The sticky business of adhesion prevention in minimally invasive gynecologic surgery.

Science.gov (United States)

Han, Esther S; Scheib, Stacey A; Patzkowsky, Kristin E; Simpson, Khara; Wang, Karen C

2017-08-01

The negative impact of postoperative adhesions has long been recognized, but available options for prevention remain limited. Minimally invasive surgery is associated with decreased adhesion formation due to meticulous dissection with gentile tissue handling, improved hemostasis, and limiting exposure to reactive foreign material; however, there is conflicting evidence on the clinical significance of adhesion-related disease when compared to open surgery. Laparoscopic surgery does not guarantee the prevention of adhesions because longer operative times and high insufflation pressure can promote adhesion formation. Adhesion barriers have been available since the 1980s, but uptake among surgeons remains low and there is no clear evidence that they reduce clinically significant outcomes such as chronic pain or infertility. In this article, we review the ongoing magnitude of adhesion-related complications in gynecologic surgery, currently available interventions and new research toward more effective adhesion prevention. Recent literature provides updated epidemiologic data and estimates of healthcare costs associated with adhesion-related complications. There have been important advances in our understanding of normal peritoneal healing and the pathophysiology of adhesions. Adhesion barriers continue to be tested for safety and effectiveness and new agents have shown promise in clinical studies. Finally, there are many experimental studies of new materials and pharmacologic and biologic prevention agents. There is great interest in new adhesion prevention technologies, but new agents are unlikely to be available for clinical use for many years. High-quality effectiveness and outcomes-related research is still needed.

Predicting postoperative haemoglobin changes after burn surgery ...

African Journals Online (AJOL)

Background. Burn surgery is associated with significant blood loss and fluid shifts that cause rapid haemoglobin (Hb) changes during and after surgery. Understanding the relationship between intraoperative and postoperative (day 1) Hb changes may assist in avoiding postoperative anaemia and unnecessary ...

Prevention of alveolar osteitis after third molar surgery: Comparative ...

African Journals Online (AJOL)

Prevention of alveolar osteitis after third molar surgery: Comparative study of the ... for surgical extraction of lower third molar were prospectively, consecutively, and ... Information on demographic, types and level of impaction, indications for ...

The role of oral antibiotics prophylaxis in prevention of surgical site infection in colorectal surgery.

Science.gov (United States)

Koullouros, Michalis; Khan, Nadir; Aly, Emad H

2017-01-01

Surgical site infection (SSI) continues to be a challenge in colorectal surgery. Over the years, various modalities have been used in an attempt to reduce SSI risk in elective colorectal surgery, which include mechanical bowel preparation before surgery, oral antibiotics and intravenous antibiotic prophylaxis at induction of surgery. Even though IV antibiotics have become standard practice, there has been a debate on the exact role of oral antibiotics. The primary aim was to identify the role of oral antibiotics in reduction of SSI in elective colorectal surgery. The secondary aim was to explore any potential benefit in the use of mechanical bowel preparation (MBP) in relation to SSI in elective colorectal surgery. Medline, Embase and the Cochrane Library were searched. Any randomised controlled trials (RCTs) or cohort studies after 1980, which investigated the effectiveness of oral antibiotic prophylaxis and/or MBP in preventing SSIs in elective colorectal surgery were included. Twenty-three RCTs and eight cohorts were included. The results indicate a statistically significant advantage in preventing SSIs with the combined usage of oral and systemic antibiotic prophylaxis. Furthermore, our analysis of the cohort studies shows no benefits in the use of MBP in prevention of SSIs. The addition of oral antibiotics to systemic antibiotics could potentially reduce the risk of SSIs in elective colorectal surgery. Additionally, MBP does not seem to provide a clear benefit with regard to SSI prevention.

Cervical spondylosis with spinal cord encroachment: should preventive surgery be recommended?

Directory of Open Access Journals (Sweden)

Murphy Donald R

2009-08-01

Full Text Available Abstract Background It has been stated that individuals who have spondylotic encroachment on the cervical spinal cord without myelopathy are at increased risk of spinal cord injury if they experience minor trauma. Preventive decompression surgery has been recommended for these individuals. The purpose of this paper is to provide the non-surgical spine specialist with information upon which to base advice to patients. The evidence behind claims of increased risk is investigated as well as the evidence regarding the risk of decompression surgery. Methods A literature search was conducted on the risk of spinal cord injury in individuals with asymptomatic cord encroachment and the risk and benefit of preventive decompression surgery. Results Three studies on the risk of spinal cord injury in this population met the inclusion criteria. All reported increased risk. However, none were prospective cohort studies or case-control studies, so the designs did not allow firm conclusions to be drawn. A number of studies and reviews of the risks and benefits of decompression surgery in patients with cervical myelopathy were found, but no studies were found that addressed surgery in asymptomatic individuals thought to be at risk. The complications of decompression surgery range from transient hoarseness to spinal cord injury, with rates ranging from 0.3% to 60%. Conclusion There is insufficient evidence that individuals with spondylotic spinal cord encroachment are at increased risk of spinal cord injury from minor trauma. Prospective cohort or case-control studies are needed to assess this risk. There is no evidence that prophylactic decompression surgery is helpful in this patient population. Decompression surgery appears to be helpful in patients with cervical myelopathy, but the significant risks may outweigh the unknown benefit in asymptomatic individuals. Thus, broad recommendations for decompression surgery in suspected at-risk individuals cannot be made

Application of intracameral moxifloxacin to prevent endophthalmitis in cataract surgery

Directory of Open Access Journals (Sweden)

Servet Cetinkaya

2015-10-01

Full Text Available AIM: To evaluate the safety and efficacy of intracameral moxifloxacin in preventing endophthalmitis after cataract surgery.METHODS:Sixty-five eyes of 65 patients underwent cataract surgery between January and June 2012. Some patients received intracameral moxifloxacin at the end of surgery, while others did not(controls. Pre- and postperative logarithm of the minimum angle of resolution(logMARbest corrected visual acuity(BCVA, intraocular pressure(IOP, corneal edema, and anterior chamber(ACstatus were examined.RESULTS: Thirty-three patients(19 males, 14 females; average age, 64.81±11.61y(range: 41-82yreceived moxifloxacin and 32 patients(15 males, 17 females; average age, 65.43±11.10y(range: 42-81ydid not. The differences in patient age(P=0.827and sex(P=0.396were insignificant. Preoperative BCVA was approximately 20/130 in both groups. After surgery, moxifloxacin and control patients had a BCVA of 20/25 and 20/23, respectively(P=0.160. Preoperative IOP was 14.93±2.77mmHg(range: 11-21mmHgin moxifloxacin patients and 15.06±2.42mm Hg(range: 12-21mmHgin controls(P=0.850. After surgery, IOP was not statistically different between two groups(moxifloxacin: 14.06±2.31(range: 10-19mmHg, controls: 14.03±2.36mmHg(range: 10-19mmHg, P=0.960. Slight differences in corneal edema(P=0.623and anterior chamber cell(P=0.726incidences between two groups were not statistically significant. CONCLUSION: Intracameral moxifloxacin is safe and effective in preventing endophtalmitis after cataract surgery.

33 CFR 117.11 - Unnecessary opening of the draw.

Science.gov (United States)

2010-07-01

... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Unnecessary opening of the draw. 117.11 Section 117.11 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY BRIDGES DRAWBRIDGE OPERATION REGULATIONS General Requirements § 117.11 Unnecessary opening of the draw. No...

Body dysmorphic factors and mental health problems in people seeking rhinoplastic surgery.

Science.gov (United States)

Javanbakht, M; Nazari, A; Javanbakht, A; Moghaddam, L

2012-02-01

There has been increasing number of requests for cosmetic rhinoplastic surgery among Iranian people in different age groups in recent years. One risk for people who undergo such plastic operations is the presence of body dysmorphic disorder (BDD), which can complicate the result and decrease the rate of satisfaction from surgery. This study aimed to investigate mental health problems in people seeking rhinoplastic surgery. In this case-control study, the scores of General Health Questionnaire (GHQ) and DCQ (Dysmorphic Concerns Questionnaire) were obtained from 50 individuals who were candidates for rhinoplasty, and the results were compared with a normal control group. The total GHQ score and scores in anxiety, depression, and social dysfunction sub-scales were higher among the study group. This was the same for the DCQ score. However, the scores of somatization sub-scale of GHQ were not significantly different between the two groups. Psychiatric evaluation of candidates for rhinoplasty seems necessary for prevention of unnecessary and repetitive surgical operations.

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

Prevention of unnecessary pregnancy terminations by counselling women on drug, chemical, and radiation exposure during the first trimester

International Nuclear Information System (INIS)

Koren, G.; Pastuszak, A.

1990-01-01

As part of a new approach to counselling pregnant women concerned about antenatal exposure to drugs, chemicals, or radiation, we measured their tendency to terminate their pregnancy by using a visual analogue scale (VAS). Analysis of 78 cases where women had less than 50% tendency to continue pregnancy before they were advised by us reveals that 61 decided to continue their pregnancy after the consultation (57 normal, healthy infants, four miscarriages) and 17 terminated. Women who continued their pregnancy significantly changed their tendency after we discussed relevant information with them (from 34.3 +/- 2.5% to 84.5 +/- 3.3%, P less than 0.00001), whereas most of those who eventually terminated pregnancy did not change their tendency to continue pregnancy beyond the 50% mark (from 24.8 +/- 5.4% to 45.1 +/- 9.8%) (P greater than 0.1). Only two of the women who terminated their pregnancy were exposed to teratogenic drugs; however, in most other cases, other obvious reasons, unrelated to the exposure in question, were identified by the women as leading reasons for termination. An appropriate intervention in early pregnancy can prevent unnecessary pregnancy terminations by correcting misinformation and thereby decreasing the unrealistically high perception of risk by women exposed to nonteratogens

Novel strategy for prevention of esophageal stricture after endoscopic surgery.

Science.gov (United States)

Mizutani, Taro; Tadauchi, Akimitsu; Arinobe, Manabu; Narita, Yuji; Kato, Ryuji; Niwa, Yasumasa; Ohmiya, Naoki; Itoh, Akihiro; Hirooka, Yoshiki; Honda, Hiroyuki; Ueda, Minoru; Goto, Hidemi

2010-01-01

Recently, novel endoscopic surgery, including endoscopic submucosal dissection (ESD), was developed to resect a large superficial gastrointestinal cancer. However, circumferential endoscopic surgery in the esophagus can lead to esophageal stricture that affects the patient's quality of life. This major complication is caused by scar formation, and develops during the two weeks after endoscopic surgery. We hypothesized that local administration of a controlled release anti-scarring agent can prevent esophageal stricture after endoscopic surgery. The aims of this study were to develop an endoscopically injectable anti-scarring drug delivery system, and to verify the efficacy of our strategy to prevent esophageal stricture. We focused on 5-Fluorouracil (5-FU) as an anti-scarring agent, which has already been shown to be effective not only for treatment of cancers, but also for treatment of hypertrophic skin scars. 5-FU was encapsulated by liposome, and then mixed with injectable 2% atelocollagen (5FLC: 5FU-liposome-collagen) to achieve sustained release. An in vitro 5-FU releasing test from 5FLC was performed using high-performance liquid chromatography (HPLC). Inhibition of cell proliferation was investigated using normal human dermal fibroblast cells (NHDF) with 5FLC. In addition, a canine esophageal mucosal resection was carried out, and 5FLC was endoscopically injected into the ulcer immediately after the operation, and compared with a similar specimen injected with saline as a control. 5-FU was gradually released from 5FLC for more than 2 weeks in vitro. The solution of 5-FU released from 5FLC inhibited NHDF proliferation more effectively than 5-FU alone. In the canine model, no findings of stricture were observed in the 5FLC-treated dog at 4 weeks after the operation and no vomiting occurred. In contrast, marked esophageal strictures were observed with repeated vomiting in the control group. Submucosal fibrosis was markedly reduced histologically in the 5FLC

Impact of Nursing Educational Program on Reducing or Preventing Postoperative Complications for Patients after Intracranial Surgery

Science.gov (United States)

Elmowla, Rasha Ali Ahmed Abd; El-Lateef, Zienab Abd; El-khayat, Roshdy

2015-01-01

Intracranial surgery means any surgery performed inside the skull to treat problems in the brain and surrounding structures. Aim: Evaluate the impact of nursing educational program on reducing or preventing postoperative complications for patients after intracranial surgery. Subjects and methods: Sixty adult patients had intracranial surgery (burr…

Prevention and management of vascular complications in middle ear and cochlear implant surgery.

Science.gov (United States)

Di Lella, Filippo; Falcioni, Maurizio; Piccinini, Silvia; Iaccarino, Ilaria; Bacciu, Andrea; Pasanisi, Enrico; Cerasti, Davide; Vincenti, Vincenzo

2017-11-01

The objective of this study is to illustrate prevention strategies and management of vascular complications from the jugular bulb (JB) and internal carotid artery (ICA) during middle ear surgery or cochlear implantation. The study design is retrospective case series. The setting is tertiary referral university hospital. Patients were included if presented pre- or intraoperative evidence of high-risk anatomical anomalies of ICA or JB during middle ear or cochlear implant surgery, intraoperative vascular injury, or revision surgery after the previous iatrogenic vascular lesions. The main outcome measures are surgical outcomes and complications rate. Ten subjects were identified: three underwent cochlear implant surgery and seven underwent middle ear surgery. Among the cochlear implant patients, two presented with anomalies of the JB impeding access to the cochlear lumen and one underwent revision surgery for incorrect positioning of the array in the carotid canal. Subtotal petrosectomy was performed in all cases. Anomalies of the JB were preoperatively identified in two patients with attic and external auditory canal cholesteatoma, respectively. In a patient, a high and dehiscent JB was found during myringoplasty, while another underwent revision surgery after iatrogenic injury of the JB. A dehiscent ICA complicated middle ear effusion in one case, while in another case, a carotid aneurysm determined a cholesterol granuloma. Rupture of a pseudoaneurysm of the ICA occurred in a child during second-stage surgery and required permanent balloon occlusion without neurological complications. Knowledge of normal anatomy and its variants and preoperative imaging are the basis for prevention of vascular complications during middle ear or cochlear implant surgery.

Plastic surgery in Nigeria-Scope and challenges

Directory of Open Access Journals (Sweden)

TOG Chukwuanukwu

2011-01-01

Full Text Available Background Plastic surgery as a major subspecialty of surgery has existed in Nigeria for several decades but the populace including medical practitioners are yet to fully appreciate its scope. This leads to very late presentation/referral of cases and management of cases that should have been referred by less qualified practitioners with attendant poor outcomes and complications. Most people still regard plastic surgery as being synonymous with cosmetic/aesthetic surgery but the scope goes far beyond this entity. It is therefore important that the public including medical practitioners who are the main sources of referral to the subspecialty are aware of the range of cases handled by plastic surgery units. The plastic surgeon in Nigeria is also faced with a lot of challenges ranging from the arduous task of one having to manage very many different and complicated cases to being very poorly equipped and appreciated. Objectives To educate the populace especially the medical practitioners on the scope of plastic surgery and the extent of development of the subspecialty in Nigeria and solicit for colleague′s cooperation in order to move plastic surgery forward. To also highlight the difficulties faced by the plastic surgeon in Nigeria and seeking help from appropriate quarters which will help to reduce unnecessary referrals abroad while improving the services rendered to patients locally. Conclusion Plastic surgery in Nigeria has developed significantly both in scope and manpower but it is still faced with a lot of challenges. Knowledge of its scope will help to reduce unnecessary referrals abroad while improving services/skill here in Nigeria.

The effects of bariatric surgery: will understanding its mechanism render the knife unnecessary?

Science.gov (United States)

Browning, Kirsteen N; Hajnal, Andras

2014-01-01

The incidence of obesity is increasing worldwide at a dramatic rate, accompanied by an associated increase in comorbid conditions. Bariatric surgery is the most effective treatment for morbid obesity with Roux-en-Y gastric bypass being the most commonly performed procedure, yet the underlying mechanisms by which it induces a wide-array of beneficial effects remains obscure. From basic science as well as clinical standpoints, there are several areas of current interest that warrant continued investigation. Several major focus areas have also emerged in current research that may guide future efforts in this field, particularly with regards to using novel, non-surgical approaches to mimic the success of bariatric surgery while minimizing its adverse side effects.

Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis.

Science.gov (United States)

Zhu, Min; Zhou, Chengmao; Huang, Bing; Ruan, Lin; Liang, Rui

2017-06-01

Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopy surgery. No significant differences in adverse reactions (dizziness and headache) were found in association with dexamethasone. Conclusion Granisetron in combination with dexamethasone was significantly more effective than granisetron alone in preventing PONV in patients undergoing laparoscopic surgery, with no difference in adverse reactions between the two groups. Granisetron alone or granisetron plus dexamethasone can be used to prevent PONV in patients undergoing laparoscopic surgery.

Ramosetron compared with granisetron for the prevention of vomiting following strabismus surgery in children

Science.gov (United States)

Fujii, Y.; Tanaka, H.; Ito, M.

2001-01-01

BACKGROUND/AIMS—Postoperative vomiting occurs frequently after strabismus surgery in children. Granisetron, a selective 5-hydroxytryptamine type 3 receptor antagonist, is effective for the prevention of vomiting following paediatric strabismus surgery. Ramosetron, another new antagonist of 5-hydroxytryptamine type 3 receptor, has more potent and longer acting properties than granisetron against cisplatin induced emesis. This study was undertaken to compare the efficacy and safety of granisetron and ramosetron for the prevention of vomiting following strabismus surgery in children.
METHODS—In a randomised, double blinded manner 80 children, aged 4-10 years, received intravenously granisetron 40 µg/kg or ramosetron 6 µg/kg (n=40 each) at the end of surgery. A standard general anaesthetic technique and postoperative analgesia were used. Emetic episodes and safety assessment were performed during the first 24 hours and the next 24 hours after anaesthesia.
RESULTS—The percentage of patients who were emesis free during 0-24 hours after anaesthesia was 85% with granisetron and 90% with ramosetron, respectively (p = 0.369); the corresponding rate during 24-48 hours after anaesthesia was 70% and 95% (p = 0.003). No clinically serious adverse events caused by the study drug were observed in any of the groups.
CONCLUSION—Prophylactic antiemetic therapy with ramosetron is comparable with granisetron for the prevention of vomiting during 0-24 hours after anaesthesia in children undergoing strabismus surgery. During 24-48 hours after anaesthesia, ramosetron is more effective than granisetron for prophylaxis against postoperative vomiting.

 PMID:11371485

Does bariatric surgery prevent progression of diabetic retinopathy?

Science.gov (United States)

Chen, Y; Laybourne, J P; Sandinha, M T; de Alwis, N M W; Avery, P; Steel, D H

2017-08-01

PurposeTo assess the changes in diabetic retinopathy (DR) in type 2 diabetes (T2DM) patients post bariatric surgery and report on the risk factors that may be associated with it.Patients and methodsRetrospective observational study of T2DM patients who underwent bariatric surgery in a UK specialist bariatric unit between 2009 and 2015. Preoperative and postoperative weight, HbA1c, and annual DR screening results were collected from medical records. Patients with preoperative retinal screening and at least one postoperative retinal screening were eligible for analysis. Multivariate analysis was used to explore significant clinical predictors on postoperative worsening in DR.ResultsA total of 102 patients were eligible for analysis and were followed up for 4 years. Preoperatively, 68% of patients had no DR compared to 30% with background retinopathy, 1% pre-proliferative retinopathy, and 1% proliferative retinopathy. In the first postoperative visit, 19% of patients developed new DR compared to 70% stable and 11% improved. These proportions remained similar for each postoperative visit over time. Young age, male gender, high preoperative HbA1c, and presence of preoperative retinopathy were the significant predictors of worsening postoperatively.ConclusionBariatric surgery does not prevent progression of DR. Young male patients with pre-existing DR and poor preoperative glycaemic control are most at risk of progression. All diabetic patients should attend regular DR screening post bariatric surgery to allow early detection of potentially sight-threatening changes, particularly among those with identifiable risk factors. Future prospective studies with prolonged follow-up are required to clarify the duration of risk.

Role of diclofenac in the prevention of postpericardiotomy syndrome after cardiac surgery

Science.gov (United States)

Sevuk, Utkan; Baysal, Erkan; Altindag, Rojhat; Yaylak, Baris; Adiyaman, Mehmet Sahin; Ay, Nurettin; Alp, Vahhac; Beyazit, Unal

2015-01-01

Objective Postpericardiotomy syndrome (PPS), which is thought to be related to autoimmune phenomena, represents a common postoperative complication in cardiac surgery. Late pericardial effusions after cardiac surgery are usually related to PPS and can progress to cardiac tamponade. Preventive measures can reduce postoperative morbidity and mortality related to PPS. In a previous study, diclofenac was suggested to ameliorate autoimmune diseases. The aim of this study was to determine whether postoperative use of diclofenac is effective in preventing early PPS after cardiac surgery. Methods A total of 100 patients who were administered oral diclofenac for postoperative analgesia after cardiac surgery and until hospital discharge were included in this retrospective study. As well, 100 patients undergoing cardiac surgery who were not administered nonsteroidal anti-inflammatory drugs were included as the control group. The existence and severity of pericardial effusion were determined by echocardiography. The existence and severity of pleural effusion were determined by chest X-ray. Results PPS incidence was significantly lower in patients who received diclofenac (20% vs 43%) (Pdiclofenac had a significantly lower incidence of pericardial effusion (15% vs 30%) (P=0.01). Although not statistically significant, pericardial and pleural effusion was more severe in the control group than in the diclofenac group. The mean duration of diclofenac treatment was 5.11±0.47 days in patients with PPS and 5.27±0.61 days in patients who did not have PPS (P=0.07). Logistic regression analysis demonstrated that diclofenac administration (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.18–0.65, P=0.001) was independently associated with PPS occurrence. Conclusion Postoperative administration of diclofenac may have a protective role against the development of PPS after cardiac surgery. PMID:26170687

Consensus Bundle on Prevention of Surgical Site Infections After Major Gynecologic Surgery.

Science.gov (United States)

Pellegrini, Joseph E; Toledo, Paloma; Soper, David E; Bradford, William C; Cruz, Deborah A; Levy, Barbara S; Lemieux, Lauren A

Surgical site infections are the most common complications of surgery in the United States. Of surgeries in women of reproductive age, hysterectomy is one of the most frequently performed, second only to cesarean birth. Therefore, prevention of surgical site infections in women undergoing gynecologic surgery is an ideal topic for a patient safety bundle. The primary purpose of this safety bundle is to provide recommendations that can be implemented into any surgical environment in an effort to reduce the incidence of surgical site infection. This bundle was developed by a multidisciplinary team convened by the Council on Patient Safety in Women's Health Care. The bundle is organized into four domains: Readiness, Recognition and Prevention, Response, and Reporting and Systems Learning. In addition to recommendations for practice, each of the domains stresses communication and teamwork between all members of the surgical team. Although the bundle components are designed to be adaptable to work in a variety of clinical settings, standardization within institutions is encouraged. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Prediction and Prevention of Acute Kidney Injury after Cardiac Surgery

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Su Rin Shin

2016-01-01

Full Text Available The incidence of acute kidney injury after cardiac surgery (CS-AKI ranges from 33% to 94% and is associated with a high incidence of morbidity and mortality. The etiology is suggested to be multifactorial and related to almost all aspects of perioperative management. Numerous studies have reported the risk factors and risk scores and novel biomarkers of AKI have been investigated to facilitate the subclinical diagnosis of AKI. Based on the known independent risk factors, many preventive interventions to reduce the risk of CS-AKI have been tested. However, any single preventive intervention did not show a definite and persistent benefit to reduce the incidence of CS-AKI. Goal-directed therapy has been considered to be a preventive strategy with a substantial level of efficacy. Many pharmacologic agents were tested for any benefit to treat or prevent CS-AKI but the results were conflicting and evidences are still lacking. The present review will summarize the current updated evidences about the risk factors and preventive strategies for CS-AKI.

No consensus on restrictions on physical activity to prevent incisional hernias after surgery

DEFF Research Database (Denmark)

Pommergaard, H-C; Burcharth, J; Danielsen, Anne Kjaergaard

2014-01-01

of restrictions on physical activity recommended for patients operated for colorectal cancer and to evaluate the agreement among surgical specialists. METHODS: A questionnaire was sent to 60 general surgeons (specialists) in Denmark and Sweden working in academic departments of surgery with a high volume......PURPOSE: In the postoperative phase after colorectal surgery, restrictions on physical activity are often recommended for patients to prevent incisional hernias. However, evidence does not support that restrictions may prevent such hernias. The purpose of this study was to evaluate the extent...... of colorectal cancer resections. The questionnaire was case based and contained questions regarding possible restrictions on physical activity recommended for patients 0-2, 2-6 and >6 weeks after resection for colorectal cancer. Agreement among the surgeon on whether restrictions should be recommended...

Removing Unnecessary Variables from Horn Clause Verification Conditions

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Emanuele De Angelis

2016-07-01

Full Text Available Verification conditions (VCs are logical formulas whose satisfiability guarantees program correctness. We consider VCs in the form of constrained Horn clauses (CHC which are automatically generated from the encoding of (an interpreter of the operational semantics of the programming language. VCs are derived through program specialization based on the unfold/fold transformation rules and, as it often happens when specializing interpreters, they contain unnecessary variables, that is, variables which are not required for the correctness proofs of the programs under verification. In this paper we adapt to the CHC setting some of the techniques that were developed for removing unnecessary variables from logic programs, and we show that, in some cases, the application of these techniques increases the effectiveness of Horn clause solvers when proving program correctness.

Sonohysterography

Medline Plus

Full Text Available ... in detail with sonohysterography. Sonohysterography can prevent unnecessary surgery, and it can ensure that all polyps and fibroids are removed at surgery. Risks For standard diagnostic ultrasound , there are no ...

The analgesic efficacy of intravenous versus oral tramadol for preventing postoperative pain after third molar surgery

NARCIS (Netherlands)

Ong, Cliff K. S.; Lirk, Phillip; Tan, Juliana M. H.; Sow, Belle W. Y.

2005-01-01

The aim of this study was to compare the analgesic efficacy of single-dose preoperative intravenous versus oral tramadol for preventing pain after third molar surgery. Seventy-two patients undergoing elective third molar surgery were randomized to receive either intravenous (n = 36) or oral (n = 36)

Preoperative Prevention of Heart Failure in Noncardiac Surgery

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V. V. Likhvantsev

2016-01-01

Full Text Available Congestive heart failure is consistently associated with adverse outcomes, and is characterized by a twofold increase in mortality in noncardiac surgery. In this regard, developing the methods aimed to prevent and treatacute heart failure (AHF in the intraoperative period remain a challenging problem.Objective. To evaluate the efficacy of preoperative levosimendan infusion in reduction both mortality and duration of treatment of elderly patients with reduced left ventricular ejection fraction in noncardiac surgery.Material and Methods. Design: Multicenter blind randomized placebocontrolled study. Patients: 81 patients operated on abdominal organs. The main endpoint of the study: The length of stay in the Intensive Care Unit (ICU and at the hospital were chosen as the primary endpoints. The secondary endpoints of the study were 30 day and annual mortality, the rate of acute myocardial infarction and stroke.Results. Levosimendan infusion at a rate of 0,05 μg/kg/min — 0,1 μg/kg/min to patients with low left ven tricular ejection fraction just before the surgery reduced the length of stay in ICU for 2 days and required hospital stay for 3 days. NTproBNP showed the best ratio of sensitivity/specificity in predicting 30day mortality in cumulative group: AUC=0,86 (90,77 to 0,93, P<0,0001. From other indicators the most informative were the Inotropes scoring, no change or decrease of a left ventricular ejection fraction, and cardiac index.Conclusion. To reduce perioperative mortality, the intravenous infusion of levosimendan at a rate of 0,05—0,1 μg/kg/min in elderly patients with low left ventricular ejection fraction is recommened as a preoperative preparation the day before the alleged noncardiac surgery.

Back surgery: Modern medical pitfall.

Science.gov (United States)

Smith, Jc

2002-01-01

Medical iatrogenesis is at an all-time high with increasing deaths, disability, and costs compounded by unnecessary and ineffective surgeries despite the warnings from WHO, the US Public Health Service, and the Institute of Medicine. One area in particular, failed back surgeries, has drawn increasing attention by researchers due to disproved medical theories and surgical treatments. Paradoxically, while spinal manipulative therapy has been shown to achieve better results for this epidemic of low back pain in particular, medical and insurance programs often limit or boycott this inexpensive and effective treatment, indicating the solution to lowering medical costs and iatrogenesis now rests with political and economic factors primarily.

Necessity of suction drains in gynecomastia surgery.

Science.gov (United States)

Keskin, Mustafa; Sutcu, Mustafa; Cigsar, Bulent; Karacaoglan, Naci

2014-05-01

The aim of gynecomastia surgery is to restore a normal chest contour with minimal signs of breast surgery. The authors examine the rate of complications in gynecomastia surgery when no closed-suction drains are placed. One hundred thirty-eight consecutive male patients who underwent gynecomastia surgery without drains were retrospectively analyzed to determine whether the absence of drains adversely affected patient outcomes. Patients were managed by ultrasonic-assisted liposuction both with and without the pull-through technique. The mean age of the patients was 29 years, and the mean volume of breast tissue aspirated was 350 mL per beast. Pull-through was needed in 23 cases. There was only 1 postoperative hematoma. These results are comparable with previously published data for gynecomastia surgery in which drains were placed, suggesting that the absence of drains does not adversely affect postoperative recovery. Routine closed-suction drainage after gynecomastia surgery is unnecessary, and it may be appropriate to omit drains after gynecomastia surgery.

Clinical observation of ondansetron administration at different time in preventing nausea and vomiting after pediatric strabismus surgery

Directory of Open Access Journals (Sweden)

Huai-Gang Liu

2014-06-01

Full Text Available AIM: To observe the efficacy of ondansetron by intravenous injection at different time in preventing nausea and vomiting after pediatric strabismus surgery. METHODS: Totally 90 children aged 3-11y were randomly selected for pediatric strabismus surgery from June 2013 to August 2013 in our hospital. The ASA grade of all children were Ⅰ-Ⅱ. Children were randomly divided into three groups with 30 cases each. Group A received intravenous drip of ondansetron 0.1mg/kg before surgery. Group B received intravenous drip of ondansetron 0.1mg/kg after surgery. Group C as control group was not given ondansetron. The number and severity of nausea and vomiting were observed within 24h after surgery. RESULTS: There were no statistical significance in patients' gender, weight, age, duration of anesthesia, ketamine dosage and vital signs intraoperative between the three groups(P>0.05. The incidence rate of postoperative nausea and vomiting(PONVof group A and B were significantly lower than group C(PP>0.05. CONCLUSION: Using ondansetron is effective and safe in preventing PONV before and at the end of the pediatric strabismus surgery, which can also improve safety and be lower cost. It is a worthy promoting antiemetic approach for eye surgery.

How to save costs by reducing unnecessary testing: Lean thinking in clinical practice

NARCIS (Netherlands)

Vegting, I.L.; van Beneden, M.; Kramer, M.H.H.; Thijs, A.; Kostense, P.J.; Nanayakkara, P.W.B.

2012-01-01

Background: The burden of health care expenditure on national budgets has increased dramatically over the past decade. A pilot study in our hospital demonstrated that many unnecessary diagnostic tests were performed routinely. The aim of this study was to reduce the costs of unnecessary diagnostic

Alcohol-related hand injuries: an unnecessary social and economic cost.

OpenAIRE

Marston, R. A.

1992-01-01

Severe hand injuries constitute the largest number of acute referrals to this plastic surgery unit, the admission of these patients often displacing routine admissions due to bed shortages, thus increasing waiting list time. This study showed that a high percentage of these injuries were alcohol-related and were therefore preventable. The economic cost to the unit is discussed.

Carvedilol for prevention of atrial fibrillation after cardiac surgery: a meta-analysis.

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Hui-Shan Wang

Full Text Available BACKGROUND: Postoperative atrial fibrillation (POAF remains the most common complication after cardiac surgery. Current guidelines recommend β-blockers to prevent POAF. Carvedilol is a non-selective β-adrenergic blocker with anti-inflammatory, antioxidant, and multiple cationic channel blocking properties. These unique properties of carvedilol have generated interest in its use as a prophylaxis for POAF. OBJECTIVE: To investigate the efficacy of carvedilol in preventing POAF. METHODS: PubMed from the inception to September 2013 was searched for studies assessing the effect of carvedilol on POAF occurrence. Pooled relative risk (RR with 95% confidence interval (CI was calculated using random- or fixed-effect models when appropriate. Six comparative trials (three randomized controlled trials and three nonrandomized controlled trials including 765 participants met the inclusion criteria. RESULTS: Carvedilol was associated with a significant reduction in POAF (relative risk [RR] 0.49, 95% confidence interval [CI] 0.37 to 0.64, p<0.001. Subgroup analyses yielded similar results. In a subgroup analysis, carvedilol appeared to be superior to metoprolol for the prevention of POAF (RR 0.51, 95% CI 0.37 to 0.70, p<0.001. No evidence of heterogeneity was observed. CONCLUSIONS: In conclusion, carvedilol may effectively reduce the incidence of POAF in patients undergoing cardiac surgery. It appeared to be superior to metoprolol. A large-scale, well-designed randomized controlled trial is needed to conclusively answer the question regarding the utility of carvedilol in the prevention of POAF.

The radiation like preventive methods of the ectopic development after hip surgery

International Nuclear Information System (INIS)

Menendez Garcia, J.C.; Delgado Macias, M.T.

1995-01-01

In view of the prevalence of ectopic bone development after hip surgery, a review has been done on the reports appearing in the literature dealing with the use of irradiation, at different doses and postoperative intervals, as a method to prevent this complication. The results demonstrate the efficacy of radiotherapy in preventing ectopic bone formation, the need to begin its application within the first four days of surgical treatment and the fact that satisfactory results can be obtained with relatively low and, thus, theoretically innocuous doses. 17 refs

Surgical Tip for Prevention of Lip Injury During Orthognathic and Facial Bone Contouring Surgery.

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Lee, Tae Sung; Park, Sanghoon

2017-10-01

Iatrogenic lip injury is a rather common complication after facial bone surgery, but is usually treated lightly by the surgeon compared with other more severe functional complications. However, these injuries can have permanent sequelae and can therefore be a reason for patient dissatisfaction, especially after cosmetic surgery. Intraoperative lip injuries during facial bone surgery are usually caused by heat-generating surgical instruments or forced traction on the operative fields. The authors have applied a special technical strategy using a hydrocolloid dressing material to avoid these intraoperative lip injuries. This method does not disturb the operative procedure itself, but efficiently prevents lip injuries and decreases surgical morbidities and postoperative swelling.

Is Preventative Long-Segment Surgery for Multi-Level Spondylolysis Necessary? A Finite Element Analysis Study.

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Jianqiang Mo

Full Text Available For multi-level spondylolysis patients, surgeons commonly choose to fix all the segments with pars interarticularis defect even those without slippage and not responsible for clinical symptoms. In this study, we tried to study the necessity of the preventative long-segment surgery for the defected segment without slippage in treatment of multi-level spondylolysis patients from a biomechanical perspective.We established a bi-level spondylolysis model with pars defects at L4 and L5 segments, and simulated posterior lumbar interbody fusion (PLIF and pedicle screw fixation at L5-S1 level. Then we compared the biomechanical changes at L4 segment before and after surgery in neutral, flexion, extension, lateral bending and axial rotation position.The stress on L4 pars interarticularis was very similar before and after surgery, and reached the highest in axial rotation. The L3-L4 intradiscal pressure was almost the same, while L4-L5 intradiscal pressure changed a little in lateral bending (increase from 1.993 to 2.160 MPa and axial rotation (decrease from 1.639 to 1.307 MPa after surgery. The PLIF surgery caused a little increase of range of motion at adjacent L4-L5 and L3-L4 levels, but the change is very tiny (1 degree.The PLIF surgery will not cause significant biomechanical change at adjacent segment with pars defect in multi-level spondylolysis. On the contrary, excessive long-segment surgery will damage surrounding soft tissues which are important for maintaining the stability of spine. So a preventative long-segment surgery is not necessary for multi-level spondylolysis as long as there are no soft tissue degeneration signs at adjacent level.

Is Preventative Long-Segment Surgery for Multi-Level Spondylolysis Necessary? A Finite Element Analysis Study.

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Mo, Jianqiang; Zhang, Wen; Zhong, Dongyan; Xu, Hao; Wang, Lan; Yu, Jia; Luo, Zongping

2016-01-01

For multi-level spondylolysis patients, surgeons commonly choose to fix all the segments with pars interarticularis defect even those without slippage and not responsible for clinical symptoms. In this study, we tried to study the necessity of the preventative long-segment surgery for the defected segment without slippage in treatment of multi-level spondylolysis patients from a biomechanical perspective. We established a bi-level spondylolysis model with pars defects at L4 and L5 segments, and simulated posterior lumbar interbody fusion (PLIF) and pedicle screw fixation at L5-S1 level. Then we compared the biomechanical changes at L4 segment before and after surgery in neutral, flexion, extension, lateral bending and axial rotation position. The stress on L4 pars interarticularis was very similar before and after surgery, and reached the highest in axial rotation. The L3-L4 intradiscal pressure was almost the same, while L4-L5 intradiscal pressure changed a little in lateral bending (increase from 1.993 to 2.160 MPa) and axial rotation (decrease from 1.639 to 1.307 MPa) after surgery. The PLIF surgery caused a little increase of range of motion at adjacent L4-L5 and L3-L4 levels, but the change is very tiny (1 degree). The PLIF surgery will not cause significant biomechanical change at adjacent segment with pars defect in multi-level spondylolysis. On the contrary, excessive long-segment surgery will damage surrounding soft tissues which are important for maintaining the stability of spine. So a preventative long-segment surgery is not necessary for multi-level spondylolysis as long as there are no soft tissue degeneration signs at adjacent level.

Blood conservation in cardiac surgery.

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Blaudszun, G; Butchart, A; Klein, A A

2017-09-21

This article aims at reviewing the currently available evidence about blood conservation strategies in cardiac surgery. Pre-operative anaemia and perioperative allogeneic blood transfusions are associated with worse outcomes after surgery. In addition, transfusions are a scarce and costly resource. As cardiac surgery accounts for a significant proportion of all blood products transfused, efforts should be made to decrease the risk of perioperative transfusion. Pre-operative strategies focus on the detection and treatment of anaemia. The management of haematological abnormalities, most frequently functional iron deficiency, is a matter for debate. However, iron supplementation therapy is increasingly commonly administered. Intra-operatively, antifibrinolytics should be routinely used, whereas the cardiopulmonary bypass strategy should be adapted to minimise haemodilution secondary to circuit priming. There is less evidence to recommend minimally invasive surgery. Cell salvage and point-of-care tests should also be a part of the routine care. Post-operatively, any unnecessary iatrogenic blood loss should be avoided. © 2017 British Blood Transfusion Society.

Analysis of Patients with Myelopathy due to Benign Intradural Spinal Tumors with Concomitant Lumbar Degenerative Diseases Misdiagnosed and Erroneously Treated with Lumbar Surgery.

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Lu, Kang; Wang, Hao-Kuang; Liliang, Po-Chou; Yang, Chih-Hui; Yen, Cheng-Yo; Tsai, Yu-Duan; Chen, Po-Yuan; Chye, Cien-Leong; Wang, Kuo-Wei; Liang, Cheng-Loong; Chen, Han-Jung

2017-09-01

When a cervical or thoracic benign intradural spinal tumor (BIST) coexists with lumbar degenerative diseases (LDD), diagnosis can be difficult. Symptoms of BIST-myelopathy can be mistaken as being related to LDD. Worse, an unnecessary lumbar surgery could be performed. This study was conducted to analyze cases in which an erroneous lumbar surgery was undertaken in the wake of failure to identify BIST-associated myelopathy. Cases were found in a hospital database. Patients who underwent surgery for LDD first and then another surgery for BIST removal within a short interval were studied. Issues investigated included why the BISTs were missed, how they were found later, and how the patients reacted to the unnecessary lumbar procedures. Over 10 years, 167 patients received both surgeries for LDD and a cervical or thoracic BIST. In 7 patients, lumbar surgery preceded tumor removal by a short interval. Mistakes shared by the physicians included failure to detect myelopathy and a BIST, and a hasty decision for lumbar surgery, which soon turned out to be futile. Although the BISTs were subsequently found and removed, 5 patients believed that the lumbar surgery was unnecessary, with 4 patients expressing regrets and 1 patient threatening to take legal action against the initial surgeon. Concomitant symptomatic LDD and BIST-associated myelopathy pose a diagnostic challenge. Spine specialists should refrain from reflexively linking leg symptoms and impaired ability to walk to LDD. Comprehensive patient evaluation is fundamental to avoid misdiagnosis and wrong lumbar surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

Escalating Health Care Cost due to Unnecessary Diagnostic Testing

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MUHAMMAD AZAM ISHAQUE CHAUDHARY

2017-07-01

Full Text Available Focusing on health care systems can improve health outcomes now and in the future. Growing economies have serious concerns on the rising cost of health, whereas, in under developed countries like Pakistan, it is not emphasized yet at all. The research is conducted to improve a unique aspect of health care systems to provide effective, patient-centred, high-standard health care while maintaining the cost effectiveness. Research is being qualified in two paradigms qualitative and quantitative. In qualitative research, expert?s interviews have been taken to get the basic knowledge of radiology based testing and their prerequisites, in quantitative research ordered are being analysed to check the frequency and if they are unnecessary or qualified medical necessity guidelines as established in qualitative method. Analysis was made on the basis of the trinity relationship of diagnosis, symptoms and respected order to determine the necessity of the order to get its impact on cost of the overall health of those patients and point out more than 50% unnecessary orders are being performed in two government hospitals. The situation is alarming and policy makers should focus on unnecessary ordering to avoid out of pocket expenses and improve quality of care. The research helps in successful application of health care system modifications and policies pertaining to one aspect of health systems, i.e. cost-effectiveness of health care.

Nebivolol in preventing atrial fibrillation following coronary surgery in patients over 60 years of age

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Nevzat Erdil

2014-12-01

Full Text Available Objective: Postoperative atrial fibrillation is a common complication after cardiac surgery, with an incidence as high as 20-50%. Increased age is associated with a significant increase in postoperative atrial fibrillation risk. This common complication is associated with higher morbidity and mortality rates. The aim of this study was to assess the efficacy of nebivolol in preventing atrial fibrillation following coronary artery bypass surgery in patients over 60 years of age. Methods: In this prospective randomized study, 200 patients who were candidates for elective coronary artery bypass surgery were divided into two groups. The first group was administered with nebivolol and the second group was administered with metoprolol. Treatment was initiated four days prior to surgery, and patients were monitored for atrial fibrillation until discharge. Forty-one patients recieved 50 mg metoprolol succinate daily, which was initiated minimum 4 days before surgery. Results: Demographic data were similar in both groups. The incidence of postoperative atrial fibrillation in both groups was similar, with no significant difference being identified [n=20 (20%; n=18 (18%, P=0.718; respectively]. There were not any mortality at both groups during study. Inotropic agent requirement at ICU was similar for both groups [n=12 (12%, n=18 (18%, P=0.32]. Conclusion: We compared the effectiveness of nebivolol and metoprolol in decreasing the incidence of postoperative atrial fibrillation, and determined that nebivolol was as effective as metoprolol in preventing postoperative atrial fibrillation at patients. Nebivolol may be the drug of choice due to its effects, especially after elective coronary artery bypass surgery.

Vertebral artery injury in cervical spine surgery: anatomical considerations, management, and preventive measures.

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Peng, Chan W; Chou, Benedict T; Bendo, John A; Spivak, Jeffrey M

2009-01-01

Vertebral artery (VA) injury can be a catastrophic iatrogenic complication of cervical spine surgery. Although the incidence is rare, it has serious consequences including fistulas, pseudoaneurysm, cerebral ischemia, and death. It is therefore imperative to be familiar with the anatomy and the instrumentation techniques when performing anterior or posterior cervical spine surgeries. To provide a review of VA injury during common anterior and posterior cervical spine procedures with an evaluation of the surgical anatomy, management, and prevention of this injury. Comprehensive literature review. A systematic review of Medline for articles related to VA injury in cervical spine surgery was conducted up to and including journal articles published in 2007. The literature was then reviewed and summarized. Overall, the risk of VA injury during cervical spine surgery is low. In anterior cervical procedures, lateral dissection puts the VA at the most risk, so sound anatomical knowledge and constant reference to the midline are mandatory during dissection. With the development and rise in popularity of posterior cervical stabilization and instrumentation, recognition of the dangers of posterior drilling and insertion of transarticular screws and pedicle screws is important. Anomalous vertebral anatomy increases the risk of injury and preoperative magnetic resonance imaging and/or computed tomography (CT) scans should be carefully reviewed. When the VA is injured, steps should be taken to control local bleeding. Permanent occlusion or ligation should only be attempted if it is known that the contralateral VA is capable of providing adequate collateral circulation. With the advent of endovascular repair, this treatment option can be considered when a VA injury is encountered. VA injury during cervical spine surgery is a rare but serious complication. It can be prevented by careful review of preoperative imaging studies, having a sound anatomical knowledge and paying attention

Timing of discharge: a key to understanding the reason for readmission after colorectal surgery.

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Kelly, Kristin N; Iannuzzi, James C; Aquina, Christopher T; Probst, Christian P; Noyes, Katia; Monson, John R T; Fleming, Fergal J

2015-03-01

There is a growing interest in surgery regarding the balance between appropriate hospital length of stay (LOS) and prevention of unnecessary readmissions. This study examines the relationship between postoperative LOS and unplanned readmission after colorectal resection, exploring whether patients discharged earlier have different readmission risk profiles. Patients undergoing colorectal resection were selected by Common Procedural Terminology (CPT) code from the 2012 ACS National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified by LOS quartile. Kaplan-Meier analysis was used to examine characteristics associated with 30-day unplanned readmission. Factors with a p rate was 11 %. After adjusting for patient and perioperative factors, a postoperative LOS ≥8 days was associated with a 55 % increase in the relative hazard of readmission. Patients with a ≤3-day LOS were more likely to be readmitted with ileus/obstruction (odds ratio (OR): 1.8, p = 0.001) and pain (OR: 2.2, p = 0.007). LOS was not significantly associated with readmission for intraabdominal infection or medical complications. Patients with longer LOS and complicated hospital courses continue to be high risk post-discharge, while straightforward early discharges have a different readmission risk profile. More targeted readmission prevention strategies are critical to focusing resource utilization for colorectal surgery patients.

Side effect experiences of South Korean women in their twenties and thirties after facial plastic surgery

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Kim YA

2018-06-01

Full Text Available Young A Kim,1 Hyang-In Cho Chung2 1Department of Nursing, Jeju National University College of Nursing, Jeju-si, Republic of Korea; 2Department of Nursing, Chonnam National University College of Nursing, Gwangju, Republic of Korea Background: Rates of plastic surgery procedures have increased dramatically over the past several decades, especially for the women in South Korea.Purpose: The purpose of this study was to explore the subjective experience of South Korean women in their twenties and thirties with facial plastic surgery (FPS side effects.Participants and methods: Seven women who have suffered from FPS side effects participated in this study. Data were collected from July to September 2015 through individual in-depth interviews using open-ended questions and analyzed using Colaizzi’s method, which is a Husserlian phenomenological approach.Results: Six themes, and 25 subthemes, were found. Major themes were “choosing FPS to gain a new self”, “facing an unintended self”, “trying to accept a changed self”, “making efforts to overcome the situation”, “coming to know a new world”, and “pursuing a new lifestyle”.Conclusion: This study raises social awareness on the risk of plastic surgery side effects, which could prevent unnecessary plastic surgery. It also suggests the need for a deeper understanding of women’s biopsychosocial suffering from plastic surgery side effects. Keywords: cosmetic surgery, aesthetic plastic surgery, qualitative research, interview 

Ursodeoxycholic Acid in the Prevention of Gallstone Formation After Bariatric Surgery: an Updated Systematic Review and Meta-analysis.

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Magouliotis, Dimitrios E; Tasiopoulou, Vasiliki S; Svokos, Alexis A; Svokos, Konstantina A; Chatedaki, Christina; Sioka, Eleni; Zacharoulis, Dimitris

2017-11-01

We aim to review the available literature on obese patients treated with ursodeoxycholic acid (UDCA) in order to prevent gallstone formation after bariatric surgery. A systematic literature search was performed in PubMed, Cochrane library, and Scopus databases, in accordance with the PRISMA guidelines. Eight studies met the inclusion criteria incorporating 1355 patients. Random-effects meta-analysis showed a lower incidence of gallstone formation in patients taking UDCA. Subgroup analysis reported fewer cases of gallstone disease in the UDCA group in relation to different bariatric procedures, doses of administered UDCA, and time from bariatric surgery. Adverse events were similar in both groups. Fewer patients required cholecystectomy in UDCA group. No deaths were reported. The administration of UDCA after bariatric surgery seems to prevent gallstone formation.

High-Risk Breast Lesions: A Machine Learning Model to Predict Pathologic Upgrade and Reduce Unnecessary Surgical Excision.

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Bahl, Manisha; Barzilay, Regina; Yedidia, Adam B; Locascio, Nicholas J; Yu, Lili; Lehman, Constance D

2018-03-01

Purpose To develop a machine learning model that allows high-risk breast lesions (HRLs) diagnosed with image-guided needle biopsy that require surgical excision to be distinguished from HRLs that are at low risk for upgrade to cancer at surgery and thus could be surveilled. Materials and Methods Consecutive patients with biopsy-proven HRLs who underwent surgery or at least 2 years of imaging follow-up from June 2006 to April 2015 were identified. A random forest machine learning model was developed to identify HRLs at low risk for upgrade to cancer. Traditional features such as age and HRL histologic results were used in the model, as were text features from the biopsy pathologic report. Results One thousand six HRLs were identified, with a cancer upgrade rate of 11.4% (115 of 1006). A machine learning random forest model was developed with 671 HRLs and tested with an independent set of 335 HRLs. Among the most important traditional features were age and HRL histologic results (eg, atypical ductal hyperplasia). An important text feature from the pathologic reports was "severely atypical." Instead of surgical excision of all HRLs, if those categorized with the model to be at low risk for upgrade were surveilled and the remainder were excised, then 97.4% (37 of 38) of malignancies would have been diagnosed at surgery, and 30.6% (91 of 297) of surgeries of benign lesions could have been avoided. Conclusion This study provides proof of concept that a machine learning model can be applied to predict the risk of upgrade of HRLs to cancer. Use of this model could decrease unnecessary surgery by nearly one-third and could help guide clinical decision making with regard to surveillance versus surgical excision of HRLs. © RSNA, 2017.

The case for restraint in spinal surgery: does quality management have a role to play?

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Deyo, Richard A; Mirza, Sohail K

2009-08-01

Most quality improvement efforts in surgery have focused on the technical quality of care provided, rather than whether the care was indicated, or could have been provided with a safer procedure. Because risk is inherent in any procedure, reducing the number of unnecessary operations is an important issue in patient safety. In the case of lumbar spine surgery, several lines of evidence suggest that, in at least some locations, there may be excessively high surgery rates. This evidence comes from international comparisons of surgical rates; study of small area variations within countries; increasing surgical rates in the absence of new indications; comparisons of surgical outcomes between geographic areas with high or low surgical rates; expert opinion; the preferences of well-informed patients; and increasing rates of repeat surgery. From a population perspective, reducing unnecessary surgery may have a greater impact on complication rates than improving the technical quality of surgery that is performed. Evidence suggests this may be true for coronary bypass surgery in the US and hysterectomy rates in Canada. Though similar studies have not been done for spine surgery, wide geographic variations in surgical rates suggest that this could be the case for spine surgery as well. We suggest that monitoring geographic variations in surgery rates may become an important aspect of quality improvement, and that rates of repeat surgery may bear special attention. Patient registries can help in this regard, if they are very complete and rigorously maintained. They can provide data on surgical rates; offer post-marketing surveillance for new surgical devices and techniques; and help to identify patient subgroups that may benefit most from certain procedures.

Prevention of intraoperative cerebrospinal fluid leaks by lumbar cerebrospinal fluid drainage during surgery for pituitary macroadenomas.

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Mehta, Gautam U; Oldfield, Edward H

2012-06-01

Cerebrospinal fluid leakage is a major complication of transsphenoidal surgery. An intraoperative CSF leak, which occurs in up to 50% of pituitary tumor cases, is the only modifiable risk factor for postoperative leaks. Although several techniques have been described for surgical repair when an intraoperative leak is noted, none has been proposed to prevent an intraoperative CSF leak. The authors postulated that intraoperative CSF drainage would diminish tension on the arachnoid, decrease the rate of intraoperative CSF leakage during surgery for larger tumors, and reduce the need for surgical repair of CSF leaks. The results of 114 transsphenoidal operations for pituitary macroadenoma performed without intraoperative CSF drainage were compared with the findings from 44 cases in which a lumbar subarachnoid catheter was placed before surgery to drain CSF at the time of dural exposure and tumor removal. Cerebrospinal fluid drainage reduced the rate of intraoperative CSF leakage from 41% to 5% (p drainage reduced the need for operative repair (from 32% to 5%, p drainage during transsphenoidal surgery for macroadenomas reduces the rate of intraoperative CSF leaks. This preventative measure obviated the need for surgical repair of intraoperative CSF leaks using autologous fat graft placement, other operative techniques, postoperative lumbar drainage, and/or reoperation in most patients and is associated with minimal risks.

A Consultation Phone Service for Patients With Total Joint Arthroplasty May Reduce Unnecessary Emergency Department Visits.

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Hällfors, Eerik; Saku, Sami A; Mäkinen, Tatu J; Madanat, Rami

2018-03-01

Different measures for reducing costs after total joint arthroplasty (TJA) have gained attention lately. At our institution, a free-of-charge consultation phone service was initiated that targeted patients with TJA. This service aimed at reducing unnecessary emergency department (ED) visits and, thus, potentially improving the cost-effectiveness of TJAs. To our knowledge, a similar consultation service had not been described previously. We aimed at examining the rates and reasons for early postdischarge phone calls and evaluating the efficacy of this consultation service. During a 2-month period, we gathered information on every call received by the consultation phone service from patients with TJAs within 90 days of the index TJA procedure. Patients were followed for 2 weeks after making a call to detect major complications and self-initiated ED visits. Data were collected from electronic medical charts regarding age, gender, type of surgery, date of discharge, and length of hospital stay. We analyzed 288 phone calls. Calls were mostly related to medication (41%), wound complications (17%), and mobilization issues (15%). Most calls were resolved in the phone consultation. Few patients (13%) required further evaluation in the ED. The consultation service failed to detect the need for an ED visit in 2 cases (0.7%) that required further care. The consultation phone service clearly benefitted patients with TJAs. The service reduced the number of unnecessary ED visits and functioned well in detecting patients who required further care. Most postoperative concerns were related to prescribed medications, wound complications, and mobilization issues. Copyright © 2017 Elsevier Inc. All rights reserved.

"Unnecessary suffering": the cornerstone of animal protection legislation considered.

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Radford, M

1999-09-01

Causing "unnecessary suffering" has been widely adopted in legislation to define criminal liability in respect of the treatment of animals. This article examines the way in which the term has been interpreted and applied by the courts, and considers its effectiveness in affording animals protection from abuse.

Serological biomarker testing helps avoiding unnecessary endoscopies in obese patients before bariatric surgery

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Jaanus Suumann

2018-02-01

Full Text Available Abstract Background To assess the value of serological biomarker testing as a substitute for esophagogastroduodenoscopy (EGDS in pre-operative assessment of patients referred for bariatric surgery. Methods Sixty-five obese patients with a mean age of 43 years (range: 21–65 and a mean body mass index (BMI of 44 (range: 36–59 were studied. The patients were tested with a four-biomarker panel: pepsinogen I and II, gastrin-17 (basal and stimulated, and Helicobacter pylori (HP antibodies (GastroPanel®, Biohit Oyj, Finland. On the basis of the biomarker test, the patients were classified into the HS (healthy stomach group (n = 22 with the normal biomarker profile and the NHS (non-healthy stomach group (n = 43. The classification of patients into HS and NHS was evaluated against the gold standard, i.e. EGDS with biopsies. Results The concordance (Cohen’s kappa between the biomarker test and gastric histology was 0.68; 95% CI 0.504–0.854, with an overall agreement of 84.6% (95% CI 73.9–91.4%. In the NHS group, all 43 patients had biopsy-confirmed chronic gastritis: 39 non-atrophic HP-gastritis, 4 atrophic antrum gastritis (AGA of moderate severity. In the HS group only 6 patients had mild superficial H.pylori negative gastritis. Of the 22 HS subjects with the normal biomarker profile, 20 (31% of all 65 had no complaints either, while the remaining two had reflux symptoms with esophagitis. In the NHS group 10 patients had esophagitis and 8 had also reflux symptoms. Conclusions The normal biomarker profile is an excellent surrogate for healthy stomach, implicating that pre-operative EGDS could have been avoided in 31% of our asymptomatic bariatric surgery patients who had the normal biomarker profile.

Medical tourism in plastic surgery: ethical guidelines and practice standards for perioperative care.

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Iorio, Matthew L; Verma, Kapil; Ashktorab, Samaneh; Davison, Steven P

2014-06-01

The goal of this review was to identify the safety and medical care issues that surround the management of patients who had previously undergone medical care through tourism medicine. Medical tourism in plastic surgery occurs via three main referral patterns: macrotourism, in which a patient receives treatments abroad; microtourism, in which a patient undergoes a procedure by a distant plastic surgeon but requires postoperative and/or long-term management by a local plastic surgeon; and specialty tourism, in which a patient receives plastic surgery from a non-plastic surgeon. The ethical practice guidelines of the American Medical Association, International Society of Aesthetic Plastic Surgery, American Society of Plastic Surgeons, and American Board of Plastic Surgeons were reviewed with respect to patient care and the practice of medical tourism. Safe and responsible care should start prior to surgery, with communication and postoperative planning between the treating physician and the accepting physician. Complications can arise at any time; however, it is the duty and ethical responsibility of plastic surgeons to prevent unnecessary complications following tourism medicine by adequately counseling patients, defining perioperative treatment protocols, and reporting complications to regional and specialty-specific governing bodies. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

[An initiative to reduce the use of unnecessary medication in infants with bronchiolitis in primary care].

Science.gov (United States)

Montejo Fernández, Marta; Benito Manrique, Iñaki; Montiel Eguía, Arantza; Benito Fernández, Javier

2018-05-23

Although evidence-based guidelines for acute bronchiolitis recommend primarily supportive care unnecessary treatments remain well documented. The objective of this study was to analyse a quality improvement initiative to reduce overuse of unnecessary treatments in infants with acute bronchiolitis in primary care settings. To determine the number of unnecessary treatments we reviewed the charts corresponding to infants aged initiative may be applied to the settings where the majority of infants with acute bronchiolitis are attended in western countries. Copyright © 2018. Publicado por Elsevier España, S.L.U.

Discussion on the Relevant Factors of General Surgery Incision Infection and Prevention Methods

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Jin Baotao

2017-01-01

Full Text Available There are many reasons that can lead to incision infection of general surgical patients. The main reasons include weight, age, body albumin level, surgical time, observation ward, etc. This paper analyzes the clinic data of patients with incision infection after general surgery based on clinic practice and study on the reasons that have impact on general surgical incision infection and gives relevant prevention countermeasures.

[Randomized controlled trial on the effectiveness of Corpitolinol 60 in the prevention of pressure sores in patients undergoing surgery].

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Chiari, Paolo; Giorgi, Sabina; Ugolini, Daniela; Montanari, Morena; Giudanella, Pietro; Gramantieri, Antonella; Collesi, Franca; Pau, Michelina; Smaldone, Maddalena; Matarasso, Maddalena; Mazzini, Cinzia; Russo, Francesca; Gazineo, Domenica; Fontana, Mirella; Taddia, Patrizia

2012-01-01

Randomized controlled trial on the effectiveness of Corpitolinol 60 in the prevention of pressure sores in surgical patients. The risk of pressure sores in surgical patients is widely recognised. The Corpitolinol 60 (Sanyréne®) applied on compressed areas seems to reduce the risk of pressure sores. To assess the efficacy of Corpitolinol 60 in preventing pressure sores in the operatory theatre. The open label randomized clinical trial was conducted in 5 operating theatres of Northen Italy. Patients were randomized to receive Corpitolinol 60 in areas undergoing compression. Experimental group and controls were treated with usual measures for preventing pressure sores. The lesions were staged according to NPUAP up to 24 hours after surgery. Three-hundred-one patients were randomized (155 in the Sanyréne® group and 143 controls). The main variables predictive of pressure sores risk (ASA class, sex, age, duration of the surgery, and BMI) were comparable across groups. At the end of the surgery 71 patients (23.8%) in the experimental group and 47 controls (30.8%) had a pressure sore (p 0.006; RR 1.81 IC95% 1.17-2.79). Twelve and 24 hours after surgery the differences between groups were not significant. The aim of reducing pressure sores was not reached for patients treated with Corpitolinol 60.

Alpha-2 adrenergic agonists for the prevention of cardiac complications among adults undergoing surgery.

Science.gov (United States)

Duncan, Dallas; Sankar, Ashwin; Beattie, W Scott; Wijeysundera, Duminda N

2018-03-06

The surgical stress response plays an important role on the pathogenesis of perioperative cardiac complications. Alpha-2 adrenergic agonists attenuate this response and may help prevent postoperative cardiac complications. To determine the efficacy and safety of α-2 adrenergic agonists for reducing mortality and cardiac complications in adults undergoing cardiac surgery and non-cardiac surgery. We searched CENTRAL (2017, Issue 4), MEDLINE (1950 to April Week 4, 2017), Embase (1980 to May 2017), the Science Citation Index, clinical trial registries, and reference lists of included articles. We included randomized controlled trials that compared α-2 adrenergic agonists (i.e. clonidine, dexmedetomidine or mivazerol) against placebo or non-α-2 adrenergic agonists. Included trials had to evaluate the efficacy and safety of α-2 adrenergic agonists for preventing perioperative mortality or cardiac complications (or both), or measure one or more relevant outcomes (i.e. death, myocardial infarction, heart failure, acute stroke, supraventricular tachyarrhythmia and myocardial ischaemia). Two authors independently assessed trial quality, extracted data and independently performed computer entry of abstracted data. We contacted study authors for additional information. Adverse event data were gathered from the trials. We evaluated included studies using the Cochrane 'Risk of bias' tool, and the quality of the evidence underlying pooled treatment effects using GRADE methodology. Given the clinical heterogeneity between cardiac and non-cardiac surgery, we analysed these subgroups separately. We expressed treatment effects as pooled risk ratios (RR) with 95% confidence intervals (CI). We included 47 trials with 17,039 participants. Of these studies, 24 trials only included participants undergoing cardiac surgery, 23 only included participants undergoing non-cardiac surgery and eight only included participants undergoing vascular surgery. The α-2 adrenergic agonist studied

Pre-emptive 8 mg dexamethasone and 120 mg etoricoxib for pain prevention after periodontal surgery: A randomised controlled clinical trial

Directory of Open Access Journals (Sweden)

Kranti Konuganti

2015-01-01

Full Text Available Several anti-inflammatory drugs have been used to reduce pain and discomfort after periodontal surgeries. This study evaluates the efficacy of using etoricoxib and dexamethasone for pain prevention after open-flap debridement surgery. In this study, 60 patients who were undergoing open flap debridment surgery were randomly assigned to receive a single dose preoperative medication 1 hour prior to surgery. The patients were divided into three groups. In Group 1, 20 patients were given placebo drug orally. In Group 2, 20 patients were given 8 mg Dexamethasone orally and in Group 3, 20 patients were given 120 mg Etoricoxib orally. Patients were instructed to complete a pain diary hourly for the first 8 hours after each surgery and three times a day on the following 3 days. The four point verbal rating scale (VRS 4 and Numerical rate scale were used to assess discomfort. Post-operative Assessment of Pain and Discomfort showed that persistent discomfort and pain were found to be more in the placebo group compared to dexamethasone and etoricoxib group. The adoption of a preemptive medication protocol using either etoricoxib or dexamethasone may be considered effective for pain and discomfort prevention after open-flap debridement surgeries.

Renal Dysfunction after Off-Pump Coronary Artery Bypass Surgery- Risk Factors and Preventive Strategies

Directory of Open Access Journals (Sweden)

Gaurab Maitra

2009-01-01

Full Text Available Postoperative renal dysfunction is a relatively common and one of the serious complications of cardiac surgery. Though off-pump coronary artery bypass surgery technique avoids cardiopulmonary bypass circuit induced adverse effects on renal function, multiple other factors cause postoperative renal dysfunction in these groups of patients. Acute kidney injury is generally defined as an abrupt and sustained decrease in kidney function. There is no consen-sus on the amount of dysfunction that defines acute kidney injury, with more than 30 definitions in use in the literature today. Although serum creatinine is widely used as a marker for changes in glomerular filtration rate, the criteria used to define renal dysfunction and acute renal failure is highly variable. The variety of definitions used in clinical studies may be partly responsible for the large variations in the reported incidence. Indeed, the lack of a uniform definition for acute kidney injury is believed to be a major impediment to research in the field. To establish a uniform definition for acute kidney injury, the Acute Dialysis Quality Initiative formulated the Risk, Injury, Failure, Loss, and End-stage Kidney (RIFLE classification. RIFLE , defines three grades of increasing severity of acute kidney injury -risk (class R, injury (class I and failure (class F - and two outcome classes (loss and end-stage kidney disease. Various perioperative risk factors for postoperative renal dysfunction and failure have been identified. Among the important preoperative factors are advanced age, reduced left ventricular function, emergency surgery, preoperative use of intraaortic balloon pump, elevated preoperative serum glucose and creatinine. Most important intraoperative risk factor is the intraoperative haemodynamic instability and all the causes of postoperative low output syndrome com-prise the postoperative risk factors. The most important preventive strategies are the identification of the

Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations; two arguments for viral load monitoring in Africa.

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Sigaloff, Kim C E; Hamers, Raph L; Wallis, Carole L; Kityo, Cissy; Siwale, Margaret; Ive, Prudence; Botes, Mariette E; Mandaliya, Kishor; Wellington, Maureen; Osibogun, Akin; Stevens, Wendy S; van Vugt, Michèle; de Wit, Tobias F Rinke

2011-09-01

This study aimed to investigate the consequences of using clinicoimmunological criteria to detect antiretroviral treatment (ART) failure and guide regimen switches in HIV-infected adults in sub-Saharan Africa. Frequencies of unnecessary switches, patterns of HIV drug resistance, and risk factors for the accumulation of nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations were evaluated. Cross-sectional analysis of adults switching ART regimens at 13 clinical sites in 6 African countries was performed. Two types of failure identification were compared: diagnosis of clinicoimmunological failure without viral load testing (CIF only) or CIF with local targeted viral load testing (targeted VL). After study enrollment, reference HIV RNA and genotype were determined retrospectively. Logistic regression assessed factors associated with multiple thymidine analogue mutations (TAMs) and NRTI cross-resistance (≥2 TAMs or Q151M or K65R/K70E). Of 250 patients with CIF switching to second-line ART, targeted VL was performed in 186. Unnecessary switch at reference HIV RNA <1000 copies per milliliter occurred in 46.9% of CIF only patients versus 12.4% of patients with targeted VL (P < 0.001). NRTI cross-resistance was observed in 48.0% of 183 specimens available for genotypic analysis, comprising ≥2 TAMs (37.7%), K65R (7.1%), K70E (3.3%), or Q151M (3.3%). The presence of NRTI cross-resistance was associated with the duration of ART exposure and zidovudine use. Clinicoimmunological monitoring without viral load testing resulted in frequent unnecessary regimen switches. Prolonged treatment failure was indicated by extensive NRTI cross-resistance. Access to virological monitoring should be expanded to prevent inappropriate switches, enable early failure detection and preserve second-line treatment options in Africa.

Balancing curability and unnecessary surgery in the context of computed tomography screening for lung cancer.

Science.gov (United States)

Flores, Raja; Bauer, Thomas; Aye, Ralph; Andaz, Shahriyour; Kohman, Leslie; Sheppard, Barry; Mayfield, William; Thurer, Richard; Smith, Michael; Korst, Robert; Straznicka, Michaela; Grannis, Fred; Pass, Harvey; Connery, Cliff; Yip, Rowena; Smith, James P; Yankelevitz, David; Henschke, Claudia; Altorki, Nasser

2014-05-01

Surgical management is a critical component of computed tomography (CT) screening for lung cancer. We report the results for US sites in a large ongoing screening program, the International Early Lung Cancer Action Program (I-ELCAP). We identified all patients who underwent surgical resection. We compared the results before (1993-2005) and after (2006-2011) termination of the National Lung Screening Trial to identify emerging trends. Among 31,646 baseline and 37,861 annual repeat CT screenings, 492 patients underwent surgical resection; 437 (89%) were diagnosed with lung cancer; 396 (91%) had clinical stage I disease. In the 54 (11%) patients with nonmalignant disease, resection was sublobar in 48 and lobectomy in 6. The estimated cure rate based on the 15-year Kaplan-Meier survival for all 428 patients (excluding 9 typical carcinoids) with lung cancer was 84% (95% confidence interval [CI], 80%-88%) and 88% (95% CI, 83%-92%) for clinical stage I disease resected within 1 month of diagnosis. Video-assisted thoracoscopic surgery and sublobar resection increased significantly, from 10% to 34% (P < .0001) and 22% to 34% (P = .01) respectively; there were no significant differences in the percentage of malignant diagnoses (90% vs 87%, P = .36), clinical stage I (92% vs 89%, P = .33), pathologic stage I (85% vs 82%, P = .44), tumor size (P = .61), or cell type (P = .81). The frequency and extent of surgery for nonmalignant disease can be minimized in a CT screening program and provide a high cure rate for those diagnosed with lung cancer and undergoing surgical resection. Copyright © 2014 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Can early aortic root surgery prevent further aortic dissection in Marfan syndrome?

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Shimizu, Hideyuki; Kasahara, Hirofumi; Nemoto, Atsushi; Yamabe, Kentaro; Ueda, Toshihiko; Yozu, Ryohei

2012-02-01

We reviewed 50 patients with Marfan syndrome who underwent surgery for aortic root pathologies comprising a root aneurysm without (n = 25; group A) and with (n = 25; group B) dissection. Aortic root repair included Bentall (n = 37) and valve-sparing (n = 13) procedures. Hospital mortality was 4.0%. Twenty-two patients required 36 repeat surgeries on the distal aorta. The main indication for re-intervention was the dilation of the false lumen. In group A, the distal aorta was stable for up to 7 years, but new dissection developed in 5 (33.3%) of the 15 patients who were followed up for >7 years after the root repair. Actuarial survival including operative mortality was 88.1 and 65.0% at 10 and 20 years, respectively; groups A and B did not significantly differ. Rates of freedom from all-cause death, new dissection or repeated aortic surgery were 60.1, 44.5 and 26.0% at 5, 10 and 15 years, respectively. Group A was significantly better than group B. Prophylactic aortic root repair apparently reduces the likelihood of overall adverse events, but it cannot guarantee the prevention of further aortic dissection. A multidisciplinary approach is needed for patients with Marfan syndrome.

Prevention of Oral Candidiasis After Free Flap Surgery: Role of 3% Sodium Bicarbonate Saline in Oral Care.

Science.gov (United States)

Yang, Yue; Zhang, Fang; Lyu, Xin; Yan, Zhimin; Hua, Hong; Peng, Xin

2017-03-01

Relevant reports about oral candidiasis status and prevention measures after free flap surgery for the oral and maxillofacial region are limited. The present study explored oral candidiasis status after free flap surgery and its prevention through a prospective comparative study. One hundred four patients were randomized to a control group (n = 54) and an experimental group (n = 50). Compared with the control group, the experimental group was provided an additional 3% sodium bicarbonate saline solution for oral care after free flap surgery. The incidence of oral candidiasis was evaluated by objective examination (saliva culture and salivary pH measurement) and subjective evaluation (clinical signs of oral candidiasis) at admission and from postoperative days 1 to 14. The salivary pH values of the 2 groups were lower than the normal salivary pH, and postoperative salivary pH values were always lower than the active range of oral lysozymes in the control group. The salivary pH values of the experimental group were higher than those of the control group from postoperative days 6 to 14 (P < .05). The incidence of oral candidiasis was 13.0% in the control group, which was higher than that in the experimental group (2.0%; P < .05). In addition, advanced age, use of a free flap for the simultaneous repair of intraoral and paraoral defects, and a combination of 2 antibiotic types were risk factors for oral candidiasis. Oral candidiasis was common in patients after free flap reconstruction surgery, and the use of 3% sodium bicarbonate saline solution for oral care effectively prevented it. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Effects of preventive surgery for unruptured intracranial aneurysms on attention, executive function, learning and memory: a prospective cohort study.

Science.gov (United States)

Chung, Joonho; Seok, Jeong-Ho; Kwon, Min A; Kim, Yong Bae; Joo, Jin-Yang; Hong, Chang-Ki

2016-01-01

We prospectively evaluated the effects of preventive surgery for unruptured intracranial aneurysms on attention, executive function, learning and memory. Between March 2012 and June 2013, 56 patients were recruited for this study. Fifty-one patients met the inclusion criteria and were enrolled. Inclusion criteria were as follows: (1) age ≤65 years and (2) planned microsurgery or endovascular surgery for unruptured intracranial aneurysm. Exclusion criteria were as follows: (1) preoperative intelligence quotient attention), WCT (executive function) and VLT (learning and memory) scores did not change significantly between the pre- and postoperative evaluations. The ACCPT, WCT, total VLT scores (verbal learning) and delayed VLT scores (memory) did not differ significantly between patients undergoing microsurgery and those undergoing endovascular surgery. However, ACCPT, WCT and delayed VLT scores decreased postoperatively in patients with leukoaraiosis on preoperative FLAIR images (OR 9.899, p = 0.041; OR 11.421, p = 0.006; OR 2.952, p = 0.024, respectively). Preventive surgery for unruptured intracranial aneurysms did not affect attention, executive function, learning or memory. However, patients with leukoaraiosis on FLAIR images might be prone to deficits in attention, executive function and memory postoperatively, whereas learning might not be affected.

Aesthetic rhinoplasty plus brow, eyelid and conchal surgery: pitfalls - complications - prevention.

Science.gov (United States)

Gubisch, Wolfgang; Dacho, Andreas

2013-12-13

Within the last years aesthetic surgery enjoys greater popularity and acceptance. One of the most frequently asked operations has been the aesthetic rhinoplasty. Hardly any other field of surgery is exposed to such a critical analysis than aesthetic rhinoplasty because the results are so obvious. According to the "International Society of Aesthetic Surgery" (ISAPS) over 980,000 cosmetic rhinoplasties have been performed in 2010. This corresponds to 10.4% of all registered aesthetic procedures worldwide. Complications can not be eliminated in such a large number of nasal operations. Five to 15% of all patients re-consult a doctor for a revision because they are much dissatisfied with their final rhinoplasty result. Findings of the tip followed by functional problems and irregularities of the nasal dorsum are named most frequently. The responsible rhinosurgeon has to take into account all anatomical and physiological details and to consider ethical and psychological aspects in the pre-selection and postoperative care of the patient. Aesthetic surgeons should be acquainted with terms and definitions like body image, dysmorphophobia or Thersites complex. Acronyms, like "SIMON" or "SYLVIA", support the physician additionally to analyze and assess the patient. The following article describes the most frequent faults, complications and pitfalls after aesthetic rhinoplasty listed by the anatomical structure. Results will be analyzed and strategies and techniques will be suggested to correct the faults and to prevent them in the future. Furthermore psychologic, social and psychiatric aspects will be discussed and handling with aesthetic patients explained.

Stent valve implantation in conventional redo aortic valve surgery to prevent patient-prosthesis mismatch.

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Ferrari, Enrico; Franciosi, Giorgio; Clivio, Sara; Faletra, Francesco; Moccetti, Marco; Moccetti, Tiziano; Pedrazzini, Giovanni; Demertzis, Stefanos

2017-03-01

The goal was to show the technical details, feasibility and clinical results of balloon-expandable stent valve implantation in the aortic position during conventional redo open-heart surgery in selected obese patients with a small aortic prosthesis and severe patient-prosthesis mismatch. Two symptomatic overweight patients (body mass index of 31 and 38), each with a small aortic prosthesis (a 4-year-old, 21-mm Hancock II biological valve and a 29-year-old, 23-mm Duromedic mechanical valve), increased transvalvular gradients (59/31 and 74/44 mmHg) and a reduced indexed effective orifice area (0.50 and 0.43 cm 2 /m 2 ) underwent implantation of two 26-mm balloon-expandable Sapien 3 valves during standard on-pump redo valve surgery. Using full re-sternotomy, cardiopulmonary bypass and cardioplegic arrest, the two balloon-expandable stent valves were implanted under direct view using a standard aortotomy, after prosthesis removal and without annulus enlargement. Aortic cross-clamp times were 162 and 126 min; cardiopulmonary bypass times were 178 and 180 min; total surgical times were 360 and 318 min. At discharge, echocardiograms showed transvalvular peak and mean gradients of 13/9 and 23/13 mmHg and indexed effective orifice areas of 0.64 and 1.08 cm 2 /m 2 . The 3-month echocardiographic follow-up showed transvalvular peak and mean gradients of 18/9 and 19/11 mmHg and indexed effective orifice areas of 0.78 cm 2 /m 2 and 0.84 cm 2 /m 2 , with improved symptoms (New York Heart Association class 1). Implantation of a balloon-expandable stent valve during redo aortic valve surgery is feasible in selected cases and prevents patient-prosthesis mismatch in obese patients without need for aortic annulus enlargement. Moreover, in the case of stent valve degeneration, this approach permits additional valve-in-valve procedures with large stent valves and prevents re-redo surgery. © The Author 2016. Published by Oxford University Press on behalf of the

Misdiagnosis of florid cemento-osseous dysplasia leading to unnecessary root canal treatment: a case report.

Science.gov (United States)

Huh, Jong-Ki; Shin, Su-Jung

2013-08-01

This case report demonstrates an unnecessary endodontic treatment of teeth with florid cemento-osseous dysplasia (FCOD) due to a misdiagnosis as periapical pathosis and emphasizes the importance of correct diagnosis to avoid unnecessary treatment. A 30-year-old woman was referred to our institution for apicoectomies of the mandibular left canine and both the lateral incisors. The periapical lesions associated with these teeth had failed to resolve after root canal treatment over a 3-year period. Radiographic examinations revealed multiple lesions on the right canine, the second premolar, and both first molars as well as the anterior region of the mandible. Based on clinical, radiographic and histological evaluations, the patient condition was diagnosed as FCOD. The patient has been monitored for 2 years. To avoid unnecessary invasive treatment, accurate diagnosis is essential before treatment is carried out in managing FCOD.

Effective diagnostic DAQ systems to reduce unnecessary data in KSTAR

Energy Technology Data Exchange (ETDEWEB)

Lee, Taegu, E-mail: glory@nfri.re.kr; Lee, Woongryol; Hong, Jaesic; Park, Kaprai

2016-11-15

Highlights: • When plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. • To overcome this problem, some KSTAR’s library were upgraded to monitor the plasma status in real-time. • With the real-time information of plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. • We were able to reduce the refuse data of approximately 698 GByte in the KSTAR 7th campaign. • It was a very effective way to store useful data, and it was helpful to analysts after shot. - Abstract: The plasma status of Korea Superconducting Tokamak Advanced Research (KSTAR) is measured by various diagnostics systems. The measured data size has been increasing every year due to increasing plasma pulse lengths, higher diagnostics operating frequencies, the additions of new diagnostic systems, and an increasing number of diagnostics channels. At times, when plasma shots do not successfully perform during the intended target time, the diagnostics systems continue to record these unusable data, contributing to increasing data size. In addition, the analysis time was affected, as these data need to be separated from the relevant data set. To overcome this problem, KSTAR’s Standard Framework (SFW), Real Time Monitoring (RTMON), and Pulse Automation and Scheduling System (PASS) were upgraded to monitor the plasma status in real-time. When the plasma current is less than 200kA, RTMON sends the plasma status information every second to the SFW via EPICS Channel Access. With the real-time information on plasma status, some of the KSTAR diagnostic systems stop the acquisition process of unnecessary data. This paper describes a method for reducing the storage of unnecessary data and its results in the KSTAR 7th campaign.

77 FR 29579 - Removing Unnecessary Office on Violence Against Women Regulations

Science.gov (United States)

2012-05-18

... now unnecessary STOP VAIW Program regulations. Higher Education Amendments of 1998 Violence against... Office on Violence Against Women Regulations AGENCY: Office on Violence Against Women, Justice. ACTION: Proposed rule. SUMMARY: This rule proposes to remove the regulations for the STOP Violence Against Indian...

A Multifactorial Intervention Based on the NICE-Adjusted Guideline in the Prevention of Delirium in Patients Hospitalized for Cardiac Surgery

Directory of Open Access Journals (Sweden)

Mohammad Ali Cheraghi

2017-05-01

Full Text Available Delirium is the most common problem in patients in intensive care units. Prevention of delirium is more important than treatment. The aim of this study is to determine the effect of the NICE-adjusted multifactorial intervention to prevent delirium in open heart surgery patients. Methods: This study is a quasi-experimental study on 88 patients (In each group, 44 patients undergoing open heart surgery in the intensive care unit of Imam Khomeini Hospital, Tehran. Subjects received usual care group, only the incidence of delirium were studied. So that patients in the two groups of second to fifth postoperative day, twice a day by the researcher, and CAM-ICU questionnaire were followed. After completion of the sampling in this group, in the intervention group also examined incidence of delirium was conducted in the same manner except that multifactorial interventions based on the intervention of NICE modified by the researcher on the second day to fifth implementation and intervention on each turn, their implementation was followed. As well as to check the quality of sleep and pain in the intervention group of CPOT and Pittsburgh Sleep assessment tools were used. Data analysis was done using the SPSS software, version 16. A T-test, a chi-square test, and a Fisher’s exact test were also carried out. Results: The incidence of delirium in the control group was 42.5%; and in the intervention group, it was 22.5%. The result showed the incidence of delirium in open heart surgery hospitalized patients after multifactorial intervention based on adjusted NICE guidelines has been significantly reduced. Conclusion: The NICE-adjusted multifactorial intervention guidelines for the prevention of delirium in cardiac surgery patients significantly reduced the incidence of delirium in these patients. So, using this method as an alternative comprehensive and reliable in preventing delirium in hospitalized patients in the ward heart surgery is recommended.

Post-operative adhesions after digestive surgery: their incidence and prevention: review of the literature.

Science.gov (United States)

Ouaïssi, M; Gaujoux, S; Veyrie, N; Denève, E; Brigand, C; Castel, B; Duron, J J; Rault, A; Slim, K; Nocca, D

2012-04-01

Post-operative adhesions after gastrointestinal surgery are responsible for significant morbidity and constitute an important public health problem. The aim of this study was to review the surgical literature to determine the incidence, consequences and the variety of possible countermeasures to prevent adhesion formation. A systematic review of English and French language surgical literature published between 1995 and 2009 was performed using the keywords "adhesion" and "surgery". Peritoneal adhesions are reported as the cause of 32% of acute intestinal obstruction and 65-75% of all small bowel obstructions. It is estimated that peritoneal adhesions develop after 93-100% of upper abdominal laparotomies and after 67-93% of lower abdominal laparotomies. Nevertheless, only 15-18% of these adhesions require surgical re-intervention. The need for re-intervention for adhesion-related complications varies depending on the initial type of surgery, the postoperative course and the type of incision. The laparoscopic approach appears to decrease the risk of adhesion formation by 45% and the need for adhesion-related re-intervention to 0.8% after appendectomy and to 2.5% after colorectal surgery. At the present time, only one product consisting of hyaluronic acid applied to a layer of carboxymethylcellulose (Seprafilm(®)) has been shown to significantly reduce the incidence of postoperative adhesion formation; but this product is also associated with a significant increase in the incidence of anastomotic leakage when the membrane is applied in direct contact with the anastomosis. The use of this product has not been shown to decrease the risk of re-intervention for bowel obstruction. The prevention of postoperative adhesions is an important public health goal, particularly in light of the frequency of this complication. The routine use of anti-adhesion products is not recommended given the lack of studies with a high level of evidence concerning their efficacy and safety of

Sonohysterography

Medline Plus

Full Text Available ... can be important when establishing a treatment or management strategy for a patient's particular condition. Following the ... in detail with sonohysterography. Sonohysterography can prevent unnecessary surgery, and it can ensure that all polyps and ...

Prevention of health care-associated infections.

Science.gov (United States)

Hsu, Vincent

2014-09-15

Health care-associated infections cause approximately 75,000 deaths annually, in addition to increasing morbidity and costs. Over the past decade, a downward trend in health care-associated infections has occurred nationwide. Basic prevention measures include administrative support, educating health care personnel, and hand hygiene and isolation precautions. Prevention of central line- or catheter-associated infections begins with avoidance of unnecessary insertion, adherence to aseptic technique when inserting, and device removal when no longer necessary. Specific recommendations for preventing central line-associated bloodstream infections include use of chlorhexidine for skin preparation, as a component of dressings, and for daily bathing of patients in intensive care units. Catheter-associated urinary tract infections are the most common device-related health care-associated infection. Maintaining a closed drainage system below the patient reduces the risk of infection. To prevent ventilator-associated pneumonia, which is associated with high mortality, mechanically ventilated patients should be placed in the semirecumbent position and receive antiseptic oral care. Prevention of surgical site infections includes hair removal using clippers, glucose control, and preoperative antibiotic prophylaxis. Reducing transmission of Clostridium difficile and multidrug-resistant organisms in the hospital setting begins with hand hygiene and contact precautions. Institutional efforts to reduce unnecessary antibiotic prescribing are also strongly recommended. Reducing rates of methicillin-resistant Staphylococcus aureus infection can be achieved through active surveillance cultures and decolonization therapy with mupirocin.

The impact of surgery and anesthesia on post-operative cognitive decline and Alzheimer's disease development: biomarkers and preventive strategies.

Science.gov (United States)

Kapila, Ayush K; Watts, Helena R; Wang, Tianlong; Ma, Daqing

2014-01-01

Alzheimer's disease (AD) is a major social and clinical burden in the elderly, affecting 5% of people aged over 65 and 20% aged over 80. Despite improved management, a cure has not been found and hence analysis of predisposing factors to identify preventive strategies has become increasingly important. Surgery and anesthesia have been proposed to increase the incidence of post-operative cognitive decline (POCD) and AD. This is hypothesized to be the result of a malignant neuroinflammatory response and subsequent synaptic impairment in the elderly and susceptible individuals. As a result, strategies are being explored to prevent surgery and anesthesia induced cognitive impairment. Whereas previously the diagnosis of AD was primarily dependent on clinical examination, biomarkers such as inflammatory cytokines, amyloid-β, and tau deposition in the cerebrospinal fluid have received increased attention. Nonetheless, AD is currently still treated symptomatically with acetylcholinesterase inhibitors and NMDA antagonists to improve cholinergic transmission and prevent glutamatergic excitotoxicity. Therapeutic success is, however, often not achieved, since these treatment methods do not address the ongoing neuroinflammatory processes and hence novel therapeutic and protective strategies are urgently needed. This review provides an insight into the current understanding of age-related cognitive impairment post-surgery and reflects on novel markers of AD pathogeneses exploring their use as targets for treatment. It gives a summary of recent efforts in preventing and treating POCD or AD with regards to the choice and depth of anesthesia, surgical strategy, and peri-operative medication, and discusses the mechanism of action and therapeutic prospects of novel agents.

The Healthy Heart-Mind trial: melatonin for prevention of delirium following cardiac surgery: study protocol for a randomized controlled trial.

Science.gov (United States)

Ford, Andrew H; Flicker, Leon; Passage, Jurgen; Wibrow, Bradley; Anstey, Matthew; Edwards, Mark; Almeida, Osvaldo P

2016-01-28

Delirium is a common occurrence in patients undergoing major cardiac surgery and is associated with a number of adverse consequences for the individual, their family and the health system. Current approaches to the prevention of delirium include identifying those at risk together with various non-pharmacological and pharmacological strategies, although the efficacy of these is often modest. Emerging evidence suggests that melatonin may be biologically implicated in the development of delirium and that melatonin supplementation may be beneficial in reducing the incidence of delirium in medical and surgical patients. We designed this trial to determine whether melatonin reduces the incidence of delirium following cardiac surgery compared with placebo. The Healthy Heart-Mind trial is a randomized, double-blind, placebo-controlled clinical trial of 3 mg melatonin or matching placebo administered on seven consecutive days for the prevention of delirium following cardiac surgery. We will recruit 210 adult participants, aged 50 and older, undergoing elective or semi-elective cardiac surgery with the primary outcome of interest for this study being the difference in the incidence of delirium between the groups within 7 days of surgery. Secondary outcomes of interest include the difference between groups in the severity and duration of delirious episodes, hospital length of stay and referrals to mental health services during admission. In addition, we will assess differences in depressive and anxiety symptoms, as well as cognitive performance, at discharge and 3 months after surgery. The results of this trial will clarify whether melatonin reduces the incidence of delirium following cardiac surgery. The trial is registered with the Australian Clinical Trials Registry, trial number ACTRN12615000819527 (10 August 2015).

Physical consequences of surgery for breast cancer in the affected upper limb and proposal of preventive physiotherapeutic treatment

International Nuclear Information System (INIS)

Masis Tenorio, Ericka; Molina Vargas, Viviana M.

2008-01-01

Breast cancer is a malignant growth that begins in breast tissue. The incidence rate in Costa Rica, for 2003, was 40.07 per 100,000 inhabitants (Registro Nacional de Tumores, 2007). The most used treatment for this pathology has been the surgery, has many variations; however, in Costa Rica the modified radical mastectomy and quadrantectomy (conservative surgery) are the most performed. Along with this, other treatments are practiced such as: hormonal therapy, radiation and chemotherapy. The physical consequences of such treatments are: lymphedema, decreased mobility of the shoulder joint on the side of surgery and postoperative pain. The consequences have represented an important change for people that live, because they will have limitations in activities of their daily lives. These can be treated, reduced and even avoided, through a program of physical therapy with techniques and exercises. Costa Rica lacks a prevention program, interdisciplinary and postoperative rehabilitation for people with breast surgery. Therefore, the creation of a proposal of physiotherapeutic intervention based on scientific criteria would be an instrument of great importance. The main objective of this transversal, descriptive and analytic study has been to examine the physical consequences of breast cancer surgery in the affected upper limb. A proposal of physiotherapeutic intervention was designed for the prevention of that physical consequences and possible treatments, from the literature review and valuing people post-breast surgery. In total 27 women were assessed post breast surgery (20 mastectomy and 7 with quadrantectomy), whose time post surgery was located at the range of 1 day -12 months (21 people), more than 12 months (6 people). The selection criteria were: unilateral breast surgery, radical type modified or quadrantectomy; located in the ranges of 35-59 years (19 people) and 60-85 years (8 people); no injuries previous in the upper limb the side of the surgery; with or

Improving Prevention, Early Recognition and Management of Acute Kidney Injury after Major Surgery: Results of a Planning Meeting with Multidisciplinary Stakeholders

Directory of Open Access Journals (Sweden)

Matthew T James

2014-08-01

Full Text Available Purpose of review: Acute kidney injury (AKI is common after major surgery, and is associated with morbidity, mortality, increased length of hospital stay, and high health care costs. Although recent guidelines for AKI provide recommendations for identification of patients at risk, monitoring, diagnosis, and management of AKI, there is lack of understanding to guide successful implementation of these recommendations into clinical practice. Sources of information: We held a planning meeting with multidisciplinary stakeholders to identify barriers, facilitators, and strategies to implement recommendations for prevention, early identification, and management of AKI after major surgery. Barriers and facilitators to knowledge use for peri-operative AKI prevention and care were discussed. Findings: Stakeholders identified barriers in knowledge (how to identify high-risk patients, what criteria to use for diagnosis of AKI, attitudes (self-efficacy in preventive care and management of AKI, and behaviors (common use of diuretics, non-steroidal anti-inflammatory drugs, withholding of intravenous fluids, and competing time demands in peri-operative care. Educational, informatics, and organizational interventions were identified by stakeholders as potentially useful elements for future interventions for peri-operative AKI. Limitation: Meeting participants were from a single centre. Implications: The information and recommendations obtained from this stakeholder's meeting will be useful to design interventions to improve prevention and early care for AKI after major surgery.

Comparison of hydrophobic and hydrophilic intraocular lens in preventing posterior capsule opacification after cataract surgery

OpenAIRE

Zhao, Yang; Yang, Ke; Li, Jiaxin; Huang, Yang; Zhu, Siquan

2017-01-01

Abstract Background: Posterior capsular opacification (PCO) is a common long-term complication of cataract surgery. Intraocular lens design and material have been implicated in influencing the development of PCO. This study evaluated the association of hydrophobic and hydrophilic intraocular lenses on preventing PCO. Methods: Medline, Cochrane, EMBASE, and Google Scholar databases were searched until August 3, 2016, using the following search terms: cataract, posterior capsule opacification, ...

Re: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers".

Science.gov (United States)

Durand-Moreau, Quentin; Loddé, Brice; Dewitte, Jean-Dominique

2015-03-01

Madsen et al (1) recently published a secondary analysis on data provided by the Project on Burnout, Motivation and Job Satisfaction (PUMA). The aim of their study, published in the Scandinavian Journal of Work, Environment & Health was to examine the associations between unnecessary work tasks and a decreased level of mental health. Though the topic was quite novel, reading this work proved disturbing and raised issues. Based on the results of this study, the authors stated that there is an association between unnecessary work tasks (assessed by a single question) and a decreased level of mental health, idem [assessed by the Mental Health Inventory (MHI-5)], in the specific population included in this PUMA survey. The authors point out a limitation of the study, namely that unnecessary work tasks were evaluated using one single question: "Do you sometimes have to do things in your job which appear to be unnecessary?". Semmer defines unnecessary work task as "tasks that should not be carried out at all because they do not make sense or because they could have been avoided, or could be carried out with less effort if things were organized more efficiently" (2). De facto, qualifying what an unnecessary task is requires stating or explaining whether the task makes sense. Making sense or not is not an objective notion. It is very difficult for either a manager or an employee to say if a task is necessary or not. Most important is that it makes sense from the worker's point of view. Making sense and being necessary are not synonyms. Some tasks do not make sense but are economically necessary (eg, when, as physicians, we are reporting our activity using ICD-10 on computers instead of being at patients' bedsides or reading this journal). Thus, there is a wide gap between Semmer's definition and the question used by the authors to evaluate his concept. A secondary analysis based on a single question is not adequate to evaluate unnecessary tasks. Nowadays, the general trend

Thoracic splenosis. Know it-avoid unnecessary investigations, interventions, and thoracotomy

International Nuclear Information System (INIS)

Khan, A.M.; Manzoor, K.; Malik, Z.; Yasim, A.; Shim, C.

2011-01-01

Thoracic splenosis (TS) is autoimplantation of ectopic splenic tissue in the thoracic cavity that occurs following splenic injury. Most cases of TS are asymptomatic and are diagnosed during the course of an evaluation of incidentally discovered pulmonary lesions. Some cases may be difficult to diagnose, especially if features suggesting TS are not recognized. This may lead to an extensive workup and unnecessary invasive diagnostic procedures including thoracotomy. Multiple, asymptomatic, left-sided pleura-based lesions associated with a history of thoracoabdominal injury and splenectomy are the key points that should alert one to suspect TS, which can then simply be confirmed with a 99m Tc-sulfa colloid radionuclide scan. If TS is suspected and radionuclide imaging studies are performed, further extensive investigations, such as bronchoscopy, biopsy, thoracoscopy, and thoracotomy, are not required as the radionuclide scan is definitive for diagnosis. Most cases are asymptomatic, so further treatment is rarely required; all cases are managed conservatively. We emphasize that all physicians, radiologists, pathologists, and interventionalists should recognize key features that suggest the diagnosis of TS, order appropriate imaging when it is suspected, and avoid unnecessary invasive diagnostic procedures including thoracotomy. (author)

Antibiotics may not decrease prostate-specific antigen levels or prevent unnecessary prostate biopsy in patients with moderately increased prostate-specific antigen levels: A meta-analysis.

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Yang, Lu; Zhu, Yuchun; Tang, Zhuang; Chen, Yongji; Gao, Liang; Liu, Liangren; Han, Ping; Li, Xiang; Wei, Qiang

2015-05-01

To evaluate the effect of empiric antibiotics on decreasing prostate-specific antigen (PSA) levels and the possibility of avoiding unnecessary prostate biopsies (PBs). A systematic search of PubMed, Embase, and the Cochrane Library was performed to identify all randomized controlled trials (RCTs) that compared effects of empiric antibiotics with no treatment or placebo on lowering PSA levels and minimizing unnecessary PBs in patients with moderately increased PSA levels. The Cochrane Collaboration Review Manager software (RevMan 5.1.4) was used for statistical analysis. The inclusion criteria for the study were met by 6 RCTs (1 placebo controlled and 5 no treatment controlled) involving 656 patients. The synthesized data from these RCTs indicated that there were no significant differences between the antibiotic and control groups in the PSA levels after treatment (mean difference [MD] = 0.15, 95% CI:-0.50 to 0.81, P = 0.65], number of patients with decreased PSA levels after treatment (relative risk [RR] = 1.22, 95% CI: 0.90-1.65, P = 0.20], prostate-specific antigen density levels after treatment (MD =-0.04, 95% CI:-0.15 to 0.07, P = 0.47), f/t% PSA after treatment (MD =-1.47, 95% CI:-4.65 to 1.71, P = 0.37), number of patients with responsive PSA (RR = 1.02, 95% CI: 0.58-1.81, P = 0.94), and individual Pca-positiverate in these patients (RR = 1.07, 95% CI: 0.53-2.16, P = 0.86), and Pca-positiverates (RR = 0.85, 95% CI: 0.48-1.50, P = 0.57). However, the antibiotic group had a significant change in the net PSA decrease after treatment compared with the control group (MD = 1.44, 95% CI: 0.70-2.17, P = 0.0001). The use of empiric antibiotics may not significantly decrease PSA levels or avoid unnecessary PBs. Copyright © 2015 Elsevier Inc. All rights reserved.

Patient Safety in Spine Surgery: Regarding the Wrong-Site Surgery

OpenAIRE

Lee, Seung-Hwan; Kim, Ji-Sup; Jeong, Yoo-Chul; Kwak, Dae-Kyung; Chun, Ja-Hae; Lee, Hwan-Mo

2013-01-01

Patient safety regarding wrong site surgery has been one of the priority issues in surgical fields including that of spine care. Since the wrong-side surgery in the DM foot patient was reported on a public mass media in 1996, the wrong-site surgery issue has attracted wide public interest as regarding patient safety. Despite the many wrong-site surgery prevention campaigns in spine care such as the operate through your initial program by the Canadian Orthopaedic Association, the sign your sit...

Cranialization of the frontal sinus for secondary mucocele prevention following open surgery for benign frontal lesions.

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Gilad Horowitz

Full Text Available OBJECTIVE: To compare frontal sinus cranialization to obliteration for future prevention of secondary mucocele formation following open surgery for benign lesions of the frontal sinus. STUDY DESIGN: Retrospective case series. SETTING: Tertiary academic medical center. PATIENTS: Sixty-nine patients operated for benign frontal sinus pathology between 1994 and 2011. INTERVENTIONS: Open excision of benign frontal sinus pathology followed by either frontal obliteration (n = 41, 59% or frontal cranialization (n = 28, 41%. MAIN OUTCOME MEASURES: The prevalence of post-surgical complications and secondary mucocele formation were compiled. RESULTS: Pathologies included osteoma (n = 34, 49%, mucocele (n = 27, 39%, fibrous dysplasia (n = 6, 9%, and encephalocele (n = 2, 3%. Complications included skin infections (n = 6, postoperative cutaneous fistula (n = 1, telecanthus (n = 4, diplopia (n = 3, nasal deformity (n = 2 and epiphora (n = 1. None of the patients suffered from postoperative CSF leak, meningitis or pneumocephalus. Six patients, all of whom had previously undergone frontal sinus obliteration, required revision surgery due to secondary mucocele formation. Statistical analysis using non-inferiority test reveal that cranialization of the frontal sinus is non-inferior to obliteration for preventing secondary mucocele formation (P<0.0001. CONCLUSION: Cranialization of the frontal sinus appears to be a good option for prevention of secondary mucocele development after open excision of benign frontal sinus lesions.

Reducing unnecessary lab testing in the ICU with artificial intelligence.

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Cismondi, F; Celi, L A; Fialho, A S; Vieira, S M; Reti, S R; Sousa, J M C; Finkelstein, S N

2013-05-01

To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1-3]. Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the likely information to be gained from proposed future

Reducing unnecessary lab testing in the ICU with artificial intelligence

Science.gov (United States)

Cismondi, F.; Celi, L.A.; Fialho, A.S.; Vieira, S.M.; Reti, S.R.; Sousa, J.M.C.; Finkelstein, S.N.

2017-01-01

Objectives To reduce unnecessary lab testing by predicting when a proposed future lab test is likely to contribute information gain and thereby influence clinical management in patients with gastrointestinal bleeding. Recent studies have demonstrated that frequent laboratory testing does not necessarily relate to better outcomes. Design Data preprocessing, feature selection, and classification were performed and an artificial intelligence tool, fuzzy modeling, was used to identify lab tests that do not contribute an information gain. There were 11 input variables in total. Ten of these were derived from bedside monitor trends heart rate, oxygen saturation, respiratory rate, temperature, blood pressure, and urine collections, as well as infusion products and transfusions. The final input variable was a previous value from one of the eight lab tests being predicted: calcium, PTT, hematocrit, fibrinogen, lactate, platelets, INR and hemoglobin. The outcome for each test was a binary framework defining whether a test result contributed information gain or not. Patients Predictive modeling was applied to recognize unnecessary lab tests in a real world ICU database extract comprising 746 patients with gastrointestinal bleeding. Main results Classification accuracy of necessary and unnecessary lab tests of greater than 80% was achieved for all eight lab tests. Sensitivity and specificity were satisfactory for all the outcomes. An average reduction of 50% of the lab tests was obtained. This is an improvement from previously reported similar studies with average performance 37% by [1–3]. Conclusions Reducing frequent lab testing and the potential clinical and financial implications are an important issue in intensive care. In this work we present an artificial intelligence method to predict the benefit of proposed future laboratory tests. Using ICU data from 746 patients with gastrointestinal bleeding, and eleven measurements, we demonstrate high accuracy in predicting the

Efficacy of ranolazine in preventing atrial fibrillation following cardiac surgery: Results from a meta-analysis

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Chintan Trivedi, MD, MPH

2017-06-01

Conclusions: Ranolazine may prove beneficial in POAF prevention following cardiac surgeries. Although the pooled treatment effect is quite impressive with a reduction of more than 50% of risk of developing POAF, small number of studies and variation in ranolazine dose regimen in each study make our results inconclusive, but worthy of further investigation. That is why this result has to be interpreted as only hypothesis generating, rather than conclusion drawing.

Venous Thromboembolism Prevention in Emergency General Surgery: A Review.

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Murphy, Patrick B; Vogt, Kelly N; Lau, Brandyn D; Aboagye, Jonathan; Parry, Neil G; Streiff, Michael B; Haut, Elliott R

2018-05-01

Venous thromboembolism (VTE) is the most preventable cause of morbidity and mortality in US hospitals, and approximately 2.5% of emergency general surgery (EGS) patients will be diagnosed with a VTE event. Emergency general surgery patients are at increased risk of morbidity and mortality because of the nature of acute surgical conditions and the challenges related to prophylaxis. MEDLINE, Embase, and the Cochrane Database of Collected Reviews were searched from January 1, 1990, through December 31, 2015. Nearly all operatively and nonoperatively treated EGS patients have a moderate to high risk of developing a VTE, and individual risk should be assessed at admission. Pharmacologic prophylaxis in the form of unfractionated or low-molecular-weight heparin should be considered unless an absolute contraindication, such as bleeding, exists. Patients should receive the first dose at admission to the hospital, and administration should continue until discharge without missed doses. Certain patient populations, such as those with malignant tumors, may benefit from prolonged VTE prophylaxis after discharge. Mechanical prophylaxis should be considered in all patients, particularly if pharmacologic prophylaxis is contraindicated. Studies that specifically target improved adherence with VTE prophylaxis in EGS patients suggest that efficacy and quality improvement initiatives should be undertaken from a system and institutional perspective. Operatively and nonoperatively treated EGS patients are at a comparatively high risk of VTE. Despite gaps in existing literature with respect to this increasing patient population, successful best practices can be applied. Best practices include assessment of VTE risk, optimal prophylaxis, and physician, nurse, and patient education regarding the use of mechanical and pharmacologic VTE prophylaxis and institutional policies.

A novel transanal tube designed to prevent anastomotic leakage after rectal cancer surgery: the WING DRAIN.

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Nishigori, Hideaki; Ito, Masaaki; Nishizawa, Yuji

2017-04-01

We introduce a novel transanal tube (TAT), named the "WING DRAIN", designed to prevent anastomotic leakage after rectal cancer surgery, and report the fundamental experiments that led to its development. We performed the basic experiments to evaluate the effect of TATs on intestinal decompression, the changes they make in patterns of watery fluid drainage, the changes in their decompression effect when the extension tube connecting the TAT to the collection bag fills with watery drainage fluid, and the variations in intestinal contact and crushing pressure made by some types of TAT. Any type of TAT contributed to decompression in the intestinal tract. Watery drainage commenced from when the water level first rose to the hole in the tip of drain. The intestinal pressure increased with the length of the vertical twist in an extension tube. The crushing pressures of most types of TAT were high enough to cause injury to the intestine. We resolved the problems using an existing TAT for the purpose of intestinal decompression and by creating the first specialized TAT designed to prevent anastomotic leakage after rectal cancer surgery in Japan.

Disposable surgical face masks for preventing surgical wound infection in clean surgery

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Allyson Lipp

Full Text Available BACKGROUND: Surgical face masks were originally developed to contain and filter droplets containing microorganisms expelled from the mouth and nasopharynx of healthcare workers during surgery, thereby providing protection for the patient. However, there are several ways in which surgical face masks could potentially contribute to contamination of the surgical wound, e.g. by incorrect wear or by leaking air from the side of the mask due to poor string tension. OBJECTIVES: To determine whether disposable surgical face masks worn by the surgical team during clean surgery prevent postoperative surgical wound infection. SEARCH METHODS: We searched The Cochrane Wounds Group Specialised Register (searched 14 September 2011; The Cochrane Central Register of Controlled Trials (CENTRAL (The Cochrane Library 2011, Issue 3; Ovid MEDLINE (2008 to August Week 5 2011; Ovid MEDLINE (In-Process &Other Non-Indexed Citations September 13, 2011; Ovid EMBASE (2008 to 2011 Week 35; and EBSCO CINAHL (2008 to 9 September 2011. SELECTION CRITERIA: Randomized controlled trials (RCTs and quasi-randomized controlled trials comparing the use of disposable surgical masks with the use of no mask. DATA COLLECTION AND ANALYSIS: Two review authors extracted data independently. MAIN RESULTS: Three trials were included, involving a total of 2113 participants. There was no statistically significant difference in infection rates between the masked and unmasked group in any of the trials. AUTHORS' CONCLUSIONS: From the limited results it is unclear whether the wearing of surgical face masks by members of the surgical team has any impact on surgical wound infection rates for patients undergoing clean surgery.

Is pre-operative imaging essential prior to ureteric stone surgery?

Science.gov (United States)

Youssef, F R; Wilkinson, B A; Hastie, K J; Hall, J

2012-09-01

The aim of this study was to identify patients not requiring ureteric stone surgery based on pre-operative imaging (within 24 hours) prior to embarking on semirigid ureteroscopy (R-URS) for urolithiasis. The imaging of all consecutive patients on whom R-URS for urolithiasis was performed over a 12-month period was reviewed. All patients had undergone a plain x-ray of the kidney, ureters and bladder (KUB), abdominal non-contrast computed tomography (NCCT-KUB) or both on the day of surgery. A total of 96 patients were identified for the study. Stone sizes ranged from 3 mm to 20 mm. Thirteen patients (14%) were cancelled as no stone(s) were identified on pre-operative imaging. Of the patients cancelled, 8 (62%) required NCCT-KUB to confirm spontaneous stone passage. One in seven patients were stone free on the day of surgery. This negates the need for unnecessary anaesthetic and instrumentation of the urinary tract, with the associated morbidity. Up-to-date imaging prior to embarking on elective ureteric stone surgery is highly recommended.

Quality improvement initiative: Preventative Surgical Site Infection Protocol in Vascular Surgery.

Science.gov (United States)

Parizh, David; Ascher, Enrico; Raza Rizvi, Syed Ali; Hingorani, Anil; Amaturo, Michael; Johnson, Eric

2018-02-01

Objective A quality improvement initiative was employed to decrease single institution surgical site infection rate in open lower extremity revascularization procedures. In an attempt to lower patient morbidity, we developed and implemented the Preventative Surgical Site Infection Protocol in Vascular Surgery. Surgical site infections lead to prolonged hospital stays, adjunctive procedure, and additive costs. We employed targeted interventions to address the common risk factors that predispose patients to post-operative complications. Methods Retrospective review was performed between 2012 and 2016 for all surgical site infections after revascularization procedures of the lower extremity. A quality improvement protocol was initiated in January 2015. Primary outcome was the assessment of surgical site infection rate reduction in the pre-protocol vs. post-protocol era. Secondary outcomes evaluated patient demographics, closure method, perioperative antibiotic coverage, and management outcomes. Results Implementation of the protocol decreased the surgical site infection rate from 6.4% to 1.6% p = 0.0137). Patient demographics and comorbidities were assessed and failed to demonstrate a statistically significant difference among the infection and no-infection groups. Wound closure with monocryl suture vs. staple proved to be associated with decreased surgical site infection rate ( p site infections in the vascular surgery population are effective and necessary. Our data suggest that there may be benefit in the incorporation of MRSA and Gram-negative coverage as part of the Surgical Care Improvement Project perioperative guidelines.

Postoperative adhesion prevention in gynecologic surgery with hyaluronic acid.

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Carta, G; Cerrone, L; Iovenitti, P

2004-01-01

Despite improvements in surgical instrumentation and techniques, adhesions continue to form after most procedures. Peritoneal adhesions develop in 60-90% of women who undergo major gynecological operations. This adhesion formation causes significant postoperative morbidity such as bowel obstruction (65%), infertility (15-20%), and chronic pelvic pain (40%). To demonstrate the efficacy of a hyaluronic acid product (Hyalobarrier Gel) for the prevention of adhesions in gynecological surgery. From October 2000 to July 2002, 18 women from 26 to 41 years old (mean age 33.66) underwent myomectomy via laparotomy as their first abdominal operation. Between August 2001 and May 2003, the patients underwent a second-look laparoscopy (7 women, 38.9%, 15 sites, 42.8%) or a second-look laparotomy (11 women, 61.1%, 20 sites, 57.1%) during which all the 35 sites corresponding to the previous myomectomies were analyzed. During the second-look procedure the presence, localization and severity of adhesions were evaluated using the Operative Laparoscopy Study Group Classification (OLSG) and American Fertility Society Classification (AFSC). All patients underwent a second-look laparoscopy/laparotomy and only five of 18 (27.7%) showed pelvic adhesions in seven sites (20%) of previous myomectomies. No adhesion was found on the previous sites of myomectomies of pedunculated leiomyomas so, excluding those, adhesions were found in seven of 29 sites of myomectomies (24.1%). The present study emphasizes the need for improved treatments to prevent adhesions, as there is no doubt that adhesions represent one of the major causes of female morbidity.

Effect of infrared laser in the prevention and treatment of paresthesia in orthognathic surgery.

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Prazeres, Lady Dayane Kalline Travassos; Muniz, Yuri Victor Siqueira; Barros, Keylla Marinho Albuquerque; Gerbi, Marleny Elizabeth Marquez de Martinez; Laureano Filho, José Rodrigues

2013-05-01

Orthognathic surgery is the surgical procedure that makes correcting deformities of the bones in the region of the maxilla and mandible a reality in the Brazilian dentistry. However, this type of surgery usually involves paresthesia in the postoperative period, concerning the surgeons who perform them and generating discomfort to patients. This study aimed at evaluating the effect of infrared laser (830 nm) in the prevention and treatment of paresthesias after orthognathic surgery. Six patients underwent orthognathic surgery: the experimental group composed of 4 patients and the control group that did not receive laser therapy composed of 2 patients. The experimental group received laser applications during the transoperative and 12 postoperative sessions. Tests for mechanical (deep and shallow) and thermal (cold) sensitivity were performed in the preoperative and postoperative period (during 12 sessions) in the lip and chin areas by the same operator. The paresthesia was classified into 1, strong; 2, moderate; 3, mild; and 4, absent, through the patient's response to stimuli. The results showed that all patients had no disturbance of sensitivity in the preoperative period, but paresthesia was presented at various levels in the postoperative period. Both groups showed recovery of deep mechanical sensitivity within a shorter time interval compared with the superficial mechanical and thermal sensitivity. However, at the 12th assessment, patients who underwent the laser therapy showed better reduction in the level of paresthesia or even complete regression of this. The laser, therefore, brought benefits to the treatment of paresthesia, accelerating the return of neurosensorial sensitivity.

Elastofibroma dorsi: MRI diagnosis in a young girl

Energy Technology Data Exchange (ETDEWEB)

Devaney, D. [Dept. of Histopathology, Hospital for Sick Children, London (United Kingdom); Livesley, P. [Dept. of Orthopaedics, Hospital for Sick Children, London (United Kingdom); Shaw, D. [Dept. of Paediatric Radiology, Hospital for Sick Children, London (United Kingdom)

1995-06-01

With indications for computerised imaging expanding, elastofibroma dorsi will probably be seen more frequently. This report describes an elastofibroma presenting in an 11-year-old girl and its appearance by magnetic resonance imaging. Presumptive diagnosis by magnetic resonance imaging may prevent unnecessary radical surgery. (orig.)

Elastofibroma dorsi: MRI diagnosis in a young girl

International Nuclear Information System (INIS)

Devaney, D.; Livesley, P.; Shaw, D.

1995-01-01

With indications for computerised imaging expanding, elastofibroma dorsi will probably be seen more frequently. This report describes an elastofibroma presenting in an 11-year-old girl and its appearance by magnetic resonance imaging. Presumptive diagnosis by magnetic resonance imaging may prevent unnecessary radical surgery. (orig.)

Author response to letter. Ref: Madsen et al. "Unnecessary work tasks and mental health: a prospective analysis of Danish human service workers".

Science.gov (United States)

Madsen, Ida Eh; Rugulies, Reiner

2015-03-01

We read with interest the letter from Drs Durand-Moreau, Loddé, and Dewitte (1) regarding our article on unnecessary work tasks and mental health (2). The authors argue that: (i) the article is flawed by an imprecise one-item exposure measurement, (ii) the results may be affected by reverse causality, and (iii) ultimately the elimination of unnecessary work tasks may increase "psychic suffering". We would like to take this opportunity to address their concerns. We acknowledge, as we did in the article itself, that measuring unnecessary work tasks using only one item is less than ideal and could have increased measurement error in our analyses. The item we used to measure unnecessary work tasks assesses the employee's overall evaluation regarding the extent to which they must conduct work tasks that they, for whatever reason, deem unnecessary. We are unconvinced by the claim by Drs Durand-Moreau, Loddé, and Dewitte that this phenomenon is somehow unrelated to Semmer's definition of unnecessary tasks (3, 4), regardless of the sense-making processes underlying an individual employee's evaluation of a particular work task as unnecessary. Regarding the issue of reverse causality, the analyses were longitudinal and the effect estimates were adjusted for the baseline mental health level of the participants. Consequently, we examined changes in mental health over time, and our results cannot be explained by poorer mental health making workers think "that what they're doing is useless" as claimed in the commentary. Although causal inference is always a delicate issue when applying observational research methods, the adjustment for baseline mental health should account for reverse causality at least. Drs Durand-Moreau, Loddé, and Dewitte question that our findings suggest that the elimination of unnecessary work tasks may be beneficial to employee mental health. Instead they propose that unnecessary work tasks may be conducive to mental health because "some tasks may seem

A Legal Analysis of the Precedents of Medical Disputes in the Cosmetic Surgery Field

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Bo Young Park

2016-05-01

Full Text Available BackgroundDisputes regarding medical malpractice occur between practitioners and patients. As patients have become increasingly aware regarding medical care, an increase in the unexpected side effects of procedures has been observed, thereby leading to an increase in disputes regarding medical malpractice. In this study, we reviewed trends in precedents involving cosmetic surgery-related medical disputes, with the goal of helping to prevent unnecessary disputes in the future.MethodsWe conducted a search of the judgments made in South Korean courts between 2000 and 2013 that were related to the field of plastic surgery. A total of 54 judgments were analyzed, and the selected precedents were reviewed and classified according to the kind of negligence involved.ResultsThe claim amounts ranged from under 8 million KRW (6,991 USD to 750 million KRW (629,995 USD. The most common ratio of the judgment amount to the claim amount was 20%–30%. The judgments were classified according to the following categories: violation of the duty of explanation in 17 cases (29%, violation of the duty of care in 10 cases (17%, violation of both duties in 20 cases (35%, and no violation of duty in six cases (10%.ConclusionsCosmetic surgery-related suits require different approaches than general malpractice suits. The Supreme Court requires plastic surgeons to determine the type, timing, methods, and scope of their treatments when considering possible results. Therefore, practitioners should be educated on their rights and responsibilities to enable them to cope with any possible medical dispute that may arise.

A Legal Analysis of the Precedents of Medical Disputes in the Cosmetic Surgery Field.

Science.gov (United States)

Park, Bo Young; Kim, Min Ji; Kang, So Ra; Hong, Seung Eun

2016-05-01

Disputes regarding medical malpractice occur between practitioners and patients. As patients have become increasingly aware regarding medical care, an increase in the unexpected side effects of procedures has been observed, thereby leading to an increase in disputes regarding medical malpractice. In this study, we reviewed trends in precedents involving cosmetic surgery-related medical disputes, with the goal of helping to prevent unnecessary disputes in the future. We conducted a search of the judgments made in South Korean courts between 2000 and 2013 that were related to the field of plastic surgery. A total of 54 judgments were analyzed, and the selected precedents were reviewed and classified according to the kind of negligence involved. The claim amounts ranged from under 8 million KRW (6,991 USD) to 750 million KRW (629,995 USD). The most common ratio of the judgment amount to the claim amount was 20%-30%. The judgments were classified according to the following categories: violation of the duty of explanation in 17 cases (29%), violation of the duty of care in 10 cases (17%), violation of both duties in 20 cases (35%), and no violation of duty in six cases (10%). Cosmetic surgery-related suits require different approaches than general malpractice suits. The Supreme Court requires plastic surgeons to determine the type, timing, methods, and scope of their treatments when considering possible results. Therefore, practitioners should be educated on their rights and responsibilities to enable them to cope with any possible medical dispute that may arise.

Impact of the Antibiotic Stewardship Program on Prevention and Control of Surgical Site Infection during Peri-Operative Clean Surgery.

Science.gov (United States)

Liu, Juyuan; Li, Na; Hao, Jinjuan; Li, Yanming; Liu, Anlei; Wu, Yinghong; Cai, Meng

2018-04-01

Surgical site infections (SSIs) are the leading cause of hospital-acquired infections and are associated with substantial healthcare costs, with increased morbidity and mortality. To investigate the effects of the antibiotic stewardship program on prevention and control of SSI during clean surgery, we investigated this situation in our institution. We performed a quasi-experimental study to compare the effect before and after the antibiotic stewardship program intervention. During the pre-intervention stage (January 1, 2010 through December 31, 2011), comprehensive surveillance was performed to determine the SSI baseline data. In the second stage (January 1, 2012 through December 31, 2016), an infectious diseases physician and an infection control practitioner identified the surgical patients daily and followed up on the duration of antimicrobial prophylaxis. From January 1, 2010 to December 31, 2016, 41,426 patients underwent clean surgeries in a grade III, class A hospital. The rate of prophylactic antibiotic use in the 41,426 clean surgeries was reduced from 82.9% to 28.0% after the interventions. The rate of antibiotic agents administered within 120 minutes of the first incision increased from 20.8% to 85.1%. The rate at which prophylactic antimicrobial agents were discontinued in the first 24 hours after surgery increased from 22.1% to 60.4%. Appropriate antibiotic selection increased from 37.0% to 93.6%. Prophylactic antibiotic re-dosing increased from 3.8% to 64.8%. The SSI rate decreased from 0.7% to 0.5% (p < 0.05). The pathogen detection rate increased from 16.7% up to 41.8% after intervention. The intensity of antibiotic consumption reduced from 74.9 defined daily doses (DDDs) per 100 bed-days to 34.2 DDDs per 100 bed-days after the interventions. Long-term and continuous antibiotic stewardship programs have important effects on the prevention and control of SSI during clean surgery.

[For active dermatocosmetics and free of unnecessary animal experimentation].

Science.gov (United States)

Piérard, G E; Piérard-Franchimont, C

1998-06-01

At the dawn of this century, dermocosmetology is at cross-roads because new European regulations are changing its face. The proof of claims must be given and the entire composition of the product must be released. In addition, animal testing is about to be banned. Such new regulations incite to search for and validate predictive tests aiming at the objective evaluation of the activity and tolerance claimed by dermocosmetic products. Such tests must be an alternative to unnecessary animal experimentation. These aspects are scrutinized scientifically by the EEMCO experts in combination with the ECVAM and COLIPA organizations.

Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

Directory of Open Access Journals (Sweden)

Evrim Eylem Akpinar

2013-06-01

Full Text Available OBJECTIVE: Pulmonary embolism (PE is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age.

What is going on in augmented reality simulation in laparoscopic surgery?

Science.gov (United States)

Botden, Sanne M B I; Jakimowicz, Jack J

2009-08-01

To prevent unnecessary errors and adverse results of laparoscopic surgery, proper training is of paramount importance. A safe way to train surgeons for laparoscopic skills is simulation. For this purpose traditional box trainers are often used, however they lack objective assessment of performance. Virtual reality laparoscopic simulators assess performance, but lack realistic haptic feedback. Augmented reality (AR) combines a virtual reality (VR) setting with real physical materials, instruments, and feedback. This article presents the current developments in augmented reality laparoscopic simulation. Pubmed searches were performed to identify articles regarding surgical simulation and augmented reality. Identified companies manufacturing an AR laparoscopic simulator received the same questionnaire referring to the features of the simulator. Seven simulators that fitted the definition of augmented reality were identified during the literature search. Five of the approached manufacturers returned a completed questionnaire, of which one simulator appeared to be VR and was therefore not applicable for this review. Several augmented reality simulators have been developed over the past few years and they are improving rapidly. We recommend the development of AR laparoscopic simulators for component tasks of procedural training. AR simulators should be implemented in current laparoscopic training curricula, in particular for laparoscopic suturing training.

Vanishing large ovarian cyst with thyroxine therapy.

Science.gov (United States)

Dharmshaktu, Pramila; Kutiyal, Aditya; Dhanwal, Dinesh

2013-01-01

A 21-year-old female patient recently diagnosed with severe hypothyroidism was found to have a large ovarian cyst. In view of the large ovarian cyst, she was advised to undergo elective laparotomy in the gynaecology department. She was further evaluated in our medical out-patient department (OPD), and elective surgery was withheld. She was started on thyroxine replacement therapy, and within a period of 4 months, the size of the cyst regressed significantly, thereby improving the condition of the patient significantly. This case report highlights the rare and often missed association between hypothyroidism and ovarian cysts. Although very rare, profound hypothyroidism that can cause ovarian cysts in an adult should always be kept in the differential diagnosis to avoid unnecessary ovarian surgery. Hypothyroidism should be considered in the differential diagnosis of adult females presenting with multicystic ovarian tumours.Adequate thyroid hormone replacement therapy can prevent these patients from undergoing unnecessary and catastrophic ovarian resection.Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement.In younger women with ovarian cysts, it is also desirable to avoid unnecessary surgery so as to not compromise fertility in the future.

Evaluating compliance with institutional preoperative testing guidelines for minimal-risk patients undergoing elective surgery.

Science.gov (United States)

Siriussawakul, Arunotai; Nimmannit, Akarin; Rattana-arpa, Sirirat; Chatrattanakulchai, Siritda; Saengtawan, Puttachard; Wangdee, Aungsumat

2013-01-01

Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. This retrospective study was conducted on adult patients over a one-year period. The institute's guidelines recommend tests according to the patients' age groups: a complete blood count (CBC) for those patients aged 18-45; CBC, chest radiograph (CXR) and electrocardiography (ECG) for those aged 46-60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN), and creatinine (Cr) for patients aged 61-65. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5-13.9). BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. The need to utilize the institution's preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.

Gross anatomy of pancreatic surgery related fascia and fascial spaces.

Science.gov (United States)

Zhou, Xiaobo; Ding, Zihai

2014-01-01

The study aims to provide anatomical basis and identify surgical planes or safe routes for pancreatic surgery by studying adult or fresh cadaver specimens. Thirty formalin-fixed adult cadavers (16 males and 14 females), provided by the Department of Anatomy at Southern Medical University, China, were perfused with red latex through the abdominal aorta, treated with antiseptic and antibacterial agents and then refrigerated. Fifteen abdomen specimens from fresh adult cadavers (Southern Medical body donation reception centers) were also perfused with red latex through the femoral artery and placed in -20 C freezer for 1 week before surgery and anatomic observation. The renal fascia surrounding pancreas and duodenum were mostly filled with loose connective tissues and adipose tissues. They were mutually connected with clear fascial borders but easily to be separated, suitable for surgical operations. Also, the integrating spaces were the connecting borders between different tissues without nerves or blood vessels inside. They may serve as ideal surgical planes for pancreatic surgery. A better understanding of the anatomy of the renal fascia and fascial spaces may provide guidance for identifying surgical landmarks and planes, and help to reduce bleeding and unnecessary side injuries in pancreatic surgery.

Human amnion as a biological dressing used to prevent prolonged air leakage in thoracic surgery

International Nuclear Information System (INIS)

Mijewski, M.; Uhrynowska-Tyszkiewicz, I.; Piech, K.; Gogowski, M.

2008-01-01

Full text: Prolonged air leakage lasting 7 days or more is one of the most common complications in thoracic surgery. This complication may result in increased morbidity and prolonged hospital stay. Amnion allografts have been used to minimise this complication. The aim of our study was to evaluate the usefulness of human amnion grafts in the treatment of air leakage following thoracic surgery. Deep-frozen, radiation-sterilized (35 kGy) human amnion grafts prepared at the Central Tissue Bank in Warsaw (Poland) were used. Amnion allografts were applied to 69 patients who had surgery: 36 thoracotomies, and 33 rethoracotomies had been performed. During lung ventilation the air leakage sites were identified and covered by the amnion flap. Air leakage were evaluated during the postoperative period. Retrospectively we analysed air leakage duration in 170 thoracothomies and rethoracotomies without amnion transplantation. The separation of lung tissue and the liberation of pleural adhesions may be result in the lung and visceral pleura injury. Deep-frozen and radiation-sterilized human amnion is biocompatible, flexible, strong and airtight. It may be easily attached to the lung parenchyma and allows coverage of the area of the lung parenchyma deprived of the visceral pleura. The use of human amnion allografts is simple and safe. After treatment with amnion in 85% of the cases air leakage last less than 7 days, and only its traces were observed. Our results suggest that the human amnion grafts applied for the prevention of air leakage in lung surgery is a safe, simple and effective method. (Author)

Rivaroxaban for venous thromboembolism prevention after major orthopedic surgery: translating trial data into routine clinical practice

Directory of Open Access Journals (Sweden)

Beyer-Westendorf J

2017-01-01

Full Text Available Jan Beyer-Westendorf,1 Patrick Mouret,2 Alexander GG Turpie3 1Thrombosis Research and Angiology, Dresden University Clinic, Dresden, Germany; 2Orthopedic Clinic, Klinikum Frankfurt Höchst GmbH, Frankfurt, Germany; 3Department of Medicine, General Division, Hamilton Health Sciences, Hamilton, ON, Canada Abstract: An established standard of care for the prevention of venous thromboembolism after major orthopedic surgery has been subcutaneous low-molecular-weight heparin. The non-vitamin K antagonist oral anticoagulant rivaroxaban has demonstrated superior efficacy and similar safety to all tested regimens of enoxaparin in large Phase III clinical studies of venous thromboembolism prevention after elective hip and knee arthroplasty. Despite regulatory approval of rivaroxaban for this indication, concerns remain among physicians regarding its optimal and effective use in routine clinical practice. Real-life studies, such as XAMOS and ORTHO-TEP, are providing physicians with more information on the routine use of rivaroxaban for venous thromboembolism prevention after orthopedic surgery, helping to establish its safety and effectiveness in everyday clinical care. Among the most important issues are the risk of bleeding complications, wound healing, timing of first dose, impact of type of anesthesia on thromboprophylaxis effectiveness, patient comorbidities and comedication use, periprocedural management, associated costs, and clinical outcomes in trauma-related fractures. Many of these issues are difficult to study in randomized, double-blind, Phase III trials, and can be assessed more readily using real-life data. In particular, real-life or noninterventional studies lack many of the strict inclusion and exclusion criteria associated with Phase III trials and involve unselected patients who often present with significant comorbidities or comedication use. Keywords: anticoagulants, arthroplasty, orthopedics, rivaroxaban, thrombosis

Surgery: a risky business.

Science.gov (United States)

Vats, Amit; Nagpal, Kamal; Moorthy, Krishna

2009-10-01

The advancement of surgical technology has made surgery an increasingly suitable management option for an increasing number of medical conditions. Yet there is also a growing concern about the number of patients coming to harm as a result of surgery. Studies show that this harm can be prevented by better teamwork and communication in operating theatres. This article discusses the extent of adverse events in surgery and how effective teamwork and communication can improve patient safety. It also highlights the role checklists and briefing in improving teamwork and reducing human error in surgery.

A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria

OpenAIRE

Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J.; Main, Cheryl; Mertz, Dominik

2015-01-01

Background Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. Objective To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Design Quasi-experimental study with a control group. Setting Two tertiary teaching adult care hospitals. Participants Consec...

Obstructive Sleep Apnea and Postoperative Complications in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Need for Preventive Strategies

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Babak Amra

2014-01-01

Conclusions: Obstructive sleep apnea is frequent, but unrecognized among patients undergoing CABG. In these patients, OSA is associated with prolonged intubation duration. Preventing these problems may be possible by early diagnosis and management of OSA in cardiac surgery patients. Further studies with larger sample of patients and longer follow-ups are required in this regard.

Clinical applications of gamma-detection probes - radioguided surgery

International Nuclear Information System (INIS)

Schneebaum, S.; Stadler, J.; Skornick, Y.

1999-01-01

Radioguided surgery (RGS) is a surgical technique that enables the surgeon to identify tissue ''marked'' by a radionuclide before surgery, based on the tissue characteristics, the radioactive tracer and its carrying molecule, or the affinity of both. Thus, yet another tool has been added to the inspection and palpation traditionally used by the surgeon. Current clinical applications of radioguided surgery are: radioimmunoguided surgery (RIGS) for colon cancer, sentinel-node mapping for malignant melanoma (which has become state-of-the-art), sentinel-node mapping for breast, vulvar and penile cancer, and detection of parathyroid adenoma and bone tumour (such as osteid osteoma). Although the same gamma-detecting probe (GDP) may be used for all these applications, the carrier substance and the radionuclide differ. MoAb and peptides are used for RIGS, sulphur colloid for sentinel-node mapping, iodine-125 for RIGS, technetium-99m for sentinel node, parathyroid and bone. The mode of injection also differs, but there are some common principles of gamma-guided surgery. RIGS enables the surgeon to corroborate tumour existence, find occult metastases, and assess the margins of resection; this may result in a change on the surgical plan. Sentinel lymph-node (SLN) scintigraphy for melanoma guides the surgeon to find the involved lymph nodes for lymph-node dissection. SLN for breast cancer is being investigated with promising results. This procedure has also changed the outlook of lymph-node pathology by giving the pathologist designated tissue samples for more comprehensive examination. Gamma-guided surgery will result in more accurate and less unnecessary surgery, better pathology and, hopefully, in better patient survival. (orig.)

Is it possible to prevent morbidity on post cardiovascular surgery applying low level laser therapy?

Science.gov (United States)

Pinto, Nathali C.; Baptista, Ivany Machado d. C.; Pereira, Mara Helena C.; Serrão, Nelson F.; Pomerantzeff, Pablo M. A.; Chavantes, Maria Cristina

2014-03-01

Background and Objective: Complications following cardiovascular surgery incision are common in mediastinitis and wound dehiscence form, a 47% mortality rate remaining. Low Level Laser Therapy (LLLT) has been employed mainly to its effectiveness analgesic and anti-inflammatory actions, aiding the tissue repair process. The aim of this study was to evaluate infrared LLLT onto surgical incision in patients submitted to cardiovascular surgery. Materials and Methods: 40 patients were divided in two groups: Placebo Group (G1) - conventional therapy + "Laser pointer" and Laser Group (G2) - conventional therapy + Infrared Laser irradiation on surgical incision. Diode Laser was employed, C.W. mode, around the surgical wound bed, on immediate Post Operative (PO), 1st PO and 3rd PO with the following parameters: wavelength (λ): 830nm, P=35mW, E=0,75J. Results: G2 didn't present any complication and 5% of patients in G1 developed incision dehiscence and infection. On 7thPO, still a large amount of G1 patients showed pain and unquestionable inflammatory signs surrounding the surgical wound, when compared to G2. Besides, hospital stay in Laser Group was 2 times shorter than in Placebo Group (p-value=0.001). Conclusion: Infrared Laser denoted to be safe and exceptionally valuable tools in preventing morbidities on post cardiovascular surgeries.

Fluorescence-guided surgery of a highly-metastatic variant of human triple-negative breast cancer targeted with a cancer-specific GFP adenovirus prevents recurrence

Science.gov (United States)

Yano, Shuya; Takehara, Kiyoto; Miwa, Shinji; Kishimoto, Hiroyuki; Tazawa, Hiroshi; Urata, Yasuo; Kagawa, Shunsuke; Bouvet, Michael; Fujiwara, Toshiyoshi; Hoffman, Robert M.

2016-01-01

We have previously developed a genetically-engineered GFP-expressing telomerase-dependent adenovirus, OBP-401, which can selectively illuminate cancer cells. In the present report, we demonstrate that targeting a triple-negative high-invasive human breast cancer, orthotopically-growing in nude mice, with OBP-401 enables curative fluorescence-guided surgery (FGS). OBP-401 enabled complete resection and prevented local recurrence and greatly inhibited lymph-node metastasis due to the ability of the virus to selectively label and subsequently kill cancer cells. In contrast, residual breast cancer cells become more aggressive after bright (white)-light surgery (BLS). OBP-401-based FGS also improved the overall survival compared with conventional BLS. Thus, metastasis from a highly-aggressive triple-negative breast cancer can be prevented by FGS in a clinically-relevant mouse model. PMID:27689331

Multicenter Quality Improvement Project to Prevent Sternal Wound Infections in Pediatric Cardiac Surgery Patients.

Science.gov (United States)

Woodward, Cathy; Taylor, Richard; Son, Minnette; Taeed, Roozbeh; Jacobs, Marshall L; Kane, Lauren; Jacobs, Jeffrey P; Husain, S Adil

2017-07-01

Children undergoing cardiac surgery are at risk for sternal wound infections (SWIs) leading to increased morbidity and mortality. Single-center quality improvement (QI) initiatives have demonstrated decreased infection rates utilizing a bundled approach. This multicenter project was designed to assess the efficacy of a protocolized approach to decrease SWI. Pediatric cardiac programs joined a collaborative effort to prevent SWI. Programs implemented the protocol, collected compliance data, and provided data points from local clinical registries using Society of Thoracic Surgery Congenital Heart Surgery Database harvest-compliant software or from other registries. Nine programs prospectively collected compliance data on 4,198 children. Days between infections were extended from 68.2 days (range: 25-82) to 130 days (range: 43-412). Protocol compliance increased from 76.7% (first quarter) to 91.3% (final quarter). Ninety (1.9%) children developed an SWI preprotocol and 64 (1.5%) postprotocol, P = .18. The 657 (15%) delayed sternal closure patients had a 5% infection rate with 18 (5.7%) in year 1 and 14 (4.3%) in year 2 P = .43. Delayed sternal closure patients demonstrated a trend toward increased risk for SWI of 1.046 for each day the sternum remained open, P = .067. Children who received appropriately timed preop antibiotics developed less infections than those who did not, 1.9% versus 4.1%, P = .007. A multicenter QI project to reduce pediatric SWIs demonstrated an extension of days between infections and a decrease in SWIs. Patients who received preop antibiotics on time had lower SWI rates than those who did not.

Improving Surveillance and Prevention of Surgical Site Infection in Pediatric Cardiac Surgery.

Science.gov (United States)

Cannon, Melissa; Hersey, Diane; Harrison, Sheilah; Joy, Brian; Naguib, Aymen; Galantowicz, Mark; Simsic, Janet

2016-03-01

Postoperative cardiovascular surgical site infections are preventable events that may lead to increased morbidity, mortality, and health care costs. To improve surgical wound surveillance and reduce the incidence of surgical site infections. An institutional review of surgical site infections led to implementation of 8 surveillance and process measures: appropriate preparation the night before surgery and the day of surgery, use of appropriate preparation solution in the operating room, appropriate timing of preoperative antibiotic administration, placement of a photograph of the surgical site in the patient's chart at discharge, sending a photograph of the surgical site to the patient's primary care physician, 30-day follow-up of the surgical site by an advanced nurse practitioner, and placing a photograph of the surgical site obtained on postoperative day 30 in the patient's chart. Mean overall compliance with the 8 measures from March 2013 through February 2014 was 88%. Infections occurred in 10 of 417 total operative cases (2%) in 2012, in 8 of 437 total operative cases (2%) in 2013, and in 7 of 452 total operative cases (1.5%) in 2014. Institution of the surveillance process has resulted in improved identification of suspected surgical site infections via direct rather than indirect measures, accurate identification of all surgical site infections based on definitions of the National Healthcare Safety Network, collaboration with all persons involved, and enhanced communication with patients' family members and referring physicians. ©2016 American Association of Critical-Care Nurses.

Granisetron plus dexamethasone for prevention of postoperative nausea and vomiting in patients undergoing laparoscopic surgery: A meta-analysis

OpenAIRE

Zhu, Min; Zhou, Chengmao; Huang, Bing; Ruan, Lin; Liang, Rui

2017-01-01

Objective This study was designed to compare the effectiveness of granisetron plus dexamethasone for preventing postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic surgery. Methods We searched the literature in the Cochrane Library, PubMed, EMBASE, and CNKI. Results In total, 11 randomized controlled trials were enrolled in this analysis. The meta-analysis showed that granisetron in combination with dexamethasone was significantly more effective than granisetron alone...

Evaluating Compliance with Institutional Preoperative Testing Guidelines for Minimal-Risk Patients Undergoing Elective Surgery

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Arunotai Siriussawakul

2013-01-01

Full Text Available Background. Few investigations preoperatively are important for low-risk patients. This study was designed to determine the level of compliance with preoperative investigation guidelines for ASA I patients undergoing elective surgery. Secondary objectives included the following: to identify common inappropriate investigations, to evaluate the impact of abnormal testing on patient management, to determine factors affecting noncompliant tests, and to estimate unnecessary expenditure. Methods. This retrospective study was conducted on adult patients over a one-year period. The institute’s guidelines recommend tests according to the patients’ age groups: a complete blood count (CBC for those patients aged 18–45; CBC, chest radiograph (CXR and electrocardiography (ECG for those aged 46–60; and CBC, CXR, ECG, electrolytes, blood glucose, blood urea nitrogen (BUN, and creatinine (Cr for patients aged 61–65. Results. The medical records of 1,496 patients were reviewed. Compliant testing was found in only 12.1% (95% CI, 10.5–13.9. BUN and Cr testings were the most frequently overprescribed tests. Overinvestigations tended to be performed on major surgery and younger patients. Overall, overinvestigation incurred an estimated cost of US 200,000 dollars during the study period. Conclusions. The need to utilize the institution’s preoperative guidelines should be emphasized in order to decrease unnecessary testing and the consequential financial burden.

[Prevention and multimodal therapy of hyperthyroidism].

Science.gov (United States)

Palitzsch, K-D

2008-12-01

Subclinical and overt hyperthyroidism have been associated with various negative clinical outcomes as for example an increased risk of atrial fibrillation or increased cardiovascular mortality, especially in old age. In order to avoid hyperthyroidism it is strongly recommended not to start any iodine containing drug therapy or to avoid application of contrast agents unless the patient presents with an unremarkable clinical course. TSH suppressive therapy for the treatment of endemic goiter or differentiated low risk thyroid carcinoma is unnecessary, since it favours the development of subclinical hyperthyroidism. Overt hyperthyroidism is treated with antithyroid drugs and/or radioiodine therapy or surgery according to the underlying disease (toxic nodular goiter, Graves' disease).

Pain Control After Surgery: Pain Medicines

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... Emotional Well-Being Mental Health Sex and Birth Control Sex and Sexuality Birth Control Family Health Infants and Toddlers Kids and Teens ... Bracing: What Works? Home Prevention and Wellness Pain Control After Surgery: Pain Medicines Pain Control After Surgery: ...

Intraocular surgery in a large diabetes patient population

DEFF Research Database (Denmark)

Ostri, Christoffer

2014-01-01

The prevalence of diabetes is on the increase in developed countries. Accordingly, the prevention and treatment of vision-threatening diabetic eye complications is assuming greater importance. The overall aim of this thesis is to analyse risk factors for intraocular surgery in a large diabetes po...... surgery, which can be used for preventive purposes, surgical decision-making and patient counselling....

Cerebral Oximetry in Cardiac Surgery

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A. N. Shepelyuk

2012-01-01

Full Text Available Based on the data of numerous current references, the review describes different neuromonitoring methods during cardiac surgery under extracorporeal circulation. It shows that it is important and necessary to make neuromonitoring for the early diagnosis and prevention of neurological complications after cardiac surgery. Particular attention is given to cerebral oximetry; the possibilities and advantages of this technique are described. Correction of cerebral oximetric values is shown to improve survival rates and to reduce the incidence of postoperative complications. Lack of cerebral oximetry monitoring denudes a clinician of important information and possibilities to optimize patient status and to prevent potentially menacing complications, which allows one to conclude that it is necessary to use cerebral oximetry procedures within neu-romonitoring in cardiac surgery. Key words: extracorporeal circulation, cerebral oximetry, neurological dysfunction, cerebral oxygenation.

Effect of Temperature-Sensitive Poloxamer Solution/Gel Material on Pericardial Adhesion Prevention: Supine Rabbit Model Study Mimicking Cardiac Surgery.

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Hyun Kang

Full Text Available We investigated the mobility of a temperature-sensitive poloxamer/Alginate/CaCl2 mixture (PACM in relation to gravity and cardiac motion and the efficacy of PACM on the prevention of pericardial adhesion in a supine rabbit model.A total of 50 rabbits were randomly divided into two groups according to materials applied after epicardial abrasion: PACM and dye mixture (group PD; n = 25 and saline as the control group (group CO; n = 25. In group PD, rabbits were maintained in a supine position with appropriate sedation, and location of mixture of PACM and dye was assessed by CT scan at the immediate postoperative period and 12 hours after surgery. The grade of adhesions was evaluated macroscopically and microscopically two weeks after surgery.In group PD, enhancement was localized in the anterior pericardial space, where PACM and dye mixture was applied, on immediate post-surgical CT scans. However, the volume of the enhancement was significantly decreased at the anterior pericardial space 12 hours later (P < .001. Two weeks after surgery, group PD had significantly lower macroscopic adhesion score (P = .002 and fibrosis score (P = .018 than did group CO. Inflammation score and expression of anti-macrophage antibody in group PD were lower than those in group CO, although the differences were not significant.In a supine rabbit model study, the anti-adhesion effect was maintained at the area of PACM application, although PACM shifted with gravity and heart motion. For more potent pericardial adhesion prevention, further research and development on the maintenance of anti-adhesion material position are required.

The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization

OpenAIRE

Rojanasarot, Sirikan

2017-01-01

PURPOSE: To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization. DESIGN: A cross-sectional study. SUBJECTS AND SETTING: A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient...

Breast Cancer Prevention

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... of Breast & Gynecologic Cancers Breast Cancer Screening Research Breast Cancer Prevention (PDQ®)–Patient Version What is prevention? Go ... from starting. Risk-reducing surgery . General Information About Breast Cancer Key Points Breast cancer is a disease in ...

The criteria for the decision of transrectal US-guided prostate biopsy: Can we reduce the number of unnecessary biopsies?

International Nuclear Information System (INIS)

Cho, Joon Hyung; Cho, Jae Ho; Ahn, Jay Hong; Chang, Jay Chun

2001-01-01

To establish the criteria which can safely reduce the number of unnecessary biopsies by comparing the transrectal ultrasonography (TRUS) findings, serum prostate-specific antigen (PSA), and prostate specific antigen density (PSAD) in the decision of criteria for the prostatic biopsy using TRUS. Two hundred and twenty patients underwent TRUS- guided prostate biopsy due to elevated PSA and/or focal nodule on TRUS were included. Sixty five (27.5%) patients were confirmed as prostate cancer, and remained 155 (70.5%) patients were reported as benign diseases including benign prostate hyperplasia. The sensitivity, specificity and accuracy of TRUS, PSA and PSAD were evaluated and the single criterion or the combination of the criteria which can safely reduce the unnecessary biopsies without missing prostatic cancer were investigated. The sensitivity, specificity and accuracy of TRUS, PSA (cut-off value, 4 ng/ml) and PSAD (cut-off level, 0.2 ng/ml/cm 3 ) were 78.5%/95.4%/95.4%/27.8%/51.6%/64/5%, 42.7%/64.5%/73.6%, respectively. PSAD cut-off level 0.2 ng/ml/cm 3 was the most excellent single criterion for the decision of prostatic biopsy and the number of unnecessary biopsies was 100 cases. But 3 cases of prostatic cancer which the PSAD level was below 0.2 ng/ml/cm 3 were included and in all these 3 cases, a focal nodule was detected on TRUS. Therefore, we applied these two criteria at once and the biopsies of 30 cases (13.6%) are unnecessary. With the single criterion, we could not obtain the satisfactory results but by the combinations of criteria (TRUS and PSAD), 30 (13.6%) cases are unnecessary biopsies without missing cancer. We think that the short term follow-up may be a substitute for the immediate when nodular lesion is suspicious on TRUS and serum PSAD level is below 0.2 ng/ml/cm 3 .

Utility of opium seed extract tests in preventing hypersensitivity reactions during surgery.

Science.gov (United States)

Armentia, A; Pineda, F; Palacios, R; Martín-Gil, F-J; Miguel, A S; Arenal, J J; Tejedor, J; Tef, B M

2014-01-01

Anaphylaxis during anaesthesia is fatal in 3-9% of patients and analgesics, including opioids, and is the second most common medicament-related cause, although the prevalence is underestimated. We recently found that patients may generate IgE antibodies to opium seeds. To determine the diagnostic accuracy of specific antibodies to morphine, codeine, rocuronium and oil body and aqueous fractions of Papaver somniferum seeds in the diagnosis and prevention of allergy to opioids. Patients with hypersensitivity reactions during surgery, and severe clinical allergy (pollen, tobacco), and illicit heroin users were selected. The sensitivity, specificity and predictive values of in vivo and in vitro diagnostic techniques including oil body and aqueous fractions of P. somniferum seeds were measured. We studied 203 patients, with mean age 35.1±17.1 and 200 healthy controls. Patients sensitised to heroin or with hypersensitivity reactions during surgery responded to P. somniferum seed tests. Of patients not known to be sensitised to opioids, the highest positivity was in patients sensitised to tobacco (pOpium seed skin tests and IgE, especially the oil body fraction, were more sensitive (64.2%) and specific (98.4%) than morphine, codeine and rocuronium tests for opioid sensitivity. Pollen allergy was not a risk factor for sensitisation to morphine. Sensitivity to opioids and intraoperative anaphylaxis can be diagnosed by routine tests. IgE and skin tests for the oil body fraction of P. somniferum had the highest sensitivity for sensitisation to opioids. Copyright © 2012 SEICAP. Published by Elsevier Espana. All rights reserved.

Giant Cell Fibroma of the Tongue: A Case Report

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Farrokh Farhadi

2014-11-01

Full Text Available Giant cell fibroma of the tongue is a rare benign fibrous tumor of connective tissues in the oral cavity, very few of which have been reported. This benign neoplasm has a predilection for the gingiva and .usually occurs in women under 30. Since this tumor is clinically, and especially histopathologically, placed in the differential diagnosis list of benign and malignant mesenchymal tumors, its proper diagnosis is of great significance because widespread and unnecessary surgeries are avoided as a result. The aim of the present report is to present a case of the tumor in the tongue of a 65-year-old man. The fibroma is a benign fibrous tumor of connective tissues which is microscopically classified in differential diagnosis with other soft tissue tumors since its proper diagnosis prevents from extensive and unnecessary surgeries on the patient.

The Impact of Early Involvement in a Postdischarge Support Program for Ostomy Surgery Patients on Preventable Healthcare Utilization.

Science.gov (United States)

Rojanasarot, Sirikan

To evaluate the impact of a postdischarge ostomy support program as an adjunct to nurse-led ostomy care on preventable healthcare utilization. A cross-sectional study. A postdischarge support program offered by an ostomy product's manufacturer provides persons living with an ostomy with patient-centered and easily accessible assistance. Individuals who underwent ostomy surgery within 18 months prior to the survey date were selected from an ostomy patient database maintained by the ostomy patient support program provider. Of 7026 surveys sent to program enrollees, 493 (7%) responded, compared with 225 (5%) out of 4149 surveys sent to individuals in a comparison group. The 2 groups were similar in demographics. A majority of the survey respondents were female (60% of program enrollees vs 55% of respondents in the comparison group). Among the program enrollees, 44% had colostomy, 43% had ileostomy, 10% had urostomy, and 4% had at least 2 types of ostomy surgery compared with 52%, 32%, 12%, and 4% of the respondents in a comparison group, respectively. The study compared hospital readmission and emergency room (ER) visit rates attributable to ostomy complications between program enrollees and respondents in the comparison group. The event rates were measured in 2 study periods: within the first month of discharge and after the first month of discharge. Eligible individuals received an online survey that included the following domains: characteristics of ostomy surgery; readmissions and ER visits within the first month or after the first month of discharge, including reasons for preventable events; and level of health care access. Multivariate logistic regressions controlling for covariates were applied to investigate associations between program enrollment and ostomy-related readmission or ER visit rates. Logistic regression analyses showed that, when compared with respondents in the comparison group, program enrollees had a significantly lower likelihood of being

The future of glaucoma surgery

Directory of Open Access Journals (Sweden)

Arsham Sheybani

2015-01-01

Full Text Available Glaucoma surgery is ripe for innovation. In the last few years, there has been a substantial increase in the number of devices approaching commercialization. While not all that is new is necessarily good, the role of these devices in changing glaucoma surgery is equally important in terms of both success and failure. Trabeculectomy, the most commonly performed incisional filtration surgery for glaucoma, is subjective by nature and certainly has risks. As devices aim to standardize glaucoma surgery, specifically subconjunctival filtration surgery, predictability and in turn safety should theoretically improve. This may allow the glaucoma surgeon to intervene earlier in the disease process, prevent more advanced vision loss and potentially decrease the burden of medications.

Which antibiotic regimen prevents implant failure or infection after dental implant surgery? A systematic review and meta-analysis.

Science.gov (United States)

Rodríguez Sánchez, Fabio; Rodríguez Andrés, Carlos; Arteagoitia, Iciar

2018-04-01

To assess which antibiotic regimen prevents dental implant failures or postoperative infections following dental implant placement. Systematic review and meta-analysis. Pubmed, Cochrane, Science Direct, and EMBASE via OVID were searched up to August 2017. Only randomized controlled clinical trials (RCT) using antibiotics were included. Outcome measures were set on dental implant failures or postoperative infection incidence after dental implant surgery. Three reviewers independently undertook risk of bias assessment and data extraction. Stratified meta-analyses of binary data using fixed-effects models were performed using Stata 14.0. The risk ratio (RR) and 95% confidence interval (CI) were estimated. Nine articles were included corresponding to 15 RCTs. All RCTs tested only oral amoxicillin. Implant-failure analysis: overall RR = 0.53 (P = .005, 95% CI: 0.34-0.82) and overall NNT = 55 (95% CI, 33-167). Single-dose oral amoxicillin preoperatively (SDOAP) is beneficial (RR = 0.50, CI: 0.29-0.86. P = .012), when compared to postoperative oral amoxicillin (POA): RR = 0.60, CI: 0.28-1.30. P = .197. Postoperative-infection analysis: overall RR = 0.76 (P = 0.250, 95% CI: 0.47-1.22). Neither SDOAP (RR = 0.82, CI = 0.46-1.45, P = .488) nor POA (RR = 0.64, CI = 0.27-1.51, P = .309) are beneficial. I 2  = 0.0%, chi-squared tests P ≈ 1. Only SDOAP is effective and efficacious at preventing implant failures, but it was not significant for postoperative infections following dental implant surgeries. Copyright © 2018 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Endothelial dysfunction after non-cardiac surgery

DEFF Research Database (Denmark)

Søndergaard, E S; Fonnes, S; Gögenur, I

2015-01-01

was to systematically review the literature to evaluate the association between non-cardiac surgery and non-invasive markers of endothelial function. METHODS: A systematic search was conducted in MEDLINE, EMBASE and Cochrane Library Database according to the PRISMA guidelines. Endothelial dysfunction was described only...... transplantation and vascular surgery respectively) had an improvement in endothelial dysfunction 1 month after surgery. CONCLUSION: Endothelial function changes in relation to surgery. Assessment of endothelial function by non-invasive measures has the potential to guide clinicians in the prevention or treatment...

A Randomized Placebo-Controlled Trial of Oral Ramosetron for Prevention of Post Operative Nausea and Vomiting after Intrathecal Morphine in Patients Undergoing Gynecological Surgery.

Science.gov (United States)

Wangnamthip, Suratsawadee; Chinachoti, Thitima; Amornyotin, Somchai; Wongtangman, Karuna; Sukantarat, Numphung; Noitasaeng, Papiroon

2016-05-01

The incidence of postoperative nausea and vomiting (PONV) after intrathecal morphine is high. Ramosetron is a 5-HT₃ antagonist that has been shown to reduce PONV in general anesthesia. The objective of this study was to evaluate the efficacy of Ramosetron in preventing PONV MATERIAL AND METHOD: 165 patients undergoing elective gynecological surgery under spinal anesthesia were randomly allocated to two groups: the Ramosetron group (0.1 mg orally, n = 82), and the placebo group (oral corn starch, n = 83). The incidence of PONV severity of nausea and use of rescue antiemetic during the first 24 hour after surgery were evaluated. The incidence of PONV was significantly lower in the Ramosetron group compared with the placebo group (24.4% vs. 44.6%, number needed to treat (NNT) = 5.0). The severity of nausea was significantly lower in the Ramosetron group compared with the placebo group (20.7% vs. 39.8%, NNT = 6.0) in the 24 hour period. Oral Ramosetron 0.1 mg was more effective than placebo in PONV prevention and reduced the incidence of moderate to severe nausea after intrathecal morphine in the first 24 hour after gynecological surgery.

Effect-site concentration of remifentanil for preventing cough during emergence in elderly patients undergoing nasal surgery: a comparison with adult patients

Directory of Open Access Journals (Sweden)

Yoo JY

2016-09-01

Full Text Available Ji Young Yoo,1 Jong Yeop Kim,1 Hyun Jeong Kwak,2 Dong Chul Lee,2 Go Wun Kim,1 Sook Young Lee,1 Yun Jeong Chae1 1Department of Anaesthesiology and Pain Medicine, Ajou University School of Medicine, Suwon, 2Department of Anaesthesiology and Pain Medicine, Gachon University, Gil Medical Center, Incheon, Korea Purpose: Prevention of cough during emergence after nasal surgery is important for avoiding surgical site bleeding. We investigated the remifentanil effect-site concentration in 50% (EC50 of the elderly patients undergoing nasal surgery for smooth emergence without cough and compared it with that of adult patients.Methods: Twenty-two elderly (aged 65–80 years and 25 adult patients (aged 20–60 years with an American Society of Anesthesiologists physical status I/II undergoing nasal surgery were enrolled. Anesthesia was maintained with sevoflurane and remifentanil. Remifentanil EC50 and EC95 for preventing cough were determined using the modified Dixon’s up-and-down method and isotonic regression with bootstrapping approach. Recovery profiles were also recorded.Results: With Dixon’s up-and-down method, the EC50 of remifentanil in elderly patients (2.40±0.25 ng/mL was not significantly different from that of adults (2.33±0.30 ng/mL (P=0.687. With isotonic regression, the EC95 of remifentanil in elderly patients (3.32 [95% confidence interval: 3.06–3.38] ng/mL was not significantly different from that of adults (3.30 [95% confidence interval: 2.96–3.37] ng/mL. However, eye opening time (14.1±3.8 vs 12.0±2.9 seconds, extubation time (17.2±4.1 vs 14.0±3.0 seconds, and postanesthesia care unit duration (44.5±7.6 vs 38.7±3.4 minutes in elderly patients were significantly longer than those in adults (P<0.05.Conclusion: Remifentanil EC50 for preventing cough after nasal surgery with sevoflurane anesthesia did not differ between elderly and adult patients. However, delayed awakening and respiratory adverse events may warrant attention

Aids and Surgery

African Journals Online (AJOL)

user

2004-12-02

Dec 2, 2004 ... HIV/AIDS patients require surgery sometimes during their illness. The objective of the ... risks to surgical equipes and analysing preventive strategies to HIV ... of Atlanta, and after an assessment of the performance status and ...

The effect of education of nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery.

Science.gov (United States)

Seyhan Ak, Ezgi; Özbaş, Ayfer

2018-03-01

The aim of the study was to investigate the effect of educating nurses on preventing catheter-associated urinary tract infections in patients who undergo hip fracture surgery. Urinary tract infections after hip fracture surgery are observed at a rate of 12% to 61%, and the most important risk factor associated with urinary tract infection is considered to be the presence of urinary catheters. Nurse education about the use and management of urinary catheters is important to decrease the risk of urinary tract infections. The study was semi-experimental. The study was conducted in an orthopedics and traumatology clinic of a training hospital between January 2014-December 2015. After a power analysis was performed, a total of 60 patients fulfilled the criteria to be included in the study, with n = 30 in the pre-education group and n = 30 in the posteducation group. Nurses who worked in the orthopedics and traumatology clinic of the military hospital were the target population, and 18 nurses who consented to join the study constituted the sample. The "Patient Monitoring Form," "Nurse Information Form" and "Daily Urinary Catheter Assessment Tool" were used as data collection tools. The mean pre-education knowledge score of the nurses was found to be 68.05 ± 10.69, while the mean posteducation score was 95.13 ± 6.27. The mean catheter duration decreased from 11.06 ± 6.34 days-3.83 ± 0.95 days after the education. The catheter-associated urinary tract infection rate decreased by 9.37 per thousand. Educating nurses on preventing catheter-associated urinary tract infections in patients who underwent hip fracture surgery significantly decreased the rate of catheter-associated urinary tract infections and the duration of catheterisation. The systematic and comprehensive education of all healthcare professionals and the development and practice of catheter removal protocols could contribute to the prevention of catheter-associated urinary tract infections. �

The preoperative reaction and decision-making process regarding colostomy surgery among Chinese rectal cancer patients.

Science.gov (United States)

Zhang, Jun-E; Wong, Frances Kam Yuet; Zheng, Mei-Chun

2017-06-01

Patients with rectal cancer have issues in adjusting to their permanent colostomy after surgery, and support is required to help them resume normal life. However, few studies have explored the experience and factors that affect a patient's decision-making and maladjustment prior to colostomy surgery. The aim of this study was to explore the experience of rectal cancer patients who have to undergo colostomy surgery. A descriptive, qualitative design was used. We studied a purposive sample of 18 patients who had received a diagnosis of primary rectal cancer and were expecting permanent colostomy surgery. The thematic analysis approach was used to analyze the data collected using semi-structured, open-ended questions. The overriding theme that emerged was 'stoma dilemma: a hard decision-making process'. From this main theme, three themes were derived: the resistance stage, the hesitation stage, and the acquiescence stage. It is hard for preoperative rectal patients to choose to undergo stoma surgery or a sphincter-saving operation. From the initial stage of definitive diagnosis to the final consent to stoma surgery, most patients experience the resistance and hesitation stages before reaching the acquiescence stage. Arriving at a decision is a process that nurses can facilitate by eliminating unnecessary misunderstanding surrounding colostomy surgery and by fully respecting patients' right to choose at the various stages. Copyright © 2017 Elsevier Ltd. All rights reserved.

GENERAL SURGERY

African Journals Online (AJOL)

Schwab , using a three-phase approach.5 In 1998, Moore et al. extended the concept and described the five-stage approach.6. The aim of damage control surgery is to prevent severely injured patients from developing the “lethal triad” of hypothermia, coagulopathy and worsening acidosis, as this confers a dismal prognosis ...

Endocrine and Nutritional Management After Bariatric Surgery

Science.gov (United States)

... or treated? Preventing weight regain begins with realistic expectations about what bariatric surgery can do and what ... by dehydration. To prevent vomiting, you need to pay attention to signs of fullness, eat slowly, and ...

Prevention of visual field defects after macular hole surgery.

LENUS (Irish Health Repository)

Cullinane, A B

2012-02-03

BACKGROUND\\/AIM: The pathogenesis of visual field loss associated with macular hole surgery is uncertain but a number of explanations have been proposed, the most convincing of which is the effect of peeling of the posterior hyaloid, causing either direct damage to the nerve fibre layer or to its blood supply at the optic nerve head. The purpose of this preliminary prospective study was to determine the incidence of visual field defects following macular hole surgery in cases in which peeling of the posterior hyaloid was confined only to the area of the macula. METHODS: 102 consecutive eyes that had macular hole surgery had preoperative and postoperative visual field examination using a Humphrey\\'s perimeter. A comparison was made between two groups: I, those treated with vitrectomy with complete posterior cortical vitreous peeling; and II, those treated with a vitrectomy with peeling of the posterior hyaloid in the area of the macula but without attempting a complete posterior vitreous detachment. Specifically, no attempt was made to separate the posterior hyaloid from the optic nerve head. Eyes with stage II or III macular holes were operated. Autologous platelet concentrate and non-expansile gas tamponade was used. Patients were postured prone for 1 week. RESULTS: In group I, 22% of patients were found to have visual field defects. In group II, it was possible to separate the posterior hyaloid from the macula without stripping it from the optic nerve head and in these eyes no pattern of postoperative visual field loss emerged. There were no significant vision threatening complications in this group. The difference in the incidence of visual field loss between group I and group II was significant (p=0.02). The anatomical and visual success rates were comparable between both groups. CONCLUSION: The results from this preliminary study suggest that the complication of visual field loss after macular surgery may be reduced if peeling of the posterior hyaloid is

The Relationship Between the Status of Unnecessary Accommodations Being Made to Unconfirmed Food Allergy Students and the Presence or Absence of a Doctor’s Diagnosis

Directory of Open Access Journals (Sweden)

Yurika Ganaha

2015-06-01

Full Text Available The present study investigated the current state of unnecessary children food allergy accommodation and the medical efforts to confirm the existence of food allergies in school lunch service kitchens in Okinawa, Japan, including kitchens accommodating food allergy students by requiring medical documentation at the start and during provisions being made (Double Diagnosis, requiring medical documentation at the start only (Single Diagnosis, and with no medical documentation (Non-Diagnosis. Unnecessary accommodations are being made to unconfirmed food allergy students, wherein the more medical consultation was required, the lower the food allergy incident rate was and the more food allergens were diagnosed (Non-Diagnosis > Single Diagnosis > Double Diagnosis. This study suggests the possibility that unconfirmed food allergy students may be receiving unnecessary food allergy accommodations per school lunches, and the number of unnecessary food allergy provisions being made could be reduced by requiring medical documentation at the start and during these provisions.

Perioperative beta-blockers for preventing surgery-related mortality and morbidity.

Science.gov (United States)

Blessberger, Hermann; Kammler, Juergen; Domanovits, Hans; Schlager, Oliver; Wildner, Brigitte; Azar, Danyel; Schillinger, Martin; Wiesbauer, Franz; Steinwender, Clemens

2018-03-13

Randomized controlled trials have yielded conflicting results regarding the ability of beta-blockers to influence perioperative cardiovascular morbidity and mortality. Thus routine prescription of these drugs in unselected patients remains a controversial issue. The objective of this review was to systematically analyse the effects of perioperatively administered beta-blockers for prevention of surgery-related mortality and morbidity in patients undergoing any type of surgery while under general anaesthesia. We identified trials by searching the following databases from the date of their inception until June 2013: MEDLINE, Embase , the Cochrane Central Register of Controlled Trials (CENTRAL), Biosis Previews, CAB Abstracts, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Derwent Drug File, Science Citation Index Expanded, Life Sciences Collection, Global Health and PASCAL. In addition, we searched online resources to identify grey literature. We included randomized controlled trials if participants were randomly assigned to a beta-blocker group or a control group (standard care or placebo). Surgery (any type) had to be performed with all or at least a significant proportion of participants under general anaesthesia. Two review authors independently extracted data from all studies. In cases of disagreement, we reassessed the respective studies to reach consensus. We computed summary estimates in the absence of significant clinical heterogeneity. Risk ratios (RRs) were used for dichotomous outcomes, and mean differences (MDs) were used for continuous outcomes. We performed subgroup analyses for various potential effect modifiers. We included 88 randomized controlled trials with 19,161 participants. Six studies (7%) met the highest methodological quality criteria (studies with overall low risk of bias: adequate sequence generation, adequate allocation concealment, double/triple-blinded design with a placebo group, intention-to-treat analysis

Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: A randomized clinical trial.

Science.gov (United States)

Soltani, Ghasem; Jahanbakhsh, Saeed; Tashnizi, Mohammad Abbasi; Fathi, Mehdi; Amini, Shahram; Zirak, Nahid; Sheybani, Shima

2017-10-01

Arrhythmia occurring during and after surgery is one of the major complications in open-heart surgery. Dexmedetomidine is an intravenous alpha-2 agonist and very specific short-acting drug to protect the various organs against ischemic injuries and blood reflow. However, the effect of dexmedetomidine for preventing intraoperative heart arrhythmias has not been recognized. This study aimed to determine the effect of dexmedetomidine on the incidence rate of heart arrhythmias and anesthetic required in off-pump coronary artery bypass surgery. This randomized clinical trial was conducted on patients who were candidates for off-pump coronary artery bypass referring to Imam Reza Hospital of Mashhad, Iran, from July 2016 through January 2017. The patients were randomly assigned to two groups of intervention (infusion of 0.5 mcg/kg/h dexmedetomidine together with induction followed by infusion of 0.5 mcg/kg/h by the end of the surgery) or control (saline infusion). Mean arterial pressure (MAP) and heart rate (HR) were measured before induction, during surgery operation and ICU admission. Data were analyzed by SPSS version 18 using Chi Square and independent-samples t-test. A total of 76 patients with a mean age of 59.8 ± 8.2 years (in two groups of 38) were studied. The two groups had no statistically significant difference in terms of background variables. The MAP and HR values before induction, during surgery and ICU admission were significantly higher in the control group than in the intervention group (p=0.001). Out of the studied arrhythmias, the values of PAC (55.2% vs. 15.7%), PVC (81.5% vs. 21.0%), AF (26.3% vs. 7.8%), VTAC (21.0% vs. 2.6%) were significantly lower in dexmedetomidine group (p=0.001). It seems that dexmedetomidine administration during induction and surgery can cause significant reduction in most of the common arrhythmias in off-pump coronary bypass surgery. The use of dexmedetomidine maintains MAP and HR at significantly lower values, and changes

Ethical and legal issues in aesthetic surgery

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Suresh Gupta

2012-01-01

Full Text Available Rapid growth and expansion of plastic surgery in general and aesthetic surgery in particular in the past decade has brought in its wake some confusions particularly raising questions for the surgeons conduct towards his colleagues and the patients in the light of ethical requirements. Some thoughts from eminent thinkers form a backdrop to consideration of theories of medical ethics. In this article raging and continuous debates on these subjects have been avoided to maintain the momentum. Apart from the western thoughts, directions from our old scriptures on ethical conduct have been included to accommodate prevelant Indian practices. The confusion created by specialists advertising their abilities directly to the lay public following removal of ethical bars by the American Courts as also latitudes allowed by the General Medical Council of Great Britain have been discussed. The medical fraternity however has its reservations. Unnecessary skirmishes with the law arose in cosmetic surgery from the freedom exercised by the police to file criminal proceedings against attending doctors in the event of a patient′s death with or without any evidence of wrong doing. This has now been curtailed in the judgement of the Supreme Court of India[1] where norms have been laid down for such prosecution. This has helped doctors to function without fear of harassment. An effort has been made to state a simple day-to-day routine for an ethical doctor-patient relationship.

DOJ News Release: West Palm Beach Sellers of Unnecessary Septic Tank Products Plead Guilty to Wire Fraud

Science.gov (United States)

Moore, Nouerand and Lincoln, in concert with other employees of FBK Products, LLC., knowingly participated in a scheme to fraudulently market and sell an unnecessary and unneeded septic treatment product to residents of various states across the country.

Suture Granuloma Showing False-Positive Findings on FDG-PET

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Kohei Takahara

2013-01-01

Full Text Available We report a case of a 33-year-old male with a mixed germ-cell testicular tumor. Postoperative follow-up FDG-PET revealed concentration of FDG in the left inguinal area which is not tumor metastasis or local recurrence but suture reactivity granuloma. In this paper, we reviewed suture granulomas associated with false-positive findings on FDG-PET after surgery. If FDG-PET will be used more frequently in the future, it will be necessary to refrain from using silk thread in order to prevent any unnecessary surgery.

The HEART score is useful to predict cardiovascular risks and reduces unnecessary cardiac imaging in low-risk patients with acute chest pain.

Science.gov (United States)

Dai, Siping; Huang, Bo; Zou, Yunliang; Guo, Jianbin; Liu, Ziyong; Pi, Dangyu; Qiu, Yunhong; Xiao, Chun

2018-06-01

The present study was to investigate whether the HEART score can be used to evaluate cardiovascular risks and reduce unnecessary cardiac imaging in China.Acute coronary syndrome patients with the thrombosis in myocardial infarction risk score risk HEART score group and 2 patients (1.5%) in the high risk HEART score group had cardiovascular events. The sensitivity of HEART score to predict cardiovascular events was 100% and the specificity was 46.7%. The potential unnecessary cardiac testing was 46.3%. Cox proportional hazards regression analysis showed that per one category increase of the HEART score was associated with nearly 1.3-fold risk of cardiovascular events.In the low-risk acute chest pain patients, the HEART score is useful to physicians in evaluating the risk of cardiovascular events within the first 30 days. In addition, the HEART score is also useful in reducing the unnecessary cardiac imaging.

Recombinant activated factor VII in the treatment of bleeds and for the prevention of surgery-related bleeding in congenital haemophilia with inhibitors.

Science.gov (United States)

Santagostino, Elena; Escobar, Miguel; Ozelo, Margareth; Solimeno, Luigi; Arkhammar, Per; Lee, Hye Youn; Rosu, Gabriela; Giangrande, Paul

2015-06-01

The availability of recombinant activated factor VII (rFVIIa, eptacog alfa activated) has greatly advanced the care of patients with haemophilia A or B who have developed inhibitors against the infused replacement factor. Recombinant FVIIa is licensed for the on-demand treatment of bleeding episodes and the prevention of bleeding in surgery or invasive procedures in patients with congenital haemophilia with inhibitors. This article attempts to review in detail the extensive evidence of rFVIIa in congenital haemophilia patients with inhibitors. Patients with acute bleeding episodes are best treated on demand at home, to achieve the short- and long-term benefits of rapid bleed control. Key prospective studies have shown that rFVIIa achieves consistently high efficacy rates in the management of acute (including joint) bleeds in inhibitor patients in the home treatment setting. Substantial post-approval data from key registries also support the on-demand efficacy profile of rFVIIa established by the prospective clinical trials. The availability of rFVIIa has allowed major surgery to become a reality for inhibitor patients. Studies in key surgery, including orthopaedic procedures, have found that rFVIIa provides consistently high efficacy rates. Importantly, the wealth of data does not raise any unexpected safety concerns surrounding rFVIIa use; this is likely because rFVIIa is a recombinant product with a localised mechanism of action at the site of vascular injury. In summary, rFVIIa is established as an effective and well-tolerated first-line treatment for on-demand bleeding control and bleed prevention during minor and major (including elective orthopaedic) surgery in inhibitor patients. Use of rFVIIa has been a major step towards narrowing the gap in outcomes between inhibitor patients and non-inhibitor patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

What Can Computed Tomography Scans of the Thorax Show after Breast Surgery?

Directory of Open Access Journals (Sweden)

Afsaneh Alikhassi

2016-06-01

Full Text Available Background: Postoperative breast abnormalities after breast conserving surgery or modified radical mastectomy are frequently overlooked and inaccurately assessed or reported using multidetector computed tomography (MDCT. These inaccurate results may have legal ramifications for the clinicians, cause patients avoidable anxiety, and lead to additional unnecessary diagnostic follow-up testing and costs.Methods: The patients with a history of breast cancer who had undergone breast-conserving surgery or modified radical mastectomy up to 6 months prior to undergoing a thoracic MDCT scan consented and enrolled in this study. These patients underwent a thoracic MDCT scan either because of respiratory or cardiac clinical symptoms or as part of breast cancer staging.Results: Forty women were included in this study. Different postoperative breast changes observed on thoracic MDCT scans including fibrous scar tissue, fat necrosis, seroma, abscess, hematoma, and recurrent and residual tumor were described.Conclusions: MDCT scans offer sufficient evidence in many postoperative cases to allow a confident diagnosis. General radiologists who review thoracic MDCT scans should know how to characterize breast lesions incidentally found on MDCT scans after breast surgeries. This information would enhance the value of the radiologist’s report for appropriate case management.

Perioperative antibiotics for prevention of acute endophthalmitis after cataract surgery

Science.gov (United States)

Gower, Emily W; Lindsley, Kristina; Tulenko, Samantha E; Nanji, Afshan A; Leyngold, Ilya; McDonnell, Peter J

2017-01-01

antibiotics alone (risk ratio (RR) 0.33, 95% confidence interval (CI) 0.12 to 0.92 (periocular penicillin and topical chloramphenicol-sulfadimidine; 6618 participants; moderate-certainty evidence); and RR 0.20, 95% CI 0.04 to 0.91 (intracameral cefuroxime and topical levofloxacin; 8101 participants; high-certainty evidence)). One study, which compared fixed versus separate instillation of gatifloxacin and prednisolone, was not sufficiently powered to detect differences in endophthalmitis between groups (very low-certainty evidence). Another study found no evidence of a difference in endophthalmitis when comparing subconjunctival versus retrobulbar antibiotic injections (RR 0.85, 95% CI 0.55 to 1.32; 77,015 participants; moderate-certainty evidence). Two studies reported any visual acuity outcome; one study, which compared fixed versus separate instillation of gatifloxacin and prednisolone, reported only that mean visual acuity was the same for both groups at 20 days postoperation. In the other study, the difference in the proportion of eyes with final visual acuity greater than 20/40 following endophthalmitis between groups receiving intracameral cefuroxime with or without topical levofloxacin compared with no intracameral cefuroxime was uncertain (RR 0.69, 95% CI 0.22 to 2.11; 29 participants; moderate-certainty evidence). Only one study reported adverse events (1 of 129 eyes had pupillary membrane in front of the intraocular lens and 8 eyes showed posterior capsule opacity). No study reported outcomes related to quality of life or economic outcomes. Authors’ conclusions Multiple measures for preventing endophthalmitis following cataract surgery have been studied. High-certainty evidence shows that injection with cefuroxime with or without topical levofloxacin lowers the chance of endophthalmitis after surgery, and there is moderate-certainty evidence to suggest that using antibiotic eye drops in addition to antibiotic injection probably lowers the chance of

Radioimmunoguided surgery using the monoclonal antibody B72.3 in colorectal tumors

International Nuclear Information System (INIS)

Sickle-Santanello, B.J.; O'Dwyer, P.J.; Mojzisik, C.

1987-01-01

The authors have developed a hand-held gamma-detecting probe (GDP) for intraoperative use that improves the sensitivity of external radioimmunodetection. Radiolabeled monoclonal antibody (MAb) B72.3 was injected in six patients with primary colorectal cancer and 31 patients with recurrent colorectal cancer an average of 16 days preoperatively. The GDP localized the MAb B72.3 in 83 percent of sites. The technique, known as a radioimmunoguided surgery (RIGS) system did not alter the surgical procedure in patients with primary colorectal cancer but did alter the approach in 26 percent (8/31) of patients with recurrent colorectal cancer. Two patients avoided unnecessary liver resections and two underwent extraabdominal approaches to document their disease. The RIGS system may influence the short-term morbidity and mortality of surgery for colorectal cancer. Larger series and longer follow-up are needed to determine whether the RIGS system confers a survival advantage to the patient with colorectal cancer

RADIATION AND SURGERY

African Journals Online (AJOL)

Dr. S.A. Adewuyi

Radiation therapy and surgery in cancer management. 1S.A.Adewuyi,. 2 ... cancer, since axillary node status may determine whether or not a ... The principles are 'En-bloc' dissection which ... prevention of symptoms of cancer, including pain alleviation, and .... Pre-Operative And Post-Operative Radiotherapy: These terms ...

Predicting, preventing and managing persistent pain after breast cancer surgery:

DEFF Research Database (Denmark)

Schreiber, Kristin L; Kehlet, Henrik; Belfer, Inna

2014-01-01

Persistent pain after breast cancer surgery (PPBCS) is increasingly recognized as a potential problem facing a sizeable subset of the millions of women who undergo surgery as part of their treatment of breast cancer. Importantly, an increasing number of studies suggest that individual variation...... in psychosocial factors such as catastrophizing, anxiety, depression, somatization and sleep quality play an important role in shaping an individual's risk of developing PPBCS. This review presents evidence for the importance of these factors and puts them within the context of other surgical, medical...

Prevention and management of postoperative urinary retention after urogynecologic surgery

Directory of Open Access Journals (Sweden)

Geller EJ

2014-08-01

Full Text Available Elizabeth J Geller Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Abstract: Postoperative urinary retention (POUR is a frequent consequence of gynecologic surgery, especially with surgical correction of urinary incontinence and pelvic organ prolapse. Estimates of retention rates after pelvic surgery range from 2.5%–43%. While there is no standard definition for POUR, it is characterized by impaired bladder emptying, with an elevation in the volume of retained urine. The key to management of POUR is early identification. All patients undergoing pelvic surgery, especially for the correction of incontinence or prolapse, should have an assessment of voiding function prior to discharge. There are several ways to assess voiding function – the gold standard is by measuring a postvoid residual. Management of POUR is fairly straightforward. The goal is to decompress the bladder to avoid long-term damage to bladder integrity and function. The decision regarding when to discontinue catheter-assisted bladder drainage in the postoperative period can be assessed in an ongoing fashion by measurement of postvoid residual. The rate of prolonged POUR beyond 4 weeks is low, and therefore most retention can be expected to resolve spontaneously within 4–6 weeks. When POUR does not resolve spontaneously, more active management may be required. Techniques include urethral dilation, sling stretching, sling incision, partial sling resection, and urethrolysis. While some risk of POUR is inevitable, there are risk factors that are modifiable. Patients that are at higher risk – either due to the procedures being performed or their clinical risk factors – should be counseled regarding the risks and management options for POUR prior to their surgery. Although POUR is a serious condition that can have serious consequences if left untreated, it

Acute Gout Following Dermofasciectomy in a Patient With Dupuytren Disease.

Science.gov (United States)

Cochrane, Elliott; Harper, Rosalyn

2017-01-01

A 62-year-old man underwent uncomplicated dermofasciectomy of the right little finger. In the week after surgery, he presented with erythema, tenderness, reduced range of movement, and a chalklike discharge from the suture line. Investigations revealed a raised serum urate level accompanied with a borderline rise in inflammatory markers. A diagnosis of acute gout was made. The patient was managed with nonsteroidal anti-inflammatory drugs. Clinicians should consider the diagnosis of gout when patients present after surgery with redness, pain, and swelling and also consider measuring urate levels before surgery and initiating colchicine prophylaxis when there is a known diagnosis of gout before surgery. Accurate diagnosis may prevent unnecessary antibiotic use. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Curcumin attenuates surgery-induced cognitive dysfunction in aged mice.

Science.gov (United States)

Wu, Xiang; Chen, Huixin; Huang, Chunhui; Gu, Xinmei; Wang, Jialing; Xu, Dilin; Yu, Xin; Shuai, Chu; Chen, Liping; Li, Shun; Xu, Yiguo; Gao, Tao; Ye, Mingrui; Su, Wei; Liu, Haixiong; Zhang, Jinrong; Wang, Chuang; Chen, Junping; Wang, Qinwen; Cui, Wei

2017-06-01

Post-operative cognitive dysfunction (POCD) is associated with elderly patients undergoing surgery. However, pharmacological treatments for POCD are limited. In this study, we found that curcumin, an active compound derived from Curcuma longa, ameliorated the cognitive dysfunction following abdominal surgery in aged mice. Further, curcumin prevented surgery-induced anti-oxidant enzyme activity. Curcumin also increased brain-derived neurotrophic factor (BDNF)-positive area and expression of pAkt in the brain, suggesting that curcumin activated BDNF signaling in aged mice. Furthermore, curcumin neutralized cholinergic dysfunction involving choline acetyltransferase expression induced by surgery. These results strongly suggested that curcumin prevented cognitive impairments via multiple targets, possibly by increasing the activity of anti-oxidant enzymes, activation of BDNF signaling, and neutralization of cholinergic dysfunction, concurrently. Based on these novel findings, curcumin might be a potential agent in POCD prophylaxis and treatment.

The efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery. A double blind randomized multicentre trail with venographic assesment

DEFF Research Database (Denmark)

Bergkvist, A; Eldor, A; Thorlacius-Ussing, O.

1997-01-01

BACKGROUND: Surgery for malignant disease carries a high risk of deep vein thrombosis. The aim of this study was to evaluate the prophylactic effect of a low molecular weight heparin, enoxaparin, 40 mg once daily, beginning 2 h before surgery, compared with that of unfractionated low-dose heparin...... three times daily. METHODS: Patients included were over 40 years of age and undergoing planned elective curative abdominal or pelvic surgery for cancer. The study was designed as a prospective double-blind randomized multicentre trial with participating departments from ten countries. Primary outcome...... severe thrombocytopenia. There were no differences in mortality at either 30 days or 3 months. CONCLUSION: Enoxaparin, 40 mg once daily, is as safe and effective as unfractionated heparin three times daily in preventing venous thromboembolism in patients undergoing major elective surgery for abdominal...

Strategies for the management and prevention of complications in refractive laser surgery

NARCIS (Netherlands)

F. Hafezi (Farhad)

2008-01-01

textabstractObjective. Reoperations after refractive surgery have increased in frequency during the past 10 years. The spectrum of the indications for repeat LASIK may have changed. Methods. All cases of reoperations after refractive surgery performed between May 1, 2004 and April 30, 2005 at the

Perioperative Rosuvastatin in Cardiac Surgery.

Science.gov (United States)

Zheng, Zhe; Jayaram, Raja; Jiang, Lixin; Emberson, Jonathan; Zhao, Yan; Li, Qi; Du, Juan; Guarguagli, Silvia; Hill, Michael; Chen, Zhengming; Collins, Rory; Casadei, Barbara

2016-05-05

Complications after cardiac surgery are common and lead to substantial increases in morbidity and mortality. Meta-analyses of small randomized trials have suggested that perioperative statin therapy can prevent some of these complications. We randomly assigned 1922 patients in sinus rhythm who were scheduled for elective cardiac surgery to receive perioperative rosuvastatin (at a dose of 20 mg daily) or placebo. The primary outcomes were postoperative atrial fibrillation within 5 days after surgery, as assessed by Holter electrocardiographic monitoring, and myocardial injury within 120 hours after surgery, as assessed by serial measurements of the cardiac troponin I concentration. Secondary outcomes included major in-hospital adverse events, duration of stay in the hospital and intensive care unit, left ventricular and renal function, and blood biomarkers. The concentrations of low-density lipoprotein cholesterol and C-reactive protein after surgery were lower in patients assigned to rosuvastatin than in those assigned to placebo (PSTICS ClinicalTrials.gov number, NCT01573143.).

Does Prior Laparoscopic and Open Surgery Experience Have Any Impact on Learning Curve in Transition to Robotic Surgery?

Directory of Open Access Journals (Sweden)

Cüneyt Adayener

2016-12-01

Full Text Available It has been 15 years since the Food And Drug Administration approved the Da Vinci® robotic surgery system. Robotic applications are being used extensively in urology, particularly in radical prostatectomy. Like all high-tech products, this system also has a high cost and a steep learning curve, therefore, preventing it from becoming widespread. There are various studies on the effect of open surgery or laparoscopy experience on the learning curve of robotic surgery. Analyzing these interactions well will provide valuable information on making the training period of robotic system more efficient.

Intravitreal low molecular weight heparin in PVR surgery.

Directory of Open Access Journals (Sweden)

Kumar Atul

2003-01-01

Full Text Available Purpose: To evaluate the efficacy of low molecular weight heparin (LMWH in prevention of postoperative fibrin formation following vitreoretinal surgery with proliferative vitreoretinopathy (PVR. Material and Methods: Thirty consecutive patients of retinal detachment with advanced PVR were enrolled in the study. They were randomised to study and control groups (n = 15 each. Study group patients received vitreoretinal surgery with 5 IU/cc of LMWH in vitrectomy infusion fluid. The control group patients received vitroretinal surgery without heparin in the infusion fluid. Patients were followed up at 1 week, 1 month and 3 months after surgery. Postoperative bleeding, media clarity, best-corrected visual acuity and success of the surgery at the end of 3 months were compared between the two groups. Results: At each follow-up visit, the study group showed a better media clarity, which was statistically significant ( P = 0.0042. The study group had a 50% better chance of retinal reattachment compared to the control group. Five patients had intraoperative bleeding in the study group (33% compared to 3 patients in the control group (20%. Conclusion: Use of intravitreal LMWH prevents postoperative fibrin formation and is beneficial in repair of retinal detachments with PVR.

Radiology of pancreatic neoplasms: An update.

Science.gov (United States)

de la Santa, Luis Gijón; Retortillo, José Antonio Pérez; Miguel, Ainhoa Camarero; Klein, Lea Marie

2014-09-15

Diagnostic imaging is an important tool to evaluate pancreatic neoplasms. We describe the imaging features of pancreatic malignancies and their benign mimics. Accurate detection and staging are essential for ensuring appropriate selection of patients who will benefit from surgery and for preventing unnecessary surgeries in patients with unresectable disease. Ultrasound, multidetector computed tomography with multiplanar reconstruction and magnetic resonance imaging can help to do a correct diagnosis. Radiologists should be aware of the wide variety of anatomic variants and pathologic conditions that may mimic pancreatic neoplasms. The knowledge of the most important characteristic key findings may facilitate the right diagnosis.

Spontaneous hemorrhage simulating rapid growth of a benign subperiosteal plexiform neurofibroma

International Nuclear Information System (INIS)

Blitman, Netta M.; Levsky, Jeffrey M.; Thornhill, Beverly A.; Villanueva-Siles, Esperanza

2007-01-01

Spontaneous subperiosteal hemorrhage is a rare complication of von Recklinghausen's disease. There are few reports describing the MR imaging characteristics of this entity. Our case is unique among these as an underlying plexiform neurofibroma was visualized by MR imaging. We present a 12-year-old child with neurofibromatosis 1 who presented with a rapidly enlarging mass of the fibula. Surgery and pathology revealed subperiosteal hemorrhage into a benign, plexiform neurofibroma. The MR imaging features, pathogenesis and clinical implications of this entity are discussed. Recognition of this disease process and differentiating it from malignant transformation can prevent unnecessary surgery. (orig.)

Cell response to surgery.

LENUS (Irish Health Repository)

Ni Choileain, Niamh

2012-02-03

OBJECTIVES: To describe the profound alterations in host immunity that are produced by major surgery as demonstrated by experimental and clinical studies, and to evaluate the benefits of therapeutic strategies aimed at attenuating perioperative immune dysfunction. DATA SOURCES: A review of the English-language literature was conducted, incorporating searches of the MEDLINE, EMBASE, and Cochrane collaboration databases to identify laboratory and clinical studies investigating the cellular response to surgery. STUDY SELECTION: Original articles and case reports describing immune dysfunction secondary to surgical trauma were included. DATA EXTRACTION: The results were compiled to show outcomes of different studies and were compared. DATA SYNTHESIS: Current evidence indicates that the early systemic inflammatory response syndrome observed after major surgery that is characterized by proinflammatory cytokine release, microcirculatory disturbance, and cell-mediated immune dysfunction is followed by a compensatory anti-inflammatory response syndrome, which predisposes the patient to opportunistic infection, multiple organ dysfunction syndrome, and death. Because there are currently no effective treatment options for multiple organ dysfunction syndrome, measures to prevent its onset should be initiated at an early stage. Accumulating experimental evidence suggests that targeted therapeutic strategies involving immunomodulatory agents such as interferon gamma, granulocyte colony-stimulating factor, the prostaglandin E(2) antagonist, indomethacin, and pentoxifylline may be used for the treatment of systemic inflammatory response syndrome to prevent the onset of multiple organ dysfunction syndrome. CONCLUSIONS: Surgical trauma produces profound immunological dysfunction. Therapeutic strategies directed at restoring immune homeostasis should aim to redress the physiological proinflammatory-anti-inflammatory cell imbalance associated with major surgery.

Selective Use of Sentinel Lymph Node Surgery in Patients Undergoing Prophylactic Mastectomy Using Intraoperative Pathology.

Science.gov (United States)

Murphy, Brittany L; Glasgow, Amy E; Keeney, Gary L; Habermann, Elizabeth B; Boughey, Judy C

2017-10-01

Routine sentinel lymph node (SLN) surgery during prophylactic mastectomy (PM) is unnecessary, because most PMs do not contain cancer. Our institution utilizes intraoperative pathology to guide the surgical decision for resection of SLNs in PM. The purpose of this study was to review the effectiveness of this approach. We identified all women aged ≥18 years who underwent bilateral PM (BPM) or contralateral PM (CPM) at our institution from January 2008 to July 2016. We evaluated the frequency of SLN resection and rate of occult breast cancer (DCIS or invasive disease) in the PM. We used the following definitions: over-treatment-SLN surgery in patients without cancer; under-treatment-no SLN surgery in patients with cancer; appropriate treatment-no SLN in patients without cancer or SLN surgery in patients with cancer. PM was performed on 1900 breasts: 1410 (74.2%) CPMs and 490 (25.8%) BPMs. Cancer was identified in 58 (3.0%) cases (32 invasive disease and 26 DCIS) and concurrent SLN surgery was performed in 44 (75.9%) of those cases. Overall, SLN surgery guided by intraoperative pathology resulted in appropriate treatment of 1787 (94.1%) cases: 1319 (93.5%) CPMs and 468 (95.5%) BPMs, by avoiding SLN in 1743/1842 cases without cancer (94.6%), and performing SLN surgery in 44/58 cases with cancer (75.9%). Use of intraoperative pathology to direct SLN surgery in patients undergoing PM minimizes over-treatment from routine SLN in PM and minimizes under-treatment from avoiding SLN in PM, demonstrating the value of intraoperative pathology in this era of focus on appropriateness of care.

[Vitreoretinal outpatient surgery: clinical and financial considerations].

Science.gov (United States)

Creuzot-Garcher, C; Aubé, H; Candé, F; Dupont, G; Guillaubey, A; Malvitte, L; Arnavielle, S; Bron, A

2008-11-01

Vitreoretinal surgery has benefited from great advances opening the opportunity for outpatient management. We report on the 6-month experience of outpatient surgery for vitreoretinal diseases. From November 2007 to April 2008, 270 patients benefited from a vitreoretinal surgery, with 173 retinal detachments, 63 epiretinal membranes, and 34 other procedures. Only 8.5% (n=23) of the patients had to stay at the hospital one or two nights. The main reasons were the distance from the hospital and surgery on a single-eye patient. The questionnaire given after the surgery showed that almost all the patients were satisfied with the outpatient setting. In contrast, the financial results showed a loss of income of around 400,000 euros due to the low level of payment of outpatient surgery in France by the national health insurance system. Vitreoretinal surgery can be achieved in outpatient surgery with an improvement in the information given to the patients and the overall organization of the hospitalization. However, the current income provided with vitreoretinal outpatient surgery is highly disadvantageous in France, preventing this method from being generalized.

Delivery of antifibroblast agents as adjuncts to filtration surgery. Part I--Periocular clearance of cobalt-57 bleomycin in experimental drug delivery: pilot study in the rabbit

Energy Technology Data Exchange (ETDEWEB)

Kay, J.S.; Litin, B.S.; Woolfenden, J.M.; Chvapil, M.; Herschler, J.

1986-10-01

Antitumor and antifibroblast agents show promise as adjuncts after glaucoma filtration surgery in reducing postoperative scarring and failure. We used nuclear imaging in rabbits to investigate periocular clearance of one such agent (/sup 57/Co-bleomycin). Sub-Tenon injection was compared to other delivery techniques. Our results showed that a collagen sponge and a silastic disc implant with a microhole prolonged drug delivery when compared to sub-Tenon injection alone or injection with a viscosity enhancing agent (0.5% sodium hyaluronate). We theorize that if an antifibroblast agent can be delivered in small and sustained amounts after filtration surgery, this may prolong bleb longevity and avoid unnecessary drug toxicity.

Delivery of antifibroblast agents as adjuncts to filtration surgery. Part I--Periocular clearance of cobalt-57 bleomycin in experimental drug delivery: pilot study in the rabbit

International Nuclear Information System (INIS)

Kay, J.S.; Litin, B.S.; Woolfenden, J.M.; Chvapil, M.; Herschler, J.

1986-01-01

Antitumor and antifibroblast agents show promise as adjuncts after glaucoma filtration surgery in reducing postoperative scarring and failure. We used nuclear imaging in rabbits to investigate periocular clearance of one such agent ( 57 Co-bleomycin). Sub-Tenon injection was compared to other delivery techniques. Our results showed that a collagen sponge and a silastic disc implant with a microhole prolonged drug delivery when compared to sub-Tenon injection alone or injection with a viscosity enhancing agent (0.5% sodium hyaluronate). We theorize that if an antifibroblast agent can be delivered in small and sustained amounts after filtration surgery, this may prolong bleb longevity and avoid unnecessary drug toxicity

One-Day Use of Preoperative Topical Nonsteroidal Anti-Inflammatory Drug Prevents Intraoperative Prostaglandin Level Elevation During Femtosecond Laser-Assisted Cataract Surgery.

Science.gov (United States)

Kiss, Huba J; Takacs, Agnes I; Kranitz, Kinga; Sandor, Gabor L; Toth, Gabor; Gilanyi, Beatrix; Nagy, Zoltan Z

2016-08-01

To determine if pretreatment with topical nonsteroidal anti-inflammatory drug (NSAID) prior to femtosecond laser-assisted cataract surgery (FLACS) prevents intraoperative prostaglandin level elevation as a potential risk factor of postoperative complications. Thirty-six patients with clinically significant cataract and without any concomitant general or ophthalmic disease were enrolled into the three age-matched groups of the study. The mean age of the patients was 62.3 ± 13.1 years. The first group of patients underwent traditional phacoemulsification (Control group), on the second group of patients FLACS was performed, and the third group of patients received topical 0.1% nepafenac pretreatment for 1one day prior to FLACS. Before the phacoemulsification part of the cataract surgery, approximately 110 µL of aqueous humor was collected in all groups. Total prostaglandin concentrations of the collected aqueous humor samples were evaluated by enzyme immunoassay (EIA). The mean of the total prostaglandin concentrations of the aqueous humor samples was 208.8 ± 140.5 pg/mL in patients in the control group, 1449.1 ± 1019.7 pg/mL in the FLACS group (p > 0.001), and 92.2 ± 51.7 pg/mL in the group pretreated with topical NSAID before the FLACS (p > 0.001 compared to FLACS; p > 0.01 compared to control), respectively. FLACS surgery increases intracameral prostaglandin concentration. However, using preoperative 1-day-long nonsteroid anti-inflammatory drops prior to FLACS, this intraoperative increase diminishes. Our study raises the possibility that NSAID pretreatment may be routinely administered before FLACS cataract surgeries to achieve a further decrease in the potential complications of increased total prostaglandin concentration during FLACS surgeries.

Glycopeptides versus β-lactams for the prevention of surgical site infections in cardiovascular and orthopedic surgery: a meta-analysis.

Science.gov (United States)

Saleh, Anas; Khanna, Ashish; Chagin, Kevin M; Klika, Alison K; Johnston, Douglas; Barsoum, Wael K

2015-01-01

To compare the efficacy of glycopeptides and β-lactams in preventing surgical site infections (SSIs) in cardiac, vascular, and orthopedic surgery. The cost-effectiveness of switching from β-lactams to glycopeptides for preoperative antibiotic prophylaxis has been controversial. β-Lactams are generally recommended in clean surgical procedures, but they are ineffective against resistant gram-positive bacteria. PubMed, International Pharmaceuticals Abstracts, Scopus, and Cochrane were searched for randomized clinical trials comparing glycopeptides and β-lactams for prophylaxis in adults undergoing cardiac, vascular, or orthopedic surgery. Abstracts and conference proceedings were included. Two independent reviewers performed study selection, data extraction, and assessment of risk of bias. Fourteen studies with a total of 8952 patients were analyzed. No difference was detected in overall SSIs between antibiotic types. However, compared with β-lactams, glycopeptides reduced the risk of resistant staphylococcal SSIs by 48% (relative risk, 0.52; 95% confidence interval, 0.29-0.93; P = 0.03) and enterococcal SSIs by 64% (relative risk, 0.36; 95% confidence interval, 0.16-0.80; P = 0.01), but increased respiratory tract infections by 54% (relative risk, 1.54; 95% confidence interval, 1.19-2.01; P ≤ 0.01). Subgroup analysis of cardiac procedures showed superiority of β-lactams in preventing superficial and deep chest SSIs, susceptible staphylococcal SSIs, and respiratory tract infections. Glycopeptides reduce the risk of resistant staphylococcal SSIs and enterococcal SSIs, but increase the risk of respiratory tract infections. Additional high-quality randomized clinical trials are needed as these results are limited by high risk of bias.

Reduction in Unnecessary Clinical Laboratory Testing Through Utilization Management at a US Government Veterans Affairs Hospital.

Science.gov (United States)

Konger, Raymond L; Ndekwe, Paul; Jones, Genea; Schmidt, Ronald P; Trey, Marty; Baty, Eric J; Wilhite, Denise; Munshi, Imtiaz A; Sutter, Bradley M; Rao, Maddamsetti; Bashir, Chowdry M

2016-03-01

To implement an electronic laboratory utilization management system (laboratory expert system [LES]) to provide safe and effective reductions in unnecessary clinical laboratory testing. The LES is a set of frequency filter subroutines within the Veterans Affairs hospital and laboratory information system that was formulated by an interdisciplinary medical team. Since implementing the LES, total test volume has decreased by a mean of 11.18% per year compared with our pre-LES test volume. This change was not attributable to fluctuations in outpatient visits or inpatient days of care. Laboratory cost savings were estimated at $151,184 and $163,751 for 2012 and 2013, respectively. A significant portion of these cost savings was attributable to reductions in high-volume, large panel testing. No adverse effects on patient care were reported, and mean length of stay for patients remained unchanged. Electronic laboratory utilization systems can effectively reduce unnecessary laboratory testing without compromising patient care. Published by Oxford University Press on behalf of the American Society for Clinical Pathology, 2016. This work is written by US Government employees and is in the public domain in the US.

Granisetron versus Granisetron-Dexamethasone for Prevention of Postoperative Nausea and Vomiting in Pediatric Strabismus Surgery: A Randomized Double-Blind Trial

Directory of Open Access Journals (Sweden)

Renu Sinha

2016-01-01

Full Text Available Aim. Efficacy of granisetron and combination of granisetron and dexamethasone was evaluated for prevention of postoperative nausea and vomiting (PONV in children undergoing elective strabismus surgery. Methods. A total of 136 children (1–15 years were included. Children received either granisetron (40 mcg/kg [group G] or combination of granisetron (40 mcg/kg and dexamethasone (150 mcg/kg [group GD]. Intraoperative fentanyl requirement and incidence and severity of oculocardiac reflex were assessed. PONV severity was assessed for first 24 hours and if score was >2, it was treated with metoclopramide. Postoperative analgesia was administered with intravenous fentanyl and ibuprofen. Results. The demographic profile, muscles operated, and fentanyl requirement were comparable. Complete response to PONV in first 24 hours was observed in 75% (51/68 of children in group G and 76.9% (50/65 of children in group GD, which was comparable statistically (p=0.96, Fisher exact test; OR 1.11, 95% CI 0.50, 2.46. Incidence of PONV between 0 and 24 hours was comparable. One child in group G required rescue antiemetic in first 24 hours and none of the children had severe PONV in group GD. There was no significant difference in incidence or severity of oculocardiac reflex. Conclusion. Dexamethasone did not increase efficacy of granisetron for prevention of PONV in elective pediatric strabismus surgery. Registration number of clinical trial was CTRI/2009/091/001000.

Catheter Associated Urinary Tract Infection Prevention bundle

Directory of Open Access Journals (Sweden)

O. Zarkotou

2017-01-01

Full Text Available Catheter-associated urinary tract infections (CAUTI are among the most common healthcare-associated infections, and potentially lead to significant morbidity and mortality. Multifaceted infection control strategies implemented as bundles can prevent nosocomial infections associated with invasive devices such as CAUTIs. The components of the CAUTI bundle proposed herein, include appropriate indications for catheterization and recommendations for the procedures of catheter insertion and catheter maintenance and care. Avoiding unnecessary urinary catheter use is the most effective measure for their prevention. To minimize the risk of CAUTI, urinary catheters should be placed only when a clinical valid indication is documented and they should be removed as soon as possible; alternatives to catheterization should also be considered. Aseptic insertion technique, maintenance of closed drainage system and strict adherence to hand hygiene are essential for preventing CAUTI. The successful implementation of the bundle requires education and training for all healthcare professionals and evaluation of surveillance data.

Bowel injury following gynecological laparoscopic surgery.

African Journals Online (AJOL)

Keywords: Laparoscopy, gynaecology, injury, bowel, prevention, treatment. ... cluding less post-operative pain, earlier return of normal bowel function, shorter hospital ... and presence of previous abdominal surgery increase the risk of bowel ...

The Longitudinal Trend of Cardiac Surgery in Korea from 2003 to 2013

Directory of Open Access Journals (Sweden)

Kyeong Soo Lee

2016-12-01

Full Text Available Background: The purpose of this study was to investigate longitudinal changes of the utilization of operational and surgical medical care inside and outside a metropolitan area over 10 years, analyzing the residential areas of patients and the locations of medical facilities for major cardiovascular surgery. Methods: Data analysis was conducted by classifying the addresses of patients and the locations of medical care facilities of metropolitan cities and provinces, using data from the National Health Insurance Corporation from January 2003 to December 2013. Results: There is serious concentration of major heart surgery to medical facilities in Seoul; this problem has not improved over time. There were differences in percentages of surgical procedures performed in the metropolitan areas according to major diseases. In the case of Busan and Daegu provinces, at least 50% of the patients underwent surgery in medical facilities in the city, but there are other regions where the percentage is less than 50%. In the case of provinces, the percentage of surgical procedures performed in medical facilities in Seoul or nearby metropolitan cities is very high. Conclusion: Policies to strengthen the regional capabilities of heart surgery and to secure human resources are required to mitigate the concentration of patients in the capital area. Many regional multi-centers must be designated to minimize unnecessary competition among regional university hospitals and activate a win-win partnership model for medical services.

Comparison of palonosetron, granisetron, and ramosetron for the prevention of postoperative nausea and vomiting after laparoscopic gynecologic surgery: a prospective randomized trial.

Science.gov (United States)

Lee, Won-Suk; Lee, Kwang-Beom; Lim, Soyi; Chang, Young Gin

2015-09-03

Selective 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists are reported to have potent antiemetic effects for postoperative nausea and vomiting (PONV). The purpose of this study was to prospectively evaluate the efficacy of palonosetron, granisetron, and ramosetron for the prevention of PONV in patients undergoing laparoscopic gynecologic surgery. In this prospective, randomized observational study, 105 healthy female patients who were undergoing laparocopic hystectomy under general anaesthesia were enrolled (clinical trial number: NCT01752374, www.clinicaltrials.gov ). Patients were divided into three groups: the palonostron (0.075 mg i.v.; n = 35), the granisetron group (3 mg i.v.; n = 35), and the ramosetron group (0.3 mg i.v.; n = 35). The treatments were given before the end of surgery. The incidence of PONV, severity of nausea/vomiting, and the use of rescue antiemetic requirements during the first 48 h after surgery were evaluated. The overall incidence of PONV was 33.3 % for this series. The number of complete responders at 48 h after the surgery was 21 (60.0 %) for palonosetron, 24 (68.6 %) for granisetron, and 26 (71.4 %) for ramosetron, representing no statistical difference (P = 0.086). There were no significant differences in the overall incidence of postoperative nausea and vomiting and complete responders for palonosetron, granisetron and ramosetron group. NCT01752374 , www.clinicaltrials.gov .

Combination of gabapentin and ramosetron for the prevention of postoperative nausea and vomiting after gynecologic laparoscopic surgery: a prospective randomized comparative study.

Science.gov (United States)

Kim, Kyung Mi; Huh, Jin; Lee, Soo Kyung; Park, Eun Young; Lee, Jung Min; Kim, Hyo Ju

2017-05-19

As a drug originally introduced for its anticonvulsant effects, gabapentin has been recently shown to be effective in the treatment of nausea and vomiting in various clinical settings. This study compared the antiemetic efficacy of oral gabapentin, intravenous ramosetron and gabapentin plus ramosetron in patients receiving fentanyl-based patient-controlled analgesia after laparoscopic gynecologic surgery. One hundred and thirty two patients undergoing laparoscopic gynecologic surgery under general anesthesia were allocated randomly into three groups: group G received 300 mg oral gabapentin 1 h before anesthesia, group R received 0.3 mg intravenous ramosetron at the end of surgery, and group GR received a combination of 300 mg oral gabapentin 1 h before anesthesia and 0.3 mg intravenous ramosetron at the end of surgery. Postoperative nausea, retching, vomiting, rescue antiemetic drug use, pain, rescue analgesic requirements and adverse effects were assessed at 0-2, 2-24 and 24-48 h after surgery. Postoperative nausea and vomiting (PONV) was defined as the presence of nausea, retching or vomiting. The incidence of complete response (no PONV and no rescue antiemetics up to 48 h postoperatively) was significantly higher in group GR (26/40, 65%) than group G (16/40, 40%; P = 0.025) and group R (18/44, 41%; P = 0.027), whereas there was no significant difference between group G and group R (P = 0.932). There were no significant between-group differences in the incidence of emetic episodes, use of rescue antiemetics, severe emesis, use of rescue analgesics or any adverse effects. Postoperative pain scores were also similar among groups. The combination with gabapentin and ramosetron is superior to either drug alone for prevention of PONV after laparoscopic gynecologic surgery. ClinicalTrials.gov NCT02617121 , registered November 25, 2015.

Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

Science.gov (United States)

Boulin, Mathieu; Diaby, Vakaramoko; Tannenbaum, Cara

2016-01-01

The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes. An economic (decision-tree) analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services) and Canadian public health payer perspectives were adopted. Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada. Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

Anterior segment surgery IOLs, lasers, and refractive keratoplasty

Energy Technology Data Exchange (ETDEWEB)

Stark, W.J.; Terry, A.C.; Maumenee, A.E.

1987-01-01

The contributors to this text combine their expertise to make this book available on intraocular lenses, refractive corneal surgery, and the use of the YAG laser. Included is information on; IOL power calculations; the use of the YAG laser; retinal damage by short wavelength light; reviews of corneal refractive surgery; possibilities for the medical prevention of cataracts; and more.

Bariatric surgery in obese adolescents: opportunities and challenges.

Science.gov (United States)

Wasserman, Halley; Inge, Thomas H

2014-09-01

Extreme obesity is defined by the Centers for Disease Control and Prevention as a body mass index (BMI) higher than 120% of the 95th percentile for age. Four to six percent of American youths fall into this subcategory and are at increased risk for developing comorbidities, including hypertension, dyslipidemia, nonalcoholic fatty liver disease, insulin resistance, sleep apnea, and bone and joint problems. Many studies have shown that nonsurgical treatment programs do not provide significant long-term improvements in BMI in adolescents with severe obesity. In adults, bariatric (weight loss) surgery has been shown to dramatically reduce BMI and to reverse or prevent many complications of obesity; thus, bariatric surgery is being used in an attempt to reverse clinically severe obesity in adolescents. This review highlights the indications for bariatric surgery in adolescents and outlines practice guidelines for adolescent surgical weight loss programs. The authors summarize available data on the effects of adolescent weight loss surgery on metabolic comorbidities and highlight the important acute and long-term complications that must be monitored by their general pediatricians. After reading this article, the general pediatrician should be able to identify adolescents who may be candidates for weight loss surgery and have the knowledge to assist in their postoperative medical management. Copyright 2014, SLACK Incorporated.

Metabolic response to surgery in the cancer patient

International Nuclear Information System (INIS)

Brennan, M.F.

1979-01-01

The metabolic response to uncomplicated surgery in the patient undergoing primary therapy for malignancy is no different than the response to surgery of similar magnitude for benign disease. Hemodynamic, nutritional-endocrine, and convalescent changes are similar. However, with current aggressive approaches to the management of cancer, the patient often comes to surgery with evidence of major debilitating side effects from his progressive malignancy or from aggressive multimodality therapy. The surgeon must be aware of the consequences of the use of combination therapies on the expected metabolic response to surgery. Awareness of such problems such as the nutritional deficit will allow preventive methods to supercede mtabolic salvage procedures

Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery: A multicenter case-control study with propensity score matching analysis.

Science.gov (United States)

Soutome, Sakiko; Yanamoto, Souichi; Funahara, Madoka; Hasegawa, Takumi; Komori, Takahide; Yamada, Shin-Ichi; Kurita, Hiroshi; Yamauchi, Chika; Shibuya, Yasuyuki; Kojima, Yuka; Nakahara, Hirokazu; Oho, Takahiko; Umeda, Masahiro

2017-08-01

The aim of this study was to investigate the effectiveness of oral care in prevention of postoperative pneumonia associated with esophageal cancer surgery.Postoperative pneumonia is a severe adverse event associated with esophageal cancer surgery. It is thought to be caused by aspiration of oropharyngeal fluid containing pathogens. However, the relationship between oral health status and postoperative pneumonia has not been well investigated.This study included 539 patients with esophageal cancer undergoing surgery at 1 of 7 university hospitals. While 306 patients received perioperative oral care, 233 did not. Various clinical factors as well as occurrence of postoperative pneumonia were retrospectively evaluated. Propensity-score matching was performed to minimize selection biases associated with comparison of retrospective data between the oral care and control groups. Factors related to postoperative pneumonia were analyzed by logistic regression analysis.Of the original 539 patients, 103 (19.1%) experienced postoperative pneumonia. The results of multivariate analysis of the 420 propensity score-matched patients revealed longer operation time, postoperative dysphagia, and lack of oral care intervention to be significantly correlated with postoperative pneumonia.The present findings demonstrate that perioperative oral care can reduce the risk of postoperative pneumonia in patients undergoing esophageal cancer surgery.

[Prevention, diagnosis and treatment of perioperative complications of bariatric and metabolic surgery].

Science.gov (United States)

Wu, Haifu; Zhong, Ming; Zhou, Di; Shi, Chenye; Jiao, Heng; Wu, Wei; Chang, Xinxia; Cang, Jing; Bian, Hua

2017-04-25

Surgical operation in treating obesity and type 2 diabetes is popularizing rapidly in China. Correct prevention and recognition of perioperation-related operative complications is the premise of ensuring surgical safety. Familiar complications of the operation include deep venous thrombosis, pulmonary artery embolism, anastomotic bleeding, anastomotic fistula and marginal ulcer. The prevention of deep venous thrombosis is better than treatment. The concrete measures contain physical prophylaxis (graduated compression stocking and intermittent pneumatic compression leg sleeves) and drug prophylaxis (unfractionated heparin and low molecular heparin), and the treatment is mainly thrombolysis or operative thrombectomy. The treatment of pulmonary artery embolism includes remittance of pulmonary arterial hypertension, anticoagulation, thrombolysis, operative thrombectomy, interventional therapy and extracorporeal membrane oxygenation (ECMO). Hemorrhage is a rarely occurred but relatively serious complication after bariatric surgery. The primary cause of anastomotic bleeding after laparoscopic gastric bypass is incomplete hemostasis or weak laparoscopic repair. The common bleeding site in laparoscopic sleeve gastrectomy is gastric stump and close to partes pylorica, and the bleeding may be induced by malformation and weak repair technique. Patients with hemodynamic instability caused by active bleeding or excessive bleeding should timely received surgical treatment. Anastomotic fistula in gastric bypass can be divided into gastrointestinal anastomotic fistula and jejunum-jejunum anastomotic fistula. The treatment of postoperative anastomotic fistula should vary with each individual, and conservative treatment or operative treatment should be adopted. Anastomotic stenosis is mainly related to the operative techniques. Stenosis after sleeve gastrectomy often occurs in gastric angle, and the treatment methods include balloon dilatation and stent implantation, and surgical

Validation of ergonomic instructions in robot-assisted surgery simulator training.

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Van't Hullenaar, C D P; Mertens, A C; Ruurda, J P; Broeders, I A M J

2018-05-01

Training in robot-assisted surgery focusses mainly on technical skills and instrument use. Training in optimal ergonomics during robotic surgery is often lacking, while improved ergonomics can be one of the key advantages of robot-assisted surgery. Therefore, the aim of this study was to assess whether a brief explanation on ergonomics of the console can improve body posture and performance. A comparative study was performed with 26 surgical interns and residents using the da Vinci skills simulator (Intuitive Surgical, Sunnyvale, CA). The intervention group received a compact instruction on ergonomic settings and coaching on clutch usage, while the control group received standard instructions for usage of the system. Participants performed two sets of five exercises. Analysis was performed on ergonomic score (RULA) and performance scores provided by the simulator. Mental and physical load scores (NASA-TLX and LED score) were also registered. The intervention group performed better in the clutch-oriented exercises, displaying less unnecessary movement and smaller deviation from the neutral position of the hands. The intervention group also scored significantly better on the RULA ergonomic score in both the exercises. No differences in overall performance scores and subjective scores were detected. The benefits of a brief instruction on ergonomics for novices are clear in this study. A single session of coaching and instruction leads to better ergonomic scores. The control group showed often inadequate ergonomic scores. No significant differences were found regarding physical discomfort, mental task load and overall performance scores.

Bariatric Surgery and Stone Disease

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Lieske, John C.; Kumar, Rajiv

2008-09-01

Bariatric surgery is an effective treatment strategy for patients with morbid obesity that can result in effective weight loss, resolution of diabetes mellitus and other weight related complications, and even improved mortality. However, it also appears that hyperoxaluria is common after modern bariatric surgery, perhaps occurring in up to 50% of patients after Rouxen-Y gastric bypass. Although increasing numbers of patients are being seen with calcium oxalate kidney stones after bariatric surgery, and even a few with oxalosis and renal failure, the true risk of these outcomes remains unknown. The mechanisms that contribute to this enteric hyperoxaluria are also incompletely defined, although fat malabsorption may be an important component. Since increasing numbers of these procedures are likely to be performed in the coming years, further study regarding the prevalence and mechanisms of hyperoxaluria and kidney stones after bariatric surgery is needed to devise effective methods of treatment in order to prevent such complications.

Irrigation port hydration in phacoemulsification surgery

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Suzuki H

2018-01-01

Full Text Available Hisaharu Suzuki,1 Yoichiro Masuda,2 Yuki Hamajima,1 Hiroshi Takahashi3 1Department of Ophthalmology, Nippon Medical School Musashikosugi Hospital, Kawasaki City, Kanagawa, 2Department of Ophthalmology, The Jikei University, Katsushika Medical Center, Tokyo, 3Department of Ophthalmology, Nippon Medical School, Tokyo, Japan Background: In most cases, hydration is performed by water injection into the stromal tissue with a needle. The technique is simple, however it is sometimes troublesome.Purpose: We describe a simple technique for hydrating the corneal stroma in cataract surgery using an irrigation port.Patients and methods: The technique began by pushing the irrigation port against the corneal stroma for a few seconds during phacoemulsification, which generated edema in the corneal incision that subsequently prevented leakage. This procedure is called the hydration using irrigation port (HYUIP technique. A total of 60 eyes were randomized and placed in two groups, 30 eyes underwent surgeries using the HYUIP technique (HYUIP group and 30 eyes underwent surgeries without the HYUIP technique (control. The three points evaluated during each surgery included 1 the occurrence of anterior chamber collapse during the pulling out of the I/A tip after inserting the intraocular lens, 2 the need for conventional hydration, and 3 watertight completion at the end stage of surgery.Results: The anterior chamber collapse and the need for conventional hydration were significantly smaller in the HYUIP group compared to the control group. Regarding the self-sealing completion, no significant difference was observed between the two groups.Conclusion: The HYUIP technique is an effective method for creating self-sealing wound. In addition, this technique helps to prevent anterior chamber collapse. Keywords: cataract surgery, hydration, irrigation and aspiration, phacoemulsification, wound, self-sealing 

Radiation induced cancer: risk assessment and prevention

International Nuclear Information System (INIS)

Shore, R.E.

1984-01-01

A number of factors have to be considered in defining the cancer risk from ionizing radiation. These include the radiation sensitivity of the target tissue(s), the temporal pattern of risk, the shape of the dose-incidence curve, the effects of low dose rates, host susceptibility factors, and synergism with other environmental exposures. For the population as a whole the largest sources of radiation exposure are natural background radiation and medical/dental radiation. Radiation exposures in the medical field make up the largest volume of occupational exposures as well. Although new technologies offer opportunities to lower exposures, worker training, careful exposure monitoring with remedial feedback, and monitoring to prevent unnecessary radiodiagnostic procedures may be even more important means of reducing radiation exposure. Screening of irradiated populations can serve a useful preventive function, but only for those who have received very high doses

Preventing Unnecessary Costs of Drug-Induced Hypoglycemia in Older Adults with Type 2 Diabetes in the United States and Canada.

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Mathieu Boulin

Full Text Available The costs of drug-induced hypoglycemia are a critical but often neglected component of value-based arguments to reduce tight glycemic control in older adults with type 2 diabetes.An economic (decision-tree analysis compared rates, costs, quality-adjusted life-years, and incremental costs per quality-adjusted life-year gained associated with mild, moderate and severe hypoglycemic events for 6 glucose-lowering medication classes in type 2 diabetic adults aged 65-79 versus those 80 years and older. The national U.S. (Center for Medicare Services and Canadian public health payer perspectives were adopted.Incidence rates of drug-induced hypoglycemia were the highest for basal insulin and sulfonylureas: 8.64 and 4.32 events per person-year in 65-79 year olds, and 12.06 and 6.03 events per person-year for 80 years and older. In both the U.S. and Canada, metformin dominated sulfonylureas, basal insulin and glucagon-like peptide1 receptor agonists. Relative to sulfonylureas, thiazolidinediones had the lowest incremental cost-effectiveness ratios in the U.S. and dominated sulfonylureas in Canada for adults 80 years and older. Relative to sulfonylureas, dipeptidyl peptidase4 inhibitors were cost-effective for adults 80 years and older in both countries, and for 65-79 year olds in Canada. Annual costs of hypoglycemia for older adults attaining very tight glycemic control with the use of insulin or sulfonylureas were estimated at U.S.$509,214,473 in the U.S. and CAN$65,497,849 in Canada.Optimizing drug therapy for older type 2 diabetic adults through the avoidance of drug-induced hypoglycemia will dramatically improve patient health while also generating millions of dollars by saving unnecessary medical costs.

Venous thromboembolism prevention in gynecologic cancer surgery: a systematic review.

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Einstein, M Heather; Pritts, Elizabeth A; Hartenbach, Ellen M

2007-06-01

Advanced age, pelvic surgery, and the presence of malignancy place gynecologic oncology patients at high risk for venous thromboembolism (VTE). This study was designed to systematically analyze the world's literature on VTE in these patients and determine the optimal prophylaxis regimen. Computerized searches of Pubmed, Ovid, DARE, ACP Journal Club, Cochrane Database of Systematic Reviews, and Cochrane Controlled Trials Registry 1966-2005 were performed, as well as EMBASE 1980-2005. Major conferences and target references were hand-searched. Inclusion criteria were randomized controlled trials (RCTs) evaluating VTE prophylaxis with heparin, low-molecular-weight heparin (LMWH), and sequential compression devices (SCD). The search yielded 278 articles; 11 met inclusion criteria. Data were abstracted by one author and analyzed with the Mantel-Haenszel method. The analysis of heparin-versus-control revealed a significant decrease in DVT in patients receiving heparin (RR=0.58, 95% CI 0.35-0.95). There were no significant differences in EBL or transfusions between the two groups. In the 320 patients in the heparin vs. LMWH studies, there was no significant difference in DVT (RR 0.91, 95% CI 0.38-2.17), although power analysis demonstrated insufficient numbers to show a difference. No patient in either group required re-exploration for bleeding. All gynecologic cancer patients should receive VTE prophylaxis. Although heparin, LMWH, and SCD have been shown to be safe and effective, due to the paucity of data in the gynecologic oncology literature, no one prevention modality can be considered superior at this time. Adequately powered RCTs are urgently needed to determine the optimal regimen in these high-risk patients.

Vitreoretinal surgery in advanced coats disease.

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Ozdamar, Yasemin; Berker, Nilufer; Batman, Cosar; Zilelioglu, Orhan

2009-01-01

To report the outcomes of vitreoretinal surgery for a patient with total retinal detachment and a subretinal nodule associated with Coats disease (CD). A 20-year-old woman stage 3B CD underwent vitreoretinal surgery with triamcinolone acetonide-assisted pars plana vitrectomy, limited retinotomy, removal of the subretinal nodule and membrane, endolaser photocoagulation, and silicone oil tamponade. The surgical outcomes were observed. Retinal attachment was achieved after vitreoretinal surgery, removal of the subretinal membrane, and endoresection of the subretinal fibrous nodule. No intraoperative or postoperative complications occurred due to the surgical technique. The retina remained attached during the postoperative follow-up period of 6 months. Vitreoretinal surgery is an effective surgical technique that provides successful reattachment of the retina and enables endoresection of the subretinal fibrous nodule in eyes with advanced CD. It also prevents the devastating intraocular complications leading to enucleation.

Timing of prophylactic surgery in prevention of diverticulitis recurrence: a cost-effectiveness analysis.

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Richards, Robert J; Hammitt, James K

2002-09-01

Although surgery is recommended after two or more attacks of uncomplicated diverticulitis, the optimal timing for surgery in terms of cost-effectiveness is unknown. A Markov model was used to compare the costs and outcomes of performing surgery after one, two, or three uncomplicated attacks in 60-year-old hypothetical cohorts. Transition state probabilities were assigned values using published data and expert opinion. Costs were estimated from Medicare reimbursement rates. Surgery after the third attack is cost saving, yielding more years of life and quality adjusted life years at a lower cost than the other two strategies. The results were not sensitive to many of the variables tested in the model or to changes made in the discount rate (0-5%). In conclusion, performing prophylactic resection after the third attack of diverticulitis is cost saving in comparison to resection performed after the first or second attacks and remains cost-effective during sensitivity analysis.

Medical innovation laws: an unnecessary innovation.

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Richards, Bernadette

2016-06-01

Objective This paper aims to demonstrate that any suggestion that there is a need for specific innovation laws is flawed. Innovation is central to good medical practice and is adequately supported by current law. Methods The paper reviews the nature of medical innovation and outlines recent attempts in the UK to introduce specific laws aimed at 'encouraging' and 'supporting' innovation. The current legal framework is outlined and the role of the law in relation to medical innovation explored. Results The analysis demonstrates the cyclic relationship between medical advancement and the law and concludes that there is no requirement for specific innovation laws. Conclusions The law not only supports innovation and development in medical treatment but encourages it as central to a functioning medical system. There is no need to introduce specific laws aimed at medical innovation; to do so represents an unnecessary legal innovation and serves to complicate matters. What is known about the topic? Over recent months, there has been a great deal of discussion surrounding the law in the context of medical innovation. This was driven by the attempts in the UK to introduce specific laws in the Medical Innovation Bill. The general subject matter - negligence and the expected standard of care in the provision of treatment - is very well understood, but not in cases where the treatment can be described as innovative. The general rhetoric in both the UK and Australia around the Medical Innovation Bill demonstrates a lack of understanding of the position of the law with regards to innovative treatment. What does this paper add? This paper adds clarity to the debate. It presents the law and explains the manner in which the law can operate around innovative treatment. The paper asserts that medical innovation is both supported and encouraged by existing legal principles. What are the implications for practitioners? The paper presents an argument that can guide the policy position

Bariatric Surgery and Kidney-Related Outcomes.

Science.gov (United States)

Chang, Alex R; Grams, Morgan E; Navaneethan, Sankar D

2017-03-01

The prevalence of severe obesity in both the general and the chronic kidney disease (CKD) populations continues to rise, with more than one-fifth of CKD patients in the United States having a body mass index of ≥35 kg/m 2 . Severe obesity has significant renal consequences, including increased risk of end-stage renal disease (ESRD) and nephrolithiasis. Bariatric surgery represents an effective method for achieving sustained weight loss, and evidence from randomized controlled trials suggests that bariatric surgery is also effective in improving blood pressure, reducing hyperglycemia, and even inducing diabetes remission. There is also observational evidence suggesting that bariatric surgery may diminish the long-term risk of kidney function decline and ESRD. Bariatric surgery appears to be relatively safe in patients with CKD, with postoperative complications only slightly higher than in the general bariatric surgery population. The use of bariatric surgery in patients with CKD might help prevent progression to ESRD or enable selected ESRD patients with severe obesity to become candidates for kidney transplantation. However, there are also renal risks in bariatric surgery, namely, acute kidney injury, nephrolithiasis, and, in rare cases, oxalate nephropathy, particularly in types of surgery involving higher degrees of malabsorption. Although bariatric surgery may improve long-term kidney outcomes, this potential benefit remains unproved and must be balanced with potential adverse events.

Awake insertion of a Laryngeal Mask Airway-Proseal™ as alternative to awake fiberoptic intubation in management of anticipated difficult airway in ambulatory surgery

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Matilde Zaballos

Full Text Available Abstract Background and objectives The decision whether to manage an ambulatory patient with a previously documented difficult airway with a supraglottic device remain controversial. We report an awake insertion of a Laryngeal Mask Airway Proseal™ in a patient with known difficult airway scheduled for ambulatory surgery. Case report A 46-yr-old woman was programmed as a day case surgery for breast nodule resection. Her anesthetic record included an impossible intubation with cancelation of surgery and subsequent awake fibroscopic intubation. She reported emotional distress with the previous experience and declined this approach. In view of the previous experience, an awake airway control with a Laryngeal Mask Airway Proseal™ was planned after explaining and reassuring the patient. After adequate topicalisation, a size 4 Laryngeal Mask Airway Proseal™ was successfully inserted after two attempts, and their patency was confirmed by capnography. Anesthesia was induced intravenously and the surgery was uneventful. Conclusion We describe a feasible alternative strategy to awake intubation in a patient with known difficult airway undergoing ambulatory surgery. In this specific clinical situation, if tracheal intubation is deemed unnecessary, awake supraglottic airway might allow adequate ventilation and their use should be considered.

Clonidine in patients undergoing noncardiac surgery

DEFF Research Database (Denmark)

Devereaux, P J; Sessler, Daniel I; Leslie, Kate

2014-01-01

BACKGROUND: Marked activation of the sympathetic nervous system occurs during and after noncardiac surgery. Low-dose clonidine, which blunts central sympathetic outflow, may prevent perioperative myocardial infarction and death without inducing hemodynamic instability. METHODS: We performed a bli...

Developing appropriate criteria for Benign Prostatic Hyperplasia Surgery Using RAND Appropriateness Method (RAM

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R Ostovar

2009-07-01

Full Text Available ABSTRACT: Introduction & Objective: Results of different studies show that a relatively large number of healthcare services offered are inappropriate or unnecessary. Benign prostatic hyperplasia is a benign enlargement of the prostate gland. Clinical features of this disease are one of the most common problems encountered by elderly males. The aim of this study was to assess the appropriateness of benign prostatic hyperplasia surgery. Materials & Methods: In this qualitative study which was conducted in 2008-9, in Tehran University of Medical Sciences, the RAN/UCLA method was used, which was designed in 1980 by the RAND institute and the University of California in Los Angeles. Regarding the stages of our method, scenarios and indications for benign prostatic hyperplasia surgery were chosen from the latest approved scientific resources and subsequently sent to urology specialists, who were chosen as members of the specialized panel. Panel members gave scores ranging from 1 to 9 to each indication and scenario based on scientific resources, clinical experiences and patient’s condition in two separate panel sessions. After compilation, the indications were finally grouped as appropriate, equivocal, and inappropriate so that they could be used to determine appropriateness of benign prostatic hyperplasia surgery in hospitals. In this study, the most suitable and most approved clinical guidelines related to benign prostatic hyperplasia, the Guidelines Evaluation and Research Appraisal (AGREE were used.The selected guidelines were used as scientific resources for choosing the indications of benign prostatic hyperplasia surgery. SPSS version 16 and kappa weighted value were used in analysis process of the study. Results: Out of 282 scenarios grouped as 9 conditions related to benign prostatic hyperplasia surgery, which were extracted from scientific sources, 73 cases (25.9% were considered as appropriate, 14 cases (5% as equivocal and 7 cases (2

Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery.

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Struijk-Mulder, M C; Ettema, H B; Verheyen, C C; Büller, H R

2010-04-01

Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. We aimed to compare (inter)national guidelines and analyse differences. MEDLINE, the Cochrane Library and the internet were searched for guidelines on the prevention of VTE in orthopedic surgery. From these, we constructed a table comparing the different antithrombotic regimens during different orthopedic surgical and plaster cast treatments. Eleven guidelines from nine different countries and one international guideline were included. Few guidelines advise on thrombosis prophylaxis after plaster cast immobilization, (prolonged) arthroscopic surgery and isolated lower extremity trauma. Different opinions exist on the sole use of aspirin and mechanical prophylaxis and on the use of vitamin K antagonists after major hip and knee surgery. Based on the same available literature, different guidelines recommend different thromboprophylactic regimens. Ideally, the grade of recommendation should be based on the same level of evidence world-wide. Whilst there is no agreement on the relevance of different endpoints (e.g. asymptomatic DVT), it is very difficult to reach a consensus. Thromboprophylaxis guidelines should be reviewed and updated on a regular basis, because the evidence is evolving rapidly.

de Quervain's thyroiditis: A review of experience with surgery.

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Ranganath, Rohit; Shaha, Manish A; Xu, Bin; Migliacci, Jocelyn; Ghossein, Ronald; Shaha, Ashok R

de Quervain's thyroiditis is an inflammatory condition of the thyroid mostly treated medically, rarely requiring surgical treatment. We intend to review the surgical experience with de Quervain's thyroiditis at a tertiary cancer center over a period of 22years. A retrospective review of medical records from 1992 to 2014 at a tertiary cancer center was performed and all patients with a histopathological diagnosis of de Quervain's thyroiditis were included. Ten patients with a histopathological diagnosis of de Quervain's thyroiditis were included in the study. One patient in the study presented with dysphagia due to the goiter. The remaining patients presented with thyroid nodules. None presented with typical symptoms of the disease. Seven of the ten patients that had been evaluated for a goiter at an outside facility underwent fine needle aspiration cytology. Of the seven patients, one patient was suspected to have medullary carcinoma of the thyroid, two had follicular neoplasia, and the others had indeterminate nodules. Eight of the ten patients underwent surgery for suspected malignancy, with eight receiving a total thyroidectomy and two patients getting a thyroid lobectomy with isthmusectomy. Two patients had an abnormally hard gland to palpate during surgery with the others not having any suspicious findings. Seven of the ten of the patients had lymph node sampling from level 6 and all were benign on final pathology. The mean duration of post-operative follow-up was 15months. There was no morbidity associated with surgery in any of these patients with eight of the ten patients requiring thyroid hormone replacement. None of the patients needed further neck surgery for thyroid disease. de Quervain's thyroiditis is an inflammatory condition of the thyroid that is rarely treated surgically. However when presentation is atypical and the FNAC is inconclusive or is suspicious for a malignancy, patients receive surgery putting them at a risk for morbidity. Good clinical

Enhanced recovery after bariatric surgery – a modern approach

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Bekkhan Bayalovich Khatsiev

2014-06-01

Full Text Available Guidelines for enhanced recovery after surgery (ERAS are widely used and their efficiency was clearly demonstrated by numerous studies. Number of publications on this topic in bariatric surgery is significantly lower compared with other fields of surgery. However, the data accumulated allow to compose recommendations based on studies with high level of evidence. Authors review existing methods of enhanced recovery in their implementation into bariatric surgery. Enhanced recovery methods can be used to optimize all stages of perioperative care and include data on preoperative preparation, maintenance of electrolyte balance, prevention of postoperative nausea and vomiting, sufficient analgesia and safe discharge form hospital. Suggested guidelines for bariatric surgery are implied to be used by a multidisciplinary team.

Review of fondaparinux sodium injection for the prevention of venous thromboembolism in patients undergoing surgery

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David Bergqvist

2006-12-01

Full Text Available David BergqvistDepartment of Surgery, University Hospital, Uppsala, SwedenAbstract: The antithrombin binding sequence of heparin, a pentasaccharide, has been synthesized as fondaparinux, an indirect, selective, and reversible factor Xa inhibitor. It can be administered subcutaneously, is well absorbed, and has a half-life of c. 17 hours permitting once-daily injection. It has been evaluated in an extensive study program in major orthopedic surgery, including hip fracture, and in major abdominal surgery with a large proportion of surgery for cancer. The effect is at least as effective as for low-molecular-weight heparins and it has also been shown effective for extended prophylaxis in hip fracture patients. Several thousands of patients have been studied and the substance is safe, although a slightly higher frequency of bleedings is found than in patients on low-molecular-weight heparins. There is no specific antidote but if necessary, recombinant activated factor VII can be used. Other side-effects are rare. Fondaparinux is cost saving and sometimes cost neutral when compared with enoxaparin. Keywords: fondaparinux, venous thrombosis, venous thromboembolism, surgery, orthopedic surgery, major abdominal surgery, bleeding complications

OWN EXPERIENCE OF LASER THERAPY FOR THE PREVENTION AND TREATMENT OF EARLY AND LATE RADIATION-INDUCED SKIN INJURIES IN PATIENTS WITH BREAST CANCER AFTER SIMULTANEOUS RECONSTRUCTIVE PLASTIC SURGERY

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S. I. Tkachev

2017-01-01

Full Text Available Low-energy laser radiation has a good anti-inflammatory and stimulating effect on the damaged tissues; therefore, it can be used for the prevention and treatment of both early and late radiation-induced skin injuries in patients receiving radiotherapy. So far, the effect of low-energy laser radiation in the prevention of radiation-induced skin damage remains poorly understood. This article presents a brief overview of the results obtained in the latest foreign studies as well as own experience of laser therapy for the prevention and treatment of both early and late radiation-induced skin injuries in patients with breast cancer after simultaneous reconstructive plastic surgery.

Help prevent hospital errors

Science.gov (United States)

... this page: //medlineplus.gov/ency/patientinstructions/000618.htm Help prevent hospital errors To use the sharing features ... in the hospital. If You Are Having Surgery, Help Keep Yourself Safe Go to a hospital you ...

Antimicrobial prophylaxis in colorectal surgery: focus on ertapenem

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Fausto de Lalla

2009-10-01

Full Text Available Fausto de LallaLibero Docente of Infectious Diseases, University of Milano, Milano, ItalyAbstract: Despite improvement in infection control measures and surgical practice, surgical site infections (SSIs remain a major cause of morbidity and mortality. In colorectal surgery, perioperative administration of a suitable antimicrobial regimen that covers both anaerobic and aerobic bacteria is universally accepted. In a prospective, double-blind, randomized study ertapenem was recently found to be more effective than cefotetan, a parenteral cephalosporin so broadly used as to be considered as gold standard in the prevention of SSIs following colorectal surgery. In this adequate and well controlled study, the superiority of ertapenem over cefotetan was clearly demonstrated from the clinical and bacteriological points of view. However, data that directly compares ertapenem with other antimicrobial regimen effective in preventing SSIs following colorectal surgery are lacking; furthermore, the possible risk of promotion of carbapenem resistance associated with widespread use of ertapenem prophylaxis as well as the ertapenem effects on the intestinal gut flora are of concern. Further comparative studies of ertapenem versus other widely used prophylactic regimens for colorectal surgery in patients submitted to mechanical bowel preparation versus no preparation as well as further research on adverse events of antibiotic prophylaxis, including emergence of resistance and Clostridium difficile infection, seem warranted.Keywords: colorectal surgery, surgical prophylaxis, ertapenem

Risk Factors For Wound Infections After Implant Surgery | Onche ...

African Journals Online (AJOL)

OBJECTIVE: Post-operative wound infection (POWI) rates for implant surgery are in the range of 0.08 to 13% in spite of the many advances in surgery in the past decades. It is therefore imperative that we develop a system of predicting the occurrence of POWI as a key to effective prevention. One approach is for each ...

How to manage RI venography in pre-orthopedic surgery patients

International Nuclear Information System (INIS)

Terazawa, Kaori; Otsuka, Hideki; Otomi, Yoichi; Morita, Naomi; Takao, Shoichiro; Iwamoto, Seiji; Osaki, Kyosuke; Harada, Masafumi; Nishitani, Hiromu

2010-01-01

The preoperative evaluation of venous thromboembolism (VTE) is important to avoid complications, because VTE is often induced by orthopedic surgery. We focused on radioisotope venography (RIV) using 99m Tc-macroaggregated human serum albumin, examining orthopedic patients. We conducted 34 examinations in 33 patients who were referred for RIV and lung perfusion scintigraphy for the pre-orthopedic operative evaluation of VTE. Two board-certified (one nuclear medicine board-certified) radiologists interpreted the images based on the following: flow defect of the lower extremities; interruption of flow; irregular or asymmetric filling of the deep vein (low flow); presence of collateral vessels; and abnormal RI retention on delayed-phase images. Scoring was based on a 5-point scale, and more than 2 points was considered VTE positive. Abnormal findings were noted in 27 of the 34 examinations performed in the 33 patients and normal findings in the other 7 examinations. According to the RI score, 21 patients were classified into the VTE-positive group and 12 into the VTE-negative group. Surgery was canceled because of advanced age and respiratory dysfunction in 2 of the 21 patients in the VTE-positive group. Of the 19 patients who underwent surgery, an IVH filter was placed before surgery in 2 and anticoagulant treatment with heparin and warfarin was initiated on the day of surgery in 12 to prevent postoperative VTE, and only one of the patients receiving anticoagulant treatment developed PTE after surgery. Surgery was canceled due to advanced age and at patient's request in 2 of 12 patients in the VTE-negative group. Anticoagulant treatment with heparin/warfarin was performed to prevent postoperative VTE in only 3 patients: one with a past medical history of pulmonary infarction, one with atrial fibrillation, and one suspected of having antiphospholipid antibody syndrome. No patient in the VTE-negative group developed VTE after surgery. The preoperative identification of

High field strength magnetic resonance imaging in paediatric brain tumour surgery--its role in prevention of early repeat resections.

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Avula, Shivaram; Pettorini, Benedetta; Abernethy, Laurence; Pizer, Barry; Williams, Dawn; Mallucci, Conor

2013-10-01

The purpose of this study is to compare the surgical and imaging outcome in children who underwent brain tumour surgery with intention of complete tumour resection, prior to and following the start of intra-operative MRI (ioMRI) service. ioMRI service for brain tumour resection commenced in October 2009. A cohort of patients operated between June 2007 and September 2009 with a pre-surgical intention of complete tumour resection were selected (Group A). A similar number of consecutive cases were selected from a prospective database of patients undergoing ioMRI (Group B). The demographics, imaging, pathology and surgical outcome of both groups were compared. Thirty-six of 47 cases from Group A met the inclusion criterion and 36 cases were selected from Group B; 7 of the 36 cases in Group A had unequivocal evidence of residual tumour on the post-operative scan; 5 (14%) of them underwent repeat resection within 6 months post-surgery. In Group B, ioMRI revealed unequivocal evidence of residual tumour in 11 of the 36 cases following initial resection. In 10 of these 11 cases, repeat resections were performed during the same surgical episode and none of these 11 cases required repeat surgery in the following 6 months. Early repeat resection rate was significantly different between both groups (p = 0.003). Following the advent of ioMRI at our institution, the need for repeat resection within 6 months has been prevented in cases where ioMRI revealed unequivocal evidence of residual tumour.

Breast Cancer Prevention (PDQ®)—Patient Version

Science.gov (United States)

Breast cancer prevention strategies include avoiding known risks, having a healthy lifestyle, and medications or surgery for those at high risk. Learn more about breast cancer prevention, risks and protective factors, and how to estimate risk in this expert-reviewed summary.

Preventing or reducing smoking-related complications in otologic and neurotologic surgery.

Science.gov (United States)

Golub, Justin S; Samy, Ravi N

2015-10-01

To discuss effects of smoking on otologic surgery in an era of electronic (e-) cigarettes and proposals for legalization of marijuana. Physiologic mechanisms and clinical outcomes are presented. Tobacco smoke can cause a variety of tissue effects that may adversely impact otologic surgery outcomes. Results in tympanoplasty using temporalis fascia are inferior in smokers compared with nonsmokers. More recent data show that in cartilage tympanoplasty, graft incorporation rates in smokers may approach those of nonsmokers. However, these results may not be as durable long-term in smokers. Evidence from nonotologic studies suggests that smoking cessation and nicotine replacement therapy may reduce perioperative morbidity. No data are available on electronic cigarettes and otologic outcomes; however, based on the pathophysiologic mechanisms of tobacco smoking, electronic cigarettes are likely a safer alternative. Marijuana smoke also needs to be considered as more states consider legalization. Cigarette smoking negatively influences otologic surgery results, mostly because of tobacco combustion byproducts. Counseling and, if needed, pharmacologic measures to reduce smoking are recommended. E-cigarettes that deliver nicotine in water vapor may be safer than tobacco smoking. Our review contributes to the discussion of how the trends of e-cigarette use and marijuana legalization will unfold in the future to affect our patients' outcomes.

Are unnecessary follow-up procedures induced by computer-aided diagnosis (CAD) in mammography? Comparison of mammographic diagnosis with and without use of CAD

International Nuclear Information System (INIS)

Marx, Christiane; Malich, Ansgar; Facius, Mirjam; Grebenstein, Uta; Sauner, Dieter; Pfleiderer, Stefan O.R.; Kaiser, Werner A.

2004-01-01

Objective: To evaluate the rate of unnecessary follow-up procedures recommended by radiologists using a CAD-system. Materials and methods: 185 patients (740 images) were consecutively selected from three groups (36 histologically proven cancers=group 1; 49 histologically proven benign lesions=group 2 and 100 screening cases (4 years-follow up=group 3). Mammograms were evaluated by a CAD system (Second Look [reg] , CADx, Canada). Five blinded radiologists assessed the images without/with CAD outputs. Diagnostic decisions were ranked from surely benign to surely malignant according to BIRADS classification, follow-up procedures were recommended for each observed lesion (a, screening; b, short interval follow-up examination in 6 months; c, pathologic clarification). Results: CAD-system detected 32/36 cancers (88.9%) (FP-rate: 1.04 massmarks and 0.27 calcmarks/image). The following values were reached by all observers without/with CAD in the mean: Sensitivity 80.6/80.0%, specificity 83.2/86.4%, PPV 53.1/58.1%, and NPV 94.6/94.7%. Observers described a similar number of additional lesions without/with the use of CAD (325/326). Whereas the number of unnecessary short-time follow up recommendations increased in all case-subgroups with CAD: 40.8/42.9% (group 1), 35.6/38.1% (group 2), 44.7/46.8% (group 3), respectively, the number of recommended biopsies decreased in all subgroups: group 1: 34.7/27.1%; group 2: 47.4/41.5%, group 3: 33.3/22.0%, respectively. Conclusion: In this rather small population additional usage of CAD led to a lower rate of unnecessary biopsies. The observed decrease of recommended unnecessary biopsies due to the usage of CAD in the screening group suggests a potential financial benefit by using CAD as diagnostic aid

Artificial intelligence may help in predicting the need for additional surgery after endoscopic resection of T1 colorectal cancer.

Science.gov (United States)

Ichimasa, Katsuro; Kudo, Shin-Ei; Mori, Yuichi; Misawa, Masashi; Matsudaira, Shingo; Kouyama, Yuta; Baba, Toshiyuki; Hidaka, Eiji; Wakamura, Kunihiko; Hayashi, Takemasa; Kudo, Toyoki; Ishigaki, Tomoyuki; Yagawa, Yusuke; Nakamura, Hiroki; Takeda, Kenichi; Haji, Amyn; Hamatani, Shigeharu; Mori, Kensaku; Ishida, Fumio; Miyachi, Hideyuki

2018-03-01

 Decisions concerning additional surgery after endoscopic resection of T1 colorectal cancer (CRC) are difficult because preoperative prediction of lymph node metastasis (LNM) is problematic. We investigated whether artificial intelligence can predict LNM presence, thus minimizing the need for additional surgery.  Data on 690 consecutive patients with T1 CRCs that were surgically resected in 2001 - 2016 were retrospectively analyzed. We divided patients into two groups according to date: data from 590 patients were used for machine learning for the artificial intelligence model, and the remaining 100 patients were included for model validation. The artificial intelligence model analyzed 45 clinicopathological factors and then predicted positivity or negativity for LNM. Operative specimens were used as the gold standard for the presence of LNM. The artificial intelligence model was validated by calculating the sensitivity, specificity, and accuracy for predicting LNM, and comparing these data with those of the American, European, and Japanese guidelines.  Sensitivity was 100 % (95 % confidence interval [CI] 72 % to 100 %) in all models. Specificity of the artificial intelligence model and the American, European, and Japanese guidelines was 66 % (95 %CI 56 % to 76 %), 44 % (95 %CI 34 % to 55 %), 0 % (95 %CI 0 % to 3 %), and 0 % (95 %CI 0 % to 3 %), respectively; and accuracy was 69 % (95 %CI 59 % to 78 %), 49 % (95 %CI 39 % to 59 %), 9 % (95 %CI 4 % to 16 %), and 9 % (95 %CI 4 % - 16 %), respectively. The rates of unnecessary additional surgery attributable to misdiagnosing LNM-negative patients as having LNM were: 77 % (95 %CI 62 % to 89 %) for the artificial intelligence model, and 85 % (95 %CI 73 % to 93 %; P  artificial intelligence significantly reduced unnecessary additional surgery after endoscopic resection of T1 CRC without missing LNM positivity. © Georg

Antibiotic prevention of postcataract endophthalmitis

DEFF Research Database (Denmark)

Kessel, Line; Flesner, Per; Andresen, Jens

2015-01-01

Endophthalmitis is one of the most feared complications after cataract surgery. The aim of this systematic review was to evaluate the effect of intracameral and topical antibiotics on the prevention of endophthalmitis after cataract surgery. A systematic literature review in the MEDLINE, CINAHL......, Cochrane Library and EMBASE databases revealed one randomized trial and 17 observational studies concerning the prophylactic effect of intracameral antibiotic administration on the rate of endophthalmitis after cataract surgery. The effect of topical antibiotics on endophthalmitis rate was reported by one...... with the use of intracameral antibiotic administration of cefazolin, cefuroxime and moxifloxacin, whereas no effect was found with the use of topical antibiotics or intracameral vancomycin. Endophthalmitis occurred on average in one of 2855 surgeries when intracameral antibiotics were used compared to one...

Can early aortic root surgery prevent further aortic dissection in Marfan syndrome?

OpenAIRE

Shimizu, Hideyuki; Kasahara, Hirofumi; Nemoto, Atsushi; Yamabe, Kentaro; Ueda, Toshihiko; Yozu, Ryohei

2011-01-01

We reviewed 50 patients with Marfan syndrome who underwent surgery for aortic root pathologies comprising a root aneurysm without (n = 25; group A) and with (n = 25; group B) dissection. Aortic root repair included Bentall (n = 37) and valve-sparing (n = 13) procedures. Hospital mortality was 4.0%. Twenty-two patients required 36 repeat surgeries on the distal aorta. The main indication for re-intervention was the dilation of the false lumen. In group A, the distal aorta was stable for up to ...

Prevention of gastrointestinal injury by using glutamine in cardiac surgery

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С. М. Ефремов

2015-10-01

Full Text Available A pilot double-blind, placebo-controlled, randomized study The aim of this study was to evaluate the efficiency of perioperative administration of glutamine to preserve intestinal integrity in patients undergoing cardiac surgery. 24 patients scheduled for elective coronary artery bypass surgery under cardiopulmonary bypass were included in this prospective, randomized, double-blind placebo controlled pilot study. 12 patients were randomized to receive glutamine (20% solution of N(2-L-alanyl-L-glutamine 0.4 g/kg a day, while the remaining 12 patients received an equivalent placebo dose (0.9% solution of NaCl. Infusion of glutamine/placebo was started after the induction of anesthesia and was continued for 24 hours. The primary end-point was dynamics of plasma concentration of a specific marker of intestinal damage, intestinal fatty acid binding protein (I-FABP. The secondary end-points were liver fatty acid binding protein (L-FABP, alpha glutathione s-transferase (aGST, heat shock protein 70 (HSP 70. There were no between-group differences of all the studied biochemical parameters at any stage of the study. Plasma I-FABP levels (median [25-75 percentile] were markedly elevated during CPB and remained the same postoperatively: 962 (577-2 067 and 883 (444-1 625 г/ml 5 min after un-clamping of aorta, 2203 (888-3 429 and 1 560 (506-2 657 г/ml 2 hours post-bypass, 897 (555-1 424 and 794 (505-951 г/ml 6 hours post-bypass in the GLN and control groups respectively. Perioperative administration of glutamine in dose of 0.4 g/kg a day does not appear to preserve intestinal integrity in low risk cardiac surgery patients.

Control and prevention of peritoneal adhesions in gynecologic surgery.

Science.gov (United States)

2006-11-01

Postoperative adhesion formation is a natural consequence of surgical tissue trauma and healing and may result in infertility, pain, and bowel obstruction. Microsurgical principles and minimally invasive surgery may help decrease adhesion formation, but anti-inflammatory agents and peritoneal instillates have no demonstrable benefit. Although some surgical barriers are effective for reducing postoperative adhesions, none has been shown to improve fertility or to decrease pain or the incidence of postoperative bowel obstruction.

National proficiency-gain curves for minimally invasive gastrointestinal cancer surgery.

Science.gov (United States)

Mackenzie, H; Markar, S R; Askari, A; Ni, M; Faiz, O; Hanna, G B

2016-01-01

Minimal access surgery for gastrointestinal cancer has short-term benefits but is associated with a proficiency-gain curve. The aim of this study was to define national proficiency-gain curves for minimal access colorectal and oesophagogastric surgery, and to determine the impact on clinical outcomes. All adult patients undergoing minimal access oesophageal, colonic and rectal surgery between 2002 and 2012 were identified from the Hospital Episode Statistics database. Proficiency-gain curves were created using risk-adjusted cumulative sum analysis. Change points were identified, and bootstrapping was performed with 1000 iterations to identify a confidence level. The primary outcome was 30-day mortality; secondary outcomes were 90-day mortality, reintervention, conversion and length of hospital stay. Some 1696, 15 008 and 16 701 minimal access oesophageal, rectal and colonic cancer resections were performed during the study period. The change point in the proficiency-gain curve for 30-day mortality for oesophageal, rectal and colonic surgery was 19 (confidence level 98·4 per cent), 20 (99·2 per cent) and three (99·5 per cent) procedures; the mortality rate fell from 4·0 to 2·0 per cent (relative risk reduction (RRR) 0·50, P = 0·033), from 2·1 to 1·2 per cent (RRR 0·43, P curve for reintervention in oesophageal, rectal and colonic resection was 19 (98·1 per cent), 32 (99·5 per cent) and 26 (99·2 per cent) procedures respectively. There were also significant proficiency-gain curves for 90-day mortality, conversion and length of stay. The introduction of minimal access gastrointestinal cancer surgery has been associated with a proficiency-gain curve for mortality and major morbidity at a national level. Unnecessary patient harm should be avoided by appropriate training and monitoring of new surgical techniques. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

Platelet Rich Plasma and Knee Surgery

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Mikel Sánchez

2014-01-01

Full Text Available In orthopaedic surgery and sports medicine, the knee joint has traditionally been considered the workhorse. The reconstruction of every damaged element in this joint is crucial in achieving the surgeon’s goal to restore the knee function and prevent degeneration towards osteoarthritis. In the last fifteen years, the field of regenerative medicine is witnessing a boost of autologous blood-derived platelet rich plasma products (PRPs application to effectively mimic and accelerate the tissue healing process. The scientific rationale behind PRPs is the delivery of growth factors, cytokines, and adhesive proteins present in platelets and plasma, as well as other biologically active proteins conveyed by the plasma such as fibrinogen, prothrombin, and fibronectin; with this biological engineering approach, new perspectives in knee surgery were opened. This work describes the use of PRP to construct and repair every single anatomical structure involved in knee surgery, detailing the process conducted in ligament, meniscal, and chondral surgery.

Traditional Chinese and western medicine for the prevention of deep venous thrombosis after lower extremity orthopedic surgery: a meta-analysis of randomized controlled trials.

Science.gov (United States)

Zhu, Shibai; Song, Yi; Chen, Xi; Qian, Wenwei

2018-04-10

Chinese herbal medicine has traditionally been considered to promote blood circulation to remove obstruction in the channels and clear pathogenic heat to drain dampness effects. We conducted this meta-analysis to evaluate its benefits for the prevention of deep venous thrombosis (DVT) after lower extremity orthopedic surgery. Relevant, published studies were identified using the following keywords: lower extremity orthopedic surgery, arthroplasty, joint replacement, fracture, traditional Chinese and western medicine, Chinese herbal medicine, deep venous thrombosis (DVT), and Venous thromboembolism (VTE). The following databases were used to identify the literature consisting of RCTs with a date of search of 31 May 2017: PubMed, Cochrane Library, Web of knowledge, the Chinese National Knowledge Infrastructure Database, the Chongqing VIP Database, the Chinese Biomedical Database, and the Wanfang Database (including three English and four Chinese databases). All relevant data were collected from studies meeting the inclusion criteria. The outcome variables were the incidence rate of DVT, activated partial thromboplastin time (APTT), prothrombin time (PT), and D-dimer; subcutaneous hematoma; and other reported outcomes. RevMan5.2. software was adopted for the meta-analysis. A total of 20 published studies (1862 cases) met the inclusion criteria. The experimental group, 910 patients (48.87%), received the Chinese herbal medicine or traditional Chinese and western medicine for prevention of DVT; the control group, 952 patients (51.13%), received the standard western treatment. The meta-analysis showed that traditional Chinese and western medicine therapy reduced the incidence rates of DVT significantly when compared with controls (risk ratio [RR] = 0.40; 95% CI, 0.30 to 0.54; P < 0.00001), and the D-dimer was lower in the experimental group (P = 0.01). Besides, the incidence rate of subcutaneous hematoma was lower in the experimental group (P < 0

[Can gene technology in agriculture prevent hunger in the world?].

Science.gov (United States)

Goewie, E A

2002-03-01

The world population grows rapidly: the number of mouths to feed increases. Is an agriculture without gene technology able to produce sufficiently in order to prevent hunger? Research indicates that hunger is not the result of short comings in agricultural outputs. It is however the result of poverty. This problem will not be solved by gene technology based agricultural production. This article explains the basic principles of mainstream and organic farming. Literature shows that the production potentials of both kinds of farming are, by far most, not yet exhausted. Gene technology is therefore unnecessary.

OPEN HEART SURGERY UNDER HYPOTHERMIA

African Journals Online (AJOL)

pulmonary blood flow by operation under hypothermia; open heart surgery ... po ition with the right arm abducted and the left arm at the ideo The ... pulmonary valve stenosis is pre ent. Mobilization ... The anaesthetist must try and prevent shivering,. 2. HOURS .... The exploratory inci ion into the right atrial cavity is then clo ed ...

Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability

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Lirong Zhang

2018-01-01

Full Text Available Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS. Three main components (naringin, naringenin, and hesperetin were isolated from C. aurantium. Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n=47 and control group (CG, received 20 mg placebo daily, n=48. After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group (P>0.01. The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

Citrus aurantium Naringenin Prevents Osteosarcoma Progression and Recurrence in the Patients Who Underwent Osteosarcoma Surgery by Improving Antioxidant Capability.

Science.gov (United States)

Zhang, Lirong; Xu, Xiaohua; Jiang, Tiechao; Wu, Kunzhe; Ding, Chuanbo; Liu, Zhen; Zhang, Xuanhe; Yu, Tianhua; Song, Changlong

2018-01-01

Citrus aurantium is rich in flavonoids, which may prevent osteosarcoma progression, but its related molecular mechanism remains unclear. Flavonoids were extracted from C. aurantium and purified by reparative HPLC. Each fraction was identified by using electrospray ionisation mass spectrometry (ESI-MS). Three main components (naringin, naringenin, and hesperetin) were isolated from C. aurantium . Naringenin inhibited the growth of MG-63 cells, whereas naringin and hesperetin had no inhibitory function on cell growth. ROS production was increased in naringin- and hesperetin-treated groups after one day of culture while the level was always lowest in the naringenin-treated group after three days of culture. 95 osteosarcoma patients who underwent surgery were assigned into two groups: naringenin group (NG, received 20 mg naringenin daily, n = 47) and control group (CG, received 20 mg placebo daily, n = 48). After an average of two-year follow-up, osteosarcoma volumes were smaller in the NG group than in the CG group ( P > 0.01). The rate of osteosarcoma recurrence was also lower in the NG group than in CG group. ROS levels were lower in the NG group than in the CG group. Thus, naringenin from Citrus aurantium inhibits osteosarcoma progression and local recurrence in the patients who underwent osteosarcoma surgery by improving antioxidant capability.

Local recurrences after conservative surgery and irradiation for breast cancer: Diagnosis with mammography and ultrasound. Mammographie und Sonographie in der Rezidivdiagnostik nach brusterhaltender Therapie des Mammakarzinoms

Energy Technology Data Exchange (ETDEWEB)

Buchberger, W; Hamberger, L; Schoen, G [Innsbruck Univ. (Austria). Universitaetsklinik fuer Radiodiagnostik; Steixner, G; Fritsch, E [Innsbruck Univ. (Austria). Universitaetsklinik fuer Strahlentherapie

1991-06-01

89 patients, who underwent conservative surgery for breast cancer were followed up with mammography and real-time sonography. 78 patients underwent postoperative irradiation. Depending on the time interval between irradiation and examination various alterations in mammographic and sonographic patterns were evident. Of 14 biospy-confirmed local recurrences, 11 were diagnosed by mammography and 12 by sonography. Combined use of mammography and sonography should therefore lead to better results in the diagnosis of local recurrences and to a reduction of unnecessary biopsies. (orig./GDG).

European multicenter trial of the prevention of cystoid macular edema after cataract surgery in nondiabetics: ESCRS PREMED study report 1.

Science.gov (United States)

Wielders, Laura H P; Schouten, Jan S A G; Winkens, Bjorn; van den Biggelaar, Frank J H M; Veldhuizen, Claudette A; Findl, Oliver; Murta, Joaquim C N; Goslings, Willem R O; Tassignon, Marie-José; Joosse, Maurits V; Henry, Ype P; Rulo, Alexander H F; Güell, José L; Amon, Michael; Kohnen, Thomas; Nuijts, Rudy M M A

2018-04-01

To compare the efficacy of a topical nonsteroidal antiinflammatory drug, topical corticosteroid, and a combination of both drugs to prevent the occurrence of cystoid macular edema (CME) after cataract surgery in nondiabetic patients. Twelve European study centers. Randomized clinical trial. Nondiabetic patients having uneventful cataract surgery were included in this study. Patients were randomized to receive topical bromfenac 0.09% twice daily for 2 weeks or dexamethasone 0.1% 4 times daily with 1 drop less per day every following week, or a combination of both. The primary outcome was the difference in central subfield mean macular thickness 6 weeks postoperatively. Secondary outcome measures included corrected distance visual acuity as well as the incidence of CME and clinically significant macular edema (CSME) within 6 weeks and 12 weeks postoperatively. This study comprised 914 patients. Six weeks postoperatively, the central subfield mean macular thickness was 288.3 μm, 296.0 μm, and 284.5 μm in the bromfenac group, dexamethasone group, and combination treatment group, respectively (overall P = .006). The incidence of clinically significant macular edema within 12 weeks postoperatively was 3.6%, 5.1%, and 1.5%, respectively (overall P = .043). Patients treated with a combination of topical bromfenac 0.09% and dexamethasone 0.1% had a lower risk for developing CSME after cataract surgery than patients treated with a single drug. Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Characteristics of Hemorrhagic Stroke following Spine and Joint Surgeries.

Science.gov (United States)

Yang, Fei; Zhao, Jianning; Xu, Haidong

2017-01-01

Hemorrhagic stroke can occur after spine and joint surgeries such as laminectomy, lumbar spinal fusion, tumor resection, and total joint arthroplasty. Although this kind of stroke rarely happens, it may cause severe consequences and high mortality rates. Typical clinical symptoms of hemorrhagic stroke after spine and joint surgeries include headache, vomiting, consciousness disturbance, and mental disorders. It can happen several hours after surgeries. Most bleeding sites are located in cerebellar hemisphere and temporal lobe. A cerebrospinal fluid (CSF) leakage caused by surgeries may be the key to intracranial hemorrhages happening. Early diagnosis and treatments are very important for patients to prevent the further progression of intracranial hemorrhages. Several patients need a hematoma evacuation and their prognosis is not optimistic.

SAPHO: What radiologists should know

Energy Technology Data Exchange (ETDEWEB)

Depasquale, R.; Kumar, N.; Lalam, R.K.; Tins, B.J.; Tyrrell, P.N.M.; Singh, J. [Radiology Department, Robert Jones and Agnes Hunt Orthopaedic and District Hospitals NHS Trust, Gobowen, Oswestry, Shropshire (United Kingdom); Cassar-Pullicino, V.N., E-mail: victor.pullicino@rjah.nhs.uk [Radiology Department, Robert Jones and Agnes Hunt Orthopaedic and District Hospitals NHS Trust, Gobowen, Oswestry, Shropshire (United Kingdom)

2012-03-15

SAPHO (synovitis, acne, pustulosis, hyperostosis, and osteitis) is an umbrella acronym for inflammatory clinical conditions whose common denominator is aseptic osteoarticular involvement with characteristic skin lesions. It involves all ages, can involve any skeletal site, and has variable imaging appearances depending on the stage/age of the lesion and imaging method. It mimics important differentials including infection and neoplasia. Awareness of the imaging features, especially in the spine, facilitates early diagnosis, prevents repeated biopsies, and avoids unnecessary surgery, while initiating appropriate treatment.

Bariatric surgery: an IDF statement for obese Type 2 diabetes

Science.gov (United States)

Dixon, J B; Zimmet, P; Alberti, K G; Rubino, F

2011-01-01

The International Diabetes Federation Taskforce on Epidemiology and Prevention of Diabetes convened a consensus working group of diabetologists, endocrinologists, surgeons and public health experts to review the appropriate role of surgery and other gastrointestinal interventions in the treatment and prevention of Type 2 diabetes. The specific goals were: to develop practical recommendations for clinicians on patient selection; to identify barriers to surgical access and suggest interventions for health policy changes that ensure equitable access to surgery when indicated; and to identify priorities for research. Bariatric surgery can significantly improve glycaemic control in severely obese patients with Type 2 diabetes. It is an effective, safe and cost-effective therapy for obese Type 2 diabetes. Surgery can be considered an appropriate treatment for people with Type 2 diabetes and obesity not achieving recommended treatment targets with medical therapies, especially in the presence of other major co-morbidities. The procedures must be performed within accepted guidelines and require appropriate multidisciplinary assessment for the procedure, comprehensive patient education and ongoing care, as well as safe and standardized surgical procedures. National guidelines for bariatric surgery need to be developed for people with Type 2 diabetes and a BMI of 35 kg/m2 or more. PMID:21480973

Geranisetron versus gabapentin in preventing postoperative nausea and vomiting after middle ear surgery in adults: A double-blinded randomized clinical trial study

Directory of Open Access Journals (Sweden)

Morteza Heidari

2015-01-01

Full Text Available Background: The incidence of postoperative nausea and vomiting (PONV after middle ear surgery is high. In this study we want to compare the effects of intravenous granisetron and oral gabapentin as a premedication before surgery on the incidence and severity of PONV after middle ear surgery in adult patents. Materials and Methods: We enrolled 90 patients that were randomly divided into the three groups of 30 in each. Group I received granisetron 3 mg iv 2 minutes before induction of anesthesia; Group II received oral gabapentin 300 mg 1 hour before anesthesia and Group III received placebo. The incidence and severity of PONV were recorded each 15 minutes in the post-anesthesia care unit (PACU and each 8 hours until 24 hours after discharge from the PACU. Result: The incidence and severity of nausea and vomiting at different time intervals in Groups I and Group II was significantly lower compared with Group III (P < 0.05. There was no significant difference in the incidence of side effects of study drug administration including respiratory depression, apnea, extra pyramidal disorders, drowsiness, dizziness, vertigo and headache in three groups. Conclusion: The study was shown that using gabapentin and granisetron have equal anti-emetic effects, but significant differences were seen between these two groups compared to the control group. These submit the efficiency of these drugs in preventing PONV.

The challenge of early surgery for cryptorchidism

DEFF Research Database (Denmark)

Thorup, Jørgen Mogens; Jensen, C.L.; Langballe, O

2011-01-01

Objective. In congenital cryptorchidism, a recent Nordic Consensus report recommends surgical correction at 6–12 months of age to prevent male infertility. In published series of orchiopexies the median age at surgery is often 3 years or more. The aim of this study was to evaluate whether early...... centres is important when treating cryptorchidism with early surgery, otherwise the positive beneficial biological impact on fertility potential may be lost due to treatment failure. Read More: http://informahealthcare.com/doi/abs/10.3109/00365599.2010.549091...

[Preventive treatment of retinal detachment in aphakic eyes].

Science.gov (United States)

Regnault, F; Bregeat, P

1977-01-01

We have examined 243 cases with retinal detachment occurring within 6 months following cataract surgery. In 92 of them retinal tear was due to lattice degeneration, in 66 to snail track degeneration and in 17 to equatorial degeneration. 290 other patients had preventive treatments. In this group, there were only 10 cases of retinal detachment. 9 out of 22 patients who had no preventive treatment suffered retinal detachments. There are two reasons for the occurrence of this retinal detachment in the 6 months following cataract surgery in eyes where retinal degenerations are found: (1) surgical trauma even with cryoextraction is responsible for traction of the vitreous base, (2) rapid disappearance of the hyaluronic acid in the aphakic vitreous is responsible for the degradation of the vitreous with formation of large zones of liquid vitreous. When adhesion between the vitreous and the retinal degeneration area remains, the traction is responsible for retinal tear or retinal detachment. The importance of the preventive treatment of retinal lesions prior to cataract surgery should be stressed.

Pathogenesis of morbidity after fast-track laparoscopic colonic cancer surgery

DEFF Research Database (Denmark)

Stottmeier, S; Harling, H; Wille-Jørgensen, P

2011-01-01

AIM: Analysis of the nature and time course of early complications after laparoscopic colonic surgery is required to allow rational strategies for their prevention and management. METHOD: One hundred and four consecutive patients who underwent elective fast-track laparoscopic colonic cancer surgery...... occurred in 14 patients, of which four were preceded by medical complications. Three patients had only medical complications. Median length of stay was 3 days (range 1-44). CONCLUSION: Further improvement of outcomes after fast-track laparoscopic colonic surgery might be obtained by improved surgical...

Burden of blood transfusion in knee and hip surgery in the US and Belgium.

Science.gov (United States)

Blanchette, Christopher M; Joshi, Ashish V; Szpalski, Marek; Gunzburg, Robert; Du Bois, Mark; Donceel, Peter; Saunders, William B

2009-09-01

Transfusion services in orthopaedic surgery can lead to unnecessary complications and increased healthcare costs. The objective of this study was to assess treatments and costs associated with blood and blood product transfusions in a historical cohort of 189,457 inpatients in the US and 34,987 inpatients in Belgium undergoing knee or hip surgery. Descriptive analysis, logistic regression and ordinary least squares regression were used to describe the factors associated with the use and cost of allogeneic blood transfusion. Hospitalisation costs for joint replacement surgery totalled $12,718 (SD=6,356) and averaged 4.33 days in the US, while costs in Belgium were $6,526 (SD=3,192) and averaged 17.1 days. The use of low molecular weight heparin and tranexamic acid was much higher in Belgium than the US (36% and 99% compared to 0% and 40%, respectively). Patients in the US spent 12.7 (pcosts per hospitalisation than patients in Belgium. While hospital costs for patients were greater in the US, length of stay was shorter and patients were less likely to have transfusion services than those patients in Belgium. While this study is limited by factors inherent to observational studies, such as omitted variable bias, misclassification, and disease comorbidity, there are substantial differences in the use of blood products between Belgium and the US.

Humidification during laparoscopic surgery: overview of the clinical benefits of using humidified gas during laparoscopic surgery.

Science.gov (United States)

Binda, Maria Mercedes

2015-11-01

The peritoneum is the serous membrane that covers the abdominal cavity and most of the intra-abdominal organs. It is a very delicate layer highly susceptible to damage and it is not designed to cope with variable conditions such as the dry and cold carbon dioxide (CO2) during laparoscopic surgery. The aim of this review was to evaluate the effects caused by insufflating dry and cold gas into the abdominal cavity after laparoscopic surgery. A literature search using the Pubmed was carried out. Articles identified focused on the key issues of laparoscopy, peritoneum, morphology, pneumoperitoneum, humidity, body temperature, pain, recovery time, post-operative adhesions and lens fogging. Insufflating dry and cold CO2 into the abdomen causes peritoneal damage, post-operative pain, hypothermia and post-operative adhesions. Using humidified and warm gas prevents pain after surgery. With regard to hypothermia due to desiccation, it can be fully prevented using humidified and warm gas. Results relating to the patient recovery are still controversial. The use of humidified and warm insufflation gas offers a significant clinical benefit to the patient, creating a more physiologic peritoneal environment and reducing the post-operative pain and hypothermia. In animal models, although humidified and warm gas reduces post-operative adhesions, humidified gas at 32 °C reduced them even more. It is clear that humidified gas should be used during laparoscopic surgery; however, a question remains unanswered: to achieve even greater clinical benefit to the patient, at what temperature should the humidified gas be when insufflated into the abdomen? More clinical trials should be performed to resolve this query.

Antibiotic prophylaxis in clean general surgery

International Nuclear Information System (INIS)

Ahmed, M.; Asghar, I.; Mansoor, N.

2007-01-01

To find out the incidence of surgical site infection in clean general surgery cases operated without prophylactic antibiotics. One hundred and twenty-four clean surgical cases operated without antibiotic prophylaxis between July 2003 and December 2004, were studied and these were compared with similar number of cases who received antibiotics. The data was collected and analyzed using software SPSS (version 10.0). Chi-square and student-t test were used to analyze the association between antibiotics and wound infection. The most frequent operation was repair of various hernias, 69.3% in group A and 75% in group B. More operations were carried out between 21-30 years, 38.7% in group A and 41.9% in group B. Surgical site infection occurred in one patient (0.8%) in each group. Chi-square test (0.636) applied to group A and B showed no association of infection and administration/ no administration of antibiotics (p > 0.25). The t-test applied on group A and B (t=0) also showed no significant difference between administration of antibiotics/ no-antibiotics and infection (p > 0.25). The use of prophylactic antibiotic in clean, non implant and elective cases is unnecessary. (author)

Comparison of palanosetron, granisetron and ondansetron as anti-emetics for prevention of postoperative nausea and vomiting in patients undergoing middle ear surgery.

Science.gov (United States)

Basu, Anjana; Saha, Debdas; Hembrom, Bani P; Roy, Amit; Naaz, Anjum

2011-05-01

The objective of the study was to compare the efficacy of palanosetron (0.25 mg), granisetron (3.0 mg) and ondansetron (8.0 mg) used as anti-emetics for the prevention of postoperative nausea/vomiting in patients undergoing middle ear surgery. The study was done among 75 adult patients (age group 30-45 years) of which 50 were males and rest (25) females, all of ASA I and ASA II. The patients were randomly allocated into 3 equal groups: Group I (n = 25) received injection palanosetron (0.25 mg) IV, group II (n = 25) received injection granisetron (3 mg) IV and group III (n = 25) received injection ondansetron (8.0 mg) IV at the end of the surgical procedure. A standard general anaesthesia technique was employed. Emetic episodes and safety assessments were performed during two periods of 0-6 hours in the postanaesthesia care unit and 6-24 hours in the ward after anaesthesia. The incidence of emesis-free patients during the 0-6 hours period was 100% for group I; 72% for group II and 56% for group III. During the 6-24 hours period incidence of emesis-free patients were 96% for group I; 56% for group II and 32% for group III. So to conclude, a single dose of palanosetron (0.25 mg) is a superior anti-emetic to granisetron (3.0 mg) or ondansetron (8.0 mg) in complete prevention of postoperative nausea and vomiting after middle ear surgery during the first 24 hours period.

Prophylactic digitalisation in pulmonary surgery.

Science.gov (United States)

Ritchie, A J; Danton, M; Gibbons, J R

1992-01-01

Prophylactic digoxin is widely used in patients undergoing pulmonary surgery to prevent or control cardiac arrhythmias, but whether it is helpful or not is uncertain. An open, controlled randomised prospective clinical study of 111 patients was undertaken to compare the incidence of cardiac arrhythmias in the 58 patients who received preoperative digoxin and the 53 who did not. Cardiac arrhythmia occurred in half (29/58) of those given prophylactic digoxin and in 36% (19/53) of those who were not. The overall incidence of arrhythmia was 43%, with no statistically significant difference between the groups. Cardiac arrhythmias remain an important complication of pulmonary surgery and the incidence is not reduced by prophylactic digoxin.

Amiodarone is a cost-neutral way of preventing atrial fibrillation after surgery for lung cancer

DEFF Research Database (Denmark)

Riber, Lars P.; Christensen, Thomas D.; Pilegaard, Hans K.

2014-01-01

OBJECTIVES: Our aim was to estimate the costs and health benefits of routinely administered postoperative amiodarone as a prophylactic agent in reducing the risk of atrial fibrillation in patients undergoing surgery for lung cancer. METHODS: This was a cost-effectiveness study, based.......23). There were no signs of adverse developments referable to amiodarone in this prophylactic regime. CONCLUSIONS: For patients undergoing surgery for lung cancer, routine use of postoperative prophylactic intravenous bolus and five subsequent days of oral amiodarone therapy reduces the risk of atrial...... on the randomized, controlled, double-blinded PASCART study, using avoidance of atrial fibrillation as the measure of benefit. Two hundred and fifty-four eligible, consecutively enrolled patients, undergoing surgery for lung cancer at the department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital...

[Fatal air embolism during open eye surgery].

Science.gov (United States)

Dermigny, F; Daelman, F; Guinot, P-G; Hubert, V; Jezraoui, P; Thomas, F; Milazzo, S; Dupont, H

2008-10-01

Gas embolism is well known for a specific subset of surgical interventions. Prevention and early detection are the main objectives of the anesthetic and surgical team. However, it may exceptionally occur during eye surgery with dramatic outcomes. We report the case of a 51-year-old man, ASA physical status 1, who presented a cardiac arrest during an open eye surgery for the extraction of a foreign body with intraocular air injection. Multiple organ failure has not been improved by hyperbaric oxygen therapy and the outcome was fatal.

[Indications for surgery in thyroiditis].

Science.gov (United States)

Diaconescu, M R; Glod, M; Costea, I; Grigorovici, M; Diaconescu, S

2012-01-01

Inflammatory processes of the thyroid represents a main proportion of the gland's pathology but the majority of them are treated by medical methods, surgery being indicated. In 14 cases (3%) from 464 operations for different thyroid conditions we have encountered authentic inflammatory lesions in 9 cases of Hashimoto's thyroiditis (two associated with papillary thyroid carcinoma and one with malignant lymphoma), two cases of Riedel's thyroiditis and respectively de Quervain thyoiditis, tuberculous thyroiditis and actynomicosis one case each. The common lymphoplasmacytic infiltration in Basedow's disease was not considered likewise as the inflammatory nespecific lesions encountered in benign and malignant pathology of the gland. The clinical and imagistic data, biological evaluation and titer of anticorps but particularly the paraffine examination together with intraoperative estimations are decisive for the diagnosis. Firm diagnosis of thyroiditis was rarely affirmed before operation, surgical indication being formulated on clinical criterions dominated by cancer suspicion. Among these are diffuse or (multi)nodular thyromegaly with a dominant nodule with recent appearance and rapid growing in temporal and geographic proximity of Chemobyl disaster, with hard consistence, celsian or compressive features and adenopathy. More added the imagistic signs but especially suspect aspects of the FNAB (follicular or with Hürthle cells smears) and also of the frozen sections. Certainty diagnosis was established by paraffine examination not always without hesitations or reexamination (Hashimoto's thyroiditis diagnosed in one case was finally a malignant lymphoma). Large removal decided after intraoperative findings induced for the most of patients a definitive hypothyroidism. All the diagnosis resources must be exhausted for the diagnosis of the inflammatory lesions of the thyroid to avoid unnecessary surgery. On the other side the chronic overstimulation by the TSH of the

Managing spine surgery referrals: The consultation of neurosurgery and its nuances.

Science.gov (United States)

Debono, B; Sabatier, P; Koudsie, A; Buffenoir, K; Hamel, O

2017-09-01

Spinal disorders, particularly low back pain, are among the most common reasons for general practitioner (GP) consultation and can sometimes be a source of professional friction. Despite their frequency and published guidelines, many patients are still mistakenly referred by their GP to specialists for spinal surgery consultation which can create colleague relationship problems, suboptimal or unnessary delayed care, as well as the financial implications for patients. To assess the management of GP lumbar spine referrals made to 4 neurosurgeons from 3 neurosurgical teams specialized in spinal surgery. All patient's medical records relating to 672 primary consultants over a period of two months (January and February 2015) at three institutions were retrospectively reviewed. Medical referral letters, clinical evidence and imaging data were analyzed and the patients were classified according the accuracy of surgical assessment. The final decisions of the surgeons were also considered. Of the 672 patients analyzed, 198 (29.5%) were considered unsuitable for surgical assessment: no spinal pathology=10.6%, no surgical conditions=35.4%, suboptimal medical treatment=31.3%, suboptimal radiology=18.2% and asymptomatic patients=4.5%. Unnecessary referrals to our consultation centers highlight the gap between the reason for the consultation and the indications for spinal surgery. Compliance with the guidelines, the creation of effective multidisciplinary teams, as well as the "hands on" involvement of surgeons in primary and continuing education of physicians are the best basis for a reduction in inappropriate referrals and effective patient care management. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Characteristics of Hemorrhagic Stroke following Spine and Joint Surgeries

Directory of Open Access Journals (Sweden)

Fei Yang

2017-01-01

Full Text Available Hemorrhagic stroke can occur after spine and joint surgeries such as laminectomy, lumbar spinal fusion, tumor resection, and total joint arthroplasty. Although this kind of stroke rarely happens, it may cause severe consequences and high mortality rates. Typical clinical symptoms of hemorrhagic stroke after spine and joint surgeries include headache, vomiting, consciousness disturbance, and mental disorders. It can happen several hours after surgeries. Most bleeding sites are located in cerebellar hemisphere and temporal lobe. A cerebrospinal fluid (CSF leakage caused by surgeries may be the key to intracranial hemorrhages happening. Early diagnosis and treatments are very important for patients to prevent the further progression of intracranial hemorrhages. Several patients need a hematoma evacuation and their prognosis is not optimistic.

Postoperative infections after major heart surgery and prevention of ventilator-associated pneumonia: a one-day European prevalence study (ESGNI-008).

Science.gov (United States)

Bouza, E; Hortal, J; Muñoz, P; Pascau, J; Pérez, M J; Hiesmayr, M

2006-11-01

Few data have been published on the prevalence of postoperative infection in patients undergoing major heart surgery (MHS). The degree of compliance with standard measures used to prevent them is unknown. This study assessed the prevalence of infections, particularly ventilator-associated pneumonia (VAP), in patients undergoing MHS in 42 institutions from 13 European countries. On the study day, there were 321 postoperative MHS patients, of whom 164 (51%) were mechanically ventilated. The overall prevalence of infection was 26.8%. Lower respiratory tract infections represented 57% of all the infections present on the study day. Other infections included intravenous-catheter-related bloodstream infections (2.8%), surgical site infections (2.2%), urinary tract infections (0.9%) and postoperative mediastinitis (0.9%). Of the mechanically ventilated patients, 55 (33.5%) were not being nursed in a semi-recumbent position, 36 (22%) had heat-moisture exchangers with no antibacterial filters, and intracuff pressure was not monitored in 78 patients (47.6%). Only 13 patients (8%) were given continuous subglottic suctioning, 64 patients (39%) did not receive postural oscillation, and gastric overdistension was not actively prevented in 23 patients (14%). In conclusion, these data from intensive care units across Europe provide information on postoperative infections in an important subset of the patient population, and stress the need for active interventions to prevent VAP in patients undergoing MHS.

[The role of antiarrhythmic surgery in 2004].

Science.gov (United States)

Guiraudon, G M

2004-11-01

In 2004, surgery for cardiac arrhythmias addresses essentially atrial fibrillation. Surgery is only a rare alternative for other cardiac arrhythmias in center that still have the surgical skill. Surgery for atrial fibrillation has the definite advantage of concomitant exclusion of the left atrial appendage which is the predominant site of intra-atrial thrombi with the associated risk of severe thrombo-embolic events. Our experience with surgery for lone atrial fibrillation, using the Corridor III operation, shows that surgery is associated with high efficacy and long term control of arrhythmia when the surgical technique is well performed. Failures were associated with incomplete line of block or exclusion. This experience shows the necessity of postoperative EP testing. Initially performed using open heart technique, surger for atrial fibrillation is now performed using mini-invasive technique. Indications for surgery for lone atrial fibrillation will decreased while other strategies are developing. To remain competitive surgery must have high efficacy and use mini-invasive techniques. i.e.: closed off pump beating heart via port access. Surgery for atrial fibrillation concomitant with other cardiac surgical repairs yields remarkable results, without increased surgical risk. Their indications go beyond mitral valve pathology. Future developments imply the following conditions: atrial surgery must not increase morbidity, and its cost-effectiveness must be documented. Combined surgery must be testable and tested to gain valid pathophysiological data to improve surgical rationales. Its impact in terms of survival, prevention of thrombo-embolic events and quality of life will be documented by clinical trials.

Multimodal prevention of pain, nausea and vomiting after breast cancer surgery

DEFF Research Database (Denmark)

Gärtner, Rune; Kroman, N; Callesen, T

2010-01-01

Despite many one- or two-modal attempts to relieve postoperative nausea and vomiting (PONV) and pain, postoperative issues following breast cancer surgery remain a substantial problem. Therefore, the aim of this explorative, hypothesis-generating study was to evaluate the effect of a multimodal...

Preventing bleeding and thromboembolic complications in atrial fibrillation patients undergoing surgery

Directory of Open Access Journals (Sweden)

Charles André

2015-08-01

Full Text Available Neurologists feel uneasy when asked about temporary anticoagulant interruption for surgery in patients with atrial fibrillation (AF. Rational decisions can be made based on current scientific evidence. Method Critical review of international guidelines and selected references pertaining to bleeding and thromboembolism during periods of oral anticoagulant interruption. Results Withholding oral anticoagulants leads to an increased risk of perioperative thromboembolism, depending on factors such as age, renal and liver function, previous ischemic events, heart failure etc. Surgeries are associated with a variable risk of bleeding - from minimal to very high. Individualized decisions about preoperative drug suspension, bridging therapy with heparin and time to restart oral anticoagulants after hemostasis can significantly reduce these opposing risks. Conclusion Rational decisions can be made after discussion with all Health care team professionals involved and consideration of patient fears and expectations. Formal written protocols should help managing antithrombotic treatment during this delicate period.

Postoperative ileus - an update on preventive techniques

DEFF Research Database (Denmark)

Kehlet, H.

2008-01-01

This article reviews techniques currently used to prevent or reduce the duration of postoperative ileus (POI), which is considered an undesirable stress response to major abdominal surgery that leads to discomfort, morbidity and prolonged hospital stay. In several randomized studies, a number...... institution of oral feeding and laparoscopic surgery might also be effective, but there is less clear evidence available to support their use. When some of these techniques are combined as part of the concept of multimodal postoperative rehabilitation (fast-track surgery), the duration of POI after open...

Orthopaedic surgeries - assessment of ionising radiations exposure in health care workers

International Nuclear Information System (INIS)

Leite, E.S.; Uva, A.S.

2006-01-01

Full text of publication follows: 1. Objectives: The health care workers are exposed to ionizing radiations during their activities. In the operating rooms, the ionizing radiations are used in orthopaedic surgery and the dose depends on some factors, like the characteristics of the equipment. This study aims to: Estimate the occupational dose of ionizing radiations exposure of the orthopaedic doctors and nurses during the orthopaedic surgeries, in a Portuguese operating room; Sensitize the health care workers to use the individual dosimeter and to adopt radiation preventive measures. 2. Population and methods The study was conducted on nine Orthopaedic doctors and two nurses of an operating room of a hospital in Lisbon neighborhoods. We made a risk evaluating concerning: the radiations dose in different points, corresponding to gonads, hands and crystalline lens levels of all the professionals, during the surgeries; the average period of radiation in the orthopaedic surgeries; the number of annual orthopaedic surgeries, looking for that in the surgeries registers, to estimate the annual ionizing radiations dose of each orthopaedic doctor and nurse. 3. Results The annual doses estimated at different levels for orthopaedic doctors were the following: gonads: between 20,63 and 68,75 mGy; hands: 4,95 16,50 mGy; crystalline lens: 8,25 27,50 mGy). For the orthopaedic nurses: gonads: 130,63 151,25 mGy; hands: 31,35 36,30 mGy; crystalline lens 52,25 60,25 mGy. 4. Conclusions Although the location and positions of health care workers are not the same during the different surgeries and the equipment has an automatic control of the X ray emission, the annual ionizing radiations dose exposure for health care workers is an important one. The risk rating justifies the use of individual dosimeters for better individual dose assessment as part of an ionizing radiations prevention program. As a matter of fact preventive measures begin with a good quantitative risk assessment of

Prophylactic levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease.

Science.gov (United States)

Hummel, Johanna; Rücker, Gerta; Stiller, Brigitte

2017-08-02

Low cardiac output syndrome remains a serious complication, and accounts for substantial morbidity and mortality in the postoperative course of paediatric patients undergoing surgery for congenital heart disease. Standard prophylactic and therapeutic strategies for low cardiac output syndrome are based mainly on catecholamines, which are effective drugs, but have considerable side effects. Levosimendan, a calcium sensitiser, enhances the myocardial function by generating more energy-efficient myocardial contractility than achieved via adrenergic stimulation with catecholamines. Thus potentially, levosimendan is a beneficial alternative to standard medication for the prevention of low cardiac output syndrome in paediatric patients after open heart surgery. To review the efficacy and safety of the postoperative prophylactic use of levosimendan for the prevention of low cardiac output syndrome and mortality in paediatric patients undergoing surgery for congenital heart disease. We identified trials via systematic searches of CENTRAL, MEDLINE, Embase, and Web of Science, as well as clinical trial registries, in June 2016. Reference lists from primary studies and review articles were checked for additional references. We only included randomised controlled trials (RCT) in our analysis that compared prophylactic levosimendan with standard medication or placebo, in infants and children up to 18 years of age, who were undergoing surgery for congenital heart disease. Two review authors independently extracted data and assessed risk of bias according to a pre-defined protocol. We obtained additional information from all but one of the study authors of the included studies. We used the five GRADE considerations (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of evidence from the studies that contributed data to the meta-analyses for the prespecified outcomes. We created a 'Summary of findings' table to

Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial

Science.gov (United States)

Skinner, Elizabeth H; Browning, Laura; Reeve, Julie; Anderson, Lesley; Hill, Cat; Robertson, Iain K; Story, David; Denehy, Linda

2018-01-01

Abstract Objective To assess the efficacy of a single preoperative physiotherapy session to reduce postoperative pulmonary complications (PPCs) after upper abdominal surgery. Design Prospective, pragmatic, multicentre, patient and assessor blinded, parallel group, randomised placebo controlled superiority trial. Setting Multidisciplinary preadmission clinics at three tertiary public hospitals in Australia and New Zealand. Participants 441 adults aged 18 years or older who were within six weeks of elective major open upper abdominal surgery were randomly assigned through concealed allocation to receive either an information booklet (n=219; control) or preoperative physiotherapy (n=222; intervention) and followed for 12 months. 432 completed the trial. Interventions Preoperatively, participants received an information booklet (control) or an additional 30 minute physiotherapy education and breathing exercise training session (intervention). Education focused on PPCs and their prevention through early ambulation and self directed breathing exercises to be initiated immediately on regaining consciousness after surgery. Postoperatively, all participants received standardised early ambulation, and no additional respiratory physiotherapy was provided. Main outcome measures The primary outcome was a PPC within 14 postoperative hospital days assessed daily using the Melbourne group score. Secondary outcomes were hospital acquired pneumonia, length of hospital stay, utilisation of intensive care unit services, and hospital costs. Patient reported health related quality of life, physical function, and post-discharge complications were measured at six weeks, and all cause mortality was measured to 12 months. Results The incidence of PPCs within 14 postoperative hospital days, including hospital acquired pneumonia, was halved (adjusted hazard ratio 0.48, 95% confidence interval 0.30 to 0.75, P=0.001) in the intervention group compared with the control group, with an absolute

Review Of Prevention Techniques For Denial Of Service DOS Attacks In Wireless Sensor Network

Directory of Open Access Journals (Sweden)

Poonam Rolla

2015-08-01

Full Text Available Wireless Sensor Networks comprised of several tiny sensor nodes which are densely deployed over the region to monitor the environmental conditions. These sensor nodes have certain design issues out of which security is the main predominant factor as it effects the whole lifetime of network. DDoS Distributed denial of service attack floods unnecessary packets in the sensor network. A review on DDoS attacks and their prevention techniques have been done in this paper.

Reply to: Mounting evidence indicates that escalating doses of allopurinol are unnecessary for cardiovascular protection.

Science.gov (United States)

Coburn, Brian W; Michaud, Kaleb; Bergman, Debra A; Mikuls, Ted R

2018-05-08

We thank Dr. Bredemeier for his comments regarding our manuscript on allopurinol dose escalation and mortality. He raises important evidence to consider in support of an interesting hypothesis that dose escalation may be unnecessary for allopurinol's cardiovascular (CV) protection and may actually be related to adverse CV outcomes. While we agree that evidence exists suggesting that low doses of allopurinol may be sufficient for CV protection, we believe that the studies cited highlight a number of areas where knowledge gaps remain which preclude any definitive conclusions about the effect of dose escalation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Quality of patient education materials for rehabilitation after neurological surgery.

Science.gov (United States)

Agarwal, Nitin; Sarris, Christina; Hansberry, David R; Lin, Matthew J; Barrese, James C; Prestigiacomo, Charles J

2013-01-01

To evaluate the quality of online patient education materials for rehabilitation following neurological surgery. Materials were obtained from the National Institute of Neurological Disorders and Stroke (NINDS), U.S. National Library of Medicine (NLM), American Occupational Therapy Association (AOTA), and the American Academy of Orthopaedic Surgeons (AAOS). After removing unnecessary formatting, the readability of each site was assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level evaluations with Microsoft Office Word software. The average values of the Flesch Reading Ease and Flesch-Kincaid Grade Level were 41.5 and 11.8, respectively, which are well outside the recommended reading levels for the average American. Moreover, no online section was written below a ninth grade reading level. Evaluations of several websites from the NINDS, NLM, AOTA, and AAOS demonstrated that their reading levels were higher than that of the average American. Improved readability might be beneficial for patient education. Ultimately, increased patient comprehension may correlate to positive clinical outcomes.

Peri-operative oral caffeine does not prevent postoperative atrial fibrillation after heart valve surgery with cardiopulmonary bypass: A randomised controlled clinical trial.

Science.gov (United States)

Lagier, David; Nee, Laetitia; Guieu, Régis; Kerbaul, François; Fenouillet, Emmanuel; Roux, Nicolas; Giorgi, Roch; Theron, Alexis; Grisoli, Dominique; Gariboldi, Vlad; Collart, Frederic; Bruder, Nicolas; Velly, Lionel; Guidon, Catherine

2018-04-26

Raised plasma levels of endogenous adenosine after cardiac surgery using cardiopulmonary bypass (CPB) have been related to the incidence of postoperative atrial fibrillation (POAF). We wished to assess if caffeine, an adenosine receptor antagonist could have a beneficial effect on the incidence of POAF. A randomised controlled study. Single University Hospital. One hundred and ten patients scheduled for heart valve surgery with CPB. We randomly assigned patients to receive peri-operative oral caffeine (400 mg every 8 h for 2 days) or placebo. Adenosine plasma concentrations and caffeine pharmacokinetic profile were evaluated in a subgroup of 50 patients. The primary endpoint was the rate of atrial fibrillation during postoperative hospital stay. The current study was stopped for futility by the data monitoring board after an interim analysis. The incidence of atrial fibrillation was similar in the caffeine and in the placebo group during hospital stay (33 vs. 29%, P = 0.67) and the first 3 postoperative days (18 vs. 15%; P = 0.60). Basal and postoperative adenosine plasma levels were significantly associated with the primary outcome. Adenosine plasma levels were similar in the two treatment groups. Caffeine administration was associated with a higher incidence of postoperative nausea and vomiting (27 vs. 7%, P = 0.005). Oral caffeine does not prevent POAF after heart valve surgery with CPB but increased the incidence of postoperative nausea and vomiting. ClinicalTrials.gov, no.: NCT01999829.

A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria.

Science.gov (United States)

Irfan, Neal; Brooks, Annie; Mithoowani, Siraj; Celetti, Steve J; Main, Cheryl; Mertz, Dominik

2015-01-01

Asymptomatic bacteriuria (ABU) should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice. To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU. Quasi-experimental study with a control group. Two tertiary teaching adult care hospitals. Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline) and January 30th and April 30th, 2013 (intervention). In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly) on one clinical teaching unit (CTU) at one hospital site, with the CTU of the other hospital serving as the control. During the baseline period, 160/341 (46.9%) positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8%) were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3), absence of a catheter (OR 2.5, 1.2-5), bacteriuria versus candiduria (OR 10.6, 3.8-29.4), pyuria (OR 2.0, 1.1-3.8), and positive nitrites (OR 2.2, 1.1-4.5). In 2013, only 2/24 (8%) of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52%) on the control CTU (OR 0.10; 95% CI 0.02-0.49). A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7) with no significant change noted on the control CTU (OR 0.47, 0.13-1.7). A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.

A Controlled Quasi-Experimental Study of an Educational Intervention to Reduce the Unnecessary Use of Antimicrobials For Asymptomatic Bacteriuria.

Directory of Open Access Journals (Sweden)

Neal Irfan

Full Text Available Asymptomatic bacteriuria (ABU should only be treated in cases of pregnancy or in-patients undergoing urologic procedures; however, unnecessary treatment of ABU is common in clinical practice.To identify risk factors for unnecessary treatment and to assess the impact of an educational intervention focused on these risk factors on treatment of ABU.Quasi-experimental study with a control group.Two tertiary teaching adult care hospitals.Consecutive patients with positive urine cultures between January 30th and April 17th, 2012 (baseline and January 30th and April 30th, 2013 (intervention.In January 2013, a multifaceted educational intervention based on risk factors identified during the baseline period was provided to medical residents (monthly on one clinical teaching unit (CTU at one hospital site, with the CTU of the other hospital serving as the control.During the baseline period, 160/341 (46.9% positive urine cultures were obtained from asymptomatic patients at the two hospitals, and 94/160 (58.8% were inappropriately treated with antibiotics. Risk factors for inappropriate use included: female gender (OR 2.1, 95% CI 1.1-4.3, absence of a catheter (OR 2.5, 1.2-5, bacteriuria versus candiduria (OR 10.6, 3.8-29.4, pyuria (OR 2.0, 1.1-3.8, and positive nitrites (OR 2.2, 1.1-4.5. In 2013, only 2/24 (8% of ABU patients were inappropriately treated on the intervention CTU as compared to 14/29 (52% on the control CTU (OR 0.10; 95% CI 0.02-0.49. A reduction was also observed as compared to baseline on the intervention CTU (OR 0.1, 0.02-0.7 with no significant change noted on the control CTU (OR 0.47, 0.13-1.7.A multifaceted educational intervention geared towards medical residents with a focus on identified risk factors for inappropriate management of ABU was effective in reducing unnecessary antibiotic use.

Taiwan experience suggests that RhD typing for blood transfusion is unnecessary in southeast Asian populations.

Science.gov (United States)

Lin, Marie

2006-01-01

The high frequency of RhD (D) antigen among Taiwanese persons (99.67%) often imposes unnecessary risks of under-transfusion on D- patients awaiting D- blood. Also because of the rare occurrence of anti-D among Taiwanese persons, routine pretransfusion D typing has been discontinued in the Mackay Memorial Hospital since 1988. This report is the retrospective evaluation of the outcome of abolishing RhD typing for Taiwanese. More than 10 years of alloantibody data at Mackay Memorial Hospital Blood Bank were reviewed. The cases with anti-D were further used to analyze the potency of D antigen and to observe whether there were differences in the incidence of anti-D before and after discontinuation of routine D typing among Taiwanese individuals. The incidence of anti-D before and after discontinuation of routine pretransfusion D typing has remained unchanged. The immunogenicity of D and "Mi(a)" in Taiwanese persons is found to be similar. In terms of opportunity for immunization, however, the "Mi(a)" antigen (phenotype frequency 7.3% in Taiwanese persons) has become the most important blood group antigen in Taiwan. The results strongly support the exclusion of D typing from routine compatibility testing for individuals of Taiwanese origin. Because the low incidence of D- and relatively high incidence of "Mi(a)"+ phenotypes are common findings throughout southeast Asia, and because a population genetic study revealed that the Taiwanese people are genetically related to southern Asian populations, it is suggested that RhD typing for blood transfusion is unnecessary among southeast Asian populations.

Comparing consensus guidelines on thromboprophylaxis in orthopedic surgery

NARCIS (Netherlands)

Struijk-Mulder, M. C.; Ettema, H. B.; Verheyen, C. C.; Büller, H. R.

2010-01-01

BACKGROUND: Different guidelines exist regarding the prevention of venous thromboembolism (VTE) in orthopedic surgery. OBJECTIVES: We aimed to compare (inter)national guidelines and analyse differences. Methods: MEDLINE, the Cochrane Library and the internet were searched for guidelines on the

Trial Manufacture and Evaluation of a Hologram with an unnecessary development process at 1.55 μm

OpenAIRE

大島, 茂

2016-01-01

A holographic optical element (HOE) for optical fiber coupling has been investigated. The hologram with an unnecessary development process has been manufactured at wavelength of 1.55μm. Diimonium organic dye was used for photosensitive material. Because diimonium organic dye did not stick to a plate glass, acrylic resin was used for binder resin. The thin film of the organic dye was exposed by improved equipment for high power light irradiation at wavelength of 1.55μm. The thin film became th...

A systematic review of laparoscopic port site hernias in gastrointestinal surgery.

LENUS (Irish Health Repository)

Owens, M

2012-02-01

INTRODUCTION: Port site hernia is an important yet under-recognised complication of laparoscopic surgery, which carries a high risk of strangulation due to the small size of the defect involved. The purpose of this study was to examine the incidence, classification, and pathogenesis of this complication, and to evaluate strategies to prevent and treat it. METHODS: Medline was searched using the words "port site hernia", "laparoscopic port hernia" "laparoscopic complications" and "trocar site hernias". The search was limited to articles on cholecystectomy, colorectal, bariatric or anti-reflux surgery published in English. A total of 42 articles were analysed and of these 35 were deemed eligible for review. Inclusion criteria were laparoscopic gastrointestinal surgery in English only with reported incidence of port site herniation. Studies were excluded if insufficient data was provided. Eligible studies were also cross-referenced. RESULTS: Analysis of 11,699 patients undergoing laparoscopic gastrointestinal procedures demonstrated an incidence of port site hernias of 0.74% with a mean follow-up of 23.9 months. The lowest incidence of port site herniation was for bariatric surgery with 0.57% in 2644 patients with a mean follow-up of 67.4 months while the highest incidence was for laparoscopic colorectal surgery with an incidence of 1.47% in 477 patients with a mean follow-up of 71.5 months. CONCLUSION: All fascial defects larger than or equal to 10mm should be closed with peritoneum, while smaller defects may require closure in certain circumstances to prevent herniation. Laparoscopic port site herniation is a completely preventable cause of morbidity that requires a second surgical procedure to repair.

Optimal anaesthesia techniques for penile surgeries

Directory of Open Access Journals (Sweden)

Yu. A. Myagkov

2016-01-01

Full Text Available Spinal anaesthesia as a method of central neuraxial blockade is the best choice for penile surgeries due to the following reasons: protection against intraoperative stress and early postoperative pain, simplicity of the procedure which does not depend on constitutional and anatomical features of a patient, prevention of postoperative complications.

Evaluation of povidone-iodine applications in cataract surgery

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Xi Zhang

2013-09-01

Full Text Available As a routine measure to prevent intraocular inflammation, rinsing conjunctival sac with povidone-iodine(PVP-Ihas been increasingly adopted in cataract surgery. It can effectively reduce the complications of cataract surgery, including endophthalmitis and corneal complications. However, PVP-I itself has certain side effects. Therefore, to achieve the best bactericidal effect and to avoid eye injury, it is necessary to find out the optimal treatment duration and concentration. This article offers a review on the latest researches worldwide in this field.

Innovative One Step Melanoma Surgical Approach (OSMS: Not a Myth-It’s a Reality! Case Related Analysis of a Patient with a Perfect Clinical Outcome Reported from the Bulgarian Society for Dermatologic Surgery (BULSDS!

Directory of Open Access Journals (Sweden)

Georgi Tchernev

2018-04-01

CONCLUSION: Thanks to this new approach, some patients could avoid one surgical intervention, which could be interpreted as a significant advantage or probably also survival benefit. This methodology and its successful application were first officialised by the representatives of the Bulgarian Society for Dermatologic Surgery- (BULSDS, and the purpose of this action, in general, is to fully improve clinical management of patients suffering from cutaneous melanoma in terms of compactness by 1 reducing the number of unnecessary surgeries or the number of surgical interventions in general; 2 reducing side effects occurring in surgeries and 3 introducing a serious optimization in terms of financial resources needed or used in the second hospitalization of patients. The question remains open whether the accepted or the current recommendations for surgical treatment of melanoma will be transformed or adapted for the matching patient groups.

An anaesthetic pre-operative assessment clinic reduces pre-operative inpatient stay in patients requiring major vascular surgery.

LENUS (Irish Health Repository)

O'Connor, D B

2012-02-01

BACKGROUND: Patients undergoing major vascular surgery (MVS) require extensive anaesthetic assessment. This can require extended pre-operative stays. AIMS: We investigated whether a newly established anaesthetic pre-operative assessment clinic (PAC) would reduce the pre-operative inpatient stay, avoid unnecessary investigations and facilitate day before surgery (DBS) admissions for patients undergoing MVS. PATIENT AND METHODS: One year following and preceding the establishment of the PAC the records of patients undergoing open or endovascular aortic aneurysm repair, carotid endarterectomy and infra-inguinal bypass were reviewed to measure pre-operative length of stay (LoS). RESULTS: Pre-operative LoS was significantly reduced in the study period (1.85 vs. 4.2 days, respectively, P < 0.0001). Only 12 out of 61 patients in 2007 were admitted on the DBS and this increased to 33 out of 63 patients (P = 0.0002). No procedure was cancelled for medical reasons. CONCLUSION: The PAC has facilitated accurate outpatient anaesthetic assessment for patients requiring MVS. The pre-operative in-patient stay has been significantly reduced.

Patients' perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study.

Science.gov (United States)

Najafzadeh, M; Kim, S C; Patterson, C; Schneeweiss, S; Katz, J N; Brick, G W; Ready, J E; Polinski, J M; Patorno, E

2015-10-26

The 9th edition of the American College of Chest Physicians' Antithrombotic Therapy and Prevention of Thrombosis guidelines emphasize the importance of considering the risk-benefit ratio of "patient-important" outcomes. However, little is known about patients' perception and understanding regarding the different outcomes of antithrombotic treatment after orthopedic surgery, and the factors that influence their decision to use these treatments. Using a series of semi-structured interviews, we explored patients' understanding and perception concerning the benefits and risks of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after joint replacement surgery. A series of semi-structured interviews were conducted with patients who had undergone knee or hip replacement surgery at a tertiary care hospital (Brigham and Women's Hospital, Boston, MA) in 2014. Discussions were recorded and transcribed. Two investigators independently coded and analyzed the data to identify important themes and concepts using the constant comparative method. Of 64 patients who were invited, 12 patients (19 %) completed the interviews. The majority of patients (92 %) were aware of the benefits of antithrombotic therapy for reducing the risk of blood clots, while less than half of them had a clear understanding of deep vein thrombosis and pulmonary embolism. While all patients were aware of risk of minor bleeding, only 6 patients (50 %) considered the risk of major bleeding as a possible side effect of antithrombotic treatment. Overall, patients perceived bleeding as a less important outcome than a thrombotic event. The lack of awareness about the risk of major bleeding, the assumption that a short-term exposure would not meaningfully affect bleeding risk, and the assumption that bleeding is a controllable event influenced their perception. Most patients (83 %) stated that their decision to use antithrombotic medications was mainly based on the trust in their

Antibiotic prophylaxis in third molar surgery: a review

NARCIS (Netherlands)

Oomens, Marjolijn A. E.; Forouzanfar, Tymour

2012-01-01

Objective. Controversy exists about the efficacy of antibiotic prophylaxis in preventing complications after lower third molar surgery. For evidence-based recommendation, a review was performed on clinical trials reporting the use of antibiotic prophylaxis compared with no treatment or placebo with

Antibiotic prophylaxis in third molar surgery: a review

NARCIS (Netherlands)

Oomens, M.A.E.; Forouzanfar, T.

2012-01-01

Objective Controversy exists about the efficacy of antibiotic prophylaxis in preventing complications after lower third molar surgery. For evidence-based recommendation, a review was performed on clinical trials reporting the use of antibiotic prophylaxis compared with no treatment or placebo with

[Postoperative recurrence of Crohn's disease, and its prevention].

Science.gov (United States)

Lakatos, László; Lakatos, Péter László

2010-05-23

Crohn's disease is a chronic, progressive disabling condition ultimately leading to stricturing and/or penetrating complications. The need for surgery may be as high as 70% in patients with severe active disease or complications. However, relapse may develop in a significant proportion of the patients after surgery leading to frequent re-operations. Despite emerging data, postoperative prevention is still controversial. After careful evaluation of the individual risk a tailored therapy should be considered. In patients with small risk for relapse mesalazine or in selected cases no-treatment may be an option. In patients with a moderate-to-high risk azathioprine should be considered together with metronidazole in the three months. Follow-up ileocolonoscopy 6-12 months after the surgery is helpful in the determination of endoscopic severity and may assist in the optimization of the therapy. In most severe cases anti-TNF agents may be appropriate for postoperative prevention and therapy.

Modeling and Analysis of Surgery Patient Identification Using RFID

OpenAIRE

Byungho Jeong; Chen-Yang Cheng; Vittal Prabhu

2009-01-01

This article proposes a workflow and reliability model for surgery patient identification using RFID (Radio Frequency Identification). Certain types of mistakes may be prevented by automatically identifying the patient before surgery. The proposed workflow is designed to ensure that both the correct site and patient are engaged in the surgical process. The reliability model can be used to assess improvements in patients’ safety during this process. A proof-of-concept system is developed to ...

The role of parental health care utilization in children's unnecessary utilization in China: evidence from Shaanxi province.

Science.gov (United States)

Zhang, Yi; Zhou, Zhongliang; Si, Yafei

2017-03-09

China has a large population of children under 18 years of age, whose health is of great concern to the Chinese health care system. However, few studies have been conducted to analyze the factors associated with children's unnecessary health care utilization in China. The objective of this study is to provide some empirical evidence on this issue by investigating the role of parental health care utilization in children's unnecessary health care use. The data were obtained from the fifth Health Service Survey of Shaanxi province in 2013. We employed three dependent variables to measure children's health care utilization: the number of children's outpatient visits during the past 2 weeks, whether or not infusion was used if the child had any outpatient visits during the past 2 weeks, and the number of children's inpatient visits during last year. Based on specific characteristics of these outcome variables, negative binomial models were used for the non-negative numbers of outpatient and inpatient visits, while a probit model was used for the zero-one indicator variable showing whether infusion was used during outpatient visits. Based on a sample of 11,024 children, our results of multivariate analysis showed that children whose parents used outpatient care were estimated to have a larger number of outpatient visits than those whose parents did not have outpatient visits in the past 2 weeks (with a difference of 0.0393 visits). Among children having outpatient visits in the last 2 weeks, the probability of obtaining infusion was 57.01 percentage points higher for children whose parents used infusion in the past 2 weeks than the probability for those whose parents did not use infusion. The predicted number of inpatient visits was higher for children whose parents used inpatient services in the last year, compared with the group whose parents did not use (with a difference of 0.0567 visits). Moreover, we noted that the positive association between parental and

Use of antifibrinolytic mouthwash solution in anticoagulated oral surgery patients

OpenAIRE

Dimova, Cena; Evrosimovska, Biljana; Papakoca, Kiro; Georgiev, Zlatko; Angelovska, Bistra; Ristoska, Sonja

2012-01-01

Introduction:The ordinary treatment of anticoagulated patients includes the interruption of anticoagulant therapy for oral surgery interventions to prevent hemorrhage. However, this practice may logically increase the risk of a potentially life-threatening thromboembolism, so this issue is still controversial. The aim of the study was to evaluate the antifibrinolitic mouthwash solution (tranexamic acid) as a local haemostatic modality after oral surgery interventions. Methods:To realize the a...

Peritoneal adhesions after laparoscopic gastrointestinal surgery.

Science.gov (United States)

Mais, Valerio

2014-05-07

Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue. Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis. Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact. Experimental data in animal models have suggested that CO₂ pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration. Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO₂, N₂O and O₂ seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum. However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation. In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers. Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects. Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available. Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers. Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers. Moreover, when barriers have been used alone, the maximum protection against adhesion formation has been no

Changes in Hematology and Calcium Metabolism After Gastric Bypass Surgery

DEFF Research Database (Denmark)

Worm, Dorte; Madsbad, Sten; Kristiansen, Viggo B

2015-01-01

.001), excessive weight loss in men, and younger age in women (p vitamin B12 increased from before surgery to 24 months after surgery (p Vitamin D increased from baseline to month 24 in both...... months after surgery. Daily supplement of 800 mg calcium, 800 U vitamin D, a multivitamin, and a vitamin B12 injection (1 mg) every third month was recommended. In subjects with low ferritin and decreasing hemoglobin levels, oral, or intravenous iron was administered. RESULTS: Hemoglobin concentration...... sexes (p vitamin D was sufficient. Iron substitution did not prevent anemia, which especially affected premenopausal women. More attention should...

Bariatric Surgery in Adolescents: Is Routine Nutrient Supplementation Sufficient to Avoid Anemia Following Bariatric Surgery?

Science.gov (United States)

Goldberg, Hanna R; Chin, Vivian L; Zitsman, Jeffrey L; Zhang, Chengchen; Williams, Kristen M; Oberfield, Sharon; Fennoy, Ilene

2017-08-01

Anemia following bariatric surgery is a known complication. To prevent nutrient deficiencies, adolescents require multivitamin/mineral supplementation following bariatric surgery. The purpose of this study was to investigate if routine multivitamin/mineral supplementation is sufficient to prevent anemia in adolescents undergoing bariatric surgery, particularly sleeve gastrectomy (SG), a procedure that may induce nutrient malabsorption. We conducted a retrospective review of pediatric patients who underwent SG (34 patients) and laparoscopic adjustable gastric banding (LAGB) (141 patients) (January 2006 through December 2013). We examined anemia marker levels (iron, ferritin, folate, B 12 , hemoglobin, and hematocrit) at first visit and 3, 6, and 12 months postsurgery by repeated-measures analysis adjusting for weight loss. Following SG, folate levels decreased 3 and 6 months postsurgery but returned to baseline levels at 12 months. Furthermore, the SG group demonstrated lower folate levels compared with LAGB at 3 and 6 months. B 12 levels decreased 6 months post-SG but returned to baseline at 12 months. Following LAGB, B 12 levels decreased 12 months postsurgery compared with baseline. Ferritin levels decreased 3 months post-LAGB but returned to baseline levels at 6 months. There were no changes within groups or differences between groups in iron, hemoglobin, or hematocrit. While anemia did not occur in any patients while on recommended routine supplementation, folate levels were significantly reduced following SG and were lower in SG compared with LAGB patients. Additional folate supplementation seemed to improve folate levels, which highlights the importance of ongoing surveillance by primary care providers and the need for additional folate supplementation following SG.

Combined stress urinary incontinence surgery at the time of ...

African Journals Online (AJOL)

based approach to the problem of preventing stress urinary incontinence (SUI) following prolapse surgery. Design. We reviewed the current English language literature available on PubMed (Medline), as well as current relevant textbooks in print.

Dabigatran in patients with myocardial injury after non-cardiac surgery (MANAGE)

DEFF Research Database (Denmark)

Devereaux, P J; Duceppe, Emmanuelle; Guyatt, Gordon

2018-01-01

BACKGROUND: Myocardial injury after non-cardiac surgery (MINS) increases the risk of cardiovascular events and deaths, which anticoagulation therapy could prevent. Dabigatran prevents perioperative venous thromboembolism, but whether this drug can prevent a broader range of vascular complications...... in patients with MINS is unknown. The MANAGE trial assessed the potential of dabigatran to prevent major vascular complications among such patients. METHODS: In this international, randomised, placebo-controlled trial, we recruited patients from 84 hospitals in 19 countries. Eligible patients were aged...

Proposal of a score to detect the need for postoperative intensive care unit admission after bariatric surgery

Directory of Open Access Journals (Sweden)

Walid H. Nofal

2017-10-01

Full Text Available Background: We developed a multi-dimensional score which may help in predicting those patients, undergoing bariatric surgery, who may be in need for postoperative ICU admission and which may also help in avoiding unnecessary admission to the critical care units after bariatric surgery. Methods: We collected the data of 111patients who underwent either laparoscopic gastric sleeve or bypass and studied the association between some risk factors related to obesity and their postoperative ICU admission. Those factors found to be statistically significant are included in the final score. The cutoff value of our scoring system is determined by running a Receiver Operating Curve (ROC analysis. Results: Forty patients (36% were admitted to the ICU postoperatively. Our final score includes 7 independent variables; 6 found to be significantly related to post-bariatric surgery ICU admission; these are age, gender, BMI, ASA, obstructive sleep apnea and spirometry results, and the seventh is the history of venous thrombo-embolism. According to the ROC curve analysis, we set the score value of 10 as our cut-off value for the need of postoperative ICU admission. The score median value is 9. Males’ odds to be admitted to the ICU after bariatric surgery are 11.9 times higher than females. Also, those with BMI above 50 kg m−2 have odds of 29.8 times higher than those below 50 kg m−2. Conclusions: We propose a scoring system for risk stratification, in which some of the well-known predictor risk factors are included in a simple way to help identify those high-risk patients undergoing bariatric surgery.Trial registry number: NCT02976649. Keywords: Bariatric surgery, Postoperative ICU admission, Score

Unfavourable outcomes in orthognathic surgery

Science.gov (United States)

Bonanthaya, Krishnamurthy; Anantanarayanan, P.

2013-01-01

Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution. PMID:24501454

Unfavourable outcomes in orthognathic surgery

Directory of Open Access Journals (Sweden)

Krishnamurthy Bonanthaya

2013-01-01

Full Text Available Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A Pre- Treatment B During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

Unfavourable outcomes in orthognathic surgery.

Science.gov (United States)

Bonanthaya, Krishnamurthy; Anantanarayanan, P

2013-05-01

Unfavourable outcomes are part and parcel of performing surgeries of any kind. Unfavourable outcomes are results of such work, which the patient and or the clinician does not like. This is an attempt to review various causes for unfavorable outcomes in orthognathic surgery and discuss them in detail. All causes for unfavorable outcomes may be classified as belonging to one of the following periods A) Pre- Treatment B) During treatment Pre-Treatment: In orthognathic surgery- as in any other discipline of surgery- which involves changes in both aesthetics and function, the patient motivation for seeking treatment is a very important input which may decide, whether the outcome is going to be favorable or not. Also, inputs in diagnosis and plan for treatment and its sequencing, involving the team of the surgeon and the orthodontist, will play a very important role in determining whether the outcome will be favorable. In other words, an unfavorable outcome may be predetermined even before the actual treatment process starts. During Treatment: Good treatment planning itself does not guarantee favorable results. The execution of the correct plan could go wrong at various stages which include, Pre-Surgical orthodontics, Intra and Post-Operative periods. A large number of these unfavorable outcomes are preventable, if attention is paid to detail while carrying out the treatment plan itself. Unfavorable outcomes in orthognathic surgery may be minimized If pitfalls are avoided both, at the time of treatment planning and execution.

Operating room fires in periocular surgery.

Science.gov (United States)

Connor, Michael A; Menke, Anne M; Vrcek, Ivan; Shore, John W

2018-06-01

A survey of ophthalmic plastic and reconstructive surgeons as well as seven-year data regarding claims made to the Ophthalmic Mutual Insurance Company (OMIC) is used to discuss operating room fires in periocular surgery. A retrospective review of all closed claim operating room fires submitted to OMIC was performed. A survey soliciting personal experiences with operating room fires was distributed to all American Society of Oculoplastic and Reconstructive Surgeons. Over the last 2 decades, OMIC managed 7 lawsuits resulting from an operating room fire during periocular surgery. The mean settlement per lawsuit was $145,285 (range $10,000-474,994). All six patients suffered burns to the face, and three required admission to a burn unit. One hundred and sixty-eight surgeons participated in the online survey. Approximately 44% of survey respondents have experienced at least one operating room fire. Supplemental oxygen was administered in 88% of these cases. Most surgical fires reported occurred in a hospital-based operating room (59%) under monitored anesthesia care (79%). Monopolar cautery (41%) and thermal, high-temperature cautery (41%) were most commonly reported as the inciting agents. Almost half of the patients involved in a surgical fire experienced a complication from the fire (48%). Sixty-nine percent of hospital operating rooms and 66% of ambulatory surgery centers maintain an operating room fire prevention policy. An intraoperative fire can be costly for both the patient and the surgeon. Ophthalmic surgeons operate in an oxygen rich and therefore flammable environment. Proactive measures can be undertaken to reduce the incidence of surgical fires periocular surgery; however, a fire can occur at any time and the entire operating room team must be constantly vigilant to prevent and manage operating room fires.

Decreasing warfarin sensitivity during the first three months after heart valve surgery : Implications for dosing

NARCIS (Netherlands)

Meijer, K.; Kim, Y. -K.; Schulman, S.

Introduction: Vitamin K antagonists are prescribed to prevent thromboembolic complications after heart valve surgery. In our experience, patients often show a progressive decrease in sensitivity to warfarin after surgery making it difficult to reach and maintain a therapeutic International

Non-indicated use of prophylactic antibiotics in gynaecological surgery at an academic tertiary medical centre.

Science.gov (United States)

Kremer, Kevin M; Foster, Raymond T; Drobnis, Erma Z; Hyde, Kassie J; Brennaman, Lisa M

2018-02-06

Surgical site infections (SSI) are the most common surgical complication. Perioperative antibiotics can reduce SSI when used properly. Despite guidelines from The American College of Obstetrics and Gynecology, non-indicated antibiotic use is widespread which exposes women to unnecessary risks. This study represents a quality improvement analysis assessing surgeon compliance with established guidelines regarding antibiotic use in gynaecological surgery. This is a single centre, retrospective study examining gynaecological procedures over two years. Cases were identified using Current Procedure Terminology codes. Perioperative antibiotics were used contrary to published guidelines in 199 of 1046 cases. Three variables were independently associated with inappropriate administration of perioperative antibiotics: entrance into abdominal cavity, higher EBL, and longer procedures. Impact statement Overuse of antibiotics has unintended consequences including allergic sequelae, extended length of hospital stay, increased healthcare costs, and the formation of antibiotic-resistant organisms. Antibiotic stewardship programmes have been shown to reduce the number of resistant pathogens, decrease incidence of Clostridium difficile colitis, and decrease length of hospital stay without increasing infection rates. Further outcomes-based research is needed regarding the use of antibiotic stewardship programmes in gynaecological surgery.

Endoscopic endonasal transsphenoidal surgery: implementation of an operative and perioperative checklist.

Science.gov (United States)

Christian, Eisha; Harris, Brianna; Wrobel, Bozena; Zada, Gabriel

2014-01-01

Endoscopic endonasal surgery relies heavily on specialized operative instrumentation and optimization of endocrinological and other critical adjunctive intraoperative factors. Several studies and worldwide initiatives have previously established that intraoperative and perioperative surgical checklists can minimize the incidence of and prevent adverse events. The aim of this article was to outline some of the most common considerations in the perioperative and intraoperative preparation for endoscopic endonasal transsphenoidal surgery. The authors implemented and prospectively evaluated a customized checklist at their institution in 25 endoscopic endonasal operations for a variety of sellar and skull base pathological entities. Although no major errors were detected, near misses pertaining primarily to missing components of surgical equipment or instruments were identified in 9 cases (36%). The considerations in the checklist provided in this article can serve as a basic template for further customization by centers performing endoscopic endonasal surgery, where their application may reduce the incidence of adverse or preventable errors associated with surgical treatment of sellar and skull base lesions.

Impact of preoperative patient education on the prevention of postoperative complications after major visceral surgery: the cluster randomized controlled PEDUCAT trial.

Science.gov (United States)

Klaiber, Ulla; Stephan-Paulsen, Lisa M; Bruckner, Thomas; Müller, Gisela; Auer, Silke; Farrenkopf, Ingrid; Fink, Christine; Dörr-Harim, Colette; Diener, Markus K; Büchler, Markus W; Knebel, Phillip

2018-05-24

The prevention of postoperative complications is of prime importance after complex elective abdominal operations. Preoperative patient education may prevent postoperative complications and improve patients' wellbeing, but evidence for its efficacy is poor. The aims of the PEDUCAT trial were (a) to assess the impact of preoperative patient education on postoperative complications and patient-reported outcomes in patients scheduled for elective complex visceral surgery and (b) to evaluate the feasibility of cluster randomization in this setting. Adult patients (age ≥ 18 years) scheduled for elective major visceral surgery were randomly assigned in clusters to attend a preoperative education seminar or to the control group receiving the department's standard care. Outcome measures were the postoperative complications pneumonia, deep vein thrombosis (DVT), pulmonary embolism, burst abdomen, and in-hospital fall, together with patient-reported outcomes (postoperative pain, anxiety and depression, patient satisfaction, quality of life), length of hospital stay (LOS), and postoperative mortality within 30 days after the index operation. Statistical analysis was primarily by intention to treat. In total 244 patients (60 clusters) were finally included (intervention group 138 patients; control group 106 patients). Allocation of hospital wards instead of individual patients facilitated study conduct and reduced confusion about group assignment. In the intervention and control groups respectively, pneumonia occurred in 7.4% versus 8.3% (p = 0.807), pulmonary embolism in 1.6% versus 1.0% (p = 0.707), burst abdomen in 4.2% versus 1.0% (p = 0.165), and in-hospital falls in 0.0% versus 4.2% of patients (p = 0.024). DVT did not occur in any of the patients. Mortality rates (1.4% versus 1.9%, p = 0.790) and LOS (14.2 (+/- 12.0) days versus 16.1 (+/- 15.0) days, p = 0.285) were also similar in the intervention and control groups. Cluster

Prospective study of use of perioperative antimicrobial therapy in general surgery.

LENUS (Irish Health Repository)

Fennessy, Brendan G

2012-02-03

BACKGROUND: Perioperative antimicrobial therapy has demonstrated efficacy in reducing the rate of surgical site infections in clinical trials. With the emergence of antibiotic resistance, the risk of reaction, and the inevitable financial repercussions, use of prophylactic antibiotics is not a panacea, and their misuse may have considerable implications. The aim of this study was to assess the use of antibiotics in the perioperative period in both general and vascular surgery procedures. METHODS: A prospective study was undertaken of 131 patients with a mean age of 43 years (range one month-88 years), of whom 68 (51%) were male, who underwent twenty-seven different general or vascular surgery procedures over a four-week period. Each patient was evaluated from the time of antibiotic commencement through their operative procedure until the treatment was discontinued. RESULTS: A total of 73 patients (54%) received ten antibiotics, with 71 (97%) of these uses being prophylactic. Of the 15 appendectomies performed for uncomplicated appendicitis, the mean number of prophylactic antibiotic doses was 5.3 (range 1-12). Where they were documented, written postoperative directives were not adhered to in 18\\/27 prescriptions (66%). CONCLUSION: This study has demonstrated a lack of adherence to guidelines in the perioperative administration of antimicrobial agents. In addition, it calls attention to the economic implications of unnecessary prophylaxis.

Promoting High-Value Practice by Reducing Unnecessary Transfusions With a Patient Blood Management Program.

Science.gov (United States)

Sadana, Divyajot; Pratzer, Ariella; Scher, Lauren J; Saag, Harry S; Adler, Nicole; Volpicelli, Frank M; Auron, Moises; Frank, Steven M

2018-01-01

Although blood transfusion is a lifesaving therapy for some patients, transfusion has been named 1 of the top 5 overused procedures in US hospitals. As unnecessary transfusions only increase risk and cost without providing benefit, improving transfusion practice is an effective way of promoting high-value care. Most high-quality clinical trials supporting a restrictive transfusion strategy have been published in the past 5 to 10 years, so the value of a successful patient blood management program has only recently been recognized. We review the most recent transfusion practice guidelines and the evidence supporting these guidelines. We also discuss several medical societies' Choosing Wisely campaigns to reduce or eliminate overuse of transfusions. A blueprint is presented for developing a patient blood management program, which includes discussion of specific methods for optimizing transfusion practice.

[Indicators of healthcare quality in day surgery (2010-2012)].

Science.gov (United States)

Martínez Rodenas, F; Codina Grifell, J; Deulofeu Quintana, P; Garrido Corchón, J; Blasco Casares, F; Gibanel Garanto, X; Cuixart Vilamajó, L; de Haro Licer, J; Vazquez Dorrego, X

2014-01-01

Monitoring quality indicators in Ambulatory Surgery centers is fundamental in order to identify problems, correct them and prevent them. Given their large number, it is essential to select the most valid ones. The objectives of the study are the continuous improvement in the quality of healthcare of day-case surgery in our center, by monitoring selective quality parameters, having periodic information on the results and taking corrective measures, as well as achieving a percentage of unplanned transfer and cancellations within quality standards. Prospective, observational and descriptive study of the day-case surgery carried out from January 2010 to December 2012. Unplanned hospital admissions and cancellations on the same day of the operation were selected and monitored, along with their reasons. Hospital admissions were classified as: inappropriate selection, medical-surgical complications, and others. The results were evaluated each year and statistically analysed using χ(2) tests. A total of 8,300 patients underwent day surgery during the 3 years studied. The day-case surgery and outpatient index increased by 5.4 and 6.4%, respectively (P<.01). Unexpected hospital admissions gradually decreased due to the lower number of complications (P<.01). Hospital admissions, due to an extended period of time in locoregional anaesthesia recovery, also decreased (P<.01). There was improved prevention of nausea and vomiting, and of poorly controlled pain. The proportion of afternoon admissions was significantly reduced (P<.01). The cancellations increased in 2011 (P<.01). The monitoring of quality parameters in day-case surgery has been a useful tool in our clinical and quality management. Globally, the unplanned transfer and cancellations have been within the quality standards and many of the indicators analysed have improved. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

[Orthognathic surgery: surgical failures and complications].

Science.gov (United States)

Guyot, Laurent

2016-03-01

Orthognathic surgery procedures mark the endpoint of lengthy orthodontic-surgical preparations and herald the completion of treatment for patients and their families. The main types of procedure are full maxillary Le Fort I osteotomies, mandibular osteotomies and chin surgery. To ensure a successful outcome, all require a favorable environment and extreme technical skill. But, like all surgical operations, they are also subject to peri- and post-operative complications resulting from treatment hazards or errors. Whatever the cause, surgical complications can entail failures in the management of the malformation. By seeking to understand and analyzing these complications, we can already help to prevent and reduce the contingent risks of failure. © EDP Sciences, SFODF, 2016.

Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting.

Science.gov (United States)

Vadivelu, Nalini; Kai, Alice M; Kodumudi, Vijay; Berger, Jack M

2016-01-01

Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with opioids and the pattern and predictive factors for pain in the ambulatory surgical setting is needed.

The strategy of therapy of the axilla in early cancer. Surgery or radiotherapy

International Nuclear Information System (INIS)

Izuo, Masaru

1998-01-01

The therapy of the axillary lymph node in early breast cancer was assessed perspectively. Recently, axillary irradiation was carried out and compared with surgery. Radiotherapy was not evaluated more successful. To carry out in accordance with the present guide line, so called ''modern technique'' or ''modern dosage schedule'', radiotherapy of the axilla is effective as well as surgery. We have many agreements that the rate of incidence of complication associated with irradiation was decreased in accordance with ''modern technique''. It is reasonable to radiate additionally after the selection by the ''node sampling'' in the sense of decreasing unnecessary irradiation. But it is not sufficient in their reliability, it is hard to expect this method getting more popular than now. We cannot find any difference in the effect of the treatment itself between present dissection and radiotherapy. However we have many agreements that axillary dissection may give the information about n-stage, and the contribution to the suitable selection to the prognosis factor and adjuvant chemotherapy was not so less even in early cancer. Some early cancers (non-invasive carcinoma or micro carcinoma) will not need the axillary therapy. It is one of the options ''to combine mastectomy under local anesthesia and radiotherapy'' in close cooperation with the skilled radiologist. (K.H.) 120 refs

Fibrin glue instillation under skin flaps to prevent seroma-related morbidity following breast and axillary surgery.

Science.gov (United States)

Sajid, Muhammad S; Hutson, Kristian H; Rapisarda, Ignazio F; Bonomi, Riccardo

2013-05-31

Fibrin glue (FG) combines fibrinogen and thrombin, under the presence of factor XIII and calcium chloride, and produces a 'fibrin clot' as would occur through the natural clotting cascade. FG is thought to close over any small vessels including lymphatics that are too small for conventional surgical closure, thereby reducing seroma formation, seroma incidence and related comorbidities. To assess the evidence on the effectiveness of FG in people undergoing breast and axillary surgery and to establish whether FG is an efficient modality to prevent postoperative seroma and seroma-related outcomes. We searched the Cochrane Breast Cancer Group's (CBCG) Specialised Register (9 December 2011), the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 1 2012), MEDLINE (9 December 2011), EMBASE (9 December 2011), LILACS (22 October 2012), SCI-E (22 October 2012), the World Health Organization's International Clinical Trial Registry (9 December 2011) and ClinicalTrials.gov (22 October 2012). Randomised controlled trials (RCTs) comparing the effectiveness of FG in terms of reducing the postoperative seroma incidence and related comorbidities in people undergoing breast and axillary surgery. At least two review authors independently scrutinised search results, selected eligible studies and extracted the data. The pooled analysis of the extracted data was achieved by the statistical analysis on Review Manager software. The quality of studies was assessed using The Cochrane Collaboration's 'Risk of bias' tool. The search of four standard electronic databases yielded 119 potentially relevant studies but only 18 RCTs involving 1252 people were found suitable for statistical analysis. There was significant heterogeneity among trials and the majority of trials were of poor quality. The use of FG under skin flaps following breast and axillary surgery failed to reduce the incidence of postoperative seroma (risk ratio (RR) 1.02; 95% Confidence Interval (CI) 0.90 to 1.16, P

[Ahmed valve in glaucoma surgery].

Science.gov (United States)

Bikbov, M M; Khusnitdinov, I I

This is a review on Ahmed valve application in glaucoma surgery. It contains, in particular, data on the Ahmed valve efficiency, results of experimental and histological studies of filtering bleb encapsulation, examines the use of antimetabolites and anti-VEGF agents, and discusses implantation techniques. The current appraisal of antimetabolites delivery systems integrated into the Ahmed valve is presented. Various complications encountered in practice and preventive measures are also covered.

Manual hyperinflation partly prevents reductions of functional residual capacity in cardiac surgical patients--a randomized controlled trial

NARCIS (Netherlands)

Paulus, Frederique; Veelo, Denise P.; de Nijs, Selma B.; Beenen, Ludo F. M.; Bresser, Paul; de Mol, Bas A. J. M.; Binnekade, Jan M.; Schultz, Marcus J.

2011-01-01

Cardiac surgery is associated with post-operative reductions of functional residual capacity (FRC). Manual hyperinflation (MH) aims to prevent airway plugging, and as such could prevent the reduction of FRC after surgery. The main purpose of this study was to determine the effect of MH on

Gastric pseudolymphoma

International Nuclear Information System (INIS)

Blum, U.; Hellerich, U.; Bodendoerfer, G.; Wimmer, B.; Ruf, G.; Freiburg Univ.; Freiburg Univ.

1989-01-01

Gastric pseudolymphoma is an uncommon benign lesion which poses a difficult problem in diagnosis and management. Lymphoid hyperplasia of the stomach, however, may occasionally precede true gastric lymphoma. Endoscopic, radiologic and pathological findings are not generally helpful in establishing the diagnosis preoperatively. Benign gastric lymphoid hyperplasia could be mistaken radiologically for ulcerated gastric carcinoma and pathologically for malignant lymphoma. Recognition of this condition is important to prevent unnecessary treatment by surgery or radiotherapy. About 140 case reports have been published to date. This paper describes the cases of two further patients. (orig.) [de

An overlap case of Parry–Romberg syndrome and en coup de sabre with striking ocular involvement and anti-double-stranded DNA positivity

Directory of Open Access Journals (Sweden)

Hatice Atas

2018-01-01

Full Text Available Parry–Romberg syndrome (PRS may overlap localized scleroderma (morphea lesions with linear depression (en coup de sabre [ECDS]. Overlap case with PRS and ECDS was presented. Enophthalmos, uveitis, ocular torticollis, keratic linear precipitates, and anti-double-stranded DNA positivity were identified. Subendothelial keratic precipitates detected by an in vivo laser scanning confocal microscopy were the first profiled in the literature. Patients must be evaluated and followed up carefully by their clinics to prevent misdiagnosis and unnecessary procedures such as surgery of ocular torticollis as muscular torticollis.

Bariatric surgery and long-term nutritional issues

Science.gov (United States)

Lupoli, Roberta; Lembo, Erminia; Saldalamacchia, Gennaro; Avola, Claudia Kesia; Angrisani, Luigi; Capaldo, Brunella

2017-01-01

Bariatric surgery is recognized as a highly effective therapy for obesity since it accomplishes sustained weight loss, reduction of obesity-related comorbidities and mortality, and improvement of quality of life. Overall, bariatric surgery is associated with a 42% reduction of the cardiovascular risk and 30% reduction of all-cause mortality. This review focuses on some nutritional consequences that can occur in bariatric patients that could potentially hinder the clinical benefits of this therapeutic option. All bariatric procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract; this alteration makes these patients more susceptible to developing nutritional complications, namely, deficiencies of macro- and micro-nutrients, which could lead to disabling diseases such as anemia, osteoporosis, protein malnutrition. Of note is the evidence that most obese patients present a number of nutritional deficits already prior to surgery, the most important being vitamin D and iron deficiencies. This finding prompts the need for a complete nutritional assessment and, eventually, an adequate correction of pre-existing deficits before surgery. Another critical issue that follows bariatric surgery is post-operative weight regain, which is commonly associated with the relapse of obesity-related co-morbidities. Nu-tritional complications associated with bariatric surgery can be prevented by life-long nutritional monitoring with the administration of multi-vitamins and mineral supplements according to the patient’s needs. PMID:29204255

Prevention of Infection in Orthopedic Prosthetic Surgery.

Science.gov (United States)

Chirca, Ioana; Marculescu, Camelia

2017-06-01

Total joint arthroplasty is a generally safe orthopedic procedure; however, infection is a potentially devastating complication. Multiple risk factors have been identified for development of prosthetic joint infections. Identification of patients at risk and preoperative correction of known risk factors, such as smoking, diabetes mellitus, anemia, malnutrition, and decolonization of Staphylococcus carriers, represent well-established actions to decrease the infection risk. Careful operative technique, proper draping and skin preparation, and appropriate selection and dosing of antimicrobials for perioperative prophylaxis are also very important in prevention of infection. Published by Elsevier Inc.

[Prevention of postoperative thrombo-embolic accidents following thoracic surgery by low-dose calcium heparinate: a comparative study (author's transl)].

Science.gov (United States)

Le Brigand, H; Morille, P; Garnier, B; Bogaty-Yver, J; Samama, M; Spriet, A

A comparative clinical trial was undertaken in 2420 patients undergoing thoracic surgery during a 4-year period (1973-1977); 40% of the patients had bronchial cancer. Random allocation was not considered as being possible by the surgeons and was replaced by allocation according to the time of operation. There were three protocol groups: Protocol A: First morning operations (1007 patients): subcutaneous calcium heparin, 5000 units (Ul) 2 hours and 30 minutes before surgery then every 12 hours for 15 days. Protocol B: Second morning operations (932 patients): same dose and duration of treatment; the first injection took place 24 to 72 hours after the surgical procedure. The doses were increased from the fourth day after surgery in order to obtain a moderately prolonged partial thromboplastin time (difference patient-control: 7 to 14 seconds). Protocol 0: 481 patients received no anticoagulant treatment because of a contraindication or minor surgical procedure. Preliminary results showed and increase of per-operative bleeding (p less than 0.01) in treated patients; this was very well accepted by the surgeons. Among the heparin-treated patients, 11 pulmonary emboli out of 13 were observed in patients with bronchial cancer. Of these 13, 10 were fatal with 9 being verified at autopsy. The pulmonary emboli episodes occurred significantly earlier in protocol B than in protocol A. Fatal pulmonary embolism in patients with bronchial cancer was significantly more frequent in protocol B (7 cases) than in protocol A (1 case); P less than 0.01. These results have shown a low frequency of fatal pulmonary emboli in patients without bronchial cancer receiving twice-daily subcutaneous injections of heparin (2 of 1102 operated subjects). The rate was higher in patients with bronchial cancer and this results supports a recommended thrice-daily dose in such patients. In addition, the pre-operative administration of heparin is useful in preventing early post-operative pulmonary embolism.

Prevention of Surgical Site Infection After Ankle Surgery Using Vacuum-Assisted Closure Therapy in High-Risk Patients With Diabetes.

Science.gov (United States)

Zhou, Zhen-Yu; Liu, Ya-Ke; Chen, Hong-Lin; Liu, Fan

2016-01-01

Patients with diabetes have a high risk of surgical site infection (SSI) after ankle surgery. The aim of the present study was to investigate the efficacy of vacuum-assisted closure (VAC) in the prevention of SSI after ankle surgery compared with the efficacy of standard moist wound care (SMWC). A retrospective study was performed of unstable ankle fractures for surgical fixation in patients with diabetes from January 2012 to December 2014. VAC and SMWC were used for surgical incision coverage. The primary outcome was the incidence of SSI, and the secondary outcomes were the length of hospital stay and crude hospital costs. The data from 76 patients were analyzed, with 22 (28.95%) in the VAC group and 54 (71.05%) in the SMWC group. The incidence of SSI was 4.6% in the VAC group compared with 27.8% in the SMWC group (chi-square 5.076; p = .024), and the crude odds ratio for SSI in the VAC group was 0.124 (95% confidence interval 0.002 to 0.938). The length of hospital stay was lower in the VAC group than in the SMWC group (12.6 ± 2.7 days and 15.2 ± 3.5 days, respectively; t = 3.122, p = .003). The crude hospital costs were also lower in the VAC group than in the SMWC group (Chinese yuan 8643.2 ± 1195.3 and 9456.2 ± 1106.3, respectively; t = 2.839, p = .006). After logistic regression analysis, the adjusted odds ratio for the total SSI rate comparing VAC and SMWC was 0.324 (95% confidence interval 0.092 to 0.804; p = .021). Compared with SMWC, VAC can decrease the SSI rate after ankle surgery in patients with diabetes. This finding should be confirmed by prospective, randomized controlled clinical trials. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Clinical results and complications of preventive laparoscopic assisted gastropexy in 17 dogs: preliminary study

Directory of Open Access Journals (Sweden)

Lucie Urbanová

2011-01-01

Full Text Available In terms of GDV prevention, a number of non-surgical measures are recommended. However, the only truly reliable method is gastropexy, most often as part of a surgical treatment of GDV. Gastropexy may be performed preventively either during laparotomy indicated for another reason than GDV, or newly laparoscopically, as independent preventive gastropexy. Preventive laparoscopic assisted gastropexy (PLAG was performed in 17 patients at the Department of Surgery and Orthopaedics of the Small Animal Clinic at the University of Veterinary and Pharmaceutical Sciences in Brno. Clinical results and complications of PLAG were evaluated 3-12 months after surgery. The most frequent clinical finding of PLAG was a skinfold at the site of gastropexy immediately after the surgery (n = 8; 47%, or still on day 12 after the surgery (n = 1; 6%. As for PLAG complications, in one case a seroma formation was found at the site of gastropexy (6%; in two patients iatrogenic perforation of the splenic capsule (12% occurred, which in one case gave reason to converting laparoscopy into laparotomy (6%. In none of the patients, death, gastropexy failure, GDV development, dehiscence, infection of or haemorrhage from the surgical wound were noted. Laparoscopic assisted gastropexy appears as a reliable and miniinvasive surgical method of GDV prevention and it may be recommended for high-risk breeds of dogs.

Prevention and management of intraoperative crisis in VATS and open chest surgery: how to avoid emergency conversion.

Science.gov (United States)

Safdie, Fernando M; Sanchez, Manuel Villa; Sarkaria, Inderpal S

2017-01-01

Video assisted thoracic surgery (VATS) has become a routinely utilized approach to complex procedures of the chest, such as pulmonary resection. It has been associated with decreased postoperative pain, shorter length of stay and lower incidence of complications such as pneumonia. Limitations to this modality may include limited exposure, lack of tactile feedback, and a two-dimensional view of the surgical field. Furthermore, the lack of an open incision may incur technical challenges in preventing and controlling operative misadventures leading to major hemorrhage or other intraoperative emergencies. While these events may occur in the best of circumstances, prevention strategies are the primary means of avoiding these injuries. Unplanned conversions for major intraoperative bleeding or airway injury during general thoracic surgical procedures are relatively rare and often can be avoided with careful preoperative planning, review of relevant imaging, and meticulous surgical technique. When these events occur, a pre-planned, methodical response with initial control of bleeding, assessment of injury, and appropriate repair and/or salvage procedures are necessary to maximize outcomes. The surgeon should be well versed in injury-specific incisions and approaches to maximize adequate exposure and when feasible, allow completion of the index operation. Decisions to continue with a minimally invasive approach should consider the comfort and experience level of the surgeon with these techniques, and the relative benefit gained against the risk incurred to the patient. These algorithms may be expected to shift in the future with increasing sophistication and capabilities of minimally invasive technologies and approaches.

Breast Cancer Prevention (PDQ®)—Health Professional Version

Science.gov (United States)

Risk factors for breast cancer are female sex and advancing age, inherited risk, breast density, obesity, alcohol consumption, and exposure to ionizing radiation. Interventions to prevent breast cancer include chemoprevention (e.g. SERMs, AIs), risk-reducing surgery (e.g. mastectomy, oophorectomy). Review the evidence on risk factors and interventions to prevent breast cancer in this expert-reviewed summary.

Treatment for preventing bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgery.

Science.gov (United States)

Coppola, Antonio; Windyga, Jerzy; Tufano, Antonella; Yeung, Cindy; Di Minno, Matteo Nicola Dario

2015-02-09

of safety assessments, no fatal adverse events were reported. The second primary outcome of blood loss was assessed after surgery and these trials showed the reduction of blood loss and requirement of post-operative replacement treatment in people receiving antifibrinolytic agents compared with placebo. The remaining primary outcome of need for re-intervention was not reported by either trial.Two trials reported on 53 people with haemophilia A and B with inhibitors treated with different regimens of recombinant activated factor VII (rFVIIa) for haemostatic coverage of 33 major and 20 minor surgical interventions. Neither of the included trials specifically addressed any of the review's primary outcomes (mortality, blood loss and need for re-intervention). In one trial a high-dose rFVIIa regimen (90 μg/kg) was compared with a low-dose regimen (35 μg/kg); the higher dose showed increased haemostatic efficacy, in particular in major surgery, with shorter duration of treatment, similar total dose of rFVIIa administered and similar safety levels. In the second trial, bolus infusion and continuous infusion of rFVIIa were compared, showing similar haemostatic efficacy, duration of treatment and safety. There is insufficient evidence from randomised controlled trials to assess the most effective and safe haemostatic treatment to prevent bleeding in people with haemophilia or other congenital bleeding disorders undergoing surgical procedures. Ideally large, adequately powered, and well-designed randomised controlled trials would be needed, in particular to address the cost-effectiveness of such demanding treatments in the light of the increasing present economic constraints, and to explore the new challenge of ageing patients with haemophilia or other congenital bleeding disorders. However, performing such trials is always a complex task in this setting and presently does not appear to be a clinical and research priority. Indeed, major and minor surgeries are effectively

Managing adolescent obesity and the role of bariatric surgery.

Science.gov (United States)

McGinty, Shannon; Richmond, Tracy K; Desai, Nirav K

2015-08-01

This update explores the current management options for adolescent obesity with a specific focus on bariatric surgery. Research has highlighted the serious health complications associated with adolescent obesity and thus emphasized the need for effective interventions. With the increasing severity of obesity seen in younger populations, coupled with the modest effects of most behavioral and even pharmacologic interventions, there has been increased interest in, and attention on, bariatric surgery in younger populations. Recent adult-focused guidelines regarding the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient outline the importance of careful patient selection, in addition to close monitoring, with a particular focus on preventing nutritional deficiencies. Several recent publications have focused on issues specific to bariatric surgery in the adolescent patient including the relationship between a patient's physical and emotional maturity and timing of surgery. Adolescent obesity is prevalent with increasing severity and long-term health implications. To date nonsurgical interventions have had modest effects. Bariatric surgery is becoming more common and has been shown to be well tolerated and effective in adolescents, but requires careful preoperative screening and postoperative monitoring.

Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

International Nuclear Information System (INIS)

Golding, Lauren P.; Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn; Gyr, Bettina M.; Gardner, Alison

2015-01-01

Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

Imaging of the elbow in children with wrist fracture: an unnecessary source of radiation and use of resources?

Energy Technology Data Exchange (ETDEWEB)

Golding, Lauren P. [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Triad Radiology Associates, Winston-Salem, NC (United States); Yasin, Yousef; Singh, Jasmeet; Anthony, Evelyn [Wake Forest University Baptist Health, Department of Radiology, Winston-Salem, NC (United States); Gyr, Bettina M. [Wake Forest University Baptist Health, Department of Orthopedic Surgery, Winston-Salem, NC (United States); Gardner, Alison [Wake Forest University Baptist Health, Department of Pediatric Emergency Medicine, Winston-Salem, NC (United States)

2015-08-15

Anecdotally accepted practice for evaluation of children with clinically suspected or radiographically proven wrist fracture in many urgent care and primary care settings is concurrent imaging of the forearm and elbow, despite the lack of evidence to support additional images. These additional radiographs may be an unnecessary source of radiation and use of health care resources. Our study assesses the necessity of additional radiographs of the forearm and elbow in children with wrist injury. We reviewed electronic medical records of children 17 and younger in whom wrist fracture was diagnosed in the emergency department. We identified the frequency with which additional radiographs of the proximal forearm and distal humerus demonstrated another site of acute injury. We identified 214 children with wrist fracture. Of those, 129 received additional radiographs of the elbow. Physical examination findings proximal to the wrist were documented in only 16 (12%) of these 129 children. A second injury proximal to the wrist fracture was present in 4 (3%) of these 129 children, all of whom exhibited physical examination findings at the elbow. No fractures were documented in children with a negative physical examination of the elbow. Although elbow fractures occasionally complicate distal forearm fractures in children, our findings indicate that a careful physical evaluation of the elbow is sufficient to guide further radiographic investigation. Routine radiographs of both the wrist and elbow in children with distal forearm fracture appear to be unnecessary when an appropriate physical examination is performed. (orig.)

Cyanoacrylate Skin Microsealant for Preventing Surgical Site Infection after Vascular Surgery : A Discontinued Randomized Clinical Trial

NARCIS (Netherlands)

Vierhout, Bastiaan P.; Ott, Alewijn; Reijnen, Michel M. P. J.; Oskam, Jacques; Ott, Alewijn; van den Dungen, Jan J. A. M.; Zeebregts, Clark J.

Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a

Advances in otolaryngology-Head and neck surgery. Volume 1

International Nuclear Information System (INIS)

Myers, E.N.; Bluestone, C.D.

1987-01-01

This book consists of 14 sections. The section titles are: The impact of AIDS on otolaryngology--head and neck surgery; The management of sleep apneas and snoring; Antimicrobial agents for infections in the ear, nose, and throat--head and neck; Nasal allergy: Medical and surgical treatment; Uses of computerized tomography and magnetic resonance imaging in temporal bone imaging; Surgical management of otitis media with effusion; middle ear reconstruction: Current status; Cochlear implants: an overview; Diagnosis and management of acute facial paralysis; The use of the laser in head and neck surgery; The management and prevention of subglottic stenosis in infants and children; Management of the mass in the thyroid; Suction-assisted lipectomy of the head and neck area; and Ambulatory surgery

Advances in otolaryngology-Head and neck surgery. Volume 1

Energy Technology Data Exchange (ETDEWEB)

Myers, E.N. (Univ. of Pittsburgh School of Medicine, Pittsburgh, PA (US)); Bluestone, C.D. (Univ. of Pittsburgh, Pittsburgh, PA (US))

1987-01-01

This book consists of 14 sections. The section titles are: The impact of AIDS on otolaryngology--head and neck surgery; The management of sleep apneas and snoring; Antimicrobial agents for infections in the ear, nose, and throat--head and neck; Nasal allergy: Medical and surgical treatment; Uses of computerized tomography and magnetic resonance imaging in temporal bone imaging; Surgical management of otitis media with effusion; middle ear reconstruction: Current status; Cochlear implants: an overview; Diagnosis and management of acute facial paralysis; The use of the laser in head and neck surgery; The management and prevention of subglottic stenosis in infants and children; Management of the mass in the thyroid; Suction-assisted lipectomy of the head and neck area; and Ambulatory surgery.

[Cataract surgery and its impact on balance and autonomy in elderly].

Science.gov (United States)

Raynal, M; Aupy, B; Jahidi, A; Ettien, D; Le Page, P; Briche, T; Kossowski, M; Pailllaud, E

2009-01-01

Cataract is a major cause of visual impairment among elderly. Cataract surgery improves visual afferencies and can have an impact on balance. The present study assessed the impact of cataract surgery upon balance and autonomy in elderly. We realized clinical examinations and objective tests the day before surgery and 2-months later. The initial cohort consisted of 66 patients that had to undergo a cataract surgery. Their mean age was 79 +/- 0.5. For logistic reasons, only 33 patients have been completely evaluated before and after surgery. Each patient underwent a history and examination that have assessed autonomy, walking, visual and then cochleo-vestibular functions including bone vibratory test and dynamic computerized posturography (Equitest). After 2 months, cataract surgery had no incidence on balance. The fear of falling has stayed the same whereas the number of falls has been noticeably reduced by surgery. The overall score of Equitest has shown an increase in visual dependence after surgery. Although cataract surgery has no incidence on autonomy, it may improve the quality of life among older people by leisure activities recovery. An early physical rehabilitation facilitated by visual improvement after surgery can also prevent visual dependence and autonomy loss. We recommend vestibular rehabilitation in elderly with major visual dependence.

Should bariatric surgery be performed in adolescents?

Science.gov (United States)

Beamish, Andrew J; Reinehr, Thomas

2017-04-01

Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications. © 2017 European Society of Endocrinology.

Prescribing antibiotic prophylaxis in orthognathic surgery: a systematic review

NARCIS (Netherlands)

Oomens, M.A.E.; Verlinden, C.; Goey, Y.; Forouzanfar, T.

2014-01-01

There is no consensus on the use of antibiotic prophylaxis in orthognathic surgery to prevent infections. A systematic review of randomized controlled trials investigating the efficacy of antibiotic prophylaxis was performed to make evidence-based recommendations. A search of Embase, Ovid Medline,

Occlusal plane change after intrusion of maxillary posterior teeth by microimplants to avoid maxillary surgery with skeletal Class III orthognathic surgery.

Science.gov (United States)

Park, Hyo-Sang; Kim, Ji-Yeun; Kwon, Tae-Geon

2010-11-01

To increase stability and mandibular setback movement, surgical maxillary impaction is normally performed with mandibular setback surgery in treating adult skeletal Class III patients. This article demonstrates the use of microimplants for anchorage to intrude molars and the resultant rotation of the maxillary occlusal plane clockwise to increase the surgical mandibular setback and reduce the posterior vertical dimension instead of maxillary surgical impaction. A 21-year-old man with mandibular prognathism was treated with mandibular setback surgery that included orthodontic treatment for decompensation. Microimplants placed into the palatal alveolar bone between the maxillary first and second molars were used to intrude the maxillary posterior teeth and change the occlusal plane clockwise. This produced 4 mm more of distal movement of the chin during mandibular setback surgery compared with the surgical prediction with no change in the occlusal plane. These results were similar to those of 2-jaw surgery with maxillary posterior impaction. The intrusion of the maxillary posterior teeth with microimplants might prevent the need for maxillary surgery in adult skeletal Class III patients. Copyright © 2010 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Implementing intermittent preventive treatment for malaria in pregnancy

DEFF Research Database (Denmark)

Mubyazi, Godfrey Martin; Magnussen, Pascal; Goodman, Catherine

2008-01-01

and other discriminatory socio-cultural values on pregnancy; target users, perceptions and attitudes towards SP, malaria, and quality of ANC; supply and cost of SP at health facilities; understaffing and demoralised staff; ambiguity and impracticability of user-fee exemption policy guidelines on essential...... and cost-effectiveness analyses of the randomised controlled trials carried out in selected geographical settings. Such studies fail to elucidate the economic, psychosocial, managerial, organization and other contextual systemic factors influencing the operational effectiveness, compliance and coverage...... in Africa. RESULTS: The importance of IPTp in preventing unnecessary anaemia, morbidity and mortality in pregnancy and improving childbirth outcomes is highly acknowledged, although the following factors appear to be the main constraints to IPTp service delivery and uptake: cost of accessing ANC; myths...

Recent advancements and prospects of plastic surgery

Directory of Open Access Journals (Sweden)

Xin XING

2011-09-01

Full Text Available Objective To summarize the recent advancements and developmental prospects of plastic surgery worldwide,and to describe the future directions,aims,and highlights of Chinese military plastic surgery.Methods Relevant articles published in the last five years were retrieved through a search in PubMed,Medline,and CMCC.A statistical survey was conducted to summarize the achievements obtained by the Chinese military plastic surgery unit in the last five years.Results Considerable progress has been achieved in both clinical treatment and basic research of plastic surgery in the past five years.Its important role in the early treatment of combat injury and trauma has been recognized and emphasized.Chinese military plastic surgery has achieved considerable accomplishments in the last five years,especially in chronic wound repair;mechanism,prevention,and treatment of explosive soft tissue injuries and seawater immersion wounds;and new remedies of maxillofacial traumatic deformity,composite facial tissue allograft,and so on.Conclusions The repair and reconstruction of tissue defect and deformity caused by war injury and trauma will be the future major research direction of military plastic surgery.Research work should focus on tissue engineering,composite tissue allograft,stem cell therapy,mechanism of abnormal scar formation,among others,to solve the clinical problems of destructive facial injuries,extensive thora-abdominal wall defects,chronic ulcer,abnormal scars,and so on.Furthermore,plastic surgeons should fully utilize their special skills and take active part in the early treatment of war injury and trauma.

The preoperative evaluation prevent the postoperative complications of thyroidectomy

Directory of Open Access Journals (Sweden)

Chien-Feng Huang

2015-03-01

Conclusions: The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention.

Data analyses and perspectives on laparoscopic surgery for esophageal achalasia

Science.gov (United States)

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2015-01-01

In general, the treatment methods for esophageal achalasia are largely classified into four groups, including drug therapy using nitrite or a calcium channel blocker, botulinum toxin injection, endoscopic therapy such as endoscopic balloon dilation, and surgery. Various studies have suggested that the most effective treatment of esophageal achalasia is surgical therapy. The basic concept of this surgical therapy has not changed since Heller proposed esophageal myotomy for the purpose of resolution of lower esophageal obstruction for the first time in 1913, but the most common approach has changed from open-chest surgery to laparoscopic surgery. Currently, the laparoscopic surgery has been the procedure of choice for the treatment of esophageal achalasia. During the process of the transition from open-chest surgery to laparotomy, to thoracoscopic surgery, and to laparoscopic surgery, the necessity of combining antireflux surgery has been recognized. There is some debate as to which type of antireflux surgery should be selected. The Toupet fundoplication may be the most effective in prevention of postoperative antireflux, but many medical institutions have selected the Dor fundoplication which covers the mucosal surface exposed by myotomy. Recently, a new endoscopic approach, peroral endoscopic myotomy (POEM), has received attention. Future studies should examine the long-term outcomes and whether POEM becomes the gold standard for the treatment of esophageal achalasia. PMID:26478674

Data analyses and perspectives on laparoscopic surgery for esophageal achalasia.

Science.gov (United States)

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2015-10-14

In general, the treatment methods for esophageal achalasia are largely classified into four groups, including drug therapy using nitrite or a calcium channel blocker, botulinum toxin injection, endoscopic therapy such as endoscopic balloon dilation, and surgery. Various studies have suggested that the most effective treatment of esophageal achalasia is surgical therapy. The basic concept of this surgical therapy has not changed since Heller proposed esophageal myotomy for the purpose of resolution of lower esophageal obstruction for the first time in 1913, but the most common approach has changed from open-chest surgery to laparoscopic surgery. Currently, the laparoscopic surgery has been the procedure of choice for the treatment of esophageal achalasia. During the process of the transition from open-chest surgery to laparotomy, to thoracoscopic surgery, and to laparoscopic surgery, the necessity of combining antireflux surgery has been recognized. There is some debate as to which type of antireflux surgery should be selected. The Toupet fundoplication may be the most effective in prevention of postoperative antireflux, but many medical institutions have selected the Dor fundoplication which covers the mucosal surface exposed by myotomy. Recently, a new endoscopic approach, peroral endoscopic myotomy (POEM), has received attention. Future studies should examine the long-term outcomes and whether POEM becomes the gold standard for the treatment of esophageal achalasia.

Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting

Directory of Open Access Journals (Sweden)

Vadivelu N

2016-06-01

Full Text Available Nalini Vadivelu,1 Alice M Kai,2 Vijay Kodumudi,3 Jack M Berger4 1Department of Anesthesiology, Yale University School of Medicine, New Haven, CT, 2Stony Brook University School of Medicine, Stony Brook, NY, 3Department of Molecular and Cell Biology, College of Liberal Arts and Sciences, University of Connecticut, Storrs, CT, 4Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA Abstract: Ambulatory surgery is on the rise, with an unmet need for optimum pain control in ambulatory surgery centers worldwide. It is important that there is a proportionate increase in the availability of acute pain-management services to match the rapid rise of clinical patient load with pain issues in the ambulatory surgery setting. Focus on ambulatory pain control with its special challenges is vital to achieve optimum pain control and prevent morbidity and mortality. Management of perioperative pain in the ambulatory surgery setting is becoming increasingly complex, and requires the employment of a multimodal approach and interventions facilitated by ambulatory surgery pain specialists, which is a new concept. A focused ambulatory pain specialist on site at each ambulatory surgery center, in addition to providing safe anesthesia, could intervene early once problematic pain issues are recognized, thus preventing emergency room visits, as well as readmissions for uncontrolled pain. This paper reviews methods of acute-pain management in the ambulatory setting with risk stratification, the utilization of multimodal interventions, including pharmacological and nonpharmacological options, opioids, nonopioids, and various routes with the goal of preventing delayed discharge and unexpected hospital admissions after ambulatory surgery. Continued research and investigation in the area of pain management with outcome studies in acute surgically inflicted pain in patients with underlying chronic pain treated with

Fracture diagnostics, unnecessary travel and treatment: a comparative study before and after the introduction of teleradiology in a remote general practice.

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Jacobs, Jac J W M; Jacobs, Jan P A M; van Sonderen, Eric; van der Molen, Thys; Sanderman, Robbert

2015-05-06

Teleradiology entails attainment of x-rays in one location, transfer over some distance and assessment at another location for diagnosis or consultation. This study documents fracture diagnostics, unnecessary trips to the hospital, treatment and number of x-rays for the years 2006 and 2009, before and after the introduction of teleradiology in a general practice on the island of Ameland in the north of the Netherlands. In a retrospective, descriptive, observational before and after study of the introduction of x-ray facilities in an island-based general practice, we compared the number of accurately diagnosed fractures, unnecessary trips, treatments and number of x-rays taken in 2006 when only a hospital x-ray facility was available 5 hours away with those in 2009 after an x-ray facility became available at a local general practice. All patients visiting a general practice on the island of Ameland in 2006 and 2009 with trauma and clinical suspicion of a fracture, dislocation or sprain were included in the study. The initial clinical diagnoses, including those based on the outcomes of x-rays, were compared for the two years and also whether the patients were treated at home or in hospital. A total of 316 and 490 patients with trauma visited a general practice in 2006 and 2009, respectively. Of these patients, 66 and 116 were found to have fractures or dislocations in the two years, respectively. In 2006, 83 x-rays were ordered; in 2009, this was 284. In 2006, 9 fractures were missed; in 2009, this was only 2. In 2006, 15 patients with fractures or dislocations were treated at the general practice; in 2009, this had increased to 77. Since the introduction of teleradiology the number of missed fractures in patients visiting the general practice with trauma and the number of the unnecessary trips to a hospital are reduced. In addition more patients with fractures and dislocations can be treated in the general practice as opposed to the hospital.

From an urologist view: are we safe with endoscopic surgery? Overview of ergonomic problems encountered by the urologist during video endoscopic surgery.

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Sataa, Sallami; Benzarti, Aida; Ben Jemaa, Abdelmajid

2012-12-01

The importance of minimally invasive surgery in urology has constantly increased in the last 20 years. Endoscopic resection of prostate and bladder tumors is actually a gold standard with many advantages for patients. To analyze the problems related to the ergonomic conditions faced by urologist during video endoscopic surgery by review of the recent literature. All evidence-based experimental ergonomic studies conducted in the fields of urology endoscopic surgery and applied ergonomics for other professions working with a display were identified by PubMed searches. Data from ergonomic studies were evaluated in terms of efficiency as well as comfort and safety aspects. Constraint postures for urologists are described and ergonomic requirements for optimal positions are discussed. The ergonomics of urological endoscopic surgery place urologists at risk for potential injury. The amount of neck flexion or extension, the amount of shoulder girdle adduction or abduction used, and stability of the upper extremities during surgery; which are maintained in a prolonged static posture; are the main risk factors. All these constraints may lead to muscle and joint fatigue, pain, and eventual musculoskeletal injury. Moreover, these issues may impact surgical accuracy. Urologist posture, operating period, training are important ergonomic factor during video surgery to prevent musculoskeletal disorders.

Bariatric Surgery: Bad to the Bone, Part 1.

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Pizzorno, Lara

2016-03-01

Obesity is now a global epidemic affecting a significant and rapidly increasing number of adults, adolescents, and children. As the incidence of obesity has increased, so has the use of bariatric surgery as a medical solution. A growing number of studies now report that, despite calcium and vitamin D supplementation, the most frequently performed types of bariatric surgery, the Roux-en-Y gastric bypass and the sleeve gastrectomy, cause significant ongoing bone loss. In resources available to the general public and to physicians, this adverse outcome is rarely mentioned or is attributed solely to reduced calcium absorption. Recent studies investigating micronutrient malabsorption and changes in a wide range of hormones induced by bariatric surgery now indicate that calcium malabsorption is the tip of a formidable iceberg. The current article, part 1 of a 2-part series, reviews the latest research findings confirming that obesity prevalence is skyrocketing and that bariatric surgery causes ongoing, accelerated bone loss. Part 1 also discusses the mechanisms through which the bariatric surgery-induced malabsorption of key nutrients adversely affects bone homeostasis. Part 2 discusses the specific changes seen in bone metabolism after bariatric surgery and reviews current data on the underlying mechanisms, in addition to nutrient malabsorption, which are thought to contribute to bariatric surgery-induced ongoing accelerated bone loss. These processes include mechanical unloading and changes in a wide variety of hormones (eg, leptin, adiponectin, testosterone, estradiol, serotonin, ghrelin, glucagon-like peptide 1, and gastric inhibitory peptide). Also, part 2 covers interventions that may help lessen bariatric surgery-induced bone loss, which are now beginning to appear in the medical literature. Bariatric surgery's adverse effects on bone must be widely recognized and protocols developed to prevent early onset osteoporosis in the recipients of an increasingly utilized

Non-invasive ventilation after surgery in amyotrophic lateral sclerosis.

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Olivieri, C; Castioni, C A; Livigni, S; Bersano, E; Cantello, R; Della Corte, F; Mazzini, L

2014-04-01

Surgery in patients affected by amyotrophic lateral sclerosis (ALS) presents a particular anesthetic challenge because of the risk of post-operative pulmonary complications. We report on the use of non-invasive ventilation (NIV) to prevent post-operative pulmonary complications (PPCs) in nine patients affected by ALS enrolled in a phase-1 clinical trial with stem cell transplantation. All patients were treated with autologous mesenchymal stem cells implanted into the spinal cord with a surgical procedure. Anesthesia was induced with propofol and maintained with remifentanil and sevoflurane. No muscle relaxant was used. After awakening and regain of spontaneous breathing, patients were tracheally extubated. Non-invasive ventilation through nasal mask was delivered and non-invasive positive pressure ventilation and continuous positive pressure ventilation were started. The average time on NIV after surgery was 3 h and 12 min. All patients regained stable spontaneous breathing after NIV discontinuation and had no episodes of respiratory failure until the following day. Our case series suggest that the use of NIV after surgery can be a safe strategy to prevent PPCs in patients affected by ALS. The perioperative procedure we chose for these patients appeared safe even in patients with advanced functional stage of the disease. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

A review of eleven cases of tuberculosis presenting as sternal wound abscess after open heart surgery.

Science.gov (United States)

Tabaja, Hussam; Hajar, Zeina; Kanj, Souha S

2017-10-01

Sternal wound infection with Mycobacterium tuberculosis is an uncommon yet highly challenging disease that can be quite insidious with various presentations. We hereby provide a review of 10 cases in current literature and describe an additional case which illustrates the difficulties associated with diagnosis. We used PubMed and Google search engine to search the literature for all published papers reporting on cases of sternal M. tuberculosis infections post open-heart surgeries. A total of 11 cases were presented, including a case of our own. The majority were males and were exposed to endemic areas. The average age was 59.6 ± 15.5 years. Coronary artery bypass surgery accounted for 73% of procedures and the average time to symptoms onset was 12.2 ± 16.6 months. Diabetes was the most reported non-cardiac comorbidity. Presenting symptoms varied and only 5 patients had other organs involved. Blood tests and radiographic studies were neither sensitive nor specific. M. tuberculosis culture on debrided tissues was the most sensitive test but often forgotten initially. Diagnostic delay was seen in almost all cases, often leading to unnecessary courses of antibiotics and aggressive surgical interventions. Finally, all patients responded well to anti-tuberculosis treatment, with reported treatment duration ranging from 9 to 12 months. M. tuberculosis infection of the sternum should be suspected in late-onset sternal wound infections post open-heart surgery especially when the course is chronic and indolent.

[Robotics in pediatric surgery].

Science.gov (United States)

Camps, J I

2011-10-01

Despite the extensive use of robotics in the adult population, the use of robotics in pediatrics has not been well accepted. There is still a lack of awareness from pediatric surgeons on how to use the robotic equipment, its advantages and indications. Benefit is still controversial. Dexterity and better visualization of the surgical field are one of the strong values. Conversely, cost and a lack of small instruments prevent the use of robotics in the smaller patients. The aim of this manuscript is to present the controversies about the use of robotics in pediatric surgery.

Fosaprepitant versus ondansetron for the prevention of postoperative nausea and vomiting in patients who undergo gynecologic abdominal surgery with patient-controlled epidural analgesia: a prospective, randomized, double-blind study.

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Soga, Tomohiro; Kume, Katsuyoshi; Kakuta, Nami; Hamaguchi, Eisuke; Tsutsumi, Rie; Kawanishi, Ryosuke; Fukuta, Kohei; Tanaka, Katsuya; Tsutsumi, Yasuo M

2015-10-01

Postoperative nausea and vomiting (PONV) is the most common postoperative complication. The postoperative use of opioids is known to increase the incidence. We compared fosaprepitant, a neurokinin-1 (NK1) receptor antagonist, and ondansetron for their preventive effects on PONV in patients who underwent gynecologic abdominal surgery with patient-controlled epidural analgesia. This prospective, double-blind, randomized study comprised 44 patients who underwent gynecologic abdominal surgery. They were randomly allocated to receive 150 mg intravenous fosaprepitant (n = 24; NKI group) or 4 mg ondansetron (n = 20; ONS group) before anesthesia, which was maintained with volatile anesthetics, remifentanil, fentanyl, and rocuronium. All patients received postoperative fentanyl by patient-controlled epidural anesthesia. The incidence of nausea and vomiting, complete response rate (i.e., no vomiting and no rescue antiemetic use), rescue antiemetic use, nausea score (0-3), and visual analog scale score (VAS 0-10) for pain were recorded at 2, 24, 48, and 72 h after surgery. No (0 %) patient in the NKI group experienced vomiting after surgery; however, 4-6 (20-30 %) of 20 patients in the ONS group experienced vomiting. This difference was significant at 0-24, 0-48, and 0-72 h. During the study period, no significant differences existed between the NK1 and ONS groups in the incidence of PONV, complete response rate, rescue antiemetic use, nausea score, and VAS score for pain. Compared to ondansetron, fosaprepitant more effectively decreased the incidence of vomiting in patients who underwent gynecologic abdominal surgery with patient-controlled epidural analgesia.

Meta-Analysis of Sodium Bicarbonate Therapy for Prevention of Cardiac Surgery-Associated Acute Kidney Injury.

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Kim, Jun Hyun; Kim, Hyun Jung; Kim, Ji Yeon; Ahn, Hyeong sik; Ahn, Il Min; Choe, Won Joo; Lim, Choon-Hak

2015-10-01

The aim of this study was to determine whether or not perioperative administration of sodium bicarbonate had a preventive effect on cardiac surgery-associated acute kidney injury (CSA-AKI) as shown in randomized controlled trials. The authors conducted a systematic review and meta-analysis using MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and KoreaMed. The authors searched MEDLINE, EMBASE, CENTRAL, and KoreaMed without language and date restrictions. They used both MeSH and free-text terms to identify relevant studies. Electronic searches were undertaken on July 31, 2014. Five randomized controlled studies included in this review. There were no differences in the development of CSA-AKI among patients in the sodium bicarbonate group compared with those in the control group (5 trials, 1,092 patients; n = 233 of 547 in sodium bicarbonate (SB) group versus 225 of 545 in control group (SC); risk ratio (RR), 0.95; 95% confidence interval (CI), 0.74-1.22. Also, there were no statistical differences in in-hospital mortality (3 trials, 573 patients; n = 21 of 288 in SB versus 14 of 285 in SC; RR, 1.44; 95% CI, 0.76-2.72), need for renal replacement therapy (4 trials, 1,000 patients; n = 21 of 503 in SB versus 23 of 497 in SC; RR, 0.90; 95% CI, 0.50-1.60), length of stay in the intensive care unit (ICU) (hours) (4 trials, n = 969 patients, weighted men difference (WMD), 2.17; 95% CI, -1.15-5.49), and length of ventilation (hours) (4 trials, 969 patients; WMD, 0.34; 95% CI,-0.80-1.48). Perioperative administration of sodium bicarbonate did not reduce the rate of CSA-AKI in randomized controlled trials. Therefore, use of perioperative administration of sodium bicarbonate for the prevention of CSA-AKI is questionable. Copyright © 2015 Elsevier Inc. All rights reserved.

Symptom distress in older adults following cancer surgery.

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Van Cleave, Janet H; Egleston, Brian L; Ercolano, Elizabeth; McCorkle, Ruth

2013-01-01

Symptom distress remains a significant health problem among older adults with cancer following surgery. Understanding factors influencing older adults' symptom distress may lead to early identification and interventions, decreasing morbidity and improving outcomes. We conducted this study to identify factors associated with symptom distress following surgery among 326 community-residing patients 65 years or older with a diagnosis of thoracic, digestive, gynecologic, and genitourinary cancers. This secondary analysis used combined subsets of data from 5 nurse-directed intervention clinical trials targeting patients after surgery at academic cancer centers in northwest and northeastern United States. Symptom distress was assessed by the Symptom Distress Scale at baseline and at 3 and 6 months. A multivariable analysis, using generalized estimating equations, showed that symptom distress was significantly less at 3 and 6 months (3 months: P psychological, treatment, and function covariates. Thoracic cancer, comorbidities, worse mental health, and decreased function were, on average, associated with increased symptom distress (all P cancer, comorbidities, mental health, and function may influence older adults' symptom distress following cancer surgery. Older adults generally experience decreasing symptom distress after thoracic, abdominal, or pelvic cancer surgery. Symptom management over time for those with thoracic cancer, comorbidities, those with worse mental health, those with decreased function, and those 75 years or older may prevent morbidity and improve outcomes of older adults following surgery.

30-Day, 90-day and 1-year mortality after emergency colonic surgery

DEFF Research Database (Denmark)

Pedersen, T; Watt, S K; Tolstrup, M-B

2017-01-01

PURPOSE: Emergency surgery is an independent risk factor in colonic surgery resulting in high 30-day mortality. The primary aim of this study was to report 30-day, 90-day and 1-year mortality rates after emergency colonic surgery, and to report factors associated with 30-day, 90-day and 1-year...... mortality. Second, the aim was to report 30-day postoperative complications and their relation to in-hospital mortality. METHODS: All patients undergoing acute colonic surgery in the period from May 2009 to April 2013 at Copenhagen University Hospital Herlev, Denmark, were identified. Perioperative data...... postoperative deaths. CONCLUSION: Mortality and complication rates after emergency colonic surgery are high and associated with patient related risk factors that cannot be modified, but also treatment related outcomes that are modifiable. An increased focus on medical and other preventive measures should...

Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

Science.gov (United States)

Daniels, Alan H; Hart, Robert A; Hilibrand, Alan S; Fish, David E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Tortolani, P Justin; Stroh, D Alex; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

2017-04-01

Retrospective cohort study of prospectively collected data. To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of iatrogenic spinal cord injury. In total, 3 cases of iatrogenic spinal cord injury following cervical spine surgery were identified. Institutional incidence rates ranged from 0.0% to 0.24%. Of the 3 patients with quadriplegia, one underwent anterior-only surgery with 2-level cervical corpectomy, one underwent anterior surgery with corpectomy in addition to posterior surgery, and one underwent posterior decompression and fusion surgery alone. One patient had complete neurologic recovery, one partially recovered, and one did not recover motor function. Iatrogenic spinal cord injury following cervical spine surgery is a rare and devastating adverse event. No standard protocol exists that can guarantee prevention of this complication, and there is a lack of consensus regarding evaluation and treatment when it does occur. Emergent imaging with magnetic resonance imaging or computed tomography myelography to evaluate for compressive etiology or malpositioned instrumentation and avoidance of hypotension should be performed in cases of intraoperative and postoperative spinal cord injury.

When pain after surgery doesn't go away...

LENUS (Irish Health Repository)

Burke, Siún

2009-02-01

Chronic post-surgical pain is a common, under-recognized and important clinical problem which affects millions of patients worldwide. It results from a series of neuroplastic changes associated most commonly with peripheral nerve injury at the time of surgery. Predisposing factors include the type of surgery, pre-operative and acute post-operative pain intensity, and probably psychological (e.g. pain-catastrophizing) and genetic factors [e.g. GCH1 (GTP cyclohydrolase 1) haplotype]. Preventive measures which are currently available include selection of a minimally invasive surgical technique and an aggressive multimodal perioperative analgesic regimen. Very promising therapeutic agents which target the sensitization process are currently in development.

Assessment of preoperative exams request in a teaching hospital

Directory of Open Access Journals (Sweden)

Eduardo Toshiyuki Moro

2014-04-01

Background: preoperative exams aim to identify disorders that may compromise the patient´s perioperative care. However, unnecessary tests rarely change the outcome, and are expensive to institution. The aim of this study was to evaluate the preoperative tests ordered in Santa Lucinda hospital, Sorocaba - SP. Methods: after approval by the Ethics Committee of PUC-SP University, we assessed pre-anesthetic evaluation of patients undergoing elective surgery from march to August, 2011. We recorded: age, sex, ASA physical status, the presence of coexisting diseases, medication use, type of surgery and preoperative tests. They were classified as sufficient, sufficient with unnecessary tests, insufficient, or insufficient with unnecessary tests. Results: two hundred and nineteen records were evaluated, of which 52% were considered sufficient, but with unnecessary tests. For 24% of patients, the tests were insufficient, with some ordered unnecessarily. To 8% of patients, the tests were insufficient, and only 16% didn´t have insufficient and unnecessary tests. The most frequently ordered tests were hematocrit and hemoglobin. The exams most unnecessarily ordered were coagulation tests and dosage of serum urea. Among the necessary examinations, but unsolicited, there were ECG (27%, electrolytes (13% and creatinine (11%. Seventy-nine tests showed some kind of problem, but they didn´t change in behavior. Conclusions: preoperative tests unnecessarily ordered are frequent, which do not guarantee that some patients present to surgery without fundamental exams according to their risk group.

CONVENTIONAL MASTOID BANDAGE FOLLOWING OTOLOGICAL SURGERIES - IS IT NECESSARY?

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Sumit

2016-03-01

Full Text Available BACKGROUND Mastoid pressure bandage post otological surgeries are usually applied to prevent post-operative wound haematoma and proper wound cover. Many other materials (e.g. Micropore, Dynaplast are used instead of conventional bandage. AIMS The purpose of this study was to assess whether compressive head bandages are necessary after ear surgery to prevent complications such as haematoma or wound infection. METHODS A hospital based study of 50 patients (30 males & 20 females who underwent tympano-mastoidectomies, were selectively applied different types of mastoid bandages, following which their advantages & disadvantages post-operatively (early & late were studied. RESULTS Out of 50 cases, in which 15 cases were applied conventional mastoid bandage resulted in 4 complications (26.66%. Whereas out of 20 cases of Dynaplast bandage, only 2 showed minor complications (10% with only pain during removal of this bandage. Out of 15 cases where Micropore was used as bandage, only 2 showed up with minor complications (13.33% with only pain during removal of Micropore.

Analysis of Surgical Success in Preventing Recurrent Acute Exacerbations in Chronic Pancreatitis

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Nealon, William H.; Matin, Sina

2001-01-01

Objective To determine whether surgical intervention prevents recurrent acute exacerbations in chronic pancreatitis (CP). Summary Background Data The primary goal of surgical intervention in the treatment of CP has been relief of chronic unrelenting abdominal pain. A subset of patients with CP have intermittent acute exacerbations, often with increasing frequency and often unrelated to ongoing ethanol abuse. Little data exist regarding the effectiveness of surgery to prevent acute attacks. Methods From 1985 to 1999, all patients identified with a diagnosis of CP were recruited to participate in an ongoing program of serial clinic visits and functional and clinical evaluations. Patients were offered surgery using standard criteria. Data were gathered regarding ethanol abuse, pain, narcotic use, and recurrent acute exacerbations requiring hospital admission before and after surgery. Patients were broadly categorized as having severe unrelenting pain alone (group 1), severe pain with intermittent acute exacerbations (group 2), and intermittent acute exacerbations only (group 3). Results Two hundred fifty-nine patients were recruited. One hundred eighty-five patients underwent 199 surgical procedures (124 modified Puestow procedure [LPJ], 29 distal pancreatectomies [DP], and 46 pancreatic head resections [PHR; 14 performed after failure of LPJ]). There were no deaths. The complication rate was 4% for LPJ, 15% for DP, and 27% for PHR. Ethanol abuse was causative in 238 patients (92%). Mean follow-up was 81 months. There were 104 patients in group 1 (86 who underwent surgery), 71 patients in group 2 (64 who underwent surgery), and 84 in group 3 (49 who underwent surgery). No patient without surgery had spontaneous resolution of symptoms. Postoperative pain relief (freedom from narcotic analgesics) was achieved in 153 of 185 patients (83%) overall: 106 of 124 (86%) for LPJ, 19 of 29 (67%) for DP, and 42 of 46 (91%) for PHR. The mean rate of acute exacerbations was 6.3 �

East and Central African Journal of Surgery Volume 15 Number 2 ...

African Journals Online (AJOL)

DELL

East and central African Journal of Surgery. Page 136 ... at school. Early presentation, immediate intervention and treatment can prevent grave .... Bank DE, Diaz L, Behrman DA, Delaney J, Bizzocco S. Tongue entrapment in an aluminum.

The high cost of low-frequency events: the anatomy and economics of surgical mishaps.

Science.gov (United States)

Couch, N P; Tilney, N L; Rayner, A A; Moore, F D

1981-03-12

We conducted a one-year prospective survey to identify adverse outcomes due to error during care in the field of general surgery. We identified 36 such cases among 5612 surgical admissions to the Peter Bent Brigham Hospital, but in 23 cases the initiating mishap had occurred in another hospital before transfer. In two thirds of the cases the mishap was due to an error of commission: an unnecessary, defective or inappropriate operative procedure. Twenty of these patients died in the hospital, and in 11 death was directly attributable to the error. Five of the 16 survivors left the hospital with serious physical impairment. A satisfactory outcome was achieved in only 11 cases (31%). The average hospital stay was 42 days, with the duration ranging from one to 325 days; the total cost for the 36 patients was $1,732,432. We suggest that all hospitals develop comprehensive methods to identify and prevent these costly and unnecessary events.

Emotional and Affective Temperaments in Smoking Candidates for Bariatric Surgery.

Science.gov (United States)

Mombach, Karin Daniele; de Souza Brito, Cesar Luis; Padoin, Alexandre Vontobel; Casagrande, Daniela Schaan; Mottin, Claudio Cora

2016-01-01

The prevalence of smoking habits in severe obesity is higher than in the general population. There is some evidence that smokers have different temperaments compared to non-smokers. The aim of this study is to evaluate the associations between smoking status (smokers, ex-smokers and non-smokers) and temperament characteristics in bariatric surgery candidates. We analyzed data on temperament of 420 bariatric surgery candidates, as assessed by the AFECTS scale, in an exploratory cross-sectional survey of bariatric surgery candidates who have been grouped into smokers, ex-smokers and non-smokers. We detected significant statistical differences in temperament related to the smoking status in this population after controlling the current use of psychiatric medication. Smokers had higher anxiety and lower control than non-smokers. Ex-smokers with BMI >50 kg/m(2) presented higher coping and control characteristics than smokers. Smoking in bariatric surgery candidates was associated with lower control and higher anxious temperament, when controlled by current use of psychiatric medication. Smokers with BMI >50 kg/m(2) presented lower coping and control than ex-smokers. Assessment of temperament in bariatric surgery candidates may help in decisions about smoking cessation treatment and prevention of smoking relapse after surgery.

Antibiotics in periodontal surgeries: A prospective randomised cross over clinical trial

Directory of Open Access Journals (Sweden)

Sheetal Oswal

2014-01-01

Full Text Available Aims and Objectives: (1 To evaluate the need of antibiotics in periodontal surgeries in reducing postsurgical infections and explore if antibiotics have any key role in reducing or eliminating inflammatory complications. (2 To establish the incidence of postoperative infections in relation to type of surgery and determine those factors, which may affect infection rates. Materials and Methods: A prospective randomized double-blind cross over clinical study was carried out for a period of 1-year with predefined inclusion and exclusion criteria. All the patients included in the study for any periodontal surgery were randomly divided into three categories: Group A (prophylactic, Group B (therapeutic, and Group C (no antibiotics. Patients were followed up for 1-week after surgery on the day of suture removal and were evaluated for pain, swelling, fever, infection, delayed wound healing and any other significant findings. Appropriate statistical analysis was carried out to evaluate the objectives and P < 0.05 was considered as statistically significant. Results: No infection was reported in any of 90 sites. Patients reported less pain and postoperative discomfort when prophylactic antibiotics were given. However, there were no statistical significant differences between the three groups. Summary and Conclusion: There was no postoperative infection reported in all the 90 sites operated in this study. The prevalence of postoperative infections following periodontal surgery is <1% and this low risk does not justify the routine use of systemic antimicrobials just to prevent infections. Use of prophylactic antibiotics may have role in prevention of inflammatory complication, but again not infection.

Dry eye following cataract surgery in Women Over 50 Years Old

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N. Bazzazi

2016-11-01

Full Text Available Introduction: Dry eye is a common problem amongst post-menopausal women. Cataract surgery may worsen symptoms of dry eye and this can inflence the quality of life in patients. Ths study was performed to evaluate the incidence and severity of dry eye symptoms aftr phacoemulsifiation surgery. Methods: Ths case-series study was performed on 43 women aged over 50 years during 2013-2014. Patients underwent phacoemulsifiation surgery on one eye. Symptoms of the operated and contra lateral eye were analyzed by χ2 statistical test and SPSS softare, preoperative and one month aftr the surgery. Results: One month aftr the surgery, the mean value of incidence and severity of dry eye in operated and non-operated eyes were 90.06 ± 3.5, 80.96 ± 3.55, 71.11 ± 3.52, and 63.51 ± 3.04, respectively. Th diffrence between the two groups was signifiant (P > 0.001. Schirmer’s test, TBUT and corneal staining showed no signifiant diffrence (P ≥ 0.05. conclusions: Cataract surgery may lead to worsening of dry eye symptoms. Treatment of dry eye before cataract surgery is an important issue to prevent ocular surface damage.

[Risk factors related to surgical site infection in elective surgery].

Science.gov (United States)

Angeles-Garay, Ulises; Morales-Márquez, Lucy Isabel; Sandoval-Balanzarios, Miguel Antonio; Velázquez-García, José Arturo; Maldonado-Torres, Lulia; Méndez-Cano, Andrea Fernanda

2014-01-01

The risk factors for surgical site infections in surgery should be measured and monitored from admission to 30 days after the surgical procedure, because 30% of Surgical Site Infection is detected when the patient was discharged. Calculate the Relative Risk of associated factors to surgical site infections in adult with elective surgery. Patients were classified according to the surgery contamination degree; patient with surgery clean was defined as no exposed and patient with clean-contaminated or contaminated surgery was defined exposed. Risk factors for infection were classified as: inherent to the patient, pre-operative, intra-operative and post-operative. Statistical analysis; we realized Student t or Mann-Whitney U, chi square for Relative Risk (RR) and multivariate analysis by Cox proportional hazards. Were monitored up to 30 days after surgery 403 patients (59.8% women), 35 (8.7%) developed surgical site infections. The factors associated in multivariate analysis were: smoking, RR of 3.21, underweight 3.4 hand washing unsuitable techniques 4.61, transfusion during the procedure 3.22, contaminated surgery 60, and intensive care stay 8 to 14 days 11.64, permanence of 1 to 3 days 2.4 and use of catheter 1 to 3 days 2.27. To avoid all risk factors is almost impossible; therefore close monitoring of elective surgery patients can prevent infectious complications.

Wrong-Site Surgery, Retained Surgical Items, and Surgical Fires : A Systematic Review of Surgical Never Events.

Science.gov (United States)

Hempel, Susanne; Maggard-Gibbons, Melinda; Nguyen, David K; Dawes, Aaron J; Miake-Lye, Isomi; Beroes, Jessica M; Booth, Marika J; Miles, Jeremy N V; Shanman, Roberta; Shekelle, Paul G

2015-08-01

Serious, preventable surgical events, termed never events, continue to occur despite considerable patient safety efforts. To examine the incidence and root causes of and interventions to prevent wrong-site surgery, retained surgical items, and surgical fires in the era after the implementation of the Universal Protocol in 2004. We searched 9 electronic databases for entries from 2004 through June 30, 2014, screened references, and consulted experts. Two independent reviewers identified relevant publications in June 2014. One reviewer used a standardized form to extract data and a second reviewer checked the data. Strength of evidence was established by the review team. Data extraction was completed in January 2015. Incidence of wrong-site surgery, retained surgical items, and surgical fires. We found 138 empirical studies that met our inclusion criteria. Incidence estimates for wrong-site surgery in US settings varied by data source and procedure (median estimate, 0.09 events per 10,000 surgical procedures). The median estimate for retained surgical items was 1.32 events per 10,000 procedures, but estimates varied by item and procedure. The per-procedure surgical fire incidence is unknown. A frequently reported root cause was inadequate communication. Methodologic challenges associated with investigating changes in rare events limit the conclusions of 78 intervention evaluations. Limited evidence supported the Universal Protocol (5 studies), education (4 studies), and team training (4 studies) interventions to prevent wrong-site surgery. Limited evidence exists to prevent retained surgical items by using data-matrix-coded sponge-counting systems (5 pertinent studies). Evidence for preventing surgical fires was insufficient, and intervention effects were not estimable. Current estimates for wrong-site surgery and retained surgical items are 1 event per 100,000 and 1 event per 10,000 procedures, respectively, but the precision is uncertain, and the per

Extensive bilateral corneal edema 6 weeks after cataract surgery: Keratopathy due to Asclepias physocarpa: a case report.

Science.gov (United States)

Matsuura, Kazuki; Hatta, Shiro; Terasaka, Yuki; Inoue, Yoshitsugu

2017-01-18

Surgeons may be unaware of the ability of plant toxins to cause corneal damage. Therefore, corneal damage following intraocular surgery due to plant toxins may be misdiagnosed as postoperative infection. A 74-year-old man presented with hyperemia and reduced visual acuity in both eyes 6 weeks after uneventful cataract surgery. We observed extensive hyperemia and corneal stromal edema with Descemet's folds in both eyes. After obtaining a detailed patient history, we diagnosed plant toxin-induced corneal edema due to Asclepias physocarpa, which can induce corneal edema by inhibiting the Na + /K + ATPase activity of the corneal endothelium. Antimicrobial and steroid eye drops and an oral steroid were prescribed accordingly. Symptons began to improve on day 3 and had almost completely resolved by day 6. At 1 month, the patient had fully recovered without any sequelae. The correct diagnosis was possible in the present case as symptoms were bilateral and the patient was able to report his potential exposure to plant toxins. However, if the symptoms had been unilateral and the patient had been unaware of these toxins, he may have undergone unnecessary surgical interventions to treat non-existent postoperative endophthalmitis.

Dexamethasone for the prevention of postpericardiotomy syndrome: A DExamethasone for Cardiac Surgery substudy

NARCIS (Netherlands)

Bunge, Jeroen J. H.; van Osch, Dirk; Dieleman, Jan M.; Jacob, Kirolos A.; Kluin, Jolanda; van Dijk, Diederik; Nathoe, Hendrik M.; Bredée, Jaap J.; Buhre, Wolfgang F.; van Herwerden, Lex A.; Kalkman, Cor J.; van Klarenbosch, Jan; Moons, Karel G.; Numan, Sandra C.; Ottens, Thomas H.; Roes, Kit C.; Sauer, Anne-Mette C.; Slooter, Arjen J.; Nierich, Arno P.; Ennema, Jacob J.; Rosseel, Peter M.; van der Meer, Nardo J.; van der Maaten, Joost M.; Cernak, Vlado; Hofland, Jan; van Thiel, Robert J.; Diephuis, Jan C.; Schepp, Ronald M.; Haenen, Jo; de Lange, Fellery; Boer, Christa; de Jong, Jan R.; Tijssen, Jan G.

2014-01-01

The postpericardiotomy syndrome (PPS) is a common complication following cardiac surgery. The pathophysiology remains unclear, although evidence exists that surgical trauma and the use of cardiopulmonary bypass provoke an immune response leading to PPS. We hypothesized that an intraoperative dose of

A simple classification system (the Tree flowchart) for breast MRI can reduce the number of unnecessary biopsies in MRI-only lesions

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Woitek, Ramona; Spick, Claudio; Schernthaner, Melanie; Kapetas, Panagiotis; Bernathova, Maria; Furtner, Julia; Pinker, Katja; Helbich, Thomas H.; Baltzer, Pascal A.T. [Medical University of Vienna, Department of Biomedical Imaging and Image-Guided Therapy, Vienna (Austria); Rudas, Margaretha [Medical University of Vienna, Clinical Institute of Pathology, Vienna (Austria)

2017-09-15

To assess whether using the Tree flowchart obviates unnecessary magnetic resonance imaging (MRI)-guided biopsies in breast lesions only visible on MRI. This retrospective IRB-approved study evaluated consecutive suspicious (BI-RADS 4) breast lesions only visible on MRI that were referred to our institution for MRI-guided biopsy. All lesions were evaluated according to the Tree flowchart for breast MRI by experienced readers. The Tree flowchart is a decision rule that assigns levels of suspicion to specific combinations of diagnostic criteria. Receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic accuracy. To assess reproducibility by kappa statistics, a second reader rated a subset of 82 patients. There were 454 patients with 469 histopathologically verified lesions included (98 malignant, 371 benign lesions). The area under the curve (AUC) of the Tree flowchart was 0.873 (95% CI: 0.839-0.901). The inter-reader agreement was almost perfect (kappa: 0.944; 95% CI 0.889-0.998). ROC analysis revealed exclusively benign lesions if the Tree node was ≤2, potentially avoiding unnecessary biopsies in 103 cases (27.8%). Using the Tree flowchart in breast lesions only visible on MRI, more than 25% of biopsies could be avoided without missing any breast cancer. (orig.)

The role of preoperative cerebral magnetic resonance angiography in the prevention of cerebral complications following cardiovascular surgery

Energy Technology Data Exchange (ETDEWEB)

Abe, Masakazu; Sakai, Akira; Kodera, Koujirou; Sudo, Kyouichi; Oosawa, Mikio [Seirei Hamamatsu General Hospital, Shizuoka (Japan)

1997-11-01

Screening of carotid and intracranial artery diseases by magnetic resonance angiography (MRA) was performed in forty-one adult patients prior to elective cardiovascular surgery. In twenty patients (48.8%), MRA demonstrated significant cerebrovascular lesions: carotid or main cerebral artery stenosis in 7, diffuse cerebral arteriosclerotic change in 6, vertebral artery lesion in 5 and berry aneurysm in 2. Advanced age (over 70 years) and previous cerebrovascular events increased the incidence of cerebrovascular lesions on MRA. Forty patients underwent scheduled surgery under cardiopulmonary bypass, and pulsatile flow perfusion was used in patients in whom significant cerebrovascular lesions were demonstrated on MRA. One patient with aortic arch aneurysm was judged to be an unacceptable candidate for surgery in light of his marked diffuse arteriosclerotic lesions on MRA. In five patients, staged operation was performed from 10 to 30 days after cerebrovascular surgery (bypass surgery for internal carotid occlusion in 2, aneurysm clipping in 2, carotid endarterectomy in 1). Postoperative neurological complications occurred in one patient (2.5%). In conclusion, screening of carotid and intracranial artery diseases by MRA is a safe and useful method for evaluation of cerebrovascular lesions in patients with advanced age, previous cerebrovascular events and/or arteriosclerotic diseases. (author)

The Benefits of an In-Office Arthroscopy in the Diagnosis of Unresolved Knee Pain

Directory of Open Access Journals (Sweden)

Garrett L. Chapman

2018-01-01

Full Text Available We report a patient who developed persistent knee pain with mechanical symptoms after an uncomplicated patellofemoral arthroplasty. The etiology of his knee pain remained inconclusive following magnetic resonance imaging due to metallic artifact image distortion. With the use of an in-office needle arthroscopy, an immediate and definitive diagnosis was obtained, preventing an unnecessary surgery for a diagnostic arthroscopy. We discovered a lateral meniscus tear, an anterior cruciate ligament tear, and a medial femoral condyle chondral defect for which the patient underwent arthroscopic partial meniscectomy, ligament reconstruction, and osteochondral allograft transplantation, with resolution of his knee pain.

Long Detection Programming in Single-Chamber Defibrillators Reduces Unnecessary Therapies and Mortality: The ADVANCE III Trial.

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Gasparini, Maurizio; Lunati, Maurizio G; Proclemer, Alessandro; Arenal, Angel; Kloppe, Axel; Martínez Ferrer, Josè B; Hersi, Ahmad S; Gulaj, Marcin; Wijffels, Maurits C E; Santi, Elisabetta; Manotta, Laura; Varma, Niraj

2017-11-01

This study sought to evaluate the effects of programming a long detection in single-chamber (VVI) implantable cardioverter-defibrillators (ICDs) in the multicenter prospective ADVANCE III (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III) trial. Programming strategies may reduce unnecessary ICD shocks and their adverse effects but to date have been described only for dual-chamber ICDs. A total of 545 subjects (85% male; atrial fibrillation 25%, left ventricular ejection fraction 31%, ischemic etiology 68%, secondary prevention indications 32%) receiving a VVI ICD were randomized to long detection (30 of 40 intervals) or standard programming (18 of 24 intervals) based on device type, atrial fibrillation history, and indication. In both arms, antitachycardia pacing (ATP) therapy during charging was programmed for episodes with cycle length 320 to 200 ms and shock only for cycle length functions enabled. Therapies delivered were compared using a negative binomial regression model. A total of 267 patients were randomized to long detection and 278 to the control group. Median follow-up was 12 months. One hundred twelve therapies (shocks and ATP) occurred in the long detection arm versus 257 in the control arm, for a 48% reduction with 30 of 40 intervals (95% confidence interval [CI]: 0.36 to 0.76; p = 0.002). In the long detection arm, overall shocks were reduced by 40% compared to the control arm (48 vs. 24; 95% CI: 0.38 to 0.94; p = 0.026) and appropriate shocks by 51% (34 vs. 74; 95% CI: 0.26 to 0.94; p = 0.033). Syncopal events did not differ between arms, but survival improved in the long detection arm. Among patients implanted with a VVI ICD, programming with the long detection interval significantly reduced appropriate therapies, shocks, and all-cause mortality. (Avoid DeliVering TherApies for Non-sustained Arrhythmias in ICD PatiEnts III [ADVANCEIII]; NCT00617175). Copyright © 2017 The Authors. Published by Elsevier Inc. All

Immediately sequential bilateral cataract surgery: advantages and disadvantages.

Science.gov (United States)

Singh, Ranjodh; Dohlman, Thomas H; Sun, Grace

2017-01-01

The number of cataract surgeries performed globally will continue to rise to meet the needs of an aging population. This increased demand will require healthcare systems and providers to find new surgical efficiencies while maintaining excellent surgical outcomes. Immediately sequential bilateral cataract surgery (ISBCS) has been proposed as a solution and is increasingly being performed worldwide. The purpose of this review is to discuss the advantages and disadvantages of ISBCS. When appropriate patient selection occurs and guidelines are followed, ISBCS is comparable with delayed sequential bilateral cataract surgery in long-term patient satisfaction, visual acuity and complication rates. In addition, the risk of bilateral postoperative endophthalmitis and concerns of poorer refractive outcomes have not been supported by the literature. ISBCS is cost-effective for the patient, healthcare payors and society, but current reimbursement models in many countries create significant financial barriers for facilities and surgeons. As demand for cataract surgery rises worldwide, ISBCS will become increasingly important as an alternative to delayed sequential bilateral cataract surgery. Advantages include potentially decreased wait times for surgery, patient convenience and cost savings for healthcare payors. Although they are comparable in visual acuity and complication rates, hurdles that prevent wide adoption include liability concerns as ISBCS is not an established standard of care, economic constraints for facilities and surgeons and inability to fine-tune intraocular lens selection in the second eye. Given these considerations, an open discussion regarding the advantages and disadvantages of ISBCS is important for appropriate patient selection.

Nutrition Care for Patients with Weight Regain after Bariatric Surgery

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Carlene Johnson Stoklossa

2013-01-01

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

Infection management following ambulatory surgery

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Chin AB

2015-10-01

Full Text Available Anne B Chin, Elizabeth C Wick Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Surgical site infections (SSIs are frequent postoperative complications that are linked to measures of surgical quality and payment determinations. As surgical procedures are increasingly performed in the ambulatory setting, management of SSIs must transition with this trend. Prevention of SSIs should include optimization of patient comorbidities, aggressive infection control policies including appropriate skin decontamination, maintenance of normothermia, and appropriate antibiotic prophylaxis. Systems must also be set in place to provide adequate surveillance for identification of SSIs when they do occur as well as provide direct feedback to surgeons regarding SSI rates. This may require utilization of claims-based surveillance. Patient education and close follow-up with the clinical team are essential for early identification and management of SSIs. Therapy should remain focused on source control and appropriate antibiotic therapy. Keywords: ambulatory surgery, SSI, infection

Patient Selection in Plastic Surgery: Recognizing Body Dysmorphic Disorder

Directory of Open Access Journals (Sweden)

Cihan Sahin

2013-04-01

Full Text Available Plastic surgery is a branch of medicine that provides significant improvements to the people with positive changes. But first of all, this branch has a characteristic which requires analysing patients' psychological situation very carefully. Plastic surgeons are often confronted by patients with mental disorders seeking aesthetic surgery. It is imperative for surgeons to recognize possible underlying psychiatric illnesses. Common psychiatric conditions seen in cosmetic surgery patients include body dysmorphic disorder (BDD, narcissistic personality disorder and histrionic personality disorders. BDD is of particular importance to plastic surgeons. Because outrageous dissatisfaction with one's appearance may conceal psychopathologic traits that are not always easily recognizable, and which, if neglected, may result in serious iatrogenic and medicolegal consequences, we hope that this paper will help plastic surgeons in ultimately preventing patient and surgeon dissatisfaction within the population of patients with psychiatric disorders, and should recognize the diagnostic features of body dysmorphic disorder and screen psychologically unstable patients who may never be satisfied with surgery. [Arch Clin Exp Surg 2013; 2(2.000: 109-115

Surgery, public health, and Pakistan.

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Zafar, Syed Nabeel; McQueen, K A Kelly

2011-12-01

Surgical healthcare is rapidly gaining recognition as a major public health issue. Surgical disparities are large, with poorest populations receiving the least amount of emergency and essential surgical care. In light of recent evidence, developing countries, such as Pakistan, must acknowledge surgical disease as a major public health issue and prioritize research and intervention accordingly. We review information from various sources and describe the current situation of surgical health care in Pakistan and highlight areas of neglect. Pakistan suffers an annual deficit of 17 million surgeries. Surgical disease kills more people than infectious diseases inclusive of tuberculosis, HIV/AIDS, diarrheal disease, and childhood infections. The incidence of trauma and maternal mortality ratio are staggeringly high. There is a severe dearth of surgical and anesthesia-related epidemiological data. Important information that would help to drive policy and planning is not available. Corruption and neglect have led to a dilapidated health care infrastructure. Surgical care is largely inaccessible to the poor, especially those living in rural areas. The country faces a dearth of healthcare professionals, especially paramedics, anesthetists, and surgeons. Unsafe surgery and anesthesia poses a significant risk to patients. There is no national policy on surgical illness and the preventive aspects of surgery are nonexistent. Consistent with other underdeveloped countries, surgical care in Pakistan is dismal. Neglecting surgery and safe anesthesia has led to countless deaths and disability. Physicians, researchers, policy makers, and the government health care system must engage and commit to provide access to emergency, essential, and safe surgical care.

Is Bariatric Surgery a Prophylaxis for Pelvic Floor Disorders?

Science.gov (United States)

Pomian, Andrzej; Majkusiak, Wojciech; Lisik, Wojciech; Tomasik, Paweł; Horosz, Edyta; Zwierzchowska, Aneta; Kociszewski, Jacek; Barcz, Ewa

2018-06-01

Obesity is one of the well-documented risk factors of pelvic floor disorders (PFDs). The PFDs include urinary and fecal incontinence (UI, FI) and pelvic organ prolapse (POP). Surgery-induced weight loss improves different kinds of incontinence as well as POP symptoms. However, there is a lack of evidence how bariatric surgery influences pelvic floor anatomy and function in women without previous PFDs and whether it may be concerned as PFD prophylaxis tool. The present analysis is a prospective, non-randomized case-control study from January 2014 to September 2017. Participants underwent pelvic floor ultrasound examination with bladder neck position estimation at rest, during levator ani tension, and at Valsalva maneuver before surgery and 12-18 months after. Pelvic organ prolapse quantification (POPQ) > 2 stage and PFD complaints were the exclusion criteria. Fifty-nine patients underwent bariatric surgery (57 sleeve gastrectomy and 2 gastric bypass). Mean BMI decreased from 43.8 ± 5.9 to 29 ± 4.6 kg/m 2 after surgery (p betterment of bladder neck position at rest, tension, and Valsalva maneuver in women without PFDs. We postulate that bariatric surgery may be a tool for PFD prevention. It does not improve levator ani function and does not limit bladder neck mobility, which implicates that it has no influence on preexisting pelvic dysfunction.

. ORIGINAL ARTICLES Prevention and treatment of cardiovascular ...

African Journals Online (AJOL)

Reasons for high morbidity and mortality associated with ... particular reference to the management of haemodynainic instability. S Afr Med! ... (iii) the performance of both anaesthesia and surgery by the ... Safe practice of spinal anaesthesia includes both prevention of ... Despite a prior obstetric or general medical work-.

The use of a biologic topical haemostatic agent (TachoSil(®)) for the prevention of postoperative bleeding in patients on antithrombotic therapy undergoing thyroid surgery: A randomised controlled pilot trial.

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Erdas, Enrico; Medas, Fabio; Podda, Francesco; Furcas, Silvia; Pisano, Giuseppe; Nicolosi, Angelo; Calò, Pietro Giorgio

2015-08-01

Anticoagulants and antiplatelet agents are well-known risk factors for post-operative bleeding. The aim of this prospective, randomized pilot study was to evaluate the effectiveness of a topical haemostatic agent, namely TachoSil, for the prevention of postoperative bleeding in patients on antithrombotic therapy undergoing thyroidectomy. Perioperative management and some distinctive aspects of cervical haematomas were also discussed. Between January 2012 and May 2014, all patients taking vitamin K antagonists (VKAs) or acetyl salicylic acid (ASA) scheduled for total thyroidectomy were enrolled and randomly allocated to group 1 (standard haemostasis) and group 2 (standard haemostasis + TachoSil). Antithrombotic drugs were always suspended prior to surgery and, when indicated, replaced by bridging anticoagulation with low-molecular-weight heparin. The primary endpoint was the incidence of postoperative cervical haematomas. A total of 70 patients were included in the study, representing 8.5% (70/820) of all patients who underwent thyroidectomies in the same period. The overall rate of post-operative cervical haematoma was 7.1% (5/70) and reached 14.8% (4/27) in patients on VKA therapy. All but one occurred more than 24 h after surgery (32nd hour, 8th, 10th, and 13th days). Group 1 (37 patients) and group 2 (33 patients) were well-matched according to clinical and demographic features. Postoperative haematoma was observed in 2/37 patients (5.4%) recruited in the Group 1 and 3/33 patients (9.1%) recruited in the Group 2 (P = 0.661). Patients taking antithrombotic drugs represent a major problem in thyroid surgery. The incidence of bleeding after thyroidectomy is significantly high and the use of TachoSil do not seem effective in preventing its occurrence. However, larger multicenter study is needed to confirm these results. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

[Physical therapy performance in respiratory and motor involvement during postoperative in children submitted to abdominal surgeries].

Science.gov (United States)

Santo, Caroline C; Gonçalves, Marcela T; Piccolo, Mariana M; Lima, Simone; Rosa, George J da; Paulin, Elaine; Schivinski, Camila S

2011-01-01

to verify the physiotherapy performance in the respiratory and motor affections during postoperative period in pediatric patients undergoing abdominal surgery. was a literature review of articles published in the databases Lilacs, Medline and SciELO in the period 1983 to 2010 as well as books, papers presented at scientific meetings and journals of the area, who approached the post-therapy of abdominal surgery in children. The keywords used were: abdominal surgery, children and physiotherapy. 28 articles, one book chapter and one dissertation had been selected that examined the question and proposed that contained all, or at least two of the descriptors listed. Most of the material included covers the incidence of respiratory complications after surgery for pediatric abdominal surgery due to immaturity of the respiratory system of this population, abdominal manipulation of surgical period, the prolonged time in bed, pain at the incision site and waste anesthetic. Some authors also discuss the musculoskeletal and connective tissue arising from the inaction and delay of psychomotor development consequent to periods of hospitalization in early childhood, taking on the role of physiotherapy to prevent motor and respiratory involvement. there are few publications addressing this topic, but the positive aspects of physiotherapy have been described, especially in relation to the prevention of respiratory complications and motor, recognized the constraints and consequences of hospitalizations and surgeries cause in children.

Pre-procedural scout radiographs are unnecessary for routine pediatric fluoroscopic examinations

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Creeden, Sean G.; Rao, Anil G.; Eklund, Meryle J.; Hill, Jeanne G.; Thacker, Paul G. [Medical University of South Carolina, Department of Radiology and Radiological Science, Charleston, SC (United States)

2017-03-15

Although practice patterns vary, scout radiographs are often routinely performed with pediatric fluoroscopic studies. However few studies have evaluated their utility in routine pediatric fluoroscopy. To evaluate the value of scout abdomen radiographs in routine barium or water-soluble enema, upper gastrointestinal (GI) series, and voiding cystourethrogram pediatric fluoroscopic procedures. We retrospectively evaluated 723 barium or water-soluble enema, upper GI series, and voiding cystourethrogram fluoroscopic procedures performed at our institution. We assessed patient history and demographics, clinical indication for the examination, prior imaging findings and impressions, scout radiograph findings, additional findings provided by the scout radiograph that were previously unknown, and whether the scout radiograph contributed any findings that significantly changed management. We retrospectively evaluated 723 fluoroscopic studies (368 males and 355 females) in pediatric patients. Of these, 700 (96.8%) had a preliminary scout radiograph. Twenty-three (3.2%) had a same-day radiograph substituted as a scout radiograph. Preliminary scout abdomen radiographs/same-day radiographs showed no new significant findings in 719 (99.4%) studies. New but clinically insignificant findings were seen in 4 (0.6%) studies and included umbilical hernia, inguinal hernia and hip dysplasia. No findings were found on the scout radiographs that would either alter the examination performed or change management with regard to the exam. Pre-procedural scout abdomen radiographs are unnecessary in routine barium and water-soluble enema, upper GI series, and voiding cystourethrogram pediatric fluoroscopic procedures and can be substituted with a spot fluoroscopic last-image hold. (orig.)

Tracking unnecessary negative urinalyses to reduce healthcare costs: a transversal study.

Science.gov (United States)

Malmartel, A; Dutron, M; Ghasarossian, C

2017-09-01

About 7 million urinalyses are reimbursed yearly by the French public healthcare system, but the results of most of these tests are normal. The aim of this study was to estimate the prevalence of negative urinalyses in ambulatory care, identify the associated factors and assess the relevance of prescriptions by general practitioners (GPs) according to French guidelines. A cross-sectional study was conducted in patients over 18 coming for urinalyses in two French ambulatory laboratories. Patients received a questionnaire on their symptoms, the reason for performing urinalysis and the use of urinary dipsticks. GP who prescribed urinalyses received a questionnaire assessing their practice. A total of 510 patients were included, and 71% of urinalyses were negative. Urinalyses were prescribed to 283 patients by GPs. Compared to those of specialists, GP prescriptions were associated with fewer negative urinalyses (59 vs 86%; p GPs, the reasons of prescription were as follows: suspected urinary tract infection (UTI) (42.7%), control of bacteriological cure after UTI (24%), fever or abdominal pain (13%) and routine test (7%). About 35% of urinalyses were not indicated according to guidelines. Only 12% of patients used dipsticks before performing urinalysis although 87% of GPs were favourable to their use if they were provided by healthcare services. The annual cost of non-indicated urinalyses is estimated at 13 million euro. A systematic use of dipsticks provided by healthcare services could help to reduce health costs and the unnecessary use of antibiotics.

Waterless Hand Rub Versus Traditional Hand Scrub Methods for Preventing the Surgical Site Infection in Orthopedic Surgery.

Science.gov (United States)

Iwakiri, Kentaro; Kobayashi, Akio; Seki, Masahiko; Ando, Yoshiyuki; Tsujio, Tadao; Hoshino, Masatoshi; Nakamura, Hiroaki

2017-11-15

MINI: Fourteen hundred consecutive patients were investigated for evaluating the utility of waterless hand rub before orthopaedic surgery. The risk in the surgical site infection incidence was the same, but costs of liquids used for hand hygiene were cheaper and the hand hygiene time was shorter for waterless protocol, compared with traditional hand scrub. A retrospective cohort study with prospectively collected data. The aim of this study was to compare SSI incidences, the cost of hand hygiene agents, and hand hygiene time between the traditional hand scrub and the waterless hand rub protocols before orthopedic surgery. Surgical site infections (SSI) prolong hospitalization and are a leading nosocomial cause of morbidity and a source of excess cost. Recently, a waterless hand rub protocol comprising alcohol based chlorhexidine gluconate for use before surgery was developed, but no studies have yet examined its utility in orthopedic surgery. Fourteen hundred consecutive patients who underwent orthopedic surgery (spine, joint replacement, hand, and trauma surgeries) in our hospital since April 1, 2012 were included. A total of 712 cases underwent following traditional hand scrub between April 1, 2012 and April 30, 2013 and 688 cases underwent following waterless hand rub between June 1, 2013 and April 30, 2014. We compared SSI incidences within all and each subcategory between two hand hygiene protocols. All patients were screened for SSI within 1 year after surgery. We compared the cost of hand hygiene agents and hand hygiene time between two groups. The SSI incidences were 1.3% (9 of 712) following the traditional protocol (2 deep and 7 superficial infections) and 1.1% (8 of 688) following the waterless protocol (all superficial infections). There were no significant differences between the two groups. The costs of liquids used for one hand hygiene were about $2 for traditional hand scrub and less than $1 for waterless hand rub. The mean hand hygiene time was 264

Intraoperative ketamine for prevention of postoperative delirium or pain after major surgery in older adults: an international, multicentre, double-blind, randomised clinical trial.

Science.gov (United States)

Avidan, Michael S; Maybrier, Hannah R; Abdallah, Arbi Ben; Jacobsohn, Eric; Vlisides, Phillip E; Pryor, Kane O; Veselis, Robert A; Grocott, Hilary P; Emmert, Daniel A; Rogers, Emma M; Downey, Robert J; Yulico, Heidi; Noh, Gyu-Jeong; Lee, Yonghun H; Waszynski, Christine M; Arya, Virendra K; Pagel, Paul S; Hudetz, Judith A; Muench, Maxwell R; Fritz, Bradley A; Waberski, Witold; Inouye, Sharon K; Mashour, George A

2017-07-15

Delirium is a common and serious postoperative complication. Subanaesthetic ketamine is often administered intraoperatively for postoperative analgesia, and some evidence suggests that ketamine prevents delirium. The primary purpose of this trial was to assess the effectiveness of ketamine for prevention of postoperative delirium in older adults. The Prevention of Delirium and Complications Associated with Surgical Treatments [PODCAST] study is a multicentre, international randomised trial that enrolled adults older than 60 years undergoing major cardiac and non-cardiac surgery under general anaesthesia. Using a computer-generated randomisation sequence we randomly assigned patients to one of three groups in blocks of 15 to receive placebo (normal saline), low-dose ketamine (0·5 mg/kg), or high dose ketamine (1·0 mg/kg) after induction of anaesthesia, before surgical incision. Participants, clinicians, and investigators were blinded to group assignment. Delirium was assessed twice daily in the first 3 postoperative days using the Confusion Assessment Method. We did analyses by intention-to-treat and assessed adverse events. This trial is registered with clinicaltrials.gov, number NCT01690988. Between Feb 6, 2014, and June 26, 2016, 1360 patients were assessed, and 672 were randomly assigned, with 222 in the placebo group, 227 in the 0·5 mg/kg ketamine group, and 223 in the 1·0 mg/kg ketamine group. There was no difference in delirium incidence between patients in the combined ketamine groups and the placebo group (19·45% vs 19·82%, respectively; absolute difference 0·36%, 95% CI -6·07 to 7·38, p=0·92). There were more postoperative hallucinations (p=0·01) and nightmares (p=0·03) with increasing ketamine doses compared with placebo. Adverse events (cardiovascular, renal, infectious, gastrointestinal, and bleeding), whether viewed individually (p value for each >0·40) or collectively (36·9% in placebo, 39·6% in 0·5 mg/kg ketamine, and 40·8% in 1·0

Vitamin D and intestinal calcium transport after bariatric surgery.

Science.gov (United States)

Schafer, Anne L

2017-10-01

Bariatric surgery is a highly effective treatment for obesity, but it may have detrimental effects on the skeleton. Skeletal effects are multifactorial but mediated in part by nutrient malabsorption. While there is increasing interest in non-nutritional mechanisms such as changes in fat-derived and gut-derived hormones, nutritional factors are modifiable and thus represent potential opportunities to prevent and treat skeletal complications. This review begins with a discussion of normal intestinal calcium transport, including recent advances in our understanding of its regulation by vitamin D, and areas of continued uncertainty. Human and animal studies of vitamin D and intestinal calcium transport after bariatric surgery are then summarized. In humans, even with optimized 25-hydroxyvitamin D levels and recommended calcium intake, fractional calcium absorption decreased dramatically after Roux-en-Y gastric bypass (RYGB). In rats, intestinal calcium absorption was lower after RYGB than after sham surgery, despite elevated 1,25-dihyroxyvitamin D levels and intestinal gene expression evidence of vitamin D responsiveness. Such studies have the potential to shed new light on the physiology of vitamin D and intestinal calcium transport. Moreover, understanding the effects of bariatric surgery on these processes may improve the clinical care of bariatric surgery patients. Published by Elsevier Ltd.

THE USE OF BIOLOGICAL PRODUCTS IN ABDOMINAL SURGERY AND LIVER TRANSPLANTATION

Directory of Open Access Journals (Sweden)

N. I. Gabrielyan

2013-01-01

Full Text Available This article provides an overview of new approaches to the prevention of infectious complications of bacterial nature after the high-technology operations in the abdominal surgery, first of all, after liver transplantation. At- tention is drawn to the first positive results of randomized studies on the use of biological preparations - probi- otics, prebiotics and synbiotics in patients after liver transplantation. The authors prove the prospects of further development of this subject based on successful model experiments on animals and various operational interven- tions in abdominal surgery. 

Meniscus tear surgery and meniscus replacement

Science.gov (United States)

Vaquero, Javier; Forriol, Francisco

2016-01-01

Summary Objective the menisci are easily injured and difficult to repair. The aim of this study was to analyze the current state of meniscal surgery aimed at preserving morphology and conserving the biomechanics of the knee to prevent joint degeneration. Methodology a search of the electronic medical literature database Medline was conducted, from http://www.ncbi.nlm.nih.gov/pubmed. The search was not limited by language. Candidate articles were identified by searching for those that included the keywords meniscus, surgery, suture, implant, allograft. The limits were included for clinical research and clinical trials. Basic research was not included. The studies selected were evaluated and classified in three different categories: basic science, reconstruction (suture and meniscectomy) and implants (scaffolds and allograft). Results the consequences of meniscectomy performed at a young age can lead to a joint cartilage degeneration twenty years later. There are few surgical options for the repair of meniscal injuries in order both to preserve the meniscus and to ensure the long term survival of the knee joint, meniscectomy, repair, suturing the tear, or reconstruction, when a meniscal allograft or synthetic substitute is used to replace the meniscus, but the biomechanical properties of the native meniscus are not reproduced entirely by the scaffolds that exist today. Conclusion therapies that successfully repair or replace the meniscus are therefore likely to prevent or delay osteoarthritis progression. PMID:27331034

Poetry and narrative therapy for anxiety about spinal surgery | Naidu ...

African Journals Online (AJOL)

This case study presents the use of poetry in psychotherapy with an adolescent girl, Buhle (a pseudonym), who needed surgery to correct a curvature of her spine due to adolescent idiopathic scoliosis. She experienced anxiety which prevented surgeons from doing the procedure. Psychotherapists used narrative therapy to ...

Myocardial protection in heart surgery.

Science.gov (United States)

Mentzer, Robert M

2011-01-01

One of the unmet clinical needs in heart surgery is the prevention of myocardial stunning and necrosis that occurs as a result of ischemia-reperfusion. Myocardial stunning, a frequent consequence after heart surgery, is characterized by a requirement for postoperative inotropic support despite a technically satisfactory heart operation. In high-risk patients with marginal cardiac reserve, stunning is a major cause of prolonged critical care and may be associated with as much as a 5-fold increase in mortality. In contrast, the frequency of myocardial necrosis (myocardial infarction [MI]) after cardiac surgery is less appreciated and its consequences are much more subtle. The consequences may not be apparent for months to years. While we now have a much better understanding of the molecular mechanisms underlying myocardial stunning and MI, we still have no effective way to prevent these complications, nor a consistently effective means to engage the well-studied endogenous mechanisms of cardioprotection. The failure to develop clinically effective interventions is multifactorial and can be attributed to reliance on findings obtained from subcellular and cellular studies, to drawing conclusions from preclinical large animal studies that have been conducted in a disease-free state, and to accepting less than robust surrogate markers of injury in phase II clinical trials. These factors also explain the disappointing failure to identify effective adjuvant therapy in the setting of percutaneous coronary revascularization for acute MI (AMI) and reperfusion injury. These issues have contributed to the disappointing outcomes of large and costly phase III trials, resulting in a lack of enthusiasm on the part of the pharmaceutical industry to engage in further drug development for this indication. The purpose of this review is to (1) define the scope of the clinical problem; (2) summarize the outcomes of selected phases II and III clinical trials; and (3) identify the gap that

Prophylaxis of Macular Edema with Intravitreal Ranibizumab in Patients with Diabetic Retinopathy after Cataract Surgery: A Pilot Study

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Patricia Udaondo

2011-01-01

Full Text Available The purpose of this study was to evaluate the effectiveness of intravitreal ranibizumab (Lucentis, Genentech, South San Francisco, Calif, USA combined with cataract surgery for the prevention of clinically significant macular edema (CSME in patients with diabetic retinopathy (DR. This prospective interventional case series included fifty-four eyes of 54 patients with a previous diagnosis of nonproliferative diabetic retinopathy (NPDR without macular edema preoperatively. Subjects were assigned in a 1 : 1 ratio to receive an intraoperative intravitreal ranibizumab injection (n=27 or not (control group, n=27 associated with standardised phacoemulsification surgery. The main outcome measure was the incidence of CSME one and three months after surgery. One month after surgery the incidence of CSME in the control group was 25.92% and 3.70% in the treatment group and at three months was 22.22% and 3.70%, respectively. Short-term results suggest that intravitreal ranibizumab immediately after phacoemulsification prevents CS ME in patients with NPDR.

Corrective Jaw Surgery

Medline Plus

Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

The impact of suction drainage on orbital compartment syndrome after craniofacial surgery.

Science.gov (United States)

Fenzl, Carlton R; Golio, Dominick

2014-07-01

Postoperative orbital compartment syndrome is a potentially blinding complication of surgery in the orbital region. We describe the technique of orbital drain placement as a method of preventing vision loss resulting from orbital compartment syndrome. We present a retrospective case series of 29 patients who underwent orbital fracture, facial fracture, and orbital implant removal from 7/4/2008 to 5/3/2013 by the same craniofacial surgeon. An orbital drain was placed in each patient. The drainage was recorded daily until drain removal. Criteria for removal included less than or equal to 5 mL of drainage in 24 hours. Of the 29 patients included in this study, 21 were men and 8 were women. Ages ranged from 17 to 67 years. The postoperative drainage ranged from less than 1 mL to 71 mL of serosanguinous fluid. All drains were removed between the first and sixth postoperative days. No postoperative visual loss, infections, or additional antibiotics were recorded with follow-up reaching as far as 40 months. Postoperative orbital compartment syndrome is a dangerous complication of surgery in the orbital region. Its rapid onset necessitates immediate intervention to prevent permanent vision loss. Morphologic changes to the optic nerve as well as reductions in electroretinogram a- and b-wave amplitudes have been demonstrated with as little as 7 mL of fluid accumulation. Intraoperative orbital drain placement should be considered in all patients undergoing surgery in the orbital region as a preventative measure.

Evaluating the combined effectiveness of influenza control strategies and human preventive behavior.

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Liang Mao

Full Text Available Control strategies enforced by health agencies are a major type of practice to contain influenza outbreaks. Another type of practice is the voluntary preventive behavior of individuals, such as receiving vaccination, taking antiviral drugs, and wearing face masks. These two types of practices take effects concurrently in influenza containment, but little attention has been paid to their combined effectiveness. This article estimates this combined effectiveness using established simulation models in the urbanized area of Buffalo, NY, USA. Three control strategies are investigated, including: Targeted Antiviral Prophylaxis (TAP, workplace/school closure, community travel restriction, as well as the combination of the three. All control strategies are simulated with and without regard to individual preventive behavior, and the resulting effectiveness are compared. The simulation outcomes suggest that weaker control strategies could suffice to contain influenza epidemics, because individuals voluntarily adopt preventive behavior, rendering these weaker strategies more effective than would otherwise have been expected. The preventive behavior of individuals could save medical resources for control strategies and avoid unnecessary socio-economic interruptions. This research adds a human behavioral dimension into the simulation of control strategies and offers new insights into disease containment. Health policy makers are recommended to review current control strategies and comprehend preventive behavior patterns of local populations before making decisions on influenza containment.

Does amphotericin B nasal douching help prevent polyp recurrence following functional endoscopic sinus surgery?

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Sayyed Mostafa Hashemi

2011-01-01

Conclusions: This study showed no benefits for topical amphotericin B solution over normal saline. It might be better to retreat to the traditional normal saline nasal douching following functional endoscopic sinus surgery in the treatment of polyposis.

[Contribution of Perioperative Oral Health Care and Management for Patients who Underwent General Thoracic Surgery].

Science.gov (United States)

Saito, Hajime; Minamiya, Yoshihiro

2016-01-01

Due to the recent advances in radiological diagnostic technology, the role of video-assisted thoracoscopic surgery in thoracic disease has expanded, surgical indication extended to the elderly patients. Cancer patients receiving surgery, radiation therapy and/or chemotherapy may encounter complications in conjunction with the oral cavity such as aspiration pneumonia, surgical site infection and various type of infection. Recently, it is recognized that oral health care management is effective to prevent the postoperative infectious complications, especially pneumonia. Therefore, oral management should be scheduled before start of therapy to prevent these complications as supportive therapy of the cancer treatment. In this background, perioperative oral function management is highlighted in the remuneration for dental treatment revision of 2012,and the importance of oral care has been recognized in generally. In this manuscript, we introduce the several opinions and evidence based on the recent previous reports about the perioperative oral health care and management on thoracic surgery.

Use of day 1 early morning cortisol to predict the need for glucocorticoid replacement after pituitary surgery.

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Bondugulapati, L N Rao; Campbell, Christopher; Chowdhury, Sharmistha Roy; Goetz, Pablo; Davies, J Stephen; Rees, D Aled; Hayhurst, Caroline

2016-01-01

Assessment of adrenal reserve in patients who have undergone pituitary surgery is crucial. However, there is no clear consensus with regards to the type and timing of the test that should be used in the immediate post-operative period. Recently, there has been increased interest in measuring post-operative cortisol levels. We present our data utilising day 1 post-operative early morning cortisol as a tool to assess adrenal reserve in steroid-naive patients. A retrospective analysis of endoscopic pituitary surgery undertaken over a 2-year period. 82 patients underwent 84 surgeries in total. Patients who were already on glucocorticoids pre-operatively and patients with Cushing's disease, pituitary apoplexy and those without follow-up data were excluded, leaving a study group of 44 patients with 45 operations. A 9am day 1 post-operative cortisol value of > 400 nmol/L was taken as an indicator of adequate adrenal reserve. All the patients were reassessed at 6 weeks with a standard short synacthen test (SST) using 250 micrograms of intravenous synacthen. 22 out of 45 patients had a cortisol value of > 400 nmol/L on day 1 post-operatively and were discharged without glucocorticoid supplementation. Of these, only 2 patients subsequently failed the SST when reassessed at 6-8 weeks. The remaining 23 patients had a cortisol value of cortisol levels whereas the remaining fourteen patients showed adequate adrenal reserve. The 9 am cortisol value had high specificity (81.8%) and positive predictive value (90.9%) for integrity of the HPA axis. Sensitivity was 58.8% and negative predictive value was 39.1%. A day 1 post-operative early morning cortisol is a useful tool to predict adrenal reserve post-pituitary surgery, enabling clinicians to avoid unnecessary blanket glucocorticoid replacement.

Antibiotic prophylaxis in dermatologic surgery: advisory statement 2008.

Science.gov (United States)

Wright, Tina I; Baddour, Larry M; Berbari, Elie F; Roenigk, Randall K; Phillips, P Kim; Jacobs, M Amanda; Otley, Clark C

2008-09-01

Antibiotic prophylaxis is an important component of dermatologic surgery, and recommendations in this area should reflect the updated 2007 guidelines of the American Heart Association, the American Dental Association with the American Academy of Orthopaedic Surgeons guidelines, and recent prospective studies on surgical site infection. To provide an update on the indications for antibiotic prophylaxis in dermatologic surgery for the prevention of infective endocarditis, hematogenous total joint infection, and surgical site infection. A literature review was performed, expert consensus was obtained, and updated recommendations were created, consistent with the most current authoritative guidelines from the American Heart Association and the American Dental Association with the American Academy of Orthopaedic Surgeons. For patients with high-risk cardiac conditions, and a defined group of patients with prosthetic joints at high risk for hematogenous total joint infection, prophylactic antibiotics are recommended when the surgical site is infected or when the procedure involves breach of the oral mucosa. For the prevention of surgical site infections, antibiotics may be indicated for procedures on the lower extremities or groin, for wedge excisions of the lip and ear, skin flaps on the nose, skin grafts, and for patients with extensive inflammatory skin disease. These recommendations are not based on multiple, large-scale, prospective trials. There is a strong shift away from administration of prophylactic antibiotics in many dermatologic surgery settings, based on updated authoritative guidelines. These recommendations provide guidance to comply with the most current guidelines, modified to address dermatology-specific considerations. Managing physicians may utilize these guidelines while individualizing their approach based on all clinical considerations.

[History of cranial surgery, cerebral tumor surgery and epilepsy surgery in Mexico].

Science.gov (United States)

Chico-Ponce de León, F

2009-08-01

The first report of intra-cerebral tumor surgery was provided by Bennett & Goodle, in London, 1884. Worldwide this kind of surgery was performed in France by Chipault, in Italy by Durante, in the United States by Keen and in Deutchland by Krause & Oppenheim. Lavista in Mexico City operated on intra-cerebral tumor in 1891, and the report was printed in 1892. In the same publication, Lavista exhibited the first cases of epilepsy surgery. Since now, it is the first report of this kind of surgery in the Spanish-speaking world.

Microdebrider complications in laryngologic and airway surgery.

Science.gov (United States)

Howell, Rebecca J; Solowski, Nancy L; Belafsky, Peter C; Courey, Mark C; Merati, Albert L; Rosen, Clark A; Weinberger, Paul M; Postma, Gregory N

2014-11-01

There is a paucity of experience in the published literature documenting complications of powered surgical instruments in laryngologic surgery. Our objective was to ascertain the nature of these complications from expert opinion and review of the literature, and to recommend strategies to decrease major complications. Review of the literature and an e-mail survey. A literature review of microdebrider complications in laryngologic surgery was conducted using PubMed and Ovid (1985 to 2013), along with an analysis of a confidential e-mail survey of various surgeons in selected high-volume laryngologic centers. Powered instrumentation is frequently used in the operating room for larynx and airway surgery. The microdebrider can improve efficiency, lower costs, and shorten operative times. However, use of the microdebrider has the potential for serious complications in the larynx and airway. Great care must be taken when utilizing the microdebrider in laryngologic surgery. Significant complications including major vocal fold scar, airway compromise, severe hemorrhage, and unintentional tissue loss have occurred. The microdebrider is a popular and valuable tool for the otolaryngologist. A thorough knowledge of the instrument and its potential complications will improve surgical outcomes and may prevent complications. Awareness of the risks and surgeon experience with use of the microdebrider will allow the surgeon to successfully utilize this device in a safe and effective manner. 5. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Inappropriately Timed Pediatric Orthopaedic Referrals From the Emergency Department Result in Unnecessary Appointments and Financial Burden for Patients.

Science.gov (United States)

Jackson, Taylor J; Blumberg, Todd J; Shah, Apurva S; Sankar, Wudbhav N

2018-03-01

Musculoskeletal injuries are among the most common reasons for emergency department (ED) visits in the pediatric population. Many such injuries can be managed with a single follow-up outpatient visit. However, untimely (ie, premature) referrals by emergency physicians to orthopaedic surgeons are common and may inadvertently create need for a second visit, generating unnecessary expenditures. We sought to elucidate the cost of premature musculoskeletal follow-up visits to the patients, families, and the health care system. We performed a retrospective review of pediatric patients with acute musculoskeletal injuries referred from our ED (without a formal orthopaedic consult) to our outpatient clinic. Patients were retrospectively reviewed in a consecutive fashion. The appropriateness of the recommended follow-up time interval was determined for each patient, and the direct and indirect cost of the inappropriate services were calculated utilizing a combination of traditional cost accounting techniques and time-driven activity-based costing. The characteristics of patients with appropriate and untimely follow-up referrals were compared. Two hundred consecutive referrals from the ED were reviewed. Overall, 96.5% of the follow-up visits recommended by the ED were premature, which led 106 (53%) patients to require a second visit to complete their clinical care. Patients who required a second visit were significantly younger (P=0.005), more likely to be male (P=0.042), more likely to have a fracture (Pcost of $342.93 per patient. Untimely referrals for follow-up of acute pediatric musculoskeletal conditions are very common and represent a significant financial burden to patients, families, and the health care system. Over 40% of unnecessary visits resulted from just 3 diagnoses. Improved orthopaedic follow-up guidelines, particularly for these readily recognizable conditions, and feedback to referring providers may reduce poorly timed clinic visits and decrease costs in

Patch Grafting Using an Ologen Collagen Matrix to Manage Tubal Exposure in Glaucoma Tube Shunt Surgery

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Masaki Tanito

2018-01-01

Full Text Available Purpose: To report the results using an ologen Collagen Matrix as a patch graft in eyes with tubal exposure after tube shunt surgery. Case Reports: Case 1 was an 82-year-old man with tubal exposure in his right eye 26 months after receiving a Baerveldt glaucoma implant. The tube was covered by surrounding conjunctival tissue combined with subconjunctival placement of an ologen Collagen Matrix as a patch graft. Two years after implantation, the tube was not exposed. Anterior-segment optical coherence tomography (AS-OCT showed dense conjunctival tissue over the tube. Case 2 was an 82-year-old man with peripheral keratitis, anterior scleritis, and secondary glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve and cataract surgery. Intraoperatively, scleritis-related scleral thinning prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Seventeen months after implantation, the tube was not exposed. Case 3 was a 52-year-old man with diabetic maculopathy and steroid-induced glaucoma in the right eye who underwent tube shunt surgery using an Ahmed glaucoma valve. Intraoperatively, a flap defect prevented the tube from being covered fully by an autologous scleral flap. An ologen Collagen Matrix was placed over the scleral flap as a patch graft. Three weeks postoperatively, AS-OCT showed thick subconjunctival tissue over the tube. Three months after implantation, the tube was not exposed. Conclusions: The ologen Collagen Matrix can be used successfully as a patch graft to prevent and treat tubal exposure after tube shunt surgery.

Incidence of intraoperative hypothermia: adopting protocol for its prevention

International Nuclear Information System (INIS)

Al-Qahtani, Ali S.; Messahel, Farouk M.

2003-01-01

To determine the incidence of hypothermia during surgical procedures when adequate methods of preserving normothermia are applied .For this was a study in which patients ASA I-IV presented for surgery at the Armed Forces Hospital, Wadi Al- Dawasir, kingdom of Saudi Arabia ,during the period from July 2000 to February 2003 in whom body core temprature was between 35-37C ,were included. Ambient temperature of the operating room was thermostatically adjusted to record 26C and 24C if patents were < 10 year-old or above .Depending on type of surgery ;the patients were provided with space blankents and were lying on warm mattresses. Fluid or blood warmers and forced-air surface were used when needed for this. = Aggressive measures must be adopted to preserve normothermia as prevention of intraoperative hypothermia improves patients outcome .All patients shoud have their body temprature monitored during surgery .However application of available methods of keeping normothermia reduces the the incidence of intraoperative hypothermia but does not abolish it completely . Hypothermia patients should be closely moniterd during gradual rewarming preferably in the intensive care setting. A protocol for prevention of intraoperative hypothermia must be adopted by all operating theatres. (author)

Prophylactic intracameral levofloxacin in cataract surgery – an evaluation of safety

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Espiritu CR

2017-12-01

. Further study is required to demonstrate effectiveness in endophthalmitis prevention. Keywords: intracameral levofloxacin, endophthalmitis prevention, phacoemulsification, cataract surgery, intraocular surgery, prophylaxis

Value of Prophylactic Postoperative Antibiotic Therapy after Bimaxillary Orthognathic Surgery: A Clinical Trial

Directory of Open Access Journals (Sweden)

Majid Eshghpour

2014-10-01

Full Text Available Introduction: Antibiotic therapy before or after orthognathic surgery is commonly recommended by surgeons to minimize the risk of wound infection. This article evaluates the value of Prophylactic antibiotic therapy in order to diminish the incidence of postoperative wound infection after orthognathic surgery.   Materials and Methods: Fifty candidates for bimaxillary orthognathic surgery were divided into cases and controls. Cefazolin (1g was administered intravenously to all participants 30 mins prior to surgery followed by a similar dose 4 hours later. Case-group patients ingested amoxicillin (500 mg orally for 7 days after surgery. Postoperative wound infection was assessed using clinical features, and the P-value significance was set at P  Results: Both groups were similar according to gender, age, and operating time. During the follow-up period no infection was observed in either the case or control group.   Conclusion:  The results of this study suggest that long-term postoperative antibiotic therapy is not essential for the prevention of postoperative infection, and that application of aseptic surgical technique and hygiene instruction after surgery are sufficient.

Wound ventilation : A new concept for prevention of complications in cardiac surgery

OpenAIRE

Persson, Mikael

2003-01-01

Cardiac surgery through an open chest wound is a major operation both in size and duration. The wound exposure to ambient air implies considerable risks. 1) Air may enter the heart and great vessels and embolize to the brain or cardiac muscle where it may cause dysfunction or permanent damage. 2) The wound is exposed to airborne bacterial contamination, which may lead to postoperative wound infection. 3) The wound is subjected to desiccation, which may lead to serious adhesi...

Waste Minimization/Pollution Prevention Crosscut Plan, 1994

International Nuclear Information System (INIS)

1994-01-01

This plan establishes a Department-wide goal to reduce total releases of toxic chemicals to the environment and off-site transfers of such toxic chemicals by 50 percent by December 31, 1999, in compliance with Executive Order 12856. Each site that meets the threshold quantities of toxic chemicals established in the Emergency Planning and Community Right-to-Know Act (EPCRA) will participate in this goal. In addition, each DOE site will establish site-specific goals to reduce generation of hazardous, radioactive, radioactive mixed, and sanitary wastes and pollutants, as applicable. Implementation of this plan will represent a major step toward the environmental risks and costs associated with DOE operations and increasing the Department's use of preventive environmental management practices. Investing in Waste Minimization Pollution Prevention (WMin/PP) steadily reduce hazardous and radioactive waste generation and will reduce the need for waste management and unnecessary expenditures for waste treatment, storage, and disposal. A preventive approach to waste management will help solve current environmental and regulatory issues and reduce the need for costly future corrective actions. The purpose of this plan is to establish the strategic framework for integrating WMin/PP into all DOE internal activities. This program includes setting DOE policy and goals for reducing the generation of wastes and pollutants, increasing recycling activities, and establishing an infrastructure to achieve and measure the goals throughout the DOE complex. Waste Minimization and Pollution Prevention Awareness Plans, submitted to Headquarters by DOE field sites, will incorporate the WMin/PP activities and goals outlined in this plan. Success of the DOE WMin/PP program is dependent upon each field operation becoming accountable for resources used, wastes and pollutants generated, and wastes recycled

Pars-plana fluid aspiration for positive vitreous cavity pressure in anterior segment surgeries

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Thomas Kuriakose

2018-01-01

Full Text Available Positive vitreous pressure due to misdirection of aqueous or choroidal effusion leads to shallowing of the anterior chamber (AC before or during anterior segment surgeries. This shallow AC if not addressed makes surgery difficult and increases the risk of surgical complications. Methods to prevent and manage this condition described in literature are not without problems. We describe a minimally invasive technique of passing a 30G needle through the pars-plana to aspirate misdirected fluid from vitreous cavity either as a prophylaxis just before surgery or during it, thereby decreasing positive vitreous pressure. This technique, used in 12 eyes, seems to be effective in patients with angle-closure glaucoma, malignant glaucoma, and per-operative sudden increase in vitreous pressure during surgery. Small-incision surgeries are ideally suited for this procedure. This minimally invasive technique is simple to perform and complications are unlikely to be more than what is seen with intravitreal injections.

[Advances in the research of prevention and treatment of postburn contractures of hand].

Science.gov (United States)

Wang, K A; Wu, G S; Sun, Y; Xia, Z F

2017-01-20

Scar contracture deformity, which can lead to dysfunction of hand and low quality of life, is one of the common complication after hand burns. The prevention measures of scar contracture after hand burns include large skin grafting, prevention of infection, insistence on wearing pressure gloves, use of silicone sheets, wearing orthosis, accepting proper physical therapy, and early functional exercise. The primary treatments of postburn contractures of the hand are surgery, drugs, laser treatment, and rehabilitation therapy. Excision of scars, release of muscle, joints or bones, and soft tissue transplantation are the core of surgery. Laser treatment has a bright future but still needs to be further studied. Additionally, some novel treatments such as molecular targeted therapy, cell therapy, fat injection, and botulinum toxin injection will play important roles in prevention and treatment of postburn contractures in the future. The purpose of this article is to review the literature concerning postburn contractures of the hand, and summarize the present situation of prevention and treatment of such disease comprehensively.

A videoscope for use in minimally invasive periodontal surgery.

Science.gov (United States)

Harrel, Stephen K; Wilson, Thomas G; Rivera-Hidalgo, Francisco

2013-09-01

Minimally invasive periodontal procedures have been reported to produce excellent clinical results. Visualization during minimally invasive procedures has traditionally been obtained by the use of surgical telescopes, surgical microscopes, glass fibre endoscopes or a combination of these devices. All of these methods for visualization are less than fully satisfactory due to problems with access, magnification and blurred imaging. A videoscope for use with minimally invasive periodontal procedures has been developed to overcome some of the difficulties that exist with current visualization approaches. This videoscope incorporates a gas shielding technology that eliminates the problems of fogging and fouling of the optics of the videoscope that has previously prevented the successful application of endoscopic visualization to periodontal surgery. In addition, as part of the gas shielding technology the videoscope also includes a moveable retractor specifically adapted for minimally invasive surgery. The clinical use of the videoscope during minimally invasive periodontal surgery is demonstrated and discussed. The videoscope with gas shielding alleviates many of the difficulties associated with visualization during minimally invasive periodontal surgery. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Bariatric surgery insurance requirements independently predict surgery dropout.

Science.gov (United States)

Love, Kaitlin M; Mehaffey, J Hunter; Safavian, Dana; Schirmer, Bruce; Malin, Steven K; Hallowell, Peter T; Kirby, Jennifer L

2017-05-01

Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; Psurgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, Psurgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Anaesthetic implications of osteo-odonto-keratoprosthesis surgery.

Science.gov (United States)

Skelton, V A; Henderson, K; Liu, C

2000-06-01

Patients with bilateral corneal blindness in whom corneal transplantation has either been unsuccessful or inappropriate may be considered for osteo-odonto-keratoprosthesis surgery. During a two-stage procedure the surface of the cornea is removed and covered with a graft of buccal mucosa. An optical cylinder, supported by an osteo-odonto lamina planed from a tooth is then inserted into the mucosa to act as a lens. The anaesthetic implications of this operation include care of patients from a wide age range, often with underlying medical problems undergoing two operations of prolonged duration. The eye can be 'open' during both stages of the operation and anaesthetic techniques directed towards prevention of rises in vitreal pressure are essential. This article outlines the surgical process of osteo-odonto-keratoprosthesis surgery with reference to our anaesthetic experiences from nine cases.

[Reconstructive surgery of cranio-orbital injuries].

Science.gov (United States)

Eolchiian, S A; Potapov, A A; Serova, N K; Kataev, M G; Sergeeva, L A; Zakharova, N E; Van Damm, P

2011-01-01

The aim of study was to optimize evaluation and surgery of cranioorbital injuries in different periods after trauma. Material and methods. We analyzed 374 patients with cranioorbital injuries treated in Burdenko Neurosurgery Institute in different periods after trauma from January 1998 till April 2010. 288 (77%) underwent skull and facial skeleton reconstructive surgery within 24 hours - 7 years after trauma. Clinical and CT examination data were used for preoperative planning and assessment of surgery results. Stereolithographic models (STLM) were applied for preoperative planning in 89 cases. The follow-up period ranged from 4 months up to 10 years. Results. In 254 (88%) of 288 patients reconstruction of anterior skull base, upper and/or midface with restoration of different parts of orbit was performed. Anterior skull base CSF leaks repair, calvarial vault reconstruction, maxillar and mandibular osteosynthesis were done in 34 (12%) cases. 242 (84%) of 288 patients underwent one reconstructive operation, while 46 (16%)--two and more (totally 105 operations). The patients with extended frontoorbital and midface fractures commonly needed more than one operation--in 27 (62.8%) cases. Different plastic materials were used for reconstruction in 233 (80.9%) patients, of those in 147 (51%) cases split calvarial bone grafts were preferred. Good functional and cosmetic results were achieved in 261 (90.6%) of 288 patients while acceptable were observed in 27 (9.4%). Conclusion. Active single-stage surgical management for repair of combined cranioorbital injury in acute period with primary reconstruction optimizes functional and cosmetic outcomes and prevents the problems of delayed or secondary reconstruction. Severe extended anterior skull base, upper and midface injuries when intracranial surgery is needed produced the most challenging difficulties for adequate reconstruction. Randomized trial is required to define the extent and optimal timing of reconstructive surgery

Effect of six sigma program on the number of surgeries cancellation.

Science.gov (United States)

Gheysari, Esmat; Yousefi, Hojatollah; Soleymani, Hossain; Mojdeh, Soheila

2016-01-01

Today, the rate of surgeries is increasing, but surgeries are canceled due to various reasons. Unexpected cancellation of surgeries not only results in disorder in the operating room schedule, but also causes stress for patients and their family and increases costs. We determined the number and causes of surgery cancellations and areas for improvement. This outcome evaluation of Six Sigma program was conducted on 850 cases after the implementation of the program and compared to that of 850 cases which received routine care before the program. Cases were selected through easy sampling during the study. Before the implementation, the number of cancellations was recorded daily and their reasons were investigated. Then, Six Sigma program was implemented in accordance with the reasons for each category and necessary steps were taken to prevent the cancellation of surgeries. Data were collected for 3 months using a three-section data collection form. For data analysis, distribution and relative frequency and chi-square test were used. The three categories of patient, physician, and hospital system were identified as the main causes. The highest rate of cancellation was related to ENT surgeries (74.19%). No cancellations were made in orology surgeries. The implementation of the Six Sigma program caused a significant difference in surgery cancellation (P = 0.003); 31 (3.6%) cases of cancellation were reduced to 12 (1.4%) cases. The results showed that Six Sigma program is a pre-surgery care quality improvement program. Patient education and the implementation of the 6 sigma program can be effective in reducing the rate of cancellation of operations.

Point of care hematocrit and hemoglobin in cardiac surgery: a review.

Science.gov (United States)

Myers, Gerard J; Browne, Joe

2007-05-01

The use of point-of-care blood gas analyzers in cardiac surgery has been on the increase over the past decade. The availability of these analyzers in the operating room and post-operative intensive care units eliminates the time delays to transport samples to the main laboratory and reduces the amount of blood sampled to measure such parameters as electrolytes, blood gases, lactates, glucose and hemoglobin/hematocrit. Point-of-care analyzers also lead to faster and more reliable clinical decisions while the patient is still on the heart lung machine. Point-of-care devices were designed to provide safe, appropriate and consistent care of those patients in need of rapid acid/base balance and electrolyte management in the clinical setting. As a result, clinicians rely on their values to make decisions regarding ventilation, acid/base management, transfusion and glucose management. Therefore, accuracy and reliability are an absolute must for these bedside analyzers in both the cardiac operating room and the post-op intensive care units. Clinicians have a choice of two types of technology to measure hemoglobin/hematocrit during bypass, which subsequently determines their patient's level of hemodilution, as well as their transfusion threshold. All modern point-of-care blood gas analyzers measure hematocrit using a technology called conductivity, while other similar devices measure hemoglobin using a technology called co-oximetry. The two methods are analyzed and compared in this review. The literature indicates that using conductivity to measure hematocrit during and after cardiac surgery could produce inaccurate results when hematocrits are less than 30%, and, therefore, result in unnecessary homologous red cell transfusions in some patients. These inaccuracies are influenced by several factors that are common and unique to cardiopulmonary bypass, and will also be reviewed here. It appears that the only accurate, consistent and reliable method to determine hemodilution

Many complications after Roux-en-Y gastric bypass surgery can be prevented and treated

DEFF Research Database (Denmark)

Gribsholt, Sigrid Bjerge; Richelsen, Bjørn

2016-01-01

A wide range of complications may occur after Roux-en-Y gastric bypass (RYGB) surgery, including surgical, medical/nutritional, and psychiatric complications. Some of the nutritional complications such as anaemia, dumping and hypoglycaemia may present rather unspecific symptoms that may easily no...

The role of long-term antibiotics in the prevention of infection in postoperative cardiac surgeries

International Nuclear Information System (INIS)

Shahid, U.; Arain, M.A.; Dar, M.I.; Khan, A.B.; Aftab, S.; Manan, A.U.

2007-01-01

To compare the effect of long-term (7 days) versus short-term (2 days) postoperative antibiotics in preventing postoperative infective complications in patients who have undergone open-heart surgeries. Cardiac patients (n=42), operated for valvular disease (36%), coronary artery bypass grafting (50%), or septal repair (14%), were included in our study. Patients were prospectively randomized into two groups. Group A (n=21) patients received oral antibiotics for 7 days, whereas group B (n=21) patients were given the same for 2 days postoperative. Pre-operative and intraoperative variables were equal in both groups. Total leukocyte count and temperature were monitored daily until the patients were discharged. The chest and leg wounds were inspected daily for any signs of infection. Sputum and urine cultures were sent for selected patients in case of respiratory tract infection or urinary tract infection, respectively. Each patient was followed until the next routine visit in outpatient department. In group A, 3 patients (14%), developed infection postoperatively, whereas in group B, 13 patients (62%) (p =0.001) had to be started on oral or intravenous antibiotics as a result of developing either wound infection, a positive sputum culture, a positive urine culture or a localized infection elsewhere. Mean ward stay in group A was 4.8 +- 4.5 days and in group B 6.5 +- 4.1 days (p =0.011). In this series, there was a significantly higher frequency of infection and longer hospital stay in patients who received antibiotics for 2 days postoperatively as compared to those who received antibiotics for 7 days. (author)

Colorectal anastomotic leakage: Aspects of prevention, detection and treatment

NARCIS (Netherlands)

F. Daams (Freek); M. Luyer (Misha); J.F. Lange (Johan)

2013-01-01

textabstractAll colorectal surgeons are faced from time to time with anastomotic leakage after colorectal surgery. This complication has been studied extensively without a significant reduction of incidence over the last 30 years. New techniques of prevention, by innovative anastomotic techniques

Povidone-Iodine Concentration and Dosing in Cataract Surgery.

Science.gov (United States)

Koerner, Jagger C; George, Mary J; Meyer, Dale R; Rosco, Michael G; Habib, Matthew M

2018-05-17

Iodine has been recognized as an effective bactericide since the 1800's, and povidone-iodine (PI) solution has been applied to the ocular surface and periocular skin since the 1980's to prevent endophthalmitis in cataract surgery. In vitro, PI solution kills bacteria very quickly at dilute concentrations (0.05-1.0%). In many instances, PI kills bacteria more quickly at these dilute concentrations than more conventional (5%-10%) concentrations. This is due to greater availability of diatomic free iodine in dilute solution, the bactericidal component of PI. The toxicity of PI, both in vitro and clinically has been shown to be related to concentration. Current American Academy of Ophthalmology (AAO) and the European Society of Cataract and Refractive Surgeons (ESCRS) recommendations regarding PI use suggest using 5% PI prior to surgery. An alternative dosing strategy uses dilute PI repetitively throughout cataract surgery (0.25% every thirty seconds). We review the povidone-iodine literature with attention to basic science and use of dilute PI. Copyright © 2018 Elsevier Inc. All rights reserved.

Corrective Jaw Surgery

Medline Plus

Full Text Available ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ...

Is transdermal nitroglycerin application effective in preventing and ...

African Journals Online (AJOL)

Objective. We evaluated the efficacy of local nitroglycerin application in preventing and treating flap complications after modified radical mastectomy in a large patient cohort. Patients and methods. Between 1993 and 2008, 6 426 patients undergoing surgery for stage II breast cancer were enrolled in this prospective study.

Sclerosing stromal tumor of the ovary: A case report

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Navjot Kaur

2014-01-01

Full Text Available Sclerosing stromal tumors are benign ovarian neoplasms of the sex cord-stromal category, occurring predominantly in the second and third decades of life. Herein, we report a 23-year-old female who presented with pelvic pain, irregular menses but normal hormonal status and was diagnosed as having a right ovarian tumor. A right oophorectomy was performed, and microscopic examination revealed a sclerosing stromal tumor of the right ovary. We stress the importance of being familiar with sclerosing stromal tumors when evaluating ovarian neoplasms in young women, in order to contribute to the appropriate clinical management, preventing extensive and unnecessary surgery, and preserving fertility.

Surgery vs. primary radiotherapy in early-stage oropharyngeal cancer

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Catia Pedro

2018-02-01

Conclusions: Longer follow-up still does not show a significant difference in OS and LRFS between both treatments. Because most patients submitted to surgery required adjuvant RT and since its side-effects were not negligible, further studies are warranted to better suit the first treatment for each patient and to prevent the need for adjuvant treatment and the risk of toxicity.

Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer

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Remzi Kızıltan

2016-02-01

Full Text Available Aim To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had undergone emergency surgery due to complicated colorectal cancer. Methods A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department of General Surgery, Dursun Odabaş Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed. Results There were 14 (42.5% male and 19 (57.5% female patients. Mean age was 60 years (range: 32- 83 years; 14 (42.5% patients were less than 60 years old , while 19 (57.5% were 60 years old or older. Operations were performed due to perforation (39.3% and obstruction (60.6% in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2% and in the left colon in 24 cases (72.7%. Eleven (33.3% patients underwent resection and anastomosis, 13 (39.3% resection and ostomy, and nine (27.2% patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%. Conclusions High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity rates.

Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer.

Science.gov (United States)

Kızıltan, Remzi; Yılmaz, Özkan; Aras, Abbas; Çelik, Sebahattin; Kotan, Çetin

2016-02-01

To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had undergone emergency surgery due to complicated colorectal cancer. A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department of General Surgery, Dursun Odabaş Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed. There were 14 (42.5%) male and 19 (57.5%) female patients. Mean age was 60 years (range: 32- 83 years); 14 (42.5%) patients were less than 60 years old , while 19 (57.5%) were 60 years old or older. Operations were performed due to perforation (39.3%) and obstruction (60.6%) in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2%) and in the left colon in 24 cases (72.7%). Eleven (33.3%) patients underwent resection and anastomosis, 13 (39.3%) resection and ostomy, and nine (27.2%) patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%). High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity rates. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

Supratentorial hematoma during infratentorial surgery: A short series of three cases

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Sandeep Mohindra

2012-01-01

Full Text Available Distant site hematoma formation may complicate an otherwise uneventful surgery. The authors describe three cases of such unexpected complications, while operating upon infratentorial lesions in prone position. Pathophysiology behind such complications and changes in intraoperative monitoring is discussed, along with all the previously reported cases. Of the three cases, there was one death, while rest of the two cases made eventless recovery. Meticulous hemostasis, isolation of operative site, avoidance of cerebrospinal fluid over-drainage during surgery may prevent such a complication. Careful interpretation of vital-monitoring may indicate the occurrence of such a complication.

Use and Effectiveness of Peri-Operative Cefotetan versus Cefazolin Plus Metronidazole for Prevention of Surgical Site Infection in Abdominal Surgery Patients.

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Danan, Eleanor; Smith, Janessa; Kruer, Rachel M; Avdic, Edina; Lipsett, Pamela; Curless, Melanie S; Jarrell, Andrew S

2018-04-24

Current practice guidelines for antimicrobial prophylaxis in surgery recommend a cephamycin or cefazolin plus metronidazole for various abdominal surgeries. In February 2016, cephamycin drug shortages resulted in a change in The Johns Hopkins Hospital's (JHH) recommendation for peri-operative antibiotic prophylaxis in abdominal surgeries from cefotetan to cefazolin plus metronidazole. The primary objective of this study was to quantify the percentage of abdominal surgeries adherent to JHH peri-operative antibiotic prophylaxis guidelines. A sub-group analysis investigated whether prophylaxis with cefazolin plus metronidazole was associated with a lower rate of surgical site infections (SSIs) versus cefotetan. This retrospective cohort study included adult inpatients who underwent an abdominal surgery at JHH in September 2015 (Study Period I: cefotetan) or February to March 2016 (Study Period II: cefazolin plus metronidazole). Two hundred abdominal surgery cases were included in the primary analysis. A subset of 156 surgical cases were included in the sub-group analysis. The overall adherence rate to JHH guidelines was 75% in Study Period I versus 17% in Study Period II (p operative administration time (87% vs. 23%, p site infections occurred in 14% (12/83) of surgeries with cefotetan versus 8.2% (6/73) with cefazolin plus metronidazole for prophylaxis (p = 0.19). Adherence to an institution-specific peri-operative antibiotic prophylaxis guideline for abdominal surgeries was limited primarily by the longer infusion time required for pre-operative metronidazole. A higher percentage of SSIs occurred among abdominal surgeries with cefotetan versus cefazolin plus metronidazole for prophylaxis.

[Case of neuroleptic malignant syndrome following open heart surgery for thoracic aortic aneurysm with parkinson's disease].

Science.gov (United States)

Shinoda, Maiko; Sakamoto, Mik; Shindo, Yuki; Ando, Yumi; Tateda, Takeshi

2013-12-01

An 80-year-old woman with Parkinson's disease was scheduled for open heart surgery to repair thoracic aortic aneurysm. Parkinson's symptoms were normally treated using oral levodopa (200 mg), selegiline-hydrochloride (5 mg), bromocriptine-mesilate (2 mg), and amantadine-hydrochloride (200 mg) daily. On the day before surgery, levodopa 50mg was infused intravenously. Another 25 mg of levodopa was infused immediately after surgery. Twenty hours later, the patient developed tremors, heyperventilation, but no obvious muscle rigidity. Two days after surgery, the patient exhibited high fever, hydropoiesis, elevated creatine kinase, and a rise in blood leukocytes. She was diagnosed with neuroleptic malignant syndrome. She was intubated, and received dantrolene sodium. Symptoms of neuroleptic malignant syndrome disappeared on the fourth postoperative day. The stress of open heart surgery, specifically extracorporeal circulation and concomitant dilution of levodopa, triggered neuroleptic malignant syndrome in this patient. Parkinson's patients require higher doses of levodopa prior to surgery to compensate and prevent neuroleptic malignant syndrome after surgery.

Intraoperative Death During Cervical Spinal Surgery: A Retrospective Multicenter Study.

Science.gov (United States)

Wang, Jeffrey C; Buser, Zorica; Fish, David E; Lord, Elizabeth L; Roe, Allison K; Chatterjee, Dhananjay; Gee, Erica L; Mayer, Erik N; Yanez, Marisa Y; McBride, Owen J; Cha, Peter I; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

2017-04-01

A retrospective multicenter study. Routine cervical spine surgeries are typically associated with low complication rates, but serious complications can occur. Intraoperative death is a very rare complication and there is no literature on its incidence. The purpose of this study was to determine the intraoperative mortality rates and associated risk factors in patients undergoing cervical spine surgery. Twenty-one surgical centers from the AOSpine North America Clinical Research Network participated in the study. Medical records of patients who received cervical spine surgery from January 1, 2005, to December 31, 2011, were reviewed to identify occurrence of intraoperative death. A total of 258 patients across 21 centers met the inclusion criteria. Most of the surgeries were done using the anterior approach (53.9%), followed by posterior (39.1%) and circumferential (7%). Average patient age was 57.1 ± 13.2 years, and there were more male patients (54.7% male and 45.3% female). There was no case of intraoperative death. Death during cervical spine surgery is a very rare complication. In our multicenter study, there was a 0% mortality rate. Using an adequate surgical approach for patient diagnosis and comorbidities may be the reason how the occurrence of this catastrophic adverse event was prevented in our patient population.

The prevention of postoperative vomiting following strabismus surgery in children with using Promethazine and Droperidol

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Shaigh al Islam V

1996-07-01

Full Text Available Children undergoing general anesthesia for strabismus surgery have a higher incidence of postoperative vomiting than those receiving the same anaesthesia for other types of ambulatory surgical procedures. Droperidol (0/0 75 mg/kg IV and promethazine (0.05-1.0 mg/kg were used in 100 children between 2-15 years old. Promethazine which has sedative property, anticholinergic antihistaminic, antiemetic and anti-motion sickness effects is recommended for children 0.05 mg-1.0 mg/kg of body weight IV. After induction of anesthesia and before operation and manipulation of the eye and combined with 0.5 mg/kg IM promethazine after operation. The incidence of vomiting following strabismus surgery might be reduced more than with intravenous droperidol

Towards standardized measurement of adverse events in spine surgery: conceptual model and pilot evaluation

Directory of Open Access Journals (Sweden)

Deyo Richard A

2006-06-01

Full Text Available Abstract Background Independent of efficacy, information on safety of surgical procedures is essential for informed choices. We seek to develop standardized methodology for describing the safety of spinal operations and apply these methods to study lumbar surgery. We present a conceptual model for evaluating the safety of spine surgery and describe development of tools to measure principal components of this model: (1 specifying outcome by explicit criteria for adverse event definition, mode of ascertainment, cause, severity, or preventability, and (2 quantitatively measuring predictors such as patient factors, comorbidity, severity of degenerative spine disease, and invasiveness of spine surgery. Methods We created operational definitions for 176 adverse occurrences and established multiple mechanisms for reporting them. We developed new methods to quantify the severity of adverse occurrences, degeneration of lumbar spine, and invasiveness of spinal procedures. Using kappa statistics and intra-class correlation coefficients, we assessed agreement for the following: four reviewers independently coding etiology, preventability, and severity for 141 adverse occurrences, two observers coding lumbar spine degenerative changes in 10 selected cases, and two researchers coding invasiveness of surgery for 50 initial cases. Results During the first six months of prospective surveillance, rigorous daily medical record reviews identified 92.6% of the adverse occurrences we recorded, and voluntary reports by providers identified 38.5% (surgeons reported 18.3%, inpatient rounding team reported 23.1%, and conferences discussed 6.1%. Trained observers had fair agreement in classifying etiology of 141 adverse occurrences into 18 categories (kappa = 0.35, but agreement was substantial (kappa ≥ 0.61 for 4 specific categories: technical error, failure in communication, systems failure, and no error. Preventability assessment had moderate agreement (mean weighted

The horror of wrong-site surgery continues: report of two cases in a regional trauma centre in Nigeria.

Science.gov (United States)

Nwosu, Arinze

2015-01-01

Wrong- site surgeries are iatrogenic errors encountered in the course of surgical patient management. Despite the 'never do harm' pledge in the 'Hippocratic Oath' drafted in 5(th) century BC, man is after all human, with this limitation manifesting in the physician's art despite his best intention. Beyond the catastrophic consequences of wrong- site surgery on the patient and surgeon, and the opprobrium on the art of medicine, the incidents have come to be regarded as a quality-of-care indicator. Orthopaedic surgery is a specialty with a preponderance of this phenomenon and the attendant medico-legal issues relating to malpractice claims. Consequently the specialty had pioneered institutional initiatives at preventing these 'friendly-fires'. Awareness and implementation of these initiatives however remain low in many parts of the world, hampered by a culture of denial and shame. This report presents two cases of wrong-site surgery following trauma from road-traffic accident. The first case was a closed reduction of the 'wrong' dislocated hip in the trauma/emergency unit under the care of senior residents, while the second case was attempted wrong-site surgery on the right leg in a patient with fracture of the left tibia, in conjunction with bilateral femoral fracture and right radio-ulnar fracture; by an experienced Chief Consultant Orthopaedic Surgeon operating elective list. Both are orthopaedic cases, each with some trauma to both lower extremeties. Neither of the cases was formally mentioned anywhere in clinical discourse in the hospital, much less a formal report or audit. There was no formal, institutionalized process to prevent wrong-site surgery in the health institution and this could have been largely responsible for these incidents. An open, mandatory process of reporting such incidents for relevant audit and awareness is necessary, as a mechanism for prevention rather than blame or punishment.

Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection

DEFF Research Database (Denmark)

Bonser, Robert S; Ranasinghe, Aaron M; Loubani, Mahmoud

2011-01-01

for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection...

Routine preoperative blood group and save testing is unnecessary for elective laparoscopic cholecystectomy

International Nuclear Information System (INIS)

Tandon, A.; Shahzad, K.; Nunes, Q.; Shrotri, M.; Lunevicius, R.

2017-01-01

Background: Although the practice of preoperative testing of ABO group and Rh (D) type for elective cholecystectomy has deep historical roots, it is not evidence-based. We aimed to assess the preoperative blood group and save testing practice for a cohort of patients subjected to elective laparoscopic cholecystectomy for symptomatic cholecystolithiasis between January 2010 and October 2014. Methods: National Health Service (NHS) hospital based, surgical procedure-specific, retrospective study was conducted. A final group consisted of 2,079 adult patients. We estimated the incidence of perioperative blood transfusion attributable to laparoscopic cholecystectomy. The results of eight other studies are presented. Results: A preoperative blood group and save test was performed in 907 patients (43.6%), whereas cross-matching was documented in 28 patients (3.1%). None required an intraoperative blood transfusion. Twelve patients (0.58%) underwent blood transfusion postoperatively following laparoscopic cholecystectomy, of which ten were transfused due to severe intra-abdominal bleeding (0.48%). There were no deaths. Conclusions: The likelihood of blood transfusion attributable to elective laparoscopic cholecystectomy is 1:200. A routine preoperative blood group and save testing is unnecessary. It neither alters the management of severe hypovolemia, secondary to perioperative bleeding, nor does it lead to better outcomes. (author)

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

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Giulio Gasparini

2015-01-01

Full Text Available Introduction. This study aims to investigate the reasons that discourage the patients affected by OSAS to undergo orthognathic surgery and compares the postoperative discomfort of phase I (soft tissue surgery and phase II (orthognathic surgery procedures for treatment of OSAS. Material and Methods. A pool of 46 patients affected by OSAS was divided into two groups: “surgery patients” who accepted surgical treatments of their condition and “no surgery patients” who refused surgical procedures. The “surgery patients” group was further subdivided into two arms: patients who accepted phase I procedures (IP and those who accepted phase II (IIP. To better understand the motivations behind the refusal of II phase procedures, we asked the patients belonging to both the IP group and “no surgery” group to indicate the main reason that influenced their decision to avoid II phase procedures. We also monitored and compared five parameters of postoperative discomfort: pain, painkiller assumption, length of hospitalization, foreign body sensation, and diet assumption following IP and IIP procedures. Results. The main reason to avoid IIP procedures was the concern of a more severe postoperative discomfort. Comparison of the postoperative discomfort following IP versus IIP procedures showed that the former scored worse in 4 out of 5 parameters analyzed. Conclusion. IIP procedures produce less postoperative discomfort. IIP procedures, namely, orthognathic surgery, should be the first choice intervention in patients affected by OSAS and dentoskeletal malformation.

Regional anesthesia procedures for shoulder and upper arm surgery upper extremity update--2005 to present.

Science.gov (United States)

Sripada, Ramprasad; Bowens, Clifford

2012-01-01

This review of the literature since 2005 assesses developments of RA techniques commonly used for shoulder surgery, and their effectiveness for postoperative analgesia. Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the ISB provides effective analgesia with minimal complications, whereas the impacts of IA single-injections remain unclear. When combined with GA, ISB can be used in lower volumes and reducing the complications for shoulder and proximal upper extremity. USG ISB and SCB are both effective and safe for shoulder surgery with a low incidence of complications, especially PONS.53 When compared with intravenous patient-controlled opioid analgesia, a perineural LA infusion using a disposable pump with patient-controlled LA bolus function has led to better pain relief and functional recovery while decreasing the need for rescue analgesics and the number of adverse events after ambulatory orthopedic surgery. The most remarkable advance in RA in the past 5 years is the increased usage of USG. Although there are no large-scale prospective studies to show the safety, efficacy, and success and complication rates for USG blocks, USG RA theoretically could have less risk for neurologic symptoms, except for those induced by LA (less likely perineurally, much more likely intraneurally). The next "quantum leap" lies in reducing LA concentrations and augmenting anesthetic-analgesic effects with perineural additives (including clonidine, buprenorphine, and likely low-dose dexamethasone). Since 2005, perineural catheters have been an analgesic option that offers improved pain relief among other benefits, and are now being used at home. It is clear that patients benefit greatly from a single injection and continuous nerve block for postoperative pain management,but the financial and logistical aspects need to be resolved, not to mention the phrenic hemiparesis coin toss. Whether combined

Delirium in cardiac surgery : A study on risk-assessment and long-term consequences

NARCIS (Netherlands)

Hogen-Koster, S.

2011-01-01

BACKGROUND: Delirium or acute confusion is a temporary mental disorder, which occurs frequently among hospitalized elderly patients. Patients who undergo cardiac surgery have an increased risk of developing delirium. Delirium is associated with many negative consequences. Therefore, prevention or

Commonly Prescribed Blood Thinner Associated with Higher Risk of Post-Surgery Complications

Science.gov (United States)

... association between preventive anticoagulant use and post-surgery infections or other problems, but this is the first multi-site study addressing the issue. "Anticoagulant use must be balanced with the need to avoid excessive post-operative bleeding, which can lead to complications and delay ...

Video-assisted-thoracoscopic surgery in left-to-right Nuss procedure for pectus excavatum for prevention of serious complications - technical aspects based on 1006 patients.

Science.gov (United States)

Pawlak, Krystian; Gąsiorowski, Łukasz; Gabryel, Piotr; Dyszkiewicz, Wojciech

2018-03-01

Additional use of the video-assisted thoracoscopic surgery (VATS) technique in the Nuss procedure has been globally accepted for the improvement of safety of surgical treatment as well as for decreased frequency of serious intraoperative and postoperative complications. To evaluate VATS in surgical treatment of patients with pectus excavatum by the left-to-right Nuss procedure for prevention of serious intra- and postoperative complications. From 2002 to 2016, 1006 patients with pectus excavatum aged 7 to 62 years (mean: 18.6) underwent the Nuss procedure. There were 796 males and 210 females. The clinical records of all patients were analyzed retrospectively. The follow-up varied from 1 to 172 months (mean: 80.7 ±43). The early 30-day postoperative mortality was zero. Early thoracoscopy-dependent postoperative complications, the majority transient and non-life-threatening, occurred in 35.6% of patients. The most frequent complication was pneumothorax, diagnosed in 24.5% of patients. Two patients required repeat surgery. One patient required VATS pleurectomy due to persistent postoperative air leakage. In another patient left thoracotomy following bleeding from the pleural cavity was performed. The use of VATS in the left-to-right Nuss procedure for pectus excavatum ensures the safety of surgical treatment and minimizes the occurrence of serious intra- and postoperative complications concerning injury of the mediastinum, lung, diaphragm or abdominal cavity.

Lower limb compartment syndrome following laparoscopic colorectal surgery: a review.

Science.gov (United States)

Rao, M M; Jayne, D

2011-05-01

  In spite of recent advances in technology and technique, laparoscopic colorectal surgery is associated with increased operating times when compared with open surgery. This increases the risk of acute lower limb compartment syndrome. The aim of this review was to gain a better understanding of postoperative lower limb compartment syndrome following laparoscopic colorectal surgery and to suggest strategies to avoid its occurrence. A MEDLINE search was performed using the keywords 'compartment syndrome', 'laparoscopic surgery' and 'Lloyd-Davies position' between 1970 and 2008. All relevant articles were retrieved and reviewed. A total of 54 articles were retrieved. Of the 30 articles in English, five were reviews, six were original articles and 19 were case reports, of which only one was following laparoscopic colorectal surgery. The remaining 24 were non-English articles. Of these, two were reviews and 22 were case reports, of which only one was following laparoscopic colorectal surgery. The incidence of acute compartment syndrome following laparoscopic colorectal surgery is unknown. The following are believed to be risk factors for acute lower limb compartment syndrome: the Lloyd-Davies operating position with exaggerated Trendelenburg tilt, prolonged operative times and improper patient positioning. Simple strategies are suggested to reduce its occurrence. Simple preventative measures have been identified which may help to reduce the incidence of acute lower limb compartment syndrome. However, if suspected, timely surgical intervention with four-compartment fasciotomy remains the standard of care. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

Predictive factors for homologous transfusion during paediatric scoliosis surgery.

Science.gov (United States)

Dupuis, Claire; Michelet, Daphné; Hilly, Julie; Diallo, Thierno; Vidal, Christophe; Delivet, Honorine; Nivoche, Yves; Mazda, Keyvan; Dahmani, Souhayl

2015-12-01

Blood saving strategies during paediatric spinal surgery often include recombinant erythropoietin (rEPO) and antifibrinolytic therapy (AFT). The goal of this study was to investigate additional preventive factors involved in the risk of blood transfusion. This prospective study was designed with the aim of identifying factors associated with the perioperative (defined as the intraoperative and the first postoperative day) probability of homologous red cell transfusion during scoliosis surgery in children operated during a one year period in our institution. The predictors analysed were: age, weight less than the 3rd percentile (W 255 minutes. ROC analysis for the latter model found an area under the curve of 0.9 (95% confidence interval: 0.8-0.97). The accuracy of the model was 92.3% (97.4% for non-transfusion and 69.2% for transfusion). Multivariate sensitivity analysis excluding patients with no preoperative administration of EPO found similar results. The current results indicate that optimising nutritional status might prevent allogenic blood transfusion and requires further investigation. Copyright © 2015 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Tennis elbow surgery

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Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is often an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

Mohs micrographic surgery

Science.gov (United States)

Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

[Thymus surgery in a general surgery department].

Science.gov (United States)

Mega, Raquel; Coelho, Fátima; Pimentel, Teresa; Ribero, Rui; Matos, Novo de; Araújo, António

2005-01-01

Evaluation of thymectomy cases between 1990-2003, in a General Surgery Department. Evaluation of the therapeutic efficacy in Miastenia Gravis patients. Retrospective study based on evaluation of data from Serviço de Cirurgia, Neurologia and Consult de Neurology processes, between 1990-2003, of 15 patients submitted to total thymectomy. 15 patients, aged 17 to 72, 11 female and 4 male. Miastenia Gravis was the main indication for surgery, for uncontrollable symptoms or suspicion of thymoma. In patients with myasthenia, surgery was accomplish after compensation of symptoms. There weren't post-surgery complications. Pathology were divided in thymic hyperplasia and thymoma. Miastenia patients have there symptoms diminished or stable with reduction or cessation of medical therapy. Miastenia was the most frequent indication for thymectomy. Surgery was good results, with low morbimortality, as long as the protocols are respected.

Mechanical ventilation in abdominal surgery.

Science.gov (United States)

Futier, E; Godet, T; Millot, A; Constantin, J-M; Jaber, S

2014-01-01

One of the key challenges in perioperative care is to reduce postoperative morbidity and mortality. Patients who develop postoperative morbidity but survive to leave hospital have often reduced functional independence and long-term survival. Mechanical ventilation provides a specific example that may help us to shift thinking from treatment to prevention of postoperative complications. Mechanical ventilation in patients undergoing surgery has long been considered only as a modality to ensure gas exchange while allowing maintenance of anesthesia with delivery of inhaled anesthetics. Evidence is accumulating, however, suggesting an association between intraoperative mechanical ventilation strategy and postoperative pulmonary function and clinical outcome in patients undergoing abdominal surgery. Non-protective ventilator settings, especially high tidal volume (VT) (>10-12mL/kg) and the use of very low level of positive end-expiratory pressure (PEEP) (PEEPventilator-associated lung injury in patients with healthy lungs. Stimulated by previous findings in patients with acute respiratory distress syndrome, the use of lower tidal volume ventilation is becoming increasingly more common in the operating room. However, lowering tidal volume, though important, is only part of the overall multifaceted approach of lung protective mechanical ventilation. In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of mechanical ventilation in patients undergoing abdominal surgery. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Risk factors for infections due to carbapenem-resistant Klebsiella pneumoniae after open heart surgery.

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Salsano, Antonio; Giacobbe, Daniele Roberto; Sportelli, Elena; Olivieri, Guido Maria; Brega, Carlotta; Di Biase, Carlo; Coppo, Erika; Marchese, Anna; Del Bono, Valerio; Viscoli, Claudio; Santini, Francesco

2016-11-01

Patients undergoing major surgery are at increased risk of developing infections due to resistant organisms, including carbapenem-resistant Klebsiella pneumoniae (CR-Kp). In this study, we assessed risk factors for CR-Kp infections after open heart surgery in a teaching hospital in northern Italy. A retrospective study was conducted from January to December 2014. The primary outcome measure was postoperative CR-Kp infection, defined as a time-to-event end-point. The effect of potentially related variables was assessed by univariable and multivariable analyses. Secondary end-points were in-hospital mortality and 180-day postoperative mortality. Among 553 patients undergoing open heart surgery, 32 developed CR-Kp infections (6%). In the final multivariable model, CR-Kp colonization [hazard ratio (HR) 227.45, 95% confidence intervals (CI) 67.13-1225.20, P open heart surgery. CR-Kp infection after surgery significantly affected survival. Preventing colonization is conceivably the most effective current strategy to reduce the impact of CR-Kp. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Risk factors and outcomes of organ-space surgical site infections after elective colon and rectal surgery

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Aina Gomila

2017-04-01

Full Text Available Abstract Background Organ-space surgical site infections (SSI are the most serious and costly infections after colorectal surgery. Most previous studies of risk factors for SSI have analysed colon and rectal procedures together. The aim of the study was to determine whether colon and rectal procedures have different risk factors and outcomes for organ-space SSI. Methods A multicentre observational prospective cohort study of adults undergoing elective colon and rectal procedures at 10 Spanish hospitals from 2011 to 2014. Patients were followed up until 30 days post-surgery. Surgical site infection was defined according to the Centers for Disease Control and Prevention criteria. Oral antibiotic prophylaxis (OAP was considered as the administration of oral antibiotics the day before surgery combined with systemic intravenous antibiotic prophylaxis. Results Of 3,701 patients, 2,518 (68% underwent colon surgery and 1,183 (32% rectal surgery. In colon surgery, the overall SSI rate was 16.4% and the organ-space SSI rate was 7.9%, while in rectal surgery the rates were 21.6% and 11.5% respectively (p < 0.001. Independent risk factors for organ-space SSI in colon surgery were male sex (Odds ratio -OR-: 1.57, 95% CI: 1.14–2.15 and ostomy creation (OR: 2.65, 95% CI: 1.8–3.92 while laparoscopy (OR: 0.5, 95% CI: 0.38–0.69 and OAP combined with intravenous antibiotic prophylaxis (OR: 0.7, 95% CI: 0.51–0.97 were protective factors. In rectal surgery, independent risk factors for organ-space SSI were male sex (OR: 2.11, 95% CI: 1.34–3.31 and longer surgery (OR: 1.49, 95% CI: 1.03–2.15, whereas OAP with intravenous antibiotic prophylaxis (OR: 0.49, 95% CI: 0.32–0.73 was a protective factor. Among patients with organ-space SSI, we found a significant difference in the overall 30-day mortality, being higher in colon surgery than in rectal surgery (11.5% vs 5.1%, p = 0.04. Conclusions Organ-space SSI in colon and rectal surgery has some

Corrective Jaw Surgery

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Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

Efficacy of amiodarone and lidocaine for preventing ventricular fibrillation after aortic cross-clamp release in open heart surgery: a meta-analysis of randomized controlled trials.

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Zheng, Yong; Gu, Qiang; Chen, Hong-Wu; Peng, Huai-Ming; Jia, Dong-Yu; Zhou, Yu; Xiang, Mei-Xiang

The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation (VF) after release of an aortic cross-clamp (ACC) during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. Prospective randomized controlled trials (RCTs) that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. PubMed, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable (relative risk (RR)=1.12, 95% confidence interval (CI): 0.70 to 1.80, P=0.63), but both were superior to the placebo (amiodarone, RR=0.71, 95% CI: 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI: 0.46 to 0.88, P=0.006). The percentage of patients requiring electric defibrillation counter shocks (DCSs) did not differ significantly among patients administered amiodarone (RR=0.21, 95% CI: 0.04 to 1.19, P=0.08), lidocaine (RR=2.44, 95% CI: 0.13 to 44.02, P=0.55), or the placebo (RR=0.56, 95% CI: 0.25 to 1.25, P=0.16). Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.

A randomised, controlled, double-blind trial of ultrasound-guided phrenic nerve block to prevent shoulder pain after thoracic surgery.

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Blichfeldt-Eckhardt, M R; Laursen, C B; Berg, H; Holm, J H; Hansen, L N; Ørding, H; Andersen, C; Licht, P B; Toft, P

2016-12-01

Moderate to severe ipsilateral shoulder pain is a common complaint following thoracic surgery. In this prospective, parallel-group study at Odense University Hospital, 76 patients (aged > 18 years) scheduled for lobectomy or pneumonectomy were randomised 1:1 using a computer-generated list to receive an ultrasound-guided supraclavicular phrenic nerve block with 10 ml ropivacaine or 10 ml saline (placebo) immediately following surgery. A nerve catheter was subsequently inserted and treatment continued for 3 days. The study drug was pharmaceutically pre-packed in sequentially numbered identical vials assuring that all participants, healthcare providers and data collectors were blinded. The primary outcome was the incidence of unilateral shoulder pain within the first 6 h after surgery. Pain was evaluated using a numeric rating scale. Nine of 38 patients in the ropivacaine group and 26 of 38 patients in the placebo group experienced shoulder pain during the first 6 h after surgery (absolute risk reduction 44% (95% CI 22-67%), relative risk reduction 65% (95% CI 41-80%); p = 0.00009). No major complications, including respiratory compromise or nerve injury, were observed. We conclude that ultrasound-guided supraclavicular phrenic nerve block is an effective technique for reducing the incidence of ipsilateral shoulder pain after thoracic surgery. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

Systematic review of the surgery-first approach in orthognathic surgery

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Chiung Shing Huang

2014-08-01

Full Text Available The surgery-first approach in orthognathic surgery has recently created a broader interest in completely eliminating time-consuming preoperative orthodontic treatment. Available evidence on the surgery-first approach should be appraised to support its use in orthognathic surgery. A MEDLINE search using the keywords "surgery first" and "orthognathic surgery" was conducted to select studies using the surgery-first approach. We also manually searched the reference list of the selected keywords to include articles not selected by the MEDLINE search. The search identified 18 articles related to the surgery-first approach. There was no randomized controlled clinical trial. Four papers were excluded as the content was only personal opinion or basic scientific research. Three studies were retrospective cohort studies in nature. The other 11 studies were case reports. For skeletal Class III surgical correction, the final long-term outcomes for maxillofacial and dental relationship were not significantly different between the surgery-first approach and the orthodontics-first approach in transverse (e.g., intercanine or intermolar width dimension, vertical (e.g., anterior open bite, lower anterior facial height dimension, and sagittal (e.g., anterior-posterior position of pogonion and lower incisors dimension. Total treatment duration was substantially shorter in cases of surgery-first approach use. In conclusion, most published studies related to the surgery-first approach were mainly on orthognathic correction of skeletal Class III malocclusion. Both the surgery-first approach and orthodontics-first approach had similar long-term outcomes in dentofacial relationship. However, the surgery-first approach had shorter treatment time.

Outbreak of bacterial endocarditis associated with an oral surgery practice: New Jersey public health surveillance, 2013 to 2014.

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Ross, Kathleen M; Mehr, Jason S; Greeley, Rebecca D; Montoya, Lindsay A; Kulkarni, Prathit A; Frontin, Sonya; Weigle, Trevor J; Giles, Helen; Montana, Barbara E

2018-03-01

In October and November 2014, the New Jersey Department of Health received reports of 3 patients who developed Enterococcus faecalis endocarditis after undergoing surgical procedures at the same oral surgery practice in New Jersey. Bacterial endocarditis is an uncommon but life-threatening condition; 3 patients with enterococcal endocarditis associated with a single oral surgery practice is unusual. An investigation was initiated because of the potential ongoing public health risk. Public health officials conducted retrospective surveillance to identify additional patients with endocarditis associated with the practice. They interviewed patients using a standardized questionnaire. An investigative public health team inspected the office environment, interviewed staff, and reviewed medical records. Public health officials identified 15 confirmed patients with enterococcal endocarditis of those patients who underwent procedures from December 2012 through August 2014. Among these patients, 12 (80%) underwent cardiac surgery. One (7%) patient died from complications of endocarditis and subsequent cardiac surgery. Breaches of recommended infection prevention practices were identified that might have resulted in transmission of enterococci during the administration of intravenous sedation, including failure to perform hand hygiene and failure to maintain aseptic technique when performing procedures and handling medications. This investigation highlights the importance of adhering to infection prevention recommendations in dental care settings. No additional patients with endocarditis were identified after infection prevention and control recommendations were implemented. Infection prevention training should be emphasized at all levels of professional dental training. All dental health care personnel establishing intravenous treatment and administering intravenous medications should be trained in safe injection practices. Copyright © 2018 American Dental Association

Turbinate surgery

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Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

Dexmedetomidine as a Cardioprotector in Cardiac Surgery (Review

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I. A. Kozlov

2017-01-01

Full Text Available The literature review presents an analysis of publications on the use of a selective α2-adrenergic receptor agonist (α2-AR dexmedetomidine as a cardioprotector in cardiosurgical interventions. It summarizes historical aspects of the introduction of α2-AR agonists in the intensive care practice. It analyzes possible mechanisms of the cardioprotective effect of dexmedetomidine (central sympatholysis, favorable effects on the coronary circulation and relief of the coronary steal syndrome in originally ischemized areas of the myocardium, antiinflammatory and antioxidant effects, and prevention of apoptosis activation. Data from experimental studies of dexmedetomidine cardioprotection were analyzed. Results of clinical studies, including data of metanalyses, were discussed. It dwells on data on the favorable effect of dexmedetomidine on various parameters of the postoperative period, including a decreased risk of delirium, general complications of cardiosurgical interventions, and the mortality rate in patients. It presents data on cardioprotective properties of dexmedetomidine in surgical patients who undergo noncardiac interventions, particularly vascular ones, including high risk surgeries in the aorta. A comparative analysis of results of clinical trials studying the dexmedetomidine cardioprotection during surgeries with extracorporeal circulation was performed. A range of pharmacological effects of dexmedetomidine during anesthesiological support of cardiac surgeries, including those in elderly and senile patients, was described. It has been concluded that the dexmedetomidine cardioprotection in the various fields of surgery is obviously very promising.

American Association for the Surgery of Trauma Prevention Committee topical overview: National Trauma Data Bank, geographic information systems, and teaching injury prevention.

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Crandall, Marie; Zarzaur, Ben; Tinkoff, Glen

2013-11-01

Injury is the leading cause of death for all Americans aged 1 to 35 years, and injury-related costs exceed $100 billion per year in the United States. Trauma centers can be important resources for risk identification and prevention strategies. The authors review 3 important resources for injury prevention education and research: the National Trauma Data Bank, geographic information systems, and an overview of injury prevention education. The National Trauma Data Bank and the Trauma Quality Improvement Program are available through the Web site of the American College of Surgeons. Links to research examples using geographic information systems software and the National Trauma Data Bank are provided in the text. Finally, resources for surgical educators in the area of injury prevention are summarized and examples provided. Database research, geographic information systems, and injury prevention education are important tools in the field of injury prevention. This article provides an overview of current research and education strategies and resources. Copyright © 2013 Elsevier Inc. All rights reserved.

A case of congenital unilateral absence of the vas deferens

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Mo B

2013-04-01

Full Text Available Bi Mo,1 Vishnu Garla,2 Lawrence M Wyner1 1Department of Surgery, 2Department of Internal Medicine, Marshall University, Huntington, WV, USA Background: Congenital unilateral absence of the vas deferens occurs in 0.5%–1.0% of males. It has been associated with various genitourinary abnormalities, including renal agenesis. We report a case of congenital unilateral absence of the vas deferens found incidentally during vasectomy in a patient with known unilateral renal agenesis. Case presentation: A 24-year-old male presented to our urology clinic requesting vasectomy. His past history was significant for left renal agenesis. Following successful right vasectomy, several attempts to locate the left vas deferens were unsuccessful. We diagnosed congenital unilateral absence of the vas deferens. Follow-up semen analysis showed azoospermia. Conclusion: As vasectomies are increasingly performed in outpatient settings, it is imperative that physicians be aware of this condition, which can be recognized by a simple physical exam. Recognition could prevent unnecessary surgery and prompt providers to investigate for associated abnormalities. Keywords: vas deferens, embryology, abnormalities, surgery

Can saline be an alternative to aesthetic surgery in extended breast quadrantectomy

International Nuclear Information System (INIS)

Hadi, Maha S.A. Abdel

2007-01-01

Objective was to explore other simpler options sparing the patients the morbidity and cost in extended breast quadrantectomy. This prospective was undertaken at King Fahd Hospital of the University, Al-Khobar Eastern Province of Saudi Arabia between 1999-2005. Factors considered for patients undergoing breast-conserving surgery were based on age, tumor size, pathological characteristics, and patient's preference. Frozen section was adopted in all procedures to insure negative margins. After extended quadrantectomy, 200-400 cc was injected into the cavity to retain breast contour. Magnetic resonance imaging was used for postoperative assessment. Twenty-four patients were included, aged 28-43 years and tumor size 3-5 cms. All margins were negative on frozen section. The contour of the breast was restored with saline, MRI was employed for follow up at the immediate post operative period and at 4-6 months, it demonstrated restored breast contour and the saline filled cavity replaced by lipo-fibrous tissue. Follow up after 4-24 months showed that all patients noticed some degree of asymmetry, yet were satisfied with the result, none required or requested additional surgery. In large issue excision injecting saline into cavities temporarily prevents the caving in of the redundant skin, which has the tendency to permanently adhere to the fascia thereby preventing gross deformities. It has proven effective, contour storing and scored high satisfaction among patients. It certainly does not replace cosmetic breast surgery, however, it should be considered in centers were once-plastic surgery is not readily available. (author)

Colorectal surgery and surgical site infection: is a change of attitude necessary?

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Elia-Guedea, Manuela; Cordoba-Diaz de Laspra, Elena; Echazarreta-Gallego, Estibaliz; Valero-Lazaro, María Isabel; Ramirez-Rodriguez, Jose Manuel; Aguilella-Diago, Vicente

2017-07-01

Surgical site infection (SSI) can be as high as 30% in patients undergoing colorectal surgery and is associated with an increase in morbidity and mortality. The aim of this study is to evaluate the impact of a set of simple preventive measures that have resulted in a reduction in surgical site infection in colorectal surgery. Prospective study with two groups of patients treated in the colorectal unit of the "Clinico Universitario Lozano Blesa" hospital in Zaragoza. One group was subject to our measures from February to May 2015. The control group was given conventional treatment within a time period of 3 months before the set of measures were implemented. One hundred forty-nine patients underwent a major colorectal surgical procedure. Seventy (47%) belonged to the control group and were compared to the remaining 79 patients (53% of the total), who were subject to our treatment bundle in the period tested. Comparing the two groups revealed that our set of measures led to a general reduction in SSI (31.4 vs. 13.6%, p = 0.010) and in superficial site infection (17.1 vs. 2.5%, p = 0.002). As a consequence, the postoperative hospital stay was shortened (10.0 vs. 8.0 days, p = 0.048). However, it did not, the number of readmissions nor the re-operation rate. SSI was clearly related to open surgery. The preventive set of measures applied in colorectal surgery led to a significant reduction of the SSI and of the length of hospital stay.

Variable Operative Experience in Hand Surgery for Plastic Surgery Residents.

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Silvestre, Jason; Lin, Ines C; Levin, Lawrence Scott; Chang, Benjamin

Efforts to standardize hand surgery training during plastic surgery residency remain challenging. We analyze the variability of operative hand experience at U.S. plastic surgery residency programs. Operative case logs of chief residents in accredited U.S. plastic surgery residency programs were analyzed (2011-2015). Trends in fold differences of hand surgery case volume between the 10th and 90th percentiles of residents were assessed graphically. Percentile data were used to calculate the number of residents achieving case minimums in hand surgery for 2015. Case logs from 818 plastic surgery residents were analyzed of which a minority were from integrated (35.7%) versus independent/combined (64.3%) residents. Trend analysis of fold differences in case volume demonstrated decreasing variability among procedure categories over time. By 2015, fold differences for hand reconstruction, tendon cases, nerve cases, arthroplasty/arthrodesis, amputation, arterial repair, Dupuytren release, and neoplasm cases were below 10-fold. Congenital deformity cases among independent/combined residents was the sole category that exceeded 10-fold by 2015. Percentile data suggested that approximately 10% of independent/combined residents did not meet case minimums for arterial repair and congenital deformity in 2015. Variable operative experience during plastic surgery residency may limit adequate exposure to hand surgery for certain residents. Future studies should establish empiric case minimums for plastic surgery residents to ensure hand surgery competency upon graduation. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Preventive effect of dietary quercetin on disuse muscle atrophy by targeting mitochondria in denervated mice.

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Mukai, Rie; Matsui, Naoko; Fujikura, Yutaka; Matsumoto, Norifumi; Hou, De-Xing; Kanzaki, Noriyuki; Shibata, Hiroshi; Horikawa, Manabu; Iwasa, Keiko; Hirasaka, Katsuya; Nikawa, Takeshi; Terao, Junji

2016-05-01

Quercetin is a major dietary flavonoid in fruits and vegetables. We aimed to clarify the preventive effect of dietary quercetin on disuse muscle atrophy and the underlying mechanisms. We established a mouse denervation model by cutting the sciatic nerve in the right leg (SNX surgery) to lack of mobilization in hind-limb. Preintake of a quercetin-mixed diet for 14days before SNX surgery prevented loss of muscle mass and atrophy of muscle fibers in the gastrocnemius muscle (GM). Phosphorylation of Akt, a key phosphorylation pathway of suppression of protein degradation, was activated in the quercetin-mixed diet group with and without SNX surgery. Intake of a quercetin-mixed diet suppressed the generation of hydrogen peroxide originating from mitochondria and elevated mitochondrial peroxisome proliferator-activated receptor-γ coactivator 1α mRNA expression as well as NADH dehydrogenase 4 expression in the GM with SNX surgery. Quercetin and its conjugated metabolites reduced hydrogen peroxide production in the mitochondrial fraction obtained from atrophied muscle. In C2C12 myotubes, quercetin reached the mitochondrial fraction. These findings suggest that dietary quercetin can prevent disuse muscle atrophy by targeting mitochondria in skeletal muscle tissue through protecting mitochondria from decreased biogenesis and reducing mitochondrial hydrogen peroxide release, which can be related to decreased hydrogen peroxide production and/or improvements on antioxidant capacity of mitochondria. Copyright © 2016 Elsevier Inc. All rights reserved.

Bariatric Surgery

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... often. Each type of surgery has advantages and disadvantages. Bariatric Surgery Benefits Bariatric surgery can improve many ... Grants & Grant History Research Resources Research at NIDDK Technology Advancement & Transfer Meetings & Workshops Health Information Diabetes Digestive ...

Radical surgery after chemotherapy: a new therapeutic strategy to envision in grade II glioma.

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Duffau, Hugues; Taillandier, Luc; Capelle, Laurent

2006-11-01

While surgery is proned in low-grade glioma (LGG), the invasion of functional areas frequently prevents a complete resection. We report the first case of a patient operated on for a left frontal LGG, diagnosed because of seizures, with partial resection due to an invasion of the controlateral hemisphere. Chemotherapy enabled a regression of this controlateral extension. Postchemotherapy surgery performed with intraoperative functional mapping then allowed a complete resection, without sequelae. The patient has a normal socio-professional life, with no seizure. No other treatment was given. There was no recurrence, with a follow-up of 2 years since the second surgery (3.5 years since the first symptom). We propose a new therapeutic strategy in unresectable LGG, with preoperative chemotherapy, to make a radical surgery possible in a second step, while preserving the quality of life.

Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

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Jimmy Thomas

2014-01-01

Full Text Available This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.

Antifibrinolytics in cardiac surgery

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Achal Dhir

2013-01-01

Full Text Available Cardiac surgery exerts a significant strain on the blood bank services and is a model example in which a multi-modal blood-conservation strategy is recommended. Significant bleeding during cardiac surgery, enough to cause re-exploration and/or blood transfusion, increases morbidity and mortality. Hyper-fibrinolysis is one of the important contributors to increased bleeding. This knowledge has led to the use of anti-fibrinolytic agents especially in procedures performed under cardiopulmonary bypass. Nothing has been more controversial in recent times than the aprotinin controversy. Since the withdrawal of aprotinin from the world market, the choice of antifibrinolytic agents has been limited to lysine analogues either tranexamic acid (TA or epsilon amino caproic acid (EACA. While proponents of aprotinin still argue against its non-availability. Health Canada has approved its use, albeit under very strict regulations. Antifibrinolytic agents are not without side effects and act like double-edged swords, the stronger the anti-fibrinolytic activity, the more serious the side effects. Aprotinin is the strongest in reducing blood loss, blood transfusion, and possibly, return to the operating room after cardiac surgery. EACA is the least effective, while TA is somewhere in between. Additionally, aprotinin has been implicated in increased mortality and maximum side effects. TA has been shown to increase seizure activity, whereas, EACA seems to have the least side effects. Apparently, these agents do not differentiate between pathological and physiological fibrinolysis and prevent all forms of fibrinolysis leading to possible thrombotic side effects. It would seem prudent to select the right agent knowing its risk-benefit profile for a given patient, under the given circumstances.

Lung surgery

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... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using ... Center-Shreveport, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, ...

A Modern Approach to Preventing Prosthetic Joint Infections.

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Papas, Paraskevi Vivian; Congiusta, Dominick; Scuderi, Giles R; Cushner, Fred D

2018-02-28

Total knee arthroplasty (TKA) is recognized as one of the most successful surgical procedures performed today. One of the most common and dreaded complications of TKA is postoperative infection. To prevent infections, it is critical to identify patients at high risk through analyzing their risk factors, and help in addressing them prior to surgery. The effort to prevent infection must be carried through every step of the surgical process, from preoperative counseling to intraoperative measures and postoperative protocols. Hair removal, the application of antiseptics, the utilization of antibiotics, barbed sutures, smart dressings, and antibacterial washes are some of the avenues surgeons may explore to help prevent infection. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Repetitive endoscopic sinus surgery failure: a role for radical surgery?

NARCIS (Netherlands)

Videler, Ward J. M.; Wreesmann, Volkert B.; van der Meulen, Freerk W.; Knegt, Paul P.; Fokkens, Wytske J.

2006-01-01

OBJECTIVES: Endoscopic sinus surgery (ESS) is considered to be the golden standard for surgery in patients with chronic rhinosinusitis and nasal polyposis. However, there is still a small group of patients unresponsive despite repetitive surgery. Radical surgery aimed at reduction of the

An economic evaluation of two interventions for the prevention of post-surgical infections in cardiac surgery.

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del Diego Salas, J; Orly de Labry Lima, A; Espín Balbino, J; Bermúdez Tamayo, C; Fernández-Crehuet Navajas, J

2016-01-01

To conduct a cost-effectiveness analysis that compares two prophylactic protocols for treating post-surgical infections in cardiac surgery. A cost effectiveness analysis was done by using a decision tree to compare two protocols for prophylaxis of post-surgical infections (Protocol A: Those patient with positive test to methicillin-resistant Staphylococcus aureus (MRSA) colonization received muripocin (twice a day during a two-week period), with no follow-up verification. Those who tested negative did not receive the prophylaxis treatment; Protocol B: all patients received the mupirocin treatment). The number of post-surgical infections averted was the measure of effectiveness from the health system's perspective, 30 days following the surgery. The incidence of infections and complications was obtained from two cohorts of patients who underwent cardiac surgery Hospital. The times for applying the two protocols were validated by experts. They cost were calculated from the hospital's analytical accounting management system and Pharmaceutical Service. Only direct costs were taken into account, no discount rates were applied. Incremental cost-effectiveness ratio (ICER) was calculated. A probabilistic sensitivity analysis was performed. A total of 1118 patients were included (721 in Protocol A and 397 in Protocol B). No statistically significant differences were found in age, sex, diabetes, exitus or length of hospital stay between the two protocols. In the control group the rate of infection was 15.3%, compared with 11.3% in the intervention group. Protocol B proves to be more effective and at a lower cost, yielding an ICER of €32,506. Universal mupirocin prophylaxis against surgical site infections (SSI) in cardiac surgery as a dominant strategy, because it shows a lower incidence of infections and cost savings, versus the strategy to treat selectively patients according to their test results prior screening. Copyright © 2015 SECA. Published by Elsevier Espana. All

Plastic Surgery

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... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries.

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Pereira, Nayara de Castro; Turrini, Ruth Natalia Teresa; Poveda, Vanessa de Brito

2017-05-25

To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of hospital stay (p=0.000), blood transfusion (p=0.013), nasogastric tube (p=0.001) and nasojejunal tube (p=0,003), postoperative admission at ICU (p=0.002), postoperative death (p=0.000) and length of preoperative fasting (p=0.000). The length of fasting is associated with complications that affect the quality of the patients' postoperative recovery and nurses' work. The nursing team should be alert to this aspect and being responsible for overseeing the patients' interest, should not permit the unnecessary extension of fasting. Identificar la duración del ayuno perioperatorio entre los pacientes sometidos a cirugías de cáncer gastrointestinal. Estudio de cohorte retrospectivo, por consulta de los registros médicos de 128 pacientes sometidos a cirugías de cáncer gastrointestinal. La media de la duración total del ayuno fue de 107,6 horas. La duración total del ayuno se asoció significativamente con el número de síntomas presentados antes (p=0,000) y después de la cirugía (p=0,007), la duración de la estancia hospitalaria (p=0,000), transfusión de sangre (p=0,013),tubo nasogástrico (P=0,003), ingreso postoperatorio en la UCI (p=0,002), muerte postoperatoria (p=0,000) y duración del ayuno preoperatorio (p=0,000). La duración del ayuno se asocia con complicaciones que afectan la calidad de la recuperación postoperatoria de los pacientes y el trabajo de enfermería. El equipo de enfermería debe estar alerta en relación a este aspecto y ser responsable de supervisar el interés de los pacientes, no

TMJ surgery following orthognathic surgery: A case series

Directory of Open Access Journals (Sweden)

C. Politis

2018-06-01

Full Text Available Orthognathic surgery may affect or cause temporomandibular joint (TMJ complaints. This study evaluated the need for TMJ surgery after orthognathic surgery.A retrospective cohort study was carried out on 630 consecutive patients undergoing at least a Le Fort I or bilateral sagittal split osteotomy (BSSO. The mean follow-up time was 2,3 years. Clinical, surgical and radiographic findings were collected.Ten of the 630 patients (1.6% had additional arthroscopic TMJ-surgery in one (9 or in both (1 joints because of internal derangement, resistant to conventional therapy. Only 4/10 patients had successful outcomes following arthroscopic surgery. One patient with unsuccessful outcome required multiple additional open TMJ-surgeries, all remaining ineffective to relieve pain and restricted mouth opening. If arthroscopy failed to relieve symptoms (5/10 patients, further conservative management was opted. Arthroscopy seemed effective mainly in patients without pre-existing TMJ complaints.A further five of the 630 patients (0.8% required more treatment because of bilateral postoperative condylar resorption, but none of them required TMJ-surgery.In contrast to patients with bilateral condylar resorption where the skeletal relapse remained the issue of concern, patients with internal derangement/osteoarthrosis exhibited major occlusal changes in one patient only (1/10, leaving the TMJ complaints as the main concern. Keywords: Sagittal split osteotomy, Le Fort I osteotomy, Orthognathic surgery, Condylar remodelling, Condylar resorption, Osteoarthrosis, Internal derangement, Relapse, Arthroscopy

A multicenter qualitative study on preventing hospital-acquired urinary tract infection in US hospitals.

Science.gov (United States)

Saint, Sanjay; Kowalski, Christine P; Forman, Jane; Damschroder, Laura; Hofer, Timothy P; Kaufman, Samuel R; Creswell, John W; Krein, Sarah L

2008-04-01

Although urinary tract infection (UTI) is the most common hospital-acquired infection, there is little information about why hospitals use or do not use a range of available preventive practices. We thus conducted a multicenter study to understand better how US hospitals approach the prevention of hospital-acquired UTI. This research is part of a larger study employing both quantitative and qualitative methods. The qualitative phase consisted of 38 semistructured phone interviews with key personnel at 14 purposefully sampled US hospitals and 39 in-person interviews at 5 of those 14 hospitals, to identify recurrent and unifying themes that characterize how hospitals have addressed hospital-acquired UTI. Four recurrent themes emerged from our study data. First, although preventing hospital-acquired UTI was a low priority for most hospitals, there was substantial recognition of the value of early removal of a urinary catheter for patients. Second, those hospitals that made UTI prevention a high priority also focused on noninfectious complications and had committed advocates, or "champions," who facilitated prevention activities. Third, hospital-specific pilot studies were important in deciding whether or not to use devices such as antimicrobial-impregnated catheters. Finally, external forces, such as public reporting, influenced UTI surveillance and infection prevention activities. Clinicians and policy makers can use our findings to develop initiatives that, for example, use a champion to promote the removal of unnecessary urinary catheters or exploit external forces, such public reporting, to enhance patient safety.

The Diabetes Surgery Summit consensus conference: recommendations for the evaluation and use of gastrointestinal surgery to treat type 2 diabetes mellitus.

Science.gov (United States)

Rubino, Francesco; Kaplan, Lee M; Schauer, Philip R; Cummings, David E

2010-03-01

body mass index > or =30 kg/m. Clinical trials to investigate the exact role of surgery in patients with less severe obesity and diabetes are considered a priority. Furthermore, investigations on the mechanisms of surgical control of diabetes are strongly encouraged, as they may help advance the understanding of diabetes pathophysiology. The DSS consensus document embodies the foundations of "diabetes surgery," and represents a timely attempt by leading scholars to improve access to surgical options supported by sound evidence, while also preventing harm from inappropriate use of unproven procedures.

Nitrates for the prevention of cardiac morbidity and mortality in patients undergoing non-cardiac surgery.

Science.gov (United States)

Zhao, Na; Xu, Jin; Singh, Balwinder; Yu, Xuerong; Wu, Taixiang; Huang, Yuguang

2016-08-04

Cardiac complications are not uncommon in patients undergoing non-cardiac surgery, especially in patients with coronary artery disease (CAD) or at high risk of CAD. Perioperative cardiac complications can lead to mortality and morbidity, as well as higher costs for patient care. Nitrates, which are among the most commonly used cardiovascular drugs, perform the function of decreasing cardiac preload while improving cardiac blood perfusion. Sometimes, nitrates are administered to patients undergoing non-cardiac surgery to reduce the incidence of cardiac complications, especially for patients with CAD. However, their effects on patients' relevant outcomes remain controversial. • To assess effects of nitrates as compared with other interventions or placebo in reducing cardiac risk (such as death caused by cardiac factors, angina pectoris, acute myocardial infarction, acute heart failure and cardiac arrhythmia) in patients undergoing non-cardiac surgery.• To identify the influence of different routes and dosages of nitrates on patient outcomes. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Chinese BioMedical Database until June 2014. We also searched relevant conference abstracts of important anaesthesiology or cardiology scientific meetings, the database of ongoing trials and Google Scholar.We reran the search in January 2016. We added three potential new studies of interest to the list of 'Studies awaiting classification' and will incorporate them into our formal review findings for the review update. We included randomized controlled trials (RCTs) comparing nitrates versus no treatment, placebo or other pharmacological interventions in participants (15 years of age and older) undergoing non-cardiac surgery under any type of anaesthesia. We used standard methodological procedures as expected by Cochrane. Two review authors selected trials, extracted data from included studies and assessed risk of bias. We

A systematic review of laparoscopic port site hernias in gastrointestinal surgery.

LENUS (Irish Health Repository)

Owens, M

2011-08-01

Port site hernia is an important yet under-recognised complication of laparoscopic surgery, which carries a high risk of strangulation due to the small size of the defect involved. The purpose of this study was to examine the incidence, classification, and pathogenesis of this complication, and to evaluate strategies to prevent and treat it.

Predictors of Vitamin Adherence After Bariatric Surgery.

Science.gov (United States)

Sunil, Supreet; Santiago, Vincent A; Gougeon, Lorraine; Warwick, Katie; Okrainec, Allan; Hawa, Raed; Sockalingam, Sanjeev

2017-02-01

Vitamin supplementation in bariatric aftercare is essential to prevent nutrient deficiencies; however, rates of vitamin adherence have been as low as 30 % 6 months post-surgery. Preliminary literature suggests non-adherence to prescribed treatments can be linked to demographic and psychological factors. We aimed to determine the relationship between these factors to vitamin adherence in post-bariatric surgery patients. A total of 92 bariatric patients were assessed 6 months post-surgery. Patients were administered a questionnaire collecting demographic information, psychological scores, and self-reported adherence. Nutrient deficiencies were analyzed through serum vitamin levels measured 3 and 6 months after surgery. Wilcoxon rank-sum and chi-square tests were used for analysis. Non-adherence was associated with male sex and full-time employment (p = 0.027, p = 0.015). There were no differences with respect to living situation, education level, or relationship type. Non-adherent patients did not have significantly higher scores for generalized anxiety, depressive symptoms, or avoidant behaviors. However, non-adherent patients displayed greater attachment anxiety than their adherent counterparts (p = 0.0186). Non-adherence was also associated with lower vitamin B12 levels 6 months post-surgery (p = 0.001). Male gender and full-time work have previously been shown to be associated with non-adherence. This is the first study to demonstrate that attachment anxiety is associated with poor multivitamin adherence in the post-surgical bariatric population. This result is concordant with recent literature that has demonstrated attachment anxiety is associated with poor adherence to dietary recommendations in bariatric patients 6 months postoperatively. Presurgical screening for attachment anxiety could facilitate early interventions to promote better bariatric aftercare in this group.

Heart bypass surgery

Science.gov (United States)

Off-pump coronary artery bypass; OPCAB; Beating heart surgery; Bypass surgery - heart; CABG; Coronary artery bypass graft; Coronary artery bypass surgery; Coronary bypass surgery; Coronary artery disease - CABG; CAD - CABG; Angina - ...