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Sample records for replacement surgery patients

  1. Univariate Risk Factors for Prolonged Mechanical Ventilation in Patients Undergoing Prosthetic Heart Valves Replacement Surgery

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery (combined surgery) from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identify risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent (50 %)were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age,weight, and preoperative hospital stay (days) were not found to be associated with prolonged mechanical ventilation. It was concluded that, for age and weight, this might be due to the lower number of old age patients (70 years and above) included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.

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

    Directory of Open Access Journals (Sweden)

    Bhalla Amandeep

    2003-06-01

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

  3. Anti-Phospholipid Antibodies in Patients Undergoing Total Joint Replacement Surgery

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    Melissa Simpson

    2012-01-01

    Full Text Available Background. Patients undergoing joint replacement remain at increased risk for venous thromboembolism (VTE compared to other types of surgery, regardless of thromboprophylactic regimen. The pathophysiologic processes rendering this group of patients at risk for VTE are multifactorial. Procedure-specific and patient-specific exposures play a role in the postoperative development of VTE, including the development of anti-phospholipid antibodies (aPL. Methods. We measured three aPL (anti-cardiolipin, anti-β2 glycoprotein, and lupus anticoagulant in 123 subjects undergoing total knee or hip arthroplasty to describe the presence of these antibodies preoperatively and to describe the rate of postoperative seroconversion among those people who were negative preoperatively. Postoperative antibodies were measured at day 7, 14, and 21. Results. The prevalence of aPL antibodies in the preoperative period was 44%, positive subjects were more likely to be smokers (P=0.05 and were less likely to have undergone a previous arthroplasty procedure (P=0.002. Subjects seroconverted in a 21 day postoperative period at a rate of 79%. Conclusions. These pilot data suggest that the prevalence of aPL in this population both preoperatively and postoperatively is higher than previously expected. Further studies are needed to describe aPL in a larger population and to establish their clinical significance in populations undergoing joint replacement surgeries.

  4. Long-Term Survival of Dialysis Patients with Bacterial Endocarditis Undergoing Valvular Replacement Surgery in the United States

    Science.gov (United States)

    Leither, Maxwell D.; Shroff, Gautam R.; Ding, Shu; Gilbertson, David T.; Herzog, Charles A.

    2013-01-01

    Background Bacterial endocarditis in dialysis patients is associated with high mortality rates. The literature is limited regarding long-term outcomes of valvular replacement surgery and choice of prosthesis in dialysis patients with bacterial endocarditis. Methods and Results Dialysis patients hospitalized for bacterial endocarditis, 2004-2007, were studied retrospectively using data from the US Renal Data System. Long-term survival of patients undergoing valve replacement surgery with tissue or non-tissue valves was compared using the Kaplan-Meier method. A Cox proportional hazards model was used to identify independent predictors of mortality in patients undergoing valvular replacement surgery. During the study period, 11,156 dialysis patients were hospitalized for bacterial endocarditis and 1267 (11.4%) underwent valvular replacement surgery (tissue valve 44.3%, non-tissue valve 55.7%). In the valve replacement cohort, 60% were men, 50% white, 54% aged 45-64 years, and 36% diabetic. Estimated survival with tissue and non-tissue valves, respectively, at 0.5, 1, 2, and 3 years was 59% and 60%, 48% and 50%, 35% and 37%, and 25% and 30% (log rank P = 0.42). Staphylococcus was the predominant organism (66% of identified organisms). Independent predictors of mortality in patients undergoing valve replacement surgery included older age, diabetes as cause of end-stage renal disease, surgery during index hospitalization, staphylococcus as the causative organism, and dysrhythmias as a comorbid condition. Conclusions Valve replacement surgery is appropriate for well-selected dialysis patients with bacterial endocarditis, but is associated with high mortality rates. Survival does not differ with tissue or non-tissue prosthesis. PMID:23785002

  5. Effect of prophylactic amiodarone in patients with rheumatic valve disease undergoing valve replacement surgery

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    Kar Sandeep

    2011-01-01

    Full Text Available The study was carried out to evaluate the effect of prophylactic single-dose intravenous amiodarone in patients undergoing valve replacement surgery. Maintenance of sinus rhythm is better than maintenance of fixed ventricular rate in atrial fibrillation (AF especially in the presence of irritable left or right atrium because of enlargement. Fifty-six patients with valvular heart disease with or without AF were randomly divided into two groups. Group I or the amiodarone group (n=28 received amiodarone (3 mg/kg in 100 ml normal saline and group II or the control group received same volume of normal saline. The standardized protocol for cardiopulmonary bypass was maintained for all the patients. AF occurred in 7.14% patients in group I, and in group II, 28.57% (P=0.035; ventricular tachycardia/fibrillation was observed in 21.43% patients in group I and 46.43% patients in group II (P=0.089 after release of aortic clamp. Most of the patients in group I (92.86% maintained sinus rhythm without cardioversion or defibrillation after release of aortic cross clamp (P=0.002. Defibrillation or cardio version was needed in 7.14% patients in group I and 28.57% patients in group II (P=0.078. A single prophylactic intraoperative dose of intravenous amiodarone decreased post bypass arrhythmia in this study in comparison to the control group. Single dose of intraoperative amiodarone may be used to decrease postoperative arrhythmia in open heart surgery.

  6. Using your shoulder after replacement surgery

    Science.gov (United States)

    Joint replacement surgery - using your shoulder; Shoulder replacement surgery - after ... You have had shoulder replacement surgery to replace the bones of your shoulder joint with artificial parts. The parts include a stem made of metal and a ...

  7. Exercise therapy may postpone total hip replacement surgery in patients with hip osteoarthritis

    DEFF Research Database (Denmark)

    Svege, Ida; Nordsletten, Lars; Fernandes, Linda

    2015-01-01

    Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown.......Exercise treatment is recommended for all patients with hip osteoarthritis (OA), but its effect on the long-term need for total hip replacement (THR) is unknown....

  8. Ultra Low-Dose Naloxone and Tramadol/Acetaminophen in Elderly Patients Undergoing Joint Replacement Surgery: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Ngozi N Imasogie

    2009-01-01

    Full Text Available OBJECTIVE: A pilot study was conducted to assess whether both the rationale and feasibility exist for future randomized clinical trials to evaluate the combined use of naloxone infusion and tramadol/acetaminophen as opioid-sparing drugs in elderly patients undergoing lower extremity joint replacement surgery.

  9. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

    2008-01-01

    after total hip and knee replacement surgery. PATIENTS AND METHODS: Between September 2003 and December 2005, 712 consecutive, unselected patients (440 women) with a mean age of 69 (31-91) years were admitted for hip and knee replacement surgery at our specialized fast-track joint replacement unit......BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... characteristics that influence postoperative outcome, LOS, and patient satisfaction in our series of consecutive fast-track joint replacement patients, enabling further attention to be paid to certain aspects of surgery and rehabilitation....

  10. Ultra Low-Dose Naloxone and Tramadol/Acetaminophen in Elderly Patients Undergoing Joint Replacement Surgery: A Pilot Study

    OpenAIRE

    Imasogie, Ngozi N; Sudha Singh; Watson, James T.; Debbie Hurley; Patricia Morley-Forster

    2009-01-01

    OBJECTIVE: A pilot study was conducted to assess whether both the rationale and feasibility exist for future randomized clinical trials to evaluate the combined use of naloxone infusion and tramadol/acetaminophen as opioid-sparing drugs in elderly patients undergoing lower extremity joint replacement surgery.DESIGN: Ten patients 70 years of age or older undergoing either total knee (n=7) or total hip (n=3) arthroplasty were treated prospectively. Each patient received two tablets of tramadol/...

  11. Impact of body mass index on outcome in patients undergoing coronary artery bypass grafting and/or valve replacement surgery

    Science.gov (United States)

    Costa, Vinícius Eduardo Araújo; Ferolla, Silvia Marinho; dos Reis, Tâmara Oliveira; Rabello, Renato Rocha; Rocha, Eduardo Augusto Victor; Couto, Célia Maria Ferreira; Couto, José Carlos Ferreira; Bento, Alduir

    2015-01-01

    Objective This study aimed to analyze the impact of body mass index on outcomes of 101 patients undergoing coronary artery bypass grafting, valve replacement, or combined valve/ coronary artery bypass grafting surgery in a private hospital in Belo Horizonte, Brazil. Methods This was a prospective cross-sectional study of patients undergoing cardiac surgery from May 2009 to December 2012. All patients were followed up from the first day of admission until discharge or death. Patients were divided into three groups according to BMI: normal weight, overweight, and obese. The main outcome measure was the association between BMI and postoperative morbidities and mortality. Results Multivariate analysis identified obesity as an independent predictor of increased risk of surgical reintervention (odds ratio [OR] 13.6; 95%CI 1.1 - 162.9; P=0.046) and reduced risk of bleeding (OR 0.05; 95% CI 0.09 - 0.69; P=0.025). Univariate analysis showed that obesity was associated with increased frequency of wound dehiscence (P=0.021). There was no association between BMI and other complications or mortality in univariate analysis. There was also no association between body mass index and duration of cardiopulmonary bypass, aortic clamping, mechanical ventilation, and intensive care unit or hospital stay. Conclusion Obese individuals undergoing coronary artery bypass grafting, valve replacement, or combined surgery have a higher postoperative risk of surgical reintervention and lower chances of bleeding. PMID:26313724

  12. Ultrasound guided single injection caudal epidural anesthesia of isobaric bupivacaine with/without dexamethasone for geriatric patients undergoing total hip replacement surgery

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    H.A. El Gendy

    2014-07-01

    Conclusion: Adding dexamethasone with isobaric bupivacaine caudal anesthesia prolongs the duration of postoperative analgesia and decreased postoperative analgesic requirement in geriatric patients undergoing total hip replacement surgery in comparison isobaric bupivacaine alone.

  13. A post-marketing assessment of major bleeding in total hip and total knee replacement surgery patients receiving rivaroxaban.

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    Kwong, Louis M; Turpie, Alexander G G; Tamayo, Sally; Peacock, W Frank; Yuan, Zhong; Sicignano, Nicholas; Hopf, Kathleen Pillsbury; Patel, Manesh R

    2017-09-01

    Rivaroxaban is a novel oral anticoagulant indicated for prophylaxis against deep vein thrombosis and pulmonary embolism in patients undergoing total hip replacement (THR) or total knee replacement (TKR) surgery. To evaluate major bleeding (MB) in THR/TKR patients receiving post-operative rivaroxaban. Electronic medical records of nearly 10 million US Department of Defense (DoD) beneficiaries were queried from 1 January 2013 through 30 June 2015. Using the validated Cunningham case-finding algorithm, post-surgical MB events in rivaroxaban users were identified and analyzed. The incidence of MB was determined, and descriptive statistics were used to compare patient characteristics and other covariates in those with and without MB. Two additional methods were used to explore and identify bleeding cases that were not considered MB events per the study case-finding algorithm. A total of 12,429 patients received THR and/or TKR surgery, and were post-operatively prescribed rivaroxaban. Nine patients had MB, yielding an incidence proportion of 0.07% (95% CI 0.02-0.13). The alternative case-finding methods found bleeding incidences of 0.46% and 0.21%, though it is not clear whether these are clinical MB cases, since the alternative methods were not validated. The incidence of MB in this retrospective analysis is lower than that observed in the clinical trials of rivaroxaban. Whether this is due to lower real-world MB rates or challenges with case-finding algorithms is unclear.

  14. Lean Six Sigma: a new approach to the management of patients undergoing prosthetic hip replacement surgery.

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    Improta, Giovanni; Balato, Giovanni; Romano, Maria; Carpentieri, Francesco; Bifulco, Paolo; Alessandro Russo, Mario; Rosa, Donato; Triassi, Maria; Cesarelli, Mario

    2015-08-01

    In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC (Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (-44%). This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs. © 2015 John Wiley & Sons, Ltd.

  15. Total intravenous anesthesia for aortic aneurysm replacement surgery in a patient with limb-girdle dystrophy.

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    López Álvarez, A; Román Fernández, A; Vilanova Vázquez, V; Corujeira Rivera, M C; Areán González, I; Valiño Hortas, C

    2014-01-01

    We report the anesthetic management with total intravenous anesthesia of a 61-year-old male diagnosed with limb-girdle muscular dystrophy admitted for replacement of ascending aorta due to an aortic aneurysm. Limb-girdle muscular dystrophy belongs to a genetically heterogeneous group of muscular dystrophies involving shoulder and hip girdles. Although the risk of malignant hyperthermia does not seem to be increased in these patients compared with the general population, the exposure to inhaled anesthetics and succinylcholine should probably be avoided because these patients have a predisposition to hyperkalemia and rhabdomyolysis. We chose to use total intravenous anesthesia with propofol, remifentanil and muscle relaxants to reduce oxygen consumption, and later to reduce the doses of propofol and remifentanil. The combination of a carefully planned anesthetic strategy, anesthetic depth, and neuromuscular blockade monitoring is explained.

  16. Cardioprotection of Electroacupuncture for Enhanced Recovery after Surgery on Patients Undergoing Heart Valve Replacement with Cardiopulmonary Bypass: A Randomized Control Clinical Trial

    Directory of Open Access Journals (Sweden)

    Fangxiang Zhang

    2017-01-01

    Full Text Available We attempted to investigate cardioprotection of electroacupuncture (EA for enhanced recovery after surgery on patients undergoing heart valve replacement with cardiopulmonary bypass. Forty-four patients with acquired heart valve replacement were randomly allocated to the EA group or the control group. Patients in the EA group received EA stimulus at bilateral Neiguan (PC6, Ximen (PC4, Shenting (GV24, and Baihui (GV20 acupoints twenty minutes before anesthesia induction to the end of surgery. The primary end point was cardioprotection effect of electroacupuncture postoperatively and the secondary endpoints were quality of recovery and cognitive functioning postoperatively. The present study demonstrated that electroacupuncture reduced the occurrence of complications and played a role of cardioprotective effect on patients after heart valve replacement surgery with cardiopulmonary bypass, and it benefits patients more comfortable and contributes to recovery after surgery. This trial is registered with ChiCTR-IOC-16009123.

  17. Effects of music on psychophysiological responses and opioid dosage in patients undergoing total knee replacement surgery.

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    Chen, Hsin-Ji; Chen, Tsung-Ying; Huang, Chiung-Yu; Hsieh, Yuan-Mei; Lai, Hui-Ling

    2015-10-01

    The present authors examined the effects of listening to music on psychophysiological parameters (blood pressure, heart rate, and respiratory rate) during preoperative and postoperative days and determined whether listening to music could lower pain intensity and opioid dosage during postoperative days in patients who underwent total knee replacements. This was a two group repeated measures design for 30 subjects aged 53-85 years who were scheduled for total knee replacement. Subjects were randomly assigned to either a music group or a control group. Psychophysiological parameters were obtained from patients' monitors. A visual analog scale was used to assess postoperative pain. Opioid dosage was recorded and converted to standardized units. Mann-Whitney U-test and generalized estimating equation analysis were used to compare groups. Respiratory rates while in the surgical waiting area were lower for the music group than for the control group (P = 0.02). There was no significant difference between these groups for blood pressure, heart rate, pain intensity, or opioid dosage. However, a within-group comparison showed that systolic blood pressure in the music group was significantly and consistently decreased during postoperative recovery (Wald = 9.21, P = 0.007). These results suggest that listening to music stabilized systolic blood pressure in patients during postoperative recovery. However, the effects of music on psychophysiological parameters, pain intensity, and opioid dosage in a surgical setting require further research. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

  18. Unstable angina early after aortic valve replacement surgery in a female patient with normal coronary arteries preoperatively – a case report

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    Schwarz Christian

    2009-07-01

    Full Text Available Abstract Background Angina pectoris early after aortic valve replacement surgery in patients with previously normal coronary arteries may be life threatening and has to be assessed immediately. Case report 12 weeks after aortic valve replacement surgery, a 60-year-old female patient was referred for evaluation of recent onset of severe chest pain on mild exertion and at rest. Coronary angiography showed severe stenosis nvolving the left coronary ostium and the left main stem. The patient was urgently referred for bypass surgery and had an uneventful postoperative recovery. Conclusion A high degree of suspicion is needed for early recognition and aggressive management of this rare but serious complication.

  19. Correlation between patient age at total hip replacement surgery and lifeexpectancy

    Science.gov (United States)

    Schwartsmann1, Carlos Roberto; Spinelli, Leandro de Freitas; Boschin, Leonardo Carbonera; Yépez, Anthony Kerbes; Crestani, Marcus Vinicius; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT Total hip arthroplasty (THA) is one of the most cost-effective hip surgeries among orthopedic procedures. We conducted an extensive literature review with 5,394 papers regarding survival rates after THA. We searched PubMed, Embase and the Cochrane library from January 1st, 1970 to July 31th, 2014 looking for all citations about total hip arthroplasty with a long term follow-up (longer than 10 years). The criteria were rigorous: no loss of follow-up, and follow-up more than 10 years. The authors should have known the complete history of patients (whether the patient is alive or dead). Considering the criteria, we found only 15 papers. To evaluate the relationship between follow-up and survival, a linear regression analysis was applied. Considering the papers analysed, and applying the search criteria, we obtained a mean age for the patients above 57.5 years. The chance of survival at 15 years was 57.6%, at 20 years it was 34.6% and at 25 years it is only 11.6%. The relationship between follow-up and survival was significantly linear (p <0.001). Only 11.6% of patients undergoing THA will be still alive 25 years after the surgical procedure. Level of Evidence I, Prognostic Study. PMID:27057147

  20. Effect of volume replacement with hydroxyethyl starch solution on splanchnic oxygenation in patients undergoing cytoreductive surgery for ovarian cancer

    Institute of Scientific and Technical Information of China (English)

    郭向阳; 徐仲煌; 任洪智; 罗爱伦; 黄宇光; 叶铁虎

    2003-01-01

    Objective To investigate the effectiveness of using a medium molecular weight hydroxyethyl starch solution (HES) administered as a replacement for estimated blood loss (EBL) during cytoreductive surgery for ovarian cancer on splanchnic oxygenation. Methods Forty-two patients undergoing cytoreductive surgery for ovarian cancer were enrolled in this prospective randomized study. As soon as the EBL exceeded 10% but was less than 20% of the estimated blood volume, the patients were randomly assigned to receive either a volume of lactated Ringer's solution (LRS) equal to three times the EBL (LRS group, n=22) or a volume of 6% HES equal to the EBL (HES group, n=20). Tissue oxygenation was assessed indirectly by measuring tonometric parameters, including the difference between gastric intramucosal PsCO2 and arterial PaCO2 (Ps-a CO2 gap), gastric intramucosal pH (pHi) and arterial lactate acid concentration at 30 min after induction of anesthesia (baseline value), 1 hour and 2 hours after skin incision, and at the end of surgery. Results At the end of surgery,the Ps-a CO2 gap in the HES group (8.7±1.6 mmHg) was significantly lower than that of the LRS group (18.74±4.4 mmHg, P<0.01), while the pHi (7.30±0.05 mmHg) in the HES group was significantly higher than that of the LRS group (7.21±0.07 mmHg, P<0.01). There was no significant difference between the two groups in terms of arterial lactate acid concentration. Conclusion In patients undergoing major surgery with relatively large blood losses, volume resuscitation with medium molecular weight hydroxyethyl starch solution may improve splanchnic blood flow and tissue oxygenation.

  1. Beating Heart Mitral Valve Replacement Surgery without Aortic Cross-Clamping via Right Thoracotomy in a Patient with Compromised Left Ventricular Functions

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    Ahmet Baris-Durukan

    2015-10-01

    Full Text Available Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous

  2. Renal replacement therapy after cardiac surgery; renal function recovers

    DEFF Research Database (Denmark)

    Steinthorsdottir, Kristin Julia; Kandler, Kristian; Agerlin Windeløv, Nis

    2013-01-01

    To assess renal outcome in patients discharged from hospital following cardiac surgery-associated acute kidney injury (CSA-AKI) with need for renal replacement therapy.......To assess renal outcome in patients discharged from hospital following cardiac surgery-associated acute kidney injury (CSA-AKI) with need for renal replacement therapy....

  3. Efficacy of serial electrical cardioversion therapy in patients with chronic atrial fibrillation after valve replacement and implications for surgery to cure atrial fibrillation

    NARCIS (Netherlands)

    Crijns, HJGM; VanGelder, IC; VanderWoude, HJ; Grandjean, JG; Tieleman, RG; Brugemann, J; DeKam, PJ; Ebels, T

    1996-01-01

    Chronic atrial fibrillation (AF) occurs often in the setting of mitral and aortic valve disease. Eventually, these patients undergo valve replacement which improves cardiac function but does not prevent AF. This study investigates which patient may benefit from additional surgery for the cure of AF

  4. Effect of safflower yellow pigment sodium chloride injection on hemorheology and blood coagulation function in patients with hip replacement surgery

    Institute of Scientific and Technical Information of China (English)

    Zhi Wang; Wei-Xin Yang; Xiu-Hua Zhang; Xian Jiang

    2016-01-01

    Objective:To investigate the effect of safflower yellow pigment sodium chloride injection on hemorheology and coagulation function in patients with hip replacement surgery.Methods:A total of 80 cases of hip joint replacement were divided into two groups according to the random number table method, 40 cases in each group. Patients in two groups were conducted with regular hip replacement, postoperative conventional symptomatic treatment. Based on it, patients of the observation group started to get the safflower yellow pigment and sodium chloride injection in the first week after operation, intravenous injection. A total of 3 weeks of treatment. blood rheological index were compared including plasma viscosity, whole blood viscosity at high shear, low shear whole blood viscosity, red blood cell hematocrit and blood coagulation indexes: prothrombin time (PT), activation activated partial thromboplastin time (APTT), thrombin time (TT), D-Dimer (D-D), fibrinogen (FIB) between the two groups postoperative 1 week, postoperative 2 weeks and postoperative 4 weeks.Results:The plasma viscosity, high shear viscosity of whole blood, low shear viscosity of whole blood, D-D in control group postoperative 2 week and 4 week were significantly higher than that of preoperative 1 week; while red blood cell volume, PT, APTT, TT, Fib were significantly lower than preoperative 1 week (P0.05). The PT, APTT in observation group postoperative 2 week and 4 week were significantly increased compared with preoperative 1 week, and the TT in observation group postoperative 4 week was significantly increased compared with preoperative 1 week (P<0.05); The plasma viscosity, high shear viscosity of whole blood, low shear viscosity of whole blood, D-D in observation group were significantly lower, while the PT, APTT, TT, Fib in observation group were significantly higher than that in control group in the same time point (P<0.05).Conclusions:Hip replacement will cause the change of blood rheology in

  5. Patient participation in postoperative care activities in patients undergoing total knee replacement surgery: Multimedia Intervention for Managing patient Experience (MIME). Study protocol for a cluster randomised crossover trial.

    Science.gov (United States)

    McDonall, Jo; de Steiger, Richard; Reynolds, John; Redley, Bernice; Livingston, Patricia; Botti, Mari

    2016-07-18

    Patient participation is an important indicator of quality care. Currently, there is little evidence to support the belief that participation in care is possible for patients during the acute postoperative period. Previous work indicates that there is very little opportunity for patients to participate in care in the acute context. Patients require both capability, in terms of having the required knowledge and understanding of how they can be involved in their care, and the opportunity, facilitated by clinicians, to engage in their acute postoperative care. This cluster randomised crossover trial aims to test whether a multimedia intervention improves patient participation in the acute postoperative context, as determined by pain intensity and recovery outcomes. A total of 240 patients admitted for primary total knee replacement surgery will be invited to participate in a cluster randomised, crossover trial and concurrent process evaluation in at least two wards at a major non-profit private hospital in Melbourne, Australia. Patients admitted to the intervention ward will receive the multimedia intervention daily from Day 1 to Day 5 (or day of discharge, if prior). The intervention will be delivered by nurses via an iPad™, comprising information on the goals of care for each day following surgery. Patients admitted to the control ward will receive usual care as determined by care pathways currently in use across the organization. The primary endpoint is the "worst pain experienced in the past 24 h" on Day 3 following TKR surgery. Pain intensity will be measured using the numerical rating scale. Secondary outcomes are interference of pain on activities of daily living, length of stay in hospital, function and pain following TKR surgery, overall satisfaction with hospitalisation, postoperative complications and hospital readmission. The results of this study will contribute to our understanding of the effectiveness of interventions that provide knowledge and

  6. Ultra low-dose naloxone and tramadol/acetaminophen in elderly patients undergoing joint replacement surgery: a pilot study.

    Science.gov (United States)

    Imasogie, Ngozi N; Singh, Sudha; Watson, James T; Hurley, Debbie; Morley-Forster, Patricia

    2009-01-01

    A pilot study was conducted to assess whether both the rationale and feasibility exist for future randomized clinical trials to evaluate the combined use of naloxone infusion and tramadol/acetaminophen as opioid-sparing drugs in elderly patients undergoing lower extremity joint replacement surgery. Ten patients 70 years of age or older undergoing either total knee (n=7) or total hip (n=3) arthroplasty were treated prospectively. Each patient received two tablets of tramadol/acetaminophen (Tramacet; Janssen-Ortho Inc, Canada) preoperatively and every 6 h postoperatively, as well as a naloxone infusion started preoperatively at 0.25 microg/kg/h and continued up to 48 h postoperatively. In addition, standard intraoperative care was provided with 0.2 mg of intrathecal morphine, 1.4 mL of 0.75% bupivacaine, and an intra-articular infiltration of 100 mL of 0.3% ropivacaine and 30 mg of ketorolac, as well as standard postoperative morphine via patient-controlled analgesia orders and celecoxib 200 mg twice daily for five days. Compared with seven historical controls, also 70 years of age or older, who had undergone either a total knee (n=4) or total hip (n=3) arthroplasty, postoperative opioid use was reduced by 80%. Except for transient nausea and vomiting in 40% and 20% of patients, respectively, the 10 patients on tramadol/acetaminophen and naloxone tolerated the new regimen without difficulty. Consequently, a randomized, double-blinded clinical trial comparing standard therapy versus standard therapy plus these two drugs seems warranted. In such a trial, it would require approximately 20 subjects per treatment arm to detect a 80% decrease in morphine use.

  7. A comparison of Rasch with Likert scoring to discriminate between patients' evaluations of total hip replacement surgery.

    Science.gov (United States)

    Fitzpatrick, R; Norquist, J M; Jenkinson, C; Reeves, B C; Morris, R W; Murray, D W; Gregg, P J

    2004-03-01

    The purpose of this study was to examine whether there are advantages in terms of outcome assessment of using Rasch methods of scoring the 12-item Oxford Hip Score (OHS) questionnaire over conventionally Likert scores. As part of a prospective cohort study of total hip replacements in five former regions of England the OHS was sent to patients pre-operatively, at 3 months and 1 year post-operatively. Post-operative data was collected on over 5000 cases. Based on the level of satisfaction with surgery, patients were divided into satisfied and dissatisfied. Analyses were performed to test the relative precision (RP) of Rasch scoring vs. conventionally Likert scores in discriminating the groups experiencing different level of satisfaction. Considerable gains in precision were achieved with Rasch scoring methods when groups were compared 3 and 12 months post-operatively. The results from the current study suggest that in some situations there may be substantial gains in measuring health related outcomes using Rasch-based scoring methods.

  8. Rescue Surgery 19 Years after Composite Root and Hemiarch Replacement

    Directory of Open Access Journals (Sweden)

    Konstantin von Aspern

    2013-01-01

    Full Text Available A 59-year-old male patient with Marfan's syndrome was referred to our clinic due to acute chest pain. His medical history contains complex surgery for type A aortic dissection 19 years ago including composite root replacement using a mechanical aortic valve. Immediate computed tomography indicated perforation at the distal ascending aortic anastomosis plus complete avulsion of both coronary ostia. The patient underwent successful rescue surgery with ascending aortic and arch replacement using a modified Cabrol technique.

  9. Comparison of the Performance of the Warfarin Pharmacogenetics Algorithms in Patients with Surgery of Heart Valve Replacement and Heart Valvuloplasty.

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    Xu, Hang; Su, Shi; Tang, Wuji; Wei, Meng; Wang, Tao; Wang, Dongjin; Ge, Weihong

    2015-09-01

    A large number of warfarin pharmacogenetics algorithms have been published. Our research was aimed to evaluate the performance of the selected pharmacogenetic algorithms in patients with surgery of heart valve replacement and heart valvuloplasty during the phase of initial and stable anticoagulation treatment. 10 pharmacogenetic algorithms were selected by searching PubMed. We compared the performance of the selected algorithms in a cohort of 193 patients during the phase of initial and stable anticoagulation therapy. Predicted dose was compared to therapeutic dose by using a predicted dose percentage that falls within 20% threshold of the actual dose (percentage within 20%) and mean absolute error (MAE). The average warfarin dose for patients was 3.05±1.23mg/day for initial treatment and 3.45±1.18mg/day for stable treatment. The percentages of the predicted dose within 20% of the therapeutic dose were 44.0±8.8% and 44.6±9.7% for the initial and stable phases, respectively. The MAEs of the selected algorithms were 0.85±0.18mg/day and 0.93±0.19mg/day, respectively. All algorithms had better performance in the ideal group than in the low dose and high dose groups. The only exception is the Wadelius et al. algorithm, which had better performance in the high dose group. The algorithms had similar performance except for the Wadelius et al. and Miao et al. algorithms, which had poor accuracy in our study cohort. The Gage et al. algorithm had better performance in both phases of initial and stable treatment. Algorithms had relatively higher accuracy in the >50years group of patients on the stable phase. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. [Evaluation of selected parameters of blood coagulation and fibrinolysis system in patients undergoing total hip replacement surgery with normovolemic hemodilution procedure and standard enoxaparine prophylaxis].

    Science.gov (United States)

    Piecuch, Wiesław; Sokołowska, Bozena; Dmoszyńska, Anna; Furmanik, Franciszek

    2003-01-01

    The aim of the study was to evaluate selected blood coagulation and fibrinolysis parameters in patients undergoing total hip replacement surgery with normovolemic hemodilution and standard enoksaparine profilaxis. The study included 66 patients undergoing hip replacement surgery. The group consisted of 51 women and 15 men, within the age range of 47-78, the mean age was 64. In 32 (subgroup II) patients the surgery was performed with the use of normovolemic hemodilution, in 34 (subgroup I) the hemodilution procedure was not applied. The enoksaparine as prophylaxis started 12 hours prior to surgery and continued during hospitalisation. The examination of the coagulation system was performed: on the day of the operation in the morning, on the day of the operation in the evening and on the first day after operation. We determined the concentrations of TAT and PAP complexes, prothrombin fragments 1 + 2 (F1 + 2) and d-dimers (DD). 1) during total hip replacement surgery and particularly in the period of the first 12 hours after the procedure marked activation of coagulation and fibrinolysis occurRed; 2) the application of the hemodilution procedure does not influence significantly the degree of coagulation and fibrinolysis disorders in the perioperative period, but could reduced incidence of thromboembolic complications in the postoperative period.

  11. Parecoxib Supplementation to Morphine Analgesia Decreases Incidence of Delirium in Elderly Patients After Hip or Knee Replacement Surgery: A Randomized Controlled Trial.

    Science.gov (United States)

    Mu, Dong-Liang; Zhang, Da-Zhi; Wang, Dong-Xin; Wang, Geng; Li, Chun-Jing; Meng, Zhao-Ting; Li, Ya-Wei; Liu, Chao; Li, Xue-Ying

    2017-06-01

    Severe pain and high-dose opioids are both associated with increased risk of postoperative delirium. The authors investigated whether parecoxib-supplemented IV morphine analgesia could decrease the incidence of delirium in elderly patients after total hip or knee replacement surgery. In a randomized, double-blind, 2-center trial, patients of 60 years or older who underwent elective total hip or knee replacement surgery were assigned in a 1:1 ratio to receive either parecoxib (40 mg at the end of surgery and then every 12 hours for 3 days) or placebo (normal saline). All patients received combined spinal-epidural anesthesia during surgery and IV morphine for postoperative analgesia. The primary outcome was the incidence of delirium within 5 days after surgery. Between January 2011 and May 2013, 620 patients were enrolled and were included in the intention-to-treat and safety analyses. The incidence of delirium was significantly reduced from 11.0% (34/310) with placebo to 6.2% (19/310) with parecoxib (relative risk 0.56, 95% confidence interval 0.33-0.96, P = .031). The severity of pain and the cumulative consumptions of morphine at 24, 48, and 72 hours after surgery were significantly lower with parecoxib than with placebo (all P delirium without increasing adverse events.

  12. Aortic valve replacement with or without coronary artery bypass graft surgery: the risk of surgery in patients > or =80 years old.

    Science.gov (United States)

    Maslow, Andrew; Casey, Paula; Poppas, Athena; Schwartz, Carl; Singh, Arun

    2010-02-01

    The purpose of this study was to evaluate the outcomes for elderly (> or =80 years) patients undergoing aortic valve replacement (AVR) with or without coronary artery bypass graft surgery (AVR/CABG). The authors hypothesized that the mortalities of AVR and AVR/CABG are lower than that predicted by published risk scores. A retrospective analysis of data from a single-hospital database. Single tertiary care, private practice. Consecutive patients undergoing AVR or AVR/CABG. Two hundred sixty-one elderly (> or =80 years) patients undergoing isolated AVR (145) or AVR/CABG (116) were evaluated. The majority (94.6%) underwent AVR for aortic valve stenosis. Outcomes were recorded and compared between the 2 surgical procedures with predicted mortalities based on published risk assessment scoring systems. The overall short-term mortality for the elderly group was 6.1% (AVR 5.5% and AVR/CABG 6.9%). The median long-term survival was 6.8 years. There were no significant differences in either morbidity or mortality between the AVR and AVR/CABG groups. Although predicted mortalities were similar for each surgical procedure, they overestimated observed outcome by up to 4-fold. Short- and long-term mortality was low for this group of elderly patients undergoing AVR or AVR/CABG and not significantly different between the 2 surgical groups. Predicted outcomes were worse than that observed, consistent with the hypothesis, and supportive of a more aggressive surgical treatment for aortic valve disease in the elderly patient. Copyright 2010 Elsevier Inc. All rights reserved.

  13. The perioperative dialogue--a model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia.

    Science.gov (United States)

    Pulkkinen, Maria; Junttila, Kristiina; Lindwall, Lillemor

    2016-03-01

    The aim of the study was to describe how patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia experienced to be a part of the perioperative dialogue as an ideal model of caring. A qualitative approach was chosen as a method. Nineteen patients undergoing either a hip or a knee replacement surgery under spinal anaesthesia participated. These patients and their nurse anaesthetists had three perioperative dialogues in the pre-, intra- and postoperative phase of care. Data were collected by means of conversational interviews by four voluntary nurse anaesthetists who wrote the dialogues from each perioperative phase. The text from the collected data was analysed by qualitative, latent content analysis. The findings of the analysis show three identified themes: Suffering while waiting for surgery (preoperative dialogue), Continuity creates togetherness (intraoperative dialogue) and Uniqueness - the patient has been seen (postoperative dialogue). The findings show evidence that the perioperative dialogue is an ideal model of caring and serves the patients' desires of individual and dignified care. The patients have a deep appreciation when there is time to develop a caring encounter with his or her own nurse. When a caring encounter has been established, the patient is involved in his or her own care. This model of caring offers the perioperative nurses a new way of caring and arouses reflections about their main task caring for the suffering patient. The continuity created by the perioperative dialogue probably has an influence on both patient satisfaction and patient safety.

  14. [Post-operative management for 86 cases of heart valve replacement surgery patients undergoing transcutaneous electrical acupoint stimulation combined with general anesthesia].

    Science.gov (United States)

    Zhou, Wen-Xiong; Xu, Jian-Jun; Wu, Yao-Yao; Chi, Hao; Chen, Tong-Yu; Ge, Wen; Zhou, Jia

    2014-02-01

    To summarize post-operative management strategy for heart valve replacement surgery under transcutaneous electrical acupoint stimulation (TEAS) combined with general anesthesia. From July 2006 to June 2012, a total of 86 cases of open-heart surgery patients experiencing TEAS plus general anesthesia with cardiopulmonary bypass (heart valve replacement surgery without intubation) were recruited in the present summary. Post-operative managements in the Intensive Care Unit (ICU) were administrated with strict hemodynamic monitoring for volume infusion, routine administration of vasoactive drugs (including dopamine and nitroglycerin), oxygen inhalation, and analgesics and monitoring of central nervous system and renal function. All the 86 patients under TEAS + general anesthesia and cardiopulmonary bypass and without intubation experienced successful heart valve replacement surgery. The post-operative pulmonary infection was found in 8 cases (9.30%), the average stay duration in ICU was (28.6 +/- 6.2) hours, and the average draining volume of the interpleural space was (291 +/- 73)mL. The cardia insufficiency was found in 5 cases (5.81%), hypoxia occurred in 8 cases (9.30%), nausea in 8 cases (9.30%), vomiting 5 cases (5.81%) and post-operative gastrointestinal distension 13 cases (15.12%), mild renal insufficiency 3 cases (3.49%), fever (> 38.5 degrees C) 1 case(1. 16%) and severe post-operative pain 7 cases (8.14%). TEAS combined with general anesthesia is safe for patients undergoing heart valve replacement surgery under cardiopulmonary bypass. The key points of treatment in ICU are volume infusion, body temperature maintenance, and pain control.

  15. Outcomes of mitral valve repair compared with replacement in patients undergoing concomitant aortic valve surgery: a meta-analysis of observational studies.

    Science.gov (United States)

    Saurav, Alok; Alla, Venkata Mahesh; Kaushik, Manu; Hunter, Claire C; Mooss, Aryan V

    2015-09-01

    Long-term superiority of mitral valve (MV) repair compared with replacement is well established in degenerative MV disease. In rheumatic heart disease, its advantages are unclear and it is often performed in conjunction with aortic valve (AV) replacement. Herein, we performed a systematic review and meta-analysis comparing outcomes of MV repair vs replacement in patients undergoing concomitant AV replacement. PubMed, Cochrane and Web of Science databases were searched up to 25 January 2014 for English language studies comparing outcomes of MV repair vs replacement in patients undergoing simultaneous AV replacement. Data of selected studies were extracted. Study quality, publication bias and heterogeneity were assessed. Analysis was performed using a random effects model (meta-analysis of observational studies in epidemiology recommendation). A total of 1202 abstracts/titles were screened. Of these, 20 were selected for full text review and 8 studies (3924 patients) were included in the final analysis: 1255 underwent MV repair and 2669 underwent replacement. Late outcome data were available in seven studies (cumulative follow-up: 15 654 patient-years). The early (in hospital and up to 30 days post-surgery) mortality [risk ratio (RR): 0.68, 95% confidence interval (CI): 0.53-0.87, P = 0.003] and late (>30 days post-surgery) mortality (RR: 0.76, 95% CI: 0.64-0.90 P = 0.001) were significantly lower in the MV repair group compared with the MV replacement group. The MV reoperation rate (RR: 1.89, 95% CI: 0.87-4.10, P = 0.108), thromboembolism (including valve thrombosis) (RR: 0.65, 95% CI: 0.38-1.13, P = 0.128) and major bleeding rates (RR: 0.88, 95% CI: 0.49-1.57, P = 0.659) were found to be comparable between the two groups. In a separate analysis of studies with exclusively rheumatic patients (n = 1106), the early as well as late mortality benefit of MV repair was lost (RR: 0.92, 95% CI: 0.44-1.90, P = 0.81 and RR: 0.69, 95% CI: 0.39-1.22, P = 0.199, respectively

  16. Predictors of inotrope use in patients undergoing concomitant coronary artery bypass graft (CABG and aortic valve replacement (AVR surgeries at separation from cardiopulmonary bypass (CPB

    Directory of Open Access Journals (Sweden)

    Nelson William B

    2009-06-01

    Full Text Available Abstract Background Left ventricular dysfunction is common after coronary artery bypass graft and valve replacement surgeries and is often treated with inotropic drugs to maintain adequate hemodynamic status. In this study, we aimed to identify the demographic, clinical, laboratory, echocardiographic and hemodynamic factors that are associated with use of inotropic drugs in patients undergoing concomitant coronary artery bypass graft and aortic valve replacement surgery. Methods The study included 97 patients who had undergone concomitant coronary artery bypass graft and aortic valve replacement at Regions Hospital, University of Minnesota Medical School from January 2006 to December 2008. All data were collected retrospectively after reviewing electronic medical records. Inotropic support was defined as the use of dopamine [greater than or equal to] 5 ug/kg/min; any dose of epinephrine, norepinephrine, dobutamine, and milrinone at the separation from cardiopulmonary bypass. Results Inotropic support was used in a total of 50 patients (52% at the separation from cardiopulmonary bypass. Average age of the patients requiring inotropic support was 72.2 +/- 8.8 years. The study identified four significant, independent predictors of inotrope use: (1 Cardiac index [less than or equal to]2.5 L/min/m2, (2 LVEDP [greater than or equal to] 20 mm Hg, (3 LVEF [less than or equal to]40%, and (4 CKD stage 3 to 5. Conclusion We identified four independent risk factors for postoperative use of inotropic support in patients undergoing concomitant coronary artery bypass graft and arotic valve replacement surgery at the separation from cardiopulmonary bypass. The study results will be helpful to prospectively identify patients who will likely to require inotropic support at the separation from cardiopulmonary bypass.

  17. AVE5026, a new hemisynthetic ultra-low-molecular-weight heparin for the prevention of venous thromboembolism in patients after total knee replacement surgery

    DEFF Research Database (Denmark)

    Lassen, Michael Rud; Dahl, O E; Mismetti, P

    2009-01-01

    after total knee replacement (TKR) surgery. OBJECTIVES: This study evaluated the dose-response of AVE5026 for the prevention of VTE in patients undergoing TKR surgery. PATIENTS/METHODS: In this parallel-group, double-blind, double-dummy study, 690 patients were randomized, and 678 treated with once....... The primary safety outcome was the incidence of major bleeding. RESULTS: The primary efficacy outcome was assessed in 464 patients. There was a significant dose-response across the five AVE5026 groups for VTE prevention (P....8% in the enoxaparin group and for proximal DVT (P=0.0002). Also, a significant dose-response for AVE5026 was seen for major bleeding (P=0.0231) and any bleeding (P=0.0003). Six patients in the AVE5026 groups, four in the 60 mg group, experienced major bleeding; none did in the enoxaparin group. CONCLUSIONS...

  18. The associations of illness perceptions and self-efficacy with psychological well-being of patients in preparation for joint replacement surgery.

    Science.gov (United States)

    Magklara, Eleni; Morrison, Val

    2016-09-01

    Patient well-being on referral to surgery likely affects their surgical experience yet few studies examine pre-surgical correlates of well-being. Guided by the Common Sense Model of Self-Regulation and Social Cognitive theory, this study examined whether illness and emotional representations, general and domain self-efficacy were associated with pre-surgical well-being. The pre-surgical assessment of a three-wave prospective study is reported. Fifty-four hip and knee replacements patients (mean age = 69.33; SD = 8.57) were recruited in the pre-surgery educational clinic at a UK general hospital. Patients completed a questionnaire-pack including the Revised Illness Perceptions Questionnaire, the General Self-Efficacy Scale, the Self-Efficacy for Rehabilitation Outcome Scale, the Falls-Efficacy Scale, and the Short Form of Psychological Well-Being Index. Multiple hierarchical regression analyses showed that above and beyond demographic and clinical characteristics, negative emotional representations were associated with lower psychological well-being while strong general self-efficacy beliefs were positively related to psychological well-being. Independent of demographic and clinical characteristics, joint replacement patients' psychological well-being was associated with their cognitions and emotional reactions to their condition before surgery. Early interventions could potentially target these modifiable factors to improve pre-surgical well-being in this group of patients, with potential for additional post-surgical benefit.

  19. Combined treatment of ulinastatin and tranexamic acid provides beneficial effects by inhibiting inflammatory and fibrinolytic response in patients undergoing heart valve replacement surgery.

    Science.gov (United States)

    Chen, Ting-Ting; Jiandong-Liu; Wang, Gang; Jiang, Sheng-Li; Li, Li-Bing; Gao, Chang-Qing

    2013-02-01

    To investigate the effect of ulinastatin and tranexamic acid administered alone or in combination on inflammatory cytokines and fibrinolytic system in patients undergoing heart valve replacement surgery during cardiopulmonary bypass (CPB). CPB-induced fibrinolytic hyperfunction and systemic inflammatory response syndrome (SIRS) are the leading causes responsible for the occurrence of postsurgical complications such as postsurgical cardiac insufficiency and lung injury, which may lead to an increase in postsurgical bleeding, prolongation of hospital stay, and increased costs. One hundred twenty patients undergoing heart valve replacement surgery during CPB were randomly assigned into 4 groups of 30 patients each: blank control group (Group C), tranexamic acid group (Group T), ulinastatin group (Group U), and tranexamic acid-ulinastatin combination group (Group D). Physiological saline, tranexamic acid, ulinastatin, and a combination of tranexamic acid and ulinastatin were given to each group, respectively. Arterial blood was collected from the radial artery at 4 time points: after induction of anesthesia (T1), unclamping the ascending aorta (T2), and at 1 hour (T3) and 24 hours (T4) after CPB. The levels of plasma tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), neutrophil elastase (NE), and the concentrations of tissue plasminogen activator (t-PA) and α2-antiplasmin (α2-AP) were detected. The changes in the volume of pericardial mediastinal drainage after surgery were observed and recorded. The plasma TNF-α, IL-6, and NE levels significantly increased in patients from all 4 groups at time points of T2, T3, and T4 in comparison to those before CPB (P surgery (P surgery.

  20. SERUM MAGNESIUM LEVELS IN AORTIC AND MITRAL VALVE REPLACEMENT SURGERIES

    Directory of Open Access Journals (Sweden)

    Srinivasa Rao

    2015-08-01

    Full Text Available BACKGROUND : The purpose of the study was to analyze serum magnesium concentration in patients undergoing Aortic and Mitral Valve replacement surgeries. METHODS: This prospective study was conducted in 60 patients who underwent elective Aortic and Mitral va lve replacement surgeries. Blood samples from radial artery were collected just before induction of anesthesia and three days post - operatively for estimation of serum magnesium. RESULTS: Magnesium level was 2.02mg/dl at baseline, 2.28mg/dl, 2.08mg/dl and 1 .90mg/dl respectively on three consecutive days post - operatively. CONCLUSION: The lowering of serum magnesium in Aortic and Mitral valve replacement surgeries postoperatively recommends the use of routine serum magnesium determination and administration to prevent post - operative arrhythmias.

  1. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study.

    Science.gov (United States)

    Lee, Trevor W R; Kowalski, Stephen; Falk, Kelsey; Maguire, Doug; Freed, Darren H; HayGlass, Kent T

    2016-01-01

    Cardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery. This prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2), anti-inflammatory (IL-10, TNF-RII, IL-1Ra), acute phase protein (CRP, PTX3) and cardiovascular risk (sST2) biomarkers. The kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005). This hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia. ClinicalTrials.gov NCT00348920.

  2. No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients.

    Science.gov (United States)

    Cheung, Graham; Carmont, Michael R; Bing, Andrew J F; Kuiper, Jan-Herman; Alcock, Robert J; Graham, Niall M

    2010-10-01

    We performed a prospective, randomised controlled trial to assess the differences in the use of a conventional suction drain, an Autologous Blood Transfusion (ABT) drain and no drain, in 168 patients. There was no significant difference between the drainage from ABT drains ( mean : 345 ml) and the suction drain (314 ml). Forty percent of patients receiving a suction drain had a haemoglobin level less than 10 g/dL at 24 hours, compared to 35% with no drain and 28% with an ABT drain. Patients that had no drains had wounds that were dry significantly sooner, mean 3.0 days compared to a mean of 3.9 days with an ABT drain and a mean of 4 days with a suction drain. Patients that did not have a drain inserted stayed in hospital a significantly shorter period of time, compared with drains. We feel the benefits of quicker drying wounds, shorter hospital stays and the economic savings justify the conclusion that no drain is required after hip replacement.

  3. Transcatheter aortic valve replacement in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Dimytri Siqueira; Alexandre Abizaid; Magaly Arrais J.; Eduardo Sousa

    2012-01-01

    Aortic stenosis is the most common native valve disease, affecting up to 5% of the elderly population. Surgical aortic valve replacement reduces symptoms and improves survival, and is the definitive therapy in patients with symptomatic severe aortic stenosis. However, despite the good results of classic surgery, risk is markedly increased in elderly patients with co-morbidities. Transcatheter aortic valve replacement (TAVR) allows implantation of a prosthetic heart valve within the diseased native aortic valve without the need for open heart surgery and cardiopulmonary bypass, offering a new therapeutic option to elderly patients considered at high surgical risk or with contraindications to surgery. To date, several multicenter registries and a randomized trial have confirmed the safety and efficacy of TAVR in those patients. In this chapter, we review the background and clinical applications of TAVR in elderly patients.

  4. Causes and indications for reoperation in valve replacement and coronary artery bypass graft (CABG in 915 patients in cardiac surgery department in Imam Khomeini Hospital, 1374-77

    Directory of Open Access Journals (Sweden)

    Radmehr H

    2001-08-01

    Full Text Available Valvular and coronary artery disease are among the most important causes of disability and death in the world and Iran as well. Every year, half a million death because of these diseases is reported in United State. The incidence of degenerative and valvular diseases of heart is increasing. Considering the industrialization of our country, the incidence of these kind of problems are increasing as well. In this study, there is an attempt to recognize the causes of cardiac surgery. We conducted a retrospective study in 915 cardiac surgery patients (630 CABG and 285 valve replacement from 1374 to 1377. In CABG patients, there were 46 cases of reoperation (78.3 percent male 21.7 percent female. The most reoperations for bleeding was less than 24 hours in 90.3 percent. In valvular patients the causes of reoperation were: A Valvular complications (female/male=3/1, B Non valvular complications (female/male=1/3. The most common nonvalvular complication was bleeding (66.6 percent. The most common valvular complication was bioprosthetic valve degeneration. The meantime between two operation in valvular complications was 11.8 years. In all cases (915 the incidence of bleeding was 3.8 percent, mediastinitis 0.8 percent, cardiac tamponade 0.8 percent and GI bleeding 0.5 percent.

  5. Our Experience with Short Stem Hip Replacement Surgery

    Directory of Open Access Journals (Sweden)

    Sumeet Rastogi

    2016-07-01

    Full Text Available Context- A short anatomical metaphyseal femoral stem is a desirable hip implant for bone and soft tissue preserving hip replacing surgery in young arthritic patients. Physiological loading of the proximal femur prevents stress shielding and preserves bone stock of the femur in the long run. Thus it is an ideal hip implant suited for conservative hip surgeries in active young adults with arthritic hips. Materials and methods- 50 Proxima hip replacements were performed on 41 patients with a mean age of 45 over a 3-year period (between July 2006 and September 2009. Diagnosis of hip pathologies varied from osteoarthritis secondary to avascular necrosis, rheumatoid arthritis, post-tubercular arthritis to dysplastic hips. 9 of these patients had symptomatic bilateral hip involvement and underwent bilateral hip replacement in a single sitting. All patient had a Proxima metaphyseal stem implantation( DePuy, Warsaw with either a large diameter metal on metal or pinnacle articulation. Clinical and radiological evaluation was done at 3 months, 6 months, 1 year and then yearly thereafter. Statiscal analysis used- VAS and Harris hip score formed the basis of evaluation Results- These patients were followed up for a mean period of 49 months (Range 36-72 months. The average incision size was 14.38 cm (10-18 cm and blood loss was 269 ml (175-450 ml. There was no peri-operative mortality or serious morbidity in any patients. One patient had an intraoperative lateral cortex crack that required only delayed rehabilitation. Five of the 41 patients (12.1 % had complications with three recovering completely and one requiring revision of femoral stem for aseptic loosening. One patient was lost in follow-up. Harris hip score improved from 52 to 89.3 at last follow-up. Overall 95.1% (39/41 patients had an excellent outcome at last follow-up. Conclusion- We conclude that Proxima metaphyseal stem provided clinically and radiologically stable fixation through snug fit

  6. Preoperative gait adaptations persist one year after surgery in clinically well-functioning total hip replacement patients.

    Science.gov (United States)

    Foucher, Kharma C; Hurwitz, Debra E; Wimmer, Markus A

    2007-01-01

    The purpose of this study was to evaluate whether preoperative gait adaptations persist one year after THR in the same set of subjects. The hypothesis tested was that hip dynamic range of motion and peak external moments during walking return to normal after THR. Hip kinematics and kinetics were measured for 28 subjects before and one year after THR and compared to those of 25 subjects with radiographically normal hips. All THR subjects improved clinically after surgery with Harris hip scores improving from 33-85 (average 53) to 61-100 (average 95) (sign test pPreoperatively dynamic hip range of motion (ROM), and all peak external moments were reduced compared to normal (Mann-Whitney ppreoperative and postoperative values of the ROM, and peak flexion, abduction and external rotation moments were all significantly correlated (Spearman prehabilitation before and after surgery.

  7. To Compare Time-Weighted Graphs to Evaluate the Inclination of the Acetabular Component of Patients Who Had Total Hip Replacement Surgery

    Directory of Open Access Journals (Sweden)

    Leman Tomak

    2015-01-01

    Full Text Available Time-weighted graphs are used to detect small shifts in statistical process control. The aim of this study is to evaluate the inclination of the acetabular component with CUmulative SUM (CUSUM chart, Moving Average (MA chart, and Exponentially Weighted Moving Average (EWMA chart. The data were obtained directly from thirty patients who had undergone total hip replacement surgery at Ondokuz Mayis University, Faculty of Medicine. The inclination of the acetabular component of these people, after total hip replacement, was evaluated. CUSUM chart, Moving Average chart, and Exponentially Weighted Moving Average were used to evaluate the quality control process of acetabular component inclination. MINITAB Statistical Software 15.0 was used to generate these control charts. The assessment done with time-weighted charts revealed that the acetabular inclination angles were settled within control limits and the process was under control. It was determined that the change within the control limits had a random pattern. As a result of this study it has been obtained that time-weighted quality control charts which are used mostly in the field of industry can also be used in the field of medicine. It has provided us with a faster visual decision.

  8. Hairline aesthetics and styling in hair replacement surgery.

    Science.gov (United States)

    Mayer, T G; Fleming, R W

    1985-01-01

    Punch grafting and flap surgery are proven methods of correcting baldness. Using either method, the location and shape of a new hairline on the frontal and temporal scalp is one of the most important aspects of hair replacement surgery. If the hairline is not aesthetic, the results can be unacceptable or even devastating for the patient and surgeon alike. The principles of planning the frontal and temporal hairline are presented using punch grafts as well as flaps. Postoperative styling of the "new" hair will vary depending upon the method used to transfer the hair (flaps or grafts), the local factors involved (texture, direction, density, tufting, etc.), as well as the patient's preference. The various advantages and disadvantages of styling possibilities with each method are presented. These factors should be discussed with the patient preoperatively.

  9. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

    2008-01-01

    BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction....... Epidemiological, physical, and perioperative parameters were registered and correlated to LOS and patient satisfaction. RESULTS: 92% of the patients were discharged directly to their homes within 5 days, and 41% were discharged within 3 days. Age, sex, marital status, co-morbidity, preoperative use of walking...... aids, pre- and postoperative hemoglobin levels, the need for blood transfusion, ASA score, and time between surgery and mobilization, were all found to influence postoperative outcome in general, and LOS and patient satisfaction in particular. INTERPRETATION: We identified several patient...

  10. No drain, autologous transfusion drain or suction drain? A randomised prospective study in total hip replacement surgery of 168 patients

    OpenAIRE

    Cheung, G.; Carmont, MR; Bing, AJ; Kuiper, JH; Alcock, RJ; Graham, NM

    2010-01-01

    We performed a prospective, randomised controlled trial to assess the differences in the use of a conventional suction drain, an Autologous Blood Transfusion (ABT) drain and no drain, in 168 patients. There was no significant difference between the drainage from ABT drains ( mean : 345 ml) and the suction drain (314 ml). Forty percent of patients receiving a suction drain had a haemoglobin level less than 10 g/dL at 24 hours, compared to 35% with no drain and 28% with an ABT drain. Patients t...

  11. Variation in age and physical status prior to total knee and hip replacement surgery

    DEFF Research Database (Denmark)

    Ackerman, Ilana N; Dieppe, Paul A; March, Lyn M

    2009-01-01

    OBJECTIVE: To investigate whether variation exists in the preoperative age, pain, stiffness, and physical function of people undergoing total knee replacement (TKR) and total hip replacement (THR) at several centers in Australia and Europe. METHODS: Individual Western Ontario and Mc...... in the timing of joint replacement across the centers studied, with potential for compromised surgical outcomes due to premature or delayed surgery. Possible contributing factors include patient preferences, the absence of concrete indications for surgery, and the capacity of the health care systems....

  12. Robotic joint replacement surgery: does technology improve outcomes?

    Science.gov (United States)

    Hill, Chelsea; El-Bash, Reem; Johnson, Leslie; Coustasse, Alberto

    2015-01-01

    Osteoarthritis is a common disease that leads patients to seek total joint replacement (TJR). Component misalignment leads to failure of TJR. Computer navigation enhances the precision of component alignment, but the addition of robotic guidance can boost TJR to a higher level of accuracy. Some 29 English-language peer-reviewed articles from 2002 to 2013 and 1 Web site were reviewed. A conceptual framework was adapted to explain benefits and barriers of adoption of robotic TJR. A total of 10 studies were reviewed with focus on more precise alignment, outcomes, length of stay, and costs. Cost to obtain robotic surgical equipment was found to be about $1 million with maintenance costs approaching $350 000. Robotic techniques compared with conventional orthopedic surgery showed slight variances in favor of robotic procedures. Although hospitals have the potential to reduce costs and improve outcomes with robotic TJR, the expenditure and maintenance have not been proven a clear return on investment. As surgical robotic technology evolves in accuracy and accessibility, joint replacement surgery may benefit from improved precision and decreased health care costs. However, equipment purchase and upkeep costs and surgeon training may impede use to its full potential in orthopedic surgery in the United States.

  13. Reduction in pulmonary complications in high risk patients undergoing surgery for total hip replacement under general anesthesia by preoperative intensive inspiratory muscle training:A randomized controlled clinical trial

    Institute of Scientific and Technical Information of China (English)

    Bingqiang Ma; Hongguang Bao

    2009-01-01

    Objective: To evaluate the effects of preoperative inspiratory muscle training (IMT) on the incidence of atelectasis in patients at high risk of postoperative pulmonary complications scheduled for elective total hip replacement surgery under general anesthesia. Methods: Thirty two high-risk paticnts undergoing elective total hip replacement surgery under general anesthesia were chosen from Nanjing Medical University, Affiliated Nanjing First Hospital. In this single-blind randomized controlled clinical trial, patients were randomly assigned to receive preoperative inspiratory muscle training or conventional treatment (CT). The major effectiveness outcome variables were atelectasis and duration of postoperative hospitalization. Results: Both groups were comparable prior to surgery. Seven patients in the CT group and 3 in the IMT group developed atelectasis (P = 0.25). Median duration of postoperative hospitalization was 13 days (range, 10~17 days) in the IMT group versus 16 days (range, 11~23 days) in the CT group (Mann-Whitney U statistics, Z =-2.22, P = 0.03). Mean postoperative inspiratory pressure was 5% higher in the IMT group. Conclusion: Preoperative intensive inspiratory muscle training appears to reduce the incidence of atelectasis and duration of postoperative hospitalization in patients at high risk of developing postoperative pulmonary complications who were scheduled for elective total hip replacement surgery under general anesthesia.

  14. AVE5026, a new hemisynthetic ultra-low-molecular-weight heparin for the prevention of venous thromboembolism in patients after total knee replacement surgery--TREK: a dose-ranging study

    DEFF Research Database (Denmark)

    Lassen, M R; Dahl, O E; Mismetti, P

    2009-01-01

    after total knee replacement (TKR) surgery. OBJECTIVES: This study evaluated the dose-response of AVE5026 for the prevention of VTE in patients undergoing TKR surgery. PATIENTS/METHODS: In this parallel-group, double-blind, double-dummy study, 690 patients were randomized, and 678 treated with once....... The primary safety outcome was the incidence of major bleeding. RESULTS: The primary efficacy outcome was assessed in 464 patients. There was a significant dose-response across the five AVE5026 groups for VTE prevention (P....8% in the enoxaparin group and for proximal DVT (P=0.0002). Also, a significant dose-response for AVE5026 was seen for major bleeding (P=0.0231) and any bleeding (P=0.0003). Six patients in the AVE5026 groups, four in the 60 mg group, experienced major bleeding; none did in the enoxaparin group. CONCLUSIONS...

  15. The management of cardiopulmonary bypass in patients undergoing mitral valve replacement surgery with total video thoracoscope%全胸腔镜下二尖瓣置换的体外循环管理

    Institute of Scientific and Technical Information of China (English)

    周和平; 孙国成; 陈涛; 熊红燕; 冯建宇; 金振晓

    2011-01-01

    目的 总结全胸腔镜下二尖瓣置换手术的体外循环的管理方法.方法 85例二尖瓣病变患者,采用全胸腔镜下二尖瓣置换术,对体外循环建立方法、体外循环管理及手术后结果进行评价.结果 85例患者体外循环时间为90~155(120.7±17.4) min,升主动脉阻断时间40~90(51.2±9.1)min.所有患者手术过程顺利.术后均恢复良好,无严重并发症.结论 全胸腔镜下二尖瓣置换术的体外循环方法安全、可行.%Objective To summarize the management of cardiopulmonary bypass ( CPB ) in patients undergoing mitral valve replacement surgery with total video thoracoscope. Methods Eighty - five consecutive patients with mitral valve diseases undergoing mitral valve replacement surgery with total video thoracoscope were included. The methods of CPB setup and the precise management during surgery and the clinical results were evaluated. Results The CPB time of the patients was 90 - 155 ( 120.7 ± 17. 4 ) min and the aortic - clamping time was 40- 90(51.2±9.1 ) min. One patient had bleeding due to aortic purse string loose after CPB disconnection, which resulted in unstable hemodynamics and necessitated urgent treatment, then recovered uneventfully. All other patients recovered well without any severe complications. Conclusion The cardiopulmonary bypass of mitral valve replacement surgery with total vedio thoracoscope is safe and practical.

  16. Effect of single intraoperative dose of amiodarone in patients with rheumatic valvular heart disease and atrial fibrillation undergoing valve replacement surgery

    Directory of Open Access Journals (Sweden)

    Selvaraj Thiruvenkadam

    2009-01-01

    Full Text Available Maintenance of sinus rhythm (SR is superior to rate control in atrial fibrillation (AF. In order to achieve SR, we administered single-dose intravenous amiodarone intraoperatively and evaluated its effect on conversion of rheumatic AF to SR in patients undergoing valvular heart surgery. Patients were randomly assigned to amiodarone ( n = 42 or control ( n = 40 group in a double blind manner. The amiodarone group received amiodarone (3 mg/kg intravenously prior to the institution of cardiopulmonary bypass and the control group received the same volume of normal saline. In the amiodarone group, the initial rhythm after the release of aortic cross clamp was noted to be AF in 14.3% ( n = 6 and remained so in 9.5% ( n = 4 of patients till the end of surgery. In the control group, the rhythm soon after the release of aortic cross clamp was AF in 37.5% ( n = 15 ( p = 0.035 and remained so in 32.5% ( n = 13 of patients till the end of surgery ( p = 0.01. At the end of first post-operative day 21.4% ( n = 9 of patients in amiodarone group and 55% ( n = 22 of patients in control group were in AF ( p = 0.002. The requirement of cardioversion/defibrillation was 1.5 (±0.54 in amiodarone group and 2.26 (±0.73 in the control group ( p = 0.014, and the energy needed was 22.5 (±8.86 joules in the amiodarone group and 40.53 (±16.5 in the control group ( p = 0.008. A single intraoperative dose of intravenous amiodarone increased the conversion rate of AF to normal sinus rhythm, reduced the need and energy required for cardioversion/defibrillation and reduced the recurrence of AF within one day.

  17. A COMPARATIVE ANALYSIS BETWEEN THE RECOVERY RESULTS OF PATIENTS WITH HIP JOINT REPLACEMENT IN THE PERIOD OF EARLY REHABILITATION AT HOME (13-45 DAYS AFTER SURGERY

    Directory of Open Access Journals (Sweden)

    Maya St. Krastanova

    2016-04-01

    Full Text Available Rehabilitation of the patients with Hip Joint Arthroplasthy is an indispensable part of the functional recovery. The purpose of this report is to track and measure the results of an applied complex rehabilitation program during the early post-surgery period in home setting (13-45 days after surgery and to make a comparative analysis between the recovery results of patients who conducted a comprehensive rehabilitation treatment, and a control group of patients who conducted only early physical therapy and occupational therapy in the hospitalization in the Department of Orthopedics and Traumatology. Methods and materials: 152 patients (107 female and 45 male aged between 22 and 84 with Hip Joint Arthroplasthy due to osteoarthritis or femoral neck fracture participated in the study, divided into two groups, according to postoperative behavior. The rehabilitation program consists of: kinesitherapy (positional therapy, isometric exercises, movement of the artificial hip joint within the allowed volumes, exercises for upper limbs and the healthy lower limb and ergotherapy (ergonomic home environment adjusted to performing the daily activities of life. Patients in the second control group have conducted kinesitherapy and occupational therapy only in the early postoperative period in orthopedic clinic. Results: Locomotion test and DAL test measurements were taken and the results for each patient were stored in a special patient file. Conclusion: Ensuring an ergonomic home environment and independent practice of kinesitherapeutic and ergotherapeutic stimulate the recovery of the patients’ self-reliance significantly improve the psycho-emotional balance and self-respect, and serves as an important basis for the latter stages of rehabilitation.

  18. Postorthopedic Surgery Joint Replacement Surgery Venous Thromboembolism Prophylaxis.

    Science.gov (United States)

    Kwong, Louis M; Kimball, Jon A

    2016-10-01

    Elective total hip or knee arthroplasty places patients at risk for venous thromboembolism (VTE). As our understanding of the pathophysiology of VTE after joint arthroplasty has increased, pharmacologic strategies have been developed to target different aspects of the coagulation cascade. Various approaches have been used as risk reduction strategies. In 2011 and 2014 the Food and Drug Administration approved rivaroxaban and apixaban as new oral antithrombotic agents. Although controversies remain with regard to the ideal VTE pharmacoprophylactic agent, this class of novel oral anticoagulants has been demonstrated to be safe and to be more effective than enoxaparin. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Segmental mobility, disc height and patient-reported outcomes after surgery for degenerative disc disease: a prospective randomised trial comparing disc replacement and multidisciplinary rehabilitation.

    Science.gov (United States)

    Johnsen, L G; Brinckmann, P; Hellum, C; Rossvoll, I; Leivseth, G

    2013-01-01

    This prospective multicentre study was undertaken to determine segmental movement, disc height and sagittal alignment after total disc replacement (TDR) in the lumbosacral spine and to assess the correlation of biomechanical properties to clinical outcomes.A total of 173 patients with degenerative disc disease and low back pain for more than one year were randomised to receive either TDR or multidisciplinary rehabilitation (MDR). Segmental movement in the sagittal plane and disc height were measured using distortion compensated roentgen analysis (DCRA) comparing radiographs in active flexion and extension. Correlation analysis between the range of movement or disc height and patient-reported outcomes was performed in both groups. After two years, no significant change in movement in the sagittal plane was found in segments with TDR or between the two treatment groups. It remained the same or increased slightly in untreated segments in the TDR group and in this group there was a significant increase in disc height in the operated segments. There was no correlation between segmental movement or disc height and patient-reported outcomes in either group.In this study, insertion of an intervertebral disc prosthesis TDR did not increase movement in the sagittal plane and segmental movement did not correlate with patient-reported outcomes. This suggests that in the lumbar spine the movement preserving properties of TDR are not major determinants of clinical outcomes.

  20. Left ventricular outflow tract pseudoaneurysm formation following three aortic valve replacement surgeries

    Directory of Open Access Journals (Sweden)

    Nasrien E Ibrahim

    2015-01-01

    Full Text Available We present a case of a pseudoaneurysm arising from the left ventricular outflow tract/aortic root as a complication of aortic valve surgery. A 45-year-old Nigerian female presented to our institution′s emergency department with chest discomfort. She had three bioprosthetic aortic valve replacements in the preceding year at an outside institution for aortic regurgitation and wanted a second opinion on remaining surgical options. The learning points relevant to this case are as follows: (1 Recognizing potential complications postmultiple valve surgeries, (2 screening patients for chronic infections and rheumatologic conditions that can contribute to failed valve surgeries.

  1. 21 CFR 874.3540 - Prosthesis modification instrument for ossicular replacement surgery.

    Science.gov (United States)

    2010-04-01

    ... replacement surgery. 874.3540 Section 874.3540 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... § 874.3540 Prosthesis modification instrument for ossicular replacement surgery. (a) Identification. A prosthesis modification instrument for ossicular replacement surgery is a device intended for use by a...

  2. Causes for revision surgery in total hip replacement. A retrospective epidemiological analysis.

    Science.gov (United States)

    Capón-García, D; López-Pardo, A; Alves-Pérez, M T

    2016-01-01

    To determine the impact of each cause of revision surgery in total hip arthroplasty during the period 2009-2013. To analyse the relationship between these causes with different variables. A study was conducted on 127 patients who had hip replacement revision surgery in our hospital during this period. Parameters, such as age, sex, date of primary arthroplasty, prosthetic replacement date, and main cause of the revision were recorded. Those revisions performed within 5 years after the primary arthroplasty were considered as early rescue. The most common cause of rescue was aseptic loosening in 38 (30%) followed by instability in 30 (24%). In terms of age at the time of rescue, statistically significant differences were found, with it being significantly higher in patients re-operated for a fracture. Differences in age at first surgery were found to be 7 years younger than those with late rescue (63.40) with respect to early (70.21). Similar results to ours have been observed in other published series, except for the higher incidence of instability in early rescue. This study demonstrates aseptic loosening and instability as the most frequent causes of revision surgery in our hospital. Age is a very influential factor in relation to longevity of primary arthroplasty. Complications were higher in when the primary hip replacement is implanted in older patients. Copyright © 2016 SECOT. Published by Elsevier Espana. All rights reserved.

  3. Prosthetic valve thrombosis in a patient with mitral valve replacement.

    Science.gov (United States)

    Bilal, Muhammad; Khan, Muhammad Shahzeb; Haseeb, Abdul; Khan, Abdul Bari

    2015-07-01

    Prosthetic valve thrombosis within one year after mitral valve replacement is rarely seen in patients on warfarin therapy and without any risk factor. Here, we describe a case of a 39-year- old female, who presented with dyspnoea and shortness of breath 11 months after mitral valve replacement. The echocardiogram revealed severe valvular stenosis due to presence of clots on the mitral valve and restricted motion of the mitral leaflets. As a result of deterioration of general condition and haemodynamic un-stability, plan was made to re-operate for her valve replacement surgery. This case report highlights the diagnosis, prevention and management of patients with prosthetic valve thrombosis following mitral valve replacement.

  4. Racial disparities in receiving total hip/knee replacement surgery: the effect of hospital admission sources.

    Science.gov (United States)

    Chen, Jie; Rizzo, John A; Parasuraman, Shreekant; Gunnarsson, Candace

    2013-02-01

    Using a nationally-representative inpatient care dataset (the HCUP National Inpatient Sample from 2002 to 2007) we examined racial disparities in receiving total hip replacement (THR) and total knee replacement (TKR) surgeries. Multivariable logistic regression models revealed that racial minorities were significantly less likely to receive THR or TKR than Whites, controlling for patients' hospital admission source and hospital characteristics. Employing Blinder-Oaxaca decomposition techniques, we found that observed difference in population characteristics explained 55%-67% and 78% of the racial disparities in THR and TKR, respectively. Differences in patients' hospital admission source emerged as the major individual factor associated with these disparities, explaining 57%-77% of racial disparities in THR and 26%-50% of racial disparities in TKR. This study suggests that substantive racial and ethnic disparities exist in utilization of THR and TKR surgery. Observed population characteristics accounted for most of these differences, with hospital admission source being the key factor.

  5. Minimally Invasive Cardiac Surgery: Transapical Aortic Valve Replacement

    Directory of Open Access Journals (Sweden)

    Ming Li

    2012-01-01

    Full Text Available Minimally invasive cardiac surgery is less traumatic and therefore leads to quicker recovery. With the assistance of engineering technologies on devices, imaging, and robotics, in conjunction with surgical technique, minimally invasive cardiac surgery will improve clinical outcomes and expand the cohort of patients that can be treated. We used transapical aortic valve implantation as an example to demonstrate that minimally invasive cardiac surgery can be implemented with the integration of surgical techniques and engineering technologies. Feasibility studies and long-term evaluation results prove that transapical aortic valve implantation under MRI guidance is feasible and practical. We are investigating an MRI compatible robotic surgical system to further assist the surgeon to precisely deliver aortic valve prostheses via a transapical approach. Ex vivo experimentation results indicate that a robotic system can also be employed in in vivo models.

  6. The Daily Practice of Pancreatic Enzyme Replacement Therapy After Pancreatic Surgery: A Northern European Survey: Enzyme Replacement After Surgery

    NARCIS (Netherlands)

    E.C.M. Sikkens (Edmée); D.L. Cahen (Djuna); C.H.J. van Eijck (Casper); E.J. Kuipers (Ernst); M.J. Bruno (Marco)

    2012-01-01

    textabstractIntroduction: After pancreatic surgery, up to 80 % of patients will develop exocrine insufficiency. For enzyme supplementation to be effective, prescribing an adequate dose of pancreatic enzymes is mandatory but challenging because the required dose varies. Data on the practice of enzyme

  7. The Daily Practice of Pancreatic Enzyme Replacement Therapy After Pancreatic Surgery: A Northern European Survey: Enzyme Replacement After Surgery

    NARCIS (Netherlands)

    E.C.M. Sikkens (Edmée); D.L. Cahen; C.H.J. van Eijck (Casper); E.J. Kuipers (Ernst); M.J. Bruno (Marco)

    2012-01-01

    textabstractIntroduction: After pancreatic surgery, up to 80 % of patients will develop exocrine insufficiency. For enzyme supplementation to be effective, prescribing an adequate dose of pancreatic enzymes is mandatory but challenging because the required dose varies. Data on the practice of enzyme

  8. IOL Implants: Lens Replacement and Cataract Surgery (Intraocular Lenses)

    Science.gov (United States)

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ...

  9. TOTAL HIP OR KNEE REPLACEMENT SURGERY: ACCOMPANYING RELATIVES´ ROLE IN SUPPORTING PATIENTS TO COMPLY WITH THE NEED FOR ACTIVE PARTICIPATION IN ACCELERATED INTERVENTION PROGRAMS

    DEFF Research Database (Denmark)

    Stampe, Mette Adler; Rasmussen, Bodil; Larsen, Birte Hedegaard

    2012-01-01

    at a patient hotel. A qualitative approach was applied to explore the patients´ experiences. Edmund Husserl´s philosophy of phenomenology was used as inspiration for the research approach applied. Five participants attended a semi-structured interview and a follow-up interview, each. The analysis was conducted...

  10. Valve replacement in pediatric patients:a single center experience

    Institute of Scientific and Technical Information of China (English)

    YU Jian-hua; GUO Hong-wei; ZHANG Gong; WU Shu-ming; SONG Guang-min; SUN Wen-yu

    2011-01-01

    Background Reconstructive surgery is the primary goal in pediatric patients with valve disease.However,in cases with irreparable valve lesions,valve replacement is the only option.This study aimed to retrospectively analyze the clinical experience of heart valve prosthesis replacement in children.Methods Between January 1990 and July 2009,35 pediatric patients (16 boys,19 girls) underwent mechanical valve replacement in Shandong University Qilu Hospital.The ages ranged from 2.5 to 14 years (mean,(8.8±3.8) years) and body weight varied from 11 to 37 kg (mean,(22.1±5.2) kg).Mechanical valve replacement was performed because of congenital heart disease in 23 patients,rheumatic disease in ten patients and infective endocarditis in two patients.St.Jude bileaflet mechanical valves were implanted in all the 35 patients including mitral valve replacement (MVR) in 18,aortic valve replacement (AVR) in 12,tricuspid valve replacement (TVR) in two,AVR and MVR in two and MVR and TVR in one.The size of the prostheses ranged between 19 and 27 mm.All patients received long-term anticoagulation treatment with sodium warfarin,aiming to maintain an international normalized ratio between 1.5 to 2.0.Follow-up was performed in all the patients with a total follow-up of 119.4 patient-years.Results The operative mortality was 8.57% (3/35).One patient,who underwent cardiac debridement and AVR,died 2 hours after being admitted to the intensive care unit because of severe low cardiac output syndrome and ventricular fibrillation.Two patients died of cardiogenic shock and renal failure during initial hospitalization after the operation.One patient who received replacement of a tricuspid valve developed complete heart block requiring temporary pacing and recovered sinus rhythm 4 days later.Thirty-two patients survived and their cardiac function was in New York Heart Association (NYHA) class Ⅰ to class Ⅱ when discharged.Late events included hemorrhage and endocarditis.Two patients required

  11. Evaluation of Bluetooth as a replacement for cables in intensive care and surgery.

    Science.gov (United States)

    Wallin, Mats K E B; Wajntraub, Samson

    2004-03-01

    In today's intensive care and surgery, a great number of cables are attached to patients. These cables can make the care and nursing of the patient difficult. Replacing them with wireless communications technology would facilitate patient care. Bluetooth is a modern radio technology developed specifically to replace cables between different pieces of communications equipment. In this study we sought to determine whether Bluetooth is a suitable replacement for cables in intensive care and during surgery with respect to electromagnetic compatibility. The following questions were addressed: Does Bluetooth interfere with medical equipment? And does the medical equipment decrease the quality of the Bluetooth communication? A Bluetooth link, simulating a patient monitoring system, was constructed with two laptops. The prototype was then used in laboratory and clinical tests according to American standards at the Karolinska Hospital in Stockholm. The tests, which included 44 different pieces of medical equipment, indicated that Bluetooth does not cause any interference. The tests also showed that the hospital environment does not affect the Bluetooth communication negatively. Bluetooth, a new radio technology transmitting at 2.4 GHz, was tested in a clinical setting. The study showed that a single Bluetooth link was robust and electromagnetically compatible with the tested electronic medical devices.

  12. A case of severe ankylosing spondylitis posted for hip replacement surgery

    Directory of Open Access Journals (Sweden)

    Nalini Kotekar

    2007-01-01

    Full Text Available A 50-year-old male patient with history of ankylosing spondylitis (AS for 30 years presented for hip replacement surgery. Airway management in ankylosing spondylitis patients presents the most serious array of intubation and airway hazards imagin-able, which is secondary to decrease in cervical spine mobility and possible temporo-mandibular joint disease. Literatures support definitive airway management and many authors consider regional anaesthesia to be contraindicated. The reasons cited include inability to gain neuraxial access and the need for urgent airway control in case of complication of regional anaesthesia.

  13. Does endoprosthetic replacement of large joints improve quality of life in patients with rheumatoid arthritis?

    Directory of Open Access Journals (Sweden)

    Nadezhda Alekseevna Savenkova

    2011-01-01

    Conclusion. The majority of patients had not initially received adequate disease-modifying anti-inflammatory therapy for many years. Endoprosthetic replacement of the lower limb joints in the first 6 months after surgery improved the functional capacity of the operated joint, by increasing QL in the patients as a whole. There was no substantial decrease in global disease activity 6 months following surgery.

  14. Meaningful changes for the Oxford hip and knee scores after joint replacement surgery.

    Science.gov (United States)

    Beard, David J; Harris, Kristina; Dawson, Jill; Doll, Helen; Murray, David W; Carr, Andrew J; Price, Andrew J

    2015-01-01

    To present estimates of clinically meaningful or minimal important changes for the Oxford Hip Score (OHS) and the Oxford Knee Score (OKS) after joint replacement surgery. Secondary data analysis of the NHS patient-reported outcome measures data set that included 82,415 patients listed for hip replacement surgery and 94,015 patients listed for knee replacement surgery was performed. Anchor-based methods revealed that meaningful change indices at the group level [minimal important change (MIC)], for example in cohort studies, were ∼ 11 points for the OHS and ∼ 9 points for the OKS. For assessment of individual patients, receiver operating characteristic analysis produced MICs of 8 and 7 points for OHS and OKS, respectively. Additionally, the between group minimal important difference (MID), which allows the estimation of a clinically relevant difference in change scores from baseline when comparing two groups, that is, for clinical trials, was estimated to be ∼ 5 points for both the OKS and the OHS. The distribution-based minimal detectable change (MDC90) estimates for the OKS and OHS were 4 and 5 points, respectively. This study has produced and discussed estimates of minimal important change/difference for the OKS/OHS. These estimates should be used in the power calculations and the interpretation of studies using the OKS and OHS. The MDC90 (∼ 4 points OKS and ∼ 5 points OHS) represents the smallest possible detectable change for each of these instruments, thus indicating that any lower value would fall within measurement error. Copyright © 2015 University of Oxford. Published by Elsevier Inc. All rights reserved.

  15. Oral nutrition or water loading before hip replacement surgery; a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Ljunggren Stefan

    2012-07-01

    Full Text Available Abstract Background Surgery induces insulin resistance that might be alleviated by a nutritional drink given preoperatively. The authors hypothesized that some of the beneficial effects of the drink could be attributed to the volume component (approximately 1 L rather than to the nutrients. Methods Sixty patients scheduled for elective total hip replacement under spinal anesthesia were recruited to a clinical trial, and randomly allocated to preoperative fasting, to oral ingestion of tap water, or to oral ingestion of a carbohydrate drink. An intravenous glucose tolerance test calculated glucose clearance and insulin sensitivity on the day before surgery, in the postoperative ward, and on the day after surgery. Other parameters were stress (cortisol in plasma and urine, muscle catabolism (urinary 3-methylhistidine, and wellbeing. Results Fifty-seven patients completed the study. In the postoperative ward, the glucose clearance and the insulin response had decreased from the previous day by 23% and 36%, respectively. Insulin sensitivity did not decrease until the next morning (−48% and was due to an increased insulin response (+51%. Cortisol excretion was highest on the day of surgery, while 3-methylhistidine increased 1 day later. Follow-up on the third postoperative day showed an average of 1.5 complications per patient. Wellbeing was better 2 weeks after than before the surgery. None of the measured parameters differed significantly between the study groups. Conclusions Preoperative ingestion of tap water or a nutritional drink had no statistically significant effect on glucose clearance, insulin sensitivity, postoperative complications, or wellbeing in patients undergoing elective hip surgery. Trial registration Registration number: NCT 01211184 (http://www.clinicaltrials.gov

  16. Computer Assisted Surgery and Current Trends in Orthopaedics Research and Total Joint Replacements

    Science.gov (United States)

    Amirouche, Farid

    2008-06-01

    Musculoskeletal research has brought about revolutionary changes in our ability to perform high precision surgery in joint replacement procedures. Recent advances in computer assisted surgery as well better materials have lead to reduced wear and greatly enhanced the quality of life of patients. The new surgical techniques to reduce the size of the incision and damage to underlying structures have been the primary advance toward this goal. These new techniques are known as MIS or Minimally Invasive Surgery. Total hip and knee Arthoplasties are at all time high reaching 1.2 million surgeries per year in the USA. Primary joint failures are usually due to osteoarthristis, rheumatoid arthritis, osteocronis and other inflammatory arthritis conditions. The methods for THR and TKA are critical to initial stability and longevity of the prostheses. This research aims at understanding the fundamental mechanics of the joint Arthoplasty and providing an insight into current challenges in patient specific fitting, fixing, and stability. Both experimental and analytical work will be presented. We will examine Cementless total hip arthroplasty success in the last 10 years and how computer assisted navigation is playing in the follow up studies. Cementless total hip arthroplasty attains permanent fixation by the ingrowth of bone into a porous coated surface. Loosening of an ingrown total hip arthroplasty occurs as a result of osteolysis of the periprosthetic bone and degradation of the bone prosthetic interface. The osteolytic process occurs as a result of polyethylene wear particles produced by the metal polyethylene articulation of the prosthesis. The total hip arthroplasty is a congruent joint and the submicron wear particles produced are phagocytized by macrophages initiating an inflammatory cascade. This cascade produces cytokines ultimately implicated in osteolysis. Resulting bone loss both on the acetabular and femoral sides eventually leads to component instability. As

  17. Study on postoperative invisible blood loss in patients with bipolar artificial femoral head replacement surgery%双极人工股骨头置换患者术后隐形失血的研究

    Institute of Scientific and Technical Information of China (English)

    农文海; 宋猛先; 黄毅; 莫金平; 潘文奇

    2014-01-01

    Objective To evaluate the postoperative invisible blood loss in patients with bipolar artificial femoral head replacement surgery. Methods The clinical data of 62 patients with bipolar artificial femoral head re-placement surgery admitted in our hospital from January 2006 to June 2013 were analyzed. The volume of postopera-tive invisible blood loss, changes in perioperative Hct and variation of invisible blood loss in patients with different age, sex, body mass index (BMI), with or without preoperative chronic diseases, with or without postoperative ve-nous thrombosis in lower limbs and different postoperative anticoagulation protocols were observed and documented. Results The postoperative invisible blood loss was (560.82 ± 89.16) ml, accounting for 62.22% of the total blood loss. 2 days after operation, the Hct reached a minimum value, and it increased steadily in the 3rd postoperative day. The postoperative blood loss volume in patients with BMI>25 kg/m2 was more than those with BMI≤25 kg/m2, and the difference was statistically significant (P0.05). Conclusion The postoperative invisible blood loss plays an impor-tant role in prognosis, which is mainly influenced by BMI.%目的:评价初次进行双极人工股骨头置换术患者的隐性失血状况。方法选取2006年1月至2013年6月在我院进行双极人工股骨头置换术的62例患者的临床资料,观察并统计患者术后隐性出血量、围术期血细胞比容(Hct)的变化以及评估在不同年龄、性别、体质量指数、术前是否合并慢性疾病、术后是否下肢静脉血栓及术后抗凝方式患者围术期的隐性出血情况。结果患者术后隐性失血量为(560.82±89.16) ml,占总失血量的62.22%;术后第2天是患者Hct的最低值,在术后第3天以后患者的Hct呈现出平稳上升趋势;患者体质量指数>25 kg/m2的术后隐性失血量明显多于≤25 kg/m2者,差异有统计学意义(P0.05)。结论隐性失血是影响患

  18. Tissue structure damage in late-stage knee osteoarthritis: medication, markers, and disease modification before replacement surgery

    NARCIS (Netherlands)

    de Boer, T.N.

    2012-01-01

    The aim of this thesis is to gain more insight in the characteristics of end-stage osteoarthritic patients who are about to undergo total knee replacement surgery. Their use of medication, potential markers of actual characteristics of joint damage and inflammation, and effects of potential disease

  19. Anatomic Total Talar Prosthesis Replacement Surgery and Ankle Arthroplasty: An Early Case Series in Thailand

    Science.gov (United States)

    2014-01-01

    Little is known about specific outcomes and early experiences of total talar prosthesis replacement surgery in the current literature, and ankle arthroplasty in Southeast Asia. This study reported on four patients with talar loss or ankle arthritis. Patients were treated with a custom total talar prosthesis (anatomic-metallic version) replacement (TPR, n=1) or with total ankle replacement (TAR, n=3). Baseline data, including Visual-Analog-Scale Foot and Ankle (VAS-FA) and Quality of Life scores via Short-Form-36 (SF-36), were collected for all patients. Mean follow-up time was 7.6 months. From preoperative to postoperative, VAS-FA score increased from 6.0 to 57.5, and SF-36 score increased from 19.3 to 73.7 in a patient with TPR. Mean VAS-FA scores increased from 51.5±15.6 to 85.7±4.7 (P=0.032), and mean SF-36 scores tended to increase from 65.2±13.3 to 99.3±1.2 (P=0.055) in TAR group. This study is the first report of anatomic-metallic TPR which appears to provide satisfactory outcomes for treatment of talar loss at a short-term follow-up. TAR also provides acceptable results for treatment of ankle arthritis at this point. PMID:25317313

  20. Anatomic total talar prosthesis replacement surgery and ankle arthroplasty: an early case series in Thailand

    Directory of Open Access Journals (Sweden)

    Chayanin Angthong

    2014-10-01

    Full Text Available Little is known about specific outcomes and early experiences of total talar prosthesis replacement surgery in the current literature, and ankle arthroplasty in Southeast Asia. This study reported on four patients with talar loss or ankle arthritis. Patients were treated with a custom total talar prosthesis (anatomic-metallic version replacement (TPR, n=1 or with total ankle replacement (TAR, n=3. Baseline data, including Visual-Analog-Scale Foot and Ankle (VAS-FA and Quality of Life scores via Short-Form-36 (SF-36, were collected for all patients. Mean follow-up time was 7.6 months. From preoperative to postoperative, VAS-FA score increased from 6.0 to 57.5, and SF-36 score increased from 19.3 to 73.7 in a patient with TPR. Mean VAS-FA scores increased from 51.5±15.6 to 85.7±4.7 (P=0.032, and mean SF-36 scores tended to increase from 65.2±13.3 to 99.3±1.2 (P=0.055 in TAR group. This study is the first report of anatomic-metallic TPR which appears to provide satisfactory outcomes for treatment of talar loss at a short-term follow-up. TAR also provides acceptable results for treatment of ankle arthritis at this point.

  1. 依达拉奉对老年患者膝关节置换术后认知功能的影响%Effects of edaravone on postoperative cognitive function in elderly patients undergoing knee replacement surgery

    Institute of Scientific and Technical Information of China (English)

    谭宇桔; 徐志鹏; 姜雨鸽; 张宏

    2015-01-01

    目的:观察氧自由基清除剂依达拉奉预处理对老年患者膝关节置换术后认知功能的影响。方法选择2014年5-9月在我院择期全麻下行全膝关节置换术的老年患者90例,年龄60~79岁,ASAⅠ~Ⅱ级,术前简易精神状态检查表(mini-mental state examination,MMSE)评分≥23分,随机分为2组,依达拉奉组(E组)和对照组(C组),每组45例,分别于麻醉诱导前30 min给予依达拉奉0.5 mg/kg(E组)和等量的氯化钠注射液(C组)。于术前1 d(T0)、术后第1天(T1)、术后第5天(T2)采用国际术后认知功能障碍研究协作组(international study of postoperative cognitive dysfunction,ISPOCD)推荐的量表对患者的认知功能进行评估。结果 T0时两组神经心理学评估量表评分无统计学差异(P>0.05)。两组术后认知功能障碍(postoperative cognitive dysfunction,POCD)发生率在T1时E组11.11%、C组33.33%;在T2时E组6.67%、C组22.22%, T1、T2时,E组POCD的发生率均低于C组(P=0.01,P=0.04)。结论依达拉奉预处理可以降低老年患者膝关节置换术POCD的发生率,改善老年患者的术后认知功能。%Objective To investigate the influence of edaravone on postoperative cognitive function in elderly patients undergoing knee replacement surgery.Methods Ninety ASAⅠ-Ⅱ elderly patients aged from 65 to 79 years old with MMSE score≥ 23 who underwent knee arthroplasty surgery in our hospital from May to September in 2014 were randomly divided into edaravone group (group E, n=45) and control group (group C, n=45). Patients in group E were given edaravone accounting for 0.5 mg/kg while the same amount of sodium chloride injection in group C was given 30 min before anesthesia induction. The cognitive function of the patients was assessed preoperative, on the 1st and 5th postoperative day with the scale recommended by the international study of postoperative cognitive dysfunction. Results On the 1st postoperative day

  2. [Surgery of aortic dissection: for which patient?].

    Science.gov (United States)

    Verhoye, Jean-Philippe; Abouliatim, Issam; Larralde, Antoine; Beneux, Xavier; Heautot, Jean-François

    2011-01-01

    In the acute stage (less than two weeks), surgery is indicated for Stanford type A aortic dissections. With respect to the initial work-up, surgery consists in replacing the ascending aorta, sometimes the aortic arch (with supra aortic vessels reimplantation), and aortic valve replacement (valve replacement, Bentall valved tube or valve sparing Tyron David technique). Ischemic visceral complications must be searched for and treated by endovascular techniques or surgery. Aneurismal evolution of chronic dissections must be treated surgically. Replacement can encompass the entire aorta. Copyright © 2010. Published by Elsevier Masson SAS.

  3. Nicotine replacement therapies: patient safety and persistence

    Directory of Open Access Journals (Sweden)

    Ferguson SG

    2011-06-01

    Full Text Available Stuart G Ferguson1,2, Saul Shiffman3,4, Joseph G Gitchell51School of Pharmacy, 2Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia; 3Pinney Associates, 4University of Pittsburgh, Pittsburgh, PA, USA; 5Pinney Associates, Bethesda, MD, USAAbstract: Nicotine replacement therapy (NRT has become a central part of the treatment of nicotine dependence. However, NRT’s potential efficacy is limited to some extent by patient adherence and persistence. Here we review the relationship between NRT compliance and adherence, and overall treatment outcome. We then examine the factors that likely impact on treatment compliance and persistence, with a special focus on users’ perceptions of treatment safety and efficacy as possible mediators. Potential clinical strategies for improving suboptimal medication use are also discussed.Keywords: nicotine replacement therapy, compliance, safety

  4. Joint replacement in human immunodeficiency virus-infected patients

    Directory of Open Access Journals (Sweden)

    Ta-I Wang

    2012-11-01

    Conclusion: HIV-positive patients can have excellent outcomes after undergoing various arthroplastic surgeries. This revelation, coupled with the advances in antiviral therapy that have helped to lengthen HIV patient lifespans, strongly suggests that these patients should receive arthroplastic surgery.

  5. Who should have knee joint replacement surgery for osteoarthritis?

    DEFF Research Database (Denmark)

    Dieppe, Paul; Lim, Keith; Lohmander, Stefan

    2011-01-01

    Knee joint replacement is an effective and cost-effective intervention for severe symptomatic osteoarthritis of the knee joint. However, utilisation rates vary hugely, there are no indications, it is difficult to know when (in the course of arthritis) it is best to operate, and some 10-20% of peo......Knee joint replacement is an effective and cost-effective intervention for severe symptomatic osteoarthritis of the knee joint. However, utilisation rates vary hugely, there are no indications, it is difficult to know when (in the course of arthritis) it is best to operate, and some 10...

  6. Usefulness of Oncoplastic Volume Replacement Techniques after Breast Conserving Surgery in Small to Moderate-sized Breasts

    Directory of Open Access Journals (Sweden)

    Jung Dug Yang

    2012-09-01

    Full Text Available BackgroundIn Korean women, many of whom have small to moderate-sized breasts, it is difficult to cover a partial breast defect using oncoplastic volume displacement techniques after removal of an adequate volume of tissue during oncologic surgery. In such cases, oncoplastic volume replacement techniques are more useful.MethodsFrom January 2007 to December 2011, 104 women underwent a total of 107 breast-conserving surgeries with various kinds of oncoplastic volume replacement techniques. We used latissimus dorsi (LD myocutaneous flap for cases in which the resection mass was greater than 150 g. In case with a resection mass less than 150 g, we used regional flaps such as a lateral thoracodorsal flap, a thoracoepigastric flap, or perforator flaps such as an intercostal artery perforator (ICAP flap or a thoracodorsal artery perforator (TDAP flap.ResultsThe mean age was 46.1 years, and the average follow-up interval was 10.3 months. The patients underwent oncoplastic volume replacement techniques with a lateral thoracodorsal flap (n=9, thoracoepigastric flap (n=7, ICAP flap (n=25, TDAP flap (n=12, and LD flap (n=54. There was one case of congestion in an LD flap, and two cases of fat necrosis in an ICAP flap. Most of the patients were satisfied with the cosmetic results.ConclusionsOncoplastic volume replacement techniques can be reliable and useful for the correction of breast deformity after breast-conserving surgery, especially in patients with small to moderate-sized breasts.

  7. Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

    Directory of Open Access Journals (Sweden)

    Fernando de Azevedo Lamana

    2015-09-01

    Full Text Available AbstractObjective:To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graftvalve replacement.Methods:From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling. Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%, with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation.Results:In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns. During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns. Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001 and lower bleeding complications (P=0.006. There was no difference for thromboembolism, endocarditis, and need of reoperation.Conclusion:The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

  8. Patient discomfort following periapical surgery.

    Science.gov (United States)

    Christiansen, René; Kirkevang, Lise-Lotte; Hørsted-Bindslev, Preben; Wenzel, Ann

    2008-02-01

    The aim of the study was to assess patient discomfort following periapical surgery. Forty-two patients with apical periodontitis were allocated to apicectomy with either smoothening of the gutta-percha root filling or a retrograde root filling with mineral trioxide aggregate (MTA). Pooling all patients, VAS score for pain peaked 3 hours postoperatively (mean VAS = 29). The VAS score for swelling peaked 1 day postoperatively (mean VAS = 41). Patients' overall perception of postoperative discomfort was induced by (questions asked at the day for suture removal): Oral awareness (36 yes, 6 no); swelling (30 yes, 12 no); compromised chewing ability (18 yes, 24 no); pain (15 yes, 27 no). There was no correlation between the operating time and VAS scores for pain and swelling (r .11). Patients experienced little pain and moderate swelling after periapical surgery. Oral awareness was the most reported reason for postoperative discomfort. The operating time was not a decisive factor in relation to postoperative discomfort.

  9. Fast-track surgery for bilateral total knee replacement

    DEFF Research Database (Denmark)

    Husted, H; Troelsen, A; Otte, K S;

    2011-01-01

    Bilateral simultaneous total knee replacement (TKR) has been considered by some to be associated with increased morbidity and mortality. Our study analysed the outcome of 150 consecutive, but selected, bilateral simultaneous TKRs and compared them with that of 271 unilateral TKRs in a standardised...

  10. Current topics in the radiology of joint replacement surgery

    Energy Technology Data Exchange (ETDEWEB)

    Weissman, B.N. (Harvard Medical School, Boston, MA (USA))

    1990-09-01

    Several methods of total hip joint replacement are currently used. Radiographic appearances after cemented, bone ingrowth, press-fit, and bipolar hip prostheses are reviewed. The roles of nuclear medicine and arthrographic procedures for identifying complications are discussed. Total knee prostheses and, in particular, complications related to the patellar component are described.115 references.

  11. Does increased prehospital replacement volume lead to a poor clinical course and an increased mortality? A matched-pair analysis of 1896 patients of the Trauma Registry of the German Society for Trauma Surgery who were managed by an emergency doctor at the accident site.

    Science.gov (United States)

    Hussmann, Bjoern; Lefering, Rolf; Waydhas, Christian; Touma, Alexander; Kauther, Max D; Ruchholtz, Steffen; Lendemans, Sven

    2013-05-01

    Severe bleeding after trauma frequently leads to a poor outcome. Prehospital fluid replacement therapy is regarded as an important primary treatment option. Our study aimed to assess the influence of prehospital fluid replacement therapy on the post-traumatic course of severely injured patients in a retrospective analysis of matched pairs. The data of 51,425 patients of the Trauma Registry of the German Society for Trauma Surgery were analysed. The following patients were included: Injury Severity Score ≥ 16 points, primary admission, age ≥ 16 years, no isolated brain injury, transfusion of at least one unit of packed red blood cells (pRBC), systolic blood pressure ≥ 60 mmHg at the accident site. The patients were divided into two groups according to the following matched-pair criteria (low-volume: 0-1500 ml prehospital volume replaced; high-volume: ≥ 1501 ml prehospital volume): intubation at the accident site (yes/no), time from injury to hospital ± 10 min., means of rescue (emergency helicopter, MICU), Abbreviated Injury Scale (body regions), injury year, systolic blood pressure and age (years). All patients were managed by an emergency doctor at the accident site. A total of 948 patients in each group met the inclusion criteria. Increasing replacement volume was associated with an increased need for transfusion (pRBCs: low-volume: 7 units, high-volume: 8.3 units; ptrauma. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Patient experiences of recovery after heart valve replacement: suffering weakness, struggling to resume normality

    DEFF Research Database (Denmark)

    Berg, Selina Kikkenborg; Zwisler, Ann-Dorthe; Pedersen, Birthe D.;

    2013-01-01

    Heart valve disease is becoming a public health problem due to increasing life expectancy and new treatment methods. Patients are at risk of developing depression, anxiety or post-traumatic stress disorder after heart valve surgery. To better plan proper care, describing and understanding patients......' perception of recovery after heart valve replacement is essential. The objective was to describe the experience of recovery at home after heart valve replacement....

  13. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

    Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance....... The economic implications of alcohol abuse in surgical patients are tremendous. Interventional studies are required to reduce future increases in post-operative morbidity....

  14. Surgeons often underestimate the amount of blood loss in replacement surgeries

    Institute of Scientific and Technical Information of China (English)

    Ganesan Ganesan Ram; Perumal Suresh; Phagal Varthi Vijayaraghavan

    2014-01-01

    Objective:To assess the accuracy of the clinically estimated blood loss (EBL) when compared with the actual blood loss (ABL) in replacement surgeries.Methods:This prospective study was done in Sri Ramachandra Medical Centre from April 2011 to April 2013.Altogether 140 patients undergoing total hip replacement or total knee replacement were included with the inclusion criteria being patients with haemoglobin higher than 100 g/ml and coagulation profile within normal limits.Exclusion criteria were intake of antiplatelet drug or anti-coagulant,bleeding disorders,thrombotic episode,and haematological disorders.There were 65 men and 75 women.In this study,the consultants were free to use any clinical method to estimate the blood loss,including counting the blood-soaked mops and gauze pieces (estimating the volume of blood carded in all the mops and gauzes),measuring blood lost to suction bottles and blood in and around the operative field.The ABL was calculated based on a modification of the Gross's formula using haematocrit values.Results:In 42 of the 140 cases,the EBL exceeded the ABL.These cases had a negative difference in blood loss (or DIFF-BL<0) and were included in the overestimation group,which accounted for 30% of the study population.Of the remaining 98 cases (70%),the ABL exceeded the EBL.Therefore they were put into the underestimation group who had a positive difference in blood loss (DIFF-BL>0).We found that when the average blood loss was small,the accuracy of estimation was high.But when the average blood loss exceeded 500 ml,the accuracy rate decreased significantly.This suggested that clinical estimation is inaccurate with the increase of blood loss.Conclusion:This study has shown that using clinical estimation alone to guide blood transfusion is inadequate.In this study,70% of patients had their blood loss underestimated,proving that surgeons often underestimate blood loss in replacement surgeries.

  15. Surgeons often underestimate the amount of blood loss in replacement surgeries

    Directory of Open Access Journals (Sweden)

    Ram Ganesan Ganesan

    2014-07-01

    Full Text Available 【Abstract】Objective:To assess the accuracy of the clinically estimated blood loss (EBL when compared with the actual blood loss (ABL in replacement surgeries. Methods: This prospective study was done in Sri Ramachandra Medical Centre from April 2011 to April 2013. Altogether 140 patients undergoing total hip replacement or total knee replacement were included with the inclusion criteria being patients with haemoglobin higher than 100 g/ml and coagulation profile within normal limits. Exclusion criteria were intake of antiplatelet drug or anti-coagulant, bleeding disorders, thrombotic episode, and haematological disorders. There were 65 men and 75 women. In this study, the consultants were free to use any clinical method to estimate the blood loss, including counting the blood-soaked mops and gauze pieces (estimating the volume of blood carried in all the mops and gauzes, measuring blood lost to suction bottles and blood in and around the operative field. The ABL was calculated based on a modification of the Gross’s formula using haematocrit values. Results: In 42 of the 140 cases, the EBL exceeded the ABL. These cases had a negative difference in blood loss (or DIFF-BL<0 and were included in the overestimation group, which accounted for 30% of the study population. Of the remaining 98 cases (70%, the ABL exceeded the EBL. Therefore they were put into the underestimation group who had a positive difference in blood loss (DIFF-BL>0. We found that when the average blood loss was small, the accuracy of estimation was high. But when the average blood loss exceeded 500 ml, the accuracy rate decreased significantly. This suggested that clinical estimation is inaccurate with the increase of blood loss. Conclusion:This study has shown that using clinical estimation alone to guide blood transfusion is inadequate. In this study, 70% of patients had their blood loss underestimated, proving that surgeons often underestimate blood loss in replacement

  16. Pharmacokinetics of cefetaxime in ICU-patients treated with continuous renal replacement : A pilot study

    NARCIS (Netherlands)

    Valk-Swinkels, C.G.H.; Rijpstra, T.A.; Van Der Meer, B.J.M.; Touw, D.J.; van't Veer, N.E.

    2013-01-01

    Introduction: Data on the optimal dosage of cefotaxime (CTX) in patients receiving continuous renal replacement therapy (CRRT) is sparse and equivocal [1]. We conducted a trial investigating the concentrations of CTX in general ICU and post-cardiac surgery ICU patients who were treated with CRRT bec

  17. Effect of etomidate and propofol induction on hemodynamic and endocrine response in patients undergoing coronary artery bypass grafting/mitral valve and aortic valve replacement surgery on cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Ram Prasad Kaushal

    2015-01-01

    Full Text Available Introduction: The concerns for induction of anaesthesia in patients undergoing cardiac surgery include hemodynamic stability, attenuation of stress response and maintenance of balance between myocardial oxygen demand and supply. Various Intravenous anaesthetic agents like Thiopentone, Etomidate, Propofol, Midazolam, and Ketamine have been used for anesthetizing patients for cardiac surgeries. However, many authors have expressed concerns regarding induction with thiopentone, midazolam and ketamine. Hence, Propofol and Etomidate are preferred for induction in these patients. However, these two drugs have different characteristics. Etomidate is preferred for patients with poor left ventricular (LV function as it provides stable cardiovascular profile. But there are concerns about reduction in adrenal suppression and serum cortisol levels. Propofol, on the other hand may cause a reduction in systemic vascular resistance and subsequent hypotension. Thus, this study was conducted to compare induction with these two agents in cardiac surgeries. Methods: Baseline categorical and continuous variables were compared using Fisher′s exact test and student′s t test respectively. Hemodynamic variables were compared using student′s t test for independent samples. The primary outcome (serum cortisol and blood sugar of the study was compared using Wilcoxon Rank Sum test. The P value less than 0.05 was considered significant. Results: Etomidate provides more stable hemodynamic parameters as compared to Propofol. Propofol causes vasodilation and may result in drop of systematic BP. Etomidate can therefore be safely used for induction in patients with good LV function for CABG/MVR/AVR on CPB without serious cortisol suppression lasting more than twenty-four hours.

  18. Patient Satisfaction After Scoliosis Surgery

    Directory of Open Access Journals (Sweden)

    V. Tari

    2008-02-01

    Full Text Available Background:Patient satisfaction with the cosmetic result of spinal fusion surgery was studied in 40 cases of adolescent idiopathic scoliosis.Neutral or dissatisfied patients were compared with satisfied patients in several physical and psychological characteristics. The aim of the study was to determine whether adolescents generally report satisfaction with the postoperative appearance of their back after the correction of severe curves and whether preoperative medical and/or psychological factors could distinguish between patients who report satisfaction with the cosmetic surgical result from those who report neutrality or dissatisfaction. Previous reports emphasize the need for medical outcome research that evaluates both patient satisfaction and technical success. Patient satisfaction with spinal surgery has largely been evaluated in retrospective studies and most consistently is related to postoperative cosmesis and degree of curve correction. Methods: 40 adolescents with idiopathic scoliosis without any comorbidity who were 10 years of age or older were studied preoperatively by physical and psychological measurements. Results: Of patients undergoing surgical correction of severe curves, 50% reported satisfaction with the cosmetic result. Neutral or dissatisfied patients were more likely to have a King II or King IV curve types and less correction than satisfied patients. Preoperative psychological difficulties (P< 0.05 and unmet expectations regarding postoperative cosmesis (P<0.05 were more common among neutral or dissatisfied patients. Conclusion: Most adolescents with idiopathic scoliosis expressed satisfaction with the cosmetic surgical result. Preoperative physical characteristics, psychological difficulties, and unrealistic expectations regarding postoperative cosmesis are associated with patient neutrality or dissatisfaction.

  19. Correlation between left ventricular diastolic function before and after valve replacement surgery and myocardial ultrastructural changes in patients with left ventricular volume-overloaded valvular heart diseases; Evaluation with gated blood pool scintigraphy using [sup 99m]Tc

    Energy Technology Data Exchange (ETDEWEB)

    Okada, Tomiro (Okayama Univ. (Japan). School of Medicine)

    1993-06-01

    Left ventricular (LV) diastolic functions in 23 patients with aortic regurgitation (AR) and 22 patients with mitral regurgitation (MR) were evaluated by gated blood pool scintigraphy. LV myocardial biopsy was performed during open heart surgery, and LV myocardial ultrastructural changes were evaluated by electron microscope. Correlation between LV diastolic function and myocardial ultrastructural changes was examined. It was suggested that preoperative LV diastolic dysfunction occurred earlier than LV systolic dysfunction in patients with AR and MR. LV early diastolic dysfunction was especially significant in patients with AR. LV systolic function was significantly improved postoperatively compared with LV diastolic function in patients with AR and MR. It was suggested that LV interstitial fibrosis caused LV diastolic dysfunction in patients with AR and MR, and insufficiency of myocardial thickening as compensation in patients with MR. It was presumed that LV diastolic dysfunction was irreversible in patients with AR and MR in the distant postoperative period due to persistence of the preoperative myocardial ultrastructural change, e.g., interstitial fibrosis. These LV diastolic indices measured by gated pool scintigraphy were useful in predicting LV ultrastructural changes and postoperative LV dysfunction in patients with LV volume-overloaded valvular heart disease. (author).

  20. Time while waiting: patients' experiences of scheduled surgery.

    Science.gov (United States)

    Carr, Tracey; Teucher, Ulrich C; Casson, Alan G

    2014-12-01

    Research on patients' experiences of wait time for scheduled surgery has centered predominantly on the relative tolerability of perceived wait time and impacts on quality of life. We explored patients' experiences of time while waiting for three types of surgery with varied wait times--hip or knee replacement, shoulder surgery, and cardiac surgery. Thirty-two patients were recruited by their surgeons. We asked participants about their perceptions of time while waiting in two separate interviews. Using interpretative phenomenological analysis (IPA), we discovered connections between participant suffering, meaningfulness of time, and agency over the waiting period and the lived duration of time experience. Our findings reveal that chronological duration is not necessarily the most relevant consideration in determining the quality of waiting experience. Those findings helped us create a conceptual framework for lived wait time. We suggest that clinicians and policy makers consider the complexity of wait time experience to enhance preoperative patient care.

  1. Rituximab therapy for flare-up of rheumatoid arthritis after total knee replacement surgery.

    Science.gov (United States)

    Mirza, Rabeea; Ishaq, Saliha; Khan, Muhammad Owais; Memon, Adil

    2012-10-01

    A variety of drug types are used alone or in combination to manage Rheumatoid Arthritis along with physiotherapy. We report herein the case of a 51 year old female patient with a history of Rheumatoid Arthritis whose disease remained active despite being on routinely used multiple disease modifying antirheumatic drugs. The patient underwent bilateral total knee arthroplasty with subtotal synovectomy due to the severe pain caused by her concomitant age related osteoarthritis which was only aggravated by her active rheumatoid arthritis disease. Three months following surgery, the patient's knee pain with typical rheumatoid flare and swelling reappeared for which a B cell monoclonal antibody, rituximab, was given. Her number of tender and swollen joints reduced to less than three and her C-reactive protein levels and erythrocyte sedimentation rate reduced significantly along with considerable improvement in her Global Assessment score. Her severity of pain also decreased to 3 from an initial score of 8 on the Visual Analog Scale. Thus, Rituximab helped improve our patient's symptoms from recurrence of synovitis after total knee replacement.

  2. [Patients' decision for aesthetic surgery].

    Science.gov (United States)

    Fansa, H; Haller, S

    2011-12-01

    Aesthetic surgery is a service which entails a high degree of trust. Service evaluation prior to provision is difficult for the patient. This leads to the question of how to manage the service successfully while still focusing on the medical needs. The decision to undergo an operation is not influenced by the operation itself, but by preoperative events which induce the patient to have the operation done. According to "buying decisions" for products or in service management, the decision for an aesthetic operation is extensive; the patient is highly involved and actively searching for information using different directed sources of information. The real "buying decision" consists of 5 phases: problem recognition, gathering of information, alternative education, purchase decision, and post purchase behaviour. A retrospective survey of 40 female patients who have already undergone an aesthetic operation assessed for problem recognition, which types of information were collected prior to the appointment with the surgeon, and why the patients have had the operation at our hospital. They were also asked how many alternative surgeons they had been seen before. Most of the patients had been thinking about undergoing an operation for several years. They mainly used the web for their research and were informed by other (non-aesthetic) physicians/general practitioners. Requested information was about the aesthetic results and possible problems and complications. Patients came based on web information and because of recommendations from other physicians. 60% of all interviewees did not see another surgeon and decided to have the operation because of positive patient-doctor communication and the surgeon's good reputation. Competence was considered to be the most important quality of the surgeon. However, the attribute was judged on subjective parameters. Environment, office rooms and staff were assessed as important but not very important. Costs of surgery were ranked second

  3. Prometheus payment model: application to hip and knee replacement surgery.

    Science.gov (United States)

    Rastogi, Amita; Mohr, Beth A; Williams, Jeffery O; Soobader, Mah-Jabeen; de Brantes, Francois

    2009-10-01

    The Prometheus Payment Model offers a potential solution to the failings of the current fee-for-service system and various forms of capitation. At the core of the Prometheus model are evidence-informed case rates (ECRs), which include a bundle of typical services that are informed by evidence and/or expert opinion as well as empirical data analysis, payment based on the severity of patients, and allowances for potentially avoidable complications (PACs) and other provider-specific variations in payer costs. We outline the methods and findings of the hip and knee arthroplasty ECRs with an emphasis on PACs. Of the 2076 commercially insured patients undergoing hip arthroplasty in our study, PAC costs totaled $7.8 million (14% of total costs; n = 699 index PAC stays). Similarly, PAC costs were $12.7 million (14% of total costs; n = 897 index PAC stays) for 3403 patients undergoing knee arthroplasty. By holding the providers clinically and financially responsible for PACs, and by segmenting and quantifying the type of PACs generated during and after the procedure, the Prometheus model creates an opportunity for providers to focus on the reduction of PACs, including readmissions, making the data actionable and turn the waste related to PAC costs into potential savings.

  4. Lifetime risk of primary total hip replacement surgery for osteoarthritis from 2003-2013

    DEFF Research Database (Denmark)

    Ackerman, Ilana N; Bohensky, Megan A; de Steiger, Richard

    2017-01-01

    OBJECTIVE: To compare the lifetime risk of total hip replacement surgery (THR) for osteoarthritis (OA) between countries, and over time. METHODS: Data on primary THR procedures performed for OA in 2003 and 2013 were extracted from national arthroplasty registries in Australia, Denmark, Finland...

  5. Cardiac-surgery associated acute kidney injury requiring renal replacement therapy. A Spanish retrospective case-cohort study

    Directory of Open Access Journals (Sweden)

    Garcia-Fernandez Nuria

    2009-09-01

    Full Text Available Abstract Background Acute kidney injury is among the most serious complications after cardiac surgery and is associated with an impaired outcome. Multiple factors may concur in the development of this disease. Moreover, severe renal failure requiring renal replacement therapy (RRT presents a high mortality rate. Consequently, we studied a Spanish cohort of patients to assess the risk factors for RRT in cardiac surgery-associated acute kidney injury (CSA-AKI. Methods A retrospective case-cohort study in 24 Spanish hospitals. All cases of RRT after cardiac surgery in 2007 were matched in a crude ratio of 1:4 consecutive patients based on age, sex, treated in the same year, at the same hospital and by the same group of surgeons. Results We analyzed the data from 864 patients enrolled in 2007. In multivariate analysis, severe acute kidney injury requiring postoperative RRT was significantly associated with the following variables: lower glomerular filtration rates, less basal haemoglobin, lower left ventricular ejection fraction, diabetes, prior diuretic treatment, urgent surgery, longer aortic cross clamp times, intraoperative administration of aprotinin, and increased number of packed red blood cells (PRBC transfused. When we conducted a propensity analysis using best-matched of 137 available pairs of patients, prior diuretic treatment, longer aortic cross clamp times and number of PRBC transfused were significantly associated with CSA-AKI. Patients requiring RRT needed longer hospital stays, and suffered higher mortality rates. Conclusion Cardiac-surgery associated acute kidney injury requiring RRT is associated with worse outcomes. For this reason, modifiable risk factors should be optimised and higher risk patients for acute kidney injury should be identified before undertaking cardiac surgery.

  6. Prognosis of patients with carcinoid heart disease after valvular surgery.

    Science.gov (United States)

    Manoly, Imthiaz; McAnelly, Sarah-Louise; Sriskandarajah, Sanjeevan; McLaughlin, Kenneth Edward

    2014-08-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. We addressed the following question: in patients who are diagnosed with carcinoid heart disease (CHD), do valvular surgeries improve their prognosis? Fifty percent of the patients with clinically diagnosed carcinoid syndrome had cardiac involvement which was present either as valvular dysfunction or as cardiac metastases. These patients often require surgery due to their heightened risk of cardiac disease. Altogether 217 relevant papers were identified as a result of the below-mentioned search, of which 10 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Of the patients who were identified to have carcinoid heart disease in different studies, 193 patients had valve procedure, mainly replacements at tricuspid, mitral and aortic valve positions and either valvuloplasty or replacement at pulmonary valve. Tricuspid and pulmonary valves represented the majority of the excised valves among patients undergoing valvular surgery for CHD. The pathology of carcinoid valve was attributed to the presence of plaque, causing thickening and retraction. Pure regurgitation was the most common finding in all the valves except pulmonary valve which had both stenosis and insufficiency. Thirty-day mortality was 17% (range 1-63%) and long-term survivors were reported to be alive at an average of 58 months (28-80 months) after the valve surgery. The evidence demonstrates that surgical intervention can lead to improved prognosis and reduce the symptoms of heart failure. Postoperative mortality was mainly due to the carcinoid disease itself and not as a complication of the surgery. Therefore, surgery could be considered for symptomatic palliation in carefully selected individuals.

  7. The metabolic consequences of thyroxine replacement in adult hypopituitary patients

    DEFF Research Database (Denmark)

    Filipsson Nyström, Helena; Feldt-Rasmussen, Ulla; Kourides, Ione;

    2012-01-01

    The metabolic consequences of thyroxine replacement in patients with central hypothyroidism (CH) need to be evaluated. The aim was to examine the outcome of thyroxine replacement in CH. Adult hypopituitary patients (n = 1595) with and without CH from KIMS (Pfizer International Metabolic Database...

  8. A 6-DOF parallel bone-grinding robot for cervical disc replacement surgery.

    Science.gov (United States)

    Tian, Heqiang; Wang, Chenchen; Dang, Xiaoqing; Sun, Lining

    2017-05-24

    Artificial cervical disc replacement surgery has become an effective and main treatment method for cervical disease, which has become a more common and serious problem for people with sedentary work. To improve cervical disc replacement surgery significantly, a 6-DOF parallel bone-grinding robot is developed for cervical bone-grinding by image navigation and surgical plan. The bone-grinding robot including mechanical design and low level control is designed. The bone-grinding robot navigation is realized by optical positioning with spatial registration coordinate system defined. And a parametric robot bone-grinding plan and high level control have been developed for plane grinding for cervical top endplate and tail endplate grinding by a cylindrical grinding drill and spherical grinding for two articular surfaces of bones by a ball grinding drill. Finally, the surgical flow for a robot-assisted cervical disc replacement surgery procedure is present. The final experiments results verified the key technologies and performance of the robot-assisted surgery system concept excellently, which points out a promising clinical application with higher operability. Finally, study innovations, study limitations, and future works of this present study are discussed, and conclusions of this paper are also summarized further. This bone-grinding robot is still in the initial stage, and there are many problems to be solved from a clinical point of view. Moreover, the technique is promising and can give a good support for surgeons in future clinical work.

  9. Two-level cervical disc replacement: perspectives and patient selection

    Directory of Open Access Journals (Sweden)

    Narain AS

    2017-02-01

    Full Text Available Ankur S Narain, Fady Y Hijji, Daniel D Bohl, Kelly H Yom, Krishna T Kudaravalli, Kern Singh Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA Introduction: Cervical disc replacement (CDR is an emerging treatment option for cervical degenerative disease. Postulated benefits of cervical disc replacement compared to anterior cervical discectomy and fusion include preserved motion at the operative segments and decreased motion at adjacent levels. Multiple studies have been performed investigating the outcomes of CDR in single-level pathology. The investigation of the use of CDR in two-level pathology is an emerging topic within the literature.Purpose: To critically evaluate the literature regarding two-level CDR in order to determine its utility compared to two-level cervical arthrodesis. Patient selection factors including indications and contraindications will also be explored.Methods: The PubMed database was searched for all articles published on the subject of two-level CDR up until October 2016. Studies were classified by publication year, study design, sample size, follow-up interval, and conflict of interest. Outcomes were recorded from each study, and included data on patient-reported outcomes, radiographic measurements, range of motion, peri- and postoperative complications, heterotopic ossification, adjacent segment disease, reoperation rate, and total intervention cost. Results: Fourteen studies were included in this review. All studies demonstrated at least noninferiority of two-level CDR compared to both two-level arthrodesis and single-level CDR. Patient selection in two-level CDR is driven by the inclusion and exclusion criteria presented in prospective, randomized controlled trials. The most common indication is subaxial degenerative disc disease over two contiguous levels presenting with radiculopathy or myelopathy. Furthermore, costs analyses trended toward at least noninferiority of two

  10. In the queue for total joint replacement: patients' perspectives on waiting times. Ontario Hip and Knee Replacement Project Team.

    Science.gov (United States)

    Llewellyn-Thomas, H A; Arshinoff, R; Bell, M; Williams, J I; Naylor, C D

    1998-02-01

    We assessed patients on the waiting lists of a purposive sample of orthopaedic surgeons in Ontario, Canada, to determine patients' attitudes towards time waiting for hip or knee replacement. We focused on 148 patients who did not have a definite operative date, obtaining complete information on 124 (84%). Symptom severity was assessed with the Western Ontario/McMaster Osteoarthritis Index and a disease-specific standard gamble was used to elicit patients' overall utility for their arthritic state. Next, in a trade-off task, patients considered a hypothetical choice between a 1-month wait for a surgeon who could provide a 2% risk of post-operative mortality, or a 6-month wait for joint replacement with a 1% risk of post-operative mortality. Waiting times were then shifted systematically until the patient abandoned his/her initial choice, generating a conditional maximal acceptable wait time. Patients were divided in their attitudes, with 57% initially choosing a 6-month wait with a 1% mortality risk. The overall distribution of conditional maximum acceptable wait time scores ranged from 1 to 26 months, with a median of 7 months. Utility values were independently but weakly associated with patients' tolerance of waiting times (adjusted R-square = 0.059, P = 0.004). After splitting the sample along the median into subgroups with a relatively 'low' and 'high' tolerance for waiting, the subgroup with the apparently lower tolerance for waiting reported lower utility scores (z = 2.951; P = 0.004) and shorter times since their surgeon first advised them of the need for surgery (z = 3.014; P = 0.003). These results suggest that, in the establishment and monitoring of a queue management system for quality-of-life-enhancing surgery, patients' own perceptions of their overall symptomatic burden and ability to tolerate delayed relief should be considered along with information derived from clinical judgements and pre-weighted health status instruments.

  11. Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel M; Sørensen, Lars T

    2012-01-01

    : To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery.......: To compare surgical site infections rate in obese patients after laparoscopic surgery with open general abdominal surgery....

  12. Bacterial contamination of suction catheter tips during aortic valve replacement surgery: a prospective observational cohort study.

    Science.gov (United States)

    Larsson, Johanna; Sutherland, Sofia; Söderström, Åsa; Roman-Emanuel, Christine; Jeppsson, Anders; Olofsson, Elisabeth Hansson; Svensson, Per-Arne

    2015-01-01

    Bacterial mediastinitis is a severe complication after open heart surgery. The infection causes prolonged hospitalization and an increased mortality risk. Observations from orthopaedic surgery showed that the suction catheter used during surgery is commonly contaminated with bacteria. The aim of this study was to describe the prevalence of suction catheter contamination in cardiac surgery and to study if suction time influences the contamination risk. Fifty suction catheter tips were collected during 25 aortic valve replacement operations. The suction tip was exchanged once during the operation (after aortotomy closure). The tips were subjected to bacterial contamination analysis. In 20 of the 25 investigated cases (80%), bacterial contamination was detected on one or both tips. The tip used during the beginning of the operation showed bacterial contamination in 13/25 cases (52%) and the second tip in 12/25 (48%). In 5/25 cases (20%) both tips were contaminated. There was no association between bacterial contamination and suction time. Coagulase-negative staphylococcus was the most commonly detected microorganism. The suction device should be considered as a potential source of bacterial contamination in cardiac surgery. The results suggest that the suction catheter should be replaced before key moments like valve implantation and sternal closure.

  13. Prevention of VTE in orthopedic surgery patients

    Directory of Open Access Journals (Sweden)

    Federico Spandonaro

    2013-10-01

    Full Text Available Venous thromboembolism (VTE is defined as the obstruction, partial or complete, of one or more veins of deep circulation. It is a condition that can lead to a deterioration in his state of health until death, manifesting as deep vein thrombosis (DVT or pulmonary embolism (PE. The major orthopedic surgery and the surgical oncology are frequently associated with thromboembolic complications, because of conditions that are often critical in these patients. It is estimated that in Italy DVT has an incidence that varies between 50 and 150 new cases per 100,000 population, while the prevalence would be between 2.5 and 5%. In the absence of thromboprophylaxis, the orthopedic surgery lead to a high increased risk of VTE. In elective hip replacement, in the absence of prophylaxis, the incidence of DVT and of fatal PE is about 50% and 2% respectively. In elective knee arthroplasty the risk of venous thromboembolic complications is even higher. It is estimated that 56.2% of the costs of prophylaxis with Low Molecular Weight Heparin (LMWH in patients undergoing major orthopedic surgery are attributable to the cost of drugs (about € 200, followed (with 44.8% by the cost of administration (approximately € 159. The average total cost/day was estimated at € 8 per patient. In Italy, it has been estimated an annual cost for new cases between 215 and 260 million €. The clinical advantages of the New Oral Anticoagulants (NOA appear to be substantially clear, the major concern with regard to their reimbursement is therefore linked to the financial impact, due to the higher cost per day of the NOA compared with LMWH. To this end, it was built a model of budget impact, in the perspective of the Italian NHS, from the data related to cases of major surgical orthopedic procedures and a meta-analysis on the pivotal RCT, which aims to measure the differential effects in terms of prevention of VTE. The results show that the financial impact of the NOA in the

  14. Older adults' perceptions of pictograph-based discharge instructions after hip replacement surgery.

    Science.gov (United States)

    Choi, Jeungok

    2013-07-01

    Current text-based discharge instructions are unsuitable for low-literate older adults who have difficulty following written action-based instructions. To address this issue, we developed discharge instructions for low-literate older adults after hip replacement surgery using pictographs (i.e., simple line drawings with stick figures showing explicit care actions). The aim of this focus group study was to examine the acceptability and comprehension of these instructions to 15 low-literate older adults. Participants perceived that the pictograph-based discharge instructions helped them understand the intended health care messages, especially for step-by-step procedures of discharge actions. The black-and-white line drawings were well received by all participants of various race/ethnicity. A pictograph-based approach is an effective strategy for developing discharge instructions not only for patients with low literacy skills in acute health care settings, but also for immigrants with significant communication challenges. Future research is suggested to compare the effects of pictograph-based and text-based instructions on adherence to instructions and health outcomes.

  15. A Water Rehabilitation Program in Patients with Hip Osteoarthritis Before and After Total Hip Replacement.

    Science.gov (United States)

    Łyp, Marek; Kaczor, Ryszard; Cabak, Anna; Tederko, Piotr; Włostowska, Ewa; Stanisławska, Iwona; Szypuła, Jan; Tomaszewski, Wiesław

    2016-07-25

    BACKGROUND Pain associated with coxarthrosis, typically occurring in middle-aged and elderly patients, very commonly causes considerable limitation of motor fitness and dependence on pharmacotherapy. This article provides an assessment of a rehabilitation program with tailored water exercises in patients with osteoarthritis before and after total hip replacement. MATERIAL AND METHODS A total of 192 patients (the mean age 61.03±10.89) suffering from hip osteoarthritis (OA) were evaluated before and after total hip replacement (THR). The clinical study covered measurements of hip active ranges of motion (HAROM) and the forces generated by pelvis stabilizer muscles. Pain intensity was assessed according to analogue-visual scale of pain (VAS) and according to the Modified Laitinen Questionnaire. The patients were divided into 6 groups (4 treatment and 2 control). We compared 2 rehabilitation programs using kinesitherapy and low-frequency magnetic field. One of them also had specially designed exercises in the water. Statistical analysis was carried out at the significance level α=0.05. This was a cross-sectional study. RESULTS A positive effect of water exercises on a number of parameters was found in patients with OA both before and after total hip replacement surgery. We noted a significant reduction of pain (prehabilitation program including water exercises most significantly reduced pain in patients with OA before and after total hip replacement surgery. 2. Inclusion of water exercises in a rehabilitation program can reduce the use of medicines in patient with OA and after THR.

  16. Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

    OpenAIRE

    Kaczmarczyk, Marcin; Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-01-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discus...

  17. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review.

    Science.gov (United States)

    Ackerman, Ilana N; Bennell, Kim L

    2004-01-01

    A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.

  18. Persistently High Hip Circumference after Bariatric Surgery Is a Major Hurdle to Successful Hip Replacement

    Directory of Open Access Journals (Sweden)

    Menachem M. Meller

    2014-01-01

    Full Text Available The prevalence of class III obesity (BMI≥40 kg/m2 in black women is 18%. As class III obesity leads to hip joint deterioration, black women frequently present for orthopedic care. Weight loss associated with bariatric surgery should lead to enhanced success of hip replacements. However, we present a case of a black woman who underwent Roux-en-Y gastric bypass with the expectation that weight loss would make her a better surgical candidate for hip replacement. Her gastric bypass was successful as her BMI declined from 52.0 kg/m2 to 33.7 kg/m2. However, her hip circumference after weight loss remained persistently high. Therefore, at surgery the soft tissue tunnel geometry presented major challenges. Tunnel depth and immobility of the soft tissue interfered with retractor placement, tissue reflection, and surgical access to the acetabulum. Therefore a traditional cup placement could not be achieved. Instead, a hemiarthroplasty was performed. After surgery her pain and reliance on external support decreased. But her functional independence never improved. This case demonstrates that a lower BMI after bariatric surgery may improve the metabolic profile and decrease anesthesia risk, but the success of total hip arthroplasties remains problematic if fat mass in the operative field (i.e., high hip circumference remains high.

  19. [Bariatric surgery and patient therapeutic education].

    Science.gov (United States)

    Mével, Katell

    2015-11-01

    Weight loss surgery or "bariatric surgery", used in cases of severe obesity, is a complex procedure aiming to reduce food intake. An increasingly accessible technique, it requires a long postoperative follow-up and a change in eating habits. Patient therapeutic education encourages the patient to become a player in their care.

  20. Patient outcome and valve performance following a second aortic valve homograft replacement.

    Science.gov (United States)

    Hasnat, K; Birks, E J; Liddicoat, J; Hon, J K; Edwards, S; Glennon, S; Yacoub, M H

    1999-11-09

    Homograft valves offer many advantages; however, there is concern about their use in second aortic valve replacement because of the complexity of the procedure and the possibility of accelerated degeneration. One hundred and forty-four patients underwent a second aortic homograft replacement between 1973 and 1997 (mean follow-up 6.5+/-5 years, range 1 to 20 years). Eighty-three were male, and 61 were female, aged 17 to 77 years, mean 49.0 years. All patients had undergone previous aortic valve replacement with a homograft. The indication for reoperation was aortic regurgitation in 75 patients (52.1%), aortic stenosis in 28 (19.4%), and mixed aortic valve disease in 41 (28.5%). Root replacement was performed in 54 patients (38%) and subcoronary in 90 (62.5%). Early mortality was 3.4%. The actuarial survival rate was 93% and 82% at 5 and 10 years, respectively. Freedom from tissue degeneration was 96% and 80% at 5 and 10 years, respectively, and freedom from reoperation was 97% and 82% at 5 and 10 years, respectively. This study shows that a second aortic valve homograft replacement results in good early and long-term survival. Accelerated degeneration does not occur. Left ventricular performance is improved, and earlier surgery could further improve outcome, indicating that an aortic homograft is a safe, durable option for patients requiring a second aortic valve replacement.

  1. Evaluation of adrenal function and hormone replacement in patients with pituitary adenoma after surgery%垂体瘤患者术后肾上腺功能与激素替代的评估

    Institute of Scientific and Technical Information of China (English)

    王琳; 李强

    2016-01-01

    Objective Surgical treatment is the first choice for treatment in pituitary adenomas except for prolactinomas�In part of patients after operation would occur hypopituitarism,which with acute adrenal crisis is the most serious, and chronic adrenal insufficiency is different degree affects the patient's quality of life�Therefore,it is very important to accurately assess the hypothalamic pituitary adrenal( HPA) axis in patients with pituitary adenoma�But there is still a lack of reliable methods for evaluating adrenal axis�We reviewed the harm of adrenal insufficiency,HPA axis evaluation method of the new progress and postoperative glucocorticoid replacement treatment of new ideas, cleared the importance of reassessment and regular follow⁃up and the development of individual programs.%手术是除泌乳素瘤外的垂体瘤的首选治疗方案,部分患者在术后可发生垂体功能减退,其中以急性肾上腺危象最为严重,而慢性肾上腺功能低下则不同程度的影响着患者的生活质量,因此术后对下丘脑⁃垂体⁃肾上腺( HPA)轴进行准确的评估对垂体瘤术后患者的合理治疗显得至关重要,但目前尚缺乏对肾上腺轴进行评估的可靠方法。本文综述了肾上腺功能低下的危害、HPA轴评估方法的新进展以及术后糖皮质激素替代治疗的新观念,明确了术后重新评估和定期随访以及制定个体化方案的重要性。

  2. A new model to predict acute kidney injury requiring renal replacement therapy after cardiac surgery

    Science.gov (United States)

    Pannu, Neesh; Graham, Michelle; Klarenbach, Scott; Meyer, Steven; Kieser, Teresa; Hemmelgarn, Brenda; Ye, Feng; James, Matthew

    2016-01-01

    Background: Acute kidney injury after cardiac surgery is associated with adverse in-hospital and long-term outcomes. Novel risk factors for acute kidney injury have been identified, but it is unknown whether their incorporation into risk models substantially improves prediction of postoperative acute kidney injury requiring renal replacement therapy. Methods: We developed and validated a risk prediction model for acute kidney injury requiring renal replacement therapy within 14 days after cardiac surgery. We used demographic, and preoperative clinical and laboratory data from 2 independent cohorts of adults who underwent cardiac surgery (excluding transplantation) between Jan. 1, 2004, and Mar. 31, 2009. We developed the risk prediction model using multivariable logistic regression and compared it with existing models based on the C statistic, Hosmer–Lemeshow goodness-of-fit test and Net Reclassification Improvement index. Results: We identified 8 independent predictors of acute kidney injury requiring renal replacement therapy in the derivation model (adjusted odds ratio, 95% confidence interval [CI]): congestive heart failure (3.03, 2.00–4.58), Canadian Cardiovascular Society angina class III or higher (1.66, 1.15–2.40), diabetes mellitus (1.61, 1.12–2.31), baseline estimated glomerular filtration rate (0.96, 0.95–0.97), increasing hemoglobin concentration (0.85, 0.77–0.93), proteinuria (1.65, 1.07–2.54), coronary artery bypass graft (CABG) plus valve surgery (v. CABG only, 1.25, 0.64–2.43), other cardiac procedure (v. CABG only, 3.11, 2.12–4.58) and emergent status for surgery booking (4.63, 2.61–8.21). The 8-variable risk prediction model had excellent performance characteristics in the validation cohort (C statistic 0.83, 95% CI 0.79–0.86). The net reclassification improvement with the prediction model was 13.9% (p < 0.001) compared with the best existing risk prediction model (Cleveland Clinic Score). Interpretation: We have developed

  3. 静脉铁剂与促红细胞生成素治疗髋关节置换术前贫血患者的效果观察%Effect observation of intravenous iron and erythropoietin in anemia patients before hip replacement surgery

    Institute of Scientific and Technical Information of China (English)

    夏乐强; 刘树平; 王瑛; 张先杰

    2016-01-01

    目的::观察静脉铁剂与促红细胞生成素治疗髋关节置换术前贫血患者的临床效果。方法:选择行髋关节置换术伴缺铁性贫血( ASAⅠ~Ⅲ级)患者100例,男性Hb<120 g/L,女性<110 g/L;其中,男性58例,女性42例。将患者分为研究组和对照组,每组各50例。研究组患者术前2周至术后1周皮下注射促红细胞生成素100 IU/kg,每周3次;并静脉输注蔗糖铁200 mg,每周2次。对照组患者未注射静脉铁剂与促红细胞生成素。术前和术后,检测两组患者的血红蛋白( Hb)和红细胞压积( Hct),并比较两组患者贫血治疗的效果,异体输血及恢复情况。结果:术前、术后1 d、术后1周和2周,研究组患者的Hb和Hct均高于对照组,两组患者的术中失血量无明显差异;研究组患者的异体输血率、输血量、发热、肺部感染等并发症均低于对照组(P<0.05)。结论:髋关节置换术前贫血患者予以静脉铁剂与促红素治疗有利于提高其围术期血红蛋白,减少异体输血,降低发热及肺部感染发生率。%Objective:To evaluate clinical effects of intravenous iron and erythropoietin ( EPO) in anemia patients before hip replacement surgery. Methods:100 cases ( male 58 cases, female 42 cases) scheduled for elective hip replacement surgery and com-bined with iron-deficiency anemia (ASA I-III, male Hb<120g and female Hb<110g) were selected and divided into study group (n=50) and control group (n=50). The study group was subcutaneously injected with EPO 100U/Kg from 2 weeks before the surgery and 1 week after the surgery at 3 times a week, and intravenously injected with iron sucrose 200 mg at times a week, while the control group did not receive any treatments. The hemoglobin ( Hb) and hematocrit ( Hct) levels of the two groups before and after the surgery were determined. The treatment effects of anemia as well as allogenetic blood transfusion and recovery conditions of the two groups were

  4. Knee Replacement for Women with Patient-Specific Instructions

    Medline Plus

    Full Text Available Knee Replacement for Women with Patient-Specific Instructions Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. All rights reserved.

  5. Knee Replacement for Women with Patient-Specific Instructions

    Medline Plus

    Full Text Available Knee Replacement for Women with Patient-Specific Instructions Click Here to view the BroadcastMed, Inc. Privacy Policy and Legal Notice © 2017 BroadcastMed, Inc. All rights reserved.

  6. Repeat Minimally Invasive Mitral Valve Replacement for Recurrent Mitral Stenosis after OMC in Patients Who Decline Blood Product Transfusion for Religious Reasons.

    Science.gov (United States)

    Ito, Yujiro; Nakamura, Yoshitsugu; Tagusari, Osamu; Yoshida, Shigehiko

    2015-01-01

    Cardiac surgery for Jehovah's Witness (JW) patients is considered to be high risk because of patients' refusal to receive blood transfusion. We report a successful mitral valve replacement for recurrent mitral stenosis after OMC with minimally invasive right thoracotomy, without any transfusion of allogeneic blood or blood products. This minimally invasive mitral valve replacement through right thoracotomy was an excellent approach for JW patients.

  7. Balloon aortic valvuloplasty as a bridge to aortic valve replacement in a patient with severe calcific aortic stenosis.

    Science.gov (United States)

    Swinkels, B M; Jaarsma, W; Wely, L Relik-van; van Swieten, H A; Ernst, J M P G; Plokker, H W M

    2003-03-01

    This case report describes a patient with severe calcific aortic stenosis who was initially considered inoperable because of a very poor left ventricular function and severe pulmonary hypertension. After balloon aortic valvuloplasty, the clinical and haemodynamic status of the patient improved to such an extent that subsequent aortic valve replacement was considered possible and eventually proved to be successful. Balloon aortic valvuloplasty has value as a potential bridge to aortic valve replacement when the risks for surgery are considered to be too high.

  8. [Oral anticoagulation after major hip or knee replacement surgery: a process-driven managerial pharmacoeconomic analysis in German hospitals].

    Science.gov (United States)

    Wilke, T; Neumann, K; Klapper, U; Messer, I; Werner, A; Seidel, U; Röleke, D

    2008-05-01

    The thrombin inhibitor dabigatranetexilat is used for prophylaxis of venous thromboembolism after total hip or knee replacement surgery (THR/TKR). Patients can take it orally in hospitals. In a managerial pharmacoeconomic analysis of six German acute-care hospitals and six German rehabilitation hospitals, the use of dabigatranetexilat was compared with the use of low-molecular-weight heparins. The analysis showed that the new drug led to an economic advantage for an acute-care hospital of 2.43 euro per patient per day. In a rehabilitation hospital, the use of dabigatranetexilat led to an economic advantage of 1.40 euro per patient per day. These results have direct implications for drug decisions in hospitals. To demonstrate that fact, the price difference between dabigatranetexilat and low-molecular-weight heparins was derived to lead exactly to their"economic neutrality" from the hospital's point of view.

  9. Persistent Compromised Hemodynamic Function, due to single ventricular epicardial pacing, after aortic valve replacement surgery: A Case Report

    Directory of Open Access Journals (Sweden)

    Konstantinos Giakoumidakis

    2017-07-01

    Full Text Available We report the case of a 69-year old woman, who was admitted to the cardiac surgery intensive care unit (ICU of a tertiary hospital, after surgical aortic valve replacement, due to severe aortic stenosis. During the early postoperative period, the patient was hemodynamically stable and her cardiac rhythm was supported by temporary epicardial ventricular pacing. One hour after her ICU admission, the woman presented compromised hemodynamics, characterized by severe hypotension with poor response to aggressive inotropic, vasopressor and fluid therapy. After 15 minutes of her significant clinical worsening, the change of the pacing mode from single ventricular to single atrial effected immediate hemodynamic stabilization, improved arterial blood pressure and optimum patient cardiovascular function. This could be explained by the significantly reduced cardiac output in the absence of atrial contraction to assist ventricular preloading, which characterized some patients with impaired ventricular function, as those with severe aortic stenosis.

  10. Full Scale 3D Preoperative Planning System of the Ankle Joint Replacement Surgery with Multimedia System

    Directory of Open Access Journals (Sweden)

    Shuh-Ping Sun

    2014-05-01

    Full Text Available This study is intended to develop a computer-aided pre-surgical planning and simulating system in a multimedia environment for ankle joint replacement surgery. This system uses full-scale 3D reverse engineering techniques in design and development of the pre-surgical planning modules for ankle joint replacement surgery. This planning system not only develops the real-scale 3D image of the artificial ankle joint but also provides a detailed interior measurement of the ankle joint from various cutting planes. In this study, we apply the multimedia user interface to integrate different software functions into a surgical planning system with integrated functions. The functions include 3D model image acquisition, cutting, horizontal shifting and rotation of related bones (tibia and talus of the ankle joint in the predetermined time. For related bones of the ankle joint, it can also be used to design artificial ankle joints for adults in Taiwan. Those planning procedures can be recorded in this system for further research and investigation. Furthermore, since this system is a multimedia user interface, surgeons can use this system to plan and find a better and more efficient surgical approach before surgery. A database is available for this system to update and expand, which can provide different users with clinical cases as per their experience and learning.

  11. Continuous Renal Replacement Therapy and Extracorporeal Membrane Oxygenation in Cardias Surgery

    Directory of Open Access Journals (Sweden)

    S. V. Kolesnikov

    2014-01-01

    Full Text Available Objective: to analyze the combined use of extracorporeal membrane oxygenation (ECMO and continuous renal replacement therapy with switching into the ECMO circuit in cardiac surgical patients over 18 years of age and to reveal predictors of a fatal outcome in this combination of auxiliary organ support techniques. Materials and methods. The retrospective cohort study postoperatively used a combination of ECMO and continuous renal replacement therapy in 27 cardiac surgical patients aged over 18 years with severe cardiopulmonary insufficiency concurrent with acute kidney lesion. In all cases, the continuous renal replacement therapy circuit was switched into the line after an ECMO pump. The end points of the study were the duration of dialysis-dependent acute renal failure, the frequency of complications, and hospital mortality. Results. In all cases with a favorable outcome, the duration of continuous renal replacement therapy was 3 days longer than that of ECMO. There were no cases of recovery if the duration of continuous renal replacement therapy was shorter than that of ECMO and the duration of the latter was more than 10 days. The duration of sympathomimetic support (>3.5 days was shown to be an independent and significant predictor of death (AUC 0.99; CI 99.9%, 0.96—1.0 in the patients receiving continuous renal replacement therapy and ECMO. It was established that the number of inotrophic drugs (>2 and the highest lactate level (>1.99 mmol/l could be used to predict hospital mortality in patients with acute kidney injury and severe cardiopulmonary insufficiency (AUC 0.85 and 0.86; sensitivity/specificity 0.83/0.67 and 0.86/0.67, respectively.Conclusion. The concurrent use of ECMO and continuous renal replacement therapy in severe cardiac surgical patients with potentially reversible cardiopulmonary insufficiency and acute kidney injury is a sound and complementary combination of auxiliary organ support techniques.  

  12. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

    Alcohol abusers have a threefold increased risk of post-operative morbidity after surgery. The most frequent complications are infections, cardiopulmonary insufficiency, and bleeding episodes. Pathogenesis is suppressed immune capacity, subclinical cardiac dysfunction, and haemostatic imbalance...

  13. The Result of the Rehabilitation for the Patients With Total Hip Replacement

    OpenAIRE

    Aykurt, Bilge; Abbasoglu, M. Adnan

    2004-01-01

    A rehabilitation program was applied for the patients with total hip replacement operated in the Clinics of Orthopaedic Surgery and Travmatology at the School of Medicine, Atatürk University. We evaluated 14 cases subsequent to preoperative and postoperative rehabilitation program. We obtained the followng results: 5 cases (%36,0) were excellent, 8 (%57.0 ) good and 1 (%7.0) moderate. The rehabilitation program together with consequents were compared with the literatures.

  14. Hospital Discharge Information After Elective Total hip or knee Joint Replacement Surgery: A clinical Audit of preferences among general practitioners

    Directory of Open Access Journals (Sweden)

    Andrew M Briggs

    2012-05-01

    Full Text Available AbstractThe demand for elective joint replacement (EJR surgery for degenerative joint disease continues to rise in Australia, and relative to earlier practices, patients are discharged back to the care of their general practitioner (GP and other community-based providers after a shorter hospital stay and potentially greater post-operative acuity. In order to coordinate safe and effective post-operative care, GPs rely on accurate, timely and clinically-informative information from hospitals when their patients are discharged. The aim of this project was to undertake an audit with GPs regarding their preferences about the components of information provided in discharge summaries for patients undergoing EJR surgery for the hip or knee. GPs in a defined catchment area were invited to respond to an online audit instrument, developed by an interdisciplinary group of clinicians with knowledge of orthopaedic surgery practices. The 15-item instrument required respondents to rank the importance of components of discharge information developed by the clinician working group, using a three-point rating scale. Fifty-three GPs and nine GP registrars responded to the audit invitation (11.0% response rate. All discharge information options were ranked as ‘essential’ by a proportion of respondents, ranging from 14.8–88.5%. Essential information requested by the respondents included early post-operative actions required by the GP, medications prescribed, post-operative complications encountered and noting of any allergies. Non-essential information related to the prosthesis used. The provision of clinical guidelines was largely rated as ‘useful’ information (47.5–56.7%. GPs require a range of clinical information to safely and effectively care for their patients after discharge from hospital for EJR surgery. Implementation of changes to processes used to create discharge summaries will require engagement and collaboration between clinical staff

  15. Good outcome of total hip replacement in patients with cerebral palsy

    Science.gov (United States)

    King, Garry; Hunt, Linda P; Wilkinson, J Mark; Blom, Ashley W

    2016-01-01

    Background and purpose — People with cerebral palsy (CP) often have painful deformed hips, but they are seldom treated with hip replacement as the surgery is considered to be high risk. However, few data are available on the outcome of hip replacement in these patients. Patients and methods — We linked Hospital Episode Statistics (HES) records to the National Joint Registry for England and Wales to identify 389 patients with CP who had undergone hip replacement. Their treatment and outcomes were compared with those of 425,813 patients who did not have CP. Kaplan-Meier estimates were calculated to describe implant survivorship and the curves were compared using log-rank tests, with further stratification for age and implant type. Reasons for revision were quantified as patient-time incidence rates (PTIRs). Nationally collected patient-reported outcomes (PROMS) before and 6 months after operation were compared if available. Cumulative mortality (Kaplan-Meier) was estimated at 90 days and at 1, 3, and 5 years. Results — The cumulative probability of revision at 5 years post-surgery was 6.4% (95% CI: 3.8–11) in the CP cohort as opposed to 2.9% (CI 2.9–3%) in the non-CP cohort (p < 0.001). Patient-reported outcomes showed that CP patients had worse pain and function preoperatively, but had equivalent postoperative improvement. The median improvement in Oxford hip score at 6 months was 23 (IQR: 14–28) in CP and it was 21 (14–28) in non-CP patients. 91% of CP patients reported good or excellent satisfaction with their outcome. The cumulative probability of mortality for CP up to 7 years was similar to that in the controls after stratification for age and sex. Interpretation — Hip replacement for cerebral palsy appears to be safe and effective, although implant revision rates are higher than those in patients without cerebral palsy. PMID:26863583

  16. Methods of patient warming during abdominal surgery.

    Directory of Open Access Journals (Sweden)

    Li Shao

    Full Text Available BACKGROUND: Keeping abdominal surgery patients warm is common and warming methods are needed in power outages during natural disasters. We aimed to evaluate the efficacy of low-cost, low-power warming methods for maintaining normothermia in abdominal surgery patients. METHODS: Patients (n = 160 scheduled for elective abdominal surgery were included in this prospective clinical study. Five warming methods were applied: heated blood transfusion/fluid infusion vs. unheated; wrapping patients vs. not wrapping; applying moist dressings, heated or not; surgical field rinse heated or not; and applying heating blankets or not. Patients' nasopharyngeal and rectal temperatures were recorded to evaluate warming efficacy. Significant differences were found in mean temperatures of warmed patients compared to those not warmed. RESULTS: When we compared temperatures of abdominal surgery patient groups receiving three specific warming methods with temperatures of control groups not receiving these methods, significant differences were revealed in temperatures maintained during the surgeries between the warmed groups and controls. DISCUSSION: The value of maintaining normothermia in patients undergoing abdominal surgery under general anesthesia is accepted. Three effective economical and practically applicable warming methods are combined body wrapping and heating blanket; combined body wrapping, heated moist dressings, and heating blanket; combined body wrapping, heated moist dressings, and warmed surgical rinse fluid, with or without heating blanket. These methods are practically applicable when low-cost method is indeed needed.

  17. Health-related quality of life in patients waiting for major joint replacement. A comparison between patients and population controls

    Directory of Open Access Journals (Sweden)

    Seitsalo Seppo

    2006-01-01

    Full Text Available Abstract Background Several quality-of-life studies in patients awaiting major joint replacement have focused on the outcomes of surgery. Interest in examining patients on the elective waiting list has increased since the beginning of 2000. We assessed health-related quality of life (HRQoL in patients waiting for total hip (THR or knee (TKR replacement in three Finnish hospitals, and compared patients' HRQoL with that of population controls. Methods A total of 133 patients awaiting major joint replacement due to osteoarthritis (OA of the hip or knee joint were prospectively followed from the time the patient was placed on the waiting list to hospital admission. A sample of controls matched by age, gender, housing and home municipality was drawn from the computerised population register. HRQoL was measured by the generic 15D instrument. Differences between patients and the population controls were tested by the independent samples t-test and between the measurement points by the paired samples t-test. A linear regression model was used to explain the variance in the 15D score at admission. Results At baseline, 15D scores were significantly different between patients and the population controls. Compared with the population controls, patients were worse off on the dimensions of moving (P Conclusion Although patients' HRQoL did not deteriorate while waiting, a consistently worse HRQoL was observed in patients waiting for major joint replacement compared with population controls.

  18. Minimally invasive aortic valve replacement - pros and cons of keyhole aortic surgery.

    Science.gov (United States)

    Kaczmarczyk, Marcin; Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-06-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures.

  19. Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery

    Science.gov (United States)

    Szałański, Przemysław; Zembala, Michał; Filipiak, Krzysztof; Karolak, Wojciech; Wojarski, Jacek; Garbacz, Marcin; Kaczmarczyk, Aleksandra; Kwiecień, Anna; Zembala, Marian

    2015-01-01

    Over the last twenty years, minimally invasive aortic valve replacement (MIAVR) has evolved into a safe, well-tolerated and efficient surgical treatment option for aortic valve disease. It has been shown to reduce postoperative morbidity, providing faster recovery and rehabilitation, shorter hospital stay and better cosmetic results compared with conventional surgery. A variety of minimally invasive accesses have been developed and utilized to date. This concise review demonstrates and discusses surgical techniques used in contemporary approaches to MIAVR and presents the most important results of MIAVR procedures. PMID:26336491

  20. The impact of anaemia and intravenous iron replacement therapy on outcomes in cardiac surgery.

    Science.gov (United States)

    Hogan, Maurice; Klein, Andrew A; Richards, Toby

    2015-02-01

    Anaemia is common in patients with cardiac disease and also in those undergoing cardiac surgery. There is increasing evidence that preoperative anaemia is associated with increased patient morbidity and mortality following surgery. We performed a systematic literature review to assess the impact of anaemia and intravenous (IV) iron supplementation on outcomes in cardiac surgery. Sixteen studies examined preoperative anaemia in detail. One study examined the role of preoperative IV iron administration and a further three, the effect of postoperative iron supplementation on haemoglobin (Hb) levels and the need for transfusion. Preoperative anaemia was associated with higher mortality, more postoperative blood transfusions, longer intensive care unit (ICU) and total hospital stay and also a greater incidence of postoperative cardiovascular events. In the single study that examined preoperative IV iron in combination with erythropoietin treatment, there was decreased blood transfusion, shorter hospital stay and an increase in patient survival. However, this was a small retrospective cohort study, with the observation and treatment groups analysed over different time periods. Postoperative administration of IV iron therapy, either alone or in combination with erythropoietin, was not effective in raising Hb levels or reducing red cell concentrate transfusion. On the basis of currently available evidence, the effect of perioperative administration of IV iron to cardiac surgery patients, alone or in combination with erythropoietin, remains unproven. Well-designed and appropriately powered prospective randomized controlled trials are needed to evaluate perioperative iron supplementation in the context of cardiac surgery.

  1. Replacement

    Directory of Open Access Journals (Sweden)

    S. Radhakrishnan

    2014-03-01

    Full Text Available The fishmeal replaced with Spirulina platensis, Chlorella vulgaris and Azolla pinnata and the formulated diet fed to Macrobrachium rosenbergii postlarvae to assess the enhancement ability of non-enzymatic antioxidants (vitamin C and E, enzymatic antioxidants (superoxide dismutase (SOD and catalase (CAT and lipid peroxidation (LPx were analysed. In the present study, the S. platensis, C. vulgaris and A. pinnata inclusion diet fed groups had significant (P < 0.05 improvement in the levels of vitamins C and E in the hepatopancreas and muscle tissue. Among all the diets, the replacement materials in 50% incorporated feed fed groups showed better performance when compared with the control group in non-enzymatic antioxidant activity. The 50% fishmeal replacement (best performance diet fed groups taken for enzymatic antioxidant study, in SOD, CAT and LPx showed no significant increases when compared with the control group. Hence, the present results revealed that the formulated feed enhanced the vitamins C and E, the result of decreased level of enzymatic antioxidants (SOD, CAT and LPx revealed that these feeds are non-toxic and do not produce any stress to postlarvae. These ingredients can be used as an alternative protein source for sustainable Macrobrachium culture.

  2. Hospital costs and clinical characteristics of continuous renal replacement therapy patients: a continuous ethical dilemma.

    Science.gov (United States)

    Coustasse, Alberto

    2008-01-01

    This study describes the clinical characteristics and examines hospital costs involved in the care of 117 patients undergoing Continuous Renal Replacement Therapy (CRRT) between January 1999 and August 2002. The majority (70.9%) of the patients undergoing CRRT expired in the hospital. Statistically significant differences were found with respect to the length of stay for discharge status and gender; and with respect to costs for surgery versus no surgery and gender. Significant differences were also found between discharge status and gender, age, and cardiovascular surgery. The results of this study raise economic and ethical questions related to the cost/benefit of CRRT and the futility of the treatment. Hospitals should ensure that they have utilization protocols in place for CRRT, promote cooperation between intensive care unit (ICU) physicians and nephrologists, and create multi-disciplinary CRRT teams in an effort to maximize the effectiveness of therapy and minimize costs.

  3. Atrioventricular valve replacement in functional single-ventricle patients

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhong; CEN Jian-zheng; XU Gang; WEN Shu-sheng; CHEN Ji-mei

    2016-01-01

    Background This article summarized the experience of atrioventricular valve replacement operation for functional single ventricle patients whose atrioventricular valve was insufficiency.The follow-up time of operation was arranged from early-to medium-term.Methods From July 2009 to July 2015,there were 40 patients of functional single ventricle receiving the operation of atrioventricular valve replacement,including 23 male and 17 female patients.The age at A-Ⅴ valve replacement was ranged from 6 days to 32 years (the medium age of 9 years),and the body weight ranged from 2.7 to 57 kg (the medium body weight of 21.5 kg).Moreover,the atrioventricular valve replacement was performed on all patients under extracorporeal circulation.Results Atrioventricular valve replacement was performed on 40 patients with function single ventricle in hospital,of which eight (20.0%) died in hospital including two neonate and infant (age range:6 days-2 years old) accounting for 25% (2/8),Among them,seven patients died of low cardiac output syndrome two patients with repeated hypoxemia concurrent infection after operation,and one with bilateral diaphragmatic paralysis and malignant arrhythmia.For the patients suffering the severe perivalvular leakage,there was a reoperation,and the cardiac function before the first operation was class Ⅳ.One patient received heart transplantation finally for severe heart failure after AV valve replacement.For the rest of patients,their cardiac function recovered to class Ⅰ-Ⅱ after operation.Conclusions For function single ventricle patients with atrioventricular valve regurgitation,the mortality rate of atrioventricular valve replacement can be accepted if the operation was indicated.For patients with severe atrioventricular value regurgitation,the result of the operation in the early and medium term was satisfying.Thus,the atrioventricular valve replacement served as a useful treatment for patients diagnosed of A-Ⅴ valve regurgitation and

  4. Aspirin in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  5. The effect of transitional care on the anticoagulant therapy compliance among discharged patients undergoing cardiac valve replacement surgery%延续护理对提高心脏瓣膜置换术出院患者抗凝治疗依从性的研究

    Institute of Scientific and Technical Information of China (English)

    李彬; 多伶俐; 于游游; 王金星; 刘静

    2014-01-01

    Objective:To explore the effect of transitional care on the anticoagulant therapy compliance among discharged patients undergoing valve replacement surgery. Methods:We recruited 121 patients undergoing cardiac valve replacement surgery in the cardiothoracic surgery department of our hospital from May 2010 to May 2013, and divided them into control group (n=61) and experimental group (n=60), respectively, according to their discharge order. All of the patients received routine discharge guidance. The control group adopted routine outpatient follow-up and recheck, and the experimental group received a telephone follow-up of speciifc disease and related health education, and received short messages about disease knowledge and medication reminders through short message platform provided by full-time nurse. We compared the anticoagulation knowledge, the anticoagulant therapy compliance, and the complications caused by improper anticoagulation between the two groups 3 months, 6 months, and 12 months after discharge by questionnaire. Results:There were signiifcant differences in each of the evaluation index between the two groups 3 months, 6 months, and 12 months after discharge (P<0.05). Conclusions:Transitional care interventions among discharged patients with cardiac valve replacement surgery could meet their health needs, improve the anticoagulant therapy compliance, and reduce the incidence of complications caused by improper anticoagulation.%目的:探讨延续护理对心脏瓣膜置换术出院患者抗凝治疗依从性的影响。方法:选取2010年5月至2013年5月在我院胸心外科行心脏瓣膜置换手术的患者121例,按患者出院先后顺序分为对照组60例与实验组61例,两组患者出院前均进行心脏瓣膜置换术后常规出院指导,出院后对照组采取常规门诊随访和复查,实验组由专职护士实施系统的电话专病随访和健康教育,同时利用短信平台向患者发送疾病知识、服药

  6. Physical activity in the elderly who underwent joint replacement surgery in the course of rheumatic diseases

    Science.gov (United States)

    Komorowski, Arkadiusz; Przepióra, Wiktor; Księżopolska-Orłowska, Krystyna

    2016-01-01

    According to the forecasts of the Central Statistical Office of Poland, in 2030 people at the age of 65 and older will account for 23.8%, i.e. their number will amount to approx. 8.5 m people. Geriatric rheumatic patients more often decide to undergo surgical joint replacement. According to the National Health Fund, the number of joint replacement services provided in 2014 increased by 93%, as compared to 2005. Improving the physical performance of this constantly expanding group of patients requires taking into account many factors to raise their functional status, reduce the risk of falling, teach rules of proper functioning with an artificial joint and encourage unassisted physical activity. Restoring fitness and independence is a difficult but necessary task due to an increasing number of seniors with replaced joint. PMID:27504021

  7. Physical activity in the elderly who underwent joint replacement surgery in the course of rheumatic diseases.

    Science.gov (United States)

    Prusinowska, Agnieszka; Komorowski, Arkadiusz; Przepióra, Wiktor; Księżopolska-Orłowska, Krystyna

    2016-01-01

    According to the forecasts of the Central Statistical Office of Poland, in 2030 people at the age of 65 and older will account for 23.8%, i.e. their number will amount to approx. 8.5 m people. Geriatric rheumatic patients more often decide to undergo surgical joint replacement. According to the National Health Fund, the number of joint replacement services provided in 2014 increased by 93%, as compared to 2005. Improving the physical performance of this constantly expanding group of patients requires taking into account many factors to raise their functional status, reduce the risk of falling, teach rules of proper functioning with an artificial joint and encourage unassisted physical activity. Restoring fitness and independence is a difficult but necessary task due to an increasing number of seniors with replaced joint.

  8. Thoracocentesis in cardiac surgery patients.

    Science.gov (United States)

    Wickbom, Anders; Cha, Soon Ok; Ahlsson, Anders

    2015-01-01

    Pleural effusion following cardiac surgery is a common complication that sometimes requires invasive treatment. Conventional methods for evacuation include needle aspiration and chest tube insertion. We present an effective, easy and potentially time-saving method of thoracocentesis, using a single-lumen central venous catheter.

  9. Dual antiplatelet treatment in patients candidates for abdominal surgery.

    Science.gov (United States)

    Illuminati, Giulio; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

    2013-01-01

    With the increasing diffusion of percutaneous interventions (PCI), surgeons are often faced with the problem of operating on patients under dual antiplatelet treatment. Replacing dual antiplatelet regiment with low molecular weight heparin may expose to the abrupt thrombosis of coronary stent and massive myocardial infarction. The purpose of this study was to test the hypothesis that abdominal operations can be safely performed under dual antiplatelet treatment. Eleven patients underwent 5 colectomies, 3 nefrectomies, 2 gastrectomies and 1 hysterectomy under aspirin and plavix without any significant perioperative hemorrhage. These preliminary results show that abdominal operations can be safely performed under dual antiplatelet regimen. Abdominal surgery, Dual antiplatelet treatment.

  10. Patient with von Willebrand Disease for Gynaecologic Surgery - Perianaesthetic Concerns

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2008-01-01

    Patients with vWD do not carry an increased operative risk during elective procedures if appropriate prophylac-tic and corrective therapy is administered. Although the administration of cryoprecipitate and other blood products has traditionally been the cornerstone of treatment for vWD, the recent development of desmopressin(DDAVP for clinical use may provide an effective alternative to replacement therapy with blood products. Further laparaoscopic procedures, taking care during ryle′s tube and foley′s catheter insertion, in such patients are the safer alternative for all kind of gynecologic surgeries.

  11. Fistuloclysis can successfully replace parenteral feeding in the nutritional support of patients with enterocutaneous fistula.

    Science.gov (United States)

    Teubner, A; Morrison, K; Ravishankar, H R; Anderson, I D; Scott, N A; Carlson, G L

    2004-05-01

    Use of total parenteral nutrition (TPN) in patients with acute intestinal failure due to enteric fistulation might be avoided if a simpler means of nutritional support was available. The aim of this study was to determine whether feeding via an intestinal fistula (fistuloclysis) would obviate the need for TPN. Fistuloclysis was attempted in 12 patients with jejunocutaneous or ileocutaneous fistulas with mucocutaneous continuity. Feeding was achieved by inserting a gastrostomy feeding tube into the intestine distal to the fistula. Infusion of enteral feed was increased in a stepwise manner, without reinfusion of chyme, until predicted nutritional requirements could be met by a combination of fistuloclysis and regular diet, following which TPN was withdrawn. Energy requirements and nutritional status were assessed before starting fistuloclysis and at the time of reconstructive surgery. Fistuloclysis replaced TPN entirely in 11 of 12 patients. Nutritional status was maintained for a median of 155 (range 19-422) days until reconstructive surgery could be safely undertaken in nine patients. Two patients who did not undergo surgery remained nutritionally stable over at least 9 months. TPN had to be recommenced in one patient. There were no complications associated with fistuloclysis. Fistuloclysis appears to provide effective nutritional support in selected patients with enterocutaneous fistula. Copyright 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

  12. Effect of intraoperative care on deep vein thrombosis in patients under-went hip-joint replacement surgery%术中护理对髋关节置换手术患者下肢深静脉血栓形成的影响

    Institute of Scientific and Technical Information of China (English)

    钟敏兰; 向福胜

    2015-01-01

    目的:探讨术中护理对髋关节置换手术患者下肢深静脉血栓形成的影响。方法选择2013年6月~2014年12月湖北省鄂州市中心医院收治的157例髋关节置换手术患者,按住院号单双分为观察组83例,对照组74例。对照组采用常规术中护理,观察组采用改进术中护理。比较两组手术前后血液流变学和凝血功能变化及下肢深静脉血栓形成情况。结果观察组出血量、术中输血量明显少于对照组(P0.05). In the control group, 1 d after surgery, high shear whole blood viscosity, low shear viscosity of whole blood, plasma viscosity, erythrocyte aggregation index, prothrombin time, fibrinogen had no significantly different with 1 d before surgery (P > 0.05). After surgery, 2 cases (2.41%) in the observation group and 8 cases (10.81%) in the control group had deep vein thrombosis, with statistically significant difference (P<0.05). Conclusion Improved intraoperative care can improve high blood coagulation state in patients with hip joint replacement, reduce the incidence of postoperative deep venous thrombosis.

  13. Risk factors for infection in total hip replacement surgery at Hospital Kuala Lumpur.

    Science.gov (United States)

    Yong, K S; Kareem, B A; Ruslan, G N; Harwant, S

    2001-06-01

    Sixty-seven primary THR surgeries in 57 patients between January 1992 and December 1998 were reviewed after a mean follow-up of 35.9 months. The rate of superficial and deep wound infections were 11.9% and 1.5% respectively. The most common organism in superficial wound infection was Staphylococcus aureus. The factors that were significantly associated with superficial wound infection were diabetes mellitus (p= 0.0230) obesity (p=0.0088). The patients who developed superficial wound infection have a significantly longer duration of surgery compared to patients without infection (p=0.014). However, there was no significant difference between the mean age among patients with and without superficial wound infection (p=0.814).

  14. Postoperative Recovery of Mechanical Muscle Function in Hip Replacement Patients

    DEFF Research Database (Denmark)

    Jensen, Carsten; Aagaard, Per; Overgaard, Søren

    2011-01-01

    INTRODUCTION Muscle function in patients with hip osteoarthritis (OA) is not well-studied. We established a new setup of tests in order to monitor patients before and after surgery. Our novel setup was used to evaluate single- and multi-joint strength (torque) and power in a group of 40 – 65 year...... weeks post surgery for both the affected (AF) as well as the non-affected (NA) side. Protocol: All contractions were performed ad libitum and for each muscle group 3 trails of 4s duration were performed. The trail with highest peak torque was used for further analysis. Statistics: Paired students t...

  15. Mixed reality simulation of rasping procedure in artificial cervical disc replacement (ACDR surgery

    Directory of Open Access Journals (Sweden)

    Bayrak Coskun

    2010-10-01

    Full Text Available Abstract Background Until quite recently spinal disorder problems in the U.S. have been operated by fusing cervical vertebrae instead of replacement of the cervical disc with an artificial disc. Cervical disc replacement is a recently approved procedure in the U.S. It is one of the most challenging surgical procedures in the medical field due to the deficiencies in available diagnostic tools and insufficient number of surgical practices For physicians and surgical instrument developers, it is critical to understand how to successfully deploy the new artificial disc replacement systems. Without proper understanding and practice of the deployment procedure, it is possible to injure the vertebral body. Mixed reality (MR and virtual reality (VR surgical simulators are becoming an indispensable part of physicians’ training, since they offer a risk free training environment. In this study, MR simulation framework and intricacies involved in the development of a MR simulator for the rasping procedure in artificial cervical disc replacement (ACDR surgery are investigated. The major components that make up the MR surgical simulator with motion tracking system are addressed. Findings A mixed reality surgical simulator that targets rasping procedure in the artificial cervical disc replacement surgery with a VICON motion tracking system was developed. There were several challenges in the development of MR surgical simulator. First, the assembly of different hardware components for surgical simulation development that involves knowledge and application of interdisciplinary fields such as signal processing, computer vision and graphics, along with the design and placements of sensors etc . Second challenge was the creation of a physically correct model of the rasping procedure in order to attain critical forces. This challenge was handled with finite element modeling. The third challenge was minimization of error in mapping movements of an actor in real

  16. Outcomes following cardiac surgery in patients with preoperative renal dialysis.

    Science.gov (United States)

    Vohra, Hunaid A; Armstrong, Lesley A; Modi, Amit; Barlow, Clifford W

    2014-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was that whether patients who are dependent on chronic dialysis have higher morbidity and mortality rates than the general population when undergoing cardiac surgery. These patients often require surgery in view of their heightened risk of cardiac disease. Altogether 278 relevant papers were identified using the below mentioned search, 16 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Dialysis-dependent (DD) patients undergoing coronary artery bypass grafting (CABG) or valve replacement have higher morbidity but acceptable outcomes. There is some evidence to show that outcomes after off-pump coronary artery bypass grafting (OPCAB) are better than after on-pump coronary artery bypass grafting (ONCAB) and that results are worse in DD patients with diabetic nephropathy. Patients undergoing combined procedures have a higher mortality.

  17. Observation of the effect of early rehabilitation training in old patients with total hip replacement revision surgery postoperative.%老年全髋关节置换翻修术患者术后早期康复训练的效果观察

    Institute of Scientific and Technical Information of China (English)

    张秀清

    2011-01-01

    Objective: To evaluate the rehabilitation training in the elderly after total hip replacement the effect of the renovation. Methods:17 cases of total hip replacement revision surgery were conducted with systematic rehabilitation of the corresponding functional training, comparing the degree of hip joint function of 17 patinets in preoperative state and postoperative state. Results:17 patients of total hip arthroplasty in patients after rehabilitation training after the renovation, Harris hip function score with the preoperative through t test, with significant difference, hip joint function after training than before training has clearly improved comparing with function before training. Conclusion :The systematic postoperative rehabilitation training can improve the hip joint function.%目的:探讨康复训练在老年全髋关节置换翻修术后的效果.方法:对17例全髋关节置换翻修术患者进行相应的系统性康复功能训练,比较每位患者术前术后髋关节功能改善的程度.结果:17例全髋置换术后翻修患者经过康复训练后,Harris髋关节功能评分与术前比较,具有显著性差异,训练后髋关节功能较训练前有明显改善.结论:术后进行系统化的康复训练能明显改善患者髋关节功能.

  18. Maverick total disc replacement in a real-world patient population: a prospective, multicentre, observational study.

    Science.gov (United States)

    Assaker, Richard; Ritter-Lang, Karsten; Vardon, Dominique; Litrico, Stéphane; Fuentes, Stéphane; Putzier, Michael; Franke, Jörg; Jarzem, Peter; Guigui, Pierre; Nakach, Gérard; Le Huec, Jean-Charles

    2015-09-01

    Controlled trials have shown that total disc replacement (TDR) can provide pain and disability relief to patients with degenerative disc disease; however, whether these outcomes can also be achieved for patients treated in normal surgical practice has not been well documented. This prospective, international study observed changes in disability and back pain in 134 patients who were implanted with Maverick TDR within the framework of routine clinical practice and followed for 2 years post-surgery. Primary and secondary outcomes were the differences from baseline to 6 months post-surgery in the means of the Oswestry Disability Index and the change in back pain intensity assessed on a 10-cm visual analogue scale, respectively. Mean patient age at surgery was 43 years, but ranged up to 65 years. One hundred twenty-three patients had an implant at one level, 10 patients at two levels, and one patient at three levels. Statistically significant improvements in mean disability (-25.4) and low back pain intensity (-4.0) scores were observed at 6 months postoperatively (P 10 TDRs per centre). During the study, 56 patients (42 %) experienced a complication or adverse event. This is the first international observational study to report outcomes of TDR in real-world clinical settings. We showed statistically significant improvements in disability and pain scores at 6 months following Maverick TDR, which were maintained for 2 years alongside an acceptable rate of perioperative complications. The safety and tolerability shown in this observational study were comparable to those from controlled trials.

  19. Time to achieving therapeutic international normalized ratio increases hospital length of stay after heart valve replacement surgery.

    Science.gov (United States)

    Arendt, Christopher J; Hong, Joon Hwa; Daly, Richard C; Scott, Christopher; Mehta, Ramila A; Bailey, Kent; Pathak, Jyotishman; Pereira, Naveen L

    2017-05-01

    Achieving a therapeutic international normalized ratio (INR) before hospital discharge is an important inpatient goal for patients undergoing mechanical cardiac valve replacement (MCVR). The use of clinical algorithms has reduced the time to achieve therapeutic INR (TTI) with warfarin therapy. Whether TTI prolongs length of stay (LOS) is unknown. Patients who underwent MCVR over a consecutive 42-month period were included. Clinical data were obtained from the Society of Thoracic Surgeons Adult Cardiac Surgery database and electronic medical records. Therapeutic INR was defined as per standard guidelines. Warfarin dose was prescribed using an inpatient pharmacy-managed algorithm and computer-based dosing tool. International normalized ratio trajectory, procedural needs, and drug interactions were included in warfarin dose determination. There were 708 patients who underwent MCVR, of which 159 were excluded for reasons that would preclude or interrupt warfarin use. Among the remainder of 549 patients, the average LOS was 6.4days and mean TTI was 3.5days. Landmark analysis showed that subjects in hospital on day 4 (n=542) who achieved therapeutic INR were more likely to be discharged by day 6 compared with those who did not achieve therapeutic INR (75% vs 59%, P<.001). Multivariable proportional hazards regression with TTI as a time-dependent effect showed a strong association with discharge (P=.0096, hazard ratio1.3) after adjustment for other significant clinical covariates. Time to achieve therapeutic INR is an independent predictor of LOS in patients requiring anticoagulation with warfarin after MCVR surgery. Alternative dosing and anticoagulation strategies will need to be adopted to reduce LOS in these patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Modeling Outcome of Patients on Renal Replacement Therapy

    NARCIS (Netherlands)

    Y.S. Liem (Ylian Serina)

    2008-01-01

    textabstractThe incidence of end-stage renal disease is increasing and therefore, the number of patients requiring renal replacement therapy (RRT), renal dialysis or renal transplantation (RTx), has been rising. The various forms of RRT are associated with differences in survival and quality of life

  1. Effects of Reiki on Pain, Anxiety, and Blood Pressure in Patients Undergoing Knee Replacement: A Pilot Study.

    Science.gov (United States)

    Baldwin, Ann Linda; Vitale, Anne; Brownell, Elise; Kryak, Elizabeth; Rand, William

    This blinded, controlled pilot study investigated the effects of Reiki on 46 patients undergoing knee replacement surgery. Of the 3 groups, Reiki, Sham Reiki, and Standard of Care, only the Reiki group showed significant reductions in pain, blood pressure, respiration rate, and state anxiety, which provides evidence for a full-scale clinical study.

  2. Total shoulder replacement for osteoarthritis in patients 80 years of age and older.

    Science.gov (United States)

    Foruria, A M; Sperling, J W; Ankem, H K; Oh, L S; Cofield, R H

    2010-07-01

    This study was performed to review the safety and outcome of total shoulder replacements in patients who are > or = 80 years of age. A total of 50 total shoulder replacements in 44 patients at a mean age of 82 years (80 to 89) were studied. Their health and shoulder status, the operation and post-operative course were analysed, including pain, movement, patient satisfaction, medical and surgical complications, radiographs, the need for revision surgery, and implant and patient survival. A total of 27 patients had an ASA classification of III or IV and medical abnormalities were common. Of the 13 shoulders with bony deficiency of the glenoid, nine required grafting. The duration of hospital stay was prolonged and blood transfusions were common. There were no peri-operative deaths. The mean follow-up was for 5.5 years (2 to 12). Pain was significantly reduced (p shoulders had an excellent or satisfactory result. There were medical or surgical complications in 17 cases. Four shoulders developed radiological evidence of loosened glenoid components, and three of these had a poor outcome. Three other shoulders required revision, two for instability. By the time of this review 39 of the patients had died from unrelated causes at a mean of 7.5 years (0.8 to 16.4) after surgery. Total shoulder replacement is a relatively effective treatment in this elderly group of patients. However, there is a requirement for more intense patient care in the peri-operative period, and non-fatal medical or surgical complications are common. Most of these elderly patients will have a comfortable functional shoulder for the rest of their lives.

  3. Vascular access for extracorporeal renal replacement therapy in veterinary patients.

    Science.gov (United States)

    Chalhoub, Serge; Langston, Cathy E; Poeppel, Karen

    2011-01-01

    Vascular access is the first and most basic requirement for successful extracorporeal renal replacement therapy (ERRT). Dual-lumen catheters are the most commonly used method of vascular access for ERRT in veterinary patients. An adequately functioning dialysis catheter allows for smooth and efficient patient management, whereas a poorly functioning catheter frustrates the technician, doctor, and patient. These catheters are fairly quick to place but require meticulous care for optimal function. The most common complications are thrombosis and infection. Monitoring catheter performance should be a routine part of dialysis patient care.

  4. Incidence of Postoperative Deep Venous Thrombosis Is Higher among Cardiac and Vascular Surgery Patients as Compared with General Surgery Patients.

    Science.gov (United States)

    Aziz, Faisal; Patel, Mayank; Ortenzi, Gail; Reed, Amy B

    2015-01-01

    Unlike general surgery patients, most of vascular and cardiac surgery patients receive therapeutic anticoagulation during operations. The purpose of this study was to report the incidence of deep venous thrombosis (DVT) among cardiac and vascular surgery patients, compared with general surgery. The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent surgical procedures from 2005 to 2010. Patients who developed DVT within 30 days of an operation were identified. The incidence of DVT was compared among vascular, general, and cardiac surgery patients. Risk factors for developing postoperative DVT were identified and compared among these patients. Of total 2,669,772 patients underwent surgical operations in the period between 2005 and 2010. Of all the patients, 18,670 patients (0.69%) developed DVT. The incidence of DVT among different surgical specialties was cardiac surgery (2%), vascular surgery (0.99%), and general surgery (0.66%). The odds ratio for developing DVT was 1.5 for vascular surgery patients and 3 for cardiac surgery patients, when compared with general surgery patients (P cardiac surgery was 2, when compared with vascular surgery (P cardiac surgery patients as compared with that of general surgery patients. Intraoperative anticoagulation does not prevent the occurrence of DVT in the postoperative period. These patients should receive DVT prophylaxis in the perioperative period, similar to other surgical patients according to evidence-based guidelines. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Single-Dose Lignocaine-Based Blood Cardioplegia in Single Valve Replacement Patients

    Directory of Open Access Journals (Sweden)

    Jaydip Ramani

    Full Text Available Abstract OBJECTIVE: Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. METHODS: A total of 110 patients who underwent single (aortic or mitral valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients, long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients, standard St Thomas IB (short-acting blood-based cardioplegia solution was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters. RESULTS: We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43 and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23 in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65 in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB, Troponin-I levels, lactate level and cardiac functions postoperatively. CONCLUSION: This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.

  6. Single-Dose Lignocaine-Based Blood Cardioplegia in Single Valve Replacement Patients.

    Science.gov (United States)

    Ramani, Jaydip; Malhotra, Amber; Wadhwa, Vivek; Sharma, Pranav; Garg, Pankaj; Tarsaria, Malkesh; Pandya, Himani

    2017-01-01

    Myocardial protection is the most important in cardiac surgery. We compared our modified single-dose long-acting lignocaine-based blood cardioplegia with short-acting St Thomas 1 blood cardioplegia in patients undergoing single valve replacement. A total of 110 patients who underwent single (aortic or mitral) valve replacement surgery were enrolled. Patients were divided in two groups based on the cardioplegia solution used. In group 1 (56 patients), long-acting lignocaine based-blood cardioplegia solution was administered as a single dose while in group 2 (54 patients), standard St Thomas IB (short-acting blood-based cardioplegia solution) was administered and repeated every 20 minutes. All the patients were compared for preoperative baseline parameters, intraoperative and all the postoperative parameters. We did not find any statistically significant difference in preoperative baseline parameters. Cardiopulmonary bypass time were 73.8±16.5 and 76.4±16.9 minutes (P=0.43) and cross clamp time were 58.9±10.3 and 66.3±11.2 minutes (P=0.23) in group 1 and group 2, respectively. Mean of maximum inotrope score was 6.3±2.52 and 6.1±2.13 (P=0.65) in group 1 and group 2, respectively. We also did not find any statistically significant difference in creatine-phosphokinase-MB (CPK-MB), Troponin-I levels, lactate level and cardiac functions postoperatively. This study proves the safety and efficacy of long-acting lignocaine-based single-dose blood cardioplegia compared to the standard short-acting multi-dose blood cardioplegia in patients requiring the single valve replacement. Further studies need to be undertaken to establish this non-inferiority in situations of complex cardiac procedures especially in compromised patients.

  7. Common experiences of patients following suboptimal treatment outcomes: implications for epilepsy surgery.

    Science.gov (United States)

    Fernando, Dinusha K; McIntosh, Anne M; Bladin, Peter F; Wilson, Sarah J

    2014-04-01

    Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals. Twenty-two studies were found of patients experiencing a range of suboptimal outcomes, including seizure recurrence, cancer recurrence and progression, unsuccessful joint replacement, unsuccessful infertility treatment, organ transplant rejection, coronary bypass graft surgery, and unsuccessful weight-loss surgery. In order of frequency, the most common patient experiences included the following: altered social dynamics and stigma, unmet expectations, negative emotions, use of coping strategies, hope and optimism, perceived failure of the treating team, psychiatric symptoms, and control issues. There is support in the epilepsy surgery literature that unmet expectations and psychiatric symptoms are key issues for patients with seizure recurrence, while other common patient experiences have been implied but not systematically examined. Several epilepsy surgery specific factors influence patient perceptions of seizure recurrence, including the nature of postoperative seizures, the presence of postoperative complications, and the need for increased postoperative medications. Knowledge of common patient experiences can assist in the delivery of patient follow-up and rehabilitation services tailored to differing outcomes after epilepsy surgery.

  8. Outcome and risk of revision following shoulder replacement in patients with glenohumeral osteoarthritis.

    Science.gov (United States)

    Rasmussen, Jeppe V

    2014-06-01

    existing knowledge, it seems like total shoulder arthroplasty should be preferred in the treatment of glenohumeral osteoarthritis. Shoulder replacement is rarely indicated in younger patients where other treatment options (e.g., physiotherapy; intraarticular injections of hyaluronate; and joint preserving surgery) should be considered until the efficacy of shoulder replacement has been more thoroughly documented.

  9. Mitral Valve Surgery in Patients with Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Mahnoosh Foroughi

    2014-01-01

    Full Text Available Valvular heart disease is the common cardiac manifestation of systemic lupus erythematosus (SLE with a tendency for mitral valve regurgitation. In this study we report a case of mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis in the setting of SLE. In addition, we provide a systematic review of the literature on mitral valve surgery in the presence of Libman-Sacks endocarditis because its challenge on surgical options continues. Surgical decision depends on structural involvement of mitral valve and presence of active lupus nephritis and antiphospholipid antibody syndrome. Review of the literature has also shown that outcome is good in most SLE patients who have undergone valvular surgery, but association of antiphospholipid antibody syndrome with SLE has negative impact on the outcome.

  10. The effect of posterior and lateral approach on patient-reported outcome measures and physical function in patients with osteoarthritis, undergoing total hip replacement

    DEFF Research Database (Denmark)

    Rosenlund, Signe; Broeng, Leif; Jensen, Carsten

    2014-01-01

    BACKGROUND: Total hip replacement provides pain relief and improves physical function and quality of life in patients with end-stage hip osteoarthritis. The incidence of hip replacement operations is expected to increase due to the growing elderly population. Overall, the posterior approach...... and lateral approach are the two most commonly used approaches for hip replacement operations. The posterior approach is associated with an increased risk of revision due to dislocations, and some studies have shown that the lateral approach is associated with reduced patient-reported outcomes, including...... is a prospective, double blinded, parallel-group controlled trial with balanced randomisation [1: 1]. Patients with hip osteoarthritis scheduled for hip replacement surgery, aged 45-70 years, will be consecutively recruited and randomised into two groups. Group A will receive hip replacement using the posterior...

  11. SHOULD DISEASE-MODIFYING THERAPY BE STOPPED IN PATIENTS WITH RHEUMATOID ARTHRITIS BEFORE ENDOPROSTHETIC JOINT REPLACEMENT?

    Directory of Open Access Journals (Sweden)

    N. A. Savenkova

    2011-01-01

    Full Text Available Objective: to analyze disease activity, functional state, quality of life (QL, and the frequency of infectious complications in methotrexate (MT – or leflunomide (LF-treated patients with rheumatoid arthritis (RA who had undergone endoprosthetic replacement of the large joints of the lower limbs. Subjects and methods. One hundred and fourteen patients with RA who had undergone endoprosthetic replacement of the knee and hip joints were divided into 3 groups: 1 36 patients who continuously received MT or LF in the perioperative period; 2 42 patients who dis- continued MT or LF 2 and 4 weeks, respectively, prior to surgery; 3 36 patients who took no disease-modifying anti-rheumatic drugs (DMARDs within 12 months before surgery. Disease activity was estimated by the DAS28 index. QL was determined using the EQ-5D questionnaire and functional capacity was estimated by the HAQ index. Results and discussion. In all the groups, there was a preponderance of patients with moderate RA activity (more than 60%. In Groups 1 and 2, the mean dose of MT was about 10 mg weekly and that of LF was 20 mg daily. The use duration of glucocorticoids (GC and their doses were comparable in all the groups. Twelve months after surgery, DAS28 significantly reduced from 4.22±1.08 to 3.58±1.07 months in Group 1 (p = 0.01; in Group 2, the decrease was insignificant: from 4.17±1.17 to 3.80±1.15 (p > 005; in Group 3, RA activity remained as before. All the groups achieved 50% functional improvement; better results were obtained in the group of patients who continued to use DMARDs in the perioperative period (∆HAQ=-0.67. The difference in the Eq-5D index corresponded to a moderate QL improvement: ∆EQ-5D = 0.28, 0.29, and 0.31 in Groups 1, 2, and 3, respectively (p < 0.05. There were no significant group differences. Deep infection in the endoprosthetic replacement area was detected in 2.8, 2.4, and 8.3% of cases, respectively (p > 005. Conclusion. Continuous use of MT

  12. Outcome of orthognathic surgery in Chinese patients

    NARCIS (Netherlands)

    Chew, Ming Tak; Sandham, John; Soh, Jen; Wong, Hwee Bee

    2007-01-01

    Objective: To evaluate the outcome of orthognathic surgery by objective cephalometric measurement of posttreatment soft-tissue profile and by subjective evaluation of profile esthetics by laypersons and clinicians. Materials and Methods: The sample consisted of 30 Chinese patients who had completed

  13. Preoperative optimization of the vascular surgery patient

    Directory of Open Access Journals (Sweden)

    Zhan HT

    2015-07-01

    Full Text Available Henry T Zhan,1 Seth T Purcell,1,2 Ruth L Bush1 1Texas A&M Health Science Center College of Medicine, Bryan, 2Baylor Scott and White, Temple, TX, USA Abstract: It is well known that patients who suffer from peripheral (noncardiac vascular disease often have coexisting atherosclerotic diseases of the heart. This may leave the patients susceptible to major adverse cardiac events, including death, myocardial infarction, unstable angina, and pulmonary edema, during the perioperative time period, in addition to the many other complications they may sustain as they undergo vascular surgery procedures, regardless of whether the procedure is performed as an open or endovascular modality. As these patients are at particularly high risk, up to 16% in published studies, for postoperative cardiac complications, many proposals and algorithms for perioperative optimization have been suggested and studied in the literature. Moreover, in patients with recent coronary stents, the risk of noncardiac surgery on adverse cardiac events is incremental in the first 6 months following stent implantation. Just as postoperative management of patients is vital to the outcome of a patient, preoperative assessment and optimization may reduce, and possibly completely alleviate, the risks of major postoperative complications, as well as assist in the decision-making process regarding the appropriate surgical and anesthetic management. This review article addresses several tools and therapies that treating physicians may employ to medically optimize a patient before they undergo noncardiac vascular surgery. Keywords: perioperative care, intraoperative care, medical management, risk evaluation/stratification, medical treatment

  14. Components of Patient Satisfaction After Orthognathic Surgery.

    Science.gov (United States)

    Kufta, Kenneth; Peacock, Zachary S; Chuang, Sung-Kiang; Inverso, Gino; Levin, Lawrence M

    2016-01-01

    The purpose of this study was to compare overall patient satisfaction after orthognathic surgery with the following specific categories: appearance, functional ability, general health, sociability, and patient-clinician communication. A 16-question survey was developed and administered to include patients at either 6 or 12 months after orthognathic surgery between June 2013 and June 2014 at the University of Pennsylvania and Massachusetts General Hospital. The predictor variables included age, sex, type of procedure, medical comorbidities, intra- or postoperative complications, and presence of paresthesia. The outcome variable was patient satisfaction overall and in each category based on a Likert scale (0: not satisfied at all to 5: very satisfied).A total of 37 patients completed the survey and had a high overall rate of satisfaction (100% of responses were 4 or 5 on Likert scale). Overall satisfaction had the highest correlation with appearance (ρ=0.52, P=0.0009) followed by sociability (ρ=0.47, P=0.004), patient-clinician communication (ρ=0.38, P=0.02) functionality (ρ=0.19, P=0.26), and general health (ρ = -0.11, P = 0.51). Patients had high satisfaction scores for orthognathic surgery. Satisfaction with postoperative appearance had the strongest correlation with overall satisfaction.

  15. Relaxation strategies for patients during dermatologic surgery.

    Science.gov (United States)

    Shenefelt, Philip D

    2010-07-01

    Patient stress and anxiety are common preoperatively and during dermatologic procedures and surgeries. Stress and anxiety can occasionally interfere with performance of procedures or surgery and can induce hemodynamic instability, such as elevated blood pressure or syncope, as well as producing considerable discomfort for some patients. Detection of excess stress and anxiety in patients can allow the opportunity for corrective or palliative measures. Slower breathing, biofeedback, progressive muscular relaxation, guided imagery, hypnosis, meditation and music can help calm and rebalance the patient's autonomic nervous system and immune functioning. Handheld miniaturized heart rate variability biofeedback devices are now available. The relaxation response can easily be taught. Guided imagery can be recorded or live. Live rapid induction hypnosis followed by deepening and then self-guided imagery requires no experience on the part of the patient but does require training and experience on the part of a provider. Recorded hypnosis inductions may also be used. Meditation generally requires more prior experience and training, but is useful when the patient already is skilled in it. Live, guided meditation or meditation recordings may be used. Relaxing recorded music from speakers or headphones or live performance music may also be employed to ease discomfort and improve the patient's attitude for dermatologic procedures and surgeries.

  16. Are valve repairs associated with better outcomes than replacements in patients with native active valve endocarditis?

    Science.gov (United States)

    Zhao, Dong; Zhang, Benqing

    2014-12-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether valve replacement was associated with higher morbidity and mortality rates than valve repair in patients with native active valve endocarditis. Altogether 662 papers were found using the reported search, of which 7 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Traditionally, valve replacement has been the standard therapy for valve endocarditis when surgical treatment is indicated. But now valve repair is increasingly used as an alternative, which may avoid disadvantages of anticoagulation, lower the risk of prosthetic infection and improve postoperative survival. To compare outcomes of these two treatments between studies can be difficult because most of related papers contain raw data on prosthetic valve endocarditis or healed endocarditis, which were excluded from our manuscript. Studies only analysing the outcomes of either of these treatments without the comparison of valve repair and replacement were also excluded. Finally, seven papers were identified. The American Heart Association/American College of Cardiology 2006 valvular guidelines recommended that mitral valve repair should be performed instead of replacement when at all possible. In three of the seven studies, there were significant differences between valve repair and replacement in long-term survival. One study found that aortic valve repair offered better outcomes in freedom from reoperation at 5 years (P = 0.021) and in survival at 4 years (repair vs replacement 88 vs 65%; P = 0.047). One study reported that there was improved event-free survival at 10 years in the mitral valve repair group (P = 0.015), although there was more previous septic embolization in this group. In one study, early and late mortality

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

    Science.gov (United States)

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

    2005-07-20

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2005-01-01

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

  19. Patient-prosthesis mismatch: surgical aortic valve replacement versus transcatheter aortic valve replacement in high risk patients with aortic stenosis.

    Science.gov (United States)

    Ghanta, Ravi K; Kron, Irving L

    2016-10-01

    Patient prosthesis mismatch (PPM) can occur when a prosthetic aortic valve has an effective orifice area (EOA) less than that of a native valve. A recent study by Zorn and colleagues evaluated the incidence and significance of PPM in high risk patients with severe aortic stenosis who were randomized to transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR). TAVR is associated with decreased incidence of severe PPM compared to traditional SAVR valves. Severe PPM increases risk for death at 1 year postoperatively in high risk patients. The increased incidence of PPM is largely due to differences in valve design and should encourage development of newer SAVR valves to reduce risk for PPM. In addition more vigorous approaches to root enlargement in small annulus should be performed with SAVR to prevent PPM.

  20. Music therapy for patients receiving spine surgery.

    Science.gov (United States)

    Lin, Pi-Chu; Lin, Man-Ling; Huang, Li-Ching; Hsu, Hsiu-Chu; Lin, Chiong-Chu

    2011-04-01

    The aim of this study was to evaluate the effects of music therapy on anxiety, postoperative pain and physiological reactions to emotional and physical distress in patients undergoing spinal surgery. Surgery-related anxiety and pain are the greatest concern of surgical patients, especially for those undergoing major procedures. A quasi-experimental study design was conducted in a medical centre in Taiwan from April-July 2006. Sixty patients were recruited. The study group listened to selected music from the evening before surgery to the second day after surgery. The control group did not listen to music. Patients' levels of anxiety and pain were measured with visual analogue scales (VAS). Physiological measures, including heart rate, blood pressure and 24-hour urinalysis, were performed. The average age of the 60 patients was 62·18 (SD 18·76) years. The mean VAS score for degree of anxiety in the study group was 0·8-2·0, compared with 2·1-5·1 in the control group. The mean VAS score for degree of pain in the study group was 1·7-3·0, compared with 4·4-6·0 in the control group. The differences between the two groups in VAS scores for both anxiety (p = 0·018-0·001) and pain (p = 0·001) were statistically significant. One hour after surgery, the mean blood pressure was significantly lower in the study group than in the control group (p = 0·014), but no significant differences were found between the two groups in urine cortisol (p = 0·145-0·495), norepinephrine (p = 0·228-0·626) or epinephrine values (p = 0·074-0·619). Music therapy has some positive effects on levels of anxiety and pain in patients undergoing spinal surgery. Complementary music therapy can alleviate pain and anxiety in patients before and after spinal surgery. © 2011 Blackwell Publishing Ltd.

  1. Resultados de pacientes submetidos à cirurgia de substituição valvar aórtica usando próteses mecânicas ou biológicas Outcomes of patients subjected to aortic valve replacement surgery using mechanical or biological prostheses

    Directory of Open Access Journals (Sweden)

    Adriana Silveira de Almeida

    2011-09-01

    Full Text Available OBJETIVO: Esse estudo avalia resultados em pacientes submetidos à cirurgia para troca valvar aórtica utilizando substituto biológico ou mecânico, com poder de relevância na seleção do tipo da prótese. MÉTODOS: Foram selecionados, randomicamente, 301 pacientes submetidos à cirurgia para troca valvar aórtica entre 1990 e 2005, com seguimento máximo de 20 anos. RESULTADOS: Sobrevivência em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 83,9%, 75,4% e 60,2% e, para substituto biológico, foi de 89,3%, 70,4% e 58,4%, respectivamente (P=0,939. Fatores associados com óbito foram: idade, obesidade, doença pulmonar, arritmias, eventos hemorrágicos e insuficiência valvar aórtica. Probabilidade livre de reoperação desses pacientes em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 97,9%, 95,8% e 95,8% e, para bioprótese, foi de 94,6%, 91,0% e 83,3%, respectivamente (P=0,057. Fatores associados com reoperação foram: insuficiência renal, endocardite de prótese e idade. Probabilidade livre de eventos hemorrágicos em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 94,5%, 91,7% e 91,7% e, para bioprótese, foi de 98,6%, 97,8% e 97,8%, respectivamente (P=0,047. Fatores associados com eventos hemorrágicos foram: insuficiência renal e prótese mecânica. CONCLUSÕES: Os autores concluíram que: 1 mortalidade foi estatisticamente semelhante entre os grupos; 2 características basais dos pacientes foram os maiores determinantes de mortalidade tardia após a cirurgia; 3 houve tendência à reoperação para o grupo com bioprótese; 4 pacientes com prótese mecânica tiveram mais eventos hemorrágicos ao longo do tempo; 5 dados encontrados no presente estudo são concordantes com a literatura atualOBJECTIVE: This paper evaluates outcomes in patients subjected to surgery for replacement of the aortic valve using biological or mechanical substitutes, where selection of the

  2. No clinical effect of prosthesis-patient mismatch after transcatheter versus surgical aortic valve replacement in intermediate- and low-risk patients with severe aortic valve stenosis at mid-term follow-up

    DEFF Research Database (Denmark)

    Thyregod, Hans Gustav Hørsted; Steinbrüchel, Daniel Andreas; Ihlemann, Nikolaj

    2016-01-01

    OBJECTIVES: Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) for severe aortic valve stenosis (AVS) is common, but less common after transcatheter aortic valve replacement (TAVR) in patients considered at high risk for death after surgery. The objectives of this st...

  3. Nepalese patients' anxiety and concerns before surgery.

    Science.gov (United States)

    Pokharel, Krishna; Bhattarai, Balkrishna; Tripathi, Mukesh; Khatiwada, Sindhu; Subedi, Asish

    2011-08-01

    To determine the changes in anxiety level and need for information at three different time points before surgery. Prospective observational study. Ward (T(1)), preoperative holding area (T(2)), and operating room (T(3)) of a university hospital. 201 adult, ASA physical status 1 and 2 patients scheduled for elective operations. Level of anxiety and need for information about surgery and/or anesthesia were assessed with the Amsterdam Preoperative Anxiety and Information Scale (APAIS) three times before the start of surgery: in the ward, the preoperative holding area, and the operating room. The psychometric characteristics of the APAIS were similar to its original Dutch version. The frequency of patients with high preoperative anxiety peaked at the preoperative holding area. The median score on need for information decreased from T(1) [4; interquartile range (IR) 2-5] to T(2) (3; IR 2-4) (P anxiety scores for anesthesia were significantly (P information about their surgical procedure was significantly (P information also were more anxious (P anxiety were female gender [odds ratio (OR) 4; 95% confidence interval (CI) 1.09-14.94] and need for general anesthesia (OR 7.1; 95% CI 0.93-54.98). The characteristics, general anesthesia (OR 3.3; 95% CI 1.1-10.0), younger age (≤ 30 yrs; OR 2.9; 95% CI 1.3-6.4), education (>12 yrs; OR 2.6; 95% CI 1.2-5.4), and no previous surgery (OR 2.6; 95% CI 1.2-5.5), correlated with greater need for information. The frequency of anxious patients is variable at different time points before surgery. The factors correlating with anxiety before surgery are nonmodifiable. Providing information to those individuals is the only modifiable option. Copyright © 2011 Elsevier Inc. All rights reserved.

  4. Aortic valve replacement in a patient with severe hemophilia.

    Science.gov (United States)

    Gasparović, Hrvoje; Zupancic-Salek, Silva; Brida, Vojtjeh; Dulić, Grgur; Jelić, Ivan

    2007-03-01

    Hemophilia A is an inherited bleeding disorder characterized by factor VIII deficiency. The basis for insufficient hemostasis lies within inadequate amplification of factor Xa production with the undersupplied factor VIII. We report on a young patient with critical aortic stenosis bearing all the clinical stigmata of severe hemophilia, in whom aortic valve replacement was performed with a tissue valve in order to avoid the need for long term anticoagulation.

  5. Comparison of Balance, Proprioception and Skeletal Muscle Mass in Total Hip Replacement Patients With and Without Fracture: A Pilot Study

    Science.gov (United States)

    2016-01-01

    Objective To determine whether there was a difference in balance, proprioception, and skeletal muscle mass among patients who undergo hip fracture surgery relative to and elective total hip replacement (THR). Methods Thirty-one THR patients were enrolled. The patients were categorized into two groups: fracture group (n=15) and non-fracture group (n=16). Berg Balance Scale (BBS) was used to balance the proprioception of the hip joint while a joint position sense (JPS) test was used to evaluate it. Skeletal muscle mass was measured by bioelectrical impedance analysis and expressed as a skeletal muscle mass index (SMI). Quality of life (QOL) was also assessed using a 36-item short form health survey (SF-36). All tests were assessed at 3 months after the surgery. An independent t-test was used to compare the fracture group and non-fracture group. Spearman correlation was used to identify the correlation of each variable. Results In an independent t-test, the BBS score of patients undergoing elective surgery was higher than the BBS score of patients undergoing hip fracture surgery. There was a significant correlation between the BBS and JPS score after a THR. SMI also correlated with the score of BBS. Conclusion It seems that THR patients undergoing surgery for a hip fracture might have more trouble balancing than elective THR patients. Therefore THR patients undergoing hip fracture surgery might need more care during rehabilitation. PMID:28119837

  6. Waiting for surgery from the patient perspective

    Directory of Open Access Journals (Sweden)

    Tracey Carr

    2009-10-01

    Full Text Available Tracey Carr1, Ulrich Teucher2, Jackie Mann4, Alan G Casson31Health Sciences, 2Department of Psychology, 3Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; 4Acute Care, Saskatoon Health Region, Saskatoon, Saskatchewan, CanadaAbstract: The aim of this study was to perform a systematic review of the impact of waiting for elective surgery from the patient perspective, with a focus on maximum tolerance, quality of life, and the nature of the waiting experience. Searches were conducted using Medline, PubMed, CINAHL, EMBASE, and HealthSTAR. Twenty-seven original research articles were identified which included each of these three themes. The current literature suggested that first, patients tend to state longer wait times as unacceptable when they experienced severe symptoms or functional impairment. Second, the relationship between length of wait and health-related quality of life depended on the nature and severity of proposed surgical intervention at the time of booking. Third, the waiting experience was consistently described as stressful and anxiety provoking. While many patients expressed anger and frustration at communication within the system, the experience of waiting was not uniformly negative. Some patients experienced waiting as an opportunity to live full lives despite pain and disability. The relatively unexamined relationship between waiting, illness and patient experience of time represents an area for future research.Keywords: wait time, scheduled surgery, patient perspective, literature review

  7. Patient Use of Cost and Quality Data When Choosing a Joint Replacement Provider in the Context of Reference Pricing

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    Ryan Kandrack

    2015-07-01

    Full Text Available Health plans are encouraging consumerism among joint replacement patients by reporting information on hospital costs and quality. Little is known about how the proliferation of such initiatives impacts patients’ selection of a surgeon and hospital. We performed a qualitative analysis of semistructured interviews with 13 patients who recently received a hip or knee replacement surgery. Patients focused on the choice of a surgeon as opposed to a hospital, and the surgeon choice was primarily made based on reputation. Most patients had long-standing relationships with an orthopedic surgeon and tended to stay with that surgeon for their replacement. Despite growing availability of cost and quality information, patients almost never used such information to make a decision.

  8. Effect of continuous stellate ganglion blocking on brain oxygen metabolism and postoperative cognitive dysfunction in patients with hip joint replacement surgery%连续星状神经节阻滞对高龄患者髋关节置换术中脑氧代谢和术后认知功能障碍的影响

    Institute of Scientific and Technical Information of China (English)

    毕燕琳; 王彬; 张高峰; 王玲; 丛丽; 尹曾; 孙晓鹏; 时飞; 王明山

    2013-01-01

    Objective To evaluate the effect of continuous stellate ganglion blocking on brain oxygen metabolism and postoperative cognitive dysfunction in patients with hip joint replacement surgery. Methods Ninety ASAⅡpatients aged 75-85 yr weighing 50-70 kg undergoing elective operation on hip joint replacement surgery were randomly divided into 3 groups(n=30 each):control group(group C) received routine treatment only, single stellate ganglion blocking group (group D)received SGB with 0.2%ropivacaine 5 ml besides routine treatment and continuous stellate ganglion blocking group (group S)received continuous SGB with 0.2% ropivacaine besides routine treatment.SGB was performed on the right side before epidural anesthesia.An epidural catheter was placed.A bolus of 0.2%ropivacaine 5 ml was followed by continuous infusion of 0.2%ropivacaine at a rate of 2 ml/h.Continuous SGB was maintained for 48 h. Blood gas analysis, glucose and lactic acid determination were carried out by taking blood samples from right internal jugular vein bulb and radial artery at different phase points:right internal jugular vein retrograde catheter immediately(T1), 20 min after SGB(T2), surgery starting 60 min(T3), at the end of surgery(T4), recording MAP, HR, SpO2. Cerebral blood flow/cerebral metabolic rate of O2 (CBF/CMRO2), cerebral metabolic rate of O2 cerebral metabolic rate of glucose (CMRO2/CMRGlu) and advent volume of lactification (ADVL) were also calculated. MMSE score was used to evaluate the cognitive dysfunction at before and 3 d and 7 d after operation recording POCD. Results Compared with C, CBF/CMRO2 and CMRO2/CMRGlu was significantly increased,ADVL and POCD was significantly decreased in group D and S. Compared with D, CBF/CMRO2 and CMRO2/CMRGlu was significantly increased, ADVL and POCD was significantly decreased in group S. Compared with T1, CBF/CMRO2 and CMRO2/CMRGlu was significantly increased, ADVL and POCD was significantly decreased at T3-4 in group D and S. Conclusion

  9. [Heart surgery in the aged patient].

    Science.gov (United States)

    Klinner, W; Bernheim, C; Laiacker, H

    1985-10-31

    107 patients at the age of 80 years or more were operated for coronary or valvular heart disease between 1978 and 1984. The indication for surgery was instable angina in coronary patients and intractable heart failure in such with valvular lesions. 9 coronary and 5 valvular patients died postoperatively, 7 were early postoperative deaths, mainly due to myocardial failure. The majority of cases could be improved for 1 to 2 stages according to NYHA-classification. In this group pulmonary complications were predominant. According to this observation heart operations can also be indicated in the older age patient group without very much more risk than in younger ones.

  10. Perioperative Optimization of Patients Undergoing Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    C. E. Owers

    2012-01-01

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

  11. Decline in Health-Related Quality of Life reported by more than half of those waiting for joint replacement surgery: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Osborne Richard H

    2011-05-01

    Full Text Available Abstract Background In many healthcare systems, people with severe joint disease wait months to years for joint replacement surgery. There are little empirical data on the health consequences of this delay and it is unclear whether people with substantial morbidity at entry to the waiting list continue to deteriorate further while awaiting surgery. This study investigated changes in Health-Related Quality of Life (HRQoL, health status and psychological distress among people waiting for total hip (THR and knee replacement (TKR surgery at a major metropolitan Australian public hospital. Methods 134 patients completed questionnaires including the Assessment of Quality of Life (AQoL instrument, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC and Kessler Psychological Distress Scale after entering an orthopaedic waiting list (baseline and before surgery (preadmission. To quantify potential decline in wellbeing, we calculated the proportion of people experiencing clinically important deterioration using published guidelines and compared HRQoL and psychological distress outcomes with population norms. Results Most participants (69% waited ≥6 months for surgery (median 286 days, IQR 169-375 days. Despite poor physical and psychological wellbeing at baseline, there was an overall deterioration in HRQoL during the waiting period (mean AQoL change -0.04, 95%CI -0.08 to -0.01, with 53% of participants experiencing decline in HRQoL (≥0.04 AQoL units. HRQoL prior to surgery remained substantially lower than Australian population norms (mean sample AQoL 0.37, 95%CI 0.33 to 0.42 vs mean population AQoL 0.83, 95%CI 0.82 to 0.84. Twenty-five per cent of participants showed decline in health status (≥9.6 WOMAC units over the waiting period and prevalence of high psychological distress remained high at preadmission (RR 3.5, 95%CI 2.8 to 4.5. Most participants considered their pain (84%, fatigue (76%, quality of life (73% and confidence

  12. Testosterone Replacement and Bone Mineral Density in Male Pituitary Tumor Patients

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    Min Jeong Lee

    2014-03-01

    Full Text Available BackgroundHypopituitarism is associated with osteoporosis and osteopenia especially when hypogonadotropic hypogonadism is present. Despite hypopituitarism being an important cause of secondary osteoporosis, osteoporosis in patients receiving surgery for pituitary tumors in Korea has not been studied. In this study, we evaluated the effects of testosterone replacement therapy (TRT on bone mineral density (BMD in postoperative hypogonadal patients with pituitary tumors.MethodsTo examine the effect of TRT on BMD, we performed a retrospective observational study in 21 postoperative male patients who underwent pituitary tumor surgery between 2003 and 2012 at the Ajou University Hospital. Testosterone was replaced in postoperative hypogonadal patients by regular intramuscular injection, daily oral medication, or application of transdermal gel. BMD (g/cm2 measurements of central skeletal sites (lumbar spine, femoral neck, and total femur were obtained using dual-energy X-ray absorptiometry (GE Lunar. For lumbar spine BMD, L1 to L4 values were chosen for analysis. Femur neck and total femur were also analyzed.ResultsDuring the follow-up period (mean, 56 months; range, 12 to 99 months serum testosterone levels increased with the administration of TRT (P=0.007. There was significant improvement (4.56%±9.81% in the lumbar spine BMD compared to baseline BMD. There were no significant changes in the femur neck BMD or total femur BMD. We did not find any statistically significant relationships between changes in testosterone levels and BMD using Spearman correlation analysis.ConclusionOur results indicated that TRT used in the postoperative period for hypogonadal pituitary tumor surgery patients may have beneficial effects on the BMD of the spine.

  13. 57. Aortic valve replacement with sutureless valve and mitral valve repair in patient with infected aortic homograft

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    A. attia

    2016-07-01

    Full Text Available The approach of implanting aortic sutureless valve inside the calcific homograft is suitable in redo surgery especially if associated with mitral valve surgery. Aortic valve replacement in patients who have undergone previous aortic root replacement with an aortic homograft remains a technical challenge because of homograft degeneration and the need for a redo Bentall operation. We report a case of redo aortic valve replacement (valve in valve with a sutureless valve and mitral valve repair by miniband annuloplasty in a female patient aged 64 years old who underwent aortic valve replacement with homograft 14 years ago and presented by sever aortic valve regurge and sever mitral valve regurge because of infective endocarditis. This technique allows rapid aortic valve replacement in a heavily calcified aortic root. It also avoids aortic valve size affection after mitral valve repair by ordinary methods especially in patients with small aortic annulus. This technique is particularly suitable in redo procedures for homograft degeneration, it avoids performing a redo Bentall operation with its known problems as well as to avoid patient prosthesis mismatch.

  14. OPCAB Surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

    Holme, Susanne Juel; Jensen Beck, Søren; Houlind, Kim;

    2013-01-01

    To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years.......To determine the cost-effective operative strategy for coronary artery bypass surgery in patients above 70 years....

  15. Pictograph-based discharge instructions for low-literate older adults after hip replacement surgery: development and validation.

    Science.gov (United States)

    Choi, Jeungok

    2011-11-01

    Current forms of written text-based discharge instructions are not suitable for presenting lengthy, complex discharge home care actions, and are difficult for low-literate patients to follow precisely at home. The aims of this study were to develop and validate pictograph-based discharge instructions for older adults after hip replacement surgery. Once low-literacy text and pictographs were created, their appropriateness, accuracy, and relevance were reviewed and validated by five experts. The findings show that pictographs (i.e., simple line drawings showing explicit discharge care actions) using stick figures are well suited for presenting action-based discharge instructions. The experts perceived the pictographs as engaging and easy to understand. The pictograph-based approach can be an effective tool in developing health care instructions not only for patients with low-literate skills in acute health care settings, but also for immigrants and refugees who speak English as a second language and present significant communication challenges for health care providers.

  16. The migration of femoral components after total hip replacement surgery: accuracy and precision of software-aided measurements

    Energy Technology Data Exchange (ETDEWEB)

    Decking, J. [Dept. of Orthopaedic Surgery, Univ. of Mainz School of Medicine, Mainz (Germany); Schuetz, U.; Decking, R.; Puhl, W. [Orthopaedic Dept., Univ. of Ulm, School of Medicine (Germany)

    2003-09-01

    Objective: To assess the accuracy and precision of a software-aided system to measure migration of femoral components after total hip replacement (THR) on digitised radiographs. Design and patients: Subsidence and varus-valgus tilt of THR stems within the femur were measured on digitised anteroposterior pelvic radiographs. The measuring software (UMA, GEMED, Germany) relies on bony landmarks and comparability parameters of two consecutive radiographs. Its accuracy and precision were calculated by comparing it with the gold standard in migration measurements, radiostereometric analysis (RSA). Radiographs and corresponding RSA measurements were performed in 60 patients (38-69 years) following cementless THR surgery. Results and conclusions: The UMA software measured the subsidence of the stems with an accuracy of {+-}2.5 mm and varus-valgus tilt with an accuracy of {+-}1.8 (95% confidence interval). A good interobserver and intraobserver reliability was calculated with Cronbach's alpha ranging from 0.86 to 0.97. Measuring the subsidence of THR stems within the femur is an important parameter in the diagnosis of implant loosening. Software systems such as UMA improve the accuracy of migration measurements and are easy to use on routinely performed radiographs of operated hip joints. (orig.)

  17. Functional activity in patients after total hip replacement.

    Science.gov (United States)

    Pogorzała, Adam M; Stryła, Wanda; Nowakowski, Andrzej

    2012-11-08

    Osteoarthritis of hip joints is one of the most common diseases limiting social functioning of patients. Pain and mobility disorders are major problems associated with the disease. The goal of the study was to compare the efficacy of surgical treatment in a selected group of patients using a modified Harris Hip Score questionnaire including questions regarding the pain, the type of gait disorders and the functional activity. Surgical treatment helped to reduce the pain and improve the gait quality and parameters as well as functional activities associated with putting on socks and shoes, climbing stairs, sitting and using public transportation. Following conclusions were drawn after the study: Surgical treatment leads to significant reduction in hip pain. Mobility improvement was observed in most analyzed patients in early post-operative period as a consequence of hip contracture and pain being eliminated. The walking speed and distance improved significantly during the first 3 months after the surgery. All patients were satisfied with the treatment.

  18. Assessing function in patients undergoing joint replacement: a study protocol for a cohort study

    Directory of Open Access Journals (Sweden)

    Wylde Vikki

    2012-11-01

    Full Text Available Abstract Background Joint replacement is an effective intervention for people with advanced arthritis, although there is an important minority of patients who do not improve post-operatively. There is a need for robust evidence on outcomes after surgery, but there are a number of measures that assess function after joint replacement, many of which lack any clear theoretical basis. The World Health Organisation has introduced the International Classification of Functioning, Disability and Health (ICF, which divides function into three separate domains: Impairment, activity limitations and participation restrictions. The aim of this study is to compare the properties and responsiveness of a selection of commonly used outcome tools that assess function, examine how well they relate to the ICF concepts, and to explore the changes in the measures over time. Methods/design Two hundred and sixty three patients listed for lower limb joint replacement at an elective orthopaedic centre have been recruited into this study. Participants attend the hospital for a research appointment prior to surgery and then at 3-months and 1-year after surgery. At each assessment time, function is assessed using a range of measures. Self-report function is assessed using the WOMAC, Aberdeen Impairment, Activity Limitation and Participation Restriction Measure, SF-12 and Measure Yourself Medical Outcome Profile 2. Clinician-administered measures of function include the American Knee Society Score for knee patients and the Harris Hip Score for hip patients. Performance tests include the timed 20-metre walk, timed get up and go, sit-to-stand-to-sit, step tests and single stance balance test. During the performance tests, participants wear an inertial sensor and data from motion analysis are collected. Statistical analysis will include exploring the relationship between measures describing the same ICF concepts, assessing responsiveness, and studying changes in measures over

  19. Nasal surgery in patients with systemic disorders

    Directory of Open Access Journals (Sweden)

    Sachse, Florian

    2010-01-01

    Full Text Available Multisystemic disorders represent a heterogenous group of diseases which can primarily manifest at the nose and paranasal sinuses as limited disease or secondarily as part of systemic involvement. Rhinologists therefore play an important role in the diagnostic but also therapeutic process. Although therapy of multisystemic disorders is primary systemic, additional rhinosurgery may become necessary. The spectrum of procedures consists of sinus surgery, surgery of the orbit and lacrimal duct, septorhinoplasty and closure of nasal septal perforation. Since the prevalence of most systemic diseases is very rare, recommendations are based on the analysis of single case reports and case series with a limited number of patients only. Although data is still limited, experiences published so far have shown that autologous cartilage or bone grafts can be used in nasal reconstruction of deformities caused by tuberculosis, leprosy, Wegener’s granulomatosis, sarcoidosis and relapsing polychondritis. Experiences gained from these diseases support the concept that well-established techniques of septorhinoplasty can be used in systemic diseases as well. However, a state of remission is an essential condition before considering any rhinosurgery in these patients. Even under these circumstances revision surgery has to be expected more frequently compared to the typical collective of patients undergoing septorhinoplasty. In addition, experiences gained from saddle nose reconstruction may in part be of value for the treatment of nasal septal perforations since implantation of cartilage grafts often represents an essential step in multilayer techniques of closure of nasal septal perforations. Aside from the treatment of orbital complications sinus surgery has been proven beneficial in reducing nasal symptoms and increasing quality of life in patients refractory to systemic treatment.

  20. Recommendations for the management of patients after heart valve surgery.

    Science.gov (United States)

    Butchart, Eric G; Gohlke-Bärwolf, Christa; Antunes, Manuel J; Tornos, Pilar; De Caterina, Raffaele; Cormier, Bertrand; Prendergast, Bernard; Iung, Bernard; Bjornstad, Hans; Leport, Catherine; Hall, Roger J C; Vahanian, Alec

    2005-11-01

    Approximately 50,000 valve replacement operations take place in Europe annually and almost as many valve repair procedures. Previous European guidelines on management of patients after valve surgery were last published in 1995 and were limited to recommendations about antithrombotic prophylaxis. American guidelines covering the broader topic of the investigation and treatment of patients with valve disease were published in 1998 but devoted relatively little space to post-surgical management. This document represents the consensus view of a committee drawn from three European Society of Cardiology (ESC) Working Groups (WG): the WG on Valvular Heart Disease, the WG on Thrombosis, and the WG on Rehabilitation and Exercise Physiology. In almost all areas of patient management after valve surgery, randomized trials and meta-analyses do not exist. Such randomized trials as do exist are very few in number, are narrowly focused with small numbers, have limited general applicability, and do not lend themselves to meta-analysis because of widely divergent methodologies and different patient characteristics. Recommendations are therefore almost entirely based on non-randomized studies and relevant basic science.

  1. A clinical research of mitral valve replacement combined with coronary artery bypass graft surgery in patients with moderate-to-severe ischemic mitral regurgitation%中重度缺血性二尖瓣反流患者行二尖瓣置换同期冠状动脉旁路移植术的临床研究

    Institute of Scientific and Technical Information of China (English)

    郭志祥; 张成鑫; 汪欢; 葛圣林

    2015-01-01

    Objective To investigate the impact of combined coronary artery bypass grafting (CABG)and mitral valve replacement (MVR)in patients with moderate-to-severe ischemic mitral regurgitation (IMR).Methods From July 2010 to January 2013,16 pa-tients of coronary artery disease with moderate-to-severe IMR underwent mitral valve replacement combined with coronary artery bypass graft surgery.There were 8 male and 8 female patients,with a mean age of (63.4 ±7.6)years.Preoperative transthoracic echocardio-graphy showed moderate IMR in 2 cases,moderate to severe in 8 cases and severe in 6 cases.The data of preoperative transthoracic ech-ocardiography were compared with postoperative ones.Results Hospital mortality was 6.25%(1 case).Postoperative transthoracic echocardiography showed that there was no regurgitation in 10 cases,minimal in 5 cases,minimal to moderate in 1 case.LVEDD de-creased from (60 ±13)mm to (47 ±12)mm (P <0.05).Conclusions Mitral valve replacement combined with coronary artery by-pass graft is a safe and effective treatment for IMR,the short-term outcomes of which are satisfactory and there is a significant improve-ment of left ventricular function.%目的:探讨二尖瓣置换(mitral valve replacement,MVR)同期冠状动脉旁路移植术(coronary artery bypass grafting,CABG)治疗中重度缺血性二尖瓣反流(ischemic mitral regurgitation,IMR)的效果。方法2010年7月—2013年1月,16例冠状动脉粥样硬化性心脏病(coronary artery disease,CAD)合并中重度 IMR 的患者接受了 CABG 联合 MVR 术。其中男性8例,女性8例;平均年龄(63.4±7.6)岁。术前经胸超声心动图示中度二尖瓣反流2例,中重度8例,重度 6例。比较患者术前及术后经胸超声心动图资料。结果院内死亡1例。术后复查超声心动图示二尖瓣无反流10例,轻度反流5例,轻中度反流1 例。左心室舒张末内径(left ventricular end-diastolic diameter

  2. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    Science.gov (United States)

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  3. Assessing Sexual Abuse/Attack Histories with Bariatric Surgery Patients

    Science.gov (United States)

    Mahony, David

    2010-01-01

    This study assessed sexual abuse/attack histories in 537 bariatric surgery patients using the PsyBari. The prevalence rates found were lower (15.5%, 19.3% of women, 5.2% of men) than other studies that used bariatric surgery patients but consistent with studies that used nonbariatric obese subjects. Furthermore, bariatric surgery patients who…

  4. Perioperative Education of Patient Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alexandros Zacharis

    2011-04-01

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

  5. [Mitral valve replacement in a patient with Sheehan's syndrome].

    Science.gov (United States)

    Morokuma, H; Nakayama, Y; Minematsu, N

    2008-09-01

    Sheehan' syndrome is caused by pituitary apoplexy occurring during parturition and results in hypopituitarism, adrenal insufficiency and hypothyroidism. A 66-year-old woman with Sheehan's syndrome had received corticosteroids and thyroid hormones for about 18 years. The patient underwent mitral valve replacement for mitral regurgitation. Intraoperatively, just after the initiation of cardiopulmonary bypass, hypotension and severe edema suddenly occurred. Crystalloid fluid was rapidly administered to increase intravascular volumes. Postoperatively the body weight increased by 9.4 kg. The patient was intubated for 64 hours, stayed in the intensive care unit (ICU) for 7 days and was discharged from hospital on the postoperative day 36. Careful perioperative hormone supplementation is necessary for patients with Sheehan's syndrome.

  6. Deep hypothermic circulatory arrest for hemiarch replacement in a pediatric patient with moyamoya disease.

    Science.gov (United States)

    Kuwajima, Ken; Yoshitani, Kenji; Kato, Shinya; Miyazaki, Atsushi; Kamei, Masataka; Ohnishi, Yoshihiko

    2014-08-01

    Moyamoya disease is a chronic cerebrovascular occlusive disease, occurring predominantly in young populations, that causes cerebral ischemia and hemorrhage. Patients with moyamoya disease are at high risk of neurological complications during cardiac surgery because of perioperative hemodynamic changes. However, there is no established evidence on temperature management during cardiopulmonary bypass. Previous reports described normothermia or mild to moderate hypothermia during cardiopulmonary bypass in patients with moyamoya disease; however, surgical conditions, such as not having enough space to clamp the aorta or a clean surgical field, sometimes force us to use deep hypothermic circuratory arrest. We report a successful case of a pediatric patient with moyamoya disease who underwent deep hypothermic circulatory arrest (18 °C) for hemiarch replacement without neurological complications. Deep hypothermia may be an alternative technique for achieving cerebral protection in the context of moyamoya disease.

  7. 不同手术时机行关节置换术对老年股骨颈骨折患者术后髋关节功能的影响%Different timing of surgery for joint replacement surgery on femoral neck fracture patients about harris indexes

    Institute of Scientific and Technical Information of China (English)

    尹虎

    2012-01-01

    Objective According to the assessment of the curative effect on different operation time of total hiparthroplasty for femoral neck fractures,to explore the effect of the different timing of surgery,itraoperative and postoperative blood loss,early postoperative complications and hip function recovery,and provide theoretical basis for selection of operation time of total hip arthroplasty for femoral neck fractures,to better guide clinical practice.Methods Retrospective analysis 90 femoral neck fracture patients with complete follow-up data for total hip arthroplasty,90 patients were divided into two groups,observation group was given the emergency surgery,the control group was given the delayed operation group.The differences of two groups about operation time,intraoperative blood loss,postoperative drainage,early postoperative complications and postoperative functional restoration of hip joint were compared.Results After 3 months follow-up,the comparison of operation time,intraoperative blood loss and postoperative drainage for the emergency operation group and the delayed operation group,the difference was statistically significant(t=2.37,15.38,22.73,all P<0.05).The emergency operation group and the delayed operation group in the postoperative complications,P>0.05,the difference was not statistically significant.After 1 month,the difference of the two groups of hip joint function by Harris score was statistically significant(t=2.76,P<0.05);and after 3 months,the difference was not statistically significant(P>0.05).Conclusion Emergency surgery can effectively shorten the operation time,reduce blood loss and postoperative drainage and conducive to the recovery of hip function in patients,reduce the pain caused by the disease,but the ultimate the hip function is not affected.%目的 探讨不同手术时机行全髋关节置换术治疗老年股骨颈骨折患者对术后髋关节功能的影响.方法 回顾性分析随访资料完整的全髋关节置换

  8. Measurement of the left ventricular regurgitation by gated cardiac blood pool scan: Before and after valvular replacement surgery

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    Shin, Sung Hae; Chung, June Key; Lee, Myung Chul; Cho, Bo Youn; Seo, Jung Don; Lee, Young Woo; Koh, Chang Soon; Suh, Kyung Phill; Lee, Yung Kyoon [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1982-09-15

    Quantification of the regurgitation amount is important before and after valvular replacement surgery. Until now cardiac catheterization with cine ventriculography, echocardiography have been used to measure the regurgitation amount, but also have many limitations EKG gated cardiac blood pool scan provides a simple, non-invasive method for quantify the regurgitation amount. By calculating the ratio of left ventricular to right ventricular stroke counts (stroke volume ratio) in gated blood pool scan, we measured the left ventricular regurgitation amount in 28 cases of valvular regurgitation and 25 cases of normal group. 1) Stroke volume ratio was higher in cases of valvular regurgitation(2.11+-0.58) than in cases of normal control(l.15+-0.31). (p<0.01). 2) Stroke volume ratio was classified by regurgitation grade using X-ray cine ventriculography. In grades of mild regurgitation(Grade I-II), stroke volume ratio was 2.02+-0.29, and in grades of severe regurgitation(Grade III-IV), stroke volume ratio was 2.55+-0.34, so stroke volume ratio was well correlated with the grade of X-ray cine ventriculography. 3) Stroke volume ratio was classified by functional class made in New York Heart Association. In classes of mild regurgitation (class I-II), stroke volume ratio was 2.08+-0.26, and in classes of severe regurgitation (class III-IV), stroke volume ratio was 2.55+-0.38, Stroke volume ratio well represented the functional class. 4) After aortic and mitral valve replacement in 28 patients, the stroke volume ratio decreased from 2.11+-0.58 to 1.06+-0.26. Gated blood pool scan provides a noninvasive method of quantifying valvular regurgitation and assessing the result of surgical interventions.

  9. Assessment Of Patient Problems Encountered With Total Hip Replacement At Baghdad Teaching Hospitals

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    Faris Fauze Ahmed

    2015-08-01

    Full Text Available Abstract Background Total hip replacements conduct highly effective in relieving pain dysfunction for patients who suffer from hip inflammation and a variety of reasons however after several decades of success in hip replacement there was also an increase in cases of fractures after you perform a detailed switch and attributed this The increase in the prevalence of a large fraction of the increase in the number of switch detailed and increasing age and poverty operations. Objectives The study aims toAssess the pre operation physical and psychosocial problems of patients with total hip replacement. To Assess the post operation physical and psychosocial problems of patients with total hip replacement. To find out the relationship between pre post physical and psychosocial problems with age gender duration of illness and type of operation. Design of the study A descriptive design study was carried out in Nursing Home hospital and Ghazi AL-Hariri for specialized surgical hospitals starting from January 13th 2015 to September 1st 2015 The study Sample A non- probability purposive sample of 50 patients undergoing total hip replacement surgery who have several problems before and after surgery. The study Instrument The study instrument was composed of three parts which as socio demographic information was included age group gender marital status level of education occupational economic part two consist of medical information was comprised of 7 items and part three contain physical and psychosocial problems through Hamilton anxiety scale consist of 84 items. Validity and Reliability The content validity of the instrument was established through a panel of 14 experts the reliability of the items was based on the internal consistency of the questionnaire was assessed by calculating Cronbach s Coefficient alpha which as 0.73. Statistical Analysis The researchers used the appropriate statistical methods for data analysis which include the descriptive data

  10. Replacement of the tumor bed following oncoplastic breast-conserving surgery with immediate latissimus dorsi mini-flap

    Science.gov (United States)

    Alço, Gül; Igdem, Sefik; Okkan, Sait; Dincer, Maktav; Sarsenov, Dauren; Ilgun, Ahmet Serkan; Agacayak, Filiz; Elbüken, Filiz; Ercan, Tulay; Selamoglu, Derya; Ozmen, Vahit

    2016-01-01

    The aim of the present study was to evaluate the geographic variability of the tumor bed following oncoplastic breast-conserving surgery (OP-BCS), and to assess its relevance for radiotherapy planning. In this prospective study, pre- and postoperative computerized tomography (CT) scans of 22 patients with early-stage breast cancer were fused. The preoperative gross tumor volume or excisional biopsy cavity were contoured under the guidance of preoperative radiological images. Postoperative lumpectomy cavities were contoured under the guidance of surgical clips. The conformity index (CI) was calculated and defined on a scale between 0 and 1, where 0 indicated no overlap and 1 indicated 100% concordance. Associations between CI and the number of clips, time interval between surgery and CT scans, pathological tumor size and age were assessed using independent sample testing. The median CI was 0.07 (in five cases, 1, and in eight cases, 0). The lumpectomy cavity shifted from the primary location in 36.4% of the cases. Median shifts between the isocenters of pre- and postoperative volumes were measured as 1.02 cm (range, 0.4–4.43 cm) in the x, 1.07 cm (range, 0.05–5.67 cm) in the y, and 1.12 cm (range, 0–3.75 cm) in the z directions. Only the clip number was determined to be significantly associated with CI (P=0.017). Pre- and postoperative tumor bed volumes were fully superposed in five of the 22 cases. The present study has shown that the tumor bed is markedly replaced following OP-BCS with latissimus dorsi mini-flap (LDMF) reconstruction. Special care should therefore be taken when defining the lumpectomy cavity following OP-BCS with LDMF reconstruction. PMID:27699027

  11. Incidence, Predictors, and Clinical Outcomes of Postoperative Cardiac Tamponade in Patients Undergoing Heart Valve Surgery.

    Science.gov (United States)

    You, Seng Chan; Shim, Chi Young; Hong, Geu-Ru; Kim, Darae; Cho, In Jeong; Lee, Sak; Chang, Hyuck-Jae; Ha, Jong-Won; Chang, Byung-Chul; Chung, Namsik

    2016-01-01

    This study aimed to investigate the incidence, predictors, and clinical outcomes of cardiac tamponade after heart valve surgery. A total of 556 patients who underwent heart valve surgery in a single tertiary center between January 2010 and March 2012 were studied. All patients underwent transthoracic echocardiography (TTE) about 5 days after surgery and TTE was repeated regularly. Patients with suspected acute pericardial hemorrhage were excluded. Cardiac tamponade occurred in twenty-four (4.3%) patients and all underwent surgical or percutaneous pericardial drainage. The median time of pericardial drainage after surgery was 17 (interquartile range, IQR, 13-30) days. Infective endocarditis, mechanical valve replacement of aortic or mitral valve, and any amount of pericardial effusion (PE) on the first postoperative TTE were related to the occurrence of cardiac tamponade (all ptamponade was associated with any amount of PE on the first postoperative TTE (hazard ratio, HR, 14.00, ptamponade was higher than those without (34.9 vs. 13.5, p = 0.031). After pericardial drainage, there was no echocardiographic recurrence of significant PE during a median of 34.8 (IQR 14.9-43.7) months after surgery. Cardiac tamponade after heart valve surgery is not uncommon. Patients with any amount of PE at the first postoperative TTE or mechanical valve replacement should receive higher attention with regard to the occurrence of cardiac tamponade. Although it prolongs hospital stay, cardiac tamponade exhibits a benign clinical course without recurrence after timely intervention.

  12. Urgent replacement of a mechanical mitral prosthesis in an anticoagulated patient with Bombay red blood cell phenotype.

    Science.gov (United States)

    Nairn, Travis K; Giulivi, Antonio; Neurath, Doris; Tokessy, Melanie; Sia, Ying T; Ruel, Marc; Wilkes, Peter R H

    2010-06-01

    Bombay red blood cell phenotype is an extremely rare blood type for which patients can receive only autologous or Bombay phenotype red blood cells. We report a case of urgent repeat sternotomy for replacement of a mechanical mitral prosthesis in a patient with Bombay phenotype anticoagulated with warfarin, to emphasize the transfusion challenges in such patients. A male of Indian descent presented to hospital with New York Heart Association IV symptoms. His medical history revealed previous mitral valve replacement with a mechanical prosthesis in 2005 and Bombay phenotype blood. Preoperative transthoracic echocardiography demonstrated thrombus obstruction of the mitral prosthesis despite anticoagulation with warfarin. Right ventricular systolic pressure was >100 mmHg with 3+ tricuspid regurgitation. The patient's condition was temporized with diuretics, bronchodilators, and bi-level positive airway pressure ventilation while transfusion medicine and cardiac surgery were consulted for urgent surgery. The patient received vitamin K and prothrombin complex concentrate prior to repeat sternotomy and successful mitral prosthesis replacement. After cardiopulmonary bypass, heparinization was corrected with protamine and followed by a second dose of prothrombin complex concentrate and recombinant activated factor VIIa. Postoperatively, the patient received four units of packed red blood cells, two autologous units and two units of Bombay specific red blood cells. Right ventricular pressures stabilized at 40 mmHg following surgery. The patient recovered following several days of inotropic support with milrinone, diuretics, and bronchodilators. Patients with Bombay phenotype red blood cells present as type O, but they are unable to receive red blood cells from any phenotype other than Bombay phenotype. They are able to receive all other blood products, including fresh frozen plasma, cryoprecipitate, platelets, prothrombin complex concentrate, and recombinant activated factor

  13. Delirium in elderly vascular surgery patients.

    Science.gov (United States)

    Cudennec, Tristan; Goëau-Brissonnière, Olivier; Coscas, Raphaël; Capdevila, Clément; Moulias, Sophi; Coggia, Marc; Teillet, Laurent

    2014-04-01

    The elderly represent a large percentage of patients seen in departments of vascular surgery. Delirium is a frequent perioperative complication in this population and contributes to increased morbidity and mortality. Prevention of problems associated with mental confusion rests in identifying comorbidities, their severity, and the risk factors associated with delirium syndrome. The aging of our population implies management of increasing numbers of older patients who often have concomitant pathologies and, consequently, polypharmacy. Optimization of their management rests on collaboration between surgeons, anesthetists, and geriatrists.

  14. Ankle replacement

    Science.gov (United States)

    Ankle arthroplasty - total; Total ankle arthroplasty; Endoprosthetic ankle replacement; Ankle surgery ... You may not be able to have a total ankle replacement if you have had ankle joint infections in ...

  15. Knee Replacement

    Science.gov (United States)

    Knee replacement is surgery for people with severe knee damage. Knee replacement can relieve pain and allow you to ... Your doctor may recommend it if you have knee pain and medicine and other treatments are not ...

  16. Patients' experiences of telerehabilitation at home after shoulder joint replacement.

    Science.gov (United States)

    Eriksson, Lisbeth; Lindström, Britta; Ekenberg, Lilly

    2011-01-01

    We investigated the experience of ten patients who received video-based physiotherapy at home for two months after a shoulder joint replacement. Videoconferencing took place via the patient's home broadband connection at a bandwidth of 256-768 kbit/s. Qualitative interviews were carried out, transcribed and analysed. Through qualitative content analysis six categories were identified: (1) a different reinforced communication; (2) pain-free exercising as an effective routine; (3) from a dependent patient to a strengthened person at home; (4) closeness at a distance; (5) facilitated daily living; and (6) continuous physiotherapy chain. The access to bodily knowledge, continuity, collaboration and being at home were all aspects that contributed to the patients' recovery. The patients described experiences of safety, and strengthening during their daily exercise routine at home. The frequent interplay with the patient during telerehabilitation made it possible for the physiotherapist to make an individual judgement about each patient; this could be one reason for the positive findings. Home video-based physiotherapy may be useful in other kinds of physiotherapy.

  17. 不同剂量右美托咪定对心肺转流风心瓣膜置换术患者心肌损伤的影响%Effect of different doses of dexmedetomidine on myocardial injury on cardiopulmonary bypass in patients with rheumatic heart valve replacement surgery

    Institute of Scientific and Technical Information of China (English)

    符炜; 顾尔伟; 王宏; 梅玫; 陈庆书; 赵浩

    2015-01-01

    Objective To investigate the effect of different doses of dexmedetomidine on myocardial injury (in perioperative peri‐od) on cardiopulmonary bypass (CPB) in patients with rheumatic heart valve replacement surgery .Methods Patients undertook rheumatic heart valve replacement surgery with mitral stenosis were divided into three groups (n=20) in randomized and double‐blind method :control group (group C) ,dexmedetomidine 0 .3 μg/kg group (DEX1 group) ,dexmedetomidine 0 .6 μg/kg group (DEX2 group) .Central venous blood was drawn respectively before anesthesia induction (T0 ) ,2h after CPB (T1 ) ,24 h after CPB (T2 ) ,48 h after CPB (T3 ) ,72 h after CPB (T4 ) .Plasma muscle calcium protein I (cTnI) and creatine kinase (CreatineKinase MB , CK‐MB) were measured and mean arterial pressure and heart rate were recorded at each time point .Furthermore ,extubation time , ICU stay ,postoperative inotropic score 24 h after operation ,drainage 24 h after operation ,cardio auto‐resuscitation rates and ad‐verse cardiovascular events were recorded .Results Compared with T0 ,HR was significantly lower in the T1 time point in DEX2 group .Compared with group C ,HR ,plasma CK‐MB ,inotropic score 24 h after operation and cardiovascular adverse events was sig‐nificantly reduced in the T1 time points in DEX1 group (P<0 .05) ,but the heart auto‐resuscitation rate did not significantly im‐proved .HR at T1 ,plasma CK‐MB values at T1 and T2 ,and plasma cTnI values at T2 -T4 were significantly reduced ;the heart re‐suscitation significantly increased ,myocardial contraction power ratings 24 h after operation and the incidence of cardiovascular e‐vents was significantly lower in DEX2 group (P<0 .05) .The extubation time ,ICU stay time and drainage 24 h after operation did not change significantly in both groups .Conclusion Dexmedetomidine has a protective effect on perioperative myocardial injury in patients with rheumatic heart valve replacement surgery ,and the

  18. Age and Comorbidities Affect Quality of Life in Patients With Osteoarthrtitis and Knee Replacement

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    Fernandez-Cuadros

    2016-08-01

    Full Text Available Background Osteoarthritis (OA is a multifactorial, disabling and degenerative disease that worsens with age and affects patient’s health-related quality of life (HRQOL. Objectives The current study aimed to assess if age and comorbidities have an influence on knee OA and knee replacement outcome before and after the surgery. Methods A quasi-experimental intervention study was conducted on a sample of 125 patients with knee osteoarthritis and designed to assess total knee arthroplasty (TKA outcomes before and after the surgery. One orthopedic surgeon performed all surgeries with the same type of joint prosthesis from 2008 to 2012. The HRQOL was assessed by the short form (36 health survey (SF-36 questionnaire. Results It was observed that knee osteoarthritis significantly affects all the dimensions of HRQOL before the surgery included in the SF-36 questionnaire and a clinical improvement observed after the intervention with total knee arthroplasty. Age influenced bodily pain (P = 0.012 and vitality (P = 0.002 in knee osteoarthritis (before the intervention, and on physical (P = 0.040 and mental health components (P = 0.002, after total knee arthroplasty. Previous arthroplasties and comorbidities had no effect on knee OA. However, previous total knee/hip arthroplasty were associated with the improvement in physical functioning (P = 0.021 after the TKA; comorbidities influenced the dimension of mental health (MH (P = 0.036 after the surgery. Conclusions Total knee arthroplasty is justified according to the perception of clinical improvement and the improvement in the dimensions of HRQOL reported by the patients. Age affects knee osteoarthritis and TKA outcomes. Comorbidities have no influence on knee OA, but affect mental health after the intervention.

  19. The Influence of Dexmedetomidine on Postoperative Cognitive Dysfunction (POCD) and Peri-operative Inflammation in the Elderly Patients Undergoing Total Hip Replacement Surgery%右美托咪定对老年髋关节手术患者早期认知功能和炎症因子的影响

    Institute of Scientific and Technical Information of China (English)

    方梅; 黄小冬; 禚海成; 张冰

    2012-01-01

    目的:观察右美托咪定对老年髋关节手术患者炎性细胞因子水平和术后认知功能的影响,为降低术后认知功能障碍(POCD)的发生提供理论参考.方法:60例择期在腰-硬联合阻滞麻醉下拟行全髋关节置换手术病人,按照术前给药方式的不同,随机分为观察组:静脉注射右美托咪定组(D组,30例)和对照组静脉注射等容量的生理盐水组(N组,30例);通过9组神经功能测验项目测定术前1d、术后第7d两组患者的术后认知功能;测定不同时点Ramsay镇静评分、血清白细胞介素-1(IL-1)、白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平.结果:60例患者均完成了神经功能测试.术后第7d认知功能障碍发生率右美托咪定组为20%(6/30),生理盐水组为50%(15/30),两组间差异有统计学意义(P<0.05).右美托咪定组T1~T5各时点血清IL-1、IL-6和TNF-α水平与对照组比较显著下降(P<0.05);Ramsay镇静评分比较术中镇静,右美托咪定组T1~T5各时点优于生理盐水组(P<0.01).结论:早期术后认知功能障碍是老年患者全髋置换手术的一个常见并发症,右美托咪定用于术中安全可行并可降低术后早期POCD的发生率,推测可能的机制与降低炎性反应有关.%Objective To observe the influence of dexmedetomidine on early postoperative cognitive dysfunction (POCD) and cytocaines in the elderly patients undergoing total hip replacement surgery. Besides, attempt to offer some references theoretically. Methods Sixty elderly patients undergoing elective total hip replacement surgery by combined spinal-epidural anesthesia were randomly allocated to receive either dexmedetomidine(DEX)intravenously (group D,30cases) or the same volume of normal saline instead (group N,30cases). Cognitive function was assessed before operation one day and on the 7th postoperative day using a battery of nine neuropsychological tests. Ramsay sedation scale and interleukin(IL)-1β, interleukin-6

  20. Cardiac surgery in a patient with immunological thrombocytopenic purpura: Complications and precautions

    Directory of Open Access Journals (Sweden)

    Vivek Chowdhry

    2013-01-01

    Full Text Available Immune thrombocytopenic purpura (ITP patients are at high-risk for bleeding complications during and after cardiac surgeries involving cardiopulmonary bypass. We report a patient with ITP with severe coronary artery disease and mitral valve regurgitation who underwent uncomplicated coronary artery bypass grafting and mitral valve replacement. Three weeks later, the patient was readmitted in a very low general condition with signs of pericardial tamponade. We describe our experience of managing the case.

  1. Nutrition support to patients undergoing gastrointestinal surgery

    Directory of Open Access Journals (Sweden)

    Ward Nicola

    2003-12-01

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

  2. Bone replacement following dental trauma prior to implant surgery--status.

    Science.gov (United States)

    Hallman, Mats; Mordenfeld, Arne; Strandkvist, Tomas

    2009-02-01

    Dento-alveolar trauma often leads to a need for reconstruction of the alveolar crest before an implant can be placed. Although autogenous bone grafts is considered the 'gold standard', this may be associated with patient morbidity and graft resorption. Consequently, the use of bone substitutes has increased. Today, a substantial number of biomaterials are available on the market, but only a few are well documented. The user should be aware that these biomaterials have different properties: resorbable or non-resorbable, time of resorption and resorption mechanism. The purpose of this review is to describe the function of various bone substitutes and indications for their use in reconstructive implant surgery and to give an overview of the current situation.

  3. Comparison of preoperative anxiety in reconstructive and cosmetic surgery patients.

    Science.gov (United States)

    Sönmez, Ahmet; Bişkin, Nurdan; Bayramiçli, Mehmet; Numanoğlu, Ayhan

    2005-02-01

    Surgery is a serious stressor and a cause of anxiety for the patients. Reconstructive surgery patients are mostly operated on because of certain functional impairment or disability; on the contrary, cosmetic surgery patients do not have any physical impairment and they are operated on because of mostly psychologic reasons. The aim of this study was to compare the anxiety levels in the reconstructive surgery patients and cosmetic surgery patients preoperatively. Thirty-two patients in the reconstructive surgery group and 30 patients in the cosmetic surgery group were included in the study. State Trait Anxiety Inventory was used to measure the anxiety levels in these 2 groups preoperatively. The 2 groups were similar in characteristics such as age, gender distribution, number of previous operations, and trait anxiety scores. Mean state anxiety scores obtained for the reconstructive surgery group was 38.0 +/- 8.7, while it was 44.2 +/- 10.79 for the cosmetic surgery group (t test, degrees of freedom = 60, P = 0.015). This study reveals that preoperative anxiety levels in the cosmetic surgery patients are higher than those of the reconstructive surgery patients. Therefore, adequate preoperative preparation for cosmetic surgery should include attempts to cope with anxiety. Anxiolytics may be used more liberally and professional psychologic assistance may be required.

  4. Ten-year survival of cemented total knee replacement in patients aged less than 55 years.

    Science.gov (United States)

    Keenan, A C M; Wood, A M; Arthur, C A; Jenkins, P J; Brenkel, I J; Walmsley, P J

    2012-07-01

    We report the ten-year survival of a cemented total knee replacement (TKR) in patients aged 55 years at the time of surgery, and compare the functional outcome with that of patients aged > 55 years. The data were collected prospectively and analysed using Kaplan-Meier survival statistics, with revision for any reason, or death, as the endpoint. A total of 203 patients aged 55 years were identified. Four had moved out of the area and were excluded, leaving a total of 221 TKRs in 199 patients for analysis (101 men and 98 women, mean age 50.6 years (28 to 55)); 171 patients had osteoarthritis and 28 had inflammatory arthritis. Four patients required revision and four died. The ten-year survival using revision as the endpoint was 98.2% (95% confidence interval 94.6 to 99.4). Based on the Oxford knee scores at five and ten years, the rate of dissatisfaction was 18% and 21%, respectively. This was no worse in the patients aged 55 years than in patients aged > 55 years. These results demonstrate that the cemented PFC Sigma knee has an excellent survival rate in patients aged 55 ten years post-operatively, with clinical outcomes similar to those of an older group. We conclude that TKR should not be withheld from patients on the basis of age.

  5. [Aortic Valve Replacement Via a Partial Sternotomy in an Ankylosing Skeletal Hyperostosis Patient after Prophylactic Tracheostomy;Report of a Case].

    Science.gov (United States)

    Saito, Shogo; Misawa, Yoshio; Kurumisawa, Soki; Aizawa, Kei; Kawahito, Koji

    2017-07-01

    A 77-year-old man presented with exertional dyspnea. The patient had a history of ankylosing skeletal hyperostosis and sleep apnea syndrome. Echocardiographic examination revealed severe aortic valve regurgitation. The patient underwent a prophylactic tracheostomy 2 weeks before cardiac surgery to decrease his risk of perioperative respiratory failure. He successfully underwent aortic valve replacement through a lower partial sternotomy. His postoperative course was uneventful, and the tracheostoma was closed 6 months after the cardiac surgery.

  6. Association of Testosterone Replacement Therapy and the Incidence of a Composite of Postoperative In-hospital Mortality and Cardiovascular Events in Men Undergoing Noncardiac Surgery.

    Science.gov (United States)

    Argalious, Maged Y; You, Jing; Mao, Guangmei; Ramos, Daniel; Khanna, Sandeep; Maheshwari, Kamal; Trombetta, Carlos

    2017-09-01

    Whether patients on testosterone replacement therapy undergoing noncardiac surgery have an increased risk of postoperative in-hospital mortality and cardiovascular events remains unknown. We therefore sought to identify the impact of testosterone replacement on the incidence of a composite of postoperative in-hospital mortality and cardiovascular events in men undergoing noncardiac surgery. Data from male American Society of Anesthesiologists I through IV patients 40 yr or older who underwent noncardiac surgery between May 2005 and December 2015 at the Cleveland Clinic (Cleveland, Ohio) main campus were included. The primary exposure was preoperative testosterone use. The primary outcome was a composite of postoperative in-hospital mortality and cardiovascular events. We compared patients who received testosterone and those who did not using propensity score matching within surgical procedure matches. Among 49,273 patients who met inclusion and exclusion criteria, 947 patients on testosterone were matched to 4,598 nontestosterone patients. The incidence of in-hospital mortality was 1.3% in the testosterone group and 1.1% in the nontestosterone group, giving an odds ratio of 1.17 (99% CI, 0.51 to 2.68; P = 0.63). The incidence of myocardial infarction was 0.2% in the testosterone group and 0.6% in the nontestosterone group (odds ratio = 0.34; 99% CI, 0.05 to 2.28; P = 0.15). Similarly, no significant difference was found in stroke (testosterone vs. nontestosterone: 2.0% vs. 2.1%), pulmonary embolism (0.5% vs. 0.7%), or deep venous thrombosis (2.0% vs. 1.7%). Preoperative testosterone is not associated with an increased incidence of a composite of postoperative in-hospital mortality and cardiovascular events.

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

    Science.gov (United States)

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

    2015-01-01

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

  8. Time-driven activity based costing of total knee replacement surgery at a London teaching hospital.

    Science.gov (United States)

    Chen, Alvin; Sabharwal, Sanjeeve; Akhtar, Kashif; Makaram, Navnit; Gupte, Chinmay M

    2015-12-01

    The aim of this study was to conduct a time-driven activity based costing (TDABC) analysis of the clinical pathway for total knee replacement (TKR) and to determine where the major cost drivers lay. The in-patient pathway was prospectively mapped utilising a TDABC model, following 20 TKRs. The mean age for these patients was 73.4 years. All patients were ASA grade I or II and their mean BMI was 30.4. The 14 varus knees had a mean deformity of 5.32° and the six valgus knee had a mean deformity of 10.83°. Timings were prospectively collected as each patient was followed through the TKR pathway. Pre-operative costs including pre-assessment and joint school were £ 163. Total staff costs for admission and the operating theatre were £ 658. Consumables cost for the operating theatre were £ 1862. The average length of stay was 5.25 days at a total cost of £ 910. Trust overheads contributed £ 1651. The overall institutional cost of a 'noncomplex' TKR in patients without substantial medical co-morbidities was estimated to be £ 5422, representing a profit of £ 1065 based on a best practice tariff of £ 6487. The major cost drivers in the TKR pathway were determined to be theatre consumables, corporate overheads, overall ward cost and operating theatre staffing costs. Appropriate discounting of implant costs, reduction in length of stay by adopting an enhanced recovery programme and control of corporate overheads through the use of elective orthopaedic treatment centres are proposed approaches for reducing the overall cost of treatment. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Valve-sparing aortic root replacement and aortic valve repair in a patient with acromegaly and aortic root dilatation

    Directory of Open Access Journals (Sweden)

    Karel Van Praet

    2015-07-01

    Full Text Available Aortic regurgitation and dilatation of the aortic root and ascending aorta are severe complications of acromegaly. The current trend for management of an aortic root aneurysm is valve-sparing root replacement as well as restoring the diameter of the aortic sinotubular junction (STJ and annulus. Our case report supports the recommendation that in patients with acromegaly, severe aortic root involvement may indicate the need for surgery.

  10. Successful Tricuspid Valve Replacement in a Patient with Severe Pulmonary Arterial Hypertension and Preserved Right Ventricular Systolic Function

    Directory of Open Access Journals (Sweden)

    Jamil A. Aboulhosn

    2009-01-01

    Full Text Available A 56-year-old patient with severe pulmonary hypertension developed severe tricuspid regurgitation, right-sided heart failure, and congestive hepatopathy. She was transferred for possible lung transplant and/or tricuspid valve surgery. Clinical and echocardiographic assessment provided confidence that acute tricuspid valve failure was responsible for the decompensation and that tricuspid valve replacement despite pulmonary hypertension could be performed.

  11. CHADS2评分对心房颤动患者二尖瓣置换术围手术期脑卒中风险的预测作用%Predictive role of CHADS2 score for perioperative stroke risk in atrial fibrillation patients undergoing mitral valve replacement surgery

    Institute of Scientific and Technical Information of China (English)

    龚志云; 任崇雷; 姜胜利; 王明岩; 肖苍松; 高长青

    2016-01-01

    住院期间脑卒中的独立危险因素。 CHADS2评分对于预测房颤患者二尖瓣置换术围手术期脑卒中风险有一定价值,值得进一步研究。%Objective Ischemic stroke is a severe complication following cardiac surgery , but its risk factors remain unclear and need further study .This study assessed the predictive value of CHADS 2 scores for perioperative ischemic stroke among atrial fibrillation ( AF) patients undergoing mitral valve replacement surgery .Methods A total of 805 AF patients , with females accounting for 52.4%and at a mean age of (53.7 ±10.5) years, undergoing mitral valve replacement in our hospital from January 2005 to December 2014 were recruited in this study .Their CHADS2 scores were used to stratify the risk for perioperative stroke .The incidence of stroke during hospitalization was observed and compared between those with the score ≥2 and the score0.05).Multivariate logistic regres-sion analysis showed that the CHADS 2 score≥2 (OR=4.164, 95%CI:1.388-12.495;P=0.011) and application of recombinant human coagulation factor Ⅶa (OR=11.757, 95%CI:2.909-47.520; P=0.001) were independent risk factors for stroke during hospitalization .Conclusion There is an increased risk for stroke in the AF patients with higher CHADS 2 score after mitral valve replacement.CHADS2 score ≥2 is an independent risk factor for stroke during hospitalization .The score is of significant value in the prediction of perioperative ischemic stroke in the AF patients undergoing mitral valve replacement surgery and worth further study .

  12. A review of rapid prototyped surgical guides for patient-specific total knee replacement.

    Science.gov (United States)

    Krishnan, S P; Dawood, A; Richards, R; Henckel, J; Hart, A J

    2012-11-01

    Improvements in the surgical technique of total knee replacement (TKR) are continually being sought. There has recently been interest in three-dimensional (3D) pre-operative planning using magnetic resonance imaging (MRI) and CT. The 3D images are increasingly used for the production of patient-specific models, surgical guides and custom-made implants for TKR. The users of patient-specific instrumentation (PSI) claim that they allow the optimum balance of technology and conventional surgery by reducing the complexity of conventional alignment and sizing tools. In this way the advantages of accuracy and precision claimed by computer navigation techniques are achieved without the disadvantages of additional intra-operative inventory, new skills or surgical time. This review describes the terminology used in this area and debates the advantages and disadvantages of PSI.

  13. Human bones obtained from routine joint replacement surgery as a tool for studies of plutonium, americium and {sup 90}Sr body-burden in general public

    Energy Technology Data Exchange (ETDEWEB)

    Mietelski, Jerzy W., E-mail: jerzy.mietelski@ifj.edu.pl [Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Cracow (Poland); Golec, Edward B. [Traumatology and Orthopaedic Clinic, 5th Military Clinical Hospital and Polyclinic, Independent Public Healthcare Facility, Wroclawska 1-3, 30-901 Cracow (Poland); Orthopaedic Rehabilitation Department, Chair of Clinical Rehabilitation, Faculty of Motor of the Bronislaw Czech' s Academy of Physical Education, Cracow (Poland); Department of Physical Therapy Basics, Faculty of Physical Therapy, Administration College, Bielsko-Biala (Poland); Tomankiewicz, Ewa [Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Cracow (Poland); Golec, Joanna [Orthopaedic Rehabilitation Department, Chair of Clinical Rehabilitation, Faculty of Motor of the Bronislaw Czech' s Academy of Physical Education, Cracow (Poland); Physical Therapy Department, Institute of Physical Therapy, Faculty of Heath Science, Jagiellonian University, Medical College, Cracow (Poland); Nowak, Sebastian [Traumatology and Orthopaedic Clinic, 5th Military Clinical Hospital and Polyclinic, Independent Public Healthcare Facility, Wroclawska 1-3, 30-901 Cracow (Poland); Orthopaedic Rehabilitation Department, Chair of Clinical Rehabilitation, Faculty of Motor of the Bronislaw Czech' s Academy of Physical Education, Cracow (Poland); Szczygiel, Elzbieta [Physical Therapy Department, Institute of Physical Therapy, Faculty of Heath Science, Jagiellonian University, Medical College, Cracow (Poland); Brudecki, Kamil [Henryk Niewodniczanski Institute of Nuclear Physics, Polish Academy of Sciences, Radzikowskiego 152, 31-342 Cracow (Poland)

    2011-06-15

    The paper presents a new sampling method for studying in-body radioactive contamination by bone-seeking radionuclides such as {sup 90}Sr, {sup 239+240}Pu, {sup 238}Pu, {sup 241}Am and selected gamma-emitters, in human bones. The presented results were obtained for samples retrieved from routine surgeries, namely knee or hip joints replacements with implants, performed on individuals from Southern Poland. This allowed to collect representative sets of general public samples. The applied analytical radiochemical procedure for bone matrix is described in details. Due to low concentrations of {sup 238}Pu the ratio of Pu isotopes which might be used for Pu source identification is obtained only as upper limits other then global fallout (for example Chernobyl) origin of Pu. Calculated concentrations of radioisotopes are comparable to the existing data from post-mortem studies on human bones retrieved from autopsy or exhumations. Human bones removed during knee or hip joint surgery provide a simple and ethical way for obtaining samples for plutonium, americium and {sup 90}Sr in-body contamination studies in general public. - Highlights: > Surgery for joint replacement as novel sampling method for studying in-body radioactive contamination. > Proposed way of sampling is not causing ethic doubts. > It is a convenient way of collecting human bone samples from global population. > The applied analytical radiochemical procedure for bone matrix is described in details. > The opposite patient age correlations trends were found for 90Sr (negative) and Pu, Am (positive).

  14. Obesity Slows Recovery for Heart Surgery Patients: Study

    Science.gov (United States)

    ... page: https://medlineplus.gov/news/fullstory_167721.html Obesity Slows Recovery for Heart Surgery Patients: Study They' ... Aug. 10 in The Annals of Thoracic Surgery . "Obesity is a growing problem for society that has ...

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

    NARCIS (Netherlands)

    Ettema, R.G.A.

    2014-01-01

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

  16. Postoperative Fluid Overload is a Useful Predictor of the Short-Term Outcome of Renal Replacement Therapy for Acute Kidney Injury After Cardiac Surgery.

    Science.gov (United States)

    Xu, Jiarui; Shen, Bo; Fang, Yi; Liu, Zhonghua; Zou, Jianzhou; Liu, Lan; Wang, Chunsheng; Ding, Xiaoqiang; Teng, Jie

    2015-08-01

    To analyze the predictive value of postoperative percent fluid overload (PFO) of renal replacement therapy (RRT) for acute kidney injury (AKI) patients after cardiac surgery.Data from 280 cardiac surgery patients between 2005 January and 2012 April were collected for retrospective analyses. A receiver operating characteristic (ROC) curve was used to compare the predictive values of cumulative PFO at different times after surgery for 90-day mortality.The cumulative PFO before RRT initiation was 7.9% ± 7.1% and the median PFO 6.1%. The cumulative PFO before and after RRT initiation in intensive care unit (ICU) was higher in the death group than in the survival group (8.8% ± 7.6% vs 6.1% ± 5.6%, P = 0.001; -0.5[-5.6, 5.1]% vs 6.9[2.2, 14.6]%, P 731, and 0.752. PFO during the whole ICU stay ≥7.2% was determined as the cut-off point for 90-day mortality prediction with a sensitivity of 77% and a specificity of 64%. Kaplan-Meier survival estimates showed a significant difference in survival among patients with cumulative PFO ≥ 7.2% and PFO < 7.2% after cardiac surgery (log-rank P < 0.001).Postoperative cumulative PFO during the whole ICU stay ≥7.2% would have an adverse effect on 90-day short-term outcome, which may provide a strategy for the volume control of AKI-RRT patients after cardiac surgery.

  17. Pharmaceutical care on a heart failure patient combined with pulmonary fungal infection after mitral valve replacement surgery due to rheumatic heart disease%1例风湿性心脏病二尖瓣置换术后心衰合并肺部真菌感染患者的药学监护

    Institute of Scientific and Technical Information of China (English)

    陈星伟; 郑英丽; 王冉冉

    2015-01-01

    1例67岁女性患者,因风湿性心脏病、二尖瓣置换术后心衰入院治疗,入院时合并肺部感染、呼吸衰竭等多种疾病。入院后给予无创呼吸机辅助呼吸,抗凝、强心、利尿、化痰、平喘、抗感染等药物治疗。患者心衰症状逐渐改善,但胸片提示肺部感染加重,结合患者症状体征及辅助检查考虑真菌感染。针对患者的肺部真菌感染,临床药师建议加用伏立康唑(负荷剂量:6 mg·kg-1,q 12 h,维持剂量4 mg·kg-1,q 12 h)进行抗真菌治疗;针对患者国际标准化比值(INR)的波动,临床药师分析了药物间的相互作用对华法林抗凝强度的影响;并对患者由于使用噻嗪类利尿剂导致的电解质紊乱,抗菌药物可能导致的QT间期延长、尖端扭转型室速等不良反应进行了药学监护。经过15 d治疗,患者病情稳定转入普通病房继续治疗。%One 67-year-old female patient with pulmonary infection, respiratory failure and other diseases was hospitalized primary for rheumatic heart disease and heart failure after mitral valve replacement surgery. The patient was treated by non-invasive mechanical ventilation, and anticoagulation, cardiotonic, diuretic, eliminating sputum, antiasthmatic as well as anti-infectious drugs. The heart failure symptom of the patient improved, however the lung infection aggravated. Fungal infection was considered according to the clinical signs and laboratory examinations of the patient. Pharmaceutical cares were given to the patient by clinical pharmacists in respect of the selection and dose adjustment of the antifungal agent, fluctuations analysis of the international normalized ratio (INR) due to the interactions between the warfarin and other drugs, the treatment of electrolyte imbalance after long-term use of thiazide diuretic and monitoring the side effect of the antibacterials such as QT interval prolonged, ventricle speed torsade de pointe

  18. Open heart surgery in dialysis-dependent patients with end stage renal failure

    Directory of Open Access Journals (Sweden)

    Orkut Güçlü

    2013-09-01

    Full Text Available Objective: Patients with chronic renal insufficiency remaina risky subgroup in open heart surgery becauseof various reasons. The incidence of cardiovascular diseasein hemodialysis dependent renal failure is found tobe higher when compared with the normal population.Chronic dialysis is still a very important independent riskfactor for mortality and morbidity despite of many studies.In this study, we retrospectively evaluated the outcome ofpatients with chronic renal failure who had undergone toopen cardiac surgery.Methods: The medical charts of 36 patients on maintenancedialysis who underwent cardiovascular surgerywere retrospectively analyzed. Peroperative findings ofthese patients were analyzed from patients’ hospital records.Results: Twenty-seven men (75% and nine women(25% totally 36 patients were included to study. Themean age was 58.3±8.5 (range, 44-76 years. 12 patientsunderwent coronary artery bypass surgery, 10 hadconcomitant coronary artery bypass surgery and valvereplacements, five had valve replacements, three hadconcomitant coronary artery bypass surgery and left ventriculectomy,four had valve replacement with other valverepair, two had aortic surgery due to ascending aortic aneurysms.The mean cross clamp time was 78.1±31.3 minand the mean perfusion time was 158.8±92.2 min. Themean intensive care unit stay was 60±41 hours, and themean hospital stay was 12±5 days. Hospital mortality ratewas %38.8.Conclusions: Cardiac and renal functions are closely associatedwith each other. Cardiac surgery operations canbe applied to patients with end-stage renal failure underacceptable risks. Appropriate preoperative preparationwith good postoperative patient follow-up is necessary tohave acceptable levels of morbidity and mortality rates. JClin Exp Invest 2013; 4 (3: 335-338Key words: Cardiac surgery, chronic renal failure, mortality

  19. Computational Patient Avatars for Surgery Planning.

    Science.gov (United States)

    González, David; Cueto, Elías; Chinesta, Francisco

    2016-01-01

    In this paper a new method is described for the generation of computational patient avatars for surgery planning. By "patient avatar" a computational, patient-specific, model of the patient is meant, that should be able to provide the surgeon with an adequate response under real-time restrictions, possibly including haptic response. The method is based on the use of computational vademecums (F. Chinesta et al., PGD-based computational vademecum for efficient design, optimization and control. Arch. Comput. Methods Eng. 20(1):31-59, 2013), that are properly interpolated so as to generate a patient-specific model. It is highlighted how the interpolation of shapes needs for a specialized technique, since a direct interpolation of biological shapes would produce, in general, non-physiological shapes. To this end a manifold learning technique is employed, that allows for a proper interpolation that provides very accurate results in describing patient-specific organ geometries. These interpolated vademecums thus give rise to very accurate patient avatars able to run at kHz feedback rates, enabling not only visual, but also haptic response to the surgeon.

  20. Transcatheter Aortic Valve Replacement: The New Standard in Patients With Previous Coronary Bypass Grafting?

    Science.gov (United States)

    Reinöhl, Jochen; Kaier, Klaus; Reinecke, Holger; Frankenstein, Lutz; Zirlik, Andreas; Zehender, Manfred; von Zur Mühlen, Constantin; Bode, Christoph; Stachon, Peter

    2016-10-24

    The aim of this study was to assess how the introduction of transcatheter aortic valve replacement (TAVR) has changed clinical practice and outcome in patients who have previously undergone coronary artery bypass grafting (CABG). A significant proportion of patients admitted for aortic valve replacement have previously undergone CABG and are therefore at increased operative risk in case of redo surgery. In-hospital outcome data were analyzed from patients with or without previous CABG undergoing isolated surgical aortic valve replacement or TAVR in Germany from 2007 to 2013. In total, 32,581 TAVR and 55,992 surgical aortic valve replacement procedures were performed in patients with (n = 6,221) or without (n = 82,352) previous CABG. TAVR increased markedly in patients with previous CABG, from 18 procedures in 2007 to 1,191 in 2013, while surgical aortic valve replacement decreased in these patients from 471 to 179 procedures. In 2013, TAVR was the preferred therapy in almost 90% of patients with previous CABG. In-hospital mortality was increased in patients with previous CABG compared with those without (7.6% vs. 6.3% for TAVR and 7.2% vs. 2.6% for surgical aortic valve replacement). Bleeding and stroke rates were also increased with redo surgical aortic valve replacement procedures (with vs. without previous CABG: stroke, 3.2% vs. 1.8%; relevant bleeding, 29.6% vs. 13.4%; acute kidney injury, 4.2% vs. 2.9%), whereas this was not the case with TAVR (stroke, 2.1% vs. 2.6%; relevant bleeding, 7.3% vs. 8.3%; acute kidney injury, 6.3% vs. 5.4% respectively). A similar influence was seen in resource utilization (discharge destination home: TAVR after CABG, 51%; surgical aortic valve replacement after CABG, 31%). Since its introduction in 2007, TAVR has been increasingly used in Germany in patients with previous CABG, and in-hospital outcome data support the trend away from redo surgery. Copyright © 2016 American College of Cardiology Foundation. Published by

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

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

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

  2. Oral and maxillofacial surgery in patients

    Directory of Open Access Journals (Sweden)

    Stavros VASSILIOU

    2014-08-01

    Full Text Available Nowadays the trend is not to interrupt an- ticoagulants or antiplatelet drugs for minor oral surgery; They can be safely performed when the INR is 2-4. The suturing of the wound and the use of hemostatic agents reduces the possibility of postoperative bleeding. In cases of major maxillofacial interventions, the shortest possible interruption of anticoagulants is recommended in order to avoid the risk of thrombosis. The same applies to as- pirin, and in cases of dual therapy (aspirin and clopido- grel discontinuation of clopidogrel and low dose of as- pirin are recommended. In case of excessive bleeding, administration of clotting factors or fresh platelets is rec- ommended when the patient is on anticoagulants or an- tiplatelets respectively. In this literature study we report the older and the newer anticoagulants (dabigatran and rivaroxaban and an- tiplatelet drugs (prasugrel as well as the surgical man- agement of patients who take them.

  3. Acute kidney injury in patients undergoing cardiac surgery.

    Science.gov (United States)

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

    2013-01-01

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

  4. Predictably replacing maxillary incisors with implants using 3-D planning and guided implant surgery.

    Science.gov (United States)

    Wöhrle, Peter S

    2014-01-01

    Replacement of multiple adjacent teeth in the esthetic zone with dental implants is a surgical and restorative challenge, especially when an esthetic outcome is essential. Sound diagnosis and treatment planning can be combined with use of cone-beam computed tomography (CBCT) and 3-dimensional (3-D) software to achieve desired results. Placement of implants using guided surgical templates is critical when there is limited space between adjacent teeth or limited bone volume. Slight deviations in implant positioning during placement can lead to implants being too close to adjacent teeth, resulting in bone loss, recession, and encroachment upon adjacent papillae. Placement of implants in anatomically deficient or compromised areas is difficult when using a freehand drill protocol, because attaining the necessary precision cannot be achieved routinely. Esthetically demanding patients require precise implant placement. Use of guided surgical planning and implant placement enables the surgeon to take maximum advantage of available bone in anatomically restricted areas. Restoratively, ideal implant placement facilitates rehabilitation; therefore, all parameters must be observed in order to achieve an esthetically pleasing final restoration.

  5. Major surgery in an osteosarcoma patient refusing blood transfusion: case report

    Directory of Open Access Journals (Sweden)

    Shanmugam Rukmanikanthan

    2010-11-01

    Full Text Available Abstract We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.

  6. Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients.

    Science.gov (United States)

    Sidhu, Amarjit Singh; Singh, Ajay Pal; Singh, Arun Pal; Singh, Sukhraj

    2010-08-01

    Fifty-three patients with A2.2 and A2.3 intertrochanteric fracture according to the Muller classification were treated with total hip replacement between April 2000 and February 2004. The average age of the patients was 77 years. Average follow-up period was 3.7 years. We studied postoperative complications, mortality rate, functional outcome using the Harris hip score, time to return to normal activities, and radiographic evidence of healing. Two patients died on the third and fifth postoperative days. Seven more patients died within one year. The Harris hip score at one month was 66 +/- 7 (mean +/- standard deviation); at three months 72 +/- 6; at one year 74 +/- 5; at three years 76 +/- 6 and in the 27 patients who completed five year follow-up it was 76 +/- 8. Mobilisation and weight-bearing was started immediately in the postoperative period. Average time taken to return to normal daily activities was 28 days (range 24-33). No loosening or infection of the implants was observed. Total hip arthroplasty is a valid treatment option for mobile and mentally healthy elderly patients with intertrochanteric fractures. This procedure offers quick recovery with little risk of mechanical failure, avoids the risks associated with internal fixation and enables the patient to maintain a good level of function immediately after surgery.

  7. Current readings: long-term management of patients undergoing successful pediatric cardiac surgery.

    Science.gov (United States)

    DiBardino, Daniel J; Jacobs, Jeffrey P

    2014-01-01

    As of 2000, more adults than children are alive with congenital heart disease. Each year, more of these adults with congenital heart disease undergo surgery. Adults with congenital heart disease require lifelong surveillance, follow-up imaging, and clinical decision making by appropriately trained and familiar physicians and extenders. Three common challenges facing adults with congenital heart disease are the neglected patient, weak programmatic infrastructure, and the planning and management of pregnancy in the adult with congenital heart disease. Many challenges must be overcome in order to establish and maintain a comprehensive medical and surgical program for adults with congenital heart disease. Three common and challenging groups of adults with congenital heart disease who may require surgery are adults requiring tricuspid valve surgery for Ebstein's malformation, those requiring reoperation for failing Fontan circulation, and those requiring pulmonary valve replacement (PVR). Surgery for Ebstein's anomaly is now offered to older patients at low risk and with good late outcome. The operation includes tricuspid valve repair or replacement and frequent concomitant procedures such as atrial septal defect closure, arrhythmia surgery (the Maze procedure), and coronary artery bypass grafting. Patients undergoing previous iterations of the Fontan operation are especially prone to arrhythmia and failing circulation. Fontan conversion with arrhythmia surgery and pacemaker therapy was developed by Constantine Mavroudis, Barbara Deal, and Carl Backer to treat these challenging patients, with the first such operation performed in 1994. Fontan conversion involves: (1) conversion of the previously created atriopulmonary connection to a total cavopulmonary connection (TCPC), extracardiac Fontan; (2) arrhythmia surgery, typically with a modified biatrial Maze procedure along with placement of an antitachycardia, dual-chamber pacemaker with steroid-eluting epicardial leads

  8. Star GK Bileaflet Mechanical Valve Prosthesis-Patient Mismatch After Mitral Valve Replacement: A Chinese Multicenter Clinical Study

    Science.gov (United States)

    Cao, Hua; Qiu, Zhihuang; Chen, Liangwan; Chen, Daozhong; Chen, Qiang

    2015-01-01

    Background The aim of this study was to investigate the incidence and immediate and mid-term effects of heart valve prosthesis-patient mismatch (PPM) after mitral valve replacement using the GK bileaflet mechanical valve. Material/Methods A total of 493 cases of mechanical mitral valve replacement were performed in the departments of cardiac surgery in 7 hospitals from January 2000 to January 2008. The patients included 142 men and 351 women ages 21 to 67 (average age, 48.75). The patients were followed for 3 years after surgery. The effective orifice area index (EOAI), ≤1.2 cm2/m2, was detected during the follow-up period and was defined as PPM. The patients were assigned to either the PPM group or the non-PPM group. Finally, the preoperative, perioperative and postoperative indexes of the 2 groups of patients were compared. Results A total of 157 patients had PPM 3 years after surgery. The incidence of PPM was 31.84%. Sixty-three patients in the PPM group received a 25-mm GK bileaflet valve (40.13%), 82 received a 27-mm valve (52.23%), and 12 (7.64%) received a 29-mm valve. There were significant differences in length of intensive care unit stay, duration of ventilator use, length of hospitalization, body surface area, EOAI, mean transmitral pressure gradient, and pulmonary artery pressure between the PPM and non-PPM group (P0.05). Conclusions PPM after mitral valve replacement influences postoperative hemodynamics. Thus, larger-sized GK bileaflet mechanical valves are often used to reduce the risk of PPM. PMID:26313311

  9. Gallbladder surgery for Medicare patients in Mississippi.

    Science.gov (United States)

    Cobb, A B; Sanchez, N; Miller, D

    1994-10-01

    Mississippi Foundation for Medical Care (MFMC) conducted a review of gallbladder surgery performed on Mississippi Medicare Patients using hospital claims files and limited record review for verification of claims file data. Significant error rates in the surgeon identification number were found in the claims files. It should also be noted that the current ICD-9-CM coding system does not allow for identification of laparoscopic cholecystectomies converted to open procedures. Past studies have attempted to use claims data alone for these types of analyses. These findings demonstrate the importance of using caution by those attempting to use claims data (without verification) to define patterns of hospital utilization, clinical outcomes and/or physician profiling. Claims data must be tested for validity for reliable pattern analysis. In addition, considerable variation was found among providers in elements such as conversion rates, complication and readmission rates. A few surgeons showed patterns for critical variables that were quite different from the universe. There was however, no statistically significant differences associated between volume of cases performed and outcomes. Time frame comparisons over several years show significant (> 80%) increase in gallbladder surgery since the introduction of the laparoscopic procedure.

  10. Reoperation on aortic disease in patients with previous aortic valve surgery

    Institute of Scientific and Technical Information of China (English)

    SUN Xiao-gang; ZHANG Liang; YU Cun-tao; QIAN Xiang-yang; CHANG Qian

    2013-01-01

    Background Aortic valve replacement (AVR) is a safe and effective method in the treatment of aortic valve diseases.This study aimed to increase the understanding on re-treatment of aortic diseases after aortic valve surgery through a retrospective analysis of 47 related cases.Methods Forty-seven patients (38 males and 9 females) with previous aortic valve surgery have received reoperation on aorta from January 2003 to June 2012,and the mean interval time of re-intervention to aortic disease was 6 years ((6.0± 3.8) years).The secondary aortic surgery included aortic root replacement (14 cases),ascending aorta replacement (10 cases),aortic root/ascending aorta plus total arch replacement with stented elephant trunk implantation (21 cases),and total thoracoabdominal aorta replacement (2 cases).All these patients have received outpatient re-exams or follow-up by phone calls.Results After the initial aortic valve replacement,patients suffered from aortic dissection (25 cases,53%),ascending aortic aneurysm (12 cases,26%) or aortic root aneurysm (10 cases,21%).Diameter in ascending aorta increased (5.2±7.1) mm per year and aortic sinus (3.3±3.1) mm per year.The annual growth value of diameter in ascending aorta was higher in patients with rheumatic heart disease than that in Marfan syndrome (P<0.05).All 47 patients have received reoperation on aorta.One patient died in operating room because aortic dissection seriously involved right coronary artery.Seven patients had renal insufficiency after operation; neurological complications occurred in 14 patients including 7 patients with stroke and the others with transient brain dysfunction.All patients were followed up,the mean survival time was (97.25±17.63) months,95% confidence interval was 55.24-73.33 months.Eight cases were died during follow-up and five-year survival rate was 83%.Conclusion To reduce the aortic adverse events after first aortic valve surgery,it is necessary to actively treat and strictly

  11. Structural, Nursing, and Physician Characteristics and 30-Day Mortality for Patients Undergoing Cardiac Surgery in Pennsylvania.

    Science.gov (United States)

    Lane-Fall, Meghan B; Ramaswamy, Tara S; Brown, Sydney E S; He, Xu; Gutsche, Jacob T; Fleisher, Lee A; Neuman, Mark D

    2017-09-01

    Cardiac surgery ICU characteristics and clinician staffing patterns have not been well characterized. We sought to describe Pennsylvania cardiac ICUs and to determine whether ICU characteristics are associated with mortality in the 30 days after cardiac surgery. From 2012 to 2013, we conducted a survey of cardiac surgery ICUs in Pennsylvania to assess ICU structure, care practices, and clinician staffing patterns. ICU data were linked to an administrative database of cardiac surgery patient discharges. We used logistic regression to measure the association between ICU variables and death in 30 days. Cardiac surgery ICUs in Pennsylvania. Patients having coronary artery bypass grafting and/or cardiac valve repair or replacement from 2009 to 2011. None. Of the 57 cardiac surgical ICUs in Pennsylvania, 43 (75.4%) responded to the facility survey. Rounds included respiratory therapists in 26 of 43 (60.5%) and pharmacists in 23 of 43 (53.5%). Eleven of 41 (26.8%) reported that at least 2/3 of their nurses had a bachelor's degree in nursing. Advanced practice providers were present in most of the ICUs (37/43; 86.0%) but residents (8/42; 18.6%) and fellows (7/43; 16.3%) were not. Daytime intensivists were present in 21 of 43 (48.8%) responding ICUs; eight of 43 (18.6%) had nighttime intensivists. Among 29,449 patients, there was no relationship between mortality and nurse ICU experience, presence of any intensivist, or absence of residents after risk adjustment. To exclude patients who may have undergone transcatheter aortic valve replacement, we conducted a subgroup analysis of patients undergoing only coronary artery bypass grafting, and results were similar. Pennsylvania cardiac surgery ICUs have variable structures, care practices, and clinician staffing, although none of these are statistically significantly associated with mortality in the 30 days following surgery after adjustment.

  12. Perioperative Physiotherapy for Total Ankle Replacement in Patients with Inherited Bleeding Disorders: Outline of an Algorithm.

    Science.gov (United States)

    Kotela, Andrzej; Wilk-Frańczuk, Magdalena; Jaczewska, Joanna; Żbikowski, Piotr; Łęgosz, Paweł; Ambroziak, Paweł; Kotela, Ireneusz

    2017-01-27

    The treatment of end-stage hemophilic arthropathy of the ankle joint remains a controversial problem, and total ankle replacement (TAR) is considered to be a valuable management option. Physiotherapy continues to be an extremely important part of TAR and has a tremendous impact on the outcomes of this procedure. Given the lack of data on the latter, this study details a protocol of perioperative physiotherapy in TAR in patients with inherited bleeding disorders (IBD). The protocol outlined in this paper was devised via consultations within an interdisciplinary group, the authors' own experiences with TAR in hemophilic and non-hemophilic patients, previous reports on this issue in the literature, and patient opinions. Our working group followed the criteria of the International Classification of Functioning, Disability and Health. The algorithm includes 4 physiotherapy phases with specified time frames, aims, interventions, and examples of exercises for each phase. We emphasize the importance of preoperative rehabilitation, and recommend introducing intensive physiotherapy immediately after the surgery, with regard to the wound protection and avoiding full weight-bearing in the first weeks. The intensity of physiotherapy should be adjusted individually depending on individual patient progress. This study details a rehabilitation protocol for TAR in patients with IBDs, which can be equally applicable to clinicians and researchers. Further scientific studies are required to investigate the beneficial effect of different protocols as well as to clarify the effectiveness of various frequencies, durations, and intensities of selected interventions.

  13. Perioperative Physiotherapy for Total Ankle Replacement in Patients with Inherited Bleeding Disorders: Outline of an Algorithm

    Science.gov (United States)

    Kotela, Andrzej; Wilk-Frańczuk, Magdalena; Jaczewska, Joanna; Żbikowski, Piotr; Łęgosz, Paweł; Ambroziak, Paweł; Kotela, Ireneusz

    2017-01-01

    The treatment of end-stage hemophilic arthropathy of the ankle joint remains a controversial problem, and total ankle replacement (TAR) is considered to be a valuable management option. Physiotherapy continues to be an extremely important part of TAR and has a tremendous impact on the outcomes of this procedure. Given the lack of data on the latter, this study details a protocol of perioperative physiotherapy in TAR in patients with inherited bleeding disorders (IBD). The protocol outlined in this paper was devised via consultations within an interdisciplinary group, the authors’ own experiences with TAR in hemophilic and non-hemophilic patients, previous reports on this issue in the literature, and patient opinions. Our working group followed the criteria of the International Classification of Functioning, Disability and Health. The algorithm includes 4 physiotherapy phases with specified time frames, aims, interventions, and examples of exercises for each phase. We emphasize the importance of preoperative rehabilitation, and recommend introducing intensive physiotherapy immediately after the surgery, with regard to the wound protection and avoiding full weight-bearing in the first weeks. The intensity of physiotherapy should be adjusted individually depending on individual patient progress. This study details a rehabilitation protocol for TAR in patients with IBDs, which can be equally applicable to clinicians and researchers. Further scientific studies are required to investigate the beneficial effect of different protocols as well as to clarify the effectiveness of various frequencies, durations, and intensities of selected interventions. PMID:28129322

  14. Position controlled Knee Rehabilitation Orthotic Device for Patients after Total Knee Replacement Arthroplasty

    Science.gov (United States)

    Wannaphan, Patsiri; Chanthasopeephan, Teeranoot

    2016-11-01

    Knee rehabilitation after total knee replacement arthroplasty is essential for patients during their post-surgery recovery period. This study is about designing one degree of freedom knee rehabilitation equipment to assist patients for their post-surgery exercise. The equipment is designed to be used in sitting position with flexion/extension of knee in sagittal plane. The range of knee joint motion is starting from 0 to 90 degrees angle for knee rehabilitation motion. The feature includes adjustable link for different human proportions and the torque feedback control at knee joint during rehabilitation and the control of flexion/extension speed. The motion of the rehabilitation equipment was set to move at low speed (18 degrees/sec) for knee rehabilitation. The rehabilitation link without additional load took one second to move from vertical hanging up to 90° while the corresponding torque increased from 0 Nm to 2 Nm at 90°. When extra load is added, the link took 1.5 seconds to move to 90° The torque is then increased from 0 Nm to 4 Nm. After a period of time, the speed of the motion can be varied. User can adjust the motion to 40 degrees/sec during recovery activity of the knee and users can increase the level of exercise or motion up to 60 degrees/sec to strengthen the muscles during throughout their rehabilitation program depends on each patient. Torque control is included to prevent injury. Patients can use the equipment for home exercise to help reduce the number of hospital visit while the patients can receive an appropriate therapy for their knee recovery program.

  15. Mitral valve replacement with preservation of subvalvular apparatus in a patient with familial dextrocardia and situs solitus.

    Science.gov (United States)

    Khan, Junaid Fayyaz; Khan, Imran; Khan, Kamran

    2014-11-01

    Familial dextrocardia with situs solitus is extremely rare entity. Dextrocardia offers a difficult situation to surgeon. A different strategy for cannulation and approach to the left atrium has to be followed. Surgery in such settings has rarely been reported. We present the case of a patient with dextrocardia and situs solitus wherein a left sided approach was adopted for a better exposure of the valve. The patient had a rheumatic regurgitant mitral valve with ruptured chordae to anterior mitral leaflet. Since the valve was severely thickened, it was replaced rather than repaired. The left sided approach provided good exposure of the valve.

  16. Acute Type A Aortic Dissection Successfully Managed with One-stage Surgery of Total Aortic Arch Replacement with Supra-aortic Transposition Plus Frozen Elephant Trunk Technique

    Directory of Open Access Journals (Sweden)

    Meng-Lin Lee

    2014-09-01

    Full Text Available Acute type A aortic dissection has long been a challenging issue. The surgical techniques traditionally vary with the anatomic extent of the aortic dissection. Simple ascending aortic grafting can be lifesaving, but the lesions beyond the aorta, which include the arch vessels and descending aorta, remain potential hazards. In this paper, we present a patient in which acute type A aortic dissection with lesions extending into descending thoracic aorta was successfully managed by total arch replacement with supra-aortic transposition plus the frozen elephant trunk technique to the descending aorta. A 67-year-old gentleman presented with severe tearing pain from the anterior to posterior chest. Computed tomography confirmed the diagnosis of acute type A dissection extending to the level of the right common iliac artery. An emergent operation was performed as in the aforementioned technique. The surgery went well and the patient was discharged without comorbidities on postoperative day 25. The patient had regular outpatient clinical follow-up. The follow-up computed tomography images showed adequate results with the obliteration of the false lumen. In conclusion, total aortic arch replacement with supra-aortic transposition plus frozen elephant trunk technique is a safe and feasible operative method for patients with detrimental acute type A aortic dissection.

  17. Bicompartmental individualized knee replacement : Use of patient-specific implants and instruments (iDuo™).

    Science.gov (United States)

    Steinert, A F; Beckmann, J; Holzapfel, B M; Rudert, M; Arnholdt, J

    2017-02-01

    Bicompartmental knee replacement in patients with combined osteoarthritis (OA) of the medial or lateral and patellofemoral compartment. Patient-specific instruments and implants (ConforMIS iDuo™) with a planning protocol for optimal implant fit. Bicompartmental OA of the knee (Kellgren & Lawrence stage IV) affecting both the medial or lateral and patellofemoral compartment after unsuccessful conservative or joint-preserving surgery. Tricompartmental OA, knee ligament instabilities, knee deformities >15° (varus, valgus, extension deficit). Relative contraindication: body mass index >40; prior unicompartmental knee replacement or osteotomies. Midline or parapatellar medial skin incision, medial arthrotomy; identify mechanical contact zone of the intact femoral condyle (linea terminalis); remove remaining cartilage and all osteophytes that may interfere with the correct placement of the individually designed instruments. Balance knee in extension with patient-specific balancing chips. Resection of proximal tibia with an individual cutting block; confirm axial alignment using an extramedullary alignment guide, balance flexion gap using spacer blocks in 90° flexion. Final femur preparation with resection of the anterior trochlea. After balancing and identification of insert heights, final tibial preparation is performed. Implant is cemented in 45° of knee flexion. Remove excess cement and final irrigation, followed by closure. Sterile wound dressing; compressive bandage. No limitation of active/passive range of motion (ROM). Partial weight bearing the first 2 weeks, then transition to full weight bearing. Follow-up directly after surgery, at 12 and 52 weeks, then every 1-2 years. In all, 44 patients with bicompartmental OA of the medial and patellofemoral compartment were treated. Mean age 59 years. Minimum follow-up 12 months. Implant converted to TKA due to tibial loosening (1 patient); patella resurfacing (3 patients). No further revisions or

  18. The effects of growth hormone deficiency and replacement on glucocorticoid exposure in hypopituitary patients on cortisone acetate and hydrocortisone replacement.

    Science.gov (United States)

    Swords, F M; Carroll, P V; Kisalu, J; Wood, P J; Taylor, N F; Monson, J P

    2003-11-01

    11 beta-hydroxysteroid dehydrogenase type 1 (11 beta HSD1) converts inactive cortisone to active cortisol. 11 beta HSD1 activity is increased in GH deficiency and inhibited by GH and IGF-I in acromegaly. However it is not known whether these changes in cortisol metabolism exert significant effects during hydrocortisone therapy, and the effect has not been studied in patients taking cortisone acetate. We have studied the effect of GH induced 11 beta HSD1 inhibition in hypopituitary adults with severe GH deficiency to determine whether this inhibition has a different magnitude of effect when patients are taking different forms of glucocorticoid replacement therapy. We have taken the ratio of 11-hydroxy/11-oxo cortisol metabolites (Fm/Em), an established measure of net 11 beta HSD activity to reflect the likely balance of cortisol to cortisone exposure in tissues expressing 11 beta HSD1, principally the liver and adipose tissue. We recruited 10 hypopituitary adults all on established glucocorticoid replacement therapy, but who were not receiving GH. Patients were treated with their standard hydrocortisone therapy for one week and an equivalent dose of cortisone acetate in its place for one week in random order. Serial serum cortisol assessments and urine steroid profiles were performed on each treatment. All patients were then established on GH therapy for at least three months before the two-week cycle was repeated. Fm/Em was also measured in a control population (20F, 20M). Prior to GH, the ratio Fm/Em was greater with hydrocortisone compared with cortisone acetate replacement (1.17 +/- 0.28 and 0.52 +/- 0.09 respectively, P cortisol/cortisone did not change indicating unchanged 11 beta HSD2 activity. Mean circulating cortisol also fell in all subjects after GH. This effect was greater during cortisone acetate treatment (-18.7%, P tissue exposure to glucocorticoid is supra-physiological in hypopituitary patients with untreated GH deficiency taking hydrocortisone

  19. Intraoperative blood loss and blood transfusion requirements in patients undergoing orthognathic surgery.

    Science.gov (United States)

    Faverani, Leonardo Perez; Ramalho-Ferreira, Gabriel; Fabris, André Luis Silva; Polo, Tárik Ocon Braga; Poli, Guilherme Henrique Souza; Pastori, Cláudio Maldonado; Marzola, Clóvis; Assunção, Wirley Gonçalves; Garcia-Júnior, Idelmo Rangel

    2014-09-01

    Procedures for the surgical correction of dentofacial deformities may produce important complications, whether due to the potential for vascular injury or to prolonged surgery, both of which may lead to severe blood loss. Fluid replacement with crystalloid, colloid, or even blood products may be required. The aim of this study was to assess blood loss and transfusion requirements in 45 patients (18 males and 27 females; mean age 29.29 years, range 16-52 years) undergoing orthognathic surgery, assigned to one of two groups according to procedure type-rapid maxillary expansion or double-jaw orthognathic surgery. Preoperative hemoglobin and hematocrit levels and intraoperative blood loss were measured. There was a substantial individual variation in pre- and postoperative hemoglobin values (10.3-17 and 8.8-15.4 g/dL, respectively; p surgery and follow meticulous protocols to minimize the risks.

  20. Stress management training for breast cancer surgery patients

    NARCIS (Netherlands)

    Garssen, B.; Boomsma, M.F.; Ede, J. van; Porsild, T.; Berkhof, J.; Berbee, M.; Visser, A.; Meijer, S.; Beelen, R.H.

    2013-01-01

    OBJECTIVE: This study evaluated the psychological effects of a pre-surgical stress management training (SMT) in cancer patients. METHODS: Stress management training comprised four sessions in total: on 5 days and 1 day pre-surgery and on 2 days and 1 month post-surgery. Patients also received audio

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

    DEFF Research Database (Denmark)

    Jensen, Claus Hjorth; Rofail, S

    1999-01-01

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

  2. Body Dysmorphic Disorder in Patients With Cosmetic Surgery

    Directory of Open Access Journals (Sweden)

    Chung-Sheng Lai

    2010-09-01

    Full Text Available Body dysmorphic disorder (BDD refers to a preoccupation with an imagined or grossly exaggerated minor physical defect. Those with BDD might seek medical help (cosmetic surgery rather than attend a psychiatric clinic. Therefore, it is often underdiagnosed. To investigate the prevalence of BDD, we reviewed the medical records of 817 individuals who sought cosmetic surgery during a 3-year period. The outcome after surgery was described for those with BDD. Our results showed that 63 (7.7% patients had BDD, of which 54 (85.7% were diagnosed at preoperative evaluation. However, nine (14.3% patients went undiagnosed and all had a bad outcome after cosmetic surgery. BDD was not uncommon at the cosmetic surgery clinic. Our results support the idea that cosmetic surgery should be avoided for patients with BDD. The development of a more effective diagnostic procedure could help address this issue.

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

    Science.gov (United States)

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

    2016-11-23

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

  4. [Non-cardiac surgery in patients with cardiac disease].

    Science.gov (United States)

    Sellevold, Olav F Münter; Stenseth, Roar

    2010-03-25

    Patients with cardiac disease have a higher incidence of cardiovascular events after non-cardiac surgery than those without such disease. This paper provides an overview of perioperative examinations and treatment. Own experience and systematic literature search through work with European guidelines constitute the basis for recommendations given in this article. Beta-blockers should not be discontinued before surgery. High-risk patients may benefit from beta-blockers administered before major non-cardiac surgery. Slow dose titration is recommended. Echocardiography should be performed before preoperative beta-blockade to exclude latent heart failure. Statins should be considered before elective surgery and coronary intervention (stenting or surgery) before high-risk surgery. Otherwise, interventions should be evaluated irrespective of planned non-cardiac surgery. Patients with unstable coronary syndrome should only undergo non-cardiac surgery on vital indications. Neuraxial techniques are optimal for postoperative pain relief and thus for postoperative mobilization. Thromboprophylaxis is important, but increases the risk of epidural haematoma and requires systematic follow-up with respect to diagnostics and treatment. Little evidence supports the use of different anaesthetic methods in cardiac patients that undergo non-cardiac surgery than in other patients. Stable circulation, sufficient oxygenation, good pain relief, thromboprophylaxis, enteral nutrition and early mobilization are important factors for improving the perioperative course. Close cooperation between anaesthesiologist, surgeon and cardiologist improves logistics and treatment.

  5. Primary hypothyroidism in the community: Lower daily dosages of levothyroxine replacement therapy for Asian patients.

    Science.gov (United States)

    Tan, Ngiap Chuan; Chew, Rong Quan; Koh, Yi Ling Eileen; Subramanian, Reena Chandini; Sankari, Usha; Meyappan, Meykkumar; Cho, Li Wei

    2017-02-01

    The goal of treatment in patients with primary hypothyroidism is to attain euthyroidism guided by the stipulated thyroid-stimulating hormone (TSH) levels range so as to minimize any potential long-term adverse effects. However, various factors may result in their Levothyroxine (T4) under and over-replacement.Our study aimed to evaluate the mean daily dose of L-T4 replacement for Asian patients with primary hypothyroidism. The secondary aims were to determine the proportion of those who were either over or under-replaced, and the factors associated with their thyroid function status and replacement adherence.Data collected using questionnaire survey from targeted patients managed in a typical public primary care center in Singapore: socio-demographic characteristics, clinical parameters, laboratory investigations, mean daily L-T4-replacement doses, and replacement regimens. The thyroid status of patients was classified based on thyroid function investigations.Complete data of 229 patients were analyzed. A total of 59.8% of patients had TSH within the normal range, 27.5% and 12.7% were under and over-replaced, respectively. About 60% of Asian patients with primary hypothyroidism achieved normal TSH status requiring average of 1.1 μg of daily L-T4/kgBW (kg body weight). Subjects who were over-replaced had a higher daily L-T4 dose/kgBW when compared to the euthyroid and the under replaced groups. Those with L-T4 over-replacement were largely due to excessive dosage. Patients who were younger, from lower socioeconomic strata, and higher BMI were more likely to be over or under-replaced.Majority of Asian patients with hypothyroidism required replacement of 1.1 μg of daily L-T4/kgBW. Their thyroid status was influenced by demographic and dosing factors.

  6. After massive weight loss: patients' expectations of body contouring surgery.

    Science.gov (United States)

    Kitzinger, Hugo B; Abayev, Sara; Pittermann, Anna; Karle, Birgit; Bohdjalian, Arthur; Langer, Felix B; Prager, Gerhard; Frey, Manfred

    2012-04-01

    Massive weight loss following bariatric surgery leads to excess skin with functional and aesthetic impairments. Surplus skin can then contribute to problems with additional weight loss or gain. The aims of the current study were to evaluate the frequency of massive soft tissue development in gastric bypass patients, to determine whether males and females experience similar post-bypass body changes, and to learn about the expectations and impairments related to body contouring surgery. A questionnaire addressing information on the satisfaction of body image, quality of life, and expectation of body contouring surgery following massive weight loss was mailed to 425 patients who had undergone gastric bypass surgery between 2003 and 2009. Of these 425 individuals, 252 (59%) patients completed the survey. Ninety percent of women and 88% of men surveyed rated their appearance following massive weight loss as satisfactory, good, or very good. However, 96% of all patients developed surplus skin, which caused intertriginous dermatitis and itching. In addition, patients reported problems with physical activity (playing sports) and finding clothing that fit appropriately. Moreover, 75% of female and 68% of male patients reported desiring body contouring surgery. The most important expectation of body contouring surgery was improved appearance, followed by improved self-confidence and quality of life. Surplus skin resulting from gastric bypass surgery is a common issue that causes functional and aesthetic impairments in patients. Consequently, this increases the desire for body contouring surgery with high expectations for the aesthetic outcome as well as improved life satisfaction.

  7. Correlation between single nucleotide polymorphisms in CYP4F2 and warfarin dosing in chinese valve replacement patients

    Directory of Open Access Journals (Sweden)

    Li Jie-Hui

    2012-09-01

    Full Text Available Abstract Background Individuals with implanted mechanical valve prostheses require lifelong anticoagulation therapy with warfarin. The narrow therapeutic index of warfarin makes it difficult to dose and maintain proper anticoagulation. A number of single nucleotide polymorphisms (SNPs affecting vitamin K or warfarin metabolism have been shown to affect warfarin dosing. Our aim was to study the effect of the CYP4F2 rs2108622-1347 (C > T variant on warfarin dosing in Chinese patients. Methods We studied 352 patients after heart valve replacement surgery. Warfarin dosing for patients was adjusted to achieve 1.8 ≤ INR ≤ 2.5. We determined the presence of SNPs in CYP4F2 in these patients and investigated their association with warfarin dosing. Results We found the frequency of the CYP4F2 rs2108622 C allele was 79.5% and T-allele frequency was 20.5%. The warfarin dose requirement for CC individuals was significantly lower than that for CT or TT individuals (P  Conclusions This study demonstrates that CYP4F2 rs2108622 significantly affects the warfarin dose requirement to achieve adequate anticoagulant activity in Chinese individuals. Genotyping of this SNP may allow clinicians to determine the initiation dose for patients following valve-replacement surgery in China.

  8. Anesthetic management for combined mitral valve replacement and aortic valve repair in a patient with osteogenesis imperfecta

    Directory of Open Access Journals (Sweden)

    Huang Jiapeng

    2011-01-01

    Full Text Available Osteogenesis imperfecta is a rare disorder of connective tissues and presents multiple challenges, including difficult airway, hyperthermia, coagulopathy and respiratory dysfunction, for anesthesiologists, especially during cardiac surgery. We present anesthetic management of a patient with osteogenesis impertecta during double valve surgery. Dexmedetomidine infusion minimized the risks of malignant hyperthermia. Glidescope and in-line stabilization facilitated endotracheal intubation and protected his oral structures and cervical spine. Transesophageal echocardiography (TEE diagnosed a flail A3 segment and redundant left coronary cusp causing mitral and aortic regurgitation. The mitral valve was replaced and the aortic valve repaired. Coagulopathy was corrected according to comprehensive coagulation analysis. Glidescope, dexmedetomidine, coagulation analysis and TEE could facilitate anesthetic management in these patients.

  9. Transcatheter Aortic Valve Replacement in a Patient With a Previous Bioprosthetic Mitral Valve Replacement: Report of a Delayed Fatal Interaction.

    Science.gov (United States)

    Poulin, Frédéric; Lamarche, Yoan; Le, Van Hoai Viet; Doucet, Michel; Roméo, Philippe; Généreux, Philippe

    2016-02-01

    We report on a man with bioprosthetic mitral valve perforation who presented late after transcatheter aortic valve replacement with a balloon-expandable transcatheter heart valve (THV). The protrusion of the commissural strut of the bioprosthetic mitral valve coupled with the low implanted THV resulted in repetitive trauma leading to rupture of a mitral leaflet. Potential preventive strategies are discussed. This case illustrates the importance of preprocedural imaging screening and cautious THV deployment in patients with a bioprosthetic mitral valve.

  10. [Preparation of patients on anticoagulant treatment for invasive surgery].

    Science.gov (United States)

    Brejcha, M; Gumulec, J; Penka, M; Klodová, D; Wróbel, M; Bogoczová, E

    2009-03-01

    The management of warfarin therapy in patients undergoing surgery or other invasive procedures involves a balance between the risk of hemorrhage, and the risk of thrombosis. Risk of hemorrhage and the trombosis depends on the type of procedure and on pre-existing conditions. Procedures with low risk of hemorrhage (dental, dermatologic or ophtalmologic procedures, endoscopy) can be provided with continuing anticoagulant therapy. Surgery with high hemorrhagic risk need stop warfarin and start bridging anticoagulant therapy, such as unfractionated heparin or low molecular weight heparin, prior and after surgery. In patients requiring emergency surgery, vitamin K, prothrombin complex concentrate or fresh frozen plasma can be used to improve coagulation.

  11. A Systematic Review Investigating the Presence of Inflammatory Synovitis in Hip and Knee Joint Replacement Surgery

    Directory of Open Access Journals (Sweden)

    Sherif Hosny

    2015-01-01

    Full Text Available Synovial tissue can display an inflammatory response in the presence of OA. There is increasing interest to better understand the role of inflammation in OA, particularly with regard to those who require joint replacement. A systematic review of inflammatory synovitis in OA of literature databases was undertaken from their inception until October 14, 2014. Independent critical appraisal of each study was undertaken using the CASP appraisal tool. From a total of sixty-six identified citations, twenty-three studies were deemed eligible for review. The studies presented moderate to strong methodological quality. Strong correlation was identified between histological and imaging synovitis severity. Correlation was weaker between clinical symptoms and imaging and/or histological synovitis severity. There was little consensus, with regard to expressed cytokines and chemokines at the different stages of OA disease progression. Few studies investigated the influence of inflammatory synovitis on the outcome of major joint replacement. Research into inflammatory synovitis in OA is an emerging field. Longitudinal studies applying proven imaging modalities, histological analysis, and longer follow-up are required in order to further define our understanding of the role of synovitis in the pathogenesis of OA and its effects on outcomes following major joint replacement.

  12. Comparative analysis of pain in patients who underwent total knee replacement regarding the tourniquet pressure

    Directory of Open Access Journals (Sweden)

    Marcos George de Souza Leão

    Full Text Available ABSTRACT OBJECTIVES: To evaluate through the visual analog scale (VAS the pain in patients undergoing total knee replacement (TKR with different pressures of the pneumatic tourniquet. METHODS: An observational, randomized, descriptive study on an analytical basis, with 60 patients who underwent TKR, divided into two groups, which were matched: a group where TKR was performed with tourniquet pressures of 350 mmHg (standard and the other with systolic blood pressure plus 100 mmHg (P + 100. These patients had their pain assessed by VAS at 48 h, and at the 5th and 15th days after procedure. Secondarily, the following were also measured: range of motion (ROM, complications, and blood drainage volume in each group; the data were subjected to statistical analysis. RESULTS: After data analysis, there was no statistical difference regarding the incidence of complications (p = 0.612, ROM (p = 0.202, bleeding after 24 and 48 h (p = 0.432 and p = 0.254 or in relation to VAS. No correlation was observed between time of ischemia compared to VAS and bleeding. CONCLUSIONS: The use of the pneumatic tourniquet pressure at 350 mmHg or systolic blood pressure plus 100 mmHg did not influence the pain, blood loss, ROM, and complications. Therefore the pressures at these levels are safe and do not change the surgery outcomes; the time of ischemia must be closely observed to avoid major complications.

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

    Directory of Open Access Journals (Sweden)

    Karmel L. Tambunan

    2009-12-01

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

  14. Knee Replacement: What you can Expect

    Science.gov (United States)

    ... improves function lessen with each additional surgery. Artificial knees can wear out Another risk of knee replacement ... replacement surgery to last about two hours. After knee replacement surgery After surgery, you're wheeled to ...

  15. INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY.

    Science.gov (United States)

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

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

  16. High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik;

    2015-01-01

    Background and purpose - Patient satisfaction is important in fast-track total hip and knee replacement (THR, TKR). We assessed: (1) how satisfied patients were with the treatment; (2) factors related to overall satisfaction; and (3) whether there was a difference between THR and TKR regarding...... length of stay (LOS) and patient satisfaction. Patients and methods - In this follow-up study, a consecutive series of 445 patients undergoing THR and TKR completed a questionnaire 2 weeks after discharge. LOS and short-term patient satisfaction with the fast-track management were measured. Patient...... satisfaction was measured using a numerical rating scale (NRS; 0-10). Results - For THR, the median satisfaction score was 9-10 and for TKR it was 8.5-10 in all parameters. Older THR patients had higher overall satisfaction. No association was found between overall satisfaction following THR or TKR and sex...

  17. The bariatric surgery patient for non-bariatric surgery

    African Journals Online (AJOL)

    and cardiac risk analysis will determine whether or not formal testing, beyond a chest ... and a slower heart rate recovery (decreased vagal tone).5. Tests used in ... Comprehensive history, clinical examination and laboratory investigations. Low-risk patient .... be initiated early in labour, and can be used for anaesthesia if the.

  18. [Evaluation of the antithrombotic strategy in low thrombotic risk patients who underwent aortic valve replacement wth bioprosthesis].

    Science.gov (United States)

    Aceves-Velázquez, Eduardo; Vieyra-Herrera, Gerardo; Rodríguez-Chávez, Laura; Herrera-Alarcón, Valentín

    2017-07-15

    According to current guidelines, in patients without additional risk factors who underwent aortic valve replacement with a bioprosthesis, anticoagulation in the first 3 months after surgery is still a matter of debate. According to current evidence, aspirin in low doses is a reasonable alternative to vitamin K antagonists (VKA). We compared the incidence of thrombotic and hemorrhagic complications in patients with low thrombotic risk who underwent aortic valve replacement with a bioprosthesis in the National Institute of Cardiology of Ignacio Chávez of Mexico. The hypothesis: aspirin as monotherapy has a beneficial effect compared to VKA. The studied patients were the low thrombotic risk patients who underwent aortic valve replacement with a bioprostesis in the National Institute of Cardiology of Ignacio Chávez of Mexico from 2011 to 2015. The groups studied were: aspirin only, VKA only and the combination of VKA plus aspirin. The patients were retrospectively followed during 12 months and the thrombotic and hemorrhagic complications were documented. Two hundred thirty-one patients were analized. Only one patient presented a hemorrhagic complication in the VKA only group. No thrombotic complications were observed. In the present study no thrombotic complications were observed in patients who did not receive anticoagulation in the first 3 months after a aortic valve replacement with a bioprosthesis after a follow up period of 12 months. This suggests that the use of aspirin only is safe during this period. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  19. Conversions from anatomic shoulder replacements to reverse total shoulder arthroplasty: do the indications for initial surgery influence the clinical outcome after revision surgery?

    Science.gov (United States)

    Holschen, Malte; Franetzki, Bastian; Witt, Kai-Axel; Liem, Dennis; Steinbeck, Jörn

    2017-02-01

    The most frequent indications for anatomic shoulder replacement are glenohumeral osteoarthritis and fractures of the humeral head. If anatomic shoulder prostheses fail, reverse total shoulder arthroplasty is often the only remaining treatment option. This study evaluates the influence of indications for primary shoulder arthroplasty on the clinical outcome after conversion to reverse total shoulder arthroplasty. From 2010 to 2012, 44 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty. Forty-four patients were available for follow-up after a mean of 24 months (14-36 months). Twenty-three of them had received an initial shoulder replacement because of osteoarthritis, while the remaining 21 patients had been treated for a fracture of the humeral head. At follow-up, patients were assessed with X-rays, constant-, and ASES scores. The total number of observed complications was higher in patients revised because of failed fracture arthroplasty (24 vs. 9%). Patients initially treated for osteoarthritis achieved a higher ASES score (71 vs. 59 points; p = 0.048). The normalized constant score was not different between the two observed groups (osteoarthritis 73% vs. fracture 67%: p = 0.45). Complications occurred more often in patients who had initially suffered from a fracture of the humeral head (fracture 23.8% vs. osteoarthritis 8.7%). Scapular notching was more frequent after initial fracture arthroplasty (33 vs. 14%). Indications for initial shoulder replacement have an influence on the clinical outcome after conversion to reverse total shoulder arthroplasty. Patients initially treated for a fracture of the humeral head have a lower subjective outcome and a higher complication rate in comparison with patients initially treated for osteoarthritis. IV (Retrospective study).

  20. Nutrition Care for Patients with Weight Regain after Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    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.

  1. Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery.

    Science.gov (United States)

    Mahesh, Balakrishnan; Wells, Francis; Nashef, Samer; Nair, Sukumaran

    2013-01-01

    Functional tricuspid regurgitation (FTR) is frequently present in patients undergoing aortic, and particularly mitral valve, surgery. Untreated FTR may lead to right heart failure. Reoperative cardiac surgery for late FTR is associated with high morbidity and mortality. Therefore, severe FTR has emerged as a Class I indication for concomitant tricuspid valve surgery in patients undergoing left valve surgery. Concomitant tricuspid valve surgery during left heart valve surgery to address moderate and mild FTR is controversial. This review addresses this issue and proposes an algorithm for the treatment of FTR in patients undergoing left heart valve surgery.

  2. Long-term follow-up of mobile-bearing total ankle replacement in patients with inflammatory joint disease.

    Science.gov (United States)

    Kraal, T; van der Heide, H J L; van Poppel, B J; Fiocco, M; Nelissen, R G H H; Doets, H C

    2013-12-01

    Little is known about the long-term outcome of mobile-bearing total ankle replacement (TAR) in the treatment of end-stage arthritis of the ankle, and in particular for patients with inflammatory joint disease. The aim of this study was to assess the minimum ten-year outcome of TAR in this group of patients. We prospectively followed 76 patients (93 TARs) who underwent surgery between 1988 and 1999. No patients were lost to follow-up. At latest follow-up at a mean of 14.8 years (10.7 to 22.8), 30 patients (39 TARs) had died and the original TAR remained in situ in 28 patients (31 TARs). The cumulative incidence of failure at 15 years was 20% (95% confidence interval (CI) 11 to 28). The mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of the surviving patients at latest follow-up was 80.4 (95% CI 72 to 88). In total, 21 patients (23 TARs) underwent subsequent surgery: three implant exchanges, three bearing exchanges and 17 arthrodeses. Neither design of TAR described in this study, the LCS and the Buechel-Pappas, remains currently available. However, based both on this study and on other reports, we believe that TAR using current mobile-bearing designs for patients with end-stage arthritis of the ankle due to inflammatory joint disease remains justified.

  3. Concomitant Right Ventricular Outflow Tract Cryoablation during Pulmonary Valve Replacement in a Patient with Tetralogy of Fallot

    Science.gov (United States)

    Shin, Hong Ju; Song, Seunghwan; Shin, Yu Rim; Park, Han Ki; Park, Young Hwan

    2017-01-01

    A 38-year-old female patient with a history of tetralogy of Fallot repair at 10 years of age underwent pulmonary valve replacement with a mechanical prosthesis, tricuspid annuloplasty, and right ventricular outflow tract cryoablation due to pulmonary regurgitation, tricuspid regurgitation, and multiple premature ventricular contractions with sustained ventricular tachycardia. After surgery, she had an uneventful postoperative course with arrhythmia monitoring. She was discharged without incident, and a follow-up Holter examination showed a decrease in the number of ventricular ectopic beats from 702 to 41. PMID:28180102

  4. Knee Replacement

    Science.gov (United States)

    ... need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some ... a total living space on one floor since climbing stairs can be difficult. Install safety bars or a ...

  5. Current role of endovascular therapy in Marfan patients with previous aortic surgery

    Directory of Open Access Journals (Sweden)

    Ibrahim Akin

    2008-02-01

    Full Text Available Ibrahim Akin, Stephan Kische, Tim C Rehders, Tushar Chatterjee, Henrik Schneider, Thomas Körber, Christoph A Nienaber, Hüseyin InceDepartment of Medicine, Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, GermanyAbstract: The Marfan syndrome is a heritable disorder of the connective tissue which affects the cardiovascular, ocular, and skeletal system. The cardiovascular manifestation with aortic root dilatation, aortic valve regurgitation, and aortic dissection has a prevalence of 60% to 90% and determines the premature death of these patients. Thirty-four percent of the patients with Marfan syndrome will have serious cardiovascular complications requiring surgery in the first 10 years after diagnosis. Before aortic surgery became available, the majority of the patients died by the age of 32 years. Introduction in the aortic surgery techniques caused an increase of the 10 year survival rate up to 97%. The purpose of this article is to give an overview about the feasibility and outcome of stent-graft placement in the descending thoracic aorta in Marfan patients with previous aortic surgery.Keywords: Marfan syndrome, aortic dissection, root replacement, stent-graft, previous aortic surgery

  6. 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...

  7. Predictors of patient relevant outcome after total hip replacement for osteoarthritis

    DEFF Research Database (Denmark)

    Nilsdotter, A-K; Petersson, I F; Roos, Ewa M.

    2003-01-01

    To investigate prospectively long term patient relevant outcomes after unilateral total hip replacement (THR) for osteoarthritis (OA). To identify non-responders to this intervention and patient related predictors of unsatisfactory outcome.......To investigate prospectively long term patient relevant outcomes after unilateral total hip replacement (THR) for osteoarthritis (OA). To identify non-responders to this intervention and patient related predictors of unsatisfactory outcome....

  8. Patient-prosthesis mismatch and reduction in left ventricular mass after aortic valve replacement

    DEFF Research Database (Denmark)

    Kandler, Kristian; Møller, Christian H; Hassager, Christian;

    2013-01-01

    The presence of patient-prosthesis mismatch (PPM) after aortic valve replacement may influence patient survival. We examined the relationship between PPM and changes in left ventricular mass index at 3 months follow-up and also overall survival.......The presence of patient-prosthesis mismatch (PPM) after aortic valve replacement may influence patient survival. We examined the relationship between PPM and changes in left ventricular mass index at 3 months follow-up and also overall survival....

  9. Total hip and total knee replacement: preoperative nursing management.

    Science.gov (United States)

    Lucas, Brian

    Total hip replacement (THR) and total knee replacement (TKR) surgery are carried out for the relief of hip or knee pain, usually caused by osteoarthritis. This is the first of two articles on THR and TKR. It will outline the different types of replacement used in lower limb joint replacement surgery. Preparation of patients for surgery requires attention to physical, psychological and social factors and these are explored in detail. The organization of services along the patient pathway to ensure comprehensive preparation is considered and the nursing role highlighted. The second article, to be published in the next issue, will discuss recovery and rehabilitation from THR and TKR surgery.

  10. Enzymatic replacement therapy for Hunter disease: Up to 9 years experience with 17 patients

    Directory of Open Access Journals (Sweden)

    Rossella Parini

    2015-06-01

    Full Text Available Hunter disease is an X-linked lysosomal storage disorder characterized by progressive storage of glycosaminoglycans (GAGs and multi-organ impairment. The central nervous system (CNS is involved in at least 50% of cases. Since 2006, the enzymatic replacement therapy (ERT is available but with no effect on the cognitive impairment, as the present formulation does not cross the blood–brain barrier. Here we report the outcome of 17 Hunter patients treated in a single center. Most of them (11 started ERT in 2006, 3 had started it earlier in 2004, enrolled in the phase III trial, and 3 after 2006, as soon as the diagnosis was made. The liver and spleen sizes and urinary GAGs significantly decreased and normalized throughout the treatment. Heart parameters improved, in particular the left ventricular mass index/m2 decreased significantly. Amelioration of hearing was seen in many patients. Joint range of motion improved in all patients. However, no improvement on respiratory function, eye, skeletal and CNS disease was found. The developmental quotient of patients with a CNS involvement showed a fast decline. These patients were no more testable after 6 years of age and, albeit the benefits drawn from ERT, their quality of life worsened throughout the years. The whole group of patients showed a consistent residual disease burden mainly represented by persistent skeletal disease and frequent need of surgery. This study suggests that early diagnosis and treatment and other different therapies which are able to cross the blood–brain barrier, might in the future improve the MPS II outcome.

  11. Transapical Mitral Valve-in-Valve Replacement in Patient With Previous Complex Sternal Reconstruction.

    Science.gov (United States)

    Hynes, Conor F; Fatemi, Omid; Sharma, Aditya C; Nagy, Christian D; Trachiotis, Gregory D

    2016-01-01

    We present a complex case of a transapical redo mitral valve-in-valve replacement. Repeat mitral valve replacement was indicated for severe symptomatic bioprosthetic stenosis. In addition to the patient's numerous comorbidities that included diabetes, hepatic cirrhosis, ischemic cardiomyopathy, and atrial flutter, he had undergone a previous open mitral valve replacement that was complicated by sternal dehiscence requiring extensive chest wall reconstruction. Transapical approach was performed through left minithoracotomy incision with balloon-expandable valve. Transapical valve-in-valve replacement of a stenotic mitral bioprosthesis is a viable solution in a patient with previous complex chest wall reconstruction and multiple comorbidities.

  12. [Robotic surgery for colorectal cancer in elderly patients].

    Science.gov (United States)

    Xu, Pingping; Wei, Ye; Xu, Jianmin

    2016-05-01

    The outstanding advantages of robotic surgery include the stable and three-dimension image and the convenience of surgery manipulation. The disadvantages include the lack of factile feedback, high cost and prolonged surgery time. It was reported that robotic surgery was associated with less trauma stress and faster recovery in elderly patients(≥75 years old) when compared with open surgery. Elderly people have a higher incidence of carcinogenesis and also have more comorbidities and reduced functional reserve. Clinical data of patients over 75 years old treated by robotic surgery in Zhongshan Hospital affiliated to Fudan University from March 2011 to October 2014 were analyzed retrospectively. A total of 24 consecutive patients were included with a median age of 77.8 years old. There were 18 male and 6 female patients. Among them, 14 patients were diagnosed with descending and sigmoid colon cancers while 10 with rectal cancers; 19 had tumor size larger than 5 cm; 16 were diagnosed with ulcerative adenocarcinoma. Fourteen patients were complicated with hypertension, 6 with cardiopulmonary diseases, 4 with diabetes mellitus and 3 with cerebrovascular diseases. Twenty-two patients underwent low anterior resection and 2 abdominoperineal resection. The estimated blood loss was 85 ml; the median operation time was (123.1±45.2) min; the median number of retrieved lymph node was 12.4. Postoperative pathologic results showed that 3 patients were stage I, 10 stage II, and 11 stage III. Postoperative complication was observed in 3 patients: urinary infection in 1 case, intraperitoneal infection in 1 case and atria fibrillation in 1 case, respectively. Median time to first postoperative flatus was 2.8 days. Our results indicated that robotic surgery is safe and feasible in the elderly patients. The next generation of robotic system may make up for these deficiencies through new technologies. With the advantage of more advanced surgical simulator, robotic surgery will play a

  13. Early and midterm results of patients above or below 65-year-old undergoing coronary artery bypass grafting combined with valve replacement

    Directory of Open Access Journals (Sweden)

    Yang WU

    2013-03-01

    Full Text Available Objective  To retrospectively analyze the early and midterm outcomes and summarize experiences of coronary artery bypass grafting (CABG combined with valve replacement (VR in patients below or above 65-year-old. Methods  The clinical data of 110 patients, who received valve replacement combined with CABG in the General Hospital of PLA from Apr. 1998 to May 2012, were analyzed retrospectively. The patients were divided into two groups according to their age of ≥65 years (39 cases or 0.05, neither in the mechanical ventilation time, the intensive care time, application of intra-aortic balloon counter pulsation (IABCP, the postoperative hospitalization time, CPB time and cross-clamping time. The patients of ≥65 years were followed up from 2 months to 11 years after surgery, of whom 3 patients were lost to follow-up. One patient died of severe drug eruption in 2 months, another one died of lung cancer 2 years later, 2 patients suffered from cerebral infarction, and the life quality in other patients improved obviously with cardiac function evaluated in class I or Ⅱ. The patients in <65 years group were followed up by 3 months to 12 years. Of whom 8 patients lost the follow-up, two patients who received mechanic valve replacement got complications related to anticoagulation treatment in 3 and 6 years after surgery. One of the two died of severe low cardiac output. Conclusion  The early and mid-term outcomes of CABG combined with valve replacement in elderly patients may be safe and satisfying as in younger patients, so long as the right surgery strategy and the precise perioperative treatment are reasonably applied.

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

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi

    2008-01-01

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

  15. Cause of death in patients awaiting bariatric surgery.

    Science.gov (United States)

    Lakoff, Joshua M; Ellsmere, James; Ransom, Tom

    2015-02-01

    Obesity is associated with increased mortality. Bariatric surgery is becoming an important treatment modality for obesity, with an associated reduction in mortality. There are few data available on the incidence and cause of death in referred patients while they are waiting for bariatric surgery. We retrospectively examined all cases of death in patients who were referred for bariatric surgery assessment but who had not yet undergone bariatric surgery at a tertiary care centre in Halifax, Nova Scotia. The wait list comprised patients referred for surgery between March 2008 and May 2013. All cases of death were reviewed to determine age, sex, time of referral, time spent on the wait list, cause of death, comorbidities and body mass index (BMI). Of the 1399 patients referred, 22 (1.57%) died before receiving surgery. The mean age of these patients was 62.7 (range of 32-70) years. The average time from referral to death was 21.6 months, and the average BMI was 51.5. The most frequent cause of death was cancer, followed by cardiac and infectious causes. This study provides useful information about mortality and causes of death among patients awaiting bariatric surgery at our centre. Our results will help guide the development of a judicious system for triage in light of long wait times.

  16. Clinical and economic outcomes after surgical aortic valve replacement in Medicare patients

    Directory of Open Access Journals (Sweden)

    Clark MA

    2012-10-01

    Full Text Available Mary Ann Clark,1 Francis G Duhay,2 Ann K Thompson,2 Michelle J Keyes,3 Lars G Svensson,4 Robert O Bonow,5 Benjamin T Stockwell,3 David J Cohen61The Neocure Group LLC, Washington, DC, 2Edwards Lifesciences Corporation, Irvine, CA, 3The Burgess Group LLC, Alexandria, VA, 4Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, OH, 5Center for Cardiovascular Innovation, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 6Saint Luke's Mid America Heart Institute, Kansas City, MO, USABackground: Aortic valve replacement (AVR is the standard of care for patients with severe, symptomatic aortic stenosis who are suitable surgical candidates, benefiting both non-high-risk and high-risk patients. The purpose of this study was to report long-term medical resource use and costs for patients following AVR and validate our assumption that high-risk patients have worse outcomes and are more costly than non-high-risk patients in this population.Methods: Patients with aortic stenosis who underwent AVR were identified in the 2003 Medicare 5% Standard Analytic Files and tracked over 5 years to measure clinical outcomes, medical resource use, and costs. An approximation to the logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation based on administrative data was used to assess surgical risk, with a computed logistic EuroSCORE > 20% considered high-risk.Results: We identified 1474 patients with aortic stenosis who underwent AVR, of whom 1222 (82.9% were non-high-risk and 252 (17.1% were high-risk. Among those who were non-high-risk, the mean age was 73.3 years, 464 (38.2% were women, and the mean logistic EuroSCORE was 7%, whereas in those who were high-risk, the mean age was 77.6 years, 134 (52.8% were women, and the mean logistic EuroSCORE was 37%. All-cause mortality was 33.2% for non-high-risk and 66.7% for high-risk patients at 5 years. Over this time period, non

  17. Postoperative bacteriuria, pyuria and urinary tract infection in patients with an orthotopic sigmoid colon neobladder replacement.

    Science.gov (United States)

    Shigemura, Katsumi; Tanaka, Kazushi; Arakawa, Soichi; Miyake, Hideaki; Fujisawa, Masato

    2014-02-01

    The purpose of this study is to investigate the prevalence of postoperative bacteriuria, pyuria and urine culture in patients with an orthotopic sigmoid colon neobladder replacement. Urine samples for bacteriuria, pyuria and urine culture, if necessary, were collected at 1, 3, 6, 9 and 12 months after surgery and the presence of blood culture and antibiotic-resistant strains, and their treatments on positive urine culture cases were investigated. Of 209 for bacteriuria and 207 for pyuria urine samples with evaluable data, 95 (45.5%) were positive for bacteriuria and 76 (36.7%) had pyuria (10 or more white blood cells per high-power field). Totally, 30 bacteria were isolated from urine culture of urinary tract infection (UTI) and Klebisiella pneumoniae, Escherichia coli, Staphylococcos aureus and Enterococcus spp. strains were representatively isolated. The incidence of pyuria significantly decreased over time (P=0.041) but that of bacteriuria did not (P=0.107). In them, there were six bacteria (20.7%) with antibiotic-resistant strains. The antibiotics used for their treatments representatively were levofloxacin in five cases, tazobactam/piperacillin in three cases and sulfamethoxazole/trimethoprim and cefepime, meropenem in two cases, respectively. In conclusion, these findings suggest that physicians taking care of sigmoid colon neobladder patients need to be aware of these high ratios of bacteriuria, pyuria and UTI, including bacteremia.

  18. Fast Track Extubation In Adult Patients On Pump Open Heart Surgery At A Tertiary Care Hospital.

    Science.gov (United States)

    Akhtar, Mohammad Irfan; Sharif, Hasanat; Hamid, Mohammad; Samad, Khalid; Khan, Fazal Hameed

    2016-01-01

    Fast-track cardiac surgery programs have been established as the standard of cardiac surgical care. Studies have shown that early extubation in elective cardiac surgery patients, including coronary and non-coronary open-heart surgery patients does not increase perioperative morbidity and mortality. The objective of this observational study was to determine the success and failure profile of fast track extubation (FTE) practice in adult open-heart surgical patients. The study was conducted at cardiac operating room and Cardiac Intensive Care Unit (CICU) of a tertiary care hospital for a period of nine months, i.e., from Oct 2014 to June-2015. All on pump elective adult cardiac surgery patients including isolated CABG, isolated Valve replacements, combined procedures and aortic root replacements were enrolled in the study. Standardized anesthetic technique was adopted. Surgical and bypass techniques were tailored according to the procedure. Success of Fast track extubation was defined as extubation within 6 hours of arrival in CICU. A total of 290 patients were recruited. The average age of the patients was 56.3±10.5 years. There were 77.6% male and 22.4% female patients. Overall success rate was 51.9% and failure rate was 48.1%. The peri-operative renal insufficiency, cross clamp time and CICU stay (hours) were significantly lower in success group. Re-intubation rate was 0.74%. The perioperative parameters were significantly better in success group and the safety was also demonstrated in the patients who were fast tracked successfully. To implement the practice in its full capacity and benefit, a fast track protocol needs to be devised to standardize the current practices and to disseminate the strategy among junior anaesthesiologists, perfusionists and nursing staff.

  19. Long-term Mortality Predictors in Patients with Small Aortic Annulus Undergoing Aortic Valve Replacement with a 19- or 21-mm Bioprosthesis

    Directory of Open Access Journals (Sweden)

    Jenny Lourdes Rivas de Oliveira

    Full Text Available Abstract Introduction: Replacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality. A prosthesis-patient mismatch is one of the main problems associated with failed valves in this patient population. Objective: To evaluate the long-term mortality predictors in patients with a small aortic annulus undergoing aortic valve replacement with a bioprosthesis. Methods: In this retrospective observational study, a total of 101 patients undergoing aortic valve replacement from January 2000 to December 2010 were studied. There were 81 (80.19% women with a mean age of 52.81±18.4 years. Severe aortic stenosis was the main indication for surgery in 54 (53.4% patients. Posterior annulus enlargement was performed in 16 (15.8% patients. Overall, 54 (53.41% patients underwent concomitant surgery: 28 (27.5% underwent mitral valve replacement, and 13 (12.7% underwent coronary artery bypass graft surgery. Results: Mean valve index was 0.82±0.08 cm2/m2. Overall, 17 (16.83% patients had a valve index lower than 0.75 cm2/m2, without statistical significance for mortality (P=0.12. The overall 10-year survival rate was 83.17%. The rate for patients who underwent isolated aortic valve replacement was 91.3% and 73.1% (P=0.02 for patients who underwent concomitant surgery. In the univariate analysis, the main predictors of mortality were preoperative ejection fraction (P=0.02; HR 0.01 and EuroSCORE II results (P=0.00000042; HR 1.13. In the multivariate analysis, the main predictors of mortality were age (P=0.01, HR 1.04 and concomitant surgery (P=0.01, HR 5.04. Those relationships were statistically significant. Conclusion: A valve index of < 0.75 cm2/m2 did not affect 10-year survival. However, concomitant surgery and age significantly affected mortality.

  20. National survey on patient's fears before a general surgery procedure.

    Science.gov (United States)

    Fernandez Lobato, Rosa Carmen; Soria-Aledo, Víctor; Jover Navalón, José María; Calvo Vecino, José María

    2015-12-01

    To assess the magnitude of the different causes of anxiety in patients and families, facing surgery. Cross-sectional multicenter national survey recruiting 1,260 participants between patients and companions, analyzing the impact of 14 areas selected based on scientific publications aimed at the general public, concerning patients and/or companions, focused on concern about surgery. Patient sex, age, type of surgery (minor/major) and expected inpatient or ambulatory surgery were analyzed. For the companions sex and age, and relationship to patient were analyzed. In both cases it was assessed based on a unidimensional scale of 0 to 10, with 0 being be minimal cause for concern and 10, maximum. The most prominent have been the fear of the unknown, possible complications, the impact on quality of life, the accuracy of diagnosis and possible malignancy of the disease, as well as anesthesia and pain control. There are significant differences in the involvement of patients and companions; and are also differences by sex and age of the patient; type of surgery (minor/major) and expected hospital admission or not. The patient faces surgery with a number of fears that can be reduced with increased information. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Operative costs, reasons for operative waste, and vendor credit replacement in spinal surgery.

    Science.gov (United States)

    Epstein, Nancy E; Roberts, Rita; Collins, John

    2015-01-01

    In 2012, Epstein et al. documented that educating spinal surgeons reduced the cost of operative waste (explanted devices: placed but removed prior to closure) occurring during anterior cervical diskectomy/fusion from 20% to 5.8%.[5] This prompted the development of a two-pronged spine surgeon-education program (2012-2014) aimed at decreasing operative costs for waste, and reducing the nine reasons for operative waste. The spine surgeon-education program involved posting the data for operative costs of waste and the nine reasons for operative waste over the neurosurgery/orthopedic scrub sinks every quarter. These data were compared for 2012 (latter 10 months), 2013 (12 months), and 2014 (first 9 months) (e.g. data were normalized). Savings from a 2013 Vendor Credit Replacement program were also calculated. From 2012 to 2013 and 2014, spinal operative costs for waste were, respectively reduced by 64.7% and 61% for orthopedics, and 49.4% and 45.2% for neurosurgery. Although reduced by the program, the major reason for operative waste for all 3 years remained surgeon-related factors (e.g. 159.6, to 67, and 96, respectively). Alternatively, the eight other reasons for operative waste were reduced from 68.4 (2012) to 12 (2013) and finally to zero by 2014. Additionally, the Vendor Replacement program for 2013 netted $78,564. The spine surgeon-education program reduced the costs/reasons for operative waste for 2012 to lower levels by 2013 and 2014. Although the major cost/reasons for operative waste were attributed to surgeon-related factors, these declined while the other eight reasons for operative waste were reduced to zero by 2014.

  2. Operative costs, reasons for operative waste, and vendor credit replacement in spinal surgery

    Directory of Open Access Journals (Sweden)

    Nancy E Epstein

    2015-01-01

    Full Text Available Background: In 2012, Epstein et al. documented that educating spinal surgeons reduced the cost of operative waste (explanted devices: placed but removed prior to closure occurring during anterior cervical diskectomy/fusion from 20% to 5.8%. [5] This prompted the development of a two-pronged spine surgeon-education program (2012-2014 aimed at decreasing operative costs for waste, and reducing the nine reasons for operative waste. Methods: The spine surgeon-education program involved posting the data for operative costs of waste and the nine reasons for operative waste over the neurosurgery/orthopedic scrub sinks every quarter. These data were compared for 2012 (latter 10 months, 2013 (12 months, and 2014 (first 9 months (e.g. data were normalized. Savings from a 2013 Vendor Credit Replacement program were also calculated. Results: From 2012 to 2013 and 2014, spinal operative costs for waste were, respectively reduced by 64.7% and 61% for orthopedics, and 49.4% and 45.2% for neurosurgery. Although reduced by the program, the major reason for operative waste for all 3 years remained surgeon-related factors (e.g. 159.6, to 67, and 96, respectively. Alternatively, the eight other reasons for operative waste were reduced from 68.4 (2012 to 12 (2013 and finally to zero by 2014. Additionally, the Vendor Replacement program for 2013 netted $78,564. Conclusions: The spine surgeon-education program reduced the costs/reasons for operative waste for 2012 to lower levels by 2013 and 2014. Although the major cost/reasons for operative waste were attributed to surgeon-related factors, these declined while the other eight reasons for operative waste were reduced to zero by 2014.

  3. Aortic valve replacement in a patient with systemic lupus erythematosus

    Directory of Open Access Journals (Sweden)

    Bhuvnesh Kansara

    2013-01-01

    Full Text Available Valvular heart disease in systemic lupus erythematosus (SLE is associated with substantial morbidity and mortality. Current therapy includes symptomatic measures and valve replacement. SLE can present major challenges because of accrued organ damage, coagulation defects and complex management regimes. The peri-operative goals are to maintain strict asepsis, avoid use of nephrotoxic drugs and thereby renal insult, and to promote early ambulation post-operatively.

  4. Precautionary Measures for Successful Open Heart Surgery in G6PD Deficient Patient- A Case Report

    Science.gov (United States)

    2016-01-01

    Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is among the most common enzymatic disorders of red blood cells. Cardiac surgeries on this group of individuals are associated with an additional risk in terms of impaired oxygenation, prolonged ventilation and increased risk of haemolysis. These patients have a very low threshold for haemolysis due to oxidative stress. Many commonly used drugs also predispose the individual for haemolysis when they are subjected to surgery. Here we present a known case of G6PD deficient patient with symptoms of breathlessness for the last nine years who was taken for surgery with pre-planned precautionary measures to avoid unnecessary haemolysis. The echocardiography report revealed severe mixed mitral lesion and moderate tricuspid regurgitation. On general examination she had mild pallor and icterus. We planned for a thorough investigation to prepare her for mitral valve replacement and tricuspid annuloplasty. These groups of patients are at high risk of haemolysis during perioperative period and need prolonged mechanical ventilation and hospital stay due to impaired oxygen carrying capacity and oxidative stress due to deficient free radical scavenging system. The patient underwent mechanical mitral valve replacement and tricuspid annuloplasty under cardiopulmonary bypass with precautionary measures to prevent the risk of haemolysis and associated complications. She had an uneventful recovery. PMID:28208930

  5. Tele-surgery simulation with a patient organ model for robotic surgery training.

    Science.gov (United States)

    Suzuki, S; Suzuki, N; Hattori, A; Hayashibe, M; Konishi, K; Kakeji, Y; Hashizume, M

    2005-12-01

    Robotic systems are increasingly being incorporated into general laparoscopic and thoracoscopic surgery to perform procedures such as cholecystectomy and prostatectomy. Robotic assisted surgery allows the surgeon to conduct minimally invasive surgery with increased accuracy and with potential benefits for patients. However, current robotic systems have their limitations. These include the narrow operative field of view, which can make instrument manipulation difficult. Current robotic applications are also tailored to specific surgical procedures. For these reasons, there is an increasing demand on surgeons to master the skills of instrument manipulation and their surgical application within a controlled environment. This study describes the development of a surgical simulator for training and mastering procedures performed with the da Vinci surgical system. The development of a tele-surgery simulator and the construction of a training center are also described, which will enable surgeons to simulate surgery from or in remote places, to collaborate over long distances, and for off-site expert assistance.

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

    Directory of Open Access Journals (Sweden)

    Lei CHEN

    2015-06-01

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

  7. Perspectives and experiences of elective surgery patients regarding pain management.

    Science.gov (United States)

    Rejeh, Nahid; Vaismoradi, Mojtaba

    2010-03-01

    The purpose of this study was to explore the perspectives and experiences of elective surgery patients regarding pain management. A qualitative design, based on the content analysis approach, was used to collect and analyze the experience of 20 elective surgery patients who all had abdominal surgery in surgical wards in two teaching hospitals in Tehran, Iran. After employing purposeful sampling for the selection of the participants, semistructured interviews were held for data collection. During the data analysis, three main themes emerged: "perceptions of pain management goals", "patients' views of nurses' role in pain management", and "interaction in pain management". It was concluded that understanding the factors that influence pain management after surgery from the patients' viewpoint will contribute to the body of knowledge of nurses in order to promote the quality of nursing care.

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

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

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

    2016-05-01

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

  10. Spinal Surgery Complications and Failures in Patients with Parkinsons Disease.

    Science.gov (United States)

    Sapkas, George S; Mavrogenis, Andreas F; Papastathis, Elias; Tsiavos, Kostas; Igoumenou, Vasilios; Megaloikonomos, Panayiotis D; Galanopoulos, Ioannis; Soultanis, Konstantinos; Papadopoulos, Elias C; Papagelopoulos, Panayiotis J

    2016-01-01

    Parkinson's disease is a degenerative disorder of the central nervous system affecting the substantia nigra in the midbrain. It accounts for 1.5% of the population in Europe over 60 years of age. Recent advances in the medical treatment of Parkinson's disease have improved the quality of life and life expectancy of the patients. However, it remains a debilitating disease. Spinal disorders are frequent in these patients, and as the population ages, more patients with Parkinson's disease are expected to require spinal surgery. Spinal surgery in patients with Parkinson's disease has been associated with an exceptionally high rate of complications; failures and reoperations are common, and patient outcomes are dismal.

  11. Patient expectations and performance measures in dermatologic surgery.

    Science.gov (United States)

    Lee, Erica H

    2016-01-01

    Patient satisfaction has increasingly played an important role in quality-of-care reforms and health care delivery. In dermatologic surgery, patient expectations of procedures and the outcomes are important determinants of satisfaction. Identification of the patient's met and unmet expectations through patient-reported outcome measures may enable a better understanding of the patient's perspective and improve communication and the delivery of care. Performance measures report on the quality of care being delivered. Performance measures currently being implemented into dermatologic practices may have a role in demonstrating the "quality" of dermatologic surgery procedures in the near future. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Facial Canal Dehiscence in Patients with Chronic Otitis Surgery

    Directory of Open Access Journals (Sweden)

    Ahmet Uluat

    2016-04-01

    Full Text Available Aim: To examine facial canal status in patients with chronic otitis media (COM surgery and to detect the relation between facial canals dehiscence (FCD with middle ear pathology in these patients. Material and Method: The surgery data of patients who were subjected to tympanoplasty with or without mastoidectomy and radical mastoidectomy due to COM were analyzed retrospectively from January 2006 to December 2012. In addition to demonstrative data of the patients, status of facial canal and preoperative diagnoses of patients, type of the operation performed, status of middle ear, number of surgeries, existence of cholesteatoma, existence of ossicular chain defect, lateral canal defect and dura defect were assessed and the relation thereof with facial canal dehiscence (FCD was analyzed statistically. Results: Seven hundred ninety six patients were included in the study. FCD was detected in 10.05% of the patients. FCD was most frequently observed in the tympanic segment. It was found out that there was a statistically significant relationship of middle ear pathology, cholesteatoma, revision surgery, lateral semicircular canal and ossicular chain defect with FCD. Discussion: COM diagnosed patients may have defect in facial canal according to their preoperative diagnoses, middle ear pathologies, number of operations and ossicular chain defects. These patients should be applied a more careful surgery and closely followed up in postoperative periods.

  13. Inguinal Hernia Surgery: a patient centered approach

    NARCIS (Netherlands)

    H.R. Langeveld-Benders (Hester)

    2014-01-01

    markdownabstract__Abstract__ The introduction of surgical mesh to create a tension free repair in inguinal hernia surgery in the 1990s, was quickly implemented worldwide, because recurrence rates dropped dramatically. Debate on the best surgical approach for this tension-free mesh repair is ongoing

  14. Noncardiac surgery in patients with aortic stenosis

    DEFF Research Database (Denmark)

    Andersson, Charlotte; Jørgensen, Mads Emil; Martinsson, Andreas

    2014-01-01

    BACKGROUND: Past research has identified aortic stenosis (AS) as a major risk factor for adverse outcomes in noncardiac surgery; however, more contemporary studies have questioned the grave prognosis. To further our understanding of this, the risks of a 30-day major adverse cardiovascular event (...

  15. [Sudden onset of EDTA-dependent pseudothrombocytopenia in a patient scheduled for open heart surgery].

    Science.gov (United States)

    Satoh, Minako; Hirose, Yoshifumi; Gamo, Masahiro; Ohtsuka, Tatsuo; Yonezawa, Kouki; Tomioka, Toshiaki; Sakai, Keiko

    2003-04-01

    A 60-year-old woman scheduled for mitral and aortic valve replacement had sudden onset of thrombocytopenia without clinical symptoms. The platelet count was found to decrease after the sampling. Microscopic examinations confirmed platelet aggregations. Changing anticoagulant added to blood samples from EDTA to heparin resolved such platelet aggregations. This phenomenon was diagnosed as demonstrating EDTA-dependent pseudothrombocytopenia and the operation was performed as scheduled without platelet transfusion. Postoperative course was almost uneventful and the patient was discharged on 26th day after surgery. EDTA-dependent pseudothrombocytopenia must be ruled out when patients have thrombocytopenia without certain causes such as infections, drugs, or autoimmune diseases.

  16. [Special considerations in dental surgery procedures on organ transplantation patients].

    Science.gov (United States)

    Schmelzeisen, R; Eckardt, A; Knoll, M; Girod, S

    1991-01-01

    In 150 patients 366 (95%) of 385 dental surgery procedures performed prior to organ transplantations were free of complications. In 6 patients circumscribed wound infections occurred, and 5 post-operative hemorrhages as well as 2 injection hematomas were observed. In the group of patients where dental surgery was performed after organ transplantation, all 123 procedures were free of complications. Treatment of transplantation patients in the dental office requires a profound understanding of the complex clinical problems these patients might present, a good coordination of the required measures and close cooperation between the transplantation center and the attending dentist. Special considerations of the treatment of organ transplantation patients and the indications for dental surgery are discussed.

  17. Reconstructive surgery in immunocompromised patients: evaluation and therapy

    Directory of Open Access Journals (Sweden)

    Dunda, Sebastian E.

    2015-12-01

    Full Text Available Background: An increasing number of patients undergoing reconstructive surgery are immunocompromised due to different reasons and different medical treatments. Some of the used immunosuppressive drugs may affect the process of wound healing and thereby, impair the long-term success of surgical treatment. Therefore, this retrospective analysis aimed at the evaluation of the perioperative treatment and surgical outcome of immunocompromised patients undergoing different reconstructive procedures.Methods: A retrospective review was performed of 8 immunocompromised patients with different primary diseases who needed reconstructive surgery: 2 patients with non-Hodgkin lymphoma, 1 patient with an acute myeloid leukemia, 1 patient with colitis ulcerosa, 1 patient with liver cirrhosis, 1 patient with chronic polyarthritis, and 2 patients with malignant melanoma.Results: In 7 of our 8 presented cases, multiple operations with wound debridements have been necessary to optimize the granulation of the wound bed before reconstructive surgery. 3 out of these 7 patients required further operations due to wound dehiscence or necrosis, with 2 of them as a result of increased immunosuppressive therapy. 5 out of 8 patients needed no further surgical treatment.Conclusions: Both the perioperative drug therapy and the reconstructive surgery concept need to be determined carefully in each individual case of the immunocompromised patients. Thus, the appropriate point in time of operation to achieve the best possible wound healing as well as the complexity of the procedure will require the consideration of a ‘less is more’ strategy in selected cases.

  18. Patient values and preferences on transcatheter or surgical aortic valve replacement therapy for aortic stenosis: a systematic review

    Science.gov (United States)

    Lytvyn, Lyubov; Guyatt, Gordon H; Manja, Veena; Siemieniuk, Reed A; Zhang, Yuan; Agoritsas, Thomas; Vandvik, Per O

    2016-01-01

    Objective To investigate patients' values and preferences regarding aortic valve replacement therapy for aortic stenosis. Setting Studies published after transcatheter aortic valve insertion (TAVI) became available (2002). Participants Adults with aortic stenosis who are considering or have had valve replacement, either TAVI or via surgery (surgical aortic valve replacement, SAVR). Outcome measures We sought quantitative measurements, or qualitative descriptions, of values and preferences. When reported, we examined correlations between preferences and objective (eg, ejection fraction) or subjective (eg, health-related quality of life) measures of health. Results We reviewed 1348 unique citations, of which 2 studies proved eligible. One study of patients with severe aortic stenosis used a standard gamble study to ascertain that the median hypothetical mortality risk patients were willing to tolerate to achieve full health was 25% (IQR 25–50%). However, there was considerable variability; for mortality risk levels defined by current guidelines, 130 participants (30%) were willing to accept low-to-intermediate risk (≤8%), 224 (51%) high risk (>8–50%) and 85 (19%) a risk that guidelines would consider prohibitive (>50%). Study authors did not, however, assess participants' understanding of the exercise, resulting in a potential risk of bias. A second qualitative study of 15 patients identified the following factors that influence patients to undergo assessment for TAVI: symptom burden; expectations; information support; logistical barriers; facilitators; obligations and responsibilities. The study was limited by serious risk of bias due to authors' conflict of interest (5/9 authors industry-funded). Conclusions Current evidence on patient values and preferences of adults with aortic stenosis is very limited, and no studies have enrolled patients deciding between TAVI and SAVR. On the basis of the data available, there is evidence of variability in individual

  19. The dislocating hip replacement - revision with a dual mobility cup in 56 consecutive patients

    DEFF Research Database (Denmark)

    Jakobsen, Thomas; Kappel, Andreas; Hansen, Flemming

    2014-01-01

    INTRODUCTION: Recurrent dislocations of hip replacements are a difficult challenge. One treatment option for recurrent dislocations is the use of a dual mobility cup. The aim of this study was to retrospective investigate the effect of dual mobility cups as a treatment for recurrent dislocations...... of the acetabular component, and one due to infection. Harris Hip Score improved from a mean of 76 before index surgery to 87 within one year after index surgery. CONCLUSION: This study advocates the use of a dual mobility cup for treatment of recurrent dislocations of THR. However, studies with a longer follow up...

  20. No more broken hearts: weight loss after bariatric surgery returns patients' postoperative risk to baseline following coronary surgery.

    Science.gov (United States)

    Baimas-George, Maria; Hennings, Dietric L; Al-Qurayshi, Zaid; Emad Kandil; DuCoin, Christopher

    2017-06-01

    The obesity epidemic is associated with a rise in coronary surgeries because obesity is a risk factor for coronary artery disease. Bariatric surgery is linked to improvement in cardiovascular co-morbidities and left ventricular function. No studies have investigated survival advantage in postoperative bariatric patients after coronary surgery. To determine if there is a benefit after coronary surgery in patients who have previously undergone bariatric surgery. National Inpatient Sample. We performed a retrospective, cross-sectional analysis of the National Inpatient Sample database from 2003 to 2010. We selected bariatric surgical patients who later underwent coronary surgery (n = 257). A comparison of postoperative complications and mortality after coronary surgery were compared with controls (n = 1442) using χ(2) tests, linear regression analysis, and multivariate logistical regression models. A subset population was identified as having undergone coronary surgery (n = 1699); of this population, 257 patients had previously undergone bariatric surgery. They were compared with 1442 controls. The majority was male (67.2%), white (82.6%), and treated in an urban environment (96.8%). Patients with bariatric surgery assumed the risk of postoperative complications after coronary surgery that was associated with their new body mass index (BMI) (BMI999.9, 95% CI .18 to>999.9, P = .07). Length of stay was significantly longer in postbariatric patients (BMIbariatric patients have a return to baseline risk of morbidity and mortality after coronary surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  1. [Approach to the patient in the ambulatory surgery unit].

    Science.gov (United States)

    Cordero-Ponce, Montserrat; Romero-Sánchez, Isabel María; López-Barea, José; Martínez-Ramos, Pablo

    2008-01-01

    Ambulatory surgery aims to improve the quality of care, provide services in an environment closer to users' normal surroundings, reduce the risk of nosocomial infection and release hospital beds for other uses demanded by the population, thus reducing health costs. Nursing activity in these units should aim to restore health and aid the rapid recovery of patients in their homes. To achieve this, an effective health education program is required. Such programs should be simple and, at the same time, cover the care that these patients will require during the recovery period at home. The unit covers patients in the Virgen de Rocío University Hospital, The Fleming Peripheral Center for Specialties and the Virgen de los Reyes Peripheral Center for Specialties in Seville, Spain and the the specialties included are plastic surgery, otorhinolaryngology, orthopedic surgery, urology, and general surgery. The duration of the education program will be at most 14-17 h.

  2. Perioperative blood management strategies for patients undergoing total knee replacement: Where do we stand now?

    Science.gov (United States)

    Themistoklis, Tzatzairis; Theodosia, Vogiatzaki; Konstantinos, Kazakos; Georgios, Drosos I

    2017-01-01

    Total knee replacement (TKR) is one of the most common surgeries over the last decade. Patients undergoing TKR are at high risk for postoperative anemia and furthermore for allogeneic blood transfusions (ABT). Complications associated with ABT including chills, rigor, fever, dyspnea, light-headedness should be early recognized in order to lead to a better prognosis. Therefore, perioperative blood management program should be adopted with main aim to reduce the risk of blood transfusion while maximizing hemoglobin simultaneously. Many blood conservation strategies have been attempted including preoperative autologous blood donation, acute normovolemic haemodilution, autologous blood transfusion, intraoperative cell saver, drain clamping, pneumatic tourniquet application, and the use of tranexamic acid. For practical and clinical reasons we will try to classify these strategies in three main stages/pillars: Pre-operative optimization, intra-operative and post-operative protocols. The aim of this work is review the strategies currently in use and reports our experience regarding the perioperative blood management strategies in TKR. PMID:28660135

  3. Evaluation of Tricuspid Valvuloplasty with Mitral Valve Replacement in severely ill patients

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    H. MOBARHAN

    1975-06-01

    Full Text Available A group or twenty ca ses or class IV or New York Hearl Assiciation Classification is reported. T hey were selected among 55 ca ses of mitral valve'10 :; JJj'[ ' ~ J i l l ; J "J( ff1 Ii rll l'li %J1 %:J '/J ; ~1 ?idJ bru: b:;ib -: Jr I'Ji lJ;q :J':.nrlT . JrI'JrrJ'J'Jlil q ':,f[ /Jw[ ' ~ I ;': J ; l q o I I J'l [ I i'1 biq% lJ :Ji•IT x l'; r1 Jo'lo lJ;r!J rlJ i 1/ ;-lm o f[;'-'JTIO' rbid'll "II (, I 10 be car ried out in seven cases. In lWO cases. reported in detail. two commissurcs and ring had to be repaired. The nature of pathology was organic and fu nctional while in the rcmaininu-live cases it was onl.v functional. None or the cases required tricuspid valve replacement. Wc believe that tricuspid va lvuloplasty has a n importa nt position in heart surgery and should not be underestimated . Also. we conclude that no patient should be denied 0PCI1"tion on the basis or the severity or his d isease unless ad vanced co ronal' di sease or primary myocardiac d isease arc also in volved.

  4. Tricuspid Valve Replacement in an HIV-Infected Patient with Severe Tricuspid Regurgitation Secondary to Remote Endocarditis.

    Science.gov (United States)

    Myerson, Merle; Armstrong, Ehrin J; Poltavskiy, Eduard; Fefer, Jose; Bang, Heejung

    2016-12-01

    Surgical intervention for severe tricuspid regurgitation secondary to remote infective endocarditis has been infrequent, especially in patients also infected with the human immunodeficiency virus (HIV). We describe the case of a 62-year-old HIV-positive man, with a 24-year history of endocarditis caused by intravenous heroin use, who presented with severe tricuspid regurgitation. The patient was initially asymptomatic, was taking antiretroviral medications, and had a satisfactory CD4 count and an undetectable viral load, so we decided to manage the regurgitation conservatively. Two years later, he presented with biventricular heart failure and dyspnea. After surgical tricuspid valve replacement, his condition improved substantially. This case illustrates that HIV-infected patients with complex medical conditions can successfully undergo cardiac surgery.

  5. Bone replacement following dental trauma prior to implant surgery - present status

    NARCIS (Netherlands)

    Hallman, Mats; Mordenfeld, Arne; Strandkvist, Tomas

    2009-01-01

    Dento-alveolar trauma often leads to a need for reconstruction of the alveolar crest before an implant can be placed. Although autogenous bone grafts is considered the 'gold standard', this may be associated with patient morbidity and graft resorption. Consequently, the use of bone substitutes has i

  6. Bone replacement following dental trauma prior to implant surgery - present status

    NARCIS (Netherlands)

    Hallman, Mats; Mordenfeld, Arne; Strandkvist, Tomas

    2009-01-01

    Dento-alveolar trauma often leads to a need for reconstruction of the alveolar crest before an implant can be placed. Although autogenous bone grafts is considered the 'gold standard', this may be associated with patient morbidity and graft resorption. Consequently, the use of bone substitutes has i

  7. Technical Aspects on the Use of Ultrasonic Bone Shaver in Spine Surgery: Experience in 307 Patients

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    Derya Burcu Hazer

    2016-01-01

    Full Text Available Aim. We discuss technical points, the safety, and efficacy of ultrasonic bone shaver in various spinal surgeries within our own series. Methods. Between June 2010 and January 2014, 307 patients with various spinal diseases were operated on with the use of an ultrasonic bone curette with microhook shaver (UBShaver. Patients’ data were recorded and analyzed retrospectively. The technique for the use of the device is described for each spine surgery procedure. Results. Among the 307 patients, 33 (10.7% cases had cervical disorder, 17 (5.5% thoracic disorder, 3 (0.9% foramen magnum disorder, and 254 (82.7% lumbar disorders. Various surgical techniques were performed either assisted or alone by UBShaver. The duration of the operations and the need for blood replacement were relatively low. The one-year follow-up with Neck Disability Index (NDI and Oswestry Disability Index (ODI scores were improved. We had 5 cases of dural tears (1.6% in patients with lumbar spinal disease. No neurological deficit was found in any patients. Conclusion. We recommend this device as an assistant tool in various spine surgeries and as a primary tool in foraminotomies. It is a safe device in spine surgery with very low complication rate.

  8. Nursing care for patients undergoing transoral robotic surgery.

    Science.gov (United States)

    Murray, Shannon

    2009-01-01

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

  9. Is peri-operative steroid replacement therapy necessary for the pituitary adenomas treated with surgery? A systematic review and meta analysis.

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    Mamatemin Tohti

    Full Text Available Patients with pituitary adenomas usually receive "stress dose" steroids in the peri-operative peroids. Though randomized controlled trials(RCT have not been performed to assess the necessity of steroid coverage, there are several studies that explained the changes of adrenal function during peri-operative peroids. The aim of the present study is to investigate whether it is necessary to employ conventional peri-operative glucocorticoid replacement therapy to all the patients undergoing surgery.We searched studies addressing peri-operative steroids coverage for pituitary adenomas in the Web of Science, Medline and the Cochrane Library. Then we extracted studies about peri-operative morning serum cortisol(MSC levels, morbidity of early postoperative adrenal insufficiency, postoperative diabetes insipidus, relationships between MSC levels and adrenal integrity. We used RevMan Software to combine the results for meta-analysis. We used fixed-effects models for there was no significant heterogeneity existed.There are 18 studies from 11 countries published between 1987 and 2013 including 1224 patients. The postoperative serum cortisol levels were significantly increased compared with the preoperative one in hypothalamic-pituitary-adrenal axis(HPAA functions preserved patients(P<0.00001. The morbidity of early postoperative adrenal insufficiency ranged from 0.96% to 12.90%, with the overall morbidity of 5.55%(41/739. There was no significant differences of early postoperative diabetes insipidus between no supplementation patients and in supplementation patients(P=0.82. Conversely, there may be some disadvantages of high levels of cortisols such as high incidence of osteopenia and bone derangement and even the increased mortality rate. The patients with MSC levels of less than 60 nmol/l at 3 days after operation is considered as adrenal insufficient and more than 270 nmol/l as adrenal sufficient. To patients with MSC levels of 60-270 nmol/l, we need more

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

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    Yang Y

    2016-07-01

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

  11. Opioid pain medication use after dermatologic surgery: a prospective observational study of 212 dermatologic surgery patients.

    Science.gov (United States)

    Harris, KaLynne; Curtis, Julia; Larsen, Brooke; Calder, Scott; Duffy, Keith; Bowen, Glen; Hadley, Michael; Tristani-Firouzi, Payam

    2013-03-01

    To better understand postoperative opioid use after dermatologic surgery. Prospective observational study. Academic dermatology department. The study included 212 adults (1) who were undergoing a single skin excision (including Mohs micrographic surgery), (2) who consented to participate,and (3) who were able to be reached by telephone on postoperative day 3 or 4. Patients who did not meet these criteria and those referred to another physician for further surgical treatment or repair were excluded. The study examined(1) the incidence of opioid prescription after dermatologic surgery, (2) the percentage of prescribed opioid pain medications used in the postoperative period, and (3) patient and surgical characteristics associated with opioid pain medication prescription and use. Opioids were prescribed to 72 of the 212 patients(34%). Twenty-five of the 72 patients (35%) who were prescribed opioids did not use them. Forty-nine of 57 patients (86%) who filled an opioid prescription had leftover pills, and 26 of the 49 patients (53%) planned to keep them. Only maximum pain score was significantly associated with opioid use. Opioids were over prescribed after dermatologic surgery. Patients who had left over opioids did not dispose of them properly, which could lead to potential misuse and abuse.

  12. Comparison of the Effects of Intrathecal Fentanyl and Intrathecal Morphine on Pain in Elective Total Knee Replacement Surgery

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    Refika Kılıçkaya

    2016-01-01

    Full Text Available Objective. Total knee replacement is one of the most painful orthopedic surgical procedures. In this study, our goal was to compare the intraoperative and postoperative hemodynamic effects, the side effects, the effect on the duration of pain start, the 24-hour VAS, and the amount of additional analgesia used, of the fentanyl and morphine we added to the local anesthetic in the spinal anesthesia we administered in cases of elective knee replacement. Materials and Methods. After obtaining the approval of the Erciyes University Medical Faculty Clinical Drug Trials Ethics Committee, as well as the verbal and written consent of the patients, we included 50 patients in our prospective, randomized study. Results. In our study, the morphine group (Group M had lower pain scores in the 2nd, 6th, 12th, and 24th hours compared to the fentanyl group (Group F. When additional analgesic requirements were compared, it was found that in the 2nd, 6th, and 24th hours fewer Group M patients needed more analgesics than did Group F patients. Conclusion. The fentanyl group also had lower first analgesic requirement times than did the morphine group. In terms of nausea and vomiting, there was no statistically significant difference between the two groups.

  13. Recurrent spine surgery patients in hospital administrative database

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    M. Sami Walid

    2012-02-01

    Full Text Available Introduction: Hospital patient databases are typically used by administrative staff to estimate loss-profit ratios and to help with the allocation of hospital resources. These databases can also be very useful in following rehospitalization. This paper studies the recurrence of spine surgery patients in our hospital population based on administrative data analysis. Methods: Hospital data on 4,958 spine surgery patients operated between 2002 and 2009 were retrospectively reviewed. After sorting the cohort per ascending discharge date, the patient official name, consisting of first, middle and last names, was used as the variable determining duplicate cases in the SPSS statistical program, designating the first case in each group as primary. Yearly recurrence rate and change in procedure distribution were studied. In addition, hospital charges and length of stay were compared using the Wilcoxon-Mann-Whitney test. Results: Of 4,958 spine surgery patients 364 (7.3% were categorized as duplicate cases by SPSS. The number of primary cases from which duplicate cases emerged was 327 meaning that some patients had more than two spine surgeries. Among primary patients (N=327 the percentage of excision of intervertebral disk procedures was 33.3% and decreased to 15.1% in recurrent admissions of the same patients (N=364. This decrease was compensated by an increase in lumbar fusion procedures. On the other hand, the rate of cervical fusion remained the same. The difference in hospital charges between primary and duplicate patients was $2,234 for diskectomy, $6,319 for anterior cervical fusion, $8,942 for lumbar fusion – lateral technique, and $12,525 for lumbar fusion – posterior technique. Recurrent patients also stayed longer in hospital, up to 0.9 day in lumbar fusion – posterior technique patients. Conclusion: Spine surgery is associated with an increasing possibility of additional spine surgery with rising invasiveness and cost.

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

    Science.gov (United States)

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

    2011-01-01

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

  15. Bariatric surgery in elderly patients: a systematic review.

    Science.gov (United States)

    Giordano, Salvatore; Victorzon, Mikael

    2015-01-01

    Controversy exists regarding the effectiveness and safety of bariatric/metabolic surgery in elderly patients. We performed a systematic review on this issue in patients aged 60 years or older. MEDLINE, Cochrane Library, Embase, Scopus, and Google Scholar were searched until August 2015 for studies on outcomes of bariatric surgery in elderly patients. The results were expressed as pooled proportions (%) with 95% confidence intervals. Heterogeneity across the studies was evaluated by the I (2) test, and a random-effects model was used. Twenty-six articles encompassing 8,149 patients were pertinent with this issue and included data on bariatric surgery outcomes in elderly population. Fourteen patients died during the 30-day postoperative period, with a pooled mortality of 0.01%. Pooled overall complication rate was 14.7%. At 1-year follow-up, pooled mean excess weight loss was 53.77%, pooled diabetes resolution was 54.5%, and pooled hypertension resolution was 42.5%, while pooled lipid disorder resolution was 41.2%. Outcomes and complication rates of bariatric surgery in patients older than 60 years are comparable to those in a younger population, independent of the type of procedure performed. Patients should not be denied bariatric surgery because of their age alone.

  16. The Psychosocial Improvement after Strabismus Surgery in Iranian Patients

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    Guita Ghiasi

    2013-10-01

    Full Text Available Purpose: To compare the psychosocial status before and after successful strabismus surgery on Iranian strabismic patientsMethods: One hundred twenty-four strabismic patients, older than 15 years were evaluated between 2009 and 2010. They were asked to complete a questionnaire about their psychosocial experiences, before and three months after successful strabismus surgery. Effects of strabismus on self-esteem, self-confidence, and self-assessment of intelligence, employment and interpersonal relationships were compared.Results: Fifty-six percent of patients had problems in adjusting to society, and 71% had developed a mannerism to camouflage their misalignment before surgery. The preoperative scores of self-esteem, self-confidence, and interpersonal relationship were 4.33±2.07, 4.23±2.53 and 6.06±2.33 which changed to 8.33±3.02, 7.29±2.89 and 6.72±3.17 after surgery, respectively (p<0.001 for all of values. More esotropic patients reported to be discriminated against compared to exotropic patients. Postoperatively, 79% of patients reported improvements in their ability to meet new people, and 82% in interpersonal relationships. Scores of self-confidence and self-esteem increased up to three and four units, respectively (p<0.001 for both values.Conclusion: Patients with strabismus have psychosocial problems and successful strabismus surgery improves their psychosocial status.

  17. Probiotics reduce psychological stress in patients before laryngeal cancer surgery.

    Science.gov (United States)

    Yang, Hui; Zhao, Xiaoyun; Tang, Shan; Huang, Hua; Zhao, Xiulan; Ning, Zhuohui; Fu, Xiurong; Zhang, Caihong

    2016-03-01

    Laryngeal cancer is a common malignancy; surgery is the preferred treatment. Psychosocial stress is one of the negative impacts on patient recovery. This study aimed to elucidate the effect of probiotics on ameliorating anxiety, and on serum corticotropin-releasing factor (CRF) in laryngeal cancer patients before surgery. A total 30 patients with laryngeal cancer and 20 healthy volunteers were recruited. During the 2 weeks before surgery, 20 patients were randomly allocated to receive probiotics or placebo twice a day. Heart rate was recorded daily. The degree of anxiety was assessed by the Hamilton Anxiety Scale (HAMA). Serum CRF levels in laryngeal cancer patients increased significantly in approaching surgery. After ingestion of probiotics, serum levels of CRF and heart rate did not increase before surgery. In addition, taking probiotics relieved the degree of anxiety of the patients from HAMA 19.8 to 10.2. Probiotics can ameliorate the clinical anxiety and biochemical features of stress in patients scheduled for laryngectomy. © 2014 Wiley Publishing Asia Pty Ltd.

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

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

    NARCIS (Netherlands)

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

    2000-01-01

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

  20. Retrograde intrarenal surgery in pediatric patients.

    Science.gov (United States)

    Resorlu, Berkan; Sancak, Eyup Burak; Resorlu, Mustafa; Gulpinar, Murat Tolga; Adam, Gurhan; Akbas, Alpaslan; Ozdemir, Huseyin

    2014-11-01

    Urinary tract stone disease is seen at a level of 1%-2% in childhood (stone disease, particularly in adolescence. A carbohydrate- and salt-heavy diet and a more sedentary lifestyle are implicated in this increase. Although stone disease is rare in childhood, its presence is frequently associated with metabolic or anatomical disorders or infectious conditions, for which reason there is a high possibility of post-therapeutic recurrence. Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children, with their expectations of a long life. In children in whom active stone removal is decided on, the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality. Thanks to today's advanced technology, renal stones that were once treated only by surgery can now be treated with minimally invasive techniques, from invasion of the urinary system in an antegrade (percutaneous nephrolithotomy) or retrograde (retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery. This compilation study examined studies involving the RIRS procedure, the latest minimally invasive technique, in children and compared the results of those studies with those from other techniques.

  1. Mortality risk factors in critical post-surgical patients treated using continuous renal replacement techniques.

    Science.gov (United States)

    Estupiñán-Jiménez, J C; Castro-Rincón, J M; González, O; Lora, D; López, E; Pérez-Cerdà, F

    2015-04-01

    To determine the influence of demographics, medical, and surgical variables on 30-day mortality in patients who need continuous renal replacement therapy (CRRT). A retrospective-following study was conducted using the data of 112 patients admitted to the postoperative intensive care unit who required CRRT, between August 2006 and August 2011, and followed-up for 30 days. The following information was collected: age, gender, history of HBP, DM, cardiovascular disease, and CKD, urgent surgery, surgical speciality, organic dysfunction according to the SOFA scale, the number of organs with dysfunction, use of mechanical ventilation, diagnostic and origin of sepsis, type of CRRT, and 30-day mortality. General linear models were used for estimating the strength of association (relative risk [RR], and 95% confidence interval [CI] between variables and 30-day mortality. In the univariant analysis, the following variables were identified as risk factors for 30-day mortality: age (RR 1.04; 95% CI 1.01-1.06; P=.0005), and history of cardiovascular disease (RR 1.57; 95% CI 1.02-2.41; P=.039). Among the variables included in the multivariable analysis (age, history of cardiovascular disease, sepsis, and number of organs with dysfunction), only age was identified as an independent risk factor for 30-day mortality (RR 1.03; 95% CI 1.00-1.05; P=.007). Thirty-day mortality in postoperative, critically ill patients who require CRRT is high (41.07%). Age has been identified as an independent risk factor, with renal failure as the most common indication for the use of these therapies. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. RISK OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY UNDERGOING NONCARDIAC SURGERY

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

  3. Living history in current orthopaedic hip surgery: intrapelvic teflon granuloma after total hip replacement.

    Science.gov (United States)

    Gheorghiu, Daniel; Peter, Viju; Lynch, Martin

    2010-02-01

    The teflon hip arthroplasty design was used by Sir John Charnley in the early 60's but was taken off the market due to high complication rates. A case is reported of an intrapelvic granuloma after total hip arthroplasty following the use of a teflon socket. This appears to be the last surviving patient treated by Sir John Charnley using a Teflon hip socket design.

  4. Aortic valve replacement in geriatric patients with small aortic roots: are sutureless valves the future? †

    Science.gov (United States)

    Shrestha, Malakh; Maeding, Ilona; Höffler, Klaus; Koigeldiyev, Nurbol; Marsch, Georg; Siemeni, Thierry; Fleissner, Felix; Haverich, Axel

    2013-01-01

    OBJECTIVES Aortic valve replacement (AVR) in geriatric patients (>75 years) with small aortic roots is a challenge. Patient–prosthesis mismatch and the long cross-clamp time necessary for stentless valves or root enlargement are matters of concern. We compared the results of AVR with sutureless valves (Sorin Perceval), against those with conventional biological valves. METHODS Between April 2007 and December 2012, 120 isolated AVRs were performed in patients with a small annulus (<22 mm) at our centre. In 70 patients (68 females, age 77.4 ± 5.5 years), conventional valves (C group) and in 50 patients (47 females, age 79.8 ± 4.5 years), sutureless valves (P group) were implanted. The Logistic EuroSCORE of the C group was 16.7 ± 10.4 and that of the P group 20.4 ± 10.7, (P = 0.054). Minimal-access surgery was performed in 4.3% (3/70) patients in the C group and 72% (36/50) patients in the P group. RESULTS The cardiopulmonary bypass (CPB) and cross-clamp times of the C group were 75.3 ± 23 and 50.3 ± 14.2 min vs 58.7 ± 20.9 and 30.1 ± 9 min in the P group, (P < 0.001). In the C group, two annulus enlargements were performed. Thirty-day mortality was 4.3% (n = 3) in the C group and 0 in the P group, (n.s.). At follow-up (up to 5 years), mortalities were 17.4% (n = 12) in the C group and 14% (n = 7) in the P group, (n.s.). CONCLUSIONS This study highlights the advantages of sutureless valves for geriatric patients with small aortic roots reflected by shorter cross-clamp and CPB times, even though most of these patients were operated on via a minimally invasive access. Moreover, due to the absence of a sewing ring, these valves are also almost stentless, with greater effective orifice area (EOA) for any given size. This may potentially result in better haemodynamics even without the root enlargement. This is of advantage, as several studies have shown that aortic root enlargement can significantly increase the risks of AVR. Moreover, as seen in this series

  5. A collaborative transdisciplinary "geriatric surgery service" ensures consistent successful outcomes in elderly colorectal surgery patients.

    Science.gov (United States)

    Tan, Kok-Yang; Tan, Phyllis; Tan, Lawrence

    2011-07-01

    We hypothesized that a dedicated collaborative transdisciplinary Geriatric Surgery Service (GSS) will improve care for elderly colorectal surgery patients. Patients older than 75 years of age who underwent major colorectal surgery were included in this study. The Geriatric Surgery Service employed a transdisciplinary, collaborative model of care. There were frequent quality reviews and a patient-centered culture was ensured. Treatment protocols and checklists were instituted. Perioperative outcome data were collected prospectively between 2007 and 2009. These data were compared to those from similar patients not managed by the service. Success and failure of surgical treatment of the two groups were analyzed using CUSUM methodology. Failure was defined as mortality, prolonged hospital stay for any reason, including morbidity, and failure to regain preoperative function by 6 weeks. Twenty-nine patients managed by the GSS were compared to 52 patients who underwent standard treatment. The median age of the patients managed by the GSS was higher but there was no difference in the ASA score and predicted morbidity scores based on the POSSUM model. The GSS achieved lower mortality and major complication rates. A large majority (84.6%) of the patients managed by the GSS returned to preoperative functional status by 6 weeks. The GSS was able to produce a trend of successively desired outcomes consistently leading to the CUSUM curve exhibiting a sustained downward slope. This was in contrast to patients not managed by the GSS. The Geriatric Surgery Service, through its transdisciplinary, collaborative care processes, was able to achieve sustained superior outcomes compared to standard management.

  6. Arthroscopic knee debridement can delay total knee replacement in painful moderate haemophilic arthropathy of the knee in adult patients.

    Science.gov (United States)

    Rodriguez-Merchan, E Carlos; Gomez-Cardero, Primitivo

    2016-09-01

    The role of arthroscopic debridement of the knee in haemophilia is controversial in the literature. The purpose of this study is to describe the results of arthroscopic knee debridement (AKD), with the aim of determining whether it is possible to delay total knee replacement (TKR) for painful moderate haemophilic arthropathy of the knee in adult patients. In a 14-year period (1998-2011), AKD was performed for moderate haemophilic arthropathy of the knee in 27 patients with haemophilia A. Their average age at operation was 28.6 years (range 26-39 years). Indications for surgery were as follows: more than 90° of knee flexion, flexion deformity less than 30°, good axial alignment of the knee, good patellar alignment, and pain above >60 points in a visual analogue scale [0 (no pain) to 100 points]. Secondary haematological prophylaxis and rehabilitation (physiotherapy) was given for at least 3 months after surgery. Follow-up was for an average of 7.5 years (range 2-14 years). We assessed the clinical outcome before surgery and at the time of latest follow-up using the Knee Society pain and function scores, the range of motion, and the radiological score of the World Federation of Haemophilia. Knee Society pain scores improved from 39 preoperatively to 66 postoperatively, and function scores improved from 36 to 52. Range of motion improved on an average from -15° of extension and 90° of flexion before surgery, to -5° of extension and 110° of flexion at the last follow-up. A radiological deterioration of 2.8 points on average was found. There were two (7.4%) postoperative complications (haemarthroses resolved by joint aspiration). One patient (3.7%) required a TKR 12.5 years later. AKD should be considered in painful moderate haemophilic arthropathy of the knee in adult patients to delay TKR.

  7. Effects and patients' experiences of interactive video-based physiotherapy at home after shoulder joint replacement

    OpenAIRE

    Eriksson, Lisbeth

    2009-01-01

    Physiotherapy is essential to optimize the results of shoulder joint replacement, but requires a close monitoring and co-operation between patient and physiotherapist. The development of telerehabilitation brings opportunities for distance-spanning and home-based physiotherapy interventions. The aim of this thesis is to explore effects and to describe experiences among patients participating in interactive video-based physiotherapy at home after shoulder joint replacement. A series of 22 pati...

  8. Pulmonary physiotherapy effect on patients undergoing open cardiac surgery

    Directory of Open Access Journals (Sweden)

    Seyed Kazem Shakuri

    2014-09-01

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

  9. Surgery in asymptomatic patients with colorectal cancer and unresectable liver metastases: the authors' experience

    Directory of Open Access Journals (Sweden)

    Boselli C

    2013-03-01

    IV colorectal cancer, the overall risk of death was significantly higher after elective surgery compared to patients receiving chemotherapy alone. However, in the literature, there is no substantial difference between these treatments. New studies are required to better evaluate outcomes. Keywords: large bowel, tumor, inoperable liver replacement, palliative surgery, 30-day mortality

  10. Metabolic Bone Disease in the Bariatric Surgery Patient

    Directory of Open Access Journals (Sweden)

    Susan E. Williams

    2011-01-01

    Full Text Available Bariatric surgery has proven to be a life-saving measure for some, but for others it has precipitated a plethora of metabolic complications ranging from mild to life-threatening, sometimes to the point of requiring surgical revision. Obesity was previously thought to be bone protective, but this is indeed not the case. Morbidly obese individuals are at risk for metabolic bone disease (MBD due to chronic vitamin D deficiency, inadequate calcium intake, sedentary lifestyle, chronic dieting, underlying chronic diseases, and the use of certain medications used to treat those diseases. After bariatric surgery, the risk for bone-related problems is even greater, owing to severely restricted intake, malabsorption, poor compliance with prescribed supplements, and dramatic weight loss. Patients presenting for bariatric surgery should be evaluated for MBD and receive appropriate presurgical interventions. Furthermore, every patient who has undergone bariatric surgery should receive meticulous lifetime monitoring, as the risk for developing MBD remains ever present.

  11. Appropriate patient selection or health care rationing? Lessons from surgical aortic valve replacement in the Placement of Aortic Transcatheter Valves I trial.

    Science.gov (United States)

    Szeto, Wilson Y; Svensson, Lars G; Rajeswaran, Jeevanantham; Ehrlinger, John; Suri, Rakesh M; Smith, Craig R; Mack, Michael; Miller, D Craig; McCarthy, Patrick M; Bavaria, Joseph E; Cohn, Lawrence H; Corso, Paul J; Guyton, Robert A; Thourani, Vinod H; Lytle, Bruce W; Williams, Mathew R; Webb, John G; Kapadia, Samir; Tuzcu, E Murat; Cohen, David J; Schaff, Hartzell V; Leon, Martin B; Blackstone, Eugene H

    2015-09-01

    The study objectives were to (1) compare the safety of high-risk surgical aortic valve replacement in the Placement of Aortic Transcatheter Valves (PARTNER) I trial with Society of Thoracic Surgeons national benchmarks; (2) reference intermediate-term survival to that of the US population; and (3) identify subsets of patients for whom aortic valve replacement may be futile, with no survival benefit compared with therapy without aortic valve replacement. From May 2007 to October 2009, 699 patients with high surgical risk, aged 84 ± 6.3 years, were randomized in PARTNER-IA; 313 patients underwent surgical aortic valve replacement. Median follow-up was 2.8 years. Survival for therapy without aortic valve replacement used 181 PARTNER-IB patients. Operative mortality was 10.5% (expected 9.3%), stroke 2.6% (expected 3.5%), renal failure 5.8% (expected 12%), sternal wound infection 0.64% (expected 0.33%), and prolonged length of stay 26% (expected 18%). However, calibration of observed events in this relatively small sample was poor. Survival at 1, 2, 3, and 4 years was 75%, 68%, 57%, and 44%, respectively, lower than 90%, 81%, 73%, and 65%, respectively, in the US population, but higher than 53%, 32%, 21%, and 14%, respectively, in patients without aortic valve replacement. Risk factors for death included smaller body mass index, lower albumin, history of cancer, and prosthesis-patient mismatch. Within this high-risk aortic valve replacement group, only the 8% of patients with the poorest risk profiles had estimated 1-year survival less than that of similar patients treated without aortic valve replacement. PARTNER selection criteria for surgical aortic valve replacement, with a few caveats, may be more appropriate, realistic indications for surgery than those of the past, reflecting contemporary surgical management of severe aortic stenosis in high-risk patients at experienced sites. Copyright © 2015 The American Association for Thoracic Surgery. Published by

  12. Patient adaptable cerebellar retractor system: Use in posterior fossa surgery

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    Hamid Borghei-Razavi

    2015-06-01

    Full Text Available A new patient adaptable dual use soft tissue spreader and cerebellar retractor system designed for use during surgery of the posterior fossa is described. We found that this new retractor design allowed for excellent exposure, plus greater freedom and dexterity during the posterior fossa surgery. This novel instrument is an improvement over the existing instrument, because it provided more force/power transmission from pins/connectors to the brain spatula via the shorter flexible arm.

  13. Do patients lose weight after total knee replacement?

    National Research Council Canada - National Science Library

    Schwartsmann, Carlos Roberto; Borges, Alexandre Moreira; Freitas, Geraldo Luiz Schuck de; Migon, Eduardo Zaniol; Oliveira, Gustavo Kaempf de; Rodrigues, Marcos Wainberg

    2017-01-01

    ...) tend to maintain or gain weight after the procedure, which would result in increased wear of the prosthesis and new surgical interventions in a smaller period of time in comparison with patients...

  14. Challenges of valve surgeries in post-renal transplant patients.

    Science.gov (United States)

    Ahmad, Tanveer; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere; Pasarad, Ashwini Kumar

    2015-01-01

    Renal transplantation remains a mainstay of therapy for the end-stage renal disease. Cardiac disease has a high prevalence in this patient population. Cardiovascular disease remains the leading cause of death among kidney transplantation patients. The cardiac disease accounts for 43% of all-cause mortality among dialysis patients and for ≈38% of all-cause mortality after transplantation. In this article, we review the factors and outcomes associated with valve surgeries in renal transplant recipients and evaluate the strategy for open heart surgery after renal transplantation performed.

  15. Patient and implant survival following joint replacement because of metastatic bone disease

    DEFF Research Database (Denmark)

    Sørensen, Michala S; Gregersen, Kristine G; Grum-Schwensen, Tomas

    2013-01-01

    Patients suffering from a pathological fracture or painful bony lesion because of metastatic bone disease often benefit from a total joint replacement. However, these are large operations in patients who are often weak. We examined the patient survival and complication rates after total joint...

  16. Morbidity After Cardiac Surgery in Patients With Adult Congenital Heart Disease in Comparison With Acquired Disease.

    Science.gov (United States)

    Karangelis, Dimos; Mazine, Amine; Narsupalli, Sreekanth; Mendis, Shamarli; Veldtman, Gruschen; Nikolaidis, Nicolas

    2017-06-28

    Due to the advancements in congenital cardiac surgery and interventional cardiology in the last five decades, more than 85% of congenital heart patients now survive to adulthood. This retrospective study included 135 Adult Congenital Heart Disease (ACHD) patients, who had cardiac surgery at Southampton General Hospital over three consecutive years. We also included 42 patients with a structurally normal heart who had cardiac surgery for acquired cardiac conditions as a control group. Preoperative, intraoperative and postoperative data were analysed in both groups to identify risk factors for morbidity and mortality. In the ACHD group, in hospital mortality was 0.7%. In the control group no deaths were observed. Fifty-eight per cent of the ACHD patients had significantly higher perioperative morbidity with arrhythmias (26%), bleeding (3%), prolonged ventilation (11.3%) and renal replacement therapy 1.5%. In the non ACHD control group 32% (p=0.003) developed perioperative complications with arrhythmias (9.8%), bleeding (2.5%), prolonged ventilation (4.3%) and renal replacement therapy (2.5%). In ACHD patients total in-hospital stay was longer in patients with longer cardiopulmonary bypass (CPB) time (p=0.005), aortic cross clamp time (p=0.013) and higher preoperative alkaline phosphatase level (p=0.005). Early postoperative complications were higher in ACHD patients with longer cardiopulmonary bypass time (p=0.04) and presence of pulmonary artery hypertension (p=0.012). Even though the preoperative and operative characteristics are similar to both groups, the morbidity is more in ACHD group. Longer CBP time, aortic cross clamp time and presence of pulmonary hypertension are risk factors for higher morbidity in this group. Copyright © 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  17. Long-term outcomes in patients after epilepsy surgery failure.

    Science.gov (United States)

    Ryzí, Michal; Brázdil, Milan; Novák, Zdeněk; Hemza, Jan; Chrastina, Jan; Ošlejšková, Hana; Rektor, Ivan; Kuba, Robert

    2015-02-01

    The primary aim of this study was to analyze the long-term outcomes of patients who were classified as Engel IV one year after resective epilepsy surgery. The secondary objectives were to evaluate the effectiveness of different treatment options and to examine the reasons that the patients did not undergo resective reoperation. Our study was designed as a retrospective open-label investigation of the long-term outcomes of 34 patients (12% of all surgically treated patients) who were classified as Engel IV one year after epilepsy surgery. At the last follow-up visit (average of 7.6 ± 4.2 years after surgery), 12 of the 34 examined patients (35.3%) were still classified as Engel IV; 22 of the 34 patients (64.7%) were improved (Engel I-III). Of the 34 patients, 8 (23.5%) achieved an excellent outcome, classified as Engel I, 3 patients (8.8%) were classified as Engel II, and 11 patients (32.4%) as Engel III. The seizure outcome in the patients classified as Engel I was achieved by resective reoperation in 4; by a change in antiepileptic medication in 3 patients; and by vagus nerve stimulation (VNS) in 1 patient. The seizure outcome of Engel II was achieved by a change in antiepileptic medication in all 3 patients. Of the 34 patients, a total of 6 (17.6%) underwent resective reoperation only. The major reasons for this were the absence of a plausible hypothesis for invasive re-evaluation, the risk of postoperative deficit, and multifocal epilepsy in the rest of patients. Although the reoperation rate was relatively low in our series, we can achieve better or even excellent seizure outcomes using other procedures in patients for whom resective surgery initially failed. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. Prevention of venous thromboembolism in patients undergoing bariatric surgery

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    Bartlett MA

    2015-08-01

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

  19. A psychiatric perspective view of bariatric surgery patients

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    Isabel Brandão

    2015-10-01

    Full Text Available Abstract Background Bariatric surgery is the only procedure that has significant results in weight loss and improvements in medical comorbidities in morbid obese patients. Severely obese patients are also associated with a higher prevalence of psychiatric disorders and poor quality of life. Objective To evaluate specific areas of psychopathology in individuals undergoing bariatric surgery. Methods A review of the literature was conducted from January 2002 to March 2014 by researching PubMed database using the following query: “morbid AND obesity AND bariatric AND surgery AND (psychiatry OR psychology”. Results Overall improvements in eating behaviors, mood disorders and body image are reported after bariatric surgery, and the mechanism is not enlightened. Risk of suicide and consumption of substances of abuse, especially alcohol, after gastric bypass surgery are problems that clinicians must be aware. Discussion Bariatric patients should be monitored after surgery to identify who did not show the expected benefits postoperatively and the ones who develop psychiatric symptoms after an initial positive response.

  20. Orthognathic surgery: is patient information on the Internet valid?

    Science.gov (United States)

    Aldairy, T; Laverick, S; McIntyre, G T

    2012-08-01

    The aims of this study were to evaluate the quality and reliability of UK websites providing information on orthognathic and jaw surgery to patients. An Internet search engine (www.google.com) was used to identify websites containing medical information on 'orthognathic surgery' and 'jaw surgery'. Of over 144,000 links for orthognathic surgery and 700,000 for jaw surgery, the first 100 were examined in detail. After excluding discussion groups, news and video feeds, and removing duplicate sites, only 25 relevant websites remained which were then evaluated using the DISCERN instrument (www.discern.org.uk/discern_instrument.php). Through the 16 questions assessing the reliability and quality of the consumer information which are scored from 1 to 5, a relative index of the quality of the information is produced. The maximum score attainable for an excellent website is 80. Of the 25 websites that were scored, DISCERN indicated the majority of websites fell well below the maximum score. The highest score achieved by one of the websites according to the DISCERN tool was 64 of 80 and the lowest score achieved was 21 of 80. The websites achieving maximum and minimum score were Wikipedia and qualitydentistry.com, respectively. By directing patients to validated websites, clinicians can ensure patients find appropriate information; however, further development of websites relating to orthognathic surgery is required. Internet information should be updated on a regular basis to account for improvements in orthodontic and surgical care.

  1. Early impact of aortic wrapping on patients undergoing aortic valve replacement with mild to moderate ascending aorta dilatation

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    Sosnowski Andrzej

    2010-08-01

    Full Text Available Abstract Background The management of mild to moderate dilatation of the ascending aorta of less than 5 cm is controversial, particularly when concomitant surgical correction of aortic valve is required. We investigate the impact of a simple method of aorta reduction using Dacron graft wrapping during aortic valve replacement on the rest of the aorta. Methods We studied 14 patients who had ascending aorta dilatation of 4-5 cm before undergoing aortic wrapping during their aortic valve replacement and compared with their post-operative imaging within a month. Results The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within 4 weeks after surgery from 44.7 ± 2.6 to 33.6 ± 3.9 mm (p Conclusions Reduction of ascending aortic dilatation by wrapping with a Dacron graft in this preliminary study is associated with favourable early reversed aortic remodelling. This supports the hypothesis that correction of mild-moderate dilatation of the ascending aorta with Dacron wrapping at the time of aortic valve surgery may prevent the progression of the dilatation, although the long-term study on a larger population is needed to confirm its benefits.

  2. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Science.gov (United States)

    Cerci, M.; Bellini, M. I.; Russo, F.; Benavoli, D.; Capperucci, M.; Gaspari, A. L.; Gentileschi, P.

    2013-01-01

    Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86%) discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87%) showed remission and 2 (13%) improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients. PMID:24454338

  3. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Directory of Open Access Journals (Sweden)

    M. Cerci

    2013-01-01

    Full Text Available Introduction. Moderate obesity (BMI 30–35 kg/m2 affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM (56%, gastric bypass was performed; in cases with hypertension (64% and obstructive sleep apnea (OSA (12%, sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86% discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87% showed remission and 2 (13% improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients.

  4. Quality of life after brainstem cavernoma surgery in 71 patients.

    Science.gov (United States)

    Dukatz, Thomas; Sarnthein, Johannes; Sitter, Helmut; Bozinov, Oliver; Benes, Ludwig; Sure, Ulrich; Bertalanffy, Helmut

    2011-09-01

    Symptomatic patients with a brainstem cavernoma are treated surgically with increasing frequency. Generally, the patient's benefit from this difficult surgical intervention is quantified by the assessment of neurological symptoms. To document the beneficial effect of surgery in a larger patient population by assessing the postoperative quality of life (QoL). In a series of 71 surgically treated patients, a detailed neurological status was assessed by Patzold Rating and Karnofsky Performance Status Scale. Patients rated their QoL with the Short Form 36 Health Survey. To document the effect of surgery on QoL, we devised a supplementary questionnaire. The last 24 patients completed Short Form 36 Health Survey pre- and postoperatively. Karnofsky Performance Status Scale improved in 44 of 71 surgical patients (62%), remained unchanged in 19 (27%), and deteriorated in 8 (11%) individuals. Patzold Rating showed a more detailed picture of the neurological symptoms. It correlated significantly with Karnofsky Performance Status Scale, which underscores its usefulness for patients with brainstem lesions. In the Short Form 36 Health Survey score, the Mental Component Summary improved with surgery (paired test, P = .015). In addition, 58 individuals (82%) declared a clear subjective benefit of surgery. The results of this large series support the notion that microsurgical removal of a brainstem cavernoma represents an effective therapy in experienced hands and is generally associated with good clinical outcome, both neurologically and in terms of QoL.

  5. Patients' attitude towards residents' participation during gynaecological surgery

    NARCIS (Netherlands)

    Versluis, Marco A. C.; van der Linden, Paul J. Q.

    2010-01-01

    Objective: To evaluate patients' attitude towards participation of residents in training in gynaecological surgery and patients understanding of resident position. Study design: An observational survey study was performed between July and February 2007-2008 in an outpatient clinic of a department of

  6. Flap surgery in treatment of patients with pathology of ankle

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    D. I. Kutyanov

    2013-01-01

    Full Text Available Objective: to determine the capabilities and perspectives of flap surgery in treatment of patients with traumas and diseases of ankle joint region. Material and methods. The results of surgical treatment of 88 such patients. All the patients were treated in the Vreden Russian Research Institute of Traumatology and Orthopedics within the period from 2000 to 2011. All the patients had pedicled flap transfer (46 cases or free tissue transfer (45 cases. 11 patients had additional need in other open orthopedic operations of ankle joint. Besides this, scientific works dealing with the studied problem have been analyzed. Results and conclusions. It has been stated that flap surgery is predominantly used as the only and exhaustive method of treatment of such patients (87,5%. In these situations pedicled flap transfer and free tissue transfer tend to be used in comparatively equal quantities. Flap surgery is now seldom used as a component of complex surgical treatment. It is used only in some cases of bone reconstruction of distal tibia by Ilizarov bone transport, in some cases of tumors of ankle joint as well as in some cases of local infectious complications after internal fixation and total ankle arthroplasty. Patients with the pathology of this kind have a high need in free tissue transfer (from 66,7% to 83,3%. Progressing technology of total ankle arthroplasty will contribute to the frequency of use of flap surgery for patients with pathology of ankle joint.

  7. Patients' attitude towards residents' participation during gynaecological surgery

    NARCIS (Netherlands)

    Versluis, Marco A. C.; van der Linden, Paul J. Q.

    2010-01-01

    Objective: To evaluate patients' attitude towards participation of residents in training in gynaecological surgery and patients understanding of resident position. Study design: An observational survey study was performed between July and February 2007-2008 in an outpatient clinic of a department of

  8. Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised clinical trial Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised

    DEFF Research Database (Denmark)

    Hørdam, Britta

    2010-01-01

    Nursing intervention by telephone interviews of patients aged over 65 years after total hip replacement improves health status: a randomised clinical trial Objective: We hypothesised that all areas of health status after total hip replacement could be improved in patients aged over 65 years...... and over by using telephone support and counselling 2 and 10 weeks after surgery compared with a control group receiving conventional care and treatment. Design: A randomised clinical trial focusing on patients' health status by using short-form 36 at 4 weeks preoperatively and 3 and 9 months...... postoperatively was carried out. Sample: 180 patients aged 65 years and over were randomised 4 weeks preoperatively to either control or intervention groups. Measurements: both groups received conventional surgical treatment, but the intervention group was interviewed by telephone 2 and 10 weeks after surgery...

  9. Evaluation of life quality of patients submitted to orthognathic surgery

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    Ana Catarina Alves e Silva

    2013-10-01

    Full Text Available OBJECTIVE: To compare changes related to self-esteem and appearance satisfaction between pre and postsurgical phases in patients undergoing orthognathic surgery and to assess the quality of life and psychosocial changes of these patients six months after surgery. METHODS: A longitudinal observational qualitative study was performed. The sample comprised 15 patients with dentofacial deformities who underwent orthognathic surgery. One questionnaire and two forms were answered during pre and postoperative phases. RESULTS: The results showed that 13.3% of patients demonstrated self-esteem improvement, especially in relation to appearance satisfaction. Improvements were also noted in social, occupational and family relationships. With regard to the assessment of quality of life, according to the World Health Organization questionnaire, the lowest improvement averages corresponded to environmental control. CONCLUSION: Orthognathic surgery brings along many emotional changes that should be considered before and after surgery, since the patients' psychological state may be favorable and/or unfavorable during recovery, influencing their quality of life, self-esteem and appearance satisfaction.

  10. [Evaluation of preoperative anxiety in patients requiring glaucoma filtration surgery].

    Science.gov (United States)

    Lemaitre, S; Blumen-Ohana, E; Akesbi, J; Laplace, O; Nordmann, J-P

    2014-01-01

    Preoperative anxiety is often expressed by patients requiring filtration surgery for their glaucoma. So far, there has been no scale for screening this group of patients for preoperative anxiety. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-evaluation questionnaire which has been used in specialties other than ophthalmology and which makes it possible to identify the adult patients with a high level of preoperative anxiety over an upcoming surgical procedure. The purpose of this study is to estimate the preoperative anxiety in glaucoma patients requiring filtration surgery. We performed a prospective study of 36 adult patients with chronic glaucoma not responding to medical treatment and who were about to undergo filtration surgery (trabeculectomy or deep sclerectomy). The APAIS questionnaire was given to the patients after discussing the indication for surgery. A global anxiety score (ranging from 4 to 20) above 10 defined patients with a high level of preoperative anxiety. We attempted to identify among these patients the factors related to filtration surgery which caused them anxiety (lack of control of intraocular pressure, risk of blindness, presence of the filtering bleb). In our sample of patients, we found that glaucoma was a source of anxiety. That was also true for the surgical procedure, though most patients believe that once the decision had been made, their psychological status was not modified by the upcoming procedure. The patient-clinician relationship is important in any chronic disease, all the more so in glaucoma, since this disease remains asymptomatic for a long time. When filtration surgery is necessary, the patients are going to express less preoperative anxiety if they trust their physician and if individualized information has been given to them The French version of the APAIS is a quick scale, easily completed, that can be recommended for evaluating anxiety and patients' need for information prior to filtering

  11. Prevalence of myopic shifts among patients seeking cataract surgery

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    Rafael Iribarren

    2013-06-01

    Full Text Available Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males. A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%. The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

  12. Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery

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    Jennifer M. Hah

    2015-01-01

    Full Text Available Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid naïve counterparts to identify differences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R score was associated with 2.37 (95% CI 1.29–4.32 increased odds of preoperative opioid use (p=0.0005. The SOAPP-R score was also associated with 3.02 (95% CI 1.36–6.70 increased odds of illicit preoperative opioid use (p=0.007. Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12–7.27 increased odds of legitimate preoperative opioid use (p=0.03. Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse after surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain.

  13. Patient prosthesis mismatch after aortic valve replacement: An Indian perspective

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    Shreedhar S Joshi

    2016-01-01

    Full Text Available Context: Perioperative period. Aims: Occurrence of PPM after AVR, factors associated with PPM, impact on mortality. Settings and Design: Teritary Care Referral Cardiac Centre. Materials and Methods: A retrospective analysis of AVR procedures at a single centre over 4 years was conducted. Demographic, echocardiographic and outcome data were collected from institute database. Rahimtoola criteria of indexed effective orifice area (iEOA were used to stratify patients into PPM categories. Patients with and without PPM were compared for associated factors. Statistical Analysis Used: Independent t-test, chi-square test, logistic regression analysis, ROC-AUC, Youden index. Results: 606 patients with complete data were analysed for PPM. The incidence of mild, moderate and severe PPM was 6.1% (37, 2.5% (15 and 0.5% (3 respectively. There was no impact of PPM on all-cause in-hospital mortality. PPM was observed more with Aortic Stenosis (AS compared to Aortic Regurgitation (AR as etiology. Aortic annulus indexed to BSA (iAA had a very good predictive ability for PPM at <16mm/m 2 BSA. Conclusions: PPM has lower incidence after AVR in this Indian population and does not increase early mortality. Patients with AS and iAA<16mm/m2BSA should be cautiously dealt with to prevent PPM.

  14. Urological surgery in elderly patients: results and complications

    Directory of Open Access Journals (Sweden)

    Brodak M

    2015-02-01

    Full Text Available Milos Brodak, Jan Tomasek, Jaroslav Pacovsky, Lukas Holub, Petr Husek Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Purpose: Owing to the large aging population, a growing number of elderly patients are undergoing surgical treatment. Surgical procedures in elderly patients are associated with a higher risk of complications. The aim of this study was to evaluate the efficacy and safety of urological surgeries in old patients.Methods: The authors carried out a retrospective study, evaluating results and early postoperative complications in patients aged 75 years and older. The cohort of patients included 221 patients who underwent surgical procedures in the department of urology between January 2011 and December 2012. The average age of patients was 78. The results and complications were categorized based on the type of surgery performed, and the Dindo–Clavien scale.Results: The median follow-up was 18 months. All surgeries for malignant tumors were performed successfully with no residual disease. Totally, 48 (22% complications were recorded. The most serious were as follows: one patient (<0.5% died; and four (<2% patients underwent reoperation. The most common complications involved infection, mainly sepsis and surgical site infections. Other complications included mild respiratory insufficiency, delirium, bleeding, etc.Conclusion: Surgeries in elderly patients were effective and safe. The cornerstone of safety is careful preparation and treatment of comorbidities. Complications occurred mainly as a result of emergency procedures during emergency procedures and in major surgeries such as cystectomy and nephrectomy. The standard use of low molecular-weight heparin caused no incidence of thromboembolic disease. Keywords: urinary tract, aged, postoperative complications, Dindo–Clavien classification

  15. The impact of prior prostatic surgery on urinary continence in patients undergoing orthotopic ileal neobladder

    Directory of Open Access Journals (Sweden)

    Homero O. de Arruda

    2003-12-01

    Full Text Available OBJECTIVE: To establish if previous surgery for benign prostatic hyperplasia (transurethral resection of the prostate or open prostatectomy, age, and preservation of prostatic apex can influence postoperative urinary continence in patients submitted to radical cystectomy and orthotopic ileal neobladder. PATIENTS AND METHODS: We analyzed 62 patients with bladder cancer who were treated with radical cystectomy and orthotopic ileal neobladder between 1987 and 1998 and had been followed for at least 24 months. The average age and median follow up were 61 years and 53 months, respectively. Postoperative urinary continence was correlated with 3 factors: patient age, preservation of prostatic apex during surgical excision and prior prostatic surgery for benign disease. Patients were defined as incontinent when they had to use more than 1 protective pad at the daytime. RESULTS: The overall incidence of urinary incontinence was 12.9% (8 out of 62 patients. The only statistically significant factor that impacted upon urinary continence was previous prostatic surgery, with respectively 33% versus 7% rate of incontinence for patients previously operated on and for those without previous operation (p = 0.023 odds ratio = 6.5, 95% confidence interval. Preservation of prostatic apex did not reach difference, 12% versus 13%, for those with and without preservation, and age also did not influence the postoperative continence rate. CONCLUSIONS: Prior prostatic surgery for benign prostatic hyperplasia probably can increases the risk for postcystectomy incontinence and preservation of prostate apex did not affect the continence rate. This issue deserves to be considered by the surgeon and must be discussed previously with the patients when planning an orthotopic bladder replacement.

  16. Technique of open laparoscopy for supramesocolic surgery in obese patients.

    Science.gov (United States)

    Deguines, Jean Baptiste; Qassemyar, Quentin; Dhahri, Abdennaceur; Brehant, Olivier; Fuks, David; Verhaeghe, Pierre; Regimbeau, Jean-Marc

    2010-08-01

    Incidence of obesity and related diseases are increasing in the world. Visceral surgeons are more often confronted with laparoscopic surgery in obese patients. Besides validated surgery procedures, such as cholecystectomy and gastroesophageal reflux surgery, bariatric procedures are increasingly performed. In obese patients, the thickness of adipose panicle makes open laparoscopy hazardous. In our department, we use systematically a technique of open laparoscopy in obese patients for supramesocolic surgery, which is safe, reproducible, and permits good closure of the abdominal wall. The surgical technique consists of opening the abdominal wall through the rectus abdominis. Helped by specific retractors called Descottes (Medtronic Laboratory), both fascias are charged by sutures separately. Incision in the fascias is made safely by pooling on sutures. Introduction of port-site is made under view control. At the end of laparoscopy, closure of both fascias is easily done. We present a technique of open laparoscopy in obese patients, systematically used, for supramesocolic surgery. This technique is safe, reproducible, and permits an efficient closure of the abdominal wall.

  17. Low arginine plasma levels in patients after thoracoabdominal aortic surgery.

    Science.gov (United States)

    Nijveldt, R J; Prins, H A; Siroen, M P; Rauwerda, J A; Teerlink, T; van Leeuwen, P A

    2000-08-01

    Thoracoabdominal aortic surgery is a high-risk procedure and associated with a significant morbidity and mortality. Ischemia reperfusion of visceral organs and lower extremities is one of the most important determinants of this morbidity. Arginine is the precursor of nitric oxide and arginine plasma levels are important in maintaining organ blood flow. Furthermore, arginine is important in wound healing and the immune system. Because of increased utilization of arginine, low arginine plasma levels could be expected after thoracoabdominal aortic surgery. We therefore measured arginine plasma levels in these patients. Six patients with thoracoabdominal aortic aneurysm were included in this study. University Hospital Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands. Six patients undergoing thoracoabdominal aortic surgery. Plasma levels of arginine were measured by high-performance liquid chromatography. Very low arginine plasma levels were seen on the first postoperative day. From day 1 arginine slowly increased, but did not reach normal plasma levels on day 6. A significant decrease of arginine plasma levels was found and because of the fact that arginine has multiple functions, it may be important to keep these arginine plasma levels at normal or even higher levels in patients undergoing major vascular surgery. European Journal of Clinical Nutrition (2000) 54, 615-617.

  18. Patient experiences with interventions to reduce surgery cancellations

    DEFF Research Database (Denmark)

    Hovlid, Einar; von Plessen, Christian; Haug, Kjell

    2013-01-01

    The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency, and redu......The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency......, and reduced post-operative complications. In our case a hospital had experienced high cancellation rates and therefore redesigned their pathway for elective surgery to reduce cancelations. We studied how patients experienced interventions to reduce cancellations....

  19. [Embracement and anxiety symptoms in patients before cardiac surgery].

    Science.gov (United States)

    Assis, Cinthia Calsinski; Lopes, Juliana de Lima; Nogueira-Martins, Luiz Antônio; de Barros, Alba Lucia Bottura Leite

    2014-01-01

    This is a randomized clinical trial, aimed to compare the frequency and intensity of symptoms of anxiety in patients of preoperative cardiac surgery who received empathic behavior from nurse or family or those who received no specific type of empathic behavior. The sample consisted of 66 patients in preoperative of cardiac surgery, which were divided in three groups: empathic behavior by nurses, without specific empathic behavior and by family. Anxiety was assessed at two points in time: before and after the intervention. The instrument used was developed and validated by Suriano, comprising 19 defining characteristics of the nursing diagnosis anxiety. It was observed that the reduction of anxiety symptoms was higher in the group receiving empathic behavior of relatives when compared to the other two groups. The results suggested that encouraging the participation of family members can contribute to the reduction of anxiety symptoms in patients in preoperative cardiac surgery.

  20. Counseling patients on facial volume replacement and adherence with posttreatment instructions

    Directory of Open Access Journals (Sweden)

    Doris Day

    2010-07-01

    Full Text Available Doris DayDay Dermatology and Aesthetics New York, USAAbstract: Use of injectable volume replacement products has increased dramatically in the US in recent years. An optimal outcome with volume replacement depends on a thorough ­knowledge of the products on the part of the dermatologic/aesthetic physician specialist, identification of patients with a likelihood of benefiting from volume replacement procedures, selection of an appropriate product for the individual patient, and effective patient counseling to ensure adherence to posttreatment care instructions. Adherence to physician instructions in the field of dermatology appears limited, and there is very little published information on adherence to physician instructions following facial volume replacement procedures. The purpose of this review is to provide strategies for understanding and overcoming the barriers to adherence with the widely used dermal fillers. Strategies include using patient-centered techniques, such as a motivational interview encouraging the patient to follow postprocedure care instructions, eg, massage. In this case, demonstrating massage techniques while the patient is still in the office, with patient participation and detailed feedback, also contributes to good adherence with posttreatment care instructions. Telephone counseling, reminder postcards, and text messages may help improve clinic attendance for follow-up. Motivated patients who demonstrate good ­adherence to physician instructions generally respond well to volume replacement treatments, and usually experience fewer adverse events than patients who do not follow instructions. Although promoting adherence to pretreatment and posttreatment protocols remains a challenge, patient counseling throughout the treatment process can lead to successful results.Keywords: improving adherence, injectable volume replacement, product selection, ­rejuvenation procedure, soft tissue augmentation

  1. The Impact of Waiting Time on Health Gains from Surgery: Evidence from a National Patient-reported Outcome Dataset.

    Science.gov (United States)

    Nikolova, Silviya; Harrison, Mark; Sutton, Matt

    2016-08-01

    Reducing waiting times has been a major focus of the English National Health Service for many years, but little is known about the impact on health outcomes. The collection of data on patient-reported outcome measures for all patients undergoing four large-volume procedures facilitates analysis of the impact of waiting times on patient outcomes. The availability of patient-reported outcome measures before and after surgery allows us to estimate the impact of waiting times on the effectiveness of treatment, controlling for pre-surgery health and the endogeneity of waiting times caused by prioritisation with respect to pre-intervention health. We find that waiting time has a negative and statistically significant impact on the health gain from hip and knee replacement surgery and no impact on the effectiveness of varicose vein and hernia surgery. The magnitude of this effect at patient level is small, 0.1% of the outcome measure range for each additional week of waiting. However, the value of this effect is substantially larger than existing estimates of the disutility experienced during the waiting period. The health losses associated with an additional week of waiting for annual populations of hip and knee replacement patients are worth £11.1m and £11.5m, respectively. Copyright © 2015 John Wiley & Sons, Ltd.

  2. Foot massage: effectiveness on postoperative pain in breast surgery patients.

    Science.gov (United States)

    Ucuzal, Meral; Kanan, Nevin

    2014-06-01

    The aim of this study was to determine the effect of foot massage on pain after breast surgery, and provide guidance for nurses in nonpharmacologic interventions for pain relief. This was a quasiexperimental study with a total of 70 patients who had undergone breast surgery (35 in the experimental group and 35 in the control group). Patients in the control group received only analgesic treatment, whereas those in the experimental group received foot massage in addition to analgesic treatment. Patients received the first dose of analgesics during surgery. As soon as patients came from the operating room, they were evaluated for pain severity. Patients whose pain severity scored ≥4 according to the Short-Form McGill Pain Questionnaire were accepted into the study. In the experimental group, pain and vital signs (arterial blood pressure, pulse, and respiration) were evaluated before foot massage at the time patients complained about pain (time 0) and then 5, 30, 60, 90, and 120 minutes after foot massage. In the control group, pain and vital signs were also evaluated when the patients complained about pain (time 0) and again at 5, 30, 60, 90, and 120 minutes, in sync with the times when foot massage was completed in the experimental group. A patient information form was used to collect descriptive characteristics data of the patients, and the Short-Form McGill Pain Questionnaire was used to determine pain severity. Data were analyzed for frequencies, mean, standard deviation, chi-square, Student t, Pillai trace, and Bonferroni test. The results of the statistical analyses showed that patients in the experimental group experienced significantly less pain (p ≤ .001). Especially notable, patients in the experimental group showed a decrease in all vital signs 5 minutes after foot massage, but patients in the control group showed increases in vital signs except for heart rate at 5 minutes. The data obtained showed that foot massage in breast surgery patients was

  3. Valve Replacement with a Sutureless Aortic Prosthesis in a Patient with Concomitant Mitral Valve Disease and Severe Aortic Root Calcification.

    Science.gov (United States)

    Lio, Antonio; Scafuri, Antonio; Nicolò, Francesca; Chiariello, Luigi

    2016-04-01

    Aortic valve replacement with concomitant mitral valve surgery in the presence of severe aortic root calcification is technically difficult, with long cardiopulmonary bypass and aortic cross-clamp times. We performed sutureless aortic valve replacement and mitral valve annuloplasty in a 68-year-old man who had severe aortic stenosis and moderate-to-severe mitral regurgitation. Intraoperatively, we found severe calcification of the aortic root. We approached the aortic valve through a transverse aortotomy, performed in a higher position than usual, and we replaced the valve with a Sorin Perceval S sutureless prosthesis. In addition, we performed mitral annuloplasty with use of an open rigid ring. The aortic cross-clamp time was 63 minutes, and the cardiopulmonary bypass time was 83 minutes. No paravalvular leakage of the aortic prosthesis was detected 30 days postoperatively. Our case shows that the Perceval S sutureless bioprosthesis can be safely implanted in patients with aortic root calcification, even when mitral valve disease needs surgical correction.

  4. Mandatory Risk Assessment Reduces Venous Thromboembolism in Bariatric Surgery Patients.

    Science.gov (United States)

    Nimeri, Abdelrahman A; Bautista, Jejomar; Ibrahim, Maha; Philip, Ruby; Al Shaban, Talat; Maasher, Ahmed; Altinoz, Ajda

    2017-08-23

    Bariatric surgery patients are at high risk for venous thromboembolism (VTE), and chemoprophylaxis is recommended. Sheikh Khalifa Medical City (SKMC) is an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) member since 2009. We report the rates of VTE in bariatric surgery patients from 2010 to 2016 compared to ACS NSQIP bariatric surgery programs before and after switching from heparin to low molecular weight heparin (LMWH), initiating mandatory risk assessment using Caprini scoring for VTE and adopting an aggressive strategy for high-risk patients regarding dosage of LMWH and chemoprophylaxis after discharge. During the study period, there were 1152 cases (laparoscopic Roux-en-Y gastric bypass (LRYGB) 625 and laparoscopic sleeve gastrectomy (LSG) 527) at Bariatric & Metabolic Institute (BMI) Abu Dhabi compared to 65,693 cases (LRYGB 32,130 and LSG 33,563) at ACS NSQIP bariatric surgery programs. VTE rates remained stable at ACS NSQIP bariatric surgery programs from 2010 to 2016 (0.45, 0.45, 0.45, 0.25, 0.35, 0.3, and 0.3%). In contrast, VTE rates at BMI Abu Dhabi decreased from 2.2% in 2011 to 0.35% after we adopted an aggressive strategy to VTE without an increase in bleeding complications. LRYGB patients with VTE had higher OR time, leak, collection, and mortality at ACS NSQIP hospitals compared to those at BMI Abu Dhabi. In contrast, rates were similar in LSG patients with VTE. Changing our approach to VTE management led our VTE rates to decrease and become like those of ACS NSQIP bariatric surgery patients in LSG and LRYGB.

  5. Complications of Lower Body Lift Surgery in Postbariatric Patients

    Science.gov (United States)

    van Dijk, Martine M.; Klein, Steven; Hoogbergen, Maarten M.

    2016-01-01

    Background: There is an exponential rise of patients with massive weight loss because of bariatric surgery or lifestyle changes. The result is an increase of patients with folds of redundant skin that may cause physical and psychological problems. The lower body lift is a procedure to correct deformities in the abdomen, mons, flanks, lateral thighs, and buttocks. Complication rates are quite high and could negatively affect the positive outcomes. The purpose of this study is to assess complication rates and to identify predictors of complications to optimize outcomes for patients after lower body lift surgery. Methods: A retrospective analysis of 100 patients who underwent a lower body lift procedure was performed. The patients were reviewed for complications, demographic data, comorbidities, smoking, highest lifetime body mass index, body mass index before lower body lift surgery, percentage of excess weight loss, and amount of tissue excised. Results: The overall complication rate was 78%. Twenty-two percent of the patients had major complications and 56% had minor complications. There is a linear relationship between body mass index before lower body lift surgery and complications (P = 0.03). The percentage of excess weight loss (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.92–1.00), highest lifetime body mass index (OR 1.08; 95% CI 1.01–1.15), body mass index before lower body lift surgery (OR 1.17; 95% CI 1.02–1.33), and smoking (OR 7.74; CI 0.98–61.16) are significantly associated with the development of complications. Conclusions: This study emphasizes the importance of a good weight status before surgery and cessation of smoking to minimize the risk of complications.

  6. Minimally invasive aortic valve replacement

    DEFF Research Database (Denmark)

    Foghsgaard, Signe; Schmidt, Thomas Andersen; Kjaergard, Henrik K

    2009-01-01

    In this descriptive prospective study, we evaluate the outcomes of surgery in 98 patients who were scheduled to undergo minimally invasive aortic valve replacement. These patients were compared with a group of 50 patients who underwent scheduled aortic valve replacement through a full sternotomy....... The 30-day mortality rate for the 98 patients was zero, although 14 of the 98 mini-sternotomies had to be converted to complete sternotomies intraoperatively due to technical problems. Such conversion doubled the operative time over that of the planned full sternotomies. In the group of patients whose...... is an excellent operation in selected patients, but its true advantages over conventional aortic valve replacement (other than a smaller scar) await evaluation by means of randomized clinical trial. The "extended mini-aortic valve replacement" operation, on the other hand, is a risky procedure that should...

  7. Acute Postoperative Pain of Indonesian Patients after Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    Chanif Chanif

    2012-08-01

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

  8. 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

  9. MINIMALLY-INVASIVE SURGERY FOR COLLORECTAL CANCER IN ELDERLY PATIENTS

    Directory of Open Access Journals (Sweden)

    I. L. Chernikovskiy

    2016-01-01

    Full Text Available Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were presented. Out of them, 66 patients underwent laparatomy and 40 patients underwent laparoscopy. Patients were matched for ASA and CR-PОSSUM scales, age-and body mass index, dis- ease stage and type of surgery. Results. The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min. Intraoperative blood loss was higher in patients treated by laparotomy than by laparoscopy (167 ml versus 109 ml, but the differences were insignificant (р=0.36. No differences in lymphodissection quality and adequate resection volume between the groups were found. The average hospital stay was not significantly shorter in the laparoscopic group (р=0.43. Complications occurred with equal frequency in both groups (13.6 % compared to 15.0 %. The median follow-up time was 16 months (range, 6-30 months. The number of patients died during a long-term follow-up was 2 times higher after laparotomic surgery than after laparoscopic surgery, however, the difference was not statistically significant. Conclusion. Postoperative compli- cations in elderly patients with colorectal cancer did not exceed the average rates and did not depend on the age. Both groups were matched for the intraoperative bleeding volume and quality of lymphodenectomy. Significantly shorter duration of laparoscopic surgery was explained by the faster surgical access however, it showed no benefit in reducing the average length of hospital stay and decreasing the number of

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

    OpenAIRE

    2015-01-01

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

  11. Patient-reported health outcomes after total hip and knee surgery in a Dutch University Hospital Setting: results of twenty years clinical registry

    NARCIS (Netherlands)

    Wees, P.J. van der; Wammes, J.J.G.; Akkermans, R.P.; Koetsenruijter, J.; Westert, G.P.; Kampen, A. van; Hannink, G.J.; Waal Malefijt, M.C. de; Schreurs, B.W.

    2017-01-01

    BACKGROUND: Patient-Reported Outcome (PRO) measurement is a method for measuring perceptions of patients on their health and quality of life. The aim of this paper is to present the results of PRO measurements in total hip and knee replacement as routinely collected during 20 years of surgery in a

  12. Drug dosing during intermittent hemodialysis and continuous renal replacement therapy : special considerations in pediatric patients.

    Science.gov (United States)

    Veltri, Michael A; Neu, Alicia M; Fivush, Barbara A; Parekh, Rulan S; Furth, Susan L

    2004-01-01

    Chronic renal failure is, fortunately, an unusual occurrence in children; however, many children with various underlying illnesses develop acute renal failure, and transiently require renal replacement therapy - peritoneal dialysis, intermittent hemodialysis (IHD), or continuous renal replacement therapy (CRRT). As children with acute and chronic renal failure often have multiple comorbid conditions requiring drug therapy, generalists, intensivists, nephrologists, and pharmacists need to be aware of the issues surrounding the management of drug therapy in pediatric patients undergoing renal replacement therapy. This article summarizes the pharmacokinetics and dosing of many drugs commonly prescribed for pediatric patients, and focuses on the management of drug therapy in pediatric patients undergoing IHD and CRRT in the intensive care unit setting. Peritoneal dialysis is not considered in this review. Finally, a summary table with recommended initial dosages for drugs commonly encountered in pediatric patients requiring IHD or CRRT is presented.

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

    Science.gov (United States)

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

    2015-01-01

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

  14. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Science.gov (United States)

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

    2015-01-01

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

  15. Patients Undergoing Dacryocystorhinostomy Surgery in Northern ...

    African Journals Online (AJOL)

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

  16. [Bariatric surgery. Patient selection and indication].

    Science.gov (United States)

    Schusdziarra, V; Hausmann, M; Erdmann, J

    2005-07-01

    Successful reduction of body weight in patients with morbid obesity (BMI >40 kg/m(2)) is difficult and on a long-term basis nearly impossible with non-interventional treatment modalities. Surgical therapy is an efficient alternative for these patients. Potential surgical treatment should be carefully evaluated during a 6-month preoperative treatment phase during which indications and contraindications should be evaluated. Qualified postoperative care must be provided.

  17. Surgery for Patients With Recalcitrant Plantar Fasciitis

    OpenAIRE

    Wheeler, Patrick; Boyd, Kevin; Shipton, Mary

    2014-01-01

    Background: Plantar fasciitis is a common cause of foot pain, and although many episodes are self-limiting with short duration, 10% leave chronic symptoms. Recalcitrant cases can be managed surgically, with studies demonstrating good results in the short term but uncertainties over longer term outcomes. Purpose: To assess the outcome following surgical intervention for patients with plantar fasciitis. Study Design: Case series; Level of evidence, 4. Methods: Seventy-nine patients were identif...

  18. ACD-A solution as anticoagulant during continuous renal replacement therapy in high risk bleeding patients

    Institute of Scientific and Technical Information of China (English)

    杨松涛

    2014-01-01

    Objective To assess the efficacy and safety of ACDA solution as anticoagulant during continuous renal replacement therapy(CRRT)in high risk of bleeding patients.Methods Forty high risk bleeding patients on continuous veno-venous hemofiltration(CVVH)were randomly divided into two groups:ACD-A group(22 patients,61 cases)and heparin-free group(18 patients,47cases).Serum creatinine,function of the coagulation

  19. Patient-related predictors of implant failure after primary total hip replacement in the initial, short- and long-terms. A nationwide Danish follow-up study including 36,984 patients

    DEFF Research Database (Denmark)

    Johnsen, S.P.; Sørensen, H.T.; Lucht, Ulf

    2006-01-01

    We examined the association between patient-related factors and the risk of initial, short- and long-term implant failure after primary total hip replacement. We used data from the Danish Hip Arthroplasty Registry between 1 January 1995 and 31 December 2002, which gave us a total of 36 984 patients....... Separate analyses were carried out for three follow-up periods: 0 to 30 days, 31 days to six months (short term), and six months to 8.6 years after primary total hip replacement (long term). The outcome measure was defined as time to failure, which included re-operation with open surgery for any reason...

  20. Ductal carcinoma In-Situ in turner syndrome patient undergoing hormone replacement therapy: A case report

    Directory of Open Access Journals (Sweden)

    Rashmi Bawa

    2016-03-01

    Full Text Available Turner’s syndrome is a rare congenital disease which affects about 1 in every 2500-3000 live-born females. This happens due to chromosomal abnormalities in a phenotypic female, causing increased gonadotropin concentrations and low concentrations of estrogens from infancy. As a result, hormone replacement therapy is started in most adolescent Turner syndrome patients to initiate and sustain sexual maturation. Accordingly, most Turner’s syndrome patients undergo several decades of estrogen replacement therapy, from puberty to post-menopausal age. The highly publicized findings of the Women’s Health Initiative have called into question the appropriateness of hormone replacement therapy in adolescents with Turner’s syndrome. Those concerns were mostly theoretical extrapolations, as few prospective studies of cancer occurrence in women with Turner syndrome have been reported. Consequently, several recent publications have challenged those extrapolations, based on the assertion that the levels of hormone replacement in Turner syndrome patients are well below the physiologic levels observed in normal menstruating women, as well as the fact that these women are significantly younger than those studied by the Women’s Health Initiative. In discord to those reports, we present a case of ductal carcinoma in-situ in a 40-year-old Turner patient, who had undergone over two decades of combined hormone replacement therapy. The patient underwent an elective excisional biopsy for a palpable mass, with histopathology revealing a complex fibroadenoma with a nidus of ductal carcinoma in-situ. The lesion was noted to be estrogen receptor positive and progesterone receptor negative, with heavy staining for HER-2/Neu receptor. The patient was treated with tamoxifen. While a rare case, it is imperative for the astute clinician to keep in mind the consequences of long-term hormone replacement therapy in Turner’s syndrome patients in order to avoid missed

  1. Patients' Perceptions of Joint Replacement Care in a Changing Healthcare System: A Qualitative Study

    OpenAIRE

    Webster, Fiona; Bremner, Samantha; Katz, Joel; Watt-Watson, Judy; Kennedy, Deborah; Sawhney, Mona; McCartney, Colin

    2014-01-01

    Background: Ontario has introduced strategies over the past decade to reduce wait times and length of stay and improve access to physiotherapy for orthopaedic and other patients. The aim of this study is to explore patients' experiences of joint replacement care during a significant system change in their care setting.

  2. Rehabilitation of patients aged 65 and over after total hip replacement

    DEFF Research Database (Denmark)

    Hørdam, Britta

    The overall aim of this thesis was to investigate improvement in health status of patients aged 65 and over after total hip replacement (THR) as a result of nursing rehabilitation. The projects conssits of three studies, first a description of patients´health status after THR, followed...

  3. Outcomes of male patients with Alport syndrome undergoing renal replacement therapy

    DEFF Research Database (Denmark)

    Temme, Johanna; Kramer, Anneke; Jager, Kitty J;

    2012-01-01

    Patients with the hereditary disease Alport syndrome commonly require renal replacement therapy (RRT) in the second or third decade of life. This study compared age at onset of RRT, renal allograft, and patient survival in men with Alport syndrome receiving various forms of RRT (peritoneal dialys...

  4. Evaluation of Tricuspid Valvuloplasty with Mitral Valve Replacement in severely ill patients

    Directory of Open Access Journals (Sweden)

    H. MOBARHAN

    1975-01-01

    Full Text Available A group or twenty ca ses or class IV or New York Hearl Assiciation Classification is reported. T hey were selected among 55 ca ses of mitral valve'10 :; JJj'[ ' ~ J i l l ; J "J( ff1 Ii rll l'li %J1 %:J '/J ; ~1 ?idJ bru: b:;ib -: Jr I'Ji lJ;q :J':.nrlT . JrI'JrrJ'J'Jlil q ':,f[ /Jw[ ' ~ I ;': J ; l q o I I J'l [ I i'1 biq% lJ :Ji•IT x l'; r1 Jo'lo lJ;r!J rlJ i 1/ ;-lm o f[;'-'JTIO' rbid'll "II (, I 10 be car ried out in seven cases. In lWO cases. reported in detail. two commissurcs and ring had to be repaired. The nature of pathology was organic and fu nctional while in the rcmaininu-live cases it was onl.v functional. None or the cases required tricuspid valve replacement. Wc believe that tricuspid va lvuloplasty has a n importa nt position in heart surgery and should not be underestimated . Also. we conclude that no patient should be denied 0PCI1 ion on the basis or the severity or his d isease unless ad vanced co ronal' di sease or primary myocardiac d isease arc also in volved.

  5. Elective Thoracolumbar Spine Fusion Surgery in Patients with Parkinson Disease.

    Science.gov (United States)

    Puvanesarajah, Varun; Jain, Amit; Qureshi, Rabia; Carstensen, S Evan; Tyger, Rosemarie; Hassanzadeh, Hamid

    2016-12-01

    Few data are available concerning clinical outcomes in patients with Parkinson disease who undergo elective thoracolumbar spine fusion surgery. The goal of this study is to elucidate complication and revision rates after posterior thoracolumbar fusion surgery in patients with Parkinson disease, with a focus on how Parkinson disease modifies these rates. The PearlDiver database (2005-2012) was queried for patients who underwent posterior approach thoracolumbar fusion from 2006 to 2011. Cohorts of patients with a previous diagnosis of Parkinson disease (n = 4816) and without (n = 280,702) were compared. Multivariate analysis that included various comorbidities and demographics was used to calculate effects of Parkinson disease on development of postoperative infection and major medical complications within 90 days and revision surgery within 1 year. For analyses, significance was set at P Parkinson disease was significantly associated with an increased risk for medical complications (adjusted odds ratio, 1.22; 95% confidence interval, 1.11-1.34; P Parkinson disease are more likely to require revision surgery and have higher rates of adverse medical events postoperatively. Patients with Parkinson disease should be appropriately selected to ensure favorable clinical outcomes. Copyright © 2016. Published by Elsevier Inc.

  6. Physical therapy in postoperative cardiac surgery: patient's perception.

    Science.gov (United States)

    Lima, Paula Monique Barbosa; Cavalcante, Hermanny Evanio Freitas; Rocha, Angelo Roncalli Miranda; Brito, Rebeca Taciana Fernandes de

    2011-01-01

    Many strategies to improve services provided by for physiotherapy are based on patients satisfaction. Listen and observe the behavior of patients in a hospital is crucial to understanding and improvement of service and the hospital. This study aimed to identify the patient's perception undergoing cardiac surgery on the physiotherapy service provided to wards of hospitals for heart surgery reference in the city of Maceió, AL, Brazil, and from that information detect what actions are perceived as priorities for which are noteworthy plans for improvements in quality of care. Cross-sectional study, conducted in quality and quantity of reference hospitals in cardiac surgery in the city of Maceio, AL, Brazil, in the period from September to November 2008. The study included 30 users of the Sistema Único de Saúde, of which 12 (40%) female and 18 (60%) males. The average age of this sample was 49.2 ± 11.9 years and most belonged to socioeconomic class D (36.7%). It was found that only 16.7% had contact with the physiotherapist before surgery. Regarding educational guidelines about postoperative period, only 2.9% patients reported having received them. However, 56.8% rated the care as good and 100% of patients reported believing that physiotherapy could improve their health status. We suggest the implementation of preoperative physical therapy protocols with preventive measures and educational as well as new researchs that may characterize the population of users of health plans/private.

  7. Patient Perceptions of Open, Laparoscopic, and Robotic Gynecological Surgeries

    Directory of Open Access Journals (Sweden)

    Mohamad Irani

    2016-01-01

    Full Text Available Objective. To investigate patient knowledge and attitudes toward surgical approaches in gynecology. Design. An anonymous Institutional Review Board (IRB approved questionnaire survey. Patients/Setting. A total of 219 women seeking obstetrical and gynecological care in two offices affiliated with an academic medical center. Results. Thirty-four percent of the participants did not understand the difference between open and laparoscopic surgeries. 56% of the participants knew that laparoscopy is a better surgical approach for patients than open abdominal surgeries, while 37% thought that laparoscopy requires the surgeon to have a higher technical skill. 46% of the participants do not understand the difference between laparoscopic and robotic procedures. 67.5% of the participants did not know that the surgeon moves the robot’s arms to perform the surgery. Higher educational level and/or history of previous abdominal surgeries were associated with the highest rates of answering all the questions correctly (p<0.05, after controlling for age and race. Conclusions. A substantial percentage of patients do not understand the difference between various surgical approaches. Health care providers should not assume that their patients have an adequate understanding of their surgical options and accordingly should educate them about those options so they can make truly informed decisions.

  8. Postoperative care for the robotic surgery bowel resection patient.

    Science.gov (United States)

    Brenner, Zara R; Salathiel, Mary; Macey, Barbara A; Krenzer, Maureen

    2011-01-01

    A new surgical method is available for colon and rectal surgery. Robotic surgery, using the daVinci Si HD Surgical System, offers surgical advances compared with the traditional open or laparoscopic surgical methods. The potential advantages of robotic technology continue to be explored and its most appropriate functions are yet to be determined. In clinical experience, the use of this surgical method has resulted in changes to postoperative nursing care management. This article describes changes in the management of postoperative patient care including fluid and electrolyte balance, and patient and staff education. Modifications were instituted in the clinical pathway to facilitate an accelerated standard of care. New discharge strategies were implemented to ensure ongoing fluid and electrolyte balance by the patient. A true team effort from a multitude of disciplines was required for the changes in patient care routine to be effective. Outcomes including length of stay and patient satisfaction are presented.

  9. Aortic valve replacement

    DEFF Research Database (Denmark)

    Kapetanakis, Emmanouil I; Athanasiou, Thanos; Mestres, Carlos A

    2008-01-01

    BACKGROUND AND AIMS OF THE STUDY: Prompted by anecdotal evidence and observations by surgeons, an investigation was undertaken into the potential differences in implanted aortic valve prosthesis sizes, during aortic valve replacement (AVR) procedures, between northern and southern European...... countries. METHODS: A multi-institutional, non-randomized, retrospective analysis was conducted among 2,932 patients who underwent AVR surgery at seven tertiary cardiac surgery centers throughout Europe. Demographic and perioperative variables including valve size and type, body surface area (BSA) and early...

  10. Medanta insulin protocols in patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Beena Bansal

    2014-01-01

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

  11. Auricular Acupressure for Managing Postoperative Pain and Knee Motion in Patients with Total Knee Replacement: A Randomized Sham Control Study

    Directory of Open Access Journals (Sweden)

    Ling-hua Chang

    2012-01-01

    Full Text Available Background. Postoperative pain management remains a significant challenge for all healthcare providers. A randomized controlled trial was conducted to examine the adjuvant effects of auricular acupressure on relieving postoperative pain and improving the passive range of motion in patients with total knee replacement (TKR. Method. Sixty-two patients who had undergone a TKR were randomly assigned to the acupressure group and the sham control group. The intervention was delivered three times a day for 3 days. A visual analog scale (VAS and the Short-Form McGill Pain Questionnaire were used to assess pain intensity. Pain medication consumption was recorded, and the knee motion was measured using a goniometer. Results. The patients experienced a moderately severe level of pain postoperatively (VAS 58.66 ± 20.35 while being on the routine PCA. No differences were found in pain scores between the groups at all points. However, analgesic drug usage in the acupressure group patients was significantly lower than in the sham control group (<0.05, controlling for BMI, age, and pain score. On the 3rd day after surgery, the passive knee motion in the acupressure group patients was significantly better than in the sham control group patients (<0.05, controlling for BMI. Conclusion. The application of auricular acupressure at specific therapeutic points significantly reduces the opioid analgesia requirement and improves the knee motion in patients with TKR.

  12. Can standardized patients replace physicians as OSCE examiners?

    Directory of Open Access Journals (Sweden)

    Jones Allan

    2006-02-01

    Full Text Available Abstract Background To reduce inter-rater variability in evaluations and the demand on physician time, standardized patients (SP are being used as examiners in OSCEs. There is concern that SP have insufficient training to provide valid evaluation of student competence and/or provide feedback on clinical skills. It is also unknown if SP ratings predict student competence in other areas. The objectives of this study were: to examine student attitudes towards SP examiners; to compare SP and physician evaluations of competence; and to compare predictive validity of these scores, using performance on the multiple choice questions examination (MCQE as the outcome variable. Methods This was a cross-sectional study of third-year medical students undergoing an OSCE during the Internal Medicine clerkship rotation. Fifty-two students rotated through 8 stations (6 physician, 2 SP examiners. Statistical tests used were Pearson's correlation coefficient, two-sample t-test, effect size calculation, and multiple linear regression. Results Most students reported that SP stations were less stressful, that SP were as good as physicians in giving feedback, and that SP were sufficiently trained to judge clinical skills. SP scored students higher than physicians (mean 90.4% +/- 8.9 vs. 82.2% +/- 3.7, d = 1.5, p Conclusion These results suggest that SP examiners are acceptable to medical students, SP rate students higher than physicians and, unlike physician scores, SP scores are not related to other measures of competence.

  13. Influence of Renal Replacement Modalities on Amikacin Population Pharmacokinetics in Critically Ill Patients on Continuous Renal Replacement Therapy.

    Science.gov (United States)

    Roger, Claire; Wallis, Steven C; Muller, Laurent; Saissi, Gilbert; Lipman, Jeffrey; Lefrant, Jean-Yves; Roberts, Jason A

    2016-08-01

    The objective of this study was to describe amikacin pharmacokinetics (PK) in critically ill patients receiving equal doses (30 ml/kg of body weight/h) of continuous venovenous hemofiltration (CVVH) and continuous venovenous hemodiafiltration (CVVHDF). Patients receiving amikacin and undergoing CVVH or CVVHDF were eligible. Population pharmacokinetic analysis and Monte Carlo simulation were undertaken using the Pmetrics software package for R. Sixteen patients (9 undergoing CVVH, 11 undergoing CVVHDF) and 20 sampling intervals were analyzed. A two-compartment linear model best described the data. Patient weight was the only covariate that was associated with drug clearance. The mean ± standard deviation parameter estimates were 25.2 ± 17.3 liters for the central volume, 0.89 ± 1.17 h(-1) for the rate constant for the drug distribution from the central to the peripheral compartment, 2.38 ± 6.60 h(-1) for the rate constant for the drug distribution from the peripheral to the central compartment, 4.45 ± 2.35 liters/h for hemodiafiltration clearance, and 4.69 ± 2.42 liters/h for hemofiltration clearance. Dosing simulations for amikacin supported the use of high dosing regimens (≥25 mg/kg) and extended intervals (36 to 48 h) for most patients when considering PK/pharmacodynamic (PD) targets of a maximum concentration in plasma (Cmax)/MIC ratio of ≥8 and a minimal concentration of ≤2.5 mg/liter at the end of the dosing interval. The mean clearance of amikacin was 1.8 ± 1.3 liters/h by CVVHDF and 1.3 ± 1 liters/h by CVVH. On the basis of simulations, a strategy of an extended-interval high loading dose of amikacin (25 mg/kg every 48 h) associated with therapeutic drug monitoring (TDM) should be the preferred approach for aminoglycoside treatment in critically ill patients receiving continuous renal replacement therapy (CRRT). (This study is a substudy of a trial registered at ClinicalTrials.gov under number NCT01403220.). Copyright © 2016, American Society

  14. Clinical and biochemical outcomes for additive mesenteric and lower body perfusion during hypothermic circulatory arrest for complex total aortic arch replacement surgery.

    Science.gov (United States)

    Fernandes, P; Cleland, A; Adams, C; Chu, M W A

    2012-11-01

    Surgical repair of transverse aortic arch aneurysms frequently employ hypothermia and antegrade cerebral perfusion as protective strategies during circulatory arrest. However, prolonged mesenteric and lower limb ischemia can lead to significant lactic acidosis and end organ dysfunction, which remains a significant cause of post-operative morbidity and mortality. We report our experience with additive warm mesenteric and lower body perfusion (1-3 L/min, 30°C) in addition to continuous cerebral and myocardial perfusion in 5 patients who underwent total aortic arch replacement with trifurcated head vessel re-implantation and distal elephant trunk reconstruction. Concomitant surgical procedures included re-operations (2), aortic root operations (2), coronary artery bypass (2) and descending thoracic aortic replacement (1). Serum lactate levels demonstrated a rapid decline from a peak 9.9 ± 2.6 post circulatory arrest to 3.4 ± 2.0 in the intensive care unit (ICU). The lowest serum bicarbonate levels were 19.3 ± 3.5 mmol/L, intra-operatively, which normalized to 28.4 ± 2.4 mmol/L on return to the ICU. The lowest pH levels were 7.25 ± 0.10, corrected to 7.43 ± 0.04 on return to the ICU. Mean cardiopulmonary bypass and aortic cross-clamp times were 361 ± 104 and 253 ± 85 minutes, respectively. Mean cerebral and lower body circulatory arrest times were 0 (0) and 50 ± 35 minutes, respectively. The mean time required for systemic rewarming was 95 ± 66 minutes. There were no in-hospital mortalities and no patient experienced any neurological, mesenteric, renal or lower limb ischemic complications. Two patients required mechanical ventilation >24 hours, and one patient returned for reoperation for bleeding. Median intensive care unit and total hospital lengths of stay were 5 and 16 days, respectively. Our results suggest early serum lactate clearance, normalization of acidosis, and metabolic recovery when utilizing a simultaneous cerebral perfusion and warm body

  15. Increased Hair Cortisol Concentrations and BMI in Patients With Pituitary-Adrenal Disease on Hydrocortisone Replacement.

    Science.gov (United States)

    Staufenbiel, Sabine M; Andela, Cornelie D; Manenschijn, Laura; Pereira, Alberto M; van Rossum, Elisabeth F C; Biermasz, Nienke R

    2015-06-01

    Intrinsic imperfections and lack of reliable biomarkers preclude optimal individual dosing of hydrocortisone replacement in adrenal insufficiency (AI). However, the clinical relevance of optimal dosing is exemplified by frequently occurring side effects of overreplacement and the dangers of underreplacement. Cortisol in scalp hair has been identified as a retrospective biomarker for long-term cortisol exposure. We compared hair cortisol concentrations (CORT(hair)) of patients with primary or secondary AI on replacement therapy with those of patient controls with a pituitary disease without AI (PCs) and of healthy controls (HCs). In this cross-sectional study, hair samples and anthropometric data were collected in 132 AI patients (52 males), 42 PCs (11 males), and 195 HCs (90 males). The proximal 3 cm of hair were used. CORT(hair) were measured using an ELISA. CORT(hair) were higher in AI patients than in HCs and PCs (P < .001), and hydrocortisone dose correlated with CORT(hair) (P = .04). Male AI patients demonstrated higher CORT(hair) than female patients (P < .001). AI patients had higher body mass index (BMI) than HCs (P < .001), and BMI correlated with CORT(hair) in the whole sample (P < .001). Physiological hydrocortisone replacement is associated with increased CORT(hair). The association between CORT(hair) and BMI could suggest a mild overtreatment that may lead to adverse anthropomorphic side effects, especially in males. CORT(hair) measurements may be a promising additional tool to monitor cumulative hydrocortisone replacement in AI.

  16. Longer hospital stay, more complications, and increased mortality but substantially improved function after knee replacement in older patients

    Science.gov (United States)

    Maempel, Julian F; Riddoch, Fraser; Calleja, Neville; Brenkel, Ivan J

    2015-01-01

    Background and purpose Total knee replacement (TKR) is being increasingly performed in elderly patients, yet there is little information on specific requirements and complication rates encountered by this group. We assessed whether elderly patients undergoing TKR had different length of stay, requirements, complication rates, and functional outcomes compared to younger counterparts. Patients and methods We analyzed prospectively gathered data on 3,144 consecutive primary TKRs (in 2,092 patients aged less than 75 years, 694 patients aged between 75 and 80 years, and 358 patients aged over 80 years at the time of surgery). Results Incidence of blood transfusion, urinary catheterization, postoperative confusion, cardiac arrhythmia, and 1-year mortality increased with age, even after adjusting for confounding factors, whereas the incidences of chest infection and mortality at 1 month were highest in those aged 75–80. Rates of thromboembolism, prosthetic infection, and revision were similar in the 3 age groups. All groups showed similar substantial improvements in American Knee Society (AKS) knee scores, which were maintained at 5 years. Older patients had smaller improvements in AKS function score, which deteriorated between 3 and 5 years postoperatively, in contrast to the younger group. Interpretation Elderly people stand to gain considerably from TKR, particularly in terms of pain relief, and they should not be denied surgery based solely on age. However, they should be warned that they can expect a longer length of stay, a higher requirement for blood transfusion and/or urinary catheterization, and more medical complications postoperatively. Mortality was also higher in the older age groups. The risks have been quantified to assist in perioperative counselling, informed consent, and healthcare planning. PMID:25885004

  17. Safety of robotic general surgery in elderly patients.

    Science.gov (United States)

    Buchs, Nicolas C; Addeo, Pietro; Bianco, Francesco M; Ayloo, Subhashini; Elli, Enrique F; Giulianotti, Pier C

    2010-08-01

    As the life expectancy of people in Western countries continues to rise, so too does the number of elderly patients. In parallel, robotic surgery continues to gain increasing acceptance, allowing for more complex operations to be performed by minimally invasive approach and extending indications for surgery to this population. The aim of this study is to assess the safety of robotic general surgery in patients 70 years and older. From April 2007 to December 2009, patients 70 years and older, who underwent various robotic procedures at our institution, were stratified into three categories of surgical complexity (low, intermediate, and high). There were 73 patients, including 39 women (53.4%) and 34 men (46.6%). The median age was 75 years (range 70-88 years). There were 7, 24, and 42 patients included, respectively, in the low, intermediate, and high surgical complexity categories. Approximately 50% of patients underwent hepatic and pancreatic resections. There was no statistically significant difference between the three groups in terms of morbidity, mortality, readmission or transfusion. Mean overall operative time was 254 ± 133 min (range 15-560 min). Perioperative mortality and morbidity was 1.4% and 15.1%, respectively. Transfusion rate was 9.6%, and median length of stay was 6 days (range 0-30 days). Robotic surgery can be performed safely in the elderly population with low mortality, acceptable morbidity, and short hospital stay. Age should not be considered as a contraindication to robotic surgery even for advanced procedures.

  18. Moxifloxacin dosing in post-bariatric surgery patients

    NARCIS (Netherlands)

    Colin, Pieter; Eleveld, Douglas J.; Struys, Michel M. R. F.; T'Jollyn, Huybrecht; Van Bortel, Luc M.; Ruige, Johannes; De Waele, Jan; Van Bocxlaer, Jan; Boussery, Koen

    2014-01-01

    Introduction Given the ever increasing number of obese patients and obesity related bypass surgery, dosing recommendations in the post-bypass population are needed. Using a population pharmacokinetic (PK) analysis and PK-pharmacodynamic (PD) simulations, we investigated whether adequate moxifloxacin

  19. pulmonary indices in post—abdominal surgery patients

    African Journals Online (AJOL)

    post-training vital capacity and peak expiratory flow rate than the emergency abdominal surgery ... of alteration in pulmonary mechanism, the lung volumes and .... Table 2: Age and Resting Vital Signs of Patients Before Commencement of the ...

  20. Physical Therapy and Surgery

    Science.gov (United States)

    Valle-Onate, Rafael; Ward, Michael M.; Kerr, Gail S.

    2012-01-01

    Physical therapy and orthopedic surgery are important components in the treatment of ankylosing spondylitis (AS). Supervised physical therapy is more effective that individual or unsupervised exercise in improving symptoms, but controlled trials suggest than combined inpatient and outpatient therapy provides the greatest improvement. Recommendations for exercise are universal, but the best types and sequence of therapies are not known. Total hip replacement is the surgery most commonly performed for AS, with good long-term implant survival. Heterotopic ossification may occur no more frequently after hip replacement in patients with AS than in patients with other diseases. Corrective spinal surgery is rarely performed and requires specialized centers and experienced surgeons. PMID:22543536

  1. Impact of patient-prosthesis mismatch on 30-day outcomes in young and middle-aged patients undergoing aortic valve replacement

    Directory of Open Access Journals (Sweden)

    Hernández-Vaquero Daniel

    2012-05-01

    Full Text Available Abstract Background The impact of patient-prosthesis mismatch (PPM on early outcomes in young and middle-aged patients undergoing conventional aortic valve replacement for severe aortic stenosis remains unknown. Our objective was to evaluate the incidence of some degree of PPM and its influence on early mortality and morbidity. Methods We analyzed our single center experience in all patients 2/m2. The influence of PPM on early mortality and postoperative complications was studied using propensity score analysis. Follow up at 30 postoperative days was 100% complete. Results Of 199 patients studied, 61 (30,7% had some degree of PPM. PPM was associated with an increased postoperative mortality (OR = 8,71; 95% CI = 1,67–45,29; p = 0,04 and major postoperative complications (OR = 2,96; CI = 1,03–8,55; p = 0,044. However, no association between PPM and prolonged hospital or ICU stay was demonstrated. Conclusions Moderate PPM is a common finding in young and middle-aged patients undergoing surgery for aortic valve replacement due to severe stenosis. In addition, its influence on early outcomes may be relevant.

  2. Car accidents after ambulatory surgery in patients without an escort.

    Science.gov (United States)

    Chung, Frances; Assmann, Nicole

    2008-03-01

    Occasionally, ambulatory surgical patients present without an escort for their procedure. This creates a dilemma for caregivers, and allowing patients to drive may have an impact on their safety. The Canadian Medical Protective Association is a mutual defense organization for 95% of Canadian physicians. The national database is a unique and extensive repository of medico-legal data. We scanned this database for malpractice patients who were discharged after an ambulatory surgery procedure and allowed to drive home with a poor outcome. From this database, two malpractice cases of patients who were discharged without an escort after an ambulatory surgical procedure were reported. Both had a car accident and sustained serious injuries. Based on this we do not recommend discharge without an escort after general anesthesia, regional anesthesia, monitored anesthesia or sedation. Driving after ambulatory surgery cannot be considered safe and caregivers need to verify a safe ride home.

  3. Pragmatic fluid optimization in high-risk surgery patients: when pragmatism dilutes the benefits.

    Science.gov (United States)

    Reuter, Daniel A

    2012-01-31

    There is increasing evidence that hemodynamic optimization by fluid loading, particularly when performed in the early phase of surgery, is beneficial in high-risk surgery patients: it leads to a reduction in postoperative complications and even to improved long-term outcome. However, it is also true that goal- directed strategies of fluid optimization focusing on cardiac output optimization have not been applied in the clinical routine of many institutions. Reasons are manifold: disbelief in the level of evidence and on the accuracy and practicability of the required monitoring systems, and economics. The FOCCUS trial examined perioperative fluid optimization with a very basic approach: a standardized volume load with 25 ml/kg crystalloids over 6 hours immediately prior to scheduled surgery in high-risk patients. The hypothesis was that this intervention would lead to a compensation of preoperative fluid deficit caused by overnight fasting, and would result in improved perioperative fluid homeostasis with less postoperative complications and earlier hospital discharge. However, the primary study endpoints did not improve significantly. This observation points towards the facts that: firstly, the differentiation between interstitial fluid deficit caused by fasting and intravascular volume loss due to acute blood loss must be recognized in treatment strategies; secondly, the type of fluid replacement may play an important role; and thirdly, protocolized treatment strategies should also always be tailored to suit the patients' individual needs in every individual clinical situation.

  4. Prevalence of hematological abnormalities in patients with Sheehan's syndrome: response to replacement of glucocorticoids and thyroxine.

    Science.gov (United States)

    Laway, Bashir Ahmad; Mir, Shahnaz Ahmad; Bashir, Mir Iftikhar; Bhat, Javid Rasool; Samoon, Jeelani; Zargar, Abdul Hamid

    2011-03-01

    Anemia and other hematological abnormalities are common in patients with Sheehan's syndrome. The response of these abnormalities to replacement of thyroxine and glucocorticoids is not clear. The aim of the present study was to document the profile of hematological abnormalities and response to treatment in patients with Sheehan's syndrome. Forty patients of Sheehan's syndrome and an equal number of age and parity matched healthy controls were studied for prevalence of hematological abnormalities. Hemoglobin concentration, hematocrit, red cell, white cell and platelet count were significantly decreased in patients with Sheehan's syndrome compared to controls. Frequency of anemia, leucopenia, thrombocytopenia and pancytopenia was significantly higher in these patients compared to controls. After achieving euthyroid and eucortisol state, there was a complete recovery of these hematological abnormalities. We conclude that anemia and other cytopenias are common in patients with Sheehan's syndrome and replacement with thyroxine and glucocorticoids results in complete recovery of these abnormalities.

  5. Efficient rehabilitation care for joint replacement patients: skilled nursing facility or inpatient rehabilitation facility?

    Science.gov (United States)

    Tian, Wenqiang; DeJong, Gerben; Horn, Susan D; Putman, Koen; Hsieh, Ching-Hui; DaVanzo, Joan E

    2012-01-01

    There has been lengthy debate as to which setting, skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF), is more efficient in treating joint replacement patients. This study aims to determine the efficiency of rehabilitation care provided by SNF and IRF to joint replacement patients with respect to both payment and length of stay (LOS). This study used a prospective multisite observational cohort design. Tobit models were used to examine the association between setting of care and efficiency. The study enrolled 948 knee replacement patients and 618 hip replacement patients from 11 IRFs and 7 SNFs between February 2006 and February 2007. Output was measured by motor functional independence measure (FIM) score at discharge. Efficiency was measured in 3 ways: payment efficiency, LOS efficiency, and stochastic frontier analysis efficiency. IRF patients incurred higher expenditures per case but also achieved larger motor FIM gains in shorter LOS than did SNF patients. Setting of care was not a strong predictor of overall efficiency of rehabilitation care. Great variation in characteristics existed within IRFs or SNFs and severity groups. Medium-volume facilities among both SNFs and IRFs were most efficient. Early rehabilitation was consistently predictive of efficient treatment. The advantage of either setting is not clear-cut. Definition of efficiency depends in part on preference between cost and time. SNFs are more payment efficient; IRFs are more LOS efficient. Variation within SNFs and IRFs blurred setting differences; a simple comparison between SNF and IRF may not be appropriate.

  6. Evaluation of periprosthetic bone cysts in patients with a scandinavian total ankle replacement

    DEFF Research Database (Denmark)

    Jensen, Janni; Frøkjær, Johnny; Gerke, Oke;

    2014-01-01

    OBJECTIVE. Periprosthetic bone cysts are a known finding after total ankle replacement (TAR). The significance of cysts is uncertain, but they may threaten the long-term survival of the implant. The aim of this prospective study was to evaluate the diagnostic accuracy of weight-bearing digital...... radiography compared with 3D weight-bearing multiplanar reconstructed (MPR) fluoroscopic imaging when diagnosing periprosthetic bone cysts in patients who have undergone TAR. SUBJECTS AND METHODS. Forty-two consecutive patients with a Scandinavian Total Ankle Replacement (STAR) were consecutively enrolled...

  7. Posterior Slope of the Tibia Plateau in Malaysian Patients Undergoing Total Knee Replacement

    Directory of Open Access Journals (Sweden)

    R Yoga

    2009-05-01

    Full Text Available The posterior slope of the tibial plateau is an important feature to preserve during knee replacement. The correct slope aids in the amount of flexion and determines if the knee will be loose on flexion. This is a study on the posterior tibial plateau slope based on preoperative and postoperative radiographs of 100 consecutive patients who had total knee replacements. The average posterior slope of the tibia plateau was 10.1 degrees. There is a tendency for patients with higher pre-operative posterior tibial plateau slope to have higher post-operative posterior tibial plate slope.

  8. Contact topical anesthesia for strabismus surgery in adult patients.

    Science.gov (United States)

    Vallés-Torres, J; García-Martín, E; Peña-Calvo, P; Sanjuan-Villarreal, A; Gil-Arribas, L M; Fernández-Tirado, F J

    2015-05-01

    To analyze the effectiveness and usefulness of contact topical anesthesia in strabismus surgery in adult patients. A prospective study was conducted on 20 patients undergoing strabismus surgery using contact topical anesthesia and sedation with remifentanil. The intensity of pain was recorded using a numeric pain rating scale at the time of anesthesia implementation, during the surgical procedure, 30 min afterwards, and during the first postoperative day. The incidence of oculocardiac reflex, postoperative nausea and vomiting, corneal ulcers, patient satisfaction (numerically from 0 to 10) and the degree of residual ocular deviation were also assessed. The operation was performed successfully in all patients. Average pain intensity was 1.40 ± 1.73 during anesthesia implementation, 4.20 ± 2.57 during the surgical procedure, 2.50 ± 2.54 30 min after surgery, and 3.55 ± 2.89 during the first postoperative day. Oculocardiac reflex was observed in 7 patients (35%), postoperative nausea and vomiting in 4 (20%), and corneal ulcer in 4 (20%). The patient satisfaction was 9.53 ± 2.51. More than two-thirds (70%) of patients had a residual ocular deviation less than 10 prism diopters. Contact topical anesthesia is a safe and effective alternative for strabismus surgery in adult patients. Contact topical anesthesia provides adequate pain control, lower incidence of postoperative nausea and vomiting and oculocardiac reflex, and optimal setting of ocular alignment. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Carotid artery stenting and cardiac surgery in symptomatic patients.

    Science.gov (United States)

    Van der Heyden, Jan; Van Neerven, Danihel; Sonker, Uday; Bal, Egbert T; Kelder, Johannes C; Plokker, Herbert W M; Suttorp, Maarten J

    2011-11-01

    The purpose of this study was to evaluate the feasibility and safety of the combined outcome of carotid artery stenting (CAS) and coronary artery bypass graft (CABG) surgery in neurologically symptomatic patients. The risk of perioperative stroke in patients undergoing CABG who report a prior history of transient ischemic attack or stroke has been associated with a 4-fold increased risk as compared to the risk for neurologically asymptomatic patients. It seems appropriate to offer prophylactic carotid endarterectomy to neurologically symptomatic patients who have significant carotid artery disease and are scheduled for CABG. The CAS-CABG outcome for symptomatic patients remains underreported, notwithstanding randomized data supporting CAS for high-risk patients. In a prospective, single-center study, the periprocedural and long-term outcomes of 57 consecutive patients who underwent CAS before cardiac surgery were analyzed. The procedural success rate of CAS was 98%. The combined death, stroke, and myocardial infarction rate was 12.3%. The death and major stroke rate from time of CAS to 30 days after cardiac surgery was 3.5%. The myocardial infarction rate from time of CAS to 30 days after cardiac surgery was 1.5%. This is the first single-center study reporting the combined outcome of CAS-CABG in symptomatic patients. The periprocedural complication rate and long-term results of the CAS-CABG strategy in this high-risk population support the reliability of this approach. In such a high-risk population, this strategy might offer a valuable alternative to the combined surgical approach; however, a large randomized trial is clearly warranted. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  10. Revisiting blood transfusion and predictors of outcome in cardiac surgery patients: a concise perspective [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Carlos E Arias-Morales

    2017-02-01

    Full Text Available In the United States, cardiac surgery-related blood transfusion rates reached new highs in 2010, with 34% of patients receiving blood products. Patients undergoing both complex (coronary artery bypass grafting [CABG] plus valve repair or replacement and non-complex (isolated CABG cardiac surgeries are likely to have comorbidities such as anemia. Furthermore, the majority of patients undergoing isolated CABG have a history of myocardial infarction. These characteristics may increase the risk of complications and blood transfusion requirement. It becomes difficult to demonstrate the association between transfusions and mortality because of the fact that most patients undergoing cardiac surgery are also critically ill. Transfusion rates remain high despite the advances in perioperative blood conservation, such as the intraoperative use of cell saver in cardiac surgery. Some recent prospective studies have suggested that the use of blood products, even in low-risk patients, may adversely affect clinical outcomes. In light of this information, we reviewed the literature to assess the clinical outcomes in terms of 30-day and 1-year morbidity and mortality in transfused patients who underwent uncomplicated CABG surgery.

  11. Is Peri-Operative Steroid Replacement Therapy Necessary for the Pituitary Adenomas Treated with Surgery? A Systematic Review and Meta Analysis

    Science.gov (United States)

    Tohti, Mamatemin; Li, Junyang; Zhou, Yuan; Hu, Yuebing; Yu, Zhuang; Ma, Chiyuan

    2015-01-01

    Background Patients with pituitary adenomas usually receive “stress dose” steroids in the peri-operative peroids. Though randomized controlled trials(RCT) have not been performed to assess the necessity of steroid coverage, there are several studies that explained the changes of adrenal function during peri-operative peroids. The aim of the present study is to investigate whether it is necessary to employ conventional peri-operative glucocorticoid replacement therapy to all the patients undergoing surgery. Methods We searched studies addressing peri-operative steroids coverage for pituitary adenomas in the Web of Science, Medline and the Cochrane Library. Then we extracted studies about peri-operative morning serum cortisol(MSC) levels, morbidity of early postoperative adrenal insufficiency, postoperative diabetes insipidus, relationships between MSC levels and adrenal integrity. We used RevMan Software to combine the results for meta-analysis. We used fixed-effects models for there was no significant heterogeneity existed. Findings There are 18 studies from 11 countries published between 1987 and 2013 including 1224 patients. The postoperative serum cortisol levels were significantly increased compared with the preoperative one in hypothalamic-pituitary-adrenal axis(HPAA) functions preserved patients(P<0.00001). The morbidity of early postoperative adrenal insufficiency ranged from 0.96% to 12.90%, with the overall morbidity of 5.55%(41/739). There was no significant differences of early postoperative diabetes insipidus between no supplementation patients and in supplementation patients(P=0.82). Conversely, there may be some disadvantages of high levels of cortisols such as high incidence of osteopenia and bone derangement and even the increased mortality rate. The patients with MSC levels of less than 60 nmol/l at 3 days after operation is considered as adrenal insufficient and more than 270 nmol/l as adrenal sufficient. To patients with MSC levels of 60

  12. Oral surgery in patients undergoing chemoradiation therapy.

    Science.gov (United States)

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

    2014-05-01

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

  13. Orthognathic Surgery in Patients With Large Condylar Destructions.

    Science.gov (United States)

    Sant'Ana, Eduardo; Dias-Ribeiro, Eduardo; de Lima, Valthierre Nunes; Correa, Ana Paula Simões; Sonoda, Celso Koogi; Nogueira, Renato Luiz Maia

    2016-03-01

    Condylar resorption is understood as changes in shape and volume of the condylar bone, due to local, systemic, and iatrogenic factors. The occurrence of condylar resorption after orthognathic surgery can occur when the condylar repositioning in mandibular fossa is performed improperly. In addition, systemic diseases such as osteoarthritis and rheumatoid arthritis seem to influence this process. The aim of this study was to report 3 cases of patients with severe condylar alterations, submitted to orthognathic surgery for treatment of dentofacial deformities. Considerations regarding the diagnosis, surgical planning (counterclockwise rotation), surgical techniques (bilateral sagittal split osteotomy, bimaxillary osteotomies, rigid fixation, maxillomandibular fixation period), and results (short terms) are discussed.

  14. Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

    Science.gov (United States)

    de Zwaan, Martina; Georgiadou, Ekaterini; Stroh, Christine E.; Teufel, Martin; Köhler, Hinrich; Tengler, Maxi; Müller, Astrid

    2014-01-01

    Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). Results: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole. PMID:25477839

  15. Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

    Directory of Open Access Journals (Sweden)

    Martina eDe Zwaan

    2014-11-01

    Full Text Available Background: Massive weight loss (MWL following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image and physical functioning.Methods: In this cross-sectional study 3 groups were compared: 1 patients prior to bariatric surgery (n=79, 2 patients after bariatric surgery who had not undergone BCS (n=252, and 3 patients after bariatric surgery who underwent subsequent body contouring surgery (BCS (n=62. All participants completed self-report questionnaires assessing body image (MBSRQ, quality of life (IWQOL-Lite, symptoms of depression (PHQ-9 and anxiety (GAD-7.Results: Overall, 62 patients (19.2% reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%, thigh lifts (24.2%, and breast lifts (16.1%. Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients; however, there were fewer differences between patients with and without BCS. Patients after BCS reported better appearance evaluation, body area satisfaction, and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better appearance evaluation and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.

  16. 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…

  17. Earlier Pulmonary Valve Replacement in Down Syndrome Patients Following Tetralogy of Fallot Repair.

    Science.gov (United States)

    Sullivan, Rachel T; Frommelt, Peter C; Hill, Garick D

    2017-08-01

    The association between Down syndrome and pulmonary hypertension could contribute to more severe pulmonary regurgitation after tetralogy of Fallot repair and possibly earlier pulmonary valve replacement. We compared cardiac magnetic resonance measures of pulmonary regurgitation and right ventricular dilation as well as timing of pulmonary valve replacement between those with and without Down syndrome after tetralogy of Fallot repair. Review of our surgical database from 2000 to 2015 identified patients with tetralogy of Fallot with pulmonary stenosis. Those with Down syndrome were compared to those without. The primary outcome of interest was time from repair to pulmonary valve replacement. Secondary outcomes included pulmonary regurgitation and indexed right ventricular volume on cardiac magnetic resonance imaging. The cohort of 284 patients included 35 (12%) with Down syndrome. Transannular patch repair was performed in 210 (74%). Down syndrome showed greater degree of pulmonary regurgitation (55 ± 14 vs. 37 ± 16%, p = 0.01) without a significantly greater rate of right ventricular dilation (p = 0.09). In multivariable analysis, Down syndrome (HR 2.3, 95% CI 1.2-4.5, p = 0.02) and transannular patch repair (HR 5.5, 95% CI 1.7-17.6, p = 0.004) were significant risk factors for valve replacement. Those with Down syndrome had significantly lower freedom from valve replacement (p = 0.03). Down syndrome is associated with an increased degree of pulmonary regurgitation and earlier pulmonary valve replacement after tetralogy of Fallot repair. These patients require earlier assessment by cardiac magnetic resonance imaging to determine timing of pulmonary valve replacement and evaluation for and treatment of preventable causes of pulmonary hypertension.

  18. The impact of coronary artery disease on early outcome of aortic valve replacement in elderly patients

    Directory of Open Access Journals (Sweden)

    Seyed Yaser Hariri

    2015-03-01

    Full Text Available Background: The operative risk of aortic valve replacement (AVR depends on several factors such as underlying coronary artery disease (CAD. Objective: The aim of this study was to determine postoperative complications and early outcome for elderly patients with CAD undergoing isolated aortic valve replacement and compare them with patients without CAD. Methods: Preoperative characteristics, postoperative in-hospital complications, 30-day mortality rate, and length of stay in hospital (LOS in 79 patients at least 65 years old that underwent isolated AVR (53 patients with CAD and 25 patients without CAD were studied and compared. Results: All studied in-hospital complications were similar between the two groups. No signi cant di erence in 30-day mortality rate between the two groups was found (CAD group 8.1%, non CAD group 10.0%, P=0.781, whereas the mean of ICU stay in patients with CAD was higher than other patients (75.9 versus 47.6 hours, P=0.006. Female gender, obesity, hypertension, prolonged ventilation, and postoperative heart block in patients with CAD and only obesity in other group were signi cant predictors of 30-day mortality. Conclusion: Early outcome of patients with and without CAD undergoing aortic valve replacement was similar.

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

    Science.gov (United States)

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

    2016-01-01

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

  20. A comparison of the clinical and experimental characteristics of four acute surgical pain models: dental extraction, bunionectomy, joint replacement, and soft tissue surgery.

    Science.gov (United States)

    Singla, Neil K; Desjardins, Paul J; Chang, Phoebe D

    2014-03-01

    When a clinical trial of an analgesic produces a negative finding, it is important to consider the influence (if any) of experimental error on the validity of that result. Although efforts to identify and minimize experimental error in chronic pain investigations have begun in earnest, less work has been performed on the optimization of acute pain methodology. Of the acute surgical pain methodology articles that have been published over the last decade, almost all focus on either the dental or bunion model. Analgesics are typically evaluated in a variety of surgical models that eventually include hospital-based models (eg, joint replacement and soft tissue surgery). Every surgical procedure has unique clinical characteristics that must be considered to optimize study design and conduct. Much of the methodological knowledge garnered from bunion and dental studies is applicable to other surgical models, but some extrapolations are hazardous. The purposes of this review were (1) to qualitatively describe the clinical and experimental characteristics of the 4 classic surgical models: dental extraction, bunionectomy, joint replacement, and soft tissue surgery; and (2) to quantitatively compare the models by analyzing 3 factors: effect size, enrollment rate, and demographics. We found that the dental extraction and bunionectomy models had higher assay sensitivity than the joint replacement and soft tissue surgery models. It is probable that this finding is secondary to the superior experimental conditions under which the dental and bunion models are executed (utilization of few centers that have the ability to reduce surgical, anesthetic, and postoperative confounders).

  1. Video-assisted thoracoscopic surgery for patients with pulmonary coccidioidomycosis.

    Science.gov (United States)

    Ashfaq, Awais; Vikram, Holenarasipur R; Blair, Janis E; Jaroszewski, Dawn E

    2014-10-01

    The study objective was to evaluate the use of video-assisted thoracoscopic surgery for removal of pulmonary sequelae of the fungal infection coccidioidomycosis. Retrospective chart review of all patients with pulmonary coccidioidomycosis treated surgically at our tertiary care center between January 1, 2009, and August 31, 2012. Of 2166 patients treated for pulmonary coccidioidomycosis, 58 (2.7%) (median age, 52 years [range, 18-84 years]) required surgical treatment. Surgical resection was performed for diagnosis (n=28 [48%]); 17 with positive positron emission tomography findings); persistent or progressive symptoms despite antifungal therapy (n=23 [40%]); or complications (n=7 [12%] of cavity rupture/infection). Of 33 patients (57%) who had serology performed, 23 (70%) had positive results. Video-assisted thoracoscopic surgery was used for most (95%; n=55) procedures, including 38 (67%) wedge resections, 14 (24%) segmentectomies, and 6 (11%) lobectomies; 4 patients also required additional decortication. Major (8%), including 1 death, and minor (12%) complications occurred in 12 patients postoperatively. Median hospitalization was 3 days (range, 1-8 days). Postoperative antifungal therapy was administered to 50% of patients for a median duration of 2 months. No patient had recurrent coccidioidomycosis at a median follow-up of 19 months. Although rarely necessary for pulmonary coccidioidomycosis, surgical intervention may be indicated. Specific indications include refractory symptomatic disease and complications of the infection, such as cavity rupture. Excisional biopsies also may be required for diagnostic confirmation of indeterminate pulmonary nodules. With video-assisted thoracoscopic surgery, diagnostic and therapeutic intervention can be undertaken with a low risk of complications and shorter length of hospital stay. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  2. Use of a retractor designed to harvest an internal thoracic artery graft during cardiac surgery for patients with a unilateral lung.

    Science.gov (United States)

    Suehiro, S; Shibata, T; Sasaki, Y; Murakami, T; Hosono, M; Fujii, H; Kinoshita, H

    1999-10-01

    Adequate exposure of the heart is required for safe cardiac surgery. We performed open heart surgery for 2 patients with a unilateral lung. In one patient, coronary artery bypass grafting was performed 13 years after left pneumonectomy for lung cancer. Mitral valve replacement was performed in the other patient whose left lung was entirely collapsed due to tuberculosis. The heart was markedly deviated to the left in both patients. A retractor designed to harvest the internal thoracic artery was very useful to obtain a good operative view of the heart. The operations were uncomplicated, and postoperative recovery was uneventful in both patients.

  3. Efficacy of continuous renal replacement therapy on patients with severe pulmonary infection

    Institute of Scientific and Technical Information of China (English)

    Ji-Feng Wang; Wen-Qiang Li; Peng Xu; Xiao-Yun Liu; Wen-Li Ji

    2016-01-01

    Objective:To analyze the efficacy of continuous renal replacement therapy on patients with severe pulmonary infection. Method:A total of 50 patients with severe pulmonary infection in our hospital from May 2014 to May 2015 were selected and were given continuous renal replacement therapy. Clinical symptoms, acute physiology and chronic health evaluation(APACHE)Ⅱ, blood routine and blood gas indexes, renal function (urea, creatinine, uric acid) and electrolyte (blood potassium, blood sodium) changes and success rate of treatment were observed and analyzed before and after treatment. Results:After continuous renal replacement therapy, dyspnea was significantly relieved for 47 cases of patients. Temperature was decreased accordingly. After treatment, electrolyte, APACHEⅡand renal function of patients were significantly improved (P<0.01);blood routine and blood gas indexes were signiicantly improved (P<0.01). Successful cases:36;death cases:14. Conclusions:continuous renal replacement therapy had better efficacy and could effectively improve the electrolyte, APACHEⅡand renal function for patients with severe pulmonary infection, which is an effective kind of adjuvant therapy.

  4. Effect of testosterone replacement therapy on bone mineral density in patients with Klinefelter syndrome.

    Science.gov (United States)

    Jo, Dae Gi; Lee, Hyo Serk; Joo, Young Min; Seo, Ju Tae

    2013-11-01

    Klinefelter syndrome (KS) is related to testicular insufficiency, which causes low testosterone levels in serum. Generally, sex hormone levels and bone mineral density (BMD) are lower in patients with KS than normal. We investigated the effects of testosterone replacement on serum testosterone levels and BMD in KS patients. From December 2005 to March 2008, 18 KS patients with a 47, XXY karyotype were treated with initial intramuscular injections of long-acting testosterone undecanoate (Nebido®, 1000 mg/4 mL) at baseline and second injections after six weeks. An additional four injections were administered at intervals of 12 weeks after the second injection. BMD was measured at the lumbar spine (L2-4), the left femoral neck and Ward's triangle, using dual energy X-ray absorptiometry. Medical histories, physical examinations and prostate specific antigen, hematology and serum chemistry were conducted for each patient. In addition, total testosterone and sex hormone-binding globulin levels were measured. Following testosterone replacement, mean serum total testosterone increased significantly from baseline (0.90 vs. 4.51 ng/mL, ptestosterone rose to normal levels after replacement in all patients. The mean BMD of the lumbar spine increased significantly (0.91 vs. 0.97 g/cm², ptestosterone replacement therapy may be effective in treating BMD deficiency in men with testosterone deficiency, especially those with Klinefelter syndrome.

  5. Patient perceptions on physician reimbursement in plastic surgery.

    Science.gov (United States)

    Garcia, Ryan M; Cassinelli, Ezequiel H; Hultman, C Scott; Erdmann, Detlev

    2014-07-01

    Public perception on physician reimbursement may be that considerable payments are received for procedures: a direct contrast to the actual decline. We aim to investigate patient perceptions toward plastic surgeon reimbursements from insurance companies. A survey of 4 common, single-staged procedures was administered to 140 patients. Patients were asked for their opinion on current insurance company reimbursement fees and what they believed the reimbursement fee should be. Eighty-four patients completed the survey. Patients estimated physician's reimbursements at 472% to 1061% more for breast reduction, 347% to 770% for abdominal hernia reconstruction, 372% to 787% for panniculectomy, and 290% to 628% for mandibular fracture repair. Despite these perceived higher-than-actual-fee payments, 87% of patients thought reimbursements should still be higher. Patients surveyed overestimated plastic surgery procedure fees by 290% to 1061%. Patients should be informed and educated regarding current fee schedules to plastic surgeons to correct current misconceptions.

  6. Ambulatory orthopaedic surgery patients' emotions when using different patient education methods.

    Science.gov (United States)

    Heikkinen, Katja; Salanterä, Sanna; Leppänen, Tiina; Vahlberg, Tero; Leino-Kilpi, Helena

    2012-07-01

    A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.

  7. Perioperative management of patient with Bombay blood group undergoing mitral valve replacement.

    Science.gov (United States)

    Priye, Shio; Sathyanarayan, J; Shivaprakash, S; Reddy, Durgaprasad

    2015-12-01

    Bombay red blood cell phenotype is an extremely rare blood type for which patients can receive only autologous or Bombay phenotype red blood cells. We report a case of stenotic mitral valve with Bombay phenotype who underwent minimal invasive right lateral thoracotomy for the replacement of the mitral valve. A male patient from Bangladesh presented to the hospital with New York Heart Association III symptoms. His medical evaluation revealed severe mitral valve stenosis and mild aortic valve regurgitation. The patient received erythropoietin, intravenous iron succinate and folic acid tablets. Autologous blood transfusion was carried out. The mitral valve was replaced with a prosthetic valve successfully. After weaning off from cardiopulmonary bypass, heparinisation was corrected with protamine. Post-operatively, the patient received autologous red blood cells. The patient recovered after 1-day of inotropic support with adrenaline and milrinone, and diuretics and was discharged on the 5(th) post-operative day.

  8. Perioperative management of patient with Bombay blood group undergoing mitral valve replacement

    Directory of Open Access Journals (Sweden)

    Shio Priye

    2015-01-01

    Full Text Available Bombay red blood cell phenotype is an extremely rare blood type for which patients can receive only autologous or Bombay phenotype red blood cells. We report a case of stenotic mitral valve with Bombay phenotype who underwent minimal invasive right lateral thoracotomy for the replacement of the mitral valve. A male patient from Bangladesh presented to the hospital with New York Heart Association III symptoms. His medical evaluation revealed severe mitral valve stenosis and mild aortic valve regurgitation. The patient received erythropoietin, intravenous iron succinate and folic acid tablets. Autologous blood transfusion was carried out. The mitral valve was replaced with a prosthetic valve successfully. After weaning off from cardiopulmonary bypass, heparinisation was corrected with protamine. Post-operatively, the patient received autologous red blood cells. The patient recovered after 1-day of inotropic support with adrenaline and milrinone, and diuretics and was discharged on the 5 th post-operative day.

  9. Patient evaluation and selection for transcatheter aortic valve replacement: the heart team approach.

    Science.gov (United States)

    Sintek, Marc; Zajarias, Alan

    2014-01-01

    Transcatheter aortic valve replacement (TAVR) has been shown to significantly impact mortality and quality of life in patients with severe aortic stenosis (AS) who are deemed high risk for surgical aortic valve replacement (SAVR). Essential to these outcomes is proper patient selection. The multidisciplinary TAVR heart team was created to provide comprehensive patient evaluation and aid in proper selection. This review with outline the history and components of the heart team, and delineate the team's role in risk and frailty assessment, evaluation of common co-morbidities that impact outcomes, and the complex multi-modality imaging necessary for procedural planning and patient selection. The heart team is critical in determining patient eligibility and benefit and the optimal operative approach for TAVR. The future of structural heart disease will certainly require a team approach, and the TAVR heart team will serve as the successful model.

  10. Resurfacing hip replacement and cemented total hip replacement have equivalent outcome at one year in a disease matched population: a case-control study of patient reported outcome measures.

    Science.gov (United States)

    Ray, Robbie; Goudie, Ewan B; Jenkins, Paul; Gaston, Paul

    2013-01-01

    Resurfacing hip replacement has demonstrated good survival and outcomes for cohorts of younger male patients, but few controlled studies exist. In this study we compared patient reported outcome measures and satisfaction scores at one year following resurfacing hip replacement in 69 male patients with two control groups of equal numbers undergoing cemented total hip replacement: aged-matched patients and disease matched patients. At one year we found no difference in improvement in patient reported outcome measures between patients undergoing resurfacing hip replacement and disease matched patients, whereas patients undergoing resurfacing hip replacement had a statistically significant improvement in Oxford Hip Score compared to the age-matched controls (pResurfacing hip replacement and total 
hip replacement both confer increase in patient reported outcome scores and high patient satisfaction at one year. The results of this study will allow better counselling of patients and help inform 
treatment decisions.

  11. Hair cortisol content in patients with adrenal insufficiency on hydrocortisone replacement therapy.

    Science.gov (United States)

    Gow, Rachel; Koren, Gideon; Rieder, Michael; Van Uum, Stan

    2011-06-01

    Patients with adrenal insufficiency (AI) require life-long replacement therapy with exogenous glucocorticoids. Several studies have shown impaired subjective health status in these patients as well as increased morbidity and mortality risk, which may be caused by glucocorticoid over-replacement. As a measure of long-term cortisol exposure, the usefulness of hair cortisol analysis in patients receiving glucocorticoid replacement therapy was investigated. Hair samples, demographics, medical history and perceived stress scale questionnaires were collected from 93 patients across North America diagnosed with primary or secondary AI. Sixty-two household partners served as a control group. Cortisol was measured in the proximal 2 cm of hair, representing the most recent 2 months of exposure. A modified enzyme immunoassay was used for the measurement of cortisol. The male patients had significantly higher hair cortisol levels than the male controls (P cortisol content correlated significantly with glucocorticoid dose (r = 0·3, P cortisol content correlates with hydrocortisone (HC) dose in patients with AI. Our results suggest that some AI patients may be over-treated and hence may be at risk for the adverse effects of cortisol. Measurement of HC in hair may become a useful monitoring tool for long-term cortisol exposure in patients treated with glucocorticoids. © 2011 Blackwell Publishing Ltd.

  12. Postoperative Complications after Thoracic Surgery in the Morbidly Obese Patient

    Directory of Open Access Journals (Sweden)

    Lebron Cooper

    2011-01-01

    Full Text Available Little has been recently published about specific postoperative complications following thoracic surgery in the morbidly obese patient. Greater numbers of patients who are obese, morbidly obese, or supermorbidly obese are undergoing surgical procedures. Postoperative complications after thoracic surgery in these patients that can lead to increased morbidity and mortality, prolonged hospital stay, and increased cost of care are considered. Complications include difficulties with mask ventilation and securing the airway, obstructive sleep apnea with risk of oversedation, pulmonary complications related to reduced total lung capacity, reduced functional residual capacity, and reduced vital capacity, risks of aspiration pneumonitis and ventilator-associated pneumonia, cardiomyopathies, and atrial fibrillation, inadequate diabetes management, positioning injuries, increased risk of venous thrombosis, and pulmonary embolism. The type of thoracic surgical procedure may also pose other problems to consider during the postoperative period. Obese patients undergoing thoracic surgery pose a challenge to those caring for them. Those working with these patients must understand how to recognize, prevent, and manage these postoperative complications.

  13. Demoralization, Patient Activation, and the Outcome of Spine Surgery

    Directory of Open Access Journals (Sweden)

    Andrew R Block

    2016-01-01

    Full Text Available It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial “maximizing” factors—characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM, an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients’ strengths as well as their vulnerabilities.

  14. 30 months follow-up of an early enzyme replacement therapy in a severe Morquio A patient: About one case.

    Science.gov (United States)

    Do Cao, J; Wiedemann, A; Quinaux, T; Battaglia-Hsu, S F; Mainard, L; Froissart, R; Bonnemains, C; Ragot, S; Leheup, B; Journeau, P; Feillet, F

    2016-12-01

    Patients under 5 years were not evaluated in the phase-3 study for enzyme replacement therapy (ERT) in MPS IV A. Here we describe the evolution of a severe Morquio A pediatric patient who was diagnosed at 19 months old and treated by ERT at 21 months old for the next 30 months. Applying the standard ERT protocol on this very young patient appeared to reduce his urinary excretion of glycosaminoglycans (GAGs); the improvements in both the 6 minute-walk test (6MWT) and the stair climb test, however, were no different than those reported in the nature history study. Additionally, this young patient experienced many ERT-associated side effects, and as a result a specific corticosteroid protocol (1 mg/kg of betamethasone the day before and 1 h before the ERT infusion) was given to avoid adverse events. Under these treatments, the height of this patient increased during the first year of the ERT although no more height gain was observed thereafter for 18 months. However, despite of ERT, his bone deformities (including severe pectus carinatum) actually worsened and his medullar cervical spine compression showed no improvement (thus needed decompression surgery).

  15. Shoulder Joint Replacement

    Science.gov (United States)

    ... Shoulder Replacement Options Shoulder replacement surgery is highly technical. It should be performed by a surgical team ... area and will meet a doctor from the anesthesia department. You, your anesthesiologist, and your surgeon will ...

  16. Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement

    NARCIS (Netherlands)

    Koene, Bart M.; Hamad, Mohamed A. Soliman; Bouma, Wobbe; Mariani, Massimo A.; Peels, Kathinka C.; van Dantzig, Jan-Melle; van Straten, Albert H.

    2013-01-01

    Background: The influence of prosthesis-patient mismatch (PPM) on survival after aortic valve replacement (AVR) remains controversial. In this study, we sought to determine the effect of PPM on early (30 days) after AVR or AVR combined with coronary artery bypass grafting (AVR with CABG). Methods:

  17. Replacing and representing patients: Professional feelings and plastic body replicas in nursing education

    DEFF Research Database (Denmark)

    Soffer, Ann Katrine Bønnelykke

    2015-01-01

    This article examines the intimate profession of nursing and the affective practices that bind bodies together into engagements that appear stable. However, once the bodies of patients are replaced with ‘plastic replicas’ for the purpose of clinical training within an educational setting, new...

  18. Increased risk of revision for infection in rheumatoid arthritis patients with total hip replacements

    DEFF Research Database (Denmark)

    Schrama, Johannes Cornelis; Fenstad, Anne M; Dale, Håvard;

    2015-01-01

    Background and purpose-Medical treatment of rheumatoid arthritis (RA) has changed dramatically over the last 15 years, including immune modulation. We investigated the risk of revision for infection after primary total hip replacement (THR) in patients with rheumatoid arthritis over a 16-year...

  19. Repeated mitral valve replacement in a patient with extensive annular calcification

    Directory of Open Access Journals (Sweden)

    Kitamura Tadashi

    2011-11-01

    Full Text Available Abstract Background Mitral valve replacement in the presence of severe annular calcification is a technical challenge. Case report A 47-year-old lady who had undergone mitral and aortic valve replacement for rheumatic disease 27 years before presented with dyspnea. At reoperation, extensive mitral annular calcification was hindering the disc motion of the Starr-Edwards mitral prosthesis. The old prosthesis was removed and a St Jude Medical mechanical valve was implanted after thorough annular debridement. Postoperatively the patient developed paravalvular leak and hemolytic anemia, subsequently undergoing reoperation three days later. The mitral valve was replaced with an Edwards MIRA valve, with a bulkier sewing cuff, after more aggressive annular debridement. Although initially there was no paravalvular leak, it recurred five days later. The patient also developed a small cerebral hemorrhage. As the paravalvular leak and hemolytic anemia gradually worsened, the patient underwent reoperation 14 days later. A Carpentier-Edwards bioprosthetic valve with equine pericardial patches, one to cover the debrided calcified annulus, another as a collar around the prosthesis, was used to eliminate paravalvular leak. At 7 years postoperatively the patient is doing well without any evidence of paravalvular leak or structural valve deterioration. Conclusion Mitral valve replacement using a bioprosthesis with equine pericardial patches was useful to overcome recurrent paravalvular leak due to severe mitral annular calcification.

  20. Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement

    NARCIS (Netherlands)

    Koene, Bart M.; Hamad, Mohamed A. Soliman; Bouma, Wobbe; Mariani, Massimo A.; Peels, Kathinka C.; van Dantzig, Jan-Melle; van Straten, Albert H.

    2013-01-01

    Background: The influence of prosthesis-patient mismatch (PPM) on survival after aortic valve replacement (AVR) remains controversial. In this study, we sought to determine the effect of PPM on early (30 days) after AVR or AVR combined with coronary artery bypass grafting (AVR with CABG). Methods: B

  1. Transobturator midurethral sling: What should patients expect after surgery?

    Science.gov (United States)

    Rechberger, Tomasz; Wrobel, Andrzej; Zietek, Alicja; Rechberger, Ewa; Bogusiewicz, Michal; Miotla, Pawel

    2017-07-08

    Midurethral sling (MUS) surgeries are minimally invasive procedures; however, they are not free of postoperative complications. The aim of the study was to assess the occurrence of lower urinary tract symptoms (LUTS) (urgency, nocturia, frequency, splitting/spraying, hesitancy, terminal dribbling, and subjective feeling of postvoid residual) in patients suffering from stress (SUI) or mixed (MUI) urinary incontinence with a predominant SUI component before and after transobturator MUS placement. The study group consisted of 88 women with SUI and 18 with MUI who underwent transobturator MUS. All participants were questioned with a self-developed questionnaire before and after surgery regarding the presence of LUTS. Seven days after surgery, 62 patients (58.5%) noted voiding and postmicturition symptoms, whereas 67 (63.2%) reported problems in storage. The more commonly reported LUTS at week 1 after surgery were urgency (52.8%), splitting/spraying (41.5%), and feeling of incomplete bladder emptying (34.0%). Patients perceived that splitting/spraying was the most bothersome. After 6 months, the most common LUTS reported were hesitancy (14.1%), terminal dribbling (10.4%), and splitting/spraying (9.4%). We noticed a decrease in the number of urgency episodes >2.7 times (p < 0.001) compared with baseline. After 6 months, 97 (91.5%) patients reported the lack of incontinence episodes. A vast majority of patients after MUS suffer from LUTS in the early postoperative period; however, the majority of undesired symptoms resolve spontaneously within the first 6 months postsurgery.

  2. FUNCTIONAL ASSESSMENT OF OLDER OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY

    Directory of Open Access Journals (Sweden)

    Denis PAJECKI

    2014-03-01

    Full Text Available Context Obesity in the elderly is associated with exacerbation of functional decline (dependency, that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years. Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72 and 75% were women. They had an average weight of 121.1 kg (72.7-204 and a mean BMI of 47.2 kg/m2 (35.8-68.9. 16 patients (40% have shown dependency for activities of daily living, 19 (47,5% for instrumental activities of daily living and 20 patients (50% had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression has shown

  3. The value of early standardized rehabilitation after hip joint replacement surgery%早期规范化康复治疗在髋关节置换术中的应用价值

    Institute of Scientific and Technical Information of China (English)

    林国联

    2016-01-01

    Objective:To evaluate the value of early standardized rehabilitation in patients after total hip joint replacement surgery. Methods:Included in this study were 252 patients who underwent total hip joint replacement surgery at the Yangjiang Public Health Hospital between January 2010 and April 2015. The subjects were randomly divided into study group and control group ( n=126 each ) . The study group received early standardized rehabilitation, whereas the control group received conventional rehabilitation and self-managed exercise. The outcomes of hip joint function rehabilitation were evaluated at weeks 1 and 2, and at 1, 3, 6, and 12 months postoperatively based on Harris score, and were compared between groups. Postoperative complications, awareness about rehabilitation and patient satisfaction were also recorded. Results:The Harris score did not differ between groups in postoperative week 1 or 2 (P>0.05). At 1, 3, 6, and 12 months after surgery, the study group showed significantly higher Harris score, recovery rate, good awareness of rehabilitation and patient satisfaction compared with the control group (P0.05);研究组术后1、3、6、12个月Harris评分,患者治愈率、康复知识掌握优良率及满意度明显高于对照组(P<0.05);研究组术后并发症发生率明显低于对照组(P<0.05)。结论:对全髋关节置换术患者进行早期规范化康复治疗能促进髋关节功能的早期康复,降低术后并发症,改善患者的生活质量,值得临床推广应用。

  4. Influence of changes in the pulmonary artery pressure on ventilation requirements in patients undergoing mitral valve replacement.

    Directory of Open Access Journals (Sweden)

    Muralidhar K

    2004-01-01

    Full Text Available The study was designed to evaluate the influence of changes in pulmonary artery pressure on the ventilation requirements in patients undergoing mitral valve surgery. Thirty patients with mitral valve disease with significant pulmonary arterial hypertension undergoing mitral valve replacement under cardiopulmonary bypass were included in this prospective study. All patients had a pulmonary artery catheter placed after the anaesthetic induction. The minute ventilation was adjusted to achieve an arterial carbon dioxide tension (PaCO2 of 35-40 mm Hg. After a stabilisation period of 15 minutes, the pulmonary artery pressure and the minute volume needed for maintaining a PaCO2 of 35-40 mm Hg in the precardiopulmonary bypass, post-cardiopulmonary bypass and six hours postoperatively were measured after ensuring stable haemodynamics and normothermia. There was a significant decrease in the mean pulmonary artery pressure from pre-cardiopulmonary bypass value of 41.3+/-15 mm Hg to 29.3+/-8 mm Hg in the postcardiopulmonary bypass period and subsequently to 25.5+/-7 mm Hg in the intensive care unit. There was a corresponding increase in the minute volume requirements from a pre-cardiopulmonary bypass value of 6.8+/-1 L/min to 8.0+/-1 L/min in the post cardiopulmonary bypass period and then to 9.4+/-1.2 L/min in the postoperative period. We conclude that there is a significant decrease in the pulmonary blood volume and a subsequent decrease in the pulmonary artery pressure after a successful mitral valve replacement in patients with pulmonary arterial hypertension. This is associated with a significant increase in the requirement of minute ventilation to maintain normocarbia.

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

    OpenAIRE

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

    2016-01-01

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

  6. USING TRABECULAR METAL AUGMENTS FOR TOTAL HIP REPLACEMENT IN PATIENTS AFTER ACETABULAR FRACTURES

    Directory of Open Access Journals (Sweden)

    R. M. Tikhilov

    2011-01-01

    Full Text Available The authors presented the experience of treatment of two patients with hip arthritis after acetabular fracture. Both patients were treated with total hip replacement. During the operation, to manage posterior-superior bone defects of the acetabulum, augments of trabecular metal were used. Pain and limitation of motions in hip were indications for operative treatment. After a year of follow up there was no pain in hip; also recovery of motion and improved quality of life were observed.

  7. A 5 year prospective study of patient-relevant outcomes after total knee replacement

    DEFF Research Database (Denmark)

    Nilsdotter, A-K; Toksvig-Larsen, S; Roos, E M

    2008-01-01

    OBJECTIVE: To prospectively describe self-reported outcomes up to 5 years after total knee replacement (TKR) in Osteoarthritis (OA) and to study which patient-relevant factors may predict outcomes for pain and physical function (PF). METHODS: 102 consecutive patients with knee OA, 63 women and 39...... postoperatively. RESULTS: Response rate at 5 years was 86%. At 6 months significant improvement was seen in all KOOS and SF-36 scores (P

  8. Impact of prosthesis-patient mismatch on survival after mitral valve replacement: a systematic review

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian-feng; WU Yi-cheng; SHEN Wei-feng; KONG Ye

    2013-01-01

    Objective To determine whether the prosthesis-patient mismatch has a deleterious impact on survival after mitral valve replacement.Data sources A comprehensive literature search of PubMed,Embase,and ScienceDirect was carried out.References and cited papers of relevant articles were also checked.Study selection All articles published after January 1980 was initially considered.Non-English and non-human studies,case reports,and reviews were excluded from the initial search.References and cited papers of relevant articles were also checked.Results A total of 8 retrospective cohort studies were identified for this review.The overall incidence of prosthesis-patient mismatch (<1.3 to <1.2 cm2/m2) after mitral valve replacement ranged from 3.7% to 85.9% (moderate prosthesis-patient mismatch (0.9 to 1.2 cm2/m2) in 37.4% to 69.5%,severe prosthesis-patient mismatch (<0.9 cm2/m2) in 8.7% to 16.4%).Four studies demonstrated an association of prosthesis-patient mismatch with reduced long-term survival,but the other four studies found no significant deleterious impact of prosthesis-patient mismatch after mitral valve replacement.No definite conclusion could be derived from these conflicting results.Conclusions Current evidence is insufficient to derive a definite conclusion whether mitral prosthesis-patient mismatch affects long-term survival because of the biases and confounding factors that interfere with late clinical outcomes.Good-quality prospective studies are warranted to evaluate the impact of mitral prosthesis-patient mismatch after mitral valve replacement in the future.

  9. [Evaluation of aortic valve replacement involving small severely calcified aortic annulus in elderly patients].

    Science.gov (United States)

    Iwahashi, M; Nishimura, Y; Hiramatsu, K; Komori, S; Shibata, M; Yuzaki, M; Okamura, Y

    2006-04-01

    We performed aortic valve replacement in 24