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Sample records for surgery frontdoor study

  1. Confounding adjustment through front-door blocking in longitudinal studies

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    Arvid Sjölander

    2013-03-01

    Full Text Available A common aim of epidemiological research is to estimate the causal effect of a particular exposure on a particular outcome. Towards this end, observed associations are often ‘adjusted’ for potential confounding variables. When the potential confounders are unmeasured, explicit adjustment becomes unfeasible. It has been demonstrated that causal effects can be estimated even in the presence of umeasured confounding, utilizing a method called ‘front-door blocking’. In this paper we generalize this method to longitudinal studies. We demonstrate that the method of front-door blocking poses a number of challenging statistical problems, analogous to the famous problems associ- ated with the method of ‘back-door blocking’.

  2. A randomized study of combining maze surgery for atrial fibrillation with mitral valve surgery

    NARCIS (Netherlands)

    Jessurun, ER; Van Hemel, NM; Defauw, JJ; De La Riviere, AB; Stofmeel, MAM; Kingma, JH; Ernst, JMPG

    Aim Mitral valve surgery seldom suppresses atrial fibrillation (AF), present prior to surgery. Maze III surgery eliminates AF in >80% of cases, the reason why combining this procedure with mitral valve surgery in patients with AF seems worthwhile. We prospectively studied the outcome of combining

  3. Bariatric Surgery and Infertility: A Prospective Study.

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    Consalvo, Vincenzo; Canero, Antonio; Salsano, Vincenzo

    2017-12-22

    Obesity is a worldwide disease affecting 13% of the world's adult female population. The reasons and the fetal risk are still unclear. The effect of weight loss as a result of bariatric surgery seems to induce an improvement in fertility in obese women. The main purpose of this prospective study is to demonstrate if there is an association between bariatric surgery-induced weight loss and an improvement in the fertility of women at reproductive age. From June 2013 to April 2016, all bariatric female patients from our institutes were prospectively evaluated for suitability in this study. A pool of 52 eligible patients was extracted from our database in the recruitment period. Of these, 28 underwent bariatric surgery and 24 did not. Both groups were observed for two-year follow-up. During follow-up, anthropometrics parameters, blood analysis, and comorbidities were checked and a gynaecological consultation was prescribed. Fifty participants were studied. Twenty-seven successfully underwent bariatric surgery with a percentage of excess weight loss (EWL) >70% at 24 months, while 23 accepted the observation and control for 24 months as an integral part of the pre-surgical bariatric program. The contingency table analysis showed an extremely significant association (Pbariatric surgery) and event (pregnancy), with a relative risk (RR) = 15.33 and confidence interval (CI) 95%=2.213 to 106.26. Bariatric surgery improves fertility in obese women at two years' postoperative. Every obese woman with difficulties becoming pregnant should undergo a bariatric surgery consultation. Further studies are necessary to confirm our results.

  4. Flapless implant surgery: an experimental study.

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    Jeong, Seung-Mi; Choi, Byung-Ho; Li, Jingxu; Kim, Han-Sung; Ko, Chang-Yong; Jung, Jae-Hyung; Lee, Hyeon-Jung; Lee, Seoung-Ho; Engelke, Wilfried

    2007-07-01

    The purpose of this study was to examine the effect of flapless implant surgery on crestal bone loss and osseointegration in a canine mandible model. In 6 mongrel dogs, bilateral, edentulated, flat alveolar ridges were created in the mandible. After 3 months of healing, 2 implants in each side were placed by either flap or flapless procedures. After a healing period of 8 weeks, microcomputerized tomography at the implantation site was performed. Osseointegration was calculated as percentage of implant surface in contact with bone. Additionally, bone height was measured in the peri-implant bone. The mean osseointegration was greater at flapless sites (70.4%) than at sites with flaps (59.5%) (P flapless sites (10.1 mm) than at sites with flaps (9.0 mm) (P Flapless surgery can achieve results superior to surgery with reflected flaps. The specific improvements of this technique include enhanced osseointegration of dental implants and increased bone height.

  5. Adolescent girls' views on cosmetic surgery: A focus group study.

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    Ashikali, Eleni-Marina; Dittmar, Helga; Ayers, Susan

    2016-01-01

    This study examined adolescent girls' views of cosmetic surgery. Seven focus groups were run with girls aged 15-18 years (N = 27). Participants read case studies of women having cosmetic surgery, followed by discussion and exploration of their views. Thematic analysis identified four themes: (1) dissatisfaction with appearance, (2) acceptability of cosmetic surgery, (3) feelings about undergoing cosmetic surgery and (4) cosmetic surgery in the media. Results suggest the acceptability of cosmetic surgery varies according to the reasons for having it and that the media play an important role by normalising surgery and under-representing the risks associated with it. © The Author(s) 2014.

  6. Adolescent girls' views on cosmetic surgery: a focus group study

    OpenAIRE

    Ashikali, E.-M.; Dittmar, H.; Ayers, S

    2016-01-01

    This study examined adolescent girls’ views of cosmetic surgery. Seven focus groups were run with girls aged 15 to 18 (N = 27). Participants read case studies of women having cosmetic surgery, followed by discussion and exploration of their views. Thematic analysis identified four themes: (1)\\ud Dissatisfaction with appearance, (2) Acceptability of cosmetic surgery, (3) Feelings about undergoing cosmetic surgery, and (4) Cosmetic surgery in the media. Results suggest the acceptability of cosm...

  7. Telemedicine and Plastic Surgery: A Pilot Study

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    Denis Souto Valente

    2015-01-01

    Full Text Available Background. Telemedicine can be defined as the use of electronic media for transmission of information and medical data from one site to another. The objective of this study is to demonstrate an experience of telemedicine in plastic surgery. Methods. 32 plastic surgeons received a link with password for real-time streaming of a surgery. At the end of the procedure, the surgeons attending the procedure by the Internet answered five questions. The results were analyzed with descriptive statistics. Results. 27 plastic surgeons attended the online procedure in real-time. 96.3% considered the access to the website as good or excellent and 3.7% considered it bad. 14.8% reported that the transmission was bad and 85.2% considered the quality of transmission as good or excellent. 96.3% classified the live broadcasting as a good or excellent learning experience and 3.7% considered it a bad experience. 92.6% reported feeling able to perform this surgery after watching the demo and 7.4% did not feel able. 100% of participants said they would like to participate in other surgical demonstrations over the Internet. Conclusion. We conclude that the use of telemedicine can provide more access to education and medical research, for plastic surgeons looking for medical education from distant regions.

  8. [Orthognathic surgery. Study of nerve injuries].

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    Nardi, P; Guarducci, M; Cervino, M

    2002-12-01

    The correction of oral and maxillo-facial mal-formations causes lesions to sensitive nerves due to the invasive and traumatic surgery techniques required. Generally neuro-sensory and cutaneous-mucosal defects are reversible, with full recovery within 6-12 months. In a follow-up study (2 and 8 years) we found altered tactile and pain sensitivity in 43% of patients at subjective evaluation, with objective alteration in 17% of the group. Dental sensitivity evaluated by a pulp test showed an increase in for all teeth tested; values were higher for superior than for inferior teeth. Despite the increased pulp sensitivity threshold, due to the surgical damage, no signs of pulp disease were detected. Quality of life was not affected even by such a high subjective change in sensitivity. We therefore believe that patients undergoing orthognathic surgery must be fully informed; they must be made to understand the risks involved, and that damage may occur to sensitive nerves following surgery. All surgeons, including those with experience in the field, should continually seek to improve their skill and learn new techniques, in order to reduce complications to a minimum.

  9. Current peripheral bypass surgery: various clinical studies

    NARCIS (Netherlands)

    Slaa, Alexander te

    2011-01-01

    Substantial post-operative edema occurs in the majority of patients who undergo peripheral bypass surgery due to severe peripheral arterial disease (PAD). The pathophysiological mechanisms that underlay edema formation following peripheral bypass surgery include hyperemia, an increased capillary

  10. 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 ...

  11. Increasing incidence of cataract surgery: Population-based study

    Science.gov (United States)

    Gollogly, Heidrun E.; Hodge, David O.; St. Sauver, Jennifer L.; Erie, Jay C.

    2015-01-01

    PURPOSE To estimate the incidence of cataract surgery in a defined population and to determine longitudinal cataract surgery patterns. SETTING Mayo Clinic, Rochester, Minnesota, USA. DESIGN Cohort study. METHODS Rochester Epidemiology Project (REP) databases were used to identify all incident cataract surgeries in Olmsted County, Minnesota, between January 1, 2005, and December 31, 2011. Age-specific and sex-specific incidence rates were calculated and adjusted to the 2010 United States white population. Data were merged with previous REP data (1980 to 2004) to assess temporal trends in cataract surgery. Change in the incidence over time was assessed by fitting generalized linear models assuming a Poisson error structure. The probability of second-eye cataract surgery was calculated using the Kaplan-Meier method. RESULTS Included were 8012 cataract surgeries from 2005 through 2011. During this time, incident cataract surgery significantly increased (P cataract surgery steadily increased over the past 3 decades (P cataract surgery steadily increased over the past 32 years and has not leveled off, as reported in Swedish population-based series. Second-eye surgery was performed sooner and more frequently, with 60% of residents having second-eye surgery within 3-months of first-eye surgery. PMID:23820302

  12. Surgery

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    ... Disease Lookup > COPD > Diagnosing and Treating COPD Surgery Chronic obstructive pulmonary disease (COPD) includes two separate lung problems, emphysema and chronic bronchitis. Some people with COPD have ...

  13. Surgery

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    ... and impairs lung function. People need to stop smoking several weeks before surgery so that the defense mechanisms of the respiratory system can recover. Doctors' evaluations The surgeon does a ...

  14. Preparing for successful surgery: an implementation study.

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    Diaz, Manuel; Larsen, Brad

    2005-01-01

    To evaluate the implementation of a mind-body program for surgical patients in a community hospital, assessing patient participation, patient perception, and program impact on anxiety, pain, and quality of sleep during the perioperative period. Two hundred thirty patients having total hip replacement, total knee replacement, hysterectomy, or colectomy participated in this investigation. One hundred fifteen patients were assigned to the control group before the start of the mind-body program and received routine care. The subsequent 115 patients were assigned to the intervention group and were given an audio CD (containing guided imagery, affirmations, and relaxation music) and a brochure three to seven days before surgery. The brochure recommended that patients listen to the CD twice a day before and after surgery. Anxiety, pain at rest, pain with movement, quality of sleep, and program participation were assessed for the first two postoperative days, and patient perception of the program was assessed at the end of the two days. Anxiety scores were lower in the intervention group on the evening of surgery. Despite a trend toward lower pain scores in the intervention group, no difference between the intervention and control groups reached statistical significance, including quality of sleep. Of patients in the intervention group, 74% listened to the CD at least once after surgery, and 37% listened to the program three or more times. Most patients who used the CD at least once rated it as helpful, and 87% said they would use it for future operations. Patient response to a perioperative mind-body program was favorable. Most patients listened to the program CD at least once, and a third used the CD repeatedly, as recommended. The majority of patients who used the CD felt it had been helpful and would use it again. Program participants experienced less anxiety on the night of surgery.

  15. A nationwide study on anastomotic leakage after colonic cancer surgery

    DEFF Research Database (Denmark)

    Krarup, Peter-Martin; Jorgensen, L N; Andreasen, A H

    2012-01-01

    : AL occurred in 593 (6.4%) of 9333 patients. Laparoscopic surgery (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.05-1.70; P = 0.03); left hemicolectomy (OR, 2.02; 95% CI, 1.50-2.72) or sigmoid colectomy (OR, 1.69; 95% CI, 1.32-2.17; P = 0.01); intraoperative blood loss (OR, 1.04; 95% CI, 1......Aim: Anastomotic leakage (AL) is a major challenge in colorectal cancer surgery due to increased morbidity and mortality. Possible risk factors should be investigated differentially, distinguishing between rectal and colonic surgery in large-scale studies to avoid selection bias and confounding....... Method: The incidence and risk factors associated with AL were analysed in an unselected nation-wide prospective cohort of patient subjected to curative colonic cancer surgery with primary anastomosis and entered into The Danish Colorectal Cancer Group database between May 2001 and December 2008. Results...

  16. Plasma glutamine levels before cardiac surgery are related to post-surgery infections; an observational study.

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    Buter, Hanneke; Koopmans, Matty; Kemperman, Ramses; Jekel, Lilian; Boerma, Christiaan

    2016-11-25

    A low plasma glutamine level was found in 34% of patients after elective cardiothoracic surgery. This could be a result of the inflammation caused by surgical stress or the use of extracorporeal circulation (ECC). But it is also possible that plasma glutamine levels were already lowered before surgery and reflect an impaired metabolic state and a higher likelihood to develop complications. In the present study plasma glutamine levels were measured before and after cardiac surgery and we questioned whether there is a relation between plasma glutamine levels and duration of ECC and the occurrence of postoperative infections. We performed a single-centre prospective, observational study in a closed-format, 20-bed, mixed ICU in a tertiary teaching hospital. We included consecutive patients after elective cardiac surgery with use of extracorporeal circulation. Blood samples were collected on the day prior to surgery and at admission on the ICU. The study was approved by the local Medical Ethics Committee (Regional Review Committee Patient-related Research, Medical Centre Leeuwarden, nWMO 115, April 28th 2015). Ninety patients were included. Pre-operative plasma glutamine level was 0.42 ± 0.10 mmol/l and post-operative 0.38 ± 0.09 mmol/l (p < 0.001). There was no relation between duration of extracorporeal circulation or aortic occlusion time and changes in plasma glutamine levels. A logistic regression analysis showed a significant correlation between the presence of a positive culture during the post-operative course and pre-operative plasma glutamine levels (p = 0.04). Plasma glutamine levels are significantly lower just after cardiac surgery compared to pre-operative levels. We did not find a relation between the decrease in plasma glutamine levels and the duration of extracorporeal circulation or aortic clamp time. There was a correlation between pre-operative plasma glutamine levels and the presence of a positive culture after cardiac surgery

  17. Plasma glutamine levels before cardiac surgery are related to post-surgery infections; an observational study

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    Hanneke Buter

    2016-11-01

    Full Text Available Abstract Background A low plasma glutamine level was found in 34% of patients after elective cardiothoracic surgery. This could be a result of the inflammation caused by surgical stress or the use of extracorporeal circulation (ECC. But it is also possible that plasma glutamine levels were already lowered before surgery and reflect an impaired metabolic state and a higher likelihood to develop complications. In the present study plasma glutamine levels were measured before and after cardiac surgery and we questioned whether there is a relation between plasma glutamine levels and duration of ECC and the occurrence of postoperative infections. Methods We performed a single-centre prospective, observational study in a closed-format, 20-bed, mixed ICU in a tertiary teaching hospital. We included consecutive patients after elective cardiac surgery with use of extracorporeal circulation. Blood samples were collected on the day prior to surgery and at admission on the ICU. The study was approved by the local Medical Ethics Committee (Regional Review Committee Patient-related Research, Medical Centre Leeuwarden, nWMO 115, April 28th 2015. Results Ninety patients were included. Pre-operative plasma glutamine level was 0.42 ± 0.10 mmol/l and post-operative 0.38 ± 0.09 mmol/l (p < 0.001. There was no relation between duration of extracorporeal circulation or aortic occlusion time and changes in plasma glutamine levels. A logistic regression analysis showed a significant correlation between the presence of a positive culture during the post-operative course and pre-operative plasma glutamine levels (p = 0.04. Conclusion Plasma glutamine levels are significantly lower just after cardiac surgery compared to pre-operative levels. We did not find a relation between the decrease in plasma glutamine levels and the duration of extracorporeal circulation or aortic clamp time. There was a correlation between pre-operative plasma glutamine levels

  18. Outpatient- and inpatient-based buckling surgery: a comparative study

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    Lee JC

    2014-04-01

    Full Text Available Jin Cheol Lee,* Yu Cheol Kim*Department of Ophthalmology, Keimyung University School of Medicine, Dongsan Medical Center, Daegu, Korea *Both authors contributed equally to this workPurpose: To evaluate the clinical outcomes of ambulatory buckling surgery, comparing outpatient- with inpatient-based surgery.Methods: The authors performed a retrospective study of 80 consecutive cases of rhegmato genous retinal detachment from January 2009 to December 2011 treated by scleral buckling surgery. Two groups of patients were defined according to inpatient (group 1 or outpatient (group 2 surgery, and a comparison of several parameters between these two groups was performed.Results: Of the 80 subjects in this study, the average age of group 1 (50 patients was 49.7 years, and that of group 2 (30 patients was 47.5 years. There were no statistically significant differences in the average logarithm of the minimum angle of resolution-visual acuity, the condition of the lens, or the presence of retinal lattice degeneration prior to the surgery between the groups. There were no statistically significant differences in the patterns of tear or retinal detachment or in surgical procedure between the groups. Comparing the best-corrected visual acuity after 6 months with that prior to the surgery, the changes in group 1 and group 2 were 0.26 and 0.31, respectively. The functional success rates of group 1 and group 2 after 6 months were 90% and 93%, respectively, and the anatomical success rates of group 1 and group 2 after 6 months were 94% and 96%, respectively, but these were also statistically insignificant.Conclusion: Hospitalization is not essential for buckling surgery in uncomplicated rhegmatogenous retinal detachment surgery.Keywords: ambulatory, scleral buckling, rhegmatogenous retinal detachment

  19. Sexual satisfaction following bariatric surgery: A prospective exploratory study.

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    Ferrer-Márquez, Manuel; Pomares-Callejón, María Ángeles; Fernández-Agis, Inmaculada; Belda-Lozano, Ricardo; Vidaña-Márquez, Elisabet; Soriano-Maldonado, Alberto

    2017-11-01

    Bariatric surgery improves sexual function in obese individuals, although the extent to which sexual satisfaction is improved following surgery is unknown. The aims of this study were 1) to describe sexual satisfaction in severely/morbidly obese men and women candidates for bariatric surgery; 2) to assess the effects of bariatric surgery on sexual satisfaction at 12-months follow-up; and 3) to assess whether weight changes at follow-up following bariatric surgery are associated with changes in sexual satisfaction. We conducted a prospective observational study from February 2011 to June 2014. A total of 44 patients with severe/morbid obesity participated in the study. Sexual satisfaction was assessed (at baseline and 12-months follow-up) through the Index of Sexual Satisfaction (ISS) questionnaire. Of 44 patients who completed the ISS at baseline (mean age 40.3 [SD=9.4] years and BMI 46.9 [SD=6.2] kg/m 2 ), 17 were lost to follow-up. The baseline ISS total scores were 32.0 (SD=20.1) in women and 24.4 (SD=16.0) in men (P>0.05). The proportion of sexually satisfied men and women at baseline was 62.5% and 46.4%, respectively (P=0.360). At follow-up, sexual satisfaction improved significantly in women (average difference 13.7 units; P=0.032) but not in men (average difference 3.6 units; P=0.717). The percentage of women with sexual satisfaction problems was reduced by 33% at follow-up (P=0.038). A relatively large percentage of severely/morbidly obese women and men present clinically significant sexual satisfaction problems before undergoing bariatric surgery. Sexual satisfaction improves significantly 12 months following bariatric surgery, particularly in women. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. A prospective clinical study of polycarboxylate cement in periapical surgery

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    Ortega-Sánchez, Bárbara; García-Mira, Berta; Maestre-Ferrín, Laura; Peñarrocha-Oltra, David; Gay-Escoda, Cosme

    2012-01-01

    Objective: To evaluate the clinical efficacy of polycarboxylate cement as retrograde filling material. Design: A prospective clinical study was made of 25 patients subjected to periapical surgery with ultrasound and magnifying loupes, in which polycarboxylate cement was used as retrograde filling material. Measurements were made of the area and diameter of the lesions pre- and postoperatively, and 6 and 12 months after the operation. The apical resection and retrograde filling areas were also measured, and the prognosis following surgery was recorded. Results: A total of 23 patients with 31 apicoectomized teeth were studied (2 patients being lost to follow-up). The mean area of the periapical lesions before surgery was 52.25 mm2, with a mean major diameter of 6.1 mm and a mean lesser diameter of 4.8 mm. The success rate after 12 months was 54.7%, according to the criteria of Von Arx and Kurt. The prognosis was poorer in females, in larger lesions, and in cases with larger retrograde filling areas. Conclusions: Polycarboxylate cement offers good results, with important bone regeneration after periapical surgery. Key words: Periapical surgery, endodontic treatment, polycarboxylate cement. PMID:22143701

  1. Ambulatory laparoscopic minor hepatic surgery: Retrospective observational study.

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    Gaillard, M; Tranchart, H; Lainas, P; Tzanis, D; Franco, D; Dagher, I

    2015-11-01

    Over the last decade, laparoscopic hepatic surgery (LHS) has been increasingly performed throughout the world. Meanwhile, ambulatory surgery has been developed and implemented with the aims of improving patient satisfaction and reducing health care costs. The objective of this study was to report our preliminary experience with ambulatory minimally invasive LHS. Between 1999 and 2014, 172 patients underwent LHS at our institution, including 151 liver resections and 21 fenestrations of hepatic cysts. The consecutive series of highly selected patients who underwent ambulatory LHS were included in this study. Twenty patients underwent ambulatory LHS. Indications were liver cysts in 10 cases, liver angioma in 3 cases, focal nodular hyperplasia in 3 cases, and colorectal hepatic metastasis in 4 cases. The median operative time was 92 minutes (range: 50-240 minutes). The median blood loss was 35 mL (range: 20-150 mL). There were no postoperative complications or re-hospitalizations. All patients were hospitalized after surgery in our ambulatory surgery unit, and were discharged 5-7 hours after surgery. The median postoperative pain score at the time of discharge was 3 (visual analogue scale: 0-10; range: 0-4). The median quality-of-life score at the first postoperative visit was 8 (range: 6-10) and the median cosmetic satisfaction score was 8 (range: 7-10). This series shows that, in selected patients, ambulatory LHS is feasible and safe for minor hepatic procedures. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  2. A STUDY ON INCISIONAL HERNIA FOLLOWING OBSTETRICS AND GYNAECOLOGICAL SURGERIES

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    Sumathi Ravikumar

    2016-12-01

    Full Text Available BACKGROUND The term ventral hernia encompasses incisional, epigastric, paraumbilical, spigelian and traumatic hernias. This is a hernia that protrudes through defect in an abdominal wound. With evolution of modern surgery and rapid increase in the number of abdominal operations performed, incisional hernias have risen in frequency and this hernia seems to be more common in females following obstetric and gynaecological surgeries. This study undertaken to stress the problem of incisional hernias in females occurring after obstetric and gynaecological surgeries. The aim of the study is to- 1. Study the incidence and prevalence of incisional hernias following obstetrics and gynaecological surgeries in KAPV Government Medical College, Tiruchirappalli. 2. Study aetiological factors for incisional hernia following obstetric and gynaecological surgeries. 3. Analyse preventive measures. 4. Analyse the problems in females, which led to incisional hernia. MATERIALS AND METHODS 178 cases of incisional hernia admitted in KAPV Government Medical College, Tiruchirappalli, during the period of 2 years from June 2014 to May 2016. The cases analysed according to age, previous history, type of incision, suture material used and associated comorbidities. RESULTS Maximum age affected is between 50 to 59 years and with 10 years of surgery. Incidence more following LSCS with midline incision. Incidence more with the usage of absorbable suture material. Postoperative wound infection and anaemia were leading associated factors for incisional hernia. CONCLUSION The incidence of incisional hernia is more common in females especially in obese and multiparous woman. The incidence is more after LSCS and puerperal sterilisation. Onlay reinforced mesh repair using Prolene mesh have given good results. Prolene mesh appears to be best tolerated by body tissues. The use of closed suction drain have significantly reduced the postoperative wound infection.

  3. Fibrinogen reduction and coagulation in cardiac surgery: an investigational study.

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    Gielen, Chantal L I; Grimbergen, Jos; Klautz, Robert J M; Koopman, Jaap; Quax, Paul H A

    2015-09-01

    Fibrinogen as precursor of fibrin plays an essential role in clot formation. There are three main mechanisms associated with a reduction in fibrinogen concentration during cardiac surgery: hemodilution, consumption, and degradation. Moreover, early fibrinogen degradation products (FgDPs) can interfere with normal fibrin formation of intact fibrinogen. The aim of this study was to determine the relative contributions of hemodilution, consumption, and degradation to fibrinogen loss in cardiac surgery and to evaluate the effects fibrinogen degradation products on blood clot formation in vitro. First, fibrin and fibrinogen concentrations, their degradation products, hematocrit, and albumin concentrations were compared in 10 patients before and after isolated coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. Second, ex-vivo fibrinogen supplementation experiments were performed. Finally, the effects of purified FgDPs on clotting time and clot firmness were established in vitro in whole blood by ROTEM. Fibrinogen plasma concentration decreased 30% during surgery. This drop appears to be mainly caused by hemodilution, as both hematocrit and albumin levels decreased and no relevant increase in D-dimer levels and FgDPs was observed. Furthermore, the coagulation profile normalized after addition of purified fibrinogen. Early FgDPs demonstrated a significant impact on in-vitro whole blood clotting. Although early FgDPs have a pronounced effect on blood clot formation in vitro and therefore may induce or enhance in vivo coagulopathy, the drop of fibrinogen concentration seen after CABG surgery (using tranexamic acid) is primarily caused by hemodilution.

  4. Robotic consolle for ocular surgery: a preliminary study

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    Rossi, Francesca; Pini, Roberto; Menabuoni, Luca; Lenzetti, Ivo; Russo, Sheila; Menciassi, Arianna; Fortuna, Damiano

    2014-02-01

    Minimally invasive surgery has recently been improved by the use of robot-assisted procedures in several medical fields. Among the ocular surgeries there are a few examples of sophisticated vitreoretinal procedures, while robotic-assisted surgery of the anterior eye segment is still under study. In this paper we propose a new approach to the robotic assisted ocular surgery: a CO2 laser system is equipped with a micromanipulator and scanner, and it is proposed to induce photothermal effects for the removal of neoformations. A sensorized tool is connected to the patient eye and to the robotic arm. This tool is equipped with force and position sensors: by the use of the spatial information from the robotic console and from the patient it is possible to control the position of the target itself and to block it in the correct position for performing surgery. The system is provided by a feedback alarm that remove the block of the patient head in any moment. The optimized robotic consolle can be used in performing scleral cuts and in the treatment of pterigium or neoformations.

  5. A prospective study on postoperative pain after cataract surgery

    Directory of Open Access Journals (Sweden)

    Porela-Tiihonen S

    2013-07-01

    Full Text Available Susanna Porela-Tiihonen,1 Kai Kaarniranta,2 Merja Kokki,1 Sinikka Purhonen,1 Hannu Kokki1 1Department of Anesthesia and Operative Services, Kuopio University Hospital, School of Medicine, University of Eastern Finland, Kuopio, Finland; 2Department of Ophthalmology, Kuopio University Hospital, School of Medicine, University of Eastern Finland, Kuopio, Finland Purpose: To evaluate postoperative pain and early recovery in cataract patients. Patients and methods: A total of 201 patients who underwent elective first eye cataract extraction surgery were enrolled, and 196 were included in the final analysis. The study design was a single-center, prospective, follow-up study in a tertiary hospital in eastern Finland. Postoperative pain was evaluated with the Brief Pain Inventory at four time points: at baseline, and at 24 hours, 1 week, and 6 weeks postsurgery. Results: Postoperative pain was relatively common during the first hours after surgery, as it was reported by 67 (34% patients. After hospital discharge, the prevalence decreased; at 24 hours, 1 week, and 6 weeks, 18 (10%, 15 (9% and 12 (7% patients reported having ocular pain, respectively. Most patients with eye pain reported significant pain, with a score of ≥4 on a pain scale of 0–10, but few had taken analgesics for eye pain. Those who had used analgesics rated the analgesic efficacy of paracetamol and ibuprofen as good or excellent. Other ocular irritation symptoms were common after surgery; as a new postoperative symptom, foreign-body sensation was reported by 40 patients (22%, light sensitivity by 29 (16%, burning by 15 (8%, and itching by 15 (8%. Conclusion: Moderate or severe postoperative pain was relatively common after cataract surgery. Thus, all patients undergoing cataract surgery should be provided appropriate counseling on pain and pain management after surgery. Keywords: eye, cataract extraction, phacoemulsification, refractive surgical procedures, follow-up study, recovery

  6. Mortality after surgery in Europe: a 7 day cohort study

    NARCIS (Netherlands)

    Pearse, Rupert M.; Moreno, Rui P.; Bauer, Peter; Pelosi, Paolo; Metnitz, Philipp; Spies, Claudia; Vallet, Benoit; Vincent, Jean-Louis; Hoeft, Andreas; Rhodes, Andrew; Moreno, Rui; Pearse, Rupert; Damster, Sandrine; Golder, Kim; Hewson, Russell; Januszewska, Marta; Leva, Brigitte; Ramos, Vasco; Hoste, Eric; Huyghens, Luc; Jacobs, Rita; van Mossevelde, Veerle; Opdenacker, Godelieve; Poelaert, Jan; Spapen, Herbert; Leleu, Kris; Rijckaert, Dirk; de Decker, Koen; Foubert, Luc; de Neve, Nikolaas; Biston, Patrick; Piagnerelli, Michael; Collin, Vincent; Blauwen, Nadia den; Clauwaert, Charlotte; de Crop, Luc; Verbeke, An; Roeselare, Heilige Hartziekenhuis; Derumeaux, Pieter; Gardin, Christophe; Kindt, Sebastiaan; Louage, Sofie; Verhamme, Bruno; Druwé, Patrick; Lahaye, Ingrid; Rosseel, Francis; Rutsaert, Robert; Vanlinthout, Luc; de Kock, Marc; Forget, Patrice; Georges, Pascal; Grosu, Irina; Kahn, David; Lois, Fernande; Momeni, Mona; Pospiech, Audrey; Yemnga, Bernadette; Jadoul, Jean-Luc; Malbrain, Manu; Bosinceanu, Dana; Collard, Edith; Jorens, Philippe; Reyntiens, Dirk; Smitz, Carine; Vercauteren, Marcel; Fagnoul, David; van Obbergh, Luc; Goranović, Tatjana; Mazul-Sunko, Branka; Toplice, Krapinske; Oremuš, Krešimir; Bešlić, Gabrijela; Duzel, Viktor; Hauptman, Ada; Peremin, Sanja; Šribar, Andrej; Župčić, Miroslav; Brod, Slavonski; Mirković, Ivan; Bauer, Zlata Šarić; Belavić, Matija; Blažanin, Božidar; Katušin, Mirjana Lončarić; Krijan, Antonija Brozović; Mišković, Petar; Šimić-Korać, Nataša; Topić, Jasna; Žilić, Antonio; Žuni, Josip; Acan, Ivana; Adanić, Mirta; Ivanov, Nikola; Šarić, Jadranka Pavičić; Tomulić, Katarina; Visković, Nataša; Bošnjak, Silvana; Drenjančevic, Ivana Haršanji; Kristek, Gordana; Kvolik, Slavica; Markić, Stela; Rakipovic, Andreja Stojanovic; Tot, Ozana Katarina; Venzera- Azenic, Darija; Fabris, Lada Kalagac; Bačak-Kocman, Iva; Balenović, Igor; Bandić, Daniela; Deutsch, Patricia Adrianne Judith; Divjak, Loredana; Filipović, Ina Grčić; Gužvinec, Zvonka; Krznarić, Zrinka; Lončarić, Yvonne; Magaš, Jelena Vadlja; Mitrović, Marek; Okić, Marija; Pavlek, Mario; Ramov, Elza; Rezek, Karolina; Sekulić, Ante; Tomasevic, Boris; Mirić, Mirjana; Tomašević, Anita; Mahečić, Tina Tomić; Vrbanović, Vilena; Bobinac, Mirna; Božić, Alfred; Debelic, Danijela; Frkovic, Vedran; Batinica, Inga Mladić; Baranović, Senka; Gavranović, Željka; Kikec, Mirna; Maldini, Branka; Marić, Stela; Agnić, Ivan; Delić, Nikola; Dropulić, Nataša; Gašpić, Toni Kljaković; Ilić, Darko; Ivančev, Božena; Karanović, Nenad; Kuščević, Dorjan; Marović, Zlatko; Milić, Matija; Nevešćanin, Ana; Petković, Tatjana; Smoje, Mario; Brozović, Gordana; Jelisavac, Milana; Matolić, Martina; Oberhofer, Dagmar; Pavičić, Ana Marija; Šakić, Kata; Bozovic, Margarita Delija; Krecek, Zvjezdana Kotorac; Krobot, Renata; Andabaka, Tatjana; Bratanić, Mislav; Dzepina, Orjana; Kraljev, Martina; Šeric, Julija; Šimurina, Tatjana; Grujić, Rosa; Nacevski-Bulaja, Biljana; Barižon, Mirna; Danira, Vrančić; Dražen, Bulaja; Dušanka, Kimer; Halužan, Marijana Bašić; Joško, Žaja; Katica, Roca; Labor, Magda; Marinković, Tea Grgurević; Mihovilčević, Danči; Marija, Bego; Srečko, Marinković; Vranković, Srđan; Kyprianou, Theodoros; Neophytou, Kyriakos; Cerny, Vladimir; Cvachovec, Karel; Belikova, Barbora; Drab, Michal; Hudacek, Kamil; Krikava, Ivo; Stourac, Petr; Zadrazilova, Katarina; Bicek, Vladimír; Brabcová, Milena; Klozová, Radka; Vajter, Jaromír; Vymazal, Tomáš; Toft, Palle; Blichfeldt, Louise; Hansen, Bo Dilling; Moller, Kirsten; Nielsen, Jeppe Sylvest; Frederiksen, Joachim; Andersen, Johnny Dohn; Kühne, Jan Peter; Leivdal, Siv; Stendell, Line; Simonsen, Martin; Zoltowski, Marcin Konrad; Ali, Zahida Salman; Freundlich, Morten; Pilypaite, Jurgita; Clausen, Nicola Groes; Thorup, Line; Hansen, Frank; Bestle, Morten; Hansen, Christian Steen; Afshari, Arash; Bille, Anders Bastholm; Lefort, Michele; Secher, Erik L.; Liboriussen, Lisbeth; Herodes, Veiko; Härma, Eve; Marvet, Kadri; Pool, Kristiina; Kallas, Pille; Mägi, Triinu-Kreete; Sütt, Jaan; Vijar, Kerli; Visk, Evelin; Vinnal, Mare; Ellermaa, Jaanus; Liibusk, Liia; Tikkerberi, Artur; Falk, Ilme; Mällo, Esta; Talving, Jaak; Pettilä, Ville; Hovilehto, Seppo; Kirsi, Anne; Mustola, Seppo; Tiainen, Pekka; Toivonen, Juhani; Dabnell, Sandra; Kaminski, Tadeusz; Sysimetsa, Anu; Kaukonen, Maija; Silvasti, Päivi; Vainio, Kaisa; Lund, Vesa; Sjövall, Sari; Saarinen, Kari; Viitanen, Matti; Ahonen, Tommi; Alaspää, Ari; Zittling, Ritva; Saarinen, Aarne; Moisander, Annette; Wagner, Bodo; Laru-Sompa, Raili; Elomaa, Esa; Lavonen, Leena; Nevantaus, Juha; Geier, Klaus; Kavasmaa, Tomi; Koorits, Ursula; Kubjas, Mare; Lauritsalo, Seppo; Ottelin, Lauri; Palve, Markki; Pynnönen, Jari; Rääbis, Inga; Saarelainen, Minna; Heikkilä, Tapani; Kontula, Timo; Lehtimäki, Markku; Liimatainen, Jari; Moilanen-Oikarinen, Mari; Pakarinen, Marika; Palanne, Riku; Seppänen, Hanna; Pulkkinen, Anni; Vääräniemi, Heikki; Paananen, Sami; Koskenkari, Juha; Sälkiö, Sinikka; Vakkala, Merja; Koskue, Talvikki; Loisa, Pekka; Laitio, Ruut; Hautamäki, Raku; Koivisto, Simo-Pekka; Futier, Emmanuel; Lefrant, Jean-Yves; Leon, Alain; Bonnet, Francis; Marret, Emmanuel; Spielvogel, Catherine; Papageorgiou, Chryssa; Szymkiewicz, Olga; Tounou-Akue, Felix; Aubrun, Frederic; Bonnet, Aurélie; Gazon, Mathieu; Guiraud, Michel; Laurent, Virginie; Béclère, Antoine; Tachon, Guillaume; Demars, Nadège; Dumenil, Anne-Sylvie; Mercier, Frederic; Landais, Alain; Mentec, Herve; Bazin, Marie; Gonnu, Sophie; Petit, Antoine; Albaladejo, Pierre; Almeras, Luc; Bataillard, Amélie; Rossi-Blancher, Marine; Lefrant, Jean Yves; Barthel, Florian; Hallel, Dan; Sbai, Hicham; Khalifeh, Pamela; Lidzborski, Lionel; Jully, Marion; Platon, Ecaterina; Pottecher, Julien; Baumgarten, Romain; Schultz, Christel; ElMiloudi, Fayçal; Lefebvre, Julie; Waton, Karen; Sprunck, Adrien; Steib, Annick; Thibaud, Adrien; Thuet, Vincent; Kieffer, Vianney; Dubois-Vallaud, Delphine; Jacob, Laurent; Becanne, Xavier; Cherfaoui, Salim; Gauzit, Remy; Godier, Anne; Lakhdari, Mourad; Samma, Charles; Bigeon, Jean-Yves; Burtin, Philippe; Halchini, Constantin; Lacroix, Magali; Pinna, Frederic; Barbes, Aurélie; Just, Bernard; Mateu, Philippe; Benayoun, Laurent; Berger, Philippe; Granier, Nathalie; Perrigault, Pierre Francois; Libert, Nicolas; de Rudnicki, Stephan; Merat, Stéphane; Bourdet, Benoit; Ferré, Fabrice; Minville, Vincent; Piriou, Vincent; Rague, Philippe; Wallet, Florent; Lebuffe, Gilles; Desbordes, Jacques; Robin, Emmanuel; Ichai, Carole; Orban, Jean-Christophe; Marx, Gernot; Sander, Michael; Gottschalk, André; Piontek, André; Unterberg, Matthias; Hilpert, Justus; Kees, Martin; Triltsch, Andreas; Wiegand-Löhnert, Carola; Glöckner, Christiane; Hohn, Andreas; Rose, Elmar; Schröder, Stefan; Wiese, Oliver; Awlakpui, Eli; Scheidemann, Mona; Wittmann, Maria; Ramminger, Axel; Dresden, Carus; Gama de Abreu, Marcelo; Heller, Axel; Marx, Christine; Neidel, Julia; Goldmann, Anton; von Heymann, Christian; Laetsch, Beatrix; Maahs, Esther; Scholz, Lars; Frenzel, Dirk; Massarat, Kyros; Lenhart, Franz-Peter; Reichle, Florian; Rudlof, Kristina; Borchers, Friedrich; Buettner, Christoph; Schmutzler, Martin; Burgard, Gerald; Lucht, Alexander; Wagner, Jan; Pilge, Stefanie; Schneider, Gerhard; Untergehrer, Gisela; Bis, Beata; Krassler, Jens; Dittmann, Jan; Haberkorn, Jörg; Eberitsch, Jürgen; Eberitsch, Karola; Nippraschk, Thomas; Wepler, Ulrich; Engelen, Wolf-Christian; Nau, Carla; Scholler, Axel; Schüttler, Jürgen; Wintzheimer, Simone; Bloos, Frank; Braune, Anke; Fergen, Daniela; Ludewig, Katrin; Paxian, Markus; Reinhart, Konrad; Graf, Nikolaus; Schwarzkopf, Konrad; Berger, Katharina; Habicher, Marit; Kasperiunaite, Ruta; Savelsberg, Sabine; Krep, Henning; Reindl, Michael; Weber, Matthias; Bauer, Wolfgang; Bingold, Florian; Christ, Saskia; Friederich, Patrick; Kaviani, Reza; Auer, Patrick; Bonnländer, Georg; Drescher, Jürgen; Braun, Roland; Eichenauer, Tim; Kerner, John; Bierbaum, Kathrin; Brünner, Horst; Grond, Stefan; Perez-Platz, Ursula; Andresen, Bent; Linstedt, Ulf; Stegmann, Nils; Erkens, Uwe; Kopcke, Jens; Meyer, Andreas; Brestrich, Hartmut; Ernst, Sandra; Merkel, Stella; Krieger, Lena; Luers, Frank; Weyland, Andreas; Noeldge-Schomburg, Gabriele; Menckie, Thomas; Wasmund, Christina; Bredtmann, Ralph-Dieter; Erler, Ines; Raufhake, Carsten; Haumann, Christine; Möllemann, Angela; Oehmichen, Uwe; Sergejewa, Olga; Lehning, Brigitte; Czeslick, Elke; Geyer, Michaela; Malcharek, Michael; Sablotzki, Armin; Stier, Marina; Feld, Florian; Rossaint, Rolf; Simon, Verena; Armaganidis, Apostolos; Koulenti, Despoina; Kotanidou, Anastasia; Nanas, Serafim; Papastylianou, Androula; Psevdi, Aikaterini; Stathopoulos, Anastasios; Voulas, Asklepieion; Kanna, Efthymia; Koutsikou, Anastasia; Moustaka, Alexandra; Chovas, Achilleas; Komnos, Apostolos; Zafiridis, Tilemachos; Franses, Josef; Lavrentieva, Athena; Koraki, Eleni; Katsenos, Chrysostomos; Kasianidou, Maria Flora; Nasopoulou, Pantelia; Spyropoulou, Eleni; Gousia, Chrysoula; Katsanoulas, Constantine; Lathyris, Dimitrios; Kyriazopoulos, George; Sfyras, Dimitrios; Tsirogianni, Athanasia; Kostopanagiotou, Georgia; Lignos, Mihail; Matsota, Paraskevi; Christopoulos, Christos; Mouratidou, Alexandra; Vrettou, Efstratia; Boufidis, Spyros; Moka, Eleni; Arnaoutoglou, Eleni; Koulouras, Vasileios; Nakos, George; Papathanakos, Georgios; Anthopoulos, Georgios; Choutas, Georgios; Karapanos, Dimitrios; Tzani, Vaso; Gkiokas, Georgios; Nastos, Konstantinos; Nikolakopoulos, Fotios; Dragoumanis, Christos; Nikitidis, Nikos; Pneumatikos, Ioannis; Theodorou, Vassiliki; Zacharouli, Danai; Kandi, Stella; Tasopoulos, Konstantinos; Arvaniti, Kostoula; Matamis, Dimitrios; Mplougoura, Eva; Petropoulou, Polixeni; Soumpasis, Ioannis; Amaniti, Ekaterini; Giannakou-Peftoulidou, Maria; Gkeka, Eleni; Soultati, Ioanna; Kokinou, Maria; Papatheodorou, Lambrini; Stafylaraki, Maria; Giasnetsova, Tatiana; Gritsi-Gerogianni, Nikoleta; Kydona, Christina; Kiskira, Olga; Koulentis, Ioannis; Apsokardos, Alexandros; Dimitropoulos, Konstantinos; Soldatou, Ourania; Nathanail, Christodoulos; Papazotos, Alexios; Tsakas, Pirros; Clouva-Molyvdas, Phyllis-Maria; Kolotoura, Athina; Sartzi, Monika; Papanikolaou, Spiros; Polakis, Pavlos; Karatzas, Stylianos; Kyparissi, Aikaterini; Papavasilopoulou, Theonymfi; Koukoubani, Triantafillia; Mastora, Evangelia; Spyropoulou-Pagdatoglou, Kyriaki; Nyktari, Vasileia; Malliotakis, Polychronis; Papaioannou, Alexandra; Bekos, Vasileios; Maragkou, Elisavet; Spring, Anna; Evagelatos, Stavros; Ioakeimidou, Aikaterini; Noulas, Nikos; Molnár, Zsolt; Csüllög, Emese; Elekes, Enikő; Molnár, Tamás; Katona, Zsuzsana; Kremer, Ildiko; Miko, Angela; Csomos, Akos; Galambos, Zsuzsanna; Szucs, Akos; Nyikos, Gyorgy; Szekeres, Gabor; Szabo, Ervin; Kranitz, Katalin; Simon, Melinda; Szigeti, Janos; Gaál, Emánuel; Havas, Attila; Ille, Alexandru; Bráz, Krisztina; Nagy, Geza; Sigurdsson, Gisli; Sigurbjörnsson, Fridrik T.; Sigurdsson, Gisli H.; Kárason, Sigurbergur; Sigurdardottir, Elin Edda; Blöndal, Ásbjörn; Gunnarsson, Björn; Westbrook, Andrew; Broderick, Alan; Hafeez, Parvaiz; Hanumanthaiah, Deepak; Brohan, Janette; O'Chroinin, Donal; Bailey, Kevin; Ramamoorthy, Karthik; Doyle, Yvonne; Freir, Noelle; O'Rourke, James; Jonson, Philip; Saeed, Sabir; Hayes, Ivan; Loughrey, John; Frohlich, Stephen; McCauley, Nuala; Ryan, Donal; Fitzpatrick, Gerry; Kevin, Leo; Thomas, Jubil; Warde, Barry; Woolhead, Alan; Duggan, Michelle; Egan, Cara; Crowley, Seamus; Lebese, Soloman; Bergin, Anne; Page, Rory; Collins, Daniel; McKenny, Michael; Della Rocca, Giorgio; Grasso, Salvatore; Bresciani, Anna; Carmino, Livio; Ghelfi, Silvia; Lorenzelli, Laura; Novelli, Maria Teresa; Pescarmona, Chiara; Roasio, Agostino; Gatta, Alessandro; Nastasi, Mauro; Sanseverino, Manlio; Tinti, Carla; Bianchin, Andrea; Tormena, Maria; Franco, Antonio; Marini, Federica; Di Mauro, Piero; Rapido, Francesca; Tommasino, Concezione; Bellotti, Ferdinando; Boninsegna, Daniele; Castellani, Gianluca; Sances, Daniele; Spano, Gianluca; Tredici, Stefano; Vezzoli, Dario; Fucecchio, Igneo; Bacci, Alessandro; Coppini, Roberta; Dell'unto, Sandro; Mori, Emanuele; Stanzani, Maria Rosa; Tosi, Monica; Collareta, Michele; Forfori, Francesco; Franchi, Matteo; Mancino, Giuseppe; Battistella, Massimo; Baricocchi, Elisa; Bona, Francesco; Debernardi, Felicino; Giacoletto, Gianmarco; Iacobellis, Antonio; Massucco, Paolo; Moselli, Nora; Muratore, Andrea; Palomba, Graziella; Sardo, Elena; de Simone, Michele; Suita, Luisa; Zocca, Edoardo; Bucci, Barbara; Della Corte, Francesco; Piciucco, Tiziana; Viarengo, Valeria; Bettelli, Gabriella; Cantarini, Eugenia; Giampieri, Marina; Tanfani, Alessandra; Recchia, Eugenio; Milano, S. Raffaele; Bignami, Elena; Bruno, Giovanna; Costagliola, Roberto; Gandolfi, Azzurra; Greco, Massimiliano; Lembo, Rosalba; Monti, Giacomo; Nicelli, Elisa; Pasculli, Nicola; Turi, Stefano; Baroselli, Antonio; Brazzoni, Marcella; Buttazzoni, Mattia; Buttera, Stefania; Centonze, Carlo; Serena, Giovanni; Spagnesi, Lorenzo; Toretti, Ilaria; Vilardi, Anna; Zearo, Ester; Arpino, Ines; Baraldi, Sara; Guarnerio, Chiara; Molene, Vincenzo; Monea, Maria Concetta; Vaccarisi, Enrico; Vicari, Luigi; Albante, Alida; Aversano, Marco; Loiacono, Cinzia; Marandola, Maurizio; Fusari, Maurizio; Petrucci, Nicola; Galla, Amerigo; Mascia, Antonio; Primieri, Paolo; Di Noto, Anna; Gratarola, Angelo; Molin, Alessandro; Spagnolo, Luigi; Spena, Claudio; Calligaro, Plinio; Marchiotto, Simonetta; Merlini, Alberto; Pedrazzoli, Eleonora; Perina, Giulia; Visentin, Renea; Fumagalli, Roberto; Garbagnati, Andrea; Manetti, Bruna; Snaier, Chiara; Somaini, Marta; Farnia, Antonio; Nani, Roberto; Pierantonio, Novello; de Michele, Michele; Gazzanelli, Sergio; Pugliese, Francesco; Ruberto, Franco; Anna, Universitaria S.; Bergamini, Elena; Tassinati, Tania; Capuzzo, Maurizia; Cirillo, Vera; Tufano, Rosalba; Oggioni, Roberto; Parrini, Vieri; Brunori, Emanuela; Capone, Micaela; Carbone, Luigi; Corradetti, Francesco; Elisei, Daniele; Fiorentino, Stefano; Francesconi, Maurizio; Gattari, Diego; Gorgoglione, Maria; Lacobone, Emanuele; Minnucci, Francesco; Montironi, Claudio; Riccioni, Gianrenato; Tappata, Giuseppe; Zompanti, Valeria; Verdenelli, Paola; Cerutti, Elisabetta; Ranieri, Vito Marco; Golubovska, Iveta; Grigorjevs, Sergejs; Rikmane, Maija; Rozkalne, Daina; Stepanovs, Jevgenijs; Suba, Olegs; Kazune, Sigita; Miscuk, Aleksej; Nemme, Janis; Oss, Peteris; Sipylaite, Jurate; Macas, Andrius; Ragaisis, Vytautas; Kontrimaviciute, Egle; Tomkute, Gabija; Boerma, Christiaan; Kramer, Irene Fleur; Poeze, Martijn; Ziekenhuis, Antonius; Maria, John; Pelzer, Gerardus; Winsser, Lex; Nijsten, Maarten; Schoorl, Michiel; Spanjersberg, Rob; Buhre, Wolfgang; Dieleman, Stefan; van Klei, Wilton; Bouw, Martijn; Pickkers, Peter; van der A, Marieke; Schreiner, Frodo; Zandvliet, Ria; van den Berg, Roy; de Wit, Esther; Keijzer, Christaan; Hollmann, Markus; Preckel, Benedikt; van Acker, Gijs; Dennesen, Paul; Veld, Bas; Kuijpers-Visser, Agnes; Inan, T.; Koopman-van Gemert, A.; Ponssen, Huibert; Brouwer, Tammo; Koopmans, Matty; van Bommel, Jasper; van Duijn, Ditty; van der Hoven, Ben; Ormskerk, Patricia; Beck, Oliver; Schiere, Sjouke; Reidinga, Auke; Venema, Allart; Hoogendoorn, Marga; Olthof, Kees; Flaatten, Hans; Jammer, Ib; Dokka, Vegard; Monsen, Svein Arne; Ytrebo, Lars Marius; Noursadeghi, Mostafa; Shahzad, Ahmed; Boksasp, Ola Dagfinn; Roiss, Christoph; Strietzel, Hans Frank; Gina, Anne; Berntsen, Schie; Haugland, Helge; Vingsnes, Svein Ove; Axelsson, Patric; Olsen, Thomas; Katre, Sanjay; Aakeroey, Kristin; Mikstacki, Adam; Tamowicz, Barbara; Bożiłow, Dominika; Goch, Robert; Grabowski, Piotr; Kupisiak, Jacek; Małłek, Małgorzata; Szyca, Robert; Kostyrka, Włodzimierz; Choma, Robert; Jankowski, Grzegorz; Kościelniak, Władysław; Pietraszek, Paweł; Szarowar, Bartosz; Matos, Ricardo; França, Carlos; Lacerda, António Pais; Ormonde, Lucindo; Rosa, Rosário; Pereira, Inês; Vitor, Paula; Bento, Henrique Completo; Lopes, Maria Raquel; Carvalho, Marques; Faria, Manuela; de Sousa, Ana Cláudia; de Freitas, Pereira; Almeida, Eduardo; Mealha, Rui; Vicente, Rachel; Monte, Raquel; Rua, Fernando; Barros, Nelson; Esteves, Francisco; Gouveia Pinheiro, Célia Maria; Real, Vila; Oliveira, Vítor Miguel; Oliveira, Maria Fátima; Martins, Isabel; Saraiva, José Pedro; Assunção, José Pedro; Bártolo, Anabela; Carvalho, Anabela; Correia, Carlos; Martins, Salomé; Milheiro, Ruth; Diaz, Alejandro; Gonçalves, Maria Imelda; Ribeiro, Rosa; Estilita, Joana; Glória, Carlos; de Almeida, José; Barros, Filipa; Ramos, Armindo; Camara, Margarida; Maul, Edward Richard; Nobrega, Julio; Langner, Anuscka; Maia, Dionísio; Afonso, Ofélia; Faria, Filomena; Serra, Sofia; Botelho, Maria Manuela; Ferreira, Pedro; Mourão, Luís; Oliveira, Ana Vintém; Resende, Margarida; Aleman, Miguel; Fonseca, Jorge; Isidoro, Marta; de Meneses, Helena; Pêgas, António; Pereira, José; Pereira, Luis; Ramos, Bárbara; Matos, Francisco; Castro, Maria de Lurdes Gonçalves; Martins, Ana; Ramos, Cristina; de Sousa, Manuel; Bento, Luís; Botas, Conceição; Lopes, Vitor; Mendes, Rosa; Grigoras, Ioana; Blaj, Mihaela; Damian, Mihaela; Lupusoru, Andreea; Ristescu, Irina; Codreanu, Monica; Diaconescu, Ciresica; Nistor, Alina; Stelian, Dorin Stanescu; Streanga, Livia; Berneanu, Maria; Bordeianu, Cristina; Florenta, Calarasu; Iacob, Alina; Lupu, Mary Nicoleta; Mocanu, Iulian; Moraru, Coca; Meran, Carleta; Nicolae, Bacalbasa; Sandu, Madalina; Turcanu, Roxana; Epure, Florina; Grigore, Monica; Hotaranu, Cristina; Popescu, Nicoleta; Baban, Oleg; Baciu, Manuela; Ciobanu, Aurica; Denciu, Catalin Ioan; Gurau, Vitalie; Maftei, Ion; Moldovan, Ion; Ungureanu, Liviu; Bogdan, Prodan; Corneci, Dan; Dinu, Melania; Madalina, Dutu; Rely, Manolescu; Silvius, Negoita; Tomescu, Dana; Gabriela, Droc; Dinescu, Stelian Adrian; Calin, Mitre; Ionescu, Daniela; Margarit, Simona; Vasian, Horatiu; Albu, Corina; Balasa, Carmen; Cadrigati, Alina; Dragulescu, Dorian; Gavra, Loredana; Hentia, Ciprian; Macarie, Claudiu; Manescu, Mihaela; Nediglea, Ioan; Ocica, Dana; Ovidiu, Bedreag; Papurica, Marius; Plavat, Cosmin; Popa, Claudia; Ramneantu, Mihaela; Sandesc, Dorel; Sandici, Zoran; Sarandan, Mihaela; Belciu, Ioana; Tincu, Eugen; Ursu, Irina; Aignatoaie, Mariana; Huzuneanu, Mariana; Cocu, Simona; Hagau, Natalia; Ciubotaru, Roxana; Copotoiu, Sanda-Maria; Copotoiu, Ruxandra; Ioana, Ghitescu; Kovacs, Judit; Leonard, Azamfirei; Szederjesi, Ianos; Genoveva, Vanvu; Mosnegutu, Simona; Surbatovic, Maja; Djordjevic, Dragan; Djordjevic, Biljana; Grujic, Krasimirka; Jovanovic, Dusko; Krstic-Lecic, Ivana; Obradovic, Jovana; Zeba, Snjezana; Jevdjic, Jasna; Miletic, Milos; Zunic, Filip; Bulasevic, Aleksandra; Brko, Radoslava; Gazibegovic, Narcisa; Kendrisic, Mirjana; Vojinovic, Radisa; Firment, Jozef; Zahorec, Roman; Capková, Judita; Grochova, Monika; Trenkler, Stefan; Griger, Martin; Bakosova, Erika; Kvasnica, Martin; Saniova, Beata; Sulaj, Miroslav; Zacharovska, Andrea; Simkova, Alexandra; Číková, Andrea; Gebhardtova, Andrea; Hanuljaková, Slávka; Koutun, Juraj; Martonová, Andrea; Žilinčárová, Veronika; Galkova, Katarína; Krbila, Stefan; Sobona, Viliam; Ocenasova, Marieta; Novak-Jankovic, Vesna; Stecher, Adela; Stivan, Feri; Grynyuk, Andriy; Damjanovska, Marija; Kostadinov, Ivan; Knezevic, Mile; Malivojevic, Marko; Borovsak, Zvonko; Kamenik, Mirt; Mekiš, Dušan; Osojnik, Irena; Kosec, Lučka; Kapš, Silva Ostojič; Aleksic, Dragoslav; Gerjevič, Božena; Kalan, Katja; Ursic, Tomaz; Aldecoa, Cesar; González, Juan Montejo; Artigas, Anna; Garcia, Andres; Lisi, Alberto; Perez, Isabel; Perez, Gisela; Poch, Nuria; Vaquer, Sergi; Balciscueta, Goiatz; Barrasa, Helena; Cabanes, Sara; Maynar, Javier; Poveda, Yolanda; Rodero, Amaia Quintano; Vallejo, Ana; Duque, Patricia; Garcia-Bunger, Beatriz; Elvira, Maria Adoracion; Lajara, Ana María; Palencia, María; Ramos, Rafael; Fernandez, Ana Saez; León, Juan Tirapu; López, Jaione Iza; Murillo, Francisco Yoldi; Ramirez, Eva Turumbay; Rico, Patricia Unzué; Patricia, Marta; Vizcaíno, Martín; Bernat Álvarez, Maria José; Real, Kenneth Planas; Serra, Arantxa Mas; Aracil, Norma; Bodega, Begoña Menendez; García, Raquel Fernández; García, Marivi Álvarez; Gordon, Borja de la Quintana; Jodrá, Alicia Gutiérrez; López, Angela De Santos; Ros, Juan José Llavador; Soto, Rocío Ayala; Sepúlveda, Isabel; Díez, Esperanza Pascual; Fernández, Luisa Fernández; Gulina, Carlos Soria; Arviza, Laura Pérez; Fernandez, Lorena Mouriz; Gómez, Antía Río; Martínez, Concepción Alonso; Rodríguez, Ana Belén Rodríguez; Soto, Carmen Lopez; Garcia, Clara; Lorenzo, Mario; Pinilla, Elena; Rico, Jesus; Ruperez, Irene; Alonso, Eduardo; Leira, Fernando; Maseda, David Pestaña Emilio; Royo, Concepcion; Villagran, Jose; Candi, Giralt Murillo; 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Arcas, Jose Juan; Arevalo, Julian; Belvert, Belén Quesada; Calvo, César Pérez; Cremades, Marta; Crespo, Pascual; Cuarental, Ana; del Olmo, Mercedes; Fernández, Pablo Turrión; Vega, José Luis Franqueza García Isabel Garcia; Herrera, Elena II; Llorente, Miguel Angel Alcala; Rabes, Cecilia Martin; de Maeyer, Ana Gamo; Marquez, Manuel Pérez; Mendoza, Diego López; Muñoz, José María Milicua; Martínez, Natividad Arias; Oviedo, Arnoldo Santos; Garrigues, Pau Benavent; Íñigo, José Alonso; Ferrandiz, Sergi Tormo; Sanchez-Morcillo, Silvia; Sánchez, Matilde Lafuente; Parra, Asunción Marqués; Vidal, Sonia Gomar; Allué, Raquel Montoiro; Etayo, Begoña Zalba; Rodriguez, Raquel Bustamante; Villen, Luis Martin; Jimenez, Cristina Molla; de Zayas, Ricardo Salas; Moreno, Cristina Dolera; Pacheco, Fernando SanJose; Pascual, Jose Luis Anton; Gude, Fernando Tejera; Riestra, Eva Manteiga; Delgado, Francisco Cota; Prados, Maria Victoria de la Torre; Barrios, Javier; Cervera-Montes, Manuel; García-Sanz, Mercedes; García, Vicente; Sanmiguel, Guillermo; Álvaro, Julian López; Barrachima, Beatriz Bornay; Bermejo, Francisco Jose Romero; Pilar, Alberto Garcia Fernandez; Garcia, Martinez; Ramírez, Carolina Navarro; Ramos, Jorge Gómez; Samaniego, Luis Angel; Belenguer-Muncharaz, Alberto; Ferrándiz-Selles, Amparo; Mateu-Campos, Maria-Lidon; Domínguez, David; Espinosa, Elena; León, Teresa; Betancor, Nazario Ojeda; Cortes, Javier Garcia; Díaz, Juan José Díaz; Canalechevarria, Ana Manzano; Novales, Beatriz Fores; Peña, Jose Manuel Garcia; Delgado, Tomas Rodriguez; Roquerio, Beatriz Santamaria; Sainz, Juan Jose Gomez; Soto, Teresa Tebar; Chew, Michelle; Seeman-Lodding, Heléne; Dahm, Peter; Hergès, Helena Odenstedt; Lundborg, Christoffer; Söndergaard, Sören; Rylander, Christian; Sari, Ferenc; Tibblin, Anna Oscarsson; Adolfsson, Anne; Klarin, Bengt; Schrey, Susann; Merisson, Edyta; Rydén, Jörgen; Divander, Mona Britt; Hedin, Annika; Hedlund, Daniel; Lindkvist, Mikael Axelsson; Jawad, Monir; Layous, Lona; Wernerman, Jan; Björne, Håkan; Brattström, Olof; Olheden, Staffan; Oldner, Anders; Sellden, Eva; Walder, Bernhard; Wickboldt, Nadine; Rossi, Ariane; Steiner, Luzius; Djurdjevic, Mirjana; Lussmann, Roger; Geisen, Martin; Hofer, Christoph; Turina, Matthias; Grocott, Mike; Goldhill, David; Everett, Lynn; Harris, Katy; Wright, Maggie; Adams, David; Alderson, Lorraine; Baker, Julie; Christie, Iain; Ferguson, Colin; Hill, Matthew; Holmes, Kate; Hutton, Andrew; Minto, Gary; Moor, Paul; Porter, Andrew; Struthers, Richard; Akotia, Niven; Belhaj, Alaa; Chang, Serene; Collantes, Enrique; Eigener, Katrin; Husband, Michael; Khan, Ahsun; Kong, Ming-Li; McAlees, Eleanor Jane; MacDonald, Neil; Niebrzegowska, Edyta; Parnell, Wendy; Smith, Amanda; Chhatwal, Ally; Jhingan, Smriti; Muswell, Richard; Poon, Yoyo; Singh, Nidhita; Stephens, Robert; Vasan, Robin; Waife, Nicola; Weda, Tahmina; Clarke, Adrian; Szakmany, Tamas; Fletcher, Simon; Rosbergen, Melissa; Blunt, Mark; Prince, Liz; Wong, Kate; Kumar, Ram; Stilwell, Sarah; Couper, Keith; Crooks, Neil; Gao-Smith, Fang; Melody, Teresa; Snaith, Catherine; Patel, Jaimin; Parekh, Dhruv; Yeung, Joyce; Loughnan, Bernadette; Moosajee, Vas; Rope, Tamsin; Edger, Lliam; Dawson, Julie; Hadfield, Daniel; Hopkins, Phil; McDonald, Lisa; Willars, Chris; Campbell, Gillian; Craig, Jayne; Smith, Andrew; Ladipo, Karleen; Lockwood, Geoff; Moreno, Juan; Ballington, Ruth; Hamandishe, Sibongilele; Rogerson, David; Cowman, Sarah; Hayden, Paul; Pinto, Nuno; Sandhar, Taj; Arawwawala, Dilshan; Brotherston, Lauren; Mitchell-Inwang, Christine; Walsh, Helena; Alagarsamy, Famila; Goon, Serena; Karcheva, Sylvia; Krepska, Amy; McKinney, Brian; Patil, Vishal; Batchelor, Nicholas; Day, Christopher; Finch, Louise; Gibson, Charlie; Grayling, Matthew; Hubble, Sheena; Key, William; Knight, Thomas; Loosley, Alexander; Margetts, Paul; Stewart, Hannah; Bewley, Jeremy; Hurley, Katrina; Murphy, Ruth; Philpott, Catherine; Pollock, Kathryn; Sweet, Katie; Thomas, Matthew; Tucker, Katy; Windsor, David; Conway, Daniel; Gold, Steve; Quraishi, Tanviha; Cupitt, Jason; Baddeley, Sally; Brown, John David; Foo, Irwin; Mantle, Damien; Carvalho, Peter; Huddart, Sam; Kirk-Bayley, Justin; Smith, Rebecca; Milligan, Lisa; Poulose, Sonia; Sarkar, Som; Nolan, Jerry; Pedley, Emma; Padkin, Andrew; Pesian, Siamak; Rajamanickam, Satish; Ramkumar, Konnur; Thomas, Jerry; Crayford, Alison; Turner, Angus; Bottrill, Fiona; Webb, Stephen; Jhanji, Shaman; MacCallum, Niall; Wessels, Kate; Wigmore, Tim; Meikle, Alistair; Wilson, Stephen; White, Stuart; Bonnett, Andrew; Rushton, Andrew; Williams, Colin; Zuzan, Oliver; Hall, Andrew; Montgomery, Jane; Piggot, Ailie; Read, Richard; Stocker, Mary; Tamm, Tiina; Agarwal, Banwari; Ward, Stephen; Brown, Lucy; Joy, Manju; Venkatesh, Suresh; Hughes, Thomas; Zsisku, Lajos; Roy, Alistair; Hooper, Victoria; Mouland, Johanna; Nightingale, Jeremy; Rose, Steve; Chiam, Patrick; Chohan, Harnita; Dickson, Chris; Gibb, Sarah; Higham, Charley; Harvey, Caroline; Janarthanan, Chandra; 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Pierson, Richard; Wollaston, Julie; Karmarkar, Amara; Ball, Clare; Calton, Emily; Maxwell, Louise; Walker, Rachel; Bland, Martin; Bullock, Lynne; Harrison-Briggs, Donna; Hodge, Paul; Krige, Anton; Dempsey, Ged; Hammell, Claire; Loveridge, Robert; Parker, Robert; Snell, Jane; Wright, Carl; Baker, Andy; Barr, Katharine; Belcher, Alex; Bonnington, Sam; Bougeard, Anne-Marie; Fitzgerald, Emma; Ford, Rachael; Gillard, Chantal; Griffiths, Liz; Greenberg, Lizzie; Huber, Jonathan; Mathieu, Steve; Richardson, Neil; Tompsett, Laura; White, Nigel; Patel, Santosh; Corner, Victoria; Thomas, Richard; Trodd, Dawn; Wilson, Jennifer; Copley, Ed; Flutter, Laura; Hulme, Jonathan; Susarla, Jay; Thwaites, Alison; Jayasundera, Suraj; McAfee, Sean; Chantler, Jonathan; McKechnie, Stuart; Neely, Julia; Mouton, Ronelle; Scarth, Edward; Soar, Jasmeet; Buss, Joanne; Currie, Vicki; Sange, Mansoor; Kuttler, Anja; Power, Fiona; Alexander, David; Dunne, Kevin; Shinner, Guy; Black, Euan; Haldane, Grant; Kerr, Jennie; Saran, Taj; Ward, Geraldine; Jefferies, Fiona; Alexander, Peter; Royle, Alison; Nahla, Farid; Bowles, Tim; Gregory, Maggie; Ahern, Rebecca; Cartlidge, David; Craker, Lloyd; Thompson, Christopher; Bidd, Heena; Giles, Julian; Manser, Amanda; Parry, Gareth; Chan, Peter; Das, Dinesh; Fahmy, Nisreen; Higgins, David; Khader, Ahmed; Stone, Alex; Leonardi, Silvia; Rose, Oliver; Bright, Elizabeth; Ercole, Ari; Rafi, Muhammed Amir; Ramasamy, Radhika; Sheshgiri, Bengeri; Merrill, Colin; Page, Valerie; Walker, Elaine; Harris, Stephen; Hughes, Sarah; Morrison, Alan; Razouk, Khaled; Ayman, Mustafa; al-Subaie, Nawaf; Arif, Fuhazia; Cashman, Jeremy; Cecconi, Maurizio; Edsell, Mark; Fossati, Nicoletta; Hammond, Sarah Jane; Hamilton, Mark; Lonsdale, Dagan; Moran, Carl; Siegmueller, Claas; Velzeboer, Freya; Wong, Patrick; Jakeman, Alicia; Mowatt, Chris

    2012-01-01

    Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international

  7. 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.

  8. NSAID Use after Bariatric Surgery: a Randomized Controlled Intervention Study.

    Science.gov (United States)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N

    2016-12-01

    Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID use in patients who underwent bariatric surgery, and to determine the use of PPIs in patients who use NSAIDs after bariatric surgery. A randomized controlled intervention study in patients after bariatric surgery. Patients were randomized to an intervention or a control group. The intervention consisted of sending a letter to patients and their general practitioners on the risks of use of NSAIDs after bariatric surgery and the importance of avoiding NSAID use. The control group received care-as-usual. Dispensing data of NSAIDs and PPIs were collected from patients' pharmacies: from a period of 6 months before and from 3 until 9 months after the intervention. Two hundred forty-eight patients were included (intervention group: 124; control group: 124). The number of users of NSAIDs decreased from 22 to 18 % in the intervention group and increased from 20 to 21 % in the control group (NS). The use of a PPI with an NSAID rose from 52 to 55 % in the intervention group, and from 52 to 69 % in the control group (NS). Informing patients and their general practitioners by letter, in addition to care-as-usual, is not an effective intervention to reduce the use of NSAIDs after bariatric surgery (trial number NTR3665).

  9. Weight loss in orthognathic surgery: a clinical study.

    Science.gov (United States)

    Hammond, Douglas; Williams, Rhodri W; Juj, Kiranjit; O'Connell, Susan; Isherwood, Grant; Hammond, Nichola

    2015-09-01

    To analyse weight change, body composition change and Body Mass Index change in patients undergoing orthognathic surgery. A service evaluation was undertaken in orthognathic patients pre-operatively and at 4 weeks post-surgery. Queen Elizabeth Hospital Birmingham outpatient department. Thirty-one patients scheduled for single- or two-jaw orthognathic surgery and rigid internal fixation. Immediately pre-operatively and at 4 weeks post-surgery the following information was gathered: (1) patient height; (2) patient weight (kg); (3) Patient Body Mass Index; and (4) patient body fat percentage. In the 4-week post-operative period, the average weight loss was -4·96 kg (range: -9·6 to +3·0 kg), with a body fat reduction of -3·07% (range: -5·80% to +2·30%) and an average reduction in Body Mass Index of -1·63 (range: -3·4 to +0·8). There was no statistically significant difference in weight loss (P = 0·1562) or body fat composition change (P = 0·2391) between single- or two-jaw surgery. There was no statistically significant difference in weight loss (P = 0·4858) or body fat composition change (P = 0·5321) between male and female patients. Weight loss observed was similar to that reported in studies using inter-maxillary fixation. Closer psychological and dietetic support is needed for patients who have a low normal or underweight Body Mass Index. Better and more bespoke tailored Oral Nutritional Supplementation must be provided for all orthognathic surgery patients to potentially reduce this significant weight loss.

  10. Clinical epidemiological studies of women undergoing surgery for urogynaecological disorders.

    Science.gov (United States)

    Sørensen, Rikke Guldberg

    2015-10-01

    This PhD thesis was performed during my employment at the Center for Clinical Epidemiology, Odense University Hospital and University of Southern Denmark, 2010-2013. It comprises an overview and four papers, two published in international peer-reviewed scientific journals, one under review, and one in draft. Urinary incontinence (UI) and pelvic organ prolapse (POP) are prevalent disorders among women worldwide, affecting their psychological and social wellbeing, with reductions in quality of life. Treatment options are conservative (e.g. pelvic floor exercises, weight loss, and bladder training), pharmacological, and surgical. Surgery has especially for UI undergone an improvement during the last decades with development of minimally-invasive sub-urethral sling procedures, and the number of surgeries has increased in Denmark and other countries. In a population of Danish women undergoing surgery for UI or POP, we aimed: to describe the establishment of the Danish Urogynaecological Database (DugaBase), and to evaluate the completeness and the validity of surgery registration in the DugaBase; to study patient reported outcome measures in Danish women undergoing urogynaecological surgery; to study the use of symptom-relieving drugs before and after surgery for UI; to study the use of antibiotics for urinary tract infection (UTI) before and after surgery for UI METHODS: Study I The completeness of DugaBase was assessed by comparing procedure codes in the DugaBase to iodes registered in the National Patient Registry, 2006-2010. The study also included review of medical journals from 200 women (computed randomly from DugaBase), representing 22 departments in Denmark. Information on selected variables was compared to registered data in the DugaBase. the National Patient Registry, the DugaBase, and medical records. Study II was based on a national cohort of women undergoing surgery for UI and POP registered in the DugaBase, 2006-2011. Clinical data and data from patient

  11. Priority setting and cardiac surgery: a qualitative case study.

    Science.gov (United States)

    Walton, Nancy A; Martin, Douglas K; Peter, Elizabeth H; Pringle, Dorothy M; Singer, Peter A

    2007-03-01

    The purpose of this study is to describe priority setting in cardiac surgery and evaluate it using an ethical framework, "accountability for reasonableness". Cardiac surgery is an expensive part of hospital budgets. Priority setting decisions are made daily regarding ever increasing volumes of patients. While much attention has been paid to the management of cardiac surgery waiting lists, little empirical research exists into the way actual decision makers deliberate upon and resolve priority setting decisions on a daily basis. A key goal of priority setting, in cardiac surgical areas as well as others, is fairness. "Accountability for reasonableness" is a leading ethical framework for fair priority setting, and can be used to identify opportunities for improvement (i.e. make it fairer) and highlight good practices. A case study was conducted to examine the process of priority setting processes at three University of Toronto affiliated cardiac surgery centres. Relevant documents were examined, weekly triage rounds were observed for 27 months, and interviews were carried out with 23 key participants including cardiac surgeons, cardiologists, and triage nurses. In data analysis, the conditions of "accountability for reasonableness" (relevance, publicity, appeals and enforcement) were used as an analytic lens. While decisions may appear to be based strictly upon clinical criteria (e.g. coronary anatomy); non-clinical criteria also have an impact upon decision-making (e.g. patients' lifestyle choices, type of surgical practice and departmental constraints on resource use). Participants stated that these factors influence their decision-making and can result in unfair and inconsistent decisions. PUBLICITY: Non-clinical reasons are not publicly accessible, nor are they clearly acknowledged in discussions between cardiac clinicians. APPEALS: There are mechanisms for challenging decisions however without access to the non-clinical reasons, this can be problematic

  12. Case-mix study of single incision laparoscopic surgery (SILS) vs. Conventional laparoscopic surgery in colonic cancer resections

    DEFF Research Database (Denmark)

    Mynster, Tommie; Wille-Jørgensen, Peer

    2013-01-01

    of administrations or amount of opioids were seen. Conclusion. With reservation of a small study group we find SILS is like worthy to CLS in colorectal cancer surgery and a benefit in postoperative recovery and pain is possible, but has to be investigated in larger randomised studies.......Single incision laparoscopic surgery (SILS) may be even less invasive to a patient than conventional laparoscopic surgery (CLS). Aim of the study of the applicability of the procedure, the first 1½ year of experiences and comparison with CLS for colonic cancer resections Material and methods. Since...

  13. Learning preferences of surgery residents: a multi-institutional study.

    Science.gov (United States)

    Kim, Roger H; Viscusi, Rebecca K; Collier, Ashley N; Hunsinger, Marie A; Shabahang, Mohsen M; Fuhrman, George M; Korndorffer, James R

    2018-01-22

    The VARK model categorizes learners by preferences for 4 modalities: visual, aural, read/write, and kinesthetic. Previous single-institution studies found that VARK preferences are associated with academic performance. This multi-institutional study was conducted to test the hypothesis that the VARK learning preferences of residents differ from the general population and that they are associated with performance on the American Board of Surgery In-Training Examination (ABSITE). The VARK inventory was administered to residents at 5 general surgery programs. The distribution of the VARK preferences of residents was compared with the general population. ABSITE results were analyzed for associations with VARK preferences. χ2, Analysis of variance, and multiple linear regression were used for statistical analysis. A total of 132 residents completed the VARK inventory. The distribution of the VARK preferences of residents was different than the general population (P VARK inventory was an independent predictor of ABSITE percentile rank (P = .03), percent of questions correct (P = .01), and standard score (P = .01). This study represents the first multi-institutional study to examine VARK preferences among surgery residents. The distribution of preferences among residents was different than that of the general population. Residents with a greater number of aural responses on VARK had greater ABSITE scores. The VARK model may have potential to improve learning efficiency among residents. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Enhanced recovery in colorectal surgery: a multicentre study

    OpenAIRE

    Casal José E; Maeso-Martínez Sergio; Roig José V; Blasco Juan A; Ramírez José M; Esteban Fernando; Lic Daniel

    2011-01-01

    Abstract Background Major colorectal surgery usually requires a hospital stay of more than 12 days. Inadequate pain management, intestinal dysfunction and immobilisation are the main factors associated with delay in recovery. The present work assesses the short and medium term results achieved by an enhanced recovery program based on previously published protocols. Methods This prospective study, performed at 12 Spanish hospitals in 2008 and 2009, involved 300 patients. All patients underwent...

  15. [Laparoscopic versus open surgery for colorectal cancer. A comparative study].

    Science.gov (United States)

    Arribas-Martin, Antonio; Díaz-Pizarro-Graf, José Ignacio; Muñoz-Hinojosa, Jorge Demetrio; Valdés-Castañeda, Alberto; Cruz-Ramírez, Omar; Bertrand, Martin Marie

    2014-01-01

    Laparoscopic surgery for colorectal cancer is currently accepted and widespread worldwide. However, according tol the surgical experience on this approach, surgical and short-term oncologic results may vary. Studies comparing laparoscopic vs. open surgery in our population are scarce. To determine the superiority of the laparoscopic vs. open technique for colorectal cancer surgery. This retrospective and comparative study collected data from patients operated on for colorectal cancer between 1999 and 2011 at the Angeles Lomas Hospital, Mexico. A total of 82 patients were included in this study; 47 were operated through an open approach and 35 laparoscopically. Mean operative time was significantly lower in the open approach group (p= 0.008). There were no significant difference between both techniques for intraoperative bleeding (p= 0.3980), number of lymph nodes (p= 0.27), time to initiate oral feeding (p= 0.31), hospital stay (p= 0.12), and postoperative pain (p= 0.19). Procedure-related complications rate and type were not significantly different in both groups (p= 0.44). Patients operated laparoscopically required significantly less analgesic drugs (p= 0.04) and less need for epidural postoperative analgesia (p= 0.01). Laparoscopic approach is as safe as the traditional open approach for colorectal cancer. Early oncological and surgical results confirm its suitability according to this indication.

  16. Immediate postoperative complications in transsphenoidal pituitary surgery: A prospective study

    Directory of Open Access Journals (Sweden)

    Tumul Chowdhury

    2014-01-01

    Full Text Available Background: Considering the important role of pituitary gland in regulating various endocrine axes and its unique anatomical location, various postoperative complications can be anticipated resulting from surgery on pituitary tumors. We examined and categorized the immediate postoperative complications according to various tumor pathologies. Materials and Methods: We carried out a prospective study in 152 consecutive patients and noted various postoperative complications during neurosurgical intensive care unit stay (within 48 hrs of hospital stay in patients undergoing transsphenoidal removal of pituitary tumors. Results: In our series, various groups showed different postoperative complications out of which, cerebrospinal fluid leak was the commonest followed by diabetes insipidus, postoperative nausea and vomiting, and hematoma at operation site. Conclusion: Various immediate postoperative complications can be anticipated in transsphenoidal pituitary surgery even though, it is considered to be relatively safe.

  17. Surgery resident selection and evaluation. A critical incident study.

    Science.gov (United States)

    Edwards, J C; Currie, M L; Wade, T P; Kaminski, D L

    1993-03-01

    This article reports a study of the process of selecting and evaluating general surgery residents. In personnel psychology terms, a job analysis of general surgery was conducted using the Critical Incident Technique (CIT). The researchers collected 235 critical incidents through structured interviews with 10 general surgery faculty members and four senior residents. The researchers then directed the surgeons in a two-step process of sorting the incidents into categories and naming the categories. The final essential categories of behavior to define surgical competence were derived through discussion among the surgeons until a consensus was formed. Those categories are knowledge/self-education, clinical performance, diagnostic skills, surgical skills, communication skills, reliability, integrity, compassion, organization skills, motivation, emotional control, and personal appearance. These categories were then used to develop an interview evaluation form for selection purposes and a performance evaluation form to be used throughout residency training. Thus a continuum of evaluation was established. The categories and critical incidents were also used to structure the interview process, which has demonstrated increased interview validity and reliability in many other studies. A handbook for structuring the interviews faculty members conduct with applicants was written, and an interview training session was held with the faculty. The process of implementation of the structured selection interviews is being documented currently through qualitative research.

  18. Pediatric cardiac surgery under the parents sight: a qualitative study.

    Science.gov (United States)

    Salgado, Christiana Leal; Lamy, Zeni Carvalho; Nina, Rachel Vilela de Abreu Haickel; de Melo, Lívia Arruda; Lamy Filho, Fernando; Nina, Vinicus José da Silva

    2011-01-01

    Congenital heart defects can often be corrected through surgery, providing for parents to expect a normal life, but the hospitalization experience often early, causes more pain, for which surgery is the worst moment. The aim of this study was to analyze the experience of families of children undergoing cardiac surgery and to identify the coping resources used by the families. A qualitative approach was the metodology of choice for this study, which took place with six semi-structured interviews and 100 hours of observation. Thematic analysis was used to understand the data. The results were categorized into four themes: feelings and emotions facing the illness of the child; heart disease under the watchful mother, mother and child on the ICU and coping resources. The speech of mothers demonstrated the importance of the heart due to its symbolism that enhances their emotional fragility in the face of illness. Religiosity and a solid social network of support were contributing factors for the maintenance of the adaptive behaviors. The presence of mothers in all stages of the child's treatment contributed to minimizing the suffering generated by hospitalization. The experience of families was characterized by ambivalent feelings such as fear of death, guilt and helplessness against the different stages of treatment. The anguish and anxiety prevailed in the face of unknown situations when information were required before therapeutic procedures, hospital routines and the actual life situation of the families.

  19. Glove failure in elective thyroid surgery: A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Dariusz Timler

    2015-06-01

    Full Text Available Objectives: To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. Material and Methods: Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10 codes. Nine hundred seventy-two pairs (sets of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1 to detect leakage. Results: Glove perforation was detected in 89 of 972 glove sets (9.2%. Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001. The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%, and the non-dominant ring finger (17.9%. Conclusions: This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery.

  20. Changes in taste preference after colorectal surgery: A longitudinal study.

    Science.gov (United States)

    Welchman, Sophie; Hiotis, Perryhan; Pengelly, Steven; Hughes, Georgina; Halford, Jason; Christiansen, Paul; Lewis, Stephen

    2015-10-01

    Nutrition is a key component of surgical enhanced recovery programmes. However, alterations in food preferences are often reported as reasons for patients not eating in the early postoperative period. We hypothesised that taste preferences are altered in the early postoperative period and this dysgeusia affects patients' food choices during this critical time. This is a longitudinal study looking at taste preferences of patients recovering from surgery. Patients undergoing colonic resections were recruited. Using visual analogue scales participants completed a questionnaire, taste tests and preference scoring of food images for the 6 groups of taste (bitter, salty, savoury, sour, spicy and sweet) preoperatively and on postoperative days 1-3. Patients were also offered snacks postoperatively, which represented foods from the six groups and consumption was measured. Differences from baseline were assessed using the Friedman's and Wilcoxon tests. 31 patients were studied. In the immediate postoperative period participants reported deterioration in their sense of taste (p ≤ 0.001), increased nausea (p tastes were the most popular during the perioperative period. However, only palatability for salty taste increased (p = 0.001) following surgery. The highest rated images were for savoury food with only the ratings for salty food increasing after surgery (p tastes with the exception of salty in the postoperative period was observed. The most desirable tastes were for savoury and sweet, reflecting patients' preoperative preferences. An improved understanding of taste may improve the resumption of eating after colonic surgery. Copyright © 2014 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

  1. Comparison study of acellular dermal matrices in complicated hernia surgery.

    Science.gov (United States)

    Bochicchio, Grant V; De Castro, Gerard P; Bochicchio, Kelly M; Weeks, Jennifer; Rodriguez, Eduardo; Scalea, Thomas M

    2013-10-01

    Damage control surgery and management of the open abdomen has led to a significant improvement in survival in trauma and emergency surgical patients. However, subsequent abdominal reconstruction has become a significant challenge. The objective of this study was to compare 2 different acellular dermal matrices in regard to hernia recurrence and complications in patients who present with a large complicated ventral hernia as a result of trauma or emergency surgery. A prospective quasi-experimental time-interrupted series design was used to evaluate the incidence of hernia recurrence in trauma/emergency surgery patients who had a ventral hernia repair with a biologic matrix. From January 2005 to December 2007, 55 patients with a complicated ventral hernia were repaired with AlloDerm (Life Cell Corporation). Beginning in February 2008 to January 2010, 40 patients with the same criteria were repaired with FlexHD (Musculoskeletal Transplant Foundation) and followed prospectively over the following year. The primary outcome for this study was hernia recurrence (functional or real) at 1 year. Other outcomes variables included abdominal laxity, seroma formation, and wound or intra-abdominal infection. There was no significant difference in age, sex, and body mass index between the groups. In addition, there was no significant difference in the mean hernia size and size of the acellular dermis that was inserted. At 1 year postsurgery, all of the AlloDerm patients were diagnosed with recurrence requiring a second formal repair. Eleven patients (31%) whose hernias were repaired with FlexHD were diagnosed with a recurrence requiring a second formal repair. FlexHD appears to have reduced the recurrence and laxity rates while maintaining a similar complication profile compared with AlloDerm in trauma/emergency surgery patients with large complicated ventral hernias. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  2. [Thymomectomy by minimally invasive surgery. Comparative study videosurgery versus robot-assisted surgery].

    Science.gov (United States)

    Witte Pfister, A; Baste, J-M; Piton, N; Bubenheim, M; Melki, J; Wurtz, A; Peillon, C

    2017-05-01

    To report the results of minimally invasive surgery in patients with stage I or II thymoma in the Masaoka classification. The reference technique is partial or complete thymectomy by sternotonomy. A retrospective single-center study of a prospective database including all cases of thymoma operated from April 2009 to February 2015 by minimally invasive techniques: either videosurgery (VATS) or robot-assisted surgery (RATS). The surgical technique, type of resection, length of hospital stay, postoperative complications and recurrences were analysed. Our series consisted of 22 patients (15 women and 7 men). The average age was 53 years. Myasthenia gravis was present in 12 patients. Eight patients were operated on by VATS and 14 patiens by RATS. There were no conversions to sternotomy and no perioperative deaths. The mean operating time was 92min for VATS and 137min for RATS (P<0.001). The average hospital stay was 5 days. The mean weight of the specimen for the VATS group was 13.2 and 45.7mg for the RATS group. Twelve patients were classified Masaoka stage I and 10 were stage II. According to the WHO classification there were 7 patients type A, 5 type AB, 4 type B1, 4 type B2 4 and 2 type B3. As proposed by the Group ITMIG-IASLC in 2015 all patients corresponded to group I. The mean follow-up period was 36 months. We noted 3 major perioperative complications according to the Clavien-Dindo classification: one pneumonia, one phrenic nerve paralysis and one recurrent laryngeal nerve palsy. We observed one case of local recurrence at 22 months. Following surgery 4 patients were treated with radiotherapy and 2 patients with chemotherapy. The minimally invasive route is safe, relatively atraumatic and may be incorporated in the therapeutic arsenal for the treatment of Masaoka stage I and II thymoma as an alternative to conventional sternotomy. RATS and VATS are two minimally invasive techniques and the results in the short and medium term are

  3. "Hardware breakage in spine surgery (A retrospective clinical study "

    Directory of Open Access Journals (Sweden)

    "Sadat MM

    2001-11-01

    Full Text Available This was a retrospective review of a consecutive series of patients with spinal disease in year 2000, who underwent posterior fusion and instrumentation with Harrington distraction and Cotrel-Dobousset system to evaluate causes of hardware failure. Many cases of clinical failure has been observed in spinal instrumentation used in spinal disorder like spondylolisthesis, fractures, deformities, … . Thirty six cases that were operated because of spinal disorders like spondylolisthesis, fractures, deformities, …, were included in this study. Seventeen of this cases had breakage of device. Factors like age at surgery, type of instrumentation, angles before and after surgery and …, were compared in two groups of patients. The most common instrument breakage was pedicle screw breakage. Pseudoarthrosis was the main factor that was presented in failure group (P value<0.001. Other important causes were, age of patient at surgery (P value=0.04, pedicle screw placement off center in the sagittal or coronal plane of the pedicle (P value=0.04. Instrumentation loads increased significantly as a direct result of variations in surgical technique that produce pseudoarthrosis, pedicle screw placement off center in the sagittal plane of the pedicle, or using less than 6 mm diameter screw. This factor can be prevented with meticulous surgical technique and using proper devices.

  4. The significance of noninvasive blood flow studies in the diabetic patient contemplating elective foot surgery.

    Science.gov (United States)

    Hill, M; Reinherz, R P; Tisa, L M

    1994-01-01

    A retrospective study was undertaken to determine the importance of performing noninvasive blood flow studies on the diabetic patient population prior to undergoing elective foot surgery. Thirty diabetic patients, contemplating elective foot surgery, underwent noninvasive blood flow studies. Eighty-seven percent of these patients, with ankle/brachial indices greater than 0.6, successfully healed after surgery was performed.

  5. a comparative study between manual small incision cataract surgery ...

    African Journals Online (AJOL)

    ... October 2012 to October 2014 for cataract surgery were followed up for 6 weeks after surgery. They were divided into two groups based on the type of surgical procedure opted by the patients. Group A consisted of 50 patients who underwent Manual Small Incision Cataract. Surgery with rigid Polymethyl Methacrylate IOL ...

  6. A large multicenter outcome study of female genital plastic surgery.

    Science.gov (United States)

    Goodman, Michael P; Placik, Otto J; Benson, Royal H; Miklos, John R; Moore, Robert D; Jason, Robert A; Matlock, David L; Simopoulos, Alex F; Stern, Bernard H; Stanton, Ryan A; Kolb, Susan E; Gonzalez, Federico

    2010-04-01

    Female Genital Plastic Surgery, a relatively new entry in the field of Cosmetic and Plastic Surgery, has promised sexual enhancement and functional and cosmetic improvement for women. Are the vulvovaginal aesthetic procedures of Labiaplasty, Vaginoplasty/Perineoplasty ("Vaginal Rejuvenation") and Clitoral Hood Reduction effective, and do they deliver on that promise? For what reason do women seek these procedures? What complications are evident, and what effects are noted regarding sexual function for women and their partners? Who should be performing these procedures, what training should they have, and what are the ethical considerations? This study was designed to produce objective, utilizable outcome data regarding FGPS. 1) Reasons for considering surgery from both patient's and physician's perspective; 2) Pre-operative sexual functioning per procedure; 3) Overall patient satisfaction per procedure; 4) Effect of procedure on patient's sexual enjoyment, per procedure; 5) Patient's perception of effect on her partner's sexual enjoyment, per procedure; 6) Complications. This cross-sectional study, including 258 women and encompassing 341 separate procedures, comes from a group of twelve gynecologists, gynecologic urologists and plastic surgeons from ten centers in eight states nationwide. 104 labiaplasties, 24 clitoral hood reductions, 49 combined labiaplasty/clitoral hood reductions, 47 vaginoplasties and/or perineoplasties, and 34 combined labiaplasty and/or reduction of the clitoral hood plus vaginoplasty/perineoplasty procedures were studied retrospectively, analyzing both patient's and physician's perception of surgical rationale, pre-operative sexual function and several outcome criteria. Combining the three groups, 91.6% of patients were satisfied with the results of their surgery after a 6-42 month follow-up. Significant subjective enhancement in sexual functioning for both women and their sexual partners was noted (p = 0.0078), especially in patients

  7. Metabolic Syndrome Prevalence and Associations in a Bariatric Surgery Cohort from the Longitudinal Assessment of Bariatric Surgery-2 Study

    Science.gov (United States)

    Selzer, Faith; Smith, Mark D.; Berk, Paul D.; Courcoulas, Anita P.; Inabnet, William B.; King, Wendy C.; Pender, John; Pomp, Alfons; Raum, William J.; Schrope, Beth; Steffen, Kristine J.; Wolfe, Bruce M.; Patterson, Emma J.

    2014-01-01

    Abstract Background: Metabolic syndrome is associated with higher risk for cardiovascular disease, sleep apnea, and nonalcoholic steatohepatitis, all common conditions in patients referred for bariatric surgery, and it may predict early postoperative complications. The objective of this study was to determine the prevalence of metabolic syndrome, defined using updated National Cholesterol Education Program criteria, in adults undergoing bariatric surgery and compare the prevalence of baseline co-morbid conditions and select operative and 30-day postoperative outcomes by metabolic syndrome status. Methods: Complete metabolic syndrome data were available for 2275 of 2458 participants enrolled in the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2), an observational cohort study designed to evaluate long-term safety and efficacy of bariatric surgery in obese adults. Results: The prevalence of metabolic syndrome was 79.9%. Compared to those without metabolic syndrome, those with metabolic syndrome were significantly more likely to be men, to have a higher prevalence of diabetes and prior cardiac events, to have enlarged livers and higher median levels of liver enzymes, a history of sleep apnea, and a longer length of stay after surgery following laparoscopic Roux-en-Y gastric bypass (RYGB) and gastric sleeves but not open RYGB or laparoscopic adjustable gastric banding. Metabolic syndrome status was not significantly related to duration of surgery or rates of composite end points of intraoperative events and 30-day major adverse surgical outcomes. Conclusions: Nearly four in five participants undergoing bariatric surgery presented with metabolic syndrome. Establishing a diagnosis of metabolic syndrome in bariatric surgery patients may identify a high-risk patient profile, but does not in itself confer a higher risk for short-term adverse postsurgery outcomes. PMID:24380645

  8. Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction.

    Science.gov (United States)

    Mah, Deuk-Hyun; Kim, Su-Gwan; Oh, Ji-Su; You, Jae-Seek; Jung, Seo-Yun; Kim, Won-Gi; Yu, Kyung-Hwan

    2017-02-01

    The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO). The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding). The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was 2.23±0.92 mm (Psurgery-first orthognathic approach group from T1 to T2 was 3.49±1.71 mm (Psurgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.

  9. Cataract surgery in uveitis: a multicentre database study.

    Science.gov (United States)

    Chu, Colin J; Dick, Andrew D; Johnston, Robert L; Yang, Yit C; Denniston, Alastair K

    2017-08-01

    Cataract is an important source of visual loss in patients with uveitis. Whether or not outcomes of cataract surgery in eyes with uveitis are worse compared with non-uveitic eyes have to date been compromised by lack of reliable estimates of benefit and harm, which require data from large cohorts. Electronic medical record data were extracted from eight independent UK clinical sites for eyes undergoing cataract extraction between January 2010 and December 2014. 1173 eyes with a recorded diagnosis of uveitis were compared with a reference group of 95 573 eyes from the same dataset. Uveitic eyes represented 1.2% of all eyes undergoing cataract surgery. Eyes in the uveitic group had worse preoperative visual acuity (0.87 vs 0.65 logarithm of the minimum angle of resolution (logMAR) units), were from younger patients and had shorter axial lengths and a higher incidence of ocular copathology including glaucoma. A greater number had documented small pupils, required additional surgical procedures, developed more intraoperative complications and had poorer postoperative visual acuity at all time points measured up to 6 months (0.41 vs 0.27 logMAR units at 12-24 weeks). This large study cohort of eyes with a diagnosis of uveitis undergoing cataract surgery highlights more precisely the complex surgical demands, copathology and worse visual outcomes in this group. These data will allow more accurate preoperative counselling and planning. Although improvement in visual acuity is achieved in most cases, prognosis should be guarded, so that patient expectations are met. Compared with the non-uveitic population, the mean postoperative visual acuity is between one and two lines worse at all time points. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  10. Emergency general surgery specific frailty index: A validation study.

    Science.gov (United States)

    Orouji Jokar, Tahereh; Ibraheem, Kareem; Rhee, Peter; Kulavatunyou, Narong; Haider, Ansab; Phelan, Herb A; Fain, Mindy; Mohler, Martha Jane; Joseph, Bellal

    2016-08-01

    Assessment of operative risk in geriatric patients undergoing emergency general surgery (EGS) is challenging. Frailty is an established measure for risk assessment in surgical cases. The aim of our study was to validate a modified 15-variable EGS-specific frailty index (EGSFI). We prospectively collected geriatric (age older than 65 years) EGS patients for 2 years. Postoperative complications were collected. Frailty index was calculated for 200 patients based on their preadmission condition using 50-variable modified Rockwood frailty index. Emergency general surgery-specific frailty index was developed based on the regression model for complications and the most significant factors in the frailty index. Receiver operating characteristic curve analysis was performed to determine cutoff for frail status. We validated our results using 60 patients for predicting complications. A total of 260 patients (developing, 200; validation, 60) were enrolled in this study. Mean age was 71 ± 11 years, and 33% developed complications. Most common complications were pneumonia (12%), urinary tract infection (9%), and wound infection (7%). Univariate analysis identified 15 variables significantly associated with complications that were used to develop the EGSFI. A cutoff frailty score of 0.325 was identified using receiver operating characteristic curve analysis for frail status. Sixty patients (frail, 18; nonfrail, 42) were enrolled in the validation cohort. Frail patients were more likely to have postoperative complications (47% vs. 20%; p II.

  11. Enhanced recovery in colorectal surgery: a multicentre study.

    Science.gov (United States)

    Ramírez, José M; Blasco, Juan A; Roig, José V; Maeso-Martínez, Sergio; Casal, José E; Esteban, Fernando; Lic, Daniel Callejo

    2011-04-14

    Major colorectal surgery usually requires a hospital stay of more than 12 days. Inadequate pain management, intestinal dysfunction and immobilisation are the main factors associated with delay in recovery. The present work assesses the short and medium term results achieved by an enhanced recovery program based on previously published protocols. This prospective study, performed at 12 Spanish hospitals in 2008 and 2009, involved 300 patients. All patients underwent elective colorectal resection for cancer following an enhanced recovery program. The main elements of this program were: preoperative advice, no colon preparation, provision of carbohydrate-rich drinks one day prior and on the morning of surgery, goal directed fluid administration, body temperature control during surgery, avoiding drainages and nasogastric tubes, early mobilisation, and the taking of oral fluids in the early postoperative period. Perioperative morbidity and mortality data were collected and the length of hospital stay and protocol compliance recorded. The median age of the patients was 68 years. Fifty-two % of the patients were women. The distribution of patients by ASA class was: I 10%, II 50% and III 40%. Sixty-four % of interventions were laparoscopic; 15% required conversion to laparotomy. The majority of patients underwent sigmoidectomy or right hemicolectomy. The overall compliance to protocol was approximately 65%, but varied widely in its different components. The median length of postoperative hospital stay was 6 days. Some 3% of patients were readmitted to hospital after discharge; some 7% required repeat surgery during their initial hospitalisation or after readmission. The most common complications were surgical (24%), followed by septic (11%) or other medical complications (10%). Three patients (1%) died during follow-up. Some 31% of patients suffered symptoms that delayed their discharge, the most common being vomiting or nausea (12%), dyspnoea (7%) and fever (5%). The

  12. Enhanced recovery in colorectal surgery: a multicentre study

    Directory of Open Access Journals (Sweden)

    Casal José E

    2011-04-01

    Full Text Available Abstract Background Major colorectal surgery usually requires a hospital stay of more than 12 days. Inadequate pain management, intestinal dysfunction and immobilisation are the main factors associated with delay in recovery. The present work assesses the short and medium term results achieved by an enhanced recovery program based on previously published protocols. Methods This prospective study, performed at 12 Spanish hospitals in 2008 and 2009, involved 300 patients. All patients underwent elective colorectal resection for cancer following an enhanced recovery program. The main elements of this program were: preoperative advice, no colon preparation, provision of carbohydrate-rich drinks one day prior and on the morning of surgery, goal directed fluid administration, body temperature control during surgery, avoiding drainages and nasogastric tubes, early mobilisation, and the taking of oral fluids in the early postoperative period. Perioperative morbidity and mortality data were collected and the length of hospital stay and protocol compliance recorded. Results The median age of the patients was 68 years. Fifty-two % of the patients were women. The distribution of patients by ASA class was: I 10%, II 50% and III 40%. Sixty-four % of interventions were laparoscopic; 15% required conversion to laparotomy. The majority of patients underwent sigmoidectomy or right hemicolectomy. The overall compliance to protocol was approximately 65%, but varied widely in its different components. The median length of postoperative hospital stay was 6 days. Some 3% of patients were readmitted to hospital after discharge; some 7% required repeat surgery during their initial hospitalisation or after readmission. The most common complications were surgical (24%, followed by septic (11% or other medical complications (10%. Three patients (1% died during follow-up. Some 31% of patients suffered symptoms that delayed their discharge, the most common being vomiting or

  13. Feasibility study of a computer-assisted radioguided surgery system

    Science.gov (United States)

    Massari, R.; Trotta, C.; Trinci, G.; Sala, R.; Basso, A.; Zappa, E.; Scopinaro, F.; Soluri, A.

    2007-12-01

    This paper deals with the study of a system prototype that can be used as an auxiliary tool in radioguided surgery methods. The use of new technologies in radioguided surgery concern the exact positioning of the lesion to be exerted. This is possible, in operation theatre, thanks to portable scintigraphics devices or to radiation counters. Due to lack of a coordinate system in the operation field, it is difficult for the surgeon to localize the pathology after removing the detection instrument. The system proposed in this paper is composed mainly of three elements: a handheld, high-resolution gamma camera with a small Field Of View (FOV) based on Hamamatsu R8900-00-C12 Position Sensitive Photomultiplier Tube (PSPMT), a laser scanner for the reconstruction of the body district and a stereoscopic system for contactless surgical tool tracking. Analyzing a set of scintigraphic images, taken from different projections, it is possible to localize the three-dimensional position of the lesion. Thanks to the use of the scanner and image fusion techniques, the pathology is shown on a PC monitor correctly positioned with respect to the body surface. Using a couple of stereoscopic cameras, the surgical tool can be tracked and shown on the same monitor, so that the surgeon can know the instantaneous relative position between the tool and the pathology. Exploiting these systems, a navigation system prototype has been developed that is suitable for radioguided surgical application.

  14. Feasibility study of a computer-assisted radioguided surgery system

    Energy Technology Data Exchange (ETDEWEB)

    Massari, R.; Trotta, C. [Institute of Biomedical Engineering, CNR, Via Salaria Km 29.300, C.P. 10 00016 Monterotondo, Rome (Italy); Li-tech srl, Lauzacco Pavia di Udine (UD) (Italy); Trinci, G. [Institute of Biomedical Engineering, CNR, Via Salaria Km 29.300, C.P. 10 00016 Monterotondo, Rome (Italy); Sala, R.; Basso, A.; Zappa, E. [Politecnico di Milano, IV Facolta di Ingegneria, Dipartimento di Meccanica, Milan (Italy); Scopinaro, F. [Institute of Biomedical Engineering, CNR, Via Salaria Km 29.300, C.P. 10 00016 Monterotondo, Rome (Italy); Department of Radiological Sciences, University ' La Sapienza' Rome (Italy); Soluri, A. [Institute of Biomedical Engineering, CNR, Via Salaria Km 29.300, C.P. 10 00016 Monterotondo, Rome (Italy); Li-tech srl, Lauzacco Pavia di Udine (Italy)], E-mail: soluri@isib.cnr.it

    2007-12-21

    This paper deals with the study of a system prototype that can be used as an auxiliary tool in radioguided surgery methods. The use of new technologies in radioguided surgery concern the exact positioning of the lesion to be exerted. This is possible, in operation theatre, thanks to portable scintigraphics devices or to radiation counters. Due to lack of a coordinate system in the operation field, it is difficult for the surgeon to localize the pathology after removing the detection instrument. The system proposed in this paper is composed mainly of three elements: a handheld, high-resolution gamma camera with a small Field Of View (FOV) based on Hamamatsu R8900-00-C12 Position Sensitive Photomultiplier Tube (PSPMT), a laser scanner for the reconstruction of the body district and a stereoscopic system for contactless surgical tool tracking. Analyzing a set of scintigraphic images, taken from different projections, it is possible to localize the three-dimensional position of the lesion. Thanks to the use of the scanner and image fusion techniques, the pathology is shown on a PC monitor correctly positioned with respect to the body surface. Using a couple of stereoscopic cameras, the surgical tool can be tracked and shown on the same monitor, so that the surgeon can know the instantaneous relative position between the tool and the pathology. Exploiting these systems, a navigation system prototype has been developed that is suitable for radioguided surgical application.

  15. Accuracy study of new computer-assisted orthopedic surgery software

    Energy Technology Data Exchange (ETDEWEB)

    Sidon, Eli [Department of Orthopaedic Surgery, Beilinson-Rabin Medical Center, Petach Tikva (Israel); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel); Steinberg, Ely L., E-mail: steinberge@tasmc.health.gov.il [Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Tel Aviv (Israel); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel)

    2012-12-15

    Purpose: The new computerized system is based on image analysis and designed to aid in orthopedic surgeries by virtual trajectory of the guide wire, intra-operative planning and various measurements. Validation of the accuracy and safety of any computer-aided surgery system is essential before implementing it clinically. We examined the accuracy of guide-wire length and angle measurements and fusion of multiple adjacent images (panoramic view image, PVI{sup ®}) of the new software. Methods: This is a 2-part study. Part I: twenty guide wires were drilled to various depths in a synthetic femur model and the results obtained by the software measurements were compared with manual measurements by a caliper and a depth gauge. Part II: a sawbone femur shaft was osteotomized and various inclinations of >10° to the varus or valgus angles were tested. The manually obtained measurements of angles and lengths were compared to the new computerized system software PVI. Results: There was a significant positive linear correlation between all groups of the computerized length and the control measurements (r > 0.983, p < 0.01). There was no significant difference among different distances, angles or positions from the image intensifier. There was a significant positive linear correlation between the angle and length measurement on the PVI and the control measurement (r > 0.993, p < 0.01). Conclusions: The new computerized software has high reliability in performing measurements of length using an aiming, positioning and referring device intra-operatively.

  16. [Complications in gynecologic laparoscopic surgery--retrospective and prospective study].

    Science.gov (United States)

    Gocevska, S; Gortchev, G; Tomov, S

    2011-01-01

    Laparoscopic surgery is a surgical approach with proven advantages in the contemporary treatment of gynaecological diseases. It is applied with proven results in oncologic patients in order to respect certain rules. Mini-invasive approach has less complication and therefore is widely recommended. In this respect, the constantly increasing interest in this surgery and additional training and education. Risk factors must be taken into consideration and patients should be informed about possible complications during surgery.

  17. Core Outcomes for Colorectal Cancer Surgery: A Consensus Study.

    Directory of Open Access Journals (Sweden)

    Angus G K McNair

    2016-08-01

    Full Text Available Colorectal cancer (CRC is a major cause of worldwide morbidity and mortality. Surgical treatment is common, and there is a great need to improve the delivery of such care. The gold standard for evaluating surgery is within well-designed randomized controlled trials (RCTs; however, the impact of RCTs is diminished by a lack of coordinated outcome measurement and reporting. A solution to these issues is to develop an agreed standard "core" set of outcomes to be measured in all trials to facilitate cross-study comparisons, meta-analysis, and minimize outcome reporting bias. This study defines a core outcome set for CRC surgery.The scope of this COS includes clinical effectiveness trials of surgical interventions for colorectal cancer. Excluded were nonsurgical oncological interventions. Potential outcomes of importance to patients and professionals were identified through systematic literature reviews and patient interviews. All outcomes were transcribed verbatim and categorized into domains by two independent researchers. This informed a questionnaire survey that asked stakeholders (patients and professionals from United Kingdom CRC centers to rate the importance of each domain. Respondents were resurveyed following group feedback (Delphi methods. Outcomes rated as less important were discarded after each survey round according to predefined criteria, and remaining outcomes were considered at three consensus meetings; two involving international professionals and a separate one with patients. A modified nominal group technique was used to gain the final consensus. Data sources identified 1,216 outcomes of CRC surgery that informed a 91 domain questionnaire. First round questionnaires were returned from 63 out of 81 (78% centers, including 90 professionals, and 97 out of 267 (35% patients. Second round response rates were high for all stakeholders (>80%. Analysis of responses lead to 45 and 23 outcome domains being retained after the first and

  18. Pilot Study on Laparoscopic Surgery in Port‑Harcourt, Nigeria

    African Journals Online (AJOL)

    surgeries long before its acceptance in pediatric surgery. The reasons for initial non‑acceptance included ... perhaps the traditionally smaller incisions in pediatric patients making the cosmetic benefit of laparoscopy ..... limited setting: Cost containment, skills transfer and outcomes. East Afr J Surg 2012;16:112‑7. How to cite ...

  19. Cataract surgery by appointment – a pilot study

    Directory of Open Access Journals (Sweden)

    Paul Bobby

    2006-04-01

    Full Text Available Abstract Background "Cataract Surgery by Appointment" is a new method of delivery of cataract surgery that reduces the time a patient spends in hospital by their direct arrival at the operating theatre, having self-prepared for surgery, thus avoiding admission to the ward or time spent in the Day Case Unit. The patient can stay as little as 20 minutes from their arrival to going home. We describe the process in detail, and seek to evaluate the visual outcome, safety and patient satisfaction of same. Methods Visual outcome and safety data were obtained from patients' medical records, prospectively. Patients were also surveyed by a questionnaire to determine their satisfaction with the service and viability as a prospect for providing a more efficient cataract surgery service. Results In 2002, fifty-one eyes of 39 consecutive patients underwent "Cataract Surgery by Appointment". There were 16 male and 23 female. The pre-operative best-corrected visual acuity was 6/9 or better in 17 (33% eyes. The post-operative best-corrected visual acuity was 6/9 or better in 44 (86% eyes. There were no per-operative complications. Post-operative complications occurred in 3 (6% eyes. The average number of days from surgery to final discharge was 14.5 days. Twenty-eight (72% completed questionnaires were returned. The results show that the majority of patients were satisfied with their overall experience of this mode of delivery for cataract surgery. Conclusion "Cataract Surgery by Appointment" performed under local anaesthesia by a skilled ophthalmic surgeon appears to be safe and effective for highly selected cases. This method of delivery gave a high level of patient satisfaction, and is the ultimate form of day case cataract surgery. The method may gain widespread use should per-operative intracameral pupil dilatation prove to be effective and acceptable. Attention should be paid to risk-stratification, so complex cases are allocated more time on the operating

  20. Adolescent Perspectives Following Ostomy Surgery: A Grounded Theory Study.

    Science.gov (United States)

    Mohr, Lynn D; Hamilton, Rebekah J

    2016-01-01

    This purpose of this study was to provide a theoretical account of how adolescents aged 13 to 18 years process the experience of having an ostomy. Qualitative study using grounded theory design. The sample comprised of 12 English-speaking adolescents aged 13-18 years: 10 with an ostomy and 2 with medical management of their disease. Respondents completed audio-recorded interviews that were transcribed verbatim. Data were analyzed using the constant comparative method until data saturation occurred. Dedoose, a Web-based qualitative methods management tool, was used to capture major themes arising from the data. Study results indicate that for adolescents between 13 and 18 years of age, processing the experience of having an ostomy includes concepts of the "physical self" and "social self" with the goal of "normalizing." Subcategories of physical self include (a) changing reality, (b) learning, and (c) adapting. Subcategories of social self include (a) reentering and (b) disclosing. This study sheds light on how adolescents process the experience of having an ostomy and how health care providers can assist adolescents to move through the process to get back to their desired "normal" state. Health care providers can facilitate the adolescent through the ostomy experience by being proactive in conversations not only about care issues but also about school and family concerns and spirituality. Further research is needed in understanding how parents process their adolescents' ostomy surgery experience and how spirituality assists adolescents in coping and adjustment with body-altering events.

  1. Pseudoepitheliomatous hyperplasia after diode laser oral surgery. An experimental study

    Science.gov (United States)

    Seoane, Juan; González-Mosquera, Antonio; García-Martín, José-Manuel; García-Caballero, Lucía; Varela-Centelles, Pablo

    2015-01-01

    Background To examine the process of epithelial reparation in a surgical wound caused by diode laser. Material and Methods An experimental study with 27 Sprage-Dawley rats was undertaken. The animals were randomly allocated to two experimental groups, whose individuals underwent glossectomy by means of a diode laser at different wattages, and a control group treated using a number 15 scalpel blade. The animals were slaughtered at the 2nd, 7th, and 14th day after glossectomy. The specimens were independently studied by two pathologists (blinded for the specimens’ group). Results At the 7th day, re-epithelisation was slightly faster for the control group (conventional scalpel) (p=0.011). At the 14th day, complete re-epithelization was observed for all groups. The experimental groups displayed a pseudoepitheliomatous hyperplasia. Conclusions It is concluded that, considering the limitations of this kind of experimental studies, early re-epithelisation occurs slightly faster when a conventional scalpel is used for incision, although re-epithelisation is completed in two weeks no matter the instrument used. In addition, pseudoepitheliomatous hyperplasia is a potential event after oral mucosa surgery with diode laser. Knowledge about this phenomenon (not previously described) may prevent diagnostic mistakes and inadequate treatment approaches, particularly when dealing with potentially malignant oral lesions. Key words:Diode laser, animal model, oral biopsy, oral cancer, oral precancer, pseudoepitheliomatous hyperplasia. PMID:26116841

  2. The Newfoundland and Labrador Bariatric Surgery Cohort Study: Rational and Study Protocol

    Directory of Open Access Journals (Sweden)

    Laurie K. Twells

    2016-10-01

    Full Text Available Abstract Background In Canada, there has been a disproportionate increase in adults with Class II (BMI 35.0–39.9 kg/m2 or Class III obesity (BMI ≥ 40 kg/m2 affecting 9 % of Canadians with increases projected. Individuals affected by severe obesity (BMI ≥ 35 are at increased risk of high blood pressure, cardiovascular disease, diabetes, cancer, impaired quality of life, and premature mortality. Bariatric surgery is the most effective treatment for severe obesity. Laparoscopic sleeve gastrectomy (LSG, a relatively new type of bariatric surgery, is growing in popularity as a treatment. The global prevalence of LSG increased from 0 to 37.0 % between 2003 and 2013. In Canada and the US, between 2011 and 2013, the number of LSG surgeries increased by 244 % and LSG now comprises 43 % of all bariatric surgeries. Since 2011, Eastern Health, the largest regional health authority in Newfoundland and Labrador (NL, Canada has performed approximately 100 LSG surgeries annually. Methods A population-based prospective cohort study with pre and post surgical assessments at 1, 3, 6, 12, 18, 24 months and annually thereafter of patients undergoing LSG. This study will report on short - to mid-term (2–4 years outcomes. Patients (n = 200 followed by the Provincial Bariatric Surgery Program between 19 and 70 years of age, with a BMI between 35.0 and 39.9 kg/m2 and an obesity-related comorbidity or with a BMI ≥ 40 kg/m2 are enrolled. The study is assessing the following outcomes: 1 complications of surgery including impact on nutritional status 2 weight loss/regain 3 improvement/resolution of comorbid conditions and a reduction in prescribed medications 4 patient reported outcomes using validated quality of life tools, and 5 impact of surgery on health services use and costs. We hypothesize a low complication rate, a marked reduction in weight, improvement/resolution of comorbid conditions, a reduction in related medications

  3. The Newfoundland and Labrador Bariatric Surgery Cohort Study: Rational and Study Protocol.

    Science.gov (United States)

    Twells, Laurie K; Gregory, Deborah M; Midodzi, William K; Dillon, Carla; Kovacs, Christopher S; MacDonald, Don; Lester, Kendra K; Pace, David; Smith, Chris; Boone, Darrell; Murphy, Raleen

    2016-10-28

    In Canada, there has been a disproportionate increase in adults with Class II (BMI 35.0-39.9 kg/m2) or Class III obesity (BMI ≥ 40 kg/m2) affecting 9 % of Canadians with increases projected. Individuals affected by severe obesity (BMI ≥ 35) are at increased risk of high blood pressure, cardiovascular disease, diabetes, cancer, impaired quality of life, and premature mortality. Bariatric surgery is the most effective treatment for severe obesity. Laparoscopic sleeve gastrectomy (LSG), a relatively new type of bariatric surgery, is growing in popularity as a treatment. The global prevalence of LSG increased from 0 to 37.0 % between 2003 and 2013. In Canada and the US, between 2011 and 2013, the number of LSG surgeries increased by 244 % and LSG now comprises 43 % of all bariatric surgeries. Since 2011, Eastern Health, the largest regional health authority in Newfoundland and Labrador (NL), Canada has performed approximately 100 LSG surgeries annually. A population-based prospective cohort study with pre and post surgical assessments at 1, 3, 6, 12, 18, 24 months and annually thereafter of patients undergoing LSG. This study will report on short - to mid-term (2-4 years) outcomes. Patients (n = 200) followed by the Provincial Bariatric Surgery Program between 19 and 70 years of age, with a BMI between 35.0 and 39.9 kg/m2 and an obesity-related comorbidity or with a BMI ≥ 40 kg/m2 are enrolled. The study is assessing the following outcomes: 1) complications of surgery including impact on nutritional status 2) weight loss/regain 3) improvement/resolution of comorbid conditions and a reduction in prescribed medications 4) patient reported outcomes using validated quality of life tools, and 5) impact of surgery on health services use and costs. We hypothesize a low complication rate, a marked reduction in weight, improvement/resolution of comorbid conditions, a reduction in related medications, improvement in quality of life, and a

  4. Psychosocial changes after cosmetic surgery: a 5-year follow-up study.

    Science.gov (United States)

    von Soest, Tilmann; Kvalem, Ingela L; Skolleborg, Knut C; Roald, Helge E

    2011-09-01

    Most studies examining psychosocial changes after cosmetic surgery have short follow-up periods and therefore provide limited information about long-term effects of such surgery. Moreover, studies that identify whether preexisting patient characteristics are associated with poor psychosocial outcomes after cosmetic surgery are lacking. The current study provides information about both of these issues. Questionnaire data from 130 female Norwegian cosmetic surgery patients were obtained before and 5 years after surgery. The questionnaire consisted of measures on appearance satisfaction, self-esteem, psychological problems, and patients' evaluation of the outcome of surgery. Data from a representative sample of 838 Norwegian women, aged 22 to 55 years, were used for comparison purposes. Analyses revealed an improvement in both general appearance satisfaction and satisfaction with the body part operated on 5 years after surgery. A small increase in self-esteem was observed as well. High rates of preoperative psychological problems and low self-esteem were related to more negative changes in some of the psychosocial measures after surgery compared with patients with better psychological health. Furthermore, factors associated with the actual decision to undergo surgery were related to changes in psychological health and patients' evaluation of the outcome of surgery. This study indicates that cosmetic surgery has positive long-term effects on appearance-related variables. However, surgeons should be particularly aware of patients with psychological problems, as these may compromise patient satisfaction with the effects of cosmetic surgery. Factors affecting the decision itself to undergo cosmetic surgery may also be relevant for subsequent psychosocial outcomes. Therapeutic, II.

  5. A Comparative Study of Single-Port Laparoscopic Surgery Versus Robotic-Assisted Laparoscopic Surgery for Rectal Cancer

    DEFF Research Database (Denmark)

    Levic, Katarina; Donatsky, Anders Meller; Bulut, Orhan

    2015-01-01

    INTRODUCTION: Conventional laparoscopic surgery is the treatment of choice for many abdominal procedures. To further reduce surgical trauma, new minimal invasive procedures such as single-port laparoscopic surgery (SPLS) and robotic assisted laparoscopic surgery (RALS) have emerged. The aim...

  6. [Remifentanil does not increase urine output during oral surgery, contrary to its effect during other surgeries - a cohort study].

    Science.gov (United States)

    Ouchi, Kentaro; Sugiyama, Kazuna

    An increase in urine output by remifentanil injection during laparoscopic procedures and surgeries such as cardiac and gynecological procedures, due to suppression of the stress response to surgery, has been reported. The aim of our prospective, observational, cohort study was to assess the effect of remifentanil analgesia on urine output during dental and minor oral surgery by comparing intraoperative urine output under defined infusion volumes with and without the use of remifentanil. Dental patients aged 16 years or older, American Society of Anesthesiologists physical status 1, with no renal diseases or abnormal blood values of serum creatinine and BUN, not on treatment with diuretic drugs, and undergoing minor oro-maxillofacial surgery or dental treatment under inhalation general anesthesia were included in this study. Urethral catheterization was performed after anesthesia induction, and urine output was measured every 30minutes. We measured urine volume (mL) and rate of urine output (mL.kg(-1).h(-1)) intraoperatively, and compared these parameters between patients who did and did not receive remifentanil during the intraoperative period. Eighty-seven patients were categorized into the remifentanil group (n=43) or remifentanil non-use group (n=44). Both volume of urine (mL) and rate of urine output (mL.kg(-1).h(-1)) were not significantly different between the two groups (remifentanil group, 372.3±273.5mL, 1.8±1.1mL.kg(-1).h(-1); remifentanil non-use group, 343.3±283.3mL, 1.9±1.2mL.kg(-1).h(-1); p=0.63; 0.57). Our results show that use of remifentanil during dental and minor oral surgeries does not increase urine output. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  7. The Utility of Outcome Studies in Plastic Surgery

    Directory of Open Access Journals (Sweden)

    Hani Sinno, MD, MEng

    2014-07-01

    Full Text Available Summary: Outcome studies help provide the evidence-based science rationalizing treatment end results that factor the experience of patients and the impact on society. They improve the recognition of the shortcoming in clinical practice and provide the foundation for the development of gold standard care. With such evidence, health care practitioners can develop evidence-based justification for treatments and offer patients with superior informed consent for their treatment options. Furthermore, health care and insurance agencies can recognize improved cost-benefit options in the purpose of disease prevention and alleviation of its impact on the patient and society. Health care outcomes are ultimately measured by the treatment of disease, the reduction of symptoms, the normalization of laboratory results and physical measures, saving a life, and patient satisfaction. In this review, we outline the tools available to measure outcomes in plastic surgery and subsequently allow the objective measurements of plastic surgical conditions. Six major outcome categories are discussed: (1 functional measures; (2 preference-based measures and utility outcome scores; (3 patient satisfaction; (4 health outcomes and time; (5 other tools: patient-reported outcome measurement information system, BREAST-Q, and Tracking Operations and Outcomes for Plastic Surgeons; and (6 cost-effectiveness analysis. We use breast hypertrophy requiring breast reduction as an example throughout this review as a representative plastic surgical condition with multiple treatments available.

  8. Postoperative nausea and vomiting after oral and maxillofacial surgery: a prospective study.

    Science.gov (United States)

    Dobbeleir, M; De Coster, J; Coucke, W; Politis, C

    2018-01-01

    Postoperative nausea and vomiting (PONV) is one of the most unpleasant experiences after surgery. It reduces patient satisfaction and also increases hospital costs due to longer hospitalizations. The aim of this prospective study was to determine whether orthognathic surgery is associated with more PONV than less invasive maxillofacial surgery. Three hundred and eight patients aged 8-87 years who underwent maxillofacial surgery were included. The PONV score, based on the Apfel score, was calculated preoperatively. PONV occurred in 142 (46.1%) patients during the first three postoperative days; these patients were further categorized as having postoperative nausea (PON) and/or postoperative vomiting (POV). PON was most frequent after orthognathic surgery to the mandible (75%), and POV was most frequent after maxillary surgery, including bimaxillary surgery, Le Fort I osteotomy, and surgically assisted rapid palatal expansion (SARPE) (43.1%). There was a small significant relationship between the preoperative PONV score and the incidence of PONV: patients experienced more PONV when the PONV score calculated preoperatively was higher. The incidence of PONV after orthognathic surgery was very high compared with the incidence after dental extractions and other minor surgeries. Further investigation is required to establish a strategy to reduce PONV after orthognathic surgery. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  9. Collaborating to increase access to clinical and educational resources for surgery: a case study.

    Science.gov (United States)

    Tomasko, Jonathan M; Adams, Nancy E; Garritano, Frank G; Santos, Mary C; Dillon, Peter W

    2014-01-01

    A case study is described in which collaborations between a Department of Surgery, a Department of Information Technology, and an academic health sciences library resulted in the development of an electronic surgical library available at the bedside, the deployment of tablet devices for surgery residents, and implementation of a tablet-friendly user interface for the institution's electronic medical record. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  10. Evaluation of neurosensory disturbance following orthognathic surgery: a prospective study.

    Science.gov (United States)

    Degala, Saikrishna; Shetty, Sujeeth Kumar; Bhanumathi, M

    2015-03-01

    The prospective study was to evaluate the incidence, type of neurosensory disturbance (NSD), grade its severity and monitor its recovery occurring in the lower lip and chin due to damage to inferior alveolar nerve following orthognathic surgery involving mandible. The study included 10 patients who have undergone sagittal split osteotomy, genioplasty, and anterior subapical osteotomy (ASO). All the patients examined preoperatively and post operatively 1 week, 1 and 6 months according to standardized test to clarify the subjective and objective neurosensory status of the injured nerve. Pin prick test, blunt test, two-point discrimator test, brush stoke direction, light touch test, warm and cold test were used bilaterally to lower lip and chin area. Seven patients underwent bilateral sagittal split osteotomy (BSSO) (70 %), one patient had BSSO with genioplasty (10 %), two patients had BSSO with ASO (20 %). During the operation none of the nerves were transectioned, in 60 % of patients nerve was not visible and in 40 % of patients nerve was seen in distal segment. 70 % of patients underwent setback, 30 % of patients underwent advancement. The subjective evaluation of the patients revealed the incidence of 90 % at 1 week, 30 % at 1 month, 20 % at 6 months and 10 % at 1 year post operatively. The altered sensation reported subjectively was hypoesthesia in 50 % of the patients, anaesthesia in 40 % of the patients. There was 100 % recovery in advancement cases and 93.5 % recovery in setback cases. There is a high incidence of NSD of the lower lip and chin after BSSO related to advancement, setback, intraoperative nerve encounter and surgical skill. However, recovery of sensation occurs with increasing frequency during the follow-up period. The clinical neurosensory tests are effective guides to study the neurosensory deficit.

  11. Anesthesia practices in intracranial mass surgery: a retrospective study

    Directory of Open Access Journals (Sweden)

    Ozlem Ozmete

    2017-03-01

    Conclusion: Several anesthetic techniques may be used successfully to provide anesthesia for resection of intracranial mass surgery. To reduced morbidity and mortality, the possible complications must be recognized and treated early with invasive monitoring, strict hemodynamics and blood gas monitoring. [Cukurova Med J 2017; 42(1.000: 86-91

  12. NSAID Use after Bariatric Surgery : a Randomized Controlled Intervention Study

    NARCIS (Netherlands)

    Yska, Jan Peter; Gertsen, Sanneke; Flapper, Gerbrich; Emous, Marloes; Wilffert, Bob; van Roon, Eric N.

    2016-01-01

    Background Use of nonsteroidal anti-inflammatory drugs (NSAIDs) should be avoided in bariatric surgery patients. If use of an NSAID is inevitable, a proton pump inhibitor (PPI) should also be used. Aim To determine the effect of an, compared to care-as-usual, additional intervention to reduce NSAID

  13. What predicts improvement of sexual function after pelvic floor surgery? A follow-up study.

    Science.gov (United States)

    Lonnée-Hoffmann, Risa A M; Salvesen, Øyvind; Mørkved, Siv; Schei, Berit

    2013-11-01

    To analyze factors predictive for changes in sexual function after pelvic floor surgery and explore differences between stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgery. Prospective observational study. St Olav Hospital, Trondheim University Hospital, Norway. Of 346 mailed questionnaires for women scheduled for SUI and POP surgery, 65 questionnaires were available for analysis together with examination findings before and 1 year after surgery. Postal questionnaires including Prolapse and Incontinence Sexual Function Questionnaire (PISQ 12), Hopkins Symptom Checklist 5 for psychological distress, questions from the validated Body Image Questionnaire, a general health question, questions addressing goals for improvement after surgery, clinical findings based on the Pelvic Organ Prolapse Quantification System and Brief Sexual Function Index for partners. Uni- and multivariate linear regressions adjusting for age were performed. Change in PISQ 12 score at follow-up. Sexual function significantly improved in the total group (p = 0.000). After stratification into SUI and POP surgery, improvement only remained significant after SUI surgery (p = 0.001). Improvement for the total group was predicted by good health or coital incontinence, whereas psychological distress or the goal of improved defecation predicted deterioration. For women undergoing SUI surgery, increasing age, parity or the goal of improving sexuality or body image predicted improvement, while for women undergoing POP surgery, menopausal status or anterior colporrhaphy predicted improvement. Significantly improved sexuality was observed after pelvic floor surgery. Predictive factors for change differed for women undergoing SUI surgery and and those undergoing POP surgery. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

  14. Carotid body paragangliomas : a systematic study on management with surgery and radiotherapy

    NARCIS (Netherlands)

    Suarez, Carlos; Rodrigo, Juan P.; Mendenhall, William M.; Hamoir, Marc; Silver, Carl E.; Gregoire, Vincent; Strojan, Primoz; Neumann, Hartmut P. H.; Obholzer, Rupert; Offergeld, Christian; Langendijk, Johannes A.; Rinaldo, Alessandra; Ferlito, Alfio

    The definitive universally accepted treatment for carotid body tumors (CBT) is surgery. The impact of surgery on cranial nerves and the carotid artery has often been underestimated. Alternatively, a few CBTs have been followed without treatment or irradiation. The goal of this study is to summarize

  15. Children Coping with Surgery through Drawings: A Case Study from a Parenting Class

    Science.gov (United States)

    Broecher, Joachim

    2012-01-01

    This case study illustrates how parents can help their children cope with the fear and pain of surgery by engaging them in expressive drawing. As part of a parenting class that utilized art therapy techniques, a father shared his 6-year-old son's spontaneous drawings that had been created directly before and after surgery. Through guidance by the…

  16. Utility of melatonin to treat surgical stress after major vascular surgery - a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose of reduc...

  17. Utility of melatonin to treat surgical stress after major vascular surgery--a safety study

    DEFF Research Database (Denmark)

    Kücükakin, Bülent; Lykkesfeldt, Jens; Nielsen, Hans Jørgen

    2008-01-01

    Surgery for abdominal aortic aneurysm is associated with elevated oxidative stress. As an antioxidant in animal and human studies, melatonin has the potential of ameliorating some of this oxidative stress, but melatonin has never been administered to adults during surgery for the purpose of reduc...

  18. Minimally invasive strabismus surgery versus paralimbal approach: A randomized, parallel design study is minimally invasive strabismus surgery worth the effort?

    Directory of Open Access Journals (Sweden)

    Richa Sharma

    2014-01-01

    Full Text Available Introduction : Minimal access surgery is common in all fields of medicine. We compared a new minimally invasive strabismus surgery (MISS approach with a standard paralimbal strabismus surgery (SPSS approach in terms of post-operative course. Materials and Methods: This parallel design study was done on 28 eyes of 14 patients, in which one eye was randomized to MISS and the other to SPSS. MISS was performed by giving two conjunctival incisions parallel to the horizontal rectus muscles; performing recession or resection below the conjunctival strip so obtained. We compared post-operative redness, congestion, chemosis, foreign body sensation (FBS, and drop intolerance (DI on a graded scale of 0 to 3 on post-operative day 1, at 2-3 weeks, and 6 weeks. In addition, all scores were added to obtain a total inflammatory score (TIS. Statistical Analysis: Inflammatory scores were analyzed using Wilcoxon′s signed rank test. Results: On the first post-operative day, only FBS (P = 0.01 and TIS (P = 0.04 showed significant difference favoring MISS. At 2-3 weeks, redness (P = 0.04, congestion (P = 0.04, FBS (P = 0.02, and TIS (P = 0.04 were significantly less in MISS eye. At 6 weeks, only redness (P = 0.04 and TIS (P = 0.05 were significantly less. Conclusion: MISS is more comfortable in the immediate post-operative period and provides better cosmesis in the intermediate period.

  19. Minimally invasive flapless implant surgery: a prospective multicenter study.

    Science.gov (United States)

    Becker, William; Goldstein, Moshe; Becker, Burton E; Sennerby, Lars

    2005-01-01

    Placement of implants with a minimally invasive flapless approach has the potential to minimize crestal bone loss, soft tissue inflammation, and probing depth adjacent to implants and to minimize surgical time. The aim of this multicenter study was to evaluate implant placement using a minimally invasive one-stage flapless technique up to 2 years. Fifty-seven patients ranging in age from 24 to 86 years were recruited from three clinical centers (Tucson, AZ, USA; Tel Aviv, Israel; Göteborg, Sweden). Seventy-nine implants were placed. A small, sharp-tipped guiding drill was used to create a precise, minimally invasive initial penetration through the mucosa and into bone (Nobel Biocare, Yorba, Linda, CA, USA). Implants were placed according to the manufacturer's instructions, with minimal countersinking. The parameters evaluated were total surgical time, implant survival, bone quality and quantity, implant position by tooth type, depth from mucosal margin to bone crest, implant length, probing depth, inflammation, and crestal bone changes. At 2 years, for 79 implants placed in 57 patients, the cumulative success rate using a minimally invasive flapless method was 98.7%, indicating the loss of 1 implant. Changes in crestal bone for 77 baseline and follow-up measurements were insignificant (radiograph 1: mean 0.7 mm, SD 0.5 mm, range 2.8 mm, minimum 0.2 mm, maximum 3.0 mm; radiograph 2: mean 0.8 mm, SD 0.5 mm, range 3.4 mm, minimum 0.12 mm, maximum 3.5 mm). Using descriptive statistics for 78 patients (one implant lost), mean changes for probing depth and inflammation were clinically insignificant. The average time for implant placement was 28 minutes (minimum 10 minutes, maximum 60 minutes, SD 13.1 minutes). Average depth from mucosal margin to bone was 3.3 mm ( SD 0.7 mm, minimum 2 mm, maximum 5 mm, range 3 mm). Thirty-two implants were placed in maxillae and 47 in mandibles. The results of this study demonstrate that following diagnostic treatment planning criteria

  20. Post-destructive eye surgery, associated depression at Sekuru Kaguvi Hospital Eye Unit, Zimbabwe: Pilot Study

    Directory of Open Access Journals (Sweden)

    M. M. Kawome

    2013-12-01

    Full Text Available Destructive eye surgery is associated with more complications than just loss of visual functions of the eye and aesthetics. Currently there is very little published literature on post-destructive eye surgery associated depression. Zimbabwe has been experiencing a surge in the rate of destructive eye surgery done at the National Tertiary Eye Unit. This situation could be churning out lots of unrecognized depressed clients into the community who require assistance in one form or another.Objectives: To determine the prevalence of post-destructive eye surgery associated depression among patients attending Sekuru Kaguvi Hospital Eye Unit and assess if the current management protocol of patients undergoing destructive eye surgery at the Eye Unit addresses the problem adequately.Methods: A cross-sectional study of 28 randomly selected patients who had destructive eye surgeries at Sekuru Kaguvi Hospital was conducted over five months from 1st March 2012 to end of July 2012. A structured questionnaire containing 15 questions on the following items: gender, age, diagnosis, surgical procedure done, expectations before and after surgery, adequacy of counseling given and involvement of family was used to collect data. Nine questions to assess depression were adapted from the Patient Health Questionnaire (PHQ-9.Setting:  The study was conducted at SekuruKaguvi Hospital Eye Unit, Parirenyatwa Group of Hospitals in Harare.Results:  Twenty-eight patients who underwent destructive eye surgery during the study period were selected using systematic random sampling. The gender ratio was 1:1 and the mean age was 38.7 years with a range from 24 to 65 years. Fifty percent of the patients in the study had orbital exenteration while the rest had enucleation (14% and evisceration (36%. Twenty-eight percent of the study population had depression.Conclusion: Destructive eye surgery is frequently associated with depression and our current management protocol of patients

  1. Evaluation of quality of life in Chilean patients with orthognathic surgery. A cohort study.

    Directory of Open Access Journals (Sweden)

    Macarena Cea-Herrera

    2016-12-01

    Full Text Available To compare the presurgical and immediate postsurgical quality of life in Chilean patients with orthognathic surgery. Material and Methods: Cohort study. The study included 30 patients (mean age 20.73, 53.33% male who underwent orthognathic surgery primarily for severe skeletal abnormalities, (17 surgeries, 56.7% and moderate skeletal abnormalities (12 surgeries, 40%, from three Chilean hospitals between February and June 2016. Patients were asked to answer the World Health Organization quality of life Bref version questionnaire (WHOQOL-BREF validated in Spanish to measure quality of life (QoL two weeks before and three months after the surgery. Scores for general QoL and for every domain of QoL were described. Variations in the scores of general QoL were analyzed according to sex and severity of orofacial malformation (mild, moderate or severe (t-test p<0.05; STATA 10.0. Results: The average score for QoL according to the WHOQOL-BREF scale was 76.43±13.83 before surgery and 90.5±7.18 three months after surgery (p<0.001. Statistically significant differences according to sex and type of orofacial malformation were found (p<0.01. An increase in the score in all the domains of the WHOQOOL-BREF scale was observed. Conclusion: Orthognathic surgery significantly improved QoL scores in Chilean patients according to the WHOQOL-BREF scale.

  2. A qualitative study of life events and psychological needs underlying the decision to have cosmetic surgery.

    Science.gov (United States)

    Locatelli, Katia; Boccara, David; De Runz, Antoine; Fournier, Mathilde; Chaouat, Marc; Villa, François; Mimoun, Maurice

    2017-01-01

    Objective A thorough psychological assessment of patients requesting cosmetic surgery can help to protect them from the risk of postoperative dissatisfaction and the onset and/or aggravation of psychiatric disorders. This study seeks to shed more light on why people desire cosmetic surgery and thus help surgeons, psychiatrists, and psychologists to conduct assessments before surgery. Methods In-depth interviews were conducted with 35 subjects who requested cosmetic surgery. The interviews were recorded and transcribed and then analyzed qualitatively with Grounded Theory. Themes and categories were identified and compared in logical order, to build a consistent theoretical model. Results In each interview, we identified one or more recent events that the subjects considered to be contributing factors in their decisions to have cosmetic surgery. We observed that 33 of 35 patients said they sought cosmetic surgery at a time when they were experiencing, or had just experienced, one or more major changes in their bodies or their relationships. Recent life events triggered or strengthened specific psychological needs in the subjects: to cope with the past and with change, attain a consistent identity, find or regain a positive self-image, alter others' perceptions, define themselves in relation to others, or please themselves or others. Patients said that they chose plastic surgery to fulfill one or more of these needs. Conclusions This study identifies the role of recent events in inciting individuals to resort to cosmetic surgery. This factor provides new perspectives for surgeons to understand those patients and opens new avenues for research.

  3. Vitamin K1 monitoring in pregnancies after bariatric surgery: a prospective cohort study.

    Science.gov (United States)

    Jans, Goele; Guelinckx, Isabelle; Voets, Willy; Galjaard, Sander; Van Haard, Paul M M; Vansant, Greet M; Devlieger, Roland

    2014-01-01

    Neonatal intracranial bleedings and birth defects have been reported, possibly related to maternal vitamin K1 deficiency during pregnancy after bariatric surgery. The objective of this study was to investigate the effects of screening and supplementation on K1 serum levels in pregnant women with bariatric surgery, and to compare K1 levels and prothrombin time (PT %) in the first trimester with pregnant women without bariatric surgery. A prospective cohort study including 49 pregnant women with bariatric surgery. Nutritional deficiencies were prospectively screened. In case of observed low K1 serum levels, supplementation was provided. K1 serum levels and PT (%) during the first trimester were compared with a nonsurgical control group of 27 women. During the first trimester, most women had low K1 serum levels (surgery group showed a higher mean PT compared to the controls (111.3 versus 98.9%; Pbariatric surgery. Supplementation during pregnancy can restore vitamin K1 in women with bariatric surgery, potentially protecting the fetus and newborn against intracranial hemorrhage. Copyright © 2014 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  4. Psychological and health comorbidities before and after bariatric surgery: a longitudinal study

    Directory of Open Access Journals (Sweden)

    Susana Sofia Pereira da Silva

    2013-12-01

    Full Text Available INTRODUCTION: Morbid obesity has multiple implications for psychological and physical health. Bariatric surgery has been selected as the treatment of choice for this chronic disease, despite the controversial impact of the surgery on psychosocial health. The objective of this study was to describe candidates for bariatric surgery and analyze changes in weight, psychopathology, personality, and health problems and complaints at 6- and 12- month follow-up assessments. METHODS: Thirty obese patients (20 women and 10 men with a mean age of 39.17±8.81 years were evaluated in different dimensions before surgery and 6 and 12 months after the procedure. RESULTS: Six and 12 months after bariatric surgery, patients reported significant weight loss and a significant reduction in the number of health problems and complaints. The rates of self-reported psychopathology were low before surgery, and there were no statistically significant changes over time. The conscientiousness, extraversion, and agreeableness dimensions increased, but neuroticism and openness remained unchanged. All changes had a medium effect size. CONCLUSIONS: Our results suggest that patients experience significant health improvements and some positive personality changes after bariatric surgery. Even though these findings underscore the role of bariatric surgery as a relevant treatment for morbid obesity, more in-depth longitudinal studies are needed to elucidate the evolution of patients after the procedure.

  5. Resolution of neurosensory deficit after mandibular orthognathic surgery: A prospective longitudinal study.

    Science.gov (United States)

    Alolayan, Albraa Badr; Leung, Yiu Yan

    2017-05-01

    To investigate the longitudinal resolution of neurosensory deficit (NSD) and the possible risk factors that might contribute to NSD following mandibular orthognathic procedures. A prospective longitudinal observational study on patients who had mandibular orthognathic procedures was performed. Standardized neurosensory assessments were performed. The 2 years longitudinal resolution and risk factors of NSD including patients' age and gender, specific mandibular procedures and surgeons' experience were analyzed. 66 patients (44 females) with 132 sides of mandibular procedures were enrolled in the study. Surgical procedures included mandibular ramus surgery, anterior mandibular surgery, or the combination of the two. The overall occurrences of subjective NSD improved from 78.8% at postoperative 2 weeks to 13.8% at post-operative 2 years. Combinations of ramus surgery and anterior mandibular surgery increased the risk of NSD at the first three post-operative months (p orthognathic surgery. The occurrence of NSD after mandibular orthognathic procedures reduced progressively within the post-operative 2 years. Combination of mandibular ramus surgery and anterior mandibular surgery increased the risk of NSD in the early post-operative period. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  6. Gynecomastia Surgery-Impact on Life Quality: A Prospective Case-Control Study.

    Science.gov (United States)

    Kasielska-Trojan, Anna; Antoszewski, Bogusław

    2017-03-01

    To evaluate the results of surgical treatment of gynecomastia in the context of quality of life and satisfaction after the surgery. Fifty male patients (mean age, 25.1 years [SD = 8 years]) who underwent surgery for gynecomastia and completed both (preoperative and postoperative) stages of the study were included in the analysis. The quality-of-life evaluation instrument was The Short Form-36 Health Survey Questionnaire. Additionally, we used a short questionnaire including 2 questions about patient satisfaction with gynecomastia surgery. The overall change in life satisfaction after gynecomastia surgery was 1 point on Likert scale (sign test, P social functioning and a scale Psychical Health (P life quality in all aspects and especially in the social aspect and psychical health. This indicates that adult men with gynecomastia are a specific group of patients, in which surgery may result in life quality improvement even over the average scores.

  7. Clinical and neuropsychiatric correlates of lumbar spinal surgery in older adults: results of a pilot study.

    Science.gov (United States)

    Karp, Jordan F; McGovern, Jonathan; Marron, Megan M; Gerszten, Peter; Weiner, Debra K; Okonkwo, David; Kanter, Adam S

    2016-11-01

    To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection.

  8. Anesthesia for Ambulatory Pediatric Surgery in Sub-Saharan Africa: A Pilot Study in Burkina Faso.

    Science.gov (United States)

    Kabré, Yvette B; Traoré, Idriss S S; Kaboré, Flavien A R; Ki, Bertille; Traoré, Alain I; Ouédraogo, Isso; Bandré, Emile; Wandaogo, Albert; Ouédraogo, Nazinigouba

    2017-02-01

    Long surgical wait times and limited hospital capacity are common obstacles to surgical care in many countries in Sub-Saharan Africa (SSA). Introducing ambulatory surgery might contribute to a solution to these problems. The purpose of this study was to evaluate the safety and feasibility of introducing ambulatory surgery into a pediatric hospital in SSA. This is a cross-sectional descriptive study that took place over 6 months. It includes all patients assigned to undergo ambulatory surgery in the Pediatric University Hospital in Ouagadougou, Burkina Faso. Eligibility criteria for the ambulatory surgery program included >1 year of age, American Society of Anesthesiologists (ASA) 1 status, surgery with a low risk of bleeding, lasting ambulatory surgery; 103 patients, with an average age of 59.74 ± 41.57 months, actually underwent surgery. The principal indications for surgery were inguinal (62) and umbilical (47) hernias. All patients had general anesthesia with halothane. Sixty-five percent also received regional or local anesthesia consisting of caudal block in 79.23% or nerve block in 20.77%. The average duration of surgery was 33 ± 17.47 minutes. No intraoperative complications were noted. All the patients received acetaminophen and a nonsteroidal anti-inflammatory drug in the recovery room. Twelve (11.7%) patients had complications in recovery, principally nausea and vomiting. Eight (7.8%) patients were admitted to the hospital. No serious complications were associated with ambulatory surgery. Its introduction could possibly be a solution to improving pediatric surgical access in low-income countries.

  9. A comparative study of short- and medium-term outcomes comparing emergent surgery and stenting as a bridge to surgery in patients with acute malignant colonic obstruction.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2013-04-01

    The use of self-expanding metal stents as a bridge to surgery in the setting of malignant colorectal obstruction has been advocated as an acceptable alternative to emergency surgery. However, concerns about the safety of stenting have been raised following recent randomized studies.

  10. Understanding people's experience of vitreo-retinal day surgery: a Gadamerian-guided study.

    Science.gov (United States)

    McCloud, Christine; Harrington, Ann; King, Lindy

    2012-01-01

    This paper is a report of a study that aimed to understand the individual's experience of day surgery for repair of vitreo-retinal pathology. Day surgery evolved as a global phenomenon in response to tensions existing between community demand for health-care services and fiscal limitations. Since then vitreo-retinal surgery has been routinely performed as day surgery. Whilst studies have reported on patients' experience's following inpatient surgery, there has been limited investigation of vitreo-retinal day surgery from the patient's perspective. In-depth unstructured interviews with 18 people were conducted between July 2006 and December 2007. Data analysis using philosophical hermeneutic techniques enabled a co-constructed understanding, where, the 'conditions of understanding' as described by Gadamer were established. Guided by a Gadamerian approach to analysis, four constitutive themes were identified: 'the physical Self', 'the psychological Self', 'the historically located Self' and 'the Self located in the community'. Within each theme the participant's positive and negative experiences were understood in the context of human need, and gaps in nursing care became illuminated. These experiences included: pain, nausea, problematic self-care and psychological angst. Insights into the experience of vitreo-retinal day surgery, gained from this study can be used to inform nurses planning care for people with vitreo-retinal pathology. Nursing care must address broader patient needs that span multiple human domains, particularly when vision has been threatened by complex pathology. © 2011 Blackwell Publishing Ltd.

  11. The effects of healing touch on pain, nausea, and anxiety following bariatric surgery: a pilot study

    National Research Council Canada - National Science Library

    Anderson, Joel G; Suchicital, Liliana; Lang, Maria; Kukic, Azra; Mangione, Lucrezia; Swengros, Diane; Fabian, Jennifer; Friesen, Mary Ann

    2015-01-01

    ... such as Healing Touch. A quasi-experimental study was conducted to determine the feasibility of a Healing Touch intervention for reducing pain, nausea, and anxiety in patients undergoing laparoscopic bariatric surgery...

  12. The comparative study of epidural levobupivacaine and bupivacaine in major abdominal surgeries

    Directory of Open Access Journals (Sweden)

    Ali Uzuner

    2011-01-01

    Conclusions: The results of our study suggest that same concentration of epidural levobupivacaine and bupivacaine with fentanyl provide stable postoperative analgesia and both were found safe for the patients undergoing major abdominal surgery.

  13. Feasibility of dexmedetomidine as sole analgesic agent during robotic urological surgery: A pilot study

    Directory of Open Access Journals (Sweden)

    Bright Jebaraj

    2017-01-01

    Conclusion: The study reveals that dexmedetomidine has equal analgesic efficacy as fentanyl for intraoperative use and can be used as the sole analgesic agent in patients undergoing robotic urological surgery.

  14. Postoperative Pain, an Unmet Problem in Day or Overnight Italian Surgery Patients: A Prospective Study

    Science.gov (United States)

    Antonielli D'Oulx, Maria Delfina; Paradiso, Rosetta; Perretta, Laura; Dimonte, Valerio

    2016-01-01

    Background. Because of economic reasons, day surgery rates have steadily increased in many countries and the trend is to perform around 70% of all surgical procedures as day surgery. Literature shows that postoperative pain treatment remains unfulfilled in several fields such as orthopedic and general surgery patients. In Italy, the day surgery program is not yet under governmental authority and is managed regionally by local practices. Aim. To investigate the trends in pain intensity and its relation to type of surgeries and pain therapy protocols, in postoperative patients, discharged from three different Ambulatory Surgeries located in North West Italy (Piedmont region). Method. The present study enrolled 276 patients who undergone different surgical procedures in ambulatory regimen. Patients recorded postoperative pain score twice a day, compliance with prescribed drugs, and pain related reasons for contacting the hospital. Monitoring lasted for 7 days. Results. At discharge, 72% of patients were under weak opioids, 12% interrupted the treatment due to side effects, 17% of patients required extra drugs, and 15% contacted the hospital reporting pain problems. About 50% of patients experienced moderate pain during the first day after surgery. Results from our study show that most of the patients experienced avoidable pain after discharge. PMID:28115878

  15. Use of Chinese Medicine and Subsequent Surgery in Women with Uterine Fibroid: A Retrospective Cohort Study

    Directory of Open Access Journals (Sweden)

    Shan-Yu Su

    2012-01-01

    Full Text Available Background. Chinese medicine (CM has been used to relieve symptoms relevant to uterine fibroids. Objective. This study investigated the association between the use of CM and the incidence of uterine surgery in women with uterine fibroids. Subjects and Methods. This retrospective cohort study extracted records for 16,690 subjects diagnosed with a uterine fibroid between 2000 and 2003 from the National Health Insurance reimbursement database. The risk factors for surgery were examined via Cox proportional hazard analysis, and the difference in incidence of surgery between CM users and nonusers was compared using incidence rate ratios (IRRs derived from Poisson's models. Results. After an average follow-up period of 4.5 years, the cumulative incidence of uterine surgery was significantly lower in CM users than CM nonusers (P<0.0001. Compared to CM nonusers, CM users were more unlikely to undergo uterine surgery (adjusted hazard ratio = 0.18, 95% confidence interval (CI = 0.17, 0.19. The incidence of surgery in CM users was dramatically different from that for CM nonusers (IRR = 0.17, 95% CI = 0.16, 0.18. Conclusion. The risk of uterine surgery among fibroid patients who used CM was significantly decreased, implying an effective treatment of fibroid-related symptoms provided by CM.

  16. Are Burnt-out Doctors Prone to Seek Cosmetic Surgery? A Cross-Sectional Study.

    Science.gov (United States)

    Milothridis, Panagiotis; Pavlidis, Leonidas; Panagopoulou, Efharis

    2017-12-01

    Studies have so far examined several psychosocial factors associated with an interest in aesthetic plastic surgery. Among them, gender, teasing history, marital status, education, social networks and body dysmorphic disorders are all predictors of interest in cosmetic surgery. Given the fact that professional status can influence health-related attitudes, our objective was firstly to identify if medical professionals are more likely to express interest in plastic surgery compared to non-medical professionals. Secondary, given the high rate of burn-out among physicians, the study examined the association between burn-out and interest in plastic surgery. One hundred doctors and 100 non-medical professionals with a University degree completed a questionnaire regarding their interest in undergoing cosmetic plastic surgery, in particular minimally invasive procedures and 9 specific aesthetic operations. Additionally, doctors completed the standardized Maslach burn-out inventory. The sample consisted of 40.5% men and 59.5% women (mean age = 34 years). Data analysis using the Mann-Whitney test revealed that women and medical professionals were more likely to express interest in cosmetic plastic surgery (p cosmetic procedures and burn-out syndrome (r = 0.53 p surgery may be attributed to their familiarity with invasive procedures. The correlation between burn-out syndrome and interest in cosmetic surgery could reveal a way of coping with the work demands. Results of this study can be used for the development of clinical tools for the screening of patients for elective cosmetic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  17. Robotic Surgery Readiness (RSR): A Prospective Randomized Skills Decay Recognition and Prevention Study

    Science.gov (United States)

    2016-08-01

    AWARD NUMBER: W81XWH-15-2-0030 TITLE: Robotic Surgery Readiness (RSR): A Prospective Randomized Skills Decay Recognition and Prevention Study...20164. TITLE AND SUBTITLE Robotic Surgery Readiness (RSR): A Prospective Randomized Skills Decay 5a. CONTRACT NUMBER R ognition and Prevention Study...design and skill decay model construction. Supply purchasing and acquisition for all four sites was also completed during this period. Working with

  18. The Zelnorm epidemiologic study (ZEST: a cohort study evaluating incidence of abdominal and pelvic surgery related to tegaserod treatment

    Directory of Open Access Journals (Sweden)

    Seeger John D

    2012-11-01

    Full Text Available Abstract Background Pre-marketing clinical studies of tegaserod suggested an increased risk of abdominal surgery, particularly cholecystectomy. We sought to quantify the association between tegaserod use and the occurrence of abdominal or pelvic surgery, including cholecystectomy. Methods This cohort study was conducted within an insured population. Tegaserod initiators and similar persons who did not initiate tegaserod were followed for up to six months for the occurrence of abdominal or pelvic surgery. Surgical procedures were identified from health insurance claims validated by review of medical records. The incidence of confirmed outcomes was compared using both as-matched and as-treated analyses. Results Among 2,762 tegaserod initiators, there were 94 abdominal or pelvic surgeries (36 gallbladder: among 2,762 comparators there were 134 abdominal or pelvic surgeries (37 gallbladder (hazard ratio HR] = 0.70, 95% confidence interval [C.I.] = 0.54-0.91 overall, HR = 0.98, 95% C.I. = 0.62-1.55 for gallbladder. Current tegaserod exposure compared to nonexposure was associated with a rate ratio [RR] of 0.68 (95% C.I. = 0.48-0.95 overall, while the RR was 0.99 (95% C.I. = 0.56-1.77 for gallbladder surgery. Conclusions In this study, tegaserod use was not found to increase the risk of abdominal or pelvic surgery nor the specific subset of gallbladder surgery.

  19. Surgery for the psyche: a longitudinal study of women undergoing reduction mammoplasty.

    Science.gov (United States)

    Hollyman, J A; Lacey, J H; Whitfield, P J; Wilson, J S

    1986-04-01

    This study suggests that surgery is effective in relieving the psychological distress of women requesting reduction mammoplasty for minimal deformity. Eleven young women who applied for operation on the NHS completed measures of psychoneurosis, mood, self-esteem and body perception. Prior to operation they had a distorted body image, low self-esteem and abnormal psychoneurotic profiles. Following surgery body image returned to a normal range; their self-confidence, and view of their femininity and sexual attractiveness were also enhanced. Improvement was maintained during 6 months of follow-up. These results have implications for the NHS provision of cosmetic surgery for such patients.

  20. Circadian actigraphic rest-activity rhythms following surgery for endometrial cancer: A prospective, longitudinal study.

    Science.gov (United States)

    Rumble, Meredith E; Rose, Stephen L; White, Kaitlin Hanley; Moore, A Holliston; Gehrman, Philip; Benca, Ruth M; Costanzo, Erin S

    2015-06-01

    To investigate (1) circadian rest-activity rhythm disturbances among endometrial cancer patients as they recover from surgery in comparison to a historical reference group of women with no cancer history and (2) health- and treatment-related predictors of dysregulated rest-activity rhythms in endometrial cancer patients. 60 endometrial cancer patients participated in a prospective, longitudinal study with actigraphic assessment at 1week, 1month, and 4months post-surgery. 60 women without cancer from an epidemiological sample completed one actigraphic assessment, acting as a reference group. On average, results revealed initial significant rest-activity dysregulation at 1week and 1month post-surgery for the endometrial cancer group and then significant recovery in rest-activity patterns at 4months post-surgery. Similarly, the cancer group had significantly more impaired rhythms than the reference group at 1week post-surgery, but demonstrated comparable rhythms by 4months post-surgery. Among the health- and treatment-related variables examined, obesity and receipt of more invasive surgery were found to predict more impaired rhythms at all time points. The current study highlights significant disturbances in rest-activity patterns for endometrial cancer patients initially during surgical recovery followed by improvement in these patterns by 4months post-surgery; however, obese patients and those having more invasive surgery demonstrated more impaired rest-activity patterns throughout the 4-month recovery period. Further research is warranted to understand how more impaired rest-activity patterns relate to health and quality of life outcomes. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Female plastic surgery patients prefer mirror-reversed photographs of themselves: A prospective study.

    Science.gov (United States)

    de Runz, Antoine; Boccara, David; Chaouat, Marc; Locatelli, Katia; Bertheuil, Nicolas; Claudot, Frédérique; Bekara, Farid; Mimoun, Maurice

    2016-01-01

    The use of a patient's image in plastic surgery is common today. Thus, plastic surgeons should master the use of the image and be aware of the implications of the patients' perception of themselves. The mere-exposure effect is a psychological phenomenon in which a person tends to rate things more positively merely because (s)he is familiar with them. Faces are asymmetric, so faces in photos are different from those observed in mirrors. The main objective of this study was to assess whether patients within a plastic surgery population, particularly those undergoing facial aesthetic surgery, preferred standard photographs or mirror-reversed photographs of themselves. A prospective study was conducted in a plastic surgery department, which included women who were admitted to the hospital the day before their procedures. The patients were separated into the following two groups: Group 1 was composed of patients who were undergoing facial aesthetic surgeries, and Group 2 consisted of other patients who presented to the plastic surgery department for surgery. The patients were required to rate their appreciation of their own faces and to choose between standard and mirror-reversed photos of themselves. A total of 214 patients participated. The median age was 47.9 years (interquartile range (IQR): 36.4-60.6), and the median face appreciation was 5 (IQR: 5-7). The preference for the mirror-reversed photograph was significantly different from chance (p Plastic surgery patients have a significant preference for mirror-reversed photographs of themselves over standard photographs. This preference is even more pronounced among patients who are undergoing facial aesthetic surgery. III. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. Relationships between study habits, burnout, and general surgery resident performance on the American Board of Surgery In-Training Examination.

    Science.gov (United States)

    Smeds, Matthew R; Thrush, Carol R; McDaniel, Faith K; Gill, Roop; Kimbrough, Mary K; Shames, Brian D; Sussman, Jeffrey J; Galante, Joseph M; Wittgen, Catherine M; Ansari, Parswa; Allen, Steven R; Nussbaum, Michael S; Hess, Donald T; Knight, David C; Bentley, Frederick R

    2017-09-01

    The American Board of Surgery In-Training Examination (ABSITE) is used by programs to evaluate the knowledge and readiness of trainees to sit for the general surgery qualifying examination. It is often used as a tool for resident promotion and may be used by fellowship programs to evaluate candidates. Burnout has been associated with job performance and satisfaction; however, its presence and effects on surgical trainees' performance are not well studied. We sought to understand factors including burnout and study habits that may contribute to performance on the ABSITE examination. Anonymous electronic surveys were distributed to all residents at 10 surgical residency programs (n = 326). Questions included demographics as well as study habits, career interests, residency characteristics, and burnout scores using the Oldenburg Burnout Inventory, which assesses burnout because of both exhaustion and disengagement. These surveys were then linked to the individual's 2016 ABSITE and United States Medical Licensing Examination (USMLE) step 1 and 2 scores provided by the programs to determine factors associated with successful ABSITE performance. In total, 48% (n = 157) of the residents completed the survey. Of those completing the survey, 48 (31%) scored in the highest ABSITE quartile (≥75th percentile) and 109 (69%) scored less than the 75th percentile. In univariate analyses, those in the highest ABSITE quartile had significantly higher USMLE step 1 and step 2 scores (P burnout scores (disengagement, P Burnout Inventory exhaustion (P = 0.02), and USMLE step 1 and 2 scores (P = 0.007 and 0.0001, respectively). Residents who perform higher on the ABSITE have a regular study schedule throughout the year, report less burnout because of exhaustion, study away from home, and have shown success in prior standardized tests. Further study is needed to determine the effects of burnout on clinical duties, career advancement, and satisfaction. Copyright © 2017

  3. Coagulation and fibrinolysis during lung surgery:an experimental study

    DEFF Research Database (Denmark)

    Trabjerg, Theis B; Sander, Klaus D; Nybo, Mads

    2014-01-01

    but significant decrease in antithrombin and a significant increase in aPTT. All other measured substances were virtually constant. CONCLUSIONS: A wide range of fibrinolytic and anticoagulant substances remained unchanged during experimental lung manipulation. Minor changes were transient and not considered...... substances, which are released by manipulation of the lung parenchyma during surgery. METHODS: Standardized lung manipulation, single-lung ventilation and pneumonectomy were performed in 10 anaesthetized pigs. Baseline and serial postmanipulation intravenous and intra-arterial blood samples were analysed...... for a wide range of fibrinolytic substances as well as pro- and anticoagulant factors. RESULTS: We found a transient but significant decrease in activated partial thromboplastin time (aPTT) and plasminogen activator inhibitor following manipulation of the lungs. Pneumonectomy resulted in minor...

  4. Use and Evaluation of a Cooling Aid in Laser-Assisted Dental Surgery: An Innovative Study.

    Science.gov (United States)

    Bernardi, Sara; Mummolo, Stefano; Zeka, Keti; Pajewski, Leonardo; Continenza, Maria Adelaide; Marzo, Giuseppe

    2016-06-01

    The aim of this study was to evaluate the beneficial effect of NeoHeal during laser-assisted oral surgery. Laser-assisted surgery is a less invasive technique than conventional surgery using a blade; however, the heat produced by the laser can damage tissue proximal to the treated area. We hypothesized the hydrogel NeoHeal could be applied during oral surgery and have similar benefits as those already described for dermatological surgery. In our randomized controlled trial, we first selected 30 patients who were to undergo laser surgical intervention using a diode laser. Both at the end of intervention and at follow-up, each patient filled out a questionnaire comprising two questions. The answers to the questions were statistically analyzed with regard to frequency of each response, and validated by the Wilcoxon test with a p value <0.05 being considered significant. The use of NeoHeal significantly reduced the pain experienced by patients both during the intervention and at the 7-day follow-up. NeoHeal clearly reduces surgery-related pain experienced by patients. The results show positive feedback from the patients, demonstrating how the hydrogel pads are necessary, useful, and effective as a cooling aid in laser-assisted dental surgery.

  5. Contraception, Menstruation, and Sexuality after Bariatric Surgery: a Prospective Cohort Study.

    Science.gov (United States)

    Luyssen, Julie; Jans, Goele; Bogaerts, Annick; Ceulemans, Dries; Matthys, Christophe; Van der Schueren, Bart; Lannoo, Matthias; Verhaeghe, Johan; Lemmens, Luc; Lannoo, Lore; Shaw, Jill; Devlieger, Roland

    2017-12-02

    Women with a history of bariatric surgery are recommended to avoid pregnancy at least 12 months after surgery. Evidence on the impact of bariatric surgery on contraception, menstrual cycle, and sexuality in the first year postoperative is therefore indispensable. The objective of this paper is to prospectively study changes in contraception, menstrual cycle and sexuality in women of reproductive age following bariatric surgery. The study was conducted in two secondary medical centers and a tertiary academic medical center. Women attending for bariatric surgery or who recently underwent bariatric surgery completed online questionnaires about contraception, menstrual cycle, and sexual behavior before surgery and 6 and 12 months after surgery. The study included data from 71 women, including 70 and 47 women at 6 and 12 months after bariatric surgery, respectively. Preoperatively, 43.6% (n = 31/71) used a short-acting hormonal contraceptive, the usage of which decreased significantly to, respectively, 32.8% (n = 23/70; p = .031) and 27.7% (n = 13/47; p = .022) 6 and 12 months post-surgery. Usage of long-acting contraceptive methods increased from 26.7% (n = 19/71) preoperatively to 38.6% (n = 27/70; p = .021) and 42.6% (n = 20/47; p = .004) at 6 and 12 months. Combined oral contraceptives (COC) remained used (39.4% preoperatively, 27.1 and 14.9% at 6 and 12 months postoperatively). Menstrual cycle (frequency, pattern, duration of the cycle, and the menstruation itself) and sexual behavior (intimate relationship, frequency of intercourse, and satisfaction) did not differ significantly before and after surgery. Women undergoing bariatric surgery appear to switch their type of contraceptive from oral, short-acting hormonal contraceptives to non-oral, long-acting contraceptives. No changes in menstrual cycle and sexual behavior were shown.

  6. Bariatric Surgery and the Incidence of Psoriasis and Psoriatic Arthritis in the Swedish Obese Subjects Study.

    Science.gov (United States)

    Maglio, Cristina; Peltonen, Markku; Rudin, Anna; Carlsson, Lena M S

    2017-12-01

    The aim of this study was to assess the effect of bariatric surgery (vertical gastroplasty, gastric banding, or gastric bypass) compared with usual care on the incidence of psoriasis and psoriatic arthritis (PsA) in the Swedish Obese Subjects study. This report includes 1,991 subjects who underwent bariatric surgery and 2,018 controls with obesity from the SOS study; none of them had psoriasis or PsA at baseline. Information about psoriasis and PsA diagnosis was retrieved through the Swedish National Patient Register and questionnaires. During follow-up for up to 26 years, bariatric surgery was associated with a lower incidence of psoriasis compared with usual care (number of events = 174; hazard ratio 0.65; 95% CI: 0.47-0.89; P = 0.008). Both smoking and a longer duration of obesity were independently associated with a higher risk for psoriasis. No significant difference was detected among the three surgical procedures in terms of lowering the risk of developing psoriasis. The association between bariatric surgery and psoriasis incidence was not influenced by baseline confounders. No significant difference in the risk of developing PsA (number of events = 46) was detected when comparing the surgery and the control groups. This study shows that bariatric surgery is associated with a lower risk of developing psoriasis compared with usual care. © 2017 The Authors. Obesity published by Wiley Periodicals, Inc. on behalf of The Obesity Society (TOS).

  7. Association between research sponsorship and study outcome in plastic surgery literature.

    Science.gov (United States)

    Momeni, Arash; Becker, Axel; Bannasch, Holger; Antes, Gerd; Blümle, Anette; Stark, G Björn

    2009-12-01

    Financial and other competing interests have recently received increasing attention. In particular clinical research in plastic surgery attracts for-profit organizations, thus, explaining the increasing number of financial sponsorships. However, research articles often lack sufficient description of study design as well as disclosure of the source of funding. Furthermore, debate exists whether industry funding influences research findings and is leading to pro-industry results. A hand search was conducted identifying all randomized controlled (RCT) and controlled clinical trials (CCT) in 4 plastic surgery journals (Plastic and Reconstructive Surgery, British Journal of Plastic Surgery, Annals of Plastic Surgery, and Aesthetic Plastic Surgery) between 1990 and 2005. Subsequently, the influence of financial support on study outcome was analyzed. A total of 10,476 original articles were analyzed, resulting in the identification of 346 clinical trials which meet the Cochrane criteria for RCTs and CCTs. One hundred eighty-three trials and 163 studies were found to be RCTs and CCTs, respectively. Hereof, only 70 trials (20.2%) reported on grant support. Of these, 42 trials (60%) were supported by the industry. Depending on the topic addressed marked differences were detected regarding grant support. Studies with a focus on reconstructive plastic surgery were supported by the industry and by public institutions in almost equal shares (18 trials vs. 15 trials), whereas aesthetic surgical topics were predominantly funded by the industry (13 trials vs. 6 trials). Industry-funded trials reported more often statistically significant differences between treatment arms (28 trials vs. 16 trials). Authors' conclusions were found to be positively associated with financial competing interests. However, trial funding is rarely declared in the plastic surgery literature. Thus, the quality of reporting needs to be improved to be able to investigate these relationships in greater detail

  8. Early career choices and successful career progression in surgery in the UK: prospective cohort studies

    OpenAIRE

    Richards Jennifer MJ; Harrison Ewen M; Laxton Louise; Goldacre Michael J; Lambert Trevor W; Parks Rowan W

    2010-01-01

    Abstract Background Changes to the structure of medical training worldwide require doctors to decide on their career specialty at an increasingly early stage after graduation. We studied trends in career choices for surgery, and the eventual career destinations, of UK graduates who declared an early preference for surgery. Methods Postal questionnaires were sent, at regular time intervals after qualification, to all medical qualifiers from all UK medical schools in selected qualification year...

  9. The impact of breast reduction surgery on breastfeeding: Systematic review of observational studies.

    Science.gov (United States)

    Kraut, Roni Y; Brown, Erin; Korownyk, Christina; Katz, Lauren S; Vandermeer, Ben; Babenko, Oksana; Gross, M Shirley; Campbell, Sandy; Allan, G Michael

    2017-01-01

    Almost half a million breast reduction surgeries are performed internationally each year, yet it is unclear how this type of surgery impacts breastfeeding. This is particularly important given the benefits of breastfeeding. To determine if breast reduction surgery impacts breastfeeding success and whether different surgical techniques differentially impact breast feeding success. Databases were searched up to September 5, 2017. Studies were included if they reported the number of women successful at breastfeeding or lactation after breast reduction surgery, and if they reported either the total number of women who had children following breast reduction surgery, or the total number of women who attempted to breastfeed following surgery. Of 1,212 studies, 51 studies met the inclusion criteria; they were located worldwide and had 31 distinct breast reduction techniques. The percentage of breastfeeding success among studies was highly variable. However, when analyzed by the preservation of the column of parenchyma from the nipple areola complex to the chest wall (subareolar parenchyma), a clear pattern emerged. The median breastfeeding success was 4% (interquartile range (IQR) 0-38%) for techniques with no preservation, compared to 75% (IQR 37-100%) for techniques with partial preservation and 100% (IQR 75-100%) for techniques with full preservation. Techniques that preserve the column of subareolar parenchyma appear to have a greater likelihood of successful breastfeeding. The preservation of the column of subareolar parenchyma should be disclosed to women prior to surgery. Guidelines on the best breast reduction techniques to be used in women of child bearing years may be advantageous to ensure women have the greatest potential for successful breastfeeding after breast reduction surgery.

  10. Outcomes study between femtosecond laser-assisted cataract surgery and conventional phacoemulsification surgery using an active fluidics system

    Directory of Open Access Journals (Sweden)

    Hida WT

    2017-09-01

    Full Text Available Wilson Takashi Hida,1–4 Patrick Frenzel Tzelikis,1–3 César Vilar,1,2 Mario Augusto Pereira Dias Chaves,1,2,5 Antônio Francisco Pimenta Motta,1–3 Pedro Carlos Carricondo,1–3 Bruna Vieira Ventura,1,2,4,6 Renato Ambrosio Junior,1–3 Walton Nosé,1,2,4 Milton Ruiz Alves1–3 1Department of Cataract of Brasília Ophthalmology Hospital (HOB, Brasília, Federal District, 2Renato Ambrosio Research Center (CEORA, Brasília, Federal District, 3Department of Ophthalmology of São Paulo University School of Medicine, (FM-USP, São Paulo, 4Department of Ophthalmology of São Paulo Federal University (UNIFESP School of Medicine, São Paulo, 5ProVisão Hospital, João Pessoa, Paraíba, 6Pernanbuco Eye Hospital (HOPE, Recife, Pernambuco, Brazil Purpose: The purpose of this study was to compare intraoperative parameters between femtosecond laser-assisted cataract surgery (FLACS and conventional phacoemulsification using Centurion® Vision System with Active Fluidics. Setting: This study was performed at Brasília Ophthalmologic Hospital, Brasília, Federal District, Brazil. Patients and methods: This was a prospective randomized comparative study. Patients with the diagnosis of cataract and surgical extraction programmed were divided into two groups: conventional phacoemulsification and FLACS. Intraoperative data were collected and submitted for statistical analysis. Results: A total of 400 eyes were enrolled, 200 in each group. There were no surgical complications. Groups were statistically equivalent in age and nucleus density. Cumulative dissipated energy and torsional time were significantly reduced in the FLACS group. Conventional surgery had less fluid usage, total case time and aspiration (ASP time. Conclusion: FLACS with Active Fluidics System can reduce the ultrasound energy use during cataract surgery, in spite of increasing case time, fluid usage and ASP time. Keywords: FLACS, ultrasound, aspiration

  11. Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative

    NARCIS (Netherlands)

    Rongen, J.J.; Rovers, M.M.; Tienen, T.G. van; Buma, P; Hannink, G.J.

    2017-01-01

    OBJECTIVE: The primary objective was to assess whether patients with knee osteoarthritis and whom undergo arthroscopic meniscectomy have an increased risk for future knee replacement surgery. DESIGN: Data used were obtained from the Osteoarthritis Initiative (OAI) study. SETTING: Participants were

  12. Tissue engineering and surgery: from translational studies to human trials

    Directory of Open Access Journals (Sweden)

    Vranckx Jan Jeroen

    2017-06-01

    Full Text Available Tissue engineering was introduced as an innovative and promising field in the mid-1980s. The capacity of cells to migrate and proliferate in growth-inducing medium induced great expectancies on generating custom-shaped bioconstructs for tissue regeneration. Tissue engineering represents a unique multidisciplinary translational forum where the principles of biomaterial engineering, the molecular biology of cells and genes, and the clinical sciences of reconstruction would interact intensively through the combined efforts of scientists, engineers, and clinicians. The anticipated possibilities of cell engineering, matrix development, and growth factor therapies are extensive and would largely expand our clinical reconstructive armamentarium. Application of proangiogenic proteins may stimulate wound repair, restore avascular wound beds, or reverse hypoxia in flaps. Autologous cells procured from biopsies may generate an ‘autologous’ dermal and epidermal laminated cover on extensive burn wounds. Three-dimensional printing may generate ‘custom-made’ preshaped scaffolds – shaped as a nose, an ear, or a mandible – in which these cells can be seeded. The paucity of optimal donor tissues may be solved with off-the-shelf tissues using tissue engineering strategies. However, despite the expectations, the speed of translation of in vitro tissue engineering sciences into clinical reality is very slow due to the intrinsic complexity of human tissues. This review focuses on the transition from translational protocols towards current clinical applications of tissue engineering strategies in surgery.

  13. Urogenital function in robotic vs laparoscopic rectal cancer surgery: a comparative study.

    Science.gov (United States)

    Panteleimonitis, Sofoklis; Ahmed, Jamil; Ramachandra, Meghana; Farooq, Muhammad; Harper, Mick; Parvaiz, Amjad

    2017-02-01

    Urological and sexual dysfunction are recognised risks of rectal cancer surgery; however, there is limited evidence regarding urogenital function comparing robotic to laparoscopic techniques. The aim of this study was to assess the urogenital functional outcomes of patients undergoing laparoscopic and robotic rectal cancer surgery. Urological and sexual functions were assessed using gender-specific validated standardised questionnaires. Questionnaires were sent a minimum of 6 months after surgery, and patients were asked to report their urogenital function pre- and post-operatively, allowing changes in urogenital function to be identified. Questionnaires were sent to 158 patients (89 laparoscopy, 69 robotic) of whom 126 (80 %) responded. Seventy-eight (49 male, 29 female) of the responders underwent laparoscopic and 48 (35 male, 13 female) robotic surgery. Male patients in the robotic group deteriorated less across all components of sexual function and in five components of urological function. Composite male urological and sexual function score changes from baseline were better in the robotic cohort (p robotic group (p = 0.003). Robotic rectal cancer surgery might offer better post-operative urological and sexual outcomes compared to laparoscopic surgery in male patients and better urological outcomes in females. Larger scale, prospective randomised control studies including urodynamic assessment of urogenital function are required to validate these results.

  14. Occurrence of trigeminocardiac reflex during dental implant surgery: An observational prospective study.

    Science.gov (United States)

    Huang, James I-Sheng; Yu, Hui-Chieh; Chang, Yu-Chao

    2017-10-01

    Trigeminocardiac reflex (TCR) is a clinical phenomenon that manifests as s sudden onset of hemodynamic perturbations. TCR has been reported in cranio-maxillofacial surgery resulting in severe medical risks. Monitoring the hemodynamic changes during cranio-maxillofacial surgery can provide important information to ensure the continuous evaluation of patient's physical conditions. This prospective observational study was conducted to determine the hemodynamic alterations related to the possibly of occurrence of TCR in patients during dental implant surgery. One hundred and thirty-five patients (69 males and 66 females) received dental implant placement were enrolled in this study. The hemodynamic changes were evaluated by monitoring heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse oximetry (SpO2). The above data were collected before, during, and after dental implant surgery. The data demonstrated that the minimal values of HR, SBP, and DBP as well as MABP decreased significantly during operation comparing with the corresponding values before operation (p dental implant placement in the mandible, patients received dental implant placement in the maxilla had more risks to confront with MABP reduction (OR = 3.98; 95% confidence interval: 1.12-13.2). A significant HR and BP reduction possibly due to TCR can occur during dental implant surgery. Therefore, the dentists should monitor the hemodynamic changes during dental implant surgery to prevent the possible occurrence of medical risks related to TCR. Copyright © 2017. Published by Elsevier B.V.

  15. Physical performance following acute high-risk abdominal surgery: a prospective cohort study.

    Science.gov (United States)

    Jønsson, Line Rokkedal; Ingelsrud, Lina Holm; Tengberg, Line Toft; Bandholm, Thomas; Foss, Nicolai Bang; Kristensen, Morten Tange

    2017-12-01

    Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activePAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization. Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.

  16. Is Endocan a Diagnostic Marker for Pneumonia After Cardiac Surgery? The ENDOLUNG Study.

    Science.gov (United States)

    Perrotti, Andréa; Chenevier-Gobeaux, Camille; Ecarnot, Fiona; Bardonnet, Karine; Barrucand, Benoit; Flicoteaux, Guillaume; Lassalle, Philippe; Chocron, Sidney

    2018-02-01

    Postoperative pneumonia is frequent after cardiac surgery and is associated with increased morbidity and mortality. We tested the hypothesis that endocan is an early biomarker for the detection of pneumonia after cardiac surgery. Between January and May 2016, 155 patients scheduled to undergo elective cardiac surgery with cardiopulmonary bypass were prospectively included in the study. Serum level of endocan was measured at five timepoints (preoperative, and at 6, 24, 48, and 72 hours after the end of surgery). Procalcitonin and C-reactive protein were measured at 24 and 72 hours. The preoperative and postoperative characteristics of the patients were recorded. Independent predictors of postoperative pneumonia were identified by logistic regression. Threshold values of endocan predictive of postoperative pneumonia were determined using receiver-operating characteristics curve analysis. Seventeen patients (11%) had pneumonia after surgery. Endocan greater than 3.7 ng/mL before induction of anesthesia, or greater than 12.1 ng/mL at 6 hours after surgery, as well body mass index higher than 27 kg/m2 and duration of surgery were independent predictors of postoperative pneumonia. At induction of anesthesia, an endocan cutoff value of 3.7 ng/mL had 65% sensitivity and 72% specificity for the prediction of postoperative pneumonia; whereas at 6 hours, with a cutoff value of 12.1 ng/mL, these values were 71% and 75%, respectively. The time saved by endocan dosage compared with clinical diagnosis of postoperative pneumonia was 96 hours. This study shows that endocan is an early marker of postoperative pneumonia in patients after cardiac surgery. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Pregnancy and foetal outcome after bariatric surgery: a review of recent studies.

    Science.gov (United States)

    Dalfrà, Maria Grazia; Busetto, Luca; Chilelli, Nino Cristiano; Lapolla, Annunziata

    2012-09-01

    It is well known that maternal obesity has adverse effects on the health of offspring, causing immediate and long-term morbidities. The various types of procedure coming under the heading of bariatric surgery have proved effective in preventing some maternal and foetal complications in morbidly obese pregnant women. This review aims to assess the role, the risks and the benefits of bariatric surgery for mothers and offspring. According to recent findings, pregnancy and neonatal outcomes in morbidly obese women who have undergone bariatric surgery depend to some extent on the type of surgery used. Maternal complications, nutritional defects and intestinal obstruction are more frequently reported after Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD) than after laparoscopic adjustable gastric banding (LAGB) procedures, whereas caesarean section, preterm delivery and neonatal death are more commonly reported after RYGB than after LAGB. The authors of the only long-term follow-up study conducted on this subject reported that the rate of obesity in the children dropped by 52% after bariatric surgery for the mother, and the cases of severe obesity decreased by 45%. Data on pregnancy and bariatric surgery confirm that the procedure is more effective than dietary measures alone in morbidly obese women, and that pregnancy outcome is generally favorable after surgery. Some studies have indicated, nonetheless, that pregnancies after bariatric surgery are at higher risk: the women affected require special medical attention, particularly as concerns gastrointestinal symptoms and vitamin deficiencies, warranting nutritional/dietary counselling by a multidisciplinary team before, during and after pregnancy.

  18. Implementation of the Spanish National Enhanced Recovery Program (ERAS) in Bariatric Surgery: A Pilot Study.

    Science.gov (United States)

    Ruiz-Tovar, Jaime; Royo, Pablo; Muñoz, José L; Duran, Manuel; Redondo, Elisabeth; Ramirez, Jose M

    2016-12-01

    The essence of Enhanced Recovery After Surgery (ERAS) programs is the multimodal approach, and many authors have demonstrated safety and feasibility in fast track bariatric surgery. According to this concept, a multidisciplinary ERAS program for bariatric surgery has been developed by the Spanish fast track group (ERAS Spain). The aim of this study was to analyze the initial implementation of this Spanish National ERAS protocol in bariatric surgery. A multicentric prospective pilot study was performed, including 125 consecutive patients undergoing bariatric surgery at 3 Spanish hospitals between January and June 2015, after the Spanish National ERAS protocol in bariatric surgery. Compliance with the protocol, morbidity, mortality, hospital stay, and readmission were evaluated. Bariatric techniques performed included 68 Roux-en-Y gastric bypass (54.4%) and 57 laparoscopic sleeve gastrectomy (45.6%) cases. All surgeries were laparoscopically performed with conversion in only 1 case (0.8%). Median postoperative pain evaluated by visual analogic scale 24 hours after surgery was 2 (range, 0 to 5). Postoperative nausea or vomiting appeared in 7 patients (5.6%). Complications appeared in 6 patients (4.8%). The reoperation rate was 4%. The mortality rate was 0.8%. The median hospital stay was 2 days (range, 2 to 10 d) and readmission rate was 2.4%. The compliance of all the items of the protocol was achieved in 78.4% of the patients. The Spanish National ERAS protocol is a safe issue with a high implementation rate. It can be recommended to establish this protocol to other institutions.

  19. Organizational Factors and Long-Term Mortality after Hip Fracture Surgery. A Cohort Study of 6143 Consecutive Patients Undergoing Hip Fracture Surgery

    DEFF Research Database (Denmark)

    Lund, Caterina A; Møller, Ann M; Wetterslev, Jørn

    2014-01-01

    OBJECTIVE: In hospital and health care organizational factors may be changed to reduce postoperative mortality. The aim of this study is to evaluate a possible association between mortality and 'length of hospital stay', 'priority of surgery', 'time of surgery', or 'surgical delay' in hip fracture......, anaesthetic and surgical procedures were retrieved. PARTICIPANTS: 6143 patients aged more than 65 years undergoing hip fracture surgery. MAIN OUTCOME MEASURES: All-cause mortality. RESULTS: The one year mortality was 30% (28-31%, 95% Confidence interval (CI)). In a multivariate model 'length of hospital stay...

  20. Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: The Mitral Surgery in Octogenarians study.

    Science.gov (United States)

    Chivasso, Pierpaolo; Bruno, Vito D; Farid, Shakil; Malvindi, Pietro Giorgio; Modi, Amit; Benedetto, Umberto; Ciulli, Franco; Abu-Omar, Yasir; Caputo, Massimo; Angelini, Gianni D; Livesey, Steve; Vohra, Hunaid A

    2017-11-20

    An increasing number of octogenarians are referred to undergo mitral valve surgery for degenerative disease, and percutaneous approaches are being increasingly used in this subgroup of patients. We sought to determine the survival and its predictors after Mitral valve Surgery in Octogenarians (MiSO) in a multicenter UK study of high-volume specialized centers. Pooled data from 3 centers were collected retrospectively. To identify the predictors of short-term composite outcome of 30 days mortality, acute kidney injury, and cerebrovascular accident, a multivariable logistic regression model was developed. Multiple Cox regression analysis was performed for late mortality. Kaplan-Meier curves were generated for long-term survival in various subsets of patients. Receiver operating characteristic analysis was done to determine the predictive power of the logistic European System for Cardiac Operative Risk Evaluation. A total of 247 patients were included in the study. The median follow-up was 2.9 years (minimum 0, maximum 14 years). A total of 150 patients (60.7%) underwent mitral valve repair, and 97 patients (39.3%) underwent mitral valve replacement. Apart from redo cardiac surgery (mitral valve repair 6 [4%] vs mitral valve replacement 11 [11.3%], P = .04) and preoperative atrial fibrillation (mitral valve repair 79 [52.6%] vs mitral valve replacement 34 [35.1%], P mitral valve repair group (10.2 ± 11.8 vs 13.7 ± 15.2 in mitral valve replacement; P = .07). No difference was found between groups for duration of cardiopulmonary bypass and aortic crossclamp times. The 30-day mortality for the whole cohort was 13.8% (mitral valve repair 4.7% vs mitral valve replacement 18.6%; P mitral valve replacement (OR, 7.7; 95% CI, 4.04-14.9; P mitral valve repair vs mitral valve replacement: 89.9% vs 70.7% at 1 year, 69.6% vs 54% at 5 years, and 51.8% vs 35.5% at 10 years; P = .0005). Cox proportional hazard model results showed mitral valve replacement (hazard

  1. Therapeutic efficacy of bromelain in impacted third molar surgery: a randomized controlled clinical study.

    Science.gov (United States)

    Ordesi, Paolo; Pisoni, Luca; Nannei, Pierluigi; Macchi, Maurizia; Borloni, Roberto; Siervo, Sandro

    2014-09-01

    Bromelain is the name given to a family of proteolytic enzymes obtained from Ananas comosus, the pineapple plant. It is considered a potent anti-inflammatory and antiedematous substance. Surgery of impacted third molars in the outpatient setting is one of the procedures most often associated with postoperative pain and swelling. The aim of this study was to evaluate the efficacy of bromelain in reducing postoperative pain and swelling. 80 patients were recruited to the study from patients attending the Maxillofacial Surgery Unit of the Istituto Stomatologico Italiano, Milan, Italy, for impacted third molar surgery. At time 0 when surgery was performed, patients started simultaneous antibiotic and analgesic therapy. On the following day, patients were divided into two groups. Patients in group 1 were prescribed bromelain. Patients in group 2 were prescribed only the analgesic if required. Three parameters were evaluated: pain, edema, and erythema. The first evaluation visit was performed 3 hours after surgery, the second 48 hours after surgery, and the final evaluation 7 days after surgery. Postoperative pain, edema, and erythema were significantly lower in the study group than in the control group. Analgesic consumption, both in terms of days of treatment and number of tablets taken, was slightly lower in the study group. Only one adverse event was recorded, which occurred in a patient in the control group. The present study demonstrates an important anti-inflammatory and anti-edematous effect of bromelain. Statistical analysis shows that in the group treated with bromelain the inflammatory response was significantly less than in the control group.

  2. Quality of life after surgery for intractable partial epilepsy in children: a cohort study with controls.

    Science.gov (United States)

    Mikati, Mohamad A; Ataya, Nour; Ferzli, Jessica; Kurdi, Rana; El-Banna, Diana; Rahi, Amal; Shamseddine, Alhan; Sinno, Durriyah; Comair, Youssef

    2010-08-01

    Investigate if quality of life (QOL) normalizes on long-term follow-up after surgery for partial epilepsy in children. This is a cohort study with controls in which a consecutive cohort of nineteen 2-14-year-old children who underwent focal resections for intractable partial seizures between 1996 and 2006, were matched with 19 non-surgery intractable partial epilepsy patients, and with 19 healthy subjects. The two epilepsy groups were matched for age, sex, socio-economic status (SES), cognitive level, seizure type, and seizure frequency. The healthy group was matched with the two epilepsy groups for age, sex, SES, and cognitive level. QOL was assessed using the QOLCE (Quality of Life in Childhood Epilepsy Questionnaire). In the surgery group (follow-up 3.84+/-2.26 years), 78.9% had Engel class-I versus 21.1% in non-surgery (p=0.01) (follow-up 3.44+/-2.95 years). Surgery patients were similar to healthy subjects in the social, emotional, cognitive, behavioral, and overall QOL (p>0.05) but had lower scores in the total QOL, physical, and health domains (p0.05, power>0.8). Our data indicate that epilepsy surgery for partial seizures in children is associated with better QOL as compared to children with intractable epilepsy who are not operated on, and suggest that in those who achieve seizure freedom normal QOL may at least potentially be possible.

  3. Incidence of myofascial pain syndrome in breast cancer surgery: a prospective study.

    Science.gov (United States)

    Torres Lacomba, María; Mayoral del Moral, Orlando; Coperias Zazo, José Luís; Gerwin, Robert D; Goñí, Alvaro Zapico

    2010-05-01

    Pain after breast cancer therapy is a recognized complication found to have an adverse impact on patient's quality of life, increasing psychosocial distress. In recent years, case reports about myofascial pain syndrome are emerging in thoracic surgery as a cause of postsurgery pain. Myofascial pain syndrome is a regional pain syndrome characterized by myofascial trigger points in palpable taut bands of skeletal muscle that refers pain a distance, and that can cause distant motor and autonomic effects. The objective of this study was to assess the incidence of myofascial pain syndrome prospectively 12 months after breast cancer surgery. Each participant was assessed preoperatively, postoperatively between day 3 and day 5, and at 1, 3, 6, and 12 months after surgery. A physical therapist, expert in the diagnosis of myofascial pain syndrome, performed follow-up assessments. Pain descriptions by the patients and pain pattern drawings in body forms guided the physical examination. The patients were not given any information concerning myofascial pain or other muscle pain syndromes. One year follow-up was completed by 116 women. Of these, 52 women developed myofascial pain syndrome (44.8%, 95% confidence interval: 35.6, 54.3). Myofascial pain syndrome is a common source of pain in women undergoing breast cancer surgery that includes axillary lymph node dissection at least during the first year after surgery. Myofascial pain syndrome is one potential cause of chronic pain in breast cancer survivors who have undergone this kind of surgery.

  4. Sevoflurane requirement during elective ankle day surgery: the effects of etirocoxib premedication, a prospective randomised study

    Directory of Open Access Journals (Sweden)

    Jakobsson Jan G

    2008-09-01

    Full Text Available Abstract Background Anti-inflammatory drugs, NSAIDs, have become an important part of the pain management in day surgery. The aim of the present study was to evaluate the effect of Coxib premedication on the intra-operative anaesthetic requirements in patients undergoing elective ankle surgery in general anaesthesia. Type of study Prospective, randomized study of the intra-operative anaesthetic-sparing effects of etoricoxib premedication as compared to no NSAID preoperatively. Methods The intra-operative requirement of sevoflurane was studied in forty-four ASA 1–2 patients undergoing elective ankle day surgical in balanced general anaesthesia. Primary study endpoint was end-tidal sevoflurane concentration to maintain Cerebral State Index of 40 – 50 during surgery. Results All anaesthesia and surgery was uneventful, no complications or adverse events were noticed. The mean end-tidal sevoflurane concentration intra-operatively was 1.25 (SD 0.2 and 0.91 (SD 0.2 for the pre and post-operative administered group of patients respectively (p Conclusion Coxib premedication before elective day surgery has an anaesthetic sparing potential.

  5. Cost minimization analysis of laparoscopic surgery for colorectal cancer within the enhanced recovery after surgery (ERAS) protocol: a single-centre, case-matched study

    OpenAIRE

    Michał Pędziwiatr; Mateusz Wierdak; Michał Nowakowski; Magdalena Pisarska; Maciej Stanek; Michał Kisielewski; Maciej Matłok; Piotr Major; Stanisław Kłęk; Andrzej Budzyński

    2016-01-01

    Introduction: The goal of modern medical treatment is to provide high quality medical care in a cost-effective environment. Aim : To assess the cost-effectiveness of laparoscopic colorectal surgery combined with the enhanced recovery after surgery protocol (ERP) in Poland. Material and methods : We designed a single-centre, case-matched study. Economic and clinical data were collected in 3 groups of patients (33 patients in each group): group 1 – patients undergoing laparoscopy wit...

  6. Plastic surgery in bariatric patients: a nationwide study of 17,000 patients on the national administrative database.

    Science.gov (United States)

    Lazzati, Andrea; Katsahian, Sandrine; Maladry, David; Gerard, Emma; Gaucher, Sonia

    2018-01-12

    Bariatric patients are often candidates for plastic surgery. However, the rate of postbariatric procedures is not known. The aim of this study was to analyze the rate of plastic surgery, and factors related to surgery, in bariatric patients. University hospital, France. This was a cohort study based on administrative data. All adult patients who received bariatric surgery in France between 2007 and 2013 were included to estimate the rate of plastic surgery and related predictive factors. Data are reported according to the reporting of studies conducted using observational routinely collected data guidelines for observational studies on administrative data. Among the 183,514 patients who underwent bariatric surgery in the study period, 23,120 plastic surgeries were performed on 17,695 patients, including abdominoplasty (62%), dermolipectomy of the upper or lower limbs (25%), and reconstruction of the breast (14%). The rates of plastic surgery were 13%, 18%, and 21% at 3, 5, and 7 years post-bariatric surgery, respectively. Multivariate analysis revealed that patients who had a biliopancreatic diversion or a gastric bypass had a hazard ratio of 2.67 and 2.67 for subsequent plastic surgery, respectively, compared with patients who had adjustable gastric banding. Women had a 2-fold probability of surgery compared with men (hazard ratio 2.02). Important variability in the rate of surgery was found among different hospitals; rates ranged from 6.1% to 41.3% at 5 years. This study showed that 21% of bariatric patients undergo plastic surgery. Large variability exists among hospitals, suggesting that several unmeasured factors may limit access to contouring surgery. Copyright © 2018. Published by Elsevier Inc.

  7. Comparison of inflammatory responses following robotic and open colorectal surgery: a prospective study.

    Science.gov (United States)

    Zawadzki, Marek; Krzystek-Korpacka, Malgorzata; Gamian, Andrzej; Witkiewicz, Wojciech

    2017-03-01

    Robotic colorectal surgery continues to rise in popularity, but there remains little evidence on the stress response following the procedure. The aim of this study was to evaluate the inflammatory response to robotic colorectal surgery and compare it with the response generated by open colorectal surgery. This was a prospective nonrandomized comparative study involving 61 patients with colorectal cancer. The evaluation of inflammatory response to either robotic or open colorectal surgery was expressed as changes in interleukin-1β, interleukin-1 receptor antagonist, interleukin-6, tumor necrosis factor-α, C-reactive protein, and procalcitonin during the first three postoperative days. Of the 61 patients, 33 underwent robotic colorectal surgery while 28 had open colorectal surgery. Groups were comparable with respect to age, sex, BMI, cancer stage, and type of resection. The relative increase of interleukin-1 receptor antagonist at 8 h postoperative, compared to baseline, was higher in the open group (P = 0.006). The decrease of interleukin-1 receptor antagonist on postoperative days 1 and 3, compared to the maximum at 8 h, was more pronounced in the open group than in the robotic group (P = 0.008, P = 0.006, respectively), and the relative increase of interleukin-6 at 8 h after incision was higher in the open group (P = 0.007). The relative increase of procalcitonin on postoperative days 1 and 3 was higher in the open group than the robotic group (P robotic colorectal surgery results in a less pronounced inflammatory response and more pronounced anti-inflammatory action.

  8. Employment status and sick-leave following obesity surgery: a five-year prospective cohort study

    Directory of Open Access Journals (Sweden)

    John Roger Andersen

    2015-09-01

    Full Text Available Background. Severe obesity is a risk factor for lower participation in paid work, but whether employment increases and sick leave decreases after obesity surgery is not well documented.Methods. We assessed 224 Norwegian patients with severe obesity (mean age: 40; mean BMI: 49; 61% female regarding employment status (working versus not working and the number of days of sick leave during the preceding 12 months, before and five years after obesity surgery (75% follow-up rate. Logistic regression analysis was used to study preoperative predictors of employment status after surgery.Results. There were no change in the employment rate over time (54% versus 58%, but the number of days of sick leave per year was significantly reduced, from a mean of 63 to a mean of 26, and from a median of 36 to a median of 4. Most of this change was attributable to patients with zero days of sick leave, which increased from 25% to 41%. Being female, older, having low education level, receiving disability pension and not being employed before obesity surgery were important risk factors for not being employed after obesity surgery. The type of obesity surgery, BMI and marital status were not useful predictors.Conclusions. Our findings suggest that undergoing obesity surgery is not associated with a higher rate of employment, although it may reduce the number of days of sick leave. Additional interventions are likely needed to influence the employment status of these patients. The significant preoperative predictors of not being employed in this study provide suggestions for further research.

  9. Delayed gastric emptying (DGE) after pancreatic surgery: A suggested definition by the International Study Group of Pancreatic Surgery (ISGPS)

    NARCIS (Netherlands)

    Wente, Moritz N.; Bassi, Claudio; Dervenis, Christos; Fingerhut, Abe; Gouma, Dirk J.; Izbicki, Jakob R.; Neoptolemos, John P.; Padbury, Robert T.; Sarr, Michael G.; Traverso, L. William; Yeo, Charles J.; Buechler, Markus W.

    2007-01-01

    Background. Delayed gastric emptying (DGE) is one of the most common complications after pancreatic resection. In the literature, the reported incidence of DGE after pancreatic surgery varies considerably between different surgical centers, primarily because an internationally accepted consensus

  10. Orthognathic surgery in the young cleft patient: preliminary study on subsequent facial growth.

    Science.gov (United States)

    Wolford, Larry M; Cassano, Daniel Serra; Cottrell, David A; El Deeb, Mohamed; Karras, Spiro C; Goncalves, Joao Roberto

    2008-12-01

    This study evaluated the long-term effects of orthognathic surgery on subsequent growth of the maxillomandibular complex in the young cleft patient. We evaluated 12 young cleft patients (9 male and 3 female patients), with a mean age of 12 years 6 months (range, 9 years 8 months to 15 years 4 months), who underwent Le Fort I osteotomies, with maxillary advancement, expansion, and/or downgrafting, by use of autogenous bone or hydroxyapatite grafts, when indicated, for maxillary stabilization. Five patients had concomitant osteotomies of the mandibular ramus. All patients had presurgical and postsurgical orthodontic treatment to control the occlusion. Radiographs taken at initial evaluation (T1) and presurgery (T2) were compared to establish the facial growth vector before surgery, whereas radiographs taken immediately postsurgery (T3) and at longest follow-up (T4) were used to determine postsurgical growth. Each patient's lateral cephalograms were traced, and 16 landmarks were identified and used to compute 11 measurements describing presurgical and postsurgical growth. Before surgery, all patients had relatively normal growth. After surgery, cephalograms showed statistically significant growth changes from T3 to T4, with the maxillary depth decreasing by -3.3 degrees +/- 1.8 degrees , Sella-nasion-point A by -3.3 degrees +/- 1.8 degrees, and point A-nasion-point B by -3.6 degrees +/- 2.8 degrees. The angulation of the maxillary incisors increased by 9.2 degrees +/- 11.7 degrees. Of 12 patients, 11 showed disproportionate postsurgical jaw growth. Maxillary growth occurred predominantly in a vertical vector with no anteroposterior growth, even though most patients had shown anteroposterior growth before surgery. The distance increased in the linear measurement from nasion to gnathion by 10.3 +/- 7.9 mm. Four of 5 patients operated on during the mixed dentition phase had teeth that erupted through the cleft area. A variable impairment of postoperative growth was seen

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

    Science.gov (United States)

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

    2016-01-01

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

  12. Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Roland Devlieger

    Full Text Available Studies report frequent micronutrient deficiencies after bariatric surgery, but less is known about micronutrient levels of pregnant women after bariatric surgery.To prospectively evaluate micronutrient levels and supplement intake in pregnancy following bariatric surgery.A multicenter prospective cohort study including women with restrictive or malabsorptive types of bariatric surgery. Nutritional deficiencies, together with supplement intake, were screened during pregnancy.The total population included 18 women in the restrictive and 31 in the malabsorptive group. Most micronutrients were depleted and declined significantly during pregnancy. The proportion of women with low vitamin A and B-1 levels increased to respectively 58 and 17% at delivery (P = 0.005 and 0.002. The proportion of women with vitamin D deficiency decreased from 14% at trimester 1 to 6% at delivery (P = 0.030. Mild anemia was found in respectively 22 and 40% of the women at trimester 1 and delivery. In the first trimester, most women took a multivitamin (57.1%. In the second and third trimester, the majority took additional supplements (69.4 and 73.5%. No associations were found between supplement intake and micronutrient deficiencies.Pregnant women with bariatric surgery show frequent low micronutrient levels. Supplementation partially normalizes low levels of micronutrients.

  13. Micronutrient levels and supplement intake in pregnancy after bariatric surgery: a prospective cohort study.

    Science.gov (United States)

    Devlieger, Roland; Guelinckx, Isabelle; Jans, Goele; Voets, Willy; Vanholsbeke, Caroline; Vansant, Greet

    2014-01-01

    Studies report frequent micronutrient deficiencies after bariatric surgery, but less is known about micronutrient levels of pregnant women after bariatric surgery. To prospectively evaluate micronutrient levels and supplement intake in pregnancy following bariatric surgery. A multicenter prospective cohort study including women with restrictive or malabsorptive types of bariatric surgery. Nutritional deficiencies, together with supplement intake, were screened during pregnancy. The total population included 18 women in the restrictive and 31 in the malabsorptive group. Most micronutrients were depleted and declined significantly during pregnancy. The proportion of women with low vitamin A and B-1 levels increased to respectively 58 and 17% at delivery (P = 0.005 and 0.002). The proportion of women with vitamin D deficiency decreased from 14% at trimester 1 to 6% at delivery (P = 0.030). Mild anemia was found in respectively 22 and 40% of the women at trimester 1 and delivery. In the first trimester, most women took a multivitamin (57.1%). In the second and third trimester, the majority took additional supplements (69.4 and 73.5%). No associations were found between supplement intake and micronutrient deficiencies. Pregnant women with bariatric surgery show frequent low micronutrient levels. Supplementation partially normalizes low levels of micronutrients.

  14. Outcome of Endoscopic Sinus Surgery in Inflammatory Sinonasal Patients: A Descriptive Study

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    S Hashemi

    2004-02-01

    Full Text Available Background: Various systems of Computerized Tomographic (CT staging and scoring have been applied to define the extent of sinus abnormality and the degree of mucosal thickening. Functional Endoscopic Sinus Surgery (FESS has been used with considerable success rate to treat chronic sinonasal patients unresponsive to medical therapy. This study was designed to investigate the relationship between the result of CT scoring and staging and the outcome of surgery. Methods: The one year outcome of FESS together with preoperative CT staging and scoring were determined and compared with each other. Results: Compared to those with higher stages (III and IV, patients with lower preoperative CT stages (I and II had a significantly higher successful outcome of surgery. CT staging and scoring were obviously correlated. Conclusions: The results of this study show that preoperative CT staging and scoring are two useful means for better prediction of the long–term outcome of surgery one year after FESS. Keywords: Endoscopic Sinus Surgery, Chronic sinusitis, Computerized Tomography

  15. Sequencing of bimaxillary surgery in the correction of vertical maxillary excess: retrospective study.

    Science.gov (United States)

    Salmen, F S; de Oliveira, T F M; Gabrielli, M A C; Pereira Filho, V A; Real Gabrielli, M F

    2017-12-12

    The aim of this study was to evaluate the precision of bimaxillary surgery performed to correct vertical maxillary excess, when the procedure is sequenced with mandibular surgery first or maxillary surgery first. Thirty-two patients, divided into two groups, were included in this retrospective study. Group 1 comprised patients who received bimaxillary surgery following the classical sequence with repositioning of the maxilla first. Patients in group 2 received bimaxillary surgery, but the mandible was operated on first. The precision of the maxillomandibular repositioning was determined by comparison of the digital prediction and postoperative tracings superimposed on the cranial base. The data were tabulated and analyzed statistically. In this sample, both surgical sequences provided adequate clinical accuracy. The classical sequence, repositioning the maxilla first, resulted in greater accuracy for A-point and the upper incisor edge vertical position. Repositioning the mandible first allowed greater precision in the vertical position of pogonion. In conclusion, although both surgical sequences may be used, repositioning the mandible first will result in greater imprecision in relation to the predictive tracing than repositioning the maxilla first. The classical sequence resulted in greater accuracy in the vertical position of the maxilla, which is key for aesthetics. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  16. 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.

  17. Conserved Metabolic Changes in Nondiabetic and Type 2 Diabetic Bariatric Surgery Patients: Global Metabolomic Pilot Study

    Directory of Open Access Journals (Sweden)

    Konrad Sarosiek

    2016-01-01

    Full Text Available The goal of this study was to provide insight into the mechanism by which bariatric surgical procedures led to weight loss and improvement or resolution of diabetes. Global biochemical profiling was used to evaluate changes occurring in nondiabetic and type 2 diabetic (T2D patients experiencing either less extreme sleeve gastrectomy or a full gastric bypass. We were able to identify changes in metabolism that were affected by standard preoperation liquid weight loss diet as well as by bariatric surgery itself. Preoperation weight-loss diet was associated with a strong lipid metabolism signature largely related to the consumption of adipose reserves for energy production. Glucose usage shift away from glycolytic pyruvate production toward pentose phosphate pathway, via glucose-6-phosphate, appeared to be shared across all patients regardless of T2D status or bariatric surgery procedure. Our results suggested that bariatric surgery might promote antioxidant defense and insulin sensitivity through both increased heme synthesis and HO activity or expression. Changes in histidine and its metabolites following surgery might be an indication of altered gut microbiome ecology or liver function. This initial study provided broad understanding of how metabolism changed globally in morbidly obese nondiabetic and T2D patients following weight-loss surgery.

  18. Patients' strategies for eating after gastric bypass surgery: a qualitative study.

    Science.gov (United States)

    Hillersdal, L; Christensen, B J; Holm, L

    2016-04-01

    There is considerable variation in the amount of weight patients lose after gastric bypass surgery, and this may be related to the way they adjust to the operation in their daily eating practices. Little is known about how this varies. On the basis of a qualitative research design, this study therefore explores how patients deal with gastric bypass surgery in their daily lives. The study is based on interviews with 24 men and women in Denmark diagnosed with morbid obesity who have had, Roux-en-Y gastric bypass surgery. The interviews were transcribed, coded and analysed using 'grounded theory' methodology. Three strategies used by patients to cope with postoperative changes were identified. In the first strategy, patients treat surgery as time-out, using the operation to facilitate a change in their ordinary habits of daily life, but not as a solution to overweight in itself. Patients adopting the second strategy of surgery as solution would expect their smaller stomach to hinder excess food intake automatically. The third strategy of abstaining was adopted by patients who were afraid to experience negative side effects, or who believed they might 'ruin the operation'. Patients adjust to their postoperative condition in very different ways. The variation in the ways patients comprehend and cope with the operation and in its effects on their eating routines and practices needs to be further investigated and compared more systematically with the outcomes of the operation in terms of weight loss and overall well-being.

  19. Factors Affecting Visual Field Outcome Post-Surgery in Sellar Region Tumors: Retrospective Study.

    Science.gov (United States)

    Sriram, Prabu Rau; Sellamuthu, Puliventhan; Ghani, Abdul Rahman Izani

    2017-12-01

    Despite the broad category of differentials for sellar region, most of them present with similar clinical signs and symptoms. Headache and visual disturbance are among the frequently seen as presenting symptom. Visual field (VF) assessment is one of the crucial component of neuroophtalmologic assessment and mean deviation (MD) value from automated perimetry allows quantification of the visual field defect. We formulated a study to look into the factors that affect the visual field outcome after surgery. All patients with sellar region tumor who has underwent surgery in Queen Elizabeth Hospital from July 2010 to July 2016 were retrospectively analysed through hospital notes. VF assessment via Humphrey visual assessment for these patient pre and post-surgery were reviewed for MD value. Eighty four patients were recruited and out of them, 151 eyes were taken into analysis after excluding eyes with missing data. Mean age of patients were 45.4 years with 70.2% of them were male. Visual disturbance is the commonest presenting symptom with mean duration of symptom prior to surgery is 9.7 months. Majority of them were pituitary adenomas (75%) followed by sellar meningioma (19%), craniopharyngioma (4.8%), and rathke cleft cyst (1.2%). 70.9% of patients showed improvement in VF based on MD outcome. Mean MD for pre surgery and post-surgery were -14.0 dB and -12.4 dB, respectively. Univariate analysis reveals younger age, female sex, shorter duration of symptom, pituitary adenoma, transsphenoidal approach, and transcranial approach favours improvement in VF. Multivariate analysis shows only shorter symptom duration, transphenoidal approach, and transcranial approach are significant for favourable VF outcome when other factors adjusted. Symptom duration and surgical approach were independent factors that affects the visual field after surgery in patients with sellar region tumors.

  20. Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients

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    Su Zhang

    2016-11-01

    Full Text Available Background Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Methods Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients’ characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Results Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120, urine abnormality (30/120 and fever (27/120. Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150–225] vs 135 [120–165] minutes, P < 0.01. Seven of the 69 laparoscopic operations were converted to open surgery because of severe adhesions. Conclusion Laparoscopic nephrectomy is as an effective treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant

  1. Does Surgical Volume Influence the Need for Second Surgery? A Pilot Study

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    Paul D. Judge MD

    2017-08-01

    Full Text Available Objective To examine outcomes of pediatric thyroidectomy in the context of training background, institution, and experience of the surgeon. Study Design Case series with chart review. Setting A tertiary academic medical center and a pediatric hospital. Subjects and Methods Eighty-one thyroidectomy patients younger than 18 years. Outcomes were major complications (recurrent laryngeal nerve injury, permanent hypocalcemia, and wound infection, length of stay (LOS, and need for repeat surgery. Results Eighty-one patients, 39 from the University of Nebraska Medical Center and 42 from the Children’s Hospital and Medical Center–Omaha, were identified over a 12-year time period. No difference was found in surgeon training (otolaryngology/head and neck surgery vs general/pediatric surgery for complications (1 vs 1, odds ratio [OR] = 0.76, 95% confidence interval [CI] = [0.05, 13.1], LOS >1 day (5 vs 13, OR = 0.39, 95% CI = [0.13, 1.24], or need for second surgery (4 vs 7, OR = 1.47, 95% CI = [0.39, 5.49]. Higher surgeon volume (≥12 surgeries was found to be significant for decreased need for second surgery (3 vs 8, OR = 6.67, 95% CI = [1.57, 27.17]. Patients of higher-volume surgeons were 4.2 times more likely to stay in the hospital 1 day or less compared with those patients operated on by surgeons with less experience (7 vs 11, 95% CI = [1.59, 15.0]. Conclusions Need for second surgery in pediatric thyroidectomy may be predicted by surgical volume.

  2. Early Oral Feeding After Surgery for Upper Gastrointestinal Malignancies: A Prospective Cohort Study

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    Saeed Shoar

    2016-05-01

    Full Text Available Objectives: Poor nutritional status following abdominal surgeries for esophageal and gastric cancers remains a major challenge in postoperative care. Our study aimed to investigate the efficacy of starting early oral feeding (EOF in patients undergoing surgical resection of upper gastrointestinal malignancies. Methods: A total of 180 consecutive patients with a diagnosis of esophageal or gastric malignancies undergoing elective surgical resection between January 2008 and February 2011 were enrolled in this prospective cohort study. Seventy-two patients were assigned to the EOF group, and 108 patients received late oral feeding (LOF. Postoperative endpoints were compared between the two groups. Results: Nasogastric tubes were removed from patients on average 3.3±1.6 days after the surgery in the EOF group and 5.2±2.5 days in the LOF group (p 0.050. Conclusions: EOF is safe following esophageal and gastric cancer surgery and results in faster recovery and hospital discharge.

  3. A randomized pilot study on single-port versus conventional laparoscopic rectal surgery

    DEFF Research Database (Denmark)

    Bulut, O; Aslak, K K; Levic, K

    2015-01-01

    BACKGROUND: Potential benefits of single-port laparoscopic surgery may include improved cosmetic results, less postoperative pain, surgical trauma and faster recovery. Results of randomized prospective studies with a focus on single-port rectal surgery have not yet been presented. The aim...... of the present study was to compare single-port and conventional laparoscopic surgery for rectal cancer in terms of short-term outcomes including postoperative pain and trauma-induced changes in certain bioactive substances. METHODS: Patients with non-metastasized rectal cancer were prospectively randomized...... groups for plasma IL-6 and TIMP-1 at all time points, while the CRP levels were significantly lower in the single-port group at 6 (p Abdominal incisions lengths were significantly shorter in the single-port group (p = 0.001). There was no significant...

  4. Ultrasonic root-end preparation in apical surgery : a prospective randomized study

    NARCIS (Netherlands)

    de Lange, Jan; Putters, Thomas; Baas, Erik M.; van Ingen, Johan M.

    2007-01-01

    Objective. The purpose of this study was to evaluate the potential benefit of an ultrasonic device in apical surgery on the outcome of treatment. Study design. A randomized prospective design was used in a standardized treatment protocol. Patients were allocated to treatment with an ultrasonic

  5. Metamizole versus ibuprofen at home after day surgery: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Stessel, Björn; Boon, Michiel; Joosten, Elbert A; Ory, Jean-Paul; Evers, Stefan; van Kuijk, Sander M J; Dubois, Jasperina; Hoofwijk, Daisy; Jamaer, Luc; Buhre, Wolfgang F F A

    2016-09-26

    Postoperative pain and, in a more extended perspective, quality of recovery (QOR) should be considered the principal endpoints after day surgery. Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are a cornerstone of pain treatment after painful day surgery. Nevertheless, NSAIDs are not always sufficiently effective, have numerous contraindications, and consequently are not suitable in up to 25 % of all patients. Metamizole is a non-opioid compound with a favourable gastrointestinal, cardiovascular and cerebrovascular profile compared to NSAIDs. The aim of this study is to assess if a combination of metamizole and paracetamol is non-inferior to a combination of ibuprofen and paracetamol in the treatment of acute postoperative pain at home after painful day case surgery. In addition, we aim to assess and compare quality of recovery (QOR) profiles of both groups. This is an investigator-initiated, double-blind, randomised controlled, non-inferiority trial. A total of 200 patients undergoing elective haemorrhoid surgery, arthroscopic shoulder or knee surgery, or inguinal hernia repair in a day care setting will be randomised to receive either a combination of metamizole and paracetamol (MP) or a combination of ibuprofen and paracetamol (IP). Participants will take study medication orally for 4 days. Primary endpoints are average postoperative pain intensity measured by an 11-point Numeric Rating Scale at postoperative day 1 and QOR profile measured by the Functional Recovery Index (FRI), the 1-item Global Surgical Recovery (GSR) index and the EuroQol (EQ-5D) questionnaire at days 1, 2, 3, 4, 7, 14 and 28 postoperatively. Secondary outcomes include compliance with study medication, adverse effects of study medication, use of rescue medication and satisfaction with study medication, surgery and hospital care and telephone follow-up. This study will provide clinical evidence on the analgesic efficacy and safety of a combination of metamizole and

  6. Fetal growth in pregnancies conceived after gastric bypass surgery in relation to surgery-to-conception interval: a Danish national cohort study.

    Directory of Open Access Journals (Sweden)

    Lone Nikoline Nørgaard

    Full Text Available OBJECTIVE: To describe early and late fetal growth in pregnancies conceived after gastric bypass surgery in relation to time from surgery to conception of pregnancy. METHODS: National cohort study on 387 Danish women, who had laparoscopic or open gastric bypass surgery prior to a singleton pregnancy in which first trimester screening was performed between January 2008 and June 2011. Data were derived from national registers (Danish National Registry of Patients and Danish National Birth Registry, Pregnancy Complications and Abortion-clinical quality database (PreCAb and the Danish Fetal Medicine Database. Main outcome measures were early and late fetal growth in relation to time from bariatric surgery to conception of the pregnancy. Early fetal growth was expressed as "Fetal Growth Index": the ratio between the estimated number of days from first trimester ultrasound to second trimester ultrasound biometries and the actual calender time elapsed in days. Late fetal growth was expressed as the observed versus expected birthweight according to gestational age (GA. RESULTS: The surgery-to-conception interval ranged from 3 to 1851 days with a mean value of 502 (SD, 351 days. The mean "fetal growth index" was 0.99 (SD, 0.02 days/day and thus significantly lower than in the background population (mean, 1.04 (SD, 0.09 days/day, p<0.0001. The proportion of infants being small for gestational age was 18.8% and the proportion of large for gestational age infants was 6.7%. The correlation coefficients between surgery-to-conception time and "fetal growth index" and birthweight according to GA were 0.01 (p = 0.8 and 0.04 (p = 0.4, respectively. CONCLUSION: Fetal growth index was lower than reported in the background population. No correlation was found between the surgery-to-conception interval and early or late fetal growth in pregnancies conceived after gastric bypass surgery.

  7. Factors predicting surgical site infection after posterior lumbar surgery: A multicenter retrospective study.

    Science.gov (United States)

    Wang, Tao; Wang, Hui; Yang, Da-Long; Jiang, Li-Qiang; Zhang, Li-Jun; Ding, Wen-Yuan

    2017-02-01

    This is a retrospective study.The purpose of this study is to explore incidence and risk factors for surgical site infection (SSI) after posterior lumbar surgery.SSI is a common complication after posterior lumbar surgery, bringing mental and physical pain and prolonging hospital stay. However, predisposing factors, as reported less, remain controversial.Patients who underwent posterior lumbar surgery at 3 centers between 2006 and 2016 were included. The possible factors include 3 aspects: demographic variables-age, sex, body mass index (BMI), waist-to-hip radio (WHR), hypertension, diabetes, heart disease, smoking, drinking, steroidal injection, surgical time between June and September, preoperative shower; blood test variables-white blood cell (WBC), neutrophil, red blood cell (RBC), hemoglobin (Hb), total protein (TP), albumin, albumin/globulin (A/G), C-reactive protein (CRP), procalcitonin (PCT), erythrocyte sedimentation rate (ESR) and surgical related variables-operation time, blood loss, operative level, instrumentation, incision length. Factors related with SSI were also performed by multivariate analysis.The prevalence of SSI was 3.00% (267 cases of 8879) had a postoperative wound infection. There were significant difference in WHR (0.92 vs 0.83), WBC (4.31 vs 6.69), TP (58.7 vs 65.2), albumin (36.9 vs 43.2), CRP (2.01 vs 0.57), PCT (0.097 vs 0.067), operation time (217.9 vs 195.7), blood loss (997.1 vs 915.3) and operative level (3.05 vs 2.45) and incision length (24.1 vs 20.0) between SSI group and non-SSI group. >60 years old, female, BMI 30.0, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, no preoperative shower, instrumentation surgery were risk factors for SSI after posterior lumbar surgery.Many factors, >60 years old, female, BMI, WHR, diabetes, male smoking, preoperative steroidal injection, surgical time between June and September, preoperative shower, WBC, TP, albumin, CRP, PCT, operation time

  8. Postoperative bacteremia in periodontal flap surgery, with and without prophylactic antibiotic administration: A comparative study

    Directory of Open Access Journals (Sweden)

    Asi Kanwarjit

    2010-01-01

    Full Text Available Objectives: Many a times in clinical periodontology, the decision whether to prescribe prophylactic antibiotics or not , is perplexing.The present study was conducted to compare the bacteremias induced after periodontal flap surgeries with and without prophylactic antibiotics. Materials and Methods: The occurrence of postoperative bacteremia following periodontal flap surgery was studied in 30 patients. On these patients, 30 quadrant wise flap surgeries were carried out without any preoperative prophylactic antibiotics and 30 surgeries carried out after prophylactic administration of amoxycillin preoperatively. A blood sample was taken from each patient at the time of maximum surgical trauma and was cultured for micro-organisms and antibiotic sensitivity. Results: 18 out of 60 blood samples were positive for micro-organisms. There was a significant reduction in post operative bacteremia after amoxycillin prophylaxis (x - 7.96 with P< 0.01 as post operative bacteremia was found in 14 of the non medicated patients as compared to only 4 of the pre medicated patients. The micro-organisms encountered in the study are as follows:- 1 Staphylococcus albus coagulase negative, 2 Klebsiella, 3 Psedomonas aerugenosa, 4 Streptococcus viridans, 5 Alpha hemolytic streptococcus, 6 Neisseria catarrhalis Conclusion: On the basis of the study, it is concluded that the incidence of postoperative bacteremia following periodontal flap surgery is not as high as previously reported. The clinical results show that Amoxicillin is highly effective in reducing postoperative bacteremia in periodontal flap surgery and thus in preventing the possible sequelae (Infective Endocarditis and other systemic maladies in susceptible patients. However, cefotaxime and cephalexin may prove to be more effective in preventing the same.

  9. Infections in orthopaedic surgery : clinical and experimental studies

    NARCIS (Netherlands)

    Vogely, Henri Charles

    2000-01-01

    The diagnostic difficulties, variability in outcome and the heterogeinity of the problem of orthopaedic infections stimulated the author to a study of the literature, and several clinical and experimental studies. The diagnosis prosthesis-related infection can only be reached with an acceptable

  10. Study examines outcomes from surgery to prevent ovarian cancer

    Science.gov (United States)

    A new study looked at women at high risk of ovarian cancer who had no clinical signs of the disease and who underwent risk-reducing salpingo-oophorectomy (RRSO). The study results showed cancer in the removed tissues of 2.6 percent (25 of 966) of the par

  11. Quantitative Lymphoscintigraphy to Predict the Possibility of Lymphedema Development After Breast Cancer Surgery: Retrospective Clinical Study.

    Science.gov (United States)

    Kim, Paul; Lee, Ju Kang; Lim, Oh Kyung; Park, Heung Kyu; Park, Ki Deok

    2017-12-01

    To predict the probability of lymphedema development in breast cancer patients in the early post-operation stage, we investigated the ability of quantitative lymphoscintigraphic assessment. This retrospective study included 201 patients without lymphedema after unilateral breast cancer surgery. Lymphoscintigraphy was performed between 4 and 8 weeks after surgery to evaluate the lymphatic system in the early postoperative stage. Quantitative lymphoscintigraphy was performed using four methods: ratio of radiopharmaceutical clearance rate of the affected to normal hand; ratio of radioactivity of the affected to normal hand; ratio of radiopharmaceutical uptake rate of the affected to normal axilla (RUA); and ratio of radioactivity of the affected to normal axilla (RRA). During a 1-year follow-up, patients with a circumferential interlimb difference of 2 cm at any measurement location and a 200-mL interlimb volume difference were diagnosed with lymphedema. We investigated the difference in quantitative lymphoscintigraphic assessment between the non-lymphedema and lymphedema groups. Quantitative lymphoscintigraphic assessment revealed that the RUA and RRA were significantly lower in the lymphedema group than in the non-lymphedema group. After adjusting the model for all significant variables (body mass index, N-stage, T-stage, type of surgery, and type of lymph node surgery), RRA was associated with lymphedema (odds ratio=0.14; 95% confidence interval, 0.04-0.46; p=0.001). In patients in the early postoperative stage after unilateral breast cancer surgery, quantitative lymphoscintigraphic assessment can be used to predict the probability of developing lymphedema.

  12. Low priority? A cross sectional study of appearance anxiety in 500 consecutive referrals for cosmetic surgery.

    Science.gov (United States)

    Clarke, A; Hansen, E L E; White, P; Butler, P E M

    2012-01-01

    Low priority treatment guidance is used in the National Health Service to manage requests for cosmetic surgery where there is no associated functional impairment. Provision is made in this guidance to provide surgery on exceptional grounds, and this may include significant psychological distress. However, without a good understanding of the common factors that underpin requests for surgery, ideally in the local population, it is very difficult to define an exception in a clear and consistent way. A prospective study of consecutive referrals for cosmetic surgery in an NHS plastic surgery unit was therefore completed over a five-year period. Five hundred and one men and women aged between 16 and 79 (mean 34.5 years) were assessed using standardised questionnaires and clinical interview carried out by two clinical psychologists specialising in the field. Results indicated very marked impact of appearance-related anxiety with significant withdrawal from social activities particularly intimate behaviour. Coping behaviours ranged from use of concealing clothing and complete social avoidance to ominous high risk strategies such as repeated pregnancy with late termination to maintain breast size. Treatment goals were predominantly psychosocial. High levels of psychological morbidity can be characterised as typical of people requesting cosmetic procedures in the NHS rather than exceptional, making the achievement of equitable access to limited resources impossible. Rather than define this population as 'low-priority', a constructive approach is to examine the utility of psychological interventions in a design which evaluates the comparative benefits of surgical and psychological approaches to management of appearance anxiety.

  13. Smoking Is Associated with an Increased Risk for Surgery in Diverticulitis: A Case Control Study.

    Science.gov (United States)

    Diamant, Michael J; Schaffer, Samuel; Coward, Stephanie; Kuenzig, M Ellen; Hubbard, James; Eksteen, Bertus; Heitman, Steven; Panaccione, Remo; Ghosh, Subrata; Kaplan, Gilaad G

    2016-01-01

    Cigarette smoking increases the risk of surgery in Crohn's disease. However, the effect of smoking on the need for surgery for diverticulitis is unknown. We evaluated whether smoking was a risk factor for surgery among patients admitted to hospital with acute diverticulitis. We conducted a population-based comparative cohort study of patients admitted to hospital for diverticulitis who were treated with medical versus surgical management. We used the population-based Discharge Abstract Database to identify 176 adults admitted emergently with a diagnosis of diverticulitis between 2009 and 2010 in Calgary. We performed a medical chart review to confirm the diagnosis of diverticulitis and to extract clinical data. The primary outcome was a partial colectomy during hospitalization. Logistic regression evaluated the association between smoking and surgery after adjusting for potential confounders, including age, sex, comorbidity, and disease severity. A partial colectomy was performed on 35.6% of patients with diverticulitis and 1.3% died. Among diverticulitis patients, 26.8% were current smokers, 31.5% were ex-smokers, and 41.6% never smoked. Compared to non-smokers, current smokers (adjusted odds ratio [OR] 9.02; 95% confidence interval [CI]: 2.47-32.97) and former smokers (adjusted OR 5.41; 95% CI: 1.54-18.96) had increased odds of surgery. Smoking is associated with the need for surgical management of diverticulitis.

  14. A comparative study of four intensive care outcome prediction models in cardiac surgery patients

    Directory of Open Access Journals (Sweden)

    Lehmann Thomas

    2011-03-01

    Full Text Available Abstract Background Outcome prediction scoring systems are increasingly used in intensive care medicine, but most were not developed for use in cardiac surgery patients. We compared the performance of four intensive care outcome prediction scoring systems (Acute Physiology and Chronic Health Evaluation II [APACHE II], Simplified Acute Physiology Score II [SAPS II], Sequential Organ Failure Assessment [SOFA], and Cardiac Surgery Score [CASUS] in patients after open heart surgery. Methods We prospectively included all consecutive adult patients who underwent open heart surgery and were admitted to the intensive care unit (ICU between January 1st 2007 and December 31st 2008. Scores were calculated daily from ICU admission until discharge. The outcome measure was ICU mortality. The performance of the four scores was assessed by calibration and discrimination statistics. Derived variables (Mean- and Max- scores were also evaluated. Results During the study period, 2801 patients (29.6% female were included. Mean age was 66.9 ± 10.7 years and the ICU mortality rate was 5.2%. Calibration tests for SOFA and CASUS were reliable throughout (p-value not Conclusions CASUS and SOFA are reliable ICU mortality risk stratification models for cardiac surgery patients. SAPS II and APACHE II did not perform well in terms of calibration and discrimination statistics.

  15. Early career choices and successful career progression in surgery in the UK: prospective cohort studies

    Directory of Open Access Journals (Sweden)

    Richards Jennifer MJ

    2010-11-01

    Full Text Available Abstract Background Changes to the structure of medical training worldwide require doctors to decide on their career specialty at an increasingly early stage after graduation. We studied trends in career choices for surgery, and the eventual career destinations, of UK graduates who declared an early preference for surgery. Methods Postal questionnaires were sent, at regular time intervals after qualification, to all medical qualifiers from all UK medical schools in selected qualification years between 1974 and 2005. They were sent in the first year after qualification, at year three and five years after qualification, and at longer time intervals thereafter. Results Responses were received from 27 749 of 38 280 doctors (73% at year one, 23 468 of 33151 (71% at year three, and 17 689 of 24 870 (71% at year five. Early career preferences showed that surgery has become more popular over the past two decades. Looking forward from early career choice, 60% of respondents (64% of men, 48% of women with a first preference for a surgical specialty at year one eventually worked in surgery (p Conclusions Surgery is a popular specialty choice in the UK. The great majority of doctors who progressed in a surgical career made an early and definitive decision to do so.

  16. Impact of Bariatric Surgery and Diet Modification on Periodontal Status: A Six Month Cohort Study.

    Science.gov (United States)

    Jaiswal, Gagan Rajesh; Jain, Vijayendra Kumar; Dhodapkar, Shrikant Vishnu; Kumathalli, Kanteshwari Iranagouda; Kumar, Rajesh; Nemawat, Arun; Jain, Ankita

    2015-09-01

    Nutrition is an essential component of oral health and improper nutrition is an important aetiological factor in the development of obesity as well. This study aimed to evaluate effect of diet modification and oral hygiene maintenance after bariatric surgery on the periodontal status of Class III and IV obese patients. Two hundred and twenty four patients between the age ranges of 18 -64 years, from both sexes, were subjected to complete periodontal examination prior to bariatric surgery and 6 months post surgery. Patients were advised diet modification which included more fibrous food intake & decreased intake of soft and sugary food along with supragingival scaling & oral health care regime after bariatric surgery with a 6 month follow up. No periodontal surgical intervention was performed. The patients showed a mean differences in the bleeding score, plaque and gingival index which was found to be statistically significant (p0.05). Thus we conclude that fibrous diet along with good periodontal care can help to improve the oral hygiene status of patients undergoing bariatric surgery, even if periodontal surgical intervention is not performed resulting in freedom from periodontitis, thus improving quality of life of the patient.

  17. Effects of Topical Antibiotic Prophylaxis on Wound Healing After Flapless Implant Surgery: A Pilot Study.

    Science.gov (United States)

    Xu, Li; Wang, Yuanyuan; Nguyen, Van Tuan; Chen, Jiangang

    2016-03-01

    The purpose of this pilot study is to investigate the effects of local application of minocycline hydrochloride ointment (MHO) and erythromycin eye ointment (EEO) on wound healing after flapless implant surgery. Forty patients with flapless implant surgery were enrolled and assigned randomly to three groups: 1) MHO group (n = 17); 2) EEO group (n = 18); and 3) control group (n = 5). All of them took systemic antibiotics; the control group did not receive the application of topical antibiotics. Three days after the surgical operation, clinical parameters, peri-implant crevicular fluid volume, and crevicular lipopolysaccharide (LPS) levels of all patients were collected, measured, and analyzed. Clinical outcomes of the two treatment groups were superior to results of the control group, indicating the effectivity of local antibiotics application in promoting early wound healing after flapless implant surgery. There was no obviously different effect between EEO and MHO in the early stages of healing. In addition, there were significant correlations between LPS level and all clinical parameters. The local application of antibiotics along with the systemic antibiotics could reduce the inflammatory response in wound healing after implant surgery. The EEO and MHO were equally effective in early wound healing. Compared to the MHO, the EEO has advantages of higher cost efficiency and convenience. Therefore, it is recommended to use the EEO in topical antibiotic prophylaxis for wound healing after flapless implant surgery.

  18. Developing the Blueprint for a General Surgery Technical Skills Certification Examination: A Validation Study.

    Science.gov (United States)

    de Montbrun, Sandra; Louridas, Marisa; Szasz, Peter; Harris, Kenneth A; Grantcharov, Teodor P

    2017-08-29

    There is a recognized need to develop high-stakes technical skills assessments for decisions of certification and resident promotion. High-stakes examinations requires a rigorous approach in accruing validity evidence throughout the developmental process. One of the first steps in development is the creation of a blueprint which outlines the potential content of examination. The purpose of this validation study was to develop an examination blueprint for a Canadian General Surgery assessment of technical skill certifying examination. A Delphi methodology was used to gain consensus amongst Canadian General Surgery program directors as to the content (tasks or procedures) that could be included in a certifying Canadian General Surgery examination. Consensus was defined a priori as a Cronbach's α ≥ 0.70. All procedures or tasks reaching a positive consensus (defined as ≥80% of program directors rated items as ≥4 on the 5-point Likert scale) were then included in the final examination blueprint. Two Delphi rounds were needed to reach consensus. Of the 17 General Surgery Program directors across the country, 14 (82.4%) and 10 (58.8%) program directors responded to the first and second round, respectively. A total of 59 items and procedures reached positive consensus and were included in the final examination blueprint. The present study has outlined the development of an examination blueprint for a General Surgery certifying examination using a consensus-based methodology. This validation study will serve as the foundational work from which simulated model will be developed, pilot tested and evaluated. Copyright © 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  19. Retrospective study on de novo postoperative urinary incontinence after pelvic organ prolapse surgery.

    Science.gov (United States)

    Ugianskiene, Aiste; Kjærgaard, Niels; Inger Lindquist, Anna Sofie; Larsen, Thomas; Glavind, Karin

    2017-12-01

    Reported incidences of de novo urinary incontinence (UI) following pelvic organ prolapse (POP) surgery in preoperatively continent women vary between 2% and 43%. The aim of this study was to investigate the incidence and the types of de novo UI and differences between operations in different compartments. Retrospective study of 678 women with POP surgery using native tissue repair during a 3-year period. Patients completed three modified prolapse questions from the International Consultation on Incontinence-Vaginal Symptoms (ICIQ-VS) and the International Consultation on Incontinence Questionnaire- Urinary Incontinence Short Form (ICIQ-UI SF) before undergoing surgery and 3 months postoperatively. Patients who were totally dry and scored 0 on ICIQ-UI SF before surgery were included in the study (N=299). The patients developing new onset UI on ICIQ-UI SF postoperatively were interviewed by telephone after median 30 months. A total of 33 patients (11%) developed subjective de novo UI at 3 months follow-up. The majority of patients (N=16) reported stress UI. The risk of developing de novo UI increased with parity (p=0.03). We found no difference between operations in different compartments. At long-term follow-up 12 patients became continent without incontinence surgery or medical treatment leaving only 21 patients (7%) incontinent. The risk of developing de novo UI after prolapse surgery with native tissue repair is low and improves over time. Parity is significantly associated with the risk of developing de novo UI. There is no difference in the incidence of de novo incontinence between operations in different compartments. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Quality of Life and Bariatric Surgery: Cross-Sectional Study and Analysis of Factors Influencing Outcome.

    Science.gov (United States)

    Janik, Michał Robert; Rogula, Tomasz; Bielecka, Ilona; Kwiatkowski, Andrzej; Paśnik, Krzysztof

    2016-12-01

    The aims of our study were to compare quality of life (QOL) in obese patients after bariatric surgery with that in controls seeking surgery and to investigate which factors are associated with QOL in the Moorehead-Ardelt Quality of Life Questionnaire II (MA II). This was a cross-sectional study. The operated group consisted of patients after laparoscopic sleeve gastrectomy or laparoscopic Roux-en-Y gastric bypass. The MA II was administered by e-mail to 305 patients 12-18 months after surgery. The control groups consisted of 101 obese patients. We compared the QOL scores and considered good and very good outcomes to be satisfactory. Multiple logistic regression and correlation analysis was performed to identify factors associated with QOL. In the operated group, the total MA II score was 1.70 ± 0.76, which was higher than 0.59 ± 1.17 in the control group. The score adjusted for the type of surgery was comparable. The prevalence of satisfactory QOL outcomes was similar in both post-operative subgroups and was still higher than in the control group. We identified four factors associated with higher QOL in obese patients. Weight loss was not correlated with total score in MAII. This study demonstrates that patients after bariatric surgery have a higher score in MA II, which reflects better QOL. The scoring adjusted by type of operation is comparable. QOL among obese patients is dependent on age, gender, history of bariatric surgery, and partnered status. Body mass reduction was not associated with outcome in MAII.

  1. Academic plastic surgery: a study of current issues and future challenges.

    Science.gov (United States)

    Zetrenne, Eleonore; Kosins, Aaron M; Wirth, Garrett A; Bui, Albert; Evans, Gregory R D; Wells, James H

    2008-06-01

    The objectives of this study were (1) to evaluate the role of a full-time academic plastic surgeon, (2) to define the indicators predictive of a successful career in academic plastic surgery, and (3) to understand the current issues that will affect future trends in the practice of academic plastic surgery. A questionnaire was developed to evaluate the role of current full-time academic plastic surgeons and to understand the current issues and future challenges facing academic plastic surgery. Each plastic surgery program director in the United States was sent the survey for distribution among all full-time academic plastic surgeons. Over a 6-week period, responses from 143 full-time academic plastic surgeons (approximately 31%) were returned. Fifty-three percent of respondents had been academic plastic surgeons for longer than 10 years. Seventy-three percent of respondents defined academic plastic surgeons as clinicians who are teachers and researchers. However, 53% of respondents believed that academic plastic surgeons were not required to teach or practice within university hospitals/academic centers. The 3 factors reported most frequently as indicative of a successful career in academic plastic surgery were peer recognition, personal satisfaction, and program reputation. Dedication and motivation were the personal characteristics rated most likely to contribute to academic success. Forty-four percent of respondents were unable to identify future academic plastic surgeons from plastic surgery residency applicants, and 27% were not sure. Most (93%) of the respondents believed that academic surgery as practiced today will change. The overall job description of a full-time academic plastic surgeon remains unchanged (teacher and researcher). Whereas peer recognition, personal satisfaction, and program reputation were most frequently cited as indicative of a successful plastic surgery career, financial success was rated the least indicative. Similarly, whereas the

  2. Does a robotic surgery approach offer optimal ergonomics to gynecologic surgeons?: a comprehensive ergonomics survey study in gynecologic robotic surgery

    Science.gov (United States)

    2017-01-01

    Objective To better understand the ergonomics associated with robotic surgery including physical discomfort and symptoms, factors influencing symptom reporting, and robotic surgery systems components recommended to be improved. Methods The anonymous survey included 20 questions regarding demographics, systems, ergonomics, and physical symptoms and was completed by experienced robotic surgeons online through American Association of Gynecologic Laparoscopists (AAGL) and Society of Robotic Surgery (SRS). Results There were 289 (260 gynecology, 22 gynecology-oncology, and 7 urogynecology) gynecologic surgeon respondents regularly practicing robotic surgery. Statistical data analysis was performed using the t-test, χ2 test, and logistic regression. One hundred fifty-six surgeons (54.0%) reported experiencing physical symptoms or discomfort. Participants with higher robotic case volume reported significantly lower physical symptom report rates (pergonomic settings not only acknowledged that the adjustments were helpful for better ergonomics but also reported a lower physical symptom rate (pergonomic settings (32.7%), took a break (33.3%) or simply ignored the problem (34%). Fingers and neck were the most common body parts with symptoms. Eye symptom complaints were significantly decreased with the Si robot (pergonomics were microphone/speaker, pedal design, and finger clutch. Conclusion More than half of participants reported physical symptoms which were found to be primarily associated with confidence in managing ergonomic settings and familiarity with the system depending on the volume of robotic cases. Optimal guidelines and education on managing ergonomic settings should be implemented to maximize the ergonomic benefits of robotic surgery. PMID:28657231

  3. A PRELIMINARY STUDY FOR SIX SIGMA IMPLEMENTATION IN LASER IN SITU KERATOMILEUSIS (LASIK SURGERIES

    Directory of Open Access Journals (Sweden)

    Mehmet Tolga Taner

    2014-01-01

    Full Text Available The purpose of this study is to show how a private eye care center in Turkey developed a Six Sigma infrastructure to investigate the root causes of complications occuring during LASIK surgeries. To analyze the collected data, main tools of Six Sigma’s Define-Measure-Analyze-Improve-Control(DMAIC improvement cycle such as SIPOC table, Fishbone Diagram and, Failure, Mode and Effect Analysis were implemented. Experience of the refractive surgeons, type of microkeratome and hygiene of microkeratome were identified to be Critical-to-Quality (CTQ factors for a successful LASIK surgery. The most frequent complications of LASIK surgeries were found to be dry eye syndrome, subconjunctival haemorrhage and flap edge melt. The process sigma level was found to be 3.7135.

  4. Prevalence and outcomes of cataract surgery in Brazil: the São Paulo eye study.

    Science.gov (United States)

    Salomão, Solange R; Soares, Francisco S; Berezovsky, Adriana; Araújo-Filho, Arnaud; Mitsuhiro, Marcia R K H; Watanabe, Sung E S; Carvalho, Alisson V; Pokharel, Gopal P; Belfort, Rubens; Ellwein, Leon B

    2009-08-01

    To investigate the prevalence and visual acuity (VA) outcomes of cataract surgery in a low- to middle-income population in São Paulo, Brazil. Population-based, cross-sectional study. Cluster sampling was used in randomly selecting those > or =50 years old for VA measurement, refraction, and ocular examination. Participants were queried as to the year and type of facility for previous cataract surgery. Surgical procedure and evidence of surgical complications were noted. Main outcome measures were presenting and best-corrected vision, and the principal cause for eyes presenting with VA 20/40, 28.1% with VA 20/40 to 20/63, 14.2% with VA visually impaired/blind because of cataract. Refractive error and other causes of impairment are common in cataract-operated eyes. Emphasis on the quality of VA outcomes and sustained government subsidy to provide access to affordable modern cataract surgery are needed.

  5. Post-discharge symptoms following fast-track colonic cancer surgery: a phenomenological hermeneutic study

    DEFF Research Database (Denmark)

    Krogsgaard, Marianne; Dreyer, Pia; Egerod, Ingrid

    2014-01-01

    to report their unfamiliar symptoms during hospital nurse follow-up telephone call. While waiting for the final histology patients suffered loss of sleep and chaotic thinking, and experienced ambiguity of hoping for the best and expecting the worst. CONCLUSION: Although fast-track surgery programmes lead...... to shorter hospitalisation and improved physical performance, post-colonic surgery patients experience various symptoms after discharge. Healthcare professionals need to address symptoms that might have immediate and long-term consequences on patients' everyday life. Follow-up studies are encouraged...

  6. Monitoring of Gas Emboli During Hysteroscopic Surgery: A Prospective Study.

    Science.gov (United States)

    Liu, Sheng-Qun; Zhao, Su-Zhen; Li, Zhan-Wen; Lv, Su-Ping; Liu, Yue-Qiang; Li, Yi

    2017-04-01

    Previous studies have demonstrated a high frequency of gas emboli during hysteroscopy, but guidelines for the prevention, early detection, and intervention of gas embolism during hysteroscopic procedures are still lacking. This study aimed to gain a clearer understanding of risk factors and specific signs and symptoms associated with gas emboli. This prospective study enrolled 120 women scheduled for hysteroscopy using 5% glucose as distension medium. The gas bubbles were monitored sequentially in internal iliac vein, common iliac vein, inferior vena cava, superior vena cava, heart, and pulmonary artery under the gray-scale imaging of Doppler ultrasound. The frequency, extent, and the hemodynamic and respiratory effects of gas emboli were evaluated. The interventions and outcomes were recorded. The risk factors associated with gas emboli, and their relationship with the frequency and extent of gas emboli, were assessed. In our study, evidence of gas emboli under Doppler ultrasound monitoring was observed in 44 (36.7%) patients. The operation was continued and finished as soon as possible for patients presenting with stable vital signs or transient hemodynamic and respiratory changes, which resolved spontaneously without intervention. The operation was paused for patients presenting with significant hemodynamic changes or loss of consciousness, and the operation was resumed shortly after resumption of stable vital signs following symptomatic treatment. All patients in our study finished the operation and recovered without developing serious complications. Data analysis showed prolonged procedure duration and increased bleeding volume were both positively correlated with the frequency and extent of gas emboli. Our study demonstrated a high frequency of gas emboli during hysteroscopy. Doppler ultrasonic monitoring combined with a clearer understanding of specific signs, symptoms, and risk factors will facilitate early detection and intervention of gas emboli during

  7. Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol.

    Science.gov (United States)

    Byamugisha, Josaphat; El Ayadi, Alison; Obore, Susan; Mwanje, Haruna; Kakaire, Othman; Barageine, Justus; Lester, Felicia; Butrick, Elizabeth; Korn, Abner; Nalubwama, Hadija; Knight, Sharon; Miller, Suellen

    2015-12-18

    Obstetric fistula is a debilitating birth injury that affects an estimated 2-3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65-95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.

  8. A comparative study between manual small incision cataract surgery ...

    African Journals Online (AJOL)

    Background: Cataract extraction is the most frequently performed surgical procedure in patients above 60 years of age. Surgical outcome in terms of visual acuity depends on the surgical technique and Intra ocular lens used. Aims and Objectives: Our study was aimed to compare the improvement in visual acuity, achieved ...

  9. A Case Study on Idiopathic Orbital Pseudotumor: Surgery and ...

    African Journals Online (AJOL)

    This is a case study of five isolated orbital nerve inflammatory pseudotumor cases presenting with protrusion and visual acuity of the right eye. Optic disk edema was observed by ophthalmoscopy. Plain and contrast-enhanced magnetic resonance imaging (MRI) were used to examine the orbital fat and enlargement of the ...

  10. Factors associated with reoperation in hypospadias surgery - A nationwide, population-based study.

    Science.gov (United States)

    Lu, Yu-Chuan; Huang, Wei-Yi; Chen, Yu-Fen; Chang, Hong-Chiang; Pong, Yuan-Hung; Shih, Tsung-Hsien; Huang, Kuo-How

    2017-04-01

    To analyze the preoperative factors associated with the need for secondary surgery following primary urethroplasty. This study utilized a subset of the National Health Insurance Research Database, which includes the data on all paid medical benefit claims from 1997 to 2007, for 1 million beneficiaries in 2005. We analyzed the claims data for all patients with hypospadias who had undergone primary urethroplasty. The characteristics of the patients, surgeons, and hospitals associated with surgical outcomes were analyzed to investigate possible associations with the need for secondary surgery. Among 52,705 live male newborn babies, 218 were diagnosed with hypospadias, of whom 89 received repair surgery. A total of 75 (84.3%) male newborn babies received single hypospadias surgery, and 14 (15.7%) underwent more than two surgical procedures. Univariate analysis demonstrated that the type of hypospadias and the surgeon caseload volume were significantly associated with the need for additional hypospadias surgery (p = 0.02 and p = 0.03, respectively). In multivariate analysis, the type of hypospadias (distal vs. proximal, odds ratio, 0.25; p = 0.03) and the surgeon caseload volume (high vs. low, odds ratio, 0.04; p = 0.05) were significantly correlated with secondary operation. The type of hypospadias and the surgeon caseload volume were significantly associated with the need for secondary hypospadias surgery. The findings of this study provide important information on the outcomes of hypospadias repair for parents and specialists. Copyright © 2017. Published by Elsevier Taiwan.

  11. The advantages of carbon dioxide laser applications in paediatric oral surgery. A prospective cohort study.

    Science.gov (United States)

    Hanna, R; Parker, S

    2016-11-01

    The aim of this study is to evaluate and demonstrate the advantages of the carbon dioxide laser in paediatric oral surgery patients in terms of less post-operative complications, healing without scaring, functional benefits, positive patient perception and acceptance of the treatment. One hundred fit and healthy paediatric patients (aged 4-15 years) were recruited to undergo laser surgery for different soft tissue conditions. The outcome of these laser treatments was examined. The Wong-Baker Faces Pain Rating Scale was employed to evaluate the pain before, immediately after laser treatment in the clinic and 1 day after post-operatively at home. Post-operative complications and patients' perception and satisfaction were self-reported during a review telephone call the day after treatment. The patients were reviewed 2 weeks after surgery. Laser parameter was 1.62 W, measured by power meter, continuous wave mode with 50 % emission cycle. The beam spot size at the target tissue was 0.8 mm. The pain score pre-operative, during and immediately after laser treatment was rated 0. Whilst the pain score 1 day after surgery was rated between 0 and 2, the healing time was measured over 2 weeks. None of the patients reported post-operative complications after surgery. Patients' perception and acceptance were rated very good. Laser dentistry is a promising field in modern minimally invasive dentistry, which enables provision of better care for children and adolescents. In this cohort study, the use of the carbon dioxide laser therapy offers a desirable, acceptable and minimally invasive technique in the surgical management of soft tissues in paediatric oral surgery with minimal post-operative complications.

  12. Pain intensity on the first day after surgery: a prospective cohort study comparing 179 surgical procedures.

    Science.gov (United States)

    Gerbershagen, Hans J; Aduckathil, Sanjay; van Wijck, Albert J M; Peelen, Linda M; Kalkman, Cor J; Meissner, Winfried

    2013-04-01

    Severe pain after surgery remains a major problem, occurring in 20-40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedure-specific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified. This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0-10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared. The 40 procedures with the highest pain scores (median numeric rating scale, 6-7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many "minor" surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of "major" abdominal surgeries resulted in comparatively low pain scores, often because of sufficient epidural analgesia. Several common minor- to medium-level surgical procedures, including some with laparoscopic approaches, resulted in unexpectedly high levels of postoperative pain. To reduce the number of patients suffering from severe pain, patients undergoing so-called minor surgery should be monitored more closely, and postsurgical pain treatment needs to comply with existing procedure-specific pain-treatment recommendations.

  13. Minimally Invasive Scoliosis Surgery with Oblique Lateral Lumbar Interbody Fusion: Single Surgeon Feasibility Study.

    Science.gov (United States)

    Abbasi, Hamid; Miller, Lynn; Abbasi, Ali; Orandi, Vali; Khaghany, Kamran

    2017-06-25

    Degenerative deformities of the spine have traditionally been treated with extensive open surgeries. However, these open procedures are associated with a high degree of surgical morbidity. In this study, we explore whether clinical improvement in patients with spinal deformities can be achieved using a new minimally invasive surgery (MIS) called oblique lateral lumbar interbody fusion (OLLIF). OLLIF is a MIS single surgeon procedure in which the disc is approached through Kambin's triangle. OLLIF can achieve correction of spinal deformities through careful cage placement. The purpose of this study is to establish the safety and efficacy of using OLLIF to correct spinal deformities and to collect early outcome data. Collected data includes perioperative outcomes, patient reported outcomes, and radiographic outcomes. This study is a retrospective review of 37 OLLIF surgeries in 36 patients with symptomatic degenerative spinal deformity. Collected perioperative data included surgery time, blood loss, and hospital stay. Follow-up was conducted at least 150 days post surgery. We recorded complications and patient reported outcomes such as Oswestry Disability Index (ODI) and pain scale. Imaging was conducted pre- and post-surgery. Fusion rates and changes in Cobb angle were also measured. A total of 37 surgeries that treated 100 vertebral levels were performed. For two and three level procedures, respectively, the mean blood loss was 83 and 178 ml, the average surgery time was 74 and 158 minutes and the average hospital stay was 2.6 and 3.3 days. The patients ambulated within 24 hours in all but two cases. The patients reported pain improvements on the ten-point pain scale from 8.3 to 3.7 (pfusion was achieved along with 71% right posterolateral and 74% left posterolateral fusion. There were three cases of mild nerve irritation/neuropraxia and no infections. OLLIF is a safe and effective MIS technique to correct adult degenerative scoliosis. Unlike alternative

  14. A COMPARATIVE STUDY BETWEEN CONVENTIONAL AND AUTOGRAFT SURGERY FOR PTERYGIUM

    Directory of Open Access Journals (Sweden)

    Venkateswara Rao

    2015-05-01

    Full Text Available Pterygium excision by bare sclera technique was first described by Ombrain. However it is associated with recurrence rate of 9 to 75%. Conjunctival autografting is safe and cost effective method in preventing recurrence. In this study 100 cases of primary pterygium are evaluated. Mean age group was 47 years. 55% were male and 45% were females. Literature documents more incidence of pterygium in outdoor workers. This correlated with our study findings where in 66% of the patients were exposed to heat dust and sunligh t while working outdoors. 89% had nasal pterygium. Most Patients (87% had with the rule astigmatism. The average with the rule astigmatism was 2 diaptors preoperatively which decreased to 0. 67D postoperatively. In our study of 100 cases 50 underwent pter ygium excision by bare sclera technique. Rest 50 underwent pterygium excision with conjunctival autografting. All cases were followed up for 6 months. In the bare sclera technique 6 (12% cases had recurrence and none in conjunctival autograft technique (p - value < 0.05. Two cases had sclera thinning following pterygium excision which resolved after tapering steroid dosage. 2 cases had graft edema and three had loose sutures. 4 cases had granuloma formation in the bare sclera group and one had corneal scarr ing

  15. Factors influencing time between surgery and radiotherapy : A population based study of breast cancer patients

    NARCIS (Netherlands)

    Katik, S.; Gort, M.; Jobsen, J. J.; Maduro, J. H.; Struikmans, H.; Siesling, S.

    This study describes variation in the time interval between surgery and radiotherapy in breast cancer (BC) patients and assesses factors at patient, hospital and radiotherapy centre (RTC) level influencing this variation. To do so, the factors were investigated in BC patients using multilevel

  16. Cataract surgery and the risk of aging macula disorder: The Rotterdam study

    NARCIS (Netherlands)

    L. Ho (Lintje); S. Boekhoorn (Sharmila); A. Liana (Alin); P. Tikka-Kleemola (Päivi); A.G. Uitterlinden (André); A. Hofman (Albert); P.T.V.M. de Jong (Paulus); Th. Stijnen (Theo); J.R. Vingerling (Hans)

    2008-01-01

    textabstractPURPOSE. To investigate still-controversial associations between prior cataract surgery and aging macula disorder (AMD) in a general population. METHODS. Baseline lens status and risk of incident AMD (iAMD) were examined in participants of the prospective population-based Rotterdam Study

  17. Patient mix optimisation and stochastic resource requirements: a case study in cardiothoracic surgery planning

    NARCIS (Netherlands)

    Adan, I.; Bekkers, J.; Dellaert, N.; Vissers, J.; Yu, X.

    2009-01-01

    Cardiothoracic surgery planning involves different resources such as operating theatre time, beds, IC beds and nursing staff. In the daily practice of the Thorax Centre case study setting, the planning focuses on optimal use of operating theatre time, though the performance of the Thorax Centre as a

  18. A prospective study of prognostic factors concerning the outcome of arthroscopic surgery for anterior ankle impingement

    NARCIS (Netherlands)

    van Dijk, C. N.; Tol, J. L.; Verheyen, C. C.

    1997-01-01

    Sixty-two consecutive patients with painful limited dorsiflexion of the ankle not responding to nonoperative treatment participated in a prospective study. All 42 men and 20 women (average age, 31 years) underwent arthroscopic surgery. Preoperative radiographs were graded according to an

  19. Surgery for Recurrent Epithelial Ovarian Cancer in the Netherlands: A Population-Based Cohort Study

    NARCIS (Netherlands)

    Laar, R. van de; Kruitwagen, R.F.P.M.; Hout, J. in't; Zusterzeel, P.L.M.; Gorp, T. Van; Massuger, L.F.A.G.

    2016-01-01

    OBJECTIVE: The value of secondary cytoreductive surgery (SCS) in patients with recurrent epithelial ovarian cancer is controversial. The aim of this population-based study was to investigate the role of SCS in the Netherlands. METHODS: Data of 408 patients who underwent SCS between 2000 and 2013

  20. Plastic surgery in the European Union: A study of development, training, manpowerplanning and migration

    NARCIS (Netherlands)

    K.H. Tan (King Hoen)

    2001-01-01

    textabstractThe aim of this study is to clarify the role of plastic surgery in the European Union (the former European Connnnnity). The idea is that this will lead to a better understanding of the specialty among laymen., colleagnes and healthcare officials. To this end, the historical development

  1. Psychosocial predictors of an interest in cosmetic surgery among young Norwegian women: a population-based study.

    Science.gov (United States)

    Javo, Iiná Márjá; Sørlie, Tore

    2010-01-01

    The present study investigated psychosocial factors expected to predict an interest in cosmetic surgery. It was hypothesized that body dysmorphic disorder-like symptoms, personality, interpersonal attachment insecurity, low self-esteem, poor body image, dissatisfaction with sexual life, distorted eating behavior, emotional distress, low education, poor relationship with parents and friends, teasing history, social acceptance of cosmetic surgery, and low level of physical activity would relate to an interest in cosmetic surgery. Questionnaire data were obtained from 1880 participants who responded to a survey distributed to a representative sample of 3500 Norwegian women between 18 and 35 years of age living in the two northernmost counties. Data were analyzed by univariate and multiple logistic regression analyses. Multiple regression analyses showed that an interest in cosmetic surgery was positively related to body dysmorphic disorder-like symptoms, body image orientation, having children, been teased for appearance, knowing someone who has had cosmetic surgery, and being recommended cosmetic surgery. Agreeability, body image evaluation, education, and quality of relationship with parents were negatively related to an interest in cosmetic surgery. The study gives new insights into psychosocial factors predicting an interest in cosmetic surgery. In addition to previously known predictors, having been teased for appearance and having children were positive predictors, whereas education and quality of relationship with parents were negative predictors of an interest in cosmetic surgery. The results may contribute to a better understanding of the various factors that may motivate an individual to undergo cosmetic surgery.

  2. Effects of tolvaptan in the early postoperative stage after heart valve surgery: results of the STAR (Study of Tolvaptan for fluid retention AfteR valve surgery) trial.

    Science.gov (United States)

    Nishi, Hiroyuki; Toda, Koichi; Miyagawa, Shigeru; Yoshikawa, Yasushi; Fukushima, Satsuki; Kawamura, Masashi; Yoshioka, Daisuke; Saito, Tetsuya; Ueno, Takayoshi; Kuratani, Toru; Sawa, Yoshiki

    2015-12-01

    The purpose of this study was to assess the efficacy of tolvaptan, a vasopressin V2 receptor antagonist, for the management of postoperative surgical fluid retention after heart valve surgery. This was a prospective observational study of 64 patients with heart valve disease who underwent valve surgery between 2013 and 2014. Those in the tolvaptan group received tolvaptan in addition to conventional diuretic therapy. The results were compared to the results of 55 patients who underwent heart valve surgery between 2007 and 2010 and received conventional postoperative diuretics alone. The time to return to the preoperative BW was significantly shorter in the patients who received tolvaptan (6.1 ± 3.8 vs. 8.7 ± 6.7 days, p tolvaptan group. The response to tolvaptan was related to the postoperative degree of BW increase and the preoperative creatinine level. Tolvaptan was effective in treating fluid retention during the early postoperative stage in cardiac surgery patients, without increased renal failure or abnormal electrolyte levels. This new type of diuretic therapy may be a suitable option for postoperative fluid management in patients undergoing cardiac surgery.

  3. Increased risk for knee replacement surgery after arthroscopic surgery for degenerative meniscal tears: a multi-center longitudinal observational study using data from the osteoarthritis initiative.

    Science.gov (United States)

    Rongen, J J; Rovers, M M; van Tienen, T G; Buma, P; Hannink, G

    2017-01-01

    The primary objective was to assess whether patients with knee osteoarthritis and whom undergo arthroscopic meniscectomy have an increased risk for future knee replacement surgery. Data used were obtained from the Osteoarthritis Initiative (OAI) study. Participants were enrolled, in four clinical centers, between February 2004 and May 2006 and were followed up on an annual basis up to and including 108-months from enrollment. 4674 participants (58.4% female), aged 45-79, of all ethnic groups, who had, and those who were at high risk for developing, symptomatic knee osteoarthritis were included, of which 3337 (71.4%) were included in the final follow up visit. Hazard ratio of knee replacement surgery for participants who underwent arthroscopic meniscectomy during follow up compared to propensity score matched participants who did not undergo arthroscopic meniscectomy during follow up. 335 participants underwent arthroscopic meniscectomy during follow up, of which 63 (18.8%) underwent knee replacement surgery in the same knee. Of the 335 propensity score matched participants 38 (11.1%) underwent knee replacement surgery during follow up. Results from the Cox-proportional hazards model demonstrated that the hazard ratio of knee replacement surgery was 3.03 (95% CI (1.67-5.26)) for participants who underwent arthroscopic meniscectomy relative to the propensity score matched participants who did not undergo arthroscopic meniscectomy. In patients with knee osteoarthritis arthroscopic knee surgery with meniscectomy is associated with a three fold increase in the risk for future knee replacement surgery. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  4. [Antireflux surgery, comperative study of three laparascopic techniques].

    Science.gov (United States)

    Gómez Cárdenas, Xavier; Flores Armenta, Jesús Humberto; Elizalde Di Martino, Alexandro; Guarneros Zárate, Joaquín Eugenio; Cervera Servín, Andrés; Ochoa Gómez, Ramón; Quijano Orvañanos, Fernando

    2005-01-01

    Laparoscopic fundoplication for the surgical treatment of gastroesophageal reflux disease is widely accepted all over the world. To compare clinical results of patients operated with the Nissen, Nissen-Rossetti and Toupet techniques, in Centro Medico ABC, for the treatment of pathologic gastroesophageal reflux, and to determine if there is a difference when dividing the short gastric vessels with complete mobilization of the gastric fundus. We carried out a retrospective, longitudinal, comparative and observational study of 241 laparoscopic fundoplications performed in Centro Medico ABC, between January 2000 and May 2001. The following variables were analyzed: age, sex, smoking, habits, drinking habits, time of evolution of gastroesophageal reflux, typical and atypical clinical manifestations, medical treatment received, preoperative dysphagia, hiatal hernia, degree of esophagitis, Barrett's esophagus, esophageal motility disorders, preoperative and postoperative pressure of the inferior esophageal sphincter, 24-hour pH monitoring, type of fundoplication, division of short gastric vessels, complete mobilization of the gastric fundus, closure of the pillars, diameter of probang, fundoplication fixed to the right pillar, suture applied, transoperative endoscopy, days of hospitalization, time before applying orally, morbidity and mortality. For the clinical follow-up, patients were contacted via telephone, assessing the following variables: dysphagia for liquids, dysphagia for solids, heartburn, postprandial fullness, gastric bubble, ability to belch, flatulence, diarrhea, medical treatment post-fundoplication, esophageal dilatation, reoperation, satisfaction with procedure divided into 5 levels: excellent, satisfied, moderately satisfied, poorly satisfied, unsatisfied and, for each group, the modified Visick scale was included. These variables were analyzed and compared between Nissen, Nissen-Rossetti and Toupet fundoplication, attempting to identify a significant

  5. Google Glass in pediatric surgery: an exploratory study.

    Science.gov (United States)

    Muensterer, Oliver J; Lacher, Martin; Zoeller, Christoph; Bronstein, Matthew; Kübler, Joachim

    2014-01-01

    Personal portable information technology is advancing at a breathtaking speed. Google has recently introduced Glass, a device that is worn like conventional glasses, but that combines a computerized central processing unit, touchpad, display screen, high-definition camera, microphone, bone-conduction transducer, and wireless connectivity. We have obtained a Glass device through Google's Explorer program and have tested its applicability in our daily pediatric surgical practice and in relevant experimental settings. Glass was worn daily for 4 consecutive weeks in a University Children's Hospital. A daily log was kept, and activities with a potential applicability were identified. Performance of Glass was evaluated for such activities. In-vitro experiments were conducted where further testing was indicated. Wearing Glass throughout the day for the study interval was well tolerated. Colleagues, staff, families and patients overwhelmingly had a positive response to Glass. Useful applications for Glass were hands-free photo/videodocumentation, making hands-free telephone calls, looking up billing codes, and internet searches for unfamiliar medical terms or syndromes. Drawbacks encountered with the current equipment were low battery endurance, data protection issues, poor overall audio quality, as well as long transmission latency combined with interruptions and cut-offs during internet videoconferencing. Glass has the some clear utility in the clinical setting. However, before it can be recommended universally for physicians and surgeons, substantial improvements to the hardware are required, issues of data protection must be solved, and specialized medical applications (apps) need to be developed. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Triclosan-coated sutures reduce wound infections after spinal surgery: a retrospective, nonrandomized, clinical study.

    Science.gov (United States)

    Ueno, Masaki; Saito, Wataru; Yamagata, Megumu; Imura, Takayuki; Inoue, Gen; Nakazawa, Toshiyuki; Takahira, Naonobu; Uchida, Kentaro; Fukahori, Nobuko; Shimomura, Kiyomi; Takaso, Masashi

    2015-05-01

    Surgical site infection (SSI) is a serious postoperative complication. The incidence of SSIs is lower in clean orthopedic surgery than in other fields, but it is higher after spinal surgery, reaching 4.15% in high-risk patients. Several studies reported that triclosan-coated polyglactin 910 sutures (Vicryl Plus; Ethicon, Inc., Somerville, NJ, USA) significantly reduced the infection rate in the general surgical, neurosurgical, and thoracic surgical fields. However, there have been no studies on the effects of such coated sutures on the incidence of SSIs in orthopedics. To compare the incidence of wound infections after spinal surgery using triclosan-coated suture materials with that of noncoated ones. A retrospective, nonrandomized, and clinical study. From May 2010 to April 2012, 405 patients underwent a spinal surgical procedure in the Department of Orthopedic Surgery of two university hospitals. The primary outcome was the number of wound infections and dehiscences. Two hundred five patients had a conventional wound closure with polyglactin 910 suture (Vicryl) between May 2010 and April 2011 (Time Period 1 [TP1]), and 200 patients underwent wound closure with triclosan-coated polyglactin 910 suture (Vicryl Plus) between May 2011 and April 2012 (TP2). Statistical comparisons of wound infections, dehiscence, and risk factors for poor wound healing or infection were performed. None of the authors has any conflict of interest associated with this study. There were two cases of wound dehiscence in TP1 and one in TP2 (p=.509). Using noncoated sutures in TP1, eight patients (3.90%) had wound infections, whereas one patient (0.50%) had wound infections in TP2 (using triclosan-coated sutures); the difference was significant (p=.020). The use of triclosan-coated polyglactin 910 sutures instead of polyglactin 910 sutures may reduce the number of wound infections after spinal surgery. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Perioperative risk factors for acute kidney injury after liver resection surgery: an historical cohort study.

    Science.gov (United States)

    Tomozawa, Arisa; Ishikawa, Seiji; Shiota, Nobuhiro; Cholvisudhi, Phantila; Makita, Koshi

    2015-07-01

    This study aimed to identify the incidence and risk factors for acute kidney injury (AKI) after liver resection surgery and to clarify the relationship between postoperative AKI and outcome. We conducted a historical cohort study of patients who underwent liver resection surgery with sevoflurane anesthesia from January 2004 to October 2011. Acute kidney injury was diagnosed based on the Acute Kidney Injury Network classification within 72 hr after the surgery. Patient data, surgical and anesthetic data, and laboratory data were extracted manually from the patients' electronic charts. Multivariable logistic regression analysis was used to identify perioperative risk factors for postoperative AKI. Acute kidney injury was diagnosed in 78 of 642 patients (12.1%; 95% confidence interval [CI]: 9.7 to 14.9). Multivariable analysis showed an independent association between postoperative AKI and preoperative estimated glomerular filtration rate (adjusted odds ratio [aOR] 0.74; 95% CI: 0.64 to 0.85), preoperative hypertension (aOR 2.10; 95% CI: 1.11 to 3.97), and intraoperative red blood cell transfusion (aOR 1.04; 95% CI: 1.01 to 1.07). Development of AKI within 72 hr after liver resection surgery was associated with increased hospital mortality, prolonged length of stay, and increased rates of mechanical ventilation, reintubation, and renal replacement therapy. Perioperative risk factors for AKI after liver resection surgery are similar to those established for other surgical procedures. Further studies are needed to establish causality and to determine whether interventions on modifiable risk factors can reduce the incidence of postoperative AKI and improve patient outcome. This study was registered at the University Hospital Medical Information Network (UMIN) Center (UMIN 000008089).

  8. The effects of healing touch on pain, nausea, and anxiety following bariatric surgery: a pilot study.

    Science.gov (United States)

    Anderson, Joel G; Suchicital, Liliana; Lang, Maria; Kukic, Azra; Mangione, Lucrezia; Swengros, Diane; Fabian, Jennifer; Friesen, Mary Ann

    2015-01-01

    Given the growth in the number of bariatric surgeries, it is important for healthcare practitioners to maximize symptom management for these patients, including the option of complementary therapies such as Healing Touch. A quasi-experimental study was conducted to determine the feasibility of a Healing Touch intervention for reducing pain, nausea, and anxiety in patients undergoing laparoscopic bariatric surgery. Following surgery, a nurse administered the Healing Touch intervention once daily. Study participants reported levels of pain, nausea, and anxiety immediately before and after the Healing Touch intervention using separate numeric rating scales. Significant decreases in pain, nausea, and anxiety were observed immediately following the intervention on post-operative days one and two, and in pain and anxiety on post-operative day three compared with pre-intervention levels. These findings indicate that the Healing Touch intervention is feasible and acceptable to patients undergoing bariatric surgery, and significantly improved pain, nausea, and anxiety in these patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Clinic study on silicone hydrogel contact lenses used as bandage contact lenses after LASEK surgery.

    Science.gov (United States)

    Qu, Xiao-Mei; Dai, Jin-Hui; Jiang, Zhen-Ying; Qian, Yi-Feng

    2011-01-01

    To compare the clinical performance of two types of silicon hydrogel contact lenses used as bandage lenses after LASEK surgery. A prospective, double-masked study was conducted on 42 eyes of 21 patients who received binocular LASEK surgeries. The interocular difference in spherical equivalent power was less than -1.50D. Patients were randomly assigned to wear Galyfilcon A (Lens A) bandage contact lens in one eye and Balafilcon A (Lens B) in the fellow eye after the surgery. The responses to a subjective questionnaire on comfort of wearing, corneal epithelial status, conjunctival hyperemia, limbal neovascularization, lens fitting and contact lens debris were assessed 1 and 5 days postoperatively. Corneal endothelium was assessed before and 5 days after the surgery upon bandage lens removal. There was no difference between the two groups in terms of conjunctival hyperemia, limbal neovascularization, contact lens fitting, corneal epithelial status, corneal endothelium cell density (CD) and endothelium cell size (CS) at any postoperative visit. Complaints of discomfort, including foreign body sensation, pain and intolerance were statistically more among Lens B wearers at any postoperative visit (Psilicon hydrogel lenses investigated in this study demonstrated similar clinical performance in terms of corneal responses and lens fitting. However, Lens A showed a better performance in terms of comfort of wearing and deposit resistance.

  10. Analysis of Complaints from Patients During Mechanical Ventilation After Cardiac Surgery: A Retrospective Study.

    Science.gov (United States)

    Wang, Yi; Li, Hua; Zou, Honglin; Li, Yaxiong

    2015-08-01

    This study analyzed major complaints from patients during mechanical ventilation after cardiac surgery and identified the most common complaints to reduce adverse psychologic responses. Retrospective. A single tertiary university hospital. Patients with heart disease who were on mechanical ventilation after cardiac surgery (N = 800). The major complaints of the patients during mechanical ventilation after cardiac surgery were analyzed. Patients' comfort was evaluated using a visual analog scale, and the factors affecting comfort were analyzed. The average visual analog scale score in all patients was 5.8±2.0, and most patients presented moderate discomfort. The factors affecting comfort included dry mouth, thirst, tracheal intubation, aspiration of sputum, communication barriers, limited mobility, fear/anxiety, patient-ventilator dyssynchrony, and poor environmental conditions. Of these factors, 8 were independent predictors of the visual analog scale score. Patients considered mechanical ventilation to be the worst part of their hospitalization. The study identified 8 independent factors causing discomfort in patients during mechanical ventilation after cardiac surgery. Clinicians should take appropriate measures and implement nursing interventions to reduce suffering, physical and psychologic trauma, and adverse psychologic responses and to promote recovery. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Nurses' educational needs for pain management of post-cardiac surgery patients: a qualitative study.

    Science.gov (United States)

    Leegaard, Marit; Watt-Watson, Judy; McGillion, Michael; Costello, Judy; Elgie-Watson, Jeanne; Partridge, Kim

    2011-01-01

    Inadequate knowledge among health care providers is a key barrier to good pain management, and nurses have a major role to provide education to patients. The purpose of this study was to identify nurses' learning needs to prepare patients for managing pain before and after discharge home from cardiac surgery. The overall aim is to develop a pain education intervention for nurses working with cardiac surgical patients. This was a focus groups study. Participants (N=22) were asked about their perceptions of patients' education needs for pain management after cardiac surgery and approaches to help nurses meet these needs. The Pain Beliefs Scale was used to capture nurses' own misbeliefs about pain that would need clarification in a successful pain education intervention. Nurses identified pain management challenges in the hospital, particularly related to patients' age, patient concerns about the use of opioids, the need to use multiple management strategies, and preparing patients to manage pain at home. Pain Beliefs Scale scores were low related to opioid dosing and adverse effects. Participants identified their most helpful educational approaches being brief in-services, hands-on learning, lunch-and-learn sessions, and designated education days. Participants identified the most common pain knowledge gaps for patients before and after discharge after cardiac surgery. These data will be used to develop an education intervention for nurses to help their cardiac surgery patients with more effective pain management strategies before and after discharge home. Copyright © 2011 Lippincott Williams & Wilkins.

  12. Evaluation of mandibular condylar changes in patients following orthognathic surgery: A retrospective study

    Directory of Open Access Journals (Sweden)

    Vikas Aneja

    2017-01-01

    Full Text Available Background: Condylar resorption as a cause of relapse after orthognathic surgery is well known. Several authors have presented evidence of the relation between orthognathic surgery and condylar remodeling and resorption. This study was done to appraise the condylar changes along with the form and function following orthognathic surgery, as well as to assess what factors may have contributed to the problems. Methodology: A diagnosis of progressive condylar resorption (PCR was made by comparison of preoperative and postoperative radiographs (cephalometric radiograms, as well as clinical evaluations. The radiographs were taken for each patient preoperatively and postoperatively, which include immediately after osteotomy, at 6 months and 24 months. Additional radiographs were taken when required. Then, preoperative and postoperative tracings were compared at 24 months postoperatively. Results and Conclusion: It can be concluded from this study that females of relative low age (<18 years appeared to be a high-risk factor for the occurrence of condylar alteration including PCR. A steep mandibular plane angle, the low facial height ratio (post/ant, and magnitude of surgery were also significantly related to the occurrence of condylar alteration, but the multivariance regression showed that these parameters had only limited value.

  13. Acute cholecystitis – early laparoskopic surgery versus antibiotic therapy and delayed elective cholecystectomy: ACDC-study

    Directory of Open Access Journals (Sweden)

    Büchler Markus W

    2007-10-01

    Full Text Available Abstract Background Acute cholecystitis occurs frequently in the elderly and in patients with gall stones. Most cases of severe or recurrent cholecystitis eventually require surgery, usually laparoscopic cholecystectomy in the Western World. It is unclear whether an initial, conservative approach with antibiotic and symptomatic therapy followed by delayed elective surgery would result in better morbidity and outcome than immediate surgery. At present, treatment is generally determined by whether the patient first sees a surgeon or a gastroenterologist. We wish to investigate whether both approaches are equivalent. The primary endpoint is the morbidity until day 75 after inclusion into the study. Design A multicenter, prospective, randomized non-blinded study to compare treatment outcome, complications and 75-day morbidity in patients with acute cholecystitis randomized to laparoscopic cholecystectomy within 24 hours of symptom onset or antibiotic treatment with moxifloxacin and subsequent elective cholecystectomy. For consistency in both arms moxifloxacin, a fluorquinolone with broad spectrum of activity and high bile concentration is used as antibiotic. Duration: October 2006 – November 2008 Organisation/Responsibility The trial was planned and is being conducted and analysed by the Departments of Gastroenterology and General Surgery at the University Hospital of Heidelberg according to the ethical, regulatory and scientific principles governing clinical research as set out in the Declaration of Helsinki (1989 and the Good Clinical Practice guideline (GCP. Trial Registration ClinicalTrials.gov NCT00447304

  14. Comparative Study on Osseointegration of Implants After Flap and Flapless Surgery in the Mandible of Dogs.

    Science.gov (United States)

    Min, Hong-Gi; Kim, Su-Gwan; Oh, Ji-Su; You, Jae-Seek; Lim, Sung-Chul; Jeong, Mi-Ae

    2017-10-01

    The objective of this study was to compare the implant stability and osseointegration of implants using a flap or flapless technique. Mandibular premolars and molars were extracted from both sides in 6 dogs. After 8 weeks, 4 fixtures were implanted using either a flap or flapless technique. Implant stability quotient was measured on insertion and at 2, 4, and 8 weeks later. The animals were killed while the tissues were histologically analyzed. Implant stability increased for 8 weeks, and no statistically significant differences were observed between the surgical protocols. Bone-implant contact showed 60.27% ± 30.99% for flapless surgery and 59.73% ± 17.12% for flap surgery. And the results of new bone formation area from total area showed 56.07% ± 27.78% for flapless surgery and 57.00% ± 14.66% for flap surgery. There were no statistically significant differences. This study showed no significant difference in implant stability as well as osseointegration regardless of flap or flapless technique.

  15. Complications and frequency of redo antireflux surgery in Denmark: a nationwide study, 1997-2005.

    Science.gov (United States)

    Funch-Jensen, Peter; Bendixen, Anette; Iversen, Maria Gerding; Kehlet, Henrik

    2008-03-01

    Outcomes after redo fundoplication (RF) in recurrent gastroesophageal reflux disease (GERD) are debatable, and they may include lower success rates with higher postoperative morbidity and mortality than outcomes after primary fundoplication (PF). However, data from large, nationwide studies are not available. Accordingly, the aim of the present study was to evaluate nationwide Danish data on RF in a nine-year period. Data in the period from 1997 through 2005 were extracted from the National Patient Register. The following information was procured: frequency of RF, rate of conversion to open surgery, rate of complications requiring reoperation, and 30-day mortality. Data for RF were compared to PF. A total of 2589 fundoplications were performed in 2465 patients. Thus, 113 patients underwent a total of 124 RF (RF rate = 5.0%). Most RF (84.7%) were performed at high-volume departments. Patients who underwent RF were converted to open surgery more often (16.1% vs. 6.1% in PF) (P < 0.0001). The median postoperative hospital stay was 3 days after RF and 2 days after PF (P = 0.96). Following RF 1.6% of the patients had complications requiring surgery compared with 1.3% after PF (P = 0.79), and 30-day mortality was 0.81% after RF compared with 0.45% after PF (P = 0.57). This nationwide Danish study showed a low rate of redo fundoplication and a similar morbidity and mortality rate after redo surgery compared with that of primary surgery.

  16. Gender differences in mortality following non-cardiovascular surgery: an observational study.

    Science.gov (United States)

    Grewal, Keerat; Wijeysundera, Duminda N; Carroll, Jo; Tait, Gordon; Beattie, W Scott

    2012-03-01

    Although inequality between males and females in cardiovascular surgery is well recognized, few studies have examined the influence of sex on mortality following non-cardiovascular surgery. The objective of the study was to determine whether there are differences in mortality between males and females following non-cardiovascular surgery and to ascertain to what extent preoperative risk factors explain these differences. This was an observational study of 39,433 consecutive non-cardiovascular inpatient surgical cases from non-sex-biased surgical services from 2003 to 2009. Data on the surgical procedure, patient risk factors, and outcomes was retrieved from the institutional Electronic Data Warehouse. The primary outcome was in-hospital mortality within 30 days of surgery. Multivariate analysis using logistic regression was conducted to determine the role of risk factors for mortality. The 30-day mortality was 2.76% for males and 1.89% for females (odds ratio, 1.47; 95% confidence interval [CI], 1.29 to 1.69). Logistic regression showed that age, number of Charlson comorbidities, American Society of Anesthesiologists (ASA) classification, and emergent/urgent status were independent predictors of mortality (receiver operating characteristic area, 0.90). After adjustment for these factors, the odds ratio for male mortality was reduced to 1.31 (95% CI, 1.14 to 1.52). Males present for non-cardiovascular surgery with a higher ASA classification, with more comorbidities, and more often emergently than females, providing a partial explanation of the observed difference in mortality.

  17. Retrospective study on change in pharyngeal airway space and hyoid bone position after mandibular setback surgery.

    Science.gov (United States)

    On, Sung Woon; Han, Min Woo; Hwang, Doo Yeon; Song, Seung Il

    2015-10-01

    The purpose of this study was to evaluate changes in the pharyngeal airway space and hyoid bone position after mandibular setback surgery with bilateral sagittal split ramus osteotomy (BSSRO) and to analyze the correlation between the amount of mandibular setback and the amount of change in pharyngeal airway space or hyoid bone position. From January 2010 to February 2013, a total of 30 patients who were diagnosed with skeletal class III malocclusion and underwent the same surgery (BSSRO) and fixation method in the Division of Oral and Maxillofacial Surgery, Department of Dentistry at the Ajou University School of Medicine (Suwon, Korea) were included in this study. Lateral cephalograms of the 30 patients were assessed preoperatively (T1), immediately postoperatively (T2), and 6 months postoperatively (T3) to investigate the significance of changes by time and the correlation between the amount of mandibular setback and the amount of change in the airway space and hyoid bone position. Three regions of the nasopharynx, oropharynx, and hypopharynx were measured and only the oropharynx showed a statistically significant decrease (Pamount of mandibular setback and the amount of final change in the airway space and hyoid bone position with Pearson's correlation showed no significant correlation. In this study, the oropharynx significantly decreased after mandibular setback surgery, and changes in the surrounding structures were identified through posteroinferior movement of the hyoid bone during long-term follow-up. Therefore, postoperative obstructive sleep apnea should be considered in patients who plan to undergo mandibular setback surgery, and necessary modifications to the treatment plan should also be considered.

  18. Predictors for Surgery in Shoulder Instability: A Retrospective Cohort Study Using the FEDS System.

    Science.gov (United States)

    Lebus, George F; Raynor, Martin B; Nwosu, Samuel K; Wagstrom, Emily; Jani, Sunil S; Carey, James L; Hettrich, Carolyn M; Cox, Charles L; Kuhn, John E

    2015-10-01

    Shoulder instability is a common cause of pain and dysfunction in young, active patients. While studies have analyzed risk factors for recurrent instability and failure after instability surgery, few have examined which variables are associated with initial surgery in this patient population. To identify variables that may be associated with surgical intervention in patients with shoulder instability in the context of the FEDS (frequency, etiology, direction, severity) classification, a system that may be useful in the surgical treatment of shoulder instability patients. Cohort study (prognosis); Level of evidence, 2. A database of patients treated for shoulder instability from 3 separate institutions from 2005 to 2010 was generated using International Classification of Diseases-9th Revision data. Data were collected via retrospective review. Injury data were categorized according to the FEDS system. Data were analyzed for significance, with the primary outcome of surgical intervention. Summary statistics were used to assess which variables were associated with eventual surgery. To test the unadjusted bivariate associations between shoulder surgery and each data point, Pearson chi-square tests were used for categorical variables and Wilcoxon tests were used for continuous variables. Over the study time period, 377 patients were treated for shoulder instability. Patients who had surgery were more likely younger, had recurrent instability, and had their initial injury while playing a sport. Most patients had anterior instability; however, there was a greater proportion of posterior instability patients in the operative group. Severity of dislocation, measured by whether the patient required help to relocate the shoulder, was not significantly associated with eventual surgery. While imaging was not available for all patients, surgical patients were more likely to have magnetic resonance imaging findings of anterior labral injury and less likely to have a supraspinatus

  19. Evidence hierarchies relating to hand surgery: current status and improvement. A bibliometric analysis study

    Directory of Open Access Journals (Sweden)

    Thaís Silva Barroso

    2017-11-01

    Full Text Available ABSTRACT BACKGROUND: Hierarchy of evidence is an important measurement for assessing quality of literature. Information regarding quality of evidence within the Brazilian hand surgery setting is sparse, especially regarding whether research has improved in either quality or quantity. This study aimed to identify and classify hand surgery studies published in the two most important Brazilian orthopedics journals based on hierarchy of evidence, with comparisons with previously published data. DESIGN AND SETTING: Bibliometric analysis study performed in a federal university. METHODS: Two independent researchers conducted an electronic database search for hand surgery studies published between 2010 and 2016 in Acta Ortopédica Brasileira and Revista Brasileira de Ortopedia. Eligible studies were subsequently classified according to methodological design, based on the Haynes pyramid model (HP and the JBJS/AAOS levels of evidence and grades of recommendations (LOR. Qualitative and quantitative data were gathered regarding all studies. Previous data were considered to assess whether the proportion of high-quality studies had improved over time (2000-2009 versus 2010-2016. RESULTS: The final analysis included 123 studies, mostly originating from the southeastern region (78.8% and private institutions (65%, with self-funding (91.8%. Methodological assessment showed that 15.4% were classified as level I/II using HP and 16.4% using LOR. No significant difference in proportions of high-quality studies was found between the two periods of time assessed (5% versus 12%; P = 0.13. CONCLUSION: Approximately 15% of hand surgery studies published in two major Brazilian journals were likely to be classified as high-quality through two different systems. Moreover, no trend towards quality-of-evidence improvement was found over the last 15 years.

  20. Long-term effect of bariatric surgery on liver enzymes in the Swedish Obese Subjects (SOS study.

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    Maria Antonella Burza

    Full Text Available BACKGROUND AND AIM: Obesity is associated with elevated serum transaminase levels and non-alcoholic fatty liver disease and weight loss is a recommended therapeutic strategy. Bariatric surgery is effective in obtaining and maintaining weight loss. Aim of the present study was to examine the long-term effects of bariatric surgery on transaminase levels in obese individuals. METHODS: The Swedish Obese Subjects (SOS study is a prospective controlled intervention study designed to compare the long-term effects of bariatric surgery and usual care in obese subjects. A total of 3,570 obese participants with no excess of alcohol consumption at baseline (1,795 and 1,775 in the control and surgery group, respectively were included in the analyses. Changes in transaminase levels during follow-up were compared in the surgery and control groups. RESULTS: Compared to usual care, bariatric surgery was associated with lower serum ALT and AST levels at 2- and 10- year follow up. The reduction in ALT levels was proportional to the degree of weight loss. Both the incidence of and the remission from high transaminase levels were more favorable in the surgery group compared to the control group. Similarly, the prevalence of ALT/AST ratio <1 was lower in the surgery compared to the control group at both 2- and 10-year follow up. CONCLUSIONS: Bariatric surgery results in a sustained reduction in transaminase levels and a long-term benefit in obese individuals.

  1. Factors of importance for the functional outcome in orthognathic surgery patients: a prospective study of 118 patients

    DEFF Research Database (Denmark)

    Øland, Jesper; Jensen, John; Melsen, Birte

    2010-01-01

    The aim of this study was to assess the influence of orthognathic surgery on patients' stomatognathic function and, further, to evaluate how post-treatment function relates to satisfaction.......The aim of this study was to assess the influence of orthognathic surgery on patients' stomatognathic function and, further, to evaluate how post-treatment function relates to satisfaction....

  2. De-hospitalization of the pediatric day surgery by means of a freestanding surgery center: pilot study in the lazio region

    Directory of Open Access Journals (Sweden)

    Mangia Giovanni

    2012-02-01

    Full Text Available Abstract Background Day surgery should take place in appropriate organizational settings. In the presence of high volumes, the organizational models of the Lazio Region are represented by either Day Surgery Units within continuous-cycle hospitals or day-cycle Day Surgery Centers. This pilot study presents the regional volumes provided in 2010 and the additional volumes that could be provided based on the best performance criterion with a view to suggesting the setting up of a regional Freestanding Center of Pediatric Day Surgery. Methods This is an observational retrospective study. The activity volumes have been assessed by means of a DRG (Diagnosis Related Group-specific indicator that measures the ratio of outpatients to the total number of treated patients (freestanding indicator, FI. The included DRGs had an FI exceeding the 3rd quartile present in at least a health-care facility and a volume exceeding 0.5% of the total patients of the pediatric surgery and urology facilities of the Lazio Region. The relevant data have been provided by the Public Health Agency and relate to 2010. The best performance FI has been used to calculate the theoretical volume of transferability of the remaining facilities into freestanding surgery centers. Patients under six months of age and DRGs common to other disciplines have been excluded. The Chi Square test has been used to compare the FI of the health-care facilities and the FI of the places of origin of the patients. Results The DRG provided in 2010 amounted to a total of 5768 belonging to 121 types of procedures. The application of the criteria of inclusion have led to the selection of seven final DRG categories of minor surgery amounting to 3522 cases. Out of this total number, there were 2828 outpatients and 694 inpatients. The recourse of the best performance determines a potential transfer of 497 cases. The total outpatient volume is 57%. The Chi Square test has pointed to a statistically significant

  3. Clonidine as a First-Line Sedative Agent After Neonatal Cardiac Surgery: Retrospective Cohort Study.

    Science.gov (United States)

    Kleiber, Niina; de Wildt, Saskia N; Cortina, Gérard; Clifford, Michael; Ducruet, Thierry; Tibboel, Dick; Millar, Johnny

    2016-04-01

    To determine the cardiovascular tolerance of clonidine used as a first-line sedative after cardiac surgery in small infants. Retrospective chart review. A tertiary and quaternary referral cardiac PICU. All infants younger than 2 months who received a clonidine infusion for sedation after cardiac surgery from October 2011 to July 2013. None. Heart rate, blood pressure, central venous and left atrial pressure, vasoactive inotropic score, volume of fluid bolus, and lactate and central mixed venous saturation were assessed. Preinfusion values were compared with postinfusion values. Of 224 potentially eligible patients, only 23 infants met inclusion criteria, as most patients only received high doses of morphine and some received midazolam instead of clonidine. Clonidine administration was started at a median of 12 hours after surgery (Q1-Q3, 5-23), and infusion rate was 0.5-2 μg/kg/hr for a median duration of 30 hours (Q1-Q3, 12-54). Heart rate decreased (maximal mean decrease: 12% [149 beats/min (SD, 17) to 131 beats/min (SD, 17)]; p sedative added to morphine in selected patients seems hemodynamically safe. The observed decrease in heart rate and diastolic blood pressure seems of minimal clinical importance as all other hemodynamic variables remained stable or improved. The safety of clonidine given early after cardiac surgery as alternative to midazolam merits further study.

  4. Fenoldopam to prevent renal replacement therapy after cardiac surgery. Design of the FENO-HSR study.

    Science.gov (United States)

    Landoni, G; Bove, T; Pasero, D; Comis, M; Orando, S; Pinelli, F; Guarracino, F; Corcione, A; Galdieri, N; Zucchetti, M; Maglioni, E; Biagioli, B; Pala, G; Frontini, M; Caramelli, F; Persi, B; Renzini, M; Paoletti, F; Lorini, L; Morelli, A; Alvaro, G; Bianco, R; Pittarello, D; Manzato, A; Pedersini, G; Mizzi, A; Lojacono, N; Leoncini, P; Iovino, T; Cariello, C; Baldassarri, R; Camata, A M; Padua, G; Frascaroli, G; Leonardi, S; Bignami, E; Zangrillo, A

    2010-01-01

    Acute kidney injury requiring renal replacement therapy is a serious complication following cardiac surgery associated with poor clinical outcomes. Until now no drug showed nephroprotective effects. Fenoldopam is a dopamine-1 receptor agonist which seems to be effective in improving postoperative renal function. The aim of this paper is to describe the design of the FENO-HSR study, planned to assess the effect of a continuous infusion of fenoldopam in reducing the need for renal replacement therapy in patients with acute kidney injury after cardiac surgery. We're performing a double blind, placebo-controlled multicentre randomized trial in over 20 Italian hospitals. Patients who develop acute renal failure defined as R of RIFLE score following cardiac surgery are randomized to receive a 96-hours continuous infusion of either fenoldopam (0.025-0.3 µg/kg/min) or placebo. The primary endpoint will be the rate of renal replacement therapy. Secondary endpoints will be: mortality, time on mechanical ventilation, length of intensive care unit and hospital stay, peak serum creatinine and the rate of acute renal failure (following the RIFLE score). This trial is planned to assess if fenoldopam could improve relevant outcomes in patients undergoing cardiac surgery who develop acute renal dysfunction. Results of this double-blind randomized trial could provide important insights to improve the management strategy of patients at high risk for postoperative acute kidney injury.

  5. Predictors of red blood cell transfusion after cardiac surgery: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Camila Takao Lopes

    2015-12-01

    Full Text Available Abstract OBJECTIVE To identify predictors of red blood cell transfusion (RBCT after cardiac surgery. METHOD A prospective cohort study performed with 323 adults after cardiac surgery, from April to December of 2013. A data collection instrument was constructed by the researchers containing factors associated with excessive bleeding after cardiac surgery, as found in the literature, for investigation in the immediate postoperative period. The relationship between risk factors and the outcome was assessed by univariate analysis and logistic regression. RESULTS The factors associated with RBCT in the immediate postoperative period included lower height and weight, decreased platelet count, lower hemoglobin level, higher prevalence of platelet count <150x10 3/mm3, lower volume of protamine, longer duration of anesthesia, higher prevalence of intraoperative RBCT, lower body temperature, higher heart rate and higher positive end-expiratory pressure. The independent predictor was weight <66.5Kg. CONCLUSION Factors associated with RBCT in the immediate postoperative period of cardiac surgery were found. The independent predictor was weight.

  6. Maxillofacial Fractures: Twenty Years of Study in the Department of Maxillofacial Surgery in Kosovo

    Science.gov (United States)

    Loxha, Mergime Prekazi; Sejfija, Osman; Salihu, Sami; Gjinolli, Fellanza; Agani, Zana; Hamiti, Vjosa; Rexhepi, Aida Namani; Gecaj-Gashi, Agreta

    2013-01-01

    The aim: The aim of this study was to analyze maxillofacial region fractures during the past 20 years in the Department of Maxillofacial Surgery in Prishtina. Methods: We have analyzed the histories of all patients with trauma who were hospitalized in the Department of Maxillofacial Surgery in Prishtina since the opening of the clinic in 1983 through 2005. Narrowing the subject of our research, we concentrated on fractures of the maxillofacial region treated at the Clinic of Maxillofacial Surgery for the period 2001–2005. We have analyzed those fractures and compared them with the period from 1983 to 2005 only when it was reasonable. Results: During this period, 1,945 patients were treated for trauma in the maxillofacial region by the Department of Maxillofacial Surgery. This group included 19.8% females and 80.2% males. The largest age group were those between 20 and 20 years of age. Causes of trauma for both periods were predominantly traffic accidents; however, during the period 2001-2005, interpersonal conflicts were increasingly the cause of fractures. Conclusion: Interpersonal conflict as a cause of maxillofacial trauma has risen in recent years. With this increase the methods of treating fractures in this region are also changing. PMID:24167433

  7. Study of the Dynamics of Transcephalic Cerebral Impedance Data during Cardio-Vascular Surgery

    Science.gov (United States)

    Atefi, S. R.; Seoane, F.; Lindecrantz, K.

    2013-04-01

    Postoperative neurological deficits are one of the risks associated with cardio vascular surgery, necessitating development of new techniques for cerebral monitoring. In this study an experimental observation regarding the dynamics of transcephalic Electrical Bioimpedance (EBI) in patients undergoing cardiac surgery with and without extracorporeal circulation (ECC) was conducted to investigate the potential use of electrical Bioimpedance for cerebral monitoring in cardio vascular surgery. Tetrapolar transcephalic EBI measurements at single frequency of 50 kHz were recorded prior to and during cardio vascular surgery. The obtained results show that the transcephalic impedance decreases in both groups of patients as operation starts, however slight differences in these two groups were also observed with the cerebral impedance reduction in patients having no ECC being less common and not as pronounced as in the ECC group. Changes in the cerebral impedance were in agreement with changes of haematocrit and temperature. The origin of EBI changes is still unexplained however these results encourage us to continue investigating the application of electrical bioimpedance cerebral monitoring clinically.

  8. Dutch surgeons' views on the volume-outcome mechanism in surgery: A qualitative interview study.

    Science.gov (United States)

    Mesman, R; Faber, M J; Westert, G P; Berden, H J J M

    2017-08-09

    To contribute to a better understanding of volume-outcome relationships in surgery by exploring Dutch surgeons' views on the underlying mechanism. A qualitative study based on face-to-face semi structured interviews and an inductive content analysis approach. Interviews were conducted in eight hospitals in the Netherlands (2 university, 4 teaching and 2 general). Twenty surgeons (gastrointestinal, vascular and trauma). Dutch surgeons' views on volume-outcome relationships in surgery and the underlying mechanism. The majority of surgeons believed volume is related to outcomes after surgery. Interviewees highlighted the importance of both focus and skills when describing the underlying mechanism. Focus was visible on three levels: hospital, surgeon and team. Focus on a hospital level referred to investing in specific infrastructure and dedicated personnel. Surgeons described both the benefits and downsides of surgeons' increased focus to a certain surgical subspeciality. And their experiences on the importance of working with fixed, procedure-specific teams. The positive influence of caseload on technical and nontechnical skills was acknowledged, as well as the benefits of combining skills by operating together. Although a basic skill set should be maintained, this does not necessarily require high volume. Focus and skills are important explanatory factors in volume-outcome relationships according to Dutch surgeons. This suggests that both high- and low-volume providers should enable specialized, fixed teams for complex surgeries and focus on maintenance of both their technical and nontechnical skills. By uncovering the underlying mechanism, imperfect quality indicators such as volume can be supplemented or replaced.

  9. Effects of flapless implant surgery on soft tissue profiles: a prospective clinical study.

    Science.gov (United States)

    Lee, Du-Hyeong; Choi, Byung-Ho; Jeong, Seung-Mi; Xuan, Feng; Kim, Ha-Rang

    2011-12-01

    Flapless implant surgery has been suggested as a suitable treatment modality for the preservation of soft tissue after implant placement. The purpose of this study was to determine the extent of soft tissue profile changes around implants after flapless implant surgery. A total of 44 patients received 76 implants using a flapless implant procedure. The marginal level of the peri-implant soft tissue was evaluated using dental casts 1 week, 1 month, and 4 months after implant placement. The mean soft tissue levels around implants showed 0.7 ± 0.3 mm of coronal growth 1 week after surgery. At 1 month, the levels were 0.2 ± 0.2 mm coronal growth and at 4 months, the values were 0.0 ± 0.3 mm. Soft tissue profiles assessed 4 months after flapless implant placement were similar to profiles assessed immediately before implant placement. Flapless implant surgery is advantageous for preserving mucosal form surrounding dental implants. © 2009 Wiley Periodicals, Inc.

  10. Socio-anthropological analysis of bariatric surgery patients: a preliminary study

    Directory of Open Access Journals (Sweden)

    Julia Navas López

    2010-01-01

    Full Text Available Using socio-anthropological analysis, this paper presents preliminary results of an inter-disciplinary investigation entitled “A nutritional and anthropological study of patients with type III and IV obesity undergoing bariatric surgery.” The medical ethnographic approach employed in this study has two goals: to study patients’ cultural context before and after surgical treatment and to analyze perceptions, representations, social inte-gration, stigmatization, and social control before and after surgery. The results show potential discrimination against these patients based on their group identification and a permissive environment; these ideas are manifested in the concepts of the “obesogenic society” and the “obese victim.” On the other hand, the process of medicalization provides a mechanism capable of both social inclusion and exclusion. The results of this preliminary analysis are informing ongoing work between patients and professionals in this nutritional study.

  11. Statins decrease perioperative cardiac complications in patients undergoing noncardiac vascular surgery: the Statins for Risk Reduction in Surgery (StaRRS) study.

    Science.gov (United States)

    O'Neil-Callahan, Kristin; Katsimaglis, George; Tepper, Micah R; Ryan, Jason; Mosby, Carla; Ioannidis, John P A; Danias, Peter G

    2005-02-01

    We sought to assess whether statins may decrease cardiac complications in patients undergoing noncardiac vascular surgery. Cardiovascular complications account for considerable morbidity in patients undergoing noncardiac surgery. Statins decrease cardiac morbidity and mortality in patients with coronary disease, and the beneficial treatment effect is seen early, before any measurable increase in coronary artery diameter. A retrospective study recorded patient characteristics, past medical history, and admission medications on all patients undergoing carotid endarterectomy, aortic surgery, or lower extremity revascularization over a two-year period (January 1999 to December 2000) at a tertiary referral center. Recorded perioperative complication outcomes included death, myocardial infarction, ischemia, congestive heart failure, and ventricular tachyarrhythmias occurring during the index hospitalization. Univariate and multivariate logistic regressions identified predictors of perioperative cardiac complications and medications that might confer a protective effect. Complications occurred in 157 of 1,163 eligible hospitalizations and were significantly fewer in patients receiving statins (9.9%) than in those not receiving statins (16.5%, p = 0.001). The difference was mostly accounted by myocardial ischemia and congestive heart failure. After adjusting for other significant predictors of perioperative complications (age, gender, type of surgery, emergent surgery, left ventricular dysfunction, and diabetes mellitus), statins still conferred a highly significant protective effect (odds ratio 0.52, p = 0.001). The protective effect was similar across diverse patient subgroups and persisted after accounting for the likelihood of patients to have hypercholesterolemia by considering their propensity to use statins. Use of statins was highly protective against perioperative cardiac complications in patients undergoing vascular surgery in this retrospective study.

  12. Medico-legal analysis of legal complaints in bariatric surgery: a 15-year retrospective study.

    Science.gov (United States)

    Tuchtan, Lucile; Kassir, Radwan; Sastre, Bernard; Gouillat, Christian; Piercecchi-Marti, Marie-Dominique; Bartoli, Christophe

    2016-05-01

    Bariatric surgery for severe obesity has become an effective and accepted treatment for sustained weight loss. The aim of our study was to analyze the complications and issues raised by the experts on which jury or judges' decisions were made for the different types of bariatric surgery. University Hospital, France. We have carried out a retrospective study of 59 expert review dossiers over a period of 15 years (1999-2014) on the different types of bariatric surgery (laparoscopic adjustable gastric band [LAGB], sleeve gastrectomy [SG], Roux-en-Y gastric bypass [RYGB], vertical banded gastroplasty [VBG], and gastric plication [GP]). Of the cases, 81% were women and the average age was 39 years old (range 19 to 68 years). Among the procedures giving rise to the complaints, 40% were for LAGB, 28% for RYGB, and 23% for SG. The most common initial complications were perforations (30%), fistulae (27%), bowel obstruction (14%), vascular injuries (9.5%), and infections (peritonitis, pleurisy, abscesses, and so forth) (8%). Revision surgery was required in 78% of patients, and perioperative complications accounted for 28.5% of dossiers. The experts concluded that fault had occurred in 40% of case. Negligence arising from an error deemed to be an act of negligence was found in 30% of cases, 67% of which were because of delayed diagnosis. Major long-term complications accounted for 8% of dossiers and minor long-term complications for 22%. Forty-seven percent of patients completely recovered. Delayed diagnosis was the main error established by the experts. Surgeons should remain vigilant postoperatively after every bariatric surgical procedure. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  13. Nutrient deficiencies in patients with obesity considering bariatric surgery: a cross-sectional study.

    Science.gov (United States)

    Lefebvre, Patrick; Letois, Flavie; Sultan, Ariane; Nocca, David; Mura, Thibaut; Galtier, Florence

    2014-01-01

    Nutritional deficiencies are common after bariatric surgery, but few studies have examined them preoperatively. The objective of this study was to evaluate several vitamins, nutrients, and nutritional markers and their determinants in patients with obesity considering bariatric surgery. Preoperative values of fasting plasma glucose, insulin, lipid profile, 25-hydroxyvitamin D (25(OH)D), parathyroid hormone, thyroid-stimulating hormone, calcium, phosphate, albumin, magnesium, total proteins, liver function tests, iron, ferritin, folate, vitamin A, vitamin B12, selenium, and zinc were evaluated in 267 Caucasian outpatients (74.2% women, aged 40.5±12.6 years) who were considering bariatric surgery. The determinants of nutrient variability were analyzed by linear regression for nutrients with a prevalence of deficiency>10%, i.e., serum 25(OH)D, iron, phosphate, magnesium, and vitamin A. Prevalence of inadequate concentrations was high for 25(OH)D (67.9% with values ≤ 20 ng/mL), magnesium (35.4%), phosphate (21.6%), iron (18.8%), and vitamin A (16.9%). Multiple deficiencies were common; 28.5%, 12.1%, and 6.3% of patients had 2, 3, and 4 deficiencies, respectively. In multivariate analyses, metabolic characteristics had an important impact on deficiencies, with lower values of 25(OH)D and vitamin A with increasing body mass index, lower values of 25(OH)D and magnesium with increasing fasting plasma glucose, and a positive correlation between vitamin A and triglycerides. Elevated TSH was associated with low iron concentrations. At all ages, micronutrient deficiencies were common, with high prevalence of concentration inadequacies for 25(OH)D, magnesium, phosphate, iron, and vitamin A. High body mass index and high fasting plasma glucose increased the risk of deficiencies, particularly for 25(OH)D. Preoperative screening and correction of deficiencies should be advised. © 2014 American Society for Bariatric Surgery Published by American Society for Metabolic and

  14. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study

    Science.gov (United States)

    Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

    2016-01-01

    Objective To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. Materials and Methods In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. Results The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. Conclusion The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon’s skills and knowledge, not as a substitute. PMID:26757365

  15. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

    Directory of Open Access Journals (Sweden)

    Liang Li

    Full Text Available To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery.In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems.The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons.The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

  16. A Novel Augmented Reality Navigation System for Endoscopic Sinus and Skull Base Surgery: A Feasibility Study.

    Science.gov (United States)

    Li, Liang; Yang, Jian; Chu, Yakui; Wu, Wenbo; Xue, Jin; Liang, Ping; Chen, Lei

    2016-01-01

    To verify the reliability and clinical feasibility of a self-developed navigation system based on an augmented reality technique for endoscopic sinus and skull base surgery. In this study we performed a head phantom and cadaver experiment to determine the display effect and accuracy of our navigational system. We compared cadaver head-based simulated operations, the target registration error, operation time, and National Aeronautics and Space Administration Task Load Index scores of our navigation system to conventional navigation systems. The navigation system developed in this study has a novel display mode capable of fusing endoscopic images to three-dimensional (3-D) virtual images. In the cadaver head experiment, the target registration error was 1.28 ± 0.45 mm, which met the accepted standards of a navigation system used for nasal endoscopic surgery. Compared with conventional navigation systems, the new system was more effective in terms of operation time and the mental workload of surgeons, which is especially important for less experienced surgeons. The self-developed augmented reality navigation system for endoscopic sinus and skull base surgery appears to have advantages that outweigh those of conventional navigation systems. We conclude that this navigational system will provide rhinologists with more intuitive and more detailed imaging information, thus reducing the judgment time and mental workload of surgeons when performing complex sinus and skull base surgeries. Ultimately, this new navigational system has potential to increase the quality of surgeries. In addition, the augmented reality navigational system could be of interest to junior doctors being trained in endoscopic techniques because it could speed up their learning. However, it should be noted that the navigation system serves as an adjunct to a surgeon's skills and knowledge, not as a substitute.

  17. A randomized prospective study of prophylactic cloxacillin in breast reduction surgery.

    Science.gov (United States)

    Lewin, Richard; Elander, Anna; Thorarinsson, Andri; Kölby, Lars; Sahlin, Per-Erik; Lundberg, Jonas; Panczel, Alexander; Lidén, Mattias

    2015-01-01

    Postoperative infection after breast reduction surgery is a common complication, with the most commonly involved pathogen being Staphylococcus aureus. Previous studies of antibiotic prophylaxis in breast reduction surgery have been inconclusive. The aim of the present study was to clarify the role of prophylactic antibiotics in breast reduction surgery. In total, 325 women were randomized to antibiotic prophylaxis [with 2 g of cloxacillin intravenously (IV) or 600 mg of clindamycin IV] (intervention group) or no antibiotic prophylaxis (control group). Follow-up was conducted at 1 and 2 weeks postoperatively. Patients with signs of infections or other complications were followed up until resolution. Patients who received antibiotic treatment within 30 days from surgery (cloxacillin 750 mg or clindamycin 300 mg orally) were considered having an infection and this was the main outcome variable. All postoperative infections were also judged according to a graded scale. In the intervention group, 26 (16.0%) patients were treated with antibiotic; and in the control group, 32 (19.6%) patients were treated with antibiotics. No difference was found between the groups (relative risk, 0.82; 95% confidence interval, 0.51-1.31; P = 0.49). Twenty-two (14%) patients in the intervention group were classified to have a possible infection according to the scale compared to 27 (17%) in the control group. No statistical difference was found (relative risk, 0.81; 95% confidence interval, 0.48-1.37; P = 0.54). Prophylactic cloxacillin as a single-dose IV in breast reduction surgery does not reduce the incidence of postoperative infections.

  18. Cardiorespiratory outcome after corrective surgery for pectus excavatum: a case study.

    Science.gov (United States)

    Malek, Moh H; Fonkalsrud, Eric W

    2004-02-01

    The purpose of this case study was to examine the effect of pectus excavatum before and after surgical correction on ventilatory and cardiorespiratory responses to submaximal and maximal exercise. The patient was a 30-yr-old longshoreman who had mild pectus excavatum since infancy that became worse during his adolescent growth years. The deformity persisted into adulthood with increasing symptoms. Although he had a history of habitual aerobic exercise, the patient experienced frequent episodes of pain in the lower anterior chest, breathlessness, and reduced stamina when performing activities of daily living. He performed pulmonary function tests, submaximal and maximal incremental exercise testing, before and 6 months after corrective surgery. Six months after corrective surgery, the patient demonstrated increases in FEV1 (13.0%), maximum voluntary ventilation (MVV, 32.3%), maximum power output (max, 15.5%), [OV0312]O2max (7.9%), metabolic threshold ([OV0312]O2theta, 30.8%), oxygen-pulse ([OV0312]O2/fc, 14.0%), and maximal tidal volume (VTmax, 11.7%). On submaximal testing, we found that the time constant for oxygen uptake kinetics was 46.8 s for the on-transit and 46.5 s for the off-transit before surgery and 33.6 s for the on-transit and 30.3 s for the off-transit six months after surgery. The information derived from this case study supports the opinion that corrective surgery for pectus excavatum may alleviate the impaired ventilatory and cardiorespiratory performance seen preoperatively.

  19. The benefits of hypopharyngeal packing in nasal surgery: a pilot study.

    LENUS (Irish Health Repository)

    Fennessy, B G

    2012-02-01

    BACKGROUND: Hypopharyngeal packs are used in nasal surgery to reduce the risk of aspiration and postoperative nausea and vomiting. Side effects associated with their use range from throat pain to retained packs postoperatively. AIM: To evaluate, as a pilot study, postoperative nausea\\/vomiting and throat pain scores for patients undergoing nasal surgery in whom a wet or dry hypopharyngeal pack was placed compared with patients who received no packing. METHODS: A randomized, double-blind prospective trial in a general ENT unit. RESULTS: The study failed to show a statistically significant difference between the three groups in terms of their postoperative nausea\\/vomiting and throat pain scores at 2 and 6 h postoperatively. This is the first study in which dry packs have been compared with wet and absent packs. CONCLUSION: Based on our findings, the authors recommend against placing hypopharyngeal packs for the purpose of preventing postoperative nausea and vomiting.

  20. Electrical impedance tomography during major open upper abdominal surgery: a pilot-study.

    Science.gov (United States)

    Schaefer, Maximilian S; Wania, Viktoria; Bastin, Bea; Schmalz, Ursula; Kienbaum, Peter; Beiderlinden, Martin; Treschan, Tanja A

    2014-01-01

    Electrical impedance tomography (EIT) of the lungs facilitates visualization of ventilation distribution during mechanical ventilation. Its intraoperative use could provide the basis for individual optimization of ventilator settings, especially in patients at risk for ventilation-perfusion mismatch and impaired gas exchange, such as patients undergoing major open upper abdominal surgery. EIT throughout major open upper abdominal surgery could encounter difficulties in belt positioning and signal quality. Thus, we conducted a pilot-study and tested whether EIT is feasible in patients undergoing major open upper abdominal surgery. Following institutional review board's approval and written informed consent, we included patients scheduled for major open upper abdominal surgery of at least 3 hours duration. EIT measurements were conducted prior to intubation, at the time of skin incision, then hourly during surgery until shortly prior to extubation and after extubation. Number of successful intraoperative EIT measurements and reasons for failures were documented. From the valid measurements, a functional EIT image of changes in tidal impedance was generated for every time point. Regions of interest were defined as horizontal halves of the picture. Monitoring of ventilation distribution was assessed using the center of ventilation index, and also using the total and dorsal ventilated lung area. All parameter values prior to and post intubation as well as extubation were compared. A p abdominal surgery lasting 4-13 hours were planned in 14 patients. The electrode belt was attached between the 2(nd) and 4(th) intercostal space. Consecutive valid measurements could be acquired in 13 patients (93%). 111 intraoperative measurements could be retrieved as planned (93%). Main obstacle was the contact of skin electrodes. Despite the high belt position, distribution of tidal volume showed a significant shift of ventilation towards ventral lung regions after intubation. This

  1. Neuroprotective efficacy of prophylactic enteral and parenteral nimodipine treatment in vestibular schwannoma surgery: a comparative study.

    Science.gov (United States)

    Scheller, Christian; Wienke, Andreas; Wurm, Franziska; Simmermacher, Sebastian; Rampp, Stefan; Prell, Julian; Rachinger, Jens; Scheller, Konstanze; Koman, Gershom; Strauss, Christian; Herzfeld, Eva

    2014-07-01

    BACKGROUND AND STUDY AIMS/OBJECT: Oral nimodipine improves neurologic outcome after aneurysmal subarachnoid hemorrhage. In addition, the neuroprotective efficacy of nimodipine has been revealed following skull base, laryngeal, and maxillofacial surgery. Pharmacokinetic investigations showed nimodipine to reach higher serum levels following parenteral versus enteral administration. Furthermore, a correlation between nimodipine levels in serum, cerebrospinal fluid, and nerve tissue could be quantified. These observations raise the question whether the proven neuroprotective effect of nimodipine is related to its serum level. A consecutive series of 37 patients with vestibular schwannoma treated with nimodipine from the day before surgery until the seventh postoperative day was analyzed retrospectively. Both groups received standard dosages for enteral (n = 17) and parenteral (n = 20) nimodipine medication. Nimodipine levels were measured in pre- and postoperative serum and cerebrospinal fluid samples. Cochlear and facial nerve functions were documented before surgery, in the early postoperative course, and 1 year after surgery. Facial nerve outcome was significantly better in the group with parenteral nimodipine medication (p = 0.038). Logistical regression analysis revealed a seven times smaller risk for a deterioration of facial nerve function in the group with parenteral treatment. There was no difference in hearing preservation between both groups despite tumor size tending to be larger in the parenteral group. Intraoperative (p = 0.004), postoperative (p = 0.001), and serum and cerebrospinal fluid (p = 0.024) nimodipine levels were significantly higher following parenteral administration as compared with enteral administration. Both groups were comparable regarding tumor size and extent of resection. These results support a dependency of nimodipine's neuroprotective efficacy on its serum levels. Parenteral nimodipine treatment produces higher serum levels and

  2. Bariatric surgery as a treatment for pseudotumor cerebri: case study and narrative review of the literature

    Directory of Open Access Journals (Sweden)

    Everton Cazzo

    2017-05-01

    Full Text Available ABSTRACT CONTEXT: Pseudotumor cerebri occurs when there is an increase in intracranial pressure without an underlying cause, usually leading to loss of vision. It is most commonly observed in obese women of child-bearing age. CASE REPORT: A 46-year-old woman presented at our service with idiopathic intracranial hypertension that had been diagnosed two years earlier, which had led to chronic refractory headache and an estimated 30% loss of visual acuity, associated with bilateral papilledema. She presented partial improvement of the headache with acetazolamide, but the visual loss persisted. Her intracranial pressure was 34 cmH2O. She presented a body mass index of 39.5 kg/m2, also associated with high blood pressure. Computed tomography of the cranium with endovenous contrast did not show any abnormalities. She underwent Roux-en-Y gastric bypass with uneventful postoperative evolution. One month following surgery, she presented a 24% excess weight loss. An ophthalmological examination revealed absence of visual loss and remission of the papilledema. There were no new episodes of headache following the surgery. There was also complete resolution of high blood pressure. The intracranial pressure decreased to 24 cmH2O, six months after the surgery. CONCLUSION: Although the condition is usually associated with obesity, there are few reports of bariatric surgery among individuals with pseudotumor cerebri. In cases studied previously, there was high prevalence of resolution or improvement of the disease following bariatric surgery. There is no consensus regarding which technique is preferable. Thus, further research is necessary in order to establish a specific algorithm.

  3. The Feasibility and Safety of Surgery in Patients Receiving Immune Checkpoint Inhibitors: A Retrospective Study

    Directory of Open Access Journals (Sweden)

    Alexandra W. Elias

    2017-06-01

    Full Text Available Immune checkpoint inhibitors (ICI are revolutionizing care for cancer patients. The list of malignancies for which the Food and Drug Administration is granting approval is rapidly increasing. Furthermore, there is a concomitant increase in clinical trials incorporating ICI. However, the safety of ICI in patients undergoing surgery remains unclear. Herein, we assessed the safety of ICI in the perioperative setting at a single center. We conducted a retrospective review of patients who underwent planned surgery while receiving ICI in the perioperative setting from 2012 to 2016. We collected 30-day postoperative morbidity and mortality utilizing the Clavien–Dindo classification system. We identified 17 patients who received perioperative ICI in 22 operations. Patients were diagnosed with melanoma (n = 14, renal cell carcinoma (n = 2, and urothelial carcinoma (n = 1. Therapies included pembrolizumab (n = 10, ipilimumab (n = 5, atezolizumab (n = 5, and ipilimumab/nivolumab (n = 2. Procedures included cutaneous/subcutaneous resection (n = 6, lymph node resection (n = 5, small bowel resection (n = 5, abdominal wall resection (n = 3, other abdominal surgery (n = 3, orthopedic surgery (n = 1, hepatic resection (n = 1, and neurosurgery (n = 2. There were no Grade III–IV Clavien–Dindo complications. There was one death secondary to ventricular fibrillation in the setting of coronary artery disease. ICI appear safe in the perioperative setting, involving multiple different types of surgery, and likely do not need to be stopped in the perioperative setting. Further studies are warranted to confirm these findings.

  4. Clinical predictors of a low central venous oxygen saturation after major surgery: a prospective prevalence study.

    Science.gov (United States)

    Litton, E; Silbert, B; Ho, K M

    2015-01-01

    Optimising perioperative haemodynamic status may reduce postoperative complications. In this prospective prevalence study, we investigated the associations between standard haemodynamic parameters and a low central venous oxygen saturation (ScvO2) in patients after major surgery. A total of 201 patients requiring continuous arterial and central venous pressure monitoring after major surgery were recruited. Simultaneous arterial and central venous blood gases, haemodynamic and biochemical data and perfusion index were obtained from patients at a single time-point within 24 hours of surgery. A low ScvO2 (central venous pressure, haemoglobin concentrations, arterial pH and lactate concentrations, arterial oxygen (PaO2) and carbon dioxide tensions (PaCO2) were all associated with a low ScvO2 in the univariate analyses. In the multivariate analysis, only a higher perfusion index (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78 to 0.98), PaO2 (OR 0.98 per mmHg increment, 95% CI 0.97 to 0.99) and PaCO2 (OR 0.88 per mmHg increment, 95% CI 0.82 to 0.95) and a lower central venous pressure (OR 1.14 per mmHg increment, 95% CI 1.04 to 1.25) were significantly associated with a reduced risk of a low ScvO2, all in a linear fashion. In conclusion, PaO2, PaCO2, perfusion index and central venous pressure were significant predictors of a low ScvO2 in patients after major surgery including cardiac surgery.

  5. Flapless implant surgery: a 2-year follow-up study of 40 implants.

    Science.gov (United States)

    Sunitha, Raja V; Sapthagiri, Enukurthi

    2013-10-01

    Flapless implant surgery is fast gaining popularity because of several advantages, such as reduced surgical time, postoperative bleeding, and swelling. Studies have shown that flap elevation results in some amount of bone loss. The aim of the current study was to compare the amount of bone loss in procedures using the flapless technique and those where flap elevation was done. Papillary fill was also compared in both techniques, which is unique to this study. Forty patients, selected according to certain inclusion and exclusion criteria, were randomly assigned to 1 of 2 groups: Flap (F), or Flapless (FL). The amount of crestal bone loss was measured from standardized radiographs at baseline, 6 months, 1 year, and 2 years after implant placement. Papillary fill was evaluated using the Papillary presence index, which was measured 6 months after loading. The bone loss was greater for the F group during all time periods and the mean papillary fill was greater for the FL group. In conclusion, the results of the current study show that flapless implant surgery results in less crestal bone loss both during the healing period and after loading. In addition, it can produce better papillary fill. The cases selected for this study were ideal cases in terms of bone volume and the operator was well experienced, however. Care should be taken during case selection for flapless implant surgery. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Online and smartphone based cognitive behavioral therapy for bariatric surgery patients: Initial pilot study.

    Science.gov (United States)

    Zhang, Melvyn W B; Ho, Roger C M; Cassin, Stephanie E; Hawa, Raed; Sockalingam, Sanjeev

    2015-01-01

    The respective rates of obesity in Canada and the United states are estimated to be 24.1% and 34.1%. Due to the increased incidence of obesity, Bariatric surgery has been recognized as one of the treatment options. Despite the success of Bariatric surgery, studies have proposed that it has neglected the contributions of other factors, such as psychological factors in the causation as well as the maintenance of obesity amongst individuals. Cognitive behavioral therapy (CBT) is largely a psychosocial intervention that has been shown to be efficacious, as studies have demonstrated that even brief CBT interventions could help in the reduction of binge eating and maintenance of weight loss. Previously identified problems with regards to the integration and the provision of such interventions include that of geographical barriers. In order to overcome the geographical barriers, telephone-based CBT has been conceptualized. Over the past decade, there has been massive advancement and development in Internet, Web-based and smartphone technologies, but there is still a paucity of applications in this area. Our current research objective is to determine if bariatric surgery patients will be receptive towards an online and smartphone based CBT intervention. The Bariatric Surgery Online CBT portal and Smartphone companion application was developed between July 2013 and December 2013. A low-cost methodology of developing the online portal was adopted. In terms of development, 4 core development phases were adopted. These included that of: a) Formulation of users' requirements, b) System design and development, c) System evaluation and d) System deployment and pilot application. The bariatric surgery workgroup from the Toronto Western Hospital helped with the recruitment of the subjects from the outpatient specialist service. Links to the web-portal was provided to each of the participants recruited. Since the inception of the online portal to date, in terms of usage rates, there

  7. Determinants for early mortality in patients awaiting coronary artery bypass graft surgery: a case-control study

    NARCIS (Netherlands)

    Suttorp, M. J.; Kingma, J. H.; Vos, J.; Koomen, E. M.; Tijssen, J. G.; Vermeulen, F. E.; Ascoop, C. A.; Ernst, J. M.

    1992-01-01

    A total of 1124 consecutive patients who were selected for coronary artery bypass graft surgery were studied. Of patients awaiting surgery (mean waiting time 98 days) 25 patients (2.2%) died before operation (mean waiting time 63 days). To assess patient characteristics predictive for early

  8. Which patient-reported factors predict referral to spinal surgery? A cohort study among 4987 chronic low back pain patients.

    NARCIS (Netherlands)

    van Dongen, J.M.; van Hooff, M.L.; Spruit, M.; de Kleuver, M.; Ostelo, Raymond

    2017-01-01

    PURPOSE: It is unknown which chronic low back pain (CLBP) patients are typically referred to spinal surgery. The present study, therefore, aimed to explore which patient-reported factors are predictive of spinal surgery referral among CLBP patients. METHODS: CLBP patients were consecutively

  9. Study of perioperative extravascular lung water and intrathoracic blood volume in patients undergoing CABG surgery with or without cardiopulmonary bypass

    Directory of Open Access Journals (Sweden)

    Samia Ragab El Azab

    2014-10-01

    Discussion and Conclusion: The clinical advantage of off-pump CABG surgery over standard extracorporeal circulation in regard to lung water content was not found in our study. In conclusion, the presumed superiority of off pump surgery for coronary artery bypass grafting could not be confirmed in our group of patients.

  10. Preoperative antibiotic prophylaxis in orthognathic surgery: a randomized, double-blind, and placebo-controlled clinical study

    NARCIS (Netherlands)

    Zijderveld, S. A.; Smeele, L. E.; Kostense, P. J.; Tuinzing, D. B.

    1999-01-01

    This study evaluated the need for antibiotic prophylaxis in orthognathic surgery. Fifty-four patients (age range, 18 to 40 years) underwent bimaxillary orthognatic surgery. After randomization, a placebo (n = 19), 2,200 mg amoxicillin-clavulanic acid (n = 18), or 1,500 mg cefuroxime (n = 17) was

  11. Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study.

    Science.gov (United States)

    Tolboom, Robert C; Draaisma, Werner A; Broeders, Ivo A M J

    2016-03-01

    Surgery for refractory gastroesophageal reflux disease (GERD) and hiatal hernia leads to recurrence or persisting dysphagia in a minority of patients. Redo antireflux surgery in GERD and hiatal hernia is known for higher morbidity and mortality. This study aims to evaluate conventional versus robot-assisted laparoscopic redo antireflux surgery, with the objective to detect possible advantages for the robot-assisted approach. A single institute cohort of 75 patients who underwent either conventional laparoscopic or robot-assisted laparoscopic redo surgery for recurrent GERD or severe dysphagia between 2008 and 2013 were included in the study. Baseline characteristics, symptoms, medical history, procedural data, hospital stay, complications and outcome were prospectively gathered. The main indications for redo surgery were dysphagia, pyrosis or a combination of both in combination with a proven anatomic abnormality. The mean time to redo surgery was 1.9 and 2.0 years after primary surgery for the conventional and robot-assisted groups, respectively. The number of conversions was lower in the robot-assisted group compared to conventional laparoscopy (1/45 vs. 5/30, p = 0.035) despite a higher proportion of patients with previous surgery by laparotomy (9/45 vs. 1/30, p = 0.038). Median hospital stay was reduced by 1 day (3 vs. 4, p = 0.042). There were no differences in mortality, complications or outcome. Robotic support, when available, can be regarded beneficial in redo surgery for GERD and hiatal hernia. Results of this observational study suggest technical feasibility for minimal-invasive robot-assisted redo surgery after open primary antireflux surgery, a reduced number of conversions and shorter hospital stay.

  12. Predictors of wound infection in elective colorectal surgery. Multicenter observational case-control study.

    Science.gov (United States)

    Fraccalvieri, Doménico; Kreisler Moreno, Esther; Flor Lorente, Blas; Torres García, Antonio; Muñoz Calero, Alberto; Mateo Vallejo, Francisco; Biondo, Sebastiano

    2014-01-01

    The aim of this study is to evaluate the usefulness of Vicryl Plus(®) suture in reducing the rate of postoperative wound infection in elective colorectal surgery. A prospective case-control multicenter study with 480 patients undergoing elective colorectal surgery was performed between 2006 and 2007. Patients were divided in 2 groups of equal sample size: group 1, closure of the abdominal wall using Vicryl Plus(®) and group 2 where PDS II(®) was used. The study involved 5 hospitals in the Spanish State. Wound infection was classified into superficial and deep. All patients diagnosed of wound infection during the hospital stay and up to 30 days after discharge were studied. For the statistical analysis Chi-square test and Fisher exact were used for bivariate analysis and logistic regression model for multivariate analysis. Wound infection rates were significantly lower in group 1: 14.6 vs. 29.2. Multivariate analysis showed that risk of wound infection was higher in patients with cancer, lung disease, anemia, operative time greater than 2 h, lack of second dose intra-operative prophylactic antibiotic and laparotomy closure with PDS suture II(®). The use of suture coated with triclosan can be an effective prophylactic tool in reducing wound infection rate in patients undergoing elective colorectal surgery. Copyright © 2013 AEC. Published by Elsevier Espana. All rights reserved.

  13. Effect of massage therapy on pain, anxiety, relaxation, and tension after colorectal surgery: A randomized study.

    Science.gov (United States)

    Dreyer, Nikol E; Cutshall, Susanne M; Huebner, Marianne; Foss, Diane M; Lovely, Jenna K; Bauer, Brent A; Cima, Robert R

    2015-08-01

    The purpose of this randomized controlled trial was to evaluate the effect of postoperative massage in patients undergoing abdominal colorectal surgery. One hundred twenty-seven patients were randomized to receive a 20-min massage (n = 61) or social visit and relaxation session (no massage; n = 66) on postoperative days 2 and 3. Vital signs and psychological well-being (pain, tension, anxiety, satisfaction with care, relaxation) were assessed before and after each intervention. The study results indicated that postoperative massage significantly improved the patients' perception of pain, tension, and anxiety, but overall satisfaction was unchanged. In conclusion, massage may be beneficial during postoperative recovery for patients undergoing abdominal colorectal surgery. Further studies are warranted to optimize timing and duration and to determine other benefits in this clinical setting. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Adoption of intracameral antibiotic prophylaxis of endophthalmitis following cataract surgery: update on the ESCRS Endophthalmitis Study.

    LENUS (Irish Health Repository)

    Barry, Peter

    2014-01-01

    To determine the use of intracameral cefuroxime at the end of cataract surgery since the beneficial results were first reported by the European Society of Cataract and Refractive Surgeons Endophthalmitis Study Group in 2006, 250 ophthalmic surgeons affiliated with both public and private hospitals and clinics across Europe were surveyed. The questions regarded their awareness of the results of the ESCRS endophthalmitis study and their current use or non-use of intracameral antibiotics in their cataract procedures. Seventy-four percent of respondents said they always or usually use intracameral antibiotics in their cataract surgery procedures. The most frequently cited reasons for not using cefuroxime or other intracameral antibiotics was the lack of an approved commercial preparation and related anxieties regarding the risk of dilution errors and contamination. More than 90% of respondents said they would use cefuroxime if an approved single-unit dose product were commercially available.

  15. A core undergraduate curriculum in plastic surgery - a Delphi consensus study in Scandinavia

    DEFF Research Database (Denmark)

    Almeland, Stian K; Lindford, Andrew; Berg, Jais Oliver

    2017-01-01

    BACKGROUND AND AIMS: In recent years, undergraduate medical education has undergone a transition from a speciality-based to a more competence-based training system. Consequently, whilst medical knowledge is rapidly expanding, time for teaching of the surgical specialties is decreasing. Thus......, there appears to be a need to define the core competences that are to be taught. The aim of this study was to establish a Scandinavian core undergraduate curriculum of competences in plastic surgery, using scientific methods. METHODS: The Delphi technique for group consensus was employed. An expert panel.......00 on a 1-4 Likert scale. Final agreement in the third round resulted in a list of 68 competences with agreement above 80% (31 skills and 37 knowledge items). CONCLUSIONS: This study proposes the first scientifically developed undergraduate core curriculum in plastic surgery. It comprises of a consensus...

  16. A tomographic study of positional and bony changes in the temporomandibular joint following orthognathic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Song, Nam Kyu; Kim Min Suk; Koh, Kwang Joon [Dept. of Oral Radiology, College of Dentistry, Chonpook National University, Chonju (Korea, Republic of)

    1992-08-15

    The purpose of this study was to aid in the evaluation of prognosis of temporomandibular joint following orthognathic surgery. For this study, 20 patients (40 TMJ) who undergone orthognathic surgery were examined. Preoperative and postoperative tomograms of TMJ were taken. And the subjects were divided into 3 groups according to postoperative periods. The obtained results were as follows : 1. There were no significant differences between preoperative and postoperative changes in joint spaces in each group and between groups (P<0.05). 2. There were no significant differences between preoperative and postoperative ratio of joint spaces (P<0.05).3. There were no significant differences between preoperative and postoperative changes in the range of motion of condylar head (P<0.05). 4. The bony changes of condylar head were observed in 14 (35%) condyles (6 erosion, 2 flattening, 5 double contour, 1 osteophyte).

  17. Laparoscopic Surgery for Severe Rectovaginal Endometriosis Compromising the Bowel: A Prospective Cohort Study.

    Science.gov (United States)

    Kent, Andrew; Shakir, Fevzi; Rockall, Tim; Haines, Pat; Pearson, Carol; Rae-Mitchell, Wendy; Jan, Haider

    2016-01-01

    Endometriosis can affect 10% of women at reproductive age. Of those, 5.3% to 12% will have endometriosis affecting the bowel. Although outcomes after surgery for severe endometriosis affecting the bowel have previously been studied and have shown improvement in generic quality of life indices and sexual function, few studies have evaluated bowel function or symptoms specific to endometriosis. Our aim was to determine the quality of life after radical excision of rectovagina endometriosis compromising the bowel. Single-center prospective cohort study (Canadian Task Force classification II-2). Specialist referral center for the management of advanced endometriosis. Women with severe rectovaginal endometriosis compromising the bowel. Comparison of preoperative data with a 2-, 6-, and 12-month follow-up was made for consecutive patients who underwent surgery for endometriosis with bowel involvement. The main outcome measures were quality of life using the Endometriosis Health Profile 30 and EuroQol-5 dimension questionnaires. Bowel symptoms were measured using the Gastrointestinal Quality of Life Index. Dysmenorrhea, dyspareunia, dyschezia, and chronic pain were measured using a visual analogue scale. To compare preoperative and postoperative scores, a Freidman test was performed followed by a preoperative and 12-month postoperative Wilcoxon signed-rank test. A Mann-Whitney U test was used to compare the results between those who had pelvic clearance and those who did not. In total, 137 patients had surgery, of which 100 completed follow-up to 12 months. The serious perioperative and postoperative complication rate was 7.3%. The results show significant improvement in almost all variables measured (p < .01). At 12 months patients who had a pelvic clearance (hysterectomy with bilateral salpingo-oophorectomy) had significantly less pain with better bowel function. Additionally, they had higher quality of life scores and greater satisfaction with their treatment

  18. The role of rehabilitative camouflage after cervicofacial reconstructive surgery: a preliminary study

    Directory of Open Access Journals (Sweden)

    Nicoletti G

    2014-01-01

    Full Text Available Giovanni Nicoletti,1–3 Andrea Sasso,1 Alberto Malovini,4,5 Luisa Ponchio,6 Silvia Scevola,2 Angela Faga,1–3 Aldo Pontone1 1Plastic and Reconstructive Surgery, Department of Clinical Surgical Diagnostic and Pediatric Sciences, 2Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Centre, University of Pavia, Pavia, Italy; 3Plastic and Reconstructive Surgery Unit, Salvatore Maugeri Research and Care Institute, Pavia, Italy; 4Department of Computer Engineering and Systems Science, University of Pavia, Pavia, Italy; 5Laboratory of Informatics and Systems Engineering for Clinical Research, 6Oncology Unit, Salvatore Maugeri Research and Care Institute, Pavia, Italy Abstract: A randomized, prospective, controlled study was carried out at the Plastic and Reconstructive Surgery Unit of the University of Pavia, Salvatore Maugeri Research and Care Institute, Pavia, Italy, to evaluate the psychological benefits from corrective medical camouflage (CMC following surgical treatment for skin cancer of the face. Twenty-four female patients, following recovery from facial skin cancer surgery, were enrolled in the study over a period of 1 year. The study was performed using two health-related quality of life tests, the Satisfaction Profile (SAT-P test and the Body Uneasiness Test (BUT. The patients were randomized into two groups: group A, patients undergoing CMC; and group B, controls. Both the SAT-P and BUT demonstrated statistically significant better results in the treated patients versus the controls in the following functional parameters: Psychological Functionality (PsF, Physical Functionality (PhF, and Work Performance (WP for the SAT-P test and Compulsive Self-Monitoring (CSM for the BUT. The PsF demonstrated a better result 6 months post-treatment. Such a difference was particularly significant when comparing the performance at 6 months versus that at 3 months. The PhF demonstrated a better outcome at 6 months post

  19. Routine calcium measurement is not necessary after most thyroid surgeries: a prospective clinical study.

    LENUS (Irish Health Repository)

    Quinn, E M

    2010-12-01

    Calcium levels are often measured to diagnose postoperative hypocalcaemia following thyroidectomy. The aims of this study were to (i) prospectively determine the incidence of symptomatic and biochemical hypocalcaemia following thyroidectomy, (ii) to identify if any associations exist between hypocalcaemia, type of surgery, histological diagnosis, specimen size\\/weight and the presence of histological parathyroid tissue and (iii) to evaluate the necessity of routine measurement of calcium levels following all thyroidectomies.

  20. Duration of intravenous fluid replacement after abdominal surgery: a prospective randomised study.

    OpenAIRE

    Salim, A S

    1991-01-01

    This prospective randomised study examined the possibility of early resumption of oral hydration and discontinuation of intravenous fluid replacement after emergency or elective abdominal surgery. Following elective cholecystectomy alone or with a choledocholithotomy or an emergency Hartmann's procedure for large bowel obstruction, patients were randomised to early oral hydration (sips of water for 12 h followed by free fluids by mouth for 24 h, when oral intake of food was allowed--intraveno...

  1. Colonic stenting as bridge to surgery versus emergency surgery for management of acute left-sided malignant colonic obstruction: a multicenter randomized trial (Stent-in 2 study

    Directory of Open Access Journals (Sweden)

    Scholten Pieter

    2007-07-01

    Full Text Available Abstract Background Acute left-sided colonic obstruction is most often caused by malignancy and the surgical treatment is associated with a high mortality and morbidity rate. Moreover, these operated patients end up with a temporary or permanent stoma. Initial insertion of an enteral stent to decompress the obstructed colon, allowing for surgery to be performed electively, is gaining popularity. In uncontrolled studies stent placement before elective surgery has been suggested to decrease mortality, morbidity and number of colostomies. However stent perforation can lead to peritoneal tumor spill, changing a potentially curable disease in an incurable one. Therefore it is of paramount importance to compare the outcomes of colonic stenting followed by elective surgery with emergency surgery for the management of acute left-sided malignant colonic obstruction in a randomized multicenter fashion. Methods/design Patients with acute left-sided malignant colonic obstruction eligible for this study will be randomized to either emergency surgery (current standard treatment or colonic stenting as bridge to elective surgery. Outcome measurements are effectiveness and costs of both strategies. Effectiveness will be evaluated in terms of quality of life, morbidity and mortality. Quality of life will be measured with standardized questionnaires (EORTC QLQ-C30, EORTC QLQ-CR38, EQ-5D and EQ-VAS. Morbidity is defined as every event leading to hospital admission or prolonging hospital stay. Mortality will be analyzed as total mortality as well as procedure-related mortality. The total costs of treatment will be evaluated by counting volumes and calculating unit prices. Including 120 patients on a 1:1 basis will have 80% power to detect an effect size of 0.5 on the EORTC QLQ-C30 global health scale, using a two group t-test with a 0.05 two-sided significance level. Differences in quality of life and morbidity will be analyzed using mixed-models repeated measures

  2. Postoperative pain management with transdermal fentanyl after forefoot surgery: a randomized, placebo-controlled study

    Directory of Open Access Journals (Sweden)

    Merivirta R

    2015-01-01

    Full Text Available Riika Merivirta,1 Mikko Pitkänen,2 Jouko Alanen,3 Elina Haapoja,1 Mari Koivisto,4 Kristiina Kuusniemi11Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine of Turku University Hospital and University of Turku, Turku, 2Department of Anaesthesia, Hospital Orton, Invalid Foundation, Helsinki, 3Terveystalo Clinic Hospital, Helsinki, 4Department of Biostatistics, University of Turku, Turku, FinlandBackground: Quality of life is decreased in patients with hallux valgus deformity, mainly because of pain. Significant improvement is usually achieved by surgery. However, postoperative pain can be moderate to severe for 2–3 days. The aim of the present study was to evaluate the use of transdermal fentanyl for postoperative pain management after forefoot surgery.Methods: Sixty patients undergoing hallux valgus or hallux rigidus surgery were allocated to receive a patch delivering either fentanyl 12 µg/hour or placebo for postoperative pain. The consumption of rescue opioid oxycodone, the primary outcome measure, was evaluated daily until the fourth postoperative day. Total consumption of oxycodone during the study period was also assessed. Pain scores and possible adverse effects were evaluated every 6 hours during the first 24 hours and on the fourth postoperative day.Results: The use of rescue opioid was low in both groups, the median (range consumption of oxycodone being 10 (0–50 mg on the day of surgery (no difference between the groups, P=0.31 and 0 (0–35 mg thereafter. The total combined consumption was 10 (0–105 mg in the fentanyl group and 20 (0–70 mg in the placebo group (P=0.23. There were no statistically significant differences in pain scores or adverse effects between the groups.Conclusion: As a part of multimodal analgesia with ibuprofen and acetaminophen, a patch delivering fentanyl 12 µg/hour did not significantly decrease the consumption of rescue opioid or pain scores after forefoot surgery

  3. Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study.

    Science.gov (United States)

    Aga, Emil; Keinan-Boker, Lital; Eithan, Arieh; Mais, Tamar; Rabinovich, Alia; Nassar, Faris

    2015-01-01

    Abdominal surgeries have high rates of surgical site infections (SSIs), contributing to increased morbidity and mortality and costs for hospitalization. The aim of this study was to determine the SSI incidence rates and risk factors after abdominal surgeries. This prospective cohort study included all patients undergoing abdominal surgeries between 2005 and 2007 in the Western Galilee Medical Center in Nahariya, Israel. SSI incidence rates were calculated per 100 operations. Odds ratios (ORs) were estimated for each risk factor using univariate and multivariate analyses by logistic regression models. Among 302 patients in the study cohort, the total SSI incidence rate was 22.2%. The univariate analysis defined 13 variables significantly associated with SSI: age > 60 years, lower functional status, diabetes mellitus, congestive heart failure, immunocompromising underlying disease, treatment with chemotherapy and other immunosuppressive medications, impaired immune system open cholecystectomy, laparotomy, an American Society of Anesthesiologists (ASA) score > 2, drain insertion, and 'dirty wound' classification. In multivariate regression analysis, treatment with immunosuppressive medications (OR = 2.5, 95% confidence interval (CI) = 1.099-143.443), open cholecystectomy (OR = 2.25, 95% CI = 2.242-40.109), and dirty wound classification (OR = 2.179, 95% CI = 3.80-20.551) were significantly associated with SSI. The significant risk factors defined should be addressed preoperatively to decrease the risk for SSI. Wound surveillance in the post-discharge period is necessary for correct estimation of SSI rates.

  4. Prophylaxis of complications after pancreatic surgery: results of a multicenter trial in Italy. Italian Study Group.

    Science.gov (United States)

    Bassi, C; Falconi, M; Lombardi, D; Briani, G; Vesentini, S; Camboni, M G; Pederzoli, P

    1994-01-01

    An Italian prospective multicentre study evaluated the efficacy of octreotide, a synthetic somatostatin analogue, in preventing the complications of elective pancreatic surgery. 303 patients with tumours of the pancreas or the ampullary region, in whom ultrasonography and computed tomography scan had shown a resectable lesion, or with chronic pancreatitis, were randomized in a double-blind fashion to treatment with octreotide 100 micrograms t.i.d. s.c. starting at least 1 h before surgery and continued till the 7th postsurgical day, or with matching placebo. Unresectable lesions were found at laparatomy in 31 patients (15% of those with tumours). In 14 others, procedures not anticipated in the study protocol had to be performed, and in 6 additional cases there were other protocol violations so that these 20 patients were excluded from the study analysis. Considering the 252 evaluable patients, the complication rate was significantly higher in the 130 placebo-treated patients than in the 122 who received octreotide (29.2 vs. 15.6%; p = 0.01). We therefore suggest that octreotide may substantially reduce the risk of complications after elective pancreatic surgery.

  5. [Anesthesia in the pleuropulmonary complications surgery of tuberculosis: a 79 cases study].

    Science.gov (United States)

    Kane, O; Diouf, E; Beye, M D; Diarra, O; Ndoye Diop, M; Diouf, M; Ndiaye, M; Ka Sall, B

    2003-01-01

    Reported is a retrospective study carried out from Aristide Le Dantec Hospital in patients who underwent pleuropulmonary surgery after tuberculosis complication, from June 1995 to June 1999. The aim of this study was to evaluate the anaesthesiology procedures and outcomes of tuberculosis pleuropulmonary complications surgery. Seventy nine patients were studied. Their mean age was 34.63 years, and the sex ratio was 3.14. They all underwent general anaesthesia procedures with barbituric, morphinics et myorelaxants drugs. The peroperative complications noted were distributed as follow: 50 cases of haemorrhage needing transfusion, 18 cases of hypotension associated to the anaesthesia. In the intensive care period, we have noticed 30 atelectasia cases associated to a spastic bronchopathy, 3 cases of pulmonary oedema and 1 case of pulmonary infarctus. In the postoperative period, 8 cases of hemodynamic instability occurred, including 5 cases of cardiovascular collapsus treated by filling, and 2 septic shocks cases. An infectious bronchopneumopathy was noticed on 11 patients with two cases of septicaemia. The mortality rate was 6.3% (5 cases of death). The pleuropulmonary surgery in tuberculosis complication is very haemorrhagic, and therefore require an adequate preoperative preparation.

  6. Less extensive surgery compared to extensive surgery

    DEFF Research Database (Denmark)

    Lauszus, Finn F; Petersen, Astrid C; Neumann, Gudrun

    2014-01-01

    OBJECTIVE: To describe the outcome of adult granulosa cell tumor (AGCT) with respect to initial clinical findings, methods of surgery, and perioperative treatment. STUDY DESIGN: Retrospective follow-up study. Setting: All hospitals in Jutland. Sample: 163 women diagnosed with AGCT. Methods: Follo...... with similar survival compared to extensive surgery, but with advancing age conservative surgery increased the risk of relapse and death....

  7. Same-day discharge in benign esophageal surgery: a prospective cohort study.

    Science.gov (United States)

    Desbeaux, A; Gronnier, C; Piessen, G; Vanderbeken, M; Ruolt, N; Triboulet, J-P; Mariette, C

    2017-04-01

    Day-case esophageal surgery has been demonstrated to be safe in small prospective cohorts and only for laparoscopic fundoplication. The aims of this study are to assess the feasibility and safety of a large series of esophageal day-case surgeries, including laparoscopic Nissen fundoplication (LNF), Zenker diverticulectomy (ZD), and laparoscopic Heller myotomy (LHM) and to compare the outcomes among three procedures.This was a prospective, observational study of selected patients who underwent day-case LNF, ZD, and LHM between 2003 and 2013. Postoperative outcomes, the patients' satisfaction, and functional results were evaluated with dedicated scores and compared.Of the 427 patients who underwent surgery for those indications during the study period, 168 (39.3%) eligible patients underwent day-case procedures (134 LNF, 14 LHM, and 20 ZD). The overnight unplanned admission rate was 16.2% and was similar among the groups (P = 0.681). Ten patients were readmitted during the first postoperative week because of dysphagia (n = 6, all in the LNF group), flu-like syndrome (n = 1), and secondary perforation (n = 3, all in the LHM group). The unplanned seven-day readmission rate was significantly higher in the LHM group than in the ZD and LNF groups (P = 0.042). The 30-day rates of unplanned readmission and consultation were 8.9% (P = 0.300) and 4.8%, respectively. At follow-up, 87.5% of the patients were satisfied with day-case treatment, and the functional results were good for 81.4% of the patients.Day-case esophageal surgery is feasible for LNF and seems to be feasible for ZD. Safety criteria have not yet been met for LHM, requiring further adaptations. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. Cost minimization analysis of laparoscopic surgery for colorectal cancer within the enhanced recovery after surgery (ERAS) protocol: a single-centre, case-matched study.

    Science.gov (United States)

    Pędziwiatr, Michał; Wierdak, Mateusz; Nowakowski, Michał; Pisarska, Magdalena; Stanek, Maciej; Kisielewski, Michał; Matłok, Maciej; Major, Piotr; Kłęk, Stanisław; Budzyński, Andrzej

    2016-01-01

    The goal of modern medical treatment is to provide high quality medical care in a cost-effective environment. To assess the cost-effectiveness of laparoscopic colorectal surgery combined with the enhanced recovery after surgery protocol (ERP) in Poland. We designed a single-centre, case-matched study. Economic and clinical data were collected in 3 groups of patients (33 patients in each group): group 1 - patients undergoing laparoscopy with ERP; group 2 - laparoscopy without ERP; group 3 - open resection without ERP. An independent administrative officer, not involved in the treatment process, matched patients for age, sex and type of resection. Primary outcome was cost analysis. It was carried out incorporating institutional costs: hospital bed stay, anaesthesia, surgical procedure and equipment, drugs and complications. Secondary outcomes were length of stay (LOS), readmission and complication rate. Cost of laparoscopic procedure alone was significantly more expensive than open resection. However, implementation of the ERAS protocol reduced additional costs. Total cost per patient in group 1 was significantly lower than in groups 2 and 3 (EUR 1826 vs. EUR 2355.3 vs. EUR 2459.5, p surgery combined with ERP can be a safe and a cost-effective alternative to open surgery with traditional perioperative care.

  9. The study of I-123-IMP-SPECT before and after surgery for craniosynostosis

    Energy Technology Data Exchange (ETDEWEB)

    Satoh, Motohiro (University Hospital of Tsukuba, Ibaraki (Japan)); Ishikawa, Nobuyoshi; Enomoto, Takao; Takeda, Tohru; Yoshizawa, Takashi; Nose, Tadao

    1990-12-01

    Single photon emission computed tomography with N-isopropyl-p-(I-123)iodoamphetamine was performed in 13 cases of craniosynostosis before and after surgery. Of 13 cases, 8 cases (62%) showed focal low perfusion area on preoperative study. Four of seven cases (57%) with brachycephaly showed low perfusion areas in either of frontal lobes, occipital lobes, and cerebellum. Besides, two patients with scaphocephaly and one with plagiocephaly showed low perfusion area in the unilateral cerebral hemisphere. Two Crouzon disease cases showed no focal low perfusion area, but an Apert disease showed low perfusion areas in both frontal lobes, cerebellum, as well as left occipital lobe. Corresponding CT and MRI showed no focal abnormality in any of these cases. These low perfusion areas were diminished or disappeared after surgical treatment in 6 cases (75%). We conclude that the I-123-IMP-SPECT is considered to be a useful index for the evaluation of functional recovery after surgery in cases of craniosynostosis. (author).

  10. Does gynecologic surgery contribute to low back problems in later life? An analysis of the women's health and aging study.

    Science.gov (United States)

    Ericksen, Jeffery J; Bean, Jonathan F; Kiely, Dan K; Hicks, Gregory E; Leveille, Suzanne G

    2006-02-01

    To examine whether women with potential injuries to the abdominal and pelvic musculature from past gynecologic surgery are at higher risk for low back pain (LBP). Cross-sectional population-based study. Eastern region of the city and county of Baltimore, MD. Disabled women (N=1002) aged 65 and older, 448 of whom reported gynecologic surgery who were participants in the Women's Health and Aging Study. Not applicable. LBP presence in the last year, LBP severity for the last month, and adjudicated lumbar diagnoses (disk disease, stenosis) were examined in relation to reports of surgical menopause or ovarian surgery adjusted for LBP risk factors. Women with surgical menopause experienced more moderate LBP (adjusted odds ratio [AOR]=1.59; 95% confidence interval [CI], 1.1-2.3) than women without surgical menopause. Women with ovarian surgery also experienced more moderate LBP than women without ovarian surgery, but this association was not statistically significant (AOR=1.39; 95% CI, 0.96-2.09). Gynecologic surgery was not associated with an increased likelihood of lumbar disk disease or stenosis. Surgical menopause may increase the risk of moderate LBP. Further research is needed to determine how gynecologic surgery might influence low back pathology. Abdominal and pelvic muscle rehabilitation after gynecologic surgery may provide protection from LBP later in life.

  11. A pilot study of Bifidobacterium breve in neonates undergoing surgery for congenital heart disease.

    Science.gov (United States)

    Umenai, Takako; Shime, Nobuaki; Asahara, Takashi; Nomoto, Koji; Itoi, Toshiyuki

    2014-01-01

    Probiotics have currently been widely used in patients undergoing various types of surgeries and improved their clinical outcomes, while data in pediatric cardiac surgery have been lacking. We investigated the safety and effects on the intestinal microbiota of the probiotic Bifidobacterium breve in neonates undergoing surgery for congenital heart disease. This pilot, randomized study was performed in a single-center, university hospital-based pediatric intensive care unit (PICU). Twenty-one neonates undergoing surgery for congenital heart disease at >7 days after birth were randomly allocated to two groups: group A received 3 × 10(9) colony-forming units (CFU)/day of enteral B. breve strain Yakult (BBG-01), which was started 1 week before and terminated 1 week after surgery (n = 10), and group B did not receive BBG-01 (n = 11). The characteristics of the patients were similar in both groups. The postoperative days until fulfillment of the criteria for discharge from the PICU tended to be fewer in group A (8 [7-8] days) than in group B (9 [8-14] days) (p = 0.10). Likewise, the postoperative days to enteral nutrition or achievement of caloric goal tended to be fewer in group A than in group B. The Bifidobacterium in fecal samples after initiating BBG-01 in group A were significantly higher in number than that in group B. Enterobacteriaceae were significantly fewer in group A than in group B immediately (7.0 [3.9-7.7] vs. 8.5 [8.0-9.1] log10 cells/g) and 1 week (7.7 [7.0-8.1] vs. 9.3 [8.6-9.5] log10 cells/g) after surgery (p congenital heart disease was safe and significantly improved their intestinal environment. The positive effects of this treatment on clinically significant outcomes remain to be investigated.

  12. Current challenges in providing bariatric surgery in France: A nationwide study.

    Science.gov (United States)

    Czernichow, Sébastien; Paita, Michel; Nocca, David; Msika, Simon; Basdevant, Arnaud; Millat, Bertrand; Fagot-Campagna, Anne

    2016-12-01

    Bariatric surgery is a well-accepted procedure for severe and massive obesity management. We aimed to determine trends, geographical variations, and factors influencing bariatric surgery and the choice of procedure in France in a large observational study.The Health Insurance Fund for Salaried Workers (Caisse National Assurance Maladie Travailleurs Salariés) covers about 86% of the French population. The Système National d'Information Inter-régimes de l'Assurance Maladie database contains individualized and anonymized patient data on all reimbursements for healthcare expenditure. All types of primary bariatric procedures (Roux-en-Y gastric bypass [RYGB] or omega loop, adjustable gastric banding [AGB], or longitudinal sleeve gastrectomy [LSG]) performed during 2011 to 2013 were systematically recorded. Surgical techniques performed by region of residence and age-range relative risks with 95% confidence intervals of undergoing LSG or RYGB versus AGB were computed.In 2013, LSG was performed more frequently than RYGB and AGB (57% vs 31% and 13%, respectively). A total of 41,648 patients underwent a bariatric procedure; they were predominantly female (82%) with a mean (±standard deviation) age of 40 (±12) years and a body mass index ≥40 kg/m for 68% of them. A total of 114 procedures were performed in patients younger than 18 years and 2381 procedures were performed in patients aged 60 years and older. Beneficiaries of the French universal health insurance coverage for low-income patients were more likely to undergo surgery than the general population. Large nationwide variations were observed in the type choice of bariatric surgical procedures. Significant positive predictors for undergoing RYGB compared to those for undergoing AGB were as follows: referral to a center performing a large number of surgeries or to a public hospital, older age, female gender, body mass index ≥50 kg/m, and treatment for obstructive sleep apnea syndrome, diabetes, or

  13. [Journal "Surgery" (1934-2004): (historiographical and cognitological study-cadastre)].

    Science.gov (United States)

    Kumanova, A; Iarŭmov, N; Kumanov, M

    2005-01-01

    The study is based on the methodology of the contemporary interdisciplinary cognitive images of the information entity of the surgical sphere, reflected in the phenomenology of the journal "Surgery", which is gathering --as a publication of the Scientific Society of Surgeons--the kaleidoscope of the genealogy of the scientific and practical thought in Bulgaria in the treated area for an impressive historical lapse of time. The information image observed is represented in the form of a triptych: I. Macrostructure of the periodicals in the field of medicine in the years 30 of XX century: Bibliographic analysis: Historiographical description [: Background]; II. Microstructure of the journal "Surgery" (1934-2004): Periodization [1934-1944: non-party system with priority of the monarchy; 1944-1989: totalitarian epoch; 1989-2004: democracy and pluralism]: Scientometrical synthesis: Transformatism of the information modeling [: History]; III. Status of the surgical field in the intelligible prism of the journal "Surgery" (1934-2004): Interdisciplinary deduction: Cognitological proscopy [: Classification]. The ontological synthesis concludes the study by which is expressed the systemic dynamical entity of the relation "surgical field"--"its scientific expression in a periodical" as a base of future scientific research--as well as a complex scientific and applied field of knowledge, and a social important phenomenon. The Supplements and References and notes are an empirical base and a fragment of the expose.

  14. Surgeons' physical discomfort and symptoms during robotic surgery: a comprehensive ergonomic survey study.

    Science.gov (United States)

    Lee, G I; Lee, M R; Green, I; Allaf, M; Marohn, M R

    2017-04-01

    It is commonly believed that robotic surgery systems provide surgeons with an ergonomically sound work environment; however, the actual experience of surgeons practicing robotic surgery (RS) has not been thoroughly researched. In this ergonomics survey study, we investigated surgeons' physical symptom reports and their association with factors including demographics, specialties, and robotic systems. Four hundred and thirty-two surgeons regularly practicing RS completed this comprehensive survey comprising 20 questions in four categories: demographics, systems, ergonomics, and physical symptoms. Chi-square and multinomial logistic regression analyses were used for statistical analysis. Two hundred and thirty-six surgeons (56.1 %) reported physical symptoms or discomfort. Among those symptoms, neck stiffness, finger, and eye fatigues were the most common. With the newest robot, eye symptom rate was considerably reduced, while neck and finger symptoms did not improve significantly. A high rate of lower back stiffness was correlated with higher annual robotic case volume, and eye symptoms were more common with longer years practicing robotic surgery (p ergonomic settings reported lower symptom report rates. Symptoms were not correlated with age and gender. Although RS provides relatively better ergonomics, this study demonstrates that 56.1 % of regularly practicing robotic surgeons still experience related physical symptoms or discomfort. In addition to system improvement, surgeon education in optimizing the ergonomic settings may be necessary to maximize the ergonomic benefits in RS.

  15. Poor prognosis after surgery for intertrochanteric fracture in elderly patients with clopidogrel treatment: A cohort study.

    Science.gov (United States)

    Zhang, Jianzheng; Chen, Xiaobin; Wang, Juan; Liu, Zhi; Wang, Xiaowei; Ren, Jixin; Sun, Tiansheng

    2017-09-01

    Choice of surgical approach in patients under clopidogrel treatment is controversial. Intertrochanteric fractures are common in the elderly, who also suffer from a number of comorbidities.The aim of this study is to assess the prognosis of elderly patients with clopidogrel treatment after surgery for intertrochanteric fracture.This was a cohort study of 238 elderly patients who underwent proximal femur intramedullary nailing for intertrochanteric fracture between January 2012 and December 2013 at the Geriatric Trauma Center of the Beijing Army General Hospital. The patients were divided into the clopidogrel (n = 32) and control (n = 206) groups according to their history of long-term clopidogrel treatment before surgery. Demographic and clinical characteristics, intraoperative parameters, postoperative complications, and 1-year survival were compared between the 2 groups.Preoperative American Society of Anesthesiologists (ASA) grade and the frequency of arterial stenting were different between the 2 groups (P = .002 and P clopidogrel group compared with the control group (all P clopidogrel group compared with the control group (37.5% vs 20.3%, P = .030).Prognosis after surgery for intertrochanteric fracture was poorer in elderly patients with clopidogrel treatment; these patients had lower 1-year survival, more intraoperative blood transfusion, longer ICU stay, and longer hospital stay. ASA grade, arterial stenting, and anesthesia mode were prognostic factors.

  16. The effect of the Ontario Bariatric Network on health services utilization after bariatric surgery: a retrospective cohort study.

    Science.gov (United States)

    Elnahas, Ahmad; Jackson, Timothy D; Okrainec, Allan; Austin, Peter C; Bell, Chaim M; Urbach, David R

    2016-01-01

    In 2009, the Ontario Bariatric Network was established to address the exploding demand by Ontario residents for bariatric surgery services outside Canada. We compared the use of postoperative hospital services between out-of-country surgery recipients and patients within the Ontario Bariatric Network. We conducted a population-based, comparative study using administrative data held at the Institute for Clinical Evaluative Sciences. We included Ontario residents who underwent bariatric surgery between 2007 and 2012 either outside the country or at one of the Ontario Bariatric Network's designated centres of excellence. The primary outcome was use of hospital services in Ontario within 1 year after surgery. A total of 4852 patients received bariatric surgery out of country, and 5179 patients underwent surgery through the Ontario Bariatric Network. After adjustment, surgery at a network centre was associated with a significantly lower utilization rate of postoperative hospital services than surgery out of country (rate ratio 0.90, 95% confidence interval [CI] 0.84 to 0.97). No statistically significant differences were found with respect to time in critical care or mortality. However, the physician assessment and reoperation rates were significantly higher among patients who received surgery at a network centre than among those who had bariatric surgery out of country (rate ratio 4.10, 95% CI 3.69 to 4.56, and rate ratio 1.84, 95% CI 1.34 to 2.53, respectively). The implementation of a comprehensive, multidisciplinary provincial program to replace outsourcing of bariatric surgical services was associated with less use of postoperative hospital services by Ontario residents undergoing bariatric surgery. Future research should include an economic evaluation to determine the costs and benefits of the Ontario Bariatric Network.

  17. [Deep infiltrative endometriosis without digestive involvement, what is the impact of surgery on in vitro fertilization outcomes? A retrospective study].

    Science.gov (United States)

    Mounsambote, L; Cohen, J; Bendifallah, S; d'Argent, E Mathieu; Selleret, L; Chabbert-Buffet, N; Ballester, M; Antoine, J M; Daraï, E

    2017-01-01

    To evaluate the impact of complete removal of endometriosis in case of deep infiltrative endometriosis without digestive involvement, on in vitro fertilization outcomes. Retrospective monocentric study. We included infertile women with deep infiltrative endometriosis without colorectal involvement that underwent IVF. Women were divided in two groups, following their history: "surgery" when they underwent complete endometriosis resection before IVF and "without surgery" when they underwent IVF without endometriosis removal. We analysed IVF outcomes considering pregnancy rates per cycle and cumulative pregnancy rates per patient. We included 72 patients: 35 in the "surgery" group and 37 in the "without surgery" group. Women in the two groups were comparable in terms of baseline characteristics (age, body mass index, anti-Müllerian hormone, antral follicular count), endometriosis localizations and in vitro fertilization parameters. Cumulative pregnancy rates per patient were similar in both groups (40 % in the "surgery" group and 41 % in the "without surgery" group; P=1). Clinical pregnancy rate per cycle were also comparable groups (24 % in the "surgery" group and 28 % in the "without surgery" group; P=0.67). Surgery performed was comparable in women that became pregnant and in women that did not. Age was lower in women that became pregnant (P=0.01) and there were more pregnancy obtained in women under 35 years. In women with deep infiltrative endometriosis without digestive involvement, in vitro fertilization outcomes were not impacted by surgery. Therapeutic choice between IVF or surgery as first-line treatment remains thus questionable and shall be guided by other influencing factors, such as pain symptomatology, age, tubal permeability, ovarian reserve, partner's sperm characteristics and woman's choice. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. Developmental outcomes and physical activity behaviour in children post major surgery: an observational study.

    Science.gov (United States)

    Dwyer, Genevieve Mary; Walker, Karen; Baur, Louise; Badawi, Nadia

    2016-08-03

    Infants may be at neurodevelopmental risk from adverse events arising in the neonatal period. This study aimed to investigate the developmental outcomes and physical activity behaviours of term infants after neonatal major surgery, at age three years. This prospective study enrolled infants who underwent major surgery in their first 90 days, between August 2006 and December 2008. Developmental status was assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III). Physical activity and sedentary behaviour (i.e. small screen recreation) (SSR) were assessed using the Preschool-Age Physical Activity Questionnaire (Pre-PAQ). Activity (moving between slow to fast pace) and SSR were reported for a 3-day period. One hundred and thirty five children (68 major surgery, 67 control) were assessed, using both measures, at age three years. Both groups were within the average range across all domains of the BSID-III although the surgical group was significantly below the controls for cognition (t = -3.162, p = 0.002) receptive language (t = -3.790, p activity time for the surgical group was 191 mins.day(-1), and 185 mins.day-1 for controls. Mean SSR time was 77 mins.day(-1), and 83 mins.day(-1) for the respective groups. There was no significant difference between groups for either physical activity (p = 0.71) or SSR time (p = 0.49). By age three, children who had major surgery in infancy are developmentally normal but have not quite caught up with their peer group in cognitive, receptive language and fine motor skill domains. Both groups met recommended 3 h of daily physical activity but exceeded 60-min SSR time recommended for preschool-age children.

  19. Surgery or general medicine: a study of the reasons underlying the choice of medical specialty

    Directory of Open Access Journals (Sweden)

    Patrícia Lacerda Bellodi

    Full Text Available CONTEXT: The reality of medical services in Brazil points towards expansion and diversification of medical knowledge. However, there are few Brazilian studies on choosing a medical specialty. OBJECTIVE: To investigate and characterize the process of choosing the medical specialty among Brazilian resident doctors, with a comparison of the choice between general medicine and surgery. TYPE OF STUDY: Stratified survey. SETTING: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (HC-FMUSP. METHODS: A randomized sample of resident doctors in general medicine (30 and surgery (30 was interviewed. Data on sociodemographic characteristics and the moment, stability and reasons for the choice of specialty were obtained. RESULTS: The moment of choice between the two specialties differed. Surgeons (30% choose the specialty earlier, while general doctors decided progressively, mainly during the internship (43%. Most residents in both fields (73% general medicine, 70% surgery said they had considered another specialty before the current choice. The main reasons for general doctors' choice were contact with patients (50%, intellectual activities (30% and knowledge of the field (27%. For surgeons the main reasons were practical intervention (43%, manual activities (43% and the results obtained (40%. Personality was important in the choice for 20% of general doctors and for 27% of surgeons. DISCUSSION: The reasons found for the choice between general medicine and surgery were consistent with the literature. The concepts of wanting to be a general doctor or a surgeon are similar throughout the world. Personality characteristics were an important influencing factor for all residents, without statistical difference between the specialties, as was lifestyle. Remuneration did not appear as a determinant. CONCLUSION: The results from this group of Brazilian resident doctors corroborated data on choosing a medical specialty from other countries

  20. Acute mesenteric ischemia following cardiovascular surgery--A nested case-control study.

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    Mothes, H; Koeppen, J; Bayer, O; Richter, M; Kabisch, B; Schwarzkopf, D; Hein, H A T; Zanow, J; Doenst, T; Settmacher, U

    2016-02-01

    Acute mesenteric ischemia is a rare but often fatal complication following cardiovascular surgery. Early suspicion may reduce overall mortality. This retrospective study aims to identify predictors and risk factors that may determine the onset and evolution of acute mesenteric ischemia. In a retrospective case-control study, we compared co-morbidities and peri-operative risk factors of patients with or without mesenteric ischemia following cardiac surgery using univariate and logistic regression analyses. Of 9385 patients, 108 (1.15%) were diagnosed with acute mesenteric ischemia within two weeks after cardiac surgery. In-hospital mortality was 68% for this group. Patients with ischemia and controls were matched in regard to patient's age and type of surgical intervention and showed similar pre-operative parameters. Only liver cirrhosis (OR 13.3, CI95% 3.6-49.3), and emergency operation (OR 2.6, CI95% 1.3-5.2) remained independent pre-operative predictors for acute mesenteric ischemia in multivariate analysis. In contrast, early postoperative parameters revealed a higher correlation with the occurrence of mesenteric ischemia including the use of norepinephrine (OR 3.5 CI95% 1.6-7.8), epinephrine (OR 2.0, CI95% 1.1-3.7), and serum lactate levels >3 mmol/L (OR 2.9, CI95% 1.5-5.6). A set of key markers of regression analysis was evaluated in a ROC curve analysis. The area under curve was 0.835, which indicates moderate to good prognostic accuracy. Early identification of pre- and post-operative predictors including liver cirrhosis, emergency operation, serum lactate >3 mmol/L, and the use of norepinephrine and epinephrine may help facilitate early diagnosis of acute mesenteric ischemia following cardiac surgery, and thus may allow immediate adequate treatment, leading to a reduction in mortality rates. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  1. Variation in the effectiveness of refractive surgery during the year: results from the Hamburg Weather Study.

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    Neuhaus-Richard, Ines; Frings, Andreas; Ament, Felix; Görsch, Isabel Caroline; Druchkiv, Vasyl; Katz, Toam; Linke, Stephan Johannes; Richard, Gisbert

    2014-07-01

    To examine the impact of seasonality on the refractive and visual outcomes of laser in situ keratomileusis (LASIK) in myopic eyes. Department of Ophthalmology and Care Vision Refractive Centers, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Retrospective cross-sectional data analysis. Two subgroups were defined. The first comprised patients having surgery during meteorological winter and the second, patients having surgery during meteorological summer. The manifest refraction and uncorrected and corrected visual acuities were assessed preoperatively and postoperatively. Robust regression analysis was applied with the efficacy index, safety index, and postoperative SE as dependent variables. This study comprised 1052 eyes of 1052 consecutive myopic patients (419 men, 633 women; mean age at surgery 35.0 years ± 9.0 [SD]) with a mean preoperative refractive spherical equivalent (SE) of -3.88 ± 1.85 diopters (D). At the 1-month follow-up (mean 33.0 ± 5.0 days), the mean postoperative SE was -0.18 ± 0.44 D. The efficacy index was 0.023 higher in eyes with refractive surgery during summer than in eyes treated during winter (P=.032), indicating less efficacy during winter. The differences in the safety index and postoperative SE between summer and winter were not statistically significant. No eye had a change of more than 1 line on the logMAR scale (corrected distance visual acuity). Although the difference in the efficacy index was statistically significant, the difference in the outcomes of LASIK was not clinically relevant, which shows the procedure's highly standardized reliability. Prospective longitudinal studies are warranted to address meteorotropic reactions by evaluating defined meteorological parameters. No author has a financial or proprietary interest in any material or method mentioned. Copyright © 2014 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

  2. The quality of control groups in nonrandomized studies published in the Journal of Hand Surgery.

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    Johnson, Shepard P; Malay, Sunitha; Chung, Kevin C

    2015-01-01

    To evaluate control group selection in nonrandomized studies published in the Journal of Hand Surgery American (JHS). We reviewed all papers published in JHS in 2013 to identify studies that used nonrandomized control groups. Data collected included type of study design and control group characteristics. We then appraised studies to determine whether authors discussed confounding and selection bias and how they controlled for confounding. Thirty-seven nonrandomized studies were published in JHS in 2013. The source of control was either the same institution as the study group, a different institution, a database, or not provided in the manuscript. Twenty-nine (78%) studies statistically compared key characteristics between control and study group. Confounding was controlled with matching, exclusion criteria, or regression analysis. Twenty-two (59%) papers explicitly discussed the threat of confounding and 18 (49%) identified sources of selection bias. In our review of nonrandomized studies published in JHS, papers had well-defined controls that were similar to the study group, allowing for reasonable comparisons. However, we identified substantial confounding and bias that were not addressed as explicit limitations, which might lead the reader to overestimate the scientific validity of the data. Incorporating a brief discussion of control group selection in scientific manuscripts should help readers interpret the study more appropriately. Authors, reviewers, and editors should strive to address this component of clinical importance. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. Assessment of cosmetic outcome of oncoplastic breast conservation surgery in women with early breast cancer: a prospective cohort study.

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    Adimulam, G; Challa, V R; Dhar, A; Chumber, S; Seenu, V; Srivastava, A

    2014-01-01

    The aim of this study was to assess the cosmetic outcome of patients undergoing oncoplastic breast conserving surgery in Indian population. A prospective cohort of 35 patients who were eligible for breast conservation surgery was included in the study from year 2007 to 2009. Patients with central quadrant tumors were excluded from the study. A double - blind cosmetic assessment was done by a plastic surgeon and a senior nurse not involved in the management of patients. Moreover, self-assessment was carried out by the patient regarding the satisfaction of surgery, comfort with brasserie, social and sexual life after oncoplastic surgery. In this study, 35 patients underwent oncoplastic breast conservation surgery by various techniques. The cosmetic outcome scores of the surgeon and nurse were analyzed for inter rater agreement using inter-class Correlation Coefficients. There was a good association between them. The risk factors for poor cosmetic outcome was studied by univariate analysis and significant correlation was obtained with age, volume of breast tissue excised and estimated percentage of breast volume excised (P surgery. Patients were offered an option for cosmetic correction of contralateral breast by mastopexy or reduction mammoplasty however, none of them agreed for another procedure. Oncoplastic breast surgery helps to resect larger volume of tissue with wider margins around the tumor. It helps to achieve better cosmesis and extends the indications for breast conservation. Most of the patients were satisfied with mere preservation of the breast mound rather than a symmetrical contralateral breast.

  4. Kinematic analysis of mandibular motion before and after orthognathic surgery for skeletal Class III malocclusion: A pilot study.

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    Ugolini, Alessandro; Mapelli, Andrea; Segù, Marzia; Galante, Domenico; Sidequersky, Fernanda V; Sforza, Chiarella

    2017-03-01

    The aim of the study was to detect the changes in 3D mandibular motion after orthognathic surgery for skeletal Class III malocclusion. Using a 3D motion analyzer, free mandibular border movements were recorded in nine patients successfully treated for skeletal Class III malocclusion and in nine patients scheduled for orthognathic surgery. Data were compared using Mann-Whitney non-parametric U-test. The results showed no differences between the groups in the total amount of mouth opening, protrusion, and in lateral excursions, but the percentage of mandibular movement explained by condylar translation was significantly increased after surgery (20% vs. 23.6%). During opening, the post-surgery patients showed a more symmetrical mandibular interincisal point and condylar path than pre-surgery patients (p Class III malocclusion recover a good and symmetric temporomandibular joint function.

  5. Robotic assisted versus pure laparoscopic surgery of the adrenal glands: a case-control study comparing surgical techniques.

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    Morelli, Luca; Tartaglia, Dario; Bronzoni, Jessica; Palmeri, Matteo; Guadagni, Simone; Di Franco, Gregorio; Gennai, Andrea; Bianchini, Matteo; Bastiani, Luca; Moglia, Andrea; Ferrari, Vincenzo; Fommei, Enza; Pietrabissa, Andrea; Di Candio, Giulio; Mosca, Franco

    2016-11-01

    The role of the da Vinci Robotic System ® in adrenal gland surgery is not yet well defined. The goal of this study was to compare robotic-assisted surgery with pure laparoscopic surgery in a single center. One hundred and 16 patients underwent minimally invasive adrenalectomies in our department between June 1994 and December 2014, 41 of whom were treated with a robotic-assisted approach (robotic adrenalectomy, RA). Patients who underwent RA were matched according to BMI, age, gender, and nodule dimensions, and compared with 41 patients who had undergone laparoscopic adrenalectomies (LA). Statistical analysis was performed using the Student's t test for independent samples, and the relationship between the operative time and other covariates were evaluated with a multivariable linear regression model. P surgery (p surgery.

  6. Iranian Parents' Supportive Umbrella during their Children Surgery: a Qualitative Study

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    Fatemeh Valizadeh

    2016-03-01

    Full Text Available Background Being in a position of vulnerability, distress and uncertainty reduces the ability of the parents to protect their children and makes them need support from others. The first step to aid clients more is to identify their supportive sources. This study aimed to determine parents' experiences of supportive sources during their children surgery. Materials and Methods This is a descriptive qualitative research. Purposive and maximum variation sampling applied to select 21 parents of operated children in Ahvaz hospitals, Iran. Semi structured interviews, with open question were used to data collection. Audio recording interviews put into written form word by word and finally analyzed with qualitative content analysis approach.  Results Parents considered the personnel's beyond-task-orientation performance, family comprehensive support, mutual facilitating of peers and the elixir of connection to God as the sources that supported them as an umbrella during their children surgery.     Conclusion It is essential for the health service providers to check each family thoroughly in terms of other supportive sources while providing professional support, and to use the sources in an organized way for the successful transition of parents from the stress of their children surgery.

  7. Pilot prospective study of post-surgery sleep and EEG predictors of post-operative delirium.

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    Evans, Joanna L; Nadler, Jacob W; Preud'homme, Xavier A; Fang, Eric; Daughtry, Rommie L; Chapman, Joseph B; Attarian, David; Wellman, Samuel; Krystal, Andrew D

    2017-08-01

    Delirium is a common post-operative complication associated with significant costs, morbidity, and mortality. We sought sleep/EEG predictors of delirium present prior to delirium symptoms to facilitate developing and targeting therapies. Continuous EEG data were obtained in 12 patients post-orthopedic surgery from the day of surgery until delirium assessment on post-operative day 2 (POD2). Diminished total sleep time (r=-0.68; pdelirium severity. Patients experiencing delirium slept 2.4h less and took 2h longer to fall asleep. Greater waking EEG delta power (r=0.84; pdelirium severity. Loss of sleep on night1 post-surgery is an early predictor of subsequent delirium. EEG Delta Power alterations in waking and sleep appear to be later indicators of impending delirium. Further work is needed to evaluate reproducibility/generalizability and assess whether sleep loss contributes to causing delirium. This first study to prospectively collect continuous EEG data for an extended period prior to delirium onset identified EEG-derived indices that predict subsequent delirium that could aid in developing and targeting therapies. Copyright © 2017. Published by Elsevier B.V.

  8. Glaucoma drainage device surgery in children and adults: a comparative study of outcomes and complications.

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    Mandalos, Achilleas; Sung, Velota

    2017-05-01

    To compare the postoperative outcomes and complications of glaucoma drainage device (GDD) surgery in pediatric (adult patients. Retrospective, comparative study including all patients who underwent Baervedlt or Molteno device surgery by the same surgeon. Success criteria included postoperative intraocular pressure (IOP) between 6 and 21 mmHg and a 20% reduction from baseline. Fifty-two children (69 eyes) and 130 adults (145 eyes) were included. Mean IOP and number of medications were significantly reduced postoperatively in both groups. Overall failure rate was similar in children and adults. However, GDD failed earlier in adults than in children. Hypotony was the most common complication in both groups in the first 6 months postoperatively. Later on, bleb encapsulation was more frequent in children, while corneal decompensation tended to be more frequent and occurred earlier in adults. Children also had a higher rate of infectious endophthalmitis and required tube repositioning more frequently than adults. GDD surgery presents different postoperative challenges in children and adults, and the surgeon should remain vigilant for complications throughout the postoperative period, especially for signs of endophthalmitis or bleb encapsulation in pediatric patients. On the other hand, adults may be more prone to early corneal decompensation.

  9. [Results of applying a fast-track protocol in a colorectal surgery unit: comparative study].

    Science.gov (United States)

    Esteban Collazo, Fernando; Garcia Alonso, Mauricio; Sanz Lopez, Rodrigo; Sanz Ortega, Gonzalo; Ortega Lopez, Mario; Zuloaga Bueno, Jaime; Jimenez Escovar, Fernando; Cerdán Miguel, F Javier

    2012-01-01

    To implement a fast-track (FT) protocol in a colorectal surgery unit, checking its safety when applied to patients subjected to elective colorectal surgery, by evaluating the differences in morbidity and hospital stay compared to a control group with traditional care. We also analyse the functional recovery of the FT group. A prospective cohort study with non-concurrent control, was conducted on a group of 108 patients operated on for colorectal cancer between 2008 and 2009, to which the FT protocol was applied, and a control group (CG) of 147 patients subjected to surgery between 2005 and 2007 with similar characteristics, with traditional postoperative care. The demographic characteristics, anaesthetic risk, and the surgical procedures performed were similar, with a higher number of patients with laparoscopic approach in the FT group. The compliance with the items in our FT protocol was high (72.2-92.6%). Complications were observed in 77 patients (52%) in the GC compared to 30 (27.8%) in the FT group (Psurgery is safe, leading to a significant decrease in morbidity and hospital stay, without increasing the number of readmissions. Copyright © 2011 AEC. Published by Elsevier Espana. All rights reserved.

  10. Genetic response in masseter muscle after orthognathic surgery in comparison with healthy controls - A Microarray study.

    Science.gov (United States)

    Marewski, Maya; Petto, Carola; Schneider, Matthias; Harzer, Winfried

    2017-04-01

    One third of adult patients with orthognathic surgery of a prognathic or retrognathic mandible show relapse. The sagittal split osteotomy of the mandible leads to a displacement of both parts up to 10 mm without any changes of muscle attachment. Changed mandible length needs adaptation of muscle capacity because of changed force to moment ratio. The aim of this Microarray study was to analyze the general genetic response of masseter muscle in patients with retrognathism or prognathism of the mandible six months after surgery in comparison with healthy untreated controls. We found in tissue samples from masseter muscle a reduction of different entities between patients and controls but less in retrognathic than in prognathic patients (274/429). The different entities to controls in prognathia were reduced from 1862 to 1749 but increased in retrognathia from 1070 to 1563. We have to consider that the total amount of different entities to the controls is higher in patients with prognathic mandible (7364) because of their strong genetic controlled development compared with that in patients with retrognathic mandible (4126), which is more environmentally influenced. It can be concluded that function follows form after surgical change with high inheritance. In retrognathic patients the adaptation could be delayed or the capacity of regeneration potential is not sufficient. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  11. Data for the Oxford Abdominal Aortic Aneurysm Study international survey of vascular surgery professionals.

    Science.gov (United States)

    Lee, Regent; Jones, Amy; Woodgate, Felicity; Killough, Nicholas; Bellamkonda, Kirthi; Williams, Matthew; Hurst, Katherine; Fulford-Smith, Lucy; Cassimjee, Ismail; Handa, Ashok

    2017-10-01

    As part of the Oxford Abdominal Aortic Aneurysm (OxAAA) Study, we conducted an international survey of vascular surgery professionals. One aspect of the survey is as published in the International Journal of Cardiology: "International Opinion on Priorities in Research for Small Abdominal Aortic Aneurysms and the Potential Path for Research to Impact Clinical Management". This Data-in-Brief article contains a detailed method for the conduct of this survey and additional original data. In this survey, we also provided vascular surgery colleagues with contemporary epidemiologic and surgical outcome data. This was followed by a hypothetical scenario whereby a patient had just been diagnosed with a small (40 mm) AAA and a novel biomarker predicted it to be fast growing in the coming years. We assessed the vascular professionals' perception of the patient's preference for management in this scenario, and their willingness to refer patients for a surgical trial that investigates the outcome of early versus late surgery in this setting. The survey then asked the vascular professionals to assume the role of the patient, and provided their own preferences in such a scenario.

  12. Nonopioid versus opioid based general anesthesia technique for bariatric surgery: A randomized double-blind study

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    Mohamed Ahmed Mansour

    2013-01-01

    Full Text Available Objective: The objective of this study was to evaluate the efficacy and safety of giving general anesthesia without the use of any opioids either systemic or intraperitoneal in bariatric surgery. Methods: Prospective randomized controlled trial. Obese patients (body mass index >50 Kg/m 2 undergoing laparoscopic sleeve gastrectomies were recruited and provided an informed signed consent. Patients were randomized using a computer generated randomization table to receive either opioid or non-opioid based anesthesia. The patient and the investigator scoring patient outcome after surgery were blinded to the anesthetic protocol. Primary outcomes were hemodynamics in the form of "heart rate, systolic, diastolic, and mean arterial blood pressure" on induction and ½ hourly thereafter. Pain monitoring through visual analog scale (VAS 30 min after recovery, hourly for 2 h and every 4 h for 24 h was also recorded. Pain monitoring through VAS and post-operative nausea and vomiting 30 min after recovery were also recorded and finally patient satisfaction and acute pain nurse satisfaction. Results: There was no difference in background characteristics in both groups. There were no statistically significant differences in different outcomes as heart rate, mean blood pressure, O 2 saturation in different timings between groups at any of the determined eight time points but pain score and nurse satisfaction showed a trend to better performance with non-opioid treatment. Conclusion: Nonopioid based general anesthesia for Bariatric surgery is as effective as opioid one. There is no need to use opioids for such surgery especially that there was a trend to less pain in non-opioid anesthesia.

  13. General practitioners' knowledge of hand surgery in Singapore: a survey study.

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    Chee, Kin Ghee; Puhaindran, Mark Edward; Chong, Alphonsus Khin Sze

    2012-08-01

    Hand surgery is a subspecialty with a dedicated training programme in Singapore. Currently, Singapore is one of two countries in the world that still provides dedicated advanced hand specialty training. As hand surgeons depend on referrals from institutions and general practitioners, appropriate hand surgical referral requires the referring physician to have knowledge and understanding of common hand conditions as well as less common but more urgent surgical conditions, and their available surgical treatments. This study aimed to determine the knowledge of hand surgery and hand surgical conditions among general practitioners. A questionnaire survey was conducted during a continuing medical education symposium on hand surgery in Singapore. Participants responded to 12 questions on hand trauma by keying the answers into a computer database system. The results were then analysed. A total of 35 general practitioners responded to our survey, and they were able to answer 53% of the questions correctly. We found knowledge gaps among the participants regarding hand surgical conditions, and identified areas where increased education during medical school, postgraduate training and continuing medical education may be beneficial. Areas that were found to be weak included recognising injuries that pose a high risk for developing wound infection, complications of topical steroid injection in trigger finger treatment and hand tumours. Improving hand surgery knowledge among general practitioners not only leads to improved primary care, but it can also facilitate prompt recognition of surgical problems and subsequent referral to appropriate hand surgeons for treatment. This may possibly reduce the load of tertiary institutions in treating non-urgent hand conditions.

  14. Cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study.

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    Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

    2014-11-01

    The primary aim was to examine exposure-response relationships between cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome (SIS), and to compare sex-specific exposure-response relationships. The secondary aim was to examine the time window of relevant exposures. We conducted a nationwide register study of all persons born in Denmark (1933-1977), who had at least 5 years of full-time employment. In the follow-up period (2003-2008), we identified first-time events of surgery for SIS. Cumulative exposure estimates for a 10-year exposure time window with a 1-year lag time were obtained by linking occupational codes with a job exposure matrix. The exposure estimates were expressed as, for example, arm-elevation-years in accordance with the pack-year concept of tobacco consumption. We used a multivariable logistic regression technique equivalent to discrete survival analysis. The adjusted OR (ORadj) increased to a maximum of 2.1 for arm-elevation-years, repetition-years and force-years, and to 1.5 for hand-arm-vibration-years. Sex-specific exposure-response relationships were similar for men and women, when assessed using a relative risk scale. The ORadj increased gradually with the number of years contributing to the cumulative exposure estimates. The excess fraction was 24%. Cumulative occupational shoulder exposures carried an increase in risk of surgery for SIS with similar exposure-response curves for men and women. The risk of surgery for SIS increased gradually, when the period of exposure assessment was extended. In the general working population, a substantial fraction of all first-time operations for SIS could be related to occupational exposures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Pain Control Following Impacted Third Molar Surgery with Bupivacaine Irrigation of Tooth Socket: A Prospective Study

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    Reza Khorshidi Khiavi

    2010-12-01

    Full Text Available Background and aims. The surgical removal of the lower third molars is a procedure generally followed by side effects such as postoperative pain. The aim of this study was to evaluate the efficacy of socket irrigation with an anesthetic solution in relieving pain following impacted third molar surgery. Materials and methods. Thirty-four patients (17 males and 17 females, aged 18-24 years, with bilateral impacted lower third molars were selected. Both third molars were extracted in one surgical session. Tooth sockets in each patient were rinsed randomly either with 4 mL of 0.5% bupivacaine hydrochloride plain (without vasoconstrictor anesthetic solution or 4 mL of normal saline, used as control. The patients were instructed not to use analgesics as long as possible, and if not, they were instructed to use an analgesic, and record the time. Pain severity was assessed using a visual analogue pain scale (VAPS at 1-, 6-, 12-, and 24-hour intervals post-operatively. Data were analyzed using Pearson’s chi-square test and P <0.05 was considered statistically significant. Results. Post-operative pain difference between the two groups was statistically significant at 1-, 6-, 12- and 24-hour postoperative intervals (P <0.05. Post-operative pain increased in both groups to a maximum 12 hours after surgery with significant improvements after that. Conclusion. Based on the results, the irrigation of surgery site with bupivacaine after third molar surgery significantly reduces post-operative pain.

  16. I-gel as an alternative to endotracheal tube in adult laparoscopic surgeries: A comparative study

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    Jigisha Prahladrai Badheka

    2015-01-01

    Full Text Available Background: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT in laparoscopic surgeries. Materials and Methods: A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded. Results: There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups. Conclusion: We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries.

  17. Prophylactic negative pressure wound therapy after lower extremity fracture surgery: a pilot study.

    Science.gov (United States)

    Dingemans, Siem A; Birnie, Merel F N; Backes, Manouk; de Jong, Vincent M; Luitse, Jan S; Carel Goslings, J; Schepers, Tim

    2018-01-29

    Infectious complications following lower extremity fracture surgery are a major concern and account for a substantial socio-economic burden to society. The aim of this pilot study was to investigate the feasibility of a new portable single-use negative pressure wound therapy device in patients undergoing major foot ankle surgery. Patients undergoing major foot ankle fracture surgery at a single level 1 trauma centre were eligible for this prospective case series. Patient characteristics were collected, as were fracture and surgical characteristics. Primary outcome was surgical site infection within 30 days as classified by the criteria from the Centers for Disease Control and Prevention. Patients in the prospective cohort were case-matched with a historical cohort from the same institution. Sixty patients were included. In seven patients, the NPWT failed and treatment was ceased. Mean age was 44 years and 85% was ASA 1; 43% of the patients were actively smoking. Indications for surgery were midfoot, calcaneal, talar, and ankle fractures. In 53 patients, four (7.5%) surgical site infections occurred, two superficial (3.3%) and two (3.3%) deep infections. For 47 patients, a match was available. The incidence of surgical site infection did not statistically significantly differ between the prospective cohort and retrospective matched cohort (4.3 versus 14.9%, p = 0.29, respectively). This was also the case when looking at superficial and deep surgical site infections separately (0 versus 8.5%, p = 0.08, and 4.3 versus 6.4%, respectively). We have observed surgical site infections in 7.5% of the patients with the use of prophylactic negative pressure wound therapy. The incidence of surgical site infections was not statistically significantly lower compared to a matched historical cohort.

  18. Surgical treatment of tricuspid regurgitation after mitral valve surgery: a retrospective study in China

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    Li Zong-Xiao

    2012-04-01

    Full Text Available Abstract Background Functional tricuspid regurgitation (TR occurs in patients with rheumatic mitral valve disease even after mitral valve surgery. The aim of this study was to analyze surgical results of TR after previous successful mitral valve surgery. Methods From September 1996 to September 2008, 45 patients with TR after previous mitral valve replacement underwent second operation for TR. In those, 43 patients (95.6% had right heart failure symptoms (edema of lower extremities, ascites, hepatic congestion, etc. and 40 patients (88.9% had atrial fibrillation. Twenty-six patients (57.8% were in New York Heart Association (NYHA functional class III, and 19 (42.2% in class IV. Previous operations included: 41 for mechanical mitral valve replacement (91.1%, 4 for bioprosthetic mitral valve replacement (8.9%, and 7 for tricuspid annuloplasty (15.6%. Results The tricuspid valves were repaired with Kay's (7 cases, 15.6% or De Vega technique (4 cases, 8.9%. Tricuspid valve replacement was performed in 34 cases (75.6%. One patient (2.2% died. Postoperative low cardiac output (LCO occurred in 5 patients and treated successfully. Postoperative echocardiography showed obvious reduction of right atrium and ventricle. The anterioposterior diameter of the right ventricle decreased to 25.5 ± 7.1 mm from 33.7 ± 6.2 mm preoperatively (P Conclusion TR after mitral valve replacement in rheumatic heart disease is a serious clinical problem. If it occurs or progresses late after mitral valve surgery, tricuspid valve annuloplasty or replacement may be performed with satisfactory results. Due to the serious consequence of untreated TR, aggressive treatment of existing TR during mitral valve surgery is recommended.

  19. Outcomes After Kidney injury in Surgery (OAKS): protocol for a multicentre, observational cohort study of acute kidney injury following major gastrointestinal and liver surgery.

    Science.gov (United States)

    2016-01-14

    Acute kidney injury (AKI) is associated with increased morbidity and mortality following cardiac surgery. Data focusing on the patterns of AKI following major gastrointestinal surgery could inform quality improvement projects and clinical trials, but there is a lack of reliable evidence. This multicentre study aims to determine the incidence and impact of AKI following major gastrointestinal and liver surgery. This prospective, collaborative, multicentre cohort study will include consecutive adults undergoing gastrointestinal resection, liver resection or reversal of ileostomy or colostomy. Open and laparoscopic procedures in elective and emergency patients will be included in the study. The primary end point will be the incidence of AKI within 7 days of surgery, identified using an adaptation of the National Algorithm for Detecting Acute Kidney Injury, which is based on the Kidney Disease Improving Global Outcomes (KDIGO) AKI guidelines. Secondary outcomes will include persistent renal dysfunction at discharge and 1 year postoperatively. The 30-day adverse event rate will be measured using the Clavien-Dindo scale. Data on factors that may predispose to the development of AKI will be collected to identify variables associated with AKI. Based on our previous collaborative studies, a minimum of 114 centres are expected to be recruited, contributing over 6500 patients in total. This study will be registered as clinical audit at each participating hospital. The protocol will be disseminated through local and national medical student networks in the UK and Ireland. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Health-related quality of life of patients following selected types of lumbar spinal surgery: A pilot study

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    Androwich Ida

    2007-12-01

    Full Text Available Abstract Background Over 500,000 spinal surgeries are performed annually in the United States. Although pain relief and improved health-related quality of life (HRQOL are expectations following lumbar spinal surgery, there is limited research regarding this experience from the individual's perspective. In addition, no studies have examined the HRQOL of persons who have had this surgery using a comprehensive approach. The intent of this study was to address this deficiency by an assessment of both the individual and environmental factors that impact perceived HRQOL using the Wilson and Cleary Model for Health-Related Quality of Life in persons who have undergone lumbar spinal surgery. Methods This was a pilot study of 57 adult patients undergoing elective lumbar spinal surgery for either herniated disk and/or degenerative changes. Individuals completed questionnaires measuring perceived pain, mood, functional status, general health perceptions, social support and HRQOL preoperatively and three months following surgery. Descriptive statistics, dependent t-tests, and MANOVAs were used to describe and compare the differences of the study variables over time. Results Preliminary results indicate overall perceived physical HRQOL was significantly improved postoperatively (t [56] = 6.45, p Conclusion Although perceived physical HRQOL was significantly improved three months postoperatively, fatigue and lack of vigor were issues for subjects postoperatively. Excessive fatigue and low vigor may have implications for successful rehabilitation and return to work for patients following lumbar spinal surgery. Further research is needed with a larger sample size and subgroup analyses to confirm these results.

  1. Changes in Functional Mobility and Musculoskeletal Pain After Bariatric Surgery in Teens With Severe Obesity: Teen-Longitudinal Assessment of Bariatric Surgery (LABS) Study.

    Science.gov (United States)

    Ryder, Justin R; Edwards, Nicholas M; Gupta, Resmi; Khoury, Jane; Jenkins, Todd M; Bout-Tabaku, Sharon; Michalsky, Marc P; Harmon, Carroll M; Inge, Thomas H; Kelly, Aaron S

    2016-09-01

    Severe obesity is associated with mobility limitations and higher incidence of multijoint musculoskeletal pain. It is unknown whether substantial weight loss improves these important outcomes in adolescents with severe obesity. To examine the association of bariatric surgery with functional mobility and musculoskeletal pain in adolescents with severe obesity up to 2 years after surgery. The Teen-Longitudinal Assessment of Bariatric Surgery Study is a prospective, multicenter, observational study, which enrolled 242 adolescents (≤19 years of age) who were undergoing bariatric surgery from March 2007 through February 2012 at 5 US adolescent bariatric surgery centers. This analysis was conducted in November 2015. Roux-en-Y gastric bypass (n = 161), sleeve gastrectomy (n = 67), or laparoscopic adjustable gastric band (n = 14). Participants completed a 400-m walk test prior to bariatric surgery (n = 206) and at 6 months (n = 195), 12 months (n = 176), and 24 months (n = 149) after surgery. Time to completion, resting heart rate (HR), immediate posttest HR, and HR difference (resting HR minus posttest HR) were measured and musculoskeletal pain concerns, during and after the test, were documented. Data were adjusted for age, sex, race/ethnicity, baseline body mass index (calculated as weight in kilograms divided by height in meters squared), and surgical center (posttest HR and HR difference were further adjusted for changes in time to completion). Of the 206 adolescents with severe obesity included in the study, 156 were female (75.7%), the mean (SD) age was 17.1 (1.6) years, and the mean (SD) body mass index was 51.7 (8.5). Compared with baseline, significant improvements were observed at 6 months for the walk test time to completion (mean, 376 seconds; 95% CI, 365-388 to 347 seconds; 95% CI, 340-358; P < .01), resting HR (mean, 84 beats per minute [bpm]; 95% CI, 82-86 to 74 bpm; 95% CI, 72-76), posttest HR (mean, 128 bpm; 95% CI, 125

  2. The Effects of Massage Therapy after Decompression and Fusion Surgery of the Lumbar Spine: a Case Study

    OpenAIRE

    Keller, Glenda

    2012-01-01

    Background Spinal fusion and decompression surgery of the lumbar spine are common procedures for problems such as disc herniations. Various studies for postoperative interventions have been conducted; however, no massage therapy studies have been completed. Purpose The objective of this study is to determine if massage therapy can beneficially treat pain and dysfunction associated with lumbar spinal decompression and fusion surgery. Participants Client is a 47-year-old female who underwent sp...

  3. The Learning Preferences of Applicants Who Interview for General Surgery Residency: A Multiinstitutional Study.

    Science.gov (United States)

    Kim, Roger H; Kurtzman, Scott H; Collier, Ashley N; Shabahang, Mohsen M

    Learning styles theory posits that learners have distinct preferences for how they assimilate new information. The VARK model categorizes learners based on combinations of 4 learning preferences: visual (V), aural (A), read/write (R), and kinesthetic (K). A previous single institution study demonstrated that the VARK preferences of applicants who interview for general surgery residency are different from that of the general population and that learning preferences were associated with performance on standardized tests. This multiinstitutional study was conducted to determine the distribution of VARK preferences among interviewees for general surgery residency and the effect of those preferences on United States Medical Licensing Examination (USMLE) scores. The VARK learning inventory was administered to applicants who interviewed at 3 general surgery programs during the 2014 to 2015 academic year. The distribution of VARK learning preferences among interviewees was compared with that of the general population of VARK respondents. Performance on USMLE Step 1 and Step 2 Clinical Knowledge was analyzed for associations with VARK learning preferences. Chi-square, analysis of variance, and Dunnett's test were used for statistical analysis, with p VARK inventory was completed by a total of 140 residency interviewees. Sixty-four percent of participants were male, and 41% were unimodal, having a preference for a single learning modality. The distribution of VARK preferences of interviewees was different than that of the general population (p = 0.02). By analysis of variance, there were no overall differences in USMLE Step 1 and Step 2 Clinical Knowledge scores by VARK preference (p = 0.06 and 0.21, respectively). However, multiple comparison analysis using Dunnett's test revealed that interviewees with R preferences had significantly higher scores than those with multimodal preferences on USMLE Step 1 (239 vs. 222, p = 0.02). Applicants who interview for general surgery

  4. Bariatric surgery outcomes: a single-center study in the United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Abusnana S

    2015-09-01

    Full Text Available Salah Abusnana,1 Sarah Abdi,1 Brigette Tagure,1 Murtada Elbagir,1 Almantas Maleckas2 1Rashid Center for Diabetes and Research, Ministry of Health, Ajman, United Arab Emirates; 2Kaunas University of Medicine, Kaunas, LithuaniaBackground: Bariatric surgery has become an attractive treatment for severe obesity over the last decade, due to its impacts on weight loss and remission of type 2 diabetes and metabolic syndrome. In the United Arab Emirates, a country where the rate of obesity is dramatically increasing bariatric surgery has gained popularity in recent years; however, published data on its outcomes in the Emirati population are lacking.Methods: We retrospectively reviewed the medical records of 95 patients who underwent bariatric surgery (ie, laparoscopic Roux-en-Y gastric bypass [RYGB] or laparoscopic sleeve gastrectomy at the Rashid Center for Diabetes and Research in Ajman, United Arab Emirates. Weight outcomes and metabolic marker data were abstracted at baseline and at 3, 6, and 12 months postoperatively.Results: Laparoscopic RYGB was the main procedure performed by our bariatric unit. All variables demonstrated postoperative improvement. An average excess weight loss of 68% was observed at 12 months. Fat mass was the body component that decreased the most, with an average reduction of 46%. Additionally, lipid profiles were significantly different (P<0.01 at 12 months, with triglyceride levels improving by 27% and low-density lipoprotein levels improving by 21%. Similarly, glycated hemoglobin (HbA1c levels decreased significantly (P<0.001 in patients with type 2 diabetes, with an average reduction of 73%.Conclusion: Our results show that a substantial short-term reduction in weight and significant improvements in metabolic markers followed bariatric surgery in severely obese Emirati patients. Our results are consistent with the outcomes of other internationally published studies. Additional studies are warranted to determine whether

  5. Percutaneous surgery for thoraco-lumbar fractures in ankylosing spondylitis: Study of 31 patients.

    Science.gov (United States)

    Bredin, S; Fabre-Aubrespy, M; Blondel, B; Falguières, J; Schuller, S; Walter, A; Fuentes, S; Tropiano, P; Steib, J-P; Charles, Y-P

    2017-12-01

    The risk of vertebral fracture is increased 4-fold in patients with ankylosing spondylitis (AS). Diagnostic challenges and the vulnerability associated with AS combine to generate high morbidity and mortality rates. The objective of this study was to assess the outcome of percutaneous thoraco-lumbar fracture surgery in patients with AS, in terms of quality of life, fracture healing, and complications. Percutaneous surgery used to treat thoraco-lumbar fractures in patients with AS reliably provides fracture healing, preserves self-sufficiency, and minimises post-operative complications. Two centres included 31 patients with AS who were managed by percutaneous surgery for thoraco-lumbar fractures in 2013-2015. The data were reviewed retrospectively, although admission data were collected prospectively. Clinical outcomes were assessed by comparing the values at baseline and last follow-up of three variables: the Parker score, the visual analogue scale (VAS) pain score, and the EuroQol five dimensions (EQ-5D) quality-of-life score. Computed tomography was performed 1 year after surgery to evaluate bone healing, screw position, and implant loosening. Intra- and post-operative complications were recorded. The 31 patients had a mean age at surgery of 75.1 years, a mean follow-up of 35.6 months, and a minimum follow-up of 12 months. Three patients died during follow-up. Mean hospital stay duration was 6 days. Cemented screw fixation was used in 18 patients. At last follow-up, all patients had recovered their self-sufficiency; the mean Parker score was 7.14, compared to 6.73 at baseline, the mean VAS pain score was 1.8, and the mean EQ-5D score decrease versus baseline was 0.07 (P=0.02). Bone healing was consistently achieved. Loosening of an uncemented pedicle screw was noted in 1 patient. Of the 228 screws implanted, 6 (2.6%) were improperly positioned, including 1 within the spinal canal in a patient free of neurological manifestations. Asymptomatic cement leakage was

  6. Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study.

    Science.gov (United States)

    Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

    2017-02-01

    Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p surgery RAS were significantly higher than those of OS (p surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.

  7. Plastic Surgery Inclusion in the Undergraduate Medical Curriculum: Perception, Challenges, and Career Choice—A Comparative Study

    Science.gov (United States)

    Vaughan, R.; Thomas, S.

    2017-01-01

    Objective The undergraduate medical curriculum has been overcrowded with core learning outcomes with no formal exposure to plastic surgery. The aim of this study was to compare medical students from two educational settings for the basic understanding, preferred learning method, and factors influencing a career choice in plastic surgery. Design and Setting A prospective cohort study based on a web-based anonymous questionnaire sent to final year medical students at Birmingham University (United Kingdom), McGill University (Canada), and a control group (non-medical staff). The questions were about plastic surgery: (1) source of information and basic understanding; (2) undergraduate curriculum inclusion and preferred learning methods; (3) factors influencing a career choice. A similar questionnaire was sent to non-medical staff (control group). The data was analysed based on categorical outcomes (Chi-square χ2) and level of significance p ≤ 0.05. Results Questionnaire was analysed for 243 students (Birmingham, n = 171/332, 52%) (McGill n = 72/132, 54%). Birmingham students (14%) considered the word “plastic” synonymous with “cosmetic” more than McGill students (4%, p plastic surgery. Conclusions Medical students recognised the need for plastic surgery inclusion in the undergraduate curriculum. There was a difference for plastic surgery source of information, operations, and preferred method of learning for students. The study highlighted the urgent need to reform plastic surgery undergraduate teaching in collaboration with national educational bodies worldwide. PMID:28630768

  8. Bariatric Surgery

    Science.gov (United States)

    ... Loss Featured Resource Find an Endocrinologist Search Bariatric Surgery September 2017 Download PDFs English Espanol Editors Durga ... Metabolic and Bariatric Surgery MedlinePlus What is bariatric surgery? Bariatric surgery helps people who are very obese ...

  9. Bariatric Surgery

    Science.gov (United States)

    ... Weight Loss Featured Resource Find an Endocrinologist Search Bariatric Surgery September 2017 Download PDFs English Espanol Editors Durga ... for Metabolic and Bariatric Surgery MedlinePlus What is bariatric surgery? Bariatric surgery helps people who are very obese ...

  10. Patient expectations of functional outcomes after rectal cancer surgery: a qualitative study.

    Science.gov (United States)

    Park, Jason; Neuman, Heather B; Bennett, Antonia V; Polskin, Lily; Phang, P Terry; Wong, W Douglas; Temple, Larissa K

    2014-02-01

    Rectal cancer patients' expectations of health and function may affect their disease- and treatment-related experience, but how patients form expectations of postsurgery function has received little study. We used a qualitative approach to explore patient expectations of outcomes related to bowel function after sphincter-preserving surgery for rectal cancer. This was a cohort study of patients who were about to undergo sphincter-preserving surgery for rectal cancer. The study was conducted through individual telephone interviews with participants. Twenty-six patients (14 men and 12 women) with clinical TNM stage I to III disease were enrolled. The semistructured interview script contained open-ended questions on patient expectations of postoperative bowel function and its perceived impact on daily function and life. Two researchers analyzed the interview transcripts for emergent themes using a grounded theory approach. Participant expectations of bowel function reflected 3 major themes: 1) information sources, 2) personal attitudes, and 3) expected outcomes. The expected outcomes theme contained references to specific symptoms and participants' descriptions of the certainty, importance, and imminence of expected outcomes. Despite multiple information sources and attempts at maintaining a positive personal attitude, participants expressed much uncertainty about their long-term bowel function. They were more focused on what they considered more important and imminent concerns about being cancer free and getting through surgery. This study was limited by context in terms of the timing of interviews (relative to the treatment course). The transferability to other contexts requires further study. Patient expectations of long-term functional outcomes cannot be considered outside of the overall context of the cancer experience and the relative importance and imminence of cancer- and treatment-related events. Recognizing the complexities of the expectation formation

  11. Survival and safety associated with aggressive surgery for stage III/IV epithelial ovarian cancer: A single institution observation study.

    Science.gov (United States)

    Tate, Shinichi; Kato, Kazuyoshi; Nishikimi, Kyoko; Matsuoka, Ayumu; Shozu, Makio

    2017-10-01

    We evaluated the efficacy and safety of aggressive surgery for advanced ovarian cancer at a non-high-volume center. We evaluated consecutive patients with stage III/IV ovarian, fallopian, and peritoneal cancer undergoing elective aggressive surgery from January 2008 to December 2012, which encompassed the first 5years after implementing an aggressive surgery protocol. After receiving appropriate training for 9months, a gynecological surgical team began performing multi-visceral resections. Primary debulking surgery was chosen when the team considered that optimal surgery was achievable on the initial laparotomy, otherwise interval debulking surgery was chosen (the protocol treatments). Analysis was performed on an intention-to-treat basis (full-set analysis), and outcomes were compared to those of patients who underwent standard surgery between 2000 and 2007. Of 106 consecutive patients studied, 87 (82%) underwent aggressive surgery per protocol and 19 were excluded. Serous carcinoma was the most common disease (78%), followed by clear cell carcinoma (7%), and 32% of the patients had stage IV disease. The respective median progression-free and overall survival rates increased from 14.6 and 38.1months before implementation, respectively, to 25.0 and 68.5months after implementation, respectively. Complete resection was achieved in 83 of the 106 patients (78%), and the surgical complexity score was high (>8) in 61 patients (58%); although there was no mortality within 12weeks of surgery, major complications occurred in 8 patients. We confirmed that outcomes improved after implementing aggressive surgery for advanced ovarian cancer, without causing a significant increase in mortality. Factors enhancing survival outcomes are discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. The structure, organisation and perioperative management of ambulatory surgery and anaesthesia in France: Methodology of the SFAR-OPERA study.

    Science.gov (United States)

    Albaladejo, Pierre; Aubrun, Frédéric; Samama, Charles-Marc; Jouffroy, Laurent; Beaussier, Marc; Benhamou, Dan; Romegoux, Pauline; Skaare, Kristina; Bosson, Jean-Luc; Ecoffey, Claude

    2017-10-01

    The organization of health care establishments and perioperative care are essential for ensuring the quality of care and safety of patients undergoing outpatient surgery. In order to correctly inventory these organizations and practices, in 2013-2014, the French society of anaesthesia and intensive care organized an extensive practical survey in French ambulatory surgery units entitled the "OPERA" study (Organisation periopératoire de l'anesthésie en chirurgie ambulatoire). From among all of the ambulatory surgery centres listed by the Agences régionales de santé (Regional health agencies, France), 206 public and private centres were randomly selected. A structural (typology, organization) survey and a medical-practice survey (focusing on the management of postoperative pain, nausea and vomiting as well as the prevention of venous thromboembolism) were collected and managed by a prospective audit of practices occurring on two randomly selected days. The latter was further accompanied by an additional audit specifically focussing on ten representative procedures: (1) stomatology surgery (third molar removal); (2) knee arthroscopy; (3) surgery of the abdominal wall (including inguinal hernia); (4) perianal surgery; (5) varicose vein surgery; (6) digestive laparoscopy-cholecystectomy; (7) breast surgery (tumourectomy); (8) uterine surgery; (9) hallux valgus and (10) hand surgery (excluding carpal tunnel). Over the 2 days of observation, 7382 patients were included comprising 2174 patients who underwent one of the procedures from the above list. The analysis of these data will provide an overview of the organization of health establishments, the modalities thus supported and compliance with standards. Copyright © 2016 Société française d'anesthésie et de réanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

  13. Early post-operative glucose levels are an independent risk factor for infection after peripheral vascular surgery. A retrospective study

    NARCIS (Netherlands)

    Vriesendorp, T. M.; Morélis, Q. J.; DeVries, J. H.; Legemate, D. A.; Hoekstra, J. B. L.

    2004-01-01

    Objective. To evaluate whether hyperglycaemia in the first 48 h after infrainguinal vascular surgery is a risk factor for postoperative infection, independent from factors associated with insulin resistance and surgical stress. Design. Retrospective cohort study. Patients and methods. Patients who

  14. Preoperative therapeutic programme for elderly patients scheduled for elective abdominal oncological surgery: A randomized controlled pilot study

    NARCIS (Netherlands)

    Dronkers, J.J.; Lamberts, H.; Reutelingsperger, I.M.M.D.; Naber, R.H.; Dronkers-Landman, C.M.; Veldman, A.; Meeteren, N.L.U. van

    2010-01-01

    Objective: Investigation of the feasibility and preliminary effect of a short-term intensive preoperative exercise programme for elderly patients scheduled for elective abdominal oncological surgery. Design: Single-blind randomized controlled pilot study. Setting: Ordinary hospital in the

  15. Patients with chronic pain after abdominal surgery show less preoperative endogenous pain inhibition and more postoperative hyperalgesia: a pilot study.

    NARCIS (Netherlands)

    Wilder-Smith, O.H.G.; Schreyer, T.; Scheffer, G.J.; Arendt-Nielsen, L.

    2010-01-01

    Chronic pain is common and undesirable after surgery. Progression from acute to chronic pain involves altered pain processing. The authors studied relationships between presence of chronic pain versus preoperative descending pain control (diffuse noxious inhibitory controls; DNICs) and postoperative

  16. Burnout syndrome in surgical oncology and general surgery nurses: a cross-sectional study.

    Science.gov (United States)

    Książek, Ilona; Stefaniak, Tomasz J; Stadnyk, Magdalena; Książek, Janina

    2011-09-01

    The occurrence of burnout syndrome is strongly associated with and modulated by multiple personality and environmental factors. In Poland, nurses experience a discrepancy between the demands, expectations and social status of the position of their profession and low salaries. Such a situation provokes frustration and depression, and further leads to problems of adaptation including burnout syndrome. The aim of this study was to evaluate the occurrence of burnout syndrome among nurses working in general surgery and surgical oncology specialties. The study was designed as a cross-sectional questionnaire survey. It was undertaken in the largest Hospital in the Pomeranian region of Poland. The participants included 60 nurses working in two departments: General Surgery and Surgical Oncology. The study was based upon an anonymous self-test composed of a questionnaire and three psychological measures: Maslach Burnout Inventory (MBI), Psychological Burden Scale and a self-constructed questionnaire on job satisfaction. Intensity of burnout syndrome was significantly higher among oncology nurses than among surgical ones. There was also a strong but not significant trend towards higher Psychological Burden Scale in the group of oncology nurses. The study revealed a high degree of emotional burden and burnout in nurses working in the study hospital suggesting that nurses are at great occupational risk. The findings of the study provide evidence of the potential need to restructure the system and suggest that nurses need more control of their work including a higher degree of involvement in clinical decision-making. Copyright © 2010 Elsevier Ltd. All rights reserved.

  17. A comparative study of bone densitometry during osseointegration: piezoelectric surgery versus rotary protocols.

    Science.gov (United States)

    Di Alberti, Luca; Donnini, Federica; Di Alberti, Claudio; Camerino, Michele

    2010-09-01

    To date, there have been no studies on the outcome of osseointegration of alveolar bone around dental implants inserted with piezoelectric osteotomy versus conventional osteotomy. The aim of this study was to compare the radiographic differences, through evaluation of peri-implant bone density, between implant insertion using traditional surgical technique and piezoelectric technique. Forty patients were selected whose treatment consisted of a minimum of two implants placed in nonpathologic native bone. A single type of implant surface (SLA) was chosen. The implants were placed following the manufacturer protocol for traditional surgical technique and piezoelectric technique. Radiographs were taken following surgery and 30, 60, and 90 days after surgery. The bone density was studied with the densitometry application. All patients completed the study period with success. Despite a limited number of treated patients, the results of this pilot study demonstrated that (1) piezoelectric implant site preparation promotes better bone density and osteogenesis, and (2) the piezoelectric technique is predictable, with a 100% success rate in this study.

  18. Perioperative Risks of Untreated Obstructive Sleep Apnea in the Bariatric Surgery Patient: a Retrospective Study.

    Science.gov (United States)

    Kong, Wing Tai; Chopra, Shawn; Kopf, Michael; Morales, Carlos; Khan, Shahzad; Zuccala, Keith; Choi, Laura; Chronakos, John

    2016-12-01

    The use of continuous positive airway pressure (CPAP) perioperatively in bariatric surgery patients with obstructive sleep apnea (OSA) has been controversial. Although studies have demonstrated that CPAP use is safe in bariatric patients, prior studies have not shown improvement in outcomes in these patients. A retrospective review of patients who underwent bariatric surgery from 2005 to 2009 was performed. All patients underwent polysomnography preoperatively. Patient age, sex, BMI, comorbidities, polysomnogram data, type of bariatric procedure, length of hospital stay, and postoperative complications were reviewed. The Fisher exact test was used for statistical analysis. Among the 352 patients studied, 47 with apnea-hypopnea index (AHI) ≥5 did not receive CPAP postoperatively. A total of 7/47 (14.9 %) developed postoperative pulmonary complications. There were no non-pulmonary complications. Some 9/305 (2.95 %) with CPAP developed pulmonary complications. There were 26/305 patients with all-cause complications (8.52 %). The AHI was higher in the group receiving treatment. There was a statistically significant difference in pulmonary complications between patients with and those without treatment (p value 0.0002). The average length of stay was 3.0 and 3.2 days in treatment and comparison groups, respectively, a difference that did not reach statistical significance. Patients who did not receive CPAP postoperatively developed more pulmonary complications than those with CPAP, suggesting that CPAP might be beneficial in decreasing pulmonary complications in patients undergoing bariatric surgery. However, further investigation is warranted to better delineate other risk factors due to small sample size in our study group.

  19. Cutaneous and Labyrinthine Tolerance of Bioactive Glass S53P4 in Mastoid and Epitympanic Obliteration Surgery: Prospective Clinical Study

    Directory of Open Access Journals (Sweden)

    Daniele Bernardeschi

    2015-01-01

    Full Text Available Objective. To evaluate the cutaneous and the inner ear tolerance of bioactive glass S53P4 when used in the mastoid and epitympanic obliteration for chronic otitis surgery. Material and Methods. Forty-one cases have been included in this prospective study. Cutaneous tolerance was clinically evaluated 1 week, 1 month, and 3 months after surgery with a physical examination of the retroauricular and external auditory canal (EAC skin and the presence of otalgia; the inner ear tolerance was assessed by bone-conduction hearing threshold 1 day after surgery and by the presence of vertigo or imbalance. Results. All surgeries but 1 were uneventful: all patients maintained the preoperative bone-conduction hearing threshold except for one case in which the round window membrane was opened during the dissection of the cholesteatoma in the hypotympanum and this led to a dead ear. No dizziness or vertigo was reported. Three months after surgery, healing was achieved in all cases with a healthy painless skin. No cases of revision surgery for removal of the granules occurred in this study. Conclusion. The bioactive glass S53P4 is a well-tolerated biomaterial for primary or revision chronic otitis surgery, as shown by the local skin reaction which lasted less than 3 months and by the absence of labyrinthine complications.

  20. Attention Deficit Hyperactivity Disorder Prevalence and Correlates Pre- and Post-Bariatric Surgery: A Comparative Cross-Sectional Study.

    Science.gov (United States)

    Nielsen, Friedrich; Georgiadou, Ekaterini; Bartsch, Merle; Langenberg, Svenja; Müller, Astrid; de Zwaan, Martina

    2017-01-01

    Previous research shows an association between obesity and attention deficit hyperactivity disorder (ADHD). The present study compares pre- and post-bariatric surgery patients using the internationally used Conners' Adult ADHD Rating Scale (CAARS™) to screen for ADHD. Matched samples pre- (N = 120) and post-bariatric surgery (N = 128) were compared using self-rating instruments to assess ADHD-relevant symptomatology, depression, eating-related psychopathology, and BMI. Prevalence of probable ADHD did not differ between groups using the CAARS Index Scale T-scores; however, CAARS subscales Inattention/Memory and Self-Concept showed significantly lower scores in post-surgery patients. All CAARS subscales correlated significantly with each other, with depression and eating-related psychopathology. There was no correlation between ADHD and excess BMI loss in post-surgery patients. The findings suggest that a considerable number of patients before and after bariatric surgery screened positive for ADHD. It can be hypothesized that some core ADHD symptoms improve after surgery. Future studies are warranted to investigate the influence of ADHD on long-term surgery outcomes. © 2017 The Author(s) Published by S. Karger GmbH, Freiburg.

  1. Attention Deficit Hyperactivity Disorder Prevalence and Correlates Pre- and Post-Bariatric Surgery: A Comparative Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Friedrich Nielsen

    2017-01-01

    Full Text Available Objective: Previous research shows an association between obesity and attention deficit hyperactivity disorder (ADHD. The present study compares pre- and post-bariatric surgery patients using the internationally used Conners' Adult ADHD Rating Scale (CAARS™ to screen for ADHD. Methods: Matched samples pre- (N = 120 and post-bariatric surgery (N = 128 were compared using self-rating instruments to assess ADHD-relevant symptomatology, depression, eating-related psychopathology, and BMI. Results: Prevalence of probable ADHD did not differ between groups using the CAARS Index Scale T-scores; however, CAARS subscales Inattention/Memory and Self-Concept showed significantly lower scores in post-surgery patients. All CAARS subscales correlated significantly with each other, with depression and eating-related psychopathology. There was no correlation between ADHD and excess BMI loss in post-surgery patients. Conclusion: The findings suggest that a considerable number of patients before and after bariatric surgery screened positive for ADHD. It can be hypothesized that some core ADHD symptoms improve after surgery. Future studies are warranted to investigate the influence of ADHD on long-term surgery outcomes.

  2. Study Spots Cause of Global Outbreak of Infections Tied to Heart Surgeries

    Science.gov (United States)

    ... Cause of Global Outbreak of Infections Tied to Heart Surgeries Bacteria traced to heating-cooling units used on ... likely caused potentially fatal infections in 33 open-heart surgery patients in several countries, investigators say. The patients ...

  3. Evaluation of the role of antibiotics in preventing postoperative complication after routine periodontal surgery: A comparative clinical study

    OpenAIRE

    Mohan, Rosh Radhika; Doraswamy, Dwarakanath Chinni; Hussain, Ahad M.; Gundannavar, Gayatri; Subbaiah, Shobha Krishna; Jayaprakash, Deepika

    2014-01-01

    Background and Objectives: Aim of this randomly controlled clinical study was to evaluate the role of antibiotics to prevent postoperative complications after routine periodontal surgery and also to determine whether their administration improved the surgical outcome. Materials and Methods: Forty-five systemically healthy patients with moderate to severe chronic periodontitis requiring flap surgery were enrolled in the study. They were randomly allocated to Amoxicillin, Doxycycline, and contr...

  4. Plastic Surgery Inclusion in the Undergraduate Medical Curriculum: Perception, Challenges, and Career Choice?A Comparative Study

    OpenAIRE

    Farid, M.; Vaughan, R; S. Thomas

    2017-01-01

    Objective The undergraduate medical curriculum has been overcrowded with core learning outcomes with no formal exposure to plastic surgery. The aim of this study was to compare medical students from two educational settings for the basic understanding, preferred learning method, and factors influencing a career choice in plastic surgery. Design and Setting A prospective cohort study based on a web-based anonymous questionnaire sent to final year medical students at Birmingham University (Unit...

  5. A prospective cohort study comparing early opioid requirement between Chinese from Hong Kong and Caucasian Australians after major abdominal surgery

    DEFF Research Database (Denmark)

    Konstantatos, A H; Imberger, G; Angliss, M

    2012-01-01

    The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia.......The relationship between ethnicity and early opioid consumption is not well understood. Our prospective cohort study tested whether Chinese patients in Hong Kong require less opioid after major abdominal surgery compared with Caucasian patients in Australia....

  6. The Misconception of Case-Control Studies in the Plastic Surgery Literature: A Literature Audit.

    Science.gov (United States)

    Hatchell, Alexandra C; Farrokhyar, Forough; Choi, Matthew

    2017-06-01

    Case-control study designs are commonly used. However, many published case-control studies are not true case-controls and are in fact mislabeled. The purpose of this study was to identify all case-control studies published in the top three plastic surgery journals over the past 10 years, assess which were truly case-control studies, clarify the actual design of the articles, and address common misconceptions. MEDLINE, Embase, and Web of Science databases were searched for case-control studies in the three highest-impact factor plastic surgery journals (2005 to 2015). Two independent reviewers screened the resulting titles, abstracts, and methods, if applicable, to identify articles labeled as case-control studies. These articles were appraised and classified as true case-control studies or non-case-control studies. The authors found 28 articles labeled as case-control studies. However, only six of these articles (21 percent) were truly case-control designs. Of the 22 incorrectly labeled studies, one (5 percent) was a randomized controlled trial, three (14 percent) were nonrandomized trials, two (9 percent) were prospective comparative cohort designs, 14 (64 percent) were retrospective comparative cohort designs, and two (9 percent) were cross-sectional designs. The mislabeling was worse in recent years, despite increases in evidence-based medicine awareness. The majority of published case-control studies are not in fact case-control studies. This misunderstanding is worsening with time. Most of these studies are actually comparative cohort designs. However, some studies are truly clinical trials and thus a higher level of evidence than originally proposed.

  7. The STROCSS statement: Strengthening the Reporting of Cohort Studies in Surgery.

    Science.gov (United States)

    Agha, Riaz Ahmed; Borrelli, Mimi R; Vella-Baldacchino, Martinique; Thavayogan, Rachel; Orgill, Dennis P

    2017-10-01

    The development of reporting guidelines over the past 20 years represents a major advance in scholarly publishing with recent evidence showing positive impacts. Whilst over 350 reporting guidelines exist, there are few that are specific to surgery. Here we describe the development of the STROCSS guideline (Strengthening the Reporting of Cohort Studies in Surgery). We published our protocol apriori. Current guidelines for case series (PROCESS), cohort studies (STROBE) and randomised controlled trials (CONSORT) were analysed to compile a list of items which were used as baseline material for developing a suitable checklist for surgical cohort guidelines. These were then put forward in a Delphi consensus exercise to an expert panel of 74 surgeons and academics via Google Forms. The Delphi exercise was completed by 62% (46/74) of the participants. All the items were passed in a single round to create a STROCSS guideline consisting of 17 items. We present the STROCSS guideline for surgical cohort, cross-sectional and case-control studies consisting of a 17-item checklist. We hope its use will increase the transparency and reporting quality of such studies. This guideline is also suitable for cross-sectional and case control studies. We encourage authors, reviewers, journal editors and publishers to adopt these guidelines. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  8. Effect of Preoperative Geriatric Evaluation on Outcomes After Elective Surgery: A Population-Based Study.

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    McIsaac, Daniel I; Huang, Allen; Wong, Coralie A; Wijeysundera, Duminda N; Bryson, Gregory L; van Walraven, Carl

    2017-12-01

    Randomized and nonrandomized single-center studies suggest that preoperative geriatric evaluation improves postoperative outcomes in older adults. The generalizability and population-level effect of preoperative geriatric evaluation has not been determined. Our objective was to measure the adjusted association between preoperative geriatric evaluation and postoperative outcomes. Multilevel multivariable regression model analysis of a population-based historical cohort. Publicly funded universal healthcare system in Ontario, Canada. All adults aged 65 and older having major, elective, noncardiac surgery from 2002 to 2014 (N = 266,499). We studied geriatric consultations and comprehensive assessments performed in the 4 months prior to surgery. These were identified using validated methods. Ninety-day survival (primary outcome), in-hospital complications, length of stay, 30-day readmissions, need for supported discharge, and 90-day costs of care. The 7,352 participants (2.8%) who had a preoperative geriatric evaluation had longer 90-day survival than those who who did not (adjusted hazard ratio = 0.81, 95% confidence interval = 0.68-0.95). Length of stay and complication rates did not differ between groups, but participants evaluated by a geriatrician preoperatively had higher rates of supported discharge, readmission rates, and costs of care. Sensitivity analyses supported the association between preoperative geriatric assessment and 90-day survival. In individuals aged 65 and older undergoing major, elective, noncardiac surgery, preoperative geriatric evaluation was associated with longer 90-day survival, but it is used infrequently. Given these results, and those of previous small studies, the influence of a geriatric evaluation on postoperative outcomes should be determined in a multicenter randomized trial. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  9. Patients’ Expectations of Functional Outcomes Following Rectal Cancer Surgery: a Qualitative Study

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    Park, Jason; Neuman, Heather B.; Bennett, Antonia V.; Polskin, Lily; Phang, P. Terry; Wong, W. Douglas; Temple, Larissa K.

    2014-01-01

    Background Rectal cancer patients’ expectations of health and function may affect their disease- and treatment-related experience, but how patients form expectations of post-surgery function has received little study. Objective We used a qualitative approach to explore patients’ expectations of outcomes related to bowel function following sphincter-preserving surgery (SPS) for rectal cancer. Design and Setting Individual telephone interviews with patients who were about to undergo SPS for rectal cancer. Patients 26 patients (14 men, 12 women) with clinical stage (cTNM) I to III disease. Main Outcome Measures The semi-structured interview script contained open-ended questions on patients’ expectations of post-operative bowel function and its perceived impact on daily function and life. Two researchers analyzed the interview transcripts for emergent themes using a grounded theory approach. Results Participants’ expectations of bowel function reflected three major themes: (1) information sources, (2) personal attitudes, and (3) expected outcomes. The expected outcomes theme contained references to specific symptoms and participants’ descriptions of the certainty, importance and imminence of expected outcomes. Despite multiple information sources and attempts at maintaining a positive personal attitude, participants expressed much uncertainty about their long term bowel function. They were more focused on what they considered more important and imminent concerns about being cancer-free and getting through surgery. Limitations This study is limited by context in terms of the timing of interviews (relative to the treatment course). The transferability to other contexts requires further study. Conclusions Patients’ expectations of long term functional outcomes cannot be considered outside of the overall context of the cancer-experience and the relative importance and imminence of cancer- and treatment-related events. Recognizing the complexities of the

  10. Awareness during anaesthesia for surgery requiring evoked potential monitoring: A pilot study

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    Pritish J Korula

    2017-01-01

    Full Text Available Background: Evoked potential monitoring such as somatosensory-evoked potential (SSEP or motor-evoked potential (MEP monitoring during surgical procedures in proximity to the spinal cord requires minimising the minimum alveolar concentrations (MACs below the anaesthetic concentrations normally required (1 MAC to prevent interference in amplitude and latency of evoked potentials. This could result in awareness. Our primary objective was to determine the incidence of awareness while administering low MAC inhalational anaesthetics for these unique procedures. The secondary objective was to assess the adequacy of our anaesthetic technique from neurophysiologist′s perspective. Methods: In this prospective observational pilot study, 61 American Society of Anesthesiologists 1 and 2 patients undergoing spinal surgery for whom intraoperative evoked potential monitoring was performed were included; during the maintenance phase, 0.7-0.8 MAC of isoflurane was targeted. We evaluated the intraoperative depth of anaesthesia using a bispectral (BIS index monitor as well as the patients response to surgical stimulus (PRST scoring system. Post-operatively, a modified Bruce questionnaire was used to verify awareness. The adequacy of evoked potential readings was also assessed. Results: Of the 61 patients, no patient had explicit awareness. Intraoperatively, 19 of 61 patients had a BIS value of above sixty at least once, during surgery. There was no correlation with PRST scoring and BIS during surgery. Fifty-four out of 61 patient′s evoked potential readings were deemed ′good′ or ′fair′ for the conduct of electrophysiological monitoring. Conclusions: This pilot study demonstrates that administering low MAC inhalational anaesthetics to facilitate evoked potential monitoring does not result in explicit awareness. However, larger studies are needed to verify this. The conduct of SSEP electrophysiological monitoring was satisfactory with the use of this

  11. Insulin resistance, adiponectin and adverse outcomes following elective cardiac surgery: a prospective follow-up study

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    Hjortdal Vibeke E

    2010-12-01

    Full Text Available Abstract Background Insulin resistance and adiponectin are markers of cardio-metabolic disease and associated with adverse cardiovascular outcomes. The present study examined whether preoperative insulin resistance or adiponectin were associated with short- and long-term adverse outcomes in non-diabetic patients undergoing elective cardiac surgery. Methods In a prospective study, we assessed insulin resistance and adiponectin levels from preoperative fasting blood samples in 836 patients undergoing cardiac surgery. Population-based medical registries were used for postoperative follow-up. Outcomes included all-cause death, myocardial infarction or percutaneous coronary intervention, stroke, re-exploration, renal failure, and infections. The ability of insulin resistance and adiponectin to predict clinical adverse outcomes was examined using receiver operating characteristics. Results Neither insulin resistance nor adiponectin were statistically significantly associated with 30-day mortality, but adiponectin was associated with an increased 31-365-day mortality (adjusted odds ratio 2.9 [95% confidence interval 1.3-6.4] comparing the upper quartile with the three lower quartiles. Insulin resistance was a poor predictor of adverse outcomes. In contrast, the predictive accuracy of adiponectin (area under curve 0.75 [95% confidence interval 0.65-0.85] was similar to that of the EuroSCORE (area under curve 0.75 [95% confidence interval 0.67-0.83] and a model including adiponectin and the EuroSCORE had an area under curve of 0.78 [95% confidence interval 0.68-0.88] concerning 31-365-day mortality. Conclusions Elevated adiponectin levels, but not insulin resistance, were associated with increased mortality and appear to be a strong predictor of long-term mortality. Additional studies are warranted to further clarify the possible clinical role of adiponectin assessment in cardiac surgery. Trial Registration The Danish Data Protection Agency; reference no

  12. The Prevalence of Ostomy-related Complications 1 Year After Ostomy Surgery: A Prospective, Descriptive, Clinical Study.

    Science.gov (United States)

    Carlsson, Eva; Fingren, Jeanette; Hallén, Anne-Marie; Petersén, Charlotta; Lindholm, Elisabet

    2016-10-01

    Despite advancements in the creation and care of stomas, ostomy and peristomal skin complications are common immediately following surgery as well as in the months and years thereafter. A prospective study to determine the prevalence of ostomy and peristomal skin complications and the influence of ostomy configuration on such complications was conducted 1 year after ostomy surgery among all patients at a university hospital in Sweden. All participants received regular (10 to 14 days post discharge, 6 weeks, 3 months, 6 months, and 1 year post surgery) ostomy follow-up care by a wound ostomy continence (WOC) nurse. All consecutive elective and emergency patients who had undergone surgery to create a colostomy (end colostomy), end ileostomy, or loop ileostomy were eligible to participate. Patients who were reoperated during their first year post-surgery, patients with a urostomy, and patients with double ostomies were excluded from the study. Patient data collected included age, gender, diagnosis, elective or emergency surgery, open or laparoscopic surgical procedure, presence of a colorectal surgeon specialist at surgery, type of ostomy (colostomy, end ileostomy, loop ileostomy), preoperative ostomy siting, counseling, body mass index, American Society of Anesthesiologists classification, and radiation and/or chemotherapy status. Ostomies were evaluated by 4 WOC nurses as to stoma configuration, convexity use, patient self-sufficiency in stoma care, and complications. All 207 patients (53% women) who were eligible agreed to participate in the study. Patient median age was 70 years (range 19-94); 74% underwent elective surgery. Main diagnoses were colorectal cancer (62%) and inflammatory bowel disease (19%). Ostomy types were: colostomy (71%), end ileostomy (26%), and loop ileostomy (3%). One or more complications occurred in 35% of the patients (27% ostomy complications, 11% peristomal skin complications). A colostomy hernia was the most common surgical complication

  13. Surgery of fast, highly charged ions studied by zero-degree Auger spectroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Stolterfoht, N.; Miller, P.D.; Krause, H.F.; Yamazaki, Y.; Swenson, J.K.; Bruch, R.; Dittner, P.F.; Pepmiller, P.L.; Datz, S.

    1986-01-01

    Zero-degree Auger spectra were measured in collisions of oxygen and carbon on He with incident charge states of q = 2 to 5 and for energies from 5 to 30 MeV. Since the light target particle He acts selectively on the projectile ion, we refer to the present method as ion surgery. Apart from the one-electron processes single excitation and single loss, two-electron processes such as transfer excitation and transfer loss are studied. 17 refs., 4 figs., 1 tab.

  14. The efficacy of preopoerative instruction in reducing anxiety following gyneoncological surgery: a case control study

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    Gungor Tayfun

    2011-04-01

    Full Text Available Abstract Background This is a quasi-experimental case control research focusing on the impact of systematic preoperative instruction on the level of postoperative anxiety in gyneoncologic patients. The population studied consists of the gyneoncologic surgery patients admitted to the Gynecologic Oncology Service at Zekai Tahir Burak Gynecology Training and Research Hospital from May to September 2010. Patients and methods Through a random sampling, 60 patients were recruited in each group. The study group was given a systematic preoperative instruction while the control group was given routine nursing care. Patients were interviewed in the postoperative period and anxiety was measured. The data-collecting tool consisted of the Individual Information Form and the State-Trait Anxiety Inventory. The collected data were analyzed by using the SPSS Program to find the frequency, the percentage, the mean and the standard variables, and the hypothesis was tested with Chi-square, variance, and t-independent test. Results It was found that the incidence rates from the post-operative anxiety score of the study group were lower than those of the control group (p Conclusions Results of this study suggest that preoperative instruction programs aiming at informing gyneoncologic surgery patients at the preoperative stage should be organized in hospitals and have an essential role.

  15. Comparison of commercial fibrin sealants in facelift surgery: a prospective study

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    Botti G

    2013-11-01

    Full Text Available Giovanni Botti,1 Michele Pascali,2 Chiara Botti,1 Florian Bodog,3 Pietro Gentile,2 Valerio Cervelli2 1Villa Bella Clinic, Salò, 2Department of Plastic and Reconstructive Surgery, University of Rome Tor Vergata, Italy; 3University of Oradea, Oradea, Romania Background: The aim of this study was to compare the effects of two types of fibrin glue in patients undergoing facelift surgery. Methods: A prospective, controlled "right-left side" study was carried out in 20 patients. The two fibrin sealants used were Quixil® and Tissucol®. The two sealants were used at the same time, ie, one on one side of the face and the other on the contralateral side. Comparisons were made with regard to rates of hematoma and seroma, degree of induration, edema, ecchymosis, pain levels, and patient satisfaction. Results: The results were almost equivalent. The only exception was a significant (40 mL hematoma in a patient treated with Quixil. Bleeding was most likely due to a sudden rise in blood pressure during the immediate postoperative period. However, it must be emphasized that, while Tissucol actually seals the undermined area, thus virtually eliminating the dead space, Quixil acts differently, in that its effectiveness in preventing hematoma is linked mainly to its hemostatic effect. Conclusion: The two fibrin sealants used were nearly identical with regard to patient safety and quality of the result. Nevertheless, it is noted that, while Tissucol has both hemostatic and "gluing" effects, Quixil is mainly effective in securing hemostasis. Keywords: facelift surgery, rhytidectomy, fibrin sealants, hematoma

  16. Continuous spinal anesthesia versus combined spinal epidural block for major orthopedic surgery: prospective randomized study

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    Luiz Eduardo Imbelloni

    Full Text Available CONTEXT AND OBJECTIVES: In major orthopedic surgery of the lower limbs, continuous spinal anesthesia (CSA and combined spinal epidural anesthesia (CSE are safe and reliable anesthesia methods. In this prospective randomized clinical study, the blockading properties and side effects of CSA were compared with single interspace CSE, among patients scheduled for major hip or knee surgery. DESIGN AND SETTING: Prospective clinical study conducted at the Institute for Regional Anesthesia, Hospital de Base, São José do Rio Preto. METHODS: 240 patients scheduled for hip arthroplasty, knee arthroplasty or femoral fracture treatment were randomly assigned to receive either CSA or CSE. Blockades were performed in the lateral position at the L3-L4 interspace. Puncture success, technical difficulties, paresthesia, highest level of sensory and motor blockade, need for complementary doses of local anesthetic, degree of technical difficulties, cardiocirculatory changes and postdural puncture headache (PDPH were recorded. At the end of the surgery, the catheter was removed and cerebrospinal fluid leakage was evaluated. RESULTS: Seven patients were excluded (three CSA and four CSE. There was significantly lower incidence of paresthesia in the CSE group. The resultant sensory blockade level was significantly higher with CSE. Complete motor blockade occurred in 110 CSA patients and in 109 CSE patients. Arterial hypotension was observed significantly more often in the CSE group. PDPH was observed in two patients of each group. CONCLUSION: Our results suggest that both CSA and CSE provided good surgical conditions with low incidence of complications. The sensory blockade level and hemodynamic changes were lower with CSA.

  17. [Influence of Attachment Style on the Outcome of Bariatric Surgery - A Pilot Study].

    Science.gov (United States)

    Appel, Johanna Elisabeth; Ift, Franziska; Kißler, Hermann; Kloos, Christof; Lehmann, Thomas; Strauß, Bernhard; Wick, Katharina

    2016-12-01

    Background: Bariatric surgery can lower body weight and comorbidities. Different factors might influence the outcome of this treatment. This pilot study examines whether patients' attachment style can influence surgical outcome. Methods: The sample consisted of 32 patients (f=24; m=8; BMI preoperative=47,8 kg/m2±5,2; age=53±9,84) who underwent a laparoscopic sleeve gastrectomy. The following variables were assessed pre- and postoperatively via questionnaires: quality of life (BAROS), self esteem (SES), depression, anxiety, psychological distress (SCL-90R), feelings of hunger, cognitive control, irritated eating behaviour (FEV) and weight related variables (BMI, EWL%, EBL%, TBL). Attachment style was determined postoperatively using the BPQE. Results: None of the participating patients suffered from a binge eating disorder. There was no significant difference of the BMI at any time between the 12 securely attached (SA) patients and the 19 insecurely attachted (IA) patients. Compared to the SA patients IA patients preoperatively showed lower outcomes in variables concerning eating behaviour and mental health. Comparing the 2 groups postoperatively the IA patients achieved lower levels in variables concerning mental health than SA patients and did not reach the preoperative values of the SA patients. Both groups benefited from surgery related to weight loss, mental health and eating behaviour. There was no difference found in the development from pre- to postoperative between SA and IA patients. Discussion & Conclusion: Patients profit by a bariatric intervention independent of their attachment style. By evaluating the attachment style, it could be possible to individually optimize pre- and postoperative patients support in order to gain more effective surgery results. Follow up studies extended to multi-site assessment are required. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Ostomy-related complications after emergent abdominal surgery: a 2-year follow-up study.

    Science.gov (United States)

    Lindholm, Elisabet; Persson, Eva; Carlsson, Eva; Hallén, Anne-Marie; Fingren, Jeanette; Berndtsson, Ina

    2013-01-01

    The aim of this study was to prospectively evaluate ostomy-related complications and describe ostomy configuration in patients undergoing acute abdominal surgery. The study sample comprised 144 patients with a median age of 67 years (IOR: 53.5-78 years) who underwent an intestinal ostomy as part of an acute abdominal surgical procedure. The research setting was the surgical and gynecological clinics at the Sahlgrenska University Hospital in Gothenburg, Sweden. Ostomy configuration, diameter, height, and the presence of stomal and peristomal complications were assessed by a WOC nurse 1 to 2 times while in hospital, once at the ostomy outpatient clinic 2 weeks after discharge, and at 3, 6, 12, and 24 months following ostomy creation. The types of ostomies evaluated were end colostomy (58%), end ileostomy (18%), loop ileostomy (17%), and loop colostomy (7%). Most stomal or peristomal complications occurred within 1 year after surgery (31 of 57; 54.4%). Necrosis, separation, and stenosis were most common in patients with an end colostomy. Peristomal skin complications occurred in 45% of subjects during the first 6 months after surgery. The ostomy's diameter decreased significantly during the hospital course and over the first 2 weeks following hospital discharge in patients with end colostomy (Postomy had peristomal skin problems ranging between 21% and 57% over this time period. The frequency of using a pouching system that incorporated convexity was highest in the case of loop ileostomy, used in 67% at 6 months. During the first 2 weeks after discharge, the physical configuration of the ostomy evolves and the pouching system must be frequently adjusted by a WOC nurse. Stomal and peristomal complications are prevalent during the first 2 postoperative years and especially during the first 6 months.

  19. [Validation and reliability study of the parent concerns about surgery questionnaire: What worries parents?

    Science.gov (United States)

    Gironés Muriel, Alberto; Campos Segovia, Ana; Ríos Gómez, Patricia

    2018-01-01

    The study of mediating variables and psychological responses to child surgery involves the evaluation of both the patient and the parents as regards different stressors. To have a reliable and reproducible valid evaluation tool that assesses the level of paternal involvement in relation to different stressors in the setting of surgery. A self-report questionnaire study was completed by 123 subjects of both sexes, subdivided into 2populations, due to their relationship with the hospital setting. The items were determined by a group of experts and analysed using the Lawshe validity index to determine a first validity of content. Subsequently, the reliability of the tool was determined by an item-re-item analysis of the 2sub-populations. A factorial analysis was performed to analyse the construct validity with the maximum likelihood and rotation of varimax type factors. A questionnaire of paternal concern was offered, consisting of 21 items with a Cronbach coefficient of 0.97, giving good precision and stability. The posterior factor analysis gives an adequate validity to the questionnaire, with the determination of 10 common stressors that cover 74.08% of the common and non-common variance of the questionnaire. The proposed questionnaire is reliable, valid and easy-to-apply and is developed to assess the level of paternal concern about the surgery of a child and to be able to apply measures and programs through the prior assessment of these elements. Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Electrophysiological and MRI study on poor outcome after surgery for cervical myelopathy

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    Kameyama, Osamu; Kawakita, Hirofumi; Ogawa, Ryokei [Kansai Medical Univ., Moriguchi, Osaka (Japan)

    1995-11-01

    Occasionally, the outcome from laminoplasty for cervical spondylosis is disappointing despite an adequate operation. Before surgery, it is difficult to diagnose the pathological extent of the involvement of the spinal cord. The purpose of this study is to determine the efficacy of magnetic resonance imaging (MRI) and of the motor evoked potentials (MEPs) for the indication of the surgery and prognosis. Retrospectively, we investigated the MEPs and the MRI of 31 patients in surgery for cervical myelopathy, involving 21 with cervical spondylosis and 10 with ossification of the posterior longitudinal ligamentum, and compared the findings from those with a poor outcome (n=3l) with the findings from those with a good outcome (n=32). The MEPs from the thenar muscle and the tibialis anterior were evoked by transcranial magnetic brain stimulation. In the poor-outcome patients, the spinal canal was narrow and lumbar spinal canal stenosis was seen in 5 cases which required lumbar laminectomy. Before operation, the MEPs from the thenar muscle could not be evoked in 5 cases while there was a remarkably prolonged central motor conduction time in the other 26 cases. MRI revealed the deformed spinal cord in the involved area, and the signal intensity of the involved spinal cord in the T2 weighted image was remarkably high. The signal intensity ratio was significantly higher in the poor-outcome patients than in the good-outcome patients. This study suggested that a high signal intensity in the T2 weighted image and a prolonged conduction time or absence of MEPs largely corresponded to the clinical and other investigative features of myelopathy responsible for a poor outcome. (author).

  1. Facial nerve injury following surgery for temporomandibular joint ankylosis: A prospective clinical study

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    S Gokkulakrishnan

    2013-01-01

    Full Text Available Objective: The purpose of this prospective study was to evaluate the incidence and degree of facial nerve damage and time taken for its recovery following surgery for temporomandibular joint (TMJ ankylosis. Materials and Methods: A total of 30 subjects with the TMJ ankylosis with or without history of previous surgery were included in this prospective study. House-Brackmann grading system was used to assess the function of the facial nerve post-operatively. Results: Most of the subjects were in the age range of 13-15 years. Eight subjects had bilateral ankylosis and remaining 22 had unilateral ankylosis. Out of 32 joints in which gap arthroplasty was performed, 4 had Grade 1 injury, 14 had Grade 2 injury, 12 had Grade 3, and 2 with the Grade 4 injury 24 h post-operatively. Whereas, out of 6 cases of interpositional arthroplasty 4 had Grade 1 injury and 2 had Grade 4 injury. According to House-Brackmann grading system, at 24 h, 78.9% patients had different grades of facial nerve injury, which gradually improved and came to normal limits within 1-3 months post-operatively. Comparison of change in the Grade of injury at 3 months follow-up as compared to baseline (24 h showed full recovery in all the cases (100% showing a statistically significant difference from baseline (P < 0.001. Conclusion: When proper care is taken during surgery for TMJ ankylosis, permanent facial nerve injury is rare. However, the incidence and degree of temporary nerve injury could be either due to the heavy retraction causing compression and or stretching of nerve fiber resulting in neuropraxia.

  2. Lower Risk of Stroke after Deformity Surgery: Long Term Benefit Demonstrated by a National Cohort Study

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    Liang-Chung Huang

    2015-10-01

    Full Text Available Objectives: This study aimed to investigate the long-term risk of stroke in adult patients with spinal deformity. Specifically, the study addressed the possible protective effect of surgery for spinal deformity against stroke. Methods: Using the National Health Insurance Research Database (NHIRD, a monopolistic national database in Taiwan, this retrospective cohort study analyzed the incidence of stroke in patients with adult spinal deformity (ASD in a 11-year period. A total of 13,503 patients, between 55 and 75 years old, were identified for the diagnosis of ASD. The patients were grouped into two: the surgical group (n = 10,439 who received spinal fusion surgery, and the control group (n = 2124 who received other medical treatment. The incidence rates of all subsequent cerebrovascular accidents, including ischemic and hemorrhagic strokes, were calculated. Hazard ratios for stroke were calculated use a full cohort and a propensity score matched cohort. Adjustments for co-morbidities that may predispose to stroke, including hypertension, diabetes mellitus, arrhythmia and coronary heart disease were conducted. Kaplan-Meier and Cox regression analyses were performed to compare the risk of stroke between the two groups. Results: During the total observation period of 50,450 person-years, the incidence rate of stroke in the surgical group (15.55 per 1000 person-years was significantly lower than that of the control group (20.89 per 1000 person-years, p < 0.001. Stroke was more likely to occur in the control group than in the surgical group (crude hazard ratio 1.34, p < 0.001; adjusted HR 1.28, p < 0.001, by a propensity score matched model. Conclusions: In this national cohort of more than 13,000 ASD patients covering 10 years, stroke was approximately 25% less likely to happen in patients who underwent spinal fusion surgery than those who received medical management. Therefore, spinal fusion surgery may provide a protective effect against stroke

  3. Reoperation rate after surgery for lumbar herniated intervertebral disc disease: nationwide cohort study.

    Science.gov (United States)

    Kim, Chi Heon; Chung, Chun Kee; Park, Choon Seon; Choi, Boram; Kim, Min Jung; Park, Byung Joo

    2013-04-01

    Retrospective cohort study using national health insurance data. To provide a longitudinal reoperation rate after surgery for lumbar herniated intervertebral disc (HIVD) disease, and to compare the reoperation rates of surgical methods. Herniated intervertebral disc disease is the most common cause of lumbar spinal surgery. Despite improved surgical techniques and instrumentation, reoperation cannot be avoided. The reoperation rates were in the range of 6% to 24% in previous studies. A population-based study is less subject to bias; hence, a nationwide longitudinal analysis was warranted. A national health insurance database was used to identify a cohort of patients who underwent first surgery for herniated intervertebral disc disease in 2003 and 18,590 patients were selected. Individual patients were followed for at least 5 years through their encrypted unique resident registration number. The primary endpoint was any type of second lumbar surgery. After adjusting for confounding factors, 5 surgical methods (fusion, laminectomy, open discectomy, endoscopic discectomy, and nucleolysis [including mechanical nucleus decompression]) were compared. Open discectomy was used as the reference method. Open discectomy was the most common procedure (68.9%) followed by endoscopic discectomy (16.1%), laminectomy (7.9%), fusion (3.9%), and nucleolysis (3.2%). The cumulative reoperation rate was 5.4% at 3 months, 7.4% at 1 year, 9% at 2 years, 10.5% at 3 years, 12.1% at 4 years, and 13.4% at 5 years. The reoperation rates were 18.6%, 14.7%, 13.8%, 12.4%, and 11.8% after laminectomy, nucleolysis, open discectomy, endoscopic discectomy, and fusion, respectively. Compared with open discectomy, the reoperation rate was higher after laminectomy at 3 months, whereas the other surgical methods had similar rates. The cumulative reoperation rate after 5 years was 13.4% and half of the reoperations occurred during the first postoperative year. With the exception of laminectomy, the

  4. Psychosocial predictors of quality of life and weight loss two years after bariatric surgery: Results from the Toronto Bari-PSYCH study.

    Science.gov (United States)

    Sockalingam, Sanjeev; Hawa, Raed; Wnuk, Susan; Santiago, Vincent; Kowgier, Matthew; Jackson, Timothy; Okrainec, Allan; Cassin, Stephanie

    2017-07-01

    Studies exploring the impact of pre-surgery psychiatric status as a predictor of health related quality of life (QOL) after bariatric surgery have been limited to short-term follow-up and variable use of psychosocial measures. We examined the effect of pre-operative psychiatric factors on QOL and weight loss 2-years after surgery. 156 patients participated in this prospective cohort study, the Toronto Bariatric Psychosocial Cohort Study, between 2010 and 2014. Patients were assessed pre-surgery for demographic factors, weight, psychiatric diagnosis using the MINI International Neuropsychiatric Interview and symptom measures for QOL, depression and anxiety at pre-surgery and at 1 and 2years post-surgery. At 2-years post-bariatric surgery, patients experienced a significant decrease in mean weight (-48.43kg, 95% [-51.1, -45.76]) and an increase only in physical QOL (+18.91, 95% [17.01, 20.82]) scores as compared to pre-surgery. Multivariate regression analysis identified pre-surgery physical QOL score (psurgery weight (psurgery. Bariatric surgery had a sustained impact on physical QOL but not mental QOL at 2-years post-surgery. A history of mood disorder unexpectedly increased physical QOL scores and weight loss following surgery. Further research is needed to determine if these results are due to bariatric surgery candidate selection within this program. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Retrospective analysis underestimates neurological deficits in complex spinal deformity surgery: a Scoli-RISK-1 Study.

    Science.gov (United States)

    Kelly, Michael P; Lenke, Lawrence G; Godzik, Jakub; Pellise, Ferran; Shaffrey, Christopher I; Smith, Justin S; Lewis, Stephen J; Ames, Christopher P; Carreon, Leah Y; Fehlings, Michael G; Schwab, Frank; Shimer, Adam L

    2017-07-01

    OBJECTIVE The authors conducted a study to compare neurological deficit rates associated with complex adult spinal deformity (ASD) surgery when recorded in retrospective and prospective studies. Retrospective studies may underreport neurological deficits due to selection, detection, and recall biases. Prospective studies are expensive and more difficult to perform, but they likely provide more accurate estimates of new neurological deficit rates. METHODS New neurological deficits were recorded in a prospective study of complex ASD surgeries (pSR1) with a defined outcomes measure (decrement in American Spinal Injury Association lower-extremity motor score) for neurological deficits. Using identical inclusion criteria and a subset of participating surgeons, a retrospective study was created (rSR1) and neurological deficit rates were collected. Continuous variables were compared with the Student t-test, with correction for multiple comparisons. Neurological deficit rates were compared using the Mantel-Haenszel method for standardized risks. Statistical significance for the primary outcome measure was p spinal deformities, and exclusion criteria were identical. Sagittal Cobb measurements were higher in pSR1, although sagittal alignment was similar. Preoperative neurological deficit rates were similar in the groups. Three-column osteotomies were more common in pSR1, particularly vertebral column resection. New neurological deficits were more common in pSR1 (pSR1 17.3% [95% CI 12.6-22.2] and rSR1 9.0% [95% CI 5.0-13.0]; p = 0.01). The majority of deficits in both studies were at the nerve root level, and the distribution of level of injury was similar. CONCLUSIONS New neurological deficit rates were nearly twice as high in the prospective study than the retrospective study with identical inclusion criteria. These findings validate concerns regarding retrospective cohort studies and confirm the need for and value of carefully designed prospective, observational cohort

  6. Does lung cancer surgery cause circulating tumor cells?-A multicenter, prospective study.

    Science.gov (United States)

    Matsutani, Noriyuki; Sawabata, Noriyoshi; Yamaguchi, Masafumi; Woo, Tetsukan; Kudo, Yujin; Kawase, Akikazu; Shiono, Satoshi; Iinuma, Hisae; Morita, Shigeki; Kawamura, Masafumi

    2017-08-01

    Cancer relapse is caused by residual isolated tumor cells (ITCs) remaining in the body after surgery. It is speculated that surgical manipulation may cause circulating tumor cells (CTCs) which are the origin of ITCs in the body. The occurrence of CTCs in surgical patients with non-small cell lung cancer (NSCLC) has been shown in retrospective observation, but not prospectively, thus we conducted a multicenter prospective study regarding the occurrence of CTCs by surgical manipulation. Patients with T1b-2N0M0 lung cancer were studied. Blood samples were collected from the peripheral artery in the operating room at both pre- and post-lobectomy to extract CTCs by a size selection method. The CTCs detection rate, pathological findings, and background of each patient were studied. The histological diagnosis of 29 patients were adenocarcinoma in 24 patients, squamous cell carcinoma in 3 patients, and other types in 2 patients. The number of pre-CTCs positive patients was 13 and the number of post CTCs positive patients was 17. Among the 16 patients who were pre-CTCs negative, 4 patients showed post CTCs positive, while all pre-CTCs positive patients remained post-CTCs positive. The likelihood of CTC dislodgement by surgical manipulation is indicated based on the result that CTCs were detected after lung cancer surgery, where there were no cases of pre-CTCs positive and post CTCs negative.

  7. Bone-anchored hearing device surgery: Linear incision without soft tissue reduction. A prospective study.

    Science.gov (United States)

    Altuna, Xabier; Navarro, Juan José; Palicio, Idoia; Álvarez, Leire

    2015-01-01

    The classic surgical procedure for percutaneous bone-anchored hearing devices involves removal of a large area of subcutaneous tissue down to the periosteum. This leads to alopecia and raises the risk of devascularization of the overlying skin with the potential for infection and scarring. The objective of this study was to determine the results of implant placement using a single, linear incision with no underlying soft tissue reduction. A prospective study was conducted in our hospital over a period of 14 months in all consecutive surgeries performed using this technique in adults. Patients were reviewed regularly (week 1, week 3, weeks 4-6 and months 3, 6 and 12) to assess wound healing including evaluation with the Holgers scale. Corresponding to 34 patients, 34 cases were consecutively enrolled in this study. We found that 15% of the patients had minor skin reactions during the first visit (Holgers grade 1 or 2); this number raised to 20% in week 3, but at week 4 only 1 patient had a reaction score of 1 (which was solved by week 6). None of the cases required revision surgery and all skin reactions were treated topically. Our results suggest that the tissue preservation technique is a simple and effective insertion technique with a favourable healing process and cosmesis. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  8. Influence of pneumoperitoneum pressure on surgical field during robotic and laparoscopic surgery: a comparative study.

    Science.gov (United States)

    Angioli, Roberto; Terranova, Corrado; Plotti, Francesco; Cafà, Ester Valentina; Gennari, Paolo; Ricciardi, Roberto; Aloisi, Alessia; Miranda, Andrea; Montera, Roberto; De Cicco Nardone, Carlo

    2015-04-01

    Studies on the influence of CO₂ pneumoperitoneum on the abdominal cavity during robotic procedures are lacking. This is the first study to evaluate surgical field modifications related to CO₂ pressure, during laparoscopic and robotic surgery. Consecutive patients scheduled for laparoscopic or robotic hysterectomy were enrolled in the study. To evaluate the level of operative field visualization, a dedicated form has been designed based on the evaluation of four different areas: Douglas space, vesico-uterine fold and, bilaterally, the broad ligament. During the initial inspection, an assistant randomly set the CO₂ pressure at 15, 10 and 5 mmHg, and the surgeon, not aware of the CO₂ values, was asked to give an evaluation of the four areas for each set pressure. In laparoscopic group, CO₂ pressure significantly influenced the surgical field visualization in all four areas analyzed. The surgeon had a good visualization only at 15 mmHg CO₂ pressure; visualization decreased with a statistically significant difference from 15 to 5, 15-10 and 10-5 mmHg. In robotic group, influence of CO₂ pressure on surgical areas visualization was not straightforward; operative field visualization remained stable at any pressure value with no significant difference. Pneumoperitoneum pressure significantly affects the visualization of the abdomino-pelvic cavity in laparoscopic procedures. Otherwise, CO₂ pressure does not affect the visualization of surgical field during robotic surgery. These findings are particularly significant especially at low CO₂ pressure with potential implications on peritoneal environment and the subsequent post-operative patient recovery.

  9. Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Enora Laas

    2012-01-01

    Full Text Available Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC in breast surgery with and without the use of TC-coated sutures. Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1 and 98 with TC-coated sutures (Group 2. We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach. Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95 (. There was a significant difference in Group 2 between predicted probabilities and observed percentages (. The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively. Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

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

    LENUS (Irish Health Repository)

    Fennessy, Brendan G

    2012-02-03

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

  11. The Course of Pain Intensity in Patients Undergoing Herniated Disc Surgery: A 5-Year Longitudinal Observational Study.

    Directory of Open Access Journals (Sweden)

    Marie Dorow

    Full Text Available The aims of this study are to answer the following questions (1 How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2 Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients?The baseline survey (T0; n = 534 was conducted 3.6 days (SD 2.48 post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients, 9 months (T2; n = 457, 15 months (T3; n = 438, and 5 years (T4; n = 404 post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0-100. Estimated changes to and influences on postoperative pain by random effects were accounted by regression models.Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p<0.001. In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135. Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001 and depression (p<0.001.In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support.

  12. The Course of Pain Intensity in Patients Undergoing Herniated Disc Surgery: A 5-Year Longitudinal Observational Study.

    Science.gov (United States)

    Dorow, Marie; Löbner, Margrit; Stein, Janine; Pabst, Alexander; Konnopka, Alexander; Meisel, Hans J; Günther, Lutz; Meixensberger, Jürgen; Stengler, Katarina; König, Hans-Helmut; Riedel-Heller, Steffi G

    2016-01-01

    The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0-100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, pherniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (pdisc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support.

  13. Postoperative analgesia in laparoscopic surgeries with small dose of preemptive ketamine: A comparative study of three small doses

    OpenAIRE

    Vaijayanti Nitin Gadre; Ninad Sunil Dhokte

    2017-01-01

    Introduction: Preemptive N-methyl-D-aspartate (NMDA) receptor antagonist ketamine inhibits central sensitization in response to peripheral nociception. The purpose of our study was to compare efficacy of three small doses of ketamine for improving postoperative analgesia after laparoscopic surgeries. Materials and Methods: A total of 120 patients of American Society of Anesthesiologists physical status I–II undergoing laparoscopic surgeries were randomly allocated into four groups. Groups...

  14. RANDOMIZED DOUBLE BLIND STUDY COMPARING ONDANSETRON, PALONOSETRON & GRANISETRON TO PREVENT POST OPERATIVE NAUSEA & VOMITING AFTER LAPAROSCOPIC SURGERIES UNDER GENERAL ANAESTHESIA

    Directory of Open Access Journals (Sweden)

    Rajendra

    2015-11-01

    Full Text Available The aim of the study is to compare the efficacy of intravenously administered 5-HT3 receptor antagonists namely Ondansetron, Palonosetron and Granisetron given as prophylaxis for postoperative nausea and vomiting in patients undergoing laparoscopic surgeries under general anaesthesia. A single dose of palonosetron (0.75 µg when given prophylactically results in a significantly lower incidence of PONV after laparoscopic surgeries than ondansetron (4mg and granisetron (2.5mg during the first 24 hours

  15. Imaging studies for failed back surgery syndrome; Imagerie du rachis lombaire opere

    Energy Technology Data Exchange (ETDEWEB)

    Cosnard, G.; Cordoliani, Y.S.; Sarrazin, J.L.; Soulie, D. [Hopital des Armees du Val-de-Grace, 75 - Paris (France)

    1995-09-01

    In patients with failed back surgery syndrome, magnetic resonance imaging (MRI) can be the best first-line imaging study because it simplifies the diagnosis. This update is based on over 600 cases. MRI shows the scar tissue at the surgical site, persistent evidence of disk herniation for several weeks after surgery, and evidence of local and regional edema in one-fourth of cases. The edema is most marked between two months and two years after the operation and can misleadingly suggest discitis. MRI is the best investigation for detecting recurrent herniation at the same vertebral level or another level. Herniated disk material is seen as a mass that does not enhance after gadolinium, in contrast to the vascularized scar tissue. Free fragments are often clearly visible within the scar tissue. Fragments that migrate to the epidural space can give rise to granulomatous reactions. Scar tissue can be seen in the epidural space and within the disk; it can show enhancement after gadolinium for several years. The scar can be atrophic or hypertrophic and can encase or impinge on the dural sac and nerve roots. Pathological fibrosis cannot be differentiated from ordinary scar tissue. Arachnoiditis causing adherence of the nerve roots to the dura mater or to each other occurs in 5 % to 10 % of cases. Nerve root enhancement after gadolinium is seen in three-fourths of cases. Bone lesions are common, especially some time after surgery; they are usually accompanied with other lesions. Hematomas are seen in less than 10 % of cases. Infections are similarly rare (0.25 % each for discitis and epiduritis). The diagnosis of discitis is difficult and requires percutaneous biopsy of the disk, especially when MRI shows fluid within the disk, with decreased signal intensity on T2 images, and non enhancement after intravenous gadolinium. (authors). 19 refs., 7 figs.

  16. Mental imagery and learning: a qualitative study in orthopaedic trauma surgery.

    Science.gov (United States)

    Ibrahim, Edward F; Richardson, Martin D; Nestel, Debra

    2015-09-01

    Good preparation for surgical procedures has been linked to better performance and enhanced learning in the operating theatre. Mental imagery is increasingly used to enhance performance in competitive sport and there has been recent interest in applying this in surgery. This study aims to identify the mental imagery components of preoperative preparation in orthopaedic trauma surgery and to locate these practices in existing socio-material theory in order to produce a model useful for surgical skills training. Semi-structured interviews were conducted with nine orthopaedic surgeons. Participants were identified by personal recommendation as regularly performing complex trauma operations to a high standard, and by affiliation to an international instruction course in trauma surgery. Interviews were audio-recorded and transcripts were independently analysed using thematic analysis. Analysis revealed that surgeons interact intensively with multiple colleagues and materials during their preparatory activities. Such interactions stimulate mental imagery in order to build strategy and rehearse procedures, which, in turn, stimulate preparatory interactions. Participants identified the discussion of a preoperative 'plan' as a key engagement tool for training junior surgeons and as a form of currency by which a trainee may increase his or her participation in a procedure. Preoperative preparation can be thought of as a socio-material ontology requiring a surgeon to negotiate imaginal, verbal and physical interactions with people, materials and his or her own mental imagery. Actor-network theory is useful for making sense of these interactions and for allowing surgeons to interrogate their own preparative processes. We recommend supervisors to use a form of preoperative plan as a teaching tool and to encourage trainees to develop their own preparatory skills. The ability of a trainee to demonstrate sound preparation is an indicator of readiness to perform a procedure.

  17. Early Complications and Outcomes in Adult Spinal Deformity Surgery: An NSQIP Study Based on 5803 Patients.

    Science.gov (United States)

    Lee, Nathan J; Kothari, Parth; Kim, Jun S; Shin, John I; Phan, Kevin; Di Capua, John; Somani, Sulaiman; Leven, Dante M; Guzman, Javier Z; Cho, Samuel K

    2017-08-01

    Retrospective analysis. The purpose of this study is to determine the incidence, impact, and risk factors for short-term postoperative complications following elective adult spinal deformity (ASD) surgery. Current Procedural Terminology codes were used to query the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) for adults who underwent spinal deformity surgery from 2010 to 2014. Patients were separated into groups of those with and without complications. Univariate analysis and multivariate logistic regression were used to assess the impact of patient characteristics and operative features on postoperative outcomes. In total, 5803 patients were identified as having undergone ASD surgery in the NSQIP database. The average patient age was 59.5 (±13.5) years, 59.0% were female, and 81.1% were of Caucasian race. The mean body mass index was 29.5(±6.6), with 41.9% of patients having a body mass index of 30 or higher. The most common comorbidities were hypertension requiring medication (54.5%), chronic obstructive pulmonary disease (4.9%), and bleeding disorders (1.2%). Nearly a half of the ASD patients had an operative time >4 hours. The posterior fusion approach was more common (56.9%) than an anterior one (39.6%). The mean total relative value unit was 73.4 (±28.8). Based on multivariate analyses, several patient and operative characteristics were found to be predictive of morbidity. Surgical correction of ASD is associated with substantial risk of intraoperative and postoperative complications. Preoperative and intraoperative variables were associated with increased morbidity and mortality. This data may assist in developing future quality improvement activities and saving costs through measurable improvement in patient safety.

  18. Focused abdominal ultrasound in preoperative liver surgery staging: a prospective study.

    Science.gov (United States)

    Cohen, Marcela P; Herman, Paulo; Chojniak, Rubens; Poli, Miriam R B; Barbosa, Paula N V; Bitencourt, Almir G V

    2013-06-14

    Because of its safety, relative low cost and widespread availability, conventional ultrasound (US) is the modality of choice for initial evaluation of the liver. Following US, in patients eligible for surgery, further computed tomography and/or magnetic resonance imaging is usually recommended for surgical planning. There are no recent published series focusing on conventional abdominal US exclusively employed for the evaluation of liver nodules before surgery. The objective of this study is to evaluate the efficacy of focused conventional preoperative US in detecting liver lesions, and the impact of US findings on surgical management. Sixty-seven noncirrhotic patients underwent surgical resection, after being previously submitted to focused liver US evaluation. US results were compared with intraoperative US (IOUS) and histology (gold standard). The IOUS was performed by the same radiologist who performed the preoperative US. Patient-by-patient and lesion-by-lesion analyses were performed. A total of 241 lesions were depicted in 67 patients. The mean number of lesions detected per patient by US and IOUS was 2.37 and 3.37, respectively (P = 0.001). In 52.2% of patients, US and IOUS depicted the same number of liver lesions. Surgery with curative intent was conducted in 61 (91.0%) patients. Histological evaluation was obtained in 196 lesions; 155 were considered malignant. The overall lesions detection rate by US was 65.6%. For lesions focused on liver evaluation, with the aim of lowering costs but not efficiency, places the method in focus again for use in the routine preoperative staging of candidates for liver resection. We suggest for preoperative evaluation that US could be associated with one section imaging method (computed tomography or magnetic resonance imaging) as routine.

  19. Changes in quality of life after elective surgery: an observational study comparing two measures.

    Science.gov (United States)

    Kronzer, Vanessa L; Jerry, Michelle R; Ben Abdallah, Arbi; Wildes, Troy S; McKinnon, Sherry L; Sharma, Anshuman; Avidan, Michael S

    2017-08-01

    Our main objective was to compare the change in a validated quality of life measure to a global assessment measure. The secondary objectives were to estimate the minimum clinically important difference (MCID) and to describe the change in quality of life by surgical specialty. This prospective cohort study included 7902 adult patients undergoing elective surgery. Changes in the Veterans RAND 12-Item Health Survey (VR-12), composed of a physical component summary (PCS) and a mental component summary (MCS), were calculated using preoperative and postoperative questionnaires. The latter also contained a global assessment question for quality of life. We compared PCS and MCS to the global assessment using descriptive statistics and weighted kappa. MCID was calculated using an anchor-based approach. Analyses were pre-specified and registered (NCT02771964). By the change in VR-12 scores, an equal proportion of patients experienced improvement and deterioration in quality of life (28% for PCS, 25% for MCS). In contrast, by the global assessment measure, 61% reported improvement, while only 10% reported deterioration. Agreement with the global assessment was slight for both PCS (kappa = 0.20, 57% matched) and MCS (kappa = 0.10, 54% matched). The MCID for the overall VR-12 score was approximately 2.5 points. Patients undergoing orthopedic surgery showed the most improvement in quality of life measures, while patients undergoing gastrointestinal/hepatobiliary or urologic surgery showed the most deterioration. Subjective global quality of life report does not agree well with a validated quality of life instrument, perhaps due to patient over-optimism.

  20. Preconditioning in laparoscopic surgery--results of a virtual reality pilot study.

    Science.gov (United States)

    Paschold, M; Huber, T; Kauff, D W; Buchheim, K; Lang, H; Kneist, W

    2014-10-01

    This prospective study investigated the effect of preconditioning in laparoscopic cholecystectomy (LC) and appendectomy (LA) based on pre- and postoperative virtual reality laparoscopy (VRL) performances, with specific regard to the impact of different motor skills, types of surgery and levels of experience. Forty laparoscopic procedures (28 LC and 12 LA) were performed by 13 residents in the operating room. Participants completed a defined set of tasks on the VRL simulator directly prior to and after the operation: one preparational task (PT), a virtual procedural task with emphasis on fine preparation (VPT) and a navigational manoeuvre for instrument coordination (ICT). VRL performances were evaluated based on the assessed items of the simulator. Overall analysis of the surgeons' performance demonstrated better postoperative results for PT and VPT in 28 and 26 cases (p = 0.001 and p = 0.034), respectively. No significant difference was found for ICT (p = 0.638). Less-experienced residents had better postoperative results for PT and VPT (p = 0.009 and p = 0.041), whereas more-experienced surgeons had better postoperative results for PT only (p = 0.030). LC resulted in better postoperative performance for PT (p = 0.007). LA improved performance for PT and VPT (p = 0.034 and p = 0.006, respectively). Comparisons of surgeon's experience demonstrated a significant advantage for more-experienced surgeons in ICT (p = 0.033), while type of surgery showed an advantage for LA in VPT (p = 0.022). There is a preconditioning effect in laparoscopic surgery. The differing results related to LC and LA and the experience levels of surgeons suggest that differentiated warm-up strategies are required.

  1. Hemodynamic challenge to early mobilization after cardiac surgery: A pilot study

    Directory of Open Access Journals (Sweden)

    Tiziano Cassina

    2016-01-01

    Full Text Available Background: Active mobilization is a key component in fast-track surgical strategies. Following major surgery, clinicians are often reluctant to mobilize patients arguing that circulatory homeostasis would be impaired as a result of myocardial stunning, fluid shift, and autonomic dysfunction. Aims: We examined the feasibility and safety of a mobilization protocol 12-24 h after elective cardiac surgery. Setting and Design: This observational study was performed in a tertiary nonacademic cardiovascular Intensive Care Unit. Materials and Methods: Over a 6-month period, we prospectively evaluated the hemodynamic response to a two-staged mobilization procedure in 53 consecutive patients. Before, during, and after the mobilization, hemodynamics parameters were recorded, including the central venous oxygen saturation (ScvO 2 , lactate concentrations, mean arterial pressure (MAP, heart rate (HR, right atrial pressure (RAP, and arterial oxygen saturation (SpO 2 . Any adverse events were documented. Results: All patients successfully completed the mobilization procedure. Compared with the supine position, mobilization induced significant increases in arterial lactate (34.6% [31.6%, 47.6%], P = 0.0022 along with reduction in RAP (−33% [−21%, −45%], P 10% and nine of them (17% required treatment. Hypotensive patients experienced a greater decrease in ScvO 2 (−18 ± 5% vs. −9 ± 4%, P = 0.004 with similar changes in RAP and HR. All hemodynamic parameters, but arterial lactate, recovered baseline values after resuming the horizontal position. Conclusions: Early mobilization after cardiac surgery appears to be a safe procedure as far as it is performed under close hemodynamic and clinical monitoring in an intensive care setting.

  2. Failed back surgery pain syndrome: therapeutic approach descriptive study in 56 patients.

    Science.gov (United States)

    Teixeira, Manoel Jacobsen; Yeng, Lin Tchia; Garcia, Oliver Garcia; Fonoff, Erich Talamoni; Paiva, Wellingson Silva; Araujo, Joaci O

    2011-01-01

    The authors show the clinical evaluation and follow-up results in 56 patients diagnosed with a failed back surgery pain syndrome. Descriptive and prospective study conducted over a one-year period. In this study, 56 patients with a failed back surgery pain syndrome were assessed in our facility. The age ranged from 28 to 76 years (mean, 48.8 ± 13.9 years). The pain was assessed through a Visual Analog Scale (VAS). Postoperative pain was more severe (mean VAS score 8.3) than preoperative pain (7.2). Myofascial pain syndromes (MPS) were diagnosed in 85.7% of patients; neuropathic abnormalities associated or not with MPS were found in 73.3%. Drug therapy associated with physical medicine treatment provided > 50% pain improvement in 57.2% of cases; trigger point injection in 60.1%, and epidural infusion of morphine with lidocaína in 69.3% of refractory cases. In patients with a post-laminectomy syndrome, postoperative pain was more severe than preoperative pain from a herniated disk. A miofascial component was found in most patients.

  3. Correlates of non-technical skills in surgery: a prospective study.

    Science.gov (United States)

    Gillespie, Brigid M; Harbeck, Emma; Kang, Evelyn; Steel, Catherine; Fairweather, Nicole; Chaboyer, Wendy

    2017-01-30

    Communication and teamwork failures have frequently been identified as the root cause of adverse events and complications in surgery. Few studies have examined contextual factors that influence teams' non-technical skills (NTS) in surgery. The purpose of this prospective study was to identify and describe correlates of NTS. We assessed NTS of teams and professional role at 2 hospitals using the revised 23-item Non-TECHnical Skills (NOTECHS) and its subscales (communication, situational awareness, team skills, leadership and decision-making). Over 6 months, 2 trained observers evaluated teams' NTS using a structured form. Interobserver agreement across hospitals ranged from 86% to 95%. Multiple regression models were developed to describe associations between operative time, team membership, miscommunications, interruptions, and total NOTECHS and subscale scores. We observed 161 surgical procedures across 8 teams. The total amount of explained variance in NOTECHS and its 5 subscales ranged from 14% (adjusted R(2) 0.12, p<0.001) to 24% (adjusted R(2) 0.22, p<0.001). In all models, inverse relationships between the total number of miscommunications and total number of interruptions and teams' NTS were observed. Miscommunications and interruptions impact on team NTS performance. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  4. GENERAL SURGERY

    African Journals Online (AJOL)

    body temperature to derive an equation for the purpose of predicting mortality in damage control surgery. It was shown to ... equation to have 100% positive predictive value (PPV) for both datasets and 24% sensitivity. The aim of the study was to .... predictive systems assess average, and not individual, risk. Increasing the ...

  5. A pilot study to record visual evoked potentials during prone spine surgery using the SightSaver™ photic visual stimulator.

    Science.gov (United States)

    Soffin, E M; Emerson, R G; Cheng, J; Mercado, K; Smith, K; Beckman, J D

    2017-12-20

    This is a pilot study to assess the clinical safety and efficacy of recording real-time flash visual evoked potentials (VEPs) using the SightSaver TM Visual Stimulator mask during prone spine surgery. A prospective, observational pilot study. Twenty patients presenting for spine surgery (microdiscectomy, 1-2 level lumbar fusion, or > 2 levels thoraco-lumbar fusion) were enrolled. The SightSaver™ Visual Stimulator™ was used to elicit VEPs throughout surgery. Somatosensory evoked potentials (SSEPs) were simultaneously recorded. All patients underwent general anesthesia with a combination of intravenous and inhaled agents. The presence, absence, and changes in VEP were qualitatively analyzed. Reproducible VEPs were elicited in 18/20 patients (36/40 eyes). VEPs were exquisitely sensitive to changes in anesthesia and decayed with rising MAC of isoflurane and/or N 2 O. Decrements in VEPs were observed without concomitant changes in SSEPs. The mask was simple to apply and use and was not associated with adverse effects. The SightSaver™ mask represents an emerging technology for monitoring developing visual insults during surgery. The definitive applications remain to be determined, but likely include use in select patients and/or surgeries. Here, we have validated the device as safe and effective, and show that VEPs can be recorded in real time under general anesthesia in the prone position. Future studies should be directed towards understanding the ideal anesthetic regimen to facilitate stable VEP recording during prone spine surgery.

  6. A Comparison of Clinical Outcomes After Unilateral or Bilateral Hip Arthroscopic Surgery: Age- and Sex-Matched Cohort Study.

    Science.gov (United States)

    Kuhns, Benjamin D; Hannon, Charles P; Makhni, Eric C; Alter, Jennifer; Mather, Richard C; Salata, Michael J; Nho, Shane J

    2017-11-01

    A significant number of patients undergoing hip arthroscopic surgery for femoroacetabular impingement (FAI) have bilateral deformities and may require surgery for both hips. To compare outcomes between patients who underwent bilateral hip arthroscopic surgery to a matched cohort of patients who underwent unilateral hip arthroscopic surgery. Cohort study; Level of evidence, 3. A consecutive series of patients who underwent primary hip arthroscopic surgery for FAI by a single fellowship-trained surgeon from January 2012 to January 2014 and had a minimum follow-up of 2 years were evaluated. Patients who underwent staged bilateral hip arthroscopic surgery were identified and matched 1:2 to patients who underwent unilateral hip arthroscopic surgery based on age, sex, and body mass index (BMI). Demographic, preoperative, and postoperative variables were compared between the groups. Forty-three patients in the bilateral group were matched with 86 patients in the unilateral group based on sex (24 female [56%] vs 48 female [56%], respectively; P > .99), age (28.6 ± 10.8 years vs 28.9 ± 10.8 years, respectively; P = .88), and BMI (24.8 ± 5.8 kg/m2 vs 24.8 ± 4.0 kg/m2, respectively; P = .98). There were no significant preoperative demographic or radiographic differences between the groups. Both groups demonstrated significant preoperative to postoperative improvements in the Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sports Subscale (HOS-SS), and modified Harris Hip Score (mHHS) ( P arthroscopic surgery had less improvement in mHHS and pain scores. Sixty-five (76%) patients in the unilateral group achieved the minimum clinically important difference (MCID) for the mHHS compared with 21 (49%) in the bilateral group ( P = .03), while 64 (74%) patients achieved the patient acceptable symptomatic state (PASS) for the mHHS compared with 22 (51%) in the bilateral group ( P = .02). Patients in the bilateral group with greater than 10 months between

  7. Adverse Events in Robotic Surgery: A Retrospective Study of 14 Years of FDA Data.

    Directory of Open Access Journals (Sweden)

    Homa Alemzadeh

    Full Text Available Use of robotic systems for minimally invasive surgery has rapidly increased during the last decade. Understanding the causes of adverse events and their impact on patients in robot-assisted surgery will help improve systems and operational practices to avoid incidents in the future.By developing an automated natural language processing tool, we performed a comprehensive analysis of the adverse events reported to the publicly available MAUDE database (maintained by the U.S. Food and Drug Administration from 2000 to 2013. We determined the number of events reported per procedure and per surgical specialty, the most common types of device malfunctions and their impact on patients, and the potential causes for catastrophic events such as patient injuries and deaths.During the study period, 144 deaths (1.4% of the 10,624 reports, 1,391 patient injuries (13.1%, and 8,061 device malfunctions (75.9% were reported. The numbers of injury and death events per procedure have stayed relatively constant (mean = 83.4, 95% confidence interval (CI, 74.2-92.7 per 100,000 procedures over the years. Surgical specialties for which robots are extensively used, such as gynecology and urology, had lower numbers of injuries, deaths, and conversions per procedure than more complex surgeries, such as cardiothoracic and head and neck (106.3 vs. 232.9 per 100,000 procedures, Risk Ratio = 2.2, 95% CI, 1.9-2.6. Device and instrument malfunctions, such as falling of burnt/broken pieces of instruments into the patient (14.7%, electrical arcing of instruments (10.5%, unintended operation of instruments (8.6%, system errors (5%, and video/imaging problems (2.6%, constituted a major part of the reports. Device malfunctions impacted patients in terms of injuries or procedure interruptions. In 1,104 (10.4% of all the events, the procedure was interrupted to restart the system (3.1%, to convert the procedure to non-robotic techniques (7.3%, or to reschedule it (2.5%.Despite

  8. A cost-benefit analysis using contingent valuation techniques: a feasibility study in spinal surgery.

    Science.gov (United States)

    Haefeli, Mathias; Elfering, Achim; McIntosh, Emma; Gray, Alastair; Sukthankar, Atul; Boos, Norbert

    2008-01-01

    To carry out a pilot study to demonstrate the feasibility of the contingent valuation (CV) approach to identify net benefits gained from spinal interventions; and to conduct a formal cost-benefit analysis (CBA) using a retrospective study design. The study design is a CBA feasibility study using a CV survey with ex post willingness-to-pay/willingness-to-accept (WTP/WTA) questions. The CBA study was carried out in the specialty of spinal surgery. Although increasing data are gathered on the societal costs of low back pain, little information is available on how patients "value" the benefits of surgery or whether interventions in this area are indeed cost-beneficial. CV surveys are used in CBA to elicit the consumer's monetary valuations for program benefits. A total of 115 patients after lumbar fusion, discectomy, or decompression were asked to respond to an ex post questionnaire on their WTP/WTA for their respective intervention. Additional questions addressed socio-demographics, household income, and clinical outcome. WTP/WTA was related to the actual intervention costs and clinical outcome. The WTP and cost data were then combined within a formal CBA framework with associated 95% confidence intervals generated using bootstrapping methods. The response rate was 91.3% (n = 105). 89.5% were satisfied/very satisfied with the treatment. 76.2% found the result of the operation was good/excellent and 75.7% would choose the operation for a given hypothetical intervention cost. Mean stated WTP was 20% lower than the actual operation costs (not known to respondents) for spinal fusion, although it was 37% higher for discectomy and 10% higher for decompression. The individuals' financial situation was the strongest predictor for WTP. Pain improvement, present pain, duration of hospitalization, and estimated intervention costs were significant independent predictors in the expected direction for the WTP, having controlled for socio-demographic and financial confounding

  9. Increasing Department of Surgery Productivity: A Study on the Effects of Adding an Ambulatory Surgery Room to Tripler Army Medical Center

    National Research Council Canada - National Science Library

    Vaseliades, Aristotle A

    2006-01-01

    ...) to increase productivity in terms of relative value units (RVUs). Tripler Army Medical Center submitted 12 initiatives, one of which was the implementation of an ambulatory surgery room within the Department of Surgery...

  10. Psychiatric comorbidity as predictor of costs in back pain patients undergoing disc surgery: a longitudinal observational study.

    Science.gov (United States)

    Konnopka, Alexander; Löbner, Margrit; Luppa, Melanie; Heider, Dirk; Heinrich, Sven; Riedel-Heller, Steffi; Meisel, Hans Jörg; Günther, Lutz; Meixensberger, Jürgen; König, Hans-Helmut

    2012-09-03

    Psychiatric comorbidity is common in back pain patients undergoing disc surgery and increases economic costs in many areas of health. The objective of this study was to analyse psychiatric comorbidity as predictor of direct and indirect costs in back pain patients undergoing disc surgery in a longitudinal study design. A sample of 531 back pain patients was interviewed after an initial disc surgery (T0), 3 months (T1) and 15 months (T2) using the Composite International Diagnostic Interview to assess psychiatric comorbidity and a modified version of the Client Sociodemographic and Service Receipt Inventory to assess resource utilization and lost productivity for a 3-month period prior interview. Health care utilization was monetarily valued by unit costs and productivity by labour costs. Costs were analysed using random coefficient models and bootstrap techniques. Psychiatric comorbidity was associated with significantly (p chronic medical disease, the number of previous disc surgeries, and time and gender. Psychiatric comorbidity presents an important predictor of direct and indirect costs in back pain patients undergoing disc surgery, even if patients do not utilize mental health care. This effect seems to be stable over time. More attention should be given to psychiatric comorbidity and cost-effective treatments should be applied to treat psychiatric comorbidity in back pain patients undergoing disc surgery to reduce health care utilization and costs associated with psychiatric comorbidity.

  11. [Incidence of urinary tract infections after cardiac surgery: comparative study accordind to catheterization device].

    Science.gov (United States)

    Hidalgo Fabrellas, I; Rebollo Pavón, M; Planas Canals, M; Barbero Cabezas, M

    2015-01-01

    Urinary tract infections (UTI) associated with urethral catheterization are the second cause of nosocomial infections in Intensive care units. We confirm a UTI when we get a result of 100,000 CFU/ml with at least one microorganism in a urine culture. Compare and determine the incidence of UTI in cardiac surgery postpoperative patients according to the catheterization device. A prospective, randomized analytical observational study of patients in the immediate cardiac surgery postoperative period. One group was probed with catheter Foley and one was inserted the catheter BIPFoley-Bactiguard® (CBF). The CBF is coated with noble metals (silver, gold and palladium) and biocompatible antimicrobial properties, covering the entire surface of the device and prevents the formation of biofilm, microbial adherence and colonization. 116 cases, 59.5% (69 cases) were negative for UTI and 40.5% (47 cases) were positive. Out of the positive UTI results, 25% were carriers of catheter Foley and 15.5% of CBF. Most common etiologic microorganisms: Escherichia coli 29.8% Klebsiella pneumonia 29.8%, Klebsiella oxytoca 9%. With the data we have observed that patients catheterized BIPfoley-Bactiguard® are infected to a lesser extent than Foley carriers. Copyright © 2013 Elsevier España, S.L.U. y SEEIUC. All rights reserved.

  12. Systematic Video Documentation in Laparoscopic Colon Surgery Using a Checklist: A Feasibility and Compliance Pilot Study.

    Science.gov (United States)

    O'Mahoney, Paul R A; Trencheva, Koiana; Zhuo, Changhua; Shukla, Parul J; Lee, Sang W; Sonoda, Toyooki; Milsom, Jeffrey W

    2015-09-01

    High-quality images can be readily captured during laparoscopic colon surgery, but there are no guidelines for documentation of these video data or how to best measure surgical quality from an operative video. This study evaluates the feasibility and compliance in documenting key steps during laparoscopic right hemicolectomy and sigmoid colectomy. A retrospective review of previously recorded videos of patients undergoing laparoscopic right hemicolectomy or sigmoid colectomy from September to December 2011 in a single institution was performed. Patients' demographics, intraoperative features, postoperative complications, and variables for video recording and editing were collected. Compliance of key surgical steps was assessed using a checklist by two independent surgeons. Sixteen laparoscopic operations (seven right hemicolectomies and nine sigmoid colectomies) were recorded. Twelve (75%) were laparoscopic-assisted, and four (25%) were hand-assisted laparoscopic operations. Compliance with key surgical steps in laparoscopic right hemicolectomy and sigmoid colectomy was demonstrated in the majority of patients, with steps ranging in compliance from 42.9% to 100% and from 77.8% to 100%, respectively. The edited video had a median duration of 3 minutes 47 seconds (range, 1 minute 44 seconds-5 minutes 38 seconds) with a production time of nearly 1 hour and a resolution of 1440 × 1080 pixels. Key surgical steps during laparoscopic right hemicolectomy and sigmoid colectomy can be documented and edited into a short representative video. Standardization of this process should allow video documentation to improve quality in laparoscopic colon surgery.

  13. Markedly elevated procalcitonin in early postoperative period in pediatric open heart surgery: a prospective cohort study.

    Science.gov (United States)

    Minami, Etsuko; Ito, Shoji; Sugiura, Takeshi; Fujita, Yoshihito; Sasano, Hiroshi; Sobue, Kazuya

    2014-01-01

    We encountered markedly elevated procalcitonin (PCT) among pediatric patients during the early postoperative period of open heart surgery. The purpose of this study is to investigate what factors are associated with the PCT elevation. Fifty-two pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) were enrolled. Plasma PCT, aspartate aminotransferase/alanine aminotransferase (AST/ALT), creatinine, lactate, and C-reactive protein (CRP) were measured on admission to ICU and during the postoperative period. The patients were categorized into high (group H) and low (group L) groups according to their peak PCT levels. Aorta cross-clamp (ACC), CPB time, ICU stay, mechanical ventilation period, peak AST/ALT, creatinine, lactate, and CRP levels were compared. ACC and CPB times, ICU stay period, and mechanical ventilation period were significantly longer in group H compared with group L (118.7 ± 51.6 vs. 49.4 ± 43.5 min, 244.5 ± 65.7 vs. 122.9 ± 63.0 min, 7.9 ± 4.6 vs. 4.0 ± 4.5 days, and 6.3 ± 4.1 vs. 2.9 ± 4.2 days, respectively; p postoperative severity and organ dysfunction.

  14. Retrospective study on therapy options of brain metastases surgery versus stereotactic radiotherapy with the linear accelerator

    CERN Document Server

    Fortunati, M K S

    2001-01-01

    Background: in the therapy of brain metastases there has been a great progress in the last years. It was shown, that more aggressive therapies can not only extend the survival of the patients, but also improve quality of life. The major question of this study was, whether surgery or stereotactic radiotherapy with the linear accelerator show better results in behalf of the survival. Beside this major question many parameters regarding the patient or his primary cancer were examined. Methods: from the 1st of January 1995 until the 30th of June 2000 233 patients with one or more brain metastases have been treated in the Wagner Jauregg Landesnervenkrankenhaus Oberoesterreich (WJ LNKH OeO). The LINAC has been established on the 1st of July 1997. The patients have been distributed in three groups: 1. LINAC-group: 81 patients have been treated from the 1st of July 1997 until the 30th of June 2000 with the LINAC. 2. Surgery-group: 81 patients have been operated from the 1st of July 1997 until the 30th June 2000. 3 Co...

  15. UBM-guided chamber angle surgery for glaucoma management: an experimental study.

    Science.gov (United States)

    Dietlein, T S; Engels, B F; Jacobi, P C; Krieglstein, G K

    2003-04-01

    The aim of this experimental study was to investigate the potential of ultrasound bimicroscopy (UBM)-guided chamber angle surgery as an alternative or supplement to gonioscopy and intraocular microendoscopy for intraoperative control. In 15 porcine cadaver eyes, mechanical goniopuncture or punctual Er:YAG laser trabecular ablation was performed without operating microscope or gonioscopy, but with real-life ultrasound biomicroscopy monitoring with a 50 MHz transducer. Intraoperative localization of the microsurgical instruments and tissue-instrument contact were qualitatively evaluated. The instruments could be clearly visualized within the chamber angle and disturbing artefacts were only minimal when using mechanically fixed instruments in slow motion. Topographic localization, tissue contact, and penetration depth of the instruments entering the scleral were well illustrated as far as the technical resolution limits of UBM would allow. UBM can be used intraoperatively to monitor the correct manoeuvring of microsurgical instruments in selected ab interno procedures. Some adaptations and further modifications of the technique presented here will be necessary before UBM-guided surgery can be considered for clinical use in humans.

  16. Industry Bias in Randomized Controlled Trials in General and Abdominal Surgery: An Empirical Study.

    Science.gov (United States)

    Probst, Pascal; Knebel, Phillip; Grummich, Kathrin; Tenckhoff, Solveig; Ulrich, Alexis; Büchler, Markus W; Diener, Markus K

    2016-07-01

    Industry sponsorship has been identified as a source of bias in several fields of medical science. To date, the influence of industry sponsorship in the field of general and abdominal surgery has not been evaluated. A systematic literature search (1985-2014) was performed in the Cochrane Library, MEDLINE, and EMBASE to identify randomized controlled trials in general and abdominal surgery. Information on funding source, outcome, and methodological quality was extracted. Association of industry sponsorship and positive outcome was expressed as odds ratio (OR) with 95% confidence interval (CI). A χ test and a multivariate logistic regression analysis with study characteristics and known sources of bias were performed. A total of 7934 articles were screened and 165 randomized controlled trials were included. No difference in methodological quality was found. Industry-funded trials more often presented statistically significant results for the primary endpoint (OR, 2.44; CI, 1.04-5.71; P = 0.04). Eighty-eight of 115 (76.5%) industry-funded trials and 19 of 50 (38.0%) non-industry-funded trials reported a positive outcome (OR, 5.32; CI, 2.60-10.88; P declaration of funding source. Industry involvement in surgical research has to ensure scientific integrity and independence and has to be based on full transparency.

  17. Thyroid Surgery

    Science.gov (United States)

    ... has had a previous neck operation (thyroid surgery, parathyroid surgery, spine surgery, carotid artery surgery, etc.) and/or who has had a suspected invasive thyroid cancer should have their vocal cord function evaluated routinely before surgery. This is necessary to ...

  18. A stepped strategy that aims at the nationwide implementation of the Enhanced Recovery After Surgery programme in major gynaecological surgery: study protocol of a cluster randomised controlled trial.

    Science.gov (United States)

    de Groot, Jeanny Ja; Maessen, José Mc; Slangen, Brigitte Fm; Winkens, Bjorn; Dirksen, Carmen D; van der Weijden, Trudy

    2015-07-30

    Enhanced Recovery After Surgery (ERAS) programmes aim at an early recovery after surgical trauma and consequently at a reduced length of hospitalisation. This paper presents the protocol for a study that focuses on large-scale implementation of the ERAS programme in major gynaecological surgery in the Netherlands. The trial will evaluate effectiveness and costs of a stepped implementation approach that is characterised by tailoring the intensity of implementation activities to the needs of organisations and local barriers for change, in comparison with the generic breakthrough strategy that is usually applied in large-scale improvement projects in the Netherlands. All Dutch hospitals authorised to perform major abdominal surgery in gynaecological oncology patients are eligible for inclusion in this cluster randomised controlled trial. The hospitals that already fully implemented the ERAS programme in their local perioperative management or those who predominantly admit gynaecological surgery patients to an external hospital replacement care facility will be excluded. Cluster randomisation will be applied at the hospital level and will be stratified based on tertiary status. Hospitals will be randomly assigned to the stepped implementation strategy or the breakthrough strategy. The control group will receive the traditional breakthrough strategy with three educational sessions and the use of plan-do-study-act cycles for planning and executing local improvement activities. The intervention group will receive an innovative stepped strategy comprising four levels of intensity of support. Implementation starts with generic low-cost activities and may build up to the highest level of tailored and labour-intensive activities. The decision for a stepwise increase in intensive support will be based on the success of implementation so far. Both implementation strategies will be completed within 1 year and evaluated on effect, process, and cost-effectiveness. The primary

  19. A Longitudinal Study of Motivations Before and Psychosexual Outcomes After Genital Gender-Confirming Surgery in Transmen.

    Science.gov (United States)

    van de Grift, Tim C; Pigot, Garry L S; Boudhan, Siham; Elfering, Lian; Kreukels, Baudewijntje P C; Gijs, Luk A C L; Buncamper, Marlon E; Özer, Müjde; van der Sluis, Wouter; Meuleman, Eric J H; Bouman, Mark-Bram; Mullender, Margriet G

    2017-12-01

    Genital dissatisfaction is an important reason for transmen to undergo genital gender-confirming surgery (GCS; phalloplasty or metoidioplasty). However, little is known about motives for choosing specific techniques, how transmen benefit postoperatively, and whether psychosexual outcomes improve. To evaluate motivations for and psychosexual outcomes after GCS. A longitudinal study of 21 transmen at least 1 year after GCS was conducted. Participants were recruited through their surgeon. Data were collected when they applied for surgery and at least 1 year after surgery. Data collection included semistructured questionnaires on motivations for surgery, postoperative experiences, and standardized measures of psychological symptoms, body image, self-esteem, sexuality, and quality of life (pre- and postoperative). Information on surgical complications and corrections was retrieved from medical records. Most participants underwent phalloplasty with urethral lengthening using a radial forearm flap. Although problematic voiding symptoms were prevalent, many participants were satisfied with their penile function. The strongest motivations to pursue penile surgery were confirmation of one's identity (100%), enabling sexual intercourse (78%), and voiding while standing (74%). No significant differences between postoperative and reference values were observed for standardized measures. After surgery, transmen were more sexually active (masturbation and with a partner) and used their genitals more frequently during sex compared with before surgery (31-78%). The present study provides input for preoperative decision making: (i) main motives for surgery include identity confirmation, voiding, and sexuality, (ii) surgery can result in more sexual activity and genital involvement during sex, although some distress can remain, but (iii) complications and voiding symptoms are prevalent. Study strengths include its longitudinal design and the novelty of the studied outcomes. The main

  20. Complications and risk factors of primary adult scoliosis surgery: a multicenter study of 306 patients.

    Science.gov (United States)

    Charosky, Sebastien; Guigui, Pierre; Blamoutier, Arnaud; Roussouly, Pierre; Chopin, Daniel

    2012-04-15

    A multicentric retrospective study on primary adult scoliosis patients operated on between 2002 and 2007. A 3-step statistical analysis was performed to describe the incidence of complications, the risk factors, and the reoperation risk with survival curves for the entire cohort. To describe complication rate and risk factors as well as survival curves associated with adult primary scoliosis surgery in patients aged 50 years or older. Adult deformity surgery is classically associated with a high rate of complications. The identification of risk factors for developing such complications is consequently of major interest as well as survival curves that can provide useful information on reoperation risks. Although many reports exist in the literature, the cohorts analyzed are often heterogeneous and the actual prevalence of complications varies widely. This study represents to our knowledge the largest series on adult patients aged 50 years or older operated for the first time for lumbar or thoracolumbar scoliosis and excluding every other possible diagnosis. A retrospective review of prospectively collected data from 6 centers in France. A total of 306 primary lumbar adult or degenerative scoliosis patients older than 50 years undergoing surgery between 2002 and 2007 were included. Demographics, comorbidities, x-ray parameters, surgical data, and complications were analyzed. Statistical analysis was performed to obtain correlations and risk factors for developing complications. Reoperation risk was calculated with Kaplan-Meier survival curves. A total of 306 patients aged 63 years (range, 50-83), with 83% women. Mean follow-up was 54 months. Mean Cumulative Illness Rating Scale score was 5 (range, 0-26). Main curve was 50° (range, 4-96) with apex between T12 and L2. Ten percent of patients had anterior surgery only, 18% had double anteroposterior approach, and 72% had posterior surgery only. Seventy-four percent (226 patients) had long fusions of 3 or more levels

  1. Comparison of minimally invasive spine surgery using intraoperative computed tomography integrated navigation, fluoroscopy, and conventional open surgery for lumbar spondylolisthesis: a prospective registry-based cohort study.

    Science.gov (United States)

    Wu, Meng-Huang; Dubey, Navneet Kumar; Li, Yen-Yao; Lee, Ching-Yu; Cheng, Chin-Chang; Shi, Chung-Sheng; Huang, Tsung-Jen

    2017-08-01

    To date, the surgical approaches for the treatment of lumbar spondylolisthesis by transforaminal lumbar interbody fusion (TLIF) using minimally invasive spine surgery assisted with intraoperative computed tomography image-integrated navigation (MISS-iCT), fluoroscopy (MISS-FS), and conventional open surgery (OS) are debatable. This study compared TLIF using MISS-iCT, MISS-FS, and OS for treatment of one-level lumbar spondylolisthesis. This is a prospective, registry-based cohort study that compared surgical approaches for patients who underwent surgical treatment for one-level lumbar spondylolisthesis. One hundred twenty-four patients from January 2010 to March 2012 in a medical center were recruited. The outcome measures were clinical assessments, including Short-Form 12, visual analog scale (VAS), Oswestry Disability Index, Core Outcome Measurement Index, and patient satisfaction, and blood loss, hospital stay, operation time, postoperative pedicle screw accuracy, and superior-level facet violation. All surgeries were performed by two senior surgeons together. Ninety-nine patients (40M, 59F) who had at least 2 years' follow-up were divided into three groups according to the operation methods: MISS-iCT (N=24), MISS-FS (N=23), and OS (N=52) groups. Charts and surgical records along with postoperative CT images were assessed. MISS-iCT and MISS-FS demonstrated a significantly lowered blood loss and hospital stay compared with OS group (p2 mm) was found. However, a lower superior-level facet violation rate was observed in the MISS-iCT and OS groups (p=.049). MISS-iCT TLIF demonstrated reduced operation time, blood loss, superior-level facet violation, hospital stay, and improved functional outcomes compared with the MISS-FS and OS approaches. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. The coronary CT angiography vision protocol: a prospective observational imaging cohort study in patients undergoing non-cardiac surgery

    Science.gov (United States)

    Sheth, Tej; Butler, Craig; Chow, Benjamin; Chan, M T V; Mitha, Ayesha; Nagele, Peter; Tandon, Vikas; Stewart, Lori; Graham, Michelle; Choi, G Y S; Kisten, T; Woodard, P K; Crean, Andrew; Abdul Aziz, Y F; Karthikeyan, G; Chow, C K; Szczeklik, W; Markobrada, M; Mastracci, T.; Devereaux, P J

    2012-01-01

    Introduction At present, physicians have a limited ability to predict major cardiovascular complications after non-cardiac surgery and little is known about the anatomy of coronary arteries associated with perioperative myocardial infarction. We have initiated the Coronary CT Angiography (CTA) VISION Study to (1) establish the predictive value of coronary CTA for perioperative myocardial infarction and death and (2) describe the coronary anatomy of patients that have a perioperative myocardial infarction. Methods and analysis The Coronary CTA VISION Study is prospective observational study. Preoperative coronary CTA will be performed in 1000–1500 patients with a history of vascular disease or at least three cardiovascular risk factors who are undergoing major elective non-cardiac surgery. Serial troponin will be measured 6–12 h after surgery and daily for the first 3 days after surgery. Major vascular outcomes at 30 days and 1 year after surgery will be independently adjudicated. Ethics and dissemination Coronary CTA results in a measurable radiation exposure that is similar to a nuclear perfusion scan (10–12 mSV). Treating physicians will be blinded to the CTA results until 30 days after surgery in order to provide the most unbiased assessment of its prognostic capabilities. The only exception will be the presence of a left main stenosis >50%. This approach is supported by best available current evidence that, excluding left main disease, prophylatic revascularisation prior to non-cardiac surgery does not improve outcomes. An external safety and monitoring committee is overseeing the study and will review outcome data at regular intervals. Publications describing the results of the study will be submitted to major peer-reviewed journals and presented at international medical conferences. PMID:22855630

  3. The fate of titanium miniplates and screws used in maxillofacial surgery: a 10 year retrospective study.

    LENUS (Irish Health Repository)

    O'Connell, J

    2012-01-31

    The objective of this 10 year, retrospective study is to evaluate the indications for the removal of titanium miniplates following osteosynthesis in maxillofacial trauma and orthognathic surgery. All patients who had miniplates placed in a Regional Oral and Maxillofacial Department between January 1998 and October 2007 were included. The following variables were recorded: patient gender and age, number of plates inserted, indications for plate placement, location of plates, number and location of plates removed, indications for plate removal, time between insertion and removal, medical co-morbidities, and the follow-up period. During the 10 years of the study, 1247 titanium miniplates were placed in 535 patients. A total of 32 (3%) plates were removed from 30 patients. Superficial infection accounted for 41% of all plates removed. All complications were minor and most plates were removed within the first year of insertion. A low removal rate of 3% suggests that the routine removal of asymptomatic titanium miniplates is not indicated.

  4. A qualitative study of Functioning, Disability, and Rehabilitation of patients after hip fracture surgery

    DEFF Research Database (Denmark)

    Ehlers, Monica Milter

    2013-01-01

    on the Model of the International Classification of Functioning, Disability and Health (The ICF model) (Figure 1) and White Paper of the Rehabilitation Concept. The method of the project is qualitative, and the design used to answer the research questions is qualitative deductive content analysis (Figure 2......A qualitative study of functioning, disability, and rehabilitation of patients after hip fracture surgery Monica Milter Ehlers PhD student, MSc in Nursing Merete Bender Bjerrum* PhD, MA, Associate Professor Claus Vinther Nielsen* Professor, PhD, MD, Specialist in Clinical Social Medicine...... fracture patients consists primarily of muscle training and daily mobilisation. Patients' functioning, disability, and involvement in their rehabilitation process have not been investigated in scientific studies. Aims To establish a specific research-based knowledge for functioning, disability...

  5. Enhanced identification and functional protective role of carbon nanoparticles on parathyroid in thyroid cancer surgery: A retrospective Chinese population study.

    Science.gov (United States)

    Shi, Chenlei; Tian, Bo; Li, Shengze; Shi, Tiefeng; Qin, Huadong; Liu, Shaoyan

    2016-11-01

    The aim of this study was to determine the effects of nanocarbon particles in combination with meticulous capsular dissection on enhancing the identification and protecting the function of parathyroid glands in thyroid cancer surgery.The data of 97 patients with papillary thyroid tumors diagnosed and treated at the Second Affiliated Hospital, Harbin Medical University between January 2014 and February 2015 were reviewed. Data regarding the sex, age, calcium and parathyroid hormone (PTH) levels, tumor size, multifocality, T stage, and extrathyroid invasion were collected. The incidence of surgeries in which the parathyroid glands were cut mistakenly, the concentration of serum calcium and parathyroid hormone before surgery (baseline) and after surgery on days 1, 3, and 7, and 1 and 6 months in the patients of the two groups (the nanocarbon and control groups) were analyzed.Fifty-two patients underwent meticulous capsular dissection combined with nanocarbon treatment (nanocarbon group), and 45 underwent meticulous capsular dissection alone (control group). The nanocarbon group showed a significantly higher total and average number of revealed parathyroid glands (average number is the mean for different individuals have different number) and a lower incidence of the parathyroid glands being mistakenly cut, in addition to a lower level of hypoparathyroidism than control group following surgery (P parathyroid in thyroid cancer surgery, reduce the risk of mistakenly cutting the parathyroid, and reduce the incidence of postoperative hypoparathyroidism.

  6. Lung volume reduction surgery since the National Emphysema Treatment Trial: study of Society of Thoracic Surgeons Database.

    Science.gov (United States)

    Decker, Marquita R; Leverson, Glen E; Jaoude, Wassim Abi; Maloney, James D

    2014-12-01

    The National Emphysema Treatment Trial demonstrated that lung volume reduction surgery is an effective treatment for emphysema in select patients. With chronic lower respiratory disease being the third leading cause of death in the United States, this study sought to assess practice patterns and outcomes for lung volume reduction surgery on a national level since the National Emphysema Treatment Trial. Aggregate statistics on lung volume reduction surgery reported in the Society of Thoracic Surgeons Database from January 2003 to June 2011 were analyzed to assess procedure volume, preoperative and operative characteristics, and outcomes. Comparisons with published data from the National Emphysema Treatment Trial were made using chi-square and 2-sided t tests. In 8.5 years, 538 patients underwent lung volume reduction surgery, with 20 to 118 cases reported in the Society of Thoracic Surgeons Database per year. When compared with subjects in the National Emphysema Treatment Trial, subjects in the Society of Thoracic Surgeons Database were younger (P volume in 1 second was 31% versus 28% of predicted (P lung volume reduction surgery. It underscores the need for dedicated centers to increasingly address the heavy burden of chronic lower respiratory disease in the United States in a multidisciplinary fashion, particularly for preoperative evaluation and postoperative management of emphysema. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  7. Feasibility of using administrative data for identifying medical reasons to delay hip fracture surgery: a Canadian database study.

    Science.gov (United States)

    Guy, Pierre; Sheehan, Katie J; Morin, Suzanne N; Waddell, James; Dunbar, Michael; Harvey, Edward; Sirett, Susan; Sobolev, Boris; Kuramoto, Lisa; Tang, Michael

    2017-10-05

    Failure to account for medically necessary delays may lead to an underestimation of early surgery benefits. This study investigated the feasibility of using administrative data to identify the National Institute for Health and Care Excellence (NICE) 124 guideline list of conditions that appropriately delay hip fracture surgery. We assembled a list of diagnosis and procedure codes to reflect the NICE 124 conditions. The list was reviewed and updated by an advanced clinical coder. The list was refined by five clinical experts. We then screened Canadian Institute for Health Information discharge abstracts for 153 918 patients surgically treated for a non-pathological first hip fracture between 1 January 2004 and 31 December 2012 for diagnosis codes present on admission and procedure codes that antedated hip fracture surgery. We classified abstracts as having medical reasons for delaying surgery based on the presence of these codes. In total, 10 237 (6.7%; 95% CI 6.5% to 6.8%) patients had diagnostic and procedure codes indicating medical reasons for delay. The most common reasons for medical delay were exacerbation of a chronic chest condition (35.9%) and acute chest infection (23.2%). The proportion of patients with reasons for medical delays increased with time from admission to surgery: 3.9% (95% CI 3.6% to 4.1%) for same day surgery; 4.7% (95% CI 4.5% to 4.8%) for surgery 1 day after admission; 7.1% (95% CI 6.9% to 7.4%) for surgery 2 days after admission; and 15.5% (95% CI 15.1% to 16.0%) for surgery more than 2 days after admission. The trend was seen for admissions on weekday working hours, weekday after hours and on weekends. Administrative data can be considered to identify conditions that appropriately delay hip fracture surgery. Accounting for medically necessary delays can improve estimates of the effectiveness of early surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights

  8. Pomegranate Supplementation Protects against Memory Dysfunction after Heart Surgery: A Pilot Study

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    Susan A. Ropacki

    2013-01-01

    Full Text Available Memory dysfunction is a common complaint following heart surgery and may be related to a diffuse ischemic state induced by microemboli dislodged during the procedure. Ischemia can induce damage by a number of mechanisms, including oxidative stress. Because pomegranates contain a variety of polyphenols with antioxidant and other potentially beneficial effects, we tested whether supplementation with a pomegranate extract before and after heart surgery could protect against postoperative cognitive dysfunction. Patients undergoing elective coronary artery bypass graft and/or valve surgery were given either 2 g of pomegranate extract (in 2 POMx pills or placebo (pills containing no pomegranate ingredients per day from one week before surgery to 6 weeks after surgery. The patients were also administered a battery of neuropsychological tests to assess memory function at 1 week before surgery (baseline, 2 weeks after surgery, and 6 weeks after surgery. The placebo group had significant deficits in postsurgery memory retention, and the pomegranate treatment not only protected against this effect, but also actually improved memory retention performance for up to 6 weeks after surgery as compared to presurgery baseline performance.

  9. Assessment of CAOS as a training model in spinal surgery: a randomised study.

    Science.gov (United States)

    Richards, P J; Kurta, I C; Jasani, V; Jones, C H Wynn; Rahmatalla, A; Mackenzie, G; Dove, J

    2007-02-01

    The objectives of this study were (1) to quantify the benefit of computer assisted orthopaedic surgery (CAOS) pedicle screw insertion in a porcine cadaver model evaluated by dissection and computed tomography (CT); (2) to compare the effect on performance of four surgeons with no experience of CAOS, and varying experience of pedicle screw insertion; (3) to see if CT with extended windows was an acceptable method to evaluate the position of the pedicle screws in the porcine cadaver model, compared to dissection. This was a prospective, randomised, controlled and blinded porcine cadaver study. Twelve 6-month-old porcine (white skinned Landrace) lumbar spines were scanned pre-operatively by spiral CT, as required for the CAOS computer data set. Computer randomisation allocated the specimens to one of four surgeons, all new to CAOS but with different levels of experience in spinal surgery. The usual anatomical landmarks for the freehand technique were known to all four surgeons. Two pedicles at each vertebral level were randomly allocated between conventional free hand insertion and an electromagnetic image guided surgery (NAVITRAK) and 6.5 mm cancellous AO screws inserted. Post-operatively, spiral CT was blindly evaluated by an independent radiologist and the spine fellow to assess the accuracy of pedicle screw placement, by each method. The inter- and intra-observer reliability of CT was evaluated compared to dissection. The pedicle screw placement was assessed as perfect if within the pedicle along its central axis, or acceptable (within research registrars acceptable rate increased from 70 to 90% and the spine fellow from 76 to 86%). CAOS did not have a statistically significant effect on the experienced consultant spine surgeon increasing from 70 to 79% (P = 0.39). The experienced general orthopaedic surgeon did not benefit from CAOS (P = 0.5). CT compared to dissection showed an intra-observer reliability of 99.4% and inter-observer reliability of 92.6%. The

  10. Foot Surgery

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    ... Heel Spur Surgery: Based on the condition and the nature of the disease, heel surgery can provide relief of pain ... Prior to surgery, the podiatrist will review your medical history and medical conditions. Specific diseases, illnesses, allergies, ...

  11. Foot Surgery

    Science.gov (United States)

    ... Foot Health Awareness Month Diabetes Awareness When is Foot Surgery Necessary? Many foot problems do not respond ... restore the function of your foot. Types of Foot Surgery Bunion Surgery: There are many different types ...

  12. Robotic surgery

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    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... computer station and directs the movements of a robot. Small surgical tools are attached to the robot's ...

  13. Plastic Surgery

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Plastic Surgery KidsHealth / For Teens / Plastic Surgery What's in ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  14. "...they should be offering it": a qualitative study to investigate young peoples' attitudes towards chlamydia screening in GP surgeries

    Directory of Open Access Journals (Sweden)

    Wallace Louise M

    2010-10-01

    Full Text Available Abstract Background Despite the known health and healthcare costs of untreated chlamydia infection and the efforts of the National Chlamydia Screening Programme (NCSP to control chlamydia through early detection and treatment of asymptomatic infection, the rates of screening are well below the 2010-2011 target rate of 35%. General Practitioner (GP surgeries are a key venue within the NCSP however; previous studies indicate that GP surgery staff are concerned that they may offend their patients by offering a screen. This study aimed to identify the attitudes to, and preferences for, chlamydia screening in 15-24 year old men and women attending GP surgeries (the target group. Methods We undertook 36 interviews in six surgeries of differing screening rates. Our participants were 15-24 year olds attending a consultation with a staff member. Data were analysed thematically. Results GP surgeries are acceptable to young people as a venue for opportunistic chlamydia screening and furthermore they think it is the duty of GP surgery staff to offer it. They felt strongly that it is important for surgery staff to have a non-judgemental attitude and they did not want to be singled out as 'needing' a chlamydia screen. Furthermore, our sample reported a strong preference for being offered a screen by staff and providing the sample immediately at the surgery rather than taking home a testing kit. The positive attitude and subjective norms demonstrated by interviewees suggest that young peoples' behaviour would be to accept a screen if it was offered to them. Conclusion Young people attending GP surgeries have a positive attitude towards chlamydia screening and given the right environment are likely to take up the offer in this setting. The right environment involves normalising screening by offering a chlamydia screen to all 15-24 year olds at every interaction with staff, offering screening with a non-judgemental attitude and minimising barriers to screening

  15. Craniotomy vs. craniectomy for posterior fossa tumors: a prospective study to evaluate complications after surgery.

    Science.gov (United States)

    Legnani, Federico G; Saladino, Andrea; Casali, Cecilia; Vetrano, Ignazio G; Varisco, Marco; Mattei, Luca; Prada, Francesco; Perin, Alessandro; Mangraviti, Antonella; Solero, Carlo L; DiMeco, Francesco

    2013-12-01

    Posterior fossa surgery traditionally implies permanent bone removal. Although suboccipital craniectomy offers an excellent exposure, it could lead to complications. Thus, some authors proposed craniotomy as a valuable alternative to craniectomy. In the present study we compare postoperative complications after craniotomy or craniectomy for posterior fossa surgery. We prospectively collected data for a consecutive series of patients who underwent either posterior fossa craniotomy or craniectomy for tumor resection. We divided patients into two groups based on the surgical procedure performed and safety, complication rates and length of hospitalization were analyzed. Craniotomies were performed with Control-Depth-Attachment(®) drill and chisel, while we did craniectomies with perforator and rongeurs. One-hundred-fifty-two patients were included in the study (craniotomy n =100, craniectomy n =52). We detected no dural damage after bone removal in both groups. The total complication rate related to the technique itself was 7 % for the craniotomy group and 32.6 % for the craniectomy group (<0.0001). Pseudomeningocele occurred in 4 % vs. 19.2 % (p =0.0009), CSF leak in 2 % vs. 11.5 % (p =0.006) and wound infection in 1 % vs. 1.9 % (p =0.33), respectively. Post-operative hydrocephalus, a multi-factorial complication which could affect our results, was also calculated and occurred in 4 % of the craniotomy vs. 9.6 % of the craniectomy group (p =0.08). The mean length of in-hospital stay was 9.3 days for the craniotomy group and 11.8 days for the craniectomy group (p =0.10). The present study suggests that fashioning a suboccipital craniotomy is as effective and safe as performing a craniectomy; both procedures showed similar results in preserving dural integrity, while post-operative complications were fewer when a suboccipital craniotomy was performed.

  16. Clowns in Paediatric Surgery: Less Anxiety and More Oxytocin? A Pilot Study.

    Science.gov (United States)

    Scheel, Tabea; Hoeppner, Dorothea; Grotevendt, Anne; Barthlen, Winfried

    2017-09-01

    Background Hospital stays and medical interventions are accompanied by worries and anxiety in children and parents. Recent studies show that hospital clowns may reduce anxiety and enhance well-being. However, so far studies are based solely on subjective measures and clowns are usually not integrated in medical routine. With this pilot study, we aim to provide both psychological and physiological evidence of positive effects of clowns' interventions in hospitalized children. Patients/Method In a consecutive randomized intervention-control group design with 31 children aged 4 to 13 years, 17 patients were accompanied by a clown prior to surgery or during ward round (intervention group) and 14 were not (control group). Saliva samples for oxytocin measurement were taken from all patients before hospitalization (T1) and prior to surgery or after ward round (T2). Self- and parents-reports were obtained at T1, T2 as well as at time of discharge from hospital (T3) regarding children's anxiety (STAI), worries and well-being. Clowns evaluated their success in cheering up the child. Health professionals were asked for their acceptance of clowns in hospitals. Results Children in the intervention group had lower anxiety ratings and a higher oxytocin concentration at T2 as compared with T1; the control group showed no changes. Parents rated the well-being of their children higher if their child had clown's contact and were more willing to recommend the hospital. The staff judged the clowns as helpful for patients. Discussion Consistent psychological and physiological results suggest the positive impact of a clown's intervention in hospitalized children. © Georg Thieme Verlag KG Stuttgart · New York.

  17. Evaluation of factors impacting cosmetic outcome of breast conservative surgery--a study in Iran.

    Science.gov (United States)

    Olfatbakhsh, Asiie; Mehrdad, Neda; Ebrahimi, Mandana; Alavi, Nasrin; Hashemi, Esmat; Kaviani, Ahmad; Najafi, Masoume; Haghighat, Shahpar; Arefanian, Saeed

    2015-01-01

    Breast conservative surgery (BCS) followed by radiotherapy is the standard approach in management of stage I-II breast cancer. Several factors can affect cosmetic outcomes. The aim of this study was to evaluate the cosmetic results of BCS and influencing factors in the Iranian Breast Cancer Research Center. Patients who had undergone BCS were included. Photographs were taken of both breasts of the patients in three aspects and were evaluated by three specialists. The cosmetic scores were calculated based on a standard questionnaire. The data were analyzed using univariate and multivariate regression for relationships between cosmetic scores and clinical data. A total number of 103 patients were included in the study. Mean age and BMI of the patients were 46.8±8.9 and 28.1±3.9, respectively. Breast cup sizes C and D accounted for 74.7% of the study group. The mean cosmetic score obtained from three referees was 5.72+2.06, consisting of 35.9% excellent-good, 35% moderate, and 29.1% unsatisfactory results. Patient BMI, volume of the resected tissue and breast cup size (D) showed significant correlation with the cosmetic score. On multivariate regression analysis, cosmetic score and BMI (p=0.022,) as well as breast cup size (p=0.040), remained significant. Immediate or delayed symmetrization of the breasts is suggested during breast conservative surgery, meanwhile performing oncoplastic techniques to improve the results significantly. Also it is suggested to discuss anticipation of less satisfactory results with patients having higher BMI and large breast cup size.

  18. Air contamination for predicting wound contamination in clean surgery: A large multicenter study.

    Science.gov (United States)

    Birgand, Gabriel; Toupet, Gaëlle; Rukly, Stephane; Antoniotti, Gilles; Deschamps, Marie-Noelle; Lepelletier, Didier; Pornet, Carole; Stern, Jean Baptiste; Vandamme, Yves-Marie; van der Mee-Marquet, Nathalie; Timsit, Jean-François; Lucet, Jean-Christophe

    2015-05-01

    The best method to quantify air contamination in the operating room (OR) is debated, and studies in the field are controversial. We assessed the correlation between 2 types of air sampling and wound contaminations before closing and the factors affecting air contamination. This multicenter observational study included 13 ORs of cardiac and orthopedic surgery in 10 health care facilities. For each surgical procedure, 3 microbiologic air counts, 3 particles counts of 0.3, 0.5, and 5 μm particles, and 1 bacteriologic sample of the wound before skin closure were performed. We collected data on surgical procedures and environmental characteristics. Of 180 particle counts during 60 procedures, the median log10 of 0.3, 0.5, and 5 μm particles was 7 (interquartile range [IQR], 6.2-7.9), 6.1 (IQR, 5.4-7), and 4.6 (IQR, 0-5.2), respectively. Of 180 air samples, 50 (28%) were sterile, 90 (50%) had 1-10 colony forming units (CFU)/m(3) and 40 (22%) >10 CFU/m(3). In orthopedic and cardiac surgery, wound cultures at closure were sterile for 24 and 9 patients, 10 and 11 had 1-10 CFU/100 cm(2), and 0 and 6 had >10 CFU/100 cm(2), respectively (P air microbial counts (P contamination (P = .22). This study suggests that particle counting is a good surrogate of airborne microbiologic contamination in the OR. Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  19. A PROSPECTIVE OBSERVATIONAL STUDY REGARDING PREVALENCE OF DRY EYE DISEASE IN POST-OPERATIVE CATARACT SURGERY PATIENTS OF 140 CASES.

    Directory of Open Access Journals (Sweden)

    S. Srinivasan

    2017-02-01

    Full Text Available BACKGROUND Dry eye disease is one of the most common ocular surface disorder with large number of studies carried out in various countries estimate the prevalence of dry eye disease to be between 5-34%. The prevalence of dry eye increases with age. As per Breaver Dam study regarding dry eye the prevalence of DED 13.3%. Dry eye was apparently higher in women than men. Studies have shown that cataract surgery worsen dry eye symptoms in patients with preexisting dry eye symptoms as well as without preexisting DES, mostly dry eye symptoms last for two months of post cataract surgery period. MATERIALS AND METHODS The prospective observational study was conducted in Department of Ophthalmology, Government Vellore Medical College and Hospital, Vellore. The total number of cataract surgery performed cases were 140 in number. The study period was four months, conducted in tertiary eye center. The Cataract patients were preoperatively at normal tear secretions. Post cataract surgery period from first POD, one week POD, four weeks, six weeks, two months and three months POD examined by slit lamp, Schirmer's test I, TBUT and corneal sensitivity test were performed. RESULTS Our study revealed that increased prevalence in female sex with increased age group range from 51-70 years showed post cataract surgery period dryness of eye. The ratio of Post cataract surgery DED in male and female is 13:29. This shows increased female sex prevalence of postoperative DED. In our study, the prevalence of post cataract surgery dry eye disease was 30%. CONCLUSION 73% cataract surgeries is now clear corneal cataract surgery and this procedure cuts a large part of corneal nerves. The nerve essential for tear production gets disturbed leading to dryness and hence decreased visual function. The corneal nerves are important in self-regulation of tears since they provide the sensation in the feedback loop that signals tear production. When the functions of the nerves get blocked

  20. Plastic Surgery Inclusion in the Undergraduate Medical Curriculum: Perception, Challenges, and Career Choice-A Comparative Study.

    Science.gov (United States)

    Farid, M; Vaughan, R; Thomas, S

    2017-01-01

    The undergraduate medical curriculum has been overcrowded with core learning outcomes with no formal exposure to plastic surgery. The aim of this study was to compare medical students from two educational settings for the basic understanding, preferred learning method, and factors influencing a career choice in plastic surgery. A prospective cohort study based on a web-based anonymous questionnaire sent to final year medical students at Birmingham University (United Kingdom), McGill University (Canada), and a control group (non-medical staff). The questions were about plastic surgery: (1) source of information and basic understanding; (2) undergraduate curriculum inclusion and preferred learning methods; (3) factors influencing a career choice. A similar questionnaire was sent to non-medical staff (control group). The data was analysed based on categorical outcomes (Chi-square χ2) and level of significance p ≤ 0.05. Questionnaire was analysed for 243 students (Birmingham, n = 171/332, 52%) (McGill n = 72/132, 54%). Birmingham students (14%) considered the word "plastic" synonymous with "cosmetic" more than McGill students (4%, p students (39%, p students and control group chose the media (70%, p students (67%) more than Birmingham (49%, p students (61%, p student groups considered a career in plastic surgery. Medical students recognised the need for plastic surgery inclusion in the undergraduate curriculum. There was a difference for plastic surgery source of information, operations, and preferred method of learning for students. The study highlighted the urgent need to reform plastic surgery undergraduate teaching in collaboration with national educational bodies worldwide.

  1. Influences on choice of surgery as a career: a study of consecutive cohorts in a medical school.

    Science.gov (United States)

    Sobral, Dejano T

    2006-06-01

    To examine the differential impact of person-based and programme-related features on graduates' dichotomous choice between surgical or non-surgical field specialties for first-year residency. A 10-year cohort study was conducted, following 578 students (55.4% male) who graduated from a university medical school during 1994-2003. Data were collected as follows: at the beginning of medical studies, on career preference and learning frame; during medical studies, on academic achievement, cross-year peer tutoring and selective clinical traineeship, and at graduation, on the first-year residency selected. Contingency and logistic regression analyses were performed, with graduates grouped by the dichotomous choice of surgery or not. Overall, 23% of graduates selected a first-year residency in surgery. Seven time-steady features related to this choice: male sex, high self-confidence, option of surgery at admission, active learning style, preference for surgery after Year 1, peer tutoring on clinical surgery, and selective training in clinical surgery. Logistic regression analysis, including all features, predicted 87.1% of the graduates' choices. Male sex, updated preference, peer tutoring and selective training were the most significant predictors in the pathway to choice. The relative roles of person-based and programme-related factors in the choice process are discussed. The findings suggest that for most students the choice of surgery derives from a temporal summation of influences that encompass entry and post-entry factors blended in variable patterns. It is likely that sex-unbiased peer tutoring and selective training supported the students' search process for personal compatibility with specialty-related domains of content and process.

  2. Using qualitative methods to understand the determinants of patients' willingness to pay for cataract surgery: a study in Tanzania.

    Science.gov (United States)

    Geneau, Robert; Massae, Patrick; Courtright, Paul; Lewallen, Susan

    2008-02-01

    Cataract is the leading cause of avoidable blindness in Africa. There are various documented barriers to the uptake of cataract surgery, cost being one of them. There is, however, little evidence regarding patients' willingness to pay (WTP) for cataract surgery in Africa and the best way to measure it. We conducted a grounded theory study in order to understand better cataract patients' WTP for surgery in Tanzania. A total of 47 cataract patients from three regions of Tanzania were interviewed. The interviews were tape-recorded and transcribed verbatim. The coding process involved identifying emerging themes and categories and their interconnection. Our study reveals that the main factors behind patients' WTP for cataract surgery are (1) the level of perceived need for sight and cataract surgery; (2) the decision-making processes at the family level and (3) the characteristics of local eye care programs. Our study shows that WTP concerns not only the patients but also their relatives. For most patients and families, the amount of $20-$30 is deemed reasonable for a sight-restoring procedure. It does not appear realistic for eye care program managers to charge the real cost of cataract surgery at present (about US $70-in Kilimanjaro). However, eye care programs can influence WTP for cataract surgery by providing quality services and by offering adequate counseling about the procedure. The qualitative findings enriched the interpretation of a previously reported quantitative survey and yield implications for both researchers and decision-makers using or relying on WTP methodologies in developing countries.

  3. Plastic Surgery Inclusion in the Undergraduate Medical Curriculum: Perception, Challenges, and Career Choice—A Comparative Study

    Directory of Open Access Journals (Sweden)

    M. Farid

    2017-01-01

    Full Text Available Objective. The undergraduate medical curriculum has been overcrowded with core learning outcomes with no formal exposure to plastic surgery. The aim of this study was to compare medical students from two educational settings for the basic understanding, preferred learning method, and factors influencing a career choice in plastic surgery. Design and Setting. A prospective cohort study based on a web-based anonymous questionnaire sent to final year medical students at Birmingham University (United Kingdom, McGill University (Canada, and a control group (non-medical staff. The questions were about plastic surgery: (1 source of information and basic understanding; (2 undergraduate curriculum inclusion and preferred learning methods; (3 factors influencing a career choice. A similar questionnaire was sent to non-medical staff (control group. The data was analysed based on categorical outcomes (Chi-square χ2 and level of significance p≤0.05. Results. Questionnaire was analysed for 243 students (Birmingham, n=171/332, 52% (McGill n=72/132, 54%. Birmingham students (14% considered the word “plastic” synonymous with “cosmetic” more than McGill students (4%, p<0.025. Teaching was the main source of knowledge for McGill students (39%, p<0.001 while Birmingham students and control group chose the media (70%, p<0.001. McGill students (67% more than Birmingham (49%, p<0.010 considered curriculum inclusion. The preferred learning method was lectures for McGill students (61%, p<0.01 but an optional module for Birmingham (61%. A similar proportion (18% from both student groups considered a career in plastic surgery. Conclusions. Medical students recognised the need for plastic surgery inclusion in the undergraduate curriculum. There was a difference for plastic surgery source of information, operations, and preferred method of learning for students. The study highlighted the urgent need to reform plastic surgery undergraduate teaching in

  4. [Comparative study between topical anesthesia and sub-Tenon's capsule anesthesia for cataract surgery].

    Science.gov (United States)

    Vielpeau, I; Billotte, C; Kreidie, J; Lecoq, P

    1999-02-01

    We performed a prospective study to compare two techniques of local anesthesia: topical and subtenon anesthesia. Twenty-five patients underwent cataract surgery on both eyes by phakoemulsification and insertion of foldable lenses in the capsular bag. The second eye was operated 24 hours after the first one. We evaluated patient confort, surgeon confort, surgical complications and pupillary diameter evolution during the procedure. 64% of patients preferred subtenon anesthesia procedure. Surgeon confort was better with subtenon anesthesia. No surgical complications occurred in either group. The pupillar diameter evolution was different, decreasing for about 25% for topical anesthesia and 15% for subtenon anesthesia. Subtenon anesthesia is more comfortable for the patient: deeper anesthesia, reliable, longer lasting; light tolerance is better. It is also more comfortable for the surgeon: better pupillar dilatation during the procedure. Topical anesthesia has inconstant efficiency.

  5. Airway management: A comparative study in cleft lip and palate repair surgery in children

    Science.gov (United States)

    Sen, Jayashree; Sen, Bitan

    2014-01-01

    Background: Cleft lip with or without palate is one of the common congenital malformations. Aim: To evaluate the per-operative complications of anesthesia, a comparative study was conducted in children using the endotracheal tubes available in the Institute so that the complications can be averted in future procedures. Materials and Methods: The rural population of Tripura, India. Result: Awareness was generated and the incidence of repair surgeries of cleft lip and palate was thus increased considerably in Dr. B. R. Ambedkar Memorial Teaching Hospital, Agartala, Tripura. Conclusion: The RAE tube has been found to be the choicest one and at a minimal risk for maintaining patients’ patent airway and other related complications. PMID:25886101

  6. Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

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    Nishimura, Reiki; Nagao, Kazuharu; Miyayama, Haruhiko [Kumamoto City Hospital (Japan)

    1999-09-01

    Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

  7. Bariatric surgery in young adults : A multicenter study into weight loss, dietary adherence, and quality of life

    NARCIS (Netherlands)

    de Jong, Marjolein M. C.; Hinnen, Chris

    Background: Numerous studies have demonstrated that bariatric surgery is an effective intervention for morbid obesity, but study samples are characterized by an underrepresentation of young adult patients. Objectives: The aim of this study was to evaluate weight loss, dietary adherence, and quality

  8. A study of patient satisfaction after cataract surgery with implantation of different types of intraocular lenses

    Directory of Open Access Journals (Sweden)

    Wei Ching-Kuo

    2012-10-01

    Full Text Available Abstract Background The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients’ decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. Methods This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one’s own expense, overall patient satisfaction and postoperative visual clarity. Results The results showed that the patient’s gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. Conclusions Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients.

  9. A study of patient satisfaction after cataract surgery with implantation of different types of intraocular lenses.

    Science.gov (United States)

    Wei, Ching-Kuo; Wang, Shun-Mu; Lin, Jen-Chieh

    2012-10-29

    The implementation of capitated payment has driven medical institutions through developing balance billing for medical services. By exploring the patients' decision-making factors on different self-pay items, a reference for the pricing and sales strategy for the related products can be formed. The major purposes of this study were to analyze the determinants of preoperative selection and postoperative satisfaction with implantation of different types of intraocular lenses in cataract surgery. This cross-sectional study consisted of 127 patients that were 50 years of age and older, and who had phacoemulsification with intraocular lens implantation in both eyes. Data were collected by using a structured questionnaire. The following parameters were measured: access to medical care, attitude towards receiving medical products at one's own expense, overall patient satisfaction and postoperative visual clarity. The results showed that the patient's gender, educational level and economic status influenced the type of intraocular lens chosen. Patients in the insurance group cared about access to medical care, and patients in the balance billing group cared about product differentiation. ANOVA results showed no statistically significant differences in the overall satisfaction of the patients among the groups with different types of intraocular lenses. Patients that received cataract surgery with implantation of multifocal intraocular lenses had better vision when trying to view smaller objects and when looking at objects under strong light. Manufacturers should increase the number of differences between their products, and health care providers can then recommend the appropriate intraocular lens in accordance with the needs or demands of their patients, and also by keeping in mind the financial constraints of their patients.

  10. Checklist to improve informed consent process in pediatric surgery: A pilot study.

    Science.gov (United States)

    Firdouse, Mohammed; Wajchendler, Amy; Koyle, Martin; Fecteau, Annie

    2017-05-01

    The purpose of this study was to develop and validate a checklist to standardize surgical informed consent process. A checklist was created following a literature search. Consent processes were observed from general surgery (GS) and urology (US) in the pre- and post-intervention phases. Competent patients/guardians were asked to complete a satisfaction questionnaire. All trainees and staff surgeons were interviewed on the checklist's utility. 73 observations (GS=39, US=34) and 66 observations (GS=30, US=36) were made in the pre- and post-intervention phase, respectively. Our checklist increased the frequency with which surgeons explained alternative treatments (pre-intervention 23.3% vs. post-intervention 81.8%), the role of trainees (15.1% vs. 72.7%), and the potential outcomes of not pursuing surgery (60.3% vs. 87.9%). The patient/guardian average satisfaction score increased between phases within GS (mean[standard deviation] 3.55[0.58] vs. 3.85[0.24]); p=0.002), but not within US (3.53[0.61] vs. 3.52[0.54]); p=0.705) or the overall sample (3.54[0.59] vs. 3.67[0.46]); p=0.329). Interestingly, there was no significant improvement in patient/guardian average anxiety levels in GS (X2=0.069, p=0.793), US (X2=0, p=1) or the overall sample (X2=0.143, p=0.706) following the intervention. Our checklist aids in standardizing the informed consent process. However, it did not significantly change satisfaction or anxiety levels of patients and guardians. Prognosis study. Level III. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Continuous intravenous analgesia with fentanyl or morphine after gynecological surgery: a cohort study.

    Science.gov (United States)

    Russo, Andrea; Grieco, Domenico Luca; Bevilacqua, Francesca; Anzellotti, Gian Marco; Scarano, Annamaria; Scambia, Giovanni; Costantini, Barbara; Marana, Elisabetta

    2017-02-01

    This retrospective study aims to compare postoperative pain relief offered by continuous intravenous infusion of either fentanyl or morphine. Sixty American Society of Anesthesiologists Physical Status I and II women who had undergone open gynecological surgery were enrolled. All patients received total intravenous postoperative analgesia for 24 h with continuous infusion of either fentanyl or morphine at comparable doses (38 patients received 0.3 µg/kg/h fentanyl and 22 received 0.02 mg/kg/h morphine). The primary endpoint was the need for analgesic rescue therapy during the postoperative period as assessed by an experienced nurse blinded to the design of the study, while the time to gastrointestinal bowel recovery was the main safety outcome measure. Visual analog scale was used to evaluate postoperative pain. Ramsay sedation score, multiparametric monitoring, bowel function and adverse effects were also recorded at 1, 6, 12, 18 and 24 h after the end of surgery. Data analysis showed that four patients (10 %) in the fentanyl group versus eight patients (36 %) in the morphine group needed to be treated with analgesic rescue drugs [unadjusted OR for fentanyl 0.2 (0.05-0.80); p = 0.02]. Patients treated with fentanyl showed a faster gastrointestinal recovery [1 (1-2) vs 3 (2.7-4) days; p fentanyl and morphine for postoperative pain relief is effective. In our cohort of patients, continuous intravenous infusion of fentanyl was associated with lower need for analgesic rescue drug, faster bowel recovery and shorter hospital length of stay.

  12. Use of Fentanyl in Adolescents with Clinically Severe Obesity Undergoing Bariatric Surgery: A Pilot Study.

    Science.gov (United States)

    Vaughns, Janelle D; Ziesenitz, Victoria C; Williams, Elaine F; Mushtaq, Alvina; Bachmann, Ricarda; Skopp, Gisela; Weiss, Johanna; Mikus, Gerd; van den Anker, Johannes N

    2017-06-01

    The number of obese pediatric patients requiring anesthesia is rapidly increasing. Although fentanyl is a commonly used narcotic during surgery, there are no pharmacokinetic (PK) data available for optimal dosing of fentanyl in adolescents with clinically severe obesity. An institutional review board-approved exploratory pilot study was conducted in six adolescents aged 14-19 years undergoing bariatric surgery. Mean total body weight (TBW) and mean BMI were 137.4 ± 14.3 kg and 49.6 ± 6.4 kg/m2 (99.5th BMI percentile), respectively. Fentanyl was administered intravenously for intraoperative analgesia based on ideal body weight per standard of care. PK blood samples were drawn over a 24-h post-dose period. Fentanyl PK parameters were calculated by non-compartmental analysis. Mean fentanyl AUC0-∞ was 1.5 ± 0.5 h·ng/mL. Systemic clearance of fentanyl was 1522 ± 310 mL/min and 11.2 ± 2.6 mL/min·kg TBW. Volume of distribution was 635 ± 282 L and 4.7 ± 2.1 L/kg TBW. While absolute clearance was increased, absolute volume of distribution was comparable to previously established adult values. These results suggest that fentanyl clearance is enhanced in adolescents with clinically severe obesity while volume of distribution is comparable to previously published studies. NCT01955993 (clinicaltrials.gov).

  13. [Neuropathological findings after cardiac surgery-retrospective study over 6 years].

    Science.gov (United States)

    Emmrich, P; Hahn, J; Ogunlade, V; Geiger, K; Schober, R; Mohr, F W

    2003-11-01

    Neuropathological studies may contribute to the discovery of central nervous system complications after heart surgery and thus help to reduce the incidence of postoperative neurological or cognitive disturbances. We examined the brains of 262 such patients operated for coronary bypass, valve replacement, or heart transplantation. Circulatory disturbances (macro- and microhemorrhages, infarcts, subarachnoid hemorrhages, and hypoxemic brain damage) were present in 128 cases (49%), as the cause of death in 33 cases (12.6%). The infarcts were caused by local arteriosclerosis of brain arteries, arterial emboli originating from the operative sites or myocardial infarctions, or by fat emboli, foreign body emboli or megakaryocytic capillary emboli in rare cases. Inflammatory disturbances were present in 17 cases and consisted of fungal or bacterial septicopyemic changes (12) or of glial nodules (5) as the substrate of a viral or autoimmunencephalitis (Bickerstaff). An incidental finding was Alzheimer's disease in 37 cases (14% of the material) of elderly patients, often associated with cerebral amyloid angiopathy but not as cause of death or cause of macroscopic brain hemorrhage. Since we have conducted an autopsy study, there is a limitation to transfer the documented changes to the total group of post-cardiac surgery patients with neurologic and cognitive deficits. Contrary to some previous reports, histologically overt microembolic phenomena do not seem to play a major role in our material. On the other hand, careful scrutiny revealed non-fatal white matter microhemorrhages of varying frequency in the different groups, especially after valve operations. These as well as the occasional glial nodules, after resorption and microscarring, could well be the cause of slight neurologic and cognitive impairments.

  14. Variables Influencing the Depth of Conscious Sedation in Plastic Surgery: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Hyeonjung Yeo

    2017-01-01

    Full Text Available BackgroundConscious sedation has been widely utilized in plastic surgery. However, inadequate research has been published evaluating adequate drug dosage and depth of sedation. In clinical practice, sedation is often inadequate or accompanied by complications when sedatives are administered according to body weight alone. The purpose of this study was to identify variables influencing the depth of sedation during conscious sedation for plastic surgery.MethodsThis prospective study evaluated 97 patients who underwent plastic surgical procedures under conscious sedation. Serum aspartate aminotransferase (AST, alanine aminotransferase (ALT, creatinine, and glucose levels were measured. Midazolam and ketamine were administered intravenously according to a preset protocol. Bispectral index (BIS recordings were obtained to evaluate the depth of sedation 4, 10, 15, and 20 minutes after midazolam administration. Associations between variables and the BIS were assessed using multiple regression analysis.ResultsAlcohol intake and female sex were positively associated with the mean BIS (P<0.01. Age was negatively associated with the mean BIS (P<0.01. Body mass index (P=0.263, creatinine clearance (P=0.832, smoking history (P=0.398, glucose (P=0.718, AST (P=0.729, and ALT (P=0.423 were not associated with the BIS.ConclusionsOlder patients tended to have a greater depth of sedation, whereas females and patients with greater alcohol intake had a shallower depth of sedation. Thus, precise dose adjustments of sedatives, accounting for not only weight but also age, sex, and alcohol consumption, are required to achieve safe, effective, and predictable conscious sedation.

  15. The effectiveness of Google GLASS as a vital signs monitor in surgery: A simulation study.

    Science.gov (United States)

    Iqbal, Mohammed Husnain; Aydin, Abdullatif; Lowdon, Alexandra; Ahmed, Hamza Ibn; Muir, Gordon H; Khan, M Shamim; Dasgupta, Prokar; Ahmed, Kamran

    2016-12-01

    To assess the effectiveness of the Google GLASS as a vital signs monitor in a surgical setting and identify potential uses. This prospective, observational and comparative study recruited novice (n = 24), intermediate (n = 8) and expert urologists (n = 5). All candidates performed a procedure on the GreenLight Simulator within a simulated setting using a standard vital signs monitor and then the Google GLASS. The time taken to respond to abnormal vital signs during both sessions was recorded. A quantitative survey was used to assess the usability and acceptability of the Google GLASS surgery. The majority (84%) of participants responded quicker to abnormal signs with the Google GLASS compared to a standard monitor (p = 0.0267). The average simulation score during a standard-monitor and GLASS-session scored to be statistically insignificant (p = 0.253). All parameters of simulation were also similar in both sessions including average sweep speed (p = 0.594), average blood loss (p = 0.761) and average grams vaporised (p = 0.102). Surgical performance between both sessions was similar and not hampered by the use of Google GLASS. Furthermore, 81% of candidates stated the GLASS was comfortable to wear during the procedure. This study has demonstrated that head-mounted displays such as the Google GLASS are potentially useful in surgery to aid patient care without hampering the surgeons view. It is hoped that the innovation and evolution of these devices triggers the potential future application of such devices within the medical field. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  16. Orthognathic Surgery

    DEFF Research Database (Denmark)

    Kjærgaard Larsen, Marie; Thygesen, Torben Henrik

    2016-01-01

    The literature shows that the indications for orthognathic surgery (OS) are often functional problems and unsatisfactory facial esthetics. This study investigated the esthetic outcomes and overall satisfaction following OS. Somatosensory change is a relatively common complication and its influence...... to sex, age, and somatosensory change. High satisfaction and improvement in facial esthetic after OS were seen. Young patients (16-25 years) and men indicated a higher degree of satisfaction than old (>25 years) patients and women. The use of social media seems to be an interesting platform...... on the level of satisfaction was studied. The social-networking web site Facebook was used to identify the study population. An online questionnaire was performed using the website SurveyMonkey. In all, 105 (9%) respondents from the Danish Facebook group about OS, called Kaebeoperation (jaw surgery), were...

  17. The Beneficial Effect of Hypnosis in Elective Cardiac Surgery: A Preliminary Study.

    Science.gov (United States)

    Akgul, Ahmet; Guner, Beyhan; Çırak, Musa; Çelik, Derya; Hergünsel, Oya; Bedirhan, Sevim

    2016-10-01

    Background Single-session hypnosis has never been evaluated as a premedication technique in patients undergoing coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the beneficial effects of clinical hypnotherapy on perioperative anxiety, pain perception, sedation, and necessity for ventilator assistance in patients undergoing CABG. Methods Double-blind, randomized, clinical trial was performed. Forty-four patients undergoing CABG surgery were randomized into two groups. The patients in group A received preprocedural hypnosis by an anesthesiologist. Patients in group B (control) had only information on the surgical intervention by the same anesthesiologist. State-Trait-Anxiety Index-I (STAI-I) and Beck Depression Inventory (BDI) were performed preoperatively in both groups. Visual analog scale (VAS) and Ramsay sedation scale (RSS) were evaluated on 0th, 1st, 2nd, 4th, 6th, 8th, 10th, 12th, and 24th hours, postoperatively. Postoperative anxiety level, analgesic drug consumption, and duration of ventilator assistance and intensive care unit (ICU) stay were also documented. Results When anxiety and depression levels were compared, significantly lower STA-I and BDI values were detected in group A after hypnotherapy (p = 0.001, p = 0.001, respectively). Significantly less total doses of remifentanil (34.4 ± 11.4 vs. 50.0 ± 13.6 mg) and morphine (4.9 ± 3.3 vs. 13.6 ± 2.7 mg) were administered in group A in the postoperative period. Ventilator assistance duration (6.8 ± 2.0 vs. 8.9 ± 2.7 hours) was also shorter in group A when compared with that in group B (p = 0.007). Conclusion Hypnosis session prior to surgery was an effective complementary method in decreasing presurgical anxiety, and it resulted in better pain control as well as reduced ventilator assistance following CABG surgery. Georg Thieme Verlag KG Stuttgart · New York.

  18. Can we predict a delirium after cardiac surgery? : A validation study of a delirium risk checklist

    NARCIS (Netherlands)

    ten Broeke, Miarca; Koster, Sandra; Konings, Thomas; Hensens, Ab G.; van der Palen, Job

    2017-01-01

    BACKGROUND: Delirium is a common temporary mental disorder that often occurs in patients who undergo cardiac surgery. It is important to prevent the negative side effects of delirium by identifying high-risk patients before surgery. Koster and colleagues designed a risk model to identify patients

  19. A comparative cross-sectional study on cosmetic outcomes after single port or conventional laparoscopic surgery.

    Science.gov (United States)

    Eom, Jeong Min; Ko, Jung Hwa; Choi, Joong Sub; Hong, Jin Hwa; Lee, Jung Hun

    2013-03-01

    The primary objective was to compare cosmetic outcomes and patients' satisfaction between women who underwent single port laparoscopic surgery (SP-LS) or conventional laparoscopic surgery (conventional-LS). The secondary objective was to evaluate the cosmetic effect of SP-LS in women with abdominal scars from prior surgeries. Patients who were followed up after SP-LS or conventional-LS for gynecologic disease were included. Cosmetic outcome was evaluated at least six months after surgery. Objective and subjective scar analysis were performed using the Vancouver scar scale, the patient and observer scar assessment scale (POSAS), and a visual analog scale (VAS). Overall satisfaction with the surgery was evaluated with VAS. 130 women were included, with 65 women in each group. No difference in objective scar assessment for only umbilical scar was shown. In the subjective scar assessment and satisfaction with the surgery, SP-LS group was more satisfied. SP-LS group with abdominal scar had higher satisfaction in overall satisfaction with the scar. SP-LS offers better cosmesis and overall patient satisfaction with surgery in women with gynecologic disease. SP-LS also seems to have considerable cosmetic benefit in women with abdominal scars from prior surgeries. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  20. Partners' experiences of the postdischarge period after day surgery - a qualitative study

    DEFF Research Database (Denmark)

    Majholm, Birgitte; Esbensen, Bente A; Thomsen, Thordis

    2012-01-01

    are now carried out on a day surgery basis, shifting responsibility of care to patients and their partners/relatives. Little is known about how partners of day surgery patients manage this responsibility. Design.  Qualitative descriptive. Methods.  Individual semi-structured interviews with 11 partners...

  1. A comparative study on Benzydamine HCL 0.5% and Acetaminophen Codeine in pain reduction following periodontal surgery

    Directory of Open Access Journals (Sweden)

    Khoshkhoonejad AA.

    2004-07-01

    Full Text Available Statement of Problem: Systemic analgesics are frequently prescribed for pain reduction following periodontal surgery. This type of treatment, however, brings about some disadvantages due to its late effect and inherent side effects. Benzydamine hydrochloride mouth wash is a non steroidal anti-inflammatory drug with local anaesthetic properties. Side effects of benzydamine are minor such as tissue numbness, burning and stinging. It brings relief to pain and inflammation rapidly. Purpose: The goal of this study was to compare benzydamine HCL 0.15% and Acetaminophen codeine as analgesics following periodontal surgery. Materials and Methods: This clinical study was performed on 18 patients referred to periodontics Department, Faculty of Dentistry, Tehran University of Medical Sciences. All patients were affected with chronic mild or moderate periodontitis and required surgery at least at two oral sites with similar lesions. Each patient received benzdamine HCL after first surgery and Acetaminophen codein following second operation. Pain reduction was evaluated by Visual Analog Scale (VAS. Data were analyzed with Wilcoxon-Signed and Mann-Whitney non-parametric tests. Results: Analgesic effect of Acetaminophene codeine was significantly more than that of benzydamine HCL following Reriodontal surgery (P=0.008. No significant difference was found between analgesic effects of Acetaminophene codeine and benzydamine HCL in patients with chronic mild periodontitis (P=0.9, and in cases that osteoplasty (P=0-31 or no osseous surgery (P=0.18 were performed. Conclusion: In cases with mild post-operative pain following periodontal surgery, Benzydamine HCL and be prescribed as an analgesic. However, in other cases this mouth wash should be prescribed along with Acetaminophene codein to reduce systemic drugs consumption.

  2. The effect of colorectal surgery in female sexual function, body image, self-esteem and general health: a prospective study.

    Science.gov (United States)

    da Silva, Giovanna M; Hull, Tracy; Roberts, Patricia L; Ruiz, Dan E; Wexner, Steven D; Weiss, Eric G; Nogueras, Juan J; Daniel, Norma; Bast, Jane; Hammel, Jeff; Sands, Dana

    2008-08-01

    To evaluate women's sexual function, self-esteem, body image, and health-related quality of life after colorectal surgery. Current literature lacks prospective studies that evaluate female sexuality/quality of life after colorectal surgery using validated instruments. Sexual function, self-esteem, body image, and general health of female patients undergoing colorectal surgery were evaluated preoperatively, at 6 and 12 months after surgery, using the Female Sexual Function Index, Rosenberg Self-Esteem scale, Body Image scale and SF-36, respectively. Ninety-three women with a mean age of 43.0 +/- 11.6 years old were enrolled in the study. Fifty-seven (61.3%) patients underwent pelvic and 36 (38.7%) underwent abdominal procedures. There was a significant deterioration in overall sexual function at 6 months after surgery, with a partial recovery at 12 months (P = 0.02). Self-esteem did not change significantly after surgery. Body image improved, with slight changes at 6 months and significant improvement at 12 months, compared with baseline (P = 0.05). Similarly, mental status improved over time with significant improvement at 12 months, with values superior than baseline (P = 0.007). Physical recovery was significantly better than baseline in the first 6 months after surgery with no significant further improvement between 6 and 12 months. Overall, there were no differences between patients who had abdominal procedures and those who underwent pelvic dissection, except that patients from the former group had faster physical recovery than patients in the latter (P = 0.031). When asked about the importance of discussing sexual issues, 81.4% of the woman stated it to be extremely or somewhat important. Surgical treatment of colorectal diseases leads to improvement in global quality of life. There is, however, a significant decline in sexual function postoperatively. Preoperative counseling is desired by most of the patients.

  3. A Pilot Study on Telephone Cognitive Behavioral Therapy for Patients Six-Months Post-Bariatric Surgery.

    Science.gov (United States)

    Sockalingam, Sanjeev; Cassin, Stephanie E; Wnuk, Susan; Du, Chau; Jackson, Timothy; Hawa, Raed; Parikh, Sagar V

    2017-03-01

    This study aimed to determine the feasibility and preliminary efficacy of a post-operative telephone-based cognitive behavioral therapy intervention (Tele-CBT) in improving eating pathology and psychosocial functioning. Six-month post-operative bariatric surgery patients (n = 19) received six sessions of Tele-CBT. Study outcome variables included binge eating (BES), emotional eating (EES), depressive symptoms (PHQ-9), and anxiety symptoms (GAD-7). Retention was 73.7 % post-intervention. Tele-CBT resulted in significant reductions in mean difference scores on BES, EES-Total, EES-Anxiety, EES-Anger, PHQ9, and GAD7. Tele-CBT patients experienced a mean weight loss of 8.62 ± 15.02 kg between 6-months post-surgery (pre-Tele-CBT) and 12-months post-surgery. These preliminary results suggest that post-surgery Tele-CBT is feasible and can improve post-surgery symptoms of psychopathology in this uncontrolled study, supporting the need for a randomized controlled trial.

  4. A Pilot Study on Telephone Cognitive Behavioral Therapy for Patients Six-Months Post-Bariatric Surgery

    Science.gov (United States)

    Cassin, Stephanie E.; Wnuk, Susan; Du, Chau; Jackson, Timothy; Hawa, Raed; Parikh, Sagar V.

    2017-01-01

    Objective This study aimed to determine the feasibility and preliminary efficacy of a post-operative telephone-based cognitive behavioral therapy intervention (Tele-CBT) in improving eating pathology and psychosocial functioning. Methods Six-month post-operative bariatric surgery patients (n = 19) received six sessions of Tele-CBT. Study outcome variables included binge eating (BES), emotional eating (EES), depressive symptoms (PHQ-9), and anxiety symptoms (GAD-7). Results Retention was 73.7 % post-intervention. Tele-CBT resulted in significant reductions in mean difference scores on BES, EES-Total, EES-Anxiety, EES-Anger, PHQ9, and GAD7. Tele-CBT patients experienced a mean weight loss of 8.62 ± 15.02 kg between 6-months post-surgery (pre-Tele-CBT) and 12-months post-surgery. Conclusions These preliminary results suggest that post-surgery Tele-CBT is feasible and can improve post-surgery symptoms of psychopathology in this uncontrolled study, supporting the need for a randomized controlled trial. PMID:27491293

  5. Wound contamination in cardiac surgery. A systematic quantitative and qualitative study of the bacterial growth in sternal wounds in cardiac surgery patients.

    Science.gov (United States)

    Kühme, Tobias; Isaksson, Barbro; Dahlin, Lars-Göran

    2007-09-01

    To investigate the degree of bacterial contamination in the sternal wound during cardiac surgery and the sternal skin flora after operation in order to increase our understanding of the pathogenesis of sternal wound infections. Prospective study where cultures were taken peri- and postoperatively from sternal wounds and skin. University Hospital. 201 cardiac surgery patients. 89% of the patients grew bacteria from the subcutaneous sternal tissue. 98% of the patients showed bacterial growth on the surrounding skin at the end of the operation. We found both commensal and nosocomial bacteria in the sternal wound. These bacteria had different temporal distribution patterns. Coagulase-negative staphylococci (CoNS) and Propionibacterium acnes (PA) were by far the most prevalent bacteria during and after the operation. Furthermore, 41% of patients had more than 10,000 CFU/pad CoNS on the skin. There was no correlation between length of operation and number of bacteria. Men displayed higher bacterial counts than women on the skin. Skin preparation with ethanol/chlorhexidine is unable to suppress the physiological skin flora for the duration of a heart operation. A decrease of CoNS and PA postoperatively can be caused by competitive recolonisation of commensal and nosocomial bacteria.

  6. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care.

    Directory of Open Access Journals (Sweden)

    Ian J Douglas

    2015-12-01

    Full Text Available Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities.This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM, hypertension, angina, myocardial infarction (MI, stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88-5.08. Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo and sleeve gastrectomy (6.29 kg/mo were associated with greater initial weight reduction than gastric banding (2.77 kg/mo. Protective hazard ratios (HRs were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55-0.83; hypertension, 0.35 (95% CI 0.27-0.45; angina, 0.59 (95% CI 0.40-0.87;MI, 0.28 (95% CI 0.10-0.74; and obstructive sleep apnoea, 0.55 (95% CI 0.40-0.87. Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84-12.62, and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI

  7. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care.

    Science.gov (United States)

    Douglas, Ian J; Bhaskaran, Krishnan; Batterham, Rachel L; Smeeth, Liam

    2015-12-01

    Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities. This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88-5.08). Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55-0.83); hypertension, 0.35 (95% CI 0.27-0.45); angina, 0.59 (95% CI 0.40-0.87);MI, 0.28 (95% CI 0.10-0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40-0.87). Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84-12.62), and between bariatric surgery and the resolution of hypertension, with a HR of 5.64 (95% CI 2

  8. Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care

    Science.gov (United States)

    Douglas, Ian J.; Bhaskaran, Krishnan; Batterham, Rachel L.; Smeeth, Liam

    2015-01-01

    Background Bariatric surgery is becoming a more widespread treatment for obesity. Comprehensive evidence of the long-term effects of contemporary surgery on a broad range of clinical outcomes in large populations treated in routine clinical practice is lacking. The objective of this study was to measure the association between bariatric surgery, weight, body mass index, and obesity-related co-morbidities. Methods and Findings This was an observational retrospective cohort study using data from the United Kingdom Clinical Practice Research Datalink. All 3,882 patients registered in the database and with bariatric surgery on or before 31 December 2014 were included and matched by propensity score to 3,882 obese patients without surgery. The main outcome measures were change in weight and body mass index over 4 y; incident diagnoses of type 2 diabetes mellitus (T2DM), hypertension, angina, myocardial infarction (MI), stroke, fractures, obstructive sleep apnoea, and cancer; mortality; and resolution of hypertension and T2DM. Weight measures were available for 3,847 patients between 1 and 4 mo, 2,884 patients between 5 and 12 mo, and 2,258 patients between 13 and 48 mo post-procedure. Bariatric surgery patients exhibited rapid weight loss for the first four postoperative months, at a rate of 4.98 kg/mo (95% CI 4.88–5.08). Slower weight loss was sustained to the end of 4 y. Gastric bypass (6.56 kg/mo) and sleeve gastrectomy (6.29 kg/mo) were associated with greater initial weight reduction than gastric banding (2.77 kg/mo). Protective hazard ratios (HRs) were detected for bariatric surgery for incident T2DM, 0.68 (95% CI 0.55–0.83); hypertension, 0.35 (95% CI 0.27–0.45); angina, 0.59 (95% CI 0.40–0.87);MI, 0.28 (95% CI 0.10–0.74); and obstructive sleep apnoea, 0.55 (95% CI 0.40–0.87). Strong associations were found between bariatric surgery and the resolution of T2DM, with a HR of 9.29 (95% CI 6.84–12.62), and between bariatric surgery and the resolution of

  9. Anterior Chamber Depth Change Following Cataract Surgery in Pseudoexfoliation Syndrome; a Preliminary Study.

    Science.gov (United States)

    Fallah Tafti, Mohammad Reza; Abdollah Beiki, Hossein; Mohammadi, S Farzad; Latifi, Golshan; Ashrafi, Elham; Fallah Tafti, Zahra

    2017-01-01

    To assess the pseudophakic anterior chamber depth (PP-ACD) or effective lens position (ELP) change after cataract surgery in patients with pseudoexfoliation syndrome (PEX). Consecutive eyes with PEX and cataract underwent standard phacoemulsification and were implanted with single-piece acrylic posterior chamber intraocular lenses (IOLs). Eyes with severe PEX and with axial length (AL) greater than 24 mm or less than 22 mm were not included. Eyes with capsular complication or unstable bags that needed capsular tension ring insertion were excluded. The SRK-II formula was applied to calculate IOL power for postoperative emmetropia. PP-ACD or ELP was measured using anterior segment optical coherence tomography. Data obtained at one and six months post operation were evaluated during analysis. Twenty-six eyes of 26 subjects (mean age: 72 years; range: 60-84 years) were studied. PP-ACD was deepened (mean change: 0.08 mm) and a concurrent hyperopic shift (0.3 D) was observed postoperatively between month 1 and month 6 (P values ≤0.002). PP-ACD and postoperative refraction changes were correlated with age and AL (P values < 0.025), respectively. Increased hyperopic shift and PP-ACD deepening in eyes with posterior capsule opacification (PCO) was noted postoperatively at six months, but the difference was not statistically significant (P values = 0.15 and 0.2, respectively). After cataract surgery in eyes with PEX syndrome, a significant backward movement of the IOL occurs postoperatively in the first six months, which is associated with a concurrent small hyperopic shift.

  10. Is surgery recommended in adults with neglected congenital muscular torticollis? A prospective study

    Directory of Open Access Journals (Sweden)

    Sharifi Reza

    2008-11-01

    Full Text Available Abstract Background Congenital muscular torticollis is the third most common congenital musculoskeletal anomaly after dislocation of the hip and clubfoot. When diagnosed early, it is obvious that it can be managed with good or excellent results. The aim of this prospective study was to determine the efficacy of surgery in neglected adult cases. Methods From January 2003 to June 2007, 18 adult skeletally matured patients were surgically treated for neglected congenital muscular torticollis and prospectively followed (at least one year. Bipolar release was performed in all patients. Radiography and the modified Lee's scoring system which included function and cosmesis, were used to measure the surgical results. Complications were also recorded. Results Four cases were lost during follow-up. Of the remaining 14 patients, 10 cases were males and 4 females. The age at operation ranged from 18 to 32 (average 21.9 years. The mean follow-up period was 2.5 years (range 1–5 years. Excellent results were noted in 7 patients, good in 5, and poor in 2 patients. Significant improvement (>10° of the cervico-thoracic scoliosis was noted only in 3 of 10 patients. Conclusion Patients with congenital muscular torticollis can benefit from surgical treatment even in adulthood. Surgical bipolar sectioning of the sternocleidomastoid muscle should be considered even in adults with irreversible facial and skeletal deformities. The surgery restores the range of neck motion and resolves the head tilt; therefore it can improve the quality of life. This procedure is an effective and relatively complication-free method.

  11. Surgery and Adjuvant Chemotherapy Use Among Veterans With Colon Cancer: Insights From a California Study

    Science.gov (United States)

    Hynes, Denise M.; Tarlov, Elizabeth; Durazo-Arvizu, Ramon; Perrin, Ruth; Zhang, Qiuying; Weichle, Thomas; Ferreira, M. Rosario; Lee, Todd; Benson, Al B.; Bhoopalam, Nirmala; Bennett, Charles L.

    2010-01-01

    Purpose US veterans have been shown to be a vulnerable population with high cancer rates, and cancer care quality in Veterans Affairs (VA) hospitals is the focus of a congressionally mandated review. We examined rates of surgery and chemotherapy use among veterans with colon cancer at VA and non-VA facilities in California to gain insight into factors associated with quality of cancer care. Methods A retrospective cohort of incident colon cancer patients from the California Cancer Registry, who were ≥ 66 years old and eligible to use VA and Medicare between 1999 and 2001, were observed for 6 months after diagnosis. Results Among 601 veterans with colon cancer, 72% were initially diagnosed and treated in non-VA facilities. Among veterans with stage I to III cancer, those diagnosed and initially treated in VA facilities experienced similar colectomy rates as those at non-VA facilities. Stage III patients diagnosed and initially treated in VA versus non-VA facilities had similar odds of receiving adjuvant chemotherapy. In both settings, older patients had lower odds of receiving chemotherapy than their younger counterparts even when race and comorbidity were considered (age 76 to 85 years: odds ratio [OR] = 0.18; 95% CI, 0.07 to 0.46; age ≥ 86 years: OR = 0.17; 95% CI, 0.04 to 0.73). Conclusion In California, older veterans with colon cancer used both VA and non-VA facilities for cancer treatment, and odds of receiving cancer-directed surgery and chemotherapy were similar in both systems. Among stage III patients, older age lowered odds of receiving adjuvant chemotherapy in both systems. Further studies should continue to explore potential health system effects on quality of colon cancer care across the United States. PMID:20406940

  12. Psychiatric comorbidity as predictor of costs in back pain patients undergoing disc surgery: a longitudinal observational study

    Directory of Open Access Journals (Sweden)

    Konnopka Alexander

    2012-09-01

    Full Text Available Abstract Background Psychiatric comorbidity is common in back pain patients undergoing disc surgery and increases economic costs in many areas of health. The objective of this study was to analyse psychiatric comorbidity as predictor of direct and indirect costs in back pain patients undergoing disc surgery in a longitudinal study design. Methods A sample of 531 back pain patients was interviewed after an initial disc surgery (T0, 3 months (T1 and 15 months (T2 using the Composite International Diagnostic Interview to assess psychiatric comorbidity and a modified version of the Client Sociodemographic and Service Receipt Inventory to assess resource utilization and lost productivity for a 3-month period prior interview. Health care utilization was monetarily valued by unit costs and productivity by labour costs. Costs were analysed using random coefficient models and bootstrap techniques. Results Psychiatric comorbidity was associated with significantly (p  Conclusion Psychiatric comorbidity presents an important predictor of direct and indirect costs in back pain patients undergoing disc surgery, even if patients do not utilize mental health care. This effect seems to be stable over time. More attention should be given to psychiatric comorbidity and cost-effective treatments should be applied to treat psychiatric comorbidity in back pain patients undergoing disc surgery to reduce health care utilization and costs associated with psychiatric comorbidity.

  13. Self-assessment of facial form oral function and psychosocial function before and after orthognathic surgery: A retrospective study

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    Narayanan Vinod

    2008-01-01

    Full Text Available Orthognathic surgery is a well-accepted treatment for patients with skeletal discrepancies. The primary motivation of many patients who seek orthognathic surgery is esthetics and not for correction of functional disability. The treatment is incomplete if the surgeon attempts to correct the physical deformity alone without adequate understanding and regard for the emotional framework. The purpose of this study is aimed at patient′s self-perceptions of facial form oral function and psychosocial function before and after orthognathic surgery. Fifty patients were included in the study, of which 21 were used as control. Twenty-two questions were asked to evaluate the problem in all four areas as mentioned earlier. Each question takes a score from one to five. In group I, the internal consistency of each scale indicates moderate to high internal reliability, ranging from α = 0.71 for general health to α = 0.88 for psychosocial problem. In group II, except for functional problems, the internal consistency of each scale has moderate to high reliability. The psychological wellbeing of an orthognathic surgery patient is enhanced by careful preoperative counseling regarding the expected surgical treatment objectives, the operative course, and the expected postoperative sequelae. Patients who undergo orthognathic surgery readily accept the changes in their postoperative appearance and are satisfied with achieved results.

  14. Self-assessment of facial form oral function and psychosocial function before and after orthognathic surgery: a retrospective study.

    Science.gov (United States)

    Narayanan, Vinod; Guhan, Shankar; Sreekumar, K; Ramadorai, Ashok

    2008-01-01

    Orthognathic surgery is a well-accepted treatment for patients with skeletal discrepancies. The primary motivation of many patients who seek orthognathic surgery is esthetics and not for correction of functional disability. The treatment is incomplete if the surgeon attempts to correct the physical deformity alone without adequate understanding and regard for the emotional framework. The purpose of this study is aimed at patient's self-perceptions of facial form oral function and psychosocial function before and after orthognathic surgery. Fifty patients were included in the study, of which 21 were used as control. Twenty-two questions were asked to evaluate the problem in all four areas as mentioned earlier. Each question takes a score from one to five. In group I, the internal consistency of each scale indicates moderate to high internal reliability, ranging from alpha = 0.71 for general health to alpha = 0.88 for psychosocial problem. In group II, except for functional problems, the internal consistency of each scale has moderate to high reliability. The psychological wellbeing of an orthognathic surgery patient is enhanced by careful preoperative counseling regarding the expected surgical treatment objectives, the operative course, and the expected postoperative sequelae. Patients who undergo orthognathic surgery readily accept the changes in their postoperative appearance and are satisfied with achieved results.

  15. Perception of control over eating after bariatric surgery for super-obesity--a 2-year follow-up study.

    Science.gov (United States)

    Engström, My; Forsberg, Anna; Søvik, Torgeir T; Olbers, Torsten; Lönroth, Hans; Karlsson, Jan

    2015-06-01

    Physiological and psychosocial factors might contribute to differences in weight loss, eating behaviour and health-related quality of life (HRQoL) after bariatric surgery. The aim of this study was to investigate how perceived control over eating changes after bariatric surgery and whether it affects outcome in super-obese patients. In a retrospective analysis of a prospective study (n = 60), 49 patients were divided into two groups based on eating control 2 years after surgery, as assessed by the Three-Factor Eating Questionnaire-R21 (TFEQ-R21): 29 with good eating control (GC) and 20 patients with poor eating control (group PC). Eating behaviour and generic and condition-specific HRQoL was assessed by questionnaires. There were significant differences in all TFEQ-R21 domains 2 years after surgery in favour of group GC; uncontrolled eating p eating p obese patients, perceived poor control over eating 2 years after bariatric surgery was associated with lower HRQoL and more emotional and cognitive restraint eating, than good control overeating.

  16. Costs and Outcomes of Increasing Access to Bariatric Surgery: Cohort Study and Cost-Effectiveness Analysis Using Electronic Health Records.

    Science.gov (United States)

    Gulliford, Martin C; Charlton, Judith; Prevost, Toby; Booth, Helen; Fildes, Alison; Ashworth, Mark; Littlejohns, Peter; Reddy, Marcus; Khan, Omar; Rudisill, Caroline

    2017-01-01

    To estimate costs and outcomes of increasing access to bariatric surgery in obese adults and in population subgroups of age, sex, deprivation, comorbidity, and obesity category. A cohort study was conducted using primary care electronic health records, with linked hospital utilization data, for 3,045 participants who underwent bariatric surgery and 247,537 participants who did not undergo bariatric surgery. Epidemiological analyses informed a probabilistic Markov model to compare bariatric surgery, including equal proportions with adjustable gastric banding, gastric bypass, and sleeve gastrectomy, with standard nonsurgical management of obesity. Outcomes were quality-adjusted life-years (QALYs) and net monetary benefits at a threshold of £30,000 per QALY. In a UK population of 250,000 adults, there may be 7,163 people with morbid obesity including 1,406 with diabetes. The immediate cost of 1,000 bariatric surgical procedures is £9.16 million, with incremental discounted lifetime health care costs of £15.26 million (95% confidence interval £15.18-£15.36 million). Patient-years with diabetes mellitus will decrease by 8,320 (range 8,123-8,502). Incremental QALYs will increase by 2,142 (range 2,032-2,256). The estimated cost per QALY gained is £7,129 (range £6,775-£7,506). Net monetary benefits will be £49.02 million (range £45.72-£52.41 million). Estimates are similar for subgroups of age, sex, and deprivation. Bariatric surgery remains cost-effective if the procedure is twice as costly, or if intervention effect declines over time. Diverse obese individuals may benefit from bariatric surgery at acceptable cost. Bariatric surgery is not cost-saving, but increased health care costs are exceeded by health benefits to obese individuals. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  17. Trans-oral robotic cleft surgery (TORCS) for palate and posterior pharyngeal wall reconstruction: A feasibility study.

    Science.gov (United States)

    Khan, Khurram; Dobbs, Tom; Swan, Marc C; Weinstein, Gregory S; Goodacre, Tim E E

    2016-01-01

    Robot-assisted surgery has become increasingly routine, replacing open and laparoscopic techniques in certain domains, with recent extension to head and neck surgery through trans-oral access. Some advantages of the robot-assisted surgery include the ability to access confined spaces, enhanced dexterity instrumentation with intuitive movement, motion scaling, tremor elimination and three-dimensional (3D) endoscopic viewing with true depth perception. The aim of this study was to investigate the technical feasibility of trans-oral robotic cleft surgery (TORCS) to access the posterior pharyngeal wall and palate for potential use in the cleft population. All possible permutations of patient and robotic instrument configurations were used with the daVinci Si Surgical System® (Intuitive Surgical, USA) 0° and 30° 3D endoscopes and 8-mm training instruments to determine the optimal visualization and surgical access to the palate and posterior pharynx in a paediatric airway manikin, and to simulate posterior pharyngeal wall surgery. A full robot-assisted cadaveric Hynes pharyngoplasty was performed using 5-mm training instruments. Experiments were recorded with still and video photography. TORCS is technically feasible in the paediatric cleft population. We predict a short learning curve due to the intuitive instrumentation, easier dissection and the potential to limit secondary insult compared with traditional surgery, as well as improved ergonomics for the operating surgeon. The as-yet unreported use of robotic-assisted cleft palate surgery may considerably enhance a surgeon's ability to perform difficult procedures of the palate and posterior pharynx in selected patients with limited access as well as lay the foundation for potential novel techniques. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Dexmedetomidine as intramuscular premedication for day-case cataract surgery. A comparative study of dexmedetomidine, midazolam and placebo.

    Science.gov (United States)

    Virkkilä, M; Ali-Melkkilä, T; Kanto, J; Turunen, J; Scheinin, H

    1994-10-01

    The effects of dexmedetomidine 1.0 microgram.kg-1, midazolam 20 micrograms.kg-1 and saline placebo were assessed in a double-blind, randomised study in 90 patients undergoing day-case cataract surgery under regional anaesthesia. The trial drug was injected into the deltoid muscle 45 min before the peri-ocular block. Dexmedetomidine 1.0 microgram.kg-1 decreased intra-ocular pressure before, during and after surgery. The maximum reduction in mean (SD) intra-ocular pressure occurred in the dexmedetomine group just before discharge from hospital (17.7 (2.8) mmHg to 11.5 (2.9) mmHg) (p study period (p case cataract surgery under regional anaesthesia.

  19. Results of Database Studies in Spine Surgery Can Be Influenced by Missing Data.

    Science.gov (United States)

    Basques, Bryce A; McLynn, Ryan P; Fice, Michael P; Samuel, Andre M; Lukasiewicz, Adam M; Bohl, Daniel D; Ahn, Junyoung; Singh, Kern; Grauer, Jonathan N

    2017-12-01

    National databases are increasingly being used for research in spine surgery; however, one limitation of such databases that has received sparse mention is the frequency of missing data. Studies using these databases often do not emphasize the percentage of missing data for each variable used and do not specify how patients with missing data are incorporated into analyses. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to examine whether different treatments of missing data can influence the results of spine studies. (1) What is the frequency of missing data fields for demographics, medical comorbidities, preoperative laboratory values, operating room times, and length of stay recorded in ACS-NSQIP? (2) Using three common approaches to handling missing data, how frequently do those approaches agree in terms of finding particular variables to be associated with adverse events? (3) Do different approaches to handling missing data influence the outcomes and effect sizes of an analysis testing for an association with these variables with occurrence of adverse events? Patients who underwent spine surgery between 2005 and 2013 were identified from the ACS-NSQIP database. A total of 88,471 patients undergoing spine surgery were identified. The most common procedures were anterior cervical discectomy and fusion, lumbar decompression, and lumbar fusion. Demographics, comorbidities, and perioperative laboratory values were tabulated for each patient, and the percent of missing data was noted for each variable. These variables were tested for an association with "any adverse event" using three separate multivariate regressions that used the most common treatments for missing data. In the first regression, patients with any missing data were excluded. In the second regression, missing data were treated as a negative or "reference" value; for continuous variables, the mean of each variable's reference range

  20. What Are the Strength of Recommendations and Methodologic Reporting in Health Economic Studies in Orthopaedic Surgery?

    Science.gov (United States)

    Makhni, Eric C; Steinhaus, Michael E; Swart, Eric; Bozic, Kevin J

    2015-10-01

    Cost-effectiveness research is an increasingly used tool in evaluating treatments in orthopaedic surgery. Without high-quality primary-source data, the results of a cost-effectiveness study are either unreliable or heavily dependent on sensitivity analyses of the findings from the source studies. However, to our knowledge, the strength of recommendations provided by these studies in orthopaedics has not been studied. We asked: (1) What are the strengths of recommendations in recent orthopaedic cost-effectiveness studies? (2) What are the reasons authors cite for weak recommendations? (3) What are the methodologic reporting practices used by these studies? The titles of all articles published in six different orthopaedic journals from January 1, 2004, through April 1, 2014, were scanned for original health economics studies comparing two different types of treatment or intervention. The full texts of included studies were reviewed to determine the strength of recommendations determined subjectively by our study team, with studies providing equivocal conclusions stemming from a lack or uncertainty surrounding key primary data classified as weak and those with definitive conclusions not lacking in high-quality primary data classified as strong. The reasons underlying a weak designation were noted, and methodologic practices reported in each of the studies were examined using a validated instrument. A total of 79 articles met our prespecified inclusion criteria and were evaluated in depth. Of the articles included, 50 (63%) provided strong recommendations, whereas 29 (37%) provided weak recommendations. Of the 29 studies, clinical outcomes data were cited in 26 references as being insufficient to provide definitive conclusions, whereas cost and utility data were cited in 13 and seven articles, respectively. Methodologic reporting practices varied greatly, with mixed adherence to framing, costs, and results reporting. The framing variables included clearly defined

  1. A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

    Science.gov (United States)

    Stuedemann, Anne E; Schwend, Richard M; Thomas, Valorie K; Leamon, Julia M; Lightner, Tammy S

    2018-03-01

    Pediatric patients undergoing surgery for spinal deformity may benefit from central venous access to provide intraoperative monitoring and fluid resuscitation. For pediatric surgical patients requiring central access, we hypothesized that placing a peripherally inserted central catheter (PICC) line preoperatively should decrease time from induction of anesthesia to incision and result in improved patient safety and decreased operating room charges. This was a retrospective, nonrandomized, and case comparison study. Clinical records of all children with adolescent idiopathic scoliosis or neuromuscular scoliosis treated surgically by the senior author between December 2007 and April 2012 were reviewed. Control group patients had a central venous catheter (CVC) placed by the anesthesiologist after induction of anesthesia. The trial group had a PICC placed under local anesthesia the day before surgery by an experienced vascular access team. The time from induction of anesthesia to the time for the surgical incision was determined for each study group. The CVC line placement charges were determined by the operating room time charges at $214/min. Charges saved were the mean time difference multiplied by the operating room time charge, less the charge for PICC line insertion ($1282). There were 29 neuromuscular patients, the mean age was 13 years (SD: 4 years). The mean time from induction to incision for the PICC group was 91 min [95% confidence interval (CI): 67-115 min] and for the CVC group 113 min (95% CI: 99-127 min, P=0.083). For this mean time difference of 22 min, the estimated cost savings would be $3426 per patient. There were 59 patients with adolescent idiopathic scoliosis, the mean age was 14 years (SD: 2 years). The mean time from induction to incision for the PICC group was 78 min (95% CI: 74-82 min) and for the CVC group 106 min (95% CI: 96-116  min, P≤0.001). For this mean time difference of 28 min, the estimated cost savings would

  2. Postoperative wound infection in patients undergoing coronary artery bypass graft surgery: A prospective study with evaluation of risk factors

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    Bhatia J

    2003-01-01

    Full Text Available PURPOSE: Wound infection is an important cause of morbidity and occasional mortality after coronary artery bypass graft surgery (CABG. The aim of this study was to report postoperative wound infection in CABG surgery patients. METHODS: Consecutive patients undergoing CABG surgery between January 1998 and October 1999 have been studied. The exclusion criteria included, age less than 30 years, penicillin / cephalosporin allergy and associated other cardiac pathologies. The parameters studied were age, sex, obesity, hypertension, diabetes, myocardial infarction, chronic renal failure, previous surgeries, alcohol consumption, smoking, length of pre and postoperative hospital stay, antibiotic prophylaxis, MRSA screening, and duration of surgery. Wounds were classified as per modified CDC′s NNIS criteria. Suspected sites of infection were cultured and antibiotic susceptibility of cultured organisms was tested. Postoperative follow up was for two months. RESULTS: Six hundred and fifteen patients were studied. Of these 116 (18.86% developed SSI, involving sternum 75%, leg 21.3%, and forearm sites 3.44%. Organisms isolated at sternum site were MSSE, MRSA, and MRSE, at leg site E. coli and MSSE, and at forearm site MSSE and MSSA. Sternal site, obesity, diabetes mellitus and female sex were associated with significantly higher infection rates (p= 0.001. No antibiotic protocol proved more effective. SSI increased the postoperative hospital stay and the total treatment cost. CONCLUSIONS: Post CABG surgery SSI rate is high. Sternum and leg are the common infection sites. Obesity, uncontrolled diabetes mellitus and female sex are associated with higher infection rates. "Higher" antibiotics do not lower postoperative infection rates.

  3. LAPARoseome SURGERY:

    African Journals Online (AJOL)

    Laparoscopic Surgery has been rightly described as the "dawn of a new era" in surgery. It has come to stay and has altered permanently the practice and teaching of surgery as we used to know it. It is not about. "new gadgets" but a new way of practicing an old art surgery. ~ The surgical world has moved on and.

  4. CANCELLATION OF ELECTIVE OPERATIONS ON THE DAY OF SURGERY : THREE YEARS STUDY

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    Asmita

    2015-10-01

    Full Text Available OBJECTIVE: There are several studies suggesting decreased operating room efficiency caused by cancellations of the surgical procedures. It also affects patient satisfaction. This study was to analyse the reasons for cancellation of elective operations so that in future necessary actions can b e taken to minimize number of unnecessary cancellations. METHODS: This was a retrospective study conducted