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Sample records for surgery patient episode

  1. Hospital Episode Statistics data analysis of postoperative venous thromboembolus in patients undergoing urological surgery: a review of 126,891 cases

    NARCIS (Netherlands)

    Dyer, J.; Wyke, S.; Lynch, C.

    2013-01-01

    INTRODUCTION: Current guidelines on venous thromboembolism (VTE) prevention do not reflect the potential varying risk for patients undergoing different urological procedures. Our study aimed to establish the procedure specific rate of postoperative VTE in patients undergoing urological surgery. METH

  2. Effect of general anesthesia and major versus minor surgery on late postoperative episodic and constant hypoxemia

    DEFF Research Database (Denmark)

    Rosenberg, J; Oturai, P; Erichsen, C J

    1994-01-01

    STUDY OBJECTIVE: To evaluate the relative contribution of general anesthesia alone and in combination with the surgical procedure to the pathogenesis of late postoperative hypoxemia. DESIGN: Open, controlled study. SETTING: University hospital. PATIENTS: 60 patients undergoing major abdominal...... surgery and 16 patients undergoing middle ear surgery, both with comparable general anesthesia. MEASUREMENTS AND MAIN RESULTS: Patients were monitored with continuous pulse oximetry on one preoperative night and the second postoperative night. Significant episodic or constant hypoxemia did not occur...... on the second postoperative night following middle ear surgery and general anesthesia, but severe episodic and constant hypoxemia did occur on the second postoperative after major abdominal surgery and general anesthesia. CONCLUSIONS: General anesthesia in itself is not an important factor in the development...

  3. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

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

  4. Episodic arterial oxygen desaturation and heart rate variations following major abdominal surgery

    DEFF Research Database (Denmark)

    Rosenberg, J; Dirkes, W E; Kehlet, H

    1989-01-01

    In 20 patients undergoing elective major abdominal surgery, heart rate and arterial oxygen saturation were monitored continuously during the night 2 days before operation and during the first and second nights after operation (23:00 to 07:30). Mean heart rate increased by 16 beat min-1 (P less than...... arrhythmias on the morning of the third day after operation. In another patient the episodes of desaturation correlated with increases in heart rate. There was no correlation between administration of opioids and heart rate and saturation disturbances. The mechanism and clinical relevance of episodic...

  5. Directed forgetting in frontal patients' episodic recall.

    Science.gov (United States)

    Andrés, Pilar; Van der Linden, Martial; Parmentier, Fabrice B R

    2007-03-25

    The aim of this study was to examine the performance of a group of patients with lesions of the prefrontal cortex in directed forgetting in episodic memory, i.e. the capacity to actively forget irrelevant information. Four lists of 24 intermixed to-be-remembered (TBR) and to-be-forgotten (TBF) words were presented for retention. Restricted (TBR only) and unrestricted (TBR and TBF) recall were tested. The results showed that prefrontal patients presented with a general reduction in episodic memory but a normal ability to selectively recall the TBR items during restricted and unrestricted recall. These results are consistent with previous reports of intact directed forgetting in frontal patients and are discussed in terms of their implications for the current debate on the neural substrate of executive functions.

  6. Apathy in first episode psychosis patients

    DEFF Research Database (Denmark)

    Evensen, Julie; Røssberg, Jan Ivar; Barder, Helene

    2012-01-01

    Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored.......Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored....

  7. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

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

  8. Variation in Bariatric Surgery Episode Costs in the Commercially Insured: Implications for Bundled Payments in the Private Sector.

    Science.gov (United States)

    Kelsall, Alexander C; Cassidy, Ruth; Ghaferi, Amir A

    2017-08-01

    To describe hospital-level variation in roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in Michigan. Bariatric surgery is an increasingly prevalent elective surgical procedure that will likely be considered for future bundled payment programs, both public and private. Past research in the Medicare population found that the index hospitalization is responsible for the majority of payment variation among hospitals. However, this research largely excluded SG, now the most commonly performed bariatric surgery procedure nationally. We used data from a state-wide quality collaborative to calculate the average risk and price-adjusted 30-day episode payment for patients undergoing RYGB and SG procedures at Michigan hospitals between January 2009 and October 2014. We organized hospitals into quintiles and compared the variation in payments between highest and lowest-cost quintiles, and also the payment categories that drove this variation. We identified 9035 patients undergoing RYGB (n = 4194) or SG (n = 4841) procedures at 31 hospitals. The average price and risk-adjusted episode payment ranged from $11,874 in the lowest hospital quintile to $13,394 in the highest quintile, representing a difference of $1519 (12.8%). Payments for the index hospitalization accounted for the largest share of total episode costs for both procedure types. Despite representing 2.7% to 6.0% of payments across quintiles, postdischarge payments explained 22.6% of hospital variation in SG. Similarly, readmissions explained 24.5% of payment variation for SG episodes, despite representing between 1.2% and 4.4% of payments. Collectively, our findings suggest that there are previously underappreciated differences in episode payment variation between bariatric surgery procedures. SG may be more amenable to cost containment under bundled payment initiatives by virtue of the greater share of variation explained by readmission and postdischarge payments, components of episode payment more

  9. Microbiology of Peritonitis in Peritoneal Dialysis Patients with Multiple Episodes

    Science.gov (United States)

    Nessim, Sharon J.; Nisenbaum, Rosane; Bargman, Joanne M.; Jassal, Sarbjit V.

    2012-01-01

    ♦ Background: Peritoneal dialysis (PD)–associated peritonitis clusters within patients. Patient factors contribute to peritonitis risk, but there is also entrapment of organisms within the biofilm that forms on PD catheters. It is hypothesized that this biofilm may prevent complete eradication of organisms, predisposing to multiple infections with the same organism. ♦ Methods: Using data collected in the Canadian multicenter Baxter POET (Peritonitis, Organism, Exit sites, Tunnel infections) database from 1996 to 2005, we studied incident PD patients with 2 or more peritonitis episodes. We determined the proportion of patients with 2 or more episodes caused by the same organism. In addition, using a multivariate logistic regression model, we tested whether prior peritonitis with a given organism predicted the occurrence of a subsequent episode with the same organism. ♦ Results: During their time on PD, 558 patients experienced 2 or more peritonitis episodes. Of those 558 patients, 181 (32%) had at least 2 episodes with the same organism. The organism most commonly causing repeat infection was coagulase-negative Staphylococcus (CNS), accounting for 65.7% of cases. Compared with peritonitis caused by other organisms, a first CNS peritonitis episode was associated with an increased risk of subsequent CNS peritonitis within 1 year (odds ratio: 2.1; 95% confidence interval: 1.5 to 2.8; p peritonitis, 48% of repeat episodes occurred within 6 months of the earlier episode. ♦ Conclusions: In contrast to previous data, we did not find a high proportion of patients with multiple peritonitis episodes caused by the same organism. Coagulase-negative Staphylococcus was the organism most likely to cause peritonitis more than once in a given patient, and a prior CNS peritonitis was associated with an increased risk of CNS peritonitis within the subsequent year. PMID:22215659

  10. Patient satisfaction with treatment in first-episode psychosis

    DEFF Research Database (Denmark)

    Haahr, Ulrik; Simonsen, Erik; Røssberg, Jan Ivar

    2012-01-01

    Purpose: To examine first-episode psychotic patients' satisfaction with elements of a comprehensive 2-year treatment program. Subjects and method: The TIPS (Early Treatment and Intervention in Psychosis) project provided a 2-year treatment program consisting of milieu therapy (inpatient), individ......Purpose: To examine first-episode psychotic patients' satisfaction with elements of a comprehensive 2-year treatment program. Subjects and method: The TIPS (Early Treatment and Intervention in Psychosis) project provided a 2-year treatment program consisting of milieu therapy (inpatient...... in satisfaction for specific interventions. In this sample of first-episode psychosis patients, there was general satisfaction with treatments based on one-to-one relationships while multi-family group intervention was consistently valued less enthusiastically....

  11. Neurocognitive performance in first-episode and chronic schizophrenic patients.

    Science.gov (United States)

    Moritz, Steffen; Andresen, Burghard; Perro, Christian; Schickel, Marc; Krausz, Micheal; Naber, Dieter

    2002-02-01

    Previous research on neuropsychological disturbances in first-episode and chronic schizophrenic patients has provided mixed results which can be partially attributed to methodological inconsistencies. For the present study, 70 schizophrenic patients (40 with chronic and 30 with first-episode schizophrenia) were compared to 30 healthy controls on a large battery of neuropsychological tests. Special attention was paid to potential confounds such as differences in psychopathology, age and educational level between the schizophrenic sub-samples. Healthy controls performed better than both first-episode and chronic patients in almost all cognitive domains (P < 0.01), while the patient samples did not differ in any of the tasks. Results were confirmed in a second series of analyses in which patient subgroups were equated for sociodemographic background variables. The present results confirm recent data collected in longitudinal studies, thus, lending further support for a neurodevelopmental model of schizophrenia. It is suggested that neuropsychological disturbances occur early in schizophrenia and do not worsen in the course beyond age-related decrement. Possible reasons why previous research has produced contradictory findings are discussed.

  12. Patient discomfort following periapical surgery.

    Science.gov (United States)

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

    2008-02-01

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

  13. RISK OF PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY UNDERGOING NONCARDIAC SURGERY

    Institute of Scientific and Technical Information of China (English)

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

    2007-01-01

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

  14. Comprehensive behavioral analysis of patients with a major depressive episode.

    Science.gov (United States)

    Rothuber, Helfried; Mitterauer, Bernhard

    2011-05-01

    A major depressive episode diagnosed according to DSM-IV criteria can be accompanied by symptoms that DSM-IV does not include. These symptoms are sometimes classified as comorbidities. Our study assessed altered behavioral modes during a major depressive episode; ie, if 1 or more modes of behavior operated less or even not at all ("never"), or if the operation of others was more frequent or even constant ("always"). We hypothesize that these altered behavioral modes, especially the extreme positions "never" (hypomodes) and "always" (hypermodes) might correlate with depression scores and thus represent a typical symptom of depression. We used the 35-item Salzburg Subjective Behavioral Analysis (SSBA) questionnaire to measure altered behavioral modes in 63 depressed patients and 87 non-depressed controls. Depression was assessed using the Hamilton Depression Scale. In our test group (n=63) we found a total of 888 extreme positions. The mean number of extreme positions per patient was 11.15±5.173 (SD). Extreme positions were found in all 35 behavioral modes. The mean Hamilton score was 22.08±7.35 (SD). The association of the incidence of extreme positions and the Hamilton score in our test group was highly significant (Spearman's Rho=0.41; p=.001). In the control group (n=87), only 11 persons were found to display extreme positions, with a total of only 25. Although this study has several limitations, such as the small sample or the use of a questionnaire in the validation procedure, the significant correlation of extreme positions and the Hamilton score indicate that altered modes of behavior as detected with the SSBA might be typical symptoms in a major depressive episode.

  15. Patient Satisfaction After Scoliosis Surgery

    Directory of Open Access Journals (Sweden)

    V. Tari

    2008-02-01

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

  16. Gender Differences among Patients with a Single Depressive Episode

    DEFF Research Database (Denmark)

    Bukh, Jens Otto Drachmann; Bock, Camilla; Vinberg, Maj

    2010-01-01

    , personality traits and disorders, stressful life events, family history, and treatment response. RESULTS: Female patients showed a higher level of neuroticism and more residual anxiety symptoms after treatment of the depression. There were no gender differences in severity of depression, psychiatric co...... in sociodemographic, clinical and treatment variables among patients suffering exclusively from single-episode depression. METHOD: Systematic recruitment of 301 participants via the Danish Psychiatric Central Research Register and assessment by means of questionnaires and interviews regarding psychiatric diagnoses......-morbidity (including personality disorders), stressful life events prior to onset, family loading of psychiatric disorders, or treatment outcome. CONCLUSION: The results provide evidence for a higher level of anxiety and neuroticism among females with a recent onset of depression, whereas other clinical...

  17. Managing the patient with episodic sinus tachycardia and orthostatic intolerance.

    Science.gov (United States)

    Narichania, Aalap D; Schleifer, J William; Shen, Win-Kuang

    2014-01-01

    Patients with episodic sinus tachycardia and associated orthostatic intolerance present a diagnostic and management dilemma to the clinician. We define this group of disorders to include sinus node reentrant tachycardia (SNRT), inappropriate sinus tachycardia (IAST), and postural orthostatic tachycardia syndrome (POTS). After a brief review of the current understanding of the pathophysiology and epidemiology of this group of disorders, we focus on the diagnosis and management of IAST and POTS. Our approach attempts to recognize the considerable overlap in pathophysiology and clinical presentation between these two heterogeneous conditions. Thus, we focus on a mechanism-based workup and therapeutic approach. Sinus tachycardia related to identifiable causes should first be ruled out in these patients. Next, a basic cardiovascular and autonomic workup is suggested to exclude structural heart disease, identify a putative diagnosis, and guide therapy. We review both nonpharmacologic and pharmacologic therapy, with a focus on recent advances. Larger randomized control trials and further mechanistic studies will help refine management in the future.

  18. [Patients' decision for aesthetic surgery].

    Science.gov (United States)

    Fansa, H; Haller, S

    2011-12-01

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

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

    DEFF Research Database (Denmark)

    Shabanzadeh, Daniel M; Sørensen, Lars T

    2012-01-01

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

  20. Predictive validity of proposed remission criteria in first-episode schizophrenic patients responding to antipsychotics

    NARCIS (Netherlands)

    Wunderink, Lex; Nienhuis, Fokko J.; Sytema, Sjoerd; Wiersma, Durk

    2007-01-01

    The objective of this study was to examine the predictive validity of the remission criteria proposed by Andreasen et all in first-episode patients responding to antipsychotics. Antipsychotic responsive patients with first-episode schizophrenia showing symptom remission (n = 60) were compared with p

  1. First-episode psychosis patients recruited into treatment via early detection teams versus ordinary pathways

    DEFF Research Database (Denmark)

    Johannessen, Jan Olav; Joa, Inge; Auestad, Bjørn;

    2011-01-01

    To compare the 5-year course and outcome of first-episode psychosis (FEP) patients recruited via active outreach detection teams (DTs) versus ordinary referral channels (not-DT).......To compare the 5-year course and outcome of first-episode psychosis (FEP) patients recruited via active outreach detection teams (DTs) versus ordinary referral channels (not-DT)....

  2. Predictors of poor adherence to medication among patients with first-episode schizophrenia-spectrum disorder

    DEFF Research Database (Denmark)

    Quach, Phuong Le; Mors, Ole; Christensen, Torben Østergaard;

    2009-01-01

    This study sought to identify predictors for poor adherence to medication among patients with first-episode schizophrenia-spectrum disorder.......This study sought to identify predictors for poor adherence to medication among patients with first-episode schizophrenia-spectrum disorder....

  3. Financial cost to institutions on patients waiting for gall bladder disease surgery.

    Science.gov (United States)

    Waqas, Ahmed; Qasmi, Shahzad Ahmed; Kiani, Faran; Raza, Ahmed; Khan, Khizar Ishtiaque; Manzoor, Shazia

    2014-01-01

    The aim of this study was to determine the financial costs to institution on patients waiting for gall bladder disease surgery and suggest measures to reduce them. This multi-centre prospective descriptive survey was performed on all patients who underwent an elective cholecystectomy by three consultants at secondary care hospitals in Pakistan between Jan 2010 to Jan 2012. Data was collected on demographics, the duration of mean waiting time, specific indications and nature of disease for including the patients in the waiting list, details of emergency re-admissions while awaiting surgery, investigations done, treatment given and expenditures incurred on them during these episodes. A total of 185 patients underwent elective open cholecystectomy. The indications for listing the patients for surgery were biliary colic in 128 patients (69%), acute cholecystitis in 43 patients (23%), obstructive jaundice in 8 patients (4.5%) and acute pancreatitis in 6 patients (3.2%). 146 (78.9%) and 39 (21.1%) of patients were listed as outdoor electives and indoor emergencies respectively. Of the 185 patients, 54 patients (29.2%) were re-admitted. Financial costs in Pakistani rupees per episode of readmission were 23050 per episode in total and total money spent on all readmissions was Rs. 17,05,700/-. Financial costs on health care institutions due to readmissions in patients waiting for gall bladder disease surgery are high. Identifying patients at risk for these readmissions and offering them early laparoscopic cholecystectomy is very important.

  4. [Bariatric surgery and patient therapeutic education].

    Science.gov (United States)

    Mével, Katell

    2015-11-01

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

  5. Transobturator midurethral sling: What should patients expect after surgery?

    Science.gov (United States)

    Rechberger, Tomasz; Wrobel, Andrzej; Zietek, Alicja; Rechberger, Ewa; Bogusiewicz, Michal; Miotla, Pawel

    2017-07-08

    Midurethral sling (MUS) surgeries are minimally invasive procedures; however, they are not free of postoperative complications. The aim of the study was to assess the occurrence of lower urinary tract symptoms (LUTS) (urgency, nocturia, frequency, splitting/spraying, hesitancy, terminal dribbling, and subjective feeling of postvoid residual) in patients suffering from stress (SUI) or mixed (MUI) urinary incontinence with a predominant SUI component before and after transobturator MUS placement. The study group consisted of 88 women with SUI and 18 with MUI who underwent transobturator MUS. All participants were questioned with a self-developed questionnaire before and after surgery regarding the presence of LUTS. Seven days after surgery, 62 patients (58.5%) noted voiding and postmicturition symptoms, whereas 67 (63.2%) reported problems in storage. The more commonly reported LUTS at week 1 after surgery were urgency (52.8%), splitting/spraying (41.5%), and feeling of incomplete bladder emptying (34.0%). Patients perceived that splitting/spraying was the most bothersome. After 6 months, the most common LUTS reported were hesitancy (14.1%), terminal dribbling (10.4%), and splitting/spraying (9.4%). We noticed a decrease in the number of urgency episodes >2.7 times (p < 0.001) compared with baseline. After 6 months, 97 (91.5%) patients reported the lack of incontinence episodes. A vast majority of patients after MUS suffer from LUTS in the early postoperative period; however, the majority of undesired symptoms resolve spontaneously within the first 6 months postsurgery.

  6. Better Patient Care At High-Quality Hospitals May Save Medicare Money And Bolster Episode-Based Payment Models.

    Science.gov (United States)

    Tsai, Thomas C; Greaves, Felix; Zheng, Jie; Orav, E John; Zinner, Michael J; Jha, Ashish K

    2016-09-01

    US policy makers are making efforts to simultaneously improve the quality of and reduce spending on health care through alternative payment models such as bundled payment. Bundled payment models are predicated on the theory that aligning financial incentives for all providers across an episode of care will lower health care spending while improving quality. Whether this is true remains unknown. Using national Medicare fee-for-service claims for the period 2011-12 and data on hospital quality, we evaluated how thirty- and ninety-day episode-based spending were related to two validated measures of surgical quality-patient satisfaction and surgical mortality. We found that patients who had major surgery at high-quality hospitals cost Medicare less than those who had surgery at low-quality institutions, for both thirty- and ninety-day periods. The difference in Medicare spending between low- and high-quality hospitals was driven primarily by postacute care, which accounted for 59.5 percent of the difference in thirty-day episode spending, and readmissions, which accounted for 19.9 percent. These findings suggest that efforts to achieve value through bundled payment should focus on improving care at low-quality hospitals and reducing unnecessary use of postacute care. Project HOPE—The People-to-People Health Foundation, Inc.

  7. Episodes of breathlessness: types and patterns: a qualitative study exploring experiences of patients with advanced diseases

    NARCIS (Netherlands)

    Simon, S.T.; Higginson, I.J.; Benalia, H.; Gysels, M.; Murtagh, F.E.M.; Spicer, J.; Bausewein, C.

    2013-01-01

    Background: Despite the high prevalence and impact of episodic breathlessness, information about characteristics and patterns is scarce. Aim: To explore the experience of patients with advanced disease suffering from episodic breathlessness, in order to describe types and patterns. Design and partic

  8. Neurocognition and occupational functioning in patients with first-episode psychosis

    DEFF Research Database (Denmark)

    Tandberg, Marte; Ueland, Torill; Sundet, Kjetil

    2011-01-01

    Neurocognitive deficits are a core feature of schizophrenia that is associated with poor occupational functioning. Few studies have investigated this relationship in patients with first-episode psychosis. The current study examined the characteristics of employed and unemployed patients with first......-episode psychosis at baseline and 2-year follow-up, and the predictive value of neurocognition on employment status. One-hundred and twenty-two first-episode psychosis patients were assessed with clinical and neurocognitive measures at baseline. Occupational status was assessed at baseline and 2-year follow...

  9. A randomised multicentre trial of integrated versus standard treatment for patients with a first episode of psychotic illness

    DEFF Research Database (Denmark)

    Petersen, Lone Bente; Jeppesen, Pia; Thorup, Anne;

    2005-01-01

    To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness.......To evaluate the effects of integrated treatment for patients with a first episode of psychotic illness....

  10. Methods of patient warming during abdominal surgery.

    Directory of Open Access Journals (Sweden)

    Li Shao

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

  11. [Multiple latency test in a patient with episodes of sleep induced by pergolide].

    Science.gov (United States)

    Jiménez-Jiménez, F J; Velasco, I; de Toledo, M; Sayed, Y; Zurdo, J; Ortí-Pareja, M

    Recently, there have been report sleep attacks in parkinsonian patients as a side effect of pramipexole and ropinirole. We report a patient with similar episodes related with pergolide. A 64 year old man with rigid akinetic parkinsonism, treated with carbidopa/levodopa and pergolide, developed sudden, irresistible sleep episodes after increasing the dose of pergolide to 2.25 mg/day because of bad control of parkinsonian symptoms. These episodes started 30 minutes after each dose of pergolide and lasted 2 hours. Following reduction of the dose of pergolide to 1.5 mg/day the sleep episodes disappeared. Two double blind multiple sleep latency tests were performed, one after intaking pergolide and other after intaking placebo. The latencies to sleep onset were lower with pergolide than with placebo, but the differences did not reach statistical significance. There was no premature REM sleep onset. Sleep episodes are likely a not specific effect of dopamine agonists

  12. Aspirin in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  13. Autoimmune episodic ataxia in patients with anti-CASPR2 antibody-associated encephalitis.

    Science.gov (United States)

    Joubert, Bastien; Gobert, Florent; Thomas, Laure; Saint-Martin, Margaux; Desestret, Virginie; Convers, Philippe; Rogemond, Véronique; Picard, Géraldine; Ducray, François; Psimaras, Dimitri; Antoine, Jean-Christophe; Delattre, Jean-Yves; Honnorat, Jérôme

    2017-07-01

    To report paroxysmal episodes of cerebellar ataxia in a patient with anti-contactin-associated protein-like 2 (CASPR2) antibody-related autoimmune encephalitis and to search for similar paroxysmal ataxia in a cohort of patients with anti-CASPR2 antibody-associated autoimmune encephalitis. We report a patient with paroxysmal episodes of cerebellar ataxia observed during autoimmune encephalitis with anti-CASPR2 antibodies. In addition, clinical analysis was performed in a retrospective cohort of 37 patients with anti-CASPR2 antibodies to search for transient episodes of ataxia. Paroxysmal symptoms were further specified from the referral physicians, the patients, or their relatives. A 61-year-old man with limbic encephalitis and anti-CASPR2 antibodies developed stereotyped paroxysmal episodes of cerebellar ataxia, including gait imbalance, dysarthria, and dysmetria, 1 month after the onset of the encephalitis. The ataxic episodes were specifically triggered by orthostatism and emotions. Both limbic symptoms and transient ataxic episodes resolved after treatment with steroids and IV cyclophosphamide. Among 37 other patients with anti-CASPR2 antibodies, we identified 5 additional cases with similar paroxysmal ataxic episodes that included gait imbalance (5 cases), slurred speech (3 cases), limb dysmetria (3 cases), and nystagmus (1 case). All had concomitant limbic encephalitis. Paroxysmal ataxia was not observed in patients with neuromyotonia or Morvan syndrome. Triggering factors (orthostatism or anger) were reported in 4 patients. Episodes resolved with immunomodulatory treatments in 4 patients and spontaneously in 1 case. Paroxysmal cerebellar ataxia must be added to the spectrum of the anti-CASPR2 antibody syndrome.

  14. Thoracocentesis in cardiac surgery patients.

    Science.gov (United States)

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

    2015-01-01

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

  15. Surgery for Patients With Recalcitrant Plantar Fasciitis

    OpenAIRE

    Wheeler, Patrick; Boyd, Kevin; Shipton, Mary

    2014-01-01

    Background: Plantar fasciitis is a common cause of foot pain, and although many episodes are self-limiting with short duration, 10% leave chronic symptoms. Recalcitrant cases can be managed surgically, with studies demonstrating good results in the short term but uncertainties over longer term outcomes. Purpose: To assess the outcome following surgical intervention for patients with plantar fasciitis. Study Design: Case series; Level of evidence, 4. Methods: Seventy-nine patients were identif...

  16. Psychometric evaluation of the Danish and Swedish Satisfaction with Life Scale in first episode psychosis patients

    DEFF Research Database (Denmark)

    Hochwälder, Jacek; Mattsson, Maria; Holmqvist, Ragnhild

    2012-01-01

    PURPOSE: To psychometrically evaluate the Satisfaction with Life Scale in two cohorts of first-episode psychosis patients in the Danish National Schizophrenia Project and in the Swedish Parachute Project. METHOD: Four properties of the Satisfaction with Life Scale were examined in the Danish cohort....... The dimensions were confirmed in the Swedish sample. CONCLUSION: The Satisfaction with Life Scale shows satisfactory psychometric properties and seems valid and useful among first-episode psychosis patients....

  17. Neuropsychological outcomes of pediatric burn patients who sustained hypoxic episodes.

    Science.gov (United States)

    Rosenberg, Marta; Robertson, Carrie; Murphy, Kevin D; Rosenberg, Laura; Mlcak, Ronald; Robert, Rhonda S; Herndon, David N; Meyer, Walter J

    2005-11-01

    The neuropsychological outcomes of children who suffered hypoxic episodes following their burns are not completely understood and vary depending on the nature and severity of the episode. A retrospective review of youth that were admitted to this acute burn care facility over the past 20 years was conducted to identify the extent of cognitive and affective difficulties. Thirty-nine children who sustained hypoxic injuries related to their burns were compared with 21 controls that were matched for age, TBSA, and time of injury. Approximately a third of the children who survived from the hypoxia group continued to have long-term cognitive and emotional difficulties. For those who recovered reasonably well, no differences were found from the matched burned controls. These results probably underestimate the true extent of neuropsychological difficulties experienced by these youth given that detailed cognitive testing was not routinely performed. Prospective studies are needed to further characterize the full nature of difficulties and outcomes associated with burn related hypoxic injuries.

  18. Risk factors for the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis patients.

    Directory of Open Access Journals (Sweden)

    Xiaoguang Fan

    Full Text Available The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD patients.This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis.In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months of 1117 CAPD patients, 309(27.7% patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years [hazard ratio (HR = 1.427, 95% confidence interval (CI = 1.051 to 1.938, P = 0.023], male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030, lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004 and albumin <38g/L (HR = 1.425, 95% CI: 1.112 to 1.825, P = 0.005.Older age, male, lower educational level and hypoalbuminemia at the commencement of PD were the risk factors associated with the first episode of peritonitis in Southern Chinese CAPD patients.

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

    Science.gov (United States)

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

    2015-01-01

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

  20. Episodic memory and executive functioning in currently depressed patients compared to healthy controls.

    Science.gov (United States)

    Pauls, Franz; Petermann, Franz; Lepach, Anja Christina

    2015-01-01

    At present, little is still known about the link between depression, memory and executive functioning. This study examined whether there are memory-related impairments in depressed patients and whether the size of such deficits depends on the age group and on specific types of cognitive measures. Memory performances of 215 clinically depressed patients were compared to the data of a matched control sample. Regression analyses were performed to determine the extent to which executive dysfunctions contributed to episodic memory impairments. When compared with healthy controls, significantly lower episodic memory and executive functioning performances were found for depressed patients of all age groups. Effect sizes appeared to vary across different memory and executive functioning measures. The extent to which executive dysfunctions could explain episodic memory impairments varied depending on the type of measure examined. These findings emphasise the need to consider memory-related functioning of depressed patients in the context of therapeutic treatments.

  1. [Epidemiology and prevention of anaphylactoid reactions in heart surgery patients].

    Science.gov (United States)

    Trekova, N A; Solovova, L E; Kuznetsov, R V; Asmangulian, E T

    2000-01-01

    A retrospective analysis of the incidence, severity, and causes of anaphylactoid reactions (AR) in 1504 cardiosurgical patients operated on at Research Center of Surgery in 1995-1999 showed that AR occurred in 109 (7.4%) patients: 60% during aortocoronary bypass operations, 27.2% during correction of acquired heart diseases, and 12.8% during correction of congenital heart diseases. Skin symptoms predominated in the structure of AR (59.7%); cardiovascular episodes ranked second (38.5%), and the incidence of pulmonary reactions was lowest (1.8%). The causes of AR during anesthesia and surgery were platelet-rich plasma and fresh-frozen plasma (35.3%), antibiotics (12.1%), protamine (12.1%), myorelaxants (9.9%), colloid plasma substitutes (8.8%), dioxidine (3.3%), heparin (2.2%), aprotinin (1.1%), diazepam (2.2%), and other agents (7.6%). A history of AR and repeated interventions are risk factors of AR. The protocol of AR prevention in cardiosurgical patients includes determination of risk factors, selection of the least hazardous agents, strict adherence to the rate of infusion of histamine-releasing drugs, minimum utilization of donor blood components (platelets and plasma), use of H1 and H2 blockers, corticosteroids (celestone) during premedication and operation. Such treatment helped decrease the severity and incidence of AR in cardiosurgical patients to 4.7%.

  2. Risk of bleeding after dentoalveolar surgery in patients taking anticoagulants.

    Science.gov (United States)

    Broekema, Ferdinand I; van Minnen, Baucke; Jansma, Johan; Bos, Rudolf R M

    2014-03-01

    To avoid increasing the risk of thromboembolic events, it is recommended that treatment with anticoagulants should be continued during dentoalveolar operations. We have evaluated the incidence of bleeding after dentoalveolar operations in a prospective study of 206 patients, 103 who were, and 103 who were not, taking anticoagulants. Seventy-one were taking thrombocyte aggregation inhibitors and 32 vitamin K antagonists. Patients were treated according to guidelines developed at the Academic Centre for Dentistry Amsterdam (ACTA), The Netherlands. The operations studied included surgical extraction (when the surgeon had to incise the gingiva before extraction), non-surgical extraction, apicectomy, and placement of implants. Patients were given standard postoperative care and those taking vitamin K antagonists used tranexamic acid mouthwash postoperatively. No patient developed a severe bleed that required intervention. Seven patients (7%) taking anticoagulants developed mild postoperative bleeds. Patients taking vitamin K antagonists reported 3 episodes (9%) compared with 4 (6%) in the group taking thrombocyte aggregation inhibitors. Among patients not taking anticoagulants, two (2%) developed mild bleeding. The differences between the groups were not significant. All bleeding was controlled by the patients themselves with compression with gauze. We conclude that dentoalveolar surgery is safe in patients being treated with anticoagulants provided that the conditions described in the ACTA guidelines are met. Copyright © 2014 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Risk Factors for the First Episode of Peritonitis in Southern Chinese Continuous Ambulatory Peritoneal Dialysis Patients

    Science.gov (United States)

    Fan, Xiaoguang; Huang, Rong; Wang, Juan; Ye, Hongjian; Guo, Qunying; Yi, Chunyan; Lin, Jianxiong; Zhou, Qian; Shao, Fengmin; Yu, Xueqing; Yang, Xiao

    2014-01-01

    Background The first episode of peritonitis affects survival of the peritoneal membrane as a medium for dialysis as well as survival of patients. The aim of this study is to investigate risk factors associated with the first episode of peritonitis in Southern Chinese continuous ambulatory peritoneal dialysis (CAPD) patients. Methods This is a single-center, retrospective, cohort study. All incident CAPD patients from 1 January 2006 to 31 December 2010 were recruited, and followed up until their first episode of peritonitis or 31 December, 2012. Baseline demographic, socioeconomic, clinical and laboratory data were collected. Cox proportional model was used to determine the factors associated with the first episode of peritonitis. Results In a cumulative 30756.5 patient-months follow-up (the median vintage 26.1 months) of 1117 CAPD patients, 309(27.7%) patients presented the first episodes of peritonitis. The cumulative peritonitis-free survival was 86.2%, 78.1%, 71.4% and 57.8% at 1, 2, 3 and 5 year, respectively. The multivariate analysis showed that factors associated with risk for the first episode of peritonitis were elderly patients (>65 years) [hazard ratio (HR) = 1.427, 95% confidence interval (CI) = 1.051 to 1.938, P = 0.023], male(HR = 1.315, 95% CI = 1.028 to 1.684, P = 0.030), lower education level (HR = 1.446, 95% CI: 1.127 to 1.855, P = 0.004) and albumin peritonitis in Southern Chinese CAPD patients. PMID:25222609

  4. Are multi family groups appropriate for patients with first episode psychosis?

    DEFF Research Database (Denmark)

    Rossberg, Jan Ivar; Johannessen, J O; Klungsoyr, O

    2010-01-01

    OBJECTIVE: To compare outcome over 5 years for patients who participated in multi family groups (MFGs) to those who refused or were not offered participation. METHOD: Of 301 first episode psychotic patients aged 15-65 years, 147 participated in MFGs. Outcome was measured by drop-out rates, positive...

  5. Subjective cognitive dysfunction in first-episode and chronic schizophrenic patients.

    Science.gov (United States)

    Moritz, S; Lambert, M; Andresen, B; Böthern, A; Naber, D; Krausz, M

    2001-01-01

    Previous studies indicate that first-episode and chronic schizophrenic patients do not differ regarding neuropsychological performance as assessed with standard cognitive tasks. For the present study, it was investigated whether first-episode and chronic schizophrenics report similar subjective cognitive deficits. The Frankfurt Complaint Questionnaire (FCQ), a scale devised for assessing subjective cognitive disturbances in schizophrenia, was administered to 20 first-episode and 36 chronic schizophrenic patients, as well as 20 healthy controls. The schizophrenic subsamples did not differ on any of the FCQ subscales or on a "lie scale," measuring illness denial. Psychopathological ratings were comparable for both groups. As expected, healthy subjects reported significantly less cognitive and perceptual problems than schizophrenic patients. In marked contrast to a Kraepelinian view of schizophrenia, the present data confirm previous studies conducted with objective neuropsychological tests that schizophrenia is a neurodevelopmental rather than a neurodegenerative disorder.

  6. Outcome of orthognathic surgery in Chinese patients

    NARCIS (Netherlands)

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

    2007-01-01

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

  7. Preoperative optimization of the vascular surgery patient

    Directory of Open Access Journals (Sweden)

    Zhan HT

    2015-07-01

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

  8. Components of Patient Satisfaction After Orthognathic Surgery.

    Science.gov (United States)

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

    2016-01-01

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

  9. Relaxation strategies for patients during dermatologic surgery.

    Science.gov (United States)

    Shenefelt, Philip D

    2010-07-01

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

  10. Music therapy for patients receiving spine surgery.

    Science.gov (United States)

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

    2011-04-01

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

  11. Relationships among tonic and episodic aspects of motivation to eat, gut peptides, and weight before and after bariatric surgery

    DEFF Research Database (Denmark)

    Bryant, Eleanor J; King, Neil A; Falkén, Ylva

    2012-01-01

    BACKGROUND: The interaction between motivation to eat, eating behavior traits, and gut peptides after Roux-en-Y gastric bypass (RYGB) surgery is not fully understood. METHODS: Appetite and hormone responses to a fixed liquid preload were assessed in 12 obese (body mass index 45±1.9 kg/m(2......)) participants immediately before and 3 days, 2 months, and 1 year after RYGB surgery. Subjective appetite and plasma levels of ghrelin, leptin, insulin, and glucagon-like peptide-1 (GLP-1) were measured for a 3-hour postprandial period. Eating behavior traits were also measured using the Three Factor Eating...... appetite ratings, eating behavior traits, and appetite peptides in obese patients both before and at 1 year after RYGB surgery may contribute to the reduction in a propensity to overeat (as measured by TFEQR18 factors) and weight loss....

  12. Trajectories of suicidal ideation in patients with first-episode psychosis

    DEFF Research Database (Denmark)

    Madsen, Trine; Karstoft, Karen-Inge; Secher, Rikke Gry

    2016-01-01

    BACKGROUND: Heterogeneity in suicidal ideation over time in patients with first-episode psychosis is expected, but prototypical trajectories of this have not yet been established. We aimed to identify trajectories of suicidal ideation over a 3-year period and to examine how these trajectories...... relate to subsequent suicidality. METHODS: We used longitudinal data from the prospective 10-year follow-up OPUS trial of young Danish patients with first-episode psychosis. Participants were recruited between January, 1998, and December, 2000, from all inpatient and outpatient mental health services...

  13. Nepalese patients' anxiety and concerns before surgery.

    Science.gov (United States)

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

    2011-08-01

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

  14. Impact of daily number of urgency urinary incontinence episodes on overactive bladder patient reported outcomes.

    Science.gov (United States)

    Angulo, J C; Brenes, F J; Lizarraga, I; Rejas, J; Trillo, S; Ochayta, D; Arumi, D

    2016-04-01

    To explore the impact of urgency urinary incontinence (UUI) on well-being in non-institutionalized patients with overactive bladder (OAB) in a community sample. A cross-sectional web-based study was conducted in the general population, including males and females, >18 years of age. Patients with probable OAB were identified using a validated algorithm together with a score ≥8 on the OAB-V8 scale. Presence of coping behavior was considered determinant for the clinical diagnosis of OAB. Individual well-being was determined through a battery of patient-reported outcomes (PRO) measurements including assessment of health-related quality of life (EQ-5D), sleep disturbances (MOS Sleep), and life satisfaction (LISAT-8). Patients were grouped according to the number of daily UUI episodes (UUI severity): 0 (dry OAB),1, 2-3, or ≥4. Multivariate analysis to evaluate factors independently affecting quality of life was undertaken. A total of 396 patients (52.5% women, mean age: 55.3 [11.1] years, OAB-V8 mean score: 14.5 [7.9]) out of 2035 subjects participating from the general population met the criteria for OAB: 203 (51.3%) with 0episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with ≥4 episodes. A statistically significant linear adjusted association was found between number of UUI episodes and PRO scores. Participants with more episodes had poorer health profiles and self-evaluated quality of life, worse life satisfaction, and more sleep disturbances and fewer hours of sleep per night. Number of incontinence episodes was independent factor to affect quality of life using both LISAT-8 and MOS questionnaires. Severity of UUI was significantly associated with poorer individual well-being in subjects with OAB in a community sample in Spain. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  15. Waiting for surgery from the patient perspective

    Directory of Open Access Journals (Sweden)

    Tracey Carr

    2009-10-01

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

  16. [Heart surgery in the aged patient].

    Science.gov (United States)

    Klinner, W; Bernheim, C; Laiacker, H

    1985-10-31

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

  17. Perioperative Optimization of Patients Undergoing Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    C. E. Owers

    2012-01-01

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

  18. Two episodes of anaphylaxis following exposure to hydroxypropyl methylcellulose during cataract surgery

    DEFF Research Database (Denmark)

    Munk, Sofie J; Heegaard, Steffen; Mosbech, Holger

    2013-01-01

    for a detached retina avoiding HPMC. This case stresses the importance of considering all medication given to patients as possible causes of an anaphylactic reaction. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned....

  19. First-episode psychosis patients recruited into treatment via early detection teams versus ordinary pathways

    DEFF Research Database (Denmark)

    Johannessen, Jan O; Friis, Svein; Joa, Inge;

    2007-01-01

    Within an early detection sector, to compare the 1- and 2-year course and outcome of first-episode psychosis patients coming into the treatment system via active outreach detection teams (DTs) versus those achieving help via ordinary referral channels (not-DT)....

  20. Specific and generalized neuropsychological deficits: a comparison of patients with various first-episode psychosis presentations.

    LENUS (Irish Health Repository)

    Zanelli, Jolanta

    2010-01-01

    Overwhelming evidence suggests that compromised neuropsychological function is frequently observed in schizophrenia. Neurocognitive dysfunction has often been reported in other psychotic disorders, although there are inconsistencies in the literature. In the context of four distinct diagnostic groups, the authors compared neuropsychological performance among patients experiencing their first psychotic episode.

  1. The quality of life among first-episode psychotic patients in the OPUS trial

    DEFF Research Database (Denmark)

    Thorup, Anne; Petersen, Lone; Jeppesen, Pia

    2010-01-01

    BACKGROUND: From an 'objective' perspective, treatment of first-episode psychosis has improved in many ways with the development of specialised early and intensive team-based treatment like e.g. the 'OPUS' treatment. However, the patients' perspective is also important and was investigated in the...... extent and more strongly with the affective balance and level of self-esteem....

  2. Mutation Spectrum in the CACNA1A Gene in 49 Patients with Episodic Ataxia.

    Science.gov (United States)

    Sintas, Cèlia; Carreño, Oriel; Fernàndez-Castillo, Noèlia; Corominas, Roser; Vila-Pueyo, Marta; Toma, Claudio; Cuenca-León, Ester; Barroeta, Isabel; Roig, Carles; Volpini, Víctor; Macaya, Alfons; Cormand, Bru

    2017-05-31

    Episodic ataxia is an autosomal dominant ion channel disorder characterized by episodes of imbalance and incoordination. The disease is genetically heterogeneous and is classified as episodic ataxia type 2 (EA2) when it is caused by a mutation in the CACNA1A gene, encoding the α1A subunit of the P/Q-type voltage-gated calcium channel Cav2.1. The vast majority of EA2 disease-causing variants are loss-of-function (LoF) point changes leading to decreased channel currents. CACNA1A exonic deletions have also been reported in EA2 using quantitative approaches. We performed a mutational screening of the CACNA1A gene, including the promoter and 3'UTR regions, in 49 unrelated patients diagnosed with episodic ataxia. When pathogenic variants were not found by sequencing, we performed a copy number variant (CNV) analysis to screen for duplications or deletions. Overall, sequencing screening allowed identification of six different point variants (three nonsense and three missense changes) and two coding indels, one of them found in two unrelated patients. Additionally, CNV analysis identified a deletion in a patient spanning exon 35 as a result of a recombination event between flanking intronic Alu sequences. This study allowed identification of potentially pathogenic alterations in our sample, five of them novel, which cover 20% of the patients (10/49). Our data suggest that most of these variants are disease-causing, although functional studies are required.

  3. Long-term outcome of infective endocarditis: A study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years

    Directory of Open Access Journals (Sweden)

    Engblom Erik

    2008-04-01

    Full Text Available Abstract Background Only a few previous studies have focused on the long-term prognosis of the patients with infective endocarditis (IE. Our purpose was to delineate factors potentially associated with the long-term outcome of IE, recurrences of IE and requirement for late valve surgery. Methods A total of 326 episodes of IE in 303 patients were treated during 1980–2004 in the Turku University Hospital. We evaluated the long-term outcome and requirement for late valve surgery for 243 of these episodes in 226 patients who survived longer than 1 year after the initial admission. Factors associated with recurrences were analysed both for the 1-year survivors and for all 303 patients. Results The mean (SD follow-up time for the 1-year survivors was 11.5 (7.3 years (range 25 days to 25.5 years. The overall survival was 95%, 82%, 66%, 51% and 45% at 2, 5, 10, 15 and 20 years. In age and sex adjusted multivariate analyses, significant predictors for long-term overall mortality were heart failure within 3 months of admission (HR 1.97, 95% CI 1.27 to 3.06; p = 0.003 and collagen disease (HR 2.54, 95% CI 1.25 to 5.19; p = 0.010 or alcohol abuse (HR 2.39, 95% CI 1.30 to 4.40; p = 0.005 as underlying conditions, while early surgery was significantly associated with lower overall mortality rates (HR 0.31, 95% CI 0.17 to 0.58; p Conclusion Heart failure during the index episode of IE was the complication, which significantly predicted a poor long-term outcome. Patients who underwent surgery during the initial hospitalisation for IE faired significantly better than those who did not.

  4. OPCAB Surgery is cost-effective for elderly patients

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  5. Sigmoid volvulus in a patient with mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS): a rare occurrence.

    Science.gov (United States)

    Hallac, Alexander; Keshava, Hari B; Morris-Stiff, Gareth; Ibrahim, Samuel

    2016-03-02

    Mitochondrial diseases are rare and devastating, with a wide spectrum of clinical presentations and systemic symptoms. The majority of the published literature focuses on the neuromuscular manifestations and genetic components of this mitochondrial cytopathy, however, cardiac, renal, endocrine and gastrointestinal manifestations may also be present. The authors report a case detailing a 56-year-old woman's final hospitalisation from the gastrointestinal sequelae of mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) (Co Q10 deficiency variant). She presented with abdominal pain and distension associated with lactic acidosis, and was shown on imaging to have a colon perforation. This resulted in emergent surgery at which a necrotic colon secondary to a sigmoid colon was identified. Following four subsequent operations, and the development of multiorgan failure, care was eventually withdrawn. Practitioners of patients with MELAS should be cognisant of the rare but devastating gastrointestinal consequences of mitochondrial diseases.

  6. Nasal surgery in patients with systemic disorders

    Directory of Open Access Journals (Sweden)

    Sachse, Florian

    2010-01-01

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

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

    Science.gov (United States)

    Mahony, David

    2010-01-01

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

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

    Science.gov (United States)

    Mahony, David

    2010-01-01

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

  9. Perioperative Education of Patient Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Alexandros Zacharis

    2011-04-01

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

  10. Fewer acute respiratory infection episodes among patients receiving treatment for gastroesophageal reflux disease

    Science.gov (United States)

    Xirasagar, Sudha; Chung, Shiu-Dong; Tsai, Ming-Chieh; Chen, Chao-Hung

    2017-01-01

    Patients with gastroesophageal reflux disease (GERD) present with comorbid complications with implications for healthcare utilization. To date, little is known about the effects of GERD treatment with a proton-pump inhibitor (PPI) on patients’ subsequent healthcare utilization for acute respiratory infections (ARIs). This population-based study compared ARI episodes captured through outpatient visits, one year before and one year after GERD patients received PPI treatment. We used retrospective data from the Longitudinal Health Insurance Database 2005 in Taiwan, comparing 21,486 patients diagnosed with GERD from 2010 to 2012 with 21,486 age-sex matched comparison patients without GERD. Annual ARI episodes represented by ambulatory care visits for ARI (visits during a 7-day period bundled into one episode), were compared between the patient groups during the 1-year period before and after the index date (date of GERD diagnosis for study patients, first ambulatory visit in the same year for their matched comparison counterpart). Multiple regression analysis using a difference-in-difference approach was performed to estimate the adjusted association between GERD treatment and the subsequent annual ARI rate. We found that the mean annual ARI episode rate among GERD patients reduced by 11.4%, from 4.39 before PPI treatment, to 3.89 following treatment (mean change = -0.5 visit, 95% confidence interval (CI) = (-0.64, -0.36)). In Poisson regression analysis, GERD treatment showed an independent association with the annual ARI rate, showing a negative estimate (with p<0.001). The study suggests that GERD treatment with PPIs may help reduce healthcare visits for ARIs, highlighting the importance of treatment-seeking by GERD patients and compliance with treatment. PMID:28222168

  11. Delirium in elderly vascular surgery patients.

    Science.gov (United States)

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

    2014-04-01

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

  12. A preliminary study on the alterations of grey matter volume in patients with early adulthood episode schizophrenia

    Institute of Scientific and Technical Information of China (English)

    刘萍萍

    2012-01-01

    Objective To investigate the grey matter volume in patients with early adulthood episode (18-25 ages)schizophrenia and the correlations between regional volume and symptoms severity. Methods Twenty-one schizophrenia patients with early adulthood episode and twenty-one normal controls matched with age,sex and education

  13. Predictors of the Onset of Manic Symptoms and a (Hypo)Manic Episode in Patients with Major Depressive Disorder

    NARCIS (Netherlands)

    Boschloo, Lynn; Spijker, Annet T.; Hoencamp, Erik; Kupka, Ralph; Nolen, Willem A.; Schoevers, Robert A.; Penninx, Brenda W. J. H.

    2014-01-01

    Objective: One third of patients with a major depressive episode also experience manic symptoms or, even, a (hypo) manic episode. Retrospective studies on the temporal sequencing of symptomatology suggest that the majority of these patients report depressive symptoms before the onset of manic sympto

  14. Nutrition support to patients undergoing gastrointestinal surgery

    Directory of Open Access Journals (Sweden)

    Ward Nicola

    2003-12-01

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

  15. Tolosa-Hunt syndrome: MR imaging features in 15 patients with 20 episodes of painful ophthalmoplegia

    Energy Technology Data Exchange (ETDEWEB)

    Schuknecht, B. [MRI Medical Radiological Institute Zurich (Switzerland)], E-mail: image-solution@ggaweb.ch; Sturm, V. [Department of Ophthalmology, University Hospital Zurich (Switzerland); Huisman, T.A.G.M. [MRI Medical Radiological Institute Zurich (Switzerland); Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore (United States); Landau, K. [Department of Ophthalmology, University Hospital Zurich (Switzerland)

    2009-03-15

    Purpose: (a) To assess MR features in patients with Tolosa-Hunt syndrome (THS) and to (b) correlate MR findings with criteria derived from previously reported pathologic observations. Methods: Fifteen patients with twenty episodes of painful ophthalmoplegia prospectively selected according to International Headache Society (IHS) standards underwent MR examinations focused on the cavernous sinus. Initial examinations in 20 and follow-up MR images in 17 episodes were retrospectively reviewed by 3 independent observers. Results: The primary criteria: an enhancing soft tissue lesion within the cavernous sinus, increase in size and lateral bulging of the anterior cavernous sinus contour were consistently present in 15 initial episodes and in 5 recurrences (20/20). Agreement among observers was 100%. The secondary criteria: internal carotid artery narrowing in 7 patients, extension towards the superior orbital fissure in 13 and orbital apex involvement in 8 patients were unanimously agreed upon in 87.5%, 86.6% and 80%. Complete resolution of findings was observed on follow-up studies. Conclusion: In patients with THS the MR features conform to previously reported pathologic findings. MR features are evocative of THS when an increase in size and bulging of the dural contour of the anterior CS supplemented by carotid artery involvement and extension towards the orbit are present. Resolution of findings within 6 months is required to support the diagnosis.

  16. Emotional Intelligence in a group of patients with first-episode psychosis in Iran.

    Science.gov (United States)

    Basseda, Zahra; Amini, Homayoun; Sharifi, Vandad; Kaviani, Hosein; Pooretemad, Hamid Reza; Zadbood, Asieh

    2012-01-01

    This study was aimed to evaluate the Emotional Intelligence (EI) of a group of patients with first episode psychosis in Iran as compared with a healthy control group. A case-control design was used. EI was assessed using Persian version of Bar-On Emotional Quotient inventory (EQ-i) administered on 25 patients with history of a single psychotic episode in the last two years, as well as 64 healthy participants. The mean (±SD) of EI scores of patients' and healthy controls' group was 319.8 (±40.9) and 328.8 (±33.3), respectively. Two-independent sample t-test revealed no significant difference in the EI scores of two groups (P=0.29). In contrast with chronic schizophrenia, the patients with first-episode psychosis were not different from the healthy subjects in terms of emotional intelligence score. It might be implied that the low emotional intelligence of the patients with chronic psychotic disorders is an accumulative result of the underlying disease over time.

  17. Emotional Intelligence in a Group of Patients with First-Episode Psychosis in Iran

    Directory of Open Access Journals (Sweden)

    Hamid Reza Pooretemad

    2012-02-01

    Full Text Available This study was aimed to evaluate the Emotional Intelligence (EI of a group of patients with first episode psychosis in Iran as compared with a healthy control group. A case-control design was used. EI was assessed using Persian version of Bar-On Emotional Quotient inventory (EQ-i administered on 25 patients with history of a single psychotic episode in the last two years, as well as 64 healthy participants. The mean (±SD of EI scores of patients and healthy controls group was 319.8 (±40.9 and 328.8 (±33.3, respectively. Two-independent sample t-test revealed no significant difference in the EI scores of two groups (P=0.29. In contrast with chronic schizophrenia, the patients with first-episode psychosis were not different from the healthy subjects in terms of emotional intelligence score. It might be implied that the low emotional intelligence of the patients with chronic psychotic disorders is an accumulative result of the underlying disease over time.

  18. Bariatric Surgery in Obese Patients with Type 1 Diabetes: Effects on Weight Loss and Metabolic Control.

    Science.gov (United States)

    Faucher, Pauline; Poitou, Christine; Carette, Claire; Tezenas du Montcel, Sophie; Barsamian, Charles; Touati, Eliabelle; Bouillot, Jean-Luc; Torcivia, Adriana; Czernichow, Sébastien; Oppert, Jean-Michel; Ciangura, Cécile

    2016-10-01

    Type 1 diabetes patients, although typically lean, experience an increased prevalence of obesity, and bariatric surgery is considered in severe cases. Bariatric surgery in such patients leads to significant weight loss and decreased insulin requirements; however, effects on glycemic control remain discussed. We assessed, in obese patients with type 1 diabetes, the effects of bariatric surgery upon body weight, body composition, and glycemic control, including the occurrence of hypoglycemic events. Thirteen obese patients with type 1 diabetes who underwent bariatric surgery (Roux-en-Y gastric bypass n = 6, sleeve gastrectomy n = 7) were matched with obese patients without diabetes and with type 2 diabetes patients during 12 months of follow-up. Outcomes included body weight, DXA-assessed body composition, HbA1c, and incidence of hypoglycemia. At 12 months, median surgery-induced weight loss was 27.9 % (21.1-33.3), 26.1 % (24.8-29.7), and 27.5 % (21.8-32.1) in patients with type 1 diabetes, type 2 diabetes, and without diabetes, respectively, with no significant differences across the groups. Similar findings were observed for body fat changes. At 12 months, median HbA1c decreased from 8.3 to 7.6 % in type 1 diabetes patients versus 8.0 to 5.9 % in type 2 diabetes patients (P = 0.04 between the groups). In type 1 diabetes patients, the number of reported minor hypoglycemia increased transiently only at 6 months. Two patients reported severe hypoglycemia (one episode each). Type 1 diabetes patients benefit from bariatric surgery in terms of weight loss and glycemic control. Close monitoring of insulin therapy appears warranted to prevent minor hypoglycemia in the first months post-surgery.

  19. Theory of Mind in first-episode schizophrenia patients: correlations with cognition and personality traits.

    Science.gov (United States)

    Koelkebeck, Katja; Pedersen, Anya; Suslow, Thomas; Kueppers, Kerstin Annika; Arolt, Volker; Ohrmann, Patricia

    2010-06-01

    There is substantial evidence for Theory of Mind (ToM) deficits in patients with schizophrenia. Many psychotic symptoms may best be understood in light of an impaired capacity to infer one's own and other persons' mental states and to relate those to executing behavior. The aim of our study was to investigate ToM abilities in first-episode schizophrenia patients and to analyze them in relation to neuropsychological and psychopathological functioning. A modified Moving Shapes paradigm was used to assess ToM abilities in 23 first-episode patients with schizophrenia and 23 matched healthy controls. Participants had to describe animated triangles which moved (1) randomly, (2) goal-directed, or (3) in complex, socially interactive ways (ToM video sequences). Neuropsychological functioning, psychopathology, autistic and alexithymic features as well as empathetic abilities were correlated with ToM performance. Compared to healthy controls, first-episode schizophrenia patients gave more incorrect descriptions and used less ToM-related vocabulary when responding to socially complex ToM video sequences. No group differences were revealed for videos with random movements. ToM abilities correlated significantly with positive symptoms, reasoning, verbal memory performance and verbal IQ, but not with empathetic abilities or autistic and alexithymic features. When controlling for reasoning, verbal memory performance and verbal IQ, the correctness of video descriptions was still significantly worse in schizophrenia patients. The results of our study in first-episode schizophrenia patients underline recent findings on ToM deficits in the early course of schizophrenia. Only a moderate influence of neurocognitive deficits on ToM performance was observed. Impairment in ToM abilities seems to be predominantly independent of clinical state, alexithymia and empathy. Copyright (c) 2009 Elsevier B.V. All rights reserved.

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

    Science.gov (United States)

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

    2005-02-01

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

  1. The association of major depressive episode and personality traits in patients with fibromyalgia

    Directory of Open Access Journals (Sweden)

    Danyella de Melo Santos

    2011-01-01

    Full Text Available INTRODUCTION: Personality traits have been associated with primary depression. However, it is not known whether this association takes place in the case of depression comorbid with fibromyalgia. OBJECTIVE: The authors investigated the association between a current major depressive episode and temperament traits (e.g., harm avoidance. METHOD: A sample of 69 adult female patients with fibromyalgia was assessed with the Temperament and Character Inventory. Psychiatric diagnoses were assessed with the Mini-International Neuropsychiatric Interview severity of depressive symptomatology with the Beck Depression Inventory, and anxiety symptomatology with the IDATE-state and pain intensity with a visual analog scale. RESULTS: A current major depressive episode was diagnosed in 28 (40.5% of the patients. They presented higher levels of harm avoidance and lower levels of cooperativeness and self-directedness compared with non-depressed patients, which is consistent with the Temperament and Character Inventory profile of subjects with primary depression. However, in contrast to previous results in primary depression, no association between a major depressive episode and self-transcendence was found. CONCLUSIONS: The results highlight specific features of depression in fibromyalgia subjects and may prove important for enhancing the diagnosis and prognosis of depression in fibromyalgia patients.

  2. Explanatory models in patients with first episode depression: a study from north India.

    Science.gov (United States)

    Grover, Sandeep; Kumar, Vineet; Chakrabarti, Subho; Hollikatti, Prabhakar; Singh, Pritpal; Tyagi, Shikha; Kulhara, Parmanand; Avasthi, Ajit

    2012-09-01

    The purpose of this work was to study the explanatory models of patients with first episode depression presenting to a tertiary care hospital located in North-western India. One hundred sixty four consecutive patients with diagnosis of first episode depression (except severe depression with psychotic symptoms) according to the International Classification of Diseases-10th Revision (ICD-10) and ≥18 years of age were evaluated for their explanatory models using the causal models section of Explanatory Model Interview Catalogue (EMIC). The most common explanations given were categorized into Karma-deed-heredity category (77.4%), followed by psychological explanations (62.2%), weakness (50%) and social causes (40.2%). Among the various specific causes the commonly reported explanations by at least one-fourth of the sample in decreasing order were: will of god (51.2%), fate/chance (40.9%), weakness of nerves (37.8%), general weakness (34.7%), bad deeds (26.2%), evil eye (24.4%) and family problems (21.9%). There was some influence of sociodemographic features on the explanations given by the patients. From the study, it can be concluded that patients with first episode depression have multiple explanatory models for their symptoms of depression which are slightly different than those reported in previous studies done from other parts of India. Understanding the multiple explanatory models for their symptoms of depression can have important treatment implications. Copyright © 2012 Elsevier B.V. All rights reserved.

  3. Estimation of the cool executive function using frontal electroencephalogram signals in first-episode schizophrenia patients.

    Science.gov (United States)

    Yu, Yi; Zhao, Yun; Si, Yajing; Ren, Qiongqiong; Ren, Wu; Jing, Changqin; Zhang, Hongxing

    2016-11-25

    In schizophrenia, executive dysfunction is the most critical cognitive impairment, and is associated with abnormal neural activities, especially in the frontal lobes. Complexity estimation using electroencephalogram (EEG) recording based on nonlinear dynamics and task performance tests have been widely used to estimate executive dysfunction in schizophrenia. The present study estimated the cool executive function based on fractal dimension (FD) values of EEG data recorded from first-episode schizophrenia patients and healthy controls during the performance of three cool executive function tasks, namely, the Trail Making Test-A (TMT-A), Trail Making Test-B (TMT-B), and Tower of Hanoi tasks. The results show that the complexity of the frontal EEG signals that were measured using FD was different in first-episode schizophrenia patients during the manipulation of executive function. However, no differences between patients and controls were found in the FD values of the EEG data that was recorded during the performance of the Tower of Hanoi task. These results suggest that cool executive function exhibits little impairment in first-episode schizophrenia patients.

  4. Repeated episodes of focal cerebral ischemia in a patient with mitral valve prolapse and migraine headache

    Directory of Open Access Journals (Sweden)

    Raičević Ranko

    2002-01-01

    Full Text Available Migraine is episodic, paroxysmal disorder where the headache represents the central symptom and is followed with different combinations of neurological gastrointestinal and vegetative changes. Not until the diagnostic procedures were developed, ischemic lesions were verified even in the patients with ordinary migraine. This is a report of a patient with migraine headache followed twice by verified episodes of temporary ischemic attacks and verified focal ischemic lesion of cerebral parenchyma. The mitral valve prolapse was also detected. This all imposed the administration of combined prophylactic antimigrainous and anticoagulant therapy as an imperative because of the risk of the development of repeated ischemia of cerebral tissue. This association also confirmed an opinion that migraine is a wider disorder with the dominant dysfunction of limbic system.

  5. 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 ...

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

    NARCIS (Netherlands)

    Ettema, R.G.A.

    2014-01-01

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

  7. Computational Patient Avatars for Surgery Planning.

    Science.gov (United States)

    González, David; Cueto, Elías; Chinesta, Francisco

    2016-01-01

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

  8. The first peritonitis episode alters the natural course of peritoneal membrane characteristics in peritoneal dialysis patients.

    Science.gov (United States)

    van Diepen, Anouk T N; van Esch, Sadie; Struijk, Dirk G; Krediet, Raymond T

    2015-01-01

    Little or no evidence is available on the impact of the first peritonitis episode on peritoneal transport characteristics. The objective of this study was to investigate the importance of the very first peritonitis episode and distinguish its effect from the natural course by comparison of peritoneal transport before and after infection. We analyzed prospectively collected data from 541 incident peritoneal dialysis (PD) patients, aged > 18 years, between 1990 and 2010. Standard Peritoneal Permeability Analyses (SPA) within the year before and within the year after (but not within 30 days) the first peritonitis were compared. In a control group without peritonitis, SPAs within the first and second year of PD were compared. SPA data included the mass transfer area coefficient of creatinine, glucose absorption and peritoneal clearances of β-2-microglobulin (b2m), albumin, IgG and α-2-macroglobulin (a2m). From these clearances, the restriction coefficient to macromolecules (RC) was calculated. Also, parameters of fluid transport were determined: transcapillary ultrafiltration rate (TCUFR), lymphatic absorption (ELAR), and free water transport. Crude and adjusted linear mixed models were used to compare the slopes of peritoneal transport parameters in the peritonitis group to the control group. Adjustments were made for age, sex and diabetes. Of 541 patients, 367 experienced a first peritonitis episode within a median time of 12 months after the start of PD. Of these, 92 peritonitis episodes were preceded and followed by a SPA within one year. Forty-five patients without peritonitis were included in the control group. Logistic reasons (peritonitis group: 48% vs control group: 83%) and switch to hemodialysis (peritonitis group: 22% vs control group: 3%) were the main causes of missing SPA data post-peritonitis and post-control. When comparing the slopes of peritoneal transport parameters in the peritonitis group and the control group, a first peritonitis episode was

  9. Prevention of VTE in orthopedic surgery patients

    Directory of Open Access Journals (Sweden)

    Federico Spandonaro

    2013-10-01

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

  10. Yield of diagnostic tests in evaluating syncopal episodes in older patients.

    Science.gov (United States)

    Mendu, Mallika L; McAvay, Gail; Lampert, Rachel; Stoehr, Jonathan; Tinetti, Mary E

    2009-07-27

    Syncopal episodes are common among older adults; etiologies range from benign to life threatening. We determined the frequency, yield, and costs of tests obtained to evaluate older persons with syncope. We also calculated the cost per test yield and determined whether the San Francisco syncope rule (SFSR) improved test yield. Review of 2106 consecutive patients 65 years or older admitted following a syncopal episode. Electrocardiograms (in 99% of admissions), telemetry (in 95%), cardiac enzyme tests (in 95%), and head computed tomographic (CT) scans (in 63%) were the most frequently obtained tests. Results from cardiac enzymes tests, CT scans, echocardiography, carotid ultrasonography, and electroencephalography all affected diagnosis or management in less than 5% of cases and helped determine the etiology of syncope less than 2% of the time. Postural blood pressure (BP) recording, performed in only 38% of episodes, had the highest yield with respect to affecting diagnosis (18%-26%) or management (25%-30%) and determining etiology of the syncopal episode (15%-21%). The cost per test affecting diagnosis or management was highest for electroencephalography ($32 973), CT scans ($24 881), and cardiac enzymes test ($22 397) and lowest for postural BP recording ($17-$20). The yields and costs for cardiac tests were better among patients meeting, vs those not meeting, the SFSR. For example, the cost per cardiac enzymes test affecting diagnosis or management was $10 331 in those meeting, vs $111 518 in those not meeting, the SFSR. Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope.

  11. Hippocampus, glucocorticoids and neurocognitive functions in patients with first-episode major depressive disorders.

    Science.gov (United States)

    Kaymak, Semra Ulusoy; Demir, Başaran; Sentürk, Senem; Tatar, Ilkan; Aldur, M Mustafa; Uluğ, Berna

    2010-04-01

    The aim of this study was to determine whether there was any relationship between hippocampal volume, and glucocorticoid regulation, and cognitive dysfunctions in drug-naïve major depressive disorder (MDD) patients during their first episode. Twenty drug-free female MDD patients in their first episode and 15 healthy females as control subjects were included in the study. All subjects underwent 3.0 Tesla (T) magnetic resonance imaging (MRI), comprehensive neuropsychological testing and dexamethasone suppression tests (DST). The volumes of the right and left hippocampus of the patients were found to be significantly smaller than those of the controls. Patients were found to have significantly lower scores on measures of attention, working memory, psychomotor speed, executive functions, and visual and verbal memory fields. The performance of the patients only in the recollection memory and memory of reward-associated rules were positively correlated with hippocampal volumes. The volumes of the left and right hippocampus did not correlate with basal or post-dexamethasone cortisol levels. Our findings indicate that depressed patients have smaller hippocampi even in the earlier phase of their illness. Further research efforts are needed to explain the mechanisms that are responsible for the small hippocampus in depressed patients.

  12. [Clinicofunctional evaluation of ischemic episodes and vascular endothelium in patients with type 2 diabetes].

    Science.gov (United States)

    Tatarchenko, I P; Pozdniakova, N V; Dudukina, E A; Morozova, O I

    2006-01-01

    The aim of the investigation was to study the significance of the functional condition of endothelium for the evaluation of ischemic episodes in patients with type 2 diabetes mellitus (DM2). Ninety-three patients (52 men; 41 women; mean age 58.3+/-4.8 years) were examined. Group 1 consisted of 47 patients with coronary heart disease (CHD) and CD2; group 2 consisted of 46 CAD patients without carbohydrate exchange disorder. Both groups were comparable by gender, age, and the main risk factors. The patients were examined using Holter monitoring, physical load test, EchoCG, reactive hyperemia test (ultrasound evaluation of the endothelium-dependent brachial artery dilation). The number of painless ischemic episodes (PIE), the total duration of ischemia, the maximum degree of ST depression prevailed in group 1 patients. Correlation analysis demonstrated a significant negative correlation between endothelial dysfunction, one the one part, and the number and duration of PIE and the time between the ischemic ST depression and pain syndrome, on the other, in group 1 patients.

  13. Oral and maxillofacial surgery in patients

    Directory of Open Access Journals (Sweden)

    Stavros VASSILIOU

    2014-08-01

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

  14. Lower LINE-1 methylation in first-episode schizophrenia patients with the history of childhood trauma.

    Science.gov (United States)

    Misiak, Błażej; Szmida, Elżbieta; Karpiński, Paweł; Loska, Olga; Sąsiadek, Maria M; Frydecka, Dorota

    2015-01-01

    We investigated methylation of DNA repetitive sequences (LINE-1 and BAGE) in peripheral blood leukocytes from first-episode schizophrenia (FES) patients and healthy controls (HCs) with respect to childhood adversities. Patients were divided into two subgroups based on the history of childhood trauma - FES(+) and FES(-) subjects. The majority of HCs had a negative history of childhood trauma - HCs(-) subjects. FES(+) patients had significantly lower LINE-1 methylation in comparison with FES(-) patients or HC(-) subjects. Emotional abuse and total trauma score predicted lower LINE-1 methylation in FES patients, while general trauma score was associated with lower BAGE methylation in HCs. Childhood adversities might be associated with global DNA hypomethylation in adult FES patients.

  15. Theory of mind impairments in patients with first-episode schizophrenia and their unaffected siblings.

    Science.gov (United States)

    Ho, Karen K Y; Lui, Simon S Y; Hung, Karen S Y; Wang, Yi; Li, Zhi; Cheung, Eric F C; Chan, Raymond C K

    2015-08-01

    Theory of mind (ToM) impairment has been consistently demonstrated in patients with schizophrenia, but whether ToM impairments exist in unaffected siblings of patients with schizophrenia remains unclear. Few studies have examined the affective and cognitive components of ToM in schizophrenia. This study aimed to examine whether ToM impairments exist in patients with first-episode schizophrenia and their unaffected siblings, and whether there is any dissociation between the affective and cognitive components of ToM. We adopted a family-based case-control design. Participants were 41 patients with first-episode schizophrenia, 43 unaffected siblings, and 42 healthy controls. The Yoni Task which measures the participants' ability to understand first- and second-order affective versus cognitive ToM and the Faux Pas Task which taps into integration of the affective and cognitive components of ToM were administered. Multivariate and univariate ANCOVAs were used to examine the group differences in ToM, while controlling for other neurocognitive functions. Compared with controls, patients with schizophrenia and their unaffected siblings performed poorer on the Faux Pas Task (pschizophrenia performed worse than controls on second-order affective condition of the Yoni Task (p=0.004), but their unaffected siblings did not (p=0.063). We did not find any significant Group-by-Condition interaction in the Yoni Task (p=0.358). Patients with first-episode schizophrenia and their unaffected siblings exhibit ToM impairments, but no dissociation between affective and cognitive component of ToM was found. Our findings support the notion that ToM deficit may be a trait marker of schizophrenia. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. [Comprehensive assessment of ischemic episodes and vasomotor function of vascular endothelium in patients with type II diabetes mellitus].

    Science.gov (United States)

    Tatarchenko, I P; Posdniakova, N V; Dudukina, E A; Morozova, O I

    2007-01-01

    Value of functional state of endothelium in assessment of episodes of ischemia was studied in 93 patients (52 men and 41 women, mean age 58.3 +/- 4.8 years) divided into 2 groups. Group 1 comprised 47 patients with ischemic heart disease (IHD) and type II diabetes, group 2 comprised 46 patients with IHD without disturbances of carbohydrate metabolism. Patients of these groups had similar sex, age, and main risk factors. Examination included Holter ECG monitoring, stress test, echocardiography, test with reactive hyperemia (ultrasound measurement of endothelium dependent vasodilation of brachial artery). Number of painless ischemic episodes (PIE), total duration of episodes of ischemia, maximal depth of ST-segment lowering were greater in patients of group I compared with group 2. Correlation analysis revealed significant negative relationship between endothelial dysfunction and number and duration of episodes of ischemia, time interval between appearances of pain and ischemic ST depression.

  17. Association between unmet needs and clinical status in patients with first episode of schizophrenia in Chile

    Directory of Open Access Journals (Sweden)

    Natalia eJorquera

    2015-04-01

    Full Text Available Background: Schizophrenia is a severe mental disorder involving needs in several matters that are often not covered. A need is defined as a gap between the ideal state and the current state of a patient about a specific topic. Aim: To describe needs in patients with first episode of schizophrenia at the start of treatment, and to describe associated clinical factors. Methods: Observational descriptive cross-sectional design. Patients were over fifteen years old, with first episode schizophrenia, and admitted to treatment in the public health system from six district in two cities of Chile, between 2005 and 2006. Sociodemographic data, clinical evaluations of current psychosis based on the PANSS, and the time of untreated psychosis were obtained. A clinical interview, was carried out followed by the Camberwell Assessment of Need. Results: 29 patients were evaluated, 79.3% male, mean age 21.9 years old. The areas with more needs reported were; psychotic symptoms with 65.5% of sample, 21.1% of which reported it unmet; and daytime activities, where 44.8% of patients reported a need, 61.54% of them as unmet. The percentage of unmet needs correlated with PANSS score (r= 0.55; p=0.003, and with time of positive symptoms prior to diagnosis (r= 0.416; p=0.03. Discussion: Needs assessment in schizophrenia is necessary. It may affect its clinical course, be relevant in its management and help monitor recovery. Defining the main needs in people with first episode schizophrenia and associated factors allows for a better design of treatment strategies in order to obtain better therapeutic results and recovery.

  18. Charateristics of First Episode Psychosis Patients with Reassessment after Eight Years

    Directory of Open Access Journals (Sweden)

    Susana Vaz Carreiro

    2014-06-01

    Full Text Available The first episode psychosis (FEP is now a widely investigated topic, given that early intervention in these cases can mean an improved prognostic. Thus, this study sought to evaluate and characterize the evolution of these early outbreaks that were admitted at the Acute Inpatient Unit of the Department of Psychiatry and Mental Health, Hospital São Francisco Xavier, as only knowledge of the needs of care can enhance the quality and appropriateness of provided health care and assistance and enable to create structures that meet real needs. The present study, naturalistic, retrospective, evaluated the first psychotic episodes in patients admitted to the inpatient unit. It documented socio-demographic and clinical variables and re-evaluated the outcomes of these patients 8 years after admission, through information in the clinical case notes. The initial sample was 25 patients. The main findings consisted of a high number of dropouts from the outpatient clinic (only 20% remaining in follow-up, large number of substance abuse (48% of patients, a large number of readmissions and a slight worsening of the socio-professional status. It should be noted also that 20% of patients evolved to a schizophrenia diagnosis. This study allows us to alert healthcare professionals to this reality and emphasize the need to develop secondary prevention strategies that promote a pro-active attitude of the technicians, in order to obtain a greater adherence to a therapeutic project.

  19. Assessment of posttraumatic symptoms in patients with first-episode psychosis.

    LENUS (Irish Health Repository)

    2011-11-01

    Posttraumatic stress disorder is common among patients with psychotic disorders. The present study examined the internal reliability and comparability of the Impact of Event Scale (IES) in a sample of 38 patients with first-episode psychosis and 47 controls exposed to severe physical and\\/or sexual abuse. The IES total score and both subscales showed high internal consistency in both groups (Cronbach\\'s alpha coefficients of approximately 0.9 or higher). Given their equivalent trauma reporting, the lack of differences in IES scores between patients and controls seems to indicate that patients are likely to report accurately and neither exaggerate nor minimize their posttraumatic symptoms. Overall, the findings suggest that the IES can be used to assess symptoms of posttraumatic stress in patients with psychotic disorders as in other populations.

  20. Gallbladder surgery for Medicare patients in Mississippi.

    Science.gov (United States)

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

    1994-10-01

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

  1. Substance Use in Patients With First-Episode Psychosis: Is Gender Relevant?

    Science.gov (United States)

    Arranz, Belen; Safont, Gemma; Corripio, Iluminada; Ramirez, Nicolas; Dueñas, Rosa Maria; Perez, Victor; Alvarez, Enric; San, Luis

    2015-01-01

    Only a few studies in patients with first-episode psychosis have included gender in the study hypothesis or considered this a primary study variable. The aim of this study was to explore the influence of gender in the pattern of substance use in patients with first-episode psychosis. This is a sub-analysis of a randomized open clinical trial that compared 1-year treatment retention rates of patients with first-episode psychosis randomized to haloperidol, olanzapine, quetiapine, risperidone, or ziprasidone. Our sub-analysis included 85 men and 29 women. Substance use was relatively high among these patients and differed significantly by gender. Men were more likely to use substances overall than women (89.4% for men vs. 55.2% for women), χ(2) = 16.2, df = 1, p <.001, and were also more likely to use alcohol (χ(2) = 13, df = 1, p <.001), cannabis (χ(2) = 9.9; df = 1, p <.002), and cocaine (χ(2) = 10.3; df = 1, p <.001), compared to women. While there were no gender differences in age at first consumption of alcohol or cocaine, men were significantly younger at first consumption of cannabis (M = 16.08 years, SD = 2.1) than women (M = 18.0 years, SD = 3.8), F(1, 59) = 5, p <.02. When analyzed separately by gender, women showed no significant differences in the influence of number of substances used on age at onset of psychosis, F(3, 29) = 1.2, p =.30. However, there was a significant difference among men, with earlier onset of psychosis noted in men consuming multiple substances; F(4, 85) = 5.8, p <.0001. Regarding prediction of age at onset of psychosis, both male gender and the use of a higher number of substances significantly predicted an earlier age at onset of psychosis. Our study provides some evidence of gender differences in the pattern of substance use in patients with first-episode psychosis, suggesting the possible need for gender-specific approaches in the interventions performed in these patients. This study is registered as #12610000954022 with the

  2. Changes in extra-striatal functional connectivity in patients with schizophrenia in a psychotic episode.

    Science.gov (United States)

    Peters, Henning; Riedl, Valentin; Manoliu, Andrei; Scherr, Martin; Schwerthöffer, Dirk; Zimmer, Claus; Förstl, Hans; Bäuml, Josef; Sorg, Christian; Koch, Kathrin

    2017-01-01

    In patients with schizophrenia in a psychotic episode, intra-striatal intrinsic connectivity is increased in the putamen but not ventral striatum. Furthermore, multimodal changes have been observed in the anterior insula that interact extensively with the putamen. We hypothesised that during psychosis, putamen extra-striatal functional connectivity is altered with both the anterior insula and areas normally connected with the ventral striatum (i.e. altered functional connectivity distinctiveness of putamen and ventral striatum). We acquired resting-state functional magnetic resonance images from 21 patients with schizophrenia in a psychotic episode and 42 controls. Patients had decreased functional connectivity: the putamen with right anterior insula and dorsal prefrontal cortex, the ventral striatum with left anterior insula. Decreased functional connectivity between putamen and right anterior insula was specifically associated with patients' hallucinations. Functional connectivity distinctiveness was impaired only for the putamen. Results indicate aberrant extra-striatal connectivity during psychosis and a relationship between reduced putamen-right anterior insula connectivity and hallucinations. Data suggest that altered intrinsic connectivity links striatal and insular pathophysiology in psychosis. © The Royal College of Psychiatrists 2017.

  3. Mild Reinforcement Learning Deficits in Patients With First-Episode Psychosis.

    Science.gov (United States)

    Chang, Wing Chung; Waltz, James A; Gold, James M; Chan, Tracey Chi Wan; Chen, Eric Yu Hai

    2016-11-01

    Numerous studies have identified reinforcement learning (RL) deficits in schizophrenia. Most have focused on chronic patients with longstanding antipsychotic treatment, however, and studies of RL in early-illness patients have produced mixed results, particularly regarding gradual/procedural learning. No study has directly contrasted both rapid and gradual RL in first-episode psychosis (FEP) samples. We examined probabilistic RL in 34 FEP patients and 36 controls, using Go/NoGo (GNG) and Gain vs Loss-Avoidance (GLA) paradigms. Our results were mixed, with FEP patients exhibiting greater impairment in the ability to use positive, as opposed to negative, feedback to drive rapid RL on the GLA, but not the GNG. By contrast, patients and controls showed similar improvement across the acquisition. Finally, we found no significant between-group differences in the postacquisition expression of value-based preference in both tasks. Negative symptoms were modestly associated with RL measures, while the overall bias to engage in Go-responding correlated significantly with psychosis severity in FEP patients, consistent with striatal hyperdopaminergia. Taken together, FEP patients demonstrated more circumscribed RL impairments than previous studies have documented in chronic samples, possibly reflecting differential symptom profiles between first-episode and chronic samples. Our finding of relatively preserved gradual/procedural RL, in briefly medicated FEP patients, might suggest spared or restored basal ganglia function. Our findings of preserved abilities to use representations of expected value to guide decision making, and our mixed results regarding rapid RL, may reflect a lesser degree of prefrontal cortical functional impairment in FEP than in chronic samples. Further longitudinal research, in larger samples, is required.

  4. The evaluation of neutrophil-lymphocyte ratio in patients with first episode psychosis

    Directory of Open Access Journals (Sweden)

    Nalan Varsak

    2016-12-01

    Full Text Available Introduction: There is a growing consensus in the literature that inflammation may play a role in the pathophysiology of schizophrenia. The blood neutrophil-lymphocyte ratio is a simple, inexpensive and reliable marker of inflammation. The aim of this study is to assess the relationship between first episode psychosis (FEP and neutrophil–lymphocyte ratio (NLR and to investigate if there is a relation between NLR and severity of disease.Methods: In this retrospective study we analyzed 58 FEP patients’ medical records from January 2011 to June 2014 who had been treated at our hospital. Hematologic parameters, Brief Psychiatric Rating Scale (BPRS scores and demographic data of the patients were obtained from the medical records of 58 FEP patients. Hematologic parameters and NLR values of 58 patients with FEP compared to values of 37 healthy control group. Correlation between NLR and BPRS scores were calculated.Results: Mean NLR was significantly higher in patients compared to control group (2.22 ± 1.25 vs. 1.63 ± 0.38, p = 0.041. Neutrophil count was not different between patients and healthy control (4.03 ± 0.70 vs. 4.20 ± 1.48, p = 0.525, but lymphocyte count was significantly lower in patients (2.56 ± 0.55 vs. 2.19 ± 0.77, p = 0.013.  In the FEP patients, NLR was not significantly correlate with severity of disease (BPRS score (n = 58; r = 0.060, p = 0.655.Conclusion: Our findings suggest that NLR levels are increased in physically healthy antipsychotic- naive first episode psychosis patients compared to physically and mentally healthy individuals.

  5. Hypomagnesemia as a possible explanation behind episodes of severe pain in cancer patients receiving palliative care.

    Science.gov (United States)

    López-Saca, José Mario; López-Picazo, José Maria; Larumbe, Ana; Urdíroz, Juli; Centeno, Carlos

    2013-02-01

    Within an oncology setting, certain chemotherapy drugs, such as cisplatin, may lead to magnesium loss causing nephropathy. Neurological and cardiovascular symptoms caused by hypomagnesaemia are well known. The relationship between serious hypomagnesemia and severe pain is not well documented but nevertheless, when faced with unexplained episodes of pain which do not respond to powerful analgesics, it is important to review blood magnesium levels. We present two cases of opioid-refractory pain attacks. Patients received drugs which have been linked to hypomagnesemia. In both cases, endovenous magnesium replacement led to a drastic improvement in pain management.

  6. The quality of life among first-episode psychotic patients in the OPUS trial

    DEFF Research Database (Denmark)

    Thorup, Anne; Petersen, Lone; Jeppesen, Pia

    2010-01-01

    BACKGROUND: From an 'objective' perspective, treatment of first-episode psychosis has improved in many ways with the development of specialised early and intensive team-based treatment like e.g. the 'OPUS' treatment. However, the patients' perspective is also important and was investigated in the...... extent and more strongly with the affective balance and level of self-esteem....... by Lancashire QoLP in a significantly different way from the standard treatment (ST). There were no significant differences in quality of life between the ST group and the OPUS group concerning the 9 life domains. Quality of life correlated with psychopathology (both psychotic and negative symptoms) to a minor...

  7. Lifetime Autism Spectrum Features in a Patient with a Psychotic Mixed Episode Who Attempted Suicide

    Directory of Open Access Journals (Sweden)

    Marly Simoncini

    2014-01-01

    Full Text Available We present a case report of a young man who attempted suicide during a mixed episode with psychotic symptoms. The patient’s history revealed the lifetime presence of signs and features belonging to the autism spectrum realm that had been completely overlooked. We believe that this case is representative of an important and barely researched topic: what happens to children with nondiagnosed and nontreated subthreshold forms of autism when they grow old. The issue of early recognition of autism spectrum signs and symptoms is discussed, raising questions on the diagnostic boundaries between autism and childhood onset psychotic spectrums among patients who subsequently develop a full-blown psychotic disorder.

  8. Nerve excitability studies characterize Kv1.1 fast potassium channel dysfunction in patients with episodic ataxia type 1.

    Science.gov (United States)

    Tomlinson, Susan E; Tan, S Veronica; Kullmann, Dimitri M; Griggs, Robert C; Burke, David; Hanna, Michael G; Bostock, Hugh

    2010-12-01

    Episodic ataxia type 1 is a neuronal channelopathy caused by mutations in the KCNA1 gene encoding the fast K(+) channel subunit K(v)1.1. Episodic ataxia type 1 presents with brief episodes of cerebellar dysfunction and persistent neuromyotonia and is associated with an increased incidence of epilepsy. In myelinated peripheral nerve, K(v)1.1 is highly expressed in the juxtaparanodal axon, where potassium channels limit the depolarizing afterpotential and the effects of depolarizing currents. Axonal excitability studies were performed on patients with genetically confirmed episodic ataxia type 1 to characterize the effects of K(v)1.1 dysfunction on motor axons in vivo. The median nerve was stimulated at the wrist and compound muscle action potentials were recorded from abductor pollicis brevis. Threshold tracking techniques were used to record strength-duration time constant, threshold electrotonus, current/threshold relationship and the recovery cycle. Recordings from 20 patients from eight kindreds with different KCNA1 point mutations were compared with those from 30 normal controls. All 20 patients had a history of episodic ataxia and 19 had neuromyotonia. All patients had similar, distinctive abnormalities: superexcitability was on average 100% higher in the patients than in controls (P episodic ataxia type 1 and controls could be clearly separated into two non-overlapping groups. Differences between the different KCNA1 mutations were not statistically significant. Studies of nerve excitability can identify K(v)1.1 dysfunction in patients with episodic ataxia type 1. The simple 15 min test may be useful in diagnosis, since it can differentiate patients with episodic ataxia type 1 from normal controls with high sensitivity and specificity.

  9. Changes in event-related potentials in patients with first-episode schizophrenia and their siblings.

    Science.gov (United States)

    Yang, Chengqing; Zhang, Tianhong; Li, Zezhi; Heeramun-Aubeeluck, Anisha; Liu, Na; Huang, Nan; Zhang, Jie; He, Leiying; Li, Hui; Tang, Yingying; Chen, Fazhan; Wang, Jijun; Lu, Zheng

    2017-01-17

    This study aimed to explore the characteristics of event-related potentials induced by facial emotion recognition in patients with first-episode schizophrenia and in their siblings. In this case-control study, 30 first-episode schizophrenia patients, 26 siblings, and 30 healthy controls were enrolled. They completed facial emotion recognition tasks from the Ekman Standard Faces Database as an induction for evoked potentials. Evoked potential data were obtained using a 64-channel electroencephalography system. Average evoked potential waveforms were computed from epochs for each stimulus type. The amplitudes and latency of the event-related potentials for P100 (positive potential 100 ms after stimulus onset), N170 (negative potential 170 ms after stimulus onset), and N250 (fronto-central peak) were investigated at O1, O2, P7, and P8 electrode locations. There were significant differences between the groups for P100 amplitude (F = 11.526, P emotion (disgust vs. happiness vs. fear) (F = 1722.467, P emotion intensity (low vs. moderate vs. high) (F = 1737.169, P emotion processing in patients with schizophrenia. P100 may be a characteristic index of schizophrenia.

  10. How patients' self-disclosure about sickle cell pain episodes to significant others relates to living with sickle cell disease.

    Science.gov (United States)

    Derlega, Valerian J; Janda, Louis H; Miranda, Jeannie; Chen, Ian A; Goodman, B Mitchell; Smith, Wally

    2014-09-01

    This cross-sectional study examines to whom and how fully sickle cell disease (SCD) patients talk to others about sickle cell pain, how helpful it is to talk with others about these pain episodes, and the association between talking to others about sickle cell pain episodes and patients' psychological adjustment and coping strategies in managing the disease. A convenience sample of 73 African American patients with SCD (30 men and 43 women), were recruited from two SCD clinics at the time of routine medical visits. Most participants had been diagnosed with hemoglobin SS, and they reported an average number of 8.61 pain episodes in the previous 12 months. Participants were asked to whom, how fully, and how helpful it was to talk to significant others about SCD pain episodes experienced in the last 12 months. Patients also completed measures of their psychological adjustment as well as how they would manage a future sickle cell pain episode. Self-report ratings were made on Likert-type scales. Based on paired samples t-tests, participants talked significantly more fully about their thoughts and feelings concerning pain episodes to God and to their primary medical providers than to either their parents, siblings, or an intimate partner/close friend. Bivariate correlations indicated that amount and helpfulness of talking about pain episodes to God and to parents were significantly associated with better psychological adjustment on selected measures. Also, bivariate correlations indicated that helpfulness in talking with siblings, intimate partner/close friend, and primary medical providers was positively related with willingness to go to a physician in the event of a future pain episode. The results document to whom and how helpful it is to talk with others about SCD pain episodes and how SCD disclosure is related to strategies for managing this disease. Wiley Periodicals, Inc.

  11. Consciousness Disorders after Elective Surgery in Patients with Cerebrovascular Insufficiency

    Directory of Open Access Journals (Sweden)

    V. V. Likhvantsev

    2015-01-01

    Full Text Available Objective: to study the impact of cerebral hypoxemia on the indicators of neuroinjury, by relying on the diagnosis of post- operative cognitive impairments, and the neuroinjury marker S100b protein and to examine the relationship of postoperative cognitive mpairments. Subjects and methods. Forty-eight non-cardiac surgical and non-neurosurgical patients with verified cerebrovascular disease, who had been operated on under total intravenous anesthesia with propofol and total myoplegia, were examined. Blood S100b protein levels were determined after cerebral hypoxemia detectable by transcranial oximetry. Postoperative delirium was diagnosed by the ICU-CAM test; postoperative cognitive dysfunction was diagnosed according to the Montreal cognitive assessment scale in the periods: 7 days, 1, 3, and 6 months, and 1 year, by using the control group, the Z scores of these indicators were standardized. Results. Cerebral desaturation led to early postoperative disorders, such as delirium and dysfunctions, in 72.7% of the cases. Cerebral saturation parameters correlated moderately, but significantly with neuropsychological indicators at 30 days of the study and 3 months after surgery and just stronger with S100b protein level. The risk of postoperative cognitive impairments in relation to the values of S100b protein was validly predicted in the models of logistic regression and ROC analysis. The rate of early and persistent cognitive dysfunction differed statistically significantly in patients with prior delirium; the logistic regression model validly predicted a relationship between this event and the neuropsychological indicators on 7 days postsurgery. Conclusion. In the patients with cerebrovascular diseases, cerebral hypoxemic episodes are dangerous. When they occur, there is an increased risk of postoperative cognitive impairments, including long-term problems. The above-threshold S100b protein concentration of 0.26 ng/mg is an early predictor of

  12. Changes in Antibody Levels during and following an Episode of Acute Adenolymphangitis (ADL among Lymphedema Patients in Leogane, Haiti.

    Directory of Open Access Journals (Sweden)

    Katherine E Mues

    Full Text Available Episodes of acute adenolymphangitis (ADL are often the first clinical sign of lymphatic filariasis (LF. They are often accompanied by swelling of the affected limb, inflammation, fever, and general malaise and lead to the progression of lymphedema. Although ADL episodes have been studied for a century or more, questions still remain as to their etiology. We quantified antibody levels to pathogens that potentially contribute to ADL episodes during and after an episode among lymphedema patients in Léogâne, Haiti. We estimated the proportion of ADL episodes hypothesized to be attributed to specific pathogens.We measured antibody levels to specific pathogens during and following an ADL episode among 41 lymphedema patients enrolled in a cohort study in Léogâne, Haiti. We calculated the absolute and relative changes in antibody levels between the ADL and convalescent time points. We calculated the proportion of episodes that demonstrated a two-fold increase in antibody level for several bacterial, fungal, and filarial pathogens.Our results showed the greatest proportion of two-fold changes in antibody levels for the carbohydrate antigen Streptococcus group A, followed by IgG2 responses to a soluble filarial antigen (BpG2, Streptococcal Pyrogenic Exotoxin B, and an antigen for the fungal pathogen Candida. When comparing the median antibody level during the ADL episode to the median antibody level at the convalescent time point, only the antigens for Pseudomonas species (P-value = 0.0351 and Streptolysin O (P-value = 0.0074 showed a significant result.Although our results are limited by the lack of a control group and few antibody responses, they provide some evidence for infection with Streptococcus A as a potential contributing factor to ADL episodes. Our results add to the current evidence and illustrate the importance of determining the causal role of bacterial and fungal pathogens and immunological antifilarial response in ADL episodes.

  13. Management of Bleeding in Post-liver Disease, Surgery and Biopsy in Patients With High Uncorrected International Normalized Ratio With Prothrombin Complex Concentrate: An Iranian Experience.

    Science.gov (United States)

    Parand, Alireza; Honar, Naser; Aflaki, Khashayar; Imanieh, Mohammad Hadi; Haghighat, Mahmood; Cohan, Nader; Haghpanah, Sezaneh; Marietta, Marco; Serati, Zahra; Haghbin, Saeedeh; Karimi, Mehran

    2013-12-01

    To evaluate the efficacy of prothrombin complex concentrate (PCC) in the management of bleeding in patients with liver disease and patients undergoing surgery or biopsy who had a high uncorrected international normalized ratio (INR). In this study, we examined an Iranian sample and investigated the efficacy of PCC to manage bleeding in patients with liver disease and also patients with high uncorrected INR who were scheduled for surgery or biopsy. A total of 25 patients including 16 patients with post-liver disease bleeding (group 1) and 9 patients with high uncorrected INR who were scheduled for surgery or biopsy (group 2) were enrolled. All patients were treated with 25 IU/kg PCC, and efficacy was defined as any reduction in or cessation of bleeding episodes and correction of INR before surgery or biopsy. The patients were also evaluated for any adverse effects. INR decreased significantly in both groups of patients, with no bleeding episodes during or after the study in group 1 and during or after surgery/biopsy in group 2. All patients tolerated the therapy well without any significant adverse effects. The efficacy of PCC therapy was satisfactory in this study. PCC therapy in patients with liver disease and patients undergoing surgery or biopsy seems to be effective and safe, and may be a good treatment strategy for these patients, if fresh frozen plasma or vitamin K are not effective.

  14. [Diabetes mellitus induced by pentamidine, without previous episodes of hypoglycemia, in patients with AIDS].

    Science.gov (United States)

    Santos, I; del Arco, C; García-Polo, I; Noguerado, A; Caso, E; Gómez-Pan, A

    1990-12-01

    The onset of a pneumonia by P. carinii in AIDS patients have force scientist to look for others therapies against this parasite. It is more necessary when the first line treatment which is cotrimoxazol produced secondary effects or not therapeutic effects. Pentamidine which is an agent usually used to treat leishmaniasis and trypanosomiasis, but it is an alternative for P. carinii infection. The problems are the frequent and severe secondary effects when administered by continuous infusions and less when it is inhaled. Between those effects are the changes in carbohydrate metabolism which are 9% of them. It is frequent observe hypoglycemia during infusion following by hyperglycemia in 5% of the cases which convert the patients in diabetic insulinodependent. A case of a patient who developed diabetes mellitus insulinodependent, 10 days after the end of pentamidine treatment, without previous episodes of hypoglycemia, is presented. The medical literature is reviewed.

  15. Impact of Sitting or Semi-Setting Position of Patients During Breast Surgery on Hemodynamic Indexes

    Directory of Open Access Journals (Sweden)

    Kasra Karvandian

    2016-09-01

    Full Text Available Background: Keeping the patient in a sitting or semi-sitting position for time-consuming oncoplastic breast surgery is a major challenge for anesthesiologists due to several considerations. This cohort study was conducted on two groups of patients undergoing breast surgery.Methods: Study participants were categorized into two groups: one group was composed of normotensive women (group A and the other group comprised women with controlled hypertension (group B. After the induction of anesthesia in the supine position, the position was changed to sitting and the surgery was done in the sitting position. Hemodynamic monitoring included ECG, heart rate, non-invasive blood pressure (NIBP, invasive blood pressure (IBP, cardiac output (CO, arterial O2 saturation (SPO2, end-tidal CO2 (EtCO2, and bispectral index (BIS. The amount of administrated fluid and vasopressor was recorded for each patient. Any episode of hemodynamic instability was recorded, too.Results: Hemodynamic variation occurred in both groups, but the changes were more significant in group B and the amount of fluid and vasopressor administration was more prominent in group B. Changing the position caused no significant variation in BIS, SPO2, and EtCO2 in the two groups.Conclusions: The sitting position can be safe for time-consuming oncoplastic breast surgery using adequate hemodynamic monitoring. Hemodynamic changes are more significant in patients with controlled hypertension, and more medical interference is needed for these patients.

  16. Antipsychotic Treatment Reduces Indices of Oxidative Stress in First-Episode Psychosis Patients

    Directory of Open Access Journals (Sweden)

    Kärt Kriisa

    2016-01-01

    Full Text Available 38 first-episode psychosis (FEP patients and 37 control subjects were recruited for the study of indices of oxidative stress (OxS. The main purpose of the study was to compare the OxS statuses (serum total antioxidant capacity (TAC, total level of peroxides (TPX, oxidative stress index (OSI, and ratio oxidized methionine (Met-SO to methionine (Met between antipsychotic-naïve FEP patients and individuals without a history of psychiatric disorders. Subsequently, the impact of 7-month antipsychotic treatment was evaluated on the OxS status in FEP patients. An attempt was made to assess links between OxS signature and inflammation markers. The oxidative stress indices remained generally unchanged in antipsychotic-naïve FEP patients compared to control subjects. Despite that, there was a significant correlation between the levels of TPX and EGF (endothelial growth factor in FEP patients. This correlation disappeared after antipsychotic treatment of FEP patients. Moreover, antipsychotic treatment was associated with a significant reduction in OxS indices, including TPX, OSI, and ratio between Met-SO and Met. By contrast, in chronic SCZ patients we established a significant high-grade OxS. In conclusion, the markers of total antioxidative capacity, lipid peroxidation, and protein oxidation revealed no high-grade OxS in FEP patients. Nevertheless, antipsychotic treatment induced a considerable anti-inflammatory effect. OxS levels were also significantly decreased if compared in FEP patients before and after antipsychotic treatment.

  17. Stress management training for breast cancer surgery patients

    NARCIS (Netherlands)

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

    2013-01-01

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

  18. Body Dysmorphic Disorder in Patients With Cosmetic Surgery

    Directory of Open Access Journals (Sweden)

    Chung-Sheng Lai

    2010-09-01

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

  19. Psychometric evaluation of the Danish and Swedish Satisfaction with Life Scale in first episode psychosis patients.

    Science.gov (United States)

    Hochwälder, Jacek; Mattsson, Maria; Holmqvist, Ragnhild; Cullberg, Johan; Rosenbaum, Bent

    2013-04-01

    To psychometrically evaluate the Satisfaction with Life Scale in two cohorts of first-episode psychosis patients in the Danish National Schizophrenia Project and in the Swedish Parachute Project. Four properties of the Satisfaction with Life Scale were examined in the Danish cohort (explorative investigation) and then confirmed in the Swedish cohort: (1) the factor structure; (2) correlations between subscales; (3) internal consistencies of subscales; and (4) main tendencies (arithmetic means) and variations (standard deviations) of subscales. The relations between the Satisfaction with Life Scale and various life conditions were investigated in the Swedish cohort. For both samples, the analysis indicated that the obtained four-dimensional 11-item scale had satisfactory properties. Moderately high scores were obtained in the four subscales: "living," "social relationships," "self and present life" and "work." They correlated positively with each other, the internal consistencies of the subscales were acceptable and the means for the subscales indicated no apparent floor or ceiling effects. The four dimensions obtained seem relevant and presented good face validity. The dimensions were confirmed in the Swedish sample. The Satisfaction with Life Scale shows satisfactory psychometric properties and seems valid and useful among first-episode psychosis patients.

  20. Increased Frontal Gyrification Negatively Correlates with Executive Function in Patients with First-Episode Schizophrenia.

    Science.gov (United States)

    Sasabayashi, Daiki; Takayanagi, Yoichiro; Nishiyama, Shimako; Takahashi, Tsutomu; Furuichi, Atsushi; Kido, Mikio; Nishikawa, Yumiko; Nakamura, Mihoko; Noguchi, Kyo; Suzuki, Michio

    2017-04-01

    Previous neuroimaging studies of gyrification, a possible marker of early neurodevelopment, in schizophrenia patients have reported inconsistent results. In addition, it remains unclear whether aberrant gyrification in schizophrenia patients, if present, is associated with cognitive impairment, which is one of the core features of schizophrenia. Magnetic resonance images were obtained from 62 patients with first-episode schizophrenia and 57 healthy control subjects. Using FreeSurfer software, local gyrification index (LGI) of the entire cortex was compared between the groups. The relationship between LGI and performance in the Wisconsin Card Sorting Test (WCST) was also examined in a subgroup of patients (n= 28). Compared with the controls, the patients showed a significantly higher LGI in a wide range of bilateral frontal regions as well as in the right inferior parietal and bilateral occipital regions. The number of WCST categories archived in patients was negatively correlated with the LGI mainly in the rostral middle frontal and anterior cingulate regions in the right hemisphere. Our findings suggested a widespread hypergyrification pattern in schizophrenia patients, which supported early neurodevelopmental abnormalities. Our results also suggested that executive dysfunction in schizophrenia patients may be at least partly related to aberrant neurodevelopment, especially in the right frontal regions. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  1. Risk for opportunistic disease and death after reinitiating continuous antiretroviral therapy in patients with HIV previously receiving episodic therapy: a randomized trial

    DEFF Research Database (Denmark)

    El-Sadr, W M; Grund, B; Neuhaus, J;

    2008-01-01

    BACKGROUND: Episodic use of antiretroviral therapy guided by CD4+ cell counts is inferior to continuous antiretroviral therapy. OBJECTIVE: To determine whether reinitiating continuous antiretroviral therapy in patients who received episodic treatment reduces excess risk for opportunistic disease ...

  2. Prevalence of metabolic syndrome among patients with major depressive disorder--differences between newly diagnosed first episode and recurrent disease.

    Science.gov (United States)

    Ljubicic, Rudolf; Jakovac, Hrvoje; Bistrović, Ivana Ljubicić; Franceski, Tanja; Mufić, Ana Kovak; Karlović, Dalibor

    2013-12-01

    The objective of the present study was to assess differences in prevalence of the metabolic syndrome among depressed patients in regard to the duration of the illness (first episode versus recurrent episodes). A total of 190 patients suffering from major depressive disorder were included in the study, diagnosed according to International classification of disorders, 10th revision. The same criteria were used to divide participants into two groups: first episode major depressive disorder and major depressive disorder with recurrent episodes. The metabolic syndrome was defined according to the criteria of the American National Cholesterol Education Program-Treatment Panel III. Results showed that metabolic syndrome is significantly more prevalent in patients with recurrent major depressive disorder (45.2%) compared to patients with first episode of major depressive disorder (27.3%), mainly due to differences in plasma glucose, triglycerides and HDL-cholesterol levels. These findings indicate the importance of the duration of depression and the number of recurring episodes as factors involved in etiopathogenesis of the associated metabolic syndrome.

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

    Science.gov (United States)

    Sellevold, Olav F Münter; Stenseth, Roar

    2010-03-25

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

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

    Science.gov (United States)

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

    2012-04-01

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

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

    Science.gov (United States)

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

    2009-03-01

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

  6. Treatment of patients with first-episode psychosis: two-year outcome data from the Danish National Schizophrenia Project

    OpenAIRE

    2006-01-01

    First episode psychosis interventions have been in focus in the last two decades in an attempt to improve the course and outcome of schizophrenic disorders. The Danish National Schizophrenia Project began in 1997 its intake of patients, aged 16-35, with a first psychotic episode of a schizophrenic spectrum disorder, diagnosed by ICD-10 (F20-29). The study was carried out as a prospective, longitudinal, multicentre investigation, encompassing 16 centres, spread all over the c...

  7. Apathy in first episode psychosis patients: a ten year longitudinal follow-up study.

    Science.gov (United States)

    Evensen, Julie; Røssberg, Jan Ivar; Barder, Helene; Haahr, Ulrik; Hegelstad, Wenche ten Velden; Joa, Inge; Johannessen, Jan Olav; Larsen, T K; Melle, Ingrid; Opjordsmoen, Stein; Rund, Bjørn Rishovd; Simonsen, Erik; Sundet, Kjetil; Vaglum, Per; Friis, Svein; McGlashan, Thomas

    2012-04-01

    Apathy is a common symptom in first episode psychosis (FEP), and is associated with poor functioning. Prevalence and correlates of apathy 10 years after the first psychotic episode remain unexplored. The aims of the study were twofold: 1) to examine prevalence and predictors of apathy at 10 years, and 2) to examine the relationship between apathy at 10 years and concurrent symptoms, functioning and outcome, including subjective quality of life. Three-hundred-and-one patients with FEP were included at baseline, 186 participated in the 10 year follow-up. Of these, 178 patients completed the Apathy Evaluation Scale (AES-S-Apathy). Patients were classified as having apathy (AES-S-Apathy≥27) or not. The relationship between apathy and baseline variables (Demographics, Diagnosis, Duration of Untreated Psychosis), measures of symptomatology (Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia), functioning (Global Assessment of Functioning Scale, Strauss Carpenter Level of Functioning Scale) and subjective quality of life (Lehman's Quality of Life Interview) were estimated through correlation analyses and blockwise multiple hierarchical regression analysis. Nearly 30% of patients met the threshold for being apathetic at follow-up. No baseline variables predicted apathy significantly at 10 years. Apathy was found to contribute independently to functioning and subjective quality of life, even when controlling for other significant correlates. Apathy is a common symptom in a FEP cohort 10 years after illness debut, and its presence relates to impaired functioning and poorer subjective quality of life. Copyright © 2011 Elsevier B.V. All rights reserved.

  8. [PSYCHOTHERAPEUTIC INTERVENTIONS IN PATIENTS WITH AUTO-AGGRESSIVE BEHAVIOR DURING THE FIRST PSYCHOTIC EPISODE].

    Science.gov (United States)

    Mudrenko, I; Potapov, A; Sotnikov, D; Kolenko, O; Kmyta, A

    2017-09-01

    In this article the formation of psychopathological predictors auto-aggressive behavior in patients with a first psychotic episode were identified, which became "targets" in the framework of a comprehensive emergency suicide assistance to conduct the crisis psychotherapy. The work was done on the basis of the Sumy regional psychoneurologic dispensary, where 100 patients with a first psychotic episode were examined: 52 of them (core group) had suicidal symptoms and 48 (control group) had not. According to the test results of severity of auto-aggressive predictors (pre-suicidal syndrome) to clinicopsychopathological predictors of auto-aggressive behavior include: the narrowing of the cognitive function (p≤0,001), the avoidance of interpersonal contact (r≤0,001), the presence of affective (p≤0,001) and vegetative (p≤0,01) violations, the autoaggression of moderate severity (p≤0,001) and impulsivity (p≤0,001). Patients of the core group with the auto-aggressive behavior (n=58) completed a course of a crisis psychotherapy comprising the stages of crisis support, crisis intervention and increase the adaptation layer. After a psychotherapy course levels of aggression (6,45±0,41), auto-aggression (of 9,68±0,67), disorders in the affective sphere (18,58±0,66) and impulsivity (of 4,23±0,30) decreased, which was manifested in increasing tolerance to emotional stress factors, control over their emotions and reduce their affective valence (p≤0,001). The expansion of interpersonal interaction, the increase of patients social activity, the blood relationships establishment (of 9,23±0,40) was observed.

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

    Directory of Open Access Journals (Sweden)

    Karmel L. Tambunan

    2009-12-01

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

  10. INTESTINAL MALROTATION IN PATIENTS UNDERGOING BARIATRIC SURGERY.

    Science.gov (United States)

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

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

  11. The bariatric surgery patient for non-bariatric surgery

    African Journals Online (AJOL)

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

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

    Directory of Open Access Journals (Sweden)

    Carlene Johnson Stoklossa

    2013-01-01

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

  13. Abnormal resting-state brain activities in patients with first-episode obsessive-compulsive disorder

    Science.gov (United States)

    Niu, Qihui; Yang, Lei; Song, Xueqin; Chu, Congying; Liu, Hao; Zhang, Lifang; Li, Yan; Zhang, Xiang; Cheng, Jingliang; Li, Youhui

    2017-01-01

    Objective This paper attempts to explore the brain activity of patients with obsessive-compulsive disorder (OCD) and its correlation with the disease at resting duration in patients with first-episode OCD, providing a forceful imaging basis for clinic diagnosis and pathogenesis of OCD. Methods Twenty-six patients with first-episode OCD and 25 healthy controls (HC group; matched for age, sex, and education level) underwent functional magnetic resonance imaging (fMRI) scanning at resting state. Statistical parametric mapping 8, data processing assistant for resting-state fMRI analysis toolkit, and resting state fMRI data analysis toolkit packages were used to process the fMRI data on Matlab 2012a platform, and the difference of regional homogeneity (ReHo) values between the OCD group and HC group was detected with independent two-sample t-test. With age as a concomitant variable, the Pearson correlation analysis was adopted to study the correlation between the disease duration and ReHo value of whole brain. Results Compared with HC group, the ReHo values in OCD group were decreased in brain regions, including left thalamus, right thalamus, right paracentral lobule, right postcentral gyrus, and the ReHo value was increased in the left angular gyrus region. There was a negative correlation between disease duration and ReHo value in the bilateral orbitofrontal cortex (OFC). Conclusion OCD is a multifactorial disease generally caused by abnormal activities of many brain regions at resting state. Worse brain activity of the OFC is related to the OCD duration, which provides a new insight to the pathogenesis of OCD. PMID:28243104

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

  16. Depression as an independent predictor of postoperative delirium in spine deformity patients undergoing elective spine surgery.

    Science.gov (United States)

    Elsamadicy, Aladine A; Adogwa, Owoicho; Lydon, Emily; Sergesketter, Amanda; Kaakati, Rayan; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Bagley, Carlos A; Karikari, Isaac O

    2017-08-01

    total, 66 patients (7.15%) had an episode of postoperative delirium, with depressed patients experiencing approximately a 2-fold higher rate of delirium (10.59% vs 5.84%). In a multivariate logistic regression analysis, depression was an independent predictor of postoperative delirium after spine surgery in spinal deformity patients (p = 0.01). CONCLUSIONS The results of this study suggest that depression is an independent risk factor for postoperative delirium after elective spine surgery. Further studies are necessary to understand the effects of affective disorders on postoperative delirium, in hopes to better identify patients at risk.

  17. Treatment of patients with first-episode psychosis: two-year outcome data from the Danish National Schizophrenia Project

    DEFF Research Database (Denmark)

    Rosenbaum, Bent; Valbak, Kristian; Harder, Susanne

    2006-01-01

    First episode psychosis interventions have been in focus in the last two decades in an attempt to improve the course and outcome of schizophrenic disorders. The Danish National Schizophrenia Project began in 1997 its intake of patients, aged 16-35, with a first psychotic episode of a schizophrenic...... patients in the treatment-as-usual group. Improvement in the intervention groups continued into the second year. Patients receiving integrated assertive treatment faired better than those being treated with the less intensive method of supportive psychodynamic psychotherapy, and the latter group improved...

  18. Comparison of hair thyroid hormones between first-episode and recurrent patients with depression in female Chinese.

    Science.gov (United States)

    Yang, Xiao; Sun, Guizhi; Wei, Jinxue; Huang, Bin; Zhao, Liansheng; Wang, Yingcheng; Zhou, Bo; Tao, Li; Ma, Xiaohong

    2016-12-01

    The aim of this study was to compare hair thyroid hormone (TH) levels among first-episode patients with major depressive disorder (F-MDD), recurrent patients with major depressive disorder (R-MDD) and healthy controls (HC). The Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were used to evaluate the clinical symptoms of patients. Electrochemiluminescence immunoassay was used to measure the hair TH levels. We compared the differences in hair TH levels among F-MDD patients, R-MDD patients, and HC. Before the disease episode, hair T3 levels differed significantly between F-MDD patients and HC. In the disease episode, hair T3 levels differed significantly between F-MDD or R-MDD patients and HC; and hair T4 levels differed significantly between R-MDD patients and HC. Hair T3 levels significantly negative correlated with HAMD scores in F-MDD patients. Our findings suggested that disease duration of recurring episodes of depression may influence hair TH levels. © 2015 Wiley Publishing Asia Pty Ltd.

  19. Clonidine in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  20. Altered Default Network Resting State Functional Connectivity in Patients with a First Episode of Psychosis

    Science.gov (United States)

    Alonso-Solís, Anna; Corripio, Iluminada; de Castro-Manglano, Pilar; Duran-Sindreu, Santiago; Garcia-Garcia, Manuel; Proal, Erika; Nuñez-Marín, Fidel; Soutullo, Cesar; Alvarez, Enric; Gómez-Ansón, Beatriz; Kelly, Clare; Castellanos, F. Xavier

    2012-01-01

    Background Default network (DN) abnormalities have been identified in patients with chronic schizophrenia using “resting state” functional magnetic resonance imaging (R-fMRI). Here, we examined the integrity of the DN in patients experiencing their first episode of psychosis (FEP) compared with sex- and age-matched healthy controls. Methods We collected R-fMRI data from 19 FEP patients (mean age 24.9±4.8 yrs, 14 males) and 19 healthy controls (26.1±4.8 yrs, 14 males) at 3 Tesla. Following standard preprocessing, we examined the functional connectivity (FC) of two DN subsystems and the two DN hubs (P<0.0045, corrected). Results Patients with FEP exhibited abnormal FC that appeared largely restricted to the dorsomedial prefrontal cortex (dMPFC) DN subsystem. Relative to controls, FEP patients exhibited weaker positive FC between dMPFC and posterior cingulate cortex (PCC) and precuneus, extending laterally through the parietal lobe to the posterior angular gyrus. Patients with FEP exhibited weaker negative FC between the lateral temporal cortex and the intracalcarine cortex, bilaterally. The PCC and temporo-parietal junction also exhibited weaker negative FC with the right fusiform gyrus extending to the lingual gyrus and lateral occipital cortex, in FEP patients, compared to controls. By contrast, patients with FEP showed stronger negative FC between the temporal pole and medial motor cortex, anterior precuneus and posterior mid-cingulate cortex. Conclusions Abnormalities in the dMPFC DN subsystem in patients with a FEP suggest that FC patterns are altered even in the early stages of psychosis. PMID:22633527

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

    Science.gov (United States)

    Xu, Pingping; Wei, Ye; Xu, Jianmin

    2016-05-01

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

  2. Change in cannabis use, clinical symptoms and social functioning among patients with first-episode psychosis

    DEFF Research Database (Denmark)

    Clausen, L; Hjorthøj, C R; Thorup, Anne A.E.

    2014-01-01

    BACKGROUND: Several studies indicate that cannabis use among patients with psychotic disorders is associated with worse outcome, but only a few studies have controlled for baseline condition and medication. METHOD: At 5-year follow-up, interviews were carried out with 314 first-episode psychosis.......26, 95% CI 2.13-14.39, p = 0.01). Those who stopped using cannabis between entry and 5-year follow-up had a significantly lower level of psychotic symptoms at 5-year follow-up even after controlling for baseline level of psychotic symptoms and for insufficient antipsychotic medication (adjusted...... difference in psychotic dimension -1.04, 95% CI -1.77 to -0.31, p = 0.006). CONCLUSIONS: Continuous cannabis use was associated with higher levels of psychotic symptoms after 5 years, and this association was only partly explained by insufficient antipsychotic medication....

  3. Pathways to Care for Patients With First-Episode Psychosis in Singapore.

    Science.gov (United States)

    Chesney, Edward; Abdin, Edimansyah; Poon, Lye Yin; Subramaniam, Mythily; Verma, Swapna

    2016-04-01

    In this study, we aim to describe the pathways to care for patients with first-episode psychosis in Singapore. We analyzed data from 900 individuals accepted by the Singapore Early Psychosis Intervention Programme between 2007 and 2012. The most common first contacts were specialist care (59%), primary care (27%), and the police (12%). Multivariate regression models showed that first contact with services varied according to demographic variables and diagnosis. The duration of untreated psychosis, total number of contacts before referral, and rate of referral to the Early Psychosis Intervention Programme varied according to demographic and clinical variables and first contact. We hope that this information will enable clinicians, managers, and other service providers to target interventions to streamline referrals, reduce distress, and improve the treatment of young people with psychotic illnesses.

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

    DEFF Research Database (Denmark)

    Bangalore, Sripal; Wetterslev, Jørn; Pranesh, Shruthi

    2008-01-01

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

  5. Cause of death in patients awaiting bariatric surgery.

    Science.gov (United States)

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

    2015-02-01

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

  6. Diagnostic stability of comorbid personality disorders among patients fully or partially remitted from first-episode depression

    DEFF Research Database (Denmark)

    Bukh, Jens Drachmann; Bech, Per; Kessing, Lars Vedel

    2017-01-01

    The diagnostic stability of comorbid personality disorders among patients with depression remains unclear. A total of 262 patients suffering from first-episode depression were assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) and reassessed after 5...

  7. Delusional disorder and schizophrenia: a comparison of the neurocognitive and clinical characteristics in first-episode patients.

    Science.gov (United States)

    Hui, C L M; Lee, E H M; Chang, W C; Chan, S K W; Lin, J; Xu, J Q; Chen, E Y H

    2015-10-01

    Delusional disorder (DD) is thought to be distinct from schizophrenia (SZ). However, few systematic investigations have been conducted on DD because of the difficulty in ascertaining a representative sample size. Existing knowledge has been mostly generated from inpatient cohorts, which may be biased towards a more severe sample. We compared the demographic, clinical and cognitive differences between 71 patients with first-episode DD and 71 age-matched patients with first-episode SZ. Participants were consecutively recruited from a population-based territory-wide study of early psychosis in Hong Kong targeting first-episode psychosis. Basic demographic information, premorbid functioning, duration of untreated psychosis, pathways to care, symptomatology, social, occupational, and cognitive functioning were comprehensively assessed using standardized measurements. Patients with DD had less premorbid schizoid and schizotypal traits compared to patients with SZ. More patients with DD were married compared to patients with SZ. However, at first episode, there were no significant differences between the two groups in regards to the duration of untreated psychosis, pathways to care, symptom severity, neurocognitive performance, treatment, and functioning. Our findings challenge previous thinking that patients with DD had better functioning than patients with SZ. This study not only provides an updated perspective into conceptualizing the clinical differences between DD and SZ, but also expands the descriptive account of the two disorders to include the neurocognitive dimension.

  8. Differences in cannabis-related experiences between patients with a first episode of psychosis and controls.

    Science.gov (United States)

    Bianconi, F; Bonomo, M; Marconi, A; Kolliakou, A; Stilo, S A; Iyegbe, C; Gurillo Muñoz, P; Homayoun, S; Mondelli, V; Luzi, S; Dazzan, P; Prata, D; La Cascia, C; O'Connor, J; David, A; Morgan, C; Murray, R M; Lynskey, M; Di Forti, M

    2016-04-01

    Many studies have reported that cannabis use increases the risk of a first episode of psychosis (FEP). However, only a few studies have investigated the nature of cannabis-related experiences in FEP patients, and none has examined whether these experiences are similar in FEP and general populations. The aim of this study was to explore differences in self-reported cannabis experiences between FEP and non-psychotic populations. A total of 252 subjects, who met International Classification of Diseases (ICD)-10 criteria for FEP, and 217 controls who reported cannabis use were selected from the Genetics and Psychosis (GAP) study. The Medical Research Council Social Schedule and the Cannabis Experience Questionnaire were used to collect sociodemographic data and cannabis use information, respectively. Both 'bad' and 'enjoyable' experiences were more commonly reported by FEP subjects than controls. Principal components factor analysis identified four components which explained 62.3% of the variance. Linear regression analysis on the whole sample showed that the type of cannabis used and beliefs about the effect of cannabis on health all contributed to determining the intensity and frequency of experiences. Linear regression analysis on FEP subjects showed that the duration of cannabis use and amount of money spent on cannabis were strongly related to the intensity and frequency of enjoyable experiences in this population. These results suggest a higher sensitivity to cannabis effects among people who have suffered their first psychotic episode; this hypersensitivity results in them reporting both more 'bad' and 'enjoyable' experiences. The greater enjoyment experienced may provide an explanation of why FEP patients are more likely to use cannabis and to continue to use it despite experiencing an exacerbation of their psychotic symptoms.

  9. Imported episodic rabies increases patient demand for and physician delivery of antirabies prophylaxis.

    Directory of Open Access Journals (Sweden)

    Zélie Lardon

    Full Text Available BACKGROUND: Imported cases threaten rabies reemergence in rabies-free areas. During 2000-2005, five dog and one human rabies cases were imported into France, a rabies-free country since 2001. The Summer 2004 event led to unprecedented media warnings by the French Public Health Director. We investigated medical practice evolution following the official elimination of rabies in 2001; impact of subsequent episodic rabies importations and national newspaper coverage on demand for and delivery of antirabies prophylaxis; regular transmission of epidemiological developments within the French Antirabies Medical Center (ARMC network; and ARMC discussions on indications of rabies post-exposure prophylaxis (RPEP. METHODOLOGY/PRINCIPAL FINDINGS: Annual data collected by the National Reference Center for Rabies NRCR (1989-2006 and the exhaustive database (2000-2005 of 56 ARMC were analyzed. Weekly numbers of patients consulting at ARMC and their RPEP- and antirabies-immunoglobulin (ARIG prescription rates were determined. Autoregressive integrated moving-average modeling and regression with autocorrelated errors were applied to examine how 2000-2005 episodic rabies events and their related national newspaper coverage affected demand for and delivery of RPEP. A slight, continuous decline of rabies-dedicated public health facility attendance was observed from 2000 to 2004. Then, during the Summer 2004 event, patient consultations and RPEP and ARIG prescriptions increased by 84%, 19.7% and 43.4%, respectively. Moreover, elevated medical resource use persisted in 2005, despite communication efforts, without any secondary human or animal case. CONCLUSIONS: Our findings demonstrated appropriate responsiveness to reemerging rabies cases and effective newspaper reporting, as no secondary case occurred. However, the ensuing demand on medical resources had immediate and long-lasting effects on rabies-related public health resources and expenses. Henceforth, when

  10. Disrupted brain anatomical connectivity in medication-naïve patients with first-episode schizophrenia.

    Science.gov (United States)

    Zhang, Ruibin; Wei, Qinling; Kang, Zhuang; Zalesky, Andrew; Li, Meng; Xu, Yong; Li, Leijun; Wang, Junjing; Zheng, Liangrong; Wang, Bin; Zhao, Jingping; Zhang, Jinbei; Huang, Ruiwang

    2015-03-01

    Previous studies suggested that the topological properties of brain anatomical networks may be aberrant in schizophrenia (SCZ), and most of them focused on the chronic and antipsychotic-medicated SCZ patients which may introduce various confounding factors due to antipsychotic medication and duration of illness. To avoid those potential confounders, a desirable approach is to select medication-naïve, first-episode schizophrenia (FE-SCZ) patients. In this study, we acquired diffusion tensor imaging datasets from 30 FE-SCZ patients and 34 age- and gender-matched healthy controls. Taking a distinct gray matter region as a node, inter-regional connectivity as edge and the corresponding streamline counts as edge weight, we constructed whole-brain anatomical networks for both groups, calculated their topological parameters using graph theory, and compared their between-group differences using nonparametric permutation tests. In addition, network-based statistic method was utilized to identify inter-regional connections which were impaired in the FE-SCZ patients. We detected only significantly decreased inter-regional connections in the FE-SCZ patients compared to the controls. These connections were primarily located in the frontal, parietal, occipital, and subcortical regions. Although small-worldness was conserved in the FE-SCZ patients, we found that the network strength and global efficiency as well as the degree were significantly decreased, and shortest path length was significantly increased in the FE-SCZ patients compared to the controls. Most of the regions that showed significantly decreased nodal parameters belonged to the top-down control, sensorimotor, basal ganglia, and limbic-visual system systems. Correlation analysis indicated that the nodal efficiency in the sensorimotor system was negatively correlated with the severity of psychosis symptoms in the FE-SCZ patients. Our results suggest that the network organization is changed in the early stages of the

  11. Tolterodine reduces the number of urge incontinence episodes in patients with an overactive bladder.

    Science.gov (United States)

    Jacquetin, B; Wyndaele, J

    2001-09-01

    To evaluate the efficacy, safety and tolerability of tolterodine compared to placebo in patients with an overactive bladder. A double-blind, multi-centre phase III study in France and Belgium 251 patients with overactive bladder symptoms, and urodynamically verified detrusor overactivity, were randomised to receive 4-week treatment with either placebo or tolterodine 1 or 2mg twice daily (bd). Efficacy was evaluated from patient micturition diaries. Safety and tolerability endpoints were also evaluated. After 4-week treatment, the number of incontinence episodes/24h decreased significantly relative to placebo in the tolterodine 1 and 2 mgbd groups (P=0.045 and P=0.0089, respectively). Both dosages of tolterodine increased volume voided per micturition compared with placebo (P=0.055 and P=0.056, respectively), although significant decreases in micturition frequency were not apparent. Tolterodine was safe and well tolerated, few patients were withdrawn due to adverse events. Dry mouth, mainly of mild-to-moderate intensity, was the most common adverse event. No clinically relevant changes in blood pressure or laboratory safety variables were reported. Tolterodine is effective, safe and well tolerated for the treatment of symptoms of an overactive bladder, particularly urge incontinence.

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

    Science.gov (United States)

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

    2015-12-01

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

  13. [Off-label use of acetazolamide in a patient with familial hemiplegic migraine and concomitant psychotic episodes].

    Science.gov (United States)

    Koch, Horst J; Sykora, André; Hausn, Patrick

    2010-04-01

    A 42-year-old patient with cognitive deficits due to childhood meningitis suffered from recurrent episodes of familial hemiplegic migraine. Additionally, he developed concomitant psychotic episodes requiring subsequent in-patient psychiatric treatment. Following combined neurological and psychiatric treatment he always recovered from the episodes within a few weeks time. Prophylactic treatment of migraine using topiramate and acetazolamide (off-label) prevented attacks for several months. When off-label compensation was refused and, as a consequence, the drug discontinued, hemiplegia relapsed within a few days. Hence, acetazolamide was prescribed again and the family paid for the medication. Since that time, the patient did not show severe attacks for at least 8 months apart from a transient attack induced by acute flu-like illness. Copyright Georg Thieme Verlag KG Stuttgart . New York.

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

    Science.gov (United States)

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

    2005-12-01

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

  15. Anti-NMDA receptor antibodies in patients with a first episode of schizophrenia

    Directory of Open Access Journals (Sweden)

    Masopust J

    2015-03-01

    Full Text Available Jirí Masopust,1,2 Ctirad Andrýs,3 Jan Bažant,1 Oldrich Vyšata,4 Kamil Kuca,5 Martin Vališ4 1Department of Psychiatry, Faculty of Medicine in Hradec Kralové, Charles University in Prague, University Hospital Hradec Králové, Hradec Králové, Czech Republic; 2National Institute of Mental Health, Klecany, Czech Republic; 3Institute of Clinical Immunology and Allergology, Charles University in Prague, Faculty of Medicine in Hradec Králové, and University Hospital Hradec Králové, Hradec Králové, Czech Republic; 4Department of Neurology, Charles University in Prague, Faculty of Medicine in Hradec Králové, and University Hospital Hradec Králové, Hradec Králové, Czech Republic; 5Biomedical Research Centrum, University Hospital Hradec Králové, Hradec Králové, Czech Republic Background: Encephalitis with antibodies against N-methyl-D-aspartate receptor (NMDA-R is classified as an autoimmune disorder with psychotic symptoms, which are frequently dominant. However, it remains unclear how frequently NMDA-R antibodies lead to a condition that mimics psychosis and first-episode schizophrenia. In our work, we investigated the presence of antibodies against NMDA-R in patients with first-episode psychosis (FEP in comparison with healthy volunteers.Methods: This study included 50 antipsychotic-naïve patients with FEP (including 21 women and 50 healthy volunteers (including 21 women. The mean age of the patients was 27.4 (±7.4 years and that of the healthy controls was 27.0 (±7.3 years. Antibodies against NMDA-R in the serum were detected by immunofluorescence.Results: None of the investigated patients with an FEP and none of the healthy controls showed positive antibodies against NMDA-Rs.Conclusion: According to results of studies, a small proportion of patients with an FEP possess antibodies against NMDA-R. However, the extent to which this finding contributes to the etiopathogenesis of the response to antipsychotic medication and

  16. The role of movement representation in episodic memory for actions: A study of patients with apraxia.

    Science.gov (United States)

    Masumoto, Kouhei; Shirakawa, Masayuki; Higashiyama, Takeshi; Yokoyama, Kazumasa

    2015-01-01

    In attempting to memorize a sentence about an action, such as "Pick up the glass," performing the action (motor encoding) results in better memory performance than simply memorizing the words (verbal encoding). Such enhancement of memory is known as the enactment effect. Several theories have been proposed to explain this phenomenon using concepts such as physical motor information associated with speed, form, amplitude of movement and/or movement representations involved in movement imaging, knowledge on manipulating tools, and spatial relationships in the enactment effect. However, there have been no cognitive neuropsychological studies investigating whether the enactment effect is crucially influenced by physical motor information or movement representations. To clarify this issue, we compared healthy adult control participants with two different types of apraxia patients. One patient with left hemisphere lesions caused by cerebral infarction had a disability involving multiple movement representations. The other patient showed symptoms of corticobasal syndrome and was not able to benefit from feedback on the accuracy of her motor movements during enactment. Participants memorized action sentences via either verbal or motor encoding and responded to recall and recognition tests. Results indicated that the patient with the movement representation deficits exhibited worse memory performance than the other patient or control participants following both verbal and motor encoding. Although the enactment effect was present during recall in both patients, the effect was not observed for recognition in the patient with severe movement representation deficits. These results suggest that movement representations are involved in encoding episodic memories of action. Moreover, the role of movement representations appears to depend on the form of retrieval that is being used.

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

    Science.gov (United States)

    Rejeh, Nahid; Vaismoradi, Mojtaba

    2010-03-01

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

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

    Science.gov (United States)

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

    2014-12-01

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

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

    African Journals Online (AJOL)

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

  20. Profiling lifetime episodes of upper gastrointestinal bleeding among patients from rural Sub-Saharan Africa where schistosoma mansoni is endemic.

    Science.gov (United States)

    Opio, Christopher Kenneth; Kazibwe, Francis; Ocama, Ponsiano; Rejani, Lalitha; Belousova, Elena Nikolaevna; Ajal, Paul

    2016-01-01

    Severe chronic hepatic schistosomiasis is a common cause of episodes upper gastrointestinal bleeding (UGIB) in sub-Saharan Africa (SSA). However, there is paucity of data on clinical epidemiology of episodes of UGIB from rural Africa despite on going public health interventions to control and eliminate schistosomiasis. Through a cross sectional study we profiled lifetime episodes of upper gastrointestinal bleeding and associated factors at a rural primary health facility in sub-Saharan Africa were schistosomiasis is endemic. The main outcome was number of lifetime episodes of UGIB analyzed as count data. From 107 enrolled participants, 323 lifetime episodes of UGIB were reported. Fifty-seven percent experienced ≥ 2 lifetime episodes of UGIB. Ninety-four percent had severe chronic hepatic schistosomiasis and 80% esophageal varices. Alcohol use and viral hepatitis was infrequent. Eighty-eight percent were previously treated with praziquantel and 70% had a history of blood transfusion. No patient had ever had an endoscopy or treatment for prevention of recurrent variceal bleeding. Multivariable analysis identified a cluster of eight clinical factor variables (age ≥ 40, female sex, history of blood transfusion, abdominal collaterals, esophageal varices, pattern x periportal fibrosis, anemia, and thrombocytopenia) significantly associated (P-value Upper gastrointestinal bleeding is a common health problem in this part of rural SSA where schistosomiasis is endemic. The clinical profile described is unique and is important for improved case management, and for future research.

  1. Recurrent Stereotyped Episodes in Cerebral Amyloid Angiopathy: Response to Migraine Prophylaxis in Two Patients

    Directory of Open Access Journals (Sweden)

    R.W. Paterson

    2013-05-01

    Full Text Available Background: Cerebral amyloid angiopathy (CAA typically presents with cognitive decline or symptomatic intracerebral hemorrhage, but episodes of recurrent stereotyped limb attacks have also been reported. Methods: Retrospective review of the medical records of 4 patients referred to the general neurology services and a specialist stroke center with clinically probable CAA. Results: Four subjects, all Caucasian, mean age 74 years, were followed up over a mean duration of 20 months. They all experienced recurrent prolonged stereotyped attacks of sensory symptoms, lasting 5-30 min, that resolved completely between attacks. Three subjects developed intracerebral hemorrhage, and 2 had an irreversible rapid cognitive decline. Two patients experienced symptomatic improvement with migraine prophylaxis (verapamil or topiramate. Conclusions: Recurrent stereotyped prolonged attacks with sensory and motor elements can predate the development of intracerebral hemorrhage in individuals with clinically probable CAA. When evaluating patients with such attacks, neurologists need to consider CAA as a possible mimic of transient ischemic attacks. We suggest a trial of migraine prophylaxis for symptomatic management.

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

    Science.gov (United States)

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

    2016-05-01

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

  3. Relationship between negative symptoms and neurocognitive functions in adolescent and adult patients with first-episode schizophrenia

    Directory of Open Access Journals (Sweden)

    Manli Huang

    2016-10-01

    Full Text Available Abstract Background This study aimed to explore differences in links between negative symptoms and neurocognitive deficits in adolescent and adult patients with first-episode schizophrenia. Schizophrenia is a mental disorder often characterized by positive and negative symptoms, reduced emotional expression, excitatory status, and poor cognitive ability. The severity of negative symptoms in patients with schizophrenia was reported to be more related to poor quality of life, weak functional ability, and heavy burden from families than with the severity of positive symptoms. Previous studies suggested correlations between the severity of negative symptoms in patients with schizophrenia and neurocognitive deficits. Methods This study included 92 patients (33 adolescents and 59 adults with first-episode schizophrenia and 57 healthy people matched by age and education level. Neurocognitive functions and clinical symptoms were assessed using a standardized questionnaire. Results Patients with first-episode schizophrenia showed neurocognitive deficits in most neuropsychological assessments compared with healthy people. With the variable of education level controlled, the negative factor score of adolescent patients with first-episode schizophrenia was strongly correlated with more time spent in part 1 (r = .646 and part 2 (r = .663 of the trail making test, and moderately correlated to more perseverative errors (r = .425 of the Wisconsin card sorting test and fewer correct trials 2 (r = −.425 of the continuous performance test. However, no such correlations were found in adult patients. Conclusions This study indicated significant correlations between negative symptoms and most neurocognitive functions in patients with first-episode schizophrenia, with a stronger correlation in adolescent patients. Trial registration The trial registration number is ChiCTR-COC-14005302 , while retrospectively registered on January 5, 2014.

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

    Science.gov (United States)

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

    2016-01-01

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

  5. Patient expectations and performance measures in dermatologic surgery.

    Science.gov (United States)

    Lee, Erica H

    2016-01-01

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

  6. Facial Canal Dehiscence in Patients with Chronic Otitis Surgery

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    Ahmet Uluat

    2016-04-01

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

  7. Inguinal Hernia Surgery: a patient centered approach

    NARCIS (Netherlands)

    H.R. Langeveld-Benders (Hester)

    2014-01-01

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

  8. Noncardiac surgery in patients with aortic stenosis

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    1991-01-01

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

  10. Reconstructive surgery in immunocompromised patients: evaluation and therapy

    Directory of Open Access Journals (Sweden)

    Dunda, Sebastian E.

    2015-12-01

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

  11. Assessment of the otolith-ocular reflex using ocular vestibular evoked myogenic potentials in patients with episodic lateral tilt sensation.

    Science.gov (United States)

    Murofushi, Toshihisa; Nakahara, Haruka; Yoshimura, Eriko

    2012-05-02

    The otolith-ocular reflex in patients with episodic lateral tilt sensation without any other vestibular symptoms was assessed using ocular vestibular evoked myogenic potentials (oVEMP). Ten patients (6 men and 4 women, mean age=53.5) were enrolled. All patients had episodic lateral tilt sensation. Patients with a medical history of rotatory vertigo, loss of consciousness, head trauma, or symptoms or signs of central nervous dysfunction or proprioceptive dysfunction and those who had been definitely diagnosed with a disease that causes disequilibrium were excluded. All of the 10 patients had oVEMP tests and cervical VEMP (cVEMP) tests and underwent caloric tests. Eight of the 10 patients showed unilateral absence of oVEMP, one displayed a bilateral absence, and one displayed normal oVEMP. Concerning cVEMP, 4 patients showed a unilateral absence of cVEMP, one displayed unilaterally decreased responses and 5 displayed normal cVEMP. All patients showed normal bilateral caloric responses. The present study showed that patients with episodic lateral tilt sensation displayed abnormal otolith-ocular reflexes, as shown by their oVEMP, suggesting that these patients were suffering from utricular dysfunction. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2017-06-01

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

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

    Science.gov (United States)

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

    2008-01-01

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

  14. Brain activation before and after cognitivebehavior therapy in first-episode patients with mildto-moderate major depressive disorder

    Institute of Scientific and Technical Information of China (English)

    谭雅容

    2014-01-01

    Objective To explore the neurobiological mechanisms underlying cognitive-behavior therapy(CBT)for major depressive disorder(MDD)by detecting the neural changes of patients following CBT.Methods Thirteen first-episode treatment-naive patients with MDD and 13 matched healthy volunteers underwent fM RI scan.All the patients were treated with 6-week CBT only and scanned again after treatment.A gender recognition task

  15. Nursing care for patients undergoing transoral robotic surgery.

    Science.gov (United States)

    Murray, Shannon

    2009-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Yang Y

    2016-07-01

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

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

    Science.gov (United States)

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

    2013-03-01

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

  18. Recurrent spine surgery patients in hospital administrative database

    Directory of Open Access Journals (Sweden)

    M. Sami Walid

    2012-02-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

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

    Science.gov (United States)

    Giordano, Salvatore; Victorzon, Mikael

    2015-01-01

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

  1. The Psychosocial Improvement after Strabismus Surgery in Iranian Patients

    Directory of Open Access Journals (Sweden)

    Guita Ghiasi

    2013-10-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

  3. Retrograde intrarenal surgery in pediatric patients.

    Science.gov (United States)

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

    2014-11-01

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

  4. Nonspecific Effect of Stress on Brain Gray Matter Volume in Drug-naive Female Patients with First Depressive Episode

    Directory of Open Access Journals (Sweden)

    Chuan-Jun Zhuo

    2016-01-01

    Conclusions: Although the results of the present study suggest the absence of significant differences in brain gray matter volume between female drug-naive patients after the first episode of major depression with and without SLEs after FDR correction, the study provides useful information for exploring the definitive role of stress in the onset of depression.

  5. Dorsal striatal volumes in never-treated patients with first-episode schizophrenia before and during acute treatment

    NARCIS (Netherlands)

    Emsley, Robin; Asmal, Laila; du Plessis, Stéfan; Chiliza, Bonginkosi; Kidd, Martin; Carr, Jonathan; Vink, Matthijs

    2015-01-01

    BACKGROUND: Studies of pre-and post-treatment striatal volume in schizophrenia have reported conflicting results. MATERIALS AND METHODS: We assessed dorsal striatal (caudate and putamen) volumes bilaterally in 22 never-treated, non-substance-abusing patients with first-episode schizophrenia or schiz

  6. Nonspecific Effect of Stress on Brain Gray Matter Volume in Drug-naive Female Patients with First Depressive Episode

    Institute of Scientific and Technical Information of China (English)

    Chuan-Jun Zhuo; Hai-Man Bian; Yan-Jie Gao; Xiao-Lei Ma; Sheng-Zhang Ji; Meng-Yuan Yao; Ning Zhai

    2016-01-01

    Background: This study aimed to observe the differences in brain gray matter volume in drug-naive female patients after the first episode of major depression with and without stressful life events (SLEs) before the onset of depression.Methods: Forty-three drug-naive female patients voluntarily participated in the present study after the first major depressive episode.The life event scale was used to evaluate the severity of the impact of SLEs during 6 months before the onset of the major depressive episode.High-field magnetic resonance imaging (MRI) scans were obtained, and the VBM and SPM8 software process were used to process and analyze the MRI.Results: Compared to that in patients without SLEs, the volume of brain gray matter was lower in the bilateral temporal lobe, right occipital lobe, and right limbic lobe in the SLE group.However, the gray matter volume did not differ significantly between the two groups after the application of false discovery rate (FDR) correction.Conclusions: Although the results of the present study suggest the absence of significant differences in brain gray matter volume between female drug-naive patients after the first episode of major depression with and without SLEs after FDR correction, the study provides useful information for exploring the definitive role of stress in the onset of depression.

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

    Science.gov (United States)

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

    2011-07-01

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

  8. Contrasting monosymptomatic patients with hallucinations and delusions in first-episode psychosis patients

    DEFF Research Database (Denmark)

    Evensen, Julie; Røssberg, Jan Ivar; Haahr, Ulrik

    2011-01-01

    The main aim of this study was to identify subgroups of patients characterized by having hallucinations only or delusions only and to examine whether these groups differed with regard to demographic characteristics, clinical characteristics and outcome factors, including suicidality....

  9. Clinical and Electron Microscopic Findings in Two Patients with Mitochondrial Myopathy Associated with Episodic Hyper-creatine Kinase-emia.

    Science.gov (United States)

    Nozuma, Satoshi; Okamoto, Yuji; Higuchi, Itsuro; Yuan, Junhui; Hashiguchi, Akihiro; Sakiyama, Yusuke; Yoshimura, Akiko; Higuchi, Yujiro; Takashima, Hiroshi

    2015-01-01

    Mitochondrial myopathy with episodic hyper-creatine kinase (CK)-emia (MIMECK) is a new disease entity characterized by episodic or persistent muscle weakness and elevated CK levels. We herein report two cases of MIMECK with the findings of histopathological studies. Histopathological examinations revealed strongly succinate dehydrogenase-reactive vessels. Electron microscopy showed abnormal mitochondria in the vessels and proliferating and vacuolated mitochondria under the sarcolemma. Both patients exhibited recurrent severe myalgia, weakness and increased CK levels. L-arginine treatment significantly ameliorated their muscle symptoms. These findings indicate that mitochondrial angiopathy plays an important role in the pathophysiology of MIMECK. L-arginine may be a potential therapeutic agent for this disorder.

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

    Science.gov (United States)

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

    2014-08-01

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

  11. Monitoring respiration and oxygen saturation in patients during the first night after elective bariatric surgery: A cohort study.

    Science.gov (United States)

    Wickerts, Liselott; Forsberg, Sune; Bouvier, Frederic; Jakobsson, Jan

    2017-01-01

    Background: Obstructive sleep apnoea and obese hypoventilation is not uncommon in patients with obesity. Residuals effect from surgery/anaesthesia and opioid analgesics may worsen respiration during the first nights after bariatric surgery. The aim of this observational study was to monitor respiration on the first postoperative night following elective bariatric surgery. Methods: This observational study aimed to determine the incidence and severity of hypo/apnoea in low risk obsess patients undergoing elective bariatric surgery in general anesthaesia. Patients with known or suspected sleep respiratory disturbances was not included. ESS was scored prior to surgery. Oxygen desaturation was analyzed by continuous respiratory monitoring. Mean oxygen saturation (SpO2), nadir SPo2, apnoea/hypopnea index and oxygen desaturation index was assess by standard tools. Results: 45 patients were monitored with portable polygraphy equipment (Embletta, ResMed) during the first postoperative night at the general ward following elective laparoscopic bariatric surgery. The prop ESS was 0-5 in 22, 6-10 in 14 and 11-16 in 6 of the patients studied (missing data 3). Mean SpO2 was 93%; 10 patients had a mean SpO2 of less than 92% and 4 of less than 90%. The lowest mean SpO2 was 87%. There were 16 patients with a nadir SpO2 of less than 85%, lowest nadir SpO2 being 63%. An Apnoea Hypo/apnoea Index (AHI) > 5 was found in 2 patients only (AHI 10 and 6), and an Oxygen Desaturation index (ODI) > 5 was found in 3 patients (24, 10 and 6, respectively). 3 patients had more prolonged (> 30 seconds) apnoea with nadir SpO2 81%, 83% and 86%. ESS score and type of surgery did not impact on respiration/oxygenation during the observation period. Conclusions: A low mean SpO2 and episodes of desaturation were not uncommon during the first postoperative night following elective bariatric surgery in patients without history of night time breathing disturbance. AHI and/or ODI of more than 5 were only

  12. Pulmonary physiotherapy effect on patients undergoing open cardiac surgery

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    Seyed Kazem Shakuri

    2014-09-01

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

  13. Cognitive deficits characterization using the CogState Research Battery in first-episode psychosis patients

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    Audrey Benoit

    2015-09-01

    Full Text Available The computer-based CogState Research Battery (CSRB proposes a test structure which follows MATRICS recommended cognitive domains but lacks direct comparison to pen and paper batteries in first-episode psychosis (FEP. The aim of this study was to compare performances obtained with the CSRB and a pen and paper battery in a historical cohort of FEP patients. Among patients entering an early intervention program between 2003 and 2014, separate cohorts completed the traditional pen and paper cognitive battery (n = 182 and the CSRB (n = 97. Composite z-scores were derived using normative data of matched controls (n = 64 pen and paper, n = 69 CSRB and were compared between the two batteries for the 7 cognitive domains. The cohort tested using the CSRB performed better on the domains of processing speed, attention, visual memory, and verbal memory than the cohort tested using the pen and paper battery (all p < 0.001. Performance did not differ between the two types of batteries for the working memory, executive functions, and social cognition domains. Cognitive profiles identified in the two patient cohorts were similar, with verbal memory being the most impaired domain. Better performances on the CSRB may be primarily due to the minimal demand of the computerized tests on graphomotor abilities and reading speed compared to the pen and paper tests. Our investigation offers a better understanding on how the results obtained with computerized batteries may compare to earlier work done with traditional tests.

  14. Neurocognition and Duration of Psychosis: A 10-year Follow-up of First-Episode Patients.

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    Rund, Bjørn Rishovd; Barder, Helene Eidsmo; Evensen, Julie; Haahr, Ulrik; ten Velden Hegelstad, Wenche; Joa, Inge; Johannessen, Jan Olav; Langeveld, Johannes; Larsen, Tor Ketil; Melle, Ingrid; Opjordsmoen, Stein; Røssberg, Jan Ivar; Simonsen, Erik; Sundet, Kjetil; Vaglum, Per; McGlashan, Thomas; Friis, Svein

    2016-01-01

    A substantial proportion of schizophrenia-spectrum patients exhibit a cognitive impairment at illness onset. However, the long-term course of neurocognition and a possible neurotoxic effect of time spent in active psychosis, is a topic of controversy. Furthermore, it is of importance to find out what predicts the long-term course of neurocognition. Duration of untreated psychosis (DUP), accumulated time in psychosis the first year after start of treatment, relapse rates and symptoms are potential predictors of the long-term course. In this study, 261 first-episode psychosis patients were assessed neuropsychologically on one or more occasions. Patients were tested after remission of psychotic symptoms and reassessed 1, 2, 5, and 10 years after inclusion. The neurocognitive battery consisted of California Verbal Learning Test, Wisconsin Card Sorting Test, Controlled Oral Word Association Task, Trail Making A and B, and Finger Tapping. We calculated a composite score by adding the z-scores of 4 tests that were only moderately inter-correlated, not including Finger Tapping. Data were analyzed by a linear mixed model. The composite score was stable over 10 years. No significant relationship between psychosis before (DUP) or after start of treatment and the composite score was found, providing no support for the neurotoxicity hypothesis, and indicating that psychosis before start of treatment has no significant impact on the course and outcome in psychosis. We found no association between symptoms and the neurocognitive trajectory. Stable remission during the first year predicted neurocognitive functioning, suggesting that the early clinical course is a good predictor for the long-term course. © The Author 2015. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  15. Time course of episodes of definitive vertigo in Meniere's disease.

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    Perez-Garrigues, Herminio; Lopez-Escamez, Jose A; Perez, Paz; Sanz, Ricardo; Orts, Miguel; Marco, Jaime; Barona, Rafael; Tapia, Mari C; Aran, Ismael; Cenjor, Carlos; Perez, Nicolas; Morera, Constantino; Ramirez, Rafael

    2008-11-01

    To evaluate the frequency and duration of episodes of definitive vertigo in Ménière's disease. Prospective longitudinal study. Multiple tertiary referral centers. Five hundred ten individuals from 8 hospitals that met the American Academy of Otolaryngology-Head and Neck Surgery diagnostic criteria for definitive Ménière's disease. Conservative treatment. Frequency and duration of episodes of definitive vertigo during follow-up. Ménière's disease affects both sexes and both ears equally, with onset generally in the fourth decade of life. The number of episodes of vertigo is greater in the first few years of the disease. Although episodes of vertigo that last longer than 6 hours are less frequent than shorter episodes, they occur with similar frequency throughout the natural course of the disease. The percentage of patients without episodes of vertigo increases as the disease progresses, and 70% of patients who did not have an episode of vertigo for 1 year will continue to be free of episodes during the following year. Thus, there is a relationship between the frequency of episodes in consecutive years, although this association decreases rapidly as the number of years increases. The frequency of definitive episodes of vertigo in Ménière's disease decreased during follow-up, and many individuals reached a steady-state phase free of vertigo.

  16. Metabolic Bone Disease in the Bariatric Surgery Patient

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    Susan E. Williams

    2011-01-01

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

  17. Detection of Borna Disease Virus (BDV in Patients with First Episode of Schizophrenia

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    Hasan Soltani

    2016-12-01

    Full Text Available Objective: Schizophrenia is a complex widespread neuropsychiatric disorder. This illness encompasses a complex debilitating mental disorder causing illusion, delusion, disturbed relationship, low motivation and decline of emotion. Viral infection of the brain including Borna Disease Virus (BDV may play a role in transient or permanent neurological and behavioral abnormalities. This role of Borna virus has not been resolved outright yet, and based on published papers investigation examining the role of this virus in schizophrenia is in progress worldwide.Method: In this study, Nested Reverse Transcription–Polymerase Chain Reaction (Nested RT-PCR was used for detection of BDV Ribonucleic Acid (RNA in Peripheral Blood Mononuclear Cells (PBMCs of a group of patients experiencing the first episode of schizophrenia. The results were compared with a normal group.Results: In our study, no BDV-positive was found in PBMCs of the case group. Out of 40 participants of control group one was positive for P24 gene of BDV. This result are similar to several published papers about this topic.Conclusion: An etiological relationship between Bornavirus and schizophrenia was not found in this study. More investigations are warranted to illustrate the probable relationship between bornavirus infection and schizophrenia.

  18. Cognitive effects of atypical antipsychotic drugs in first-episode drug-na?ve schizophrenic patients

    Institute of Scientific and Technical Information of China (English)

    Juan Wang; Maorong Hu; Xiaofeng Guo; Renrong Wu; Lehua Li; Jingping Zhao

    2013-01-01

    Cognitive impairment is a core feature of schizophrenia. The present randomized open study enrolled antipsychotic-na?ve patients who were experiencing their first episode of schizophrenia. After baseline neurocognitive tests and clinical assessment, subjects were randomly assigned to olanzapine, risperidone and aripiprazole treatment groups. A battery of neurocognitive tests showed that risperidone produced cognitive benefits in all five cognitive domains, including verbal learning and memory, visual learning and memory, working memory, processing speed, and selective attention; olanzapine improved processing speed and selective attention; and aripiprazole improved visual learning and memory, and working memory. However, the three atypical antipsychotic drugs failed to reveal any significant differences in the composite cognitive scores at the study endpoint. In addition, the three drugs all significantly improved clinical measures without significant differences between the drugs after 6 months. These results suggest that the atypical antipsychotics, olanzapine, risperidone and aripiprazole may improve specific cognitive domains with similar global clinical efficacy. In clinical practice, it may be feasible to choose corresponding atypical antipsychotics according to impaired cognitive domains.

  19. Plasma metabonomics study of first-Episode schizophrenia treated with olanzapine in female patients.

    Science.gov (United States)

    Qiao, Ying; Zhang, Lei; He, Shen; Wen, Hui; Yu, Yi-Min; Cao, Chun-Hua; Li, Hua-Fang

    2016-03-23

    Schizophrenia is a persistent chronic mental illness with an unknown pathogenic mechanism; no empirical laboratory-based tests are available to support the diagnosis of schizophrenia or to identify biomarkers correlated with the therapeutic effect of olanzapine. For this study, 15 female first-episode, drug-naïve patients with schizophrenia and 15 healthy female volunteers were recruited. Tests for blood glucose and lipids were conducted at baseline and after 4 weeks of treatment with olanzapine. UPLC-MS based metabonomic analysis was performed on both case and control groups to identify biomarkers of schizophrenia at baseline and to explore which biomarkers correlated with the therapeutic effect of olanzapine after a 4-week treatment. Compared with the control group, the case group showed significant changes in plasma metabolites. Thirteen distinct metabolites were identified. Among all the therapeutically effective cases, levels of these metabolites appeared to shift towards the normal trend; 8 of the identified 13 metabolites changed dramatically. The metabolites that we found are potential biomarkers for the diagnosis and treatment of schizophrenia.

  20. Detection of Borna Disease Virus (BDV) in Patients with First Episode of Schizophrenia.

    Science.gov (United States)

    Soltani, Hasan; Mohammadzadeh, Serwa; Makvandi, Manoochehr; Pakseresht, Siroos; Samarbaf-Zadeh, Alireza

    2016-10-01

    Objective: Schizophrenia is a complex widespread neuropsychiatric disorder. This illness encompasses a complex debilitating mental disorder causing illusion, delusion, disturbed relationship, low motivation and decline of emotion. Viral infection of the brain including Borna Disease Virus (BDV) may play a role in transient or permanent neurological and behavioral abnormalities. This role of Borna virus has not been resolved outright yet, and based on published papers investigation examining the role of this virus in schizophrenia is in progress worldwide. Method: In this study, Nested Reverse Transcription-Polymerase Chain Reaction (Nested RT-PCR) was used for detection of BDV Ribonucleic Acid (RNA) in Peripheral Blood Mononuclear Cells (PBMCs) of a group of patients experiencing the first episode of schizophrenia. The results were compared with a normal group. Results: In our study, no BDV-positive was found in PBMCs of the case group. Out of 40 participants of control group one was positive for P24 gene of BDV. This result are similar to several published papers about this topic. Conclusion: An etiological relationship between Bornavirus and schizophrenia was not found in this study. More investigations are warranted to illustrate the probable relationship between bornavirus infection and schizophrenia.

  1. Patient adaptable cerebellar retractor system: Use in posterior fossa surgery

    Directory of Open Access Journals (Sweden)

    Hamid Borghei-Razavi

    2015-06-01

    Full Text Available A new patient adaptable dual use soft tissue spreader and cerebellar retractor system designed for use during surgery of the posterior fossa is described. We found that this new retractor design allowed for excellent exposure, plus greater freedom and dexterity during the posterior fossa surgery. This novel instrument is an improvement over the existing instrument, because it provided more force/power transmission from pins/connectors to the brain spatula via the shorter flexible arm.

  2. Beyond stopping the bleed: short-term episodic prophylaxis with recombinant activated factor FVII in haemophilia patients with inhibitors

    Science.gov (United States)

    Šalek, Silva Zupančić; Auerswald, Günter; Benson, Gary; Dolan, Gerry; Duffy, Anne; Hermans, Cedric; Jiménez-Yuste, Victor; Ljung, Rolf; Morfini, Massimo; Santagostino, Elena; Lambert, Thierry

    2017-01-01

    Preventing haemarthroses and arthropathy is a major challenge in patients with haemophilia and inhibitors, as treatment options are limited. One potential strategy is short-term episodic prophylaxis, which extends bypassing agent therapy beyond the resolution of bleeding to include the post-bleed inflammatory phase. At the 13th Zürich Haemophilia Forum, an expert panel reviewed the rationale behind this strategy, explored its current use with recombinant activated factor VII (rFVIIa) and considered treatment monitoring and optimisation. Two protocols are currently used for short-term episodic prophylaxis, both of which stipulate on-demand rFVIIa until resolution of bleeding, followed by daily dosing for ≥3 days to prevent re-bleeds. Short-term episodic prophylaxis should be individualised to optimise outcomes, perhaps through early treatment initiation or by combining rFVIIa with other treatments (e.g. factor VIII, tranexamic acid). Encouraging treatment compliance can also improve outcomes. Additionally, there is a need to develop objective clinical outcome measures, biomarkers and imaging protocols that can monitor treatment outcomes and joint disease in patients with inhibitors. A proactive approach incorporating a systematic package of care is needed. Currently, short-term episodic prophylaxis with rFVIIa may be an alternative treatment option to on-demand treatment for patients with inhibitors. PMID:26674816

  3. Challenges of valve surgeries in post-renal transplant patients.

    Science.gov (United States)

    Ahmad, Tanveer; Kishore, Kolkebaile Sadanand; Maheshwarappa, Nandakumar Neralakere; Pasarad, Ashwini Kumar

    2015-01-01

    Renal transplantation remains a mainstay of therapy for the end-stage renal disease. Cardiac disease has a high prevalence in this patient population. Cardiovascular disease remains the leading cause of death among kidney transplantation patients. The cardiac disease accounts for 43% of all-cause mortality among dialysis patients and for ≈38% of all-cause mortality after transplantation. In this article, we review the factors and outcomes associated with valve surgeries in renal transplant recipients and evaluate the strategy for open heart surgery after renal transplantation performed.

  4. Long-term outcomes in patients after epilepsy surgery failure.

    Science.gov (United States)

    Ryzí, Michal; Brázdil, Milan; Novák, Zdeněk; Hemza, Jan; Chrastina, Jan; Ošlejšková, Hana; Rektor, Ivan; Kuba, Robert

    2015-02-01

    The primary aim of this study was to analyze the long-term outcomes of patients who were classified as Engel IV one year after resective epilepsy surgery. The secondary objectives were to evaluate the effectiveness of different treatment options and to examine the reasons that the patients did not undergo resective reoperation. Our study was designed as a retrospective open-label investigation of the long-term outcomes of 34 patients (12% of all surgically treated patients) who were classified as Engel IV one year after epilepsy surgery. At the last follow-up visit (average of 7.6 ± 4.2 years after surgery), 12 of the 34 examined patients (35.3%) were still classified as Engel IV; 22 of the 34 patients (64.7%) were improved (Engel I-III). Of the 34 patients, 8 (23.5%) achieved an excellent outcome, classified as Engel I, 3 patients (8.8%) were classified as Engel II, and 11 patients (32.4%) as Engel III. The seizure outcome in the patients classified as Engel I was achieved by resective reoperation in 4; by a change in antiepileptic medication in 3 patients; and by vagus nerve stimulation (VNS) in 1 patient. The seizure outcome of Engel II was achieved by a change in antiepileptic medication in all 3 patients. Of the 34 patients, a total of 6 (17.6%) underwent resective reoperation only. The major reasons for this were the absence of a plausible hypothesis for invasive re-evaluation, the risk of postoperative deficit, and multifocal epilepsy in the rest of patients. Although the reoperation rate was relatively low in our series, we can achieve better or even excellent seizure outcomes using other procedures in patients for whom resective surgery initially failed. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Prevention of venous thromboembolism in patients undergoing bariatric surgery

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    Bartlett MA

    2015-08-01

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

  6. A psychiatric perspective view of bariatric surgery patients

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    Isabel Brandão

    2015-10-01

    Full Text Available Abstract Background Bariatric surgery is the only procedure that has significant results in weight loss and improvements in medical comorbidities in morbid obese patients. Severely obese patients are also associated with a higher prevalence of psychiatric disorders and poor quality of life. Objective To evaluate specific areas of psychopathology in individuals undergoing bariatric surgery. Methods A review of the literature was conducted from January 2002 to March 2014 by researching PubMed database using the following query: “morbid AND obesity AND bariatric AND surgery AND (psychiatry OR psychology”. Results Overall improvements in eating behaviors, mood disorders and body image are reported after bariatric surgery, and the mechanism is not enlightened. Risk of suicide and consumption of substances of abuse, especially alcohol, after gastric bypass surgery are problems that clinicians must be aware. Discussion Bariatric patients should be monitored after surgery to identify who did not show the expected benefits postoperatively and the ones who develop psychiatric symptoms after an initial positive response.

  7. Orthognathic surgery: is patient information on the Internet valid?

    Science.gov (United States)

    Aldairy, T; Laverick, S; McIntyre, G T

    2012-08-01

    The aims of this study were to evaluate the quality and reliability of UK websites providing information on orthognathic and jaw surgery to patients. An Internet search engine (www.google.com) was used to identify websites containing medical information on 'orthognathic surgery' and 'jaw surgery'. Of over 144,000 links for orthognathic surgery and 700,000 for jaw surgery, the first 100 were examined in detail. After excluding discussion groups, news and video feeds, and removing duplicate sites, only 25 relevant websites remained which were then evaluated using the DISCERN instrument (www.discern.org.uk/discern_instrument.php). Through the 16 questions assessing the reliability and quality of the consumer information which are scored from 1 to 5, a relative index of the quality of the information is produced. The maximum score attainable for an excellent website is 80. Of the 25 websites that were scored, DISCERN indicated the majority of websites fell well below the maximum score. The highest score achieved by one of the websites according to the DISCERN tool was 64 of 80 and the lowest score achieved was 21 of 80. The websites achieving maximum and minimum score were Wikipedia and qualitydentistry.com, respectively. By directing patients to validated websites, clinicians can ensure patients find appropriate information; however, further development of websites relating to orthognathic surgery is required. Internet information should be updated on a regular basis to account for improvements in orthodontic and surgical care.

  8. [Episodic central nervous system symptoms with reversible white matter involvement in Chinese patients with X-linked Charcot-Marie-Tooth disease and literatures review].

    Science.gov (United States)

    Zhang, Hai-hua; Gao, Li-guo; Wang, Jing-min; Gao, Zhi-jie; Jiang, Yu-wu; Wang, Shuang; Xiong, Hui; Chang, Xing-zhi; Wu, Ye

    2013-11-01

    To analyze the phenotype and genotype of CMTX1 patients with episodic transient reversible white matter involvement, and delineate the features of brain MRI in the episode and the possible mechanisms. Three Chinese probands and their family members were sequenced in the coding regions of GJB1. With the other 16 reported CMTX1 patients with episodic transient reversible white matter involvement, the clinical feature of the episodic central nervous system symptoms and the genotypes were reviewed. Missense mutations in GJB1 were identified in all 3 probands. In 19 patients with transient reversible white matter involvement, the episodes were manifested as weakness of the limbs, dysarthria, and dysphagia, without disturbance of consciousness or seizures. The episodes lasted for 13 hours (10 min-72 hours) with complete remission in all patients; There were multiple episodes in 9 patients. During the episode, brain MRI showed symmetrical high signals in T2 weighted, Flair and DWI images in periventricular white matter, with predominance in posterior region including splenium of corpus callosum. These changes in imaging were most prominent during or within 1 week after the clinical episode.Significant improvements occurred within 1 month, with complete remission within 4-6 months.No specific locations of mutant amino acids in GJB1 protein were found in these patients with episodic transient reversible white matter involvement. Episodic transient reversible white matter involvement may present in a small number of patients with CMTX1. Transient edema of oligodendrocytes due to the dysfunction of gap junction may be involved in the pathogenesis. There is no correlation between the location of the mutant amino acids in GJB1 and the occurrence of the episodes.

  9. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

    Science.gov (United States)

    Cerci, M.; Bellini, M. I.; Russo, F.; Benavoli, D.; Capperucci, M.; Gaspari, A. L.; Gentileschi, P.

    2013-01-01

    Introduction. Moderate obesity (BMI 30–35 kg/m2) affects 25% of the western population. The role of bariatric surgery in this context is currently debated, reserved for patients with comorbidity, as an alternative to conservative medical treatment. We describe our experience in moderately obese patients treated with bariatric surgery. Materials and Methods. Between September 2011 and September 2012, 25 patients with grade I obesity and comorbidities underwent bariatric surgery: preoperative mean BMI 33.2 kg/m2, 10 males, mean age 42 years. In presence of type 2 diabetes mellitus (T2DM) (56%), gastric bypass was performed; in cases with hypertension (64%) and obstructive sleep apnea (OSA) (12%), sleeve gastrectomy was performed. All operations were performed laparoscopically. Results. Mean follow-up was 12.4 months. A postoperative complication occurred: bleeding from the trocar site was resolved with surgery in local anesthesia. Reduction in average BMI was 6 points, with a value of 27.2 kg/m2. Of the 14 patients with T2DM, 12 (86%) discontinued medical therapy because of a normalization of glycemia. Of the 16 patients with arterial hypertension, 14 (87%) showed remission and 2 (13%) improvement. Complete remission was observed in patients with OSAS. Conclusions. The results of our study support the validity of bariatric surgery in patients with BMI 30–35 kg/m2. Our opinion is that, in the future, bariatric surgery could be successful in selected cases of moderately obese patients. PMID:24454338

  10. Bariatric Surgery in Moderately Obese Patients: A Prospective Study

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    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.

  11. Quality of life after brainstem cavernoma surgery in 71 patients.

    Science.gov (United States)

    Dukatz, Thomas; Sarnthein, Johannes; Sitter, Helmut; Bozinov, Oliver; Benes, Ludwig; Sure, Ulrich; Bertalanffy, Helmut

    2011-09-01

    Symptomatic patients with a brainstem cavernoma are treated surgically with increasing frequency. Generally, the patient's benefit from this difficult surgical intervention is quantified by the assessment of neurological symptoms. To document the beneficial effect of surgery in a larger patient population by assessing the postoperative quality of life (QoL). In a series of 71 surgically treated patients, a detailed neurological status was assessed by Patzold Rating and Karnofsky Performance Status Scale. Patients rated their QoL with the Short Form 36 Health Survey. To document the effect of surgery on QoL, we devised a supplementary questionnaire. The last 24 patients completed Short Form 36 Health Survey pre- and postoperatively. Karnofsky Performance Status Scale improved in 44 of 71 surgical patients (62%), remained unchanged in 19 (27%), and deteriorated in 8 (11%) individuals. Patzold Rating showed a more detailed picture of the neurological symptoms. It correlated significantly with Karnofsky Performance Status Scale, which underscores its usefulness for patients with brainstem lesions. In the Short Form 36 Health Survey score, the Mental Component Summary improved with surgery (paired test, P = .015). In addition, 58 individuals (82%) declared a clear subjective benefit of surgery. The results of this large series support the notion that microsurgical removal of a brainstem cavernoma represents an effective therapy in experienced hands and is generally associated with good clinical outcome, both neurologically and in terms of QoL.

  12. Patients' attitude towards residents' participation during gynaecological surgery

    NARCIS (Netherlands)

    Versluis, Marco A. C.; van der Linden, Paul J. Q.

    2010-01-01

    Objective: To evaluate patients' attitude towards participation of residents in training in gynaecological surgery and patients understanding of resident position. Study design: An observational survey study was performed between July and February 2007-2008 in an outpatient clinic of a department of

  13. Flap surgery in treatment of patients with pathology of ankle

    Directory of Open Access Journals (Sweden)

    D. I. Kutyanov

    2013-01-01

    Full Text Available Objective: to determine the capabilities and perspectives of flap surgery in treatment of patients with traumas and diseases of ankle joint region. Material and methods. The results of surgical treatment of 88 such patients. All the patients were treated in the Vreden Russian Research Institute of Traumatology and Orthopedics within the period from 2000 to 2011. All the patients had pedicled flap transfer (46 cases or free tissue transfer (45 cases. 11 patients had additional need in other open orthopedic operations of ankle joint. Besides this, scientific works dealing with the studied problem have been analyzed. Results and conclusions. It has been stated that flap surgery is predominantly used as the only and exhaustive method of treatment of such patients (87,5%. In these situations pedicled flap transfer and free tissue transfer tend to be used in comparatively equal quantities. Flap surgery is now seldom used as a component of complex surgical treatment. It is used only in some cases of bone reconstruction of distal tibia by Ilizarov bone transport, in some cases of tumors of ankle joint as well as in some cases of local infectious complications after internal fixation and total ankle arthroplasty. Patients with the pathology of this kind have a high need in free tissue transfer (from 66,7% to 83,3%. Progressing technology of total ankle arthroplasty will contribute to the frequency of use of flap surgery for patients with pathology of ankle joint.

  14. Patients' attitude towards residents' participation during gynaecological surgery

    NARCIS (Netherlands)

    Versluis, Marco A. C.; van der Linden, Paul J. Q.

    2010-01-01

    Objective: To evaluate patients' attitude towards participation of residents in training in gynaecological surgery and patients understanding of resident position. Study design: An observational survey study was performed between July and February 2007-2008 in an outpatient clinic of a department of

  15. Evaluation of life quality of patients submitted to orthognathic surgery

    Directory of Open Access Journals (Sweden)

    Ana Catarina Alves e Silva

    2013-10-01

    Full Text Available OBJECTIVE: To compare changes related to self-esteem and appearance satisfaction between pre and postsurgical phases in patients undergoing orthognathic surgery and to assess the quality of life and psychosocial changes of these patients six months after surgery. METHODS: A longitudinal observational qualitative study was performed. The sample comprised 15 patients with dentofacial deformities who underwent orthognathic surgery. One questionnaire and two forms were answered during pre and postoperative phases. RESULTS: The results showed that 13.3% of patients demonstrated self-esteem improvement, especially in relation to appearance satisfaction. Improvements were also noted in social, occupational and family relationships. With regard to the assessment of quality of life, according to the World Health Organization questionnaire, the lowest improvement averages corresponded to environmental control. CONCLUSION: Orthognathic surgery brings along many emotional changes that should be considered before and after surgery, since the patients' psychological state may be favorable and/or unfavorable during recovery, influencing their quality of life, self-esteem and appearance satisfaction.

  16. Early detection of atrial high rate episodes predicts atrial fibrillation and thromboembolic events in patients with cardiac resynchronization therapy

    DEFF Research Database (Denmark)

    Witt, Christoffer Tobias; Kronborg, Mads Brix; Nohr, Ellen Aagaard

    2015-01-01

    BACKGROUND: In patients without any history of atrial fibrillation (AF), detection of subclinical atrial high rate episodes (AHRE) by implanted devices has been associated with an increased thromboembolic risk. The predictive value of AHRE in patients with cardiac resynchronization therapy (CRT...... of AF, detection of early AHRE after CRT implantation is associated with a significantly increased risk of clinical AF and thromboembolic events, particularly AHRE longer than 24 hours....

  17. Unemployment among patients with newly diagnosed first-episode psychosis: prevalence and clinical correlates in a U.S. sample.

    Science.gov (United States)

    Ramsay, Claire E; Stewart, Tarianna; Compton, Michael T

    2012-05-01

    Although it is well established that people with schizophrenia have markedly high rates of unemployment, less is known about the prevalence and clinical correlates of unemployment in patients newly diagnosed with first-episode psychosis. This analysis documented the prevalence of unemployment and examined previously reported clinical correlates of unemployment in patients with first-episode psychosis hospitalized in an urban, public-sector setting in the southeastern US. Participants (n = 181) were assessed as part of an overarching study of first-episode psychosis using a variety of standardized research instruments. The rate of unemployment was compared to that documented in the general population according to US census data. Bivariate tests of associations between employment status and a number of variables of interest were followed by a multiple logistic regression model based on a previous study from Dublin, Ireland. Some 65.0% of first-episode patients were unemployed in the month prior to hospital admission, which is substantially higher than the rate of unemployment during the same period in the two counties in which recruitment took place. In bivariate tests, unemployment was associated with younger age, fewer years of educational attainment, lower global functioning scores, and more severe negative symptoms. In the logistic regression model, only age and global functioning were independently significant correlates. The remarkably high rate of unemployment in this young, first-episode sample, and the evidence of associations between unemployment, greater symptomatology, and poorer functioning, argue for further research and development on supported employment programs for such patients.

  18. Unusual formation of keloids after each episode of recurrent herpes zoster in an HIV positive patient

    Directory of Open Access Journals (Sweden)

    Koley Sankha

    2009-01-01

    Full Text Available Herpes Zoster (HZ lesions are well known to heal with keloids. As immunity plays an important role in the development of abnormal scars and keloids, the latter is unusual in HIV where immunity is low. We report a rare case of recurrent HZ in an HIV-positive male where the lesions have healed with formation of keloids in both episodes. Within 50 days of last episode, he had an attack of herpes progenitalis.

  19. [Evaluation of preoperative anxiety in patients requiring glaucoma filtration surgery].

    Science.gov (United States)

    Lemaitre, S; Blumen-Ohana, E; Akesbi, J; Laplace, O; Nordmann, J-P

    2014-01-01

    Preoperative anxiety is often expressed by patients requiring filtration surgery for their glaucoma. So far, there has been no scale for screening this group of patients for preoperative anxiety. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-evaluation questionnaire which has been used in specialties other than ophthalmology and which makes it possible to identify the adult patients with a high level of preoperative anxiety over an upcoming surgical procedure. The purpose of this study is to estimate the preoperative anxiety in glaucoma patients requiring filtration surgery. We performed a prospective study of 36 adult patients with chronic glaucoma not responding to medical treatment and who were about to undergo filtration surgery (trabeculectomy or deep sclerectomy). The APAIS questionnaire was given to the patients after discussing the indication for surgery. A global anxiety score (ranging from 4 to 20) above 10 defined patients with a high level of preoperative anxiety. We attempted to identify among these patients the factors related to filtration surgery which caused them anxiety (lack of control of intraocular pressure, risk of blindness, presence of the filtering bleb). In our sample of patients, we found that glaucoma was a source of anxiety. That was also true for the surgical procedure, though most patients believe that once the decision had been made, their psychological status was not modified by the upcoming procedure. The patient-clinician relationship is important in any chronic disease, all the more so in glaucoma, since this disease remains asymptomatic for a long time. When filtration surgery is necessary, the patients are going to express less preoperative anxiety if they trust their physician and if individualized information has been given to them The French version of the APAIS is a quick scale, easily completed, that can be recommended for evaluating anxiety and patients' need for information prior to filtering

  20. Prevalence of myopic shifts among patients seeking cataract surgery

    Directory of Open Access Journals (Sweden)

    Rafael Iribarren

    2013-06-01

    Full Text Available Modern cataract surgery by phacoemulsification is a widely accepted procedure with a rapid recovery time. The prescription of specific intraocular lens, implanted during surgery, makes it possible to anticipate whether the patient will need reading glasses after the procedure. The present study analyses a sample of cataract surgery patients to show the frequency of myopic shifts related to nuclear opacity, which can result in clear near vision before surgery. A non-selected sample of consecutive patients who underwent elective cataract surgery in a private clinic was studied retrospectively. The myopic shift in refraction was assessed by comparing the old prescription with the spectacle correction at the time of interviewing.The mean age of the 229 subjects studied was 71.5 ± 10.4 years (109, 47.6%, males. A myopic shift in refraction, defined as at least - 0.5 diopters, was present in 37.1% of subjects (95% CI: 30.8%-43.4%. The mean change in refraction in these subjects was -2.52 ± 1.52 diopters. The percentage of subjects who had developed a myopic shift was significantly greater in those who presented greater nuclear opalescence. There were also differences in the mean myopic shift by refractive group, with the emmetropes having the greatest myopic shift. In this study of patients seeking cataract surgery in a clinical setting, more than one third had myopic shifts in refraction. This must be taken into account in order that patients maintain the benefit of clear near vision after surgery.

  1. Urological surgery in elderly patients: results and complications

    Directory of Open Access Journals (Sweden)

    Brodak M

    2015-02-01

    Full Text Available Milos Brodak, Jan Tomasek, Jaroslav Pacovsky, Lukas Holub, Petr Husek Department of Urology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic Purpose: Owing to the large aging population, a growing number of elderly patients are undergoing surgical treatment. Surgical procedures in elderly patients are associated with a higher risk of complications. The aim of this study was to evaluate the efficacy and safety of urological surgeries in old patients.Methods: The authors carried out a retrospective study, evaluating results and early postoperative complications in patients aged 75 years and older. The cohort of patients included 221 patients who underwent surgical procedures in the department of urology between January 2011 and December 2012. The average age of patients was 78. The results and complications were categorized based on the type of surgery performed, and the Dindo–Clavien scale.Results: The median follow-up was 18 months. All surgeries for malignant tumors were performed successfully with no residual disease. Totally, 48 (22% complications were recorded. The most serious were as follows: one patient (<0.5% died; and four (<2% patients underwent reoperation. The most common complications involved infection, mainly sepsis and surgical site infections. Other complications included mild respiratory insufficiency, delirium, bleeding, etc.Conclusion: Surgeries in elderly patients were effective and safe. The cornerstone of safety is careful preparation and treatment of comorbidities. Complications occurred mainly as a result of emergency procedures during emergency procedures and in major surgeries such as cystectomy and nephrectomy. The standard use of low molecular-weight heparin caused no incidence of thromboembolic disease. Keywords: urinary tract, aged, postoperative complications, Dindo–Clavien classification

  2. Verbal expressions used by anaclitic and introjective patients with depressive symptomatology: Analysis of change and stuck episodes within therapeutic sessions

    Directory of Open Access Journals (Sweden)

    Nelson Valdés

    2015-01-01

    Full Text Available A person’s speech makes it possible to identify significant indicators which reflect certain characteristics of his/her personality organization, but also can vary depending on the relevance of specific moments of the session and the symptoms type. The present study analyzed 10 completed and successful therapeutic processes using a mixed methodology. The therapies were video–and audio-taped, as well as observed through a one-way mirror by trained observers. All the sessions of each therapy were considered (N = 230 in order to identify, delimit, transcribe, and analyze Change Episodes (CEs = 24 and Stuck Episodes (SEs = 26. Each episode was made up by patients’ speech segments (N = 1,282, which were considered as the sampling unit. The Therapeutic Activity Coding System (TACS-1.0 was used to manually code each patient’s verbalizations, nested within episodes and individuals, in order to analyze them using Hierarchical Linear Modelling (HLM. The findings suggest that anaclitic patients tend to use more verbalizations in order to ask for feedback or to be understood by their therapists (attune, whereas introjective patients tend to use more verbalizations in order to construct new meanings (resignify during therapeutic conversation, but especially during SEs. Clinical implications to enrich the therapeutic practice are discussed.

  3. Technique of open laparoscopy for supramesocolic surgery in obese patients.

    Science.gov (United States)

    Deguines, Jean Baptiste; Qassemyar, Quentin; Dhahri, Abdennaceur; Brehant, Olivier; Fuks, David; Verhaeghe, Pierre; Regimbeau, Jean-Marc

    2010-08-01

    Incidence of obesity and related diseases are increasing in the world. Visceral surgeons are more often confronted with laparoscopic surgery in obese patients. Besides validated surgery procedures, such as cholecystectomy and gastroesophageal reflux surgery, bariatric procedures are increasingly performed. In obese patients, the thickness of adipose panicle makes open laparoscopy hazardous. In our department, we use systematically a technique of open laparoscopy in obese patients for supramesocolic surgery, which is safe, reproducible, and permits good closure of the abdominal wall. The surgical technique consists of opening the abdominal wall through the rectus abdominis. Helped by specific retractors called Descottes (Medtronic Laboratory), both fascias are charged by sutures separately. Incision in the fascias is made safely by pooling on sutures. Introduction of port-site is made under view control. At the end of laparoscopy, closure of both fascias is easily done. We present a technique of open laparoscopy in obese patients, systematically used, for supramesocolic surgery. This technique is safe, reproducible, and permits an efficient closure of the abdominal wall.

  4. Low arginine plasma levels in patients after thoracoabdominal aortic surgery.

    Science.gov (United States)

    Nijveldt, R J; Prins, H A; Siroen, M P; Rauwerda, J A; Teerlink, T; van Leeuwen, P A

    2000-08-01

    Thoracoabdominal aortic surgery is a high-risk procedure and associated with a significant morbidity and mortality. Ischemia reperfusion of visceral organs and lower extremities is one of the most important determinants of this morbidity. Arginine is the precursor of nitric oxide and arginine plasma levels are important in maintaining organ blood flow. Furthermore, arginine is important in wound healing and the immune system. Because of increased utilization of arginine, low arginine plasma levels could be expected after thoracoabdominal aortic surgery. We therefore measured arginine plasma levels in these patients. Six patients with thoracoabdominal aortic aneurysm were included in this study. University Hospital Vrije Universiteit, Department of Surgery, Amsterdam, The Netherlands. Six patients undergoing thoracoabdominal aortic surgery. Plasma levels of arginine were measured by high-performance liquid chromatography. Very low arginine plasma levels were seen on the first postoperative day. From day 1 arginine slowly increased, but did not reach normal plasma levels on day 6. A significant decrease of arginine plasma levels was found and because of the fact that arginine has multiple functions, it may be important to keep these arginine plasma levels at normal or even higher levels in patients undergoing major vascular surgery. European Journal of Clinical Nutrition (2000) 54, 615-617.

  5. Patient experiences with interventions to reduce surgery cancellations

    DEFF Research Database (Denmark)

    Hovlid, Einar; von Plessen, Christian; Haug, Kjell

    2013-01-01

    The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency, and redu......The cancellation of planned surgery harms patients, increases waiting times and wastes scarce health resources. Previous studies have evaluated interventions to reduce cancellations from medical and management perspectives; these have focused on cost, length of stay, improved efficiency......, and reduced post-operative complications. In our case a hospital had experienced high cancellation rates and therefore redesigned their pathway for elective surgery to reduce cancelations. We studied how patients experienced interventions to reduce cancellations....

  6. [Embracement and anxiety symptoms in patients before cardiac surgery].

    Science.gov (United States)

    Assis, Cinthia Calsinski; Lopes, Juliana de Lima; Nogueira-Martins, Luiz Antônio; de Barros, Alba Lucia Bottura Leite

    2014-01-01

    This is a randomized clinical trial, aimed to compare the frequency and intensity of symptoms of anxiety in patients of preoperative cardiac surgery who received empathic behavior from nurse or family or those who received no specific type of empathic behavior. The sample consisted of 66 patients in preoperative of cardiac surgery, which were divided in three groups: empathic behavior by nurses, without specific empathic behavior and by family. Anxiety was assessed at two points in time: before and after the intervention. The instrument used was developed and validated by Suriano, comprising 19 defining characteristics of the nursing diagnosis anxiety. It was observed that the reduction of anxiety symptoms was higher in the group receiving empathic behavior of relatives when compared to the other two groups. The results suggested that encouraging the participation of family members can contribute to the reduction of anxiety symptoms in patients in preoperative cardiac surgery.

  7. Rorschach Inkblot Method data at baseline and after 2 years treatment of consecutively admitted patients with first-episode schizophrenia

    DEFF Research Database (Denmark)

    Rosenbaum, Bent; Andersen, Palle Bent; Knudsen, Per Bjerregaard;

    2012-01-01

    Background: The Rorschach Inkblot Method is regarded as an important clinical instrument for detailed diagnostic description of the integrative capacities of individuals in psychotic states and as an instrument for measuring progression in the course of treatment. Aims: To describe relevant...... Rorschach variables at baseline in a group of consecutively admitted patients with first-episode schizophrenia. Furthermore, to describe the changes in these variables from baseline to year 2 for the group of patients given psychiatric standard treatment, and to compare these changes with changes in other......'s Rorschach Comprehensive System at inclusion and after 2 years. Results: Core variables of the Rorschach, assumed to show changes (e.g. reality testing, perceptual and thought disorders) in patients with a first episode of schizophrenia, all improved but revealed no significant changes after 2 years...

  8. Treatment of patients with first-episode psychosis: two-year outcome data from the Danish National Schizophrenia Project

    DEFF Research Database (Denmark)

    Rosenbaum, Bent; Valbak, Kristian; Harder, Susanne;

    2006-01-01

    First episode psychosis interventions have been in focus in the last two decades in an attempt to improve the course and outcome of schizophrenic disorders. The Danish National Schizophrenia Project began in 1997 its intake of patients, aged 16-35, with a first psychotic episode of a schizophrenic...... psychodynamic psychotherapy as a supplement to treatment as usual", "integrated, assertive, psychosocial and educational treatment programme", or "treatment as usual". Data on symptoms and social function and sociodemographic data were obtained at inclusion, and at year 1 and 2. The three sub-cohorts did...... patients in the treatment-as-usual group. Improvement in the intervention groups continued into the second year. Patients receiving integrated assertive treatment faired better than those being treated with the less intensive method of supportive psychodynamic psychotherapy, and the latter group improved...

  9. Foot massage: effectiveness on postoperative pain in breast surgery patients.

    Science.gov (United States)

    Ucuzal, Meral; Kanan, Nevin

    2014-06-01

    The aim of this study was to determine the effect of foot massage on pain after breast surgery, and provide guidance for nurses in nonpharmacologic interventions for pain relief. This was a quasiexperimental study with a total of 70 patients who had undergone breast surgery (35 in the experimental group and 35 in the control group). Patients in the control group received only analgesic treatment, whereas those in the experimental group received foot massage in addition to analgesic treatment. Patients received the first dose of analgesics during surgery. As soon as patients came from the operating room, they were evaluated for pain severity. Patients whose pain severity scored ≥4 according to the Short-Form McGill Pain Questionnaire were accepted into the study. In the experimental group, pain and vital signs (arterial blood pressure, pulse, and respiration) were evaluated before foot massage at the time patients complained about pain (time 0) and then 5, 30, 60, 90, and 120 minutes after foot massage. In the control group, pain and vital signs were also evaluated when the patients complained about pain (time 0) and again at 5, 30, 60, 90, and 120 minutes, in sync with the times when foot massage was completed in the experimental group. A patient information form was used to collect descriptive characteristics data of the patients, and the Short-Form McGill Pain Questionnaire was used to determine pain severity. Data were analyzed for frequencies, mean, standard deviation, chi-square, Student t, Pillai trace, and Bonferroni test. The results of the statistical analyses showed that patients in the experimental group experienced significantly less pain (p ≤ .001). Especially notable, patients in the experimental group showed a decrease in all vital signs 5 minutes after foot massage, but patients in the control group showed increases in vital signs except for heart rate at 5 minutes. The data obtained showed that foot massage in breast surgery patients was

  10. Identification of novel and recurrent CACNA1A gene mutations in fifteen patients with episodic ataxia type 2.

    Science.gov (United States)

    Mantuano, Elide; Romano, Silvia; Veneziano, Liana; Gellera, Cinzia; Castellotti, Barbara; Caimi, Sara; Testa, Daniela; Estienne, Margherita; Zorzi, Giovanna; Bugiani, Marianna; Rajabally, Yusuf A; Barcina, Maria J Garcìa; Servidei, Serena; Panico, Aurora; Frontali, Marina; Mariotti, Caterina

    2010-04-15

    Episodic ataxia type 2 is a rare autosomal dominant disease characterized by recurrent attacks of vertigo and cerebellar ataxia. The disease was caused by mutations in the CACNA1A gene, on chromosome 19p. We perform a mutational screening in a group of 43 unrelated patients. Forty-two patients presented episodes of disequilibrium and ataxia, and one child was studied because of the occurrence of episodic torticollis. The genetic analysis showed 15 mutated patients (35%). In 13 cases we found novel CACNA1A gene mutations, including missense, protein truncating, and aberrant splicing mutations. Two truncating mutations lead to the uppermost premature stop so far reported, challenging recent hypotheses on dominant negative effect. In patients without CACNA1A mutations, molecular testing for CACNB4 gene mutations excluded this genetic subtype. Clinical features of mutated subjects mostly confirmed previous sign and symptoms associated with EA2, including paroxysmal torticollis and mental retardation. CACNA1A mutated patients have an earlier age at onset, interictal nystagmus, and abnormalities of ocular movements. A review of all CACNA1A mutations so far reported showed that they are mainly located downstream exon 18. Our data substantially increase the number of the described CACNA1A mutations, and propose clinical and molecular criteria for a more focused genetic screening. Copyright 2010 Elsevier B.V. All rights reserved.

  11. Mandatory Risk Assessment Reduces Venous Thromboembolism in Bariatric Surgery Patients.

    Science.gov (United States)

    Nimeri, Abdelrahman A; Bautista, Jejomar; Ibrahim, Maha; Philip, Ruby; Al Shaban, Talat; Maasher, Ahmed; Altinoz, Ajda

    2017-08-23

    Bariatric surgery patients are at high risk for venous thromboembolism (VTE), and chemoprophylaxis is recommended. Sheikh Khalifa Medical City (SKMC) is an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) member since 2009. We report the rates of VTE in bariatric surgery patients from 2010 to 2016 compared to ACS NSQIP bariatric surgery programs before and after switching from heparin to low molecular weight heparin (LMWH), initiating mandatory risk assessment using Caprini scoring for VTE and adopting an aggressive strategy for high-risk patients regarding dosage of LMWH and chemoprophylaxis after discharge. During the study period, there were 1152 cases (laparoscopic Roux-en-Y gastric bypass (LRYGB) 625 and laparoscopic sleeve gastrectomy (LSG) 527) at Bariatric & Metabolic Institute (BMI) Abu Dhabi compared to 65,693 cases (LRYGB 32,130 and LSG 33,563) at ACS NSQIP bariatric surgery programs. VTE rates remained stable at ACS NSQIP bariatric surgery programs from 2010 to 2016 (0.45, 0.45, 0.45, 0.25, 0.35, 0.3, and 0.3%). In contrast, VTE rates at BMI Abu Dhabi decreased from 2.2% in 2011 to 0.35% after we adopted an aggressive strategy to VTE without an increase in bleeding complications. LRYGB patients with VTE had higher OR time, leak, collection, and mortality at ACS NSQIP hospitals compared to those at BMI Abu Dhabi. In contrast, rates were similar in LSG patients with VTE. Changing our approach to VTE management led our VTE rates to decrease and become like those of ACS NSQIP bariatric surgery patients in LSG and LRYGB.

  12. Complications of Lower Body Lift Surgery in Postbariatric Patients

    Science.gov (United States)

    van Dijk, Martine M.; Klein, Steven; Hoogbergen, Maarten M.

    2016-01-01

    Background: There is an exponential rise of patients with massive weight loss because of bariatric surgery or lifestyle changes. The result is an increase of patients with folds of redundant skin that may cause physical and psychological problems. The lower body lift is a procedure to correct deformities in the abdomen, mons, flanks, lateral thighs, and buttocks. Complication rates are quite high and could negatively affect the positive outcomes. The purpose of this study is to assess complication rates and to identify predictors of complications to optimize outcomes for patients after lower body lift surgery. Methods: A retrospective analysis of 100 patients who underwent a lower body lift procedure was performed. The patients were reviewed for complications, demographic data, comorbidities, smoking, highest lifetime body mass index, body mass index before lower body lift surgery, percentage of excess weight loss, and amount of tissue excised. Results: The overall complication rate was 78%. Twenty-two percent of the patients had major complications and 56% had minor complications. There is a linear relationship between body mass index before lower body lift surgery and complications (P = 0.03). The percentage of excess weight loss (odds ratio [OR] 0.97; 95% confidence interval [CI] 0.92–1.00), highest lifetime body mass index (OR 1.08; 95% CI 1.01–1.15), body mass index before lower body lift surgery (OR 1.17; 95% CI 1.02–1.33), and smoking (OR 7.74; CI 0.98–61.16) are significantly associated with the development of complications. Conclusions: This study emphasizes the importance of a good weight status before surgery and cessation of smoking to minimize the risk of complications.

  13. Neuron-specific Enclose and Myelin Basic Protein in Cerebrospinal Fluid of Patients with First Episode Schizophrenia

    Institute of Scientific and Technical Information of China (English)

    LI Shuying; WU Hanrong; GUO Huirong; ZHAO Zheng

    2006-01-01

    In order to study whether patients with schizophrenia have cerebral injury, neuron-specific enolase (NSE) and myelin basic protein (MBP)in cerebrospinal fluid (CSF) of 33 patients with first episode schizophrenia and 9 from the control group were determined by double antibody sandwich enzyme immunoassay method. The results showed that there was significant difference in the NSE contents between the experimental group and control group (P<0.01). The NSE contents in CSF in the experimental group were positively correlated with MBP in schizophrenia patients (P<0.05). These findings suggested that patients with schizophrenia had cerebral injury.

  14. Acute Postoperative Pain of Indonesian Patients after Abdominal Surgery

    Directory of Open Access Journals (Sweden)

    Chanif Chanif

    2012-08-01

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

  15. Patient Selection in Plastic Surgery: Recognizing Body Dysmorphic Disorder

    Directory of Open Access Journals (Sweden)

    Cihan Sahin

    2013-04-01

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

  16. MINIMALLY-INVASIVE SURGERY FOR COLLORECTAL CANCER IN ELDERLY PATIENTS

    Directory of Open Access Journals (Sweden)

    I. L. Chernikovskiy

    2016-01-01

    Full Text Available Introduction. The patient’s age is one of the major risk factors of death from colorectal cancer. The role of laparo- scopic radical surgeries in the treatment of colorectal cancer in elderly patients is being studied. The purpose of the study was to evaluate the experience of surgical treatment for elderly patients with colorectal cancer. material and methods. The treatment outcomes of 106 colorectal cancer patients aged 75 years or over, who underwent surgery between 2013 and 2015 were presented. Out of them, 66 patients underwent laparatomy and 40 patients underwent laparoscopy. Patients were matched for ASA and CR-PОSSUM scales, age-and body mass index, dis- ease stage and type of surgery. Results. The mean duration of surgery was significantly less for laparoscopy than for laparotomy (127 min versus 146 min. Intraoperative blood loss was higher in patients treated by laparotomy than by laparoscopy (167 ml versus 109 ml, but the differences were insignificant (р=0.36. No differences in lymphodissection quality and adequate resection volume between the groups were found. The average hospital stay was not significantly shorter in the laparoscopic group (р=0.43. Complications occurred with equal frequency in both groups (13.6 % compared to 15.0 %. The median follow-up time was 16 months (range, 6-30 months. The number of patients died during a long-term follow-up was 2 times higher after laparotomic surgery than after laparoscopic surgery, however, the difference was not statistically significant. Conclusion. Postoperative compli- cations in elderly patients with colorectal cancer did not exceed the average rates and did not depend on the age. Both groups were matched for the intraoperative bleeding volume and quality of lymphodenectomy. Significantly shorter duration of laparoscopic surgery was explained by the faster surgical access however, it showed no benefit in reducing the average length of hospital stay and decreasing the number of

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

    OpenAIRE

    2015-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  19. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Science.gov (United States)

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

    2015-01-01

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

  20. Patients Undergoing Dacryocystorhinostomy Surgery in Northern ...

    African Journals Online (AJOL)

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

  1. [Bariatric surgery. Patient selection and indication].

    Science.gov (United States)

    Schusdziarra, V; Hausmann, M; Erdmann, J

    2005-07-01

    Successful reduction of body weight in patients with morbid obesity (BMI >40 kg/m(2)) is difficult and on a long-term basis nearly impossible with non-interventional treatment modalities. Surgical therapy is an efficient alternative for these patients. Potential surgical treatment should be carefully evaluated during a 6-month preoperative treatment phase during which indications and contraindications should be evaluated. Qualified postoperative care must be provided.

  2. Undiagnosed Bipolar Disorders in Patients with Major Depressive Episode: Iran’s Part of a Multicenter Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Seyed Ali Ahmadi Abhari

    2013-03-01

    Full Text Available Objective: Bipolar spectrum disorders may often go undiagnosed or unrecognized. The aim of this study was to determine the proportion of bipolar disorder symptoms in Iranian patients with a major depressive episode.Methods: 313 patients with a current DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders 4th ed. Text rev. diagnosed with a major depressive episode entered this cross-sectional study. Thirty two items revised Hypomania/ mania Symptoms Checklist (HCL-32 was used to determine the frequency of bipolar episodes.Results: Considerable proportion of patients (53.9% previously diagnosed as major depressive disorder fulfilled the criteria for bipolar disorder by Bipolarity Specifier. The Bipolarity Specifier additionally identified significant association for manic / hypomanic states during antidepressants therapy (p<0.0003 and current mixed mood symptoms (p<0.0001Conclusion: Bipolar symptoms meeting the criteria for bipolar disorders in depressed patients who have not been previously diagnosed with bipolar disorder are frequent. Current DSM criteria may not be sufficient to diagnose more subtle or atypical forms of bipolar disorders.

  3. The association between psychopathology of first-episode psychosis patients within the schizophrenia spectrum and previous offending.

    Science.gov (United States)

    Munkner, Runa; Haastrup, Soeren; Joergensen, Torben; Kramp, Peter

    2009-01-01

    Patients with schizophrenia have been shown to have an increased risk of criminality. The aim was to describe possible psychopathological differences between schizophrenia spectrum patients with and without a criminal career before first-episode psychosis. In a multi-centre study, 16 psychiatric treatment centres included and rated 477 patients with first-episode psychosis over a 2-year period on socio-demography, the Positive and Negative Syndrome Scale, OPerational CRITeria checklist, Global Assessment of Functioning, Premorbid Adjustment Scale and Self-report Insight Scale for psychosis. Data were linked with data concerning criminal and psychiatric history. No key characteristics were found to assist the early detection of criminal persons before first psychiatric hospital contact for a psychotic incident. However, when adjusted for sex, age, abuse, living conditions, marital status, employment status and education, a primarily positive symptomatology was associated with a prior criminal career. The premorbid level of functioning and several function parameters were also significantly associated with criminal history. There are significant differences in psychopathology between schizophrenia spectrum patients with and without a criminal career before first-episode psychosis, and a better screening procedure in the judicial system could detect these individuals earlier and make adequate treatment possible.

  4. Elective Thoracolumbar Spine Fusion Surgery in Patients with Parkinson Disease.

    Science.gov (United States)

    Puvanesarajah, Varun; Jain, Amit; Qureshi, Rabia; Carstensen, S Evan; Tyger, Rosemarie; Hassanzadeh, Hamid

    2016-12-01

    Few data are available concerning clinical outcomes in patients with Parkinson disease who undergo elective thoracolumbar spine fusion surgery. The goal of this study is to elucidate complication and revision rates after posterior thoracolumbar fusion surgery in patients with Parkinson disease, with a focus on how Parkinson disease modifies these rates. The PearlDiver database (2005-2012) was queried for patients who underwent posterior approach thoracolumbar fusion from 2006 to 2011. Cohorts of patients with a previous diagnosis of Parkinson disease (n = 4816) and without (n = 280,702) were compared. Multivariate analysis that included various comorbidities and demographics was used to calculate effects of Parkinson disease on development of postoperative infection and major medical complications within 90 days and revision surgery within 1 year. For analyses, significance was set at P Parkinson disease was significantly associated with an increased risk for medical complications (adjusted odds ratio, 1.22; 95% confidence interval, 1.11-1.34; P Parkinson disease are more likely to require revision surgery and have higher rates of adverse medical events postoperatively. Patients with Parkinson disease should be appropriately selected to ensure favorable clinical outcomes. Copyright © 2016. Published by Elsevier Inc.

  5. Physical therapy in postoperative cardiac surgery: patient's perception.

    Science.gov (United States)

    Lima, Paula Monique Barbosa; Cavalcante, Hermanny Evanio Freitas; Rocha, Angelo Roncalli Miranda; Brito, Rebeca Taciana Fernandes de

    2011-01-01

    Many strategies to improve services provided by for physiotherapy are based on patients satisfaction. Listen and observe the behavior of patients in a hospital is crucial to understanding and improvement of service and the hospital. This study aimed to identify the patient's perception undergoing cardiac surgery on the physiotherapy service provided to wards of hospitals for heart surgery reference in the city of Maceió, AL, Brazil, and from that information detect what actions are perceived as priorities for which are noteworthy plans for improvements in quality of care. Cross-sectional study, conducted in quality and quantity of reference hospitals in cardiac surgery in the city of Maceio, AL, Brazil, in the period from September to November 2008. The study included 30 users of the Sistema Único de Saúde, of which 12 (40%) female and 18 (60%) males. The average age of this sample was 49.2 ± 11.9 years and most belonged to socioeconomic class D (36.7%). It was found that only 16.7% had contact with the physiotherapist before surgery. Regarding educational guidelines about postoperative period, only 2.9% patients reported having received them. However, 56.8% rated the care as good and 100% of patients reported believing that physiotherapy could improve their health status. We suggest the implementation of preoperative physical therapy protocols with preventive measures and educational as well as new researchs that may characterize the population of users of health plans/private.

  6. Patient Perceptions of Open, Laparoscopic, and Robotic Gynecological Surgeries

    Directory of Open Access Journals (Sweden)

    Mohamad Irani

    2016-01-01

    Full Text Available Objective. To investigate patient knowledge and attitudes toward surgical approaches in gynecology. Design. An anonymous Institutional Review Board (IRB approved questionnaire survey. Patients/Setting. A total of 219 women seeking obstetrical and gynecological care in two offices affiliated with an academic medical center. Results. Thirty-four percent of the participants did not understand the difference between open and laparoscopic surgeries. 56% of the participants knew that laparoscopy is a better surgical approach for patients than open abdominal surgeries, while 37% thought that laparoscopy requires the surgeon to have a higher technical skill. 46% of the participants do not understand the difference between laparoscopic and robotic procedures. 67.5% of the participants did not know that the surgeon moves the robot’s arms to perform the surgery. Higher educational level and/or history of previous abdominal surgeries were associated with the highest rates of answering all the questions correctly (p<0.05, after controlling for age and race. Conclusions. A substantial percentage of patients do not understand the difference between various surgical approaches. Health care providers should not assume that their patients have an adequate understanding of their surgical options and accordingly should educate them about those options so they can make truly informed decisions.

  7. Postoperative care for the robotic surgery bowel resection patient.

    Science.gov (United States)

    Brenner, Zara R; Salathiel, Mary; Macey, Barbara A; Krenzer, Maureen

    2011-01-01

    A new surgical method is available for colon and rectal surgery. Robotic surgery, using the daVinci Si HD Surgical System, offers surgical advances compared with the traditional open or laparoscopic surgical methods. The potential advantages of robotic technology continue to be explored and its most appropriate functions are yet to be determined. In clinical experience, the use of this surgical method has resulted in changes to postoperative nursing care management. This article describes changes in the management of postoperative patient care including fluid and electrolyte balance, and patient and staff education. Modifications were instituted in the clinical pathway to facilitate an accelerated standard of care. New discharge strategies were implemented to ensure ongoing fluid and electrolyte balance by the patient. A true team effort from a multitude of disciplines was required for the changes in patient care routine to be effective. Outcomes including length of stay and patient satisfaction are presented.

  8. Medanta insulin protocols in patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Beena Bansal

    2014-01-01

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

  9. Homeostatic imbalance of purine catabolism in first-episode neuroleptic-naive patients with schizophrenia.

    Directory of Open Access Journals (Sweden)

    Jeffrey K Yao

    Full Text Available BACKGROUND: Purine catabolism may be an unappreciated, but important component of the homeostatic response of mitochondria to oxidant stress. Accumulating evidence suggests a pivotal role of oxidative stress in schizophrenia pathology. METHODOLOGY/PRINCIPAL FINDINGS: Using high-pressure liquid chromatography coupled with a coulometric multi-electrode array system, we compared 6 purine metabolites simultaneously in plasma between first-episode neuroleptic-naïve patients with schizophrenia (FENNS, n = 25 and healthy controls (HC, n = 30, as well as between FENNS at baseline (BL and 4 weeks (4w after antipsychotic treatment. Significantly higher levels of xanthosine (Xant and lower levels of guanine (G were seen in both patient groups compared to HC subjects. Moreover, the ratios of G/guanosine (Gr, uric acid (UA/Gr, and UA/Xant were significantly lower, whereas the ratio of Xant/G was significantly higher in FENNS-BL than in HC. Such changes remained in FENNS-4w with exception that the ratio of UA/Gr was normalized. All 3 groups had significant correlations between G and UA, and Xan and hypoxanthine (Hx. By contrast, correlations of UA with each of Xan and Hx, and the correlation of Xan with Gr were all quite significant for the HC but not for the FENNS. Finally, correlations of Gr with each of UA and G were significant for both HC and FENNS-BL but not for the FENNS-4w. CONCLUSIONS/SIGNIFICANCE: During purine catabolism, both conversions of Gr to G and of Xant to Xan are reversible. Decreased ratios of product to precursor suggested a shift favorable to Xant production from Xan, resulting in decreased UA levels in the FENNS. Specifically, the reduced UA/Gr ratio was nearly normalized after 4 weeks of antipsychotic treatment. In addition, there are tightly correlated precursor and product relationships within purine pathways; although some of these correlations persist across disease or medication status, others appear to be lost among FENNS

  10. Prevalence and profile of cognitive deficits in a cohort of first-episode antipsychotic-naïve schizophrenia patients

    DEFF Research Database (Denmark)

    Jensen, Maria Høj; Glenthøj, Birte Yding; Nielsen, Mette Ødegaard;

    medication, which can affect the results on specific domains such as processing speed. As part of the PECANS project (Pan European Collaboration on Antipsychotic Naïve Schizophrenia) the aim of the present study is to establish the prevalence and profile of cognitive deficits in a cohort of first......Background and Aims: Cognitive deficits are considered a core feature of schizophrenia with prevalence estimates ranging from ca. 75-85 %. These deficits are present in the early phase of the illness; however in most first-episode schizophrenia studies the patients are receiving antipsychotic......-episode antipsychotic-naïve schizophrenia patients, without the potential confounding effects associated with medication and chronicity. Methods: The overall design of the PECANS project is a 2-year longitudinal case-control study with assessment at baseline and follow-ups after 6 weeks, 6 months, 1 and 2 years. Sixty...

  11. Multiple episodes in children and adolescents with bipolar disorder: comorbidity, hospitalization, and treatment (data from a cohort of 8,129 patients of a national managed care database).

    Science.gov (United States)

    Castilla-Puentes, Ruby

    2008-01-01

    The purpose of this study was to delineate the prevalence, demographic characteristics, comorbidity, hospitalization, and medication use of a large cohort of patients with and without multiple episodes per year. We hypothesized that children and adolescents with multiple episodes per year would have a higher comorbidity and require more hospitalizations and pharmacological treatment than their counterparts without multiple episodes. Analysis was conducted on a cohort of 8,129 children and adolescents patients (bipolar disorders (BD), from the Integrated Healthcare Information Services (IHCIS) identified from June 30, 2000 to July 1, 2003. Demographics variables, type of hospitalization, and psychotropic medication used in the year of follow-up were compared between children and adolescents with multiple and those without multiple episodes per year. Included were 58 patients with multiple episodes (defined as: > or = 4 or more reports of inpatient treatment for any affective disorders per year) and 8,071 without multiple episodes. Children and adolescents with multiple episodes versus those without multiple episodes were differentiated as follows: more comorbid attention deficit disorder (ADD) (80.9% versus 29.4%) (chi2 = 70.61, df = 1, p children and adolescents with multiple episodes per year present a higher comorbidity and require more hospitalizations and pharmacological treatment than those without multiple episodes. The diagnosis and treatment of children and adolescents with BD will have to take into account the high comorbidity of ADD mainly in children and adolescents with multiple episodes. Future prospective studies will help to better characterize the impact of multiple episodes in the course of pediatric BD and facilitate appropriate treatment strategies.

  12. Safety of robotic general surgery in elderly patients.

    Science.gov (United States)

    Buchs, Nicolas C; Addeo, Pietro; Bianco, Francesco M; Ayloo, Subhashini; Elli, Enrique F; Giulianotti, Pier C

    2010-08-01

    As the life expectancy of people in Western countries continues to rise, so too does the number of elderly patients. In parallel, robotic surgery continues to gain increasing acceptance, allowing for more complex operations to be performed by minimally invasive approach and extending indications for surgery to this population. The aim of this study is to assess the safety of robotic general surgery in patients 70 years and older. From April 2007 to December 2009, patients 70 years and older, who underwent various robotic procedures at our institution, were stratified into three categories of surgical complexity (low, intermediate, and high). There were 73 patients, including 39 women (53.4%) and 34 men (46.6%). The median age was 75 years (range 70-88 years). There were 7, 24, and 42 patients included, respectively, in the low, intermediate, and high surgical complexity categories. Approximately 50% of patients underwent hepatic and pancreatic resections. There was no statistically significant difference between the three groups in terms of morbidity, mortality, readmission or transfusion. Mean overall operative time was 254 ± 133 min (range 15-560 min). Perioperative mortality and morbidity was 1.4% and 15.1%, respectively. Transfusion rate was 9.6%, and median length of stay was 6 days (range 0-30 days). Robotic surgery can be performed safely in the elderly population with low mortality, acceptable morbidity, and short hospital stay. Age should not be considered as a contraindication to robotic surgery even for advanced procedures.

  13. Impaired cue identification and intention retrieval underlie prospective memory deficits in patients with first-episode schizophrenia.

    Science.gov (United States)

    Liu, Dengtang; Ji, Chengfeng; Zhuo, Kaiming; Song, Zhenhua; Wang, Yingchan; Mei, Li; Zhu, Dianming; Xiang, Qiong; Chen, Tianyi; Yang, Zhilei; Zhu, Guang; Wang, Ya; Cheung, Eric Fc; Xiang, Yu-Tao; Fan, Xiaoduo; Chan, Raymond Ck; Xu, Yifeng; Jiang, Kaida

    2017-03-01

    Schizophrenia is associated with impairment in prospective memory, the ability to remember to carry out an intended action in the future. It has been established that cue identification (detection of the cue event signaling that an intended action should be performed) and intention retrieval (retrieval of an intention from long-term memory following the recognition of a prospective cue) are two important processes underlying prospective memory. The purpose of this study was to examine prospective memory deficit and underlying cognitive processes in patients with first-episode schizophrenia. This study examined cue identification and intention retrieval components of event-based prospective memory using a dual-task paradigm in 30 patients with first-episode schizophrenia and 30 healthy controls. All participants were also administered a set of tests assessing working memory and retrospective memory. Both cue identification and intention retrieval were impaired in patients with first-episode schizophrenia compared with healthy controls ( ps schizophrenia. Cue identification and intention retrieval could be potentially used as biomarkers for early detection and treatment prognosis of schizophrenia. In addition, addressing cue identification deficit through cognitive enhancement training may potentially improve negative symptoms as well.

  14. Moxifloxacin dosing in post-bariatric surgery patients

    NARCIS (Netherlands)

    Colin, Pieter; Eleveld, Douglas J.; Struys, Michel M. R. F.; T'Jollyn, Huybrecht; Van Bortel, Luc M.; Ruige, Johannes; De Waele, Jan; Van Bocxlaer, Jan; Boussery, Koen

    2014-01-01

    Introduction Given the ever increasing number of obese patients and obesity related bypass surgery, dosing recommendations in the post-bypass population are needed. Using a population pharmacokinetic (PK) analysis and PK-pharmacodynamic (PD) simulations, we investigated whether adequate moxifloxacin

  15. pulmonary indices in post—abdominal surgery patients

    African Journals Online (AJOL)

    post-training vital capacity and peak expiratory flow rate than the emergency abdominal surgery ... of alteration in pulmonary mechanism, the lung volumes and .... Table 2: Age and Resting Vital Signs of Patients Before Commencement of the ...

  16. Decreased glutathione levels and impaired antioxidant enzyme activities in drug-naive first-episode schizophrenic patients

    Science.gov (United States)

    2011-01-01

    Background The aim of this study was to determine glutathione levels and antioxidant enzyme activities in the drug-naive first-episode patients with schizophrenia in comparison with healthy control subjects. Methods It was a case-controlled study carried on twenty-three patients (20 men and 3 women, mean age = 29.3 ± 7.5 years) recruited in their first-episode of schizophrenia and 40 healthy control subjects (36 men and 9 women, mean age = 29.6 ± 6.2 years). In patients, the blood samples were obtained prior to the initiation of neuroleptic treatments. Glutathione levels: total glutathione (GSHt), reduced glutathione (GSHr) and oxidized glutathione (GSSG) and antioxidant enzyme activities: superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) were determined by spectrophotometry. Results GSHt and reduced GSHr were significantly lower in patients than in controls, whereas GSSG was significantly higher in patients. GPx activity was significantly higher in patients compared to control subjects. CAT activity was significantly lower in patients, whereas the SOD activity was comparable to that of controls. Conclusion This is a report of decreased plasma levels of GSHt and GSHr, and impaired antioxidant enzyme activities in drug-naive first-episode patients with schizophrenia. The GSH deficit seems to be implicated in psychosis, and may be an important indirect biomarker of oxidative stress in schizophrenia early in the course of illness. Finally, our results provide support for further studies of the possible role of antioxidants as neuroprotective therapeutic strategies for schizophrenia from early stages. PMID:21810251

  17. Vitamin D Deficiency and Depressive Symptomatology in Psychiatric Patients Hospitalized with a Current Depressive Episode: A Factor Analytic Study.

    Directory of Open Access Journals (Sweden)

    Roland von Känel

    Full Text Available Low vitamin D levels have been associated with depressive symptoms in population-based studies and non-clinical samples as well as with clinical depression. This study aimed to examine the association of vitamin D levels with the severity and dimensions of depressive symptoms in hospitalized patients with a current episode of depression taking into account confounding variables.We investigated 380 patients (mean age 47 ± 12 years, 70% women who were consecutively hospitalized with a main diagnosis of an ICD-10 depressive episode. All patients self-rated depressive symptom severity with the Hospital Anxiety and Depression Scale (HADS-D, the Beck Depression Inventory-II (BDI-II, and the Brief Symptom Inventory. A principal component analysis was performed with all 34 items of these questionnaires and serum levels of 25-hydroxyvitamin D3 (25-OH D were measured.Vitamin D deficiency ( 75 nmol/l were present in 55.5%, 31.8% and 12.6%, respectively, of patients. Patients with vitamin D deficiency scored higher on the HADS-D scale and on an anhedonia symptom factor than those with insufficient (p-values ≤ 0.023 or sufficient (p-values ≤ 0.008 vitamin D. Vitamin D deficient patients also scored higher on the BDI-II scale than those with sufficient vitamin D (p = 0.007; BDI-II cognitive/affective symptoms, but not somatic/affective symptoms, were higher in patients with vitamin D deficiency (p = 0.005 and insufficiency (p = 0.041 relative to those with sufficient vitamin D. Effect sizes suggested clinically relevant findings.Low vitamin D levels are frequent in hospitalized patients with a current episode of depression. Especially 25-OH D levels < 50 nmol/l were associated with cognitive/affective depressive symptoms, and anhedonia symptoms in particular.

  18. Vitamin D Deficiency and Depressive Symptomatology in Psychiatric Patients Hospitalized with a Current Depressive Episode: A Factor Analytic Study.

    Science.gov (United States)

    von Känel, Roland; Fardad, Nasser; Steurer, Nadine; Horak, Nicole; Hindermann, Esther; Fischer, Franz; Gessler, Katharina

    2015-01-01

    Low vitamin D levels have been associated with depressive symptoms in population-based studies and non-clinical samples as well as with clinical depression. This study aimed to examine the association of vitamin D levels with the severity and dimensions of depressive symptoms in hospitalized patients with a current episode of depression taking into account confounding variables. We investigated 380 patients (mean age 47 ± 12 years, 70% women) who were consecutively hospitalized with a main diagnosis of an ICD-10 depressive episode. All patients self-rated depressive symptom severity with the Hospital Anxiety and Depression Scale (HADS-D), the Beck Depression Inventory-II (BDI-II), and the Brief Symptom Inventory. A principal component analysis was performed with all 34 items of these questionnaires and serum levels of 25-hydroxyvitamin D3 (25-OH D) were measured. Vitamin D deficiency ( 75 nmol/l) were present in 55.5%, 31.8% and 12.6%, respectively, of patients. Patients with vitamin D deficiency scored higher on the HADS-D scale and on an anhedonia symptom factor than those with insufficient (p-values ≤ 0.023) or sufficient (p-values ≤ 0.008) vitamin D. Vitamin D deficient patients also scored higher on the BDI-II scale than those with sufficient vitamin D (p = 0.007); BDI-II cognitive/affective symptoms, but not somatic/affective symptoms, were higher in patients with vitamin D deficiency (p = 0.005) and insufficiency (p = 0.041) relative to those with sufficient vitamin D. Effect sizes suggested clinically relevant findings. Low vitamin D levels are frequent in hospitalized patients with a current episode of depression. Especially 25-OH D levels < 50 nmol/l were associated with cognitive/affective depressive symptoms, and anhedonia symptoms in particular.

  19. Multi-center MRI prediction models : Predicting sex and illness course in first episode psychosis patients

    NARCIS (Netherlands)

    Nieuwenhuis, Mireille; Schnack, Hugo G.; van Haren, Neeltje E.; Kahn, René S.; Lappin, Julia; Dazzan, Paola; Morgan, Craig; Reinders, Antje A.; Gutierrez-Tordesillas, Diana; Gutierrez-Tordesillas, Diana; Roiz-Santiañez, Roberto; Crespo-Facorro, Benedicto; Schaufelberger, Maristela S.; Rosa, Pedro G.; Zanetti, Marcus V.; Busatto, Geraldo F.; McGorry, Patrick D.; Velakoulis, Dennis; Pantelis, Christos; Wood, Stephen J.; Mourao-Miranda, Janaina; Mourao-Miranda, Janaina; Dazzan, Paola; Crespo-Facorro, Benedicto

    2017-01-01

    Structural Magnetic Resonance Imaging (MRI) studies have attempted to use brain measures obtained at the first-episode of psychosis to predict subsequent outcome, with inconsistent results. Thus, there is a real need to validate the utility of brain measures in the prediction of outcome using large

  20. Car accidents after ambulatory surgery in patients without an escort.

    Science.gov (United States)

    Chung, Frances; Assmann, Nicole

    2008-03-01

    Occasionally, ambulatory surgical patients present without an escort for their procedure. This creates a dilemma for caregivers, and allowing patients to drive may have an impact on their safety. The Canadian Medical Protective Association is a mutual defense organization for 95% of Canadian physicians. The national database is a unique and extensive repository of medico-legal data. We scanned this database for malpractice patients who were discharged after an ambulatory surgery procedure and allowed to drive home with a poor outcome. From this database, two malpractice cases of patients who were discharged without an escort after an ambulatory surgical procedure were reported. Both had a car accident and sustained serious injuries. Based on this we do not recommend discharge without an escort after general anesthesia, regional anesthesia, monitored anesthesia or sedation. Driving after ambulatory surgery cannot be considered safe and caregivers need to verify a safe ride home.

  1. Contact topical anesthesia for strabismus surgery in adult patients.

    Science.gov (United States)

    Vallés-Torres, J; García-Martín, E; Peña-Calvo, P; Sanjuan-Villarreal, A; Gil-Arribas, L M; Fernández-Tirado, F J

    2015-05-01

    To analyze the effectiveness and usefulness of contact topical anesthesia in strabismus surgery in adult patients. A prospective study was conducted on 20 patients undergoing strabismus surgery using contact topical anesthesia and sedation with remifentanil. The intensity of pain was recorded using a numeric pain rating scale at the time of anesthesia implementation, during the surgical procedure, 30 min afterwards, and during the first postoperative day. The incidence of oculocardiac reflex, postoperative nausea and vomiting, corneal ulcers, patient satisfaction (numerically from 0 to 10) and the degree of residual ocular deviation were also assessed. The operation was performed successfully in all patients. Average pain intensity was 1.40 ± 1.73 during anesthesia implementation, 4.20 ± 2.57 during the surgical procedure, 2.50 ± 2.54 30 min after surgery, and 3.55 ± 2.89 during the first postoperative day. Oculocardiac reflex was observed in 7 patients (35%), postoperative nausea and vomiting in 4 (20%), and corneal ulcer in 4 (20%). The patient satisfaction was 9.53 ± 2.51. More than two-thirds (70%) of patients had a residual ocular deviation less than 10 prism diopters. Contact topical anesthesia is a safe and effective alternative for strabismus surgery in adult patients. Contact topical anesthesia provides adequate pain control, lower incidence of postoperative nausea and vomiting and oculocardiac reflex, and optimal setting of ocular alignment. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Carotid artery stenting and cardiac surgery in symptomatic patients.

    Science.gov (United States)

    Van der Heyden, Jan; Van Neerven, Danihel; Sonker, Uday; Bal, Egbert T; Kelder, Johannes C; Plokker, Herbert W M; Suttorp, Maarten J

    2011-11-01

    The purpose of this study was to evaluate the feasibility and safety of the combined outcome of carotid artery stenting (CAS) and coronary artery bypass graft (CABG) surgery in neurologically symptomatic patients. The risk of perioperative stroke in patients undergoing CABG who report a prior history of transient ischemic attack or stroke has been associated with a 4-fold increased risk as compared to the risk for neurologically asymptomatic patients. It seems appropriate to offer prophylactic carotid endarterectomy to neurologically symptomatic patients who have significant carotid artery disease and are scheduled for CABG. The CAS-CABG outcome for symptomatic patients remains underreported, notwithstanding randomized data supporting CAS for high-risk patients. In a prospective, single-center study, the periprocedural and long-term outcomes of 57 consecutive patients who underwent CAS before cardiac surgery were analyzed. The procedural success rate of CAS was 98%. The combined death, stroke, and myocardial infarction rate was 12.3%. The death and major stroke rate from time of CAS to 30 days after cardiac surgery was 3.5%. The myocardial infarction rate from time of CAS to 30 days after cardiac surgery was 1.5%. This is the first single-center study reporting the combined outcome of CAS-CABG in symptomatic patients. The periprocedural complication rate and long-term results of the CAS-CABG strategy in this high-risk population support the reliability of this approach. In such a high-risk population, this strategy might offer a valuable alternative to the combined surgical approach; however, a large randomized trial is clearly warranted. Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  3. Plasma brain-derived neurotrophic factor levels, learning capacity and cognition in patients with first episode psychosis

    Directory of Open Access Journals (Sweden)

    de Azua Sonia Ruiz

    2013-01-01

    Full Text Available Abstract Background Cognitive impairments are seen in first psychotic episode (FEP patients. The neurobiological underpinnings that might underlie these changes remain unknown. The aim of this study is to investigate whether Brain Derived Neurotrophic Factor (BDNF levels are associated with cognitive impairment in FEP patients compared with healthy controls. Methods 45 FEP patients and 45 healthy controls matched by age, gender and educational level were selected from the Basque Country area of Spain. Plasma BDNF levels were assessed in healthy controls and in patients. A battery of cognitive tests was applied to both groups, with the patients being assessed at 6 months after the acute episode and only in those with a clinical response to treatment. Results Plasma BDNF levels were altered in patients compared with the control group. In FEP patients, we observed a positive association between BDNF levels at six months and five cognitive domains (learning ability, immediate and delayed memory, abstract thinking and processing speed which persisted after controlling for medications prescribed, drug use, intelligence quotient (IQ and negative symptoms. In the healthy control group, BDNF levels were not associated with cognitive test scores. Conclusion Our results suggest that BDNF is associated with the cognitive impairment seen after a FEP. Further investigations of the role of this neurotrophin in the symptoms associated with psychosis onset are warranted.

  4. Oral surgery in patients undergoing chemoradiation therapy.

    Science.gov (United States)

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

    2014-05-01

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

  5. Orthognathic Surgery in Patients With Large Condylar Destructions.

    Science.gov (United States)

    Sant'Ana, Eduardo; Dias-Ribeiro, Eduardo; de Lima, Valthierre Nunes; Correa, Ana Paula Simões; Sonoda, Celso Koogi; Nogueira, Renato Luiz Maia

    2016-03-01

    Condylar resorption is understood as changes in shape and volume of the condylar bone, due to local, systemic, and iatrogenic factors. The occurrence of condylar resorption after orthognathic surgery can occur when the condylar repositioning in mandibular fossa is performed improperly. In addition, systemic diseases such as osteoarthritis and rheumatoid arthritis seem to influence this process. The aim of this study was to report 3 cases of patients with severe condylar alterations, submitted to orthognathic surgery for treatment of dentofacial deformities. Considerations regarding the diagnosis, surgical planning (counterclockwise rotation), surgical techniques (bilateral sagittal split osteotomy, bimaxillary osteotomies, rigid fixation, maxillomandibular fixation period), and results (short terms) are discussed.

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

    Science.gov (United States)

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

    2014-01-01

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

  7. Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

    Science.gov (United States)

    de Zwaan, Martina; Georgiadou, Ekaterini; Stroh, Christine E.; Teufel, Martin; Köhler, Hinrich; Tengler, Maxi; Müller, Astrid

    2014-01-01

    Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). Results: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole. PMID:25477839

  8. Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups

    Directory of Open Access Journals (Sweden)

    Martina eDe Zwaan

    2014-11-01

    Full Text Available Background: Massive weight loss (MWL following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image and physical functioning.Methods: In this cross-sectional study 3 groups were compared: 1 patients prior to bariatric surgery (n=79, 2 patients after bariatric surgery who had not undergone BCS (n=252, and 3 patients after bariatric surgery who underwent subsequent body contouring surgery (BCS (n=62. All participants completed self-report questionnaires assessing body image (MBSRQ, quality of life (IWQOL-Lite, symptoms of depression (PHQ-9 and anxiety (GAD-7.Results: Overall, 62 patients (19.2% reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%, thigh lifts (24.2%, and breast lifts (16.1%. Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients; however, there were fewer differences between patients with and without BCS. Patients after BCS reported better appearance evaluation, body area satisfaction, and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better appearance evaluation and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  11. Risk factors associated with postoperative seizures in patients undergoing cardiac surgery who received tranexamic acid: A case-control study

    Directory of Open Access Journals (Sweden)

    Felix R Montes

    2012-01-01

    Full Text Available Antifibrinolytic agents are used during cardiac surgery to minimize bleeding and reduce exposure to blood products. Several reports suggest that tranexamic acid (TA can induce seizure activity in the postoperative period. To examine factors associated with postoperative seizures in patients undergoing cardiac surgery who received TA. University-affiliated hospital. Case-control study. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB between January 2008 and December 2009 were identified. During this time, all patients undergoing heart surgery with CPB received TA. Cases were defined as patients who developed seizures that required initiation of anticonvulsive therapy within 48 h of surgery. Exclusion criteria included subjects with preexisting epilepsy and patients in whom the convulsive episode was secondary to a new ischemic lesion on brain imaging. Controls who did not develop seizures were randomly selected from the initial cohort. From an initial cohort of 903 patients, we identified 32 patients with postoperative seizures. Four patients were excluded. Twenty-eight cases and 112 controls were analyzed. Cases were more likely to have a history of renal impairment and higher preoperative creatinine values compared with controls (1.39 ± 1.1 vs. 0.98 ± 0.02 mg/dL, P = 0.02. Significant differences in the intensive care unit, postoperative and total lengths of stay were observed. An association between high preoperative creatinine value and postoperative seizure was identified. TA may be associated with the development of postoperative seizures in patients with renal dysfunction. Doses of TA should be reduced or even avoided in this population.

  12. Video-assisted thoracoscopic surgery for patients with pulmonary coccidioidomycosis.

    Science.gov (United States)

    Ashfaq, Awais; Vikram, Holenarasipur R; Blair, Janis E; Jaroszewski, Dawn E

    2014-10-01

    The study objective was to evaluate the use of video-assisted thoracoscopic surgery for removal of pulmonary sequelae of the fungal infection coccidioidomycosis. Retrospective chart review of all patients with pulmonary coccidioidomycosis treated surgically at our tertiary care center between January 1, 2009, and August 31, 2012. Of 2166 patients treated for pulmonary coccidioidomycosis, 58 (2.7%) (median age, 52 years [range, 18-84 years]) required surgical treatment. Surgical resection was performed for diagnosis (n=28 [48%]); 17 with positive positron emission tomography findings); persistent or progressive symptoms despite antifungal therapy (n=23 [40%]); or complications (n=7 [12%] of cavity rupture/infection). Of 33 patients (57%) who had serology performed, 23 (70%) had positive results. Video-assisted thoracoscopic surgery was used for most (95%; n=55) procedures, including 38 (67%) wedge resections, 14 (24%) segmentectomies, and 6 (11%) lobectomies; 4 patients also required additional decortication. Major (8%), including 1 death, and minor (12%) complications occurred in 12 patients postoperatively. Median hospitalization was 3 days (range, 1-8 days). Postoperative antifungal therapy was administered to 50% of patients for a median duration of 2 months. No patient had recurrent coccidioidomycosis at a median follow-up of 19 months. Although rarely necessary for pulmonary coccidioidomycosis, surgical intervention may be indicated. Specific indications include refractory symptomatic disease and complications of the infection, such as cavity rupture. Excisional biopsies also may be required for diagnostic confirmation of indeterminate pulmonary nodules. With video-assisted thoracoscopic surgery, diagnostic and therapeutic intervention can be undertaken with a low risk of complications and shorter length of hospital stay. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  13. Diffusion and Perfusion Characteristics of MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Stroke-Like Episode) in Thirteen Patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Hye; Jeon, Tae Yeon; Eo, Hong; Yoo, So Young [Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul (Korea, Republic of); Lim, Myung Kwan; Rha, Jung Ho; Shu, Chang Hae [Inha University Hospital, Incheon (Korea, Republic of)

    2011-02-15

    We analyzed the diffusion and perfusion characteristics of acute MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episode) lesions in a large series to investigate the controversial changes of the apparent diffusion coefficient (ADC) that were reported in prior studies. We analyzed 44 newly appearing lesions during 28 stroke-like episodes in 13 patients with MELAS. We performed a visual assessment of the MR images including the ADC and perfusion maps, comparison of the ADC between the normal and abnormal areas, comparison of % ADC between the 44 MELAS lesions and the 30 acute ischemic infarcts. In addition, the patterns of evolution on follow-up MR images were analyzed. Decreased, increased, and normal ADCs were noted in 16 (36%), 16 (36%), and 12 (27%) lesions, respectively. The mean % ADC was 102 {+-} 40.9% in the MELAS and 64 {+-} 17.8% in the acute vascular infarcts (p < 0.001), while perfusion imaging demonstrated hyper-perfusion in six acute MELAS lesions. On follow-up images, resolution, progression, and tissue loss were noted in 10, 4, and 17 lesions, respectively. The cytotoxic edema gradually evolves following an acute stroke-like episode in patients with MELAS, and this may overlap with hyper-perfusion and vasogenic edema. The edematous swelling may be reversible or it may evolve to encephalomalacia, suggesting irreversible damage

  14. Patient perceptions on physician reimbursement in plastic surgery.

    Science.gov (United States)

    Garcia, Ryan M; Cassinelli, Ezequiel H; Hultman, C Scott; Erdmann, Detlev

    2014-07-01

    Public perception on physician reimbursement may be that considerable payments are received for procedures: a direct contrast to the actual decline. We aim to investigate patient perceptions toward plastic surgeon reimbursements from insurance companies. A survey of 4 common, single-staged procedures was administered to 140 patients. Patients were asked for their opinion on current insurance company reimbursement fees and what they believed the reimbursement fee should be. Eighty-four patients completed the survey. Patients estimated physician's reimbursements at 472% to 1061% more for breast reduction, 347% to 770% for abdominal hernia reconstruction, 372% to 787% for panniculectomy, and 290% to 628% for mandibular fracture repair. Despite these perceived higher-than-actual-fee payments, 87% of patients thought reimbursements should still be higher. Patients surveyed overestimated plastic surgery procedure fees by 290% to 1061%. Patients should be informed and educated regarding current fee schedules to plastic surgeons to correct current misconceptions.

  15. Does early ED CT scanning of afebrile patients with first episodes of acute pancreatitis ever change management?

    Science.gov (United States)

    Dachs, Robert J; Sullivan, Luke; Shanmugathasan, Preshanthini

    2015-06-01

    Rising utilization of computed tomography (CT) imaging early in the course of acute pancreatitis (AP) has been recently reported. However, radiographic demonstration of the degree of necrosis or the presence of complications is not fully apparent within the first days of an acute attack. The objective of this study was to examine if CT scanning early in the course of disease (<48 h of symptoms) in afebrile patients with an emergency department (ED) diagnosis of first episode of AP revealed any unanticipated pathology that altered clinical management. A retrospective chart review of all adult patients with a first episode of AP without fever admitted to the medical ward through the ED of our community hospital from January 1, 2011 to May 31, 2012 was performed. In cases in which CT scans were performed, the record was reviewed to determine if any unexpected findings were uncovered or if patient care was altered by the CT report. Two hundred forty-eight patients were admitted with an ED diagnosis of AP; 26.2 % (n = 65) met inclusion criteria; 70.8 % (n = 46) received a CT scan within 48 h of symptom onset. No patient that underwent CT scanning had an unexpected finding (95 % CI, 0.923-1.0). Our results demonstrate that afebrile patients with first episodes of AP do not benefit from early abdominal CT imaging. These results support the ACR Appropriateness Criteria recommendation that CT is not indicated in the first 48 h after symptom onset in unequivocal cases of AP.

  16. Ambulatory orthopaedic surgery patients' emotions when using different patient education methods.

    Science.gov (United States)

    Heikkinen, Katja; Salanterä, Sanna; Leppänen, Tiina; Vahlberg, Tero; Leino-Kilpi, Helena

    2012-07-01

    A randomised controlled trial was used to evaluate elective ambulatory orthopaedic surgery patients' emotions during internet-based patient education or face-to-face education with a nurse. The internet-based patient education was designed for this study and patients used websites individually based on their needs. Patients in the control group participated individually in face-to-face patient education with a nurse in the ambulatory surgery unit. The theoretical basis for both types of education was the same. Ambulatory orthopaedic surgery patients scored their emotions rather low at intervals throughout the whole surgical process, though their scores also changed during the surgical process. Emotion scores did not decrease after patient education. No differences in patients' emotions were found to result from either of the two different patient education methods.

  17. Differing patterns of brain structural abnormalities between black and white patients with their first episode of psychosis.

    LENUS (Irish Health Repository)

    Morgan, K D

    2010-07-01

    African-Caribbean and black African people living in the UK are reported to have a higher incidence of diagnosed psychosis compared with white British people. It has been argued that this may be a consequence of misdiagnosis. If this is true they might be less likely to show the patterns of structural brain abnormalities reported in white British patients. The aim of this study therefore was to investigate whether there are differences in the prevalence of structural brain abnormalities in white and black first-episode psychosis patients.

  18. Analysis of macular and nerve fiber layer thickness in multiple sclerosis patients according to severity level and optic neuritis episodes.

    Science.gov (United States)

    Soler García, A; Padilla Parrado, F; Figueroa-Ortiz, L C; González Gómez, A; García-Ben, A; García-Ben, E; García-Campos, J M

    2016-01-01

    Quantitative assessment of macular and nerve fibre layer thickness in multiple sclerosis patients with regard to expanded disability status scale (EDSS) and presence or absence of previous optic neuritis episodes. We recruited 62 patients with multiple sclerosis (53 relapsing-remitting and 9 secondary progressive) and 12 disease-free controls. All patients underwent an ophthalmological examination, including quantitative analysis of the nerve fibre layer and macular thickness using optical coherence tomography. Patients were classified according to EDSS as A (lower than 1.5), B (between 1.5 and 3.5), and C (above 3.5). Mean nerve fibre layer thickness in control, A, B, and C groups was 103.35±12.62, 99.04±14.35, 93.59±15.41, and 87.36±18.75μm respectively, with statistically significant differences (P<.05). In patients with no history of optic neuritis, history of episodes in the last 3 to 6 months, or history longer than 6 months, mean nerve fibre layer thickness was 99.25±13.71, 93.92±13.30 and 80.07±15.91μm respectively; differences were significant (P<.05). Mean macular thickness in control, A, B, and C groups was 220.01±12.07, 217.78±20.02, 217.68±20.77, and 219.04±24.26μm respectively. Differences were not statistically significant. The mean retinal nerve fibre layer thickness in multiple sclerosis patients is related to the EDSS level. Patients with previous optic neuritis episodes have a thinner retinal nerve fibre layer than patients with no history of these episodes. Mean macular thickness is not correlated to EDSS level. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Metabolic syndrome and aerobic fitness in patients with first-episode schizophrenia, including a 1-year follow-up

    DEFF Research Database (Denmark)

    Nyboe, L.; Vestergaard, C. H.; Moeller, M. K.

    2015-01-01

    OBJECTIVE: To compare the prevalence of metabolic syndrome (MetS) and metabolic abnormalities in patients with first-episode schizophrenia (FES) with sex- and age-matched healthy controls; to investigate changes in MetS during 1year of treatment; and to investigate predictors of MetS. METHODS......: Patients with FES (N=99) and healthy controls (N=50) were included in the study. MetS was defined according to IDF based on waist circumference (WC), blood pressure (BP), triglycerides (TG), high-density lipoprotein (HDL), and fasting-glucose. Data on physical activity, aerobic fitness, smoking...

  20. Postoperative Complications after Thoracic Surgery in the Morbidly Obese Patient

    Directory of Open Access Journals (Sweden)

    Lebron Cooper

    2011-01-01

    Full Text Available Little has been recently published about specific postoperative complications following thoracic surgery in the morbidly obese patient. Greater numbers of patients who are obese, morbidly obese, or supermorbidly obese are undergoing surgical procedures. Postoperative complications after thoracic surgery in these patients that can lead to increased morbidity and mortality, prolonged hospital stay, and increased cost of care are considered. Complications include difficulties with mask ventilation and securing the airway, obstructive sleep apnea with risk of oversedation, pulmonary complications related to reduced total lung capacity, reduced functional residual capacity, and reduced vital capacity, risks of aspiration pneumonitis and ventilator-associated pneumonia, cardiomyopathies, and atrial fibrillation, inadequate diabetes management, positioning injuries, increased risk of venous thrombosis, and pulmonary embolism. The type of thoracic surgical procedure may also pose other problems to consider during the postoperative period. Obese patients undergoing thoracic surgery pose a challenge to those caring for them. Those working with these patients must understand how to recognize, prevent, and manage these postoperative complications.

  1. Demoralization, Patient Activation, and the Outcome of Spine Surgery

    Directory of Open Access Journals (Sweden)

    Andrew R Block

    2016-01-01

    Full Text Available It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial “maximizing” factors—characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM, an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients’ strengths as well as their vulnerabilities.

  2. Ascites in a patient with episodic angio-oedema and eosinophilia: thinking outside the box.

    Science.gov (United States)

    Rigopoulou, Eirini I; Ioannou, Maria; Papadamou, Georgia; Dalekos, Georgios N

    2017-04-21

    Episodic angio-oedema with eosinophilia (EAE) or Gleich's syndrome is a rare condition characterised by recurrent episodes of oedema and eosinophilia, accompanied by urticaria, fever and weight gain. The presence of ascites has not been reported so far. We report a 21-year-old Caucasian woman who presented with marked ocular oedema and ascites. Laboratory evaluation revealed marked eosinophilia. During the last 3 months, three episodes of facial and neck oedema were reported, which resolved spontaneously over a period of 3-5 days. The diagnosis of EAE was established after exclusion of secondary causes (infections, allergic reactions, collagen diseases, neoplasms) and clonal disorders associated with marked eosinophilia. Low-dose steroids resulted in eosinophil decrease and complete resolution of symptoms, including ascites. This case highlights that ascites can be a very rare manifestation of EAE particularly if other more frequent causes of ascites have been excluded and the clinical and laboratory findings are supportive of EAE. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Ventilator-associated pneumonia in patients undergoing major heart surgery: an incidence study in Europe.

    Science.gov (United States)

    Hortal, Javier; Muñoz, Patricia; Cuerpo, Gregorio; Litvan, Hector; Rosseel, Peter M; Bouza, Emilio

    2009-01-01

    Patients undergoing major heart surgery (MHS) represent a special subpopulation at risk for nosocomial infections. Postoperative infection is the main non-cardiac complication after MHS and has been clearly related to increased morbidity, use of hospital resources and mortality. Our aim was to determine the incidence, aetiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients who have undergone MHS in Europe. Our study was a prospective study of patients undergoing MHS in Europe who developed suspicion of VAP. During a one-month period, participating units submitted a protocol of all patients admitted to their units who had undergone MHS. Overall, 25 hospitals in eight different European countries participated in the study. The number of patients intervened for MHS was 986. Fifteen patients were excluded because of protocol violations. One or more nosocomial infections were detected in 43 (4.4%) patients. VAP was the most frequent nosocomial infection (2.1%; 13.9 episodes per 1000 days of mechanical ventilation). The microorganisms responsible for VAP in this study were: Enterobacteriaceae (45%), Pseudomonas aeruginosa (20%), methicillin-resistant Staphylococcus aureus (10%) and a range of other microorganisms. We identified the following significant independent risk factors for VAP: ascending aorta surgery (odds ratio (OR) = 6.22; 95% confidence interval (CI) = 1.69 to 22.89), number of blood units transfused (OR = 1.08 per unit transfused; 95% CI = 1.04 to 1.13) and need for re-intervention (OR = 6.65; 95% CI = 2.10 to 21.01). The median length of stay in the intensive care unit was significantly longer (P < 0.001) in patients with VAP than in patients without VAP (23 days versus 2 days). Death was significantly more frequent (P < 0.001) in patients with VAP (35% versus 2.3%). Patients undergoing aortic surgery and those with complicated post-intervention courses, requiring multiple transfusions or re-intervention, constitute a high

  4. Effects of antipsychotics on insight in schizophrenia: results from independent samples of first-episode and acutely relapsed patients.

    Science.gov (United States)

    Misiak, Błażej; Frydecka, Dorota; Beszłej, Jan A; Moustafa, Ahmed A; Tybura, Piotr; Kucharska-Mazur, Jolanta; Samochowiec, Agnieszka; Bieńkowski, Przemysław; Samochowiec, Jerzy

    2016-07-01

    We aimed to investigate whether antipsychotics differentially impact insight and whether these effects appear because of improvement in psychopathological manifestation in 132 first-episode schizophrenia patients and 201 acutely relapsed schizophrenic patients, who were followed up for 12 weeks. Olanzapine and risperidone were administered to first-episode schizophrenia patients, whereas acutely relapsed schizophrenic patients were treated with olanzapine, perazine and ziprasidone. The Positive And Negative Syndrome Scale (PANSS) was used to assess psychopathology. Insight was assessed using the G12 item of PANSS. Unadjusted mixed-model regression analysis indicated a significant improvement in the PANSS G12 item score in both groups. There were no significant differences between distinct treatment subgroups of patients in terms of improvement in the PANSS G12 item score. After adjustment for the trajectories of changes in symptom dimensions, a decrease in the PANSS G12 item score was because of an improvement in positive, negative and excitement symptoms. A decrease in the PANSS G12 item score was also related to an increase in the severity of depressive symptomatology. Our results indicate that antipsychotics exert similar effects on insight in acute psychosis. These effects are likely because of an improvement in psychopathological manifestation. The improvement in insight might be related to the development of depressive symptoms.

  5. Low Cerebral Oxygen Consumption and Blood Flow in Patients With Cirrhosis and an Acute Episode of Hepatic Encephalopathy

    DEFF Research Database (Denmark)

    Iversen, Peter; Bak, Lasse Kristoffer; Waagepetersen, Helle Sønderby

    2009-01-01

    BACKGROUND & AIMS: It is unclear whether patients with hepatic encephalopathy (HE) have disturbed brain oxygen metabolism and blood flow. METHODS: We measured cerebral oxygen metabolism rate (CMRO(2)) by using (15)O-oxygen positron emission tomography (PET), and cerebral blood flow (CBF) by using....../min in patients with HE, 0.47 +/- 0.02 in patients without HE, and 0.49 +/- 0.03 in healthy subjects. CMRO(2) and CBF were correlated, and both variables correlated negatively with arterial ammonia concentration. Analysis of regional values, using individual magnetic resonance co-registrations, showed...... that the reductions in CMRO(2) and CBF in patients with HE were essentially generalized throughout the brain. CONCLUSIONS: The observations imply that reduced cerebral oxygen consumption and blood flow in cirrhotic patients with an acute episode of overt HE are associated with HE and not cirrhosis as such...

  6. Intracranial hemorrhage recurrence on vitamin K antagonist: severity of the first episode and HASBLED score fail to identify high-risk patients from the CHIRONE study.

    Science.gov (United States)

    Poli, Daniela; Antonucci, Emilia; Dentali, Francesco; Testa, Sophie; Palareti, Gualtiero

    2017-01-01

    The most feared complication of vitamin K antagonists (VKAs) treatment is intracranial hemorrhage (ICH). The previously published CHIRONE Study fails to identify risk factors associated with ICH recurrence after VKAs resumption. The aim of this secondary analysis of the study is to evaluate if patients who need surgery or with severe neurological sequelae after the first episode show a higher risk of ICH recurrence. The HASBLED score was used to stratify bleeding risk and to evaluate the distribution of recurrence in relation to each class of risk. The study included 267 patients from 27 Italian centers. The treatment of the index ICH, surgical or medical was recorded; modified Rankin Scale score of 3 or more was used to define patients with severe neurological impairment; HASBLED score of 3 or more was used to identify high bleeding risk patients. During follow-up, 20 patients (7.5%) had ICH recurrence (rate of 2.56 × 100 patient-years). No difference in the type of treatment [hazard ratio = 1.5; 95% confidence interval (CI): 0.49-4.74] and neurological impairment with modified Rankin Scale 3 or more (hazard ratio = 0.9; 95% CI: 0.31-2.83) were found in relation to ICH recurrence. The mean HASBLED score was similar between the two groups (P = 0.54). In conclusion, the results of our study suggest that neither the severity of the index ICH at presentation nor the HASBLED clinical prediction rule should be used to assess the risk of recurrence in patients who need VKAs resumption after a previous ICH.

  7. Relationship between nocturnal hypoxaemia, tachycardia and myocardial ischaemia after major abdominal surgery

    DEFF Research Database (Denmark)

    Gögenur, I; Rosenberg-Adamsen, S; Lie, C;

    2004-01-01

    BACKGROUND: Episodic hypoxaemia, cardiac arrhythmias, and myocardial ischaemia may be related after major abdominal surgery. METHODS: We studied 52 patients on the second and third nights after major abdominal operations, using continuous pulse oximetry and Holter ECG. We recorded the amount...... of tachycardia, and 265 (individual range 1-73) episodes of ST segment deviation. Of the 52 patients, 50 had episodes of hypoxaemia and tachycardia, and 19 patients had one or more episodes of ST segment deviation. For 38% of the episodes of ST deviation, there was an episode of hypoxaemia at the same time...

  8. FUNCTIONAL ASSESSMENT OF OLDER OBESE PATIENTS CANDIDATES FOR BARIATRIC SURGERY

    Directory of Open Access Journals (Sweden)

    Denis PAJECKI

    2014-03-01

    Full Text Available Context Obesity in the elderly is associated with exacerbation of functional decline (dependency, that occurs with aging, because of decreased muscle mass and strength, and increased joint dysfunction. Consequently, there is progressive loss of independence, autonomy, chronic pain and impaired quality of life. The weight loss can bring benefits in all these aspects, especially when accompanied by exercises. Elderly patients with morbid obesity may be submitted to surgical treatment, taking into account that the massive weight loss, eventually caused by bariatric surgery, may exacerbate the loss of muscle mass and nutritional complications that may bring harm to the overall health and quality of life of these patients. The functional assessment of elderly patients, candidates for bariatric surgery and the extent to which surgery can bring benefits to the patients, in the field of functionality, has still to be determined. Objective To describe profile functionality in obese elderly referred to a bariatric surgery program. Methods Patients with age ≥60 and BMI ≥35 underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, and the “Timedupandgo” test to evaluate mobility, whose cut-off point was ≤10 seconds. Statistical analysis was performed in order to see if there is a positive correlation of dependency with BMI and age (over or under 65 years. Results Forty subjects have completed evaluation. The mean age was 64.1 years (60-72 and 75% were women. They had an average weight of 121.1 kg (72.7-204 and a mean BMI of 47.2 kg/m2 (35.8-68.9. 16 patients (40% have shown dependency for activities of daily living, 19 (47,5% for instrumental activities of daily living and 20 patients (50% had a “Timedupandgo” test over 10 seconds. Statistical analysis (t-Student, Mann-Whitney, Binary Logistic Regression has shown

  9. Central autonomic nervous system response to autonomic challenges is altered in patients with a previous episode of Takotsubo cardiomyopathy.

    Science.gov (United States)

    Pereira, Vitor H; Marques, Paulo; Magalhães, Ricardo; Português, João; Calvo, Lucy; Cerqueira, João J; Sousa, Nuno

    2016-04-01

    Takotsubo cardiomyopathy is an intriguing disease characterized by acute transient left ventricular dysfunction usually triggered by an episode of severe stress. The excessive levels of catecholamines and the overactivation of the sympathetic system are believed to be the main pathophysiologic mechanisms of Takotsubo cardiomyopathy, but it is unclear whether there is a structural or functional signature of the disease. In this sense, our aim was to characterize the central autonomic system response to autonomic challenges in patients with a previous episode of Takotsubo cardiomyopathy when compared with a control group of healthy volunteers. Functional magnetic resonance imaging (fMRI) was performed in four patients with a previous episode of Takotsubo cardiomyopathy (average age of 67 ± 12 years) and in eight healthy volunteers (average age of 66 ± 5 years) while being submitted to different autonomic challenges (cold exposure and Valsalva manoeuvre). The fMRI analysis revealed a significant variation of the blood oxygen level dependent signal triggered by the Valsalva manoeuvre in specific areas of the brain involved in the cortical control of the autonomic system and significant differences in the pattern of activation of the insular cortex, amygdala and the right hippocampus between patients with Takotsubo cardiomyopathy and controls, even though these regions did not present significant volumetric changes. The central autonomic response to autonomic challenges is altered in patients with Takotsubo cardiomyopathy, thus suggesting a dysregulation of the central autonomic nervous system network. Subsequent studies are needed to unveil whether these alterations are causal or predisposing factors to Takotsubo cardiomyopathy. © The European Society of Cardiology 2015.

  10. Reversal of cerebral glucose hypometabolism on positron emission tomography with electroconvulsive therapy in an elderly patient with a psychotic episode.

    Science.gov (United States)

    Hassamal, Sameer; Jolles, Paul; Pandurangi, Ananda

    2016-11-01

    AB, a 74-year-old Caucasian woman, was admitted for acute onset of psychosis, anxiety, and cognitive impairment. Pharmacotherapy was unsuccessful and the patient was referred for electroconvulsive therapy (ECT). Pre-ECT, (18) F-fluorodeoxyglucose-positron emission tomography (PET)/computed tomography showed extensive frontal, parietal, and temporal cortical hypometabolism suggestive of a neurodegenerative disease. After eight ECT sessions, the psychotic and anxiety symptoms as well as the cognitive impairment resolved. The rapid improvement in symptoms was more suggestive of a psychotic episode rather than dementia. Two days after the ECT course, (18) F-fluorodeoxyglucose-PET/computed tomography showed improvements in cerebral cortical hypometabolism, especially in the left parietal cortex, left temporal/occipital cortex. and bifrontal regions. At a follow-up visit 2 months after the ECT course, the psychotic episode was still in remission, and (18) F-fluorodeoxyglucose-PET/computed tomography continued to show improved cerebral cortical hypometabolism in these areas. This case illustrated the effect of ECT in reversing cerebral glucose hypometabolism on PET. The improvement in cerebral glucose hypometabolism may represent the neurophysiological mechanism of ECT in the treatment of a psychotic episode. Improved cerebral glucose hypometabolism was present 2 months post-ECT, which suggests that ECT caused sustained functional neural changes. © 2016 The Authors. Psychogeriatrics © 2016 Japanese Psychogeriatric Society.

  11. Suicidality and symptoms of anxiety, irritability, and agitation in patients experiencing manic episodes with depressive symptoms: a naturalistic study

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    Eberhard J

    2016-08-01

    Full Text Available Jonas Eberhard,1 Emmanuelle Weiller2 1Department of Clinical Sciences, Lund University, Lund, Sweden; 2H. Lundbeck A/S, Copenhagen, Denmark Purpose: Patients with a bipolar I disorder (BD-I manic episode meeting the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5, criteria for “with mixed features” have a high incidence of suicide attempts and of anxiety, irritability, and agitation (AIA symptoms. The aim of this analysis was to explore the relationship between suicidality and AIA symptoms in patients with BD-I experiencing mania with depressive symptoms, using data from a previous naturalistic study.Patients and methods: Psychiatrists completed an online questionnaire about their adult patients who had a current BD-I manic episode. Questions covered the DSM-5 “with mixed features” specifier, the severity of AIA symptoms, the frequency and controllability of suicidal ideation, and the number of suicide attempts.Results: Of 1,035 patients with BD-I mania who were included in the analyses, 348 (33.6% met the criteria for the DSM-5 “with mixed features” specifier (three or more depressive symptoms. These patients were further stratified according to the severity of their AIA symptoms: “mild AIA” (zero or one AIA symptom above a severity threshold; 105 patients or “severe AIA” (all three AIA symptoms above a severity threshold; 167 patients. A greater incidence of suicidal ideation was observed in the severe AIA group (71.9% than in the mild AIA group (47.6%. Twice as many patients had easily controlled suicidal ideation than difficult-to-control suicidal ideation in both subgroups. The mean number of suicide attempts was higher in the severe AIA group than in the mild AIA group, during the current episode (0.84 vs 0.34 attempts, respectively; P<0.05 and over the patient’s lifetime (1.56 vs 1.04 attempts, respectively.Conclusion: The high risk of suicide among BD-I mania patients with depressive

  12. Increasing Rates of Imaging in Failed Back Surgery Syndrome Patients: Implications for Spinal Cord Stimulation.

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    Farber, S Harrison; Han, Jing L; Petraglia Iii, Frank W; Gramer, Robert; Yang, Siyun; Pagadala, Promila; Parente, Beth; Xie, Jichun; Petrella, Jeffrey R; Lad, Shivanand P

    2017-09-01

    Failed back surgery syndrome (FBSS) has a high incidence following spinal surgery, is notoriously refractory to treatment, and results in high health care utilization. Spinal cord stimulation (SCS) is a well-accepted modality for pain relief in this population; however, until recently magnetic resonance imaging (MRI) was prohibited due to risk of heat conduction through the device. We examined trends in imaging use over the past decade in patients with FBSS to determine its impact on health care utilization and implications for patients receiving SCS. Retrospective. Inpatient and outpatient sample. We identified patients from 2000 to 2012 using the Truven MarketScan database. Annual imaging rates (episodes per 1000 patient months) were determined for MRI, computed tomography (CT) scan, x-ray, and ultrasound. A multivariate Poisson regression model was used to determine imaging trends over time, and to compare imaging in SCS and non-SCS populations. A total of 311,730 patients with FBSS were identified, of which 5.17% underwent SCS implantation (n = 16,118). The median (IQR) age was 58.0 (49.0 - 67.0) years. Significant increases in imaging rate ratios were found in all years for each of the modalities. Increases were seen in the use of CT scans (rate ratio [RR] = 3.03; 95% confidence interval [CI]: 2.79 - 3.29; P imaging procedures overall (P pain symptomatology. Miscoding cannot be precluded, as this sample is taken from a large nationwide database. We found a significant trend for increased use of advanced imaging modalities between the years 2000 and 2012 in FBSS patients. Those patients treated with SCS were 50% less likely to receive an MRI (as expected, given prior incompatibility of neuromodulation devices), yet 32% and 27% more likely to receive CT and x-ray, respectively. Despite the decrease in the use of MRI in those patients treated with SCS, their overall imaging rate increased by 19% compared to patients without SCS. This underscores the utility of MR

  13. Improved quality of life in hyperthyroidism patients after surgery.

    Science.gov (United States)

    Bukvic, Branka; Zivaljevic, Vladan; Sipetic, Sandra; Diklic, Aleksandar; Tausanovic, Katarina; Stojanovic, Dragos; Stevanovic, Dejan; Paunovic, Ivan

    2015-02-01

    The most common causes of hyperthyroidism are Graves disease (GD) and toxic nodular goiter (TNG). GD and TNG might influence patients' quality of life (QoL). The aim of our study was to analyze and compare the QoL of patients with GD with that of TNG patients and to evaluate the influence of surgical treatment on their QoL. A prospective case-control study was conducted at the Center for Endocrine surgery in Belgrade, Serbia. The ThyPRO questionnaire was used in the QoL assessment of the GD and TNG patients (31 and 28, respectively) pre- and post-operatively. All patients were receiving antithyroid drugs, and none of the patients were overtly hyperthyroid at the time of completing the preoperative questionnaire. The QoL of the GD patients was worse than that of the TNG patients, with significant differences in eye symptoms, anxiety, and sex life domains (P < 0.001, P = 0.005, and P = 0.004, respectively), preoperatively, and in eye symptoms, anxiety, emotional susceptibility, and overall QoL (P = 0.001, P = 0.027, P = 0.005 and P = 0.013, respectively), postoperatively. The improvement in QoL in the GD patients was significant after surgical treatment in all ThyPRO domains. In the TNG patients, the improvement was significant in all but one ThyPRO domain, sex life (P = 0.066). The QoL of GD patients is worse than those of TNG patients. Surgery may improve QoL in patients with GD and TNG even if they have achieved satisfying thyroid status with medication treatment, preoperatively. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Insulin in the Medical Management of Postprandial Hypoglycemia in a Patient with Type 2 Diabetes after Gastric Bypass Surgery

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    Jennifer Leung Schoenberger

    2012-01-01

    Full Text Available Objective. We evaluated a 47-year-old woman with a history of type 2 diabetes and severe obesity who developed postprandial hypoglycemia after undergoing Roux-en-Y gastric bypass surgery and losing 60% of her total body weight. We studied her insulin secretion and blood glucose dynamics and were able to tailor a therapeutic regimen involving insulin that eliminated episodes of hypoglycemia. Methods. We studied blood glucose levels during a prolonged fast, performed continuous glucose monitoring studies using a subcutaneous glucose sensor, and evaluated regional pancreatic insulin secretion using selective arterial calcium stimulation. Results. Continuous glucose monitoring revealed that the patient had early (1-2 hr postprandial hyperglycemia followed by late (3-4 hr postprandial hypoglycemia. Biochemical studies confirmed endogenous pancreatogenous insulin secretion as the cause of episodic hypoglycemia, but imaging studies and selective arterial calcium stimulation failed to localize an insulinoma. The patient was treated with preprandial doses of insulin aspart in order to attenuate the early postprandial hyperglycemia, and the late hypoglycemic episodes were avoided. Conclusion. We describe an interesting and novel nonsurgical approach to the prevention of postprandial hypoglycemia in a patient with noninsulinoma pancreatogenous hypoglycemia after gastric bypass.

  15. REVISION SURGERY IN PATIENTS WITH SCOLIOSIS OPERATED WITH PLATE ENDOCORRECTORS

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    S. V. Kolesov

    2012-01-01

    Full Text Available The authors presented 19 clinical observations of patients undergoing surgery at the primary idiopathic scoliosis using plate endocorrectors. The following characteristics were determined: the fixation of posterior elements of the spine there is no possibility of adequate derotation scoliotic vertebrae arc and require extensive fixation of the spine (Th2-L4, significantly reducing the functional activity of the patients. The lack of the fusion is accompanied by system micromotion, causes the instability of the upper pole of the metal construction and provokes the formation of a fistula. The presence of fibrous scar, and later - bone block, doesn’t allow to realize the lengthening effect during the patient’s growth and causes the development of Crankshaft-phenomenon, the correction of which requires a long, traumatic, multi-stage surgery.

  16. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

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    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  17. Altered functional connectivity of the dorsolateral prefrontal cortex in first-episode patients with major depressive disorder

    Energy Technology Data Exchange (ETDEWEB)

    Ye, Ting, E-mail: yeting@ihep.ac.cn [Key Laboratory of Nuclear Analytical Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, PO Box 918, Yu-Quan St, Shijingshan District, Beijing 100049 (China); Graduate School of Chinese Academy of Sciences, PO Box 918, Yu-Quan St, Shijingshan District, Beijing 100049 (China); Peng, Jing, E-mail: ppengjjing@sina.com.cn [Department of Radiology, Xuanwu Hospital of Capital Medical University, No. 45, Chang-Chun St, Xuanwu District, Beijing 100053 (China); Nie, Binbin, E-mail: niebb@ihep.ac.cn [Key Laboratory of Nuclear Analytical Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, PO Box 918, Yu-Quan St, Shijingshan District, Beijing 100049 (China); Gao, Juan, E-mail: gaojuan@ihep.ac.cn [Key Laboratory of Nuclear Analytical Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, PO Box 918, Yu-Quan St, Shijingshan District, Beijing 100049 (China); Graduate School of Chinese Academy of Sciences, PO Box 918, Yu-Quan St, Shijingshan District, Beijing 100049 (China); Liu, Jiangtao, E-mail: Liujiangtao813@sina.com [Department of Radiology, Xuanwu Hospital of Capital Medical University, No. 45, Chang-Chun St, Xuanwu District, Beijing 100053 (China); Li, Yang, E-mail: Liyang2007428@hotmail.com [Department of Psychiatry, Anding Hospital of Capital Medical University, No. 5, An Kang Hutong, Deshengmen wai, Xicheng District, Beijing 100088 (China); Wang, Gang, E-mail: gangwang@gmail.com [Department of Psychiatry, Anding Hospital of Capital Medical University, No. 5, An Kang Hutong, Deshengmen wai, Xicheng District, Beijing 100088 (China); Ma, Xin, E-mail: lijianshe@medmail.com.cn [Department of Psychiatry, Anding Hospital of Capital Medical University, No. 5, An Kang Hutong, Deshengmen wai, Xicheng District, Beijing 100088 (China); Li, Kuncheng [Department of Radiology, Xuanwu Hospital of Capital Medical University, No. 45, Chang-Chun St, Xuanwu District, Beijing 100053 (China); and others

    2012-12-15

    Background: The aim of this study was to investigate resting-state functional connectivity alteration of the right dorsolateral prefrontal cortex (DLPFC) in patients with first-episode major depressive disorder (MDD). Methods: Twenty-two first-episode MDD patients and thirty age-, gender- and education-matched healthy control subjects were enrolled. Rest state functional magnetic resonance images and structure magnetic resonance images were scanned. The functional connectivity analysis was done based on the result of voxel-based morphometry (VBM). And the right DLPFC was chosen as the seed region of interests (ROI), as its gray matter density (GMD) decreased in the MDD patients compared with controls and its GMD values were negative correlation with the Hamilton Depression Rating Scale (HDRS) scores. Results: Compared to healthy controls, the MDD patients showed increased functional connectivity with right the DLPFC in the left dorsal anterior cingulate cortex (ACC), left parahippocampal gyrus (PHG), thalamus and precentral gyrus. In contrast, there were decreased functional connectivity between the right DLPFC and right parietal lobe. Conclusions: By applying the VBM results to the functional connectivity analysis, the study suggested that abnormality of GMD in right DLPFC might be related to the functional connectivity alteration in the pathophysiology of MDD, which might be useful in further characterizing structure–function relations in this disorder.

  18. Intensive case management for high-risk patients with first-episode psychosis: service model and outcomes.

    Science.gov (United States)

    Brewer, Warrick J; Lambert, Timothy J; Witt, Katrina; Dileo, John; Duff, Cameron; Crlenjak, Carol; McGorry, Patrick D; Murphy, Brendan P

    2015-01-01

    The first episode of psychosis is a crucial period when early intervention can alter the trajectory of the young person's ongoing mental health and general functioning. After an investigation into completed suicides in the Early Psychosis Prevention and Intervention Centre (EPPIC) programme, the intensive case management subprogramme was developed in 2003 to provide assertive outreach to young people having a first episode of psychosis who are at high risk owing to risk to self or others, disengagement, or suboptimal recovery. We report intensive case management model development, characterise the target cohort, and report on outcomes compared with EPPIC treatment as usual. Inclusion criteria, staff support, referral pathways, clinical review processes, models of engagement and care, and risk management protocols are described. We compared 120 consecutive referrals with 50 EPPIC treatment as usual patients (age 15-24 years) in a naturalistic stratified quasi-experimental real-world design. Key performance indicators of service use plus engagement and suicide attempts were compared between EPPIC treatment as usual and intensive case management, and psychosocial and clinical measures were compared between intensive case management referral and discharge. Referrals were predominately unemployed males with low levels of functioning and educational attainment. They were characterised by a family history of mental illness, migration and early separation, with substantial trauma, history of violence, and forensic attention. Intensive case management improved psychopathology and psychosocial outcomes in high-risk patients and reduced risk ratings, admissions, bed days, and crisis contacts. Characterisation of intensive case management patients validated the clinical research focus and identified a first episode of psychosis high-risk subgroup. In a real-world study, implementation of an intensive case management stream within a well-established first episode of psychosis

  19. Spinal stenosis surgery in pediatric patients with achondroplasia.

    Science.gov (United States)

    Sciubba, Daniel M; Noggle, Joseph C; Marupudi, Neena I; Bagley, Carlos A; Bookland, Markus J; Carson, Benjamin S; Ain, Michael C; Jallo, George I

    2007-05-01

    Achondroplasia is a hereditary form of dwarfism caused by a defect in endochondral bone formation, resulting in skeletal abnormalities including short stature, shortened limb bones, macrocephaly, and small vertebral bodies. In the pediatric population, symptomatic spinal stenosis occurs at all spinal levels due to the abnormally narrow bone canal. In this study, clinical outcomes were assessed in children with achondroplasia after spinal canal decompression. A retrospective review was conducted involving pediatric patients with heterozygous achondroplasia and symptomatic stenosis after decompressive procedures at the authors' institution within a 9-year period. Measured outcomes included resolution of symptoms, need for repeated surgery, presence of fusion, development of deformity, and complications. Forty-four pediatric patients underwent a total of 60 decompressive procedures. The average patient age at surgery was 12.7 years (range 5-21 years). Forty-nine operations were performed for initial treatment of stenosis, and 11 were performed as revision surgeries on previously operated levels. A large proportion of patients (> 60%) required additional cervicomedullary decompressions, most often preceding the symptoms of spinal stenosis. Of the initial procedures, decompression locations included 32 thoracolumbar (65%), 10 lumbar (20%), four cervical (8%), two cervicothoracic (4%), and one thoracic (2%). Forty-three of the decompressive procedures (72%) included spinal fusion procedures. Of the 11 revisions, five were fusion procedures for progressive deformity at levels previously decompressed but not fused (all thoracolumbar), five were for decompressions of symptomatic junctional stenosis with extension of fusion, and one was for repeated decompression at the same level due to recurrence of symptomatic stenosis. Decompression of the spinal canal in pediatric patients with achondroplasia can be accomplished safely with significant clinical benefit. Patients with a

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

    Science.gov (United States)

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

    2017-06-07

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

  1. Patient preferences in print advertisement marketing for plastic surgery.

    Science.gov (United States)

    Sanan, Akshay; Quinn, Candace; Spiegel, Jeffrey H

    2013-05-01

    Plastic surgeons are competing for their share of a growing but still limited market, thus making advertising an important component in a successful plastic surgery practice. The authors evaluate the variables, characteristics, and presentation features that make print advertisements most effectively pique the interest of individuals selecting a plastic surgeon. An online survey was administered to 404 individuals with active interest in plastic surgery from 10 major metropolitan areas. Participants were presented with 5 different advertisements from plastic surgeons throughout the country and were asked a series of both closed- and open-ended questions to assess verity, quality, and marketability of each advertisement. Reponses to open-ended questions were analyzed using the Wordle program (www.wordle.net). The most frequent themes identified for all 5 ads were "Being beautiful is possible" (41%), "I could be beautiful" (24%), "Some people need surgery to be beautiful" (16%), and "Being beautiful is important" (14%). Advertisement 1-featuring 3 women and no pre- or posttreatment photography, no physician photography, and a listing of the 3 physicians' credentials but not a list of the services provided-received the highest overall preference rating. Factors including emotions felt while reading, unique qualities of the advertisement, list of procedures performed, use of models versus actual patients, and pictures of the plastic surgeons were found to contribute to the respondents' overall perception of advertisements used to market a plastic surgery practice.

  2. Candidates for Bariatric Surgery: Morbidly Obese Patients with Pulmonary Dysfunction

    Directory of Open Access Journals (Sweden)

    Yu-Feng Wei

    2012-01-01

    Full Text Available Obesity is a well-known major risk factor of cardiovascular disease and is associated with various comorbidities. The impact of obesity on pulmonary function remains unclear. Reductions in chest wall compliance and respiratory muscle strength due to a high percent body fat and localized fat distribution contributes to impaired pulmonary function and the occurrence of adverse respiratory symptoms. Dietary modifications and pharmaceutical agents are not effective in the long-term treatment of obesity. Treatment of morbidly obese patients using bariatric surgery has increased each year, especially after the introduction of video laparoscopic techniques. Effective weight loss after bariatric surgery may improve cardiovascular disease risk factors, including diabetes, hypertension, dyslipidemia, atherosclerosis, inflammation, chronic kidney disease, obstructive sleep apnea, and obesity hypoventilation syndrome. Bariatric surgery has also been associated with significantly improved respiratory symptoms and pulmonary function. We currently present a review of principal studies that evaluated the effects of obesity on pulmonary function and the identification of anthropometric factors of obesity that correspond to the reversal of respiratory symptoms and impaired pulmonary function after bariatric surgery.

  3. First episode of psychosis in a middle-aged patient with a 14-year history of conversion disorder.

    Science.gov (United States)

    Peritogiannis, Vaios; Manthopoulou, Thiresia; Mavreas, Venetsanos

    2014-01-01

    We present a case of a middle-aged male patient with a long history of conversion disorder and histrionic personality, who presented with newly onset psychotic symptoms while being engaged to treatment with a community mental health team in a primary care setting. The symptoms could not be attributed to an organic cause. After a short course of olanzapine treatment which caused adverse effects, the symptomatology responded well to low dose amisulpride. Conversion symptoms were stable throughout the psychotic episode. This case illustrates the complex interplay between disorders classified in different categories (somatoform versus psychotic disorders).

  4. First Episode of Psychosis in a Middle-Aged Patient with a 14-Year History of Conversion Disorder

    Directory of Open Access Journals (Sweden)

    Vaios Peritogiannis

    2014-01-01

    Full Text Available We present a case of a middle-aged male patient with a long history of conversion disorder and histrionic personality, who presented with newly onset psychotic symptoms while being engaged to treatment with a community mental health team in a primary care setting. The symptoms could not be attributed to an organic cause. After a short course of olanzapine treatment which caused adverse effects, the symptomatology responded well to low dose amisulpride. Conversion symptoms were stable throughout the psychotic episode. This case illustrates the complex interplay between disorders classified in different categories (somatoform versus psychotic disorders.

  5. Prevalence and Profile of Cognitive Deficits in a Cohort of First-Episode Antipsychotic-Naïve Schizophrenia Patients

    DEFF Research Database (Denmark)

    Jensen, Maria Høj; Glenthøj, Birte Yding; Nielsen, Mette Ødegaard

    2014-01-01

    ; however in most first-episode schizophrenia studies the patients are receiving antipsychotic medication, which can affect the results on specific domains such as processing speed. As part of the PECANS project (Pan European Collaboration on Antipsychotic Naïve Schizophrenia) the aim of the present study...... in Schizophrenia) and CANTAB (Cambridge Neuropsychological Test Automated Battery). Premorbid intelligence is estimated using DART (Danish Adult Reading Test) and current intelligence is estimated from 4 subtests from WAIS-III (Wechsler´s Adult Intelligence Scale, 3rd ed.). Psychopathology ratings are obtained...

  6. Limb salvage surgery for osteosarcoma- Early results in Indian patients

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    Akshay Tiwari

    2014-01-01

    Full Text Available Background: While limb salvage surgery has long been established as the standard of care for osteosarcoma, large studies from Indian centers are few. Given the diverse socio economic milieu of our patients, it becomes significant to determine the feasibility and outcome of management of osteosarcoma in our population. We analyzed the early outcome of limb salvage surgery with multimodality treatment of osteosarcoma of the extremity/girdle bones at a tertiary North Indian Cancer Centre. Materials and Methods: A total of 51 limb salvage surgeries performed during the months between November 2008 and November 2012 were studied. Neoadjuvant/adjuvant chemotherapy was given by the pediatric/adult medical oncology teams as applicable. The mean followup was 19.45 months (range 2-50 months. The oncological outcome was correlated with age, sex, size of tumor, stage at presentation, site, histological subtype, type of chemotherapy protocol followed and necrosis seen on postoperative examination of resected specimen. The functional outcome of the patients was evaluated using the musculoskeletal tumor society (MSTS scoring system. Results: Out of a total of 37 males and 14 females with an average age of 18.8 years, the 3 year overall survival was 66% and 3 year event free survival was 61.8%. In this group of patients with a short followup, a better oncological outcome was associated with good postoperative tumor necrosis, nonchondroblastic histology and age <14 years. The average MSTS score was highest in patients with proximal or distal femur prosthesis and the lowest in patients undergoing a knee arthrodesis. Conclusion: The present study shows oncological and functional outcomes of limb salvage combined with chemotherapy in Indian patients with osteosarcoma comparable to those in world literature. Larger studies on Indian population with longer followup are recommended.

  7. Medical management of patients after bariatric surgery: Principles and guidelines

    Science.gov (United States)

    Elrazek, Abd Elrazek Mohammad Ali Abd; Elbanna, Abduh Elsayed Mohamed; Bilasy, Shymaa E

    2014-01-01

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review. PMID:25429323

  8. Medical management of patients after bariatric surgery: Principles and guidelines

    Institute of Scientific and Technical Information of China (English)

    Abd; Elrazek; Mohammad; Ali; Abd; Elrazek; Abduh; Elsayed; Mohamed; Elbanna; Shymaa; E; Bilasy

    2014-01-01

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index(BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients(BMI ≥ 30 kg/m2) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m2 and those with BMI > 35 kg/m2 with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  9. Medical management of patients after bariatric surgery: Principles and guidelines.

    Science.gov (United States)

    Elrazek, Abd Elrazek Mohammad Ali Abd; Elbanna, Abduh Elsayed Mohamed; Bilasy, Shymaa E

    2014-11-27

    Obesity is a major and growing health care concern. Large epidemiologic studies that evaluated the relationship between obesity and mortality, observed that a higher body-mass index (BMI) is associated with increased rate of death from several causes, among them cardiovascular disease; which is particularly true for those with morbid obesity. Being overweight was also associated with decreased survival in several studies. Unfortunately, obese subjects are often exposed to public disapproval because of their fatness which significantly affects their psychosocial behavior. All obese patients (BMI ≥ 30 kg/m(2)) should receive counseling on diet, lifestyle, exercise and goals for weight management. Individuals with BMI ≥ 40 kg/m(2) and those with BMI > 35 kg/m(2) with obesity-related comorbidities; who failed diet, exercise, and drug therapy, should be considered for bariatric surgery. In current review article, we will shed light on important medical principles that each surgeon/gastroenterologist needs to know about bariatric surgical procedure, with special concern to the early post operative period. Additionally, we will explain the common complications that usually follow bariatric surgery and elucidate medical guidelines in their management. For the first 24 h after the bariatric surgery, the postoperative priorities include pain management, leakage, nausea and vomiting, intravenous fluid management, pulmonary hygiene, and ambulation. Patients maintain a low calorie liquid diet for the first few postoperative days that is gradually changed to soft solid food diet within two or three weeks following the bariatric surgery. Later, patients should be monitored for postoperative complications. Hypertension, diabetes, dumping syndrome, gastrointestinal and psychosomatic disorders are among the most important medical conditions discussed in this review.

  10. Family Functioning in First-Episode and Chronic Psychosis: The Role of Patient's Symptom Severity and Psychosocial Functioning.

    Science.gov (United States)

    Koutra, Katerina; Triliva, Sofia; Roumeliotaki, Theano; Basta, Maria; Lionis, Christos; Vgontzas, Alexandros N

    2016-08-01

    The aim of the present study was to assess the relationship between illness-related characteristics, such as symptom severity and psychosocial functioning, and specific aspects of family functioning both in patients experiencing their first episode of psychosis (FEP) and chronically ill patients. A total of 50 FEP and 50 chronic patients diagnosed with schizophrenia or bipolar disorder (most recent episode manic severe with psychotic features) and their family caregivers participated in the study. Family functioning was evaluated in terms of cohesion and flexibility (FACES IV Package), expressed emotion (FQ), family burden (FBS) and caregivers' psychological distress (GHQ-28). Patients' symptom severity (BPRS) and psychosocial functioning (GAS) were assessed by their treating psychiatrist within 2 weeks from the caregivers' assessment. Increased symptom severity was associated with greater dysfunction in terms of family cohesion and flexibility (β coefficient -0.13; 95 % CI -0.23, -0.03), increased caregivers' EE levels on the form of emotional overinvolvement (β coefficient 1.03; 95 % CI 0.02, 2.03), and psychological distress (β coefficient 3.37; 95 % CI 1.29, 5.45). Family burden was found to be significantly related to both symptom severity (β coefficient 3.01; 95 % CI 1.50, 4.51) and patient's functioning (β coefficient -2.04; 95 % CI -3.55, -0.53). No significant interaction effect of chronicity was observed in the afore-mentioned associations. These findings indicate that severe psychopathology and patient's low psychosocial functioning are associated with poor family functioning. It appears that the effect for family function is significant from the early stages of the illness. Thus, early psychoeducational interventions should focus on patients with severe symptomatology and impaired functioning and their families.

  11. Predicting Delirium Duration in Elderly Hip-Surgery Patients: Does Early Symptom Profile Matter?

    Directory of Open Access Journals (Sweden)

    Chantal J. Slor

    2013-01-01

    Full Text Available Background. Features that may allow early identification of patients at risk of prolonged delirium, and therefore of poorer outcomes, are not well understood. The aim of this study was to determine if preoperative delirium risk factors and delirium symptoms (at onset and clinical symptomatology during the course of delirium are associated with delirium duration. Methods. This study was conducted in prospectively identified cases of incident delirium. We compared patients experiencing delirium of short duration (1 or 2 days with patients who had more prolonged delirium (≥3 days with regard to DRS-R-98 (Delirium Rating Scale Revised-98 symptoms on the first delirious day. Delirium symptom profile was evaluated daily during the delirium course. Results. In a homogenous population of 51 elderly hip-surgery patients, we found that the severity of individual delirium symptoms on the first day of delirium was not associated with duration of delirium. Preexisting cognitive decline was associated with prolonged delirium. Longitudinal analysis using the generalised estimating equations method (GEE identified that more severe impairment of long-term memory across the whole delirium episode was associated with longer duration of delirium. Conclusion. Preexisting cognitive decline rather than severity of individual delirium symptoms at onset is strongly associated with delirium duration.

  12. Intraocular surgery in a large diabetes patient population

    DEFF Research Database (Denmark)

    Ostri, Christoffer

    2014-01-01

    population and to report surgical results. The specific objectives are to (1) estimate the incidence of diabetic vitrectomy and analyse risk factors (Study I), (2) report long-term results, prognostic factors and incidence of cataract surgery after diabetic vitrectomy (Study II), (3) report results...... retinopathy screening population. Study I (cohort study, 3980 type 1 diabetes patients) illustrates that diabetic vitrectomy is rarely required in a diabetes patient population with varying degrees of diabetic retinopathy. The risk of reaching diabetic vitrectomy increases fourfold with poor metabolic control...

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Rakesh Garg

    2008-01-01

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

  15. Robotic versus conventional laparoscopic rectal cancer surgery in obese patients.

    Science.gov (United States)

    Gorgun, E; Ozben, V; Costedio, M; Stocchi, L; Kalady, M; Remzi, F

    2016-11-01

    Obesity adds to the technical difficulty of laparoscopic colorectal surgery. The robotic approach has the potential to overcome this limitation because of its proposed technical advantages over laparoscopy. The aim of this retrospective study was to compare the short-term outcomes of robotic surgery (RS) vs conventional laparoscopy surgery (LS) in this patient population. Patients with a body mass index ≥ 30 kg/m(2) undergoing RS or LS for rectal cancer between January 2011 and June 2014 were identified from an institutional database. Perioperative parameters, oncological findings and postoperative 30-day short-term outcomes were compared between the RS and LS groups. The RS and LS groups included 29 and 27 patients, respectively. Groups were comparable in terms of patient demographics, body mass index (34.9 ± 7.2 vs 35.2 ± 5.0 kg/m(2) , P = 0.71), comorbidities, surgical and tumour characteristics. Comparison of the intra-operative findings revealed no significant differences between the groups including operative time (329.0 ± 102.2 vs 294.6 ± 81.1 min, P = 0.13), blood loss (434.0 ± 612.4 vs 339.4 ± 271.9 ml, P = 0.68), resection margin involvement (6.9% vs 7.4%, P = 0.99), conversions (3.4% vs 18.5%, P = 0.09) and complications (6.9% vs 0%, P = 0.49). Regarding postoperative outcomes, there were no significant differences in morbidity except that robotic surgery was associated with a quicker return of bowel function (median 3 vs 4 days, P = 0.01) and shorter hospital stay (median 6 vs 7 days, P = 0.02). Robotic surgery for rectal cancer in obese patients has short-term outcomes similar to laparoscopy, but accelerated postoperative recovery. Colorectal Disease © 2016 The Association of Coloproctology of Great Britain and Ireland.

  16. The Inequity of Bariatric Surgery: Publicly Insured Patients Undergo Lower Rates of Bariatric Surgery with Worse Outcomes.

    Science.gov (United States)

    Hennings, Dietric L; Baimas-George, Maria; Al-Quarayshi, Zaid; Moore, Rachel; Kandil, Emad; DuCoin, Christopher G

    2017-06-30

    Bariatric surgery has been shown to be the most effective method of achieving weight loss and alleviating obesity-related comorbidities. Yet, it is not being used equitably. This study seeks to identify if there is a disparity in payer status of patients undergoing bariatric surgery and what factors are associated with this disparity. We performed a case-control analysis of National Inpatient Sample. We identified adults with body mass index (BMI) greater than or equal to 25 kg/m(2) who underwent bariatric surgery and matched them with overweight inpatient adult controls not undergoing surgery. The sample was analyzed using multivariate logistic regression. We identified 132,342 cases, in which the majority had private insurance (72.8%). Bariatric patients were significantly more likely to be privately insured than any other payer status; Medicare- and Medicaid-covered patients accounted for a low percentage of cases (Medicare 5.1%, OR 0.33, 95% CI 0.29-0.37, p bariatric surgery had an increased risk of complications compared to privately insured patients. Publicly insured patients are significantly less likely to undergo bariatric surgery. As a group, these patients experience higher rates of obesity and related complications and thus are most in need of bariatric surgery.

  17. No difference in the prevalence of cavum septum pellucidum (CSP) between first-episode schizophrenia patients, offspring of schizophrenia patients and healthy controls.

    Science.gov (United States)

    Rajarethinam, Rajaprabhakaran; Sohi, Jasdeep; Arfken, Cynthia; Keshavan, Matcheri S

    2008-08-01

    The reported prevalence of cavum septum pellucidum (CSP), is extremely variable (from 0.1% to 85%) depending upon the measurement method or imaging resolution. Higher prevalence of CSP has been found in schizophrenia. In this study, we examined the prevalence of CSP in a large number of first-episode schizophrenia patients, young relatives of schizophrenia patients and healthy controls. We manually measured CSP using 1.5 mm T1 MRI scans from ongoing studies at University of Pittsburgh in 89 first-episode patients with schizophrenia (age=23.8+/-7.4, M/F=61/28), 64 genetically at-risk individuals (offspring and siblings of schizophrenia patients, age 15.2+/-3.7, M/F=29/32) and 120 comparison subjects (n=120, age=22.1+/-7.9, M/F62/50). CSP was present in 64% of the first-episode patients (mean length 1.87+/-2.3 mm), 64.6% of the at-risk individuals (1.64+/-1.96 mm) and 64.2% of the normal controls (1.88+/-2.0 mm). There was no difference in the prevalence of CSP exceeding 4 mm. We also did not find any influence of the sex or age in the presence or size of CSP. Our data cast doubt on the significance of CSP as markers of neurodevelopmental pathology in schizophrenia.

  18. Carotid artery surgery in patients over 70 years of age.

    Science.gov (United States)

    Benhamou, A C; Kieffer, E; Tricot, J F; Maraval, M; Lethoai, H; Benhamou, M; Boespflug, O; Natali, J

    1981-01-01

    Between 1965 and 1979, 934 patients underwent 1,057 operations for extracranial carotid stenosis at this institute, and over a recent 30-month period 463 patients underwent 511 operations of this type. This number is equal to the total of operations performed during the years 1965-1976. The increase in the frequency of carotid artery surgery has been more marked in patients of over 70 years. The percentage of elderly patients has increased from 17.5% to 27% in the recent period. In the latter group of 511 operations, results were good in 93.17% of cases, while there was a mortality rate of 1.95% (1% of which were directly related to the surgery), in 1.95% the neurologic condition deteriorated and in 3.13% there was no change. In the first period the mortality rate for patients over 70 years of age was 7.69%. In the second it was 3.27% (1.63% of which were due to non-neurologic causes), 4.09% deteriorated, in 2.18% there was no change and good results were obtained in 90.46%.

  19. Approach to the patient with persistent acromegaly after pituitary surgery.

    Science.gov (United States)

    Katznelson, Laurence

    2010-09-01

    The approach to a patient with acromegaly and persistent disease after surgery requires a complex diagnostic assessment. Acromegaly is a chronic and insidious disease that is associated with multisystem comorbidities, including cardiovascular disease, hypertension, sleep apnea syndrome, colon polyposis, arthropathy, and metabolic complications including glucose intolerance and type 2 diabetes mellitus. Patients also have a variety of signs and symptoms, including headache, arthralgias, carpal tunnel syndrome, sweating, fatigue, and psychological issues that impact significantly on quality of life. The recommended approach to the evaluation of the postoperative patient includes a biochemical assessment, with measurement of serum IGF-I along with a glucose-suppressed GH value, radiological assessment to determine location of residual tumor and presence of mass effects, a physical examination for evidence of skeletal and soft tissue overgrowth and related signs of acromegaly, and a thorough clinical assessment for the presence of comorbidities. Repeat surgery is indicated if there is residual tumor that is surgically accessible and there may be a chance for surgical cure, or if there are persistent mass effects upon the optic chiasm. Otherwise, medical therapy is indicated, utilizing somatostatin analogs, dopamine agonists, and pegvisomant, a GH receptor antagonist. Radiation therapy is usually relegated to situations where medical therapy is ineffective or poorly tolerated or where patients would prefer not to sustain the cost of long-term medical therapy. The choice of therapy requires close dialog among endocrinologists, neurosurgeons, radiation therapists, and neuroophthalmologists for optimal care of patients.

  20. [Patient information and obtaining informed consent in laparoscopic surgery].

    Science.gov (United States)

    Rougé, C; Tuesch, J J; Casa, C; Ludes, B; Arnaud, J P

    1997-12-01

    Since the advent of laparoscopic surgery, the number of suits against surgeons has risen. One of the most frequent complaints is the lack of sufficient information. Physicians in France have a formal obligation to provide information in the contractual legal context established since 1936. This notion has been confirmed in several court cases. The requirement for patient informed consent has been confirmed by several decisions of the Appeals Court and is stated in the code of deontology. The value of classical oral information has been recently questioned in certain court cases. We analyse the current legal situation in France and try to define the content of information required in the case of laparoscopic surgery in addition to the way this information is provided and the means of obtaining informed consent. The information provided must be personalised. The patient must informed that laparoscopy remains a surgical operation. It is licit to warn the patient of predictable risks according to statistical probabilities, of the team's experience and of the patients own status including past history and psychological factors. A written statement may be prepared but must remain a document complementary to personalised oral information. The surgeon must obtain and assure good patient comprehension. The surgical community should publish risk rates in order for surgeons to have reliable references which can be used to define the notion of exceptional risk.

  1. Characteristics of morbidly obese patients before gastric bypass surgery.

    Science.gov (United States)

    de Zwaan, Martina; Mitchell, James E; Howell, L Michael; Monson, Nancy; Swan-Kremeier, Lorraine; Crosby, Ross D; Seim, Harold C

    2003-01-01

    The prevalence of binge eating disorder (BED) was assessed in a sample of 110 morbidly obese presurgery patients by means of self-report (Questionnaire on Eating and Weight Patterns [QEWP]). Subsequently, patients with (n = 19, 17.3%) and without BED (n = 91, 82.7%) were compared on several eating-related and general psychopathological instruments, as well as an obesity-specific health-related quality-of-life measure. Patients with BED exhibited higher scores than non-BED patients on most of the subscales of two questionnaires measuring eating behavior and attitudes towards eating, shape, and weight (Three Factor Eating Questionnaire [TFEQ], Eating Disorders Examination-questionnaire version [EDE-Q4]) with the exception of the respective restraint subscales. The two groups also differed significantly on the disease-specific quality-of-life measure (Impact of Quality of Life Questionnaire-Lite [IWQOL-Lite]). No differences were found for measures of severity of depressive symptoms (Inventory of Depressive Symptoms [IDS]) and impairment of self-esteem (Rosenberg Self-Esteem Questionnaire [RSE]). Our findings replicate the results of other studies comparing patients with and without BED in samples with different degrees of obesity and extend the results to an obesity-specific quality-of-life measure. Further research needs to investigate the short- and long-term impact of presurgery BED on surgery outcome, as well as the impact of surgery on binge eating and eating-related psychopathology.

  2. Impaired prepulse inhibition of acoustic startle in Chinese patients with first-episode, medication-na(i)ve schizophrenia

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi-ren; TAN Yun-long; YANG Fu-de; ZHANG Wu-fang; ZOU Yi-zhuang; TAN Shu-ping; SONG Chong-sheng

    2013-01-01

    Background Patients with schizophrenia have prominent abnormality in information processing that can be observed by measures of prepulse inhibition (PPI) of acoustic startle reflex and PPI deficits have been considered as a candidate endophenotypic marker of schizophrenia.However,there has been little information on PPI and related measures in Chinese patients with schizophrenia.The research was to explore the deficits of acoustic startle reflex that might exist in Chinese patients with schizophrenia.Methods Startle response to acoustic stimuli,habituation,and PPI were examined in 31 Chinese patients with first-episode,medication-naǐve schizophrenia and 30 age-and sex-matched healthy Chinese controls.At the same day of startle testing,psychopathological symptoms of the patients were assessed with the Positive and Negative Syndrome Scale (PANSS).Results Compared with healthy controls,patients exhibited the significant reduction in startle response and PPI deficits at 60 milliseconds (ms) intervals (PPI60,P <0.05) but not at 30 or 120 ms intervals.Furthermore,there was a relatively strong correlation between PPI60 (P <0.05) and scores of positive scale of PANSS in patients with schizophrenia.Conclusion Our findings confirmed impaired PPI in Chinese patients with schizophrenia and suggested that a relationship between sensorimotor gating deficits and clinical symptoms of patients with schizophrenia might exist.

  3. Efeito da cirurgia de revascularização miocárdica sobre os episódios isquêmicos assintomáticos Effect of coronary artery bypass graft surgery on ischemic asymptomatic episodes

    Directory of Open Access Journals (Sweden)

    Humberto Pierri

    1998-04-01

    Full Text Available OBJETIVO: Avaliar o efeito da cirurgia de revascularização miocárdica (CRM sobre episódios isquêmicos assintomáticos (EIA. MÉTODOS: Foram estudados 28 homens, com angina estável (idade média 57,3±9,6 anos sem condições relacionadas a alterações de microcirculação e que, após retirada da medicação, apresentaram EIA à eletrocardiografia ambulatorial (ECGA. No pré-operatório e 4 meses após a cirurgia foram analisados os comportamentos dos EIA, segundo sua freqüência, e o de suas freqüências cardíacas (FC. A revascularização miocárdica foi completa em 75% dos casos. RESULTADOS: O número dos EIA foi reduzido de 162 (9 sintomáticos no pré-operatório para, apenas, 4 no pós-operatório (pPURPOSE: To evaluate the effect of coronary artery bypass graft surgery (CABG on ischemic asymptomatic episodes (IAE. METHODS: Twenty eight males (mean age 57.3±9.6 years with stable angina and no microcirculation abnormalities, who presented with IAE after medication withdrawal, were studied using ambulatory electrocardiography monitoring. Presence of IEA was analyzed before and 4 months after CABG according to its frequency and heart rate (HR response. CAGB was considered complete in 75% of the cases. RESULTS: The number of IAE was reduced from 162 (9 symptomatic in the preoperative period to 4 after surgery (p<0.05. In two patients with IAE in the postoperative period, coronariography confirmed obstruction of aortocoronary grafts. Analysis of HR at the beginning and peak of IAE suggested as mechanisms both reduced blood flow and increased oxygen consumption by the myocardium. CONCLUSION: CABC eliminated IAE regardless of HR. When IAE is present after surgery, graft occlusion should be suspected.

  4. Prevalence of Arm Lymphedema among Patients with Breast Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Radha Acharya Pandey

    2016-11-01

    Full Text Available Background & Objectives: Lymphedema is a common complication of cancer therapeutics; its prevalence, treatment outcomes, and costs have been poorly defined. It is potentially debilitating condition in breast cancer survivors which negatively affects the quality of life. This study aims to assess the prevalence of arm lymphedema among patients with breast cancer surgery.Materials & Methods: A cross-sectional study was conducted to assess the prevalence of arm lymphedema among the women with breast cancer surgery. Purposive sampling technique was used to collect the data from a sample of 66 women of selected hospitals.  Data were collected through self constructed structured and semi structured interview based questionnaire which consisted socio demographic information and clinical related factors. Results: Among The overall prevalence of arm lymphedema was found to be seven (10.6% respondents among the study population. In this study, 41 (62.1% respondents were < 50 years of age, 13 (19.7% had education of secondary level, 27 (40.9% had received radiation therapy, 63 (95.5% had no history of infection, 54 (81.8% had undergone modified radical mastectomy, and 56 (84.8% had involved lymph node resection. Statistically no any significant association was found between these variables.Conclusion: On the basis of the findings, this conclusion has been drawn that prevalence of arm lymphedema among patients with breast cancer surgery was low (10.6%. Moreover no association was found between the prevalence of arm lymphedema, sociodemographic variables and clinical related factors.

  5. Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries

    Directory of Open Access Journals (Sweden)

    Nayara de Castro Pereira

    Full Text Available Abstract OBJECTIVE To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. METHOD Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. RESULTS The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000 and after the surgery (p=0.007, the length of hospital stay (p=0.000, blood transfusion (p=0.013, nasogastric tube (p=0.001 and nasojejunal tube (p=0,003, postoperative admission at ICU (p=0.002, postoperative death (p=0.000 and length of preoperative fasting (p=0.000. CONCLUSION The length of fasting is associated with complications that affect the quality of the patients’ postoperative recovery and nurses’ work. The nursing team should be alert to this aspect and being responsible for overseeing the patients’ interest, should not permit the unnecessary extension of fasting.

  6. Preprosthetic and implantological surgery in patients with severe maxillary atrophy.

    Science.gov (United States)

    González-García, Raúl; Naval-Gías, Luís; Muñoz-Guerra, Mario Fernando; Sastre-Pérez, Jesús; Rodríguez-Campo, Francisco José; Gil-Díez-Usandizaga, José Luís

    2005-01-01

    To evaluate the success of the osseointegration of dental implants in patients with severe maxillary atrophy after sinus lift augmentation and onlay graft surgery with autologous bone grafts. A descriptive and analytic study of 27 patients with severe maxillary atrophy and partial or total edentulism, after 4 years follow-up. All cases underwent to autologous bone graft sinus lift augmentation with or without onlay grafts in the anterior maxillae. After this, reconstruction with osseointegrated implants was performed. After the follow-up period, 89.1% of implants were osseointegrated and loaded. Anterior iliac crest bone graft provides good results with respect to implant osseointegration. The achievement of two surgical procedures for bone grafts surgery and implants surgery, separated 2 or more months, provides better results for osseointegration in comparison to a sole surgical procedure (p<0.01). Implants survival predictability is greater when a second surgical procedure is performed, once bone grafts have experimented an appropriate consolidation. The use of onlay graft and sinus lift augmentation techniques is useful in the resolution of complex problems such as the severe maxillary atrophy.

  7. Impairment of neuropsychological function in patients with hemodynamic cerebral ischemia and efficacy of bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sasoh, Masayuki [Iwate Medical Univ., Morioka (Japan). School of Medicine

    1999-08-01

    In order to evaluate the relation between neuropsychological functions and hemodynamic cerebral ischemia, the author analyzed neuropsychological examination and the cerebral blood flow and metabolism of patients before and after bypass surgery. Twenty-five patients were defined by clinical and laboratory criteria as suffering from hemodynamic cerebral ischemia. All patients had one or more episodes of focal cerebral ischemia due to unilateral internal carotid or middle cerebral artery occlusion. Computerized tomography scans either were normal or showed evidence of watershed infarction. Based on these criteria, superficial temporal artery-proximal middle cerebral artery anastomosis was performed. The baseline cerebral blood flow (CBF), oxygen extraction fraction (OEF), cerebral metabolic rate of oxygen (CMRO{sub 2}) and cerebrovascular reserve capacity (CVRC) were studied using positron emission computerized tomography (PET) and the acetazolamide test. Neuropsychological evaluations including Hasegawa Dementia Scale-Revised, Mini-Mental State and Wechsler Adult Intelligence Scale-Revised (WAIS-R), and PET study were completed one month after the last ischemic event and 3-6 months after the operation. A significant negative correlation was observed between OEF and neuropsychological functions. Postoperative neuropsychological functions showed significant improvement. Significant correlations were observed for {delta}WAIS-R (preoperative WAIS-R postoperative WAIS-R) versus preoperative CMRO{sub 2} (r=0.52), for {delta}WAIS-R versus preoperative OEF (r=0.47). In view of these findings, the author concludes that elevation of OEF impairs neuropsychological functions and bypass surgery improves neuropsychological functions in patients with normal CMRO{sub 2} and elevated OEF. (author)

  8. Evaluation of long-term soft tissue changes after bimaxillary orthognathic surgery in Class III patients.

    Science.gov (United States)

    Aydemir, Halise; Efendiyeva, Ruchengiz; Karasu, Hakan; Toygar-Memikoğlu, Ufuk

    2015-07-01

    To assess soft tissues in the short and long term after bimaxillary surgery in Class III patients by comparing the hard tissue changes and results between time periods. Twenty-six Class III adult patients treated with bimaxillary surgery were included in the study. Cephalometric records were taken before surgery (T1) and 5 months (T2), 1.4 years (T3), 3 years (T4), and 5 years (T5) after surgery. There was no significant relapse in skeletal parameters. Overjet was significantly reduced between T4-T3 time intervals (P bimaxillary surgery patients in the first 3 years after surgery.

  9. Cognitive control deficit in patients with first-episode schizophrenia is associated with complex deviations of early brain development

    Science.gov (United States)

    Gay, Olivier; Plaze, Marion; Oppenheim, Catherine; Gaillard, Raphael; Olié, Jean-Pierre; Krebs, Marie-Odile; Cachia, Arnaud

    2017-01-01

    Background Several clinical and radiological markers of early neurodevelopmental deviations have been independently associated with cognitive impairment in patients with schizophrenia. The aim of our study was to test the cumulative and/or interactive effects of these early neurodevelopmental factors on cognitive control (CC) deficit, a core feature of schizophrenia. Methods We recruited patients with first-episode schizophrenia-spectrum disorders, who underwent structural MRI. We evaluated CC efficiency using the Trail Making Test (TMT). Several markers of early brain development were measured: neurological soft signs (NSS), handedness, sulcal pattern of the anterior cingulate cortex (ACC) and ventricle enlargement. Results We included 41 patients with schizophrenia in our analysis, which revealed a main effect of ACC morphology (p = 0.041) as well as interactions between NSS and ACC morphology (p = 0.005), between NSS and handedness (p = 0.044) and between ACC morphology and cerebrospinal fluid (CSF) volume (p = 0.005) on CC measured using the TMT-B score – the TMT-A score. Limitations No 3- or 4-way interactions were detected between the 4 neurodevelopmental factors. The sample size was clearly adapted to detect main effects and 2-way interactions, but may have limited the statistical power to investigate higher-order interactions. The effects of treatment and illness duration were limited as the study design involved only patients with first-episode psychosis. Conclusion To our knowledge, our study provides the first evidence of cumulative and interactive effects of different neurodevelopmental markers on CC efficiency in patients with schizophrenia. Such findings, in line with the neurodevelopmental model of schizophrenia, support the notion that CC impairments in patients with schizophrenia may be the final common pathway of several early neurodevelopmental mechanisms. PMID:28245174

  10. HEART TRANSPLANTATION IN PATIENTS WITH PREVIOUS OPEN HEART SURGERY

    Directory of Open Access Journals (Sweden)

    R. Sh. Saitgareev

    2016-01-01

    Full Text Available Heart Transplantation (HTx to date remains the most effective and radical method of treatment of patients with end-stage heart failure. The defi cit of donor hearts is forcing to resort increasingly to the use of different longterm mechanical circulatory support systems, including as a «bridge» to the follow-up HTx. According to the ISHLT Registry the number of recipients underwent cardiopulmonary bypass surgery increased from 40% in the period from 2004 to 2008 to 49.6% for the period from 2009 to 2015. HTx performed in repeated patients, on the one hand, involves considerable technical diffi culties and high risks; on the other hand, there is often no alternative medical intervention to HTx, and if not dictated by absolute contradictions the denial of the surgery is equivalent to 100% mortality. This review summarizes the results of a number of published studies aimed at understanding the immediate and late results of HTx in patients, previously underwent open heart surgery. The effect of resternotomy during HTx and that of the specifi c features associated with its implementation in recipients previously operated on open heart, and its effects on the immediate and long-term survival were considered in this review. Results of studies analyzing the risk factors for perioperative complications in repeated recipients were also demonstrated. Separately, HTx risks after implantation of prolonged mechanical circulatory support systems were examined. The literature does not allow to clearly defi ning the impact factor of earlier performed open heart surgery on the course of perioperative period and on the prognosis of survival in recipients who underwent HTx. On the other hand, subject to the regular fl ow of HTx and the perioperative period the risks in this clinical situation are justifi ed as a long-term prognosis of recipients previously conducted open heart surgery and are comparable to those of patients who underwent primary HTx. Studies

  11. An audit of pharyngeal pouch surgery using endoscopic stapling. The patient's viewpoint.

    Science.gov (United States)

    Weller, M D; Porter, M J; Rowlands, J

    2004-07-01

    We report an audit designed to assess patient satisfaction resulting from pharyngeal pouch surgery using an endoscopic stapler. A personal series of 16 patients all operated on by the senior author over a 3-year period is reported. Information was gathered using a retrospective telephone questionnaire to establish pre- and postoperative symptoms, complications of surgery and patient satisfaction. This showed endoscopic pharyngeal pouch surgery to be successful in the majority of cases. Eighty-seven percent of patients felt better as a result of surgery. Seventy-five percent had no symptoms postoperatively. This series shows that surgery on pharyngeal pouches results in significant improvement in patient symptoms with minimal morbidity and mortality.

  12. Penetration of prulifloxacin into sinus mucosa of patients undergoing paranasal sinus elective endoscopic surgery.

    Science.gov (United States)

    De Benedetto, Michele; Passali, Desiderio; Tomacelli, Giovanni; Ruggieri, Alessandro; Rosignoli, Maria Teresa; Picollo, Rossella; Bellussi, Luisa; Dionisio, Paolo

    2012-02-01

    The aim of this study was to assess the concentration of ulifloxacin, the active metabolite of prulifloxacin, in sinuses mucosa and plasma of patients with chronic rhinosinusitis, requiring sinus elective endoscopic surgery. Thirty-nine patients (30 males, 9 females; age range 22-77 years) with chronic sinusitis were enrolled, 35 were treated with the investigational medication. Samples from four untreated patients were used to validate the analytical method, while four treated patients dropped out before surgery. One 600 mg prulifloxacin tablet once daily was administered for 5 days before surgery. The last dosing was scheduled from 2 to 12 hours from tissue and plasma sampling. In each patient, two samples of paranasal sinus mucosa (from ethmoid and turbinate, respectively) and one blood sample were collected. Concentrations of ulifloxacin in plasma and sinuses mucosa were measured using validated bioanalytical LC/MS/MS methods. Individual and mean ulifloxacin concentrations in tissues were always higher than the relevant plasma levels. The highest concentrations were observed between 2.5 and 4.5 hours after the last dosing in all districts. The mean tissue/plasma ratios were 2.5 and 3.0 for ethmoid and turbinate, respectively. Data expressed as Area Under the Curves (AUC±SD) showed that ulifloxacin concentrations in the ethmoid were slightly higher (18.68±6.48 μg/g*h) than in turbinate (15.00±2.89 μg/g*h), and definitely higher than in plasma (6.32±1.14 μg/ml*h). The AUC ratios between tissues and plasma were 3.0 for ethmoides and 2.4 for turbinates. One patient reported two treatment-related episodes of diarrhea, which spontaneously resolved after the drug suspension. Results from this study seem to suggest that prulifloxacin showed good distribution in sinus tissues, where it reaches concentrations significantly higher than in plasma. These findings strongly call for confirmatory clinical trials in patients with bacterial rhinosinusitis.

  13. Hydrosyringomyelia in an Ankylosing Spondylitis Patient After Stabilization Surgery

    Directory of Open Access Journals (Sweden)

    Deniz Oke Topcu

    2013-08-01

    Full Text Available Ankylosing Spondylitis (AS is a chronic, systemic, and autoimmune inflammatory disease which mainly affects axial skeleton. Despite current approaches in ankylosing spondylitis treatment, the disease frequently causes to thoracolumbar kyphotic deformity due to its progressive course. Many surgical procedures including decompression, stabilization and final fusion could be performed for the treatment of kyphotic deformity. Hydromyelia and syrinx are the terms used to define dilatation in central spinal cord. Some authors reported syringomyelia progression related to spinal operation. In our case; 48-year-old woman, who has been followed for ankylosing spondylitis; spinal cord injury secondary to syringomyelia was detected 7 years after stabilization surgery. Consequently, it should be kept in mind that syringomyelia, which is a rare complication, may develop in patients who underwent stabilization surgery.

  14. Mitral Valve Surgery in Patients with Systemic Lupus Erythematosus

    Directory of Open Access Journals (Sweden)

    Mahnoosh Foroughi

    2014-01-01

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

  15. CABG surgery in a patient with left iliac artery occlusion

    Directory of Open Access Journals (Sweden)

    Oscar F. De La Peña Brush

    2015-09-01

    Full Text Available We present the case of an 82 years old male with Congestive Heart Failure (Left Ventricle Ejection Fraction: 20% and Acute Pulmonary Edema secondary to Acute Myocardial Infarction that required Coronary Artery Bypass Graft (CABG surgery. Past Medical History included Aortoiliac Occlusive Ddisease with total occlusion of the Left Iliac Artery and collateral circulation to the left inferior limb through the Left Internal Mammary Artery (LIMA. CABG was perfomed without harvesting the LIMA due to high risk of leg ischemia. An attempt to revascularize the left limb previous to the cardiac surgery in other to do so. Would have been too risky in this case. After 2 months follow up, patient showed good clinical outcomes.

  16. Metacognition, social cognition, and symptoms in patients with first episode and prolonged psychoses.

    Science.gov (United States)

    Vohs, J L; Lysaker, P H; Francis, M M; Hamm, J; Buck, K D; Olesek, K; Outcalt, J; Dimaggio, G; Leonhardt, B; Liffick, E; Mehdiyoun, N; Breier, A

    2014-03-01

    While it has been documented that persons with prolonged schizophrenia have deficits in metacognition and social cognition, it is less clear whether these difficulties are already present during a first episode. To explore this issue we assessed and compared metacognition using the Metacognition Assessment Scale-Abbreviated (MAS-A) and social cognition using the Eyes, Hinting and Bell-Lysaker Emotional Recognition Tests (BLERT) in participants with first episode psychosis (FEP; n=26), participants with a prolonged psychosis (n=72), and a psychiatric control group consisting of persons with a substance use disorder and no history of psychosis (n=14). Analyses revealed that both psychosis cohorts scored lower than controls on the MAS-A total and all subscales except metacognitive mastery. Compared to the FEP group, the persons with prolonged psychosis demonstrated greater metacognitive capacities only in those MAS-A domains reflective of the ability to understand the mental state of others and to see that others may have motivations and desires separate from their own. Other domains of metacognition did not differ between psychosis groups. The Eyes, Hinting and BLERT scores of the two psychosis groups did not differ but were poorer than those produced by the control group. Exploratory correlations in the FEP group showed a pattern similar to that previously observed in prolonged psychosis. Taken together, these findings suggest that while certain domains of metacognition could improve with prolonged psychosis, difficulties with global metacognition and social cognition may be stable features of the disorder and perhaps unique to psychosis. Copyright © 2014 Elsevier B.V. All rights reserved.

  17. In situ saphenous vein bypass surgery in diabetic patients

    DEFF Research Database (Denmark)

    Jensen, L P; Schroeder, T V; Lorentzen, J E

    1992-01-01

    .005). Indication for surgery was gangrene or ulceration in 57% of diabetics, as opposed to 36% in non-diabetic patients (p = 0.0002). A femoro-popliteal bypass was performed in 18% of patients, whereas 82% received an infrapopliteal procedure, of which 42% were to the distal third of the calf or foot. Diabetic......From 1986 through to 1990 a total of 483 consecutive in situ infra-inguinal vein bypass procedures were performed in 444 patients, of whom 112 (25%) were diabetics (57 insulin dependent diabetes mellitus and 55 non-insulin-dependent diabetes mellitus). Based on a prospective vascular data registry...... this material was analysed to determine the influence of diabetes on the outcome. Preoperative risk factors were equally distributed among diabetic and non-diabetic patients, except for smoking habits (diabetics: 48%; non-diabetics: 64%, p = 0.002) and cardiac disease (diabetics: 45%; non-diabetics: 29%, p = 0...

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

    Science.gov (United States)

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

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Tomar Akhlesh

    2003-01-01

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

  20. Diagnostic criteria for bipolarity based on an international sample of 5,635 patients with DSM-IV major depressive episodes.

    Science.gov (United States)

    Angst, J; Gamma, A; Bowden, C L; Azorin, J M; Perugi, G; Vieta, E; Young, A H

    2012-02-01

    To assess the clinical validity of individual DSM-IV criteria for hypomania. In an international sample of 5,635 patients with major depressive episodes (Bridge Study), DSM-IV criteria for hypomania (stem questions, number and quality of symptoms, duration and exclusion criteria) were systematically assessed and their validity analysed on the basis of clinical data including family history, course, and other clinical characteristics. Three stem questions for hypomania, irritability, elevated mood and the added question of increased activity, showed comparable validity. The results support the current DSM-IV requirement for a higher symptom threshold (4 of 7 hypomanic symptoms) in cases of irritable mood. Longer durations of hypomanic episodes were associated with higher scores on all validators. The results did not support the DSM-IV durational requirements for hypomanic episodes (4 days) and manic episodes (7 days). Brief hypomanic episodes of 1, 2 or 3 days were valid and would meet validity criteria for inclusion. The three exclusion criteria in DSM-IV (hypomania due to the use of antidepressants or of other substances, or to other medical conditions) were found to exclude patients with bipolar depression and should therefore not be retained. These results support several revisions of the DSM-IV concept of hypomanic episodes: specifically, the inclusion of increased activity as a gate question, the inclusion of 1 or 2 to 3-day episodes and the elimination of all exclusion criteria.

  1. Cognition and the prediction of functioning in patients with a first treated episode of psychosis: a prospective study.

    Science.gov (United States)

    Norman, Ross M G; Carr, Jason; Manchanda, Rahul

    2015-03-01

    Past research on the role of cognitive performance in predicting later psychosocial functioning for individuals with first treated episode of a psychotic disorder has yielded inconsistent results. Several factors have been suggested as determining the strength of any such relationship including the type of functioning measured, time of the cognitive assessment, covariates included and the use of global versus specific measures of cognitive functioning. In the current study, we examined the importance of these factors in a five year prospective study of individuals with first episode psychotic disorders. Just over 80% of the sample had a schizophrenia spectrum disorder. Cognitive assessments were carried out after initiation of treatment on 113 patients, and at one year for 79 patients. There was evidence that cognition predicted occupational functioning and use of a disability pension, but not a summary index of functioning or use of supervised housing, at follow-up. Overall I.Q. was a more consistent predictor than measures of specific cognitive functions, and there was evidence that cognition assessed after presentation for treatment, particularly after a year of treatment, was more predictive of later functioning than premorbid I.Q. Cognitive functioning, however, did not add to the prediction of outcomes beyond the level possible using past educational achievement or academic premorbid adjustment.

  2. Social cognition in schizophrenia, Part 2: 12-month stability and prediction of functional outcome in first-episode patients.

    Science.gov (United States)

    Horan, William P; Green, Michael F; DeGroot, Michael; Fiske, Alan; Hellemann, Gerhard; Kee, Kimmy; Kern, Robert S; Lee, Junghee; Sergi, Mark J; Subotnik, Kenneth L; Sugar, Catherine A; Ventura, Joseph; Nuechterlein, Keith H

    2012-06-01

    This study evaluated the longitudinal stability and functional correlates of social cognition during the early course of schizophrenia. Fifty-five first-episode schizophrenia patients completed baseline and 12-month follow-up assessments of 3 key domains of social cognition (emotional processing, theory of mind, and social/relationship perception), as well as clinical ratings of real-world functioning and symptoms. Scores on all 3 social cognitive tests demonstrated good longitudinal stability with test-retest correlations exceeding .70. Higher baseline and 12-month social cognition scores were both robustly associated with significantly better work functioning, independent living, and social functioning at the 12-month follow-up assessment. Furthermore, cross-lagged panel analyses were consistent with a causal model in which baseline social cognition drove later functional outcome in the domain of work, above and beyond the contribution of symptoms. Social cognitive impairments are relatively stable, functionally relevant features of early schizophrenia. These results extend findings from a companion study, which showed stable impairments across patients in prodromal, first-episode, and chronic phases of illness on the same measures. Social cognitive impairments may serve as useful vulnerability indicators and early clinical intervention targets.

  3. Grey matter morphological anomalies in the caudate head in first-episode psychosis patients with delusions of reference.

    Science.gov (United States)

    Tao, Haojuan; Wong, Gloria H Y; Zhang, Huiran; Zhou, Yuan; Xue, Zhimin; Shan, Baoci; Chen, Eric Y H; Liu, Zhening

    2015-07-30

    Delusions of reference (DOR) are theoretically linked with aberrant salience and associative learning. Previous studies have shown that the caudate nucleus plays a critical role in the cognitive circuits of coding prediction errors and associative learning. The current study aimed at testing the hypothesis that abnormalities in the caudate nucleus may be involved in the neuroanatomical substrate of DOR. Structural magnetic resonance imaging of the brain was performed in 44 first-episode psychosis patients (with diagnoses of schizophrenia or schizophreniform disorder) and 25 healthy controls. Patients were divided into three groups according to symptoms: patients with DOR as prominent positive symptom; patients with prominent positive symptoms other than DOR; and patients with minimal positive symptoms. All groups were age-, gender-, and education-matched, and patient groups were matched for diagnosis, duration of illness, and antipsychotic treatment. Voxel-based morphometric analysis was performed to identify group differences in grey matter density. Relationships were explored between grey matter density and DOR. Patients with DOR were found to have reduced grey matter density in the caudate compared with patients without DOR and healthy controls. Grey matter density values of the left and right caudate head were negatively correlated with DOR severity. Decreased grey matter density in the caudate nucleus may underlie DOR in early psychosis.

  4. Nutrition interventions in patients with gynecological cancers requiring surgery.

    Science.gov (United States)

    Obermair, Andreas; Simunovic, Marko; Isenring, Liz; Janda, Monika

    2017-04-01

    Including developing countries, between 20 and 88% of gynecological oncology patients may present with at least mild malnutrition at diagnosis. Significant morbidity and mortality is attributed to malnutrition. Here we reviewed randomized clinical trials of nutritional interventions used to achieve early return to oral diet, enhance recovery from surgery and reduce adverse events in gynecological cancer patients undergoing surgery. Ebscohost (CINAHL+Medline+PsycINFO), Cochrane, Embase, PubMed and Scopus databases were searched for articles published from 2000 onwards. Potentially eligible articles were screened by two reviewers. Length of hospital stay (LOS), postoperative complications, recovery of intestinal function, quality of life (QOL), hematological and immunological parameters were outcome measures of the nutritional interventions. Seven randomized clinical trials were included in the review. Early clear liquid diet, semiliquid diet, regular diet or immune-enhanced enteral diets were all found to be safe as nutritional interventions. In five of the seven trials significantly better outcomes were observed in the intervention group compared to usual care for one of more of the outcomes intestinal recovery time, LOS, postoperative complications and immunological parameters. However, the nutritional interventions varied greatly between the trials, making it difficult to directly compare their findings. Trial quality was low to moderate. Recommended malnutrition screening and assessment tools and guidelines for treatment are reviewed. From the limited findings it would appear that nutritional interventions of early oral feeding and enteral feeding are safe. Receiving nutritional interventions seems to reduce LOS, intestinal recovery time and postoperative complications for some patients. Increasing use of neoadjuvant treatment may reduce the prevalence of patients presenting malnourished for surgery in the future. Crown Copyright © 2017. Published by Elsevier

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

    Institute of Scientific and Technical Information of China (English)

    Mahdi; Najafi; David; Faraoni

    2015-01-01

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

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

    Science.gov (United States)

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

    2005-11-01

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

  7. Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: a randomized double-blind study.

    Science.gov (United States)

    Simón-Talero, Macarena; García-Martínez, Rita; Torrens, Maria; Augustin, Salvador; Gómez, Susana; Pereira, Gustavo; Guevara, Mónica; Ginés, Pere; Soriano, Germán; Román, Eva; Sánchez-Delgado, Jordi; Ferrer, Roser; Nieto, Juan C; Sunyé, Pilar; Fuentes, Inma; Esteban, Rafael; Córdoba, Juan

    2013-12-01

    Episodic hepatic encephalopathy is frequently precipitated by factors that induce circulatory dysfunction, cause oxidative stress-mediated damage or enhance astrocyte swelling. The administration of albumin could modify these factors and improve the outcome of hepatic encephalopathy. The aim of this study is to assess the efficacy of albumin in a multicenter, prospective, double-blind, controlled trial (ClinicalTrials.gov number, NCT00886925). Cirrhotic patients with an acute episode of hepatic encephalopathy (grade II-IV) were randomized to receive albumin (1.5g/kg on day 1 and 1.0g/kg on day 3) or isotonic saline, in addition to the usual treatment (laxatives, rifaximin 1200mg per day). The primary end point was the proportion of patients in which encephalopathy was resolved on day 4. The secondary end points included survival, length of hospital stay, and biochemical parameters. Fifty-six patients were randomly assigned to albumin (n=26) or saline (n=30) stratified by the severity of HE. Both groups were comparable regarding to demographic data, liver function, and precipitating factors. The percentage of patients without hepatic encephalopathy at day 4 did not differ between both groups (albumin: 57.7% vs. saline: 53.3%; p>0.05). However, significant differences in survival were found at day 90 (albumin: 69.2% vs. saline: 40.0%; p=0.02). Albumin does not improve the resolution of hepatic encephalopathy during hospitalization. However, differences in survival after hospitalization suggest that the development of encephalopathy may identify a subgroup of patients with advanced cirrhosis that may benefit from the administration of albumin. Copyright © 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

  8. Gait and electromyographic analysis of patients recovering after limb-saving surgery

    NARCIS (Netherlands)

    De Visser, E; Mulder, T; Schreuder, HWB; Veth, RPH; Duysens, J

    2000-01-01

    Objective. Control of gait after limb-saving surgery. Design. Case series study. Background. At the moment little is known about adaptations in patients' gait after limb-saving surgery. Methods. Nineteen patients who underwent limb-saving surgery at least 1 yr earlier and 10 normal subjects were stu

  9. Physical Activity in Bariatric Surgery Patients: Does Temperament Matter?

    Science.gov (United States)

    Gruner-Labitzke, Kerstin; Claes, Laurence; Bartsch, Merle; Schulze, Mareike; Langenberg, Svenja; Köhler, Hinrich; Marschollek, Michael; de Zwaan, Martina; Müller, Astrid

    2017-07-01

    Our aim was to investigate if physical activity (PA) in bariatric surgery patients is related to temperament. Preoperative (n = 70) and post-operative (n = 73) patients were categorized as being physically 'active' versus 'inactive' on the basis of objective PA monitoring. Assessment included the behavioural inhibition system (BIS)/behavioural activation system (BAS) scales, the effortful control (EC) subscale of the Adult Temperament Questionnaire-Short Form, a numeric pain rating scale and measures for depressive and eating disorder symptoms. 'Active' did not differ from 'inactive' patients with regard to temperament (BIS, BAS, and EC). Regressions with PA grouping as dependent variable (adjusted for age, gender, body mass index (BMI), depressive or eating disorder symptoms, or pain intensity) indicated an association between lower BMI and more PA in the preoperative and the post-operative group. In the post-operative group, in addition to lower BMI, also lower age and higher BIS reactivity contributed to more PA. Furthermore, there was a significant interaction between BMI and BIS suggesting that low BMI was only associated with more PA in post-operative patients with high BIS. The results indicate that temperament per se does not contribute to the level of PA in bariatric surgery patients. However, in post-operative patients, lower BMI was associated with a higher likelihood of being physically active particularly in patients with anxious temperament. These preliminary findings need further investigation within longitudinal studies. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

  10. Perspectives on Episodic-like and Episodic Memory

    Directory of Open Access Journals (Sweden)

    Bettina M Pause

    2013-04-01

    Full Text Available Episodic memory refers to the conscious recollection of a personal experience that contains information on what has happened and also where and when it happened. Recollection from episodic memory also implies a kind of first-person subjectivity that has been termed autonoetic consciousness. Episodic memory is extremely sensitive to cerebral aging and neurodegenerative diseases. In Alzheimer’s disease deficits in episodic memory function are among the first cognitive symptoms observed. Furthermore, impaired episodic memory function is also observed in a variety of other neuropsychiatric diseases including dissociative disorders, schizophrenia and Parkinson disease. Unfortunately, it is quite difficult to induce and measure episodic memories in the laboratory and it is even more difficult to measure it in clinical populations. Presently, the tests used to assess episodic memory function do not comply with even down-sized definitions of episodic-like memory as a memory for what happened, where and when. They also require sophisticated verbal competences and are difficult to apply to patient populations. In this review, we will summarize the progress made in defining behavioral criteria of episodic-like memory in animals (and humans as well as the perspectives in developing novel tests of human episodic memory which can also account for phenomenological aspects of episodic memory such as autonoetic awareness. We will also define basic behavioral, procedural and phenomenological criteria which might be helpful for the development of a valid and reliable clinical test of human episodic memory.

  11. Sex-Specific Patterns of Aberrant Brain Function in First-Episode Treatment-Naive Patients with Schizophrenia

    Directory of Open Access Journals (Sweden)

    Wei Lei

    2015-07-01

    Full Text Available Male and female patients with schizophrenia show significant differences in a number of important clinical features, yet the neural substrates of these differences are still poorly understood. Here we explored the sex differences in the brain functional aberrations in 124 treatment-naïve patients with first-episode schizophrenia (61 males, compared with 102 age-matched healthy controls (50 males. Maps of degree centrality (DC and amplitude of low-frequency fluctuations (ALFF were constructed using resting-state functional magnetic resonance imaging data and compared between groups. We found that: (1 Selective DC reduction was observed in the right putamen (Put_R in male patients and the left middle frontal gyrus (MFG in female patients; (2 Functional connectivity analysis (using Put_R and MFG as seeds found that male and female patients have disturbed functional integration in two separate networks, i.e., the sensorimotor network and the default mode network; (3 Significant ALFF alterations were also observed in these two networks in both genders; (4 Sex specific brain functional alterations were associated with various symptoms in patients. These results suggested that sex-specific patterns of functional aberration existed in schizophrenia, and these patterns were associated with the clinical features both in male and female patients.

  12. A History of Childhood Trauma and Response to Treatment With Antipsychotics in First-Episode Schizophrenia Patients: Preliminary Results.

    Science.gov (United States)

    Misiak, Błażej; Frydecka, Dorota

    2016-10-01

    In this study, we aimed to investigate whether a history of childhood trauma (CT) can help predict early response to antipsychotic treatment in patients with first-episode schizophrenia (FES). We recruited 64 FES patients who were followed up after 12 weeks of treatment with second-generation antipsychotics. Symptomatic manifestation was examined using the Positive and Negative Syndrome Scale (PANSS). Childhood adversities were assessed using the Early Trauma Inventory Self-Report-Short Form. Nonresponders had significantly higher general trauma score, emotional abuse score, total trauma score, and baseline PANSS negative factor score. A history of CT was significantly more frequent among nonresponders. Logistic regression analysis revealed that positive history of CT, higher emotional abuse score, and higher baseline PANSS negative factor score are significant predictors of poor response to treatment. Our results indicate that a history of CT, especially emotional abuse, and higher severity of negative symptoms are independent predictors of poor response to treatment with antipsychotics.

  13. The association between psychopathology of first-episode psychosis patients within the schizophrenia spectrum and previous offending

    DEFF Research Database (Denmark)

    Munkner, Runa; Haastrup, Soeren; Joergensen, Torben

    2008-01-01

    Patients with schizophrenia have been shown to have an increased risk of criminality. The aim was to describe possible psychopathological differences between schizophrenia spectrum patients with and without a criminal career before first-episode psychosis. In a multi-centre study, 16 psychiatric...... were linked with data concerning criminal and psychiatric history. No key characteristics were found to assist the early detection of criminal persons before first psychiatric hospital contact for a psychotic incident. However, when adjusted for sex, age, abuse, living conditions, marital status......, employment status and education, a primarily positive symptomatology was associated with a prior criminal career. The premorbid level of functioning and several function parameters were also significantly associated with criminal history. There are significant differences in psychopathology between...

  14. [Patient satisfaction in ambulatory cataract surgery : Differences between outpatients in a special surgery or in a hospital].

    Science.gov (United States)

    Stein, I; Schoenfelder, T; Kugler, J

    2017-01-03

    The evaluation of patient satisfaction provides important information about subjective quality indicators from the patient's perspective. In Germany, cataract surgery is mostly done ambulatory in a special surgery or in a hospital. This study examines if there are differences in global patient satisfaction of either outpatient setting and if there are different determinants of global satisfaction with regard to the outpatient settings. The survey comprises ambulatory operated cataract patients in Saxony between 2014 and 2015. A total of 4800 cataract patients sent back a standardized, written questionnaire. Regression analysis identified determinants of global patient satisfaction in both groups. The most influencing parameters for the global satisfaction were satisfaction with the treatment outcome, atmosphere and facilities in the surgery or hospital as well as the staff's level of kindness. Results of the conducted study show most identified determinants of patient satisfaction are associated with service variables, such as atmosphere and facilities in surgery or hospital and waiting time in surgery or hospital. These aspects should be focused on to improve patient satisfaction in cataract patients.

  15. Rural patients' experiences accessing surgery in British Columbia.

    Science.gov (United States)

    Humber, Nancy; Dickinson, Paul

    2010-12-01

    More than 33% of Canadians live in rural areas. The vulnerability of rural surgical patients makes them particularly sensitive to barriers to accessing health care. This study aims to describe rural patients' experiences accessing local nonspecialist, family physician-surgeon care and regional specialist surgical care when no local surgical care was available. We conducted a qualitative pilot study of self-selected patients. Interviews were analyzed using a modified Delphi technique and NVivo qualitative software. The needs of rural surgical patients were reflective of Maslow's hierarchy of needs: physiologic, safety and security, community belonging and self-esteem/self-actualization. Rural patients expressed a strong desire for individualized care in a familiar environment. When such care was not available, patients found it difficult to meet even basic physiologic needs. Maternity patients and marginalized populations were particularly vulnerable. Rural patients seem to prefer individualized care in a familiar environment to address more of their qualitative emotional, psychological and cultural needs rather than only the physiologic needs of surgery. Larger studies are needed to delineate more clearly the qualitative aspects of surgical care.

  16. Is Seizure Surgery an Option for Patients with Very Low IQ?

    National Research Council Canada - National Science Library

    Garcia, Paul

    2008-01-01

    Epilepsy surgery has been questioned for patients with low IQ, since a low cognitive level is taken to indicate a widespread disturbance of cerebral function with unsatisfactory prognosis following resective surgery...

  17. Seizure outcome after resective epilepsy surgery in patients with low IQ

    National Research Council Canada - National Science Library

    Malmgren, Kristina; Olsson, Ingrid; Engman, Elisabeth; Flink, Roland; Rydenhag, Bertil

    2008-01-01

    Epilepsy surgery has been questioned for patients with low IQ, since a low cognitive level is taken to indicate a widespread disturbance of cerebral function with unsatisfactory prognosis following resective surgery...

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

    Science.gov (United States)

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

    2011-03-01

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

  19. [Enteral nutrition in maxillofacial surgery patients (1989-1995)].

    Science.gov (United States)

    Orduña Espinosa, R M; Giménez Martínez, R; Luján Selles, J M; Laguna Salguero, J I; Pérez de la Cruz, A J

    1996-01-01

    One of the clearest indications for enteral nutrition is made up by patients who underwent treatment for orofacial pathology. In this way, we have reviewed retrospectively, 321 clinical histories of patients who underwent treatment (orofacial surgery), dividing these according to the pathology; neoplasia or non-neoplasia (173/148), with enteral nutrition 24 hours after the intervention. Data are collected with regard to the tolerance (vomiting, diarrhea), time needed to reach 1.500 kcal/day, need of parenteral nutritional support, transferrin, prealbumin, and albumin quantification at the start of the nutritional therapy, as well as the total duration there of. Globally, the good enteric tolerance of both groups of patients is noted, despite the fact that the oncological group showed a greater degree of protein malnutrition (statistically significant). As for the total duration of the nutrition, this is greater in the neoplasias, probably due to a more aggressive surgery. The results obtained permit modification of the basic enteral nutrition protocol (reduction of the time used to reach the maximum volume), as well as stressing the preoperative and postoperative regulated nutritional evaluation.

  20. Morbidity of Early Spine Surgery in the Multiply Injured Patient

    Science.gov (United States)

    2014-07-31

    EBL ) were obtained by inspection of the 1212 Arch Orthop Trauma Surg (2014) 134:1211–1217 123 anesthesia record. If a patient underwent multiple proce...3.5. Mean operative time for the spine surgery was 3.7 h. Mean EBL from the anesthesia record was 902.5 mL (median 575), with a wide range noted...50 mL to 4 L). Eight (27 %) cases had EBL exceeding Table 1 Cohort characteristics Mean (median) Range Age (years) 27.6 (25.9) (19.3, 47.3) ISS 26.1

  1. Baropodometric analyses of patients before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Ivan Leo Bacha

    2015-11-01

    Full Text Available OBJECTIVE: The aim of this study was to evaluate the vertical component of the ground reaction force, plantar pressure, contact area of the feet and double-support time using static and dynamic (gait baropodometry before and after bariatric surgery. METHODS: Sixteen individuals with a body mass index of between 35 and 55 were evaluated before and after bariatric surgery. Thirteen patients (81.3% were female and three (18.8% male and their average age was 46±10 (21-60 years. An FSCAN system (version 3848 was used for baropodometric analyses (1 km/h and 3 km/h. The peak plantar pressure and ground reaction force were measured for the rear foot and forefoot. The double-support time and foot contact area were measured during gait. RESULTS: There were reductions in the ground reaction force in the forefoot and rear foot and in the foot contact area in all evaluations and of the double-support time at 3 km/h, as well as a significant reduction in the body mass index at six months post-surgery. The peak pressure did not vary at 1 km/h and at 3 km/h, reductions in peak pressure were observed in the left and right rear feet and left forefoot. CONCLUSIONS: Weight loss after bariatric surgery resulted in decreases in the ground reaction force and contact area of the foot. Plantar pressure was decreased at 3 km/h, especially in the forefoot. There was an increase in rhythm because of a reduction in the double-support time at 3 km/h.

  2. Overgeneral autobiographical memory at baseline predicts depressive symptoms at follow-up in patients with first-episode depression.

    Science.gov (United States)

    Liu, Yansong; Zhang, Fuquan; Wang, Zhiqiang; Cao, Leiming; Wang, Jun; Na, Aiguo; Sun, Yujun; Zhao, Xudong

    2016-09-30

    Previous studies have shown that overgeneral autobiographical memory (OGM) is a characteristic of depression. However, there are no studies to explore the association between baseline OGM and depressive symptoms at follow-up in patients with first-episode depression (FE). This study investigated whether baseline OGM predicts depressive symptoms at follow-up in patients with FE. We recruited 125 patients with FE. The participants were divided into remitted group and non-remitted group according to the severity of their depression at 12 months follow-up. The measures consisted of the 17-item Hamilton Depression Rating Scale, Ruminative Response Scale, and Autobiographical Memory Test. Hierarchical linear regression analyses and bootstrap mediation analyses were conducted. The results showed that non-remitted patients had more OGM at baseline. Baseline OGM predicted depressive symptoms at follow-up in patients with FE. Rumination mediated the relationship between baseline OGM and depressive symptoms at follow-up. Our findings highlight OGM as a vulnerability factor involved in the maintenance of depression in patients with FE.

  3. Flat affect and social functioning: a 10 year follow-up study of first episode psychosis patients.

    Science.gov (United States)

    Evensen, Julie; Røssberg, Jan Ivar; Barder, Helene; Haahr, Ulrik; Hegelstad, Wenche Ten Velden; Joa, Inge; Johannessen, Jan Olav; Larsen, T K; Melle, Ingrid; Opjordsmoen, Stein; Rund, Bjørn Rishovd; Simonsen, Erik; Vaglum, Per; McGlashan, Thomas; Friis, Svein

    2012-08-01

    Affective flattening has been described as enduring, but long term follow-up studies of first episode psychosis patients are lacking. The aim of this study was to follow the symptom development of flat affect (FA), over a 10 year follow-up period, with focus on prevalence, predictors and outcome factors including social functioning. Three-hundred-and-one patients with FEP were included at baseline, 186 participated in the 10 year follow-up. These were followed on PANSS item N1 (FA) from baseline through 5 follow-up assessments over 10 years. Patients were grouped as having never-present, improving, deteriorating, fluctuating or enduring FA. The groups were compared on baseline variables, variables at 10 year follow-up, and social functioning throughout the follow-up period. Twenty nine percent never displayed FA, 66% had improving, deteriorating or fluctuating FA, while 5% of patients had enduring FA. Premorbid social function predicted enduring FA. The patients with enduring, fluctuating and deteriorating FA did poorer on all outcome variables, including remission and recovery rates. The enduring FA group did significantly poorer in social functioning over the 10 year period. FA is expressed at some point of time in the majority of FEP patients in a 10 year follow-up period, and appears more fluctuant than expected from the relevant literature. FA is associated with poorer outcome after 10 years, and enduring FA to poorer social function at all points of assessment. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. Longitudinal volume changes of the pituitary gland in patients with schizotypal disorder and first-episode schizophrenia.

    Science.gov (United States)

    Takahashi, Tsutomu; Zhou, Shi-Yu; Nakamura, Kazue; Tanino, Ryoichiro; Furuichi, Atsushi; Kido, Mikio; Kawasaki, Yasuhiro; Noguchi, Kyo; Seto, Hikaru; Kurachi, Masayoshi; Suzuki, Michio

    2011-01-15

    An enlarged volume of the pituitary gland has been reported in the schizophrenia spectrum, possibly reflecting the hypothalamic-pituitary-adrenal (HPA) hyperactivity. However, it remains largely unknown whether the pituitary size longitudinally changes in the course of the spectrum disorders. In the present study, longitudinal magnetic resonance imaging (MRI) data were obtained from 18 patients with first-episode schizophrenia, 13 patients with schizotypal disorder, and 20 healthy controls. The pituitary volume was measured at baseline and follow-up (mean, 2.7 years) scans and was compared across groups. The pituitary volume was larger in the schizophrenia patients than controls at baseline, and both patient groups had significantly larger pituitary volume than controls at follow-up. In a longitudinal comparison, both schizophrenia (3.6%/year) and schizotypal (2.7%/year) patients showed significant pituitary enlargement compared with controls (-1.8%/year). In the schizophrenia patients, greater pituitary enlargement over time was associated with less improvement of delusions and higher scores for thought disorders at the follow-up. These findings suggest that the pituitary gland exhibits ongoing volume changes during the early course of the schizophrenia spectrum as a possible marker of state-related impairments. Copyright © 2010 Elsevier Inc. All rights reserved.

  5. Quality of life of patients who undergone myocardial revascularization surgery

    Directory of Open Access Journals (Sweden)

    Hirla Vanessa Soares de Araújo

    Full Text Available ABSTRACT Objective: to evaluate the quality of life of patients who underwent revascularization surgery. Method: a descriptive, cross sectional study, with quantitative approach carried out with 75 patients. The questionnaire WHOQOL-Bref was used to evaluate the quality of life (QOL. Results: patients' QOL evaluation presented a moderate result, with need of improvement of all domains. Low income patients had the worst evaluation of QOL in the domain environment (p=0,021, and the ones from Recife/metropolitan area, in the domain social relationship (p=0,021. Smoker (p=0,047, diabetic (p=0,002 and alcohol consumption (p=0,035 patients presented the worst evaluation of the physical domain. Renal patients presented the worst evaluation of QOL in the physical (P=0,037, psychological (p=0,008, social relationship (p=0,006 domains and total score (p=0,009. Conclusion: the improvement of QOL depends on the individual's process of behavioral change and the participation of health professionals is essential to formulate strategies to approach these patients, especially concerning health education.

  6. Patient information and patient preparation in orthognathic surgery : A medical audit study

    NARCIS (Netherlands)

    Rittersma, J.; Casparie, A.F.; Reerink, E.

    1980-01-01

    In 110 patients who had undergone various kinds of orthognathic surgery, patient satisfaction was measured by means of a written questionnaire. Ninety-four percent expressed satisfaction, both with regard to total preparation and the final outcome of the surgical procedure itself. Twenty to forty p

  7. The influence of episodic mood disorders on length of stay among patients admitted to private and non-profit hospitals with alcohol dependence syndrome

    Directory of Open Access Journals (Sweden)

    Justin B. Dickerson

    2011-02-01

    Full Text Available Episodic mood disorders are often associated with alcohol dependence. Few studies have explored the contribution of episodic mood disorders to length of stay among those hospitalized with alcohol dependence syndrome. Filling this research gap could improve care for patients while minimizing hospital utilization costs. This study was a cross-sectional analysis of the National Hospital Discharge Survey. ICD-9-CM diagnosis codes were used to identify those admitted to a private or non-profit hospital with alcohol dependence syndrome, and a co-morbid diagnosis of an episodic mood disorder (n=358. Descriptive statistics were used to highlight differences in key demographic and hospital variables between those with and without episodic mood disorders. Negative binomial regression was used to associate episodic mood disorders with hospital length of stay. Incidence rate ratios were calculated. Co-morbid episodic mood disorders (b=0.31, P=0.001, referral to a hospital by a physician (b=0.35, P=0.014, and increasing age (b= 0.01, P=0.001 were associated with longer hospital stays. Hospital patients with an admitting diagnosis of alcohol dependence syndrome were 36% more likely to have a longer hospital stay if they also had a co-morbid diagnosis of an episodic mood disorder (IRR=1.36, CI=1.14-1.62. Patients admitted to a hospital with alcohol dependence syndrome should be routinely screened for episodic mood disorders. Opportunities exist for enhanced transitional care between acute, ambulatory, and community-based care settings to lower hospital utilization.

  8. The influence of episodic mood disorders on length of stay among patients admitted to private and non-profit hospitals with alcohol dependence syndrome.

    Science.gov (United States)

    Dickerson, Justin B

    2011-02-22

    Episodic mood disorders are often associated with alcohol dependence. Few studies have explored the contribution of episodic mood disorders to length of stay among those hospitalized with alcohol dependence syndrome. Filling this research gap could improve care for patients while minimizing hospital utilization costs. This study was a cross-sectional analysis of the National Hospital Discharge Survey. ICD-9-CM diagnosis codes were used to identify those admitted to a private or non-profit hospital with alcohol dependence syndrome, and a co-morbid diagnosis of an episodic mood disorder (n=358). Descriptive statistics were used to highlight differences in key demographic and hospital variables between those with and without episodic mood disorders. Negative binomial regression was used to associate episodic mood disorders with hospital length of stay. Incidence rate ratios were calculated. Co-morbid episodic mood disorders (β=0.31, P=0.001), referral to a hospital by a physician (β=0.35, P=0.014), and increasing age (β= 0.01, P=0.001) were associated with longer hospital stays. Hospital patients with an admitting diagnosis of alcohol dependence syndrome were 36% more likely to have a longer hospital stay if they also had a co-morbid diagnosis of an episodic mood disorder (IRR=1.36, CI=1.14-1.62). Patients admitted to a hospital with alcohol dependence syndrome should be routinely screened for episodic mood disorders. Opportunities exist for enhanced transitional care between acute, ambulatory, and community-based care settings to lower hospital utilization.

  9. EVALUATION OF ANXIETY & DEPRESSIVE SYMPTOMS IN PATIENTS WITH 1 ST EPISODE OF CHEST PAIN ATTENDING MEDICINE OUT PATIENT DEPARTMENT OF TERTIARY CARE TEACHING HOSPITAL

    Directory of Open Access Journals (Sweden)

    Bhavik S.

    2015-06-01

    Full Text Available INTRODUCTION: As chest pain is an important symptom of coronary artery disease (CAD and other non - cardiac diseases , the presentation of the symptom often prompts referral to physicians for further investigation. Previous studies h ad shown significant as sociation between chest pain and D e pr e ssive and anxiety symptoms. AIMS AND OBJECTIVES: Evaluate and screen depressive symptoms , anxiety symptoms and somatic symptoms in patients with 1 st episode of chest pain attending medicine out - patient department of tertiary care teaching hospital. METHODOLGY : Cross - sectional observational study. Prior permission from institutional ethics committee of ‘SUMANDEEP VIDYAPEETH’ had been taken. 100 patients having first episosde of chest pain coming to M edicine opd of DHIRAJ HOSPITAL are recruited randomly after 1st December 2014. Each patient is given case r eport form containing sociodemographic data , patients medical history , depression and somatic symptoms scale and Hamilton’s anxiety scale (HAM - A. All data are entered in spss 16 and analysed with different ( S tatistical tests. Differences on categorical m easures will be reported as P value. The result is significant if P <0.05. RESULT: 38% & 49% patients have clinically significant depression and anxiety respectively. DSSS score is positively correlated with duration of chest pain. CONCLUSION : significant level of depression and anxiety found in 1 st episode of chest pain patients.

  10. [Clinical Review of Hypospermatogenesis in Patients with a Previous Episode of Mumps Orchitis].

    Science.gov (United States)

    Takeshima, Teppei; Yumura, Yasushi; Iwasaki, Akira; Noguchi, Kazumi

    2015-06-01

    This study included 10 patients who had developed mumps orchitis previously and had visited our hospital from January 1997 to November 2007. The present illness, testicular volume and semen analysis of 7 of these patients were retrospectively investigated. Semen analyses and pregnancy statuses were followed up over time. The mean age of the 7 patients was 33 years (range, 21-43 years). Four patients had unilateral (right side) orchitis, and three had bilateral orchitis. In the unilateral orchitis group, 1 patient had an atrophic testis. Findings of semen analysis were severe oligozoospermia in three and mild oligozoospermia in one. None of the patients in the bilateral orchitis group, had atrophic testes. Findings of semen analysis were azoospermia in one and severe oligozoospermia in two patients. Findings of semen analysis in most patients improved gradually, and wives of 2 patients eventually achieved pregnancy. Dysfunction of seminiferous tubules in the diseased testis is thought to be reversible when treated adequately in the initial phase. In the patients not conceiving successfully, testicular sperm extraction (TESE) and assisted reproductive technique (ART) are thought to be effective ways to achieve pregnancy.

  11. Gynaecological Prolapse Surgery in Very Old Female Patients

    Science.gov (United States)

    Mothes, A. R.; Lehmann, T.; Kwetkat, A.; Radosa, M. P.; Runnebaum, I. B.

    2016-01-01

    Background: The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications. Method: In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Studentʼs t, Fisherʼs exact and Mann-Whitney U tests. Results: The analysis comprised n = 57 vs. n = 60 operations. In the very elderly patients there was often a grade IV prolapse (p < 0.001), apical fixations were more frequent (p < 0.001), but the operating times were not different. In the very elderly patients 21 % CD II+III complications were observed, in the control group 6.6 % (p = 0.031). No CD IV and V complications occurred in either group, the duration of inpatient stay amounted to 5 (± 1) vs. 4.1 (± 0.8; p < 0.001) days, the very elderly patients needed an inpatient follow-up more frequently (p < 0.001). The co-morbidities of the very elderly patients differed from those of the control group in number (median 2.0 vs. 1.5; p < 0.001), in CIRS-G (4.1 ± 2.2 vs. 2.4 ± 1.7; p < 0.01) and in Charlson Index (1.6 ± 1.6 vs. 0.5 ± 0.7; p < 0.001). Conclusions: A prolapse in very elderly women can be safely managed by surgery. In no case did the complications require intensive care treatment nor were they life-threatening, but they did lead to a longer duration of hospital stay and more frequently to further treatment geriatric or inpatient internal medicine facilities. PMID:27582580

  12. Criticism and Depression among the Caregivers of At-Risk Mental State and First-Episode Psychosis Patients.

    Science.gov (United States)

    Hamaie, Yumiko; Ohmuro, Noriyuki; Katsura, Masahiro; Obara, Chika; Kikuchi, Tatsuo; Ito, Fumiaki; Miyakoshi, Tetsuo; Matsuoka, Hiroo; Matsumoto, Kazunori

    2016-01-01

    Expressed emotion (EE), especially criticism, is an important predictor of outcomes for the patient for a wide range of mental health problems. To understand complex links between EE and various relevant variables in early phase psychosis, this study examined criticism, distress of caregivers, other patients', and caregivers' variables, and links between criticism and these variables in those with at-risk mental state (ARMS) for psychosis and first-episode psychosis (FEP). The participants were 56 patients (mean age 18.8 ± 4.2 years) with ARMS and their caregivers (49.4 ± 5.8 years) and 43 patients (21.7 ± 5.2 years) with FEP and their caregivers (49.3 ± 7.4 years). We investigated criticisms made by caregivers using the Japanese version of the Family Attitude Scale and caregiver depressive symptoms via the self-report Beck Depression Inventory. We also assessed psychiatric symptoms and functioning of the patients. Approximately one-third of caregivers of patients with ARMS or FEP had depressive symptoms, predominately with mild-to-moderate symptom levels, whereas only a small portion exhibited high criticism. The level of criticism and depression were comparable between ARMS and FEP caregivers. The link between criticism, caregivers' depression, and patients' symptoms were observed in FEP but not in ARMS caregivers. These findings imply that the interaction between criticism and caregivers' and patients' mental states may develop during or after the onset of established psychosis and interventions for the caregivers should be tailored to the patient's specific stage of illness. Interventions for FEP caregivers should target their emotional distress and include education about patient's general symptoms.

  13. The relationship between facial emotion recognition and executive functions in first-episode patients with schizophrenia and their siblings.

    Science.gov (United States)

    Yang, Chengqing; Zhang, Tianhong; Li, Zezhi; Heeramun-Aubeeluck, Anisha; Liu, Na; Huang, Nan; Zhang, Jie; He, Leiying; Li, Hui; Tang, Yingying; Chen, Fazhan; Liu, Fei; Wang, Jijun; Lu, Zheng

    2015-10-08

    Although many studies have examined executive functions and facial emotion recognition in people with schizophrenia, few of them focused on the correlation between them. Furthermore, their relationship in the siblings of patients also remains unclear. The aim of the present study is to examine the correlation between executive functions and facial emotion recognition in patients with first-episode schizophrenia and their siblings. Thirty patients with first-episode schizophrenia, their twenty-six siblings, and thirty healthy controls were enrolled. They completed facial emotion recognition tasks using the Ekman Standard Faces Database, and executive functioning was measured by Wisconsin Card Sorting Test (WCST). Hierarchical regression analysis was applied to assess the correlation between executive functions and facial emotion recognition. Our study found that in siblings, the accuracy in recognizing low degree 'disgust' emotion was negatively correlated with the total correct rate in WCST (r = -0.614, p = 0.023), but was positively correlated with the total error in WCST (r = 0.623, p = 0.020); the accuracy in recognizing 'neutral' emotion was positively correlated with the total error rate in WCST (r = 0.683, p = 0.014) while negatively correlated with the total correct rate in WCST (r = -0.677, p = 0.017). People with schizophrenia showed an impairment in facial emotion recognition when identifying moderate 'happy' facial emotion, the accuracy of which was significantly correlated with the number of completed categories of WCST (R(2) = 0.432, P emotion recognition in the healthy control group. Our study demonstrated that facial emotion recognition impairment correlated with executive function impairment in people with schizophrenia and their unaffected siblings but not in healthy controls.

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

    Science.gov (United States)

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

    2012-01-01

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

  15. Effects of Dopamine D2/D3 Blockade on Human Sensory and Sensorimotor Gating in Initially Antipsychotic-Naive, First-Episode Schizophrenia Patients

    DEFF Research Database (Denmark)

    Düring, Signe; Glenthøj, Birte Y; Andersen, Gitte Saltoft;

    2014-01-01

    , habituation, and sensitization. Treatment with amisulpride showed no effects on these measures, either at 2 or 6 weeks of follow-up. This is the first study investigating the effects of monotherapy with a relatively selective dopamine D2/D3 receptor antagonist (amisulpride) on sensory and sensorimotor gating......, the effects of a potent D2/D3 receptor antagonist, amisulpride, were investigated on PPI and P50 gating in a large sample of antipsychotic-naive, first-episode patients with schizophrenia. A total of 52 initially antipsychotic-naive, first-episode schizophrenia patients were assessed for their P50 gating, PPI...... deficits in a longitudinal study of a large group of initially antipsychotic-naive, first-episode patients with schizophrenia. Our finding that amisulpride effectively reduced symptom severity in our patients without reducing their PPI deficits indicates that increased activity of dopamine D2 receptors may...

  16. Outcome of Anesthesia and Open Heart Surgery in Pregnant Patients

    Directory of Open Access Journals (Sweden)

    Golamali Mollasadeghi

    2007-06-01

    Full Text Available Background: Cardiovascular disease is an important non-obstetric cause of maternal and fetal /neonatal morbidity and mortality during pregnancy. For a pregnant woman with cardiac disease, the potential inability of the maternal cardiovascular system to contend with normal pregnancy-induced physiologic changes may produce deleterious effects on both mother and fetus. To determine the most frequent surgical indications of maternal and fetal mortality, we studied 15 cases of severe cardiac disease in pregnant women who required cardiac surgical procedures. Methods: In this descriptive study, fifteen pregnant women who underwent cardiac surgery were studied. Maternal age ranged from 27 to 36 years, and gestational age varied from 4 to 22 weeks. Most of the patients were in New York Heart Association Classes II and III. Opioid- based anesthesia with fentanyl citrate (50µ/kg or sufentanil (5µ/kg plus low dose of thiopental were used for the induction of anesthesia. During non-pulsatile cardio-pulmonary bypass, core temperature was between 28-36 °C, average CBP time was 61.2±22 min, average aortic cross-clamp time was 34.13±14 min, and mean pump pressure was maintained between 65-80 mmHg. Results: Ten patients had severe mitral valve disease (66.6%, three had aortic valve disease (20%, one had subvalvular aortic stenosis (6.7%, and the remaining one had left atrial myxoma (6.7%. There were five fetal deaths (33.3% and one maternal death (6.7%. Conclusion: It seems that open heart surgery in the first trimester is very hazardous for the fetus and may lead to fetal death. If possible, surgery should be carried out in the second trimester of pregnancy. The recommendations are simply guidelines because research data and clinical experience in this area are limited.

  17. Acute kidney injury in patients undergoing cardiac surgery.

    Science.gov (United States)

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

    2013-01-01

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

  18. CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY

    DEFF Research Database (Denmark)

    Elenius Madsen, Daniel

    2012-01-01

    Title: CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY Objectives: Orthognathic surgery involves surgical manipulation of jaw and face skeletal structure. A subgroup of patients undergoing orthognathic surgery suffers from excessive ...... to their bleeding risk. This valuable knowledge will be useful with regard to optimization of patient safety, staff composition and transfusion preparations. This pilot study included only 41 patients, and further studies are needed to consolidate the observations done....

  19. CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY

    DEFF Research Database (Denmark)

    Elenius Madsen, Daniel

    2012-01-01

    Title: CLASSIFICATION OF ORTHOGNATHIC SURGERY PATIENTS INTO LOW AND HIGH BLEEDING RISK GROUPS USING THROMBELASTOGRAPHY Objectives: Orthognathic surgery involves surgical manipulation of jaw and face skeletal structure. A subgroup of patients undergoing orthognathic surgery suffers from excessive...... intraoperative blood loss. Classification of patients according to their bleeding risk will improve the surgical procedure with regard to staff composition, blood transfusion and patient safety. Thrombelastography is a global coagulation assay measuring the viscoelastic properties of whole blood samples, taking...

  20. Interest in bariatric surgery among obese patients with obstructive sleep apnea.

    Science.gov (United States)

    Dudley, Katherine A; Tavakkoli, Ali; Andrews, Robert A; Seiger, Ashley N; Bakker, Jessie P; Patel, Sanjay R

    2015-01-01

    Standard obstructive sleep apnea (OSA) therapies are poorly tolerated. Bariatric surgery is a potential alternative but the level of interest in this intervention among OSA patients is unknown. Determine the proportion of OSA patients who would be interested in bariatric surgery. Sleep clinics, United States. Consecutive adult patients with untreated severe OSA and a body mass index of 35-45 kg/m(2) were approached. Patients at low perioperative risk and no urgent indication for OSA treatment were invited to a separate informational visit about bariatric surgery as primary treatment for OSA. Of 767 eligible patients, 230 (30.0%) were not at low perioperative risk, 49 (6.4%) had drowsy driving, and 16 (2.1%) had no insurance coverage for bariatric surgery. Of the remaining 482 patients, over one third (35.5%) were interested in bariatric surgery. Surgical interest was 47.2% in women versus 27.6% in men (Pbariatric surgery interest. Nearly two thirds of obese patients with severe OSA are good candidates for bariatric surgery. Among candidates, over one third are interested in this treatment. Interest rates are highest among women and diabetics, indicating that metabolic improvements continue to be a major driver of surgery even in patients with severe OSA. Given patient interest, the role of bariatric surgery should be routinely discussed with obese OSA patients. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  1. Antiplatelet therapy and outcome in patients undergoing surgery following coronary stenting: Results of the surgery after stenting registry.

    Science.gov (United States)

    Rossini, Roberta; Angiolillo, Dominick J; Musumeci, Giuseppe; Capodanno, Davide; Lettino, Maddalena; Trabattoni, Daniela; Pilleri, Annarita; Calabria, Paolo; Colombo, Paola; Bernabò, Paola; Ferlini, Marco; Ferri, Marco; Tarantini, Giuseppe; De Servi, Stefano; Savonitto, Stefano

    2017-01-01

    The aim of the present study was to define the feasibility and clinical impact of complying with national consensus recommendations on perioperative management of antiplatelet therapy in patients with coronary stents undergoing cardiac and noncardiac surgery. There are limited evidence-based recommendations on the perioperative management of antiplatelet therapy in stented patients undergoing surgery. The recommendations provided by the national consensus document were applied in a multicenter, prospective registry of consecutive patients with prior coronary stenting undergoing any type of surgery at 19 hospitals in Italy. The primary end-point was in-hospital net adverse clinical events (NACE) represented by the composite of all-cause death, myocardial infarction, probable/definite stent thrombosis and Bleeding Academic Research Consortium (BARC) grade ≥3 bleeding. Patients were followed for 30 days. A total of 1,082 patients were enrolled. Adherence to consensus recommendations occurred in 85% of the cases. Perioperative aspirin and dual antiplatelet therapy were maintained in 69.7 and 10.5% of the cases, respectively. In-hospital NACE rate was 12.7%, being significantly higher in patients undergoing cardiac surgery (36.3% vs. 7.3%, P antiplatelet therapy in stented patients undergoing surgery. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  2. Patients with chronic headache tend to have more psychological symptoms than those with sporadic episodes of pain

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Junqueira Zampieri

    2014-08-01

    Full Text Available There are controversial associations between headaches and psychological symptoms. Objective To design a profile of neuroticism, a term that groups variables related to negative personality traits, in patients with chronic daily headache (CDH when compared to episodic migraine (EM patients, applying the Factorial Scale of Emotional Adjustment/Neuroticism (NFS. Method One hundred adult patients with CDH and forty with EM answered the NFS. Results Comorbidities of subtypes of neuroticism (p=0.006 were more common in chronic daily headache patients, with three or more disorders (p=0.0002: dependent personality disorder (p=0.0001, anxiety, reduced concentration and production (p=0.0008, depression (p<0.0001, suicidal ideation (p=0.0008 and hopelessness even without depression (p<0.0001. Conclusion Patients with CDH tend to have dependent personality disorder, low production and concentration, anxiety, depression, suicidal ideation and hopelessness, superimposing two or more psychological disorders. These factors should be pondered for a better resolution in the treatment of CDH.

  3. The history of childhood trauma is associated with lipid disturbances and blood pressure in adult first-episode schizophrenia patients.

    Science.gov (United States)

    Misiak, Błażej; Kiejna, Andrzej; Frydecka, Dorota

    2015-01-01

    It has repeatedly been found that early-life traumatic events may contribute to metabolic dysregulation. Therefore, the aim of this study was to investigate the association between the history of childhood trauma and cardiovascular risk factors in first-episode schizophrenia (FES) patients. The history of childhood trauma was assessed using the Early Trauma Inventory Self Report - Short Form (ETISR-SF) in 83 FES patients. Based on the ETISR-SF, patients were divided into those with positive and negative history of childhood trauma: FES(+) and FES(-) patients. Serum levels of fasting glucose lipids, homocysteine, vitamin B12 and folate, as well as anthropometric parameters and resting systolic and diastolic blood pressure (SBP and DBP) were measured. The history of childhood trauma was associated with higher low-density lipoprotein (LDL) levels, SBP and DBP after covarying for age, gender, body mass index, education and chlorpromazine equivalent. There were significant correlations between scores of distinct ETISR-SF subscales and LDL, high-density lipoprotein, SBP, DBP and the number of metabolic syndrome criteria. Results of this study indicate that traumatic events during childhood might be related to higher resting blood pressure and higher LDL levels in adult FES patients. Copyright © 2015. Published by Elsevier Inc.

  4. Patient surveillance after curative-intent surgery for rectal cancer.

    Science.gov (United States)

    Johnson, Frank E; Longo, Walter E; Ode, Kenichi; Shariff, Umar S; Papettas, Trifonas; McGarry, Alaine E; Gammon, Steven R; Lee, Paul A; Audisio, Riccardo A; Grossmann, Erik M; Virgo, Katherine S

    2005-09-01

    The follow-up of patients with rectal cancer after potentially curative resection has significant financial and clinical implications for patients and society. The ideal regimen for monitoring patients is unknown. We evaluated the self-reported practice patterns of a large, diverse group of experts. There is little information available describing the actual practice of clinicians who perform potentially curative surgery on rectal cancer patients and follow them after recovery. The 1795 members of the American Society of Colon and Rectal Surgeons were asked, via a detailed questionnaire, how often they request 14 discrete follow-up modalities in their patients treated for cure with TNM stage I, II, or III rectal cancer over the first five post-treatment years. 566/1782 (32%) responded and 347 of the respondents (61%) provided evaluable data. Members of the American Society of Colon and Rectal Surgeons typically follow their own patients postoperatively rather than sending them back to their referral source. Office visit and serum CEA level are the most frequently requested items for each of the first five postoperative years. Endoscopy and imaging tests are also used regularly. Considerable variation exists among these highly experienced, highly credentialed experts. The surveillance strategies reported here rely most heavily on relatively simple and inexpensive tests. Endoscopy is employed frequently; imaging tests are employed less often. The observed variation in the intensity of postoperative monitoring is of concern.

  5. Physical activity and anomalous bodily experiences in patients with first-episode schizophrenia

    DEFF Research Database (Denmark)

    Nyboe, Lene; Moeller, Marianne K; Vestergaard, Claus H

    2016-01-01

    were obtained from medical records of all patients. RESULTS: Physical activity and aerobic fitness was significantly lower in patients with FES compared with healthy controls (p fitness. Patients with more severe....... AIM: The purpose of the study was to compare physical activity in patients with FES with healthy controls; to investigate changes in physical activity over 1 year of follow-up; and to explore the correlations of physical activity and anomalous bodily experiences reported by patients with FES. METHODS......: Both physical activity and aerobic fitness were measured. Anomalous bodily experiences were measured by selected items from the Examination of Anomalous Self-Experience and The Body Awareness Scale. Psychopathological data comprising negative and positive symptoms and data on psychotropic medication...

  6. 抑郁发作与躁狂发作者暴力犯罪特点对照研究%A case control study of the characteristic of violent crime between the patients with manic episode and depressive episode

    Institute of Scientific and Technical Information of China (English)

    孔晓明; 张晓莉

    2011-01-01

    目的 比较司法精神病鉴定中躁狂发作与抑郁发作患者暴力犯罪行为的特点及其责任能力评定结果.方法 对2000年1月至2010年12月在合肥市精神病医院司法鉴定科所鉴定的33例躁狂发作和30例抑郁发作患者暴力犯罪的资料进行回顾性分析.结果 抑郁发作组凶杀案件(53.3%)显著高于躁狂发作组凶杀案件(18.2%)的比例(P<0.01);在居住地、作案地点及与受害人关系等条目两组间比较差异有统计学意义;两组责任能力评定比较差异无统计学意义(P>0.05).结论 躁狂发作和抑郁发作者的暴力犯罪行为特点各自不同,这可能与两者的疾病症状表现、严重程度以及辨认和控制能力差异有关.%Objective To investigate the characteristic of index offence and the criminal responsibility of the forensic patients with manic episode and depressive episode.Methods A comparative study was conducted between 33 cases of manic episode and 30 cases of depressive episode referred for forensic psychiatric assessment from 2000 to 2010 at Hefei psychiatric hospital.Results There was significant difference between the two groups in the homicide rate(depression 53.3% vs mania 18.2%,P <0.01),and there was asignificant difference between the two groups in place of residence,place of crime and the relationship of the victim.No difference was found in the result of criminal responsibility between the two groups.Conclusions There were differences in violent crime between patients with manic episode and depressive episode,these maybe due to the difference of the symptoms,the severity of the diseases and the ability of identification and self control between the two groups.

  7. Association Between Genetic Polymorphisms in the Serotonergic System and Comorbid Personality Disorders Among Patients with First-Episode Depression

    DEFF Research Database (Denmark)

    Bukh, Jens D; Bock, Camilla; Kessing, Lars V

    2014-01-01

    the serotonin transporter, serotonin receptors 1A, 2A, 2C, and tryptophan hydroxylase 1 were genotyped. The authors found a significant effect of the length polymorphism in the serotonin transporter gene (5-HTTLPR) on cluster B personality disorder (mainly borderline disorder), but no influence on cluster C......Studies on the association between genetic polymorphisms and personality disorders have provided inconsistent results. Using the "enriched sample method," the authors of the present study aimed to assess the association between polymorphisms in the serotonergic transmitter system and comorbid...... personality disorders in patients recently diagnosed with first-episode depression. A total of 290 participants were systematically recruited via the Danish Psychiatric Central Research Register. Diagnoses of personality disorders were assessed by a SCID-II interview, and polymorphisms in the genes encoding...

  8. [Impulsivity-focused Group Intervention to reduce Binge Eating Episodes in Patients with Binge Eating Disorder - A Group Training Program].

    Science.gov (United States)

    Schag, Kathrin; Leehr, Elisabeth J; Skoda, Eva-Maria; Becker, Sandra; Zipfel, Stephan; Giel, Katrin E

    2016-11-01

    Binge Eating Disorder (BED) is an eating disorder where cognitive behavioural therapy (CBT) could already show reliable efficacy. Relying on basic research, CBT interventions which especially focus on impulsivity could be effective, because binge eating episodes represent highly impulsive eating behaviour. For this reason, we developed a treatment concept about an impulsivity-focused behavioural group intervention for patients with BED, called IMPULS. The efficacy of IMPULS is currently investigated in a randomised controlled trial 1. IMPULS is drafted as a weekly group training programme with 5-6 participants per group. The essential interventions are food-related cue exposure with response prevention and the development of self-control strategies. These interventions are adapted onto the impulsivity concept from conventional treatment of addictive disorders and BED. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Association between genetic polymorphisms in the serotonergic system and comorbid personality disorders among patients with first-episode depression.

    Science.gov (United States)

    Bukh, Jens D; Bock, Camilla; Kessing, Lars V

    2014-06-01

    Studies on the association between genetic polymorphisms and personality disorders have provided inconsistent results. Using the "enriched sample method," the authors of the present study aimed to assess the association between polymorphisms in the serotonergic transmitter system and comorbid personality disorders in patients recently diagnosed with first-episode depression. A total of 290 participants were systematically recruited via the Danish Psychiatric Central Research Register. Diagnoses of personality disorders were assessed by a SCID-II interview, and polymorphisms in the genes encoding the serotonin transporter, serotonin receptors 1A, 2A, 2C, and tryptophan hydroxylase 1 were genotyped. The authors found a significant effect of the length polymorphism in the serotonin transporter gene (5-HTTLPR) on cluster B personality disorder (mainly borderline disorder), but no influence on cluster C personality disorder, and no associations between other polymorphisms and personality disorders. The study adds evidence to the effect of the serotonin transporter gene specifically on cluster B personality disorders.

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

    Science.gov (United States)

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

    2017-01-01

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

  11. Efficacy comparison between direct stent implantation surgery and deferred stent implantation surgery for patients with ST-segment elevation myocardial infarction after PCT thrombus aspiration surgery

    Institute of Scientific and Technical Information of China (English)

    Xiao-Xia Han; Xiu-Hong Liu; Ping Zhou; Guo-Mei Dan

    2016-01-01

    Objective:To compare the efficacy of direct stent implantation surgery and deferred stent implantation surgery for patients with ST-segment elevation myocardial infarction after PCT thrombus aspiration surgery. Method:A total of 74 cases with STEMI were selected, who had been given PCT thrombus aspiration surgery treatment, and were randomly divided into direct group and deferred group (n=37). Patients in direct group were given direct stent implantation surgery after PCT thrombus aspiration surgery treatment. Patients in deferred group were given deferred stent implantation surgery 14 d later after anticoagulant and anti-platelet treatment. Heart structure and function, stent release characteristics and adverse reactions) were compared 6 months after the surgery. Results:Two hours after surgery, ST segment drop amplitude in deferred group was significantly higher than that in direct group (P<0.05);TIMI frame number was obvious and no reflow/slow blood flow occurrence ratio was significantly lower than that in direct group (P<0.05);implantation stent number and stent length in deferred group were significantly less than that in direct group (P<0.05);the release characteristic indexes of implantation stent in deferred group:stent diameter and stent expansion pressure were significantly higher than that in direct group (P<0.05);6 months after surgery, LVEF improvement in deferred group was significantly higher than that in direct group (P<0.05), while LVEDD、LVEDV ventricular remodeling was significantly lower than that in direct group (P<0.05);The total adverse event occurrence rate in deferred group was 5.4%, which was significantly lower than that in direct group (18.9%) (P<0.05). Conclusions:The deferred stent implantation surgery after PCI thrombus aspiration surgery could obviously reduce the occurrence rate of no reflow/slow blood flow, obviously improve the heart function and myocardial perfusion, reduce the usage amount of stent, reduce the occurrence of

  12. Confabulation and false memory in young first-episode psychosis patients and normal controls

    OpenAIRE

    Andri Hrafn Sigurðsson 1989

    2016-01-01

    Studies have demonstrated that forced confabulation can increase susceptibility to false memories in normal controls whereas patients with psychotic disorder generate more confabulation, but it is unclear whether their confabulation leads to increased false memory recall. Furthermore, it is unclear to what extent false memory recall and confabulation in early psychosis patients is based on their impaired cognitive functions. The aim of the present study was to investigate confabulation and th...

  13. Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries.

    Science.gov (United States)

    Pereira, Nayara de Castro; Turrini, Ruth Natalia Teresa; Poveda, Vanessa de Brito

    2017-05-25

    To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of hospital stay (p=0.000), blood transfusion (p=0.013), nasogastric tube (p=0.001) and nasojejunal tube (p=0,003), postoperative admission at ICU (p=0.002), postoperative death (p=0.000) and length of preoperative fasting (p=0.000). The length of fasting is associated with complications that affect the quality of the patients' postoperative recovery and nurses' work. The nursing team should be alert to this aspect and being responsible for overseeing the patients' interest, should not permit the unnecessary extension of fasting. Identificar la duración del ayuno perioperatorio entre los pacientes sometidos a cirugías de cáncer gastrointestinal. Estudio de cohorte retrospectivo, por consulta de los registros médicos de 128 pacientes sometidos a cirugías de cáncer gastrointestinal. La media de la duración total del ayuno fue de 107,6 horas. La duración total del ayuno se asoció significativamente con el número de síntomas presentados antes (p=0,000) y después de la cirugía (p=0,007), la duración de la estancia hospitalaria (p=0,000), transfusión de sangre (p=0,013),tubo nasogástrico (P=0,003), ingreso postoperatorio en la UCI (p=0,002), muerte postoperatoria (p=0,000) y duración del ayuno preoperatorio (p=0,000). La duración del ayuno se asocia con complicaciones que afectan la calidad de la recuperación postoperatoria de los pacientes y el trabajo de enfermería. El equipo de enfermería debe estar alerta en relación a este aspecto y ser responsable de supervisar el interés de los pacientes, no

  14. Prescriber and pharmacy variation in patient adherence to five medication classes measured using implementation during persistent episodes.

    Science.gov (United States)

    Genberg, Becky L; Rogers, William H; Lee, Yoojin; Qato, Danya M; Dore, David D; Hutchins, David S; Brennan, Troyen; Matlin, Olga S; Wilson, Ira B

    2016-07-01

    The objective of this study was to determine the fraction of variance in patient-level medication adherence accounted for by prescribers and pharmacies. We used prescription drug claims paid between January 2010 and July 2011 to a national pharmacy benefits manager to define implementation during persistent episodes. Patients in Massachusetts or Rhode Island covered by Blue Cross Blue Shield of Rhode Island and their prescribers were included. Five drug classes were analyzed: angiotensin converting enzyme (ACE) inhibitors, antihyperglycemics (ANHGs), drugs for prostatic hyperplasia (PH), statins, and levothyroxine (THYR). We performed mixed models with random intercepts (drug, patient, prescriber, and pharmacy) and examined the fraction of variance explained at each level using intraclass correlations. Overall implementation ranged from 87 to 91%. The fraction of the explained variance in implementation to ACEs, ANHG, PH, statins, and THYR accounted for by prescribers was 16.4%, 12.6%, 14.6%, 15.6%, and 15% respectively; and for pharmacies 20.4%, 20%, 15.2%, 10.6%, and 9.4%, respectively. Prescriber and pharmacy effects accounted for a substantial amount of the explained variance in implementation across all five drug classes. Adherence interventions for chronic conditions that target prescribers and pharmacies, in addition to patients, could be effective and efficient. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  15. Increased activities of both superoxide dismutase and catalase were indicators of acute depressive episodes in patients with major depressive disorder.

    Science.gov (United States)

    Tsai, Meng-Chang; Huang, Tiao-Lai

    2016-01-30

    Oxidative stress may play an important role in the pathophysiology of major depressive disorder (MDD). The aim of this study was to investigate the serum levels of oxidative stress biomarkers and S100B in patients with MDD in an acute phase, and evaluate the changes in superoxide dismutase (SOD), protein carbonyl content (PCC), glutathione peroxidase (GPX), 8-hydroxy 2'-deoxyguanosine after treatment (8-OHdG), catalase (CAT), thiobarbituric acid reactive substances (TBARS) and S100B. We consecutively enrolled 21 MDD inpatients in an acute phase and 40 healthy subjects. Serum oxidative stress markers were measured with assay kits. Serum SOD and CAT activities in MDD patients in an acute phase were significantly higher than those of healthy subjects, and serum PCC levels were significantly lower. The HAM-D scores had a significantly positive association with S100B levels. Eighteen depressed patients were followed up, and there was no significant difference among all of the markers after treatment. In conclusion, our results suggest that increased activities of both SOD and CAT might be indicators of acute depressive episodes in MDD patients.

  16. Bariatric surgery in patients with bipolar spectrum disorders: Selection factors, postoperative visit attendance, and weight outcomes.

    Science.gov (United States)

    Friedman, Kelli E; Applegate, Katherine; Portenier, Dana; McVay, Megan A

    2017-04-01

    As many as 3% of bariatric surgery candidates are diagnosed with a bipolar spectrum disorder. 1) To describe differences between patients with bipolar spectrum disorders who are approved and not approved for surgery by the mental health evaluator and 2) to examine surgical outcomes of patients with bipolar spectrum disorders. Academic medical center, United States. A retrospective record review was conducted of consecutive patients who applied for bariatric surgery between 2004 and 2009. Patients diagnosed with bipolar spectrum disorders who were approved for surgery (n = 42) were compared with patients with a bipolar spectrum disorder who were not approved (n = 31) and to matched control surgical patients without a bipolar spectrum diagnosis (n = 29) on a variety of characteristics and surgical outcomes. Of bariatric surgery candidates diagnosed with a bipolar spectrum disorder who applied for surgery, 57% were approved by the psychologist and 48% ultimately had surgery. Patients with a bipolar spectrum disorder who were approved for surgery were less likely to have had a previous psychiatric hospitalization than those who were not approved for surgery. Bariatric surgery patients diagnosed with a bipolar spectrum disorder were less likely to attend follow-up care appointments 2 or more years postsurgery compared to matched patients without bipolar disorder. Among patients with available data, those with a bipolar spectrum disorder and matched patients had similar weight loss at 12 months (n = 21 for bipolar; n = 24 for matched controls) and at 2 or more years (mean = 51 mo; n = 11 for bipolar; n = 20 for matched controls). Patients diagnosed with a bipolar spectrum disorder have a high rate of delay/denial for bariatric surgery based on the psychosocial evaluation and are less likely to attend medical follow-up care 2 or more years postsurgery. Carefully screened patients with bipolar disorder who engage in long-term follow-up care may benefit from bariatric

  17. Assessment of the epidemiological profile of patients with dentofacial deformities who underwent orthognathic surgery.

    Science.gov (United States)

    Castro, Vanessa; do Prado, Celio Jesus; Neto, Antonio Irineu Trindade; Zanetta-Barbosa, Darceny

    2013-05-01

    The present study aimed to establish the profile of patients who underwent orthognathic surgery in a private clinic by evaluating their demographic characteristics, their facial types, and aspects related to the surgical procedures that were performed. The sample consisted of 419 medical records from male and female patients aged 15 to 62 years who underwent orthognathic surgery between 2001 and 2011. A single examiner collected data by evaluating a database of information extracted from medical records, particularly radiographic and photographic analyses. The following criteria were evaluated: gender, age, skin color, type of orthognathic surgery, type of associated temporomandibular joint (TMJ) surgery, complications, and recurrences. Seventeen patients were rejected because they had incomplete records. The average age of the patients was 28.5 years old; most were females (255 patients) and faioderm (295 patients). The most prevalent facial pattern was Pattern III (n = 166, 41.3%). Orthognathic surgery that affected the maxilla, jaw, and chin was the most prevalent type (n = 199, 49.5% of cases). A genioplasty was performed concurrently with combined surgeries and single-jaw surgery in 76.86% of patients (n = 309). TMJ surgery was performed concomitantly with orthognathic surgery in 4% of cases (n = 16). The most common postoperative complication was infection/inflammation (n = 12). We concluded that there was a higher frequency of orthognathic surgery among women and young people, the brunette skin phenotype was prevalent, and most patients had a combination of maxillary and mandibular problems.

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

    Science.gov (United States)

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

    2017-03-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  20. DoSurgeons Have More Difficulties in the Hospital Care of Non-surgery Patients Than With Surgery Patients?

    Science.gov (United States)

    Montero Ruiz, Eduardo; Barbero Allende, José María; Melgar Molero, Virginia; Rebollar Merino, Ángela; García Sánchez, Marta; López Álvarez, Joaquín

    2015-05-01

    A variable percentage of patients admitted to surgical departments are not operated on for several reasons. Our goal is to check if surgeons have more problems in caring for non-operated hospitalized patients than operated ones. We included all patients aged ≥ 14 years discharged in 2010 from General Surgery, Gynaecology, Urology, and Otolaryngology. The main variables were the length of stay, mortality, readmissions, and number of consultations/referrals requested to medical services. Secondary variables were age, sex, number of emergency admissions, total number of diagnoses, and the Charlson comorbidity index (ICh). Between 8.7% and 22.8% of patients admitted to these surgical departments are not operated on. The non-operated patients had a significantly higher stay, mortality, readmissions and consultations/referrals requests than operated ones, with significantly higher age (except Urology), number of diagnoses, emergency admissions and ICh (except Urology). Patients admitted to surgical departments and are not operated on have higher mortality, readmissions and consultation/referrals requests than those operated on, which may be due to their greater medical complexity and urgency of admission. This suggests a greater difficulty in their care by surgeons. Copyright © 2012 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Cystoid macular edema after cataract surgery in a patient with previous severe iritis following argon laser peripheral iridoplasty

    Directory of Open Access Journals (Sweden)

    Bagnis A

    2011-04-01

    Full Text Available Alessandro Bagnis1, Sergio Claudio Saccà2, Michele Iester1, Carlo Enrico Traverso11Centro di Ricerca Clinica e Laboratorio per il Glaucoma e la Cornea, Clinica Oculistica Di NOG, University of Genova, 2Division of Ophthalmology, St. Martino Hospital, Genova, ItalyAbstract: This report describes a patient who had exaggerated responses to different inflammatory stimuli represented by laser and incisional surgery, respectively. These separate episodes should have a common link represented by a genetic predisposition to abnormal release of proinflammatory mediators within the eye. This 51-year old Hispanic woman showed a narrow iridocorneal angle with plateau iris configuration. Nd-YAG laser peripheral iridotomy was successfully performed to both eyes. No substantial changes in the iridotrabecular angle occurred despite patent iridotomies, thus confirming the diagnosis of plateau iris configuration. Argon laser iridoplasty was then performed to the right eye, while the left eye was scheduled for a later session. A severe inflammatory reaction within the anterior chamber developed after tapering of a one-week course of steroid therapy. Phacoemulsification of the lens was performed some months later when no signs of inflammation were detectable; no intraoperative complications occurred during surgery and an intraocular lens was placed. Cystoid macular edema developed four weeks after surgery despite no apparent risk factors, and resolved completely after anti-inflammatory medical therapy. Based on this case report, the unusual occurrence of severe iritis after laser treatment should be regarded as a risk factor for any other incisional or nonincisional procedures because it might indicate that the patient's ocular tissues are prone to release of abnormally elevated proinflammatory mediators. Although further studies are needed to confirm this predisposition, prophylactic adjunctive topical nonsteroidal anti-inflammatory drug administration after

  2. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than ty

  3. Risk Factors for Complications after Peripheral Vascular Surgery in 3,202 Patient Procedures

    DEFF Research Database (Denmark)

    Kehlet, Mette; Jensen, Leif Panduro; Schroeder, Torben V.

    2016-01-01

    Background Complications after open vascular surgery are a major health challenge for the healthcare system and the patients. Infrainguinal vascular surgery is often perceived as less risky than aortic surgery and the aim of this study was to identify which risk factors correlated with postoperat...

  4. Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk.

    NARCIS (Netherlands)

    Pull ter Gunne, A.F.; Laarhoven, C.J.H.M. van; Cohen, D.B.

    2010-01-01

    Surgical site infection (SSI) following spinal surgery is a frequent complication and results in higher morbidity, mortality and healthcare costs. Patients undergoing surgery for spinal deformity (scoliosis/kyphosis) have longer surgeries, involving more spinal levels and larger blood losses than

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

    OpenAIRE

    Pavlína Homzová; Renáta Zeleníková

    2015-01-01

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

  6. Protocol guided bleeding management improves cardiac surgery patient outcomes.

    Science.gov (United States)

    Pearse, B L; Smith, I; Faulke, D; Wall, D; Fraser, J F; Ryan, E G; Drake, L; Rapchuk, I L; Tesar, P; Ziegenfuss, M; Fung, Y L

    2015-10-01

    Excessive bleeding is a risk associated with cardiac surgery. Treatment invariably requires transfusion of blood products; however, the transfusion itself may contribute to postoperative sequelae. Our objective was to analyse a quality initiative designed to provide an evidenced-based approach to bleeding management. A retrospective analysis compared blood product transfusion and patient outcomes 15 months before and after implementation of a bleeding management protocol. The protocol incorporated point-of-care coagulation testing (POCCT) with ROTEM and Multiplate to diagnose the cause of bleeding and monitor treatment. Use of the protocol led to decreases in the incidence of transfusion of PRBCs (47·3% vs. 32·4%; P bleeding (5·6% vs. 3·4; P = 0·01), superficial chest wound (3·3% vs. 1·4%; P = 0·002), leg wound infection (4·6% vs. 2·0%; P bleeding management protocol supported by POCCT in a cardiac surgery programme was associated with significant reductions in the transfusion of allogeneic blood products, improved outcomes and reduced cost. © 2015 International Society of Blood Transfusion.

  7. Markers of Perioperative Bowel Complications in Colorectal Surgery Patients

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    Radomír Hyšpler

    2015-01-01

    Full Text Available Colorectal cancer is a clinical condition whose treatment often involves intestinal resection. Such treatment frequently results in two major gastrointestinal complications after surgery: anastomotic leakage and prolonged ileus. Anastomotic leakage is a serious complication which, more often than not, is diagnosed late; to date, C-reactive protein is the only available diagnostic marker. A monocentric, prospective, open case-control study was performed in patients (n=117 undergoing colorectal surgery. Intestinal fatty acid binding protein (i-FABP, citrulline, D-lactate, exhaled hydrogen, Escherichia coli genomic DNA, and ischemia modified albumin (IMA were determined preoperatively, postoperatively, and on the following four consecutive days. Bacterial DNA was not detected in any sample, and i-FABP and D-lactate lacked any distinct potential to detect postoperative bowel complications. Exhaled breath hydrogen content showed unacceptably low sensitivity. However, citrulline turned out to be a specific marker for prolonged ileus on postoperative days 3-4. Using a cut-off value of 20 μmol/L, a sensitivity and specificity of ~75% was achieved on postoperative day 4. IMA was found to be an efficient predictor of anastomosis leak by calculating the difference between preoperative and postoperative values. This test had 100% sensitivity and 80% specificity and 100% negative and 20% positive predictive value.

  8. Preparation of Plaster Moulage (Cast in Plastic Surgery patients

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    Rana R

    2003-01-01

    Full Text Available The purpose of this paper is to describe the technique of making casts using alginate compound for negative and dental stone plaster for positive impressions. With certain modifications a cast could be made of any part of the body and one can make a museum of interesting cases. Casts serve as useful teaching material especially in cleft lip and palate patients to study the effect of surgery on growth and development of the cleft lip-palate-nose complex in relation to the remaining face. It also helps in planning reconstruction in cases of facial defects, recording serial changes in multistage surgery, pre-operative and post-operative comparison as in rhinoplasty, ear reconstruction, hand etc; for comparing results before and after treatment in keloid and hypertrophic scars, fabrication of implants and preparation of prosthesis. In spite of newer modalities like 3-D imaging and stereolithography, the usefulness of this old technique in certain interesting cases can not be denied.

  9. The interaction of working memory performance and episodic memory formation in patients with Korsakoff's amnesia

    NARCIS (Netherlands)

    Geldorp, B. van; Bergmann, H.; Robertson, J.; Wester, A.J.; Kessels, R.P.C.

    2012-01-01

    Both neuroimaging work and studies investigating amnesic patients have shown involvement of the medial temporal lobe during working memory tasks, especially when multiple items or features have to be associated. However, so far no study has examined the relationship between working memory and subseq

  10. The interaction of working memory performance and episodic memory formation in patients with Korsakoff's amnesia.

    NARCIS (Netherlands)

    Geldorp, B. van; Bergmann, H.C.; Robertson, J.; Wester, A.J.; Kessels, R.P.C.

    2012-01-01

    Both neuroimaging work and studies investigating amnesic patients have shown involvement of the medial temporal lobe during working memory tasks, especially when multiple items or features have to be associated. However, so far no study has examined the relationship between working memory and

  11. The interaction of working memory performance and episodic memory formation in patients with Korsakoff's amnesia

    NARCIS (Netherlands)

    Geldorp, B. van; Bergmann, H.; Robertson, J.; Wester, A.J.; Kessels, R.P.C.

    2012-01-01

    Both neuroimaging work and studies investigating amnesic patients have shown involvement of the medial temporal lobe during working memory tasks, especially when multiple items or features have to be associated. However, so far no study has examined the relationship between working memory and

  12. Renal acidification defects in patients with their first renal stone episode

    DEFF Research Database (Denmark)

    Osther, P J; Hansen, A B; Röhl, H F

    1988-01-01

    tubular acidosis, the rest had normal urinary acidification. In view of the short duration of stone disease in the patients studied, the acidification defects were considered to be primary, and the stone formation secondary. The results justify extension of these simple screening procedures for unmasking...

  13. The interaction of working memory performance and episodic memory formation in patients with Korsakoff's amnesia.

    NARCIS (Netherlands)

    Geldorp, B. van; Bergmann, H.C.; Robertson, J.; Wester, A.J.; Kessels, R.P.C.

    2012-01-01

    Both neuroimaging work and studies investigating amnesic patients have shown involvement of the medial temporal lobe during working memory tasks, especially when multiple items or features have to be associated. However, so far no study has examined the relationship between working memory and subseq

  14. Clinical utility of Standardised Assessment of Personality - Abbreviated Scale (SAPAS) among patients with first episode depression

    DEFF Research Database (Denmark)

    Bukh, Jens Drachmann; Bock, Camilla; Vinberg, Maj;

    2010-01-01

    , by the Structured Clinical Interview for DSM-IV Personality Disorders. RESULTS: We found, that a cut-off of 3 on the screen correctly identified the presence of comorbid personality disorder in 73.1% of the patients. The sensitivity and specificity were 0.80 and 0.70, respectively. LIMITATIONS: The findings cannot...

  15. The impact of patients controlled analgesia undergoing orthopedic surgery

    Directory of Open Access Journals (Sweden)

    Aluane Silva Dias

    2016-06-01

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

  16. Evaluation of occupational and patient radiation doses in orthopedic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Sulieman, A. [Salman bin Abdulaziz University, College of Applied Medical Sciences, Radiology and Medical Imaging Department, P.O. Box 422, Alkharj (Saudi Arabia); Habiballah, B.; Abdelaziz, I. [Sudan Univesity of Science and Technology, College of Medical Radiologic Sciences, P.O. Box 1908, Khartoum (Sudan); Alzimami, K. [King Saud University, College of Applied Medical Sciences, Radiological Sciences Department, P.O. Box 10219, 11433 Riyadh (Saudi Arabia); Osman, H. [Taif University, College of Applied Medical Science, Radiology Department, Taif (Saudi Arabia); Omer, H. [University of Dammam, Faculty of Medicine, Dammam (Saudi Arabia); Sassi, S. A., E-mail: Abdelmoneim_a@yahoo.com [Prince Sultan Medical City, Department of Medical Physics, Riyadh (Saudi Arabia)

    2014-08-15

    Orthopedists are exposed to considerable radiation dose during orthopedic surgeries procedures. The staff is not well trained in radiation protection aspects and its related risks. In Sudan, regular monitoring services are not provided for all staff in radiology or interventional personnel. It is mandatory to measure staff and patient exposure in order to radiology departments. The main objectives of this study are: to measure the radiation dose to patients and staff during (i) Dynamic Hip Screw (Dhs) and (i i) Dynamic Cannula Screw (Dcs); to estimate the risk of the aforementioned procedures and to evaluate entrance surface dose (ESD) and organ dose to specific radiosensitive patients organs. The measurements were performed in Medical Corps Hospital, Sudan. The dose was measured for unprotected organs of staff and patient as well as scattering radiation. Calibrated Thermoluminescence dosimeters (TLD-Gr-200) of lithium fluoride (LiF:Mg, Cu,P) were used for ESD measurements. TLD signal are obtained using automatic TLD Reader model (Plc-3). The mean patients doses were 0.46 mGy and 0.07 for Dhs and Dcs procedures, respectively. The mean staff doses at the thyroid and chest were 4.69 mGy and 1.21 mGy per procedure. The mean radiation dose for staff was higher in Dhs compared to Dcs. This can be attributed to the long fluoroscopic exposures due to the complication of the procedures. Efforts should be made to reduce radiation exposure to orthopedic patients, and operating surgeons especially those with high work load. Staff training and regular monitoring will reduce the radiation dose for both patients and staff. (Author)

  17. Suicidal ideation and quality of life in patients with a first episode of schizophrenia

    Directory of Open Access Journals (Sweden)

    Krystyna Górna

    2010-03-01

    Full Text Available Introduction: Risk of suicide in patients with schizophrenia is 20- to 50-fold higher than in the general population. The impact of suicidal behaviour on quality of life rarely was a subject of in-depth analysis. The issue is particularly important in patients after first psychiatric hospitalisation, since the risk of suicide is very high during the first postdischarge months. The aim of this study was to analyse correlations between presence of suicidal ideations prior to first hospitalisation and quality of life of patients with schizophrenia during the first post-hospitalisation year. Material and method: Overall, 86 patients were enrolled in the study. Suicidal ideations and behaviours were assessed based on interviews with patients and their relatives, as well as on medical records. The patients’ quality of life was evaluated one month (1st exam and after one year (2nd exam after discharge. Quality of life was assessed using the WHOQOL questionnaire and the SFS scale. Psychopathological symptoms were evaluated using the PANSS inventory. Results: Prior to first hospitalisation, suicidal ideations were present in 39.5% of our patients. Persons with suicidal thoughts presented more severe psychopathological symptoms (1st exam; p=0.05. Both examinations revealed differences in the patients’ quality of life. Lack of suicidal ideations was associated with a better quality of life as assessed by the WHOQOL questionnaire in the following domains: general well-being (1st and 2nd exam, state of health (1st exam, Mental (1st and 2nd exam, Physical (1st exam, Environmental domains (1st exam and Work/Employment (SFS scale, 1st and 2nd exam. A correlation was noticed between suicidal ideation and change in quality of life (WHOQOL in domains Social relationships and Environmental. An improvement of quality of life in this domain was noticed in persons with suicidal ideations. Conclusions: Suicidal ideations prior to first psychiatric hospitalisation

  18. Gastroesophageal reflux episodes in asthmatic patients and their temporal relation with sleep architecture

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    L. Mello-Fujita

    2008-02-01

    Full Text Available Gastroesophageal reflux (GER is common in asthma patients and can contribute to sleep disruption. The aim of the present study was to determine the time-related distribution of GER events together with their impact on sleep in asthmatic subjects with GER disease symptoms. The inclusion criteria were: 18-65 years, controlled moderate to severe asthma and GER-compatible clinical evidence. The exclusion criteria were: chronic obstructive lung disease, smoking, infections of the upper airways, use of oral corticosteroids, other co-morbidities, pregnancy, sleep-related disorders, night-time shift work, and the use of substances with impact on sleep. Asthmatic patients with nocturnal symptoms were excluded. All-night polysomnography and esophageal pH monitoring were recorded simultaneously. Of the 147 subjects selected, 31 patients and 31 controls were included. Seventeen patients were classified as DeMeester positive and 14 as DeMeester negative. Both groups displayed similar outcomes when general variables were considered. Sleep stage modification one minute prior to GER was observed in the DeMeester-positive group. Awakening was the most frequent occurrence at GER onset and during the 1-min period preceding 38% of the nocturnal GER. Sleep stage 2 was also prevalent and preceded 36% of GER events. In the DeMeester-negative group, awakening was the most frequent response before and during GER. Modifications in sleep stages, arousals or awakenings were associated with 75% of the total GER events analyzed during the period of one minute before and after the fall of esophageal pH below 4 in the DeMeester-positive group. These data provide evidence that sleep modifications precede the GER events in asthmatic patients.

  19. Phacoemulsification versus small incision cataract surgery in patients with uveitis

    Directory of Open Access Journals (Sweden)

    Rahul Bhargava

    2015-10-01

    Full Text Available AIM: To compare the safety and efficacy of phacoemulsification and small incision cataract surgery (SICS in patients with uveitic cataract.METHODS:In aprospective, randomized multi-centric study, consecutive patients with uveitic cataract were randomized to receive phacoemulsification or manual SICS by either of two surgeons well versed with both the techniques. A minimum inflammation free period of 3mo (defined as less than 5 cells per high power field in anterior chamber was a pre-requisite for eligibility for surgery. Superior scleral tunnel incisions were used for both techniques. Improvement in visual acuity post-operatively was the primary outcome measure and the rate of post-operative complications and surgical time were secondary outcome measures, respectively. Means of groups were compared using t-tests. One way analysis of variance (ANOVA was used when there were more than two groups. Chi-square tests were used for proportions. Kaplan Meyer survival analysis was done and means for survival time was estimated at 95% confidence interval (CI. A P value of <0.05 was considered statistically significant.RESULTS:One hundred and twenty-six of 139 patients (90.6% completed the 6-month follow-up. Seven patients were lost in follow up and another six excluded due to either follow-up less than six months (n=1 or inability implant an intraocular lens (IOL because of insufficient capsular support following posterior capsule rupture (n=5. There was significant improvement in vision after both the procedures (paired t-test; P<0.001. On first postoperative day, uncorrected distance visual acuity (UDVA was 20/63 or better in 31 (47% patients in Phaco group and 26 (43.3% patients in SICS group (P=0.384. The mean surgically induced astigmatism (SIA was 0.86±0.34 dioptres (D in the phacoemulsification group and 1.16±0.28 D in SICS group. The difference between the groups was significant (t-test, P=0.002. At 6mo, corrected distance visual acuity (CDVA

  20. Thyroid profiles in a patient with resistance to thyroid hormone and episodes of thyrotoxicosis, including repeated painless thyroiditis.

    Science.gov (United States)

    Taniyama, Matsuo; Otsuka, Fumiko; Tozaki, Teruaki; Ban, Yoshiyuki

    2013-07-01

    Thyrotoxic disease can be difficult to recognize in patients with resistance to thyroid hormone (RTH) because the clinical symptoms of thyrotoxicosis cannot be observed, and thyrotropin (TSH) may not be suppressed because of hormone resistance. Painless thyroiditis is a relatively common cause of thyrotoxicosis, but its occurrence in RTH has not been reported. We assessed the thyroid profile in a patient with RTH and episodes of thyrotoxicosis who experienced repeated painless thyroiditis. A 44-year-old Japanese woman with RTH, which was confirmed by the presence of a P453A mutation in the thyroid hormone receptor β (TRβ) gene, showed a slight elevation of the basal levels of thyroid hormones, which indicated that her pituitary RTH was mild. She experienced a slight exacerbation of hyperthyroxinemia concomitant with TSH suppression. A diagnosis of painless thyroiditis was made because of the absence of TSH receptor antibodies, low Tc-99m pertechnetate uptake by the thyroid gland, and transient suppression followed by a slight elevation of TSH following the elevation of thyroid hormones. The patient's complaints of general malaise and occasional palpitations did not change throughout the course of painless thyroiditis. Three years later, painless thyroiditis occurred again without any deterioration of the clinical manifestations. Mild pituitary RTH can be overcome by slight exacerbation of hyperthyroxinemia during mild thyrotoxicosis. When pituitary resistance is severe and TSH is not suppressed, thyrotoxicosis may be overlooked.

  1. Airway Management of Patients Undergoing Oral Cancer Surgery: A Retrospective Analysis of 156 Patients.

    Science.gov (United States)

    Nikhar, Sapna Annaji; Sharma, Ashima; Ramdaspally, Mahesh; Gopinath, Ramachandran

    2017-04-01

    Oral cancer patients have a potentially difficult airway, but if managed properly during the perioperative period, morbidity and mortality can be reduced or avoided. The medical records of 156 patients who were operated for oral cancers were reviewed for airway management during the perioperative period. The surgical procedures ranged from excisions, wide local excisions with split skin graftings, hemiglossectomies and radical neck nodes dissections to pectoralis major myocutaneous or free fibular flaps. Intubation was assessed as difficult in 14.7% of patients because of tumour- or radiation fibrosis-related trismus, restricted neck mobility and prior similar surgeries. Twenty patients had undergone surgery for oral cancer previously and were scheduled for flap reconstruction. Nasotracheal intubation was a preferred route, and 62.8% of patients could be intubated nasotracheally after neuromuscular blockade. Tracheostomy (elective or existing) was utilised for airway control in 19.2% cases. Patients who had undergone prior radiotherapy were more likely to be tracheostomised. McCoy laryngoscopes (13.4%), gum elastic bougies (23.6%), Airtraq devices (0.006%) and fibreoptic bronchoscopes (FOBs) (0.03%) were the additional airway techniques employed. In total, 64 patients (50.7%) could be extubated immediately after surgery. Proper preoperative evaluation and planning help manage difficult airways effectively with minimal need of advanced airway gadgets. Gum elastic bougies and Magill forceps are very useful in airway management and decrease the need of elective tracheostomy in oral cancer patients.

  2. WHEN TO POSTPONE CATARACT SURGERY: TAKING IN CONSIDERATION PATIENTS' QUALITY OF LIFE

    Directory of Open Access Journals (Sweden)

    Jovanović Miloš

    2015-12-01

    Full Text Available Purpose: Assessment of complication in surgery of complicated cataracts and option of postponement of surgery. Setting: Clinic for eye diseases, Clinical Centre of Serbia Methods: This was a retrospective observational case series. Results: In 16 patients subjected to cataract surgery by method of phacoemulsification, three experienced complications during surgery. Two experienced rupture of posterior lens capsule and prolapse of the vitreous body, and one, expulsive hemorrhage. The visual acuity in all three patients was lesser than the preoperative visual acuity. In the second group of 16 patients, after having been acquainted with the survey, the cataract surgery was postponed and the patients were controlled after one year. The cataract progressed just partially in certain patients and all the patients were satisfied with the status of their vision and did not demand surgery. Conclusions: Cataract surgery in complicated cases may be accompanied by complications with uncertain postoperative visual results. Therefore, in patients with complicated cataracts and relatively preserved visual acuity, it is necessary to be careful with proposing surgery and often obey their wish to postpone surgery. This should be done particularly with patients of advanced age, patients with poor general status of life and in monoculuses

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

    OpenAIRE

    Campagna, Sara; Antonielli D'Oulx, Maria Delfina; Paradiso, Rosetta; Perretta, Laura; Re Viglietti, Silvia; Berchialla, Paola; 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...

  4. Cerebral oedema in episodic ataxia.

    Science.gov (United States)

    Crevits, L; Cambron, M; Anseeuw, S

    2009-03-01

    We report a patient with episodic ataxia (presumably of type 2) who developed cerebral oedema secondary to a common infection (presumably viral). Cerebral oedema may be a part of the clinical spectrum of familial episodic ataxia and argues for an overlap with hemiplegic migraine. It is suggested to consider a diagnosis of episodic ataxia or familial hemiplegic migraine in catastrophic reactions to apparent trivial trauma or infection.

  5. [Diverticulitis and indication for surgery--are there new data?].

    Science.gov (United States)

    Weimann, A; Hirsch, W D; Schiefke, I

    2013-12-01

    The treatment in acute diverticulitis has undergone a considerable shift from an offensive to a more restrictive and individual indication for surgery. This review of the very recent literature with special regard to long-term observation of conservatively treated patients clearly shows that surgery is not required in any case of a first episode of severe diverticulitis, but should be recommended in high-risk patients under immunosuppression or chronic renal failure. In all other groups of patients the indication for surgery should be weighed on an individual basis after each episode, again aiming for the laparoscopic procedure. A therapeutic algorithm is proposed according to the Hansen-Stock classification.

  6. Clinical characteristics of patients with factor V Leiden or prothrombin G20210A and a first episode of venous thromboembolism. Findings from the RIETE Registry.

    Science.gov (United States)

    Gadelha, Telma; Roldán, Vanessa; Lecumberri, Ramón; Trujillo-Santos, Javier; del Campo, Raquel; Poggio, Renzo; Monreal, Manuel

    2010-10-01

    The clinical characteristics of patients with factor V Leiden or prothrombin G20210A presenting with a first episode of venous thromboembolism (VTE) have not been thoroughly studied. RIETE is an ongoing registry of consecutive patients with acute VTE. We compared the clinical characteristics of patients with factor V Leiden, prothrombin G20210A, or no thrombophilia, at presentation with a first episode of VTE. As of May 2009, 22428 patients had been enrolled with a first episode of VTE. Of these, 345 had factor V Leiden, 261 had prothrombin G20210A, and 2399 tested negative. Sixty-two percent of the VTE episodes in women with factor V Leiden or prothrombin G20210A (40% in men) were associated with an acquired risk factor. Among women, pregnancy or contraceptive use accounted for 63% and 67% of such risk factors. Patients with factor V Leiden presented with pulmonary embolism (PE) less likely than those with prothrombin G20210A (31% vs. 51%; pFactor V Leiden presented with hypoxaemia (Sat O(2) levelsfactor V Leiden or prothrombin G20210A were associated with an acquired risk factor (mostly pregnancy or contraceptive use). Only 4.5% of patients with factor V Leiden presenting with acute PE had hypoxaemia. Copyright © 2010 Elsevier Ltd. All rights reserved.

  7. Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery - a prospective randomized trial in 150 patients

    Directory of Open Access Journals (Sweden)

    Robinson Yohan

    2011-05-01

    Full Text Available Abstract Background Epidural analgesia with bupivacain, epinephrine and fentanyl provides excellent pain control after lumbar fusion surgery, but pruritus and motor block are frequent side effects. Theoretically epidural ropivacain combined with oral oxycodone could decrease the incidence of these side effects. The two regimens were compared in a prospective randomized trial. Patients and methods 150 patients (87 women treated with posterior instrumented lumbar fusion were included. The mean age was 51 +/- 11 years. 76 were randomized to bupivacain, epinephrine and fentanyl (group B and 74 to ropivacain and oxycodone (group R. Pruritus, motor block and pain were measured 6 hours after surgery, thereafter 6 times per day for 5 days. Any pain breakthrough episode was registered whenever it occurred. Results The epidural treatment could be performed in 143 patients (72 in group B and 71 in group R. Disturbing pruritus occurred in 53 patients in group B compared to 12 in group R (p Conclusions Pruritus could be reduced with a combination of epidural ropivacain and oral oxycodone, at the price of a slightly higher pain level. Ropivacaine was not found to be superior to bupivacaine with regard to motor blocks.

  8. Chemotherapy followed by surgery versus surgery alone in patients with resectable oesophageal squamous cell carcinoma : Long-term results of a randomized controlled trial

    NARCIS (Netherlands)

    Boonstra, Jurjen J.; Kok, Tjebbe C.; Wijnhoven, Bas P. L.; van Heijl, Mark; Henegouwen, Mark I. van Berge; ten Kate, Fiebo J. W.; Siersema, Peter D.; Dinjens, Winand N. M.; van Lanschot, Jan J. B.; Tilanus, Hugo W.; van der Gaast, Ate

    2011-01-01

    Background: This is a randomized, controlled trial of preoperative chemotherapy in patients undergoing surgery for oesophageal squamous cell carcinoma (OSCC). Patients were allocated to chemotherapy, consisting of 2-4 cycles of cisplatin and etoposide, followed by surgery (CS group) or surgery alone

  9. Unilateral pallidal deep brain stimulation in a patient with dystonia secondary to episodic ataxia type 2.

    Science.gov (United States)

    Harries, Anwen M; Sandhu, Mandeep; Spacey, Sian D; Aly, Mohamed M; Honey, Christopher R

    2013-01-01

    This paper describes the use of deep brain stimulation (DBS) of the globus pallidus internus (GPi) in the treatment of secondary dystonia caused by expisodic ataxia type 2 (EA2). We present the case of a patient with EA2, an autosomal dominant condition, who developed late-onset cervical and right upper limb segmental dystonia. The patient underwent left GPi DBS. Within 4 months of commencing stimulation of the left GPi, the patient had resolution of his neck pain and was able to keep the head straighter for longer time intervals. There was also improvement in right arm segmental dystonia. There was an improvement in the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS 21.5) of 55% at 4 months and of 51% at 22 months. The treatment of secondary dystonia is difficult and the results with GPi DBS are less favourable compared with primary dystonia. This case illustrates the successful treatment of secondary dystonia caused by EA2. Copyright © 2013 S. Karger AG, Basel.

  10. [Criteria for selection of patients for bariatric surgery].

    Science.gov (United States)

    Hell, E; Miller, K

    2002-12-01

    Because of the high prevalence of co-morbid conditions and poor life expectancy a Body Mass Index (BMI) of 40 kg/m(2) or more is an indication for surgery in a fully informed, consenting adult in optimal medical condition to tolerate general anaesthesia. Patients with BMI of 35-40 kg/m(2) and the existence of one or more serious obesity-related conditions ameliorated by weight loss, such as hypertension, pulmonary insufficiency, non-insulin-dependent diabetes mellitus etc., are also candidates for surgical treatment. The bariatric surgeon should use these international criteria as guidelines only, not strict rules. Attempts on the part of internists and more frequently insurance carriers to require documented failure of previous non-operative treatment is not meaningful.

  11. Personalized surgery for rectal tumours: the patient's opinion counts.

    Science.gov (United States)

    Audisio, R A; Filiberti, A; Geraghty, J G; Andreoni, B

    1997-01-01

    In recent times there have been many important changes in the surgical management of rectal cancer. The general thrust of these changes has been towards a less invasive approach with preservation of intestinal continuity and avoidance of the psychological sequelae of a stoma. It is also becoming increasingly apparent that profound sexual and autonomic dysfunction can be associated with abdominoperineal resection. This paper highlights these issues and the conflict between performing an adequate oncological procedure and reducing the incidence of postoperative psychological morbidity. It outlines the great changes there have been in surgical technique and their relevance to psychological problems after surgery for rectal cancer. The need for auditing psychological morbidity when assessing the outcome of surgical series is emphasised, as is the importance of involving the patient in the medical decision making.

  12. ACCOMPANYING THERAPY IN PATIENTS AFTER ENDOSCOPIC LARYNGEAL SURGERY

    Directory of Open Access Journals (Sweden)

    E. N. Novozhilova

    2014-01-01

    Full Text Available The paper describes the experience with accompanying therapy in patients after endoscopic laryngeal surgery, which has been gained at the Unit of Head and Neck Tumors, Moscow City Cancer Hospital Sixty-Two. Endolaryngeal operations have been performed using robotic CO2 laser and alternative modes of mechanical ventilation. Methods for abolishing laser-induced reactive tissue changes with different groups of pharmaceuticals are considered. Both the possible side effects of some drugs and their potential interaction are taken into account. The high efficacy of current inhalation systems (PARI delivering the required doses of medicaments over a short period of time and with minimal losses and regulating their dispersion in relation to the drug used is noted.

  13. Cataract surgery in patients with neovascular age-related macular degeneration

    DEFF Research Database (Denmark)

    Kessel, Line; Koefoed Theil, Pernille; Lykke Sørensen, Torben;

    2016-01-01

    being treated with a median of 10 (range 3-36) anti-VEGF injections for neovascular AMD. Visual acuity improved by a mean of 7.1 [95% confidence interval (CI) 4.6-9.6] ETDRS letters in the first 6 months after cataract surgery. The need of anti-VEGF injections did not change after cataract surgery...... in electronic databases managing anti-VEGF injections and cataract surgery. We compared Early Treatment of Diabetic Retinopathy Study (ETDRS) visual acuity and frequency of anti-VEGF injections before and after cataract surgery. RESULTS: We identified 89 eyes from 89 patients who had cataract surgery after...... AMD. Cataract surgery was not associated with an increased need for anti-VEGF treatment and patients who were in active anti-VEGF treatment had better visual outcomes than patients who had cataract surgery after long injection-free periods....

  14. Morbidities of lung cancer surgery in obese patients.

    Science.gov (United States)

    Dhakal, Binod; Eastwood, Daniel; Sukumaran, Sunitha; Hassler, George; Tisol, William; Gasparri, Mario; Choong, Nicholas; Santana-Davila, Rafael

    2013-08-01

    Obesity is a risk factor for increased perioperative morbidity and mortality in surgical patients. There have been limited studies to correlate the morbidity of lung cancer resection with obesity. We performed a retrospective study of patients who underwent surgical resection for lung cancer at the Medical College of Wisconsin, Milwaukee, from 2006 to 2010. Data on patient demographics, weight, pathological findings, and hospital course were abstracted after appropriate institutional review board approval. Perioperative morbidity was defined as atrial fibrillation, heart failure, respiratory failure, pulmonary embolism, or any medical complications arising within 30 days after surgery. The Fisher exact test was used to test the association between body mass index (BMI) and perioperative morbidities. Between 2006 and 2010, 320 lung resections were performed for lung cancer. The median age was 67 (interquartile range, 59-75) years, and 185 (57.8%) were females. A total of 121 (37.8%) of patients had a BMI lower than 25, and 199 (62.18%) patients had a BMI of 25 or higher. The 30-day mortality rate was 1.8% (n = 6) in the whole group; only 2 of these patients had a BMI of 25 or higher. Perioperative morbidity occurred in 28 (23.14%) of patients with a normal BMI and in 47 (23.61%) of patients with a BMI of 25 or higher (P = .54). Specific morbidities encountered by patients with normal versus BMI of 25 or higher were as follows: atrial fibrillation, 11 (9.09%) versus 24 (12.06%) (P = .46); pulmonary embolism, 1 (0.83%) versus 3 (1.51%) (P = 1.0); congestive heart failure, 2 (1.65%) versus 2 (1.01%) (P = .63); renal failure, 4 (3.3%) versus 2 (1.0%) (P = .29); respiratory failure, 12 (9.92%) versus 17 (8.54%) (P = .69); and acute respiratory distress syndrome, 2 (1.65%) versus 1 (0.50%) (P = .55). The median hospital stay was 5 days in the lower BMI group and 4 days in the BMI of 25 or higher group (P = .52). Overweight and normal weight patients do not differ

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

    Science.gov (United States)

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

    2014-04-01

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

  16. First-episode psychosis

    DEFF Research Database (Denmark)

    Simonsen, Erik

    2011-01-01

    . Patients with first-episode psychosis had significantly high NEO-PI-R scores for neuroticism and agreeableness, and lower scores for conscientiousness and extroversion. The median time for remission in the total sample was three months. Female gender and better premorbid functioning were predictive of less...

  17. Appendiceal Mucocele in an Elderly Patient: How Much Surgery

    Directory of Open Access Journals (Sweden)

    C. Kim-Fuchs

    2011-09-01

    Full Text Available Appendiceal mucoceles are rare cystic lesions with an incidence of 0.3–0.7% of all appendectomies. They are divided into four subgroups according to their histology. Even though the symptoms may vary – depending on the level of complication – from right lower quadrant pain, signs of intussusception, gastrointestinal bleeding to an acute abdomen with sepsis, most mucoceles are asymptomatic and found incidentally. We present the case of a 70-year-old patient with an incidentally found appendiceal mucocele. He was seen at the hospital for backache. The CT scan showed a vertebral fracture and a 7-cm appendiceal mass. A preoperative colonoscopy displayed several synchronous adenomas in the transverse and left colon with high-grade dysplasia. In order to lower the cancer risk of this patient, we performed a subtotal colectomy. The appendiceal mass showed no histopathological evidence of malignancy and no sign of perforation. The follow-up was therefore limited to 2 months. In this case, appendectomy would have been sufficient to treat the mucocele alone. The synchronous high-grade dysplastic adenomas were detected in the preoperative colonoscopy and determined the therapeutic approach. Generally, in the presence of positive lymph nodes, a right colectomy is the treatment of choice. In the histological presence of mucinous peritoneal carcinomatosis, cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is indicated. In conclusion, mucoceles of the appendix are detected with high sensitivity by CT scan. If there is no evidence of synchronous tumor preoperatively and no peritoneal spillage, invasion or positive sentinel lymph nodes during surgery, a mucocele is adequately treated by appendectomy.

  18. Reduction of Severity of Recurrent Psychotic Episode by Sustained Treatment with Aripiprazole in a Schizophrenic Patient with Dopamine Supersensitivity: A Case Report

    Science.gov (United States)

    Tadokoro, Shigenori; Nonomura, Naho; Kanahara, Nobuhisa; Hashimoto, Kenji; Iyo, Masaomi

    2017-01-01

    Dopamine supersensitivity psychosis (DSP) is a type of acute exacerbation of recurrent psychosis caused by long-term treatment with antipsychotics in schizophrenic patients. Although DSP is exceedingly troublesome for clinicians, effective treatment has not yet been established. Based on clinical research and our animal study, we hypothesize that aripiprazole, an atypical anti-psychotic, may reduce the exacerbation of recurrent psychotic episodes. We report the case of a 46-year-old female who suffered from schizophrenia with DSP. In this case, sustained treatment with a high dose of aripiprazole gradually reduced the severity of her recurrent psychotic episodes. In conclusion, sustained treatment with aripiprazole may reduce the exacerbation of recurrent psychotic episodes in schizophrenic patients with DSP, and may be an effective treatment of DSP. PMID:28138118

  19. Prevalence and desire for body contouring surgery in postbariatric patients in Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Saleh M Aldaqal

    2012-01-01

    Full Text Available Background: Morbid obesity has become a common problem worldwide and as a result the demand for bariatric surgery has increased as well. Most patients develop skin redundancy and sagging at many body parts after major weight loss procedures which increased the demand for body contouring procedures. Aims : The study was to address the prevalence and patient′s desire for body contouring procedures. Materials and Methods: A cross-sectional study targeting the postbariatric patients from April 2011 to October 2011 was conducted at our hospital. Questionnaire was administered in order to measure frequency and patients desire to undergo body contouring surgery after massive weight loss. Results: The total number of patients was 128 patients. The mean age of our patients was 37-year old (range 18-56 year. The percentage of the desire for body contouring surgery after bariatric surgery was 78.1%. There was very pronounced desire to body contouring surgery after those who underwent gastric bypass surgery with P-value 0.001. Only 18 patients (14% have underwent body contouring surgery, with a total of 29 procedures, in which abdominoplasty considered the most commonly procedure performed (57%. Conclusion : With the increasing number of weight loss surgery, there is higher number of patients that desire a body contouring surgery, which create huge disparity between demand and accessibility.

  20. Dental extraction for patients presenting at oral surgery student clinic.

    Science.gov (United States)

    Baqain, Zaid H; Khraisat, Ameen; Sawair, Faleh; Ghanam, Sana; Shaini, Firas J; Rajab, Lamis D

    2007-03-01

    The aim of this study was to examine the reasons for dental extraction and to determine the pattern of tooth loss in patients seeking care at the oral surgery teaching clinics in the Faculty of Dentistry of the University of Jordan, Amman, Jordan, over a 3-year period. Data pertaining to the dental extractions of 2435 patients were analyzed. The results showed that 63.8% of the teeth included in this study were extracted because of dental caries, 22.9% because of periodontal disease, and 11.0% for prosthetic reasons. Pericoronitis, orthodontic treatment, trauma, and eruption problems accounted for 2.4% of the reported extractions. The upper premolars were the teeth most commonly extracted, and the lower first and second molars were the teeth most commonly extracted because of dental caries. The logistic regression test revealed that extraction because of dental caries occurred mostly in the group aged 21 to 30 years (P Periodontal disease was not likely the cause of extraction in patients younger than 40 years. Mandibular incisors were the teeth least likely extracted because of dental caries (P periodontal disease (P orthodontic reasons mostly involved the premolars (P periodontal disease (P < .05 and P < .001, respectively) and were more likely to lose teeth for prosthetic reasons and trauma. The information gained from this study is useful to shift oral health planning toward emphasizing the importance of maintaining natural dentition and preventing dental disease.

  1. A manic episode after CPAP in a patient with obstructive sleep apnoea

    Directory of Open Access Journals (Sweden)

    Margarida Lobo

    2014-10-01

    Full Text Available Obstructive slee apnoea (OSA is a common sleep disorder. It has been recognized a link between OSA and depression , which is most of the times resistant to treatment. Other aspects of OSA are metabolic: insulin resistance, hypertension and obesity. A common treatment for OSA is Continuous Positive Airway Pressure (CPAP. This treatment may reverse the cognitive and affective dysfunction but in some cases with residual impairment. The author reports a case of a 48 years old man with family history of bipolar disorder but no past history of psychiatric disorders. A diagnosis of OSA led to the use of CPAP. Ten days later he started hypomanic symptoms and 15 days later he was strongly manic. He was hospitalized and treated with olanzapine, lorazepam and divalproate. CPAP treatment was interrupted. After recovery the patient became depressed and, since then, although he doesn't meet the criteria for major depression, depressive symptoms persisted even with olanzapine and lamotrigibne. Meanwhile he was diagnosed with diabettes mellitus 2 and olanzapine was discontinued and he was put on ziprasidone. The author discusses the contribution of the OSA and treatment with CPAC to the appearance and maintenance of the affective disorder in a patient with family susceptibility. The discussion also includes the metabolic aspects of OSA that can be worsened with the medication to control the affective disorder.

  2. Recurrent Episodes of Stroke-Like Symptoms in a Patient with Charcot-Marie-Tooth Neuropathy X Type 1

    Directory of Open Access Journals (Sweden)

    Ning Wu

    2015-12-01

    Full Text Available Charcot-Marie-Tooth disease (CMT, also known as hereditary motor sensory neuropathy, is a heterogeneous group of disorders best known for causing inherited forms of peripheral neuropathy. The X-linked form, CMTX1, is caused by mutations in the gap junction protein beta 1 (GJB1 gene, expressed both by peripheral Schwann cells and central oligodendrocytes. Central manifestations are known but are rare, and there are few case reports of leukoencephalopathy with transient or persistent neurological deficits in patients with this CMT subtype. Here, we report the case of a man with multiple male and female family members affected by neuropathy who carries a pathologic mutation in GJB1. He has experienced three transient episodes with variable neurological deficits over the course of 7 years with corresponding changes on magnetic resonance imaging (MRI. This case illustrates CMT1X as a rare cause of transient neurological deficit and demonstrates the evolution of associated reversible abnormalities on MRI over time. To the best of our knowledge, this report provides the longest period of serial imaging in a single patient with this condition in the English language literature.

  3. Enhanced Recovery After Surgery Program in Patients Undergoing Pancreaticoduodenectomy

    Science.gov (United States)

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

    2016-01-01

    Abstract Enhanced recovery after surgery (ERAS) pathways are multimodal, evidence-based approaches to optimize patient outcome after surgery. However, the use of ERAS protocols to improve morbidity and recovery time without compromising safety following pancreaticoduodenectomy (PD) remains to be elucidated. We conducted a systemic review and meta-analysis to assess the safety and efficacy of ERAS protocols compared with conventional perioperative care (CPC) in patients following PD. PubMed, Medline, Embase, and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library were searched between January 2000 and June 2015. The patients who underwent PD with ERAS protocols or CPC were eligible. The studies that compared postoperative length of hospital stay (PLOS), postoperative complications, or in-hospital costs in the 2 groups were included. A meta-analysis, meta-regression, sensitivity analysis, and subgroup analysis were performed to estimate the postoperative outcomes between the 2 groups and identified the potential confounders. We used the methodological index for nonrandomized studies checklist to assess methodological qualities. Weighted mean differences (WMD) or odds ratios (OR) were calculated with their corresponding 95% confidence intervals (CI). The publication bias tests were also performed through the funnel plots. In total, 14 nonrandomized comparative studies with 1409 ERAS cases and 1310 controls were analyzed. Implementation of an ERAS protocol significantly reduced PLOS (WMD: −4.17 days; 95%CI: −5.72 to −2.61), delayed gastric emptying (OR: 0.56; 95%CI: 0.44–0.71), overall morbidity (OR: 0.63; 95% CI: 0.54–0.74), and in-hospital costs compared to CPC (all P < 0.001). There were no statistically significant differences in other postoperative outcomes. Age, gender, and ERAS component implementation did not significantly contribute to heterogeneity for PLOS as shown by meta

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

    Science.gov (United States)

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

    2016-06-01

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

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

    Science.gov (United States)

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

    2005-02-01

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

  6. Relationship between vascular dysfunction in peripheral arteries and ischemic episodes during daily life in patients with ischemic heart disease and hypercholesterolemia

    DEFF Research Database (Denmark)

    Søndergaard, Eva; Møller, Jacob E; Egstrup, Kenneth

    2002-01-01

    BACKGROUND: It is well established that endothelial dysfunction is present in patients with ischemic heart disease and hypercholesterolemia. Some of these patients will have signs of transient myocardial ischemia during Holter monitoring. We sought to describe the correlation between daily life...... cardiovascular risk factors. CONCLUSIONS: These results indicate a significant relationship between ischemic episodes and vascular dysfunction in patients with ischemic heart disease and hypercholesterolemia and may justify an aggressive preventive therapy targeted directly at the endothelium....

  7. Severe Burns and Amputation of Both Arms in the First Psychotic Episode of a Schizophrenic Patient

    Directory of Open Access Journals (Sweden)

    Lizardo Cruzado

    2015-01-01

    Full Text Available An alleged reduction of sensitivity to pain in people with schizophrenia has been reported, but the nature of this complex phenomenon has not been elucidated yet. Reports of insensitivity to burns from people with schizophrenia are extremely rare. We report the case of a 24-year-old man who set both of his arms on fire during the first break of paranoid schizophrenia. As a result of severe tissue damage, both of his limbs had to be amputated. Today, at the age of 59, the patient is physically and mentally rehabilitated and is adherent to treatment. Additionally, given the uncertainty about the true nature of the alleged hypoalgesia in schizophrenia, we postulate the need for a comprehensive phenomenological approach in the study of embodiment in people with this condition.

  8. Bariatric surgery: a viable treatment option for patients with severe mental illness.

    Science.gov (United States)

    Shelby, Sarah R; Labott, Susan; Stout, Rebecca A

    2015-01-01

    Although bariatric surgery has become a recognized treatment for obesity, its utility among patients with severe psychiatric disorders has not been extensively studied. A few studies have reported similar weight loss outcomes in these patients, but psychiatric status after bariatric surgery has been studied only minimally, and it is unknown if exacerbation of the mental illness affects weight loss. The aim of this study was to shed greater light on the issue of serious mental illness and bariatric surgery. Specifically, do patients with a diagnosis of schizophrenia, bipolar I, and bipolar II have poorer weight loss outcomes postbariatric surgery than the general bariatric surgery population? Also, do patients with these diagnoses experience an exacerbation of psychiatric symptoms after bariatric surgery, and if so, is the exacerbation of these disorders linked to poorer weight loss results? Midwest university medical center. A medical record review of approximately 1500 bariatric patients in a Midwest university medical center was conducted to identify those patients with diagnoses of schizophrenia, bipolar I, and bipolar II. Information was gathered on bariatric surgery outcomes and changes in psychiatric status postsurgery. Eighteen patients were identified as undergoing bariatric surgery and having a diagnosis of schizophrenia, bipolar I, or bipolar II. Weight loss in this group was significant and comparable to expected outcomes of absolute weight lost, changes in body mass index, and percentage excess weight loss for patients in the typical bariatric population. Postsurgery psychiatric status was known on 10 patients. All 10 patients experienced some exacerbation of psychiatric problems yet weight loss outcomes were still as expected. Bariatric surgery is a viable obesity treatment option for patients with schizophrenia, bipolar I, and bipolar II disorders. Symptom exacerbations occurred postsurgery, although it is not clear if these were due to the surgery or

  9. Interest, views and perceived barriers to bariatric surgery in patients with morbid obesity.

    Science.gov (United States)

    Wharton, S; Serodio, K J; Kuk, J L; Sivapalan, N; Craik, A; Aarts, M-A

    2016-04-01

    The objective of the study was to assess the interest, views and patient-perceived barriers to bariatric surgery among surgery-eligible patients. Surveys were completed at a weight management clinic and local hospital in Ontario, Canada. Patients were ≥18 years of age with a body mass index (BMI) >40 kg m(-2) or BMI > 35 kg m(-2) with ≥1 comorbidity. The sample included 105 participants, 73.3% female, with a mean BMI of 46.6 ± 7.1 kg m(-2) . Only 33.3% of participants were interested in surgery; 50.5% of participants were not interested and 16.2% had mixed feelings. Participants identified risks (69.5%) and side effects (57.1%) as significant surgical barriers. Interested participants were more likely to perceive themselves as obese, were unhappy with their current weight loss method and were less likely to fear surgery (P bariatric surgery, the majority of qualified patients are not interested in surgery mainly due to the perceived risk of surgery in general and satisfaction with current non-surgical weight loss efforts. The self-perception of obesity, as opposed to medical comorbidities, may be a stronger driver of the decision to have bariatric surgery. It is unclear if patients are aware of the effectiveness of bariatric surgery to help improve comorbidities or if bariatric surgery is perceived as being more cosmetic in nature.

  10. The Hispanic Clinic for Pediatric Surgery: A model to improve parent-provider communication for Hispanic pediatric surgery patients.

    Science.gov (United States)

    Jaramillo, Joshua; Snyder, Elizabeth; Dunlap, Jonathan L; Wright, Robert; Mendoza, Fernando; Bruzoni, Matias

    2016-04-01

    26 million Americans have limited English proficiency (LEP). It is well established that language barriers adversely affect health and health care. Despite growing awareness of language barriers, there is essentially a void in the medical literature regarding the influence of language disparity on pediatric surgery patients. This study was designed to assess the impact of patient-provider language concordance on question-asking behavior and patient satisfaction for pediatric surgery patients. Participants included families of patients in a General Pediatric Surgery Clinic categorized into 3 groups by patient-provider language concordance: concordant English-speaking, LEP concordant Spanish-speaking, and LEP discordant Spanish-speaking using an interpreter. Clinical visits were audio recorded and the number of patient-initiated questions and the length of clinical encounter were measured. Families were administered a surgery-specific, 5-point Likert scale questionnaire modeled after validated surveys concerning communication, trust, perceived discrimination and patient-provider language concordance. Regression models were performed to analyze associations between language concordance and patient's question-asking behavior and between language concordance and survey results. A total of 156 participants were enrolled including 57 concordant-English, 52 LEP concordant-Spanish and 47 LEP-discordant-Spanish. There was significant variation in the mean number of patient-initiated questions among the groups (p=0.002). Both the English and Spanish concordant groups asked a similar number of questions (p=0.9), and they both asked more questions compared to the Spanish-discordant participants (p=0.002 and p=0.001). Language discordance was associated with fewer questions asked after adjustment for socioeconomic status. Language concordant participants rated higher scores of communication. Both Spanish-concordant and Spanish-discordant patients reported significantly increased

  11. Identifying Episodes of Back Pain Using Medical Expenditures Panel Survey (MEPS) Data: Patient Experience, Use of Services, and Chronicity

    Science.gov (United States)

    Monica, Smith

    2010-01-01

    Objective To explore the correspondence between “episodes of pain” and “episodes of care” for individuals with back pain. Data Source Secondary analysis of Medical Expenditures Panel Survey (MEPS) 2-year longitudinal data. Study Design Individual use and utilization of back pain services were examined across ambulatory settings and providers, and linked to MEPS medical condition data to identify individuals with back pain who do not use, or who delay or discontinue utilization of health services for back pain. Data Collection/Extraction Methods Episodes-of-care and episodes-of-pain were approximated through round-by-round temporal mapping of MEPS back pain utilization events data and medical conditions data. Principal Findings Of 10,193 individuals with back pain, approximately one fifth did not actively seek care for their back pain. Utilization of services for back pain (episodes-of-care) does not always correspond with an individual’s full experience of back pain (episodes-of-pain). Upwards of 20% of MEPS respondents who use services for some back pain episodes, reported additional episodes for which they do not use services. Conclusions These findings suggest that other longitudinal studies based only on data that reflect service use, e.g., claims data, may incorrectly infer the nature of back pain and back pain episodes. Many individuals report ongoing back pain that continues beyond their episodes-of-care, and many individuals with persistent back pain may use prescription drugs, medical services, and other health services only intermittently. PMID:21036278

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

    OpenAIRE

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

    2016-01-01

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

  13. Oral surgery for patients on anticoagulant therapy: current thoughts on patient management.

    Science.gov (United States)

    Doonquah, Ladi; Mitchell, Anika D

    2012-01-01

    Minor oral surgical procedures make up a significant part of the daily practice of dentistry. With the increased sophistication of medical technology and medications there is increased likelihood of performing surgery on patients who are being treated for conditions that require some type of anticoagulant therapy. These patients are at an increased risk for perioperative bleeding or thrombotic complications if anticoagulation is discontinued or the dosage is adjusted. Therefore, a fine balance needs to be obtained and adequate preparation of these patients is the key to establishing this balance. This article reviews suggested approaches to the management of such patients.

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

    OpenAIRE

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  16. Frequency and predictive values of first rank symptoms at baseline among 362 young adult patients with first-episode schizophrenia Results from the Danish OPUS study

    DEFF Research Database (Denmark)

    Thorup, Anne; Petersen, Lone; Jeppesen, Pia;

    2007-01-01

    To investigate the frequency of the Schneiderian First Rank Symptoms (FRSs) in a representative group of patients with first-episode schizophrenia and to analyse the predictive value of these symptoms in relation to psychopathology, work situation, depression, dependency and admission after 2 years...

  17. The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial.

    NARCIS (Netherlands)

    Aalderen, J.R. van; Donders, A.R.T.; Giommi, F.; Spinhoven, P.; Barendregt, H.P.; Speckens, A.E.M.

    2012-01-01

    BACKGROUND: The aim of this study is to examine the efficacy of mindfulness-based cognitive therapy (MBCT) in addition to treatment as usual (TAU) for recurrent depressive patients with and without a current depressive episode. METHOD: A randomized, controlled trial comparing MBCT+TAU (n=102) with T

  18. Selective deficits in semantic verbal fluency in patients with a first affective episode with psychotic symptoms and a positive history of mania.

    LENUS (Irish Health Repository)

    Kravariti, Eugenia

    2009-05-01

    Neurocognitive dysfunction is likely to represent a trait characteristic of bipolar disorder, but the extent to which it comprises \\'core\\' deficits as opposed to those secondary to longstanding illness or intellectual decline is unclear. We investigated neuropsychological performance in an epidemiologically derived sample of patients with a first affective episode with psychotic symptoms and a positive history of mania, compared to community controls.

  19. Effect of goal attainment theory based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: Randomized study.

    Science.gov (United States)

    Park, Moonkyoung; Song, Rhayun; Jeong, Jin-Ok

    2017-02-24

    Effect of goal-attainment-theory-based education program on cardiovascular risks, behavioral modification, and quality of life among patients with first episode of acute myocardial infarction: randomized study BACKGROUND: The behavioral modification strategies should be explored at the time of admission to lead the maximum effect of cardiovascular risk management.

  20. Relationship between episodic memory and resting-state brain functional connectivity network in patients with Alzheimer’s disease and mild cognition impairment

    Institute of Scientific and Technical Information of China (English)

    吴钦娟

    2013-01-01

    Objective To explore the relationship between the scores of episodic memory (EM) encoding and retrieving and the resting-state changes of brain functional connectivity (FC) network of Alzheimer’s disease (AD) and mild cognition impairment (MCI) patients.Methods All

  1. Long-term outcome of mindfulness-based cognitive therapy in recurrently depressed patients with and without a depressive episode at baseline

    NARCIS (Netherlands)

    Aalderen, J.R. van; Donders, A.R.T.; Peffer, K.; Speckens, A.E.M.

    2015-01-01

    BACKGROUND: In a previous randomized controlled trial in patients with three or more previous depressive episodes, mindfulness-based cognitive therapy (MBCT) appeared to be equally effective in those who were depressed and those who were in remission at the start of the trial. AIM: The aim of this s

  2. Frequency and predictive values of first rank symptoms at baseline among 362 young adult patients with first-episode schizophrenia Results from the Danish OPUS study

    DEFF Research Database (Denmark)

    Thorup, Anne; Petersen, Lone; Jeppesen, Pia;

    2007-01-01

    To investigate the frequency of the Schneiderian First Rank Symptoms (FRSs) in a representative group of patients with first-episode schizophrenia and to analyse the predictive value of these symptoms in relation to psychopathology, work situation, depression, dependency and admission after 2 yea...

  3. Course of illness in a sample of 265 patients with first-episode psychosis--five-year follow-up of the Danish OPUS trial

    DEFF Research Database (Denmark)

    Bertelsen, Mette; Jeppesen, Pia; Petersen, Lone;

    2009-01-01

    -sample of the OPUS trial of 265 first-episode psychotic patients after five years. Recovery, defined as no psychotic or negative symptoms, living independently, GAF (f)>59, working or studying, was reached for 18% after five years, whereas 13% were institutionalized either at hospital or supported housing after five...

  4. Ten-Year Follow-up of the OPUS Specialized Early Intervention Trial for Patients With a First Episode of Psychosis

    DEFF Research Database (Denmark)

    Secher, Rikke Gry; Hjorthøj, Carsten Rygaard; Austin, Stephen F

    2014-01-01

    INTRODUCTION: Specialized early intervention programs such as The Danish OPUS treatment are efficient in treating patients with a first episode of psychosis (FEP) at least after 2 and 5 years. Few studies have examined long-term outcomes of these interventions. AIM: To examine the effect of 2 years...

  5. Postsurgical volumetric airway changes in 2-jaw orthognathic surgery patients.

    Science.gov (United States)

    Hart, P Sheamus; McIntyre, Brian P; Kadioglu, Onur; Currier, G Fräns; Sullivan, Steven M; Li, Ji; Shay, Christina

    2015-05-01

    Findings from early cephalometric studies on airway changes after 2-jaw orthognathic surgery have been challenged because the previous anteroposterior interpretation of airway changes can now be evaluated in 3 dimensions. The aims of this study were to use cone-beam computed tomography to quantify the nasopharynx, oropharynx, and total airway volume changes associated with skeletal movements of the maxilla and mandible in a sample of patients undergoing 2-jaw orthognathic surgery for correction of skeletal malocclusion. Skeletal movements and airway volumes of 71 postpubertal patients (31 male, 40 female; mean age, 18.8 years) were measured. They were divided into 2 groups based on ANB angle, overjet, and occlusion (Class II: ANB, >2°; overjet, >1 mm; total, 35 subjects; and Class III: ANB, overjet, <1 mm; total, 36 subjects). Presurgical and postsurgical measurements were collected for horizontal, vertical, and transverse movements of the maxilla and the mandible, along with changes in the nasopharynx, oropharynx, and total airways. Associations between the directional movements of skeletal structures and the regional changes in airway volume were quantified. Changes in the most constricted area were also noted. Horizontal movements of D-point were significantly associated with increases in both total airway (403.6 ± 138.6 mm(3); P <0.01) and oropharynx (383.9 ± 127.9 mm(3); P <0.01) volumes. Vertical movements of the posterior nasal spine were significantly associated with decreases in total airway volume (-459.2 ± 219.9 mm(3); P = 0.04) and oropharynx volume (-639.7 ± 195.3 mm(3); P <0.01), increases in nasopharynx (187.2 ± 47.1 mm(3); P <0.01) volume, and decreases in the most constricted area (-10.63 ± 3.69 mm(2); P <0.01). In the Class III patients only, the vertical movement of D-point was significantly associated with decreases in both total airway (-724.0 ± 284.4 mm(3); P = 0.02) and oropharynx (-648.2 ± 270.4 mm(3); P = 0.02) volumes. A similar

  6. Glucomannan prevents postprandial hypoglycaemia in patients with previous gastric surgery.

    Science.gov (United States)

    Hopman, W P; Houben, P G; Speth, P A; Lamers, C B

    1988-07-01

    Glucomannan (Propol), a potent gel forming dietary fibre, was added to a carbohydrate rich breakfast in eight patients with previous gastric surgery suffering from postprandial hypoglycaemia. Addition of only 2.6 g and 5.2 g glucomannan to the meal dose dependently improved reactive hypoglycaemia from 2.3 (0.2) mmol/l to 3.3 (0.2) mmol/l (p less than 0.0005) after 2.6 g and 4.1 (0.2) mmol/l (p = 0.0005) after 5.2 g, and decreased postprandial rise in plasma insulin (p less than 0.05). Expiratory breath hydrogen excretion tended to decrease reflecting improvement of carbohydrate metabolism. Addition of glucomannan to an intraduodenal sucrose solution significantly raised plasma glucose nadirs, indicating glucomannan to be effective during the intestinal phase. It is concluded that small amounts of glucomannan may be beneficial to patients with reactive postprandial hypoglycaemia, without the disadvantage of unpalatability and carbohydrate malabsorption.

  7. Validation of pulse oximetry for monitoring of hypoxaemic episodes in the late postoperative period

    DEFF Research Database (Denmark)

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

    1997-01-01

    We monitored 12 patients undergoing major abdominal surgery using a pulse oximeter (Nellcor N-200) and a transcutaneous oxygen tension monitor (TINA, Radiometer A/S) on the second or third night after operation. Of the shortest hypoxaemic episodes measured with the pulse oximeter (... duration), 78% also occurred in the transcutaneous oxygen tension measurement. Episodes of longer duration (> or = 1 min duration on the pulse oximeter) were, in 95% of cases, reflected in the transcutaneous oxygen tension measurement also. Thus postoperative episodic desaturations lasting > or = 1 min...

  8. Body contouring after obesity surgery is associated with a weight loss benefit among patients.

    Science.gov (United States)

    Agarwal, Shailesh; Shenaq, Deana; Teven, Chad M; Prachand, Vivek; Roughton, Michelle; Zachary, Lawrence

    2017-09-01

    Patients who undergo obesity surgery often require body contouring procedures to eliminate excess skin. Recent studies suggest that body contouring surgery may provide psychological benefits to patients after obesity surgery. However, it remains unclear how body contouring may affect weight loss maintenance after obesity surgery. This is a retrospective review of patients who underwent obesity surgery with or without body contouring at a single institution from 2000 to 2005. Charts were reviewed for demographic, medical, and surgical information. The primary outcome of interest was the difference in weight loss maintenance among patients who underwent body contouring versus those who did not. A total of 318 patients were included for analysis in this study, of which 70 underwent obesity surgery with body contouring and 248 underwent obesity surgery without body contouring. The mean change in BMI among patients who did not undergo body contouring was 19.7 kg/m(2). The mean change in BMI among patients who underwent body contouring was 22.1 kg/m(2). Among patients who underwent body contouring surgery, 2.9% (2/70) of patients did not maintain at least a 20% decrease in body weight during the entire follow-up period (mean follow-up time 92.2 months). Among patients who did not undergo body contouring surgery, 10% (25/248) of patients did not maintain at least a 20% decrease in body weight during the entire follow-up period (mean follow-up time 39.0 months) (χ(2) = 3.67, p = 0.055). Body contouring surgery may have a positive effect on weight loss maintenance after body contouring determined from the mean weight change and on percentage of patients who maintain at least a 20% decrease in body weight. Copyright © 2017. Published by Elsevier Ltd.

  9. Changeover Trial of Azilsartan and Olmesartan Comparing Effects on the Renin-Angiotensin-Aldosterone System in Patients with Essential Hypertension after Cardiac Surgery (CHAOS Study).

    Science.gov (United States)

    Sezai, Akira; Osaka, Shunji; Yaoita, Hiroko; Arimoto, Munehito; Hata, Hiroaki; Shiono, Motomi; Sakino, Hisakuni

    2016-06-20

    Angiotensin II receptor blockers (ARBs) have been widely used to treat hypertension and large-scale clinical studies have shown various benefits. In this study, we compared olmesartan with azilsartan, the newest ARB. The subjects were outpatients who were clinically stable after cardiac surgery. Sixty patients were randomized to receive either azilsartan or olmesartan for 1 year and were switched to the other drug for the following 1 year. The primary endpoints were the levels of plasma renin activity, angiotensin II, and aldosterone. Home blood pressure exceeded 140/90 mmHg and additional antihypertensive medication was administered to 12 patients (20 episodes) in the azilsartan group versus 4 patients (4 episodes) in the olmesartan group, with the number being significantly higher in the azilsartan group. After 1 year of treatment, both angiotensin II and aldosterone levels were significantly lower in the olmesartan group than the azilsartan group. Left ventricular mass index was also significantly lower in the olmesartan group than the azilsartan group. This study showed that olmesartan reduces angiotensin II and aldosterone levels more effectively than azilsartan. Accordingly, it may be effective in patients with increased renin-angiotensin-aldosterone system activity after cardiac surgery or patients with severe cardiac hypertrophy.

  10. Trashepatic left gastric vein embolization in the treatment of recurrent hemorrhaging in patients with schistosomiasis previously submitted to non-derivative surgery

    Directory of Open Access Journals (Sweden)

    Paulo Fernandes Saad

    2012-12-01

    Full Text Available CONTEXT: Non-derivative surgical techniques are the treatment of choice for the control of upper digestive tract hemorrhages after schistosomotic portal hypertension. However, recurrent hemorrhaging due to