolonged in the DQS group (P=0.015, but not in the AT group. Fluorescein staining score was significantly improved in both groups (P<0.001. Total subjective symptom

  10. The influence of awake craniotomy on postoperative neuropsychology

    Directory of Open Access Journals (Sweden)

    YANG Ming-yuan

    2012-12-01

    Full Text Available Objective To assess the neuropsychological function and quality of life of the patients after awake craniotomy (AC. Methods A case-control study was conducted among 81 patients who underwent awake craniotomy, and a 1-to-1 control group (matched by age, gender, degree of education, tumor location and characteristic undergoing general anesthesia (GA in glioma resections was assembled. The incidence of postoperative neurological deficits, psychological disorders and recurrence were investigated during telephone follow-ups, and Medical Outcomes Study Short Form 36 (SF-36 was adopted to evaluate the life quality of patients. Results Almost 73 pairs of patients fulfilled the survey of AC and GA group respectively. There were 21 patients and 28 patients with postoperative neurological deficits, and 12 patients and 8 patients with psychological disorders in AC and GA group respectively. Thirty patients of AC group had the recollection of being awake during the surgery. There were 9 patients in CA group having long-term ( > 6 months neurological deficits, which was less than the number of GA group (18 patients, P = 0.038. According to the assessment in short-term, medium-term and long-term postoperative neurological deficits, there was no significant difference in the quality-of-life scores between the two groups (P > 0.05, for all. Conclusion Awake craniotomy can be the main method for removing the lesions located in or close to functional areas with lower incidence of long?term postoperative neurological deficits, and it has no significant impact on the psychological status and the quality of life postoperatively.

  11. Predictors of postoperative hemoglobin drop after laparoscopic myomectomy.

    Science.gov (United States)

    Watrowski, Rafał; Jäger, Christoph; Forster, Johannes

    2017-01-01

    Laparoscopic myomectomy (LM) can be associated with significant bleeding. To identify factors influencing the postoperative hemoglobin (Hb) drop after LM. This is a retrospective, single-center study. We evaluated data of 150 consecutive patients undergoing LM due to intramural myomas between 2010 and 2015. The median age of the patients was 37 (23-53) years. The mean diameter of the largest myoma was 5.7 ±2.3 (1.5-12) cm. The mean surgical time was 83 ±38 (35-299) min. The median number of sutures was 3 (1-11). The mean postoperative Hb drop was 1.6 ±1.2 (0-6) g/dl, and the mean estimated blood loss was 261 ±159 (50-1700) ml. In the univariate analysis, the postoperative Hb drop correlated with the duration of surgery (p < 0.001), diameter of the largest myoma (p < 0.001), cumulative myoma weight (p < 0.001), and number of sutures (p < 0.001), but not with patients' age or number of intramural myomas. In the multivariable analysis, the surgical time ( β = 0.395, p < 0.001), diameter of the largest myoma ( β = 0.292, p = 0.03) and preoperative Hb concentration ( β = 0.299, p < 0.001) predicted the postoperative Hb change. Surgical time and dominant myoma diameter are independent predictors of the postoperative Hb drop after LM.

  12. Risk factors for postoperative delirium in patients undergoing major head and neck cancer surgery: a meta-analysis.

    Science.gov (United States)

    Zhu, Yun; Wang, Gangpu; Liu, Shengwen; Zhou, Shanghui; Lian, Ying; Zhang, Chenping; Yang, Wenjun

    2017-06-01

    Postoperative delirium is common after extensive surgery. This study aimed to collate and synthesize published literature on risk factors for delirium in patients with head and neck cancer surgery. Three databases were searched (MEDLINE, Embase, and Cochrane Library) between January 1987 and July 2016. The Newcastle Ottawa Scale (NOS) was adopted to evaluate the study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods. They provided a total of 1940 patients (286 with delirium and 1654 without), and predominantly included patients undergoing head and neck cancer surgery. The incidence of postoperative delirium ranged from 11.50% to 36.11%. Ten statistically significant risk factors were identified in pooled analysis. Old age, age >70 years, male sex, duration of surgery, history of hypertension, blood transfusions, tracheotomy, American Society of Anesthesiologists physical status grade at least III, flap reconstruction and neck dissection were more likely to sustain delirium after head and neck cancer surgery. Delirium is common in patients undergoing major head neck cancer surgery. Several risk factors were consistently associated with postoperative delirium. These factors help to highlight patients at risk of developing delirium and are suitable for preventive action. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  13. A characterization of factors determining postoperative ileus after laparoscopic colectomy enables the generation of a novel predictive score.

    Science.gov (United States)

    Kronberg, Udo; Kiran, Ravi P; Soliman, Mohamed S M; Hammel, Jeff P; Galway, Ursula; Coffey, John Calvin; Fazio, Victor W

    2011-01-01

    Postoperative ileus (POI) after colorectal surgery is associated with prolonged hospital stay and increased costs. The aim of this study is to investigate pre-, intra-, and postoperative risk factors associated with the development of POI in patients undergoing laparoscopic partial colectomy. Patients operated between 2004 and 2008 were retrospectively identified from a prospectively maintained database, and clinical, metabolic, and pharmacologic data were obtained. Postoperative ileus was defined as the absence of bowel function for 5 or more days or the need for reinsertion of a nasogastric tube after starting oral diet in the absence of mechanical obstruction. Associations between likelihood of POI and study variables were assessed univariably by using χ tests, Fisher exact tests, and logistic regression models. A scoring system for prediction of POI was constructed by using a multivariable logistic regression model based on forward stepwise selection of preoperative factors. A total of 413 patients (mean age, 58 years; 53.5% women) were included, and 42 (10.2%) of them developed POI. Preoperative albumin, postoperative deep-vein thrombosis, and electrolyte levels were associated with POI. Age, previous abdominal surgery, and chronic preoperative use of narcotics were independently correlated with POI on multivariate analysis, which allowed the creation of a predictive score. Patients with a score of 2 or higher had an 18.3% risk of POI (P POI can be predicted by using a preoperative scoring system. Addressing the postoperative factors may be expected to reduce the incidence of this common complication in high-risk patients.

  14. Ranitidine prevents postoperative transfusion-induced depression of delayed hypersensitivity

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Hammer, J H; Moesgaard, F

    1989-01-01

    The influence of perioperative blood transfusion on postoperative depression of cell-mediated immunity (CMI) and the effect of ranitidine on transfusion-induced changes in postoperative CMI were investigated. CMI was assessed preoperatively and postoperatively by skin testing with seven common...

  15. Factores predictivos de las infecciones posoperatorias Prediction factors of the postoperative infections

    Directory of Open Access Journals (Sweden)

    Manuel Pascual Bestard

    2011-09-01

    , which still involve a significant number of patients operated on, thus justifying the interest in the conduction of present paper. Objective: to describe the behavior the some of the prediction factors related to appearance of the postoperative infections in our practice. Methods: a cross-sectional, descriptive and observational study was conducted in admitted and operated on patients with postsurgical infections in the general surgery service of the "Saturnino Lora" Teaching Provincial Hospital over 2008, according to the selected prediction factors. Results: in relation to the contamination, the global rate of postoperative infection and that of the clean wounds are within the universally accepted limits, although are higher in the urgent, dirty and contaminated interventions for that located in the surgical site, as well as in patients with an ASA II and ASA III physical condition according the American Society of Anaesthesiology (ASA independently of its nutritional status and the surgical time of interventions. Conclusions: the postsurgical infection rates increase as far as the conditions to operate on are unfavourable and the selected prediction factors are related mainly to that located in the surgical site, with de contamination level, the type of intervention and the physical preoperative status of patient.

  16. Postoperative radiotherapy in patients with salivary duct carcinoma. Clinical outcomes and prognostic factors

    International Nuclear Information System (INIS)

    Shinoto, Makoto; Shioyama, Yoshiyuki; Nakamura, Katsumasa

    2013-01-01

    This study sought to investigate the clinical outcome and the role of postoperative radiotherapy for patients with salivary duct carcinoma (SDC) who had undergone surgery and postoperative radiotherapy. We performed a retrospective analysis of 25 SDC patients treated between 1998 and 2011 with surgery and postoperative radiotherapy. The median prescribed dose was 60 Gy (range, 49.5-61.4 Gy). The clinical target volume (CTV) was defined as the tumor bed in four patients, the tumor bed and ipsilateral neck in 14 patients, and the tumor bed and bilateral neck in six patients. Local control (LC), disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and prognostic variables were analyzed with the log-rank test. The 5-year LC, DFS and OS were 67%, 45% and 47%, respectively. Disease recurrence was found in 12 patients: seven as local, four as regional and eight as distant failure. Perineural and lymphovascular invasion was a significant prognostic factor for LC (P=0.03). Local failure was common, and the presence of local recurrence significantly affected the OS (P<0.05). We conclude that surgery and postoperative radiotherapy is expected to decrease the risk of local failure and contribute to good prognoses for patients with SDC. It might be advisable to have the CTV include the cranial nerves involved and the corresponding parts of the skull base in cases of pathologically positive perineural invasion. (author)

  17. Postoperative delirium and postoperative cognitive dysfunction in the elderly - what are the differences?

    DEFF Research Database (Denmark)

    Krenk, L; Rasmussen, L S

    2011-01-01

    Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. There are two main entities of postoperat......Postoperative cognitive impairment is an increasingly common problem as more elderly patients undergo major surgery. Cognitive deficits in the postoperative period cause severe problems and are associated with a marked increase in morbidity and mortality. There are two main entities...... of postoperative cognitive decline, delirium and postoperative cognitive dysfunction, which are often reported as being part of the same continuum. Although there are similarities in the predisposing factors, it seems unlikely that they share the same pathophysiology. Both have multifactorial pathogenesis...... but differ in numerous other ways, with delirium being well-defined and acute in onset and postoperative cognitive dysfunction (POCD) being subtler and with longer duration. This review aims to provide an overview of the differences in the diagnosis of the two entities and to illustrate the methodological...

  18. Screening for postoperative delirium in patients with acute hip fracture: Assessment of predictive factors.

    Science.gov (United States)

    Koskderelioglu, Asli; Onder, Ozlem; Gucuyener, Melike; Altay, Taskin; Kayali, Cemil; Gedizlioglu, Muhtesem

    2017-06-01

    The aim of the present study was to estimate the incidence and risk factors of delirium during the early postoperative period after hip fracture surgery. Furthermore, we investigated the accuracy of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) for detection and assessment of delirium in orthopedic patients. We consecutively recruited patients aged 65 years or older undergoing hip fracture surgery. The presence of delirium was determined daily by two of the authors according to the CAM-ICU criteria. A further evaluation was made with the reference standard Diagnostic and Statistical Manual of Mental Disorders Fourth Edition criteria for delirium. Their cognitive function was evaluated with the Mini-Mental State Examination, and possible depressive mood with the Beck Depression Inventory. Baseline characteristics, as well as the American Society of Anesthesiologists classification and clinical outcomes, were analyzed for a correlation with accompanying delirium. Among 109 patients, 20 (18.3%) were diagnosed with delirium. The concurrent validity of CAM-ICU was good (kappa = 0.84). Specificity was 98.9%, and sensitivity was 80%. Multivariate regression analysis showed that Mini-Mental State Examination (P = 0.001; odds ratio 0.75, 95% confidence interval 0.65-0.86) and Beck Depression Inventory scores (P = 0.001; odds ratio 1.13, 95% confidence interval 1.05-1.22) correlated with the occurrence of delirium. The present results show that CAM-ICU is highly sensitive and specific to identify delirium in hip fracture patients in the postoperative period. Among all of the risk factors, cognitive impairment and depressive mood were strongly associated with postoperative delirium. We suggest that a preoperative assessment of cognition and depression might be useful for identifying patients with a higher risk of postoperative delirium. Geriatr Gerontol Int 2017; 17: 919-924. © 2016 Japan Geriatrics Society.

  19. Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery.

    Science.gov (United States)

    Rao, Raghavendra M; Nagendra, H R; Raghuram, Nagarathna; Vinay, C; Chandrashekara, S; Gopinath, K S; Srinath, B S

    2008-01-01

    Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL)-2 receptor (IL-2R), tumor necrosis factor (TNF)-alpha and interferon (IFN)-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36). The results suggest a significant decrease in the duration of hospital stay (P = 0.003), days of drain retention (P = 0.001) and days for suture removal (P = 0.03) in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group (P < 0.001), as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. The results suggest possible benefits of yoga in reducing postoperative complications in

  20. Operative treatment of spontaneous spinal epidural hematomas : a study of the factors determining postoperative outcome

    NARCIS (Netherlands)

    Groen, R J; van Alphen, H A

    OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas. METHODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was

  1. Long-term adherence to a local guideline on postoperative body temperature measurement: mixed methods analysis

    NARCIS (Netherlands)

    Storm-Versloot, Marja N.; Knops, Anouk M.; Ubbink, Dirk T.; Goossens, Astrid; Legemate, Dink A.; Vermeulen, Hester

    2012-01-01

    Aim To find out whether a successful multifaceted implementation approach of a local evidence-based guideline on postoperative body temperature measurements (BTM) was persistent over time, and which factors influenced long-term adherence. Methods Mixed methods analysis. Patient records were

  2. Risks of postoperative paresis in motor eloquently and non-eloquently located brain metastases

    International Nuclear Information System (INIS)

    Obermueller, Thomas; Schaeffner, Michael; Gerhardt, Julia; Meyer, Bernhard; Ringel, Florian; Krieg, Sandro M

    2014-01-01

    When treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients. For the resection of brain metastasis several studies reported a considerable risk of new postoperative paresis. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. As such factors were repeatedly considered risk factors for perioperative complications, we designed this study to also identify risk factors for brain metastases resection. Between 2006 and 2011, we resected 206 brain metastases consecutively, 56 in eloquent motor areas and 150 in non-eloquent ones. We evaluated the influences of preoperative paresis, previous Rtx or Ctx as well as recursive partitioning analysis (RPA) class on postoperative outcome. In general, 8.7% of all patients postoperatively developed a new permanent paresis. In contrast to preoperative Ctx, previous Rtx as a single or combined treatment strategy was a significant risk factor for postoperative motor weakness. This risk was even increased in perirolandic and rolandic lesions. Our data show significantly increased risk of new deficits for patients assigned to RPA class 3. Even in non-eloquently located brain metastases the risk of new postoperative paresis has not to be underestimated. Despite the microsurgical approach, our cohort shows a high rate of unexpected residual tumors in postoperative MRI, which supports recent data on brain metastases’ infiltrative nature but might also be the result of our strict study protocol. Surgical resection is a safe treatment of brain metastases. However, preoperative Rtx and RPA score 3 have to be taken into account when surgical resection is considered

  3. Postoperative delirium in intensive care patients: risk factors and outcome.

    Science.gov (United States)

    Veiga, Dalila; Luis, Clara; Parente, Daniela; Fernandes, Vera; Botelho, Miguela; Santos, Patricia; Abelha, Fernando

    2012-07-01

    Postoperative delirium (POD) in Surgical Intensive Care patients is an important independent outcome determinant. The purpose of our study was to evaluate the incidence and determinants of POD. Prospective cohort study conducted during a period of 10 months in a Post-Anesthesia Care Unit (PACU) with five intensive care beds. All consecutive adult patients submitted to major surgery were enrolled. Demographic data, perioperative variables, length of stay (LOS) and the mortality at PACU, hospital and at 6-months follow-up were recorded. Postoperative delirium was evaluated using the Intensive Care Delirium Screening Checklist (ICDSC). Descriptive analyses were conducted and the Mann-Whitney test, Chi-square test or Fisher's exact test were used for comparisons. Logistic regression analysis evaluated the determinants of POD with calculation of odds ratio (OR) and its confidence interval 95% (95% CI). There were 775 adult PACU admissions and 95 patients had exclusion criteria. Of the remaining 680 patients, 128 (18.8%) developed POD. Independent determinants of POD identified were age, ASA-PS, emergency surgery and total amount of fresh frozen plasma administered during surgery. Patients with delirium had higher mortality rates, were more severely ill and stayed longer at the PACU and in the hospital. POD was an independent risk factor for hospital mortality There was a high incidence of delirium had a high incidence in intensive care surgical patients. POD was associated with worse severity of disease scores, longer LOS in hospital, and in PACU and higher mortality rates. The independent risk factors for POD were age, ASAPS, emergency surgery and the amount of plasma administered during surgery. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

  4. Investigation of clinical and dosimetric factors associated with postoperative pulmonary complications in esophageal cancer patients treated with concurrent chemoradiotherapy followed by surgery

    International Nuclear Information System (INIS)

    Wang Shulian; Liao Zhongxing; Vaporciyan, Ara A.; Tucker, Susan L.; Liu, Helen; Wei Xiong; Swisher, Stephen; Ajani, Jaffer A.; Cox, James D.; Komaki, Ritsuko

    2006-01-01

    Purpose: To assess the association of clinical and especially dosimetric factors with the incidence of postoperative pulmonary complications among esophageal cancer patients treated with concurrent chemoradiation therapy followed by surgery. Method and Materials: Data from 110 esophageal cancer patients treated between January 1998 and December 2003 were analyzed retrospectively. All patients received concurrent chemoradiotherapy followed by surgery; 72 patients also received irinotecan-based induction chemotherapy. Concurrent chemotherapy was 5-fluorouracil-based and in 97 cases included taxanes. Radiotherapy was delivered to a total dose of 41.4-50.4 Gy at 1.8-2.0 Gy per fraction with a three-dimensional conformal technique. Surgery (three-field, Ivor-Lewis, or transhiatal esophagectomy) was performed 27-123 days (median, 45 days) after completion of radiotherapy. The following dosimetric parameters were generated from the dose-volume histogram (DVH) for total lung: lung volume, mean dose to lung, relative and absolute volumes of lung receiving more than a threshold dose (relative V dose and absolute V dose ), and absolute volume of lung receiving less than a threshold dose (volume spared, or VS dose ). Occurrence of postoperative pulmonary complications, defined as pneumonia or acute respiratory distress syndrome (ARDS) within 30 days after surgery, was the endpoint for all analyses. Fisher's exact test was used to investigate the relationship between categorical factors and incidence of postoperative pulmonary complications. Logistic analysis was used to analyze the relationship between continuous factors (e.g., V dose or VS dose ) and complication rate. Logistic regression with forward stepwise inclusion of factors was used to perform multivariate analysis of those factors having univariate significance (p < 0.05). The Mann-Whitney test was used to compare length of hospital stay in patients with and without lung complications and to compare lung volumes, VS5

  5. Chest cage angle difference and rotation of main thoracic curve are independent risk factors of postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis.

    Science.gov (United States)

    Yagi, Mitsuru; Takemitsu, Masakazu; Machida, Masafumi

    2013-09-01

    Retrospective case series of surgically treated adolescent patients with scoliosis. To assess the prevalence and independent risk factors for postoperative shoulder imbalance in surgically treated adolescent patients with idiopathic scoliosis. Despite recent reports that have identified risk factors for postoperative shoulder imbalance, the relative risks remain unclear. A retrospective review of 85 consecutive patients treated with thoracic fusion with a minimum 2-year follow-up (mean, 3.1 yr) was conducted to investigate the patient radiographical measurements and demographics. Shoulder height difference (SHD) was measured as the graded height difference of the soft tissue shadows. A SHD more than 2 cm indicated an unbalanced shoulder. Patient demographics and radiographical data were studied to determine risk factors for postoperative SHD. The potential risk factors included age, sex, Risser sign, Cobb angle, flexibility, and apical vertebral rotation (AVR) of the main curve, upper-instrumented vertebra level, SHD, and clavicle chest cage angle difference (CCAD). Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for postoperative shoulder imbalance. Of the 85 patients, 21 patients presented postoperative shoulder imbalance. The univariate analysis indicated age, Risser sign, Cobb angle of the main curve, AVR of the main curve, and CCAD as risk factors, but the multivariate logistic regression analysis showed that only AVR of the main curve and CCAD were independent risk factors for postoperative shoulder imbalance (AVR, P = 0.04, odds ratio (OR): 3.54; CCAD, P = 0.01, OR: 5.10). Postoperative shoulder imbalance was observed in 25% of the surgically treated adolescent patients. The CCAD and AVR of the main thoracic curve were independent risk factors for postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis. The significant correlation between CCAD and

  6. Postoperative Insulin-Like Growth Factor 1 Levels Reflect the Graft's Function and Predict Survival after Liver Transplantation.

    Directory of Open Access Journals (Sweden)

    Daniele Nicolini

    Full Text Available The reduction of insulin-like growth factor 1 (IGF-1 plasma levels is associated with the degree of liver dysfunction and mortality in cirrhotic patients. However, little research is available on the recovery of the IGF-1 level and its prognostic role after liver transplantation (LT.From April 2010 to May 2011, 31 patients were prospectively enrolled (25/6 M/F; mean age±SEM: 55.2±1.4 years, and IGF-1 serum levels were assessed preoperatively and at 15, 30, 90, 180 and 365 days after transplantation. The influence of the donor and recipient characteristics (age, use of extended criteria donor grafts, D-MELD and incidence of early allograft dysfunction on hormonal concentration was analyzed. The prognostic role of IGF-1 level on patient survival and its correlation with routine liver function tests were also investigated.All patients showed low preoperative IGF-1 levels (mean±SEM: 29.5±2.1, and on postoperative day 15, a significant increase in the IGF-1 plasma level was observed (102.7±11.7 ng/ml; p65 years or extended criteria donor grafts. An inverse correlation between IGF-1 and bilirubin serum levels at day 15 (r = -0.3924, p = 0.0320 and 30 (r = -0.3894, p = 0.0368 was found. After multivariate analysis, early (within 15 days IGF-1 normalization [Exp(b = 3.913; p = 0.0484] was the only prognostic factor associated with an increased 3-year survival rate.IGF-1 postoperative levels are correlated with the graft's quality and reflect liver function. Early IGF-1 recovery is associated with a higher 3-year survival rate after LT.

  7. Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery : a prospective cohort study

    NARCIS (Netherlands)

    Koorevaar, Rinco C. T.; van't Riet, Esther; Ipskamp, Marcel; Bulstra, Sjoerd K.

    Frozen shoulder is a potential complication after shoulder surgery. It is a clinical condition that is often associated with marked disability and can have a profound effect on the patient's quality of life. The incidence, etiology, pathology and prognostic factors of postoperative frozen shoulder

  8. Post-operative Transient Hypoparathyroidism: Incidence and Risk ...

    African Journals Online (AJOL)

    Background: There is limited data on the incidence and risk factors for developing postoperative hypoparathyroidism (POHP) in the South African setting. Objectives: This study aims to calculate the incidence of postoperative hypoparathyroidism in a South African tertiary setting, and to compare local risk factors for POHP to ...

  9. Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients.

    Science.gov (United States)

    Frasson, Matteo; Granero-Castro, Pablo; Ramos Rodríguez, José Luis; Flor-Lorente, Blas; Braithwaite, Mariela; Martí Martínez, Eva; Álvarez Pérez, Jose Antonio; Codina Cazador, Antonio; Espí, Alejandro; Garcia-Granero, Eduardo

    2016-01-01

    Studies focused on postoperative outcome after oncologic right colectomy are lacking. The main objective was to determine pre-/intraoperative risk factors for anastomotic leak after elective right colon resection for cancer. Secondary objectives were to determine risk factors for postoperative morbidity and mortality. Fifty-two hospitals participated in this prospective, observational study (September 2011-September 2012), including 1102 patients that underwent elective right colectomy. Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak and postoperative morbidity and mortality. Anastomotic leak was diagnosed in 93 patients (8.4 %), and 72 (6.5 %) of them needed radiological or surgical intervention. Morbidity, mortality, and wound infection rates were 29.0, 2.6, and 13.4 %, respectively. Preoperative serum protein concentration was the only independent risk factor for anastomotic leak (p leaks, stapled technique (p = 0.03, OR 2.1) and preoperative serum protein concentration (p = 0.004, OR 0.6 g/dL) were identified as the only two independent risk factors. Age and preoperative serum albumin concentration resulted to be risk factors for postoperative mortality. Male gender, pulmonary or hepatic disease, and open surgical approach were identified as risk factors for postoperative morbidity, while male gender, obesity, intraoperative complication, and end-to-end anastomosis were risk factors for wound infection. Preoperative nutritional status and the stapled anastomotic technique were the only independent risk factors for clinically relevant anastomotic leak after elective right colectomy for cancer. Age and preoperative nutritional status determined the mortality risk, while laparoscopic approach reduced postoperative morbidity.

  10. Influence of yoga on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery

    Directory of Open Access Journals (Sweden)

    Rao Raghavendra

    2008-01-01

    Full Text Available Context : Pre- and postoperative distress in breast cancer patients can cause complications and delay recovery from surgery. Objective : The aim of our study was to evaluate the effects of yoga intervention on postoperative outcomes and wound healing in early operable breast cancer patients undergoing surgery. Methods : Ninety-eight recently diagnosed stage II and III breast cancer patients were recruited in a randomized controlled trial comparing the effects of a yoga program with supportive therapy and exercise rehabilitation on postoperative outcomes and wound healing following surgery. Subjects were assessed at the baseline prior to surgery and four weeks later. Sociodemographic, clinical and investigative notes were ascertained in the beginning of the study. Blood samples were collected for estimation of plasma cytokines-soluble Interleukin (IL-2 receptor (IL-2R, tumor necrosis factor (TNF-alpha and interferon (IFN-gamma. Postoperative outcomes such as the duration of hospital stay and drain retention, time of suture removal and postoperative complications were ascertained. We used independent samples t test and nonparametric Mann Whitney U tests to compare groups for postoperative outcomes and plasma cytokines. Regression analysis was done to determine predictors for postoperative outcomes. Results : Sixty-nine patients contributed data to the current analysis (yoga: n = 33, control: n = 36. The results suggest a significant decrease in the duration of hospital stay ( P = 0.003, days of drain retention ( P = 0.001 and days for suture removal ( P = 0.03 in the yoga group as compared to the controls. There was also a significant decrease in plasma TNF alpha levels following surgery in the yoga group ( P < 0.001, as compared to the controls. Regression analysis on postoperative outcomes showed that the yoga intervention affected the duration of drain retention and hospital stay as well as TNF alpha levels. Conclusion : The results suggest

  11. Diagnosis, Prevention and Management of Postoperative Pulmonary Edema

    OpenAIRE

    Bajwa, SJ Singh; Kulshrestha, A

    2012-01-01

    Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema...

  12. Risk Factors Associated with Discordant Ki-67 Levels between Preoperative Biopsy and Postoperative Surgical Specimens in Breast Cancers.

    Directory of Open Access Journals (Sweden)

    Hyung Sun Kim

    Full Text Available The Ki-67 labelling index is significant for the management of breast cancer. However, the concordance of Ki-67 expression between preoperative biopsy and postoperative surgical specimens has not been well evaluated. This study aimed to find the correlation in Ki-67 expression between biopsy and surgical specimens and to determine the clinicopathological risk factors associated with discordant values.Ki-67 levels were immunohistochemically measured using paired biopsy and surgical specimens in 310 breast cancer patients between 2008 and 2013. ΔKi-67 was calculated by postoperative Ki-67 minus preoperative levels. The outliers of ΔKi-67 were defined as [lower quartile of ΔKi-67-1.5 × interquartile range (IQR] or (upper quartile + 1.5 × IQR and were evaluated according to clinicopathological parameters by logistic regression analysis.The median preoperative and postoperative Ki-67 levels were 10 (IQR, 15 and 10 (IQR, 25, respectively. Correlation of Ki-67 levels between the two specimens indicated a moderately positive relationship (coefficient = 0.676. Of 310 patients, 44 (14.2% showed outliers of ΔKi-67 (range, ≤-20 or ≥28. A significant association with poor prognostic factors was found among these patients. Multivariate analysis determined that significant risk factors for outliers of ΔKi-67 were tumor size >1 cm, negative progesterone receptor (PR expression, grade III cancer, and age ≤35 years. Among 171 patients with luminal human epidermal growth factor receptor 2-negative tumors, breast cancer subtype according to preoperative or postoperative Ki-67 levels discordantly changed in 46 (26.9% patients and a significant proportion of patients with discordant cases had ≥1 risk factor.Ki-67 expression showed a substantial concordance between biopsy and surgical specimens. Extremely discordant Ki-67 levels may be associated with aggressive tumor biology. In patients with luminal subtype disease, clinical application of Ki-67

  13. Incidence, prognostic factors and impact of postoperative delirium after major vascular surgery: A meta-analysis and systematic review.

    Science.gov (United States)

    Aitken, Sarah Joy; Blyth, Fiona M; Naganathan, Vasi

    2017-10-01

    Although postoperative delirium is a common complication and increases patient care needs, little is known about the predictors and outcomes of delirium in patients having vascular surgery. This review aimed to determine the incidence, prognostic factors and impact of postoperative delirium in vascular surgical patients. MEDLINE and EMBASE were systematically searched for articles published between January 2000 and January 2016 on delirium after vascular surgery. The primary outcome was the incidence of delirium. Secondary outcomes were contributing prognostic factors and impact of delirium. Study quality and risk of bias was assessed using the QUIPS tool for systematic reviews of prognostic studies, and MOOSE guidelines for reviews of observational studies. Quantitative analyses of extracted data were conducted using meta-analysis where possible to determine incidence of delirium and prognostic factors. A qualitative review of outcomes was performed. Fifteen articles were eligible for inclusion. Delirium incidence ranged between 5% and 39%. Meta-analysis found that patients with delirium were older than those without delirium (OR 3.6, pdelirium included increased age (OR 1.04, pdelirium. Data were limited on the impact of procedure complexity, endovascular compared to open surgery or type of anaesthetic. Postoperative delirium occurs frequently, resulting in major morbidity for vascular patients. Improved quality of prognostic studies may identify modifiable peri-operative factors to improve quality of care for vascular surgical patients.

  14. Influence of accompanying immunocorrecting therapy on the quality of life of breast cancer patients at post-operative radiation therapy

    International Nuclear Information System (INIS)

    Prokhach, N.E.

    2013-01-01

    To investigate the influence of accompanying immunotherapy on the parameters of the quality of life of the patients with breast cancer with various profiles of cytokines at post-operative radiation therapy. The study was performed on 30 breast cancer patients at stages of combination therapy

  15. Therapeutic effect of radiofrequency ablation on children with supraventricular tachycardia and the risk factors for postoperative recurrence.

    Science.gov (United States)

    Li, Chunli; Jia, Libo; Wang, Zhenzhou; Niu, Ling; An, Xinjiang

    2018-05-01

    The present study investigated the therapeutic effect of radiofrequency ablation on children with supraventricular tachycardia (SVT), and explored the risk factors for postoperative recurrence. A total of 312 patients with pediatric SVT were selected in the Affiliated Children's Hospital of Xuzhou Medical University from April, 2011 to March, 2017. All the patients were subjected to radiofrequency ablation, and clinical data were retrospectively analyzed. Tilt table test was performed before and after treatment, and heart rate, systolic and diastolic blood pressure before and after treatment were compared. Plasma levels of D-dimer (D-D), platelet α-granule membrane protein (GMP-140) and thrombin-antithrombin III complex (TAT) were detected by enzyme-linked immunosorbent assay before treatment, immediately after radiofrequency oblation, and at 1, 3 and 7 days after treatment. Treatment outcomes were compared between the atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT) groups. Risk factors for postoperative recurrence were analyzed. Supine position heart rate after treatment was not significantly different from that before treatment (P>0.05), while the upright position heart rate was significantly increased after treatment (P0.05). No significant difference in radiofrequency ablation rate, recurrence rate and incidence of complications were found between the AVRT and AVNRT groups (P>0.05). After radiofrequency, the levels of D-D, GMP-140 and TAT ablation showed an upward trend, but decreased at day 7 to reach preoperative levels. Logistic regression analysis revealed that residual slow pathway (OR=6.718, P=0.005) and inaccurate targeting (OR=2.815, P=0.007) were independent risk factors for postoperative recurrence (Pradiofrequency ablation can damage the cardiac vagal nerve, resulting in an increase in the heart rate after ablation during the course of the tilt table test and changed hemagglutination state

  16. Incidence and risk factors for postoperative lingual neuropraxia following airway instrumentation: A retrospective matched case-control study.

    Directory of Open Access Journals (Sweden)

    Yi-Kai Su

    Full Text Available Lingual nerve injury or neuropraxia is a rare but potentially serious perioperative complication following airway instrumentation during general anesthesia. This study explored the the incidence and perioperative risk factors for lingual nerve injury in patients receiving laryngeal mask (LMA or endotracheal (ETGA general anesthesia in a single center experience.All surgical patients in our hospital who received LMA or ETGA from 2009 to 2013 were included, and potential perioperative risk factors were compared. Matched controls were randomly selected (in 1:5 ratio from the same database in non-case patients. A total of 36 patients in the records had reported experiencing tongue numbness after anesthesia in this study. Compared with the non-case surgical population (n = 54314, patients with tongue numbness were significantly younger (52.2±19.5 vs 42.0±14.5; P = 0.002 and reported lower ASA physical statuses (2.3±0.7 vs 1.6±0.6; P<0.001. Patient gender, anesthesia technique used, and airway device type (LMA or ETGA did not differ significantly across the two groups. A significantly higher proportion of patients underwent operations of the head-and-neck region (38.9 vs 15.6%; P = 0.002 developed tongue numbness after anesthesia. Multivariate logistic regression analysis indicated that head-and-neck operations remained the most significant independent risk factor for postoperative lingual nerve injury (AOR 7.63; 95% CI 2.03-28.70.The overall incidence rate of postoperative lingual neuropraxy was 0.066% in patients receiving general anesthesia with airway device in place. Young and generally healthy patients receiving head-and-neck operation are at higher risk in developing postoperative lingual neuropraxy. Attention should be particularly exercised to reduce the pressure of endotracheal tube or laryngeal mask on the tongue during head-and-neck operation to avert the occurrence of postoperative lingual neuropraxy.

  17. Surgery for hepatic hidatidosis. Risk factors and variables associated with postoperative morbidity. Overview of the existing evidence.

    Science.gov (United States)

    Manterola, Carlos; Otzen, Tamara; Muñoz, Gloria; Alanis, Martín; Kruuse, Eileen; Figueroa, Gustavo

    2017-12-01

    There are few publications related to postoperative morbidity in hepatic hydatidosis and these have mixed results. The aim of this study was to determine risk and protective factors of postoperative morbidity in patients operated on for hepatic hydatidosis. A comprehensive review was made of the evidence, based on systematic reviews, clinical analyses and observational studies, obtained from the Trip Database, BVS, SciELO, Cochrane Central Register of Controlled Trials, WoS, MEDLINE, EMBASE, SCOPUS, EBSCOhost, IBECS, ePORTUGUESe, LILACS and WHOLIS. 1,087 related articles were identified; 69 fulfilled the selection criteria (2 systematic reviews, 3 clinical trials and 64 observational studies). Age, history of previous surgery for hepatic hydatidosis, location in the hepatic center, existence of biliary communications and evolutionary complications of the cyst were identified as risk factors, and radical surgical techniques as protective factors. Risk and protective factors were identified; however, the studies are few and the quality moderate to low. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  18. Is postoperative cognitive dysfunction a risk factor for dementia?

    DEFF Research Database (Denmark)

    Steinmetz, J; Siersma, Volkert Dirk; Kessing, L V

    2013-01-01

    BACKGROUND: /st>Postoperative cognitive dysfunction (POCD) is a common complication in elderly patients after major surgery. An association between POCD and the development of dementia has been suspected. In this study, we assessed if POCD was a risk factor for the occurrence of dementia. METHODS...... surgery, using a neuropsychological test battery. The time of (first) occurrence of dementia after surgery was assessed using the National Patient Register and the Psychiatric Central Research Register. Recorded dementia diagnoses (ICD-8 and ICD-10) were: Alzheimer's disease, vascular dementia......, frontotemporal dementia, or dementia without specification. The risk of dementia according to POCD was assessed in the Cox regression models. RESULTS: /st>A total of 686 patients with a median age of 67 [inter-quartile range (IQR) 61-74] yr were followed for a median of 11.1 (IQR 5.2-12.6) yr. Only 32 patients...

  19. FACTORS ASSOCIATED WITH VISUAL OUTCOME AFTER MACULA-OFF RHEGMATOGENOUS RETINAL DETACHMENT SURGERY.

    Science.gov (United States)

    Park, Dae Hyun; Choi, Kyung Seek; Sun, Hae Jung; Lee, Sung Jin

    2018-01-01

    To evaluate preoperative factors influencing the visual outcome and postoperative factors associated with the changes in visual acuity, after reattachment surgery to treat macula-off rhegmatogenous retinal detachment. A total of 180 eyes of 180 patients who underwent reattachment surgery to treat macula-off rhegmatogenous retinal detachment, and who were followed up for more than 12 months, were reviewed retrospectively. Preoperative and postoperative characteristics, including optical coherence tomography findings, were comprehensively analyzed using univariate and multivariate models to evaluate preoperative factors influencing best-corrected visual acuity 12 months after macula-off rhegmatogenous retinal detachment surgery and postoperative factors associated with changes in best-corrected visual acuity after surgery. Preoperatively, the extent of detachment (P = 0.037), macula-off duration (P macula-off rhegmatogenous retinal detachment surgery were the extent of detachment, macula-off duration, and external limiting membrane integrity. Postoperatively, predictive factors were the outer retinal microstructures, particularly the photoreceptor outer segment layer.

  20. The effect of postoperative symptom experience, and personality and psychosocial factors on depression among postgastrectomy patients in Japan.

    Science.gov (United States)

    Maeda, Takako; Onuoha, Francis N; Munakata, Tsunetsugu

    2006-01-01

    Depression, the most common affective disorder in cancer, has a major impact on quality of life. Various risk factors may interact and affect a cancer patient's depressive state. The purpose of this study was to examine the relationships between depression and postoperative symptom experience, personality, and psychosocial factors in Japanese gastrectomy patients. Causal relationships of these variables were also estimated. Eighty-two Japanese gastrectomy patients (M age = 63.63 years, SD = 10.21; men = 50, women = 32), who had been discharged within the last 3 years with no indication of cancer recurrence, participated in the study. Results showed significant correlations between depression and age, time-since-discharge, postoperative symptom experience, frequency of symptoms, self-esteem, and emotional support. Path analysis showed sufficient goodness of fit index (GFI = 0.993, AGFI = 0.963). Interpersonal dependency, emotional support, and marital status showed a direct effect on self-esteem, which, along with postoperative symptom experience, had a direct effect on depression. Findings provide a useful reference point for further understanding the mental health condition of postgastrectomy patients.

  1. Early Postoperative Nociceptive Threshold and Production of Brain-Derived Neurotrophic Factor Induced by Plantar Incision Are Not Influenced with Minocycline in a Rat: Role of Spinal Microglia

    Directory of Open Access Journals (Sweden)

    Eiji Masaki

    2016-03-01

    Full Text Available Background: Brain-derived neurotrophic factor (BDNF from spinal microglia is crucial for aberrant nociceptive signaling in several pathological pain conditions, including postoperative pain. We assess the contribution of spinal microglial activation and associated BDNF overexpression to the early post-incisional nociceptive threshold. Methods: Male Sprague-Dawley rats were implanted with an intrathecal catheter. A postoperative pain model was established by plantar incision. Thermal and mechanical nociceptive responses were assessed by infrared radiant heat and von Frey filaments before and after plantar incision. Rats were injected intrathecally the microglial activation inhibitor minocycline before incision, 24 h after incision, or both. Other groups were subjected to the same treatments and the L4-L5 spinal cord segment removed for immunohistochemical analysis of microglia activation and BNDF expression. Results: Plantar incision reduced both thermal latency and mechanical threshold, indicating thermal hypersensitivity and mechanical allodynia. Minocycline temporally reduced thermal withdrawal latency but had no effect on mechanical withdrawal threshold, spinal microglial activity, or dorsal horn BDNF overexpression during the early post-incision period. Conclusion: These results suggest that spinal microglia does not contribute substantially to post-incisional nociceptive threshold. The BDNF overexpression response that may contribute to postoperative hyperalgesia and allodynia is likely derived from other sources.

  2. Postoperative rhabdomyolysis following robotic renal and adrenal surgery: a cautionary tale of compounding risk factors.

    Science.gov (United States)

    Terry, Russell S; Gerke, Travis; Mason, James B; Sorensen, Matthew D; Joseph, Jason P; Dahm, Philipp; Su, Li-Ming

    2015-09-01

    This study aimed at reviewing a contemporary series of patients who underwent robotic renal and adrenal surgery by a single surgeon at a tertiary referral academic medical center over a 6-year period, specifically focusing on the unique and serious complication of post-operative rhabdomyolysis of the dependent lower extremity. The cases of 315 consecutive patients who underwent robotic upper tract surgery over a 6-year period from August 2008 to June 2014 using a standardized patient positioning were reviewed and analyzed for patient characteristics and surgical variables that may be associated with the development of post-operative rhabdomyolysis. The incidence of post-operative rhabdomyolysis in our series was 3/315 (0.95%). All three affected patients had undergone robotic nephroureterectomy. Those patients who developed rhabdomyolysis had significantly higher mean Body Mass Index, Charlson Comorbidity Index, and median length of stay than those who did not. The mean OR time in the rhabdomyolysis group was noted to be 52 min longer than the non-rhabdomyolysis group, though this value did not reach statistical significance. Given the trends of increasing obesity in the United States and abroad as well as the continued rise in robotic upper tract urologic surgeries, urologists need to be increasingly vigilant for recognizing the risk factors and early treatment of the unique complication of post-operative rhabdomyolysis.

  3. Pre-operative and early post-operative factors associated with surgical site infection after laparoscopic sleeve gastrectomy.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Oller, Inmaculada; Llavero, Carolina; Arroyo, Antonio; Muñoz, Jose Luis; Calero, Alicia; Diez, María; Zubiaga, Lorea; Calpena, Rafael

    2013-08-01

    Surgical procedures on obese patients are expected to have a high incidence of surgical site infection (SSI). The identification of pre-operative or early post-operative risk factors for SSI may help the surgeon to identify subjects in risk and adequately optimize their status. We conducted a study of the association of comorbidities and pre- and post-operative analytical variables with SSI following laparoscopic sleeve gastrectomy for the treatment of morbid obesity. We performed a prospective study of all morbidly obese patients undergoing laparoscopic sleeve gastrectomy as a bariatric procedure between 2007 and 2011. An association of clinical and analytical variables with SSI was investigated. The study included 40 patients with a mean pre-operative body mass index (BMI) of 51.2±7.9 kg/m(2). Surgical site infections appeared in three patients (7.5%), of whom two had an intra-abdominal abscess located in the left hypochondrium and the third had a superficial incisional SSI. Pre-operatively, a BMI >45 kg/m(2) (OR 8.7; p=0.008), restrictive disorders identified by pulmonary function tests (OR 10.0; p=0.012), a serum total protein concentration 30 mcg/dL (OR 13.0; p=0.003), and a mean corpuscular volume (MCV) operative SSI. Post-operatively, a serum glucose >128 mg/dL (OR 4.7; p=0.012) and hemoglobin operative anemia and hyperglycemia as risk factors for SSI. In these situations, the surgeon must be aware of and seek to control these risk factors.

  4. A prospective cohort study of postoperative complications in the management of perforated peptic ulcer.

    Science.gov (United States)

    Sharma, Smita S; Mamtani, Manju R; Sharma, Mamta S; Kulkarni, Hemant

    2006-06-16

    With dwindling rates of postoperative mortality in perforated peptic ulcer that is attributable to H2-receptor blocker usage, there is a need to shift the focus towards the prevention of postoperative morbidity. Further, the simultaneous contribution of several putative clinical predictors to this postoperative morbidity is not fully appreciated. Our objective was to assess the predictors of the risk, rate and number of postoperative complications in surgically treated patients of perforated peptic ulcer. In a prospective cohort study of 96 subjects presenting as perforated peptic ulcer and treated using Graham's omentoplatsy patch or gastrojejunostomy (with total truncal vagotomy), we assessed the association of clinical predictors with three domains of postoperative complications: the risk of developing a complication, the rate of developing the first complication and the risk of developing higher number of complications. We used multiple regression methods - logistic regression, Cox proportional hazards regression and Poisson regression, respectively - to examine the association of the predictors with these three domains. We observed that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness [odds ratio (OR) = 8.9, p = 0.001], abdominal distension (3.8, 0.048) and a need of blood transfusion (OR = 8.2, p = 0.027). Using Poisson regression, it was observed that the risk for a higher number of complications was influenced by the same three factors [relative risk (RR) = 2.6, p = 0.015; RR = 4.6, p management in patients of perforated peptic ulcer.

  5. [Risk factors and frequency of postoperative nausea and vomiting in patients operated under general anesthesia].

    Science.gov (United States)

    Grabowska-Gaweł, Anna; Porzych, Katarzyna; Piskunowicz, Grazyna

    2006-01-01

    Postoperative nausea and vomiting belong to fairly frequent postoperative complications, but they occupy a distant position on the list of complications, which most probably result from a general conviction that they do not pose a direct threat to patients. The objective of this work is specification of factors facilitating occurrence of postoperative nausea and vomiting, and determination of frequency of their occurrence in patients operated under general anesthesia. Questionnaire about the occurrence of postoperative nausea and vomiting (PONV), was carried out and included 253 adult sick persons (102 female and 151 male patients), in the age between 23-76 (average 42.3 +/- 6.1 years), who had undergone operative procedure in the field of abdominal and urology surgery, orthopedic, thyroid surgery and laryngological, ophthalmology and plastic surgery, under general anesthesia. The questionnaire form included preoperative characteristics of a patient (age, sex, smoking, motion sickness and migraine headaches in history, and PONV occurring earlier), type of operative procedure, used anesthetic agents, and analgesic agents applied in postoperative analgesia. The anesthesiologist administering anesthetic was not informed about the investigation carried out and did not receive any additional pieces of advice regarding the type of applied anesthetic agents or the method of conducting postoperative analgesia. Visual Analogue Scale (VAS) was used in the evaluation of nausea. Nausea and vomiting were assessed every two hours within the first postoperative 12 hours and every 4 hours for the next 24 hours. Nausea and vomiting were treated as two separate complications. Nausea itself occurred in 22.7% of patients; whereas vomiting in 13.2%. Both symptoms occurred in 14.2% of patients. Nausea occurred 4.1 +/- 0.8 hours after operation; whereas vomiting after 5.3 +/- 1.1 hours. Women suffered more often than men from (R = 0.678 p patients suffering from PONV earlier (R = 0

  6. Evaluation of Factors Influencing Liver Function Test in On-Pump Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Shahrbano Shahbazi

    2013-12-01

    Full Text Available Background: Liver dysfunction during on-pump coronary artery bypass graft surgery (CABG is a rare complication but is associated with significant morbidity and mortality. The ability to identify high-risk patients may be helpful in planning appropriate management strategies. We aimed to evaluate the factors influencing liver function tests during on-pump CABG. Methods: In 146 patients scheduled for on-pump CABG, the liver function test was done preoperatively and on the first postoperative day. Some preoperative and intraoperative risk factors were checked and then the postoperative liver function tests were compared with the preoperative ones. Probable relationships between these changes and the preoperative and intraoperative risk factors were studied. Results: A medical history of diabetes had a significant relationship with the changes in direct bilirubin. Preoperative central venous pressure had a significant relationship with the changes in aspartate aminotransferase and alanine aminotransferase. Use of intra-aortic balloon pump and duration of aortic cross-clamp were significantly related to the changes in the liver function tests except for alanine aminotransferase and alkaline phosphatase. Conclusion: It seems that the techniques for the reduction of cardiopulmonary bypass and aortic cross-clamp duration may be useful to protect liver function. We recommend that a larger population of patients be studied to confirm these findings.

  7. Outcome measures in stapes surgery: postoperative results are independent from preoperative parameters.

    Science.gov (United States)

    Koopmann, Mario; Weiss, Daniel; Savvas, Eleftherios; Rudack, Claudia; Stenner, Markus

    2015-09-01

    The aim of this study was to compare audiometric results before and after stapes surgery and identify potential prognostic factors to appropriately select patients with otosclerosis who will most likely benefit from surgery. We enrolled 126 patients with otosclerosis (162 consecutive ears) in our study who underwent stapes surgery between 2007 and 2012 at our institution. Preoperative and postoperative data including pure-tone audiometry, speech audiometry, stapedial reflex audiometry and surgical data were analyzed. The average preoperative air-bone gap (ABG) was 28.9 ± 8.6 dB. Male patients and patients older than 45 years of age had greater preoperative ABGs in comparison to females and younger patients. Postoperative ABGs were 11.2 ± 7.4 dB. The average ABG gain was 17.7 ± 11.1 dB. Preoperative audiometric data, age, gender and type of surgery did not influence the postoperative results. Stapes surgery offers predictable results independent from disease progression or patient-related factors. While absolute values of hearing improvement are instrumental in reflecting audiometric results of a cohort, relative values better reflect individual's audiometric data resembling the patient's benefit.

  8. Effects of posture on postoperative pulmonary function

    DEFF Research Database (Denmark)

    Nielsen, K G; Holte, Kathrine; Kehlet, H

    2003-01-01

    effect on postoperative pulmonary function in the sitting or standing position compared with the supine. Thus, avoidance of the supine position may improve postoperative pulmonary function. Three of six studies showed a positive effect on postoperative pulmonary function of the lateral side compared......BACKGROUND: Pulmonary morbidity is still a relevant complication to major surgery despite improvements in surgical technique and anaesthetic methods. Postoperative posture may be a pathogenic factor, but the effects of changes in postoperative posture on pulmonary function have not been reviewed...... with the supine. Thus, the lateral position has limited effects on pulmonary function. CONCLUSION: Changes of postoperative position from supine to sitting or standing are of major importance in the interpretation of postoperative pulmonary outcome studies and in future strategies to improve pulmonary outcome....

  9. Risk factors for postoperative retropharyngeal hematoma after anterior cervical spine surgery.

    Science.gov (United States)

    O'Neill, Kevin R; Neuman, Brian; Peters, Colleen; Riew, K Daniel

    2014-02-15

    Retrospective review of prospective database. To investigate risk factors involved in the development of anterior cervical hematomas and determine any impact on patient outcomes. Postoperative (PO) hematomas after anterior cervical spine surgery require urgent recognition and treatment to avoid catastrophic patient morbidity or death. Current studies of PO hematomas are limited. Cervical spine surgical procedures performed on adults by the senior author at a single academic institution from 1995 to 2012 were evaluated. Demographic data, surgical history, operative data, complications, and neck disability index (NDI) scores were recorded prospectively. Cases complicated by PO hematoma were reviewed, and time until hematoma development and surgical evacuation were determined. Patients who developed a hematoma (HT group) were compared with those that did not (no-HT group) to identify risk factors. NDI outcomes were compared at early (11 mo) time points. There were 2375 anterior cervical spine surgical procedures performed with 17 occurrences (0.7%) of PO hematoma. In 11 patients (65%) the hematoma occurred within 24 hours PO, whereas 6 patients (35%) presented at an average of 6 days postoperatively. All underwent hematoma evacuation, with 2 patients (12%) requiring emergent cricothyroidotomy. Risk factors for hematoma were found to be (1) the presence of diffuse idiopathic skeletal hyperostosis (relative risk = 13.2, 95% confidence interval = 3.2-54.4), (2) presence of ossification of the posterior longitudinal ligament (relative risk = 6.8, 95% confidence interval = 2.3-20.6), (3) therapeutic heparin use (relative risk 148.8, 95% confidence interval = 91.3-242.5), (4) longer operative time, and (5) greater number of surgical levels. The occurrence of a PO hematoma was not found to have a significant impact on either early (HT: 30, no-HT: 28; P = 0.86) or late average NDI scores (HT: 28, no-HT 31; P = 0.76). With fast recognition and treatment, no long-term detriment

  10. Factors Influencing of Social Conflict

    Directory of Open Access Journals (Sweden)

    Suwandi Sumartias

    2013-07-01

    Full Text Available Social conflicts that occur in several areas in Indonesia lately, one of them is caused by the weakness of law certainty. This is feared to threaten the integration of the Republic of Indonesia. This study aims to determine the factors that affect social conflict in Manis Lor village in Kuningan district. The method used the explanatory quantitative methods, the statistical test Path Analysis. The study population was a formal and informal community leaders (village chief, clergy, and youth, and the people who involved in a conflict in Manis Lor village Kuningan regency. The result shows a There is no significant influence between social identity factors with social conflict anarchist. b There is significant influence between socio-economic factors with social conflict anarchists. c There is no significant influence between the credibility factor anarchist leaders with social conflict. d There is no significant influence between the motive factor with anarchist social conflict. e There is significant influence between personality factors/beliefs with anarchist social conflict. f There is significant influence of behavioral factors anarchist communication with social conflict.

  11. Influence of esmolol on requirement of inhalational agent using entropy and assessment of its effect on immediate postoperative pain score

    Directory of Open Access Journals (Sweden)

    Bhawna

    2012-01-01

    Full Text Available Background and Context: Beta - blockers have been used for attenuation of stress response, decreasing anaesthetic requirement and augmentation of the effect of opioids during general anaesthesia. Aims and Objectives: The present study aims to evaluate the influence of esmolol on the requirement of an inhalational agent while monitoring the depth of anaesthesia by entropy and also its effect on immediate postoperative pain score. Methods: Fifty American Society of Anaesthesiologists (ASA I and II patients, between 25 and 65 years of age who underwent lower abdominal surgeries were randomly allocated to two groups: Group E and Group S of 25 patients each. Group E received esmolol infusion while Group S received the same volume of saline infusion. Demographic data, haemodynamics, amount of isoflurane used, end-tidal isoflurane concentration, postoperative pain score and total dose of morphine consumed in immediate postoperative period of 30 min were analyzed by using appropriate statistical tests. Value of P<0.05 was considered significant and P<0.001 as highly significant. Results: The two groups were comparable with respect to age, weight, ASA physical status, duration of surgery and amount of isoflurane used during anaesthesia. Assessment of postoperative pain was assessed by Visual Analogue Scale (VAS which showed significant difference at 30 min. The total dose of morphine consumption was significantly less (P<0.05 in Group E for relief of postoperative pain. Conclusions: We conclude that in light of depth of anaesthesia monitor esmolol has no effect on requirement of isoflurane, but it decreases the postoperative pain as well as postoperative requirement of morphine without increasing the risk of awareness.

  12. A prospective cohort study of postoperative complications in the management of perforated peptic ulcer

    Directory of Open Access Journals (Sweden)

    Sharma Mamta S

    2006-06-01

    Full Text Available Abstract Background With dwindling rates of postoperative mortality in perforated peptic ulcer that is attributable to H2-receptor blocker usage, there is a need to shift the focus towards the prevention of postoperative morbidity. Further, the simultaneous contribution of several putative clinical predictors to this postoperative morbidity is not fully appreciated. Our objective was to assess the predictors of the risk, rate and number of postoperative complications in surgically treated patients of perforated peptic ulcer. Methods In a prospective cohort study of 96 subjects presenting as perforated peptic ulcer and treated using Graham's omentoplatsy patch or gastrojejunostomy (with total truncal vagotomy, we assessed the association of clinical predictors with three domains of postoperative complications: the risk of developing a complication, the rate of developing the first complication and the risk of developing higher number of complications. We used multiple regression methods – logistic regression, Cox proportional hazards regression and Poisson regression, respectively – to examine the association of the predictors with these three domains. Results We observed that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness [odds ratio (OR = 8.9, p = 0.001], abdominal distension (3.8, 0.048 and a need of blood transfusion (OR = 8.2, p = 0.027. Using Poisson regression, it was observed that the risk for a higher number of complications was influenced by the same three factors [relative risk (RR = 2.6, p = 0.015; RR = 4.6, p - blood group (RH = 4.7, p = 0.04. Conclusion Abdominal distension, presence of a concomitant medical illness and a history suggestive of shock at the time of admission warrant a closer and alacritous postoperative management in patients of perforated peptic ulcer.

  13. Keratinocyte Growth Factor Combined with a Sodium Hyaluronate Gel Inhibits Postoperative Intra-Abdominal Adhesions

    Directory of Open Access Journals (Sweden)

    Guangbing Wei

    2016-09-01

    Full Text Available Postoperative intra-abdominal adhesion is a very common complication after abdominal surgery. One clinical problem that remains to be solved is to identify an ideal strategy to prevent abdominal adhesions. Keratinocyte growth factor (KGF has been proven to improve the proliferation of mesothelial cells, which may enhance fibrinolytic activity to suppress postoperative adhesions. This study investigated whether the combined administration of KGF and a sodium hyaluronate (HA gel can prevent intra-abdominal adhesions by improving the orderly repair of the peritoneal mesothelial cells. The possible prevention mechanism was also explored. The cecum wall and its opposite parietal peritoneum were abraded after laparotomy to induce intra-abdominal adhesion formation. Animals were randomly allocated to receive topical application of HA, KGF, KGF + HA, or normal saline (Control. On postoperative day 7, the adhesion score was assessed with a visual scoring system. Masson’s trichrome staining, picrosirius red staining and hydroxyproline assays were used to assess the magnitude of adhesion and tissue fibrosis. Cytokeratin, a marker of the mesothelial cells, was detected by immunohistochemistry. The levels of tissue plasminogen activator (tPA, interleukin-6 (IL-6, and transforming growth factor β1 (TGF-β1 in the abdominal fluid were determined using enzyme-linked immunosorbent assays (ELISAs. Western blotting was performed to examine the expression of the TGF-β1, fibrinogen and α-smooth muscle actin (α-SMA proteins in the rat peritoneal adhesion tissue. The combined administration of KGF and HA significantly reduced intra-abdominal adhesion formation and fibrin deposition and improved the orderly repair of the peritoneal mesothelial cells in the rat model. Furthermore, the combined administration of KGF and HA significantly increased the tPA levels but reduced the levels of IL-6, tumor necrosis factor α (TNF-α and TGF-β1 in the abdominal fluid. The

  14. Effects of posture on postoperative pulmonary function

    DEFF Research Database (Denmark)

    Nielsen, K G; Holte, Kathrine; Kehlet, H

    2003-01-01

    BACKGROUND: Pulmonary morbidity is still a relevant complication to major surgery despite improvements in surgical technique and anaesthetic methods. Postoperative posture may be a pathogenic factor, but the effects of changes in postoperative posture on pulmonary function have not been reviewed...

  15. Risk Factors for Postoperative Encephalopathies in Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    A. N. Shepelyuk

    2012-01-01

    Full Text Available Objective: to reveal risk factors for postoperative neurological complications (PONC during surgery under extracorporeal circulation (EC. Subjects and methods. Five hundred and forty-eight patients were operated on under EC. Multimodality monitoring was performed in all the patients. Pre-, intra-, and postoperative data were analyzed. Results. Two patient groups were identified. These were 1 59 patients with PONC and 2 489 patients without PONC. The patients with PONC were older than those without PONC (61.95±1.15 and 59±0.4 years and had a smaller body surface area (1.87±0.02 and 1.97±0.01 m2; in the PONC group, there were more women (37.3±6.4 and 22.1±1.9%. In Group 1, comorbidity was a significantly more common indication for surgery (33.9±6.22 and 9.2±1.29%. In this group, cerebral oxygenation (CO was significantly lower (64±1.41 and 69.9±0.38%. In the preoperative period, there were group differences in hemoglobin (Hb, total protein, creatinine, and urea (135±2.03; 142±0.71 g/l, 73±0.93; 74.9±0.3 mmol/l, 104.7±3.3; 96.3±1.06 mmol/l, 7.5±0.4; 6.5±0.1 mmol/l, respectively. The PONC group more frequently exhibited more than 50% internal carotid artery (ICA stenosis (28.8±5.95; 15.3± 1.63%; р<0.05, dyscirculatory encephalopathies (DEP (38.9±6.4 and 19.4±1.8%; р<0.05, CO, Hb, hematocrit, and oxygen delivery were lower in Group 1 at all stages. In the preperfusion period, cardiac index was lower in Group 1 (2.3±0.1 and 2.5±0.03 l/min/m2; р<0.01. In the postper-fusion period, blood pressure was lower in Group 1 (72.3±1.4 and 76.4±0.47 mm Hg; р=0.007 and higher rate was higher (92.65±1.5 and 88.16±0.49 min-1; р=0.007. Lower PCO2a was noted in Group 1. In this group, the patients were given epinephrine more frequently (33.9±6.2 and 20.5±1.8%; р<0.05 and in larger dosages (0.02±0.001 and 0.01±0.003 ^g/kg/min; р<0.05. Conclusion. The preoperative risk factors of CONC is female gender, lower body surface area

  16. Postoperative mortality and morbidity in octogenarians and nonagenarians with hip fracture: an analysis of perioperative risk factors

    Directory of Open Access Journals (Sweden)

    MA Ren-shi

    2012-02-01

    Full Text Available 【Abstract】Objective: To evaluate the role of high risk factors in octogenarians and nonagenarians with hip trauma, which may lead to excessive mortality and morbi- dity postoperatively. Methods: Fifty-four octogenarians and nonagenarians patients were enrolled in the study, receiving surgical repair of hip fracture in our hospital from January 2006 to January 2010. High risk factors were recorded preoperatively in detail. Complications and survival state were followed up by telephone for 2 years postoperatively. All the data were analyzed by Chi-square test with SPSS 13.0. Results: Twenty-six males (48.1%, aged from 80 to 94 years with a mean age of 84.2 years, and twenty-eight females (51.9%, aged from 80 to 95 years with a mean age of 83.4 years, were presented in the cohort study. The hip traumas were caused by daily slight injuries (52 cases and car accidents (2 cases, respectively. Twenty-eight patients (51.9% with femoral neck fracture while 26 patients (48.1% with intertrochanteric fracture were diagnosed through an anterior-posterior pelvic radiophotograph. In this series, 39 patients (72.2% suffered from one or more comorbidities preoperatively. The morbidity was 48.1% and the major cause was urinary tract infection, while a significant difference was noted between females and males. The mortality was 20.4% with a predominant cause of acute renal failure. Conclusions: The gender should be considered as a critical high risk factor in octogenarians and nonagenarians with hip trauma postoperatively. Females are more likely to suffer complications postoperatively, which is especially obvious in senile patients over 80 years (P<0.05. Urinary tract infection is the most frequent complication after hip surgery, followed by low limb embolism and malnutrition. The mortality is dramatically greater in patients over 80 years old than those below, and major causes are acute renal failure, multiple organ dysfunction syndrome and mental

  17. Postoperative adjuvant therapy of breast cancer. Oncology Overview

    International Nuclear Information System (INIS)

    1984-12-01

    Oncology Overviews are a service of the International Cancer Research Data Bank (ICRDB) Program of the National Cancer Institute, intended to facilitate and promote the exchange of information between cancer scientists by keeping them aware of literature related to their research being published by other laboratories throughout the world. Each Oncology Overview represents a survey of the literature associated with a selected area of cancer research. It contains abstracts of articles which have been selected and organized by researchers associated with the field. Contents: Postoperative chemotherapy; Postoperative radiotherapy; Postoperative hormone therapy; Postoperative immunotherapy and chemoimmunotherapy; Postoperative multimodal therapy; Prognostic factors in postoperative adjuvant therapy

  18. Predisposing factors for postoperative nausea and vomiting in gynecologic tumor patients.

    Science.gov (United States)

    de Souza, Daiane Spitz; Costa, Amine Farias; Chaves, Gabriela Villaça

    2016-11-01

    To evaluate the predictors of postoperative nausea and vomiting (PONV) in women with gynecologic tumor. The analysis was based on prospectively collected data of 82 adult patients with gynecologic tumor, who were submitted to open surgical treatment and undergoing general anesthesia. The predictors included were age ≥50 years, non-smoker, use of postoperative opioids, mechanical bowel preparation, intraoperative intravenous hydration (IH) ≥10 mL/kg/h, and IH in the immediate postoperative, first and second postoperative days (PO1 and PO2) ≥30 mL/kg. A score with predictor variables was built. A multiple logistic regression was fitted. To estimate the discriminating power of the chosen model, a receiver operating characteristic (ROC) curve was plotted and the area under the ROC curve (AUC) was calculated. Statistical significance was set at p value 30 mL/kg of IH in the PO2. The results of the adjusted model showed an increased risk of PONV for each 1-point increase in the score punctuation. The relative risk was higher than 2.0 for vomiting in all period and in the PO1. The ROC curve showed great discrimination of postoperative nausea and vomiting from the proposed score (AUC >0.75). The study population was at high risk of PONV. Therefore, institutional guidelines abolishing modificable variables following temporal evaluation of the effectiveness should be undertaken.

  19. Thirty-day Postoperative Complications following Primary Total Knee Arthroplasty: A Retrospective Study of Incidence and Risk Factors at a Single Center in China

    Directory of Open Access Journals (Sweden)

    Bin Feng

    2017-01-01

    Conclusions: This study highlighted complications with cardiac and respiratory origins as the most common complications within 30 postoperative days following primary TKA. The BMI of ≥30.0 kg/m2 and age ≥80 years were significant risk factors for 30-day postoperative complications.

  20. Inguinal pain syndrome. The influence of intraoperative local administration of 0.5% bupivacaine on postoperative pain control following Lichtenstein hernioplasty. A prospective case-control study.

    Science.gov (United States)

    Cybułka, Bartosz

    2017-04-30

    With current technological advancement and availability of synthetic materials used in inguinal hernia repair, a recurrence after first intervention is not a common and important adverse event. On the other hand, however, some patients complain about chronic pain of the operated site after surgeries using a polypropylene mesh. Many patients are constrained to a prolonged use of analgesics and increased frequency of control visits, which may eventually result in loss of trust in the operator. Every surgical intervention is associated with the risk of immediate or delayed complications. Genitofemoral neuralgia is associated with dysfunction of peripheral nerves passing through the inguinal canal or the surrounding tissue and it is a chronic, troublesome and undesired complication of an inguinal hernia repair. The possibility of minimizing chronic inguinal pain by proper management during herniorraphy should be considered in all cases of an inguinal canal reconstruction. The aim of the study was to investigate whether an intraoperative injection of 0.5% bupivacaine into the operated site (preemptive analgesia) has an influence on the postoperative pain assessed on the day of operation as well as the 1st and 2nd postoperative day after Lichtenstein hernioplasty of an inguinal, scrotal or recurrent hernia. In the studied population, we attempted to identify risk factors affecting pain level after surgical repair of an inguinal, scrotal or recurrent hernia. During the period between December 2015 and May 2016, 133 patients with preoperative diagnosis of an inguinal (81.95%, n=109), scrotal (13.53%, n=18) or recurrent hernia (4.51%, n=6) underwent an elective intervention and were randomly allocated to the group, which intraoperatively received 20 mL of 0.5% bupivacaine locally in selected anatomical points of the inguinal canal. In the group with preoperative diagnosis of an inguinal hernia, this intervention was applied in 56.88% of cases (n=62). In the case of scrotal

  1. Use of Probiotics as Prophylaxis for Postoperative Infections

    Directory of Open Access Journals (Sweden)

    Peter Mangell

    2011-05-01

    Full Text Available Postoperative bacterial infections are common despite prophylactic administration of antibiotics. The wide-spread use of antibiotics in patients has contributed to the emergence of multiresistant bacteria. A restricted use of antibiotics must be followed in most clinical situations. In surgical patients there are several reasons for an altered microbial flora in the gut in combination with an altered barrier function leading to an enhanced inflammatory response to surgery. Several experimental and clinical studies have shown that probiotics (mainly lactobacilli may reduce the number of potentially pathogenia bacteria (PPM and restore a deranged barrier function. It is therefore of interest to test if these abilities of probiotics can be utilized in preoperative prophylaxis. These factors may be corrected by perioperative administration of probiotics in addition to antibiotics. Fourteen randomized clinical trials have been presented in which the effect of such regimens has been tested. It seems that in patients undergoing liver transplantation or elective surgery in the upper gastrointestinal tract prophylactic administration of different probiotic strains in combination with different fibers results in a three-fold reduction in postoperative infections. In parallel there seems to be a reduction in postoperative inflammation, although that has not been studied in a systematic way. The use of similar concepts in colorectal surgery has not been successful in reducing postoperative infections. Reasons for this difference are not obvious. It may be that higher doses of probiotics with longer duration are needed to influence microbiota in the lower gastrointestinal tract or that immune function in colorectal patients may not be as important as in transplantation or surgery in the upper gastrointestinal tract. The favorable results for the use of prophylactic probiotics in some settings warrant further controlled studies to elucidate potential

  2. Ureteroneocystostomy in primary vesicoureteral reflux: critical retrospective analysis of factors affecting the postoperative urinary tract infection rates

    Directory of Open Access Journals (Sweden)

    Hasan Serkan Dogan

    2014-08-01

    Full Text Available Introduction To determine the parameters affecting the outcome of ureteroneocystostomy (UNC procedure for vesicoureteral reflux (VUR. Materials and Methods Data of 398 patients who underwent UNC procedure from 2001 to 2012 were analyzed retrospectively. Different UNC techniques were used according to laterality of reflux and ureteral orifice configuration. Effects of several parameters on outcome were examined. Disappearance of reflux on control VCUG or absence of any kind of UTI/symptoms in patients without control VCUG was considered as clinical improvement. Results Mean age at operation was 59.2 ± 39.8 months and follow-up was 25.6 ± 23.3 months. Grade of VUR was 1-2, 3 and 4-5 in 17, 79, 302 patients, respectively. Male to female ratio was 163/235. UNC was performed bilaterally in 235 patients and intravesical approach was used in 373 patients. The frequency of voiding dysfunction, scar on preoperative DMSA, breakthrough infection and previous surgery was 28.4%, 70.7%, 49.3% and 22.4%, respectively. Twelve patients (8.9% with postoperative contralateral reflux were excluded from the analysis. Overall clinical improvement rate for UNC was 92%. Gender, age at diagnosis and operation, laterality and grade of reflux, mode of presentation, breakthrough infections (BTI under antibiotic prophylaxis, presence of voiding dysfunction and renal scar, and operation technique did not affect the surgical outcome. However, the clinical improvement rate was lower in patients with a history of previous endoscopic intervention (83.9% vs. 94%. Postoperative UTI rate was 27.2% and factors affecting the occurrence of postoperative UTI were previous failed endoscopic injection on univariate analysis and gender, preoperative BTI, postoperative VUR state, voiding dysfunction on multivariate analysis. Surgery related complication rate was 2% (8/398. These were all low grade complications (blood transfusion in 1, hematoma under incision in 3 and prolonged

  3. Bone fragment union and remodeling after arthroscopic bony bankart repair for traumatic anterior shoulder instability with a glenoid defect: influence on postoperative recurrence of instability.

    Science.gov (United States)

    Nakagawa, Shigeto; Ozaki, Ritsuro; Take, Yasuhiro; Mae, Tatsuo; Hayashida, Kenji

    2015-06-01

    Although good clinical outcomes have been reported after arthroscopic bony Bankart repair, the extent of bone union is still unclear. To investigate bone union after arthroscopic bony Bankart repair and its influence on postoperative recurrence of instability. Cohort study; Level of evidence, 3. Among 113 consecutive shoulders that underwent arthroscopic bony Bankart repair, postoperative evaluation of bone union by computed tomography (CT) was performed at various times in 81 shoulders. Bone union was investigated during 3 periods: 3 to 6 months postoperatively (first period), 7 to 12 months postoperatively (second period), and 13 months or more postoperatively (third period). The influence of the size of the preoperative glenoid defect and the size of the bone fragment on bone union was investigated, as well as the influence of bone union on postoperative recurrence of instability. In shoulders with bone union, bone fragment remodeling and changes in the glenoid defect size were also investigated. The bone union rate was 30.5% in the first period, 55.3% in the second period, and 84.6% in the third period. Among 53 shoulders with CT evaluation in the second period or later and follow-up for a minimum of 1 year, there was complete union in 33 shoulders (62.3%), partial union in 3 (5.7%), nonunion in 8 (15.1%), and no fragment on CT in 9 (17.0%). The complete union rate was 50% for 22 shoulders with small bone fragments (fragments (5%-10%), and 86.7% for 15 shoulders with large fragments (>10%). The recurrence rate for postoperative instability was only 6.1% for shoulders with complete union, while it was 50% for shoulders with partial union, nonunion, no fragment, and no fragment on CT. The recurrence rate was significantly higher (36.4%) in shoulders with small fragments, but it was significantly lower in shoulders with bone union. In shoulders with bone union, the bone fragment frequently became larger over time, while the size of the glenoid defect decreased

  4. Prediction of postoperative pain after percutaneous nephrolithotomy

    DEFF Research Database (Denmark)

    Pedersen, Katja Venborg; Olesen, Anne Estrup; Osther, Palle Jørn Sloth

    2013-01-01

    Postoperative pain remains a significant problem and the individual variance in postoperative pain is not fully understood. In recent years, there has been focus on identifying risk factors predicting patients with high postoperative pain intensity or consumption of analgesics, which may facilitate...... thresholds were measured using electrical (single and 5 repeated) and pressure pain stimulation over the flank bilaterally (stone-side = operation side and control-side = non-operation side). Postoperative pain scores were recorded on a numerical rating scale and analgesic consumption was registered....... The responses to repeated electrical stimuli (temporal summation) were preoperatively increased on the stone-side compared to the control-side (P = 0.016). Preoperative electrical pain thresholds from the control-side correlated inversely with postoperative opioid consumption (single stimuli: ρ = -0.43, P

  5. Two-factor logistic regression in pediatric liver transplantation

    Science.gov (United States)

    Uzunova, Yordanka; Prodanova, Krasimira; Spasov, Lyubomir

    2017-12-01

    Using a two-factor logistic regression analysis an estimate is derived for the probability of absence of infections in the early postoperative period after pediatric liver transplantation. The influence of both the bilirubin level and the international normalized ratio of prothrombin time of blood coagulation at the 5th postoperative day is studied.

  6. Factors affecting postoperative hypocalcemia after thyroid surgery: Importance of incidental parathyroidectomy

    OpenAIRE

    Ozemir, Ibrahim Ali; Buldanli, Mehmet Zeki; Yener, Oktay; Leblebici, Metin; Eren, Tunc; Baysal, Hakan; Alimoglu, Orhan

    2016-01-01

    OBJECTIVE: The present study evaluated effects of incidental parathyroidectomy, surgical technique, and presence of thyroiditis or hyperthyroidism on occurrence of postoperative persistent or transient hypocalcemia. METHODS: Patients who underwent thyroidectomy at ?stanbul Medeniyet University between 2013 and 2015 were included in the study. Patient information, postoperative serum calcium levels, and pathology reports were investigated retrospectively. Group 1 was made up of patients who we...

  7. Monitoring of skin conductance to assess postoperative pain intensity.

    Science.gov (United States)

    Ledowski, T; Bromilow, J; Paech, M J; Storm, H; Hacking, R; Schug, S A

    2006-12-01

    Pain is known to alter the electrogalvanic properties of the skin. The aim of this pilot study was to investigate the influence of postoperative pain on skin conductance (SC) readings. After obtaining ethical approval and written informed consent, 25 postoperative patients were asked to quantify their level of pain on a numeric rating scale (NRS, 0-10) at different time points in the recovery room. As a parameter of SC, the number of fluctuations within the mean SC per second (NFSC) was recorded. Simultaneously, the NRS was obtained from patients by a different observer who was blinded to the NFSC values. Data from 110 readings of 25 patients (14 female, 11 male; 21-67 yr) were included. NFSC showed a significant correlation with the NRS (r=0.625; P3 on the NRS was predicted with sensitivity of 89% and specificity of 74%. The severity of postoperative pain significantly influences SC. Using cut-off values, NFSC may prove a useful tool for pain assessment in the postoperative period.

  8. Influence of preoperative parenteral alimentation on postoperative growth in adolescent Crohn's disease.

    Science.gov (United States)

    Lake, A M; Kim, S; Mathis, R K; Walker, W A

    1985-04-01

    The postoperative growth rates achieved in eight early pubertal adolescent males with Crohn's disease undergoing surgery for obstructive complications is reported as a function of the use of 1 month's preoperative central venous alimentation. All patients had ileal strictures with ileocolitis, bone ages less than 13, Tanner stages 1 or 2, and growth velocities below the 3rd percentile for age. During a 3-year follow-up, those receiving preoperative venous alimentation demonstrated greater oral caloric intake (significant for 1 year) and greater postoperative growth velocity (significant for 2 years) in comparison to those patients who did not receive preoperative venous alimentation. There was no significant difference between the two groups of patients in postoperative weight gain, sexual development, and 3-year disease control.

  9. Factors influencing liver and spleen volume changes after donor hepatectomy for living donor liver transplantation

    International Nuclear Information System (INIS)

    Bae, Ji Hee; Ryeom, Hunku; Song, Jung Hup

    2013-01-01

    To define the changes in liver and spleen volumes in the early postoperative period after partial liver donation for living-donor liver transplantation (LDLT) and to determine factors that influence liver and spleen volume changes. 27 donors who underwent partial hepatectomy for LDLT were included in this study. The rates of liver and spleen volume change, measured with CT volumetry, were correlated with several factors. The analyzed factors included the indocyanine green (ICG) retention rate at 15 minutes after ICG administration, preoperative platelet count, preoperative liver and splenic volumes, resected liver volume, resected-to-whole liver volume ratio (LV R /LV W ), resected liver volume to the sum of whole liver and spleen volume ratio [LV R /(LV W + SV 0 )], and pre and post hepatectomy portal venous pressures. In all hepatectomy donors, the volumes of the remnant liver and spleen were increased (increased rates, 59.5 ± 50.5%, 47.9 ± 22.6%). The increment rate of the remnant liver volume revealed a positive correlation with LV R /LV W (r = 0.759, p R /LV W influences the increment rate of the remnant liver volume.

  10. Four Cases of Postoperative Pneumothorax Among 2814 Consecutive Laparoscopic Gynecologic Surgeries: A Possible Correlation Between Postoperative Pneumothorax and Endometriosis.

    Science.gov (United States)

    Hirata, Tetsuya; Nakazawa, Akari; Fukuda, Shinya; Hirota, Yasushi; Izumi, Gentaro; Takamura, Masashi; Harada, Miyuki; Koga, Kaori; Wada-Hiraike, Osamu; Fujii, Tomoyuki; Osuga, Yutaka

    2015-01-01

    To evaluate the frequency of pneumothorax after laparoscopic surgery and to identify possible correlations to endometriosis. Retrospective review. Tokyo University Hospital between 2006 and 2013. Four patients among a total of 2814 patients with a postoperative pneumothorax. Laparoscopic surgery for gynecologic benign disease. The main outcome was the clinical frequency and characteristics of the patients with postoperative pneumothorax. We observed 4 (0.14%) cases of postoperative pneumothorax after laparoscopic surgery, all of whom were diagnosed with endometriomas and developed a right-sided pneumothorax. The incidence of postoperative pneumothorax in 1097 patients with endometriomas was 0.36%, which was significantly higher than those without endometriomas. The presence of endometrioma should be considered a risk factor for postoperative pneumothorax in gynecologic laparoscopic surgery. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  11. Surgical management of spontaneous pneumothorax: are there any prognostic factors influencing postoperative complications?

    Science.gov (United States)

    Delpy, Jean-Philippe; Pagès, Pierre-Benoit; Mordant, Pierre; Falcoz, Pierre-Emmanuel; Thomas, Pascal; Le Pimpec-Barthes, Francoise; Dahan, Marcel; Bernard, Alain

    2016-03-01

    There are no guidelines regarding the surgical approach for spontaneous pneumothorax. It has been reported, however, that the risk of recurrence following video-assisted thoracic surgery is higher than that following open thoracotomy (OT). The objective of this study was to determine whether this higher risk of recurrence following video-assisted thoracic surgery could be attributable to differences in intraoperative parenchymal resection and the pleurodesis technique. Data for 7647 patients operated on for primary or secondary spontaneous pneumothorax between 1 January 2005 and 31 December 2012 were extracted from Epithor®, the French national database. The type of pleurodesis and parenchymal resection was collected. Outcomes were (i) bleeding, defined as postoperative pleural bleeding; (ii) pulmonary and pleural complications, defined as atelectasis, pneumonia, empyema, prolonged ventilation, acute respiratory distress syndrome and prolonged air leaks; (iii) in-hospital length of stay and (iv) recurrence, defined as chest drainage or surgery for a second pneumothorax. Of note, 6643 patients underwent videothoracoscopy and 1004 patients underwent OT. When compared with the thoracotomy group, the videothoracoscopy group was associated with more parenchymal resections (62.4 vs 80%, P = 0.01), fewer mechanical pleurodesis procedures (93 vs 77.5%, P pneumothorax, videothoracoscopy is associated with a higher rate of recurrence than OT. This difference might be attributable to differences in the pleurodesis technique rather than differences in the parenchymal resection. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  12. Postoperative nausea and vomiting following orthognathic surgery

    Science.gov (United States)

    Phillips, C.; Brookes, C. D.; Rich, J.; Arbon, J.; Turvey, T. A.

    2015-01-01

    The purpose of this study was to assess the incidence and risk factors associated with postoperative nausea (PON) and vomiting (POV) after orthognathic surgery. A review of the clinical records of consecutively enrolled subjects (2008–2012) at a single academic institution was conducted between 9/2013 and 3/2014. Data on the occurrence of PON and POV and potential patient-related, intraoperative, and postoperative explanatory factors were extracted from the medical records. Logistic models were used for the presence/absence of postoperative nausea and vomiting separately. Data from 204 subjects were analyzed: 63% were female, 72% Caucasian, and the median age was 19 years. Thirty-three percent had a mandibular osteotomy alone, 27% a maxillary osteotomy alone, and 40% had bimaxillary osteotomies. Sixty-seven percent experienced PON and 27% experienced POV. The most important risk factors for PON in this series were female gender, increased intravenous fluids, and the use of nitrous oxide, and for POV were race, additional procedures, and morphine administration. The incidence of PON and POV following orthognathic surgery in the current cohort of patients, after the introduction of the updated 2007 consensus guidelines for the management of postoperative nausea and vomiting, has not decreased substantially from that reported in 2003–2004. PMID:25655765

  13. Effects of posture on postoperative pulmonary function

    DEFF Research Database (Denmark)

    Nielsen, K G; Holte, Kathrine; Kehlet, H

    2003-01-01

    BACKGROUND: Pulmonary morbidity is still a relevant complication to major surgery despite improvements in surgical technique and anaesthetic methods. Postoperative posture may be a pathogenic factor, but the effects of changes in postoperative posture on pulmonary function have not been reviewed....... METHODS: Review of controlled, clinical trials evaluating postoperative pulmonary function in patients positioned in the supine vs. the sitting or standing position and patients positioned in the supine vs. the lateral position. Data were obtained from a search in the Medline and Cochrane databases (1966...

  14. Human factors influencing decision making

    OpenAIRE

    Jacobs, Patricia A.

    1998-01-01

    This report supplies references and comments on literature that identifies human factors influencing decision making, particularly military decision making. The literature has been classified as follows (the classes are not mutually exclusive): features of human information processing; decision making models which are not mathematical models but rather are descriptive; non- personality factors influencing decision making; national characteristics influencing decision makin...

  15. The results of postoperative irradiation for locally advanced carcinoma of the larynx

    International Nuclear Information System (INIS)

    Wieczorek, A.; Fijuth, J.; Michalski, W.

    2002-01-01

    . In multivariate analysis pathologically positive lymph nodes and the time interval between surgery and radiation were found to be the significant prognostic factors influencing the overall survival. The extra-capsular lymph node extension was found to be the only significant prognostic factor affecting local control. In order to decrease the local recurrence rate we postulate the use of the boost dose up to 70 Gy to the small volume in the cases where capsular rupture was noticed. We recommend to start postoperative radiotherapy as soon as healing is adequate. Shortening the interval between surgery and radiation is not associated with a significant increase in treatment toxicity. (author)

  16. Influence of the timing of surgery and postoperative radiotherapy on treatment results

    International Nuclear Information System (INIS)

    Fietkau, R.

    2000-01-01

    Background: The timing of surgery and postoperative radiotherapy - especially if combined with chemotherapy - has been a subject of interest over the past years. Methods: This analysis was based on a literature review of mostly retrospective publications. Data concerning the interval between surgery and radiotherapy were correlated with the locoregional control, incidence of distant metastases and prognosis of breast cancer, lung carcinoma, and head and neck carcinomas. Results and Conclusions: The reviewed data did not show a clear relationship of the time interval between surgery and start of radiotherapy and locoregional control. However, evaluation of the data was difficult, because in most publications, retrospective analyses were performed and other prognostically more relevant parameters may influence locoregional control stronger than the time interval. In patients with head and neck carcinomas, there is a negative effect of time interval between surgery and radiotherapy on local control if unfavorable factors exist, i.e., close surgical margins, unfavorable pathohistological parameters and low radiation dose. In patients with breast cancer who do not receive chemotherapy, there are inconsistent reports in the literature. If additional chemotherapy is necessary, the sequence surgery, chemotherapy and radiotherapy seems adequate. Although some data suggest that delaying the initiation of radiotherapy due to chemotherapy may increase the risk of local recurrences, there may, on the other hand, be an increased likelihood of systemic metastases, if radiotherapy is applied before chemotherapy. Concerning lung cancer, only one retrospective analysis exists suggesting a better survival of patients with an interval of more than 36 days between surgery and radiotherapy as compared to patients with a shorter interval. (orig.) [de

  17. Effects of living environment on the postoperative Scoliosis Research Society-24 results in females with adolescent idiopathic scoliosis.

    Science.gov (United States)

    Misterska, Ewa; Głowacki, Maciej; Panek, Sławomir; Ignyś-O'Byrne, Anna; Głowacki, Jakub; Ignyś, Iwona; Krauss, Hanna; Piątek, Jacek

    2012-08-01

    There are many factors influencing postoperative health-related quality of life of adolescent idiopathic scoliosis patients, including the degree of the deformity, culture, differences in geography, rural versus urban living environments, and social factors. The objective of this study was to analyze the significance of geographic factors and their differences influencing the postoperative quality of life in females with adolescent idiopathic scoliosis residing in urban and rural environments, by use of the Polish version of the SRS-24 questionnaire. Forty urban and 20 rural postoperative patients with adolescent scoliosis with a minimum 2-year follow-up period after surgery were included in the study. The process of cross-cultural adaptation was performed according to the IQOLA Project. General results of the Polish SRS-24 equalled 4.1 (SD 0.5) and 4.0 (SD.0.5) in the rural and urban groups of patients, respectively. The 2 groups do not differ in incidence of floor and ceiling effects. The Cronbach's alpha values are excellent for the general result of SRS-24 in urban and rural groups (0.85 and 0.85, respectively). The sub-groups differed significantly in the self-image after surgery domain (p=0.048). Patients from the rural group scored higher in the self-image after surgery domain but reported higher pain levels when compared to urban patients. The associations between SRS-24 results and radiographic parameters in the rural group of patients were strong, compared with moderate relations reported in the urban group.

  18. The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study.

    Science.gov (United States)

    Koorevaar, Rinco C T; van 't Riet, Esther; Gerritsen, Marleen J J; Madden, Kim; Bulstra, Sjoerd K

    2016-01-01

    Psychological symptoms are highly prevalent in patients with shoulder complaints. Psychological symptoms in patients with shoulder complaints might play a role in the aetiology, perceived disability and pain and clinical outcome of treatment. The aim of this study was to assess whether preoperative symptoms of distress, depression, anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function. In addition, the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function. A prospective longitudinal cohort study was performed in a general teaching hospital. 315 consecutive patients planned for elective shoulder surgery were included. Outcome measures included change of Disabilities of the Arm, Shoulder and Hand (DASH) score and anchor questions about improvement in pain and function after surgery. Psychological symptoms were identified before and 12 months after surgery with the validated Four-Dimensional Symptom Questionnaire (4DSQ). Psychological symptoms were encountered in all the various shoulder diagnoses. Preoperative symptoms of psychological disorders persisted after surgery in 56% of patients, 10% of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms. Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery. Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score. Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain. Postoperative symptoms of distress, depression and somatisation were

  19. Risk factors associated with postoperative seizures in patients undergoing cardiac surgery who received tranexamic acid: A case-control study

    Directory of Open Access Journals (Sweden)

    Felix R Montes

    2012-01-01

    Full Text Available Antifibrinolytic agents are used during cardiac surgery to minimize bleeding and reduce exposure to blood products. Several reports suggest that tranexamic acid (TA can induce seizure activity in the postoperative period. To examine factors associated with postoperative seizures in patients undergoing cardiac surgery who received TA. University-affiliated hospital. Case-control study. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB between January 2008 and December 2009 were identified. During this time, all patients undergoing heart surgery with CPB received TA. Cases were defined as patients who developed seizures that required initiation of anticonvulsive therapy within 48 h of surgery. Exclusion criteria included subjects with preexisting epilepsy and patients in whom the convulsive episode was secondary to a new ischemic lesion on brain imaging. Controls who did not develop seizures were randomly selected from the initial cohort. From an initial cohort of 903 patients, we identified 32 patients with postoperative seizures. Four patients were excluded. Twenty-eight cases and 112 controls were analyzed. Cases were more likely to have a history of renal impairment and higher preoperative creatinine values compared with controls (1.39 ± 1.1 vs. 0.98 ± 0.02 mg/dL, P = 0.02. Significant differences in the intensive care unit, postoperative and total lengths of stay were observed. An association between high preoperative creatinine value and postoperative seizure was identified. TA may be associated with the development of postoperative seizures in patients with renal dysfunction. Doses of TA should be reduced or even avoided in this population.

  20. Independent risk factors for postoperative pain in need of intervention early after awakening from general anaesthesia.

    Science.gov (United States)

    Mei, Wei; Seeling, Matthes; Franck, Martin; Radtke, Finn; Brantner, Benedikt; Wernecke, Klaus-Dieter; Spies, Claudia

    2010-02-01

    Despite advances in postoperative pain management, the proportion of patients with moderate to severe postoperative pain is still ranging 20-80%. In this retrospective study, we investigated 1736 patients to determine the incidence of postoperative pain in need of intervention (PPINI)defined as numeric rating scale >4 at rest in the post anaesthesia care unit early after awakening from general anaesthesia, and to identify possible risk factors. The proportion of patients with PPINI was 28.5%. On multivariate analysis, younger age (OR=1.300 [1.007-1.678], p=0.044), female gender (OR=1.494 [1.138-1.962], p=0.004), obesity (OR=1.683 [1.226-2.310], p=0.001), use of nitrous oxide (OR=1.621 [1.110-2.366], p=0.012), longer duration of surgery (OR=1.165 [1.050-1.292], p=0.004), location of surgery (musculoskeletal OR=2.026 [1.326-3.095], p=0.001; intraabdominal OR=1.869 [1.148-3.043], p=0.012), and ASA-PS I-II (OR=1.519 [1.131-2.039], P=0.005) were identified as independent risk factors for PPINI. Patients with PPINI experienced significantly more PONV (10.3% vs. 6.2%, p=0.003), more psychomotor agitation (5.5% vs. 2.7%, p=0.004), needed more application of opioid in PACU (62.8% vs. 24.2%, p<0.001), stayed significantly longer in PACU (89.6min [70-120] vs. 80min [60-100], p<0.001), had a longer median length of hospital stay (6.6 days [4.0-8.8] vs. 6.0 days [3.2-7.8

  1. Study populations and casemix: influence on analysis of postoperative outcomes.

    Science.gov (United States)

    Isbister, W H

    2000-04-01

    The importance of patient casemix as a determinant of surgical outcome is now being recognized. The present study was undertaken in order to compare the presentation and outcomes in colorectal patients managed surgically by the same surgeon, in the same way, in different settings. Colorectal outcome data from the University Department of Surgery in Wellington and the King Faisal Specialist Hospital in Riyadh were analysed in order to determine casemix differences between the two hospitals. Data relating to the type of surgery, the surgeon, the patient's disease, the operation performed and the postoperative complications were compared. Specific colorectal clinical indicators were compared for two commonly performed operations for rectal cancer: anterior resection and abdomino-perineal resection of the rectum. Wellington patients were slightly older and there were more females. Emergency surgery was more frequent in Wellington. Left hemicolectomy, sigmoid colectomy, abscess drainage and pilonidal surgery were more common in Wellington whereas abdomino-perineal resection and anterior resection of the rectum, stoma closure, fistula surgery, seton insertion, restorative proctocolectomy and ileostomy were undertaken more frequently in Riyadh. More complex anal fistulas were managed in Riyadh. Condylomata accuminata, pilonidal abscess, anorectal abscess, rectal prolapse and diverticular disease were rarely seen in Riyadh. There were more postoperative pulmonary and cardiac complications in Wellington. Patients having anterior resection of the rectum were younger in Riyadh and there were proportionally more females. There were some obvious numerical outcome differences in postoperative atelectasis, wound infection, anastomotic leak and deep vein thrombosis rates but none of these reached statistical significance except atelectasis. In Riyadh the usual male-to-female ratio of patients undergoing abdomino-perineal resection was reversed but, again, none of the numerical

  2. [Natural factors influencing sleep].

    Science.gov (United States)

    Jurkowski, Marek K; Bobek-Billewicz, Barbara

    2007-01-01

    Sleep is a universal phenomenon of human and animal lives, although the importance of sleep for homeo-stasis is still unknown. Sleep disturbances influence many behavioral and physiologic processes, leading to health complications including death. On the other hand, sleep improvement can beneficially influence the course of healing of many disorders and can be a prognostic of health recovery. The factors influencing sleep have different biological and chemical origins. They are classical hormones, hypothalamic releasing and inhibitory hormones, neuropeptides, peptides and others as cytokines, prostaglandins, oleamid, adenosine, nitric oxide. These factors regulate most physiologic processes and are likely elements integrating sleep with physiology and physiology with sleep in health and disorders.

  3. Postoperative pain

    DEFF Research Database (Denmark)

    Kehlet, H; Dahl, J B

    1993-01-01

    also modify various aspects of the surgical stress response, and nociceptive blockade by regional anesthetic techniques has been demonstrated to improve various parameters of postoperative outcome. It is therefore stressed that effective control of postoperative pain, combined with a high degree......Treatment of postoperative pain has not received sufficient attention by the surgical profession. Recent developments concerned with acute pain physiology and improved techniques for postoperative pain relief should result in more satisfactory treatment of postoperative pain. Such pain relief may...

  4. Better consenting for thyroidectomy: who has an increased risk of postoperative hypocalcaemia?

    Science.gov (United States)

    Harris, Andrew S; Prades, Eduardo; Tkachuk, Olena; Zeitoun, Hisham

    2016-12-01

    Hypocalcaemia is the most common complication following thyroidectomy. This study aimed to establish the factors associated with increased risk of hypocalcaemia on day 1 following thyroidectomy. All patients who underwent thyroidectomy under a single consultant during a 5-year period were included. A multivariate analysis was undertaken to ascertain which variables had the most effect on the risk of hypocalcaemia. A prognosis table was constructed to allow risk to be predicted for individual patients based on these factors. Included in the analysis were 210 procedures and 194 patients. Eighty-two percent of patients had no calcium derangement postoperatively. Fourteen point nine percent were categorised as early hypocalcaemia, 1 % had protracted hypocalcaemia and 2.1 % had permanent hypocalcaemia. For hemi-thyroidectomies 2.8 % had postoperative hypocalcaemia and 0.9 % had permanent hypocalcaemia. The multivariate analysis revealed total thyroidectomy (risk ratio 26.5, p < 0.0001), diabetes (risk ratio 4.8, p = 0.07) and thyrotoxicosis (risk ratio 3.1, p = 0.04) as statistically significant variables for early postoperative hypocalcaemia. Gender as an isolated factor did not reach significance but was included in the model. The p value for the model was p < 1 × 10 -12 . Total thyroidectomy increases risk of early hypocalcaemia when compared to hemithyroidectomy. Gender, diabetes and thyrotoxicosis were also been found to influence the risk. All of these factors are available pre-operatively and can therefore be used to predict a more specific risk for individual patients. It is hoped that this can lead to better informed consent, prevention and better resource allocation.

  5. An analysis of intraoperative versus post-operative dosimetry with CT, CT-MRI fusion and XMR for the evaluation of permanent prostate brachytherapy implants

    International Nuclear Information System (INIS)

    Acher, Peter; Puttagunta, Srikanth; Rhode, Kawal; Morris, Stephen; Kinsella, Janette; Gaya, Andrew; Dasgupta, Prokar; Deehan, Charles; Beaney, Ronald; Popert, Rick; Keevil, Stephen

    2010-01-01

    Background and purpose: To assess the agreement between intraoperative and post-operative dosimetry and to identify factors that influence dose calculations of prostate brachytherapy implants. Materials and methods: Patients treated with prostate brachytherapy implants underwent post-operative CT and XMR (combined X-ray and MR) imaging. Dose-volume histograms were calculated from CT, XMR and CT-MR fusion data and compared with intraoperative values for two observers. Multiple linear regression models assessed the influences of intraoperative D90, gland oedema, gland volume, source loss and migration, and implanted activity/volume prostate on post-operative D90. Results: Forty-nine patients were studied. The mean D90 differences (95% confidence limits) between intraoperative and post-operative CT, XMR and CT-MR fusion assessments were: 11 Gy (-22, 45), 18 Gy (-13, 49) and 20 Gy (-17, 58) for Observer 1; and 15 Gy (-34, 63), 13 Gy (-29, 55) and 14 Gy (-27, 54) for Observer 2. Multiple linear regression modelling showed that the observed oedema and intraoperative D90 were significant independent variables for the prediction of post-operative D90 values for both observers using all modalities. Conclusion: This is the first study to report Bland-Altman agreement analysis between intraoperative and post-operative dosimetry. Agreement is poor. Post-operative dosimetry is dependent on the intraoperative D90 and the subjectively outlined gland volume.

  6. Perioperative management in order to minimise postoperative delirium and postoperative cognitive dysfunction: Results from a Swedish web-based survey

    Directory of Open Access Journals (Sweden)

    Pether K. Jildenstål

    2014-09-01

    Conclusion: Swedish anaesthesia personnel are concerned about the risk of postoperative cognitive side-effects but are more concerned about cardiovascular/pulmonary risks, pain, PONV and the rare event of awareness. Most respondents were not convinced about the use of depth-of-anaesthesia monitors. There is a need to improve knowledge around risk factors, prevention and management of postoperative cognitive side effects.

  7. Theoretical difference between impact factor and influence factor

    Directory of Open Access Journals (Sweden)

    Đilda Pečarić

    2010-06-01

    Full Text Available Bibliometric constructions of "knowledge maps" and "cognitive structures of science" do not differentiate between impact and influence factors. The difference can be constructedaccording to different meaning and interpretation of the terms reference and citation. Reference is "acknowledgment which one author gives to another", whereas citation is "acknowledgment which one document receives from another". Development of Information Science according to period and subject area is analyzed on the corpus of citation literature retrieved from doctoral dissertations in Information Science from 1978 to 2007 at Croatian universities. The research aim is to indicate the difference between document impact factor and author's influence factor (i.e. reference ability to produce effects on actions, behavior, and opinions of authors of doctoral theses. The influence factor serves to distinguish the key role of cited authors in time and according to the duration of the influence (the average age for cited papers of dominant authors in different periods is between eight and ten years. The difference between linear and interactive communication seems vital for the interpretation of cited half-life, i.e. the attitude of one science community towards used information resources and cognitive heritage. The analyzed corpus of 22,210 citations can be divided into three communication phases according to influence factor criteria: in the phase of dialogue and interactive communication 25% of bibliographic units are cited in the first four years; in the second phase another 25% of units are cited from the fifth to the ninth year; after ten years, in the dominant linear communication phase, approximately 30% of units are cited.

  8. Post-operative urinary retention in a general surgical population

    DEFF Research Database (Denmark)

    Dreijer, Bjørn; Møller, Morten H; Bartholdy, Jens

    2011-01-01

    Post-operative urine retention is a frequent and serious complication. The aims of this study were to evaluate the prevalence of post-operative urinary retention in a general surgical population and to identify the perioperative risk factors for developing this condition....

  9. In-hospital resuscitation: opioids and other factors influencing survival

    Directory of Open Access Journals (Sweden)

    Karamarie Fecho

    2009-12-01

    Full Text Available Karamarie Fecho1, Freeman Jackson1, Frances Smith1, Frank J Overdyk21Department of Anesthesiology, University of North Carolina, Chapel Hill, North Carolina, USA; 2Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina, USAPurpose: “Code Blue” is a standard term used to alertt hospital staff that a patient requires resuscitation. This study determined rates of survival from Code Blue events and the role of opioids and other factors on survival.Methods: Data derived from medical records and the Code Blue and Pharmacy databases were analyzed for factors affecting survival.Results: During 2006, rates of survival from the code only and to discharge were 25.9% and 26.4%, respectively, for Code Blue events involving cardiopulmonary resuscitation (CPR; N = 216. Survival rates for events not ultimately requiring CPR (N = 77 were higher, with 32.5% surviving the code only and 62.3% surviving to discharge. For CPR events, rates of survival to discharge correlated inversely with time to chest compressions and defibrillation, precipitating event, need for airway management, location and age. Time of week, witnessing, postoperative status, gender and opioid use did not influence survival rates. For non-CPR events, opioid use was associated with decreased survival. Survival rates were lowest for patients receiving continuous infusions (P < 0.01 or iv boluses of opioids (P < 0.05.Conclusions: One-quarter of patients survive to discharge after a CPR Code Blue event and two-thirds survive to discharge after a non-CPR event. Opioids may influence survival from non-CPR events.Keywords: code blue, survival, opioids, cardiopulmonary resuscitation, cardiac arrest, patient safety

  10. Peritumoral ductular reaction: a poor postoperative prognostic factor for hepatocellular carcinoma

    International Nuclear Information System (INIS)

    Xu, Minhui; Wei, Lixin; Xie, Feng; Qian, Guangyang; Jing, Yingying; Zhang, Shanshan; Gao, Lu; Zheng, Tao; Wu, Mengchao; Yang, Jiamei

    2014-01-01

    The role of ductular reaction (DR) in hepatocellular carcinoma (HCC) remains to be elucidated. In this study, we tried to uncover possible effect by correlating peritumoral DR in a necroinflammatory microenvironment with postoperative prognosis in HCC. The expression of peritumoral DR/CK19 by immunohistochemistry, necroinflammation and fibrosis were assessed from 106 patients receiving curative resection for HCC. Prognostic values for these and other clinicopathologic factors were evaluated. Peritumoral DR significantly correlated with necroinflammation (r = 0.563, p = 3.4E-10), fibrosis (r = 0.435, p = 3.1E-06), AFP level (p = 0.010), HBsAg (p = 4.9E-4), BCLC stage (p = 0.003), TNM stage (p = 0.002), multiple nodules (p = 0.004), absence of tumor capsule (p = 0.027), severe microscopic vascular invasion (p = 0.031) and early recurrence (p = 0.010). Increased DR was significantly associated with decreased RFS/OS (p = 4.8E-04 and p = 2.6E-05, respectively) in univariate analysis and were identified as an independent prognostic factor (HR = 2.380, 95% CI = 1.250-4.534, p = 0.008 for RFS; HR = 4.294, 95% CI = 2.255-8.177, p = 9.3E-6 for OS) in multivariate analysis. These results suggested that peritumoral DR in a necroinflammatory microenvironment was a poor prognostic factor for HCC after resection

  11. Risk Factors and Stroke Characteristic in Patients with Postoperative Strokes.

    Science.gov (United States)

    Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang

    2017-07-01

    Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.

  12. Influence of different phacoemulsification incision on postoperative corneal astigmatism for cataract patients

    Directory of Open Access Journals (Sweden)

    Zhao-Rong Zeng

    2014-05-01

    Full Text Available AIM: To compare the effect of different phacoemulsification incision on postoperative corneal astigmatism for cataract patients. METHODS: The cataract patients were selected in our hospital. The patients were divided into control group(corneal limbus opposite curved scleral tunnel incision groupand observation group(above the top of cornea or temporal transparent corneal incision grouprandomly. At 1wk; 1 and 3mo after surgery, the change of corneal astigmatism and vision of the patients in two groups were compared and analyzed. RESULTS:Compared with control group, 1wk; 1 and 3mo after surgery, the average corneal astigmatism and surgically induced corneal astigmatism of the patients in observation group were decreased significantly. The visual acuity and corrected visual acuity were increased significantly. There was statistically significant(PPCONCLUSION: Center distance and small incision corneal phacoemulsification can reduce postoperative astigmatism and improve postoperative visual acuity for cataract patients. It provides guarantee for further strengthen the clinical treated effect for cataract patients.

  13. Demotivating factors influencing rubber production workers

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Iravani

    2012-01-01

    Full Text Available Motivation is one of the most important factors influencing workers' productivity. An increase in workers' motivation could add more value to organizations' structure and influence the profitability, significantly. In this paper, we study different factors on demotivating workers using questionnaire consist of various questions. The questionnaire is distributed among some employees who work for rubber production units located in Esfahan, Iran. The results of this survey indicate that discrimination on annual job compensation, entrusting responsibilities and unpleasant relationship with family partner are some of the most important factors influencing employees' motivation. While financial factors play important role on increasing employees' motivation, non-financial factors are considered more important.

  14. Factors influencing women's decisions to purchase specific ...

    African Journals Online (AJOL)

    aimed at identifying the factors that influence women's decisions to purchase specific .... influence of all the factors influencing their decision to purchase a selected .... one free” promotions seemed to have had the greatest influence on this ...

  15. Intraoperative and postoperative risk factors for anastomotic leakage and pneumonia after esophagectomy for cancer.

    Science.gov (United States)

    Goense, L; van Rossum, P S N; Tromp, M; Joore, H C; van Dijk, D; Kroese, A C; Ruurda, J P; van Hillegersberg, R

    2017-01-01

    Morbidity and mortality after esophagectomy are often related to anastomotic leakage or pneumonia. This study aimed to assess the relationship of intraoperative and postoperative vital parameters with anastomotic leakage and pneumonia after esophagectomy. Consecutive patients who underwent transthoracic esophagectomy with cervical anastomosis for esophageal cancer from January 2012 to December 2013 were analyzed. Univariable and multivariable logistic regression analyses were used to determine potential associations of hemodynamic and respiratory parameters with anastomotic leakage or pneumonia. From a total of 82 included patients, 19 (23%) developed anastomotic leakage and 31 (38%) experienced pneumonia. The single independent factor associated with an increased risk of anastomotic leakage in multivariable analysis included a lower minimum intraoperative pH (OR 0.85, 95% CI 0.77-0.94). An increased risk of pneumonia was associated with a lower mean arterial pressure (MAP) in the first 12 hours after surgery (OR 0.93, 95% CI 0.86-0.99) and a higher maximum intraoperative pH (OR 1.14, 95% CI 1.02-1.27). Interestingly, no differences were noted for the MAP and inotrope requirement between patients with and without anastomotic leakage. A lower minimum intraoperative pH (below 7.25) is associated with an increased risk of anastomotic leakage after esophagectomy, whereas a lower postoperative average MAP (below 83 mmHg) and a higher intraoperative pH (above 7.34) increase the risk of postoperative pneumonia. These parameters indicate the importance of setting strict perioperative goals to be protected intensively. © International Society for Diseases of the Esophagus 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  16. Analysis of influence factors on the volume of pelvic bowel irradiated for rectal cancer

    International Nuclear Information System (INIS)

    He Yuxiang; Cai Yong; Zhu Xianggao; Han Shukui; Xu Bo

    2007-01-01

    Objective: To evaluate influence of prone/ supine position, gender, operation, bladder distension on bowel irradiated for patients with rectal cancer during pelvic radiotherapy. Methods: 36 patients with rectal cancer were investigated. Treatment plans were created with three dimensional treatment planning system. The dose and volume of bowel irradiated were analyzed according to dose-volume histograms (DVH) for every patient. The prescribed dose was 50 Gy. Results: The extent of bladder distension significantly influenced the mean doses and the V 45 high dose volumes of bowel irradiated. The treatment position and gender significantly influenced the V 15 low dose volume of bowel irradiated, the operation significantly influenced the mean doses of bowel. Either prone and supine position, or preoperative and postoperative, the doses of bowel irradiated for good bladder distension were lower and the volumes were smaller than that for bad bladder distension. The V 45 high dose volume of bowel irradiated for bad and good bladder distension at prone position were 15.3% and 7.4% (P=0.023), respectively, and at postoperative 14.1% and 7.2% (P=0.014), respectively. Conclusions: The doses and volumes of pelvic bowel irradiated were significantly influenced by the extent of bladder distension, and partly influenced by the prone/supine position, gender and operation. (authors)

  17. Influence of perioperative resuscitation status on postoperative spine surgery complications.

    NARCIS (Netherlands)

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

    2010-01-01

    BACKGROUND CONTEXT: Restrictive transfusion criteria have led to decreased morbidity and mortality in critically ill patients. Their use has been extended to other patient groups. In adult spine surgery, ongoing postoperative blood losses and soft-tissue trauma may make these patients not

  18. Postoperative stiff shoulder after open rotator cuff repair: a 3- to 20-year follow-up study.

    Science.gov (United States)

    Vastamäki, H; Vastamäki, M

    2014-12-01

    Stiffness after a rotator cuff tear is common. So is stiffness after an arthroscopic rotator cuff repair. In the literature, however, postoperative restriction of passive range of motion after open rotator cuff repair in shoulders with free passive range of motion at surgery has seldom been recognized. We hypothesize that this postoperative stiffness is more frequent than recognized and slows the primary postoperative healing after a rotator cuff reconstruction. We wondered how common is postoperative restriction of both active and passive range of motion after open rotator cuff repair in shoulders with free passive preoperative range of motion, how it recovers, and whether this condition influences short- and long-term results of surgery. We also explored factors predicting postoperative shoulder stiffness. We retrospectively identified 103 postoperative stiff shoulders among 416 consecutive open rotator cuff repairs, evaluating incidence and duration of stiffness, short-term clinical results and long-term range of motion, pain relief, shoulder strength, and functional results 3-20 (mean 8.7) years after surgery in 56 patients. The incidence of postoperative shoulder stiffness was 20%. It delayed primary postoperative healing by 3-6 months and resolved during a mean 6.3 months postoperatively. External rotation resolved first, corresponding to that of the controls at 3 months; flexion and abduction took less than 1 year after surgery. The mean summarized range of motion (flexion + abduction + external rotation) increased as high as 93% of the controls' range of motion by 6 months and 100% by 1 year. Flexion, abduction, and internal rotation improved to the level of the contralateral shoulders as did pain, strength, and function. Age at surgery and condition of the biceps tendon were related to postoperative stiffness. Postoperative stiff shoulder after open rotator cuff repair is a common complication resolving in 6-12 months with good long-term results. © The

  19. Increased risk of post-operative complications in patients with Crohn's disease treated with anti-tumour necrosis factor α agents - a systematic review

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa; Theede, Klaus; Olaison, Gunnar

    2014-01-01

    INTRODUCTION: Tumour necrosis factor α (TNF-α) plays a role in the immune defence, angiogenesis and collagen synthesis. Inhibition of these pathways may increase the risk of infections and impair wound healing in patients after surgery. Biologic treatments including anti-TNF-α agents are increasi......INTRODUCTION: Tumour necrosis factor α (TNF-α) plays a role in the immune defence, angiogenesis and collagen synthesis. Inhibition of these pathways may increase the risk of infections and impair wound healing in patients after surgery. Biologic treatments including anti-TNF-α agents...... are increasingly used in the treatment of inflammatory bowel disease. Taking into consideration the biologics' mechanism of action, fears have been expressed that they might increase the rate of post-operative complications. Results from 18 retrospective studies were conflicting, and meta-analyses based...... an increased risk of overall post-operative complications and an increased rate of infectious or anastomosis-related complications in patients receiving anti-TNF-α. CONCLUSION: The use of anti-TNF-α agents in Crohn's disease patients is associated with an increased risk of post-operative complications after...

  20. Management of Surgical Third Lower Molar Extraction and Postoperative Progress in Patients With Factor VII Deficiency: A Clinical Protocol and Focus on This Rare Pathologic Entity.

    Science.gov (United States)

    Passarelli, Pier Carmine; Pasquantonio, Guido; D'Addona, Antonio

    2017-10-01

    The purpose of the present study was to analyze the management of surgical third molar extraction and postoperative progress in patients with a diagnosis of factor VII deficiency. Close collaboration between the oral-maxillofacial surgeon and hematologist will allow the team to categorize the risk and operate safely, thereby minimizing the incidence and severity of intraoperative and postoperative complications. The present retrospective study included 7 patients with factor VII deficiency who had undergone third lower molar surgery. Their factor VII deficiency ranged from 10.5 to 21.0%. Recombinant activated factor VII (rFVIIa) (coagulation factor VIIa [recombinant]; NovoSeven RT; Novo Nordisk, Bagsvaerd, Denmark) was transfused intravenously in a single dose of 25 μg/kg body weight, 30 minutes before surgical extractions. After the surgery, betamethasone, an analgesic, and an ice pack were administered. Pretreatment with recombinant activated factor VII resulted in excellent hemostasis. No hemorrhagic complications and no postoperative major bleeding were observed. The extraction of the third lower molar appears to be a safe procedure for patients with factor VII deficiency when appropriate prophylaxis with rFVIIa is used. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Factores pronósticos de complicaciones postoperatorias en el trasplante hepático Prognostic factors associated with postoperative complications in liver transplantation

    Directory of Open Access Journals (Sweden)

    A. Rodríguez-Ariza

    2008-03-01

    Full Text Available Objetivo: la evolución postoperatoria de los pacientes sometidos a trasplante hepático ortotópico (THO se encuentra frecuentemente asociada a la aparición de diversas complicaciones tales como disfunción renal, rechazo agudo, infecciones y complicaciones neurológicas. Estas complicaciones constituyen las causas más significativas de morbilidad y mortalidad tempranas en pacientes que reciben un THO. El propósito del presente estudio es la identificación de factores relacionados con las distintas complicaciones postoperatorias del THO. Diseño experimental: se llevó a cabo un estudio prospectivo. Pacientes: se analizaron 78 variables en 32 pacientes consecutivos sometidos a THO. Utilizando un análisis de regresión logística se identificaron aquellos factores asociados de forma independiente con la aparición de complicaciones postoperatorias. Resultados: el análisis multivariante demostró que los niveles pretrasplante en suero de malondialdehído y creatinina estaban asociados con el desarrollo de disfunción renal. Los niveles pretrasplante de hemoglobina y las unidades de plaquetas administradas durante la cirugía fueron factores pronósticos de infecciones. El rechazo agudo fue pronosticado por los niveles séricos de γ-glutamil transpeptidasa y de bilirrubina total. Los niveles pretrasplante de sodio y glutaredoxina en suero estuvieron asociados con complicaciones neurológicas. Conclusiones: proponemos estos marcadores para la identificación de pacientes de alto riesgo, permitiendo una vigilancia y/o tratamiento anticipados que mejorarán la morbilidad y la supervivencia en pacientes sometidos a THO.Objectives: the postoperative evolution of patients submitted to orthotopic liver transplant (OLT is frequently associated with the appearance of different types of complications such as renal failure, graft rejection, infections, and neurological disorders. These complications are the most significant causes of early morbidity

  2. Factors influencing liver and spleen volume changes after donor hepatectomy for living donor liver transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Ji Hee; Ryeom, Hunku; Song, Jung Hup [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2013-11-15

    To define the changes in liver and spleen volumes in the early postoperative period after partial liver donation for living-donor liver transplantation (LDLT) and to determine factors that influence liver and spleen volume changes. 27 donors who underwent partial hepatectomy for LDLT were included in this study. The rates of liver and spleen volume change, measured with CT volumetry, were correlated with several factors. The analyzed factors included the indocyanine green (ICG) retention rate at 15 minutes after ICG administration, preoperative platelet count, preoperative liver and splenic volumes, resected liver volume, resected-to-whole liver volume ratio (LV{sub R}/LV{sub W}), resected liver volume to the sum of whole liver and spleen volume ratio [LV{sub R}/(LV{sub W} + SV{sub 0})], and pre and post hepatectomy portal venous pressures. In all hepatectomy donors, the volumes of the remnant liver and spleen were increased (increased rates, 59.5 ± 50.5%, 47.9 ± 22.6%). The increment rate of the remnant liver volume revealed a positive correlation with LV{sub R}/LV{sub W} (r = 0.759, p < 0.01). The other analyzed factors showed no correlation with changes in liver and spleen volumes. The spleen and remnant liver volumes were increased at CT volumetry performed 2 weeks after partial liver donation. Among the various analyzed factors, LV{sub R}/LV{sub W} influences the increment rate of the remnant liver volume.

  3. Factors associated to the length of time on mechanical ventilation in the postoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Laura Fonseca

    Full Text Available Our objective was to identify factors associated with the duration of mechanical ventilation (MV postoperative to cardiac surgery and assess the association between duration of endotracheal intubation, length of stay in the Intensive Care Unit (ICU and hospital. Longitudinal, retrospective study of medical records of 116 adults undergoing cardiac surgery from March 2012 to May 2013. The mean age was 57±14 years, predominantly male and coronary artery bypass grafting surgery (52.6%. The MV time was 15.25(7.66 to 23.68 hours. Associated with longer MV was the age (r=0.5,p<0.001, comorbidities (r=0.344,p<0.001, cardiopulmonary bypass time (r=0.244,p=0.008, duration of continuous sedation (r=0.607,p<0.001, sedative doses (r=0.4, p<0.001, time of vasoconstrictors and vasodilators (r=0.711, p< 0.001, r=0.368, p<0.001, drainage of the 1st time (r=0.201, p<0.031, presence of drains (r=0.445, p<0.001, postoperative complications (r=0.524, p< 0.001 and hospital stay. Our data confirms that both preoperative, transoperative and postoperative variables prolong the VM and therefore the hospital stay.

  4. Impact of postoperative glycemic control and nutritional status on clinical outcomes after total pancreatectomy.

    Science.gov (United States)

    Shi, Hao-Jun; Jin, Chen; Fu, De-Liang

    2017-01-14

    To evaluate the impact of glycemic control and nutritional status after total pancreatectomy (TP) on complications, tumor recurrence and overall survival. Retrospective records of 52 patients with pancreatic tumors who underwent TP were collected from 2007 to 2015. A series of clinical parameters collected before and after surgery, and during the follow-up were evaluated. The associations of glycemic control and nutritional status with complications, tumor recurrence and long-term survival were determined. Risk factors for postoperative glycemic control and nutritional status were identified. High early postoperative fasting blood glucose (FBG) levels (OR = 4.074, 95%CI: 1.188-13.965, P = 0.025) and low early postoperative prealbumin levels (OR = 3.816, 95%CI: 1.110-13.122, P = 0.034) were significantly associated with complications after TP. Postoperative HbA1c levels over 7% (HR = 2.655, 95%CI: 1.299-5.425, P = 0.007) were identified as one of the independent risk factors for tumor recurrence. Patients with postoperative HbA1c levels over 7% had much poorer overall survival than those with HbA1c levels less than 7% (9.3 mo vs 27.6 mo, HR = 3.212, 95%CI: 1.147-8.999, P = 0.026). Patients with long-term diabetes mellitus (HR = 15.019, 95%CI: 1.278-176.211, P = 0.031) and alcohol history (B = 1.985, SE = 0.860, P = 0.025) tended to have poor glycemic control and lower body mass index levels after TP, respectively. At least 3 mo are required after TP to adapt to diabetes and recover nutritional status. Glycemic control appears to have more influence over nutritional status on long-term outcomes after TP. Improvement in glycemic control and nutritional status after TP is important to prevent early complications and tumor recurrence, and improve survival.

  5. Effects of preoperative and postoperative enteral nutrition on postoperative nutritional status and immune function of gastric cancer patients.

    Science.gov (United States)

    Ding, Dayong; Feng, Ye; Song, Bin; Gao, Shuohui; Zhao, Jisheng

    2015-03-01

    Effects of preoperative one week enteral nutrition (EN) support on the postoperative nutritional status, immune function and inflammatory response of gastric cancer patients were investigated. 106 cases of gastric cancer patients were randomly divided into preoperative one week EN group (trial group) and early postoperative EN group (control group), which were continuously treated with EN support until the postoperative 9th day according to different treatment protocols. All the patients were checked for their body weight, skinfold thickness, upper arm circumference, white blood cell count (WBC), albumin (ALB), prealbumin (PA), C-reactive protein (CRP), humoral immunity (IgA, IgG), T cell subsets (CD4, CD8 and CD4/CD8), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), etc. on the preoperative and the postoperative 1st and 10th day, respectively. PA and IgG levels of the experimental group were higher than those of the control group on the postoperative 10th day, whereas IL-6 level of the experimental group was lower than that of the control group. EN support for preoperative gastric cancer patients will improve the postoperative nutritional status and immune function, alleviate inflammatory response, and facilitate the recovery of patients.

  6. Postoperative radiation therapy for major salivary gland cancer

    International Nuclear Information System (INIS)

    Kato, Fumio; Yahara, Katsuya; Ohguri, Takayuki

    2003-01-01

    A retrospective study was performed on 29 patients with major salivary gland cancer treated with postoperative irradiation between 1981 and 2002. Univariate and multivariate analyses of age, gender, cancer grade, T stage, N stage, surgical resectability, concomitant chemotherapy, and neoadjuvant or adjuvant chemotherapy were performed for disease-free survival. The 5-year survival rates and 5-year disease-free survival rate were 61.6% and 41.4%, respectively. Both univariate and multivariate analyses showed that cancer grade and surgical resectability influenced survival rates. Chemotherapy did not influence the disease-free survival. The total dose of postoperative radiation was 47.6±8.8 Gy in the complete excision group as planned, but was 56.1±7.9 Gy in the incomplete excision group, which may be insufficient and lead to poor treatment outcome. (author)

  7. Influence of Postoperative Thrombosis Prophylaxis on the Recurrence of Chronic Subdural Hematoma After Burr-Hole Drainage.

    Science.gov (United States)

    Licci, Maria; Kamenova, Maria; Guzman, Raphael; Mariani, Luigi; Soleman, Jehuda

    2018-01-01

    .83-9.36]). Higher dosage of thrombosis prophylaxis correlated with recurrence rates of chronic subdural hematoma, both in univariate and multivariate analyses. Our data suggest that the application of postoperative thrombosis prophylaxis after burr-hole drainage for chronic subdural hematoma does not result in higher recurrence rates of chronic subdural hematoma. In addition, it seems that early administration of thrombosis prophylaxis (< 48 hr) has no influence on recurrence rates; however, high dosage seems to increase recurrence rates.

  8. Risk factors for post-operative periprosthetic fractures following primary total hip arthroplasty with a proximally coated double-tapered cementless femoral component

    DEFF Research Database (Denmark)

    Gromov, K; Bersang, A; Nielsen, C S

    2017-01-01

    ratio were recorded post-operatively. Periprosthetic fractures were identified and classified according to the Vancouver classification. Regression analysis was performed to identify risk factors for early periprosthetic fracture. RESULTS: The mean follow-up was 713 days (1 to 2058). A total of 48......AIMS: The aim of this study was to identify patient- and surgery-related risk factors for sustaining an early periprosthetic fracture following primary total hip arthroplasty (THA) performed using a double-tapered cementless femoral component (Bi-Metric femoral stem; Biomet Inc., Warsaw, Indiana...... periprosthetic fractures (3.0%) were identified during the follow-up and median time until fracture was 16 days, (interquartile range 10 to 31.5). Patients with femoral Dorr type C had a 5.2 times increased risk of post-operative periprosthetic fracture compared with type B, while female patients had a near...

  9. Factors Influencing Substance Abuse among Undergraduate ...

    African Journals Online (AJOL)

    The study investigated the factors influencing substance abuse amongundergraduate students in Osun State; Nigeria. A sample of 1, 200undergraduate students were randomly selected from three tertiaryinstitution in Osun State. Factors Influencing Substance Abuse Questionnaire (FISA) was developed by the researcher ...

  10. Postoperative infections in craniofacial reconstructive procedures.

    Science.gov (United States)

    Fialkov, J A; Holy, C; Forrest, C R; Phillips, J H; Antonyshyn, O M

    2001-07-01

    The rate of, and possible risk factors for, postoperative craniofacial infection is unclear. To investigate this problem, we reviewed 349 cases of craniofacial skeletal procedures performed from 1996 to 1999 at our institution. Infection rate was determined and correlated with the use of implants, operative site, and cause of deformity. The inclusion criteria consisted of all procedures requiring autologous or prosthetic implantation in craniofacial skeletal sites, as well as all procedures involving bone or cartilage resection, osteotomies, debridement, reduction and/or fixation. Procedures that did not involve bone or cartilage surgery were excluded. The criteria for diagnosis of infection included clinical confirmation and one or more of 1) intravenous or oral antibiotic treatment outside of the prophylactic surgical regimen; 2) surgical intervention for drainage, irrigation, and or debridement; and 3) microbiological confirmation. Among the 280 surgical cases that fit the inclusion criteria and had complete records, there were 23 cases of postoperative infection (8.2%). The most common site for postoperative infection was the mandible (infection rate = 16.7%). Multiple logistic regression analysis revealed gunshot wound to be the most significant predictor of postoperative infection. Additionally, porous polyethylene implantation through a transoral route was correlated with a significant risk of postoperative infection.

  11. FACTORS INFLUENCING THE EVOLUTION OF YOUTH TRAVEL

    Directory of Open Access Journals (Sweden)

    Student Claudia MOISĂ

    2010-01-01

    Full Text Available Youth travel is an important part of global tourism, consequently, getting to know the evolution of this form of tourism requires an approach of the aspects regarding the permissive and restrictive factors that influence the youth travel dynamic worldwide. In terms of the factors that influence youth travel, we highlighted these two categories of factors (permissive and restrictive and, within each category, we tried to singularize the influence of every factor over youth travel.

  12. Increased risk of post-operative complications in patients with Crohn’s disease treated with anti-tumour necrosis factor α agents - a systematic review

    DEFF Research Database (Denmark)

    El-Hussuna, Alaa; Theede, Klaus; Olaison, Per Olov Gunnar

    2014-01-01

    INTRODUCTION: Tumour necrosis factor α (TNF-α) plays a role in the immune defence, angiogenesis and collagen synthesis. Inhibition of these pathways may increase the risk of infections and impair wound healing in patients after surgery. Biologic treatments including anti-TNF-α agents are increasi......INTRODUCTION: Tumour necrosis factor α (TNF-α) plays a role in the immune defence, angiogenesis and collagen synthesis. Inhibition of these pathways may increase the risk of infections and impair wound healing in patients after surgery. Biologic treatments including anti-TNF-α agents...... are increasingly used in the treatment of inflammatory bowel disease. Taking into consideration the biologics' mechanism of action, fears have been expressed that they might increase the rate of post-operative complications. Results from 18 retrospective studies were conflicting, and meta-analyses based...... an increased risk of overall post-operative complications and an increased rate of infectious or anastomosis-related complications in patients receiving anti-TNF-α. CONCLUSION: The use of anti-TNF-α agents in Crohn's disease patients is associated with an increased risk of post-operative complications after...

  13. Milrinone Use is Associated With Postoperative Atrial Fibrillation Following Cardiac Surgery

    Science.gov (United States)

    Fleming, Gregory A.; Murray, Katherine T.; Yu, Chang; Byrne, John G.; Greelish, James P.; Petracek, Michael R.; Hoff, Steven J.; Ball, Stephen K.; Brown, Nancy J.; Pretorius, Mias

    2009-01-01

    Background Postoperative atrial fibrillation (AF), a frequent complication following cardiac surgery, causes morbidity and prolongs hospitalization. Inotropic drugs are commonly used perioperatively to support ventricular function. This study tested the hypothesis that the use of inotropic drugs is associated with postoperative AF. Methods and Results We evaluated perioperative risk factors in 232 patients who underwent elective cardiac surgery. All patients were in sinus rhythm at surgery. Sixty-seven (28.9%) patients developed AF a mean of 2.9±2.1 days after surgery. Patients who developed AF stayed in the hospital longer (PMilrinone use was associated with an increased risk of postoperative AF (58.2% versus 26.1% in non-users, Pmilrinone use (odds ratio 4.86, 95% CI 2.31-10.25, Pmilrinone use (odds ratio 4.45, 95% CI 2.01-9.84, Pmilrinone use with postoperative AF. Conclusion Milrinone use is an independent risk factor for postoperative AF following elective cardiac surgery. PMID:18824641

  14. Postoperative spinal column; Postoperative Wirbelsaeule

    Energy Technology Data Exchange (ETDEWEB)

    Kaefer, W. [Westpfalzklinikum GmbH, Standort II, Abteilung fuer Wirbelsaeulenchirurgie, Kusel (Germany); Heumueller, I. [Westpfalzklinikum GmbH, Standort II, Institut fuer Radiologie II, Kusel (Germany); Harsch, N.; Kraus, C.; Reith, W. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2016-08-15

    As a rule, postoperative imaging is carried out after spinal interventions to document the exact position of the implant material. Imaging is absolutely necessary when new clinical symptoms occur postoperatively. In this case a rebleeding or an incorrect implant position abutting a root or the spinal cord must be proven. In addition to these immediately occurring postoperative clinical symptoms, there are a number of complications that can occur several days, weeks or even months later. These include the failed back surgery syndrome, implant loosening or breakage of the material and relapse of a disc herniation and spondylodiscitis. In addition to knowledge of the original clinical symptoms, it is also important to know the operation details, such as the access route and the material used. In almost all postoperative cases, imaging with contrast medium administration and corresponding correction of artefacts by the implant material, such as the dual energy technique, correction algorithms and the use of special magnetic resonance (MR) sequences are necessary. In order to correctly assess the postoperative imaging, knowledge of the surgical procedure and the previous clinical symptoms are mandatory besides special computed tomography (CT) techniques and MR sequences. (orig.) [German] In der Regel erfolgt bei spinalen Eingriffen eine postoperative Bildgebung, um die exakte Lage des Implantatmaterials zu dokumentieren. Unbedingt notwendig ist die Bildgebung, wenn postoperativ neue klinische Symptome aufgetreten sind. Hier muessen eine Nachblutung bzw. inkorrekte, eine Wurzel oder das Myelon tangierende Implantatlage nachgewiesen werden. Neben diesen direkt postoperativ auftretenden klinischen Symptomen gibt es eine Reihe von Komplikationen, die erst nach mehreren Tagen, Wochen oder sogar nach Monaten auftreten koennen. Hierzu zaehlen das Failed-back-surgery-Syndrom, die Implantatlockerung oder -bruch, aber auch ein Rezidivvorfall und die Spondylodiszitis. Neben der

  15. Independent Factors Affecting Postoperative Complication Rates After Custom-Made Porous Hydroxyapatite Cranioplasty: A Single-Center Review of 109 Cases.

    Science.gov (United States)

    Still, Megan; Kane, Abdoulaye; Roux, Alexandre; Zanello, Marc; Dezamis, Edouard; Parraga, Eduardo; Sauvageon, Xavier; Meder, Jean-François; Pallud, Johan

    2018-06-01

    Cranioplasties are an important neurosurgical procedure not only for improved cosmesis but also for improved functional recovery after craniectomy with a large cranial defect. The aim of this study was to identify predictive factors of postcranioplasty complications using custom-made porous hydroxyapatite cranioplasty. Retrospective review was performed of all patients who underwent a reconstructive cranioplasty using custom-made hydroxyapatite at our institution between February 2008 and September 2017. Postoperative complications considered included bacterial infection, seizures, hydrocephalus requiring ventricular shunt placement, and cranioplasty-to-bone shift. Variables associated at P < 0.1 level in unadjusted analysis were entered into backward stepwise logistic regression models. Of 109 patients included, 15 (13.8%) experienced postoperative infection, with craniectomy performed at an outside institution (adjusted odds ratio [OR] 10.37 [95% confidence interval [CI], 2.03-75.27], P = 0.012) and a previous infection at the surgical site (adjusted OR 6.15 [95%CI, 1.90-19.92], P = 0.003) identified as independent predictors. Six patients (5.5%) experienced postoperative seizures, with stroke (ischemic and hemorrhagic) as a reason for craniectomy (adjusted OR 11.68 [95% CI, 2.56-24.13], P < 0.001) and the presence of seizures in the month before cranioplasty (adjusted OR 9.39 [95% CI, 2.04-127.67], P = 0.002) identified as independent predictors. Four patients (3.7%) experienced postcranioplasty hydrocephalus necessitating shunt placement, and 5 patients (4.6%) experienced cranioplasty-to-bone shift ≥5 mm, but no significant predictive factors were identified for either complication. This study identified possible predictive factors for postcranioplasty complications to help identify at-risk patients, guide prophylactic care, and improve morbidity of this important surgical procedure. Copyright © 2018 Elsevier Inc. All rights reserved.

  16. The role of postoperative external irradiation for the incompletely resected meningiomas

    International Nuclear Information System (INIS)

    Kim, Tae Hyun; Yang, Dae Sik; Kim, Chul Young; Choi, Myung Sun

    2000-01-01

    The aim of this study is to look for the possible efficacy of postoperative external irradiation for incompletely resected meningiomas. From August 1981 to January 1997, forty-four patients with intracranial meningioma were treated by postoperative external irradiation. Of the 44 meningiomas, 18 transitional, 13 meningotheliomatous, 6 hemangiopericytic, 4 atypical, 2 fibroblastic and 1 malignant meningioma were identified. We classified all patients into two groups by the histology. The benign group was consisted of the meningotheliomatous, transitional and fibroblastic types. The malignant group was consisted of the atypical, hemangiopericytic and malignant types.In the means of surgery, 37 patients were resected incompletely and 7 patients were managed by biopsy only. After surgery, all patients were received postoperative external irradiation. Radiotherapy was delivered using Co-60 or 4 MV photon beam to a total dose of 50 to 66 Gy (mean dose:57.4 Gy) with a 1.8 to 2 Gy per fraction. The median follow-up was 48 months (range:21-101 months). Multivariate analysis of the influence by age, sex, location, histology and radiation dose on local control has been done using Cox's proportional hazard model. 5-year local control rate was 93.8% for the benign histology and 51.8% for the malignant histology (p=0.0110) and overall local control rate at 5 years was 87.4%. The analysis of the prognostic factors, such as age, sex, location, and radiation dose were not significant except for the histology. Adjuvant postoperative external irradiation appears to be significantly improved local control in the patients with incompletely resected meningiomas

  17. Perceptions about traditional and novel methods to learn about postoperative pain management: a qualitative study.

    Science.gov (United States)

    Ingadottir, Brynja; Blondal, Katrin; Jaarsma, Tiny; Thylen, Ingela

    2016-11-01

    The aim of this study was to explore the perceptions of surgical patients about traditional and novel methods to learn about postoperative pain management. Patient education is an important part of postoperative care. Contemporary technology offers new ways for patients to learn about self-care, although face-to-face discussions and brochures are the most common methods of delivering education in nursing practice. A qualitative design with a vignette and semi-structured interviews used for data collection. A purposeful sample of 13 postsurgical patients, who had been discharged from hospital, was recruited during 2013-2014. The patients were given a vignette about anticipated hospital discharge after surgery with four different options for communication (face-to-face, brochure, website, serious game) to learn about postoperative pain management. They were asked to rank their preferred method of learning and thereafter to reflect on their choices. Data were analysed using an inductive content analysis approach. Patients preferred face-to-face education with a nurse, followed by brochures and websites, while games were least preferred. Two categories, each with two sub-categories, emerged from the data. These conceptualized the factors affecting patients' perceptions: (1) 'Trusting the source', sub-categorized into 'Being familiar with the method' and 'Having own prejudgments'; and (2) 'Being motivated to learn' sub-categorized into 'Managing an impaired cognition' and 'Aspiring for increased knowledge'. To implement successfully novel educational methods into postoperative care, healthcare professionals need to be aware of the factors influencing patients' perceptions about how to learn, such as trust and motivation. © 2016 John Wiley & Sons Ltd.

  18. Opioids Consumed in the Immediate Post-Operative Period Do Not Influence How Patients Rate Their Experience of Care After Total Hip Arthroplasty.

    Science.gov (United States)

    Etcheson, Jennifer I; Gwam, Chukwuweike U; George, Nicole E; Virani, Sana; Mont, Michael A; Delanois, Ronald E

    2018-04-01

    Patient perception of care, commonly measured with Press Ganey (PG) surveys, is an important metric used to determine hospital and provider reimbursement. However, post-operative pain following total hip arthroplasty (THA) may negatively affect patient satisfaction. As a result, over-administration of opioids may occur, even without marked evidence of pain. Therefore, this study evaluated whether opioid consumption in the immediate postoperative period bears any influence on satisfaction scores after THA. Specifically, this study assessed the correlation between post-operative opioid consumption and 7 PG domains: (1) Overall hospital rating; (2) Communication with nurses; (3) Responsiveness of hospital staff; (4) Communication with doctors; (5) Hospital environment; (6) Pain Management; and (7) Communication about medicines. Our institutional PG database was reviewed for patients who received THA from 2011 to 2014. A total of 322 patients (mean age = 65 years; 61% female) were analyzed. Patient's opioid consumption was measured using a morphine milli-equivalent conversion algorithm. Bivariate correlation analysis assessed the association between opioid consumption and Press-Ganey survey elements. Pearson's r assessed the strength of the association. No correlation was found between total opioid consumption and Overall hospital rating (r = 0.004; P = .710), Communication with nurses (r = 0.093; P = .425), Responsiveness of hospital staff (r = 0.104; P = .381), Communication with doctors (r = 0.009; P = .940), Hospital environment (r = 0.081; P = .485), and Pain management (r = 0.075; P = .536). However, there was a positive correlation between total opioid consumption and "Communication about medicines" (r = 0.262; P = .043). Our report demonstrates that PG patient satisfaction scores are not influenced by post-operative opioid use, with the exception of PG domain, "Communication about medications." These results suggest that opioid medications should be

  19. What are the risk factors for post-operative infection after hip hemiarthroplasty? Systematic review of literature.

    Science.gov (United States)

    Noailles, Thibaut; Brulefert, Kévin; Chalopin, Antoine; Longis, Pierre Marie; Gouin, François

    2016-09-01

    Femoral neck fractures are frequent in the elderly population and lead to high morbidity and mortality. Hemiarthroplasty is an established surgical procedure for displaced intracapsular femoral neck fractures. Post-operative infection is frequent and is potentially devastating for the patient and the healthcare services. The goal of this study was to identify the risk factors of infection after hemiarthroplasty and help adapt our surgical practice. A systematic review of the literature was performed in July 2015 by two authors using the MedLine, PubMed and Cochrane databases. We used the MeSH keywords "hip hemiarthroplasty" AND "infection" to identify risk factors and methods of prevention for surgical site infection after hemiarthroplasty. Following the search, two authors independently performed the first stage based on titles and abstracts. Thirty-seven articles were selected. Review and analysis of the references was performed to find other articles of interest. Thirteen articles were selected to analyse. According to literature, the surgical site infection (SSI) rate after hip hemiarthroplasty (HHA) is between 1.7 and 7.3 %. Pre-operative comorbidities (obesity, liver disease, advanced age), operative conditions (junior surgeon, uncemented stems, time of surgery) and post-operative management (length of hospitalisation, haematoma, prolonged wound drainage and two urinary catheterisations) were identified as risk factors of surgical site infection. Authors describe conditions to decrease the incidence of these complications and underline the importance of "a specialised hip team" that provides fast care and helps decrease the duration of hospitalisation. Careful patient management for hemiarthroplasty is vital and may decrease the incidence of surgical site infection, which is associated with high morbidity and high procedure cost. Our review suggests that there are specific correctable risk factors for SSIs after HHA. Being able to identify these risk factors

  20. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy

    DEFF Research Database (Denmark)

    Gutierrez, Jorge; Smith, Arthur; Geavlete, Petrisor

    2013-01-01

    PURPOSE: To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. MATERIALS AND METHODS: Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre...

  1. Depressive Symptoms and Risk of Postoperative Delirium.

    Science.gov (United States)

    Smith, Patrick J; Attix, Deborah K; Weldon, B Craig; Monk, Terri G

    2016-03-01

    Previous studies have shown that elevated depressive symptoms are associated with increased risk of postoperative delirium. However, to our knowledge no previous studies have examined whether different components of depression are differentially predictive of postoperative delirium. One thousand twenty patients were screened for postoperative delirium using the Confusion Assessment Method and through retrospective chart review. Patients underwent cognitive, psychosocial, and medical assessments preoperatively. Depression was assessed using the Geriatric Depression Scale-Short Form. Thirty-eight patients developed delirium (3.7%). Using a factor structure previously validated among geriatric medical patients, the authors examined three components of depression as predictors of postoperative delirium: negative affect, cognitive distress, and behavioral inactivity. In multivariate analyses controlling for age, education, comorbidities, and cognitive function, the authors found that greater behavioral inactivity was associated with increased risk of delirium (OR: 1.95 [1.11, 3.42]), whereas negative affect (OR: 0.65 [0.31, 1.36]) and cognitive distress (OR: 0.95 [0.63, 1.43]) were not. Different components of depression are differentially predictive of postoperative delirium among adults undergoing noncardiac surgery. Copyright © 2016 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  2. Surgical outcome of tuberculous meningitis hydrocephalus treated by endoscopic third ventriculostomy: prognostic factors and postoperative neuroimaging for functional assessment of ventriculostomy.

    Science.gov (United States)

    Chugh, Ashish; Husain, Mazhar; Gupta, Rakesh K; Ojha, Bal K; Chandra, Anil; Rastogi, Manu

    2009-05-01

    Endoscopic third ventriculostomy (ETV) is increasingly being used as an alternative treatment for post-tuberculous meningitis (TBM) hydrocephalus. The aim of this study was to affirm the role of ETV in patients with TBM hydrocephalus and also to study the usefulness of cine phase-contrast MR imaging (cine MR imaging) for functional assessment of the ETV stoma. An additional goal was to identify factors that influence the outcome of ETV, so as to define patients with TBM hydrocephalus in whom ETV is warranted. Twenty-six patients with TBM hydrocephalus treated with ETV were evaluated clinically and with cine MR imaging postoperatively. The duration of follow-up ranged from 1 to 15 months. The authors evaluated flow void changes in the floor of the third ventricle and analyzed parameters from the preoperative data, which they then used as a basis for comparison between endoscopically successful and endoscopically unsuccessful cases. The overall success rate of ETV in TBM hydrocephalus was 73.1% in this case series. Cine MR imaging showed a sensitivity of 94.73% and specificity of 71.42% for the functional assessment of third ventriculostomy in these patients, with the efficacy being maintained during follow-up. The outcome of ETV showed a statistically significant correlation with the stage of illness and presence of intraoperative cisternal exudates. Although duration of symptoms and duration of preoperative antituberculous therapy (ATT) appeared to influence the outcome, their correlation with outcome was not statistically significant. Endoscopic third ventriculostomy should be considered as the first surgical option for CSF diversion (that is, before shunt surgery) in patients with TBM hydrocephalus. Cine MR imaging is a highly effective noninvasive tool for the postoperative functional assessment of stomata. Patients who presented with a history of longer duration and those who were administered preoperative ATT for a longer period had a better outcome of

  3. Division of overall duration of stay into operative stay and postoperative stay improves the overall estimate as a measure of quality of outcome in burn care.

    Directory of Open Access Journals (Sweden)

    Islam Abdelrahman

    Full Text Available Surgically managed burn patients admitted between 2010-14 were included. Operative stay was defined as the time from admission until the last operation, postoperative stay as the time from the last operation until discharge. The difference in variation was analysed with F-test. A retrospective review of medical records was done to explore reasons for extended postoperative stay. Multivariable regression was used to assess factors associated with operative stay and postoperative stay.Operative stay/TBSA% showed less variation than total duration/TBSA% (F test = 2.38, p<0.01. The size of the burn, and the number of operations, were the independent factors that influenced operative stay (R2 0.65. Except for the size of the burn other factors were associated with duration of postoperative stay: wound related, psychological and other medical causes, advanced medical support, and accommodation arrangements before discharge, of which the two last were the most important with an increase of (mean 12 and 17 days (p<0.001, R2 0.51.Adjusted operative stay showed less variation than total hospital stay and thus can be considered a more accurate outcome measure for surgically managed burns. The size of burn and number of operations are the factors affecting this outcome measure.

  4. Description of preoperative risk factors and postoperative complications of radical hysterectomy in patients of Hospital Dr. Rafael Angel Calderon Guardia: period 2000-2006

    International Nuclear Information System (INIS)

    Sosa Quesada, Carlos Ivan; Wang Zuniga, Sylvia

    2008-01-01

    Preoperative risk factors and postoperative complications were determined in patients with radical hysterectomy in gynecologic oncology service of Hospital Rafael Angel Calderon Guardia in 2000-2006. Radical hysterectomy Piver type II and III was carried out among women in the gynecology service. The information derived from the qualitative variables were analyzed using frequency distributions and percentages. The most common preoperative comorbidity has been hypertension, the most frequently encountered complication has been urinary incontinence. Postoperative complications have been located in a period less than three months. [es

  5. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy

    NARCIS (Netherlands)

    Gutierrez, Jorge; Smith, Arthur; Geavlete, Petrisor; Shah, Hemendra; Kural, Ali Riza; de Sio, Marco; Amón Sesmero, José H.; Hoznek, András; de la Rosette, Jean

    2013-01-01

    To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who

  6. Incidence, risk factors, and phenomenological characteristics of postoperative delirium in patients receiving intravenous patient-controlled analgesia: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Lin YT

    2016-12-01

    Full Text Available Yao Tsung Lin,1 Kuo Mao Lan,1 Li-Kai Wang,1 Chin-Chen Chu,1 Su-Zhen Wu,1 Chia-Yu Chang,2 Jen-Yin Chen1,3 1Department of Anesthesiology, 2Department of Neurology, Chi Mei Medical Center, 3Department of the Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan Background: Intravenous patient-controlled analgesia (IVPCA is a common method of relieving pain which is a risk factor of postoperative delirium (POD. However, research concerning POD in IVPCA patients is limited. Objective: We aimed to determine the incidence, risk factors, and phenomenological characteristics of POD in patients receiving IVPCA. Methods: A prospective, cohort study was conducted in post-general anesthesia IVPCA patients aged ≥60 years. POD was measured by the Nursing Delirium Screening Scale (NuDESC; 0–10. Delirium, pain severity at rest and/or on movement, and side effects of IVPCA during 3 postoperative days were examined twice-daily by the acute pain service team. Pain severity is measured by an 11-point verbal numerical rating scale (11-point VNRS (0–10. An 11-point VNRS >3 was considered inadequate pain relief. If POD (detected by NuDESC ≥1 is suspected, consulting a neurologist or a psychiatrist to confirm suspected POD is required. Results: In total, 1,608 patients were included. The incidence rate of POD was 2.2%. Age ≥70 years and American Society of Anesthesiologists physical status >III were the risk factors of POD in IVPCA patients. Approximately three-quarters of all POD cases occurred within the first 2 postoperative days. For pain at rest, patients with inadequate pain relief had significantly greater rates of POD than patients with adequate pain relief (day 1, 8.4% vs 1.5%, P<0.001; day 2, 9.6% vs 2.0%, P=0.028; day 3, 4.1% vs 2.1%, P=0.412. However, the incidence of POD was not associated with movement-evoked pain relief. Most (79.9% POD cases in IVPCA patients showed either one or two symptoms. The

  7. Diagnosis, prevention and management of postoperative pulmonary edema.

    Science.gov (United States)

    Bajwa, Sj Singh; Kulshrestha, A

    2012-07-01

    Postoperative pulmonary edema is a well-known postoperative complication caused as a result of numerous etiological factors which can be easily detected by a careful surveillance during postoperative period. However, there are no preoperative and intraoperative criteria which can successfully establish the possibilities for development of postoperative pulmonary edema. The aims were to review the possible etiologic and diagnostic challenges in timely detection of postoperative pulmonary edema and to discuss the various management strategies for prevention of this postoperative complication so as to decrease morbidity and mortality. The various search engines for preparation of this manuscript were used which included Entrez (including Pubmed and Pubmed Central), NIH.gov, Medknow.com, Medscape.com, WebMD.com, Scopus, Science Direct, MedHelp.org, yahoo.com and google.com. Manual search was carried out and various text books and journals of anesthesia and critical care medicine were also searched. From the information gathered, it was observed that postoperative cardiogenic pulmonary edema in patients with serious cardiovascular diseases is most common followed by noncardiogenic pulmonary edema which can be due to fluid overload in the postoperative period or it can be negative pressure pulmonary edema (NPPE). NPPE is an important clinical entity in immediate post-extubation period and occurs due to acute upper airway obstruction and creation of acute negative intrathoracic pressure. NPPE carries a good prognosis if promptly diagnosed and appropriately treated with or without mechanical ventilation.

  8. Assessing the impact of a fistula after a pancreaticoduodenectomy using the Post-operative Morbidity Index.

    Science.gov (United States)

    Miller, Benjamin C; Christein, John D; Behrman, Stephen W; Callery, Mark P; Drebin, Jeffrey A; Kent, Tara S; Pratt, Wande B; Lewis, Russell S; Vollmer, Charles M

    2013-10-01

    The Post-operative Morbidity Index (PMI) is a quantitative utility measure of a complication burden created by severity weighting. The Fistula Risk Score (FRS) is a validated model that predicts whether a patient will develop a post-operative pancreatic fistula (POPF). These novel tools might provide further discrimination of the ISGPF grading system. From 2001 to 2012, 1021 pancreaticoduodenectomies were performed at four institutions. POPFs were categorized by ISGPF standards. PMI scores were calculated based on the Modified Accordion Severity Grading System. FRS scores were assigned according to the relative influence of four recognized factors for developing a clinically relevant POPF (CR-POPF). In total, 231 patients (22.6%) developed a POPF, of which 54.1% were CR-POPFs. The PMI differed significantly between the ISGPF grades and patients with no or non-fistulous complications (P concept of clinical severity. CR-POPFs usually reflect the patient's highest Accordion score whereas biochemical POPFs are often superseded. The correlation between FRS and PMI indicates that risk factors for a fistula contribute to overall pancreaticoduodenectomy morbidity. © 2013 International Hepato-Pancreato-Biliary Association.

  9. Adjuvant postoperative radiation therapy for carcinoma of the uterine cervix

    International Nuclear Information System (INIS)

    Lee, Kyung Ja; Moon, Hye Seong; Kim, Seung Cheol; Kim, Chong Il; Ahn, Jung Ja

    2003-01-01

    This study was undertaken to evaluate the efficacy of postoperative radiotherapy, and to investigate the prognostic factors for FIGO stages IB-IIB cervical cancer patients who were treated with simple hysterectomy, or who had high-risk factors following radical hysterectomy and pelvic lymph node dissection. Between March 1986 and December 1998, 58 patients, with FIGO stages IB-IIB cervical cancer were included in this study, The indications for postoperative radiation therapy were based on the pathological findings, including lymph node metastasis, positive surgical margin, parametrial extension, Iymphovascular invasion, invasion of more than half the cervical stroma, uterine extension and the incidental finding of cervix cancer following simple hysterectomy. All patients received external pelvic radiotherapy, and 5 patients, received an additional intracavitary radiation therapy. The radiation dose from the external beam to the whole pelvis was 45 - 50 Gy. Vagina cuff irradiation was performed, after completion of the external beam irradiation, al a low-dose rate of CS-137, with the total dose of 4488-4932 chy (median: 4500 chy) at 5 mm depth from the vagina surface. The median follow-up period was 44 months (15-108 months), The 5-yr actuarial local control rate, distant free survival and disease-free survival rate were 98%, 95% and 94%, respectively. A univariate analysis of the clinical and pathological parameters revealed that the clinical stage (p=0.0145), status of vaginal resection margin (p=0.0002) and parametrial extension (p=0.0001) affected the disease-free survival. From a multivariate analysis, only a parametrial extension independently influenced the disease-free survival. Five patients (9%) experienced Grade 2 late treatment-related complications, such as radiation proctitis (1 patient), cystitis (3 patients) and lymphedema of the leg (1 patient). No patient had grade 3 or 4 complications. Our results indicate that postoperative radiation therapy can

  10. CNS tumors: postoperative evaluation

    International Nuclear Information System (INIS)

    Dayanir, Y.

    2012-01-01

    Full text: Imaging assessment of brain tumors following surgery is complex and depends upon several factors, including the location of the tumor, the surgical procedure and the disease process for which it was performed. Depending upon these factors, one or a combination of complementary imaging modalities may be required to demonstrate any clinically relevant situation, to assist the surgeon in deciding if repeat surgery is necessary. Conventional magnetic resonance imaging (MRI) can show the shape, size, signal intensity, and enhancement of a brain tumor. It has been widely used to diagnose and differentiate brain tumors and to assess the surgery outcomes. Longitudinal MRI scans have also been applied for the assessment of treatment and response to surgery. The newly developed MRI techniques, including diffusion weighted imaging (DWI), perfusion weighted imaging (PWI) and magnetic resonance spectroscopy (MRS), have the potential to provide the molecular, functional and metabolic information of preoperative and postoperative brain tumors. Postoperative diffusion and perfusion magnetic resonance imaging are especially useful in predicting early functional recovery from new deficits after brain tumor surgery.This lecture will stress the principles, applications, and pitfalls of conventional as well as newly developing functional imaging techniques following operation of brain tumors

  11. Early and late postoperative seizure outcome in 97 patients with supratentorial meningioma and preoperative seizures: a retrospective study.

    Science.gov (United States)

    Zheng, Zhe; Chen, Peng; Fu, Weiming; Zhu, Junming; Zhang, Hong; Shi, Jian; Zhang, Jianmin

    2013-08-01

    We identified factors associated with early and late postoperative seizure control in patients with supratentorial meningioma plus preoperative seizures. In this retrospective study, univariate analysis and multivariate logistic regression analysis compared 24 clinical variables according to the occurrence of early (≤1 week) or late (>1 week) postoperative seizures. Sixty-two of 97 patients (63.9 %) were seizure free for the entire postoperative follow-up period (29.5 ± 11.8 months), while 13 patients (13.4 %) still had frequent seizures at the end of follow-up. Fourteen of 97 patients (14.4 %) experienced early postoperative seizures, and emergence of new postoperative neurological deficits was the only significant risk factor (odds ratio = 7.377). Thirty-three patients (34.0 %) experienced late postoperative seizures at some time during follow-up, including 12 of 14 patients with early postoperative seizures. Associated risk factors for late postoperative seizures included tumor progression (odds ratio = 7.012) and new permanent postoperative neurological deficits (odds ratio = 4.327). Occurrence of postoperative seizures in patients with supratentorial meningioma and preoperative seizure was associated with new postoperative neurological deficits. Reduced cerebral or vascular injury during surgery may lead to fewer postoperative neurological deficits and better seizure outcome.

  12. Factors influencing knowledge and practice of exclusive ...

    African Journals Online (AJOL)

    Factors influencing knowledge and practice of exclusive breastfeeding in Nyando ... The overall objective of this study was to determine factors influencing the ... EBF and its benefits), pre lacteal feeds and exclusive breastfeeding consistency.

  13. Postoperative glaucoma following infantile cataract surgery: an individual patient data meta-analysis.

    Science.gov (United States)

    Mataftsi, Asimina; Haidich, Anna-Bettina; Kokkali, Stamatia; Rabiah, Peter K; Birch, Eileen; Stager, David R; Cheong-Leen, Richard; Singh, Vineet; Egbert, James E; Astle, William F; Lambert, Scott R; Amitabh, Purohit; Khan, Arif O; Grigg, John; Arvanitidou, Malamatenia; Dimitrakos, Stavros A; Nischal, Ken K

    2014-09-01

    .03). Results were similar in the aggregate data meta-analysis that included data from 10 published articles. Although confounding factors such as size of the eye and surgeon experience are not accounted for in this meta-analysis, the risk for postoperative glaucoma after infantile cataract surgery appears to be influenced by the timing of surgery, primary implantation, and additional intraocular surgery.

  14. Predictors of Postoperative Complications After Trimodality Therapy for Esophageal Cancer

    International Nuclear Information System (INIS)

    Wang, Jingya; Wei, Caimiao; Tucker, Susan L.; Myles, Bevan; Palmer, Matthew; Hofstetter, Wayne L.; Swisher, Stephen G.; Ajani, Jaffer A.; Cox, James D.; Komaki, Ritsuko; Liao, Zhongxing; Lin, Steven H.

    2013-01-01

    Purpose: While trimodality therapy for esophageal cancer has improved patient outcomes, surgical complication rates remain high. The goal of this study was to identify modifiable factors associated with postoperative complications after neoadjuvant chemoradiation. Methods and Materials: From 1998 to 2011, 444 patients were treated at our institution with surgical resection after chemoradiation. Postoperative (pulmonary, gastrointestinal [GI], cardiac, wound healing) complications were recorded up to 30 days postoperatively. Kruskal-Wallis tests and χ 2 or Fisher exact tests were used to assess associations between continuous and categorical variables. Multivariate logistic regression tested the association between perioperative complications and patient or treatment factors that were significant on univariate analysis. Results: The most frequent postoperative complications after trimodality therapy were pulmonary (25%) and GI (23%). Lung capacity and the type of radiation modality used were independent predictors of pulmonary and GI complications. After adjusting for confounding factors, pulmonary and GI complications were increased in patients treated with 3-dimensional conformal radiation therapy (3D-CRT) versus intensity modulated radiation therapy (IMRT; odds ratio [OR], 2.018; 95% confidence interval [CI], 1.104-3.688; OR, 1.704; 95% CI, 1.03-2.82, respectively) and for patients treated with 3D-CRT versus proton beam therapy (PBT; OR, 3.154; 95% CI, 1.365-7.289; OR, 1.55; 95% CI, 0.78-3.08, respectively). Mean lung radiation dose (MLD) was strongly associated with pulmonary complications, and the differences in toxicities seen for the radiation modalities could be fully accounted for by the MLD delivered by each of the modalities. Conclusions: The radiation modality used can be a strong mitigating factor of postoperative complications after neoadjuvant chemoradiation

  15. Prognostic significance of postoperative pneumonia after curative resection for patients with gastric cancer.

    Science.gov (United States)

    Tu, Ru-Hong; Lin, Jian-Xian; Li, Ping; Xie, Jian-Wei; Wang, Jia-Bin; Lu, Jun; Chen, Qi-Yue; Cao, Long-Long; Lin, Mi; Zheng, Chao-Hui; Huang, Chang-Ming

    2017-12-01

    Few studies have been designed to investigate the incidence of postoperative pneumonia after radical gastrectomy and its effect on prognosis of these patients. Incidences of postoperative pneumonia after radical gastrectomy in our department between January 1996 and December 2014 were summarized. Their effects on prognosis were retrospectively analyzed using survival curves and Cox regression. A total of 5237 patients were included in this study, 767 (14.4%) of them had complications, including 383 cases of postoperative pneumonia (7.2%). The 5-year overall and disease-specific survival of patients with postoperative pneumonia were both lower than those without this complication (P pneumonia were independent risk factors for disease-specific survival. Postoperative pneumonia after radical gastrectomy is an independent risk factor for prognosis of gastric cancer patients, especially in stage III. © 2017 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  16. Early Postoperative Magnetic Resonance Imaging in Detecting Radicular Pain After Lumbar Decompression Surgery: Retrospective Study of the Relationship Between Dural Sac Cross-sectional Area and Postoperative Radicular Pain.

    Science.gov (United States)

    Futatsugi, Toshimasa; Takahashi, Jun; Oba, Hiroki; Ikegami, Shota; Mogami, Yuji; Shibata, Syunichi; Ohji, Yoshihito; Tanikawa, Hirotaka; Kato, Hiroyuki

    2017-07-01

    A retrospective analysis. To evaluate the association between early postoperative dural sac cross-sectional area (DCSA) and radicular pain. The correlation between postoperative magnetic resonance imaging (MRI) findings and postoperative neurological symptoms after lumbar decompression surgery is controversial. This study included 115 patients who underwent lumbar decompression surgery followed by MRI within 7 days postoperatively. There were 46 patients with early postoperative radicular pain, regardless of whether the pain was mild or similar to that before surgery. The intervertebral level with the smallest DCSA was identified on MRI and compared preoperatively and postoperatively. Risk factors for postoperative radicular pain were determined using univariate and multivariate analyses. Subanalysis according to absence/presence of a residual suction drain also was performed. Multivariate regression analysis showed that smaller postoperative DCSA was significantly associated with early postoperative radicular pain (per -10 mm; odds ratio, 1.26). The best cutoff value for radicular pain was early postoperative DCSA of 67.7 mm. Even with a cutoff value of surgery. The best cutoff value for postoperative radicular pain was 67.7 mm. Absence of a suction drain at the time of early postoperative MRI was related to smaller DCSA.

  17. Postoperative B-Type Natriuretic Peptide as Predictor for Postoperative Outcomes in Patients Implanted With Left Ventricular Assist Devices.

    Science.gov (United States)

    Yost, Gardner; Bhat, Geetha; Pappas, Patroklos; Tatooles, Antone

    2018-04-18

    Brain natriuretic peptide (BNP) is a cardiac neurohormone known to correlate with left ventricular (LV) dilation, decreased contractility, and increased stiffness. Consequently, BNP has been used as a prognostic tool to assess the degree of LV unloading for patients supported by continuous-flow LV assist devices (LVADs). We assessed the prognostic value of changes in BNP in the 2 weeks after LVAD implantation. This retrospective study analyzed laboratory findings and outcomes of 189 LVAD patients. Patients were separated into two groups based on whether serum BNP levels had improved from preoperative levels by postoperative day 14. Group 1 had improvement in BNP levels, whereas group 2 had no improvement or worsening in BNP. There were no significant differences between the groups in age, gender, race, body mass index, or comorbidities. Group 1 had preoperative BNP 1,125 ± 1,078.3 pg/dl and postoperative BNP 440.2 ± 267.7 pg/dl (ΔBNP = -693.09 ± 942.4 pg/dl), whereas group 2 had preoperative BNP 346.0 ± 309.1 pg/dl and postoperative BNP 631.57 ± 483.4 pg/dl (ΔBNP = 289.32 ± 329.7 pg/dl). Postoperative survival in group 2 was significantly worse than in group 1. Rates of right ventricular failure (RVF) were significantly higher in group 2 (group 1: 39%, group 2: 52.7%; p = 0.01). In most patients implanted with a LVAD, BNP improves significantly in the postoperative period as the LV is unloaded. Our results indicate that lack of improvement in postoperative BNP is associated with longer length of stay, increased rates of RVF, and is an independent risk factor for reduced postoperative survival.

  18. Patients' experience of breast reconstruction after mastectomy and its influence on postoperative satisfaction.

    Science.gov (United States)

    Schmidt, Jana L; Wetzel, Cordula M; Lange, Klaus W; Heine, Norbert; Ortmann, Olaf

    2017-10-01

    Breast cancer patients have the option to choose a breast reconstruction after mastectomy. A range of studies have postulated that patients' individually appraised significance of their breast is an important factor in the decision for or against breast reconstruction. This study explored the individually perceived significance of the breast among patients with and without breast reconstruction and its correlation with postoperative satisfaction. Ten patients without breast reconstruction, and ten patients with immediate breast reconstruction after mastectomy participated in the study. The perceived importance of the breast and the pre-and postoperative esthetic satisfaction of the patients were obtained using an 11-point Likert scale. Qualitative interviews explored patients' views on the meaning of their breast and their experience after surgery. Patients who had decided for breast reconstruction rated the importance of their breast for femininity (p = 0.004) and attractiveness (p = 0.037) significantly higher than patients without reconstruction. The qualitative data provide evidence that the breast of a woman fulfills a variety of intrapsychic and interactional functions. Difficulties in integrating the reconstructed breast into the body image were reported. A high importance of the breast correlated significantly with a decrease in satisfaction with the breast after reconstruction (rs = -0.652, p = 0.041). Patients who found their breast to be highly important were more likely to decide for a reconstruction. Mastectomy has an impact on various psychosocial variables but impairments may also occur after breast reconstruction. Patients reporting a high significance of their breast showed the greatest decrease in satisfaction with their breast after reconstruction.

  19. Arthroscopic suture bridge rotator cuff repair: functional outcome, repair integrity, and preoperative factors related to postoperative outcome.

    Science.gov (United States)

    Rimmke, Nathan; Maerz, Tristan; Cooper, Ross; Yadavalli, Sailaja; Anderson, Kyle

    2016-01-01

    To assess the retear rate, retear size and location, the clinical impact of a retear, and preoperative patient factors related to postoperative outcome after arthroscopic suture bridge rotator cuff repair. Fifty six patients with an isolated, full-thickness supraspinatus tendon tear who underwent arthroscopic suture bridge rotator cuff repair were retrospectively identified. Patients were evaluated and rotator cuff integrity was assessed using ultrasonography. Visual analog score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, shoulder range of motion and strength were used for clinical evaluation. Retears were assessed for size and location on ultrasonography. Forty two patients (75%) aged a mean 59.7 ± 8.6 years (range 41-79 years) were available for follow-up at a mean 13.5 months. Postoperative evaluation indicated significant improvements in ASES score (49.76 ± 18.2 to 86.57 ± 13.4, P rotation ROM (44.13° ± 12.0 to 52.09° ± 12.0, P = 0.003). The retear rate was 14.28% (6/42). Patients with retears were not older (P = 0.526) but had a larger preoperative tear size (3.25 cm ± 0.5 vs. 2.05 cm ± 0.48, P rotation ROM (P = 0.002), and internal rotation strength (P = 0.004). Arthroscopic suture bridge repair provides good clinical results with a low retear rate. The duration of preoperative symptoms was associated with postoperative outcome, indicating that delaying surgery may result in inferior outcomes. IV, Case Series.

  20. Postoperative radiotherapy for parotid gland malignancy

    Energy Technology Data Exchange (ETDEWEB)

    Eom, Keun Yong; Wu, Hong Gyun; Kim, Jae Sung; Park, Charn Il; Kim, Kwang Hyun; Lee, Chae Seo [Seoul National University College of Medicine, Seoul (Korea, Republic of); Kim, In Ah [Bundang Seoul National University Hospital, Seongnam (Korea, Republic of)

    2005-09-15

    The aim of this study was to evaluate the clinical results of postoperative radiotherapy for parotid gland malignancy, and determine prognostic factors for locoregional control and survival. Between 1980 and 2002, 130 patients with parotid malignancy were registered in the database of the Department of Radiation Oncology, Seoul National University Hospital. The subjects of this analysis were the 72 of these 130 patients who underwent postoperative irradiation. There were 42 males and 30 females, with a median age of 46.5 years. The most common histological type was a mucoepidermoid carcinoma. There were 6, 23, 23 and 20 patients in Stages I, II, III and IV, respectively. The median dose to the tumor bed was 60 Gy, with a median fraction size of 1.8 Gy. The overall 5 and 10 year survival rates were 85 and 76%, respectively. The five-year locoregional control rate was 85%, which reached a plateau phase after 6 years. Sex and histological type were found to be statistically significant for overall survival from a multivariate analysis. No other factors, including age, facial nerve palsy and stage, were related to overall survival. For locoregional control, nodal involvement and positive resection margin were associated with poor local control. Histological type, tumor size, perineural invasion and type of surgery were not significant for locoregional control. A high survival rate of parotid gland malignancies, with surgery and postoperative radiotherapy, was confirmed. Sex and histological type were significant prognostic factors for overall survival. Nodal involvement and a positive resection margin were associated with poor locoregional control.

  1. Analysis of Unplanned Intensive Care Unit Admissions in Postoperative Pediatric Patients.

    Science.gov (United States)

    Landry, Elizabeth K; Gabriel, Rodney A; Beutler, Sascha; Dutton, Richard P; Urman, Richard D

    2017-03-01

    Currently, there are only a few retrospective, single-institution studies that have addressed the prevalence and risk factors associated with unplanned admissions to the pediatric intensive care unit (ICU) after surgery. Based on the limited amount of studies, it appears that airway and respiratory complications put a child at increased risk for unplanned ICU admission. A more extensive and diverse analysis of unplanned postoperative admissions to the ICU is needed to address risk factors that have yet to be revealed by the current literature. To establish a rate of unplanned postoperative ICU admissions in pediatric patients using a large, multi-institution data set and to further characterize the associated risk factors. Data from the National Anesthesia Clinical Outcomes Registry were analyzed. We recorded the overall risk of unplanned postoperative ICU admission in patients younger than 18 years and performed univariate and multivariate logistic regression analysis to identify the associated patient, surgical, and anesthetic-related characteristics. Of the 324 818 cases analyzed, 211 reported an unexpected ICU admission. There was an increased likelihood of unplanned postoperative ICU in infants (age anesthesia were also associated with unplanned ICU admissions. This study establishes a rate of unplanned ICU admission following surgery in the heterogeneous pediatric population. This is the first study to utilize such a large data set encompassing a wide range of practice environments to identify risk factors leading to unplanned postoperative ICU admissions. Our study revealed that patient, surgical, and anesthetic complexity each contributed to an increased number of unplanned ICU admissions in the pediatric population.

  2. Factors that influencing veterinary drug’s metabolisation

    Directory of Open Access Journals (Sweden)

    Cristina, Romeo T.

    2007-12-01

    Full Text Available The paper wants to make a recall for the vet practitioners, of the main veterinary drug's metabolism rate influencing factors. Among the most important physiological factors (pharmacokinetics, sanguine flow and urinary ones, plasmatic proteins binding, enzymatic induction and inhibition are essential. Between the animal’s bounded factors more important are: species, individuality, age, sex, pregnancy, alimentation, genetic factors, and health status and from exogenous factors, daily rhythm, influences of chemical compounds and of the stress are presented.

  3. Minimal Invasive Urologic Surgery and Postoperative Ileus

    Directory of Open Access Journals (Sweden)

    Fouad Aoun

    2015-07-01

    Full Text Available Postoperative ileus (POI is the most common cause of prolonged length of hospital stays (LOS and associated healthcare costs. The advent of minimal invasive technique was a major breakthrough in the urologic landscape with great potential to progress in the future. In the field of gastrointestinal surgery, several studies had reported lower incidence rates for POI following minimal invasive surgery compared to conventional open procedures. In contrast, little is known about the effect of minimal invasive approach on the recovery of bowel motility after urologic surgery. We performed an overview of the potential benefit of minimal invasive approach on POI for urologic procedures. The mechanisms and risk factors responsible for the onset of POI are discussed with emphasis on the advantages of minimal invasive approach. In the urologic field, POI is the main complication following radical cystectomy but it is rarely of clinical significance for other minimal invasive interventions. Laparoscopy or robotic assisted laparoscopic techniques when studied individually may reduce to their own the duration and prevent the onset of POI in a subset of procedures. The potential influence of age and urinary diversion type on postoperative ileus is contradictory in the literature. There is some evidence suggesting that BMI, blood loss, urinary extravasation, existence of a major complication, bowel resection, operative time and transperitoneal approach are independent risk factors for POI. Treatment of POI remains elusive. One of the most important and effective management strategies for patients undergoing radical cystectomy has been the development and use of enhanced recovery programs. An optimal rational strategy to shorten the duration of POI should incorporate minimal invasive approach when appropriate into multimodal fast track programs designed to reduce POI and shorten LOS.

  4. Risk Factors and Predictive Model Development of Thirty-Day Post-Operative Surgical Site Infection in the Veterans Administration Surgical Population.

    Science.gov (United States)

    Li, Xinli; Nylander, William; Smith, Tracy; Han, Soonhee; Gunnar, William

    2018-04-01

    Surgical site infection (SSI) complicates approximately 2% of surgeries in the Veterans Affairs (VA) hospitals. Surgical site infections are responsible for increased morbidity, length of hospital stay, cost, and mortality. Surgical site infection can be minimized by modifying risk factors. In this study, we identified risk factors and developed accurate predictive surgical specialty-specific SSI risk prediction models for the Veterans Health Administration (VHA) surgery population. In a retrospective observation study, surgical patients who underwent surgery from October 2013 to September 2016 from 136 VA hospitals were included. The Veteran Affairs Surgical Quality Improvement Program (VASQIP) database was used for the pre-operative demographic and clinical characteristics, intra-operative characteristics, and 30-day post-operative outcomes. The study population represents 11 surgical specialties: neurosurgery, urology, podiatry, otolaryngology, general, orthopedic, plastic, thoracic, vascular, cardiac coronary artery bypass graft (CABG), and cardiac valve/other surgery. Multivariable logistic regression models were developed for the 30-day post-operative SSIs. Among 354,528 surgical procedures, 6,538 (1.8%) had SSIs within 30 days. Surgical site infection rates varied among surgical specialty (0.7%-3.0%). Surgical site infection rates were higher in emergency procedures, procedures with long operative duration, greater complexity, and higher relative value units. Other factors associated with increased SSI risk were high level of American Society of Anesthesiologists (ASA) classification (level 4 and 5), dyspnea, open wound/infection, wound classification, ascites, bleeding disorder, chemotherapy, smoking, history of severe chronic obstructive pulmonary disease (COPD), radiotherapy, steroid use for chronic conditions, and weight loss. Each surgical specialty had a distinct combination of risk factors. Accurate SSI risk-predictive surgery specialty

  5. Factors influencing customer satisfaction with reference and ...

    African Journals Online (AJOL)

    This paper examines factors influencing customer satisfaction with reference and information services in an academic environment. The paper identifies types of reference services in libraries, factors influencing customer satisfaction and dissatisfaction with reference and information services and suggested the way forward ...

  6. Factors associated to post-operative nausea and vomiting following oral and maxillofacial surgery: a prospective study.

    Science.gov (United States)

    Albuquerque, Assis Filipe Medeiros; Queiroz, Salomão Israel Monteiro Lourenço; Germano, Adriano Rocha; da Silva, José Sandro Pereira

    2017-03-01

    This study aims to address and assess possible factors associated with nausea and vomiting (NV) following oral and maxillofacial surgery. A prospective study was carried out in the period from December 2013 to January 2016 targeting all attended cases in that period. For statistical analysis, Pearson chi-square and Fisher tests were used to verify association and ANOVA and Student's t tests to test for significant difference, p was defined as ≤0.05. The sample group consisted of 207 patients with an average age of 33.56 years (±13.23), and 70.5% of subjects were male. Calculations based on the predictive model showed that a female patient with prior history of nausea and vomiting who used opioids and had intra-oral surgical access would have a 96% chance of experiencing a nausea and vomiting episode. Other factors like age, being overweight, anesthesia, surgery duration, and duration of hospital stay also contribute so that these aspects must be paid careful attention prior to surgery to ensure a suitably orientated treatment that will avoid disturbances caused by post-operative nausea and vomiting. The occurrence of post-operative nausea and vomiting after oral and maxillofacial surgery was found to be more higher incidence associated to female patients who used opioids, who had a prior history of NV, whose surgery involved intra-oral access, who were in the second or third decades of their lives, who have above average weight, and who have long anesthesia when undergoing surgery, resulting in a long hospital stays.

  7. Race as a predictor of postoperative hospital readmission after spine surgery.

    Science.gov (United States)

    Martin, Joel R; Wang, Timothy Y; Loriaux, Daniel; Desai, Rupen; Kuchibhatla, Maragatha; Karikari, Isaac O; Bagley, Carlos A; Gottfried, Oren N

    2017-12-01

    Hospital readmission after surgery results in a substantial economic burden, and several recent studies have investigated the impact of race and ethnicity on hospital readmission rates, with the goal to identify hospitals and patients with high readmission risk. This single-institution, retrospective cohort study assesses the impact of race, along with other risk factors, on 30-day readmission rates following spinal surgery. This study is a single-institution retrospective cohort study with accrual from January 1, 2008, to December 31, 2010. Inclusion criteria included adult patients who underwent anterior and/or posterior spinal surgery. The primary aim of this study was to assess the impact of patient race and other risk factors for postoperative hospital readmission within 30days following spine surgery. A total of 1346 patients (654 male, 692 female) were included in the study. Overall, 159 patients (11.8%) were readmitted in the 30days following their surgery. Multivariate logistic regression found significant risk factors for 30-day readmission, including Black race (OR: 2.20, C.I. 95% (1.04, 4.64)) and total length of stay greater than 7days (OR: 4.73, C.I. 95% (1.72, 12.98)). Cervical surgery was associated with decreased odds of readmission (OR: 0.27, C.I. 95% (0.08, 0.91)). Our study demonstrates that race and length of hospital stay influence the incidence of 30-day readmission rates after spinal surgery. Studies such as ours will aid in identifying patients with postoperative readmission risk and help elucidate the underlying factors that may be contributing to disparities in readmission after surgery. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. Factors influencing survival and recurrence-free intervals after treatment of primary breast cancer

    International Nuclear Information System (INIS)

    O'Higgins, N.; Brady, H.R.; Clark, C.G.

    1984-01-01

    A retrospective analysis of 739 patients with breast cancer is presented. Factors influencing overall survival, recurrence-free interval and survival after first recurrence are analysed and discussed. None of the factors was affected by age or menopausal status at the time of presentation. Overall survival and recurrence-free intervals varied significantly with tumour size, extent of nodal spread and tumour site. Medially situated tumours, large tumours and extensive nodal spread were associated with earlier first recurrence and poor prognosis. No difference in survival or recurrence-free interval was observed between different surgical operations. Although overall survival was longer in patients who received post-operative radiotherapy, no significant differences in survival or disease-free intervals were noted when patients were standardised for operation or tumour stage. Survival after local recurrence was longer than survival after distant metastases, although the time of onset of local and distant disease followed an identical pattern. These results suggest that the tumour characteristics of size, site and nodal spread are important determinants of survival and recurrence-free interval in primary breast cancer. Local recurrence should be regarded as a manifestation of systemic disease. (author)

  9. Understanding postoperative fatigue.

    Science.gov (United States)

    Rose, E A; King, T C

    1978-07-01

    Performance characteristics of the central nervous, cardiovascular, respiratory and muscular systems in man postoperatively have received little investigative attention, despite the well known syndrome of postoperative fatigue. The impairmen in perception and psychomotor skills that has been shown to result from caloric restriction, bedrest, sedation and sleep deprivation suggests that a similar deficit may occur after surgical procedures. After a simple elective surgical procedure, maximal oxygen uptake decreases and the adaptability of heart rate to submaximal workloads is impaired. Similar deleterious effects on cardiorespiratory performance have been documented with starvation and bedrest; an understanding of cardiorespiratory performance postoperatively awaits further investigation. Maximal muscular force of contraction is also impaired by caloric restriction and bedrest, suggesting that similar effects may be seen in the postoperative state, although this has not been studied. A better understanding of the syndrome of postoperative fatigue could be achieved by a descriptive analysis of physiologic performance postoperatively. Such descriptive data could form the basis for objective evaluation of therapeutic measures intended to improve performance, such as nutritional supplementation and pharmacologic intervention. The observation that exercise with the patient in the supine position may decrease the impairment in maximal aerobic power otherwise expected in immobilized patients suggests that controlled exercise therapy may be of value in reducing physiologic impairment postoperatively.

  10. Postoperative MRI of the ankle; Postoperative Magnetresonanztomographie des Sprunggelenks

    Energy Technology Data Exchange (ETDEWEB)

    Sharabianlou Korth, M.; Fritz, L.B. [Rheinlandaerzte, Willich (Germany)

    2017-11-15

    Postoperative imaging of the ankle can be challenging, even for the experienced radiologist. Pathological and postoperative changes to the primarily complex anatomy of the ankle with its great variety of bone structures, tendons, ligaments, and soft tissue in a very limited space may cause great difficulty in differentiating underlying pathology from expected postoperative changes and artifacts, especially in magnetic resonance imaging (MRI). Selecting the appropriate radiological modality is key to making the correct diagnosis. Therefore, knowledge of the initial and current symptoms is just as important as familiarity with the most frequently performed operations in the ankle. This article aims to give its reader a summary of the most important and frequently performed operation techniques of the ankle and discusses the expected appearance and possible complications in postoperative imaging. (orig.) [German] Die postoperative radiologische Bildgebung des Sprunggelenks kann auch fuer den erfahrenen Radiologen eine besondere Herausforderung darstellen. Die komplex aufgebaute Anatomie des Sprunggelenks, mit seinen multiplen Gelenkflaechen, Sehnen, Baendern und neurovaskulaeren Strukturen auf engstem Raum, kann durch Operationen signifikant veraendert und insbesondere in der Magnetresonanztomographie (MRT) verfaelscht dargestellt werden. Fuer eine fundierte Befundung und Beurteilung der Operationsergebnisse ist die Kenntnis der praeoperativen Diagnose, Zeitpunkt und Technik der durchgefuehrten Operation(en) sowie der aktuellen klinischen Symptomatik von grosser Bedeutung. Dieser Artikel konzentriert sich auf zu erwartende radiologische Veraenderungen und gibt Tipps zur Befundung der postoperativen MRT des Sprunggelenks bei einer Auswahl relevanter operativer Eingriffe. Zudem wird auf moegliche postoperative Komplikationen und ihre radiologische Darstellung hingewiesen. (orig.)

  11. Factors Influencing Endometrial Thickness in Postmenopausal Women

    African Journals Online (AJOL)

    Background: Cut‑off values for endometrial thickness (ET) in asymptomatic postmenopausal woman have been standardized. However, there are no comprehensive studies to document how various factors can influence the ET after the age of menopause. Aim: To study the various factors influencing the ET in ...

  12. Factors Influencing Livelihood Diversification among Rural Farmers ...

    African Journals Online (AJOL)

    This research study was set out to analyze factors influencing rural farmer's engagement in livelihood diversification in the study area. The specific objectives were; to identify the different levels of farmers' engagement in livelihood diversification, determine the socio-demographic factors or forces that influence farmers' ...

  13. Postoperative intraspinal subdural collections after pediatric posterior fossa tumor resection: incidence, imaging, and clinical features.

    Science.gov (United States)

    Harreld, J H; Mohammed, N; Goldsberry, G; Li, X; Li, Y; Boop, F; Patay, Z

    2015-05-01

    Postoperative intraspinal subdural collections in children after posterior fossa tumor resection may temporarily hinder metastasis detection by MR imaging or CSF analysis, potentially impacting therapy. We investigated the incidence, imaging and clinical features, predisposing factors, and time course of these collections after posterior fossa tumor resection. Retrospective review of postoperative spine MRI in 243 children (5.5 ± 4.6 years of age) from our clinical data base postresection of posterior fossa tumors from October 1994 to August 2010 yielded 37 (6.0 ± 4.8 years of age) subjects positive for postoperative intraspinal subdural collections. Their extent and signal properties were recorded for postoperative (37/37), preoperative (15/37), and follow-up spine (35/37) MRI. Risk factors were compared with age-matched internal controls (n = 37, 5.9 ± 4.5 years of age). Associations of histology, hydrocephalus and cerebellar tonsillar herniation, and postoperative intracranial subdural collections with postoperative intraspinal subdural collections were assessed by the Fisher exact test or χ(2) test. The association between preoperative tumor volume and postoperative intraspinal subdural collections was assessed by the Wilcoxon rank sum test. The overall incidence of postoperative intraspinal subdural collections was 37/243 (15.2%), greatest ≤7 days postoperatively (36%); 97% were seen 0-41 days postoperatively (12.9 ± 11.0 days). They were T2 hyperintense and isointense to CSF on T1WI, homogeneously enhanced, and resolved on follow-up MR imaging (35/35). None were symptomatic. They were associated with intracranial subdural collections (P = .0011) and preoperative tonsillar herniation (P = .0228). Postoperative intraspinal subdural collections are infrequent and clinically silent, resolve spontaneously, and have a distinctive appearance. Preoperative tonsillar herniation appears to be a predisposing factor. In this series, repeat MR imaging by 4 weeks

  14. Delayed postoperative radiation therapy in local control of squamous cell carcinoma of the tongue and floor of the mouth

    Energy Technology Data Exchange (ETDEWEB)

    Amar, Ali; Chedid, Helma Maria; Curioni, Otavio Alberto; Rapoport, Abrao, E-mail: arapoport@uol.com.br [Universidade de Sao Paulo (USP), Sao Paulo, SP (Brazil); Dedivitis, Rogerio Aparecido; Cernea, Claudio Roberto; Brandao, Lenine Garcia [Hospital Heliopolis, Sao aulo, SP (Brazil)

    2014-10-15

    Objective: to evaluate the effect of time between surgery and postoperative radiation therapy on local recurrence of squamous cell carcinoma of the tongue and floor of the mouth. Methods: a total of 154 patients treated between 1996 and 2007 were selected considering local recurrence rate and time of the adjuvant radiotherapy. Results: local recurrence was diagnosed in 54 (35%) patients. Radiation therapy reduced the rate of local recurrences, although with no statistical significance. The time between surgery and initiation of postoperative radiotherapy did not significantly influence the risk of local recurrence in patients referred to adjuvant treatment (p=0.49). Conclusion: in the presence of risk factors for local recurrence, a short delay in starting the adjuvant radiation therapy does not contraindicate its performance. (author)

  15. Patients' Experiences of Performing Self-care of Stomas in the Initial Postoperative Period.

    Science.gov (United States)

    Lim, Siew Hoon; Chan, Sally Wai Chi; He, Hong-Gu

    2015-01-01

    With the loss of an important bodily function and the distortion in body image, a stoma patient experiences physical, psychological, and social changes. With limited current studies exploring experiences of patients in the management of their stoma, there is a need to explore their experiences, their needs, and factors that influence their self-management. The aim of this study was to investigate patients' experiences of performing self-care of stomas in the initial postoperative period. This study adopted a descriptive qualitative approach from the interpretive paradigm. Semistructured interviews were conducted with 12 patients 1 month postoperatively in a colorectal ward in a hospital in Singapore. Thematic analysis was applied to the interview data. Five themes were identified: process of acceptance and self-management of stoma, physical limitations, psychological reactions, social support, and need for timely and sufficient stoma preparation and education. This study highlights the importance of health professionals' role in helping patients adjust preoperatively and postoperatively and accept the presence of a stoma. Health professionals need to be aware of the physical, psychological, and social impact of stoma on patients in the initial 30-day postoperative period. Research findings informed the type and level of assistance and support to be offered to patients by nurses and the importance of encouraging patients to be involved in stoma care at an early stage, which will ultimately contribute to effective and independent self-management. Patients can be prepared preoperatively to reduce the psychological and social impact of stoma after creation of their stoma.

  16. Analysis of the correlative factors for velopharyngeal closure of patients with cleft palate after primary repair.

    Science.gov (United States)

    Chen, Qi; Li, Yang; Shi, Bing; Yin, Heng; Zheng, Guang-Ning; Zheng, Qian

    2013-12-01

    The objective of this study was to analyze the correlative factors for velopharyngeal closure of patients with cleft palate after primary repair. Ninety-five nonsyndromic patients with cleft palate were enrolled. Two surgical techniques were applied in the patients: simple palatoplasty and combined palatoplasty with pharyngoplasty. All patients were assessed 6 months after the operation. The postoperative velopharyngeal closure (VPC) rate was compared by χ(2) test and the correlative factors were analyzed with logistic regression model. The postoperative VPC rate of young patients was higher than that of old patients, the group with incomplete cleft palate was higher than the group with complete cleft palate, and combined palatoplasty with pharyngoplasty was higher than simple palatoplasty. Operative age, cleft type, and surgical technique were the contributing factors for postoperative VPC rate. Operative age, cleft type, and surgical technique were significant factors influencing postoperative VPC rate of patients with cleft palate. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Influence of a New "Call-Out Algorithm" for Management of Postoperative Pain and Its Side Effects on Length of Stay in Hospital: A Two-Centre Prospective Randomized Trial.

    Science.gov (United States)

    Dybvik, Lisa; Skraastad, Erlend; Yeltayeva, Aigerim; Konkayev, Aidos; Musaeva, Tatiana; Zabolotskikh, Igor; Bjertnaes, Lars; Dahl, Vegard; Raeder, Johan; Kuklin, Vladimir

    2017-01-01

    We recently introduced the efficacy safety score (ESS) as a new "call-out algorithm" for management of postoperative pain and side effects. In this study, we report the influence of ESS recorded hourly during the first 8 hours after surgery on the mobility degree, postoperative nonsurgical complications, and length of hospital stay (LOS). We randomized 1152 surgical patients into three groups for postoperative observation: (1) ESS group ( n = 409), (2) Verbal Numeric Rate Scale (VNRS) for pain group ( n = 417), and (3) an ordinary qualitative observation (Control) group ( n = 326). An ESS > 10 or VNRS > 4 at rest or a nurse's observation of pain or adverse reaction to analgesic treatment in the Control group served as a "call-out alarm" for an anaesthesiologist. We found no significant differences in the mobility degree and number of postoperative nonsurgical complications between the groups. LOS was significantly shorter with 12.7 ± 6.3 days (mean ± SD) in the ESS group versus 14.2 ± 6.2 days in the Control group ( P < 0.001). Postoperative ESS recording in combination with the possibility to call upon an anaesthesiologist when exceeding the threshold score might have contributed to the reductions of LOS in this two-centre study. This trial is registered with NCT02143128.

  18. Preoperative psychosocial risk factors for poor outcomes at 1 and 5 years after total knee replacement.

    Science.gov (United States)

    Wylde, Vikki; Trela-Larsen, Lea; Whitehouse, Michael R; Blom, Ashley W

    2017-10-01

    Background and purpose - Psychosocial factors are important risk factors for poor outcomes in the first year after total knee replacement (TKR), however their impact on long-term outcomes is unclear. We aimed to identify preoperative psychosocial risk factors for poor outcomes at 1 year and 5 years after TKR. Patients and methods - 266 patients were recruited prior to TKR surgery. Knee pain and function were assessed preoperatively and at 1 and 5 years postoperative using the WOMAC Pain score, WOMAC Function score and American Knee Society Score (AKSS) Knee score. Preoperative depression, anxiety, catastrophizing, pain self-efficacy and social support were assessed. Statistical analyses involved multiple linear regression and mixed effect linear regression. Results - Higher anxiety was a risk factor for worse pain at 1 year postoperative. No psychosocial factors were associated with any outcomes at 5 years postoperative. Analysis of change over time found that patients with higher pain self-efficacy had lower preoperative pain and experienced less improvement in pain up to 1 year postoperative. Higher pain self-efficacy was associated with less improvement in the AKSS up to 1 year postoperative but more improvement between 1 and 5 years postoperative. Interpretation - Preoperative anxiety was found to influence pain at 1 year after TKR. However, none of the psychosocial variables were risk factors for a poor outcome at 5 years post-operative, suggesting that the negative effects of anxiety on outcome do not persist in the longer-term.

  19. Evaluation of Postoperative Hydronephrosis Following Ureteroscopy in Pediatric Population: Incidence and Predictors.

    Science.gov (United States)

    Gökce, Mehmet Ilker; Telli, Onur; Özkıdık, Mete; Akıncı, Aykut; Hajıyev, Perviz; Soygür, Tarkan; Burgu, Berk

    2016-07-01

    To identify the incidence and associated factors of the postoperative hydronephrosis in pediatric patients who underwent ureterorenoscopy (URS) for renal or ureteral stones. We evaluated the results of 116 patients who underwent semirigid or flexible URS retrospectively. Primary end points of the study were to determine the incidence of postoperative hydronephrosis and factors associated with the development of postoperative hydronephrosis. Logistic regression analysis was used to define factors associated with the presence of hydronephrosis. Mean age of the population was 9.5 years and mean stone size was 9.4 mm. Hydronephrosis was detected in 32 (27.6%) patients. Stone-free status was achieved in 101 (87%) patients. Univariate analysis revealed history of ipsilateral URS, duration of operation, presence of impacted stone, development of ureteral injury during operation, and presentation with a renal colic episode as the parameter associated with increased risk of hydronephrosis. History of ipsilateral URS (odds ratio: 1.664, P = .027), presence of impacted stones (odds ratio: 1.788, P = .014), and development of ureteral injury during operation (odds ratio: 1.106, P = .039) were found to be the independent markers of developing postoperative hydronephrosis in a multivariate analysis. Ipsilateral hydronephrosis following URS develops in a significant portion of patients. In patients with history of ipsilateral procedure and those with an impacted stone and had ureteral injury, the risk of postoperative hydronephrosis is higher; therefore, physicians should keep these parameters in mind in the decision-making process of selective imaging postoperatively. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. Factors influencing choice of oral hygiene products by dental ...

    African Journals Online (AJOL)

    Background: Several factors, such as cost, branding, packaging and family influence, had been implicated as influencing the choice of toothpastes and toothbrushes by individuals. Media advertisement is also considered a very strong factor influencing consumer's choice. Aim: To assess the extent to which some factors ...

  1. Assessment of Outcomes of Treatment of Fractures of Distal Femur with a Locking Plate Taking into Account Factors Influencing the Result.

    Science.gov (United States)

    Pakuła, Grzegorz; Kwiatkowski, Krzysztof; Kuczmera, Piotr; Fudalej, Piotr

    2015-10-01

    The aim of this paper is to evaluate the results of treatment of distal femoral fractures (DFF) fixed with locking plates and analysis of factors that influence the final outcome. The patients were treated at the Department of Traumatology and Orthopedics, Military Medical Institute in Warsaw, and the Department of Orthopedics and Traumatology, 4th Military Research Hospital in Wroclaw. We analysed 39 patients with 42 fractures of the distal femur. Treatment results were analysed using the KOOS and KSS scales. Factors influencing the outcome were also investigated. Statistical analysis was performed using STATISTICA v. 10. Mean KOOS scores indicate a predominance of poor outcomes, while mean KSS scores indicate good outcomes. Treatment outcomes were significantly influenced by pain and limited mobility. 1. Subjective evaluation of treatment of fractures of the distal femur using the KOOS scale per form edworse than a clinical evaluation using the KSS. 2. Post-operative management should emphasise pain relief and restoration of the performance of the treated lower limb to ensure good mobility without crutches. 3. Despite the use of modern operational methods of fracture fixation, treatment of distal femur fractures is still a challenge.

  2. Biomarkers of postoperative delirium and cognitive dysfunction

    Directory of Open Access Journals (Sweden)

    Ganna eAndrosova

    2015-06-01

    Full Text Available Elderly surgical patients frequently experience postoperative delirium (POD and the subsequent development of postoperative cognitive dysfunction (POCD. Clinical features include deterioration in cognition, disturbance in attention and reduced awareness of the environment and result in higher morbidity, mortality and greater utilization of social financial assistance. The aging Western societies can expect an increase in the incidence of POD and POCD. The underlying pathophysiological mechanisms have been studied on the molecular level albeit with unsatisfying small research efforts given their societal burden. Here, we review the known physiological and immunological changes and genetic risk factors, identify candidates for further studies and integrate the information into a draft network for exploration on a systems level. The pathogenesis of these postoperative cognitive impairments is multifactorial; application of integrated systems biology has the potential to reconstruct the underlying network of molecular mechanisms and help in the identification of prognostic and diagnostic biomarkers.

  3. Urinary tract infections and post-operative fever in percutaneous nephrolithotomy.

    Science.gov (United States)

    Gutierrez, Jorge; Smith, Arthur; Geavlete, Petrisor; Shah, Hemendra; Kural, Ali Riza; de Sio, Marco; Amón Sesmero, José H; Hoznek, András; de la Rosette, Jean

    2013-10-01

    To review the incidence of UTIs, post-operative fever, and risk factors for post-operative fever in PCNL patients. Between 2007 and 2009, consecutive PCNL patients were enrolled from 96 centers participating in the PCNL Global Study. Only data from patients with pre-operative urine samples and who received antibiotic prophylaxis were included. Pre-operative bladder urine culture and post-operative fever (>38.5°C) were assessed. Relationship between various patient and operative factors and occurrence of post-operative fever was assessed using logistic regression analyses. Eight hundred and sixty-five (16.2%) patients had a positive urine culture; Escherichia coli was the most common micro-organism found in urine of the 350 patients (6.5%). Of the patients with negative pre-operative urine cultures, 8.8% developed a fever post-PCNL, in contrast to 18.2% of patients with positive urine cultures. Fever developed more often among the patients whose urine cultures consisted of Gram-negative micro-organisms (19.4-23.8%) versus those with Gram-positive micro-organisms (9.7-14.5%). Multivariate analysis indicated that a positive urine culture (odds ratio [OR] = 2.12, CI [1.69-2.65]), staghorn calculus (OR = 1.59, CI [1.28-1.96]), pre-operative nephrostomy (OR = 1.61, CI [1.19-2.17]), lower patient age (OR for each year of 0.99, CI [0.99-1.00]), and diabetes (OR = 1.38, CI [1.05-1.81]) all increased the risk of post-operative fever. Limitations include the use of fever as a predictor of systemic infection. Approximately 10% of PCNL-treated patients developed fever in the post-operative period despite receiving antibiotic prophylaxis. Risk of post-operative fever increased in the presence of a positive urine bacterial culture, diabetes, staghorn calculi, and a pre-operative nephrostomy.

  4. ENERGY EFFICIENCY. TRENDS AND INFLUENCE FACTORS

    Directory of Open Access Journals (Sweden)

    Zizi GOSCHIN

    2006-12-01

    Full Text Available Energy efficiency is correlated with many factors of influence: Gross National Income per capita, energy imports (% of energy use, renewable combustible and waste (% of total, energy use per capita, services as % of GDP and others. In this paper we are testing a model of piecewise linear regression with breakpoint in order to measure the influence of these factors on the variation of GDP per unit of energy use in Europe in the year 2003.

  5. Risk factors of distant metastasis in patients with squamous cell carcinoma of the uterine cervix treated with postoperative irradiation

    International Nuclear Information System (INIS)

    Yokoyama, Takashi; Beppu, Michiko; Kawakami, Yousuke; Nogawa, Takayoshi; Chiba, Take; Hiura, Masamichi

    2000-01-01

    This paper reports the results of a study of risk factors for recurrence in non-irradiated sites in patients with squamous cell carcinoma of the uterine cervix who received postoperative irradiation. It also discusses clinical experience with such patients, particularly those with a poor prognosis, based on a review of the literature. The study was conducted at the National Shikoku Cancer Center in 62 patients with squamous cell carcinoma of the uterine cervix (mean age=50.5, range=30-66) who received 10 MeV postoperative irradiation with a Linac between 1981 and 1990. An analysis was performed in terms of sites and times of recurrence, risk factors for distant metastasis, and groups at high risk for distant metastasis. Based on the results of the study as well as the review of the literature, it was concluded that squamous cell carcinoma of the uterine cervix is sensitive to radiation therapy and that the clinical outcome of local treatment is satisfactory. However, systemic chemotherapy should be considered for patients who are suspected of having minute distant metastasis at the time of surgical operation, i.e., those with moderate to severe vascular space invasion, multiple lymph node metastasis, parametrium infiltration, and/or endometrial infiltration. (K.H.)

  6. Classification and Risk-factor Analysis of Postoperative Cardio-pulmonary 
Complications after Lobectomy in Patients with Stage I Non-small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Yutian LAI

    2016-05-01

    Full Text Available Background and objective There are incresing lung cancer patients detected and diagnosed at the intermediate stage when the pre-malignant or early lesions are amenable to resection and cure, owing to the progress of medical technology, the renewal of detection methods, the popularity of medical screening and the improvement of social health consciousness. The aim of this study is to investigate the risk factors of the occurrence of postoperative cardio-pulmonary complications in stage I non-small cell lung cancer (NSCLC patients, based on routine laboratory tests, basic characteristics, and intraoperative variables in hospital. Methods The 421 patients after lobectomy in patients with stage I NSCLC at the West China Hospital of Sichuan University from January 2012 to December 2013 were included into the study and stratified into complication group and non-complication group, according to whether to occur postoperative cardio-pulmonary complications after lobectomy in 30 days. Results Of them, 64 (15.2% patients were finally identified and selected into the complication group, compared with 357 (84.8% in non-complication group: pneumonia (8.8%, 37/421 was the primary complication, and other main complications included atelectasis (5.9%, 25/421, pleural effusion (≥middle (5.0%, 21/421, persistent air leak (3.6%, 15/421; The operation time (P=0.007, amount of blood loss (P=0.034, preoperative chronic obstructive pulmonary disease (COPD (P=0.027, white blood cell (WBC count (P<0.001, neutrophil-lymphocyte ratio (NLR (P<0.001 were significantly different between the two groups. According to the binary logistics regression analysis, preoperative COPD (OR=0.031, 95%CI: 0.012-0.078, P<0.001 and WBC count (OR=1.451, 95%CI: 1.212-1.736, P<0.001 were independent risk factors for postoperative cardio-pulmonary complications. Conclusion Among an array of clinical variables in hospital, operation time, preoperative white blood cell count, preoperative COPD

  7. Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons' Experience During Learning Curve.

    Science.gov (United States)

    Shigemura, Katsumi; Tanaka, Kazushi; Yamamichi, Fukashi; Chiba, Koji; Fujisawa, Masato

    2016-03-01

    To detect predictive factors for postoperative incontinence following holmium laser enucleation of the prostate (HoLEP) according to surgeon experience (beginner or experienced) and preoperative clinical data. Of 224 patients, a total of 203 with available data on incontinence were investigated. The potential predictive factors for post-HoLEP incontinence included clinical factors, such as patient age, and preoperative urodynamic study results, including detrusor overactivity (DO). We also classified the surgeons performing the procedure according to their HoLEP experience: beginner (predictive factor at the super-short period (the next day of catheter removal: odds ratio [OR], 3.375; P=0.000). Additionally, patient age, surgeon mentorship (inverse correlation), and prostate volume were significant predictive factors at the 1-month interval after HoLEP (OR, 1.072; P=0.004; OR, 0.251; P=0.002; and OR, 1.008; P=0.049, respectively). With regards to surgeon experience, DO and preoperative International Prostate Symptom Score (inverse) at the super-short period, and patient age and mentorship (inverse correlation) at the 1-month interval after HoLEP (OR, 3.952; P=0.002; OR, 1.084; P=0.015; and OR,1.084; P=0.015; OR, 0.358; P=0.003, respectively) were significant predictive factors for beginners, and first desire to void (FDV) at 1 month after HoLEP (OR, 1.009; P=0.012) was a significant predictive factor for experienced surgeons in multivariate analysis. Preoperative DO, IPSS, patient age, and surgeon mentorship were significant predictive factors of postoperative patient incontinence for beginner surgeons, while FDV was a significant predictive factors for experienced surgeons. These findings should be taken into account by surgeons performing HoLEP to maximize the patient's quality of life with regards to urinary continence.

  8. Ten-year study of postoperative complications following dental extractions in patients with inherited bleeding disorders.

    Science.gov (United States)

    Hsieh, J-T; Klein, K; Batstone, M

    2017-09-01

    Dental extractions challenge the body's haemostatic mechanism. Postoperative bleeding from dental extraction can be prolonged, or even life threatening in patients with inherited bleeding disorders. Pre- and postoperative clotting factor replacements or systemic desmopressin (ddAVP) have been advocated at our institution to prevent bleeding complications in these patients. This study aimed to assess the postoperative bleeding rate in patients with inherited bleeding disorders that underwent dental extractions at our institution between 2003 and 2012. Patients with inherited bleeding disorders such as haemophilia A, haemophilia B, and von Willebrand's disease were included. Retrospective chart review was conducted. The result showed 53 extraction events occurred in 45 patients over the 10-year period. Ten out of 53 extraction events (18.9%) had postoperative bleeding requiring further factor replacement or ddAVP. Postoperative bleeding in one patient with mild haemophilia A was complicated by the development of inhibitors. Type and severity of bleeding disorder, bone removal, and use of a local haemostatic agent did not have any significant effect on postoperative bleeding. Despite the use of perioperative factors and desmopressin, the postoperative bleeding rates remain high for patients with inherited bleeding disorders. More studies are required to assess the safety and effectiveness of using local haemostatic control to achieve haemostasis following extractions. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  9. What factors influence mitigative capacity?

    International Nuclear Information System (INIS)

    Winkler, Harald; Baumert, Kevin; Blanchard, Odile; Burch, Sarah; Robinson, John

    2007-01-01

    This article builds on Yohe's seminal piece on mitigative capacity, which elaborates 'determinants' of mitigative capacity, also reflected in the IPCC's third assessment report. We propose a revised definition, where mitigative capacity is a country's ability to reduce anthropogenic greenhouse gas emissions or enhance natural sinks. By 'ability' we mean skills, competencies, fitness, and proficiencies that a country has attained which can contribute to GHG emissions mitigation. A conceptual framework is proposed, linking mitigative capacity to a country's sustainable development path, and grouping the factors influencing mitigative capacity into three main sets: economic factors, institutional ones, and technology. Both quantitative and qualitative analysis of factors is presented, showing how these factors vary across countries. We suggest that it is the interplay between the three economic factors-income, abatement cost and opportunity cost-that shape mitigative capacity. We find that income is an important economic factor influencing mitigative capacity, while abatement cost is important in turning mitigative capacity into actual mitigation. Technology is a critical mitigative capacity, including the ability to absorb existing climate-friendly technologies or to develop innovative ones. Institutional factors that promote mitigative capacity include the effectiveness of government regulation, clear market rules, a skilled work force and public awareness. We briefly investigate such as high abatement cost or lack of political willingness that prevent mitigative capacity from being translated into mitigation

  10. Risk factors for unfavourable postoperative outcome in patients with Crohn's disease undergoing right hemicolectomy or ileocaecal resection. An international audit by ESCP and S-ECCO

    DEFF Research Database (Denmark)

    2018-01-01

    and intra-operative risk factors on 30-day postoperative outcome in patients undergoing surgery for Crohn's disease. MethodThis was an international prospective snapshot audit including consecutive patients undergoing right hemicolectomy or ileocaecal resection. The study analysed a subset of patients who...... to produce odds ratios and 95% confidence intervals. ResultsIn all, 375 resections in 375 patients were included. The median age was 37 and 57.1% were women. In multivariate analyses, postoperative complications were associated with preoperative parenteral nutrition (OR 2.36, 95% CI 1.10-4.97), urgent...

  11. Factors influencing the tensile strength of repaired Achilles tendon: a biomechanical experiment study.

    Science.gov (United States)

    Jielile, Jiasharete; Bai, Jing Ping; Sabirhazi, Gulnur; Redat, Darebai; Yilihamu, Tuoheti; Xinlin, Baoltri; Hu, Geyang; Tang, Bin; Liang, Bing; Sun, Qi

    2010-10-01

    Operative treatment has been advocated as the method of choice to repair Achilles tendon rupture as surgery results in reduced re-rupture rate and faster rehabilitation. Many surgical techniques have been introduced allowing for postoperative early motion of the ankle joint. However, it is currently very difficult for surgeons to determine the optimal treatment conditions for ruptured Achilles tendon with an increasing number of end-to-end suture methods, suture materials, and epitenon suture techniques. In the present biomechanical experiment study based on an orthogonal design, thirty-two New Zealand white rabbits received Achilles tendon tenotomy and subsequent operative treatment to repair the tendon employing four end-to-end suture methods, four suture materials, and four epitenon suture techniques. The tensile strength of the repaired Achilles tendon was investigated at four rehabilitation periods, and in comparison with the results of another sixteen rabbits with normal Achilles tendons. The end-to-end suture method contributed most to the final Achilles tendon tensile strength in addition to rehabilitation period, with the highest values occurring with the use of the parachute-like ("Pa" bone) suture method. The other two factors, namely, suture material and epitenon suture technique, had relatively little influence on the results. The parachute-like ("Pa" bone) surgical technique is superior to the other three end-to-end suture methods, with enhanced tensile strength of the repaired tendon. This method allows for postoperative early kinesitherapy of the ankle and knee joints. Therefore, this technique is highly recommended in clinical situations for treatment of ruptured Achilles tendon. 2010 Elsevier Ltd. All rights reserved.

  12. Incidence of and risk factors for postoperative urinary retention in fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars; Bogø, Stina; Raaschou, Sofie

    2015-01-01

    BACKGROUND AND PURPOSE: Postoperative urinary retention (POUR) is a clinical challenge, but there is no scientific evidence for treatment principles. We describe the incidence of and predictive factors for POUR in fast-track total hip (THA) and knee arthroplasty (TKA). PATIENTS AND METHODS......, and preoperative international prostate symptom score (IPSS) were compared between catheterized and non-catheterized patients. RESULTS: The incidence of POUR was 40% (range between departments: 30-55%). Median bladder volume evacuated by catheterization was 0.6 (0.1-1.9) L. Spinal anesthesia increased the risk...... was 40%, with spinal anesthesia and increased IPSS in males as predictive factors. The large variation in perioperative bladder management and in bladder volumes evacuated by catheterization calls for randomized studies to define evidence-based principles for treatment of POUR in the future....

  13. Postoperative Morbidity and Mortality of Perforated Peptic Ulcer: Retrospective Cohort Study of Risk Factors among Black Africans in Côte d’Ivoire

    Directory of Open Access Journals (Sweden)

    Soro Kountele Gona

    2016-01-01

    Full Text Available Introduction. Surgical treatment of perforated peptic ulcer (PPU is a challenge for surgeons in Africa. Aim. To determine risk factors of postoperative complications or mortality among black Ivoirian patients with PPU. Methods. All 161 patients (median age = 34 years, 90.7 male operated on for PPU in the visceral and general surgery unit were enrolled in a retrospective cohort study. Variables were studied with Kaplan Meier and Cox proportional hazard models. Results. Among 161 patients operated on for PPU, 36 (27.5% experienced complications and 31 (19.3% died. Follow-up results were the incidence of complications and mortality of 6.4 (95% CI: 4.9–8.0 per 100 person-days and 3.0 (95% CI: 1.9–4.0 per 100 person-days for incidence of mortality. In multivariate analysis, risk factors of postoperative complications or mortality were comorbidities (HR = 2.1, P=0.03, tachycardia (pulse rate > 100/minutes (HR = 2.4, P=0.02, purulent intra-abdominal fluid collection (HR = 2.1, P=0.04, hyponatremia (median value ≤ 134 mEq/L (HR = 2.3, P=0.01, delayed time of hospital admission > 72 hours (HR = 2.6, P<0.0001, and delayed time of surgical intervention between 24 and 48 hours (HR = 3.8, P<0.0001. Conclusion. The delayed hospital admission or surgical intervention and hyponatremia may be considered as additional risk of postoperative complications or mortality in Black African patients with PPU.

  14. The postoperative stomach

    Energy Technology Data Exchange (ETDEWEB)

    Woodfield, Courtney A. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Levine, Marc S. [Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104 (United States)]. E-mail: marc.levine@uphs.upenn.edu

    2005-03-01

    Gastric surgery may be performed for the treatment of a variety of benign and malignant diseases of the upper gastrointestinal tract, including peptic ulcers and gastric carcinoma. Radiographic studies with water-soluble contrast agents often are obtained to rule out leaks, obstruction, or other acute complications during the early postoperative period. Barium studies may also be obtained to evaluate for anastomotic strictures or ulcers, bile reflux gastritis, recurrent tumor, or other chronic complications during the late postoperative period. Cross-sectional imaging studies such as CT are also helpful for detecting abscesses or other postoperative collections, recurrent or metastatic tumor, or less common complications such as afferent loop syndrome or gastrojejunal intussusception. It is important for radiologists to be familiar not only with the radiographic findings associated with these various abnormalities but also with the normal appearances of the postoperative stomach on radiographic examinations, so that such appearances are not mistaken for pseudoleaks or other postoperative complications. The purpose of this article is to describe the normal postsurgical anatomy after the most commonly performed operations (including partial gastrectomy, esophagogastrectomy and gastric pull-through, and total gastrectomy and esophagojejunostomy) and to review the acute and chronic complications, normal postoperative findings, and major abnormalities detected on radiographic examinations in these patients.

  15. The postoperative stomach

    International Nuclear Information System (INIS)

    Woodfield, Courtney A.; Levine, Marc S.

    2005-01-01

    Gastric surgery may be performed for the treatment of a variety of benign and malignant diseases of the upper gastrointestinal tract, including peptic ulcers and gastric carcinoma. Radiographic studies with water-soluble contrast agents often are obtained to rule out leaks, obstruction, or other acute complications during the early postoperative period. Barium studies may also be obtained to evaluate for anastomotic strictures or ulcers, bile reflux gastritis, recurrent tumor, or other chronic complications during the late postoperative period. Cross-sectional imaging studies such as CT are also helpful for detecting abscesses or other postoperative collections, recurrent or metastatic tumor, or less common complications such as afferent loop syndrome or gastrojejunal intussusception. It is important for radiologists to be familiar not only with the radiographic findings associated with these various abnormalities but also with the normal appearances of the postoperative stomach on radiographic examinations, so that such appearances are not mistaken for pseudoleaks or other postoperative complications. The purpose of this article is to describe the normal postsurgical anatomy after the most commonly performed operations (including partial gastrectomy, esophagogastrectomy and gastric pull-through, and total gastrectomy and esophagojejunostomy) and to review the acute and chronic complications, normal postoperative findings, and major abnormalities detected on radiographic examinations in these patients

  16. Factors Influencing Intraocular Pressure Changes after Laser In Situ Keratomileusis with Flaps Created by Femtosecond Laser or Mechanical Microkeratome.

    Directory of Open Access Journals (Sweden)

    Meng-Yin Lin

    Full Text Available The aim of this study is to describe factors that influence the measured intraocular pressure (IOP change and to develop a predictive model after myopic laser in situ keratomileusis (LASIK with a femtosecond (FS laser or a microkeratome (MK. We retrospectively reviewed preoperative, intraoperative, and 12-month postoperative medical records in 2485 eyes of 1309 patients who underwent LASIK with an FS laser or an MK for myopia and myopic astigmatism. Data were extracted, such as preoperative age, sex, IOP, manifest spherical equivalent (MSE, central corneal keratometry (CCK, central corneal thickness (CCT, and intended flap thickness and postoperative IOP (postIOP at 1, 6 and 12 months. Linear mixed model (LMM and multivariate linear regression (MLR method were used for data analysis. In both models, the preoperative CCT and ablation depth had significant effects on predicting IOP changes in the FS and MK groups. The intended flap thickness was a significant predictor only in the FS laser group (P < .0001 in both models. In the FS group, LMM and MLR could respectively explain 47.00% and 18.91% of the variation of postoperative IOP underestimation (R2 = 0.47 and R(2 = 0.1891. In the MK group, LMM and MLR could explain 37.79% and 19.13% of the variation of IOP underestimation (R(2 = 0.3779 and 0.1913 respectively. The best-fit model for prediction of IOP changes was the LMM in LASIK with an FS laser.

  17. Influence of postoperative enteral nutrition on cellular immunity. A random double-blinded placebo controlled clinical trial

    DEFF Research Database (Denmark)

    Beier-Holgersen, R; Brandstrup, B

    2012-01-01

    The aim of this study was to discover if the cellular immunological response is different in patients receiving early postoperative enteral nutrition compared to patients who only receive "water".......The aim of this study was to discover if the cellular immunological response is different in patients receiving early postoperative enteral nutrition compared to patients who only receive "water"....

  18. Intra-operative remifentanil might influence pain levels in the immediate postoperative period after major abdominal surgery

    DEFF Research Database (Denmark)

    Hansen, EG; Duedahl, Tina H; Rømsing, Janne

    2005-01-01

    Remifentanil, a widely used analgesic agent in anaesthesia, has a rapid onset and short duration of action. In clinical settings, this requires an appropriate pain strategy to prevent unacceptable pain in the post-operative period. The aim of this study was to investigate whether remifentanil had...... any impact on post-operative pain and opioid consumption after major abdominal surgery....

  19. Prevalence and Risk Factors of Postoperative Delirium in Patients Undergoing Open Heart Surgery in Northwest of Iran

    Directory of Open Access Journals (Sweden)

    Ahmadreza Jodati

    2013-09-01

    Full Text Available Introduction: Delirium as a relatively common complication following cardiac surgery remains a contributory factor in postoperative mortality and an obstacle to early discharge of patients.Methods: In the present study 329 patients who underwent open heart surgery between 1st January 2008 to 1st January 2009 in Shahid Madani Heart Center, Tabriz, Iran were enrolled.Results: Overall 4.9% of patients developed delirium after cardiac surgery. We found atrial fibrillation (P = 0.005, lung diseases (P = 0.04 and hypertension (P = 0.02 to be more common in patients who develop delirium postoperatively. Furthermore, the length of intensive care unit (ICU stay, cardiopulmonary bypass (CPB time, and ventilation period were also significantly increased. Also a statistically meaningful relationship between the female gender and development of delirium was also noted (P = 0.02. On the other hand no meaningful relationship was detected between diabetes, history of cerebral vascular diseases, peripheral vascular diseases, myocardial infarction, development of pneumonia following surgery, and laboratory levels of sodium, potassium, glucose, and complete blood cell count (CBC including white blood cells, red blood cells, platelets in the blood-hemoglobin and hematocrits. Also environmental factors like presence of other patients or companion with the patient, and objects like clock, window and calendar in the patient’s room did not affect prevention of delirium.Conclusion: Based on this and other investigations, it can be suggested to use MMPI test to recognize pathologic elements to prevented delirium after surgery and complementary treatment for coping with delirium.

  20. Risk factors and outcomes of postoperative pancreatic fistula after pancreatico-duodenectomy: an audit of 532 consecutive cases.

    Science.gov (United States)

    Fu, Shun-Jun; Shen, Shun-Li; Li, Shao-Qiang; Hu, Wen-Jie; Hua, Yun-Peng; Kuang, Ming; Liang, Li-Jian; Peng, Bao-Gang

    2015-03-26

    Pancreatic fistula (PF) remains the most challenging complication after pancreaticoduodenectomy (PD). The purpose of this study was to identify the risk factors of PF and delineate its impact on patient outcomes. We retrospectively reviewed clinical data of 532 patients who underwent PD and divided them into PF group and no PF group. Risk factors and outcomes of PF following PD were examined. PF was found in 65 (12.2%) cases, of whom 11 were classified into ISGPF grade A, 42 grade B, and 12 grade C. Clinically serious postoperative complications in the PF versus no PF group were mortality, abdominal bleeding, bile leak, intra-abdominal abscess and pneumonia. Univariate and multivariate analysis showed that blood loss ≥ 500 ml, pancreatic duct diameter ≤ 3 mm and pancreaticojejunostomy type were independent risk factors of PF after PD. Blood loss ≥ 500 ml, pancreatic duct diameter ≤ 3 mm and pancreatico-jejunostomy type were independent risk factors of PF after PD. PF was related with higher mortality rate, longer hospital stay, and other complications.

  1. Early postoperative physical therapy for improving short-term gross motor outcome in infants with cyanotic and acyanotic congenital heart disease.

    Science.gov (United States)

    Haseba, Sumihito; Sakakima, Harutoshi; Nakao, Syuhei; Ohira, Misaki; Yanagi, Shigefumi; Imoto, Yutaka; Yoshida, Akira; Shimodozono, Megumi

    2018-07-01

    We analysed the gross motor recovery of infants and toddlers with cyanotic and acyanotic congenital heart disease (CHD) who received early postoperative physical therapy to see whether there was any difference in the duration to recovery. This study retrospectively evaluated the influence of early physical therapy on postoperative gross motor outcomes of patients with CHD. The gross motor ability of patients with cyanotic (n = 25, average age: 376.4 days) and acyanotic (n = 26, average age: 164.5 days) CHD was evaluated using our newly developed nine-grade mobility assessment scale. Physical therapy was started at an average of five days after surgery, during which each patient's gross motor ability was significantly decreased compared with the preoperative level. Patients (who received early postoperative physical therapy) with cyanotic (88.0%) and acyanotic CHD (96.2%) showed improved preoperative mobility grades by the time of hospital discharge. However, patients with cyanotic CHD had a significantly prolonged recovery period compared to those with acyanotic CHD (p congenital heart disease are likely at greater risk of gross motor delays and have a prolonged recovery period of gross motor ability compared to those with acyanotic congenital heart disease. Early postoperative physical therapy for patients with congenital heart disease after cardiac surgery promoted gross motor recovery. The postoperative recovery period to preoperative mobility grade was affected by pre-, intra-, and postoperative factors. Rehabilitation experts should consider the risk of gross motor delays of patients with congenital heart disease after cardiac surgery and the early postoperative physical therapy to promote their gross motor recovery.

  2. Incidence, predictors and outcomes of postoperative coma: an observational study of 858,606 patients.

    Science.gov (United States)

    Newman, Jessica; Blake, Kathryn; Fennema, Jordan; Harris, David; Shanks, Amy; Avidan, Michael S; Kelz, Max B; Mashour, George A

    2013-08-01

    Coma is a state of profound unresponsiveness that can occur as a serious perioperative complication. The study of risk factors for, and sequelae of, postoperative coma has been limited due to the rarity of the event. To determine the incidence, risk factors and impact of postoperative coma in a large patient population. Observational study using a prospectively gathered national dataset. Data from 858 606 patients were analysed. The incidence of postoperative coma of more than 24-h duration was identified. Logistic regression was used to identify independent predictors and develop a risk model of postoperative coma in derivation and validation cohorts; 30-day mortality was also analysed. The incidence of postoperative coma was 0.06%. Multivariate analysis revealed the following independent predictors: liver disease, systemic sepsis, age at least 63 years, renal disease, emergency operation, cardiac disease, hypertension, prior neurological disease, diabetes mellitus and BMI 25 to 29.99 kg m (protective). These predictors were incorporated into a risk index classification; odds ratios for postoperative coma increased from 2.5 with one risk factor to 18.4 with three. Coma was associated with 74.2% all-cause mortality; coma associated with cardiac arrest had a 1.9-fold higher mortality. This is the largest study of postoperative coma ever reported and will be useful for determining risk of coma of more than 24 h duration when evaluating an unresponsive patient following surgery. Data on prognosis will aid medical and ethical decision-making for the comatose surgical patient.

  3. Elevated body mass index and risk of postoperative CSF leak following transsphenoidal surgery

    Science.gov (United States)

    Dlouhy, Brian J.; Madhavan, Karthik; Clinger, John D.; Reddy, Ambur; Dawson, Jeffrey D.; O’Brien, Erin K.; Chang, Eugene; Graham, Scott M.; Greenlee, Jeremy D. W.

    2012-01-01

    Object Postoperative CSF leakage can be a serious complication after a transsphenoidal surgical approach. An elevated body mass index (BMI) is a significant risk factor for spontaneous CSF leaks. However, there is no evidence correlating BMI with postoperative CSF leak after transsphenoidal surgery. The authors hypothesized that patients with elevated BMI would have a higher incidence of CSF leakage complications following transsphenoidal surgery. Methods The authors conducted a retrospective review of 121 patients who, between August 2005 and March 2010, underwent endoscopic endonasal transsphenoidal surgeries for resection of primarily sellar masses. Patients requiring extended transsphenoidal approaches were excluded. A multivariate statistical analysis was performed to investigate the association of BMI and other risk factors with postoperative CSF leakage. Results In 92 patients, 96 endonasal endoscopic transsphenoidal surgeries were performed that met inclusion criteria. Thirteen postoperative leaks occurred and required subsequent treatment, including lumbar drainage and/or reoperation. The average BMI of patients with a postoperative CSF leak was significantly greater than that in patients with no postoperative CSF leak (39.2 vs 32.9 kg/m2, p = 0.006). Multivariate analyses indicate that for every 5-kg/m2 increase in BMI, patients undergoing a transsphenoidal approach for a primarily sellar mass have 1.61 times the odds (95% CI 1.10–2.29, p = 0.016, by multivariate logistic regression) of having a postoperative CSF leak. Conclusions Elevated BMI is an independent predictor of postoperative CSF leak after an endonasal endoscopic transsphenoidal approach. The authors recommend that patients with BMI greater than 30 kg/m2 have meticulous sellar reconstruction at surgery and close monitoring postoperatively. PMID:22443502

  4. Oral surgery in patients under antithrombotic therapy: perioperative bleeding as a significant risk factor for postoperative hemorrhage.

    Science.gov (United States)

    Rocha, Amanda L; Souza, Alessandra F; Martins, Maria A P; Fraga, Marina G; Travassos, Denise V; Oliveira, Ana C B; Ribeiro, Daniel D; Silva, Tarcília A

    2018-01-01

    : To investigate perioperative and postoperative bleeding, complications in patients under therapy with anticoagulant or antiplatelet drugs submitted to oral surgery. To evaluate the risk of bleeding and safety for dental surgery, a retrospective chart review was performed. Medical and dental records of patients taking oral antithrombotic drugs undergoing dental surgery between 2010 and 2015 were reviewed. Results were statistically analyzed using Fisher's exact test, t test or the χ test. One hundred and seventy-nine patients underwent 293 surgical procedures. A total of eight cases of perioperative and 12 episodes of postoperative bleeding were documented. The complications were generally managed with local measures and did not require hospitalization. We found significant association of postoperative hemorrhage with increased perioperative bleeding (P = 0.043) and combination of anticoagulant and antiplatelet therapy (P bleeding is 8.8 times bigger than procedures without perioperative bleeding. Dental surgery in patients under antithrombotic therapy might be carried out without altering the regimen because of low risk of perioperative and postoperative bleeding. However, patients with increased perioperative bleeding should be closely followed up because of postoperative complications risk.

  5. Factors Influencing Colorectal Cancer Screening Participation

    Directory of Open Access Journals (Sweden)

    Antonio Z. Gimeno García

    2012-01-01

    Full Text Available Colorectal cancer (CRC is a major health problem worldwide. Although population-based CRC screening is strongly recommended in average-risk population, compliance rates are still far from the desirable rates. High levels of screening uptake are necessary for the success of any screening program. Therefore, the investigation of factors influencing participation is crucial prior to design and launches a population-based organized screening campaign. Several studies have identified screening behaviour factors related to potential participants, providers, or health care system. These influencing factors can also be classified in non-modifiable (i.e., demographic factors, education, health insurance, or income and modifiable factors (i.e., knowledge about CRC and screening, patient and provider attitudes or structural barriers for screening. Modifiable determinants are of great interest as they are plausible targets for interventions. Interventions at different levels (patient, providers or health care system have been tested across the studies with different results. This paper analyzes factors related to CRC screening behaviour and potential interventions designed to improve screening uptake.

  6. Strategies used to inhibit postoperative swelling following removal of impacted lower third molar

    Directory of Open Access Journals (Sweden)

    Francesco Sortino

    2011-01-01

    Full Text Available Postoperative swelling following different surgical strategies is an area of great interest. The main part of literature on the topic deals with swelling after extraction of low impacted third molar. In this review, we have analyzed publications of the last 20 years with a pubmed search using the following key words: impacted third molar, swelling third molar, wisdom tooth, edema jaw, corticosteroids and extraction third molar, antibiotic prophylaxis and tooth extraction. Attention has often been focused on corticosteroid therapy administered by diverse routes (orally, IV, IM, topically and at different time schedules (before or after surgery or both. This investigation revealed how the use of different molecules and dosages makes the obtained results hardly comparable. Similar conclusions can be drawn from studies aimed at evaluating the efficacy of antibiotic therapy administered either before or after surgery. A complete review has also to take into account different surgical strategies used including various flaps, no traumatic osteothomy, and primary or secondary closure. The use of pharmacological therapy and application of an ice pack is critical in the postoperative period and has always provided positive results. However, even if it is difficult to come to definite conclusions, due to the variability of the design of studies analyzed, the postoperative discomfort identified with edema, pain and trismus following wisdom tooth removal is influenced by various factors such as the difficulty of the surgical procedure involved, age and gender of the patient, and experience of the surgeon. The pharmacological therapy when performed with corticosteroids seems to improve control of the postoperative swelling related with this kind of surgeries.

  7. Pilot Study on Early Postoperative Discharge in Pituitary Adenoma Patients: Effect of Socioeconomic Factors and Benefit of Specialized Pituitary Centers.

    Science.gov (United States)

    Sarkiss, Christopher A; Lee, James; Papin, Joseph A; Geer, Eliza B; Banik, Rudrani; Rucker, Janet C; Oudheusden, Barbara; Govindaraj, Satish; Shrivastava, Raj K

    2015-08-01

    Introduction Pituitary neoplasms are benign entities that require distinct diagnostic and treatment considerations. Recent advances in endoscopic transsphenoidal surgery have resulted in shorter lengths of stay (LOS). We implemented a postoperative day (POD) 1 discharge paradigm involving a multidisciplinary approach and detailed preoperative evaluation and review of both medical and socioeconomic factors. Methods The experience of a single neurosurgeon/ears, nose, throat (ENT) team was reviewed, generating a preliminary retrospective database of the first 30 patients who underwent resection of pituitary lesions under the POD 1 discharge paradigm. We assessed multiple axes from their preoperative, in-house, and postoperative care. Results There were 14 men and 16 women with an average age of 53.8 years (range: 27-76 years). There were 22 nonsecretory and 8 secretory tumors with average size of 2.80 cm (range: 1.3-5.0 cm). All 30 patients underwent preoperative ENT evaluation. Average LOS was 1.5 ± 0.7 days. A total of 18 of 30 patients were discharged on POD 1. The insurance status included 15 with public insurance such as emergency Medicaid and 15 with private insurance. Four patients had transient diabetes insipidus (DI); none had permanent DI. Overall, 28 of 30 patients received postoperative steroids. Factors that contributed to LOS > 1 day included public insurance status, two or more medical comorbidities, diabetes mellitus, transient panhypopituitarism, and DI. Conclusion The implementation of a POD 1 discharge plan for pituitary tumors is feasible and safe for elective patients. This implementation requires the establishment of a dedicated Pituitary Center model with experienced team members. The consistent limitation to early discharge was socioeconomic status. Efforts that incorporate the analysis of social disposition parameters with proper management of clinical sequelae are crucial to the maintenance of ideal LOS and optimal patient

  8. Influence of a Shorter Duration of Post-Operative Antibiotic Prophylaxis on Infectious Complications in Patients Undergoing Elective Liver Resection.

    Science.gov (United States)

    Sakoda, Masahiko; Iino, Satoshi; Mataki, Yuko; Kawasaki, Yota; Kurahara, Hiroshi; Maemura, Kosei; Ueno, Shinichi; Natsugoe, Shoji

    Antibiotic prophylaxis has been recommended to reduce post-operative infectious complications. Discontinuation of post-operative antibiotic administration within 24 hours of operation is currently recommended. Many surgeons, however, conventionally tend to extend the duration of prophylactic antibiotic use. In this study, we performed a retrospective analysis to assess the efficacy of extended post-operative antibiotic use in patients who underwent elective liver resection. A total of 208 consecutive patients who underwent liver resection without biliary reconstruction were investigated. Patients were divided into two groups according to the duration of post-operative antibiotic use: Only once after the operation (the post-operative day [POD] 0 group) and until three days after the operation (the POD 3 group). Post-operative complications in the two groups were analyzed and compared. Incisional surgical site infections (SSIs) were observed in 5% of the POD 0 group and 3% of the POD 3 group (p = 0.517). Organ/space SSIs were observed in 2% of the POD 0 group and 3% of the POD 3 group (p = 0.694). Overall infectious complications including SSIs and remote site infections were observed in 12% of the POD 0 group and 11% of the POD 3 group. Multi-variable analyses revealed that the short-term post-operative antibiotic regimen did not confer additional risk for infectious complications. In elective liver resection, the administration of prophylactic antibiotics on the operative day alone appears to be sufficient, because no additional benefit in the incidence of post-operative infectious complications was conferred on patients given antibiotic agents for three days.

  9. Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery

    Directory of Open Access Journals (Sweden)

    Joseph M. Blankush

    2016-09-01

    Conclusions: The risk factors of post-operative infection are multiple and likely synergistic. While pre-operative HbA1c level is not independently associated with risk of post-operative infection, there are scenarios and patient subgroups where pre-operative HbA1c is useful in predicting an increased risk of infectious complications in the post-operative period.

  10. PATIENT POSITION AS A POSSIBLE RISK FACTOR FOR POSTOPERATIVE NAUSEA AND VOMITING (PONV IN GYNECOLOGIC LAPAROSCOPY

    Directory of Open Access Journals (Sweden)

    Aleksandar Ćirić

    2012-01-01

    Full Text Available Postoperative nausea and vomiting (PONV are still a significant problem in modern anesthetic practice. Discomfort caused by PONV intensifies other unpleasant elements of recovery, such as pain, frustration or fear. PONV also generates aversion to future anesthesia and have a negative impact on staff and patient's family. PONV can increase the cost of completing a surgical procedure, because it extends the time a patient spends in the postanesthesia care unit (PACU or delay discharge of ambulatory patients. It is generally accepted that the incidence of PONV after general anesthesia for various types of surgery in the last decade is still between 20-30%, and 70% in laparoscopic abdominal surgery. The incidence is three times higher in females compared to males. Many factors are involved in triggering PONV, such as patientrelated factors, the type of surgery, anesthesia management, etc. The results of this study suggest that the patient positioning (modified supine lithotomy position with ''Trendelenburg" increases the risk of PONV in gynecologic laparoscopy.

  11. Evaluating Persistent Postoperative Pain in One Tertiary Hospital: Incidence, Quality of Life, Associated Factors, and Treatment.

    Science.gov (United States)

    Guimaraes-Pereira, Luis; Valdoleiros, Ines; Reis, Pedro; Abelha, Fernando

    2016-04-01

    Persistent postoperative pain (PPP) is defined as persistent pain after surgery of greater than three months' duration. Identify the incidence of PPP in our hospital and its associated factors; evaluate quality of life (QoL) and treatment of patients. We conducted an observational prospective study in adults proposed to various types of surgery using the brief pain inventory short form preoperatively (T0), one day after surgery, and three months later (T3). If the patient had pain at T3 and other causes of pain were excluded, they were considered to have PPP, and the McGill Pain Questionnaire Short Form was applied. QoL was measured with the EuroQol 5-dimension questionnaire (EQ-5D). One hundred seventy-five patients completed the study. The incidence of PPP was 28%, and the affected patients presented lower QoL. The majority referred to a moderate to severe level of interference in their general activity. Cholecystectomies were less associated with PPP, and total knee/hip replacements were more associated with it. Preoperative pain, preoperative benzodiazepines or antidepressants, and more severe acute postoperative pain were associated with the development of PPP. Half of the patients with PPP were under treatment, and they refer a mean symptomatic relief of 69%. This study, apart from attempting to better characterize the problem of PPP, emphasizes the lack of its treatment.

  12. An Investigation into factors influencing the choice of business ...

    African Journals Online (AJOL)

    There was significant difference between male and female career influencing factors. There was no significant difference regarding the influence exercised by parent in the students' choice of Business Education. There is significant difference between male and female in the influence exerted by external factors in their ...

  13. Urban water consumption and its influencing factors in China

    NARCIS (Netherlands)

    Fan, Liangxin; Gai, Lingtong; Tong, Yan; Li, Ruihua

    2017-01-01

    Factors that affect water consumption should be identified to develop effective public policies. However, factors influencing domestic water consumption in cities in China, particularly on a national scale, are unclear. In this study, urban water consumption and its influencing factors in 286

  14. Assessment of quality of care in acute postoperative pain management

    Directory of Open Access Journals (Sweden)

    Milutinović Dragana

    2009-01-01

    Full Text Available Background/Aim. Managing of acute postoperative pain should be of great interest for all hospital institutions, as one of the key components of patients satisfaction, which indicates quality, as well as the outcome of treatment. The aim of this study was to assess the quality of nursing care in managing acute postoperative pain and to establish factors which influence patients assessment of the same. Method. The investigation was conducted on the sample of 135 patients hospitalized in surgical clinics of the Clinical Centre of Vojvodina in Novi Sad in the form of cross-sectional study, by interviewing patients during the second postoperative day and collecting sociodemographic variables, type of surgical procedure and applied analgesic therapy which were taken from their medical documentation. The modified questionnaire of the Strategic and Clinical Quality Indicators in Postoperative Pain Management (SCQIPP was used as the instrument of the investigation. The data were processed with suitable mathematical statistics methods such as multivariate analyses of variance (MANOVA, discriminative and other parametric procedures and methods. Roy's test, Pearson's coefficient contingency (χ, multiple correlation coefficient (R were conducted amongst other invariant procedures. Results. The mean score for the individual items of SCQIPP questionnaire was between 2.0 and 4.7 (scale range 1-5 and the percentage of patients answers 'strongly agree' ranged from 4.4 to 77%. The smallest number of positive answers were given by the patients for the item 'In order to assess pain intensity, some of the staff asked me at least once in the morning, in the afternoon and in the evening to show the number from 0-10'. Most of the patients (57% evaluated severe pain during the previous 24 hours, as moderate pain, which represents significantly greater number of patients which complain of severe pain and mild pain (p < 0.001. The analysis of patients evaluation (MANOVA p

  15. Factors Influencing Pregnancy Desires among HIV Positive Women ...

    African Journals Online (AJOL)

    Factors Influencing Pregnancy Desires among HIV Positive Women in Sibande District in Mpumalanga, South Africa. ... Gender and Behaviour ... The objective of the study is to present findings on factors influencing pregnancy desires amongst HIV positive women that have participated in Prevention of Mother to child ...

  16. Social Factors Influencing Child Health in Ghana.

    Directory of Open Access Journals (Sweden)

    Emmanuel Quansah

    Full Text Available Social factors have profound effects on health. Children are especially vulnerable to social influences, particularly in their early years. Adverse social exposures in childhood can lead to chronic disorders later in life. Here, we sought to identify and evaluate the impact of social factors on child health in Ghana. As Ghana is unlikely to achieve the Millennium Development Goals' target of reducing child mortality by two-thirds between 1990 and 2015, we deemed it necessary to identify social determinants that might have contributed to the non-realisation of this goal.ScienceDirect, PubMed, MEDLINE via EBSCO and Google Scholar were searched for published articles reporting on the influence of social factors on child health in Ghana. After screening the 98 articles identified, 34 of them that met our inclusion criteria were selected for qualitative review.Major social factors influencing child health in the country include maternal education, rural-urban disparities (place of residence, family income (wealth/poverty and high dependency (multiparousity. These factors are associated with child mortality, nutritional status of children, completion of immunisation programmes, health-seeking behaviour and hygiene practices.Several social factors influence child health outcomes in Ghana. Developing more effective responses to these social determinants would require sustainable efforts from all stakeholders including the Government, healthcare providers and families. We recommend the development of interventions that would support families through direct social support initiatives aimed at alleviating poverty and inequality, and indirect approaches targeted at eliminating the dependence of poor health outcomes on social factors. Importantly, the expansion of quality free education interventions to improve would-be-mother's health knowledge is emphasised.

  17. Modeling Factors with Influence on Sustainable University Management

    Directory of Open Access Journals (Sweden)

    Oana Dumitrascu

    2015-01-01

    Full Text Available The main objective of this paper is to present the factors with influence on the sustainable university management and the relationships between them. In the scientific approach we begin from a graphical model, according to which the extracurricular activities together with internal environmental factors influence students’ involvement in such activities, the university attractiveness, their academic performance and their integration into the socially-economic and natural environment (components related with sustainable development. The model emphasizes that individual performances, related to students’ participation in extracurricular activities, have a positive influence on the sustainability of university management. The results of the study have shown that the university sustainability may be influenced by a number of factors, such as students’ performance, students’ involvement in extracurricular activities or university’s attractiveness and can in turn influence implicitly also the sustainability of university management. The originality of the paper consists in the relationships study using the modeling method in general and informatics tools of modeling in particular, as well as through graphical visualization of some influences, on the sustainability university management.

  18. Predictive factors for postoperative visual function of primary chronic rhegmatogenous retinal detachment after scleral buckling.

    Science.gov (United States)

    Fang, Wei; Li, Jiu-Ke; Jin, Xiao-Hong; Dai, Yuan-Min; Li, Yu-Min

    2016-01-01

    To evaluate predictive factors for postoperative visual function of primary chronic rhegmatgenous retinal detachment (RRD) after sclera buckling (SB). Totally 48 patients (51 eyes) with primary chronic RRD were included in this prospective interventional clinical cases study, which underwent SB alone from June 2008 to December 2014. Age, sex, symptoms duration, detached extension, retinal hole position, size, type, fovea on/off, proliferative vitreoretinopathy (PVR), posterior vitreous detachment (PVD), baseline best corrected visual acuity (BCVA), operative duration, follow up duration, final BCVA were measured. Pearson correlation analysis, Spearman correlation analysis and multivariate linear stepwise regression were used to confirm predictive factors for better final visual acuity. Student's t-test, Wilcoxon two-sample test, Chi-square test and logistic stepwise regression were used to confirm predictive factors for better vision improvement. Baseline BCVA was 0.8313±0.6911 logMAR and final BCVA was 0.4761±0.4956 logMAR. Primary surgical success rate was 92.16% (47/51). Correlation analyses revealed shorter symptoms duration (r=0.3850, P=0.0053), less detached area (r=0.5489, Ppredictive factors were better baseline BCVA [partial R-square (PR(2))=0.5316, Ppredictive factors for better vision improvement were better baseline vision [odds ratio (OR) =50.369, P=0.0041] and longer follow up duration (OR=1.144, P=0.0067). Independent predictive factors for better visual outcome of primary chronic RRD after SB are better baseline BCVA, shorter symptoms duration, shorter operative duration and longer follow up duration, while independent predictive factors for better vision improvement after operation are better baseline vision and longer follow up duration.

  19. EVALUATION OF POSTOPERATIVE VISUAL OUTCOME IN TRAUMATIC CATARACT AND A STUDY OF POSTOPERATIVE COMPLICATIONS IN SUCH CASES

    Directory of Open Access Journals (Sweden)

    Shantanu Bhattacharjee

    2017-12-01

    Full Text Available BACKGROUND Cataract formation is commonly observed as a result of blunt or penetrating ocular injury and constitutes one of major causes of acute or longstanding visual loss. The surgical technique, timing of surgery and postoperative complications have all been considered to be significant factors in determining the final visual outcome. The aim of the present study is to evaluate postoperative visual outcome in a series of patients with traumatic cataract and to assess the postoperative complications conducted at IQ City Medical College, Durgapur, West Bengal. MATERIALS AND METHODS A consecutive series of 45 patients with traumatic cataract were carefully selected from outpatient department between May 2015 and April 2017. All the patients had undergone manual Small Incision Cataract Surgery (SICS with IOL implantation. Postoperative visual outcome and postoperative complications were assessed. RESULTS Corrected Visual Acuity (VA at the end of 6th week in 45 cases ranged between 6/6 and 6/60. Subjective correction with glasses ranged from -2 dioptre spherical to +1.5 dioptre spherical. 25 cases (55.5% had VA 6/6-6/9, 15 cases (33.3% had VA of 6/12 to 6/18, 4 cases (8.9% had VA between 6/24 and 6/36 and 1 case had VA 6/60. The group which had VA between 6/12 and 6/18 was due to the presence of posterior capsular opacification. CONCLUSION The present study reveals most of the traumatic cataract cases had favourable visual outcome. Considering the fact that a good number of paediatric patients were treated in this study, it assumes more significance with the favourable visual outcome that could be achieved, thus preventing deprivation amblyopia and blindness.

  20. Comparison of Predictive Factors for Postoperative Incontinence of Holmium Laser Enucleation of the Prostate by the Surgeons’ Experience During Learning Curve

    Directory of Open Access Journals (Sweden)

    Katsumi Shigemura

    2016-03-01

    Full Text Available Purpose: To detect predictive factors for postoperative incontinence following holmium laser enucleation of the prostate (HoLEP according to surgeon experience (beginner or experienced and preoperative clinical data. Methods: Of 224 patients, a total of 203 with available data on incontinence were investigated. The potential predictive factors for post-HoLEP incontinence included clinical factors, such as patient age, and preoperative urodynamic study results, including detrusor overactivity (DO. We also classified the surgeons performing the procedure according to their HoLEP experience: beginner (<21 cases and experienced (≥21 cases. Results: Our statistical data showed DO was a significant predictive factor at the super-short period (the next day of catheter removal: odds ratio [OR], 3.375; P=0.000. Additionally, patient age, surgeon mentorship (inverse correlation, and prostate volume were significant predictive factors at the 1-month interval after HoLEP (OR, 1.072; P=0.004; OR, 0.251; P=0.002; and OR, 1.008; P=0.049, respectively. With regards to surgeon experience, DO and preoperative International Prostate Symptom Score (inverse at the super-short period, and patient age and mentorship (inverse correlation at the 1-month interval after HoLEP (OR, 3.952; P=0.002; OR, 1.084; P=0.015; and OR,1.084; P=0.015; OR, 0.358; P=0.003, respectively were significant predictive factors for beginners, and first desire to void (FDV at 1 month after HoLEP (OR, 1.009; P=0.012 was a significant predictive factor for experienced surgeons in multivariate analysis. Conclusions: Preoperative DO, IPSS, patient age, and surgeon mentorship were significant predictive factors of postoperative patient incontinence for beginner surgeons, while FDV was a significant predictive factors for experienced surgeons. These findings should be taken into account by surgeons performing HoLEP to maximize the patient’s quality of life with regards to urinary continence.

  1. FACTORS INFLUENCING SECOND LANGUAGE ACQUISITION

    Directory of Open Access Journals (Sweden)

    Siti Khasinah

    2014-05-01

    Full Text Available Motivation, attitude, age, intelligence, aptitude, cognitive style, and personality are considered as factors that greatly influence someone in the process of his or her second language acquisition. Experts state that those factors give a more dominant contribution in SLA to learners variedly, depend on who the learners are, their age, how they behave toward the language, their cognitive ability, and also the way they learn.

  2. Influence of a New “Call-Out Algorithm” for Management of Postoperative Pain and Its Side Effects on Length of Stay in Hospital: A Two-Centre Prospective Randomized Trial

    Science.gov (United States)

    Dybvik, Lisa; Skraastad, Erlend; Yeltayeva, Aigerim; Konkayev, Aidos; Musaeva, Tatiana; Zabolotskikh, Igor; Dahl, Vegard; Raeder, Johan

    2017-01-01

    Background We recently introduced the efficacy safety score (ESS) as a new “call-out algorithm” for management of postoperative pain and side effects. In this study, we report the influence of ESS recorded hourly during the first 8 hours after surgery on the mobility degree, postoperative nonsurgical complications, and length of hospital stay (LOS). Methods We randomized 1152 surgical patients into three groups for postoperative observation: (1) ESS group (n = 409), (2) Verbal Numeric Rate Scale (VNRS) for pain group (n = 417), and (3) an ordinary qualitative observation (Control) group (n = 326). An ESS > 10 or VNRS > 4 at rest or a nurse's observation of pain or adverse reaction to analgesic treatment in the Control group served as a “call-out alarm” for an anaesthesiologist. Results We found no significant differences in the mobility degree and number of postoperative nonsurgical complications between the groups. LOS was significantly shorter with 12.7 ± 6.3 days (mean ± SD) in the ESS group versus 14.2 ± 6.2 days in the Control group (P < 0.001). Conclusion Postoperative ESS recording in combination with the possibility to call upon an anaesthesiologist when exceeding the threshold score might have contributed to the reductions of LOS in this two-centre study. This trial is registered with NCT02143128. PMID:28855800

  3. Influence of a New “Call-Out Algorithm” for Management of Postoperative Pain and Its Side Effects on Length of Stay in Hospital: A Two-Centre Prospective Randomized Trial

    Directory of Open Access Journals (Sweden)

    Lisa Dybvik

    2017-01-01

    Full Text Available Background. We recently introduced the efficacy safety score (ESS as a new “call-out algorithm” for management of postoperative pain and side effects. In this study, we report the influence of ESS recorded hourly during the first 8 hours after surgery on the mobility degree, postoperative nonsurgical complications, and length of hospital stay (LOS. Methods. We randomized 1152 surgical patients into three groups for postoperative observation: (1 ESS group (n=409, (2 Verbal Numeric Rate Scale (VNRS for pain group (n=417, and (3 an ordinary qualitative observation (Control group (n=326. An ESS > 10 or VNRS > 4 at rest or a nurse’s observation of pain or adverse reaction to analgesic treatment in the Control group served as a “call-out alarm” for an anaesthesiologist. Results. We found no significant differences in the mobility degree and number of postoperative nonsurgical complications between the groups. LOS was significantly shorter with 12.7±6.3 days (mean ± SD in the ESS group versus 14.2±6.2 days in the Control group (P<0.001. Conclusion. Postoperative ESS recording in combination with the possibility to call upon an anaesthesiologist when exceeding the threshold score might have contributed to the reductions of LOS in this two-centre study. This trial is registered with NCT02143128.

  4. Nitrous oxide does not influence operating conditions or postoperative course in colonic surgery

    DEFF Research Database (Denmark)

    Krogh, B; Jørn Jensen, P; Henneberg, S W

    1994-01-01

    We studied 150 patients undergoing elective colonic surgery; they were allocated randomly to undergo artificial ventilation with either air-oxygen or nitrous oxide-oxygen during surgery. Eleven patients were excluded. Preoperative management, surgery and postoperative analgesia were similar in bo...

  5. [Effect of early postoperative use of ACEI/ARB or diuretics on the incidence of acute kidney injury after cardiac surgery in elderly patients].

    Science.gov (United States)

    Hu, Peng-hua; Chen, Yuan-han; Liang, Xin-ling; Li, Rui-zhao; Li, Zhi-lian; Jiang, Fen; Shi, Wei

    2013-07-01

    To explore the influence of early postoperative use of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) or diuretics on acute kidney injury (AKI) after cardiac surgery in elderly patients. Data from elderly patients (age≥60 years old) who underwent cardiac surgery with extracorporeal circulation in Guangdong General Hospital between January 2007 and December 2010 were analyzed in this retrospective research. The primary endpoint was AKI as diagnosed according to the serum creatinine criteria of RIFLE (risk, injury, failure, loss, end stage renal disease). The baseline serum creatinine was defined as the latest serum creatinine level before cardiac surgery. Multivariate analysis by logistic regression was used to obtain the independent risk factors for AKI. Among 618 elderly patients, 76 (12.3%) patients received ACEI/ARB during early postoperative period, 491 (79.4%) patients were given diuretics during early postoperative period, and postoperative AKI occurred in 394 (63.8%) patients. The incidence of AKI was 46.1% in patients who received early postoperative ACEI/ARB, and 66.2% in patients who did not (Pdiuretics postoperatively were less likely to suffer from AKI compared with patients who did not (57.0% vs. 89.8%, Pdiuretics (OR=0.149, 95%CI 0.076-0.291, Pdiuretics is associated with a lower incidence of AKI after cardiac surgery with extracorporeal circulation in elderly patients.

  6. [Postoperative intraperitoneal complications in colon cancer surgery].

    Science.gov (United States)

    Erokhina, E A; Topuzov, É G; Topuzov, É É

    2014-01-01

    The authors studied the clinical characteristics and terms of the development of postoperative intraperitoneal complications in patients undergoing colon cancer surgery. It was stated, that the diversity of clinical data depended on complication characteristics. Results of investigation allowed defining of the most dangerous terms of intraperitoneal complications and risk factors.

  7. Influence of organizational factors on safety

    International Nuclear Information System (INIS)

    Haber, S.B.; Metlay, D.S.; Crouch, D.A.

    1990-01-01

    There is a need for a better understanding of exactly how organizational management factors at a nuclear power plant (NPP) affect plant safety performance, either directly or indirectly, and how these factors might be observed, measured, and evaluated. The purpose of this research project is to respond to that need by developing a general methodology for characterizing these organizational and management factors, systematically collecting information on their status and integrating that information into various types of evaluative activities. Research to date has included the development of the Nuclear Organization and Management Analysis Concept (NOMAC) of a NPP, the identification of key organizational and management factors, and the identification of the methods for systematically measuring and analyzing the influence of these factors on performance. Most recently, two field studies, one at a fossil fuel plant and the other at a NPP, were conducted using the developed methodology. Results are presented from both studies highlighting the acceptability, practicality, and usefulness of the methods used to assess the influence of various organizational and management factors including culture, communication, decision-making, standardization, and oversight. 6 refs., 3 figs., 1 tab

  8. Sphenopalatine Artery Ligation for Epistaxis: Factors Influencing Outcome and Impact of Timing of Surgery.

    Science.gov (United States)

    McDermott, Ailbhe M; O'Cathain, Eadaoin; Carey, Brian William; O'Sullivan, Peter; Sheahan, Patrick

    2016-03-01

    Sphenopalatine artery ligation is a commonly employed surgical intervention for control of posterior epistaxis unresponsive to nasal packing. The objective of the present study was to evaluate the outcome of sphenopalatine artery ligation for control of epistaxis at our institution and the impact of timing and other factors on outcome. Case series with chart review. Academic tertiary referral center. Case notes were reviewed for 45 consecutive patients undergoing sphenopalatine artery ligation for control of epistaxis between October 2008 and October 2014. Forty-one patients had nasal packing prior to sphenopalatine artery ligation, with 33 undergoing ≥2 packings. Postoperatively, 6 patients had rebleeding, which was treated with repacking (n = 4) and return to the operating room (n = 2). The overall success rate of sphenopalatine artery ligation was 87% (39 of 45). Rebleeding rate was not affected by concomitant septoplasty, anterior ethmoidal artery ligation, or postoperative nasal packing. Patients undergoing SPA ligation within the first 24 hours of admission had a significantly shorter hospital length of stay (3 vs 6 days, P = .02) and treatment cost (€5905 vs €10,001, P = .03). Length of stay was not influenced by sphenopalatine artery ligation after ≤1 nasal pack versus ≥2 packs. Timing of sphenopalatine artery ligation did not affect blood transfusion requirement (P = .84). Sphenopalatine artery ligation is an effective management strategy for surgical control of refractory epistaxis. Early timing of sphenopalatine artery ligation may lead to reductions in length of stay. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  9. INFLUENCE FACTORS FOR LEASING MARKET CONTRACTS

    Directory of Open Access Journals (Sweden)

    Oana BĂRBULESCU

    2016-11-01

    Full Text Available This paper aims to investigate the relationship between leasing contracts and some factors that influence the value of these contracts. In order to do this, we have decided on some quantitative marketing research by appealing to statistics for accomplishing the objectives that we have set: to find a correlation between the turnover percentage assigned to leasing expenses and several influence factors. This study indicated that the more contracts are signed by a firm, the more likely is to assign a bigger fraction of the income to each new leasing contract. The study confirmed that bigger companies are relying more on leasing as a way of financing than small companies. This study also discovered that companies with more employees are using larger contracts in order to sustain their activity. The findings are expected to contribute to adjusting the offers by the leasing companies, taking into consideration these factors and to using these factors in order to better predict the market evolution.

  10. Factors that negatively influence consumption of traditionally ...

    African Journals Online (AJOL)

    Factors that negatively influence consumption of traditionally fermented milk ... in various countries of sub-Saharan Africa and a number of health benefits to human ... influence consumption of Mursik, a traditionally fermented milk product from ...

  11. Is low serum albumin associated with postoperative complications in patients undergoing oesophagectomy for oesophageal malignancies?

    Science.gov (United States)

    Goh, Sean L; De Silva, Ramesh P; Dhital, Kumud; Gett, Rohan M

    2015-01-01

    A best evidence topic was written according to a structured protocol. The question addressed was: in patients undergoing oesophagectomy for oesophageal malignancy, is low serum albumin associated with postoperative complications? Altogether, 87 papers were found using the reported search, of which 16 demonstrated the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. This paper includes 2 level 2 papers, 12 level 3 papers and 2 level 4 papers. All the papers compared either all or some of the following postoperative complications: mortality, morbidity, anastomotic leak, respiratory and non-respiratory complications, and length of hospital stay. Eleven of the 16 papers found an association between low serum albumin and postoperative complications. Of these, one study showed that low serum albumin combined with low fibrinogen levels (FA score) was predictive of postoperative recurrence of oesophageal cancer. Another study showed that when combined with white cell count and C-reactive protein (CRP, NUn score), serum albumin had a high diagnostic accuracy for major complications after postoperative day 3. The largest study compared the in-hospital mortality in 7227 patients who underwent oesophageal surgery for malignancy. The percentage of in-hospital mortality was associated with low serum albumin (35.0 g/l, 21.0 vs 11.3%, P papers found no significant association between low serum albumin and postoperative complications. Of these papers, one showed that low serum albumin was not an independent risk factor, while four others found no association between low serum albumin with respiratory complications, anastomotic leak and postoperative mortality. Instead, these studies found other factors responsible for postoperative complications such as: CRP, smoking, disease duration, malnutrition and low T-cell levels. Taken together

  12. AB194. A 12-year retrospective evaluation of TVT and TVT-O in the surgical management of SUI in females and the analysis of influence factors

    Science.gov (United States)

    Zhu, Kejia; Liu, Yaxiao; Chen, Fan; Cheng, Shanshan; Yang, Yue; Shi, Benkang

    2016-01-01

    Objective We evaluate the clinical effect of TVT and TVT-O slings in the surgical management of SUI in women at mostly 12-year follow-ups and the factors that influence it. Methods In this retrospective analysis, 94 women with stress incontinence treated by TVT (14 cases) or TVT-O (80 cases) were included. Subjective evaluation included ICIQ-SF, KHQ, PGI-I and patient satisfaction, and we recorded the objective data of the procedures. We analyzed whether the age, BMI, disease duration, surgery history, postoperative follow-up duration or other factors were related to the subjective cure rate. Results Eight cases of TVT and 59 cases of TVT-O completed the follow-up. Patients were followed up for 1.3–12 years in TVT and 0.2–9.2 years in TVT-O group. The rates of subjectively assessed success were 87.5% and 84.7%, respectively (P=1.00). The total KHQ were (21.93±30.42) and (16.89±25.85) (P=0.55). The operation duration were (59.29±21.02) in TVT group and (29.87±12.04) in TVT-O group (P=0.00). The postoperative days of indwelling catheter were (4.14±1.79) and (3.11±1.51) (P=0.02), and the post-operation hospitalization days were (5.64±2.06) and (5.01±1.77) (P=0.27). The factors above didn’t affect the subjective cure rate. Conclusions The patient reported long-term success rate were both high and had no significant differences between the groups. Operation duration and postoperative durations of indwelling catheter of TVT-O was shorter. The factors above didn’t affect the subjective cure rate.

  13. Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty.

    Science.gov (United States)

    Picavet, Valerie A; Gabriëls, Loes; Grietens, Jente; Jorissen, Mark; Prokopakis, Emmanuel P; Hellings, Peter W

    2013-04-01

    In patients seeking aesthetic rhinoplasty, a high prevalence of body dysmorphic disorder symptoms has recently been reported. However, the impact of these symptoms on the outcomes after rhinoplasty remains elusive. This large-scale study determines the influence of preoperative body dysmorphic disorder symptoms on patients' postoperative satisfaction and quality of life, using validated questionnaires. A 1-year prospective study of 166 adult patients undergoing cosmetic rhinoplasty in a tertiary referral center was performed. Severity of body dysmorphic disorder symptoms was assessed by the modified Yale-Brown Obsessive Compulsive Scale. Postoperative satisfaction was evaluated using a visual analog scale for patients' appraisal of nasal shape and the Rhinoplasty Outcome Evaluation. Generic quality of life was quantified by the Sheehan Disability Scale, whereas the appearance-related disruption of everyday life was measured by the Derriford Appearance Scale-59. Preoperative body dysmorphic disorder symptom scores inversely correlated with postoperative satisfaction at 3 months (visual analog scale nasal shape: rho = -0.43, p dysmorphic disorder symptom scores positively correlated with Sheehan Disability Scale scores and Derriford Appearance Scale-59 scores at 3 months (rho = 0.43, p dysmorphic disorder symptoms on subjective outcomes after rhinoplasty, hence unveiling a crucial factor in patient dissatisfaction after aesthetic rhinoplasty.

  14. Influencing factors for early acute cerebrovascular accidents in patients with stroke history following off-pump coronary artery bypass grafting.

    Science.gov (United States)

    Wang, Bin; Jia, Ming; Jia, Shijie; Wan, Jiuhe; Zhou, Xiao; Luo, Zhimin; Zhou, Ye; Zhang, Jianqun

    2014-06-01

    To analyse risk factors for early acute cerebrovascular accidents following off-pump coronary artery bypass grafting (OPCAB) in patients with stroke history, and to propose preventive measures to reduce the incidence of these events. A total of 468 patients with a history of stroke underwent OPCAB surgery in Beijing Anzhen Hospital of China from January 2010 to September 2012. They were retrospectively divided into two groups according to the occurrence of early acute cerebrovascular accidents within 48 hours following OPCAB. Multivariate logistic regression analysis was used to find risk or protective factors for early acute cerebrovascular accidents following the OPCAB. Fifty-two patients (11.1%) suffered from early acute cerebrovascular accidents in 468 patients, including 39 cases of cerebral infarction, two cases of cerebral haemorrhage, 11 cases of transient ischaemic attack (TIA). There were significant differences between the two groups in preoperative left ventricular ejection fraction ≤ 35%, severe bilateral carotid artery stenosis, poorly controlled hypertension, intraoperative application of Enclose® II proximal anastomotic device, postoperative acute myocardial infarction, atrial fibrillation, hypotension, ventilation time > 48h, ICU duration >48h and mortality. Multivariate logistic regression analysis showed that preoperative severe bilateral carotid stenosis (OR=6.378, 95%CI: 2.278-20.987) and preoperative left ventricular ejection fraction ≤ 35% (OR=2.737, 95%CI: 1.267-6.389), postoperative acute myocardial infarction (OR=3.644, 95%CI: 1.928-6.876), postoperative atrial fibrillation (OR=3.104, 95%CI:1.135∼8.016) and postoperative hypotension (OR=4.173, 95%CI: 1.836∼9.701) were independent risk factors for early acute cerebrovascular accidents in patients with a history of stroke following OPCAB procedures, while intraoperative application of Enclose® II proximal anastomotic device was protective factor (OR=0.556, 95%CI: 0.337-0.925). This

  15. Factors Influencing Organization Adoption Decision On Cloud Computing

    OpenAIRE

    Ailar Rahimli

    2013-01-01

    Cloud computing is a developing field, using by organization that require to computing resource to provide the organizational computing needs. The goal of this research is evaluate the factors that influence on organization decision to adopt the cloud computing in Malaysia. Factors that relate to cloud computing adoption that include : need for cloud computing, cost effectiveness, security effectiveness of cloud computing and reliability. This paper evaluated the factors that influence on ado...

  16. Influence of postoperative low-level laser therapy on the osseointegration of self-tapping implants in the posterior maxilla: A 6-week split-mouth clinical study

    OpenAIRE

    Mandić Borka; Lazić Zoran; Marković Aleksa; Mandić Bojan; Mandić Miška; Đinić Ana; Miličić Biljana

    2015-01-01

    Background/Aim. Low-level laser therapy (LLLT) has been proven to stimulate bone repair, affecting cellular proliferation, differentiation and adhesion, and has shown a potential to reduce the healing time following implant placement. The aim of this clinical study was to investigate the influence of postoperative LLLT osseointegration and early success of self-tapping implants placed into low-density bone. Methods. Following the split-mouth design, self-ta...

  17. Postoperative care in geriatrics

    Directory of Open Access Journals (Sweden)

    Grzegorz Ulenberg

    2017-08-01

    Full Text Available Treatment of the elderly is becoming increasingly common problem and is of interest, because in the future this phenomenon will affect most of us. For many years, he observed in different countries increasingly rapid aging of the population, including in Poland. The operation in such a patient poses a high risk of complications and life-threatening conditions. Their age makes in the postoperative period there are many medical problems. Many factors can affect the scope of a different self-care nursing with such a patient.

  18. Post-operative diabetes insipidus after endoscopic transsphenoidal surgery.

    Science.gov (United States)

    Schreckinger, Matthew; Walker, Blake; Knepper, Jordan; Hornyak, Mark; Hong, David; Kim, Jung-Min; Folbe, Adam; Guthikonda, Murali; Mittal, Sandeep; Szerlip, Nicholas J

    2013-12-01

    Diabetes insipidus (DI) after endoscopic transsphenoidal surgery (ETSS) can lead to increased morbidity, longer hospital stays, and increased medication requirements. Predicting which patients are at high risk for developing DI can help direct services to ensure adequate care and follow-up. The objective of this study was to review our institution's experience with ETSS and determine which clinical/laboratory variables are associated with DI in this patient population. The authors wanted to see if there was an easily determined single value that would help predict which patients develop DI. This represents the largest North American series of this type. We retrospectively reviewed the charts of patients who had undergone ETSS for resection of sellar and parasellar pathology between 2006 and 2011. We examined patient and tumor characteristics and their relationship to postoperative DI. Out of 172 endoscopic transsphenoidal surgeries, there were 15 cases of transient DI (8.7%) and 14 cases of permanent DI (8.1%). Statistically significant predictors of postoperative DI (p 1-deamino-8-D-arginine vasopressin. An increase in serum sodium of ≥2.5 mmol/L is a positive marker of development of DI with 80% specificity, and a postoperative serum sodium of ≥145 mmol/L is a positive indicator with 98% specificity. Identifying perioperative risk factors and objective indicators of DI after ETSS will help physicians care for patients postoperatively. In this large series, we demonstrated that there were multiple perioperative risk factors for the development of DI. These findings, which are consistent with other reports from microscopic surgical series, will help identify patients at risk for diabetes insipidus, aid in planning treatment algorithms, and increase vigilance in high risk patients.

  19. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis.

    Science.gov (United States)

    Kawada, Kenji; Sakai, Yoshiharu

    2016-07-07

    Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR.

  20. Influence of smoking status on treatment outcomes after post-operative radiation therapy for non-small-cell lung cancer

    International Nuclear Information System (INIS)

    Nguyen, Sonia K.A.; Masson-Cote, Laurence; Fortin, Andre; Dagnault, Anne

    2010-01-01

    Background and purpose: The role of post-operative radiotherapy in patients with resected non-small-cell lung cancer (NSCLC) is unclear. Modifiable factors, like smoking, may help guide therapy. We retrospectively evaluated the impact of smoking on control in patients undergoing post-operative radiation therapy (PORT) for NSCLC. Materials and methods: Between 1995 and 2007, 152 patients who underwent surgery for NSCLC were analyzed (median follow-up 26 months). Non-smokers were defined as patients who never smoked or who had stopped smoking at the time of initial consultation. Sixty seven percent were non-smokers; 5% never smoked, 40% of the non-smokers had ceased smoking for a year or less, while 55% had stopped for more than a year. Results: On univariate analysis, smokers had worse 5-year local control than non-smokers (70% versus 90%, p = 0.001) and locoregional control (52% versus 77%, p = 0.002). The 5 -year survival rate was 21% for smokers and 31% for non-smokers (p = 0.2). On multivariate analysis, smokers maintained a detrimental effect on locoregional control (HR 3.6, p = 0.0006). Conclusions: Smokers at initial consultation have poorer local and locoregional control after PORT than non-smokers. In patients being considered for PORT for NSCLC, quitting smoking before treatment confers additional treatment advantage.

  1. A Comparison of Factors that Influence the Lyophilization Process

    OpenAIRE

    Mnerie, Dumitru; Anghel, Gabriela Victoria; Mnerie, Alin Vasile; Cheveresan, Constantin

    2007-01-01

    The lyophilization (or freeze drying) process for agro-foods products depends on a series of technological factors that are in an inter-dependence with the process performance. This paper presents an expert method and its application. This method characterizes the influence factors of the lyophilization process, after the importance level of some factors in correlation with other factors, is defined. Only the most important factors were considered; influence considerations were made in relati...

  2. Postoperative delirium: age and low functional reserve as independent risk factors.

    Science.gov (United States)

    Pinho, Cristiana; Cruz, Sofia; Santos, Alice; Abelha, Fernando J

    2016-09-01

    The aim of this study was to determine the incidence of postoperative delirium (POD) and the presence of previous conditions related to its development. Prospective observational study. The study was performed in adult patients (n=221) scheduled for elective surgery and admitted to the postanesthesia care unit (PACU). The presence of POD was assessed by the Nursing Delirium Screening Scale at discharge from the PACU and 24hours after surgery. Descriptive analyses were carried out, and statistical comparisons were performed with Mann-Whitney U, χ(2), or Fisher exact test. Logistic regression analysis was used for evaluation of independent determinants of POD. POD was found in 25 patients (11%). Patients who developed POD were older (median age, 69 vs 57years; P<.001); had a higher American Society of Anesthesiologists physical status score (≥3) (60% vs 19%, respectively, had American Society of Anesthesiologists physical status III/IV; P<.001); and showed higher incidences of ischemic heart disease (24% vs 6%; P=.001), chronic kidney disease (20% vs 5%; P=.005), hypertension (80% vs 45%; P=.001), chronic obstructive pulmonary disease (20% vs 6%; P=.009), and low functional reserve (LFR) (24% vs 2%; P<.001). Age (odds ratio, 1.06; 95% confidence interval, 1.02-1.10; P=.003) and LFR (odds ratio, 8.04; 95% confidence interval, 3.95-32.27; P=.003) were considered independent risk factors for POD. The incidence of POD in the study population (11%) is consistent with that described in the literature (5%-15%). The comorbidities associated with its development were ischemic heart disease, hypertension, chronic kidney disease, LFR, and chronic obstructive pulmonary disease. Age ≥65years and LFR were independent risk factors for POD development. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Postoperative anemia and early functional outcomes after fast-track hip arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Bandholm, Thomas; Kurbegovic, Sorel

    2016-01-01

    BACKGROUND: Postoperative anemia is prevalent in fast-track hip arthroplasty (THA) where patients are mobilized and discharged early, but whether anemia impairs functional recovery after discharge has not been adequately evaluated previously. This study aimed to evaluate whether postoperative...... anemia influenced recovery of mobility and quality of life (Qol) during the first 2 weeks after discharge from THA. STUDY DESIGN AND METHODS: This was a prospective observational study in 122 THA patients more than 65 years of age. Mobility and Qol were assessed pre- and postoperatively by the 6-minute...... walk test (6MWT; primary outcome), the timed up-and-go test, and the FACT-anemia subscale. Twenty-four-hour mobility at home was assessed by activity monitoring on Days 1 to 6 after discharge. Hemoglobin (Hb) at discharge (HbD) and the Hb decrease from preoperatively (ΔHb) were compared to mobility...

  4. Time Trends and Predictors of Abnormal Postoperative Body Temperature in Infants Transported to the Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Hedwig Schroeck

    2016-01-01

    Full Text Available Background. Despite increasing adoption of active warming methods over the recent years, little is known about the effectiveness of these interventions on the occurrence of abnormal postoperative temperatures in sick infants. Methods. Preoperative and postoperative temperature readings, patient characteristics, and procedural factors of critically ill infants at a single institution were retrieved retrospectively from June 2006 until May 2014. The primary endpoints were the incidence and trend of postoperative hypothermia and hyperthermia on arrival at the intensive care units. Univariate and adjusted analyses were performed to identify factors independently associated with abnormal postoperative temperatures. Results. 2,350 cases were included. 82% were normothermic postoperatively, while hypothermia and hyperthermia each occurred in 9% of cases. During the study period, hypothermia decreased from 24% to 2% (p<0.0001 while hyperthermia remained unchanged (13% in 2006, 8% in 2014, p=0.357. Factors independently associated with hypothermia were higher ASA status (p=0.02, lack of intraoperative convective warming (p<0.001 and procedure date before 2010 (p<0.001. Independent associations for postoperative hyperthermia included lower body weight (p=0.01 and procedure date before 2010 (p<0.001. Conclusions. We report an increase in postoperative normothermia rates in critically ill infants from 2006 until 2014. Careful monitoring to avoid overcorrection and hyperthermia is recommended.

  5. Association between COMT Polymorphism Val158Met and Opioid Consumption in Patients with Postoperative Pain: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Bo Hu

    2018-01-01

    Full Text Available Background/Aims: Several factors influencing postoperative pain and the effect of opioid analgesics have been investigated on an individual level. The aim of this study was to clarify the impact of catecholamine-O-methyltransferase (COMT gene Val158Met on opioid consumption in postoperative patients. Methods: A systematic review and meta-analysis of the literature up to September 30, 2017, were performed by using PubMed, Cochrane Library, ISI Web of Science, and Chinese National Knowledge Infrastructure (CNKI database. The meta-analysis examined all studies involving the association between genetic polymorphisms of COMT Val158Met and opioid consumption during the acute postoperative period. Results: Of the 153 identified studies, 23 studies were retrieved for systematic review and 10 studies were retrieved for meta-analysis. However, it was impossible to conduct meta-analysis on the association between COMT Val158Met polymorphism and postoperative pain because of heterogeneity of the data. Overall, meta-analysis showed that COMT Val/Met carriers consumed less opioid for analgesia within the first 24 hours after surgery (SMD = 0.14, 95% CI = [0.03, 0.25], P = 0.01 but not within 48 hours (SMD = 0.14, 95% CI = [0.08, 0.36], P = 0.21. There was no significant difference in opioid consumption between Val/ Val and Met/Met patients. Conclusion: Patients with Val/Met but not Met/Met allele variant consumed less opioid, though larger and better-designed studies are required to obtain an exclusive conclusion about the correlation between postoperative pain and COMT Val158Met polymorphism.

  6. Factors influencing e-commerce development in Serbia

    OpenAIRE

    Kalinić, Zoran; Ranković, Vladimir; Kalinić, Ljubina

    2016-01-01

    In this paper, an overview of current state of e-commerce development in Serbia is presented. Also, some important factors influencing e-commerce diffusion are discussed. The factors are divided into four groups: technical factors, which cover e- commerce telecommunication and logistics infrastructure; legal factors, i.e. necessary laws and regulations on e-commerce; economic factors, and psychological factors and local culture. The study showed very strong correlation between broadband inter...

  7. Factors that influence beverage choices at meal times

    DEFF Research Database (Denmark)

    Mueller Loose, Simone; Jaeger, S. R.

    2012-01-01

    Beverages are consumed at almost every meal occasion, but knowledge about the factors that influence beverage choice is less than for food choice. The aim of this research was to characterize and quantify factors that influence beverage choices at meal times. Insights into what beverages are chosen...... consumers. Participants (n=164) described 8356 meal occasions in terms of foods and beverages consumed, and the contextual characteristics of the occasion. Beverage choice was explored with random-parameter logit regressions to reveal influences linked to food items eaten, context factors and person factors....... Thereby this study contributed to the food choice kaleidoscope research approach by expressing the degree of context dependency in form of odds ratios and according significance levels. The exploration of co-occurrence of beverages with food items suggests that beverage-meal item combinations can be meal...

  8. A Prospective Study of Postoperative Vomiting in Children Undergoing Different Surgical Procedures under General Anaesthesia

    Directory of Open Access Journals (Sweden)

    Jaya Choudhary

    2008-01-01

    Full Text Available To identify the risk factors associated with postoperative vomiting (POV in paediatric population undergoing common surgeries. The risk factors studied for association with POV were age> 5 years, female gender, previous history of POV/motion sickness, type of surgery and duration of anaesthesia> 45 min. A total of 100 ASA grade I and II patients of either sex aged between 2-12 years undergoing elective surgical procedures were screened for the study. All patients underwent similar anaesthe-sia protocol and received two antiemetic agents (ondansetron 0.05mg.kg-1 and dexamethasone 0.15mg.kg-1 in premedication. The patients were observed for 24 hours postoperatively for the incidence of vomiting, number of times rescue antiemetic given and any adverse reaction to antiemetic.Overall 34% patients (34/100 developed POV of which 26 had only one episode and 8 patients had 2 episodes during first 24 h. Incidence of POV was 13% (13/100 in first 4 h whereas it was 29% (29/100 in late postoperative period. In early post operative period, POV was not associated significantly with any predicted risk factors. However, age>5years, duration of anaesthesia>45 minutes and history of motion sickness/POV were significantly associated in late postoperative period(4-24h. Female gender and type of surgery were not associated with increased POV. The combination antiemetic effectively prevented POV in early postoperative period (0-4h only but not in late postoperative period(0-24h.

  9. COMPARATIVE STUDY OF NALBUPHINE VS. PENTAZOCINE FOR POSTOPERATIVE ANALGESIA

    Directory of Open Access Journals (Sweden)

    Naresh Ganpatrao Tirpude

    2016-10-01

    Full Text Available BACKGROUND To provide postoperative pain relief is a prime duty of health care providers. Failure to relieve pain is morally and ethically unacceptable. Post-operative pain may results in adverse effects such as: a Physiological Changes: Reduced pulmonary functions, e.g. vital capacity, tidal volume, functional residual capacity; sympathetic stimulation; reduced the physical activity of patients; thereby increasing the risk of venous thrombosis. b Psychological disturbances: Anger, Resentment, Depression, Adversarial Relationship with Doctors, Insomnia. Aim of this study was 1. To investigate whether “Postoperative analgesia with Nalbuphine is longer than Pentazocine”. 2. To investigate whether “Side effects/complications are less with Nalbuphine as compared to Pentazocine”. MATERIALS AND METHODS It was a prospective randomized double blind observational study. Eighty patients of hydrocoele & inguinal hernia were operated under spinal anaesthesia of age group 20-70 years, ASA grade I & II & patients with controlled co-morbid conditions. In postoperative period, Group N- Inj. Nalbuphine (0.3 mg/kg IM or Group P- Inj. Pentazocine (0.5 mg/kg IM was administered to provide postoperative pain relief & to know the duration of pain relief & its side effects. RESULTS On statistical analysis, demographic data i.e. age, sex had no influence on outcome of study. Mean VAS score in group N was highly significant (p-value in Inj. Pentazocine group. 2. Side Effects - Incidence of sedation was more in Nalbuphine group as compared to Pentazocine group. Nausea & Vomiting were more so in Pentazocine group as compared to Nalbuphine group. Limitation of the present study was that sample size was very small.

  10. Intrinsic and extrinsic factors influencing large African herbivore movements

    NARCIS (Netherlands)

    Venter, J.A.; Prins, H.H.T.; Mashanova, A.; Boer, de W.F.; Slotow, R.

    2015-01-01

    Understanding environmental as well as anthropogenic factors that influence large herbivore ecological patterns and processes should underpin their conservation and management. We assessed the influence of intrinsic, extrinsic environmental and extrinsic anthropogenic factors on movement behaviour

  11. Factors associated with pulmonary dysfunction in patients undergoing coronary artery bypass graft surgery with use of intra-aortic balloon pump.

    Science.gov (United States)

    Amaral Gonçalves Fusatto, Helena; Castilho de Figueiredo, Luciana; Ragonete Dos Anjos Agostini, Ana Paula; Sibinelli, Melissa; Dragosavac, Desanka

    2018-01-01

    The aim of this study was to identify pulmonary dysfunction and factors associated with prolonged mechanical ventilation, hospital stay, weaning failure and mortality in patients undergoing coronary artery bypass grafting with use of intra-aortic balloon pump (IABP). This observational study analyzed respiratory, surgical, clinical and demographic variables and related them to outcomes. We analyzed 39 patients with a mean age of 61.2 years. Pulmonary dysfunction, characterized by mildly impaired gas exchange, was present from the immediate postoperative period to the third postoperative day. Mechanical ventilation time was influenced by the use of IABP and PaO2/FiO2, female gender and smoking. Intensive care unit (ICU) stay was influenced by APACHE II score and use of IABP. Mortality was strongly influenced by APACHE II score, followed by weaning failure. Pulmonary dysfunction was present from the first to the third postoperative day. Mechanical ventilation time was influenced by female gender, smoking, duration of IABP use and PaO2/FiO2 on the first postoperative day. ICU stay was influenced by APACHE II score and duration of IABP. Mortality was influenced by APACHE II score, followed by weaning failure. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  12. Factors influencing workplace health promotion intervention: a qualitative systematic review.

    Science.gov (United States)

    Rojatz, Daniela; Merchant, Almas; Nitsch, Martina

    2017-10-01

    Although workplace health promotion (WHP) has evolved over the last 40 years, systematically collected knowledge on factors influencing the functioning of WHP is scarce. Therefore, a qualitative systematic literature review was carried out to systematically identify and synthesize factors influencing the phases of WHP interventions: needs assessment, planning, implementation and evaluation. Research evidence was identified by searching electronic databases (Scopus, PubMed, Social Sciences Citation Index, ASSIA, ERIC, IBBS and PsycINFO) from 1998 to 2013, as well as by cross-checking reference lists of included peer-reviewed articles. The inclusion criteria were: original empirical research, description of WHP, description of barriers to and/or facilitators of the planning, implementation and/or evaluation of WHP. Finally, 54 full texts were included. From these, influencing factors were extracted and summarized using thematic analysis. The majority of influencing factors referred to the implementation phase, few dealt with planning and/or evaluation and none with needs assessment. The influencing factors were condensed into topics with respect to factors at contextual level (e.g. economic crisis); factors at organizational level (e.g. management support); factors at intervention level (e.g. quality of intervention concept); factors at implementer level (e.g. resources); factors at participant level (e.g. commitment to intervention) and factors referring to methodological and data aspects (e.g. data-collection issues). Factors regarding contextual issues and organizational aspects were identified across three phases. Therefore, future research and practice should consider not only the influencing factors at different levels, but also at different phases of WHP interventions. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  13. Influence of postoperative low-level laser therapy on the osseointegration of self-tapping implants in the posterior maxilla: a 6-week split-mouth clinical study.

    Science.gov (United States)

    Mandić, Borka; Lazić, Zoran; Marković, Aleksa; Mandić, Bojan; Mandić, Miška; Djinić, Ana; Miličić, Biljana

    2015-03-01

    Low-level laser therapy (LLLT) has been proven to stimulate bone repair, affecting cellular proliferation, differentiation and adhesion, and has shown a potential to reduce the healing time following implant placement. The aim of this clinical study was to investigate the influence of postoperative LLLT osseointegration and early success of self-tapping implants placed into low-density bone. Following the split-mouth design, self-tapping implants n = 44) were inserted in the posterior maxilla of 12 patients. One jaw side randomly received LLLT (test group), while the other side was placebo (control group). For LLLT, a 637 nm gallium-aluminum-arsenide (GaAlAs) laser (Medicolaser 637, Technoline, Belgrade, Serbia) with an output power of 40 mW and continuous wave was used. Low-level laser treatment was performed immediately after the surgery and then repeated every day in the following 7 days. The total irradiation dose per treatment was 6.26 J/cm2 per implant. The study outcomes were: implant stability, alkaline-phosphatase (ALP) activity and early implant success rate. The follow-up took 6 weeks. Irradiated implants achieved a higher stability compared with controls during the entire follow-up and the difference reached significance in the 5th postoperative week (paired t-test, p = 0.030). The difference in ALP activity between the groups was insignificant in any observation point (paired t-test, p > 0.05). The early implant success rate was 100%, regardless of LLLT usage. LLLT applied daily during the first postoperative week expressed no significant influence on the osseointegration of self-tapping implants placed into low density bone of the posterior maxilla. Placement of self-tapping macro-designed implants into low density bone could be a predictable therapeutic procedure with a high early success rate regardless of LLLT usage.

  14. Influence of postoperative low-level laser therapy on the osseointegration of self-tapping implants in the posterior maxilla: A 6-week split-mouth clinical study

    Directory of Open Access Journals (Sweden)

    Mandić Borka

    2015-01-01

    Full Text Available Background/Aim. Low-level laser therapy (LLLT has been proven to stimulate bone repair, affecting cellular proliferation, differentiation and adhesion, and has shown a potential to reduce the healing time following implant placement. The aim of this clinical study was to investigate the influence of postoperative LLLT osseointegration and early success of self-tapping implants placed into low-density bone. Methods. Following the split-mouth design, self-tapping implants (n = 44 were inserted in the posterior maxilla of 12 patients. One jaw side randomly received LLLT (test group, while the other side was placebo (control group. For LLLT, a 637 nm gallium-aluminum-arsenide (GaAlAs laser (Medicolaser 637, Technoline, Belgrade, Serbia with an output power of 40 mW and continuous wave was used. Low-level laser treatment was performed immediately after the surgery and then repeated every day in the following 7 days. The total irradiation dose per treatment was 6.26 J/cm² per implant. The study outcomes were: implant stability, alkaline-phosphatase (ALP activity and early implant success rate. The follow-up took 6 weeks. Results. Irradiated implants achieved a higher stability compared with controls during the entire follow-up and the difference reached significance in the 5th postoperative week (paired t-test, p = 0.030. The difference in ALP activity between the groups was insignificant in any observation point (paired t-test, p > 0.05. The early implant success rate was 100%, regardless of LLLT usage. Conclusion. LLLT applied daily during the first postoperative week expressed no significant influence on the osseointegration of selftapping implants placed into low density bone of the posterior maxilla. Placement of self-tapping macro-designed implants into low density bone could be a predictable therapeutic procedure with a high early success rate regardless of LLLT usage.

  15. Long-term postoperative cognitive dysfunction in the elderly: ISPOCD1 study

    NARCIS (Netherlands)

    Moller, J.T.; Cluitmans, P.J.M.; Rasmussen, L.S.; Houx, P.J.; Rasmussen, H.; Canet, J.; Rabbitt, P.; Jolles, J.; Larsen, K.; Hanning, C.D.; Langeron, O.; Johnson, T.; Lauven, P.M.; Kristensen, P.A.; Biedler, A.; Beem, van H.; Fraidakis, O.; Silverstein, J.H.; Beneken, J.E.W.; Gravenstein, J.S.

    1998-01-01

    Summary Background Long-term postoperative cognitive dysfunction may occur in the elderly. Age may be a risk factor and hypoxaemia and arterial hypotension causative factors. We investigated these hypotheses in an international multicentre study. Methods 1218 patients aged at least 60 years

  16. Intravenous fluid administration may improve post-operative course of patients with chronic subdural hematoma: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Miroslaw Janowski

    Full Text Available BACKGROUND: The treatment of chronic subdural hematoma (cSDH is still charged of significant risk of hematoma recurrence. Patient-related predictors and the surgical procedures themselves have been addressed in many studies. In contrast, postoperative management has infrequently been subjected to detailed analysis. Moreover variable intravenous fluid administration (IFA was not reported in literature till now in the context of cSDH treatment. METHODOLOGY/PRINCIPAL FINDINGS: A total of 45 patients with cSDH were operated in our department via two burr hole craniostomy within one calendar year. Downward drainage was routinely left in hematoma cavity for a one day. Independent variables selected for the analysis were related to various aspects of patient management, including IFA. Two dependent variables were chosen as measure of clinical course: the rate of hematoma recurrence (RHR and neurological status at discharge from hospital expressed in points of Glasgow Outcome Scale (GOS. Univariate and multivariate regression analyses were performed. Hematoma recurrence with subsequent evacuation occurred in 7 (15% patients. Univariate regression analysis revealed that length of IFA after surgery influenced both dependent variables: RHR (p = 0.045 and GOS (p = 0.023. Multivariate regression performed by backward elimination method confirmed that IFA is a sole independent factor influencing RHR. Post hoc dichotomous division of patients revealed that those receiving at least 2000 ml/day over 3 day period revealed lower RHR than the group with less intensive IFA. (p = 0.031. CONCLUSIONS/SIGNIFICANCE: IFA has been found to be a sole factor influencing both: RHR and GOS. Based on those results we may recommend administration of at least 2000 ml per 3 days post-operatively to decrease the risk of hematoma recurrence.

  17. The effect of dietary fatty acids on post-operative inflammatory response in a porcine model

    DEFF Research Database (Denmark)

    Langerhuus, Sine Nygaard; Jensen, Karin Hjelholt; Tønnesen, Else Kirstine

    2012-01-01

    ), sunflower oil (SO, n 28), or animal fat (AF, n 28) was evaluated with respect to post-operative responses in inflammatory markers in a porcine model on aortic vascular prosthetic graft infection. In the early post-operative period (0 necrosis factor...

  18. Adult tonsillectomy: postoperative pain depends on indications

    Directory of Open Access Journals (Sweden)

    Olaf Zagólski

    Full Text Available ABSTRACT INTRODUCTION: Intense pain is one of the most important postoperative complaints after tonsillectomy. It is often described by patients as comparable to the pain that accompanies an acute tonsillitis. Although recurrent tonsillitis is the most frequent indication for surgery, many tonsillectomies are performed due to other indications and these patients may be unfamiliar with such pain. OBJECTIVE: To verify whether individuals with recurrent tonsillitis experience different post-tonsillectomy pain intensity than those with other indications for surgery, with no history of episodes of acute tonsillitis. METHODS: A total of 61 tonsillectomies were performed under general anesthesia, using a potassium titanyl phosphate (KTP laser (to eliminate the potential influence on the study results of forceful dissection of fibrotic tonsils in patients with history of recurrent tonsillitis and multiple ligations of blood vessels within the tonsillar beds. The patients received 37.5 mg Tramadoli hydrochloridum + 325 mg Paracetamol tablets for 10 days. Postoperative variables included the duration of hospital stay, postoperative hemorrhage and readmission rate. The patients reported pain intensity on consecutive days, pain duration, weight loss on postoperative day 10, character, intensity and duration of swallowing difficulties, and the need for additional doses of painkillers. Healing was also assessed. Capsular nerve fibers were histologically examined in the resected tonsils by immunostainings for general and sensory markers. RESULTS: Indications for the surgery were: recurrent acute tonsillitis (34 patients, no history of recurrent tonsillitis: focus tonsil (20 and intense malodour (7. Pain intensity on postoperative days 3-4 and incidence of readmissions due to dehydration were significantly higher in the group with no history of recurrent tonsillitis. No significant differences in relative densities of protein gene product (PGP 9.5- and

  19. Factors influencing bone scan quality

    International Nuclear Information System (INIS)

    Adams, F.G.; Shirley, A.W.

    1983-01-01

    A reliable subjective method of assessing bone scan quality is described. A large number of variables which theoretically could influence scan quality were submitted to regression and factor analysis. Obesity, age, sex and abnormality of scan were found to be significant but weak variables. (orig.)

  20. Conservative treatment of rectal cancer with local excision and postoperative radiation therapy

    International Nuclear Information System (INIS)

    Minsky, B.D.

    1995-01-01

    The conventional surgical treatment for patients with potentially curable transmural and/or node positive rectal cancer is a low anterior resection or abdominoperineal resection. Recently, there has been increasing interest in the use of local excision and postoperative radiation therapy as primary therapy for selected rectal cancers. The limited data suggest that the approach of local excision and postoperative radiation therapy should be limited to patients with either T 1 tumours with adverse pathological factors or T 2 tumours. Transmural tumours, which have a 24% local failure rate, are treated more effectively with standard surgery and pre- or postoperative therapy. The results of local excision and postoperative radiation therapy are encouraging, but more experience is needed to determine if this approach ultimately has similar local control and survival rates as standard surgery. (author)

  1. Influence of the definition of acute renal failure post-cardiac surgery on incidence, patient identification, and identification of risk factors.

    Science.gov (United States)

    Noyez, Luc

    2011-03-01

    Acute renal failure post-cardiac surgery (RF) is a major complication and is associated with increased postoperative morbidity and mortality. Early recognition and identification of risk factors for RF is therefore important. However, several definitions of RF are used. The intention of this study is to evaluate if the used definitions influence the incidence and the identification of risk factors for RF. We identified, after exclusion of 13 patients with preoperative dialysis, 995 consecutive patients undergoing cardiac surgery at the UMC St. Radboud Medical Center between January 2009 and 15 February 2010 as our study cohort. Apart from the definition used by the Society of Thoracic Surgeons, we selected five major international studies concerning RF, each using a different RF definition. These six definitions were used to evaluate the incidence of and identification of risk factors for RF in our study cohort. There is not only a statistically significant difference in incidence (range 4.94-38.1%) of RF between the definitions (p definition several common but also several different risk variables. Multivariate analysis identified also different independent predictors, with different odds ratios for RF for each definition. This study shows that the used definition of RF influences not only the incidence of RF, but also patient identification and the identification of risk variables. Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  2. Postoperative Displacement of Deep Brain Stimulation Electrodes Related to Lead-Anchoring Technique

    NARCIS (Netherlands)

    Contarino, M. Fiorella; Bot, Maarten; Speelman, Johannes D.; de Bie, Rob M. A.; Tijssen, Marina A.; Denys, Damiaan; Bour, Lo J.; Schuurman, P. Richard; van den Munckhof, Pepijn

    2013-01-01

    BACKGROUND: Displacement of deep brain stimulation (DBS) electrodes may occur after surgery, especially due to large subdural air collections, but other factors might contribute. OBJECTIVE: To investigate factors potentially contributing to postoperative electrode displacement, in particular,

  3. Factors influencing consumer behaviour in market vegetables in Yemen

    Directory of Open Access Journals (Sweden)

    Tarish H. Al-Gahaifi

    2011-01-01

    Full Text Available The purpose of the research is to understand factors influencing consumer behaviour when buying vegetables in Republic of Yemen. Data collection was done by structured questionnaire administered through schools, universities, government offices, and markets from 13 provinces in 5 governorates. Random convenience sampling technique was used. Total sample comprised of 463 completed questionnaires which were used for analysis. The respondents were classified into five categories on the base of their monthly income, age, education, gender, and type of settlement. Authors present the factors that can influence significantly this behaviour, e.g. price, quality, the location of seller, habit, personal relationship between consumer and seller, occasions, discount, sorting, word-mouth, time of purchase, the way of products display, and recommendation of friends and families. From the obtained results, it is obvious that there was high influence on the behaviour of Yemeni consumer when buying vegetables for factors price, occasions, discontent, and time of purchase, while factors habit, display, sorting, and the location of seller suggests medium influence, and the influence was low for word-mouth.

  4. Preoperative alcoholism and postoperative morbidity

    DEFF Research Database (Denmark)

    Tonnesen, H; Kehlet, H

    1999-01-01

    BACKGROUND: Preoperative risk assessment has become part of daily clinical practice, but preoperative alcohol abuse has not received much attention. METHODS: A Medline search was carried out to identify original papers published from 1967 to 1998. Relevant articles on postoperative morbidity...... in alcohol abusers were used to evaluate the evidence. RESULTS: Prospective and retrospective studies demonstrate a twofold to threefold increase in postoperative morbidity in alcohol abusers, the most frequent complications being infections, bleeding and cardiopulmonary insufficiency. Wound complications...... to postoperative morbidity. CONCLUSION: Alcohol consumption should be included in the preoperative assessment of likely postoperative outcome. Reduction of postoperative morbidity in alcohol abusers may include preoperative alcohol abstinence to improve organ function, or perioperative alcohol administration...

  5. What factors influence British medical students' career intentions?

    Science.gov (United States)

    Ibrahim, Michael; Fanshawe, Angela; Patel, Vanash; Goswami, Karan; Chilvers, Geoffrey; Ting, Michelle; Pilavakis, Yiannis; Rao, Christopher; Athanasiou, Thanos

    2014-12-01

    The aim of this study was to identify factors that influence career choice in UK medical students. Students at seven institutions were invited to rate how important various factors were on influencing their career choices and how interested they were in pursuing different specialties. The influence of interpersonal relationship networks on career choice was also evaluated. 641 responses were collected. 44% (283) were male, 16% (105) were graduates and 41% (263) were final-year students. For Dermatology (p = 0.009), Paediatrics (p = 0.000), Radiology (p = 0.000), Emergency Medicine (p = 0.018) and Cardiothoracic Surgery (p = 0.000), there was a clear correlation between completing a clinical attachment and an interest in pursuing the specialty. Perceived characteristics of the speciality, individually and in clusters were considered important by specific subgroups of students, such as those interested in surgery. These students considered prestige (p = 0.0003), role models (p = 0.014), financial rewards after training (p = 0.0196) and technical challenge (p = 0.0011) as important factors. Demographics such as sex and age played a significant role in career choice. Interpersonal relationship networks do not have a significant influence on career intentions. This study shows that the career intentions of British medical students are influenced by their undergraduate experience and by the weight they place on different specialty-related factors.

  6. Postoperative Ileus in the Elderly

    Directory of Open Access Journals (Sweden)

    Chih-Peng Tu

    2014-03-01

    Full Text Available Postoperative ileus is among the most common complications after surgery. Aging is associated with an increased colonic transit time, and anesthetic disturbance to colonic motility is often aggravated in the elderly. Postoperative ileus increases morbidity, prolongs the length of hospital stay, and constitutes a significant economic burden on the healthcare system. Multimodal enhanced recovery protocols, or fast-track surgeries, have been developed to improve postoperative recovery. Patient education, avoidance of perioperative fluid overload, selective use of nasogastric decompression, early ambulation, adopting a minimally invasive approach, early initiation of clear fluids, and gum chewing are all possible measures to reduce postoperative ileus. Thoracic epidural anesthesia is a well-established technique to hasten recovery, whereas insufficient data are available to ascertain the safety and efficacy of opioid-sparing analgesia in the elderly. The evidence is clear that traditional prokinetic medications are not helpful in the treatment or prevention of postoperative ileus. Early results suggest that alvimopan is a promising agent to reverse opioid-induced ileus. Since postoperative ileus is a multifactorial condition, a concerted effort is therefore necessary to prevent or decrease the duration of postoperative ileus using multimodal strategies.

  7. Postoperative radiotherapy prophylaxis of periarticular ossification after total hip replacement

    International Nuclear Information System (INIS)

    Sauer, R.; Seegenschmiedt, M.H.; Andreas, P.; Goldmann, A.; Beck, H.

    1992-01-01

    Since June 1988, we have treated 77 patients or 80 hips respectively with prophylactic irradiation. Individual risk factors included severe coxarthrosis grade IV, ipsi- or contralateral heterotopic ossification and severe hip trauma. As of July 1991 60 patients with a minimum follow-up of six months could be analyzed using clinical and radiological scoring systems. The patients had been prospectively randomized in two different treatment arms: 32 patients were treated with low dose (LD), five times 2 Gy daily fractions to a total dose of 10 Gy, whereas 28 patients were treated with high dose (HD), ten times 2 Gy (eight patients) or five times 3.5 Gy (20 patients). Operative procedures and individual risk factors were equally distributed in both groups. 23 patients (38% received indometacin three times 25 mg for six weeks, 19 patients (32%) diphosphonate EHDP 20 mg/kg body weight and 18 patients (30%) had no additional medication. 56/60 (93%) patients developed no significant heterotopic ossification and/or remained without impairment of their postoperative radiological and clinical hip status according to the applied Brooker and Harris Scores. Only 4/60 (7%) patients demonstrated treatment failures developing postoperative worsening one grade of Brooker score in two patients and two and three grades of Brooker score in the two others. Only 1/49 patients experienced a treatment failure, when radiotherapy had been initiated before and at postoperative day 4 compared to 3/11 patients initiated after postoperative day 4 (p [de

  8. Multimodal approach to control postoperative pathophysiology and rehabilitation

    DEFF Research Database (Denmark)

    Kehlet, H

    1997-01-01

    Major surgery is still associated with undesirable sequelae such as pain, cardiopulmonary, infective and thromboembolic complications, cerebral dysfunction, nausea and gastrointestinal paralysis, fatigue and prolonged convalescence. The key pathogenic factor in postoperative morbidity, excluding...... failures of surgical and anaesthetic technique, is the surgical stress response with subsequent increased demands on organ function. These changes in organ function are thought to be mediated by trauma-induced endocrine metabolic changes and activation of several biological cascade systems (cytokines......, complement, arachidonic acid metabolites, nitric oxide, free oxygen radicals, etc). To understand postoperative morbidity it is therefore necessary to understand the pathophysiological role of the various components of the surgical stress response and to determine if modification of such responses may...

  9. [Postoperative unilateral acute glaucoma after abdominal surgery].

    Science.gov (United States)

    Hidalgo Grau, L A; Opisso Juliá, L L; Roqué Meseguer, A; Yuste Graupera, M; Suñol Sala, X

    2012-11-01

    An early and correct diagnosis substantially improves the post-operative prognosis of acute angle closure glaucoma (AACG). A 90 year-old woman was operated on for a right colon tumour by laparotomy, under combined anaesthesia without any adverse events. Twelve hours after the operation, the patient described recurrent periorbital pain in her right eye, with ocular hyperaemia, blurred vision, and unresponsive mydriasis. A diagnosis of AACG was made, but although conservative treatment was started YAG laser iridotomies were required to reduce the intraocular pressure. In the AACG postoperative period, as well as with an eye with several predisposed local factors including genetic predisposition, female gender, hypermetropia, increased lens thickness and small corneal diameter, can be added a pupillary block induced by adrenergic and anticholinergic drugs used in anaesthetic procedures. An acute and intensive periorbital or ocular pain, with or without visual disturbance, must aware the doctor. A differential diagnosis with other postoperative ocular diseases and cranial pain causes must be done. Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  10. The relationship of the factor V Leiden mutation or the deletion-deletion polymorphism of the angiotensin converting enzyme to postoperative thromboembolic events following total joint arthroplasty

    Directory of Open Access Journals (Sweden)

    Fang Carrie

    2001-04-01

    Full Text Available Abstract Background Although all patients undergoing total joint arthroplasty are subjected to similar risk factors that predispose to thromboembolism, only a subset of patients develop this complication. The objective of this study was to determine whether a specific genetic profile is associated with a higher risk of developing a postoperative thromboembolic complication. Specifically, we examined if the Factor V Leiden (FVL mutation or the deletion polymorphism of the angiotensin-converting enzyme (ACE gene increased a patient's risk for postoperative thromboembolic events. The FVL mutation has been associated with an increased risk of idiopathic thromboembolism and the deletion polymorphism of the ACE gene has been associated with increased vascular tone, attenuated fibrinolysis and increased platelet aggregation. Methods The presence of these genetic profiles was determined for 38 patients who had a postoperative symptomatic pulmonary embolus or proximal deep venous thrombosis and 241 control patients without thrombosis using molecular biological techniques. Results The Factor V Leiden mutation was present in none of the 38 experimental patients and in 3% or 8 of the 241 controls (p = 0.26. Similarly there was no difference detected in the distribution of polymorphisms for the ACE gene with the deletion-deletion genotype present in 36% or 13 of the 38 experimental patients and in 31% or 74 of the 241 controls (p = 0.32. Conclusions Our results suggest that neither of these potentially hypercoaguable states are associated with an increased risk of symptomatic thromboembolic events following total hip or knee arthroplasty in patients receiving pharmacological thromboprophylaxis.

  11. BANGERTER FOILS IN THE POSTOPERATIVE MANAGEMENT OF ESOTROPIA.

    Directory of Open Access Journals (Sweden)

    Galina G. Dimitrova

    2014-12-01

    Full Text Available Purpose: To evaluate the application of Bangerter foils in the postoperative management of esotropia Methods: A retrospective study of 200 patients who underwent bimedial recessions for various forms of alternating/alternated esotropia in the period of 2000-2013. In the cases of residual postoperative angle, tendency of recurrence of strabismus and preferred fixation, Bangerter foil was fixed on the corrective glass of the dominant eye- either on the next day of surgery, or on the 10-th postoperative day and was in use for at least 6 months. Results: Bangerter foils were applied in 67(35,1% under corrected patients with a mean residual angle for near 7,01±3,51Δ. Mean residual angle in patients without foils was 3,47±4,06Δ (p<0,001. Statistically significant factors in patients with filters were amblyopia treatment before surgery (p<0,001, anisometropia (p=0,003 and type of esotropia (accommodative vs. non accommodative (p<0,001. Within the group without filters there was a significant increase of the residual angle for near on the third (p<0,001 and sixth month (p=0,036, while within the group with foils angle was not significantly changed (p=0,325; p=0,058 with time. In the group with foils no cases with relapse of strabismus and amblyopia were recorded and even a decrease of the postoperative angle was clinically observed in some patients. Conclusion: To our experience Bangerter foils are a reliable tool in the postoperative management of undercorrected esotropia.

  12. Factors negatively influencing knowledge sharing in software development

    Directory of Open Access Journals (Sweden)

    Lucas T. Khoza

    2017-07-01

    Objective: This study seeks to identify factors that negatively influence knowledge sharing in software development in the developing country context. Method: Expert sampling as a subcategory of purposive sampling was employed to extract information, views and opinions from experts in the field of information and communication technology, more specifically from those who are involved in software development projects. Four Johannesburg-based software developing organisations listed on the Johannesburg Stock Exchange (JSE, South Africa, participated in this research study. Quantitative data were collected using an online questionnaire with closed-ended questions. Results: Findings of this research reveal that job security, motivation, time constraints, physiological factors, communication, resistance to change and rewards are core factors negatively influencing knowledge sharing in software developing organisations. Conclusions: Improved understanding of factors negatively influencing knowledge sharing is expected to assist software developing organisations in closing the gap for software development projects failing to meet the triple constraint of time, cost and scope.

  13. Postoperative recurrence after VATS for spontaneous pneumothorax

    International Nuclear Information System (INIS)

    Katsuno, Gotaro; Tsumura, Makoto; Kokudo, Yasutaka; Muraoka, Atsushi; Tsuruno, Masaki

    2003-01-01

    A total of 88 cases of 81 patients with spontaneous pneumothorax treated at the hospital from March 1992 to August 2001 were subjected to a study of examining preoperative chest CT and thoracographic findings from the standpoint of postoperative recurrence. Preoperative chest CT and thoracography were conducted in 82 cases and 41 cases (including 25 cases with continuous air leakage), respectively. Eight (9.1%) patients developed recurrence of pneumothorax, and three patients of them underwent reoperation. Considering the intraoperative findings, newly formed bullae appeared to be a cause of recurrence. Resulting from these examinations, we conclude that it is difficult to predict the risk factor for postoperative recurrence at this time, in addition, it is important that the area of air leakage can be confirmed by thoracoscopic findings. (author)

  14. Postoperative Compensatory Ammonium Excretion Subsequent to Systemic Acidosis in Cardiac Patients.

    Science.gov (United States)

    Roehrborn, Friederike; Dohle, Daniel-Sebastian; Waack, Indra N; Tsagakis, Konstantinos; Jakob, Heinz; Teloh, Johanna K

    2017-01-01

    Postoperative acid-base imbalances, usually acidosis, frequently occur after cardiac surgery. In most cases, the human body, not suffering from any severe preexisting illnesses regarding lung, liver, and kidney, is capable of transient compensation and final correction. The aim of this study was to correlate the appearance of postoperatively occurring acidosis with renal ammonium excretion. Between 07/2014 and 10/2014, a total of 25 consecutive patients scheduled for elective isolated coronary artery bypass grafting with cardiopulmonary bypass were enrolled in this prospective observational study. During the operative procedure and the first two postoperative days, blood gas analyses were carried out and urine samples collected. Urine samples were analyzed for the absolute amount of ammonium. Of all patients, thirteen patients developed acidosis as an initial disturbance in the postoperative period: five of respiratory and eight of metabolic origin. Four patients with respiratory acidosis but none of those with metabolic acidosis subsequently developed a base excess > +2 mEq/L. Ammonium excretion correlated with the increase in base excess. The acidosis origin seems to have a large influence on renal compensation in terms of ammonium excretion and the possibility of an overcorrection.

  15. The Influence of psychological-sociological factors on self-employment

    OpenAIRE

    Remeikienė, Rita; Startienė, Gražina; Vasauskaitė, Jovita

    2011-01-01

    The article deals with the influence of psychological-sociological factors on a self-employed person, which is little explored in business literature. Analysis of scientific literature revealed that the psychological-sociological factors of self-employment can be divided into groups based on certain personal characteristics and individual psychological states, and the influence of psychological-sociological factors of self-employment is threefold: positive, negative, and unclear (both positiv...

  16. A survey on critical factors influencing organizational commitment

    Directory of Open Access Journals (Sweden)

    Hamidreza Kheirkhah

    2014-04-01

    Full Text Available Organizational commitment is an important issue and organization attitude has become an area of study among many researchers in the fields of organizational behavior. In fact, there are many studies on human resource management where the effects of organizational commitment on other issues have been investigated and the purpose of this research is to find critical factors influencing on organizational commitment. Based on an exploration of the literature review and interviews, the proposed study of this paper extracts 24 variables and using factor analysis, we select the most important factors, which are grouped in four categories. The implementation of our factor analysis has revealed Affective commitment, Continuous commitment, Moral commitment and Enduring commitment are the most important factors influencing organizational commitment.

  17. Factors of influence upon the SF-36-based health related quality of life of patients following surgery for petroclival and lateral posterior surface of pyramid meningiomas.

    Science.gov (United States)

    Pintea, B; Kandenwein, J A; Lorenzen, H; Boström, J P; Daher, F; Velazquez, V; Kristof, R A

    2018-03-01

    To describe the patient's self assessed health related quality of life (saHRQoL) based upon the medical outcome study 36-item short form health survey (SF-36) as well as the factors of influence upon the saHRQoL following surgery for petroclival (PCM) and lateral posterior surface of the pyramid (LPPM) meningiomas. In a series of 78 patients operated consecutively for PCM (n = 46) or LPPM (n = 32) the preoperative, intraoperative and postoperative data were collected retrospectively. The saHRQoL was obtained by mailing the SF-36 questionnaire to the patients. The SF-36 data of the whole patients group was compared with a healthy population. The SF-36 data of the PCM- and LPPM were compared to each other. The influence of pre-, intra- and postoperative findings upon the SF-36 was assessed by uni- and multifactorial analysis. 58 (69%) out of the 78 patients answered the SF-36 questionnaire at a median postoperative follow-up of 59 months. The patients, who answered the SF-36 questionnaire, had a significant lower perioperative complication rate than those who did not (46% vs. 75%, p = 0.019). The saHRQoL of the LPPM and PCM was reduced on several sub-scales, when compared to the German reference population. The outcome of PCM is, assessed by saHRQoL as well as by conventional neurosurgical grading scales, inferior to that of LPPM. The saHRQoL of LPPM correlated in the uni- and multivariate analysis with the early postoperative KPI on the sub-scales SF1 (physical functioning) and SF5 (vitality). Accordingly, the sub-scale SF2 (role-physical) of PCM correlated with the change of the KPI from preoperative to the last follow up. The saHRQoL of the evaluable patients was lower than that of the normal population. The saHRQoL score of PCM-patients was lower than that of LPPM-patients. For the future the saHRQol should be assessed routinely; It reflects the patients' perspective upon postoperative outcome and enables the comparison with other treatment modalities

  18. Hierarchical and coupling model of factors influencing vessel traffic flow.

    Science.gov (United States)

    Liu, Zhao; Liu, Jingxian; Li, Huanhuan; Li, Zongzhi; Tan, Zhirong; Liu, Ryan Wen; Liu, Yi

    2017-01-01

    Understanding the characteristics of vessel traffic flow is crucial in maintaining navigation safety, efficiency, and overall waterway transportation management. Factors influencing vessel traffic flow possess diverse features such as hierarchy, uncertainty, nonlinearity, complexity, and interdependency. To reveal the impact mechanism of the factors influencing vessel traffic flow, a hierarchical model and a coupling model are proposed in this study based on the interpretative structural modeling method. The hierarchical model explains the hierarchies and relationships of the factors using a graph. The coupling model provides a quantitative method that explores interaction effects of factors using a coupling coefficient. The coupling coefficient is obtained by determining the quantitative indicators of the factors and their weights. Thereafter, the data obtained from Port of Tianjin is used to verify the proposed coupling model. The results show that the hierarchical model of the factors influencing vessel traffic flow can explain the level, structure, and interaction effect of the factors; the coupling model is efficient in analyzing factors influencing traffic volumes. The proposed method can be used for analyzing increases in vessel traffic flow in waterway transportation system.

  19. Persistent Postoperative Pain after Cardiac Surgery: Incidence, Characterization, Associated Factors and its impact in Quality of Life.

    Science.gov (United States)

    Guimarães-Pereira, Luís; Farinha, Filomena; Azevedo, Luís; Abelha, Fernando; Castro-Lopes, José

    2016-10-01

    Cardiac surgery (CS) ranks among the most frequently performed interventions worldwide and persistent postoperative pain (PPP) has been recognized as a relevant clinical outcome in this context. We aimed to evaluate its incidence, characteristics, associated factors and patient's quality of life (QoL). Observational prospective study conducted in patients undergoing CS in a tertiary university hospital. PPP was defined as persistent pain after surgery with higher than 3 months' duration, after excluding other causes of pain. We used a set of questionnaires for data collection: Pain Catastrophizing Scale, Duke Health Profile, Brief Pain Inventory Short Form, McGill Pain Questionnaire Short Form, Douleur Neuropathique en 4 Questions and standardized questions regarding pain periodicity. A total of 288 patients have completed the study and 43% presented PPP assessed at 3 months (PPP3M); out of which 84% were not under any treatment. PPP patients reported significantly lower QoL, and a neuropathic pain (NP) component was present in 50% of them. Younger age, female gender, higher body mass index, catastrophizing, coronary artery bypass graft, osteoarthritis, history of previous surgery (excluding sternotomy) and moderate to severe acute postoperative pain were independent predictors of PPP3M. This is the first study comprehensively describing PPP after CS and identifying NP in half of them. Our results support the important role that PPP plays after CS in considering its interference in patients' daily life and their lower QoL, which deserves the attention of health care professionals in order to improve prevention, assessment and treatment of these patients. WHAT DOES THIS STUDY ADD?: This study comprehensively describes persistent postoperative pain (PPP) after cardiac surgery (CS) and identifies neuropathic pain (NP) in half of them. Our results support the important role that PPP plays after CS in considering its interference in patients' daily life and their

  20. Risk factors for postoperative pancreatic fistula after laparoscopic distal pancreatectomy using stapler closure technique from one single surgeon.

    Directory of Open Access Journals (Sweden)

    Tao Xia

    Full Text Available Laparoscopic distal pancreatectomy (LDP is a safe and reliable treatment for tumors in the body and tail of the pancreas. Postoperative pancreatic fistula (POPF is a common complication of pancreatic surgery. Despite improvement in mortality, the rate of POPF still remains high and unsolved. To identify risk factors for POPF after laparoscopic distal pancreatectomy, clinicopathological variables on 120 patients who underwent LDP with stapler closure were retrospectively analyzed. Univariate and multivariate analyses were performed to identify risk factors for POPF. The rate of overall and clinically significant POPF was 30.8% and13.3%, respectively. Higher BMI (≥25kg/m2 (p-value = 0.025 and longer operative time (p-value = 0.021 were associated with overall POPF but not clinically significant POPF. Soft parenchymal texture was significantly associated with both overall (p-value = 0.012 and clinically significant POPF (p-value = 0.000. In multivariable analyses, parenchymal texture (OR, 2.933, P-value = 0.011 and operative time (OR, 1.008, P-value = 0.022 were risk factors for overall POPF. Parenchymal texture was an independent predictive factor for clinically significant POPF (OR, 7.400, P-value = 0.001.

  1. Postoperative radiology

    International Nuclear Information System (INIS)

    Burhenne, H.J.

    1989-01-01

    This paper reports on the importance of postoperative radiology. Most surgical procedures on the alimentary tract are successful, but postoperative complications remain a common occurrence. The radiologist must be familiar with a large variety of possible surgical complications, because it is this specialty that is most commonly called on to render a definitive diagnosis. The decision for reoperation, for instance, is usually based on results from radiologic imaging techniques. These now include ultrasonography, CT scanning, needle biopsy, and interventional techniques in addition to contrast studies and nuclear medicine investigation

  2. [Influence of postoperative pelvic floor function on different surgical procedures of hysterectomy].

    Science.gov (United States)

    Tan, A L; Hong, L; Zhao, Y Z; Jiang, L

    2017-05-25

    Objective: To compare the influence of postoperative pelvic floor function after different surgical procedures of hysterectomy. Methods: A total of 260 patients who underwent hysterectomy in Renmin hospital of Wuhan University from January 2012 to January 2014 were enrolled in the study, and divided into 5 groups by different surgical procedures, which were total abdominal hysterectomy (A-TH; 46 cases), total laparoscopic hysterectomy (L-TH; 59 cases), total vaginal hysterectomy (V-TH; 42 cases), abdominal intrafascial hysterectomy (A-CISH; 78 cases), laparoscopic intrafascial hysterectomy (L-CISH; 35 cases). Pelvic examination, pelvic organ prolapse quantitation (POP-Q), test of pelvic muscle strength, pelvic floor distress inventory-short form 20 (PFDI-20) and the female sexual function index (FSFI) questionnaire were measured after 6 months and 12 months. Results: The differences of pelvic organ prolapse incidence after 6 months, A-TH and A-CISH [7% (3/46) versus 3% (2/78)], A-TH and L-CISH [7% (3/46) versus 3% (1/35)] were statistically significance (all P CISH was statistically different in degree ( P CISH [59% (27/46) versus 29% (23/78)], A-TH and L-CISH [59% (27/46) versus 26% (9/35)] were statistically significant (all P CISH [61% (36/59) versus 29%(23/78)] was statistically different ( P CISH [53% (31/59) verus 24% (19/78)], V-TH and A-CISH [60% (25/42) verus 24% (19/78)], V-TH and L-CISH [60% (25/42) verus 23% (8/35)] were statistically significant (all P CISH [57% (24/42) versus 26%(20/78)] was statistically significant ( P 0.05), PFDI-20 total score was not statistically significant ( P >0.05). FSFI total score after 6 months and 12 months in A-TH and A-CISH, L-TH and A-CISH, A-CISH and L-CISH were statistically significant (all P <0.05). Conclusion: The influences of different surgical procedures to pelvic floor function are no statistical difference; as to the surgical resection of hysterectomy, intrafascia hysterectomy compared with extrafascia

  3. POSTOPERATIVE NAUSEA AND VOMITING | Yusufu | Annals of ...

    African Journals Online (AJOL)

    Antiemetics, acupuncture and other drugs are used to prevent and treat postoperative nausea and vomiting. Those that manage patients in the postoperative period should endeavour to make postoperative nausea and vomiting as unacceptable as postoperative pain. Key words: Postoperative, Nausea, Vomiting, Narcotics, ...

  4. Training of medical staff positively influences postoperative pain management at home in children.

    Science.gov (United States)

    Sepponen, K; Kokki, H; Ahonen, R

    1999-08-01

    The aim of this study was to describe how parents manage their child's postoperative pain at home following day-case surgery. The incidence of pain, different analgesics used and problems related to administering medications were the main interests of the study. A postal questionnaire was sent to the parents of 275 children who were under 8 years of age and had undergone an ear, nose and throat (ENT) day-case operation. The questionnaire was sent to the parents a week after discharge from hospital. Altogether, the parents of 227 children answered the questionnaire (response rate 83%). The study was divided into two phases (preintervention and postintervention), and incorporated a training program for doctors and nurses between these two phases. The training program aimed to improve the treatment practices of postoperative pain in children. Seventy-eight per cent of the children in the preintervention study and 75% in the postintervention study experienced at least mild pain after discharge. The training program for doctors and nurses affected the home treatment practices of postoperative pain. The proportion of parents treating their children increased from 68% to 80% after the training program (p = 0.028). Many parents faced problems while treating their children; for example, 19% (n = 30) of the children refused to take their medicine, and suppositories were regarded to be an especially unpleasant dosage form. However, no serious adverse effects were reported. We conclude that due to the pain experienced at home by the great majority of children following day-case ENT operations, parents need information on how to manage their child's pain. A training program for doctors and nurses can improve the treatment of children's pain even at home. Since some children dislike suppositories, it would be worth considering the use of small tablets or mixtures instead.

  5. [Factors influencing nurses' organizational citizenship behavior].

    Science.gov (United States)

    Park, Junhee; Yun, Eunkyung; Han, Sangsook

    2009-08-01

    This study was conducted to identify the factors that influence nurses' organizational citizenship behavior. A cross-sectional design was used, with a convenience sample of 547 nurses from four university hospitals in Seoul and Gyeonggi province. The data were collected through a questionnaire survey done from September 22 to October 10, 2008. The tools used for this study were scales on organizational citizenship behavior (14 items), self-leadership (14 items), empowerment (10 items), organizational commitment (7 items), job satisfaction (8 items) and transformational.transactional leadership (14 items). Cronbach's alpha and factor analysis were examined to test reliability and construct validity of the scale. The data collected were processed using SPSS Window 15.0 Program for actual numbers and percentages, differences in the dependent variable according to general characteristics, and means, standard deviations, correlation coefficients and multiple regression analysis. The factors influencing nurses' organizational citizenship behavior were identified as self-leadership(beta=.247), empowerment (beta=.233), job satisfaction (beta=.209), organizational commitment (beta=.158), and transactional leadership (beta=.142). Five factors explained 42.0% of nurses' organizational citizenship behavior. The results of this study can be used to develop further management strategies for enhancement of nurses' organizational citizenship behavior.

  6. Treatment outcome of thymic epithelial tumor: prognostic factors and optimal postoperative radiation therapy

    International Nuclear Information System (INIS)

    Oh, Dong Ryul; Ahn, Yong Chan; Kim, Kwan Min; Kim, Jhin Gook; Shim, Young Mog; Han, Jung Ho

    2005-01-01

    This study was conducted to analyze treatment outcome and prognostic significance of World Health Organization (WHO)-defined thymic epithelial tumor (TET) subtype and to assess optimal radiation target volume in patients receiving surgery and adjuvant radiation therapy with TET. The record of 160 patients with TET, who received surgical resection at the Samsung medical Center, from December 1994 to June 2004, were reviewed. 99 patients were treated with postoperative radiation therapy (PORT). PORT was recommended when patients had more than one findings among suspicious incomplete resection or positive resection margin or Masaoka stage II ∼ IV or WHO tumor type B2 ∼ C. PORT performed to primary tumor bed only with a mean dose of 54 Gy. The prognostic factor and pattern of failure were analyzed retrospectively. The overall survival rate at 5 years was 87.3%. Age (more than 60 years 77.8%, less than 60 years 91.1%; ρ = 0.03), Masaoka stage (I 92.2%, II 95.4%, III 82.1%, IV 67.5%; ρ = 0.001), WHO tumor type (A-B1 96.0%, B2-C 82.3%; ρ = 0.001), Extent of resection (R0 resection 92.3%, R1 or 2 resection 72.6%; ρ = 0.001) were the prognostic factors according to univariate analysis. But WHO tumor type was the only significant prognostic factor according to multivariate analysis. Recurrence was observed in 5 patients of 71 Masoka stage I-III patients who received grossly complete tumor removal (R0, R1 resection ) and PORT to primary tumor bed. Mediastinal recurrence was observed in only one patients. There were no recurrence within irradiation field. WHO tumor type was the important prognostic factor to predict survival of patients with TET. This study suggest that PORT to only primary tumor bed was optimal. To avoid pleura-or pericardium-based recurrence, further study of effective chemotherapy should be investigated

  7. Factors Influencing Title VII Bilingual Program Institutionalization.

    Science.gov (United States)

    Lewis, Gerald R.; And Others

    1985-01-01

    This study of the primary restraining and driving forces that influence Title VII bilingual education programs found the external environment, the local community, to be the main factor influencing institutionalization and self-renewal. The internal environment--the local school, and the local school's organization or central office, school board,…

  8. The impact of obesity on early postoperative outcomes in adults with congenital heart disease.

    Science.gov (United States)

    Zaidi, Ali N; Bauer, John A; Michalsky, Marc P; Olshove, Vincent; Boettner, Bethany; Phillips, Alistair; Cook, Stephen C

    2011-01-01

    As the prevalence of obesity continues to increase, it now includes the growing number of patients with congenital heart disease (CHD). This particular obese patient population may pose additional intraoperative as well as postoperative challenges that may contribute to poor outcomes. Our aims were to determine the influence of obesity on morbidity and mortality in adults with CHD undergoing surgical repair at a free standing children's hospital. A retrospective analysis of adult (≥18 years) CHD surgery cases from 2002 to 2008 was performed. Congenital heart lesions were defined as mild, moderate, or complex. Patients were categorized by body mass index (BMI): underweight (BMI obese (BMI ≥ 30 kg/m(2)). Demographics, incidence of mortality, or specific morbidities were statistically compared using Fisher's exact test and analyses of variance (anovas). In this population (n = 165), overweight (29%) and obese (22%) patients were prevalent. Hypertension (HTN) and pre-HTN were more prevalent in obese and overweight patients. Postoperative renal dysfunction was observed in obese patients with complex CHD (P = .04). Mortality was not different among groups. Obesity is becoming increasingly common among adults with CHD. Despite marginal evidence of postoperative renal complications in obese patients with CHD of severe complexity, the overall presence of obesity did not influence mortality or short term postoperative morbidities. © 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.

  9. Risk Evaluation of Postoperative Delirium Using Comprehensive Geriatric Assessment in Elderly Patients with Esophageal Cancer.

    Science.gov (United States)

    Yamamoto, Masaaki; Yamasaki, Makoto; Sugimoto, Ken; Maekawa, Yoshihiro; Miyazaki, Yasuhiro; Makino, Tomoki; Takahashi, Tsuyoshi; Kurokawa, Yukinori; Nakajima, Kiyokazu; Takiguchi, Shuji; Rakugi, Hiromi; Mori, Masaki; Doki, Yuichiro

    2016-11-01

    The number of geriatric patients with esophageal cancer is increasing in step with the aging of the population. Geriatric patients have a higher risk of postoperative complications, including delirium that can cause a fall or impact survival. Therefore, it is very important that we evaluate risks of postoperative complications before surgery. The aim of this study was to predict postoperative delirium in elderly patients. We retrospectively reviewed the medical records of 91 patients aged 75 years and over who underwent esophagectomy between January 2006 and December 2014. We investigated the association between postoperative delirium and clinicopathological factors, including comprehensive geriatric assessment (CGA). Postoperative delirium developed in 24 (26 %) patients. Postoperative delirium was significantly associated with low mini-mental state examination (MMSE) and high Geriatric Depression Scale 15 (GDS15), which are components of CGA, and psychiatric disorder (P patients undergoing esophagectomy for esophageal cancer. Intervention by a multidisciplinary team using CGA might help prevent postoperative delirium.

  10. A factor analysis to detect factors influencing building national brand

    Directory of Open Access Journals (Sweden)

    Naser Azad

    Full Text Available Developing a national brand is one of the most important issues for development of a brand. In this study, we present factor analysis to detect the most important factors in building a national brand. The proposed study uses factor analysis to extract the most influencing factors and the sample size has been chosen from two major auto makers in Iran called Iran Khodro and Saipa. The questionnaire was designed in Likert scale and distributed among 235 experts. Cronbach alpha is calculated as 84%, which is well above the minimum desirable limit of 0.70. The implementation of factor analysis provides six factors including “cultural image of customers”, “exciting characteristics”, “competitive pricing strategies”, “perception image” and “previous perceptions”.

  11. Predictors of postoperative outcomes of cubital tunnel syndrome treatments using multiple logistic regression analysis.

    Science.gov (United States)

    Suzuki, Taku; Iwamoto, Takuji; Shizu, Kanae; Suzuki, Katsuji; Yamada, Harumoto; Sato, Kazuki

    2017-05-01

    This retrospective study was designed to investigate prognostic factors for postoperative outcomes for cubital tunnel syndrome (CubTS) using multiple logistic regression analysis with a large number of patients. Eighty-three patients with CubTS who underwent surgeries were enrolled. The following potential prognostic factors for disease severity were selected according to previous reports: sex, age, type of surgery, disease duration, body mass index, cervical lesion, presence of diabetes mellitus, Workers' Compensation status, preoperative severity, and preoperative electrodiagnostic testing. Postoperative severity of disease was assessed 2 years after surgery by Messina's criteria which is an outcome measure specifically for CubTS. Bivariate analysis was performed to select candidate prognostic factors for multiple linear regression analyses. Multiple logistic regression analysis was conducted to identify the association between postoperative severity and selected prognostic factors. Both bivariate and multiple linear regression analysis revealed only preoperative severity as an independent risk factor for poor prognosis, while other factors did not show any significant association. Although conflicting results exist regarding prognosis of CubTS, this study supports evidence from previous studies and concludes early surgical intervention portends the most favorable prognosis. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  12. Postoperative dental morbidity in children following dental treatment under general anesthesia.

    Science.gov (United States)

    Hu, Yu-Hsuan; Tsai, Aileen; Ou-Yang, Li-Wei; Chuang, Li-Chuan; Chang, Pei-Ching

    2018-05-10

    General anesthesia has been widely used in pediatric dentistry in recent years. However, there remain concerns about potential postoperative dental morbidity. The goal of this study was to identify the frequency of postoperative dental morbidity and factors associated with such morbidity in children. From March 2012 to February 2013, physically and mentally healthy children receiving dental treatment under general anesthesia at the Department of Pediatric Dentistry of the Chang Gung Memorial Hospital in Taiwan were recruited. This was a prospective and observational study with different time evaluations based on structured questionnaires and interviews. Information on the patient demographics, anesthesia and dental treatment performed, and postoperative dental morbidity was collected and analyzed. Correlations between the study variables and postoperative morbidity were analyzed based on the Pearson's chi-square test. Correlations between the study variables and the scale of postoperative dental pain were analyzed using the Mann-Whitney U test. Fifty-six pediatric patients participated in this study, with an average age of 3.34 ± 1.66 years (ranging from 1 to 8 years). Eighty-two percent of study participants reported postoperative dental pain, and 23% experienced postoperative dental bleeding. Both dental pain and bleeding subsided 3 days after the surgery. Dental pain was significantly associated with the total number of teeth treated, while dental bleeding, with the presence of teeth extracted. Patients' gender, age, preoperative dental pain, ASA classification, anesthesia time, and duration of the operation were not associated with postoperative dental morbidity. Dental pain was a more common postoperative dental morbidity than bleeding. The periods when parents reported more pain in their children were the day of the operation (immediately after the procedure) followed by 1 day and 3 days after the treatment.

  13. Risk Prediction Model for Severe Postoperative Complication in Bariatric Surgery.

    Science.gov (United States)

    Stenberg, Erik; Cao, Yang; Szabo, Eva; Näslund, Erik; Näslund, Ingmar; Ottosson, Johan

    2018-01-12

    Factors associated with risk for adverse outcome are important considerations in the preoperative assessment of patients for bariatric surgery. As yet, prediction models based on preoperative risk factors have not been able to predict adverse outcome sufficiently. This study aimed to identify preoperative risk factors and to construct a risk prediction model based on these. Patients who underwent a bariatric surgical procedure in Sweden between 2010 and 2014 were identified from the Scandinavian Obesity Surgery Registry (SOReg). Associations between preoperative potential risk factors and severe postoperative complications were analysed using a logistic regression model. A multivariate model for risk prediction was created and validated in the SOReg for patients who underwent bariatric surgery in Sweden, 2015. Revision surgery (standardized OR 1.19, 95% confidence interval (CI) 1.14-0.24, p prediction model. Despite high specificity, the sensitivity of the model was low. Revision surgery, high age, low BMI, large waist circumference, and dyspepsia/GERD were associated with an increased risk for severe postoperative complication. The prediction model based on these factors, however, had a sensitivity that was too low to predict risk in the individual patient case.

  14. Factors Influencing Prevention and Control of Malaria among ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    investigate factors that influence malaria prevention and control practices among pregnant ... treatment of clinical cases and the promotion of ... influence their decision regarding malaria ..... have the ability to purchase anti-malaria drugs that.

  15. Decreased plasma ADAMTS-13 activity as a predictor of postoperative bleeding in cyanotic congenital heart disease

    Directory of Open Access Journals (Sweden)

    Rosangela P.S. Soares

    2013-04-01

    Full Text Available OBJECTIVE: To analyze the preoperative plasma antigenic concentration and activity of von Willebrand factor and its main cleaving protease ADAMTS-13 in pediatric patients with cyanotic congenital heart disease undergoing surgical treatment and investigate possible correlations with postoperative bleeding. METHODS: Plasma antigenic concentrations (von Willebrand factor:Ag and ADAMTS-13:Ag were measured using enzyme-linked immunoassays. Collagen-binding assays were developed to measure biological activities (von Willebrand factor:collagen binding and ADAMTS-13 activity. The multimeric structure of von Willebrand factor was analyzed using Western immunoblotting. Demographic, diagnostic, and general and specific laboratory data and surgery-related variables were subjected to univariate, bivariate, and multivariate analysis for the prediction of postoperative bleeding. RESULTS: Forty-eight patients were enrolled, with ages ranging from 9 months to 7.6 years (median 2.5 years. The plasma concentrations of von Willebrand factor:Ag and ADAMTS-13:Ag were decreased by 65 and 82%, respectively, in the patients compared with the controls (p<0.001. An increased density of low-molecular-weight fractions of von Willebrand factor, which are suggestive of proteolytic degradation (p = 0.0081, was associated with decreased ADAMTS-13 activity, which was likely due to ADAMTS-13 consumption (71% of controls, p = 0.0029 and decreased von Willebrand factor:collagen binding (76% of controls, p = 0.0004. Significant postoperative bleeding occurred in 13 patients. The preoperative ADAMTS-13 activity of <64.6% (mean level for the group, preoperative activated partial thromboplastin time, and the need for cardiopulmonary bypass were characterized as independent risk factors for postoperative bleeding, with respective hazard ratios of 22.35 (95% CI 1.69 to 294.79, 1.096 (95% CI 1.016 to 1.183, and 37.43 (95% CI 1.79 to 782.73. CONCLUSION: Low plasma ADAMTS-13

  16. Association of postoperative nausea/vomiting and pain with breastfeeding success

    Directory of Open Access Journals (Sweden)

    Ramon Abola

    2017-11-01

    Full Text Available Abstract Background Successful breastfeeding is a goal set forth by the World Health Organization to improve neonatal care. Increasingly, patients express the desire to breastfeed, and clinicians should facilitate successful breastfeeding. The primary aim of this study is to determine if postoperative nausea and vomiting (PONV or postoperative pain are associated with decreased breastfeeding success after cesarean delivery. Methods This is a historical cohort study using the Stony Brook Elective Cesarean Delivery Database. Self-reported breastfeeding success at 4 weeks postoperative was analyzed for associations with postoperative antiemetic use and postoperative pain scores. Breastfeeding success was also analyzed for associations with patient factors and anesthetic medications. Results Overall, 86% of patients (n = 81 who intended on breastfeeding reported breastfeeding success. Breastfeeding success was not associated with postoperative nausea or vomiting as measured by post anesthesia care unit antiemetic use (15% use in successful vs. 18% use in unsuccessful, p = 0.67 or 48-h antiemetic use (28% use in successful group vs 36% use in unsuccessful group, p = 0.732. Pain visual analog scale scores at 6, 12 and 24 h postoperatively were not significantly different between patients with or without breastfeeding success. Breastfeeding success was associated with having had at least 1 previous child (86% vs 36%, p < 0.001. Patients with asthma were less likely to have breastfeeding success (45% vs 4%, p = 0.002. Conclusions Efforts to improve PONV and pain after cesarean delivery may not be effective in improving breastfeeding success. To possibly improve breastfeeding rates, resources should be directed toward patients with no previous children and patients with asthma.

  17. Postoperative Clinical Outcome and Risk Factors for Poor Outcome of Foraminal and Extraforaminal Lumbar Disc Herniation.

    Science.gov (United States)

    Bae, Jung Sik; Kang, Kyung Hee; Park, Jeong Hyun; Lim, Jae Hyeon; Jang, Il Tae

    2016-03-01

    We evaluated postoperative outcomes in patients who have lumbar foraminal or extraforaminal disc herniation (FELDH) and suggested the risk factors for poor outcomes. A total of 234 patients were selected for this study. Pre- and post-operative Visual Analogue Scale (VAS) and Korean version Oswestry Disability Index (KODI) were evaluated and the changes of both score were calculated. Outcome was defined as excellent, good, fair, and poor based on Mcnab classification. The percentage of superior facetectomy was calculated by using the Maro-view 5.4 Picture Archiving Communication System (PACS). Paramedian lumbar discectomy was performed in 180 patients and combined lumbar discectomy was performed in 54 patients. Paramedian lumbar discectomy group showed better outcome compared with combined discectomy group. p value of VAS change was 0.009 and KODI was 0.013. The average percentage of superior facetectomy was 33% (range, 0-79%) and it showed negative correlation with VAS and KODI changes (Pearson coefficient : -0.446 and -0.498, respectively). Excellent or good outcome cases (Group I) were 136 (58.1%) and fair or poor outcome cases (Group II) were 98 (41.9%). The percentage of superior facetectomy was 26.5% at Group I and 42.5% at Group II. There was significant difference in superior facetectomy percentage between Group I and II (p=0.000). This study demonstrated that paramedian lumbar discectomy with preservation of facet joints is an effective and good procedure for FELDH. At least 60% of facet should be preserved for excellent or good outcomes.

  18. Management of postoperative urinary retention: a randomized trial of in-out versus overnight catheterization.

    Science.gov (United States)

    Lau, Hung; Lam, Becky

    2004-08-01

    There has been no consensus on the best catheterization strategy for the management of postoperative urinary retention. A prospective randomized trial was undertaken to establish the best practice guidelines for the management of postoperative urinary retention. The authors also evaluated the contemporary incidence of urinary retention following different categories of general surgery and examined risk factors associated with its occurrence. All patients who underwent elective inpatient surgery between January 2002 and June 2003 were recruited into the study. Patients who developed postoperative urinary retention were randomized to either having in-out catheterization or placement of an indwelling catheter for 24 h after surgery. A total of 1448 patients was recruited. The overall incidence of urinary retention was 4.1% (n = 60). Significant risk factors associated with postoperative urinary retention included old age, anorectal procedures and use of spinal anaesthesia. Comparison of re-catheterization and urinary tract infection rates between patients who were treated with in-out versus overnight catheterization found no significant differences. Postoperative urinary retention should be managed by in-out catheterization. Indwelling catheterization for 24 h appeared to bestow no additional benefits. The incidence of urinary retention increases with age, anorectal procedures and the use of spinal anaesthesia.

  19. Long-term Postoperative Nutritional Status Affects Prognosis Even After Infectious Complications in Gastric Cancer.

    Science.gov (United States)

    Kiuchi, Jun; Komatsu, Shuhei; Kosuga, Toshiyuki; Kubota, Takeshi; Okamoto, Kazuma; Konishi, Hirotaka; Shiozaki, Atsushi; Fujiwara, Hitoshi; Ichikawa, Daisuke; Otsuji, Eigo

    2018-05-01

    This study was designed to investigate the clinical impact of postoperative serum albumin level on severe postoperative complications (SPCs) and prognosis. Data for a total of 728 consecutive patients who underwent curative gastrectomy for gastric cancer between 2004 and 2013 were retrospectively analyzed. From these patients, a propensity score-matched analysis was performed based on 14 clinicopathological and surgical factors. Short-term decrease in postoperative serum albumin level was not associated with the occurrence of SPCs. Regarding long-term decrease in serum albumin level, a decrease of ≥0.5 g/dl at 3 months did not affect the long-term survival of patients without SPCs, but was related to a significantly poorer prognosis in patients with SPCs. By multivariate analysis, long-term decrease of serum albumin level was an independent prognostic factor in patients with SPCs. Long-term postoperative nutritional status as shown by a low level of albumin was related to prognosis in patients with SPCs. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  20. Factors influencing detail detectability in radiologic imaging

    International Nuclear Information System (INIS)

    Gurvich, A.M.

    1985-01-01

    The detectability of various details is estimated quantitatively from the essential technical parameters of the imaging system and additional influencing factors including viewing of the image. The analysis implies the formation of the input radiation distribution (contrast formation, influence of kVp). Noise, image contrast (gamma), modulation transfer function and contrast threshold of the observer are of different influence on details of different size. Thus further optimization of imaging systems and their adaption to specific imaging tasks are facilitated

  1. Factors influencing choice of paediatrics as a career among medical ...

    African Journals Online (AJOL)

    None of the male students but 12 of the female students (30%) considered gender distribution to be a factor influencing their career choice (p=0.046). Conclusion. This study indicates that paediatrics is popular among female students and that several factors influence choice of this specialty. Understanding these factors may ...

  2. Hierarchical and coupling model of factors influencing vessel traffic flow.

    Directory of Open Access Journals (Sweden)

    Zhao Liu

    Full Text Available Understanding the characteristics of vessel traffic flow is crucial in maintaining navigation safety, efficiency, and overall waterway transportation management. Factors influencing vessel traffic flow possess diverse features such as hierarchy, uncertainty, nonlinearity, complexity, and interdependency. To reveal the impact mechanism of the factors influencing vessel traffic flow, a hierarchical model and a coupling model are proposed in this study based on the interpretative structural modeling method. The hierarchical model explains the hierarchies and relationships of the factors using a graph. The coupling model provides a quantitative method that explores interaction effects of factors using a coupling coefficient. The coupling coefficient is obtained by determining the quantitative indicators of the factors and their weights. Thereafter, the data obtained from Port of Tianjin is used to verify the proposed coupling model. The results show that the hierarchical model of the factors influencing vessel traffic flow can explain the level, structure, and interaction effect of the factors; the coupling model is efficient in analyzing factors influencing traffic volumes. The proposed method can be used for analyzing increases in vessel traffic flow in waterway transportation system.

  3. Factors influencing cassava - pulp fermentation period for gari ...

    African Journals Online (AJOL)

    Factors influencing cassava - pulp fermentation period for gari processing among ... Result of probit model analysis at 5% significance level shows an R value ... Marital status (2.236**) and respondents' cultural influences (1.960**) were ...

  4. Quantitative influence of risk factors on blood glucose level.

    Science.gov (United States)

    Chen, Songjing; Luo, Senlin; Pan, Limin; Zhang, Tiemei; Han, Longfei; Zhao, Haixiu

    2014-01-01

    The aim of this study is to quantitatively analyze the influence of risk factors on the blood glucose level, and to provide theory basis for understanding the characteristics of blood glucose change and confirming the intervention index for type 2 diabetes. The quantitative method is proposed to analyze the influence of risk factors on blood glucose using back propagation (BP) neural network. Ten risk factors are screened first. Then the cohort is divided into nine groups by gender and age. According to the minimum error principle, nine BP models are trained respectively. The quantitative values of the influence of different risk factors on the blood glucose change can be obtained by sensitivity calculation. The experiment results indicate that weight is the leading cause of blood glucose change (0.2449). The second factors are cholesterol, age and triglyceride. The total ratio of these four factors reaches to 77% of the nine screened risk factors. And the sensitivity sequences can provide judgment method for individual intervention. This method can be applied to risk factors quantitative analysis of other diseases and potentially used for clinical practitioners to identify high risk populations for type 2 diabetes as well as other disease.

  5. Factors Influencing Healthcare Service Quality

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Mosadeghrad

    2014-07-01

    Full Text Available Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

  6. Variance of indoor radon concentration: Major influencing factors

    Energy Technology Data Exchange (ETDEWEB)

    Yarmoshenko, I., E-mail: ivy@ecko.uran.ru [Institute of Industrial Ecology UB RAS, Sophy Kovalevskoy, 20, Ekaterinburg (Russian Federation); Vasilyev, A.; Malinovsky, G. [Institute of Industrial Ecology UB RAS, Sophy Kovalevskoy, 20, Ekaterinburg (Russian Federation); Bossew, P. [German Federal Office for Radiation Protection (BfS), Berlin (Germany); Žunić, Z.S. [Institute of Nuclear Sciences “Vinca”, University of Belgrade (Serbia); Onischenko, A.; Zhukovsky, M. [Institute of Industrial Ecology UB RAS, Sophy Kovalevskoy, 20, Ekaterinburg (Russian Federation)

    2016-01-15

    Variance of radon concentration in dwelling atmosphere is analysed with regard to geogenic and anthropogenic influencing factors. Analysis includes review of 81 national and regional indoor radon surveys with varying sampling pattern, sample size and duration of measurements and detailed consideration of two regional surveys (Sverdlovsk oblast, Russia and Niška Banja, Serbia). The analysis of the geometric standard deviation revealed that main factors influencing the dispersion of indoor radon concentration over the territory are as follows: area of territory, sample size, characteristics of measurements technique, the radon geogenic potential, building construction characteristics and living habits. As shown for Sverdlovsk oblast and Niška Banja town the dispersion as quantified by GSD is reduced by restricting to certain levels of control factors. Application of the developed approach to characterization of the world population radon exposure is discussed. - Highlights: • Influence of lithosphere and anthroposphere on variance of indoor radon is found. • Level-by-level analysis reduces GSD by a factor of 1.9. • Worldwide GSD is underestimated.

  7. FACTORS INFLUENCING YIELD SPREADS OF THE MALAYSIAN BONDS

    Directory of Open Access Journals (Sweden)

    Norliza Ahmad

    2009-01-01

    Full Text Available Malaysian bond market is developing rapidly but not much is understood in terms of macroeconomic factors that could influence the yield spread of the Ringgit Malaysian denominated bonds. Based on a multifactor model, this paper examines the impact of four macroeconomic factors namely: Kuala Lumpur Composite Index (KLCI, Industry Production Index (IPI, Consumer Price Index (CPI and interest rates (IR on bond yield spread of the Malaysian Government Securities (MGS and Corporate Bonds (CBs for a period from January 2001 to December 2008. The findings support the expected hypotheses that CPI and IR are the major drivers that influence the changes in MGS yield spreads. However IPI and KLCI have weak and no influence on MGS yield spreads respectively Whilst IR, CPI and IPI have significant influence on the yield spreads of CB1, CB2 and CB3, KLCI has significant influence only on the CB1 yield spread but not on CB2 and CB3 yield spreads.

  8. Postoperative mental confusion--association with postoperative hypoxemia

    DEFF Research Database (Denmark)

    Rosenberg, J; Kehlet, H

    1993-01-01

    under general anesthesia, were monitored for oxygen saturation (SpO2) with a pulse oximeter on a preoperative night and on the second night after operation (11:00 PM to 7:00 AM). All patients were tested with a mental test questionnaire (the Hodkinson modification of the original Roth-Hopkins test...... major surgery had decreased mental function on the third day (p operation, whereas minor surgery did not impair mental function. There was a significant correlation between mental function on the third day after operation and mean SpO2 on the second postoperative.......04). During stepwise multiple regression analysis in patients undergoing major surgery, a significant relationship was found between postoperative mental test score and SpO2 (p mental function and other perioperative variables (age, premedication dose, duration of operation...

  9. [Postoperative Chylotholax;Intraoperative Prevention and Postoperative Management].

    Science.gov (United States)

    Saito, Tomohito; Kariya, Shuji; Murakawa, Tomohiro

    2017-07-01

    Postoperative chylothorax is a relatively rare but potentially fatal complication caused by iatrogenic injury to thoracic duct system, with an incidence ranging from 2 to 4% after major lung surgery or esophagectomy. The pathophysiologic features of chylothorax include dehydration, loss of nutrients and immunological components. Intraopreative prevention is the first step for the management, and treatment options include conservative therapy, percutaneous intervention, and redo-operation. Although the treatment algorithm has not been standardized, chylothorax which is refractory to conservative treatment, or that with high output greater than 1,000 ml/day should be treated aggressively with thoracic duct embolization or redo-operation in a timely fashion. We herein review the anatomy and physiology of thoracic duct system and describe the overview of prevention and each theapeutic options of postoperative chylothorax.

  10. Postoperative Strontium-90 Brachytherapy in the Prevention of Keloids: Results and Prognostic Factors

    International Nuclear Information System (INIS)

    Viani, Gustavo A.; Stefano, Eduardo J.; Afonso, Sergio L.; De Fendi, Ligia I.

    2009-01-01

    Purpose: The aim of this study was to evaluate the results of keloidectomy and strontium 90 brachytherapy in the prevention of keloid recurrence following excision and to identify outcome and the prognostic factors that predict keloid recurrence after irradiation. Methods and Materials: Data of 612 patients with 892 keloids treated between 1992 and 2006 were evaluated retrospectively. Brachytherapy was performed using a Sr-90Y surface applicator. Total dose was 20 Gy in 10 fractions. Results: With a median follow-up of 61 months, the overall recurrence-free response rate for all keloids was 87.6%. Multivariate analysis revealed the following prognostic factors for recurrence: keloid size > 5 cm (p < 0.0001), burn scars as the keloid etiology (p < 0.0001), and previous treatment (p < 0.0001). Outcome was not found to be significantly related to the interval between surgery and radiotherapy, sex, or age. Pruritus and skin reddening were the most common symptoms of keloids, but all signs and symptoms abated with time after treatment. Cosmetic results from the keloid treatment were considered good or excellent in 70.6% of the patients. Conclusion: Our study findings show that excision plus Sr-90 brachytherapy is effective in the eradication of keloids. Sr-90 radiotherapy (20 Gy in 10 fractions) achieved a similar local control rate, as have higher doses per fraction in other series. It also resulted in a good cosmetic rate and relief of symptoms. Our data further suggest that the initiation of postoperative irradiation within hours of surgical excision is not important to therapeutic outcome.

  11. Factors influencing US medical students' decision to pursue surgery.

    Science.gov (United States)

    Schmidt, Lauren E; Cooper, Clairice A; Guo, Weidun Alan

    2016-06-01

    Interest and applications to surgery have steadily decreased over recent years in the United States. The goal of this review is to collect the current literature regarding US medical students' experience in surgery and factors influencing their intention to pursue surgery as a career. We hypothesize that multiple factors influence US medical students' career choice in surgery. Six electronic databases (PubMed, SCOPUS, Web of Science, Education Resources Information Center, Embase, and PsycINFO) were searched. The inclusion criteria were studies published after the new century related to factors influencing surgical career choice among US medical students. Factors influencing US medical student surgical career decision-making were recorded. A quality index score was given to each article selected to minimize risk of bias. We identified 38 relevant articles of more than 1000 nonduplicated titles. The factors influencing medical student decision for a surgical career were categorized into five domains: mentorship and role model (n = 12), experience (clerkship n = 9, stereotype n = 4), timing of exposure (n = 9), personal (lifestyle n = 8, gender n = 6, finance n = 3), and others (n = 2). This comprehensive systemic review identifies mentorship, experience in surgery, stereotypes, timing of exposure, and personal factors to be major determinants in medical students' decisions to pursue surgery. These represent areas that can be improved to attract applicants to general surgery residencies. Surgical faculty and residents can have a positive influence on medical students' decisions to pursue surgery as a career. Early introduction to the field of surgery, as well as recruitment strategies during the preclinical and clinical years of medical school can increase students' interest in a surgical career. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Postoperative radiotherapy in salivary ductal carcinoma: a single institution experience

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hyung; Kim, Mi Sun; Choi, Seo Hee; Suh, Yang Gun; Koh, Yoon Woo; Kim, Se Hun; Choi, Eun Chang; Keum, Ki Chang [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2014-09-15

    We reviewed treatment outcomes and prognostic factors for patients with salivary ductal carcinoma (SDC) treated with surgery and postoperative radiotherapy from 2005 to 2012. A total of 16 patients were identified and 15 eligible patients were included in analysis. Median age was 61 years (range, 40 to 71 years) and 12 patients (80%) were men. Twelve patients (80%) had a tumor in the parotid gland, 9 (60%) had T3 or T4 disease, and 9 (60%) had positive nodal disease. All patients underwent surgery and postoperative radiotherapy. Postoperative radiotherapy was delivered using 3-dimensional conformal radiotherapy or intensity-modulated radiotherapy. Locoregional failure-free survival (LRFFS), distant failure-free survival (DFFS), progression-free survival (PFS), and overall survival (OS) were calculated using the Kaplan-Meier method. Differences in survival based on risk factors were tested using a log-rank test. Median total radiotherapy dose was 60 Gy (range, 52.5 to 63.6 Gy). Four patients received concurrent weekly chemotherapy with cisplatin. Among 10 patients who underwent surgery with neck dissection, 7 received modified radical neck dissection. With a median follow-up time of 38 months (range, 24 to 105 months), 4-year rates were 86% for LRFFS, 51% for DFFS, 46% for PFS, and 93% for OS. Local failure was observed in 2 patients (13%), and distant failure was observed in 7 (47%). The lung was the most common involved site of distant metastasis. Surgery and postoperative radiotherapy in SDC patients resulted in good local control, but high distant metastasis remained a major challenge.

  13. EARLY POSTOPERATIVE COMPLICATIONS AFTER RADICAL CYSTECTOMY

    Directory of Open Access Journals (Sweden)

    V. O. Mager

    2014-08-01

    Full Text Available Radical cystectomy (RCE is associated with a considerable number of early postoperative complications as before. Based on 10 years’ experience, this paper demonstrates the frequency (33.9 % and types of early complications following RCE, as well as postoperative mortality (5.5 % and its resulting causes. Although postoperative mortality is relatively low today, the frequency of early postoperative complications remains high as before.

  14. Determinants of postoperative acute kidney injury.

    Science.gov (United States)

    Abelha, Fernando José; Botelho, Miguela; Fernandes, Vera; Barros, Henrique

    2009-01-01

    Development of acute kidney injury (AKI) during the perioperative period is associated with increases in morbidity and mortality. Our aim was to evaluate the incidence and determinants of postoperative AKI after major noncardiac surgery in patients with previously normal renal function. This retrospective cohort study was carried out in the multidisciplinary Post-Anaesthesia Care Unit (PACU) with five intensive care beds. The study population consisted of 1166 patients with no previous renal insufficiency who were admitted to these intensive care unit (ICU) beds over 2 years. After admission patients were followed for the development of AKI, defined as proposed by The Acute Kidney Injury Network (increment of serum creatinine [greater than or equal to] 0.3 mg/dL or 50% from baseline within 48 hours or urine output 6 hours despite fluid resuscitation when applicable). Patient preoperative characteristics, intraoperative management and outcome were evaluated for associations with acute kidney injury using an univariate and multiple logistic regression model. A total of 1597 patients were admitted to the PACU and of these, 1166 met the inclusion criteria. Eighty-seven patients (7.5%) met AKI criteria. Univariate analysis identified age, American Society of Anesthesiologists (ASA) physical status, emergency surgery, high risk surgery, ischemic heart disease, congestive heart disease and Revised Cardiac Risk Index (RCRI) score as independent preoperative determinants for AKI in the postoperative period. Multivariate analysis identified ASA physical status, RCRI score, high risk surgery and congestive heart disease as preoperative determinants for AKI in the postoperative period. Patients that developed AKI had higher Simplified Acute Physiology Score (SAPS) II and Acute Physiology and Chronic Health Evaluation (APACHE) II, higher PACU length of stay (LOS), higher PACU mortality, higher hospital mortality and higher mortality at 6 months follow-up. AKI was an independent

  15. A survey on critical factors influencing agricultural insurance

    Directory of Open Access Journals (Sweden)

    Ali Valipour

    2013-01-01

    Full Text Available Agricultural business is a very high-risk job and an increase demand for agricultural products from one side and steady increase in production cost and weather changes, on the other side, have motivated many to use insurance for agricultural products. Insurance plays an important role in influencing crop production and insured satisfaction or farmers. The purpose of this research is to find critical components in agricultural insurance. Based on an exploration of the literature review and interviews, the proposed study of this paper extracts 24 variables and using factor analysis, we select the most important factors, which are grouped in seven categories. The implementation of our factor analysis has revealed uncertainty, moderator, market equilibrium, risky environment, empowering factor, education, training, structural hazards and natural ecosystems as the most important factors influencing agricultural industry.

  16. Which factors influence women in the decision to breastfeed?

    Directory of Open Access Journals (Sweden)

    Cândida Canicali Primo

    Full Text Available Objective.Identify the factors that influence women in the decision to breastfeed. Methods. Integrative review. Information was gathered from original articles, case studies, theoretical studies, consensus and systematic reviews published between 2007-2013 in Spanish, Portuguese and English and recovered in the databases MEDLINE and LILACS. The descriptors used in this study were: breastfeeding, maternal behavior, risk factors, lactation and newborn. Results. Were included 30 articles, grouped into five categories. Factors influencing the decision of the breastfeeding woman are a convergence of breastfeeding's advantages, benefits and justifications, family, social and professional support, sociodemographic and clinical characteristics of women, personal experience and family tradition and personal choice. Conclusion. The decision to breastfeed by women is influenced by a convergence of factors. It is essential the role of nursing to encourage women in the decision to initiate and maintain breastfeeding her child.

  17. College factors that influence drinking.

    Science.gov (United States)

    Presley, Cheryl A; Meilman, Philip W; Leichliter, Jami S

    2002-03-01

    The purpose of this article is to examine the aspects of collegiate environments, rather than student characteristics, that influence drinking. Unfortunately, the existing literature is scant on this topic. A literature review of articles primarily published within the last 10 years, along with some earlier "landmark" studies of collegiate drinking in the United States, was conducted to determine institutional factors that influence the consumption of alcohol. In addition, a demonstration analysis of Core Alcohol and Drug Survey research findings was conducted to further elucidate the issues. Several factors have been shown to relate to drinking: (1) organizational property variables of campuses, including affiliations (historically black institutions, women's institutions), presence of a Greek system, athletics and 2- or 4-year designation; (2) physical and behavioral property variables of campuses, including type of residence, institution size, location and quantity of heavy episodic drinking; and (3) campus community property variables, including pricing and availability and outlet density. Studies, however, tend to look at individual variables one at a time rather than in combination (multivariate analyses). Some new analyses, using Core Alcohol and Drug Survey data sets, are presented as examples of promising approaches to future research. Given the complexities of campus environments, it continues to be a challenge to the field to firmly establish the most compelling institutional and environmental factors relating to high-risk collegiate drinking.

  18. Overview of factors influencing the secondary market

    International Nuclear Information System (INIS)

    Bleistine, P.A.

    1982-01-01

    The major factor influencing secondary trading for the last few years has been the large contractural commitments built up by consumers for reactor programs which have proven to be unrealistic. The situation has intensified as a result of utilities needing to generate capital through inventory liquidation or reductions. The flexibilities in most contracts are inadequate to match the types of external and/or internal factors faced by the industry. This situation also suggests the need for secondary markets to help the industry adjust to unforeseen difficulties. They are very active markets at this time, but their influence in relation to the long-term method of doing business should not be exaggerated

  19. Factors influencing job satisfaction of oncology nurses over time.

    Science.gov (United States)

    Cummings, Greta; Olson, Karin; Raymond-Seniuk, Christy; Lo, Eliza; Masaoud, Elmabrok; Bakker, Debra; Fitch, Margaret; Green, Esther; Butler, Lorna; Conlon, Michael

    2013-01-01

    In this study, we tested a structural equation model to examine work environment factors related to changes in job satisfaction of oncology nurses between 2004 and 2006. Relational leadership and good physician/nurse relationships consistently influenced perceptions of enough RNs to provide quality care, and freedom to make patient care decisions, which, in turn, directly influenced nurses' job satisfaction over time. Supervisor support in resolving conflict and the ability to influence patient care outcomes were significant influences on job satisfaction in 2004, whereas, in 2006, a clear philosophy of nursing had a greater significant influence. Several factors that influence job satisfaction of oncology nurses in Canada have changed over time, which may reflect changes in work environments and work life. These findings suggest opportunities to modify work conditions that could improve nurses' job satisfaction and work life.

  20. [Characteristics of postoperative peritonitis].

    Science.gov (United States)

    Lock, J F; Eckmann, C; Germer, C-T

    2016-01-01

    Postoperative peritonitis is still a life-threatening complication after abdominal surgery and approximately 10,000 patients annually develop postoperative peritonitis in Germany. Early recognition and diagnosis before the onset of sepsis has remained a clinical challenge as no single specific screening test is available. The aim of therapy is a rapid and effective control of the source of infection and antimicrobial therapy. After diagnosis of diffuse postoperative peritonitis surgical revision is usually inevitable after intestinal interventions. Peritonitis after liver, biliary or pancreatic surgery is managed as a rule by means of differentiated therapy approaches depending on the severity.

  1. The efficacy of preoperative versus postoperative rofecoxib for preventing acute postoperative dental pain: a prospective randomized crossover study using bilateral symmetrical oral surgery

    NARCIS (Netherlands)

    Ong, K. S.; Seymour, R. A.; Yeo, J. F.; Ho, K. H.; Lirk, P.

    2005-01-01

    Previous data have demonstrated that rofecoxib has good analgesic efficacy for acute postoperative dental pain. However, up to half of these patients require rescue analgesics within the first 24 hours. As the timing of analgesic interventions may be an important factor in pain control, the present

  2. Factors influencing warfarin control in Australia and Singapore.

    Science.gov (United States)

    Bernaitis, Nijole; Ching, Chi Keong; Teo, Siew Chong; Chen, Liping; Badrick, Tony; Davey, Andrew K; Crilly, Julia; Anoopkumar-Dukie, Shailendra

    2017-09-01

    Warfarin is widely used for patients with non-valvular atrial fibrillation (NVAF). Variations in warfarin control, as measured by time in therapeutic range (TTR), have been reported across different regions and ethnicities, particularly between Western and Asian countries. However, there is limited data on comparative factors influencing warfarin control in Caucasian and Asian patients. Therefore, the aim of this study was to determine warfarin control and potential factors influencing this in patients with NVAF in Australia and Singapore. Retrospective data was collected for patients receiving warfarin for January to June 2014 in Australia and Singapore. TTR was calculated for individuals with mean patient TTR used for analysis. Possible influential factors on TTR were analysed including age, gender, concurrent co-morbidities, and concurrent medication. The mean TTR was significantly higher in Australia (82%) than Singapore (58%). At both sites, chronic kidney disease significantly lowered this TTR. Further factors influencing control were anaemia and ageWarfarin control was significantly higher in Australia compared to Singapore, however chronic kidney disease reduced control at both sites. The different levels of control in these two countries, together with patient factors further reducing control may impact on anticoagulant choice in these countries with better outcomes from warfarin in Australia compared to Singapore. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. The Influence of Preoperative Bladder Outlet Obstruction on Continence and Satisfaction in Patients with Stress Urinary Incontinence after Midurethral Sling

    Directory of Open Access Journals (Sweden)

    Su Jin Kim

    2010-12-01

    Full Text Available Purpose We studied the influence of preoperative bladder outlet obstruction (BOO on postoperative continence rates and patient satisfaction after the midurethral sling procedure. Methods A total of 159 women who underwent the midurethral sling procedure were evaluated. Using the Blaivas-Groutz nomogram, we assigned the patients were assigned to Group I (n=37, no obstruction, Group II (n=89, mild obstruction, or Group III (n=33, moderate to severe obstruction. Continence rates, patient satisfaction, urinary sensation scale and uroflowmetry were evaluated postoperatively. Results There were no significant differences in continence rates, satisfaction, or postoperative maximal flow rate between the 3 groups. Postoperative urgency was improved after surgery in Groups I and II (P<0.05 but not in Group III. Conclusions BOO does not seem to be a risk factor for failure after the midurethral sling procedure. However, BOO may be considered as a potential factor for persistent storage symptoms after the midurethral sling.

  4. [Preventive efficacy of ondansetron and granisetron for postoperative nausea and vomiting in high risk patients].

    Science.gov (United States)

    Quan, Xiang; Zhu, Bo; Ye, Tie-hu

    2011-08-01

    To compare the efficacy of ondansetron and granisetron in the prevention of postoperative nausea and vomiting (PONV) in high-risk patients. Totally 200 patients with three key risk factors for PONV (female, non-smoking and postoperative opioid use) were equally randomized into ondansetron group and granisetron group. Ondansetron (4 mg) or granisetron (3 mg) was intravenously administered upon the completion of surgery. The episodes of nausea and vomiting were observed for 24 hours after surgery. A significantly greater proportion of patients in granisetron group achieved a complete response (i.e., no PONV or rescue medication) during the first 24 hours postoperatively versus those in ondansetron group (62.6% vs. 46.9%, respectively; P=0.048). There were no significant differences in terms of postoperative nausea incidences (42.9% vs. 34.3%, respectively), postoperative vomiting incidences (25.5% vs. 20.2%, respectively) and postoperative rescue anti-emetics incidences (19.4% vs. 15.2%, respectively) (P>0.05). Granisetron is more effective than ondansetron in preventing PONV in high-risk patients during the first 24 hours postoperatively.

  5. Clinical study on postoperative steroid hormon replacement for preclinical Cushing's syndrome

    International Nuclear Information System (INIS)

    Furuta, Nozomu; Koide, Haruhisa; Sasaki, Hiroshi; Miki, Jun; Kimura, Takahiro; Egawa, Shin

    2009-01-01

    Diagnostic criteria for preclinical Cushing's syndrome (PCS) were reported in 1996. However, requirement of postoperative steroid hormone replacement is still controversial issue. In this study, we observed recent surgical cases retrospectively and evaluate the use of postoperative steroid hormone replacement. Eighteen patients with PCS underwent surgery from 1997 to 2007 in Jikei University Hospital. Thirteen of them received postoperative steroid hormone replacement. We investigated preoperative hormone activity by 131 I-adosterol scintigraphy and suppression of adrenocorticotropic hormone (ACTH) and evaluated the requirement of postoperative steroid hormone replacement. Preoperative serum cortisol was normal range in all patients. Serum ACTH was suppressed in 10 of them (56%). In 131 I-adosterol scintigraphy, accumulation in ipsilateral side was observed in all patients. Accumulation in contralateral side was observed in 13 patients whose serum ACTH had tendency to be suppressed. Mean period of steroid hormone replacement was 19.8 weeks. Patients with lower preoperative ACTH tended to require longer period until withdrawal of steroid hormone replacement. In addition, patients received steroid hormone replacement with higher starting dose significantly required longer period. Three of them had complications during tapering of steroid hormone. Postoperative adrenal insufficiency is important issue as postoperative management of PCS patients whose function of contralateral adrenal or pituitary gland is suppressed. 131 I-adosterol scintigraphy and preoperative serum ACTH were important factors to evaluate the requirement of postoperative steroid hormone replacement. Especially, patients with low preoperative serum ACTH tended to require long duration of postoperative steroid hormone replacement. On the other hand, patients with accumulation of contralateral side in 131 I-adosterol scintigraphy and without suppression of serum ACTH may not require steroid hormone

  6. A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture

    OpenAIRE

    Stenvall, M.; Olofsson, B.; Lundstr?m, M.; Englund, U.; Borss?n, B.; Svensson, O.; Nyberg, L.; Gustafson, Y.

    2006-01-01

    Introduction This study evaluates whether a postoperative multidisciplinary, intervention program, including systematic assessment and treatment of fall risk factors, active prevention, detection, and treatment of postoperative complications, could reduce inpatient falls and fall-related injuries after a femoral neck fracture. Methods A randomized, controlled trial at the orthopedic and geriatric departments at Ume? University Hospital, Sweden, included 199 patients with femoral neck fracture...

  7. Risk factors for postoperative intraretinal cystoid changes after peeling of idiopathic epiretinal membranes among patients randomized for balanced salt solution and air-tamponade.

    Science.gov (United States)

    Leisser, Christoph; Hirnschall, Nino; Hackl, Christoph; Döller, Birgit; Varsits, Ralph; Ullrich, Marlies; Kefer, Katharina; Karl, Rigal; Findl, Oliver

    2018-02-20

    Epiretinal membranes (ERM) are macular disorders leading to loss of vision and metamorphopsia. Vitrectomy with membrane peeling displays the gold standard of care. Aim of this study was to assess risk factors for postoperative intraretinal cystoid changes in a study population randomized for balanced salt solution and air-tamponade at the end of surgery. A prospective randomized study, including 69 eyes with idiopathic ERM. Standard 23-gauge three-port pars plana vitrectomy with membrane peeling, using intraoperative optical coherence tomography (OCT), was performed. Randomization for BSS and air-tamponade was performed prior to surgery. Best-corrected visual acuity improved from 32.9 letters to 45.1 letters 3 months after surgery. Presence of preoperative intraretinal cystoid changes was found to be the only risk factor for presence of postoperative intraretinal cystoid changes 3 months after surgery (p = 0.01; odds ratio: 8.0). Other possible risk factors such as combined phacoemulsification with 23G-ppv and membrane peeling (p = 0.16; odds ratio: 2.4), intraoperative subfoveal hyporeflective zones (p = 0.23; odds ratio: 2.6), age over 70 years (p = 0.29; odds ratio: 0.5) and air-tamponade (p = 0.59; odds ratio: 1.5) were not found to be significant. There is strong evidence that preoperative intraretinal cystoid changes lead to smaller benefit from surgery. © 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  8. Microsatellite Status of Primary Colorectal Cancer Predicts the Incidence of Postoperative Colorectal Neoplasms.

    Science.gov (United States)

    Takiyama, Aki; Tanaka, Toshiaki; Yamamoto, Yoko; Hata, Keisuke; Ishihara, Soichiro; Nozawa, Hiroaki; Kawai, Kazushige; Kiyomatsu, Tomomichi; Nishikawa, Takeshi; Otani, Kensuke; Sasaki, Kazuhito; Watanabe, Toshiaki

    2017-10-01

    Few studies have evaluated the risk of postoperative colorectal neoplasms stratified by the nature of primary colorectal cancer (CRC). In this study, we revealed it on the basis of the microsatellite (MS) status of primary CRC. We retrospectively reviewed 338 patients with CRC and calculated the risk of neoplasms during postoperative surveillance colonoscopy in association with the MS status of primary CRC. A propensity score method was applied. We identified a higher incidence of metachronous rectal neoplasms after the resection of MS stable CRC than MS instable CRC (adjusted HR 5.74, p=0.04). We also observed a higher incidence of colorectal tubular adenoma in patients with MSS CRC (adjusted hazard ratio 7.09, pcolorectal cancer influenced the risk of postoperative colorectal neoplasms. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  9. Clinical factors influencing participation in society after successful kidney transplantation

    NARCIS (Netherlands)

    van der Mei, S.F.; Groothoff, J.W.; van Sonderen, E.L.P.; van den Heuvel, W.J.A.; de Jong, P.E.; van Son, W.J.

    2006-01-01

    Background. Little information is available on the degree of actual social functioning after successful kidney transplantation. Moreover, information on factors that influence participation in social activities is scarce. The aim of this study was to examine the influence of clinical factors on

  10. Factors influencing home care nurse intention to remain employed.

    Science.gov (United States)

    Tourangeau, Ann; Patterson, Erin; Rowe, Alissa; Saari, Margaret; Thomson, Heather; MacDonald, Geraldine; Cranley, Lisa; Squires, Mae

    2014-11-01

    To identify factors affecting Canadian home care nurse intention to remain employed (ITR). In developed nations, healthcare continues to shift into community settings. Although considerable research exists on examining nurse ITR in hospitals, similar research related to nurses employed in home care is limited. In the face of a global nursing shortage, it is important to understand the factors influencing nurse ITR across healthcare sectors. A qualitative exploratory descriptive design was used. Focus groups were conducted with home care nurses. Data were analysed using qualitative content analysis. Six categories of influencing factors were identified by home care nurses as affecting ITR: job characteristics; work structures; relationships/communication; work environment; nurse responses to work; and employment conditions. Findings suggest the following factors influence home care nurse ITR: having autonomy; flexible scheduling; reasonable and varied workloads; supportive work relationships; and receiving adequate pay and benefits. Home care nurses did not identify job satisfaction as a single concept influencing ITR. Home care nursing management should support nurse autonomy, allow flexible scheduling, promote reasonable workloads and create opportunities for team building that strengthen supportive relationships among home care nurses and other health team members. © 2013 John Wiley & Sons Ltd.

  11. Postoperative diagnosis of the temporomandibular joint; Postoperative Kiefergelenkdiagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Robinson, S. [Universitaetsklinik fuer Radiodiagnostik, Vienna (Austria). Abt. fuer Osteologie; Undt, G. [Universitaetsklinik fuer Mund-, Kiefer- und Gesichtschirurgie, Vienna (Austria)

    2001-09-01

    Postoperative management of patients suffering from symptoms of the temporomandibular joint does not differ considerably from the one of preoperative examination protocols. Knowledge of previous surgery helps to plan patient work-up and to interpret normal postoperative findings (eminectomy, discectomy, susceptibility artefacts from metallic residues..) and typical complications (intraarticular loose bodies, dislocations, avascular necrosis, foreign body granulomatous reactions) appropriately. (orig.) [German] Wie auch in anderen Koerperregionen differiert das Diagnoseprotokoll von prae- und postoperativen Patienten mit Beschwerden des Kiefergelenks nicht wesentlich voneinander. Die Kenntnis des vorangegangenen Eingriffs hilft allerdings, die Untersuchung entsprechend zu planen und den Befund im Kontext richtig zu bewerten, um moegliche Komplikationen (intraartikulaere Fragmente, Dislokationen, avaskulaere Nekrose, Fremdkoerperreaktionen) und zu erwartende Befunde (Eminektomie, Diskektomie, Metallartefakte usw.) richtig zu interpretieren. (orig.)

  12. Environmental factors influencing fluctuation of share prices on ...

    African Journals Online (AJOL)

    Environmental factors influencing fluctuation of share prices on Nigeria stock exchange market. ... What are these environmental variables that affect the fluctuation of share prices in Nigeria? ... The results show inflation, money supply, total deficits index of industrial production, interest rate and GDP influence stock prices.

  13. An investigation on factors influencing on human resources productivity

    Directory of Open Access Journals (Sweden)

    Masoumeh Seifi Divkolaii

    2014-05-01

    Full Text Available Human resources development is one of the most important components of any organization and detecting important factors influencing on human resources management plays essential role on the success of the firms. In this paper, we present an empirical investigation to determine different factors influencing productivity of human resources of Islamic Republic of Iran Broadcasting (IRIB in province of Mazandaran, Iran. The study uses analytical hierarchy process (AHP to rank 17 important factors and determines that personal characteristics were the most important factors followed by management related factors and environmental factors. In terms of personal characteristics, job satisfaction plays essential role on human resources development. In terms of managerial factors, paying attention on continuous job improvement by receiving appropriate training is the most important factor followed by welfare facilities for employees and using a system of reward/punishment in organization. Finally, in terms of environmental factors, occupational safety is number one priority followed by organizational rules and regulations.

  14. THE INFLUENCE OF CORPORATE SPECIFIC FACTORS UPON FINANCING DECISIONS

    Directory of Open Access Journals (Sweden)

    Lacatus Viorel-Dorin

    2013-07-01

    Full Text Available The purpose of this paper is to analyze the existing theories for the capital structure of a corporation and to determine the factors that influence the financing decisions of Romanian corporations. The gearing ratios vary a lot among Romanian corporations pointing out the fact that the internal specific factors are the ones with a greater impact upon their capital structure, and not the external factors. Our empiric research evaluates the determining factors for the debt ratio (total debt/total assets of some Romanian corporations, focusing on its explanatory variables by including them within simple and multiple econometric models. The panel data indicators computed for the companies in the Cluj area listed on the Bucharest Stock Exchange were evaluated with the OLS and FEM techniques.The results have been interpreted, pointing out that company size and asset turnover seem to have a positive influence upon the debt ratio of selected companies, while profitability and liquidity seem to influence the debt ratio of selected companies negatively.

  15. Maturity of hospital information systems: Most important influencing factors.

    Science.gov (United States)

    Vidal Carvalho, João; Rocha, Álvaro; Abreu, António

    2017-07-01

    Maturity models facilitate organizational management, including information systems management, with hospital organizations no exception. This article puts forth a study carried out with a group of experts in the field of hospital information systems management with a view to identifying the main influencing factors to be included in an encompassing maturity model for hospital information systems management. This study is based on the results of a literature review, which identified maturity models in the health field and relevant influencing factors. The development of this model is justified to the extent that the available maturity models for the hospital information systems management field reveal multiple limitations, including lack of detail, absence of tools to determine their maturity and lack of characterization for stages of maturity structured by different influencing factors.

  16. A retrospective study on analgesic requirements for thoracoscopic surgery postoperative pain

    Directory of Open Access Journals (Sweden)

    Kuroda H

    2017-11-01

    Full Text Available Hiroaki Kuroda,1 Hitomi Mizuno,2 Hitoshi Dejima,1 Kiyoe Watanabe,2 Tatsuya Yoshida,3 Yumiko Naito,2 Yukinori Sakao1 1Department of Thoracic Surgery, 2Department of Nursing, 3Department of Thoracic Oncology, Aichi Cancer Center Hospital, Nagoya, Japan Background: Thoracoscopic surgery (TS has been performed as a minimally invasive procedure since the beginning of the 1990s. This has led to a dramatic change in the postoperative condition of these patients, facilitating early ambulation and easier management of postoperative pain. However, empirical evidence on postoperative pain management after TS is limited. The aims of this study were to determine the efficacy and adequacy of postoperative analgesic medications and to simplify the choice of additional drugs based on a numerical rating scale (NRS.Materials and methods: A retrospective study of patients who underwent TS was performed to evaluate postoperative pain, analgesia requirements, and the number of drugs needed during the perioperative period based on the NRS score.Results: Of the 524 patients, mild pain was noted in 87% patients on the day of the operation and in 75.6% patients on ambulation. The mean NRS score was 1.83±1.49 on the day of the operation and 2.73±1.75 on ambulation. An NRS score of 3 on both the day of operation and on ambulation was defined as the necessary condition for improved pain management. Multivariate analysis showed that high surgical stress significantly influenced pain scores. Reduction in pain with an NRS score of ≥1 was significant with the addition of pentazocine hydrochloride (p<0.01 and flurbiprofen (p<0.01. Interestingly, the addition of tramadol was borderline efficacious (p=0.05 in patients with an NRS score of >3 on ambulation.Conclusion: A small number of patients have moderate-to-severe pain after TS. Tramadol demonstrated borderline efficacy in controlling postoperative intense pain with an NRS score of ≥3. Keywords: tramadol, thoracoscopic

  17. FACTORS INFLUENCING THE PURCHASE DECISION OF ORGANIC TOFU

    Directory of Open Access Journals (Sweden)

    Tantry Nugroho

    2015-09-01

    Full Text Available This study aimed to analyze the factors that influence consumers in making the decision to buy organic tofu. The theory of factors that influence the purchasing behavior developed by Kotler was used as the analytical tool, and these factors include cultural factors, social factors, personal factors, psychological factors and purchasing process. These data were collected through interview techniques and analyzed descriptively using multinomial logistic regression. The characteristics of respondents indicated the consumers who never bought organic tofu are mostly at the age of 26-35 years old and university graduates, do not work, have an expenditure from Rp 1 million to Rp 2.5 million, are highly knowledge, and have the highest scores on the perceptions on sustainable and environmentally friendly organic farming, health benefits, and a more expensive price. There are a number of factors that influence consumers in making purchase decisions of organic tofu including age, education, knowledge and product external factors. The consumers who are potentially interested in purchasing the organic tofu are at the age of 36–50 years old, university graduates, highly knowledgeable in food and organic tofu products, because the higher the education and knowledge, the greater the interest in buying the products, and they approved of the external products such as price, advertising, personal selling and places of selling which are also potentially equal. The managerial implications for the business agents of tofu organic product is that they must be more active in assuring the consumers that these products are good for them by creating a blog, an ad in the local paper, or a pamphlet containing information of the product.Keywords: purchase decision, logistic regression, organic tofu product, purchasing interest

  18. Soft-laser use in the preoperative preparation and postoperative treatment of the patients with chronic lung abscesses

    Science.gov (United States)

    Ledin, A. O.; Dobkin, V. G.; Sadov, A. Y.; Galichev, K. V.; Rzeutsky, V. S.

    1999-07-01

    We counted expedient to include different methods of the soft-laser use in the preoperative medicinal program and in the postoperative period. During the preoperative preparation the basic group patients together with standard treatment received the combined soft-laser therapy, which included intravenous laser blood irradiation (ILBI) by He-Ve laser and external transcutaneous irradiation of the abscess projection by semi-conductorial arrenite-gallium laser. During postoperative treatment with ILBI remarkable changes were observed in the functional activity of the T- and B- cell. The soft-laser use allowed to achieve improvement of quality and shortening of terms of the preoperative preparation of 1,4 times, to level the immunosuppressive influence of surgery to reduce amount of the postoperative complications in 1,8 times and duration of the postoperative period in 1,5 times.

  19. Postoperative Urinary Retention and Urinary Tract Infections Predict Midurethral Sling Mesh Complications.

    Science.gov (United States)

    Punjani, Nahid; Winick-Ng, Jennifer; Welk, Blayne

    2017-01-01

    To determine if postoperative urinary retention and urinary tract infections (UTIs) were predictors of future mesh complications requiring surgical intervention after midurethral sling (MUS). Administrative data in Ontario, Canada, between 2002 and 2013 were used to identify all women who underwent a mesh-based MUS. The primary outcome was revision of the transvaginal mesh sling (including mesh removal/erosion/fistula, or urethrolysis). Two potential risk factors were analyzed: postoperative retention (within 30 days of procedure) and number of postoperative emergency room visits or hospital admissions for UTI symptoms. A total of 59,556 women had a MUS, of which 1598 (2.7%) required revision surgery. Of the 2025 women who presented to the emergency room or were admitted to hospital for postoperative retention, 212 (10.5%) required operative mesh revision. Of the 11,747 patients who had at least one postoperative UTI, 366 (3.1%) patients required operative mesh revision. In adjusted analysis, postoperative retention was significantly predictive of future reoperation (hazard ratio [HR] 3.46, 95% confidence interval [CI] 2.97-4.02), and this difference persisted when urethrolysis was excluded as a reason for sling revision (HR 3.08, 95% CI 2.62-3.63). Similarly, in adjusted analysis, each additional postoperative hospital visit for UTI symptoms increased the risk for surgical intervention for mesh complications (HR 1.74, 95% CI 1.61-1.87). Postoperative urinary retention and hospital presentation for UTI symptoms are associated with an increased risk of reoperation for MUS complications. These patients should be followed and investigated for mesh complications when appropriate. Copyright © 2016 Elsevier Inc. All rights reserved.

  20. A Review of Factors Influencing Athletes' Food Choices.

    Science.gov (United States)

    Birkenhead, Karen L; Slater, Gary

    2015-11-01

    Athletes make food choices on a daily basis that can affect both health and performance. A well planned nutrition strategy that includes the careful timing and selection of appropriate foods and fluids helps to maximize training adaptations and, thus, should be an integral part of the athlete's training programme. Factors that motivate food selection include taste, convenience, nutrition knowledge and beliefs. Food choice is also influenced by physiological, social, psychological and economic factors and varies both within and between individuals and populations. This review highlights the multidimensional nature of food choice and the depth of previous research investigating eating behaviours. Despite numerous studies with general populations, little exploration has been carried out with athletes, yet the energy demands of sport typically require individuals to make more frequent and/or appropriate food choices. While factors that are important to general populations also apply to athletes, it seems likely, given the competitive demands of sport, that performance would be an important factor influencing food choice. It is unclear if athletes place the same degree of importance on these factors or how food choice is influenced by involvement in sport. There is a clear need for further research exploring the food choice motives of athletes, preferably in conjunction with research investigating dietary intake to establish if intent translates into practice.

  1. Relationship Between Pre-operative Anxiety and Post-operative Psychosomatic Adjustment and Its Related Factors and Nursing Strategies%术前焦虑与术后心身康复的相关性及其心理社会影响因素

    Institute of Scientific and Technical Information of China (English)

    沈晓红; 姜乾金

    2003-01-01

    Objective:To study the relationship between pre-operative anxiety and post-operative psychosomatic adjustment and the related psyehosoeial factors in upper- abdominal surgery patients. Methods: Forty patients undergoing upper- abdominalsurgery were assessed in this report. One day before surgery, the Medical Coping Mode Questionnaire (MCMQ), Perceived Social Support Scale (PSSS), Eysenek Personality Questionnaire (EPQ), State Anxiety Inventory (SAI) of State - Trait Arixiety Invento-ry (STAI) and a self- developed patients'' pre - operative appraisal questionnaire were used. In an hour before operation,the shift of the mean value of the pulse of every ease compared with the base line measured at his (or her ) admission was also recorded. Af-ter surgery, State Anxiety Inventory (SAI) of State- Trait Anxiety Inventory (STAI), a self-developed postoperative appraisal scale were used, and the indexes of somatic adjustment, including intestinal aerofluxus, total dosage of analgesia and so on were recorded. Results:Firstly, pre - operative anxiety was remarkably correlated to many indexes of post - operative psychosomatic adjustment. Secondly, hopelessness about operation, concern over sequela, resignation coping style and psychosis personality were the significant predictors of pre- operative anxiety. Conclusion: Post- operative psychosomatic adjustment could be handicapped by pre - operative anxiety which might be influenced by stress - related psyehosocial factors.

  2. Is Early Enteral Nutrition Better for Postoperative Course in Esophageal Cancer Patients?

    Directory of Open Access Journals (Sweden)

    Toshifumi Wakai

    2013-09-01

    Full Text Available We retrospectively examined esophageal cancer patients who received enteral nutrition (EN to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and postoperation, duration of systematic inflammatory response syndrome (SIRS, incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Group E showed fewer days for the first fecal passage (p < 0.01, lesser dose of postoperative albumin infusion (p < 0.01, less use of TPN (p < 0.01, and shorter duration of SIRS (p < 0.01. However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation.

  3. Is Early Enteral Nutrition Better for Postoperative Course in Esophageal Cancer Patients?

    Science.gov (United States)

    Kobayashi, Kazuaki; Koyama, Yu; Kosugi, Shin-ichi; Ishikawa, Takashi; Sakamoto, Kaoru; Ichikawa, Hiroshi; Wakai, Toshifumi

    2013-01-01

    We retrospectively examined esophageal cancer patients who received enteral nutrition (EN) to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and postoperation, duration of systematic inflammatory response syndrome (SIRS), incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN) were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Group E showed fewer days for the first fecal passage (p < 0.01), lesser dose of postoperative albumin infusion (p < 0.01), less use of TPN (p < 0.01), and shorter duration of SIRS (p < 0.01). However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation. PMID:24067386

  4. Influence of Macroeconomic Factors on Residential Property ...

    African Journals Online (AJOL)

    Sultan

    exerted by macroeconomic factors on residential property returns in Abuja. The backward .... explanatory power and positive influence of employment and ...... Project. Management In Property Development: the Nigeria experience. Ibadan:.

  5. Factors Influencing Self Employment Media Service Providers ...

    African Journals Online (AJOL)

    Factors Influencing Self Employment Media Service Providers among Tertiary ... role stereotype and common business practices on media self employment in ... Sex, Psycho-social Characteristics, self Employment, Providing Media Services.

  6. Factors influencing societal response of nanotechnology : an expert stakeholder analysis

    OpenAIRE

    Gupta, N.; Fischer, A.R.H.; Lans, van der, I.A.; Frewer, L.J.

    2012-01-01

    Nanotechnology can be described as an emerging technology and, as has been the case with other emerging technologies such as genetic modification, different socio-psychological factors will potentially influence societal responses to its development and application. These factors will play an important role in how nanotechnology is developed and commercialised. This article aims to identify expert opinion on factors influencing societal response to applications of nanotechnology. Structured i...

  7. Factors influencing societal response of nanotechnology: an expert stakeholder analysis

    OpenAIRE

    Gupta, Nidhi; Fischer, Arnout R. H.; van der Lans, Ivo A.; Frewer, Lynn J.

    2012-01-01

    Nanotechnology can be described as an emerging technology and, as has been the case with other emerging technologies such as genetic modification, different socio-psychological factors will potentially influence societal responses to its development and application. These factors will play an important role in how nanotechnology is developed and commercialised. This article aims to identify expert opinion on factors influencing societal response to applications of nanotechnology. Structured i...

  8. Factors Influencing Choice of Inguinal Hernia Repair Technique

    African Journals Online (AJOL)

    This study sought to highlight factors that may influence ... Experienced peers play a major role in training on the various repair ... Reasons influencing choice of repair technique include training ... (after appendectomy) accounting for 10 to 15% of all surgical ..... in medical school [as undergraduate students or as residents].

  9. The effect and influence of lumen holmium laser lithotripsy on serum oxidative stress proteins and inflammatory factors of ureteral calculi patients

    Directory of Open Access Journals (Sweden)

    Fan Zhang

    2016-09-01

    Full Text Available Objective: To investigate the effect and influence of lumen holmium laser lithotripsy on treating serum oxidative stress proteins and inflammatory factors of patients with ureteral calculi. Methods: A total of 120 cases of patients with ureteral calculi treated in our hospital from May 2010 to Nov 2014 were enrolled in this research for an analysis study. The effect and influence on serum oxidative stress proteins and inflammatory factors of lumen holmium laser lithotripsy on ureteral calculi patients were assayed. Then 120 cases of healthy subjects in our hospital at the same period were taken as control. Results: Among the 120 cases of ureteral calculi patients, 113 cases of patients showed successful operation, with a success rate of 94.2%. The average calculi-discharged time was (28.4 ± 11.2 d and the average operation time was (58.9 ± 10.7 min, while the postoperative hospital stay is (3.8 ± 1.2 d. The results also showed that the levels of NOX1. NOX3, NOX4 and NOX5, and levels of interleukin-2 (IL-2, IL-6, IL-10 and TNF-α of patients with ureteral calculi were significantly higher, compared with the control group, and these parameters were normalized greatly after operation with that the levels of them were significantly different from those before operation. Conclusion: Lumen holmium laser lithotripsy exerts a significant effect on ureteral calculi patients and the oxidative stress parameters and inflammatory factor were normalized greatly.

  10. Factors Influencing Information and Communication Technology ...

    African Journals Online (AJOL)

    Information and communication technology (ICT) is a veritable tool for sustainable agricultural development in Nigeria. This paper analyzed the factors that influenced ICT use by women research scientists in the Universities of Agriculture in Nigeria. Simple random sampling technique was used to select 40 respondents per ...

  11. Factors Influencing Part-time Faculty Engagement With Online Nursing Programs.

    Science.gov (United States)

    Reneau, Margaret; Wallace, Cara; Claywell, Lora; Price, Jill; Burdi, Melissa; Trybulski, Joanne

    2018-03-28

    This research investigated factors that influenced the engagement of part-time faculty teaching in online nursing programs with their institutions. Of the 257 part-time faculty surveyed, the most significant factor was being supported in decisions regarding student issues, followed by institutional commitment to quality online education. Compensation was moderately influential; a negative factor was requiring too frequent meetings. Understanding factors that influence the engagement of part-time faculty teaching in online nursing programs can help leaders of online programs attract and retain experienced, highly skilled faculty.

  12. Lymphovascular space invasion and tumor differentiation are predictors for postoperative recurrence in patients with pathological stage I nonsmall cell lung cancer

    Directory of Open Access Journals (Sweden)

    Ying-Yi Chen

    2014-08-01

    Conclusion: Tumor differentiation and LVSI were predictors of postoperative relapse for patients with pathological stage I NSCLC. Risk factors of postoperative recurrence in patients with pathological Stage I NSCLC may enable us to optimize the patient selection for postoperative adjuvant therapies to prevent possibly occult micrometastases.

  13. OSAS Surgery and Postoperative Discomfort: Phase I Surgery versus Phase II Surgery

    Directory of Open Access Journals (Sweden)

    Giulio Gasparini

    2015-01-01

    Full Text Available Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery and phase II (orthognathic surgery procedures for treatment of OSAS. Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: “surgery patients” who accepted surgical treatments of their condition and “no surgery patients” who refused surgical procedures. The “surgery patients” group was further subdivided into two arms: patients who accepted phase I procedures (IP and those who accepted phase II (IIP. To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and “no surgery” group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. Results. The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation.

  14. Postoperative nausea and vomiting in pediatric anesthesia.

    Science.gov (United States)

    Höhne, Claudia

    2014-06-01

    Postoperative nausea and vomiting (PONV) has a high incidence in children and requires prophylactic and therapeutic strategies. PONV can be reduced by the avoidance of nitrous oxide, volatile anesthetics, and the reduction of postoperative opioids. The use of dexamethasone, 5-HT3 antagonists, or droperidol alone is potent, but combinations are even more effective to reduce PONV. Droperidol has a Food and Drug Administration warning. Hence, dexamethasone and 5-HT3 antagonists should be preferred as prophylactic drugs. It is further reasonable to adapt PONV prophylaxis to different risk levels. Prolonged surgery time, inpatients, types of surgery (e.g. strabismus and ear-nose-throat surgery), and patients with PONV in history should be treated as high risk, whereas short procedures and outpatients are to be treated as low risk. Concluding from the existing guidelines and data on the handling of PONV in children at least 3 years, the following recommendations are given: outpatients undergoing small procedures should receive a single prophylaxis, outpatients at high risk a double prophylaxis, inpatients with surgery time of more than 30 min and use of postoperative opioids should get double prophylaxis, and inpatients receiving a high-risk surgical procedure or with other risk factors a triple prophylaxis (two drugs and total intravenous anesthesia). Dimenhydrinate can be used as a second choice, whereas droperidol and metoclopramide can only be recommended as rescue therapy.

  15. FACTORS INFLUENCING BRAND EQUITY OF BALI AS A TOURISM DESTINATION

    Directory of Open Access Journals (Sweden)

    I Ketut Surya Diarta

    2016-03-01

    Full Text Available Globally, competition among tourism destinations is more stringent in getting foreign tourists, including Bali. One effort to win the competition is increasing destination brand equity through maintaining its influencing factors and gaining tourist positive behavior toward destination. This effort, in long run, will increase and stabilize destination revenue and sustainability. This research aims to analyze factors influencing brand equity of Bali as a tourism destination. This research was conducted in Bali’s five major tourism objects. The 240 foreign tourists were chosen as respondents through convenience sampling technique. Data were analyzed using factor analysis. The results showed that factors that significantly influenced Bali brand equity were: symbolic and experiential benefit factor, direct and indirect destinations attributes, destination reliability and tangibility, assurance and empathy, brand destinations recognition and recall, destinations common psychological attributes, destination common functional attributes, unique functional attributes, behavioral loyalty, destination awareness, and attitudinal loyalty. Given the fluctuative nature of brand equity, Bali needs a consistent effort to maintain or to enhance brand equity of Bali as a tourism destination. Maintaining the dominant factors that influence the strength of brand equity can be used as a basis to develop destination branding strategy to expand market segment,  choose the right target market, and anchoring destination position in world market competition.

  16. Factors That Influence the Practice of Elective Induction of Labor

    Science.gov (United States)

    Moore, Jennifer; Low, Lisa Kane

    2012-01-01

    Elective induction of labor has been linked to increased rates of prematurity and rising rates of cesarean birth. The purpose of this investigation was to evaluate current trends in induction of labor scholarship focusing on evidence-based factors that influence the practice of elective induction. A key word search was conducted to identify studies on the practice of elective induction of labor. Analysis of the findings included clustering and identification of recurrent themes among the articles with 3 categories being identified. Under each category, the words/phrases were further clustered until a construct could be named. A total of 49 articles met inclusion criteria: 7 patient, 6 maternity care provider, and 4 organization factors emerged. Only 4 of the articles identified were evidence based. Patient factors were divided into preferences/convenience, communication, fear, pressure/influence, trust, external influences, and technology. Provider factors were then divided into practice preferences/convenience, lack of information, financial incentives, fear, patient desire/demand, and technology. Organization factors were divided into lack of enforcement/accountability, hospital culture, scheduling of staff, and market share issues. Currently, there is limited data-based information focused on factors that influence elective induction of labor. Despite patient and provider convenience/preferences being cited in the literature, the evidence does not support this practice. PMID:22843006

  17. Postoperative MRI of the ankle

    International Nuclear Information System (INIS)

    Sharabianlou Korth, M.; Fritz, L.B.

    2017-01-01

    Postoperative imaging of the ankle can be challenging, even for the experienced radiologist. Pathological and postoperative changes to the primarily complex anatomy of the ankle with its great variety of bone structures, tendons, ligaments, and soft tissue in a very limited space may cause great difficulty in differentiating underlying pathology from expected postoperative changes and artifacts, especially in magnetic resonance imaging (MRI). Selecting the appropriate radiological modality is key to making the correct diagnosis. Therefore, knowledge of the initial and current symptoms is just as important as familiarity with the most frequently performed operations in the ankle. This article aims to give its reader a summary of the most important and frequently performed operation techniques of the ankle and discusses the expected appearance and possible complications in postoperative imaging. (orig.) [de

  18. Tumor size measured by preoperative ultrasonography and postoperative pathologic examination in papillary thyroid carcinoma: relative differences according to size, calcification and coexisting thyroiditis.

    Science.gov (United States)

    Yoon, Young Hoon; Kwon, Ki Ryun; Kwak, Seo Young; Ryu, Kyeung A; Choi, Bobae; Kim, Jin-Man; Koo, Bon Seok

    2014-05-01

    Ultrasonography (US) is a useful diagnostic modality for evaluation of the size and features of thyroid nodules. Tumor size is a key indicator of the surgical extent of thyroid cancer. We evaluated the difference in tumor sizes measured by preoperative US and postoperative pathologic examination in papillary thyroid carcinoma (PTC). We reviewed the medical records of 172 consecutive patients, who underwent thyroidectomy for PTC treatment. We compared tumor size, as measured by preoperative US, with that in postoperative specimens. And we analyzed a number of factors potentially influencing the size measurement, including cancer size, calcification and coexisting thyroiditis. The mean size of the tumor measured by preoperative US was 11.4, and 10.2 mm by postoperative pathologic examination. The mean percentage difference (US-pathology/US) of tumor sizes measured by preoperative US and postoperative pathologic examination was 9.9 ± 19.3%, which was statistically significant (p 20.0 mm) and the presence of calcification or coexisting thyroiditis on the tumor size discrepancy between the two measurements was analyzed, the mean percentage differences according to tumor size (9.1 vs. 11.2% vs. 9.8%, p = 0.842), calcification (9.2 vs. 10.2%, p = 0.756) and coexisting thyroiditis (17.6 vs. 9.5%, p = 0.223) did not show statistical significance. Tumor sizes measured in postoperative pathology were ~90% of those measured by preoperative US in PTC; this was not affected by tumor size, the presence of calcification or coexisting thyroiditis. When the surgical extent of PTC treatment according to tumor size measured by US is determined, the relative difference between tumor sizes measured by preoperative US and postoperative pathologic examination should be considered.

  19. Factors Influencing Tacit Knowledge in Construction

    Directory of Open Access Journals (Sweden)

    Jawahar Nesan

    2012-11-01

    Full Text Available Increased complexity of the construction business and consequentuse of new management concepts and technologies ledconstruction organisations to focus more on the transfer of explicitknowledge. However, it is the tacit knowledge that determinesthe construction companies’ competitiveness in a business thatis driven by turbulent market conditions and customers’ everincreasingdemands. This paper highlights the importance of tacitknowledge sharing in construction, explores the challenges andopportunities to efficiently share tacit knowledge, and based on theliterature review identifies some critical factors that influence tacitknowledge in construction. It is argued that employees’ knowledgesharing (learning behaviours are influenced by work practices thatare borne by respective organisational behaviours. Organisational,cultural, and project characteristics that facilitate knowledgesharing among construction employees are explored and thepractices that influence the construction employee behaviour insharing tacit knowledge are highlighted.

  20. Multilevel factors influencing preterm birth in an urban setting

    Directory of Open Access Journals (Sweden)

    Saba W. Masho

    2014-01-01

    Full Text Available Racial disparity in preterm is a major problem in the US. Although significant strides have been made in identifying some of the risk factors, the complexities between community and individual factors are not understood. This study examines the influence of individual and community level factors affecting preterm birth among Black and White women in an urban setting. A 10-year live birth registry dataset from a mid-sized, racially diverse city was analyzed (N = 30,591. Data were geocoded and merged with block group level Census data. Five hierarchical models were examined using PROC GLIMMIX. Education, illicit drug use, pregnancy complications, previous preterm birth, paternal presence, inadequate and adequate plus prenatal care, and poverty were associated with preterm births in both Blacks and Whites. In Black women, increasing maternal age, maternal smoking, and a previous infant death were significant predictors of preterm births, which was not the case for White women. Residing in medium or high poverty neighborhoods resulted in 19% and 28% higher odds, respectively, of preterm birth for Black women. In addition to individual level factors, neighborhood poverty is an important risk factor influencing preterm birth. It is essential to engage multisectoral agencies in addressing factors influencing preterm birth.

  1. Pre- and postoperative MR imaging of craniopharyngiomas

    Energy Technology Data Exchange (ETDEWEB)

    Hald, J.K. [Rijkshospitalet, Oslo (Norway). Dept. of Radiology; Eldevik, O.P. [Rijkshospitalet, Oslo (Norway). Dept. of Neurosurgery; Quint, D.J. [Rijkshospitalet, Oslo (Norway). Dept. of Neurosurgery; Chandler, W.F. [Univ. of Michigan Hospital, Ann Arbor, MI (United States). Dept. of Radiology; Kollevold, T. [Univ. of Michigan Hospital, Ann Arbor, MI (United States). Dept. of Neurosurgery

    1996-09-01

    Purpose: To compare the pre- and postoperative MR appearance of craniopharyngiomas with respect to lesion size, tumour morphology and identification of surrounding normal structures. Material and Methods: MR images obtained prior to and following craniopharyngioma resection were evaluated retrospectively in 10 patients. Tumour signal charcteristics, size and extension with particular reference to the optic chiasm, the pituitary gland, the pituitary stalk and the third ventricle were evaluated. Results: Following surgery, tumour volume was reduced in all patients. In 6 patients there was further tumour volume reduction between the first and second postoperative images. Two of these patients received radiation therapy between the 2 postoperative studies, while 4 had no adjuvant treatment to the surgical intervention. There was improved visualization of the optic chiasm, in 3, the pituitary stalk in one, and the third ventricle in 9 of the 10 patients. The pituitary gland was identified preoperatively only in one patient, postoperatively only in another, pre- and postoperatively in 5, and neither pre- nor postoperatively in 3 patients. In 3 patients MR imaging 0-7 days postoperatively identified tumour remnants not seen at the end of the surgical procedure. The signal intensities of solid and cystic tumour components were stable from pre- to the first postoperative MR images. Optic tract increased signal prior to surgery was gone 28 days postoperatively in one patient, but persisted on the left side for 197 days after surgery in another. Conclusion: Postoperative MR imaging of craniopharyngiomas demonstrated tumour volume reduction and tumour remnants not seen at surgery. Early postoperative MR imaging of craniopharyngiomas may overestimate the size of residual tumour. Improved visualization of peritumoral structures may be achieved. (orig.).

  2. Optimization of postoperative analgesia after adenoidectomy in children

    Directory of Open Access Journals (Sweden)

    M. A. Georgiyants

    2017-04-01

    intensity on the «Faces» scale. A very strong correlation between «cortisol – BIS index» was observed during the traumatic moment of operation and unidirectional positive correlations were seen both between ΔBIS-index «intubation-the traumatic moment of operation» and between the level of cortisolemia (Δcortisol before surgery – the traumatic moment of operation, Δcortisol extubation – the 1st day after the surgery and Δcortisol before surgery – the 1st day after the surgery and the intensity of postoperative pain by the «Faces» and Oucher scales. The around-the-clock prescribed administration of ibuprofen at dose 10 mg/kg after adenoidectomy provided effective postoperative analgesia. At the 1st hour after the operation lower pain intensity was revealed in patients using propofol in combination with fentanyl by both pain scales. We believe that propofol is able to influence the level of cortisol and assume that due to minimal changes in the level of cortisol during the perioperative period, propofol can reduce the intensity of postoperative pain.

  3. Incidence of postoperative delirium in patients undergoing total knee arthroplasty-an Asian perspective.

    Science.gov (United States)

    Huang, Juncheng; Bin Abd Razak, Hamid Rahmatullah; Yeo, Seng Jin

    2017-08-01

    Very little is known in the literature with regards to the incidence of postoperative delirium following total knee arthroplasty (TKA) in Asians and the associated surgical factors. We conducted a retrospective study on incidence of postoperative delirium following TKA in Asians. One thousand sixteen knees of 954 consecutive patients who underwent TKA by the senior author of this study in the year 2006 were included in this review. All written and electronic medical records for patients were screened. Delirium was recorded to be present based on clinical entry onto the patients' inpatient hospital notes and a diagnosis made by psychiatrist based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). All statistical analysis was performed using SPSS v.18.0 (IBM Corp., Armonk, NY, USA). The incidence of postoperative delirium in our patients undergoing TKA was 0.59%. Six patients had a confirmed diagnosis of delirium postoperatively. We noted an association between a higher mean age (P<0.0001), a lower body mass index (P<0.0001), Chinese ethnicity (P=0.002), male gender (P=0.002) and chronic opioid use (P<0.0001) with incidence of post-operative delirium. We also noted a higher proportion of post-operative DVT (P<0.0001) and wound infection (P<0.0001) in the delirium group. The incidence of postoperative delirium in Asians undergoing TKA in our institution is very low at 0.59%. Advanced age, lower body mass index, Chinese ethnicity, male gender and preoperative chronic opioid use may be associated with developing postoperative delirium.

  4. Factors influencing purchase intention towards consumer-to-consumer e-commerce

    OpenAIRE

    Muhammad Dachyar; Liska Banjarnahor

    2017-01-01

    Purpose: This study explores factors that influence consumer’s purchase intention at three consumer-to-consumer (C2C) e-commerce companies in Indonesia. Design/methodology: 5 Expert opinions are used to determine the indicators of each factor and the Structural Equation Modelling (SEM) method is used to analyze the empirical data of 400 respondents for each company. Findings: It is found different significant factors that influence customer’s purchase intention in each compa...

  5. Socio-Economic Factors Influencing Entrepreneurship Among ...

    African Journals Online (AJOL)

    Socio-Economic Factors Influencing Entrepreneurship Among Women In Fishing Communities In Ondo State, Nigeria. ... The study found that overall entrepreneurial rating of the study group is low, essential input can not be easily gotten in the area, the respondents has large household size thereby had a large dependents ...

  6. Factors Influencing Donor Partnership Effectiveness | IDRC ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    2010-11-03

    Nov 3, 2010 ... A two-dimensional tool probing eight factors that influence partnership performance was developed, and used in conjunction with a Partnering Process Model, to guide the preparation of the case studies. The incorporation of the temporality dimension is quite novel and adds to the understanding and ...

  7. Influencing Factor of Postoperation Fast-track Recovery and in Hospital Cost after Lobctomy for Lung Cancer

    Directory of Open Access Journals (Sweden)

    Jianhua SU

    2014-07-01

    Full Text Available Background and objective It is unknown that the postoperation fast-track recovery and in hospital cost of the lobectomy in lung cancer, we explored the influencing factor of postoperative fast-track recovery and in hospital cost after undergoing lobectomy for lung cancer. Methods We retrospectively reviewed the medical records of all patients (n=176 who underwent lobectomy for lung cancer between January 2010 and November 2011 by a thoracic surgeon. Results The hospital costs of video-assisted thoracic surgery (VATS lobectomy (47,308.21 ¥ is significantly higher than open lobectomy (45,664.31 ¥(P=0.007. The hospital costs of body mass index (BMI ≥ 24 kg/m2 (51,186.99 ¥ is significantly higher than BMI < 24 kg/m2 (41,701.64 ¥(P=0.032. The hospital stay of VATS lobectomy (5.70 d is significantly less than open lobectomy (7.10 d(P<0.001. Conclusion These findings indicate that preoperative pulmonary rehabilitation and VATS lobectomy is contributed to fast-track recovery for patients who undergo lobectomy, but increase the hospital costs.

  8. Postoperative Stereotactic Body Radiation Therapy (SBRT) for Spine Metastases: A Critical Review to Guide Practice

    Energy Technology Data Exchange (ETDEWEB)

    Redmond, Kristin J., E-mail: kjanson3@jhmi.edu [Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland (United States); Lo, Simon S. [Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center, Cleveland, Ohio (United States); Fisher, Charles [Department of Surgery, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia (Canada); Sahgal, Arjun [Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario (Canada)

    2016-08-01

    Postoperative stereotactic body radiation therapy (SBRT) for metastatic spinal tumors is increasingly being performed in clinical practice. Whereas the fundamentals of SBRT practice for intact spinal metastases are established, there are as yet no comprehensive practice guidelines for the postoperative indications. In particular, there are unique considerations for patient selection and treatment planning specific to postoperative spine SBRT that are critical for safe and effective management. The purpose of this critical review is to discuss the rationale for treatment, describe those factors affecting surgical decision making, introduce modern surgical trends, and summarize treatment outcomes for both conventional postoperative external beam radiation therapy and postoperative spine SBRT. Lastly, an in-depth practical discussion with respect to treatment planning and delivery considerations is provided to help guide optimal practice.

  9. Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery.

    Science.gov (United States)

    Elsamadicy, Aladine A; Adogwa, Owoicho; Lydon, Emily; Sergesketter, Amanda; Kaakati, Rayan; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Bagley, Carlos A; Karikari, Isaac O

    2017-08-01

    OBJECTIVE Depression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity. METHODS The medical records of 923 adult patients (age ≥ 18 years) undergoing elective spine surgery at a single major academic institution from 2005 through 2015 were reviewed. Of these patients, 255 (27.6%) patients had been diagnosed with depression by a board-certified psychiatrist and constituted the Depression group; the remaining 668 patients constituted the No-Depression group. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient and compared between groups. The primary outcome investigated in this study was rate of postoperative delirium, according to DSM-V criteria, during initial hospital stay after surgery. The association between depression and postoperative delirium rate was assessed via multivariate logistic regression analysis. RESULTS Patient demographics and comorbidities other than depression were similar in the 2 groups. In the Depression group, 85.1% of the patients were taking an antidepressant prior to surgery. There were no significant between-group differences in intraoperative variables and rates of complications other than delirium. Postoperative complication rates were also similar between the cohorts, including rates of urinary tract infection, fever, deep and superficial surgical site infection, pulmonary embolism, deep vein thrombosis, urinary retention, and proportion of patients transferred to the intensive care unit. In

  10. Community Factors Influencing Birth Spacing among Married ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    level factors on birth spacing behaviour in Uganda and Zimbabwe, to ... environments as potential influences on birth spacing ..... health: multivariable cross-country analysis, MACRO ... Equity monitoring for social marketing: Use of wealth.

  11. Factors Influencing Adoption of Cocoa Technologies Disseminated ...

    African Journals Online (AJOL)

    Factors Influencing Adoption of Cocoa Technologies Disseminated by Olam Organisation in ... Journal of Agricultural Research and Development ... level, household size, no of farm family assisting on the farm, management system adopted, ...

  12. Habitat factors influencing the distribution of Cymbopogon validus in ...

    African Journals Online (AJOL)

    Habitat factors influencing the distribution of Cymbopogon validus in Mkambati Game Reserve, Transkei. ... disturbance; game reserve; grassland; grasslands; habitat conditions; habitat factors; mkambati game ... AJOL African Journals Online.

  13. Retrospective study of 48 cases of post-operative radiotherapy for head and neck cancer

    International Nuclear Information System (INIS)

    Mnejja, W.; Yahiaoui, S.; Siala, W.; Daoud, J.; Ghorbel, A.; Frikha, M.

    2011-01-01

    The authors report a study which aimed at assessing therapeutic results after post-operative radiotherapy of 48 patients suffering from head and neck cancers. The analysis is made in terms of cancer control, survival without recurrence and global survival. The post-operative radiotherapy improves the disease control rate. Ganglionary attack and capsular failure are survival prognosis factors. The concomitant association of chemo-therapy and radiotherapy should improve therapeutic results. Short communication

  14. Factors that influence household and individual clothing expenditure ...

    African Journals Online (AJOL)

    S Blignaut

    Contributing factors are the growth of low-priced apparel ... determine which factors influence household and individual ... explicitly deals with this concept. .... The income elasticity for clothing for the two-parent ..... Nelson (1989) found that mothers with less than a .... fashion consciousness and style preferences should.

  15. Factors influencing internal color of cooked meats.

    Science.gov (United States)

    Suman, Surendranath P; Nair, Mahesh N; Joseph, Poulson; Hunt, Melvin C

    2016-10-01

    This manuscript overviews the pertinent research on internal color of uncured cooked meats, biochemical processes involved in meat cookery, and fundamental mechanisms governing myoglobin thermal stability. Heat-induced denaturation of myoglobin, responsible for the characteristic dull-brown color of cooked meats, is influenced by a multitude of endogenous (i.e., pH, muscle source, species, redox state) and exogenous (i.e., packaging, ingredients, storage) factors. The interactions between these factors critically influence the internal cooked color and can confuse the consumers, who often perceive cooked color to be a reliable indicator for doneness and safety. While certain phenomena in cooked meat color are cosmetic in nature, others can mislead consumers and result in foodborne illnesses. Research in meat color suggests that processing technologies and cooking practices in industry as well as households influence the internal cooked color. Additionally, the guidelines of many international public health and regulatory authorities recommend using meat thermometers to determine safe cooking endpoint temperature and to ensure product safety. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Postoperative long-term changes of nutritional and immunological states in patients with esophageal cancer

    International Nuclear Information System (INIS)

    Kimura, Keiko

    1990-01-01

    Under nutritional support, surgical and postoperative adjuvant therapy were performed in 27 patients with thoracic esophageal cancer. The patients were divided into 2 groups, that were patients with postoperative chemotherapy (group A; 13 cases) and patients with postoperative radiation therapy (group B; 14 cases). Nutritional and immunological parameters were measured and compared among each groups. Group B had received higher nutritional support than group A, especially during the period of postoperative therapy. In group B, nutritional and immunological parameters maintained normal level, except serum albumin levels, counts of peripheral lymphocytes and factor XIII. In spite of higher nutritional support, levels of Zn in group B kept low. As for arterio-venous difference of amino acids, the tendency of negative balance in group B was stronger than that in group A. Arginine concentration in venous plasma increased evidently in group B. (author)

  17. Hepatobiliary transporter expression and post-operative jaundice in patients undergoing partial hepatectomy.

    Science.gov (United States)

    Bernhardt, Gerwin A; Zollner, Gernot; Cerwenka, Herwig; Kornprat, Peter; Fickert, Peter; Bacher, Heinz; Werkgartner, Georg; Müller, Gabriele; Zatloukal, Kurt; Mischinger, Hans-Jörg; Trauner, Michael

    2012-01-01

    Post-operative hyperbilirubinaemia in patients undergoing liver resections is associated with high morbidity and mortality. Apart from different known factors responsible for the development of post-operative jaundice, little is known about the role of hepatobiliary transport systems in the pathogenesis of post-operative jaundice in humans after liver resection. Two liver tissue samples were taken from 14 patients undergoing liver resection before and after Pringle manoeuvre. Patients were retrospectively divided into two groups according to post-operative bilirubin serum levels. The two groups were analysed comparing the results of hepatobiliary transporter [Na-taurocholate cotransporter (NTCP); multidrug resistance gene/phospholipid export pump(MDR3); bile salt export pump (BSEP); canalicular bile salt export pump (MRP2)], heat shock protein 70 (HSP70) expression as well as the results of routinely taken post-operative liver chemistry tests. Patients with low post-operative bilirubin had lower levels of NTCP, MDR3 and BSEP mRNA compared to those with high bilirubin after Pringle manoeuvre. HSP70 levels were significantly higher after ischaemia-reperfusion (IR) injury in both groups resulting in 4.5-fold median increase. Baseline median mRNA expression of all four transporters prior to Pringle manoeuvre tended to be lower in the low bilirubin group whereas expression of HSP70 was higher in the low bilirubin group compared to the high bilirubin group. Higher mRNA levels of HSP70 in the low bilirubin group could indicate a possible protective effect of high HSP70 levels against IR injury. Although the exact role of hepatobiliary transport systems in the development of post-operative hyper bilirubinemia is not yet completely understood, this study provides new insights into the molecular aspects of post-operative jaundice after liver surgery. © 2011 John Wiley & Sons A/S.

  18. Factors influencing selection of office furniture by corporations and universities

    Science.gov (United States)

    R. Bruce Anderson

    1976-01-01

    Evaluation of the factors that influence the selection of office furniture by large corporations and universities shows that quality, appearance, and purchase price have the most important influence on the purchase decision. The intended use of the furniture and the appearance of the furniture were the key factors in the purchase of wooden furniture.

  19. Spinal Implant Density and Postoperative Lumbar Lordosis as Predictors for the Development of Proximal Junctional Kyphosis in Adult Spinal Deformity.

    Science.gov (United States)

    McClendon, Jamal; Smith, Timothy R; Sugrue, Patrick A; Thompson, Sara E; O'Shaughnessy, Brian A; Koski, Tyler R

    2016-11-01

    To evaluate spinal implant density and proximal junctional kyphosis (PJK) in adult spinal deformity (ASD). Consecutive patients with ASD receiving ≥5 level fusions were retrospectively analyzed between 2007 and 2010. ASD, elective fusions, minimum 2-year follow-up. age lordosis (LL) were predictors for PJK (P = 0.018 and 0.045, respectively). Controlling for age, BMI, and gender, postoperative LL (not implant density) continued to show significance in multivariate logistic regression model. PJK, although influenced by a multitude of factors, may be statistically related to implant density and LL. Copyright © 2016. Published by Elsevier Inc.

  20. Cerebrospinal Fluid Pressure: Revisiting Factors Influencing Optic Nerve Head Biomechanics

    Science.gov (United States)

    Hua, Yi; Voorhees, Andrew P.; Sigal, Ian A.

    2018-01-01

    Purpose To model the sensitivity of the optic nerve head (ONH) biomechanical environment to acute variations in IOP, cerebrospinal fluid pressure (CSFP), and central retinal artery blood pressure (BP). Methods We extended a previously published numerical model of the ONH to include 24 factors representing tissue anatomy and mechanical properties, all three pressures, and constraints on the optic nerve (CON). A total of 8340 models were studied to predict factor influences on 98 responses in a two-step process: a fractional factorial screening analysis to identify the 16 most influential factors, followed by a response surface methodology to predict factor effects in detail. Results The six most influential factors were, in order: IOP, CON, moduli of the sclera, lamina cribrosa (LC) and dura, and CSFP. IOP and CSFP affected different aspects of ONH biomechanics. The strongest influence of CSFP, more than twice that of IOP, was on the rotation of the peripapillary sclera. CSFP had similar influence on LC stretch and compression to moduli of sclera and LC. On some ONHs, CSFP caused large retrolamina deformations and subarachnoid expansion. CON had a strong influence on LC displacement. BP overall influence was 633 times smaller than that of IOP. Conclusions Models predict that IOP and CSFP are the top and sixth most influential factors on ONH biomechanics. Different IOP and CSFP effects suggest that translaminar pressure difference may not be a good parameter to predict biomechanics-related glaucomatous neuropathy. CON may drastically affect the responses relating to gross ONH geometry and should be determined experimentally. PMID:29332130

  1. A systematic review of preoperative predictors for postoperative clinical outcomes following lumbar discectomy.

    Science.gov (United States)

    Wilson, Courtney A; Roffey, Darren M; Chow, Donald; Alkherayf, Fahad; Wai, Eugene K

    2016-11-01

    Sciatica is often caused by a herniated lumbar intervertebral disc. When conservative treatment fails, a lumbar discectomy can be performed. Surgical treatment via lumbar discectomy is not always successful and may depend on a variety of preoperative factors. It remains unclear which, if any, preoperative factors can predict postsurgical clinical outcomes. This review aimed to determine preoperative predictors that are associated with postsurgical clinical outcomes in patients undergoing lumbar discectomy. This is a systematic review. This systematic review of the scientific literature followed the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. MEDLINE and PubMed were systematically searched through June 2014. Results were screened for relevance independently, and full-text studies were assessed for eligibility. Reporting quality was assessed using a modified Newcastle-Ottawa Scale. Quality of evidence was assessed using a modified version of Sackett's Criteria of Evidence Support. No financial support was provided for this study. No potential conflict of interest-associated biases were present from any of the authors. The search strategy yielded 1,147 studies, of which a total of 40 high-quality studies were included. There were 17 positive predictors, 20 negative predictors, 43 non-significant predictors, and 15 conflicting predictors determined. Preoperative predictors associated with positive postoperative outcomes included more severe leg pain, better mental health status, shorter duration of symptoms, and younger age. Preoperative predictors associated with negative postoperative outcomes included intact annulus fibrosus, longer duration of sick leave, worker's compensation, and greater severity of baseline symptoms. Several preoperative factors including motor deficit, side and level of herniation, presence of type 1 Modic changes and degeneration, age, and gender had non-significant associations with postoperative clinical

  2. The efficacy of postoperative radiotherapy in localized primary soft tissue sarcoma treated with conservative surgery

    International Nuclear Information System (INIS)

    Zhao, Ru-Ping; Yu, Xiao-Li; Zhang, Zhen; Jia, Li-Juan; Feng, Yan; Yang, Zhao-Zhi; Chen, Xing-Xing; Wang, Jian; Ma, Sheng-Lin; Guo, Xiao-Mao

    2016-01-01

    To evaluate the efficacy of postoperative radiotherapy (RT) on local failure-free survival (LFFS), distant metastasis-free survival (DMFS) and overall survival (OS) in patients with localized primary soft tissue sarcoma (STS) and to identify prognostic factors. Between January 2000 and July 2010, 220 consecutive patients with localized primary STS, who received conservative surgery with or without postoperative RT, were enrolled in the study. Survival curves were constructed by the Kaplan-Meier method and log-rank test was used to assess statistical significance. Multivariate analysis was applied to identify the prognostic factors. After a median follow-up of 68 months (range, 5–127 months), the 5-year LFFS, DMFS and OS were 70.0, 78.2 and 71.2 %, respectively. Tumor size, histological subtypes, margin status and postoperative RT were independent predictors for OS. Postoperative RT was associated with a significant reduced local recurrence risk versus surgery alone (hazard ratio [HR] = 0.408, 95 % confidence interval [CI] 0.235–0.707, P = 0.001), with 5-year LFFS of 81.1 and 63.6 %, respectively (log-rank, P = 0.004). The log-rank test showed that postoperative RT had a tendency of improving OS compared with surgery alone, with 5-year OS of 74.8 and 65.0 %, respectively (P = 0.089). Multivariate analysis demonstrated that postoperative RT significantly reduced mortality rate compared with surgery alone (HR = 0.512, 95 % CI 0.296–0.886, p = 0.017), especially in patients with liposarcoma (p = 0.034). Postoperative radiotherapy reduce both local recurrence and STS mortality in patients with localized primary STS. The efficacy of RT on survival warrants further prospective study. The online version of this article (doi:10.1186/s13014-016-0605-y) contains supplementary material, which is available to authorized users

  3. Association between serum lactate and postoperative outcomes following coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Fatemeh Hasanshiri

    2017-02-01

    Full Text Available Background: Increased serum lactate during cardio-pulmonary bypass is associated with high mortality and cardiac complications up to 10-20 percent. The aim of this study was to evaluate the effect of serum lactate increase on postoperative outcomes after coronary artery bypass graft (CABG Surgery. Materials and Methods: This descriptive-analytical study was performed on cases (no=116 undergoing CABG at Beheshti hospital in Kashan between 2013-2014. Demographic data, variables related to surgery, serum lactate level and the time of tracheal extubation, length of stay in intensive care unit (ICU and hospital post-surgery left ventricular ejection fraction were collected. These data was compared in two groups: Normal serum lactate ( 2 m mol\\liter group. Results: The postoperative hyperlactatemia was observed in 62.1 % of patients. There were no significant differences between two groups in time of tracheal extubation, length of stay in ICU and hospital. There was a relationship between the mean postoperative serum lactate and blood sugar, bicarbonate, pH, length of cardiopulmonary bypass and the aortic cross clamping time. There was a significant relationship between the serum lactate increment and the left ventricular ejection fraction decrement. Conclusion: Hyperlactatemia is probably associated with such important factors as high blood sugar, longer duration of aortic cross clamp and cardio-pulmonary bypass time. So controlling such factors can reduce the rate of hyperlactatemia and help postoperative recovery.

  4. Factors That Influence Technology Integration in the Classroom

    Science.gov (United States)

    Montgomery, Maureen C.

    2017-01-01

    Education is one area where the use of technology has had great impact on student learning. The integration of technology in teaching and learning can significantly influence the outcome of education in the classroom. However, there are a myriad of factors that influence technology integration in the classroom. The purpose of this study was to…

  5. Factors influencing the, selection of state office furniture

    Science.gov (United States)

    R. Bruce Anderson; R. Bruce Anderson

    1973-01-01

    Evaluation of the factors influencing the selection of office furniture by nine state governments shows that quality and purchase price have the most important influence on the purchase decision. The intended use of the furniture and the purchasing regulations of the states were key f8CbrS in the use of wood furniture.

  6. Relative importance of natural and anthropogenic factors influencing karst rocky desertification

    Science.gov (United States)

    Xu, Erqi; Zhang, Hongqi

    2017-04-01

    As the most severe ecological issue in southwest China, karst rocky desertification (KRD) has both threatened and constrained regional sustainable development. Comprehensively understanding the relationship between the evolution of KRD and relevant driving data would provide more information to combat KRD in such complex karst environments. Past studies have been limited in quantifying the relative importance of driving factors influencing fine-scale KRD evolution, and have also lacked insight into their interactive impacts. To address these issues, we have used geographical information system techniques and a geographical detector model to explore the spatial consistency of driving factors and their interactions in relation to the evolution of KRD. Changshun County in China was selected as a representative area for the study. Nine relevant driving factors, including both natural and anthropogenic factors, were studied in regard to their relationships with KRD transformation between 2000 and 2010. Our results demonstrate the relative importance of driving data in influencing the improvement and deterioration of KRD. Lithology, soil type and road influence are identified as the leading factors. Interestingly, to our study at least, there is no significant difference between the impacts of natural and anthropogenic factors influencing KRD improvement, and even natural factors have a higher impact on KRD deterioration. Factors were found to enhance the influence of each other for KRD transformation. In particular, the results show a non-linearly enhanced effect between driving factors, which significantly aggravates KRD. New information found in our study helps to effectively control and restore areas afflicted by KRD.

  7. New insights into the pathophysiology of postoperative cognitive dysfunction

    DEFF Research Database (Denmark)

    Krenk, Lene; Rasmussen, Lars Simon; Kehlet, H

    2010-01-01

    using a fast-track methodology. It is concluded that the pathogenesis of POCD is multifactorial and future studies should focus on evaluating the role of postoperative sleep disturbances, inflammatory stress responses, pain and environmental factors. Potential prophylactic intervention may include...... minimal invasive surgery, multi-modal non-opioid pain management and pharmacological manipulation of the inflammatory response and sleep architecture....

  8. Postoperative pain assessment using four behavioral scales in Pakistani children undergoing elective surgery

    Directory of Open Access Journals (Sweden)

    Faisal Shamim

    2015-01-01

    Full Text Available Background: Several measurement tools have been used for assessment of postoperative pain in pediatric patients. Self-report methods have limitations in younger children and parent, nurse or physician assessment can be used as a surrogate measure. These tools should be tested in different cultures as pain can be influenced by sociocultural factors. The objective was to assess the inter-rater agreement on four different behavioral pain assessment scales in our local population. Materials and Methods: This prospective, descriptive, observational study was conducted in Pakistan. American Society of Anesthesiologists I and II children, 3-7 years of age, undergoing elective surgery were enrolled. Four pain assessment scales were used, Children′s Hospital of Eastern Ontario Pain Scale (CHEOPS, Toddler Preschool Postoperative Pain Scale (TPPPS, objective pain scale (OPS, and Face, Legs, Activity, Cry, Consolability (FLACC. After 15 and 60 min of arrival in the postanesthesia care unit (PACU, each child evaluated his/her postoperative pain by self-reporting and was also independently assessed by the PACU nurse, PACU anesthetist and the parent. The sensitivity and specificity of the responses of the four pain assessment scales were compared to the response of the child. Results: At 15 min, sensitivity and specificity were >60% for doctors and nurses on FLACC, OPS, and CHEOPS scales and for FLACC and CHEOPS scale for the parents. Parents showed poor agreement on OPS and TPPS. At 60 min, sensitivity was poor on the OPS scale by all three observers. Nurses showed a lower specificity on FLACC tool. Parents had poor specificity on CHEOPS and rate of false negatives was high with TPPS. Conclusions: We recommend the use of FLACC scale for assessment by parents, nurses, and doctors in Pakistani children aged between 3 and 7.

  9. [Postoperative pain management. Aims and organization of a strategy for postoperative acute pain therapy].

    Science.gov (United States)

    Nolli, M; Nicosia, F

    2000-09-01

    The Health Services, not only the Italian one, is under pressure because of request for improving treatment quality and the financial need for reorganization and cost-saving. It's required a rationalization of intervention, together with a careful choice of the best and cheapest techniques and the demonstration of their efficacy. The anaesthesia service activity, in a period of cost rationalization and funds restriction should be aimed to appropriate outcome measures corrected by both patient's risk factors and surgical-anaesthesiological case-mix. The development of a complete strategy for surgical pain management might run into two phases. The first phase, internal and mono-specialistic, should develop like the creation of an Acute Pain Team. The main processes are: focusing the problem (charge of the care), training, information, teaching methodology (timing, methods, drugs, techniques, etc.) and the audit (before and after changes). The main aims are the evaluation of the level of analgesia and pain relief or patient's satisfaction which are partial endpoints useful to demonstrate the improvement and the efficacy of the new pain management strategies. The second phase, multidisciplinary, is directed toward the creation of a Postoperative Evaluation Team. The main objective is to set up a collaborative clinical group able to identify the criteria for quality, efficacy and safety. The major purpose is the evaluation of major outcome measures: surgical outcome, morbidity, mortality and length of hospitalization. The improvement in the quality of postoperative pain treatment goes through a better organization and a progressive increase of the already available therapy. The achievement of the result and the quality projects depend on the interaction among staff members with different behaviours and settings. Internal teaching and training, continuous education for doctors and nurses, and external information, marketing and improvement of attractive capability of

  10. Assessment of Factors Influencing Beneficiary Participation in ...

    African Journals Online (AJOL)

    ISSN 0794-5698. Assessment of Factors Influencing Beneficiary Participation in Fadama II Project ... project implementation (80%) in the stages of project development. Women .... the project as they appeared to have more family burden to ...

  11. Psychosocial factors for influencing healthy aging in adults in Korea.

    Science.gov (United States)

    Han, KyungHun; Lee, YunJung; Gu, JaSung; Oh, Hee; Han, JongHee; Kim, KwuyBun

    2015-03-07

    Healthy aging includes physical, psychological, social, and spiritual well-being in later years. The purpose of this study is to identify the psychosocial factors influencing healthy aging and examining their socio-demographic characteristics. Perceived health status, depression, self-esteem, self-achievement, ego-integrity, participation in leisure activities, and loneliness were identified as influential factors in healthy aging. 171 Korean adults aged between 45 and 77 years-old participated in the study. Self-reporting questionnaires were used, followed by descriptive statistics and multiple regressions as inferential statistical analyses. There were significant differences between participants' general characteristics: age, education, religion, housing, hobby, and economic status. The factors related to healthy aging had positive correlation with perceived health status, self-esteem, self-achievements, and leisure activities, and negative correlation with depression and loneliness. The factors influencing healthy aging were depression, leisure activities, perceived health status, ego integrity, and self-achievements. These factors were able to explain 51.9%. According to the results, depression is the factor with the greatest influence on healthy aging. Perceived health status, ego integrity, self-achievement, self-esteem, participation of leisure activities were also influential on healthy aging as beneficial factors.

  12. Comparison of TVT and TVT-O in patients with stress urinary incontinence: short-term cure rates and factors influencing the outcome. A prospective randomised study.

    Science.gov (United States)

    Karateke, Ates; Haliloglu, Berna; Cam, Cetin; Sakalli, Mustafa

    2009-02-01

    Recently, mid-urethral slings have been commonly used in treatment of patients with stress urinary incontinence (SUI). To investigate tension-free vaginal tape (TVT) and tension-free obturator tape (TVT-O) for surgical treatment of SUI for cure rates (primary endpoint), complications and factors influencing cure rate (secondary endpoints). One-hundred and sixty-four patients were included in the study (n = 81 for TVT, n = 83 for TVT-O). The cure rates, complications, preoperative and postoperative urodynamic evaluation, Q-tip test, the Turkish version of Incontinence Impact Questionnaire (IIQ-7) and Urogenital Distress Inventory (UDI-6) scores were recorded. At three and 12 months, the patients were evaluated regarding outcome measures. The cure rates were similar in TVT and TVT-O groups, 88.9% versus 86.7% respectively. Mean operative time was significantly shorter in TVT-O group (P = 0.001). The cure rate was significantly higher in both groups in patients with urethral hypermobility when compared with those with no hypermobility (P = 0.001). The TVT and TVT-O procedures appear to be equally effective for the treatment of SUI. Also, urethral hypermobility seems to be a factor influencing cure rate of mid-urethral slings.

  13. A brief review of salient factors influencing adult eating behaviour.

    Science.gov (United States)

    Emilien, Christine; Hollis, James H

    2017-12-01

    A better understanding of the factors that influence eating behaviour is of importance as our food choices are associated with the risk of developing chronic diseases such as obesity, CVD, type 2 diabetes or some forms of cancer. In addition, accumulating evidence suggests that the industrial food production system is a major contributor to greenhouse gas emission and may be unsustainable. Therefore, our food choices may also contribute to climate change. By identifying the factors that influence eating behaviour new interventions may be developed, at the individual or population level, to modify eating behaviour and contribute to society's health and environmental goals. Research indicates that eating behaviour is dictated by a complex interaction between physiology, environment, psychology, culture, socio-economics and genetics that is not fully understood. While a growing body of research has identified how several single factors influence eating behaviour, a better understanding of how these factors interact is required to facilitate the developing new models of eating behaviour. Due to the diversity of influences on eating behaviour this would probably necessitate a greater focus on multi-disciplinary research. In the present review, the influence of several salient physiological and environmental factors (largely related to food characteristics) on meal initiation, satiation (meal size) and satiety (inter-meal interval) are briefly discussed. Due to the large literature this review is not exhaustive but illustrates the complexity of eating behaviour. The present review will also highlight several limitations that apply to eating behaviour research.

  14. Alternative Administrative Certification: Socializing Factors Influencing Program Choice

    Science.gov (United States)

    Bickmore, Dana L.; Bickmore, Steven T.; Raines, Sarah

    2013-01-01

    This study used an organizational socialization lens to examine factors influencing participants' decision to pursue the principalship and choice to engage in an alternate administration certification program. Through an analysis of participant focus groups and interviews, factors emerged from the codes that were compared with dimensions of…

  15. Delirium is associated with early postoperative cognitive dysfunction

    DEFF Research Database (Denmark)

    Rudolph, J.L.; Marcantonio, E.R.; Culley, D.J.

    2008-01-01

    The purpose of this analysis was to determine if postoperative delirium was associated with early postoperative cognitive dysfunction (at 7 days) and long-term postoperative cognitive dysfunction (at 3 months). The International Study of Postoperative Cognitive Dysfunction recruited 1218 subjects...

  16. Influence Factors of the Economic Development Level Across European Countries

    OpenAIRE

    Diana Ioana POPA

    2016-01-01

    The economic development level of a country refers to the measure of the progress in an economy that could be measured, especially through GDP or GDP per capita. The level of these indicators can be influenced by many factors as a large scale, from social and economical to environmental and government policies factors. The paper aims to investigate some of these influence factors of the economic development level, represented in this case by GDP per capita, across European countries in the...

  17. [The Influence of Flurbiprofen on the Frequency of Postoperative Shivering].

    Science.gov (United States)

    Urabe, Tomoaki; Nakanuno, Ryuichi; Hayase, Kazuma; Takata, Nanako; Senami, Masaki

    2015-10-01

    Many methods to prevent postoperative shivering (POS) has been reported. However, there are few reports demonstrating the effect of flurbiprofen on POS which affects the set point in the thermocenter of the hypothalamus. One hundred and forty six patients undergoing lung lobectomy or segmentectomy under video-assisted thoracic surgery were divided into a flurbiprofen-treated group (Group F) and a non-treated group (Group N). We retrospectively investigated the incidence of POS associated with total intravenous anesthesia with epidural anesthesia compared with or without flurbiprofen. We weighed the incidence of POS against age, body mass index, the effective site concentration of fentanyl on extubation, the mean dose of remifentanil, the minimum rectal temperature, the surgical duration and total hemorrhage volume based on the anesthetic chart Chi-square and Student t-test were used for statistical analysis. Although the surgical duration in Group F was shorter than that in Group N (223±83 vs. 165±80 (min), Pflurbiprofen has a possible beneficial effect in preventing POS.

  18. Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery

    OpenAIRE

    Drake, T. M.; Nepogodiev, D.; Chapman, S. J.; Glasbey, J. C.; Khatri, C.; Kong, C. Y.; Claireaux, H. A.; Bath, M. F.; Mohan, M.; McNamee, L.; Kelly, M.; Mitchell, H.; Fitzgerald, J. E.; Harrison, E. M.; Bhangu, A.

    2016-01-01

    BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive pati...

  19. LITERATURE REVIEW ON FACTORS INFLUENCING MILK PURCHASE BEHAVIOUR

    Directory of Open Access Journals (Sweden)

    Klaudia Kurajdova

    2015-01-01

    Full Text Available In today’s highly informed, competitive and saturated market, a key to success of any business depends on knowing consumer and his consumption patterns and recognizing and understanding factors influencing his decision-making for the purpose of developing an attractive offer of products, supporting services, communication means and other marketing tools that would fit like a glue to customer’s needs. Study of consumer behaviour belongs to a group of very wide and strong subjects of marketing attention and its examination requires ongoing approach. Milk, as one category of dairy products, belongs to the group of basic daily-consumed products characterized by relatively high purchase frequency. On the other hand, its production and consumption is experiencing certain negative trend in Slovakia what inevitably calls for a scientific attention and examination in order to reverse this unfavourable development having a negative impact on the milk companies in Slovakia. Therefore, we focus our attention on studying various factors influencing consumers when purchasing this specific product. Our research in this stage resulted in the compilation of literature review on factors influencing consumers when purchasing milk and determination of boundaries and guidelines for our future research activity

  20. How modifiable factors influence parental decision-making about organ donation.

    Science.gov (United States)

    Luberda, Kamila; Cleaver, Karen

    2017-11-07

    A global shortage of organs from children and adults available for transplantation is compounded by the failure of next of kin to consent for organs to be donated after death. Non-modifiable and modifiable factors influence decision-making in this area. Modifiable factors are of interest when examining families' decision-making about the donation of organs from their deceased child. A scoping review was undertaken to determine how modifiable factors influence parental decision-making about organ donation. Thematic analysis identified two themes: interactions with healthcare professionals and pre-disposition to organ donation. Satisfaction with experiences of hospital care, the information provided and the way it was communicated, as well as interactions pertaining to emotional support were all found to be modifiable factors that influenced decision making. Likewise, a predisposition to organ donation and knowing the deceased's wishes were associated with the consent decision. Nurses working in critical care environments need to be able to support parents during this difficult time. This article aims to raise awareness of modifiable factors that influence parental decision-making, highlighting their relevance for children's nursing practice. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  1. Emergency department crowding: factors influencing flow.

    Science.gov (United States)

    Arkun, Alp; Briggs, William M; Patel, Sweha; Datillo, Paris A; Bove, Joseph; Birkhahn, Robert H

    2010-02-01

    THE OBJECTIVE OF THIS STUDY WAS TO EVALUATE THOSE FACTORS, BOTH INTRINSIC AND EXTRINSIC TO THE EMERGENCY DEPARTMENT (ED) THAT INFLUENCE TWO SPECIFIC COMPONENTS OF THROUGHPUT: "door-to-doctor" time and dwell time. We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday) during a three-month period. Variables measured included daily ED volume, patient acuity, staffing, ED occupancy, daily admissions, ED boarder volume, hospital volume, and intensive care unit volume. Both log-rank tests and time-to-wait (survival) proportional-hazard regression models were fitted to determine which variables were most significant in predicting "door-to-doctor" and dwell times, with full account of the censoring for some patients. We captured 1,543 patients during our study period, representing 27% of total daily volume. The ED operated at an average of 85% capacity (61-102%) with an average of 27% boarding. Median "door-to-doctor" time was 1.8 hours, with the biggest influence being triage category, day of the week, and ED occupancy. Median dwell time was 5.5 hours with similar variable influences. The largest contributors to decreased patient flow through the ED at our institution were triage category, ED occupancy, and day of the week. Although the statistically significant factors influencing patient throughput at our institution involve problems with inflow, an increase in ED occupancy could be due to substantial outflow obstruction and may indicate the necessity for increased capacity both within the ED and hospital.

  2. Factors influencing thermal tolerances of individual organisms

    International Nuclear Information System (INIS)

    Hutchison, V.H.

    1976-01-01

    The diversity of experimental methods and terminology employed by investigators to measure the effects of high temperatures on individual organisms, plus the often overlooked complexities of the holocoenotic environment, has often led to disconcerting conclusions. A plea is made for standardization of testing methods and for a wider appreciation of factors that may alter thermal tolerances. The influence of elevated temperature is grouped into three categories, lethal effects, controlling effects, and directive effects, all of which should be considered in assessing the impact of thermal effluent on organisms. In addition, the terminology (acclimation, acclimatization, adaptation, habituation, lethal temperature, critical thermal maximum, etc.) needs standardized definitions. The important factors influencing thermal effects on organisms include photoperiod, seasonal and daily cycles, geographic variation, diet, sex, breeding condition, age, life-cycle stage, salinity, chemicals, body water content and partitioning, oxygen supply, pH, innate and learned behavior, history of thermal exposure, sublethal exposure to limiting factors, and experimental methods. Examples of most of these are given to illustrate the role of temperature in the holocoenotic environmental complex of individual organisms

  3. Postoperative irradiation of endometrial cancer by iridium afterloading technique

    International Nuclear Information System (INIS)

    Kucera, H.; Weghaupt, K.

    1988-01-01

    From 1981 to 1986 708 patients were operated and postoperativly treated by total hysterectomy, bilateral salpingo-oophorectomy and postoperative vaginal irradiation with high-dose-afterloading (iridium 192). A percutaneous irradiation (cobalt 60) was done in stage I cases only when myometrial infiltration was deep. Highly differentiated tumors with infiltration of the first and second thirth of the myometrium were treated by vaginal irradiation alone. Poorly differentiated tumors with infiltration of the second and third thirth of the myometrium were treated by vaginal and percutaneous irradiation. A group of 125 cases with good prognosis and with postoperative vaginal irradiation alone had the same five-year-survival of 83% as a group of 152 cases with bad prognosis treated by vaginal and percutaneous irrradiation. This result shows clearly the importance of additional irradiation of the pelvis in cases with bad prognosis factors. The incidence of radiation side effect in all 708 cases was: cystitis 4.6%, proctitis 5.2%, vaginal or rectal ulcera 1.4% and fistulas 0.2%. Cases with vaginal irradiation alone and with the optimal intravaginal fraction dose of 700 cGy (twice) had the lowest level of side effects: cystitis 3.8% proctitis 2.1%, vaginal necrosis 0.7%, no further severe complications. None of the patients with postoperative vaginal irradiation alone had a vaginal recurrence. The incidence of recurrences in 708 patients was 1.6%. All recurrence cases in stage I (0.7%) had bad prognosis factors and were treated with vaginal and percutaneous irradiation. (orig./MG) [de

  4. Factors influencing the pattern of malnutrition among acutely ill ...

    African Journals Online (AJOL)

    Factors influencing the pattern of malnutrition among acutely ill children presenting in ... height/length) measurements and z-scores calculated for the individual nutritional ... The factors associated with malnutrition included early introduction of ...

  5. High-dose preoperative chemoradiotherapy in esophageal cancer patients does not increase postoperative pulmonary complications: Correlation with dose-volume histogram parameters

    International Nuclear Information System (INIS)

    Hurmuzlu, Meysan; Ovrebo, Kjell; Wentzel-Larsen, Tore; Muren, Ludvig Paul; Viste, Asgaut; Smaaland, Rune

    2010-01-01

    Purpose: To investigate the association of high-dose preoperative chemoradiotherapy (CRT) and dose-volume histogram (DVH) parameters of lungs with incidence of postoperative pulmonary complications and to identify predictive clinical factors of pulmonary complications. Methods: Data of 65 patients were collected retrospectively. Thirty-five patients underwent transthoracic esophagectomy (TTE) alone and 30 received cisplatin and 5-fluorouracil, concomitant with radiotherapy, median dose 66 Gy, and followed by TTE. From the DVH for each lung alone and for both lungs together as one organ we generated total lung volume, mean radiotherapy dose, relative and absolute volumes receiving more than a threshold dose, and relative and absolute volumes receiving less than a threshold dose. Postoperative pulmonary complications were defined as pneumonia or respiratory failure. Results: Sixty percent of the patients in the TTE alone group had postoperative pulmonary complications versus 63% in the CRT + TTE group. Postoperative mortality was 8.6% and 16.7% in the respective patient groups (p = NS). None of the DVH parameters was associated with postoperative pulmonary complications. Squamous cell carcinoma was an adverse factor related to increased postoperative pulmonary complications. Conclusion: High-dose preoperative CRT was not associated with increased postoperative pulmonary complications in this cohort of esophageal cancer patients.

  6. Factors Influencing the Adoption of Minimally Invasive Surgery ...

    African Journals Online (AJOL)

    Background: Cost is a major concern for delivery of minimally invasive surgical technologies due to the nature of resources required. It is unclear whether factors extrinsic to technology availability impact on this uptake. Objectives: To establish the influence of institutional, patient and surgeon-related factors in the adoption of ...

  7. Experience with early postoperative feeding after abdominal aortic surgery.

    Science.gov (United States)

    Ko, Po-Jen; Hsieh, Hung-Chang; Liu, Yun-Hen; Liu, Hui-Ping

    2004-03-01

    Abdominal aortic surgery is a form of major vascular surgery, which traditionally involves long hospital stays and significant postoperative morbidity. Experiences with transit ileus are often encountered after the aortic surgery. Thus traditional postoperative care involves delayed oral feeding until the patients regain their normal bowel activities. This report examines the feasibility of early postoperative feeding after abdominal aortic aneurysm (AAA) open-repair. From May 2002 through May 2003, 10 consecutive patients with infrarenal AAA who underwent elective surgical open-repair by the same surgeon in our department were reviewed. All of them had been operated upon and cared for according to the early feeding postoperative care protocol, which comprised of adjuvant epidural anesthesia, postoperative patient controlled analgesia, early postoperative feeding and early rehabilitation. The postoperative recovery and length of hospital stay were reviewed and analyzed. All patients were able to sip water within 1 day postoperatively without trouble (Average; 12.4 hours postoperatively). All but one patient was put on regular diet within 3 days postoperatively (Average; 2.2 days postoperatively). The average postoperative length of stay in hospital was 5.8 days. No patient died or had major morbidity. Early postoperative feeding after open repair of abdominal aorta is safe and feasible. The postoperative recovery could be improved and the length of stay reduced by simply using adjuvant epidural anesthesia during surgery, postoperative epidural patient-controlled analgesia, early feeding, early ambulation, and early rehabilitation. The initial success of our postoperative recovery program of aortic repair was demonstrated.

  8. Factors Influencing Indonesian Internet Users Intention on Buying Books Online

    Directory of Open Access Journals (Sweden)

    Beatrik Messah

    2003-09-01

    Full Text Available The purpose of this research is to discover and analyse factors influencing Indonesian internet users intention on buying books online. Certain factors will be investigated are demographic, features, convenience, web design, and security. This research used questionaires to obtain data from the respondents. After the data collected, SPSS software is used to process the data with using Chi-Square test. The result found that features, convenience, and security factors of online bookstores and level of education, income, and occupation of the Indonesian Internet Users influence the people intention on buying books online. In the other hand, web design of the online bookstores and the age of the Indonesian internet users have no influence on their intention on buying books online.

  9. Factors influencing eating attitudes in secondary-school girls in ...

    African Journals Online (AJOL)

    Family, especially maternal, factors play a role in determining eating attitudes. Peer and media (television) factors are not significantly influential. The findings provide preliminary data on factors that influence eating attrtudes in a group at risk for the development of eating disorders. The findings have implications for the ...

  10. Iranian nurses self-perception -- factors influencing nursing image.

    Science.gov (United States)

    Varaei, Shokoh; Vaismoradi, Mojtaba; Jasper, Melanie; Faghihzadeh, Soghrat

    2012-05-01

    The purpose of this study was to describe the perspectives of Iranian nurses regarding factors influencing nursing image. Nursing image is closely tied to the nurse's role and identity, influencing clinical performance, job satisfaction and quality of care. Images of nursing and nurses are closely linked to the cultural context in which nursing is practised, hence, this study explores how Iranian nurses perceive the factors that influence their own image. A descriptive study using a survey design was conducted with 220 baccalaureate qualified nurses working in four teaching hospitals in an urban area of Iran. A Nursing Image Questionnaire was used and analysed using descriptive and inferential statistics. In the domains of 'characteristics required for entry to work', 'social role characteristics of nursing' and 'prestige, economic and social status, and self image' the nurses had negative images. 'Reward' and 'opportunity for creativity and originality' were factors that least influenced choosing nursing as a career. The presence of a nurse in the family and working in the hospital had the greatest impact on the establishment of nurses' nursing image. Improving the nursing profession's prestige and social position as well as providing the opportunity for creativity and originality in nursing practice will change the self-image of Iranian nurses, facilitating effective and lasting changes in nursing's image. Nurse managers are well-placed to influence nurses' perceptions of nursing's image. Given the finding that thinking about leaving a job positively correlates with holding a negative nursing image, nurse managers need to consider how they can work effectively with their staff to enhance morale and nurses' experience of their job. © 2012 Blackwell Publishing Ltd.

  11. Acute postoperative neurological deterioration associated with surgery for ruptured intracranial aneurysm: incidence, predictors, and outcomes.

    Science.gov (United States)

    Mahaney, Kelly B; Todd, Michael M; Bayman, Emine O; Torner, James C

    2012-06-01

    of postoperative deficit. Acute postoperative neurological deterioration was observed in 42.6% of the patients. New focal motor deficit accounted for 65% of postoperative neurological deterioration, while 60% was accounted for using the NIHSS total score change and 51% by Glasgow Coma Scale score change. Factors significantly associated with occurrence of postoperative neurological deterioration included: age, Fisher grade on admission, occurrence of a procedure prior to aneurysm surgery (ventriculostomy), timing of surgery, systolic blood pressure during surgery, ST segment depression during surgery, history of abnormality in cardiac valve function, use of intentional hypotension during surgery, duration of anterior cerebral artery occlusion, intraoperative blood loss, and difficulty of aneurysm exposure. Of the 426 patients with postoperative neurological deterioration at 24 hours after surgery, only 46.2% had a good outcome (GOS score of 1) at 3 months, while 77.7% of those without postoperative neurological deterioration at 24 hours had a good outcome (p surgery for aneurysmal SAH. Avoiding surgical factors associated with postoperative neurological deterioration and directing investigative efforts at developing improved neuroprotection for use in aneurysm surgery may significantly improve long-term neurological outcomes in patients with SAH.

  12. E-commerce factors influencing consumers‘ online shopping decision

    OpenAIRE

    Baubonienė, Živilė; Gulevičiūtė, Gintarė

    2015-01-01

    Purpose – The purpose of this paper is to look at the factors driving online shopping and to develop an understanding of the factors influencing the online shopping by the consumers. This is done by exploring the factors that encourage consumers to shop online through analysis of such advantages as security, fast delivery, comparable price, convenience, cheaper prices and a wider choice. At the same time, the research project reveals the factors that are discouraging for consumers and the ben...

  13. Postoperative respiratory muscle dysfunction: pathophysiology and preventive strategies.

    Science.gov (United States)

    Sasaki, Nobuo; Meyer, Matthew J; Eikermann, Matthias

    2013-04-01

    Postoperative pulmonary complications are responsible for significant increases in hospital cost as well as patient morbidity and mortality; respiratory muscle dysfunction represents a contributing factor. Upper airway dilator muscles functionally resist the upper airway collapsing forces created by the respiratory pump muscles. Standard perioperative medications (anesthetics, sedatives, opioids, and neuromuscular blocking agents), interventions (patient positioning, mechanical ventilation, and surgical trauma), and diseases (lung hyperinflation, obesity, and obstructive sleep apnea) have differential effects on the respiratory muscle subgroups. These effects on the upper airway dilators and respiratory pump muscles impair their coordination and function and can result in respiratory failure. Perioperative management strategies can help decrease the incidence of postoperative respiratory muscle dysfunction. Such strategies include minimally invasive procedures rather than open surgery, early and optimal mobilizing of respiratory muscles while on mechanical ventilation, judicious use of respiratory depressant anesthetics and neuromuscular blocking agents, and noninvasive ventilation when possible.

  14. Factors influencing job satisfaction and organizational commitment.

    Science.gov (United States)

    Watson, Liana M

    2008-01-01

    To assess the relationship between intrinsic and extrinsic motivational factors influencing job satisfaction and the perspective of frontline medical imaging staff in acute care health care facilities in the United States. The sample consisted of 359 registered radiologic technologists who were working as staff technologists in acute care health care facilities in the United States. The results of the study suggest that satisfaction with intrinsic and extrinsic motivators influences overall satisfaction with the work environment and job and commitment to the employer.

  15. Patients' perception of postoperative pain management: validation of the International Pain Outcomes (IPO) questionnaire.

    Science.gov (United States)

    Rothaug, Judith; Zaslansky, Ruth; Schwenkglenks, Matthias; Komann, Marcus; Allvin, Renée; Backström, Ragnar; Brill, Silviu; Buchholz, Ingo; Engel, Christoph; Fletcher, Dominique; Fodor, Lucian; Funk, Peter; Gerbershagen, Hans J; Gordon, Debra B; Konrad, Christoph; Kopf, Andreas; Leykin, Yigal; Pogatzki-Zahn, Esther; Puig, Margarita; Rawal, Narinder; Taylor, Rod S; Ullrich, Kristin; Volk, Thomas; Yahiaoui-Doktor, Maryam; Meissner, Winfried

    2013-11-01

    PAIN OUT is a European Commission-funded project aiming at improving postoperative pain management. It combines a registry that can be useful for quality improvement and research using treatment and patient-reported outcome measures. The core of the project is a patient questionnaire-the International Pain Outcomes questionnaire-that comprises key patient-level outcomes of postoperative pain management, including pain intensity, physical and emotional functional interference, side effects, and perceptions of care. Its psychometric quality after translation and adaptation to European patients is the subject of this validation study. The questionnaire was administered to 9,727 patients in 10 languages in 8 European countries and Israel. Construct validity was assessed using factor analysis. Discriminant validity assessment used Mann-Whitney U tests to detect mean group differences between 2 surgical disciplines. Internal consistency reliability was calculated as Cronbach's alpha. Factor analysis resulted in a 3-factor structure explaining 53.6% of variance. Cronbach's alpha at overall scale level was high (.86), and for the 3 subscales was low, moderate, or high (range, .53-.89). Significant mean group differences between general and orthopedic surgery patients confirmed discriminant validity. The psychometric quality of the International Pain Outcomes questionnaire can be regarded as satisfactory. The International Pain Outcomes questionnaire provides an instrument for postoperative pain assessment and improvement of quality of care, which demonstrated good psychometric quality when translated into a variety of languages in a large European and Israeli patient population. This measure provides the basis for the first comprehensive postoperative pain registry in Europe and other countries. Copyright © 2013. Published by Elsevier Inc.

  16. Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia

    DEFF Research Database (Denmark)

    Rosenberg, J; Oturai, P; Erichsen, C J

    1994-01-01

    STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal...... surgery and 16 patients undergoing middle ear surgery, both with comparable general anesthesia. MEASUREMENTS AND MAIN RESULTS: Patients were monitored with continuous pulse oximetry on one preoperative night and the second postoperative night. Significant episodic or constant hypoxemia did not occur...... on the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the development...

  17. The effects of postoperative irradiation on loco-regional tumor control and survival in patients with head and neck carcinomas by tumor subsites and relative risk factors for recurrence

    International Nuclear Information System (INIS)

    Schmidt-Ullrich, Rupert K.; Johnson, Christopher R.; Payne, Cheryl; Lu Jiandong; Han, Daniel

    1997-01-01

    Purpose/Objective: This study reports on a unique experience in the management of patients with advanced head and neck squamous cell carcinomas (HNSCC) in which, between 1982 and 1990, patients with varied risk for recurrence were either referred for immediate postoperative irradiation by one surgical group or offered radiotherapy after surgical failure by the other. We have previously demonstrated in patients with high risk for recurrence that combined surgery and postoperative radiotherapy (S/RT) resulted in improved loco-regional tumor control (LRC) and overall patient survival (OS) for the entire patient cohort. This updated and expanded analysis describes the benefit of postoperative irradiation for patients with HNSCC depending upon relative risk factors for recurrence and different subsites of primary tumors. Materials and Methods: Of 219 patients, 190 were evaluable because of tumor locations in the major subsites analyzed, i.e. oral cavity (OC), oropharynx (OP), hypopharynx (HP), and larynx (L). Depending upon the philosophy of the two surgical groups, 79 patients were treated with combined S/RT and 111 with S alone with a >90% compliance. Minimum 2-year follow-up applies to all data reported. The two patient groups were well balanced with respect to tumor stages (AJCC 1983) and other patient characteristics. Histopathological review revealed 88 cases with one risk factor for recurrence, 49 patients with positive resection margin (PRM) and 39 with extracapsular extension (ECE); an additional 22 patients presented with both risk factors and 80 patients were found to have no risk factors. S, consisting of wide local excisions or radical resections including neck dissections, and postoperative RT with doses between 50 and 70 Gy were similar for both groups. Statistical evaluations consisted of Kaplan-Meier analyses to calculate LRC and OS rates and of multivariate Cox's proportional hazard models to estimate significance of treatment effects including S vs. S

  18. What Factors Influence Knowledge Sharing in Organizations?

    DEFF Research Database (Denmark)

    Razmerita, Liana; Kirchner, Kathrin; Nielsen, Pia

    2016-01-01

    factors drive employees’ participation and what factors hamper their participation in enterprise social media. Design/methodology/approach: Based on a literature review, a unified research model is derived integrating demographic, individual, organizational and technological factors that influence......Purpose: Enterprise social media platforms provide new ways of sharing knowledge and communicating within organizations to benefit from the social capital and valuable knowledge that employees have. Drawing on social dilemma and self-determination theory, the aim of the study is to understand what...... knowledge sharing framework helps to understand what factors impact engagement on social media. Furthermore the article suggests different types of interventions to overcome the social dilemma of knowledge sharing. Originality/value: The study contributes to an understanding of factors leading...

  19. [Effect of postoperative precision nutrition therapy on postoperative recovery for advanced gastric cancer after neoadjuvant chemotherapy].

    Science.gov (United States)

    Zhao, Q; Li, Y; Yu, B; Yang, P G; Fan, L Q; Tan, B B; Tian, Y; Yang, A B

    2018-02-23

    Objective: To investigate the effect of postoperative precision nutrition therapy on postoperative recovery (PR) of patients with advanced gastric cancer (AGC) after neoadjuvant chemotherapy (NC). Methods: 71 subjects were randomly divided into 2 groups. The 34 patients of research group were treated with postoperative precision nutrition treatment according to the indirect energy measurement method. The 31 patients of control group were treated with traditional postoperative nutrition treatment. All participants were measured for body mass index (BMI), NRS2002, PG-SGA and relevant laboratory test within the 1st day before surgery and 7th day after surgery. Moreover, the difference between two groups in short-term effects were evaluated. Results: The daily energy supply of control group was 30.1%-43.74% higher than that of the experimental group ( P nutritional risk became lower in the research group ( P recovery of patients in the research group was comparable to that of the control group ( P >0.05). Moreover, the complication rate and hospitalization costs of in research group were significantly lower than that of in control group ( P nutritional risks before surgery, the nutritional index and inflammatory index in the research group were better than those in the control group. Conclusion: Postoperative precision nutrition therapy may improve the postoperative nutritional status and short-term effects of patients with AGC after NC.

  20. Factors influencing laser cutting of wood

    Science.gov (United States)

    V.G. Barnekov; C.W. McMillin; H.A. Huber

    1986-01-01

    Factors influencing the ability of lasers to cut wood may be generally classified into these three areas: 1) characteristics of the laser beam; 2) equipment and processing variables; and 3) properties of the workpiece. Effects of beam power, mode, polarization, and stability are discussed as are aspects of optics, location of focal point, feed speed, gas-jet assist...

  1. Review on Factors Influencing Physician Guideline Adherence in Cardiology.

    Science.gov (United States)

    Hoorn, C J G M; Crijns, H J G M; Dierick-van Daele, A T M; Dekker, L R C

    2018-04-09

    Cardiovascular disease is the most common cause of death in Western countries. Physician adherence to guidelines is often suboptimal, resulting in impaired patient outcome and prognosis. Multiple studies have been conducted to evaluate patterns and the influencing factors of patient adherence, but little is known about factors influencing physician guideline adherence. This review aims to identify factors influencing physician guideline adherence relevant to cardiology and to provide insights and suggestions for future improvement. Physician adherence was measured as adherence to standard local medical practice and applicable guidelines. Female gender and older age had a negative effect on physician guideline adherence. In addition, independent of the type of heart disease, physicians without cardiologic specialization were linked to physician noncompliance. Also, guideline adherence in primary care centers was at a lower level compared to secondary or tertiary care centers. The importance of guideline adherence increases as patients age, and complex diseases and comorbidity arise. Appropriate resources and interventions, taking important factors for nonadherence in account, are necessary to improve guideline adoption and adherence in every level of the chain. This in turn should improve patient outcome.

  2. Multimodality imaging of the postoperative shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany)

    2007-12-15

    Multimodality imaging of the postoperative shoulder includes radiography, magnetic resonance (MR) imaging, MR arthrography, computed tomography (CT), CT arthrography, and ultrasound. Target-oriented evaluation of the postoperative shoulder necessitates familiarity with surgical techniques, their typical complications and sources of failure, knowledge of normal and abnormal postoperative findings, awareness of the advantages and weaknesses with the different radiologic techniques, and clinical information on current symptoms and function. This article reviews the most commonly used surgical procedures for treatment of anterior glenohumeral instability, lesions of the labral-bicipital complex, subacromial impingement, and rotator cuff lesions and highlights the significance of imaging findings with a view to detection of recurrent lesions and postoperative complications in a multimodality approach. (orig.)

  3. Factors influencing women\\'s decisions to purchase specific children ...

    African Journals Online (AJOL)

    Factors influencing women\\'s decisions to purchase specific children\\'s ... they had selected a children's multi-nutrient supplement with the intention of buying it. ... Price, performance and brand loyalty, affect and normative factors were most ...

  4. Librarians' Perspectives on the Factors Influencing Research Data Management Programs

    Science.gov (United States)

    Faniel, Ixchel M.; Connaway, Lynn Silipigni

    2018-01-01

    This qualitative research study examines librarians' research data management (RDM) experiences, specifically the factors that influence their ability to support researchers' needs. Findings from interviews with 36 academic library professionals in the United States identify 5 factors of influence: (1) technical resources; (2) human resources; (3)…

  5. Factors influencing societal response of nanotechnology: an expert stakeholder analysis

    International Nuclear Information System (INIS)

    Gupta, Nidhi; Fischer, Arnout R. H.; Lans, Ivo A. van der; Frewer, Lynn J.

    2012-01-01

    Nanotechnology can be described as an emerging technology and, as has been the case with other emerging technologies such as genetic modification, different socio-psychological factors will potentially influence societal responses to its development and application. These factors will play an important role in how nanotechnology is developed and commercialised. This article aims to identify expert opinion on factors influencing societal response to applications of nanotechnology. Structured interviews with experts on nanotechnology from North West Europe were conducted using repertory grid methodology in conjunction with generalized Procrustes analysis to examine the psychological constructs underlying societal uptake of 15 key applications of nanotechnology drawn from different areas (e.g. medicine, agriculture and environment, chemical, food, military, sports, and cosmetics). Based on expert judgement, the main factors influencing societal response to different applications of nanotechnology will be the extent to which applications are perceived to be beneficial, useful, and necessary, and how 'real' and physically close to the end-user these applications are perceived to be by the public.

  6. Factors influencing societal response of nanotechnology: an expert stakeholder analysis

    Science.gov (United States)

    Gupta, Nidhi; Fischer, Arnout R. H.; van der Lans, Ivo A.; Frewer, Lynn J.

    2012-05-01

    Nanotechnology can be described as an emerging technology and, as has been the case with other emerging technologies such as genetic modification, different socio-psychological factors will potentially influence societal responses to its development and application. These factors will play an important role in how nanotechnology is developed and commercialised. This article aims to identify expert opinion on factors influencing societal response to applications of nanotechnology. Structured interviews with experts on nanotechnology from North West Europe were conducted using repertory grid methodology in conjunction with generalized Procrustes analysis to examine the psychological constructs underlying societal uptake of 15 key applications of nanotechnology drawn from different areas (e.g. medicine, agriculture and environment, chemical, food, military, sports, and cosmetics). Based on expert judgement, the main factors influencing societal response to different applications of nanotechnology will be the extent to which applications are perceived to be beneficial, useful, and necessary, and how 'real' and physically close to the end-user these applications are perceived to be by the public.

  7. Does the number of veins ligated during varicococele surgery influence post-operative semen and hormone results?

    Science.gov (United States)

    Majzoub, A; Elbardisi, H; Arafa, M; Agarwal, A; Al Said, S; Al Rumaihi, K

    2016-09-01

    Varicocele is a well-established cause of male subfertility, which is directly proportional to its clinical grade. Although newer ultrasonic grading systems have taken into account the existence of pampiniform venous plexi, little is known about the clinical significance of the number of veins ligated during surgery. Very few undersized studies reported an influence which triggered the need to evaluate such association. This is a retrospective study of 378 patients who underwent left microsurgical subinguinal varicocoelectomy. Semen analyses and blood hormone studies performed pre-operatively were compared to those executed 6 months after surgery. Patients were divided into abnormal semen and normal semen groups based on their initial semen results. They were also subdivided according to the number of veins ligated intraoperatively into three groups: 10 veins. Sperm count, total motility, and progressive motility were significantly increased in 62, 60.3, and 53.3% of patients post-operatively (p = 0.001), respectively. No significant differences in hormone levels were detected overall. Of the 378 patients, 332 had an abnormal semen analysis, while the remaining 46 patients had a normal result. Sperm count, total motility, and progressive motility significantly increased after varicocoelectomy in patients with an abnormal initial semen analysis (p = 0.001). In 48.7% of patients, 5-10 veins were ligated during surgery, whereas 28.3% had >10 and 23% had <5 ligated veins. No statistically significant differences were noted in the initial or the follow-up results among the number of vein subgroups. Varicocele ligation improves patients' fertility potential. This improvement, however, is not influenced by the number of veins ligated intraoperatively. Clinical grading maintains its superiority in the evaluation of varicocele patients. © 2016 American Society of Andrology and European Academy of Andrology.

  8. Emergency Department Crowding: Factors Influencing Flow

    Directory of Open Access Journals (Sweden)

    Arkun, Alp

    2010-02-01

    Full Text Available Background: The objective of this study was to evaluate those factors, both intrinsic and extrinsic to the emergency department (ED that influence two specific components of throughput: “door-to-doctor” time and dwell time.Methods: We used a prospective observational study design to determine the variables that played a significant role in determining ED flow. All adult patients seen or waiting to be seen in the ED were observed at 8pm (Monday-Friday during a three-month period. Variables measured included daily ED volume, patient acuity, staffing, ED occupancy, daily admissions, ED boarder volume, hospital volume, and intensive care unit volume. Both log-rank tests and time-to-wait (survival proportional-hazard regression models were fitted to determine which variables were most significant in predicting “door-to-doctor” and dwell times, with full account of the censoring for some patients.Results: We captured 1,543 patients during our study period, representing 27% of total daily volume. The ED operated at an average of 85% capacity (61-102% with an average of 27% boarding. Median “door-to-doctor” time was 1.8 hours, with the biggest influence being triage category, day of the week, and ED occupancy. Median dwell time was 5.5 hours with similar variable influences.Conclusion: The largest contributors to decreased patient flow through the ED at our institution were triage category, ED occupancy, and day of the week. Although the statistically significant factors influencing patient throughput at our institution involve problems with inflow, an increase in ED occupancy could be due to substantial outflow obstruction and may indicate the necessity for increased capacity both within the ED and hospital. [West J Emerg Med. 2010; 11(1:10-15

  9. Postoperative imaging of the shoulder

    International Nuclear Information System (INIS)

    Woertler, K.; Rummeny, E.J.

    2004-01-01

    Correct interpretation of imaging findings in the postoperative shoulder is impaired by surgical distortion of normal anatomy and possible artifacts. Advanced postoperative imaging of the shoulder in addition to the selection of the best suited modality necessitates familiarity with the surgical procedure that has been performed and its consecutive morphological changes. This article reviews the most common arthroscopic and open techniques used for treatment of shoulder instability, lesions of the superior labral-bicipital complex, primery impingement, and rotator cuff tears, their typical postoperative imaging findings, as well as the diagnostic performance of cross sectional imaging techniques in the detection of recurrent lesions and complications. (orig.) [de

  10. Diagnostics of the Factors Influencing the Export Activity of an Enterprise

    Directory of Open Access Journals (Sweden)

    Skrynkovskyy Ruslan M.

    2017-09-01

    Full Text Available The modern practice of doing business proves that a successful entrance of any enterprise to external (international markets depends on the level of its readiness for carrying out foreign economic activity. Under such circumstances, the process of targeted analysis and assessment of factors influencing the export activity of the enterprise is relevant, expedient and important. The aim of the article is the formation and development of theoretical and methodological bases for diagnosing factors influencing the export activity of an enterprise on the basis of theory and practice in the field of management and administration. It is found that the diagnostics should be understood as the process of identification, analysis and evaluation of influence (functional, dysfunctional of the factors (circumstances, conditions, etc. on the export activity of an enterprise in order to identify and solve problems (current, possible ones in the sphere of supply and implementation of specific actions (steps related to its entrance to external (international markets. It is determined that the key business indicators of the system for diagnosing the factors influencing the export activity of an enterprise are indicators reflecting the influence of the main factors on its export activity: level of fulfillment of obligations in terms of cost; level of conclusion of “expensive contracts”; share of renewed business contracts in the total number of contracts; level of satisfaction of claims; level of delivery variability. The prospect for further research in this scientific direction is developing a system of partial diagnostic goals of the integrated system of goals for conducting economic diagnostics of enterprises taking into account the diagnostics of factors influencing the export activity of an enterprise as a partial diagnostic goal.

  11. Post-operative serious adverse events in a mixed surgical population

    DEFF Research Database (Denmark)

    Hansen, M S; Petersen, E E; Dahl, J B

    2016-01-01

    BACKGROUND: The number of surgical procedures is increasing, and knowledge of surgical risk factors, post-operative mortality and serious adverse events (SAE) is essential. The aim with our study was to determine the risk of a composite outcome of post-operative: death; myocardial infarction...... or gynaecological surgery was conducted retrieving data from The Danish Civil Registration System and the National Patient Register. Total observation time was from January 1, 2012 to June 6, 2013. RESULTS: A total7449 adult patients were included in the final analysis. The risk of the composite outcome during...... of 8.3% (7.8-9.0). The results are applicable in estimations of adequate sample sizes in future clinical trials investigating effects of interventions on SAEs....

  12. Factors Influencing Medical Students' Choice of Specialty

    OpenAIRE

    Chang, Pei-Yeh; Hung, Chih-Young; Wang, Kuei-lng; Huang, Yuan-Huei; Chang, King-Jen

    2006-01-01

    Medical school graduates are the source of a country's physicians. Determining how the graduates of these schools select their areas of specialization is the key to achieving a balanced distribution of doctors among all specialties. The purposes of this study were to determine the factors that influence medical students' choice of medical specialty, and to derive the relative weight of each factor. Methods: We constructed a two-tiered analytic hierarchy process (AHP) model which was repres...

  13. The influence of various anesthesia techniques on postoperative recovery and discharge criteria among geriatric patients

    Directory of Open Access Journals (Sweden)

    Dilsen Ornek

    2010-01-01

    Full Text Available OBJECTIVE: We aim to compare selective spinal anesthesia and general anesthesia with regard to postoperative recovery and fast-track eligibility in day surgeries. MATERIALS AND METHOD: Sixty geriatric outpatient cases, with ASA II-III physical status and requiring shortduration transurethral intervention, were enrolled in the study. The cases were split into 2 groups: as general anesthesia (Group GA and selective spinal anesthesia (Group SSA. Group GA (n = 30 received propofol 2 mg kg-1 (until loss of eyelash reflex, remifentanil induction 0.5-1 µg kg-1, and laryngeal mask. Maintenance was achieved by 4-6% desflurane in 60% N2O and 40% O2 along with remifentanil infusion at 0.05 µg /kg-1 /min-1. Drugs were discontinued after the withdrawal of the ureteroscope, and extubation was carried out with 100% O2. Group SSA (n = 30 received 0.5% spinal anesthesia via L4-5 space by 0.5% hyperbaric bupivacaine 5 mg. Anesthesia preparation time, time to surgical anesthesia level, postoperative fast-tracking, and time to White-Song recovery score of 12, were noted. In the operating room, we evaluated hemodynamics, nausea/vomiting, surgeon and patient satisfaction with anesthesia, perioperative midazolam-fentanyl administration, postoperative pain, and discharge time. RESULTS: Anesthesia preparation time, length of surgery, anesthesia-related time in the operating room, time to sit, and time to walk were significantly low in Group GA (p < 0.05, whereas time to fast-track eligibility, length of stay in the PACU, discharge time, and other parameters were similar in both of the groups. CONCLUSION: While anesthesia preparation time, length of surgery, start time of surgery, time to sit, and time to walk were shorter in the General Anesthesia group, time to fast-track eligibility, phase 1 recovery time, and discharge time were similar among patients subjected to selective spinal anesthesia.

  14. Computer Self-Efficacy and Factors Influencing E-Learning Effectiveness

    Science.gov (United States)

    Chien, Tien-Chen

    2012-01-01

    Purpose: The purpose of this study is to investigate the influences of system and instructor factors on e-learning effectiveness under the interactions of computer self-efficacy. In this study, the factors of the e-learning system are functionality, interaction, and response. The factors of the e-learning instructor are attitude, technical skills,…

  15. Factors influencing woodlands of southwestern North Dakota

    Science.gov (United States)

    Michele M. Girard; Harold Goetz; Ardell J. Bjugstad

    1987-01-01

    Literature pertaining to woodlands of southwestern North Dakota is reviewed. Woodland species composition and distribution, and factors influencing woodland ecosystems such as climate, logging, fire, and grazing are described. Potential management and improvement techniques using vegetation and livestock manipulation have been suggested.

  16. Factors that influence advertising design ideation | Usman ...

    African Journals Online (AJOL)

    Factors that influence advertising design ideation. ... PROMOTING ACCESS TO AFRICAN RESEARCH ... inevitably, more than ever before, on advertisement to take products to the doorsteps of potential consumers. Consequently, local and global corporations employ all manner of advertising media to achieve their end.

  17. Preoperative nutrition status and postoperative outcome in elderly general surgery patients: a systematic review.

    Science.gov (United States)

    van Stijn, Mireille F M; Korkic-Halilovic, Ines; Bakker, Marjan S M; van der Ploeg, Tjeerd; van Leeuwen, Paul A M; Houdijk, Alexander P J

    2013-01-01

    Poor nutrition status is considered a risk factor for postoperative complications in the adult population. In elderly patients, who often have a poor nutrition status, this relationship has not been substantiated. Thus, the aim of this systematic review was to assess the merit of preoperative nutrition parameters used to predict postoperative outcome in elderly patients undergoing general surgery. A systematic literature search of 10 consecutive years, 1998-2008, in PubMed, EMBASE, and Cochrane databases was performed. Search terms used were nutrition status, preoperative assessment, postoperative outcome, and surgery (hip or general), including their synonyms and MeSH terms. Limits used in the search were human studies, published in English, and age (65 years or older). Articles were screened using inclusion and exclusion criteria. All selected articles were checked on methodology and graded. Of 463 articles found, 15 were included. They showed profound heterogeneity in the parameters used for preoperative nutrition status and postoperative outcome. The only significant preoperative predictors of postoperative outcome in elderly general surgery patients were serum albumin and ≥ 10% weight loss in the previous 6 months. This systematic review revealed only 2 preoperative parameters to predict postoperative outcome in elderly general surgery patients: weight loss and serum albumin. Both are open to discussion in their use as a preoperative nutrition parameter. Nonetheless, serum albumin seems a reliable preoperative parameter to identify a patient at risk for nutrition deterioration and related complicated postoperative course.

  18. ICT Interventions for Girls: Factors Influencing ICT Career Intentions

    Directory of Open Access Journals (Sweden)

    Elena Gorbacheva

    2014-11-01

    Full Text Available Intervention programs aimed at promoting study and work opportunities in the Information and Communications Technology (ICT field to schoolgirls have been encouraged to combat a decline in the interest among girls to study ICT at school. The goal of our study is to investigate the influence of such interventions on schoolgirls’ intentions to choose a career in the ICT field by analysing comprehensive survey data (n = 3577, collected during four interventions in Australia, using the Partial Least Squares method. Our study is also aimed at identifying other factors influencing ICT career intentions. We found that the attitude towards interventions has an indirect influence on ICT career intentions by affecting interest in ICT. Our results also challenge several existing theoretical studies by showing that factors that had previously been suggested as influencers were found to have little or no impact in this study, these being same-sex education and computer usage.

  19. Predicting Factors for Allogeneic Blood Transfusion and Excessive Postoperative Blood Loss after Single Low-Dosage Intra-Articular Tranexamic Acid Application in Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    Paphon Sa-ngasoongsong

    2017-01-01

    Full Text Available Background. Recently, intra-articular tranexamic acid (IA-TXA application has become a popular method for perioperative blood loss (PBL reduction in total knee replacement (TKR. Nevertheless, through our knowledge, no previous studies had shown the correlation perioperative factors and the risk of excessive PBL or need of blood transfusion (BT after IA-TXA. Materials and Methods. A retrospective study was conducted in patients underwent 299 primary TKRs, using IA-TXA, during 2-year period (2013-2014. Patient’s characteristic and perioperative data were reviewed and collected. PBL was measured as total hemoglobin loss (THL, estimated total blood loss (ETBL, and drainage volume per kg (DV/kg. Excessive PBL was defined as PBL that exceeded 90th percentile. Results. From multivariate analysis, low preoperative hemoglobin (Hb level and body mass index (BMI were the significant predictors of postoperative BT (p<0.0001 and 0.003, resp.. Excessive THL significant associated with preoperative Hb (p<0.0001. Excessive ETBL significantly associated with preoperative Hb, height, preoperative range-of-motion, and creatinine clearance (p<0.05 all. Low BMI and large prosthesis size were the significant predictors of excessive DV/kg (p=0.0001 and 0.002, resp.. Conclusions. Low preoperative Hb and BMI were the significant risks of postoperative transfusion after TKR with IA-TXA. Moreover, multiple perioperative factors could result in higher PBL.

  20. Postoperative Radiation Therapy in Resected N2 Stage Non-Small Cell Lung Cancer

    International Nuclear Information System (INIS)

    Lee, Chang Geol

    1993-01-01

    A total of forty patients with resected N2 stage non-small cell lung cancer treated with postoperative adjuvant radiation therapy between Jan. 1975 and Dec. 1990 at the Department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center were retrospectively analysed to evaluate whether postoperative radiation therapy improves survival. Patterns of failure and prognostic factors affecting survival were also analysed. The 5 year overall and disease free survival rate were 26.3%, 27.3% and median survival 23.5 months. The 5 year survival rates by T-stage were T1 66.7%, T2 25.6% and T3 12.5%. Loco-regional failure rate was 14.3% and distant metastasis rate was 42.9% and both 2.9%. Statistically significant factor affecting distant failure rate was number of positive lymph nodes(>= 4). This retrospective study suggests that postoperative radiation therapy in resected N2 stage non-small cell lung cancer can reduce loco-regional recurrence and may improve survival rate as compared with other studies which were treated by surgery alone. Further study of systemic control is also needed due to high rate of distant metastasis