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Sample records for ii postoperative findings

  1. Abdominal CT findings of delayed postoperative complications

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    Zissin, R.; Osadchy, A. [Sapir Medical Center, Dept. of Diagnostic Imaging, Kfar Saba (Israel)]. E-mail: zisinrivka@clalit.org.il; Gayer, G. [Assaf Harofe Medical Center, Dept. of Diagnostic Imaging, Zrifin (Israel)

    2007-10-15

    Despite progress in surgical techniques and modern medical treatment, postoperative complications occur not infrequently and vary according to type of surgery, clinical setting, and time elapsed since surgery. In general, they can be divided into early and delayed complications. Delayed postoperative complications can be classified as specific and nonspecific. The common nonspecific delayed complications are incisional hernia and postoperative bowel obstruction. Bowel obstruction can be further categorized as obstruction related to benign or neoplastic etiology, the latter occurring in oncology patients in whom the primary surgery was related to an underlying abdominal neoplasm. Gossypiboma is another, fortunately rare, postoperative complication. Specific complications appear after specific operations and include the following: Splenosis - following splenectomy. Retained gallstones and spilled gallstones - following cholecystectomy, mainly laparoscopic. Dropped appendicolith and stump appendicitis - following appendectomy, mainly laparoscopic. Obturation obstruction by a bezoar - following gastric surgery. Afferent loop syndrome (ALS) - following Bilroth II gastrectomy. (author)

  2. Postoperative MRI findings after cholesteatoma surgery

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    Segawa, Yuko; Tono, Tetsuya; Kano, Kiyo; Morimitsu, Tamotsu [Miyazaki Medical Coll., Kiyotake (Japan)

    1995-07-01

    This study was designed to show MRI findings of postoperative middle ear pathologies and to discuss the usefulness of Gadolinium-enhanced MRI in evaluating the postoperative state of cholesteatoma. Thirty-eight ears which underwent intact canal wall tympanoplasty for cholesteatoma were examined. Recurrent cholesteatoma was detected as an iso-intensity area on T1-weighted images with negative enhancement. Notably, residual cholesteatoma were generally depicted as a round iso-intensity area with negative enhancement. Residual cholesteatoma less than 5 mm in diameter were, however, not generally detectable with our MRI scanner. Granulation tissue can be separated from cholesteatoma as an area with positive enhancement. Cholesterol granuloma shows a characteristic high signal pattern on both T1 and T2-weighted images. Hypovascular fibrous tissue and fluid collection may be depicted as a pattern similar to that of cholesteatoma. However, the signal is usually more homogeneous than that of cholesteatoma. We conclude that Gadolinium-enhanced MRI is useful for detecting postoperative cholesteatoma and avoiding unnecessary second-look operations after cholesteatoma surgery, by the canal-up procedure. (author).

  3. [Postoperative findings in the spinal column].

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    Lieb, J M; Ulmer, S; Kelm, J; Shariat, K; Stippich, C; Ahlhelm, F J

    2011-09-01

    Postoperative imaging after spinal surgery is usually performed to document the correct positioning of implants or to rule out complications if patients still suffer from pain after surgery. Depending on the question various imaging modalities can be used all of which have benefits and limitations. Conventional X-ray is used for the documentation of the correct positioning of spinal implants, stability (olisthesis) and during follow-up to rule out fractures or instability of the implants, whereas soft tissue changes cannot be completely assessed. Besides these indications, imaging is usually performed because of ongoing symptoms (pain for the most part) of the patients. Soft tissue changes including persistent or recurrent herniated disc tissue, hematoma or infection can best be depicted using magnetic resonance imaging (MRI) which should be performed within the immediate postoperative period to be able to distinguish physiological development of scar tissue from inflammatory changes in the area of the surgical approach. Often imaging alone cannot differentiate between these and imaging can therefore only be considered as an adjunct. Computed tomography is the modality of choice for the evaluation of bony structures and an adjunct of new therapies such as image-guided application of cement for kyphoplasty or vertebroplasty.

  4. Computed tomography findings of early abdominal postoperative complications

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    Zissin, R.; Osadchy, A. [Sapir Medical Center, Dept. of Diagnostic Imaging, Kfar Saba (Israel)]. E-mail: zisinrivka@clalit.org.il; Gayer, G. [Assaf Harofe Medical Center, Dept. of Diagnostic Imaging, Zrifin (Israel)

    2007-06-15

    Various surgical approaches are used for different abdominal pathological conditions. Postoperative complications occur not infrequently and vary according to the type of the surgery and the clinical context. Nowadays, multidetector computed tomography (MDCT) provides superb anatomic detail and diagnostic accuracy for various intraabdominal pathological processes, even if clinically unsuspected, and it thus has become an essential diagnostic tool for evaluating postoperative insults. Other advantages of abdominal MDCT include its accessibility and its speed, which allow scanning of uncooperative, marginally stable patients. Computed tomography (CT)-guided percutaneous (PC) drainage of postoperative collections is another advantage of CT. Therefore, although CT requires transportation of a critically ill, postoperative patient, it is recommended in any suspicious clinical setting because several conditions require prompt management and a correct diagnosis is crucial. In assessing a patient for suspected postoperative complications, several points should be taken into consideration, including the relevant clinical and laboratory data, the surgical findings, the type of the surgery, the time elapsed since surgery, and the operative technique (either open laparotomy of laparoscopic procedure). (author)

  5. Postoperative MR findings of the anterior cervical fusion

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    Jin, Uk; Choi, Woo Suk; Oh, Joo Hyeong; Kim, Eui Jong; Yoon, Yup [Kyunghee Univ. , Seoul (Korea, Republic of)

    1996-02-01

    This study was conducted to describe the postoperative MRI findings with contrast enhancement following anterior cervical fusion(ACF). Thirteen patients after anterior cervical fusions for disc herniation or traumatic injury were studied with MRI 1 month to 10 month to 10 months after operation. MRI findings were analysed with attention to the remained vertebral body, disc material, retropharyngeal soft tissue, grafted bone fragment, and biological orthopedic prosthesis(BOP). In 8/13 cases(62%), enhancement of the retropharyngeal soft tissue was seen with good demarcation between soft tissue and surrounding vertebra or disc. In 9/13 cases (69%), grafted bone or BOP was well defined by intersurface with low signal intensity. In 4 cases of ACF with bone graft, 2 cases(50%) showed heterogeneous or homogeneous enhancement of grafted bone fragments. Remained vertebral bodies and discs showed enhancements in 8/13 cases(62%). Postoperative MR findings after ACF included good margination of enhanced retropharyngeal soft tissue, grafted bone, and remained vertebral bodies/discs. The MRI could be a useful study to differentiate findings after ACF from postoperative inflammations such as spondylitis or discitis, and be a good imaging modality for follow up of grafted bony fragment or BOP.

  6. Repaired supraspinatus tendons in clinically improving patients: Early postoperative findings and interval changes on MRI

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    Lee, Jung Eun; Park, Ji Seon; Ryu, Kyung Nam; Rhee, Yong Girl [Kyung Hee University Hospital, Seoul (Korea, Republic of); Yoon, So Hee; Park, So Young; Jin Wook [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, Seoul (Korea, Republic of)

    2015-04-15

    To demonstrate and further determine the incidences of repaired supraspinatus tendons on early postoperative magnetic resonance imaging (MRI) findings in clinically improving patients and to evaluate interval changes on follow-up MRIs. Fifty patients, who showed symptomatic and functional improvements after supraspinatus tendon repair surgery and who underwent postoperative MRI twice with a time interval, were included. The first and the second postoperative MRIs were obtained a mean of 4.4 and 11.5 months after surgery, respectively. The signal intensity (SI) patterns of the repaired tendon on T2-weighted images from the first MRI were classified into three types of heterogeneous high SI with fluid-like bright high foci (type I), heterogeneous high SI without fluid-like bright high foci (type II), and heterogeneous or homogeneous low SI (type III). Interval changes in the SI pattern, tendon thickness, and rotator cuff interval thickness between the two postoperative MRIs were evaluated. The SI patterns on the first MRI were type I or II in 45 tendons (90%) and type III in five (10%). SI decreased significantly on the second MRI (p < 0.050). The mean thickness of repaired tendons and rotator cuff intervals also decreased significantly (p < 0.050). Repaired supraspinatus tendons exhibited high SI in 90% of clinically improving patients on MRI performed during the early postsurgical period. The increased SI and thickness of the repaired tendon decreased on the later MRI, suggesting a gradual healing process rather than a retear.

  7. Preoperative and postoperative histopathological findings in patients with endometrial hyperplasia

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    Đorđević Biljana; Stanojević Zorica; Živković Vesna; Lalošević Dušan; Gligorijević Jasmina; Krstić Miljan

    2007-01-01

    Introduction. The aim of this study was to analyze and compare the histopathological findings in curettage and hysterectomy specimens, to evaluate the accuracy of histopathological diagnosis in curettage specimens, and to determine the frequency of coexisting endometrial carcinoma in patients with histopathological diagnosis of endometrial hyperplasia. Material and methods. Curettage and hysterectomy specimens of 135 female patients with initially diagnosed endometrial hyperplasia were retros...

  8. Classifications,symptoms and imaging findings of 195 cases confirmed by biopsy or postoperative pathology

    Institute of Scientific and Technical Information of China (English)

    董秦雯

    2014-01-01

    Objective To summarize and analyze the classifications,symptoms,imaging findings of the cerebral space occupying lesions which confirmed by biopsy or postoperative pathology.Methods The classifications,symptoms,imaging findings of 195 cases who visited the Neurology Department of Naval General Hospital were analyzed by retrospective study.Results Classifications:among the 86 neoplastic lesions(NL),there were 49

  9. Utility of Postoperative Radiographs for Pediatric Scoliosis: Association Between History and Physical Examination Findings and Radiographic Findings.

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    Shau, David N; Bible, Jesse E; Gadomski, Stephen P; Samade, Richard; Armaghani, Sheyan; Mencio, Gregory A; Devin, Clinton J

    2014-07-02

    Postoperative radiographs are routinely obtained following surgery for the correction of scoliosis in pediatric patients. The purpose of this study was to comprehensively evaluate the utility of obtaining routine postoperative radiographs in the management of these patients. A total of 1969 clinic notes and corresponding radiographs regarding 451 consecutive patients with scoliosis (age range, ten to eighteen years) who had surgical correction over a ten-year period at a single institution were retrospectively reviewed. Curve etiology, preoperative curve characteristics, and surgical procedures performed were recorded. All postoperative clinic notes and radiographs were reviewed for abnormalities and changes in treatment course. It was then determined whether clinical signs and symptoms and/or abnormal radiographic findings led to a change in treatment course, which was defined as a therapeutic intervention or further diagnostic testing. Of the 451 patients in this study (average age [and standard deviation], 14.7 ± 2.4 years), 72.5% had adolescent idiopathic scoliosis, 23.3% had neuromuscular scoliosis, and 4.2% had other underlying causes of scoliosis. A change in treatment course occurred in the cases of forty-two patients, all of whom had symptomatic findings on postoperative history and physical examination and only fifteen of whom had supportive abnormal findings on postoperative radiographs. Curve etiology and surgical procedures performed had no impact on radiographic utility. A significant increase in utility was seen for radiographs obtained at visits one year or more following surgery compared with those obtained at visits less than one year following surgery (1.7% compared with 0.3%, p = 0.001). The overall sensitivity, specificity, positive predictive value, and negative predictive value of routine postoperative radiographs in guiding treatment course were 35.7%, 98.1%, 28.8%, and 98.6%, respectively. Routine radiographs provide low utility in guiding

  10. Postoperative findings following the Whipple procedure : determination of prevalence and morphologic abdominal CT features

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    Mortele, KJ; Lemmerling, M; de Hemptinne, B; De Vos, M; De Bock, G; Kunnen, M

    2000-01-01

    This study was conducted to determine characteristic CT findings following the Whipple procedure and to evaluate the usefulness of CT in re-dieting tumor recurrence. Eighty-four postoperative abdominal CT scans and medical records of 43 patients were retrospectively reviewed. Perioperative histopath

  11. Postoperative findings following the Whipple procedure: determination of prevalence and morphologic abdominal CT features

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    Mortele, K.J.; Lemmerling, M.; Bock, G. de; Kunnen, M. [Department of Radiology, University Hospital Gent (Belgium); Hemptinne, B. de [Department of Digestive Surgery, University Hospital Gent (Belgium); Vos, M. de [Department of Gastroenterology, University Hospital Gent (Belgium)

    2000-01-01

    This study was conducted to determine characteristic CT findings following the Whipple procedure and to evaluate the usefulness of CT in predicting tumor recurrence. Eighty-four postoperative abdominal CT scans and medical records of 43 patients were retrospectively reviewed. Perioperative histopathologic examinations revealed malignancy in 32 patients (74.4 %). Time interval between surgery and CT varied from 13 days to 6 years and 7 months. Common postoperative findings were unopacified anastomotic bowel loops in the porta hepatis (n = 69 scans), perivascular cuffing (n = 42 scans), pneumobilia (n = 40 scans), dilated intrahepatic bile ducts (n = 22 scans), reactive lymphadenopathy (n = 21 scans), and transient fluid collections (n = 20 scans). Postoperative complications were detected on 17 CT scans (20.2 %): generalized ascites (n = 8 patients), deep abscesses (n = 3 patients), wound abscess (n = 1 patient), pancreatitis (n = 1 patient), and pseudomembranous colitis (n = 1 patient). Tumor recurrence appeared in 15 patients (46.8 %) after a mean postoperative period of 11 months (1 month to 3 years): local (9 of 15), regional lymph nodes (9 of 15), and liver metastasis (8 of 15). Detection of generalized ascites more than 30 days after surgery was associated with tumor recurrence in 6 of 6 patients (100 %). Diffuse ascites (> 30 days after surgery) behaved as an early predictive sign of tumor recurrence. In our series CT accuracy for detecting recurrent tumor with CT was 93.5 %. No predilection site for disease recurrence could be determined. (orig.)

  12. Preoperative MRI findings predict two-year postoperative clinical outcome in lumbar spinal stenosis.

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    Pekka Kuittinen

    Full Text Available To study the predictive value of preoperative magnetic resonance imaging (MRI findings for the two-year postoperative clinical outcome in lumbar spinal stenosis (LSS.84 patients (mean age 63±11 years, male 43% with symptoms severe enough to indicate LSS surgery were included in this prospective observational single-center study. Preoperative MRI of the lumbar spine was performed with a 1.5-T unit. The imaging protocol conformed to the requirements of the American College of Radiology for the performance of MRI of the adult spine. Visual and quantitative assessment of MRI was performed by one experienced neuroradiologist. At the two-year postoperative follow-up, functional ability was assessed with the Oswestry Disability Index (ODI 0-100% and treadmill test (0-1000 m, pain symptoms with the overall Visual Analogue Scale (VAS 0-100 mm, and specific low back pain (LBP and specific leg pain (LP separately with a numeric rating scale from 0-10 (NRS-11. Satisfaction with the surgical outcome was also assessed.Preoperative severe central stenosis predicted postoperatively lower LP, LBP, and VAS when compared in patients with moderate central stenosis (p<0.05. Moreover, severe stenosis predicted higher postoperative satisfaction (p = 0.029. Preoperative scoliosis predicted an impaired outcome in the ODI (p = 0.031 and lowered the walking distance in the treadmill test (p = 0.001. The preoperative finding of only one stenotic level in visual assessment predicted less postoperative LBP when compared with patients having 2 or more stenotic levels (p = 0.026. No significant differences were detected between quantitative measurements and the patient outcome.Routine preoperative lumbar spine MRI can predict the patient outcome in a two-year follow up in patients with LSS surgery. Severe central stenosis and one-level central stenosis are predictors of good outcome. Preoperative finding of scoliosis may indicate worse functional ability.

  13. Pylorus-preserving whipple pancreaticoduodenectomy : CT findings of immediate postoperative complications

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    Kim, Keon Woo; Kim, Tae Hun [Kyungpook National Univ., Taegu (Korea, Republic of). School of Medicine

    1998-03-01

    The purpose of this paper is to determine the CT findings of immediately postoperative complications including anastomotic leakage, and to evaluate the usefulness of CT scan in the assessment of early postoperative complications of pylorus preserving whipple pancreaticoduodenectomy (PPPD). During the early postoperative period, fluid accumulated in the abdominal cavity of ten of 23 patients who had undergone PPPD. In all cases, the time interval between the first follow up CT scan and surgery was no more than two weeks. At each leakage site, we compared CT findings with those of conventional fluoroscopic studies: upper gastrointestinal studies with oral water-soluble contrast materials, a contrast injection study via drainage catheters in place in the stomach, the site of choledochojejunostomy during surgery and pancreaticojejunostomy, and nine cases of sinogram via percutaneous drainage catheters. We also evaluated CT findings of the locations, amounts, and margin of the fluid collections. If conventional fluoroscopic studies showed no evidence of anastomotic leakage, as was the case with six patients, the leakage site was determined on the basis of clinical and laboratory data. In four of the six, this was found to be the site of pancreaticojejunostomy, and in the other two, an abscess without anastomotic leakage. In some cases of suspected complications arising after PPPD, and including anastomotic leakage and abdominal abscess, leakage is not revealed by conventional fluoroscopic studies; in such cases, CT scanning may help detect the complications and determine the site of anastomotic leakage. (author). 10 refs., 2 figs.

  14. OSAS Surgery and Postoperative Discomfort: Phase I Surgery versus Phase II Surgery

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    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.

  15. Mucoceles in post-operative maxillary sinuses: CT and MR findings

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    Han, Moon Hee; Chang, Kee Hyun; Min, Yang Gi; Yeon, Kyung Mo; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1994-03-15

    This study describes the CT and MR findings of mucoceles occurred in the post-operative maxillary sinuses. CT and/or MR of 19 maxillary mucoceles in 16 patients who had been operated by Caldwell-Luc procedure were reviewed. CT scans were performed after contrast enhancement in axial and coronal planes with 5mm thickness. Three cases were studied with a 2.0 T or 0.5 T MRI, which demonstrated multi-compartment lesions. The lesions were bilateral in 3 cases. Compartmentalization of the antral cavity was seen in 7 out of 19 involved sinuses. Surgical bone defect of the anterior wall was the most frequent route of extension (11 cases) and extension into the infratemporal fossa with erosion of posterolateral wall was seen in 7 lesions. In 6 cases, the lesion involved orbit. The expansile and erosive bone changes were localized in every case. In one case with multi-compartment lesion, both T1-and T2-weighted MR images showed different signal intensities in each compartment which represented different protein concentration. Post-operative maxillary mucocele showed CT findings of localized erosion and bulging most frequently at the anterior wall in which the bone windows were made during he previous surgery. Post-operative compartmentalization of maxillary antrum may cause eccentric expansion of mucocele and each compartment may show different signal intensities on MR.

  16. Questions That Science Teachers Find Difficult (II).

    Science.gov (United States)

    Goodwin, Alan

    2003-01-01

    Presents some questions that science teachers find difficult. Focuses on three further questions relating to "simple" everyday situations that are normally explained in terms of the kinetic theory of matter. Identifies looking at the difference between chemical and physical changes as the most problematic question. (Author/YDS)

  17. Questions That Science Teachers Find Difficult (II).

    Science.gov (United States)

    Goodwin, Alan

    2003-01-01

    Presents some questions that science teachers find difficult. Focuses on three further questions relating to "simple" everyday situations that are normally explained in terms of the kinetic theory of matter. Identifies looking at the difference between chemical and physical changes as the most problematic question. (Author/YDS)

  18. Clinical prediction of postoperative seizure control: structural, functional findings and disease histories.

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    Stefan, H; Hildebrandt, M; Kerling, F; Kasper, B S; Hammen, T; Dörfler, A; Weigel, D; Buchfelder, M; Blümcke, I; Pauli, E

    2009-02-01

    Mesial temporal lobe epilepsy (MTLE) constitutes a heterogenic entity with different clinical histories, pathomorphological hippocampal findings and varying postoperative outcome. 64 patients with MTLE, scheduled for hippocampal resection, were included. Initial precipitating injuries (IPI), structural and functional findings and neuropathological classification of hippocampal specimens were related to prediction of surgical outcome. Patients with severe hippocampal sclerosis (mesial temporal sclerosis (MTS) type 1b) became completely seizure free (80% Engel Ia) significantly more often compared with approximately 40% of seizure freedom in other types of MTS or in patients without hippocampal cell loss (non-MTS), irrespective of the extent of hippocampal resection. Age at IPI was found to be related to MTS variants (psilent period of about 5 years; (3) unequivocal unilateral EEG localisation; (4) MRI signs of MTS; and (5) Wada Test indicates contralateral memory compensation and ipsilateral reduced memory capacity. MTS type 1b, characterised by severe cell loss in all hippocampal subfields including the dentate gyrus, and associated with optimal postoperative seizure control, was preoperatively clinically best differentiated from other MTS types by the Wada Memory Test.

  19. Preventing postoperative tooth sensitivity in class I, II and V restorations.

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    Christensen, Gordon J

    2002-02-01

    Postoperative tooth sensitivity in Class I, II and V resin-based composite restorations continues to be an unpredictable problem in dentistry. In spite of meticulous use of dentin bonding agents, dentists and patients are faced with the sensitivity problem and the frustrating need to remove restorations and occasionally accomplish endodontic therapy on teeth that were not sensitive before the restorations were placed. Practitioners have developed numerous preventive methods to overcome the sensitivity challenge, which I have described in this article.

  20. Chronic postoperative pain: recent findings in understanding and management [version 1; referees: 3 approved

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    Darin Correll

    2017-07-01

    Full Text Available Chronic postoperative pain is a poorly recognized potential outcome from surgery. It affects millions of patients every year, with pain lasting for months to years, resulting in patient suffering and ensuing economic consequences. The operations with the highest incidence of chronic postoperative pain are amputations, thoracotomies, cardiac surgery, and breast surgery. Other risk factors include preoperative pain, psychological factors, demographics, and the intensity of acute postoperative pain. Attempts to prevent chronic postoperative pain have often led to debatable results. This article presents data from recently published studies examining the incidence, risk factors, mechanisms, treatment options, and preventive strategies for chronic postoperative pain in adults. In summary, many of the previously identified risk factors for chronic postoperative pain have been confirmed and some novel ones discovered, such as the importance of the trajectory of acute pain and the fact that catastrophizing may not always be predictive. The incidence of chronic postoperative pain hasn’t changed over time, and there is limited new information regarding an effective preventive therapy. For example, pregabalin may actually cause more harm in certain surgeries. Further research is needed to demonstrate whether multimodal analgesic techniques have the best chance of significantly reducing the incidence of chronic postoperative pain and to determine which combination of agents is best for given surgical types and different patient populations.

  1. Magnetic resonance imaging findings of disc-related epidural cysts in nonsurgical and postoperative patients

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    Simao, Marcelo Novelino, E-mail: marcelo_simao@hotmail.com [Central de Diagnostico Ribeirao Preto (CEDIRP), Ribeirao Preto, SP (Brazil); Helms, Clyde A. [Radiology, Musculoskeletal Section, Duke University Medical Center, Durham, NC (United States); Richardson, William J. [Orthopedic Surgery, Spine Surgery Section, Duke University Medical Center, Durham, NC (United States)

    2012-07-15

    Objective: To demonstrate five discal cysts with detailed magnetic resonance imaging findings in nonsurgical and following postoperative microdiscectomy. Materials And Methods: Five discal cysts in four patients who underwent magnetic resonance imaging were found through a search in our database and referral from a single orthopedic spine surgeon. Computed tomography in two cases and computed tomography discography in one case were also performed. Results: Five discal cysts were present in four patients. Three patients had no history of previous lumbar surgery and the other patient presented with two discal cysts and recurrent symptoms after partial laminectomy and microdiscectomy. All were oval shaped and seated in the anterior epidural space. Four were ventrolateral, and the other one was centrally positioned in the anterior spinal canal. One showed continuity with the central disc following discography. Three were surgically removed. Conclusion: Magnetic resonance imaging can easily depict an epidural cyst and the diagnosis of a discal cyst should be raised when an homogeneous ventrolateral epidural cyst contiguous to a mild degenerated disc is identified. (author)

  2. Detection of postoperative residual cholesteatoma with delayed contrast-enhanced MR imaging: initial findings

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    Williams, Marc T.; Heran, Francoise; Lafitte, Francois; Elmaleh-Berges, Monique; Piekarski, Jean-Daniel [Department of Medical Imaging, Fondation Ophthalmologique Adolphe de Rothschild, 25, rue Manin, 75940 Paris (France); Ayache, Denis [Department of Otorhinolaryngology, Fondation Ophthalmologique Adolphe de Rothschild, 25, rue Manin, 75940 Paris (France); Alberti, Corinne [Department of Biostatistics, Hopital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris (France)

    2003-01-01

    Our objective was to assess the value of delayed contrast-enhanced T1-weighted spin-echo MR imaging in the detection of residual cholesteatoma in patients who have undergone canal wall-up tympanoplasty procedure. The MR imaging was obtained prior to revision surgery in 18 patients with opacity of the post-operative cavity at CT examination 12-18 months after canal wall-up tympanoplasty. In each patient the following was performed: precontrast T1- and T2-weighted images; and early and delayed contrast-enhanced axial and coronal T1-weighted imaging. Early and delayed MR imaging results were separately compared with surgical second-look findings. Sensitivity, specificity, and predictive values were evaluated for early and delayed post-contrast MR imaging, compared with second-look surgery findings. A residual cholesteatoma was correctly identified in 8 of 9 cases with delayed contrast-enhanced T1-weighted MR imaging. Mean sensitivity, specificity, positive predictive value, and interobserver agreement (evaluated by kappa statistics) were, respectively, 85.2, 92.6, 92.6%, and kappa=0.78 for the delayed contrast-enhanced MR imaging technique. The same parameters were, respectively, 96.3, 33.3, 60.6, and 0.30 for the early contrast-enhanced T1-weighted MR images. We conclude that delayed contrast-enhanced T1-weighted MR imaging is reliable for the detection of residual cholesteatomas of the middle ear in patients who have undergone canal wall-up tympanoplasty. (orig.)

  3. A combination of preoperative CT findings and postoperative serum CEA levels improves recurrence prediction for stage I lung adenocarcinoma.

    Science.gov (United States)

    Yamazaki, Motohiko; Ishikawa, Hiroyuki; Kunii, Ryosuke; Tasaki, Akiko; Sato, Suguru; Ikeda, Yohei; Yoshimura, Norihiko; Hashimoto, Takehisa; Tsuchida, Masanori; Aoyama, Hidefumi

    2015-01-01

    To assess the prognostic value of combined evaluation of preoperative CT findings and pre/postoperative serum carcinoembryonic antigen (CEA) levels for pathological stage I lung adenocarcinoma. This retrospective study included 250 consecutive patients who underwent complete resection for ≤ 3-cm pathological stage I (T1-2aN0M0) adenocarcinomas (132 men, 118 women; mean age, 67.8 years). Radiologists evaluated following CT findings: maximum tumor diameter, percentage of solid component (%solid), air bronchogram, spiculation, adjacency of bullae or interstitial pneumonia (IP) around the tumor, notch, and pleural indent. These CT findings, pre/postoperative CEA levels, age, gender, and Brinkman index were assessed by Cox proportional hazards model to determine the best prognostic model. Prognostic accuracy was examined using the area under the receiver operating characteristic curve (AUC). Median follow-up period was 73.2 months. In multivariate analysis, high %solid, adjacency of bullae or IP around the tumor, and high postoperative CEA levels comprised the best combination for predicting recurrence (Psensitivity of 85.7% and a specificity of 74.3% at the optimal threshold. The best cut-off values of %solid and postoperative CEA levels for predicting high-risk patients were ≥ 48% and ≥ 3.7 ng/mL, respectively. Compared to %solid alone, combined evaluation of %solid, adjacency of bullae or IP change around the tumor, and postoperative CEA levels improves recurrence prediction for stage I lung adenocarcinoma. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Intraoperative findings and postoperative CT-follow-up of inflammatory aortic aneurysms; Intraoperative Befunde und postoperative computertomographische Verlaufskontrolle des inflammatorischen Aortenaneurysmas

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    Koch, J.A.; Poll, L.; Moedder, U. [Duesseldorf Univ. (Germany). Inst. fuer Diagnostische Radiologie; Klinger, G.; Kniemeyer, H.W. [Duesseldorf Univ. (Germany). Abt. Gefaesschirurgie und Nierentransplantation

    1998-08-01

    Retrospective evaluation of postoperative long-term results after surgery of inflammatory aortic aneurysms (IAAA) with computed tomography (CT). Findings in CT were analysed with particular attention to the development of inflammatory tissue adjacent to the aneurysm site. Results: All follow-up-studies revealed a correct location of the aortic prostheses. In 85.1% of the cases there was either no or negligible persisting inflammatory tissue with a diameter of less than 2 mm. 10.6% of the patients demonstrated remaining but reduced inflammatory tissue. In 4.3% of the cases the extent of the inflammatory tissue had not changed. Aneurysms of the anastomoses (n=4), morphologic renal changes (n=7) and an aorto-enteric fistula were demonstrated by CT as postoperative complications. Conclusions: In evaluating recurrence of the aneurysm and possible complications as well as the development of the inflammatory tissue, postoperatively performed computed tomography proved a reliable diagnostic method. (orig.) [Deutsch] Retrospektiv wurden an einem grossen Patientenkollektiv computertomographisch die postoperativen Langzeitergebnisse nach prothetischem Ersatz eines inflammatorischen Aortenaneurysmas (IAAA) bewertet. Insbesondere interessierte das Ausmass der Rueckbildungsfaehigkeit des perianeurysmal gelegenen inflammatorischen Gewebes. Ergebnisse: In saemtlichen Verlaufs-Untersuchungen fand sich eine regelrechte Prothesenlage. In 85,1% der Faelle wurde entweder kein oder allenfalls minimales inflammatorisches Restgewebe (Breite < 2 mm) gefunden. In 10,6% der Faelle zeigte sich inflammatorisches Restgewebe, bei 4,3% der Patienten war das Ausmass der Entzuendung im Vergleich zur praeoperativen Situation unveraendert. Nachzuweisende Komplikationen waren Anastomosenaneurysmen (n=4), auf einer ureteralen Abflussbehinderung basierende morphologische Veraenderungen der Nieren (n=7) sowie aortoenterale Fisteln (n=1). Schlussfolgerungen: Die zum Ausschluss eines Rezidiv

  5. Comparison of MR imaging findings between post-operative change and residual/recurrent tumor in cerebral glioma

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    Sim, Jung Suk; Chang, Kee Hyun; Han, Moon Hee; Park, Hong Suk; Jung Hee Won [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of)

    1996-11-01

    To describe the MR imaging findings of post-operative change and residual/recurrent tumor following resection of the glioma and to determine whether there are any specific MR imaging findings useful for differentiation of post-operative change from a residual/recurrent tumor. We retrospectively analysed 71 post-operative follow-up brain MR images of 26 patients who had undergone surgical resection of intracranial glioma. They consisted of 49 MRI studies of 12 patients with post-operative change and 22 MRI studies of 14 patients with residual/recurrent tumors. The follow-up MRI examinations were performed from one to 75 months after tumor resection. The lesion was defined as post-operative change when any enhancing lesion disappeared or diminished during follow-up MRI studies of at least 20 months. The diagnosis of residual/recurrent tumor was established when on MR images, lesion size increased definitively during the follow up period of between four and 66 months;residual/recurrent tumors were surgically proven in five patients. The shape, degree of contrast enhancement and time of appearance and disappearance of the lesions were analysed. Post-operative change consisted of hemorrhage(n=3), marginal(n=7) and nodular(n=1) enhancement of sugical bed, adjacent dural enhancement(n=9), extracerebral fluid collection(n=4) and only tissue defect(n=1). Hemorrhage was obseved at between two and eight months;marginal and nodular enhancement of surgical bed were seen at between three and 30 months (usually less than one year);dural enhancement and fluid collection were seen at between three and 75 months. Residual/recurrent tumor appeared most frequently as enhancing solid nodules(n=7) or solid and cystic masses(n=2) followed by non-enhancing solid nodules(n=3). In five of seven cases, marginal enhancement of a residual/recurrent tumor appeared after more than one year. Marginal and dural enhancement around surgical tissue defects are the most common finding of post-operative

  6. A combination of preoperative CT findings and postoperative serum CEA levels improves recurrence prediction for stage I lung adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Motohiko, E-mail: xackey2001@gmail.com [Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences (Japan); Ishikawa, Hiroyuki [Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences (Japan); Kunii, Ryosuke [Division of Cellular and Molecular Pathology, Niigata University Graduate School of Medical and Dental Sciences (Japan); Tasaki, Akiko; Sato, Suguru; Ikeda, Yohei; Yoshimura, Norihiko [Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences (Japan); Hashimoto, Takehisa; Tsuchida, Masanori [Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences (Japan); Aoyama, Hidefumi [Department of Radiology, Niigata University Graduate School of Medical and Dental Sciences (Japan)

    2015-01-15

    Objectives: To assess the prognostic value of combined evaluation of preoperative CT findings and pre/postoperative serum carcinoembryonic antigen (CEA) levels for pathological stage I lung adenocarcinoma. Methods: This retrospective study included 250 consecutive patients who underwent complete resection for ≤3-cm pathological stage I (T1–2aN0M0) adenocarcinomas (132 men, 118 women; mean age, 67.8 years). Radiologists evaluated following CT findings: maximum tumor diameter, percentage of solid component (%solid), air bronchogram, spiculation, adjacency of bullae or interstitial pneumonia (IP) around the tumor, notch, and pleural indent. These CT findings, pre/postoperative CEA levels, age, gender, and Brinkman index were assessed by Cox proportional hazards model to determine the best prognostic model. Prognostic accuracy was examined using the area under the receiver operating characteristic curve (AUC). Results: Median follow-up period was 73.2 months. In multivariate analysis, high %solid, adjacency of bullae or IP around the tumor, and high postoperative CEA levels comprised the best combination for predicting recurrence (P < 0.05). A combination of these three findings had a greater accuracy in predicting 5-year disease-free survival than did %solid alone (AUC = 0.853 versus 0.792; P = 0.023), with a sensitivity of 85.7% and a specificity of 74.3% at the optimal threshold. The best cut-off values of %solid and postoperative CEA levels for predicting high-risk patients were ≥48% and ≥3.7 ng/mL, respectively. Conclusion: Compared to %solid alone, combined evaluation of %solid, adjacency of bullae or IP change around the tumor, and postoperative CEA levels improves recurrence prediction for stage I lung adenocarcinoma.

  7. Fibrosis and postoperative fistula of the pancreas: correlation with MR imaging findings--preliminary results.

    Science.gov (United States)

    Watanabe, Haruo; Kanematsu, Masayuki; Tanaka, Kaori; Osada, Shinji; Tomita, Hiroyuki; Hara, Akira; Goshima, Satoshi; Kondo, Hiroshi; Kawada, Hiroshi; Noda, Yoshifumi; Tanahashi, Yukichi; Kawai, Nobuyuki; Yoshida, Kazuhiro; Moriyama, Noriyuki

    2014-03-01

    To assess the potential value of magnetic resonance (MR) imaging in evaluating pancreatic fibrosis and predicting the development of postoperative pancreatic fistula. This retrospective study had institutional review board approval, and the requirement for informed consent was waived. MR images obtained in 29 consecutive patients (15 men, 14 women; mean age, 64.9 years; age range, 21-80 years) who underwent pancreatectomy were evaluated. The pancreas-to-muscle signal intensity (SI) ratio on unenhanced T1- and T2-weighted, dynamic contrast material-enhanced, and diffusion-weighted images and the apparent diffusion coefficient (ADC) of the pancreas were measured. MR imaging parameters were correlated with the degrees of pancreatic fibrosis and expression of activated pancreatic stellate cells (PSCs) by using univariate and multivariate regression analyses and receiver operating characteristic curve analysis. The relationships between the development of postoperative pancreatic fistula and the MR imaging measurements were examined by using logistic regression analysis and the Mann-Whitney U test. Multiple regression analysis showed that pancreas-to-muscle SI ratios on T1-weighted images and ADC values were independently associated with pancreatic fibrosis (r(2) = 0.66, P fistula (1.6 ± 0.2) than for those without (1.2 ± 0.2), and the odds ratio for postoperative pancreatic fistula was 21.3 in patients with an SI ratio of 1.41 and higher. The pancreas-to-muscle SI ratio on T1-weighted MR images of the pancreas may be a potential biomarker for assessment of pancreatic fibrosis and prediction of postoperative pancreatic fistula. RSNA, 2013

  8. Rotator cuff tears: correlation between geometric tear patterns on MRI and arthroscopy and pre- and postoperative clinical findings.

    Science.gov (United States)

    Sela, Yaron; Eshed, Iris; Shapira, Shachar; Oran, Ariel; Vogel, Guy; Herman, Amir; Perry Pritsch, Moshe

    2015-02-01

    Magnetic resonance imaging (MRI) is considered to be the best non-invasive procedure for the evaluation of rotator cuff (RC) tendon tears. Burkhart's classification is a geometric classification of full-thickness RC tears on MRI. To correlate MRI and arthroscopic geometric full-thickness RC tears according to the Burkhart's classification with pre- and postoperative clinical findings. Patients who underwent arthroscopic RC repair between 2006 and 2010 were retrospectively evaluated. Preoperative MRI and arthroscopic surgical reports were reviewed for tear geometry (Burkhart's) by three (1 radiologist, 2 surgeons) and two (surgeons) readers. MRIs were also evaluated for tear size and change of tear size in successive sagittal sections and for muscle mass and fatty infiltration. Clinical examinations were performed preoperatively and at least 12 months afterwards. Postoperative function questionnaires were filled in by the patients. Forty-six patients (35 men, 11 women; mean age, 57 years; range, 41-72 years) were evaluated. Tears depicted on MRIs were classified as crescent in 11 patients (24%), longitudinal in three (6.5%), massive contracted in 29 (63%), and cuff arthropathy in three (6.5%). Muscle changes were noted almost exclusively in patients with massive tears and cuff arthropathy (16/32 patients, P = 0.013). MRIs and arthroscopic geometric classifications were in close agreement. Tear type did not correlate with pre- and postoperative physical examination or with postoperative clinical questionnaires scores. Geometric RC tear characterizations on preoperative MRIs were closely associated with arthroscopic findings. Postoperative results were not affected by the geometric pattern of the tears. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  9. Comparative analyses of postoperative complications and prognosis of different surgical procedures in stage II endometrial carcinoma treatment

    Directory of Open Access Journals (Sweden)

    Yin H

    2016-02-01

    Full Text Available Hongmei Yin,1 Ting Gui2 1Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou Medical University, Binzhou, Shandong, 2Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China Objective: To investigate the impact of surgical resection extent on the postoperative complications and the prognosis in patients with stage II endometrial cancer. Methods: A total of 54 patients were retrospectively reviewed, 35 patients underwent subradical hysterectomy and 19 patients received radical hysterectomy, both with simultaneous bilateral salpingo-oophorectomy and pelvic and paraaortic lymphadenectomy. Results: Comparing the surgical outcomes in subradical hysterectomy group vs radical hysterectomy group, there were no significant differences in operative time, estimated blood loss, and hospital stay. After surgery, 37.1% vs 36.8% patients received postoperative radiotherapy in the subradical hyster­ectomy group vs radical hysterectomy group, without statistically significant difference. As for postoperative complications, the early postoperative complication rate in patients who underwent subradical hysterectomy was 14.3%, significantly lower than that in patients submitted to radical hysterectomy (14.3% vs 42.1%, with P=0.043. However, there was no significant difference in late postoperative complication rate between the two surgical procedures. Regarding the clinical prognosis, patients receiving the subradical hysterectomy showed similar survival to their counterparts undergoing the radical procedures. The relapse rate was 5.71% vs 5.26%, respectively, without significant difference. There were no deaths in both surgical groups. Conclusion: For stage II endometrial carcinoma, subradical hysterectomy presented with less early postoperative complications and similar survival duration and recurrence

  10. Pancreatic surgical biopsy in 24 dogs and 19 cats: postoperative complications and clinical relevance of histological findings.

    Science.gov (United States)

    Pratschke, K M; Ryan, J; McAlinden, A; McLauchlan, G

    2015-01-01

    To assess the immediate postoperative complications associated with pancreatic biopsy in dogs and cats and review the clinical relevance of biopsy findings. Retrospective review of clinical records from two referral institutions for cases undergoing pancreatic biopsy between 2000 and 2013. Twenty-four dogs and 19 cats that had surgical pancreatic biopsy had sufficient detail in their clinical records and fulfilled the inclusion criteria. Postoperative complications were seen in 10 cases of which 5 were suggestive of post-surgical pancreatitis. Two patients were euthanased within 10 days of surgery because of the underlying disease; neither suffered postoperative complications. Pancreatic pathology was found in 19 cases, 7 cases showed no change other than benign pancreatic nodular hyperplasia, and no abnormalities were seen in 18 cases. Complications may be encountered following surgical pancreatic biopsy, although the risk should be minimal with good surgical technique. Pancreatic biopsy may provide a useful contribution to case management but it is not clear whether a negative pancreatic biopsy should be used to rule out pancreatic disease. Dogs were more likely to have no significant pathology found on pancreatic biopsy than cats, where chronic pancreatitis was the most common finding. © 2014 British Small Animal Veterinary Association.

  11. The BREASTrial Stage II: ADM Breast Reconstruction Outcomes from Definitive Reconstruction to 3 Months Postoperative.

    Science.gov (United States)

    Mendenhall, Shaun D; Anderson, Layla A; Ying, Jian; Boucher, Kenneth M; Neumayer, Leigh A; Agarwal, Jayant P

    2017-01-01

    The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a prospective randomized trial comparing outcomes of tissue expander breast reconstruction using either AlloDerm or DermaMatrix. The trial was divided into 3 outcome stages; this study reports stage II outcomes, which are those from the time of definitive reconstruction to 3 months postoperative. A randomized trial was conducted to compare complication rates between AlloDerm and DermaMatrix groups. The impact of matrix type, age, obesity, radiation therapy, chemotherapy, and reconstruction type on complications was analyzed with regression models. Of the 128 patients (199 breasts) who were randomly assigned into the trial, 111 patients (173 breasts) were available for analysis in stage II. There was no difference in overall rates of complications (15.4% vs 18.3%, P = 0.8) or implant loss (2.2% vs 3.7%, P = 0.5) between the AlloDerm and DermaMatrix groups, respectively. Obesity was the only significant predictor of complications on regression analysis (odds ratio, 4.31, P = 0.007). Matrix type, age, radiation therapy, chemotherapy, or reconstruction type had no impact on the incidence/severity of complications. Acellular dermal matrix (ADM) will likely continue to have a role in breast reconstructive surgery; however, caution should be taken when using ADM because of relatively high complication rates, especially in obese patients. The particular ADM product should be selected based on individual surgeon preference, experience, and success rates. These data and forthcoming long-term outcomes from the Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial will enable surgeons to carefully weigh the risks and benefits of ADM use in breast reconstruction.

  12. The BREASTrial Stage II: ADM Breast Reconstruction Outcomes from Definitive Reconstruction to 3 Months Postoperative

    Science.gov (United States)

    Mendenhall, Shaun D.; Anderson, Layla A.; Ying, Jian; Boucher, Kenneth M.; Neumayer, Leigh A.

    2017-01-01

    Background: The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a prospective randomized trial comparing outcomes of tissue expander breast reconstruction using either AlloDerm or DermaMatrix. The trial was divided into 3 outcome stages; this study reports stage II outcomes, which are those from the time of definitive reconstruction to 3 months postoperative. Methods: A randomized trial was conducted to compare complication rates between AlloDerm and DermaMatrix groups. The impact of matrix type, age, obesity, radiation therapy, chemotherapy, and reconstruction type on complications was analyzed with regression models. Results: Of the 128 patients (199 breasts) who were randomly assigned into the trial, 111 patients (173 breasts) were available for analysis in stage II. There was no difference in overall rates of complications (15.4% vs 18.3%, P = 0.8) or implant loss (2.2% vs 3.7%, P = 0.5) between the AlloDerm and DermaMatrix groups, respectively. Obesity was the only significant predictor of complications on regression analysis (odds ratio, 4.31, P = 0.007). Matrix type, age, radiation therapy, chemotherapy, or reconstruction type had no impact on the incidence/severity of complications. Conclusions: Acellular dermal matrix (ADM) will likely continue to have a role in breast reconstructive surgery; however, caution should be taken when using ADM because of relatively high complication rates, especially in obese patients. The particular ADM product should be selected based on individual surgeon preference, experience, and success rates. These data and forthcoming long-term outcomes from the Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial will enable surgeons to carefully weigh the risks and benefits of ADM use in breast reconstruction. PMID:28203509

  13. An Overview of the BIOMOVS II Study and its Findings

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-11-01

    BIOMOVS II. Section 2 provides information on the overall study objectives; the organisational structure of the study and its Working Groups are described in Section 3. Section 4 describes the objectives of the individual Working Groups and summarises their key scientific and technical findings. Section 5 examines the extent to which the main objectives of the study have been fulfilled, assesses progress in generic aspects of biosphere modelling, summarises overall conclusions and implications, and provides suggestions for further work. The primary objectives of BIOMOVS II were threefold: 1. to test the accuracy of the predictions of environmental assessment models for selected contaminants and exposure scenarios; 2. to explain differences in model predictions due to differences in model structure, modelling assumptions and/or differences in selected input data; 3. to recommend priorities for future research to improve the accuracy of model predictions. A secondary objective of the study was to act as a forum for the exchange of ideas, experience and information in order to improve the confidence with which the behaviour of trace substances in the biosphere could be assessed quantitatively. It was the aim of BIOMOVS II that this forum should include modelers and other scientists working in the fields of safety assessment, radioecology, geology, climatology, etc, as well as experimentalists performing laboratory studies in these areas. In developing these objectives, additional objectives consistent with the background to the project were established within the individual themes addressed within BIOMOVS II. Notably, these included methodological developments for radiological assessments. Two different approaches were employed within BIOMOVS II for fulfilling these objectives. One approach to model testing, Approach A, involved the formulation of test scenarios based on suitable data and a comparison of model predictions against these independent data sets. The other

  14. Obstetric ultrasonographic findings of Chiari type II: Case report

    Directory of Open Access Journals (Sweden)

    Alptekin Tosun

    2009-01-01

    Full Text Available Chiari malformations divided into 3 groups. Chiari type I malformation is caudal protrusion of cerebellar tonsils. Type II malformation is the most common and associate with meningomyelocele. Type III is a high cervical men-ingoencephalocele and uncommon.Spina bifida, has classified into open and closed forms as skin covered spine lesions. Cranial signs are not ac-companiment on closed type. Open type usually diag-nosed on prenatal period. Typical findings are ventricu-lomegaly, lemon sign (bifrontal indentation, banana sign (Chiari II malformation, obliteration of cisterna magna and small BPD and body measurements according to gestation age. Occipital horns are higher than 10 mm in ventriculomegaly. Choroid plexus are small and looking like tear. Limon sign defines biconcave frontal bones as looking like a lemon. Banana sign and obliteration of cis-terna magna resulted cause of hypoplasia of posterior fossa. Compression of cerebellum causing abnormal lo-calization, although cerebellar tonsils and vermis herni-ated to foramen magnum. Hemispheres are wrapping brain stem and looking like ‘‘C’’ (banana sign. Spinal longitudinal sonogram reveals open spine and skin de-fect, although dilatation on spine canal and increased in-terpedincular distance.

  15. Noncardiac findings on cardiac CT. Part II: spectrum of imaging findings.

    LENUS (Irish Health Repository)

    Killeen, Ronan P

    2012-02-01

    Cardiac computed tomography (CT) has evolved into an effective imaging technique for the evaluation of coronary artery disease in selected patients. Two distinct advantages over other noninvasive cardiac imaging methods include its ability to directly evaluate the coronary arteries and to provide a unique opportunity to evaluate for alternative diagnoses by assessing the extracardiac structures, such as the lungs and mediastinum, particularly in patients presenting with the chief symptom of acute chest pain. Some centers reconstruct a small field of view (FOV) cropped around the heart but a full FOV (from skin to skin in the area irradiated) is obtainable in the raw data of every scan so that clinically relevant noncardiac findings are identifiable. Debate in the scientific community has centered on the necessity for this large FOV. A review of noncardiac structures provides the opportunity to make alternative diagnoses that may account for the patient\\'s presentation or to detect important but clinically silent problems such as lung cancer. Critics argue that the yield of biopsy-proven cancers is low and that the follow-up of incidental noncardiac findings is expensive, resulting in increased radiation exposure and possibly unnecessary further testing. In this 2-part review we outline the issues surrounding the concept of the noncardiac read, looking for noncardiac findings on cardiac CT. Part I focused on the pros and cons for and against the practice of identifying noncardiac findings on cardiac CT. Part II illustrates the imaging spectrum of cardiac CT appearances of benign and malignant noncardiac pathology.

  16. Postoperative computed tomography and low-field magnetic resonance imaging findings in dogs with degenerative lumbosacral stenosis treated by dorsal laminectomy.

    Science.gov (United States)

    Rapp, Martin; Ley, Charles J; Hansson, Kerstin; Sjöström, Lennart

    2017-03-20

    To describe postoperative computed tomography (CT) and magnetic resonance imaging (MRI) findings in dogs with degenerative lumbosacral stenosis (DLSS) treated by dorsal laminectomy and partial discectomy. Prospective clinical case study of dogs diagnosed with and treated for DLSS. Surgical and clinical findings were described. Computed tomography and low field MRI findings pre- and postoperatively were described and graded. Clinical, CT and MRI examinations were performed four to 18 months after surgery. Eleven of 13 dogs were clinically improved and two dogs had unchanged clinical status postoperatively despite imaging signs of neural compression. Vacuum phenomenon, spondylosis, sclerosis of the seventh lumbar (L7) and first sacral (S1) vertebrae endplates and lumbosacral intervertebral joint osteoarthritis became more frequent in postoperative CT images. Postoperative MRI showed mild disc extrusions in five cases, and in all cases contrast enhancing non-discal tissue was present. All cases showed contrast enhancement of the L7 spinal nerves both pre- and postoperatively and seven had contrast enhancement of the lumbosacral intervertebral joints and paraspinal tissue postoperatively. Articular process fractures or fissures were noted in four dogs. The study indicates that imaging signs of neural compression are common after DLSS surgery, even in dogs that have clinical improvement. Contrast enhancement of spinal nerves and soft tissues around the region of disc herniation is common both pre- and postoperatively and thus are unreliable criteria for identifying complications of the DLSS surgery.

  17. FINDING THE FIRST COSMIC EXPLOSIONS. II. CORE-COLLAPSE SUPERNOVAE

    Energy Technology Data Exchange (ETDEWEB)

    Whalen, Daniel J. [Department of Physics, Carnegie Mellon University, Pittsburgh, PA 15213 (United States); Joggerst, Candace C. [T-2, Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); Fryer, Chris L. [CCS-2, Los Alamos National Laboratory, Los Alamos, NM 87545 (United States); Stiavelli, Massimo [Space Telescope Science Institute, 3700 San Martin Drive, Baltimore, MD 21218 (United States); Heger, Alexander [School of Physics and Astronomy, University of Minnesota, Minneapolis, MN 55455 (United States); Holz, Daniel E. [Enrico Fermi Institute, Department of Physics, and Kavli Institute for Cosmological Physics, University of Chicago, Chicago, IL 60637 (United States)

    2013-05-01

    Understanding the properties of Population III (Pop III) stars is prerequisite to elucidating the nature of primeval galaxies, the chemical enrichment and reionization of the early intergalactic medium, and the origin of supermassive black holes. While the primordial initial mass function (IMF) remains unknown, recent evidence from numerical simulations and stellar archaeology suggests that some Pop III stars may have had lower masses than previously thought, 15-50 M{sub Sun} in addition to 50-500 M{sub Sun }. The detection of Pop III supernovae (SNe) by JWST, WFIRST, or the TMT could directly probe the primordial IMF for the first time. We present numerical simulations of 15-40 M{sub Sun} Pop III core-collapse SNe performed with the Los Alamos radiation hydrodynamics code RAGE. We find that they will be visible in the earliest galaxies out to z {approx} 10-15, tracing their star formation rates and in some cases revealing their positions on the sky. Since the central engines of Pop III and solar-metallicity core-collapse SNe are quite similar, future detection of any Type II SNe by next-generation NIR instruments will in general be limited to this epoch.

  18. Waardenburg syndrome type II: phenotypic findings and diagnostic criteria.

    Science.gov (United States)

    Liu, X Z; Newton, V E; Read, A P

    1995-01-02

    The Waardenburg syndrome (WS) consists of at least two distinct autosomal dominant hereditary disorders. WS Type I has been mapped to the distal part of chromosome 2q and the gene identified as PAX3. Other gene(s) are responsible for WS Type II. Mapping WS Type II requires accurate diagnosis within affected families. To establish diagnostic criteria for WS Type II, 81 individuals from 21 families with Type II WS were personally studied, and compared with 60 personally studied patients from 8 families with Type I and 253 cases of WS (Type I or II) from the literature. Sensorineural hearing loss (77%) and heterochromia iridum (47%) were the two most important diagnostic indicators for WS Type II. Both were more common in Type II than in Type I. Other clinical manifestations, such as white forelock and skin patches, were more frequent in Type I. We estimate the frequency of phenotypic traits and propose diagnostic criteria for WS Type II. In practice, a diagnosis of WS Type II can be made with confidence given a family history of congenital hearing loss and pigmentary disorders, where individuals have been accurately measured for ocular distances to exclude dystopia canthorum.

  19. Postoperative spine; Postoperative Wirbelsaeule

    Energy Technology Data Exchange (ETDEWEB)

    Schlaeger, R. [Universitaetsspital Basel, Neurologische Klinik und Poliklinik, Basel (Switzerland); Lieb, J.M. [Universitaetsspital Basel, Klinik fuer Radiologie und Nuklearmedizin, Basel (Switzerland); Shariat, K. [Neurochirurgie Koeln-Merheim, Koeln (Germany); Ahlhelm, F.J. [Kantonsspital Baden AG, Abteilung Neuroradiologie, Institut fuer Radiologie, Baden (Switzerland)

    2014-11-15

    Approximately 15-30 % of surgical procedures involving the lumbar spine are associated with complications that require further diagnostic work-up. The choice of imaging modality for postoperative complications depends on the extent, pattern and temporal evolution of the postoperative neurological signs and symptoms as well as on the preoperative clinical status, the surgical procedure itself and the underlying pathology. The interpretation of imaging findings, in particular the distinction between postoperative complications and normally expected nonspecific postoperative imaging alterations can be challenging and requires the integration of clinical neurological information and the results of laboratory tests. The combination of different imaging techniques might help in cases of equivocal imaging results. (orig.) [German] Etwa 15-30 % der operativen Eingriffe im Bereich der lumbalen Wirbelsaeule verlaufen nicht komplikationsfrei und erfordern weiterfuehrende Abklaerungen. Die Auswahl des bildgebenden Verfahrens im Rahmen postoperativer Komplikationen haengt dabei wesentlich von der zeitlichen Entwicklung, dem Ausmass und Verteilungsmuster der neuaufgetretenen klinisch-neurologischen bzw. orthopaedischen Symptome sowie von den Ausfaellen vor dem Eingriff, der zugrundeliegenden Pathologie und der Lokalisation und Art des Eingriffs ab. Die Interpretation der bildgebenden Befunde, insbesondere die Abgrenzung postoperativer Komplikationen von natuerlicherweise zu erwartenden postoperativen Veraenderungen kann dabei eine Herausforderung darstellen. Bei unklaren Befunden kann ergaenzend zur eingehend klinisch-neurologischen und laborchemischen Bestandsaufnahme auch der kombinierte Einsatz mehrerer bildgebender Modalitaeten diagnostisch weiterhelfen. (orig.)

  20. Early post-operative magnetic resonance imaging in glioblastoma: correlation among radiological findings and overall survival in 60 patients

    Energy Technology Data Exchange (ETDEWEB)

    Majos, Carles [IDI Centre Bellvitge, HU de Bellvitge, Department of Radiology, Barcelona (Spain); Centro de Investigacion en Red en Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona (Spain); Hospital Duran i Reynals, IDI Centre Bellvitge, Barcelona (Spain); Cos, Monica; Castaner, Sara [IDI Centre Bellvitge, HU de Bellvitge, Department of Radiology, Barcelona (Spain); Gil, Miguel [ICO l' Hospitalet, HU de Bellvitge, Department of Medical Onclogy, Barcelona (Spain); Plans, Gerard [HU de Bellvitge, Department of Neurosurgery, Barcelona (Spain); Lucas, Anna [ICO l' Hospitalet, HU de Bellvitge, Department of Radiotherapy Oncology, Barcelona (Spain); Bruna, Jordi [HU de Bellvitge, Department of Neurology, Barcelona (Spain); Aguilera, Carles [IDI Centre Bellvitge, HU de Bellvitge, Department of Radiology, Barcelona (Spain); Centro de Investigacion en Red en Bioingenieria, Biomateriales y Nanomedicina (CIBER-BBN), Barcelona (Spain)

    2016-04-15

    To evaluate early post-operative magnetic resonance (EPMR) as a prognostic tool after resection of glioblastoma. Sixty EPMR examinations were evaluated for perioperative infarct, tumour growth between diagnosis and EPMR, contrast enhancement pattern, and extent of resection (EOR). The EOR was approached with the subjective evaluation of radiologists and by quantifying volumes. These parameters were tested as predictors of survival using the Kaplan-Meier method. Contrast enhancement was found in 59 patients (59/60; 98 %). Showing a thin-linear pattern of enhancement was the most favourable finding. Patients with this pattern survived longer than patients with thick-linear (median overall survival (OS) thin-linear=609 days; thick-linear=432 days; P =.023) or nodular (median OS = 318 days; P =.001) enhancements. The subjective evaluation of the EOR performed better than its quantification. Patients survived longer when resection was total (median OS total resection=609 days; subtotal=371 days; P =.001). When resection was subtotal, patients survived longer if it was superior to 95 % (median OS resection superior to 95 %=559 days; inferior to 95 %=256 days; P =.034). EPMR provides valuable prognostic information after surgical resection of glioblastomas. A thin-linear pattern of contrast enhancement is the most favourable finding. Further prognostic stratification may be obtained by assessing the EOR. (orig.)

  1. CXC chemokine receptor 1 predicts postoperative prognosis and chemotherapeutic benefits for TNM II and III resectable gastric cancer patients.

    Science.gov (United States)

    Cao, Yifan; Liu, Hao; Zhang, Heng; Lin, Chao; Li, Ruochen; Wu, Songyang; Li, He; He, Hongyong; Zhang, Weijuan; Xu, Jiejie

    2017-03-21

    Backround: Abnormal expression of CXC chemokine receptor 1 (CXCR1) has shown the ability to promote tumor angiogensis, invasion and metastasis in several cancers. The purpose of our curret study is to discover the clinical prognostic significance of CXCR1 in resectable gastric cancer. 330 gastric cancer patients who underwent R0 gastrectomy with standard D2 lymphadenectomy at Zhongshan Hospital, Fudan University between 2007 and 2008 were enrolled. CXCR1 expression was evaluated with use of immunohistochemical staining. The relation between CXCR1 expression and clinicopathological features and postoperative prognosis was respectively inspected. In both discovery and validation data sets, CXCR1 high expression indicated poorer overall survival (OS) in TNM II and III patients. Furthermore, multivariate analysis identified CXCR1 expression and TNM stage as two independent prognostic factors for OS. Incorporating CXCR1 expression into current TNM staging system could generate a novel clinical predictive model for gastric cancer, showing better prognostic accuracy with respect to patients' OS. More importantly, TNM II patients with higher CXCR1 expression were shown to significantly benefit from postoperative 5-fluorouracil (5-FU) based adjuvant chemotherapy (ACT). CXCR1 in gastric cancer was identified as an independent adverse prognostic factor. Combining CXCR1 expression with current TNM staging system could lead to better risk stratification and more accurate prognosis for gastric cancer patients. High expression of CXCR1 identified a subgroup of TNM stage II gastric cancer patients who appeared to benefit from 5-FU based ACT.

  2. The effect of intracameral epinephrine on pupil size during phacoemulsification and its postoperative effect on specular findings and macular thickness

    Directory of Open Access Journals (Sweden)

    Hassan Gamal El-Din Farahat

    Full Text Available ABSTRACT Objective: To evaluate pupillary size and vital signs following intraoperative intracameral adrenaline during phacoemulsification and postoperative effect of on co specular microscopy findings and macular thickness by OCT. Methods: A prospective interventional study carried out from December 2014 to December 2015 on 90 eyes. They were divided randomly into further 6 groups (15 each. The inclusion criteria consisted of no history of ocular pathologic conditions, trauma, previous ocular surgery, or recent ocular medication use. All patients were dilated preoperatively by phenylephrine 10% and operated under local peribulbar anesthesia. Then systemic monitoring regarding (pulse rate, blood pressure and measurement of the horizontal pupil diameter by a caliper to the nearest 0.25mm pre and post intracameral adrenaline injection. Results: In our study there were great effect for intracameral epinephrine, with concentrations used, in dilatation and maintainance of papillary dilatation, The mean pre intracameral epinephrine was 4.53± 1.27 mm.The mean post epinephrine papillary diameter was 6.46± 1.00 mm. Three cases from group 1/10000 weren't dilated properly. Also three cases from group 1/9000 weren't dilated properly after intracameral epinephrine. Conclusion: Intracameral epinephrine even in higher concentrations is effective in papillary dilatation especially in cases with long duration and poorly dilated cases by usual topical mydriatics.

  3. Topoisomerase II alpha expression and the benefit of adjuvant chemotherapy for postoperative patients with non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Jie Li

    2010-11-01

    Full Text Available Abstract Background Adjuvant chemotherapy has been shown to improve survival rates of postoperative patients with non-small cell lung cancer (NSCLC. Biomarkers could help select an appropriate chemotherapy for NSCLC patients or predict the efficacy of chemotherapy. The objective of this study was to explore the possible prognostic and predictive role of topoisomerase II alpha (TopIIα expression level in postoperative NSCLC patients who received adjuvant chemotherapy. Methods Patients with stage I-III NSCLC, who underwent surgery in our hospital from January 2004 to December 2007 and who also received adjuvant chemotherapy after surgery, were analyzed in this study. Expression of TopIIα and Ki67 in paraffin-embedded tissues was detected by immunohistochemistry (IHC. The relationships between clinicopathological characteristics, chemotherapy regimens, the expression of biomarkers and disease free survival (DFS were analyzed. Results TopIIα and Ki67 were highly expressed in 22.5% and 36.4% of the 151 patients, respectively. Univariate survival analysis showed that male sex (P = 0.036, non-adenocarcinoma (P = 0.004, earlier pathological TNM stage (P = 0.001 or pathological N stage (P Conclusions High TopIIα expression was discovered to be correlated with better DFS for postoperative NSCLC patients who received adjuvant chemotherapy. The NVB-containing chemotherapy regimen was more effective than the TXT-containing regimen in improving DFS in patients with low TopIIα expression. TopIIα could be considered to be an independent prognostic biomarker of DFS in postoperative NSCLC patients who received adjuvant chemotherapy.

  4. Finding joy in social work. II: Intrapersonal sources.

    Science.gov (United States)

    Pooler, David Kenneth; Wolfer, Terry; Freeman, Miriam

    2014-07-01

    Despite the social work profession's strengths orientation, research on its workforce tends to focus on problems (for example, depression, problem drinking, compassion fatigue, burnout). In contrast, this study explored ways in which social workers find joy in their work. The authors used an appreciative inquiry approach, semistructured interviews (N = 26), and a collaborative grounded theory method of analysis. Participants identified interpersonal (making connections and making a difference) and intrapersonal (making meaning and making a life) sources of joy and reflected significant personal initiative in the process of finding joy. The authors present findings regarding these intrapersonal sources of joy.

  5. Postoperative Metamorphopsia in Macula-Off Rhegmatogenous Retinal Detachment : Associations with Visual Function, Vision Related Quality of Life, and Optical Coherence Tomography Findings

    NARCIS (Netherlands)

    van de Put, Mathijs A. J.; Vehof, Jelle; Hooymans, Johanna. M. M.; Los, Leonoor I.

    2015-01-01

    Purpose To evaluate postoperative metamorphopsia in macula-off rhegmatogenous retinal detachment (RRD) and its association with visual function, vision related quality of life, and optical coherence tomography (OCT) findings. Methods 45 patients with primary macula-off RRD were included. At 12

  6. The Outcome of Postoperative Radiation Therapy for Patients with Stage II Pancreatic Cancer (T3 or N1 Disease)

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sang Won; Chun, Misun; Kim, Myung Wook; Kim, Wook Hwan; Kang, Seok Yun; Kang, Seung Hee; Oh, Young Taek; Lee, Sunyoung; Yang, Juno [Ajou University School of Medicine, Suwon (Korea, Republic of)

    2007-12-15

    Purpose: To analyze retrospectively the outcome of postoperative radiation therapy with or without concurrent chemotherapy for curatively resected stage II pancreatic cancer with T3 or N1 disease. Materials and Methods: Between January 1996 and December 2005, twenty-eight patients completed adjuvant radiation therapy at Ajou University Hospital. The patients had either pathologic T3 stage or N1 stage. The radiation target volume encompassed the initial tumor bed identified preoperatively, resection margin area and celiac nodal area. In the case of N1 patients, the radiation field extended to the lower margin of the L3 vertebra for covering both para-aortic lymph nodes bearing area. The median total radiation dose was 50 Gy. Ten patients received concurrent chemotherapy. Results: Thirteen patients (46%) showed loco-regional recurrences. The celiac axis nodal area was the most frequent site (4 patients). Five patients showed both loco-regional recurrence and a distant metastasis. Patients with positive lymph nodes had a relatively high probability of a distant metastasis (57.1%). Patients that had a positive resection margin showed a relatively high local failure rate (57.1%). The median disease-free survival period of all patients was 6 months and the 1- and 2-year disease free survival rates were 27.4% and 8.2%, respectively. The median overall survival period was 9 months. The 2- and 3-year overall survival rates were 31.6% and 15.8%, respectively. Conclusion: The pancreatic cancer patients with stage II had a high risk of local failure and a high risk of a distant metastasis. We suggest the concurrent use of an effective radiation-sensitizing chemotherapeutic drug and adjuvant chemotherapy after postoperative radiation therapy for the treatment of patients with stage II pancreatic cancer.

  7. Ki-67 overexpression in WHO grade II gliomas is associated with poor postoperative seizure control.

    Science.gov (United States)

    Yuan, Yang; Xiang, Wang; Yanhui, Liu; Ruofei, Liang; Shuang, Liu; Yingjun, Fan; Qiao, Zhou; Yanwu, Yang; Qing, Mao

    2013-12-01

    Seizures are the most common initial symptom in patients with low-grade gliomas, and approximately 30% of these patients still suffer from epilepsy after gross-total resection of the tumour. We examined the relationship between the overexpression of ki-67 in WHO grade II gliomas and seizure control. A series of 93 histologically confirmed WHO grade II glioma tissues were analysed through immunohistochemical staining for ki-67 expression. Follow-up visits regarding seizure control were scheduled at 12 months. The Engel classification was used to categorise patients' seizure status. Of the 93 patients analysed, 65 (66.3%) patients initially presented with seizures. A total of 36 patients were diagnosed with WHO grade II oligodendrogliomas, 29 patients had oligoastrocytomas and 28 patients had astrocytomas. Ki-67 was over-expressed in 15 patients. One year after surgery poor seizure control was observed in 11 of these patients. In contrast, low ki-67 expression (seizure control was observed in 36 patients (difference between ki-67 over- and low expression groups P = 0.002). Logistic regression analysis revealed that patients with gross-total resection achieved better seizure control while ki-67 overexpression and age below 38 years were poor seizure control factors explained of the variance of seizure outcome (OR: 0.382, 4.354 and 1.822, respectively). In WHO grade II gliomas, Ki-67 is a molecular marker which predicts poor seizure control of glioma patients after the resection of the tumour. Gross-total resection, ki-67 overexpression and age below 38 years significantly affect seizure prognosis. Copyright © 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  8. An evaluation of the accuracy of the ORange® (Gen II) by comparing it to the IOLMaster® in the prediction of postoperative refraction

    Science.gov (United States)

    Chen, Ming

    2012-01-01

    Purpose The aim of this study was to evaluate the accuracy of ORange® Gen II (WaveTec Vision, Aliso Viejo, CA). Setting The Surgical Suites, Honolulu, HI. Methods The prospective 28 consecutive cataract surgical cases were selected from 85 cataract surgical cases between December 16, 2010 and February 24, 2011. With the same intraocular lens implantation, the predicted spherical equivalent refraction from IOLMaster® (Carl Zeiss AG, Oberkochen, Germany) and ORange Gen II were statistically compared and verified with 1-month postoperative manifest refraction. The data were put into IBM SPSS 19 (SPSS Inc, Chicago, IL) for analysis of variance. Pearson’s correlation coefficient was also calculated to evaluate the correlation between the IOLMaster, ORange Gen II, and 1-month postoperative manifest refraction. Results There were no statistically significant differences in the mean spherical equivalent refraction from the IOLMaster, ORange Gen II, and 1-month postoperative manifest refraction (IOLMaster −0.40 diopters, P = 0.07; ORange Gen II −0.43 diopters, P = 0.16; 1-month refraction −0.41 diopters, P = 0.07). Pearson’s correlation study demonstrated that all three were positively correlated (P refraction (r = +0.6, P < 0.01). Conclusion The ORange Gen II can be considered as an alternative method for intraocular lens selection for cataract patients. PMID:22457590

  9. An evaluation of the accuracy of the ORange (Gen II) by comparing it to the IOLMaster in the prediction of postoperative refraction.

    Science.gov (United States)

    Chen, Ming

    2012-01-01

    The aim of this study was to evaluate the accuracy of ORange(®) Gen II (WaveTec Vision, Aliso Viejo, CA). The Surgical Suites, Honolulu, HI. The prospective 28 consecutive cataract surgical cases were selected from 85 cataract surgical cases between December 16, 2010 and February 24, 2011. With the same intraocular lens implantation, the predicted spherical equivalent refraction from IOLMaster(®) (Carl Zeiss AG, Oberkochen, Germany) and ORange Gen II were statistically compared and verified with 1-month postoperative manifest refraction. The data were put into IBM SPSS 19 (SPSS Inc, Chicago, IL) for analysis of variance. Pearson's correlation coefficient was also calculated to evaluate the correlation between the IOLMaster, ORange Gen II, and 1-month postoperative manifest refraction. There were no statistically significant differences in the mean spherical equivalent refraction from the IOLMaster, ORange Gen II, and 1-month postoperative manifest refraction (IOLMaster -0.40 diopters, P = 0.07; ORange Gen II -0.43 diopters, P = 0.16; 1-month refraction -0.41 diopters, P = 0.07). Pearson's correlation study demonstrated that all three were positively correlated (P refraction (r = +0.6, P < 0.01). The ORange Gen II can be considered as an alternative method for intraocular lens selection for cataract patients.

  10. Temozolomide combined with irradiation as postoperative treatment of primary glioblastoma multiforme. Phase I/II study

    Energy Technology Data Exchange (ETDEWEB)

    Combs, S.E.; Gutwein, S.; Schulz-Ertner, D.; Thilmann, C.; Wannenmacher, M.M.; Debus, J. [Dept. of Radiation Oncology, Univ. of Heidelberg, Heidelberg (Germany); Kampen, M. van [Dept. of Radiation Oncology, Nordwestkrankenhaus Frankfurt, Frankfurt/Main (Germany); Edler, L. [Central Unit Biostatistics, German Cancer Research Center (DKFZ), Heidelberg (Germany)

    2005-06-01

    Background and purpose: the role of radiochemotherapy in the treatment of primary glioblastoma multiforme is still discussed controversially. To evaluate the feasibility and toxicity of irradiation and concomitant administration of 50 mg/m{sup 2} temozolomide in patients with primary malignant glioma, this phase I/II study was conducted. Patients and methods: 53 patients with histologically confirmed WHO grade IV malignant glioma were enrolled into the study. All patients were treated with radiation therapy up to a total dose of 60 Gy using conventional fractionation of 5 x 2.0 Gy/week. Temozolomide was administered orally each therapy day at a dose of 50 mg/m{sup 2}. Results: prior to radiochemotherapy, complete resection (n = 14), subtotal resection (n = 22) or a biopsy (n = 17) of the tumor was performed. The median time interval between surgery and radiochemotherapy was 21 days. Treatment-related toxicity was very mild. Acute toxicity > grade 2 was observed in one patient who developed grade 4 hemotoxicity. Minor side effects of chemotherapy included nausea and vomiting. No severe late effects were observed. Median progression-free and overall survival were 8 and 19 months, respectively. The overall survival rate was 72% at 1 and 26% at 2 years. Age and extent of surgery significantly influenced survival. Conclusion: the combination of temozolomide plus radiation therapy is feasible and safe in terms of toxicity. Overall survival times were relatively long compared to survival times reported for radiotherapy alone. The application of 50 mg/m{sup 2} of temozolomide can be performed throughout the whole time course without interruption due to side effects and might largely contribute to the prolonged overall survival. Further evaluation is warranted as to which dose of temozolomide is optimal with regard to tumor response and toxicity. (orig.)

  11. Role of Postoperative Radiotherapy for Stage I/II/III Thymic Tumor - Results of the ChART Retrospective Database

    Directory of Open Access Journals (Sweden)

    Qianwen LIU

    2016-07-01

    Full Text Available Background and objective Postoperative radiotherapy (PORT for thymic tumor is still controversial. The object of the study is to evaluate the role of PORT for stage I/II/III thymic tumor. Methods The database of Chinese Alliance of Research for Thymomas (ChART was retrieved for patients with stage I/II/III thymic tumor who underwent surgical therapy without neoajuvant therapy between 1994 and 2012. Univariate and multivariate survival analyses were performed. Cox proportional hazard model was used to determine the hazard ratio for death. Results 1,546 stage I/II/III patients were identified from ChART database. Among these patients, 649 (41.98% underwent PORT. PORT was associated with gender, histologic type (World Health Organization, WHO, surgical extent, complete resection, Masaoka stage and adjuvant chemotherapy. The 5-yr and 10-yr overall survival (OS rates and disease-free survival (DFS rate for patients underwent surgery followed by PORT were 90% and 80%, 81% and 63%, comparing with 96% and 95%, 92% and 90% for patients underwent surgery alone (P=0.001, P<0.001 respectively. In univariate analysis, age, histologic type (WHO, Masaoka stage, completeness of resection, and PORT were associated with OS. Multivariable analysis showed that histologic type (WHO(P=0.001, Masaoka stage (P=0.029 and completeness of resection (P=0.003 were independently prognostic factors of OS. In univariate analysis, gender, myasthenia gravis, histologic type (WHO, Masaoka stage, surgical approach, PORT and completeness of resection were associated with DFS. Multivariable analysis showed that histologic type (WHO (P<0.001, Masaoka stage (P=0.005 and completeness of resection (P=0.006 were independently prognostic factors of DFS. Subgroup analysis showed that patients with incomplete resection underwent PORT achieved the better OS and DFS (P=0.010, 0.017, respectively. However, patients with complete resection underwent PORT had the worse OS and DFS (P<0.001, P<0

  12. Computed tomography findings of postoperative complications in lung transplantation; Achados tomograficos nas complicacoes pos-operatorias do transplante pulmonar

    Energy Technology Data Exchange (ETDEWEB)

    Hochhegger, Bruno; Irion, Klaus Loureiro; Marchiori, Edson; Bello, Rodrigo; Moreira, Jose; Camargo, Jose Jesus [Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS (Brazil). Postgraduate Program in Respiratory Sciences; Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Postgraduate Program in Radiological Sciences], e-mail: brunorgs@mail.ufsm.br

    2009-03-15

    Due to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, post transplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis. (author)

  13. Discrepancy between preoperative MRI evaluation and intraoperative or postoperative pathological findings for the extent of local invasion in maxillary squamous cell carcinoma.

    Science.gov (United States)

    Lee, D J; Lee, M J; Kwon, K H; Chung, E J; Yoon, D Y; Rho, Y S

    2014-06-01

    Preoperative radiological evaluation of the extent of local invasion in maxillary squamous cell carcinoma (SCC) is very important in planning curative surgery. The aim of this study was to examine the accuracy of preoperative radiological evaluation with magnetic resonance imaging (MRI) for the extent of local invasion in maxillary SCC. A retrospective study was conducted of 33 patients who underwent a maxillectomy for maxillary SCC. We compared the MRI findings for 18 structures around the maxillary sinus with intraoperative or postoperative pathological findings. Discrepancies were found between preoperative MRI findings and intraoperative or postoperative pathological findings for 22 patients (66.7%). Overall, the specificity, sensitivity, positive predictive value, and negative predictive value of MRI were 83.4%, 83.0%, 64.5%, and 90.4%, respectively. The receiver operating characteristic curve showed that MRI evaluation of the posterolateral structures including the pterygoid plate, pterygoid muscle, and infratemporal fossa had a lower area under the curve (0.614) and a significantly lower accuracy when compared with the other structures (P = 0.294, 95% confidence interval 0.405-0.822). In conclusion, as the accuracy of preoperative MRI evaluation of the posterolateral structures is low, careful evaluation of local extension to the posterolateral structures is needed when planning curative surgery for maxillary SCC. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  14. Predicting Individualized Postoperative Survival for Stage II/III Colon Cancer Using a Mobile Application Derived from the National Cancer Data Base

    Science.gov (United States)

    Gabriel, Emmanuel; Attwood, Kristopher; Thirunavukarasu, Pragatheeshwar; Al-Sukhni, Eisar; Boland, Patrick; Nurkin, Steven

    2017-01-01

    BACKGROUND Prediction calculators estimate postoperative survival and assist the decision-making process for adjuvant treatment. The objective of this study was to create a postoperative overall survival (OS) calculator for patients with stage II/III colon cancer. Factors that influence OS, including comorbidity and postoperative variables, were included. STUDY DESIGN The National Cancer Data Base was queried for patients with stage II/III colon cancer, diagnosed between 2004 and 2006, who had surgical resection. Patients were randomly divided to a testing (nt) cohort comprising 80% of the dataset and a validation (nv) cohort comprising 20%. Multivariable Cox proportional hazards regression of nt was performed to identify factors associated with 5-year OS. These were used to build a prediction model. The performance was assessed using the nv cohort and translated into mobile software. RESULTS A total of 129,040 patients had surgery. After exclusion of patients with carcinoma in situ, non-adenocarcinoma histology, more than 1 malignancy, stage I or IV disease, or missing data, 34,176 patients were used in the development of the calculator. Independent predictors of OS included patient-specific characteristics, pathologic factors, and treatment options, including type of surgery and adjuvant therapy. Length of postoperative stay and unplanned readmission rates were also incorporated as surrogates for postoperative complications (1-day increase in postoperative stay, hazard ratio [HR] 1.019, 95% CI 1.018 to 1.021, p cancer. This prediction model uses nationwide data, culminating in a highly comprehensive, clinically useful tool. PMID:26922599

  15. Superior labrum anterior to posterior lesion type II with accompanied findings: assessment of shoulder MR arthrographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sun Young; Chun, Kyung Ah; Kwon, Oh Soo; Kim, Ki Tae [The Catholic University of Korea, Uijeongbu St. Mary' s Hospital, Uijeongbu (Korea, Republic of)

    2006-12-15

    To describe the pattern of various shoulder abnormalities with an associated superior labrum anterior to posterior (SLAP) lesion type II using magnetic resonance (MR) arthrography, and to assess the clinical significance of the associated abnormalities. A retrospective review of the MR arthrographic findings of 92 cases of a shoulder with an arthroscopically confirmed SLAP lesion type II was performed. The MR arthrography images were reviewed and analyzed. MR arthrographic analysis noted the presence of a rotator cuff abnormality, acromioclavicular arthritis, adhesive capsulitis, glenohumeral arthritis, a labral abnormality besides the SLAP lesion, and a paralabral cyst. The patients with SLAP lesions were divided into two age groups: those over 40 years of age and those forty years old or younger. Statistical analysis was performed to evaluate the influence of age on the various shoulder abnormalities with associated SLAP lesion. Of the 92 SLAP lesions type II, there were 7 cases (8%) of isolated SLAP lesions without any associated any shoulder abnormality. Eighty-five (92%) SLAP lesions were associated with various shoulder abnormalities including rotator cuff tendinosis (30/92, 33%), partial-thickness tear (36/92, 39%), full-thickness tear (2/92, 2%), acromioclavicular arthritis (46/92, 50%), adhesive capsulitis (7/92, 8%), glenohumeral arthritis (15/92, 16%), labral abnormality (26/92, 28%) and paralabral cyst (7/92, 8%). The SLAP lesions (60/92, 65%) in patients over forty years of age were accompanied by a significantly high number of rotator cuff abnormalities ({rho} < 0.001), glenohumeral osteoarthritis ({rho} = 0.001), and acromioclavicular osteoarthritis ({rho} < 0.001). In contrast, the SLAP lesions (32/92, 35%) in patients forty years old or younger had a significantly high number of anterior or posterior labral lesions ({rho} < 0.001). Isolated SLAP lesions type II without other associated shoulder abnormalities are uncommon, and the age of the patient

  16. MR imaging findings of painful type II accessory navicular bone: correlation with surgical and pathologic studies

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yun Sun; Lee, Kyung Tai; Kim, Eun Kyung [Eulji Hospital, Eulji University School of Medicine, Daejeon (Korea, Republic of); Kang, Heung Sik [Seoul National University Bundang Hospital, Seoul (Korea, Republic of)

    2004-12-15

    To evaluate the MR imaging findings of painful type II accessory navicular bone and to correlate these with the surgical and pathologic findings. The MR images of 17 patients with medial foot pain and surgically proven type II accessory navicular abnormalities were reviewed. The changes of signal intensity in the accessory navicular, synchondrosis and adjacent soft tissue, the presence of synchondrosis widening, and posterior tibial tendon (PTT) pathology on the T1-weighted and fat-suppressed T2-weighted images were analyzed. The MR imaging findings were compared with the surgical and pathologic findings. The fat-suppressed T2-weighted images showed high signal intensity in the accessory navicular bones and synchondroses in all patients, and in the soft tissue in 11 (64.7%) of the 17 patients, as well as synchondrosis widening in 3 (17.6%) of the 17 patients. The MR images showed tendon pathology in 12 (75%) of the 16 patients with PTT dysfunction at surgery. The pathologic findings of 16 surgical specimens included areas of osteonecrosis with granulomatous inflammation, fibrosis and destruction of the cartilage cap. The MR imaging findings of painful type II accessory navicular bone are a persistent edema pattern in the accessory navicular bone and within the synchondrosis, indicating osteonecrosis, inflammation and destruction of the cartilage cap. Posterior tibial tendon dysfunction was clinically evident in most patients.

  17. Postoperative simultaneous integrated boost-intensity modulated radiation therapy for patients with locoregionally advanced papillary thyroid carcinoma: preliminary results of a phase II trial and propensity score analysis.

    Science.gov (United States)

    Lee, Eun Kyung; Lee, You Jin; Jung, Yuh-S; Ryu, Junsun; Kim, Tae Hyun; Lee, Chang Yoon; Ryu, Chang Hwan; Kim, Tae Sung; Kim, Seok Ki; Chung, Ki-Wook; Kim, Sang Soo; Kim, Dae Yong; Kim, Joo Young; Cho, Kwan Ho

    2015-03-01

    With recent technical advances in radiotherapy (RT) planning, simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) has made possible the delivery of high radiation dose to the tumor, minimizing surrounding normal tissues. This study aimed to evaluate the clinical effectiveness and safety of postoperative SIB-IMRT in patients with locoregionally advanced papillary thyroid cancer (PTC). This was a propensity score-matched case control study conducted at a tertiary referring center. This study included locoregionally advanced patients with PTC (pT4 or N1b) who underwent thyroid cancer surgery and radioactive iodine ablation (RIA) followed by postoperative SIB-IMRT (RT group) under a phase II trial or no postoperative RT (Non-RT group) Intervention: Postoperative SIB-IMRT was the intervention. locoregional relapse-free survival (LRFS) was compared between RT group and Non-RT group. Multivariate analysis showed that several factors, including sex, American Thyroid Association risk category, and use of postoperative RT were significantly associated with LRFS in all 201 patients (P propensity score-matched patients, there were no significant differences in baseline characteristics between the RT and Non-RT groups, but the LRFS rate was significantly higher in the RT than in the Non-RT group (4 y: 100% vs 84.6%, P = .002). Overall, SIB-IMRT was well tolerated, with no grade ≥3 toxicity, and was completed as planned in all patients. Postoperative SIB-IMRT is feasible and effective in improving locoregional control in patients with locally advanced PTC. Large-scale randomized studies are warranted.

  18. Clinical Impact of Dental Adhesives on Postoperative Sensitivity in Class I and Class II Resin-Composite Restorations

    Directory of Open Access Journals (Sweden)

    Manchorova-Veleva Neshka A.

    2015-12-01

    Full Text Available BACKGROUND: Self-etch adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based composite restorations. STUDY OBJECTIVE: A hypothesis that a one-step self-etch adhesive (1-SEA would result in less postoperative sensitivity than a three-step etch-and-rinse adhesive (3-E&RA was tested. PATIENTS AND METHODS: One hundred restorations were placed with a 1-SEA and 100 restorations with a 3-E&RA. Teeth were restored with Filtek Supreme nanofilled resin-composite and were evaluated for sensitivity to cold and masticatory forces at baseline, 7 days, 14 days, 30 days, and 6 months postoperatively. Vitality test scores of the teeth were recorded at the same periods. RESULTS: The evaluation of cold sensitivity intensity (VAS score for all observation periods in both restoration groups did not reveal any statistical significance. The differences in the response time to cold stimulation (0 - 15 sec for the restorations made with a 1-SEA and those made with a separate etch step are statistically insignificant. There are no significant differences in the vitality of the restored teeth at intra- or inter-group comparison. The statistical analysis revealed significant differences in postoperative sensitivity to masticatory forces at postoperative day 14 and day 30 in the 3-E&RA group. CONCLUSIONS: Postoperative sensitivity depends on the type of dentin adhesive used. More intensive complaints of postoperative sensitivity were recorded under masticatory forces at postoperative day 14 and day 30 in 3-E&RA in comparison with 1-SEA.

  19. MRI findings of type II sacral agenesis: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang A; Kim, Myung Soon; Kwon, Woo Cheol [Dept. of Radiology, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital, Wonju (Korea, Republic of)

    2016-07-15

    Sacral agenesis (or caudal regression syndrome) is a rare congenital anomaly involving various levels of coccygeal, sacral, and even lumbar or lower thoracic vertebral dysgenesis, as well as spinal cord abnormalities. A few cases have been previously reported in Korea, especially based upon MRI findings. We describe a case of a 4-year-old girl with partially bilateral agenesis of the sacrum (type II), and club-shaped (chisel-shaped) spinal cord disruption. We also review MRI findings of sacral agenesis, focused on classification and radiological findings.

  20. Arnold-Chiari Type II Malformation: A Case Report and Review of Prenatal Sonographic Findings

    Directory of Open Access Journals (Sweden)

    Maryam Nik Nejadi

    2008-01-01

    Full Text Available The Arnold-Chiari malformation is a congenital abnormality of CNS, characterized by downwarddisplacement the parts of the cerebellum, fourth ventricle, pons and medulla oblongata into thespinal canal. This malformation is one of causative factor of death in neonates and infants. Athorough understanding of the direct and indirect sonographic findings is necessary for diagnosis ofChiari II malformation in the developing fetus.In this case report, we present a Chiari malformation II detected at 23 weeks of gestation by routinelysonographic screening. The Role of prenatal sonography in recognition of the malformation andprognostic value of these features are discussed.

  1. Clinical Impact of Dental Adhesives on Postoperative Sensitivity in Class I and Class II Resin-Composite Restorations

    OpenAIRE

    Manchorova-Veleva Neshka A.; Vladimirov Stoyan B.; Keskinova Donka А.

    2015-01-01

    BACKGROUND: Self-etch adhesives are believed to prevent postoperative sensitivity when used under posterior resin-based composite restorations. STUDY OBJECTIVE: A hypothesis that a one-step self-etch adhesive (1-SEA) would result in less postoperative sensitivity than a three-step etch-and-rinse adhesive (3-E&RA) was tested. PATIENTS AND METHODS: One hundred restorations were placed with a 1-SEA and 100 restorations with a 3-E&RA. Teeth were restored with Filtek Supreme nanofilled resin-compo...

  2. 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...

  3. 2014 Leonard Goldner Award Winner: Correlation of Postoperative Midfoot Position with Patient Outcomes Following Reconstruction of the Stage II Adult Acquired Flatfoot Deformity

    Science.gov (United States)

    Conti, Matthew S.; Chan, Jeremy Y.; Do, Huong T.; Ellis, Scott J.; Deland, Jonathan T.

    2016-01-01

    Background No studies investigating the effect of midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from AP radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). Methods Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors’ institution that underwent flatfoot reconstruction for stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo-first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with two or more measurements in the abduction category were classified as the abduction group (n=30); those with one or fewer measurements in the abduction category were placed in the adduction group (n=25). Preoperative FAOS and postoperative FAOS with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests. Results Patients corrected to a position of adduction showed a significantly lower improvement in the FAOS daily activities (p=0.012) and quality of life subscales (p=0.046). Mean improvement in subscale score for the adducted group was lower for pain (p=0.052) and sports activities (p=0.085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (p=0.372) between groups was found. Conclusions Correction of the talonavicular joint to a position of adduction following stage II AAFD is associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in the

  4. Prospective Phase I-II Trial of Helical Tomotherapy With or Without Chemotherapy for Postoperative Cervical Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Schwarz, Julie K., E-mail: jschwarz@radonc.wustl.edu [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Cell Biology and Physiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Wahab, Sasa [Cobb Center for Radiation Oncology Center, Austell, GA (United States); Grigsby, Perry W. [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO (United States); Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States); Department of Obstetrics and Gynecology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO (United States)

    2011-12-01

    Purpose: To investigate, in a prospective trial, the acute and chronic toxicity of patients with cervical cancer treated with surgery and postoperative intensity-modulated radiotherapy (RT) delivered using helical tomotherapy, with or without the administration of concurrent chemotherapy. Patients and Methods: A total of 24 evaluable patients entered the study between March 2006 and August 2009. The indications for postoperative RT were tumor size, lymphovascular space invasion, and the depth of cervical stromal invasion in 15 patients; 9 patients underwent postoperative RT because of surgically positive lymph nodes. All patients underwent pelvic RT delivered with helical tomotherapy and intracavitary high-dose-rate brachytherapy. Treatment consisted of concurrent weekly platinum in 17, sequential carboplatin/Taxol in 1, and RT alone in 6. The patients were monitored for acute and chronic toxicity using the Common Toxicity Criteria, version 3.0. Results: The median follow-up was 24 months (range, 4-49). At the last follow-up visit, 23 patients were alive and disease free. Of the 24 patients, 12 (50%) experienced acute Grade 3 gastrointestinal toxicity (anorexia in 5, diarrhea in 4, and nausea in 3). One patient developed acute Grade 4 genitourinary toxicity (vesicovaginal fistula). For patients treated with concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 71% and 24%, respectively. For patients treated without concurrent chemotherapy, the incidence of acute Grade 3 and 4 hematologic toxicity was 29% and 14%, respectively. Two long-term toxicities occurred (vesicovaginal fistula at 25 months and small bowel obstruction at 30 months). The overall and progression-free survival rate at 3 years for all patients was 100% and 89%, respectively. Conclusion: The results of our study have shown that postoperative external RT for cervical cancer delivered with helical tomotherapy and high-dose-rate brachytherapy and with or without

  5. Postoperative handover

    DEFF Research Database (Denmark)

    Møller, Thea P; Madsen, Marlene D; Fuhrmann, Lone

    2013-01-01

    Current research has identified numerous safety risks related to patient handovers including postoperative handovers. During the postoperative handover and the recovery period, the patient is at risk of potential complications of surgery or anaesthesia. Furthermore, patients are subject to a down......Current research has identified numerous safety risks related to patient handovers including postoperative handovers. During the postoperative handover and the recovery period, the patient is at risk of potential complications of surgery or anaesthesia. Furthermore, patients are subject...

  6. Education as Experimentation: A Planned Variation Model. Volume IIIA: Findings: Cohort II; Interim Findings: Cohort III. Volume IIIB: Appendices.

    Science.gov (United States)

    Stebbins, Linda B.; And Others

    This segment of the national evaluation study of the Follow Through Planned Variation Model reviews the background of the study, describes 13 of the Follow Through models involved, and presents an analysis of the effects of these models on students. The analysis is based on data from 4 years of Follow Through participation by Cohort II children…

  7. Brain MRI findings in patients with mucopolysaccharidosis types I and II and mild clinical presentation

    Energy Technology Data Exchange (ETDEWEB)

    Matheus, M.Gisele; Castillo, Mauricio; Smith, J. Keith [Department of Radiology, University of North Carolina School of Medicine, 27599-7510, Chapel Hill, NC (United States); Armao, Diane [Department of Pathology, University of North Carolina School of Medicine, Chapel Hill, NC (United States); Towle, Diane; Muenzer, Joseph [Department of Genetics and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC (United States)

    2004-08-01

    Our objective was to determine the brain magnetic resonance imaging (MRI) abnormalities in a selected group of patients with mucopolysaccharidosis (MPS) types I and II who had only mild clinical manifestations. We retrospectively assessed MRI brain studies in 18 patients with MPS (type I: 6 and type II: 12). We evaluated abnormal signal intensity in the white matter, widening of the cortical sulci, size of the supratentorial ventricles, dilatation of the perivascular spaces (PVS) and enlargement of the subarachnoid spaces. We observed a broad spectrum of findings, and despite severely abnormal MRI studies, no patients had mental retardation. We also observed that dilated PVS, previously believed to be caused by macroscopic deposition of the mucopolysaccharides, had an appearance similar to cerebrospinal fluid (CSF) in all MRI sequences performed, even in FLAIR and trace diffusion weighted images. Based on our results, we believe that with the exception of white matter abnormalities and brain atrophy, all other findings may be related to abnormal resorption of CSF, and there is no relationship between the imaging and clinical manifestations of the disease. (orig.)

  8. [Postoperative hypothyroidism].

    Science.gov (United States)

    Olifirova, O S; Trynov, N N

    2015-01-01

    There is a number of factors such as the thyroidectomy and limiting subtotal thyroid resection against the background of euthyroidism and initial hypothyroidism (in any extent of operation) which leads to the prediction of early postoperative hypothyroidism origin during 10 days of the postoperative peri- od. The early postoperative hypothyroidism is accompanied by activation processes of lipid peroxide oxidation and at the same time by reduction of antioxidant protection.

  9. Postoperative Delirium

    Science.gov (United States)

    Marcantonio, Edward R.

    2013-01-01

    Delirium (acute confusion) complicates 15% to 50% of major operations in older adults and is associated with other major postoperative complications, prolonged length of stay, poor functional recovery, institutionalization, dementia, and death. Importantly, delirium may be predictable and preventable through proactive intervention. Yet clinicians fail to recognize and address postoperative delirium in up to 80% of cases. Using the case of Ms R, a 76-year-old woman who developed delirium first after colectomy with complications and again after routine surgery, the diagnosis, prevention, and treatment of delirium in the postoperative setting is reviewed. The risk of postoperative delirium can be quantified by the sum of predisposing and precipitating factors. Successful strategies for prevention and treatment of delirium include proactive multifactorial intervention targeted to reversible risk factors, limiting use of sedating medications (especially benzodiazepines), effective management of postoperative pain, and, perhaps, judicious use of antipsychotics. PMID:22669559

  10. Toxicity and survival results of a phase II study investigating the role of postoperative chemoradioimmunotherapy for gastric adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Bese, N.S.; Yildirim, A.; Oeber, A. [Dept. of Radiation Oncology, Istanbul Univ., Cerrahpasa Medical School, Istanbul (Turkey); Bueyuekuenal, E.; Oezgueroglu, M.; Demir, G.; Mandel, N.M.; Demirelli, F.; Serdengecti, S. [Dept. of Internal Medicine, Medical Oncology Section, Istanbul Univ., Cerrahpasa Medical School, Istanbul (Turkey)

    2005-10-01

    Background and purpose: to investigate the role of postoperative concomitant chemoradioimmunotherapy in gastric adenocarcinoma patients. Patients and methods: 59 pateints, who underwent total or subtotal gastrectomy, with lymph node involvement, positive microscopic surgical margins or serosal involvement were included in the study. Radiotherapy started concomitantly with chemotherapy and levamisole. Extended-field radiotherapy was given to gastric bed and regional lymphatics via two anterior-posterior/posterior-anterior fields. A total dose of 45 Gy in 25 fractions with a fraction size of 1.8 Gy was planned. In 28 patients (48%) with positive surgical margins a 10-Gy boost dose was given to the anastomosis site. An adjuvant i.v. bolus of 450 mg/m{sup 2}/day 5-fluorouracil (5-FU) was administered concomitantly during the first 3 days and at the 20th day of irradiation. After completion of radiotherapy, i.v. boluses of 450 mg/m{sup 2}/day 5-FU and 25 mg/m{sup 2}/day rescuvorin were continued for 6 months once a week. Levamisole 40 mg/day orally was started at the 1st day of radiotherapy and also continued for 6 months. Median follow-up was 37 months (7-112 months). Results: median survival was 23 months. Overall 3- and 5-year survival rates amounted to 35% and 14%, respectively. Median survival of the patients with positive surgical margins was 22 months. The 3- and 5-year locoregional control rates were 59% and 55%, respectively. The most common toxicity was upper gastrointestinal system toxicity, which was observed in 42 patients (71%). Four patients (7%) died on account of early toxic effects, and six (10%) could not complete treatment. Conclusion: although 48% of the study population involved patients with microscopic residual disease, the survival results as a whole were satisfactory. However, due to high toxicity, radiotherapy must be delivered with the most proper techniques along with adequate nutrition and supportive care. (orig.)

  11. Hallazgos ecográficos en la proctalgia espontánea y postoperatoria Ultrasound findings in spontaneous and postoperative anal pain

    Directory of Open Access Journals (Sweden)

    I. Pascual

    2008-12-01

    Full Text Available Objetivo: valorar la utilidad de la ecografía endoanal como prueba de imagen para identificar la causa del dolor anal en los pacientes que presentan proctalgia idiopática o dolor postoperatorio y analizar cuáles son sus causas más frecuentes. Métodos: se realiza un estudio descriptivo de los hallazgos encontrados en las ecografías endoanales de pacientes con dolor anal en los últimos seis años. Todas las ecografías se llevaron a cabo con un ecógrafo B&K (Cheetah 2003, B&K Medical, Gentofte, Denmark con sonda endoanal de 7 MHz. Resultados: se estudiaron noventa y cinco casos de proctalgia mediante ecografía endoanal. Sesenta y siete correspondieron a pacientes con una cirugía previa perineal o pélvica tras la cual comenzó el dolor anal: 48 habían sido intervenidos de fisura anal, 12 de hemorroidectomía, 4 de episiotomía, 2 de fístula y 1 de prostatectomía. El hallazgo más frecuente tras la cirugía de fisura anal fue la presencia de una esfinterotomía incompleta. Entre los veintiocho pacientes sin cirugía previa, el 57,14% presentaba hipertrofia del esfínter anal interno como única alteración ecográfica. Conclusiones: los pacientes con proctalgia espontánea y postoperatoria pueden ser estudiados mediante ecografía endoanal ya que el uso de la sonda no impide completar la exploración. Con esta prueba se encontró una causa del dolor en el 81,93% de los casos. La hipertrofia del esfínter anal interno aislada es el hallazgo ecográfico más frecuente asociado a proctalgia espontánea.Objective: to assess the use of endoanal ultrasounds to identify anal pain etiology in patients with either spontaneous or postoperative pain, and to review the most frequent causes. Methods: a descriptive study of ultrasound findings in patients with anal pain during the last six years was performed. All ultrasound scans were performed using a B&K Diagnostic Ultrasound System (Cheetah 2003, B&K Medical, Gentofte, Denmark with a 7-MHz

  12. Long-term outcomes following post-operative radiotherapy for Stage I/II testicular seminoma - an Australasian single-institution experience.

    Science.gov (United States)

    Ong, Wee Loon; Nazareth, Lester; Hindson, Benjamin; Matheson, Bronwyn; Millar, Jeremy L

    2016-09-01

    The aim of the study is to review the long-term oncological outcomes and adverse effects of post-operative radiotherapy (PORT) for Stage I/II seminoma patients in an Australian radiation treatment centre. This is a retrospective study of 125 patients with Stage I/II seminoma treated with PORT at the Alfred Health Radiation Oncology Service between 1992 and 2013. Patients were linked to the Victorian Cancer Registry to enable confirmation of survival and diagnosis of secondary malignancies (SM). The relapse-free survival (RFS), testicular-cancer-specific survival (TCSS), overall survival (OS) and SM-free survival (SMFS) were estimated with Kaplan-Meier methods. The median age at diagnosis was 36 (range 20-62). The median time between diagnosis and PORT was 1.6 months (range: 0.5-4.5). Fifty patients (40%) had PORT to the para-aortic (PA) target alone, while the remaining had PORT to PA and ipsilateral or bilateral iliac lymph nodes. There were no acute adverse effects requiring admission. The median follow-up after PORT was 7.8 years (range = 0.1-19.1). There were two relapses, both of which occurred within 1 year of PORT (estimated 10-year RFS = 98.4%). Five deaths were reported, none of which were testicular cancer-related death (estimated 10-year TCSS = 100%, 10-year OS = 97.3%). There were seven SM (one lower lip cancer, one upper shoulder melanoma, one mesothelioma, two prostate cancer, one acute myeloid leukaemia and one contralateral testicular seminoma) reported in six patients, with estimated 10-year SMFS of 92.9%. Our series confirms excellent oncological outcomes among patients with Stage I/II seminoma treated with PORT, with uncommon occurrence of SM.

  13. 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.

  14. Comparing acquired angioedema with hereditary angioedema (types I/II): findings from the Icatibant Outcome Survey.

    Science.gov (United States)

    Longhurst, H J; Zanichelli, A; Caballero, T; Bouillet, L; Aberer, W; Maurer, M; Fain, O; Fabien, V; Andresen, I

    2017-04-01

    Icatibant is used to treat acute hereditary angioedema with C1 inhibitor deficiency types I/II (C1-INH-HAE types I/II) and has shown promise in angioedema due to acquired C1 inhibitor deficiency (C1-INH-AAE). Data from the Icatibant Outcome Survey (IOS) were analysed to evaluate the effectiveness of icatibant in the treatment of patients with C1-INH-AAE and compare disease characteristics with those with C1-INH-HAE types I/II. Key medical history (including prior occurrence of attacks) was recorded upon IOS enrolment. Thereafter, data were recorded retrospectively at approximately 6-month intervals during patient follow-up visits. In the icatibant-treated population, 16 patients with C1-INH-AAE had 287 attacks and 415 patients with C1-INH-HAE types I/II had 2245 attacks. Patients with C1-INH-AAE versus C1-INH-HAE types I/II were more often male (69 versus 42%; P = 0·035) and had a significantly later mean (95% confidence interval) age of symptom onset [57·9 (51·33-64·53) versus 14·0 (12·70-15·26) years]. Time from symptom onset to diagnosis was significantly shorter in patients with C1-INH-AAE versus C1-INH-HAE types I/II (mean 12·3 months versus 118·1 months; P = 0·006). Patients with C1-INH-AAE showed a trend for higher occurrence of attacks involving the face (35 versus 21% of attacks; P = 0·064). Overall, angioedema attacks were more severe in patients with C1-INH-HAE types I/II versus C1-INH-AAE (61 versus 40% of attacks were classified as severe to very severe; P types I/II, respectively. © 2016 British Society for Immunology.

  15. ACES II Seat Roller Study: Findings of Detrimental Friction under High Windblast or Adverse Flight Conditions

    Science.gov (United States)

    2015-08-12

    Criteria (0-1 scaled collation of individual-axis DRI) ROCAT = Rocket Catapult ejection propulsion system SBLAZ (g) = Seat Back Linear Accelerometer...holes, shafts, brackets, etc.), require no machining modifications to the ACES-II seat (only removal of the old wheel, shaft, etc), and minimal...are finely computer- machined , off- the-shelf, industry-proven, of reasonable size for the ACES-II seat and rails, and appear of higher reliability than

  16. Parental influences on adolescents' physical activity and sedentary behavior: longitudinal findings from Project EAT-II

    Directory of Open Access Journals (Sweden)

    Bauer Katherine W

    2008-02-01

    Full Text Available Abstract Background The long-term role that parental encouragement and attitudes about fitness and exercise play in adolescents' physical activity and sedentary behavior habits remains unclear. This paper aims to longitudinally examine how parental encouragement to be physically active and parental concern about staying fit are associated with adolescents' physical activity and sedentary behavior habits five years later. Methods Project EAT-II adolescent and young adult participants (1130 male, 1386 female completed surveys while in middle school or high school (1998–1999, and again 5 years later. Participants were asked whether their mother and father encourage them to be physically active and care about staying fit and exercising. Adolescent moderate and vigorous physical activity (MVPA and TV/video watching (hours/week were assessed. Linear regression models adjusted for socio-demographic characteristics and baseline behavior were used to examine the association of Time 1 parental factors with behavioral outcomes among adolescents and young adults five years later (Time 2. Results After adjustment for socio-demographic characteristics and baseline MVPA, adolescent-reported maternal and paternal encouragement to be active, and paternal care for fitness, were positively associated with weekly hours of MVPA after five years in young adult males (p for trend ≤ .01. The positive relationship between maternal encouragement and MVPA approached significance among high-school aged females (p for trend = .06, and paternal encouragement was positively related to MVPA among high-school aged males (p for trend = .02. While maternal encouragement to be active was associated with decreased TV/video time among younger females (p for trend = .02, other parental factors were not associated with lower TV/video time among the other groups. Conclusion Parental encouragement to be active was associated with increased physical activity among males and younger

  17. Postoperative MRI findings after anterior cruciate ligament reconstruction. A prospective study with 50 patients; Die postoperative MRT-Morphologie des vorderen Kreuzbandes nach primaerer Bandnaht oder Bandplastik. Eine prospektive Studie an 50 Patienten

    Energy Technology Data Exchange (ETDEWEB)

    Uhl, M. [Abt. Radiodiagnostik, Chirurgische Klinik und Poliklinik, Sektion Unfall- und Wiederherstellungschirurgie, Universitaetsklinik Heidelberg (Germany); Schmidt, C. [Abt. Radiodiagnostik, Chirurgische Klinik und Poliklinik, Sektion Unfall- und Wiederherstellungschirurgie, Universitaetsklinik Heidelberg (Germany); Riedl, S. [Abt. Radiodiagnostik, Chirurgische Klinik und Poliklinik, Sektion Unfall- und Wiederherstellungschirurgie, Universitaetsklinik Heidelberg (Germany); Brado, M. [Abt. Radiodiagnostik, Chirurgische Klinik und Poliklinik, Sektion Unfall- und Wiederherstellungschirurgie, Universitaetsklinik Heidelberg (Germany); Kauffmann, G.W. [Abt. Radiodiagnostik, Chirurgische Klinik und Poliklinik, Sektion Unfall- und Wiederherstellungschirurgie, Universitaetsklinik Heidelberg (Germany); Friedl, W. [Abt. Radiodiagnostik, Chirurgische Klinik und Poliklinik, Sektion Unfall- und Wiederherstellungschirurgie, Universitaetsklinik Heidelberg (Germany)

    1996-01-01

    Aim: Identification of typical postoperative change after anterior cruciate ligament reconstruction (sutures, tendon grafts) and comparison with clinical tests and ultrasound. Patients and methods: 50 patients with anterior cruciate ligament ruptures were examinated with MRI (1.0 T, surface coil, sagittal T{sub 1}-3DFT-Fast and sagittal spin-echo), US and clinical function tests (Lachmann, pivot-shift, anterior drawer test). Results: In 19 of 21 patients with continuous low-intensity ligament structures in the MRI, knee stability was very good or good in the clinical tests and US. In 17 of 20 patients with a diagnosis of partial rupture at MRI, we also found a stable knee. 5 of 7 patients with the MRI-signs of ligament rupture showed knee stability at US and clinical tests. Furthermore, at MRI we found minor effusions in 10 patients, meniscus tears in 8 patients and ligament impingement in 2 patients. Conclusion: MRI is a valuable method for evaluating and assessing anterior ligament reconstructions. We found a good correlation between the continuous low-intensity ligaments at MRI and knee-stability. In contrast there is a bad correlation between discontinuous ligament structures at MRI and clinical stability of the knee. MRI seems to provide more information than US and clinical tests (for example: minor effusion, meniscus tears, ligament impingement, bone lesions). (orig.) [Deutsch] Methode: 50 Patienten mit Rekonstruktionen des vorderen Kreuzbandes (43 primaere Bandnaehte, 7 Sehnenplastiken) wurden 2-5 Jahre postoperativ mittels MRT, (1,0 T Picker, Oberflaechenspule, sagittale 1,5 mm dicke MRT-Schichten in T{sub 1}-3DFT-Fast) und Gelenkultraschall untersucht und einer detaillierten uniformen klinischen Untersuchung inklusive Lachmann-Test, vordere Schublade und Pivot-Shift unterzogen. Ergebnisse: Bei 19 von 21 Patienten mit durchgehend signalarm dargestelltem vorderen Kreuzband waren die Stabilitaetsverhaeltnisse des Kniegelenkes klinisch und sonographisch gut

  18. Smith-Lemli-Opitz syndrome type II: report of a case with additional radiographic findings.

    Science.gov (United States)

    Herman, T E; Siegel, M J; Lee, B C; Dowton, S B

    1993-01-01

    A phenotypically female infant with 46-XY chromosomes was found to have Smith-Lemli-Opitz syndrome, type II a rare congenital malformation syndrome with many features of the more common classic Smith-Lemli-Opitz syndrome. The patient's skeletal survey revealed characteristic and previously undescribed skeletal anomalies which are reported. In addition a lipoma of the pituitary gland was found on magnetic resonance imaging. This lesion is particularly interesting given the hypothesized steroid abnormality in Smith-Lemli-Opitz, type II syndrome, the sexual ambiguity of males with this syndrome and the similarity of this syndrome to the Pallister-Hall syndrome which characteristically has a hamartoblastoma of the hypothalamus.

  19. MAJEWSKI OSTEODYSPLASTIC PRIMORDIAL DWARFISM TYPE II: CLINICAL FINDINGS AND DENTAL MANAGEMENT OF A CHILD PATIENT

    Directory of Open Access Journals (Sweden)

    Arslan Terlemez

    2015-01-01

    Full Text Available Majewski osteodysplastic primordial dwarfism type II (MOPD II is an unusual autosomal recessive inherited form of primordial dwarfism, which is characterized by a small head diameter at birth, but which also progresses to severe microcephaly, progressive bony dysplasia, and characteristic facies and personality. This report presents a case of a five-year-old girl with MOPD II syndrome. The patient was referred to our clinic with the complaint of severe tooth pain at the left mandibular primary molar teeth. Clinical examination revealed that most of the primary teeth had been decayed and all primary teeth were hypoplastic. Patient’s history revealed delayed development in the primary dentition and radiographic examination showed rootless primary molar teeth and short-rooted incisors. The treatment was not possible due to the lack of root of the left mandibular primary molars; so the teeth were extracted. Thorough and timely dental evaluation is crucial for the prevention of dental problems and the maintenance of oral health in patients with MOPD II syndrome is of utmost importance.

  20. Usability of Operational Performance Support Tools - Findings from Sea Test II

    Science.gov (United States)

    Byrne, Vicky; Litaker, Harry; McGuire, Kerry

    2014-01-01

    Sea Test II, aka NASA Extreme Environment Mission Operations 17(NEEMO 17) took place in the Florida Aquarius undersea habitat. This confined underwater environment provides a excellent analog for space habitation providing similarities to space habitation such as hostile environment, difficult logistics, autonomous operations, and remote communications. This study collected subjective feedback on the usability of two performance support tools during the Sea Test II mission, Sept 10-14, 2013; Google Glass and iPAD. The two main objectives: - Assess the overall functionality and usability of each performance support tool in a mission analog environment. - Assess the advantages and disadvantages of each tool when performing operational procedures and Just-In-Time-Training (JITT).

  1. Postoperative astigmatism.

    Science.gov (United States)

    Swinger, C A

    1987-01-01

    With the numerous significant advances in surgical methodology--e.g., microinstrumentation, the operating microscope, the surgical keratometer, and intraocular lenses--that have been developed over the past two decades, both surgeons and patients have become increasingly aware of the final optic result of any surgical intervention. This is especially so since the development of refractive surgery, where good uncorrected vision is frequently the final arbiter of success. We have progressed to the stage where the optic manipulation of the cornea, whether intentional or otherwise, can be understood in terms of a number of variables. These include the preparation and closure of the surgical wound, the choice of suture material, and both intraoperative and postoperative manipulations. Where these have failed and postoperative astigmatism still occurs, a number of surgical procedures are available to reduce the astigmatic error to an acceptable level.

  2. 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

  3. [Radiographic diagnosis of abdominal diseases in foals and ponys. II. Pathologic findings in 60 cases].

    Science.gov (United States)

    Gerhards, H; Klein, H J; Offeney, F

    1990-08-01

    A diagnostic approach based on clinical and radiographic examinations for evaluation of young foals and small ponies with acute abdominal discomfort is presented. Standing right to left lateral abdominal radiographs were taken of 54 foals and 6 ponies using a previously described technique. Interpretation of the radiographs was in conjunction with all clinical and laboratory findings and patient management. Using this approach, the site and cause of acute abdominal discomfort could be diagnosed accurately in 55 of 60 (91%) patients as confirmed by clinical, surgical or necropsy findings. Typical radiographs and photographs taken at surgery or at necropsy are presented. Typical radiographic findings, their interpretation and possible underlying gastrointestinal diseases are listed. The incorporation of standing lateral abdominal radiography in the clinical evaluation of foals and ponies with acute abdominal diseases gives findings of high diagnostic significance and should contribute to clinical decision-making. Abdominal radiography can replace data from rectal palpation in foals and ponies.

  4. [Hereditary sensory and autonomic neuropathy type II A: early neurological and skeletal findings].

    Science.gov (United States)

    Esmer, C; Díaz Zambrano, S; Santos Díaz, M A; González Huerta, L M; Cuevas Covarrubias, S A; Bravo Oro, A

    2014-04-01

    The hereditary sensory and autonomic neuropathies are genetic disorders characterized by the loss of sensation including pain, tactile and temperature. Its clinical and molecular features vary widely; the symptoms may begin from birth or be noticed in the first or second decade, with different types of complications of trauma to the extremities such as ulcers, mutilations and acral amputations. They are classified into six groups from I to VI, determined by the abnormality in eleven genes leading to phenotypic variations in the age of onset and the presence or absence of dysautonomia signs. With the exception of type I, all are autosomal recessive. The type II of these neuropathies is characterized by insensitivity to pain, heat and proprioception. We describe three members of a Mexican family with WNK1 gene mutation that caused hereditary neuropathy IIA.

  5. Retears of postoperative knee meniscus: findings on magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) by using low and high field magnets

    Energy Technology Data Exchange (ETDEWEB)

    Cardello, Paolo; Pofi, Enrico [Belcolle Hospital, Department of Radiodiagnostic, Viterbo (Italy); Gigli, Carlo; Voglino, Nicola [Belcolle Hospital, Division of Knee Surgery and Arthroscopy, Department of Orthopedics and Traumatology, Viterbo (Italy); Ricci, Alessandra; Chiatti, Leonardo [Belcolle Hospital, Department of Medical Physics, Viterbo (Italy)

    2009-02-15

    The purpose of this study was to determine the diagnostic performance of magnetic resonance (MR) obtained with intra-articular contrast medium in the evaluation of recurrent meniscal tears using low-field extremity-only and high-field whole-body magnets. Postoperative standard MR examinations and MR arthrographies of 95 knees were reviewed. Patients experiencing pain and disability after meniscal repair underwent standard MR and MR arthrography (Gadoterate meglumine 0.0025 mmol/ml) on both a 0.2-T and 1.5-T magnet. In 52 of 95 patients, second-look arthroscopy was performed; in the remaining 43 of 95 patients, clinical follow-up was used as the standard of reference. Sensitivity, specificity, positive and negative predictive values as well as accuracy of MRI/MR arthrographic signs as meniscal morphologic changes and the presence of contrast medium tracking into the tear at T1- and T2-weighted sequences in the detection of recurrent meniscal tears were determined. All MR and MR arthrograpic signs were sensitive in the detection of recurrent tears (range 80-91%). Abnormal meniscal morphology had low specificity [26% (13/50)] for both the 0.2-T and 1.5-T scanner, whereas accuracy was 55% (52/95) and 57% (54/95), respectively. The presence of contrast medium within the meniscus substance on T2-weighted images had higher value of specificity [84% (42/50)] and accuracy [84% (80/95)] by using low field strength magnet than by using high field strength magnet [74% (37/50) and 81% (77/95), respectively]. Whereas, the increased intrameniscal signal intensity extending to the meniscal surface at T1-weighted sequences after intra-articular contrast medium administration had lower specificity and accuracy on 0.2-T images [84% (42/50) and 82% (78/95), respectively] than on 1.5-T images [90% (45/50) and 88% (84/95), respectively]. A diagnosis of recurrent meniscal tear in a previously arthroscopically repaired meniscus can be made both on 0.2-T and 1.5-T magnets on the basis of

  6. Shock finding on a moving-mesh: II. Hydrodynamic shocks in the Illustris universe

    CERN Document Server

    Schaal, Kevin; Pakmor, Rüdiger; Pfrommer, Christoph; Nelson, Dylan; Vogelsberger, Mark; Genel, Shy; Pillepich, Annalisa; Sijacki, Debora; Hernquist, Lars

    2016-01-01

    Hydrodynamical shocks are a manifestation of the non-linearity of the Euler equations and play a fundamental role in cosmological gas dynamics. In this work, we identify and analyse shocks in the Illustris simulation, and contrast the results with those of non-radiative runs. We show that simulations with more comprehensive physical models of galaxy formation pose new challenges for shock finding algorithms due to radiative cooling and star forming processes, prompting us to develop a number of methodology improvements that robustly suppress spurious shock detections. We find in Illustris a total shock surface area which is about 1.4 times larger at the present epoch compared to non-radiative runs, and an energy dissipation rate at shocks which is higher by a factor of around 7. Remarkably, shocks with Mach numbers above and below $\\mathcal{M} \\approx 10$ contribute about equally to the total dissipation across cosmic time. This is in strong contrast to non-radiative simulations, and we demonstrate that a lar...

  7. High resolution computed tomography findings on the lung of early breast-cancer patients treated by postoperative breast irradiation with a hypofractionated radiotherapy schedule

    Directory of Open Access Journals (Sweden)

    Plataniotis G

    2005-01-01

    Full Text Available Context: Hypofractionated breast radiotherapy (RT, although convenient for patients and health care systems, could have a negative impact on normal tissues such as lung. Aims: To evaluate radiation-induced lung toxicity in early breast-cancer patients treated by hypofractionated RT. Settings and Design: We have been using the 42.5 Gy/16 fractions RT schedule since May 2003. As large fraction size is related to increased normal tissue toxicity we intended to investigate the possible radiation-induced lung toxicity to these patients, by performing high-resolution computed tomography (HRCT 6 months after the completion of the treatment. Methods and Material: A group of 30 consecutive early breast cancer patients (T1-2N0M0 have been treated by the above-mentioned RT schedule, using a pair of opposing tangential fields. The impact of chemotherapy and hormonotherapy and various breast size-related parameters on HRCT lung changes were investigated. Acute skin and breast tissue reactions were also recorded. Statistical analysis: used Correlation of numerical variables was investigated by Pearson correlation coefficient. Logistic regression analysis was used to investigate correlation between HRCT findings (present vs absent with other variables. Results: Minimal HRCT findings were evident in 15/30 patients. These included small septal lines, linear and subpleural opacities and to a lesser extend, focal-ground glass opacification. The HRCT findings were positively correlated only to field separation (distance between the entrance points of the tangential beams on the breast (H.R.=1.33, 95% CI: 1.013-1.75. Conclusions: The short 16-fraction RT schedule for early breast-cancer patients appears to have a minor effect on the underlying lung parenchyma.

  8. Shock finding on a moving-mesh - II. Hydrodynamic shocks in the Illustris universe

    Science.gov (United States)

    Schaal, Kevin; Springel, Volker; Pakmor, Rüdiger; Pfrommer, Christoph; Nelson, Dylan; Vogelsberger, Mark; Genel, Shy; Pillepich, Annalisa; Sijacki, Debora; Hernquist, Lars

    2016-10-01

    Hydrodynamical shocks are a manifestation of the non-linearity of the Euler equations and play a fundamental role in cosmological gas dynamics. In this work, we identify and analyse shocks in the Illustris simulation, and contrast the results with those of non-radiative runs. We show that simulations with more comprehensive physical models of galaxy formation pose new challenges for shock finding algorithms due to radiative cooling and star-forming processes, prompting us to develop a number of methodology improvements. We find in Illustris a total shock surface area which is about 1.4 times larger at the present epoch compared to non-radiative runs, and an energy dissipation rate at shocks which is higher by a factor of around 7. Remarkably, shocks with Mach numbers above and below mathcal {M}≈ 10 contribute about equally to the total dissipation across cosmic time. This is in sharp contrast to non-radiative simulations, and we demonstrate that a large part of the difference arises due to strong black hole radio-mode feedback in Illustris. We also provide an overview of the large diversity of shock morphologies, which includes complex networks of halo-internal shocks, shocks on to cosmic sheets, feedback shocks due to black holes and galactic winds, as well as ubiquitous accretion shocks. In high-redshift systems more massive than 1012 M⊙, we discover the existence of a double accretion shock pattern in haloes. They are created when gas streams along filaments without being shocked at the outer accretion shock, but then forms a second, roughly spherical accretion shock further inside.

  9. Postoperative extradural hematomas.

    Science.gov (United States)

    Pichierri, Angelo; Ruggeri, Andrea; Donnarumma, Pasquale; Delfini, Roberto

    2013-01-01

    Postoperative extradural hematoma (POEH) is a possible complication after head surgery, often neglected in the literature. In a single surgeon experience we found 13 cases of POEH (0.8%). We distinguished two subtypes: (1) larger hematomas (>40 cc) with typical features and overt clinical picture that always needed evacuation, and (2) smaller hematomas (<40 cc) with insidious clinical onset and different radiological features compared with traumatic and spontaneous extradural hematomas. On the basis of our experience, we propose that clinical picture and radiologic appearance lead the decision between conservative or interventional treatment of type II hematomas.

  10. Immunohistochemical findings type I and type II collagen in prenatal mouse mandibular condylar cartilage compared with the tibial anlage.

    Science.gov (United States)

    Ishii, M; Suda, N; Tengan, T; Suzuki, S; Kuroda, T

    1998-07-01

    In growing animals the mandibular condylar cartilage serves not only as an articular but also as a growth cartilage, yet, condylar cartilage has some characteristic features that are not found in growth cartilage. For example, some reports suggest that type I collagen, which is not seen in the growth plate cartilage of long bones, is present in the extracellular matrix of condylar cartilage postnatally. Here, the condylar and limb bud cartilage of fetal mice was examined. The distribution of type I and type II collagen in condylar cartilage was already different from that in the limb bud at the first appearance of the cartilage. Type I collagen was demonstrated in the extracellular matrix of the condylar cartilage that first appeared on day 15 of gestation. However, the reaction for type II collagen was much weaker than that for type I collagen. On day 18 of gestation, type I collagen was still found throughout the cell layers but became gradually weaker with depth. Type II collagen was limited exclusively to the deeper layers at this stage. These findings are different from those in the limb bud cartilage, indicating a characteristic feature of the cells in the condylar cartilage present from the prenatal period.

  11. Postoperative hyperkalemia.

    Science.gov (United States)

    Ayach, Taha; Nappo, Robert W; Paugh-Miller, Jennifer L; Ross, Edward A

    2015-03-01

    Hyperkalemia occurs frequently in hospitalized patients and is of particular concern for those who have undergone surgery, with postoperative care provided by clinicians of many disciplines. This review describes the normal physiology and how multiple perioperative factors can disrupt potassium homeostasis and lead to severe elevations in plasma potassium concentration. The pathophysiologic basis of diverse causes of hyperkalemia was used to broadly classify etiologies into those with altered potassium distribution (e.g. increased potassium release from cells or other transcellular shifts), reduced urinary excretion (e.g. reduced sodium delivery, volume depletion, and hypoaldosteronism), or an exogenous potassium load (e.g. blood transfusions). Surgical conditions of particular concern involve: rhabdomyolysis from malpositioning, trauma or medications; bariatric surgery; vascular procedures with tissue ischemia; acidosis; hypovolemia; and volume or blood product resuscitation. Certain acute conditions and chronic co-morbidities present particular risk. These include chronic kidney disease, diabetes mellitus, many outpatient preoperative medications (e.g. beta blockers, salt substitutes), and inpatient agents (e.g. succinylcholine, hyperosmolar volume expanders). Clinicians need to be aware of these pathophysiologic mechanisms for developing perioperative hyperkalemia as many of the risks can be minimized or avoided.

  12. Adjuvant post-operative radiotherapy vs radiotherapy plus 5-FU and levamisole in patients with TNM stage II-III resectable rectal cancer. A phase III randomized clinical trial

    Energy Technology Data Exchange (ETDEWEB)

    Cafiero, F.; Gipponi, M.; Di Somma, C. [Istituto Nazionale per la Ricerca sul Cancro, Geneo (Italy). Istituto di Oncologia Clinica] [and others

    1995-08-01

    Loco-regional and distant relapses contribute to impair the outcome of rectal cancer patients. As to the former, either pre-or post-operative radiation therapy (RT) significantly reduce loco-regional recurrence; post-operative chemotherapy (CT), alone or in different combinations with RT, is effective in improving both disease-free survival and survival. However, many drawbacks still exist regarding the method of RT delivery as well as the toxicity of combination adjuvant chemotherapy. The aim of this trial is to assess the effectiveness and toxicity of adjuvant post-operative RT vs combined RT and CT (5-FU plus levamisole) in patients with TNM stage II-III resectable rectal cancer (pT3-4, pN0, M0; pT1-4, pN1-3, M0). The primary endpoint is overall survival; secondary endpoints are disease-free survival rate of loco-regional recurrence, and treatment-related toxicity/morbidity. (author).

  13. Is postoperative radiation beneficial in the management of Stage I-II squamous-cell carcinoma of the uterine cervix with negative metastatic nodes and positive parametrial involvement; A retrospective review of 70 patients

    Energy Technology Data Exchange (ETDEWEB)

    Takamura, Akio (Asahikawa Kosei Hospital, Hokkaido (Japan)); Mizoe, Jun-etsu; Arimoto, Takuro; Kamada, Tadashi; Shirato, Hiroki; Matsuoka, Yoshisuke; Tomita, Masayoshi; Irie, Goro

    1993-06-01

    Seventy patients having squamous-cell carcinoma of the uterine cervix FIGO (Federation Internationale de Gynecologie et d'Obstetrique : International Federation of Gynecology and Obstetrics) Stage I-II with negative lymph nodes and positive parametrial involvement received postoperative radiotherapy following radical hysterectomy and pelvic lymphadenectomy. In 48 patients with microscopic parametrial involvement had a 5-year survival rate of 75%. The overall recurrence was 13% (9 of 70). The sites of failure were 3 pelvic alone, 5 distant metastases alone, and 1 combined pelvis and para-aortic lymph node. All of those with recurrence were Stage-II cases. The absolute pelvic-control rate was 94.3% (66/70). Fifty-six percent of the patients experienced mild-to-moderate lymphedema. Severe complications requiring surgical intervention were observed in 6 patients (5 bowel obstructions and 1 femoral head fracture). A review of the literature suggests that early carcinoma can be successfully treated by surgery alone. Taking into consideration the risk and benefits involved, postoperative radiotherapy is not recommended for most patients with cervical carcinoma with negative lymph nodes and positive parametrial involvement in the present form, despite excellent local control. However, no definite conclusion can be drawn from this retrospective analysis. (author).

  14. The issues regarding postoperative adjuvant therapy and prognostic risk factors for patients with stage I-II cervical cancer: A review.

    Science.gov (United States)

    Takekuma, Munetaka; Kasamatsu, Yuka; Kado, Nobuhiro; Kuji, Shiho; Tanaka, Aki; Takahashi, Nobutaka; Abe, Masakazu; Hirashima, Yasuyuki

    2017-04-01

    The treatment for most patients with early-stage cervical cancer involves radical hysterectomy and pelvic lymph node dissection, and indications for postoperative adjuvant therapy have been determined by evaluating the prognostic risk factors for recurrence in each case. The aim of this review is to raise and discuss the various issues that have not yet been resolved regarding the prognostic risk factors and postoperative adjuvant therapy. Several clinicopathological factors, such as tumor size, lymphovascular space involvement, deep stromal invasion, parametrial involvement and lymph node metastasis, have been identified to have prognostic significance in early-stage cervical cancer. However, this remains controversial because there is suggested to be substantial heterogeneity among patients after radical hysterectomy and lymphadenectomy and it would be difficult to define the risk groups clearly. This indicates the need to develop more convenient and accurate criteria to define risk groups. According to the currently available evidence, patients in the high-risk group should receive adjuvant concurrent chemoradiotherapy (CCRT) with cisplatin (CDDP) and fluolouracil. However, CCRT with CDDP administered weekly (CCRT-P) has instead been applied in a clinical context worldwide. Whether CCRT-P has a survival benefit compared with radiotherapy (RT) alone is unknown because no randomized phase III trials have been performed for patients in the high-risk group after radical surgery. Patients with high-risk factors have a high incidence of distant metastasis, for whom systemic chemotherapy might be a key to improving overall survival. The pivotal study that investigated the role of RT alone for patients with intermediate-risk factors after hysterectomy is the GOG092 trial. This trial showed a 47% reduction in the risk of recurrence after RT compared with no further treatment (NFT). However, the improvement in overall survival with RT did not reach statistical

  15. "Quadruple whammy"- a preventable newly described syndrome of post-operative AKI in CKD II and CKD III patients on combination "Triple whammy" medications: a Mayo Clinic Health System, Eau Claire, Wisconsin experience.

    Science.gov (United States)

    Onuigbo, M A; Agbasi, N

    2014-01-01

    The potential combination of diuretics- angiotensin-converting enzyme inhibitors- Non-steroidal anti-inflammatory drugs (diuretics-ACEIs-NSAIDs), the so-called 'triple whammy', to produce clinically significant nephrotoxicity in chronic kidney disease (CKD) is often unrecognized. In 2013, in the British Medical Journal, we described accelerated post-operative acute kidney injury (AKI) in CKD patients concurrently on 'triple whammy' medications, a new syndrome that we aptly named 'quadruple whammy'. Two case reports. I. A 59-year-old Caucasian male, hypertensive CKD III, serum creatinine (SCr) 1.42 mg/dL, developed accelerated oliguric AKI after elective right nephrectomy. Outpatient medications included Lisinopril-Hydrochlorothiazide and Nabumetone (NSAID). SCr rapidly more than doubled with metabolic acidosis and hyperkalemia within 24 hours, peaking at 4.02 mg/dL. 'Triple whammy' medications were promptly stopped and the hypotension was corrected. SCr was 1.64 mg/dL and stable, after three months. II. A 46-year-old Caucasian male, hypertensive CKD II, SCr 1.21 mg/dL, developed accelerated AKI after elective right hip arthroplasty. Outpatient medications included Lisinopril and Hydrochlorothiazide. Celecoxib (200 mg) was given pre-operatively. Within 36 hours, SCr rapidly more than doubled to 2.58 mg/dL, with metabolic acidosis. 'Triple whammy' medications were promptly stopped and the hypotension was corrected. SCr was 0.99 mg/dL, and stable, after one month. We have described two cases of preventable accelerated AKI following post-operative hypotension in CKD patients concurrently on 'triple whammy' medications. We dubbed this new syndrome "Quadruple Whammy". It is not uncommon. 'Renoprevention', the pre-emptive withholding of (potentially nephrotoxic) medications, including 'triple whammy' medications, pre-operatively, in CKD patients, together with the simultaneous avoidance of peri-operative hypotension would help reduce, if not eliminate such AKI - a call

  16. 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...

  17. Prevention of postoperative ileus

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    Postoperative ileus (PI) is a major contributor to postoperative morbidity and prolonged convalescence after major surgical procedures. The pathophysiology of PI is multifactorial, including activation of the stress response to surgery, with inhibitory sympathetic visceral reflexes and inflammato...

  18. INTERATHECAL INJECTION OF NEOSTIGMINE FOR POSTOPERATIVE PAIN REDUCTION

    Directory of Open Access Journals (Sweden)

    H.R ABASI

    2000-03-01

    Full Text Available Background. Nowadays, important aim of surgical and anesthetic teams is removing of postoperative pain. One way for decreasing of postoperative pain is usage of interathecal injection of neostigmine. Neostigmine is an anticholinesterase drug to reverse the muscle relaxant effects. The main purpose of this study was evaluation the postoperative pain analgesic efficacy and safety of intrathecal neostigmine in patient undergoing below knee surgery with spinal anesthesia. Methods. In a clinical trial study sixty adult patients in ASA physical Status I or II were randomly divided into two groups. Group one received normal 1 ml normal saline plus 3ml marcaine and another one received 1ml neostigmine (50µg plus 3ml normal saline intrathecaly. The severity of postoperative pain was measured using a 10 cm visual analogue scale (0 mean no pain, 10 excruciating pain. If visual analogue scale was> 3, the patient requested analgesia. Findings. The mean time to the first analgesic administration was significantly prolonged by intrathecal neostigmine (10 h compared to normal saline (4.5 h (P < 0.001. Hypertension is seen in 2 patients in the neostigmine group but isn't seen in the normal saline (SO. also hypotension is seen only in one patient in the neostigmine group and 4 patients in the normal saline (SO. Four patients in the neostigmine group, one patient in the normal saline (SO had nausea. In the neostigmine group there isn't any vomiting, sweating, agitation or pruritis.

  19. Myopathic EMG findings and type II muscle fiber atrophy in patients with Lambert-Eaton myasthenic syndrome

    DEFF Research Database (Denmark)

    Crone, Clarissa; Christiansen, Ingelise; Vissing, John

    2013-01-01

    Lambert-Eaton myasthenic syndrome (LEMS) is a rare condition, which may mimic myopathy. A few reports have described that EMG in LEMS may show changes compatible with myopathy, and muscle biopsies have been described with type II as well as type I atrophy. The EMG results were, however, based...

  20. Recovery room nurses' knowledge regarding postoperative airway ...

    African Journals Online (AJOL)

    Adele

    patients. Aim: To determine the knowledge of recovery room nurses regarding postoperative airway emergencies in adult patients in private hospitals ..... sia nursing care, as well as current research findings and new technologies in this field.

  1. Imaging of the postoperative middle ear

    Energy Technology Data Exchange (ETDEWEB)

    Williams, Marc T. [Department of Medical Imaging, Fondation Ophtalmologique Adolphe de Rothschild, 25 rue Manin, 75940, Paris (France); Ayache, Denis [Department of Otorhinolaryngology, Fondation Ophtalmologique Adolphe de Rothschild, Paris (France)

    2004-03-01

    The aim of this article is twofold: (a) to present the principles and the indications of surgical treatment of middle ear pathologies; and (b) to review the imaging findings after middle ear surgery, including the normal postoperative aspects and imaging findings in patients presenting with unsatisfactory surgical results or with suspicion of postoperative complications. This review is intentionally restricted to the most common diseases involving the middle ear: chronic otitis media and otosclerosis. In these specific fields of interest, CT and MR imaging play a very important role in the postoperative follow-up and in the work-up of surgical failures and complications. (orig.)

  2. Postoperative rhabdomyolysis following pars-plana vitrectomy under general anesthesia

    Directory of Open Access Journals (Sweden)

    Campbell JP

    2013-08-01

    Full Text Available John P Campbell,1 Cobin Soelberg,2 Andreas K Lauer11Retina Division, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA; 2Division of Anesthesiology, Oregon Health and Science University, Portland, OR, USAImportance: Rhabdomyolysis is a known, but rare, complication of general anesthesia. To the authors' knowledge, it has never before been reported following an ocular surgery, and we could find no similar cases in the surgical literature following any brief surgical procedure. We believe this case to be unique in those regards and aim to raise awareness among ophthalmologists of this postoperative complication, as timely intervention can prevent renal failure and death.Observations: We report the case of a 58-year-old male who developed rhabdomyolysis following vitrectomy for retinal detachment repair under general anesthesia. The patient had several risk factors for this complication including morbid obesity, type II diabetes mellitus, and American Society of Anesthesia class III risk profile. His postoperative course was notable for significant myalgias in the postoperative recovery area, followed several hours later by oliguria, "root beer" colored urine, and a markedly elevated creatinine kinase level. He was hospitalized for two days for intravenous hydration and monitoring of his renal function and has fully recovered.Relevance: As the prevalence of obesity and type II diabetes mellitus increase worldwide, ophthalmologists need to be aware of the signs and symptoms of postoperative rhabdomyolysis. Treatment often requires inpatient hospitalization to prevent the associated morbidity and mortality.Keywords: rhabdomyolysis, general anesthesia, vitrectomy, retinal detachment, obesity, diabetes

  3. Postoperative Complications of Beger Procedure

    Directory of Open Access Journals (Sweden)

    Nayana Samejima Peternelli

    2015-01-01

    Full Text Available Introduction. Chronic pancreatitis (CP is considered an inflammatory disease that may cause varying degrees of pancreatic dysfunction. Conservative and surgical treatment options are available depending on dysfunction severity. Presentation of Case. A 36-year-old male with history of heavy alcohol consumption and diagnosed CP underwent a duodenal-preserving pancreatic head resection (DPPHR or Beger procedure after conservative treatment failure. Refractory pain was reported on follow-up three months after surgery and postoperative imaging uncovered stones within the main pancreatic duct and intestinal dilation. The patient was subsequently subjected to another surgical procedure and intraoperative findings included protein plugs within the main pancreatic duct and pancreaticojejunal anastomosis stricture. A V-shaped enlargement and main pancreatic duct dilation in addition to the reconstruction of the previous pancreaticojejunal anastomosis were performed. The patient recovered with no further postoperative complications in the follow-up at an outpatient clinic. Discussion. Main duct and pancreaticojejunal strictures are an unusual complication of the Beger procedure but were identified intraoperatively as the cause of patient’s refractory pain and explained intraductal protein plugs accumulation. Conclusion. Patients that undergo Beger procedures should receive close outpatient clinical follow-up in order to guarantee postoperative conservative treatment success and therefore guarantee an early detection of postoperative complications.

  4. Chronic Postoperative Roseomonas Endophthalmitis▿

    OpenAIRE

    Chen, Kuan-Jen; Lai, Chi-Chun; Kuo, Ya-Hui; WU, WEI-CHI; CHEN, TUN-LU

    2008-01-01

    We report one case with chronic postoperative endophthalmitis caused by Roseomonas species. Roseomonas spp. induced chronic endophthalmitis, which might result in misdiagnosis and delayed treatment and causes ocular damage and severe visual loss. This report is the first one related to a case with postoperative endophthalmitis secondary to Roseomonas infection.

  5. Chronic postoperative Roseomonas endophthalmitis.

    Science.gov (United States)

    Chen, Kuan-Jen; Lai, Chi-Chun; Kuo, Ya-Hui; Wu, Wei-Chi; Chen, Tun-Lu

    2009-01-01

    We report one case with chronic postoperative endophthalmitis caused by Roseomonas species. Roseomonas spp. induced chronic endophthalmitis, which might result in misdiagnosis and delayed treatment and causes ocular damage and severe visual loss. This report is the first one related to a case with postoperative endophthalmitis secondary to Roseomonas infection.

  6. Mechanisms of postoperative pain

    Institute of Scientific and Technical Information of China (English)

    YUE Yun

    2007-01-01

    @@ The practice of modern anaesthesiology has extended into perioperative medicine. Due to their expertise in analgesic drug pharmacology and peripheral nerve blocking, anaesthesiologists have pioneered in the management of acute postoperative pain. Effective postoperative analgesia reduces the incidence of postoperative chronic pain, improves the functioning of organs following surgery and shortens the hospital stay.1,2 Although a variety of analgesic techniques and preventative approaches are at the disposal of modem aneasthesiologists, including patient controlled epidural analgesia (PCEA), patient controlled intravenous analgesia, multimodal analgesia and pre-empty analgesia.Despite this array of strategies, these predominantly opioid based techniques are still limited by side-effects such as vomiting, nausea, itching and urinary retention.To optimize further the management of acute postoperative pain, basic mechanisms of postoperative pain must be explored and new treatments must continue to be developed.

  7. Postoperative imaging of paranasal sinuses; Postoperative Bildgebung der Nasennebenhoehlen

    Energy Technology Data Exchange (ETDEWEB)

    Nemec, S.; Czerny, C. [Abt. fuer Osteologie, Klinik fuer Radiodiagnostik, AKH/Medizinische Univ. Wien (Austria); Formanek, M. [Klinik fuer Hals-, Nasen- und Ohrenheilkunde, AKH/Medizinische Univ. Wien (Austria)

    2007-07-15

    The radiological interpretation of postoperative changes of the paranasal sinuses requires knowledge of why and how the surgical intervention was performed and what the basic clinical findings were. It is important to know whether there was an inflammation, a reconstructive procedure, or a tumorous process. Multidetector computed tomography (MDCT) evaluated in a high-resolution bone window level setting represents the method of choice for imaging after nonfunctional and functional procedures after inflammatory changes as well as for imaging after reconstructive surgery because of facial trauma or before dental implantation. In the postoperative follow-up of tumor patients contrast-enhanced MDCT evaluated in a soft tissue window and bone window and especially magnetic resonance imaging (MRI) represent the standard. In many cases it is possible to differentiate tumor recurrence from inflammation with the help of contrast-enhanced multiplanar MRI and to detect bone marrow changes prior to CT. (orig.)

  8. International Epidemiology of Child and Adolescent Psychopathology II: Integration and Applications of Dimensional Findings from 44 Societies

    Science.gov (United States)

    Rescorla, Leslie; Ivanova, Masha Y.; Achenbach, Thomas M.; Begovac, Ivan; Chahed, Myriam; Drugli, May Britt; Emerich, Deisy Ribas; Fung, Daniel S. S.; Haider, Mariam; Hansson, Kjell; Hewitt, Nohelia; Jaimes, Stefanny; Larsson, Bo; Maggiolini, Alfio; Markovic, Jasminka; Mitrovic, Dragan; Moreira, Paulo; Oliveira, Joao Tiago; Olsson, Martin; Ooi, Yoon Phaik; Petot, Djaouida; Pisa, Cecilia; Pomalima, Rolando; da Rocha; Marina Monzani; Rudan, Vlasta; Sekulic, Slobodan; Shahini, Mimoza; de Mattos Silvares, Edwiges Ferreira; Szirovicza, Lajos; Valverde, Jose; Vera, Luis Anderssen; Villa, Maria Clara; Viola, Laura; Woo, Bernadine S. C.; Zhang, Eugene Yuqing

    2012-01-01

    Objective: To build on Achenbach, Rescorla, and Ivanova (2012) by (a) reporting new international findings for parent, teacher, and self-ratings on the Child Behavior Checklist, Youth Self-Report, and Teacher's Report Form; (b) testing the fit of syndrome models to new data from 17 societies, including previously underrepresented regions; (c)…

  9. 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.)

  10. Loeys-Dietz syndrome type I and type II: clinical findings and novel mutations in two Italian patients

    Directory of Open Access Journals (Sweden)

    Calzavara-Pinton Pier

    2009-11-01

    Full Text Available Abstract Background Loeys-Dietz syndrome (LDS is a rare autosomal dominant disorder showing the involvement of cutaneous, cardiovascular, craniofacial, and skeletal systems. In particular, LDS patients show arterial tortuosity with widespread vascular aneurysm and dissection, and have a high risk of aortic dissection or rupture at an early age and at aortic diameters that ordinarily are not predictive of these events. Recently, LDS has been subdivided in LDS type I (LDSI and type II (LDSII on the basis of the presence or the absence of cranio-facial involvement, respectively. Furthermore, LDSII patients display at least two of the major signs of vascular Ehlers-Danlos syndrome. LDS is caused by mutations in the transforming growth factor (TGF beta-receptor I (TGFBR1 and II (TGFBR2 genes. The aim of this study was the clinical and molecular characterization of two LDS patients. Methods The exons and intronic flanking regions of TGFBR1 and TGFBR2 genes were amplified and sequence analysis was performed. Results Patient 1 was a boy showing dysmorphic signs, blue sclerae, high-arched palate, bifid uvula; skeletal system involvement, joint hypermobility, velvety and translucent skin, aortic root dilatation, tortuosity and elongation of the carotid arteries. These signs are consistent with an LDSI phenotype. The sequencing analysis disclosed the novel TGFBR1 p.Asp351Gly de novo mutation falling in the kinase domain of the receptor. Patient 2 was an adult woman showing ascending aorta aneurysm, with vascular complications following surgery intervention. Velvety and translucent skin, venous varicosities and wrist dislocation were present. These signs are consistent with an LDSII phenotype. In this patient and in her daughter, TGFBR2 genotyping disclosed in the kinase domain of the protein the novel p.Ile510Ser missense mutation. Conclusion We report two novel mutations in the TGFBR1 and TGFBR2 genes in two patients affected with LDS and showing marked

  11. CT differentiation of abscess and non-infected fluid in the postoperative neck

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Soo Jeong; Yoon, Dae Young [Dept. of Radiology, Kangdong Seong-Sim Hospital, Hallym Univ. Coll. of Medicine, Seoul (Korea, Republic of)], e-mail: evee0914@chollian.net; Kim, Sam Soo [Dept. of Radiology, Kangwon National Univ. Coll. of Medicine, Kangwon-do (Korea, Republic of); Rho, Young-Soo; Chung, Eun-Jae [Dept. of Otorhinolaryngology, Ilsong Memorial Inst. of Head and Neck Cancer, Kangdong Seong-Sim Hospital, Hallym Univ. Coll. of Medicine, Seoul (Korea, Republic of); Eom, Joong Sik; Lee, Jin Seo [Dept. of Internal Medicine, Div. of infectious disease, Kangdong Seong-Sim Hospital, Hallym Univ. Coll. of Medicine, Seoul (Korea, Republic of)

    2013-02-15

    Background: Differentiation of postoperative neck abscess from non-infected fluid is important because the treatment is different. Purpose: To determine specific CT findings that might help to differentiate abscesses from non-infected fluid collections in the postoperative neck. Material and Methods: We retrospectively reviewed CT scans of 50 patients (43 men and 7 women; mean age, 62.5 {+-} 8.9 years) who had postoperative fluid collections in the neck (26 abscesses and 24 non-infected fluid collections). Diagnosis of an abscess was determined by a positive bacteria culture from the fluid collection. Diagnoses were correlated with the following CT findings: anatomic spaces involved, the maximum transverse diameter, margin, attenuation, rim enhancement, gas bubbles, and manifestations of soft tissue adjacent to a fluid collection. Results: Rim enhancement pattern and soft tissue manifestations showed significant differences between abscess and non-infected fluid. The reliable CT findings for abscess were: (i) rim enhancement > 50% of the circumference, 54% sensitive, 71% specific, and 62% accurate; and (ii) severe soft tissue manifestations, 39% sensitive, 92% specific, and 64% accurate. There were no significant differences in the anatomic spaces involved, the maximum transverse diameter, margin, attenuation, and gas bubbles between abscess and non-infected fluid. Conclusion: CT findings that may help differentiate postoperative neck abscess from non-infected fluid were rim enhancement > 50% of the circumference and severe soft tissue manifestations.

  12. [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.

  13. [Postoperative biliary peritonitis].

    Science.gov (United States)

    Kurbonov, K M; Daminova, N M; Mukhiddinov, N D

    2008-01-01

    An analysis of results of surgical treatment of 91 patients with postoperative biliary peritonitis has shown that frequency of postoperative biliary peritonitis depended on the volume and character of operative interventions, as well as on technical errors made at the preoperative period and during operation. The presence of latent hepatic insufficiency made for the development of polyorganic insufficiency, had negative influence on the course of the disease and might be one of the causes of high postoperative lethality (up to 23.1%) in this category of patients.

  14. Is there an association between work stress and diurnal cortisol patterns? Findings from the Whitehall II study.

    Directory of Open Access Journals (Sweden)

    Jing Liao

    Full Text Available OBJECTIVE: The evidence on whether there is work stress related dysregulation of the hypothalamic-pituitary-adrenal axis is equivocal. This study assessed the relation between work stress and diurnal cortisol rhythm in a large-scale occupational cohort, the Whitehall II study. METHODS: Work stress was assessed in two ways, using the job-demand-control (JDC and the effort-reward-imbalance (ERI models. Salivary cortisol samples were collected six times over a normal day in 2002-2004. The cortisol awakening response (CAR and diurnal cortisol decline (slope were calculated. RESULTS: In this large occupational cohort (N = 2,126, mean age 57.1, modest differences in cortisol patterns were found for ERI models only, showing lower reward (β = -0.001, P-value = 0.04 and higher ERI (β = 0.002, P-value = 0.05 were related to a flatter slope in cortisol across the day. Meanwhile, moderate gender interactions were observed regarding CAR and JDC model. CONCLUSIONS: We conclude that the associations of work stress with cortisol are modest, with associations apparent for ERI model rather than JDC model.

  15. Postoperative refraction in the second eye having cataract surgery.

    Science.gov (United States)

    Leffler, Christopher T; Wilkes, Martin; Reeves, Juliana; Mahmood, Muneera A

    2011-01-01

    Introduction. Previous cataract surgery studies assumed that first-eye predicted and observed postoperative refractions are equally important for predicting second-eye postoperative refraction. Methods. In a retrospective analysis of 173 patients having bilateral sequential phacoemulsification, multivariable linear regression was used to predict the second-eye postoperative refraction based on refractions predicted by the SRK-T formula for both eyes, the first-eye postoperative refraction, and the difference in IOL selected between eyes. Results. The first-eye observed postoperative refraction was an independent predictor of the second eye postoperative refraction (P refraction. Compared with the SRK-T formula, this model reduced the root-mean-squared (RMS) error of the predicted refraction by 11.3%. Conclusions. The first-eye postoperative refraction is an independent predictor of the second-eye postoperative refraction. The first-eye predicted refraction is less important. These findings may be due to interocular symmetry.

  16. Domestic violence and immigration status among Latina mothers in the child welfare system: findings from the National Survey of Child and Adolescent Well-being II (NSCAW II).

    Science.gov (United States)

    Ogbonnaya, Ijeoma Nwabuzor; Finno-Velasquez, Megan; Kohl, Patricia L

    2015-01-01

    Many children involved with the child welfare system witness parental domestic violence. The association between children's domestic violence exposure and child welfare involvement may be influenced by certain socio-cultural factors; however, minimal research has examined this relationship. The current study compares domestic violence experiences and case outcomes among Latinas who are legal immigrants (n=39), unauthorized immigrants (n=77), naturalized citizens (n=30), and US-born citizen mothers (n=383) reported for child maltreatment. This analysis used data from the second round of the National Survey of Child and Adolescent Well-being. Mothers were asked about whether they experienced domestic violence during the past year. In addition, data were collected to assess if (a) domestic violence was the primary abuse type reported and, if so, (b) the maltreatment allegation was substantiated. Results show that naturalized citizens, legal residents, and unauthorized immigrants did not differ from US-born citizens in self-reports of domestic violence; approximately 33% of mothers reported experiences of domestic violence within the past year. Yet, unauthorized immigrants were 3.76 times more likely than US-born citizens to have cases with allegations of domestic violence as the primary abuse type. Despite higher rates of alleged domestic violence, unauthorized citizens were not more likely than US-born citizens to have these cases substantiated for domestic violence (F(2.26, 153.99)=0.709, p=.510). Findings highlight that domestic violence is not accurately accounted for in families with unauthorized immigrant mothers. We recommend child welfare workers are trained to properly assess and fulfill the needs of immigrant families, particularly as it relates to domestic violence.

  17. Postoperative peritoneale adhaerencer

    DEFF Research Database (Denmark)

    Jendresen, Marianne Bille; Qvist, Niels

    2008-01-01

    Postoperative adhesions occur after most surgical intraabdominal procedures, and small bowel obstruction is a common complication. Research has focused on the pathophysiology of adhesion formation and on the development of prophylactic barriers and drugs. The present paper provides a resume...

  18. Hardware Demonstrator of a Level-1 Track Finding Algorithm with FPGAs for the Phase II CMS Experiment

    CERN Document Server

    Cieri, Davide

    2016-01-01

    At the HL-LHC, proton bunches collide every 25\\,ns, producing an average of 140 pp interactions per bunch crossing. To operate in such an environment, the CMS experiment will need a Level-1 (L1) hardware trigger, able to identify interesting events within a latency of 12.5\\,$\\mu$s. This novel L1 trigger will make use of data coming from the silicon tracker to constrain the trigger rate. Goal of this new \\textit{track trigger} will be to build L1 tracks from the tracker information. The architecture that will be implemented in future to process tracker data is still under discussion. One possibility is to adopt a system entirely based on FPGA electronic. The proposed track finding algorithm is based on the Hough transform method. The algorithm has been tested using simulated pp collision data and it is currently being demonstrated in hardware, using the ``MP7'', which is a $\\mu$TCA board with a powerful FPGA capable of handling data rates approaching 1 Tb/s. Two different implementations of the Hough tran...

  19. Hardware Demonstrator of a Level-1 Track Finding Algorithm with FPGAs for the Phase II CMS Experiment

    Science.gov (United States)

    Cieri, D.; CMS Collaboration; of the Time Multiplexed Track Trigger Group

    2016-10-01

    At the HL-LHC, proton bunches collide every 25 ns, producing an average of 140 pp interactions per bunch crossing. To operate in such an environment, the CMS experiment will need a Level-1 (L1) hardware trigger, able to identify interesting events within a latency of 12.5 μs. This novel L1 trigger will make use of data coming from the silicon tracker to constrain the trigger rate. Goal of this new track trigger will be to build L1 tracks from the tracker information. The architecture that will be implemented in future to process tracker data is still under discussion. One possibility is to adopt a system entirely based on FPGA electronic. The proposed track finding algorithm is based on the Hough transform method. The algorithm has been tested using simulated pp collision data and it is currently being demonstrated in hardware, using the “MP7”, which is a μTCA board with a powerful FPGA capable of handling data rates approaching 1 Tb/s. Two different implementations of the Hough transform technique are currently under investigation: one utilizes a systolic array to represent the Hough space, while the other exploits a pipelined approach.

  20. Hardware Demonstrator of a Level-1 Track Finding Algorithm with FPGAs for the Phase II CMS Experiment

    CERN Document Server

    AUTHOR|(CDS)2090481

    2016-01-01

    At the HL-LHC, proton bunches collide every 25\\,ns, producing an average of 140 pp interactions per bunch crossing. To operate in such an environment, the CMS experiment will need a Level-1 (L1) hardware trigger, able to identify interesting events within a latency of 12.5\\,$\\mu$s. This novel L1 trigger will make use of data coming from the silicon tracker to constrain the trigger rate. Goal of this new \\textit{track trigger} will be to build L1 tracks from the tracker information. The architecture that will be implemented in future to process tracker data is still under discussion. One possibility is to adopt a system entirely based on FPGA electronic. The proposed track finding algorithm is based on the Hough transform method. The algorithm has been tested using simulated pp collision data and it is currently being demonstrated in hardware, using the ``MP7'', which is a $\\mu$TCA board with a powerful FPGA capable of handling data rates approaching 1 Tb/s. Two different implementations of the Hough tran...

  1. Postoperative Spine Infections

    Science.gov (United States)

    Evangelisti, Gisberto; Andreani, Lorenzo; Girardi, Federico; Darren, Lebl; Sama, Andrew; Lisanti, Michele

    2015-01-01

    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 postoperative 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. PMID:26605028

  2. Computed tomography findings of postoperative complications in lung transplantation Achados tomográficos nas complicações pós-operatórias do transplante pulmonar

    Directory of Open Access Journals (Sweden)

    Bruno Hochhegger

    2009-03-01

    Full Text Available Due to the increasing number and improved survival of lung transplant recipients, radiologists should be aware of the imaging features of the postoperative complications that can occur in such patients. The early treatment of complications is important for the long-term survival of lung transplant recipients. Frequently, HRCT plays a central role in the investigation of such complications. Early recognition of the signs of complications allows treatment to be initiated earlier, which improves survival. The aim of this pictorial review was to demonstrate the CT scan appearance of pulmonary complications such as reperfusion edema, acute rejection, infection, pulmonary thromboembolism, chronic rejection, bronchiolitis obliterans syndrome, cryptogenic organizing pneumonia, post-transplant lymphoproliferative disorder, bronchial dehiscence and bronchial stenosis.Com o número cada vez maior e uma melhor sobrevida dos pacientes submetidos ao transplante pulmonar, os radiologistas devem estar cientes das diversas possibilidades de complicações associadas ao transplante de pulmão. O tratamento precoce das complicações é importante para a sobrevida a longo prazo dos receptores de transplante pulmonar. Com frequência, a TCAR desempenha um papel central na investigação de tais complicações. O reconhecimento precoce dos sinais de complicações proporciona um tratamento rápido e melhora a sobrevida. O objetivo desta revisão pictórica foi proporcionar uma visão sobre as complicações mais prevalentes na TC, tais como edema de reperfusão, rejeição aguda, infecção, tromboembolismo pulmonar, rejeição crônica, síndrome da bronquiolite obliterante, pneumonia em organização criptogênica, doença linfoproliferativa pós-transplante, deiscência brônquica e estenose brônquica.

  3. Postoperative upper airway problems

    African Journals Online (AJOL)

    QuickSilver

    2003-06-09

    Jun 9, 2003 ... REVIEW ARTICLE. Southern African Journal of Anaesthesia & Analgesia - May 2003. 12. Postoperative upper airway problems way. A number of factors, some avoidable, influence the incidence ... debilitating pain, inability to swallow and temporary voice changes, and are a ..... decrease airway resistance.

  4. Postoperative incentive spirometry use.

    Science.gov (United States)

    Hassanzadeh, Hamid; Jain, Amit; Tan, Eric W; Stein, Benjamin E; Van Hoy, Megan L; Stewart, Nadine N; Lemma, Mesfin A

    2012-06-01

    The authors hypothesized that the use of incentive spirometry by orthopedic patients is less than the recommended level and is affected by patient-related factors and type of surgery. To determine its postoperative use, the authors prospectively surveyed all patients in their institution's general orthopedic ward who had undergone elective spine surgery or total knee or hip arthroplasty during a consecutive 3-month period in 2010, excluding patients with postoperative delirium or requiring a monitored bed. All 182 patients (74 men, 108 women; average age, 64.5 years; range, 32-88 years; spine group, n=55; arthroplasty group, n=127), per protocol, received preoperative spirometry education by a licensed respiratory therapist (recommended use, 10 times hourly) and reinforcement education by nurses. Patients were asked twice daily (morning and evening) regarding their spirometry use during the previous 1-hour period by a registered nurse on postoperative days 1 through 3. All data were collected by the same 2 nurses using the same standardized questionnaire. Spirometry use was correlated with surgery type, postoperative day/time, and patient's age and sex. Student's t test, Spearman test, and one-way analysis of variance were used to compare differences (PSpirometry use averaged 4.1 times per hour (range, 0-10 times). No statistical correlations were found between spirometry use and age. Sex did not influence spirometry use. The arthroplasty group reported significantly higher use than did the spine group: 4.3 and 3.5 times per hour, respectively. Mean use increased significantly between postoperative days 1, 2, and 3.

  5. Publishing negative findings and the challenge of avoiding type II errors in studies of suspect teratogens: Example of a recent ondansetron publication.

    Science.gov (United States)

    Edlavitch, Stanley A

    2017-01-01

    It is important that negative, as well as positive, studies be published to complete the available picture in areas of scientific inquiry. At the same time, it is critical that the implications of a negative study not be overstated and generalized when major issues of study design and data accuracy may be the reason that no relationship was discovered. The challenge of avoiding type II errors in interpreting negative findings has major public health implications, especially when the relationship of an exposure to birth defects is the concern. This is particularly important when interpreting the report by Fazio et al. (June issue of Reproductive Toxicology) on the relationship of ondansetron exposure to pregnancy outcome and birth defects. This review addresses the study design and conclusions and suggests that an alternative concluding statement would be more apropos, given the limitations of the data.

  6. Two-Year Comparative Outcomes of MIS Lateral and MIS Transforaminal Interbody Fusion in the Treatment of Degenerative Spondylolisthesis: Part II: Radiographic Findings.

    Science.gov (United States)

    Isaacs, Robert E; Sembrano, Jonathan N; Tohmeh, Antoine G

    2016-04-01

    Prospective, multicenter, institutional review board approved study with randomized and observational study arms. The purpose of this study was to compare radiographic outcomes between minimally invasive transforaminal (MIS TLIF) or MIS lateral interbody fusion (XLIF) in the treatment of patients with low-grade degenerative spondylolisthesis with stenosis through 2-year postoperative. Few reports exist comparing different MIS approaches directly in the treatment of similar pathology, as most studies report differences between MIS and open procedures. A total of 55 patients undergoing surgical treatment for degenerative spondylolisthesis with spinal stenosis at one or two contiguous levels between L1 and L5 were enrolled. Twenty-nine patients were treated with XLIF and 26 patients were treated with MIS TLIF. Disc height was significantly improved from preoperative at all postoperative time points in both groups, though the XLIF group experienced less subsidence and resultant loss of disc height than the MIS TLIF group by 24-month postoperative (P = 0.002). Postoperative change in central canal area was statistically greater in the MIS TLIF compared with the XLIF group (43.1 mmvs. 4.1 mm, P = 0.028). At several postoperative time points, foraminal height and area on the ipsilateral side and foraminal height on the contralateral side to the approach were significantly increased postoperatively in the XLIF group, and the magnitude of ipsilateral height increase was greater than in the MIS TLIF cohort (P MIS TLIF levels were solidly bridged (P = 0.448). Different mechanisms of stenosis correction (direct vs. indirect) between the MIS TLIF and XLIF groups studied resulted in several significantly different radiographic characteristics. Despite these differences, both groups of patients experienced significant and maintained clinical improvements with high fusion rates at 2-year follow-up, suggesting that the mechanism of correction may not be critical and

  7. Prevention of postoperative ileus

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2002-01-01

    Postoperative ileus (PI) is a major contributor to postoperative morbidity and prolonged convalescence after major surgical procedures. The pathophysiology of PI is multifactorial, including activation of the stress response to surgery, with inhibitory sympathetic visceral reflexes and inflammatory...... mediators. We update evidence on the advances in the prevention and treatment on PI. As single interventions, continuous thoracic epidural analgesia with local anesthetics and minimally invasive surgery are the most efficient interventions in the reduction of PI. The effects of pharmacological agents have...... generally been disappointing with the exception of cisapride and the introduction of the new selective peripherally acting m-opioid antagonists. Presently, introduction of a multi-modal rehabilitation programme (including continuous epidural analgesia with local anesthetics, early oral feeding and enforced...

  8. [Postoperative medical icterus].

    Science.gov (United States)

    Cerf, M

    1978-06-01

    The onset of jaundice following a surgical operation sometimes raises difficult problems. It is rarely due to hemolysis, infective hepatitis or decomposated cirrhosis of the liver. One should seek as a routine hepatitis due to halotane. However the most frequent cause is "benign postoperative cholestasis". This variety of jaundice presents in the form of an icterus due to conjugated bilirubine with often a large increase in alkaline phosphatase levels. The ocurse is variable. Almost always due to severe surgical or septic trauma, accompanied by shock and/or anoxia, it raises difficult diagnostic problems. The clinical and physiopathological aspects of benign postoperative cholestasis are recalled. One should remember, above all, that this is not an autonomous clinical entity but the sign of local or general complications which should be sought carefully.

  9. Pediatric cardiac postoperative care

    Directory of Open Access Journals (Sweden)

    Auler Jr. José Otávio Costa

    2002-01-01

    Full Text Available The Heart Institute of the University of São Paulo, Medical School is a referral center for the treatment of congenital heart diseases of neonates and infants. In the recent years, the excellent surgical results obtained in our institution may be in part due to modern anesthetic care and to postoperative care based on well-structured protocols. The purpose of this article is to review unique aspects of neonate cardiovascular physiology, the impact of extracorporeal circulation on postoperative evolution, and the prescription for pharmacological support of acute cardiac dysfunction based on our cardiac unit protocols. The main causes of low cardiac output after surgical correction of heart congenital disease are reviewed, and methods of treatment and support are proposed as derived from the relevant literature and our protocols.

  10. Keratophakia--postoperative astigmatism.

    Science.gov (United States)

    Swinger, C A; Troutman, R C; Forman, J S

    1987-01-01

    Forty-nine cases of primary keratophakia and 13 cases of secondary keratophakia were analyzed for postoperative astigmatism. For primary cases, the surgically induced astigmatism was 1.55 D, whereas for secondary cases it was 0.19 D (insignificant). There was a tendency for both procedures to induce against-the-rule astigmatism, and both procedures were found capable of producing irregular astigmatism.

  11. Imaging of postoperative knee extensor mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Motamedi, Kambiz [David Geffen School of Medicine at UCLA, Musculoskeletal Imaging-Department of Radiology, 200 Medical Plaza, Suite 165-59, Los Angeles, CA 90095 (United States); Seeger, Leanne L. [David Geffen School of Medicine at UCLA, Musculoskeletal Imaging-Department of Radiology, 200 Medical Plaza, Suite 165-57, Los Angeles, CA 90095 (United States); Hame, Sharon L. [David Geffen School of Medicine at UCLA, Department of Orthopedic Surgery, Box 956902, 76-143 CHS, Los Angeles, CA 90095 (United States)

    2005-05-01

    Disorders of the anterior knee are common and include patellofemoral syndrome, patella instability, patella fracture, and patellar and quadriceps tendon ruptures. Depending on the operative procedure performed, the post-operative imaging appearance of these knees may be confusing. It is crucial for the radiologist to be familiar with the procedures performed in order to recognize the postoperative findings. Radiologists must be able to interpret hardware (anchors, screw and wires) and disruptions in soft tissue planes that may persist with these types of procedures.

  12. [Post-operative pain therapy of a chronic pain patient].

    Science.gov (United States)

    Pawlik, Michael T; Ittner, Karl Peter

    2006-11-01

    Post-operative pain therapy of chronic pain patients poses a challenge. Here we report the perioperative management of a 39-year-old male under chronic therapy with oxycodon, gabapentin and tolperison. Particular the pharmacointeractions regarding premedication and postoperative dose finding of opioids with intravenous PCIA are discussed.

  13. Postoperative normalization of left ventricular noncompaction and new echocardiographic signs in aorta to left ventricular tunnel.

    Science.gov (United States)

    Malakan Rad, Elaheh; Zeinaloo, Ali Akbar

    2013-04-01

    We report postoperative normalization of left ventricular noncompaction in a neonate undergoing successful neonatal surgery for type II aorta to left ventricular tunnel (ALVT) associated with a large patent ductus arteriosus, floppy and extremely redundant anterior mitral leaflet, right coronary artery arising directly from the tunnel, and severe left ventricular noncompaction. We also described 2 novel echocardiographic findings in ALVT including "triple wavy line sign" on M-mode echocardiography which disappeared 1 month after operation and "abnormally increased left ventricular posterior wall motion" on M-mode of standard parasternal long-axis view on color tissue Doppler imaging (TDI) that also normalized postoperatively. We showed that proper definition of endocardial border is extremely important in strain and strain rate imaging in the context of left ventricular noncompaction. Preoperative longitudinal strain and strain rate were significantly decreased in comparison to radial strain and strain rate. Circumferential strain and strain rate were normal. © 2013, Wiley Periodicals, Inc.

  14. Postoperative conversion disorder.

    Science.gov (United States)

    Afolabi, Kola; Ali, Sameer; Gahtan, Vivian; Gorji, Reza; Li, Fenghua; Nussmeier, Nancy A

    2016-05-01

    Conversion disorder is a psychiatric disorder in which psychological stress causes neurologic deficits. A 28-year-old female surgical patient had uneventful general anesthesia and emergence but developed conversion disorder 1 hour postoperatively. She reported difficulty speaking, right-hand numbness and weakness, and right-leg paralysis. Neurologic examination and imaging revealed no neuronal damage, herniation, hemorrhage, or stroke. The patient mentioned failing examinations the day before surgery and discontinuing her prescribed antidepressant medication, leading us to diagnose conversion disorder, with eventual confirmation by neuroimaging and follow-up examinations. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Pre- and post-operative hydromyelia in spinal dysraphism

    Energy Technology Data Exchange (ETDEWEB)

    Scatliff, James H.; Kwon, Lanna [University of North Carolina, Department of Radiology, School of Medicine, Chapel Hill, NC (United States); Hayward, Richard [Great Ormond Street Hospital, Department of Neurosurgery, London (United Kingdom); Armao, Diane [University of North Carolina, Department of Radiology, Chapel Hill, NC (United States)

    2005-03-01

    Background and purpose: There has been limited description of hydromyelia after surgery for spinal dysraphism. The opportunity to compare pre- and post-operative hydromyelia in patients with spinal dysraphism has been possible in two groups of patients using MRI. Post-operative assessment and possible relationship of hydromyelia to clinical findings has been made during a 7- to 14-year period. Methods: A total of 38 patients with congenital lumbar or sacral lipomas and 20 with diastematomyelia were studied pre-operatively with a 1.5-T MRI. Most patients in each group were examined with surveillance MRI (1.5 T) post-operatively. Clinical correlations were carried out with each examination. Of the 38 dorsal or terminal lipoma post-operative patients, hydromyelia increased in 3 and was a new finding in 4. One symptomatic patient in the latter group had extensive septated lumbar hydromyelia. In 8 of 20 diastematomyelia patients, pre-operative hydromyelia was unchanged post-operatively. Hemicord hydromyelia developed in 1. Hydromyelia of varying degree was found in almost one-third of post-operative dorsal or terminal lipoma patients and nearly one-half of diastematomyelia patients. In five post-operative lipoma and two diastematomyelia patients, significant neurological findings remained. One of the six post-operative lipomas had new extensive lumbar hydromyelia that may have been responsible for the patient's symptoms. In the remaining symptomatic patients, hydromyelia was absent or modest. (orig.)

  16. management of postoperative pyrexia

    African Journals Online (AJOL)

    tlniii. ':>i.l.t.“/i'ii fir: i,§i:': ii'i1r,!Zifl§'.i i't:">'-/{Ti one.' plai §'i*;.?(l l"i_y. ;;'>£tii'l()i(3g,},/,i tire . id ire due tr :'narar'ia ai'ai';1.iit'.1. he hit' '_j;,/ eorisirJ'er'er;1, 1:» couid.

  17. Imaging the post-operative meniscus

    Energy Technology Data Exchange (ETDEWEB)

    Toms, Andoni P. [Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom)]. E-mail: andoni.toms@nnuh.nhs.uk; White, Lawrence M. [Department of Medical Imaging, University of Toronto, Mount Sinai Hospital and the University Health Network, 600 University Avenue, Toronto, Ont., M5G 1X5 (Canada); Marshall, Thomas J. [Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk NR4 7UY (United Kingdom); Donell, Simon T. [Institute of Health, University of East Anglia, Norwich, Norfolk NR4 7TJ (United Kingdom)

    2005-05-01

    Considerable developments have occurred in meniscal surgery, and consequently in the imaging of post-operative menisci, over the last 15 years. A drive to preserve meniscal physiologic function for as long as possible, in order to delay osteoarthrosis, has resulted in limited partial meniscectomies, meniscal repairs and meniscal transplants. Each of these techniques affects the imaging appearance of the meniscus, reducing the accuracy of conventional MRI in predicting recurrent tears. The specificity of conventional MRI can be improved by employing at least two T2-weighted sequences, but this still leaves a shortfall in sensitivity. In an attempt to increase the diagnostic accuracy of cross-sectional imaging, MR arthrography (MRA) and CT arthrography (CTA), have been applied to the post-operative meniscus. Sensitivities and specificities for these two techniques approach 90% in predicting recurrent meniscal tears. In the setting of clinical symptoms and gross meniscal deficiency, meniscal allografts are being transplanted with increasing frequency. In these transplants meniscal degeneration, fragmentation and separation are common findings, but the role of imaging in the management of these patients has not yet been well defined. This review explores the imaging techniques available for the evaluation of the post-operative meniscus, their strengths and weaknesses, and the reasons that they may find a place in a rational strategy for imaging of the symptomatic post-operative knee.

  18. The role of postoperative adjuvant radiotherapy in resected esophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Chang Geol; Kim, Choong Bae; Chung, Kyung Young; Lee, Doo Yun; Seong Jin Sil; Kim, Gwi Eon; Suh, Chang Ok [Yonsei University College of Medicine, Yonsei Cancer Center, Seoul (Korea, Republic of)

    2002-12-15

    A retrospective study was performed to evaluate whether postoperative adjuvant radiotherapy can improve survival and decrease recurrence as compared with surgery alone in resected esophageal cancer. From Jan. 1985 to Dec. 1993, among 94 esophageal cancer patients treated with surgery, fifty-one patients were included in this study. Transthoracic esophagectomy was performed in 35 patients and transhiatal esophagectomy in 16. Postoperative adjuvant radiotherapy was performed 4 weeks after surgery in 26 among 38 patients in stage II and III. A total dose of 30 {approx} 60 Gy in 1.8 Gy daily fraction, median 54 Gy over 6 weeks, was delivered in the mediastinum + both supraclavicular lymph nodes or celiac lymph nodes according to the tumor location. Forty-seven patients (92%) had squamous histology. The median follow-up period was 38 months. The overall 2-year and 5-year survival and median survival were 56.4%, 36.8% and 45 months. Two-year and 5-year survival and median survival by stage were 92%, 60.3% for stage I, 63%, 42% and 51 months for stage II and 34%, 23% and 19 months for stage III ({rho} = 0.04). For stage II and III patients, 5-year survival and median survival were 22.8%. 45 months for the surgery alone group and 37.8%, 22 months for the postoperative RT group ({rho} = 0.89). For stage III patients, 2-year survival and median survival were 0%, 11 months for the surgery alone group and 36.5%, 20 months for the postoperative RT group ({rho} = 0.14). Local and distant failure rates for stage II and III were 50%, 16% for the surgery alone and 39%, 31% for the postoperative RT group. For N1 patients, local failure rate was 71% for the surgery alone group and 37% for the postoperative RT group ({rho} = 0.19). Among 10 local failures in the postoperative RT group, in-field failures were 2, marginal failures 1, out-field 5 and anastomotic site failures 2. There were no statistically significant differences in either the overall survival or the patterns of failure

  19. Evaluation of the postoperative breast.

    Science.gov (United States)

    Mendelson, E B

    1992-01-01

    With widespread use of mammography for breast cancer screening, the number of surgical procedures has also increased. Overlapping with radiographic signs of malignancy, including masses, areas of asymmetric density and architectural distortion, microcalcifications, and skin thickening, postsurgical changes may make mammographic evaluation difficult. After tumor excision and irradiation where breast alterations are more profound and prolonged, the task of distinguishing recurrent tumor from scarring or fat necrosis is even more challenging. Mammograms after breast conservation therapy for carcinoma or after cosmetic surgery require correlation with physical findings and the surgical procedures that were performed. Responses of tissue to lumpectomy and radiation, such as breast edema and skin thickening, are most pronounced 6 to 12 months after treatment, gradually resolving within 1 to 3 years. Carefully tailored mammographic studies will promote the dual goal of early detection of local tumor recurrence and avoidance of misinterpreting postoperative and irradiation changes as malignancy. Sequential examinations should begin with a postoperative preradiation mammogram for residual carcinoma, particularly when microcalcifications have been present, followed by the baseline postradiation examination at 6 months with the next study 6 months later (1 year after initial treatment). Mammograms of the treated breast may be performed at intervals of 6 months until radiographic stability has been recognized. Annual studies thereafter are suggested. The contralateral, unaffected breast should be evaluated mammographically according to screening guidelines or clinical concerns. Mammograms performed after cosmetic and reconstructive procedures should be correlated with the surgical techniques and clinical history. Modified views for silicone implants can maximize visualization of breast parenchyma. Ultrasonography is a useful complement to mammography in demonstrating the

  20. Extended phenotype description and new molecular findings in late onset glycogen storage disease type II: a northern Italy population study and review of the literature.

    Science.gov (United States)

    Remiche, Gauthier; Ronchi, Dario; Magri, Francesca; Lamperti, Costanza; Bordoni, Andreina; Moggio, Maurizio; Bresolin, Nereo; Comi, Giacomo P

    2014-01-01

    Glycogen storage disease type II (GSDII) is a lysosomal storage disorder caused by acid alpha-1,4-glucosidase deficiency and associated with recessive mutations in its coding gene GAA. Few studies have provided so far a detailed phenotypical characterization in late onset GSDII (LO-GSDII) patients. Genotype-phenotype correlation has been previously attempted with controversial results. We aim to provide an in-depth description of a cohort (n = 36) of LO-GSDII patients coming from the north of Italy and compare our population's findings to the literature. We performed a clinical record-based retrospective and prospective study of our patients. LO-GSDII in our cohort covers a large variability of phenotype including subtle clinical presentation and did not differ significantly from previous data. In all patients, molecular analysis disclosed GAA mutations, five of them being novel. To assess potential genotype-phenotype correlations we divided IVS1-32-13T>G heterozygous patients into two groups following the severity of the mutations on the second allele. Our patients harbouring "severe" mutations (n = 21) presented a strong tendency to have more severe phenotypes and more disability, more severe phenotypes and more disability, higher prevalence of assisted ventilation and a shorter time of evolution to show it. The determination of prognostic factors is mandatory in order to refine the accuracy of prognostic information, to develop follow-up strategy and, more importantly, to improve the decision algorithm for enzyme replacement therapy administration. The demonstration of genotype-phenotype correlations could help to reach this objective. Clinical assessment homogeneity is required to overcome limitations due to the lack of power of most studies.

  1. Postoperative circadian disturbances

    DEFF Research Database (Denmark)

    Gögenur, Ismail

    2010-01-01

    An increasing number of studies have shown that circadian variation in the excretion of hormones, the sleep wake circle, the core body temperature rhythm, the tone of the autonomic nervous system and the activity rhythm are important both in health and in disease processes. An increasing attention...... has also been directed towards the circadian variation in endogenous rhythms in relation to surgery. The attention has been directed to the question whether the circadian variation in endogenous rhythms can affect postoperative recovery, morbidity and mortality. Based on the lack of studies where...... night after minimally invasive surgery. The core body temperature rhythm was disturbed after both major and minor surgery. There was a change in the sleep wake cycle with a significantly increased duration of REM-sleep in the day and evening time after major surgery compared with preoperatively...

  2. Postoperative circadian disturbances

    DEFF Research Database (Denmark)

    Gögenur, Ismail

    2010-01-01

    in patients with lower than median pain levels for a three days period after laparoscopic cholecystectomy. In the series of studies included in this thesis we have systematically shown that circadian disturbances are found in the secretion of hormones, the sleep-wake cycle, core body temperature rhythm......An increasing number of studies have shown that circadian variation in the excretion of hormones, the sleep wake circle, the core body temperature rhythm, the tone of the autonomic nervous system and the activity rhythm are important both in health and in disease processes. An increasing attention...... has also been directed towards the circadian variation in endogenous rhythms in relation to surgery. The attention has been directed to the question whether the circadian variation in endogenous rhythms can affect postoperative recovery, morbidity and mortality. Based on the lack of studies where...

  3. The Effects of Single-Dose Rectal Midazolam Application on Postoperative Recovery, Sedation, and Analgesia in Children Given Caudal Anesthesia Plus Bupivacaine

    Directory of Open Access Journals (Sweden)

    Sedat Saylan

    2014-01-01

    Full Text Available Background. This study aimed to compare the effects of rectal midazolam addition after applying bupivacaine and caudal anesthesia on postoperative analgesia time, the need for additional analgesics, postoperative recovery, and sedation and to find out its adverse effects in children having lower abdominal surgery. Methods. 40 children between 2 and 10 years of ASA I-II were randomized, and they received caudal anesthesia under general anesthesia. Patients underwent the application of caudal block in addition to saline and 1 mL/kg bupivacaine 0.25%. In the postoperative period, Group C (n = 20 was given 5 mL saline, and Group M (n = 20 was given 0.30 mg/kg rectal midazolam diluted with 5 mL saline. Sedation scale and postoperative pain scale (CHIPPS of the patients were evaluated. The patients were observed for their analgesic need, first analgesic time, and adverse effects for 24 hours. Results. Demographic and hemodynamic data of the two groups did not differ. Postoperative sedation scores in both groups were significantly lower compared with the preoperative period. There was no significant difference between the groups in terms of sedation and sufficient analgesia. Conclusions. We conclude that caudal anesthesia provided sufficient analgesia in peroperative and postoperative periods, and rectal midazolam addition did not create any differences. This trial is registered with ClinicalTrials.gov NCT02127489.

  4. Pilot study on a fast postoperative programming approach to subthalamic nucleus stimulation in Parkinson′s disease

    Directory of Open Access Journals (Sweden)

    Peng Li

    2011-01-01

    Full Text Available Objectives : T0 o evaluate the advantages and disadvantages of a fast post-operative screening method using deep brain stimulation (DBS of the subthalamic nucleus (STN in patients with Parkinson′s disease. Materials and Methods : T0 wenty-four patients implanted with electrodes for STN-DBS were divided into two groups : G0 roup I received traditional programming and Group II was treated with the fast method. The time required for programming in each group and the treatment effects were analyzed. Results : S0 ignificant postoperative improvement of the Unified Parkinson′s Disease Rating Scale III was achieved in the "off medication" and "on stimulation" condition in both the groups (Group I: 51.2% vs. Group II: 54.0%, P<0.05. The average time needed for programming, however, was significantly shorter in Group II as compared to Group I (P<0.05. Conclusions : T0 he new fast method can significantly reduce the time required to find a preliminary effective STN-DBS protocol in the early postoperative phase without sacrificing clinical efficacy.

  5. Evaluation of the surgical factor in postoperative pain control

    Directory of Open Access Journals (Sweden)

    Shams Mohamed

    2010-01-01

    Full Text Available Background: Postoperative pain control has been studied extensively, including many perioperative pain control procedures. Unfortunately, the impact of the surgical technique was not objectively studied. Aim: The aim of this study is to evaluate if the type of surgical dissection needed for extensive abdominal wall dissection actually has an effect in the reduction of postoperative pain or not. Materials and Methods: Forty adult patients, 19 males and 21 females, were randomly divided into two groups with each group containing 20 patients having different varieties of anterior abdominal wall ventral hernia. Patients in group I had their hernias and abdominal wall flaps dissected by only sharp dissection using scalpel. Patients in group II had their hernias and abdominal wall flaps dissected using mainly blunt dissection assisted by sharp dissection where blunt dissection could not do the job. All the patients had general anesthesia. No preemptive analgesia was used. Nalbufen was used as the only postoperative pain killer and the total amount used of it was treated as the indicator for the intensity of postoperative pain. Results: The results of the present study showed that the total amount of Nalbufen used for the control of postoperative pain is significantly less in group I throughout the postoperative follow-up period. Conclusion: This study concludes that use of sharp dissection in cases of extensive abdominal wall dissection is statistically better than other methods of dissection in terms of postoperative pain control.

  6. Oxygen therapy reduces postoperative tachycardia

    DEFF Research Database (Denmark)

    Stausholm, K; Kehlet, H; Rosenberg, J

    1995-01-01

    Concomitant hypoxaemia and tachycardia in the postoperative period is unfavourable for the myocardium. Since hypoxaemia per se may be involved in the pathogenesis of postoperative tachycardia, we have studied the effect of oxygen therapy on tachycardia in 12 patients randomly allocated to blinded...

  7. 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...

  8. [Management of postoperative chylothorax].

    Science.gov (United States)

    Smati, B; Sadok Boudaya, M; Marghli, A; Mestiri, T; Baccari, S; Hantous, T; Djilani, H; Kilani, T

    2006-04-01

    A chylothorax can occur following any intrathoracic procedure. It is generally straightforward to make the diagnosis but optimal management can be problematic. Between 1995 and 2002, three women and one man aged from 13 to 58 years were treated for chylothorax after thoracic surgery. Their initial illnesses were a right pulmonary hydatid cyst associated with hepatic disease, a tumour of the posterior mediastinum, an oesophageal carcinoma and metastases in the left lung. These patients had: a pulmonary and hepatic cystectomies, a resection of the mediastinal tumor, an Akyama oesophagectomy and a resection of four left pulmonary metastases. Chylothorax became apparent post operatively between the 1st and the 4th day. All patients were treated with a medium-chain triglyceride diet. Two patients were re-explored with ligation of lymphatic vessels. One woman who did not have further surgery was treated with etilefrine. In the patient who had had an oesophagectomy, chylothorax persisted after re-operation. He was successfully treated by talc pleurodesis via a chest drain, which prevented further recurrence. In the management of postoperative chylothorax, medical treatment must be started early but surgery should not be delayed as operative risk is increased by the development of malnutrition and immune deficiency.

  9. Fast track surgery accelerates the recovery of postoperative insulin sensitivity

    Institute of Scientific and Technical Information of China (English)

    YANG Dong-jie; ZHANG Chang-hua; HE Yu-long; ZHANG Sheng; HE Wei-ling; CHEN Hua-yun; CAI Shi-rong; CHEN Chuang-qi; SONG Xin-ming; CUI Ji; MA Jin-ping

    2012-01-01

    Background Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity.This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.Methods Controlled,randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up.Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups:a fast track group (35 cases) and a conventional care group (35 cases).All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia.Clinical parameters (complication rates,return of gastrointestinal function and postoperative length of stay),stress index and insulin sensitivity were evaluated in both groups perioperatively.Reaults Sixty-two patients finally completed the study,32 cases in the fast-track group and 30 cases in the conventional care group.Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group.We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.Conclusion Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

  10. Fast track surgery accelerates the recovery of postoperative insulin sensitivity.

    Science.gov (United States)

    Yang, Dong-jie; Zhang, Sheng; He, Wei-ling; Chen, Hua-yun; Cai, Shi-rong; Chen, Chuang-qi; Song, Xin-ming; Cui, Ji; Ma, Jin-Ping; Zhang, Chang-Hua; He, Yu-Long

    2012-09-01

    Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection. Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters (complication rates, return of gastrointestinal function and postoperative length of stay), stress index and insulin sensitivity were evaluated in both groups perioperatively. Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation. Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

  11. Trauma and postoperative follow-up; Traumata und postoperative Folgezustaende

    Energy Technology Data Exchange (ETDEWEB)

    Voth, E. [Univ. Koeln (Germany). Klinik und Poliklinik fuer Nuklearmedizin

    1997-10-01

    Indications for the use of nuclear medicine techniques, mostly bone scintigraphy, occur in case of diagnostic problems, especially if there are discrepancies between the clinical symptoms and X-ray findings. This may happen in case of stress fractures, fractures in bones difficult to judge by X-ray imaging, and in the differentation of recent versus old fracture. A further indication for bone scanning is to assess the extent of skeletal lesions in polytrauma and in the battered child syndrome. In postoperative patients bone scanning is most frequently performed in order to assess loosening or infection of endoprosthesis. Due to bone remodelling uptake of Tc-diphosphonates varies between cemented and cementfree implants. This fact should be taken into consideration when interpreting bone scans in areas with endoprostheses. In both trauma and postoperative patients, indications for nuclear medicine imaging exist if healing is complicated. Bone scanning can be used to assess pseudoartrosis or non-union, infection, viability of grafts and bone fragments and reflex sympathetic dystrophy. In suspicious infection with positive bone scan, white blood cell or microcollid scintigraphy can be used for further differentiation. (orig./MG) [Deutsch] Indikationen zum Einsatz nuklearmedizinischer Verfahren, in der Regel der Skelettszintigraphie, ergeben sich bei diagnostischen Problemen, speziell bei Diskrepanzen zwischen der klinischen Symptomatik und dem roentgenologischen Befund. In der Traumatologie kann dies Stressfrakturen, Frakturen in roentgenologisch schwer beurteilbaren Skelettabschnitten, das Ausmass der knoechernen Verletzungen bei Polytraumata oder Kindermisshandlungen sowie die Differenzierung alte versus frische Fraktur betreffen. In der postoperativen Verlaufs- bzw. Therapiekontrolle ist die haeufigste Indikation zur Skelettszintigraphie die Frage nach Lockerung einer Endoprothese. Wegen des aus pathophysiologischen Gruenden unterschiedlichen Anreicherungsmusters

  12. Finding Potent Sirt Inhibitor in Coffee: Isolation, Confirmation and Synthesis of Javamide-II (N-Caffeoyltryptophan as Sirt1/2 Inhibitor.

    Directory of Open Access Journals (Sweden)

    Jae B Park

    Full Text Available Recent studies suggest that Sirt inhibition may have beneficial effects on several human diseases such as neurodegenerative diseases and cancer. Coffee is one of most popular beverages with several positive health effects. Therefore, in this paper, potential Sirt inhibitors were screened using coffee extract. First, HPLC was utilized to fractionate coffee extract, then screened using a Sirt1/2 inhibition assay. The screening led to the isolation of a potent Sirt1/2 inhibitor, whose structure was determined as javamide-II (N-caffeoyltryptophan by NMR. For confirmation, the amide was chemically synthesized and its capacity of inhibiting Sirt1/2 was also compared with the isolated amide. Javamide-II inhibited Sirt2 (IC50; 8.7 μM better than Sirt1(IC50; 34μM. Since javamide-II is a stronger inhibitor for Sirt2 than Sirt1. The kinetic study was performed against Sirt2. The amide exhibited noncompetitive Sirt2 inhibition against the NAD+ (Ki = 9.8 μM and showed competitive inhibition against the peptide substrate (Ki = 5.3 μM. Also, a docking simulation showed stronger binding pose of javamide-II to Sirt2 than AGK2. In cellular levels, javamide-II was able to increase the acetylation of total lysine, cortactin and histone H3 in neuronal NG108-15 cells. In the same cells, the amide also increased the acetylation of lysine (K382 in p53, but not (K305. This study suggests that Javamide-II found in coffee may be a potent Sirt1/2 inhibitor, probably with potential use in some conditions of human diseases.

  13. Finding Potent Sirt Inhibitor in Coffee: Isolation, Confirmation and Synthesis of Javamide-II (N-Caffeoyltryptophan) as Sirt1/2 Inhibitor.

    Science.gov (United States)

    Park, Jae B

    2016-01-01

    Recent studies suggest that Sirt inhibition may have beneficial effects on several human diseases such as neurodegenerative diseases and cancer. Coffee is one of most popular beverages with several positive health effects. Therefore, in this paper, potential Sirt inhibitors were screened using coffee extract. First, HPLC was utilized to fractionate coffee extract, then screened using a Sirt1/2 inhibition assay. The screening led to the isolation of a potent Sirt1/2 inhibitor, whose structure was determined as javamide-II (N-caffeoyltryptophan) by NMR. For confirmation, the amide was chemically synthesized and its capacity of inhibiting Sirt1/2 was also compared with the isolated amide. Javamide-II inhibited Sirt2 (IC50; 8.7 μM) better than Sirt1(IC50; 34μM). Since javamide-II is a stronger inhibitor for Sirt2 than Sirt1. The kinetic study was performed against Sirt2. The amide exhibited noncompetitive Sirt2 inhibition against the NAD+ (Ki = 9.8 μM) and showed competitive inhibition against the peptide substrate (Ki = 5.3 μM). Also, a docking simulation showed stronger binding pose of javamide-II to Sirt2 than AGK2. In cellular levels, javamide-II was able to increase the acetylation of total lysine, cortactin and histone H3 in neuronal NG108-15 cells. In the same cells, the amide also increased the acetylation of lysine (K382) in p53, but not (K305). This study suggests that Javamide-II found in coffee may be a potent Sirt1/2 inhibitor, probably with potential use in some conditions of human diseases.

  14. PRE-EMPTIVE ORAL CLONIDINE FOR IMMEDIATE POSTOPERATIVE PAIN IN SURGERIES UNDER SUB-ARACHNOID BLOCK

    Directory of Open Access Journals (Sweden)

    Priti

    2014-10-01

    Full Text Available : BACKGROUND: Pre-emptive analgesia is a treatment that is initiated before the surgical procedure in order to reduce sensitization of central and peripheral pain pathways produced by pain signals evoked by tissue damage. Clonidine has demonstrated efficacy in clinical trials as pre-emptive analgesic in postoperative pain management. OBJECTIVE: The present study was conducted to evaluate postoperative analgesic benefit in patients administered clonidine or placebo for below umbilical surgeries to be performed under subarachnoid block (SAB using 3ml 0.5%bupivacaine & to compare their postoperative efficacy with respect to duration of analgesia, 24hrs postoperative requirements of total analgesics and study side effects. MATERIAL & METHODS: Sixty patients of either sex (30 per group, 20-65yrs, ASA class I-II received either oral placebo (group PC or clonidine 150µg (group CL one hr preoperatively. The postoperative Visual Analogue Scale (VAS score was assessed for 24hrs every 2hrly. The patients were given iv Diclofenac75mg as rescue analgesic at VAS ≥4.The time at which patient demanded rescue analgesic for first time & total requirement of 24 hrs postoperative analgesics was noted. STATISTICAL ANALYSIS: Software used in the analysis was EPI info software (3.4.3. Data was reported as mean value ± SD, P-value of < 0.05 was considered statistically significant. Unpaired T – test was used to find out significance between two samples. The comparison of normally distributed continuous variables between the groups was performed by means of one-way analysis of variance (ANOVA and, if appropriate, followed by Dunnett multiple comparison tests. Nominal categorical data among study groups were compared using the chi-square test. Results: Total duration of analgesia in Group-CL was significantly more than Group-PC. (492.66 ±78.29 min. Group-CL, 264.83 ±13.67 min. Group-PC, p=0.000, lower rescue analgesic requirement in Group-CL than in Group-PC (2

  15. 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.

  16. The Importance of California Public Libraries in Increasing Public Access to the Internet: Findings from the InFoPeople Site Visits. Stage II Final Report.

    Science.gov (United States)

    Bertot, John Carlo; McClure, Charles R.; Ryan, Joe

    In less than five years, the California State Library-sponsored InFoPeople project connected 46% of California's public libraries to the Internet and established a highly regarded, sustained training program to assist librarians in taking advantage of the new networked resources and services. The primary objective of this Stage II report was to…

  17. Risk factors for mortality in postoperative peritonitis in critically ill patients

    Science.gov (United States)

    Launey, Yoann; Duteurtre, Benjamin; Larmet, Raphaëlle; Nesseler, Nicolas; Tawa, Audrey; Mallédant, Yannick; Seguin, Philippe

    2017-01-01

    AIM To identify the risk factors for mortality in intensive care patients with postoperative peritonitis (POP). METHODS This was a retrospective analysis using a prospective database that includes all patients hospitalized in a surgical intensive care unit for POP from September 2006 to August 2011. The data collected included demographics, comorbidities, postoperative severity parameters, bacteriological findings, adequacy of antimicrobial therapy and surgical treatments. Adequate source control was defined based on a midline laparotomy, infection source control and intraoperative peritoneal lavage. The number of reoperations needed was also recorded. RESULTS A total of 201 patients were included. The overall mortality rate was 31%. Three independent risk factors for mortality were identified: The Simplified Acute Physiological II Score (OR = 1.03; 95%CI: 1.02-1.05, P number of reoperations (OR = 2.45; 95%CI: 1.16-5.17, P = 0.015). Surgery was considered as optimal in 69% of the cases, but without any significant effect on mortality. CONCLUSION The results from the large cohort in this study emphasize the role of the initial postoperative severity parameters in the prognosis of POP. No predefined criteria for optimal surgery were significantly associated with increased mortality, although the number of reoperations appeared as an independent risk factor of mortality.

  18. Nutritional predictors for postoperative short-term and long-term outcomes of patients with gastric cancer.

    Science.gov (United States)

    Kanda, Mitsuro; Mizuno, Akira; Tanaka, Chie; Kobayashi, Daisuke; Fujiwara, Michitaka; Iwata, Naoki; Hayashi, Masamichi; Yamada, Suguru; Nakayama, Goro; Fujii, Tsutomu; Sugimoto, Hiroyuki; Koike, Masahiko; Takami, Hideki; Niwa, Yukiko; Murotani, Kenta; Kodera, Yasuhiro

    2016-06-01

    Evidence indicates that impaired immunocompetence and nutritional status adversely affect short-term and long-term outcomes of patients with cancer. We aimed to evaluate the clinical significance of preoperative immunocompetence and nutritional status according to Onodera's prognostic nutrition index (PNI) among patients who underwent curative gastrectomy for gastric cancer (GC).This study included 260 patients with stage II/III GC who underwent R0 resection. The predictive values of preoperative nutritional status for postoperative outcome (morbidity and prognosis) were evaluated. Onodera's PNI was calculated as follows: 10 × serum albumin (g/dL) + 0.005 × lymphocyte count (per mm).The mean preoperative PNI was 47.8. The area under the curve for predicting complications was greater for PNI compared with the serum albumin concentration or lymphocyte count. Multivariate analysis identified preoperative PNI < 47 as an independent predictor of postoperative morbidity. Moreover, patients in the PNI < 47 group experienced significantly shorter overall and disease-free survival compared with those in the PNI ≥ 47 group, notably because of a higher prevalence of hematogenous metastasis as the initial recurrence. Subgroup analysis according to disease stage and postoperative adjuvant treatment revealed that the prognostic significance of PNI was more apparent in patients with stage II GC and in those who received adjuvant chemotherapy.Preoperative PNI is easy and inexpensive to determine, and our findings indicate that PNI served as a significant predictor of postoperative morbidity, prognosis, and recurrence patterns of patients with stage II/III GC.

  19. Postoperative radiotherapy for endometrial cancer

    National Research Council Canada - National Science Library

    Choi, Eun Cheol; Kim, Jin Hee; Kim, Ok Bae; Byun, Sang Jun; Park, Seung Gyu; Kwon, Sang Hoon

    2012-01-01

    .... Sixty four patients with stage I-III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study...

  20. Alcohol abuse and postoperative morbidity

    DEFF Research Database (Denmark)

    Tønnesen, Hanne

    2003-01-01

    precise identification of alcohol abuse. However, the inability of the questionnaires to detect short-term changes in intake and abuse without dependence, the inconsistent predictive values of the biological markers, and the lack of evidence of an association to postoperative morbidity reduces......Patients who drink too much have more complications after surgery. The aim of this thesis was to evaluate the evidence, possible mechanisms, and prevention of the increased postoperative morbidity in alcohol abusers, defined by a consumption of at least five drinks per day. The literature could...... be criticised for several methodological flaws. Nevertheless, the results are in agreement showing moderate to strong evidence of increased postoperative morbidity after surgical procedures on alcohol abusers. There is weak to moderate evidence of increased postoperative mortality, hospital stay, and re...

  1. Normal postperative computed tomography findings after avariety of pancreatic surgeries

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Ji Won; Hwang, Ho Kyoung; Lee, Min Wook; Kim, Ki Whang; Kang, Chang Moo; Kim, Myeong Jin; Chung, Yong Eun [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2017-04-15

    Pancreatic surgery remains the only curative treatment for pancreatic neoplasms, and plays an important role in the management of medically intractable diseases. Since the original Whipple operation in the 20th century, surgical techniques have advanced, resulting in decreased postoperative complications and better clinical outcomes. Normal postoperative imaging findings vary greatly depending on the surgical technique used. Radiologists are required to be familiar with the normal postoperative imaging findings, in order to distinguish from postoperative complications or tumor recurrence. In this study, we briefly review a variety of surgical techniques for the pancreas, and present the normal postoperative computed tomography findings.

  2. Postoperative care in trichiasis surgery

    Directory of Open Access Journals (Sweden)

    Esmael Ali

    2016-10-01

    Full Text Available Postoperative care is an important aspect of trachomatous trichiasis (TT surgical services. Follow-up visits should ideally take place on the first postoperative day (to remove the eye patch, after 8–14 days (to remove sutures; optional if absorbable sutures are used, at 3 months (to re-examine the operated lid for intermediate surgical outcomes, and then at or after six months.

  3. Radiological Features and Postoperative Histopathologic Diagnosis ...

    African Journals Online (AJOL)

    Radiological Features and Postoperative Histopathologic Diagnosis of Intracranial Masses at Tikur Anbessa ... East and Central African Journal of Surgery ... features and postoperative histopathology diagnosis of intracranial mass lesions.

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

    Science.gov (United States)

    Wei, Naili; Jia, Yanfei; Wang, Xiu; Zhang, Yinian; Yuan, Guoqiang; Zhao, Baotian; Wang, Yao; Zhang, Kai; Zhang, Xinding; Pan, Yawen; Zhang, Jianguo

    2015-01-01

    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 postoperative

  5. Impact of postoperative radiation therapy on survival in patients with complete resection and stage I, II, or IIIA non-small-cell lung cancer treated with adjuvant chemotherapy: the adjuvant Navelbine International Trialist Association (ANITA) Randomized Trial.

    Science.gov (United States)

    Douillard, Jean-Yves; Rosell, Rafael; De Lena, Mario; Riggi, Marcello; Hurteloup, Patrick; Mahe, Marc-Andre

    2008-11-01

    To study the impact of postoperative radiation therapy (PORT) on survival in the Adjuvant Navelbine International Trialist Association (ANITA) randomized study of adjuvant chemotherapy. ANITA is a randomized trial of adjuvant cisplatin and vinorelbine chemotherapy vs. observation in completely resected non-small-cell lung carcinoma (NSCLC) Stages IB to IIIA. Use of PORT was recommended for pN+ disease but was not randomized or mandatory. Each center decided whether to use PORT before initiation of the study. We describe here the survival of patients with and without PORT within each treatment group of ANITA. No statistical comparison of survival was performed because this was an unplanned subgroup analysis. Overall, 232 of 840 patients received PORT (33.3% in the observation arm and 21.6% in the chemotherapy arm). In univariate analysis, PORT had a deleterious effect on the overall population survival. Patients with pN1 disease had an improved survival from PORT in the observation arm (median survival [MS] 25.9 vs. 50.2 months), whereas PORT had a detrimental effect in the chemotherapy group (MS 93.6 months and 46.6 months). In contrast, survival was improved in patients with pN2 disease who received PORT, both in the chemotherapy (MS 23.8 vs. 47.4 months) and observation arm (median 12.7 vs. 22.7 months). This retrospective evaluation suggests a positive effect of PORT in pN2 disease and a negative effect on pN1 disease when patients received adjuvant chemotherapy. The results support further evaluation of PORT in prospectively randomized studies in completely resected pN2 NSCLC.

  6. Pathophysiology and prevention of postoperative peritoneal adhesions

    Institute of Scientific and Technical Information of China (English)

    Willy Arung1; Michel Meurisse; Olivier Detry

    2011-01-01

    Peritoneal adhesions represent an important clinical challenge in gastrointestinal surgery. Peritoneal adhesions are a consequence of peritoneal irritation by infection or surgical trauma, and may be considered as the pathological part of healing following any peritoneal injury, particularly due to abdominal surgery. The balance between fibrin deposition and degradation is critical in determining normal peritoneal healing or adhesion formation. Postoperative peritoneal adhesions are a major cause of morbidity resulting in multiple complications, many of which may manifest several years after the initial surgical procedure. In addition to acute small bowel obstruction, peritoneal adhesions may cause pelvic or abdominal pain, and infertility. In this paper, the authors reviewed the epidemiology, pathogenesis and various prevention strategies of adhesion formation, using Medline and PubMed search. Several preventive agents against postoperative peritoneal adhesions have been investigated. Their role aims in activating fibrinolysis, hampering coagulation, diminishing the inflammatory response, inhibiting collagen synthesis or creating a barrier between adjacent wound surfaces. Their results are encouraging but most of them are contradictory and achieved mostly in animal model. Until additional findings from future clinical researches, only a meticulous surgery can be recommended to reduce unnecessary morbidity and mortality rates from these untoward effects of surgery. In the current state of knowledge, pre-clinical or clinical studies are still necessary to evaluate the effectiveness of the several proposed prevention strategies of postoperative peritoneal adhesions.

  7. Intravitreal Daptomycin for Recalcitrant Postoperative Endophthalmitis

    Directory of Open Access Journals (Sweden)

    Jennifer M. Sim

    2016-02-01

    Full Text Available Purpose: To report the first case to our knowledge of intravitreal daptomycin used to successfully treat culture-negative vancomycin resistant to exogenous endophthalmitis. Methods: Case report with preoperative, intraoperative, and postoperative findings. Results: A 63-year-old Caucasian male underwent routine pars plana vitrectomy with epiretinal membrane peeling. He developed acute postoperative endophthalmitis, and underwent vitreous tap and injection of intravitreal vancomycin/ceftazidime/dexamethasone. Gram stain showed Gram-positive cocci, but cultures were negative. His infection subsequently proved very recalcitrant and his treatment course involved pars plana vitrectomy with anterior chamber washout and repeat injection of antibiotics, followed by repeat intravitreal vancomycin and ceftazidime. Ultimately, a second vitrectomy with intravitreal daptomycin controlled his intraocular infection. On each occasion, cultures were negative. Conclusion: This case suggests that vancomycin resistance should be considered in culture-negative postoperative endophthalmitis, and intravitreal daptomycin should be considered as an important treatment alternative. Although vancomycin resistance is fairly rare in endophthalmitis, acknowledgment of its increasing occurrence rate is critical for optimal management.

  8. Takotsubo Cardiomyopathy Occurring in the Postoperative Period.

    Science.gov (United States)

    Deniz, Süleyman; Bakal, Ömer; İnangil, Gökhan; Şen, Hüseyin; Özkan, Sezai

    2015-02-01

    Takotsubo cardiomyopathy simulates acute myocardial infarction, and it is characterised by reversible left ventricular failure. A case of Takotsubo cardiomyopathy diagnosed after emergency angiography performed in a patient with evidence of acute myocardial infarction in the postoperative period will be described in this report. Transurethral resection of a bladder tumour (TUR-BT) was performed in a 92-year-old male patient by the urology clinic. The patient was transferred to the post-anaesthesia care unit after the operation. An echocardiography was performed because of the sudden onset of dyspnoea, tachycardia (140-150 beats per minute, rhythm-atrial fibrillation) and ST-segment elevation on electrocardiography (ECG) at the first postoperative hour, and midapical dyskinesia was detected at the patient. An immediate angiography was performed due to suspicion of acute coronary syndrome. Patent coronary arteries and temporary aneurysmatic dilatation of the apex of the heart were revealed by angiography. As a result of these findings, the patient was diagnosed with Takotsubo cardiomyopathy by the cardiology service. The patient was discharged uneventfully following 10 days in the intensive care unit. Aneurysm of the apex of the left ventricle and normal anatomy of the coronary arteries in the angiography have diagnostic value for Takotsubo cardiomyopathy. Diuretics (furosemide) and beta-blockers (metoprolol) are commonly used for the treatment of Takotsubo cardiomyopathy. Even though Takotsubo cardiomyopathy is a rare and benign disease, it should be kept in mind in patients suspected for acute myocardial infarction in the postoperative period.

  9. CT findings suggesting anastomotic leak and predicting the recovery period following gastric surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Ho; Kim, Jung Hoon; Shin, Cheong-Il; Kim, Se Hyung; Han, Joon Koo; Choi, Byung Ihn [Seoul National University College of Medicine, Department of Radiology, Institute of Radiation Medicine, Jongno-gu, Seoul (Korea, Republic of)

    2015-07-15

    To assess diagnostic performance of routine CT for detecting anastomotic leak after gastric surgery, and analyse the relationship between recovery period and CT findings. We included 179 patients who underwent immediate CT and fluoroscopy after gastric surgery. Two reviewers retrospectively rated the possibility of leak on CT using a five-point scale focused on predefined CT findings. They also evaluated CT findings. Patients were categorised as: Group I, leak on fluoroscopy; Group II, possible leak on CT but negative on fluoroscopy; Group III, no leak. We analysed the relationship between recovery period and group. Area under the curve for detecting leak on CT was 0.886 in R1 and 0.668 in R2 with moderate agreement (k = 0.482). Statistically common CT findings for leak included discontinuity, large amount of air-fluid and wall thickening at anastomosis site (p < 0.05). Discontinuity at anastomosis site and a large air-fluid collection were independently associated with leak (p < 0.05). The recovery period including hospitalisation and postoperative fasting period was longer in Group I than Group II or III (p < 0.05). Group II showed a longer recovery period than Group III (p < 0.05). Postoperative routine CT was useful for predicting anastomotic leak using specific findings, and for predicting length of recovery period. (orig.)

  10. First finding of Trypanosoma cruzi II in vampire bats from a district free of domestic vector-borne transmission in Northeastern Argentina.

    Science.gov (United States)

    Argibay, Hernán D; Orozco, M Marcela; Cardinal, M Victoria; Rinas, Miguel A; Arnaiz, María; Mena Segura, Carlos; Gürtler, Ricardo E

    2016-09-01

    Establishing the putative links between sylvatic and domestic transmission cycles of Trypanosoma cruzi, the etiological agent of Chagas disease, is of public health relevance. We conducted three surveys to assess T. cruzi infection in wild mammals from a rural and a preserved area in Misiones Province, Northeastern Argentina, which had recently been declared free of vector- and blood-borne transmission of human T. cruzi infection. A total of 200 wild mammals were examined by xenodiagnosis (XD) and/or polymerase chain reaction (PCR) amplification of the hyper-variable region of kinetoplast DNA minicircles of T. cruzi (kDNA-PCR). The overall prevalence of T. cruzi infection was 8%. Nine (16%) of 57 Didelphis albiventris opossums and two (7%) of 29 Desmodus rotundus vampire bats were positive by both XD and kDNA-PCR. Additionally, one D. rotundus positive for T. cruzi by kDNA-PCR tested positive by satellite-DNA-PCR (SAT-DNA-PCR). The T. cruzi-infected bats were captured indoors and in the yard of a vacant dwelling. All D. albiventris were infected with TcI and both XD-positive D. rotundus by TcII. Fifty-five opossum cubs within the marsupium were negative by XD. The mean infectiousness to the vector was 62% in D. albiventris and 50% in D. rotundus. Mice experimentally infected with a parasite isolate from a vampire bat displayed lesions typically caused by T. cruzi. Our study documents the presence of the genotype TcII in a sylvatic host for the first time in Argentina, and the occurrence of two transmission cycles of T. cruzi in a district free of domestic vector-borne transmission.

  11. Alcohol abuse and postoperative morbidity

    DEFF Research Database (Denmark)

    Tønnesen, Hanne

    2003-01-01

    Patients who drink too much have more complications after surgery. The aim of this thesis was to evaluate the evidence, possible mechanisms, and prevention of the increased postoperative morbidity in alcohol abusers, defined by a consumption of at least five drinks per day. The literature could...... be criticised for several methodological flaws. Nevertheless, the results are in agreement showing moderate to strong evidence of increased postoperative morbidity after surgical procedures on alcohol abusers. There is weak to moderate evidence of increased postoperative mortality, hospital stay, and re......-operation. The personal and economic consequences are tremendous. The incidence of alcohol abusers undergoing surgery was 7% to 49%, according to gender and diagnosis. They have been identified by a self-reported alcohol intake, which implies the possibility of underestimation. Alcohol markers could be used for a more...

  12. Post-operative urinary retention.

    Science.gov (United States)

    Steggall, Martin; Treacy, Colm; Jones, Mark

    Urinary retention is a common complication of surgery and anaesthesia. The risk of post-operative urinary retention is increased following certain surgical procedures and anaesthetic modalities, and with patients' advancing age. Patients at increased risk of post-operative urinary retention should be identified before surgery or the condition should be identified and treated in a timely manner following surgery. If conservative measures do not help the patient to pass urine, the bladder will need to be drained using either an intermittent catheter or an indwelling urethral catheter, which can result in catheter-associated urinary tract infections. This article provides an overview of normal bladder function, risk factors for developing post-operative urinary retention, and treatment options. Guidance drawn from the literature aims to assist nurses in identifying at-risk patients and inform patient care.

  13. Postoperative adjuvant chemoradiotherapy in rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Sei Kyung; Kim, Jong Woo; Oh, Do Yeun; Chong, So Young; Shin, Hyun Soo [Bundang CHA General Hospital, Pochon CHA University, Seongnam (Korea, Republic of)

    2006-09-15

    To evaluate the role of postoperative adjuvant chemoradiotherapy in rectal cancer, we retrospectively analyzed the treatment outcome of patients with rectal cancer taken curative surgical resection and postoperative adjuvant chemoradiotherapy. A total 46 patients with AJCC stage II and III carcinoma of rectum were treated with curative surgical resection and postoperative adjuvant chemoradiotherapy. T3 and T4 stage were 38 and 8 patients, respectively. N0, N1, and N2 stage were 12, 16, 18 patients, respectively. Forty patients received bolus infusions of 5-fluorouracil (500 mg/m{sup 2}/day) with leucovorin (20 mg/m{sup 2}/day), every 4 weeks interval for 6 cycles. Oral Uracil/Tegafur on a daily basis for 6 {approx} 12 months was given in 6 patients. Radiotherapy with 45 Gy was delivered to the surgical bed and regional pelvic lymph node area, followed by 5.4 {approx} 9 Gy boost to the surgical bed. The follow up period ranged from 8 to 75 months with a median 35 months. Treatment failure occurred in 17 patients (37%). Locoregional failure occurred in 4 patients (8.7%) and distant failure in 16 patients (34.8%). There was no local failure only. Five year actuarial overall survival (OS) was 51.5% and relapse free survival (RFS) was 58.7%. The OS and RFS were 100%, 100% in stage N0 patients, 53.7%, 47.6% in N1 patients, and 0%, 41.2% in N2 patients ({rho} = 0.012, {rho} = 0.009). The RFS was 55%, 78.5%, and 31.2% in upper, middle, and lower rectal cancer patients, respectively ({rho} = 0.006). Multivariate analysis showed that N stage ({rho} = 0.012) was significant prognostic factor for OS and that N stage ({rho} = 0.001) and location of tumor ({rho} = 0.006) were for RFS. Bowel complications requiring surgery occurred in 3 patients. Postoperative adjuvant chemoradiotherapy was an effective modality for locoregional control of rectal cancer. But further investigations for reducing the distant failure rate are necessary because distant failure rate is still high.

  14. The efficacy of ketamine gargles on postoperative sore throat

    Directory of Open Access Journals (Sweden)

    Maryam Hadavi

    2011-10-01

    Full Text Available Background: Sore throat is one of the major post-operative complications. Despite efforts to reduce sore throat, this complication is still one of the main problems after surgery. The aim of this study was to analyze the effectiveness of ketamine gargle on sore throat after tracheal intubation.Materials and method: This double blind clinical trial was performed on 120, ASA-I and II, patients undergoing elective surgery for herniorrhaphy under general anesthesia. Patients in group 1 were gargled 40 mg ketamine in 30mg saline and in group 2, only 30ml saline. For third group we did not do any intervention. Postoperative sore throat was graded at 0, 2, 4 and 24 h after operation on Verbal Analogue Scale (0-4.Results: Postoperative sore throat occurred less frequently in group 1, when compared with groups 2 and 3, but the difference was not significant. Frequently sore throat was reported at two hours after surgery. In this study, there was no severe (score 3 or very severe (score 4 sore throat. No systemic or local side effects were observed. Conclusion: In this study, ketamine gargle reduced the incidence and severity of post-operative sore throat. Therefore, gargling of ketamine solution is recommended for cases that need to tracheal intubation, especially when the probability of difficult intubation and post-operative sore throat is high

  15. Postoperative Pain in Children After Dentistry Under General Anesthesia.

    Science.gov (United States)

    Wong, Michelle; Copp, Peter E; Haas, Daniel A

    2015-01-01

    The objective of this study was to determine the prevalence, severity, and duration of postoperative pain in children undergoing general anesthesia for dentistry. This prospective cross-sectional study included 33 American Society of Anesthesiology (ASA) Class I and II children 4-6 years old requiring multiple dental procedures, including at least 1 extraction, and/or pulpectomy, and/or pulpotomy of the primary dentition. Exclusion criteria were children who were developmentally delayed, cognitively impaired, born prematurely, taking psychotropic medications, or recorded baseline pain or analgesic use. The primary outcome of pain was measured by parents using the validated Faces Pain Scale-Revised (FPS-R) and Parents' Postoperative Pain Measure (PPPM) during the first 72 hours at home. The results showed that moderate-to-severe postoperative pain, defined as FPS-R ≥ 6, was reported in 48.5% of children. The prevalence of moderate-to-severe pain was 29.0% by FPS-R and 40.0% by PPPM at 2 hours after discharge. Pain subsided over 3 days. Postoperative pain scores increased significantly from baseline (P < .001, Wilcoxon matched pairs signed rank test). Moderately good correlation between the 2 pain measures existed 2 and 12 hours from discharge (Spearman rhos correlation coefficients of 0.604 and 0.603, P < .005). In conclusion, children do experience moderate-to-severe pain postoperatively. Although parents successfully used pain scales, they infrequently administered analgesics.

  16. The project ENABLE II randomized controlled trial to improve palliative care for rural patients with advanced cancer: baseline findings, methodological challenges, and solutions.

    Science.gov (United States)

    Bakitas, Marie; Lyons, Kathleen Doyle; Hegel, Mark T; Balan, Stefan; Barnett, Kathleen N; Brokaw, Frances C; Byock, Ira R; Hull, Jay G; Li, Zhongze; McKinstry, Elizabeth; Seville, Janette L; Ahles, Tim A

    2009-03-01

    There is a paucity of randomized controlled trials (RCTs) to evaluate models of palliative care. Although interventions vary, all have faced a variety of methodological challenges including adequate recruitment, missing data, and contamination of the control group. We describe the ENABLE II intervention, methods, and sample baseline characteristics to increase intervention and methodological transparency, and to describe our solutions to selected methodological issues. Half of the participants recruited from our rural U.S. comprehensive cancer center and affiliated clinics were randomly assigned to a phone-based, nurse-led educational, care coordination palliative care intervention model. Intervention services were provided to half of the participants weekly for the first month and then monthly until death, including bereavement follow-up call to the caregiver. The other half of the participants were assigned to care as usual. Symptoms, quality of life, mood, and functional status were assessed every 3 months until death. Baseline data of 279 participants were similar to normative samples. Solutions to methodological challenges of recruitment, missing data, and "usual care" control group contamination are described. It is feasible to overcome many of the methodological challenges to conducting a rigorous palliative care RCT.

  17. The progenitors of present-day massive red galaxies up to z {\\approx} 0.7 - finding passive galaxies using SDSS-I/II and SDSS-III

    CERN Document Server

    Tojeiro, Rita; Wake, David A; Maraston, Claudia; Skibba, Ramin A; Zehavi, Idit; Ross, Ashley J; Conroy, Charlie; Guo, Hong; Manera, Marc; Masters, Karen L; Pforr, Janine; Samushia, Lado; Schneider, Donald P; Thomas, Daniel; Bizyaev, Dmitry; Brewington, Howard; Malanushenko, Elena; Malanushenko, Viktor; Oravetz, Daniel; Pan, Kaike; Shelden, Alaina; Simmons, Audrey; Snedden, Stephanie

    2012-01-01

    We present a comprehensive study of 250,000 galaxies targeted by the Baryon Oscillation Spectroscopic Survey (BOSS) up to z {\\approx} 0.7 with the specific goal of identifying and characterising a population of galaxies that has followed passive evolution (no mergers) as closely as possible. We compute a likelihood that each BOSS galaxy is a progenitor of the Luminous Red Galaxies (LRGs) sample, targeted by SDSS-I/II up z {\\approx} 0.5, by using the fossil record of LRGs and their inferred star-formation histories, metallicity histories and dust content. We determine merger rates, luminosity growth rates and the evolution of the large-scale clustering between the two surveys, and we investigate the effect of using different stellar population synthesis models in our conclusions. We demonstrate that our sample is slowly evolving (of the order of 2 {\\pm} 1.5% Gyr-1 by merging) by computing the change in weighted luminosity-per-galaxy between the two samples, and that this result is robust to our choice of stell...

  18. Associations between change in sleep duration and inflammation: findings on C-reactive protein and interleukin 6 in the Whitehall II Study.

    Science.gov (United States)

    Ferrie, Jane E; Kivimäki, Mika; Akbaraly, Tasnime N; Singh-Manoux, Archana; Miller, Michelle A; Gimeno, David; Kumari, Meena; Davey Smith, George; Shipley, Martin J

    2013-09-15

    Cross-sectional evidence suggests associations between sleep duration and levels of the inflammatory markers, C-reactive protein and interleukin-6. This longitudinal study uses data from the London-based Whitehall II study to examine whether changes in sleep duration are associated with average levels of inflammation from 2 measures 5 years apart. Sleep duration (≤5, 6, 7, 8, ≥9 hours on an average week night) was assessed in 5,003 middle-aged women and men in 1991/1994 and 1997/1999. Fasting levels of C-reactive protein and interleukin-6 were measured in 1997/1999 and 2002/2004. Cross-sectional analyses indicated that shorter sleep is associated with higher levels of inflammatory markers. Longitudinal analyses showed that each hour per night decrease in sleep duration between 1991/1994 and 1997/1999 was associated with higher levels of C-reactive protein (8.1%) and interleukin-6 (4.5%) averaged across measures in 1997/1999 and 2002/2004. Adjustment for longstanding illness and major cardiometabolic risk factors indicated that disease processes may partially underlie these associations. An increase in sleep duration was not associated with average levels of inflammatory markers. These results suggest that both short sleep and reductions in sleep are associated with average levels of inflammation over a 5-year period.

  19. Finding $\\eta$ Car Analogs in Nearby Galaxies Using Spitzer: II. Identification of An Emerging Class of Extragalactic Self-Obscured Stars

    CERN Document Server

    Khan, Rubab; Stanek, K Z; Gerke, Jill

    2014-01-01

    Understanding the late-stage evolution of the most massive stars such as $\\eta$ Carinae is challenging because no true analogs of $\\eta$ Car have been clearly identified in the Milky Way or other galaxies. In Khan et. al. (2013), we utilized Spitzer IRAC images of $7$ nearby ($\\lesssim4$ Mpc) galaxies to search for such analogs, and found $34$ candidates with flat or red mid-IR spectral energy distributions. Here, in Paper II, we present our characterization of these candidates using multi-wavelength data from the optical through the far-IR. Our search detected no true analogs of $\\eta$ Car, which implies an eruption rate that is a fraction $0.01\\lesssim F \\lesssim 0.19$ of the ccSN rate. This is roughly consistent with each $M_{ZAMS} \\gtrsim 70M_\\odot$ star undergoing $1$ or $2$ outbursts in its lifetime. However, we do identify a significant population of $18$ lower luminosity $\\left(\\log(L/L_\\odot)\\simeq5.5-6.0\\right)$ dusty stars. Stars enter this phase at a rate that is fraction $0.09 \\lesssim F \\lesssim...

  20. Correlates of prediabetes and type II diabetes in US South Asians: findings from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study.

    Science.gov (United States)

    Shah, Arti D; Vittinghoff, Eric; Kandula, Namratha R; Srivastava, Shweta; Kanaya, Alka M

    2015-02-01

    In this study, we aim to elucidate the role of sociodemographic, lifestyle, and cultural factors in prediabetes and diabetes in South Asian immigrants to the United States, a population at high risk of type II diabetes. We performed a cross-sectional analysis of a community-based cohort of 899 South Asians without known cardiovascular disease from the Mediators of Atherosclerosis in South Asians Living in America study. Glycemic status was determined by fasting glucose, 2-hour postchallenge glucose, and use of diabetes medication. We used multinomial logistic regression models to estimate the independent associations of sociodemographic, lifestyle, and cultural factors with prediabetes and diabetes, adjusting for confounders identified using directed acyclic graphs. Approximately 33% of participants had prediabetes and 25% had diabetes. In multivariate analyses, an independent correlate of prediabetes was low exercise. Additional covariates associated with diabetes included lower family income, less education, high chronic psychological burden score, and greater time spent watching television; and fasting monthly or annually was inversely associated with diabetes prevalence. We found several modifiable risk factors associated with prediabetes and diabetes that may help guide diabetes prevention interventions for South Asian immigrants to the United States. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Postoperative ileus: a preventable event

    DEFF Research Database (Denmark)

    Holte, Kathrine; Kehlet, H

    2000-01-01

    BACKGROUND: Postoperative ileus has traditionally been accepted as a normal response to tissue injury. No data support any beneficial effect of ileus and indeed it may contribute to delayed recovery and prolonged hospital stay. Efforts should, therefore, be made to reduce such ileus. METHODS: Mat...

  2. Postoperative Chemoradiotherapy After Local Resection for High-Risk T1 to T2 Low Rectal Cancer: Results of a Single-Arm, Multi-Institutional, Phase II Clinical Trial.

    Science.gov (United States)

    Sasaki, Takeshi; Ito, Yoshinori; Ohue, Masayuki; Kanemitsu, Yukihide; Kobatake, Takaya; Ito, Masaaki; Moriya, Yoshihiro; Saito, Norio

    2017-09-01

    After treatment with local excision for TNM stage I low rectal cancer, the risk of local recurrence is not only high for T2 lesions but also for T1 lesions with features of massive invasion to the submucosal layer and/or lymphovascular invasion. The purpose of this study was to determine the efficacy of chemoradiotherapy combined with local excision in the treatment of T1 to T2 low rectal cancer. We conducted a prospective, single-arm, phase II trial. This was a multicenter study. From April 2003 to October 2010, 57 patients were treated with local excision after additional external beam irradiation (45 Gy) plus continuous 5-week intravenous injection of 5-fluorouracil (250 mg/m per day) at 10 domestic hospitals. Fifty-three patients had clinical T1N0 lesions, and 4 had T2N0 lesions in the low rectum, located below the peritoneal reflection. The primary end point was disease-free survival at 5 years. The completion rate for full-dose chemoradiotherapy was 86% (49/57). Serious, nontransient treatment-related complications were not reported. With a median follow-up of 7.3 years after local excision, the 5-year disease-free survival rate was 94% for the 53 patients with T1 lesions and 75% for the 4 patients with T2 lesions. There were 2 local recurrences during the entire observation period. Anal function after local excision and chemoradiation were kept at almost the same levels as observed before treatment. The study was limited by the small number of registered T2 rectal cancers, retrospective evaluations of quality of life, and the exclusion of poorly differentiated adenocarcinoma (a high-risk feature of T1 lesions). The addition of chemoradiotherapy to local excision of T1 rectal adenocarcinomas with poor prognostic features including deep submucosal invasion and lymphovascular invasion could improve on less favorable historic oncologic outcomes of local excision alone in this high-risk group for lymph node metastasis. See Video Abstract at http

  3. Assessment and provision of rehabilitation among patients hospitalized with acute ischemic stroke in China: Findings from the China National Stroke Registry II.

    Science.gov (United States)

    Bettger, Janet Prvu; Li, Zixiao; Xian, Ying; Liu, Liping; Zhao, Xingquan; Li, Hao; Wang, Chunxue; Wang, Chunjuan; Meng, Xia; Wang, Anxin; Pan, Yuesong; Peterson, Eric D; Wang, Yilong; Wang, Yongjun

    2017-04-01

    Background Stroke rehabilitation improves functional recovery among stroke patients. However, little is known about clinical practice in China regarding the assessment and provision of rehabilitation among patients with acute ischemic stroke. Aims We examined the frequency and determinants of an assessment for rehabilitation among acute ischemic stroke patients from the China National Stroke Registry II. Methods Data for 19,294 acute ischemic stroke patients admitted to 219 hospitals from June 2012 to January 2013 were analyzed. The multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was used to identify patient and hospital factors associated with having a rehabilitation assessment during the acute hospitalization. Results Among 19,294 acute ischemic stroke patients, 11,451 (59.4%) were assessed for rehabilitation. Rates of rehabilitation assessment varied among 219 hospitals (IQR 41.4% vs 81.5%). In the multivariable analysis, factors associated with increased likelihood of a rehabilitation assessment ( p < 0.05) included disability prior to stroke, higher NIHSS on admission, receipt of a dysphagia screen, deep venous thrombosis prophylaxis, carotid vessel imaging, longer length of stay, and treatment at a hospital with a higher number of hospital beds (per 100 units). In contrast, patients with a history of atrial fibrillation and hospitals with higher number of annual stroke discharges (per 100 patients) were less likely to receive rehabilitation assessment during the acute stroke hospitalization. Conclusions Rehabilitation assessment among acute ischemic stroke patients was suboptimal in China. Rates varied considerably among hospitals and support the need to improve adherence to recommended care for stroke survivors.

  4. The efficacy of ketamine gargles on postoperative sore throat

    OpenAIRE

    Maryam Hadavi; Mohsen Rezaeian

    2011-01-01

    Background: Sore throat is one of the major post-operative complications. Despite efforts to reduce sore throat, this complication is still one of the main problems after surgery. The aim of this study was to analyze the effectiveness of ketamine gargle on sore throat after tracheal intubation.Materials and method: This double blind clinical trial was performed on 120, ASA-I and II, patients undergoing elective surgery for herniorrhaphy under general anesthesia. Patients in group 1 were gargl...

  5. Animal-related fatalities--part II: characteristic autopsy findings and variable causes of death associated with envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis.

    Science.gov (United States)

    Bury, Danielle; Langlois, Neil; Byard, Roger W

    2012-03-01

    In addition to blunt and sharp trauma, animal-related fatalities may result from envenomation, poisoning, anaphylaxis, asphyxiation, and sepsis. Although the majority of envenomation deaths are caused by hornets, bees, and wasps, the mechanism of death is most often anaphylaxis. Envenomation resulting from the injection of a poison or toxin into a victim occurs with snakes, spiders, and scorpions on land. Marine animal envenomation may result from stings and bites from jellyfish, octopus, stonefish, cone fish, stingrays, and sea snakes. At autopsy, the findings may be extremely subtle, and so a history of exposure is required. Poisoning may also occur from ingesting certain fish, with three main forms of neurotoxin poisoning involving ciguatera, tetrodotoxin ingestion, and paralytic shellfish poisoning. Asphyxiation may follow upper airway occlusion or neck/chest compression by animals, and sepsis may follow bites. Autopsy analysis of cases requires extensive toxinological, toxicological, and biochemical analyses of body fluids.

  6. Coleção líquida adjacente ao ligamento falciforme em pacientes no pós-operatório imediato de transplante de fígado: achado ultra sonográfico normal ou anormal? Estudo prospectivo Fluid collection around the falciform ligament in the immediate postoperative period of liver transplantation: an unusual ultrasonographic finding or a normal occurrence? A prospective study

    Directory of Open Access Journals (Sweden)

    Márcio Martins Machado

    2003-03-01

    Full Text Available Os transplantes de fígado estão sendo cada vez mais realizados, havendo necessidade, cada vez maior, de uma avaliação acurada das possíveis complicações. A ultra-sonografia é entendida, nesse contexto, como o método de escolha para a avaliação inicial das complicações envolvendo o transplante. Os autores relatam, neste estudo, o achado de coleção líquida adjacente ao ligamento falciforme, no pós-operatório imediato de pacientes transplantados de fígado e que não apresentavam nenhum sinal de complicação infecciosa intra-abdominal. Foi demonstrada a presença de coleção líquida em torno do ligamento falciforme em 33 (94,3% de 35 pacientes avaliados. Dessa forma, os autores sugerem que este achado pode corresponder a aspecto normal encontrado no pós-operatório imediato de transplante de fígado.Liver transplantations are increasingly being performed, thus requiring accurate evaluation of related complications. Ultrasonography is the first screening technique for the detection of complications of liver transplantation. The authors report the finding of fluid collection around the falciform ligament in the immediate postoperative period of liver transplantation in patients with no signs of intraabdominal sepsis. This finding was observed in 33 (94.3% of the 35 patients evaluated. The authors consider this finding to be a normal occurrence in the immediate postoperative period of liver transplantation.

  7. Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction. II. Findings in experimentally induced ureteric stenosis.

    Science.gov (United States)

    Rohrschneider, W K; Becker, K; Hoffend, J; Clorius, J H; Darge, K; Kooijman, H; Tröger, J

    2000-08-01

    To assess the diagnostic value of combined static-dynamic MR urography (MRU) for the functional-morphological evaluation of experimentally induced urinary tract obstruction in the piglet. In 20 piglets unilateral ureteric stenosis was created operatively. Post-surgery repeated comparative examinations were obtained with MRU, diuretic renal scintigraphy (DRS), excretory urography (EU) and ultrasound (US). MRU was performed as a combination study with a static 3D-IR-TSE sequence and a dynamic 2D-FFE sequence after Gd-DTPA with frusemide administration. MRU allowed complete depiction of the prestenotic urinary tract and of the stenosis in all cases. In 43 comparative studies MRU was superior to EU in 36, EU to MRU in 2. When single kidney function was calculated with both MRU and DRS, results were highly correlated (r = 0.92). When urinary excretion was compared, significant agreement was achieved with concordant findings in 86% and slightly discordant results in 12%. Static-dynamic MR urography permits excellent depiction of experimentally induced urinary tract obstruction in piglets and reliable assessment of individual renal function and urinary excretion. Two advantages of the method stand out--it does not require radiation and it permits functional-morphological correlation.

  8. Combined static-dynamic MR urography for the simultaneous evaluation of morphology and function in urinary tract obstruction. II. Findings in experimentally induced ureteric stenosis

    Energy Technology Data Exchange (ETDEWEB)

    Rohrschneider, W.K.; Becker, K.; Hoffend, J.; Clorius, J.H.; Darge, K.; Kooijman, H.; Troeger, J. [Paediatric Radiology, Univ. of Heidelberg (Germany)

    2000-08-01

    Purpose. To assess the diagnostic value of combined static-dynamic MR urography (MRU) for the functional-morphological evaluation of experimentally induced urinary tract obstruction in the piglet. Materials and methods. In 20 piglets unilateral ureteric stenosis was created operatively. Post-surgery repeated comparative examinations were obtained with MRU, diuretic renal scintigraphy (DRS), excretory urography (EU) and ultrasound (US). MRU was performed as a combination study with a static 3D-IR-TSE sequence and a dynamic 2D-FFE sequence after Gd-DTPA with frusemide administration. Results. MRU allowed complete depiction of the prestenotic urinary tract and of the stenosis in all cases. In 43 comparative studies MRU was superior to EU in 36, EU to MRU in 2. When single kidney function was calculated with both MRU and DRS, results were highly correlated (r = 0.92). When urinary excretion was compared, significant agreement was achieved with concordant findings in 86 % and slightly discordant results in 12 %. Conclusions. Static-dynamic MR urography permits excellent depiction of experimentally induced urinary tract obstruction in piglets and reliable assessment of individual renal function and urinary excretion. Two advantages of the method stand out - it does not require radiation and it permits functional-morphological correlation. (orig.)

  9. Persistent postoperative hiccups: a review

    DEFF Research Database (Denmark)

    Hansen, B J; Rosenberg, J

    1993-01-01

    The pathogenesis of persistent postoperative hiccups is not known. Hiccups can present as a symptom of a subphrenic abscess of gastric distention, and metabolic alterations may also cause hiccups. The hiccups may develop because of increased activity in neural reflex pathways not yet fully defined....... Numerous treatment modalities have been tried but with questionable success. Valproate has proven effective in two trials investigating persistent non-surgical hiccups. The simple application of a nasogastric tube may successfully treat the hiccups, possibly because of an alteration of the activity...... in the reflex neural pathways involved. The available literature on the treatment of persistent hiccups is reviewed, and a treatment protocol for persistent postoperative hiccups is provided....

  10. Psychological aspects of patients with breast cancer depending on the presence of visible postoperative defect

    Directory of Open Access Journals (Sweden)

    A. D. Zikiryakhodzhaev

    2015-01-01

    Full Text Available Objective. The study of coping behavior of patients with breast cancer (I, II stages in the postoperative period with «externally visible postoperative defect".Materials and methods. We studied the psychological characteristics of 35 patients with breast cancer (I, II stage, who underwent radical mastectomy, women were characterized in the postoperative period as "externally visible postoperative defect" ("e.v.p.d.", 35 patients with breast cancer (I, II stage who underwent ablative and reconstructive plastic surgery, women were characterized in the postoperative period as "without an externally visible postoperative defect" ("without an e.v.p.d.".The results and conclusions. The results of the study of women in both groups indicate that the patients are moderately using coping strategies for coping with the disease, preferring the strategy of "problem resolution" and "search of social support". Patients with breast cancer "with externally visible postoperative defect in comparing with patients with breast cancer "without an externally visible postoperative defect" often use positive religious coping in coping with the disease. The group of women with «externally visible postoperative defect" usually operate with negative religious coping. Both groups of women focused on the perception of social support. In a greater degree of social support they perceive from family and significant for them. Women with breast cancer and "externally visible postoperative defect” compared with women “without an externally visible postoperative defect" are not satisfied with your opportunities, have a feeling of weakness, doubt ability to evoke respect, sympathy, understanding and approval from others. They seek to change, doubt their self-worth, willing to put themselves in the guilt of their mistakes, failures, have low self-esteem. The group of patients with breast cancer "with externally visible postoperative defect" has an external locus of control

  11. Bleeding pattern and cycle control with estetrol-containing combined oral contraceptives: results from a phase II, randomised, dose-finding study (FIESTA).

    Science.gov (United States)

    Apter, Dan; Zimmerman, Yvette; Beekman, Louise; Mawet, Marie; Maillard, Catherine; Foidart, Jean-Michel; Coelingh Bennink, Herjan J T

    2016-10-01

    This study aims to assess vaginal bleeding patterns and cycle control of oral contraceptives containing estetrol (E4) combined with either drospirenone (DRSP) or levonorgestrel (LNG). An open-label, multicentre, randomised, dose-finding study lasting six cycles in healthy women aged 18-35 years was used. Four treatments (15 mg or 20 mg E4, combined with either 3 mg DRSP or 150 mcg LNG) were administered in a 24/4-day regimen. A marketed dosing regimen of estradiol valerate with dienogest (E2V/DNG) served as reference since it contains (like E4) a natural oestrogen. A total of 396 women were randomised, of whom 389 received study medication, and 316 completed the study. By cycle 6, the frequencies of unscheduled bleeding and/or spotting and absence of withdrawal bleeding were the lowest in the 15 mg E4/DRSP group (33.8% and 3.5%, respectively). In the E2V/DNG reference group, these frequencies were 47.8% and 27.1%, respectively. By cycle 6, the frequency of women with absence of withdrawal bleeding was <20% for all E4 treatment groups: 3.5-3.8% combined with DRSP and 14.0-18.5% combined with LNG. By cycle 6, unscheduled intracyclic bleeding was reported by <20% of women in the 20 mg E4/LNG group (18.9%) and in the 15 mg E4/DRSP group (16.9%). This study showed that, of the four treatment modalities investigated, the 15 mg E4/DRSP combination has the most favourable bleeding pattern and cycle control. Due to its favourable bleeding pattern and cycle control, the 15 mg E4/DRSP combination is the preferred combination for further phase III clinical development. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Postoperative hand therapy in Dupuytren's disease

    NARCIS (Netherlands)

    Herweijer, H.; Dijkstra, P.U.; Nicolai, J.P.A.; van der Sluis, C.K.

    2007-01-01

    Background. Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common medical practice to improve outcomes. Until now, patients are referred for postoperative hand rehabilitation on an empirical basis. Purpose. To evaluate whether referral criteria after surgery

  13. Postoperative hand therapy in Dupuytren's disease

    NARCIS (Netherlands)

    Herweijer, H.; Dijkstra, P.U.; Nicolai, J.P.A.; van der Sluis, C.K.

    2007-01-01

    Background. Postoperative hand therapy in patients after surgery for Dupuytren's contracture is common medical practice to improve outcomes. Until now, patients are referred for postoperative hand rehabilitation on an empirical basis. Purpose. To evaluate whether referral criteria after surgery beca

  14. Prevention of postoperative recurrence of Crohn's disease

    NARCIS (Netherlands)

    van Loo, E. S.; Dijkstra, G.; Ploeg, R. J.; Nieuwenhuijs, V. B.

    2012-01-01

    Background: Up to 75% of patients with Crohn's disease (CD) will have intestinal resection during their life. Most patients will, however, develop postoperative recurrence (endoscopic, clinical or surgical). Several medical and surgical strategies have been attempted to prevent postoperative recurre

  15. Variability of Automated Intraoperative ST Segment Values Predicts Postoperative Troponin Elevation.

    Science.gov (United States)

    Maile, Michael D; Engoren, Milo C; Tremper, Kevin K; Tremper, Theodore T; Jewell, Elizabeth S; Kheterpal, Sachin

    2016-03-01

    Intraoperative electrocardiographic monitoring is considered a standard of care. However, there are no evidence-based algorithms for using intraoperative ST segment data to identify patients at high risk for adverse perioperative cardiac events. Therefore, we performed an exploratory study of statistical measures summarizing intraoperative ST segment values determine whether the variability of these measurements was associated with adverse postoperative events. We hypothesized that elevation, depression, and variability of ST segments captured in an anesthesia information management system are associated with postoperative serum troponin elevation. We conducted a single-institution, retrospective study of intraoperative automated ST segment measurements from leads I, II, and III, which were recorded in the electronic anesthesia record of adult patients undergoing noncardiac surgery. The maximum, minimum, mean, and SD of ST segment values were entered into logistic regression models to find independent associations with myocardial injury, defined as an elevated serum troponin concentration during the 7 days after surgery. Performance of these models was assessed by measuring the area under the receiver operator characteristic curve. The net reclassification improvement was calculated to quantify the amount of information that the ST segment values analysis added regarding the ability to predict postoperative troponin elevation. Of 81,011 subjects, 4504 (5.6%) had postoperative myocardial injury. After adjusting for patient characteristics, the ST segment maximal depression (e.g., lead I: odds ratio [OR], 1.66; 95% confidence interval [CI], 1.26-2.19; P = 0.0004), maximal elevation (e.g., lead I: OR, 1.70; 95% CI, 1.34-2.17; P accounting for the maximal amount of ST segment depression and elevation and for patient characteristics. The ST segment summary statistics model had fair discrimination, with an area under the receiver operator characteristic curve of 0.71 (95

  16. Postoperative activity restrictions: any evidence?

    Science.gov (United States)

    Weir, Larissa F; Nygaard, Ingrid E; Wilken, Jason; Brandt, Debra; Janz, Kathleen F

    2006-02-01

    Because of a widespread but untested belief that increased intra-abdominal pressure contributes to pelvic floor disorders, physicians commonly restrict various activities postoperatively. Our aim was to describe intra-abdominal pressures during common physical activities. Thirty women of wide age and weight ranges who were not undergoing treatment for pelvic floor disorders performed 3 repetitions of various activities while intra-abdominal pressures (baseline and maximal) were approximated via microtip rectal catheters. We calculated median peak and net pressures (centimeters of H(2)O). We assessed correlations between abdominal pressures and body mass index, abdominal circumference, and grip strength (a proxy for overall strength). P climbing stairs, walking briskly, or doing abdominal crunches. Body mass index and abdominal circumference each correlated positively with peak, but not net, pressures. Age and grip strength were not associated with abdominal pressure. Some activities commonly restricted postoperatively have no greater effect on intra-abdominal pressures than unavoidable activities like rising from a chair. How lifting is done impacts intra-abdominal pressure. Many current postoperative guidelines are needlessly restrictive. Further research is needed to determine whether increased intra-abdominal pressure truly promotes pelvic floor disorders. III.

  17. CLINICAL STUDY OF POSTOPERATIVE WOUND INFECTION

    OpenAIRE

    Sudheer Darbha; Giddaluru Srihari

    2016-01-01

    BACKGROUND The aim of the study is to study the most common organisms encountered and their sensitivity and resistance to antibiotics in postoperative wound infection and to study relation of emergency and elective surgery to postoperative wound infection and to study efficacy of different modes of preoperative preparation on postoperative wound infection and to study distribution of postoperative wound infection among different surgeries based on bacterial contamination such a...

  18. Results of emergency coronary artery bypass grafting for acute myocardial infarction: importance of intraoperative and postoperative cardiac medical therapy.

    Science.gov (United States)

    Sezai, Akira; Hata, Mitsumasa; Yoshitake, Isamu; Kimura, Haruka; Takahashi, Kana; Hata, Hiroaki; Shiono, Motomi

    2012-01-01

    The results of emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) are less than satisfactory, and readmission for cardiac events is common. 105 patients underwent emergency CABG for AMI. We examined the long-term results of emergency CABG for AMI from the viewpoints of preoperative, intraoperative, and postoperative factors. The operative mortality rate was 11.4%. Risk factors for early death were age ≥80 years, shock, veno-arterial bypass, creatine kinase isoenzyme Mb ≥100 U/L, non-use of a left internal thoracic artery graft and an extracorporeal circulation time ≥120 min. Risk factors for late cardiac events were ejection fraction <40%, non-use of human atrial natriuretic peptide (hANP) therapy, angiotensin II receptor blockers (ARB) and aldosterone blockers, and a 3-month postoperative brain natriuretic peptide level ≥200 pg/ml. Early results of this study are similar to those seen in previous reports, whereas late phase results yield some new and interesting findings. We suggest that intraoperative hANP, and postoperative aldosterone blocker and ARB, following CABG for AMI, will, through control of the renin-angiotensin-aldsterone system, inhibit left ventricular remodelling, reduce the extent of infarction, and improve cardiac function, yielding a favourable long-term prognosis.

  19. Postoperative pleural effusion following upper abdominal surgery

    DEFF Research Database (Denmark)

    Nielsen, P H; Jepsen, S B; Olsen, A D

    1989-01-01

    Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum a...

  20. Postoperative pleural effusion following upper abdominal surgery

    DEFF Research Database (Denmark)

    Nielsen, P H; Jepsen, S B; Olsen, A D

    1989-01-01

    Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum a...

  1. Postoperative management of pulmonary endarterectomy and outcome

    Directory of Open Access Journals (Sweden)

    Narayana Iyengar Ramakrishna

    2010-01-01

    Full Text Available Pulmonary artery thromboendarterectomy (PTE has been regarded as a promising, potentially curative surgical procedure. However, PTE is associated with specific postoperative complications, such as reperfusion pulmonary edema and right heart failure leading to a considerable mortality of 7-24%. Despite its limitations PTE is a better surgical alternative to lung transplantation which carries high morbidity and mortality. The aim of the study is to analyze the efficacy, safety, morbidity and survival associated in the postoperative period and quality of life after six months of PTE in Indian patients. Forty-one patients with surgically correctable chronic thromboembolic pulmonary hypertension underwent pulmonary endarterectomy. All patients were in New York Heart Association (NYHA Class II, III or IV. Preoperative mean pulmonary artery pressure was 40.98 ± 9.29 mmHg and mean pulmonary vascular resistance was 418.39 ± 95.88 dynes/sec/cm -5 . All patients were followed up to six months and a telephonic survey was conducted using a standard questionnaire. They were assessed and classified as per NYHA grading. There was a significant reduction in the mean pulmonary artery pressure (from 40.98 ± 9.29 mmHg to 24.13 ± 7.36 mmHg, P < 0.001 and pulmonary vascular resistance (from 418.39 ± 95.88 dynes/sec/cm -5 to 142.45 ± 36.27 dynes/sec/cm -5 , P < 0.001 with a concomitant increase in the cardiac index (from 1.99 ± 0.20 L/min/m 2 to 3.28 ± 0.56 L/min/m 2 , P < 0.001 during the postoperative period. The mortality rate in our study was 12.19% (five patients. Ninety per cent of the patients reported a significant improvement in the quality of life and exercise tolerance after surgery compared to the preoperative state. Pulmonary endarterectomy is an effective and potentially curative surgical treatment for patients with severe chronic thromboembolic pulmonary hypertension. The current techniques of operation make the procedure relatively safe and

  2. 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

  3. The significance of post-operative fever following airway reconstruction.

    Science.gov (United States)

    Schraff, Scott A; Brumbaugh, Cheryl; Meinzen-Derr, Jareen; Willging, J Paul

    2010-05-01

    Post-operative management of children undergoing airway reconstruction has been well-described. However, many of these patients develop post-operative fevers. We conducted a retrospective review in an attempt to define the significance of post-operative fever following pediatric airway reconstruction. Retrospective analysis of 78 pediatric laryngotracheoplasties (LTPs) from May 1, 2006 - April 30, 2007 at a tertiary care pediatric hospital. Fever was defined as temperature >or=38.5. A fever was "significant" if accompanied by a positive sputum, blood or urine culture, or an elevated WBC. Chest radiograph (CXR) results and co-morbidities were examined. Forty-five percent of cases (35/78) had fever. Of those febrile, 46% (n=16) had significant fever. Overall, 20.5% had significant fevers. Fifty-two cases were single-stage LTP (SSLTP) with 31 febrile and 26 cases were double-stage LTP (DSLTP) with 4 febrile. SSLTP cases were at a significantly greater risk for post-operative fever compared with DSLTP, 59% vs 15% respectively (p=0.0002). 42% of febrile SSLTPs (n=13) had significant fevers compared to 50% (n=2) of febrile DSLTPs (Fisher's Exact p=1.0). 81.5% of cases with CXR findings had fevers, but only 50% of these fevers were significant. Subjects with post-operative atelectasis were more likely to have a fever compared to subjects with no post-operative atelactasis (93% vs. 33% respectively, pfever, compared to 52% of those without atelectasis (p=0.2) and 25 of SSLTPs vs. 3.9% of DSLTPs had atelactasis (p=0.027). No comorbidities were shown to be significant risk factors for post-operative fever. Based on our review, most children undergoing LTPs will have insignificant fevers. Those children undergoing SSTLP and/or having post-operative atelectasis are at higher risk for post-operative fever. Fevers in children with double-stage procedures or all reconstruction cases with CXR findings other than atelectasis should have a thorough fever work-up. Copyright (c) 2010

  4. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology

    OpenAIRE

    French, Daniel G.; Dilena, Michael; LaPlante, Simon; Shamji, Farid; Sundaresan, Sudhir; Villeneuve, James; Seely, Andrew; Maziak, Donna; Gilbert, Sebastien

    2016-01-01

    Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be appl...

  5. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors.

    Science.gov (United States)

    Kain, Zeev N; Caldwell-Andrews, Alison A; Maranets, Inna; McClain, Brenda; Gaal, Dorothy; Mayes, Linda C; Feng, Rui; Zhang, Heping

    2004-12-01

    Based on previous studies, we hypothesized that the clinical phenomena of preoperative anxiety, emergence delirium, and postoperative maladaptive behavioral changes were closely related. We examined this issue using data obtained by our laboratory over the past 6 years. Only children who underwent surgery and general anesthesia using sevoflurane/O(2)/N(2)O and who did not receive midazolam were recruited. Children's anxiety was assessed preoperatively with the modified Yale Preoperative Anxiety Scale (mYPAS), emergence delirium was assessed in the postanesthesia care unit, and behavioral changes were assessed with the Post Hospital Behavior Questionnaire (PHBQ) on postoperative days 1, 2, 3, 7, and 14. Regression analysis showed that the odds of having marked symptoms of emergence delirium increased by 10% for each increment of 10 points in the child's state anxiety score (mYPAS). The odds ratio of having new-onset postoperative maladaptive behavior changes was 1.43 for children with marked emergence status as compared with children with no symptoms of emergence delirium. A 10-point increase in state anxiety scores led to a 12.5% increase in the odds that the child would have a new-onset maladaptive behavioral change after the surgery. This finding is highly significant to practicing clinicians, who can now predict the development of adverse postoperative phenomena, such as emergence delirium and postoperative behavioral changes, based on levels of preoperative anxiety.

  6. 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...... patients at high risk of postoperative pain....

  7. Postoperative Maxillary Cyst: A Case Report

    Directory of Open Access Journals (Sweden)

    Asiye Şafak Bulut

    2010-01-01

    Full Text Available Postoperative maxillary cyst is a quite rare delayed complication of surgical intervention associated with maxillary sinuses. It occurs many years after surgery. This paper describes a 54-year-old woman presenting with swelling of left cheek for seven-years duration. The orthopantomograph revealed a unilocular cystic radiolucency with well-defined margins in left maxillary sinus. In the computerized tomography, the cyst had a sclerotic wall with bony condensations. Aspiration cytology revealed many neutrophil leukocytes. Cyst was drained and enucleated. Histopathologically, it had a fibrous wall with inflammation and focal reactive bone formation and lined by a respiratory-type epithelium. In the clinical history, it is learned that she had a maxillary sinus surgery 8 years ago and the diagnosis was made considering the clinical and histopathological findings.

  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. Postoperative seizure control in patients with tumor-associated epilepsy.

    Science.gov (United States)

    Neal, Andrew; Morokoff, Andrew; O'Brien, Terence John; Kwan, Patrick

    2016-11-01

    The patterns of postoperative seizure control and response to antiepileptic drugs (AEDs) in tumor-associated epilepsy (TAE) are poorly understood. We aim to document these characteristics in patients with supratentorial gliomas. This was a retrospective analysis of 186 patients with supratentorial gliomas. Seizure patterns were classified into four groups: A, no postoperative seizure; B, early postoperative seizure control within 6 months; C, fluctuating seizure control; and D, never seizure-free. Rates and duration of seizure freedom, subsequent seizure relapse, and response to AED were analyzed. Among patients included, 49 (26.3%) had grade II, 28 (15.1%) had grade III, and 109 (58.6%) had grade IV glioma. Outcome pattern A was observed in 95 (51.1%), B in 22 (11.8%), C in 45 (24.2%), and D in 24 (12.9%). One hundred nineteen patients had at least one seizure and were classified as having TAE. Compared to pattern A, pattern B was predicted by histologic progression; pattern C by tumor grade, preoperative seizure, and histologic progression, and pattern D by preoperative seizure and gross total resection. Among patients with TAE, 57.5% of grade II, 68.2% of grade III, and 26.3% of grade IV experienced a period of 12-month seizure freedom. After first 12-month seizure remission, 39.1%, 60.0%, and 13.3% of grade II, III, and IV gliomas, respectively, experienced subsequent seizure; 22.6% of those with TAE reached terminal seizure freedom of at least 12 months on their first postoperative AED regimen, 6.5% on their second regimen, and 5.4% on subsequent regimens. Distinct patterns of postoperative seizure control exist in gliomas; they have specific risk factor profiles, and we hypothesize these correspond to unique pathogenic mechanisms. Twelve-month seizure freedom with subsequent relapse is frequent in grade II-III gliomas. Response to AEDs is markedly poorer than with non-TAE, highlighting the complex epileptogenicity of gliomas. Wiley Periodicals, Inc. © 2016

  10. Postoperative radiotherapy for endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Eun Cheol; Kim, Jin Hee; Kim, Ok Bae; Byun, Sang Jun; Park, Seung Gyu; Kwon, Sang Hoon [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2012-09-15

    To investigate the prognostic factors and effectiveness of postoperative radiotherapy alone for endometrial carcinoma. Sixty four patients with stage I?III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study. Typically, total hysterectomy, salpingo-oophorectomy and lymphadenectomy were performed on the patient's pelvis. Total dose from 50.4 Gy to 63 Gy was irradiated at pelvis or extended fi eld. Thirteen patients were treated with Co-60 or Ir-192 intracavitary radiotherapy. Follow-up periods were from 7 to 270 months, with a median of 56 months. Five year overall survival (OS) rate was 58.7%, respectively. Five year disease-free survival (DFS) rate was 59.2%, respectively. In univariate analysis for OS and DFS, stage, menopausal age, type of operation, serosal invasion, and lymph node involvement were found to be statistically significant. Histologic type was marginally significant. In multivariate analysis for OS and DFS, stage, types of operation, histologic type were also found to be statistically significant. Treatment failure occurred in 14 patients. The main pattern of failure was found to be distant metastasis. Time to distant metastasis was from 3 to 86 months (median, 12 months). There were no grade 3 or 4 complications. Stage, types of operation, and histologic type could be the predictive prognostic factors in patients. We contemplated postoperative radiation as effective and safe treatment method for EC. Additional treatment would be needed to reduce distant metastasis.

  11. Time course of postoperative hypoxaemia

    DEFF Research Database (Denmark)

    Rosenberg, J; Ullstad, T; Rasmussen, J;

    1994-01-01

    OBJECTIVE: To study the time course of nocturnal episodic and constant hypoxaemia during the first five nights after a major abdominal operation in patients not given supplementary oxygen. DESIGN: Open study. SUBJECTS: 17 patients undergoing major elective operations and with no recognised risk...... factors. MAIN OUTCOME MEASURES: Arterial oxygen saturation measured by pulse oximetry. RESULTS: The level of constant hypoxaemia was lowest during night 2 (p time spent below 90% saturation (p ... during night 3 (p constant hypoxaemia on postoperative nights 1, 3, 4, and 5...

  12. Rock Finding

    Science.gov (United States)

    Rommel-Esham, Katie; Constable, Susan D.

    2006-01-01

    In this article, the authors discuss a literature-based activity that helps students discover the importance of making detailed observations. In an inspiring children's classic book, "Everybody Needs a Rock" by Byrd Baylor (1974), the author invites readers to go "rock finding," laying out 10 rules for finding a "perfect" rock. In this way, the…

  13. Finding Family

    Institute of Scientific and Technical Information of China (English)

    LIU YUNYUN

    2010-01-01

    @@ It took 14 years--and just two min-utes-for an adopted Chinese girl to find her biological family. July 21 this year marked the first anniversary of Haley Butler's finding of her biological parents in Maanshan in east China's Anhui Province.

  14. Bases of Radio Direction Finding, Part II

    Science.gov (United States)

    1977-12-22

    the wave of tha frimework (Fig. 7.4b) oin b- witiaut change used formula (7.18) of the transmission gain. one should only consider that hearth Ro...fazt that in input circuit of thu directed systein artificially is intr~duced DOC 77223219 PAGE " supplementary emf, equal in maynitude and opposite...duct from antenna. Thus, in formulas (7.86)- (7.88) and (7.90)-(7.92) hearth A should understand resulting phase displacement: cP? tiO,, -- o DOc

  15. ROLE OF TRANEXAMIC ACID IN REDUCING POSTOPERATIVE BLOOD LOSS AND TRANSFUSION REQUIREMENT IN PATIENTS UNDERGOING LOWER LIMB ORTHOPEDIC SURGERIES

    Directory of Open Access Journals (Sweden)

    Yashwant

    2014-09-01

    Full Text Available AIM: Aim of our study to assess the effects of tranexamic acid (TA in patients undergoing lower limb orthopedic surgeries. OBJECTIVE: Assess the effects of tranexamic acid on prevention of bleeding and requirement of blood transfusion after major lower limb orthopedic surgeries. MATERIAL AND METHOD: 90 patients ASA grade I & II undergoing elective surgery for femoral fracture like open reduction internal fixation, hemiarthroplasty, total hip replacement (THR under anaesthesia were taken. Patients were classified randomly into 2 groups (forty five patients in each group. Group T: Patients received inj. TA 10 mg/kg body weight. Group P: Patients received normal saline 1 ml/kg body weight 15 min before surgery. Postoperative hemoglobin concentration (on day 0 and day 2 and volume of blood in the drain were measured. The number of units of packed red cells transfused during the hospital stay was recorded and any thromboembolic and other complications were documented. RESULT: Analysis revealed that there were no significant differences between the patients with respect to age, sex, duration and type of surgery and preoperative mean hemoglobin concentration. Neither heart rate nor MABP has statistically significant difference or results (P>0.05. The drains were removed in the evening of the first postoperative day. Mean volume of blood in the drain compared to placebo group showing a highly significant reduction in postoperative blood loss (P=0.01. Mean fall in hemoglobin at day 0 and day 2 was 2 less in the study group as compared to the placebo that has P value 0.01 making it significant finding. CONCLUSION: the present paired study demonstrated that the administration of TA given preoperatively reduces the blood loss in the first 24 h by a highly significant degree as well it causes a significant reduction in postoperative anemia and need for transfusion among these patients.

  16. SMOFlipid versus Intralipid in Postoperative ICU Patients

    Directory of Open Access Journals (Sweden)

    Ayman Anis Metry

    2014-12-01

    Full Text Available Aim of the work Lipids are important components of total parentral nutrition, especially for patients after major abdominal surgery. Traditionally used intralipid has many complications and can lead to increased infection rate and sepsis, that is why, it is not indicated in cases with low immunity and sepsis. So, in this study, we compared the effect of intralipid and SMOFlipid on the level of IL-6, in addition to lipid profile, liver enzymes, coagulation profile and renal functions. Patients and Methods This prospective, randomized, double-blinded study was designed to compare between two groups of postsurgical ICU patients. Group I and group II had 42 and 41 patients respectively. Both the groups were given total parentral nutrition for not less than 7 days postoperatively. Group I was given Intralipid as a source of fat, and Group II was given SMOFlipid in substitution of intralipid. Vital signs (including blood pressure, heart rate, and body temperature, blood liver function test, renal function test, coagulation profile, white blood cells (WBCs, and lipid profile (triglycerides [TGs], cholesterol [CH], low-density lipoprotein [LDL], and high-density lipoprotein [HDL] were monitored. The assessments for IL-6 was performed which indicate inflammatory response. The clinical outcomes, including morbidity, mortality, and infectious complications during the hospital stay, were also evaluated. Results The study showed no significant differences between the two groups with regard of vital signs and chemical profiles for cholesterol, triglycerides and liver enzymes. IL 6 levels were significantly different between the two groups on day 4 and 7. IL-6 was significantly lower in SMOFlipid group on day 4 and 7 than in intralipid group. Conclusion On comparing intralipid versus SMOFlipid, we have discovered that SMOFlipid group showed low level of IL6 which is as a single agent gives an indication of reduced inflammatory response with SMOFlipid but with

  17. cobalt (ii), nickel (ii)

    African Journals Online (AJOL)

    DR. AMINU

    ABSTRACT. The manganese (II), cobalt (II), nickel (II) and copper (II) complexes of N, N' – ... temperature and coordinated water were determined ... indicating fairly stable complex compounds (Table 1). The complex compounds are insoluble [Table 2] in water and common organic solvents, but are readily soluble in ...

  18. Risk of postoperative recurrence and postoperative management of Crohn's disease

    Institute of Scientific and Technical Information of China (English)

    Antonino Spinelli; Matteo Sacchi; Gionata Fiorino; Silvio Danese; Marco Montorsi

    2011-01-01

    Crohn's disease (CD) is a chronic inflammatory disease of the digestive tract with systemic manifestations. Etiology is unknown, even if immunological, genetic and environmental factors are involved. The majority of CD patients require surgery during their lifetime due to progressive bowel damage, but, even when all macroscopic lesions have been removed by surgery, the disease recurs in most cases. Postoperative management represents therefore a crucial mean for preventing recurrence. Several drugs and approaches have been proposed to achieve this aim. Endoscopic inspection of the ileocolic anastomosis within 1 year from surgery is widely encouraged, given that endoscopic recurrence is one of the greatest predictors for clinical recurrence. A strategy should be planned only after stratifying patients according to their individual risk of recurrence, avoiding unnecessary therapies when possible benefits are reduced, and selecting high-risk patients for more aggressive intervention.

  19. Ketamine gargle for attenuating postoperative sore throat.

    Science.gov (United States)

    Canbay, O; Celebi, N; Sahin, A; Celiker, V; Ozgen, S; Aypar, U

    2008-04-01

    Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sore throat (POST) with reported incidences of 21-65%. We compared the effectiveness of ketamine gargles with placebo in preventing POST after endotracheal intubation. Forty-six, ASA I-II, patients undergoing elective surgery for septorhinoplasty under general anaesthesia were enrolled in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly allocated into two groups of 23 subjects each: Group C, saline 30 ml; Group K, ketamine 40 mg in saline 30 ml. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anaesthesia. POST was graded at 0, 2, 4, and 24 h after operation on a four-point scale (0-3). POST occurred more frequently in Group C, when compared with Group K, at 0, 2, and 24 h and significantly more patients suffered severe POST in Group C at 4 and 24 h compared with Group K (PKetamine gargle significantly reduced the incidence and severity of POST.

  20. Prevention of postoperative tooth sensitivity: a preliminary clinical trial.

    Science.gov (United States)

    Sobral, M A P; Garone-Netto, N; Luz, M A A C; Santos, A P

    2005-09-01

    The purpose of this study was to evaluate clinically the effects of pre-treatments with a 35% hydroxyethyl metacrylate/5% glutaraldehyde dentine desensitizer (Gluma Desensitizer) and a 2% chlorexidine-based cavity disinfectant (Cav-Clean) on postoperative sensitivity. Three premolar teeth with no pain symptoms were selected from each one of 17 patients, totalling 51 teeth, for which Class II restoration using a composite was indicated. Each one of the three premolar teeth of the same patient was submitted to a different treatment. After acid etching, only a dental adhesive was applied to the first tooth, which served as the control. Gluma Desensitizer dentinal desensitizer was applied to the second premolar tooth prior to applying the dental adhesive. Cav-Clean cavity disinfectant was used on the third premolar tooth before applying the dental adhesive. Only one tooth was restored per session, and all premolar teeth were restored with a condensable composite, according to current restoration technique guidelines. Sensitivity to different stimuli (cold, heat, sweet and dental floss) was assessed on Day 1, Day 4 and Day 7 by questionnaire following restorative procedures. The results of this clinical research showed that, as far as the investigated stimuli and postoperative course are concerned, there was no statistically significant difference in the three different treatments (P>0.05). Postoperative sensitivity resulting from Class II restorations using composite resin cannot be completely eliminated with the prior use of a dentinal desensitizer or a cavity disinfectant. In day-to-day clinical treatment, postoperative sensitivity may possibly be related to the technique employed.

  1. 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.

  2. Finding Family

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Discovering her birth parents was an exciting adventure for a 15-year-old girl It took 14 years-and just two minutes-for an adopted Chinese girl to find her biological family.July 21 this year marked the first

  3. [Hip fracture, antiplatelet drugs treatment and postoperative complications].

    Science.gov (United States)

    Reguant, F; Martínez, E; Gil, B; Prieto, J C; del Milagro Jiménez, L; Arnau, A; Bosch, J

    2013-11-01

    To assess the incidence of postoperative complications, blood transfusions and survival at one month, in the old patients operated for hip fracture undergoing chronic treatment with antiplatelet drugs. Two hundred twenty three patients operated for hip fracture were studied retrospectively, separated into 3 groups: patients who received acetylsalicylic acid (group I), patients who were given 100mg/day of acetylsalicylic acid or 300mg/day of triflusal (group II) and patients receiving>100mg/day of acetylsalicylic acid, or>300mg/day of triflusal or thienopyridines (group III). Surgery was delayed for 4 days in patients in group III. Demographic, biological, clinical and treatment characteristics, postoperative complications and survival at one month were recorded. Patients in group III were older and sustain worse general health status. Patients with a higher transfusion requirement were those of group II (73.8%) (P=0.192), who also showed a higher percentage of anaemia on admission. Severe cardiovascular complications were experienced by 5.4% of group III patients, 4.8% of group II patients and 2.1% of group I patients. Patients from group III presented a significant amount of respiratory complications (P=0.007). Our results suggest that delaying surgery for 4 days in patients treated with clopidogrel can be associated to an increase in postoperative respiratory complications and severe adverse cardiovascular events, without increasing the tranfusional index, hospital stay, mortality, and without complications related to neuraxial anaesthesia. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  4. 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.).

  5. Postoperative chemoradiotherapy in high risk locally advanced gastric cancer

    Energy Technology Data Exchange (ETDEWEB)

    Song, Sang Hyuk; Chie, Eui Kyu; Kim, Kyu Bo; Lee, Hyuk Joon; Yang, Han Kwang; Han, Sae Won; Oh, Do Youn; Im, Seok Ah; Bang, Yung Jue; Ha, Sung W. [Seoul National University College of Medicine, Seoul(Korea, Republic of)

    2012-12-15

    To evaluate treatment outcome of patients with high risk locally advanced gastric cancer after postoperative chemoradiotherapy. Between May 2003 and May 2012, thirteen patients who underwent postoperative chemoradiotherapy for gastric cancer with resection margin involvement or adjacent structure invasion were retrospectively analyzed. Concurrent chemotherapy was administered in 10 patients. Median dose of radiation was 50.4 Gy (range, 45 to 55.8 Gy). The median follow-up duration for surviving patients was 48 months (range, 5 to 108 months). The 5-year overall survival rate was 42% and the 5-year disease-free survival rate was 28%. Major pattern of failure was peritoneal seeding with 46%. Loco-regional recurrence was reported in only one patient. Grade 2 or higher gastrointestinal toxicity occurred in 54% of the patients. However, there was only one patient with higher than grade 3 toxicity. Despite reported suggested role of adjuvant radiotherapy with combination chemotherapy in gastric cancer, only very small portion of the patients underwent the treatment. Results from this study show that postoperative chemoradiotherapy provided excellent locoregional control with acceptable and manageable treatment related toxicity in patients with high risk locally advanced gastric cancer. Thus, postoperative chemoradiotherapy may improve treatment result in terms of locoregional control in these high risk patients. However, as these findings are based on small series, validation with larger cohort is suggested.

  6. A comparison of postoperative pain scales in neonates.

    Science.gov (United States)

    Suraseranivongse, S; Kaosaard, R; Intakong, P; Pornsiriprasert, S; Karnchana, Y; Kaopinpruck, J; Sangjeen, K

    2006-10-01

    Practical, valid and reliable pain measuring tools in neonates are required in clinical practice for effective pain management and prevention of the evaluator bias. This prospective study was designed to cross-validate three pain scales: CRIES (cry, requires O(2), increased vital signs, expression, sleeplessness), CHIPPS (children's and infants' postoperative pain scale) and NIPS (neonatal infant pain scale) in terms of validity, reliability and practicality. The pain scales were translated. Concurrent validity, predictive validity and interrater reliability in postoperative pain were studied in 22 neonates after major surgery. Construct validity and concurrent validity in procedural pain were determined in 24 neonates before and during frenulectomy under topical anaesthesia. All scales had excellent interrater reliability (intraclass correlation >0.9). Construct validity was determined for all pain scales by the ability to differentiate the group with low pain scores before surgery and high scores during surgery (P0.9) with routine decisions to treat postoperative pain. High sensitivity and specificity (>90%) for postoperative pain from all scales were achieved with the same cut-off point of 4. In terms of practicality, NIPS was the most acceptable (65%). Based on our findings, we recommended NIPS as a valid, reliable and practical tool.

  7. Nurse practitioners in postoperative cardiac surgery: are they effective?

    Science.gov (United States)

    Goldie, Catherine L; Prodan-Bhalla, Natasha; Mackay, Martha

    2012-01-01

    High demand for acute care nurse practitioners (ACNPs) in Canadian postoperative cardiac surgery settings has outpaced methodologically rigorous research to support the role. To compare the effectiveness of ACNP-led care to hospitalist-led care in a postoperative cardiac surgery unit in a Canadian, university-affiliated, tertiary care hospital. Patients scheduled for urgent or elective coronary artery bypass and/or valvular surgery were randomly assigned to either ACNP-led (n=22) or hospitalist-led (n=81) postoperative care. Both ACNPs and hospitalists worked in collaboration with a cardiac surgeon. Outcome variables included length of hospital stay, hospital readmission rate, postoperative complications, adherence to follow-up appointments, attendance at cardiac rehabilitation and both patient and health care team satisfaction. Baseline demographic characteristics were similar between groups except more patients in the ACNP-led group had had surgery on an urgent basis (p cardiac surgery. Our findings provide support for the ACNP role in this setting as patients who received care from an ACNP had similar outcomes to hospitalist-led care and reported greater satisfaction in some measures of care.

  8. MRI Markers of Neurodegenerative and Neurovascular Changes in Relation to Postoperative Delirium and Postoperative Cognitive Decline.

    Science.gov (United States)

    Kant, Ilse M J; de Bresser, Jeroen; van Montfort, Simone J T; Slooter, Arjen J C; Hendrikse, Jeroen

    2017-06-28

    Postoperative delirium (POD) and postoperative cognitive decline (POCD) are common in elderly patients. The aim of the present review was to explore the association of neurodegenerative and neurovascular changes with the occurrence of POD and POCD. Fifteen MRI studies were identified by combining multiple search terms for POD, POCD, and brain imaging. These studies described a total of 1,422 patients and were all observational in design. Neurodegenerative changes (global and regional brain volumes) did not show a consistent association with the occurrence of POD (four studies) or POCD (two studies). In contrast, neurovascular changes (white matter hyperintensities and cerebral infarcts) were more consistently associated with the occurrence of POD (seven studies) and POCD (five studies). In conclusion, neurovascular changes appear to be consistently associated with the occurrence of POD and POCD, and may identify patients at increased risk of these conditions. Larger prospective studies are needed to study the consistency of these findings and to unravel the underlying pathophysiological mechanisms. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  9. Post-operative pain relief in children following caudal bupivacaine and buprenorphine--a comparative study.

    Directory of Open Access Journals (Sweden)

    Anilkumar T

    1994-04-01

    Full Text Available Eighty-five paediatric patients (age range: 6 mths-12yrs undergoing lower abdominal surgery were studied for post-operative pain relief following either caudal bupivacaine (GpI: n = 43 or buprenorphine (GpII: n = 42. Bupivacaine was administered as 0.5ml/kg body weight of 0.25% solution and buprenorphine as 4 micrograms/ml and volume of 0.5 ml/Kg body weight in normal saline. Post-operatively pain was graded on a 4-point scale and behaviour on a 5-point scale. Any post-operative complications and need for additional analgesia were also noted. Bupivacaine provided good pain relief in the early post-operative hours but buprenorphine provided pain relief lasting for 24 hrs or more post-operatively. Post-operative behaviour of 10 patients receiving buprenorphine was graded as cheerful as compared to 2 from bupivacaine group. Till the end of observation period (i.e. 8 hr post-operatively, majority of patients receiving buprenorphine remained cheerful.

  10. Ventilatory pattern and associated episodic hypoxaemia in the late postoperative period in the general surgical ward

    DEFF Research Database (Denmark)

    Rosenberg, J; Rasmussen, G I; Wøjdemann, K R;

    1999-01-01

    Episodic oxygen desaturation is frequent in the late postoperative period and seems most pronounced on the second and third postoperative nights. However, the ventilatory pattern has not been described systematically during this period. We studied the ventilatory pattern and associated arterial...... oxygenation using the Edentrace II equipment (impedance pneumography and pulse oximetry) on the second and third postoperative nights in 28 patients undergoing major abdominal surgery. Ventilatory disturbances were common and included periods of hypopnoea, and obstructive, central and mixed apnoeas. Overall...... disturbances. Overall, 23% (0-100) of the hypopnoeas and 7% (0-100) of the apnoeas were associated with episodic hypoxaemia. In conclusion, ventilatory disturbances were common in the late postoperative period in the general surgical ward and often associated with episodes of oxygen desaturation....

  11. Preoperative Smoking Status and Postoperative Complications

    DEFF Research Database (Denmark)

    Grønkjær, Marie; Eliasen, Marie; Skov-Ettrup, Lise Skrubbeltrang;

    2014-01-01

    To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type.......To systematically review and summarize the evidence of an association between preoperative smoking status and postoperative complications elaborated on complication type....

  12. Galactorrhea after aesthetic breast augmentation with silicone implants: report of two cases and management of postoperative galactorrhea.

    Science.gov (United States)

    Ayestaray, Benoit; Dudrap, Emmanuel; Chaibi, Amir

    2011-06-01

    Galactorrhea is a rare event after breast augmentation. The physiopathologic bases of galactorrhea depend on the central secretion of prolactin. These physiopathologic bases must be clearly understood for the prevention and treatment of postoperative galactorrhea. This report describes two cases of a postoperative galactorrhea after aesthetic breast augmentation with silicone implants. The clinical appearance closely resembles a postoperative sepsis without hyperthermia. Bacteriologic samples are negative. Endocrinologic examination finds a characteristic hyperprolactinemia. The evolution is favorable under dopaminergic agonists.

  13. Automated postoperative blood pressure control

    Institute of Scientific and Technical Information of China (English)

    Hang ZHENG; Kuanyi ZHU

    2005-01-01

    It is very important to maintain the level of mean arterial pressure (MAP).The MAP control is applied in many clinical situations,including limiting bleeding during cardiac surgery and promoting healing for patient's post-surgery.This paper presents a fuzzy controller-based multiple-model adaptive control system for postoperative blood pressure management.Multiple-model adaptive control (MMAC) algorithm is used to identify the patient model,and it is a feasible system identification method even in the presence of large noise.Fuzzy control (FC) method is used to design controller bank.Each fuzzy controller in the controller bank is in fact a nonlinear proportional-integral (PI) controller,whose proportional gain and integral gain are adjusted continuously according to error and rate of change of error of the plant output,resulting in better dynamic and stable control performance than the regular PI controller,especially when a nonlinear process is involved.For demonstration,a nonlinear,pulsatile-flow patient model is used for simulation,and the results show that the adaptive control system can effectively handle the changes in patient's dynamics and provide satisfactory performance in regulation of blood pressure of hypertension patients.

  14. Postoperative radicular neuroma. Case report.

    Science.gov (United States)

    Erman, T; Tuna, M; Göçer, A I; Idan, F; Akgül, E; Zorludemir, S

    2001-11-15

    Lumbar discectomy is the most common surgical procedure performed in neurosurgery clinics. Such a large number of procedures underscore not only the prevalence of conditions such as intervertebral disc herniation, but also the strong belief of surgeons that the operation does provide benefits to patients suffering from sciatica. In spite of this belief, sciatic pain may continue after the surgery. The recurrence of sciatic and/or back pain after primary discectomy is called the "failed back surgery syndrome." The rate of the complications involved in standard lumbar discectomy ranges from 5.4 to 14%. One of the complications of the lumbar disc surgery is nerve root injury. The complication rate of this injury ranges from 0.7 to 2.2%. Postoperative radicular neuroma must be considered in differential diagnosis for the patient who has failed back surgery syndrome. In this study the authors evaluate a patient who had undergone surgery for lumbar disc herniation and suffered intractable pain. A traumatic radicular neuroma is demonstrated and the pertinent literature is presented.

  15. Recovery from post-operative anaemia.

    Science.gov (United States)

    Wallis, J P; Wells, A W; Whitehead, S; Brewster, N

    2005-10-01

    Acceptance of lower transfusion thresholds and shorter post-operative stays results in patients leaving hospital after surgery with lower haemoglobin (Hb) than previously. We undertook a prospective observational study to assess the haematological response to post-operative anaemia and to determine the utility of quality of life (QoL) measures in assessing the impact of anaemia on such patients. Thirty patients undergoing unilateral hip arthroplasty had blood samples taken and QoL questionnaires administered pre-operatively and at 7, 28 and 56 days post-operatively. Increased erythropoiesis was evident at day 7 post-operatively. Approximately two-thirds of the post-operative Hb deficit was corrected by day 28. There was evidence of functional iron deficiency in more than one-quarter of patients at day 56. QoL scores used did not show any relationship with Hb in the post-operative period. Red cell 2,3-diphosphoglycerate (2,3DPG) levels increased in proportion to the degree of post-operative anaemia. We concluded that substantial recovery of Hb occurs between day 7 and day 28 post-operatively. Complete recovery of Hb may be delayed beyond day 56 due to development of iron deficiency. Patients are at significant risk of developing post-operative iron deficiency depending on operative blood loss and pre-operative iron stores. Increased red cell 2,3DPG may offset the effect of anaemia on oxygen delivery. We found no evidence that anaemia produces a measurable effect on chosen QoL scores in the post-operative period.

  16. Insulin-like growth factor I preserves renal function postoperatively.

    Science.gov (United States)

    Franklin, S C; Moulton, M; Sicard, G A; Hammerman, M R; Miller, S B

    1997-02-01

    Deterioration of renal function, which can lead to postoperative renal failure, is a complication of surgery involving the suprarenal aorta and surgery involving the renal arteries. Fifty-four patients who were at risk for developing this complication were enrolled in a double-blind, randomized, placebo-controlled trial of insulin-like growth factor (IGF-I) as a therapeutic agent to prevent the decline in renal function. The primary end point was the incidence of renal dysfunction, defined as a reduction of the glomerular filtration rate (creatinine clearance) at each of three measurements over 72 h. IGF-I (100 microg/kg subcutaneously every 12 h for 6 doses) or placebo was administered on admission to the intensive care unit immediately postoperatively. IGF-I- and placebo-treated groups were well matched for sex, age, type of surgery, renal ischemic time during surgery (ischemic index), baseline creatinine clearance, and baseline serum creatinine. No patient in the study developed acute renal failure postoperatively. IGF-I was well tolerated. A smaller proportion of patients in the IGF-I group had a postoperative decline in renal function (22%) than in the placebo-treated group (33%). There were no significant differences in levels of serum creatinine at time of discharge, length of hospital stay, length of intensive care unit stay, length of intubation, or incidence of dialysis or death. Our findings establish the feasibility and potential utility for the use of IGF-I to reduce the incidence of postoperative renal dysfunction in high-risk patients.

  17. Deep brain stimulation: postoperative issues.

    Science.gov (United States)

    Deuschl, Günther; Herzog, Jan; Kleiner-Fisman, Galit; Kubu, Cynthia; Lozano, Andres M; Lyons, Kelly E; Rodriguez-Oroz, Maria C; Tamma, Filippo; Tröster, Alexander I; Vitek, Jerrold L; Volkmann, Jens; Voon, Valerie

    2006-06-01

    Numerous factors need to be taken into account when managing a patient with Parkinson's disease (PD) after deep brain stimulation (DBS). Questions such as when to begin programming, how to conduct a programming screen, how to assess the effects of programming, and how to titrate stimulation and medication for each of the targeted sites need to be addressed. Follow-up care should be determined, including patient adjustments of stimulation, timing of follow-up visits and telephone contact with the patient, and stimulation and medication conditions during the follow-up assessments. A management plan for problems that can arise after DBS such as weight gain, dyskinesia, axial symptoms, speech dysfunction, muscle contractions, paresthesia, eyelid, ocular and visual disturbances, and behavioral and cognitive problems should be developed. Long-term complications such as infection or erosion, loss of effect, intermittent stimulation, tolerance, and pain or discomfort can develop and need to be managed. Other factors that need consideration are social and job-related factors, development of dementia, general medical issues, and lifestyle changes. This report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society, outlines answers to a series of questions developed to address all aspects of DBS postoperative management and decision-making with a systematic overview of the literature (until mid-2004) and by the expert opinion of the authors. The report has been endorsed by the Scientific Issues Committee of the Movement Disorder Society and the American Society of Stereotactic and Functional Neurosurgery.

  18. Postoperative chemoradiotherapy for gallbladder cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, K. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Chie, E.K.; Ha, S.W. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Radiation Oncology; Seoul National Univ. (Korea, Republic of). Inst. of Radiation Medicine; Jang, J.Y.; Kim, S.W. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Surgery; Han, S.W.; Oh, D.Y.; Im, S.A.; Kim, T.Y.; Bang, Y.J. [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of). Dept. of Internal Medicine

    2012-05-15

    The goal of this work was to analyze the outcome of adjuvant chemoradiotherapy for patients with gallbladder cancer who underwent surgical resection and to identify the prognostic factors for these patients. Between August 1989 and November 2006, 47 patients with gallbladder cancer underwent surgical resection followed by adjuvant radiotherapy. There were 21 males and 26 females, and median age was 60 years (range 44-75 years). Postoperative radiotherapy was delivered to the tumor bed and regional lymph nodes up to 40-50 Gy at 2 Gy/fraction; 41 patients also received intravenous 5-fluorouracil as a radiosensitizer. Median follow-up duration was 48 months for survivors. There were 2 isolated locoregional recurrences, 14 isolated distant metastases, and 7 combined locoregional and distant relapses. The 5-year overall survival rate was 43.7%. According to the extent of resection, the 5-year overall survival rates were 52.8%, 20.0%, and 0% in R0-, R1-, and R2-resected patients, respectively (p = 0.0038). On multivariate analysis incorporating extent of resection, T stage, N stage, performance of lymph node dissection, and histologic differentiation, extent of resection was the only prognostic factor associated with overall survival (p = 0.0075). Among the 37 patients with R0 resection, there was no difference of 5-year overall survival rates in patients with N0, N1, and Nx diseases (46.2%, 60.0%, and 44.4%, respectively, p = 0.6246). As for significant treatment-related morbidity, there was only 1 patient with grade 4 gastric ulcer. Adjuvant chemoradiotherapy after R0 resection can achieve a good long-term survival rate in gallbladder cancer patients, even in those with lymph node metastases, and may play a role for patients who underwent R0 resection of primary tumor without lymph node dissection. (orig.)

  19. Role of buprenorphine in acute postoperative pain

    Directory of Open Access Journals (Sweden)

    J. Alcázar-Castro

    2016-07-01

    Full Text Available Nowadays acute postoperative pain persists as a high prevalence symptom. The incidence, intensity and duration of postoperative pain vary considerably from one patient to another, from one surgery to another, from one hospital to another, and even from one country to another. It is important to learn about recent developments in central sensitisation, as it plays an important role in postoperative pain. Postoperative pain is mainly nociceptive somatic, in response to surgical damage. The surgical trauma and pain cause an endocrine response that increases the secretion of cortisol, catecholamines, and other stress hormones. Tachycardia, hypertension, decreased regional blood flow, impaired immune response, hyperglycaemia, lipolysis, and negative nitrogen balance also occur. All this plays an important role in morbidity and mortality in the postoperative period. Buprenorphine is a semi-synthetic opioid derived from thebaine. It has a binding affinity for the mu, kappa and delta receptors, and has a slow dissociation from these receptors. Because of its action on the mu and kappa receptors it can be used as an analgesic, as well as for maintenance therapy in patients with a history of drug abuse. This article will describe the characteristics of acute postoperative pain, the pharmacology of buprenorphine, and its interference in the management of postoperative pain.

  20. Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review

    DEFF Research Database (Denmark)

    Bitsch, Martin; Foss, Nicolai; Kristensen, Billy Bjarne

    2004-01-01

    is to summarize current knowledge about the pathogenesis of postoperative delirium with a view to finding strategies for prevention and management. METHOD: We conducted an Internet search through the Medline database (1966-March 2003) and supplemented it with a manual search. We included 12 studies which...... specifically discussed pathogenic factors or interventions against postoperative delirium following operation for hip fracture. RESULTS: 1,823 patients were included with an average incidence of delirium of 35%. We concentrated on pre-, intra-, and postoperative risk factors. Only advanced age and dementia met...

  1. Complications of rotator cuff surgery—the role of post-operative imaging in patient care

    Science.gov (United States)

    Thakkar, R S; Thakkar, S C; Srikumaran, U; Fayad, L M

    2014-01-01

    When pain or disability occurs after rotator cuff surgery, post-operative imaging is frequently performed. Post-operative complications and expected post-operative imaging findings in the shoulder are presented, with a focus on MRI, MR arthrography (MRA) and CT arthrography. MR and CT techniques are available to reduce image degradation secondary to surgical distortions of native anatomy and implant-related artefacts and to define complications after rotator cuff surgery. A useful approach to image the shoulder after surgery is the standard radiography, followed by MRI/MRA for patients with low “metal presence” and CT for patients who have a higher metal presence. However, for the assessment of patients who have undergone surgery for rotator cuff injuries, imaging findings should always be correlated with the clinical presentation because post-operative imaging abnormalities do not necessarily correlate with symptoms. PMID:24734935

  2. 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...

  3. Characterization of persistent postoperative pain by quantitative sensory testing

    DEFF Research Database (Denmark)

    Werner, Mads U.; Kehlet, Henrik

    2010-01-01

    Postoperative pain remains inadequately treated, and it has been estimated that 5-10% undergoing surgery will develop moderate to severe persistent pain leading to chronic physical disability and psychosocial distress. Quantitative sensory testing (QST) is a graded, standardized activation...... research tool in studies investigating the correlation between responses to preoperatively applied experimental pain stimuli and clinical postoperative pain. Second, the use of QST as a valuable prognostic, sequential assessment tool in surgical procedure specific research is presented. Third......, the implications of these findings for use of QST in future research are discussed. More rational design of predictive studies in PPP, based on surgical procedure specific approaches, is needed in order to improve our understanding of prevention and management of this debilitating postsurgical condition....

  4. Characterization of persistent postoperative pain by quantitative sensory testing

    DEFF Research Database (Denmark)

    Werner, Mads U.; Kehlet, Henrik

    2010-01-01

    research tool in studies investigating the correlation between responses to preoperatively applied experimental pain stimuli and clinical postoperative pain. Second, the use of QST as a valuable prognostic, sequential assessment tool in surgical procedure specific research is presented. Third......Postoperative pain remains inadequately treated, and it has been estimated that 5-10% undergoing surgery will develop moderate to severe persistent pain leading to chronic physical disability and psychosocial distress. Quantitative sensory testing (QST) is a graded, standardized activation......, the implications of these findings for use of QST in future research are discussed. More rational design of predictive studies in PPP, based on surgical procedure specific approaches, is needed in order to improve our understanding of prevention and management of this debilitating postsurgical condition....

  5. [Effect of capnoperitoneum on postoperative carbon dioxide homeostasis].

    Science.gov (United States)

    Blobner, M; Felber, A R; Hösl, P; Gögler, S; Schneck, H J; Jelen-Esselborn, S

    1994-11-01

    release of the KP for 60 min. Simultaneously, a nasal side-stream capnometry probe was placed and the PeCO2 and respiratory frequency (RF) were obtained by the Capnomac Ultima (Datex) and registered every minute as well. Values were averaged over four periods of 15 min each. An arterial blood gas sample was drawn at the end of every 15-min period. Postoperative pain was scored by a visual analog scale and completed by a subjective index questionnaire on general well-being. All data were analysed by the Friedman or Wilcoxon test; P < 0.05 was considered significant. RESULTS. The findings do not indicate CO2 resorption in the postoperative period after laparoscopic cholecystectomy (Tables 2 and 3, Fig. 1). Arterial CO2 as well as PeCO2 were elevated postoperatively (45 mm Hg vs. 36 mm Hg intraoperatively), while VCO2 and VO2 were unchanged when compared to the preoperative measuring period. The postoperative RF was comparable to preoperative values. Calculated delta CO2 was lower than 10 ml/min and within accuracy of measurements. The post-operative pain index ranged between 3 and 4, and 3.75-15 mg piritramid was administered. All patients felt tired immediately after the operation, but scores improved slightly at the end of the 60-min period of metabolic monitoring. CONCLUSIONS. There is no significant resorption of CO2 from the abdominal cavity later than 30 min after releasing the KP. Up to this time, any CO2 remaining in the abdominal cavity after careful emptying by the surgeon has been resorbed and exhaled. An increased PeCO2 as late as 30 to 90 min postoperatively should rather be considered a consequence of residual anaesthetics and narcotics than of CO2 resorption.

  6. A Meta-Synthesis of Children's Experiences of Postoperative Pain Management.

    Science.gov (United States)

    Sng, Qian Wen; He, Hong-Gu; Wang, Wenru; Taylor, Beverley; Chow, Aloysius; Klainin-Yobas, Piyanee; Zhu, Lixia

    2017-02-01

    Ineffective management of postoperative pain in children has been reported widely. To improve the effectiveness of postoperative pain management for children, it was necessary to conduct a systematic review to better understand the current knowledge of children's experiences of their postoperative pain management. The aim of this review was to update and synthesize current qualitative research of postoperative pain management based on children's experiences. Qualitative studies published between January 1990 and July 2014 were searched from the electronic databases of CINAHL, MEDLINE, MedNar, ProQuest, PsycINFO, Scopus, ScienceDirect, Sociological Abstracts, and Web of Science. A broad range of search keywords and a three-step search strategy were used. Meta-syntheses were used to summarize the findings from the included studies. Nine qualitative studies were included. Three meta-syntheses from 22 categories based on 72 findings were generated: (a) Children experienced various negative emotions related to postoperative pain, and could assess and express their pain but need their parents as advocates; (b) apart from pain medication, various nonpharmacological strategies to relieve children's postoperative pain were employed by children, parents, and nurses; and (c) suggestions from children for their parents and nurses to better relieve postoperative pain. This review provided preliminary support for increasing the provision of information and education for children and their parents about postoperative conditions, pain, and pain relief strategies. Nurses should also be encouraged to employ more nonpharmacological pain-relieving strategies and build rapport with children and their parents. Future intervention studies are needed to improve children's postoperative experiences. © 2016 Sigma Theta Tau International.

  7. EVALUATION OF POST-OPERATIVE SENSITIVITY AND ...

    African Journals Online (AJOL)

    Prof

    composites in wear resistance and achievement of good proximal contour ... change in result was recorded for post-operative sensitivity at the end of the evaluation period. 100% was recorded ..... Overcoming challenges with resin in class II ...

  8. [Postoperative inconveniences after breast cancer surgery

    DEFF Research Database (Denmark)

    Gartner, R.; Callesen, T.; Kroman, N.

    2008-01-01

    The most common postoperative inconveniences after breast cancer surgery are pain, nausea and vomiting, which contribute to reduced patient satisfaction, prolonged hospital stays and delayed courses of rehabilitation. This article summarizes the literature regarding available procedure...

  9. Prevention of postoperative infections in ophthalmic surgery

    Directory of Open Access Journals (Sweden)

    Ram Jagat

    2001-01-01

    Full Text Available Postoperative endophthalmitis is a serious, vision-threatening complication of intraocular surgery. Better instrumentation, surgical techniques, prophylactic antibiotics and better understanding of asepsis have significantly reduced the incidence of this complication. Postoperative endophthalmitis may occur as an isolated event or as a cluster infection. Topical antibiotics, preoperative periocular preparation with povidone-iodine combined with a sterile operating room protocol significantly reduce the incidence of isolated postoperative endophthalmitis. The role of antibiotics in the irrigating fluid and subconjunctival antibiotics remains controversial. Cluster infections on the other hand are more likely to occur due to the use of contaminated fluids/viscoelastics or a breach in operating room asepsis. Prevention of postoperative endophthalmitis requires strict adherence to operating room norms, with all involved personnel discharging their assigned roles faithfully.

  10. Methodological issues of postoperative cognitive dysfunction research

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    to reveal postoperative cognitive decline, and questionnaires are not useful for this purpose. There is a profound lack of consensus regarding the research methodology for detection of cognitive deterioration, especially the diagnostic criteria. Issues, such as baseline performance, learning effects...

  11. Postoperative Pain Management: Clinicians' Knowledge and ...

    African Journals Online (AJOL)

    Postoperative Pain Management: Clinicians' Knowledge and Practices on Assessment and ... It, therefore, commands a central position in health seeking behavior. ... it causes, but also because of its negative effects on the process of recovery.

  12. A dedicated intravenous cannula for postoperative use effect on incidence and severity of phlebitis.

    LENUS (Irish Health Repository)

    Panadero, A

    2012-02-03

    A prospective, randomised, controlled clinical study was performed to compare the incidence and severity of postoperative peripheral venous thrombophlebitis associated with a single intravenous cannula used for both intra-operative and postoperative purposes, and two cannulae, one used intra-operatively and the other postoperatively. Sixty American Society of Anaesthesiologists (ASA) physical status I or II patients aged 18-65 years undergoing elective surgery were studied. The technique of cannula insertion was standardised. After surgery, the cannulation sites were examined daily by a blinded investigator for the presence and severity of thrombophlebitis using the Baxter Scale. The two groups were similar in terms of age, gender, weight, type and duration of surgical procedures, and drugs and fluids administered both intra-operatively and postoperatively. The proportion of patients that developed phlebitis was significantly less in the two cannulae group (26.1%) than in the single cannula group (63.3%) (p < 0.0001). The severity of phlebitis was greater in the single cannula group than in the two cannulae group. These results indicate that the use of a dedicated cannula for postoperative use decreases the incidence and severity of postoperative, peripheral, cannula-related phlebitis.

  13. Association of Preoperative Thrombocytosis and Leukocytosis With Postoperative Morbidity and Mortality Among Patients With Ovarian Cancer.

    Science.gov (United States)

    Barber, Emma L; Boggess, John F; Van Le, Linda; Kim, Kenneth H; Bae-Jump, Victoria L; Brewster, Wendy R; Soper, John T; Gehrig, Paola A

    2015-12-01

    To examine whether preoperative thrombocytosis or leukocytosis is associated with increased postoperative morbidity or mortality. Patients with ovarian cancer undergoing primary surgery from 2005 to 2012 were identified from the American College of Surgeons National Surgical Quality Improvement Project. Thrombocytosis was defined as platelets greater than 450,000/mm and leukocytosis as white blood cells greater than 10,000/mm. We examined 30-day postoperative complications and mortality. Descriptive statistics and adjusted multivariable logistic regression were used for analysis. We identified 1,072 patients. The incidence of thrombocytosis was 9.6%, leukocytosis was 18.7%, and 4.9% had both. Leukocytosis was associated with major complication (16.5% compared with 10.3%, P=.01) but not postoperative death (3.0% compared with 1.3%, P=.08). Thrombocytosis was also associated with major complication (19.4% compared with 10.7%, Pthrombocytosis and leukocytosis had increased rates of both major complication (22.6% compared with 10.9%, Pthrombocytosis (adjusted odds ratio [OR] 2.16, 95% confidence interval [CI], 1.25-3.74, Pthrombocytosis and leukocytosis together were associated with postoperative death (adjusted OR 5.4, 95% CI, 1.4-22.3, P=.02). Preoperative thrombocytosis or leukocytosis is associated with an increased risk of major postoperative complication. Patients with both thrombocytosis and leukocytosis experienced twice the rate of major complication and a fourfold increase in postoperative death. II.

  14. [Postoperative fever in orthopedic and urologic surgery].

    Science.gov (United States)

    Saavedra, Federico; Myburg, Cristina; Lanfranconi, Marisa B; Urtasun, Martin; De Oca, Luis Montes; Silberman, Andres; Lambierto, Alberto; Gnocchi, Cesar A

    2008-01-01

    Post-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303) of which 81% (34/42) was noninfectious and 19% (8/42) was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n = 19) consisting of chest x-ray, blood (2) and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45) and the blood cultures in only one case (5%, IC 95%: 0.1-26). Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post-operative fever was non-infectious, related to the normal inflammatory host response to surgery. Based on the present results, the extensive fever work-up performed to investigate post-operative infection does not seem to be a useful tool. The diagnosis of post-operative infection was based on clinical follow up and the correct interpretation of the patient's symptoms and signs.

  15. Postoperative pyrexia after arthroplasty - when to panic ?

    OpenAIRE

    Agarwala Sanjay; Jain Deepak; Bhagwat Abhijit

    2005-01-01

    Background: Success of arthroplasty is contingent on a clear understanding of the potential complications. Today with improved methods of sepsis control, incidence of joint sepsis has dropped to less than 2%. Despite this fever is still common in the early post-operative period. Methods: We reviewed 184 consecutive hip and knee replacement surgeries for incidence and clinical significance of post-operative fever. The cases were followed up for a period of over 3 to 5 years. Temperat...

  16. Need for improved treatment of postoperative pain

    DEFF Research Database (Denmark)

    Mathiesen, Ole; Thomsen, Berit Ahlmann; Kitter, Birgitte;

    2012-01-01

    A cross-sectional study was performed at Rigshospitalet, Copenhagen, a Danish tertiary university hospital, to describe current postoperative pain and nausea treatment with a view to identifying areas with improvement potential.......A cross-sectional study was performed at Rigshospitalet, Copenhagen, a Danish tertiary university hospital, to describe current postoperative pain and nausea treatment with a view to identifying areas with improvement potential....

  17. Methodological issues of postoperative cognitive dysfunction research

    DEFF Research Database (Denmark)

    Funder, Kamilia S; Steinmetz, Jacob; Rasmussen, Lars S

    2010-01-01

    Postoperative cognitive dysfunction (POCD) is a subtle impairment of memory, concentration, and speed of information processing. It is a frequent complication following surgery and can have a debilitating effect on patients' recovery and future prognosis. Neuropsychological testing is needed...... to reveal postoperative cognitive decline, and questionnaires are not useful for this purpose. There is a profound lack of consensus regarding the research methodology for detection of cognitive deterioration, especially the diagnostic criteria. Issues, such as baseline performance, learning effects...

  18. Benzodiazepines and postoperative cognitive dysfunction in the elderly

    DEFF Research Database (Denmark)

    Rasmussen, L.S.; Steentoft, Anni; Rasmussen, H.

    1999-01-01

    hypnotics benzodiazepine,diazepam,age factor,anaesthesia,geriatric,psychological responses,postoperative......hypnotics benzodiazepine,diazepam,age factor,anaesthesia,geriatric,psychological responses,postoperative...

  19. Effects of ketoprofen for prevention of postoperative cognitive dysfunction in aged rats.

    Science.gov (United States)

    Kawano, Takashi; Takahashi, Tetsuya; Iwata, Hideki; Morikawa, Akihiro; Imori, Satoko; Waki, Sayaka; Tamura, Takahiko; Yamazaki, Fumimoto; Eguchi, Satoru; Kumagai, Naoko; Yokoyama, Masataka

    2014-12-01

    Postoperative cognitive dysfunction is a common geriatric complication that may be associated with increased mortality. Here, we investigated the effects of postoperative analgesia with ketoprofen on cognitive functions in aged animals and compared its effectiveness to morphine. Rats were randomly allocated to one of four groups: isoflurane anesthesia without surgery (group C), isoflurane anesthesia with laparotomy (group IL), and isoflurane anesthesia with laparotomy plus postoperative analgesia with ketoprofen or morphine. There was no difference in postoperative locomotor activity among groups. In group IL, postoperative pain levels assessed by the Rat Grimace Scale significantly increased until 8 h after surgery, which was similarly inhibited by both ketoprofen and morphine. Cognitive function was assessed using radial arm maze testing for 12 consecutive days from postoperative day 3. Results showed that the number of memory errors in group IL were significantly higher than those in goup C. However, both ketoprofen and morphine could attenuate the increase in memory errors following surgery to a similar degree. Conversely, ketoprofen showed no effect on cognitive function in the nonsurgical rats that did not experience pain. Our findings suggest that postoperative analgesia with ketoprofen can prevent the development of surgery-associated memory deficits via its pain-relieving effects.

  20. Acute Postoperative Pain of Indonesian Patients after Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    Chanif Chanif

    2012-08-01

    Full Text Available Background: Pain is the most common problem found in postoperative patients.Purpose: The study aimed to describe pain intensity and pain distress at the first 24-48 hours experienced by the patients after abdominal surgery.Method: The study employed a descriptive research design. The samples consisted of 40 adult patients older than 18 years who underwent major abdominal surgery under general anesthesia. The patients were admitted at Doctor Kariadi Hospital Semarang, Central Java Province Indonesia during November 2011 to February 2012. A Visual Numeric Rating Scale was used to measure the pain intensity scores and the pain distress scores at the 5th hour after subjects received 30 mg of Ketorolac injection intravenously, a major analgesic drug being used at the studied hospital. Minimum-maximum scores, mean, standard deviation, median and interquartile range were used to describe pain intensity and pain distress.Result: The findings revealed that on average, postoperative patients had experienced moderate to severe pain, both in their report of pain intensity and pain distress as evidenced by the range of scores from 4 to 9 out of 10 and median score of 5 and 6 (IQR = 2, respectively. It indicated that postoperative pain was common symptom found in patients after abdominal surgery.Keywords: pain intensity, pain distress, abdominal surgery.

  1. Serial MRI in the early postoperative period after lumbar discectomy

    Energy Technology Data Exchange (ETDEWEB)

    Annertz, M. [Dept. of Radiology, University Hospital, Lund (Sweden); Joensson, B. [Dept. of Orthopaedics, University Hospital, Lund (Sweden); Stroemqvist, B. [Dept. of Orthopaedics, University Hospital, Lund (Sweden); Holtaas, S. [Dept. of Radiology, University Hospital, Lund (Sweden)

    1995-04-01

    The aim of this study was to determine MRI findings in patients successfully operated upon for lumbar disc herniation. We investigated 20 patients with a successful outcome after L4-5 or L5-S1 disc operations clinically and with MRI preoperatively, and at 5 days, 6 weeks, and 4 months after surgery. Postoperatively, T1- and T2-weighted images were obtained. At 4 months gadolinium-enhanced images were added. Pronounced intraspinal MRI changes were seen during follow-up. Deformation of the dural sac was seen in 13 patients preoperatively, in 19 at 5 days after operation, in 15 at 6 weeks, and in 12 at 4 months. Nerve root involvement was seen in all cases both preoperatively and at 5 days after operation, in 17 at 6 weeks, and in 15 at 4 months. No correlation between symptoms or the straight leg raising test and the size or nature of the abnormal tissue in the spinal canal postoperatively could be demonstrated. It was concluded that early postoperative MRI after lumbar discectomy must be interpreted carefully, and that oedema and scar formation are probable reasons for difficulties in interpretation. (orig.)

  2. Correlation between magnetoencephalography-based "clusterectomy" and postoperative seizure freedom.

    Science.gov (United States)

    Vadera, Sumeet; Jehi, Lara; Burgess, Richard C; Shea, Katherine; Alexopoulos, Andreas V; Mosher, John; Gonzalez-Martinez, Jorge; Bingaman, William

    2013-06-01

    During the presurgical evaluation of patients with medically intractable focal epilepsy, a variety of noninvasive studies are performed to localize the hypothetical epileptogenic zone and guide the resection. Magnetoencephalography (MEG) is becoming increasingly used in the clinical realm for this purpose. No investigators have previously reported on coregisteration of MEG clusters with postoperative resection cavities to evaluate whether complete "clusterectomy" (resection of the area associated with MEG clusters) was performed or to compare these findings with postoperative seizure-free outcomes. The authors retrospectively reviewed the charts and imaging studies of 65 patients undergoing MEG followed by resective epilepsy surgery from 2009 until 2012 at the Cleveland Clinic. Preoperative MEG studies were fused with postoperative MRI studies to evaluate whether clusters were within the resected area. These data were then correlated with postoperative seizure freedom. Sixty-five patients were included in this study. The average duration of follow-up was 13.9 months, the mean age at surgery was 23.1 years, and the mean duration of epilepsy was 13.7 years. In 30 patients, the main cluster was located completely within the resection cavity, in 28 it was completely outside the resection cavity, and in 7 it was partially within the resection cavity. Seventy-four percent of patients were seizure free at 12 months after surgery, and this rate decreased to 60% at 24 months. Improved likelihood of seizure freedom was seen with complete clusterectomy in patients with localization outside the temporal lobe (extra-temporal lobe epilepsy) (p = 0.04). In patients with preoperative MEG studies that show clusters in surgically accessible areas outside the temporal lobe, we suggest aggressive resection to improve the chances for seizure freedom. When the cluster is found within the temporal lobe, further diagnostic testing may be required to better localize the epileptogenic zone.

  3. Diffusion MR Imaging of Postoperative Bilateral Acute Ischemic Optic Neuropathy

    Energy Technology Data Exchange (ETDEWEB)

    Kannan, Anusha; Srinivasan, Sivasubramanian [Khoo Teck Puat Hospital, Singapore (Singapore)

    2012-09-15

    We read with great interest, the case report on ischemic optic neuropathy (1). We would like to add a few points concerning the blood supply of the optic nerve and the correlation with the development of post-operative ischemic neuropathy. Actually, the perioperative or post-operative vision loss (postoperative ischemic neuropathy) is most likely due to ischemic optic neuropathy. Ischemic optic neuropathy (2) is classified as an anterior ischemic optic neuropathy (AION) and posterior ischemic optic neuropathy (PION). This classification is based on the fact that blood supply (2) to the anterior segment of the optic nerve (part of the optic nerve in the scleral canal and the optic disc) is supplied by short posterior ciliary vessels or anastamotic ring branches around the optic nerve. The posterior part of the optic canal is relatively less perfused, and is supplied by ophthalmic artery and central fibres are perfused by a central retinal artery. So, in the post-operative period, the posterior part of the optic nerve is more vulnerable for ischemia, especially, after major surgeries (3), one of the theories being hypotension or anaemia (2) and resultant decreased perfusion. The onset of PION is slower than the anterior ischemic optic neuropathy. AION on the other hand, is usually spontaneous (idiopathic) or due to arteritis, and is usually sudden in its onset. The reported case is most likely a case of PION. The role of imaging, especially the diffusion weighted magnetic resonance imaging, is very important because the ophthalmoscopic findings in early stages of PION is normal, and it may delay the diagnosis. On the other hand, edema of the disc is usually seen in the early stages of AION.

  4. Duration of postoperative immunosuppression assessed by repeated delayed type hypersensitivity skin tests

    DEFF Research Database (Denmark)

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

    1992-01-01

    The duration of postoperative impairment in cell-mediated immunity was assessed by repeated skin testing with seven delayed type common antigens in 15 patients undergoing major elective abdominal surgery compared to a similar testing regimen in 10 healthy volunteers. All were skin tested four times......, with 72-hour intervals, and in the surgical patients the first test was applied 2 days before surgery, followed by tests on postoperative days 1, 4 and 7. The tests were read after 48 h. Postoperatively, the skin test area decreased on day 3 (p less than 0.01) and recurred to preoperative levels on day 9....... In contrast, the skin test area in the volunteers increased from test to test (p less than 0.001) during the study, confirming a previous finding of a vaccination effect. These results suggest that the postoperative immunosuppression is maintained for about 6-9 days....

  5. Postoperative elevation of amylase/creatinine clearance ratio in patients without pancreatitis.

    Science.gov (United States)

    Gross, J B; Levitt, M D

    1979-09-01

    An elevated CAm/CCr ratio has been used as evidence for the frequent occurrence of acute pancreatitis in the postoperative period. We measured CAm/CCr pre and postoperatively in 28 patients undergoing extraperitoneal surgical procedures. None of the patients had clinical evidence of pancreatitis, although 2 of the 28 patients had elevated CAm/CCr ratios preoperatively. Mean CAm/CCr rose from a preoperative level of 2.3 +/- 0.3% (1 SE) to 3.2 +/- 0.3% on the first postoperative day (P less than 0.001). Of the 26 patients with normal preoperative CAm/CCr, 12% (3 of 26) developed a clearly abnormal ratio and 12% (3 of 26) developed borderline elevated values. An elevated CAm/CCr appears to be a nonspecific postoperative finding and cannot be used as evidence of acute pancreatitis during this period.

  6. The surgery and early postoperative radicular pain in cases with multifocal lumbar disc herniation

    Science.gov (United States)

    Ulutaş, Murat; Çınar, Kadir; Seçer, Mehmet

    2017-01-01

    Abstract Persistence of postoperative radicular pain after surgery for multifocal disc herniation (MFDH) is a clinical problem. This study aims to evaluate the effects of a combined treatment approach compared with unilateral stabilization on early postoperative radicular pain in patients with MFDH. Age, sex, level of operation, clinical findings, and radicular pain visual analogue scale (VAS) scores before surgery in the early postoperative period and at 3 months after surgery were retrospectively reviewed for 20 cases of multifocal lumbar disc herniation. The combined approach (translaminar and far lateral) was used for 13 cases. Seven cases underwent transforaminal lumbar interbody fusion (TLIF) and unilateral transpedicular stabilization following total facetectomy. The mean age of the sample was 49.4 ± 10.1 years and the female-to-male ratio was 8:12. The mean VAS scores for radicular pain in cases treated with the combined approach were 8.2, 4.07, and 2.3 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean score for radicular pain improved by 50.4% in the early postoperative period and by 72% in the late postoperative period. The mean VAS scores for radicular pain in cases who underwent TLIF and unilateral stabilization after facetectomy were 8.4, 2.1, and 1.4 in the preoperative and early postoperative periods and 3 months after surgery, respectively. The mean VAS score for radicular pain improved by 75% in the early postoperative period and by 83.3% in the late postoperative period. The combined approach is an effective alternative in cases with MFDH. TLIF and unilateral segmental stabilization provide substantial decompression and eliminate mechanical compression by conserving the height of the intervertebral foramen in the event that sufficient decompression is unable to obtain. We suggest that elimination of chemical mediators, particularly those causing pain in the dorsal ganglion, contributes to

  7. Relationship between surgical time and postoperative complications in senile patients with hip fractures

    Institute of Scientific and Technical Information of China (English)

    MA Ren-shi; GU Gui-shan; WANG Cheng-xue; ZHU Dong; ZHANG Xi-zheng

    2010-01-01

    Objective:To elucidate the relationship between surgical time and postoperative complications in senile patients with hip fractures, and try to find out other factors which are related to these complications.Methods: Sixty-two patients, 28 males aged from 65 to 72 years with a mean age of 76.3 years and 34 females aged from 65 to 95 years with a mean age of 78.1 years, who had undergone orthopedic surgery because of hip fractures,were enrolled in a retrospective cohort study. The surgical time and pattern, the type of fracture, preoperative comorbidities, American Society of Anesthesiologists (ASA) score and the volume of blood transfusion during operation were obtained from these patients who were followed up by telephone calls for postoperative complications.All the patients were followed up at least for 1 year and were divided into subgroups according to their clinical characteristics and the results were analyzed by the Statistical Analysis System software.Results:There was no significant difference in the morbidity of postoperative eomplications with the gender,age,surgical time and pattern,or ASA score. There was significant difference in the morbidity of postoperative complications related to preoperative comorbidities and the volume of blood transfusion. There was a significant causality between preoperative comorbidities and postoperative complications. The morbidity of postoperative complications was 1.651 times higher in patients with preoperative comorbidities than those without.Conclusions:There is no relationship between the surgical time and postoperative complications in senile patients who received surgery for hip fracture within 1 year.No correlation is found between the postoperative complications and gender,age,type of fracture, surgical pattern,ASA score and the volume of blood transfusion. Preoperative comorbidities are an independent predictor for postoperative complications.

  8. Efficacy of Prophylactic Ketamine in Preventing Postoperative Shivering

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    Emine Köse

    2012-04-01

    Full Text Available Aim: Treatment with ketamine and meperidine is effective in postoperative shivering. The aim of this study was to investigate the minimum effective dose of ketamine in the prevention of postanaesthetic shivering compared to placebo and meperidine. Material and Method: This prospective randomized double-blind study involved 150 ASA I and II patients undergoing general anesthesia. Patients were randomly allocated to receive normal saline (Group S, n=30, meperidine 20 mg (Group M, n=30, ketamine 0.1 mg/kg (Group K1, n=30, ketamine 0.25 mg/kg (Group K2, n=30 and ketamine 0.5 mg/ kg (Group K5, n=30 intravenously 20 minutes before completion of surgery. The anesthesia was induced with propofol 2 mg/kg, fentanyl 1 %u03BCg/kg and vecuronium 0.1 mg/kg. It was maintained with sevoflurane 2-3% and nitrous oxide 60% in oxygen. Tympanic temperature was measured immediately after induction of anesthesia, 30 minutes after induction and before administration of the study drug. Postoperative shivering was recorded using a four point scale and postoperative pain using a visual analogue scale (VAS ranging between 0 and 10. Results: The number of patients shivering on arrival the recovery room and at 10 minutes after operation were significantly less in Groups M and K5 than in Groups K1, K2 and Group S (p < 0.001 and p=0.001. The time to first analgesic requirement in Groups M and K5 was longer than in the Groups K1, K2 and Group S (P< 0.001. There was no difference between the five groups regarding VAS pain scores (p > 0.05. Discussion: Prophylactic usage of ketamine 0.5 mg/kg was effective to prevent postanaesthetic shivering, but ketamine 0.1 mg/kg and 0.25 mg/kg had no prophylactic effect.

  9. Does Psychological Profile Influence Third Molar Extraction and Postoperative Pain?

    Science.gov (United States)

    González-Martínez, Raquel; Jovani-Sancho, María Del Mar; Cortell-Ballester, Isidoro

    2017-03-01

    Our purposes were to determine the influence of psychological profile on hemodynamic changes in patients who undergo surgical removal of the third molars under intravenous sedation and to evaluate the effect on patients' anxiety and postoperative recovery. We performed a prospective study of 100 patients (American Society of Anesthesiologists classes I and II; aged ≥18 years) seen in the CIMIVClinic (Department of Oral Surgery, Casa de Salud University Hospital, Valencia, Spain) who underwent extractions of all third molars under intravenous sedation. All patients were administered the Symptom Checklist 90 Revised (SCL-90-R). The following parameters were monitored at different times during the surgical interventions: systolic blood pressure, diastolic blood pressure, oxygen saturation, and heart rate. Position and depth of impaction of the tooth (Pell and Gregory classification and Winter classification), surgery duration, and surgical technique also were recorded. Finally, the degree of pain experienced the week after the surgical intervention was measured using a visual analog scale. Patients' anxiety levels preoperatively were significantly higher in patients with psychological distress (P = .023). Postoperative pain significantly decreased from the first day to the seventh day in healthy patients but not in patients with altered psychological conditions (P < .05). Nevertheless, the hemodynamic changes were not correlated with the psychological impairment. Intravenous sedation enables the control of hemodynamic changes in all patients independently of their psychological profile. Patients with psychological distress present with higher levels of dental anxiety and postoperative pain. Future studies are needed to further clarify this interaction. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  10. EFFICACY OF HYOSCINE BUTYL BROMIDE SUPPOSITORY FOR POSTOPERATIVE PAIN RELIEF

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    Soniya C. Alphonse

    2017-07-01

    Full Text Available BACKGROUND Caesarean Section is on the rise all over the world. Women undergoing Caesarean section often wish to be awake post operatively and to avoid excessive medications affecting interactions with the new born infant. Multimodal pain therapy has been advocated for postoperative pain management after caesarean section. MATERIALS AND METHODS The study is a prospective randomized controlled study conducted at a tertiary care hospital to study the effect of Hyoscine Butyl Bromide Suppositories for postoperative analgesia following elective repeat caesarean section. The study included sixty patients divided into two groups- Group1 (study group were given Hyoscine Butyl Bromide Suppository (10 mg along with Injection. Tramadol 50 mg IM and Group II (control group were given Injection Tramadol IM only at the end of surgery. Pain score of the patient assessed at 1 hr, 2 hrs, 6hrs and 24 hrs post operatively. The total no of doses of injection tramadol needed in 24 hrs and the interval between 1st and 2nd dose of tramadol was also noted. The adverse effects of the drug and additional advantages of the drug if any were also assessed. RESULTS There was no statistically significant difference in pain score during the assessment intervals between the two groups. There was no difference in the number of doses of tramadol needed in the first 24 hrs. The mean interval between the 1st and 2nd dose of tramadol was found to be 7.6538 hours for group 1 patients and 6.9130 for group patients which was found to be statistically significant. There was no statistically significant side effects/ additional advantages for the drugs. CONCLUSION Concurrent administration of Hyoscine Butyl Bromide Suppository (10 mg and injection Tramadol 50 mg IM offers a longer postoperative analgesia without any increased adverse effects.

  11. Postoperative pyrexia after arthroplasty - when to panic ?

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    Agarwala Sanjay

    2005-01-01

    Full Text Available Background: Success of arthroplasty is contingent on a clear understanding of the potential complications. Today with improved methods of sepsis control, incidence of joint sepsis has dropped to less than 2%. Despite this fever is still common in the early post-operative period. Methods: We reviewed 184 consecutive hip and knee replacement surgeries for incidence and clinical significance of post-operative fever. The cases were followed up for a period of over 3 to 5 years. Temperature charts up to 6 th postoperative day and all investigations were reviewed to determine the cause of fever. Results: Post operative fever was recorded after 82 procedures (44.6%. The average maximum temperature occurred on post-operative day 1 (98.9 o F. Only 2 TKR got infected. Incidence of fever was higher in TKR as compared to THR. Conclusion: Post-operative fever is common and probably inflammatory. It is not an important predictive factor of joint infection. Work up for joint infection is not indicated unless other corroborative features are present. Aspiration of painful joint is a highly accurate for identifying an infection.

  12. Management of postoperative recurrence of Crohn's disease.

    Science.gov (United States)

    van Lent, Anja U; D'Haens, Geert R

    2013-01-01

    The course of Crohn's disease (CD) is unpredictable and potentially destructive. The percentage of patients requiring surgery at some stage in their disease accumulates to over 70%. After resection of the affected intestine, reappearance of CD occurs in the majority of patients. Prophylactic medical therapy to reduce the rate of postoperative recurrence has been proven to be effective, yet the incidence of recurrence remains high. Patient profiling (risk stratification) is important in this postoperative setting. High-risk patients (associated with e.g. smoking, the need of repetitive surgery and penetrating disease) require strong immunosuppressive treatment, which should be commenced immediately after surgery, when recurrent disease activity begins. Additionally, early screening endoscopy should be performed to monitor treatment effect. The efficacy of thiopurines is shown to be higher than mesalazine or imidazole antibiotics alone for preventing and ameliorating endoscopic recurrence of CD postoperatively; however, anti-tumor necrosis factors (anti-TNFs) are increasingly considered the most potent agents. In patients with a risk factor for early postoperative recurrence, the first line of treatment is 6-mercaptopurine, in combination with imidazole antibiotics if tolerated, followed by anti-TNFs. When lesions are found at colonoscopy, therapy should be upscaled. We propose a treatment algorithm to direct therapeutic management of CD postoperatively. © 2013 S. Karger AG, Basel.

  13. Hyperprolactinaemia: a cause of severe postoperative complication after reduction mammaplasty.

    Science.gov (United States)

    Mestak, Ondrej; Mestak, Jan; Borsky, Jiri

    2014-12-01

    Galactorrhoea is a rare complication of wound healing after breast reduction and its association with necrosis of the areolar skin in women with no recent history of breast feeding has to our knowledge never been described. Galactorrhoea is common and there are many differential diagnoses. We report a case of a 46-year-old woman who had bilateral reductions of the breast and developed hyperprolactinaemia and galactorrhoea six weeks postoperatively. Subsequently she developed dry necrosis of both areolas. All radiographic and laboratory findings were within the reference ranges except for of prolactin.

  14. 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...

  15. Multiple 18F-FDG, PET-CT for Postoperative Monitoring of Breast Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kurata, A.; Murata, Y.; Kubota, K.; Shibuya, H. (Dept. of Radioloy, Tokyo Medical and Dental Univ. Hospital, Tokyo (Japan)); Osanai, T. (Dept. of Breast Surgery, Tokyo Medical and Dental Univ. Hospital, Tokyo (Japan))

    2009-11-15

    Background: Positron emission tomography (PET)-computed tomography (CT) may be useful in the post-treatment follow-up of breast cancer patients. Purpose: To assess the usefulness of 18F-fluorodeoxyglucose (FDG) PET-CT (PET-CT) for postoperative monitoring of breast cancer patients. Material and Methods: One hundred twenty-nine PET-CT studies performed on 55 female postoperative breast cancer patients (median age 56 years, range 36-86 years) were analyzed. The median interval between the PET-CT studies was 6 months (range 1-15 months). In order to determine the usefulness of serial PET-CT examinations in the postoperative follow-up of breast cancer patients, the PET-CT findings were compared with the physical findings, findings obtained by other imaging modalities, and the 18F-FDG-PET (PET) findings. Results: The PET findings were negative in 4 metastatic bone lesions with a positive bone scan. The PET findings were also negative in 6 of 9 osteogenic bone metastases and one of 64 osteolytic bone lesions. There were 5 cases with false-positive of PET, which were determined to be areas of soft-tissue hyperactivity. All false-positive/-negative findings were corrected by the addition of CT. Conclusion: The results of this study lend support to the clinical role of PET-CT in the postoperative follow-up/monitoring of breast cancer patients

  16. Effect of submucosal application of tramadol on postoperative pain after third molar surgery.

    Science.gov (United States)

    Gönül, Onur; Satılmış, Tülin; Bayram, Ferit; Göçmen, Gökhan; Sipahi, Aysegül; Göker, Kamil

    2015-10-14

    The aim of this study was to evaluate the effectiveness of submucosal application of tramadol, for acute postoperative facial pain, following the extraction of impacted third molar teeth. This prospective, double-blind, randomised placebo-controlled study included 60 ASA I-II patients undergoing impacted third molar surgery under local anaesthesia. Following the surgical procedure, patients were randomly divided into two groups; group T (1 mg/kg tramadol) and group S (2-mL saline). Treatments were applied submucosally after surgery. Pain after extraction was evaluated using a visual analogue scale (VAS) 0.5, 1, 2, 4, 6, 12, 24, and 48 h postoperatively. The time at which the first analgesic drug was taken, the total analgesic dose used, and adverse tissue reactions were also evaluated. In group T, postoperative VAS scores were significantly lower compared to that in group S (p third molar surgery.

  17. COMPARISON OF PREOPERATIVE RECTAL DICLOFENAC AND RECTAL PARACETAMOL FOR POSTOPERATIVE ANALGESIA IN PAEDIATRIC PATIENTS

    Directory of Open Access Journals (Sweden)

    Ketaki

    2014-01-01

    Full Text Available Acute postoperative pain has adverse effects on the patients moral as well as various physiological functions of the body. We conducted a prospective randomized study to compare the efficacy of preoperative rectal diclofenac and paracetamol for postoperative analgesia in pediatric age group. Sixty children (3 – 13 yrs. undergoing minor surgical procedures were randomly alloc ated into 2 groups, group I comprising of 30 children who received diclofenac suppository post induction and group II comprising of 30 children who received paracetamol suppository post induction. Pain was assessed by the “Hanallah pain scale” which catego rizes pain based on 5 parameters, viz, systolic blood pressure, crying, movements, agitation (confused, excited, and complaints of pain 1 . We concluded that though both, diclofenac sodium and paracetamol are good postoperative analgesics when given by rect al route in pediatric patients undergoing minor surgeries, diclofenac sodium provides better analgesia than paracetamol when given by rectal route in pediatric patients.

  18. 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......). Postoperative cognitive dysfunction was defined as a composite Z-score > 2 across tests or at least two individual test Z-scores > 2. Subjects with delirium were significantly less likely to participate in postoperative testing. Delirium was associated with an increased incidence of early postoperative...... cognitive dysfunction (adjusted risk ratio 1.6, 95% CI 1.1-2.1), but not long-term postoperative cognitive dysfunction (adjusted risk ratio 1.3, 95% CI 0.6-2.4). Delirium was associated with early postoperative cognitive dysfunction, but the relationship of delirium to long-term postoperative cognitive...

  19. Peripherally applied opioids for postoperative pain

    DEFF Research Database (Denmark)

    Nielsen, B N; Henneberg, S W; Schmiegelow, K;

    2015-01-01

    BACKGROUND: Opioids applied peripherally at the site of surgery may produce postoperative analgesia with few side effects. We performed this systematic review to evaluate the analgesic effect of peripherally applied opioids for acute postoperative pain. METHODS: We searched PubMed (1966 to June...... 2013), Embase (1980 to June 2013), and the Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 6). Randomized controlled trials investigating the postoperative analgesic effect of peripherally applied opioids vs. systemic opioids or placebo, measured by pain intensity...... difference -5 mm, 95% CI: -7 to -3) for peripherally applied opioids vs. placebo and statistically significant increased time to first analgesic (mean difference 153 min, 95% CI: 41-265). When preoperative inflammation was reported (five studies), peripherally applied opioids significantly improved...

  20. Evaluation for postoperative recurrence of Crohn disease.

    Science.gov (United States)

    Swoger, Jason M; Regueiro, Miguel

    2012-06-01

    Disease recurrence following resective surgery for Crohn disease remains a challenging clinical problem, and more studies are needed to better define risk stratification and treatment recommendations in the postoperative setting. Endoscopy remains the gold standard for the assessment of postoperative disease recurrence, and all Crohn disease patients who undergo surgery should undergo ileocolonoscopy within 6 to 12 months of surgery. The degree of endoscopic recurrence in the neoterminal ileum during this procedure provides prognostic information regarding the severity of the future disease course. WCE, MRE, and SICUS are all promising noninvasive modalities to assess for postoperative Crohn disease activity. However, further studies are needed to better define scoring systems, operating characteristics and variability, and prognostic data for each of these modalities. In patients at risk for early disease recurrence, more aggressive prophylactic therapy should be considered, in hopes of delivering true “top-down” therapy that may offer maximum impact in altering the natural history of Crohn disease.

  1. 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.

  2. Postoperative course of chronic subdural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Toshiaki; Tsubone, Kyoji; Kyuma, Yoshikazu; Kuwabara, Takeo (Yokohama City Univ. (Japan). Faculty of Medicine)

    1983-10-01

    1) Fourty cases of chronic subdural hematoma were operated on by trephination, irrigation and external drainage. Postoperative neurological recovery and decrease of hematoma cavity on CT scan were followed. 2) Operations were effective for recovery of neurological grade in 28 cases, moderately effective in 7 cases and not effective in 5 cases. 3) Within the tenth postoperative day, more than half residual hematoma cavity existed in 53% of examined cases. After that, more than half residual cavity existed in only 17%. 4) Preoperative feature of neurologically unimproved cases were no definite history of head trauma and water like low density of hematoma cavity. Postoperative feature was persistence of more than three fourth of residual hematoma cavity on CT scan. 5) A group of unimproved cases described above are thought to have a feature of subdural hygroma rather than subdural hematoma. When possibility of subdural hygroma is high in preoperative differential diagnosis, indication of operation should be different from chronic subdural hematoma.

  3. [Postoperative respiratory insufficiency and its treatment].

    Science.gov (United States)

    Kösek, V; Wiebe, K

    2015-05-01

    The development of a postoperative respiratory insufficiency is typically caused by several factors and include patient-related risks, the extent of the procedure and postoperative complications. Morbidity and mortality rates in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are high. It is important to have consistent strategies for prevention and preoperative conditioning is essential primarily for high-risk patients. Treatment of established postoperative lung failure requires early tracheotomy, protective ventilation (tidal volume 6 ml/kg body weight), elevated positive end expiratory pressure (PEEP, 10-20 mmH2O), recurrent bronchoscopy and early patient mobilization. In critical cases an extracorporeal lung assist is considered to be beneficial as a bridge to recovery and for realizing a protective ventilation protocol. Different systems with separate indications are available. The temporary application of a lung assist allows thoracic surgery to be performed safely in patients presenting with insufficient respiratory function.

  4. [Stair climbing test in prediction of postoperative complications after lung cancer surgery].

    Science.gov (United States)

    Zurauskas, Aleksas; Tikuisis, Renatas; Miliauskas, Povilas

    2002-01-01

    Preoperative physical state of a patient is very important for adaptation of the patient after lung resections. Purpose of this work is to evaluate an information factor of a stair-climbing test while predicting of postoperative complications after lung cancer surgery. Fifty two patients were examined, who passed lung surgery of different volume. The patients are distributed to two groups: I(st) group included the patients able to climb 1-44 footsteps (n=22/42.3%) and the II(nd) group included the patients able to climb more than 44 footsteps at a moderate speed without stopping for rest (n=30/57.7%). One flight of stairs made up to 22 footsteps with 15 cm of height each. Postoperative myocardial ischemia, disorders of heart rhythm, pneumonias, atelectasis, prolonged artificial ventilation of lungs, sanative bronchoscopy, duration of treatment, and cases of death were registered. It was established that postoperative cardiac and lung complications occurred in 17 patients (32.7%), two patients died (3.8%). Rate of complications between the patients of the I(st) and II(nd) group was 82.4 ir 17.6 percent. Postoperative course was normal for those patients (n=11) who were able to climb five or more flights of stairs. It was noticed that duration of postoperative period has an inverse proportion to a number of the climbed up footsteps. The stair-climbing test is a simple, safe, cheap and informative enough for prediction of postoperative cardiopulmonary complications after lung cancer surgery.

  5. Postoperative radiotherapy appeared to improve the disease free survival rate of patients with extrahepatic bile duct cancer at high risk of loco-regional recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mi Young; Kim, Jin Hee; Kim, Yong Hoon [Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of); Byun, Sang Jun [Dept. of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of)

    2016-12-15

    To investigate the outcomes of postoperative radiotherapy (RT), in patients with extrahepatic bile duct (EHBD) cancer by comparing the survival rate between patients undergoing surgery alone or surgery plus postoperative RT, and to identify the prognostic factors affecting survival. Between 2000 and 2013, 52 patients with EHBD cancer underwent surgical resection. Of these, 33 patients did not receive postoperative RT (group I), and 19 patients did (group II). R1 resection was significantly more frequent in group II. The median radiation dose was 5,040 cGy. The 3-year overall survival (OS) rate for group I and group II was 38% and 56%, respectively (p = 0.274). The 3-year disease free survival (DFS) rate for group I and group II was 20% and 31%, respectively (p = 0.049), and the 3-year loco-regional recurrence free survival (LRFS) rates were 19% and 58%, respectively (p = 0.002). Multivariate analyses showed that postoperative RT and lymphovascular invasion were independent prognostic factors for DFS and LRFS. Overall, 42 patients (80%) experienced treatment failure. Distant metastasis was the predominant pattern of failure in group II. Postoperative RT after surgical resection appeared to improve the loco-regional control and DFS rate. More effort is needed to reduce distant metastasis, the major pattern of failure, in patients who receive postoperative RT.

  6. Post-operative delirium in elderly patients

    Directory of Open Access Journals (Sweden)

    B Vijayakumar

    2014-01-01

    Full Text Available Delirium is a common, but an often underdiagnosed complication in the elderly following major surgery. Recognising delirium in early stages and diagnosing the condition based on established criteria can improve the outcome and management. Managing delirium with environmental, supportive and pharmacological interventions will possibly reduce the incidence and side-effects associated with post-operative delirium. The purpose of this article is to provide an over view of the current knowledge about the disease, diagnosis, pathogenesis, preventive strategies, and treatment of post-operative delirium.

  7. Outsourced cataract surgery and postoperative endophthalmitis

    DEFF Research Database (Denmark)

    Solborg Bjerrum, Søren; Kiilgaard, Jens F; Mikkelsen, Kim Lyngby;

    2013-01-01

    To compare the risk of postoperative endophthalmitis (PE) after cataract surgery at eye departments in public hospitals and private hospitals/eye clinics and to evaluate if the Danish National Patient Registry (NPR) is a reliable database to monitor the PE risk.......To compare the risk of postoperative endophthalmitis (PE) after cataract surgery at eye departments in public hospitals and private hospitals/eye clinics and to evaluate if the Danish National Patient Registry (NPR) is a reliable database to monitor the PE risk....

  8. Comparing efficacy of preemptively used dexketoprofen and tramadol for postoperative pain in patients underwent laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Süreyya Özkan

    2015-03-01

    Full Text Available Objective: In our study, we aimed to compare effects of preoperative dexketoprofen and tramadol administered by intravenous route on intraoperative and postoperative analgesic consumption, postoperative pain, durations of hospital stay and patient satisfaction in patients, undergoing laparoscopic cholecystectomy. Methods:After approval of ethic committee and written consent of patients were obtained, 60 patients between 18-70 years old with ASA I-II were included in the study. After routine monitorization and 20 minutes before induction of anesthesia, dexketoprofen 50 mg in 100 cc 0.9% NaCl was administered in Dexketoprofen Group and tramadol 100 mg in 100 cc 0.9% NaCl in Tramadol Group as intravenous infusion during 20 minutes. Intraoperative hemodynamic parameters, analgesic-anesthetic consumptions and complications of patients, on whom standard general anesthesia was applied, were recorded. Pain severity, degree of sedation, morphine consumptions and hemodynamic parameters were recorded at postoperative 30 th minute, and 4 th, 8th, 12th and 24 th hours. Additional analgesia requirement, times for requiring first analgesia, duration of hospital stay, postoperative complications and patient satisfactions were recorded. Results: Intraoperative analgesic-anesthetic consumptions, postoperative visual analogue scale (VAS scores, sedation degrees, intravenous patient controlled analgesia (PCA and morphine consumptions, times for requiring first analgesic, durations of hospital stay, intraoperative-postoperative complications developed and patient satisfactions were similar in both groups. Consequently, postoperative analgesic efficacy of pre-emptive dexketoprofen intravenous 50 mg and tramadol intravenous 100 mg administered was found to be similar in cases, who had laparoscopic cholecystectomy operation. Conclusion:Because VAS scores were low in our patients, morphine consumptions with intravenous PCA were similar in both groups, and there wasn

  9. Color Doppler Ultrasonography in Evaluation of the Postoperative Penis

    Directory of Open Access Journals (Sweden)

    M. Ghafouri

    2005-08-01

    particularly helpful in determining the causes of erectile dysfunction and other unsatisfactory long-term results following penile surgery. Conclusion: Our findings indicate that color Doppler US is the imaging modality of choice in evaluating pa-tients who have undergone penile surgery because it clearly depicts normal penile anatomy and postoperative changes.

  10. Treatment outcome of thymic epithelial tumor: prognostic factors and optimal postoperative radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Oh, Dong Ryul; Ahn, Yong Chan; Kim, Kwan Min; Kim, Jhin Gook; Shim, Young Mog; Han, Jung Ho [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2005-06-15

    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 {approx} IV or WHO tumor type B2 {approx} 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%; {rho} = 0.03), Masaoka stage (I 92.2%, II 95.4%, III 82.1%, IV 67.5%; {rho} = 0.001), WHO tumor type (A-B1 96.0%, B2-C 82.3%; {rho} = 0.001), Extent of resection (R0 resection 92.3%, R1 or 2 resection 72.6%; {rho} = 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.

  11. Thoracic textilomas: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Machado, Dianne Melo; Zanetti, Glaucia; Araujo Neto, Cesar Augusto; Nobre, Luiz Felipe; Meirelles, Gustavo de Souza Portes; Silva, Jorge Luiz Pereira e; Guimaraes, Marcos Duarte; Escuissato, Dante Luiz; Souza Junior, Arthur Soares; Hochhegger, Bruno; Marchiori, Edson, E-mail: edmarchiori@gmail.com [Hospital Universitario Antonio Pedro (HUAP/UFF), Niteroi, RJ (Brazil)

    2014-09-15

    Objective: the aim of this study was to analyze chest CT scans of patients with thoracic textiloma. Methods: this was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. Results: the majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). Conclusions: it is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication. (author)

  12. 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...

  13. Effect of Music Therapy on Postoperative Pain Management in Gynecological Patients: A Literature Review.

    Science.gov (United States)

    Sin, Wai Man; Chow, Ka Ming

    2015-12-01

    Unrelieved postoperative pain may have a negative impact on the physiological and psychological well-being of patients. Pharmacological methods are currently used to relieve such pain in gynecological patients; however, inadequate pain control is still reported, and the use of nonpharmacological pain-relieving methods is increasingly being advocated, one of which is music therapy. The purpose of this literature review was to identify, summarize, and critically appraise current evidence on music therapy and postoperative pain management among gynecological patients. A systematic search of MEDLINE, CINAHL, PsycINFO, British Nursing Index, and Allied and Complementary Medicine was conducted using the search terms music, gynecological, pain, surgery, operative, and post-operative to identify relevant articles in English from 1995 to the present. All identified articles were assessed independently for inclusion into review. A total of 7 articles were included after removal of duplicates and exclusion of irrelevant studies. All the included studies assessed the effects of music therapy on postoperative pain intensity, and three of them measured pain-related physiological symptoms. The findings indicated that music therapy, in general, was effective in reducing pain intensity, fatigue, anxiety, and analgesic consumption in gynecological patients during the postoperative period. It is recommended as an adjunct to pharmacological pain-relieving methods in reducing postoperative pain. Future researches on music therapy to identify the most effective application and evaluate its effect by qualitative study are recommended.

  14. Modified skin incision for avoiding the lesser occipital nerve and occipital artery during retrosigmoid craniotomy: potential applications for enhancing operative working distance and angles while minimizing the risk of postoperative neuralgias and intraoperative hemorrhage.

    Science.gov (United States)

    Tubbs, R Shane; Fries, Fabian N; Kulwin, Charles; Mortazavi, Martin M; Loukas, Marios; Cohen-Gadol, Aaron A

    2016-10-01

    Chronic postoperative neuralgias and headache following retrosigmoid craniotomy can be uncomfortable for the patient. We aimed to better elucidate the regional nerve anatomy in an effort to minimize this postoperative complication. Ten adult cadaveric heads (20 sides) were dissected to observe the relationship between the lesser occipital nerve and a traditional linear versus modified U incision during retrosigmoid craniotomy. Additionally, the relationship between these incisions and the occipital artery were observed. The lesser occipital nerve was found to have two types of course. Type I nerves (60%) remained close to the posterior border of the sternocleidomastoid muscle and some crossed anteriorly over the sternocleidomastoid muscle near the mastoid process. Type II nerves (40%) left the posterior border of the sternocleidomastoid muscle and swung medially (up to 4.5cm posterior to the posterior border of the sternocleidomastoid muscle) as they ascended over the occiput. The lesser occipital nerve was near a midpoint of a line between the external occipital protuberance and mastoid process in all specimens with the type II nerve configuration. Based on our findings, the inverted U incision would be less likely to injure the type II nerves but would necessarily cross over type I nerves, especially more cranially on the nerve at the apex of the incision. As the more traditional linear incision would most likely transect the type I nerves and more so near their trunk, the U incision may be the overall better choice in avoiding neural and occipital artery injury during retrosigmoid approaches.

  15. Preoperative exercise training to improve postoperative outcomes

    NARCIS (Netherlands)

    Valkenet, K.

    2017-01-01

    It is common knowledge that better preoperative physical fitness is associated with better postoperative outcomes. However, as a result of aging of the population and improved surgical and anaesthesia techniques, the proportion of frail patients with decreased physical fitness levels undergoing majo

  16. Postoperative pain treatment for ambulatory surgery.

    Science.gov (United States)

    Rawal, Narinder

    2007-03-01

    One of the most significant changes in surgical practice during the last two decades has been the growth of ambulatory surgery. Adequate postoperative analgesia is a prerequisite for successful ambulatory surgery. Recent studies have shown that large numbers of patients suffer from moderate to severe pain during the first 24-48 hr. The success of fast-tracking depends to a considerable extent on effective postoperative pain management routines and the cost saving of outpatient surgery may be negated by unanticipated hospital admission for poorly treated pain. Depending on the intensity of postoperative pain current management includes the use of analgesics such as paracetamol, NSAIDs including coxibs and tramadol as single drugs or in combination as part of balanced (multimodal) analgesia. However, in the ambulatory setting many patients suffer from pain at home in spite of multimodal analgesic regimens. Sending patients home with perineural, incisional, and intra-articular catheters is a new and evolving area of postoperative pain management. Current evidence suggests that these techniques are effective, feasible and safe in the home environment if appropriate patient selection routines and organization for follow-up are in place.

  17. Ranitidine improves postoperative monocyte and neutrophil function

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Nielsen, H; Jensen, S;

    1994-01-01

    BACKGROUND: The histamine H2-receptor antagonist ranitidine hydrochloride has been shown to improve trauma-, blood transfusion-, and sepsis-induced immunosuppression. OBJECTIVE: To evaluate the effect of ranitidine on postoperative impairment in monocyte and neutrophil function. METHODS: Twenty...... difference (P detected. There were no infectious complications in ranitidine-treated patients. CONCLUSION: These results support previous studies...

  18. Characterizing postoperative cognitive dysfunction in the elderly

    NARCIS (Netherlands)

    Hovens, Iris Bertha

    2015-01-01

    In the Netherlands, yearly more than 400.000 elderly patients undergo surgery. An estimated ten percent of these patients develops long-lasting postoperative cognitive dysfunction (POCD), associated with a reduced quality of life, increased dependency and worse prognosis. Currently, there is no

  19. Prevention of postoperative pain by balanced analgesia

    DEFF Research Database (Denmark)

    Dahl, J B; Rosenberg, J; Dirkes, W E;

    1990-01-01

    Fourteen patients undergoing colorectal surgery received an intraoperative afferent neural block with combined intrathecal and extradural local anaesthetics plus a balanced postoperative low-dose regimen of extradural bupivacaine 10 mg h-1-morphine 0.2 mg h-1 and systemic piroxicam 20 mg/24 h...

  20. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  1. Postoperative opioid analgesia: time for a reconsideration?

    DEFF Research Database (Denmark)

    Kehlet, H; Rung, G W; Callesen, T

    1996-01-01

    limit their future use in some situations. Thus, the recent emphasis on ambulatory surgery and accelerated surgical stay programs, both with a focus on early recovery of organ function and provision of functional analgesia [i.e., pain relief that allows normal function (Kehlet H: Postoperative pain...

  2. Management of pain in the postoperative neonate.

    Science.gov (United States)

    Truog, R; Anand, K J

    1989-03-01

    Only recently has the use of anesthesia and analgesia become widely accepted in the newborn infant. This is largely a result of the overwhelming evidence that neonates have the neurologic substrate for the perception of pain and display characteristic behavioral, physiologic, metabolic, and hormonal responses to noxious stimuli. The management of postoperative pain in the surgical neonate begins in the operating room, where techniques can be chosen that will ease the transition into the postoperative period. For postoperative analgesia, the most widely used and effective agents are the narcotics morphine and fentanyl. They may be administered either intermittently or continuously, and with proper precautions may be given to both intubated and nonintubated newborns. Other medications for analgesia and sedation are not as well studied in the newborn, but chloral hydrate and the benzodiazepines are useful for sedation, and acetaminophen may be used for analgesia alone or for potentiating the effect of narcotics. In addition, a number of creative nonpharmacologic techniques are being developed and promise to further decrease the discomfort experienced by postoperative neonates.

  3. Postoperative omental infarction following colonic resection

    Energy Technology Data Exchange (ETDEWEB)

    Kerr, S.F., E-mail: skerr44@doctors.org.uk [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Hyland, R.; Rowbotham, E.; Chalmers, A.G. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

    2012-02-15

    Aim: To illustrate the computed tomography (CT) appearances and natural history of postoperative omental infarction following colonic resection and to highlight the important clinical implications of this radiological diagnosis. Materials and methods: Over a 3 year period, 15 patients with a history of colonic resection were identified as having a CT diagnosis of postoperative omental infarction. Relevant clinical and pathological data were retrospectively collected from the institution's electronic patient records system and all relevant imaging was reviewed, including serial CT images in 10 patients. Results: A diagnosis of postoperative omental infarction was made in symptomatic and asymptomatic patients who had undergone open or laparoscopic colonic resection for benign or malignant disease. CT appearances ranged from diffuse omental stranding to discrete masses, which typically appeared within weeks of surgery and could persist for years. In four (36%) of the patients with colorectal cancer, the CT appearances raised concern for recurrent malignancy, but percutaneous biopsy and/or serial CT allowed a confident diagnosis of omental infarction to be made. Although most cases were self-limiting, three (20%) cases were complicated by secondary infection and required radiological or surgical intervention. Conclusion: Postoperative omental infarction is an under-recognized complication of colonic resection. It has the potential to mimic recurrent malignancy and may require radiological or surgical intervention for secondary infection.

  4. Predicting postoperative delirium after vascular surgical procedures

    NARCIS (Netherlands)

    Visser, Linda; Prent, Anna; van der Laan, Maarten J.; van Leeuwen, Barbara L.; Izaks, Gerbrand J.; Zeebregts, Clark J.; Pol, Robert A.

    Objective: The objective of this study was to determine the incidence of and specific preoperative and intraoperative risk factors for postoperative delirium (POD) in electively treated vascular surgery patients. Methods: Between March 2010 and November 2013, all vascular surgery patients were

  5. Postoperative pain treatment' practice guideline revised

    NARCIS (Netherlands)

    Houweling, P.L.; Molag, M.L.; Boekel, R.L.M. van; Verbrugge, S.J.; Haelst, I.M. van; Hollmann, M.W.

    2013-01-01

    - On the initiative of the Dutch Association of Anaesthesiologists, a multidisciplinary workgroup has revised the 2003 practice guideline on 'Postoperative pain treatment' for adults and children.- The main reason for revision was the availability of new drugs and new methods of administration. The

  6. Body position and late postoperative nocturnal hypoxaemia

    DEFF Research Database (Denmark)

    Rosenberg-Adamsen, S; Stausholm, K; Edvardsen, L

    1997-01-01

    Thirteen patients were monitored for nocturnal body position (supine vs. side) and arterial oxygen saturation pre-operatively and on the second postoperative night after major abdominal surgery. The number of positional changes were significantly decreased after operation (p ... position than on the side (p reason for decreased nocturnal movements....

  7. Ranitidine improves postoperative monocyte and neutrophil function

    DEFF Research Database (Denmark)

    Nielsen, Hans Jørgen; Nielsen, H; Jensen, S

    1994-01-01

    BACKGROUND: The histamine H2-receptor antagonist ranitidine hydrochloride has been shown to improve trauma-, blood transfusion-, and sepsis-induced immunosuppression. OBJECTIVE: To evaluate the effect of ranitidine on postoperative impairment in monocyte and neutrophil function. METHODS: Twenty...... difference (P detected. There were no infectious complications in ranitidine-treated patients. CONCLUSION: These results support previous studies...

  8. Anaesthesia, surgery, and challenges in postoperative recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Dahl, Jørgen B

    2003-01-01

    Surgical injury can be followed by pain, nausea, vomiting and ileus, stress-induced catabolism, impaired pulmonary function, increased cardiac demands, and risk of thromboembolism. These problems can lead to complications, need for treatment in hospital, postoperative fatigue, and delayed......, and by collaborating with surgeons, surgical nurses, and physiotherapists to reduce risk and pain....

  9. Postoperative pain after total abdominal hysterectomy and bilateral salpingo-oophorectomy depending on the type of anaesthesia administration

    Directory of Open Access Journals (Sweden)

    Octavian Cătălin Ciobotaru

    2016-03-01

    Full Text Available Total abdominal hysterectomy and bilateral salpingo-oophorectomy is a surgical procedure frequently associated with severe or moderate postoperative pain. We conducted a retrospective study on 90 patients who underwent this procedure. One part of the patients (58; 64.4% was administered bupivacaine 5% without intrathecal opioid administration. The other part (32; 35.6% underwent general anaesthesia with endotracheal intubation. We evaluated the postoperative analgesic requirements based on the type of anaesthesia used and other factors like age, environment and body mass index. The findings indicated that the patients who received general anaesthesia with endotracheal intubation developed severe postoperative pain more frequently than those who underwent spinal anaesthesia (P = 0.018. A higher percentage of patients from rural areas scored lower in postoperative pain intensity on the numerical rating scale (P = 0.033. There was no statistically significant correlation regarding postoperative pain and age or body mass index.

  10. 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

  11. Preoperative prediction of severe postoperative pain.

    Science.gov (United States)

    Kalkman, C J; Visser, K; Moen, J; Bonsel, G J; Grobbee, D E; Moons, K G M

    2003-10-01

    We developed and validated a prediction rule for the occurrence of early postoperative severe pain in surgical inpatients, using predictors that can be easily documented in a preoperative setting. A cohort of surgical inpatients (n=1416) undergoing various procedures except cardiac surgery and intracranial neurosurgery in a University Hospital were studied. Preoperatively the following predictors were collected: age, gender, type of scheduled surgery, expected incision size, blood pressure, heart rate, Quetelet index, the presence and severity of preoperative pain, health-related quality of life the (SF-36), Spielberger's State-Trait Anxiety Inventory (STAI) and the Amsterdam Preoperative Anxiety and Information Scale (APAIS). The outcome was the presence of severe postoperative pain (defined as Numeric Rating Scale > or =8) within the first hour postoperatively. Multivariate logistic regression in combination with bootstrapping techniques (as a method for internal validation) was used to derive a stable prediction model. Independent predictors of severe postoperative pain were younger age, female gender, level of preoperative pain, incision size and type of surgery. The area under the receiver operator characteristic (ROC) curve was 0.71 (95% CI: 0.68-0.74). Adding APAIS scores (measures of preoperative anxiety and need for information), but not STAI, provided a slightly better model (ROC area 0.73). The reliability of this extended model was good (Hosmer and Lemeshow test p-value 0.78). We have demonstrated that severe postoperative pain early after awakening from general anesthesia can be predicted with a scoring rule, using a small set of variables that can be easily obtained from all patients at the preoperative visit. Before this internally validated preoperative prediction rule can be applied in clinical practice to support anticipatory pain management, external validation in other clinical settings is necessary.

  12. Pericardium-6 Acupressure for the Prevention of Postoperative Nausea and Vomiting

    Science.gov (United States)

    1999-10-01

    conducted to provide information to the anesthesia community on the use of acupressure for the prevention of postoperative nausea and vomiting. It was...that is expected in this study (Dr. Levine, personal communication , Feb 13, 1998). An attempt was made to recruit approximately 50 subjects into the...background . Journal of Nurse- Midwifery , 37(4), 254-259. Beal, M. (1992b). Acupuncture and related treatment modalities part II: Applications to

  13. Different MMSE Score Is Associated with Postoperative Delirium in Young-Old and Old-Old Adults

    Science.gov (United States)

    Wang, Meijuan; Zhu, Yingbo; Li, Cheng; Li, Guodong; Marcantonio, Edward R.; Xie, Zhongcong; Shen, Yuan

    2015-01-01

    Background Postoperative delirium is one of the most common postoperative complications in geriatric patients. Mini-mental state examination (MMSE) assesses cognitive function in patients and is associated with postoperative delirium. However, whether there is an age-dependent relationship between preoperative MMSE score and postoperative delirium remains unknown. Methods We therefore set out to investigate the association between preoperative MMSE score and postoperative delirium in young-old (≤80 year-old, 75.46±4.69 years, 27.0% male, n = 63) and old-old (>80 year-old, 84.51±3.46 years, 20.9% male, n = 67) participants, who had repairs of hip fractures under general anesthesia. The Confusion Assessment Method and Memorial Delirium Assessment Scale were administrated before surgery, and on the first, second and fourth days after surgery, to assess the incidence and severity of the delirium, respectively. A receiver operating characteristic curve analysis was used to calculate the optimal cutoff score of MMSE in predicting postoperative delirium. Results Thirty-four (26.2%) of 130 patients (80.12±6.12 years, 23.8% male) developed postoperative delirium. Preoperative MMSE scores were negatively associated with higher incidences and greater severity of postoperative delirium. The optimal cutoff scores of MMSE associated with postoperative delirium for young-old and old-old participants were 18.4 and 21.4, with a sensitivity of 60% and 83.8%, and a specificity of 92.5% and 62.8%, respectively. Conclusion The data demonstrated the optimal cutoff score of MMSE associated with postoperative delirium in young-old adults might be lower than that in old-old adults. Pending further investigation, these findings suggest that the association between preoperative MMSE score and postoperative delirium is age-dependent. PMID:26460750

  14. Impact of Postoperative Antibiotic Prophylaxis Duration on Surgical Site Infections in Autologous Breast Reconstruction.

    Science.gov (United States)

    Drury, Kerry E; Lanier, Steven T; Khavanin, Nima; Hume, Keith M; Gutowski, Karol A; Thornton, Brian P; Hansen, Nora M; Murphy, Robert X; Fine, Neil A; Kim, John Y S

    2016-02-01

    Although some surgeons prescribe prolonged postoperative antibiotics after autologous breast reconstruction, evidence is lacking to support this practice. We used the Tracking Operations and Outcomes for Plastic Surgeons database to evaluate the association between postoperative antibiotic duration and the rate of surgical site infection (SSI) in autologous breast reconstruction. The intervention of interest for this study was postoperative duration of antibiotic prophylaxis: either discontinued 24 hours after surgery or continued beyond 24 hours. The primary outcome variable of interest for this study was the presence of SSI within 30 days of autologous breast reconstruction. Cohort characteristics and 30-day outcomes were compared using χ² and Fischer exact tests for categorical variables and Student t tests for continuous variables. Multivariate logistic regression was used to control for confounders. A total of 1036 patients met inclusion criteria for our study. Six hundred fifty-nine patients (63.6%) received antibiotics for 24 hours postoperatively, and 377 patients (36.4%) received antibiotics for greater than 24 hours. The rate of SSI did not differ significantly between patients given antibiotics for only 24 hours and those continued on antibiotics beyond the 24-hour postoperative time period (5.01% vs 2.92%, P = 0.109). Furthermore, antibiotic duration was not predictive of SSI in multivariate regression modeling. We did not find a statistically significant difference in the rate of SSI in patients who received 24 hours of postoperative antibiotics compared to those that received antibiotics for greater than 24 hours. These findings held for both purely autologous reconstruction as well as latissimus dorsi reconstruction in conjunction with an implant. Thus, our study does not support continuation of postoperative antibiotics beyond 24 hours after autologous breast reconstruction.

  15. Effect of postoperative experiences on willingness to pay to avoid postoperative pain, nausea, and vomiting

    NARCIS (Netherlands)

    J.E. van den Bosch; G.J. Bonsel; K.G. Moons; C.J. Kalkman

    2006-01-01

    Background: The authors assessed the willingness to pay (WTP) for "perfect" prophylactic antiemetics and analgesics in patients who were scheduled to undergo surgery during general anesthesia. Furthermore, they determined whether postoperative experiences of pain and nausea and vomiting (PONV) chang

  16. Comparative Assessment of Preoperative versus Postoperative Dexamethasone on Postoperative Complications following Lower Third Molar Surgical Extraction

    Directory of Open Access Journals (Sweden)

    Hashem M. Al-Shamiri

    2017-01-01

    Full Text Available Aim. To evaluate the effect of preoperative versus postoperative administration of oral Dexamethasone on postoperative complications including pain, edema, and trismus following lower third molar surgery. Methods. 24 patients were divided into two equal groups receiving 8 mg Dexamethasone orally, one group one hour preoperatively and the other group immediately after surgery. Pain was measured using VAS, edema was measured using a graduated tape between 4 fixed points in the face, and the mouth opening was measured using a graduated sliding caliper. Results. In this study pain and trismus records were similar and statistically nonsignificant in both groups. The results had proven that preoperative administration was superior when compared to postoperative administration regarding edema (0.002. Conclusions. Preoperative oral administration of 8 mg Dexamethasone was superior to the postoperative administration of the same dose concerning edema after lower third molar surgery.

  17. Radiological findings after endoscopic incision of ureterocele

    Energy Technology Data Exchange (ETDEWEB)

    Cheon, Jung Eun; Kim, In One; Seok, Eul Hye; Cha, Joo Hee; Choi, Gook Myung; Kim, Woo Sun; Yeon, Kyung Mo; Kim, Kwang Myung; Choi, Hwang [Seoul National Univ. College of Medicine, Seoul (Korea, Republic of); Cheon, Jung Eun [Chungmu General Hospital, Chungmu (Korea, Republic of); Seok, Eul Hye [Seran General Hospital, Seoul (Korea, Republic of); Cha, Joo Hee [Green General Hospital, Seoul(Korea, Republic of); Choi, Guk Myung [Halla General Hospital, Cheju (Korea, Republic of)

    2001-01-01

    Endoscopic incision of ureterocele is considered a simple and safe method for decompression of urinary tract obstruction above ureterocele. The purpose of this study was to evaluate the radiological findings after endoscopic incision of ureterocele. We retrospectively reviewed the radiological findings (ultrasonography (US), intravenous urography, and voiding cystourethrography(VCU)) in 16 patients with ureterocele who underwent endoscopic incision (mean age at surgery, 15 months; M:F 3:13; 18 ureteroceles). According to the postoperative results, treatment was classified as successful when medical treatment was still required, and second operation when additional surgical treatment was required. Postoperative US (n=10) showed that in all patients, urinary tract obstruction was relieved: the kidney parenchima was thicker and the ureterocele was smaller. Intravenous urography (n=8), demonstrated that in all patients, urinary tract obstruction and the excretory function of the kidney had improved. Postoperative VCU indicated that in 92% of patients (12 of 13), endoscopic incision of the ureterocele led to vesicoureteral reflux(VUR). Of these twelve, seven (58%) showed VUR of more than grade 3, while newly developed VUR was seen in five of eight patients (63%) who had preoperative VCU. Surgery was successful in four patients (25%), partially successful in three (19%), and a second operation-on account of recurrent urinary tract infection and VUR of more than grase 3 during the follow-up period-was required by nine (56%). Although endoscopic incision of a ureterocele is a useful way of relieving urinary tract obstruction, an ensuing complication may be VUR. Postoperative US and intravenous urography should be used to evaluate parenchymal change in the kidney and improvement of uronary tract obstructon, while to assess the extend of VUR during the follow-up period , postoperative VCU is required.

  18. Acute Pancreatitis in the Postoperative Course after Esophagectomy: A Major Complication Described in 4 Patients

    Directory of Open Access Journals (Sweden)

    R.L.G.M. Blom

    2009-11-01

    Full Text Available Background: Postoperative pancreatitis is a rare but devastating complication after esophageal surgery. It has been described in connection with abdominal surgery but the etiology in connection with esophageal surgery has never been evaluated. The present study describes 4 cases of postoperative pancreatitis, and a hypothesis about the etiology is formed. Methods: We performed a search for patients with postoperative pancreatitis after esophagectomy using our prospective database including all patients that underwent esophageal resection at our institution between 1993 and 2008. Pancreatitis was described as abdominal pain, hyperamylasemia, signs of pancreatitis on CT scan or findings during laparotomy or autopsy. Results: A total of 950 patients underwent esophagectomy at our institution, 4 patients developed postoperative pancreatitis (incidence 0.4%. Two out of four patients died. Discussion: Pancreatitis following esophageal surgery is a serious, potentially lethal complication. Diagnosis can be difficult as clear clinical or laboratory findings might be lacking. Peroperative manipulation of the pancreas, mobilization of the duodenum or compromized vascularization have been suggested as etiological factors; although in the described patients, none of these factors were identified as the cause of pancreatitis. In conclusion, pancreatitis following esophageal surgery is a serious but rare complication that should always be considered in patients who deteriorate postoperatively.

  19. Relationship between retention of the posterior cruciate ligament and postoperative flexion in total knee arthroplasty.

    Directory of Open Access Journals (Sweden)

    Yokoyama,Yoshiki

    1995-12-01

    Full Text Available This study was conducted to retrospectively analyzed the outcome of 192 total knee arthroplasties in 132 patients with rheumatoid arthritis (118 women, 14 men. The Okayama Mark II prosthesis, which requires the posterior cruciate ligament (PCL to be resected, was used in 83 knees (group I, the Mark II prosthesis, which allows the PCL to be retained, was used in 68 knees (group II, and the new Okayama PCL-R prosthesis, which also allows the PCL to be retained, was used in 41 (group III. According to the Japanese Orthopaedic Association knee scoring system, the clinical outcome of groups I, II and III at 1 year after the operation were 64.9, 71.2 and 72.3 points, respectively, and the average flexion angles in each group at 1 year were 78.4, 92.6 and 101.3 degrees. Postoperative flexion in groups III was significantly greater than in groups I and II. These results suggest that postoperative flexion is greater when the posterior cruciate ligament is retained.

  20. Postoperative wound infections after a proctectomy—Patient experiences

    Directory of Open Access Journals (Sweden)

    Karin Hassel

    2016-02-01

    Full Text Available Poor perineal wound healing and infections after proctectomy surgery cause a significant proportion of physical and psychological morbidities, such as pain, leakage, and abscesses. In the long run, some of these symptoms will lead to extended periods of hospitalization. These kinds of postoperative complications are also associated with delays in possible chemotherapy treatment. The aim of this study was to describe patient experiences of perineal wound infections following proctectomy due to rectal cancer, and the importance of the communication with and the self-care support from the nurse for these patients. Five women and five men (61–87 years, median age 71 years were included and interviewed. A qualitative content analysis of the interviews was carried out and the following main categories emerged: “Managing postoperative complications,” “Being independent,” “Feeling safe,” and “Accepting the situation.” A perineal wound infection after a proctectomy is devastating for the individual patient. The limitations and changes to the patients’ lives turn into new daily routines, which force them to find new ways to live and to accept the situation. For many of them, the infections remained for several months and, sometimes, for years. The ability to lead an independent life is drastically reduced, but through continuity in care it is possible to create a feeling of safety. Information, communication, and self-care support are all important and valuable factors for recovery. Specialized care containing an action plan is therefore needed in clinical practice to reduce the number of perineal wound infections postoperatively and should be initiated when the patient is discharged from the ward and continue until recovery.

  1. 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

  2. Postoperative pelvic pain: An imaging approach.

    Science.gov (United States)

    Farah, H; Laurent, N; Phalippou, J; Bazot, M; Giraudet, G; Serb, T; Poncelet, E

    2015-10-01

    Postoperative pelvic pain after gynecological surgery is a readily detected but unspecific sign of complication. Imaging as a complement to physical examination helps establish the etiological diagnosis. In the context of emergency surgery, vascular, urinary and digestive injuries constitute the most frequent intraoperative complications. During the follow-up of patients who had undergone pelvic surgery, imaging should be performed to detect recurrent disease, postoperative fibrosis, adhesions and more specific complications related to prosthetic material. Current guidelines recommend using pelvic ultrasonography as the first line imaging modality whereas the use of pelvic computed tomography and/or magnetic resonance imaging should be restricted to specific situations, depending on local availability of equipment and suspected disease.

  3. Postoperative ileus - an update on preventive techniques

    DEFF Research Database (Denmark)

    Kehlet, H.

    2008-01-01

    institution of oral feeding and laparoscopic surgery might also be effective, but there is less clear evidence available to support their use. When some of these techniques are combined as part of the concept of multimodal postoperative rehabilitation (fast-track surgery), the duration of POI after open......This article reviews techniques currently used to prevent or reduce the duration of postoperative ileus (POI), which is considered an undesirable stress response to major abdominal surgery that leads to discomfort, morbidity and prolonged hospital stay. In several randomized studies, a number...... of techniques have been demonstrated to reduce the occurrence and/or duration of POI: thoracic epidural analgesia with local anesthetics, peripheral opioid antagonists, laxatives, chewing gum, intravenous and incisional local anesthetics, and avoidance of routine nasogastric intubation and fluid excess. Early...

  4. [Pneumothorax revealed by postoperative computed tomography].

    Science.gov (United States)

    Ikeda, Shizuka; Katori, Kiyoshi; Fujimoto, Minoru; Nitahara, Keiichi; Higa, Kazuo

    2005-11-01

    We report a case of pneumothorax revealed by postoperative computed tomography. A 39-year-old obese woman (height 153 cm, weight 70 kg) with fractures of the radius, ulna, clavicle, and femur in a traffic accident, was scheduled for osteosynthesis. Anesthesia was induced with thiopental and maintained with 50% nitrous oxide in oxygen and sevoflurane. The Spo2 decreased from 99% to 94% during the surgery. Bilateral chest sounds were symmetrical. The Spo2 increased to 100% after discontinuation of nitrous oxide. Pneumothorax was not evident on a postoperative chest X-ray, but computed tomography of the chest demonstrated right-sided pneumothorax. An ECG electrode had overlapped the fractured rib on the preoperative chest X-ray.

  5. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv......Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity...... is controversial. We therefore update the effects of postoperative analgesia on surgical outcome. After major abdominal surgery, postoperative epidural analgesia with local anesthetics significantly reduces postoperative ileus and pulmonary complications while effects on cardiac morbidity are debatable. Continuous...... regimen does not contain a sufficient amount of local anesthetics. Future evaluation of the effects of epidural analgesia on postoperative outcome also requires integration of epidural analgesia within a multimodal rehabilitation programme....

  6. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv...

  7. Predicting and preventing postoperative decline in older cardiac surgery patients

    NARCIS (Netherlands)

    Ettema, R.G.A.

    2014-01-01

    Introduction: Delirium, depression, pressure ulcers and infection are frequently occurring postoperative complications in older cardiac surgery patients. Prevention of postoperative complications in cardiac surgery is mainly focused on the period of the hospital admission itself. There is however a

  8. Optimized imaging of the postoperative spine.

    Science.gov (United States)

    McLellan, Anne Marie; Daniel, Simon; Corcuera-Solano, Idoia; Joshi, Vivek; Tanenbaum, Lawrence N

    2014-05-01

    Few tasks in imaging are more challenging than that of optimizing evaluations of the instrumented spine. The authors describe how applying fundamental and more advanced principles to postoperative spine computed tomography and magnetic resonance examinations mitigates the challenges associated with metal implants and significantly improves image quality and consistency. Newer and soon-to-be-available enhancements should provide improved visualization of tissues and hardware as multispectral imaging sequences continue to develop.

  9. Postoperative infection in the foot and ankle.

    LENUS (Irish Health Repository)

    Chan, Victoria O

    2012-07-01

    Our discussion highlights the commonly performed surgical procedures in the foot and ankle and reviews the various imaging modalities available for the detection of infection with graphic examples to better enable radiologists to approach the radiological evaluation of postoperative infection in the foot and ankle. Discrimination between infectious and noninfectious inflammation remains a diagnostic challenge usually needing a combination of clinical assessment, laboratory investigations, and imaging studies to increase diagnostic accuracy.

  10. The Postoperative Pain Assessment Skills Pilot Trial

    Directory of Open Access Journals (Sweden)

    Michael McGillion

    2011-01-01

    Full Text Available BACKGROUND/OBJECTIVES: Pain-related misbeliefs among health care professionals (HCPs are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs have been effectively used to improve HCPs’ assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method – deteriorating patient-based simulation (DPS – versus SPs for improving HCPs’ pain knowledge and assessment skills.

  11. Postoperative delirium: diagnostic evaluation and treatment

    Directory of Open Access Journals (Sweden)

    C. Mussi

    2013-05-01

    Full Text Available BACKGROUND Postoperative delirium (POD is an acute, transient and fluctuating disturbance of consciousness that occurs shortly after surgery. Its clinical importance is high, since it increases mortality, length of stay, institutionalization, and it is related to poor prognosis. AIM OF THE REVIEW The aim of this short review is to describe the epidemiology of POD, to assess risk factors of POD, to define the diagnosis and to focus on the possible pharmacologic and non pharmacologic therapies.

  12. Post-operative delirium in elderly patients

    OpenAIRE

    Vijayakumar, B.; Elango, P; Ganessan, R

    2014-01-01

    Delirium is a common, but an often underdiagnosed complication in the elderly following major surgery. Recognising delirium in early stages and diagnosing the condition based on established criteria can improve the outcome and management. Managing delirium with environmental, supportive and pharmacological interventions will possibly reduce the incidence and side-effects associated with post-operative delirium. The purpose of this article is to provide an over view of the current knowledge ab...

  13. Postoperative Rehabilitation After Rotator Cuff Repair

    Science.gov (United States)

    Mollison, Scott; Shin, Jason J.; Glogau, Alexander; Beavis, R. Cole

    2017-01-01

    Background: Postoperative rehabilitation after arthroscopic rotator cuff repair (ARCR) remains controversial and suffers from limited high-quality evidence. Therefore, appropriate use criteria must partially depend on expert opinion. Hypothesis/Purpose: The purpose of the study was to determine and report on the standard and modified rehabilitation protocols after ARCR used by member orthopaedic surgeons of the American Orthopaedic Society for Sports Medicine (AOSSM) and the Arthroscopy Association of North America (AANA). We hypothesized that there will exist a high degree of variability among rehabilitation protocols. We also predict that surgeons will be prescribing accelerated rehabilitation. Study Design: Cross-sectional study; Level of evidence, 4. Methods: A 29-question survey in English language was sent to all 3106 associate and active members of the AOSSM and the AANA. The questionnaire consisted of 4 categories: standard postoperative protocol, modification to postoperative rehabilitation, operative technique, and surgeon demographic data. Via email, the survey was sent on September 4, 2013. Results: The average response rate per question was 22.7%, representing an average of 704 total responses per question. The most common immobilization device was an abduction pillow sling with the arm in neutral or slight internal rotation (70%). Surgeons tended toward later unrestricted passive shoulder range of motion at 6 to 7 weeks (35%). Strengthening exercises were most commonly prescribed between 6 weeks and 3 months (56%). Unrestricted return to activities was most commonly allowed at 5 to 6 months. The majority of the respondents agreed that they would change their protocol based on differences expressed in this survey. Conclusion: There is tremendous variability in postoperative rehabilitation protocols after ARCR. Five of 10 questions regarding standard rehabilitation reached a consensus statement. Contrary to our hypothesis, there was a trend toward later

  14. Controlling postoperative ileus by vagal activation

    Institute of Scientific and Technical Information of China (English)

    Tim; Lubbers; Wim; Buurman; Misha; Luyer

    2010-01-01

    Postoperative ileus is a frequently occurring surgical complication, leading to increased morbidity and hospital stay. Abdominal surgical interventions are known to result in a protracted cessation of bowel movement. Activation of inhibitory neural pathways by nociceptive stimuli leads to an inhibition of propulsive activity, which resolves shortly after closure of the abdomen. The subsequent formation of an inflammatory infiltrate in the muscular layers of the intestine results in a more prolonged phase of...

  15. Preoperative Alcohol Consumption and Postoperative Complications

    DEFF Research Database (Denmark)

    Eliasen, Marie; Grønkjær, Marie; Skov-Ettrup, Lise Skrubbeltrang

    2013-01-01

    .30-2.49), prolonged stay at the hospital (RR = 1.24; 95% CI: 1.18-1.31), and admission to intensive care unit (RR = 1.29; 95% CI: 1.03-1.61). Clearly defined high alcohol consumption was associated with increased risk of postoperative mortality (RR = 2.68; 95% CI: 1.50-4.78). Low to moderate preoperative alcohol...... complications, prolonged stay at the hospital, and admission to intensive care unit....

  16. Leiomyoma cellulare in postoperative material: clinical cases

    OpenAIRE

    2013-01-01

    Introduction: Leiomyoma in one of the most common benign endometrial cancers. Location of the myoma in the cervix and the area of the broad ligament of the uterus is rare. Leiomyoma cellulare (LC) occurs in about 5.0% of leiomyoma cases. Aim of the research: To determine the occurrence of LC among 294 cases of myomas as well as myomas and uterine endometriosis, found in postoperative examinations. Material and methods: Patients were qualified for the surgery based on a gynaecolog...

  17. Postoperative pain: specific-procedure approach

    OpenAIRE

    Martínez-Vísbal Alfonso Luis; Rodríguez-Betancourt Nancy Tatiana

    2012-01-01

    Pain is an unpleasant sensorial and emotional experience associated to real or potentialtissue response, in special if the trigger factor is known, as it occurs in a surgicalprocedure. In spite of the advance in analgesic techniques and medication, moderateto severe postoperative pain is presented in 70% of the operated patients. Multimodalanalgesia has been proposed due to it involves preventive analgesia and advanceanalgesia. Equally an specific analgesic management for each surgical proced...

  18. [Diagnosis and risk assessment of postoperative complications of gastric cancer in Japan and Korea].

    Science.gov (United States)

    Hu, Xiang; Zhang, Chi

    2017-02-25

    Radical surgery of gastric cancer (D2 lymph node dissection) as the standard operation is widely used in clinical practice and satisfactory prognosis can be obtained in patients who receive radical gastrectomy. But surgical invasion can cause high morbidity of complications and mortality. The data of large-scale evidence-based medical clinical trials and large databases in Japan and Korea showed that anastomotic leakage, pancreatic leakage and abdominal abscess were the most common complications after gastrectomy, and the morbidity of complication was about 20% and mortality was about 1%. The risk factors such as elderly, obesity, and comorbidities may increase the morbidity of complications and mortality, and these factors were regarded as poor predictors after operation. Postoperative complications criteria of gastric cancer surgery is mainly used with Clavien-Dindo classification of surgical complications as international standard, and this criteria is also used in Korea. The postoperative complications are evaluated with the Common Terminology Criteria for Adverse Events (CTCAE v4.0) and Japanese Clinical Oncology Group(JCOG) postoperative complications criteria for grading definitions of postoperative complications after gastric surgery in Japan. These classifications of postoperative complications criteria were adopted widely in Japan with large-scale evidence-based medical clinical trials of gastric cancer. PS, ASA, POSSUM, E-PASS, APACHE-II(, Charison weighted index of comorbidities (WIC), Frailty Score was used in predicting postoperative mortality and morbidity in gastric cancer patients. These risk factors were assigned points in scoring systems to objectively evaluate risk of surgery, and surgical operation method was one of the risk factors on the basis of these scoring systems. We can use these scoring systems for choosing reasonable surgical methods and proper perioperative management.

  19. A systematic review of cost-effective treatment of postoperative rotator cuff repairs.

    Science.gov (United States)

    Dickinson, Rebecca N; Kuhn, John E; Bergner, Jamie L; Rizzone, Katherine H

    2017-05-01

    The Bundled Payments for Care Improvement initiative combines payment of multiple services for episodes of care into 1 bundle. Rotator cuff repair is a likely candidate for future inclusion. The objective of this study was to determine cost-effective, high-quality postoperative rehabilitation dosing and cryotherapy for patients undergoing rotator cuff repair based on systematic review of the literature. Systematic review of level I and level II articles was performed in PubMed, Cochrane Databases, and PEDro. Conference references and bibliographies were also reviewed. For postoperative therapy, keywords included rotator cuff, rotator cuff repair, exercise therapy, exercise, unsupervised, self-care, postoperative period, physical therapy, and physiotherapy; for cryotherapy, keywords included rotator cuff repair, shoulder, cryotherapy, and ice. Five studies compared postoperative outcomes in participants assigned to supervised therapy vs. unsupervised therapy. Three found no difference between groups. One found improved outcomes in supervised therapy. Limitations included that therapies were not consistently defined and significant methodologic issues were present, decreasing the applicability and validity of the results. Five articles examined cryotherapy outcomes in the postoperative shoulder. Two studies showed improved patient outcomes with cryotherapy vs. no cryotherapy; 2 studies showed no decrease in joint space temperatures at 90 minutes but decrease in temperature at 4 to 23 hours postoperatively. One study indicated that an ice bag and Ace bandage might be as effective as continuous, compressive cryotherapy units using patient-reported outcomes. Further studies are needed to determine effective dosing of physical therapy after rotator cuff repair. Cryotherapy is favorable and cost-effective using simple methods for delivery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. Radical cystectomy: Analysis of postoperative course

    Directory of Open Access Journals (Sweden)

    Jeremić Dimitrije

    2010-01-01

    Full Text Available Background/Aim. Radical cystectomy is a method of choice in the therapy of infiltrative bladder cancer. The aim of this research was to analyze postoperative course after radical cystectomy (length of hospitalization, most frequent complications and utilization of antibiotics and transfusions. Methods. We analyzed the records of 82 patients operated on in the Department of Urology, Clinical Center of Vojvodina, in a three-year period. In order to aquire data World Health Organization (WHO has developed Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD methodology. Defined daily dose (DDD is the assumed average maintenance dose per day for a drug use for its main indication. Results. Continent urinary derivation was preformed in 23.15% cases. Postoperative complications occurred in 18.29% of patients. Average blood utilization was 2.19 units. Blood utilization for continent derivations (n = 48 was 4.6 units, and incontinent ones 3.36 units. Totally 159.33 DDD/100 bed days were used. Conclusion. When preforming continent derivation there is a significant increase in blood utilization. Frequency of postoperative complications correlates to those reported in the literature.

  1. Postoperative Autologous Reinfusion in Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    A. Crescibene

    2015-01-01

    Full Text Available Surgeries for total knee replacement (TKR are increasing and in this context there is a need to develop new protocols for management and use of blood transfusion therapy. Autologous blood reduces the need for allogeneic blood transfusion and the aim of the present study was to verify the safety and the clinical efficacy. An observational retrospective study has been conducted on 124 patients, undergoing cemented total knee prosthesis replacement. Observed population was stratified into two groups: the first group received reinfusion of autologous blood collected in the postoperative surgery and the second group did not receive autologous blood reinfusion. Analysis of data shows that patients undergoing autologous blood reinfusion received less homologous blood bags (10.6% versus 30%; p=0.08 and reduced days of hospitalization (7.88 ± 0.7 days versus 8.96 ± 2.47 days for the control group; p=0.03. Microbiological tests were negative in all postoperatively salvaged and reinfused units. Our results emphasize the effectiveness of this procedure and have the characteristics of simplicity, low cost (€97.53 versus €103.79; p<0.01, and easy reproducibility. Use of autologous drainage system postoperatively is a procedure that allows reducing transfusion of homologous blood bags in patients undergoing TKR.

  2. Postoperative radiotherapy for prevention of heterotopic ossification following total hip arthroplasty; Postoperative Strahlentherapie zur Praevention heterotoper Ossifikationen nach endoprothetischem Hueftgelenkersatz

    Energy Technology Data Exchange (ETDEWEB)

    Heyd, R. [Abt. fuer Strahlentherapie und Onkologie, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany); Strassmann, G. [Abt. fuer Strahlentherapie und Onkologie, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany); Kirchner, J. [Abt. fuer Roentgendiagnostik, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany); Schopohl, B. [Abt. fuer Strahlentherapie und Onkologie, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany); Boettcher, H.D. [Abt. fuer Strahlentherapie und Onkologie, Zentrum Radiologie, Klinikum J.-W.-Goethe-Universitaet, Frankfurt am Main (Germany)

    1996-10-01

    Following total hip arthroplasty high-grade heterotopic ossification occurs with a range of 0.5 to 27%. Local postoperative hip irradiation using different dosage and fractionation schedules reduces the incidence in high-risk cases on an average of 8%. The present retrospective study compares results after conventionally fractionated and high-dose radiotherapy. A total of 50 hips (46 patients) from 2 different risk groups had complete follow-up. In group I (40 hips [80.0%]) radiotherapy was indicated after surgical excision of pre-existing high-grade heterotopic ossification, in group II (10 hips [20.0%]) for several risk factors (contralateral heterotopic ossification [n=7], hypertrophic osteoarthritis [n=2], spondylosis hyperostotica [n=1]). In 28/50 cases (56.0%) conventionally fractionated irradiation with total doses ranging from 12.0 to 20.0 Gy was given, in 22/50 hips (44.0%) a high-dose irradiation consisting of 10.0 Gy given in 2 fractions on each of the first 2 postoperative days was applied. After a minimal observation period of 6 months (median: 22 months, range: 6 to 56 months) roentgenograms were analysed using a modified Brooker-score. At follow-up, 2 hips in group I had recurrence of high-grade heterotopic ossification with the stages IIIA and IVB. In 1 case radiotherapy was interrupted after 3x2.0 Gy due to sepsis (IIIA), in the other case ectopic bone recurred from bony islands which layed outside the radiation portal (IVB). In group II, 9 patients had stage 0 and 1 patient stage IA. Statistical analysis using the Wilcoxon-test showed a highly significant reduction of the amount of pre-existing heterotopic ossification (p<0.0001) for both fractionation schedules. The comparison of both fractionation groups with the Whitney-Mann-U-test (p=0.92) showed no statistical significant difference. (orig.) [Deutsch] Nach endoprothetischem Hueftgelenkersatz treten mit einer Spannbreite von 0,5 bis 27% hoehergradige heterotope Ossifikationen auf. Deren

  3. Evaluation of Buprenorphine in a Postoperative Pain Model in Rats

    OpenAIRE

    Curtin, Leslie I; Grakowsky, Julie A.; Suarez, Mauricio; Thompson, Alexis C; DiPirro, Jean M.; Martin, Lisa BE; Kristal, Mark B.

    2009-01-01

    We evaluated the commonly prescribed analgesic buprenorphine in a postoperative pain model in rats, assessing acute postoperative pain relief, rebound hyperalgesia, and the long-term effects of postoperative opioid treatment on subsequent opioid exposure. Rats received surgery (paw incision under isoflurane anesthesia), sham surgery (anesthesia only), or neither and were treated postoperatively with 1 of several doses of subcutaneous buprenorphine. Pain sensitivity to noxious and nonnoxious m...

  4. Battery of behavioral tests in mice to study postoperative delirium.

    Science.gov (United States)

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R; Xie, Zhongcong

    2016-07-20

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium.

  5. Platelet activation in the postoperative period after lung transplantation

    Science.gov (United States)

    Sternberg, David I.; Shimbo, Daichi; Kawut, Steven M.; Sarkar, Joydeep; Hurlitz, Georg; D’Ovidio, Frank; Lederer, David J.; Wilt, Jessie S.; Arcasoy, Selim M.; Pinsky, David J.; D’Armiento, Jeanine M.; Sonett, Joshua R.

    2010-01-01

    Objective During lung transplantation, cells in the pulmonary parenchyma are subjected to ischemia, hypothermic storage, and reperfusion injury. Platelets, whose granular contents include adhesion receptors, chemokines, and coactivating substances that activate inflammatory and coagulant cascades, likely play a critical role in the lung allograft response to ischemia and reperfusion. The platelet response to the pulmonary allograft, however, has never been studied. Here we report significant platelet activation immediately after lung transplantation. Methods We performed a prospective cohort study comparing markers of platelet activation in patients undergoing lung transplantation and patients undergoing nontransplant thoracotomy. Plasma levels of soluble P-selectin, soluble CD40 ligand, and platelet–leukocyte conjugates were measured before surgery, after skin closure, and at 6 postoperative hours. Results Both soluble P-selectin and soluble CD40 ligand levels increased significantly after lung transplantation but not after thoracotomy. Additionally, platelet–monocyte conjugate fluorescence was significantly higher after lung transplantation than after thoracotomy alone. Conclusion These findings suggest that platelet activation is significantly increased after lung transplantation beyond that expected from the postoperative state. The increase in circulating platelet–monocyte conjugates suggests an important interaction between platelets and inflammatory cells. Further research should examine whether platelet activation affects early graft function after lung transplantation. PMID:18329493

  6. Postoperative adjuvant chemotherapy in rectal cancer operated for cure.

    Science.gov (United States)

    Petersen, Sune Høirup; Harling, Henrik; Kirkeby, Lene Tschemerinsky; Wille-Jørgensen, Peer; Mocellin, Simone

    2012-03-14

    those undergoing observation (HR=0.75, CI: 0.68-0.83). Between-study heterogeneity was moderate (I-squared=41%) but significant (P=0.03).While analyzing both OS and DFS data, sensitivity analyses did not find any difference in treatment effect based on trial sample size or geographical region (Western vs Japanese). Available data were insufficient to investigate on the effect of adjuvant chemotherapy separately in different TNM stages in terms of both OS and DFS. No plausible source of heterogeneity was formally identified, although variability in treatment regimens and TNM stages of enrolled patients might have played a significant role in the difference of reported results. The results of this meta-analysis support the use of 5-FU based postoperative adjuvant chemotherapy for patients undergoing apparently radical surgery for non-metastatic rectal carcinoma. Available data do not allow us to define whether the efficacy of this treatment is highest in one specific TNM stage. The implementation of modern anti-cancer agents in the adjuvant setting is warranted to improve the results shown by this meta-analysis. Randomized trials of adjuvant chemotherapy for patients receiving preoperative neoadjuvant therapy are also needed in order to define the role of postoperative chemotherapy in the multimodal treatment of resectable rectal cancer.

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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Ja; Moon, Hye Seong; Kim, Seung Cheol; Kim, Chong Il; Ahn, Jung Ja [College of Medicine, Ewha Womans Univ., Seoul (Korea, Republic of)

    2003-09-01

    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

  8. Postoperative sensitivity associated with low shrinkage versus conventional composites

    OpenAIRE

    Ivanović Vladimir; Savić-Stanković Tatjana; Karadžić Branislav; Ilić Jugoslav; Santini Ario; Beljić-Ivanović Katarina

    2013-01-01

    Introduction. Postoperative sensitivity in restorative dentistry can be related to preparation trauma, dentin adhesives’ ability to seal open dentinal tubules, deformation of restorations under occlusal stresses and microleakage. Objective. The study assessed possible reduction in postoperative sensitivity with low shrinkage compared to conventional composites using different bonding agents and the influence of the operator skill on the incidence of postoperative sensitivity. Methods. N...

  9. Circadian aspects of post-operative morbidity and mortality

    DEFF Research Database (Denmark)

    Kvaslerud, T.; Hansen, M.V.; Rosenberg, J.;

    2010-01-01

    concerning post-operative circadian disturbances. We also present the literature concerning circadian variation in post-operative morbidity and mortality. PubMed and the Cochrane database were searched for papers using a combination of 'circadian,' 'surgery,' 'post-operative,' 'mortality' and 'morbidity...

  10. 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.

  11. Effect of Aspirin in Postoperative Management of Adult Ischemic Moyamoya Disease.

    Science.gov (United States)

    Zhao, Yahui; Zhang, Qian; Zhang, Dong; Zhao, Yuanli

    2017-09-01

    Aspirin has been implicated in the postoperative management of moyamoya disease (MMD) in order to avoid bypass failure and decrease the incidence of subsequent stroke. However, its effect has not been completely determined yet. In this study, we retrospectively reviewed data of 184 adult patients (197 hemispheres) presented with ischemic-onset MMD who had undergone direct or combined revascularization in our hospital, to clarify the effect of postoperative aspirin therapy in the management of moyamoya disease. Fifty-nine hemispheres that had been administered with aspirin (100 mg/day) after bypass surgery were defined as the "aspirin group," whereas 138 that hadn't been given aspirin postoperatively were defined as the "control group". Among 197 hemispheres, the mortality rate was 0. The incidence of postoperative newly developed infarction, transient ischemic attack, and hemorrhage were not significantly different between the aspirin and control groups. The patency rate of bypass graft was not significantly different between the groups, either. Notably, more patients experienced major stroke in the control group (9/138) than the aspirin group (1/59), but no statistical difference was found (P > 0.05). In the aspirin group, more patients had improved outcome than the control group (P = 0.04). Our findings showed that aspirin might not decrease the incidence of postoperative ischemic stroke or increase patency rate of bypass graft, but it does not increase the risk of hemorrhages, either. Also, postoperative aspirin therapy might improve outcome. More studies are needed to provide evidence for postoperative antiplatelet therapy in MMD management. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. The Relationship Between Intraoperative Tear Dimensions and Postoperative Pain in 1624 Consecutive Arthroscopic Rotator Cuff Repairs.

    Science.gov (United States)

    Yeo, Daniel Y T; Walton, Judie R; Lam, Patrick; Murrell, George A C

    2017-03-01

    Rotator cuff repair often results in significant pain postoperatively, the cause of which is undetermined. Purpose/Hypothesis: The aim of this study was to evaluate the relationship between rotator cuff tear area and postoperative pain in patients who had undergone arthroscopic rotator cuff repair. We hypothesized that larger tears would be more painful because of elevated repair tension at 1 week postoperatively but that smaller tears would be more painful because of a greater healing response, especially from 6 weeks postoperatively. Cohort study; Level of evidence, 3. A total of 1624 patients who underwent arthroscopic rotator cuff repair were included in this study. Exclusion criteria were moderate to severe osteoarthritis, isolated subscapularis repair, calcific tendinitis, synthetic patch repair, revision surgery, and retears on ultrasound at 6 months after surgery. Rotator cuff tears were subdivided into groups based on the tear size and retear rate found for each group. A modified L'Insalata questionnaire was given before surgery and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Pearson and Spearman correlation coefficient tests were performed between rotator cuff tear areas and pain scores. Intraoperative rotator cuff tear areas did not correlate with pain scores preoperatively or at 1 week after surgery. A smaller tear area was associated with more frequent and severe pain with overhead activities, at rest, and during sleep as well as a poorer perceived overall shoulder condition at 6 weeks, 3 months, and 6 months after repair ( r = 0.11-0.23, P 8 cm(2). There were fewer retears with smaller tears, but they were more painful than large tears postoperatively from 6 weeks to 6 months after surgery. Smaller tears may heal more vigorously, causing more pain. Patients with smaller tears experienced more pain after rotator cuff repair compared with patients with larger tears. These findings are contrary to previous ideas about tear size and

  13. Carperitide and Atrial Fibrillation After Coronary Bypass Grafting: The Nihon University Working Group Study of Low-Dose HANP Infusion Therapy During Cardiac Surgery Trial for Postoperative Atrial Fibrillation

    National Research Council Canada - National Science Library

    Sezai, Akira; Iida, Mitsuru; Yoshitake, Isamu; Wakui, Shinji; Osaka, Shunji; Kimura, Haruka; Yaoita, Hiroko; Hata, Hiroaki; Shiono, Motomi; Nakai, Toshiko; Takayama, Tadateru; Kunimoto, Satoshi; Kasamaki, Yuji; Hirayama, Atsushi

    2015-01-01

    ...%) from the carperitide group versus 110 of 333 patients (32.7%) from the placebo group (P<0.0001). Postoperative levels of angiotensin-II, aldosterone, creatine kinase MB isoenzyme, human heart fatty acid...

  14. Postoperative delirium and myocardial infarction in elderly patients with hip fractures: the role of postoperative anemia

    Directory of Open Access Journals (Sweden)

    V. V. Kuz’Min

    2015-01-01

    Full Text Available Objective. To assess the impact of anemia on the incidence of myocardial infarction and delirium in the early postoperative period in patients with hip fractures who underwent total hip replacement. Materials and methods. A retrospective study of 303 patients with hip fractures who underwent total hip replacement was performed. Patients were divided into two groups according to the level of hemoglobin (Hb on the 2nd postoperative day: Group 1 (n = 116 with Hb levels above 100 g/L and Group 2 (n = 187 with Hb levels below 100 g/L. Results and conclusion. Transfusion in Group 1 was performed more often intraoperatively or in the early postoperative hours (67 vs. 35 patients; p <0.001. Hb levels on the 2nd day were significantly higher in Group 1 (108 [104; 117] vs. 87 [80; 92] g/L; p <0.001. Moderate and severe anemia in the early postoperative period was noted in 53.5% and 4.3% of the patients of Group 2, respectively. The incidence of myocardial infarction and delirium was higher in Group 2 than in Group 1 (6.4% vs. 0%; p = 0,013 and 7.5% vs 0.8%; p = 0.021, respectively. The study has shown that moderate and severe anemia in the early postoperative period is associated with an increase in the incidence of myocardial infarction and delirium.

  15. The Analgesic Effects of Morphine and Tramadol Added to Intra-articular Levobupivacaine-Tenoxicam Combination for Arthroscopic Knee Surgery on Postoperative Pain; a Randomized Clinical Trial

    OpenAIRE

    Oral, Ebru Gelici; Hanci, Ayse; Ulufer Sivrikaya, Gulcihan; Dobrucali, Hale; Turkoglu Kilinc, Leyla

    2015-01-01

    Background: Arthroscopic knee surgery is commonly performed as an outpatient procedure and is often associated with postoperative pain. Objectives: We aimed to compare the effects of intra-articular levobupivacaine-tenoxicam-tramadol and levobupivacaine-tenoxicam-morphine combinations on postoperative pain in patients undergoing elective arthroscopic knee surgery. Materials and Methods: A total of 90 ASA I-II patients undergoing elective arthroscopic meniscectomy under general anesthesia were...

  16. A qualitative analysis of the nursing documentation of post-operative pain management.

    Science.gov (United States)

    Briggs, M; Dean, K L

    1998-03-01

    As part of trust-wide practice development project to improve post-operative pain management, a descriptive study was conducted in the orthopaedic directorate of a large teaching hospital in the north of England. Sixty-five patients were included in this prospective study. Patients were interviewed post-operatively about their pain experience, and present and worst pain scores were recorded. The nursing documentation relating to pain management was also transcribed and a content analysis of this nursing documentation is reported. Findings indicate that individual assessment of pain was poorly documented and that the nurses' record of the patient's post-operative pain experience differed from the patient report. Reliance on pharmacological methods of pain relief was evident and interventions to help patients cope with night time pain were rarely documented. The results are discussed in light of a theoretical framework for acute pain management and current research. Implications for practice are discussed and areas for further research are suggested.

  17. Postoperative craniospinal radiotherapy of medulloblastoma in children and young adults

    Directory of Open Access Journals (Sweden)

    Golubičić Ivana V.

    2003-01-01

    Full Text Available PURPOSE The aim of this study was: 1. to evaluate treatment results of combined therapy (surgery, postoperative craniospinal radiotherapy with or without chemotherapy and 2. to assess factors affecting prognosis (extend of tumor removal, involvement of the brain stem, extent of disease postoperative meningitis, shunt placement, age, sex and time interval from surgery to start of postoperative radiotherapy. PATIENTS AND METHODS During the period 1986-1996, 78 patients with medulloblastoma, aged 1-22 years (median 8.6 years, were treated with combined modality therapy and 72 of them were evaluable for the study end-points. Entry criteria were histologically proven diagnosis, age under 22 years, and no history of previous malignant disease. The main characteristics of the group are shown in Table 1. Twenty-nine patients (37.2% have total, 8 (10.3% near total and 41 (52.5% partial removal. Seventy-two of 78 patients were treated with curative intent and received postoperative craniospinal irradiation. Radiotherapy started 13-285 days after surgery (median 36 days. Only 13 patients started radiotherapy after 60 days following surgery. Adjuvant chemotherapy was applied in 63 (80.7% patients. The majority of them (46 73% received chemotherapy with CCNU and Vincristine. The survival rates were calculated with the Kaplan-Meier method and the differences in survival were analyzed using the Wilcoxon test and log-rank test. RESULTS The follow-up period ranged from 1-12 years (median 3 years. Five-year overall survival (OS was 51% and disease-free survival (DFS 47% (Graph 1. During follow-up 32 relapses occurred. Patients having no brain stem infiltration had significantly better survival (p=0.0023 (Graph 2. Patients with positive myelographic findings had significantly poorer survival compared to dose with negative myelographic findings (p=0.0116. Significantly poorer survival was found in patients with meningitis developing in the postoperative period

  18. Comparison of postoperative pain relief by intercostal block between pre-rib harvest and post-rib harvest groups.

    Science.gov (United States)

    Bashir, Muhammad Mustehsan; Shahzad, Muhammad Ateeq; Yousaf, Muhammad Nadeem; Khan, Bilal Ahmad; Khan, Farid Ahmad

    2014-01-01

    To compare intercostal nerve block before and after rib harvest in terms of mean postoperative pain score and mean postoperative tramadol usage. Randomized controlled trial. Department of Plastic Surgery, Mayo Hospital, KEMU, Lahore, from January 2011 to July 2012. Patients (n = 120) of either gender with ASA class-I and II requiring autogenous costal cartilage graft were inducted. Patients having history of local anaesthetic hypersensitivity and age 60 years were excluded. Subjects were randomly assigned to pre-rib harvest (group-1) and post-rib harvest (group-2). Local anaesthetic mixture was prepared by adding 10 milliliters 2% lidocaine to 10 milliliters 0.5% bupivacaine to obtain a total 20 ml solution. Group-1 received local anaesthetic infiltration along the proposed incision lines and intercostals block before the rib harvest. Group-2 received the infiltration and block after rib harvest. Postoperative consumption of tramadol and pain scores were measured at 6 and 12 hours postoperatively using VAS. Mean age was 31.43 ± 10.78 years. The mean pain scores at 6 hours postoperatively were 1.033 ± 0.609 and 2.4667 ± 0.812 in pre-rib harvest and post-rib harvest groups respectively (p Intercostal block administered before rib harvest as preemptive strategy result in decreased postoperative pain scores and narcotic use.

  19. COMPARISON OF INTRAVENOUS MAGNESIUM AND PLACEBO ADMINISTRATION ON POSTOPERATIVE PAIN AND ANALGESIC CONSUMPTION DURING SPINAL ANESTHESIA FOR INGUINAL HERNIA REPAIR

    Directory of Open Access Journals (Sweden)

    Olapour A

    2013-06-01

    Full Text Available Previous studies have suggested that magnesium may be a useful adjuvant to postoperative analgesia. We investigated efficacy of intravenous infusion of magnesium sulfate during spinal anesthesia to reduce post-operative pain and opioid consumption in patients undergoing inguinal hernia surgery.We randomly divided one hundred patients’ age 18-55 years old and ASA class I-II undergoing inguinal surgery into two groups. The magnesium group (Group M received magnesium sulfate 50 mg/kg in 100 ml normal saline intravenously within 10 minutes and 15 mg/kg/h by continuous infusion during the operation in one hour. The control group (Group S received the same amount of normal saline without magnesium sulfate. All patients received spinal anesthesia. Postoperative pain scores, meperidine consumption, and motor block were evaluated during 24 hours after surgery.Postoperative pain scores were significantly lower in Group M at 2, 3, 4 and 6 hours after surgery (P<0.05. Motor block was longer in Group M (P<0.05. Cumulative postoperative meperidine consumptions were also significantly lower in Group M at 24 h after surgery (P<0.05. 12% nausea and 26% flashing have been reported in Group M. A bolus and intravenous infusion of magnesium sulfate administration during spinal anesthesia improves postoperative analgesia. IRCT201201088645N1.

  20. Surgical treatment of partial atrioventricular septal defect: functional analysis of the mitral valve in the postoperative period

    Directory of Open Access Journals (Sweden)

    Josué Viana Castro Neto

    2002-11-01

    Full Text Available OBJECTIVE: To study mitral valve function in the postoperative period after correction of the partial form of atrioventricular septal defect. METHODS: Fifty patients underwent surgical correction of the partial form of atrioventricular septal defect. Their mean age was 11.8 years and 62% of the patients were males. Preoperative echocardiography showed moderate and severe mitral insufficiency in 44% of the patients. The mitral valve cleft was sutured in 45 (90% patients (group II - GII. Echocardiographies were performed in the early postoperative period, and 6 and 12 months after hospital discharge. RESULTS: The patients who had some type of arrhythmia in the postoperative period had ostium primum atrial septal defect of a larger size (2.74 x 2.08 cm. All 5 patients in group I (GI, who did not undergo closure of the cleft, had a competent mitral valve or mild mitral insufficiency in the preoperative period. One of these patients began to have moderate mitral insufficiency in the postoperative period. On the other hand, in GII, 88.8% and 82.2% of the patients had competent mitral valve or mild mitral insufficiency in the early and late postoperative periods, respectively. CONCLUSION: The mitral valve cleft was repaired in 90% of cases. Echocardiography revealed competent mitral valve or mild mitral insufficiency in 88.8% and 82.2% of GII patients in the early and late postoperative periods, respectively.

  1. Reversal of neuromuscular blockade with sugammadex or neostigmine/atropine: Effect on postoperative gastrointestinal motility.

    Science.gov (United States)

    Sen, A; Erdivanli, B; Tomak, Y; Pergel, A

    2016-08-01

    To compare sugammadex with conventional reversal of neuromuscular block in terms of postoperative gastrointestinal motility. Double blinded, randomized, controlled clinical trial. Operating room, postoperative recovery area. Seventy-two patients with ASA physical status I or II, scheduled for total thyroid surgery were studied. When 4 twitches were observed on train-of-four stimulation, neuromuscular block was reversed conversatively in the control group, and with sugammadex in the study group. Time to first flatus and feces, incidence of postoperative nausea, vomiting, diarrhea and constipation were collected. Median time of first flatus was 24 hours (18-32 [10-36]) in the neostigmine group, and 24 (18-28 [12-48]) in the sugammadex group (P > .05). Median (IQR) time of first feces was 24 hours (18-36 [10-48]) in neostigmine group, 32 hours (28-36 [12-72]) in sugammadex group (P > .05). There were no occurrences of nausea, vomiting, diarrhea, or constipation. Sugammadex may be safely used in cases where postoperative ileus is expected. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting

    Directory of Open Access Journals (Sweden)

    Özgür Yağan

    Full Text Available Abstract Background and objectives: The aim of our study is to compare the effects of sugammadex and neostigmine, used for neuromuscular blockage antagonism, on postoperative nausea and vomiting (PONV. Methods: Our study was completed with 98 ASA I-II risk patients undergoing endotracheal intubation under general anesthesia. At the end of the surgery patients were randomly divided into two groups given 2 mg kg-1 sugammadex (Group S or 50 µg kg-1 neostigmine plus 0.2 mg kg-1 atropine (Group N. Monitoring and recording times were set as 1 hour postoperative and from 1-6, 6-12, and 12-24 hours. The anti-emetic amounts administered were recorded. Results: In the first hour postoperative 13 patients in Group N (27% and 4 in Group S (8% were observed to have nausea and/or vomiting and the difference was statistically significant (p = 0.0016. During the 24 hours of monitoring there was no significant difference in the incidence and severity of PONV (p > 0.05, however the number of patients given ondansetron for PONV treatment in Group N was statistically significantly higher than the number in Group S (16 in Group N, 6 in Group S, p < 0.011. Conclusions: At the end of our study comparing neostigmine with sugammadex for neuromuscular blockage antagonism, we found use of sugammadex had lower incidence of PONV in the postoperative 1st hour and less anti-emetic use in 24 hours of monitoring.

  3. Comparison of the effects of sugammadex and neostigmine on postoperative nausea and vomiting.

    Science.gov (United States)

    Yağan, Özgür; Taş, Nilay; Mutlu, Tuğçe; Hancı, Volkan

    The aim of our study is to compare the effects of sugammadex and neostigmine, used for neuromuscular blockage antagonism, on postoperative nausea and vomiting (PONV). Our study was completed with 98 ASA I-II risk patients undergoing endotracheal intubation under general anesthesia. At the end of the surgery patients were randomly divided into two groups given 2mgkg(-1) sugammadex (Group S) or 50μgkg(-1) neostigmine plus 0.2mgkg(-1) atropine (Group N). Monitoring and recording times were set as 1 hour postoperative and from 1-6, 6-12, and 12-24hours. The anti-emetic amounts administered were recorded. In the first hour postoperative 13 patients in Group N (27%) and 4 in Group S (8%) were observed to have nausea and/or vomiting and the difference was statistically significant (p=0.0016). During the 24 hours of monitoring there was no significant difference in the incidence and severity of PONV (p>0.05), however the number of patients given ondansetron for PONV treatment in Group N was statistically significantly higher than the number in Group S (16 in Group N, 6 in Group S, psugammadex for neuromuscular blockage antagonism, we found use of sugammadex had lower incidence of PONV in the postoperative 1st hour and less anti-emetic use in 24 hours of monitoring. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  4. Effect of preemptive analgesia with parecoxib sodium on the postoperative pain for gynecological laparoscopy

    Institute of Scientific and Technical Information of China (English)

    Yu-Jing Zhou

    2015-01-01

    Objective:To observe the effect of preemptive analgesia with parecoxib sodium on the postoperative pain and complications for patients undergoing gynecological laparoscopy. Methods:A total of 100 patients with ASA I-II grade who were admitted in our hospital from January, 2013 to February, 2014 and were undergoing gynecological laparoscopy were included in the study and randomized into the observation group and the control group. The patients in the observation group were given parecoxib sodium injection (40 mg) 30 min before operation and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery, while the patients in the control group were givens injections of parecoxib sodium injection (40 mg) and fentanyl citrate injection (1.0μg/kg) 30 min before the end of the surgery. The analgesia and sedation effects 4, 8, 12 h after the operation in the two groups were observed, and the postoperative additional fentanyl dosage and the adverse reactions were recorded.Results: The postoperative VAS score in each timing point and the total dosage of fentanyl in the observation group were significantly lower than those in the control group (P0.05).Conclusions: The preemptive analgesia with parecoxib sodium can reduce the dosage of postoperative analgesia medications with an accurate analgesic effect; therefore, it deserves to be widely recommended in the clinic.

  5. Effect of unrestricted bottle-feeding on early postoperative course after cleft palate repair.

    Science.gov (United States)

    Kim, Eun Key; Lee, Taik Jong; Chae, Soo Wook

    2009-09-01

    Although bottle-feeding after cheiloplasty is widely accepted, postoperative feeding regimen after palatoplasty is still controversial. The aim of this prospective randomized study was to evaluate the effect of bottle-feeding on early postoperative course after palatoplasty in a relatively homogeneous group of patients. Eighty-two consecutive patients with nonsyndromic cleft palate undergoing 2-flap palatoplasty by a single surgeon were randomized to feeding from a bottle with the usual nipple (G1, N = 42) or to feeding with a spoon, cup, or syringe (G2, N = 40). Complication rates, postoperative sedative use, oral intake for the first 6 days, and relative weight gain at 1 and 2 months were compared. There were no significant complications such as bleeding or respiratory problem. The overall complication rate including wound dehiscence and oronasal fistula was similar in G1 and G2 (11.9% versus 12.5%, P = 1.000) as was postoperative sedative use and mean daily oral intake for the first 5 days. Mean intake on the sixth day was significantly higher in G1. There were no significant between-group differences in relative weight gain after 1 and 2 months. In conclusion, bottle-feeding had no adverse effect on the early postoperative course after palatoplasty including complication rate, oral intake, and weight gain. These findings suggest that an unrestricted feeding regimen is appropriate immediately after palatoplasty.

  6. [Evaluation of immediate post-operative pain in heart surgery using the Behavioural Pain Scale].

    Science.gov (United States)

    Pozas Abril, J; Toraño Olivera, M J; Latorre-Marco, I

    2014-01-01

    Patients in the immediate postoperative period of cardiac surgery have abolished communication skills and therefore can not express pain. Pain produces significant adverse effects that alter the patients' course. Therefore, identifying and controlling them will lead to increased quality of care for the critical patient. To measure the degree of pain in patients in the immediate postoperative period of cardiac surgery by scaling Behavioural Pain Scale. An observational, prospective and longitudinal. Patients over 18 years in the first 24 hours of admission with no communication problems who were under sedation and subjected to mechanical ventilation were included. Twenty patients were enrolled in the study. The Behavioural Pain Scale (BPS) was used during two procedures usually considered as a painful practice in the literature, that is, mobilization and/or postural changes and aspiration of secretions. Twenty-seven measurements were made of procedures considered as painful. The results obtained by applying the scale BPS showed that 70.4% of patients had no pain, 22.2% had mild to moderate pain and 7.4% had unacceptable pain. This study has identified that the patients suffer pain during the postoperative period. Within these patients, there is a small, but not insignificant number whose pain is unacceptable during this period. This finding serves as a beginning for a line of research to improve the handling of the postoperative pain during immediate post-operative cardiac surgery. Copyright © 2013 Elsevier España, S.L. y SEEIUC. All rights reserved.

  7. Cardiac surgery patients' evaluation of the quality of theatre nurse postoperative follow-up visit.

    Science.gov (United States)

    Falk-Brynhildsen, Karin; Nilsson, Ulrica

    2009-06-01

    Theatre nurses at the Department of Cardiothoracic Surgery in Orebro, Sweden, have since 2001 routinely conducted a follow-up visit to postoperative cardiac patients. A model with a standardized information part and an individual-caring conversation including both a retrospective and a prospective part designed the visit. The purpose of this study was to evaluate the quality of the postoperative follow-up visit conducted by the theatre nurses and find out if the quality was related to gender or type of admission. The method was prospective and explorative, including 74 cardiac surgery patients who had had a postoperative follow-up visit by a theatre nurse in Sweden. The instrument measuring quality, from the patient's perspective, measured the quality of the visit, and consisted of 16 items modified to suit the study. The results showed an overall high quality rating, with statistically significant higher scores for six items between patients who had undergone emergency surgery, in comparison with elective patients. When comparing gender, women had statistically significant higher scores in two items. In conclusion, this postoperative follow-up visit by the theatre nurse was a valuable and useful tool especially for the patients who had undergone emergency surgery. In the follow-up visit the theatre nurse creates a caring relationship by meeting the patient as an individual with his/her own experience and needs for information about the surgery, intra and postoperative care, and recovery.

  8. Impact of neoadjuvant chemoradiation therapy on the postoperative complication rate in rectal cancer

    Directory of Open Access Journals (Sweden)

    Kruschewski M

    2014-10-01

    Full Text Available Purpose: The impact of neoadjuvant chemoradiation therapy (CRT on the postoperative complication rate is discussed controversially. Thus the aim of this study was to evaluate the postoperative complication rate in our patient population. Methods: A retrospective analysis was performed to examine all patients documented online who had undergone conventionally fractionated adjuvant or neoadjuvant CRT from 2001 to 2009 in conjunction with curative resection (R0 for sporadic primary colorectal cancer in the middle or lower third. A total of 246 patients were included and analyzed. Two groups were formed: Group I, 2001-2004, adjuvant CRT, n=108, and Group II, 2005-2009, neoadjuvant CRT, n=138. Results: The two groups had comparable patient-, tumor- and therapy-related characteristics. No difference was found in the anastomotic leak rate (Group I vs. II: 10% vs. 11%. The rate of perineal wound healing problems differed significantly (Group I vs. II: 5% vs. 36%, p=0.016. While no patient died in Group I, lethality amounted to 1.5% (2/138 in Group II. Conclusions: Neoadjuvant CRT does not lead to a higher anastomotic leak rate or lethality in comparison to patients who were primarily operated and received adjuvant CRT in the further course. The rate of perineal wound healing problems is significantly increased.

  9. Bariatric surgery: A review of normal postoperative anatomy and complications

    Energy Technology Data Exchange (ETDEWEB)

    Quigley, S., E-mail: shaun.quigley@bartsandthelondon.nhs.uk [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Colledge, J. [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Mukherjee, S. [Bariatric Surgery Unit, Homerton University Hospital NHS Foundation Trust, London (United Kingdom); Patel, K. [Radiology Department, Homerton University Hospital NHS Foundation Trust, London (United Kingdom)

    2011-10-15

    The number of bariatric surgery procedures performed is increasing every year. Patients may be referred for radiological investigations to exclude complications not only in the early postoperative period but many months later. Radiologists who do not work in bariatric centres are therefore required to have an understanding of the complex normal anatomy and complications associated with bariatric surgery to interpret imaging studies correctly. The purpose of this article is to describe the surgical techniques and normal anatomy of the four bariatric operations performed today, review the most common problems encountered in this patient group, and to describe the imaging findings that allow the accurate diagnosis of complications. In particular, we focus on identification of the internal hernia, a grave complication of bariatric surgery often missed by radiologists.

  10. The use of postoperative suction drainage in total hip arthroplasty.

    Science.gov (United States)

    Acus, R W; Clark, J M; Gradisar, I A; Kovacik, M W

    1992-11-01

    Two hundred eight primary total hip arthroplasties were reviewed to evaluate the effect of closed suction drainage. This review included 45 hips in which closed drains were used and 163 hips in which drains were not used. These two groups were compared for possible differences in wound problems, temperature elevations, changes in Hgb/Hct, and the need for transfusions. There was no statistically significant difference in postoperative temperatures or decrease in Hgb. However, there were four superficial wound infections in the drained group and three superficial wound infections in the non-drained group (P < .025). There were no deep infections in either group. These findings suggest closed suction drainage provides no apparent advantage in uncomplicated primary total hip arthroplasty.

  11. Comparative study of postoperative morbidity in dental treatment under general anesthesia in pediatric patients with and without an underlying disease.

    Science.gov (United States)

    Escanilla-Casal, Alejandro; Ausucua-Ibáñez, Martina; Aznar-Gómez, Mireia; Viaño-García, José M; Sentís-Vilalta, Joan; Rivera-Baró, Alejandro

    2016-03-01

    To identify and quantify the variables and their influence on postoperative morbidity in dental treatment under general anesthesia (GA) in pediatric patients with and without an underlying disease. A prospective, descriptive, and comparative analysis was conducted of healthy (n = 49) and disabled/medically compromised (n = 81) children treated under GA. Intra-/post-surgical, clinical epidemiology, technical, care-related, and pharmacologic data were gathered, as were postoperative complications. The average age of ASA I patients (6.7 ± 4.4 years) was younger than that of ASA II-III patients (9.0 ± 4.5 years). Average hospitalization time was 4.27 ± 6.5 h in ASA I and 7.41 ± 6.8 h in ASA II-III. Significant differences were found between the two groups in fillings, pulpotomies, oral surgery, and scaling. Postoperative morbidity in ASA I and ASA II-III was similar both in frequency and severity and decreased during the first 72 h. The most common complication in both groups was toothache. Postoperative morbidity is high after dental treatment under GA, but it is not higher in disabled/medically compromised patients. © 2015 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  12. Postoperative analgesia in children when using clonidine in addition to fentanyl with bupivacaine given caudally.

    Science.gov (United States)

    Jarraya, Anouar; Elleuch, Sahar; Zouari, Jawhar; Smaoui, Mohamed; Laabidi, Sofiene; Kolsi, Kamel

    2016-01-01

    The aim of the study was to evaluate the efficacy of clonidine in association with fentanyl as an additive to bupivacaine 0.25% given via single shot caudal epidural in pediatric patients for postoperative pain relief. In the present prospective randomized double blind study, 40 children of ASA-I-II aged 1-5 years scheduled for infraumblical surgical procedures were randomly allocated to two groups to receive either bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg and clonidine 1μg/kg (group I) or bupivacaine 0.25% (1 ml/kg) with fentanyl 1 μg/kg (group II). Caudal block was performed after the induction of general anesthesia. Postoperatively patients were observed for analgesia, sedation, hemodynamic parameters, and side effects or complications. Both the groups were similar with respect to patient and various block characteristics. Heart rate and blood pressure were not different in 2 groups. Significantly prolonged duration of post-operative analgesia was observed in group I (Pbupivacaine in single shot caudal epidural in children may provide better and longer analgesia after infraumblical surgical procedures.

  13. PREEMPTIVE PREGABLIN: EFFICACY ON POSTOPERATIVE PAIN RELIEF AND OPIOID SPARING IN LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Mohamed

    2015-01-01

    Full Text Available OBJECTIVES : We aimed to evaluate the preemptive analgesic properties of pregabalin, an anticonvulsant drug used in clinical practice for the treatment of neuropathic pain. METHOD S : This study was performed on 40 patients from ASA I - II risk group aged 18 - 60 years which underwent lower abdominal surgeries. Group I received 300 mg pregabalin and Group II was given a placebo in oral capsule form. Visual analog scale (VAS scores, morphine consumption and side effects of all patients were recorded at 1, 4, 8, 12 and 24 hour s postoperatively. When Aldrette recovery score reached 9, morphine 0.75mcg/kg was given as rescue analgesia. RESULTS : There was no difference observed in the first analgesic requirement time values between the two groups (p>0.05. A statistically signific ant decrease was observed in the VAS scores of the pregabalin group at 1, 4, 12 and 24 hours after surgery (p0.05. CONCLUSION : Our study demonstrated that a 300 mg pregabalin administered preoperatively is an ef ficient and safe agent for preemptive analgesia. Premedication with pregabalin reduces postoperative pain scores and total analgesic consumption without increasing sedation or other side effects in the postoperative period.

  14. Bladder exstrophy: current management and postoperative imaging

    Energy Technology Data Exchange (ETDEWEB)

    Pierre, Ketsia [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Borer, Joseph [Boston Children' s Hospital, Department of Urology, Boston, MA (United States); Phelps, Andrew [University of California, San Francisco, Department of Pediatric Radiology, San Francisco, CA (United States); Chow, Jeanne S. [Boston Children' s Hospital, Department of Radiology, Boston, MA (United States); Boston Children' s Hospital, Department of Urology, Boston, MA (United States)

    2014-07-15

    Bladder exstrophy is a rare malformation characterized by an infra-umbilical abdominal wall defect, incomplete closure of the bladder with mucosa continuous with the abdominal wall, epispadias, and alterations in the pelvic bones and muscles. It is part of the exstrophy-epispadias complex, with cloacal exstrophy on the severe and epispadias on the mild ends of the spectrum. Bladder exstrophy is the most common of these entities and is more common in boys. The goal of this paper is to describe common methods of repair and to provide an imaging review of the postoperative appearances. (orig.)

  15. Visuel analog skala til postoperative smerter

    DEFF Research Database (Denmark)

    Rauh, Katja Halladin; Andersen, Rikke Søby; Rosenberg, Jacob

    2013-01-01

    All patients with pain who are admitted to hospitals in Denmark must be assessed for levels of pain. However, it is not certain how pain should be measured. One way to measure pain is to use a visual analogue scale (VAS). This article focuses on how the VAS should be used in clinical practice...... in the assessment of post-operative pain. Furthermore, other suitable methods are compared with VAS. VAS is particularly useful for clinical research, but for daily clinical practice it may be easier to use a numeric rating scale....

  16. [Endoscopic management of postoperative biliary fistulas].

    Science.gov (United States)

    Farca, A; Moreno, M; Mundo, F; Rodríguez, G

    1991-01-01

    Biliary fistulas have been managed by surgical correction with no good results. From 1986 to 1990, endoscopic therapy was attempted in 24 patients with postoperative persistent biliary-cutaneous fistulas. Endoscopic retrograde cholangiography demonstrated residual biliary stones in 19 patients (79%). The mean fistula drainage was 540 ml/day, and in 75% the site of the fistula was near the cistic duct stump. Sphincterotomy with or without biliary stent placement resulted in rapid resolution of the fistula in 23 patients (95.8%). In those patients treated with biliary stents the fistula healed spectacularly in 24-72 hrs.

  17. Visuel analog skala til postoperative smerter

    DEFF Research Database (Denmark)

    Rauh, Katja Halladin; Andersen, Rikke Søby; Rosenberg, Jacob

    2013-01-01

    All patients with pain who are admitted to hospitals in Denmark must be assessed for levels of pain. However, it is not certain how pain should be measured. One way to measure pain is to use a visual analogue scale (VAS). This article focuses on how the VAS should be used in clinical practice...... in the assessment of post-operative pain. Furthermore, other suitable methods are compared with VAS. VAS is particularly useful for clinical research, but for daily clinical practice it may be easier to use a numeric rating scale....

  18. [Postoperative management of hip and knee endoprostheses].

    Science.gov (United States)

    Seitz, S; Rüther, W

    2012-10-01

    Rheumatoid arthritis is often accompanied by massive destruction of the smaller and larger joints even with early therapy using antirheumatic drugs. In these cases total joint arthroplasty is the only surgical option, especially for the knee and hip joint. Knowledge of the specific disease-related postoperative characteristics is a prerequisite for the successful treatment of patients with rheumatoid arthritis. As dislocation of the arthroplastic joint does not occur more often in rheumatoid arthritis, the risk of periprosthetic infection is increased due to the use of biologicals. Therefore, a perioperative optimization is obligatory. In order to facilitate independence in daily living physiotherapy in combination with aids such as arthritis crutches, gripping pliers or raised toilet seat need to be started as soon as possible after surgical treatment. To achieve this goal it is recommended to refer patients with inflammatory arthritis to inpatient rehabilitation facilities. With respect to the specific postoperative treatment after joint replacement the long-term results are comparable with those from patients with primary osteoarthritis.

  19. Postoperative maintaining patients after a phacoemulsification

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    S. N. Akulov

    2013-01-01

    Full Text Available Purpose: Studying of efficiency and safety of application of «Sistаnе-gel» after a cataract phaсoemulsification for postoperative therapy of a syndrome of a dry eye was.Methods: 56 patients (56 eyes are surveyed. 26 of them (26 eyes have primary open-angle glaucoma and receive antiglaukomе preparations in instillations. Other 30 patients didn’t use any drops. To all patients the cataract phacoemulsification is executed. After operation applied standard antibacterial and anti-inflammatory therapy and conducted complex examination, including biomicroscopy,Shirmer’s test, Norn’s test, staining the anterior surface of the eye with Fluoresceine. Besides, patients answered the questions containingin a simple questionnaire.Results: Application of the preparation «Sistane-gel» showed its high efficiency and safety in treatment of a postoperative syndrome of a dry eye after a cataract phacoemulsification.Conclusion: Taking into account specifics of patients with a cataract (advanced age, existence of the somatic diseases, the changed hormonal background, reception of medicines, all of them can recommend application of sistant-gel for prevention and dry eye treatment after phacoemulsification. Especially it is necessary to pay attention to dry eye prevention at the patients who have glaucoma and constantly using hypotensive drops.

  20. Postoperative maintaining patients after a phacoemulsification

    Directory of Open Access Journals (Sweden)

    S. N. Akulov

    2014-07-01

    Full Text Available Purpose: Studying of efficiency and safety of application of «Sistаnе-gel» after a cataract phaсoemulsification for postoperative therapy of a syndrome of a dry eye was.Methods: 56 patients (56 eyes are surveyed. 26 of them (26 eyes have primary open-angle glaucoma and receive antiglaukomе preparations in instillations. Other 30 patients didn’t use any drops. To all patients the cataract phacoemulsification is executed. After operation applied standard antibacterial and anti-inflammatory therapy and conducted complex examination, including biomicroscopy,Shirmer’s test, Norn’s test, staining the anterior surface of the eye with Fluoresceine. Besides, patients answered the questions containingin a simple questionnaire.Results: Application of the preparation «Sistane-gel» showed its high efficiency and safety in treatment of a postoperative syndrome of a dry eye after a cataract phacoemulsification.Conclusion: Taking into account specifics of patients with a cataract (advanced age, existence of the somatic diseases, the changed hormonal background, reception of medicines, all of them can recommend application of sistant-gel for prevention and dry eye treatment after phacoemulsification. Especially it is necessary to pay attention to dry eye prevention at the patients who have glaucoma and constantly using hypotensive drops.

  1. Postoperative management of the exotic animal patient.

    Science.gov (United States)

    Pollock, Christal

    2002-01-01

    Careful postoperative management is crucial for the success of any orthopedic surgical repair. The special needs of the exotic animal must be met during the immediate postoperative period and during hospitalization. Many exotic animals require a quiet, stress-free environment and careful attention to housing parameters, such as perching, temperature, and visual security. To provide adequate pain relief in these patients, analgesia should be given before, during, and after surgery. The drugs most often used for pain relief are NSAIDs and opioid analgesics. After surgery, monitor the healing process carefully with regular examinations and radiographs while remaining vigilant for potential problems such as osteomyelitis or nonunion. Physical therapy prevents the development of fracture disease, which includes joint or ligament contracture and bone or muscle mass loss. Because physical therapy affords the patient full use of the affected limb, it is considered a helpful practice in all patients. Physical therapy, however, is critical for free-ranging exotic animals that will be released back into the wild, such as birds of prey.

  2. Imaging of postoperative middle ear cholesteatoma

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    Khemani, S.; Singh, A. [Department of Otolaryngology, Northwick Park and Central Middlesex Hospitals, London (United Kingdom); Lingam, R.K., E-mail: raviklingam@yahoo.co.uk [Department of Radiology, Northwick Park and Central Middlesex Hospitals, London (United Kingdom); Kalan, A. [Department of Otolaryngology, Northwick Park and Central Middlesex Hospitals, London (United Kingdom)

    2011-08-15

    Cholesteatoma is often treated surgically using canal wall-preserving techniques. Clinical and otoscopic diagnosis of residual or recurrent disease after this form of surgery is unreliable and thus radiological imaging is often used prior to mandatory 'second-look' surgery. Imaging needs to be able to differentiate residual or recurrent disease from granulation tissue, inflammatory tissue or fluid within the middle ear cavity and mastoid cavity. High-resolution computed tomography (HRCT), conventional magnetic resonance imaging (MRI), and delayed contrast MRI have all been used in detecting postoperative cholesteatoma. Although delayed contrast MRI performs better than HRCT and conventional MRI, the sensitivities and specificities of these different imaging methods are relatively poor. Diffusion-weighted MRI (DWI and, in particular, non-echo planar DWI) has been shown to have a high sensitivity and specificity for detecting recurrent cholesteatoma. In this review we provide examples of postoperative imaging appearances following cholesteatoma surgery and we review the relevant literature with an emphasis on studies evaluating the diagnostic accuracy of DWI.

  3. Management of recurrent postoperative fungal endophthalmitis

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    Anand Vinekar

    2014-01-01

    Full Text Available Aim: To report the management of recurrent postoperative fungal endophthalmitis (POFE after failed pars plana vitrectomy (PPV and antifungal therapy. Settings and Design: Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case-series. Materials and Methods: Six patients with microbiologically proven recurrent post-operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL explantation and re-PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. ′Anatomical success′ was defined as preserved anatomy of the globe, and absence of signs of inflammation. ′Functional success′ was defined as an attached retina and a best corrected visual acuity of better than 20/400. Results: Of the six cases of POFE, five were culture positive [Aspergillus flavus (1, Aspergillus fumigatus (2, Candida albicans (1 and Candida glabrata (1] and one was smear positive for yeast. All recurred (mean recurrences, 4 despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re - PPV (median follow-up, 37 months. Pre-study defined criteria for successful ′anatomical′ and ′functional′ outcomes were achieved in 83.3% and 50% respectively. Conclusion: This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.

  4. Postoperative Infection Rates in Patients with a Negative Baseline Urine Culture Undergoing Ureteroscopic Stone Removal

    DEFF Research Database (Denmark)

    Martov, Alexey; Gravas, Stavros; Etemadian, Masoud;

    2015-01-01

    Abstract Purpose: To examine the effects of antibiotic prophylaxis on postoperative infection rate in patients with negative urine cultures undergoing ureteroscopy (URS). Patients and Methods: Using the Clinical Research Office of the Endourological Society (CROES) URS Global Study database...... in both groups. Factors predictive of postoperative UTI or fever were female gender, Crohn's and cardiovascular disease, a high stone burden, and an ASA score of II or higher. Conclusions: In patients with a negative baseline urine culture undergoing URS for ureteral or renal stones, rates......, patients with a negative baseline urine culture undergoing URS for ureteral stones (n=1141) or kidney stones (n=184) not receiving antibiotic prophylaxis were matched with those who were predefined by risk factors, including gender, American Society of Anesthesiologists (ASA) score, and ureteral stent...

  5. Biomarkers of Brain Damage and Postoperative Cognitive Disorders in Orthopedic Patients: An Update.

    Science.gov (United States)

    Tomaszewski, Dariusz

    2015-01-01

    The incidence of postoperative cognitive dysfunction (POCD) in orthopedic patients varies from 16% to 45%, although it can be as high as 72%. As a consequence, the hospitalization time of patients who developed POCD was longer, the outcome and quality of life were worsened, and prolonged medical and social assistance were necessary. In this review the short description of such biomarkers of brain damage as the S100B protein, NSE, GFAP, Tau protein, metalloproteinases, ubiquitin C terminal hydrolase, microtubule-associated protein, myelin basic protein, α-II spectrin breakdown products, and microRNA was made. The role of thromboembolic material in the development of cognitive decline was also discussed. Special attention was paid to optimization of surgical and anesthetic procedures in the prevention of postoperative cognitive decline.

  6. Biomarkers of Brain Damage and Postoperative Cognitive Disorders in Orthopedic Patients: An Update

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    Dariusz Tomaszewski

    2015-01-01

    Full Text Available The incidence of postoperative cognitive dysfunction (POCD in orthopedic patients varies from 16% to 45%, although it can be as high as 72%. As a consequence, the hospitalization time of patients who developed POCD was longer, the outcome and quality of life were worsened, and prolonged medical and social assistance were necessary. In this review the short description of such biomarkers of brain damage as the S100B protein, NSE, GFAP, Tau protein, metalloproteinases, ubiquitin C terminal hydrolase, microtubule-associated protein, myelin basic protein, α-II spectrin breakdown products, and microRNA was made. The role of thromboembolic material in the development of cognitive decline was also discussed. Special attention was paid to optimization of surgical and anesthetic procedures in the prevention of postoperative cognitive decline.

  7. Postoperative Spondylodiscitis and Epidural Abscess Becoming Visible on Magnetic Resonance Imaging before Positive Laboratory Tests

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    Aysin Pourbagher

    2015-03-01

    Full Text Available Post operative disc space infection is relatively uncommon. The incidence of postoperative disc space infection is 0.21%-3.6% in association with all vertebral surgical procedures. Surgery causes a variety of neuroendocrine and metabolic responses which generally results in immunosupression. Clinical results of immunosupression include delayed wound healing and septic complications. In this article, we report magnetic resonance imaging findings of a case with spondylodiscitis and spinal epidural abscess in which the imaging findings were apparent before the infection and inflammation related laboratory findings laboratory findings become positive. She has a history of surgery due to lumbar herniated disc a month. She was complaining of back and left leg pain. We performed contrast-enhanced MR imaging. MR imaging showed post operative changes at level L5 and S1. There was contrast enhancement at the level of the surgical gap in the posterior paravertebral muscles. MR imaging may help to differentiate postoperative spondylodiscitis and epidural abscess from early postoperative changes even before the laboratory tests appearing positive. In our case, surgery induced immunosupression may cause the infection and inflammation related laboratory findings being within normal limits at the beginning. [Cukurova Med J 2015; 40(Suppl 1: 97-101

  8. Post-operative antibiotics after appendectomy and post-operative abscess development: a retrospective analysis.

    Science.gov (United States)

    Hughes, Michael J; Harrison, Ewen; Paterson-Brown, Simon

    2013-02-01

    Appendectomy is one of the most common emergency operations. Prophylaxis against infective complications involves post-operative antibiotics. There is no consensus as to the optimum antibiotic regimen. This study aimed to assess the relation between the duration of the post-operative antibiotic administration and intra-abdominal infections (IAIs). All patients who underwent appendectomy between September 1, 2009, and August 31, 2010, were identified. The appearance of the appendix at operation, post-operative antibiotics, white blood cell count, and temperature at the time of conversion of intravenous (IV) to oral antibiotics were compiled. IAIs were assessed as the final outcome. Two hundred sixty six patients underwent appendectomy-188 for simple appendicitis and 78 for complicated appendicitis. There were 18 IAIs (6.8%) overall, 10 (12.8%) after complicated appendicitis and eight (4.2%) after simple appendicitis. Prolonging antibiotics beyond the operation in the simple appendicitis group did not alter the incidence of IAI. Similarly, in the complicated appendicitis group, prolonging antibiotics beyond five days did not alter the incidence of IAI. Furthermore, in patients with complicated appendicitis, the presence of leukocytosis, fever, or both when IV antibiotics were converted to oral drugs was associated with the development of IAI (p=0.013). In simple appendicitis, post-operative antibiotics may not be beneficial at all. In complicated appendicitis, prolonging the course of antibiotics was not associated with a reduced IAI rate. However, cessation of IV antibiotics when fever or leukocytosis was present was associated with IAI development.

  9. Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

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    Chung-Sik Oh

    2016-01-01

    Full Text Available Background. Residual neuromuscular block (NMB after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD. We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P=0.750. Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P<0.001 and the frequency of postoperative hypoxia were significantly lower (23% versus 43%; P=0.010 in the sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia.

  10. Postoperative internal carotid artery restenosis after local anesthesia: presence of risk factors versus intraoperative shunt.

    Science.gov (United States)

    Hudorovic, Narcis; Lovricevic, Ivo; Hajnic, Hrvoje; Ahel, Zaky

    2010-08-01

    Published data suggest that the regional anesthetic technique used for carotid endarterectomy (CEA) increases the systolic arterial blood pressure and heart rate. At the same time local anesthesia reduced the shunt insertion rate. This study aimed to analyze risk factors and ischemic symptomatology in patients with postoperative internal carotid artery restenosis. The current retrospective study was undertaken to assess the results of CEA in 8000 patients who were operated during a five-year period in six regional cardiovascular centers. Carotid color coded flow imaging, medical history, clinical findings and atherosclerotic risk factors were analyzed. Among them, there were 33 patients (0.4%) with postoperative re-occlusion after CEA. The patients with restenosis were re-examined with carotid color coded flow imaging and data were compared with 33 consecutive patients with satisfactory postoperative findings to serve as a control group. In the restenosis group eight risk factors were analyzed (hypertension, smoking, hyperlipidemia, diabetes mellitus, history of stroke, transitory ischemic attack, heart attack and coronary disease), and compared with risk factors in control group. Study results suggested that early postoperative internal carotid artery restenosis was not caused by atherosclerosis risk factors but by intraoperative shunt usage.

  11. Immunological findings in autism.

    Science.gov (United States)

    Cohly, Hari Har Parshad; Panja, Asit

    2005-01-01

    elevated in autistic brains. In measles virus infection, it has been postulated that there is immune suppression by inhibiting T-cell proliferation and maturation and downregulation MHC class II expression. Cytokine alteration of TNF-alpha is increased in autistic populations. Toll-like-receptors are also involved in autistic development. High NO levels are associated with autism. Maternal antibodies may trigger autism as a mechanism of autoimmunity. MMR vaccination may increase risk for autism via an autoimmune mechanism in autism. MMR antibodies are significantly higher in autistic children as compared to normal children, supporting a role of MMR in autism. Autoantibodies (IgG isotype) to neuron-axon filament protein (NAFP) and glial fibrillary acidic protein (GFAP) are significantly increased in autistic patients (Singh et al., 1997). Increase in Th2 may explain the increased autoimmunity, such as the findings of antibodies to MBP and neuronal axonal filaments in the brain. There is further evidence that there are other participants in the autoimmune phenomenon. (Kozlovskaia et al., 2000). The possibility of its involvement in autism cannot be ruled out. Further investigations at immunological, cellular, molecular, and genetic levels will allow researchers to continue to unravel the immunopathogenic mechanisms' associated with autistic processes in the developing brain. This may open up new avenues for prevention and/or cure of this devastating neurodevelopmental disorder.

  12. EFFECT OF PREOPERATIVE PREGABALIN ON POSTOPERATIVE ANALGESIC REQUIREMENT AFTER SKIN GRAFTING

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    Mamta

    2014-05-01

    Full Text Available BACKGROUND: Pain relief after surgical procedures continues to be a major medical challenge. The alleviation of pain is given a high priority by the medical profession and health authorities. Preemptive analgesia is an antinociceptive treatment that prevents establishment of altered processing of afferent input which amplifies postoperative pain. The present study evaluated the efficacy of two different doses (75mg & 150mg of pregabalin on post-operative analgesia. METHOD: This randomized, double blind study was conducted in 90 patients of ASA grade I & II, aged (20-60 yrs. undergoing lower limb plastic surgery (SSG under spinal anesthesia. All patients were randomly allocated into 3 groups of 30 each. Group I received oral pregabalin 150mg, group II oral pregabalin 75mg and group III oral diazepam 5mg. All groups in addition received 1gm paracetamol orally. All drugs were given with a sip of water one hour before spinal anesthesia. After 4 hours of surgery, 1gm paracetamol was given and then repeated every 8 hrs. Rescue analgesia was provided with tramadol 100mg I/V when VAS>3. Patients VAS score was recorded at rest and during motion at 2, 4, 6, and 24 hours after operation. Request for additional analgesia, nausea, number of vomits, sedation and dizziness were noted. RESULT: After observation in all 3 groups it was found that VAS score was significantly lower in group I than group II and III. Level of Sedation at 2 & 4 hrs. was significantly higher in group I as compared to II and III but at 6 and 24 hrs. difference was not significant. Total amount of rescue analgesia required was significantly less in group I as compared to group II and III. It was less in group II as compared to group III. CONCLUSION: Preemptive use of pregabalin 150mg in patients undergoing SSG under spinal anesthesia resulted in significant analgesia, decreased need for rescue analgesia, favorable sedation and anxiolysis without cardiovascular, respiratory adverse

  13. EARLY POSTOPERATIVE COMPLICATIONS IN ROUX-EN-Y GASTRIC BYPASS

    Science.gov (United States)

    STOLL, Aluisio; ROSIN, Leandro; DIAS, Mariana Fernandes; MARQUIOTTI, Bruna; GUGELMIN, Giovana; STOLL, Gabriela Fanezzi

    2016-01-01

    ABSTRACT Background: Roux-en-Y gastric bypass is one of the most common bariatric surgery and leads to considerable weight loss in the first months. Aim: To quantify the main early postoperative complications in patients submitted to the gastric bypass. Method: Observational retrospective cohort. Data of 1051 patients with class II obesity associated with comorbidities or class III obesity submitted to the gastric bypass with 30 days of follow-up starting from the date of the surgery. Results: The age average was 36 years with a predominance of females (81.1%). The mean preoperative body mass index was 43 kg/m². The major complication was fistula (2.3%), followed by intestinal obstruction (0.5%) and pulmonary embolism (0.5%). Death occurred in 0.6% of the cases. Conclusion: In the period of 30 days after surgery the overall complication rate was 3.8%; reoperation was necessary in 2.6% and death occurred in 0.6%. Fistula was the main complication and the leading cause of hospitalization in intensive care unit, reoperation and death. PMID:27683781

  14. Nebulized ketamine decreases incidence and severity of post-operative sore throat.

    Science.gov (United States)

    Ahuja, Vanita; Mitra, Sukanya; Sarna, Rashi

    2015-01-01

    Post-operative sore throat (POST) occurs in 21-65% of patients. Ketamine used earlier as gargle for reducing POST has limitations. The aim of this study was to see if nebulised ketamine reduces POST. We conducted a prospective, randomised, placebo-control, and double-blind controlled trial. After written informed consent, 100 patients belonging to American Society of Anaesthesiologists physical status I-II in the age group 20-60 years, of either sex undergoing surgery under general anaesthesia (GA) were enrolled. Patients were randomised into two groups; group saline (S) received saline nebulisation 5.0 ml and group ketamine (K) received ketamine 50 mg (1.0 ml) with 4.0 ml of saline nebulisation for 15 min. GA was induced 10 min after completion of nebulisation in the patients. The POST and haemodynamic monitoring were done pre-nebulization, pre-induction, on reaching post-anaesthesia care unit, and at 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3). The overall incidence of POST was 33%; 23 patients (46%) in saline and 10 patients (20%) in ketamine group experienced POST (Fisher's exact P = 0.01). The use of ketamine nebulization attenuated POST at 2 h and 4 h post-operatively (P sore throat occurred in 6 patients in group S and none in group K at 2 h, post-operatively (P = 0.02). Ketamine nebulization significantly attenuated the incidence and severity of POST, especially in the early post-operative period, with no adverse effects.

  15. Nebulized ketamine decreases incidence and severity of post-operative sore throat

    Directory of Open Access Journals (Sweden)

    Vanita Ahuja

    2015-01-01

    Full Text Available Background and Aims: Post-operative sore throat (POST occurs in 21-65% of patients. Ketamine used earlier as gargle for reducing POST has limitations. The aim of this study was to see if nebulised ketamine reduces POST. Methods: We conducted a prospective, randomised, placebo-control, and double-blind controlled trial. After written informed consent, 100 patients belonging to American Society of Anaesthesiologists physical status I-II in the age group 20-60 years, of either sex undergoing surgery under general anaesthesia (GA were enrolled. Patients were randomised into two groups; group saline (S received saline nebulisation 5.0 ml and group ketamine (K received ketamine 50 mg (1.0 ml with 4.0 ml of saline nebulisation for 15 min. GA was induced 10 min after completion of nebulisation in the patients. The POST and haemodynamic monitoring were done pre-nebulization, pre-induction, on reaching post-anaesthesia care unit, and at 2, 4, 6, 8, 12 and 24 h post-operatively. POST was graded on a four-point scale (0-3. Results: The overall incidence of POST was 33%; 23 patients (46% in saline and 10 patients (20% in ketamine group experienced POST (Fisher′s exact P = 0.01. The use of ketamine nebulization attenuated POST at 2 h and 4 h post-operatively (P < 0.05. The primary outcome was incidence of POST at 4 h; 13 patients in group S versus 4 patients in group K (P = 0.03 experienced POST at 4 h. The moderate sore throat occurred in 6 patients in group S and none in group K at 2 h, post-operatively (P = 0.02. Conclusion: Ketamine nebulization significantly attenuated the incidence and severity of POST, especially in the early post-operative period, with no adverse effects.

  16. Course of illness in a sample of patients diagnosed with a schizotypal disorder and treated in a specialized early intervention setting. Findings from the 3.5year follow-up of the OPUS II study

    DEFF Research Database (Denmark)

    Albert, Nikolai; Glenthøj, Louise Birkedal; Melau, Marianne

    2017-01-01

    of a randomized clinical trial testing the effect of prolonged specialized early intervention, we recruited 83 participants diagnosed with a schizotypal disorder. Participants were recruited 18 months into their two-year treatment program, and follow-up interviews were conducted three and a half year later....... They were randomized to either discontinuation after the standard two year treatment or continuation of the specialized treatment for totally five year. The study investigated whether prolonged treatment could affect the rate of transition to psychosis and other clinical outcomes, and what would predict...... transition to psychosis. DISCUSSION: Comparable to previous ultra-high risk studies, we found that level of functioning was the strongest predictor of transition to psychosis. Prior studies have found effect of specialized early intervention on transition rates, but we were not able to reproduce this finding...

  17. Postoperative adverse outcomes in intellectually disabled surgical patients: a nationwide population-based study.

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    Jui-An Lin

    Full Text Available BACKGROUND: Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients. METHODS: A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact. RESULTS: Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37, pneumonia (odds ratio 2.01, 1.61 to 2.49, postoperative bleeding (odds ratio 1.35, 1.09 to 1.68 and septicemia (odds ratio 2.43, 1.85 to 3.21 without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability. CONCLUSION: Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients.

  18. Anterior chamber depth and refractive change in late postoperative capsular bag distension syndrome: a retrospective analysis.

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    Min Kyu Yang

    Full Text Available To assess the characteristic findings and effects of laser capsulotomy in patients with late postoperative capsular bag distension syndrome (CBDS.Twenty patients diagnosed with late postoperative CBDS between July 2010 and August 2013 were retrospectively reviewed. Before and 1 week after capsulotomy, changes in the anterior chamber depth (ACD were assessed using ultrasound biomicroscopy. Changes in the refractive status and uncorrected visual acuity (UCVA were also measured 1 week and 1 month after capsulotomy. For patients who received bilateral cataract surgery, preoperative ACD and axial length measured by IOLMaster were compared between the two eyes.Twenty-two eyes from 20 patients who had undergone laser capsulotomy showed a mean UCVA improvement of 0.27 ± 0.24 logMAR (range, 0.00-0.90. ACD was increased by an average of +0.04 mm (95% confidence interval, +0.01 to +0.06 mm, p = 0.034, equivalent to predicted refractive change of +0.10 D. The discrepancy between actual (+1.33 D and predicted refractive change after capsulotomy suggests that refractive change may not be generated from IOL displacement in late postoperative CBDS. Preoperative ACD was deeper in the eye with late postoperative CBDS in all bilaterally pseudophakic patients (mean, 3.68 mm vs. 3.44 mm in the fellow eye, p = 0.068.Late postoperative CBDS showed refractive changes that were resolved successfully after laser capsulotomy. The convex lens effects of opalescent material in the distended capsular bag may play a major role in myopic shift. A larger preoperative ACD is possibly associated with the development of late postoperative CBDS.

  19. Single dose dipyrone for acute postoperative pain.

    Science.gov (United States)

    Edwards, Jayne; Meseguer, Fuensanta; Faura, Clara; Moore, R Andrew; McQuay, Henry J; Derry, Sheena

    2010-09-08

    Dipyrone (metamizole) is a non-steroidal anti-inflammatory drug used in some countries to treat pain (postoperative, colic, cancer, and migraine); it is banned in others because of an association with life-threatening blood agranulocytosis. This review updates a 2001 Cochrane review, and no relevant new studies were identified, but additional outcomes were sought. To assess the efficacy and adverse events of single dose dipyrone in acute postoperative pain. The earlier review searched CENTRAL, MEDLINE, EMBASE, LILACS and the Oxford Pain Relief Database to December 1999. For the update we searched CENTRAL, MEDLINE,EMBASE and LILACS to February 2010. Single dose, randomised, double-blind, placebo or active controlled trials of dipyrone for relief of established moderate to severe postoperative pain in adults. We included oral, rectal, intramuscular or intravenous administration of study drugs. Studies were assessed for methodological quality and data extracted by two review authors independently. Summed total pain relief over six hours (TOTPAR) was used to calculate the number of participants achieving at least 50% pain relief. Derived results were used to calculate, with 95% confidence intervals, relative benefit compared to placebo, and the number needed to treat (NNT) for one participant to experience at least 50% pain relief over six hours. Use and time to use of rescue medication were additional measures of efficacy. Information on adverse events and withdrawals was collected. Fifteen studies tested mainly 500 mg oral dipyrone (173 participants), 2.5 g intravenous dipyrone (101), 2.5 g intramuscular dipyrone (99); fewer than 60 participants received any other dose. All studies used active controls (ibuprofen, paracetamol, aspirin, flurbiprofen, ketoprofen, dexketoprofen, ketorolac, pethidine, tramadol, suprofen); eight used placebo controls.Over 70% of participants experienced at least 50% pain relief over 4 to 6 hours with oral dipyrone 500 mg compared to 30

  20. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study

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    Tumul Chowdhury

    2014-01-01

    Full Text Available Background: Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies. Materials and Methods: We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay (within 48 hrs of hospital stay in patients undergoing transsphenoidal removal of pituitary tumors. Results: In our series, various groups showed different postoperative complications out of which, cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site. Conclusion: Various immediate postoperative complications can be anticipated in transsphenoidal pituitary surgery even though, it is considered to be relatively safe.

  1. 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...... ranitidine, 50 mg intravenously every 6 hours for 72 hours, received perioperative blood transfusion. Eleven of these patients could be matched to 11 transfused patients not receiving perioperative ranitidine. Ranitidine prevented postoperative reduction in skin test response (+6% vs -55%, p less than 0.......0001). It is concluded that perioperative transfusion with whole blood amplifies the postoperative impairment in delayed hypersensitivity and that transfusion-induced postoperative impairment in delayed hypersensitivity may be prevented by perioperative ranitidine treatment....

  2. Postoperative intussusception in pediatric abdominal malignancies: early diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Maged M. Elshafiey; Gehad T. Meselhy; Amal Refaat; Alaa A. Younes

    2012-01-01

    Objective: The aim of this study was to review the incidence of postoperative intussusception (POI) in our patients with pediatric abdominal malignancies and the end result of management of these cases. Methods: From November2007 till the end of December 2011, a total of 538 patients with different abdominal malignancies were operated upon by laparotomies in our hospital. Reoperations were required in 12 patients for post operative intestinal obstruction developed in the 1st postoperative month. Review of the identified cases focused on patient's characteristics, the primary tumor type, the primary surgical procedure, clinical and imaging features of the intussusceptions, timing and findings at the 2nd laparotomy and the end result of subsequent interventions. Results: Early post operative intestinal obstruction (within 1 month) developed in 12 patients of whom 8 patients had POI. Five patients had adhesive intestinal obstruction (one patient developed POI then adhesive obstruction). The median duration between the primary surgery and the onset of intestinal obstruction symptoms was 5 days (range 4-12 days) in the POI group and 24 days (range 10-30 days) in the adhesion group. Abdominal CT was done in all cases and it could properly diagnose POI and detect its site in the POI group while in the adhesion group it showed evidence of complete obstruction. Plain radiograph failed to detect signs of intestinal obstruction in 3 cases (two in the POI group and one in the adhesion group). In POI group simple reduction was done in 7 cases while resection anastmosis was done in 1 case due to gangrene of the ileocecal region. Adhesiolysis was done in the 5 cases of intestinal adhesion group.Conclusion: Early POI in pediatric abdominal cancer is a rare complication; however it should be kept in mind with high index of suspicion. Early diagnosis and intervention is essential for successful management. Abdominal CT is very helpful as it can detect the level and possible cause of

  3. Postoperative ad lib feeding for hypertrophic pyloric stenosis.

    Science.gov (United States)

    Carpenter, R O; Schaffer, R L; Maeso, C E; Sasan, F; Nuchtern, J G; Jaksic, T; Harberg, F J; Wesson, D E; Brandt, M L

    1999-06-01

    The aim of this study was to compare three methods of postoperative feeding after pyloromyotomy for hypertrophic pyloric stenosis (HPS). The authors reviewed retrospectively the charts of 308 patients who underwent pyloromyotomy for HPS from 1984 to 1997. Nineteen patients had prolonged hospitalization for other reasons and were excluded from the study, leaving 289 patients for analysis. All procedures were performed by a single group of pediatric surgeons. The individual preferences of these surgeons resulted in three different feeding schedules: R, strictly regimented (>12 hours nothing by mouth, then incremental feeding over > or =24 hours), I, intermediate (>8 hours nothing by mouth, then incremental feeding over lib (lib feedings). Of the 289 patients, 248 (80.5%) were boys. The average age of the patients was 5.64 weeks (range, 1 to 21 weeks). A total of 265 of 289 (92%) were full term. Thirty-nine of 289 (13.5%) had a family history positive for pyloric stenosis. A total of 104 of 289 (36%) were first-born infants, 89 of 289 (31%) were second born. The diagnosis of pyloric stenosis was made by a combination of physical examination findings and diagnostic image for most patients. An "olive" was palpated in 60.6% of the patients. Sixty percent (60.4%) of patients had an upper gastrointestinal series performed, and 42.5% were examined by ultrasonography. Overall, 53% of the patients had postoperative emesis. Only 3.5% had emesis that persisted greater than 48 hours after surgery. Patients fed ad lib after pyloromyotomy had slightly more emesis (2.2 A v. 1.2 R, and 0.7 I episodes, P = .002), but tolerated full feedings sooner than patients fed with a regimented or intermediate schedule. No patient required additional therapy or readmission after tolerating two consecutive full feedings, suggesting that this might be a suitable discharge criterion for most patients with HPS.

  4. Trimodality therapy for malignant pleural mesothelioma: Results from an EORTC phase II multicentre trial

    NARCIS (Netherlands)

    P.E.Y. van Schil (Paul); P. Baas (Paul); R.M. Gaafar (Rabab); A.W.P.M. Maat (Alex); F. Van De Pol (Francien); B. Hasane (B.); H.M. Klomp (Houke); A.M. Abdelrahman (A.); J. Welche (J.); J.P. van Meerbeeck (Jan)

    2010-01-01

    textabstractThe European Organisation for Research and Treatment of Cancer (EORTC; protocol 08031) phase II trial investigated the feasibility of trimodality therapy consisting of induction chemotherapy followed by extrapleural pneumonectomy and post-operative radiotherapy in patients with malignant

  5. Which frailty measure is a good predictor of early post-operative complications in elderly hip fracture patients?

    Science.gov (United States)

    Kua, Joanne; Ramason, Rani; Rajamoney, Ganesan; Chong, Mei Sian

    2016-05-01

    Current pre-operative assessment using, e.g., American Society of Anaesthesiologists score does not accurately predict post-operative outcomes following hip fracture. The multidimensional aspect of frailty syndrome makes it a better predictor of post-operative outcomes in hip fracture patients. We aim to discover which frailty measure is more suitable for prediction of early post-operative outcomes in hip fracture patients. Hundred consecutive hip fracture patients seen by the orthogeriatric service were included. We collected baseline demographic, functional and comorbidity data. In addition to ASA, a single blinded rater measured frailty using two scales (i) modified fried criteria (MFC) and (ii) reported edmonton frail scale (REFS). The MFC adopted a surrogate gait speed measure with two questions: (i) Climbing one flight of stairs and (ii) Ability to walk 1 km in the last 2 weeks. Immediate post-operative complications during the inpatient stay were taken as the primary outcome measure. Subjects had mean age of 79.1 ± 9.6 years. Sixty six percent were female and 87 % of Chinese ethnicity. Eighty two percent had surgery, of which 37.8 % (n = 31) had post-operative complications. Frailty, measured by MFC (OR 4.46, p = 0.04) and REFS (OR 6.76, p = 0.01) were the only significant predictors of post-operative complications on univariate analyses. In the hierarchical logistic regression model, only REFS (OR 3.42, p = 0.04) predicted early post-operative complications. At 6 months follow-up, REFS significantly predicted [basic activities of daily living (BADL)] function on the multivariable logistic regression models. (BADL, OR 6.19, p = 0.01). Frailty, measured by the REFS is a good predictor of early post-operative outcomes in our pilot study of older adults undergoing hip surgery. It is also able to predict 6 months BADL function. We intend to review its role in longer-term post-operative outcomes and validate its potential role in pre

  6. Evaluation of postoperative cardiac function in severe ischemic heart disease associated with decreased ejection fraction

    Energy Technology Data Exchange (ETDEWEB)

    Natsuaki, Masafumi; Itoh, Tsuyoshi; Norita, Hiroaki; Naitoh, Kouzou; Suda, Hisao [Saga Medical School (Japan)

    1997-09-01

    This clinical study was performed to clarify the postoperative cardiac functions after coronary artery bypass graft surgery in the cases associated with decreased left ventricular ejection fraction (EF) or increased end-diastolic volume index (EDVI). The patients were divided into two groups by preoperative EF. The EF of Group I ranged from 31 to 39% in 42 cases, and the EF of Group II was below 30% in 27 cases. Several parameters of cardiac function such as EF, peak ejection rate (PER), peak filling rate (PFR) or early diastolic peak filling rate were evaluated with radionuclide ventriculography. Postoperative mean values of these parameters significantly improved in both Group I and Group II compared to preoperative values. Although these parameters and left ventricular wall motion did not improve in the 7 cases with an EDVI over 140 ml/m{sup 2} in Group II, the clinical results of these 7 cases were good during the follow-up period except one case which preoperatively had frequent ventricular arrythmia. The clinical condition improved remarkably in the 3 patients who had preoperative angina pectoris among these 7 cases. Surgical indications must be carefully determined in cases with increased EDVI and frequent ventricular arrythmia. (author)

  7. [Clinical and functional considerations in some cases of postoperative endophthalmitis].

    Science.gov (United States)

    Muşat, O; Toma, Oana; Cristescu, R; Coman, Corina; Asandi, R; Burcea, M

    2013-01-01

    We present 3 cases of postsurgery endophthalmitis, with good initial operatory technique, which were admitted in our hospital within variable time, to which a second surgery was performed, with good postoperative evolution, without any inflammatory signs and preserving the eye. We analyse the pre and post-operative treatment of endophthalmitis, but also the ways to prevent the appearance of this post-operative complication.

  8. STRATEGIES OF PROPHYLAXIS AND MANAGEMENT OF POSTOPERATIVE ATRIAL FIBRILLATION

    Directory of Open Access Journals (Sweden)

    Dembele, A.

    2016-07-01

    Full Text Available This article analyses different strategies of prophylaxis and management of postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG at different periods after acute myocardial infarction (AMI. It examines the efficacy of early administration of beta-adrenergic blocking agents (metoprolol and amiodarone (in prophylactic doses in the diminution of the risk of postoperative atrial fibrillation in different groups of patients. The article also discerns the effectiveness of digoxin in the management of episodes of postoperative atrial fibrillation.

  9. Does effective postoperative pain management influence surgical morbidity?

    DEFF Research Database (Denmark)

    Rosenberg, J; Kehlet, H

    1999-01-01

    after major procedures. In lower body procedures, however, intra- and early postoperative pain relief with epidural or spinal anaesthesia reduces blood loss and thromboembolic complications. It is hypothesized that effective postoperative pain relief may significantly improve outcome only if integrated......It has been assumed that adequate postoperative pain relief will improve outcome from surgery, but several controlled trials have demonstrated that pain treatment with nonsteroidal anti-inflammatory drugs, patient-controlled analgesia or epidural techniques will not significantly improve outcome...

  10. Ketamine gargling and postoperative sore throat.

    Science.gov (United States)

    Shrestha, S K; Bhattarai, B; Singh, J

    2010-01-01

    Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sorethroat (POST). The aim of the study was to compare the effectiveness of ketamine gargle with placebo in preventing POST after endotracheal intubation. Forty patients scheduled for elective surgery under general anaesthesia were enrolled in this randomized, control trial. Patients were randomly allocated into two groups of 20 patients each: Group C, gargling with drinking water 30 ml; Group K, gargling with ketamine 50 mg in drinking water 30 ml for 30 s, 5 min before induction of anaesthesia. POST was graded at 4, 8, and 24 hours respectively after operation on a four- point scale (0-3). POST occurred more frequently in Group C, when compared with Group K at 4, 8, and 24 hours. Ketamine gargle reduces the incidence of POST after endotracheal intubation.

  11. Ketamine gargling and postoperative sore throat

    Directory of Open Access Journals (Sweden)

    S K Shrestha

    2010-12-01

    Full Text Available INTRODUCTION: Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sorethroat (POST. The aim of the study was to compare the effectiveness of ketamine gargle with placebo in preventing POST after endotracheal intubation. METHODS: Forty patients scheduled for elective surgery under general anaesthesia were enrolled in this randomized, control trial. Patients were randomly allocated into two groups of 20 patients each: Group C, gargling with drinking water 30 ml; Group K, gargling with ketamine 50 mg in drinking water 30 ml for 30 s, 5 min before induction of anaesthesia. POST was graded at 4, 8, and 24 hours respectively after operation on a four- point scale (0-3. RESULTS: POST occurred more frequently in Group C, when compared with Group K at 4, 8, and 24 hours. CONCLUSIONS: Ketamine gargle reduces the incidence of POST after endotracheal intubation.

  12. Hair transplantation: Preventing post-operative oedema

    Directory of Open Access Journals (Sweden)

    Abbasi Gholamali

    2010-01-01

    Full Text Available Swelling or oedema of forehead or eyelids is a common consequence of hair transplantation surgery. However, this results in increased morbidity and absence from work due to unaesthetic appearance. To study various physical and therapeutic modalities to reduce or completely prevent the occurrence of such oedema. Three hundred forty hair transplant patients were recruited in the study and were categorized into 8 groups depending upon the intervention employed. There were 32 dropouts in the study due to various reasons. Patients who were administered steroid with tumescent solution had the highest number of patients without oedema, with only 3 out of 117 patients developing oedema. Physical measures like position of head during sleeping, application of occlusion bands or ice packs did not show satisfactory results. Addition of triamcinolone to tumescent anaesthetic solution is a very effective technique of preventing post-operative swelling.

  13. POSTOPERATIVE ATRIAL FIBRILLATION – AN UPDATE

    Directory of Open Access Journals (Sweden)

    Johnson Francis

    2015-12-01

    Full Text Available Atrial fibrillation is the most common perioperative cardiac arrhythmia. Sympathetic overactivity, inflammatory state and oxidative stress are important contributors to the genesis of postoperative atrial fibrillation. Advancing age and mitral valve disease along with left atrial size are important parameters in noted in multivariate prediction model. Genetic predisposition has also been noted. Preventive strategies tried include beta blockers, statins, posterior pericardiotomy, carperitide infusion and thoracic epidural analgesia. Treatment options include rate and rhythm control along with anticoagulation if it persists more than 48 hours with high CHADS2 score. Some of the therapeutic modalities which have been found to be NOT useful in preventing post operative atrial fibrillation are dexamethasone, magnesium infusion and concomitant pulmonary vein isolation.

  14. Circadian variation in unexpected postoperative death

    DEFF Research Database (Denmark)

    Rosenberg, J; Pedersen, M H; Ramsing, T

    1992-01-01

    Unexpected deaths still occur following major surgical procedures. The cause is often unknown but may be cardiac or thromboembolic in nature. Postoperative ischaemia, infarction and sudden cardiac death may be triggered by episodic or constant arterial hypoxaemia, which increases during the night....... This study examined the circadian variation of sudden unexpected death following abdominal surgery between 1985 and 1989 inclusive. Deaths were divided into those occurring during the day (08.00-16.00 hours), evening (16.00-24.00 hours) and night (24.00-08.00 hours). Twenty-three deaths were considered...... to have been totally unexpected. Of 16 such patients undergoing autopsy, pulmonary embolism was the cause of death in five. In the remaining 11 patients, death occurred at night in eight (P

  15. Lidocaine for preventing postoperative sore throat.

    Science.gov (United States)

    Tanaka, Yuu; Nakayama, Takeo; Nishimori, Mina; Tsujimura, Yuka; Kawaguchi, Masahiko; Sato, Yuki

    2015-07-14

    Sore throat is a common side-effect of general anaesthesia and is reported by between 30% and 70% of patients after tracheal intubation. The likelihood of a sore throat varies with the type, diameter, and cuff pressure of the endotracheal tube used. If intubation is essential, it may be helpful to give drugs prophylactically to alleviate postoperative sore throat. Local anaesthetics and steroids have been used for this purpose. This review was originally published in 2009 and was updated in 2015. The objective of this review was to evaluate the efficacy and any harm caused by topical and systemic lidocaine used prophylactically to prevent postoperative sore throat in adults undergoing general anaesthesia with endotracheal intubation. We searched CENTRAL (The Cochrane Library 2013, Issue 9), MEDLINE (January 1966 to October 2013), and EMBASE (1980 to October 2013). We also contacted manufacturers and researchers in the field. The original search was undertaken in June 2007. We reran the search in February 2015 and found four studies of interest. We will deal with those studies when we next update the review. We included randomized controlled trials (RCTs) of topical and systemic prophylactic lidocaine therapy versus control (using air or saline) that reported on the risk and severity of postoperative sore throat as an outcome. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information, such as the risk of any adverse effects. We included 19 studies involving 1940 participants in this updated review. Of those 1940 participants, 952 received topical or systemic lidocaine therapy and 795 were allocated to the control groups. Topical and systemic lidocaine therapy appeared to reduce the risk of postoperative sore throat (16 studies, 1774 participants, risk ratio (RR) was 0.64 (95% confidence interval (CI) 0.48 to 0.85), the quality of the evidence was low), although when only high-quality trials were

  16. 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.

  17. Postoperative jaundice after cardiac surger y

    Institute of Scientific and Technical Information of China (English)

    Aikaterini Mastoraki; Emmanouil Karatzis; Sotiria Mastoraki; Ioannis Kriaras; Petros Sifrakis; Stefanos Geroulanos

    2007-01-01

    BACKGROUND:The frequency and pattern of hyperbili-rubinemia after open-heart surgery and its severe perioperative complications are not well clariifed. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac operation, to analyze the determinants, and to identify the clinical signiifcance of this complication with regard to the associated morbidity and mortality. METHODS:A prospective observational study was made during the period of 2003-2004 in a Surgical Intensive Care Unit of a Cardiac Surgery Center, Athens. One hundred twenty-eight adult patients for open heart surgery were divided into three groups. Group A included 50 patients who underwent coronary artery bypass crafting (CABG), group B 31 patients who were subjected to aortic valve replacement (AVR)+CABG and group C 47 patients who underwent mitral valve replacement (MVR)+CABG. Aminotransferases, alkaline phosphatase, gamma-glutamyl-transpeptidase and both types of bilirubin were determined at admission, 24 hours after the operation and thereafter according to clinical evolution. The presence of jaundice was associated with elevated serum bilirubin above 3 mg/dl. RESULTS: Hyperbilirubinemia developed in 34 patients (26.5%). The incidence of postoperative jaundice was higher in patients who were subjected to MVR+CABG than to CABG and AVR+CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary by-pass time (P CONCLUSIONS: Although hyperbilirubinemia seems to be multifactorial, the type of operation, the preoperative hepatic dysfunction due to advanced heart failure (NYHAⅡ-Ⅲ) and the decreased hepatic lfow during the operation seem to determine the incidence of jaundice.

  18. Prostate cancer postoperative nomogram scores and obesity.

    Directory of Open Access Journals (Sweden)

    Jacqueline M Major

    Full Text Available PURPOSE: Nomograms are tools used in clinical practice to predict cancer outcomes and to help make decisions regarding management of disease. Since its conception, utility of the prostate cancer nomogram has more than tripled. Limited information is available on the relation between the nomograms' predicted probabilities and obesity. The purpose of this study was to examine whether the predictions from a validated postoperative prostate cancer nomogram were associated with obesity. METHODS: We carried out a cross-sectional analysis of 1220 patients who underwent radical prostatectomy (RP in southern California from 2000 to 2008. Progression-free probabilities (PFPs were ascertained from the 10-year Kattan postoperative nomogram. Multivariable logistic regression models estimated odds ratios (ORs and 95% confidence intervals (CIs. RESULTS: In the present study, aggressive prostate cancer (Gleason ≥7, but not advanced stage, was associated with obesity (p = 0.01. After adjusting for age, black race, family history of prostate cancer and current smoking, an inverse association was observed for 10-year progression-free predictions (OR = 0.50; 95% CI = 0.28-0.90 and positive associations were observed for preoperative PSA levels (OR = 1.23; 95% CI = 1.01-1.50 and Gleason >7 (OR = 1.45; 95% CI = 1.11-1.90. CONCLUSION: Obese RP patients were more likely to have lower PFP values than non-obese patients, suggesting a higher risk of experiencing prostate cancer progression. Identifying men with potentially higher risks due to obesity may improve disease prognosis and treatment decision-making.

  19. Prostate cancer postoperative nomogram scores and obesity.

    Science.gov (United States)

    Major, Jacqueline M; Klonoff-Cohen, Hillary S; Pierce, John P; Slymen, Donald J; Saltzstein, Sidney L; Macera, Caroline A; Mercola, Dan; Kattan, Michael W

    2011-02-24

    Nomograms are tools used in clinical practice to predict cancer outcomes and to help make decisions regarding management of disease. Since its conception, utility of the prostate cancer nomogram has more than tripled. Limited information is available on the relation between the nomograms' predicted probabilities and obesity. The purpose of this study was to examine whether the predictions from a validated postoperative prostate cancer nomogram were associated with obesity. We carried out a cross-sectional analysis of 1220 patients who underwent radical prostatectomy (RP) in southern California from 2000 to 2008. Progression-free probabilities (PFPs) were ascertained from the 10-year Kattan postoperative nomogram. Multivariable logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs). In the present study, aggressive prostate cancer (Gleason ≥7), but not advanced stage, was associated with obesity (p = 0.01). After adjusting for age, black race, family history of prostate cancer and current smoking, an inverse association was observed for 10-year progression-free predictions (OR = 0.50; 95% CI = 0.28-0.90) and positive associations were observed for preoperative PSA levels (OR = 1.23; 95% CI = 1.01-1.50) and Gleason >7 (OR = 1.45; 95% CI = 1.11-1.90). Obese RP patients were more likely to have lower PFP values than non-obese patients, suggesting a higher risk of experiencing prostate cancer progression. Identifying men with potentially higher risks due to obesity may improve disease prognosis and treatment decision-making.

  20. Management of postoperative instrumented spinal wound infection

    Institute of Scientific and Technical Information of China (English)

    FANG Xiu-tong; Kirkham B.Wood

    2013-01-01

    Background Wound infection following spinal instrumented surgery is a frequent complication.The optimal treatment of acute deep wound infection following spinal instrumentation fusion remains controversial because of variability in cohort identification,definition of an infection,and the instrument used to measure outcomes.This retrospective study evaluated the clinical curative effect for postoperative spinal infection after instrumented spine fusion with extensive debridement,or implant removal.Methods From January 2004 to October 2009,851 patients were identified who underwent surgical treatment of spinal diseases.The medical records of patients who developed infections were reviewed in detail.Results Of 851 patients,41 (4.9%) developed an infection.Thirty-three were acute,and eight were delayed.Acute infected cases were managed with antibiotic therapy,and aggressive debridement of the wound and soft tissues leaving all instrumentation in situ in all but one patient.The most common symptoms of acute infection included:posterior incisional drainage (26 of 33 patients),back pain (22 of 33 patients) and fever (13 of 33 patients).Among patients with delayed onset infection,five of eight patients had local pain,four of eight patients had incision drainage,and one patient had a prolonged period of intermittent fever.The most frequent causative organism for postoperative spinal infection following spine surgery is Staphylococcus aureus.Pseudarthrosis was noted in long-term follow-up in four of 41 patients.Conclusions We recommend irrigation and debridement,no instrumentation removal,and,if necessary,repeat debridement followed by delayed primary closure for the treatment of acute deep infection with instrumentation.

  1. The use of perioperative serial blood lactate levels, the APACHE II and the postoperative MELD as predictors of early mortality after liver transplantation O uso da dosagem seriada do lactato sérico no perioperatório, do APACHE II e do MELD pós-operatório como preditores de mortalidade precoce após transplante hepático

    Directory of Open Access Journals (Sweden)

    Anibal Basile-Filho

    2011-12-01

    Full Text Available PURPOSE: To evaluate the accuracy of different parameters in predicting early (one-month mortality of patients submitted to orthotopic liver transplantation (OLT. METHODS: This is a retrospective study of forty-four patients (38 males and 10 females, mean age of 52.2 ± 8.9 years admitted to the Intensive Care Unit of a tertiary hospital. Serial lactate blood levels, APACHE II, MELD post-OLT, creatinine, bilirubin and INR parameters were analyzed by receiver-operator characteristic (ROC curves as evidenced by the area under the curve (AUC. The level of significance was set at 0.05. RESULTS: The mortality of OLT patients within one month was 17.3%. Differences in blood lactate levels became statistically significant between survivors and nonsurvivors at the end of the surgery (pOBJETIVO: Avaliar qual parâmetro é o mais eficiente na predição de mortalidade precoce (um mês de pacientes submetidos a transplante ortotópico de fígado (OLT. MÉTODOS: Estudo retrospectivo em cinqüenta e oito pacientes adultos (44 homens e 14 mulheres, com uma idade média de 51,7 ± 10,1 anos admitidos na Unidade de Terapia Intensiva de um hospital terciário. Os parâmetros como a dosagem seriada de lactato no sangue, APACHE II, MELD pós-OLT, creatinina, bilirrubina e INR foram analisados por curvas ROC (Receiver-operator characteristic, evidenciado pela área abaixo da curva (AUC. O nível de significância foi definido em 0,05. RESULTADOS: A mortalidade dos pacientes OLT em até um mês foi de 17,3%. As diferenças no nível de lactato no sangue tornaram-se estatisticamente significantes entre sobreviventes e não sobreviventes no final da cirurgia (p < 0,05. A AUC foi de 0,726 (95%CI = 0,593-0,835 para APACHE II (p = 0,02; 0,770 (95%CI = 0,596-0,849 para o lactato sérico (L7-L8 (p = 0,03; 0,814 (95%CI = 0,690-0,904 para MELD post-OLT (p < 0,01; 0,550 (95%CI = 0,414-0,651 de creatinina (p = 0,64; 0,705 (95%CI = 0,571-0,818 de bilirrubina (p = 0,05 e 0

  2. Predicting postoperative exercise capacity after major lung resection.

    Science.gov (United States)

    Nagamatsu, Yoshinori; Sueyoshi, Susumu; Tsubuku, Tatsuji; Kawasaki, Masayuki; Akagi, Yoshito

    2015-12-01

    This study investigates whether postoperative exercise capacity can be predicted from preoperative lung perfusion scintigraphy and the number of subsegments resected. We studied 315 patients, with 158 being assigned odd numbers and 157 being assigned even numbers. In the 158 patients assigned odd numbers, the predicted postoperative VO2 max/m2 (ppo VO2 max/m2) was obtained from the results of lung perfusion scintigraphy and the number of subsegments scheduled for resection. We then examined correlations with the actual values, 2 weeks and 1 month postoperatively, to obtain a regression equation (Series 1). In the 157 patients assigned even numbers, the ppo VO2 max/m2 corrected by the regression equation derived from Series 1 (corrected-ppo VO2 max/m2) was compared with the actual values, 2 weeks and 1 month postoperatively, to establish whether the postoperative VO2 max/m2 could be predicted. The regression equation between the ppo VO2 max/m2 and its actual value was y = 0.83x + 103, 2 weeks postoperatively, and y = 0.923x + 82, 1 month postoperatively. The difference between the corrected-ppo VO2 max/m2 and the actual postoperative value was small. Calculating the residual [Formula: see text]o2 max/m2 preoperatively from the results of lung perfusion scintigraphy and the number of segments scheduled for resection is useful for predicting postoperative exercise capacity.

  3. Postoperative pyoderma gangrenosum: A rare complication after appendectomy

    Directory of Open Access Journals (Sweden)

    G Faghihi

    2015-01-01

    Full Text Available Pyoderma gangrenosum (PG is an uncommon inflammatory ulcerative skin disease. It is characterized by painful progressive necrosis of the wound margins. Rarely, postoperative pyoderma gangrenosum (PPG manifests as a severe disturbance of wound healing following surgical interventions. Only rare cases of this complication have been reported after appendectomy. We report a case of PPG in a 29-year-old female after appendectomy. She was successfully treated with oral prednisolone. Postoperative pyoderma gangrenosum should be kept in mind in the differential diagnosis of any postoperative delayed wound healing, because this disease is simply distinguished from a postoperative wound.

  4. Postoperative sensitivity associated with low shrinkage versus conventional composites

    National Research Council Canada - National Science Library

    Ivanović, Vladimir; Savić-Stanković, Tatjana; Karadzić, Branislav; Ilić, Jugoslav; Santini, Ario; Beljić-lvanović, Katarina

    2013-01-01

    Postoperative sensitivity in restorative dentistry can be related to preparation trauma, dentin adhesives' ability to seal open dentinal tubules, deformation of restorations under occlusal stresses and microleakage...

  5. EFFICACY OF HYOSCINE BUTYL BROMIDE SUPPOSITORY FOR POSTOPERATIVE PAIN RELIEF

    National Research Council Canada - National Science Library

    Soniya C. Alphonse; Acka Priya Varghese

    2017-01-01

    .... MATERIALS AND METHODS The study is a prospective randomized controlled study conducted at a tertiary care hospital to study the effect of Hyoscine Butyl Bromide Suppositories for postoperative...

  6. Simple visual review of pre- to post-operative renal ultrasound images predicts pyeloplasty success equally as well as geometric measurements: A blinded comparison with a gold standard.

    Science.gov (United States)

    Kern, Adam J M; Schlomer, Bruce J; Timberlake, Matthew D; Peters, Craig A; Hammer, Matthew R; Jacobs, Micah A

    2017-04-28

    MAG3 diuretic renal scan remains the gold standard for determination of improvement in renal drainage following pyeloplasty for ureteropelvic junction obstruction. We hypothesized that (i) a change in geometric measurements between pre-operative and post-operative renal ultrasound (RUS) images and (ii) blinded simple visual review of images both would predict pyeloplasty success. To determine if simple visual review and/or novel geometric measurement of renal ultrasounds can detect pyeloplasty failure. This study was a retrospective, blinded comparison with a gold standard. Included were children aged ≤18 years undergoing pyeloplasty at our institution from 2009 to 2015. For each kidney, representative pre-operative and post-operative RUS images were chosen. Our standard for pyeloplasty success was improved drainage curve on MAG3 and lack of additional surgery. Measurements for collecting system circularity, roundness, and renal parenchymal to collecting system area ratio (RPCSR) were obtained by three raters (Figure), who were blinded to the outcome of the pyeloplasty. Changes in geometric measurements were analyzed as a diagnostic test for MAG3-defined pyeloplasty success using ROC curve analysis. In addition, six reviewers blinded to pyeloplasty success reviewed pre-operative and post-operative images visually for improved hydronephrosis and categorized pyeloplasty as success or failure based on simple visual review of RUS. Fifty-three repaired renal units were identified (50 children). There were five pyeloplasty failures, four of which underwent revision or nephrectomy. While all geometric measurements could discriminate pyeloplasty failure and success, the geometric measurements that discriminated best between pyeloplasty failure and success were change in collecting system roundness and change in RPCSR. Consensus opinion among six blinded reviewers using simple visual review had a sensitivity of 94% and PPV of 100% with respect to identifying pyeloplasty

  7. The comparison of analgesic effects of various administration methods of diclofenac sodium, transdermal, oral and intramuscular, in early postoperative period in laparoscopic cholecystectomy operations.

    Science.gov (United States)

    Gulcin Ural, Sedef; Yener, Ozlem; Sahin, Hasan; Simsek, Tuncer; Aydinli, Bahar; Ozgok, Aysegul

    2014-01-01

    The aim of this study was to compare the efficacy of oral, intra muscular and transdermal diclofenac sodium for pain treatment in patients undergoing laparoscopic cholecystectomy, and their effect on postoperative opioid consumption. Following informed consent, 90 ASA I-II patients scheduled for laparoscopic cholecystectomy were randomized into three groups. Group PO got oral diclofenac sodium 1 hour before the operation, Group IM 75 mg diclofenac sodium intra muscular and Group TD diclofenac sodium patch 6 hours before the operation. Patients were not premedicated. Routine anaesthesia induction was used. After the operation in post anaesthesia care unit tramadol HCl infusion was delivered by intravenous patient controlled analgesia (iv PCA). Ramsey Sedation Score (RSS), Modified Aldrete's Score System(MASS) and Visual Analog Scale Pain Score (VAS) was used for postoperative evaluation. Postoperative opioid consumption was recorded. Demographic characteristics, intraoperative and postoperative hemodynamics of the patients were similar between groups. Postoperative VAS were lower at all time points in Group IM and Group TD than in Group PO. Lowest Postoperative RSS were in Group IM and the highest were in Group PO, and the difference between groups was significant. There was no significant difference in Postoperative MASS between groups. Postoperative tramadol consumption was statistically different between groups. Tramadol consumption in Group IM and Group TD was lower than Group PO. Postoperative nausea and vomiting was not observed. Local complications related to transdermal and intra muscular applications was not reported. In patients undergoing ambulatory laparoscopic cholecystectomy, a noninvasive application transdermal diclofenac sodium is as effective as intramuscular diclofenac sodium and can be preferred in postoperative pain treatment.

  8. A Comparative Assessment of Postoperative Analgesic Efficacy of Lornoxicam versus Tramadol after Open Reduction and Internal Fixation of Mandibular Fractures.

    Science.gov (United States)

    Jain, Ankesh Dilip; Vsm, Ravisankar; Ksn, Siva Bharani; Km, Sudheesh; Tewathia, Nisha

    2017-09-01

    Pain after any surgical procedure is inevitable but can be controlled by administration of analgesics in most cases. Postoperative pain after surgical treatment of mandibular fractures can be treated by nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid analgesics. The purpose of this study is to critically compare the postoperative analgesic efficacy of small doses of intravenous TRAMADOL (opioid analgesic) versus LORNOXICAM (NSAID) in patients with mandibular trauma undergoing open reduction and internal fixation (ORIF) and to assess the presence of any adverse effects due to NSAID or opioid use. Forty adult ASA grade I-II patients with mandibular trauma, scheduled for ORIF under general anesthesia in the Department of Oral and Maxillofacial Surgery, College of Dental Sciences, Davangere, were selected for the study. The patients were randomly assigned into a tramadol group (Group T) and a lornoxicam group (Group L) and were administered intravenous tramadol 50 mg and intravenous lornoxicam 8 mg, respectively, at specific postoperative intervals. Pain intensity was quantitatively assessed at the 2nd, 4th, 6th, 12th, and 24th postoperative hours using a visual analog scale of 10 cm. Adverse effects of the analgesics were also recorded and compared. Both the drugs resulted in a significant decrease in pain intensity from 2nd to 24th postoperative hours, but better pain control was observed in Group L at 24th postoperative hour. Only two patients experienced nausea and vomiting in Group T and one patient experienced gastric acidity in Group L. The comparative results clearly demonstrate that pain control by intravenous lornoxicam is significantly better than by intravenous tramadol at 24th postoperative hour after ORIF of mandibular trauma. Side effects produced by both the drugs were minor and had no apparent effect on the study results.

  9. 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.

  10. Mitochondrial DAMPs Are Released During Cardiopulmonary Bypass Surgery and Are Associated With Postoperative Atrial Fibrillation.

    Science.gov (United States)

    Sandler, Nicola; Kaczmarek, Elzbieta; Itagaki, Kiyoshi; Zheng, Yi; Otterbein, Leo; Khabbaz, Kamal; Liu, David; Senthilnathan, Venkatachalam; Gruen, Russell L; Hauser, Carl J

    2017-03-24

    Atrial fibrillation (AF) is the most frequent complication of surgery performed on cardiopulmonary bypass (CPB) and recent work associates CPB with postoperative inflammation. We have shown that all tissue injury releases mitochondrial damage associated molecular patterns (mtDAMPs) including mitochondrial DNA (mtDNA). This can act as a direct, early activator of neutrophils (PMN), eliciting a systemic inflammatory response syndrome (SIRS) while suppressing PMN function. Neutrophil Extracellular Traps (NETs) are crucial to host defence. They carry out NETosis wherein webs of granule proteins and chromatin trap and kill bacteria. We hypothesised that surgery performed on CPB releases mtDAMPs into the circulation. Molecular patterns thus mobilised during CPB might then participate in the pathogenesis of SIRS and predict postoperative complications like AF [1]. We prospectively studied 16 patients undergoing elective operations on CPB. Blood was sampled preoperatively, at the end of CPB and on days 1-2 postoperatively. Plasma samples were analysed for mtDNA. Neutrophil IL-6 gene expression was studied to assess induction of SIRS. Neutrophils were also assayed for the presence of neutrophil extracellular traps (NETs/NETosis). These biologic findings were then correlated to clinical data and compared in patients with and without postoperative AF (POAF). Mitochondrial DNA was significantly elevated following CPB (six-fold increase post-CPB, p=0.008 and five-fold increase days 1-2, p=0.02). Patients with POAF showed greater increases in mtDNA post-CPB than those without. Postoperative AF was seen in all patients with a ≥2-fold increase of mtDNA (p=0.037 vs. SIRS that was greatest days 1-2 (p=0.039). Neutrophil extracellular trap (NET) formation was markedly suppressed in the post-CPB state. Mitochondrial DNA is released by CPB surgery and is associated with POAF. IL-6 gene expression increases after CPB, demonstrating the evolution of postoperative SIRS. Lastly, cardiac

  11. Postoperative Decrease in Platelet Counts Is Associated with Delayed Liver Function Recovery and Complications after Partial Hepatectomy.

    Science.gov (United States)

    Takahashi, Kazuhiro; Kurokawa, Tomohiro; Oshiro, Yukio; Fukunaga, Kiyoshi; Sakashita, Shingo; Ohkohchi, Nobuhiro

    2016-05-01

    Peripheral platelet counts decrease after partial hepatectomy; however, the implications of this phenomenon are unclear. We assessed if the observed decrease in platelet counts was associated with postoperative liver function and morbidity (complications grade ≤ II according to the Clavien-Dindo classification). We enrolled 216 consecutive patients who underwent partial hepatectomy for primary liver cancers, metastatic liver cancers, benign tumors, and donor hepatectomy. We classified patients as either low or high platelet percentage (postoperative platelet count/preoperative platelet count) using the optimal cutoff value calculated by a receiver operating characteristic (ROC) curve analysis, and analyzed risk factors for delayed liver functional recovery and morbidity after hepatectomy. Delayed liver function recovery and morbidity were significantly correlated with the lowest value of platelet percentage based on ROC analysis. Using a cutoff value of 60% acquired by ROC analysis, univariate and multivariate analysis determined that postoperative lowest platelet percentage ≤ 60% was identified as an independent risk factor of delayed liver function recovery (odds ratio (OR) 6.85; P decreased postoperative prothrombin time ratio and serum albumin level and increased serum bilirubin level when compared with patients with platelet percentage ≥ 61%. A greater than 40% decrease in platelet count after partial hepatectomy was an independent risk factor for delayed liver function recovery and postoperative morbidity. In conclusion, the decrease in platelet counts is an early marker to predict the liver function recovery and complications after hepatectomy.

  12. Correlation of antibiotic prophylaxis and difficulty of extraction with postoperative inflammatory complications in the lower third molar surgery.

    Science.gov (United States)

    Lee, J Y; Do, H S; Lim, J H; Jang, H S; Rim, J S; Kwon, J J; Lee, E S

    2014-01-01

    Our aim was to investigate the correlation among antibiotic prophylaxis, difficulty of extraction, and postoperative complications in the removal of lower 3rd molars. A total of 1222 such extractions in 890 patients between January 2010 and January 2012 were analysed retrospectively. The difficulty of extraction measured by Pederson's index, antibiotic prophylaxis with cefditoren, and postoperative complications were recorded. The difficulty of extraction was significantly associated with postoperative complications (p=0.03). There were no significant associations between antibiotic prophylaxis and postoperative complications in groups of equal difficulty ("easy" group (class I) p=1.00; "moderate" group (class II) p=1.00; and "difficult" group (class III) p=0.65). There was a small but insignificant increase in the number of dry sockets and infections in class III cases. In conclusion, this study provides further evidence that antibiotic prophylaxis for the prevention of postoperative inflammatory complications is unnecessary for extraction of 3rd molars. Copyright © 2013. Published by Elsevier Ltd.

  13. The effect of patient-selected music on early postoperative pain, anxiety, and hemodynamic profile in cesarean section surgery.

    Science.gov (United States)

    Ebneshahidi, Amin; Mohseni, Masood

    2008-09-01

    After cesarean section surgery, routine pharmacologic methods of analgesia--opioids and benzodiazepines--may impair the immediate close contact of mother and neonate for their sedative and emetic effects. The aim of this study was to explore the effect of patient-selected music on postoperative pain, anxiety, opioid requirement, and hemodynamic profile. A total of 80 patients, American Society of Anesthesiologists (ASA) physical status I-II, scheduled to undergo general anesthesia and elective cesarean section surgery were enrolled. Patients were randomly allocated to receive 30 minutes of music or silence via headphones postoperatively. Pain and anxiety were measured with a visual analogue scale. Total postoperative morphine requirement as well as blood pressure and heart rate were recorded after the intervention period. Pain score and postoperative cumulative opioid consumption were significantly lower among patients in the music group (p 0.05). Postoperative use of patient-selected music in cesarean section surgery would alleviate the pain and reduce the need for other analgesics, thus improving the recovery and early contact of mothers with their children.

  14. Find a Cancer Doctor

    Science.gov (United States)

    ... Home > Find a Cancer Doctor Find a Cancer Doctor Status message Locating you... The Find an Oncologist ... and caregivers. The database includes the names of physicians and other health professionals from certain ASCO membership ...

  15. Nebulized ketamine decreases incidence and severity of post-operative sore throat

    OpenAIRE

    Vanita Ahuja; Sukanya Mitra; Rashi Sarna

    2015-01-01

    Background and Aims: Post-operative sore throat (POST) occurs in 21-65% of patients. Ketamine used earlier as gargle for reducing POST has limitations. The aim of this study was to see if nebulised ketamine reduces POST. Methods: We conducted a prospective, randomised, placebo-control, and double-blind controlled trial. After written informed consent, 100 patients belonging to American Society of Anaesthesiologists physical status I-II in the age group 20-60 years, of either sex undergoing su...

  16. A comparison of the postoperative analgesic efficacy of three in one block with intravenous injection tramadol

    OpenAIRE

    Naitam, Jyoti M.; Bengali, Rashmi

    2017-01-01

    Aim and objective: Aim of the present study was to compare the efficacy of Three – In – One block with intravenous injection tramadol used for postoperative analgesia.Methods: The study enrolling 60 patients of either sex (age 20-60 years), ASA grade I and II were randomly allocated into two groups of thirty each. Group I (Three – In – One block group) received 2.5 mg/kg of 0.5% bupivacaine + 25µg fentanyl which was diluted with distilled water to make total volume of 40 ml, group 2 (intraven...

  17. Interventions for treating inadvertent postoperative hypothermia.

    Science.gov (United States)

    Warttig, Sheryl; Alderson, Phil; Campbell, Gillian; Smith, Andrew F

    2014-11-20

    Inadvertent postoperative hypothermia (a drop in core body temperature to below 36°C) occurs as an effect of surgery when anaesthetic drugs and exposure of the skin for long periods of time during surgery result in interference with normal temperature regulation. Once hypothermia has occurred, it is important that patients are rewarmed promptly to minimise potential complications. Several different interventions are available for rewarming patients. To estimate the effectiveness of treating inadvertent perioperative hypothermia through postoperative interventions to decrease heat loss and apply passive and active warming systems in adult patients who have undergone surgery. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, Issue 2), MEDLINE (Ovid SP) (1956 to 21 February 2014), EMBASE (Ovid SP) (1982 to 21 February 2014), the Institute for Scientific Information (ISI) Web of Science (1950 to 21 February 2014) and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCO host (1980 to 21 February 2014), as well as reference lists of articles. We also searched www.controlled-trials.com and www.clincialtrials.gov. Randomized controlled trials of postoperative warming interventions aiming to reverse hypothermia compared with control or with each other. Three review authors identified studies for inclusion in this review. One review author extracted data and completed risk of bias assessments; two review authors checked the details. Meta-analysis was conducted when appropriate by using standard methodological procedures as expected by The Cochrane Collaboration. We included 11 trials with 699 participants. Ten trials provided data for analysis. Trials varied in the numbers and types of participants included and in the types of surgery performed. Most trials were at high or unclear risk of bias because of inappropriate or unclear randomization procedures, and because blinding of assessors and participants generally was

  18. Impact of mild renal impairment on early postoperative mortality after open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Ghani A

    2010-01-01

    Full Text Available Preoperative severe renal impairment is included in the risk scores to predict out-come after open cardiac surgery. The purpose of this study was to assess the impact of pre-operative mild renal impairment on the early postoperative mortality after open heart surgery. Data of all cases of open cardiac surgery performed from January 2005 to June 2006 were collec-ted. Cases with preoperative creatinine clearance below 60 mL/min were excluded from the study. Data were retrospectively analyzed to find the impact of renal impairment on short-term outcome. Of the 500 cases studied, 47 had preoperative creatinine clearance between 89-60 mL/min. The overall mortality in the study cases was 6.8%. The mortality was 28.7% in those who developed postoperative ARF, 33.3% in those who required dialysis and 40.8% in those with preoperative mild renal impairment. Binary logistic regression analysis showed that female gender (P = 0.01, preoperative mild renal impairment (P = 0.007 as well as occurrence of multi organ failure (P < 0.001 were the only independent variables determining the early postoperative mortality after cardiac surgeries. Among them, preoperative mild renal impairment was the most significant and the best predictor for early postoperative mortality after cardiac surgery. Our study suggests that renal impairment remains a strong predictor of early mortality even after adjustment for several confounders.

  19. Effect of sugammadex versus neostigmine/atropine combination on postoperative cognitive dysfunction after elective surgery.

    Science.gov (United States)

    Batistaki, C; Riga, M; Zafeiropoulou, F; Lyrakos, G; Kostopanagiotou, G; Matsota, P

    2017-09-01

    This study aimed to assess the effects of sugammadex and neostigmine/atropine on postoperative cognitive dysfunction (POCD) in adult patients after elective surgery. A randomised, double-blind controlled trial was carried out on 160 American Society of Anesthesiologists physical status I to III patients who were >40 years. The Mini-Mental State Evaluation, clock-drawing test and the Isaacs Set test were used to assess cognitive function at three timepoints: 1) preoperatively, 2) one hour postoperatively, and 3) at discharge. The anaesthetic protocol was the same for all patients, except for the neuromuscular block reversal, which was administered by random allocation using either sugammadex or neostigmine/atropine after the reappearance of T2 in the train-of-four sequence. POCD was defined as a decline ≥1 standard deviation in ≥2 cognitive tests. The incidence of POCD was similar in both groups at one hour postoperatively and at discharge (28% and 10%, in the neostigmine group, 23% and 5.4% in the sugammadex group, P=0.55 and 0.27 respectively). In relation to individual tests, a significant decline of clock-drawing test in the neostigmine group was observed at one hour postoperatively and at discharge. For the Isaacs Set test, a greater decline was found in the sugammadex group. These findings suggest that there are no clinically important differences in the incidence of POCD after neostigmine or sugammadex administration.

  20. Predictive factors for postoperative visual acuity in idiopathic epiretinal membrane: a systematic review.

    Science.gov (United States)

    Scheerlinck, Laura M E; van der Valk, Rikkert; van Leeuwen, Redmer

    2015-05-01

    The aim of this study was to review the literature on predictive factors for postoperative visual acuity (VA) in surgery for idiopathic epiretinal membrane (ERM). A systematic review of the literature in the databases of PubMed and Embase was performed. The risk of bias was assessed based on predefined criteria and the results were summarized. In total, 1927 studies were retrieved of which 35 were potentially eligible. Nineteen studies were of adequate quality in terms of bias. Preoperative VA, central foveal thickness (CFT) and inner segment/outer segment (IS/OS) integrity on optical coherence tomography (OCT) were most extensively studied. Other preoperative factors studied were severity of metamorphopsia, several OCT parameters, fundus autofluorescence and multifocal electroretinogram. In the current literature, preoperative VA is the only variable consistently associated with postoperative VA. IS/OS integrity on OCT is probably associated, and the severity of metamorphopsia, cone outer segment tips integrity and fundus autofluorescence are possibly associated with postoperative VA. CFT is not associated with postoperative VA. Further studies with adequate methodological quality are needed to confirm these findings. Therefore, an overall prediction model, including different parameters, is still awaited.

  1. Impact of preoperative defecation pattern on postoperative constipation for patients undergoing cardiac surgery.

    Science.gov (United States)

    Iyigun, Emine; Ayhan, Hatice; Demircapar, Aslı; Tastan, Sevinc

    2017-02-01

    To analyse the impact of preoperative defecation pattern on postoperative defecation pattern for patients undergoing cardiac surgery. Constipation is a neglected problem that occurs frequently after cardiac surgery. Descriptive study. The study sample comprised 102 patients who underwent cardiac surgery. A Descriptive Information Form, Rome III Diagnostic Criteria, Constipation Severity Instrument, Postoperative Defecation Pattern Evaluation Form and Bristol Stool Form Scale were used for data collection and analysis. The Constipation Severity Instrument scores of just over one-third (37·2%) of the patients who were constipated prior to surgery were higher compared to those who were not constipated. Following cardiac surgery, 39·2% of patients developed constipation and 80% of these patients were constipated prior to cardiac surgery. The findings indicate a significantly high relationship between preoperative and postoperative defecation pattern (r = 0·71, p cardiac surgery. During the preoperative period, clinical nurses may evaluate the patients' defecation patterns using valid and reliable scales and follow the defecation of the patients, especially patients with defecation problems, during the postoperative period. © 2016 John Wiley & Sons Ltd.

  2. CT findings of osteogenesis imperfecta

    Energy Technology Data Exchange (ETDEWEB)

    Kojo, Nobuto; Otsuru, Katsuyasu; Lee, Soichi; Takagi, Shigeyuki; Shigemori, Minoru.

    1987-08-01

    Two cases of osteogenesis imperfecta found in one family (father and daughter) are reported, and the CT findings are described. Case 1 is a 58-year-old man who fell and struck his head at home on November 10, 1984. He was transferred to Omuta City Hospital when he became semicomatose and decerebrate posturing was noted. His family history revealed 8 persons with osteogenesis imperfecta. A skull X-ray film showed a large skull vault, many wormian bones at the lambdoid suture, platybasia, and a basilar impression. A CT scan demonstrated a right acute subdural hematoma, while the bone image showed well-developed mastoid air cells and a skull deformity characteristic of osteogenesis imperfecta. He had an emergency operation, and a 170-gr clot was successfully evacuated. A postoperative CT scan demonstrated brain atrophy, possibly present before head trauma. Case 2 is the daughter of Case 1 (a 27-year-old woman). She also showed characteristic neuroradiological manifestations on a plain skull film and on a CT scan. A basilar impression and platybasia were also demonstrated. In this report, the possible mechanism of the production of a traumatic acute subdural hematoma is also discussed.

  3. Trigeminal nerve deficit in large and compressive acoustic neuromas and its correlation with MRI findings.

    Science.gov (United States)

    Karkas, Alexandre; Lamblin, Eléa; Meyer, Mikael; Gay, Emmanuel; Ternier, Jessica; Schmerber, Sébastien

    2014-10-01

    Evaluate the prevalence of preoperative trigeminal nerve deficit in large/compressive acoustic neuromas and try to find a correlation between pre/postoperative magnetic resonance imaging (MRI) findings and pre/postoperative trigeminal nerve deficit. Case series with chart review. University medical center. Retrospective study (1994-2009) including patients with stage 4 or 5 acoustic neuromas (Zini-Magnan classification). All patients underwent surgical resection. Pre- and postoperative trigeminal symptoms were sought. Imaging criteria were sought on pre- and 3-month postoperative MRI scans. Pearson χ(2) statistical test was used. Fifty-three patients (27 females, mean 51 years) were operated on. Preoperatively, 3 patients (5.7%) had trigeminal neuralgia, 1 (1.9%) trigeminal anesthesia, and 28 (52.8%) trigeminal hypoesthesia. Sixteen patients (30.2%) had no corneal reflex (ophthalmic branch); keratitis occurred in 1 patient (1.9%). Postoperatively, 2 patients (3.8%) had trigeminal neuralgia, 1 (1.9%) trigeminal anesthesia, and 24 (45.3%) trigeminal hypoesthesia. Twenty-six patients (49%) had no corneal reflex; keratitis occurred in 11 patients (20.7%). Preoperative trigeminal hypoesthesia was statistically correlated with impaction of the tumor on cerebellar peduncles on preoperative MRI. Postoperative trigeminal hypoesthesia was statistically correlated with nonvisibility of the trigeminal nerve on postoperative MRI. In large/compressive acoustic neuromas, trigeminal nerve deficit has to be sought to avoid corneal complications in particular. Trigeminal hypoesthesia occurs preoperatively in about half of the cases. It remains relatively stable after tumor removal, but there appears to be an increased rate of absent corneal reflex and keratitis postoperatively. We were able to correlate pre/postoperative trigeminal hypoesthesia with pre/postoperative MRI findings. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  4. Imaging findings of liposuction with an emphasis on postsurgical complications

    Energy Technology Data Exchange (ETDEWEB)

    You, Je Sung; Chung, Sung Phil; Kim, Myeong Jin [Dept. of mergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Chung, Yong Eun; Baek, Song Ee [Dept. of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-12-15

    Liposuction is one of the most frequently performed cosmetic surgeries worldwide for reshaping the body contour. Although liposuction is minimally invasive and relatively safe, it is a surgical procedure, and it carries the risk of major and minor complications. These complications vary from postoperative nausea to life-threatening events. Common complications include infection, abdominal wall injury, bowel herniation, bleeding, haematoma, seroma, and lymphoedema. Life-threatening complications such as necrotizing fasciitis, deep vein thrombosis, and pulmonary embolism have also been reported. In this paper, we provide a brief introduction to liposuction with the related anatomy and present computed tomography and ultrasonography findings of a wide spectrum of postoperative complications associated with liposuction.

  5. Imaging Findings of Liposuction with an Emphasis on Postsurgical Complications.

    Science.gov (United States)

    You, Je Sung; Chung, Yong Eun; Baek, Song-Ee; Chung, Sung Phil; Kim, Myeong-Jin

    2015-01-01

    Liposuction is one of the most frequently performed cosmetic surgeries worldwide for reshaping the body contour. Although liposuction is minimally invasive and relatively safe, it is a surgical procedure, and it carries the risk of major and minor complications. These complications vary from postoperative nausea to life-threatening events. Common complications include infection, abdominal wall injury, bowel herniation, bleeding, haematoma, seroma, and lymphoedema. Life-threatening complications such as necrotizing fasciitis, deep vein thrombosis, and pulmonary embolism have also been reported. In this paper, we provide a brief introduction to liposuction with the related anatomy and present computed tomography and ultrasonography findings of a wide spectrum of postoperative complications associated with liposuction.

  6. The CASPAR finding aids

    OpenAIRE

    Meghini, Carlo; Avancini, Henry; Versienti, Loredana

    2011-01-01

    One of the CASPAR key components is the FIND Components, which is implementing the Finding Aids of OAIS. According to OAIS, FIND manages Description Information that is associated to Information Packages in order to support the discovery of those Packages. FIND allows defining, creating, persisting, querying, browsing, and accessing both Description Information and the association between Information Packages and Description Information

  7. Postoperative Analgesia in Children- Comparative Study between Caudal Bupivacaine and Bupivacaine plus Tramadol

    Directory of Open Access Journals (Sweden)

    Meena Doda

    2009-01-01

    Full Text Available Thirty children, ASAI-II, aged between 2yrs-5yrs, undergoing sub umbilical operation (inguinal and penile surgery were selected for this double blind study. They were randomly divided in two groups, group Aand group B. Group A(n15 received 0.25%bupivacaine 0.5ml.kg -1 and Group B (n=15 received 0.25% bupivaeaine 0.5ml.kg -1 and tramadol 2mg.kg -1 as single shot caudal block. Postoperative pain was assessed by a modified TPPPS (Toddler-Preschool Postoperative Pain Scale and analgesic given only when the score was more than 3. In the first 24 hrs it was observed that the mean duration of time interval between the caudal block and first dose of analgesic was significantly long(9. lhrs in Group B as compared to Group A (6.3hrs which was much shorter(p< 0.01.There was no significant haemodynamie changes, motor weakness or respiratory depression in both groups. This study con-cluded that addition of tramadol 2mg.kg -1 to caudal 0.25% bupivacaine 0.5ml.kg -1 significantly prolong the duration of postoperative analgesia in children withoutprodueing much adverse effects.

  8. Postoperative Radiation Therapy for Non-Small Cell Lung Cancer and Thymic Malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Gomez, Daniel R., E-mail: dgomez@mdanderson.org; Komaki, Ritsuko [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1840 Old Spanish Trail, Houston, TX 77054 (United States)

    2012-03-14

    For many thoracic malignancies, surgery, when feasible, is the preferred upfront modality for local control. However, adjuvant radiation plays an important role in minimizing the risk of locoregional recurrence. Tumors in the thoracic category include certain subgroups of non-small cell lung cancer (NSCLC) as well as thymic malignancies. The indications, radiation doses, and treatment fields vary amongst subtypes of thoracic tumors, as does the level of data supporting the use of radiation. For example, in the setting of NSCLC, postoperative radiation is typically reserved for close/positive margins or N2/N3 disease, although such diseases as superior sulcus tumors present unique cases in which the role of neoadjuvant vs. adjuvant treatment is still being elucidated. In contrast, for thymic malignancies, postoperative radiation therapy is often used for initially resected Masaoka stage III or higher disease, with its use for stage II disease remaining controversial. This review provides an overview of postoperative radiation therapy for thoracic tumors, with a separate focus on superior sulcus tumors and thymoma, including a discussion of acceptable radiation approaches and an assessment of the current controversies involved in its use.

  9. Efficacy of Prophylactic Dexmedetomidine in Preventing Postoperative Junctional Ectopic Tachycardia After Pediatric Cardiac Surgery.

    Science.gov (United States)

    El Amrousy, Doaa Mohamed; Elshmaa, Nagat S; El-Kashlan, Mohamed; Hassan, Samir; Elsanosy, Mohamed; Hablas, Nahed; Elrifaey, Shimaa; El-Feky, Wael

    2017-03-01

    Postoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery. A prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P0.005). Prophylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  10. Perioperative low-dose ketamine improves postoperative analgesia following Cesarean delivery with general anesthesia.

    Science.gov (United States)

    Haliloglu, Murat; Ozdemir, Mehtap; Uzture, Neslihan; Cenksoy, Pinar Ozcan; Bakan, Nurten

    2016-03-01

    In this study, the effect of perioperative uses of low dose ketamine on post-operative wound pain and analgesic consumption in patients undergoing elective Cesarean section was evaluated. In randomized, double blind clinical trial, 52 women with American Society of Anesthesiologists (ASA) class I-II identification undergoing elective Cesarean section in general anesthesia were enrolled. In the ketamine group (group K), a ketamine bolus of 0.5 mg kg(-1) IV was administered at the time of induction of general anesthesia. After induction, a ketamine infusion of 0.25 mg kg(-1) h(-1) was started and discontinued at the end of surgery. Patients allocated to the control group (group C) were given identical volumes of saline. The cumulative dose of morphine consumption after surgery was measured as the primary outcome of this study. Secondary outcomes were pain control assessed by numeric rating scale (NRS) and need for rescue analgesia and incidence of side effects. The mean 24-h morphine consumption was lower in group K (p = 0,001). At 15 min postoperatively, NRS values were lower in group K than group C (p = 0,001). There was no difference among groups regarding the need for supplemental analgesia (rescue diclofenac doses) (p > 0.05). Perioperative uses of low dose ketamine decreased post-operative opioid requirements, which was observed long after the normal expected duration of ketamine.

  11. Predictive biomarkers and metabolic hallmark of postoperative hypoxaemia

    DEFF Research Database (Denmark)

    Maltesen, Raluca Georgiana; Hanifa, Munsoor; Kucheryavskiy, Sergey

    2016-01-01

    Pulmonary dysfunctions resulting in postoperative hypoxaemia is a common complication of cardiac surgery. The disease is challenging as it lacks predictive biomarkers. Since a comprehensive metabolic overview of lung microvasculature injury is lacking, we have compared the metabolome of patients...... undergoing cardiac surgery from blood collected on the first postoperative day from the pulmonary artery and left atrium....

  12. Does goal-directed fluid therapy affect postoperative orthostatic intolerance?

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, Morten; Jans, Øivind; Müller, Rasmus Gamborg;

    2013-01-01

    Early mobilization is important for postoperative recovery but is limited by orthostatic intolerance (OI) with a prevalence of 50% 6 h after major surgery. The pathophysiology of postoperative OI is assumed to include hypovolemia besides dysregulation of vasomotor tone. Stroke volume-guided fluid...

  13. Postoperative complications and mortality after major gastrointestinal surgery

    DEFF Research Database (Denmark)

    Jakobson, Triin; Karjagin, Juri; Vipp, Liisa

    2014-01-01

    BACKGROUND AND OBJECTIVE: The incidence of postoperative complications and death is low in the general population, but a subgroup of high-risk patients can be identified amongst whom adverse postoperative outcomes occur more frequently. The present study was undertaken to describe the incidence o...

  14. Decreased heart rate variability responses during early postoperative mobilization

    DEFF Research Database (Denmark)

    Jans, Øivind; Brinth, Louise; Kehlet, Henrik

    2015-01-01

    to postoperative autonomic dysfunction. Thus, based on a previous study on haemodynamic responses during mobilization before and after elective total hip arthroplasty (THA), we performed secondary analyses of heart rate variability (HRV) and aimed to identify possible abnormal postoperative autonomic responses...

  15. [One case of postoperative facial paralysis after first branchial fistula].

    Science.gov (United States)

    Wang, Xia; Xu, Yaosheng

    2015-12-01

    Pus overflow from patent's fistula belew the left face near mandibular angle 2 years agowith a little pain. Symptoms relieved after oral antibiotics. This symptom frequently occurred in the past six months. Postoperative facial paralysis occurred after surgery, and recovered after treatment. It was diagnosed as the postoperative facial paralysis after first branchial fistula surgery.

  16. 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.

  17. Postoperative Trunk Shift in Lenke 1C Scoliosis

    DEFF Research Database (Denmark)

    Wang, Yu; Bünger, Cody Eric; Wu, Chunsen

    2012-01-01

    STUDY DESIGN: A risk factor analysis study. OBJECTIVE: To identify the causative factors for postoperative trunk shift in Lenke 1C scoliosis and investigate how to prevent it. SUMMARY OF BACKGROUND DATA: When selective thoracic fusion is performed, postoperative trunk shift is a significant probl...

  18. Late post-operative hypoxaemia and organ dysfunction

    DEFF Research Database (Denmark)

    Kehlet, H; Rosenberg, J

    1995-01-01

    an adverse effect of tissue hypoxia on wound healing and on resistance to bacterial wound infections. Finally, mental confusion and surgical delirium may be related to inadequate arterial oxygenation during the late post-operative period. Late post-operative constant and episodic hypoxaemia may therefore...

  19. Circadian aspects of post-operative morbidity and mortality

    DEFF Research Database (Denmark)

    Kvaslerud, T.; Hansen, M.V.; Rosenberg, J.;

    2010-01-01

    concerning post-operative circadian disturbances. We also present the literature concerning circadian variation in post-operative morbidity and mortality. PubMed and the Cochrane database were searched for papers using a combination of 'circadian,' 'surgery,' 'post-operative,' 'mortality' and 'morbidity.......' Eleven relevant studies were found, and seven of these were excluded due to the use of time of surgery and not time of morbidity or mortality as the main variable. The results from the four articles showed a circadian distribution of morbidity and mortality that mimics the one seen without surgery....... There is a peak incidence of myocardial ischemia, fatal thromboembolism and sudden unexpected death in the morning hours. A circadian variation exists in post-operative morbidity and mortality. The observed circadian variation in post-operative morbidity and mortality may warrant a chronopharmacological approach...

  20. 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...... delayed-type antigens in 83 consecutive patients undergoing major elective abdominal surgery. Sixty-six of these patients were randomly divided into ranitidine or no-ranitidine-treatment groups, and the remaining 17 patients were operated on without ranitidine. Thus, 50 patients were operated on without.......0001). It is concluded that perioperative transfusion with whole blood amplifies the postoperative impairment in delayed hypersensitivity and that transfusion-induced postoperative impairment in delayed hypersensitivity may be prevented by perioperative ranitidine treatment....

  1. Enhanced identification of postoperative infections among inpatients.

    Science.gov (United States)

    Yokoe, Deborah S; Noskin, Gary A; Cunnigham, Susan M; Zuccotti, Gianna; Plaskett, Theresa; Fraser, Victoria J; Olsen, Margaret A; Tokars, Jerome I; Solomon, Steven; Perl, Trish M; Cosgrove, Sara E; Tilson, Richard S; Greenbaum, Maurice; Hooper, David C; Sands, Kenneth E; Tully, John; Herwaldt, Loreen a; Diekema, Daniel J; Wong, Edward S; Climo, Michael; Platt, Richard

    2004-11-01

    We evaluated antimicrobial exposure, discharge diagnoses, or both to identify surgical site infections (SSI). This retrospective cohort study in 13 hospitals involved weighted, random samples of records from 8,739 coronary artery bypass graft (CABG) procedures, 7,399 cesarean deliveries, and 6,175 breast procedures. We compared routine surveillance to detection through inpatient antimicrobial exposure (> 9 days for CABG, > 2 days for cesareans, and > 6 days for breast procedures), discharge diagnoses, or both. Together, all methods identified SSI after 7.4% of CABG, 5.0% of cesareans, and 2.0% of breast procedures. Antimicrobial exposure had the highest sensitivity, 88%-91%, compared with routine surveillance, 38%-64%. Diagnosis codes improved sensitivity of detection of antimicrobial exposure after cesareans. Record review confirmed SSI after 31% to 38% of procedures that met antimicrobial surveillance criteria. Sufficient antimicrobial exposure days, together with diagnosis codes for cesareans, identified more postoperative SSI than routine surveillance methods. This screening method was efficient, readily standardized, and suitable for most hospitals.

  2. Postoperative systemic dissemination of injected elemental mercury.

    Science.gov (United States)

    Kang, Suk-Hyung; Park, Seung Won; Moon, Kyung-Yoon

    2011-04-01

    There were only a few reports of mercury on pulmonary artery. However, there is no data on surgery related mercury dissemination. The objective of the present article is to describe one case of postoperative injected mercury dissemination. A 19-year-old man presented severe neck pain including meningeal irritation sign and abdominal pain after injection of mercury for the purpose of suicide. Radiologic study showed injected mercury in the neck involving high cervical epidural space and subcutaneous layer of abdomen. Partial hemilaminectomy and open mercury evacuation of spinal canal was performed. For the removal of abdominal subcutaneous mercury, C-arm guided needle aspiration was done. After surgery, radiologic study showed disseminated mercury in the lung, heart, skull base and low spinal canal. Neck pain and abdominal pain were improved after surgery. During 1 month after surgery, there was no symptom of mercury intoxication except increased mercury concentration of urine, blood and hair. We assumed the bone work during surgery might have caused mercury dissemination. Therefore, we recommend minimal invasive surgical technique for removal of injected mercury. If open exposures are needed, cautious surgical technique to prohibit mercury dissemination is necessary and normal barrier should be protected to prevent the migration of mercury.

  3. Postoperative abdominal complications after cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Dong Guohua

    2012-10-01

    Full Text Available Abstract Background To summarize the diagnostic and therapeutic experiences on the patients who suffered abdominal complications after cardiovascular surgery with cardiopulmonary bypass(CPB. Methods A total of 2349 consecutive patients submitted to cardiovascular surgery with CPB in our hospital from Jan 2004 to Dec 2010 were involved. The clinical data of any abdominal complication, including its incidence, characters, relative risks, diagnostic measures, medical or surgical management and mortality, was retrospectively analyzed. Results Of all the patients, 33(1.4% developed abdominal complications postoperatively, including 11(33.3% cases of paralytic ileus, 9(27.3% of gastrointestinal haemorrhage, 2(6.1% of gastroduodenal ulcer perforation, 2(6.1% of acute calculus cholecystitis, 3(9.1% of acute acalculus cholecystitis, 4(12.1% of hepatic dysfunction and 2(6.1% of ischemia bowel diseases. Of the 33 patients, 26 (78.8% accepted medical treatment and 7 (21.2% underwent subsequent surgical intervention. There were 5(15.2% deaths in this series, which was significantly higher than the overall mortality (2.7%. Positive history of peptic ulcer, advanced ages, bad heart function, preoperative IABP support, prolonged CPB time, low cardiac output and prolonged mechanical ventilation are the risk factors of abdominal complications. Conclusions Abdominal complications after cardiovascular surgery with CPB have a low incidence but a higher mortality. Early detection and prompt appropriate intervention are essential for the outcome of the patients.

  4. Results of Chiari pelvic osteotomy for acetabular dysplasia in adults; Association with bone scintigraphic findings

    Energy Technology Data Exchange (ETDEWEB)

    Nakamura, Nobuo; Ozono, Kenji; Sugano, Nobuhiko; Takaoka, Kunio; Ono, Hiroo (Osaka Univ. (Japan). Faculty of Medicine)

    1993-02-01

    In an attempt to determine indications of Chiari pelvic osteotomy in acetabular dysplasia, postoperative outcome of hip joint (64 joints) was examined on the basis of findings of bone scintigraphy. The subjects were 61 patients with osteoarthrosis of hip joint who underwent preoperative bone scintigraphy. The follow-up period ranged from 2 years to 9 years and 7 months with a mean of 4 years and 9 months. According to X-ray findings, 37 osteoarthrosis joints were staged as early and 27 as progressive. Preoperative bone scintigraphic findings fell into three: (I) normal or slight hot type (33 joints), (II) hot type at the weighting part (16 joints), and (III) double hot type in the weighting part and inside part (15 joints). None of the patients had severe surgical complications such as deep-seated infection, neuroparalysis and pseudojoint. According to the clinical staging for hip joint function, 7 (47%) of 64 joints were judged as poor after osteotomy, belonging to type III. Deterioration of osteoarthrosis was seen in 11 joints (41%) on X-ray films. Of these, 9 had type III. In conclusion, Chiari pelvic osteotomy should not be indicated when type III is shown on bone scintigrams. (N.K.).

  5. Co-administration of morphine and gabapentin leads to dose dependent synergistic effects in a rat model of postoperative pain.

    Science.gov (United States)

    Papathanasiou, Theodoros; Juul, Rasmus Vestergaard; Heegaard, Anne-Marie; Kreilgaard, Mads; Lund, Trine Meldgaard

    2016-01-20

    Despite much evidence that combination of morphine and gabapentin can be beneficial for managing postoperative pain, the nature of the pharmacological interaction of the two drugs remains unclear. The aim of this study was to assess the interaction of morphine and gabapentin in range of different dose combinations and investigate whether co-administration leads to synergistic effects in a preclinical model of postoperative pain. The pharmacodynamic effects of morphine (1, 3 and 7mg/kg), gabapentin (10, 30 and 100mg/kg) or their combination (9 combinations in total) were evaluated in the rat plantar incision model using an electronic von Frey device. The percentage of maximum possible effect (%MPE) and the area under the response curve (AUC) were used for evaluation of the antihyperalgesic effects of the drugs. Identification of synergistic interactions was based on Loewe additivity response surface analyses. The combination of morphine and gabapentin resulted in synergistic antihyperalgesic effects in a preclinical model of postoperative pain. The synergistic interactions were found to be dose dependent and the increase in observed response compared to the theoretical additive response ranged between 26 and 58% for the synergistic doses. The finding of dose-dependent synergistic effects highlights that choosing the right dose-dose combination is of importance in postoperative pain therapy. Our results indicate benefit of high doses of gabapentin as adjuvant to morphine. If these findings translate to humans, they might have important implications for the treatment of pain in postoperative patients.

  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. Oral clonidine: a simple yet effective and safe premedicant for hemodynamic stability during laparoscopic surgery and a calm post-operative period

    Directory of Open Access Journals (Sweden)

    Ketaki Marodkar

    2016-04-01

    Conclusions: Oral clonidine in the present dose is able to maintain stable intra-operative haemodynamics and achieve a calm post-operative period during laparoscopic surgeries in ASA I/II patients. [Int J Basic Clin Pharmacol 2016; 5(2.000: 293-299

  8. Combined parecoxib and I.V. paracetamol provides additional analgesic effect with better postoperative satisfaction in patients undergoing anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Zeinab Ahmed Elseify

    2011-01-01

    Full Text Available Background : Adequacy of postoperative analgesia is one of the most important factors that determine early hospital discharge and patients′ ability to resume their normal activities postoperatively. The optimal non-opioid analgesic technique for postoperative pain management would reduce pain and enhance patient satisfaction, and it also facilitates earlier mobilization and rehabilitation by reducing pain-related complications after surgery. The aim of this study was to evaluate the analgesic efficacy of intravenous paracetamol and parecoxib when used alone, or in combination. Methods : Sixty American Society of Anesthesiology (ASA physical status I and II adult patients who were scheduled for anterior cruciate ligament reconstruction were included in this study. Patients were allocated into three groups: group I patients received 1g intravenous paracetamol after induction and another 1 g 4 h later, group II received 40 mg parecoxib after induction, while group III received combination of both drugs (paracetamol 1 g and parecoxib 40 mg. Pain during rest and mobility was assessed in the immediate postoperative period, 2 h and 8 h successively using visual analog scale (VAS. Patient satisfaction was rated according to satisfaction score. Results : Total morphine requirements were lower in group III patients (6.9±2.7 mg in comparison to group I patients (12.6±3.6 mg or group II patients (9.8±2.8 mg. The least VAS scores were recorded during knee movement (3.8±1.1 in group III patients compared to group I (6.0±1.8 and group II patients (4.8±1.9. Eight hours postoperatively, group III patients were more satisfied regarding the postoperative pain management. Conclusion : Combination of intravenous paracetamol and parecoxib provided better analgesia and higher patient satisfaction than each drug when used separately.

  9. Pb II

    African Journals Online (AJOL)

    Windows User

    ISSN 1684–5315 ©2012 Academic Journals ... Exposure to Pb above permissible limit (50 ppb in water) .... taken and analyzed for residual metal concentration determination. ..... loss in Pb(II) sorption capacity up to five cycles of reuse of.

  10. A study of 60 patients with percutaneous trigger finger releases: clinical and ultrasonographic findings.

    Science.gov (United States)

    Gulabi, D; Cecen, G S; Bekler, H I; Saglam, F; Tanju, N

    2014-09-01

    We present the clinical results and ultrasonographic findings of 61 trigger digits treated with percutaneous A1 pulley release. An endoscopic carpal tunnel knife was used for the release in the outpatient department. The mean follow-up period was 3.5 months. A total of 55 digits (90%) had complete relief of their triggering postoperatively. Six digits (10%) had Grade 2 triggering clinically in the early postoperative period.The complications included six cases of insufficient release (10%), scar sensitivity in one patient, short-term hypoaesthesia in three digits (5%), and flexor tendon laceration noted on postoperative ultrasonography in eight digits (13%). No neurovascular damage was noted on the postoperative ultrasonography. Ultrasonograpy provides information about tendon laceration and changes in thickness of the pulleys and confirm A1 pulley release after surgery, but it does not alter clinical decision-making. We believe that pre- and postoperative ultrasonograpy does not need to be included as a routine examination.

  11. Management of Postoperative Hypoxaemia in Patients Following Upper Abdominal Laparoscopic Surgery. - A Comparative Study

    Directory of Open Access Journals (Sweden)

    Sampa Datta Gupta

    2008-01-01

    Full Text Available Noninvasive ventilation has been shown to reduce acute postoperative hypoxaemia, with significant reduction in the incidence of re-intubation, complications and a trend towards lower mortality. The aim of the study was to determine the effectiveness of CPAP vs venturi therapy in early achievement of oxygenation goals and in prevention of re-intubation for management of postoperative hypoxaemia following laparoscopic cholecystectomy. Forty adult patients of ASA physical status I& II, scheduled for elective laparoscopic cholecystectomy, those were unable to maintain SpO2 > 95% breathing room air after extubation, were recruited for a prospective, randomized comparative study. Patients with PaO2 / FiO2 between 250 and 300 were included in the study and were randomly allocated to one of the two groups to receive oxygen therapy either using a CPAP of 10 cm of water and a FiO2 of 0.5 (Group A or using a venturi mask of FiO2 of 0.5 (Group B . All patients were observed postoperatively upto 18 h and were screened by ABG analyses at 6, 12 and 18 h of treatment. SpO2, ECG, heart rate, respiratory rate, temperature and NIBP were monitored throughout the study period. Patients in Group A showed significant improvement in early achievement of adequate oxygenation than those in Group B, although, due to intolerance to CPAP therapy two patients in Group A needed reintubation to maintain adequate oxygenation. To conclude, oxygenation using continuous positive airway pressure is a safe and effective means in improving gas exchange to treat acute postoperative hypoxaemia in conscious and cooperative patients.

  12. POSTOPERATIVE ANALGESIA WITH TRANSDERMAL DICLOFENAC VERSUS INTRAMUSCULAR DICLOFENAC – A COMPARATIVE STU DY

    Directory of Open Access Journals (Sweden)

    Soumya

    2013-05-01

    Full Text Available ABSTRACT: BACKGROUND: The search for an ideal drug for postoperative anal gesia is ongoing. Diclofenac is commonly used drug for this purpose i n different routes. AIMS: To compare the efficacy of transdermal diclofenac with intramuscul ar diclofenac for postoperative analgesia. SETTINGS AND DESIGN: This prospective comparative study was conducted i n the department of anaesthesiology in a medical college & general hosp ital. METHODS AND MATERIALS: The study subjects were 200 patients of both sexes between 18 -50 years of age who were scheduled for elective laparoscopic, gynaecological & orthopaedic surgeries on limb. They divided into two groups. Group I received intramuscular injection of diclofenac sodium (75mg & Group II received transdermal diclofenac diethylamine patch (200mg pe r 75 sq.cm postoperatively. The outcome measures were pain intesity, changes in vital param eters, requirment for rescue analgesia & adverse effects. STATISTICAL ANALYSIS: Parametric data were analysed by using student t-te st (unpaired. Non parametric data were analysed by us ing test of association (chi-square test. RESULTS: The mean pain score was significantly high in intra muscular diclofenac group (Group I in laparoscopic & gynaecological surgeries (P = 0.0 02. Though the mean pain score was different among two groups in orthopaedic surgeries it was no t statistically significant (P = 0.377. There were no significant differences in vital parameters & adverse reactions in between two groups. The requirment of rescue anlgesia was significantly mor e in intramuscular diclofenac group (Group I. CONCLUSIONS: Transdermal diclofenac is more effective in reducing the intens ity of postoperative pain following laparoscopic & gynaecological surgeries but the eff ect is similar to intramuscular diclofenac in orthopedic limb surgeries

  13. Evaluation of the effect of gabapentin on postoperative analgesia with epidural morphine after abdominal hysterectomy

    Directory of Open Access Journals (Sweden)

    Diptesh Aryal

    2017-07-01

    Full Text Available Background & Objectives: Gabapentin has been used successfully as a non-opioid analgesic adjuvant for postoperative pain management. We hypothesized that the preoperative use of gabapentin prolonged the analgesic effect of epidural morphine without an increase in adverse effects of morphine. Materials & Methods: In a randomized, double blind study sixty ASA PS I and II patients undergoing abdominal hysterectomy were assigned to receive either placebo or gabapentin 1200mg 1 hour before surgery. Postoperatively, 0.125% bupivacaine with morphine 50 µg per kg body weight was used for epidural analgesia. Vital parameters, time to the first request for analgesic, visual analogue scale scoring for pain at rest and during movement, 24-hour morphine consumption, and side effects were studied.Results: The patients were comparable with respect to age, weight, ASA PS, baseline hemodynamic parameters and duration of surgery. Gabapentin significantly decreased the duration of analgesia compared to placebo (1078.26 min Vs. 303.5 min; P value <0.0001. The VAS scores at rest and during movement at 1, 2, 4, 8, 12, and 24h were significantly lower in gabapentin group. The total amount of morphine consumption in 24 h postoperatively was significantly lower in gabapentin group (1.93mg Vs. 6.30mg; P value <0.0001. The incidence of nausea and pruritus was significantly lower with gabapentin. Conclusion: Oral gabapentin 1200 mg as a premedication decreases the dose requirement of epidural morphine and postoperative pain after total abdominal hysterectomy. It also decreases the pain scores at rest and during movement significantly. 

  14. Container II

    OpenAIRE

    Baraklianou, Stella

    2016-01-01

    Container II, self-published artists book.\\ud The book was made on the occasion of the artists residency at the Banff Arts Centre, in Alberta Canada. \\ud \\ud Container II is a performative piece, it worked in conjunction with the photographic installation "Stage Set: Cool Tone" . (photographic floor installation, Reclaimed wood, frames, 130x145cm, 2016) \\ud The photographic installation was also part of the artists residency titled "New Materiality" at the Banff Arts Centre. \\ud \\ud Limited E...

  15. The Effect of Transdermal Scopolamine for the Prevention of Postoperative Nausea and Vomiting

    Directory of Open Access Journals (Sweden)

    Maria A. Antor

    2014-04-01

    Full Text Available Postoperative nausea and vomiting is one of the most common and undesirable complaints recorded in as many as 70%-80% of high-risk surgical patients. The current prophylactic therapy recommendations for PONV management stated in the Society of Ambulatory Anesthesia guidelines should start with monotherapy and patients at moderate to high risk, a combination of antiemetic medication should be considered. Consequently, if rescue medication is required, the antiemetic drug chosen should be from a different therapeutic class and administration mode than the drug used for prophylaxis. The guidelines restrict the use of dexamethasone, transdermal scopolamine, aprepitant, and palonosetron as rescue medication 6 hours after surgery. In an effort to find a safer and reliable therapy for postoperative nausea and vomiting, new drugs with antiemetic properties and minimal side effects are needed, and scopolamine may be considered an effective alternative. Scopolamine is a belladonna alkaloid, α-(hydroxymethyl benzene acetic acid 9-methyl-3-oxa-9-azatricyclo non-7-yl ester, acting as a nonselective muscarinic antagonist and producing both peripheral antimuscarinic and central sedative, antiemetic, and amnestic effects. The empirical formula is C17H21NO4 and its structural formula is a tertiary amine L-(2-scopolamine (tropic acid ester with scopine; MW = 303.4. Scopolamine became the first drug commercially available as a transdermal therapeutic system used for extended continuous drug delivery during 72 hours. Clinical trials with transdermal scopolamine have consistently demonstrated its safety and efficacy in postoperative nausea and vomiting. Thus, scopolamine is a promising candidate for the management of postoperative nausea and vomiting in adults as a first line monotherapy or in combination with other drugs. In addition, transdermal scopolamine might be helpful in preventing postoperative discharge nausea and vomiting owing to its long

  16. Find a Massage Therapist

    Science.gov (United States)

    ... for Members Student Experience AMTA News Find a Massage Therapist » Browse by location » Browse by technique » Find ... massage therapy school Proprietary Information and Legal Notice Massage is Good Medicine A growing body of research ...

  17. Thrombotic gene polymorphisms and postoperative outcome after coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Zaim Cagin

    2011-09-01

    Full Text Available Abstract Background Emerging perioperative genomics may influence the direction of risk assessment and surgical strategies in cardiac surgery. The aim of this study was to investigate whether single nucleotide polymorphisms (SNP affect the clinical presentation and predispose to increased risk for postoperative adverse events in patients undergoing coronary artery bypass grafting surgery (CABG. Methods A total of 220 patients undergoing first-time CABG between January 2005 and May 2008 were screened for factor V gene G1691A (FVL, prothrombin/factor II G20210A (PT G20210A, angiotensin I-converting enzyme insertion/deletion (ACE-ins/del polymorphisms by PCR and Real Time PCR. End points were defined as death, myocardial infarction, stroke, postoperative bleeding, respiratory and renal insufficiency and event-free survival. Patients were compared to assess for any independent association between genotypes for thrombosis and postoperative phenotypes. Results Among 220 patients, the prevalence of the heterozygous FVL mutation was 10.9% (n = 24, and 3.6% (n = 8 were heterozygous carriers of the PT G20210A mutation. Genotype distribution of ACE-ins/del was 16.6%, 51.9%, and 31.5% in genotypes I/I, I/D, and D/D, respectively. FVL and PT G20210A mutations were associated with higher prevalence of totally occluded coronary arteries (p p = 0.002. ACE D/D genotype was associated with hypertension (p = 0.004, peripheral vascular disease (p = 0.006, and previous myocardial infarction (p = 0.007. Conclusions FVL and PT G20210A genotypes had a higher prevalence of totally occluded vessels potentially as a result of atherothrombotic events. However, none of the genotypes investigated were independently associated with mortality.

  18. [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

  19. Hyperbaric oxygen preconditioning attenuates postoperative cognitive impairment in aged rats.

    Science.gov (United States)

    Sun, Li; Xie, Keliang; Zhang, Changsheng; Song, Rui; Zhang, Hong

    2014-06-18

    Cognitive decline after surgery in the elderly population is a major clinical problem with high morbidity. Hyperbaric oxygen (HBO) preconditioning can induce significant neuroprotection against acute neurological injury. We hypothesized that HBO preconditioning would prevent the development of postoperative cognitive impairment. Elderly male rats (20 months old) underwent stabilized tibial fracture operation under general anesthesia after HBO preconditioning (once a day for 5 days). Separate cohorts of animals were tested for cognitive function with fear conditioning and Y-maze tests, or euthanized at different times to assess the blood-brain barrier integrity, systemic and hippocampal proinflammatory cytokines, and caspase-3 activity. Animals exhibited significant cognitive impairment evidenced by a decreased percentage of freezing time and an increased number of learning trials on days 1, 3, and 7 after surgery, which were significantly prevented by HBO preconditioning. Furthermore, HBO preconditioning significantly ameliorated the increase in serum and hippocampal proinflammatory cytokines tumor necrosis factor-α, interleukin-1 β (IL-1β), IL-6, and high-mobility group protein 1 in surgery-challenged animals. Moreover, HBO preconditioning markedly improved blood-brain barrier integrity and caspase-3 activity in the hippocampus of surgery-challenged animals. These findings suggest that HBO preconditioning could significantly mitigate surgery-induced cognitive impairment, which is strongly associated with the reduction of systemic and hippocampal proinflammatory cytokines and caspase-3 activity.

  20. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma : multicentre randomised trial

    NARCIS (Netherlands)

    Creutzberg, CL; van Putten, WLJ; Koper, PCM; Lybeert, MLM; Jobsen, JJ; Warlam-Rodenhuis, CC; De Winter, KAJ; Lutgens, LCHW; van den Bergh, ACM; van de Steen-Banasik, E; Beerman, H; van Lent, M

    2000-01-01

    Background Postoperative radiotherapy for international Federation of Gynaecology and Obstetrics (FIGO) stage-1 endometrial carcinoma is a subject of controversy due to the low relapse rate and the lack of data from randomised trials. We did a multicentre prospective randomised trial to find whether

  1. The clinical applicability of a daily summary of patients' self-reported postoperative pain-A repeated measure analysis.

    Science.gov (United States)

    Wikström, Lotta; Eriksson, Kerstin; Fridlund, Bengt; Nilsson, Mats; Årestedt, Kristofer; Broström, Anders

    2017-03-23

    (i) To determine whether a central tendency, median, based on patients' self-rated pain is a clinically applicable daily measure to show patients' postoperative pain on the first day after major surgery (ii) and to determine the number of self-ratings required for the calculation of this measure. Perioperative pain traits in medical records are difficult to overview. The clinical applicability of a daily documented summarising measure of patients' self-rated pain scores is little explored. A repeated measure design was carried out at three Swedish country hospitals. Associations between the measures were analysed with nonparametric statistical methods; systematic and individual group changes were analysed separately. Measure I: pain scores at rest and activity postoperative day 1; measure II: retrospective average pain from postoperative day 1. The sample consisted of 190 general surgery patients and 289 orthopaedic surgery patients with a mean age of 65; 56% were men. Forty-four percent had a pre-operative daily intake of analgesia, and 77% used postoperative opioids. A range of 4-9 pain scores seem to be eligible for the calculation of the daily measures of pain. Rank correlations for individual median scores, based on four ratings, vs. retrospective self-rated average pain, were moderate and strengthened with increased numbers of ratings. A systematic group change towards a higher level of reported retrospective pain was significant. The median values were clinically applicable daily measures. The risk of obtaining a higher value than was recalled by patients seemed to be low. Applicability increased with increased frequency of self-rated pain scores and with high-quality pain assessments. The documenting of daily median pain scores at rest and during activity could constitute the basis for obtaining patients' experiences by showing their pain severity trajectories. The measures could also be an important key to predicting postoperative health

  2. Sarcopenia is an Independent Predictor of Severe Postoperative Complications and Long-Term Survival After Radical Gastrectomy for Gastric Cancer

    Science.gov (United States)

    Zhuang, Cheng-Le; Huang, Dong-Dong; Pang, Wen-Yang; Zhou, Chong-Jun; Wang, Su-Lin; Lou, Neng; Ma, Liang-Liang; Yu, Zhen; Shen, Xian

    2016-01-01

    Abstract Currently, the association between sarcopenia and long-term prognosis after gastric cancer surgery has not been investigated. Moreover, the association between sarcopenia and postoperative complications remains controversial. This large-scale retrospective study aims to ascertain the prevalence of sarcopenia and assess its impact on postoperative complications and long-term survival in patients undergoing radical gastrectomy for gastric cancer. From December 2008 to April 2013, the clinical data of all patients who underwent elective radical gastrectomy for gastric cancer were collected prospectively. Only patients with available preoperative abdominal CT scan within 30 days of surgery were considered for analysis. Skeletal muscle mass was determined by abdominal (computed tomography) CT scan, and sarcopenia was diagnosed by the cut-off values obtained by means of optimum stratification. Univariate and multivariate analyses evaluating risk factors of postoperative complications and long-term survival were performed. A total of 937 patients were included in this study, and 389 (41.5%) patients were sarcopenic based on the diagnostic cut-off values (34.9 cm2/m2 for women and 40.8 cm2/m2 for men). Sarcopenia was an independent risk factor for severe postoperative complications (OR = 3.010, P sarcopenia did not show significant association with operative mortality. Moreover, sarcopenia was an independent predictor for poorer overall survival (HR = 1.653, P sarcopenia remained an independent risk factor for overall survival and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. Sarcopenia is an independent predictive factor of severe postoperative complications after radical gastrectomy for gastric cancer. Moreover, sarcopenia is independently associated with overall and disease-free survival in patients with TNM stage II and III, but not in patients with TNM stage I. PMID:27043677

  3. Differentially expressed proteins on postoperative 3

    Directory of Open Access Journals (Sweden)

    Jialili Ainuer

    2011-04-01

    Full Text Available 【Abstract】Objectives: Surgical repair of Achilles tendon (AT rupture should immediately be followed by active tendon mobilization. The optimal time as to when the mobilization should begin is important yet controversial. Early kinesitherapy leads to reduced rehabilitation period. However, an insight into the detailed mechanism of this process has not been gained. Proteomic technique can be used to separate and purify the proteins by differential expression profile which is related to the function of different proteins, but research in the area of proteomic analysis of AT 3 days after repair has not been studied so far. Methods: Forty-seven New Zealand white rabbits were randomized into 3 groups. Group A (immobilization group, n=16 received postoperative cast immobilization; Group B (early motion group, n=16 received early active motion treatments immediately following the repair of AT rupture from tenotomy. Another 15 rabbits served as control group (Group C. The AT samples were prepared 3 days following the microsurgery. The proteins were separated employing twodimensional polyacrylamide gel electrophoresis (2D-PAGE. PDQuest software version 8.0 was used to identify differentially expressed proteins, followed by peptide mass fingerprint (PMF and tandem mass spectrum analysis, using the National Center for Biotechnology Information (NCBI protein database retrieval and then for bioinformatics analysis. Results: A mean of 446.33, 436.33 and 462.67 protein spots on Achilles tendon samples of 13 rabbits in Group A, 14 rabbits in Group B and 13 rabbits in Group C were successfully detected in the 2D-PAGE. There were 40, 36 and 79 unique proteins in Groups A, B and C respectively. Some differentially expressed proteins were enzyme with the gel, matrix-assisted laser-desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS. We successfully identified 9 and 11 different proteins in Groups A and B, such as GAPDH, phosphoglycerate kinase 1

  4. Postoperative Crohn's disease recurrence: A practical approach

    Institute of Scientific and Technical Information of China (English)

    Pilar Nos; Eugeni Domènech

    2008-01-01

    Crohn's disease is a chronic inflammatory condition that may involve any segment of the gastrointestinal tract. Although several drugs have proven efficacy in inducing and maintaining disease in remission, resectional surgery remains as a cornerstone in the management of the disease, mainly for the treatment of its stenosing and penetrating complications. However, the occurrence of new mucosal (endoscopic) lesions in the neoterminal ileum early after surgery is almost constant, it is followed in the mid-term by clinical symptoms and, in a proportion of patients, repeated intestinal resections are required. Pathogenesis of postoperative recurrence (POR) is not fully understood, but luminal factors (commensal microbes, dietary antigens) seem to play an important role, and environmental and genetic factors may also have a relevant influence. Hany studies tried to identify clinical predictors for POR with heterogeneous results, and only smoking has repeatedly been associated with a higher risk of POR. Ileocolonoscopy remains as the gold standard for the assessment of appearance and severity of POR, although the real usefulness of the available endoscopic score needs to be revisited and alternative techniques are emerging. Several drugs have been evaluated to prevent POR with limited success. Smoking cessation seems to be one of the more beneficial therapeutic measures. Aminosalicylates have only proved to be of marginal benefit, and they are only used in lowrisk patients. Nitroimidazolic antibiotics, althoug efficient, are associated with a high rate of intolerano and might induce irreversible side effects when used for a long-term. Thiopurines are not widely used after ileocecal resection, maybe because some concerns igiving immunomodulators in asymptomatic patient still remain. In the era of biological agents and geneti testing, a well-established preventive strategy for POR I still lacking, and larger studies to identify good clinica serological, and genetic

  5. Primary closure for postoperative mediastinitis in children.

    Science.gov (United States)

    Ohye, Richard G; Maniker, Robert B; Graves, Holly L; Devaney, Eric J; Bove, Edward L

    2004-09-01

    Mediastinitis affects approximately 1% of children undergoing median sternotomy. Conventional therapy involves debridement followed by open wound care with delayed closure, days to weeks of closed suction or antimicrobial irrigation, and vacuum-assisted closure or muscle flap closure. We hypothesized that primary closure without prolonged suction or irrigation is an effective, less traumatic treatment for mediastinitis in children. From January 1986 to July 2002, 6705 procedures involving median sternotomy were performed at the C. S. Mott Children's Hospital, resulting in 57 cases of mediastinitis (0.85%). Cases were divided into 2 groups, with 42 cases treated with primary closure and 15 cases treated with delayed or muscle flap closure. The 42 cases of primary closure comprised the primary study group of this institutional review board-approved, retrospective analysis. Patient demographics, surgical variables, mediastinitis-related parameters, and outcomes were evaluated. One patient had recurrent mediastinitis for an overall infection eradication rate of 97% (40/41). Three patients (7%) required re-exploration for suspected ongoing infection. Of these re-explorations, 1 patient had evidence of continued mediastinitis. The remaining 2 patients with sepsis of unclear cause had no clinical or culture evidence of recurrent infection. One of these patients ultimately died of sepsis without active mediastinitis for a hospital survival of 97% (41/42). No significant differences could be detected between the treatment successes and failures in this small cohort of patients. Simple primary closure is an effective means to treat selected cases of postoperative mediastinitis in children. The results compare favorably with other more lengthy or debilitating treatments.

  6. Fetal MRI: incidental findings in the mother

    Energy Technology Data Exchange (ETDEWEB)

    Abdullah, Selwan B. [University of Maryland Medical Center, Diagnostic Radiology and Nuclear Medicine, Baltimore, MD (United States); University of Minnesota, Medical School, Minneapolis, MN (United States); Dietz, Kelly R.; Holm, Tara L. [University of Minnesota, Department of Radiology, Minneapolis, MN (United States)

    2016-11-15

    Fetal magnetic resonance imaging (MRI) is a routinely used tool in prenatal diagnosis; however, there is a lack of studies evaluating incidental findings observed in the mother. This study describes and quantifies incidental findings observed in the mother during fetal MRI. We reviewed all fetal MRI studies at the University of Minnesota Medical Center from February 2008 to September 2014. Two pediatric radiologists retrospectively conducted a consensus evaluation. The maternal findings were categorized into neurologic, gynecologic, urinary, gastrointestinal and musculoskeletal. Hydronephrosis consistent with the stage of pregnancy was recorded but was not included as an abnormal finding. Abnormal findings were classified into three groups, depending on their clinical significance: level I (low), level II (medium) and level III (high). We evaluated 332 pregnant patients with a mean age of 29.3 years and a mean gestational age of 29 weeks. Of these, 55.4% had at least 1 incidental finding, for a total of 262 incidental maternal findings. Of the 262 abnormalities, 113 (43.1%) were neurologic, 69 were gynecologic (26.3%), 36 (13.7%) urinary, 24 (9.2%) gastrointestinal and 20 (7.6%) musculoskeletal. Of the 262 incidental findings, 237 (90.5%) were level I, 24 (9.2%) were level II and 1 (0.4%) was level III. Our results suggest that although the vast majority of incidental maternal findings are benign, more significant findings are still encountered and should be expected. (orig.)

  7. The Genesis II in primary total knee replacement: a systematic literature review of clinical outcomes.

    Science.gov (United States)

    Bhandari, Mohit; Pascale, Walter; Sprague, Sheila; Pascale, Valerio

    2012-01-01

    Since its introduction in 1996, the Genesis II Total Knee System has produced good clinical results in patients undergoing primary total knee replacement. A systematic review of the literature-the first of its kind for this device-was undertaken to collect data on the Genesis II in order to provide a better understanding of its medium- to long-term performance. Of 124 Genesis II-related studies published in the literature, 11 met the eligibility criteria and were included in the final analysis. The included studies had a mean follow-up length of 38.1 months. Data from 1201 knees were available for review. Patients were an average of 70.5 years of age and predominantly female (63%). Findings indicated that the revision rate with this implant is low with up to 11.9 years of follow-up, with 14 revisions in total. The survival rate ranged from 100% at 1 and 2 years to 96.0% at 11.9 years. The mean Knee Society knee score improved 51.0 points from preoperative to postoperative evaluation. In conclusion, the Genesis II exhibited good clinical performance with up to 11 years follow-up, with an encouraging rate of survival and improvement in function. Additional studies with larger sample sizes and longer follow-up periods are needed to better understand the long-term performance of this implant.

  8. Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables

    Science.gov (United States)

    de Souza-Santos, Jadson A.; Martins-Filho, Paulo R.; da Silva, Luiz C.; de Oliveira e Silva, Emanuel D.; Gomes, Ana C.

    2013-01-01

    Objective: This paper investigates the relationship between preoperative findings and short-term outcome in third molar surgery. Study design: A prospective study was carried out involving 80 patients who required 160 surgical extractions of impacted mandibular third molars between January 2009 and December 2010. All extractions were performed under local anesthesia by the same dental surgeon. Swelling and maximal inter-incisor distance were measured at 48 h and on the 7th day postoperatively. Mean visual analogue pain scores were determined at four different time periods. Results: One-hundred eight (67.5%) of the 160 extractions were performed on male subjects and 52 (32.5%) were performed on female subjects. Median age was 22.46 years. The amount of facial swelling varied depending on gender and operating time. Trismus varied depending on gender, operating time and tooth sectioning. The influence of age, gender and operating time varied depending on the pain evaluation period (p trismus and pain) differ depending on the patients’ characteristics (age, gender and body mass index). Moreover, surgery characteristics such as operating time and tooth sectioning were also associated with postoperative variables. Key words:Third molar extraction, pain, swelling, trismus, postoperative findings, prediction. PMID:23229245

  9. Postoperative Delirium in Elderly Patients Undergoing Hip Fracture Surgery in the Sugammadex Era: A Retrospective Study

    Science.gov (United States)

    Oh, Chung-Sik; Rhee, Ka Young; Yoon, Tae-Gyoon; Woo, Nam-Sik; Hong, Seung Wan; Kim, Seong-Hyop

    2016-01-01

    Background. Residual neuromuscular block (NMB) after general anesthesia has been associated with pulmonary dysfunction and hypoxia, which are both associated with postoperative delirium (POD). We evaluated the effects of sugammadex on POD in elderly patients who underwent hip fracture surgery. Methods. Medical records of 174 consecutive patients who underwent hip fracture surgery with general anesthesia were reviewed retrospectively to compare the perioperative incidence of POD, pulmonary complications, time to extubation, incidence of hypoxia, and laboratory findings between patients treated with sugammadex and those treated with a conventional cholinesterase inhibitor. Results. The incidence of POD was not significantly different between the two groups (33.3% versus 36.5%, resp.; P = 0.750). Postoperative pulmonary complications and laboratory findings did not showed significant intergroup difference. However, time to extubation (6 ± 3 versus 8 ± 3 min; P sugammadex group than in the conventional cholinesterase inhibitor group. Conclusion. Sugammadex did not reduce POD or pulmonary complications compared to conventional cholinesterase inhibitors, despite reducing time to extubation and postoperative hypoxia in elderly patients who underwent hip fracture surgery under general anesthesia. PMID:26998480

  10. 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.

  11. Postoperative sensitivity associated with low shrinkage versus conventional composites

    Directory of Open Access Journals (Sweden)

    Ivanović Vladimir

    2013-01-01

    Full Text Available Introduction. Postoperative sensitivity in restorative dentistry can be related to preparation trauma, dentin adhesives’ ability to seal open dentinal tubules, deformation of restorations under occlusal stresses and microleakage. Objective. The study assessed possible reduction in postoperative sensitivity with low shrinkage compared to conventional composites using different bonding agents and the influence of the operator skill on the incidence of postoperative sensitivity. Methods. Nine hundred and sixty permanent premolars and molars with primary carious lesions from patients 21 to 40 years old were used. Cavities 2 to 3 mm deep and with margins in enamel were prepared by four operators. Two operators had five years (A and B and two had over 20 years (C and D of clinical experience. Teeth were