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Sample records for monitoring patients undergoing

  1. Dexmedetomidine for monitored anesthesia care in patients undergoing liberation procedure for multiple sclerosis: An observational study

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    Saurabh Anand

    2012-01-01

    Full Text Available Background: It has been postulated that Multiple sclerosis (MS stems from a narrowing in the veins that drain blood from the brain, known medically as chronic cerebrospinal venous insufficiency, or CCSVI. It has been proposed that balloon angioplasty should alleviate the symptoms of MS. This procedure is also known as "The Liberation Procedure." Accordingly, a clinical study was undertaken to determine the effects of dexmedetomidine in patients undergoing the liberation procedure. Aims: To assess the effectiveness of dexmedetomidine in providing adequate sedation and pain relief for patients undergoing the liberation procedure. Settings and design: A prospective, nonrandomized observational study of 60 consecutive adult patients undergoing the liberation procedure under monitored anesthesia care (MAC who will receive dexmedetomidine as an anesthetic agent. Methods: A total of 60 adult patients were enrolled in the study. Dexmedetomidine was administered to all patients in a loading dose of 1 mcg/kg, which was followed by a maintenance dose of 0.2-0.5 mcg/kg/h. The evaluation of quality of sedation was based on Ramsay Sedation and the quality of analgesia was assessed using the visual analog scale. The following parameters were measured continuously: heart rate, mean arterial pressure and hemoglobin oxygen saturation. Patients were asked to answer the question, "How would you rate your experience with the sedation you have received during surgery?" using a seven-point Likert-like verbal rating scale. Statistical analysis: Repeated measurements were analyzed by repeated measures ANOVA for HR and BP. Results: Most of our patients were satisfied with their sedation. In most of the patients, MAP and HR dropped after the bolus dose of dexmedetomidine, and the drop was statistically significant. Conclusions: Dexmedetomidine can be used as a sole sedative agent in patients undergoing the liberation procedure.

  2. The laboratory of clinical virology in monitoring patients undergoing monoclonal antibody therapy.

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    Cavallo, R

    2011-12-01

    The relevant efficacy of monoclonal antibodies (mAbs) has resulted in the successful treatment of several diseases, although susceptibility to infections remains a major problem. This review summarizes aspects of the literature regarding viral infections and mAbs, specifically addressing the risk of infection/reactivation, the measures that can reduce this risk, and the role played by the laboratory of clinical virology in monitoring patients undergoing mAb therapy. © 2011 The Author. Clinical Microbiology and Infection © 2011 European Society of Clinical Microbiology and Infectious Diseases.

  3. Analysis of postoperative monitoring of patients undergoing shoulder arthroscopy for anterior instability.

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    Almeida, Alexandre; Menegotto, Samuel Millán; Almeida, Nayvaldo Couto de; Agostini, Ana Paula; Almeida, Letícia Agostini de

    2017-01-01

    Analyze the postoperative follow-up of patients undergoing shoulder arthroscopy for treatment of anterior instability and correlate with the prevalence of recurrence. A six-question survey was applied by phone and mail to 65 patients, seeking information on the current result of the surgical procedure. All patients were treated arthroscopically for anterior shoulder instability, with at least 12 months of postoperative time. Patients with associated posterior labial lesions and revision surgeries were not included. At the time of the survey the patients had a median of 56 (IQR: 34.5-110.5) postoperative months. The mean sample age was 24.6 years (maximum = 47, minimum = 12; SD = 7.3). Complaint of pain in the shoulder was observed in 20 patients (30.7%). Dislocation recurrence was observed in 10 patients (15.3%). Forty-four patients (67.6%) considered their shoulder normal, which was more frequent in non-recurrence patients (p < 0.001). Forty-three patients (66.1%) returned to their previous level of sport and there was no difference between recurrence and non-recurrence patients (p = 0.456). It was found that the prevalence of recurrence was 5.6 (95% CI: 1.30-24.46) times higher in individuals who abandoned monitoring before six months postoperatively (p = 0.012). The abandonment of postoperative monitoring in the early stages, when the patients receive orientation for muscle strengthening, proprioceptive education, and dangerous movements to avoid, can increase the rates of recurrent shoulder dislocation in patients treated for anterior instability by arthroscopy.

  4. Cerebral oxygenation monitoring in patients with bilateral carotid stenosis undergoing urgent cardiac surgery: Observational case series

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    Dincer Aktuerk

    2016-01-01

    Full Text Available Background: Patients with significant bilateral carotid artery stenosis requiring urgent cardiac surgery have an increased risk of stroke and death. The optimal management strategy remains inconclusive, and the available evidence does not support the superiority of one strategy over another. Materials and Methods: A number of noninvasive strategies have been developed for minimizing perioperative stroke including continuous real-time monitoring of cerebral oxygenation with near-infrared spectroscopy (NIRS. The number of patients presenting with this combination (bilateral significant carotid stenosis requiring urgent cardiac surgery in any single institution will be small and hence there is a lack of large randomized studies. Results: This case series describes our early experience with NIRS in a select group of patients with significant bilateral carotid stenosis undergoing urgent cardiac surgery (n = 8. In contrast to other studies, this series is a single surgeon, single center study, where the entire surgery (both distal ends and proximal ends was performed during single aortic clamp technique, which effectively removes several confounding variables. NIRS monitoring led to the early recognition of decreased cerebral oxygenation, and corrective steps (increased cardiopulmonary bypass flow, increased pCO 2 , etc., were taken. Conclusion: The study shows good clinical outcome with the use of NIRS. This is our "work in progress," and we aim to conduct a larger study.

  5. The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery.

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    Lu, I-Cheng; Chang, Pi-Ying; Su, Miao-Pei; Chen, Po-Nien; Chen, Hsiu-Ya; Chiang, Feng-Yu; Wu, Che-Wei

    2017-08-01

    The use of neuromuscular blocking agent (NMBA) during anesthesia may interfere with facial nerve monitoring (FNM) during parotid surgery. Sugammadex has been reported to be an effective and safe reversal of rocuronium-induced neuromuscular block (NMB) during surgery. This study investigated the feasibility and clinical effectiveness of sugammadex for NMB reversal during FNM in Parotid surgery. Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25) and sugammadex group (Group S, n = 25). Group C did not receive any NMBA. Group S received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at skin incision. The intubating condition and influence on FNM evoked EMG results were compared between groups. The intubation condition showed significantly better in group S patients than C group patients (excellent in 96% v.s. 24%). In group S, rapid reverse of NMB was found and the twitch (%) recovered from 0 to >90% within 10 min. Positive and high EMG signals were obtained in all patients at the time point of initial facial nerve stimulation in both groups. There was no significant difference as comparing the EMG amplitudes detected at the time point of initial and final facial nerve stimulation in both groups. Implementation of sugammadex in anesthesia protocol is feasible and reliable for successful FNM during parotid surgery. Copyright © 2017. Published by Elsevier Taiwan.

  6. Monitoring breast masses with ultrasound tomography in patients undergoing neoadjuvant chemotherapy

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    Lupinacci, Jessica; Duric, Neb; Littrup, Peter; Wang, Ding; Li, Cuiping; Schmidt, Steven; Rama, Olsi; Bey-Knight, Lisa; Myc, Lukasz

    2009-02-01

    As part of an ongoing assessment of the in-vivo performance of a operator independent breast imaging device, based on acoustic tomography, we report on new results obtained with patients undergoing neoadjuvant chemotherapy. Five patients were examined with the prototype on multiple occasions corresponding in time to their chemotherapy sessions. Images of reflection, sound speed and attenuation, representing the entire volume of the breast, were reconstructed from the exam data and analyzed for time-dependent changes during the treatment period. It was found that changes in acoustic properties of the tumors could be measured directly from the images. The measured properties include reflectivity, sound speed and attenuation, leading to measurable changes in the volume, shape and internal attributes of the tumors. These measurements were used to monitor the response of the tumors to the therapy with the long term goal of correlating results with pathological and clinical outcomes. Comparisons with tumor size changes based on traditional US and MRI indicates potential for accurate, quantifiable tracking of tumor volume. Furthermore, our tentative results also show declines in internal properties of the tumors, possibly relating to a reduction in tissue stiffness and/or density. Future work will include an expansion of the study to a larger cohort of patients for determining the statistical significance of our findings.

  7. Daily Energy Expenditure and Its Relation to Health Care Costs in Patients Undergoing Ambulatory Electrocardiographic Monitoring.

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    George, Jason; Abdulla, Rami Khoury; Yeow, Raymond; Aggarwal, Anshul; Boura, Judith; Wegner, James; Franklin, Barry A

    2017-02-15

    Our increasingly sedentary lifestyle is associated with a heightened risk of obesity, diabetes, heart disease, and cardiovascular mortality. Using the recently developed heart rate index formula in 843 patients (mean ± SD age 62.3 ± 15.7 years) who underwent 24-hour ambulatory electrocardiographic (ECG) monitoring, we estimated average and peak daily energy expenditure, expressed as metabolic equivalents (METs), and related these data to subsequent hospital encounters and health care costs. In this cohort, estimated daily average and peak METs were 1.7 ± 0.7 and 5.5 ± 2.1, respectively. Patients who achieved daily bouts of peak energy expenditure ≥5 METs had fewer hospital encounters (p = 0.006) and median health care costs that were nearly 50% lower (p health care costs depending on whether they achieved monitoring (p = 0.005). Interestingly, patients who achieved ≥5 METs had lower and no significant difference in their health care costs, regardless of their body mass index (p = 0.46). Patients with previous percutaneous coronary intervention who achieved ≥5 METs had lower health care costs (p = 0.044) and fewer hospital encounters (p = 0.004) than those who achieved monitoring may provide useful information regarding health care utilization in patients with and without previous percutaneous coronary intervention, irrespective of body habitus. Our findings are the first to link lower intensities of peak daily energy expenditure, estimated from ambulatory ECG monitoring, with increased health care utilization.

  8. The feasibility of sugammadex for general anesthesia and facial nerve monitoring in patients undergoing parotid surgery

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    I-Cheng Lu

    2017-08-01

    Fifty patients undergoing parotid surgery were randomized allocated into conventional anesthesia group (Group C, n = 25 and sugammadex group (Group S, n = 25. Group C did not receive any NMBA. Group S received rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at skin incision. The intubating condition and influence on FNM evoked EMG results were compared between groups. The intubation condition showed significantly better in group S patients than C group patients (excellent in 96% v.s. 24%. In group S, rapid reverse of NMB was found and the twitch (% recovered from 0 to >90% within 10 min. Positive and high EMG signals were obtained in all patients at the time point of initial facial nerve stimulation in both groups. There was no significant difference as comparing the EMG amplitudes detected at the time point of initial and final facial nerve stimulation in both groups. Implementation of sugammadex in anesthesia protocol is feasible and reliable for successful FNM during parotid surgery.

  9. Conscientious metabolic monitoring on a patient with hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome undergoing anaesthesia.

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    Mühling, J; Dehne, M G; Fuchs, M; Sablotzki, A; Weiss, S; Spatz, J; Hempelmann, G

    2001-01-01

    Currently we know not more than 50 patients who show an interesting combination of increased plasma ornithine concentrations, postprandial hyperammonemia, and homocitrullinuria (HHH-syndrome). Since exact knowledge of this severe, although rare syndrome is important for any perioperative or intensive medical treatment concerning therapy and progression of the disease, we report a comprehensive study on a 32-year old woman with this rare multifaceted disorder who had to undergo general anaesthesia. For the first time amino acid status in plasma, urine, cerebrospinal fluid and especially polymorphonuclear leucocytes, which in the investigation showed to be valuable tool for evaluating amino acid metabolism in nucleated cells in HHH-syndrome, and further important pathophysiologic indicators of cellular and metabolic function have been conscientiously investigated and compared. The pathophysiological repercussions of our results as well as the recommendations for conscientious therapeutical management are discussed.

  10. Developing a tool to preserve eye contact with patients undergoing colonoscopy for pain monitoring

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    Niv Y

    2012-08-01

    Full Text Available Yaron Niv, Yossi TalDepartment of Gastroenterology, Rabin Medical Center, Tel Aviv University, IsraelAbstract: Colonoscopy has become the leading procedure for early detection and prevention of colorectal cancer. Patients’ experience of colonic endoscopic procedures is scarcely reported, even though it is considered a major factor in colorectal cancer screening participation. Pain due to air inflation or stretching the colon with an endoscope is not rare during examination and may be the main obstacle to cooperation and participation in a screening program. We propose a four-stage study for developing a tool dedicated to pain monitoring during colonoscopy, as follows: (1 comparison of patient, nurse, and endoscopist questionnaire responses about patient pain and technical details of the procedure using the PAINAD tool during colonoscopy; (2 observation of the correlation between patients’ facial expressions and other parameters (using the short PAINAD; (3 development of a device for continuous monitoring of the patient’s facial expression during the procedure; (4 assessment of the usability of such a tool and its contribution to the outcomes of colonoscopy procedures. Early intervention by the staff performing the procedure, in reaction to alerts encoded by this tool, may prevent adverse events during the procedure.Keywords: pain scoring, colonoscopy, pain monitoring, facial expression

  11. Application of intraoperative arterial pressure-based cardiac output monitoring for patients undergoing coronary artery bypass grafting surgery

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    LU Jia-kai; ZHU Chen; JING He; WANG Yi-jun; QING En-ming

    2012-01-01

    Background For patients undergoing off-pump coronary artery bypass grafting (OPCABG),it is important to establish a hemodynamic monitoring system to obtain powerful parameters for better intraoperative treatment.This study aimed to observe the clinical feasibility of artedal pressure-based cardiac output (APCO) for cardiac output (CO) monitoring and to evaluate the correlation between APCO and pulmonary artery catheter (PAC) for CO measurement for patients undergoing OPCABG intraoperatively.Methods Fifty patients of Amedcan Society of Anaesthesiologists (ASA) classification Ⅱ-Ⅲ,undergoing elective OPCABG at Beijing Anzhen Hospital were randomly enrolled into this study.All patients were assigned to CO monitoring by PAC and APCO simultaneously.Patients with pacemaker,severe valvular heart disease,left ventdcular ejection fraction (EF) <40%,cardiac arrhythmias,peripheral vascular disease,application of intra-aortic balloon pump (IABP) and emergent diversion to cardiac pulmonary bypass were excluded.The radial artery wavaform was analyzed to estimate the stroke volume (SV) and heart rate (HR) continuously.CO was calculated as SV x HR; other derived parameters were cardiac index (CI),stroke volume index (SVI),systemic vascular resistance (SVR),and systemic vascular resistance index (SVRI).PAC was placed via right internal jugular vein and the correct position was confirmed by PAC waveforms.Continuous cardiac output (CCO),CI and other hemodynamic parameters were monitored at following 5 time points:immediate after anesthesia induction (baseline value),anastomosis of left intemal mammary artery to left anterior descending artery (LAD),anastomosis of left circumflex (LCX),anastomosis of posterior descending artery (PDA) and immediate after sternal closure.Results In the 50 patients,preoperative echocardiography measured left ventricular EF was (52.8±11.5)%,and 35 patients (70%) showed regional wall motion abnormalities.The correlation coefficient of CO

  12. Evaluation of continuous non-invasive arterial pressure monitoring during induction of general anaesthesia in patients undergoing cardiac surgery.

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    Kumar, G Anil; Jagadeesh, A M; Singh, Naveen G; Prasad, S R

    2015-01-01

    Continuous arterial pressure monitoring is essential in cardiac surgical patients during induction of general anaesthesia (GA). Continuous non-invasive arterial pressure (CNAP) monitoring is fast gaining importance due to complications associated with the invasive arterial monitoring. Recently, a new continuous non-invasive arterial pressure device (CNAP™) has been validated perioperatively in non-cardiac surgeries. The aim of our study is to compare and assess the performance of CNAP during GA with invasive arterial pressure (IAP) in patients undergoing cardiac surgeries. Sixty patients undergoing cardiac surgery were included. Systolic, diastolic, and mean arterial pressure (MAP) data were recorded every minute for 20 min simultaneously for both IAP and CNAP™. Statistical analysis was performed using mountain plot and Bland Altman plots for assessing limits of agreement and bias (accuracy) calculation. Totally 1200 pairs of data were analysed. The CNAP™ systolic, diastolic and MAP bias was 5.98 mm Hg, -3.72 mm Hg, and - 0.02 mm Hg respectively. Percentage within limits of agreement was 96.0%, 95.2% and 95.7% for systolic, diastolic and MAP. The mountain plot showed similar results as the Bland Altman plots. We conclude CNAP™ provides real-time estimates of arterial pressure comparable to IAP during induction of GA for cardiac surgery. We recommend CNAP can be used as an alternative to IAP in situations such as cardiac patients coming for non-cardiac surgeries, cardiac catheterization procedures, positive Allen's test, inability to cannulate radial artery and vascular diseases, where continuous blood pressure monitoring is required.

  13. Postoperative monitoring in pregnant patients undergoing surgery for advanced malignancy in last trimester: How long is enough?

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    Arushi Gupta

    2014-01-01

    Full Text Available Surgery for advanced breast malignancy in the last trimester of pregnancy is uncommon. We present successful management of a 32-year-old woman, 30 weeks pregnant with stage 3 breast malignancy, for surgery followed by normal labor and chemotherapy. Surgery and intraoperative period were uneventful. Patient had uterine contractions 36 h postsurgery, which were managed timely with active interventions and tocolytics. Risk of premature labor following nonobstetric surgery in pregnant patients is estimated to be 8.3%, but majority of the studies have been carried out in second trimester following appendectomy. There is insufficient data in literature regarding the estimation and duration of persistence of risk of premature labor in these patients. No guidelines are available regarding how long they need to be monitored for premature labor. There is some evidence, although little that risk of premature labor persists for 7 days postsurgery. In the absence of convincing studies and guidelines, we recommend postoperative monitoring for at least 7 days in patients undergoing major surgeries for malignancies in last trimester. Multidisciplinary approach is required to manage these patients.

  14. The effects of bispectral index monitoring on hemodynamics and recovery profile in developmentally delayed pediatric patients undergoing dental surgery.

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    Sargin, Mehmet; Uluer, Mehmet Selcuk; Ozmen, Sadık

    2015-09-01

    General anesthesia is often preferred for dental surgery or rehabilitation in developmentally delayed pediatric patients. Bispectral index monitoring is used to monitor the depth of anesthesia and to ensure early recovery. However, studies on the topic in developmentally delayed pediatric patients are limited. To evaluate the effects of Bispectral Index Scale (BIS) on hemodynamics and recovery profile in developmentally delayed pediatric patients undergoing dental surgery. Forty children between the ages of 6-16 years were studied in this prospective and randomized study. The children were randomized into two groups. In Group 1 (n = 20), general anesthesia was maintained with 1-2 minimum alveolar concentration (MAC) of sevoflurane in oxygen by standard practice. In Group 2 (n = 20), the depth of anesthesia was monitored by BIS. BIS values were continuously recorded from awake status to tracheal extubation. The duration of the surgical procedure, anesthesia, postanesthesia care unit (PACU) stay was noted. To evaluate recovery profile, time to spontaneous ventilation, extubation, open eyes, and PACU discharge were also noted. There were significant differences between recovery times and Non-communicating Children's Pain Checklist - Postoperative Version (NCCPC-PV) scores of two groups. Time to spontaneous ventilation [Difference in means (95% CI); 3.17 (1.79-4.54) P < 0.001], extubation [Difference in means (95% CI); 3.13 (1.66-4.60) P < 0.001], open eyes [Difference in means (95% CI); 3.97 (2.34-5.59) P < 0.001], and PACU stay time [Difference in means (95% CI); 23.55 (18.08-29.01) P < 0.001] were significantly shorter in Group 2. In conclusion, results suggest that routine BIS monitoring may be beneficial due to its favorable effects on the recovery profile in developmentally delayed pediatric patients. © 2015 John Wiley & Sons Ltd.

  15. Perioperative monitoring of pulsatile and static intracranial pressure in patients with Chiari malformation type 1 undergoing foramen magnum decompression.

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    Frič, Radek; Eide, Per Kristian

    2016-02-01

    Patients with Chiari malformation type 1 (CMI) often present with elevated pulsatile and static intracranial pressure (ICP). The preferred treatment of CMI, foramen magnum decompression (FMD), is assumed to normalise ICP and craniospinal pressure dissociation. In order to further explore the mechanisms behind FMD, the present study investigated whether or not pulsatile and static ICP normalises immediately after FMD. The study included CMI patients undergoing FMD with perioperative ICP monitoring as a part of clinical management. The pulsatile and static ICP scores were retrieved from the department's ICP database, and the clinical and radiological data from the patient records. Eleven patients were included in the study. During the first 3 days following FMD, mixed model analysis revealed no significant time-dependent differences of preoperatively elevated either pulsatile (mean wave amplitude, MWA; p = 0.85) and/or static (mean ICP, p = 0.90) ICP. Percentage of mean ICP >15 mmHg increased during days 2 and 3 after FMD. Two patients from the present series had to receive ventriculoperitoneal shunt after FMD in the early postoperative period. The present observations suggest that anatomical restoration of cerebrospinal fluid pathways by FMD does not lead to immediate normalisation of preoperatively altered pulsatile and static ICP in patients with CMI. This finding may explain persistent symptoms during the early period after FMD.

  16. Monitoring breast masses with ultrasound tomography in patients undergoing neoadjuvant chemotherapy

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    Lupinacci, Jessica; Duric, Neb; Littrup, Peter; Wang, Ding; Li, Cuiping; Schmidt, Steven; Ranger, Bryan; West, Erik; Szczepanski, Amy; Rama, Olsi; Bey-Knight, Lisa; Myc, Lukasz

    2010-03-01

    The purpose of this study was to correlate changes in biomechanical properties of breast cancer lesions in response to neoadjuvant chemotherapy. Nine patients were examined repeatedly throughout their treatment, using an experimental prototype based on the principles of ultrasound tomography. The study was HIPAA compliant, approved by the Institutional Review Board, and performed after obtaining the requisite informed consent. Images of reflection, sound speed and attenuation, representing the entire volume of the breast, were reconstructed from the exam data and analyzed for time-dependent changes during the treatment period. It was found that changes in tumor properties could be measured in all cases. Furthermore, changes in sound speed were found to vary strongly from patient to patient. A comparison of the sound speed response curves with pathological findings suggests that complete responders exhibit distinctly different responses as measured by sound speed. These preliminary results were used to define a cut-point for predicting response. Subsequently, a prospective prediction of the treatment response of a new patient was made correctly. We hypothesize that changes in the biomechanical properties of breast cancers, as measured by sound speed, can predict response. Future studies will focus on testing this hypothesis and defining and quantifying markers of response.

  17. Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery : a prospective observational study

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    Schierenbeck, Fanny; Nijsten, Maarten W. N.; Franco-Cereceda, Anders; Liska, Jan

    2014-01-01

    Introduction: Lactate is a marker of hypoperfusion and may be used for risk assessment in critically ill patients. Although evidence suggests that repeated lactate measurements are of clinical interest, how and when lactate should be analyzed is controversial. Intravascular microdialysis provides a

  18. Introducing intravascular microdialysis for continuous lactate monitoring in patients undergoing cardiac surgery : a prospective observational study

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    Schierenbeck, Fanny; Nijsten, Maarten W. N.; Franco-Cereceda, Anders; Liska, Jan

    2014-01-01

    Introduction: Lactate is a marker of hypoperfusion and may be used for risk assessment in critically ill patients. Although evidence suggests that repeated lactate measurements are of clinical interest, how and when lactate should be analyzed is controversial. Intravascular microdialysis provides a

  19. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists.

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    Cannesson, Maxime; Pestel, Gunther; Ricks, Cameron; Hoeft, Andreas; Perel, Azriel

    2011-08-15

    Several studies have demonstrated that perioperative hemodynamic optimization has the ability to improve postoperative outcome in high-risk surgical patients. All of these studies aimed at optimizing cardiac output and/or oxygen delivery in the perioperative period. We conducted a survey with the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA) to assess current hemodynamic management practices in patients undergoing high-risk surgery in Europe and in the United States. A survey including 33 specific questions was emailed to 2,500 randomly selected active members of the ASA and to active ESA members. Overall, 368 questionnaires were completed, 57.1% from ASA and 42.9% from ESA members. Cardiac output is monitored by only 34% of ASA and ESA respondents (P = 0.49) while central venous pressure is monitored by 73% of ASA respondents and 84% of ESA respondents (P < 0.01). Specifically, the pulmonary artery catheter is being used much more frequently in the US than in Europe in the setup of high-risk surgery (85.1% vs. 55.3% respectively, P < 0.001). Clinical experience, blood pressure, central venous pressure, and urine output are the most widely indicators of volume expansion. Finally, 86.5% of ASA respondents and 98.1% of ESA respondents believe that their current hemodynamic management could be improved. In conclusion, these results point to a considerable gap between the accumulating evidence about the benefits of perioperative hemodynamic optimization and the available technologies that may facilitate its clinical implementation, and clinical practices in both Europe and the United States.

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

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    Shijiang Liu

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

  1. Patterns of intra-arterial blood pressure monitoring for patients undergoing total shoulder arthroplasty under general anesthesia: a retrospective analysis of 23,073 patients.

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    Gabriel, Rodney A; Beverly, Anair; Dutton, Richard P; Urman, Richard D

    2016-10-13

    Total shoulder arthroplasty (TSA) is typically performed in the beach-chair position. Maintenance of adequate mean arterial pressure is required to provide appropriate cerebral perfusion pressure and prevent cerebral ischemia. Placement of an arterial line to facilitate invasive monitoring is discretionary, based on clinical judgment. We aimed to describe patient, surgical and institutional factors associated with the current use of blood pressure monitoring via an arterial line for TSA. We used de-identified patient data from the National Anesthesia Clinical Outcomes Registry between 2010 and 2015 to identify patients undergoing TSA under general anesthesia. We conducted a multivariable logistic regression model to demonstrate factors significantly associated with arterial line placement. We report results as odds ratios (OR) with their associated 95 % confidence intervals (CI). Of 23,073 patients undergoing TSA under general anesthesia, 443 (1.92 %) had intra-arterial blood pressure monitoring. Patient age over 65 years old (OR 1.74, CI 1.37-2.21), congestive heart failure (OR 7.09, CI 2.63-19.14) and surgery lasting at least 180 min (OR 4.10, CI 3.33-5.05) were all associated with increased odds for arterial line placement. Compared to university hospitals, arterial line placement was more likely in attached or freestanding surgical centers (OR 2.01, CI 1.37-2.96) and less likely in medium sized community hospitals (OR 0.62, CI 0.42-0.93), small community hospitals (OR 0.11, CI 0.03-0.34) and facilities performing less than 100 TSAs per year (OR 0.19, CI 0.12-0.31). Utilization of arterial line monitoring for TSA has associations with both institutional and patient factors. This study demonstrates the national patterns for the use of arterial lines for TSA and may serve as a resource to aid in clinical judgment.

  2. Comparison of Continuous Noninvasive Blood Pressure Monitoring by TL-300 With Standard Invasive Blood Pressure Measurement in Patients Undergoing Elective Neurosurgery.

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    Lin, Wen-Qian; Wu, Huang-Hui; Su, Chang-Sheng; Yang, Jian-Teng; Xiao, Jin-Rong; Cai, Yu-Ping; Wu, Xiao-Zhi; Chen, Guo-Zhong

    2017-01-01

    Intraoperative blood pressure (BP) is one of the basic vital signs monitoring. Compared with standard invasive BP measurement, TL-300 allows for a continuous and beat-to-beat noninvasive intraoperative BP monitoring. The current retrospective study compared the accuracy and precision of this noninvasive technique for continuous BP monitoring with that of standard invasive BP measurement in patients undergoing elective neurosurgery. BP records of 23 patients undergoing elective neurosurgery, measured by both noninvasive TL-300 and invasive radial arterial catheter method, were retrospectively analyzed. Variability in BP data was analyzed by using linear regressions and Bland-Altman analysis. Four thousand three hundred eighty-one pairs of BP measurements from a total of 23 patients were included. The coefficient of determination of systolic, diastolic, and mean BP were 0.908, 0.803, and 0.922, respectively. And their bias was found to be 1.3±5.87 mm Hg (95% limits of agreement: -10.2 to +12.8 mm Hg), 2.8±6.40 mm Hg (95% limits of agreement: -9.8 to +15.3 mm Hg), and 1.8±4.20 mm Hg (95% limits of agreement: -6.4 to +10.1 mm Hg), respectively. TL-300 system is a promising noninvasive alternative to the invasive arterial catheter method for intraoperative BP monitoring, with a high accuracy and precision. With the limitation of the current retrospective study, further prospective method comparison studies are needed.

  3. Continuous Monitoring and Intrafraction Target Position Correction During Treatment Improves Target Coverage for Patients Undergoing SBRT Prostate Therapy

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    Lovelock, D. Michael, E-mail: lovelocm@mskcc.org [Memorial Sloan Kettering Cancer Center, New York, New York (United States); Messineo, Alessandra P. [Memorial Sloan Kettering Cancer Center, New York, New York (United States); Cox, Brett W. [North Shore-Long Island Jewish Health System, New Hyde Park, New York (United States); Kollmeier, Marisa A.; Zelefsky, Michael J. [Memorial Sloan Kettering Cancer Center, New York, New York (United States)

    2015-03-01

    Purpose: To compare the potential benefits of continuous monitoring of prostate position and intervention (CMI) using 2-mm displacement thresholds during stereotactic body radiation therapy (SBRT) treatment to those of a conventional image-guided procedure involving single localization prior to treatment. Methods and Materials: Eighty-nine patients accrued to a prostate SBRT dose escalation protocol were implanted with radiofrequency transponder beacons. The planning target volume (PTV) margin was 5 mm in all directions, except for 3 mm in the posterior direction. The prostate was kept within 2 mm of its planned position by the therapists halting dose delivery and, if necessary, correcting the couch position. We computed the number, type, and time required for interventions and where the prostate would have been during dose delivery had there been, instead, a single image-guided setup procedure prior to each treatment. Distributions of prostate displacements were computed as a function of time. Results: After the initial setup, 1.7 interventions per fraction were required, with a concomitant increase in time for dose delivery of approximately 65 seconds. Small systematic drifts in prostate position in the posterior and inferior directions were observed in the study patients. Without CMI, intrafractional motion would have resulted in approximately 10% of patients having a delivered dose that did not meet our clinical coverage requirement, that is, a PTV D95 of >90%. The posterior PTV margin required for 95% of the dose to be delivered with the target positioned within the PTV was computed as a function of time. The margin necessary was found to increase by 2 mm every 5 minutes, starting from the time of the imaging procedure. Conclusions: CMI using a tight 2-mm displacement threshold was not only feasible but was found to deliver superior PTV coverage compared with the conventional image-guided procedure in the SBRT setting.

  4. Impact of β-lactam antibiotic therapeutic drug monitoring on dose adjustments in critically ill patients undergoing continuous renal replacement therapy.

    Science.gov (United States)

    Economou, Caleb J P; Wong, Gloria; McWhinney, Brett; Ungerer, Jacobus P J; Lipman, Jeffrey; Roberts, Jason A

    2017-05-01

    The objective of this study was to describe the effect of therapeutic drug monitoring (TDM) and dose adjustments of β-lactam antibiotics administered to critically ill patients undergoing continuous renal replacement therapy (CRRT) in a 30-bed tertiary intensive care unit (ICU). β-Lactam TDM data in our tertiary referral ICU were retrospectively reviewed. Clinical, demographic and dosing data were collected for patients administered β-lactam antibiotics while undergoing CRRT. The target trough concentration range was 1-10× the minimum inhibitory concentration (MIC). A total of 111 TDM samples from 76 patients (46 male) with a mean ± standard deviation age of 56.6 ± 15.9 years and weight of 89.1 ± 25.8 kg were identified. The duration of antibiotic therapy was between 2 days and 42 days. TDM identified a need for dose modification of β-lactam antibiotics in 39 (35%) instances; in 27 (24%) samples, TDM values resulted in decreasing the prescribed dose of β-lactam antibiotic whereas an increase in the prescribed dose occurred in 12 (11%) cases. In patients treated for hospital-acquired pneumonia and primary or secondary bacteraemia, the dose was required to be decreased in 10/25 (40%) and 7/46 (15%) cases, respectively, to attain target concentrations. β-Lactam TDM is a useful tool for guiding drug dosing in complex patients such as those receiving CRRT. Although over one-third of patients manifested concentrations outside the therapeutic range, most of these CRRT patients had excessive β-lactam concentrations. Copyright © 2017 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.

  5. Simplified response monitoring criteria for multiple myeloma in patients undergoing therapy with novel agents using computed tomography.

    Science.gov (United States)

    Schabel, Christoph; Horger, Marius; Kum, Sara; Weisel, Katja; Fritz, Jan; Ioanoviciu, Sorin D; Bier, Georg

    2016-12-01

    Multiple myeloma is a malignant hematological disorder of the mature B-cell lymphocytes originating in the bone marrow. While therapy monitoring is still mainly based on laboratory biomarkers, the additional use of imaging has been advocated due to inaccuracies of serological biomarkers or in a-secretory myelomas. Non-enhanced CT and MRI have similar sensitivities for lesions in yellow marrow-rich bone marrow cavities with a favourable risk and cost-effectiveness profile of CT. Nevertheless, these methods are still limited by frequently high numbers of medullary lesions and its time consumption for proper evaluation. To establish simplified response criteria by correlating size and CT attenuation changes of medullary multiple myeloma lesions in the appendicular skeleton with the course of lytic bone lesions in the entire skeleton. Furthermore to evaluate these criteria with respect to established hematological myeloma-specific parameters for the prediction of treatment response to bortezomib or lenalidomide. Non-enhanced reduced-dose whole-body CT examinations of 78 consecutive patients (43 male, 35 female, mean age 63.69±9.2years) with stage III multiple myeloma were retrospectively re-evaluated. On per patient basis, size and mean CT attenuation of 2-4 representative lesions in the limbs were measured at baseline and at a follow-up after a mean of 8 months. Results were compared with the course of lytical bone lesions as well with that of specific hematological biomarkers. Myeloma response was assessed according to the International Myeloma Working Group (IMWG) uniform response criteria. Testing for correlation between response of medullary lesions (Respmed) and response of all myeloma manifestations including osteolyses (Resptotal) was performed using the corrected contingency coefficient (Ccorr). The correlation between Respmed based on length diameter and transverse diameter and Resptotal was perfect (Ccorr=1.0; p0.05). Measurements of size of a minimum of

  6. A comparison of noninvasive blood pressure measurement on the wrist with invasive arterial blood pressure monitoring in patients undergoing bariatric surgery.

    Science.gov (United States)

    Hager, Helmut; Mandadi, Goutham; Pulley, Debra; Eagon, J Chris; Mascha, Edward; Nutter, Benjamin; Kurz, Andrea

    2009-06-01

    In morbidly obese patients, oscillometric blood pressure measurements with an upper-arm cuff are often difficult to perform. The alternative method, invasive blood pressure monitoring, can be difficult to place and is associated with risks. A wrist-mounted blood pressure-monitoring device, the Vasotrac, provides accurate blood pressure measurements in lean patients. Even in the obese, wrist morphology remains relatively unchanged. We thus assessed the degree to which blood pressure measurements with the Vasotrac on the wrist and cuff measurements agree with invasive arterial blood pressure monitoring. We evaluated 22 morbidly obese patients undergoing bariatric surgery lasting 3.8+/-1.1 h. Intraoperative blood pressure was simultaneously measured using the Vasotrac mounted on one wrist; an arterial catheter was inserted in the opposite radial artery, and an oscillometric cuff was positioned on the upper arm. Preoperative patient comfort was evaluated on a scale from 1 to 10, with 10 being most uncomfortable, just after the first oscillometric cuff inflation. Values from the Vasotrac and arterial catheter were recorded at 5-s intervals. Bias, precision, and clinically acceptable agreement were calculated between the two continuous monitoring devices and between the arterial catheter and the cuff measurements, with the arterial catheter providing the reference value. The patients' age was 44.3+/-9.5 years (mean+/-SD), body mass index was 66.7+/-13.8 kg/m2, and arm circumference was 48.6+/-7.5 cm. Patients found the Vasotrac more comfortable than the oscillometric device [1.7+/-1.8 vs 5.3+/-0.5 (P=0.009)]. A total of 40,411 pairs of values from the Vasotrac and arterial catheter were recorded. Lin's concordance correlation coefficient (95% CI) for mean arterial blood pressure measured between the arterial line and the Vasotrac was 0.74 (0.67, 0.82). The bias (mean error) was -0.25 mmHg; however, the Bland-Altman limits where 95% of individual pressure differences are

  7. Continuous blood pressure monitoring via non-invasive radial artery applanation tonometry and invasive arterial catheter demonstrates good agreement in patients undergoing colon carcinoma surgery.

    Science.gov (United States)

    Sun, Jing; Chen, Hanjian; Zheng, Jun; Mao, Bin; Zhu, Shengmei; Feng, Jingyi

    2016-12-20

    Radial artery applanation tonometry (RAAT) has been developed and utilized for continuous arterial pressure monitoring. However, evidence is lacking to clinically verify the RAAT technology and identify appropriate patient groups before routine clinical use. This study aims to evaluate the RAAT technology by comparing systolic blood pressure (SBP), mean blood pressure (MBP) and diastolic blood pressure (DBP) values in patients undergoing colon carcinoma surgery. Blood Pressure (BP) values obtained via RAAT (TL-300, Tensys Medical Inc., San Diego, CA, USA) and conventional arterial catheterization from 30 colon carcinoma surgical patients were collected and compared via Bland-Atman method, linear regression and 4-quadrant plot concordance analysis. For SBPs, MBPs and DBPs, means of the differences (±standard deviation; 95% limits of agreement) were -0.9 (±7.6; -15.7 to 13.9) mmHg, 3.1 (±6.5; -9.6 to 15.8) mmHg and 4.3 (±7.4; -10.3 to 18.8) mmHg, respectively. Linear regression coefficients of determination were 0.8706 for SBPs, 0.8353 for MBPs and 0.6858 for DBPs. Four-quadrant concordance correlation coefficients were 0.8740, 0.8522 and 0.7108 for SBPs, MBPs and DBPs, respectively. A highly selected patient collective undergoing colon carcinoma surgery was studied. BP measurements obtained via the TL-300 had clinically acceptable agreement with that acquired invasively using an arterial catheter. For use in clinical routine, it is necessary to take measures for improvement regarding movement artifacts and dilution of noise. A large sample size of patients under various conditions is also needed to further evaluate the RAAT technology before clinically routine use.

  8. PFA-100 test in the detection of platelet dysfunction and monitoring DDAVP in a patient with liver cirrhosis undergoing inguinal hernia repair

    Directory of Open Access Journals (Sweden)

    Vučelić Dragica

    2012-01-01

    Full Text Available Introduction. Hemostatic abnormalities in liver cirrhosis are complex and multifactorial and may predispose to prolonged hemorrhage following invasive procedures. Due to increased perioperative bleeding risks, patients with cirrhosis should undergo elective surgery after making medical preparations. It has been shown that 1-deamino-8-D-arginine vasopressin (DDAVP, desmopressin, can be used as a safe and effective remedy in preventing and treating bleeding in cirrhotics. However, there is still scarce information of adequate test(s for assessing effects of DDAVP in platelet dysfunction. The use of platelet function analyzer-100 (PFA-100 allows more reliable assessment of impaired primary hemostasis as well as follow-up of hemostatic changes induced by DDAVP effects. Case Outline. In a 49-year-old male with ethylic liver cirrhosis and prolonged bleeding time scheduled for elective left side inguinal hernia repair, we carried out PFA-100 testing to investigate the patient’s platelet functional status. Results were affirmative for the presence of platelet functional problems. By standard coagulation tests the patient was also identified as having secondary hemostasis. Preoperatively, PFA-100 was used to test the patient’s response to a standard dose of DDAVP, which was favorable. The patient was operated after medical preparations with DDAVP and vitamin K. Neither bleeding complications nor side effects of DDAVP were recorded in the perioperative period. Conclusion. The PFA-100 is a simple and reliable test for the assessment of primary hemostasis as well as in monitoring of DDAVP therapy.

  9. Early Prognostic Value of Monitoring Serum Free Light Chain in Patients with Multiple Myeloma Undergoing Autologous Stem Cell Transplantation.

    Science.gov (United States)

    Özkurt, Zübeyde Nur; Sucak, Gülsan Türköz; Akı, Şahika Zeynep; Yağcı, Münci; Haznedar, Rauf

    2017-03-16

    We hypothesized the levels of free light chains obtained before and after autologous stem cell transplantation can be useful in predicting transplantation outcome. We analyzed 70 multiple myeloma patients. Abnormal free light chain ratios before stem cell transplantation were found to be associated early progression, although without any impact on overall survival. At day +30, the normalization of levels of involved free light chain related with early progression. According to these results almost one-third reduction of free light chain levels can predict favorable prognosis after autologous stem cell transplantation.

  10. Glycemic Variability Assessed by Continuous Glucose Monitoring and Short-Term Outcome in Diabetic Patients Undergoing Percutaneous Coronary Intervention: An Observational Pilot Study

    Directory of Open Access Journals (Sweden)

    Annunziata Nusca

    2015-01-01

    Full Text Available Poor glycemic control is associated with unfavorable outcome in patients undergoing percutaneous coronary intervention (PCI, irrespective of diabetes mellitus. However a complete assessment of glycemic status may not be fully described by glycated hemoglobin or fasting blood glucose levels, whereas daily glycemic fluctuations may influence cardiovascular risk and have even more deleterious effects than sustained hyperglycemia. Thus, this paper investigated the effectiveness of a continuous glucose monitoring (CGM, registering the mean level of glycemic values but also the extent of glucose excursions during coronary revascularization, in detecting periprocedural outcome such as renal or myocardial damage, assessed by serum creatinine, neutrophil gelatinase-associated lipocalin (NGAL, and troponin I levels. High glycemic variability (GV has been associated with worse postprocedural creatinine and NGAL variations. Moreover, GV, and predominantly hypoglycemic variations, has been observed to increase in patients with periprocedural myocardial infarction. Thus, our study investigated the usefulness of CGM in the setting of PCI where an optimal glycemic control should be achieved in order to prevent complications and improve outcome.

  11. [Role of beta-carotene in the prevention of genotoxic damage in patients undergoing radiotherapy. Monitoring by the micronucleus test in exfoliative cells of the oral cavity].

    Science.gov (United States)

    Oldini, C; Malusardi, G; Grossi, L; Chiarelli, G

    1992-01-01

    Radiotherapic treatment of patients with carcinoma usually causes genotoxis damage. This has been studied recently using the test of micronuclei in esfoliated cells. This test presents methodologic advantages in compared with the classic citogenetic analysis and as it is carried out on esfolieted cells from the oral cavity it faithfully reflects the genotoxic damage undergone by the cells of the basal layer of the epitelium. The preliminary result obtained so far have confirmed the anticlastogenic activity of beta-carotene in fact, the frequence of micronuclei in esfolieted cells from the oral cavity in patients undergoing radiotherapy or undergoing treatment with beta-carotene is inferior to that of patients undergoing treatment with beta-carotene is inferior to that of patients undergoing radiotherapy without the subministration of carotenoids. Treatment with carotenoids does not influence the therapeutic efficiency of radiotherapy treatment. Therefore, the results seem to confirm that indirect ossidaction processes are involved in the mechanism of the clastogenic action of radiotherapia. The carotenoids seem to be able to contrast validly this undesirable effect without interfering with the desirable therapeutic effect.

  12. A nurse-led rheumatology clinic versus rheumatologist-led clinic in monitoring of patients with chronic inflammatory arthritis undergoing biological therapy: a cost comparison study in a randomised controlled trial.

    Science.gov (United States)

    Larsson, Ingrid; Fridlund, Bengt; Arvidsson, Barbro; Teleman, Annika; Svedberg, Petra; Bergman, Stefan

    2015-11-16

    Recommendations for rheumatology nursing management of chronic inflammatory arthritis (CIA) from European League Against Rheumatism (EULAR) states that nurses should take part in the monitoring patients' disease and therapy in order to achieve cost savings. The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic (NLC), based on person-centred care (PCC), versus a rheumatologist-led clinic (RLC), in monitoring of patients with CIA undergoing biological therapy. Patients with CIA undergoing biological therapy (n = 107) and a Disease Activity Score of 28 ≤ 3.2 were randomised to follow-up by either NLC or RLC. All patients met the rheumatologist at inclusion and after 12 months. In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC. The primary outcome was total annual cost of rheumatology care. A total of 97 patients completed the RCT at the 12 month follow-up. Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit, resulted in no additional contacts to the rheumatology clinic, but rather a decrease in the use of resources and a reduction of costs. The total annual rheumatology care costs including fixed monitoring, variable monitoring, rehabilitation, specialist consultations, radiography, and pharmacological therapy, generated € 14107.7 per patient in the NLC compared with € 16274.9 in the RCL (p = 0.004), giving a € 2167.2 (13 %) lower annual cost for the NLC. Patients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced resource use and at a lower annual cost by an NLC, based on PCC with no difference in clinical outcomes. This could free resources for more intensive monitoring of patients early in the disease or patients with high disease activity. The trial is registered as a clinical trial at the ClinicalTrials.gov (NCT01071447). Registration date: October 8

  13. Should patients undergoing a bronchoscopy be sedated?

    Science.gov (United States)

    Gonzalez, R; De-La-Rosa-Ramirez, I; Maldonado-Hernandez, A; Dominguez-Cherit, G

    2003-04-01

    The techniques, drugs and depth of sedation for flexible fiberoptic bronchoscopy is controversial, and several reports consider that the routine use of sedation is not a prerequisite. We evaluate whether the addition of sedation with propofol improves patient tolerance, compared to local anesthesic of the airway only. Eighteen patients with pneumonia undergoing flexible fiberoptic bronchoscopy were included in a randomized, single blind, prospective controlled study. The non-sedation group received airway topical anesthesia, whereas the sedation group received topical anesthesia and intravenous sedation with propofol. The degree of pain, cough, sensation of asphyxiation, degree of amnesia, global tolerance and acceptance of another bronchoscopy in the future were noted. Changes in blood pressure, heart rate and saturation of oxygen by pulse oximetry were also evaluated. The patients in sedation group had less cough (P < 0.05), pain (P < 0.01) and sensation of asphyxiation (P < 0.001). Global tolerance to the procedure was significantly better in the group under sedation (P < 0.01). These patients had total amnesia to the procedure (P < 0.0001), thus is more probable that will accept another bronchoscopy in the future (P < 0.01). There was a significant rise in heart rate and blood pressure in the patients without sedation. There were no differences in oxygen saturation (P = 0.75). Our results show that if we administer propofol for sedation, in addition to local anesthesia of the airway, the tolerance to the procedure is much better. Also it appears that sedation with propofol is safe if we carefully select and monitor the patient.

  14. Aspirin in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

    Devereaux, P J; Mrkobrada, Marko; Sessler, Daniel I

    2014-01-01

    BACKGROUND: There is substantial variability in the perioperative administration of aspirin in patients undergoing noncardiac surgery, both among patients who are already on an aspirin regimen and among those who are not. METHODS: Using a 2-by-2 factorial trial design, we randomly assigned 10......,010 patients who were preparing to undergo noncardiac surgery and were at risk for vascular complications to receive aspirin or placebo and clonidine or placebo. The results of the aspirin trial are reported here. The patients were stratified according to whether they had not been taking aspirin before...... the study (initiation stratum, with 5628 patients) or they were already on an aspirin regimen (continuation stratum, with 4382 patients). Patients started taking aspirin (at a dose of 200 mg) or placebo just before surgery and continued it daily (at a dose of 100 mg) for 30 days in the initiation stratum...

  15. Sleep Disorders in ESRD Patients Undergoing Hemodialysis

    OpenAIRE

    Mohammad Reza Abassi; Amin Safavi; Masoumeh Haghverdi; Babak Saedi

    2016-01-01

    Kidney failure affects different aspects of normal life. Among different manifestations, sleep problem can be considered as a common complaint of ESRD (End Stage Renal Disease) patients. In this study, we aimed to investigate the interrelationship between sleep disorders in ESRD patients and their characteristics. Through a cross-sectional study (2010-2011), 88 ESRD patients undergoing maintenance hemodialysis thrice weekly were recruited to enter the study. We used a self-administered questi...

  16. Coagulation management in patients undergoing neurosurgical procedures.

    Science.gov (United States)

    Robba, Chiara; Bertuetti, Rita; Rasulo, Frank; Bertuccio, Alessando; Matta, Basil

    2017-10-01

    Management of coagulation in neurosurgical procedures is challenging. In this contest, it is imperative to avoid further intracranial bleeding. Perioperative bleeding can be associated with a number of factors, including anticoagulant drugs and coagulation status but is also linked to the characteristic and the site of the intracranial disorder. The aim of this review will be to focus primarily on the new evidence regarding the management of coagulation in patients undergoing craniotomy for neurosurgical procedures. Antihemostatic and anticoagulant drugs have shown to be associated with perioperative bleeding. On the other hand, an increased risk of venous thromboembolism and hypercoagulative state after elective and emergency neurosurgery, in particular after brain tumor surgery, has been described in several patients. To balance the risk between thrombosis and bleeding, it is important to be familiar with the perioperative changes in coagulation and with the recent management guidelines for anticoagulated patients undergoing neurosurgical procedures, in particular for those taking new direct anticoagulants. We have considered the current clinical trials and literature regarding both safety and efficacy of deep venous thrombosis prophylaxis in the neurosurgical population. These were mainly trials concerning both elective surgical and intensive care patients with a poor grade intracranial bleed or multiple traumas with an associated severe traumatic brain injury (TBI). Coagulation management remains a major issue in patients undergoing neurosurgical procedures. However, in this field of research, literature quality is poor and further studies are necessary to identify the best strategies to minimize risks in this group of patients.

  17. Prospective Register Of patients undergoing repeated OFfice and Ambulatory Blood Pressure Monitoring (PROOF-ABPM): protocol for an observational cohort study.

    Science.gov (United States)

    Sheppard, James P; Martin, Una; Gill, Paramjit; Stevens, Richard; McManus, Richard J

    2016-10-31

    The diagnosis and management of hypertension depends on accurate measurement of blood pressure (BP) in order to target antihypertensive treatment appropriately. Most BP measurements take place in a clinic setting, but it has long been recognised that readings taken out-of-office (via home or ambulatory monitoring) estimate true underlying BP more accurately. Recent studies have shown that the change in clinic BP over multiple readings is a significant predictor of the difference between clinic and out-of-office BP. Used in combination with patient characteristics, this change has been shown to accurately predict a patient's out-of-office BP level. The present study proposes to collect real-life BP data to prospectively validate this new prediction tool in routine clinical practice. A prospective, multicentre observational cohort design will be used, recruiting patients from primary and secondary care. All patients attending participating centres for ambulatory BP monitoring will be eligible to participate. Anonymised clinical data will be collected from all eligible patients, who will be invited to give informed consent to permit identifiable data to be collected for data linkage to external outcome registries. Descriptive statistics will be used to calculate the sensitivity, specificity, positive and negative predictive values of the out-of-office BP prediction tool. Area under the receiver operator characteristic curve statistics will be used to examine model performance. Ethical approval for this study has been obtained from the National Research. Ethics Service Committee South Central-Oxford A (reference; 15/SC/0184), and site-specific R&D approval has been acquired from the relevant NHS trusts. All findings will be presented at relevant conferences and published in peer-reviewed journals, on the study website and disseminated in lay and social media where appropriate. Published by the BMJ Publishing Group Limited. For permission to use (where not already

  18. Sugammadex facilitates early recovery after surgery even in the absence of neuromuscular monitoring in patients undergoing laryngeal microsurgery: a single-center retrospective study.

    Science.gov (United States)

    Park, Eui-Seok; Lim, Byung Gun; Lee, Won-Joon; Lee, Il Ok

    2016-08-02

    In many countries, routine clinical anaesthesia does not always involve neuromuscular monitoring. In these clinical settings, the efficacy and safety of sugammadex use has not yet been confirmed. We investigated the efficacy and safety of sugammadex in the absence of neuromuscular monitoring. One hundred and forty patients who underwent laryngeal microsurgery with the use of rocuronium as a neuromuscular blocking agent, without the use of a neuromuscular monitoring device, were retrospectively investigated. The patients were randomly chosen among all the patients who met the inclusion criteria at a tertiary university hospital between July 2013 and February 2015 and were allocated to group S (sugammadex group) or group P (pyridostigmine group) according to the neuromuscular reversal agent administered. Five patients were excluded from analysis and 135 patients completed the study. Primary outcome was extubation time. Secondary outcomes were anaesthesia time, the correlation between anaesthesia time and extubation time, the total amount of rocuronium, and postoperative adverse events in the post-anaesthesia care unit (PACU). Extubation time was significantly shorter in group S (6.3 ± 3.9 min) than in group P (9.0 ± 5.4 min). Anaesthesia time was also significantly shorter in group S (30.7 ± 10.3 min) than in group P (35.8 ± 12.6 min). In the patients with an anaesthesia time of 30 min or less, there was a positive correlation between anaesthesia time and extubation time in group P (r = 0.453), but there was no significant relationship in group S. The total amount of rocuronium used was higher in group S (0.62 ± 0.11 mg kg(-1)) than in group P (0.38 ± 0.14 mg kg(-1)). Postoperative adverse events in the PACU were comparable between the groups, except for tachycardia events: the incidence of tachycardia was significantly lower in group S (8.0 %) than in group P (17.3 %). Sugammadex could shorten anaesthesia and extubation

  19. Reducing psychological distress in patients undergoing chemotherapy.

    Science.gov (United States)

    Milanti, Ariesta; Metsälä, Eija; Hannula, Leena

    Psychological distress is a common problem among patients with cancer, yet it mostly goes unreported and untreated. This study examined the association of a psycho-educational intervention with the psychological distress levels of breast cancer and cervical cancer patients undergoing chemotherapy. The design of the study was quasi-experimental, pretest-posttest design with a comparison group. One hundred patients at a cancer hospital in Jakarta, Indonesia, completed Distress Thermometer screening before and after chemotherapy. Fifty patients in the intervention group were given a psycho-educational video with positive reappraisal, education and relaxation contents, while receiving chemotherapy. Patients who received the psycho-educational intervention had significantly lower distress levels compared with those in the control group. Routine distress screening, followed by distress management and outcome assessment, is needed to improve the wellbeing of cancer patients.

  20. Unexplained hemolysis in patients undergoing ECMO: beware of hypertriglyceridemia.

    Science.gov (United States)

    Venado, A; Wille, K; Belott, S C; Diaz-Guzman, E

    2015-09-01

    Hemolysis is a common complication of extracorporeal membrane oxygenation (ECMO) support and is associated with increased mortality. Frequent monitoring of markers of hemolysis is performed at ECMO centers. We report two cases of spurious hemolysis caused by hypertriglyceridemia in patients undergoing ECMO support. Critically ill patients, including those receiving ECMO, may be at risk of developing medication-induced hypertriglyceridemia. The interference of lipids with the measurement of plasma free hemoglobin, a marker of hemolysis, should be recognized. Our cases highlight the importance of investigating hypertriglyceridemia as part of the assessment of unexplained hemolysis in patients supported with ECMO. © The Author(s) 2014.

  1. Sinusitis in patients undergoing allogeneic bone marrow transplantation - a review.

    Science.gov (United States)

    Drozd-Sokolowska, Joanna Ewa; Sokolowski, Jacek; Wiktor-Jedrzejczak, Wieslaw; Niemczyk, Kazimierz

    Sinusitis is a common morbidity in general population, however little is known about its occurrence in severely immunocompromised patients undergoing allogeneic hematopoietic stem cell transplantation. The aim of the study was to analyze the literature concerning sinusitis in patients undergoing allogeneic bone marrow transplantation. An electronic database search was performed with the objective of identifying all original trials examining sinusitis in allogeneic hematopoietic stem cell transplant recipients. The search was limited to English-language publications. Twenty five studies, published between 1985 and 2015 were identified, none of them being a randomized clinical trial. They reported on 31-955 patients, discussing different issues i.e. value of pretransplant sinonasal evaluation and its impact on post-transplant morbidity and mortality, treatment, risk factors analysis. Results from analyzed studies yielded inconsistent results. Nevertheless, some recommendations for good practice could be made. First, it seems advisable to screen all patients undergoing allogeneic hematopoietic stem cell transplantation with Computed Tomography (CT) prior to procedure. Second, patients with symptoms of sinusitis should be treated before hematopoietic stem cell transplantation (HSCT), preferably with conservative medical approach. Third, patients who have undergone hematopoietic stem cell transplantation should be monitored closely for sinusitis, especially in the early period after transplantation. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  2. Dermatillomania: In patient undergoing orthodontic treatment

    Directory of Open Access Journals (Sweden)

    Adit

    2014-01-01

    Full Text Available Dermatillomania is a disorder in which a person habitually picks their skin, and this is a form of self-injury. It can involve any part of the body, but usually involves the face, neck, arms and shoulders. Symptoms often follow an event that has caused severe emotional distress. A dermatillomania or compulsive skin picking episode may be a conscious response to anxiety or depression but is frequently done as an unconscious habit. In this case report, a patient undergoing orthodontic treatment was found to be suffering from dermatillomania and was treated using psychological counseling.

  3. Oral surgery in patients undergoing chemoradiation therapy.

    Science.gov (United States)

    Demian, Nagi M; Shum, Jonathan W; Kessel, Ivan L; Eid, Ahmed

    2014-05-01

    Oral health care in patients undergoing chemotherapy and/or radiation therapy can be complex. Care delivered by a multidisciplinary approach is timely and streamlines the allocation of resources to provide prompt care and to attain favorable outcomes. A hospital dentist, oral and maxillofacial surgeon, and a maxillofacial prosthodontist must be involved early to prevent avoidable oral complications. Prevention and thorough preparation are vital before the start of chemotherapy and radiation therapy. Oral complications must be addressed immediately and, even with the best management, can cause delays and interruption in treatment, with serious consequences for the outcome and prognosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Perioperative Education of Patient Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alexandros Zacharis

    2011-04-01

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

  5. Measuring radiation dose to patients undergoing fluoroscopically-guided interventions

    Science.gov (United States)

    Lubis, L. E.; Badawy, M. K.

    2016-03-01

    The increasing prevalence and complexity of fluoroscopically guided interventions (FGI) raises concern regarding radiation dose to patients subjected to the procedure. Despite current evidence showing the risk to patients from the deterministic effects of radiation (e.g. skin burns), radiation induced injuries remain commonplace. This review aims to increase the awareness surrounding radiation dose measurement for patients undergoing FGI. A review of the literature was conducted alongside previous researches from the authors’ department. Studies pertaining to patient dose measurement, its formalism along with current advances and present challenges were reviewed. Current patient monitoring techniques (using available radiation dosimeters), as well as the inadequacy of accepting displayed dose as patient radiation dose is discussed. Furthermore, advances in real-time patient radiation dose estimation during FGI are considered. Patient dosimetry in FGI, particularly in real time, remains an ongoing challenge. The increasing occurrence and sophistication of these procedures calls for further advances in the field of patient radiation dose monitoring. Improved measuring techniques will aid clinicians in better predicting and managing radiation induced injury following FGI, thus improving patient care.

  6. Sleep Disorders in ESRD Patients Undergoing Hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Abassi

    2016-04-01

    Full Text Available Kidney failure affects different aspects of normal life. Among different manifestations, sleep problem can be considered as a common complaint of ESRD (End Stage Renal Disease patients. In this study, we aimed to investigate the interrelationship between sleep disorders in ESRD patients and their characteristics. Through a cross-sectional study (2010-2011, 88 ESRD patients undergoing maintenance hemodialysis thrice weekly were recruited to enter the study. We used a self-administered questionnaire into which the data were reflected. The patients selected their specific sleep disorders using a nine-item scale while the Epworth Sleepiness Scale (ESS determined both the presence and severity of sleep disorders. The data was finally analyzed with their baseline characteristics, dialysis characteristics, medication/stimulants use, and clinical and biochemical parameters. Over 95% of the patients had, at least, one specific sleep disorder while the ESS revealed 36.36% of patients as normal, 59.09% as having mild sleep disorders, and 4.54% as having moderate to severe sleep disorders. Sleep disorders were significantly correlated with older ages (P=0.035, dialysis dose (P=0.001, blood creatinine levels (P=0.037, upper airways obstruction (P=0.035, hepatomegaly (P=0.006, hepatic failure (P=0.001, higher blood TSH levels (P=0.039, history of hypothyroidism (P=0.005, and the use of levodopa (P=0.004, anti-hypertensive medications (P=0.006, benzodiazepines (P=0.006, Eprex (Erythropoietin (P=0.001, Venofer (Iron Sucrose Injection (P=0.013, and phosphate-binders agents (P=0.018. Sleep disorders are common findings among ESRD patients and seem to be a more complicated issue than a simple accumulation of the wastes products in the body. Whatever the causes of sleep disorders are, disorder-specific treatments should be considered.

  7. Clinical effect of Fuzheng quyu therapy in patients undergoing ...

    African Journals Online (AJOL)

    undergoing radiotherapy after cervical carcinoma surgery ... level blood coagulation, and also improves quality of life (QoL) in patients undergoing radiotherapy after cervical ... require high postoperative QoL and hope to ... clinical symptoms.

  8. INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY.

    Science.gov (United States)

    Vidal, Eduardo Arevalo; Rendon, Francisco Abarca; Zambrano, Trino Andrade; García, Yudoco Andrade; Viteri, Mario Ferrin; Campos, Josemberg Marins; Ramos, Manoela Galvão; Ramos, Almino Cardoso

    Intestinal malrotation is a rare congenital anomaly. In adults is very difficult to recognize due to the lack of symptoms. Diagnosis is usually incidental during surgical procedures or at autopsy. To review the occurrence and recognition of uneventful intestinal malrotation discovered during regular cases of bariatric surgeries. Were retrospectively reviewed the medical registry of 20,000 cases undergoing bariatric surgery, from January 2002 to January 2016, looking for the occurrence of intestinal malrotation and consequences in the intraoperative technique and immediate evolution of the patients. Five cases (0,025%) of intestinal malrotation were found. All of them were males, aging 45, 49, 37,52 and 39 years; BMI 35, 42, 49, 47 and 52 kg/m2, all of them with a past medical history of morbid obesity. The patient with BMI 35 kg/m2 suffered from type 2 diabetes also. All procedures were completed by laparoscopic approach, with no conversions. In one patient was not possible to move the jejunum to the upper abdomen in order to establish the gastrojejunostomy and a sleeve gastrectomy was performed. In another patient was not possible to fully recognize the anatomy due to bowel adhesions and a single anastomosis gastric bypass was preferred. No leaks or bleeding were identified. There were no perioperative complications. All patients were discharged 72 h after the procedure and no immediate 30-day complications were reported. Patients with malrotation can successfully undergo laparoscopic bariatric surgery. May be necessary changes in the surgical original strategy regarding the malrotation. Surgeons must check full abdominal anatomical condition prior to start the division of the stomach. Má-rotação intestinal é rara anomalia congênita em adultos de difícil reconhecimento devido à falta de sintomas. O diagnóstico é feito geralmente incidentalmente durante procedimentos cirúrgicos ou durante autópsia. Verificar a ocorrência e reconhecimento não eventual

  9. Insulin pump therapy in patients with diabetes undergoing surgery.

    Science.gov (United States)

    Nassar, Adrienne A; Boyle, Mary E; Seifert, Karen M; Beer, Karen A; Apsey, Heidi A; Schlinkert, Richard T; Stearns, Joshua D; Cook, Curtiss B

    2012-01-01

    To assess perioperative management of patients with diabetes mellitus who were being treated with insulin pump therapy. We reviewed records for documentation of insulin pump status and glucose monitoring during preoperative, intraoperative, and postanesthesia care unit (PACU) phases of surgery. Thirty-five patients (21 men) with insulin pumps underwent surgical procedures between January 1, 2006, and December 31, 2010. Mean age was 56 years, mean diabetes duration was 31 years, and mean duration of insulin pump therapy was 7 years. All patients were white, and 29 had type 1 diabetes mellitus. Of the 50 surgical procedures performed during the study period, 16 were orthopedic, 9 were general surgical, 7 were urologic, and 7 were kidney transplant operations; the remaining 11 procedures were in other surgical specialties. The mean (± standard deviation) time in the preoperative area was 118 ± 75 minutes, mean intraoperative time was 177 ± 102 minutes, and mean PACU time was 170 ± 78 minutes. Of the 50 procedures, status of pump use was documented in 32 cases in the preoperative area, 14 cases intraoperatively, and 30 cases in the PACU. Glucose values were recorded in 47 cases preoperatively, 30 cases intraoperatively, and 48 cases in the PACU. Results showed inconsistent documentation of pump use and glucose monitoring throughout the perioperative period, even for patients with prolonged anesthesia and recovery times. It was often unclear whether the pump was in place and operational during the intraoperative period. Guidelines should be developed for management of insulin pump-treated patients who are to undergo surgery.

  10. Experiense with remineraling means in patients undergoing orthodontic treatment

    Directory of Open Access Journals (Sweden)

    Stepanova Ye.A.

    2011-03-01

    Full Text Available In patients undergoing orthodontic treatment using bracket-technology a high risk of caries development. The algorithm of preventive interventions for the prevention of hair demineralization of enamel of the teeth

  11. Coagulation profile in patients undergoing video-assisted thoracoscopic lobectomy

    DEFF Research Database (Denmark)

    Christensen, Thomas Decker; Vad, Henrik; Pedersen, Søren

    2017-01-01

    -, and the first two days postoperatively by standard coagulation blood test, thromboelastometry (ROTEM®) and thrombin generation. RESULTS: Patients undergoing potential curative surgery for lung cancer were not hypercoagulable preoperatively. There was no statistically significant difference in the majority...

  12. Perioperative Optimization of Patients Undergoing Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    C. E. Owers

    2012-01-01

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

  13. Accuracy of continuous noninvasive hemoglobin monitoring in patients undergoing cesarean section%剖宫产术患者连续无创血红蛋白监测的准确性

    Institute of Scientific and Technical Information of China (English)

    黄星辉; 姚伟瑜; 肖全胜; 李师阳

    2015-01-01

    目的:评价剖宫产术患者连续无创血红蛋白监测的准确性。方法择期行剖宫产术患者200例,孕周36~42周,年龄19~40岁,BMI 20.5~35.1 kg∕m2,ASA 分级Ⅰ或Ⅱ级。术中采用Masimo Radical⁃7连续无创血红蛋白监测仪监测Hb( SpHb)。分别于切皮前( T0)、胎盘娩出后( T1)、子宫止血缝合后(T2)、手术结束(T3)时抽取桡动脉血样2 ml,测定全血Hb(tHb),并于上述时点记录SpHb。采用Bland⁃Altman法进行一致性检验。结果 T0~T3时tHb分别为111±9、103±8、94±8和(89±7) g∕L,SpHb分别为124±9、120±12、108±9和(103±8) g∕L。 Bland⁃Altman一致性分析结果:T0~T3时 tHb与 SpHb偏离度分别为13.5、17.1、14.1和13.9 g∕L,95%可信区间分别为13.1~13.9、16.5~17.7、13.6~14.6、13.4~14.4 g∕L;一致性界限分别为8.4~18.6、9.1~25.1、7.8~20.4和7.4~20.4 g∕L,两种方法可以互换的界限范围为3.5~23.5、7.1~27.1、4.1~24.1和3.9~23.9 g∕L;实验室法和连续无创法的重复系数分别为16.5和15.8 g∕L;SpHb的相对误差分别为(4.6±1.0)%、(5.3±1.4)%、(4.9±1.2)%和(4.8±1.2)%。结论剖宫产术患者连续无创血红蛋白监测的准确性较高。%Objective To evaluate the accuracy of continuous noninvasive hemoglobin ( Hb ) monitoring in the patients undergoing cesarean section. Methods A total of 200 patients, at 36-42 weeks of gestation, aged 19-40 yr, with body mass index of 20.5-35.1 kg∕m2 , of ASA physical statusⅠorⅡ, undergoing elective cesarean section from June 2014 to October 2014 in our hospital, were enrolled. A sensor was positioned at patient′s finger and connected to the Masimo Radical⁃7 Pulse CO⁃Oximeter, a continuous noninvasive Hb measurement device. Noninvasive Hb obtained with Pulse CO⁃oximeter ( SpHb) was

  14. Patients Undergoing Dacryocystorhinostomy Surgery in Northern ...

    African Journals Online (AJOL)

    Department of Nursing and. Midwifery, Vesal ... A dacryocystorhinostomy (DCR) is the treatment of choice for most patients with .... Technology, Mazandaran University of Medical Sciences. References. 1. ... 1st ed. New Delhi: Jaypee. Brothers ...

  15. Patients direct costs to undergo TB diagnosis

    Institute of Scientific and Technical Information of China (English)

    Rachel M.Anderson de Cuevas; Lovett Lawson; Najla Al-Sonboli; Nasher Al-Aghbari; Isabel Arbide; Jeevan B.Sherchand; Emenyonu E.Nnamdi

    2016-01-01

    Background:A major impediment to the treatment of TB is a diagnostic process that requires multiple visits.Descriptions of patient costs associated with diagnosis use differentprotocols and are not comparable.Methods:We aimed to describe the direct costs incurred by adults attending TB diagnostic centres in four countries and factors associated with expenditure for diagnosis.Surveys of 2225 adults attending smear-microscopy centres in Nigeria,Nepal,Ethiopia and Yemen.Adults >18 years with cough >2 weeks were enrolled prospectively.Direct costs were quantified using structured questionnaires.Patients with costs >75th quartile were considered to have high expenditure (cases) and compared with patients with costs <75th quartile to identify factors associated with high expenditure.Results:The most significant expenses were due to clinic fees and transport.Most participants attended the centres with companions.High expenditure was associated with attending with company,residing in rural areas/other towns and illiteracy.Conclusions:The costs incurred by patients are substantial and share common patterns across countries.Removing user fees,transparent charging policies and reimbursing clinic expenses would reduce the poverty-inducing effects of direct diagnostic costs.In locations with limited resources,support could be prioritised for those most at risk of high expenditure;those who are illiterate,attend the service with company and rural residents.

  16. Systemic Assessment of Patients Undergoing Dental Implant ...

    African Journals Online (AJOL)

    Background: Procedure‑related and patient‑related factors influence the prognosis of dental implants ... Results: Out of 51, 29 patients were males while 22 were females, with ratio of 1.32:1. ... difference of average STAI‑State subscore before and after the surgery was ... bleeding, swelling, bruising, pain, and tenderness to.

  17. Experiences of patients undergoing chemotherapy - a qualitative ...

    African Journals Online (AJOL)

    body', with the subthemes dry and sensitive skin, changes in eating and bowel habits, fever and ... and will likely stay as near to the data as possible 7-8. Setting .... questioned why this had happened to them. ... years):“Other things I rarely eat because most of the time, ... I shouldn't smoke or take alcohol” (Patient E, male, 47.

  18. Clopidogrel Responsiveness in Patients Undergoing Peripheral Angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Pastromas, Georgios, E-mail: geopastromas@gmail.com; Spiliopoulos, Stavros, E-mail: stavspiliop@upatras.gr; Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr; Diamantopoulos, Athanasios, E-mail: adiamantopoulos@gmail.com; Kitrou, Panagiotis, E-mail: panoskitrou@gmail.com; Karnabatidis, Dimitrios, E-mail: karnaby@med.upatras.gr; Siablis, Dimitrios, E-mail: siablis@med.upatras.gr [Patras University Hospital, Department of Interventional Radiology (Greece)

    2013-12-15

    Purpose: To investigate the incidence and clinical significance of platelet responsiveness in patients receiving clopidogrel after peripheral angioplasty procedures. Materials and Methods: This prospective study included patients receiving antiplatelet therapy with clopidogrel 75 mg after infrainguinal angioplasty or stenting and who presented to our department during routine follow-up. Clopidogrel responsiveness was tested using the VerifyNow P2Y12 Assay. Patients with residual platelet reactivity units (PRU) {>=} 235 were considered as nonresponders (NR group NR), whereas patients with PRU < 235 were considered as normal (responders [group R]). Primary end points were incidence of resistance to clopidogrel and target limb reintervention (TLR)-free survival, whereas secondary end points included limb salvage rates and the identification of any independent predictors influencing clinical outcomes. Results: In total, 113 consecutive patients (mean age 69 {+-} 8 years) with 139 limbs were enrolled. After clopidogrel responsiveness analysis, 61 patients (53.9 %) with 73 limbs (52.5 %) were assigned to group R and 52 patients (46.1 %) with 66 limbs (47.5 %) to group NR. Mean follow-up interval was 27.7 {+-} 22.9 months (range 3-95). Diabetes mellitus, critical limb ischemia, and renal disease were associated with clopidogrel resistance (Fisher's exact test; p < 0.05). According to Kaplan-Meier analysis, TLR-free survival was significantly superior in group R compared with group NR (20.7 vs. 1.9 %, respectively, at 7-year follow-up; p = 0.001), whereas resistance to clopidogrel was identified as the only independent predictor of decreased TLR-free survival (hazard rate 0.536, 95 % confidence interval 0.31-0.90; p = 0.01). Cumulative TLR rate was significantly increased in group NR compared with group R (71.2 % [52 of 73] vs. 31.8 % [21 of 66], respectively; p < 0.001). Limb salvage was similar in both groups. Conclusion: Clopidogrel resistance was related with

  19. Nutrition support to patients undergoing gastrointestinal surgery

    Directory of Open Access Journals (Sweden)

    Ward Nicola

    2003-12-01

    Full Text Available Abstract Nutritional depletion has been demonstrated to be a major determinant of the development of post-operative complications. Gastrointestinal surgery patients are at risk of nutritional depletion from inadequate nutritional intake, surgical stress and the subsequent increase in metabolic rate. Fears of postoperative ileus and the integrity of the newly constructed anastomosis have led to treatment typically entailing starvation with administration of intravenous fluids until the passage of flatus. However, it has since been shown that prompt postoperative enteral feeding is both effective and well tolerated. Enteral feeding is also associated with specific clinical benefits such as reduced incidence of postoperative infectious complications and an improved wound healing response. Further research is required to determine whether enteral nutrition is also associated with modulation of gut function. Studies have indicated that significant reductions in morbidity and mortality associated with perioperative Total Parenteral Nutrition (TPN are limited to severely malnourished patients with gastrointestinal malignancy. Meta-analyses have shown that enteral nutrition is associated with fewer septic complications compared with parenteral feeding, reduced costs and a shorter hospital stay, so should be the preferred option whenever possible. Evidence to support pre-operative nutrition support is limited, but suggests that if malnourished individuals are adequately fed for at least 7–10 days preoperatively then surgical outcome can be improved. Ongoing research continues to explore the potential benefits of the action of glutamine on the gut and immune system for gastrointestinal surgery patients. To date it has been demonstrated that glutamine-enriched parenteral nutrition results in reduced length of stay and reduced costs in elective abdominal surgery patients. Further research is required to determine whether the routine supplementation of

  20. The effect of malnutrition on patients undergoing elective joint arthroplasty.

    Science.gov (United States)

    Huang, Ronald; Greenky, Max; Kerr, Glenn J; Austin, Matthew S; Parvizi, Javad

    2013-09-01

    Malnutrition has been linked to serious complications in patients undergoing elective total joint arthroplasty (TJA). This study prospectively evaluated 2,161 patients undergoing elective TJA for malnutrition as defined by either an abnormal serum albumin or transferrin. The overall incidence of malnutrition was 8.5% (184 of 2,161) and the rate of overall complications in the malnourished group was 12% as compared to 2.9% in patients with normal parameters (PMalnutrition predicted serious complications involving hematoma formation, infection, renal and cardiac complications. Obesity, defined by a body mass index (BMI) of 30kg/m(2) was present in 42.9% of malnourished patients with a significantly higher complication rate in this cohort. Malnutrition remains prevalent in patients >55years-old undergoing TJA and is associated with a significant increase in post-operative complications.

  1. Rosuvastatin and cardiovascular events in patients undergoing hemodialysis

    DEFF Research Database (Denmark)

    Fellström, Bengt C; Jardine, Alan G; Schmieder, Roland E;

    2009-01-01

    BACKGROUND: Statins reduce the incidence of cardiovascular events in patients at high cardiovascular risk. However, a benefit of statins in such patients who are undergoing hemodialysis has not been proved. METHODS: We conducted an international, multicenter, randomized, double-blind, prospective...... trial involving 2776 patients, 50 to 80 years of age, who were undergoing maintenance hemodialysis. We randomly assigned patients to receive rosuvastatin, 10 mg daily, or placebo. The combined primary end point was death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke......: In patients undergoing hemodialysis, the initiation of treatment with rosuvastatin lowered the LDL cholesterol level but had no significant effect on the composite primary end point of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. (ClinicalTrials.gov number, NCT00240331.)...

  2. Application of continuous noninvasive hemoglobin monitoring in patients undergoing liver transplantation%连续无创血红蛋白监测在肝移植术中的应用

    Institute of Scientific and Technical Information of China (English)

    朱辉; 曹强; 张燕; 苏殿三; 陈湧鸣; 王祥瑞

    2013-01-01

    目的 评价肝移植患者术中应用Masimo Radical-7脉搏氧测量仪连续、无创地监测血红蛋白的临床价值.方法 选择24例行原位肝移植的成年患者,应用Masimo Radical-7脉搏氧测量仪连续监测并分别记录患者麻醉诱导前及麻醉诱导后5 min、切皮后5 min、无肝期前5 min、无肝期、新肝期5 min、新肝期30 min、新肝期90 min、术毕(后8个时间点为术中数据)时的血红蛋白水平(SpHb值),同时于上述时间点抽取2 mL动脉血即刻行动脉血气分析并测定血红蛋白水平(THb值),并对应作记录后进行相关分析.结果 麻醉诱导前SpHb值与THb值呈线性相关(r=0.81,P<0.001),回归方程为y=1.66+0.785x;Bland-Altman一致性分析显示,SpHb与THb的差值的平均值为9 g/L,两者的差值95%CI为-26~44 g/L.术中SpHb值与THb值呈线性相关(r=0.75,P<0.001),回归方程为y=0.589+0.766x;Bland-Altman一致性分析显示,SpHb与THb的差值的平均值为20 g/L,两者的差值95%CI为-15~55 g/L.结论 肝移植术中,脉搏氧测量仪连续无创监测血红蛋白值与同时间点动脉血气分析测得的血红蛋白值之间具有良好的相关性,但术中准确性低于术前.%Objective To evaluate the value of continuous noninvasive hemoglobin (SpHb) measured by Masimo Radical-7 Pulse CO-Oximeter in patients undergoing liver transplantation. Methods Twenty-four adult patients undergoing orthotopic liver transplantation were enrolled in this study. SpHb was monitored continually and recorded before induction of anesthesia, 5 minutes after induction of anesthesia, 5 minutes after skin incision, 5 minutes before anhepatic phase, at anhepatic phase, 5, 30 and 90 minutes in neohepatic phase, and at the end of surgery (the data at the last 8 time points was regarded as intraoperative SpHb). The arterial blood samples were collected and invasive hemoglobin (THb) levels were measured at above mentioned time points. THb levels were compared with

  3. Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.

    Science.gov (United States)

    Watters, William; Rethman, Michael P; Hanson, Nicholas Buck; Abt, Elliot; Anderson, Paul A; Carroll, Karen C; Futrell, Harry C; Garvin, Kevin; Glenn, Stephen O; Hellstein, John; Hewlett, Angela; Kolessar, David; Moucha, Calin; O'Donnell, Richard J; O'Toole, John E; Osmon, Douglas R; Evans, Richard Parker; Rinella, Anthony; Steinberg, Mark J; Goldberg, Michael; Ristic, Helen; Boyer, Kevin; Sluka, Patrick; Martin, William Robert; Cummins, Deborah S; Song, Sharon; Woznica, Anne; Gross, Leeaht

    2013-03-01

    The Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures evidence-based clinical practice guideline was codeveloped by the American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association. This guideline replaces the previous AAOS Information Statement, "Antibiotic Prophylaxis in Bacteremia in Patients With Joint Replacement," published in 2009. Based on the best current evidence and a systematic review of published studies, three recommendations have been created to guide clinical practice in the prevention of orthopaedic implant infections in patients undergoing dental procedures. The first recommendation is graded as Limited; this recommendation proposes that the practitioner consider changing the long-standing practice of routinely prescribing prophylactic antibiotic for patients with orthopaedic implants who undergo dental procedures. The second, graded as Inconclusive, addresses the use of oral topical antimicrobials in the prevention of periprosthetic joint infections. The third recommendation, a Consensus statement, addresses the maintenance of good oral hygiene.

  4. Predictors of seizure occurrence in children undergoing pre-surgical monitoring.

    Science.gov (United States)

    Harini, Chellamani; Singh, Kanwaljit; Takeoka, Masanori; Parulkar, Isha; Bergin, Ann Marie; Loddenkemper, Tobias; Kothare, Sanjeev V

    2013-10-01

    Long-Term-Monitoring (LTM) is a valuable tool for seizure localization/lateralization among children with refractory-epilepsy undergoing pre-surgical-monitoring. The aim of this study was to examine the factors predicting occurrence of single/multiple seizures in children undergoing pre-surgical monitoring in the LTM unit. Chart review was done on 95 consecutive admissions on 92 children (40 females) admitted to the LTM-unit for pre-surgical workup. Relationship between occurrence of multiple (≥ 3) seizures and factors such as home seizure-frequency, demographics, MRI-lesions/seizure-type and localization/AED usage/neurological-exam/epilepsy-duration was evaluated by logistic-regression and survival-analysis. Home seizure-frequency was further categorized into low (up-to 1/month), medium (up-to 1/week) and high (>1/week) and relationship of these categories to the occurrence of multiple seizures was evaluated. Mean length of stay was 5.24 days in all 3 groups. Home seizure frequency was the only factor predicting the occurrence of single/multiple seizures in children undergoing presurgical workup. Other factors (age/sex/MRI-lesions/seizure-type and localization/AED-usage/neurological-exam/epilepsy-duration) did not affect occurrence of single/multiple seizures or time-to-occurrence of first/second seizure. Analysis of the home-seizure frequency categories revealed that 98% admissions in high-frequency, 94% in the medium, and 77% in low-frequency group had at-least 1 seizure recorded during the monitoring. Odds of first-seizure increased in high vs. low-frequency group (p=0.01). Eighty-nine percent admissions in high-frequency, 78% in medium frequency, versus 50% in low-frequency group had ≥ 3 seizures. The odds of having ≥ 3 seizures increased in high-frequency (p=0.0005) and in medium-frequency (p=0.007), compared to low-frequency group. Mean time-to-first-seizure was 2.7 days in low-frequency, 2.1 days in medium, and 2 days in high-frequency group. Time

  5. The application of noninvasive hemodynamic monitoring for evaluation of volume status in patients undergoing hemodialysis%应用无创血流动力学监测评估血液透析容量状况研究

    Institute of Scientific and Technical Information of China (English)

    张俊霞; 徐金升; 周薇; 崔立文; 白亚玲

    2012-01-01

    目的 应用无创血流动力学监测评估维持性血液透析( MHD)患者的容量状况.方法 选择2011年8月至2012年1月河北医科大学第四医院血液净化中心行MHD治疗的患者42例,同时收集健康志愿者200名.应用BioZ.com无创血流动力学监测仪测量200名健康志愿者及42例MHD患者的胸液含量(TFC),观察患者容量负荷状况.结果 正常男性TFC高于正常女性(29.91±2.05对25.61±1.95,P<0.05).正常参考值范围(均数±1个标准差)为男性27.86~31.96 kOhm-1,女性23.66~27.56 kOhm-1.病例组中TFC偏高亚组(男性>31.96 kO-hm-1,女性>27.56 kOhm-1)、TFC正常亚组(男性在27.86 ~ 31.96 kOhm-1之间,女性在23.66 ~ 27.56 kOhm -1之间),TFC偏低亚组(男性<27.86 kOhm-1,女性<23.66 kOhm -1)分别占28.57%、47.62%、23.81%.应用Maltron BioScan 916生物电阻抗分析仪测量MHD患者总体水占体重百分比(TBW%).TFC偏高亚组TBW%高于正常人群(P<0.05),TFC正常亚组TBW%在正常范围内(P>0.05),TFC偏低亚组TBW%低于正常人群(P<0.05).TFC变化量(△TFC=TFC透析后- TFC透析前)与超滤量(ultrafiltration,UF)呈负相关(r=- 0.699,P<0.01),回归方程为UF=1.545 -0.223×△TFC.结论 应用BioZ.com无创血流动力学监测仪评估MHD患者的容量状态方法与全身生物电阻抗分析法具有良好的相关性,能够在临床判断干体重达标的基础之上进一步准确、客观地评估干体重,对干体重的调整有一定的指导意义.%Objective To evaluate the volume status in patients undergoing maintenance hemodialysis (MHD) using noninvasive hemodynamic monitoring. Methods BioZ. com noninvasive hemodynamic monitoring system was used to measure the thoracic fluid content (TFC) in 200 healthy volunteers and 42 patients treated with MHD. The volume status of patients was then observed. Results TFC of normal males is higher than that of normal females (29. 91 ±2. 05 vs 25. 61 ± 1. 95, P 31.96 kOhm-1

  6. General Anaesthesia Protocols for Patients Undergoing Electroconvulsive Therapy

    Science.gov (United States)

    Narayanan, Aravind; Lal, Chandar; Al-Sinawi, Hamed

    2017-01-01

    Objectives This study aimed to review general anaesthesia protocols for patients undergoing electroconvulsive therapy (ECT) at a tertiary care hospital in Oman, particularly with regards to clinical profile, potential drug interactions and patient outcomes. Methods This retrospective study took place at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman. The electronic medical records of patients undergoing ECT at SQUH between January 2010 and December 2014 were reviewed for demographic characteristics and therapy details. Results A total of 504 modified ECT sessions were performed on 57 patients during the study period. All of the patients underwent a uniform general anaesthetic regimen consisting of propofol and succinylcholine; however, they received different doses between sessions, as determined by the treating anaesthesiologist. Variations in drug doses between sessions in the same patient could not be attributed to any particular factor. Self-limiting tachycardia and hypertension were periprocedural complications noted among all patients. One patient developed aspiration pneumonitis (1.8%). Conclusion All patients undergoing ECT received a general anaesthetic regimen including propofol and succinylcholine. However, the interplay of anaesthetic drugs with ECT efficacy could not be established due to a lack of comprehensive data, particularly with respect to seizure duration. In addition, the impact of concurrent antipsychotic therapy on anaesthetic dose and subsequent complications could not be determined. PMID:28417028

  7. Analyzing intra-abdominal pressures and outcomes in patients undergoing emergency laparotomy

    Directory of Open Access Journals (Sweden)

    Khan Shehtaj

    2010-01-01

    Full Text Available Background : Studies have documented the impact of intra-abdominal hypertension (IAH on virtually every organ. However, it still remains strangely underdiagnosed. The aims of the study were to assess, in patients undergoing emergency laparotomy, whether intra-abdominal pressure (IAP is an independent predictor of morbidity and mortality, to evaluate the effects of IAH, and to identify hidden cases of abdominal compartment syndrome (ACS. Materials and Methods : The study comprised 197 patients undergoing emergency laparotomy. IAP was measured preoperatively and then postoperatively at 0, 6, and 24 hours. Duration of hospital stay, occurrence of burst abdomen, and mortality were noted as outcomes. Results : At admission, incidence of IAH was 80%. No significant association was found between IAP and occurrence of burst abdomen (P > 0.1. IAP was found to be a significant predictor of mortality in patients undergoing laparotomy (P < 0.001. Elevated IAP was found to affect all the organ systems adversely. The incidence of post-op ACS was 3.05% in the general population and 13.16% in trauma patients. The mortality rate for this subgroup was 100%. Conclusions : IAP is a significant predictor of mortality in patients undergoing laparotomy. IAH has detrimental effects on various organ systems. A more frequent monitoring with prompt decompression may be helpful in decreasing the mortality rate. Further studies are required to establish a screening protocol in patients undergoing laparotomy to detect and manage cases of IAH and ACS.

  8. Sedation versus general anaesthesia in paediatric patients undergoing chest CT

    Energy Technology Data Exchange (ETDEWEB)

    Lam, W.W.M.; So, N.M.C.; Metreweli, C. [Chinese Univ. of Hong Kong, Dept. of Diagnostic Radiology and Organ Imaging (China); Chen, P.P. [Chinese Univ. of Hong Kong, Anaesthesiology and Intensive Care (China)

    1998-05-01

    Objective: CT of the chest in paediatric patients often requires sedation or general anaesthesia to minimize motion artefacts. Both sedation and general anaesthesia are associated with atelectasis which obscures the underlying pulmonary pathology. We conducted a prospective study to compare these two methods with respect to degree of motion artefacts and extent of atelectasis. Material and Methods: Nineteen patients undergoing 22 chest CT examinations were randomly selected for either sedation or general anaesthesia. The total area of atelectasis and the degree of motion artefacts were measured. Results: The mean percentage of atelectasis was 6.67% for general anaesthesia and 0.01% for sedation (p=0.01). There was no significant difference in the quality of the images between the sedation patients and the general anaesthesia patients. Conclusion: Whenever the clinical condition permits it, sedation rather than general anaesthesia should be given to paediatric patients undergoing chest CT. (orig.).

  9. Inflammatory response in patients undergoing uterine artery embolization as compared to patients undergoing conventional hysterectomy

    DEFF Research Database (Denmark)

    Brøchner, A C; Mygil, B; Elle, B;

    2009-01-01

    : To investigate whether uterine artery embolization generates a reduced inflammatory response as compared with conventional hysterectomy. MATERIAL AND METHODS: 40 women, 20 in each group, entered this prospective, non-randomized study. The two groups were comparable concerning age, comorbidity, and body......-mass index (BMI). RESULTS: We found a significant difference between the inflammatory responses in women undergoing embolization compared with the inflammatory response in women having an abdominal hysterectomy. Women undergoing embolization were subjected to a much smaller inflammatory burden, their total...... morphine consumption was lower, and their return to work was faster than women subjected to conventional hysterectomy. CONCLUSION: Uterine artery embolization generates a reduced inflammatory response compared with conventional hysterectomy....

  10. Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Whitlock, Richard P; Chan, Simon; Devereaux, P J;

    2008-01-01

    We sought to establish the efficacy and safety of prophylactic steroids in adult patients undergoing cardiopulmonary bypass (CPB). We performed a meta-analysis of randomized trials reporting the effects of prophylactic steroids on clinical outcomes after CPB. Outcomes examined were mortality...

  11. Fecal corticoid monitoring in whooping cranes (Grus americana) undergoing reintroduction

    Science.gov (United States)

    Hartup, Barry K.; Olsen, Glenn H.; Czekala, Nancy M.

    2005-01-01

    We used radioimmunoassay to determine fecal corticoid concentrations and assess potential stress in 10 endangered whooping cranes (Grus americana) undergoing reintroduction to the wild. Fecal samples were collected shortly after hatching at a captive facility in Maryland, during field training in Wisconsin, and throughout a human-led migration to Florida. After a 14-day decline following hatching, fecal corticoid concentrations stabilized at baseline levels for the duration of the captive period, despite exposure to potentially stressful stimuli. Shipment of the cranes to the field training site was correlated with an eight- to 34-fold increase in fecal corticoid concentrations, which returned to baseline levels within 1 week. Increases were positively correlated with age but not body weight at the time of shipping. Fecal corticoid concentrations during the training period increased slightly and exhibited greater variation than levels observed at the captive facility, but were well within expected norms based on previous studies. Fecal corticoid concentrations increased twofold following premigration physical examinations and placement of radiotransmitters, and persisted for up to 4 days before they returned to baseline levels. Though fecal corticoid concentrations and variation during the migration period were similar to training levels, there was an overall decline in fecal corticoid concentrations during the artificial migration. Acute stressors, such as capture, restraint, and severe storms, were associated with stress responses by the cranes that varied in accordance with lasting physical or psychological stimuli. The overall reintroduction process of costume-rearing, ultralight aircraft habituation, training, and artificial migration was not associated with elevations in fecal corticoid concentrations suggestive of chronic stress.

  12. Nursing Care of Patients Undergoing Chemotherapy Desensitization: Part II.

    Science.gov (United States)

    Jakel, Patricia; Carsten, Cynthia; Carino, Arvie; Braskett, Melinda

    2016-04-01

    Chemotherapy desensitization protocols are safe, but labor-intensive, processes that allow patients with cancer to receive medications even if they initially experienced severe hypersensitivity reactions. Part I of this column discussed the pathophysiology of hypersensitivity reactions and described the development of desensitization protocols in oncology settings. Part II incorporates the experiences of an academic medical center and provides a practical guide for the nursing care of patients undergoing chemotherapy desensitization.
.

  13. Nursing care for patients undergoing transoral robotic surgery.

    Science.gov (United States)

    Murray, Shannon

    2009-01-01

    Otorhinolaryngologists began developing new operative techniques to minimize open surgical resections of the head and neck. While striving to reduce the morbidity and mortality associated with head and neck surgery and decrease the many psychosocial issues facing these patients, a new procedure defined as Transoral Robotic Surgery (TORS) was developed. With the development of new surgical techniques, nursing care must also change to meet the needs of the patient. As the TORS procedure becomes fully defined, so is nursing's role in the care of the patient. This paper aims to define TORS and discuss the nursing care of the patient undergoing this new surgical procedure.

  14. Laparoscopy decreases complications for obese patients undergoing elective rectal surgery.

    Science.gov (United States)

    Vargas, Gabriela M; Sieloff, Eric P; Parmar, Abhishek D; Tamirisa, Nina P; Mehta, Hemalkumar B; Riall, Taylor S

    2016-05-01

    While there are many reported advantages to laparoscopic surgery compared to open surgery, the impact of a laparoscopic approach on postoperative morbidity in obese patients undergoing rectal surgery has not been studied. Our goal was to determine whether obese patients undergoing laparoscopic rectal surgery experienced the same benefits as non-obese patients. We identified patients undergoing rectal resections using the National Surgical Quality Improvement Project Participant Use Data File. We performed multivariable analyses to determine the independent association between laparoscopy and postoperative complications. A total of 26,437 patients underwent rectal resection. The mean age was 58.5 years, 32.6 % were obese, and 47.2 % had cancer. Laparoscopic procedures were slightly less common in obese patients compared to non-obese patients (36.0 vs. 38.2 %, p = 0.0006). In unadjusted analyses, complications were lower with the laparoscopic approach in both obese (18.9 vs. 32.4 %, p obese (15.6 vs. 25.3 %, p obesity worsened. The likelihood of experiencing a postoperative complication increased by 25, 45, and 75 % for obese class I, obese class II, and obese class III patients, respectively. A laparoscopic approach was associated with a 40 % decreased odds of a postoperative complication for all patients (OR 0.60, 95 % CI 0.56-0.64). Laparoscopic rectal surgery is associated with fewer complications when compared to open rectal surgery in both obese and non-obese patients. Obesity was an independent risk factor for postoperative complications. In appropriately selected patients, rectal surgery outcomes may be improved with a minimally invasive approach.

  15. Venous thromboembolism in 13 Indonesian patients undergoing major orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Karmel L. Tambunan

    2009-12-01

    Full Text Available Aim: To estimate the incidence of VTE in Indonesian patients undergoing major orthopedic surgery and not receiving thromboprophylaxis.Methods: This was an open clinical study of consecutive Indonesian patients undergoing major orthopedic surgery, conducted in 3 centers in Jakarta. Bilateral venography was performed between days 5 and 8 after surgery to detect the asymptomatic and to confi rm the symptomatic VTE. These patients were followed up to one month after surgery.Results: A total of 17 eligible patients were studied, which a median age of 69 years and 76.5% were females. Sixteen out of the 17 patients (94.1% underwent hip fracture surgery (HFS. The median time from injury to surgery was 23 days (range 2 to 197 days, the median duration of surgery was 90 minutes (range 60 to 255 minutes, and the median duration of immobilization was 3 days (range 1 to 44 days. Thirteen out of the 17 patients were willing to undergo contrast venography. A symptomatic VTE was found in 9 patients (69.2% at hospital discharge. Symptomatic VTE was found in 3 patients (23.1%, all corresponding to clinical signs of DVT and none with clinical sign of PE. These patients were treated initially with a low molecular weight heparin, followed by warfarin. Sudden death did not occur up to hospital discharge. From hospital discharge until 1-month follow-up, there were no additional cases of symptomatic VTE. No sudden death, bleeding complication, nor re-hospitalization was found in the present study.Conclusion: The incidence of asymptomatic (69.2% and symptomatic (23.1% VTE after major orthopedic surgery without thromboprophylaxis in Indonesian patients (SMART and AIDA, and still higher than the results of the Western studies. A larger study is required to establish the true incidence, and more importantly, that the use of thromboprophylaxis in these patients is warranted. (Med J Indones 2009; 18: 249-56Keywords: venous thromboembolism (VTE, orthopedic surgery, Indonesia

  16. Fospropofol disodium injection for the sedation of patients undergoing colonoscopy.

    Science.gov (United States)

    Levitzky, Benjamin E; Vargo, John J

    2008-08-01

    Sedation plays a central role in making colonoscopy tolerable for patients and feasible for the endoscopist to perform. The array of agents used for endoscopic sedation continues to evolve. Fospropofol (FP), a prodrug of propofol with a slower pharmacokinetic profile, is currently under evaluation for use during endoscopic procedures. Preliminary data suggests that FP dosed at 6.5 mg/kg is well tolerated by most patients with perineal paresthesias being the most commonly experienced adverse effect. This article will examine the current literature on the use of FP for the sedation of patients undergoing colonoscopy, highlighting the pharmacokinetics, pharmacodynamics, risks, and common adverse events associated with the novel sedative/hypnotic.

  17. Estimating glomerular filtration rate preoperatively for patients undergoing hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Yoshimi Iwasaki; Tokihiko Sawada; Shozo Mori; Yukihiro Iso; Masato Katoh; Kyu Rokkaku; Junji Kita; Mitsugi Shimoda; Keiichi Kubota

    2009-01-01

    AIM: To compare creatinine clearance (Ccr) with estimated glomerular filtration rate (eGFR) in preoperative renal function tests in patients undergoing hepatectomy. METHODS: The records of 197 patients undergoing hepatectomy between August 2006 and August 2008 were studied, and preoperative Ccr, a three-variable equation for eGFR (eGFR3) and a five-variable equation for eGFR (eGFR5) were calculated. Abnormal values were defined as Ccr < 50 mL/min, eGFR3 and eGFR5 < 60 mL/min per 1.73 m2. The maximum increases in the postoperative serum creatinine (post Cr) level and postoperative rate of increase in the serum Cr level (post Cr rate) were compared. RESULTS: There were 37 patients (18.8%) withabnormal Ccr, 31 (15.7%) with abnormal eGFR3, and 40 (20.3%) with abnormal eGFR5. Although there were no significant differences in the post Cr rate between patients with normal and abnormal Ccr, eGFR3 and eGFR5 values, the post Cr level was significantly higher in patients with eGFR3 and eGFR5 abnormality than in normal patients ( P < 0.0001). Post Cr level tended to be higher in patients with Ccr abnormality ( P = 0.0936 and P = 0.0875, respectively). CONCLUSION: eGFR5 and the simpler eGFR3, rather than Ccr, are recommended as a preoperative renal function test in patients undergoing hepatectomy.

  18. Cerebroprotective effect of piracetam in patients undergoing open heart surgery.

    Science.gov (United States)

    Holinski, Sebastian; Claus, Benjamin; Alaaraj, Nour; Dohmen, Pascal Maria; Neumann, Konrad; Uebelhack, Ralf; Konertz, Wolfgang

    2011-01-01

    Reduction of cognitive function is a possible side effect after the use of cardiopulmonary bypass (CPB) during cardiac surgery. Since it has been proven that piracetam is cerebroprotective in patients undergoing coronary bypass surgery, we investigated the effects of piracetam on the cognitive performance of patients undergoing open heart surgery. Patients scheduled for elective open heart surgery were randomized to the piracetam or placebo group in a double-blind study. Patients received 12 g of piracetam or placebo at the beginning of the operation. Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer's Disease Assessment Scale were performed preoperatively and on day 3, postoperatively. To assess the overall cognitive function and the degree of cognitive decline across all tests after the surgery, we combined the six test-scores by principal component analysis. A total of 88 patients with a mean age of 67 years were enrolled into the study. The mean duration of CPB was 110 minutes. Preoperative clinical parameters and overall cognitive functions were not significantly different between the groups. The postoperative combined score of the neuropsychological tests showed deterioration of cognitive function in both groups (piracetam: preoperative 0.19 ± 0.97 vs. postoperative -0.97 ± 1.38, p piracetam did not perform better than those taking placebo, and both groups had the same decline of overall cognitive function (p = 0.955). Piracetam had no cerebroprotective effect in patients undergoing open heart surgery. Unlike the patients who underwent coronary surgery, piracetam did not reduce the early postoperative decline of neuropsychological abilities in heart valve patients.

  19. [Pharmacokinetics of defibrotide in uremic patients undergoing hemodialysis].

    Science.gov (United States)

    Rossi, R; Farma, A; Maggi, G C; Marelli, A

    1991-12-01

    Defibrotide pharmacokinetics were studied in 6 voluntary healthy subjects and in 10 uremic patients undergoing dialysis during which (instead of heparin) defibrotide was administered to prevent fibrino-formation in the circuit. Blood concentrations of the drug were assessed (expressed with reference to the residual glycidic deoxyribose) during a standard dialysis using defibrotide, 3.5, 15, 30, 45, 60 and 90 minutes after the defibrotide bolus (200 mg) had been injected into the arterial channel. The half-lives of the alpha and beta plasmatic phases were found to be equal at 3.79 and 41.4 min in dialysed subjects and at 1.13 and 16.54 in healthy volunteers. These results indicate that in uremic patients undergoing dialysis at intervals using defibrotide, a longer time is required to eliminate the drug from the circulation. This variation does not however appear to be significant in terms of the therapeutic use of the drug during dialysis.

  20. Knowledge of electromyography (EMG) in patients undergoing EMG examinations.

    Science.gov (United States)

    Mondelli, Mauro; Aretini, Alessandro; Greco, Giuseppe

    2014-01-01

    The aim of this study was to evaluate knowledge of electromyography (EMG) in patients undergoing the procedure. In one year, 1,586 consecutive patients (mean age 56 years; 58.8% women) were admitted to two EMG labs to undergo EMG for the first time. The patients found to be "informed" about the how an EMG examination is performed and about the purpose of EMG numbered 448 (28.2%), while those found to be "informed" only about the manner of its execution or only about its purpose numbered 161 (10.2%) and 151 (9.5%), respectively. The remaining 826 (52.1%) patients had either no information, or the information they had was very poor or incorrect (this was particularly true if they had been consulting websites). Being "informed" was associated with level of education (high), type of referring physician (specialist) and with an appropriate referral diagnosis specified in the EMG request. The quality of patient information on EMG was found to be very poor and could be improved. Physicians referring patients for EMG examinations, especially general practitioners, should assume primary responsibility for patient education and counseling in this field.

  1. Cerebroprotective effect of piracetam in patients undergoing coronary bypass burgery.

    Science.gov (United States)

    Holinski, Sebastian; Claus, Benjamin; Alaaraj, Nour; Dohmen, Pascal Maria; Kirilova, Kremena; Neumann, Konrad; Uebelhack, Ralf; Konertz, Wolfgang

    2008-11-01

    Reduction of cognitive function is a possible side effect after cardiac surgery using cardiopulmonary bypass. We investigated the cerebroprotective effect of piracetam on cognitive performance in patients undergoing coronary artery bypass surgery under cardiopulmonary bypass. Patients scheduled for elective, primary and isolated coronary bypass surgery were randomised either to piracetam or placebo group. The study was performed in a double blind fashion. Patients received either 12 g piracetam or placebo at the beginning of the operation. Six neuropsychological subtests from the Syndrom Kurz Test and the Alzheimer's Disease Assessment Scale were performed preoperatively and on the third postoperative day. To assess the overall cognitive function and the degree of cognitive decline across all tests after surgery we combined the six test-scores by principal component analysis. A total number of 120 patients were enrolled into the study. Preoperative overall cognitive function were not significantly different between the groups. The postoperative combined score of the neuropsychological tests showed a deterioration of cognitive function in both groups (placebo-pre: -0.06+/-0.99 vs placebo-post: -1.38+/-1.11; ppiracetam-pre: 0.06+/-1.02 vs piracetam-post: -0.65+/-0.93; ppiracetam patients performed significantly better compared to the placebo patients after the operation and had a less decline of overall cognitive function (pPiracetam has a cerebroprotective effect in patients undergoing coronary artery bypass surgery with the use of cardiopulmonary bypass. It reduces an early postoperative substantial decline of neuropsychological abilities.

  2. Prevalence of renal artery stenosis in patients undergoing cardiac catheterization.

    Science.gov (United States)

    Marcantoni, Carmelita; Carmelita, Marcantoni; Rastelli, Stefania; Stefania, Rastelli; Zanoli, Luca; Luca, Zanoli; Tripepi, Giovanni; Giovanni, Tripepi; Di Salvo, Marilena; Marilena, Di Salvo; Monaco, Sergio; Sergio, Monaco; Sgroi, Carmelo; Carmelo, Sgroi; Capodanno, Davide; Davide, Capodanno; Tamburino, Corrado; Corrado, Tamburino; Castellino, Pietro; Pietro, Castellino

    2013-08-01

    To investigate the prevalence of significant renal artery stenosis (RAS ≥50%), and to identify clinical predictors for significant RAS in patients with an elevated cardiovascular risk, such as those affected by ischemic heart disease. In patients with an elevated cardio-vascular risk, both atherosclerotic renovascular disease and coronary artery disease (CAD) are likely to occur. Prospectively from April 2007 to March 2008, all consecutive patients with ischemic heart disease undergoing non-emergent cardiac catheterization were also evaluated for atherosclerotic RAS by renal arteriography. A RAS ≥50% was considered as significant. A total of 1,298 patients underwent cardiac and renal angiography. Significant RAS was found in 70 out of 1,298 patients (5.4%). The presence of peripheral vascular disease, eGFR 66 years, dyslipidemia, CAD severity and pulse pressure >52 mmHg were independent clinical predictors of significant RAS, and jointly produced a ROC AUC of 0.79 (95% CI 0.73-0.85, P < 0.001). Based on these data, a prediction rule for significant RAS was developed, and it showed an adequate predictive performance with 64% sensitivity and 82% specificity. In a large cohort of patients undergoing coronary angiography, significant RAS is a relatively rare comorbidity (5.4%). A model based on simple clinical variables may be useful for the clinical identification of high CV risk patients who may be suitable for renal arteriography at the time of cardiac catheterization.

  3. The impact of patients controlled analgesia undergoing orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Aluane Silva Dias

    2016-06-01

    Full Text Available ABSTRACT INTRODUCTION: The currently common musculoskeletal disorders have been increasingly treated surgically, and the pain can be a limiting factor in postoperative rehabilitation. RATIONALE: Patient controlled analgesia (PCA controls pain, but its adverse effects can interfere with rehabilitation and in the patient discharge process. This study becomes important, since there are few studies evaluating this correlation. OBJECTIVES: To compare the outcomes of patients who used and did not use patient controlled analgesia in postoperative orthopedic surgery with respect to pain, unscheduled need for O2 (oxygen, and time of immobility and in-hospital length of stay. METHODS: This is an observational, prospective study conducted at Hospital Abreu Sodré from May to August 2012. The data was daily obtained through assessments and interviews of patients undergoing total hip arthroplasty (THA and total knee arthroplasty (TKA, thoracolumbar spine arthrodesis (long PVA, cervical spine arthrodesis (cervical AVA and lumbar spine arthrodesis (lumbar PVA. RESULTS: The study showed some differences between groups, namely: the painful level was higher in the group undergoing lumbar PVA without PCA compared with the group with PCA (p = 0.03 and in the group of long PVA without PCA in the early postoperative period. This latter group used O2 for a longer time (p = 0.09. CONCLUSION: In this study, PCA was useful for analgesia in patients undergoing lumbar PVA and probably would have influenced the usage time of O2 in the group of long PVA in face of a larger sample. The use of PCA did not influence the time of leaving the bed and the in-hospital length of stay for the patients studied.

  4. [Has ketamine preemptive analgesic effect in patients undergoing abdominal hysterectomy?].

    Science.gov (United States)

    Karaman, Semra; Kocabaş, Seden; Zincircioğlu, Ciler; Firat, Vicdan

    2006-07-01

    The aim of this study was to determine if preemptive use of the NMDA receptor antogonist ketamine decreases postoperative pain in patients undergoing abdominal hystrectomy. A total of 60 patients admitted for total abdominal hysterectomy were included in this study after the approval of the ethic committee, and the patients were randomly classified into three groups. After standart general anaesthesia, before or after incision patients received bolus saline or ketamine. Group S received only saline while Group Kpre received ketamine 0.4 mg/kg before incision and saline after incision, and Group Kpost received saline before incision and 0.4 mg/kg ketamine after incision. Postoperatif analgesia was maintained with i.v. PCA morphine. Pain scores were assessed with Vizüal Analog Scale (VAS), Verbal Rating Scale (VRS) at 1., 2, 3., 4., 8., 12. ve 24. hours postoperatively. First analgesic requirement time, morphine consumption and side effects were recorded. There were no significant differences between groups with respect to VAS / VRS scores, the time for first analgesic dose, and morphine consumption ( p>0.05). Patients in Group S had significantly lower sedation scores than either of the ketamine treated groups ( pketamin had no preemptive analgesic effect in patients undergoing abdominal hysterectomy, but further investigation is needed for different operation types and dose regimens.

  5. Liquid discharges from patients undergoing {sup 131}I treatments

    Energy Technology Data Exchange (ETDEWEB)

    Barquero, R. [Servicio de Radiofisica y Proteccion Radiologica, Hospital Universitario Rio Hortega, E-47010 Valladolid (Spain)], E-mail: rbarquero@hurh.sacyl.es; Basurto, F. [Departamento de Fisica Teorica, Atomica y Optica, Universidad de Valladolid, E-47010 Valladolid (Spain); Nunez, C. [Servicio de Radiofisica y Proteccion Radiologica, Fundacion Jimenez Diaz, FJD, E-82001 Madrid (Spain); Esteban, R. [Servicio de Radiologia, Hospital Clinico Universitario, E-47005 Valladolid (Spain)

    2008-10-15

    This work discusses the production and management of liquid radioactive wastes as excretas from patients undergoing therapy procedures with {sup 131}I radiopharmaceuticals in Spain. The activity in the sewage has been estimated with and without waste radioactive decay tanks. Two common therapy procedures have been considered, the thyroid cancer (4.14 GBq administered per treatment), and the hyperthyroidism (414 MBq administered per treatment). The calculations were based on measurements of external exposure around the 244 hyperthyroidism patients and 23 thyroid cancer patients. The estimated direct activity discharged to the sewage for two thyroid carcinomas and three hyperthyroidisms was 14.57 GBq and 1.27 GBq, respectively, per week; the annual doses received by the most exposed individual (sewage worker) were 164 {mu}Sv and 13 {mu}Sv, respectively. General equations to calculate the activity as a function of the number of patient treated each week were also obtained.

  6. [Mucositis in head and neck cancer patients undergoing radiochemotherapy].

    Science.gov (United States)

    Santos, Renata Cristina Schmidt; Dias, Rodrigo Souza; Giordani, Adelmo José; Segreto, Roberto Araújo; Segreto, Helena Regina Comodo

    2011-12-01

    The objective of present study was to classify oral mucositis according to the Common Toxicity Criterion (CTC) international parameters in head and neck tumor patients simultaneously treated with radio and chemotherapy, and characterize a patient profile in our area, observing the individuals' habits, tumor characteristics, treatment protocol and acute reaction intensity. Fifty patients undergoing simultaneous 66 to 70 Gy megavoltage radiotherapy and cisplatin/carboplatin chemotherapy were evaluated in this study. Weekly evaluations of the degree of mucositis were perfoemed according to CTC, a four-degree ordinal scale; 36% of all patients and 100% of those with diabetes discontinued treatment due to mucositis, showing that this pathology contributes to the severity of mucositis.

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

    Institute of Scientific and Technical Information of China (English)

    Mahdi; Najafi; David; Faraoni

    2015-01-01

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

  8. Postpolypectomy bleeding in patients undergoing colonoscopy on uninterrupted clopidogrel therapy.

    Science.gov (United States)

    Singh, Mandeep; Mehta, Nilesh; Murthy, Uma K; Kaul, Vivek; Arif, Asma; Newman, Nancy

    2010-05-01

    The risk of postpolypectomy bleeding (PPB) in patients undergoing colonoscopy on uninterrupted clopidogrel therapy has not been established. To assess the PPB rate and outcome and identify risk factors associated with PPB in patients taking clopidogrel. Single-center, retrospective study. Demographics, clinical parameters, polyp characteristics, polypectomy techniques, and postpolypectomy events in the groups were compared by univariate analysis. Stepwise logistic regression analyses identified independent risk factors associated with PPB. Veterans Affairs Medical Center. A total of 142 patients (375 polypectomies) taking clopidogrel (cases) and 1243 patients (3226 polypectomies) not taking clopidogrel (controls). None. Postpolypectomy bleeding, hospitalization, and mortality. The immediate (intraprocedural) bleeding rate was similar in the 2 groups (2.1% vs 2.1%). Delayed (postprocedural) PPB rate was higher in the group taking clopidogrel (3.5% vs 1.0%, P = .02). Delayed bleeding of significance requiring hospitalization and transfusion/intervention was also higher in patients taking clopidogrel (2.1% vs 0.4%, P = .04). The length of hospital stay and interventions for PPB were comparable between the 2 groups. There was no mortality. Concomitant use of clopidogrel and aspirin/other nonsteroidal anti-inflammatory drugs (odds ratio 3.7; 95% CI, 1.6-8.5) and the number of polyps removed (OR 1.3; 95% CI, 1.2-1.4) were the only significant risk factors associated with PPB. Clopidogrel alone was not an independent risk factor for PPB. Retrospective study and small number of patients with PPB. The PPB rate is significantly higher in patients undergoing polypectomy while taking clopidogrel and concomitant aspirin/nonsteroidal anti-inflammatory drugs; however, the risk is small and the outcome is favorable. Routine cessation of clopidogrel in patients before colonoscopy/polypectomy is not necessary. 2010 American Society for Gastrointestinal Endoscopy. Published by Mosby

  9. Performance of PROMIS for Healthy Patients Undergoing Meniscal Surgery.

    Science.gov (United States)

    Hancock, Kyle J; Glass, Natalie; Anthony, Chris A; Hettrich, Carolyn M; Albright, John; Amendola, Annunziato; Wolf, Brian R; Bollier, Matthew

    2017-06-07

    The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed as an extensive question bank with multiple health domains that could be utilized for computerized adaptive testing (CAT). In the present study, we investigated the use of the PROMIS Physical Function CAT (PROMIS PF CAT) in an otherwise healthy population scheduled to undergo surgery for meniscal injury with the hypotheses that (1) the PROMIS PF CAT would correlate strongly with patient-reported outcome instruments that measure physical function and would not correlate strongly with those that measure other health domains, (2) there would be no ceiling effects, and (3) the test burden would be significantly less than that of the traditional measures. Patients scheduled to undergo meniscal surgery completed the PROMIS PF CAT, Knee injury and Osteoarthritis Outcome Score (KOOS), Marx Knee Activity Rating Scale, Short Form-36 (SF-36), and EuroQol-5 Dimension (EQ-5D) questionnaires. Correlations were defined as high (≥0.7), high-moderate (0.61 to 0.69), moderate (0.4 to 0.6), moderate-weak (0.31 to 0.39), or weak (≤0.3). If ≥15% respondents to a patient-reported outcome measure obtained the highest or lowest possible score, the instrument was determined to have a significant ceiling or floor effect. A total of 107 participants were analyzed. The PROMIS PF CAT had a high correlation with the SF-36 Physical Functioning (PF) (r = 0.82, p ceiling effects, with 0% of the participants achieving the lowest and highest score, respectively. The PROMIS PF CAT correlates strongly with currently used patient-reported outcome measures of physical function and demonstrates no ceiling effects for patients with meniscal injury requiring surgery. It may be a reasonable alternative to more burdensome patient-reported outcome measures.

  10. Immediate hemodynamic response to furosemide in patients undergoing chronic hemodialysis.

    Science.gov (United States)

    Schmieder, R E; Messerli, F H; deCarvalho, J G; Husserl, F E

    1987-01-01

    To evaluate the effect of furosemide on cardiovascular hemodynamics in patients with end-stage renal failure, we studied ten patients undergoing hemodialysis three times a week. Arterial pressure, heart rate, and cardiac output (indocyanine green dye) were measured in triplicate; total peripheral resistance and central blood volume were calculated by standard formulas. Hemodynamics were determined at baseline and 5, 10, 15, and 30 minutes after intravenous (IV) bolus injection of furosemide 60 mg. Furosemide produced a decrease in central blood volume of -13% +/- 2.2% from pretreatment values (P less than .01) that was most pronounced five minutes after injection, together with a fall in cardiac output (from 6.76 +/- 0.59 to 6.17 +/- 0.52 L/min, P less than .10). Stroke volume decreased with a maximum fall occurring after 15 minutes (from 84 +/- 7 to 79 +/- 7 mL/min, P less than .05), and total peripheral resistance increased (from 15.8 +/- 2.1 to 17.8 +/- 2.3 units, P less than .05) after furosemide. Arterial pressure and heart rate did not change. The decrease in central blood volume reflects a shift of the total blood volume from the cardiopulmonary circulation to the periphery, suggesting dilation of the peripheral venous bed. Thus, even in patients undergoing hemodialysis, furosemide acutely decreases left ventricular preload by venous dilation and should therefore prove to be beneficial in acute volume overload.

  11. Maintaining periodontal health in patients undergoing orthodontic treatment

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    Shobhana Misra

    2012-01-01

    Full Text Available Presence of fixed orthodontic appliances in the mouth leads to accumulation of food debris and an elevation in the amount of plaque. It also hinders plaque removal by tooth brushing alone. Chemical agents may be used during the active phase of orthodontic treatment to reduce the bacterial plaque accumulation and decrease the occurrence of periodontal disease in these patients. The present study was therefore done to compare the efficacy of chemical plaque control by chlorhexidiene in patients undergoing orthodontic treatment. Forty five subjects for this double blind study were assigned randomly into three groups of 15 each. Gingival inflammation, plaque accumulation, and bleeding on probing, were recorded at baseline (10 days after prophylaxis, and at the end of one month in all the three groups. The data obtained was subjected to stastical analysis. Anova test showed significant difference among all the three groups for bleeding index, modified gingival index and plaque index. Paired t test showed significant differences in bleeding index for pre and post treatment recordings for chlorhexidine group. Modified gingival index showed significant difference in the chlorhexidine group. For plaque index significant difference was found for chlorhexidine, and control groups. Chlorhexidine mouthrinse 0.12% was found to be the most effective in reducing the bleeding scores, modified gingival index scores and the plaque index scores. It can therefore be said that chlorhexidine mouthrinse 0.12% provides greater benefits to the patients undergoing fixed orthodontic treatment.

  12. Fospropofol disodium injection for the sedation of patients undergoing colonoscopy

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    Benjamin E Levitzky

    2008-09-01

    Full Text Available Benjamin E Levitzky1, John J Vargo21Department of Gastroenterology and Hepatology, 2Section of Therapeutic and Hepatobiliary Endoscopy, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USAAbstract: Sedation plays a central role in making colonoscopy tolerable for patients and feasible for the endoscopist to perform. The array of agents used for endoscopic sedation continues to evolve. Fospropofol (FP, a prodrug of propofol with a slower pharmacokinetic profi le, is currently under evaluation for use during endoscopic procedures. Preliminary data suggests that FP dosed at 6.5 mg/kg is well tolerated by most patients with perineal paresthesias being the most commonly experienced adverse effect. This article will examine the current literature on the use of FP for the sedation of patients undergoing colonoscopy, highlighting the pharmacokinetics, pharmacodynamics, risks, and common adverse events associated with the novel sedative/hypnotic.Keywords: fospropofol, Aquavan, propofol, sedation, colonoscopy

  13. Cilostazol may prevent cardioembolic stroke in patients undergoing antiplatelet therapy.

    Science.gov (United States)

    Horie, Nobutaka; Kaminogo, Makio; Izumo, Tsuyoshi; Hayashi, Kentaro; Tsujino, Akira; Nagata, Izumi

    2015-07-01

    Randomised trials have shown the efficacy of antiplatelet therapy with cilostazol to prevent secondary ischaemic stroke. Recently, cilostazol has been reported to prevent the development and/or recurrence of atrial fibrillation (AF), which can potentially prevent cardioembolic stroke in patients undergoing antiplatelet therapy. Herein, we examined the impact of prior antiplatelet therapy with cilostazol on the incidence of cardioembolic stroke, which had not been fully investigated. Using the multicenter retrospective study of stroke risk in antithrombotic therapy (RESTATE) database, we analysed consecutive patients with primary or secondary stroke under single antiplatelet therapy. We evaluated the characteristics of ischaemic stroke based on the type of antiplatelet agent used: aspirin, ticlopidine/clopidogrel or cilostazol. Of 1069 consecutive patients with primary or secondary stroke during antithrombotic therapy from January to December 2012, 615 patients received single antiplatelet therapy (293 and 322 cases of primary and secondary strokes, respectively). Interestingly, the percentage of cardioembolic infarction was significantly lower in patients taking cilostazol compared with other agents. Multivariate regression analysis found that age (OR: 1.03, 95% CI: 1.01-1.06, P = 0.0029), serum creatinine (OR: 1.17, 95% CI: 1.03-1.34, P = 0.0198), aspirin (OR: 1.75, 95% CI: 1.00-3.22, P = 0.0486), cilostazol (OR: 0.19, 95% CI: 0.03-0.73, P = 0.0125), and smoking (OR: 1.86, 95% CI: 1.16-2.94, P = 0.0102) were independently associated with cardioembolic stroke. Cilostazol may prevent cardioembolic stroke in patients undergoing antiplatelet therapy. This could be a novel strategy for cardioembolic stroke prevention potentially by affecting cardiac remodelling, in contrast to secondary anticoagulant therapy.

  14. Incidence of bacteremia in cirrhotic patients undergoing upper endoscopic ultrasonography.

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    Fernández-Esparrach, Gloria; Sendino, Oriol; Araujo, Isis; Pellisé, Maria; Almela, Manel; González-Suárez, Begoña; López-Cerón, María; Córdova, Henry; Sanabria, Erwin; Uchima, Hugo; Llach, Josep; Ginès, Àngels

    2014-01-01

    The incidence of bacteremia after endoscopic ultrasonography (EUS) or EUS-guided fine-needle aspiration (EUS-FNA) is between 0% and 4%, but there are no data on this topic in cirrhotic patients. To prospectively assess the incidence of bacteremia in cirrhotic patients undergoing EUS and EUS-FNA. We enrolled 41 cirrhotic patients. Of these, 16 (39%) also underwent EUS-FNA. Blood cultures were obtained before and at 5 and 30 min after the procedure. When EUS-FNA was used, an extra blood culture was obtained after the conclusion of radial EUS and before the introduction of the sectorial echoendoscope. All patients were clinically followed up for 7 days for signs of infection. Blood cultures were positive in 16 patients. In 10 patients, blood cultures grew coagulase-negative Staphylococcus, Corynebacterium species, Propionibacterium species or Acinetobacterium Lwoffii, which were considered contaminants (contamination rate 9.8%, 95% CI: 5.7-16%). The remaining 6 patients had true positive blood cultures and were considered to have had true bacteremia (15%, 95% CI: 4-26%). Blood cultures were positive after diagnostic EUS in five patients but were positive after EUS-FNA in only one patient. Thus, the frequency of bacteremia after EUS and EUS-FNA was 12% and 6%, respectively (95% CI: 2-22% and 0.2-30%, respectively). Only one of the patients who developed bacteremia after EUS had a self-limiting fever with no other signs of infection. Asymptomatic Gram-positive bacteremia developed in cirrhotic patients after EUS and EUS-FNA at a rate higher than in non-cirrhotic patients. However, this finding was not associated with any clinically significant infections. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

  15. Anesthesia for patients undergoing transsternal thymectomy for juvenile myasthenia gravis

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    Lianne Stephenson

    2011-01-01

    Full Text Available Background: Juvenile myasthenia gravis (JMG is the rare form of myasthenia gravis presenting in childhood and adolescence. When medical management fails, thymectomy is offered for these patients. Complete resection of the thymus is best achieved through transsternal thymectomy. Anesthetic management of patients with JMG is challenging, particularly in regards to the goals of postoperative pain control, respiratory function, and extubation. Methods: We retrospectively reviewed the medical records of 13 patients, ranging in age from 6 to 22 years, who underwent transsternal thymectomy for JMG. Information on patient demographics, characteristics of their disease and treatment, anesthetic management, and postoperative course were collected. Results: All patients had undergone multiple treatment modalities and presented for surgery because of inadequate symptom control with medical management. As expected for a pediatric population, anesthesia induction was age dependent. 40% of the patients underwent an inhalation induction and 60% underwent an intravenous induction. Anesthesia was maintained with a low-dose inhalation agent in all patients, supplemented in 84% of patients with a remifentanil infusion, and in 69% of patients with an epidural infusion. Muscle relaxants were avoided in all patients. With this regimen, 92% of patients could be extubated successfully in the operating room. Conclusion: We found that avoidance of muscle relaxants and use of remifentanil with a low-dose hypnotic agent provided a stable intraoperative course, facilitated rapid emergence, and allowed early extubation in patients with JMG undergoing transsternal thymectomy. Epidural analgesia reduced the need for intra- and postoperative intravenous opioids and did not have an adverse effect on respiratory strength.

  16. Blood Transfusion Strategies in Patients Undergoing Extracorporeal Membrane Oxygenation

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    Hyoung Soo Kim

    2017-02-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO is frequently associated with bleeding and coagulopathy complications, which may lead to the need for transfusion of multiple blood products. However, blood transfusions are known to increase morbidity and mortality, as well as hospital cost, in critically ill patients. In current practice, patients on ECMO receive a transfusion, on average, of 1-5 packed red blood cells (RBCs/day, with platelet transfusion accounting for the largest portion of transfusion volume. Generally, adult patients require more transfusions than neonates or children, and patients receiving venovenous ECMO for respiratory failure tend to need smaller transfusion volumes compared to those receiving venoarterial ECMO for cardiac failure. Observation studies have reported that a higher transfusion volume was associated with increased mortality. To date, the evidence for transfusion in patients undergoing ECMO is limited; most knowledge on transfusion strategies was extrapolated from studies in critically ill patients. However, current data support a restrictive blood transfusion strategy for ECMO patients, and a low transfusion trigger seems to be safe and reasonable.

  17. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    Science.gov (United States)

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-06-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1-5) and 6 to 20 (area 6-20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function.

  18. Positron emission tomography in patients with aggressive fibromatosis/desmoid tumours undergoing therapy with imatinib

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    Kasper, Bernd; Hohenberger, Peter [University of Heidelberg, Sarcoma Unit, ITM - Interdisciplinary Tumor Center Mannheim, Mannheim University Medical Center, Mannheim (Germany); Dimitrakopoulou-Strauss, Antonia; Strauss, Ludwig G. [German Cancer Research Center, Clinical Cooperation Unit Nuclear Medicine, Heidelberg (Germany)

    2010-10-15

    We used {sup 18}F-FDG PET to evaluate the FDG uptake in patients with aggressive fibromatosis (AF, also known as desmoid tumours) undergoing therapy with imatinib (imatinib mesylate, Glivec). The pilot study included nine patients with progressive AF receiving oral treatment with imatinib at a daily dose of 800 mg. Patients were examined using PET prior to the start of therapy and during imatinib treatment. Restaging according to the Response Evaluation Criteria in Solid Tumors (RECIST) was performed in parallel using CT and/or MRI and served as reference. The clinical outcomes in nine evaluable patients were as follows: seven patients with stable disease, and two patients with progressive disease. A 27% decrease in the median average standardized uptake value (SUV) of the sequential PET examinations was demonstrated in all evaluable patients with three patients (33%) showing a decrease in SUV of more than 40% (48%, 52% and 54%, respectively); no patient showed a substantial increase in SUV. To our knowledge, this is the first series of AF patients undergoing treatment with imatinib and monitored using sequential PET imaging, that allows detection of SUV changes after imatinib induction, thus helping to decide whether treatment should be continued or not. (orig.)

  19. Preoperative autologous plateletpheresis in patients undergoing open heart surgery.

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    Tomar Akhlesh

    2003-01-01

    Full Text Available Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB. It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and difficulty in achieving the haemostasis and in patients with negative blood group and emergency operations, the availability of sufficient blood can be a problem. Harvesting the autologous platelet rich plasma (PRP can be a useful method of blood conservation in these patients. The above four categories of patients were prospectively studied, using either autologous whole blood donation or autologous platelet rich plasma (PRP harvest in the immediate pre-bypass period. Forty two patients were included in the study and randomly divided into two equal groups of 21 each, control group (Group I in which one unit of whole blood was withdrawn, and PRP group (Group II where autologous plateletpheresis was utilised. After reversal of heparin, autologous whole blood was transfused in the control group and autologous PRP was transfused in the PRP group. The chest tube drainage and the requirement of homologous blood and blood products were recorded. Average PRP harvest was 643.33 +/- 133.51 mL in PRP group and the mean whole blood donation was 333.75 +/- 79.58 mL in the control group. Demographic, preoperative and intra operative data showed no statistically significant differences between the two groups. The PRP group patients drained 26.44% less (p<0.001 and required 38.5% less homologous blood and blood products (p<0.05, in the postoperative period. Haemoglobin levels on day zero (day of operation and day three were statistically not different between the two groups. We

  20. Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy.

    LENUS (Irish Health Repository)

    Manning, B J

    2012-02-03

    BACKGROUND: The routine use of nasogastric tubes in patients undergoing elective abdominal operation is associated with an increased incidence of postoperative fever, atelectasis, and pneumonia. Previous studies have shown that nasogastric tubes have no significant effect on the incidence of gastroesophageal reflux or on lower esophageal sphincter pressure in healthy volunteers. We hypothesized that nasogastric intubation in patients undergoing laparotomy reduces lower esophageal sphincter pressure and promotes gastroesophageal reflux in the perioperative period. METHODS: A prospective randomized case-control study was undertaken in which 15 consenting patients, admitted electively for bowel surgery, were randomized into 2 groups. Group 1 underwent nasogastric intubation after induction of anesthesia, and Group 2 did not. All patients had manometry and pH probes placed with the aid of endoscopic vision at the lower esophageal sphincter and distal esophagus, respectively. Nasogastric tubes, where present, were left on free drainage, and sphincter pressures and pH were recorded continuously during a 24-hour period. Data were analyzed with 1-way analysis of variance. RESULTS: The mean number of reflux episodes (defined as pH < 4) in the nasogastric tube group was 137 compared with a median of 8 episodes in the group managed without nasogastric tubes (P =.006). The median duration of the longest episode of reflux was 132 minutes in Group 1 and 1 minute in Group 2 (P =.001). A mean of 13.3 episodes of reflux lasted longer than 5 minutes in Group 1, with pH less than 4 for 37.4% of the 24 hours. This was in contrast to Group 2 where a mean of 0.13 episodes lasted longer than 5 minutes (P =.001) and pH less than 4 for 0.2% of total time (P =.001). The mean lower esophageal sphincter pressures were lower in Group 1. CONCLUSIONS. These findings demonstrate that patients undergoing elective laparotomy with routine nasogastric tube placement have significant gastroesophageal

  1. Opportunistic microorganisms in patients undergoing antibiotic therapy for pulmonary tuberculosis

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    Silvia Maria Rodrigues Querido

    2011-12-01

    Full Text Available Antimicrobial therapy may cause changes in the resident oral microbiota, with the increase of opportunistic pathogens. The aim of this study was to compare the prevalence of Candida, Staphylococcus, Pseudomonas and Enterobacteriaceae in the oral cavity of fifty patients undergoing antibiotic therapy for pulmonary tuberculosis and systemically healthy controls. Oral rinsing and subgingival samples were obtained, plated in Sabouraud dextrose agar with chloramphenicol, mannitol agar and MacConkey agar, and incubated for 48 h at 37ºC. Candida spp. and coagulase-positive staphylococci were identified by phenotypic tests, C. dubliniensis, by multiplex PCR, and coagulase-negative staphylococci, Enterobacteriaceae and Pseudomonas spp., by the API systems. The number of Candida spp. was significantly higher in tuberculosis patients, and C. albicans was the most prevalent specie. No significant differences in the prevalence of other microorganisms were observed. In conclusion, the antimicrobial therapy for pulmonary tuberculosis induced significant increase only in the amounts of Candida spp.

  2. Medanta insulin protocols in patients undergoing cardiac surgery

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    Beena Bansal

    2014-01-01

    Full Text Available Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient′s estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification.

  3. [Anesthetic consideration in patients undergoing catheter ablation for atrial fibrillation].

    Science.gov (United States)

    Oda, Toshiyuki; Takahama, Yutaka

    2012-11-01

    This chapter describes anesthetic consideration in patients undergoing catheter ablation for atrial fibrillation (AF) based on electrophysiologic or pharmacological aspects. In the 2011 guidelines of the Japanese Circulation Society for non-pharmacotherapy of cardiac arrhythmias, catheter ablation is recommended as Class I therapeutic modality for the patients with drug-refractory paroxysmal AF. Catheter ablation of AF is an invasive and long-lasting procedure necessitating sedation during treatment. However, in the most of the patients, sedation or anesthesia is possibly performed by cardiologists using propofol, midazolam or dexmedetomidine. Deep sedation accompanies a high risk of ventilatory or circulatory derangement. Furthermore, life-threatening complications, such as cerebral infarction or cardiac tamponade, can occur during ablation. Patients with AF are increasing in number as a trend in the aging society, resulting in an increase in catheter ablation in high risk patients. To accomplish safe anesthetic management of the patients for catheter ablations, anesthesiologists are required to have fundamental knowledge and skill in the performance of the catheter ablation.

  4. Incidental adenocarcinoma in patients undergoing surgery for stricturing Crohn's disease

    Science.gov (United States)

    Kristo, Ivan; Riss, Stefan; Argeny, Stanislaus; Maschke, Svenja; Chitsabesan, Praminthra; Stift, Anton

    2017-01-01

    AIM To evaluate frequency and clinical course of incidental adenocarcinoma in patients with stricturing Crohn's disease (CD). METHODS In this study, consecutive patients, who were operated on for stricturing CD between 1997-2012, were included at an academic tertiary referral center. Demographic data and clinical course were obtained by an institutional database and individual chart review. Besides baseline characteristics, intraoperative findings and CD related history were also recorded. Colorectal cancer was classified and staged according to the Union for International Cancer Control (UICC). RESULTS During the study period 484 patients underwent resections due to stricturing CD. Incidental adenocarcinoma was histologically confirmed in 6 (1.2%) patients (4 males, 2 females). Patients diagnosed with colorectal cancer had a median age of 43 (27-66) years and a median history of CD of 16 (7-36) years. Malignant lesions were found in the rectum (n = 4, 66.7%), descending colon (n = 1, 16.7%) and ileocolon (n = 1, 16.7%). According to the UICC classification two patients were stages as I (33.3%), whereas the other patients were classified as stage IIA (16.7%), stage IIIB (16.7%), stage IIIC (16.7%) and stage IV (16.7%), respectively. After a median follow-up of 2 (0.03-8) years only 1 patient is still alive. CONCLUSION The frequency of incidental colorectal cancer in patients, who undergo surgery for stenotic CD, is low but associated with poor prognosis. However, surgeons need to be aware about the possibility of malignancy in stricturing CD, especially if localized in the rectum. PMID:28210083

  5. Dysphagia outcomes in patients with brain tumors undergoing inpatient rehabilitation.

    Science.gov (United States)

    Wesling, Michele; Brady, Susan; Jensen, Mary; Nickell, Melissa; Statkus, Donna; Escobar, Nelson

    2003-01-01

    The purpose of this retrospective study was to compare functional dysphagia outcomes following inpatient rehabilitation for patients with brain tumors with that of patients following a stroke. Group 1 (n = 24) consisted of consecutive admissions to the brain injury program with the diagnosis of brain tumor and dysphagia. Group 2 (n = 24) consisted of matched, consecutive admissions, with the diagnosis of acute stroke and dysphagia. Group 2 was matched for age, site of lesion, and initial composite cognitive FIM score. The main outcome measures for this study included the American Speech-Language-Hearing Association (ASHA) National Outcome Measurement System (NOMS) swallowing scale, length of stay, hospital charges, and medical complications. Results showed that swallowing gains made by both groups as evaluated by the admission and discharge ASHA NOMS levels were considered to be statistically significant. The differences for length of stay, total hospital charges, and speech charges between the two groups were not considered to be statistically significant. Three patients in the brain tumor group (12.5%) demonstrated dysphagia complications of either dehydration or pneumonia during their treatment course as compared to 0% in the stroke group. This study confirms that functional dysphagia gains can be achieved for patients with brain tumors undergoing inpatient rehabilitation and that they should be afforded the same type and intensity of rehabilitation for their swallowing that is provided to patients following a stroke.

  6. Analysis of corneal esthesia in patients undergoing photorefractive keratectomy

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    Elmar Torres Neto

    2015-12-01

    Full Text Available ABSTRACT Purpose: To quantitatively analyze corneal esthesia in patients undergoing photorefractive keratectomy (PRK surgery. Methods: Forty-five patients selected for PRK in one eye underwent corneal esthesia using a Cochet-Bonnet esthesiometer preoperatively and 30 and 90 days postoperatively. Patients with a refractive diopter error of 4 or greater received intraoperative 0.02% mitomycin C for 20 s. Results: Twenty-four (53.3% of the 45 eyes received intraoperative 0.02% mitomycin. Decreased sensitivity was observed on postoperative day 30. By postoperative day 90, corneal esthesia had normalized but remained 14.9% lower than preoperative levels. In the mitomycin group, no recovery of corneal esthesia to normal sensitivity levels was observed. The mean esthesiometer level was 39.2 mm on postoperative day 90 (P<0.001. Conclusions: The results of the present study demonstrate recovery of corneal esthesia to normal levels at 90 days postoperatively in patients who did not receive mitomycin C. In patients administered mitomycin C, a 23.59% reduction in the corneal touch threshold was observed compared with preoperative levels indicating a failure of recovery to normal levels.

  7. Postoperative sepsis prediction in patients undergoing major cancer surgery.

    Science.gov (United States)

    Sood, Akshay; Abdollah, Firas; Sammon, Jesse D; Arora, Nivedita; Weeks, Matthew; Peabody, James O; Menon, Mani; Trinh, Quoc-Dien

    2017-03-01

    Cancer patients are at increased risk for postoperative sepsis. However, studies addressing the issue are lacking. We sought to identify preoperative and intraoperative predictors of 30-d sepsis after major cancer surgery (MCS) and derive a postoperative sepsis risk stratification tool. Patients undergoing one of nine MCSs (gastrointestinal, urological, gynecologic, or pulmonary) were identified within the American College of Surgeons National Surgical Quality Improvement Program (2005-2011, n = 69,169). Multivariable adjusted analyses (MVA) were performed to identify the predictors of postoperative sepsis. A composite sepsis risk score (CSRS) was constructed using the regression coefficients of predictors significant on MVA. The score was stratified into low, intermediate, and high risk, and its predictive accuracy for sepsis, septic shock, and mortality was assessed using the area under the curve analysis. Overall, 4.3% (n = 2954) of patients developed postoperative sepsis. In MVA, Black race (odds ratio [OR] = 1.30, P = 0.002), preoperative hematocrit 3 (P sepsis. CSRS demonstrated favorable accuracy in predicting postoperative sepsis, septic shock, and mortality (area under the curve 0.72, 0.75, and 0.74, respectively). Furthermore, CSRS risk stratification demonstrated high concordance with sepsis rates, 1.3% in low-risk patients versus 9.7% in high-risk patients. Similarly, 30-d mortality rate varied from 0.5% to 5.5% (10-fold difference) in low-risk patients versus high-risk patients. Our study identifies the major risk factors for 30-d sepsis after MCS. These risk factors have been converted into a simple, accurate bedside sepsis risk score. This tool might facilitate improved patient-physician interaction regarding the risk of postoperative sepsis and septic shock. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Nitric oxide synthetase and Helicobacter pylori in patients undergoing appendicectomy.

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    Kell, M R

    2012-02-03

    BACKGROUND: This study was designed to determine whether Helicobacter pylori forms part of the normal microenvironment of the appendix, whether it plays a role in the pathogenesis of acute appendicitis, and whether it is associated with increased expression of inducible nitric oxide synthetase (iNOS) in appendicular macrophages. METHODS: Serology for H. pylori was performed on 51 consecutive patients undergoing emergency appendicectomy. Appendix samples were tested for urease activity, cultured and stained for H. pylori, graded according to the degree of inflammatory infiltrate, and probed immunohistochemically for iNOS expression. RESULTS: The mean age of the patients was 21 (range 7-51) years. Seventeen patients (33 per cent) were seropositive for H. pylori but no evidence of H. pylori was found in any appendix specimen. However, an enhanced inflammatory cell infiltration was observed in seropositive patients (P < 0.04) and the expression of macrophage iNOS in the mucosa of normal and inflamed appendix specimens was increased (P < 0.01). CONCLUSION: H. pylori does not colonize the appendix and is unlikely to be a pathogenic stimulus for appendicitis. Priming effects on mucosal immunology downstream from the foregut may occur after infection with H. pylori.

  9. Radiation dose estimation of patients undergoing lumbar spine radiography

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    Prince Kwabena Gyekye

    2013-01-01

    Full Text Available Radiation dose to organs of 100 adult patients undergoing lumbar spine (LS radiography at a University Hospital have been assessed. Free in air kerma measurement using an ionization chamber was used for the patient dosimetry. Organ and effective dose to the patients were estimated using PCXMC (version 1.5 software. The organs that recorded significant dose due to LS radiography were lungs, stomach, liver, adrenals, kidney, pancreas, spleen, galbladder, and the heart. It was observed that the stomach recorded the highest dose (48.2 ± 1.2 μGy for LS anteroposterior (AP. The spleen also recorded the highest dose (41.2 ± 0.5 μGy for LS lateral (LAT. The mean entrance surface air kerma (ESAK of LS LAT (122.2 μGy was approximately twice that of LS AP (76.3 μGy, but the effective dose for both examinations were approximately the same (LS LAT = 8.6 μSv and LS AP = 10.4 μSv. The overall stochastic health effect of radiation to patients due to LS radiography in the University Hospital is independent of the projection of the examination (AP or LAT.

  10. Heart-Kidney Biomarkers in Patients Undergoing Cardiac Stress Testing

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    Mikko Haapio

    2011-01-01

    Full Text Available We examined association of inducible myocardial perfusion defects with cardiorenal biomarkers, and of diminished left ventricular ejection fraction (LVEF with kidney injury marker plasma neutrophil gelatinase-associated lipocalin (NGAL. Patients undergoing nuclear myocardial perfusion stress imaging were divided into 2 groups. Biomarkers were analyzed pre- and poststress testing. Compared to the patients in the low ischemia group (n=16, the patients in the high ischemia group (n=18 demonstrated a significantly greater rise in cardiac biomarkers plasma BNP, NT-proBNP and cTnI. Subjects were also categorized based on pre- or poststress test detectable plasma NGAL. With stress, the group with no detectable NGAL had a segmental defect score 4.2 compared to 8.2 (P=.06 in the detectable NGAL group, and 0.9 vs. 3.8 (P=.03 at rest. BNP rose with stress to a greater degree in patients with detectable NGAL (10.2 vs. 3.5 pg/mL, P=.03. LVEF at rest and with stress was significantly lower in the detectable NGAL group; 55.8 versus 65.0 (P=.03 and 55.1 vs. 63.8 (P=.04, respectively. Myocardial perfusion defects associate with biomarkers of cardiac stress, and detectable plasma NGAL with significantly lower LVEF, suggesting a specific heart-kidney link.

  11. Effect of music on patients undergoing outpatient colonoscopy

    Institute of Scientific and Technical Information of China (English)

    Matthew L Bechtold; Rodney A Perez; Srinivas R Puli; John B Marshall

    2006-01-01

    AIM: To evaluate the effect of relaxing music during colonoscopy under low-dose conscious sedation, on patient satisfaction, scope insertion time and procedure duration, medication doses, and the perceived adequacy of sedation and scope insertion difficulty on the part of the endoscopist.SETHODS: One hundred and sixty-seven consecutive adult outpatients presenting for routine colonoscopy under low-dose conscious sedation were randomized to undergo their procedures either with music played during the procedure or no music played.RESULTS: There were no statistical differences between the two groups in terms of meperidine dose, midazolam dose, time to reach the cecum, total procedure time,endoscopist assessment of scope insertion difficulty,endoscopist assessment of adequacy of sedation, or the pain experience of the patients during their procedure.The music group did report significantly better overall procedure satisfaction as compared to the non music group on two of our three different scales.CONCLUSION: While music does not result in shortened procedure times, lower doses of sedative medications or perceived patient pain, the patients who have music playing during their procedures report modestly greater satisfaction with their procedures.

  12. Care of the patient undergoing robotic-assisted laparoscopic pyeloplasty.

    Science.gov (United States)

    Francis, Paula; Winfield, Howard N

    2006-04-01

    Laparoscopic pyeloplasty as a treatment for ureteropelvic junction obstruction has shown comparable success rates with open pyeloplasty techniques. The use of robotic technology to assist during laparoscopic pyeloplasty procedures has been encouraged by the steep learning curve for laparoscopic surgical skills, and the complexity of laparoscopic suturing. Robotic technology provides the surgeon with the ability to filter out any physiologic hand tremor, more degrees of freedom of movement than traditional laparoscopic instruments, the ability to scale movement to provide better control for microsurgery, better ergonomics during surgery, and three-dimensional vision. Details of the procedure and specific nursing care of the patient undergoing robotic-assisted laparoscopic pyeloplasty at the University of Iowa Hospital and Clinics are described.

  13. Anesthetic management in an appendix tumor patient undergoing hyperthermic chemotherapy

    Directory of Open Access Journals (Sweden)

    Yonca Yanlı

    2013-06-01

    Full Text Available Cytoreductive surgery combined with hyperthermic intraperitonealchemotherapy (HIPEC is a complex and multidisciplinerprocedure that is being used increasingly forperitoneal and appendix malignency. First of all the macroscopictumor tissues are extracted after that peritonealperfusion is started with giving heated 42°C chemotherapeuticsolution via abdominal drains. It is important tomaintain normovolemia, to regulate coagulation and renalparameters during perioperative period, to compansatehypothermia during cytoreductive surgery and hyperthermiaduring HIPEC and to regulate hemodynamic changesdue to increased abdominal pressure during HIPEC.In this case report, we aimed to share anaesthetic experienceand to evaluate anaesthetic problems in 45 yearsold ASA I patient undergoing cytoreductive surgery andhypertermic intraperitoneal chemotherapy in which newlyestablished in our hospital for appendix tumor. J Clin ExpInvest 2013; 4 (2: 234-237Key words: Anaesthesia, general, hyperthermic intraperitonealchemotherapy, cytoreductive surgery.

  14. Gait analysis, bone and muscle density assessment for patients undergoing total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Benedikt Magnússon

    2012-12-01

    Full Text Available Total hip arthroplasty (THA is performed with or without the use of bone cement. Facing the lack of reliable clinical guidelines on decision making whether a patient should receive THA with or without bone cement, a joint clinical and engineering approach is proposed here with the objective to assess patient recovery developing monitoring techniques based on gait analysis, measurements of bone mineral density and structural and functional changes of quadriceps muscles. A clinical trial was conducted with 36 volunteer patients that were undergoing THA surgery for the first time: 18 receiving cemented implant and 18 receiving non-cemented implant. The patients are scanned with Computer Tomographic (CT modality prior-, immediately- and 12 months post-surgery. The CT data are further processed to segment muscles and bones for calculating bone mineral density (BMD. Quadriceps muscle density Hounsfield (HU based value is calculated from the segmented file on healthy and operated leg before and after THA surgery. Furthermore clinical assessment is performed using gait analysis technologies such as a sensing carpet, wireless electrodes and video. Patients undergo these measurements prior-, 6 weeks post - and 52 weeks post-surgery. The preliminary results indicate computational tools and methods that are able to quantitatively analyze patient’s condition pre and post-surgery: The spatial parameters such as step length and stride length increase 6 weeks post op in the patient group receiving cemented implant while the angle in the toe in/out parameter decrease in both patient groups.

  15. [Evaluation of nurse workload in patients undergoing therapeutic hypothermia].

    Science.gov (United States)

    Argibay-Lago, Ana; Fernández-Rodríguez, Diego; Ferrer-Sala, Nuria; Prieto-Robles, Cristina; Hernanz-del Río, Alexandre; Castro-Rebollo, Pedro

    2014-01-01

    Therapeutic hypothermia (TH) is recommended to minimize neurological damage in patients surviving sudden cardiac arrest (SCA). There is scarcity of data evaluating the nursing workload in these patients. The objective of the study is to assess the workload of nurses whilst treating patients undergoing TH after SCA. A 43-month prospective-retrospective comparative cohort study was designed. Patients admitted to intensive care unit, for recovered SCA and persistent coma, were included. A comparison was made using the baseline characteristics, medical management, in-hospital mortality, and nursing workload during the first 96hours using the Therapeutic Intervention Scoring System-28 (TISS-28); Nursing Activities Score (NAS); and Nine Equivalents of Nursing Manpower Use Score (NEMS) scales among patients who received TH and those who did not. A total 46 patients were included: 26 in the TH group and 20 in the Non-TH group. Regarding baseline characteristics and management, the TH group presented higher prevalence of smoking habit (69 vs. 25%, p=0.012), out-of-hospital SCA (96 vs. 55%, p<0.001), and the performance of coronary angiography (96 vs. 65%, p=0.014) compared with the non-TH group. No differences were observed in the nursing workload, assessed by TISS 28, NAS or NEMS scales, or in-hospital mortality. In this study performance of TH in SCA survivors is not associated with an increase in nursing workload. The installation of a TH program does not require the use of more nursing resources in terms of workload. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  16. Is Antibiotic Prophylaxis Necessary in Patients Undergoing Ureterolithotripsy?

    Directory of Open Access Journals (Sweden)

    Ali Pasha Meysamie

    2011-08-01

    Full Text Available Transurethral Ureterolithotripsy (TUL is a frequently used procedure in urology departments. Many urologists perform TUL without antibiotic prophylaxis; however the use of chemoprophylaxis before TUL remains a controversial issue in urology. Thisstudy was carried out to assess the safety of omitting antibiotic prophylaxis prior to TUL. In a prospective randomized clinical trial from January 2005 to December 2007, 114 patients with ureteral stones were enrolled; Fifty seven had preoperative antibiotic prophylaxis administered before TUL and fifty seven patients underwent TUL without antibiotic prophylaxis. The rate of postoperative infectious complications (fever, positive blood culture, significant bactriuria, the length of hospital stay and overall stone free rate were compared between the two groups. There was no statistically significant difference between two groups in the operation time, length of hospital stay, postoperative bacteriuria, positive urine culture, postoperative fever and overall success rate of TUL. It appears that the incidence of infectious complications does not increase in patients undergoing TUL without antibiotic prophylaxis if they have negative pre-operative urine culture and antiseptic technique have been performed thorough the procedure.

  17. Preoperative expectations and values of patients undergoing Mohs micrographic surgery.

    Science.gov (United States)

    Chuang, Gary S; Leach, Brian C; Wheless, Lee; Lang, Pearon G; Cook, Joel

    2011-03-01

    Dermatologists have championed Mohs micrographic surgery (MMS) for its unsurpassed treatment success for skin cancers, safety profile, cost-effectiveness, and tissue-sparing quality. It is unclear whether patients undergoing MMS also value these characteristics. To evaluate patients' preoperative expectations of MMS and identify the factors that may influence such expectations The study prospectively recruited participants who were newly diagnosed with skin cancer and referred for MMS. A questionnaire listing the characteristics of MMS was given to the participants asking them to score the importance of each characteristic on a 10-point scale. The participants were also asked to provide information regarding their gender, age, subjective health status, education level, family annual income, and their referral source On average, participants placed the highest value, in descending order, on a treatment that yielded the highest cure rate, reconstruction initiation only after complete tumor removal, and the surgeon being a skin cancer specialist. Overall, participants placed high values on characteristics of MMS that dermatologists have long esteemed. Our data corroborate that MMS is a valuable procedure that meets the expectations not just of physicians, but also of patients. The authors have indicated no significant interest with commercial supporters. © 2011 by the American Society for Dermatologic Surgery, Inc.

  18. Can patients with schizophrenia undergo renal transplantation with success?

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    Saoussen Bouhlel

    2014-01-01

    Full Text Available We report a case of a 41-year-old man suffering from paranoid schizophrenia. The patient has been consulting in our psychiatric hospital since he was 29 years old. Eight years later, he developed kidney failure and required peritoneal dialysis. After more than two years, the nephrology team indicated a renal transplantation and his brother suggested giving his kidney. There were no obstacles for transplantation in the immune and histological compatibilities; the psychiatric staff decided to check the patient′s compliance with medication. The patient was compliant to all his medications and to the salt-free diet after the transplant operation. Few weeks later, he developed steroid-induced diabetes. Through the last two years, he had psychotic exacerbations with major anxiety and fear of losing the transplant. These relapses were managed by increasing doses of antipsychotics without need for hospitalization. At the present time, three years after transplantation, the nephrologists are decreasing the immunosuppressive agents and the steroids. The renal function is optimum and the diabetes is stabilized. This case exemplifies the potential for schizophrenic patients to undergo renal transplantation and to comply with follow-up medical care through a close cooperation between the patient′s family, the psychiatric staff and the nephrology team.

  19. Myoinositol Improves Embryo Development in PCOS Patients Undergoing ICSI

    Science.gov (United States)

    2016-01-01

    The aim of this study was to investigate the activity of myoinositol, in a court of 217 PCOS women undergoing intracytoplasmic sperm injection (ICSI), on pregnancy rate, embryo development, estradiol, and progesterone concentration in blood serum, superoxide dismutase (SOD), and catalase (CAT) in follicular fluid. Concerning the court of patient, 112 (groups I and II) out of 217 were PCOS women, whereas group III consisted of healthy subjects (not PCOS). Group I patients were treated with 400 μg of folic acid per day for 3 months before ICSI, whereas group II patients received 4000 mg of myoinositol and 400 μg of folic acid per day for 3 months before ICSI. Group II revealed a shorter embryo/blastocyst development period between microinjection and 5-cell stage compared to group I. The difference in SOD concentration between groups I and II and between groups II and III was statistically significant. In group II, 34.62% of pregnancies were obtained, whereas in group I this number reached 20% (NS). Myoinositol increased embryo development dynamics and accelerated blastocyst stage reaching time; however, no effect was shown on clinical pregnancy. Furthermore, it restored SOD concentration, lowered in PCOS women, but did not exert any effect on CAT concentration. PMID:27777587

  20. Radiation Dose Estimation for Pediatric Patients Undergoing Cardiac Catheterization

    Science.gov (United States)

    Wang, Chu

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

  1. Sedations and analgesia in patients undergoing percutaneous transhepatic biliary drainage

    Energy Technology Data Exchange (ETDEWEB)

    Hatzidakis, A.A.; Charonitakis, E.; Athanasiou, A.; Tsetis, D.; Chlouverakis, G.; Papamastorakis, G.; Roussopoulou, G.; Gourtsoyiannis, N.C

    2003-02-01

    AIM: To present our experience using intravenous sedoanalgesia for percutaneous biliary drainage. MATERIALS AND METHODS: This study comprised 100 patients, all of whom were continuously monitored [electrocardiogram (ECG), blood pressure, pulse oxymetry] and received an initial dose of 2 mg midazolam followed by 0.02 mg fentanyl. Before every anticipated painful procedure, a maintenance dose of 0.01 mg fentanyl was administered. If the procedure continued and the patient became aware, another 1 mg midazolam was given. This was repeated if patients felt pain. A total dose of 0.08 mg fentanyl and 7 mg midazolam was never exceeded. Immediately after the procedure, the nurse was asked to evaluate patients' pain score. The patients were asked 3 h later to complete a visual 10-degree pain score scale. RESULTS: The average dose of fentanyl and midazolam was 0.042 mg (0.03-0.08 mg) and 4.28 mg (2-7 mg), respectively. Only one patient recorded the procedure as painful. The scores given by the attending nurse (1-7 points, mean 2.9) correlated well with those given by the patients (1-6 points, mean 2.72). No complications were noted. CONCLUSION: According to our experience, interventional radiologists practising biliary procedures can administer low doses of midazolam and minimize the doses of fentanyl, without loss of adequate sedation and analgesia. Hatzidakis, A. A. et al. (2003). Clinical Radiology58, 121-127.

  2. The effect of music on the anxiety levels of patients undergoing hysterosalpingography

    Energy Technology Data Exchange (ETDEWEB)

    Agwu, K.K. [Department of Medical Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, University of Nigeria, Enugu Campus, Enugu (Nigeria)]. E-mail: kenagwu2000@yahoo.com; Okoye, I.J. [Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu (Nigeria)

    2007-05-15

    Objectives: To determine the effect of music on the anxiety levels of patients undergoing a hysterosalpingography procedure. Patients and methods: One hundred hysterosalpingography referrals were randomly assigned to either the experimental or control group. Music chosen earlier by the patients was played during the hysterosalpingography procedure for the experimental group. The control group was studied without music. Certain physiological parameters and the State-Trait Anxiety Inventory were used to assess the patients' anxiety levels before and during the investigation. Patient's willingness to have a repeat procedure, should it become necessary, was also assessed in both groups as a measure of acceptability of the investigation. The z-test was used to analyze the results for any statistically significant differences between the experimental and the control groups. Results: The blood pressure (BP) monitored during the procedure was reduced in 31 (62%) of the patients in the experimental group compared to their pre-investigation values. Reduction in the pulse rate (PR) in 28 (56%) of the patients was also noted in the experimental group. On the other hand, the blood pressure of 37 (74%) of the patients and the pulse rate of 32 (64%) patients in the control group were increased from their pre-investigation values. The physiological parameters in the experimental group were significantly lower than the values in the control group during the investigation (p < 0.05). A comparison of the State-Trait Anxiety Inventory scores taken before and during the procedure shows significantly lower scores for the experimental group compared to those for the control group (p < 0.05). More patients, 41 (82%) in the experimental group were also willing to have a repeat procedure compared to 16 (32%) patients in the control. Conclusion: Music reduces the physiological and cognitive responses of anxiety in patients undergoing hysterosalpingography and can be harnessed for

  3. The myocardial protective effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery

    Science.gov (United States)

    Soliman, Rabie; Zohry, Gomaa

    2016-01-01

    Objective: The aim of the study was to assess the effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery. Design: A randomized prospective study. Setting: Cairo University, Egypt. Materials and Methods: The study included 150 patients undergoing aortic vascular surgery. Intervention: The patients were classified into two groups (n = 75). Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0.3 μg/kg/h to the end of the procedure. Group C: The patients received an equal volume of normal saline. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included the heart rate, mean arterial blood pressure, central venous pressure, electrocardiogram (ECG), serum troponin I level, end-tidal sevoflurane, and total dose of morphine in addition transthoracic echocardiography to the postoperative in cases with elevated serum troponin I level. Main Results: The dexmedetomidine decreased heart rate and minimized the changes in blood pressure compared to control group (P vascular surgery. It decreases the changes in heart rate and blood pressure during the procedures. It provides cardiac protection in high-risk patients reflected by decreasing the incidence of myocardial ischemia and serum level of troponin. The main side effects of dexmedetomidine were hypotension and bradycardia. PMID:27716690

  4. Accuracy of invasive arterial pressure monitoring in cardiovascular patients: an observational study

    National Research Council Canada - National Science Library

    Romagnoli, Stefano; Ricci, Zaccaria; Quattrone, Diego; Tofani, Lorenzo; Tujjar, Omar; Villa, Gianluca; Romano, Salvatore M; De Gaudio, A Raffaele

    2014-01-01

    Critically ill patients and patients undergoing high-risk and major surgery, are instrumented with intra-arterial catheters and invasive blood pressure is considered the "gold standard" for arterial pressure monitoring...

  5. Monitoring of stable glaucoma patients

    NARCIS (Netherlands)

    K.M. Holtzer-Goor (Kim); N.S. Klazinga (Niek); M.A. Koopmanschap (Marc); H.G. Lemij (Hans); T. Plochg; E. van Sprundel (Esther)

    2010-01-01

    textabstractA high workload for ophthalmologists and long waiting lists for patients challenge the organization of ophthalmic care. Tasks that require less specialized skills, like the monitoring of stable (well controlled) glaucoma patients could be substituted from ophthalmologists to other profes

  6. The myocardial protective effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery

    Directory of Open Access Journals (Sweden)

    Rabie Soliman

    2016-01-01

    Full Text Available Objective: The aim of the study was to assess the effect of dexmedetomidine in high-risk patients undergoing aortic vascular surgery. Design: A randomized prospective study. Setting: Cairo University, Egypt. Materials and Methods: The study included 150 patients undergoing aortic vascular surgery. Intervention: The patients were classified into two groups (n = 75. Group D: The patients received a loading dose of 1 μg/kg dexmedetomidine over 15 min before induction and maintained as an infusion of 0.3 μg/kg/h to the end of the procedure. Group C: The patients received an equal volume of normal saline. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included the heart rate, mean arterial blood pressure, central venous pressure, electrocardiogram (ECG, serum troponin I level, end-tidal sevoflurane, and total dose of morphine in addition transthoracic echocardiography to the postoperative in cases with elevated serum troponin I level. Main Results: The dexmedetomidine decreased heart rate and minimized the changes in blood pressure compared to control group (P < 0.05. Furthermore, it decreased the incidence of myocardial ischemia reflected by troponin I level, ECG changes, and the development of new regional wall motion abnormalities (P < 0.05. Dexmedetomidine decreased the requirement for nitroglycerin and norepinephrine compared to control group (P < 0.05. The incidence of hypotension and bradycardia was significantly higher with dexmedetomidine (P < 0.05. Conclusion: The dexmedetomidine is safe and effective in patients undergoing aortic vascular surgery. It decreases the changes in heart rate and blood pressure during the procedures. It provides cardiac protection in high-risk patients reflected by decreasing the incidence of myocardial ischemia and serum level of troponin. The main side effects of dexmedetomidine were hypotension and bradycardia.

  7. Emergence in Elderly Patient Undergoing General Anesthesia with Xenon

    Directory of Open Access Journals (Sweden)

    Maria Sanfilippo

    2013-01-01

    Full Text Available Introduction. It is a consensus that the postoperative cognitive function is impaired in elderly patients after general anaesthesia, and such category patient takes more time to recover. Xenon is a noble gas with anesthetic properties mediated by antagonism of N-methyl-D-aspartate receptors. With a minimum alveolar concentration of 0.63, xenon is intended for maintaining hypnosis with 30% oxygen. The fast recovery after xenon anaesthesia was hypothesized to be advantageous in this scenario. Case Presentation. We report the case of 99-year-old woman who underwent sigmoid colon carcinoma resection with colorectal anastomosis. We carried out the induction phase by propofol, oxygen, fentanil, and rocuronium bromide, and then we proceeded to a rapid sequence endotracheal intubation consequently. The patient was monitored by IBP, NIBP, ECG, cardiac frequency, respiratory rate, capnometry, TOF Guard, blood gas analysis, and BIS. For maintenance we administrated oxygen, remifentanil, rocuronium bromide, and xenon gas 60–65%. Shortly after the end of surgery the patients started an autonomous respiratory activity, and a high BIS level was also recorded. Decision was made by our team to proceed into the emergence phase. The residual neuromuscular block was antagonized by sugammadex, modified Aldrete score was implicated, and we got our patient fully awake without any cognitive dysfunction or delirium. Conclusion. The rapid emergence to full orientation in very elderly patient who had been anesthetized by xenon shows concordance to the high BIS values and the clinical signs of the depth of anesthesia.

  8. Selected indices of peritoneal fibrosis in patients undergoing peritoneal dialysis

    Directory of Open Access Journals (Sweden)

    Józef Penar

    2009-04-01

    Full Text Available Peritoneal dialysis is an alternative to hemodialysis in the treatment of patients with end-stage renal disease. Long-term use of peritoneal dialysis is limited by progressive alterations in the peritoneal membrane. The pathological changes in the peritoneum are due to the exposure to traditional nonphysiological peritoneal dialysis fluids that have low pH, high glucose and glucose degradation product content, and high molarity. Repeated episodes of bacterial peritonitis are another cause of peritoneal membrane damage. The characteristic features of peritoneal alterations include peritoneal fibrosis and morphologic changes in the peritoneal microvasculature with the accumulation of extracellular matrix in the submesothelial area and loss of mesothelial cells. These changes in the peritoneal membrane cause ultrafiltration failure and loss of dialysis efficacy. The pathogenesis of the peritoneal membrane damage is very complicated and understanding the processes involved in these alterations will be crucial in improving treatment with peritoneal dialysis. Some points of view on fibrosis of peritoneal membrane in patients undergoing peritoneal dialysis are presented here.

  9. Malnutrition risk predicts surgical outcomes in patients undergoing gastrointestinal operations: Results of a prospective study.

    Science.gov (United States)

    Ho, Judy W C; Wu, Arthur H W; Lee, Michelle W K; Lau, So-ying; Lam, Pui-shan; Lau, Wai-shan; Kwok, Sam S S; Kwan, Rosa Y H; Lam, Cheuk-fan; Tam, Chun-kit; Lee, Suk-on

    2015-08-01

    Patients undergoing gastrointestinal operations are at risk of malnutrition which may increase the chance of adverse surgical outcomes. This prospective study aimed at correlating nutritional status of patients having gastrointestinal operations with their short-term surgical outcomes captured by a territory-wide Surgical Outcomes Monitoring and Improvement Program. The preoperative malnutrition risk of Chinese adult patients undergoing elective/emergency ultra-major/major gastrointestinal operations in two surgical departments over a 12-month period were assessed by Chinese version of Malnutrition Universal Screening Tool. Their perioperative risk factors and clinical outcomes, including length of hospital stay, mortality and morbidity, were retrieved from the above mentioned program. Correlation of malnutrition risk with clinical outcomes was assessed by logistic regression analysis after controlling for known confounders. 943 patients (58% male; mean age 65.9 ± 14.8 years) underwent gastrointestinal operations (40.3% emergency operation; 52.7% ultra-major procedures; 66.9% bowel resections) had analyzable data. 15.8% and 17.1% of patients were at medium and high risk of malnutrition, respectively. Malnutrition risk score according to the screening tool was an independent predictor of length of hospital stay, 30-day mortality, 60-day mortality and minor medical complications. Similar correlations were found for various sub-scores of malnutrition risk. Weight loss sub-score was predictive of 30-day mortality, 60-day mortality and minor medical complications. Body mass index was predictive of mortality (30- and 60- day) whereas the acute disease sub-score was predictive of length of hospital stay. Preoperative malnutrition was an important predictor of poor clinical outcomes in patients undergoing gastrointestinal operations in Hong Kong. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  10. Anaesthesia for patients undergoing ventricular assist-device implantation.

    Science.gov (United States)

    Feussner, Markus; Mukherjee, Chirojit; Garbade, Jens; Ender, Joerg

    2012-06-01

    In the last 10 years, implantation of ventricular-assist devices has become an interesting option as either bridge-to-transplantation or destination procedure for patients with end-stage congestive heart failure. In the future, the number of ventricular assist device implantations is expected to increase furthermore. In general, this patient cohort is associated with significant co-morbidities, for example, pulmonary hypertension, peripheral vascular disease and renal insufficiency. Anaesthetic management for implantation of ventricular assist devices can be challenging for cardiac anaesthesiologists. Even minor changes in their haemodynamics and physiological parameters can cause significant morbidity and mortality. Experience in haemodynamic monitoring including echocardiography and pharmacological management (use of inotropes, phosphodiesterase inhibitors and vasopressors) is a requirement. Particularly, the diagnosis and therapy of right-sided heart failure after implantation of left-ventricular assist devices should be addressed.

  11. Pulmonary physiotherapy effect on patients undergoing open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Seyed Kazem Shakuri

    2014-09-01

    Full Text Available Backgrounds and Objectives — Respiratory complications after open heart surgeries are common problems which can lead to death if not properly managed. The aim of this study was to evaluate the role of pulmonary rehabilitation before and after surgery for reducing the risk of pulmonary complications after surgery also correlations of the six-minute walk test and respiratory following open heart surgery. Material and Methods — In a randomized clinical trial, 60 patients undergoing heart surgery were divided into two groups randomly (groups A and B. In group A it was performed physiotherapy before and after chest physiotherapy surgery, but on patients in group B were done only chest physiotherapy after surgery. Effects of preoperative pulmonary rehabilitation were compared between two groups, using spirometry and six-minute walk test. Results — Thirty nine of males (65% and 21 females (35% with a mean age of 8.10±9.56 was been analyzed. The mean difference in predicted forced vital capacity (CI95%: 1.3 to 8.7 and predicted peak flow indices (CI95%: 1.9 to 9.4 of spirometery indicator was significant, also evaluation of six-minute walk test showed, mean difference in walking distant (CI95%: 8.8 to 21.0 and mean oxyhemoglobin saturation (CI95%: 0.59 to 1.67 in group A was more than group B. Inverse correlation of heart rate with forced vital capacity showed that patients with more restriction had more heart rate during the walking test. Conclusion — Pulmonary rehabilitation program before surgery is recommended to reduce complications of heart surgery. Further evaluations are necessary in relation to the sensitivity and specificity of six-minute walk test parameters alone in the evaluation of respiratory performance.

  12. Brain measures of nociception using near-infrared spectroscopy in patients undergoing routine screening colonoscopy.

    Science.gov (United States)

    Becerra, Lino; Aasted, Christopher M; Boas, David A; George, Edward; Yücel, Meryem A; Kussman, Barry D; Kelsey, Peter; Borsook, David

    2016-04-01

    Colonoscopy is an invaluable tool for the screening and diagnosis of many colonic diseases. For most colonoscopies, moderate sedation is used during the procedure. However, insufflation of the colon produces a nociceptive stimulus that is usually accompanied by facial grimacing/groaning while under sedation. The objective of this study was to evaluate whether a nociceptive signal elicited by colonic insufflation could be measured from the brain. Seventeen otherwise healthy patients (age 54.8 ± 9.1; 6 female) undergoing routine colonoscopy (ie, no history of significant medical conditions) were monitored using near-infrared spectroscopy (NIRS). Moderate sedation was produced using standard clinical protocols for midazolam and meperidine, titrated to effect. Near-infrared spectroscopy data captured during the procedure was analyzed offline to evaluate the brains' responses to nociceptive stimuli evoked by the insufflation events (defined by physician or observing patients' facial responses). Analysis of NIRS data revealed a specific, reproducible prefrontal cortex activity corresponding to times when patients grimaced. The pattern of the activation is similar to that previously observed during nociceptive stimuli in awake healthy individuals, suggesting that this approach may be used to evaluate brain activity evoked by nociceptive stimuli under sedation, when there is incomplete analgesia. Although some patients report recollection of procedural pain after the procedure, the effects of repeated nociceptive stimuli in surgical patients may contribute to postoperative changes including chronic pain. The results from this study indicate that NIRS may be a suitable technology for continuous nociceptive afferent monitoring in patients undergoing sedation and could have applications under sedation or anesthesia.

  13. Effects of Glutamine Supplementation on Patients Undergoing Abdominal Surgery

    Institute of Scientific and Technical Information of China (English)

    Yue-ping Fan; Jian-chun Yu; Wei-ming Kang; Qun Zhang

    2009-01-01

    Objective To evaluate the effects of supplementation of glutamine (GLN) on maintaining glutathione (GSH) level, immune system function, liver function, and clinical outcome of patients receiving abdominal operation. Methods Forty patients undergoing elective abdominal surgical treatment were randomly divided into 2 groups: study group (n = 20) and control group (n = 20). All patients received total parenteral nutrition (TPN) for up to 7 days during perioperative period. The study group received TPN supplemented with GLN dipeptide while the control group received TPN without GLN dipeptide. Patients in both groups received equivalent nitrogen and caloric intake. Blood sample was taken on preoperative day, and the 1st, 3rd, 6th postoperative day to measure GSH level, immune indexes, and liver function indexes. Results The decrease of GSH level in plasma and red blood cell (RBC) in study group was less than that in control group during postoperative period. Ratio of GSH/glutathione disulfide (GSSG) in plasma in study group was higher than that in control group on the 3rd postoperative day (52.53 ± 11.46 vs. 31.43 ± 7.27, P = 0.001). Albumin level in study group was higher than that in control group on the 3rd postoperative day (37.7 ± 3.8 g/L vs. 33.8 ± 4.2 g/L, P = 0.02). There was no significant difference in the levels of immunoglobin (IgG, IgM, IgA) or T lymphocyte subgroup (CD4, CD8, CD4/CD8) in both groups during postoperative period. There was one case with infectious complication in control group, while none in study group. A trend of shortened hospital stay was observed in study group compared with control group (22.3 ± 2.1 d vs. 24.9 ± 1.7 d, P = 0.32). Conclusions Supplementation of GLN-enriched TPN has beneficial effects on maintaining GSH levels in plasma and RBC, sustaining GSH/GSSG ratio and albumin level, and keeping antioxidant abilities during postoperative period in patients with abdominal operation, with the trends of decreasing incidence of

  14. Acute kidney injury in patients undergoing cardiac surgery.

    Science.gov (United States)

    Coppolino, Giuseppe; Presta, Piera; Saturno, Laura; Fuiano, Giorgio

    2013-01-01

    The incidence of postoperative acute kidney injury (AKI) in patients undergoing cardiac surgery ranges from 7.7% to 28.1% in different studies, probably in relation to the criteria adopted to define AKI. AKI markedly increases mortality risk. However, despite the development of less invasive techniques, cardiac surgery remains the first option in many conditions such as severe coronary artery disease, valve diseases and complex interventions. The risk of postsurgery AKI can be reduced by adopting less invasive approaches, such as off-pump coronary artery bypass grafting or transcatheter aortic valve implantation, but these options cannot be employed in all cases. Thus, since traditional cardiac surgery remains the only option in many cases, it is important to adopt strategies helping the clinician to prevent AKI or diagnose it early. Old age, preprocedural chronic kidney disease, obesity, some comorbidities, wide pulse pressure and some pharmacological regimens represent risk factors for postsurgery AKI and mortality. Important intraoperative factor are use and duration of cardiopulmonary bypass. Postoperative efforts should be aimed toward maximizing cardiac output, avoiding drugs vasoconstricting the renal artery, providing adequate crystalloid infusion and alkalinizing urine. Fluid management should not be based on the measurements for cardiac filling pressures, which are mostly unreliable in these patients. Novel biomarkers such as cystatin C, kidney injury molecule-1 and human neutrophil gelatinase-associated lipocalin have been found to change earlier than creatinine, particularly when measured in combination, so their use in clinical practice can facilitate early diagnosis and treatment of AKI. The occurrence of oliguria despite adequate cardiovascular therapy can be managed with furosemide, possibly using continuous infusion, or renal replacement therapy.

  15. Enhanced Recovery After Surgery Program in Patients Undergoing Pancreaticoduodenectomy

    Science.gov (United States)

    Xiong, Junjie; Szatmary, Peter; Huang, Wei; de la Iglesia-Garcia, Daniel; Nunes, Quentin M.; Xia, Qing; Hu, Weiming; Sutton, Robert; Liu, Xubao; Raraty, Michael G.

    2016-01-01

    -regression analysis. Our study suggested that ERAS was as safe as CPC and improved recovery of patients undergoing PD, thus reducing in-hospital costs. General adoption of ERAS protocols during PD should be recommended. PMID:27149448

  16. Benefits of monitoring patients with mobile cardiac telemetry (MCT) compared with the Event or Holter monitors.

    Science.gov (United States)

    Tsang, Jean-Patrick; Mohan, Shunmugam

    2013-01-01

    This research is meant to establish if a patient monitored with mobile cardiac telemetry (MCT) sees different outcomes regarding diagnostic yield of arrhythmia, therapeutic management through the use of antiarrhythmic drugs, and cardiovascular costs incurred in the hospital setting when compared with more traditional monitoring devices, such as the Holter or the Event monitor. We conducted a retrospective analysis spanning 57 months of claims data from January 2007 to September 2011 pertaining to 200,000+ patients, of whom 14,000 used MCT only, 54,000 an Event monitor only, and 163,000 a Holter monitor only. Those claims came from the Truven database, an employer database that counts 2.8 million cardiovascular patients from an insured population of about 10 million members. We employed a pair-wise pre/post test-control methodology, and ensured that control patients were similar to test patients along the following dimensions: age, geographic location, type of cardiovascular diagnosis both in the inpatient and outpatient settings, and the cardiovascular drug class the patient uses. First, the diagnostic yield of patients monitored with MCT is 61%, that is significantly higher than that of patients that use the Event monitor (23%) or the Holter monitor (24%). Second, patients naive to antiarrhythmic drugs initiate drug therapy after monitoring at the following rates: 61% for patients that use MCT compared with 39% for patients that use the Event and 43% for patients that use the Holter. Third, there are very significant inpatient cardiovascular savings (in the tens of thousands of dollars) for patients that undergo ablation, coronary artery bypass graft (CABG) and valve septa. Savings are more modest but nonetheless significant when it comes to the heart/pericardium procedure. Given the superior outcome of MCT regarding both patient care and hospital savings, hospitals only stand to gain by enforcing protocols that favor the MCT system over the Event or the Holter

  17. Peripheral doses in patients undergoing Cyberknife treatment for intracranial lesions. A single centre experience

    Directory of Open Access Journals (Sweden)

    Vlachopoulou Vassiliki

    2011-11-01

    Full Text Available Abstract Background Stereotactic radiosurgery/radiotherapy procedures are known to deliver a very high dose per fraction, and thus, the corresponding peripheral dose could be a limiting factor for the long term surviving patients. The aim of this clinical study was to measure the peripheral dose delivered to patients undergoing intracranial Cyberknife treatment, using the MOSFET dosimeters. The influence of the supplemental shielding, the number of monitor units and the collimator size to the peripheral dose were investigated. Methods MOSFET dosimeters were placed in preselected anatomical regions of the patient undergoing Cyberknife treatment, namely the thyroid gland, the nipple, the umbilicus and the pubic symphysis. Results The mean peripheral doses before the supplemental shielding was added to the Cyberknife unit were 51.79 cGy, 13.31 cGy and 10.07 cGy while after the shielding upgrade they were 38.40 cGy, 10.94 cGy, and 8.69 cGy, in the thyroid gland, the umbilicus and the pubic symphysis, respectively. The increase of the collimator size corresponds to an increase of the PD and becomes less significant at larger distances, indicating that at these distances the PD is predominate due to the head leakage and collimator scatter. Conclusion Weighting the effect of the number of monitor units and the collimator size can be effectively used during the optimization procedure in order to choose the most suitable treatment plan that will deliver the maximum dose to the tumor, while being compatible with the dose constraints for the surrounding organs at risk. Attention is required in defining the thyroid gland as a structure of avoidance in the treatment plan especially in patients with benign diseases.

  18. Knee injury and obesity in patients undergoing total knee replacement: a retrospective study in 115 patients

    DEFF Research Database (Denmark)

    Jensen, Claus Hjorth; Rofail, S

    1999-01-01

    The prevalence of obesity and previous knee injury was assessed in a retrospective study of 115 patients under-going total knee replacement due to osteoarthritis. Obesity was considered a contributing factor in the development of osteoarthritis in 37% of the patients, and 33% of the patients had...... had an injury to the knee in question. Unilateral osteoarthritis was significantly more frequent than bilateral osteoarthritis among patients with a history of previous knee injury. The association of previous injury to the knee and unilateral osteoarthritis was stronger in men than women. Aggressive...... treatment of patients with knee injuries seems warranted....

  19. Paravertebral block versus thoracic epidural for patients undergoing thoracotomy.

    Science.gov (United States)

    Yeung, Joyce H Y; Gates, Simon; Naidu, Babu V; Wilson, Matthew J A; Gao Smith, Fang

    2016-02-21

    Operations on structures in the chest (usually the lungs) involve cutting between the ribs (thoracotomy). Severe post-thoracotomy pain can result from pleural (lung lining) and muscular damage, costovertebral joint (ribcage) disruption and intercostal nerve (nerves that run along the ribs) damage during surgery. Poor pain relief after surgery can impede recovery and increase the risks of developing complications such as lung collapse, chest infections and blood clots due to ineffective breathing and clearing of secretions. Effective management of acute pain following thoracotomy may prevent these complications and reduce the likelihood of developing chronic pain. A multi-modal approach to analgesia is widely employed by thoracic anaesthetists using a combination of regional anaesthetic blockade and systemic analgesia, with both non-opioid and opioid medications and local anaesthesia blockade.There is some evidence that blocking the nerves as they emerge from the spinal column (paravertebral block, PVB) may be associated with a lower risk of major complications in thoracic surgery but the majority of thoracic anaesthetists still prefer to use a thoracic epidural blockade (TEB) as analgesia for their patients undergoing thoracotomy. In order to bring about a change in practice, anaesthetists need a review that evaluates the risk of all major complications associated with thoracic epidural and paravertebral block in thoracotomy. To compare the two regional techniques of TEB and PVB in adults undergoing elective thoracotomy with respect to:1. analgesic efficacy;2. the incidence of major complications (including mortality);3. the incidence of minor complications;4. length of hospital stay;5. cost effectiveness. We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL 2013, Issue 9); MEDLINE via Ovid (1966 to 16 October 2013); EMBASE via Ovid (1980 to 16 October 2013); CINAHL via EBSCO host (1982 to 16 October 2013); and reference lists of

  20. "Wet diapers--dry patients": an effective dressing for patients undergoing arthroscopic shoulder surgery.

    Science.gov (United States)

    Kapila, Atul; Bhargava, Amit; Funk, Len; Copeland, Stephen; Levy, Ofer

    2005-02-01

    Shoulder arthroscopy is very commonly associated with postoperative leakage of irrigation fluid. This causes apprehension to patients and their relatives and leads to frequent change of dressings. We describe a simple and effective diaper dressing for patients undergoing arthroscopic shoulder surgery. It is highly absorbent, cost-effective, and easy to apply. We have used this dressing successfully in more than 1,500 shoulder arthroscopies over the last 3 years with no adverse reaction.

  1. Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery

    Science.gov (United States)

    Ellakany, Mohamed Hamdy

    2014-01-01

    Aim: A double-blinded randomized controlled study to compare discharge time and patient satisfaction between two groups of patients submitted to open surgeries for abdominal malignancies using segmental thoracic spinal or general anesthesia. Background: Open surgeries for abdominal malignancy are usually done under general anesthesia, but many patients with major medical problems sometimes can’t tolerate such anesthesia. Regional anesthesia namely segmental thoracic spinal anesthesia may be beneficial in such patients. Materials and Methods: A total of 60 patients classified according to American Society of Anesthesiology (ASA) as class II or III undergoing surgeries for abdominal malignancy, like colonic or gastric carcinoma, divided into two groups, 30 patients each. Group G, received general anesthesia, Group S received a segmental (T9-T10 injection) thoracic spinal anesthesia with intrathecal injection of 2 ml of hyperbaric bupivacaine 0.5% (10 mg) and 20 ug fentanyl citrate. Intraoperative monitoring, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two groups. Results: Spinal anesthesia was performed easily in all 30 patients, although two patients complained of paraesthesiae, which responded to slight needle withdrawal. No patient required conversion to general anesthesia, six patients required midazolam for anxiety and six patients required phenylephrine and atropine for hypotension and bradycardia, recovery was uneventful and without sequelae. The two groups were comparable with respect to gender, age, weight, height, body mass index, ASA classification, preoperative oxygen saturation and preoperative respiratory rate and operative time. Conclusion: This preliminary study has shown that segmental thoracic spinal anesthesia can be used successfully and effectively for open surgeries for abdominal malignancies by experienced anesthetists. It showed shorter postanesthesia care unit stay

  2. The transversus abdominis plane block provides effective postoperative analgesia in patients undergoing total abdominal hysterectomy.

    LENUS (Irish Health Repository)

    Carney, John

    2008-12-01

    Patients undergoing total abdominal hysterectomy suffer significant postoperative pain. The transversus abdominis plane (TAP) block is a recently described approach to providing analgesia to the anterior abdominal wall. We evaluated the analgesic efficacy of the TAP block in patients undergoing total abdominal hysterectomy via a transverse lower abdominal wall incision, in a randomized, controlled, double-blind clinical trial.

  3. Hemodynamic, ventilator, and ECG changes in pediatric patients undergoing extraction

    Directory of Open Access Journals (Sweden)

    Y K Sanadhya

    2013-01-01

    Full Text Available Background: Dental treatment induces pain anxiety and fear. This study was conducted to assess the changes in hemodynamic, ventilator, and electrocardiograph changes during extraction procedure among 12-15-year-old children and compare these changes with anxiety, fear, and pain. Materials and Methods: A purposive sample of 60 patients selected based on inclusion and exclusion criteria underwent study procedure in the dental OPD of a medical college and hospital. The anxiety, fear, and pain were recorded by dental anxiety scale, dental fear scale, and visual analogue scale, respectively, before the start of the procedure. The systolic blood pressure, diastolic blood pressure, heart rate, oxygen saturation, and electrocardiogram changes were monitored during the extraction procedure. The recording was taken four times (preinjection phase, injection, extraction, and postextraction and was analyzed. Results: At the preinjection phase the mean vales were systolic blood pressure (128 ± 11.2, diastolic blood pressure (85.7 ± 6.3, heart rate (79.7 ± 9.3, and oxygen saturation (97.9 ± 5.8. These values increased in injection phases and decreased in extraction phase and the least values were found after 10 min of procedure and this relation was significant for all parameters except oxygen saturation (P = 0.48, NS. ECG abnormalities were seen among 22 patients and were significant before and after injection of Local anesthetic (P = 0.0001, S. Conclusions: Anxiety, fear, and pain have an effect on hemodynamic, ventilator, and cardiovascular parameters during the extraction procedure and hence behavioral management has to be emphasized among children in dental clinics.

  4. Comparison of automated and manual follicle monitoring in an unrestricted population of 100 women undergoing controlled ovarian stimulation for IVF.

    Science.gov (United States)

    Ata, Baris; Seyhan, Ayse; Reinblatt, Shauna Leigh; Shalom-Paz, Einat; Krishnamurthy, Srinivasan; Tan, Seang Lin

    2011-01-01

    Ovarian response to gonadotrophin stimulation is monitored with serial ultrasound (US) examinations. Sonography-based Automated Volume Count (SonoAVC) is a relatively new three-dimensional (3D) US technology, which automatically generates a set of measurements including the mean follicular diameter (MFD) and a volume-based diameter (d(V)) for each follicle in the ovaries. The present study aimed to assess the applicability and reproducibility of this automated follicle measurement method in an IVF programme. For this prospective method comparison study, 100 women undergoing US monitoring of a controlled ovarian stimulation cycle were recruited. Each follicle was manually measured by taking the mean of maximal diameters on three orthogonal planes with two-dimensional (2D) US. A 3D volume of each ovary was then captured. The ovarian volumes were later analysed using SonoAVC. The agreement between the two methods for the numbers of follicles and the size of the leading follicle was assessed with the Bland-Altman method. The reproducibility of SonoAVC measurements was assessed with the intraclass correlation coefficient (ICC). Both SonoAVC-generated MFD and d(V)-based follicle counts, as well as the leading follicle diameter, had good agreement with conventional 2D US measurements. SonoAVC measurements had very good reproducibility, with ICC ≥0.8 for most evaluations. Automated follicle monitoring with SonoAVC can replace or be used interchangeably with conventional 2D measurements. Automated follicle monitoring can save time, provide a method of quality control and create opportunities for developing HCG criteria based on follicular volume or for monitoring patients from a distance.

  5. Evaluation of pulmonary function in renal transplant recipients and chronic renal failure patients undergoing maintenance hemodialysis

    Directory of Open Access Journals (Sweden)

    Mohamed E. Abdalla

    2013-01-01

    Conclusion: There is impairment of lung function in patients with CRF undergoing hemodialysis. The main changes are small airway obstruction, reduction in carbon monoxide transfer and diminished 6MWT that were not completely improved in the kidney transplant patients.

  6. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

    NARCIS (Netherlands)

    Mastenbroek, Mirjam H; van t Sant, Jetske; Versteeg, Henneke; Cramer, MJ; Doevendans, Pieter A; Pedersen, Susanne S; Meine, Mathias

    BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time

  7. Relationship between reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy

    NARCIS (Netherlands)

    Mastenbroek, M.H.; Sant, Jetske Van't; Versteeg, H.; Cramer, Maarten J; Doevendans, Pieter A; Pedersen, Susanne S; Meine, Mathias

    2016-01-01

    BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time

  8. Mean platelet volume and long-term mortality in patients undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Shah, Binita; Oberweis, Brandon; Tummala, Lakshmi; Amoroso, Nicholas S; Lobach, Iryna; Sedlis, Steven P; Grossi, Eugene; Berger, Jeffrey S

    2013-01-15

    Increased platelet activity is associated with adverse cardiovascular events. The mean platelet volume (MPV) correlates with platelet activity; however, the relation between the MPV and long-term mortality in patients undergoing percutaneous coronary intervention (PCI) is not well established. Furthermore, the role of change in the MPV over time has not been previously evaluated. We evaluated the MPV at baseline, 30 days, 60 days, 90 days, 1 year, 2 years, and 3 years after the procedure in 1,512 patients who underwent PCI. The speed of change in the MPV was estimated using the slope of linear regression. Mortality was determined by query of the Social Security Death Index. During a median of 8.7 years, mortality was 49.3% after PCI. No significant difference was seen in mortality when stratified by MPV quartile (first quartile, 50.1%; second quartile, 47.7%; third quartile, 51.3%; fourth quartile, 48.3%; p = 0.74). For the 839 patients with available data to determine a change in the MPV over time after PCI, mortality was 49.1% and was significantly greater in patients with an increase (52.9%) than in those with a decrease (44.2%) or no change (49.1%) in the MPV over time (p <0.0001). In conclusion, no association was found between the baseline MPV and long-term mortality in patients undergoing PCI. However, increased mortality was found when the MPV increased over time after PCI. Monitoring the MPV after coronary revascularization might play a role in risk stratification.

  9. Postural balance in Alzheimer's disease patients undergoing sensory pitfalls

    Directory of Open Access Journals (Sweden)

    Brunna Berton

    Full Text Available Abstract Despite consensus regarding the interference of cognitive processes on the human balance, the impact that different sensory stimuli have on the stabilometric measures remains unclear. Here, we investigated changes in the postural balance of individuals with Alzheimer's disease (AD and in healthy controls undergoing different proprioceptive and somesthetic pitfalls. We included 17 subjects submitted to eight sensorimotor dynamics with differences in the support bases, contact surfaces, and visual clues. The measurements used to assess participants balance were as follows: position of the body in space, range of instability, area of the support base, and velocity of postural control. From a total of 56 cross-sectional analyses, 21.42% pointed out differences between groups. Longitudinal analyses showed that tasks with proprioceptive and somesthetic pitfalls similarly impact imbalance in both groups. The current results suggest that AD subjects and healthy controls had different patterns submitted to balance, but suffered similar interference when undergoing proprioceptive and somesthetic challenges.

  10. Educational Needs of Patients Undergoing Total Joint Arthroplasty

    Science.gov (United States)

    MacKay, Crystal; Saryeddine, Tina; Davis, Aileen M.; Flannery, John F.; Jaglal, Susan B.; Levy, Charissa; Mahomed, Nizar

    2010-01-01

    ABSTRACT Purpose: To identify the educational needs of adults who undergo total hip and total knee replacement surgery. Methods: A qualitative research design using a semi-standardized interviewing method was employed. A purposive sampling technique was used to recruit participants, who were eligible if they were scheduled to undergo total hip or total knee replacement or had undergone total hip or total knee replacement in the previous 3 to 6 months. A comparative contrast method of analysis was used. Results: Of 22 potential participants who were approached, 15 participated. Five were booked for upcoming total hip or total knee replacement and 10 had undergone at least one total hip or total knee replacement in the previous 3 to 6 months. Several themes related to specific educational needs and factors affecting educational needs, including access, preoperative phase, surgery and medical recovery, rehabilitation process and functional recovery, fears, and expectations counterbalanced with responsibility, emerged from the interviews. Conclusions: Educational needs of adults who undergo total hip and knee replacement surgery encompass a broad range of topics, confirming the importance of offering an all-inclusive information package regarding total hip and total knee replacement. PMID:21629598

  11. Predictors of outcome in neck pain patients undergoing chiropractic care: comparison of acute and chronic patients

    Directory of Open Access Journals (Sweden)

    Peterson Cynthia

    2012-08-01

    Full Text Available Abstract Background Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment. Methods Acute ( 3 months (n = 255 neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS and Bournemouth questionnaire (BQ at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement. Results Baseline mean neck pain and total disability scores were significantly (p  Conclusions The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.

  12. NASA's contributions to patient monitoring, appendix

    Science.gov (United States)

    Murray, D. M.; Siemens, W. D.

    1971-01-01

    Health care problems, and markets for patient monitoring equipment are discussed along with contributions to all phases of patient monitoring, and technology transfer to nonaerospace problems. Health care medical requirements, and NASA achievements in patient monitoring are described, and a summary of the technology transfer is included.

  13. Hypovitaminosis D in patients undergoing kidney transplant: the importance of sunlight exposure.

    Science.gov (United States)

    Vilarta, Cristiane F; Unger, Marianna D; Dos Reis, Luciene M; Dominguez, Wagner V; David-Neto, Elias; Moysés, Rosa M; Titan, Silvia; Custodio, Melani R; Hernandez, Mariel J; Jorgetti, Vanda

    2017-07-01

    Recent studies have shown a high prevalence of hypovitaminosis D, defined as a serum 25-hydroxyvitamin D level less than 30 ng/ml, in both healthy populations and patients with chronic kidney disease. Patients undergoing kidney transplant are at an increased risk of skin cancer and are advised to avoid sunlight exposure. Therefore, these patients might share two major risk factors for hypovitaminosis D: chronic kidney disease and low sunlight exposure. This paper describes the prevalence and clinical characteristics of hypovitaminosis D among patients undergoing kidney transplant. We evaluated 25-hydroxyvitamin D serum levels in a representative sample of patients undergoing kidney transplant. We sought to determine the prevalence of hypovitaminosis D, compare these patients with a control group, and identify factors associated with hypovitaminosis D (e.g., sunlight exposure and dietary habits). Hypovitaminosis D was found in 79% of patients undergoing kidney transplant, and the major associated factor was low sunlight exposure. These patients had higher creatinine and intact parathyroid hormone serum levels, with 25-hydroxyvitamin D being inversely correlated with intact parathyroid hormone serum levels. Compared with the control group, patients undergoing kidney transplant presented a higher prevalence of 25-hydroxyvitamin D deficiency and lower serum calcium, phosphate and albumin but higher creatinine and intact parathyroid hormone levels. Our results confirmed the high prevalence of hypovitaminosis D in patients undergoing kidney transplant. Therapeutic strategies such as moderate sunlight exposure and vitamin D supplementation should be seriously considered for this population.

  14. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

    DEFF Research Database (Denmark)

    Pihl, Kenneth; Englund, Martin; Lohmander, L. Stefan

    2017-01-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA...... and patients' characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods - 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18...... established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear....

  15. [Management of aortic stenosis in patients undergoing non-cardiac surgery].

    Science.gov (United States)

    Labbé, Vincent; Ederhy, Stéphane; Szymkiewicz, Olga; Cohen, Ariel

    2015-01-01

    There is a significant risk of cardiovascular morbidity and mortality in patients with severe aortic stenosis (valve area angina, syncope, or heart failure). Before any surgery, clinical assessment should search for signs of aortic stenosis which justifies echocardiographic examination, particularly in the elderly. A systematic rest echocardiography with searching aortic stenosis should be considered in patients undergoing high risk surgery. The key points of pre-operative cardiac risk assessment are: assessment of the severity of aortic stenosis, measurement of the functional capacity, evaluation of the left ventricular systolic function, search of associated coronary artery disease, estimate of the surgical risk of cardiac events, and achievement of risk indices. In symptomatic patients with severe aortic stenosis, only urgent non-cardiac surgery should be performed under careful haemodynamic monitoring. Aortic valve replacement should be considered before elective non-cardiac surgery. In asymptomatic patients with severe aortic stenosis, aortic valve replacement should be considered before non-cardiac high risk surgery. Non-cardiac surgery at low/intermediate risk can be performed provided an adapted anaesthetic technique.

  16. Effects of different degrees of neuromuscular blockade induced by rocuronium on facial nerve evoked-electromyographic monitoring in patients undergoing resection of acoustic neuroma%罗库溴铵不同神经肌肉阻滞程度对听神经瘤切除术患者面神经诱发肌电图监测的影响

    Institute of Scientific and Technical Information of China (English)

    杨丽娜; 鄢建勤; 崔亚萍; 邹望远; 杨治权; 刘尚明; 袁贤瑞

    2012-01-01

    目的 探讨罗库溴铵不同神经肌肉阻滞(NMB)程度对听神经瘤切除术患者面神经诱发肌电图(EEMG)监测的影响.方法 择期在全身麻醉下行听神经瘤切除术患者35例,年龄20~64岁,性别不限,体重指数≤30 kg/m2,ASA分级Ⅰ或Ⅱ级.采用美国Axon公司的Epoch XP2000型16通道多功能电生理监测仪监测面神经EEMG,术中电刺激面神经,记录眼轮匝肌的诱发电位;采用荷兰0rganon公司的TOF-Watch SX肌松监测仪监测外周NMB程度,采用四个成串刺激模式.静脉注射罗库溴铵0.6 mg/kg后,在不同外周NMB程度(100%、75%、50%、25%、0)时测定面神经EEMG的振幅和潜伏期,计算振幅保留比率(实测EEMG振幅与基础值的比值).面神经EEMG的振幅保留比率与外周NMB程度间进行直线回归分析,面神经EEMG的振幅保留比率和潜伏期分别与外周NMB程度间进行等级相关分析.结果 当NMB为100%,有6例患者未能诱发出EEMG反应;振幅保留比率(Y)与外周NMB(X)程度之间的回归方程为Y=1-0.787X,决定系数为0.898(P< 0.05);二者间的相关系数为-0.947(P <0.05);潜伏期与外周NMB间的相关系数为0.328(P< 0.05).结论 听神经瘤切除术中维持外周NMB 25%~50%时不仅可保证有效地监测面神经EEMG,而且具有良好的制动效果.%Objective To investigate the effects of different degrees of neuromuscular blockade (NMB) induced by rocuronium on facial nerve evoked-electromyographic (EEMG) monitoring in patients undergoing resection of acoustic neuroma.Methods Thirty-five ASA Ⅰ or Ⅱ patients of both sexes,aged 20-64 yr,with body mass index ≤30 kg/m2,scheduled for elective resection of acoustic neuroma under general anesthesia,were included in the study.Anesthesia was induced with midazolam,fentanyl and propofol.The patients were mechanically ventilated after tracheal intubation.Facial nerve EEMG monitoring and peripheral NMB monitoring were performed simultaneously

  17. Anaesthesia for the patient with dementia undergoing outpatient surgery

    DEFF Research Database (Denmark)

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

    2009-01-01

    PURPOSE OF REVIEW: Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both...

  18. Patient variables and referral paradigms associated with osteoporosis screening and treatment in neurosurgical patients undergoing kyphoplasty.

    Science.gov (United States)

    Morr, Simon; Shakir, Hakeem J; Lipinski, Lindsay J; Dimopoulos, Vassilios G; Leonardo, Jody; Pollina, John

    2015-12-01

    OBJECT Vertebral fractures are the most common osteoporotic fracture. Bone density testing and medical treatment with bisphosphonates or parathormone are recommended for all patients with an osteoporotic fracture diagnosis. Inadequate testing and treatment of patients presenting with low-impact fractures have been reported in various specialties. Similar data are not available from academic neurosurgery groups. The authors assessed compliance with treatment and testing of osteoporosis in patients with vertebral compression fractures evaluated by the authors' academic neurosurgery service, and patient variable and health-systems factors associated with improved compliance. METHODS Data for patients who underwent percutaneous kyphoplasty for compression fractures was retrospectively collected. Diagnostic and medical interventions were tabulated. Pre-, intra-, and posthospital factors that had been theorized to affect the compliance of patients with osteoporosis-related therapies were tabulated and statistically analyzed. RESULTS Less than 50% of patients with kyphoplasty received such therapies. Age was not found to correlate with other variables. Referral from a specialist rather than a primary care physician was associated with a higher rate of bone density screening, as well as vitamin D and calcium therapy, but not bisphosphonate/parathormone therapy. Patients who underwent preoperative evaluation by their primary care physician were significantly more likely to receive bisphosphonates compared with those only evaluated by a hospitalist. Patients with unprovoked fractures were more likely to undergo multiple surgeries compared with those with minor trauma. CONCLUSIONS These results suggest poor compliance with current standard of care for medical therapies in patients with osteoporotic compression fractures undergoing kyphoplasty under the care of an academic neurosurgery service.

  19. Evaluation of dental anxiety in patients undergoing dentoalveolar surgery with laser treatment.

    Science.gov (United States)

    Ugurlu, Faysal; Cavus, Onur; Kaya, Alper; Sener, Cem B

    2013-04-01

    The purpose of this study was to evaluate dental anxiety in patients undergoing apicectomy procedures performed with conventional instruments or an erbium-doped yttrium aluminum garnet (Er:YAG) laser. Twenty-eight patients undergoing apicectomy were divided into two groups; roots were removed with an Er:YAG laser in group A (n=14) and with conventional instruments in group B (n=14). All patients completed preoperative State-Trait Anxiety Inventories (STAI) and postoperative questionnaires. Although state anxiety, trait anxiety, and postoperative questionnaire scores were lower in patients undergoing Er:YAG laser treatment than in those treated with conventional instruments, the differences were not statistically significant. Surgical instruments affect the anxiety levels of dental patients. Even with the STAI scores being lower for patients treated with Er:YAG, use of the Er:YAG laser alone cannot contribute to the resolution of dental anxiety. A patient's individual condition is the major factor influencing that patient's anxiety level.

  20. Stress reduction through music in patients undergoing cerebral angiography.

    Science.gov (United States)

    Schneider, N; Schedlowski, M; Schürmeyer, T H; Becker, H

    2001-06-01

    We studied the influence of music on stress reaction of patients during cerebral angiography. We randomised 30 patients to a music or a control group. We measured stress hormones, blood pressure, heart rate and psychological parameters. Patients examined without music showed rising levels of cortisol in plasma, indicating high stress levels, while cortisol in patients examined with music remained stable. Systolic blood pressure was significantly lower listening to music. Patients with a high level of fear did appear to benefit particularly from the music.

  1. Stress reduction through music in patients undergoing cerebral angiography

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, N.; Becker, H. [Dept. of Neuroradiology, Hannover Medical School (Germany); Schedlowski, M. [Dept. of Clinical Psychiatry and Psychotherapy, Hannover Medical School (Germany); Schuermeyer, T.H. [Dept. of Endocrinology, Hannover Medical School (Germany)

    2001-06-01

    We studied the influence of music on stress reaction of patients during cerebral angiography. We randomised 30 patients to a music or a control group. We measured stress hormones, blood pressure, heart rate and psychological parameters. Patients examined without music showed rising levels of cortisol in plasma, indicating high stress levels, while cortisol in patients examined with music remained stable. Systolic blood pressure was significantly lower listening to music. Patients with a high level of fear did appear to benefit particularly from the music. (orig.)

  2. Management of postoperative pain in patients undergoing total knee

    Directory of Open Access Journals (Sweden)

    Sonia Marchán Espinosa

    2011-09-01

    Full Text Available The postoperatory pain after total prothesis of knee is a special type of agony, of great repercussion in the health area, since it affects the surgical patients who suffer it, the family that "suffer" together with the patient, the responsible doctors, the nursing personnel and the involved institutions. Aim: To value the pain degree for the immediate postoperatory of the prothesis of knee surgical patients during his stay at the Post-anesthesic Recovery Unit.Material and method: There was realized a descriptive study at the Valdepeña´s Hospital at the Post-anesthesic Recovery Unit for 7 months. The sample was formed by the prothesis of knee surgical patients during this period. There was designed a multiple answers questionnaire to which the patients answered during his stay in the unit and there was in use as instrument of measure of the pain the visual analogical scale.Results: 50 % of the patients suffered an intense pain after the anesthesic effect disappear. Almost the totality of the patients (90 % needed an analgesic rescue. In spite of it, the satisfaction that the patients expressed with the relief of his pain was very high.Conclusions: The patients experience high pain levels during the immediate postoperatory. The results reveal the need to design analgesic protocols more adapted to the individual patients need.

  3. Can shared care deliver better outcomes for patients undergoing total hip replacement?

    NARCIS (Netherlands)

    Rosendal, H.; Beekum, W.T. van; Nijhof, P.; Witte, L.P. de; Schrijvers, A.J.P.

    2000-01-01

    Objectives: To assess whether shared care for patients undergoing total hip replacement delivers better outcomes compared to care as usual. Design: Prospective, observational cohort study. Setting: Two regions in the Netherlands where different organisational health care models have been

  4. Impact of Intraoperative Events on Cerebral Tissue Oximetry in Patients Undergoing Cardiopulmonary Bypass

    NARCIS (Netherlands)

    Severdija, E.E.; Vranken, N.P.; Teerenstra, S.; Ganushchak, Y.M.; Weerwind, P.W.

    2015-01-01

    Previous studies showed that decreased cerebral saturation during cardiac surgery is related to adverse postoperative outcome. Therefore, we investigated the influence of intraoperative events on cerebral tissue saturation in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). A t

  5. The association between radiographic severity and pre-operative function in patients undergoing primary knee replacement for osteoarthritis

    DEFF Research Database (Denmark)

    Dowsey, Michelle M; Dieppe, Paul; Lohmander, Stefan

    2012-01-01

    To determine the association between radiographic osteoarthritis (OA) and pre-operative function in patients undergoing primary knee replacement.......To determine the association between radiographic osteoarthritis (OA) and pre-operative function in patients undergoing primary knee replacement....

  6. Anesthetic recovery and hemodynamic effects of continuous thiopental infusion versus halothane for maintenance anesthesia in patients undergoing ocular surgery

    NARCIS (Netherlands)

    Shoroghi, Mehrdad; Farahbakhsh, Farshid; Sheikhvatan, Mehrdad; Sheikhfathollahi, Mahmood; Abbasi, Ali; Talebi, Azam

    2011-01-01

    Purpose: To investigate anesthesia recovery and hemodynamic status in patients under thiopental infusion or halothane maintenance anesthesia undergoing ocular surgery. Methods: Fifty-nine voluntary patients undergoing ocular surgery in Farabi hospital were allocated to one of two maintenance anesthe

  7. Management of oral anticoagulation in patients undergoing minor dental procedures.

    Science.gov (United States)

    Alaali, Yathreb; Barnes, Geoffrey D; Froehlich, James B; Kaatz, Scott

    2012-08-01

    Approximately 4.2 million patients in the United States are taking warfarin, making it the 11th most prescribed drug. Warfarin is primarily used for treatment of venous thromboembolic disease and stroke prevention in patients with atrial fibrillation and mechanical heart valves. Dentists frequently encounter anticoagulated patients and are faced with management decisions in these patients who require dental procedures. Observational studies suggest the risk of thrombosis if anticoagulation is suspended during dental procedures is higher than the risk of bleeding if anticoagulation is not suspended. Several groups now offer guidelines that recommend most minor dental procedures should be performed while on therapeutic warfarin. The recent approval of several new oral anticoagulants has introduced greater complexity to the management of the anticoagulated patient, and this narrative review will discuss current guidelines, the scientific underpinnings of the guidelines, and offer some practical suggestions for patients that are receiving the new agents.

  8. Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy

    Institute of Scientific and Technical Information of China (English)

    Hiromichi Maeda; Takehiro Okabayashi; Tomoaki Yatabe; Koichi Yamashita; Kazuhiro Hanazaki

    2009-01-01

    Perioperative glycemic control is important for reducing postoperative infectious complications. However,clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead to the destruction of glucose homeostasis, which is termed pancreatogenic diabetes. Pancreatogenic diabetes is characterized by the occurrence of hyperglycemia and iatrogenic severe hypoglycemia, which adversely effects patient recovery.Postoperatively, a variety of factors including surgical stress, inflammatory cytokines, sympathomimetic drug therapy, and aggressive nutritional support can also affect glycemic control. This review discusses the endocrine aspects of pancreatic resection and highlights postoperative glycemic control using a closed-loop system or artificial pancreas. In previous experiments,we have demonstrated the reliability of the artificial pancreas in dogs with total pancreatectomy, and its postoperative clinical use has been shown to be effective and safe, without the occurrence of hypoglycemic episodes, even in patients after total pancreatectomy.Considering the increasing requirement for tight perioperative glycemic control and the recognized risk of hypoglycemia, we propose the use of an artificial endocrine pancreas that is able to monitor continuously blood glucose concentrations with proven accuracy, and administer automatically substances to return blood glucose concentration to the optimal narrow range.

  9. EVALUATION OF UPPER GASTROINTESTINAL ENDOSCOPY IN PATIENTS UNDERGOING BARIATRIC SURGERY

    OpenAIRE

    2015-01-01

    Background: Obesity has become epidemic, and is associated with greater morbidity and mortality. Treatment is multidisciplinary. Surgical treatment is a consistent resource in severe obesity. The indication of preoperative upper gastrointestinal endoscopy in asymptomatic patients is controversial; however, most studies recommend its implementation in all patients. Aim: To analyze endoscopic performance in patients who were in preoperative for bariatric surgery and compare them with control gr...

  10. Management of postoperative pain in patients undergoing total knee

    OpenAIRE

    Sonia Marchán Espinosa; Amparo Gómez-Rico Pareja

    2011-01-01

    The postoperatory pain after total prothesis of knee is a special type of agony, of great repercussion in the health area, since it affects the surgical patients who suffer it, the family that "suffer" together with the patient, the responsible doctors, the nursing personnel and the involved institutions. Aim: To value the pain degree for the immediate postoperatory of the prothesis of knee surgical patients during his stay at the Post-anesthesic Recovery Unit.Material and method: There was r...

  11. Functional Assessments in Patients Undergoing Radial Forearm Flap Following Hemiglossectomy.

    Science.gov (United States)

    Li, Xiangru; Sun, Qiang; Guo, Shu

    2016-03-01

    Our goal was to evaluate the functional outcomes following radial forearm free-flap reconstruction with a focus on radiotherapy. A 2-year prospective study was performed. A total of 47 patients were enrolled finally. They were asked to complete the swallowing, chewing, speech domains of the University of Washington Quality of Life questionnaire preoperatively and at 2 years postoperatively. Swallowing capacity was apparently affected after surgery, but no patients reported there was chokes cough during eating, the mean score was 51.1 (SD: 21.3). Most patients (70.2%) presented their articulation was good enough for everyday life, and the mean score was 60.0 (SD: 21.1). As for chewing, only 7 (14.9%) patients complained there was negative effect, and the mean score was as high as 92.6 (SD: 18.0). Compared to patients with surgery only, patients with postoperative radiotherapy only had significantly worse swallowing and speech capacity. Compared with patients with postoperative radiotherapy only, patients with both preoperative and postoperative radiotherapy tended to have better swallowing and speech. No significant differences were found between chewing and radiotherapy. In most patients, the results of swallowing, speech, and chewing are favorable. Postoperative radiotherapy has an apparent impact on functional impairment, but preoperative tends to preserve the original tongue function.

  12. Mycoplasma in urine and blood following catheterisation of patients undergoing vascular surgery

    DEFF Research Database (Denmark)

    Levi, N; Eiberg, J; Skov Jensen, J;

    1997-01-01

    The purpose of this investigation was to determine if mycoplasmas enter the bloodstream after urinary tract catheterisation in patients undergoing vascular surgery in order to evaluate the efficiency of the routine prophylactic antibiotic treatment.......The purpose of this investigation was to determine if mycoplasmas enter the bloodstream after urinary tract catheterisation in patients undergoing vascular surgery in order to evaluate the efficiency of the routine prophylactic antibiotic treatment....

  13. Population pharmacokinetics of daptomycin in adult patients undergoing continuous renal replacement therapy

    OpenAIRE

    Xu, Xiaoying; Khadzhynov, Dmytro; Peters, Harm; Chaves, Ricardo L.; Hamed, Kamal; Levi, Micha; Corti, Natascia

    2016-01-01

    Aim The objective of this population pharmacokinetic (PK) analysis was to provide guidance for the dosing interval of daptomycin in patients undergoing continuous renal replacement therapy (CRRT). Methods A previously published population PK model for daptomycin was updated with data from patients undergoing continuous veno?venous haemodialysis (CVVHD; n?=?9) and continuous veno?venous haemodiafiltration (CVVHDF; n?=?8). Model?based simulations were performed to compare the 24?h AUC, C max an...

  14. Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy

    DEFF Research Database (Denmark)

    Quist, Morten; Rørth, Mikael; Langer, Seppo

    2012-01-01

    To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption, muscle strength and health related quality of life (HRHRQOL) in patients with inoperable lung cancer, undergoing chemotherapy.......To investigate the safety and feasibility of a six-week supervised structured exercise and relaxation training programme on estimated peak oxygen consumption, muscle strength and health related quality of life (HRHRQOL) in patients with inoperable lung cancer, undergoing chemotherapy....

  15. Cardioprotective effect of sevoflurane in patients with coronary artery disease undergoing vascular surgery

    Directory of Open Access Journals (Sweden)

    Ahmed S Bassuoni

    2012-01-01

    Full Text Available Objectives: The present study was conducted to evaluate the cardioprotective effect of sevoflurane compared with propofol in patients with coronary artery disease (CAD undergoing peripheral vascular surgery; and to address the question whether a volatile anesthetic might improve cardiac outcome in these patients. Methods: One hundred twenty-six patients scheduled for elective peripheral vascular surgery were prospectively randomized to receive either sevoflurane inhalation anesthesia or total intravenous anesthesia. ST-segment monitoring was performed continuously during intra- and post-operative 48 h periods. The number of ischemic events and the cumulative duration of ischemia in each patient were recorded. Blood was sampled in all patients for the determination of cTnI. Samples were obtained before the induction of anesthesia, on admission to the ICU, and at 6, 12, 24, and 48 h after admission to the intensive care unit (ICU. Patients were followed-up during their hospital stay for any adverse cardiac events. Results: The incidence of ischemia were comparable among the groups [16 (25% patients in sevoflurane group vs 24 (39% patients in propofol group; P=0.126]. Duration, cumulative duration, and magnitude of ST-segment depression of ischemic events in each patient were significantly less in sevoflurane group (P=0.008, 0.048, 0.038, respectively. cTnI levels of the overall population were significantly less in sevoflurane group vs propofol group (P values <0.0001 from 6 h postoperative and onward. Meanwhile, cTnI levels at 6, 12, 24, and 48 h after admission to the ICU in patients who presented with ischemic electrocardiographic (ECG changes were significantly lower in sevoflurane group than in the propofol group (P<0.0001, <0.0001, <0.0001, 0.0003. None of the patients presented with unstable angina, myocardial infarction, congestive heart failure, or serious arrhythmia either during ICU or hospital stay. Conclusion: Patients with CAD

  16. Atrial electromechanical delay in patients undergoing heart transplantation

    Directory of Open Access Journals (Sweden)

    Mustafa Bulut, MD

    2017-04-01

    Conclusion: Inter-AEMD and intra-AEMD were prolonged in patients who underwent heart transplantation as compared to a control population. This may explain the increased atrial fibrillation and other atrial arrhythmia incidences associated with the biatrial anastomosis heart transplantation technique and may contribute to the treatment of atrial fibrillation in this special patient group.

  17. Inflammatory bowel diseases activity in patients undergoing pelvic radiation therapy

    Science.gov (United States)

    Seisen, Thomas; Klotz, Caroline; Mazeron, Renaud; Maroun, Pierre; Petit, Claire; Deutsch, Eric; Bossi, Alberto; Haie-Meder, Christine; Chargari, Cyrus; Blanchard, Pierre

    2017-01-01

    Background Few studies with contradictory results have been published on the safety of pelvic radiation therapy (RT) in patients with inflammatory bowel disease (IBD). Methods From 1989 to 2015, a single center retrospective analysis was performed including all IBD patients who received pelvic external beam radiation therapy (EBRT) or brachytherapy (BT) for a pelvic malignancy. Treatment characteristics, IBD activity and gastrointestinal (GI) toxicity were examined. Results Overall, 28 patients with Crohn’s disease (CD) (n=13) or ulcerative colitis (n=15) were included in the present study. Median follow-up time after irradiation was 5.9 years. Regarding IBD activity, only one and two patients experienced a severe episode within and after 6 months of follow-up, respectively. Grade 3/4 acute GI toxicity occurred in 3 (11%) patients, whereas one (3.6%) patient experienced late grade 3/4 GI toxicity. Only patients with rectal IBD location (P=0.016) or low body mass index (BMI) (P=0.012) experienced more severe IBD activity within or after 6 months following RT, respectively. Conclusions We report an acceptable tolerance of RT in IBD patients with pelvic malignancies. Specifically, a low risk of uncontrolled flare-up was observed. PMID:28280621

  18. INGUINAL NERVE BLOCK FOR PATIENTS UNDERGOING INGUINAL HERNIOPLASTY

    OpenAIRE

    2015-01-01

    Inguinal hernia repair is the most common elective surgical procedure performed under general, regional or local anesthesia. The advantages of day case surgery include greater patient satisfaction and reduced financial costs to the health service. Inguinal nerve b locks may be particularly helpful for patients with cardiovascular or respiratory dis...

  19. Age as a prognostic variable in patients undergoing transurethral prostatectomy

    DEFF Research Database (Denmark)

    Krogh, J; Jensen, J S; Iversen, H G;

    1993-01-01

    In a retrospective study the outcome of transurethral prostatectomy (TURP) for benign prostatic hyperplasia (BPH) in patients more than 80 years old was compared to a control group of patients with a mean age ten years younger. The elderly had significantly more tissue resected and presented...

  20. RISK OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY UNDERGOING NONCARDIAC SURGERY

    Institute of Scientific and Technical Information of China (English)

    Tian-ming Xuan; Yong Zeng; Wen-ling Zhu

    2007-01-01

    To determine the risk of noncardiac surgery in patients with hypertrophic cardiomyopathy.Methods We reviewed the medical records of all patients who were diagnosed as hypertrophic cardiomyopathy at Peking Union Medical College Hospital from January 1998 to August 2006 and identified 24 patients who subsequently underwent noncardiac surgery.Results There were no intraoperative cardiac events. Postoperative cardiac events were identified in 3 patients including 1 death due to acute myocardial infarction and 2 episodes of transient hypotension.Conclusions The risk of anesthesia and noncardiac surgery is low in patients with hypertrophic cardiomyopathy.During the perioperative period, beta-blockers and/or calcium channel blockers should be given; vasodilator and inotropic agents should be avoided due to the side effects on hemodynamics.

  1. Depression and hopelessness in Turkish patients with cancer undergoing chemotherapy.

    Science.gov (United States)

    Arslan, Sevban; Celebioglu, Ayda; Tezel, Ayfer

    2009-12-01

    This study aimed to determine the levels of depression and hopelessness of patients receiving chemotherapy. Through knowledge of the levels of hopelessness and depression in such patients, this study could contribute to the planning of nursing interventions. The study involved 101 patients with cancer who presented to the outpatient unit of a medical oncology clinic to receive outpatient chemotherapy between January and March 2006. Data on the patients' sociodemographic features, as well as their scores on the Beck Hopelessness Scale and the Beck Depression Inventory, were obtained. The patients' mean total depression score was 16.0 +/- 8.3 and their mean hopelessness score was 6.9 +/- 3.4. There was a statistically significant positive relationship between depression and hopelessness. The results indicated that depression and hopelessness were strongly and positively correlated.

  2. Oral manifestation and salivary changes in renal patients undergoing hemodialysis

    Science.gov (United States)

    Honarmand, Marieh; Nakhaee, Alireza; Sargolzaie, Fahimeh

    2017-01-01

    Background Salivary changes in hemodialysis patients may result in various oral manifestations. This research intended to determine oral manifestations and some salivary markers in hemodialysis patients. Material and Methods This cross-sectional study was conducted on 30 hemodialysis patients (the patient group) and 30 healthy individuals (the control group). Saliva urea and calcium levels and pH values of the participants were measured, and oral manifestations such as pale mucosa, xerostomia, halitosis, changes in the sense of taste, increased calculus formation, gingival bleeding, etc. were recorded in the information collection form. The data was analyzed using T-test and chi-square, and pHalitosis, xerostomia, and increased calculus were the most prevalent manifestations, and gum bleeding was the least prevalent among the patients. Conclusions Advanced chronic renal insufficiency can increase salivary urea level, pH value, halitosis, xerostomia, and calculus formation, and may cause pale mucosa. Key words:Renal dialysis, biomarkers, oral manifestation, saliva. PMID:28210437

  3. Oral manifestation and salivary changes in renal patients undergoing hemodialysis.

    Science.gov (United States)

    Honarmand, Marieh; Farhad-Mollashahi, Leila; Nakhaee, Alireza; Sargolzaie, Fahimeh

    2017-02-01

    Salivary changes in hemodialysis patients may result in various oral manifestations. This research intended to determine oral manifestations and some salivary markers in hemodialysis patients. This cross-sectional study was conducted on 30 hemodialysis patients (the patient group) and 30 healthy individuals (the control group). Saliva urea and calcium levels and pH values of the participants were measured, and oral manifestations such as pale mucosa, xerostomia, halitosis, changes in the sense of taste, increased calculus formation, gingival bleeding, etc. were recorded in the information collection form. The data was analyzed using T-test and chi-square, and pcalculus were the most prevalent manifestations, and gum bleeding was the least prevalent among the patients. Advanced chronic renal insufficiency can increase salivary urea level, pH value, halitosis, xerostomia, and calculus formation, and may cause pale mucosa. Key words:Renal dialysis, biomarkers, oral manifestation, saliva.

  4. Postoperative Adiponectin Levels in Pediatric Patients Undergoing Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    A. Thaler

    2013-01-01

    Full Text Available Background. Adipose tissue is an important endocrine organ that secretes cytokines, including adiponectin, levels of which are negatively correlated with the severity of the inflammatory process. Aim. To assess the time course of adiponectin levels following open heart surgery with cardiopulmonary bypass and its correlation with early postoperative outcomes. Materials and Methods. Blood samples were obtained from 24 children undergoing cardiac surgery and analyzed for adiponectin, C-reactive protein, and other inflammatory markers. Results. Baseline adiponectin levels were negatively correlated with patients’ preoperative weight and age. Postoperative adiponectin levels decreased compared to baseline ( and correlated negatively with duration of cardiopulmonary bypass (, , length of stay in the pediatric intensive care unit (, , and the inotropic score (, . Adiponectin levels were positively correlated with sVCAM 1 levels; however, there was no correlation between adiponectin levels and sP selectin, tPA, MCP1, and sCD40. Conclusions. The inflammatory response after open heart surgery with cardiopulmonary bypass is associated with a reduction in adiponectin levels. Prolonged or more complicated surgery induced a more substantial inflammatory process characterized by a significant reduction in adiponectin levels over time and a delayed return to baseline levels.

  5. The use of ovarian cancer cells from patients undergoing surgery to generate primary cultures capable of undergoing functional analysis.

    Science.gov (United States)

    O Donnell, Rachel L; McCormick, Aiste; Mukhopadhyay, Asima; Woodhouse, Laura C; Moat, Madeleine; Grundy, Anna; Dixon, Michelle; Kaufman, Angelika; Soohoo, San; Elattar, Ahmed; Curtin, Nicola J; Edmondson, Richard J

    2014-01-01

    The use of cell lines or animal models has significant disadvantages when dealing with a set of heterogeneous diseases such as epithelial ovarian cancer. This has clinical relevance in that biomarkers developed using cell line or animal models are often not transferable to the clinical setting. In this study, we describe the development of a robust protocol for developing primary cultures of ovarian cancer which will overcome some of these difficulties. Women undergoing surgery for ovarian cancer were recruited and samples of ascites and solid tumour deposits were used to develop primary cultures. Cells were characterised using a panel of immunofluorescent antibodies prior to use in a variety of assays including functional assessment of DNA repair pathways. During the four year study period, viable cultures, confirmed to be epithelial in origin were generated from 156 of 172 (91%) cases recruited. Characterisation was carried out using a panel of antibodies including pancytokeratin, CA125, EpCAM, MOC-31, D2-40 and vimentin. Senescence occurred between the 2nd and 8th passages in all cultures except one in which spontaneous immortalization occurred. Cells could be successfully cultured even after a period of storage at 4°C and cultured cells were capable of being used for a variety of applications including functional assays. Upon functional assessment there was minimal intra-tumour heterogeneity. It is therefore possible to derive viable ovarian cancer cell cultures in the majority of patients undergoing surgery. Cells cultured directly from patient cancers provide an accurate and highly diverse model.

  6. The use of ovarian cancer cells from patients undergoing surgery to generate primary cultures capable of undergoing functional analysis.

    Directory of Open Access Journals (Sweden)

    Rachel L O Donnell

    Full Text Available The use of cell lines or animal models has significant disadvantages when dealing with a set of heterogeneous diseases such as epithelial ovarian cancer. This has clinical relevance in that biomarkers developed using cell line or animal models are often not transferable to the clinical setting. In this study, we describe the development of a robust protocol for developing primary cultures of ovarian cancer which will overcome some of these difficulties. Women undergoing surgery for ovarian cancer were recruited and samples of ascites and solid tumour deposits were used to develop primary cultures. Cells were characterised using a panel of immunofluorescent antibodies prior to use in a variety of assays including functional assessment of DNA repair pathways. During the four year study period, viable cultures, confirmed to be epithelial in origin were generated from 156 of 172 (91% cases recruited. Characterisation was carried out using a panel of antibodies including pancytokeratin, CA125, EpCAM, MOC-31, D2-40 and vimentin. Senescence occurred between the 2nd and 8th passages in all cultures except one in which spontaneous immortalization occurred. Cells could be successfully cultured even after a period of storage at 4°C and cultured cells were capable of being used for a variety of applications including functional assays. Upon functional assessment there was minimal intra-tumour heterogeneity. It is therefore possible to derive viable ovarian cancer cell cultures in the majority of patients undergoing surgery. Cells cultured directly from patient cancers provide an accurate and highly diverse model.

  7. Experience with daptomycin daily dosing in ICU patients undergoing continuous renal replacement therapy.

    Science.gov (United States)

    Preiswerk, B; Rudiger, A; Fehr, J; Corti, N

    2013-04-01

    For critically ill patients undergoing continuous renal replacement therapy (CRRT), daptomycin dosing recommendations are scarce. We, therefore, retrospectively assessed routinely measured daptomycin plasma concentrations, daptomycin dose administered and microbiological data in 11 critically ill patients with Gram-positive infections that had received daptomycin once daily. The retrospective analysis included critically ill patients treated at the intensive care unit (ICU) who had daptomycin plasma concentrations measured. Daptomycin dose ranged from 3 to 8 mg/kg/q24 h in patients undergoing CRRT (n = 7) and 6 to 10 mg/kg/q24 h in patients without CRRT (n = 4). Peak and trough concentrations showed a high intra- and inter-patient variability in both groups, independent of the dosage per kg body weight. No drug accumulation was detected in CRRT patients with once-daily daptomycin dosing. Causative pathogens were Enterococcus faecium (n = 6), coagulase-negative Staphylococcus (n = 2), Staphylococcus aureus (n = 2) and unknown in one patient. Microbiological eradication was successful in 8 of 11 patients. Two of three patients with unsuccessful microbiological eradication and fatal outcome had an Enterococcus faecium infection. In critically ill patients undergoing CRRT, daptomycin exposure with once-daily dosing was similar to ICU patients with normal renal function, but lower compared to healthy volunteers. Our data suggest that daptomycin once-daily dosing is appropriate in patients undergoing CRRT.

  8. Pharmacokinetics and pharmacodynamics of propofol in patients undergoing abdominal aortic surgery.

    Science.gov (United States)

    Wiczling, Paweł; Bienert, Agnieszka; Sobczyński, Paweł; Hartmann-Sobczyńska, Roma; Bieda, Krzysztof; Marcinkowska, Aleksandra; Malatyńska, Maria; Kaliszan, Roman; Grześkowiak, Edmund

    2012-01-01

    Available propofol pharmacokinetic protocols for target-controlled infusion (TCI) were obtained from healthy individuals. However, the disposition as well as the response to a given drug may be altered in clinical conditions. The aim of the study was to examine population pharmacokinetics (PK) and pharmacodynamics (PD) of propofol during total intravenous anesthesia (propofol/fentanyl) monitored by bispectral index (BIS) in patients scheduled for abdominal aortic surgery. Population nonlinear mixed-effect modeling was done with Nonmem. Data were obtained from ten male patients. The TCI system (Diprifusor) was used to administer propofol. The BIS index served to monitor the depth of anesthesia. The propofol dosing was adjusted to keep BIS level between 40 and 60. A two-compartment model was used to describe propofol PK. The typical values of the central and peripheral volume of distribution, and the metabolic and inter-compartmental clearance were V(C) = 24.7 l, V(T) = 112 l, Cl = 2.64 l/min and Q = 0.989 l/min. Delay of the anesthetic effect, with respect to plasma concentrations, was described by the effect compartment with the rate constant for the distribution to the effector compartment equal to 0.240 min(-1). The BIS index was linked to the effect site concentrations through a sigmoidal E(max) model with EC(50) = 2.19 mg/l. The body weight, age, blood pressure and gender were not identified as statistically significant covariates for all PK/PD parameters. The population PK/PD model was successfully developed to describe the time course and variability of propofol concentration and BIS index in patients undergoing surgery.

  9. Small-bowel neoplasms in patients undergoing video capsule endoscopy

    DEFF Research Database (Denmark)

    Rondonotti, E; Pennazio, M; Toth, E

    2008-01-01

    BACKGROUND AND STUDY AIM: Small-bowel tumors account for 1% - 3% of all gastrointestinal neoplasms. Recent studies with video capsule endoscopy (VCE) suggest that the frequency of these tumors may be substantially higher than previously reported. The aim of the study was to evaluate the frequency...... findings. 55 patients underwent VCE as the third procedure after negative bidirectional endoscopy. The lesions were single in 89.5% of cases, and multiple in 10.5%. Retention of the capsule occurred in 9.8% of patients with small-bowel tumors. After VCE, 54/124 patients underwent 57 other examinations...

  10. [Patient with a Fontan circulation undergoing caesarean section: Anesthesiological management].

    Science.gov (United States)

    Schneck, E; Mann, V; Körner, C; Jost, A; Thul, J; Engel, J B; Müller, M F

    2015-07-01

    Adults suffering from congenital heart diseases (CHD) represent a challenge to anesthesiologists because of the diverse pathologies, complex pathophysiology and special treatment strategies. Due to improved therapeutic options for CHD, patient quality of life and life expectancy is increasing, leaving them as a growing population including pregnant patients with CHD. This article presents the main principles of the pathophysiology and anesthesiological management of pregnant patients living with a Fontan circulation based on a case report, which was complicated by an aortic coarctation and atonic uterine hemorrhage.

  11. Compensatory renal hypertrophia in patients undergoing unilateral nephrectomy

    DEFF Research Database (Denmark)

    Mogensen, P; Munck, O; Tonnesen, K H;

    1977-01-01

    Estimations of the residual glomerular filtration rate (GFR) were made from renography and GFR measurements before unilateral nephrectomy in 28 patients aged 42-77 years. The GFR was measured one week and three months after the operation and comparisons were made between the function...... of the remaining kidney and the preoperative estimate. In 23 patients where the removed kidney had some function, the mean GFR increased by 32% and 22% after one week and three months, respectively. In 5 patients where the removed kidney had no function, no compensatory hypertrophy occurred....

  12. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis

    DEFF Research Database (Denmark)

    Chertow, Glenn M; Block, Geoffrey A; Correa-Rotter, Ricardo

    2012-01-01

    Disorders of mineral metabolism, including secondary hyperparathyroidism, are thought to contribute to extraskeletal (including vascular) calcification among patients with chronic kidney disease. It has been hypothesized that treatment with the calcimimetic agent cinacalcet might reduce the risk...

  13. [Nursing care in patients undergoing radiological surgery. A case report].

    Science.gov (United States)

    Armero-Barranco, David; Ruiz-Mateos, María; Alcaraz-Baños, Miguel; Bernal-Páez, Fernando Luis

    2007-01-01

    We report the case of a 73-year-old man with medical diagnoses of long-standing diabetes mellitus, chronic ischemia of the lower limbs and intermittent claudication, for which the patient had been treated with minimally invasive radiological surgery. On arrival at the radiology unit, the patient had nursing diagnoses of anxiety and fear. Intraoperatively, the client had nursing diagnoses of pain, urine retention and infection risk. At discharge, a collaboration problem was detected and hemorrhagic risk. The patient received individualized nursing care. Interventions were planned following the nursing intervention classification (NIC) and the expected results for these interventions followed the Nursing Outcomes Classification (NOC) taxonomy. The application of an appropriate nursing care plan contributes to making the patient's hospital stay easier, more comfortable and less traumatic.

  14. Outcome of patients undergoing open heart surgery at the Uganda ...

    African Journals Online (AJOL)

    Training of the superspecialties abroad is largely limited to observation with little or no opportunity ... Results: A total of 124 patients underwent open heart surgery during the study period. ..... The experience at the Uganda heart institute shows.

  15. Anaesthetic challenges in a patient with mitochondrial cytopathy undergoing surgery

    Directory of Open Access Journals (Sweden)

    D N Dhananjay

    2007-01-01

    Full Text Available This article will highlight certain basic aspects in the management of a case of mitochondrial cytopathy that is unknown to most of us. Clinical condition of the patient is the most important aspect in the management, as the patients with mild disease may be at lower risk for complications while those with severe disease are at a higher risk. We managed a 45year old lady posted for incisional hernia repair

  16. Use of PROMIS for Patients Undergoing Primary Total Shoulder Arthroplasty.

    Science.gov (United States)

    Dowdle, S Blake; Glass, Natalie; Anthony, Chris A; Hettrich, Carolyn M

    2017-09-01

    The Patient-Reported Outcomes Measurement Information System (PROMIS) consists of question banks for health domains through computer adaptive testing (CAT). For patients with glenohumeral arthritis, (1) there would be high correlation between traditional patient-reported outcome (PRO) measures and the PROMIS upper extremity item bank (PROMIS UE) and PROMIS physical function CAT (PROMIS PF CAT), and (2) PROMIS PF CAT would not demonstrate ceiling effects. Cohort study (diagnosis); Level of evidence, 3. Sixty-one patients with glenohumeral osteoarthritis were included. Each patient completed the American Shoulder and Elbow Surgeons (ASES) assessment form, Marx Shoulder Activity Scale, Short Form-36 physical function scale (SF-36 PF), EuroQol 5 Dimensions (EQ-5D) questionnaire, Western Ontario Osteoarthritis Shoulder (WOOS) index, PROMIS PF CAT, and the PROMIS UE. Correlation was defined as high (>0.7), moderate (0.4-0.6), or weak (0.2-0.3). Significant floor and ceiling effects were present if more than 15% of individuals scored the lowest or highest possible total score on any PRO. The PROMIS PF demonstrated excellent correlation with the SF-36 PF (r = 0.81, P ceiling or floor effects observed. The mean number of items administered by the PROMIS PRO was 4. These data suggest that for a patient population with operative shoulder osteoarthritis, PROMIS UE and PROMIS PF CAT may be valid alternative PROs. Additionally, PROMIS PF CAT offers a decreased question burden with no ceiling effects.

  17. The prevalence of iron deficiency anaemia in patients undergoing bariatric surgery.

    Science.gov (United States)

    Khanbhai, M; Dubb, S; Patel, K; Ahmed, A; Richards, T

    2015-01-01

    As bariatric surgery rates continue to climb, anaemia will become an increasing concern. We assessed the prevalence of anaemia and length of hospital stay in patients undergoing bariatric surgery. Prospective data (anaemia [haemoglobin bariatric surgery. Results from a prospective database of 1530 patients undergoing elective general surgery were used as a baseline. Fifty-seven patients (14%) were anaemic pre-operatively, of which 98% were females. Median MCV (fL) and overall median ferritin (μg/L) was lower in anaemic patients (83 vs. 86, p=0.001) and (28 vs. 61, psurgery patients, prevalence of anaemia was similar (14% vs. 16%) but absolute iron deficiency was more common in those undergoing bariatric surgery; microcytosis pbariatric surgery. In bariatric patients with anaemia there was an overall increased length of hospital stay. Copyright © 2013 Asian Oceanian Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

  18. Routine pre-operative focused ultrasonography by anesthesiologists in patients undergoing urgent surgical procedures

    DEFF Research Database (Denmark)

    Bøtker, M T; Vang, M L; Grøfte, T;

    2014-01-01

    with focused ultrasonography in patients undergoing urgent surgical procedures. Methods We performed pre-operative focused cardiopulmonary ultrasonography in patients aged 18 years or above undergoing urgent surgical procedures at pre-defined study days. Known and unexpected cardiopulmonary pathology...... was recorded, and subsequent changes in the anesthesia technique or supportive actions were registered. Results A total of 112 patients scheduled for urgent surgical procedures were included. Their mean age (standard deviation) was 62 (21) years. Of these patients, 24% were American Society....... Unexpected pathology leading to changes in anesthesia technique or supportive actions was only disclosed in a group of patients above the age of 60 years and/or in ASA class ≥ 3. Conclusion Focused cardiopulmonary ultrasonography disclosed unexpected pathology in patients undergoing urgent surgical...

  19. Design and construct an optical device to determine relative blood volume in patients undergoing hemodialysis.

    Science.gov (United States)

    Dormanesh, Banafshe; Tofangchiha, Shahnaz; Abouei, Vahid; Sharifian, Hani

    2014-04-01

    Occurrence of hypotension during hemodialysis in nearly 20-30% of patients, shows is the necessity of continuous monitoring the patients' blood pressure during hemodialysis. Since directly and non-invasively continuous blood pressure monitoring, is not easy, finding a parameter related to blood pressure, for indirect monitoring is of great value. Related blood volume (RBV) is one of the parameters, related to blood pressure and have a good potential to reflect the patient's hemodynamic condition. The main objective of this study was to design and construct an optical device to determine the RBV in patients undergoing hemodialysis, during the process. After initial studies in order to select a proper sensor, using the ORCAD software, an analog circuit was designed. The implementation and modification of the circuit was done by the clinical tests, using expired blood. Afterwards, for calculation the RBV, controlling the display, data storage and sending it to the computer, an ATmega16 microcontroller was used. For programing the microcontroller, CodeVision software and then Altium Designer software were used for the circuit compression, in order to design the printed circuit board. Finally, all parts of the analog and digital circuit, AC to DC converter and the LCD were embedded in a box. After finalization of the device and before testing it in a real situation, expired blood was used for final evaluation. The evaluation was done by changing the blood concentration, at the start point by adding water to it. In fact, the device can track the changes in blood concentration and display the RBV. After this evaluation, the device was tested in a clinical situation. The results showed there are no interactions between this device and the other devices used in the dialysis section and it can work properly in order to measure the RBV. Considering the hypotension and its consequences in a patient on hemodialysis, solving this problem seems necessary. One method for

  20. Recovery of older patients undergoing ambulatory anaesthesia with isoflurane or sevoflurane.

    LENUS (Irish Health Repository)

    Mahajan, V A

    2007-06-01

    Delayed recovery of cognitive function is a well-recognized phenomenon in older patients. The potential for the volatile anaesthetic used to contribute to alterations in postoperative cognitive function in older patients following minor surgical procedures has not been determined. We compared emergence from isoflurane and sevoflurane anaesthesia in older surgical patients undergoing urological procedures of short duration.

  1. Increased concentrations of L-lactate in the rectal lumen in patients undergoing cardiopulmonary bypass

    DEFF Research Database (Denmark)

    Perner, A; Jørgensen, V L; Poulsen, T D

    2005-01-01

    Gut ischaemia may contribute to morbidity in patients after cardiopulmonary bypass (CPB), but little is known about the metabolic state of the large bowel in such patients. Therefore we estimated the concentrations of L-lactate and Pco(2) in rectal mucosa in patients undergoing cardiac surgery wi...

  2. Vancomycin Utilization Review in Patients Undergoing Bone MarrowTransplantation

    Directory of Open Access Journals (Sweden)

    Saghar Taheri

    2015-10-01

    Full Text Available Background:  Infections  in  neutropenic  patients  are  considered  as  major  causes  of  mortality and the emergence of drug resistance. Gram positive bacterial infections are crucially important to be covered if indicated. Vancomycin is active against most Gram positive bacteria including Methicillin Resistant Staphylococcus Aureus (MRSA. In this study, we evaluated the appropriate utilization of this agent in bone marrow transplantation (BMT patients.Methods: In a cross sectional study, all patients who received vancomycin in a seven months period at bone marrow transplantation research center in Shariati teaching hospital in Tehran, Iran, were entered to the study. Clinical and preclinical parameters such as serum creatinine, microbial culture, antibacterial sensitivity, WBC count and fever were collected and recorded for analysis. We also measured vancomycin trough level after administration of three doses.Results: Fifty one patients were entered in the study and reviewed in two adult BMT wards. The age range was 18 to 65 years. Most patients received allogenic versus autologous transplantation (56.9%, 43.1%. About 80% of the vancomycin used for the patients with febrile neutropenia was compatible with National Comprehensive Cancer Network (NCCN guideline. 21.6% of patients received appropriate doses. Vancomycin trough serum concentration range was 15.0±11.9 μg/mL.Conclusion: Vancomycin is an antibiotic used to treat resistant gram-positive infections and must be prescribed by a specialist. Vancomycin wrong dosing or initiation prescribing with dose 1 gr/q12h increases the resistance and toxicity to drug, and cause an inappropriate response to the drug.

  3. Economic considerations of antifungal prophylaxis in patients undergoing surgical procedures

    Directory of Open Access Journals (Sweden)

    Maria Adriana Cataldo

    2011-01-01

    Full Text Available Maria Adriana Cataldo, Nicola PetrosilloSecond Infectious Diseases Division, National Institute for Infectious Diseases, “Lazzaro Spallanzani”, Rome, ItalyAbstract: Fungi are a frequent cause of nosocomial infections, with an incidence that has increased significantly in recent years, especially among critically ill patients who require intensive care unit (ICU admission. Among ICU patients, postsurgical patients have a higher risk of Candida infections in the bloodstream. In consideration of the high incidence of fungal infections in these patients, their strong impact on mortality rate, and of the difficulties in Candida diagnosis, some experts suggest the use of antifungal prophylaxis in critically ill surgical patients. A clinical benefit from this strategy has been demonstrated, but the economic impact of the use of antifungal prophylaxis in surgical patients has not been systematically evaluated, and its cost–benefit ratio has not been defined. Whereas the costs associated with treating fungal infections are very high, the cost of antifungal drugs varies from affordable (ie, the older azoles to expensive (ie, echinocandins, polyenes, and the newer azoles. Adverse drug-related effects and the possibly increased incidence of fluconazole resistance and of isolates other than Candida albicans must also be taken into account. From the published studies of antifungal prophylaxis in surgical patients, a likely economic benefit of this strategy could be inferred, but its usefulness and cost–benefits should be evaluated in light of local data, because the available evidence does not permit general recommendations.Keywords: antifungal prophylaxis, cost-effectiveness, economics, surgery, fungal infection 

  4. Trough Concentrations of Vancomycin in Patients Undergoing Extracorporeal Membrane Oxygenation.

    Directory of Open Access Journals (Sweden)

    So Jin Park

    Full Text Available To investigate the appropriateness of the current vancomycin dosing strategy in adult patients with extracorporeal membrane oxygenation (ECMO, between March 2013 and November 2013, patients who were treated with vancomycin while on ECMO were enrolled. Control group consisted of 60 patients on vancomycin without ECMO, stayed in medical intensive care unit during the same study period and with the same exclusion criteria. Early trough levels were obtained within the fourth dosing, and maintenance levels were measured at steady state. A total of 20 patients were included in the analysis in ECMO group. Sixteen patients received an initial intravenous dose of 1.0 g vancomycin followed by 1.0 g every 12 hours. The non-steady state trough level of vancomycin after starting administration was subtherapeutic in 19 patients (95.00% in ECMO group as compared with 40 patients (66.67% in the control group (p = 0.013. Vancomycin clearance was 1.27±0.51 mL/min/kg, vancomycin clearance/creatinine clearance ratio was 0.90 ± 0.37, and elimination rate constant was 0.12 ± 0.04 h-1. Vancomycin dosingfrequency and total daily dose were significantly increased after clinical pharmacokinetic services of the pharmacist based on calculated pharmacokinetic parameters (from 2.10 ± 0.72 to 2.90 ± 0.97 times/day, p = 0.002 and from 32.54 ± 8.43 to 42.24 ± 14.62mg/kg, p = 0.014 in ECMO group in contrast with those (from 2.11 ± 0.69 to 2.37 ± 0.86 times/day, p = 0.071 and from 33.91 ± 11.85 to 31.61 ± 17.50 mg/kg, p = 0.350 in the control group.Although the elimination rate for vancomycin was similar with population parameter of non ECMO patients, the current dosing strategy of our institution for vancomycinin our ICU was not sufficient to achieve the target trough in the initial period in most patients receiving ECMO.

  5. Evaluation of secondary hyperparathyroidism in patients undergoing hemodialysis.

    Science.gov (United States)

    Rahimian, Mohammad; Sami, Ramin; Behzad, Fariba

    2008-01-01

    Renal osteodystrophy is a complication of chronic kidney disease (CKD) that present in low and high turnover patterns. This disorder has a key role in the disability of CKD patients in whom early diagnosis and treatment can result in better outcome. We studied hyperparathyroidism prevalence and its relationship with renal osteodystrophy in our advanced CKD population. We included 80 patients (of whom 44 (55%) were diabetic) during 6 months period. The patients answered a questionnaire about symptoms related to bone disease and blood levels of parathormone (PTH), calcium, phosphorus, and alkaline phosphatase were obtained, in addition to hand and skull radiographs in all the study patients. Prevalence of clinically evident hyperparathyroidism in our patients was 45%. Hyperparathyroidism had significant relationship with alkaline phosphatase and radiological findings, but did not have a significant relationship with dialysis duration, age, sex, familial history, diabetes mellitus, or hypertension. We conclude that secondary hyperparathyroidism is prevalent in our dialysis population and has high correlation with serum alkaline phosphatase levels and radiological changes.

  6. Iron Overload in Patients Undergoing Hematopoietic Stem Cell Transplantation

    Directory of Open Access Journals (Sweden)

    Vinod Pullarkat

    2010-01-01

    Full Text Available Recipients of hematopoietic stem cell transplantation (HSCT frequently have iron overload resulting from chronic transfusion therapy for anemia. In some cases, for example, in patients with myelodysplastic syndromes and thalassemia, this can be further exacerbated by increased absorption of iron from the gut as a result of ineffective erythropoiesis. Accumulating evidence has established the negative impact of elevated pretransplantation serum ferritin, a surrogate marker of iron overload, on overall survival and nonrelapse mortality after HSCT. Complications of HSCT associated with iron overload include increased bacterial and fungal infections as well as sinusoidal obstruction syndrome and possibly other regimen-related toxicities. Based on current evidence, particular attention should be paid to prevention and management of iron overload in allogeneic HSCT candidates, especially in patients with thalassemia and myelodysplastic syndromes. The pathophysiology of iron overload in the HSCT patient and optimum strategies to deal with iron overload during and after HSCT require further study.

  7. Management of antithrombotic agents in patients undergoing flexible bronchoscopy

    Directory of Open Access Journals (Sweden)

    Sami Abuqayyas

    2017-07-01

    Full Text Available Bleeding is one of the most feared complications of flexible bronchoscopy. Although infrequent, it can be catastrophic and result in fatal outcomes. Compared to other endoscopic procedures, the risk of morbidity and mortality from the bleeding is increased, as even a small amount of blood can fill the tracheobronchial tree and lead to respiratory failure. Patients using antithrombotic agents (ATAs have higher bleeding risk. A thorough understanding of the different ATAs is critical to manage patients during the peri-procedural period. A decision to stop an ATA before bronchoscopy should take into account a variety of factors, including indication for its use and the type of procedure. This article serves as a detailed review on the different ATAs, their pharmacokinetics and the pre- and post-bronchoscopy management of patients receiving these medications.

  8. Vocal changes in patients undergoing radiation therapy for glottic carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Miller, S.; Harrison, L.B.; Solomon, B.; Sessions, R.B. (Memorial Sloan-Kettering Cancer Center, New York, NY (USA))

    1990-06-01

    A prospective evaluation of vocal changes in patients receiving radiation therapy for T1 and T2 (AJC) glottic carcinoma was undertaken in January 1987. Vocal analysis was performed prior to radiotherapy and at specific intervals throughout the radiation treatment program. The voicing ratio was extrapolated from a sustained vowel phonation using the Visipitch interfaced with the IBM-PC. Preliminary observations suggested three distinct patterns of vocal behavior: 1. reduced voicing ratio with precipitous improvement within the course of treatment, 2. high initial voicing ratio with reduction secondary to radiation induced edema, with rapid improvement in the voicing component after the edema subsided, and 3. fluctuating voicing ratio during and following treatment. Enrollment of new patients and a 2-year follow-up of current patients was undertaken.

  9. Exploring the experiences patients who undergo 24hour Video- electroencephalography

    Directory of Open Access Journals (Sweden)

    Antigoni Fountouki

    2012-07-01

    Full Text Available Epilepsy is a frequent neurological disorder well-known by ancient times. The most accurate and valid diagnostic tool for epilepsy, is electroencephalography which provides details on the brain's function by recording brain cells' waves. Aim of the study was the exploration of the patients' total experience at a psychological and emotional level during a 24hour EEG. Materials and Methods: The sample included 40 subjects aged 18-40 years with a history or suspicion of epileptic symptoms. Due to the study's explorative/explicative nature, a qualitative research design was used. Data collection was performed through semi-structured interviews, direct observations and field notes. Following patients' permission, the interviews were recorded and the verbatim data was analyzed via thematic content analysis. Results: The verbatim text was the raw material where key words or phrases with autonomous meaning, relevant to the study's aims where subsequently organized in 4 major themes and 20 sub-categories, namely: Emotional-Psychological state (Positive: Joy, Optimism, Positive Thinking, Self-Confidence. Negative: Sadness, Anxiety, Fear, Panic, Pessimism. Behavior of patients (Calmness, Comfort, Nervousness, Aggravation. Options for patient involvement (TV, Reading, Music, Sleep, Lack of internet. Interpersonal relationships (family, friendly. Conclusions: During achieving the study's aims, many methodological and practical obstacles have been encountered as it proved to be particularly challenging to encompass patients' emotions and accurately cite their experiences during the EEG. However, results that have been revealed are adequate in formulating a holistic picture about the psychological state and the emotions that patients experience during the procedure.

  10. Effect of intravenous clonidine premedication in patients undergoing laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    S. K. Gvalani

    2016-09-01

    Results: Data was analysed by Pearson's chi-square test. Clonidine significantly attenuated the rise in heart rate, and the blood pressure. The incidence of postoperative nausea and vomiting was less in the clonidine group. It also reduced shivering. Conclusions: 2 microgm/kg of clonidine iv can be reasonably recommended as a premedicant for laparoscopic procedures in otherwise healthy patients. However further study is required to test its efficacy in patients with compromised cardiovascular function. [Int J Res Med Sci 2016; 4(9.000: 3806-3811

  11. Hepatitis Viral Markers in Patients Undergoing Primary Liver Transplants

    OpenAIRE

    1993-01-01

    The purpose of the study was to determine the prevalence in liver transplant (OLTx) patients of the hepatitis markers (anti-A, anti-B, anti-C, anti-D and HBsAg) and the interrelationships between markers and patients’ sexes, ages, dates of transplant, clinicopathological diagnoses, and short-term survivals. Slightly more than half of the patients were male. Anti-A and anti-B were about evenly distributed between male and female. Anti-C, anti-D, and HBsAg were far more common in males. Age and...

  12. Adequacy of oxygenation parameters in elderly patients undergoing mechanical ventilation

    OpenAIRE

    Guedes, Luana Petruccio Cabral Monteiro; Delfino,Fabrício Costa; de Faria, Flavia Perassa; de Melo, Gislane Ferreira; Carvalho, Gustavo Azevedo

    2013-01-01

    ABSTRACT Objective: To compare ideal PaO2 with PaO2 found, ideal PaO2/FiO2 of room air with the one found, and ideal FiO2 with FiO2 found in mechanically ventilated elderly patients. Methods: Cross-sectional study that evaluated elderly mechanically ventilated patients for at least 72 hours and who underwent three subsequent blood gas analyses. Results: The sample consisted of 48 elderly with mean age of 74.77±9.36 years. There was a significant difference between the ideal PaO2 and the one f...

  13. INGUINAL NERVE BLOCK FOR PATIENTS UNDERGOING INGUINAL HERNIOPLASTY

    Directory of Open Access Journals (Sweden)

    Amirthagadeswar

    2015-02-01

    Full Text Available Inguinal hernia repair is the most common elective surgical procedure performed under general, regional or local anesthesia. The advantages of day case surgery include greater patient satisfaction and reduced financial costs to the health service. Inguinal nerve b locks may be particularly helpful for patients with cardiovascular or respiratory disease, for whom there may be advantages in avoiding general anesthesia. The absence of post - operative sedation or drowsiness allows early ambulation and diminishes the requirement for recovery facilities with inguinal nerve block.

  14. COMPARATIVE EVALUATION OF QTC INTERVAL CHANGES WITH INTRAVENOUS ONDANSETRON AND PALONOSETRON IN PATIENTS UNDERGOING LAPROSCOPIC CHOLECYSTECTOMY

    Directory of Open Access Journals (Sweden)

    Anju

    2015-06-01

    Full Text Available Post - operative nausea and vomiting (PONV is a common and distressing symptom after surgery performed under general anesthesia. 5HT 3 antagonists are routinely used for PONV but are dreaded to cause QTc interval prolongation. The aim of our study was to compare the incidence of QTc interval prolongation and quantify the amount of QTc prolongation from the baseline value with IV ondansetron and Palonosetron when given for PONV prevention. 60 patients undergoing elective laproscopic surgery for cholelithiasis were randomly divided into 2 groups of 30 patients each and received 4mg of Ondansetron and 0.075mg of Palonosetron intravenously respectively before induction of anesthesia. Intraoperatively serial ECG was recorded at various intervals 0min, 3min, 15min, 1hr and 2hrs along with other routine monitoring and QTc was calculated in secs by Bazett Formula. RESULTS: The QTc interval was prolonged in Ondansetron group at all - time intervals as compared to Palonosetron group where prolongation was observed only at 3 min though this difference was statistically insignificant (P>0.05 . The difference between Ondansetron and Palonosetron group was comparable.

  15. Evaluation of exposure dose to patients undergoing catheter ablation procedures - a phantom study

    Energy Technology Data Exchange (ETDEWEB)

    Seguchi, S. [Nagoya University, Graduate School of Medicine, Nagoya (Japan); Nagoya Daini Red Cross Hospital, Division of Radiology, Department of Medical Technology, Nagoya (Japan); Aoyama, T.; Koyama, S.; Kawaura, C. [Nagoya University, Graduate School of Medicine, Nagoya (Japan); Fujii, K. [Nagoya University, Graduate School of Medicine, Nagoya (Japan); National Institute of Radiological Sciences, Section of Radiological Protection, Chiba (Japan)

    2008-11-15

    The aim of this study was to evaluate entrance skin dose (ESD), organ dose and effective dose to patients undergoing catheter ablation for cardiac arrhythmias, based on the dosimetry in an anthropomorphic phantom. ESD values associated with mean fluoroscopy time and digital cine frames were in a range of 0.12-0.30 Gy in right anterior oblique (RAO) and 0.05-0.40 Gy in left anterior oblique (LAO) projection, the values which were less than a threshold dose of 2 Gy for the onset of skin injury. Organs that received high doses in ablation procedures were lung, followed by bone surface, esophagus, liver and red bone marrow. Doses for lung were 24.8-122.7 mGy, and effective doses were 7.9-34.8 mSv for mean fluoroscopy time of 23.4-92.3 min and digital cine frames of 263-511. Conversion coefficients of dose-area product (DAP) to ESD were 8.7 mGy/(Gy.cm{sup 2}) in RAO and 7.4 mGy/(Gy.cm{sup 2}) in LAO projection. The coefficients of DAP to the effective dose were 0.37 mSv/(Gy.cm{sup 2}) in RAO, and 0.41 mSv/(Gy.cm{sup 2}) in LAO projection. These coefficients enabled us to estimate patient exposure in real time by using monitored values of DAP. (orig.)

  16. Anti-ENA antibody profile in hepatitis C patients undergoing hemodialysis.

    Science.gov (United States)

    Batchoun, Raymond G; Al-Najdawi, Malek A; Al-Taamary, Sameh

    2011-07-01

    Infection with hepatitis C virus (HCV) is increasing all over the world, especially among hemodialysis patients. HCV is one of the major autoantibody inducing viruses, where anti-nuclear antibodies (ANA), anti-smooth muscle antibodies (ASMA), anti-liver kidney microsome antibodies (LKM-1), and rheumatoid factor (RF) have been related to HCV. Few studies have investigated the presence of anti-extractable nuclear antigens (ENA) antibodies in chronic liver diseases, especially in chronic hepatitis C cases, but none investigated its immunostimulation role in hemodialysis units. The aim of the study was to assess the prevalence of HCV among chronic kidney disease- Stage 5 (CKD5) patients undergoing hemodialysis and the prevalence of ENA antibodies among them. Sera of 134 patients with chronic kidney disease undergoing hemodialysis, were screened for HCV antibodies and ENA antibodies profile, using ELISA and Immunoblot technique. 41 HCV-positive blood bank donors were used as controls. Sixty-four (47.7%) of 134 patients undergoing hemodialysis were infected with HCV. Thirty-three (51.6%) of 64 patients with HCV infection undergoing hemodialysis had anti-ENA antibodies: 9 (27.3%) showed anti-SSA antibodies and 22 (66.7%) had anti-SSB antibodies. The prevalence of anti-ENA antibodies was significantly higher in the patients with HCV infection, undergoing hemodialysis, compared with both control groups (hepatitis C-positive blood bank donors and hepatitis C-negative patients undergoing hemodialysis). Seventeen of 33 HCV antibodies-positive males undergoing hemodialysis had anti-ENA antibodies, compared with 16 of 31 females, indicating no sex related difference. This study emphasizes the high prevalence of HCV infection in our hemodialysis patients, comparable to that of other Middle Eastern countries, but higher than Western ones. A strong association was observed between anti-HCV positivity and hemodialysis duration, as well as anti-ENA antibody profile. However, these

  17. Outcomes are Worse in US Patients Undergoing Surgery on Weekends Compared With Weekdays.

    Science.gov (United States)

    Glance, Laurent G; Osler, Turner; Li, Yue; Lustik, Stewart J; Eaton, Michael P; Dutton, Richard P; Dick, Andrew W

    2016-06-01

    Increasing surgical access to previously underserved populations in the United States may require a major expansion of the use of operating rooms on weekends to take advantage of unused capacity. Although the so-called weekend effect for surgery has been described in other countries, it is unknown whether US patients undergoing moderate-to-high risk surgery on weekends are more likely to experience worse outcomes than patients undergoing surgery on weekdays. The aim of this study was to determine whether patients undergoing surgery on weekends are more likely to die or experience a major complication compared with patients undergoing surgery on a weekday. Using all-payer data, we conducted a retrospective cohort study of 305,853 patients undergoing isolated coronary artery bypass graft surgery, colorectal surgery, open repair of abdominal aortic aneurysm, endovascular repair of abdominal aortic aneurysm, and lower extremity revascularization. We compared in-hospital mortality and major complications for weekday versus weekend surgery using multivariable logistic regression analysis. After controlling for patient risk and surgery type, weekend elective surgery [adjusted odds ratio (AOR)=3.18; 95% confidence interval (CI), 2.26-4.49; Psurgery (AOR=2.11; 95% CI, 1.68-2.66; Psurgery. Weekend elective (AOR=1.58; 95% CI, 1.29-1.93; Psurgery (AOR=1.61; 95% CI, 1.42-1.82; Psurgery. Patients undergoing nonemergent major cardiac and noncardiac surgery on the weekends have a clinically significantly increased risk of death and major complications compared with patients undergoing surgery on weekdays. These findings should prompt decision makers to seek to better understand factors, such physician and nurse staffing, which may contribute to the weekend effect.

  18. INFECTIOUS COMPLICATIONS IN PATIENTS UNDERGOING ORTHOTOPIC HEART TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    Y. P. Ostrovsky

    2011-01-01

    Full Text Available This article presents a retrospective analysis of infectious complications in the structure of morbidity and mortality of the patients underwent orthotopic heart transplantation. A significant role was assigned to the predisposing to in- fection factors. This study was based on the two years heart transplantation experience in the Republic of Belarus. 

  19. Galectin-3 in patients undergoing ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Nicolas Clementy

    2014-11-01

    Conclusions: Persistent type of atrial fibrillation is an independent predictor of higher Galectin-3 concentration. This biomarker of fibrosis may be implied in the mechanisms of atrial remodeling and maintenance of atrial fibrillation, and thus be helpful for the design of therapeutic strategy in patients with atrial fibrillation.

  20. Characterization of Chronic Kidney Disease Patients Undergoing Hemodialysis

    Directory of Open Access Journals (Sweden)

    Niovis Sosa Barberena

    2016-08-01

    Full Text Available Background: Cienfuegos has a high prevalence of chronic kidney disease, which is a health problem of great social and economic impact. Objective: to characterize patients with chronic kidney disease receiving hemodialysis. Methods: a cross-sectional study was conducted in 80 patients treated at the Specialized Outpatient Center of Cienfuegos in 2013. General variables such as age, sex, and place of origin were analyzed, in addition to the causes of the disease, length of time on hemodialysis, type of vascular access, and prevalence of hepatitis C. Absolute frequencies, percentages, and rates were calculated. Results: the 45 to 54 age group was the most affected by the condition. Males accounted for 63.7%. Cienfuegos municipality showed the highest prevalence with 27.6 per 100 000 inhabitants. The most common cause of chronic kidney disease was nephroangiosclerosis (33.3%. Seventy three percent of patients started hemodialysis as an emergency therapy. The time on hemodialysis was less than one year and one to two years in more than half of patients. An arteriovenous fistula was used in 81.3% of cases. Hepatitis C showed a high prevalence. Conclusion: renal disease is more common in men of working age in Cienfuegos municipality. The major causes of this disease are associated with hypertension and diabetes mellitus.

  1. Maximum physical capacity testing in cancer patients undergoing chemotherapy

    DEFF Research Database (Denmark)

    Knutsen, L.; Quist, M; Midtgaard, J

    2006-01-01

    BACKGROUND: Over the past few years there has been a growing interest in the field of physical exercise in rehabilitation of cancer patients, leading to requirements for objective maximum physical capacity measurement (maximum oxygen uptake (VO(2max)) and one-repetition maximum (1RM)) to determine...

  2. Sarcopenia and Sarcopenic Obesity in Patients Undergoing Orthopedic Surgery.

    Science.gov (United States)

    Ji, Hyung-Min; Han, Jun; Jin, Dong San; Suh, Hyunseok; Chung, Yoon-Sok; Won, Ye-Yeon

    2016-06-01

    The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared, total body weight, and height and fat mass (residuals). Obesity was defined as body mass index (BMI) > 25.0 kg/m(2). The prevalence of sarcopenia in the OS group was 25.7%, 44.1%, and 26.6%, respectively, according to the 3 different criteria. The prevalence was significantly lower in the OPD group (6.0%, 33.1%, and 14.8%, respectively). The highest rates of sarcopenia with height-adjusted definition were seen in patients with a femoral neck fracture. In the multivariate analysis, factors associated with sarcopenia were male gender, older age, and lower BMI (odds ratio [OR]: 28.38, 1.03, and 1.83, respectively) when muscle mass was adjusted for height, whereas male gender, older age, and higher BMI were associated with sarcopenia (OR: 1.04, 2.57, and 1.83, respectively) when adjusted for weight. When residuals were used as a cutoff, decreased BMI and total hip bone mineral density (0.1 g/cm(2)) were independent risk factors associated with sarcopenia (OR: 1.09 and 1.05). The prevalence of sarcopenic obesity ranged from 1.8% to 21.2%. Our study demonstrated a high prevalence of sarcopenia among OS patients.

  3. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear

    OpenAIRE

    Pihl, Kenneth; Englund, Martin; Lohmander, L Stefan; Jørgensen, Uffe; Nissen, Nis; Schjerning, Jeppe; Thorlund, Jonas Bloch

    2016-01-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients' characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods - 641 patients assigned for arthroscopy on suspicion of meniscus tear ...

  4. HEARING ASSESSMENT IN CHRONIC RENAL FAILURE PATIENTS UNDERGOING HEMODIALYSIS

    Directory of Open Access Journals (Sweden)

    Arjun Singh

    2014-01-01

    Full Text Available The auditory sensitivity of 63 patient of chronic renal failure on hemodialysis was assessed in order to know the effect of dialysis on hearing threshold. All selected patient were non diabetic with normal tympanic membrane and with no history of ototoxic drug and any hereditary hearing problems. Pure tone audiometry was done before and after dialys is and all cases were followed for 3 month. A high incidence of high frequency sensorineural hearing loss was obtained which could not be attributed to age , noise exposure and ottotoxicity. An association between high frequency sensorineural hearing loss a nd hemodialysis is thus suggested KEYWORDS: Hemodialysis ; Pure tone audiometry ; High frequency sensorineural hearing loss ; Duration of disease ; Chronic renal failure

  5. Care of the patient undergoing robotic-assisted prostatectomy.

    Science.gov (United States)

    Starnes, Danielle N; Sims, Terran Warren

    2006-04-01

    Prostate cancer has many treatment options. In addition to open retropubic and perineal approaches to radical prostatectomy, laparoscopic robotic prostatectomy is available as a newer surgical option. Potential advantages of robotic surgery include reduced pain and trauma, less blood loss, reduced infection risk, shorter hospital stay, faster recovery, and less scarring (Intuitive Surgical, 2005). A variety of nursing care considerations involving pre-operative education and preparation, intra-operative and immediate postoperative care issues, and long-term followup must be understood to meet the needs of a robotic surgical patient. Patient selection is very important to optimize a positive surgical outcome. Just as certain criteria make a good surgical candidate, there are factors that could complicate the surgery or adversely affect recovery.

  6. SUPPRESSION OF TINNITUS IN PATIENTS UNDERGOING COCHLEAR IMPLANTATION

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    M. T. Khorsandi

    1999-07-01

    Full Text Available 7 'innitus is a frequent complaint in patients with sensorineural deafness. Different reports suggest that electrical stimulation caused by cochlear implant devices "upn"ises tinnitus to a considerable degree. In a longitudinal -.mdv we have evaluated the severity and duration of tinnitus in both ears of J 7 cochlear implant patients before and after operation. Severity of tinnitus was reduced in both implanted and not implanted ears after the implantation (P=0.003 and p - 0.00-1 respectively. Duration of tinnitus, however, was not affected significantly. No significant difference in tinnitus suppression was observed between the implanted and not implanted ears. This might be attributed to both the electrical stimulation caused by the device and the psychogenic stability provided by return to the world of sound.

  7. Nursing Care of Patients Undergoing Chemotherapy Desensitization: Part I.

    Science.gov (United States)

    Jakel, Patricia; Carsten, Cynthia; Braskett, Melinda; Carino, Arvie

    2016-02-01

    Hypersensitivity reactions to chemotherapeutic agents can cause the discontinuation of first-line therapies. Chemotherapy desensitization is a safe, but labor-intensive, process to administer these important medications. A desensitization protocol can enable a patient to receive the entire target dose of a medication, even if the patient has a history of severe infusion reactions. In this article, the authors explain the pathophysiology of hypersensitivity reactions and describe the recent development of desensitization protocols in oncology. In part II of this article, which will appear in the April 2016 issue of the Clinical Journal of Oncology Nursing, the authors will give a detailed account of how a desensitization protocol is performed at an academic medical center.
.

  8. [Clinical study of patients undergoing paperless electroencephalography in emergency room].

    Science.gov (United States)

    Inoue, Takeshi; Kawawaki, Hisashi; Nukui, Megumi; Kuki, Ichiro; Okazaki, Shin; Tomiwa, Kiyotaka; Amo, Kiyoko; Togawa, Masao; Rinka, Hiroshi; Shiomi, Masashi

    2012-07-01

    Fifty-eight patients who visited the emergency room of our center with febrile convulsions and impaired consciousness, and underwent paperless electroencephalography soon after arrival. They consisted of 25 male and 33 female children, ranging in age from 5 months to 15 years and 4 months, with a mean age of 4 years and 10 months. The final diagnoses were poor responsiveness associated with fever and febrile delirium in 5 patients, febrile convulsions in 26, encephalitis/encephalopathy in 24, convulsions associated with mild gastroenteritis in 2, and aseptic meningitis in 1. The appearance of spindle wave within 24 hours after admission was considered to be a favorable prognostic factor, whereas generalized high-amplitude delta waves without fast-wave components and dysrhythmic flat basic waves were considered poor prognostic factors. We conclude that bed-side paperless electroencephalography is useful for the evaluation of changes in the brain function and course of treatment.

  9. Acute respiratory viral infections in pediatric cancer patients undergoing chemotherapy

    Directory of Open Access Journals (Sweden)

    Eliana C.A. Benites

    2014-07-01

    Full Text Available OBJECTIVE: to estimate the prevalence of infection by respiratory viruses in pediatric patients with cancer and acute respiratory infection (ARI and/or fever. METHODS: cross-sectional study, from January 2011 to December 2012. The secretions of nasopharyngeal aspirates were analyzed in children younger than 21 years with acute respiratory infections. Patients were treated at the Grupo em Defesa da Criança Com Câncer (Grendacc and University Hospital (HU, Jundiaí, SP. The rapid test was used for detection of influenza virus (Kit Biotrin, Inc. Ireland, and real-time multiplex polymerase chain reaction (FTD, Respiratory pathogens, multiplex Fast Trade Kit, Malta for detection of influenza virus (H1N1, B, rhinovirus, parainfluenza virus, adenovirus, respiratory syncytial virus, human parechovirus, bocavirus, metapneumovirus, and human coronavirus. The prevalence of viral infection was estimated and association tests were used (χ2 or Fisher's exact test. RESULTS: 104 samples of nasopharyngeal aspirate and blood were analyzed. The median age was 12 ± 5.2 years, 51% males, 68% whites, 32% had repeated ARIs, 32% prior antibiotic use, 19.8% cough, and 8% contact with ARIs. A total of 94.3% were in good general status. Acute lymphocytic leukemia (42.3% was the most prevalent neoplasia. Respiratory viruses were detected in 50 samples: rhinoviruses (23.1%, respiratory syncytial virus AB (8.7%, and coronavirus (6.8%. Co-detection occurred in 19% of cases with 2 viruses and in 3% of those with 3 viruses, and was more frequent between rhinovirus and coronavirus 43. Fever in neutropenic patients was observed in 13%, of which four (30.7 were positive for viruses. There were no deaths. CONCLUSIONS: the prevalence of respiratory viruses was relevant in the infectious episode, with no increase in morbidity and mortality. Viral co-detection was frequent in patients with cancer and ARIs.

  10. Treatment of Hepatitis C in Patients Undergoing Immunosuppressive Drug Therapy

    Science.gov (United States)

    Ooka, Kohtaro; Lim, Joseph K.

    2016-01-01

    Abstract With 185 million people chronically infected globally, hepatitis C is a leading bloodborne infection. All-oral regimens of direct acting agents have superior efficacy compared to the historical interferon-based regimens and are significantly more tolerable. However, trials of both types of regimens have often excluded patients on immunosuppressive medications for reasons other than organ transplantation. Yet, these patients—most often suffering from malignancy or autoimmune diseases—could stand to benefit from these treatments. In this study, we systematically review the literature on the treatment of hepatitis C in these neglected populations. Research on patients with organ transplants is more robust and this literature is reviewed here non-systematically. Our systematic review produced 2273 unique works, of which 56 met our inclusion criteria and were used in our review. The quality of data was low; only 3 of the 56 studies were randomized controlled trials. Sustained virologic response was reported sporadically. Interferon-containing regimens achieved this end-point at rates comparable to that in immunocompetent individuals. Severe adverse effects and death were rare. Data on all-oral regimens were sparse, but in the most robust study, rates of sustained virologic response were again comparable to immunocompetent individuals (40/41). Efficacy and safety of interferon-containing regimens and all-oral regimens were similar to rates in immunocompetent individuals; however, there were few interventional trials. The large number of case reports and case series makes conclusions vulnerable to publication bias. While firm conclusions are challenging, given the dearth of high-quality studies, our results demonstrate that antiviral therapy can be safe and effective. The advent of all-oral regimens offers patients and clinicians greatly increased chances of cure and fewer side effects. Preliminary data reveal that these regimens may confer such benefits in

  11. Fospropofol disodium injection for the sedation of patients undergoing colonoscopy

    OpenAIRE

    Levitzky, Benjamin E; Vargo, John J.

    2008-01-01

    Benjamin E Levitzky1, John J Vargo21Department of Gastroenterology and Hepatology, 2Section of Therapeutic and Hepatobiliary Endoscopy, Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USAAbstract: Sedation plays a central role in making colonoscopy tolerable for patients and feasible for the endoscopist to perform. The array of agents used for endoscopic sedation continues to evolve. Fospropofol (FP), a prodrug of propofol with a slower pharmacokin...

  12. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Bartlett MA

    2015-08-01

    Full Text Available Matthew A Bartlett, Karen F Mauck, Paul R Daniels Division of General Internal Medicine, Mayo Clinic Thrombophilia Center, Department of Medicine, Mayo Clinic, Rochester, MN, USA Abstract: Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. Keywords: bariatric surgery, venous thromboembolism, prophylaxis, vena cava filter, heparin

  13. Prevention of venous thromboembolism in patients undergoing bariatric surgery.

    Science.gov (United States)

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented.

  14. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Science.gov (United States)

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. PMID:26316771

  15. Anesthesia Management in Aortic Dissection in Patients Undergoing Kidney Transplant.

    Science.gov (United States)

    Ucar, Muharrem; Erdil, Feray; Sanlı, Mukadder; Aydogan, Mustafa Said; Durmus, Mahmut

    2016-04-01

    Kidney transplant is a last resort to increase the life expectancy and quality of life in patients with renal failure. Aortic dissection is a disease that requires emergency intervention; it is characterized by sudden life-threatening back or abdominal pain. In the case described, constant chest pain that increased with respiration was present on examination of a 28-year-old man (85 kg, 173 cm) who presented at our emergency department complaining of severe back pain. He had undergone a kidney transplant in 2004 from his mother (live donor). He was diagnosed with acute Type II aortic dissection and was scheduled for emergent surgery. Because there were no surgical or anesthetic complications, the patient with 79 and 89 minutes aortic cross-clamping and cardiopulmonary bypass durations was sent, intubated, to intensive care unit. When nephrotoxic agents are avoided and blood flow is stabilized, cardiovascular surgery with cardio-pulmonary bypass may be performed seamlessly in patients who have undergone a kidney transplant.

  16. Femoral nerve block for patient undergoing total knee arthroplasty

    Science.gov (United States)

    Heo, Bong Ha; Lee, Hyeon Jung; Lee, Hyung Gon; Kim, Man Young; Park, Keun Suk; Choi, Jeong Il; Yoon, Myung Ha; Kim, Woong Mo

    2016-01-01

    Abstract Background: The existence of peripheral opioid receptors and its effectiveness in peripheral nerve block remain controversial. The aim of this prospective, randomized, double-blinded study was to examine the analgesic effects of adding fentanyl to ropivacaine for continuous femoral nerve block (CFNB) using patient-controlled analgesia after total knee arthroplasty (TKA). Methods: The patients were divided into 2 groups, each with n = 40 in ropivacaine (R) group and n = 42 in R with fentanyl (R + F) group. After operation, the patients in each group received R + F and R alone via a femoral nerve catheter, respectively. We assessed the visual analog scale (VAS) pain immediately before administration (baseline) and at 15, 30, and 60 minutes on postanesthesia care unit (PACU), and resting and ambulatory VAS score up to 24 hours. Results: Overall, the average VAS scores in the R + F group were slightly lower than those of the R group. However, the VAS score differences between groups were not statistically significant, except for 30 minutes (P = 0.009) in PACU. R group showed higher supplemental analgesics consumption in average compared with R + F group, but not significant. Conclusion: Additional fentanyl did not show prominent enhancement of analgesic effect in the field of CFNB after TKA. PMID:27603376

  17. Neoadjuvant hormonal deprivation for patients undergoing radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Xu Gao; Tie Zhou; Yuan-Jie Tang; Xin Lu; Ying-Hao Sun

    2009-01-01

    The purpose of this study is to evaluate the therapeutic effect of radical prostatectomy combined with preoperative neoadjuvant hormonal ablation therapy for prostate cancer (PCa).In this study,a total of 31 patients with local PCa underwent radical prostatectomy;of these,12 patients underwent preoperative hormonal deprivation with a combination of goserelin and flutamide for a period of 5.6 months.Data regarding clinical characteristics were compared between the neoadjuvant therapy and radical prostatectomy groups.A total of 31 patients received pelvic lymph node clearance,and the rate of positive lymph nodes was 12.9% (4/31).Serum prostate-specific antigen (PSA) was 8.9±1.2μg L-1 after the neoadjuvant therapy and 0.4±0.3μg L-1 one month after the radical prostatectomy.There were significant differences in the positive surgical margins,seminal vesicle invasion and lymph node metastasis between the neoadjuvant therapy group (n=12) and the radical prostatectomy group (n=19,P<0.01).The resulsts indicates that preoperative hormonal deprivation induced by goserelin and flutamide can decrease clinical and pathological staging,but assessment of its influence on long-term prognosis requires further study.

  18. GASTRIC AND JEJUNAL HISTOPATHOLOGICAL CHANGES IN PATIENTS UNDERGOING BARIATRIC SURGERY

    Science.gov (United States)

    RODRIGUES, Rosemary Simões Nomelini; ALMEIDA, Élia Cláudia de Souza; CAMILO, Silvia Maria Perrone; TERRA-JÚNIOR, Júverson Alves; GUIMARÃES, Lucinda Calheiros; DUQUE, Ana Cristina da Rocha; ETCHEBEHERE, Renata Margarida

    2016-01-01

    ABSTRACT Background: Morbid obesity is a multifactorial disease that increasingly is being treated by surgery. Aim: To evaluate gastric histopathological changes in obese, and to compare with patients who underwent gastrojejunal bypass and the jejunal mucosa after the surgery. Methods: This is an observational study performed at a tertiary public hospital, evaluating endoscopic biopsies from 36 preoperative patients and 35 postoperative. Results: In the preoperative group, 80.6% had chronic gastritis, which was active in 38.9% (77.1% and 20.1%, respectively, in the postoperative). The postoperative group had a significant reduction in H. pylori infection (p=0.0001). A longer length of the gastric stump and a time since surgery of more than two years were associated with Helicobacter pylori infection. The jejunal mucosa was normal in 91.4% and showed slight nonspecific chronic inflammation in 8.6%. Conclusion: There was a reduction in the incidence of Helicobacter pylori infection in the postoperative group. A longer length of the gastric stump and longer time elapsed since surgery were associated with Helicobacter pylori infection. The jejunal mucosa was considered normal in an absolute majority of patients. PMID:27683773

  19. Development of a high-resolution apparatus to monitor physiological state of a person undergoing extreme conditions

    Directory of Open Access Journals (Sweden)

    Kodermyatov Radik

    2016-01-01

    Full Text Available The present research has shown that ECG recordings and parameters of the body functional state are crucial for all kinds of the astronaut pre-flight preparations (centrifuge, thermal chamber, pressure chamber, pressure chamber with special equipment. It is, therefore, important to develop methods and tools for early detection of the preclinical forms of the functional state disorders in patients undergoing high-intensity loads of mixed character. The method based on the hardware-software compleх (HSC with nanosensors of high resolution has been proposed to measure the electrophysiological characteristics and bioelectrical impedance of the body tissues directly exposed to loading. The hardware-software compleх is subjected to clinical trials in Tomsk Research Institute for Cardiology. The obtained results show that the use of nanosensors of high resolution in the HSC without standard filters allows elimination of the power-line interference in ECG recordings. Monitoring of the tissue bioimpedance parameters under test loads enables the detection of preclinical (latent forms of various diseases. After clinical trials in Tomsk Institute for Cardiology the developed apparatus will be proposed for in-depth study of the cardiovascular system and the functional state of the body of astronauts and other persons exposed to extreme loads.

  20. The effectiveness of patient navigation programs for adult cancer patients undergoing treatment: a systematic review.

    Science.gov (United States)

    Tho, Poh Chi; Ang, Emily

    2016-02-01

    Advancements in technology and medical treatment have made cancer care treatment more complex. With the current trend of sub-specialization in health care, cancer patients commonly receive care from multiple specialists and have wider treatment options. In view of this, there is a need to coordinate care and integrate information to enhance care and quality of outcomes for patients. Since the successful implementation of programs for increasing the survival rate of breast cancer patients at Harlem Hospital Center, New York, USA, patient navigation programs have been widely introduced in healthcare settings. Some literature has identified nurses as a primary candidate in assuming the role of a navigator. However, there is a need to further explore the effectiveness of patient navigation programs for their effectiveness in improving quality of life, and patient satisfaction and outcomes during the commencement of cancer treatment. The objective of this review was to synthesize the best available evidence on the effectiveness of patient navigation programs in adult cancer patients undergoing treatments such as radiotherapy and/or chemotherapy. This review considered studies that included adults aged 18 years and over, diagnosed with any type of cancer and undergoing treatment in an acute care hospital setting, including inpatient and outpatient/ambulatory care.This review considered studies that evaluated nurse-led patient navigation programs versus no patient navigation program or non-structured care coordination.A patient navigation program includes patient education, psychosocial support, and care coordination.This review considered randomized controlled trials and quasi-experimental studies.The review focused on the effects of patient navigator program clinical/patient outcomes. The review included studies on patient wellbeing and clinical outcomes, but excluded studies that had examined the impact of these programs on efficiency-related outcomes, such as length

  1. APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

    Institute of Scientific and Technical Information of China (English)

    Hong Zhao; Tie-hu Ye; Zhi-yi Gong; Yang Xue; Zhang-gang Xue; Wen-qi Huang

    2005-01-01

    Objective To assess the efficacy and safety of lomoxicam, one non-steroidal anti-inflammatory drug (NSAID) in patientcontrolled analgesia (PCA) in patients undergoing abdominal surgeries.Methods Thirty-nine patients scheduled for abdominal surgeries were randomly assigned to different PCA treatment groups using either lomoxicam or fentanyl postoperatively. Pain intensity difference (PID) and sum of pain intensity difference (SPID) were used to assess the analgesic efficacy of both drugs during a 24-hour period.Results The analgesic efficacy of lornoxicam is 1/66 of fentanyl, which was shown by SPID value of 3.250 and 3.058,respectively (P > 0.05). Lornoxicam caused fewer adverse events than fentanyl (33% vs. 68%, P < 0.05).Conclusion In clinic, we can use lomoxicam to treat postoperative pain effectively and with less adverse reactions compared with fentanyl.

  2. [Infectious complications in patients undergoing a heart transplant].

    Science.gov (United States)

    Bouza, E; Muñoz, P

    1995-01-01

    Infectious complications are, with rejection, the main cause of morbidity and mortality in heart transplantation recipients. Adequate management of these patients requires an adequate knowledge of risk factors, of most common infectious syndromes and of relevant microorganism, as long as of their resistance pattern. Among the first group, we may mention lower respiratory tract infections, mediastinitis and meningitis, and among the microorganisms, Citomegalovirus, Aspergillus and Toxoplasma gondii. The impressive development of diagnostical techniques and of prophylactic and therapeutical possibilities suggest the convenience of a multidisciplinar approach to these complications.

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

    Directory of Open Access Journals (Sweden)

    Lynn Reese Kakos

    2013-01-01

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

  4. Effect of common herbal medicines on patients undergoing anaesthesia

    Directory of Open Access Journals (Sweden)

    Yatindra Kumar Batra

    2007-01-01

    Full Text Available Herbal medicines are the oldest known remedies to mankind. Herbs have been used by all cultures throughout history but India has one of the oldest, and most diverse cultural living traditions associated with the use of medicinal plants. The use of these agents may have perioperative implications, which often is a result of various factors. The constituents of these medications may not be adequately described. Conventional agents like ste-roids, oral hypoglycaemic agent, nonsteroidal anti-inflammatory agents and antihistamines are frequently added to herbal medicines. Toxic materials like arsenic, mercury, lead, etc. have been detected from time to time in some herbs. The use of herbal medicines can result in drug interactions, most of which are less well defined. The interactions that are most important in the perioperative period include sympathomimetic, sedative, and coagulopathic effects. Less than 50% of patients admit to taking these medicines, which compounds the prob-lem. It is imperative that anaesthesiologists obtain a history of herbal medicine use from patients and anticipate the adverse drug interactions. In case of any doubt, it may be prudent to stop these herbal medicines atleast 2-3 weeks prior to anaesthesia and surgery.

  5. 右美托咪定用于运动诱发电位监测神经外科手术患者的安全性和可行性%Feasibility and safety of dexmedetomidine used in motor evoked potentials monitoring in patients under-going neurosurgery

    Institute of Scientific and Technical Information of China (English)

    郭余大; 戴寒英; 周小平; 陈立科; 戴祺

    2016-01-01

    目的:观察右美托咪定用于运动诱发电位(MEP)监测神经外科手术患者的安全性和可行性。方法选择择期全麻下需做 MEP 监测颅脑肿瘤切除术患者30例,男15例,女15例,年龄20~60岁,体重40~80 kg,ASA Ⅰ或Ⅱ级,随机分为两组:右美托咪定组(D 组)和对照组(C 组),每组15例。D 组在麻醉诱导前经静脉10 min 输注右美托咪定0.5μg/kg,随后以右美托咪定0.5μg·kg-1·h-1输注至术毕,C 组采取同样方法给予等容量生理盐水。于入室时(T0),切皮时(T1),停肌松药时(T2),停肌松药后50 min(T3)观察 HR、MAP 和 BIS 值;记录诱发 MEP 的电流强度,监测等待时间(停肌松药后至首次诱发 MEP 时间),T3时大鱼际肌 MEP(直接电刺激运动皮质诱发的大鱼际肌 MEP)的波幅及潜伏期;同时记录术中丙泊酚和瑞芬太尼的用量,不良反应发生情况。结果与T0时比较,T1、T3时 C 组 HR 明显增快(P <0.05),T2、T3时 D 组 HR 明显减慢(P <0.05), T1~T3时 C 组 MAP 明显升高(P <0.05),T1~T3时两组 BIS 值明显降低(P <0.05);T1~T3时D 组 HR 明显慢于 C 组、MAP 明显低于 C 组(P <0.05)。D 组丙泊酚用量和首次诱发 MEP 的电流强度明显低于 C 组(P <0.05),T3时大鱼际肌 MEP 波幅明显高于 C 组(P <0.05)。D 组高血压和心动过速发生率明显低于 C 组、心动过缓发生率明显高于 C 组(P <0.05)。结论右美托咪定用于MEP 监测神经外科手术患者,可满足手术需求、维持围术期血流动力学稳定,降低部分不良反应发生率,改善 MEP 监测质量,是一种安全、可行的麻醉方法。%Objective To observe the feasibility and safety of dexmedetomidine used in motor evoked potentials(MEP)monitoring in patients undergoing neurosurgery.Methods Thirty ASA Ⅰ orⅡ patients,male 1 5 cases,female 1 5 cases,aged 20-60 years,weighing 40-80 kg undergoing neuro-surgery receiving MEP monitoring were randomly divided into 2 groups (n =1 5 each

  6. 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...

  7. Severe aortic arch calcification predicts mortality in patients undergoing peritoneal dialysis

    OpenAIRE

    Ching-Fang Wu; Yee-Fan Lee; Wen-Jeng Lee; Chi-Ting Su; Lukas Jyuhn-Hsiarn Lee; Kwan-Dun Wu; Pau-Chung Chen; Tze-Wah Kao

    2017-01-01

    Vascular calcification can predict cardiovascular (CV) morbidity and mortality in patients with end-stage renal disease. We evaluated the prevalence, association factors, and outcomes of chest X-ray-detected aortic arch calcification (AoAC) in patients undergoing peritoneal dialysis (PD). Methods: We included 190 patients undergoing PD (mean age, 52.6 ± 14.3 years) for whom chest radiographs were available. AoAC revealed by chest X-ray was graded from 0 to 3 according to an AoAC score (AoA...

  8. Efficacy of crushed lanthanum carbonate for hyperphosphatemia in hemodialysis patients undergoing tube feeding.

    Science.gov (United States)

    Kitajima, Yukie; Takahashi, Taeko; Sato, Yuzuru; Nakaya, Yutaka

    2011-08-01

    Lanthanum carbonate (LaC) is a non-calcium-based phosphate binder used to treat hyperphosphatemia in patients with chronic kidney disease. Oral administration of LaC is difficult in patients undergoing tube feeding or those who are of advanced age because it is essential to chew the LaC tablet sufficiently before swallowing it. We report two cases in whom crushed LaC was used in hemodialysis patients undergoing tube feeding. In both cases, previously crushed LaC was mixed into enteral nutrients. We found that LaC administered this way was effective for decreasing serum phosphorus levels.

  9. Plasma mepivacaine concentrations in patients undergoing third molar surgery.

    Science.gov (United States)

    Scarparo, H C; Maia, R N; Filho, Ea Dos Santos; Soares, Ecs; Costa, Fwg; Fonteles, Csr; Bezerra, T P; Ribeiro, T R; Romero, N R

    2016-12-01

    Local anaesthetic-related systemic toxicity mainly results from elevated plasma concentrations of these drugs. We hypothesized that intraoral injection of submaximal doses of mepivacaine does not lead to toxic levels of this drug in blood. This study evaluated the plasma levels of mepivacaine in third molars surgeries. Twenty-one patients were randomly assigned into two groups: group I (two unilateral third molars; submaximal dose of mepivacaine 108 mg with epinephrine 54 μg) and group II (four third molars; submaximal dose of mepivacaine 216 mg with epinephrine 108 μg). Blood samples were collected before anaesthesia, and 5, 10, 15, 20, 30, 40, 60, 90 and 120 min after anaesthesia. Individual peak plasma concentrations ranged 0.77-8.31 μg/mL (group I) and from 2.36-7.72 μg/mL (group II). An increase in the average dose of mepivacaine from 1.88 ± 0.12 mg/kg (group I) to 3.35 ± 0.17 mg/kg (group II) increased the mean mepivacaine peak plasma levels from 2.33 ± 0.58 to 4.01 ± 0.69 μg/mL, respectively. Four patients obtained plasma levels of mepivacaine above the threshold for toxicity (5 μg/mL). Toxic levels of mepivacaine are possible, even when a submaximal dose is used. A twofold increase in the dose of mepivacaine caused the mean peak plasma concentration to increase proportionally, indicating that they may be predicted based on the relation of dose per bodyweight. © 2016 Australian Dental Association.

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

    Science.gov (United States)

    Wang, Yun; Yue, Yun; Sun, Yong-hai; Wu, An-shi; Wu, Qi-wei; Zhang, Yong-qian; Feng, Chun-sheng

    2005-07-20

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

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

  12. Management of patients with hematological malignancies undergoing coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Deepak Borde

    2013-01-01

    Full Text Available The number of patients with a previously diagnosed malignancy who need cardiac surgery is increasing. Patients with hematological malignancies represent only 0.38% of all patients undergoing cardiac surgery. The literature in this subset of patients is limited to only a few retrospective case series, with limited number of patients undergoing emergency cardiac surgery. We describe three cases with hematological malignancies namely chronic myelogenous leukemia, acute promyelocytic leukemia and chronic lymphocytic leukemia presenting for coronary artery bypass grafting (CABG. Two patients were taken up for emergency CABG in view of ongoing ischemia, one of them was on preoperative intra-aortic balloon pump support. No mortality was observed. Two patients needed transfusion of blood products which was guided by thromboelastography. One patient developed superficial sternal wound infection requiring antibiotic therapy.

  13. Influence of Continuous Nursing on the Psychological State and Coping Style of Patients Undergoing Pacemaker Implantation

    Directory of Open Access Journals (Sweden)

    Xin LIU

    2015-10-01

    Full Text Available Background: Patients undergoing pacemaker implantation often experience anxiety and fear. As such, studies have focused on the mechanisms that relieve the negative emotions caused by the intervention. Continuous nursing is a safe and effective nursing mode. In this study, continuous nursing intervention was provided for elderly patients undergo-ing pacemaker implantation and an empirical investigation was performed to determine the effects of their negative emotion and disease-coping ability.Methods: Overall, 114 (68 males and 46 females elderly patients who were undergoing pacemaker implantation from Harbin City (China, were enrolled in the study. The patients were divided into two groups, namely, the control group and the intervention group, based on different nursing methods. Routine nursing was applied to the control group; continuous nursing support was provided for the intervention group from January 2014 to January 2015. The nursing results of the two groups were compared. These results were also evaluated using self-rating depression scale, self-rating anxiety scale, and trait coping style questionnaire.Result: The effects of depression and anxiety intervention were significant in the intervention group (P<0.05. Com-pared with the control group, the intervention group did not significantly differ. The coping style of the intervention group elicited significant effects. Compared with the control group, the intervention group was significantly different (P < 0.05.Conclusion: Continuous nursing can relieve the negative emotion and improve the negative coping style of patients undergoing pacemaker implantation.

  14. Relationship Between Reverse Remodeling and Cardiopulmonary Exercise Capacity in Heart Failure Patients Undergoing Cardiac Resynchronization Therapy

    NARCIS (Netherlands)

    Mastenbroek, Mirjam H; van t Sant, Jetske; Versteeg, Henneke; Cramer, MJ; Doevendans, Pieter A; Pedersen, Susanne S; Meine, Mathias

    2016-01-01

    BACKGROUND: Studies on the relationship between left ventricular reverse remodeling and cardiopulmonary exercise capacity in heart failure patients undergoing cardiac resynchronization therapy (CRT) are scarce and inconclusive. METHODS AND RESULTS: Eighty-four patients with a 1st-time CRT-defibrilla

  15. Clinical impact of intracoronary abciximab in patients undergoing primary percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Piccolo, Raffaele; Gu, Youlan L; Iversen, Allan Zeeberg

    2012-01-01

    The aim of this study was to perform an individual patient-level pooled analysis of randomised trials, comparing intracoronary versus intravenous abciximab bolus use in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI)....

  16. Preoperative Thyroid Ultrasound Is Indicated in Patients Undergoing Parathyroidectomy for Primary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Cletus A. Arciero, Zita S. Shiue, Jeremy D. Gates, George E. Peoples, Alan P. B. Dackiw, Ralph P. Tufano, Steven K. Libutti, Martha A. Zeiger, Alexander Stojadinovic

    2012-01-01

    Full Text Available Background: Primary hyperaparathyroidism (pHPT is often accompanied by underlying thyroid pathology that can confound preoperative parathyroid localization studies and complicate intra-operative decision making. The aim of this study was to examine the utility of preoperative thyroid ultrasonography (US in patients prior to undergoing parathyroidectomy for pHPT.Methods: An Institutional Review Board approved prospective study was undertaken from January 2005 through July 2008. All patients with pHPT meeting inclusion criteria (n=94 underwent preoperative thyroid ultrasound in addition to standard 99mTc-sestamibi scintigraphy for parathyroid localization. Demographics, operative management and final pathology were examined in all cases.Results: Fifty-four of the 94 patients (57% were noted to have a thyroid nodule on preoperative US, of which 30 (56% underwent further examination with fine needle aspiration biopsy. Alteration of the operative plan attributable to underlying thyroid pathology occurred in 16 patients (17%, with patients undergoing either total thyroidectomy (n=9 or thyroid lobectomy (n=7. Thyroid cancer was noted in 33% of patients undergoing thyroid resection, and 6% of all patients with HPT.Conclusions: The routine utilization of preoperative thyroid ultrasound in patients prior to undergoing parathyroid surgery for pHPT is indicated. The added information from this non-invasive modality facilitates timely management of co-incidental, and sometimes malignant, thyroid pathology.

  17. Additional effective dose by patients undergoing NAI-131 capsules therapy

    Energy Technology Data Exchange (ETDEWEB)

    Orlic, M.; Jovanovic, M.; Spasic Jokic, V.; Cuknic, O.; Ilic, Z.; Vranjes Djuric, S. [VINCA - Institute of Nuclear Sciences, Belgrade, Serbia and Montenegro (Yugoslavia)

    2006-07-01

    Capsules or solutions containing Na{sup 131}I are indicated for the therapy of some thyroid carcinomas such as functioning metastatic papillary or follicular carcinoma of the thyroid; and for the treatment of hyperthyroidism (diffuse toxic goiter and single or multiple toxic nodular goiter). The recommended dosage ranges of Na{sup 131}I capsules or solution for the therapy of the average patient (70 kg) are: (3.7-5.55) GBq for ablation of normal thyroid tissue; (3.7-7.4) GBq for subsequent treatments; a (148-370) MBq for hyperthyroidism. The purpose of this paper is to calculate effective dose as a result of iodine-131 capsules remaining in stomach before absorption starts. This result can determine the disadvantage of capsule versus solution containing sodium iodine-131 (Na{sup 131}I) in radionuclide therapy application from radiation protection point of view. The Monte Carlo code MCNP4b was used to model transport of gamma and beta particles emitted by radionuclide {sup 131}I treated as a point source at the bottom of stomach. Absorbed energy per unit transformation in stomach and surrounding organs has been calculated. (authors)

  18. Parenteral nourishment of patients undergoing surgical or traumatic stress.

    Science.gov (United States)

    Gilder, H

    1986-01-01

    Severe surgical or other traumatic stress initiates an integrated central nervous system and metabolic response characterized by catabolism which selectively preserves vital organs, drawing on peripheral tissue proteins for required amino acids. When oral intake is prohibited adequate intravenous nutritional support hastens convalescence and may be life-saving. Intravenous nutrients routinely consist of amino acids for replacement of lost protein, a nonprotein calorie source--usually glucose, and vitamins and minerals. Lipid, infrequently used in routine surgery as part of the calorie source, supplies essential fatty acids and prevents side effects resulting with large amounts of intravenous glucose. Lipid has other benefits. Stress-induced hormones stimulate lipid catabolism. When lipid is used for part of the calorie requirement in intravenous feedings, the plasma insulin level is reduced and peripheral amino acids become available for synthesis of critically needed visceral proteins. Recent work has shown that the branched chain amino acids carnitine and some species of lipid added to intravenous nutrient formulations postoperatively affect the nitrogen retention and may hasten convalescence. Further work should be directed at understanding the unique biochemical changes occurring after injury, devising objective assay procedures to measure the severity of the response and improving intravenous formulations for the acutely ill surgical patient.

  19. [Difficulties facing spouses of in-patients undergoing tocolysis].

    Science.gov (United States)

    Hu, Ya-Ling

    2008-08-01

    When a pregnant woman needs tocolysis to preempt the need for an abortion, there are great impacts on the daily life of her family and on the relationships between the couple and their family members, which negatively influence the balance of the family system. For a pregnant woman under tocolysis in hospital, the spouse indeed plays an important supportive role in helping her to endure many difficulties. Because men are always controllers of power and opinion, being strong and active in attitude to everything, male spouses always suppress their emotions and do not express their feelings to others. These characteristics of men, either in Eastern or Western countries, always cause nursing staff to realize the needs of the male spouse poorly during tocolysis. The current concept of nursing emphasizes family-centered nursing, so the patient's family members are also recipients of treatment, especially male spouses during the process of tocolysis. This is usually neglected, however. In this paper, the author analyzes the characteristics and the roles of male spouses in the family, and the difficulties faced by a pregnant woman during tocolysis in hospital, for the benefit of future clinical nursing practice.

  20. Design and Development of Patient Monitoring System

    Science.gov (United States)

    Hazwanie Azizulkarim, Azra; Jamil, Muhammad Mahadi Abdul; Ambar, Radzi

    2017-08-01

    Patient monitoring system allows continuous monitoring of patient vital signs, support decision making among medical personnel and help enhance patient care. This system can consist of devices that measure, display and record human’s vital signs, including body temperature, heart rate, blood pressure and other health-related criteria. This paper proposes a system to monitor the patient’s conditions by monitoring the body temperature and pulse rate. The system consists of a pulse rate monitoring software and a wearable device that can measure a subject’s temperature and pulse rate only by using a fingertip. The device is able to record the measurement data and interface to PC via Arduino microcontroller. The recorded data can be viewed as a historical file or can be archived for further analysis. This work also describes the preliminary experimental results of the selected sensors to show the usefulness of the sensors for the proposed patient monitoring system.

  1. Temperature Changes in the Brain of Patients Undergoing MRI Examination

    Directory of Open Access Journals (Sweden)

    Theresa Bebaaku Dery

    2013-04-01

    Full Text Available Magnetic Resonance Imaging scanners have become important tools in modern day health care. During the imaging process, total radiofrequency power is transferred from the RF coil to the brain tissues resulting in increase in temperature in the subject being imaged. Currently, reliable and validated means to predict RF heating are not unavailable.This research was conducted to determine temperature changes in the human brain during MRI examination.This study was carried out at two MRI Units in Ghana. One hundred and twenty-six patients were investigated. Data collected include pre- and post-scan tympanic temperatures and specific absorption rates values. The average pre- and post-scan tympanic temperatures measured for Centre A were 36.5±0.1 °C and 37.0±0.1 °C respectively with an average change in temperature of 0.5±0.1 °C for 30.68 minutes scan and an average SAR value of 1.25 W/kg. Centre B measured average pre- and post-scan tympanic temperatures of 36.4±0.1 °C and 36.8±0.1 °C respectively with an average change in temperature of 0.4±0.1 °C for 41.58 minutes scan and an average SAR value of 0.1 W/kg.The rise in tympanic temperature and SAR values were within guidance level of 1 °C recommended by theUnited States Food and Administration and the International Electrotechnical Commission.

  2. [Anesthetic management of a patient with stiff-person syndrome undergoing thymectomy].

    Science.gov (United States)

    Tadokoro, Takahiro; Yamashita, Soichiro; Ishigaki, Maiko; Takahashi, Shinji; Tanaka, Makoto

    2012-02-01

    Stiff-person syndrome is an uncommon disease characterized by muscular rigidity and painful spasms in the axial and limb muscles. We report a 58-year-old woman with stiff-person syndrome undergoing thymectomy under general anesthesia. Before surgery, her medications were 25 mg of diazepam, 2 mg of clonazepam, and 15 mg of gabapentin per day. After epidural catheterization for the postoperative analgesia, general anesthesia was induced and maintained with continuous remifentanil infusion and propofol with target controlled infusion. With train-of-four ratio (TOFR) monitoring by stimulating the ulnar nerve, her trachea was intubated after 0.6mg x kg(-1) of rocuronium intravenous administration. Since then, additional rocuronium was not given for 4 hours. After surgery, she was fully awake and TOFR recovered to 100%, but tidal volume was too low to remove the tracheal tube, and mechanical ventilation was continued in ICU. On the next day, the tracheal tube was removed, and she was discharged from ICU. Because anesthetics may delay the recovery of respiratory function in a patient with stiff-person syndrome, careful assessment of respiratory function is needed at the emergence from general anesthesia.

  3. A Comparison of Third-Generation Semi-Invasive Arterial Waveform Analysis with Thermodilution in Patients Undergoing Coronary Surgery

    Directory of Open Access Journals (Sweden)

    Ole Broch

    2012-01-01

    Full Text Available Uncalibrated semi-invasive continous monitoring of cardiac index (CI has recently gained increasing interest. The aim of the present study was to compare the accuracy of CI determination based on arterial waveform analysis with transpulmonary thermodilution. Fifty patients scheduled for elective coronary surgery were studied after induction of anaesthesia and before and after cardiopulmonary bypass (CPB, respectively. Each patient was monitored with a central venous line, the PiCCO system, and the FloTrac/Vigileo-system. Measurements included CI derived by transpulmonary thermodilution and uncalibrated semi-invasive pulse contour analysis. Percentage changes of CI were calculated. There was a moderate, but significant correlation between pulse contour CI and thermodilution CI both before (2=0.72, <0.0001 and after (2=0.62, <0.0001 CPB, with a percentage error of 31% and 25%, respectively. Changes in pulse contour CI showed a significant correlation with changes in thermodilution CI both before (2=0.52, <0.0001 and after (2=0.67, <0.0001 CPB. Our findings demonstrated that uncalibrated semi-invasive monitoring system was able to reliably measure CI compared with transpulmonary thermodilution in patients undergoing elective coronary surgery. Furthermore, the semi-invasive monitoring device was able to track haemodynamic changes and trends.

  4. Association of systemic collagen type IV formation with survival among patients undergoing hemodialysis

    DEFF Research Database (Denmark)

    Leeming, Diana Julie; Karsdal, Morten A; Rasmussen, Lars M;

    2013-01-01

    The 7S domain of collagen type IV (P4NP_7S) assessed in plasma represents systemic collagen type IV formation. The objective of the study was to investigate the association of systemic collagen type IV formation with survival among patients undergoing hemodialysis.......The 7S domain of collagen type IV (P4NP_7S) assessed in plasma represents systemic collagen type IV formation. The objective of the study was to investigate the association of systemic collagen type IV formation with survival among patients undergoing hemodialysis....

  5. Postoperative Respiratory Exercises Reduce the Risk of Developing Pulmonary Complications in Patients Undergoing Lobectomy.

    Science.gov (United States)

    Rodriguez-Larrad, Ana; Vellosillo-Ortega, Juan Manuel; Ruiz-Muneta, Carlos; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús

    2016-07-01

    To evaluate the effects of an intensive postoperative physiotherapy program focused on respiratory exercises in patients undergoing lobectomy by open thoracotomy. Quasi-experimental study. Tertiary referral academic hospital. 208 patients undergoing lobectomy by open thoracotomy. Control group patients (n=102) received standard medical/nursing care, and experimental group patients (n=106) added to the standard clinical pathway a daily physiotherapy program focused on respiratory exercises until discharge. Analyzed outcomes were the frequency of postoperative pulmonary complications (PPCs) more amenable to physiotherapy (pneumonia, atelectasis and respiratory insufficiency) and length of hospital stay (LOS). Both groups were comparable regarding preoperative and surgical characteristics. Incidence of PPCs was 20.6% in control and 6.6% in experimental group (P=.003). Median (IQR) LOS in control group was 14 (7) days (Huber M estimator 14.21) and 12 (6) days (Huber M estimator 12.81) in experimental. Logistic regression model identified the evaluated physiotherapy program (P=.017; EXP [B] 95% CI 0.081-0.780) and % FEV1 (P=.042; EXP [B] 95% CI 0.941-0.999) as protective factors for the development of PPCs in patients undergoing lobectomy. Implementing a postoperative intensive physiotherapy program focused on respiratory exercises reduces the risk of PPCs and resultant LOS on patients undergoing lobectomy. Copyright © 2016 SEPAR. Published by Elsevier Espana. All rights reserved.

  6. Health related quality of life in 2002 and 2015 in patients undergoing hemodialysis

    DEFF Research Database (Denmark)

    de Place Knudsen, Signe; Eidemak, I.; Molsted, Stig

    2016-01-01

    Health related quality of life (HRQOL) has become a recognized outcome in studies of the treatment of patients undergoing hemodialysis (HD). The aim of this study was to assess changes in HRQOL reported by two different samples of patients undergoing HD in the same dialysis center in 2002 and 2015....... Two samples of patients from the same Danish dialysis center completed the HRQOL questionnaire Kidney Disease Quality of Life version 1.3 in 2002 (n = 71) and 2015 (n = 81), respectively. The associations between KDQOL summery scores and the time frame were analyzed in multivariable regression...... analyses. The 2015 sample of patients were older compared to the 2002 sample (66 ± 13 vs. 59 ± 16 years, p = 0.003, respectively), they comprised more obese patients (20.6 vs. 3.2%, p = 0.002) and more patients with hypoalbuminemia (66.7 vs. 42.9%, p = 0.006). After confounder adjustment the time period...

  7. Recurrent Pseudomembranous Colitis in an Ovarian Cancer Patient Undergoing Carboplatin Chemotherapy.

    Science.gov (United States)

    Allen, Valerie A; Manahan, Kelly J; Geisler, John P

    2016-01-01

    Background. Diarrhea is a common problem in ovarian cancer patients undergoing chemotherapy and Clostridium difficile infection has been identified as a cause. The proper diagnosis and treatment of diarrhea are critical to patient care, especially to prevent the serious complications from a severe Clostridium difficile infection (CDI). Case. We present a heavily pretreated ovarian cancer patient who developed recurrent pseudomembranous colitis while receiving carboplatin chemotherapy. Despite treatment with oral metronidazole for fourteen days, the patient's diarrhea relapsed and colonoscopy revealed extensive pseudomembranous colitis. The infection eventually resolved with the combination of oral vancomycin and metronidazole. Conclusions. Diarrhea is a common problem in patients undergoing chemotherapy for ovarian cancer. Management requires obtaining the proper diagnosis. Clostridium difficile associated pseudomembranous colitis must be part of the differential diagnosis. Treatment must be sufficient to prevent relapses of the Clostridium difficile infection to prevent serious consequences in an already vulnerable patient population.

  8. Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery

    DEFF Research Database (Denmark)

    Jensen, L S; Andersen, A J; Christiansen, P M

    1992-01-01

    The frequency of infection in 197 patients undergoing elective colorectal surgery and having either no blood transfusion, transfusion with whole blood, or filtered blood free from leucocytes and platelets was investigated in a prospective randomized trial. Natural killer cell function was measured...... before operation and 3, 7 and 30 days after surgery in 60 consecutive patients. Of the patients 104 required blood transfusion; 48 received filtered blood and 56 underwent whole blood transfusion. Postoperative infections developed in 13 patients transfused with whole blood (23 per cent, 95 per cent...... function was significantly (P less than 0.001) impaired up to 30 days after surgery in patients transfused with whole blood. These data provide a strong case against the use of whole blood transfusion in patients undergoing elective colorectal surgery. Udgivelsesdato: 1992-Jun...

  9. Applied Research on the Fluid Resuscitation in Geriatric Patients Undergoing Major Chest Trauma Operation by Monitoring ITBVI,EVLWI%ITBVI、EVLWI在老年重大胸部外伤手术中液体复苏的应用研究

    Institute of Scientific and Technical Information of China (English)

    王智钧; 韩全国; 刘永宏; 杜秀珍

    2015-01-01

    Objective:To research the valve of ITBVI and EVLWI in fluid resuscitation of geriatric patients undergoing major chest trauma operation.Method:48 cases undergoing major chest trauma operation were included and randomly divided into two groups,24 cases in each group.The study group received pulse indicator continous output(PICCO) monitoring and ITBVI+EVLWI were used as indicator for fluid management.The control group was used central venous pressure (CVP) as indicator for fluid management.Heart rate (HR),mean arterial pressure (MAP),central venous oxygen saturation (ScvO2) and lactic acid were compared.Postoperative shock improvement and oxygenation index,duration of mechanical ventilation,the incidence of acute pulmonary edema as well as mortality in these two groups were observed and compared.Result:The study group of tissue perfusion and shock were significantly improved than that of control group and oxygenation index increased,ScvO2 of the study group was higher than that of the control group,the concentration of lactic acid of the study group was lower than that of the control group,the incidency rate of acute pulmonary edema and mortality rate of the study group were lower than that of the control group,the differences were statistically significant (P<0.05).Conclusion:Compared with CVP,ITBVI and EVLWI data can assess more accurately and guide fluid management in geriatric patients undergoing major chest trauma operation with less duration of mechanical ventilation,reduce the acute pulmonary edema,staying in ICU and mortality.%目的:观察以胸腔内血容量指数(intrathoracic blood volume index,ITBVI)/血管外肺水指数(extravascular lung water index,EVLWI)在老年重大胸部外伤手术中液体复苏的应用研究。方法:急诊行重大胸部外伤手术的老年患者48例,随机分为以ITBVI/EVLWI为导向的研究组(Study group S组)和对照组(Routine group,R组),每组各24例患者。对照组监测CVP指

  10. Absorbed doses on patients undergoing tomographic exams for pre-surgery planning of dental implants

    Energy Technology Data Exchange (ETDEWEB)

    Zenobio, M.A.F. [Centro de Desenvolvimento da Tecnologia Nuclear, Comissao Nacional de Energia Nuclear, Caixa Postal 941, CEP 30123-970 Belo Horizonte, MG (Brazil)]. E-mail: silvata@cdtn.br; da Silva, T.A. [Centro de Desenvolvimento da Tecnologia Nuclear, Comissao Nacional de Energia Nuclear, Caixa Postal 941, CEP 30123-970 Belo Horizonte, MG (Brazil)]. E-mail: madelon@cdtn.br

    2007-06-15

    The thermoluminescent (TL) dosimetry was used to measure entrance skin absorbed doses at anatomical points close to critical organs of patients undergoing tomographic techniques as part of a pre-surgery planning for dental implants. The dosimetric procedure was applied in 19 patients, and absorbed doses could be measured with a combined uncertainty down to 14%. Results showed that patient doses may be increased by a factor of 20 in the helical computed tomography compared to panoramic and spiral conventional tomographic exams.

  11. Epidemiology of viral hepatitis among patients undergoing hemodialysis at nephrology center Benghazi

    OpenAIRE

    Vinay Rao; Prasannalakshmi Rao

    2014-01-01

    Introduction: During hemodialysis, patients are at-risk of acquiring blood-borne viruses and pathogenic bacteria. Within dialysis units, prevention of infection is of paramount importance. The nursing staff must take adequate precaution to prevent the spread of infection within this high-risk environment. Patients and Methods: All patients undergoing hemodialysis for the period of 7 days were interviewed once during dialysis, using a closed-ended questionnaire. Patients′ files were checked fo...

  12. Erectile Dysfunction Among HIV Patients Undergoing Highly Active Antiretroviral Therapy: Dyslipidemia as a Main Risk Factor

    Directory of Open Access Journals (Sweden)

    Gustavo Romero‐Velez, MD

    2014-04-01

    Conclusions: ED is highly prevalent in HIV patients. Dyslipidemia should be considered as a risk factor for ED in HIV patients. Romero‐Velez G, Lisker‐Cervantes A, Villeda‐Sandoval CI, Sotomayor de Zavaleta M, Olvera‐Posada D, Sierra‐Madero JG, Arreguin‐Camacho LO, and Castillejos‐Molina RA. Erectile dysfunction among HIV patients undergoing highly active antiretroviral therapy: Dyslipidemia as a main risk factor. Sex Med 2014;2:24–30.

  13. Recurrent Pseudomembranous Colitis in an Ovarian Cancer Patient Undergoing Carboplatin Chemotherapy

    OpenAIRE

    2016-01-01

    Background. Diarrhea is a common problem in ovarian cancer patients undergoing chemotherapy and Clostridium difficile infection has been identified as a cause. The proper diagnosis and treatment of diarrhea are critical to patient care, especially to prevent the serious complications from a severe Clostridium difficile infection (CDI). Case. We present a heavily pretreated ovarian cancer patient who developed recurrent pseudomembranous colitis while receiving carboplatin chemotherapy. Despite...

  14. The Investigation of Nail Disorders in Patients with Chronic Renal Failure Undergoing Hemodialysis

    OpenAIRE

    Perihan Öztürk; Neslihan Dokur; Ergül Kurutaş; Ekrem Doğan; Tuğba Karakaş; Murat Kalender; Hasan Ekerbiçer

    2012-01-01

    Objective: Nail changes are often observed in patients with end-stage renal disease. These changes may occur due to chronic renal failure itself or to the treatment. This study aims to investigate the frequency of nail findings in patients undergoing hemodialysis therapy and to compare with healthy controls. Methods: One hundred and four patients with chronic renal failure treated with hemodialysis, and 104 healthy controls without any dermatological and sistemic diseases, were examined fo...

  15. Measuring preoperative anxiety in patients undergoing elective surgery in Czech Republic

    OpenAIRE

    Pavlína Homzová; Renáta Zeleníková

    2015-01-01

    Aim: The main aim of the study was to measure preoperative anxiety in patients in the Czech Republic before elective surgery, using the Visual Analogue Scale for Anxiety (VAS-A). Design: A cross-sectional descriptive study. Methods: The sample consisted of 344 patients undergoing elective surgery. The day before surgery patients completed a questionnaire consisting of demographic data, the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the VAS-A. Spearman correlation was use...

  16. Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

    OpenAIRE

    Cihan Doger; Kadriye Kahveci; Dilsen Ornek; Abdulkadir But; Mustafa Aksoy; Derya Gokcinar; Didem Katar

    2016-01-01

    Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n = 30) an...

  17. Management of gallstones and gallbladder disease in patients undergoing gastric bypass

    Institute of Scientific and Technical Information of China (English)

    Bernabé; M; Quesada; Gustavo; Kohan; Hernán; E; Roff; Carlos; M; Canullán; Luis; T; Chiappetta; Porras

    2010-01-01

    The appropriate management of gallstones and gallbladder disease in patients undergoing gastric bypass remains unknown.Several therapeutic modalities are used and include performing cholecystectomy on all patients at the time of gastric bypass,performing concomitant cholecystectomy only when patients have gallstones and performing cholecystectomy only in the presence of both symptoms and gallstones.Some groups administer ursodeoxycholic acid for gallstone prevention in the postoperative period.All treatment...

  18. Fragmented QRS for Risk Stratification in Patients Undergoing First Diagnostic Coronary Angiography

    Science.gov (United States)

    Eyuboglu, Mehmet; Ekinci, Mehmet Akif; Karakoyun, Suleyman; kucuk, Ugur; Senarslan, Omer; Akdeniz, Bahri

    2016-01-01

    Background Only a small proportion of patients referred for coronary angiography with suspected coronary artery disease (CAD) have the diagnosis of obstructive CAD confirmed by the exam. For this reason, further strategies for risk stratification are necessary. Objective To investigate the relationship of the presence of fragmented QRS (fQRS) on admission electrocardiogram with angiographically detected CAD and CAD severity in patients without known vascular diseases and myocardial fibrosis, undergoing first diagnostic coronary angiography. Methods We enrolled 336 consecutive patients undergoing coronary angiography for suspected CAD. The patients were divided into two groups according to the presence or absence of fQRS on admission. We compared the groups regarding the presence and severity of CAD. Results Seventy-nine (23.5%) patients had fQRS on admission. There was not a statistically significant difference between patients with fQRS (41.8%) and non-fQRS (30.4%), regarding the presence of CAD (p = 0.059). However, there was a statistically significant difference between patients with fQRS and non-fQRS regarding the presence of stenotic CAD (40.5% vs. 10.5%, p22 compared to patients with SYNTAX score ≤22. Conclusions Our findings suggest that fQRS may be an indicator of early-stage myocardial damage preceding the appearance of fibrosis and scar, and may be used for risk stratification in patients undergoing first diagnostic coronary angiography PMID:27849256

  19. Remote monitoring in patients with spondylitis

    Directory of Open Access Journals (Sweden)

    Akulova A.l.

    2014-06-01

    Full Text Available Objective: to evaluate the adherence to therapy and treatment outcomes in patients with spondylitis (SpA in which activity of the disease managed remotely. Material and Methods. 193 patients with axial SpA were randomized into 3 groups with the different ways of the disease activity monitoring: 96 patients were managed in free way, 26 patients visited rheumatologist every 12 weeks, 69 patients managed remotely — we called them every 4 weeks. After the first year of follow up we made 3-month break in the telephone monitoring. The data on the treatment and SpA activity (indexes BASDAI, PASS, ESR, CRP were collected. Results. In patients managed in a free way SpA activity was severe after a year. In groups managed remotely and once in 3 month the significant reduction in the disease activity was achieved with maximal decrease in remote monitoring group. Positive PASS group 3 was found in 15 patients (57.69%, n=26, in group 2 — in 4 patients (20%, n=20, in group 1 — no patients (0%. NSAIDs intake was arbitrarily changed by 5 (19.23%, n=26, 15(75%, n=20, and 93(96.87%, n=96 patients of groups 3, 2 and 1, respectively. After a 3- month break in remote monitoring in 13 patients with initial BASDAI>4 disease activity significantly increased, in 33 patients with BASDAK4 disease activity decreased. 17 (51.5% patients independently changed the drug intake regimen after the break in monitoring. Conclusion. Remote monitoring is associated with better adherence to therapy and the best results of treatment of patients with SpA than the other modes of observation. Remote monitoring frequency must be determined individually.

  20. Radiological findings in patients undergoing revision endoscopic sinus surgery: a retrospective case series study

    Directory of Open Access Journals (Sweden)

    Eweiss Ahmed Z

    2011-05-01

    Full Text Available Abstract Background Functional endoscopic sinus surgery (FESS is now a well-established strategy for the treatment of chronic rhinosinusitis which has not responded to medical treatment. There is a wide variation in the practice of FESS by various surgeons within the UK and in other countries. Objectives To identify anatomic factors that may predispose to persistent or recurrent disease in patients undergoing revision FESS. Methods Retrospective review of axial and coronal CT scans of patients undergoing revision FESS between January 2005 and November 2008 in a tertiary referral centre in South West of England. Results The CT scans of 63 patients undergoing revision FESS were reviewed. Among the patients studied, 15.9% had significant deviation of the nasal septum. Lateralised middle turbinates were present in 11.1% of the studied sides, and residual uncinate processes were identified in 57.1% of the studied sides. There were residual cells in the frontal recess in 96% of the studied sides. There were persistent other anterior and posterior ethmoidal cells in 92.1% and 96% of the studied sides respectively. Conclusions Analysis of CT scans of patients undergoing revision FESS shows persistent structures and non-dissected cells that may be responsible for persistence or recurrence of rhinosinusitis symptoms. Trials comparing the outcome of conservative FESS techniques with more radical sinus dissections are required.

  1. Systematic Review of Peri-Operative Nutritional Supplementation in Patients Undergoing Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Kolitha Sanjaya Goonetilleke

    2006-01-01

    Full Text Available Background: Although nutritional supplementation is established in surgicalpractice, studies on feeding patients undergoing pancreaticoduodenectomy utilize widely disparate protocols, include small numbers of patients and have disparate endpoints. The aim of this study is to carry out a systematic review of peri-operative nutritional supplementation in patients undergoing pancreaticoduodenectomy in order to identify consistent themes. Methods :Searches of the MEDLINE and EMBASE databases yielded 10 studies examining nutritional support in 571 patients undergoing pancreaticoduodenectomy. Data were retrieved on: proportion of pre-operative weight loss, biochemical parameters (preoperative albumin and the presence of jaundice, type and duration of nutritional support and clinical outcome (morbidity, mortality and hospital stay. Results: Pre-operative percentage weight loss was similar in all studies evaluated. Routine post-operative total parenteral nutrition (TPN was associated with a higher incidence of complications. Enteral nutrition reduced infective complications. Cyclical nutrition was associated with a lower incidence of postoperative gastric stasis. Conclusion :Clear themes emerge from this systematic review. Patients undergoing pancreaticoduodenectomy are nutritionally depleted at the time of surgery and the preoperative period may present a window for intervention. Routine TPN is not beneficial. Routine post-operative enteral nutritional support, delivered on a cyclical basis appears to be the optimal mode of delivery.

  2. Recurrent Pseudomembranous Colitis in an Ovarian Cancer Patient Undergoing Carboplatin Chemotherapy

    Directory of Open Access Journals (Sweden)

    Valerie A. Allen

    2016-01-01

    Full Text Available Background. Diarrhea is a common problem in ovarian cancer patients undergoing chemotherapy and Clostridium difficile infection has been identified as a cause. The proper diagnosis and treatment of diarrhea are critical to patient care, especially to prevent the serious complications from a severe Clostridium difficile infection (CDI. Case. We present a heavily pretreated ovarian cancer patient who developed recurrent pseudomembranous colitis while receiving carboplatin chemotherapy. Despite treatment with oral metronidazole for fourteen days, the patient’s diarrhea relapsed and colonoscopy revealed extensive pseudomembranous colitis. The infection eventually resolved with the combination of oral vancomycin and metronidazole. Conclusions. Diarrhea is a common problem in patients undergoing chemotherapy for ovarian cancer. Management requires obtaining the proper diagnosis. Clostridium difficile associated pseudomembranous colitis must be part of the differential diagnosis. Treatment must be sufficient to prevent relapses of the Clostridium difficile infection to prevent serious consequences in an already vulnerable patient population.

  3. Changes in preoperative characteristics in patients undergoing radical prostatectomy - a 16-year nationwide analysis

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Brasso, Klaus; Christensen, Ib Jarle;

    2013-01-01

    . Our hypothesis was that an increasing amount of men undergo RP for lower risk PCa. MATERIAL AND METHODS: All patients operated from 1995 to 2011 were identified via patient files and registries. Changes over time in age at surgery, preoperative PSA, clinical T-category, biopsy Gleason score (GS....... This effect is most likely attributed to an increasing use of PSA as marker for early prostate cancer diagnosis in Denmark and new international guidelines for Gleason grading and scoring.......-risk patients increased significantly. The proportion of patients age 70 or above increased from 2% to 13% in the period studies. CONCLUSION: Significant preoperative stage- and Gleason grade migration was found in this complete Danish nationwide cohort of patients undergoing RP during the past 16 years...

  4. CUTANEOUS MANIFESTATIONS IN PATIENTS UNDERGOING HAEMODIALYSIS FOR END STAGE RENAL DISEASE

    Directory of Open Access Journals (Sweden)

    Gupta

    2015-04-01

    Full Text Available OBJECTIVE: To determine the frequency of cutaneous lesions in patients of chronic kidney disease (CKD undergoing haemodialysis. MATERIALS AND METHODS: 100 patients of CKD undergoing haemodialysis in the renal dialysis unit of R. L. Jalappa Hospital, Kolar . An informed consent was taken. Detailed history was taken and examination were carried out, noted and entered in a structured proforma. RESULTS: Out of 100 patients evaluated, 94% had skin changes. 68% patients were males and 32% were females. The most prevalent finding was pallor in 84% followed by xerosis present in 72% patients. Platynychia was seen in 48% with other findings being pigmentation chan ges, sparse hair and various nail changes. CONCLUSION: Chronic kidney disease is associated with complex array of cutaneous manifestations caused either by disease or treatment. The commonest are pallor, xerosis and platynychia in our study.

  5. Evaluation of self-esteem in cancer patients undergoing chemotherapy treatment

    Directory of Open Access Journals (Sweden)

    Marilia Aparecida Carvalho Leite

    2015-12-01

    Full Text Available Objective: to evaluate the self-esteem of cancer patients undergoing chemotherapy. Method: descriptive analytical cross-sectional study with a quantitative approach. Around 156 patients that attended an oncology unit of a mid-sized hospital participated in the study. Results: we found a higher frequency of patients with high self-esteem, but some of them showed average or low self-esteem. The scale showed a Cronbach's alpha value of 0.746, by considering its acceptable internal consistency for the evaluated items. No independent variables showed significant associations with self-esteem. Conclusion: the cancer patients evaluated have presented high self-esteem; thus, it becomes crucial for nursing to plan the assistance of patients undergoing chemotherapy treatments, which enables actions and strategies that meet their physical and psychosocial conditions, aiming to maintain and rehabilitate these people's emotional aspects.

  6. Successful afatinib treatment of advanced non-small-cell lung cancer patients undergoing hemodialysis.

    Science.gov (United States)

    Imai, Hisao; Kaira, Kyoichi; Naruse, Ichiro; Hayashi, Hideki; Iihara, Hirotoshi; Kita, Yutaro; Mizusaki, Naoki; Asao, Takayuki; Itoh, Yoshinori; Sugiyama, Tadashi; Minato, Koichi; Yamada, Masanobu

    2017-01-01

    The treatment for patients with lung cancer undergoing hemodialysis, who are frequently elderly and have poor performance status, becomes a more important subject. However, the feasibility of afatinib in patients with chronic renal failure undergoing hemodialysis has not, so far, been reported. Here, afatinib was administered to three patients with NSCLC harboring EGFR mutation and chronic renal failure undergoing hemodialysis. Pharmacokinetic (PK) data of afatinib supported the safety of afatinib treatment. After receiving their written informed consent from all patients, they were administered 30 mg afatinib daily with HD three times a week. We performed PK analyses of afatinib on days 1, 2, 10, and 11 after initial administration of afatinib. All three patients exhibited a partial response without any serious adverse events during the administration of afatinib. These PK data were similar to those of patients with normal organ function, which were previously reported. Our findings may be particularly useful given the current opportunity to use afatinib as a first-line treatment for EGFR-mutated NSCLC patients, providing an additional option for patients with impaired renal function.

  7. Perioperative concerns in pediatric patients undergoing different types of scoliosis correction surgery: A retrospective observational study

    Directory of Open Access Journals (Sweden)

    Anjolie Chhabra

    2013-01-01

    Patients and Methods: After taking parental consent, data were collected retrospectively for 33 patients who underwent 37 procedures (four patients had both anterior and posterior procedures on 2 days of the week mainly from August 2008 to February 2010 at a tertiary care institution. Results: Children undergoing GR surgery were younger (8.1 ± 2.1 years than patients undergoing AR (12.9 ± 1.7 years or posterior fusion (14.2 ± 2.2 years. AR children had a significantly higher Cobb′s angle and more rigid curves. (P = 0.057 Associated congenital abnormalities especially neurological were commoner in the GR children. Surgical duration and blood loss was significantly more for PF (2207.5 ± 1224.13 ml than GR (456 ± 337.5 ml, or AR (642.85 ± 304.72 ml, (P = 0.0002. PF patients needed Intensive care unit (ICU care mainly due to the blood loss and prolonged surgery (35%. AR performed via thoracotomy was associated with the need for mechanical ventilation in 28.6%. The GR patients had major intraoperative hemodynamic events and 20% needed ICU care. Conclusions: Post-operative ventilation may be required in 20-35% patients undergoing procedures for scoliosis correction. Despite GR insertion involving lesser blood loss; younger age, congenital abnormalities, positioning, and surgical manipulation resulted in life threatening events in these patients.

  8. Clinical analysis of propofol deep sedation for 1,104 patients undergoing gastrointestinal endoscopic procedures: A three year prospective study

    Institute of Scientific and Technical Information of China (English)

    Stojanka Ga(s)parovi(c); Nadan Rustemovi(c); Milorad Opa(c)i(c); Marina Premu(z)i(c); An(d)elko Koru(s)i(c); Jadranka Bo(z)ikov; Tamara Bates

    2006-01-01

    AIM: To analyze the hemodynamic and respiratory effects of propofol on patients undergoing gastroscopy and colonoscopy.METHODS: In this prospective study, conducted over a period of three years, 1,104 patients referred for a same day GI endoscopy procedure were analyzed. All patients were given a propofol bolus (0.5-1.5 mg/kg). Arterial blood pressure (BP) was monitored at 3 min intervals and heart rate and oxygen saturation (SpO2) were recorded continuously by pulse oximetry. Analyzed data acquisition was carried out before, during, and after the procedure.RESULTS: A statistically significant reduction in mean arterial pressure was demonstrated (P<0.001) when compared to pre-intervention values, but severe hypotension, defined as a systolic blood pressure below 60 mmHg, was noted in only 5 patients (0.5%). Oxygen saturation decreased from 96.5% to 94.4 % (P<0.001).A critical decrease in oxygen saturation (<90%) was documented in 27 patients (2.4%).CONCLUSION: Our results showed that propofol provided good sedation with excellent pain control, a short recovery time and no significant hemodynamic side effects if carefully titrated. All the patients (and especially ASA Ⅲ group) require monitoring and care of an anesthesiologist.

  9. A PROSPECTIVE, RANDOMIZED CONTROL STUDY EVALUATING THE POSTOPERATIVE ANALGESIA USING RECTAL DICLOFENAC IN PATIENTS UNDERGOING ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY SURGERIES

    Directory of Open Access Journals (Sweden)

    Padmaja

    2015-05-01

    Full Text Available BACKGROUND: To assess the efficacy of rectal diclofenac suppository in patients undergoing elective laparoscopic cholecystectomy surgeries in management of postoperative pain, in reduction of intra operative opioid requirement and in prolongation of postoperative anal gesic initiation time. OBJECTIVES: This prospective randomized single blinded clinical trial evaluates the efficacy of rectal diclofenac suppository for the management of postoperative pain. MATERIALS AND METHODS: 100 patients undergoing elective laparosco pic cholecystectomy surgeries were randomized into two groups, Group 1 patients receiving 100mg diclofenac rectal suppository after induction of general anaesthesia, Group 2 patients does not receive any diclofenac rectal suppository. Intra operative hemod ynamic monitoring, post - operative VAS score and adverse reactions were recorded over period of 24 hrs. Intra operative opioid (fentanyl was repeated when heart rate and blood pressure variability of more than 20% from base line are noted. Post operatively if VAS score is more than 4 rescue analgesia with inj. Tramadol is given intramuscularly. RESULTS: Administration of single dose of rectal diclofenac had statistically significant reduction in VAS score post operatively compared to control group, reduced requirement of intra operative opioids (fentanyl. Post - operative rescue analgesia initiation time is prolonged in group 1 mean 9.56 hrs compared to group 2, mean 0.72 hrs (p - 0.000. CONCLUSION: Rectal Diclofenac used in laparoscopic cholecystectomy cases provide adequate, effective prolonged analgesia in the post - operative period with good safety profile

  10. Continuous Non-Invasive Arterial Pressure Technique Improves Patient Monitoring during Interventional Endoscopy

    Directory of Open Access Journals (Sweden)

    Sylvia Siebig, Felix Rockmann, Karl Sabel, Ina Zuber-Jerger, Christine Dierkes, Tanja Brünnler, Christian E. Wrede

    2009-01-01

    Full Text Available Introduction: Close monitoring of arterial blood pressure (BP is a central part of cardiovascular surveillance of patients at risk for hypotension. Therefore, patients undergoing diagnostic and therapeutic procedures with the use of sedating agents are monitored by discontinuous non-invasive BP measurement (NIBP. Continuous non-invasive BP monitoring based on vascular unloading technique (CNAP®, CN Systems, Graz may improve patient safety in those settings. We investigated if this new technique improved monitoring of patients undergoing interventional endoscopy. Methods: 40 patients undergoing interventional endoscopy between April and December 2007 were prospectively studied with CNAP® in addition to standard monitoring (NIBP, ECG and oxygen saturation. All monitoring values were extracted from the surveillance network at one-second intervals, and clinical parameters were documented. The variance of CNAP® values were calculated for every interval between two NIBP measurements. Results: 2660 minutes of monitoring were recorded (mean 60.1±34.4 min/patient. All patients were analgosedated with midazolam and pethidine, and 24/40 had propofol infusion (mean 90.9±70.3 mg. The mean arterial pressure for CNAP® was 102.4±21.2 mmHg and 106.8±24.8 mmHg for NIBP. Based on the first NIBP value in an interval between two NIBP measurements, BP values determined by CNAP® showed a maximum increase of 30.8±21.7% and a maximum decrease of 22.4±28.3% (mean of all intervals. Discussion: Conventional intermittent blood pressure monitoring of patients receiving sedating agents failed to detect fast changes in BP. The new technique CNAP® improved the detection of rapid BP changes, and may contribute to a better patient safety for those undergoing interventional procedures.

  11. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel S.); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective: Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment str

  12. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G.M. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee J.); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment stra

  13. Orthostatic hypotension during postoperative continuous thoracic epidural bupivacaine-morphine in patients undergoing abdominal surgery

    DEFF Research Database (Denmark)

    Crawford, M E; Møiniche, S; Orbæk, Janne;

    1996-01-01

    Fifty patients undergoing colonic surgery received combined thoracic epidural and general anesthesia followed by continuous epidural bupivacaine 0.25% and morphine 0.05 mg/mL, 4 mL/h, for 96 h postoperatively plus oral tenoxicam 20 mg daily. Heart rate (HR) and arterial blood pressure (BP) were...

  14. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

    OpenAIRE

    André Luiz Lisboa Cordeiro; Thiago Araújo de Melo; Daniela Neves; Julianne Luna; Mateus Souza Esquivel; André Raimundo França Guimarães; Daniel Lago Borges; Jefferson Petto

    2016-01-01

    Abstract Introduction: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods: This is a clinical randomized controlled tri...

  15. Long-term outcomes in patients with rheumatologic disorders undergoing percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Nochioka, Kotaro; Biering-Sørensen, Tor; Hansen, Kim Wadt;

    2017-01-01

    AIMS: Rheumatologic disorders are characterised by inflammation and an increased risk of coronary artery disease (CAD). However, the association between rheumatologic disorders and long-term prognosis in CAD patients undergoing percutaneous coronary intervention (PCI) is unknown. Thus, we aimed t...

  16. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G.M. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee J.); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment stra

  17. Current trends in patients with chronic total occlusions undergoing coronary CT angiography

    NARCIS (Netherlands)

    M.P. Opolski (Maksymilian P.); B.T. Hartaigh (Bríain ó); D.S. Berman (Daniel S.); M.J. Budoff (Matthew J.); S. Achenbach (Stephan); M. Al-Mallah (Mouaz); D. Andreini (Daniele); F. Cademartiri (Filippo); H.-J. Chang (Hyuk-Jae); K. Chinnaiyan (Kavitha); B.J.W. Chow (Benjamin); M. Hadamitzky (Martin); J. Hausleiter (Jörg); G. Feuchtner (Gudrun); Y.-J. Kim (Yong-Jin); P.A. Kaufmann (Philipp A.); J. Leipsic (Jonathon); E. Maffei (Erica); G. Pontone (Gianluca); G.L. Raff (Gilbert); L.J. Shaw (Leslee); T.C. Villines (Todd); J.K. Min (James)

    2015-01-01

    textabstractObjective: Data describing the prevalence, characteristics and management of coronary chronic total occlusions (CTOs) in patients undergoing coronary CT angiography (CCTA) have not been reported. The purpose of this study was to determine the prevalence, characteristics and treatment str

  18. Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy

    Directory of Open Access Journals (Sweden)

    Pankaj Kundra

    2013-01-01

    Conclusion: To conclude, lung functions are well-preserved in patients undergoing modified radical mastectomy under general anesthesia supplemented with paravertebral or IPB. IPB is as effective as PVB for post-operative pain relief. PVB has the added advantage of achieving a more complete block.

  19. Risk factors and prognosis of postpericardiotomy syndrome in patients undergoing valve surgery

    NARCIS (Netherlands)

    van Osch, Dirk; Dieleman, Jan M.; Bunge, Jeroen J.; van Dijk, Diederik; Doevendans, Pieter A.; Suyker, Willem J.; Nathoe, Hendrik M.

    OBJECTIVE: The study aim was to investigate the long-term prognosis and risk factors of postpericardiotomy syndrome (PPS). METHODS: We performed a single-center cohort study in 822 patients undergoing nonemergent valve surgery. Risk factors of PPS were evaluated using multivariable logistic

  20. Different duration strategies of perioperative antibiotic prophylaxis in adult patients undergoing cardiac surgery : an observational study

    NARCIS (Netherlands)

    Hamouda, Khaled; Oezkur, Mehmet; Sinha, Bhanu; Hain, Johannes; Menkel, Hannah; Leistner, Marcus; Leyh, Rainer; Schimmer, Christoph

    2015-01-01

    Background: All international guidelines recommend perioperative antibiotic prophylaxis (PAB) should be routinely administered to patients undergoing cardiac surgery. However, the duration of PAB is heterogeneous and controversial. Methods: Between 01.01.2011 and 31.12.2011, 1096 consecutive cardiac

  1. Reduction of the inflammatory response in patients undergoing minimally invasive coronary artery bypass grafting

    NARCIS (Netherlands)

    Gu, YJ; Mariani, MA; van Oeveren, W; Grandjean, JG; Boonstra, PW

    1998-01-01

    Background. The aim of this prospective study was to determine whether the inflammation-associated clinical morbidity as well as the subclinical markers of the inflammatory response are reduced in patients who undergo minimally invasive coronary artery bypass grafting without cardiopulmonary bypass.

  2. The effect of peer support group on self-transcendence in patients undergoing haemodialysis

    Directory of Open Access Journals (Sweden)

    Maryam Jadid Milani

    2017-03-01

    Full Text Available Introduction: Self-transcendence helps patients undergoing haemodialysis to organize the variety of challenges caused by the disease in order to make them feel well. This study  was   conducted  to determine the effect of counterpart group on improving self-transcendence level in patients undergoing haemodialysis. Materials and Methods: This clinical trial was conducted with two groups of intervention and control, with 55 patients undergoing hemodialysis. The samples were divided in 2 groups of intervention and control through block randomization. Two-hour counterpart group sessions were held for eight weeks for intervention group. The session's topics were based on the patients’ needs and interests. Research tools were questionnaire, demographic information and "Reed’s Self-Transcendence Scale (STS". The descriptive and inferential statistics were used for data analysis using the SPSS v18. Results: There was a significant difference between self-transcendence scores in two groups of intervention and control (P<0.05. A significant increase in the level of self-transcendence in both groups was seen at the end of the study compared to basal status (P<0.05. Conclusions: According to the study results, attending the counterpart groups improved  self-transcendence in patients undergoing haemodialysis. The results can be used in nursing education and management. Training Self-transcendence evaluation is recommended for other chronic diseases with the emphasize on participating in counterpart groups for assessing its efficiency.

  3. Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?

    Directory of Open Access Journals (Sweden)

    Malik Madhur

    2010-01-01

    Full Text Available Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery were prospectively collected as per the EuroSCORE model. The model′s validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73 and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6% was double that of predicted mortality (7.5%. The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.

  4. Metabolic syndrome in patients with prostate cancer undergoing intermittent androgen-deprivation therapy

    Science.gov (United States)

    Rezaei, Mohammadali Mohammadzadeh; Rezaei, Mohammadhadi Mohammadzadeh; Ghoreifi, Alireza; Kerigh, Behzad Feyzzadeh

    2016-01-01

    Introduction: The presence of metabolic syndrome in men with prostate cancer (PCa) undergoing androgen-deprivation therapy (ADT), especially intermittent type, has not been completely evaluated. The aim of this study is to evaluate metabolic syndrome in men with PCa undergoing intermittent ADT. Methods: In this longitudinal study, we studied the prevalence of metabolic syndrome and its components in 190 patients who were undergoing intermittent ADT. The metabolic syndrome was defined according to the Adult Treatment Panel III criteria. All metabolic parameters, including lipid profile, blood glucose, blood pressures, and waist circumferences of the patients were measured six and 12 months after treatment. Results: Mean age of the patients was 67.5 ± 6.74 years. The incidence of metabolic syndrome after six and 12 months was 6.8% and 14.7%, respectively. Analysis of various components of the metabolic syndrome revealed that patients had significantly higher overall prevalence of hyperglycemia, abdominal obesity, and hypertriglyceridemia in their six- and 12-month followups, but blood pressure has not been changed in the same period except for diastolic blood pressure after six months. Conclusions: Although there was an increased risk of metabolic syndrome in patients receiving intermittent ADT, it was lower than other studies that treated the same patients with continuous ADT. Also it seems that intermittent ADT has less metabolic complications than continuous ADT and could be used as a safe alternative in patients with advanced and metastatic PCa. PMID:27695584

  5. Prospective Randomized Controlled Trial of Liberal Vs Restricted Perioperative Fluid Management in Patients Undergoing Pancreatectomy.

    Science.gov (United States)

    Grant, Florence; Brennan, Murray F; Allen, Peter J; DeMatteo, Ronald P; Kingham, T Peter; D'Angelica, Michael; Fischer, Mary E; Gonen, Mithat; Zhang, Hao; Jarnagin, William R

    2016-10-01

    The aim of this study is to examine, by a prospective randomized controlled trial, the influence of liberal (LIB) vs restricted (RES) perioperative fluid administration on morbidity following pancreatectomy. Randomized controlled trials in patients undergoing major intra-abdominal surgery have challenged the historical use of LIB fluid administration, suggesting that a more restricted regimen may be associated with fewer postoperative complications. Patients scheduled to undergo pancreatic resection were consented for randomization to a LIB (n = 164) or RES (n = 166) perioperative fluid regimen. Sample size was designed with 80% power to decrease Grade 3 complications from 35% to 21%. Between July 2009 and July 2015, we randomized 330 patients undergoing pancreaticoduodenectomy (PD, n = 218), central (n = 16), or distal pancreatectomy (DP, n = 96). Patients were equally distributed for all demographic and intraoperative characteristics. Intraoperatively, LIB patients received crystalloid 12 mL/kg/h and RES patients 6 mL/kg/h. Cumulative crystalloid given (median, range, mL) days 0 to 3 was LIB: 12,252 (6600 to 21,365), RES 7808 (2700 to 16,274) P LIB and 27% of RES patients (P = 0.6). Median length of stay was 7 and 5 days for PD and DP, respectively, in both arms. In a high volume institution, major perioperative complications from pancreatic resection were not significantly influenced by fluid regimens that differed approximately 1.6-fold.

  6. Use of quantitative lung scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing lobectomy.

    Science.gov (United States)

    Win, Thida; Laroche, Clare M; Groves, Ashley M; White, Carol; Wells, Francis C; Ritchie, Andrew J; Tasker, Angela D

    2004-10-01

    In patients with non-small cell lung cancer, the only realistic chance of cure is surgical resection. However, in some of these patients there is such poor respiratory reserve that surgery can result in an unacceptable quality of life. In order to identify these patients, various pulmonary function tests and scintigraphic techniques have been used. The current American College of Physicians and British Thoracic Society guidelines do not recommend the use of quantitative ventilation-perfusion scintigraphy to predict postoperative function in lung cancer patients undergoing lobectomy. These guidelines may have been influenced by previous scintigraphic studies performed over a decade ago. Since then there have been advances in both surgical techniques and scintigraphic techniques, and the surgical population has become older and more female represented. We prospectively performed spirometry and quantitative ventilation-perfusion scintigraphy on 61 consecutive patients undergoing lobectomy for lung cancer. Spirometry was repeated one-month postsurgery. Both a simple segment counting technique alone and scintigraphy were used to predict the postoperative lung function. There was statistically significant correlation (p lung function using both the simple segment counting technique and the scintigraphic techniques. However, the correlation using simple segment counting was of negligible difference compared to scintigraphy. In keeping with current American Chest Physician and British Thoracic Society guidelines, our results suggest that quantitative ventilation-perfusion scintigraphy is not necessary in the preoperative assessment of lung cancer patients undergoing lobectomy. The simple segmenting technique can be used to predict postoperative lung function in lobectomy patients.

  7. Perioperative outcomes of patients with hypertrophic cardiomyopathy undergoing non-cardiac surgery.

    Science.gov (United States)

    Dhillon, Ashwat; Khanna, Ashish; Randhawa, Mandeep Singh; Cywinski, Jacek; Saager, Leif; Thamilarasan, Maran; Lever, Harry M; Desai, Milind Y

    2016-10-15

    Due to their unique pathophysiological profile, patients with hypertrophic cardiomyopathy (HCM) undergoing non-cardiac surgery require additional attention to perioperative management. We sought to compare perioperative outcomes of patients with HCM undergoing non-cardiac surgery with a matched group patients without HCM. This observational cohort study conducted at a tertiary care centre included patients with HCM (n=92, age 67 years, 54% men) undergoing intermediate-risk and high-risk non-cardiac surgeries between 1/2007 and 12/2013 (excluding surgery) who were 1:2 matched (based on age, gender, type and time of non-cardiac surgery) with patients without HCM (n=184, median age 65 years, 53% men). A composite endpoint (30-day postoperative death, myocardial infarction, stroke, in-hospital decompensated congestive heart failure (CHF) and rehospitalisation within 30 days) and postoperative atrial fibrillation (AF) were recorded. There was a significantly lower incidence of intraoperative hypotension/tachycardia in patients with HCM versus those without HCM (pcardiac surgery, high anaesthesia risk score and intraoperative duration of hypotension were independently associated with 30-day composite events (pcardiac surgeries have a low perioperative event rate, at an experienced centre. However, they have a higher risk of composite events versus matched patients without HCM. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  8. Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Karimi Fatemeh

    2007-01-01

    Full Text Available Abstract Background Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. Methods 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male underwent preoperative ultrasonography for assessment of carotid artery wall thickness. Results Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8% had significant ( Conclusion Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

  9. Prevalence of hepatitis C in patients with renal disease undergoing hemodialysis treatment

    Directory of Open Access Journals (Sweden)

    Marcos Frank Bastiani

    2014-10-01

    Full Text Available Introduction and Objective: This study aimed at determining the prevalence of hepatitis C among 649 patients diagnosed with chronic or acute kidney disease − patients were undergoing hemodialysis treatment at a large hemodialysis center in Porto Alegre-RS, from January through December, 2012 –, as well as relating our data to that presented in the national census, reporting cases of coinfection by hepatitis C and human immunodeficiency virus (HIV, and defining the demographic profile of these patients. Method: An observational cross-sectional study was conducted and data was obtained from information in patients’ electronic medical records. Result and conclusion: The prevalence of hepatitis C in this study was 10.17% of the sampled population. However, further analysis of other liver centers would be required to estimate an accurate prevalence rate of infection caused by the hepatitis C virus in patients undergoing hemodialysis in Porto Alegre.

  10. Does physical activity improve quality of life in cancer patients undergoing chemotherapy?

    Science.gov (United States)

    Kripp, Melanie; Heußer, Anna-Lena; Belle, Sebastian; Gerhardt, Axel; Merx, Kirsten; Hofmann, Wolf-Karsten; Hofheinz, Ralf-Dieter

    2015-01-01

    Improved cancer treatments have resulted in prolonged survival. Nevertheless, tumor symptoms and side effects still compromise physical activity and quality of life (QoL). We conducted an anonymous survey among cancer patients undergoing chemotherapy using standardized questionnaires: the 'Freiburger Fragebogen zur körperlichen Aktivität' (Freiburg Questionnaire on Physical Activity) and European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30. Two main questions were addressed: were there differences (1) in physical activity and QoL between patients who do not believe that sport could improve their QoL and those who believe it could (group A vs. B); and (2) in QoL between patients with a total activity (TA) cancer patients undergoing chemotherapy. © 2015 S. Karger GmbH, Freiburg.

  11. Single-Beat Noninvasive Imaging of Ventricular Endocardial and Epicardial Activation in Patients Undergoing CRT

    OpenAIRE

    Thomas Berger; Bernhard Pfeifer; Friedrich F Hanser; Florian Hintringer; Gerald Fischer; Michael Netzer; Thomas Trieb; Markus Stuehlinger; Wolfgang Dichtl; Christian Baumgartner; Otmar Pachinger; Michael Seger

    2011-01-01

    BACKGROUND: Little is known about the effect of cardiac resynchronization therapy (CRT) on endo- and epicardial ventricular activation. Noninvasive imaging of cardiac electrophysiology (NICE) is a novel imaging tool for visualization of both epi- and endocardial ventricular electrical activation. METHODOLOGY/PRINCIPAL FINDINGS: NICE was performed in ten patients with congestive heart failure (CHF) undergoing CRT and in ten patients without structural heart disease (control group). NICE is a f...

  12. Functional outcome of patients undergoing replantation of hand at wrist level-7 year experience

    OpenAIRE

    Ravi Kumar Mahajan; Seema Mittal

    2013-01-01

    Background: Replantation is defined as reattachment of amputated limb using neurovascular and musculoskeletal structures in order to obtain recovery of limb. Re-vascularisation involves all the above steps in case of limb injuries that result in a near total amputation. Aim and Objective : To study the functional outcome of patients undergoing replantation of hand at wrist level. Material and Methods: This is a retrospective study of patients who underwent replantation of total amputation of ...

  13. Hemostatic function to regulate perioperative bleeding in patients undergoing spinal surgery: A prospective observational study

    OpenAIRE

    KIMURA, Atsushi; Ohmori, Tsukasa; Sakata, Asuka; Endo, Teruaki; Inoue, Hirokazu; Nishimura, Satoshi; Takeshita, Katsushi

    2017-01-01

    Although bleeding is a common complication of surgery, routine laboratory tests have been demonstrated to have a low ability to predict perioperative bleeding. Better understanding of hemostatic function during surgery would lead to identification of high-risk patients for bleeding. Here, we aimed to elucidate hemostatic mechanisms to determine perioperative bleeding. We prospectively enrolled 104 patients undergoing cervical spinal surgery without bleeding diathesis. Blood sampling was perfo...

  14. Antibody Production in Response to Staphylococcal MS-1 Phage Cocktail in Patients Undergoing Phage Therapy

    OpenAIRE

    Maciej Żaczek; Marzanna Łusiak-Szelachowska; Ewa Jończyk-Matysiak; Beata Weber-Dąbrowska; Ryszard Międzybrodzki; Barbara Owczarek; Agnieszka Kopciuch; Wojciech Fortuna; Paweł Rogóż; Andrzej Górski

    2016-01-01

    In this study, we investigated the humoral immune response (through the release of IgG, IgA, and IgM antiphage antibodies) to a staphylococcal phage cocktail in patients undergoing experimental phage therapy at the Phage Therapy Unit, Medical Center of the Ludwik Hirszfeld Institute of Immunology and Experimental Therapy in Wrocław, Poland. We also evaluated whether occurring antiphage antibodies had neutralizing properties towards applied phages (K rate). Among 20 examined patients receiving...

  15. Determinants of outcome for patients undergoing lumbar discectomy: a pilot study.

    LENUS (Irish Health Repository)

    Hickey, Oonagh T

    2010-08-01

    One-third of patients who undergo lumbar discectomy continue to suffer from persistent pain postoperatively. Greater preoperative warmth thresholds and greater preoperative cerebrospinal fluid concentrations of stable serum nitric oxide metabolites are associated with a worse outcome. The principal objective of this study was to examine the relationship between patient outcome (defined using the Modified Stauffer-Coventry evaluating criteria) and preoperative pain perception threshold to an electrical stimulus.

  16. Gastrointestinal symptoms in patients undergoing peritoneal dialysis: Multivariate analysis of correlated factors

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    AIM: To investigate gastrointestinal (GI) symptoms in peritoneal dialysis (PD) patients and to explore related factors contributing to GI symptoms. METHODS: One hundred and twelve patients undergoing PD participated in the study. The gastrointestinal symptom rating scale was used for measuring GI symptoms. Information on age, height, weight, body mass index, disease leading to chronic renal failure, history of corticosteroid therapy, presence of predialytic GI symptoms, daily dosage of pills, and duration, ...

  17. Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Poonam Malhotra Kapoor

    2017-01-01

    Full Text Available Background: There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management. Material and Method: Patients with the European System for Cardiac Operative Risk Evaluation ≥3 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI, systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO 2 , global end-diastolic volume, and extravascular lung water (EVLW, using FloTrac™ , PreSep™ , and EV-1000 ® monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU and corrected according to GDT protocol. A total of 163 patients consented for the study. Result: Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study. Conclusion: The length of stay in hospital (LOS-H (7.42 ± 1.48 vs. 5.61 ± 1.11 days, P < 0.001 and ICU stay (4.2 ± 0.82 vs. 2.53 ± 0.56 days, P < 0.001 were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 ± 0

  18. Perioperative Endocrine Therapy for Patients with Cushing's Syndrome Undergoing Retroperitoneal Laparoscopic Adrenalectomy

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    Xiaobo Cui

    2012-01-01

    Full Text Available Objectives. To investigate the efficacy and safety of perioperative endocrine therapy (PET for patients with Cushing’s syndrome (CS undergoing retroperitoneal laparoscopic adrenalectomy (RLA. Methods. The novel, simplified PET modality of 82 patients who underwent RLA procedures for CS were studied. Clinical manifestations were observed for all patients on days 1 and 5 postoperatively, and clinical data, such as blood pressure (BP, levels of serum cortisol, adrenocorticotropin (ACTH, blood glucose, and electrolytes, were acquired and analyzed. Results. Supraphysiological doses of glucocorticoid were administered during the perioperative period, and the dosage was reduced gradually. In all 82 cases, the RLAs were performed successfully without any perioperative complication, such as steroid withdrawal symptoms. The patient’s symptoms and signs were improved quickly and safely during the hospital days. The serum cortisol and potassium levels were rather stable on days 1 and 5 postoperatively, and most were within the normal range. The clinical manifestations, serum levels of cortisol, ACTH, and potassium in most patients restored to normal gradually after several months (mean, 6.7 ± 1.2 months, except for one patient undergoing bilateral adrenalectomy. Conclusions. This perioperative endocrine therapy for patients with Cushing’s syndrome (mainly for adrenocortical adenoma undergoing retro-laparoscopic adrenalectomy is both effective and safe.

  19. Music and ambient operating room noise in patients undergoing spinal anesthesia.

    Science.gov (United States)

    Ayoub, Chakib M; Rizk, Laudi B; Yaacoub, Chadi I; Gaal, Dorothy; Kain, Zeev N

    2005-05-01

    Previous studies have indicated that music decreases intraoperative sedative requirements in patients undergoing surgical procedures under regional anesthesia. In this study we sought to determine whether this decrease in sedative requirements results from music or from eliminating operating room (OR) noise. A secondary aim of the study was to examine the relationship of response to intraoperative music and participants' culture (i.e., American versus Lebanese). Eighty adults (36 American and 54 Lebanese) undergoing urological procedures with spinal anesthesia and patient-controlled IV propofol sedation were randomly assigned to intraoperative music, white noise, or OR noise. We found that, controlling for ambient OR noise, intraoperative music decreases propofol requirements (0.004 +/- 0.002 mg . kg(-1) . min(-1) versus 0.014 +/- 0.004 mg . kg(-1) . min(-1) versus 0.012 +/- 0.002 mg . kg(-1) . min(-1); P = 0.026). We also found that, regardless of group assignment, Lebanese patients used less propofol as compared with American patients (0.005 +/- 0.001 mg . kg(-1) . min(-1) versus 0.017 +/- 0.003 mg . kg(-1) . min(-1); P = 0.001) and that, in both sites, patients in the music group required less propofol (P noise, intraoperative music decreases propofol requirements of both Lebanese and American patients who undergo urological surgery under spinal anesthesia.

  20. Pharmacodynamic Effect of Clopidogrel in Patients Undergoing Transcatheter Aortic Valve Implantation

    Directory of Open Access Journals (Sweden)

    Petr Tousek

    2013-01-01

    Full Text Available The aim of this study was to analyze periprocedural and mid-term effect of clopidogrel on platelet function using the VerifyNow P2Y12 point-of-care assay in patients undergoing TAVI. Platelet reactivity was measured at the beginning of the procedure after 300 mg clopidogrel bolus administration and during the follow-up (at 1 month after the procedure in 52 patients undergoing TAVI using the Medtronic CoreValve prosthesis (Medtronic CoreValve. A cutoff value of 240 PRU was used to identify nonresponders to clopidogrel treatment with high residual platelet reactivity (HRPR. Baseline HRPR was identified in 80% of patients and in 72% of patients during 6-month follow-up. There was no significant difference in the pharmacodynamic effects of clopidogrel on platelet reactivity from baseline to 6-months follow-up (297±57 vs. 275±62; P=0.058. Ischemic event occurred only in 3 patients (5.8% from the study group. In conclusion, majority of patients undergoing TAVI had high residual platelet reactivity after pretreatment with 300 mg of clopidogrel and during the 6-month follow-up at dual antiplatelet treatment. The noneffectiveness of clopidogrel in the TAVI population raises the question of the routine use of dual antiplatelet treatment in this setting.

  1. What questions do patients undergoing lower extremity joint replacement surgery have?

    Directory of Open Access Journals (Sweden)

    Bhalla Amandeep

    2003-06-01

    Full Text Available Abstract Background The value of the Internet to deliver preoperative education would increase if there was variability in questions patients want answered. This study's goal was to have patients consulting an orthopedic surgeon about undergoing either a total hip arthroplasty (THA or a total knee arthroplasty (TKA rate the importance of different questions concerning their care. Methods We assembled questions patients might have about joint replacement surgery by analyzing the literature and querying a pilot group of patients and surgeons. Twenty-nine patients considering undergoing THA and 19 patients considering TKR completed a written survey asking them to rate 30 different questions, with a 5 point Likert scale from 1 (least important – 5 (most important. Results For patients considering THA or TKR, the 4 highest rated questions were: Will the surgery affect my abilities to care for myself?, Am I going to need physical therapy?, How mobile will I be after my surgery?, When will I be able to walk normally again? The mean percentage disagreement was 42% for questions answered by TKR patients and 47% for the THA group. Some patients gave a high rating to questions lowly rated by the rest of the group. Conclusions Although there was enough agreement to define a core set of questions that should be addressed with most patients considering THA or TKA, some of the remaining questions were also highly important to some patients. The Web may offer a flexible medium for accommodating this large variety of information needs.

  2. Effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing gastrectomy

    Institute of Scientific and Technical Information of China (English)

    Han-Cheng Liu; Yan-Bing Zhou; Dong Chen; Zhao-Jian Niu; Yang Yu

    2012-01-01

    AIM:To investigate the effect of intensive vs conventional insulin therapy on perioperative nutritional substrates metabolism in patients undergoing radical distal gastrectomy.METHODS:Within 24 h of intensive care unit management,patients with gastric cancer were enrolled after written informed consent and randomized to the intensive insulin therapy (IIT) group to keep glucose levels from 4.4 to 6.1 mmol/L or the conventional insulin therapy (CIT) group to keep levels less than 10 mmol/L.Resting energy expenditure (REE),respiratory quotient (RQ),resting energy expenditure per kilogram (REE/kg),and the lipid oxidation rate were monitored by the indirect calorimeter of calcium citrate malate nutrition metabolism investigation system.The changes in body composition were analyzed by multi-frequency bioimpedance analysis.Blood fasting glucose and insulin concentration were measured for assessment of Homeostasis model assessment of insulin resistance.RESULTS:Sixty patients were enrolled.Compared with preoperative baseline,postoperative REE increased by over 22.15% and 11.07%; REE/kg rose up to 27.22 ± 1.33 kcal/kg and 24.72 ± 1.43 kcal/kg; RQ decreased to 0.759 ± 0.034 and 0.791 ± 0.037; the lipid oxidation ratio was up to 78.25% ± 17.74% and 67.13% ± 12.76% supported by parenteral nutrition solutions from 37.56% ± 11.64% at the baseline; the level of Ln-HOMA-IR went up dramatically (P < 0.05,respectively) on postoperative days 1 and 3 in the IIT group.Meanwhile the concentration of total protein,albumin and triglyceride declined significantly on postoperative days 1 and 3 compared with pre-operative levels (P < 0.05,respectively).Compared with the CIT group,IIT reduced the REE/kg level (27.22 ± 1.33 kcal/kg vs 29.97 ± 1.47 kcal/kg,P =0.008; 24.72 ± 1.43 kcal/kg vs 25.66 ± 1.63 kcal/kg,P =0.013); and decreased the Ln-HOMA-IR score (P =0.019,0.028) on postoperative days 1 and 3; IIT decreased the level of CRP on postoperative days 1 and 3 (P

  3. Renal Impairment and Prognosis of Patients with Atrial Fibrillation Undergoing Coronary Intervention - The AFCAS Trial.

    Directory of Open Access Journals (Sweden)

    Heli M Lahtela

    Full Text Available Renal impairment is a well-known risk factor for cardiovascular complications, but the effect of different stages of renal impairment on thrombotic/thromboembolic and bleeding complications in patients with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI remains largely unknown. We sought to evaluate the incidence and clinical impact of four stages of renal impairment in patients with AF undergoing PCI.We assessed renal function by estimated glomerular filtration rate (eGFR and outcomes in 781 AF patients undergoing PCI by using the data from a prospective European multicenter registry. End-points included all-cause mortality, major adverse cardiac and cerebrovascular events (MACCE and bleeding events at 12 months.A total of 195 (25% patients had normal renal function (eGFR ≥90 mL/min, 290 (37% mild renal impairment (eGFR 60-89, 263 (34% moderate renal impairment (eGFR 30-59 and 33 (4% severe renal impairment (eGFR <30. Degree of renal impairment remained an independent predictor of mortality and MACCE in an adjusted a Cox regression model. Even patients with mild renal impairment had a higher risk of all-cause mortality (HR 2.25, 95%CI 1.02-4.98, p=0.04 and borderline risk for MACCE (HR 1.56, 95%CI 0.98- 2.50, p=0.06 compared to those with normal renal function.Renal impairment is common in patients with AF undergoing PCI and even mild renal impairment has an adverse prognostic effect in these patients requiring multiple antithrombotic medications.

  4. Outcome of patients undergoing balloon angioplasty in the two months prior to noncardiac surgery.

    Science.gov (United States)

    Brilakis, Emmanouil S; Orford, James L; Fasseas, Panayotis; Wilson, Stephanie H; Melby, Steven; Lennon, Ryan J; Berger, Peter B

    2005-08-15

    We report on the incidence of adverse cardiac events in 350 patients who underwent noncardiac surgery within 2 months of successful balloon angioplasty (BA) at our institution between 1988 and 2001. Three patients died perioperatively (n = 1) or had myocardial infarction (n = 2) (0.9%, 95% confidence interval [CI] 0.2% to 2.5%), which is a lower incidence than that reported for patients undergoing noncardiac surgery after stenting (3.9% to 32%). One patient died, and 2 had a nonfatal myocardial infarction. All 3 (1.6%, 95% CI 0.3% to 4.6%) were among the 188 patients who underwent surgery within 2 weeks of BA. Repeat target vessel revascularization was performed in 10 patients (2.9%, 95% CI 1.4% to 5.2%): in 3 (1.6%, 95% CI 0.3% to 4.6%) of 188 patients who underwent surgery within 2 weeks of BA and in 7 (5.1%, 95% CI 2.1% to 10.2%) of 138 patients who underwent surgery within 3 to 7 weeks of BA. Therefore, in patients in whom percutaneous coronary revascularization is required before noncardiac surgery, BA appears to be safe, especially in patients who need to undergo surgery early after percutaneous coronary intervention.

  5. Outcomes in Patients With Hemophilia and von Willebrand Disease Undergoing Invasive or Surgical Procedures.

    Science.gov (United States)

    Chapin, John; Bamme, Jaqueline; Hsu, Fraustina; Christos, Paul; DeSancho, Maria

    2017-03-01

    Adults with hemophilia A (HA), hemophilia B (HB), and von Willebrand disease (VWD) frequently require surgery and invasive procedures. However, there is variability in perioperative management guidelines. We describe our periprocedural outcomes in this setting. A retrospective chart review from January 2006 to December 2012 of patients with HA, HB, and VWD undergoing surgery or invasive procedures was conducted. Type of procedures, management including the use of continuous factor infusion, and administration of antifibrinolytics were reviewed. Adverse outcomes were defined as acute bleeding (patients with HA and HB. In all, 24 patients had severe hemophilia and 12 had mild/moderate hemophilia. Twelve patients had inhibitors. There were also 5 female carriers of HA and 6 patients with VWD. There were 34 major surgeries (26 orthopedic, 8 nonorthopedic) and 129 minor surgeries. Continuous infusion was used in 55.9% of major surgeries versus 8.5% of minor surgeries. Antifibrinolytics were administered in 14.7% of major surgeries versus 23.2% of minor surgeries. In all, 4 patients developed acute bleeding and 10 patients developed delayed bleeding. Delayed bleeding occurred in 28.6% of genitourinary procedures and in 16.1% of dental procedures. Five patients acquired an inhibitor and 2 had thrombosis. In conclusion, patients with HA, HB, or VWD had similar rates of adverse outcomes when undergoing minor surgeries or major surgeries. This finding underscores the importance of an interdisciplinary management and procedure-specific guidelines for patients with hemophilia and VWD prior to even minor invasive procedures.

  6. Preoperative ambulatory inspiratory muscle training in patients undergoing esophagectomy. A pilot study.

    Science.gov (United States)

    Agrelli, Taciana Freitas; de Carvalho Ramos, Marisa; Guglielminetti, Rachel; Silva, Alex Augusto; Crema, Eduardo

    2012-01-01

    A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The objective of this study was to evaluate the efficacy of preoperative ambulatory respiratory muscle training in patients undergoing esophagectomy. The sample consisted of 20 adult patients (14 men [70%] and 6 women [30%]) with a diagnosis of advanced chagasic megaesophagus. A significant increase in maximum inspiratory pressure was observed after inspiratory muscle training when compared with baseline values (from -55.059 ± 18.359 to -76.286 ± 16.786). Preoperative ambulatory inspiratory muscle training was effective in increasing respiratory muscle strength in patients undergoing esophagectomy and contributed to the prevention of postoperative complications.

  7. Prevention and Control of Perioperative Incision Infection in Patients Undergoing Day Cataract Surgery

    Institute of Scientific and Technical Information of China (English)

    Chunyan Yang; Aihuan Chen; Yinghuan Wang; Xiaoqun Fang; Ronghua Ye; Jingyi Lin

    2014-01-01

    Purpose:.To explore the effects of the prevention and control of perioperative incision infection on the quality of day cataract surgery.Methods:.The nursing care and efficacy of 5087 patients un-dergoing day cataract surgery between October 2012 and Oc-tober 2013 were retrospectively reviewed. The disinfection and isolation guidance was established for perioperative prevention and control of infection,.topical administration of ocular a-gents, reexamination and healthcare instruction, and alterna-tive measures were taken.Results: All 5087 patients successfully underwent day surgery of phacoemulsification combined with intraocular lens im-plantation. All cases recovered without incision infection.Conclusion: Preoperative preparation, and intraoperative and postoperative prevention and control of infection serve as vital measures for effectively avoiding the incidence of incision in-fection in patients undergoing day cataract surgery. (Eye Science 2014; 29:182-185)

  8. Kinetics of salivary pH after acidic beverage intake by patients undergoing orthodontic treatment.

    Science.gov (United States)

    Turssi, Cecilia P; Silva, Carolina S; Bridi, Enrico C; Amaral, Flavia Lb; Franca, Fabiana Mg; Basting, Roberta T

    2015-01-01

    The saliva of patients undergoing orthodontic treatment with fixed appliances can potentially present a delay in the diluting, clearing, and buffering of dietary acids due to an increased number of retention areas. The aim of this clinical trial was to compare salivary pH kinetics of patients with and without orthodontic treatment, following the intake of an acidic beverage. Twenty participants undergoing orthodontic treatment and 20 control counterparts had their saliva assessed for flow rate, pH, and buffering capacity. There was no significant difference between salivary parameters in participants with or without an orthodontic appliance. Salivary pH recovery following acidic beverage intake was slower in the orthodontic subjects compared to controls. Patients with fixed orthodontic appliances, therefore, seem to be at higher risk of dental erosion, suggesting that dietary advice and preventive care need to be implemented during orthodontic treatment.

  9. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

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    André Luiz Lisboa Cordeiro

    Full Text Available Abstract Introduction: Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective: To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods: This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results: 50 patients, 27 (54% males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073 and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031. Conclusion: We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery.

  10. Inspiratory Muscle Training and Functional Capacity in Patients Undergoing Cardiac Surgery

    Science.gov (United States)

    Cordeiro, André Luiz Lisboa; de Melo, Thiago Araújo; Neves, Daniela; Luna, Julianne; Esquivel, Mateus Souza; Guimarães, André Raimundo França; Borges, Daniel Lago; Petto, Jefferson

    2016-01-01

    Introduction Cardiac surgery is a highly complex procedure which generates worsening of lung function and decreased inspiratory muscle strength. The inspiratory muscle training becomes effective for muscle strengthening and can improve functional capacity. Objective To investigate the effect of inspiratory muscle training on functional capacity submaximal and inspiratory muscle strength in patients undergoing cardiac surgery. Methods This is a clinical randomized controlled trial with patients undergoing cardiac surgery at Instituto Nobre de Cardiologia. Patients were divided into two groups: control group and training. Preoperatively, were assessed the maximum inspiratory pressure and the distance covered in a 6-minute walk test. From the third postoperative day, the control group was managed according to the routine of the unit while the training group underwent daily protocol of respiratory muscle training until the day of discharge. Results 50 patients, 27 (54%) males were included, with a mean age of 56.7±13.9 years. After the analysis, the training group had significant increase in maximum inspiratory pressure (69.5±14.9 vs. 83.1±19.1 cmH2O, P=0.0073) and 6-minute walk test (422.4±102.8 vs. 502.4±112.8 m, P=0.0031). Conclusion We conclude that inspiratory muscle training was effective in improving functional capacity submaximal and inspiratory muscle strength in this sample of patients undergoing cardiac surgery. PMID:27556313

  11. Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery

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    Sevuk U

    2015-08-01

    Full Text Available Utkan Sevuk,1 Erkan Baysal,2 Nurettin Ay,3 Yakup Altas,2 Rojhat Altindag,2 Baris Yaylak,2 Vahhac Alp,3 Ertan Demirtas4 1Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 2Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 3Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 4Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey Background: Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12 deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG surgery.Material and methods: A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98.Results: Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017 and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034 than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004. Delirium severity score showed a moderate correlation with cobalamin levels (Ρ=-0.27; P=0.024. Logistic regression analysis demonstrated that

  12. Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized Study

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    Rabie Soliman

    2017-01-01

    Full Text Available Objective: The study was done to compare propofol and ketofol for sedation of pediatric patients scheduled for elective pulmonary valve implantation in a catheterization laboratory. Design: This was a double-blind randomized study. Setting: This study was conducted in Prince Sultan Cardiac Centre, Saudi Arabia. Patients and Methods: The study included 60 pediatric patients with pulmonary regurge undergoing pulmonary valve implantation. Intervention: The study included sixty patients, classified into two groups (n = 30. Group A: Propofol was administered as a bolus dose (1–2 mg/kg and then a continuous infusion of 50–100 μg/kg/min titrated as needed. Group B: Ketofol was administered 1–2 mg/kg and then infusion of 20–60 μg/kg/min. The medication was prepared by the nursing staff and given to anesthetist blindly. Measurements: The monitors included heart rate, mean arterial blood pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, fentanyl dose, antiemetic medications, and Aldrete score. Main Results: The comparison of heart rate, mean arterial pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, and Aldrete score were insignificant (P > 0.05. The total fentanyl increased in Group A more than Group B (P = 0.045. The required antiemetic drugs increased in Group A patients more than Group B (P = 0.020. The durations of full recovery and in the postanesthesia care unit were longer in Group A than Group B (P = 0.013, P < 0.001, respectively. Conclusion: The use of propofol and ketofol is safe and effective for sedation of pediatric patients undergoing pulmonary valve implantation in a catheterization laboratory. However, ketofol has many advantages more than the propofol. Ketofol has a rapid onset of sedation, a rapid recovery time, decreased incidence of nausea and vomiting and leads to rapid discharge of patients from the postanesthesia care unit.

  13. Comparison of two antiplatelet therapy strategies in patients undergoing transcatheter aortic valve implantation.

    Science.gov (United States)

    Durand, Eric; Blanchard, Didier; Chassaing, Stephan; Gilard, Martine; Laskar, Marc; Borz, Bogdan; Lafont, Antoine; Barbey, Christophe; Godin, Matthieu; Tron, Christophe; Zegdi, Rachid; Chatel, Didier; Le Page, Olivier; Litzler, Pierre-Yves; Bessou, Jean-Paul; Danchin, Nicolas; Cribier, Alain; Eltchaninoff, Hélène

    2014-01-15

    Dual antiplatelet therapy is commonly used in patients undergoing transcatheter aortic valve implantation (TAVI), but the optimal antiplatelet regimen is uncertain and remains to be determined. The objective of this study was to compare 2 strategies of antiplatelet therapy in patients undergoing TAVI. A strategy using monoantiplatelet therapy (group A, n = 164) was prospectively compared with a strategy using dual antiplatelet therapy (group B, n = 128) in 292 consecutive patients undergoing TAVI. The primary end point was a combination of mortality, major stroke, life-threatening bleeding (LTB), myocardial infarction, and major vascular complications at 30 days. All adverse events were adjudicated according to the Valve Academic Research Consortium. The primary end point occurred in 22 patients (13.4%) in the group A and in 30 patients (23.4%) in the group B (hazard ratio 0.51, 95% confidence interval 0.28 to 0.94, p = 0.026). LTB (3.7% vs 12.5%, p = 0.005) and major bleedings (2.4% vs 13.3%, p antiplatelet therapy persisted after multivariate adjustment and propensity score analysis (hazard ratio 0.53, 95% confidence interval 0.28 to 0.95, p = 0.033). In conclusion, a strategy using mono versus dual antiplatelet therapy in patients undergoing TAVI reduces LTB and major bleedings without increasing the risk of stroke and myocardial infarction. The results of our study question the justification of dual antiplatelet therapy and require confirmation in a randomized trial. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. Evaluation of insulin and C-peptide in diabetic patients undergoing renal dialysis

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    P. T. Annamala

    2016-10-01

    Conclusions: There are alterations in the levels of insulin, c-peptide and the glycemic status in diabetic patients during dialysis. This significant reduction may affect glucose metabolism in diabetic patients on dialysis. Hence, glycemic status should be continuously monitored in these patients. [Int J Res Med Sci 2016; 4(10.000: 4579-4582

  15. Signs of knee osteoarthritis common in 620 patients undergoing arthroscopic surgery for meniscal tear.

    Science.gov (United States)

    Pihl, Kenneth; Englund, Martin; Lohmander, L Stefan; Jørgensen, Uffe; Nissen, Nis; Schjerning, Jeppe; Thorlund, Jonas B

    2017-02-01

    Background and purpose - Recent evidence has questioned the effect of arthroscopic knee surgery for middle-aged and older patients with degenerative meniscal tears with or without concomitant radiographic knee osteoarthritis (OA). We investigated the prevalence of early or more established knee OA and patients' characteristics in a cohort of patients undergoing arthroscopic surgery for a meniscal tear. Patients and methods - 641 patients assigned for arthroscopy on suspicion of meniscus tear were consecutively recruited from February 2013 through January 2015. Of these, 620 patients (mean age 49 (18-77) years, 57% men) with full datasets available were included in the present study. Prior to surgery, patients completed questionnaires regarding onset of symptoms, duration of symptoms, and mechanical symptoms along with the knee injury and osteoarthritis outcome score (KOOS). At arthroscopy, the operating surgeon recorded information about meniscal pathology and cartilage damage. Early or more established knee OA was defined as the combination of self-reported frequent knee pain, cartilage damage, and the presence of degenerative meniscal tissue. Results - 43% of patients (269 of 620) had early or more established knee OA. Of these, a large proportion had severe cartilage lesions with almost half having a severe cartilage lesion in at least 1 knee compartment. Interpretation - Based on a definition including frequent knee pain, cartilage damage, and degenerative meniscal tissue, early or more established knee OA was present in 43% of patients undergoing knee arthroscopy for meniscal tear.

  16. Electrolyte disorders and aging: risk factors for delirium in patients undergoing orthopedic surgeries.

    Science.gov (United States)

    Wang, Li-Hong; Xu, Dong-Juan; Wei, Xian-Jiao; Chang, Hao-Teng; Xu, Guo-Hong

    2016-11-23

    At present, the exact mechanism of postoperative delirium has not been elucidated. The purpose of this study was to analyze the incidence of delirium in patients undergoing orthopedic surgeries and to explore possible related factors. This is a retrospective study. We used 582 patients who had undergone orthopedic surgery between January 2011 and December 2014. The surgeries consisted of 155 cases of internal fixation for intertrochanteric fracture (IFIF), 128 cases of femoral head replacement (FHR), 169 cases of total hip arthroplasty (THA) and 130 cases of total knee arthroplasty (TKA). Among the 582 patients, 75 developed postoperative delirium (an incidence of 12.9%). The demographics of the patients, which included age, gender, operation duration and blood loss, were statistically analyzed with univariate logistic regression analysis and then multivariate logistic regression. To investigate the influences of different electrolytes disorders for postoperative delirium, the Chi-square test was used. Multivariate logistic regression analysis indicated that postoperative delirium incidence in patients aged 70-79 years and in patients aged ≥80 years was higher than that in patients aged delirium in the group of patients with electrolyte disorders was higher than that in the normal group (OR, 2.38). There were statistically significant differences between the delirium group and the non-delirium group in the incidences of the sodium and calcium disorders. Aging and postoperative electrolyte disorders (hyponatremia and hypocalcemia) are risk factors for postoperative delirium in patients undergoing orthopedic surgeries.

  17. Lack of motivation: a new modifiable risk factor for peritonitis in patients undergoing peritoneal dialysis?

    Science.gov (United States)

    Paudel, Klara; Namagondlu, Girish; Samad, Nasreen; McKitty, Khadija; Fan, Stanley L

    2015-03-01

    Can we identify modifiable risk factors for peritonitis in patients undergoing peritoneal dialysis (PD)? We aimed to determine whether housing standard, PD exchange technique or patient motivation might be modifiable risks for peritonitis. We also explored the relationship between lack of motivation and depression. Nurse home visits assessed PD exchange technique, environment and patient motivation. Motivation scores were correlated separately with an Apathy Evaluation Score and a depression score using PHQ-9 questionnaires. Home hygiene, exchange technique and motivation were above average in 53%, 56% and 60%, respectively in 104 patients undergoing PD. After 15 months, 25.9% patients developed peritonitis but nurses' ratings of homes and exchange techniques were not predictive. Low patient motivation was predictive. Patients rated to have above or below median motivation had significantly different Apathy Scores (p = 0.0002). Unmotivated depressed patients were significantly more likely to develop peritonitis compared to motivated depressed patients. Lack of motivation predicted peritonitis particularly if associated with depression. Further studies are required focusing on specific motivation scoring schemes and the psychosocial support that might lead to better outcomes. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  18. Timed Stair Climbing is the Single Strongest Predictor of Perioperative Complications in Patients Undergoing Abdominal Surgery

    Science.gov (United States)

    Reddy, Sushanth; Contreras, Carlo M; Singletary, Brandon; Bradford, T Miller; Waldrop, Mary G; Mims, Andrew H; Smedley, W Andrew; Swords, Jacob A; Thomas N, Wang; Martin J, Heslin

    2016-01-01

    Background Current methods to predict patients' peri-operative morbidity utilize complex algorithms with multiple clinical variables focusing primarily on organ-specific compromise. The aim of the present study is to determine the value of a timed stair climb (SC) in predicting peri-operative complications for patients undergoing abdominal surgery. Study Design From March 2014 to July 2015, 362 patients attempted SC while being timed prior to undergoing elective abdominal surgery. Vital signs were measured before and after SC. Ninety day post-operative complications were assessed by the Accordion Severity Grading System. The prognostic value of SC was compared to the ACS NSQIP risk calculator. Results A total of 264 (97.4%) patients were able to complete SC. SC time directly correlated to changes in both mean arterial pressure and heart rate as an indicator of stress. An Accordion grade 2 or higher complication occurred in 84 (25%) patients. There were 8 mortalities (2.4%). Patients with slower SC times had an increased complication rate (P<0.0001). In multivariable analysis SC time was the single strongest predictor of complications (OR=1.029, P<0.0001), and no other clinical co-morbidity reached statistical significance. Receiver operative characteristic curves predicting post-operative morbidity by SC time was superior to that of the ACS risk calculator (AUC 0.81 vs. 0.62, P<0.0001). Additionally slower patients had a greater deviation from predicted length of hospital stay (P=0.034) Conclusions SC provides measurable stress, accurately predicts post-operative complications, and is easy to administer in patients undergoing abdominal surgery. Larger patient populations with a diverse group of operations will be needed to further validate the use of SC in risk prediction models. PMID:26920993

  19. Psychological characteristics, eating behavior, and quality of life assessment of obese patients undergoing weight loss interventions.

    Science.gov (United States)

    Miras, A D; Al-Najim, W; Jackson, S N; McGirr, J; Cotter, L; Tharakan, G; Vusirikala, A; le Roux, C W; Prechtl, C G; Scholtz, S

    2015-03-01

    Bariatric surgery is the most effective treatment for obesity. However, not all patients have similar weight loss following surgery and many researchers have attributed this to different pre-operative psychological, eating behavior, or quality-of-life factors. The aim of this study was to determine whether there are any differences in these factors between patients electing to have bariatric surgery compared to less invasive non-surgical weight loss treatments, between patients choosing a particular bariatric surgery procedure, and to identify whether these factors predict weight loss after bariatric surgery. This was a prospective study of 90 patients undergoing gastric bypass, vertical sleeve gastrectomy, or adjustable gastric banding and 36 patients undergoing pharmacotherapy or lifestyle interventions. All patients completed seven multi-factorial psychological, eating behavior, and quality-of-life questionnaires prior to choosing their weight loss treatment. Questionnaire scores, baseline body mass index, and percent weight loss at 1 year after surgical interventions were recorded. Surgical patients were younger, had a higher body mass index, and obesity had a higher impact on their quality of life than on non-surgical patients, but they did not differ in the majority of eating behavior and psychological parameters studied. Patients opting for adjustable gastric banding surgery were more anxious, depressed, and had more problems with energy levels than those choosing vertical sleeve gastrectomy, and more work problems compared to those undergoing gastric bypass. Weight loss after bariatric surgery was predicted by pre-operative scores of dietary restraint, disinhibition, and pre-surgery energy levels. The results of this study generate a number of hypotheses that can be explored in future studies and accelerate the development of personalized weight loss treatments. © The Finnish Surgical Society 2014.

  20. Dose audit for patients undergoing two common radiography examinations with digital radiology systems.

    Science.gov (United States)

    İnal, Tolga; Ataç, Gökçe

    2014-01-01

    We aimed to determine the radiation doses delivered to patients undergoing general examinations using computed or digital radiography systems in Turkey. Radiographs of 20 patients undergoing posteroanterior chest X-ray and of 20 patients undergoing anteroposterior kidney-ureter-bladder radiography were evaluated in five X-ray rooms at four local hospitals in the Ankara region. Currently, almost all radiology departments in Turkey have switched from conventional radiography systems to computed radiography or digital radiography systems. Patient dose was measured for both systems. The results were compared with published diagnostic reference levels (DRLs) from the European Union and International Atomic Energy Agency. The average entrance surface doses (ESDs) for chest examinations exceeded established international DRLs at two of the X-ray rooms in a hospital with computed radiography. All of the other ESD measurements were approximately equal to or below the DRLs for both examinations in all of the remaining hospitals. Improper adjustment of the exposure parameters, uncalibrated automatic exposure control systems, and failure of the technologists to choose exposure parameters properly were problems we noticed during the study. This study is an initial attempt at establishing local DRL values for digital radiography systems, and will provide a benchmark so that the authorities can establish reference dose levels for diagnostic radiology in Turkey.

  1. Comparison of propofol versus sevoflurane on thermoregulation in patients undergoing transsphenoidal pituitary surgery: A preliminary study

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    Tumul Chowdhury

    2012-01-01

    Full Text Available Purpose: General anesthesia causes inhibition of thermoregulatory mechanisms. Propofol has been reported to cause more temperature fall, but in case of deliberate mild hypothermia, both sevoflurane and propofol were comparable. Thermoregulation is found to be disturbed in cases of pituitary tumors. We aimed to investigate which of the two agents, sevoflurane or propofol, results in better preservation of thermoregulation in patients undergoing transsphenoidal excision of pituitary tumors. Methods: Twenty-six patients scheduled to undergo transsphenoidal removal of pituitary adenomas were randomly allocated to receive propofol or sevoflurane anesthesia. Baseline esophageal temperature was noted. Times for temperature to fall by 1°C or 35°C and to return to baseline were also comparable ( P>0.05. After that warmer was started at 43°C and time to rise to baseline was noted. Duration of surgery, total blood loss, and total fluid intake were also noted. If any, side effects such as delayed arousal and recovery from muscle relaxant were noted. Results: The demographics of the patients were comparable. Duration of surgery and total blood loss were comparable in the two groups. The time for temperature to fall by 1°C or 35°C and time to return to baseline was also comparable ( P>0.05. No side effects related to body temperature were noted. Conclusion: Both propofol and sevoflurane show similar effects in maintaining thermal homeostasis in patients undergoing transsphenoidal pituitary surgery.

  2. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis

    Science.gov (United States)

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-01-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life. PMID:27512289

  3. Effect of virtual reality distraction on pain among patients with hand injury undergoing dressing change.

    Science.gov (United States)

    Guo, Chunlan; Deng, Hongyan; Yang, Jian

    2015-01-01

    To assess the effect of virtual reality distraction on pain among patients with a hand injury undergoing a dressing change. Virtual reality distraction can effectively alleviate pain among patients undergoing a dressing change. Clinical research has not addressed pain control during a dressing change. A randomised controlled trial was performed. In the first dressing change sequence, 98 patients were randomly divided into an experimental group and a control group, with 49 cases in each group. Pain levels were compared between the two groups before and after the dressing change using a visual analog scale. The sense of involvement in virtual environments was measured using the Pearson correlation coefficient analysis, which determined the relationship between the sense of involvement and pain level. The difference in visual analog scale scores between the two groups before the dressing change was not statistically significant (t = 0·196, p > 0·05), but the scores became statistically significant after the dressing change (t = -30·792, p virtual environment and pain level during the dressing was statistically significant (R(2) = 0·5538, p Virtual reality distraction can effectively alleviate pain among patients with a hand injury undergoing a dressing change. Better results can be obtained by increasing the sense of involvement in a virtual environment. Virtual reality distraction can effectively relieve pain without side effects and is not reliant on a doctor's prescription. This tool is convenient for nurses to use, especially when analgesics are unavailable. © 2014 John Wiley & Sons Ltd.

  4. Effect of systematic relaxation techniques on anxiety and pain in older patients undergoing abdominal surgery.

    Science.gov (United States)

    Rejeh, Nahid; Heravi-Karimooi, Majideh; Vaismoradi, Mojtaba; Jasper, Melanie

    2013-10-01

    Inadequate pain control in older patients who have undergone abdominal surgery can lead to many complications. This study investigates the effect of systematic relaxation techniques on pain and anxiety in older patients undergoing abdominal surgery. One hundred twenty-four patients were randomly assigned into the experimental and control groups. The systematic relaxation techniques consisted of older patients in the experimental group slowly reading relaxing sentences during recovery in ambulation after the surgery. Patients' satisfaction with pain and anxiety relief was recorded, as was their use of opioid analgesia. Statistically significant differences in pain and anxiety, and in analgesic use, were reported between the patients in experimental and control groups after the intervention. These relaxation techniques can be incorporated into the care plan to reduce pain and anxiety after surgery as well as offering a measure for increasing the patients' independence in pain management control. © 2013 Wiley Publishing Asia Pty Ltd.

  5. Obstructive sleep apnea affects the clinical outcomes of patients undergoing percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Zhang JJ

    2016-05-01

    Full Text Available Jun-jie Zhang,1,2,* Xiao-fei Gao,1,* Zhen Ge,1,2 Xiao-Min Jiang,1 Ping-xi Xiao,1,2 Nai-liang Tian,1,2 Jing Kan,2 Chi-Hang Lee,3 Shao-Liang Chen1,2 1Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 2Department of Cardiology, Nanjing Heart Center, Nanjing, People’s Republic of China; 3Department of Cardiology, National University Heart Center, Singapore *These authors contributed equally to this work Background: There is a paucity of evidence regarding the association between obstructive sleep apnea (OSA and patients undergoing percutaneous coronary intervention (PCI for coronary artery disease. We sought to investigate whether OSA affects the clinical outcomes of patients undergoing PCI.Patients and methods: All enrolled individuals treated with PCI were evaluated for OSA by polysomnography. The primary end point was defined as major adverse cardiac events (MACEs at 2 years, including cardiac death, myocardial infarction (MI, and/or target vessel revascularization.Results: A total of 340 consecutive patients undergoing PCI were assigned to the OSA (n=152, apnea–hypopnea index ≥15 and non-OSA (n=188, apnea–hypopnea index <15 groups. The incidence of OSA in patients with coronary artery disease undergoing PCI was 44.7%. Patients in the OSA group had more three-vessel disease (34.9%, increased number of total implanted stents (3.3±2.0, and longer total stent length (83.8±53.1 mm when compared to the non-OSA group (23.4%, P=0.020; 2.8±1.9, P=0.007; 68.7±48.4, P=0.010. After a median follow-up of 2 years, the incidence of MACEs was significantly higher in patients with OSA (25.0% vs 16.0%, P=0.038, mainly driven by the increased periprocedural MI (19.2% vs 11.2%, P=0.038 in the OSA group. By Cox regression multivariable analysis, the independent predictor of MACEs was OSA (hazard ratio: 1.962, 95% confidence interval: 1.036–3.717, P=0.039.Conclusion: There was a high prevalence of moderate-to-severe OSA

  6. β-Blocker-Associated Risks in Patients With Uncomplicated Hypertension Undergoing Noncardiac Surgery.

    Science.gov (United States)

    Jørgensen, Mads E; Hlatky, Mark A; Køber, Lars; Sanders, Robert D; Torp-Pedersen, Christian; Gislason, Gunnar H; Jensen, Per Føge; Andersson, Charlotte

    2015-12-01

    Perioperative β-blocker strategies are important to reduce risks of adverse events. Effectiveness and safety may differ according to patients' baseline risk. To determine the risk of major adverse cardiovascular events (MACEs) associated with long-term β-blocker therapy in patients with uncomplicated hypertension undergoing noncardiac surgery. Association study based on in-hospital records and out-of-hospital pharmacotherapy use using a Danish nationwide cohort of patients with uncomplicated hypertension treated with at least 2 antihypertensive drugs (β-blockers, thiazides, calcium antagonists, or renin-angiotensin system [RAS] inhibitors) undergoing noncardiac surgery between 2005 and 2011. Various antihypertensive treatment regimens, chosen as part of usual care. Thirty-day risk of MACEs (cardiovascular death, nonfatal ischemic stroke, nonfatal myocardial infarction) and all-cause mortality, assessed using multivariable logistic regression models and adjusted numbers needed to harm (NNH). The baseline characteristics of the 14,644 patients who received β-blockers (65% female, mean [SD] age, 66.1 [12.0] years) were similar to those of the 40,676 patients who received other antihypertensive drugs (57% female, mean [SD] age, 65.9 [11.8] years). Thirty-day MACEs occurred in 1.3% of patients treated with β-blockers compared with 0.8% of patients not treated with β-blockers (P risks of MACEs in 2-drug combinations with RAS inhibitors (odds ratio [OR], 2.16 [95% CI, 1.54-3.04]), calcium antagonists (OR, 2.17 [95% CI, 1.48-3.17]), and thiazides (OR, 1.56 [95% CI, 1.10-2.22]), compared with the reference combination of RAS inhibitors and thiazides. Results were similar for all-cause mortality. Risk of MACEs associated with β-blocker use seemed especially pronounced for patients at least 70 years old (number needed to harm [NNH], 140 [95% CI, 86-364]), for men (NNH, 142 [95% CI, 93-195]), and for patients undergoing acute surgery (NNH, 97 [95% CI, 57

  7. Management of Patients with Hernia or Incisional Hernia Undergoing Surgery for Morbid Obesity

    Directory of Open Access Journals (Sweden)

    Ramon Vilallonga

    2011-01-01

    Full Text Available Morbidly obese patients (MOPs are predisposed to developing abdominal wall hernias with the potential complication of small bowel obstruction and other morbidity. We report our experience in treating morbidly obese patients. Hernia prophylaxis has been attempted as a means of decreasing the incisional hernia risk associated with weight loss surgery. The controversy regarding the optimal time and method of repair of abdominal wall hernias in patients undergoing open or laparoscopic gastric bypass is discussed with emphasis placed on either a simultaneous repair or splits of the omentum, and of leaving a plug in the hernia defect, to allow time to perform a delayed repair.

  8. Transient Intraoperative Central Diabetes Insipidus in Moyamoya Patients Undergoing Revascularization Surgery: A Mere Coincidence?

    Science.gov (United States)

    Hong, Joe C; Ramos, Emilio; Copeland, Curtis C; Ziv, Keren

    2016-04-15

    We present 2 patients with Moyamoya disease undergoing revascularization surgery who developed transient intraoperative central diabetes insipidus with spontaneous resolution in the immediate postoperative period. We speculate that patients with Moyamoya disease may be predisposed to a transient acute-on-chronic insult to the arginine vasopressin-producing portion of their hypothalamus mediated by anesthetic agents. We describe our management, discuss pertinent literature, and offer possible mechanisms of this transient insult. We hope to improve patient safety by raising awareness of this potentially catastrophic complication.

  9. Blood glucose management in the patient undergoing cardiac surgery: A review

    Institute of Scientific and Technical Information of China (English)

    Pingle; Reddy; Brian; Duggar; John; Butterworth

    2014-01-01

    Both diabetes mellitus and hyperglycemia per se are associated with negative outcomes after cardiac surgery. In this article, we review these associations, the possible mechanisms that lead to adverse outcomes, and the epidemiology of diabetes focusing on those patients requiring cardiac surgery. We also examine outpatient and perioperative management of diabetes with the same focus. Finally, we discuss our own efforts to improve glycemic management of patients undergoing cardiac surgery at our institution, including keys to success, results of implementation, and patient safety concerns.

  10. Outcomes of patients with cirrhosis undergoing non-hepatic surgery: Risk assessment and management

    Institute of Scientific and Technical Information of China (English)

    Farida Millwala; Geoffrey C Nguyen; Paul J Thuluvath

    2007-01-01

    The reported mortality rates in patients with cirrhosis undergoing various non-transplant surgical procedures range from 8.3% to 25%. This wide range of mortality rates is related to severity of liver disease, type of surgery, demographics of patient population, expertise of the surgical, anesthesia and intensive care unit team and finally, reporting bias. In this article, we will review the pathophysiology, morbidity and mortality associated with non-hepatic surgery in patients with cirrhosis, and then recommend an algorithm for risk assessment and evidence based management strategy to optimize postsurgical outcomes.

  11. Provisional stenting in the real world: results in 1058 consecutive patients undergoing percutaneous coronary angioplasty.

    Science.gov (United States)

    Ten Berg, Jurriën M; Kelder, Johannes C; Suttorp, Maarten Jan; Plokker, Thijs HW

    2001-09-01

    OBJECTIVE: To study a strategy of aggressive coronary balloon angioplasty with provisional stenting in allcomers. In randomized trials, stenting has improved the outcome of patients undergoing coronary intervention. However, whether these results hold up in clinical practice is largely unknown. Furthermore, the results of balloon angioplasty have also improved dramatically. It is therefore essential to evaluate the current results of balloon angioplasty and to assess whether stents are required in all patients. METHODS: The authors prospectively studied the occurrence of death, myocardial infarction (MI) and target lesion revascularization (TLR) of a large consecutive group of patients undergoing aggressive balloon angioplasty with provisional stenting. None of the patients received a platelet glycoprotein IIb/IIIa receptor blocker. The results were compared with the outcome of routine stenting in recent randomized trials. RESULTS: Angioplasty was performed in 1058 patients of whom 369 (34.9%) received a stent. The angiographic success rate was 98.9%. During hospital stay, 4.8% of the patients suffered any cardiac event. At one-year follow-up, death occurred in 1.1%, MI in 3.3%, TLR in 12.4% and any event in 16.7% of the patients. Event-free survival at one-year was 82.3%. These results compare favorably with routine stenting in recent trials. CONCLUSIONS: Aggressive balloon angioplasty with provisional stenting yields excellent results in a general patient population.

  12. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis.

    Science.gov (United States)

    Kadry, Bassam; Press, Christopher D; Alosh, Hassan; Opper, Isaac M; Orsini, Joe; Popov, Igor A; Brodsky, Jay B; Macario, Alex

    2014-01-01

    Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI) in patients undergoing total hip arthroplasty (THA) with different components of operating room (OR) time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE) was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P 35 kg/m(2) each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization.

  13. Obesity increases operating room times in patients undergoing primary hip arthroplasty: a retrospective cohort analysis

    Directory of Open Access Journals (Sweden)

    Bassam Kadry

    2014-08-01

    Full Text Available Background. Obesity impacts utilization of healthcare resources. The goal of this study was to measure the relationship between increasing body mass index (BMI in patients undergoing total hip arthroplasty (THA with different components of operating room (OR time. Methods. The Stanford Translational Research Integrated Database Environment (STRIDE was utilized to identify all ASA PS 2 or 3 patients who underwent primary THA at Stanford Medical Center from February 1, 2008 through January 1, 2013. Patients were divided into five groups based on the BMI weight classification. Regression analysis was used to quantify relationships between BMI and the different components of total OR time. Results. 1,332 patients were included in the study. There were no statistically significant differences in age, gender, height, and ASA PS classification between the BMI groups. Normal-weight patients had a total OR time of 138.9 min compared 167.9 min (P 35 kg/m2 each incremental BMI unit increase was associated with greater incremental total OR time increases. Conclusion. Morbidly obese patients required significantly more total OR time than normal-weight patients undergoing a THA procedure. This increase in time is relevant when scheduling obese patients for surgery and has an important impact on health resource utilization.

  14. The correlation of anemia and contrast-induced nephropathy in patients with chronic kidney disease undergoing percutaneous coronary intervention

    Institute of Scientific and Technical Information of China (English)

    刘远辉

    2014-01-01

    Objective To investigate the correlation of anemia and contrast-induced nephropathy(CIN)in patients with chronic kidney disease(CKD)undergoing percutaneous coronary intervention(PCI).Methods A total of 292 patients with CKD undergoing PCI admitted to Guangdong General Hospital from October 2010 to December 2012were consecutively enrolled in this study.Anemia was

  15. Pulmonary vein orientation assessment: Is it necessary in patients undergoing contact force sensing guided radiofrequency catheter ablation of atrial fibrillation

    Directory of Open Access Journals (Sweden)

    Pim Gal

    2015-09-01

    Conclusions: This study shows that in patients undergoing PVI with the CFC ablation system, PV orientation does not affect CF and is not associated with AF free survival. PV orientation assessment does not appear to be necessary in patients undergoing CFC PVI.

  16. Propofol versus Ketofol for Sedation of Pediatric Patients Undergoing Transcatheter Pulmonary Valve Implantation: A Double-blind Randomized Study.

    Science.gov (United States)

    Soliman, Rabie; Mofeed, Mohammed; Momenah, Tarek

    2017-01-01

    The study was done to compare propofol and ketofol for sedation of pediatric patients scheduled for elective pulmonary valve implantation in a catheterization laboratory. This was a double-blind randomized study. This study was conducted in Prince Sultan Cardiac Centre, Saudi Arabia. The study included 60 pediatric patients with pulmonary regurge undergoing pulmonary valve implantation. The study included sixty patients, classified into two groups (n = 30). Group A: Propofol was administered as a bolus dose (1-2 mg/kg) and then a continuous infusion of 50-100 μg/kg/min titrated as needed. Group B: Ketofol was administered 1-2 mg/kg and then infusion of 20-60 μg/kg/min. The medication was prepared by the nursing staff and given to anesthetist blindly. The monitors included heart rate, mean arterial blood pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, fentanyl dose, antiemetic medications, and Aldrete score. The comparison of heart rate, mean arterial pressure, respiratory rate, temperature, SPO2and PaCO2, Michigan Sedation Score, and Aldrete score were insignificant (P > 0.05). The total fentanyl increased in Group A more than Group B (P = 0.045). The required antiemetic drugs increased in Group A patients more than Group B (P = 0.020). The durations of full recovery and in the postanesthesia care unit were longer in Group A than Group B (P = 0.013, P < 0.001, respectively). The use of propofol and ketofol is safe and effective for sedation of pediatric patients undergoing pulmonary valve implantation in a catheterization laboratory. However, ketofol has many advantages more than the propofol. Ketofol has a rapid onset of sedation, a rapid recovery time, decreased incidence of nausea and vomiting and leads to rapid discharge of patients from the postanesthesia care unit.

  17. Comprehensive geriatric assessment can predict postoperative morbidity and mortality in elderly patients undergoing elective surgery.

    Science.gov (United States)

    Kim, Kwang-Il; Park, Kay-Hyun; Koo, Kyung-Hoi; Han, Ho-Seong; Kim, Cheol-Ho

    2013-01-01

    The proportion of elderly patients who undergo surgery has rapidly increased; however, clinical indicators predicting outcomes are limited. Our aim was to evaluate the significance of comprehensive geriatric assessment (CGA) in elderly patients undergoing elective surgery. We studied 141 consecutive elderly patients (age: 78.0±6.5 years old, male: 41.1%) who were referred to our geriatric department for surgical risk evaluation. CGA was performed to evaluate physical health, functional status, psychological health, and social support. The primary composite outcome of this study was in-hospital death or post-discharge institutionalization. In-hospital adverse events, such as delirium, pressure ulcers, pneumonia, and urinary tract infections, were also evaluated. The associations between CGA and in-hospital adverse events, in-hospital death, and post-discharge institutionalization were investigated. There were 32 adverse outcomes (6 in-hospital deaths and 26 post-discharge institutionalizations). Compared with the patients who were discharged to their homes, patients with adverse outcomes were characterized by poor nutritional status and prior strokes. However, there was no significant difference in surgical risk or anesthesia type. The CGA results showed that patients with adverse outcomes were associated with functional dependency and poor nutrition. The cumulative number of impairments in the CGA domain was significantly associated with adverse outcomes, in-hospital events, and prolonged hospital stays. In multiple logistic regression analysis, cumulative impairment in CGA was independently associated with surgical outcomes in elderly patients undergoing elective surgery. Preoperative CGA can identify elderly patients at greater risk for mortality, post-discharge institutionalization, adverse in-hospital events, and prolonged length of hospital stay.

  18. Effects of handholding and providing information on anxiety in patients undergoing percutaneous vertebroplasty.

    Science.gov (United States)

    Kim, Bong-Hee; Kang, Hee-Young; Choi, Eun-Young

    2015-12-01

    This study evaluated the effects of handholding and spoken information provided on the anxiety of patients undergoing percutaneous vertebroplasty under local anaesthesia. A surgical intervention usually entails physical discomfort and psychological burden. Furthermore, patients under local anaesthesia are conscious during the surgical intervention, which leads to more anxiety, as patients are aware of their surroundings in the operating theatre. A quasi-experimental design with a nonequivalent control group was utilised. Amsterdam preoperative anxiety scale assessed psychological anxiety, while blood pressure and pulse were measured to evaluate physiological anxiety. Participants were 94 patients undergoing percutaneous vertebroplasty in a spine hospital in Gwangju Metropolitan City, South Korea. Thirty patients were assigned to Experimental Group I, 34 to the Experimental Group II and 30 to the control group. During a surgical intervention, nurses held the hands of those in Experimental Group I and provided them with spoken information. Patients in Experimental Group II experienced only handholding. Psychological anxiety in Experimental Group I was low compared to those in Experimental Group II and the control group. In addition, there were significant decreases in systolic blood pressure in both Experimental Groups compared to the control group. Handholding and spoken information provided during a surgical intervention to mitigate psychological anxiety, and handholding to mitigate physiological anxiety can be used in nursing interventions with patients undergoing percutaneous vertebroplasty. Handholding and providing nursing information are possibly very useful interventions that are easily implemented by circulating nurses during a surgical intervention. In particular, handholding is a simple, economical and appropriate way to help patient in the operating theatre. © 2015 John Wiley & Sons Ltd.

  19. Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Whitlock, Richard P; Devereaux, P J; Teoh, Kevin H; Lamy, Andre; Vincent, Jessica; Pogue, Janice; Paparella, Domenico; Sessler, Daniel I; Karthikeyan, Ganesan; Villar, Juan Carlos; Zuo, Yunxia; Avezum, Álvaro; Quantz, Mackenzie; Tagarakis, Georgios I; Shah, Pallav J; Abbasi, Seyed Hesameddin; Zheng, Hong; Pettit, Shirley; Chrolavicius, Susan; Yusuf, Salim

    2015-09-26

    Cardiopulmonary bypass initiates a systemic inflammatory response syndrome that is associated with postoperative morbidity and mortality. Steroids suppress inflammatory responses and might improve outcomes in patients at high risk of morbidity and mortality undergoing cardiopulmonary bypass. We aimed to assess the effects of steroids in patients at high risk of morbidity and mortality undergoing cardiopulmonary bypass. The Steroids In caRdiac Surgery (SIRS) study is a double-blind, randomised, controlled trial. We used a central computerised phone or interactive web system to randomly assign (1:1) patients at high risk of morbidity and mortality from 80 hospital or cardiac surgery centres in 18 countries undergoing cardiac surgery with the use of cardiopulmonary bypass to receive either methylprednisolone (250 mg at anaesthetic induction and 250 mg at initiation of cardiopulmonary bypass) or placebo. Patients were assigned with block randomisation with random block sizes of 2, 4, or 6 and stratified by centre. Patients aged 18 years or older were eligible if they had a European System for Cardiac Operative Risk Evaluation of at least 6. Patients were excluded if they were taking or expected to receive systemic steroids in the immediate postoperative period or had a history of bacterial or fungal infection in the preceding 30 days. Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcomes were 30-day mortality and a composite of death and major morbidity (ie, myocardial injury, stroke, renal failure, or respiratory failure) within 30 days, both analysed by intention to treat. Safety outcomes were also analysed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00427388. Patients were recruited between June 21, 2007, and Dec 19, 2013. Complete 30-day data was available for all 7507 patients randomly assigned to methylprednisolone (n=3755) and to placebo (n=3752). Methylprednisolone, compared

  20. Severe tracheobronchial compression in a patient with Turner′s syndrome undergoing repair of a complex aorto-subclavian aneurysm: Anesthesia perspectives

    Directory of Open Access Journals (Sweden)

    Christopher C .C. Hudson

    2014-01-01

    Full Text Available We present a case of severe tracheobronchial compression from a complex aorto-subclavian aneurysm in a patient with Turner′s syndrome undergoing open surgical repair. Significant airway compression is a challenging situation and requires careful preoperative preparation, maintenance of spontaneous breathing when possible, and consideration of having an alternative source of oxygenation and circulation established prior to induction of general anesthesia. Cardiopulmonary monitoring is essential for safe general anesthesia and diagnosis of unexpected intraoperative events.

  1. Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery.

    Science.gov (United States)

    Elsamadicy, Aladine A; Adogwa, Owoicho; Lydon, Emily; Sergesketter, Amanda; Kaakati, Rayan; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Bagley, Carlos A; Karikari, Isaac O

    2017-08-01

    OBJECTIVE Depression is the most prevalent affective disorder in the US, and patients with spinal deformity are at increased risk. Postoperative delirium has been associated with inferior surgical outcomes, including morbidity and mortality. The relationship between depression and postoperative delirium in patients undergoing spine surgery is relatively unknown. The aim of this study was to determine if depression is an independent risk factor for the development of postoperative delirium in patients undergoing decompression and fusion for deformity. METHODS The medical records of 923 adult patients (age ≥ 18 years) undergoing elective spine surgery at a single major academic institution from 2005 through 2015 were reviewed. Of these patients, 255 (27.6%) patients had been diagnosed with depression by a board-certified psychiatrist and constituted the Depression group; the remaining 668 patients constituted the No-Depression group. Patient demographics, comorbidities, and intra- and postoperative complication rates were collected for each patient and compared between groups. The primary outcome investigated in this study was rate of postoperative delirium, according to DSM-V criteria, during initial hospital stay after surgery. The association between depression and postoperative delirium rate was assessed via multivariate logistic regression analysis. RESULTS Patient demographics and comorbidities other than depression were similar in the 2 groups. In the Depression group, 85.1% of the patients were taking an antidepressant prior to surgery. There were no significant between-group differences in intraoperative variables and rates of complications other than delirium. Postoperative complication rates were also similar between the cohorts, including rates of urinary tract infection, fever, deep and superficial surgical site infection, pulmonary embolism, deep vein thrombosis, urinary retention, and proportion of patients transferred to the intensive care unit. In

  2. Olmesartan, other antihypertensives, and chronic diarrhea among patients undergoing endoscopic procedures: a case-control study.

    Science.gov (United States)

    Greywoode, Ruby; Braunstein, Eric D; Arguelles-Grande, Carolina; Green, Peter H R; Lebwohl, Benjamin

    2014-09-01

    To investigate a recent association between the use of the angiotensin receptor-blocker (ARB) olmesartan and a severe enteropathy resembling celiac disease. We searched our endoscopy database for all outpatient esophagogastroduodenoscopy (EGD) or colonoscopy examinations in patients aged at least 50 years during the period January 1, 2007, to March 31, 2013. Cases were those whose examination indication was diarrhea, and controls were those whose examination indication was esophageal reflux (EGD) or colorectal cancer screening (colonoscopy). We compared cases with controls with regard to the proportion of those listing olmesartan among their medications. Secondary exposures were the proportion of those taking nonolmesartan ARBs or other antihypertensive medications. We also examined biopsy results to determine whether there were histologic changes associated with the use of olmesartan. We identified 2088 patients undergoing EGD and 12,428 patients undergoing colonoscopy meeting inclusion criteria. On multivariate analysis, there was no statistically significant association between olmesartan and diarrhea among those undergoing EGD (odds ratio, 1.99; 95% CI, 0.79-5.00) or colonoscopy (odds ratio, 0.63; 95% CI, 0.23-1.74). Review of pathology reports of the EGD and colonoscopy groups showed no association between the use of olmesartan and the histologic diagnosis of celiac disease (P=.61) or microscopic colitis (P=1.0), respectively. Our findings suggest that neither olmesartan nor other ARBs were associated with diarrhea among patients undergoing endoscopy. The spruelike enteropathy recently associated with olmesartan is likely a rare adverse effect and milder presentations are unlikely. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  3. Sleep disturbances and changes in urinary 6-sulphatoxymelatonin levels in patients with breast cancer undergoing lumpectomy

    DEFF Research Database (Denmark)

    Voigt Hansen, Melissa; Madsen, M T; Wildschiødtz, Gordon

    2013-01-01

    Sleep disturbances and changes in self-reported discomfort and melatonin secretion are common in the post-operative period. We aimed to study the distribution of sleep stages in the perioperative period and evaluate changes in secretion of the melatonin metabolite aMT6s and subjective parameters ...... of sleepiness, pain, general well-being and fatigue in patients undergoing surgery for breast cancer....

  4. Compressive cryotherapy versus cryotherapy alone in patients undergoing knee surgery: a meta-analysis

    OpenAIRE

    Song, Mingzhi; Sun, Xiaohong; Tian, Xiliang; Zhang, Xianbin; Shi, Tieying; SUN, RAN; Dai, Wei

    2016-01-01

    Aim This study aims to conduct a meta-analysis to identify and compare the effectiveness of compressive cryotherapy and cryotherapy alone for patients undergoing knee surgery. Background Postoperative management is an important guarantee for the success of surgery. Cryotherapy and compression are two common nursing techniques after knee surgery, and are considered to be effective for postoperative clinical symptoms such as local pain and swelling. However, no previous meta-analyses have compa...

  5. Body mass index, conversion rate and complications among patients undergoing robotic surgery for endometrial carcinoma.

    Science.gov (United States)

    Cunningham, Mary J; Dorzin, Esther; Nguyen, Loan; Anderson, Elizabeth; Bunn, W Douglas

    2015-12-01

    A retrospective cohort study was performed to evaluate the relationship of BMI to conversion rate in patients undergoing robotic surgery for endometrial cancer. Secondary outcomes were operative times, number of lymph nodes retrieved, and complications. Women with endometrial cancer scheduled for robotic surgery from September 2008 to September 2012 were included. Women were divided into three groups based on BMI, and conversion rates to laparotomy were compared. Descriptive and comparative analyses were performed among non-obese, obese, and morbidly obese women who completed robotic surgery. 298 women were scheduled for robotic surgery for endometrial carcinoma: 87 non-obese (BMI 19-29, μ 25.23), 110 obese (BMI 30-39, μ 34.21), and 101 morbidly obese (BMI 40-71, μ 47.38). Conversion to laparotomy occurred in 18 patients (6%), with no difference in conversion rate between BMI categories. Direct comparison between converted and completed robotic patients showed no significant differences in preoperative characteristics, except that patients who required conversion had a higher number of previous abdominal surgeries. Patients completing robotic surgery underwent node dissections at similar rates in all three BMI categories. Operating room time, but not surgical time, was increased in morbidly obese patients. There were no significant differences in complications, performance of lymphadenectomy, or lymph node yields between BMI categories. Increase in BMI was not associated with an increase in rate of conversion to laparotomy or complication rate in patients undergoing robotic surgery for endometrial carcinoma. Node dissections were pathologically equivalent between BMI categories.

  6. Angiographic and Clinical Impact of Successful Manual Thrombus Aspiration in Diabetic Patients Undergoing Primary PCI

    Directory of Open Access Journals (Sweden)

    Mohamed Shehata

    2014-01-01

    Full Text Available Background. Diabetes mellitus is associated with worse angiographic and clinical outcomes after percutaneous coronary intervention (PCI. Aim. To investigate the impact of manual thrombus aspiration on in-stent restenosis (ISR and clinical outcome in patients treated by bare-metal stent (BMS implantation for ST-segment elevation myocardial infarction (STEMI. Methods. 100 diabetic patients were prospectively enrolled. They were randomly assigned to undergo either standard primary PCI (group A, 50 patients or PCI with thrombus aspiration using Export catheter (group B, 50 patients. The primary endpoint was the rate of eight-month ISR. The secondary endpoint included follow-up for major adverse cardiac events (MACE. Results. Mean age of the study cohort was 59.86±8.3 years, with 64 (64% being males. Baseline characteristics did not differ between both groups. Eight-month angiogram showed that group B patients had significantly less late lumen loss (0.17±0.35 versus 0.60±0.42 mm, P<0.001, with lower incidence of ISR (4% versus 16.6%, P<0.001. There was a trend towards lower rate of MACE in the same group of patients. Conclusion. In diabetic patients undergoing primary PCI, manual thrombus aspiration (compared with standard PCI was associated with better ISR rate after BMS implantation.

  7. Cardiac arrests in patients undergoing gastrointestinal endoscopy: A retrospective analysis of 73,029 procedures

    Directory of Open Access Journals (Sweden)

    Basavana Goudra

    2015-01-01

    Full Text Available Background/Aims: Airway difficulties leading to cardiac arrest are frequently encountered during propofol sedation in patients undergoing gastrointestinal (GI endoscopy. With a noticeable increase in the use of propofol for endoscopic sedation, we decided to examine the incidence and outcome of cardiac arrests in patients undergoing gastrointestinal (GI endoscopy with sedation. Patients and Methods: In this retrospective study, cardiac arrest data obtained from the clinical quality improvement and local registry over 5 years was analyzed. The information of patients who sustained cardiac arrest attributable to sedation was studied in detail. Analysis included comparison of cardiac arrests due to all causes until discharge (or death versus the cardiac arrests and death occurring during the procedure and in the recovery area. Results: The incidence of cardiac arrest and death (all causes, until discharge was 6.07 and 4.28 per 10,000 in patients sedated with propofol, compared with non–propofol-based sedation (0.67 and 0.44. The incidence of cardiac arrest during and immediately after the procedure (recovery area for all endoscopies was 3.92 per 10,000; of which, 72% were airway management related. About 90.0% of all peri-procedural cardiac arrests occurred in patients who received propofol. Conclusions: The incidence of cardiac arrest and death is about 10 times higher in patients receiving propofol-based sedation compared with those receiving midazolam–fentanyl sedation. More than two thirds of these events occur during EGD and ERCP.

  8. Effect of music on level of anxiety in patients undergoing colonoscopy without sedation.

    Science.gov (United States)

    Ko, Chia-Hui; Chen, Yi-Yu; Wu, Kuan-Ta; Wang, Shu-Chi; Yang, Jeng-Fu; Lin, Yu-Yin; Lin, Chia-I; Kuo, Hsiang-Ju; Dai, Chia-Yen; Hsieh, Meng-Hsuan

    2017-03-01

    Listening to music can be a noninvasive method for reducing the anxiety level without any adverse effects. The aim of this study was to explore whether music can reduce anxiety and to compare two different styles of music, informal classical music and light music, to ascertain the more effective style of music in reducing anxiety in patients undergoing colonoscopy without sedation. This study enrolled 138 patients who underwent colonoscopy without sedation during a general health examination from February 2009 to January 2015. The patients were randomly assigned to a group that did not listen to music, a group that listened to music by David Tolley, or a group that listened to music by Kevin Kern. The State-Trait Anxiety Inventory was used to evaluate the status of anxiety. A trend test for mild anxiety was performed on the patients in the three groups, and a significant trend was noted (p=0.017 for all patients; p=0.014 for analysis by sex). Multivariate analysis for mild anxiety on the patients in each group was also performed in this study, and music by Kevin Kern was found to have the lowest odds ratio (Odds ratio=0.34, p=0.045). Listening to music, especially music by Kevin Kern, reduced the level of anxiety in patients undergoing colonoscopy examination without sedation. Copyright © 2016. Published by Elsevier Taiwan LLC.

  9. Iron overload in patients with acute leukemia or MDS undergoing myeloablative stem cell transplantation.

    Science.gov (United States)

    Armand, Philippe; Kim, Haesook T; Rhodes, Joanna; Sainvil, Marie-Michele; Cutler, Corey; Ho, Vincent T; Koreth, John; Alyea, Edwin P; Hearsey, Doreen; Neufeld, Ellis J; Fleming, Mark D; Steen, Hanno; Anderson, Damon; Kwong, Raymond Y; Soiffer, Robert J; Antin, Joseph H

    2011-06-01

    Patients with hematologic malignancies undergoing allogeneic stem cell transplantation (HSCT) commonly have an elevated serum ferritin prior to HSCT, which has been associated with increased mortality after transplantation. This has led to the suggestion that iron overload is common and deleterious in this patient population. However, the relationship between serum ferritin and parenchymal iron overload in such patients is unknown. We report a prospective study of 48 patients with acute leukemia (AL) or myelodysplastic syndromes (MDS) undergoing myeloablative HSCT, using magnetic resonance imaging (MRI) to estimate liver iron content (LIC) and cardiac iron. The median (and range) pre-HSCT value of serum ferritin was 1549 ng/mL (20-6989); serum hepcidin, 59 ng/mL (10-468); labile plasma iron, 0 LPI units (0.0-0.9). Eighty-five percent of patients had hepatic iron overload (HIO), and 42% had significant HIO (LIC ≥5.0 mg/gdw). Only 1 patient had cardiac iron overload. There was a strong correlation between pre-HSCT serum ferritin and estimated LIC (r = .75), which was mostly dependent on prior transfusion history. Serum hepcidin was appropriately elevated in patients with HIO. Labile plasma iron elevation was rare. A regression calibration analysis supported the hypothesis that elevated pre-HSCT LIC is significantly associated with inferior post-HSCT survival. These results contribute to our understanding of the prevalence, mechanism, and consequences of iron overload in HSCT.

  10. Herpes zoster in psoriasis patients undergoing treatment with biological agents: prevalence, impact, and management challenges

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    el Hayderi L

    2016-10-01

    Full Text Available Lara el Hayderi, Fany Colson, Bita Dezfoulian, Arjen F Nikkels Department of Dermatology, CHU du Sart Tilman, University Hospital of Liège, Liège, Belgium Abstract: As TNF-α is a major factor in the immune defense against herpes zoster (HZ; an increased incidence and severity of HZ cases were suspected in patients undergoing treatment with TNF antagonists. Several studies and clinical experience provided evidence that the incidence of HZ increases by twofold to threefold in this patient category. The number of severe cases of HZ, with multisegmental, disseminated cutaneous, and/or systemic involvement, is also increased. Concerning psoriasis patients under biologicals, the clinician should be more alert for an eventual HZ event, in particular during the first year of biological treatment, and be aware of the possibility of more severe HZ cases. HZ may also undergo an age-shift toward younger patients. Rapid identification of risk factors for severe HZ, such as severe prodromal pains and/or the presence of satellite lesions, is recommended. The treatment recommendations of HZ in this patient group are identical to the recently published guidelines for the management of HZ. The live attenuated viral vaccine OKA/Merck strain anti-HZ vaccination is recommended before initiating biological treatment in psoriasis patients. The new adjuvanted anti-HZ vaccine will probably also benefit patients while on biological treatment. Keywords: herpes zoster, TNF antagonists, anti-IL17, anti-IL12/23, psoriasis, aciclovir

  11. Individualized Comprehensive Lifestyle Intervention in Patients Undergoing Chemotherapy with Curative or Palliative Intent: Who Participates?

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    Karianne Vassbakk-Brovold

    Full Text Available Knowledge about determinants of participation in lifestyle interventions in cancer patients undergoing chemotherapy, particularly with palliative intent, remains poor. The objective of the present study was to identify determinants of participating in a 12 month individualized, comprehensive lifestyle intervention, focusing on diet, physical activity, mental stress and smoking cessation, in cancer patients receiving chemotherapy with curative or palliative intent. The secondary objective was to identify participation determinants 4 months into the study.Newly diagnosed cancer patients starting chemotherapy at the cancer center in Kristiansand/Norway (during a 16 month inclusion period were screened. Demographic and medical data (age, sex, body mass index, education level, marital status, smoking status, Eastern Cooperative Oncology Group performance status (ECOG, diagnosis, tumor stage and treatment intention was analyzed for screened patients.100 of 161 invited patients participated. There were more females (69 vs. 48%; P = 0.004, breast cancer patients (46 vs. 25%; P = 0.007, non-smokers (87 vs. 74%; P = 0.041, younger (mean age 60 vs. 67 yrs; P 70 years were less likely to participate at baseline and 4 months.Individualized lifestyle interventions in cancer patients undergoing chemotherapy appear to facilitate a high participation rate that declines with increasing age; both during the enrollment process and completing the intervention. Neither oncologic nor socioeconomic variables deterred participation.

  12. Role of calf muscle stimulation in the prevention of DVT in Indian patients undergoing surgeries for fractures around the hip

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    Aman Goyal

    2012-01-01

    Conclusion: The role of peroperative calf muscle electrostimulation for DVT prophylaxis remains controversial. The risk of developing DVT in patients undergoing surgeries around the hip joint is very less in patients analysed in our series.

  13. Balanced Propofol Sedation in Patients Undergoing EUS-FNA: A Pilot Study to Assess Feasibility and Safety

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    Pagano, N.; Arosio, M.; Romeo, F.; Rando, G.; Del Conte, G.; Carlino, A.; Strangio, G.; Vitetta, E.; Malesci, A.; Repici, A.

    2011-01-01

    Introduction and aims. Balanced propofol sedation (BPS) administered by gastroenterologists has gained popularity in endoscopic procedures. Few studies exist about the safety of this approach during endosonography with fine needle aspiration (EUS-FNA). We assessed the safety of BPS in EUS-FNA. Materials and methods. 112 consecutive patients, referred to our unit to perform EUS-FNA, from February 2008 to December 2009, were sedated with BPS. A second gastroenterologist administered the drugs and monitorized the patient. Results. All the 112 patients (62 males, mean age 58.35) completed the examination. The mean dose of midazolam and propofol was, respectively, of 2.1 mg (range 1–4 mg) and 350 mg (range 180–400). All patients received oxygen with a mean flux of 4 liter/minute (range 2–6 liters/minute). The mean recovery time after procedure was 25 minutes (range 18–45 minutes). No major complications related to sedation were registered during all procedures. The oxygen saturation of all patients never reduced to less than 85%. Blood systolic pressure during and after the procedure never reduced to less than 100 mmHg. Conclusions. In our experience BPS administered by non-anaesthesiologists provided safe and successful sedation in patients undergoing EUS-FNA. PMID:21785561

  14. Balanced Propofol Sedation in Patients Undergoing EUS-FNA: A Pilot Study to Assess Feasibility and Safety

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    N. Pagano

    2011-01-01

    Full Text Available Introduction and aims. Balanced propofol sedation (BPS administered by gastroenterologists has gained popularity in endoscopic procedures. Few studies exist about the safety of this approach during endosonography with fine needle aspiration (EUS-FNA. We assessed the safety of BPS in EUS-FNA. Materials and methods. 112 consecutive patients, referred to our unit to perform EUS-FNA, from February 2008 to December 2009, were sedated with BPS. A second gastroenterologist administered the drugs and monitorized the patient. Results. All the 112 patients (62 males, mean age 58.35 completed the examination. The mean dose of midazolam and propofol was, respectively, of 2.1 mg (range 1–4 mg and 350 mg (range 180–400. All patients received oxygen with a mean flux of 4 liter/minute (range 2–6 liters/minute. The mean recovery time after procedure was 25 minutes (range 18–45 minutes. No major complications related to sedation were registered during all procedures. The oxygen saturation of all patients never reduced to less than 85%. Blood systolic pressure during and after the procedure never reduced to less than 100 mmHg. Conclusions. In our experience BPS administered by non-anaesthesiologists provided safe and successful sedation in patients undergoing EUS-FNA.

  15. Intensive serial biomarker profiling for the prediction of neutropenic fever in patients with hematologic malignancies undergoing chemotherapy: a pilot study

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    Steven M. Chan

    2014-06-01

    Full Text Available Neutropenic fever (NF is a life-threatening complication of myelosuppressive chemotherapy in patients with hematologic malignancies and triggers the administration of broad-spectrum antimicrobials. The ability to accurately predict NF would permit initiation of antimicrobials earlier in the course of infection with the goal of decreasing morbid complications and progression to septic shock and death. Changes in the blood level of inflammatory biomarkers may precede the occurrence of NF. To identify potential biomarkers for the prediction of NF, we performed serial meas- urements of nine biomarkers [C-reactive protein (CRP, protein C, interleukin (IL-6, IL-8, IL-10, IL-1β, tumor necrosis factor-α, monocyte chemotactic protein-1, and intercellular adhesion molecule-1] using a multiplex ELISA array platform every 6-8 hours in patients undergoing myelosuppressive chemotherapy for hematologic malignancies. We found that the blood levels of IL-6 and CRP increased significantly 24 to 48 hours prior to the onset of fever. In addition, we showed that frequent biomarker monitoring is feasible using a bedside micro sample test device. The results of this pilot study suggest that serial monitoring of IL-6 and CRP levels using a bedside device may be useful in the prediction of NF. Prospective studies involving a larger cohort of patients to validate this observation are warranted. This trial is registered at ClinicalTrials.gov (NCT01144793.

  16. Reiki for Cancer Patients Undergoing Chemotherapy in a Brazilian Hospital: A Pilot Study.

    Science.gov (United States)

    Siegel, Pamela; da Motta, Pedro Mourão Roxo; da Silva, Luis G; Stephan, Celso; Lima, Carmen Silvia Passos; de Barros, Nelson Filice

    2016-01-01

    The purpose of this pilot study was to explore whether individualized Reiki given to cancer patients at a Brazilian hospital improved symptoms and well-being. Data from 36 patients who received 5 Reiki sessions were collected using the MYMOP and were compared before and after their treatment and also with 14 patients who did not receive Reiki and who acted as a comparison group. Twenty-one patients reported feeling better, 12 felt worse, and 3 reported no change. Of the comparison group, 6 patients reported feeling better and 8 felt worse. The Reiki practice delivered as part of the integrative care in oncology did produce clinically significant effects, although not statistically significant results, for more than half of the patients undergoing cancer treatment.

  17. Stress perception among patients in pre-colonoscopy period and those undergoing chemotherapy treatment

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    Graziela de Souza Alves da Silva

    2015-05-01

    Full Text Available Objective: comparing the perception of stress among patients with colorectal cancer undergoing chemotherapy with those in pre-colonoscopy period. Methods: a comparative descriptive study developed with 144 people receiving chemotherapy and 100 patients in the pre-colonoscopy period, using biosocial and clinical data, Stress Assessment Tool and Perceived Stress Scale. Results: a predominance of females (73%, aged over 65 (50% were predominant for the pre-colonoscopy period patients. In patients receiving chemotherapy, gender parity with ages ranging from 40-64 years (68.1% was observed. Pre-colonoscopy patients showed higher perceived stress compared to those receiving chemotherapy (p <0.001. Conclusion: the phase of diagnostic definition represents greater stress to patients in comparison to period of treatment, even despite the characteristic manifestations of chemotherapy.

  18. Population pharmacokinetics of daptomycin in adult patients undergoing continuous renal replacement therapy.

    Science.gov (United States)

    Xu, Xiaoying; Khadzhynov, Dmytro; Peters, Harm; Chaves, Ricardo L; Hamed, Kamal; Levi, Micha; Corti, Natascia

    2017-03-01

    The objective of this population pharmacokinetic (PK) analysis was to provide guidance for the dosing interval of daptomycin in patients undergoing continuous renal replacement therapy (CRRT). A previously published population PK model for daptomycin was updated with data from patients undergoing continuous veno-venous haemodialysis (CVVHD; n = 9) and continuous veno-venous haemodiafiltration (CVVHDF; n = 8). Model-based simulations were performed to compare the 24 h AUC, Cmax and Cmin of daptomycin following various dosing regimens (4, 6, 8, 10, and 12 mg kg(-1) every [Q] 24 h and Q48 h), with the safety and efficacy exposure references for Staphylococcus aureus bacteraemia/right-sided infective endocarditis. The previously developed daptomycin structural population PK model could reasonably describe data from the patients on CRRT. The clearance in patients undergoing CVVHDF and CVVHD was estimated at 0.53 and 0.94 l h(-1) , respectively, as compared with 0.75 l h(-1) in patients with creatinine clearance (CrCl) ≥ 30 ml min(-1) . Daptomycin Q24 h dosing in patients undergoing CRRT resulted in optimal exposure for efficacy, with AUC comparable to that in patients with CrCl ≥ 30 ml min(-1) . In contrast, Q48 h dosing was associated with considerably lower AUC24-48h in all patients for doses up to 12 mg kg(-1) and is therefore inappropriate. Q24 h dosing of daptomycin up to 12 mg kg(-1) provides comparable drug exposure in patients on CVVHD and in those with CrCl ≥ 30 ml min(-1) . Daily daptomycin use up to 8 mg kg(-1) doses are appropriate for patients on CVVHDF, but higher doses may increase the risk of toxicity. © 2016 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

  19. Smoker's Paradox in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention.

    Science.gov (United States)

    Gupta, Tanush; Kolte, Dhaval; Khera, Sahil; Harikrishnan, Prakash; Mujib, Marjan; Aronow, Wilbert S; Jain, Diwakar; Ahmed, Ali; Cooper, Howard A; Frishman, William H; Bhatt, Deepak L; Fonarow, Gregg C; Panza, Julio A

    2016-04-22

    Prior studies have found that smokers undergoing thrombolytic therapy for ST-segment elevation myocardial infarction have lower in-hospital mortality than nonsmokers, a phenomenon called the "smoker's paradox." Evidence, however, has been conflicting regarding whether this paradoxical association persists in the era of primary percutaneous coronary intervention. We used the 2003-2012 National Inpatient Sample databases to identify all patients aged ≥18 years who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Multivariable logistic regression was used to compare in-hospital mortality between smokers (current and former) and nonsmokers. Of the 985 174 patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention, 438 954 (44.6%) were smokers. Smokers were younger, were more often men, and were less likely to have traditional vascular risk factors than nonsmokers. Smokers had lower observed in-hospital mortality compared with nonsmokers (2.0% versus 5.9%; unadjusted odds ratio 0.32, 95% CI 0.31-0.33, Pparadox also applies to ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  20. Anti-Phospholipid Antibodies in Patients Undergoing Total Joint Replacement Surgery

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    Melissa Simpson

    2012-01-01

    Full Text Available Background. Patients undergoing joint replacement remain at increased risk for venous thromboembolism (VTE compared to other types of surgery, regardless of thromboprophylactic regimen. The pathophysiologic processes rendering this group of patients at risk for VTE are multifactorial. Procedure-specific and patient-specific exposures play a role in the postoperative development of VTE, including the development of anti-phospholipid antibodies (aPL. Methods. We measured three aPL (anti-cardiolipin, anti-β2 glycoprotein, and lupus anticoagulant in 123 subjects undergoing total knee or hip arthroplasty to describe the presence of these antibodies preoperatively and to describe the rate of postoperative seroconversion among those people who were negative preoperatively. Postoperative antibodies were measured at day 7, 14, and 21. Results. The prevalence of aPL antibodies in the preoperative period was 44%, positive subjects were more likely to be smokers (P=0.05 and were less likely to have undergone a previous arthroplasty procedure (P=0.002. Subjects seroconverted in a 21 day postoperative period at a rate of 79%. Conclusions. These pilot data suggest that the prevalence of aPL in this population both preoperatively and postoperatively is higher than previously expected. Further studies are needed to describe aPL in a larger population and to establish their clinical significance in populations undergoing joint replacement surgeries.

  1. Comparison of neostigmine and sugammadex for hemodynamic parameters in cardiac patients undergoing noncardiac surgery.

    Science.gov (United States)

    Kizilay, Deniz; Dal, Didem; Saracoglu, Kemal T; Eti, Zeynep; Gogus, Fevzi Y

    2016-02-01

    The aim of this study is to compare the hemodynamic effects of neostigmine-atropine combination and sugammadex in patients with cardiac problems undergoing noncardiac surgery. Prospective randomized study. In the operating room. Ninety patients with a class 2 or 3 cardiovascular disease according to the New York Heart Association classification and aged between 18 and 75 years undergoing noncardiac surgery were randomized. Group N (n = 45) received 0.03 mg/kg IV neostigmine when T2 appeared as measured with a nerve muscle stimulator. When heart rate was 5 beats/min (±10 beats/min) lower than the heart rate before administration of the medication, 0.5 mg IV atropine sulfate was given. Group S (n = 45) received 3 mg/kg IV sugammadex when T2 appeared as measured with a nerve muscle stimulator. Heart rate, mean systolic and diastolic blood pressures, and electrocardiographic alterations including the QTc (QT Fredericia and QT Bazett) were recorded. There were no significant differences between and within the groups in terms of QTc values. Sugammadex group had a significant decrease on heart rate 1 minute after the medication when compared to the measurement before the medication (P Sugammadex group had lower systolic, diastolic, and mean blood pressures and heart rate when compared to neostigmine group (P sugammadex might be preferred as it provides more hemodynamic stability compared to neostigmine-atropine combination to reverse rocuronium-induced neuromuscular blockage in cardiac patients undergoing noncardiac surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Blood Pressure and Heart Rate Alterations through Music in Patients Undergoing Cataract Surgery in Greece

    Science.gov (United States)

    Merakou, Kyriakoula; Varouxi, Georgia; Barbouni, Anastasia; Antoniadou, Eleni; Karageorgos, Georgios; Theodoridis, Dimitrios; Koutsouri, Aristea; Kourea-Kremastinou, Jenny

    2015-01-01

    INTRODUCTION Music has been proposed as a safe, inexpensive, nonpharmacological antistress intervention. The purpose of this study was to determine whether patients undergoing cataract surgery while listening to meditation music experience lower levels of blood pressure and heart rate. METHODS Two hundred individuals undergoing cataract surgery participated in the study. Hundred individuals listened to meditation music, through headphones, before and during the operation (intervention group) and 100 individuals received standard care (control group). Patients stress coping skills were measured by the Sense of Coherence Scale (SOC Scale). Systolic and diastolic blood pressure and heart rate were defined as outcome measures. RESULTS According to the SOC Scale, both groups had similar stress coping skills (mean score: 127.6 for the intervention group and 127.3 for the control group). Before entering the operating room (OR) as well as during surgery the rise in systolic and diastolic pressures was significantly lower in the intervention group (P blood pressure at both time recordings was recorded (P music influenced patients’ preoperative stress with regard to systolic blood pressure. This kind of music can be used as an alternative or complementary method for blood pressure stabilizing in patients undergoing cataract surgery. PMID:26106264

  3. The minimally invasive approach is associated with reduced surgical site infections in obese patients undergoing proctectomy.

    Science.gov (United States)

    Pasam, R T; Esemuede, I O; Lee-Kong, S A; Kiran, R P

    2015-12-01

    While laparoscopic colorectal resection may be underused in technically challenging circumstances, the minimally invasive approach may in fact maximally benefit patients at the greatest risk of complications. Obesity and proctectomy pose particular technical challenges during laparoscopic resection and are also associated with the greatest risks of complications, especially surgical site infections (SSIs). We evaluated the role of laparoscopy in minimizing SSI in such patients. From the American College of Surgeons-National Surgical Quality Improvement Program database, outcomes for obese [body mass index (BMI) ≥ 30 kg/m(2)] and non-obese (BMI laparoscopy on SSI for obese patients undergoing proctectomy. OC patients were more likely than OP, LC, and LP, respectively, to undergo emergency operation and have an American Society of Anesthesiologists (ASA) score of 3-5. Overall SSI rates after OC, OP, LC, and LP were 15.2, 17.6, 8.6, and 10.1 %, respectively (p obese patients, the rates were 18.7, 22.3, 10.7, and 13.3 % (p obesity, proctectomy, younger age, race, steroid use, diabetes, chronic obstructive pulmonary disease, prior wound infection, transfusion history, previous operation within 30 days, coronary artery or vascular disease, ASA class 3-5, tobacco use, resident involvement, male gender, albumin Laparoscopy reduced the risk of SSI by at least 35 % across all BMI classes and procedures, an effect that persisted on multivariate analysis even in obese patients undergoing proctectomy. In colorectal surgery, an already high-risk outlier for SSI, obesity and proctectomy are associated with the highest risk of SSI. Despite the particular technical challenges of laparoscopy in these circumstances, the minimally invasive approach attenuates the risk of SSI in these high-risk patients and thus should be strongly considered during treatment planning.

  4. Comparison of pain scores between patients undergoing panretinal photocoagulation using navigated or pattern scan laser systems

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    Umit Ubeyt Inan

    2016-02-01

    Full Text Available ABSTRACT Purpose: To compare the pain responses of patients with proliferative diabetic retinopathy (PDR undergoing panretinal photocoagulation (PRP using either pattern scan laser (PASCAL or navigated laser photocoagulation (NAVILAS. Methods: Patients diagnosed with PDR were randomly assigned to undergo either PASCAL or NAVILAS photocoagulation treatment. PRP was performed using the multi-shot mode with a spot size of 200-400 µm and a pulse duration of 30 ms to obtain a white-grayish spot on the retina. Parameters were identical in both procedures. After 30 min of PRP application, patients were asked to verbally describe their pain perception as either "none," "mild," "moderate," "severe," or "very severe" using a verbal rating scale (VRS and visual analog scale (VAS by indicating a score from "0" to "10," representing the severity of pain from "no pain" to "severe pain." Results: A total of 60 eyes of 60 patients (20 females and 40 males diagnosed with PDR were treated. The mean age of patients was 62.22 ± 9.19 years, and the mean diabetes duration was 195.47 ± 94.54 months. The mean number of laser spots delivered during PRP was 389.47 ± 71.52 in the NAVILAS group and 392.70 ± 54.33 in the PASCAL group (p=0.57. The difference in pain responses between patients in the NAVILAS and PASCAL groups was significant with regard to the mean VRS (1.10 ± 0.67 and 1.47 ± 0.69, respectively; p=0.042 and mean VAS (2.13 ± 1.17 and 2.97 ± 1.35, respectively; p=0.034 scores. Conclusions: Pain responses in patients undergoing PRP with a 30-ms pulse duration were significantly milder in the NAVILAS group than in the PASCAL group.

  5. Patient benefit from seamless implant monitoring

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    Karsten Wallbrück

    2005-12-01

    Full Text Available Background: Patients with electrostimulation devices visit the hospital regularly for follow-up. The workload of out-patient departments is ever increasing, but a less frequent check-up is unwanted, as it could impair reliability and effectiveness of the therapy. A system of remote patient monitoring might improve this situation by enabling identification of patients who benefit from a shortened time for corrective action after any undesired event. A completely automatic system for patient remote monitoring has been introduced (BIOTRONIK Home Monitoring, HM. Daily patient and device data are displayed on an internet site which allows authorized persons to follow the parameters trends. Several clinical studies are presently being conducted to investigate the benefit of HM in pacemaker and implantable cardioverter/defibrillator therapy. Preliminary results show the system’s ability to individualize implant therapy for the patients’ and the physicians’ benefits. Previous studies in heart failure (HF therapy have shown that hospital readmission rates, hospitalisation duration and also mortality can be reduced by patient monitoring programs. A recently started study investigating HM in heart failure therapy aims to define a HF-indicator that predicts a worsening of the patient’s status leading to hospitalisation. With such an indicator, the responsible physician could be alerted and the patient can be called in. Although several issues connected to Home Monitoring remain to be solved, the time has come for a more flexible patient management. The incorporation of modern information technology into cardiovascular implants offers a way to solve the conflict between limited resources and high quality medical therapy for an aging population.

  6. Impact of Triple Therapy in Elderly Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.

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    Antonia Sambola

    Full Text Available Selecting an ideal antithrombotic therapy for elderly patients with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI can be challenging since they have a higher thromboembolic and bleeding risk than younger patients. The current study aimed to assess the efficacy and safety of triple therapy (TT: oral anticoagulation plus dual antiplatelet therapy: aspirin plus clopidogrel in patients ≥75 years of age with atrial fibrillation (AF undergoing percutaneous coronary intervention (PCI.A prospective multicenter study was conducted from 2003 to 2012 at 6 Spanish teaching hospitals. A cohort study of consecutive patients with AF undergoing PCI and treated with TT or dual antiplatelet therapy (DAPT was analyzed. All outcomes were evaluated at 1-year of follow-up.Five hundred and eighty-five patients, 289 (49% of whom were ≥75 years of age (79.6±3.4 years; 33% women were identified. TT was prescribed in 55.9% of patients at discharge who had a higher thromboembolic risk (CHA2DS2VASc score: 4.23±1.51 vs 3.76±1.40, p = 0.007 and a higher bleeding risk (HAS-BLED ≥3: 88.6% vs 79.2%, p = 0.02 than those on DAPT. Therefore, patients on TT had a lower rate of thromboembolism than those on DAPT (0.6% vs 6.9%, p = 0.004; HR 0.08, 95% CI: 0.01-0.70, p = 0.004. Major bleeding events occurred more frequently in patients on TT than in those on DAPT (11.7% vs 2.4%, p = 0.002; HR 5.2, 95% CI: 1.53-17.57, p = 0.008. The overall mortality rate was similar in both treatment groups (11.9% vs 13.9%, p = 0.38; however, after adjustment for confounding variables, TT was associated with a reduced mortality rate (HR 0.33, 95% CI: 0.12-0.86, p = 0.02.In elderly patients with AF undergoing PCI, the use of TT compared to DAPT was associated with reduced thromboembolism and mortality rates, although a higher rate of major bleeding.

  7. The effect of live classical piano music on the vital signs of patients undergoing ophthalmic surgery.

    Science.gov (United States)

    Camara, Jorge G; Ruszkowski, Joseph M; Worak, Sandra R

    2008-06-25

    Music and surgery. To determine the effect of live classical piano music on vital signs of patients undergoing ophthalmic surgery. Retrospective case series. 203 patients who underwent various ophthalmologic procedures in a period during which a piano was present in the operating room of St. Francis Medical Center. [Note: St. Francis Medical Center has recently been renamed Hawaii Medical Center East.] Demographic data, surgical procedures, and the vital signs of 203 patients who underwent ophthalmic procedures were obtained from patient records. Blood pressure, heart rate, and respiratory rate measured in the preoperative holding area were compared with the same parameters taken in the operating room, with and without exposure to live piano music. A paired t-test was used for statistical analysis. Mean arterial pressure, heart rate, and respiratory rate. 115 patients who were exposed to live piano music showed a statistically significant decrease in mean arterial blood pressure, heart rate, and respiratory rate in the operating room compared with their vital signs measured in the preoperative holding area (P piano music showed a statistically significant increase in mean arterial blood pressure (P piano music lowered the blood pressure, heart rate, and respiratory rate in patients undergoing ophthalmic surgery.

  8. Total intravenous anesthesia with superficial cervical block or morphine transition in patients undergoing carotid endarterectomy.

    Science.gov (United States)

    Camerani, S; Capuzzo, M; Ieffa, E; Pescolderung, M; Braccini, L; Volta, C A

    2014-06-01

    The aim of this study was compare the Aldrete score at 5 minutes of two groups of patients undergoing carotid endarterectomy with intravenous anesthesia, receiving either anesthetic superficial cervical plexus block or intravenous morphine as transition analgesia. After Ethics Committee approval, this randomized, controlled, double-blind, single-center study was performed on patients undergoing carotid endarterectomy, who received total intravenous anesthesia with propofol and remifentanil infusion. After intubation, each patient was randomly assigned to Block (superficial cervical block with levobupivacaine before the surgical incision), or Morphine group (standardized dose of morphine 30 minutes before the end of surgery). In the recovery room, an investigator unaware of the patient randomization recorded time to extubation, Aldrete score, pain, nausea/vomiting, and shiver at T0 (time of extubation), and at 5 (T5), 10 (T10), and 30 minutes (T30) after extubation. Sixty-four patients were studied. Time to extubation was 11 ± 6 min for Block and 20 ± 10 min for Morphine group (P>0.001). Median Aldrete score at T0 was 9 in the Block and 6.5 in the Morphine group (PAldrete score ≥ 8 (P<0.001). Systolic blood pressure was higher in the Block than in Morphine patients at T0 and T5. This study demonstrates shorter time to extubation and better emergence from anesthesia when total intravenous anesthesia is associated with superficial cervical block than with morphine as transition analgesia.

  9. One-year follow-up of the nutritional status of patients undergoing liver transplantation

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    Maria Eugênia Deutrich Aydos

    Full Text Available Background: Choosing the method of nutritional assessment is essential for proper follow-up of the nutritional status of patients undergoing liver transplantation. Objectives: Evaluate and compare the nutritional status of cirrhotic patients before and after liver transplantation over a year by different methods of nutritional assessment. Methods: Patients undergoing liver transplantation were assessed in five phases: pre-transplant, 1, 3, 6 and 12 months after transplantation at the hospital Santa Casa de Misericordia de Porto Alegre, RS, Brazil. The methods used for nutritional assessment were anthropometry, grip strength of the non-dominant hand (HGS by dynamometry, thickness of the adductor pollicis muscle (APM and phase angle (PA by bioelectrical impedance analysis (BIA. In all evaluations, the same measurements were taken. Results: Evaluations were performed in 22 patients. Methods that showed a higher prevalence of malnourished patients before transplantation were PA by BIA (25%, arm muscle circumference (AMC (21.9% and arm circumference (AC (18.8%. When comparing the nutritional status of patients during follow-up, there was a significant difference only in the evaluation methods AC, triceps skinfold thickness and PA by BIA. At the end, the methods of nutritional assessment were compared again. They showed a significant statistical difference, with HGS being the best method for detecting malnutrition. Conclusions: In conclusion, it is suggested that the method PA by BIA could be widely used with this population since the results are consistent with other findings in the literature and they are significant, reliable, and reproducible.

  10. THE EFFECT OF CINACALCET (SENSIPAR®) ON INTRAOPERATIVE FINDINGS IN TERTIARY HYPERPARATHYROIDISM PATIENTS UNDERGOING PARATHYROIDECTOMY

    Science.gov (United States)

    Somnay, Yash R.; Weinlander, Eric; Schneider, David F.; Sippel, Rebecca S.; Chen, Herbert

    2014-01-01

    Introduction Tertiary hyperparathyroidism (3HPTH) patients who undergo parathyroidectomy are often managed with calcium lowering medications such as cinacalcet (Sensipar®) preceding surgery. Here, we assess how cinacalcet (Sensipar®) treatment influences intraoperative PTH (IOPTH) kinetics and surgical findings in 3HPTH patients undergoing parathyroidectomy. Methods 116 retrospectively reviewed 3HPTH patients underwent, parathyroidectomy of which 14 were on cinacalcet and 112 were on no drug. IOPTH levels fitted to linear curves vs. time were used to evaluate the role of cinacalcet. Results Cinacalcet did not significantly correlate with rates of cure (p=0.41) or recurrence (p=0.54). Patients on cinacalcet experienced a significantly steeper decline in IOPTH compared to those not on medication (p=0.005). Cinacalcet treatment was associated with a significant increase in rate of hungry bones (p=0.04). Weights of the heaviest glands resected (p=0.02) and preoperative PTH levels (p=0.0004) were significantly higher among patients on cinacalcet. Conclusions Perioperative cinacalcet treatment in 3HPTH patients alters IOPTH kinetics by causing a steeper IOPTH decline, but does not require modifying standard IOPTH protocol. Although cinacalcet use does not adversely affect cure rates, it is associated with higher preoperative PTH and an increased incidence of hungry bones, hence serving as an indicator of more severe disease. Cinacalcet does not need to be held prior to surgery. PMID:25456900

  11. A comparison of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy

    Institute of Scientific and Technical Information of China (English)

    Chenglan Xie; Congjin Ju; Jiawen Cheng; Xuejun Yan; Dengquan Guo

    2009-01-01

    Objective:To assess the effects of lightwand and laryngoscopic intubation techniques in patients undergoing laparoscopic cholecystectomy (LC). Methods: 300 ASA physical status Ⅰ and Ⅱ patients, undergoing LC, were randomly assigned to two groups, with 150 cases in each group. Patients in the LS group underwent endotracheal intubation using a standard direct-suspension laryngoscopic technique. Patients in the LW group were intubated by using transillumination with a lightwand. Mean arterial pressure and heart rate were recorded before induction, and at 1, 3 and 5 min after intubation. The incidence and of sore throat, hoarseness, and dysphagia was assessed twenty-four hours after surgery. Results: This study demonstrated no clinically significant difference in cardiovascular variables between the two techniques. Patients had a significantly lower incidence of sore throat, hoarseness, and dysphagia when the lightwand was used for intubation. Conclusion: This study suggests that lightwand intubation may decrease the incidence of postoperative sore throat, hoarseness,and dysphagia, thereby potentially increasing satisfaction in surgical patients. Therefore, more frequent use of the lightwand is recommended for endotracheal intubation.

  12. Aluminum concentrations in serum, dialysate, urine and bone among patients undergoing continuous ambulatory peritoneal dialysis (CAPD)

    DEFF Research Database (Denmark)

    Joffe, P; Olsen, F; Heaf, J G

    1989-01-01

    Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations in the d......Aluminum (Al) concentration in serum, urine, and dialysate was estimated in 21 patients undergoing continuous ambulatory peritoneal dialysis (CAPD). In 12 of the patients bone Al concentration was measured as well. Mean serum Al level was 32.4 +/- 21.0 micrograms/l. The Al concentrations...... in the dialysate and urine were 9.1 +/- 4.1 micrograms/l and 52.5 +/- 47.3 micrograms/l, respectively. Bone Al concentration was 21.0 +/- 14.9 ppm and correlated significantly with concentrations of Al in serum (p less than 0.01) and dialysate (p less than 0.01). A mass transfer (MT) from the patients...... to the dialysate was observed in all patients (-44.0 +/- 28.8 micrograms/24 h). There was a highly significant correlation between peritoneal Al MT and serum Al (p less than 0.001), actual Al consumption (p less than 0.05) and bone Al concentration (p less than 0.005) supporting the existence of an overflow...

  13. Relation of metformin treatment to clinical events in diabetic patients undergoing percutaneous intervention.

    Science.gov (United States)

    Kao, John; Tobis, Jonathan; McClelland, Robyn L; Heaton, Melissa R; Davis, Barry R; Holmes, David R; Currier, Jesse W

    2004-06-01

    Diabetic patients undergoing coronary interventions have worse clinical and angiographic outcomes than do patients without diabetes. Metformin, an insulin sensitizer, may decrease the occurrence of these outcomes. Diabetic patients in the Prevention of Restenosis with Tranilast and its Outcomes Trial were identified through their medical records (n = 2,772). In this trial, 1,110 diabetic patients received nonsensitizer therapy (insulin and/or sulfonylureas) and 887 received sensitizer therapy (metformin with or without additional therapy). Logistic regression was used to obtain odds ratios (ORs) (sensitizer vs nonsensitizer therapy) of any clinical event (death, myocardial infarction, or ischemia-driven target vessel revascularization) and adjusted for multiple risk factors. Multivariate analysis showed no effect of lesion characteristics on clinical outcomes. Compared with patients on nonsensitizer therapy, those on sensitizer therapy showed an adjusted OR of 0.72 (95% confidence interval [CI] 0.57 to 0.91, p = 0.005) for any clinical event. The differences between the nonsensitizer therapy group and the sensitizer group were attributable mainly to decreased rates of death (OR 0.39, 95% CI 0.19 to 0.77, p = 0.007) and myocardial infarction (OR 0.31, 95% CI 0.15 to 0.66, p = 0.002). In our retrospective analysis, use of metformin in diabetics undergoing coronary interventions appeared to decrease adverse clinical events, especially death and myocardial infarction, compared with diabetic patients treated with nonsensitizer therapy.

  14. Procedural Predictors of Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Rai, Ansaar T., E-mail: ansaar.rai@gmail.com; Jhadhav, Yahodeep; Domico, Jennifer [West Virginia University Health Sciences Center, Interventional Neuroradiology (United States); Hobbs, Gerald R. [West Virginia University Health Sciences Center, Department of Community Medicine (United States)

    2012-12-15

    Purpose: To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS). Materials and Methods: This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grade 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion). Results: A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality. Conclusion: Angiographic findings and preprocedure variables can help

  15. Unnecessary axillary surgery for patients with node-negative breast cancer undergoing total mastectomy.

    Science.gov (United States)

    Olaya, Windy; Morgan, John W; Lum, Sharon S

    2011-09-01

    To identify factors associated with the use of axillary lymph node dissection (ALND) as the initial axillary staging in node-negative breast cancer patients undergoing total mastectomy. California Cancer Registry study. Academic research. Women treated with total mastectomy for Tis, T1, or T2 node-negative breast carcinoma treated between January 1, 2004, and December 31, 2008. Proportions of patients who underwent ALND without prior sentinel lymph node dissection were compared by demographic characteristics. Of 18,238 women treated with total mastectomy for Tis, T1, or T2 node-negative breast carcinoma, 35.1% underwent initial axillary staging by ALND without prior sentinel lymph node dissection. On multivariable analyses, patients were significantly more likely to undergo ALND if they had T2 disease or were 65 years or older, were hormone receptor negative, of Hispanic or Asian/Pacific Islander race/ethnicity, of lower socioeconomic quintile, operated on during earlier years of the study period, and not treated by a hospital cancer program approved by the American College of Surgeons. More than one-third of patients in California who underwent total mastectomy for treatment of early-stage node-negative breast carcinoma received ALND without prior sentinel lymph node dissection; furthermore, certain subsets of patients have higher odds of undergoing ALND alone. To avoid the unnecessary morbidity of ALND in early-stage breast carcinoma, further research is required to elucidate how tumor, patient, and system factors can be modified to improve delivery of optimal breast cancer care.

  16. Inter-individual differences in cytokine release in patients undergoing cardiac surgery with cardiopulmonary bypass

    Science.gov (United States)

    Roth-Isigkeit, A; Hasselbach, L; Ocklitz, E; Brückner, S; Ros, A; Gehring, H; Schmucker, P; Rink, L; Seyfarth, M

    2001-01-01

    Cardiac surgery with cardiopulmonary bypass (CPB) leads to a systemic inflammatory response with secretion of cytokines (e.g. IL-6, TNF-α, IL-1β and sIL-2R). The objective of the following study was to investigate in vitro and in vivo cytokine responses and white blood cell counts (WBC) of patients with high versus low cytokine secretion after a coronary artery bypass grafting (CABG) procedure. Twenty male patients undergoing elective CABG surgery with CPB under general anaesthesia were enrolled in the study. On the day of surgery (postoperatively), serum levels of TNF-α and IL-1β were significantly higher in patients of the high IL-6 level group compared to the respective values in the patient group with low IL-6 levels. The inter-individual differences in IL-6 release in patients undergoing CABG surgery with CPB were accompanied by differences in the release of other cytokines, such as TNF-α, IL-1β and sIL-2R. To understand whether genetic background plays a role in influencing cytokine plasma levels under surgical stress, we examined the distribution of polymorphic elements within the promoter regions of the TNF-α and IL-6 genes, and determined their genotype regarding the BAT2 gene and TNF-β intron polymorphisms. Our preliminary data suggests that regulatory polymorphisms in or near the TNF locus, more precisely the allele set 140/150 of the BAT2 microsatellite marker combined with the G allele at −308 of the TNF-α gene, could be one of the genetic constructions providing for a less sensitive response to various stimuli. Our results suggest: (1) close relationships between cytokine release in the postoperative period, and (2) inter-individually varying patterns of cytokine release in patients undergoing CABG surgery with CPB. PMID:11472429

  17. Pattern of liver function tests in morbidly obese Saudi patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ahmad Al Akwaa

    2011-01-01

    Full Text Available Background/Aim: Morbidly obese patients have a high prevalence of fatty liver disease and its serious complications, and high prevalence of abnormal liver function tests (LFT. The LFT can give a clue to the liver damage and correlate with activity. We aim to study the pattern of LFT in morbidly obese Saudi patients undergoing bariatric surgery in Eastern region. Patients and Methods: Medical records of patients undergoing bariatric surgery were reviewed. Demographic data, comorbid conditions, and medications taken were recorded. Intraoperative liver appearance was noted. Patients with alcohol intake or without LFT were excluded. Results: Out of 113 patients, 15 patients were excluded, and of the remaining 98 patients analyzed, 58.2% were females. Mean age was 33.1 ± 8.87 years. Mean body mass index (BMI was 53.7 ± 1.27 kg/m 2 . Abnormal LFT (alanine aminotransaminase (ALT, aspartate aminotransaminase (AST alkaline phosphatase (ALK, and Gamma glutamyl transpeptidase (GTT were observed in 17.3%, with 1.5 to 2 times the upper limit of normal. ALT was most elevated in 12.2%. Abdominal ultrasonography was done in 67 (68.4% patients, of whom 51 (76% had fatty liver. Comorbid conditions including diabetes mellitus, hypertension, hyperlipidemia, bronchial asthma, and obstructive sleep apnea were observed in 51 (51.50% patients, eight of them (16.3% had abnormal LFT. No intraoperative changes of cirrhosis were observed. Conclusion: The prevalence of abnormal LFT is low in morbidly obese patients from the eastern region of Saudi Arabia. A prospective study with a larger sample and liver biopsy, is needed to clarify the findings.

  18. A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass.

    Science.gov (United States)

    Odaka, Mizuho; Minakata, Kenji; Toyokuni, Hideaki; Yamazaki, Kazuhiro; Yonezawa, Atsushi; Sakata, Ryuzo; Matsubara, Kazuo

    2015-08-01

    This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. This novel protocol was assessed by comparing patients undergoing open heart surgery before (control group; n = 30) and after its implementation (protocol group; n = 31) at Kyoto University Hospital between July 2012 and January 2013. Surgical site infections (SSIs) were observed in 4 control group patients (13.3 %), whereas no SSIs were observed in the protocol group patients (P protocol group (P protocol significantly decreased the total antibiotic dose used in the perioperative period (P protocol group patients required this additional change in the antibiotic regimen (P protocol based on preoperative kidney function effectively prevents SSIs in patients undergoing open heart surgery.

  19. Wearable impedance monitoring system for dialysis patients.

    Science.gov (United States)

    Bonnet, S; Bourgerette, A; Gharbi, S; Rubeck, C; Arkouche, W; Massot, B; McAdams, E; Montalibet, A; Jallon, P

    2016-08-01

    This paper describes the development and the validation of a prototype wearable miniaturized impedance monitoring system for remote monitoring in home-based dialysis patients. This device is intended to assess the hydration status of dialysis patients using calf impedance measurements. The system is based on the low-power AD8302 component. The impedance calibration procedure is described together with the Cole parameter estimation and the hydric volume estimation. Results are given on a test cell to validate the design and on preliminary calf measurements showing Cole parameter variations during hemodialysis.

  20. The Need for Guidelines in Asplenic Patients Undergoing Total Joint Arthroplasty: A Case Report

    Directory of Open Access Journals (Sweden)

    S. R. Shaarani

    2012-01-01

    Full Text Available There are currently no guidelines for splenectomy patient undergoing total joint arthroplasty. We present a case history of a 63-year-old man with a history of splenectomy that underwent a total knee arthroplasty with standard intravenous antibiotic prophylaxis. Two weeks postoperatively, he developed a prosthetic joint infection and followed the standard antimicrobial management with intravenous and oral antibiotics prior to having revision surgery. We propose that there are guidelines to properly manage these patients in the pre- and perioperative setting following an orthopaedic procedure.

  1. Patients undergoing radical prostatectomy have a better survival than the background population

    DEFF Research Database (Denmark)

    Andreas Røder, Martin; Brasso, Klaus; Drimer Berg, Kasper;

    2013-01-01

    INTRODUCTION: The objective of this study was to investigate standardised relative survival and mortality ratio for patients undergoing radical prostatectomy for localized prostate cancer at our institution. MATERIAL AND METHODS: Between 1995 and 2010, a total of 1,350 consecutive patients underw...... better than expected in the age-matched background population. This finding is likely explained by selection bias. Although the results indicate an excellent outcome in terms of cancer control, the efficacy of prostatectomy for localized prostate cancer remains at debate....

  2. Pseudo-outbreak of pseudomonas aeruginosa in HIV-infected patients undergoing fiberoptic bronchoscopy

    DEFF Research Database (Denmark)

    Kolmos, H J; Lerche, A; Kristoffersen, Kirsten Lydia

    1994-01-01

    Pseudomonas aeruginosa was isolated from bronchoalveolar lavage fluid from 8 consecutive patients undergoing bronchoscopy at an infectious diseases unit. None of the patients developed signs of respiratory tract infection that could be ascribed to the organism. The source of contamination...... was the suction channels of 2 fiberoptic bronchoscopes which, due to a lapse in routine procedures, were not cleansed manually prior to disinfection with glutaraldehyde. Although rarely of pathogenetic importance, the possible presence of P. aeruginosa in lavage fluids should never be discounted, as it may...

  3. Lymphoscintigraphy as an adjunctive procedure in the perioperative assessment of patients undergoing microlymphaticovenous anastomoses

    Energy Technology Data Exchange (ETDEWEB)

    Sacks, G.A.; Sandler, M.P.; Born, M.L.; Clanton, J.A.; Franklin, J.D.; Partain, C.L.

    1983-07-01

    Microlymphaticovenous anastomoses provide a potential for reducing lymphedema of the upper extremity complicating radical mastectomy or irradiation. Lymphoscintigraphy with technetium isotopes is a valuable investigative modality in the perioperative evaluation of patients undergoing this surgical procedure. The radionuclide studies provide information regarding structural change and physiologic derangement with a low radiation dose to the patient. It is a simple, painless procedure requiring minimal skill and no surgical intervention. In addition, a reproducible method for preparing a radiocolloid suitable for lymphatic imaging using an approved drug as a precursor has been developed.

  4. Advanced thymic cancer treated with carboplatin and paclitaxel in a patient undergoing hemodialysis.

    Science.gov (United States)

    Miura, Satoru; Kagamu, Hiroshi; Sakai, Takehito; Nozaki, Koichiro; Asakawa, Katsuaki; Moro, Hiroshi; Okajima, Masaaki; Watanabe, Satoshi; Yamamoto, Suguru; Iino, Noriaki; Goto, Shin; Kazama, Junichiro James; Yoshizawa, Hirohisa; Narita, Ichiei

    2015-01-01

    A 53-year-old man with an asymptomatic anterior mediastinal tumor undergoing hemodialysis was referred to our institution. He was diagnosed with thymic basaloid carcinoma based on the findings of a chest tomography-guided biopsy and successfully treated with carboplatin (300 mg/m(2)/day) and paclitaxel (200 mg/m(2)/day) on day 1 for six three-week cycles. To our knowledge, this is the first report regarding the efficiency of a carboplatin dose-definition method based on the body surface area with paclitaxel in a hemodialysis patient. This report may therefore be useful for treating hemodialysis patients who are candidates for carboplatin and paclitaxel therapy.

  5. Intra-operative haemodynamic volatility in a patient undergoing retroperitoneal cyst excision

    Directory of Open Access Journals (Sweden)

    Thrivikrama Padur Tantry

    2012-01-01

    Full Text Available Excision of a suspected retroperitoneal, duodenal duplication cyst was performed in a pre-operatively normotensive patient under combined epidural and general anaesthesia. Intraoperatively, the cystic tumour was discovered to be a retroperitoneal mass, free from duodenal or adrenal origin. Development of severe arrhythmias, ST segment changes and hypertensive spikes during cyst handling and dissection suggested the possibility of a catecholamine-secreting tumour. These were managed effectively with pharmacological agents. Subsequently, histopathology of the specimen revealed a paraganglioma. Vasoactive tumour has to be suspected in every patient undergoing anaesthesia for retroperitoneal cystic lesion.

  6. Cognitive Function in Patients Undergoing Arthroplasty: The Implications for Informed Consent

    Directory of Open Access Journals (Sweden)

    N. Demosthenous

    2011-01-01

    Full Text Available Obtaining informed consent for an operation is a fundamental daily interaction between orthopaedic surgeon and patient. It is based on a patient's capacity to understand and retain information about the proposed procedure, the potential consequences of having it, and the alternative options available. We used validated tests of memory on 59 patients undergoing lower limb arthroplasty to assess how well they learned and recalled information about their planned procedure. All patients showed an ability to learn new material; however, younger age and higher educational achievement correlated with better performance. These results have serious implications for orthopaedic surgeons discussing planned procedures. They identify groups of patients who may require enhanced methods of communicating the objectives, risks, and alternatives to surgery. Further research is necessary to assess interventions to improve communication prior to surgery.

  7. Development of Information System for Patients with Cleft Lip and Palate undergoing Operation.

    Science.gov (United States)

    Augsornwan, Darawan; Pattangtanang, Pantamanas; Surakunprapha, Palakorn

    2015-08-01

    Srinagarind Hospital has 150-200 patients with cleft lip and palate each year. When patients are admitted to hospital for surgery patients and family feel they are in a crisis of life, they feel fear anxiety and need to know about how to take care of wound, they worry if patient will feel pain, how to feed patients and many things about patients. Information is very important for patients/family to prevent complications and help their decision process, decrease parents stress and encourage better co-operation. To develop information system for patients with cleft lip-palate undergoing operation. This is an action research divided into 3 phases. Phase 1 Situation review: in this phase we interview, nursing care observation, and review nursing documents about the information giving. Phase 2 Develop information system: focus groups, for discussion about what nurses can do to develop the system to give information to patients/parents. Phase 3 evaluation: by interviewing 61 parents using the structure questionnaire. 100 percent of patients/parents received information but some items were not received. Patients/parents satisfaction was 94.9 percent, no complications. The information system development provides optimal care for patients and family with cleft lip and palate, but needs to improve some techniques or tools to give more information and evaluate further the nursing outcome after.

  8. Evaluation of reactivation of HSV1, HHV6, CMV and EBV in a population of patients undergoing allogeneic bone marrow transplantation

    Directory of Open Access Journals (Sweden)

    Caterina Matinato

    2011-06-01

    Full Text Available Herpes viruses are recognized as important pathogens as a result of viral reactivation in immunocompromised hosts, especially in patients undergoing bone marrow transplantation. Objectives of this study were the assessment of the reactivation of herpes virus HSV1, HHV6, CMV and EBV and the correlation between viral reactivation and progression of transplantation in a population of patients undergoing allogeneic bone marrow transplantation at Fondazione IRCCS Ospedale Maggiore Ca’ Granda Policlinico, Milan. Viral DNA was detected and quantified by Real Time PCR in a population of 35 patients undergoing allogeneic bone marrow transplantation. The viral reactivation was observed in 7 patients for HSV1 (20%, 6 patients for HHV6 (17.1%, 11 patients for CMV (31.4% and 4 patients for EBV (11.4%. Difference in the incidence of aGVDH between patients with viral reactivation versus those for which there was no reactivation was statistically significant. These data confirm the importance of monitoring viral load for the management of antiviral therapy in order to prevent CMV disease and complications related to herpes viruses reactivation.

  9. Prognostic Value of Reverse Dipper Blood Pressure Pattern in Chronic Kidney Disease Patients not Undergoing Dialysis: Prospective Cohort Study

    Science.gov (United States)

    Wang, Cheng; Ye, Zengchun; Li, Yan; Zhang, Jun; Zhang, Qunzi; Ma, Xinxin; Peng, Hui; Lou, Tanqi

    2016-01-01

    The “reverse dipping” blood pressure (BP) pattern has been studied among the general population and in individuals suffering from hypertension. However, the prognosis of this pattern in chronic kidney disease (CKD) patients is not known. We monitored BP throughout the day and followed health outcomes in 588 CKD patients admitted to our hospital. Time to all-cause mortality, cardiovascular mortality, renal events and cardiovascular events was recorded. Multivariate-adjusted Cox regression analyses were carried out to detect the prognostic value of a reverse dipping BP pattern. Prevalence of a “dipper”, “non-dipper” and “reverse dippers” was 34.69%, 43.54% and 18.03%, respectively. Patients with a reverse dipping pattern had a higher prevalence of total mortality, cardiovascular mortality, renal events and cardiovascular events than patients with a dipping pattern (P < 0.025). Multivariate-adjusted Cox regression analyses showed that reverse dippers (versus dippers) were associated with a higher risk of total mortality (hazard ratio [HR], 5.08; 95% confidence interval [CI], 1.79~14.47), cardiovascular mortality (4.17; 1.25~13.88), renal events (3.00; 1.59~5.65) and cardiovascular events (4.12; 1.78~9.51) even after adjustment by 24-h systolic BP. These data suggest that a reverse dipping BP pattern, independent of 24-h levels of systolic BP, has prognostic value in CKD patients not undergoing dialysis. PMID:27713498

  10. Evaluation of the frequency and accuracy of gonad shield placement in patients undergoing pelvic radiography

    Energy Technology Data Exchange (ETDEWEB)

    Karami, V.; Zabihzadeh, Mansour; Sarikhani, S. [Ahvaz Jundishapur University of Medical Sciences, Ahvaz (Iran, Islamic Republic of)

    2016-11-01

    Gonad shielding has been advocated to reduce radiation exposure in patients undergoing pelvic radiography. The aim of this study is to evaluate the frequency and accuracy of gonad shield placement in patients undergoing pelvic radiography. A retrospective study was performed on 1230 anteroposterior (AP) pelvic radiographs of 939 children under 16 years old. All the radiographs were reviewed to determine the frequency of gonad shielding and to evaluate whether gonad shields were correctly positioned when they are used. The gonad shield was present in 82 radiographs (30 girls and 52 boys) and was completely disregarded in 1148 radiographs. From 82 images which shield was present, the gonad shields adequately positioned in 28 radiographs (3 girls and 25 boys) and in the remaining 54 radiographs, the shield did not adequately protected the gonads due to incorrect placement of the shield. The inaccuracy placement and absence of gonad shields were more common in girls than boys (P-value < 0.05). More care should be taken to correctly positioning of the gonad shields in boys and its usage should be encouraged. However, the practice of ovarian shielding is not an effective way to reduce radiation exposure in girls undergoing pelvis radiography. (author)

  11. The pharmacokinetics of propofol in ICU patients undergoing long-term sedation.

    Science.gov (United States)

    Smuszkiewicz, Piotr; Wiczling, Paweł; Przybyłowski, Krzysztof; Borsuk, Agnieszka; Trojanowska, Iwona; Paterska, Marta; Matysiak, Jan; Kokot, Zenon; Grześkowiak, Edmund; Bienert, Agnieszka

    2016-11-01

    The aim of this study was to characterize the pharmacokinetics (PK) of propofol in ICU patients undergoing long-term sedation and to assess the influence of routinely collected covariates on the PK parameters. Propofol concentration-time profiles were collected from 29 patients. Non-linear mixed-effects modelling in NONMEM 7.2 was used to analyse the observed data. The propofol pharmacokinetics was best described with a three-compartment disposition model. Non-parametric bootstrap and a visual predictive check were used to evaluate the adequacy of the developed model to describe the observations. The typical value of the propofol clearance (1.46 l/min) approximated the hepatic blood flow. The volume of distribution at steady state was high and was equal to 955.1 l, which is consistent with other studies involving propofol in ICU patients. There was no statistically significant covariate relationship between PK parameters and opioid type, SOFA score on the day of admission, APACHE II, predicted death rate, reason for ICU admission (sepsis, trauma or surgery), gender, body weight, age, infusion duration and C-reactive protein concentration. The population PK model was developed successfully to describe the time-course of propofol concentration in ICU patients undergoing prolonged sedation. Despite a very heterogeneous group of patients, consistent PK profiles were observed. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  12. The Effect of Antifibrinolytic Prophylaxis on Postoperative Outcomes in Patients Undergoing Cardiac Operations

    Science.gov (United States)

    Koul, Abhinav; Ferraris, Victor; Davenport, Daniel L; Ramaiah, Chandrashekhar

    2012-01-01

    Antifibrinolytic agents such as aprotinin and epsilon aminocaproic acid limit postoperative bleeding and blood transfusion in patients undergoing cardiac operations using cardiopulmonary bypass (CPB). Recent evidence suggests that these agents have adverse side effects that influence operative mortality and morbidity. We studied postoperative bleeding, transfusion rates, and operative outcomes in our patients in order to assess the efficacy of these agents during cardiac operations requiring CPB. We reviewed records of 520 patients undergoing a variety of cardiac operations between January 2005 and May 2009. We measured multiple variables including pre-operative risk factors, antifibrinolytic agent used, and outcomes of operation, such as measures of bleeding and blood transfusion, as well as serious operative morbidity and mortality. Postoperative bleeding rates varied significantly between patients receiving aprotinin and those receiving aminocaproic acid (P 0.05), though individuals in the aprotinin group did receive FFP more frequently than patients in the aminocaproic acid group (P 0.05). Our study shows that aprotinin is more effective at controlling operative site bleeding than aminocaproic acid. Reduced operative site bleeding did not portend better outcome or differences in transfusion requirements. Aminocaproic acid remains a safe and cost-effective option for antifibrinolytic prophylaxis because of unavailability of aprotinin. PMID:23101999

  13. Effects of hand massage on anxiety in patients undergoing ophthalmology surgery using local anesthesia

    Directory of Open Access Journals (Sweden)

    Jafar Rafiei Kiasari

    2012-08-01

    Full Text Available Introduction: Anxiety is a common disorder in patients before surgery. Inappropriately managed anxiety can cause psychological and physiological reactions and will affect the process of surgery and recovery. Therefore, this study examined the effects of hand mas-sage on anxiety in patients undergoing ophthalmology surgery using local anesthesia. Methods: In this interventional study, 52 patients who were supposed to undergo oph-thalmology surgery using local anesthesia were studied. Patients were randomly as-signed to two groups of intervention, who received hand massage before surgery (n = 27 and control (n = 25. Massaging lasted for 5 minutes (2.5 minutes on each hand before surgery. Stroking and scrubbing methods were performed by 2 trained research-ers. Anxiety level, blood pressure, heart rate, and respiratory rate were measured before and after the intervention in both groups. Anxiety was evaluated using Spielberger State-Trait Anxiety Inventory. Data was analyzed by chi-square, independent samples t-test, and paired t-test. Results: There were no significant differences in mean anxiety, systolic blood pressure, diastolic blood pressure, heart rate, and respiratory rate between the two groups before the intervention (p > 0.05. However, there was a significant differenc in the mean stress level between the two groups after the intervention (p 0.05. Conclusion: Our findings suggested that 5 minutes of hand massage before ophthalmology surgery (under local anesthesia could reduce anxiety. Therefore, this method can be used to increase patient comfort and reduce anxiety before surgical interventions.

  14. Uncorrected and Albumin-Corrected Calcium, Phosphorus, and Mortality in Patients Undergoing Maintenance Dialysis.

    Science.gov (United States)

    Rivara, Matthew B; Ravel, Vanessa; Kalantar-Zadeh, Kamyar; Streja, Elani; Lau, Wei Ling; Nissenson, Allen R; Kestenbaum, Bryan; de Boer, Ian H; Himmelfarb, Jonathan; Mehrotra, Rajnish

    2015-07-01

    Uncorrected serum calcium concentration is the first mineral metabolism metric planned for use as a quality measure in the United States ESRD population. Few studies in patients undergoing either peritoneal dialysis (PD) or hemodialysis (HD) have assessed the association of uncorrected serum calcium concentration with clinical outcomes. We obtained data from 129,076 patients on dialysis (PD, 10,066; HD, 119,010) treated in DaVita, Inc. facilities between July 1, 2001, and June 30, 2006. After adjustment for potential confounders, uncorrected serum calcium excess mortality in patients on PD or HD (comparison group uncorrected calcium 9.0 to albumin concentration substantially attenuated the all-cause mortality hazard ratios (HRs) associated with uncorrected calcium Albumin-corrected calcium ≥10.2 mg/dl and serum phosphorus ≥6.4 mg/dl were also associated with increased risk for death, irrespective of dialysis modality. In summary, in a large nationally representative cohort of patients on dialysis, abnormalities in markers of mineral metabolism, particularly high concentrations of serum calcium and phosphorus, were associated with increased mortality risk. Additional studies are needed to investigate whether control of hypercalcemia and hyperphosphatemia in patients undergoing dialysis results in improved clinical outcomes.

  15. Narrative Based Medicine as a tool for needs assessment of patients undergoing hematopoietic stem cell transplantation.

    Science.gov (United States)

    Gargiulo, Gianpaolo; Sansone, Vincenza; Rea, Teresa; Artioli, Giovanna; Botti, Stefano; Continisio, Grazia Isabella; Ferri, Paola; Masi, Daniela; Risitano, Antonio Maria; Simeone, Silvio; La Sala, Rachele

    2017-03-14

    In the last years we have seen an ever increasing number of patients with haematologic disorders who need hematopoietic stem cell transplantation (HSCT). The whole sector of HSCT results, infact to be in a continous scientific and technological clinical progress, offering a very advanced care. Despite this, some aspects are underconsidered, some of which could be fundamental to determine the success of the care pathway, such as the experience of the illness by the patient. Using a Narrative Based Medicine approach we wanted to investigate clinical, psychosocial and organizational aspects of the patient's journey whilst undergoing HSCT. Various narrative interviews were conducted using non-structured approach. Results were analysed by thematic contents. Psycological dimension is the most compromised: above all emerged sentiments of oppression linked to the isolation period in the Low Bacterial Load (LBL) room. To note are also the different dynamics with which the patients perceive the organisation and hospital structures, and how much these factors can influence their care experience. Results suggest the need in clinical practice of an integration between qualitative and clinical approach, so as to permit the psychosocial and relational necessities to emerge, often unexpressed by patients undergoing HSCT.

  16. Nutritional status of patients with alcoholic cirrhosis undergoing liver transplantation: time trends and impact on survival.

    Science.gov (United States)

    Singal, Ashwani K; Kamath, Patrick S; Francisco Ziller, Nickie; DiCecco, Sara; Shoreibah, M; Kremers, Walter; Charlton, Michael R; Heimbach, Julie K; Watt, Kymberly D; Shah, Vijay H

    2013-08-01

    Alcoholic cirrhotics evaluated for liver transplantation are frequently malnourished or obese. We analyzed alcoholic cirrhotics undergoing transplantation to examine time trends of nutrition/weight, transplant outcome, and effects of concomitant hepatitis C virus (HCV) and/or hepatocellular carcinoma (HCC). Nutrition and transplant outcomes were reviewed for alcoholic cirrhosis with/without HCV/HCC. Malnutrition was defined by subjective global assessment. Body mass index (BMI) classified obesity. A total of 261 patients receiving transplants were separated (1988-2000, 2001-2006, and 2007-2011) to generate similar size cohorts. Mean BMI for the whole cohort was 28 ± 6 with 68% classified as overweight/obese. Mean BMI did not vary among cohorts and was not affected by HCV/HCC. While prevalence of malnutrition did not vary among cohorts, it was lower in patients with HCV/HCC (P graft/patient survival was 90% and not impacted by time period, HCV/HCC, or malnutrition after adjusting for demographics and model end-stage liver disease (MELD). Alcoholic cirrhotics undergoing transplantation are malnourished yet frequently overweight/obese. Among patients selected for transplantation, 1-year post-transplant graft/patient survival is excellent, have not changed over time, and do not vary by nutrition/BMI. Our findings support feasibility of liver transplantation for alcoholic cirrhotics with obesity and malnutrition.

  17. Characteristics of polypoid lesions in patients undergoing microsurgery of the larynx

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    Ido Filho, Jorge Massaaki

    2014-01-01

    Full Text Available Introduction: Dysphonia is the main symptom of lesions that affect the vocal tract. Many of those lesions may require surgical treatment. Polyps are one of the most common forms of vocal cord lesions and the most prevalent indication for laryngeal microsurgery. There are different types of polyps, and their different characteristics can indicate different prognosis and treatments. Aim: To conduct a comparative study of polypoid lesions (angiomatous and gelatinous in patients undergoing laryngeal microsurgery via an electronic protocol. Method: We prospectively evaluated 93 patients diagnosed with vocal fold polyps; the polyps were classified as angiomatous or gelatinous. Results: In total, 93 patients undergoing laryngeal microsurgery were diagnosed with vocal fold polyps. Of these, 63 (64.74% had angiomatous and 30 (32.26% gelatinous polyps. Most patients with angiomatous polyps were men; their polyps were frequently of medium size, positioned in the middle third of the vocal fold, and accompanied by minimal structural alterations (MSA. In contrast, the majority of patients with gelatinous polyps were women; their polyps were smaller, positioned in the middle and posterior third of the vocal fold, and were not accompanied by MSA. Both types of polyps were more frequently located on the right vocal fold. Conclusion: Angiomatous polyps were more frequently encountered than gelatinous polyps. In addition, correlations between polyp type and sex, polyp size, position, location, and the presence of MSA were observed. Different surgical techniques were used, but the postoperative results were similar and satisfactory after speech therapy.

  18. Effect of Desmopressin on Platelet Aggregation and Blood Loss in Patients Undergoing Valvular Heart Surgery

    Institute of Scientific and Technical Information of China (English)

    Lei Jin; Hong-Wen Ji

    2015-01-01

    Background:Blood loss after cardiac surgery can be caused by impaired platelet (PLT) function after cardiopulmonary bypass.Desmopressin or 1-deamino-8-D-arginine vasopressin (DDAVP) is a synthetic analog of vasopressin.DDAVP can increase the level of von Willebrand factor and coagulation factor Ⅷ,thus it may enhance PLT function and improve coagulation.In this study,we assessed the effects of DDAVP on PLT aggregation and blood loss in patients undergoing cardiac surgery.Methods:A total of 102 patients undergoing valvular heart surgery (from October 2010 to June 2011) were divided into DDAVP group (n =52) and control group (n =50).A dose of DDAVP (0.3 μtg/kg) was administered to the patients intravenously when they were being re-warmed.At the same time,an equal volume of saline was given to the patients in the control group.PLT aggregation rate was measured with the AggRAM four-way PLT aggregation measurement instrument.The blood loss and transfusion,hemoglobin levels,PLT counts,and urine outputs at different time were recorded and compared.Results:The postoperative blood loss in the first 6 h was significantly reduced in DDAVP group (202 ± 119 ml vs.258 ± 143 ml,P =0.023).The incidence of fresh frozen plasma (FFP) transfusion was decreased postoperatively in DDAVP group (3.8% vs.12%,P =0.015).There was no significant difference in the PLT aggregation,urine volumes,red blood cell transfusions and blood loss after 24 h between two groups.Conclusions:A single dose of DDAVP can reduce the first 6 h blood loss and FFP transfusion postoperatively in patients undergoing valvular heart surgery,but has no effect on PLT aggregation.

  19. Desflurane reinforces the efficacy of propofol target-controlled infusion in patients undergoing laparoscopic cholecystectomy.

    Science.gov (United States)

    Chen, Po-Nien; Lu, I-Cheng; Chen, Hui-Ming; Cheng, Kuang-I; Tseng, Kuang-Yi; Lee, King-Teh

    2016-01-01

    Whether low-concentration desflurane reinforces propofol-based intravenous anesthesia on maintenance of anesthesia for patients undergoing laparoscopic cholecystectomy is to be determined. The aim of this study was to investigate whether propofol-based anesthesia adding low-concentration desflurane is feasible for laparoscopic cholecystectomy. Fifty-two patients undergoing laparoscopic cholecystectomy were enrolled in the prospective, randomized, clinical trial. Induction of anesthesia was achieved in all patients with fentanyl 2 μg/kg, lidocaine 1 mg/kg, propofol 2 mg/kg, and rocuronium 0.8 mg/kg to facilitate tracheal intubation and to initiate propofol target-controlled infusion (TCI) to effect site concentration (Ce: 4 μg/mL with infusion rate 400 mL/h). The patients were then allocated into either propofol TCI based (group P) or propofol TCI adding low-concentration desflurane (group PD) for maintenance of anesthesia. The peri-anesthesia hemodynamic responses to stimuli were measured. The perioperative psychomotor test included p-deletion test, minus calculation, orientation, and alert/sedation scales. Group PD showed stable hemodynamic responses at CO2 inflation, initial 15 minutes of operation, and recovery from general anesthesia as compared with group P. There is no significant difference between the groups in operation time and anesthesia time, perioperative psychomotor functional tests, postoperative vomiting, and pain score. Based on our findings, the anesthetic technique combination propofol and desflurane for the maintenance of general anesthesia for laparoscopic cholecystectomy provided more stable hemodynamic responses than propofol alone. The combined regimen is recommended for patients undergoing laparoscopic cholecystectomy.

  20. Desflurane reinforces the efficacy of propofol target-controlled infusion in patients undergoing laparoscopic cholecystectomy

    Directory of Open Access Journals (Sweden)

    Po-Nien Chen

    2016-01-01

    Full Text Available Whether low-concentration desflurane reinforces propofol-based intravenous anesthesia on maintenance of anesthesia for patients undergoing laparoscopic cholecystectomy is to be determined. The aim of this study was to investigate whether propofol-based anesthesia adding low-concentration desflurane is feasible for laparoscopic cholecystectomy. Fifty-two patients undergoing laparoscopic cholecystectomy were enrolled in the prospective, randomized, clinical trial. Induction of anesthesia was achieved in all patients with fentanyl 2 μg/kg, lidocaine 1 mg/kg, propofol 2 mg/kg, and rocuronium 0.8 mg/kg to facilitate tracheal intubation and to initiate propofol target-controlled infusion (TCI to effect site concentration (Ce: 4 μg/mL with infusion rate 400 mL/h. The patients were then allocated into either propofol TCI based (group P or propofol TCI adding low-concentration desflurane (group PD for maintenance of anesthesia. The peri-anesthesia hemodynamic responses to stimuli were measured. The perioperative psychomotor test included p-deletion test, minus calculation, orientation, and alert/sedation scales. Group PD showed stable hemodynamic responses at CO2 inflation, initial 15 minutes of operation, and recovery from general anesthesia as compared with group P. There is no significant difference between the groups in operation time and anesthesia time, perioperative psychomotor functional tests, postoperative vomiting, and pain score. Based on our findings, the anesthetic technique combination propofol and desflurane for the maintenance of general anesthesia for laparoscopic cholecystectomy provided more stable hemodynamic responses than propofol alone. The combined regimen is recommended for patients undergoing laparoscopic cholecystectomy.

  1. Pharmacokinetics of ertapenem in critically ill patients with acute renal failure undergoing extended daily dialysis.

    Science.gov (United States)

    Burkhardt, Olaf; Hafer, Carsten; Langhoff, Anita; Kaever, Volkhard; Kumar, Vipul; Welte, Tobias; Haller, Hermann; Fliser, Danilo; Kielstein, Jan T

    2009-01-01

    Extended (daily) dialysis (EDD) is an increasingly popular mode of renal replacement therapy in the ICU (intensive care unit) as it combines the advantages of intermittent haemodialysis (IHD) and continuous renal replacement therapy (CRRT), i.e. excellent detoxification accompanied by cardiovascular tolerability. The aim of this study was to evaluate pharmacokinetics (PK) of ertapenem, the newest carbapenem with once-daily dosing, in critically ill patients with anuric acute renal failure (ARF) undergoing EDD. In a single-centre, prospective, open-label study six ICU patients with ARF undergoing EDD were treated with 1 g ertapenem given as a single intravenous dose. EDD was performed using a high-flux dialyzer (polysulphone, 1.3 m(2)). Blood and dialysate flow were 160 mL/min, and the length of treatment was 480 min. Plasma samples were collected at different time-points up to 24 h after medication. Drug concentrations were determined by a validated LC-MS method. Free drug concentrations were estimated using a two-class binding site equation. After a single dose of 1000 mg free ertapenem, protein-unbound plasma concentrations exceeded a MIC(90) value of 2 mg/L for >20 h after dosing. The clearance of the tested dialyzer was 38.5 +/- 14.2 mL/min. In contrast to patients undergoing regular IHD, in which a dose reduction is required, our data suggest that in patients treated with EDD a standard dose of ertapenem (1 g/day), i.e. dose for patients without renal failure, is required to maintain adequate plasma drug levels.

  2. 45. Nursing care of the patient undergoing coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    M. Bayoumi

    2015-10-01

    The patient undergoing CABG surgery deserves to have confidence that the professional nurse is knowledgeable, caring, efficient, and effective in providing necessary perioperative care. Proper preparation of the patient and significant others, expertise during the intraoperative phase, and a thorough knowledge base combined with skill and compassion of the nursing staff during the postoperative phase increase the likelihood of a positive outcome for the patient. A compassionate, knowledgeable, and skilled nurse caring for the patient after open heart surgery is an asset in the achievement of positive outcomes for the patient and his/her significant others. The care of the CABG patient is intense, complex, and rewarding. The patient is admitted to the intensive care unit unconscious, intubated, and completely dependent on advanced technology as well as the expert care of the health team. Typically 24–48 h after the surgery, the invasive lines have been discontinued, the patient no longer needs to be mechanically ventilated, organ system function is returning to normal, and the patient is now ready to work toward increasing independence. Cardiac surgery is not the cure for coronary artery disease. It gives the patient the opportunity to make needed lifestyle adjustments and achieve the highest degree of health possible. Nurses are a part of the team that makes this return to health a possibility for the patient.

  3. Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe.

    Science.gov (United States)

    Hortal, Javier; Muñoz, Patricia; Cuerpo, Gregorio; Litvan, Hector; Rosseel, Peter M; Bouza, Emilio

    2009-01-01

    Patients undergoing major heart surgery (MHS) represent a special subpopulation at risk for nosocomial infections. Postoperative infection is the main non-cardiac complication after MHS and has been clearly related to increased morbidity, use of hospital resources and mortality. Our aim was to determine the incidence, aetiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients who have undergone MHS in Europe. Our study was a prospective study of patients undergoing MHS in Europe who developed suspicion of VAP. During a one-month period, participating units submitted a protocol of all patients admitted to their units who had undergone MHS. Overall, 25 hospitals in eight different European countries participated in the study. The number of patients intervened for MHS was 986. Fifteen patients were excluded because of protocol violations. One or more nosocomial infections were detected in 43 (4.4%) patients. VAP was the most frequent nosocomial infection (2.1%; 13.9 episodes per 1000 days of mechanical ventilation). The microorganisms responsible for VAP in this study were: Enterobacteriaceae (45%), Pseudomonas aeruginosa (20%), methicillin-resistant Staphylococcus aureus (10%) and a range of other microorganisms. We identified the following significant independent risk factors for VAP: ascending aorta surgery (odds ratio (OR) = 6.22; 95% confidence interval (CI) = 1.69 to 22.89), number of blood units transfused (OR = 1.08 per unit transfused; 95% CI = 1.04 to 1.13) and need for re-intervention (OR = 6.65; 95% CI = 2.10 to 21.01). The median length of stay in the intensive care unit was significantly longer (P < 0.001) in patients with VAP than in patients without VAP (23 days versus 2 days). Death was significantly more frequent (P < 0.001) in patients with VAP (35% versus 2.3%). Patients undergoing aortic surgery and those with complicated post-intervention courses, requiring multiple transfusions or re-intervention, constitute a high

  4. The perioperative management of patients with left ventricular assist devices undergoing noncardiac surgery.

    Science.gov (United States)

    Barbara, David W; Wetzel, David R; Pulido, Juan N; Pershing, Bryan S; Park, Soon J; Stulak, John M; Zietlow, Scott P; Morris, David S; Boilson, Barry A; Mauermann, William J

    2013-07-01

    To describe the perioperative management of patients with left ventricular assist devices (LVADs) who require general anesthesia while undergoing noncardiac surgery (NCS) at a single, large tertiary referral center. Electronic medical records from September 2, 2005, through May 31, 2012, were retrospectively reviewed to evaluate the perioperative management and outcomes in LVAD patients undergoing NCS. Patients were included only if they required a general anesthetic and had previously been discharged from the hospital after initial LVAD implantation. Thirty-three patients with LVADs underwent general anesthesia for 67 noncardiac operations. The mean ± SD time from LVAD implantation to NCS was 317 ± 349 days. All but 1 patient had axial flow LVADs. Anticoagulation or antiplatelet agents were present within 7 days before NCS in 49 procedures (73%) and reversed in 32 of 49 (65%). No perioperative thrombotic complications related to anticoagulation or antiplatelet reversal were noted. Red blood cell, fresh frozen plasma, and platelet transfusions were administered during 10, 6, and 4 operations, respectively. The only intraoperative complication was surgical bleeding. Postoperative complications were present in 12 patients after NCS and were mainly composed of bleeding. Three patients died within 30 days of NCS, with the causes of death not attributed to NCS. Patients with LVAD safely underwent NCS in a multidisciplinary setting that included preoperative optimization by cardiologists familiar with LVADs when feasible. Anticoagulation or antiplatelet agents were present preoperatively in most patients with LVADs and were safely reversed when necessary for NCS. The relatively high occurrence of postoperative bleeding is consistent with previous series. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  5. Risk factors associated with venous thromboembolism in patients undergoing spine surgery.

    Science.gov (United States)

    Piper, Keaton; Algattas, Hanna; DeAndrea-Lazarus, Ian A; Kimmell, Kristopher T; Li, Yan Michael; Walter, Kevin A; Silberstein, Howard J; Vates, G Edward

    2017-01-01

    OBJECTIVE Patients undergoing spinal surgery are at risk for developing venous thromboembolism (VTE). The authors sought to identify risk factors for VTE in these patients. METHODS The American College of Surgeons National Surgical Quality Improvement Project database for the years 2006-2010 was reviewed for patients who had undergone spinal surgery according to their primary Current Procedural Terminology code(s). Clinical factors were analyzed to identify associations with VTE. RESULTS Patients who underwent spinal surgery (n = 22,434) were identified. The rate of VTE in the cohort was 1.1% (pulmonary embolism 0.4%; deep vein thrombosis 0.8%). Multivariate binary logistic regression analysis revealed 13 factors associated with VTE. Preoperative factors included dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race. Operative factors included surgery duration > 4 hours, emergency presentation, and American Society of Anesthesiologists Class III-V, whereas postoperative sepsis was the only significant postoperative factor. A risk score was developed based on the number of factors present in each patient. Patients with a score of ≥ 7 had a 100-fold increased risk of developing VTE over patients with a score of 0. The receiver-operating-characteristic curve of the risk score generated an area under the curve of 0.756 (95% CI 0.726-0.787). CONCLUSIONS A risk score based on race, preoperative comorbidities, and operative characteristics of patients undergoing spinal surgery predicts the postoperative VTE rate. Many of these risks can be identified before surgery. Future protocols should focus on VTE prevention in patients who are predisposed to it.

  6. Effects of music therapy under general anesthesia in patients undergoing abdominal surgery.

    Science.gov (United States)

    Kahloul, Mohamed; Mhamdi, Salah; Nakhli, Mohamed Said; Sfeyhi, Ahmed Nadhir; Azzaza, Mohamed; Chaouch, Ajmi; Naija, Walid

    2017-12-01

    Music therapy, an innovative approach that has proven effectiveness in many medical conditions, seems beneficial also in managing surgical patients. The aim of this study is to evaluate its effects, under general anesthesia, on perioperative patient satisfaction, stress, pain, and awareness. This is a prospective, randomized, double-blind study conducted in the operating theatre of visceral surgery at Sahloul Teaching Hospital over a period of 4 months. Patients aged more than 18 undergoing a scheduled surgery under general anesthesia were included. Patients undergoing urgent surgery or presenting hearing or cognitive disorders were excluded. Before induction, patients wore headphones linked to an MP3 player. They were randomly allocated into 2 groups: Group M (with music during surgery) and group C (without music). Hemodynamic parameters, quality of arousal, pain experienced, patient's satisfaction, and awareness incidence during anesthesia were recorded. One hundred and forty patients were included and allocated into 2 groups that were comparable in demographic characteristics, surgical intervention type and anesthesia duration. Comparison of these two groups regarding the hemodynamic profile found more stability in group M for systolic arterial blood pressure. A calm recovery was more often noted in group M (77.1% versus 44%, p < 10(-3)). The average Visual Analog Scale (VAS) score was lower in the intervention group (33.8 ± 13.63 versus 45.1 ± 16.2; p < 10(-3)). The satisfaction rate was significantly higher among the experimental group (81.4% versus 51.4%; p < 10(-3)). The incidence of intraoperative awareness was higher in group C (8 cases versus 3 cases) but the difference was not statistically significant. Music therapy is a non-pharmacological, inexpensive, and non-invasive technique that can significantly enhance patient satisfaction and decrease patients' embarrassing experiences related to perioperative stress, pain, and awareness.

  7. Caspofungin as antifungal prophylaxis in pediatric patients undergoing allogeneic hematopoietic stem cell transplantation: a retrospective analysis

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    Döring Michaela

    2012-07-01

    Full Text Available Abstract Background Pediatric patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT often receive intravenous liposomal amphotericin B (L-AmB as antifungal prophylaxis. There are no guidelines for antifungal prophylaxis in children in this situation. Caspofungin (CAS, a broad-spectrum echinocandin, could be an effective alternative with lower nephrotoxicity than L-AmB. Methods We retrospectively analyzed the safety, feasibility, and efficacy of CAS in our center, and compared the results with L-AmB as antifungal monoprophylaxis in pediatric patients undergoing HSCT. 60 pediatric patients received L-AmB (1 or 3 mg/kg bw/day and another 60 patients received CAS (50 mg/m2/day as antifungal monoprophylaxis starting on day one after HSCT. The median ages of patients receiving L-AmB and CAS were 7.5 years and 9.5 years, respectively. Results No proven breakthrough fungal infection occurred in either group during the median treatment period of 23 days in the L-AmB group and 24 days in the CAS group. One patient receiving CAS developed probable invasive aspergillosis. During L-AmB treatment, potassium levels significantly decreased below normal values. Patients treated with L-AmB had more drug-related side effects and an increased need for oral supplementation with potassium, sodium bicarbonate and calcium upon discharge as compared with the CAS group. CAS was well-tolerated and safe in this cohort of immunocompromised pediatric patients, who underwent high-dose chemotherapy and HSCT. Conclusion Prophylactic CAS and L-AmB showed similar efficacy in this biggest cohort of pediatric patients after allogeneic HSCT reported, so far. A prospective randomized trial in children is warranted to allow for standardized guidelines.

  8. Topics and structure in preoperative nursing consultations with patients undergoing colorectal cancer surgery.

    Science.gov (United States)

    Pettersson, Monica E; Öhlén, Joakim; Friberg, Febe; Hydén, Lars-Christer; Carlsson, Eva

    2016-11-08

    The preoperative education, which occurs in preoperative patient consultations, is an important part of the surgical nurse's profession. These consultations may be the building blocks of a partnership that facilitates communication between patient and nurse. The aim of the study was to describe topics and structure and documentation in preoperative nursing consultations with patients undergoing surgery for colorectal cancer. The study was based on analysis of consultations between seven patients and nurses at a Swedish university hospital. The preplanned preoperative consultations were audio-recorded and transcribed verbatim. The structure of the consultations was described in terms of phases and the text was analysed according to a manifest content analysis RESULTS: The consultations were structured on an agenda that was used variously and communicating different topics in an equally varied manner. Seven main topics were found: Health status, Preparation before surgery, Discovery, Tumour, Operation, Symptoms and Recovery after surgery. The topic structure disclosed a high number of subtopics. The main topics 'Discovery', 'Tumour' and 'Symptoms' were only raised by patients and occupied only 11% of the discursive space. Documentation was sparse and included mainly task-oriented procedures rather than patients' worries and concerns. There was no clear structure regarding preoperative consultation purpose and content. Using closed questions instead of open is a hindrance of developing a dialogue and thus patient participation. Preoperative consultation practice needs to be strengthened to include explicit communication of the consultations' purpose and agenda, with nurses actively discussing and responding to patients' concerns and sensitive issues. The results of the study facilitate the development of methods and structure to support person-centred communication where the patient is given space to get help with the difficult issues he/she may have when undergoing

  9. Retrospective analysis of perioperative factors on outcome of patients undergoing surgery for Moyamoya disease

    Directory of Open Access Journals (Sweden)

    Navneh Samagh

    2015-01-01

    Full Text Available Background: The short term outcome of patients undergoing surgery for Moyamoya disease can be affected by various perioperative factors. However, due to lesser prevalence of this disease in our country, data relating the effect of perioperative factors on the overall neurological outcomes of these patients is lacking. Aims: To analyze the effect of perioperative factors on the duration of postoperative hospital stay in patients undergoing surgery for Moyamoya disease. Settings and Design: It is a retrospective study analyzing various perioperative factors influencing the overall outcome of patients undergoing surgery for Moyamoya disease at a tertiary care centre in North India. Methods and Material: The medical records of all patients who underwent revascularization surgeries for Moyamoya disease from 2007 to till January 2014 were included for retrospective analysis. Various preoperative, intraoperative, and postoperative data were recorded. The data was statistically compared for short and prolonged hospital stay for various perioperative factors. The duration of post operative hospital stay was categorized as short (5 days. Statistical Analysis: Kolmogrov Smirnov test was applied to see the normality of continuous data. The association of various categorically classified data with 2 groups was found using Fisher Exact test. The trends in intraoperative hemodynamics were analysed using 2 way repeated measure Anova test. T-test was used for comparing two group means for various parameters. Results: A total of 15 patients were included in the study. One patient underwent surgery twice on two different occasions. Thirteen patients belonged to paediatric age group (<18 years. The type of anaesthetics used for induction and maintenance had no effect on patient outcome. Mean duration of anaesthesia was 2.45 (1.3-4.0 hours. The mean duration of hospital stay was 5.13 (3-10 days. Most of the parameters did not have significant effect on postoperative

  10. Retrospective analysis of perioperative factors on outcome of patients undergoing surgery for Moyamoya disease

    Science.gov (United States)

    Samagh, Navneh; Bhagat, Hemant; Grover, Vinod K.; Sahni, Neeru; Agarwal, Ashish; Gupta, Sunil K.

    2015-01-01

    Background: The short term outcome of patients undergoing surgery for Moyamoya disease can be affected by various perioperative factors. However, due to lesser prevalence of this disease in our country, data relating the effect of perioperative factors on the overall neurological outcomes of these patients is lacking. Aims: To analyze the effect of perioperative factors on the duration of postoperative hospital stay in patients undergoing surgery for Moyamoya disease. Settings and Design: It is a retrospective study analyzing various perioperative factors influencing the overall outcome of patients undergoing surgery for Moyamoya disease at a tertiary care centre in North India. Methods and Material: The medical records of all patients who underwent revascularization surgeries for Moyamoya disease from 2007 to till January 2014 were included for retrospective analysis. Various preoperative, intraoperative, and postoperative data were recorded. The data was statistically compared for short and prolonged hospital stay for various perioperative factors. The duration of post operative hospital stay was categorized as short (5 days). Statistical Analysis: Kolmogrov Smirnov test was applied to see the normality of continuous data. The association of various categorically classified data with 2 groups was found using Fisher Exact test. The trends in intraoperative hemodynamics were analysed using 2 way repeated measure Anova test. T-test was used for comparing two group means for various parameters. Results: A total of 15 patients were included in the study. One patient underwent surgery twice on two different occasions. Thirteen patients belonged to paediatric age group (<18 years). The type of anaesthetics used for induction and maintenance had no effect on patient outcome. Mean duration of anaesthesia was 2.45 (1.3-4.0) hours. The mean duration of hospital stay was 5.13 (3-10) days. Most of the parameters did not have significant effect on postoperative hospital stay

  11. Ultra Low-Dose Naloxone and Tramadol/Acetaminophen in Elderly Patients Undergoing Joint Replacement Surgery: A Pilot Study

    OpenAIRE

    Imasogie, Ngozi N; Sudha Singh; Watson, James T.; Debbie Hurley; Patricia Morley-Forster

    2009-01-01

    OBJECTIVE: A pilot study was conducted to assess whether both the rationale and feasibility exist for future randomized clinical trials to evaluate the combined use of naloxone infusion and tramadol/acetaminophen as opioid-sparing drugs in elderly patients undergoing lower extremity joint replacement surgery.DESIGN: Ten patients 70 years of age or older undergoing either total knee (n=7) or total hip (n=3) arthroplasty were treated prospectively. Each patient received two tablets of tramadol/...

  12. Effect of a Multimodal High Intensity Exercise Intervention in Cancer Patients Undergoing Chemotherapy

    DEFF Research Database (Denmark)

    Adamsen, Lis; Quist, Morten; Andersen, Christina

    2009-01-01

    Abstract: Objective To assess the effect of a multimodal group exercise intervention, as an adjunct to conventional care, on fatigue, physical capacity, general wellbeing, physical activity, and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment.......4 to 34.9, Peffect was seen on global health status/quality of life. Conclusion: A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant...... for advanced disease. Design: Randomised controlled trial. Setting: Two university hospitals in Copenhagen, Denmark. Participants: 269 patients with cancer; 73 men, 196 women, mean age 47 years (range 20-65) representing 21 diagnoses. Main exclusion criteria were brain or bone metastases. 235 patients...

  13. The role of MRI in patients undergoing transurethral resection of the prostate; Assessment of residual tumor

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    Sugimura, Kazuro; Kaji, Yasushi; Okizuka, Hiromi; Ishida, Tetsuya; Mizutani, Masami (Shimane Medical Univ., Izumo (Japan))

    1992-03-01

    This prospective study was designed to evaluate the role of MRI in patients undergoing transurethral resection of the prostate (TURP). Ten patients with prostatic carcinoma and 12 patients with benign prostatic hyperplasia (BPH) as controls were studied. MR findings of detection of primary tumor, periprostatic tissue invasion and seminal vesicle invasion were compared with pathologic findings. MRI detected 16 of 22 lesions rendering a sensitivity of 73%. MRI sensitivity of tumor depiction within the peripheral zone was 83%, specificity 84% and accuracy 84%. However, MR imaging depicted only 25% of tumor in the transition zone. The diagnostic accuracy in the prediction of local invasion was better in MRI (73%) than TRUS (37%). MRI was useful in evaluation of residual tumor in patients who underwent TURP. (author).

  14. Successful rescue of pure red cell aplasia in two aged patients undergoing pancrease-kindey transplantation

    Institute of Scientific and Technical Information of China (English)

    ZHANG Yin-fu; YANG Tong-han; WANG Qing-yu; Wang Ping-xian; Fan Ming-qi; Feng Jia-yu

    2001-01-01

    To explore the correlation between hypoimmunity and the occurrence of pure red cell aplasia (PRCA) in senile patients undergoing combined pancrease-kindey transplantation. Methods: PRCA occurred in 2 patients out of 5 who were performed combined pancrease-kindey transplantation.The general scheme of treatment mainly included selective administration of immunosuppressants and antivirus drugs, infusion of red blood cells on the basis of surveillance of parvorirus B19 and the ratio of T4 and T8 as well as the changes of the myelogram.Results: The myelogram of the patients returned to normal in 2 and 3 weeks after operation, respectively, and subsequent follow-up revealed no recurrence. Conclusion: This series illustrate the point that advanced age, hypo immunity, parvorirus B19 and immunosuppressants are vulnerable to PRCA. Combined treatment is an effectiveremedy for these patients.

  15. Feasibility, physical capacity, and health benefits of a multidimensional exercise program for cancer patients undergoing chemotherapy

    DEFF Research Database (Denmark)

    Adamsen, Lis; Midtgaard, Julie; Rorth, Mikael

    2003-01-01

    Cancer patients frequently experience considerable loss of physical capacity and general wellbeing when diagnosed and treated for their disease. The aim of this study was to evaluate the feasibility, physical capacity, and health benefits of a multidimensional exercise program for cancer patients...... during advanced stages of disease who are undergoing adjuvant or high-dose chemotherapy. The supervised program included high- and low-intensity activities (physical exercise, relaxation, massage, and body-awareness training). A total of 23 patients between 18 and 65 years of age (median 40 years......) participated in groups of seven to nine patients for 9 h weekly for 6 weeks. Physical capacity in terms of repetition maximum (RM) and maximal oxygen uptake (VO(2)max), physical activity level and psychosocial wellbeing (EORTC QLQ-C30, SF-36, HAD) were compared prior to and after completion of the program...

  16. Radiation exposure to caregivers from patients undergoing common radionuclide therapies: a review.

    Science.gov (United States)

    Stefanoyiannis, A P; Ioannidou, S P; Round, W H; Carinou, E; Mavros, M N; Liotsou, T; Geronikola-Trapali, X; Armeniakos, I; Chatziioannou, S N

    2015-12-01

    The contribution of radionuclide therapies (RNTs) to effective patient treatment is widely appreciated. The administration of high doses has necessitated investigating the potential radiation hazard to caregivers from patients undergoing RNTs. This work aimed to review the literature regarding measured effective doses to caregivers from such patients. The main selection criterion was the presence of real radiation exposure measurements. The results were categorised according to the treatment protocol and dose parameters. Analysis of the collected data demonstrated that the measured effective dose values were within the dose constraints defined by the International Commission on Radiological Protection, provided that the radiation protection instructions were followed by both patients and caregivers. In conclusion, the radiation risk for caregivers was almost negligible. In this context, treatments could be administered more often on an outpatient basis, once cost-effectiveness criteria were established and radiation protection training and procedures were appropriately applied.

  17. Selective decontamination of the gastrointestinal tract in patients undergoing esophageal resection

    Directory of Open Access Journals (Sweden)

    Lange Jochen

    2010-12-01

    Full Text Available Abstract Background Selective decontamination of the digestive tract (SDD to eliminate gram-negative bacteria is still not widely accepted, although it reduces the incidence of nosocomial infections. In a previous retrospective study, a clear benefit to perioperative morbidity, and a reduction in nosocomial infections were found in patients who underwent an esophageal anastomosis. Thus, SDD was applied routinely for esophageal anastomoses. We report the outcome of a cohort of 81 patients who underwent this treatment. Methods From 2002, patients who underwent an esophageal anastomosis (esophagojejunostomy were prospectively recorded. Perioperatively, patients received polymyxin, tobramycin, vancomycin and nystatin by mouth four times a day. Outcome was compared to a control group that was treated before 2002 (68 patients without SDD and 53 patients with SDD. Postoperative morbidity and mortality were assessed. Results Between 2002 and 2007, 81 patients who underwent an esophageal anastomosis received SDD. Compared to a retrospective control group, patients with SDD had significantly less pneumonia (OR 0.06 (0.01-0.46, p Conclusions SDD significantly reduces perioperative morbidity and mortality in patients who undergo a distal esophageal anastomosis compared to a historical control group. In patients with an anastomotic leakage, there was a strong tendency of SDD to reduce postoperative mortality.

  18. Evaluation of periodontal parameters in patients undergoing peritoneal dialysis or hemodialysis.

    Science.gov (United States)

    Bayraktar, G; Kurtulus, I; Kazancioglu, R; Bayramgurler, I; Cintan, S; Bural, C; Bozfakioglu, S; Besler, M; Trablus, S; Issever, H; Yildiz, A

    2008-03-01

    To analyze and compare periodontal parameters in chronic renal failure (CRF) patients undergoing peritoneal dialysis (PD) therapy with a group of patients on hemodialysis (HD) treatment and healthy controls (C). Seventy-five PD patients (mean age: 44 +/- 12 years) were matched with 41 HD patients (mean age: 46 +/- 15 years) and 61 C (mean age: 46 +/- 18 years). Plaque (PI) and calculus (CSI) accumulation and gingival bleeding (GI) were recorded with the appropriate indices. Periodontal condition was assessed using the probing pocket depth (PPD). One-way anova test, Pearson chi-squared test, Mann-Whitney U-test and Kruskal-Wallis test were performed to compare PD patients with HD patients and healthy C. Plaque Index values were significantly higher (P < 0.001) in the PD and HD groups than the C group. GI values were significantly higher (P < 0.01) in the HD group than the PD group. Finally, CSI values in the PD and HD groups were also significantly higher (P < 0.001) than the C group. Chronic renal failure patients on PD treatment are more susceptible to periodontal diseases like HD patients. Thus, it is very important to maintain an optimal oral hygiene level. Further studies on periodontal parameters of only PD patients are needed to get more information on the oral health status of this patient group.

  19. The importance of peripheral angiography in elderly patients undergoing coronary angiography

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Giorgio Rigatelli

    2005-01-01

    Objectives Early and accurate diagnosis of peripheral atherosclerosis is of paramount importance for global managerment of patients with known coronary artery disease (CAD), especially in the elderly. We sought to evaluate the prevalence and clinical relevance of significant abdominal vessel stenosis or aneurysm (AVA) in patients undergoing coronary angiography. Methods Medical records of consecutive > 75-year old patients who underwent coronary angiography at two public institutions over a 12-month period were evaluated. Angiographic results of patients who underwent coincident diagnostic abdominal aorta angiography to evaluate abdominal vessels on the basis of clinical and angiographic criteria were analyzed. Results During the study period, AVA was found in 90 (35.7% ) of 252 consecutive patients (185 males, mean age 79±5.8 years), renal artery stenosis in 13.1% of cases (33 patients), aortoiliac artery disease in 13.7 % (35 patients), and aortic aneurismal disease in 8.9% (22 patients). Logistic regression analyses revealed > 3-vessel CAD (odds ratio [OR] :9.917, P = 0.002), and > 3 risk factors (OR: 2.8, P =0. 048) as independent predictors of AVA. Conclusions Aged patients with multivessel CAD frequently have a high risk profile and multiple vascular atherosclerotic distributions, suggesting the usefulness of a mere global and comprehensive cardiovascular approach in aged patients.

  20. Early removal of nasogastric tube is beneficial for patients undergoing radical cystectomy with urinary diversion

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    Ioannis Adamakis

    2011-02-01

    Full Text Available PURPOSE: Examine the beneficial effect of early nasogastric tube (NGT removal in patients undergoing radical cystectomy with urinary diversion. PATIENTS AND METHODS: 43 consecutive patients underwent radical cystectomy with urinary diversion and were randomized into 2 groups. In the intervention group (n = 22, the NGT was removed 12 hours after the operation. Comparatively, in the control group (n = 21, the NGT remained in place until the appearance of the first flatus. The appearance of ileus, patient ambulation, time to regular diet, and hospital discharge of the two patient groups were assessed. Patient discomfort due to the NGT was also recorded. RESULTS: The 2 groups showed statistical homogeneity of their baseline characteristics. Two patients (9.09% from the intervention and 3 patients (14.3% from the control group developed postoperative ileus and were treated conservatively. No significant differences in intraoperative, postoperative, bowel outcomes or other complications were found between the two groups. All patients preferred the NGT to be removed first in comparison to their other co-existing drains. CONCLUSIONS: This is the first randomized, prospective study, to our knowledge, to assess early NGT removal after radical cystectomy. We advocate early removal, independently of the selected type of urinary diversion, since it is not correlated with ileus and is advantageous in terms of patient comfort and earlier ambulation.

  1. Comparison of Two Doses of Dexmedetomidine on Haemodynamic Stability in Patients Undergoing Laparoscopic Surgeries

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    Amruta S. Pathak

    2016-07-01

    Full Text Available Background: Dexmedetomidine has gained its popularity in providing stable haemodynamics, with significant post operative analgesia and sedation in patients undergoing laparoscopic surgeries. Two different doses of dexmedetomidine boluses were used pre-operatively and studied the intra and postoperative effects. Aim & Objectives: To compare two doses (1.0 µg/kg or 0.7µg/kg of dexmedetomidine infusion administered pre-operatively with regards to their haemodynamic, sedative and analgesic effect in patients undergoing laparoscopic surgeries. To study the effect of intravenous dexmedetomidine on postoperative analgesia. Material and Methods: 84 patients were randomly divided into two groups of 42 each. Group A received injection dexmedetomidine 1µg/kg, while group B received 0.7µg/kg; as an intravenous bolus dose in 48 ml NS over 15 min in preanesthesia room. Parameters assessed were Heart Rate (HR, Systolic Blood Pressure (SBP, Diastolic Blood Pressure (DBP, Mean Arterial Blood Pressure (MABP, Saturation of Oxygen (SpO , End Tidal 2 Carbon Dioxide (Et CO , Respiratory Rate (RR; 2 perioperatively, at regular intervals. In the postoperative period, intramuscular injection diclofenac 75 mg was used as a rescue analgesic. Postoperative pain and level of sedation were gauged with Visual Analog Scale (VAS score and Ramsay scale respectively. Observations and Results: The hemodynamic stability, level of sedation achieved were better with Group A. The duration of post extubation analgesia observed in group A was significantly (P= 0.01 more. The adverse events noted in both the groups were very few. Conclusion: We hereby conclude that dexmedetomidine in a dose of 1µg/kg as pre operative bolus dose in patients undergoing lapararoscopic surgeries gives better haemodynamic stability, post operative analgesia, sedation and reduction in the dose of inhalational anesthetic agent compared to 0.7µg/kg dose without increase in the incidence of adverse effects.

  2. Influence of calcitriol treatment on nutritional status, inflammation and oxidative stress of patients undergoing maintenance hemodialysis

    Institute of Scientific and Technical Information of China (English)

    Lin-Fang Zhang; Hong-Li Yan; Xin Chen

    2015-01-01

    Objective:To analyze influences of calcitriol treatment on nutritional status, inflammation and oxidative stress of patients undergoing maintenance hemodialysis.Methods:A total of 132 patients undergoing maintenance hemodialysis in our hospital were enrolled and randomly divided into observation group and control group. The observation group (n=66 cases) underwent calcitriol treatment, while control group (n=66 cases) underwent routine treatment. Nutrition status, micro inflammation and oxidative stress of the two groups were compared. Results: (1) After treatment, patients’ TSF, MAC, AMC, Hb levels of the observation group were higher than that of the control group (P<0.05); (2) After treatment, TGF-beta 1, CTGF levels of the observation group was significantly lower than that of the control group (P<0.05), but BMP-7 level was higher than control group (P<0.05). (3) Patients’ MPO, CAT, NO, TAC levels of the observation group were higher than control group (P<0.05).Conclusion:For patients with maintenance hemodialysis, Calcitriol can optimize patients' nutritional status, reduce systemic inflammatory response, enhance antioxidant capacity.

  3. Cryopreservation of very low numbers of spermatozoa from male patients undergoing infertility treatment using agarose capsules.

    Science.gov (United States)

    Hatakeyama, Shota; Tokuoka, Susumu; Abe, Hiroyuki; Araki, Yasuyuki; Araki, Yasuhisa

    2017-07-01

    This study tried to cryopreserve low numbers of spermatozoa from men undergoing infertility treatments by inserting into agarose capsules. The capsules were transferred into a drop of cryoprotectant solution and injected 3-4 motile spermatozoa that were selected by the swim-up method by conventional intracytoplasmic sperm injection. These capsules were put on a Cryotop(®) and frozen in liquid nitrogen vapor, and then submerged into liquid nitrogen and subsequently thawed and recovered. The motile spermatozoa in the capsules were counted. Eventually, we cryopreserved 2142 motile spermatozoa in 702 agarose capsules from 26 male patients and 1356 (63%) spermatozoa maintained their motility after thawing. The spermatozoa motility rates after thawing (MRAT) ranged from 20.0% (5/25) to 95.1% (58/61) among patients. The median MRAT was 68.3% (interquartile range 46.1-75.7). The total number of motile spermatozoa collected by swim-up method strongly correlated with MRAT (r = 0.746). It was possible to cryopreserve spermatozoa from male patients undergoing infertility treatment using agarose capsules. However, there were wide differences in MRAT among patients. It seems the spermatozoa from semen where there were many motile spermatozoa may have higher freezing resistance. Further studies using this method in cryptozoospermic semen, testicular and epididymal spermatozoa are required.

  4. Validation of different staging systems for hepatocellular carcinoma in a cohort of 249 patients undergoing radiotherapy

    Science.gov (United States)

    Lu, Hui-Rong; Li, Ye-Fei; Liang, Shi-Xiong; Zhang, Chun-Yan

    2017-01-01

    There is no consensus on predicting prognosis for hepatocellular carcinoma patients undergoing radiotherapy. This study aims to evaluate the validity of different staging systems. Overall, 249 hepatocellular carcinoma patients were evaluated retrospectively. All patients were classified by different staging systems. The cumulative survival rates were calculated using the Kaplan-Meier method, and survival curves were compared using the log-rank test. Harrell's concordance index (c-index) was calculated. The 1-, 3-, and 5-year overall survival rates were 58%, 31% and 20%, respectively. Significant differences in overall survival were observed between stages I and II of the Okuda staging system (p=0.004), between scores of 3 and 4 of Cancer of the Liver Italian Program prognostic score (p=0.009), between Chinese University Prognostic Index low-risk and intermediate-risk groups (p=0.01), between 1 and 2 points of the Japan Integrated Staging score (p=0.037), between stages III and IV of American Joint Committee on Cancer 1997 TNM staging system (p=0.011), between stages II and III of American Joint Committee on Cancer 2002 TNM staging system (p=0.026) and between stages I and II of Guangzhou 2001 staging system (p=0.000). In conclusion, the Okuda staging system, Chinese University Prognostic Index, and Chinese Guangzhou 2001 staging system were more discriminative than the other staging systems in the prognostic stratification for hepatocellular carcinoma patients undergoing radiotherapy. PMID:28147327

  5. Nutritional Interventions in Head and Neck Cancer Patients Undergoing Chemoradiotherapy: A Narrative Review

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    Maurizio Bossola

    2015-01-01

    Full Text Available The present review aimed to define the role of nutritional interventions in the prevention and treatment of malnutrition in HNC patients undergoing CRT as well as their impact on CRT-related toxicity and survival. Head and neck cancer patients are frequently malnourished at the time of diagnosis and prior to the beginning of treatment. In addition, chemo-radiotherapy (CRT causes or exacerbates symptoms, such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea and vomiting, with consequent worsening of malnutrition. Nutritional counseling (NC and oral nutritional supplements (ONS should be used to increase dietary intake and to prevent therapy-associated weight loss and interruption of radiation therapy. If obstructing cancer and/or mucositis interfere with swallowing, enteral nutrition should be delivered by tube. However, it seems that there is not sufficient evidence to determine the optimal method of enteral feeding. Prophylactic feeding through nasogastric tube or percutaneous gastrostomy to prevent weight loss, reduce dehydration and hospitalizations, and avoid treatment breaks has become relatively common. Compared to reactive feeding (patients are supported with oral nutritional supplements and when it is impossible to maintain nutritional requirements enteral feeding via a NGT or PEG is started, prophylactic feeding does not offer advantages in terms of nutritional outcomes, interruptions of radiotherapy and survival. Overall, it seems that further adequate prospective, randomized studies are needed to define the better nutritional intervention in head and neck cancer patients undergoing chemoradiotherapy.

  6. Safety of an Enhanced Recovery Pathway for Patients Undergoing Open Hepatic Resection.

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    Clancy J Clark

    Full Text Available Enhanced recovery pathways (ERP have not been widely implemented for hepatic surgery. The aim of this study was to evaluate the safety of an ERP for patients undergoing open hepatic resection.A single-surgeon, retrospective observational cohort study was performed comparing the clinical outcomes of patients undergoing open hepatic resection treated before and after implementation of an ERP. Morbidity, mortality, and length of hospital stay (LOS were compared between pre-ERP and ERP groups.126 patients (pre-ERP n = 73, ERP n = 53 were identified for the study. Patient characteristics and operative details were similar between groups. Overall complication rate was similar between pre-ERP and ERP groups (37% vs. 28%, p = 0.343. Before and after pathway implementation, the median LOS was similar, 5 (IQR 4-7 vs. 5 (IQR 4-6 days, p = 0.708. After adjusting for age, type of liver resection, and ASA, the ERP group had no increased risk of major complication (OR 0.38, 95% CI 0.14-1.02, p = 0.055 or LOS greater than 5 days (OR 1.21, 95% CI 0.56-2.62, p = 0.627.Routine use of a multimodal ERP is safe and is not associated with increased postoperative morbidity after open hepatic resection.

  7. Evaluation of Knowledge About and Attitudes Towards Kidney Transplantation in Patients Undergoing Hemodialysis Treatment

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    Nurten KALENDER

    2015-09-01

    Full Text Available OBJECTIVE: The aim of the present study was to evaluate hemodialysis (HD patients’ knowledge about and attitudes towards Kidney Transplantation (KT. MATERIAL and METHODS: A total of 104 HD patients from two HD centers in a large city in central Turkey were included in this descriptive study. The questionnaire that was developed by researchers included questions on sociodemographic data and dialysis vintage, level of satisfaction resulting from HD treatment, willingness to undergo KT, knowledge about KT and choice of donor, etc. RESULTS: The mean age of the 104 patients was 60.03±17.01 years and the mean of dialysis vintage was 4.53±3.04 years. Of these patients, 62.5% declared their willingness to undergo KT, and among these, 76.9% declared that they had knowledge about KT. In regard to choice of donor, 79.7% stated that it was not important, while 56.7% were not informed about the existence of a waiting list for cadaveric donors. CONCLUSION: In order to increase in our country the number of cadaveric donors, which represent the most appropriate source of organ donation, several strategies should be considered, such as awareness-raising activities for patients and the community through campaigns by both the public and private sectors, and mass media.

  8. An update on predictive biomarkers for major adverse cardiovascular events in patients undergoing vascular surgery.

    Science.gov (United States)

    Patelis, Nikolaos; Kouvelos, George N; Koutsoumpelis, Andreas; Moris, Demetrios; Matsagkas, Miltiadis I; Arnaoutoglou, Eleni

    2016-09-01

    Cardiovascular complications signify a major cause of morbidity and mortality in patients undergoing vascular surgery adversely affecting both short- and long-term prognosis. During the last decade, unmet needs for a distinct cardiovascular risk assessment have led to an intensive research for establishment of biomarkers with sufficient predictive value. This literature review aims in examining the value of several biomarkers in predicting the incidence of major adverse cardiac events in vascular surgery patients. We reviewed the English language literature and analyzed the biomarkers as independent predictors or in correlation with other factors. We found several biomarkers showing a significant predictive value for a major adverse cardiovascular event in patients undergoing vascular surgery. These biomarkers can be used in clinical practice as outcome predictors, although sensitivity and specificity varies. Detection of subclinical cardiovascular damage may improve total risk estimation and facilitate clinical assessment of patients at risk for future cardiovascular events. The wide variety of sensitivity and specificity in predicting a MACE of these biomarkers exert the need for future trials in which these markers will be tested as adjunctive tools of cardiovascular risk estimation scoring systems.

  9. Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery.

    Science.gov (United States)

    Doger, Cihan; Kahveci, Kadriye; Ornek, Dilsen; But, Abdulkadir; Aksoy, Mustafa; Gokcinar, Derya; Katar, Didem

    2016-01-01

    Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n = 30) and low-flow sevoflurane anesthesia group (Group L, n = 30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy.

  10. Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    Cihan Doger

    2016-01-01

    Full Text Available Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n=30 and low-flow sevoflurane anesthesia group (Group L, n=30. The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR, mean arterial blood pressure (MABP, peripheral oxygen saturation (SpO2, and end-tidal carbon dioxide concentration (ETCO2 were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy.

  11. [The value of an intervention for improving secondary prevention in patients undergoing cardiac surgery].

    Science.gov (United States)

    Reyes, Guillermo; Rodríguez-Abella, Hugo; Cuerpo, Gregorio; López, José; Montalvo, Elena; Duarte, Juan; Vallejo, José L; Bueno, Héctor

    2008-07-01

    Given that treatment for secondary prevention in patients undergoing cardiac surgery is underused, we devised a hospital intervention to increase its implementation. The intervention involved all physicians in the department of cardiac surgery agreeing to complete a report on each patient before hospital discharge. The document recorded the indications for the recommended treatments, and prompted for details of the drugs prescribed, the doses used, the reasons for not prescribing the recommended drugs, if that was the case, and the use of alternative medicines. The efficacy of the intervention was evaluated by comparing the rate of drug use in the year in which it was introduced (2003, n=341) with retrospective data on the rate in the previous year (n=369). The rates of use of aspirin, statins, angiotensin-converting enzyme inhibitors, and beta-blockers by patients who required them all showed an absolute increase, of 13.4%, 38.3%, 21.8%, and 21.5%, respectively. In conclusion, the introduction of a simple and inexpensive intervention was able to significantly increase the use of drugs for secondary prevention in patients undergoing cardiac surgery.

  12. Red cell distribution width in anemic patients undergoing transcatheter aortic valve implantation

    Institute of Scientific and Technical Information of China (English)

    Katharina Hellhammer; Tobias Zeus; Pablo E Verde; Verena Veulemanns; Lisa Kahlstadt; Georg Wolff; Ralf Erkens; Ralf Westenfeld; Eliano P Navarese; Marc W Merx; Tienush Rassaf; Malte Kelm

    2016-01-01

    AIM: To determine the impact of red blood cell distribution width on outcome in anemic patients undergoing transcatheter aortic valve implantation(TAVI).METHODS: In a retrospective single center cohort study we determined the impact of baseline red cell distribution width(RDW) and anemia on outcome in 376 patients with aortic stenosis undergoing TAVI. All patients were discussed in the institutional heart team and declined for surgical aortic valve replacement due to high operative risk. Collected data included patient characteristics, imaging findings, periprocedural in hospital data, laboratory results and follow up data. Blood samples for hematology and biochemistry analysis were taken from every patient before and at fixed intervals up to 72 h after TAVI including blood count and creatinine. Descriptive statistics were used for patient’s characteristics. KaplanMeier survival curves were used for time to event outcomes. A recursive partitioning regression and classification was used to investigate the association between potential risk factors and outcome variables.RESULTS: Mean age in our study population was 81 ± 6.1 years. Anemia was prevalent in 63.6%(n = 239) of our patients. Age and creatinine were identified as risk factors for anemia. In our study population, anemia per se did influence 30-d mortality but did not predict longterm mortality. In contrast, a RDW > 14% showed to be highly predictable for a reduced short- and longterm survival in patients with aortic valve disease after TAVI procedure.CONCLUSION: Age and kidney function determine the degree of anemia. The anisocytosis of red blood cells in anemic patients supplements prognostic information in addition to that derived from the WHO-based definition of anemia.

  13. Cardiac Troponin Elevation Predicts Mortality in Patients Undergoing Orthotopic Liver Transplantation

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    David Snipelisky

    2013-01-01

    Full Text Available Introduction. While patients undergoing orthotopic liver transplantation (OLT have high cardiovascular event rates, preoperative risk stratification may not necessarily predict those susceptible patients. Troponin T (TnT may help predict patients at risk for cardiovascular complications. Methods. Consecutive patients undergoing OLT at Mayo Clinic in Florida between 1998 and 2010 who had TnT obtained within 10 days following surgery were included. Three groups were compared based on TnT level: (1 normal (TnT ≤0.01 ng/mL, (2 intermediate (TnT 0.02–0.11 ng/mL, and (3 elevated (TnT >0.11 ng/mL. Overall and cardiovascular mortality was assessed. Results. Of the 78 patients included, there was no difference in age, gender, severity of liver disease, and echocardiographic findings. Patients in the normal and intermediate TnT groups had a lower overall mortality rate (14.3% and 0%, resp. when compared with those with elevated TnT (50%; P=0.001. Patients in the elevated TnT group had a cardiovascular mortality rate of 37.5% compared with 1.4% in the other groups combined (P<0.01. The elevated TnT group had a much higher mortality rate when compared with those in the intermediate group (P<0.0001. Conclusion. TnT may accurately help risk stratify patients in the early postoperative setting to better predict cardiovascular complications.

  14. Effects of oral premedication on cognitive status of elderly patients undergoing cardiac catheterization

    Institute of Scientific and Technical Information of China (English)

    Javed M Ashraf; Marc Schweiger; Neelima Vallurupalli; Sandra Bellantonio; James R Cook

    2015-01-01

    Background Sedatives and analgesics are often administered to achieve conscious sedation for diagnostic and therapeutic procedures. Appropriate concerns have been raised regarding post procedure delirium related to peri-procedural medication in the elderly. The objective of this study was to investigate the effect of premedication on new onset delirium and procedural care in elderly patients. Methods Patients≥70 years old and scheduled for elective cardiac catheterization were randomly assigned to receive either oral diphenhydramine and diaze-pam (25 mg/5 mg) or no premedication. All patients underwent a mini mental state exam and delirium assessment using confusion assess-ment method prior to the procedure and repeated at 4 h after the procedure and prior to discharge. Patients’ cooperation during the procedure and ease of post-procedure were measured using Visual Analog Scale (VAS). The degree of alertness was assessed immediately on arrival to the floor, and twice hourly afterwards using Observer’s Assessment of Alertness/Sedation Scale (OAA/S). Results A total of 93 patients were enrolled. The mean age was 77 years, and 47 patients received premedication prior to the procedure. None of the patients in either group developed delirium. Patients’ cooperation and the ease of procedure was greater and pain medication requirement less both during and after the procedure in the pre-medicated group (P < 0.05 for both). Nurses reported an improvement with patient management in the pre-medicated group (P=0.08). Conclusions In conclusion, premedication did not cause delirium in elderly patients undergoing cardiac catheterization. The reduced pain medication requirement, perceived procedural ease and post procedure management favors premedication in elderly patients undergoing cardiac catheterization.

  15. Dexmedetomidine versus propofol for sedation in patients undergoing vitreoretinal surgery under sub-Tenon′s anesthesia

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    Ashraf Ghali

    2011-01-01

    Full Text Available Purpose: The purpose of this study was to evaluate the hemodynamic, respiratory effects, the recovery profile, surgeons, and patients satisfaction with dexmedetomidine sedation compared with those of propofol sedation in patients undergoing vitreoretinal surgery under sub-Tenon′s anesthesia. Methods: Sixty patients were enrolled in this prospective, single-blind, randomized study. The patients were divided into two groups to receive either dexmedetomidine (group D or propofol (group P. Sedation level was titrated to a Ramsay sedation scale (RSS of 3. Hemodynamic and respiratory effects, postoperative recovery time, analgesic effects, surgeons and patients satisfaction were assessed. Results: Both groups provided a similar significant reduction in heart rate and mean arterial pressure compared with baseline values. The respiratory rate values of the dexmedetomidine group were significantly higher than those in the propofol group. The oxygen saturation values of the dexmedetomidine group were significantly higher than those of the propofol group. The expired CO 2 was similar in both groups. Postoperatively, the time to achieve an Aldrete score of 10 was similar in both groups. Dexmedetomidine patients have significantly lower visual analog scale for pain than propofol patients. The surgeon satisfaction with patients′ sedation was similar for both groups. The patients′ satisfaction was higher in the dexmedetomidine group. Conclusion: Dexmedetomidine at similar sedation levels with propofol was associated with equivalent hemodynamic effects, maintaining an adequate respiratory function, similar time of discharge from PACU, better analgesic properties, similar surgeon′s satisfaction, and higher patient′s satisfaction. Thus, dexmedetomidine may prove to be a valuable adjuvant for sedation in patients undergoing vitreoretinal surgery under sub-Tenon′s anesthesia.

  16. Low-dose midazolam sedation: an option for patients undergoing serial hepatic venous pressure measurements.

    Science.gov (United States)

    Steinlauf, A F; Garcia-Tsao, G; Zakko, M F; Dickey, K; Gupta, T; Groszmann, R J

    1999-04-01

    The hepatic venous pressure gradient (HVPG) is becoming increasingly used clinically. It is useful in the differential diagnosis of portal hypertension and provides a prognostic index in cirrhotic patients. Performance of serial measurements has been shown to be useful in guiding pharmacological therapy of portal hypertension and variceal hemorrhage. The technique is safe to perform; however, many patients are anxious and reluctant to undergo serial measurements. The effects of sedatives on portal pressure measurements have not yet been defined. The objective of this study was to evaluate the effects of midazolam on the HVPG. Twenty patients with compensated cirrhosis were included in this prospective, double-blind study. The HVPG was determined by subtracting the free hepatic venous pressure (FHVP) from the wedged hepatic venous pressure (WHVP). Patients were randomized to receive either placebo, 0.02 mg/kg midazolam, or 0.03 mg/kg midazolam, administered intravenously over 3 minutes. Immediately after drug administration and every 3 minutes thereafter, for a total of 30 or 40 minutes, measurements were repeated. Three hours later, patients were asked to state whether the sedative affected their state of comfort/relaxation. The effects of both doses of midazolam on HVPG did not differ significantly from those of placebo. Furthermore, neither dose of midazolam induced significant changes in HVPG as compared with baseline values. However, higher-dose midazolam (0.03 mg/kg) was associated with significant reductions in FHVP from baseline and a tendency for a reduction in WHVP. Both doses significantly increased patient comfort and relaxation during the test. Midazolam, used at a dose of 0.02 mg/kg, is effective in increasing patient comfort and relaxation during hepatic venous pressure measurements, without significantly affecting pressures (HVPG, WHVP, or FHVP). It is therefore an acceptable option for patients undergoing serial hepatic venous pressure measurements.

  17. Prevalence of Candida species in the oral cavity of patients undergoing head and neck radiotherapy

    Directory of Open Access Journals (Sweden)

    Arash Azizi

    2009-09-01

    Full Text Available Background and aims. Candidiasis is a common opportunistic infection in immunocompromised patients. Radiation to the head and neck affects the oral mucous membrane and produces xerostomia. Xerostomia alters the oral mucosa and predisposes them to colonization by Candida species. The aim of this study was evaluation of Candida species before and after radiotherapy. Materials and Methods. Twenty patients undergoing radiation therapy were selected. None of the patients had taken any antibiotics and antifungals during the 3-month period prior to the study and did not take any during the study; in addition, they did not have any systemic conditions predisposing them to Candida infections. Swabs were collected from all the patients for Candida species culturing procedures 3±1 days before treatment and 2 and 4 weeks after radiotherapy. Swabs were inoculated on 2% Sabouraud’s dextrose agar. Different types of Candida species are specified by colony color. Analysis of variance was used to assess the difference between the periods before and after treatment. Results. Mean age of the patients were 59.4 years. Ten patients were Candida-positive before the initiation of radiotherapy. Eighteen and 20 patients were Candida-positive after two and four weeks of radiotherapy, respectively. The most frequent type of Candida in this study was Candida albicans both before and after radiotherapy. Conclusion. The present study suggests that patients undergoing head and neck radiotherapy should take antifungal agents, especially sugar-free agents, topical fluoride and salivary substitutes. The most commonly found Candida in this study was Candida albicans, which might be attributed to its high pathogenecity.

  18. Caspofungin Population Pharmacokinetics in Critically Ill Patients Undergoing Continuous Veno-Venous Haemofiltration or Haemodiafiltration.

    Science.gov (United States)

    Roger, Claire; Wallis, Steven C; Muller, Laurent; Saissi, Gilbert; Lipman, Jeffrey; Brüggemann, Roger J; Lefrant, Jean-Yves; Roberts, Jason A

    2016-12-29

    Sepsis and continuous renal replacement therapy (CRRT) can both significantly affect antifungal pharmacokinetics. This study aimed to describe the pharmacokinetics of caspofungin in critically ill patients during different CRRT modes. Patients receiving caspofungin and undergoing continuous veno-venous haemofiltration (CVVH) or haemodiafiltration (CVVHDF) were eligible to take part in the study. Blood samples were collected at seven sampling times during a dosing interval. Demographics and clinical data were recorded. Population pharmacokinetic analysis and Monte-Carlo simulation were undertaken using Pmetrics. Twelve pharmacokinetic profiles from nine patients were analysed. The caspofungin CRRT clearance (CL) was 0.048 ± 0.12 L/h for CVVH and 0.042 ± 0.042 L/h for CVVHDF. A two-compartment linear model best described the data. Patient weight was the only covariate affecting drug CL and central volume. The mean (standard deviation) parameter estimates were 0.64 ± 0.12 L/h for CL, 9.35 ± 3.56 L for central volume, 0.25 ± 0.19 per h for the rate constant for drug distribution from central to peripheral compartments and 0.19 ± 0.10 per h from peripheral to central compartments. Based on simulation results, a caspofungin 100 mg loading dose followed by a 50 mg maintenance dose for patients with a total body weight of ≤80 kg best achieved the pharmacokinetic/PD targets whilst a 70 mg maintenance dose was required for patients with a weight of >80 kg. No caspofungin dosing adjustment is necessary for patients undergoing either form of CRRT. However, higher than recommended loading doses of caspofungin are required to achieve pharmacokinetic/pharmacodynamic targets in critically ill patients. Registration: ClinicalTrials.gov Identifier NCT01403220.

  19. Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery.

    Science.gov (United States)

    Mahesh, Balakrishnan; Wells, Francis; Nashef, Samer; Nair, Sukumaran

    2013-01-01

    Functional tricuspid regurgitation (FTR) is frequently present in patients undergoing aortic, and particularly mitral valve, surgery. Untreated FTR may lead to right heart failure. Reoperative cardiac surgery for late FTR is associated with high morbidity and mortality. Therefore, severe FTR has emerged as a Class I indication for concomitant tricuspid valve surgery in patients undergoing left valve surgery. Concomitant tricuspid valve surgery during left heart valve surgery to address moderate and mild FTR is controversial. This review addresses this issue and proposes an algorithm for the treatment of FTR in patients undergoing left heart valve surgery.

  20. Blood gas analysis, blood saturation and chosen parameters of spirometric examination in NSCLC patients undergoing chemotherapy and pulmonary rehabilitation.

    Science.gov (United States)

    Tokarski, Sławomir; Tokarska, Kamila; Schwarz, Ewa; Obrebska, Agnieszka; Mejer, Anna; Kowalski, Jan

    2014-04-01

    In industrialized countries lung cancer is associated with highest mortality among carcinoma. Progression of the disease is associated with diminished tolerance for physical activities, aggravated dyspnea and lowering of life quality. The aim of study was the evaluation of blood gas, blood saturation and chosen parameters of spirometric examination in NSCLC patients undergoing chemotherapy and pulmonary rehabilitation. Analysis of capillary blood was done using RapidPoint 405 Siemens device. Spirometric examination was done using PNEUMO abcMED device. Forty-nine patients with inoperable NSCLC were subjected to the examination. This included 38 men and 11 women aged between 46-75 years (mean age 63 +/- 7.5 years) who were separated into two groups: group I--25 patients undergoing standard chemotherapy (group C); group II--24 patients undergoing standard chemotherapy and pulmonary rehabilitation (group CK). All patients were subjected to blood gas analysis, blood saturation analysis and spirometric examination twice, before and after first-line chemotherapy Increase of pO2 and SaO2 in blood, and FEV1 and FVC in spirometric examination was significantly higher in patients undergoing pulmonary rehabilitation and chemotherapy (group II) (p < 0.05) in comparison to NSCLC patients undergoing only chemotherapy (group I). Pulmonary rehabilitation of NSCLC patients undergoing first-line chemotherapy results in improvement of indicators of blood gas, blood saturation analysis and chosen parameters of spirometric analysis. Pulmonary rehabilitation in patients with lung cancer seems to be an important form of supplementary treatment.

  1. Patient-controlled sedation with propofol/remifentanil versus propofol/alfentanil for patients undergoing outpatient colonoscopy, a randomized, controlled double-blind study

    Directory of Open Access Journals (Sweden)

    Sherif S Sultan

    2014-01-01

    Full Text Available Context: Many techniques are used for sedation of colonoscopies. Patient-controlled sedation (PCS is utilizing many drugs or drug combinations. Aims: The aim of this study is to compare the safety and feasibility of propofol/remifentanil versus propofol/alfentanil given to sedate patients undergoing outpatient colonoscopies through a patient-controlled technique. Settings and Design: Controlled randomized and double-blind study. Materials and Methods: A total of 80 patients were randomly divided into two groups; PA group received a combination of propofol/alfentanil and PR group received propofol/remifentanil combination. Patients were monitored for heart rate (HR, blood pressure (BP, oxygen saturation, and Ramsay sedation scale (RSS. Times of the following events were recorded; initiation of sedation, insertion and removal of the colonoscope, recovery and discharge. Five intervals were calculated; time to sedation, procedure time, postprocedure time, procedure room time, and postanesthesia care unit (PACU time. Endoscopist and patient satisfaction scores were obtained. Statistical Analysis Used: Unpaired Student′s t-test was used to compare between the two groups. Paired Student′s t-test was used to compare baseline readings with readings after 30 min of sedation in the same group when needed. Results: Both groups showed slowing of the HR and decrease in mean arterial BP. HR and mean arterial BP were significantly lower 5 and 10 min after initiation of sedation in PR group when compared with PA group. Both HR and mean arterial BP returned to presedation readings 30 min after initiation of sedation in PR group but not in PA group. No differences between the two groups c