WorldWideScience

Sample records for surgery patients response

  1. Metabolic response to surgery in the cancer patient

    International Nuclear Information System (INIS)

    Brennan, M.F.

    1979-01-01

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

  2. Cell response to surgery.

    LENUS (Irish Health Repository)

    Ni Choileain, Niamh

    2012-02-03

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

  3. Cephalometric predictors of therapeutic response to multilevel surgery in patients with obstructive sleep apnea.

    Science.gov (United States)

    Kim, Su-Jung; Kim, Young-Suk; Park, Jeong-Ho; Kim, Sung-Wan

    2012-06-01

    The present study investigated whether cephalometric measurements can predict the therapeutic efficacy of multilevel phase I surgery for patients with obstructive sleep apnea (OSA). Among 210 patients with OSA who underwent multilevel phase I surgery, 85 were recruited on the basis of the baseline polysomnography, body mass index, and lateral cephalogram recordings. The patients were divided into 2 groups according to the degree of change in the apnea-hypopnea index before and 6 months after multilevel surgery: good responders (>50% decrease in apnea-hypopnea index) and poor responders (0% to 50% decrease or increase in apnea-hypopnea index). Cephalometric analysis was performed to identify the relevant variables, with division into 5 compartments: craniofacial, soft palate, tongue, hyoid bone, and upper airway variables. In the craniofacial compartment, poor responders represented skeletal Class II with a more retrognathic mandible, and a hyperdivergent vertical pattern with a larger mandibular plane angle, longer lower facial height, and steeper occlusal plane than good responders. In the upper airway compartment, poor responders had narrower middle and inferior airway spaces and a longer upper airway length than good responders. No significant differences were found in the soft palate, tongue, and hyoid measurements between the 2 groups. Some preoperative cephalometric measurements were verified retrospectively to predict the therapeutic response to the multilevel surgery in patients with OSA. This study would contribute not only to establishing selective criteria for the surgical approach to patients with OSA in ear-nose-throat practice but also in deciding on the referral to orthodontists or maxillofacial surgeons. Copyright © 2012 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry

    OpenAIRE

    Rustemeyer, Jan; Martin, Alice

    2012-01-01

    Purpose Since improvement of facial aesthetics after orthognathic surgery moves increasingly into the focus of patients, prediction of soft tissue response to hard tissue movement becomes essential for planning. The aim of this study was to assess the facial soft tissue response in skeletal class II and III patients undergoing orthognathic surgery and to compare the potentials of cephalometry and two-dimensional (2-D) photogrammetry for predicting soft tissue changes. Material and methods Twe...

  5. The Impact of Two Different Transfusion Strategies on Patient Immune Response during Major Abdominal Surgery: A Preliminary Report

    OpenAIRE

    Theodoraki, Kassiani; Markatou, Maria; Rizos, Demetrios; Fassoulaki, Argyro

    2014-01-01

    Blood transfusion is associated with well-known risks. We investigated the difference between a restrictive versus a liberal transfusion strategy on the immune response, as expressed by the production of inflammatory mediators, in patients subjected to major abdominal surgery procedures. Fifty-eight patients undergoing major abdominal surgery were randomized preoperatively to either a restrictive transfusion protocol or a liberal transfusion protocol (with transfusion if hemoglobin dropped be...

  6. Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients.

    Science.gov (United States)

    Markovitz, Sabine E; Schrooten, Ward; Arntz, Arnoud; Peters, Madelon L

    2015-12-01

    The purposes of the present study were to investigate the role of resilience in the prediction of emotional response in breast cancer patients and to examine whether this association is specific for women undergoing this emotionally taxing condition or whether resilience is more generally associated with higher levels of emotional well-being. Two hundred fifty-three breast cancer patients and 211 healthy female controls completed four psychological questionnaires. Measures comprised the Connor-Davidson Resilience Scale, the Hospital Anxiety and Depression Scale, Positive and Negative Affect Schedule, and two happiness items. Cancer patients were assessed after diagnosis and surgery. Cancer patients reported higher levels of anxiety, depression, and negative affect and lower levels of positive affect and current happiness compared with control women. There was no difference between the two groups in level of resilience. Higher levels of resilience were related to better emotional adjustment both in women with breast cancer and in control women, but this association was stronger within the sample of cancer patients. In fact, patients scoring high on resilience seemed to experience similar levels of anxiety, depression, and current happiness as healthy women. Our results confirm that resilience may at least partially protect against emotional distress in cancer patients. Our findings suggest that resilience may be a relatively stable trait that is not affected by adversity. Copyright © 2015 John Wiley & Sons, Ltd.

  7. Oncoplastic techniques extend breast-conserving surgery to patients with neoadjuvant chemotherapy response unfit for conventional techniques.

    Science.gov (United States)

    Regaño, Sara; Hernanz, Fernando; Ortega, Estrella; Redondo-Figuero, Carlos; Gómez-Fleitas, Manuel

    2009-10-01

    Oncoplastic surgery is extending the role of breast-conserving surgery in an increasing number of patients who are unsuitable for conventional breast-conserving techniques. The aim of this retrospective study was to analyze the surgical approach, oncoplastic surgery guided by bracketing, used in the treatment of patients who required a wide breast tissue excision after neoadjuvant chemotherapy. The parameters evaluated were as follows: margin status, rate of re-excision for positive margin, early ipsilateral recurrence, and cosmetic outcomes. A total of 23 patients were treated with an oncoplastic breast-conserving surgery one-stage procedure using volume-replacement (20) and volume-displacement techniques (3). We reviewed medical records, mammograms and magnetic resonance images. Cosmetic assessment was carried out by a mixed panel made up of three women: a general practitioner, a resident general surgeon and a nurse. All margins were negative and none of the patients had to have a re-excision for positive margins. One ipsilateral local recurrence was observed after a 32-month follow-up period. Cosmetic outcome was good, with an overall score of 8 out of 10. Oncoplastic techniques extend breast-conserving surgery to patients with neoadjuvant chemotherapy response unfit for conventional techniques. The surgical approach combining oncoplastic techniques with bracketing allows breast-conserving surgery to be performed in these patients.

  8. Practice makes perfect? Patient response to a prebariatric surgery behavior modification program.

    Science.gov (United States)

    Brandenburg, Dana; Kotlowski, Rebecca

    2005-01-01

    Although bariatric surgery has been identified as an effective treatment for weight loss in the morbidly obese, some patients regain weight postoperatively. A pre-treatment program focused on changing lifestyle behaviors could facilitate improved post-surgical outcomes. The purpose of this study was to determine patient satisfaction and perceived usefulness of a preoperative program. Participants completed a bariatric surgery program that incorporated a 6-week behavior modification component before the surgery date. A selfreport questionnaire was sent to individuals who had completed the program. The questionnaire assessed demographics, satisfaction with the pre-surgery program, and patients' perceived usefulness of the program. Of 124 questionnaires sent, 70 were returned (56%). Participants had a mean age of 46.3 years. The majority of participants were Caucasian (97.1%), female (78.6%), and employed (68.6%). Mean preoperative BMI was 55.3; mean postoperative BMI was 36.3. Participants were 1 year post-surgery (mean 48.8 weeks). Patients were very satisfied with the overall program (mean Likert score 4.51), as well as with the behavior modification groups (mean 4.44). They found the groups to be very useful in making postoperative changes (mean 4.45). Patient satisfaction and perceived usefulness were not significantly correlated with the degree of weight lost (r=.05, P=.69; r=.05, P=.71). Patients found the preoperative behavior modification program useful in helping them make the necessary post-surgical lifestyle changes.

  9. Response of recurrent binge eating and weight gain to topiramate in patients with binge eating disorder after bariatric surgery.

    Science.gov (United States)

    Guerdjikova, Anna I; Kotwal, Renu; McElroy, Susan L

    2005-02-01

    The effectiveness of topiramate was evaluated in the treatment of recurrent binge eating and weight gain in patients with binge eating disorder (BED) and obesity who had undergone initially successful bariatric surgery. The records of 3 consecutive patients with BED and obesity who presented to our clinic with recurrent binge eating and weight gain after undergoing initially successful bariatric surgery were reviewed. They were treated with topiramate for an average of 10 months. All three patients reported complete amelioration of their binge eating symptoms and displayed weight loss (31.7 kg in 17 months, 14.5 kg in 9 months, 2 kg in 4 months, respectively) in response to topiramate (mean dose 541 mg). Although anecdotal, these observations suggest that topiramate may be an effective treatment for patients with BED and obesity who experience recurrent binge eating and weight gain after initially successful bariatric surgery.

  10. Soft tissue response in orthognathic surgery patients treated by bimaxillary osteotomy: cephalometry compared with 2-D photogrammetry.

    Science.gov (United States)

    Rustemeyer, Jan; Martin, Alice

    2013-03-01

    Since improvement of facial aesthetics after orthognathic surgery moves increasingly into the focus of patients, prediction of soft tissue response to hard tissue movement becomes essential for planning. The aim of this study was to assess the facial soft tissue response in skeletal class II and III patients undergoing orthognathic surgery and to compare the potentials of cephalometry and two-dimensional (2-D) photogrammetry for predicting soft tissue changes. Twenty-eight patients with class II relationship and 33 with class III underwent bimaxillary surgery. All subjects had available both a traced lateral cephalogram and a traced lateral photogram taken pre- and postsurgery in natural head position (median follow-up, 9.4 ± 0.6 months). Facial convexity and lower lip length were highly correlated with hard tissue movements cephalometrically in class III patients and 2-D photogrammetrically in both classes. In comparison, cephalometric correlations for class II patients were weak. Correlations of hard and soft tissue movements between pre- and postoperative corresponding landmarks in horizontal and vertical planes were significant for cephalometry and 2-D photogrammetry. No significant difference was found between cephalometry and 2-D photogrammetry with respect to soft to hard tissue movement ratios. This study revealed that cephalometry is still a feasible standard for evaluating and predicting outcomes in routine orthognathic surgery cases. Accuracy could be enhanced with 2-D photogrammetry, especially in class II patients.

  11. Patient satisfaction with cataract surgery

    Directory of Open Access Journals (Sweden)

    Wasfi Ehab I

    2008-10-01

    Full Text Available Abstract Introduction Measuring the patient satisfaction is a very important issue that will help very much in improving the service provided to patients and improve the level of satisfaction. Aim To evaluate patient satisfaction with the cataract surgery service and identify any areas for improvement, determination of patient satisfaction with referral, out-patient consultation, pre-assessment clinic, surgery and post-operative care, also to report patients' comments relating to improvement in service provision. Methodology A retrospective study was undertaken for 150 patients underwent cataract surgery at Barrow General Hospital, UK, the survey sample was by postal questionnaires. We collected our data from the theatre lists for a period of 4 month. Results This study included 150 patients; the response rate was (72% 108 patients, Most patients were referred from their general practitioner 86.1%, 93 (86.1% patients were happy with the time interval from seeing their GP to eye clinic. In the eye out patient department many factors significantly affected the level of patient satisfaction, in general the more information provided for the patient the more the satisfaction. Conclusion Patient satisfaction is on important health outcome old understanding both the domains of satisfaction as well as their relative importance to patients is necessary to improve the overall quality of patient care. Meeting the doctor, presenting all relevant information and giving printed information are very important factors in improving the patient's satisfaction with cataract surgery.

  12. The effects of transfusion of irradiated blood upon cellular immune response in patients underwent open heart surgery

    International Nuclear Information System (INIS)

    Togashi, Ken-ichi; Nakazawa, Satoshi; Moro, Hisanaga; Yazawa, Masatomo; Kanazawa, Hiroshi; Hayashi, Jun-ichi; Yamazaki, Yoshihiko; Eguchi, Shoji

    1989-01-01

    The purpose of this paper is to demonstrate the effect of the transfusion of blood received 1500 rad exposure upon the immune response in 14 patients underwent various type of cardiac surgery. 13 patients received known amounts banked blood and irradiated fresh blood, while one patient received a lot of amounts of banked and irradiated and non-irradiated fresh blood. The authors studied the numbers of lymphocytes as well as lymphocyte subsets such as pan-T cells, B cells, helper/inducer T cells (T H/I ), cytotoxic/supressor T cells (T C/S ), active T cells, natural killer (NK) cells and NK cell activity during two weeks after surgeries. In all 14 patients, pan-T lymphocytes decreased markedly in a few days after surgeries, but increased to higher levels on the eight postoperative day than the levels preoperatively. T H/I and T C/S lymphocytes changed on the similar pattern as pan-T lymphocytes. Active T and B cells did not change significantly in two weeks. The number and activity of NK cells gave the lowest levels on the second postoperative day and did not recovery to the preoperative levels in two weeks. One patient received non-irradiated fresh blood showed the similar immune response as other 13 patients, while he gave the lower levels than others did. This patient died of graft-versus-host disease (GVHD)-like syndrome on the 36th postoperative day. It may be thought that the transfusion of irradiated blood would prevent the host from GVHD and gave the better effects on the immune response than that of non-irradiated blood following open-heart surgeries. (author)

  13. An application of structural equation modeling to detect response shifts and true change in quality of life data from cancer patients undergoing invasive surgery

    NARCIS (Netherlands)

    Oort, Frans J.; Visser, Mechteld R. M.; Sprangers, Mirjam A. G.

    2005-01-01

    The objective is to show how structural equation modeling can be used to detect reconceptualization, reprioritization, and recalibration response shifts in quality of life data from cancer patients undergoing invasive surgery. A consecutive series of 170 newly diagnosed cancer patients,

  14. I-gel Laryngeal Mask Airway Combined with Tracheal Intubation Attenuate Systemic Stress Response in Patients Undergoing Posterior Fossa Surgery

    Directory of Open Access Journals (Sweden)

    Chaoliang Tang

    2015-01-01

    patients. In this study, we proposed that I-gel combined with tracheal intubation could reduce the stress response of posterior fossa surgery patients. Methods. Sixty-six posterior fossa surgery patients were randomly allocated to receive either tracheal tube intubation (Group TT or I-gel facilitated endotracheal tube intubation (Group TI. Hemodynamic and respiratory variables, stress and inflammatory response, oxidative stress, anesthesia recovery parameters, and adverse events during emergence were compared. Results. Mean arterial pressure and heart rate were lower in Group TI during intubation and extubation (P<0.05 versus Group TT. Respiratory variables including peak airway pressure and end-tidal carbon dioxide tension were similar intraoperative, while plasma β-endorphin, cortisol, interleukin-6, tumor necrosis factor-alpha, malondialdehyde concentrations, and blood glucose were significantly lower in Group TI during emergence relative to Group TT. Postoperative bucking and serious hypertensions were seen in Group TT but not in Group TI. Conclusion. Utilization of I-gel combined with endotracheal tube in posterior fossa surgery patients is safe which can yield more stable hemodynamic profile during intubation and emergence and lower inflammatory and oxidative response, leading to uneventful recovery.

  15. Time to surgery and pathologic complete response after neoadjuvant chemoradiation in rectal cancer: A population study on 2094 patients

    Directory of Open Access Journals (Sweden)

    Gabriella Macchia

    2017-06-01

    Results: Data on 2094 LARC patients treated between 1997 and 2016 were considered suitable for analysis. Overall, 578 patients had stage II while 1516 had stage III histological proven invasive rectal adenocarcinoma. A CRT schedule of one agent (N = 1585 or 2-drugs (N = 509 was administered. Overall, pCR was 22.3% (N = 468 patients. The proportion of patients achieving pCR with respect to time interval was, as follows: 12.6% (1st group, 23% (2nd group and 31.1% (3rd group (p 5040 cGy (p = 0.002 and longer interval (p 13 weeks from CRT to surgery improves the pathological response (pCR and pathologic partial response; pPR in comparison to historic data. Furthermore, radiotherapy dose >5040 cGy and two drugs chemotherapy correlated with pPR rate.

  16. Tumor Surface Regularity at MR Imaging Predicts Survival and Response to Surgery in Patients with Glioblastoma.

    Science.gov (United States)

    Pérez-Beteta, Julián; Molina-García, David; Ortiz-Alhambra, José A; Fernández-Romero, Antonio; Luque, Belén; Arregui, Elena; Calvo, Manuel; Borrás, José M; Meléndez, Bárbara; Rodríguez de Lope, Ángel; Moreno de la Presa, Raquel; Iglesias Bayo, Lidia; Barcia, Juan A; Martino, Juan; Velásquez, Carlos; Asenjo, Beatriz; Benavides, Manuel; Herruzo, Ismael; Revert, Antonio; Arana, Estanislao; Pérez-García, Víctor M

    2018-04-03

    Purpose To evaluate the prognostic and predictive value of surface-derived imaging biomarkers obtained from contrast material-enhanced volumetric T1-weighted pretreatment magnetic resonance (MR) imaging sequences in patients with glioblastoma multiforme. Materials and Methods A discovery cohort from five local institutions (165 patients; mean age, 62 years ± 12 [standard deviation]; 43% women and 57% men) and an independent validation cohort (51 patients; mean age, 60 years ± 12; 39% women and 61% men) from The Cancer Imaging Archive with volumetric T1-weighted pretreatment contrast-enhanced MR imaging sequences were included in the study. Clinical variables such as age, treatment, and survival were collected. After tumor segmentation and image processing, tumor surface regularity, measuring how much the tumor surface deviates from a sphere of the same volume, was obtained. Kaplan-Meier, Cox proportional hazards, correlations, and concordance indexes were used to compare variables and patient subgroups. Results Surface regularity was a powerful predictor of survival in the discovery (P = .005, hazard ratio [HR] = 1.61) and validation groups (P = .05, HR = 1.84). Multivariate analysis selected age and surface regularity as significant variables in a combined prognostic model (P surface regularity was a predictor of survival for patients who underwent complete resection (P = .01, HR = 1.90). Tumors with irregular surfaces did not benefit from total over subtotal resections (P = .57, HR = 1.17), but those with regular surfaces did (P = .004, HR = 2.07). Conclusion The surface regularity obtained from high-resolution contrast-enhanced pretreatment volumetric T1-weighted MR images is a predictor of survival in patients with glioblastoma. It may help in classifying patients for surgery. © RSNA, 2018 Online supplemental material is available for this article.

  17. Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients.

    OpenAIRE

    Markovitz, S.E.; Schrooten, Ward; Arntz, A.; Peters, M.L.

    2015-01-01

    OBJECTIVE: The purposes of the present study were to investigate the role of resilience in the prediction of emotional response in breast cancer patients and to examine whether this association is specific for women undergoing this emotionally taxing condition or whether resilience is more generally associated with higher levels of emotional well-being. METHODS: Two hundred fifty-three breast cancer patients and 211 healthy female controls completed four psychological questionnaire...

  18. Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients

    NARCIS (Netherlands)

    Markovitz, S.E.; Schrooten, W.; Arntz, A.; Peters, M.L.

    2015-01-01

    Objective: The purposes of the present study were to investigate the role of resilience in the prediction of emotional response in breast cancer patients and to examine whether this association is specific for women undergoing this emotionally taxing condition or whether resilience is more generally

  19. Reliability, validity and responsiveness of the Spanish Manchester-Oxford Foot Questionnaire (MOXFQ) in patients with foot or ankle surgery.

    Science.gov (United States)

    Garcés, Juan B Gerstner; Winson, Ian; Goldhahn, Sabine; Castro, Michael D; Swords, Michael P; Grujic, Leslie; Rammelt, Stefan; Sands, Andrew K

    2016-03-01

    The Manchester-Oxford Foot Questionnaire (MOXFQ) has been validated in Spanish for use in patients undergoing foot and ankle surgery. 120 patients completed the MOXFQ and the SF-36 before surgery and 6 and 12 months postoperative. Surgeons completed the American Orthopaedic Foot and Ankle Society (AOFAS) Clinical Rating System. Psychometric properties were assessed for all three MOXFQ dimensions, and for the MOXFQ Index. The Spanish MOXFQ demonstrated consistency with Cronbach's alpha values between 0.65 and 0.90, and reliability ([ICCs] >0.95). It shows a moderate to strong correlation between the Walking/standing dimension and the related domains of the SF-36 (|r|>0.6), the AOFAS Ankle-Hindfoot Scale (|r|>0.47) and Hallux-MTP-IP Scale (|r|>0.64). Responsiveness was excellent, (effect sizes >2.1). The respective minimal detectable change (MDC90) was 14.18 for the MOXFQ Index. The Spanish version of the MOXFQ showed good psychometric properties in patients with foot and ankle disorders. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  20. Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in patients undergoing lower limb surgeries: a randomized controlled study.

    Science.gov (United States)

    Lao, Hsuan-Chih; Tsai, Pei-Shan; Su, Jung-Yuan; Kwok, Tiew-Guan; Huang, Chun-Jen

    2013-01-01

    Activation of sympathetic nervous system has a crucial role in mediating the pneumatic tourniquet inflation induced hyperdynamic response. Dexmedetomidine, a selective α(2)-adrenergic receptor agonist, has potent sympatholytic effects. We conducted this prospective, randomized, placebo-controlled, double-blinded study to elucidate the effects of dexmedetomidine on attenuating the tourniquet-induced hyperdynamic response during general anesthesia. We included a total of 72 healthy adult patients undergoing elective lower limb surgery. Under general anesthesia, patients were randomized to the dexmedetomidine or the control group (n = 36 in each group). The dexmedetomidine group received a loading dose of dexmedetomidine (0.8 μg·kg(-1) over 10 min) followed by continuous infusion of dexmedetomidine (0.4 μg·kg(-1).h(-1)) until tourniquet deflation. The control group received normal saline instead. We compared tourniquet-induced changes in hemodynamic parameters between groups to elucidate the effects of dexmedetomidine. Tourniquet inflation induced significant increases in hemodynamic parameters, including heart rate, systolic arterial pressure, mean arterial pressure, diastolic arterial pressure, rate pressure product, cardiac output, and stroke volume in the control group. The effects of tourniquet inflation on increasing hemodynamic parameters were significantly attenuated by dexmedetomidine: heart rate (P product (P < 0.001), and cardiac output (P = 0.001) of the dexmedetomidine group were significantly lower than those of the control group. However, the stroke volume of these groups was comparable. Dexmedetomidine attenuates tourniquet-induced hyperdynamic response in general anesthesia patients undergoing lower limb surgeries. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Reliability, validity and responsiveness of the German Manchester-Oxford Foot Questionnaire (MOXFQ) in patients with foot or ankle surgery.

    Science.gov (United States)

    Arbab, Dariusch; Kuhlmann, Katharina; Ringendahl, Hubert; Bouillon, Bertil; Eysel, Peer; König, Dietmar

    2017-06-13

    Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopaedic procedures. The intention of this study was to develop and culturally adapt a German version of the Manchester-Oxford Foot Questionnaire (MOXFQ) and to evaluate reliability, validity and responsiveness. According to guidelines forward and backward translation has been performed. The German MOXFQ was investigated in 177 consecutive patients before and 6 months after foot or ankle surgery. All patients completed MOXFQ, Foot and Ankle Outcome Score (FAOS), Short form 36 and numeric scales for pain and disability (NRS). Test-Retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. The German MOXFQ demonstrated excellent test-retest reliability with ICC values >0.9 Cronbach's alpha (α) values demonstrated strong internal consistency. No floor or ceiling effects were observed. As hypothesized MOXFQ subscales correlated strongly with corresponding FAOS and SF-36 domains. All subscales showed excellent (ES/SRM >0.8) responsiveness between preoperative assessment and postoperative follow-up. The German version of the MOXFQ demonstrated good psychometric properties. It proofed to be a valid and reliable instrument for use in foot and ankle patients. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  2. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal.

    Science.gov (United States)

    Goldfine, A B; Mun, E C; Devine, E; Bernier, R; Baz-Hecht, M; Jones, D B; Schneider, B E; Holst, J J; Patti, M E

    2007-12-01

    Hyperinsulinemic hypoglycemia is newly recognized as a rare but important complication after Roux-en-Y gastric bypass (GB). The etiology of the syndrome and metabolic characteristics remain incompletely understood. Recent studies suggest that levels of incretin hormones are increased after GB and may promote excessive beta-cell function and/or growth. We performed a cross-sectional analysis of metabolic variables, in both the fasting state and after a liquid mixed-meal challenge, in four subject groups: 1) with clinically significant hypoglycemia [neuroglycopenia (NG)] after GB surgery, 2) with no symptoms of hypoglycemia at similar duration after GB surgery, 3) without GB similar to preoperative body mass index of the surgical cohorts, and 4) without GB similar to current body mass index of the surgical cohorts. Insulin and C-peptide after the liquid mixed meal were both higher relative to the glucose level achieved in persons after GB with NG compared with asymptomatic individuals. Glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide levels were higher in both post-GB surgical groups compared with both overweight and morbidly obese persons, and glucagon-like peptide 1 was markedly higher in the group with NG. Insulin resistance, assessed by homeostasis model assessment of insulin resistance, the composite insulin sensitivity index, or adiponectin, was similar in both post-GB groups. Dumping score was also higher in both GB groups but did not discriminate between asymptomatic and symptomatic patients. Notably, the frequency of asymptomatic hypoglycemia after a liquid mixed meal was high in post-GB patients. A robust insulin secretory response was associated with postprandial hypoglycemia in patients after GB presenting with NG. Increased incretin levels may contribute to the increased insulin secretory response.

  3. The Impact of Two Different Transfusion Strategies on Patient Immune Response during Major Abdominal Surgery: A Preliminary Report

    Directory of Open Access Journals (Sweden)

    Kassiani Theodoraki

    2014-01-01

    Full Text Available Blood transfusion is associated with well-known risks. We investigated the difference between a restrictive versus a liberal transfusion strategy on the immune response, as expressed by the production of inflammatory mediators, in patients subjected to major abdominal surgery procedures. Fifty-eight patients undergoing major abdominal surgery were randomized preoperatively to either a restrictive transfusion protocol or a liberal transfusion protocol (with transfusion if hemoglobin dropped below 7.7 g dL−1 or 9.9 g dL−1, respectively. In a subgroup of 20 patients randomly selected from the original allocation groups, blood was sampled for measurement of IL-6, IL-10, and TNFα. Postoperative levels of IL-10 were higher in the liberal transfusion group on the first postoperative day (49.82±29.07 vs. 15.83±13.22 pg mL−1, P<0.05. Peak postoperative IL-10 levels correlated with the units of blood transfused as well as the mean duration of storage and the storage time of the oldest unit transfused (r2=0.38, P=0.032, r2=0.52, P=0.007, and r2=0.68, P<0.001, respectively. IL-10 levels were elevated in patients with a more liberal red blood cell transfusion strategy. The strength of the association between anti-inflammatory IL-10 and transfusion variables indicates that IL-10 may be an important factor in transfusion-associated immunomodulation. This trial is registered under ClinicalTrials.gov Identifier: NCT02020525.

  4. Hemodynamic responses to endotracheal intubation performed with video and direct laryngoscopy in patients scheduled for major cardiac surgery.

    Science.gov (United States)

    Sarkılar, Gamze; Sargın, Mehmet; Sarıtaş, Tuba Berra; Borazan, Hale; Gök, Funda; Kılıçaslan, Alper; Otelcioğlu, Şeref

    2015-01-01

    This study aims to compare the hemodynamic responses to endotracheal intubation performed with direct and video laryngoscope in patients scheduled for cardiac surgery and to assess the airway and laryngoscopic characteristics. One hundred ten patients were equally allocated to either direct Macintosh laryngoscope (n = 55) or indirect Macintosh C-MAC video laryngoscope (n = 55). Systolic, diastolic, and mean arterial pressure, and heart rate were recorded prior to induction anesthesia, and immediately and two minutes after intubation. Airway characteristics (modified Mallampati, thyromental distance, sternomental distance, mouth opening, upper lip bite test, Wilson risk sum score), mask ventilation, laryngoscopic characteristics (Cormack-Lehane, percentage of glottic opening), intubation time, number of attempts, external pressure application, use of stylet and predictors of difficult intubation (modified Mallampati grade 3-4, thyromental distance Cormack-Lehane grade 3-4) were recorded. Hemodynamic parameters were similar between the groups at all time points of measurement. Airway characteristics and mask ventilation were no significant between the groups. The C-MAC video laryngoscope group had better laryngoscopic view as assessed by Cormack-Lehane and percentage of glottic view, and a longer intubation time. Number of attempts, external pressure, use of stylet, and difficult intubation parameters were similar. Endotracheal intubation performed with direct Macintosh laryngoscope or indirect Macintosh C-MAC video laryngoscope causes similar and stable hemodynamic responses.

  5. Relations of Changes in Serum Carcinoembryonic Antigen Levels before and after Neoadjuvant Chemoradiotherapy and after Surgery to Histologic Response and Outcomes in Patients with Locally Advanced Rectal Cancer.

    Science.gov (United States)

    Saito, Gota; Sadahiro, Sotaro; Ogimi, Takashi; Miyakita, Hiroshi; Okada, Kazutake; Tanaka, Akira; Suzuki, Toshiyuki

    2018-01-01

    The histologic response to neoadjuvant chemoradiotherapy (nCRT) has been intimately related to outcomes in locally advanced rectal cancer. Serum carcinoembryonic antigen (CEA) levels change after nCRT and after surgery as compared with before nCRT. The subjects were 149 patients with locally advanced rectal cancer who received nCRT between 2005 and 2013. The patients were divided into 4 groups according to the serum CEA levels: group 1, 55 patients with negative serum CEA levels before nCRT; group 2, 41 patients with positive serum CEA levels before nCRT that became negative after nCRT; group 3, 37 patients with positive serum CEA levels after nCRT that became negative after surgery; and group 4, 16 patients with positive serum CEA levels after nCRT as well as after surgery. Pathological complete response, T downstaging, and tumor shrinkage were significantly higher in group 1 than in other groups. Disease-free survival was significantly poorer in group 4. The lack of a decrease in the serum CEA level in group 4 was most likely attributed to the persistence of micrometastases outside the resection field. Changes in serum CEA levels measured before nCRT, after nCRT, and after surgery can be used to reliably predict the histologic response to nCRT and outcomes. © 2017 S. Karger AG, Basel.

  6. Mediators of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients: Response Expectancies and Emotional Distress

    Science.gov (United States)

    Montgomery, Guy H.; Hallquist, Michael N.; Schnur, Julie B.; David, Daniel; Silverstein, Jeffrey H.; Bovbjerg, Dana H.

    2010-01-01

    Objective: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Method: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years;…

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

    Science.gov (United States)

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

    2015-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Trevor W R Lee

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

  9. The immune response to surgery and infection.

    Science.gov (United States)

    Dąbrowska, Aleksandra M; Słotwiński, Robert

    2014-01-01

    Surgical trauma affects both the innate and acquired immunity. The severity of immune disorders is proportional to the extent of surgical trauma and depends on a number of factors, including primarily the basic disease requiring surgical treatment (e.g. cancer), often coexisting infections and impaired nutritional status. Disorder of the immune response following surgical trauma may predispose to septic complications burdened with the highest mortality rate. Extensive surgery in cancer patients is associated with simultaneous activation of pro- and anti-inflammatory processes defined as SIRS (systemic inflammatory immune response) and CARS (compensatory anti-inflammatory immune response). However, it is generally believed that major surgical trauma is accompanied by sustained postoperative immunosuppression, which is particularly important in patients operated on for cancer, since the suppression of the immune system promotes not only septic complications, but also proliferation and tumor metastasis. This paper reviews the main features of immune response to surgical trauma and possibilities of its regulation.

  10. Influence of head flexion on intraocular pressure, cardiovascular, and respiratory responses in patients undergoing cataract surgery after endotracheal intubation

    Directory of Open Access Journals (Sweden)

    MR Safavi

    2007-11-01

    Full Text Available Background: In cataract surgery, the periorbital area is prepared anddraped after induction of general anesthesia and endotracheal intubation (ETI.For this purpose, the patient’s head and neck is usually flexed 30 to 45degrees. Neck flexion causes displacement of the endotracheal tube tip towardthe carina. Stimulation of the tracheal mucosa may cause bucking, increasedintraocular pressure (IOP, laryngospasm and/or bronchospasm, during lightanesthesia. Laryngeal constriction and all components of the tracheal responsemay affect end-tidal carbon dioxide pressure (PETCO2 and peripheral arterialhemoglobin oxygen saturation (SpaO2. Thus, in the current study, weinvestigated the influence of head and neck flexion on heart rate (HR, systolicand diastolic blood pressure (SAP and DAP, SpaO2, PETCO2, and IOP in patientsundergoing cataract surgery with endotracheal intubation during generalanesthesia.Patients and Methods: The present prospective study comprised patientsaged from 40 to 80 year with 106 American Society of Anesthesia (ASA physicalstatus I and II. Anesthesia was induced with thiopental sodium, lidocaine andfentanyl. Atracurium 0.5 mg/kg was administered to facilitate trachealintubation. HR, SAP, DAP, SpaO2, PETCO2, and IOP were measured at 1, 2, and 5minutes after head flexion.Results: Mean SAP, DAP, IOP, and HR was increased after ETI and headflexion compared with baseline values. PETCO2 and SpaO2 were decreased after ETIand at 1, 2 minutes after head flexion compared with baseline values.Conclusion: In patients undergoing cataract surgery during generalanesthesia, endotracheal tube movement caused changes in head and neck positionresulting in significant effects on heart rate, systolic and diastolic bloodpressures, laryngeal reflexes, SpaO2, PETCO2, and intraocular pressure.

  11. Interleukin-6 mediates host defense responses induced by abdominal surgery

    NARCIS (Netherlands)

    Wortel, C. H.; van Deventer, S. J.; Aarden, L. A.; Lygidakis, N. J.; Büller, H. R.; Hoek, F. J.; Horikx, J.; ten Cate, J. W.

    1993-01-01

    Cytokines have been implicated as pivotal mediators of the host defense reaction. In patients undergoing surgery we investigated the relationship between such mediators and postoperative host defense responses. Tumor necrosis factor (TNF) was determined with an immunoradiometric assay, interleukin

  12. Plastic surgery and the teenage patient.

    Science.gov (United States)

    McGrath, M H; Mukerji, S

    2000-08-01

    Over the past year, the media have reported an increase in the number of teenagers undergoing plastic surgery, and with a tone of faint alarm have suggested that this merits some cultural self-scrutiny. This paper presents the statistics on the number and types of plastic surgery operations done in teenagers over the last eight years and discusses these in the context of cultural influences and societal concepts of beauty. The reason to have plastic surgery is psychological and involves body image, which is defined as the subjective perception of the body as it is seen through the mind's eye. To explain why changing the external appearance affects personality and behavior, the complex psychological reactions that occur after an operation that alters the size or shape of a body part are reviewed. Body image development occurs in stages, and puberty stands out as a particularly sensitive time as the teenager undergoes major changes in his or her physical appearance and does this at a time of heightened vulnerability to the opinion of others. Plastic surgery to correct a truly unattractive feature is enormously successful and remarkably free of conflict in this population. Teenagers undergo a rapid reorganization of their self-image after plastic surgery with subsequent positive changes in behavior and interpersonal interactions. The key to achieving success with plastic surgery is patient selection. The core value of the surgery lies not in the objective beauty of the visible result, but in the patient's opinion of and response to the change. Good patient management includes selecting candidates with clear and realistic expectations who are free of psychopathology. There must be true informed consent and attention to psychological issues must continue into the postoperative period. It is the responsibility of the patient's physician and plastic surgeon to recognize a need for psychiatric evaluation and to help the patient get this as needed. The eight operations most

  13. The alcohol patient and surgery

    DEFF Research Database (Denmark)

    Tønnesen, H

    1999-01-01

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

  14. Patients with neuroglycopenia after gastric bypass surgery have exaggerated incretin and insulin secretory responses to a mixed meal

    DEFF Research Database (Denmark)

    Goldfine, A B; Mun, E C; Devine, E

    2007-01-01

    in both GB groups but did not discriminate between asymptomatic and symptomatic patients. Notably, the frequency of asymptomatic hypoglycemia after a liquid mixed meal was high in post-GB patients. CONCLUSION: A robust insulin secretory response was associated with postprandial hypoglycemia in patients...... are increased after GB and may promote excessive beta-cell function and/or growth. PATIENTS AND METHODS: We performed a cross-sectional analysis of metabolic variables, in both the fasting state and after a liquid mixed-meal challenge, in four subject groups: 1) with clinically significant hypoglycemia...... the liquid mixed meal were both higher relative to the glucose level achieved in persons after GB with NG compared with asymptomatic individuals. Glucagon, glucagon-like peptide 1, and glucose-dependent insulinotropic peptide levels were higher in both post-GB surgical groups compared with both overweight...

  15. The role of quantitative estrogen receptor status in predicting tumor response at surgery in breast cancer patients treated with neoadjuvant chemotherapy.

    Science.gov (United States)

    Raphael, Jacques; Gandhi, Sonal; Li, Nim; Lu, Fang-I; Trudeau, Maureen

    2017-07-01

    Estrogen receptor (ER) negative (-) breast cancer (BC) patients have better tumor response rates than ER-positive (+) patients after neoadjuvant chemotherapy (NCT). We conducted a retrospective review using the institutional database "Biomatrix" to assess the value of quantitative ER status in predicting tumor response at surgery and to identify potential predictors of survival outcomes. Univariate followed by multivariable regression analyses were conducted to assess the association between quantitative ER and tumor response assessed as tumor size reduction and pathologic complete response (pCR). Predictors of recurrence-free survival (RFS) were identified using a cox proportional hazards model (CPH). A log-rank test was used to compare RFS between groups if a significant predictor was identified. 304 patients were included with a median follow-up of 43.3 months (Q1-Q3 28.7-61.1) and a mean age of 49.7 years (SD 10.9). Quantitative ER was inversely associated with tumor size reduction and pCR (OR 0.99, 95% CI 0.99-1.00, p = 0.027 and 0.98 95% CI 0.97-0.99, p Quantitative ER status is inversely associated with tumor response in BC patients treated with NCT. A cut-off of 60 and 80% predicts best the association with tumor size reduction and pCR, respectively. Therefore, patients with an ER status higher than the cut-off might benefit from a neoadjuvant endocrine therapy approach. Patients with pCR had better survival outcomes independently of their tumor phenotype. Further prospective studies are needed to validate the clinical utility of quantitative ER as a predictive marker of tumor response.

  16. Inflammatory response in laparoscopic vs. open surgery for gastric cancer

    DEFF Research Database (Denmark)

    Okholm, Cecilie; Goetze, Jens Peter; Svendsen, Lars Bo

    2014-01-01

    lead to an increased susceptibility to complications and morbidity. The aim of this review was to investigate if laparoscopic surgery reduces the immunological response compared to open surgery in gastric cancer. METHODS: We conducted a literature search identifying relevant studies comparing......OBJECTIVE: Laparoscopic surgery may offer advantages compared to open surgery, such as earlier mobilization, less pain and lower post-surgical morbidity. Surgical stress is thought to be associated with the postoperative immunological changes in the body as an impaired immune function, which may...... laparoscopy or laparoscopic-assisted surgery with open gastric surgery. The main outcome was postoperative immunological status defined as surgical stress parameters, including inflammatory cytokines and blood parameters. RESULTS: We identified seven studies that addressed the immunological status in patients...

  17. Reliability, validity and responsiveness of the German self-reported foot and ankle score (SEFAS) in patients with foot or ankle surgery.

    Science.gov (United States)

    Arbab, Dariusch; Kuhlmann, Katharina; Schnurr, Christoph; Bouillon, Bertil; Lüring, Christian; König, Dietmar

    2017-10-10

    Patient-reported outcome measures are a critical tool in evaluating the efficacy of orthopedic procedures and are increasingly used in clinical trials to assess outcomes of health care. The intention of this study was to develop and culturally adapt a German version of the Self-reported Foot and Ankle Score (SEFAS) and to evaluate reliability, validity and responsiveness. According to Cross Cultural Adaptation of Self-Reported Measure guidelines forward and backward translation has been performed. The German SEFAS was investigated in 177 consecutive patients. 177 Patients completed the German SEFAS, Foot and Ankle Outcome Score (FAOS), Short-Form 36 and numeric scales for pain and disability (NRS) before and 118 patients 6 months after foot or ankle surgery. Test-Retest reliability, internal consistency, floor and ceiling effects, construct validity and minimal important change were analyzed. The German SEFAS demonstrated excellent test-retest reliability with ICC values of 0.97. Cronbach's alpha (α) value of 0.89 demonstrated strong internal consistency. No floor or ceiling effects were observed for the German version of the SEFAS. As hypothesized SEFAS correlated strongly with FAOS and SF-36 domains. It showed moderate (ES/SRM > 0.5) responsiveness between preoperative assessment and postoperative follow-up. The German version of the SEFAS demonstrated good psychometric properties. It proofed to be a valid and reliable instrument for use in foot and ankle patients. DRKS00007585.

  18. Bariatric surgery patients: reasons to visit emergency department after surgery.

    Science.gov (United States)

    Gonzalez-Sánchez, Juan A; Corujo-Vázquez, Omar; Sahai-Hernández, Mrisa

    2007-01-01

    Morbid obesity prevalence is reaching epidemic proportions in Western society. Long-term weight loss can be achieved by bariatric surgery. This surgery also has a positive impact in the reduction of obesity related co-morbid conditions. The purpose of this study is to determine the reasons that bariatric surgery patients had to visit the emergency department within a three month period after surgery. A retrospective chart review study was performed at the UPR Hospital in Carolina. Patients with the diagnosis of morbid obesity who had bariatric surgery were identified. Of the 283 patients who met the criteria, the following information was obtained: gender, age, height, weight, pre-operative BMI, obesity-related comorbid conditions, post operative length of stay (LOS), and reasons and length of stay of Emergency Department (ED) visits within a 3 month period after surgery. Statistical analysis was done with Statistical Package for Social Sciences (SPSS) Program. The same profile of gender and BMI was obtained between the population that had the surgery and the sample that visited the ED, the group of patients between 20-29 years old was more likely to visit the ED. No correlation was found between a longer post operative length of stay and an increased probability of visiting the ED. Of the population, 5% had to visit ED within a three month period. The most common post operative complications were: Abdominal Pain (46.2%), Emesis (38.5%), and Dehydration (30.8%). Other less frequent complications were nausea, DVT, pneumonia, dizziness, gastritis, infected wound and upper GI bleeding. The most common reasons that bariatric surgery patients had to visit the emergency department within a three month period after surgery were: abdominal pain, emesis, dehydration and nausea. These complications could most likely be attributed to patient poor compliance with diet, resulting in the classical symptoms of the dumping syndrome which is common in patients that have undergone

  19. Receptivity to Bariatric Surgery in Qualified Patients

    OpenAIRE

    Fung, Michael; Wharton, Sean; Macpherson, Alison; Kuk, Jennifer L.

    2016-01-01

    Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to comple...

  20. The role of recalibration response shift in explaining bodily pain in cancer patients undergoing invasive surgery: an empirical investigation of the Sprangers and Schwartz model.

    Science.gov (United States)

    Visser, Mechteld R M; Oort, Frans J; van Lanschot, J Jan B; van der Velden, Jacobus; Kloek, Jaap J; Gouma, Dirk J; Schwartz, Carolyn E; Sprangers, Mirjam A G

    2013-03-01

    This study aims to explain bodily pain using the Sprangers and Schwartz theoretical model (1999) on quality of life (QL) and response shift in its entirety. Response shift refers to the phenomenon that the meaning of a person's self-evaluation changes over time. In this model, response shift mediates effects of changes in health status (catalysts), stable characteristics of the person (antecedents), and coping mechanisms (mechanisms) on QL. Cancer patients (202) were assessed prior to and 3 months following surgery. Measures were for catalysts: type of operation and possibility of tumor resection; for antecedents: age, duration of pain, optimism, and rigidity; for mechanisms: post-traumatic growth, social comparisons, social support, denial, and acceptance; and for QL: bodily pain; for response shift: the pretest-minus-thentest bodily pain score, further referred to as recalibration response shift. Structural equation modeling and sequential regression analyses were used. The final model reached close fit (RMSEA = 0.03; 90% CI = 0.000-0.071; χ2 (18) = 21.13; p = 0.27). Significant effects were found for catalysts on mechanisms, antecedents on mechanisms, mechanisms on response shift, and response shift on bodily pain. Four extra model effects had to be permitted. Using sequential regression analysis, recalibration response shift added 4.4% to the total amount of 29.8% explained variance of bodily pain. Many effects as hypothesized by the model were found. Recalibration response shift had a unique albeit small contribution to the explanation of bodily pain. Copyright © 2012 John Wiley & Sons, Ltd.

  1. Patient and staff satisfaction with 'day of admission' elective surgery.

    Science.gov (United States)

    Sofela, Agbolahan A; Laban, James T; Selway, Richard P

    2013-04-01

    To evaluate patient and staff satisfaction with day of admission surgery in a neurosurgical unit and its effect on theatre start times. Patients were admitted to a Neurosciences admission lounge (NAL) for neurosurgery on the morning of their operation if deemed appropriate by their neurosurgical consultant. All patients in the NAL were asked to complete patient satisfaction questionnaires. Staff members involved in the care of these patients also completed a satisfaction questionnaire. Theatre start times were compared with those whose patients had been admitted prior to the day of surgery. 378 patients admitted on the day of surgery, 16 doctors (5 anaesthetists, 7 neurosurgeons and 4 neuro high dependency unit, HDU doctors) and 5 nurses. Patients completed an anonymised emotional mapping patient satisfaction questionnaire, and short interviews were carried out with staff members. Theatre start times were obtained retrospectively from the theatre database for lists starting with patients admitted on the day of surgery, and lists starting with patients admitted prior to the day of surgery. 83% of patients felt positive on arrival in the NAL and 88% felt positive on being seen by the doctors and nurses prior to surgery. Overall 79% of patients gave positive responses throughout their patient pathway. 90% of staff were positive about day of admission surgery and all staff members were satisfied that there were no negative effects on surgical outcome. Theatre start time was on average 27 minutes earlier in patients admitted on the day of surgery. Neurosurgical patients, appropriately selected, can be admitted on the day of surgery with high staff and patient satisfaction and without delaying theatre start times.

  2. Immunonutrition – the influence of early postoperative glutamine supplementation in enteral/parenteral nutrition on immune response, wound healing and length of hospital stay in multiple trauma patients and patients after extensive surgery

    Directory of Open Access Journals (Sweden)

    Lorenz, Kai J.

    2015-12-01

    Full Text Available Introduction: In the postoperative phase, the prognosis of multiple trauma patients with severe brain injuries as well as of patients with extensive head and neck surgery mainly depends on protein metabolism and the prevention of septic complications. Wound healing problems can also result in markedly longer stays in the intensive care unit and general wards. As a result, the immunostimulation of patients in the postoperative phase is expected to improve their immunological and overall health. Patients and methods: A study involving 15 patients with extensive ENT tumour surgery and 7 multiple-trauma patients investigated the effect of enteral glutamine supplementation on immune induction, wound healing and length of hospital stay. Half of the patients received a glutamine-supplemented diet. The control group received an isocaloric, isonitrogenous diet.Results: In summary, we found that total lymphocyte counts, the percentage of activated CD4+DR+ T helper lymphocytes, the in-vitro response of lymphocytes to mitogens, as well as IL-2 plasma levels normalised faster in patients who received glutamine-supplemented diets than in patients who received isocaloric, isonitrogenous diets and that these parameters were even above normal by the end of the second postoperative week.Summary: We believe that providing critically ill patients with a demand-oriented immunostimulating diet is fully justified as it reduces septic complications, accelerates wound healing, and shortens the length of ICU (intensive care unit and general ward stays.

  3. Evaluating the correlation and responsiveness of patient-reported pain with function and quality-of-life outcomes after spine surgery.

    Science.gov (United States)

    DeVine, John; Norvell, Daniel C; Ecker, Erika; Fourney, Daryl R; Vaccaro, Alex; Wang, Jeff; Andersson, Gunnar

    2011-10-01

    Systematic review. To determine the correlation of patient-reported pain with physical function and health-related quality of life (HRQoL) after spine surgery and to determine the responsiveness of pain, physical function, and HRQoL after spine surgery. Several validated outcome instruments are available to assess the success of treatment for chronic low back pain. These patient-centered tools include measurements for pain based on numeric scales, validated condition-specific functional outcomes measures, and HRQoL outcomes measures. It is unclear whether these three types of patient-reported outcomes are measuring different constructs and whether all three should be measured after spine surgery. In addition, it is unclear which of these outcomes measures is most sensitive to change after spine surgery for low back pain. A systematic search was conducted in MEDLINE, EMBASE, and the Cochrane Collaboration Library for literature published through December 2010. The correlation between pain (visual analog scale, VAS), physical function (Oswestry Disability Index, ODI), and HRQoL (36-Item Short Form Health Survey [SF-36] and European Quality of Life [EQ-5D]) change scores was performed using the Spearman rank correlation coefficients. To compare the responsiveness of pain, function, and HRQoL scores after spine surgery, we calculated effect sizes by dividing change scores by the SD of the baseline scores. This standardized method allowed us to compare the responsiveness of each outcome measure directly and reported an effect size of 0.2 to 0.3 as a "small" effect, around 0.5 a "medium" effect and 0.8 to infinity, a "large" effect. To determine whether the differences in effect sizes measuring responsiveness were significantly different, we conducted a Wilcoxon signed-rank test between each of the three measurements of pain, function, and HRQoL scores when there was enough data to perform the test. None of the correlations exceeded 0.70 using the Spearman rank

  4. 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....

  5. Spectral entropy and haemodynamic response to surgery during ...

    African Journals Online (AJOL)

    Adele

    Spectral entropy and haemodynamic response to surgery during sevoflurane anaesthesia. Introduction. Apart from somatic responses, surgery also evokes autonomic responses, including haemodynamic responses. Spectral entropy has been validated as a means to monitor the hypnotic state during sevoflurane ...

  6. Reconstructive Surgery in the Thermally Injured Patient

    Science.gov (United States)

    2012-01-01

    the same or Conflicts of interest: The authors disclose no conflicts. a Division of Oral and Maxillofacial Surgery , Dental and Trauma Research...Reconstructive Surgery in the Thermally Injured Patient Davin Mellus, DMDa,* Rodney K. Chan, MDb KEYWORDS • Microvascular free-tissue transfer...Pedicle flaps • Reconstructive Surgery • Thermal injury • Z-plasties • Skin grafting AN INCREASED NEED FOR RECONSTRUCTIVE SURGERY Reconstruction is a

  7. Receptivity to Bariatric Surgery in Qualified Patients

    Directory of Open Access Journals (Sweden)

    Michael Fung

    2016-01-01

    Full Text Available Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to complete an elective questionnaire between February 2013 and April 2014. Results. A total of 371 patients (72% female completed the questionnaire. Only 87 of 371 (23% participants were interested in bariatric surgery. Individuals interested in bariatric surgery had a higher BMI (48.0 versus 46.2 kg/m2, P=0.03 and believed that they would lose more weight with surgery (51 versus 44 kg, P=0.0069. Those who scored highly on past weight loss success and financial concerns were less likely to be interested in bariatric surgery, whereas those who scored highly on high receptivity to surgery and positive social support were more likely to be interested in bariatric surgery. Conclusion. Although participants overestimated the effect of bariatric surgery on weight loss, most were still not interested in bariatric surgery.

  8. Receptivity to Bariatric Surgery in Qualified Patients.

    Science.gov (United States)

    Fung, Michael; Wharton, Sean; Macpherson, Alison; Kuk, Jennifer L

    2016-01-01

    Objectives. Bariatric surgery has been shown to be an effective intervention for weight loss and diabetes management. Despite this, many patients qualified for bariatric surgery are not interested in undergoing the procedure. The objective of this study is to determine the factors influencing receptivity to bariatric surgery among those who qualify for the procedure. Methods. Patients attending a publicly funded weight management clinic who qualified for bariatric surgery were asked to complete an elective questionnaire between February 2013 and April 2014. Results. A total of 371 patients (72% female) completed the questionnaire. Only 87 of 371 (23%) participants were interested in bariatric surgery. Individuals interested in bariatric surgery had a higher BMI (48.0 versus 46.2 kg/m(2), P = 0.03) and believed that they would lose more weight with surgery (51 versus 44 kg, P = 0.0069). Those who scored highly on past weight loss success and financial concerns were less likely to be interested in bariatric surgery, whereas those who scored highly on high receptivity to surgery and positive social support were more likely to be interested in bariatric surgery. Conclusion. Although participants overestimated the effect of bariatric surgery on weight loss, most were still not interested in bariatric surgery.

  9. Ventilator-induced central venous pressure variation can predict fluid responsiveness in post-operative cardiac surgery patients

    NARCIS (Netherlands)

    Cherpanath, T. G. V.; Geerts, B. F.; Maas, J. J.; de Wilde, R. B. P.; Groeneveld, A. B.; Jansen, J. R.

    2016-01-01

    Ventilator-induced dynamic hemodynamic parameters such as stroke volume variation (SVV) and pulse pressure variation (PPV) have been shown to predict fluid responsiveness in contrast to static hemodynamic parameters such as central venous pressure (CVP). We hypothesized that the ventilator-induced

  10. Plasma fibronectin in patients undergoing major surgery

    International Nuclear Information System (INIS)

    Sallam, M.H.M.

    2003-01-01

    Plasma fibronectin in patients undergoing major surgery had been determined before and after operation. The study was done on 15 patients and 15 normal healthy individuals. The study revealed that patients subjected to major operation, their fibronectin level was normal before operation followed by reduction one day post-operation. After one week, fibronectin level raised again nearly to the pre-operations levels. The probable mechanisms of fibronectin in healing processes were discussed. Fibronectin (FN) is a family of structurally and immunologically related high molecular weight glycoproteins that are present in many cell surfaces, in extracellular fluids, in connective tissues and in most membranes. Interaction with certain discrete extracellular substances, such as a glucosaminoglycans (e.g. heparin), fibrin and collagen and with cell surface structure seem to account for many of its biological activities, among which are regulation of adhesion, spreading and locomotion (Mosesson and amrani, 1980). The concentration of Fn in human plasma decreases after extensive destruction such as that occurs in major surgery, burns or other trauma. This decrease has been generally though to be due to increased consumption of soluble plasma Fn in opsonization of particulate and soluble debris from circulation by the reticuloendothelial (RE) system. Fn rapidly appears in injury areas, in experimentally induced blisters, wounded and epithelium tissues (Petersen et al., 1985). Fn accumulates at times of increased vascular permeability and it is produced by cell of blood vessels in response to injury

  11. 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...

  12. Noncardiac Surgery in Patients With Aortic Stenosis

    DEFF Research Database (Denmark)

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

    2014-01-01

    (MACE) and all-cause mortality were investigated in a contemporary Danish cohort. HYPOTHESIS: AS is not an independent risk factor for adverse outcomes in noncardiac surgery. METHODS: All patients with and without diagnosed AS who underwent noncardiac surgery in 2005 to 2011 were identified through......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...... nationwide administrative registers. AS patients (n = 2823; mean age, 75.5 years, 53% female) were matched with patients without AS (n = 2823) on propensity score for AS and surgery type. RESULTS: In elective surgery, MACE (ie, nonfatal myocardial infarction, ischemic stroke, or cardiovascular death...

  13. PATIENT SATISFACTION WITH TRICHIASIS SURGERY IN JIGAWA ...

    African Journals Online (AJOL)

    FOBUR

    Purpose: Following the implementation of the SAFE (Surgery, Antibiotics, Facial Cleanliness,. Environmental improvements) strategy for the ... and quality of lid surgeries in endemic areas, to deal with the backlog of the trichiasis cases needing ... Materials and Methods: This was a retrospective cohort study of patients.

  14. The immune response to surgery and infection

    OpenAIRE

    D?browska, Aleksandra M.; S?otwi?ski, Robert

    2014-01-01

    Surgical trauma affects both the innate and acquired immunity. The severity of immune disorders is proportional to the extent of surgical trauma and depends on a number of factors, including primarily the basic disease requiring surgical treatment (e.g. cancer), often coexisting infections and impaired nutritional status. Disorder of the immune response following surgical trauma may predispose to septic complications burdened with the highest mortality rate. Extensive surgery in cancer patien...

  15. Morbidity after thyroid surgery: patient perspective.

    Science.gov (United States)

    Grover, Gagandeep; Sadler, Gregory P; Mihai, Radu

    2013-09-01

    To evaluate patient perception of morbidity after thyroid surgery. Survey of consecutive patients (case series). A standardized questionnaire was mailed to 312 patients who underwent thyroid surgery during a 3-year period (January 2008 to December 2010). Replies were received from 202 (64%) patients (56 male, 166 female; age, 55 ± 16 years) at 6 to 39 months (median, 23 months) after lobectomy (n = 119) or total thyroidectomy (n = 76) for benign (n = 160) or malignant (n = 42) conditions. Subjective voice assessment using a visual analogue scale was normal in 111 patients, deteriorated in 80 patients, and improved in 21 patients. Voice handicap index scores were normal in 126 (62%) patients and increased in 76 (38%) patients to a median of 17 (range, 11-29). Voice-related quality of life was excellent in 107 (53%) patients, fair to good in 66 patients, and poor to fair in 29 patients. Subjective assessment of swallowing was reported as normal in 84 patients, moderately affected in 56 patients (score, 11-15) and severely affected in 62 patients (score, 16-40; median, 23). Calcium supplements prescribed routinely after bilateral surgery were interrupted within 2 to 4 weeks in 56 patients and within 3 to 6 months in 18 patients. None of the respondents had persistent hypoparathyroidism. Appearance of the scar assessed using the Manchester score ranged from 5 to 16 (median, 7). Asked whether they would consider robotic thyroid surgery to avoid a cervical scar, only 38 patients said they were definitely interested. A large proportion of patients report persistent moderate voice and swallowing problems after thyroid surgery. These findings are similar to a recent international multicenter survey of more than 2,000 patients with thyroid cancer. Hypocalcemia and cosmetic outcome raised no significant concerns. Copyright © 2012 The American Laryngological, Rhinological and Otological Society, Inc.

  16. Patients' preferences for information in bariatric surgery.

    Science.gov (United States)

    Coblijn, Usha K; Lagarde, Sjoerd M; de Raaff, Christel A L; van Wagensveld, Bart A; Smets, Ellen M A

    2018-01-31

    The decision to undergo bariatric surgery is multifactorial and made both by patient and doctor. Information is of the utmost importance for this decision. To investigate the bariatric surgery patient's preferences regarding information provision in bariatric surgery. A teaching hospital, bariatric center of excellence in Amsterdam, the Netherlands. All patients who underwent a primary laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy between September 2013 and September 2014 were approached by mail to participate. A questionnaire was used to elicit patient preferences for the content and format of information. Sociodemographic characteristics, clinicopathologic factors, and psychologic factors were explored as predictors for specific preferences. Of the 356 eligible patients, 112 (31.5%) participated. The mean age was 49.2 (±10.7) years, and 91 (81.3%) patients were female. Patients deemed the opportunity to ask questions (96.4%) the most important feature of the consult, followed by a realistic view on expectations-for example, results of the procedure (95.5%) and information concerning the consequences of surgery for daily life (89.1%). Information about the risk of complications on the order of 10% was desired by 93% of patients; 48% desired information about lower risks (.1%). Only 25 patients (22.3%) desired detailed information concerning their weight loss after surgery. Bariatric patients wished for information about the consequences of surgery on daily life, whereas the importance of information concerning complications decreased when their incidence lessened. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  17. Gastric cancer surgery in elderly patients.

    Science.gov (United States)

    Gretschel, Stephen; Estevez-Schwarz, Lope; Hünerbein, Michael; Schneider, Ulrike; Schlag, Peter M

    2006-08-01

    To investigate the value of individual risk-adapted therapy in geriatric patients, we performed a consecutive analysis of 363 patients undergoing potentially curative surgery for gastric cancer. All patients underwent extensive preoperative workup to assess surgical risk. The following criteria were evaluated in 3 age groups (75 years): comorbidity, tumor characteristics, type of resection, postoperative morbidity and mortality, recurrence rate, overall survival, and disease-free survival. There was an increased rate of comorbidity in the higher age groups (51% vs 76% vs 83%; PPatient selection and risk-adapted surgery in elderly patients can result in acceptable therapeutic results comparable to younger patients. Limited surgery in elderly gastric cancer patients with high comorbidity does not necessarily compromise oncological outcome.

  18. Recommended nutritional supplements for bariatric surgery patients.

    Science.gov (United States)

    Malone, Margaret

    2008-12-01

    To review nutritional supplements commonly required after bariatric surgery to provide a practical guide and reference source for generalist healthcare providers. A PubMed literature search (1988-July 2008) was conducted, using the search term nutritional deficiency after bariatric surgery, and was limited to English-language literature on adult (aged >19 y) human subjects. Additional references from the selected literature were also included. Data were extracted from large clinical series and practice guidelines whenever possible. Case reports were used only when they were the sole information source. Nutritional deficiencies that occur after bariatric surgery depend significantly on the type of surgery performed. Restrictive procedures such as gastric banding are the least likely to cause nutritional deficits, since none of the intestine is bypassed. Malabsorptive procedures such as biliopancreatic diversion or mixed restrictive/malabsorptive procedures (eg, Roux-en-Y gastric bypass) can result in serious nutritional problems when patients do not take required supplements after surgery. Vitamins and minerals that are commonly deficient in this circumstance include vitamin B(12), calcium, vitamin D, thiamine, folic acid, iron, zinc, and magnesium. Rare ocular complications have been reported with hypovitaminosis A. Healthcare professionals, especially those who practice outside large bariatric centers, must be aware of the supplements required by patients who have had bariatric surgery. Many patients fail to follow up with the surgery centers and are managed by their primary care teams and community pharmacists, especially in the selection of multivitamin and nutritional supplements.

  19. Effect on pain relief and inflammatory response following addition of tenoxicam to intravenous patient-controlled morphine analgesia: a double-blind, randomized, controlled study in patients undergoing spine fusion surgery.

    Science.gov (United States)

    Chang, Wen-Kuei; Wu, Hsin-Lun; Yang, Chang-Sue; Chang, Kuang-Yi; Liu, Chien-Lin; Chan, Kwok-Hon; Sung, Chun-Sung

    2013-05-01

    This study tested the hypothesis that adding tenoxicam (T) to intravenous patient-controlled analgesia (IV-PCA) with morphine (M) would improve postoperative pain relief and wound inflammatory responses compared with M alone after spine surgery. Randomized, prospective, double-blind, controlled study. Ninety-four patients eligible for elective spine surgery. Teaching hospital. Patients were randomized to one of three groups: the M group (PCA regimen with M), the TM group (PCA regimen with T and M), or the T+TM group (20 mg T administered 30 minutes before wound closure in addition to the TM regimen). The primary end point was the numeric rating scale score for pain intensity, and secondary end points pertaining to postoperative pain management included M consumption, PCA demand/delivery, use of rescue analgesics, adverse events, and levels of inflammatory mediators in wound drainages. PCA demand was reduced in both the TM and T+TM groups compared with the M group (both P ≤ 0.001). The incidence of skin itching was significantly reduced in the T+TM group compared with the other groups (both P ≤ 0.05). PGE2 and interleukin-6 levels in wound drainages were reduced in the TM and T+TM groups compared with the M group (both P ≤ 0.001). The combination of T and M for IV-PCA was not more efficacious than IV-PCA with M alone in reducing postoperative pain after spine surgery but reduced PCA demand and suppressed local inflammation at the surgical site. Administration of T before wound closure may ameliorate IV-PCA M-induced skin itching. Wiley Periodicals, Inc.

  20. Bariatric surgery: nutritional considerations for patients.

    Science.gov (United States)

    Rickers, Lisa; McSherry, Ciara

    Nutritional deficiencies are common in patients who are obese and therefore individuals considering bariatric surgery may require dietary supplementation with multivitamins and minerals before surgery. Nutritional deficiencies following bariatric surgery are often proportional to the degree of malabsorption created by the surgical procedure or the extent of weight loss. Eating habits often contribute to nutritional deficiencies, so appropriate dietary and lifestyle counselling are essential following bariatric procedures to ensure appropriate macronutrient and micronutrient status. Nutritional supplementation following bariatric surgery commonly includes calcium with vitamin D, iron and vitamin B12 in addition to a daily multivitamin and mineral tablet. Although general guidelines exist, individual monitoring and tailoring are frequently required. This article provides an update of guidelines regarding the most common nutritional concerns and myths surrounding bariatric surgery.

  1. Complement activation and interleukin response in major abdominal surgery.

    Science.gov (United States)

    Kvarnström, A L; Sarbinowski, R T; Bengtson, J-P; Jacobsson, L M; Bengtsson, A L

    2012-05-01

    The objective of this study was to evaluate whether major abdominal surgery leads to complement activation and interleukin response and whether the kind of anaesthesia influence complement activation and the release of inflammatory interleukins. The study design was prospective and randomised. Fifty patients undergoing open major colorectal surgery due to cancer disease or inflammatory bowel disease were studied. Twenty-five patients were given total intravenous anaesthesia (TIVA) with propofol and remifentanil, and 25 patients were given inhalational anaesthesia with sevoflurane and fentanyl. To determine complement activation (C3a and SC5b-9) and the release of pro- and anti-inflammatory interleukins (tumour necrosis factor-a (TNF-a)), interleukin-1b (IL-1b), IL-6, IL-8, IL-4 and IL-10), blood samples were drawn preoperatively, 60 minutes after start of surgery, 30 minutes after end of surgery and 24 hours postoperatively. Complement was activated and pro-inflammatory interleukins (IL-6 and IL-8) and anti-inflammatory interleukins (IL-10) were released during major colorectal surgery. There was no significant difference between TIVA and inhalational anaesthesia regarding complement activation and cytokine release. Major colorectal surgery leads to activation of the complement cascade and the release of both pro-inflammatory and anti-inflammatory cytokines. There are no significant differences between total intravenous anaesthesia (TIVA) with propofol and remifentanil and inhalational anaesthesia with sevoflurane and fentanyl regarding complement activation and the release of pro- and anti-inflammatory interleukins. © 2012 The Authors. Scandinavian Journal of Immunology © 2012 Blackwell Publishing Ltd. Scandinavian Journal of Immunology.

  2. Patients' perceptions of laparoendoscopic single-site surgery: the cosmetic effect.

    Science.gov (United States)

    Golkar, Farhaad C; Ross, Sharona B; Sperry, Steffanie; Vice, Michelle; Luberice, Kenneth; Donn, Natalie; Morton, Connor; Hernandez, Jonathan M; Rosemurgy, Alexander S

    2012-11-01

    Laparoendoscopic single-site (LESS) surgery can be performed without apparent scarring, while maintaining the salutary benefits of conventional laparoscopic surgery. The purpose of this study was to compare patients' preoperative and postoperative perceptions of LESS surgery. Before and after undergoing LESS surgery, 120 patients were given questionnaires; their responses were assimilated and analyzed. Of 120 patients, 62% were female (age, 52 ± 16.6 y), and 54% had prior abdominal surgery. Preoperatively, women and older patients reported heightened appearance dissatisfaction. Preoperatively, most patients would not accept more risk, pain, surgery/recovery times, and/or costs than associated with standard laparoscopy. Postoperatively, patients reported increased satisfaction in their overall and abdominal region appearance. Satisfaction was noted by 92%; satisfaction was related significantly to scar appearance and cosmesis. Preoperatively, patients were most concerned with safety; postoperatively, patients' concerns shifted to cosmetic outcome. LESS surgery provides an opportunity for improved patient satisfaction. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. 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...

  4. Revisional bariatric surgery in a transplant patient

    Directory of Open Access Journals (Sweden)

    Salman Al Sabah

    2017-01-01

    Conclusion: Bariatric surgery is a safe and effective procedure to assist renal transplant patients in losing weight. In addition, it has proven to be effective in the management of the co-morbidities that are associated with renal failure. Our study was also able to prove that converting form an SG to a bypass in a transplant patient is a safe and feasible option.

  5. The immune response to surgery and trauma: Implications for treatment.

    Science.gov (United States)

    Marik, Paul E; Flemmer, Mark

    2012-10-01

    Infection after surgery and trauma is a major cause of increased morbidity, mortality, and cost. Alterations of the hosts immune system following these insults is believed to be responsible for the increased risk of infection. The hosts' immune response to tissue injury is widely believed to follow a bimodal response, with the systemic inflammatory response syndrome (SIRS) followed by the compensated anti-inflammatory response syndrome (CARS). Recent data, however, suggests that his paradigm may not be correct. We reviewed the literature to describe the immunological changes following surgery and trauma and possible therapeutic interventions to limit this process. Physical injury related to trauma and surgery increase the expression of T-helper 2 (Th2) lymphocytes which cause impaired cell mediated immunity (CMI). Activation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathoadrenal system (SAS) with the release of cortisol and catecholamines appear to be responsible for altering the Th1/Th2 balance. Decreased expression and signalling of interleukin-12 (IL-12) and increased expression of T regulatory cells (Tregs) appear to play a central role in mediating this immune depression. Furthermore, Th2 cytokines increase the expression of arginase-1 (ARG1) in myeloid-derived suppressor cells (MDSC's) causing an arginine deficient state, which further impairs lymphocyte function. Immunomodulating diets (IMDs) containing supplemental arginine and omega-3 fatty acids have been demonstrated to restore the Th1/Th2 balance after surgical trauma and to reduce the risk of infectious complications. β-adrenergic receptor blockage reverses the Th-1 to Th2 shift and preliminary data suggests that such therapy may be beneficial. Tissue injury following surgery and trauma results in depressed CMI leading to an increased risk of infections. The peri-operative use of IMDs appear to reverse this immunosuppression and decrease the risk of postoperative complications. While

  6. Global patient outcomes after elective surgery

    DEFF Research Database (Denmark)

    2016-01-01

    - and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN51817007....... adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration...... of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients...

  7. Personality traits in aesthetic surgery patients

    Directory of Open Access Journals (Sweden)

    S. Visal Buturak

    2016-09-01

    Full Text Available Purpose: It has been known that psychological factors have an important effect on the decision to undergo aesthetic surgery. In this study, we aimed to test the hypothesis that the personality traits of people admitted for aesthetic surgery differ from those of people who have never planned to undergo aesthetic surgery in their lives. Material and Methods: Forty-seven patients who were referred to the outpatient clinic of the Faculty of Medicine, Department of Plastic, Reconstructive, and Aesthetic Surgery, Kirikkale University to undergo aesthetic surgery were enrolled in the study. Forty-three subjects who neither underwent nor planned to undergo aesthetic surgery at any time in their lives were included in the study as a control group. Psychometric evaluation of the patients and the control group was conducted using the Turkish version of the Minnesota Multiphasic Personality Inventory (MMPI. Results: Taking 65 as a cut-off point, the ratio of patients who scored and #8805;65 on the hysteria subscale of the MMPI was found to be significantly higher in the sugery group than in the control group and the ratio on social introversion subscale was also higher in the patient group than in the control group, very closely approaching significance. Conclusion: It should be kept in mind that people who have personality traits that can be partially improved with psyachiatric treatment, such as social introverted, lonely, timid, shy, and hysterical and feel the need for validation by others, may be more often admitted for aesthetic surgery. [Cukurova Med J 2016; 41(3.000: 554-558

  8. Emergency general surgery in the geriatric patient.

    Science.gov (United States)

    Desserud, K F; Veen, T; Søreide, K

    2016-01-01

    Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care. This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care. Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  9. Safety of Cosmetic Surgery in Adolescent Patients.

    Science.gov (United States)

    Yeslev, Max; Gupta, Varun; Winocour, Julian; Shack, R Bruce; Grotting, James C; Higdon, K Kye

    2017-10-01

    Limited surgical literature currently exists that evaluates postoperative complications after cosmetic surgery in adolescents. The purpose of this study was to determine the incidence of major postoperative complications in adolescent patients undergoing cosmetic surgery and compare their complication rates to older patients. A prospective cohort of patients undergoing cosmetic surgical procedures between 2008 and 2013 was identified from the CosmetAssure database. Demographics, clinical characteristics, surgical procedures, and major complications in adolescent patients (age 10-19 years) and older patients (≥20 years old) were compared. Risk factors analyzed included age, gender, body mass index, smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. Overall, 3519 adolescents and 124,409 older patients underwent cosmetic surgical procedures. The adolescent cohort contained more men (20.0% vs 6.0%, P cosmetic procedures. Adolescent patients had lower complications rates after face, breast, and body procedures compared to the older cohort. The most common postoperative complications in adolescent patients were hematoma (0.34%) and infection (0.28%). Cosmetic surgical procedures in adolescent patients are safe with a lower rate of major postoperative complications compared to older patients. 2. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

  10. Patients' existential situation prior to colorectal surgery.

    Science.gov (United States)

    Moene, Monica; Bergbom, Ingegerd; Skott, Carola

    2006-04-01

    The aim of this paper is to present a hermeneutic phenomenological study illuminating patients' existential situation prior to colorectal surgery. The intention was also to explore the value of the encounter between patient and nurse. Patients waiting for major surgery experience multifarious reactions. Emotions of anxiety, fears of the unknown, anaesthesia, cancer diagnosis and death can arise. Several earlier studies have reported the importance of information, coping strategies and the need to reduce anxiety and stress in relation to surgery. However, there is a lack of studies focusing on patients' existential situation in the preoperative phase. Conversational interviews were conducted with 28 patients 1 week before their surgery during autumn 2002. Analysis of the data was influenced by van Manen's existential themes: lived space/spatiality, lived body/corporeality, lived time/temporality and lived relation/relationality. Participants expressed either hope of increased spatiality or fear of restricted spatiality, according to whether they had a benign or malign diagnosis. Statements about lived time were also related to the diagnosis. Patients waiting for surgery for a benign diagnosis could use the time to relax and gather energy, while malignancy gave them high levels of anxiety and stress. Lived body experiences showed the ambivalence felt in entrusting one's body to professionals. Statements about lived relations drew attention to the need for considerate caregivers to enhance feelings of security and continuity. The existential situation of patients in a preoperative context was shown to be a state of uncertainty with regard to lived space, body, time and relation. The significance of meeting and talking to the nurse did not appear in the statements. The nurse was invisible. If nurses were to employ the existential themes proposed by van Manen in preoperative encounter with patients, their need for care might be more clearly identified and affirmed.

  11. A psychiatric perspective view of bariatric surgery patients

    Directory of Open Access Journals (Sweden)

    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.

  12. Medical Crowdfunding for Patients Undergoing Orthopedic Surgery.

    Science.gov (United States)

    Durand, Wesley M; Johnson, Joseph R; Eltorai, Adam E M; Daniels, Alan H

    2018-01-01

    Crowdfunding for medical expenses is growing in popularity. Through several websites, patients create public campaign profiles to which donors can contribute. Research on medical crowdfunding is limited, and there have been no studies of crowdfunding in orthopedics. Active medical crowdfunding campaigns for orthopedic trauma, total joint arthroplasty, and spine surgery were queried from a crowdfunding website. The characteristics and outcomes of crowdfunding campaigns were abstracted and analyzed. For this study, 444 campaigns were analyzed, raising a total of $1,443,528. Among the campaigns that received a donation, mean amount raised was $4414 (SE, $611). Multivariate analysis showed that campaigns with unspecified location (odds ratio, 0.26; P=.0008 vs West) and those for total joint arthroplasty (odds ratio, 0.35; P=.0003 vs trauma) had significantly lower odds of receipt of any donation. Description length was associated with higher odds of donation receipt (odds ratio, 1.13 per +100 characters; Pcrowdfunding may be disproportionately available to patients with specific diagnoses, those from specific regions, those who are able to craft a lengthy descriptive narrative, and those with access to robust digital social networks. Clinicians are likely to see a greater proportion of patients turning to crowdfunding as it grows in popularity. Patients may ask physicians for information about crowdfunding or request testimonials to support campaigns. Surgeons should consider their response to such requests individually. These findings shed light on the dynamics of medical crowdfunding and support robust personal and professional deliberation. [Orthopedics. 2018; 41(1):e58-e63.]. Copyright 2017, SLACK Incorporated.

  13. Conservation laryngeal surgery in the elderly patient.

    Science.gov (United States)

    Tucker, H M

    1977-12-01

    In the 100 years since Bilroth first undertook a total laryngectomy, general improvements in the prevention and management of childhood and adult disease have led to continuing increase in life expectancy to the point that, in many developed countries, 25% or more of the population is over the age of 65. Although many of these individuals are in otherwise reasonable health, major head and neck procedures are often not performed in favor of radiation therapy for cure, even for lesions that would otherwise be considered amenable to surgery in younger patients, on the grounds that the patient is too old to tolerate the necessary procedure. The same argument has been employed in favoring total laryngectomy over subtotal procedures in the older patient. Review of the author's experience (27 cases) with conservation laryngeal surgery in patients over the age of 65 at the time treatment was undertaken reveals that such procedures are well tolerated in this age group. There were no mortalities and an overall complication rate of 11.1% resulted. These findings compare favorably with complication rates reported for similar patients and surgery in the under 65 age group and strongly suggest that chronologic age alone need not be a contraindication to such surgery.

  14. Patients undergoing dacryocystorhinostomy surgery in northern Iran ...

    African Journals Online (AJOL)

    The authors suggest regarding high prevalence of sinusitis and allergies in Northern Iran, checking by ENT specialist is beneficial to exact diagnosis and programming for treatment of this kind of patients. Keywords: Dacryocystitis, Dacryocystorhinostomy surgery, Mucopurulent, Nasolacrimal duct obstruction, Tearing ...

  15. PATIENT SATISFACTION WITH TRICHIASIS SURGERY IN JIGAWA ...

    African Journals Online (AJOL)

    FOBUR

    PATIENT SATISFACTION WITH TRICHIASIS SURGERY IN JIGAWA STATE, NIGERIA. 1. 2. 3. 1. 1. Ramyil Alice , Bascaran Covadonga , Bunce Catey , Oyediji Funmilayo , Mpyet Caleb. 1Department of Ophthalmology University of Jos and Jos University Teaching Hospital, Nigeria. 2International Centre for Eye Health, ...

  16. 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

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

    African Journals Online (AJOL)

    governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally. Keywords: Open heart surgery, ... where surgery is the definitive therapy were operated. The mean age of the patients .... plasma and vitamin K. She remained ventilator depend- ent from initial surgery.

  18. Social Media and the Plastic Surgery Patient.

    Science.gov (United States)

    Sorice, Sarah C; Li, Alexander Y; Gilstrap, Jarom; Canales, Francisco L; Furnas, Heather J

    2017-11-01

    Many plastic surgeons use social media as a marketing tool to attract and retain patients, but information about how patients use social media and their preferred types of plastic surgery posts have been lacking. To investigate patients' preferred social media networks and the type of posts they wished to see, a cross-sectional study was conducted in a single aesthetic practice of two plastic surgeons by surveying 100 consecutive patients. The age of the patients averaged 44.4 years (range, 17 to 78 years). Facebook had the greatest patient use and engagement, with YouTube second in use, and Instagram second in number of engaged users. Over half used Pinterest, but with little daily engagement. Only one-fourth used Snapchat, but the percentage of users who were highly engaged was second only to Facebook. The least popular network was Twitter, with the fewest patient users and least engagement. Social media played a minor role compared with the practice's Web site in both influencing patients to choose the practice and providing information on the day of the appointment. Patients most wanted to see posts on a plastic surgeon's social media platform related to practice information, before-and-after photographs, and contests. Articles about plastic surgery held the least interest. Among five types of Web site content, patients expressed most interest in before-and-after photographs. This study is the first to articulate the plastic surgery patient perspective regarding social media. The findings aim to help plastic surgeons maximize their influence on their target audience.

  19. STRESS-RESPONSE TO RADICAL SURGERIES FOR GASTRIC CANCER

    Directory of Open Access Journals (Sweden)

    S. V. Avdeev

    2017-01-01

    Full Text Available The purpose of the study was to evaluate the anesthetic effect of the combination of xenon and dexmedetomidine during surgery for gastric cancer. Material and methods. The prospective randomized study included 53 patients with operable II–III stage gastric cancer. The age range was from 26 to 75 years. The patients underwent gastrectomy (n=21 and subtotal distal gastrectomy (n=32. The study group comprised 27 patients who received anesthesia with xenon and dexmedetomidine combined with epidural analgesia. The control group consisted of 26 patients who received anesthesia with sevoflurane in combination with epidural analgesia. Intraoperative patient monitoring was performed according to Harvard intraoperative monitoring standards. Plasma levels of ACTH, STH cortisole, IL-1β, IL-6, and CRP as well as cytokine profile were used to evaluate the effect of two anesthetic methods. Results. In the perioperative period, the combination of xenon and dexmedetomidine in combination with epidural analgesia was characterized by significant inhibition of systemic inflammatory reactions and a lower release of stress hormones as components of a surgical stress response expressed by a lower level of pro-inflammatory cytokines and somatotropic hormone. The frequency of postoperative inflammatory complications was lower in the xenon group than in the control group. Conclusion. The use of the combination of xenon and dexmedetomidine during surgery for gastric cancer provides a more adequate course of the perioperative period. 

  20. Plastic Surgery Response in Natural Disasters.

    Science.gov (United States)

    Chung, Susan; Zimmerman, Amanda; Gaviria, Andres; Dayicioglu, Deniz

    2015-06-01

    Disasters cause untold damage and are often unpredictable; however, with proper preparation, these events can be better managed. The initial response has the greatest impact on the overall success of the relief effort. A well-trained multidisciplinary network of providers is necessary to ensure coordinated care for the victims of these mass casualty disasters. As members of this network of providers, plastic surgeons have the ability to efficiently address injuries sustained in mass casualty disasters and are a valuable member of the relief effort. The skill set of plastic surgeons includes techniques that can address injuries sustained in large-scale emergencies, such as the management of soft-tissue injury, tissue viability, facial fractures, and extremity salvage. An approach to disaster relief, the types of disasters encountered, the management of injuries related to mass casualty disasters, the role of plastic surgeons in the relief effort, and resource management are discussed. In order to improve preparedness in future mass casualty disasters, plastic surgeons should receive training during residency regarding the utilization of plastic surgery knowledge in the disaster setting.

  1. Endocrine, metabolic and cardiovascular responses to adrenaline after abdominal surgery

    DEFF Research Database (Denmark)

    Hilsted, J; Wilken-Jensen, Charlotte; Birch, K

    1990-01-01

    Adrenaline-induced changes in heart rate, blood pressure, plasma adrenaline and noradrenaline, cortisol, glucagon, insulin, cAMP, glucose lactate, glycerol and beta-hydroxybutyrate were studied preoperatively and 4 and 24 h after skin incision in 8 patients undergoing elective cholecystectomy. Late...... postoperative responses of blood glucose, plasma cAMP, lactate and glycerol to adrenaline infusion were reduced, whereas other responses were unaffected. Blood glucose appearance and disappearance rate as assessed by [3H]3-glucose infusion was unchanged pre- and postoperatively. The increase in glucose...... appearance rate following adrenaline was similar pre- and postoperatively. These findings suggest that several beta-receptor-mediated responses to adrenaline are reduced after abdominal surgery....

  2. Nutritional management of patients after bariatric surgery.

    Science.gov (United States)

    Parkes, Emmy

    2006-04-01

    Bariatric surgery is currently the most effective method of sustainable weight loss among morbidly obese patients. The types of bariatric surgeries can be divided into three categories: restrictive procedures, malabsorptive procedures, and combination (restrictive and malabsorption) procedures. In general, patients undergoing restrictive procedures have the least risk for long-term diet-related complications, whereas patients undergoing malabsorptive procedures have the highest risk. For many patients, the benefits of weight loss, such as decreased blood glucose, lipids, and blood pressure and increased mobility, will outweigh the risks of surgical complications. Most diet-related surgical complications can be prevented by adhering to strict eating behavior guidelines and supplement prescriptions. Eating behavior guidelines include restricting portion sizes, chewing foods slowly and completely, eating and drinking separately, and avoiding foods that are poorly tolerated. Supplement prescriptions vary among practitioners and usually involve at least a multivitamin with minerals. Some practitioners may add other supplements only as needed for diagnosed deficiencies; others may prescribe additional prophylactic supplements. The most common nutrient deficiencies are of iron, folate, and vitamin B12. However, deficiencies of fat-soluble vitamins have been reported in patients with malabsorption procedures, and thiamin deficiency has been reported among patients with very poor intake and/or nausea and vomiting. Frequent monitoring of nutrition status for all patients can aid in preventing severe clinical deficiencies.

  3. Nurses' Perceptions of Patient Care Continuity in Day Surgery.

    Science.gov (United States)

    Renholm, Marja; Suominen, Tarja; Puukka, Pauli; Leino-Kilpi, Helena

    2017-12-01

    The increase in day surgery has brought about a significant change in patient care and care continuity. The purpose of this study was to analyze nurses' perceptions of the realization of continuity of care in day surgery. Continuity of care is examined from the perspectives of time, flow, co-ordination flow, caring relationship flow, and information flow. Descriptive study. A questionnaire including demographics and questions about continuity of care was completed by 83 of the 120 eligible nurses (response rate, 69%) in one hospital district in Finland. According to the nurses, continuity of patient care is mostly well realized. On the day of surgery, information flow was the domain that was best realized. In the opinion of the nurses, continuity of care was least realized at home before surgery and at home during the period after surgery. Based on nurses' perceptions, continuity of care was relatively well realized. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  4. 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…

  5. Bariatric surgery influences the number and quality of oocytes in patients submitted to assisted reproduction techniques.

    Science.gov (United States)

    Christofolini, Juliana; Bianco, Bianca; Santos, Gustavo; Adami, Fernando; Christofolini, Denise; Barbosa, Caio Parente

    2014-03-01

    To determine differences in follicle stimulation, oocyte retrieval, maturation, and fertilization among patients who underwent bariatric surgery, obese patients, and patients with 18 assisted reproduction techniques and check that these patients may have some impairment in ovarian response. The study comprised three groups: GI: 29 patients who had undergone restrictive and/or malabsorptive bariatric surgery; GII: 57 obese patients (BMI > 30 kg/m²); and GIII: 94 patients (18 reproductive process can be impaired. Bariatric surgery appears to have an important impact on the formation of follicles and oocytes. © 2013 The Obesity Society.

  6. The influence of plastic surgery "reality TV" on cosmetic surgery patient expectations and decision making.

    Science.gov (United States)

    Crockett, Richard J; Pruzinsky, Thomas; Persing, John A

    2007-07-01

    The aim of this study was to survey first-time patients seeking cosmetic surgery and examine what role "reality TV" played in their perception of the risks and benefits of surgery and their overall decision-making process. Information on demographics, television viewing patterns, and patients' self-assessed plastic surgery knowledge was collected from 42 patients. They were asked how similar they believed the shows were to real life and what degree of influence the shows had on their decision to pursue cosmetic surgery. Patients were then divided into groups by program viewing intensity. Fifty-seven percent of patients were "high-intensity" viewers of plastic surgery reality television shows. When compared with low-intensity viewers, high-intensity viewers believed themselves to be more knowledgeable about plastic surgery (p cosmetic surgery procedure, with nearly one-third feeling "very much" or "moderately" influenced. Plastic surgery reality television plays a significant role in cosmetic surgery patient perceptions and decision making. Patients who regularly watched one or more reality television show reported a greater influence from television and media to pursue cosmetic surgery, felt more knowledgeable about cosmetic surgery in general, and felt that plastic surgery reality television was more similar to real life than did low-intensity viewers.

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

    Directory of Open Access Journals (Sweden)

    Ram Prasad Kaushal

    2015-01-01

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

  8. Plastic surgery for the oncological patient

    Directory of Open Access Journals (Sweden)

    Adrien eDaigeler

    2014-10-01

    Full Text Available The therapy of oncological patients has seen tremendous progress in the last decades. For most entities, it has been possible to improve the survival as well as the quality of life of the affected patients.To supply optimal cancer care, a multidisciplinary approach is vital. Together with oncologists, radiotherapists and other physicians, plastic surgeons can contribute to providing such care in all stages of treatment. From biopsies to the resection of advanced tumors, the coverage of the resulting defects and even palliative care, plastic surgery techniques can help to improve survival and quality of life as well as mitigate negative effects of radiation or the problems arising from exulcerating tumors in a palliative setting.This article aims to present the mentioned possibilities by illustrating selected cases and reviewing the literature. Especially in oncological patients, restoring their quality of life with the highest patient safety possible is of utmost importance.

  9. [Lumbar spinal surgery in elderly patients].

    Science.gov (United States)

    Pulido-Rivas, P; Sola, R G; Pallares-Fernández, J M; Pintor-Escobar, A

    In the geriatric population, pain with sciatic irradiation requires a differential diagnosis to enable a distinction to be made mainly between a herniated disc, lateral recess stenosis or lumbar stenosis. In addition, in many cases the degenerative problems are often associated with lumbar listhesis or instability. Furthermore, these patients present very diverse associated cardiovascular, pulmonary or metabolic pathologies which can make surgery complicated and, above all, prolong post-operative recovery, as well as increasing morbidity and mortality. We reviewed a group of 50 patients aged between 70 and 87 who had been submitted to surgery between 1997 and 2003; 27 were females and 23 males. 76% of them presented associated systemic pathologies and 22% had a history of previous spinal surgery. In 15 cases clinical symptoms were gait disorders involving claudication, there were three cases of paraparesis with cauda equina syndrome, 19 lumbagos with bilateral sciatica and 16 cases of lumbago with unilateral sciatica. Unilateral decompression hemilaminectomy was performed in 16 patients (group I) with microdiscectomy in 13 cases, laminectomy of one or several vertebrae (group II) was carried out in 17 patients and another 17 patients were submitted to decompression laminectomy plus arthrodesis with transpedicular instrumentation (group III). Overall a significant improvement was observed in 86% of patients. Detected complications involved two serious deep infections (4%), one of which was secondary to cerebrospinal fluid fistula, and the other occurred in an instrumented patient. No instabilities secondary to the laminectomy were observed in non-instrumented patients. No intraoperative anaesthetic or surgical complications were produced. Patients are followed up simultaneously during the post-operative period by both Internal Medicine and Neurosurgery. In the geriatric population there is a high incidence of degenerative problems, not only involving canal stenosis

  10. Risk of Venous Thromboembolism Among Otolaryngology Patients vs General Surgery and Plastic Surgery Patients.

    Science.gov (United States)

    Cramer, John D; Dilger, Amanda E; Schneider, Alex; Smith, Stephanie Shintani; Samant, Sandeep; Patel, Urjeet A

    2017-10-19

    Venous thromboembolism (VTE), which includes deep venous thrombosis or pulmonary embolism, is the number 1 cause of preventable death in surgical patients. Current guidelines from the American College of Chest Physicians provide VTE prevention recommendations that are specific to individual surgical subspecialties; however, no guidelines exist for otolaryngology. To examine the rate of VTE for various otolaryngology procedures compared with an established average-risk field (general surgery) and low-risk field (plastic surgery). This cohort study compared the rate of VTE after different otolaryngology procedures with those of general and plastic surgery in the American College of Surgeons National Surgical Quality Improvement Program from January 1, 2005, through December 31, 2013. We used univariate and multivariable logistic regression analysis of clinical characteristics, cancer status, and Caprini score to compare different risk stratification of patients. Data analysis was performed from May 1, 2016, to April 1, 2017. Surgery. Thirty-day rate of VTE. A total of 1 295 291 patients, including 31 896 otolaryngology patients (mean [SD] age, 53.9 [16.7] years; 14 260 [44.7%] male; 21 603 [67.7%] white), 27 280 plastic surgery patients (mean [SD] age, 50.5 [13.9] years; 4835 [17.7%] male; 17 983 [65.9%] white), and 1 236 115 general surgery patients (mean [SD] age, 54.9 [17.2] years; 484 985 [39.2%] male; 867 913 [70.2%] white) were compared. The overall 30-day rate of VTE was 0.5% for otolaryngology compared with 0.7% for plastic surgery and 1.2% for general surgery. We identified a high-risk group for VTE in otolaryngology (n = 3625) that included free or regional tissue transfer, laryngectomy, composite resection, skull base surgery, and incision and drainage. High-risk otolaryngology patients experienced similar rates of VTE as general surgery patients across all Caprini risk levels. Low-risk otolaryngology patients (n = 28 271) experienced

  11. Acute systemic inflammatory response after cardiac surgery in ...

    African Journals Online (AJOL)

    2017-09-03

    Sep 3, 2017 ... pandemic, there have been various concerns about the operative risks, infections and benefits of cardiac surgery in patients infected with HIV, as they are known to al- ready have a compromised immune system, chronic in- flammation and reduced survival.1,2 This led to cardiac surgery departments setting ...

  12. Spectral entropy and haemodynamic response to surgery during ...

    African Journals Online (AJOL)

    Adele

    Apart from somatic responses, surgery also evokes autonomic responses, including haemodynamic responses. Spectral entropy has been validated as a means to monitor the hypnotic state during sevoflurane anaesthesia. Aim. To investigate the relationship between spectral entropy, heart rate, and blood pressure during ...

  13. Psychological characteristics and outcomes of elective cosmetic surgery patients: the influence of cosmetic surgery history.

    Science.gov (United States)

    Dowling, Nicki A; Jackson, Alun C; Honigman, Roberta J; Francis, Kate L

    2011-01-01

    The early cosmetic surgery literature suggested that individuals re-presenting for aesthetic surgical procedures (referred to as "insatiable patients") display poorer psychological functioning and satisfaction with surgical outcomes than those who request one procedure. The aim of the study was to compare 284 patients with and without a history of cosmetic procedures on demographic characteristics, appearance concerns, expectations of surgery, psychosocial dysfunction, and postoperative dissatisfaction. There were few differences between the groups, suggesting that the group of patients with a history of aesthetic surgeries did not represent the population that has been described as "surgery insatiable." Post hoc analyses of subgroups of patients with a history of surgeries also revealed few differences except for lower self-esteem and postoperative satisfaction. Further research is required to fully explore the applicability of the "insatiable patient" label in the context of increasing societal acceptance of cosmetic surgery.

  14. The bariatric surgery patient--nutrition considerations.

    Science.gov (United States)

    Shannon, Caroline; Gervasoni, Ashlee; Williams, Trudy

    2013-08-01

    Bariatric surgery is an effective method of weight loss for the treatment of morbid obesity. It is more effective when combined with nutritional care, which is sometimes complex, always ongoing and differs between surgical procedures. In Australia, the three most common bariatric surgical procedures are the adjustable gastric banding, sleeve gastrectomy and the Roux-en-Y gastric bypass. This article introduces the nutritional and dietary considerations for each procedure, and provides practical advice to support the general practitioner's role in managing patients who are considering, or who have had, bariatric surgery. While bariatric procedures influence the volume of food consumed, none of the procedures necessarily improve the quality of food consumed or compliance with recommended supplement usage, leaving nutrition care and food choice important lifelong considerations. Ongoing coordinated care by the GP, that links with the bariatric dietitian and others in the health management team, maximises the benefits and health outcomes for the patient through ongoing monitoring of nutritional status, prevention of nutrient deficiencies and maximising long term weight loss.

  15. Randomized clinical trial examining the effect of music therapy in stress response to day surgery.

    Science.gov (United States)

    Leardi, S; Pietroletti, R; Angeloni, G; Necozione, S; Ranalletta, G; Del Gusto, B

    2007-08-01

    Music therapy could reduce stress and the stress response. The aim of this study was to investigate the role of music therapy in alleviating stress during day surgery. Sixty patients undergoing day surgery were randomized to one of three groups, each containing 20 patients. Before and during surgery, patients in group 1 listened to new age music and those in group 2 listened to a choice of music from one of four styles. Patients in group 3 (control group) heard the normal sounds of the operating theatre. Plasma levels of cortisol and subpopulations of lymphocytes were evaluated before, during and after operation. Plasma cortisol levels decreased during operation in both groups of patients who listened to music, but increased in the control group. Postoperative cortisol levels were significantly higher in group 1 than in group 2 (mean(s.d.) 14.21(6.96) versus 8.63(2.72) ng/dl respectively; P < 0.050). Levels of natural killer lymphocytes decreased during surgery in groups 1 and 2, but increased in controls. Intraoperative levels of natural killer cells were significantly lower in group 1 than in group 3 (mean(s.d.) 212.2(89.3) versus 329.1(167.8) cells/microl; P < 0.050). Perioperative music therapy changed the neurohormonal and immune stress response to day surgery, especially when the type of music was selected by the patient. Copyright (c) 2007 British Journal of Surgery Society Ltd.

  16. Comparison of fentanyl, sufentanil, and alfentanil anesthesia in patients undergoing valvular heart surgery

    NARCIS (Netherlands)

    Bovill, J. G.; Warren, P. J.; Schuller, J. L.; van Wezel, H. B.; Hoeneveld, M. H.

    1984-01-01

    The hemodynamic responses to anesthesia and surgery were studied in three groups of 20 patients undergoing valve replacement surgery. Anesthesia was induced with either fentanyl (75 micrograms/kg), sufentanil (15 micrograms/kg), or alfentanil (125 micrograms/kg). Pancuronium (8 mg) was given for

  17. Age and other perioperative risk factors for postoperative systemic inflammatory response syndrome after cardiac surgery

    NARCIS (Netherlands)

    Dieleman, J. M.; Peelen, L. M.; Coulson, T. G.; Tran, L.; Reid, C. M.; Smith, Jennifer A.; Myles, P. S.; Pilcher, C.D.

    2017-01-01

    Background The inflammatory response to surgery varies considerably between individual patients. Age might be a substantial factor in this variability. Our objective was to examine the association of patient age and other potential risk factors with the occurrence of a postoperative systemic

  18. Surgical stress response: does endoscopic surgery confer an advantage?

    DEFF Research Database (Denmark)

    Kehlet, H

    1999-01-01

    , mostly studied during laparoscopy, when compared with similar open operations, has no important effects on classic endocrine metabolic responses but may slightly reduce inflammatory responses and various immune functions, although the data are not consistent. In contrast, most data show improvement...... of postoperative pulmonary function and less hypoxemia with endoscopic operation. The slight modification of surgical stress responses by endoscopic surgery is in contrast to the common, though not universal, demonstration of less pain, shorter hospital stay, and less morbidity after endoscopic surgery....... In conclusion, endoscopic surgery has so far not been demonstrated to have important modifying effects on classic endocrine metabolic responses and only a slight inhibitory effect on various inflammatory responses, but with improved pulmonary function and less hypoxemia. More data are needed from major...

  19. Presence of early stage cancer does not impair the early protein metabolic response to major surgery.

    Science.gov (United States)

    Engelen, Mariëlle P K J; Klimberg, V Suzanne; Allasia, Arianna; Deutz, Nicolaas Ep

    2017-06-01

    Combined bilateral mastectomy and reconstruction is a common major surgical procedure in women with breast cancer and in those with a family history of breast cancer. As this large surgical procedure induces muscle protein loss, a preserved anabolic response to nutrition is warranted for optimal recovery. It is unclear whether the presence of early stage cancer negatively affects the protein metabolic response to major surgery as this would mandate perioperative nutritional support. In nine women with early stage (Stage II) breast malignancy and nine healthy women with a genetic predisposition to breast cancer undergoing the same large surgical procedure, we examined whether surgery influences the catabolic response to overnight fasting and the anabolic response to nutrition differently. Prior to and within 24 h after combined bilateral mastectomy and reconstruction surgery, whole body protein synthesis and breakdown rates were assessed after overnight fasting and after meal intake by stable isotope methodology to enable the calculation of net protein catabolism in the post-absorptive state and net protein anabolic response to a meal. Major surgery resulted in an up-regulation of post-absorptive protein synthesis and breakdown rates (P surgery (P cancer (P breast cancer or surgery. The presence of early stage breast cancer does not enhance the normal catabolic response to major surgery or further attenuates the anabolic response to meal intake within 24 h after major surgery in patients with non-cachectic breast cancer. This indicates that the acute anabolic potential to conventional feeding is maintained in non-cachectic early stage breast cancer after major surgery. © 2017 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of the Society on Sarcopenia, Cachexia and Wasting Disorders.

  20. Body Contouring Surgery in Post-Bariatric Patients

    NARCIS (Netherlands)

    Beek, E.S.J. van der

    2015-01-01

    The dramatic rise of morbid obesity worldwide and the success of bariatric surgery results in a significant rise in the demand for post-bariatric body contouring surgery, a new field in plastic surgery. This makes a national clinical guideline for patient selection and treatment mandatory. In

  1. Focus assessed transthoracic echocardiography for preoperative assessment in patients scheduled for acute surgery

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann; Frederiksen, C.A.; Lauridsen Vang, M.K.

    2013-01-01

    of cardiopulmonary function by visualisation of the heart and pleura. The aim of this study was to determine the frequency of unexpected cardio-pulmonary pathology by FATE in unselected patients scheduled for acute surgery. Patients and methods: Patients scheduled for acute orthopaedic or abdominal surgery...... were recorded. After the routine preoperative assessment these were reported to the anaesthetist responsible for the anaesthesia.Whether or not this led to changes in the perioperative management was registered. Results: 112 patients scheduled for acute surgery were included. Mean age was 62 years (57......% of the patients with unexpected pathology. All findings that lead to a change in management occurred in patients above the age of 60 and/or in ASA group 3. Conclusion: In an unselected population of patients scheduled for acute surgery, we found a high number of patients with unexpected pathology by FATE leading...

  2. Nursing Care for Patient after Surgery of Valvular Defects

    OpenAIRE

    Beranová, Veronika

    2015-01-01

    This thesis is focused on the nursing care for patient after valvular defects surgery. The aim of this final paper is to ascertain the principles of specialized nursing care for patient after valvular defects surgery, analyse the condition of written standards for providing aftercare to patients who underwent valvular defects surgery, or the state of the nursing protocols in specialized nursing care. The purpose of qualitative - observational research in providing specialized nursing care is ...

  3. Outcome of Colonic Surgery in Elderly Patients with Colon Cancer

    OpenAIRE

    Hermans, E.; van Schaik, P. M.; Prins, H. A.; Ernst, M. F.; Dautzenberg, P. J. L.; Bosscha, K.

    2010-01-01

    Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients aged 65 years or older. Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare five-year survival rates between the younger and elderly patients. Methods. 207 consecutive patients underwent surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years. Results. Elderly patients presented significantly m...

  4. 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.

  5. PROFILE OF PATIENTS WHO SEEK THE BARIATRIC SURGERY

    OpenAIRE

    da SILVA, Paola Turchiello; PATIAS, Luciana Dapieve; ALVAREZ, Glauco da Costa; KIRSTEN, Vanessa Ramos; COLPO, Elis?ngela; de MORAES, Cristina Machado Bragan?a

    2015-01-01

    Background : Nowadays obesity is a chronic disease considered one of the greatest problems in public healthy. Showing to be effective in a short and long term, the bariatric surgery has emerged as an optional treatment for morbid obesity. Aim: Identify the profile of patients seeking bariatric surgery. Methods: Were interviewed 100 patients in preoperative nutritional monitoring of bariatric surgery. The study was conducted by applying a questionnaire prepared according to the research ob...

  6. Bariatric surgery in elderly patients: a systematic review

    OpenAIRE

    Giordano S; Victorzon M

    2015-01-01

    Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: 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...

  7. NUTRITION SUPPORT COMPLICATIONS IN PATIENT WHO UNDERWENT CARDIAC SURGERY

    OpenAIRE

    Krdžalić, Alisa; Kovčić, Jasmina; Krdžalić, Goran; Jahić, Elmir

    2016-01-01

    Background: The nutrition support complications after cardiac surgery should be detected and treated on time. Aim: To show the incidence and type of nutritional support complication in patients after cardiac surgery. Methods: The prospective study included 415 patients who underwent cardiac surgery between 2010 and 2013 in Clinic for Cardiovascular Disease of University Clinical Center Tuzla. Complications of the delivery system for nutrition support (NS) and nutrition itself were analy...

  8. Psychosocial issues and their relevance to the cosmetic surgery patient.

    Science.gov (United States)

    Grossbart, Ted A; Sarwer, David B

    2003-06-01

    Psychosocial issues permeate the field of cosmetic surgery: 1. The preoperative psychological profile of cosmetic surgery patients is likely to differ from that of people who don't come for surgery. Despite several decades of research, this difference is not well understood. 2. Cosmetic surgery patients often look for more than changes in their physical appearance. If these procedures do not lead to improvements in body satisfaction, self-esteem, or quality of life, then what is their purpose? 3. Patient-surgeon rapport is not simply a nice plus if it happens. Patient satisfaction, reduced legal liability, and improved surgical outcome can all be direct reflections of the surgeon's mastery of relationship-building techniques. 4. Identifying and screening out patients who should not have cosmetic surgery can prevent both patient and surgeon frustration and more extreme adverse outcomes. 5. A wide range of studies document the use of psychological techniques to improve surgical outcome.

  9. A patient-based questionnaire to assess outcomes of foot surgery: validation in the context of surgery for hallux valgus.

    Science.gov (United States)

    Dawson, Jill; Coffey, Jane; Doll, Helen; Lavis, Grahame; Cooke, Paul; Herron, Mark; Jenkinson, Crispin

    2006-09-01

    A patient-based outcome measure with good measurement properties is urgently needed for use in clinical trials of foot surgery. We evaluated an existing foot pain and disability questionnaire (the Manchester Foot Pain and Disability Questionnaire) for its suitability as an outcome measure in the context of hallux valgus corrective surgery. Interviews with patients led to initial changes, resulting in 20 candidate questionnaire items with five response categories each. These were tested in a prospective study of 100 patients (representing 138 foot operations) undergoing hallux valgus corrective surgery. Analysis of underlying factor structure, dimensionality, internal reliability, construct validity and responsiveness of the questionnaire items in relation to (i) SF-36 general health survey and (ii) American Orthopaedic Foot & Ankle Society (AOFAS) hallux clinical scale resulted in a final 16 item questionnaire (the 'Manchester-Oxford Foot Questionnaire' (MOXFQ)), consisting of three domains/scales: 'Walking/standing' (seven items), 'Pain' (five items) and 'Social interaction' (four items) each having good measurement properties. All three domains were unidimensional. The new 16-item MOXFQ has good measurement properties in the context of outcomes assessment of surgery for hallux valgus. Future studies should assess the MOXFQ in the context of surgery for other foot and ankle conditions.

  10. Vestibular Disorders after Stapedial Surgery in Patients with Otosclerosis

    Directory of Open Access Journals (Sweden)

    Ditza de Vilhena

    2016-01-01

    Full Text Available Introduction and Objectives. Vertigo is a described complication of stapedial surgery. Many studies have been conducted to assess the improvement of hearing loss, but there are few studies that assess vestibular function after stapedial surgery. The aim of this study was to evaluate the presence and characterize the vertigo after stapedial surgery. Methods. We conducted a prospective observational study. Patients undergoing stapedial surgery in our hospital between October 2013 and December 2014 were invited to participate. The vertigo was assessed before and 4 months after surgery, using the Dizziness Handicap Inventory. Results. We included 140 patients in the study. 12 patients (8.6% reported vertigo before surgery, and all of them denied vertigo after surgery. 36 patients (25.7% reported vertigo four months after surgery, and none of them had vertigo before surgery. Postoperative total scores in patients with vertigo ranged between 2 and 18 points. Conclusion. The study shows that vestibular disorders may remain after the immediate postoperative period and reinforces the need for clarification of the patient in the informed consent act.

  11. 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

  12. Physical activity and sitting time in bariatric surgery patients 1-16 years post-surgery.

    Science.gov (United States)

    Herman, K M; Carver, T E; Christou, N V; Andersen, R E

    2014-10-01

    Physical activity (PA) is an important adjunct to bariatric surgery in the treatment of severe obesity; however, patient PA levels prior to and in the short-term following surgery are usually low. Scarce data exist describing PA and sedentary behaviours in the long term following surgery. The objectives were to describe PA and sitting time in bariatric patients 1-16 years post-surgery and assess their associations with patient, surgery and weight-loss characteristics. A total of 398 bariatric patients (73% female; mean age 47 ± 11 years, mean 6 ± 4 years since surgery) completed a telephone questionnaire. Patients reported moderate-to-vigorous PA (MVPA: # sessions week(-1)  ≥30 min), sitting time (h d(-1)) and change in PA and sitting time vs. pre-surgery (more/same/less). Associations with patient, surgery and weight-loss characteristics were assessed. Only 53% of patients reported ≥1 session week(-1) MVPA, mean sitting time was 7 ± 4 h d(-1), 74% of patients reported more PA and 53% reported less sitting, now vs. pre-surgery. Age, sex, smoking status, pre-surgery body mass index, time-since-surgery and percent excess weight lost were significantly associated with PA and/or sitting outcomes. Patients currently experiencing ≥50% excess weight loss had over three times the odds of reporting ≥1 session week(-1) MVPA (odds ratio [95% confidence interval] 3.28 [1.57, 6.89]) and almost four times greater odds of reporting 'more' PA vs. pre-surgery (3.78 [2.15, 6.62]) compared with their less successful counterparts. Results point to low PA and high sedentariness among bariatric patients in the long-term following surgery, associated with several characteristics. Associations with long-term weight management highlight the need for tailored interventions to promote active living in this patient population. © 2014 The Authors. Clinical Obesity © 2014 World Obesity.

  13. 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.

  14. Transphenoidal surgery in acromegalic patients: anatomical considerations and potential pitfalls.

    Science.gov (United States)

    Carrabba, Giorgio; Locatelli, Marco; Mattei, Luca; Guastella, Claudio; Mantovani, Giovanna; Rampini, Paolo; Gaini, Sergio Maria

    2013-01-01

    Transphenoidal surgery is an effective treatment for acromegalic patients with growth hormone (GH) producing pituitary adenomas. Since acromegaly is a systemic disease which causes multiple bony alterations, we hypothesized that it could affect the sphenoid sinus anatomy. The aim of the study was to determine whether acromegalic patients have sphenoid sinus alterations with potential surgical impact. Fourty-six consecutive patients (23 acromegalics-GH group, 23 non-acromegalics-nGH group) undergoing transphenoidal surgery were included in this study. Pre-operative volumetric CT scan of the head was used to assess the following anatomic characteristics: type of sphenoid sinus (sellar, pre-sellar, conchal); number of intrasphenoid septa; number of carotid-directed septa; intercarotid distance; depth of the sphenoid sinus; depth and size of the sella. The sphenoid sinus was of the pre-sellar/conchal type in 26 % of the patients with acromegaly (n = 23) versus 9 % of the patients of the nGH group (n = 23). The number of intrasphenoid septations was significantly higher in the GH group than in the nGH group (P = .03). Interestingly, the intercarotid distance was smaller in GH patients than in nGH displaying a trend toward significance (P = .05). The sphenoid bone was deeper in the GH group as compared to the nGH group (P = .01) but the distance sphenoid sinus-sella was reduced (P < .01). Finally, the sella was not deeper, nor larger in acromegalic patients. The sphenoid sinus of acromegalic patients resulted in being deeper, characterized by more septa and by a reduced intercarotid distance. These alterations deserve special pre- and intraoperative care, being potentially responsible for surgical difficulties.

  15. Lumbar Spine Surgery in Patients with Parkinson Disease.

    Science.gov (United States)

    Schroeder, Joshua E; Hughes, Alexander; Sama, Andrew; Weinstein, Joseph; Kaplan, Leon; Cammisa, Frank P; Girardi, Federico P

    2015-10-21

    Parkinson disease is the second most common neurodegenerative condition. The literature on patients with Parkinson disease and spine surgery is limited, but increased complications have been reported. All patients with Parkinson disease undergoing lumbar spine surgery between 2002 and 2012 were identified. Patients' charts, radiographs, and outcome questionnaires were reviewed. Parkinson disease severity was assessed with use of the modified Hoehn and Yahr staging scale. Complications and subsequent surgeries were analyzed. Risk for reoperation was assessed. Ninety-six patients underwent lumbar spine surgery. The mean patient age was 63.0 years. The mean follow-up duration was 30.1 months. The Parkinson disease severity stage was Parkinson disease severity stage of ≥3 (p Parkinson disease is good, with improvement of spine-related pain. A larger prospective study is warranted. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  16. Cataract surgery in patients with ocular pseudoexpholiation.

    Science.gov (United States)

    Petrovic, Mirjana Janicijevic; Vulovic, Tatjana Sarenac; Vulovic, Dejan; Janicijevic, Katarina; Petrovic, Marko; Vujic, Dragan

    2013-01-01

    Retrospective 5-year study based on general and ophthalmic history records, and including 268 eyes (174 patients), aged 50 years and over. Ophthalmological examination involved visual acuity, measuring of intraocular pressure, slit lamp examination and indirect ophthalmoscopy. Type of surgical treatment was tailored for each patient (extra capsular cataract extraction, phaco-emulsiphication). Preoperative slit lamp examination showed phacodonesis in 17.91% (47), iridodonesis in 2.98% (8), pigment dispersion in 6.72% (18), lens subluxation in 4.85% (13) on the total. Extra capsular cataract extraction was performed in 36.94% (99) and phaco-emulsiphication in the others. Analysis of intra operative complications showed: posterior capsular rupture 17.91% (48), zonular dialysis or break 5.97% (16), lens subluxation 1.86% (5), intraocular bleeding 2.98% (8), vitreous loss 13.80% (37). Postoperative complications include: anterior chamber reaction 45.90% (123), intraocular lens tilt 15.67% (42), endothelial decompensation 21.64% (58), subluxation/luxation IOL 3.73% (10), secondary cataract 21.46% (58), pigment dispersion 37.68% (101), increased IOP 13.80% (37), residual lens matter 13.80% (37), hyphema 3.73% (10), posterior synechiae 6.72% (18), iris prolapsus 2.73% (8). Cataract surgery in PES will frequently encounter small pupils, shallow anterior chambers, posterior adhesions, weak zonular support, partial subluxation or complete dislocation of lens. Authors presented the best possible approach on PES and surgical methods for patients with cataract with special accent of possible surgical complications.

  17. 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.

  18. Aesthetic surgery and Google: ubiquitous, unregulated and enticing websites for patients considering cosmetic surgery.

    Science.gov (United States)

    Rufai, Sohaib R; Davis, Christopher R

    2014-05-01

    Patient safety is a fundamental issue in aesthetic surgery. In an attempt to improve safety, the Department of Health (DoH) and Professor Sir Bruce Keogh published a review in 2013 of the regulation of cosmetic interventions. Proposals included: (1) Banning free consultations; (2) Restricting time-limited promotional deals; (3) Two-stage written pre-operative consent; (4) Consultations with a medical professional rather than a sales 'consultant'. The Cosmetic Surgical Practice Working Party (CSWP) recommended a two week "cooling off" period before surgery. This study quantified compliance with the above national initiatives by aesthetic surgery providers in the UK. To replicate a patient searching for aesthetic surgery providers, "cosmetic surgery UK" was searched via Google. The top fifty websites of aesthetic surgery providers were included in the study. Websites were analysed for compliance with the DoH Keogh and CSWP recommendations. When clarification was required, aesthetic surgery providers were contacted via telephone. Pearson's Chi-squared test compared actual compliance with national recommendations of full compliance. Fifty cosmetic surgery providers in the UK entered the study. Consultations with the operating surgeon occurred in 90% of cases. Mean compliance with all parameters from the national guidelines was 41%, significantly less than the desired level of full compliance (P time limited. No provider stipulated compliance with two stages of signed consent. This study demonstrated low compliance with national guidelines for aesthetic surgery. Aggressive sales techniques and enticing offers by aesthetic surgery providers were widespread. Statutory government guidelines on aesthetic surgery and increased public awareness into potential risks from inappropriate cosmetic surgery may improve patient decision making and safety. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights

  19. [Operative and postoperative management of patients after neck surgery].

    Science.gov (United States)

    Szybiak, Bartosz; Golusiński, Wojciech

    2012-01-01

    Cancer patients after neck surgeries require specific operative and postoperative management, which to some extent determines the final outcome of the surgery. Such procedures require particular attention due to the respiratory and gastrointestinal tracts as well as the presence of functionally and morphologically important anatomical structures on the neck. The majority of patients qualified for surgery have concomitant medical conditions, which increases the probability of certain operative and postoperative complications. Preparation for the procedure requires close cooperation between the laryngologist-head and neck surgeon, general practitioner and anaesthetist. The purpose of the paper was to analyse the factors that influence the normal process of healing in the operative and postoperative periods in patients after neck surgery. The study group consisted of 220 patients who underwent neck surgery in the years 2007-2010. 92.8% of the operations were performed due to a malignant cancer. The following factors were taken into consideration in the evaluation of the healing process: On average, following surgery, patients stayed in the ward for: 5-7 days after selective removal of lymph nodes, 5 days after removal of branchial cleft cyst or persistent thyroglossal duct, 14 days after total laryngectomy, and 12 days after reconstructive laryngeal surgery. All patients after oncological surgery of the oral cavity, oropharynx and larynx stayed in the ICU for the first 24 hours and remained under analgosedation. Laryngeal surgery was performed using a separate surgical incision for tracheotomy. In all cases suction drainage was used for 48 hours. After surgery, patients were mobilised during the first 24 hours in the ward. Appropriate operative and postoperative management, following specific standards, increases the safety of the patient. Providing optimal conditions for healing shortens the patient's stay in the ICU, which reduces the cost of hospitalisation and

  20. Risk factors in patient safety : Minimally invasive surgery versus conventional surgery

    NARCIS (Netherlands)

    Rodrigues, S.P.; Wever, A.M.; Denkelman, J.; Jansen, F.W.

    2011-01-01

    Background This study aimed to identify the frequency of events in the different patient safety risk domains during minimally invasive surgery (MIS) and conventional surgery (CS). Methods A convenience sample of gynecologic MIS and CS was observed. Events were observed and categorized into one of

  1. Morbidity of Early Spine Surgery in the Multiply Injured Patient

    Science.gov (United States)

    2014-07-31

    chest trauma 9 30 % Exploratory laparotomy 8 27 % Lactate [ 2.5 mEq/L 6 20 % Platelet \\110,000/mm3 4 13 % 10 U PRBCs pre-spine surgery 4 13 % ISS...ORTHOPAEDIC SURGERY Morbidity of early spine surgery in the multiply injured patient J. W. Galvin • B. A. Freedman • A. J. Schoenfeld • A. P. Cap • J... surgery for multiply injured patients with operative spinal injuries remains unknown. The purported benefits of early intervention must be weighed

  2. Smartphone-Based Patient Education in Plastic Surgery.

    Science.gov (United States)

    Noel, Warren; Bosc, Romain; Jabbour, Samer; Kechichian, Elio; Hersant, Barbara; Meningaud, Jean-Paul

    2017-12-01

    Internet use for health information has dramatically increased in the past decade. Mobile medical applications (MMAs) could be a useful tool to improve postoperative patient education and care. The objective of this study is to evaluate the impact of an MMA on patient care in plastic surgery. An MMA was developed to improve postoperative plastic surgery patients care. All patients who underwent surgery at our plastic surgery department between August and November 2014 and were willing to download the MMA were included. Two to 4 weeks after the procedure, the patients were asked to fill a questionnaire that assessed the content, design, and efficacy of the application. Sixty patients were included. The patients reported that their questions regarding the postoperative management were addressed by the application with a mean score of 4.1 over 5. Most patients would recommend the application to other plastic surgery patients with a mean score of 4.6 over 5. The application prevented 12 patients (20%) from calling the plastic surgeon or the emergency department. A smartphone application can optimize the plastic surgery patient care. It can provide additional information allowing the patients to get involved in their own medical care.

  3. The impact of marketing language on patient preference for robot-assisted surgery.

    Science.gov (United States)

    Dixon, Peter R; Grant, Robert C; Urbach, David R

    2015-02-01

    Robot-assisted surgery is gaining momentum as a new trend in minimally invasive surgery. With limited evidence supporting its use in place of the far less expensive conventional laparoscopic surgery, it has been suggested that marketing pressure is partly responsible for its widespread adoption. The impact of phrases that promote the novelty of robot-assisted surgery on patient decision making has not been investigated. We conducted a discrete choice experiment to elicit preference of partial colectomy technique for a hypothetical diagnosis of colon cancer. A convenience sample of 38 participants in an ambulatory general surgery clinic consented to participate. Each participant made 2 treatment decisions between robot-assisted surgery and conventional laparoscopic surgery, with robot-assisted surgery described as "innovative" and "state-of-the-art" in one of the decisions (marketing frame), and by a disclosure of the uncertainty of available evidence in the other (evidence-based frame). The magnitude of the framing effect was large with 12 of 38 subjects (31.6%, P = .005) selecting robot-assisted surgery in the marketing frame and not the evidence-based frame. This is the first study to our knowledge to demonstrate that words that highlight novelty have an important influence on patient preference for robot-assisted surgery and that use of more neutral language can mitigate this effect. © The Author(s) 2014.

  4. 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

  5. External dacryocystorhinostomy surgery in patients with Wegener granulomatosis.

    Science.gov (United States)

    Lee, Brian J; Nelson, Christine C; Lewis, Craig D; Perry, Julian D

    2012-01-01

    To determine surgical outcomes after external dacryocystorhinostomy (DCR) surgery in patients with Wegener granulomatosis (WG). The authors retrospectively reviewed the charts of consecutive patients with WG who underwent primary or secondary external DCR surgery between January 2001 and January 2010. Clinical data reviewed included patient demographics, systemic disease involvement and immunosuppression therapy, intraoperative biopsy findings, and postoperative outcomes and complications. Success was defined as resolution of epiphora. Sixteen primary external DCRs were performed on 9 patients with WG, and 2 secondary external DCRs were performed on 2 patients. At the time of surgery, all patients with WG were on systemic immunosuppressive agents including methotrexate, rapamycin, sirolimus, tacrolimus, azathioprine, cyclophosphamide, rituximab, and prednisone, and no patients received increased corticosteroids after surgery. Intraoperative biopsy in patients with WG revealed chronic inflammation (4 patients) and fibrosis (1 patient). Silicone stents were removed at an average of 5.8 months (range, 3-12 months). All surgeries were successful in resolving epiphora with an average follow up of 3.5 years (range, 10 months-6 years) and no complications. Primary and secondary external DCR surgery successfully treats nasolacrimal duct obstruction in patients with WG on systemic immunosuppression.

  6. Bariatric surgery rapidly improves mitochondrial respiration in morbidly obese patients.

    Science.gov (United States)

    Nijhawan, Sheetal; Richards, William; O'Hea, Martha F; Audia, Jonathon P; Alvarez, Diego F

    2013-12-01

    Obesity and its attendant comorbidities are an emerging epidemic. Chronic metabolic inflammation (metainflammation) is thought to precipitate obesity-associated morbidities; however, its mechanistic progression is poorly understood. Moreover, although interventions such as diet, exercise, and bariatric surgery can control body weight, their effects on metainflammation are also poorly understood. Recently, metainflammation and the pathobiology of obesity have been linked to mitochondrial dysfunction. Herein we examined the effects of bariatric surgery on mitochondrial respiration as an index of resolving metainflammation in morbidly obese patients. This institutional review board-approved study involved morbidly obese patients (body mass index > 35 kg/m(2)) undergoing sleeve gastrectomy or Roux-en-Y gastric bypass. Mitochondrial respiration was assessed in peripheral blood monocytes and in skeletal muscle samples before surgery and at 12 weeks after surgery. Patient biometrics, homeostasis model assessment-estimated insulin resistance (HOMA-IR) score, C-reactive protein, and lipid profile were analyzed. Twenty patients were enrolled and showed an average percent excess body weight loss of 30.3% weight loss at 12 weeks after surgery. Average HOMA-IR score decreased from 3.0 to 1.2 in insulin-resistant patients. C-reactive protein, an index of metainflammation, showed a modest decrease. Lipid profile remained stable. Intriguingly, mitochondrial basal and maximal respiration rates in peripheral blood monocytes increased after surgery. Basal rates of skeletal muscle mitochondrial respiration were unchanged, but the maximal respiration rate trended toward an increase after surgery. Cellular and tissue mitochondrial respiration increased in a morbidly obese patient cohort after laparoscopic bariatric surgery. These changes were consistent in patients with postsurgical weight loss. Importantly, no significant changes or improvements occurred in canonical indices used to

  7. 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.

  8. Acute phase response to surgery of varying intensity in horses

    DEFF Research Database (Denmark)

    Jacobsen, Stine; Nielsen, Jon Vedding; Kjelgaard-Hansen, Mads

    2009-01-01

    OBJECTIVE: To evaluate the postoperative inflammatory response of horses to elective surgery of varying intensity. STUDY DESIGN: Prospective longitudinal study. ANIMALS: Horses referred to 2 hospitals for either arthroscopic removal of a unilateral osteochondritic lesion in the tibiotarsal joint...... (WBC) counts and concentrations of serum amyloid A (SAA), fibrinogen, and iron were assessed in blood samples obtained before, and 1-3, 5, 7, 9, and 11 days after surgery. Differences in levels of the inflammatory markers between the 3 surgical groups were analyzed using repeated measures ANOVA...

  9. Transfusion requirements in elective cardiopulmonary bypass surgery patients

    DEFF Research Database (Denmark)

    Sivapalan, Praleene; Bäck, Anne Caroline; Ostrowski, Sisse Rye

    2017-01-01

    Managing haemostasis in patients undergoing cardiopulmonary bypass (CPB) surgery remains a challenge. There is no established laboratory test to predict transfusion requirements in cardiac surgery. We investigated whether preoperative Thromboelastography (TEG) with Platelet Mapping Assay (PMA......) or Multiple Electrode Aggrometry (MEA) could predict transfusion requirements in patients undergoing elective coronary artery bypass grafting (CABG) or combined CABG with aortic or mitral valve replacement. We prospectively investigated 199 patients undergoing elective CABG or combined procedures. PMA and MEA...

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

    OpenAIRE

    I. L. Chernikovskiy; V. M. Gelfond; A. S. Zagryadskikh; S. A. Savchuk

    2016-01-01

    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 pres...

  11. The role of the physiotherapy in the plastic surgery patients after oncological breast surgery.

    Science.gov (United States)

    Nevola Teixeira, Luiz Felipe; Sandrin, Fabio

    2014-02-01

    Breast cancer is the disease which causes the greatest concern among women worldwide, with an estimated 1,152,161 new cases each year. The improvement of surgical techniques, neoadjuvant and adjuvant treatment enhance the survival time and recovery of these patients. As surgery is the first choice for the treatment of breast neoplasms reconstructive surgery has become an important procedure helping to reconstruct the mutilation after radical or conservative breast surgery. The objective of this article is to review the scientific literature and examine the available data regarding the role of physiotherapy in patients who undergo plastic reconstruction after oncological breast surgery, including suggestions on how physiotherapy could be applied in that population. Our review was obtained by searching the PubMed (National Library of Medicine, USA) and LILACS (Latin American and Caribbean Health Sciences) databases. Terms applied concerned physiotherapy and breast reconstructive surgery. The time of limit for our search was from 1995 until the present date. Fourteen articles were included in our review that matched our search criteria. Physiotherapy is a field that still needs evidence based on daily routine and studies in the oncological physiotherapy field. Evaluation should be standardized and rehabilitation techniques used are empirical and should be researched in patients who undergo plastic reconstruction after breast surgery. The lack of post-surgery exercise protocols makes it difficult to analyse the patient's evolution and makes it a challenge to investigate the true role of physiotherapy in this population.

  12. Clonidine in patients undergoing noncardiac surgery

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  13. Post-Cataract Surgery Visual Disturbance in a Retinitis Pigmentosa Patient with Asteroid Hyalosis

    Directory of Open Access Journals (Sweden)

    Yoko Jingami

    2011-08-01

    Full Text Available A patient with retinitis pigmentosa showed visual disturbances following successful cataract surgery. He had a dense asteroid hyalosis in the eye before cataract surgery. After the surgery he noticed that his vision became worse. The visual disturbance was explained as being caused by the progression of retinal degeneration. Although the electroretinogram was non-recordable, the degeneration of macular area appeared relatively small. We considered that dense asteroid hyalosis was responsible for his visual disturbances, and pars plana vitrectomy (PPV was performed to remove the asteroid hyalosis. After the PPV, rapid improvement of his visual acuity was observed. Cataract surgery may affect the status of asteroid hyalosis and cause rapid visual loss. PPV should be considered for retinitis pigmentosa patients with dense asteroid hyalosis, especially when a large decrease in visual acuity is noted shortly after cataract surgery.

  14. HIV Seroprevalence in Patients Undergoing Ophthalmic Surgery in ...

    African Journals Online (AJOL)

    Aim: The aim of this study was to determine the number of HIV positive cases undergoing ophthalmic surgery at two centres in Nigeria and to assess if routine testing is clinically or economically effective. Methods: All patients listed for ophthalmic surgery in two eye units in southern Nigeria during a six-month period in 2005,

  15. More patients should undergo surgery after sigmoid volvulus.

    Science.gov (United States)

    Ifversen, Anne Kathrine Wewer; Kjaer, Daniel Willy

    2014-12-28

    To assess the outcome of patients treated conservatively vs surgically during their first admission for sigmoid volvulus. We conducted a retrospective study of 61 patients admitted to Aarhus University Hospital in Denmark between 1996 and 2011 for their first incidence of sigmoid volvulus. The condition was diagnosed by radiography, sigmoidoscopy or surgery. Patients treated with surgery underwent either a sigmoid resection or a percutaneous endoscopic colostomy (PEC). Conservatively treated patients were managed without surgery. Data was recorded into a Microsoft Access database and calculations were performed with Microsoft Excel. Kaplan-Meier plotting and Mantel-Cox (log-rank) testing were performed using GraphPad Prism software. Mortality was defined as death within 30 d after intervention or surgery. Among the total 61 patients, 4 underwent emergency surgery, 55 underwent endoscopy, 1 experienced resolution of the volvulus after contrast enema, and 1 died without treatment because of large bowel perforation. Following emergency treatment, 28 patients underwent sigmoid resection (semi-elective n = 18; elective n = 10). Two patients who were unfit for surgery underwent PEC and both died, 1 after 36 d and the other after 9 mo, respectively. The remaining 26 patients were managed conservatively without sigmoid resection. Patients treated conservatively on their first admission had a poorer survival rate than patients treated surgically on their first admission (95%CI: 3.67-14.37, P = 0.036). Sixty-three percent of the 26 conservatively treated patients had not experienced a recurrence 3 mo after treatment, but that number dropped to 24% 2 years after treatment. Eight of the 14 patients with recurrence after conservative treatment had surgery with no 30-d mortality. Surgically-treated sigmoid volvulus patients had a higher long-term survival rate than conservatively managed patients, indicating a benefit of surgical resection or PEC insertion if feasible.

  16. Do patients return to sports and work after total shoulder replacement surgery?

    Science.gov (United States)

    Bülhoff, Matthias; Sattler, Peter; Bruckner, Thomas; Loew, Markus; Zeifang, Felix; Raiss, Patric

    2015-02-01

    Studies evaluating the return to sports and work after shoulder arthroplasty are rare, and there are no studies evaluating return to work after total shoulder arthroplasty (TSA). Patients undergoing TSA will be able to return to their preoperative sports levels and occupations. Case series; Level of evidence, 4. A total of 154 patients with 170 TSAs for primary glenohumeral arthritis were included. Two subgroups were formed: patients who had participated in sports during the 5 years before surgery (group 1; n = 105 [68%]) and patients who had never participated in sports (group 2; n = 49 [32%]). The return-to-work rate in patients who had not retired after surgery were also analyzed, as were responses to a survey. The mean age at the time of surgery was 71 years (range, 33-88 years) in group 1 and 76 years (range, 54-88 years) in group 2. Mean follow-up time was 6.2 years (range, 2.5-12.6 years). Fifty-seven patients (54%) in group 1 participated in sports right up to the time of surgery. All 57 (100%) returned to sports after surgery. A further 3 patients (3%) from group 1 resumed sporting activity after surgery; swimming was the most popular sport. No patient in group 2 started sports activity after shoulder replacement surgery. Many of the patients, 14% of the entire group, had retired by final follow-up because of TSA. Fourteen percent of patients in group 1 and group 2 were pursuing their work at the time of most recent follow-up. Thirty patients of the entire cohort (19.5%) had to change their occupations because of surgery. Patients who participated in sports before TSA were successfully able to return to sports activities after surgery. Patients who did not participate in sports just before surgery were unlikely to start sports after surgery. Fourteen percent of the entire cohort was able to return to work after surgery. © 2014 The Author(s).

  17. The immune response of the human brain to abdominal surgery

    DEFF Research Database (Denmark)

    Forsberg, Anton; Cervenka, Simon; Jonsson Fagerlund, Malin

    2017-01-01

    OBJECTIVE: Surgery launches a systemic inflammatory reaction that reaches the brain and associates with immune activation and cognitive decline. Although preclinical studies have in part described this systemic-to-brain signaling pathway, we lack information on how these changes appear in humans....... This study examines the short- and long-term impact of abdominal surgery on the human brain immune system by positron emission tomography (PET) in relation to blood immune reactivity, plasma inflammatory biomarkers, and cognitive function. METHODS: Eight males undergoing prostatectomy under general...... anesthesia were included. Prior to surgery (baseline), at postoperative days 3 to 4, and after 3 months, patients were examined using [11C]PBR28 brain PET imaging to assess brain immune cell activation. Concurrently, systemic inflammatory biomarkers, ex vivo blood tests on immunoreactivity...

  18. 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

  19. Stress management training for breast cancer surgery patients.

    Science.gov (United States)

    Garssen, Bert; Boomsma, Martijn F; Meezenbroek, Eltica de Jager; Porsild, Terry; Berkhof, Johannes; Berbee, Monique; Visser, Adriaan; Meijer, Sybren; Beelen, Rob H J

    2013-03-01

    This study evaluated the psychological effects of a pre-surgical stress management training (SMT) in cancer patients. 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 CDs with relaxation and coping skills exercises. Patients were randomly assigned to the SMT (N = 34) or a regular care condition (N = 36). Depression, anxiety, quality of life, perception of control, fatigue, pain, sleep problems, and surgery-related somatic symptoms were measured at Day 6 and Day 1 pre-surgery, and Day 2, 5, 30 and 90 post-surgery. Depression and fatigue decreased in the intervention group and increased in the control group, leading to significant group differences at Day 2 (fatigue) and Day 5 post-surgery (fatigue and depression). It also appeared that surgery-related symptoms had increased more in the control group 3 months post-surgery than in the SMT group. No intervention effects were observed for anxiety, pain, and sleep problems. The use of a short psychological intervention is effective in reducing depression and fatigue in the post-surgical period, although the effects are of short duration. Copyright © 2012 John Wiley & Sons, Ltd.

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

    Science.gov (United States)

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

    2014-12-01

    Research on patients' experiences of wait time for scheduled surgery has centered predominantly on the relative tolerability of perceived wait time and impacts on quality of life. We explored patients' experiences of time while waiting for three types of surgery with varied wait times--hip or knee replacement, shoulder surgery, and cardiac surgery. Thirty-two patients were recruited by their surgeons. We asked participants about their perceptions of time while waiting in two separate interviews. Using interpretative phenomenological analysis (IPA), we discovered connections between participant suffering, meaningfulness of time, and agency over the waiting period and the lived duration of time experience. Our findings reveal that chronological duration is not necessarily the most relevant consideration in determining the quality of waiting experience. Those findings helped us create a conceptual framework for lived wait time. We suggest that clinicians and policy makers consider the complexity of wait time experience to enhance preoperative patient care. © The Author(s) 2014.

  1. Cognitive Investigation Study of Patients Admitted for Cosmetic Surgery: Information, Expectations, and Consent for Treatment

    Directory of Open Access Journals (Sweden)

    Mauro Barone

    2015-01-01

    Full Text Available BackgroundIn all branches of medicine, it is the surgeon's responsibility to provide the patient with accurate information before surgery. This is especially important in cosmetic surgery because the surgeon must focus on the aesthetic results desired by the patient.MethodsAn experimental protocol was developed based on an original questionnaire given to 72 patients. The nature of the responses, the patients' motivation and expectations, the degree of patient awareness regarding the planned operation, and the patients' perceptions of the purpose of the required consent for cosmetic surgery were all analyzed using Fisher's exact test.ResultsCandidates for abdominal wall surgery had significantly more preoperative psychological problems than their counterparts did (P=0.035. A significantly different percentage of patients under 40 years of age compared to those over 40 years of age searched for additional sources of information prior to the operation (P=0.046. Only 30% of patients with a lower educational background stated that the preoperative information had been adequate, whereas 92% of subjects with secondary schooling or a postsecondary degree felt that the information was sufficient (P=0.001. A statistically significant difference was also present between patients according to their educational background regarding expected improvements in their quality of life postoperatively (P=0.008.ConclusionsThis study suggests that patients require more attention in presurgical consultations and that clear communication should be prioritized to ensure that the surgeon understands the patient's expectations.

  2. Cognitive investigation study of patients admitted for cosmetic surgery: information, expectations, and consent for treatment.

    Science.gov (United States)

    Barone, Mauro; Cogliandro, Annalisa; La Monaca, Giuseppe; Tambone, Vittoradolfo; Persichetti, Paolo

    2015-01-01

    In all branches of medicine, it is the surgeon's responsibility to provide the patient with accurate information before surgery. This is especially important in cosmetic surgery because the surgeon must focus on the aesthetic results desired by the patient. An experimental protocol was developed based on an original questionnaire given to 72 patients. The nature of the responses, the patients' motivation and expectations, the degree of patient awareness regarding the planned operation, and the patients' perceptions of the purpose of the required consent for cosmetic surgery were all analyzed using Fisher's exact test. Candidates for abdominal wall surgery had significantly more preoperative psychological problems than their counterparts did (P=0.035). A significantly different percentage of patients under 40 years of age compared to those over 40 years of age searched for additional sources of information prior to the operation (P=0.046). Only 30% of patients with a lower educational background stated that the preoperative information had been adequate, whereas 92% of subjects with secondary schooling or a postsecondary degree felt that the information was sufficient (P=0.001). A statistically significant difference was also present between patients according to their educational background regarding expected improvements in their quality of life postoperatively (P=0.008). This study suggests that patients require more attention in presurgical consultations and that clear communication should be prioritized to ensure that the surgeon understands the patient's expectations.

  3. Ambulatory surgery for the patient with breast cancer: current perspectives

    Directory of Open Access Journals (Sweden)

    Pek CH

    2016-08-01

    Full Text Available Chong Han Pek,1 John Tey,2 Ern Yu Tan1 1Department of General Surgery, 2Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore, Singapore Abstract: Ambulatory breast cancer surgery is well accepted and is the standard of care at many tertiary centers. Rather than being hospitalized after surgery, patients are discharged on the day of surgery or within 23 hours. Such early discharge does not adversely affect patient outcomes and has the added benefits of better psychological adjustment for the patient, economic savings, and a more efficient utilization of health care resources. The minimal care needed post-discharge also means that the caregiver is not unduly burdened. Unplanned conversions to inpatient admission and readmission rates are low. Wound complications are infrequent and no issues with drain care have been reported. Because the period of postoperative observation is short and monitoring is not as intensive, ambulatory surgery is only suitable for low-risk procedures such as breast cancer surgery and in patients without serious comorbidities, where the likelihood of major perioperative events is low. Optimal management of pain, nausea, and vomiting is essential to ensure a quick recovery and return to normal function. Regional anesthesia such as the thoracic paravertebral block has been employed to improve pain control during the surgery and in the immediate postoperative period. The block provides excellent pain relief and reduces the need for opiates, which also consequently reduces the incidence of nausea and vomiting. The increasing popularity of total intravenous anesthesia with propofol has also helped reduce the incidence of nausea and vomiting in the postoperative period. Ambulatory surgery can be safely carried out in centers where there is a well-designed workflow to ensure proper patient selection, counseling, and education, and where patients and caregivers have easy access to

  4. Bariatric Surgery Patients' Perceptions of Weight-Related Stigma in Healthcare Settings Impair Post-surgery Dietary Adherence

    Science.gov (United States)

    Raves, Danielle M.; Brewis, Alexandra; Trainer, Sarah; Han, Seung-Yong; Wutich, Amber

    2016-01-01

    Background: Weight-related stigma is reported frequently by higher body-weight patients in healthcare settings. Bariatric surgery triggers profound weight loss. This weight loss may therefore alleviate patients' experiences of weight-related stigma within healthcare settings. In non-clinical settings, weight-related stigma is associated with weight-inducing eating patterns. Dietary adherence is a major challenge after bariatric surgery. Objectives: (1) Evaluate the relationship between weight-related stigma and post-surgical dietary adherence; (2) understand if weight loss reduces weight-related stigma, thereby improving post-surgical dietary adherence; and (3) explore provider and patient perspectives on adherence and stigma in healthcare settings. Design: This mixed methods study contrasts survey responses from 300 postoperative bariatric patients with ethnographic data based on interviews with 35 patients and extensive multi-year participant-observation within a clinic setting. The survey measured experiences of weight-related stigma, including from healthcare professionals, on the Interpersonal Sources of Weight Stigma scale and internalized stigma based on the Weight Bias Internalization Scale. Dietary adherence measures included patient self-reports, non-disordered eating patterns reported on the Disordered Eating after Bariatric Surgery scale, and food frequencies. Regression was used to assess the relationships among post-surgical stigma, dietary adherence, and weight loss. Qualitative analyses consisted of thematic analysis. Results: The quantitative data show that internalized stigma and general experiences of weight-related stigma predict worse dietary adherence, even after weight is lost. The qualitative data show patients did not generally recognize this connection, and health professionals explained it as poor patient compliance. Conclusion: Reducing perceptions of weight-related stigma in healthcare settings and weight bias internalization could

  5. Factors Affecting Patients Undergoing Cosmetic Surgery in Bushehr, Southern Iran

    OpenAIRE

    Salehahmadi, Zeinab; Rafie, Seyyed Reza

    2012-01-01

    BACKGROUND Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. METHODS From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr...

  6. A psychiatric perspective view of bariatric surgery patients

    OpenAIRE

    Isabel Brandão; Ana Luísa Fernandes; Eva Osório; Maria da Conceição Calhau; Rui Coelho

    2015-01-01

    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 PubMe...

  7. Patient factors in referral choice for total joint replacement surgery.

    Science.gov (United States)

    Conner-Spady, Barbara L; Marshall, Deborah A; Bohm, Eric; Dunbar, Michael J; Loucks, Lynda; Hennigar, Allan W; Frank, Cy; Noseworthy, Tom W

    2014-04-01

    Although the option of next available surgeon can be found on surgeon referral forms for total joint replacement surgery, its selection varies across surgical practices. Objectives are to assess the determinants of (a) a patient's request for a particular surgeon; and (b) the actual referral to a specific versus the next available surgeon. Questionnaires were mailed to 306 consecutive patients referred to orthopedic surgeons. We assessed quality of life (Oxford Hip and Knee scores, Short Form-12, EuroQol 5D, Pain Visual Analogue Scale), referral experience, and the importance of surgeon choice, surgeon reputation, and wait time. We used logistic regression to build models for the 2 objectives. We obtained 176 respondents (response rate, 58%), 60% female, 65% knee patients, mean age of 65 years, with no significant differences between responders versus nonresponders. Forty-three percent requested a particular surgeon. Seventy-one percent were referred to a specific surgeon. Patients who rated surgeon choice as very/extremely important [adjusted odds ratio (OR), 6.54; 95% confidence interval (CI), 2.57-16.64] and with household incomes of $90,000+ versus <$30,000 (OR, 5.74; 95% CI, 1.56-21.03) were more likely to request a particular surgeon. Hip patients (OR, 3.03; 95% CI, 1.18-7.78), better Physical Component Summary-12 (OR, 1.29; 95% CI, 1.02-1.63), and patients who rated surgeon choice as very/extremely important (OR, 3.88; 95% CI, 1.56-9.70) were more likely to be referred to a specific surgeon. Most patients want some choice in the referral decision. Providing sufficient information is important, so that patients are aware of their choices and can make an informed choice. Some patients prefer a particular surgeon despite longer wait times.

  8. [Nutritional deficiencies in bariatric surgery patients: prevention, diagnosis and treatment].

    Science.gov (United States)

    Schweiger, Chaya; Keidar, Andrei

    2010-11-01

    The number of people suffering from surgery and obesity in the western world is constantly growing. In 1997 the World Health Organization (WHO) defined obesity as a plague and one of greatest public health hazards of our time. The National Institution of Health (NIH) declared that surgery is the only long-term solution for obesity. Today there are four different types of bariatric surgery. Each variation has different implications on the nutritional status of bariatric surgery patients. Bariatric surgery candidates are at risk of developing vitamin and mineral nutritional deficiencies in the post-operative stage, due to vomiting, decrease in food intake, food intolerance, diminution of gastric secretions and bypass of absorption area. It is easier and more efficient to treat nutritional deficiencies in the preoperative stage. Therefore, preoperative detection and correction are crucial. Blood tests before surgery to detect and treat nutritional deficiencies are crucial. In the postoperative period, blood tests should be conducted every 3 months in the first year after operation, every six months in the second year and annually thereafter. Multivitamin is recommended to prevent nutritional deficiencies in all bariatric surgery patients. Furthermore, iron, calcium, Vitamin D and B12 are additionally recommended for Roux-en-Y Gastric Bypass patients. Patients with Biliopancreatic diversion and Duodenal Switch should also take fat soluble vitamins.

  9. Safe Surgery Checklist, Patient Safety, Teamwork, and Responsibility—Coequal Demands? A Focus Group Study

    Science.gov (United States)

    Willassen, Elin Thove; Jacobsen, Inger Lise Smith; Tveiten, Sidsel

    2018-01-01

    The use of World Health Organization’s (WHO’s) Safe Surgery checklist is an established practice worldwide and contributes toward ensuring patient safety and collaborative teamwork. The aim of this study was to elucidate operating room nurses’ and operating room nursing students’ experiences and opinions about execution of and compliance with checklists. We chose a qualitative design with semistructured focus group discussions. Qualitative content analysis was conducted. Two main themes were identified; the Safe Surgery checklists have varied influence on teamwork and patient safety, and taking responsibility for executing the checks on the Safe Surgery checklist entails practical and ethical challenges. The experiences and opinions of operating room nurses and their students revealed differences of practices and attitudes toward checklist compliance and the intentions of checklist procedures. These differences are related to cultural and professional distances between team members and their understanding of the Safe Surgery checklists as a tool for patient safety. PMID:29623287

  10. Geriatric patient profile in the cardiovascular surgery intensive care unit.

    Science.gov (United States)

    Korhan, Esra Akin; Hakverdioglu, Gulendam; Ozlem, Maryem; Ozlem, Maryem; Yurekli, Ismail; Gurbuz, Ali; Alp, Nilgun Akalin

    2013-11-01

    To determine hospitalization durations and mortalities of elderly in the Cardiovascular Surgery Intensive Care Unit. The retrospective study was conducted in a Cardiovascular Surgery Intensive Care Unit in Turkey and comprised patient records from January 1 to December 31, 2011. Computerized epicrisis reports of 255, who had undergone a cardiac surgery were collected. The patients were grouped according to their ages, Group I aged 65-74 and Group II aged 75 and older. European society for Cardiac Operative Risk Evaluation scores of the two groups were compared using SPSS 17. Overall, there were 80 (31.37%) females and 175 (68.62%) males. There were 138 (54.1%) patients in Group I and 117 (45.9%) in Group II. Regarding their hospitalization reasons, it was determined that 70 (27.5%) patients in Group I and 79 (30.9%) patients in Group II were treated with the diagnosis ofcoronary artery disease. The average hospitalization duration of patients in the intensive care unit was determined to be 11.57 +/- 0.40 days. Regarding the EuroSCORE score intervals of patients, 132 (51.8%) had 3-5 and 225 (88.2%) patients were transferred to the Cardiovascular Surgery and then all of them were discharged; 5 (4.1%) had a mortal course; and 11 (7.7%) were transferred to the anaesthesia intensive care unit. The general mortality rates are very low in the Cardiovascular Surgery Intensive Care Unit and the patients have a good prognosis.

  11. Facial Plastic Surgery Patient Resources Exceed National Institute Recommendations.

    Science.gov (United States)

    Chu, Michael W; Cook, Julia A; Tholpady, Sunil S; Schmalbach, Cecelia E; Momeni, Arash

    2017-05-01

    Patient education is essential in enhancing the physician-patient therapeutic alliance, patient satisfaction, and clinical outcomes. The American Medical Association and National Institute of Health recommend that information be written at a 6th-grade reading level, but online resources often exceed patient literacy. The purpose of this study is to assess readability of online material for facial plastics procedures presented on academic plastic surgery and otolaryngology websites.An Internet search was performed of all academic institutions that had both plastic surgery and otolaryngology training programs who offered patient information on facial plastic surgery procedures. National society websites for both plastic surgery and otolaryngology were also analyzed. All procedural information was compiled and readability analyses were performed. A 2-tailed Z-test was used to compare scores, and statistical significance was set at P plastic surgery website had a significantly higher word count and number of syllables per word compared to the national otolaryngology website (P < 0.001, P = 0.04).The complexity of written resources represents an obstacle to online patient education and efforts to improve readability could benefit patients seeking medical information online. Current online education materials are a potential hindrance to patient education, satisfaction, and decision making. Healthcare institutions should consider writing new materials with simpler language that would be accessible to patients.

  12. Patient blood management in elective orthopaedic surgery

    NARCIS (Netherlands)

    So-Osman, Cynthia

    2012-01-01

    Chapter 2 describes the results of a RCT on the effect of a restrictive trigger on RBC sparing. In three hospitals, a restrictive transfusion policy was compared with standard care transfusion policy. A randomised comparison of transfusion triggers in elective orthopaedic surgery using

  13. Bariatric surgery in elderly patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Giordano S

    2015-10-01

    Full Text Available Salvatore Giordano,1 Mikael Victorzon2,3 1Department of Plastic and General Surgery, Turku University Hospital, Turku, 2Department of Gastrointestinal Surgery, Vaasa Central Hospital, Vaasa, 3University of Turku, Turku, Finland Abstract: 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 I2 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. Keywords: morbid obesity, bariatric surgery, elderly, gastric bypass, weight loss, laparoscopy

  14. Fear and anxiety in patients undergoing minor oral surgery | Saheeb ...

    African Journals Online (AJOL)

    Objective: This study was carried out to determine the causes of fear and anxiety in consecutive patients who attended the University of Benin Teaching Hospital for minor oral surgical treatment. Method: All consenting consecutive patients referred for minor oral surgery were studied. Information on all the patients was ...

  15. The male cosmetic surgery patient: a matched sample gender analysis of elective cosmetic surgery and cosmetic dentistry patients.

    Science.gov (United States)

    Dowling, Nicki A; Honigman, Roberta J; Jackson, Alun C

    2010-06-01

    Plastic surgeons have traditionally perceived male patients as more psychologically disturbed than female patients. This study employed a matched sample design to explore the psychosocial experiences of 50 male and 50 female elective cosmetic surgery and cosmetic dentistry patients. It also aimed to compare male and female patients on preoperative psychosocial dysfunction on standardized measures (psychiatric disturbance, anxiety, depression, low self-esteem, dysmorphic concern, and low body image) and postoperative dissatisfaction. The findings revealed that there were many similarities between the self-reported appearance concerns, motivations for surgery, and expectations of surgery between male and female patients. Although male patients did not report higher levels of preoperative psychosocial dysfunction than their female counterparts, they were more likely to report postoperative dissatisfaction. Preoperative screening is recommended to identify the minority of male patients who will report an unsatisfactory outcome despite a technically good result.

  16. 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.

  17. The bariatric surgery patient: a growing role for registered dietitians.

    Science.gov (United States)

    Kulick, Doina; Hark, Lisa; Deen, Darwin

    2010-04-01

    Between 1998 and 2004, the total number of bariatric procedures increased almost 10-fold, from 13,386 procedures in 1998 to 121,055 in 2004. Current estimates suggest the number of bariatric operations will exceed 220,000 in 2010. Bariatric surgery encompasses several surgical techniques classified as restrictive or malabsorptive, based on the main mechanism of weight loss. Clinical studies and meta-analyses show that bariatric surgery decreases morbidity and mortality when compared with nonsurgical treatments. A successful long-term outcome of bariatric surgery is dependent on the patient's commitment to a lifetime of dietary and lifestyle changes. The registered dietitian (RD) is an important member of the bariatric team and provides critical instructions to help patients adhere to the dietary changes consistent with surgery. Referencing current literature, this article outlines the indications, contraindications, and types of bariatric surgery. The role of the RD for preoperative and postoperative nutrition assessment and medical nutrition therapy is highlighted. Management of long-term nutrition issues is also reviewed. The current recommendations include a multivitamin/mineral supplement plus vitamin B-12, calcium, vitamin D-3, iron, and folic acid. Given the increasing prevalence of obesity and bariatric surgery procedures, caring for patients who have undergone surgery will be an expanding role for the RD. Close postoperative follow-up and careful monitoring will improve the odds for successful surgical outcomes, and RDs play a very important part in this process. Copyright (c) 2010 American Dietetic Association. Published by Elsevier Inc. All rights reserved.

  18. Information needs among adolescent bariatric surgery patients and their caregivers.

    Science.gov (United States)

    Schneider, Nicole M; Tully, Carrie B; Washington, Gia A; Price, Karin L

    2016-05-01

    Bariatric surgery is an invasive medical treatment for morbid obesity that requires behavioral maintenance for physical success. Patient knowledge, motivation, and adherence are important factors in optimizing results. The purpose of the present study was to identify perceived informational gaps of adolescent and young adult bariatric surgery patients with morbid obesity (body mass index≥40 kg/m(2)). This study took place in a pediatric tertiary care academic medical center. Thirty-one adolescents/young adults who had undergone Roux-en-Y gastric bypass surgery at the authors' institution were recruited to complete questionnaires at their postsurgical visits (≥3 months postsurgery). Seventeen caregivers also participated in this study. The questionnaire used in the present study prompted patients and caregivers to reflect on information they wish they had known before surgery; questionnaire items included multiple choice and open-ended questions. Participants indicated that their informational needs were generally well met before surgery, although there were more needs noted by patients than by caregivers. Adolescent/young adult participants expressed a desire to have had more information about the necessity of taking vitamins daily and about having more gas. An association between informational needs and satisfaction was also found. Qualitative data revealed the importance of conveying cognitive-behavioral aspects of surgery to families (e.g., adherence, motivation). Despite most patients and caregivers being satisfied with the adolescent bariatric surgery program at the authors' institution, informational gaps exist. Teen-friendly ways to disseminate information would be helpful in influencing patients' satisfaction. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  19. 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

  20. Extensive endoscopic image-guided sinus surgery decreases BPI-ANCA in patients with cystic fibrosis

    DEFF Research Database (Denmark)

    Aanaes, K; Rasmussen, N; Pressler, T

    2012-01-01

    of BPI-ANCA may be due to the costimulation of BPI when mounting an immune response against P. aeruginosa. The effect of surgery aiming to eradicate bacteria and infected tissue on BPI-ANCA levels is sparsely described. A cohort of patients with CF were included: 53 patients having extensive image......-guided sinus surgery (EIGSS) with topical postoperative antibiotic treatment, 131 non-operated controls and 36 who had double lung transplantation (LTX). In all 219 patients, serum samples before and after surgery or at similar intervals were analysed for IgG and IgA BPI-ANCA. The EIGSS group showed a highly...... in patients with CF, indicating that extensive removal of infected tissue influences the pathogenic process of autoantibody production. The results shown herein are in favour of applying EIGSS in selected patients with CF and for using BPI-ANCA as a surrogate marker for guiding further therapeutic...

  1. 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...

  2. News media reports of patient deaths following 'medical tourism' for cosmetic surgery and bariatric surgery.

    Science.gov (United States)

    Turner, Leigh

    2012-04-01

    Contemporary scholarship examining clinical outcomes in medical travel for cosmetic surgery identifies cases in which patients traveled abroad for medical procedures and subsequently returned home with infections and other surgical complications. Though there are peer-reviewed articles identifying patient deaths in cases where patients traveled abroad for commercial kidney transplantation or stem cell injections, no scholarly publications document deaths of patients who traveled abroad for cosmetic surgery or bariatric surgery. Drawing upon news media reports extending from 1993 to 2011, this article identifies and describes twenty-six reported cases of deaths of individuals who traveled abroad for cosmetic surgery or bariatric surgery. Over half of the reported deaths occurred in two countries. Analysis of these news reports cannot be used to make causal claims about why the patients died. In addition, cases identified in news media accounts do not provide a basis for establishing the relative risk of traveling abroad for care instead of seeking elective cosmetic surgery at domestic health care facilities. Acknowledging these limitations, the case reports suggest the possibility that contemporary peer-reviewed scholarship is underreporting patient mortality in medical travel. The paper makes a strong case for promoting normative analyses and empirical studies of medical travel. In particular, the paper argues that empirically informed ethical analysis of 'medical tourism' will benefit from rigorous studies tracking global flows of medical travelers and the clinical outcomes they experience. The paper contains practical recommendations intended to promote debate concerning how to promote patient safety and quality of care in medical travel. © 2012 Blackwell Publishing Ltd.

  3. Impact of preoperative diagnosis on patient satisfaction following lumbar spine surgery.

    Science.gov (United States)

    Crawford, Charles H; Carreon, Leah Y; Bydon, Mohamad; Asher, Anthony L; Glassman, Steven D

    2017-06-01

    OBJECTIVE Patient satisfaction is a commonly used metric in the current health care environment. While factors that affect patient satisfaction following spine surgery are complex, the authors of this study hypothesized that specific diagnostic groups of patients are more likely to be satisfied after spine surgery and that this is reflected in patient-reported outcome measures. The purpose of this study was to determine if the preoperative diagnosis-disc herniation, stenosis, spondylolisthesis, adjacent segment degeneration, or mechanical disc collapse-would impact patient satisfaction following surgery. METHODS Patients enrolled in the Quality Outcomes Database, formerly known as the National Neurosurgery Quality and Outcomes Database (N 2 QOD), completed patient-reported outcome measures, including the Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS) for back pain (NRS-BP) and leg pain (NRS-LP) preoperatively and 1-year postoperatively. Patients were stratified by diagnosis and by their response to the satisfaction question: 1) surgery met my expectations; 2) I did not improve as much as I hoped, but I would undergo the same operation for the same results; 3) surgery helped, but I would not undergo the same operation for the same results; or 4) I am the same or worse as compared with before surgery. RESULTS A greater proportion of patients with primary disc herniation or spondylolisthesis reported that surgery met expectations (66% and 67%, respectively), followed by recurrent disc herniation and stenosis (59% and 60%, respectively). A smaller proportion of patients who underwent surgery for adjacent segment degeneration or mechanical disc collapse had their expectations met (48% and 41%, respectively). The percentage of patients that would undergo the same surgery again, by diagnostic group, was as follows: disc herniation 88%, recurrent disc herniation 79%, spondylolisthesis 86%, stenosis 82%, adjacent segment disease 75%, and mechanical collapse

  4. 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.

  5. Frequency of Surgery in Black Patients with Malignant Pleural Mesothelioma

    Directory of Open Access Journals (Sweden)

    Emanuela Taioli

    2015-01-01

    Full Text Available Introduction. Malignant Pleural Mesothelioma (MPM is a rare disease, even less frequently described in minority patients. We used a large population-based dataset to study the role of race in MPM presentation, treatment, and survival. Methods. All cases of pathologically proven MPM were identified in the Surveillance, Epidemiology, and End Results (SEER database. Age, sex, diagnosis year, stage, cancer-directed surgery, radiation, and vital status were analyzed according to self-reported race (black or white. Results. There were 13,046 white and 688 black MPM patients (incidence: 1.1 per 100,000 whites; 0.5 per 100,000 blacks; age-adjusted, p=0.01. Black patients were more likely to be female, younger, and with advanced stage and less likely to undergo cancer-directed surgery than whites, after adjustment by stage. On multivariable analysis, younger age and having surgery were associated with longer survival for both cohorts; female gender (HR 0.82 (0.77–0.88 and early stage at diagnosis (HR 0.83 (0.76–0.90 were predictive of longer survival in white, but not in black, patients. Conclusions. Surgery was associated with improved survival for both black and white MPM patients. However, black patients were less likely to undergo cancer-directed surgery. Increased surgical intervention in MPM black patients with early stage disease may improve their survival.

  6. 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.

  7. 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.

  8. Improvement in cognitive impairment after cataract surgery in elderly patients.

    Science.gov (United States)

    Tamura, Hiroki; Tsukamoto, Hidetoshi; Mukai, Satoshi; Kato, Tomoko; Minamoto, Atsushi; Ohno, Yuko; Yamashita, Hidetoshi; Mishima, Hiromu K

    2004-03-01

    To evaluate whether cognitive impairment improves in elderly patients who have cataract surgery with intraocular lens (IOL) implantation. Kouki Hospital, Yamaguchi, Japan. A prospective observational study evaluated patients' scores on the Revised Hasegawa Dementia Scale (HDS-R) and the HDS-R minus 1 item regarding immediate regeneration (ie, function of vision and memory). Twenty patients (6 men, 14 women) with cognitive impairment had cataract surgery in 1 eye between March 1996 and July 2001 at Kouki Hospital, Japan. The mean age of the patients was 81.8 years (range 61 to 90 years). Twenty patients (4 men, 16 women) with cognitive impairment who did not have cataract surgery were selected as a control. The mean age in the control group was 84.3 years (range 70 to 93 years). The HDS-R was administered twice between March 1996 and July 2001. The mean HDS-R scores in the cataract surgery group improved from 12.5 points +/- 5.3 (SD) preoperatively to 16.6 +/- 6.2 points postoperatively; the improvement was significant (t = -5.02; Pcognitive impairment improved in 12 patients (60%), was unchanged in 7 (35%), and was worse in 1 (5%). Cataract surgery improved cognitive impairment in elderly Japanese patients.

  9. 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.

  10. Evaluation of Patient Radiation Dose during Orthopedic Surgery

    International Nuclear Information System (INIS)

    Osman, H; Elzaki, A.; Sam, A.K.; Sulieman, A.

    2013-01-01

    The number of orthopedic procedures requiring the use of the fluoroscopic guidance has increased over the recent years. Consequently the patient exposed to un avoidable radiation doses. The aim of the current study was to evaluate patient radiation dose during these procedures.37 patients under went dynamic hip screw (DHS) and dynamic cannulated screw (DCS) were evaluated using calibrated Thermolumincent Dosimeters (TLDs), under carm fluoroscopic machines ,in three centers in Khartoum-Sudan. The mean Entrance Skin Dose (ESD) was 7.9 m Gy per procedure. The bone marrow and gonad organ exposed to significant doses. No correlation was found between ESD and Body Mass Index (BMI), or patient weight. Well correlation was found between kilo voltage applied and ESD. Orthopedic surgeries delivered lower radiation dose to patients than cardiac catheterization or hysterosalpingraphy (HSG) procedures. More study should be implemented to follow radiation dose before surgery and after surgery

  11. Physicians' attitudes about referring their type 2 diabetes patients for bariatric surgery.

    Science.gov (United States)

    Sarwer, David B; Ritter, Scott; Wadden, Thomas A; Spitzer, Jacqueline C; Vetter, Marion L; Moore, Reneé H

    2012-01-01

    Despite increasing evidence about the beneficial effects of bariatric surgery, little is known about physicians' attitudes toward it as a treatment of type 2 diabetes. Our objective was to investigate physicians' attitudes about referring patients with type 2 diabetes for bariatric surgery. Physicians were identified from the Pennsylvania Integrated Clinical and Administrative Research Database and other databases. Physicians at an academic medical center (n = 142) and community-based physicians (n = 197) in the Philadelphia area in specialties likely to treat type 2 diabetes were sent a survey about their perceptions of the safety and efficacy of bariatric surgery as a treatment for obesity and type 2 diabetes. Of the physicians, 93 returned the survey, for a combined response rate of 27.4%. Respondents reported having positive impressions of bariatric surgery as a treatment for obesity and type 2 diabetes (79.6% and 67.4%, respectively). Only 20.8% of respondents indicated that they would be likely to refer their patients with type 2 diabetes with a body mass index of 30-34.9 kg/m(2) to a randomized research trial of bariatric surgery. In general, physicians who treat patients with type 2 diabetes had favorable impressions about bariatric surgery as a treatment for obesity and type 2 diabetes. However, only a few were willing to refer their patients with type 2 diabetes and a body mass index of 30-34.9 kg/m(2) to randomized research trials of bariatric surgery. This reluctance to refer patients represents an important barrier to the successful completion of studies of the efficacy of bariatric surgery for those with type 2 diabetes and a body mass index Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  12. Depressive Symptoms in Bariatric Surgery Patients with Multiple Sclerosis.

    Science.gov (United States)

    Fisher, Carolyn J; Heinberg, Leslie J; Lapin, Brittany; Aminian, Ali; Sullivan, Amy B

    2018-04-01

    Bariatric surgery has been shown to be a safe and effective intervention for patients with comorbid obesity and multiple sclerosis (MS); however, this sub-population may be at heightened risk for pre- and postoperative depressive symptoms. This current exploratory study aims to describe the prevalence and nature of depressive symptoms in a sample of patients with MS who undergo bariatric surgery. Medical records were retrospectively reviewed to identify patients who received bariatric surgery and had a diagnosis of MS (n = 31) and a control sample of non-surgical MS patients with severe obesity (n = 828). Longitudinal outcome measures included the Patient Health Questionnaire-9 (PHQ-9) and Multiple Sclerosis Performance Scale (MSPS). There were no significant differences in PHQ-9 total and item scores between groups at baseline. PHQ-9 scores significantly improved at years 1 (p bariatric surgery when compared to non-surgical controls. Higher BMI (p = 0.03) and worse overall quality of life (p bariatric group. When compared to controls, the bariatric group demonstrated improved MSPS scores on a trend level 1 year post-surgery (p = 0.08). Consistent with the literature on more general bariatric surgery populations, current findings highlight the possible early benefits of bariatric surgery for reducing depressive symptoms in this population when compared to controls. Importantly, results should be viewed as preliminary and additional research is needed to examine bariatric surgery and associations with depressive symptoms and performance in the MS population.

  13. Permanent atrial fibrillation ablation surgery in patients with advanced age

    Directory of Open Access Journals (Sweden)

    Stephan Geidel

    2005-10-01

    Full Text Available Background: Even if permanent atrial fibrillation (pAF is a frequent concomitant problem in patients undergoing open heart surgery and particularly in those with advanced age, data of pAF ablation surgery in older aged patients are scarce. This study was performed to assess early and late results of combined open heart surgery and pAF ablation procedures in patients with advanced aged, compared to young patients. Material and Methods: A selective group of 126 patients (Group A: age ≥70 [76.4±4.8] years, n=70; Group B: age <70 [62.0±6.2] years: n=56 with pAF (≥6 months underwent either monopolar (Group A, B: n=51 vs. n=44 or bipolar (Group A, B: n=19 vs. n=12 radiofrequency (RF ablation procedures concomitant to open heart surgery. Regular follow-up was performed 3 to 36 months after surgery to assess survival, New York Heart Association (NYHA class and conversion rate to stable sinus rhythm (SR. Results: Early mortality (<30 days was 2.9% in Group A (Group B: 0%, cumulative survival at long-term follow up was 0.78 vs. 0.98 (p=0.03 and NYHA-class improved significantly in both groups, particularly in cases with stable SR. At 12-months follow-up 73% of Group A patients were in stable SR (Group B 78%. Conclusions: Concomitant mono- and bipolar RF ablation surgery represents a safe option to cure pAF during open heart surgery with a very low risk, even in patients with advanced age.

  14. Metabolic Bone Disease in the Bariatric Surgery Patient

    Directory of Open Access Journals (Sweden)

    Susan E. Williams

    2011-01-01

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

  15. Risk factors of systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position.

    Science.gov (United States)

    Tabei, Tadashi; Ito, Hiroki; Usui, Kimitsugu; Kuroda, Shinnosuke; Kawahara, Takashi; Terao, Hideyuki; Fujikawa, Atsushi; Makiyama, Kazuhide; Yao, Masahiro; Matsuzaki, Junichi

    2016-08-01

    To identify risk factors of developing systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position for renal stone treatment. We retrospectively analyzed 370 consecutive patients who underwent endoscopic combined intrarenal surgery procedures in the modified Valdivia position to treat renal stones. Antibiotic therapy based on preoperative urine cultures was administered to all patients from induction of anesthesia until at least postoperative day 3. Postoperative systemic inflammation response syndrome was diagnosed if the patient met two or more systemic inflammation response syndrome criteria. A multivariate logistic regression model with backward selection was used to evaluate the relationships between the incidence of systemic inflammation response syndrome after endoscopic combined intrarenal surgery and other clinical factors. Of the 370 patients, 61 patients (16.5%) were diagnosed with systemic inflammation response syndrome after endoscopic combined intrarenal surgery. Significant differences were found between the non-systemic inflammation response syndrome and systemic inflammation response syndrome groups with regard to female sex (29.8% vs 44.3%, P = 0.027), history of febrile urinary tract infection (16.5% vs 32.8%, P = 0.015) and number of involved calyces (2.68 vs 4.1, P systemic inflammation response syndrome: the number of involved calyces (P = 0.017), stone surface area (P = 0.021) and history of febrile urinary tract infection (P = 0.005). The number of involved calyces larger than four, stone surface area >500 mm(2) and a history of febrile urinary tract infection independently predicted the development of systemic inflammation response syndrome after endoscopic combined intrarenal surgery. This is the first study to identify the independent predictors of systemic inflammation response syndrome after endoscopic combined intrarenal surgery in the modified Valdivia position. © 2016 The

  16. Biochemical response and the effects of bariatric surgeries on type 2 diabetes

    Science.gov (United States)

    Allen, Roland; Hughes, Tyler; Lerd Ng, Jia; Ortiz, Roberto; Abou Ghantous, Michel; Bouhali, Othmane; Arredouani, Abdelilah

    2013-03-01

    A general method is introduced for calculating the biochemical response to pharmaceuticals, surgeries, or other medical interventions. This method is then applied in a simple model of the response to Roux-en-Y gastric bypass (RYGB) surgery in obese diabetic patients. We specifically address the amazing fact that glycemia correction is usually achieved immediately after RYGB surgery, long before there is any appreciable weight loss. Many studies indicate that this result is not due merely to caloric restriction, and it is usually attributed to an increase in glucagon-like peptide 1 (GLP-1) levels observed after the surgery. However, our model indicates that this mechanism alone is not sufficient to explain either the largest declines in glucose levels or the measured declines in the homeostatic model assessment insulin resistance (HOMA-IR). The most robust additional mechanism would be production of a factor which opens an insulin-independent pathway for glucose transport into cells, perhaps related to the well-established insulin-independent pathway associated with exercise. Potential candidates include bradykinin, a 9 amino acid peptide. If such a substance were found to exist, it would offer hope for medications which mimic the immediate beneficial effect of RYGB surgery. Supported by Qatar Biomedical Research Institute and Science Program at Texas A&M University at Qatar

  17. 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.

  18. Fasting abbreviation among patients submitted to oncologic surgery: systematic review

    OpenAIRE

    PINTO, Andressa dos Santos; GRIGOLETTI, Shana Souza; MARCADENTI, Aline

    2015-01-01

    INTRODUCTION: The abbreviation of perioperative fasting among candidates to elective surgery have been associated with shorter hospital stay and decreased postoperative complications. OBJECTIVE: To conduct a systematic review from randomized controlled trials to detect whether the abbreviation of fasting is beneficial to patients undergoing cancer surgery compared to traditional fasting protocols. METHOD: A literature search was performed in electronic databases: MEDLINE (PubMed), SciELO...

  19. Early Assessment of Delirium in Elderly Patients after Hip Surgery

    OpenAIRE

    Lee, Hyo Jin; Hwang, Deuk Soo; Wang, Seong Keun; Chee, Ik Seung; Baeg, Sengmi; Kim, Jeong Lan

    2011-01-01

    Objective This study is intended to identify predictive factors of delirium, including risk factors and prodromal symptoms. Methods This study included sixty-five patients aged 65 years or older who had undergone hip surgery. Baseline assessments included age; gender; admission type (acute/elective); reason for surgery (fracture/replacement); C-reactive protein (CRP); Acute Physiology, Age, Chronic Health Evaluation (APACHE III); and the Mini-Mental State Examination (MMSE). The Korean versio...

  20. Towards safer surgery in patients with sickle cell disease

    International Nuclear Information System (INIS)

    Meshikhes, Abdul-Wahed N.

    2007-01-01

    Surgery in patients with sickle cell disease (SCD) has been associated with high morbidity and mortality. In recent years, a marked improvement in the safety of surgery and anesthesia in this high-risk group of patients has been witnessed; owing to the improvements in surgical and anesthetic care, greater awareness of pathophysiology of disease, proper perioperative preparation and attention to factors predisposing to vasoocclusive crises. However, this is not paralleled by similar improvement in countries where the disease is not prevalent. Greater population mobility in recent years makes recognition of surgical manifestations of the disease and awareness of perioperative management of sickle cell patients undergoing surgical interventions of paramount importance. This article aims to summarize steps towards safer surgery in patients with SCD. (author)

  1. Anaesthesia for the patient with dementia undergoing outpatient surgery

    DEFF Research Database (Denmark)

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

    2009-01-01

    PURPOSE OF REVIEW: Dementia is common in elderly patients, and anaesthesiologists are increasingly challenged in managing these patients who are especially vulnerable. The aim of this article is to highlight some of the most important perioperative issues relating to demented patients, both...... with preexisting cognitive impairment and several preventive measurements can be provided. SUMMARY: Outpatient surgery for demented patients causes many concerns in relation to anaesthesia. Extensive drug-related problems may arise and restrictive drug usage is recommended to avoid serious complications....

  2. Psychological evaluation of patients scheduled for orthognathic surgery.

    OpenAIRE

    Barbosa, A. L.; Marcantonio, E.; Barbosa, C. E.; Gabrielli, M. F.; Gabrielli, M. A.

    1993-01-01

    Using a questionnaire, 41 patients scheduled for orthognathic surgery were evaluated pre- and postoperatively to determine some of their psychological characteristics and treatment outcome from the patient's standpoint. Among other conclusions, the results showed that some patients may not fully understand the details of their deformity, despite a full explanation by the orthodontist and surgeon. Expectations regarding treatment outcome may be unrealistic even in patients with valid self-moti...

  3. Role of nutrition in oral and maxillofacial surgery patients.

    Science.gov (United States)

    Giridhar, V Usha

    2016-01-01

    Diet, nutrition, and dental health are closely related and have multidirectional impacts. Any oral diseases, may it be congenital, infective, traumatic, inflammatory, or neoplastic, affect routine functions of the oral cavity and even after corrective surgeries done to improve may adversely affect the food and fluid intake and further compromises nutritional status. Unlike other general surgeries, the surgeries done in oral and maxillofacial region impairs normal food intake, especially by mouth which is the preferred commonly used route. This oral cavity being harbored by multiple organisms makes it prone to further infection which again hampers the healing. Oral surgeries include the dentoalveolar region for the treatment of fracture or prosthetic reasons, for maxillofacial trauma, orthognathic surgeries, tumors, cleft lip and palate correction, etc., Nutrition plays a major role in the postoperative recovery and healing. Malnutrition in the Oral and Maxillofacial Surgery (OMFS) patients increases the postoperative morbidity and mortality rate. Nutrition in jaw fractures treated with intermaxillary fixation is more compromised. Healing is impaired in malnourished, critically ill, elderly, and patients with prolonged stay in hospital and hence nutrition in the form of enteral, parenteral, and oral sip feeding plays a major role in providing nutritional care. Preoperative nutrition and perioperative nutrition influence the postoperative outcome and hence metabolic and nutritional care is important for the uneventful healing. This article provides a basic review of the role of nutrition in the postoperative outcome of OMFS patients based on the search through articles in journal and internet.

  4. 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.

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

    Directory of Open Access Journals (Sweden)

    M. Cerci

    2013-01-01

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

  6. The Challenges of Recruiting Patients into a Sham Surgery Trial

    DEFF Research Database (Denmark)

    Hare, Kristoffer Borbjerg; Lohmander, Stefan; Roos, Ewa M.

    meniscectomy or placebo surgery. Patients referred from general practitioners were screened. If eligible, oral and written information about the study including a 10 minute video was given to the patients and they were subsequently invited to participate. If willing they were referred to an MRI to confirm...

  7. The Patient Journey to Gastric Band Surgery: A Qualitative Exploration

    Science.gov (United States)

    Pulford, Amanda; Mahon, David; Ferguson, Yasmin; Lewis, Michael PN

    2013-01-01

    Aims This study explored the views and experiences of obese people preparing to undergo laparoscopic gastric banding (LAGB) leading up to the time of surgery. Background Weight loss surgery (WLS) is the most successful intervention available for the treatment of morbid obesity, and LAGB is among the most commonly used procedures in bariatric surgery. So far, the patient experience of deciding to undergo LAGB has been explored rarely and predominantly retrospectively. Design Semi-structured interviews took place with 23 patients about to undergo LAGB between June 2011 and March 2012. Data were analyzed using thematic analysis. Demographic and quality of life data situated the sample within the LAGB patient population. Results Three overarching themes were described. Participants were “living with obesity,” including the physical, social, and psychological challenges and consequences of being obese. These created in them a “desire to change,” expressed in multiple unsuccessful attempts to lose weight, and a quest for information, finally focusing on WLS. Eventually, “expectations toward LAGB” were formed, mainly to hand back a measure of control that enabled them to achieve, as well as ultimately to maintain, weight loss. This active process resulted in the patients' decision to undergo LAGB. When combined, these themes outline a distinct patient journey toward gastric banding. Conclusion Knowledge of the patient journey can inform both selection and care of patients awaiting gastric band surgery and is required by all health professionals working with this patient group. PMID:24761368

  8. [Patient volume and quality in surgery for abdominal aortic aneurysm].

    Science.gov (United States)

    Austvoll-Dahlgren, Astrid; Underland, Vigdis; Straumann, Gyri Hval; Forsetlund, Louise

    2017-04-01

    BACKGROUND Patient volume is assumed to affect quality, whereby complex procedures are best performed by those who perform them frequently. We have conducted a systematic review of the research on the association between patient volume and quality of vascular surgery. In this article we describe the outcomes for abdominal aortic aneurysm surgery.MATERIAL AND METHOD We undertook systematic searches in relevant databases. We searched for systematic reviews, and randomised and observational studies. The search was concluded in December 2015. We have summarised the results descriptively and assessed the overall quality of the evidence.RESULTS Forty-six observational studies fulfilled our inclusion criteria. We found a possible association for both hospital and surgeon volume. Higher patient volume may possibly be associated with lower 30-day mortality and lower hospital mortality for both open and endovascular surgery. Although the association appears to apply to both elective and acute hospitalisations, there is greater uncertainty with regard to the most ill patients. For hospital volume there may also be fewer complications for open and endovascular surgery, as well as for all surgery assessed as a whole. We considered the evidence base to be medium to very low quality.INTERPRETATION We found a possible correlation between patient volume and quality indicators such as mortality and complications. It may be advantageous to allocate planned procedures to institutions and surgeons with high volume, while this is less certain with regard to acute hospitalisations.

  9. General surgery training without laparoscopic surgery fellows: the impact on residents and patients.

    Science.gov (United States)

    Linn, John G; Hungness, Eric S; Clark, Sara; Nagle, Alexander P; Wang, Edward; Soper, Nathaniel J

    2011-10-01

    To evaluate resident case volume after discontinuation of a laparoscopic surgery fellowship, and to examine disparities in patient care over the same time period. Resident case logs were compared for a 2-year period before and 1 year after discontinuing the fellowship, using a 2-sample t test. Databases for bariatric and esophageal surgery were reviewed to compare operative time, length of stay (LOS), and complication rate by resident or fellow over the same time period using a 2-sample t test. Increases were seen in senior resident advanced laparoscopic (Mean Fellow Year = 21 operations vs Non Fellow Year = 61, P surgery. Operative time for complex operations may increase in the absence of a fellow. Other patient outcomes are not affected by this change. Copyright © 2011 Mosby, Inc. All rights reserved.

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

    Science.gov (United States)

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

    2014-01-01

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

  11. Enhanced recovery after surgery program in patients from Tibet Plateau undergoing surgeries for hepatic alveolar echinococcosis.

    Science.gov (United States)

    Yang, Mengchang; Su, Wenjie; Deng, Xiaofan; Deng, Jia; Li, Peng; Li, Xiangkui

    2017-11-01

    Hepatic alveolar echinococcosis (HAE) is a severe and common parasitic disease in Tibetan Plateau of China. The infected patients have to move to plain areas to receive treatments due to the poor medical conditions in plateau areas. Our aim was to investigate the application of Enhanced Recovery after Surgery (ERAS) program in perioperative management for HAE patients from Tibet Plateau and the notes for patients with landform changes. A total of 89 HAE patients from Tibet Plateau (altitude: average of 4500 m) prior received adaptive treatments at the cooperative hospital (altitude: 1500-2000 m) and accepted surgery at plain regions (altitude: 200-400 m). The patients in ERAS group received ERAS program care and patients in conventional management group received conventional care during perioperative period. Patients in ERAS group displayed significant shorter hospital stay and shorter time for recovery of gurgling compared with conventional management group (ERAS group versus conventional management group: 10.48 ± 3.525 d versus 20.29 ± 8.632 d; 1.56 ± 1.236 d versus 2.8 ± 1.19 d; all P Tibet Plateau need to receive adaptive treatments for landform changes before receiving surgeries at plain regions. ERAS program is effective and safe for Tibetan HAE patients during perioperative period. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Computers in the surgery. The patient's view.

    Science.gov (United States)

    Pringle, M; Robins, S; Brown, G

    1984-01-01

    A postal survey sent to 350 patients from two rural practices confirmed that an appreciable minority of patients (17%) were opposed to doctors using computers. The questionnaire distributed had been carefully designed to identify their opposition more specifically. Most of the general concern was accounted for by the 91 patients (31%) who feared that confidentiality of information would be reduced. The sensitive nature of medical information alerts patients to the possibility of diminished security of records and obliges practices considering acquiring a computer to ensure that these fears are not realised. Smaller proportions of patients were found to oppose computers on other grounds--namely, impersonality, economy, and general anxiety. PMID:6419902

  13. 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.

  14. Phacoemulsification versus small incision cataract surgery in patients with uveitis

    Directory of Open Access Journals (Sweden)

    Rahul Bhargava

    2015-10-01

    was 20/60 or better in 60 (90.9% patients in Phaco group and 53 (88.3% in the manual SICS group (P=0.478. The mean surgical time was significantly shorter in the manual SICS group (10.8±2.9 versus 13.2±2.6min (P<0.001. Oral prednisolone, 1 mg/kg body weight was given 7d prior to surgery, continued post-operatively and tapered according to the inflammatory response over 4-6wk in patients with previously documented macular edema, recurrent uveitis, chronic anterior uveitis and intermediate uveitis. Rate of complications like macular edema (Chi-square, P=0.459, persistent uveitis (Chi-square, P=0.289 and posterior capsule opacification (Chi-square, P=0.474 were comparable between both the groups.CONCLUSION:ManualSICS and phacoemulsification do not differ significantly in complication rates and final CDVA outcomes. However, manual SICS is significantly faster. It may be the preferred technique in settings where surgical volume is high and access to phacoemulsification is limited, such as in eye camps. It may also be the appropriate technique for uveitic cataract under such circumstances.

  15. Functional intravascular volume deficit in patients before surgery

    DEFF Research Database (Denmark)

    Bundgaard-Nielsen, M; Jørgensen, C C; Secher, N H

    2010-01-01

    limited data on the volume required to establish a maximal SV before the start of surgery. Therefore, we estimated the occurrence and size of the potential functional intravascular volume deficit in surgical patients. METHODS: Patients scheduled for mastectomy (n=20), open radical prostatectomy (n=20......BACKGROUND: Stroke volume (SV) maximization with a colloid infusion, referred to as individualized goal-directed therapy, improves outcome in high-risk surgery. The fraction of patients who need intravascular volume to establish a maximal SV has, however, not been evaluated, and there are only...... deficit. RESULTS: Forty-two (70%) of the patients needed volume to establish a maximal SV. For the patients needing volume, the required amount was median 200 ml (range 200-600 ml), with no significant difference between the three groups of patients. The required volume was >or=400 ml in nine patients (15...

  16. Outcome of colonic surgery in elderly patients with colon cancer.

    Science.gov (United States)

    Hermans, E; van Schaik, P M; Prins, H A; Ernst, M F; Dautzenberg, P J L; Bosscha, K

    2010-01-01

    Introduction. Colonic cancer is one of the most commonly diagnosed malignancies and most often occurs in patients aged 65 years or older. Aim. To evaluate the outcome of colonic surgery in the elderly in our hospital and to compare five-year survival rates between the younger and elderly patients. Methods. 207 consecutive patients underwent surgery for colon cancer. Patients were separated in patients younger than 75 and older than 75 years. Results. Elderly patients presented significantly more (P younger group was 62% compared with 36% in the elderly (P younger patients compared with 32% in the elderly (P < .05). Conclusion. Curative resection of colonic carcinoma in the elderly is well tolerated and age alone should not be an indication for less aggressive therapy. However, the type and number of co-morbidities influence post-operative mortality and morbidity.

  17. Psychopathology symptoms in a sample of female cosmetic surgery patients.

    Science.gov (United States)

    Mulkens, Sandra; Bos, Arjan E R; Uleman, Richard; Muris, Peter; Mayer, Birgit; Velthuis, Peter

    2012-03-01

    During the past decades, cosmetic surgery has become increasingly popular. People with certain psychopathology disorders, for example, body dysmorphic disorder (BDD), are dissatisfied with their physical appearance, and a significant number try to receive cosmetic medical treatment for their complaints. It seems relatively easy for them to receive this type of surgery, despite the fact that it has no or even adverse effects on the symptoms. The present study aimed to investigate the psychological condition and especially the presence of psychopathological symptoms such as BDD in cosmetic surgery patients. Questionnaires about body image dissatisfaction, symptoms of BDD and psychopathology in general and satisfaction about surgery were sent to patients who had been treated in a large cosmetic surgery clinic. Of the patients who replied, 86% were pleased with the outcome of the cosmetic procedure. Further, 21-59% of these former patients scored higher on questionnaires of body image dissatisfaction and psychopathological symptoms than a norm group from the general population. When differentiating the group on the basis of BDD symptomatology, it appeared that the high BDD symptomatic group displayed significantly worse outcome on all measurements. That is, high BDD symptomatic patients were more dissatisfied about the result of surgery, exhibited higher levels of psychopathology, and had lower self-esteem than the low symptomatic BDD patients. These findings clearly suggest that the evaluation of the psychological condition and motivation of the candidate patient might be a valuable addition to the standard procedure in cosmetic medical treatment settings. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Effect of surgery and/or radiotherapy on the cellular immune status in cancer patients

    International Nuclear Information System (INIS)

    Garg, K.K.; Sareen, P.M.; Sodhi, J.; Lodha, S.K.; Singh, H.P.; Kalra, V.B.; Singh, M.P.

    1984-01-01

    Assessment of cellular immune status, as measured by E-rosette forming T-lymphocyctes, was done in 10 healthy controls and 30 cancer patients during and after therapy. Cancer patients were divided into 3 groups treated by different modalities, viz. surgery alone (group I), radio-therapy alone (group II) and combination therapy (group III). Pre-treatment T-lymphocyte number and percentage were significantly lower in cancer patients in comparison to the healthy controls. Group II and III patients revealed progressive impairment of cellular immune status till completion of therapy while in group I patients, the depression of cellular immune response was transient-recovering within one week. Thus, surgery alone produces less marked impairment of cellular immune response- a valuable defence mechanism, than radio-therapy/ combination therapy. (author)

  19. Physician Empathy as a Driver of Hand Surgery Patient Satisfaction.

    Science.gov (United States)

    Menendez, Mariano E; Chen, Neal C; Mudgal, Chaitanya S; Jupiter, Jesse B; Ring, David

    2015-09-01

    To examine the relationship between patient-rated physician empathy and patient satisfaction after a single new hand surgery office visit. Directly after the office visit, 112 consecutive new patients rated their overall satisfaction with the provider and completed the Consultation and Relational Empathy Measure, the Newest Vital Sign health literacy test, a sociodemographic survey, and 3 Patient-Reported Outcomes Measurement Information System-based questionnaires: Pain Interference, Upper-Extremity Function, and Depression. We also measured the waiting time in the office to see the physician, the duration of the visit, and the time from booking until appointment. Multivariable logistic and linear regression models were used to identify factors independently associated with patient satisfaction. Patient-rated physician empathy correlated strongly with the degree of overall satisfaction with the provider. After controlling for confounding effects, greater empathy was independently associated with patient satisfaction, and it alone accounted for 65% of the variation in satisfaction scores. Older patient age was also associated with satisfaction. There were no differences between satisfied and dissatisfied patients with regard to waiting time in the office, duration of the appointment, time from booking until appointment, and health literacy. Physician empathy was the strongest driver of patient satisfaction in the hand surgery office setting. As patient satisfaction plays a growing role in reimbursement, targeted educational programs to enhance empathic communication skills in hand surgeons merit consideration. Prognostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  20. Psychiatric conditions in cosmetic surgery patients.

    Science.gov (United States)

    Ritvo, Eva C; Melnick, Ilan; Marcus, Gina R; Glick, Ira D

    2006-08-01

    Beauty is important. As psychiatrists, we see the interface of beauty with mental health, self-esteem, and mental illness. As physicians who enhance cosmetic appearance, you encounter a broad spectrum of patients ranging from those with a healthy pursuit of enhanced appearance to those whose behavior is extremely maladaptive. This article provides some examples of unhealthy pursuit and how to recognize patients who may be inappropriate for cosmetic procedures. Patients with body dysmorphic disorder and narcissistic and histrionic personality disorders are suffering from psychiatric illnesses that interfere with their judgment and can lead them to make poor choices when considering cosmetic procedures. Clinicians who acquire a basic understanding of these psychiatric conditions can properly screen their patients and enhance their understanding of their patients' goals, both realistic and unrealistic, thus saving them from performing inappropriate procedures that cause frustration to both the clinician and the patient.

  1. [Management of the post-bariatric surgery patient].

    Science.gov (United States)

    Frey, Daniel M

    2012-01-01

    Worldwide the obesity epidemic is becoming one of the leading causes of mortality and morbidity. The rates of bariatric surgery procedures are sharply increasing. Today it is the only treatment option for a substantial and durable long-term weight loss. However, bariatric surgery is not a guarantee of successful weight loss and maintenance. For all patients undergoing bariatric surgery, education and clinical management to prevent and detect nutritional deficiencies are recommended. Particularly for patients undergoing malabsorptive procedures, the management of potential nutritional deficiencies is important. Strategies should be employed to compensate for food intolerance aiming at risk reduction for nutritional deficiencies. All patients should receive care from a multidisciplinary team and be considered for comprehensive perioperative program for nutrition and lifestyle management.

  2. [Treatment of anemia in patients undergoing bariatric surgery].

    Science.gov (United States)

    Basora Macaya, M

    2015-06-01

    Iron deficiency in patients with morbid obesity can occur before bariatric surgery due to its inflammatory component and after surgery as the result of implementing the malabsorptive techniques. For patients with morbid obesity, micronutrient deficiencies, such as vitamin B12, iron and folate, should be suspected. Iron deficiency and other hematinics should be corrected, even when anemia has not been established. Normal ferritin levels do not allow us to rule out a possible iron deficiency, given that ferritin can increase due to the chronic inflammatory condition of obesity. After bariatric surgery, patients should take iron supplements; however, these supplements are frequently poorly tolerated. Rapid and effective correction of hemoglobin levels might require the intravenous administration of iron preparations. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. Advances in minimally invasive surgery in pediatric patients.

    Science.gov (United States)

    Jackson, Hope T; Kane, Timothy D

    2014-08-01

    Surgery has changed dramatically over the last several decades. The emergence of MIS has allowed pediatric surgeons to manage critically ill neonates, children, and adolescents with improved outcomes in pain, postoperative course, cosmesis, and return to normal activity. Procedures that were once thought to be too difficult to attempt or even contraindicated in pediatric patients in many instances are now the standard of care. New and emerging techniques, such as single-incision laparoscopy, endoscopy-assisted surgery, robotic surgery, and techniques yet to be developed, all hold and reveal the potential for even further advancement in the management of these patients. The future of MIS in pediatrics is exciting; as long as our primary focus remains centered on developing techniques that limit morbidity and maximize positive outcomes for young patients and their families, the possibilities are both promising and infinite.

  4. 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....

  5. Patients' experiences with at-home preoperative skin disinfection before elective hip replacement surgery.

    Science.gov (United States)

    Qvistgaard, Maria; Almerud Österberg, Sofia; Heikkilä, Kristiina; Thorén, Ann-Britt; Lovebo, Jenny

    2017-07-01

    The aim of the study was to describe patients' experiences with preoperative skin disinfection carried out in their home before elective hip replacement surgery with the aim of lowering the microbial burden and avoiding surgical site infections. The literature was reviewed for relevant studies. Optimal preparations before surgery depend on patients being able to assimilate preoperative information and instructions. The study was based on 14 interviews with patients who had undergone elective hip replacement surgery. Data were analysed with qualitative manifest content analysis according to Graneheim and Lundman (2004). The main categories of findings were: patients' experience of obstacles and limitations, the importance of supportive surroundings, and personal resources as strength when performing preoperative skin disinfection. The findings of this study agree with earlier studies showing a lack of compliance to preoperative skin disinfection. The findings also suggest reasons for non-compliance. Preoperative skin disinfection involves many important steps that need to be accomplished to ensure the maximum effect on microbial burden on skin surface. These steps can be difficult for some patient groups. Perioperative dialogue is one way to identify patients' individual needs and to help patients participate in the process. The study concludes that patients who carried out skin disinfection at home before surgery have a great responsibility to prepare themselves. The challenge for perioperative nurses who work with preoperative information is to identify and individually guide those patients who need extended support so that all patients with elective hip replacement surgery receive the same quality of care. Further research should focus on how caregivers discover individuals with extended needs and on identifying the kind of support that is effective to achieve optimal conditions for hip replacement surgery. Copyright the Association for Perioperative Practice.

  6. Long-term pharmacotherapy considerations in the bariatric surgery patient.

    Science.gov (United States)

    Bland, Christopher M; Quidley, April Miller; Love, Bryan L; Yeager, Catherine; McMichael, Bliss; Bookstaver, P Brandon

    2016-08-15

    Pharmacists' role in optimizing long-term pharmacotherapy for bariatric surgery patients is detailed. Bariatric surgery patients provide a difficult challenge in terms of many pharmacotherapy issues, especially in the chronic care setting, where data on long-term effects of bariatric surgery are limited. The most common procedures are Roux-en-Y gastric bypass (RYGB), adjustable gastric banding, and sleeve gastrectomy. Sleeve gastrectomy has become the most common procedure in the United States, primarily because it has less overall chronic malabsorption effects than RYGB. Pharmacotherapy management is complicated by rapid weight loss combined with a number of pharmacokinetic changes, such as decreased absorption of some medications due to altered gastrointestinal tract anatomy and potentially increased concentrations of some medications due to a decreased volume of distribution resulting from weight loss. Nutritional and metabolic supplementation are of the utmost importance in order to limit deficiencies that can lead to a number of conditions. Many chronic diseases, including hypertension, diabetes, gastroesophageal reflux disease, and urinary incontinence, are improved by bariatric surgery but require close monitoring to ensure the effectiveness of maintenance pharmacotherapy and avoidance of adverse effects. Psychotropic medication management is also an important pharmacotherapy concern, as evidenced by antidepressants being the most commonly used medication class among preoperative bariatric surgery patients. Pharmacists have an increasing role in the chronic management of the bariatric surgery patient due to their knowledge of medication dosage forms and expertise in disease states affected by bariatric surgery. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  7. Travel patterns of cancer surgery patients in a regionalized system.

    Science.gov (United States)

    Smith, Andrew K; Shara, Nawar M; Zeymo, Alexander; Harris, Katherine; Estes, Randy; Johnson, Lynt B; Al-Refaie, Waddah B

    2015-11-01

    Regionalization of complex surgeries has increased patient travel distances possibly leaving a substantial burden on those at risk for poorer surgical outcomes. To date, little is known about travel patterns of cancer surgery patients in regionalized settings. To inform this issue, we sought to assess travel patterns of those undergoing a major cancer surgery within a regionalized system. We identified 4733 patients who underwent lung, esophageal, gastric, liver, pancreatic, and colorectal resections from 2002-2014 within a multihospital system in the Mid-Atlantic region of the United States. Patient age, race and/or ethnicity, and insurance status were extracted from electronic health records. We used Geographical Information System capabilities in R software to estimate travel distance and map patient addresses based on cancer surgery type and these characteristics. We used visual inspection, analysis of variance, and interaction analyses to assess the distribution of travel distances between patient populations. A total of 48.2% of patients were non-white, 49.9% were aged >65 y, and 54.9% had private insurance. Increased travel distance was associated with decreasing age and those undergoing pancreatic and esophageal resections. Also, black patients tend to travel shorter distances than other racial and/or ethnic groups. These maps offer a preliminary understanding into variations of geospatial travel patterns among patients receiving major cancer surgery in a Mid-Atlantic regionalized setting. Future research should focus on the impact of regionalization on timely delivery of surgical care and other quality metrics. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Geriatric patient profile in the cardiovascular surgery intensive care unit

    International Nuclear Information System (INIS)

    Korha, E.A.; Hakverdioglu, G.; Ozlem, M.; Yurekli, I.; Gurbuz, A.; Alp, N.A

    2013-01-01

    Objectives: To determine hospitalization durations and mortalities of elderly in the Cardiovascular Surgery Intensive Care Unit. Methods: The retrospective study was conducted in a Cardiovascular Surgery Intensive Care Unit in Turkey and comprised patient records from January 1 to December 31, 2011. Computerized epicrisis reports of 255, who had undergone a cardiac surgery were collected. The patients were grouped according to their ages, Group I aged 65-74 and Group II aged 75 and older. European society for Cardiac Operative Risk Evaluation scores of the two groups were compared using SPSS 17. Results: Overall, there were 80 (31.37%) females and 175 (68.62%) males. There were 138 (54.1%) patients in Group I and 117 (45.9%) in Group II. Regarding their hospitalization reasons, it was determined that 70 (27.5%) patients in Group I and 79 (30.9%) patients in Group II were treated with the diagnosis of coronary artery disease. The average hospitalization duration of patients in the intensive care unit was determined to be 11.57+-10.40 days. Regarding the EuroSCORE score intervals of patients, 132 (51.8%)had 3-5 and 225 (88.2%) patients were transferred to the Cardiovascular Surgery and then all of them were discharged; 5 (4.1%) had a mortal course; and 11 (7.7%) were transferred to the anaesthesia intensive care unit Conclusions: The general mortality rates are very low in the Cardiovascular Surgery Intensive Care Unit and the patients have a good prognosis. (author)

  9. Intraocular surgery in a large diabetes patient population

    DEFF Research Database (Denmark)

    Ostri, Christoffer

    2014-01-01

    The prevalence of diabetes is on the increase in developed countries. Accordingly, the prevention and treatment of vision-threatening diabetic eye complications is assuming greater importance. The overall aim of this thesis is to analyse risk factors for intraocular surgery in a large diabetes...... 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...... and prognostic factors after cataract surgery in diabetes patients (Study III) and (4) analyse risk factors for diabetic papillopathy with emphasis on metabolic control variability (Study IV). All studies are based on a close-to-complete national surgery register and a large, closely followed diabetic...

  10. 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

    2018-02-01

    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.

  11. Thyroid and parathyroid surgery performed with patient under regional anesthesia.

    Science.gov (United States)

    Saxe, A W; Brown, E; Hamburger, S W

    1988-04-01

    Thyroid and parathyroid surgery is usually performed with the patient under general anesthesia; however, for selected patients regional anesthesia may be preferable. Between September 1977 and March 1986 regional anesthesia was used successfully as the sole anesthetic technique in 17 patients who underwent thyroid surgery and two patients who underwent parathyroid surgery. Procedures included two total thyroidectomies, 14 lobectomies or lobectomies with isthmusectomies, and one isthmusectomy. These 17 operations represent approximately 5% of the thyroid operations performed by the senior surgeon over the corresponding time. One patient underwent combined completion thyroidectomy and parathyroidectomy, and another patient underwent successful parathyroidectomy under regional anesthesia. In two additional patients, procedures could not be completed under regional anesthesia alone. In one of these two patients regional anesthesia appeared to effect a transient recurrent nerve paralysis. The indications for use of regional anesthesia have been primarily patient preference and associated cardiac or pulmonary disease. We now consider as contraindications to regional anesthesia patient apprehension about the technique, deafness, high spinal cord injury, recurrent laryngeal or phrenic nerve palsy, and allergy to local anesthesia. During this period, from 1977 to 1986, our administration of regional anesthesia has evolved from bilateral deep and superficial cervical plexus blocks to bilateral superficial blocks alone using bupivacaine with epinephrine, 1:200,000.

  12. Patients Undergoing Dacryocystorhinostomy Surgery in Northern ...

    African Journals Online (AJOL)

    Department of Nursing and. Midwifery ... Bu Ali Hospital, 1Departments of Medicine and 2Nursing, Mazandaran University of Medical Science, Sari, Iran. Abstract .... Fifty percent 20/40 of patients were living in rural and the rest in urban areas. In terms of jobs. 12.5% (5/40) were farmer, 79.5% (29/40) patient's housewives.

  13. 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

  14. PROFILE OF PATIENTS WHO SEEK THE BARIATRIC SURGERY.

    Science.gov (United States)

    da Silva, Paola Turchiello; Patias, Luciana Dapieve; Alvarez, Glauco da Costa; Kirsten, Vanessa Ramos; Colpo, Elisângela; de Moraes, Cristina Machado Bragança

    2015-01-01

    Nowadays obesity is a chronic disease considered one of the greatest problems in public healthy. Showing to be effective in a short and long term, the bariatric surgery has emerged as an optional treatment for morbid obesity. Identify the profile of patients seeking bariatric surgery. Were interviewed 100 patients in preoperative nutritional monitoring of bariatric surgery. The study was conducted by applying a questionnaire prepared according to the research objectives. From the individuals that were seeking bariatric surgery, 78% were female, 62% were married and 69% reported physical activity. The average age of those surveyed was 37±10.83 years and mean body mass index (BMI) was 43.51± 6.25 kg/m². The comorbidity more prevalent in this group was high blood pressure (51%). In previous treatments for weight reduction, 92% have already done hypocaloric diet followed by anorectic drug (83%). The success of these treatments was reported by 92% of patients; however, the weight lost was recovered in less than one year of 75%. Patients with diabetes mellitus and dyslipidemia had higher BMI values. The patients with comorbidities showed lower levels of BMI. The profile of patients who sought surgical treatment for their obesity were predominantly women with a family background of obesity and obesity-related comorbidities, especially hypertension and diabetes mellitus.

  15. 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

  16. Factors affecting patients undergoing cosmetic surgery in bushehr, southern iran.

    Science.gov (United States)

    Salehahmadi, Zeinab; Rafie, Seyyed Reza

    2012-07-01

    Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr, Southern Iran and Pars Clinic, Iran were enrolled by a simple random sampling method. They all completed a questionnaire to consider reasons for cosmetic procedures. The collected data were statistically analyzed. Demographical, sociological and psychological factors such as age, gender, educational level, marital status, media, perceived risks, output quality, depression and self-improvement were determined as factors affecting tendency of individuals to undergo cosmetic surgery in this region. Trend to undergo cosmetic surgery was more prevalent in educational below bachelor degree, married subjects, women population of 30-45 years age group. Education level, age, marital status and gender were respectively the influential factors in deciding to undergo cosmetic surgery. Among the socio-psychological factors, self-improvement, finding a better job opportunity, rivalry, media, health status as well as depression were the most persuasive factors to encourage people to undergo cosmetic surgery too. Cost risk was not important for our samples in decision making to undergo cosmetic surgery. We need to fully understand the way in which the combination of demographic, social and psychological factors influence decision-making to undergo cosmetic surgery.

  17. Patient-Reported Outcomes in Foot and Ankle Surgery.

    Science.gov (United States)

    Hunt, Kenneth J; Lakey, Eric

    2018-04-01

    Patient-reported outcomes (PROs) are a measure of health care quality that empower patients to share their health care perceptions with their providers. In orthopedic foot and ankle surgery, these measures can range from global assessments of pain or satisfaction to complex questionnaires designed to assess the function of specific anatomic regions or the recovery from specific procedures. This article seeks to characterize the use of PROs in foot and ankle surgery, describe some of the most commonly used measures, discuss implementation in everyday clinical practice, and explore the future of PROs in foot and ankle orthopedics. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Negative pressure pulmonary edema in healthy cosmetic surgery patients.

    Science.gov (United States)

    Dieu, Tam; Upjohn, Edward

    2003-01-01

    Anesthetic complications are uncommon in young and healthy patients undergoing cosmetic surgery. We report 2 cases of negative pressure pulmonary edema (NPPE) in young patients, 1 who underwent rhinoplasty and another who underwent augmentation mammaplasty and suction-assisted lipoplasty of the thighs and buttocks This rare and potentially fatal complication requires admission to an intensive-care unit and delayed discharge. Although cases of NPPE have been reported in the medical and anesthetic literature, NPPE in plastic surgery has never been reported previously.

  19. Vitamin D deficiency in preoperative bariatric surgery patients.

    Science.gov (United States)

    Gemmel, Kelly; Santry, Heena P; Prachand, Vivek N; Alverdy, John C

    2009-01-01

    Obese patients are at risk of hypovitaminosis D. This is particularly concerning for those considering bariatric surgery because of the risk of postoperative nutritional deficiency. We hypothesized that it is necessary to screen for vitamin D deficiency preoperatively and conducted a study to identify the patterns of vitamin D deficiency among prospective bariatric surgery patients. A retrospective analysis of available preoperative laboratory values was conducted for all consecutive patients (n = 312) scheduled to undergo bariatric surgery from January 2004 to October 2006. Of the 312 patients, 179 (57.4%) were deficient in vitamin D preoperatively (25-hydroxyvitamin D deficient; of the 156 white patients evaluated, 57 (36.5%) were vitamin D deficient; and of the 14 Hispanic patients evaluated, 11 (78.6%) were vitamin D deficient. We also evaluated serum red blood cell folate, vitamin B(12), and free retinol vitamin A levels preoperatively. Of the 312 patients, 39 (12.5%) were vitamin A deficient and 11 (3.5%) were vitamin B(12) deficient. No patient had a red blood cell folate deficiency. Patients with hypovitaminosis D were also checked for secondary hyperparathyroidism; 42 patients (23.5%) fit the criteria (parathyroid hormone levels >75 pg/mL). Many patients with low vitamin D levels were being considered for the duodenal switch procedure. The results of our study have shown that prospective bariatric surgery patients, particularly candidates for highly malabsorptive procedures, should be screened for hypovitaminosis D preoperatively. Our findings also showed that blacks are particularly at risk of vitamin D deficiency.

  20. Long-term Management of Patients After Weight Loss Surgery

    OpenAIRE

    Richardson, William S.; Plaisance, Amber M.; Periou, Laura; Buquoi, Jennifer; Tillery, Deanna

    2009-01-01

    Bariatric surgery is becoming very common, and most physicians will have contact with bariatric patients. Many aspects to follow-up are not generally known. The objective of this article is to help other physicians understand what follow-up entails to assist them with the care of these patients. It is expected that patients are followed up by the bariatric team for a lifetime, as care is complicated and lifetime follow-up is the key to long-term success.

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

    OpenAIRE

    Johnson Stoklossa, Carlene; Atwal, Suneet

    2013-01-01

    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 ...

  2. Informed consent in clinical practice: patients' experiences and perspectives following surgery.

    Science.gov (United States)

    Ochieng, Joseph; Buwembo, William; Munabi, Ian; Ibingira, Charles; Kiryowa, Haruna; Nzarubara, Gabriel; Mwaka, Erisa

    2015-12-09

    Informed consent during medical practice is an essential component of comprehensive medical care and is a requirement that should be sought all the time the doctor interacts with the patients, though very challenging when it comes to implementation. Since the magnitude and frequency of surgery related risk are higher in a resource limited setting, informed consent for surgery in such settings should be more comprehensive. This study set out to evaluate patients' experiences and perspectives of informed consent for surgery. This was a survey of post-operative patients at three university teaching hospitals in Uganda. The participants were interviewed using guided, semi-structured questionnaires. Patients from different surgical disciplines participated in the study. A total of 371 patients participated in the study. Eighty percent of the participants reported having been given explanations on the indication for their surgery, 56.1 % had all their questions answered before the operation, 17 % did not know the type of operation they had undergone and another 17 % did not give their consent for the operation. Additionally, more than 81 % of the participants reported giving their own permission for surgery, although only 23.7 % were able to identify the person who obtained consent from them and 22.4 % knew the names of the surgeons who conducted the surgical procedure on them. About 20 % of the participants were not satisfied with the information provided by both the doctor before and after the operation. However, there were varying responses on when doctors should explain to patients with the majority saying it should be done before treatment or surgery, while others thought it should be done on admission, others proposed that it be made immediately after the examination among other responses. On what should be done to improve communication between doctors and patients, a number of suggestions, including the need for a detailed explanation for the patient by the doctor

  3. Perioperative and Long-Term Smoking Behaviors in Cosmetic Surgery Patients.

    Science.gov (United States)

    Van Slyke, Aaron C; Carr, Michael; Knox, Aaron D C; Genoway, Krista; Carr, Nicholas J

    2017-09-01

    Many plastic surgeons advocate smoking cessation before patients undergo cosmetic surgery with extensive soft-tissue dissection. Smoking cessation rates after cosmetic surgery are unknown. The preoperative consultation may be an opportunity to promote long-term smoking cessation. This is a retrospective, cross-sectional cohort study. All patients over an 8-year study period who smoked before their preoperative consultation; who quit 2 weeks before surgery; and who subsequently underwent rhytidectomy, abdominoplasty, or mastopexy were included. Patients were asked to complete a Web-based survey at long-term follow-up. Eighty-five smokers were included, and 47 patients completed the survey, for a response rate of 55.3 percent. Average follow-up was 63.3 months. Five respondents were social smokers and thus excluded. Of the 42 daily smokers, 17 patients (40.5 percent) were no longer smoking cigarettes on a daily basis at long-term follow-up. Of these 17 patients, 10 (23.8 percent) had not smoked since their operation. A total of 24 patients (57.1 percent) had reduced their cigarette consumption by any amount, and 70.8 percent (17 of 24) of these patients agreed that discussing adverse surgical outcomes related to smoking influenced their ability to quit/reduce. Twenty-one of 42 patients (50.0 percent) admitted that they were not compliant with the preoperative smoking cessation instructions. This is the first report to investigate long-term smoking cessation from a cosmetic surgery practice. The authors have shown a positive association between smoking cessation and cosmetic surgery. Requesting a period of cessation before cosmetic surgery may promote long-lasting smoking cessation.

  4. Patient-perceived surgical indication influences patient expectations of surgery for degenerative spinal disease.

    Science.gov (United States)

    Wilson, Thomas J; Franz, Eric; Vollmer, Carolyn F; Chang, Kate W-C; Upadhyaya, Cheerag; Park, Paul; Yang, Lynda J-S

    2017-06-01

    Patients frequently have misconceptions regarding diagnosis, surgical indication, and expected outcome following spinal surgery for degenerative spinal disease. In this study, we sought to understand the relationship between patient-perceived surgical indications and patient expectations. We hypothesized that patients reporting appendicular symptoms as a primary surgical indication would report a higher rate of having expectations met by surgery compared to those patients reporting axial symptoms as a primary indication. Questionnaires were administered to patients who had undergone surgery for degenerative spinal disease at 2 tertiary care institutions. Questions assessed perception of the primary indication for undergoing surgery (radicular versus axial), whether the primary symptom improved after surgery, and whether patient expectations were met with surgery. Outcomes of interest included patient-reported symptomatic improvement following surgery and expectations met by surgery. Various factors were assessed for their relationship to these outcomes of interest. There were 151 unique survey respondents. Respondents were nearly split between having a patient-perceived indication for surgery as appendicular symptoms (55.6%) and axial symptoms (44.4%). Patient-perceived surgical indication being appendicular symptoms was the only factor predictive of patient-reported symptomatic improvement in our logistic regression model (OR 2.614; 95% CI 1.218-5.611). Patient-perceived surgical indication being appendicular symptoms (OR 3.300; 95% CI 1.575-6.944) and patient-reported symptomatic improvement (OR 33.297; 95% CI 12.186-90.979) were predictive of patients reporting their expectations met with surgery in both univariate and multivariate logistic regression modeling. We found that patient-reported appendicular symptoms as the primary indication for surgery were associated with a higher rate of both subjective improvement following surgery and having expectations met

  5. 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.

  6. 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

  7. Determinants of time to surgery for patients with hip fracture.

    Science.gov (United States)

    Zeltzer, Justin; Mitchell, Rebecca J; Toson, Barbara; Harris, Ian A; Close, Jacqueline

    2014-09-01

    Guidelines for hip fracture care suggest that patients with hip fracture should undergo surgery on the day of or day after admission to hospital. This study examined factors affecting time to surgery for hip fracture extracted from existing administrative datasets in New South Wales (NSW), Australia. A retrospective analysis of patients with hip fracture aged 65 years and over undergoing surgical intervention in NSW public hospitals between 1 July 2000 and 30 June 2011. A multinomial logistic model was used to identify factors impacting on time to surgery from 1 July 2006 to 30 June 2011. A total of 49,317 hip fracture procedures were recorded during 2000-2001 to 2010-2011. Sixty-four per cent of patients received operative treatment on the day of or day after admission. Co-morbidity, type of surgical procedure and day of presentation all impacted significantly on time to surgery. Fourteen per cent required an inter-hospital transfer prior to receiving operative intervention. Transferred patients were 2.6 (95% confidence interval (CI): 2.31-2.85) times more likely to wait 2-4 days and 3.2 times more likely to wait 5 or more days (95% CI: 2.77-3.76) for surgery compared with patients presenting to an operating hospital. Significant variation exists between hospitals in the time to surgery that is not solely explained by measures of case mix or geography. Opportunities exist to consider other factors contributing to this variation and to ensure timely access to surgical intervention in the future. © 2014 Royal Australasian College of Surgeons.

  8. Point-of-care ultrasonography changes patient management following open heart surgery.

    Science.gov (United States)

    Christiansen, Lærke Kamstrup; Frederiksen, Christian Alcaraz; Juhl-Olsen, Peter; Jakobsen, Carl-Johan; Sloth, Erik

    2013-12-01

    Although pericardial effusions (PE) and pleural effusions (PLE) may lead to life-threatening respiratory and circulatory deterioration following open heart surgery the postoperative frequency is not fully recognized. The diagnosis is typically based on ultrasonography, X-ray or computer tomography and often disclosed when circulatory collapse is evident. Point-of-care (POC) ultrasonography protocols constitute a noninvasive evaluation of the cardiopulmonary status. We hypothesized that POC ultrasonography could diagnose unknown PE and PLE. Patients scheduled for open heart surgery were eligible for inclusion. Baseline evaluation including POC examination and dyspnea score was performed one day prior to surgery and repeated on the 4th and 30th postoperative day. Eighty patients were included and complete follow-up was 80%. Thirteen patients (19%) had PE on the 4th day postsurgery and 19 patients (30%) had PE on the 30th day. Ultrasonography facilitated change in management in one patient with PE requiring drainage. Forty-nine patients (70%) had PLE on the 4th day following surgery and 19 patients (30%) had PLE on the 30th postoperative day. Ultrasonography facilitated a change in management in seven patients with PLE requiring drainage. POC ultrasonography detected pathology, otherwise undisclosed, and was responsible for a change in management in a considerable number of cases.

  9. Evaluation of a decision aid for patients considering autologous blood donation before open-heart surgery

    Science.gov (United States)

    Grant, F. Curry; Laupacis, Andreas; O'Connor, Annette M.; Rubens, Fraser; Robblee, James

    2001-01-01

    Background Patients undergoing open-heart surgery frequently require one or more blood transfusions. Because of the risks of receiving blood from volunteer donors, some patients choose to donate their own blood before surgery. This reduces their risk of exposure to volunteer-donated blood, but it increases their chance of receiving any transfusion, either of self-donated or volunteer-donated blood. Also, preoperative hemoglobin levels tend to be lower in patients who donate their own blood, and surgeons may be more likely to give transfusions to patients with self-donated blood. To help patients decide whether to donate their blood before surgery, we designed a decision aid comprising a booklet and audiotape and assessed its effectiveness. Methods The 59 study subjects were a sample of consecutive patients referred to the Ottawa Heart Institute between Oct. 1, 1998, and Jan. 5, 1999, for future coronary artery bypass grafting, valve surgery or combined surgery. All were eligible to donate blood. Initial questionnaires were administered in the clinic by a physician or study nurse, and follow-up questionnaires were completed at home and mailed in after use of the decision aid. Outcome measures included patients' knowledge, values (importance ratings), preferences for transfusion methods, decisional conflict (the amount of uncertainty about the course of action to take), risk perception and acceptability of the decision aid. Results Mean knowledge scores on a 15-item test increased from 67% correct responses before the decision aid to 85% correct responses after use of the aid (p decision aid was acceptable to the majority of patients, and 95% indicated that they would recommend it to others. Interpretation The decision aid improved knowledge and risk perceptions of blood donation and transfusion, and it helped uncertain patients to make choices. PMID:11338799

  10. Patients' perceptions of waiting for bariatric surgery: a qualitative study.

    Science.gov (United States)

    Gregory, Deborah M; Temple Newhook, Julia; Twells, Laurie K

    2013-10-18

    In Canada waiting lists for bariatric surgery are common, with wait times on average > 5 years. The meaning of waiting for bariatric surgery from the patients' perspective must be understood if health care providers are to act as facilitators in promoting satisfaction with care and quality care outcomes. The aims of this study were to explore patients' perceptions of waiting for bariatric surgery, the meaning and experience of waiting, the psychosocial and behavioral impact of waiting for treatment and identify health care provider and health system supportive measures that could potentially improve the waiting experience. Twenty-one women and six men engaged in in-depth interviews that were digitally recorded, transcribed verbatim and analysed using a grounded theory approach to data collection and analysis between June 2011 and April 2012. The data were subjected to re-analysis to identify perceived health care provider and health system barriers to accessing bariatric surgery. Thematic analysis identified inequity as a barrier to accessing bariatric surgery. Three areas of perceived inequity were identified from participants' accounts: socioeconomic inequity, regional inequity, and inequity related to waitlist prioritization. Although excited about their acceptance as candidates for surgery, the waiting period was described as stressful, anxiety provoking, and frustrating. Anger was expressed towards the health care system for the long waiting times. Participants identified the importance of health care provider and health system supports during the waiting period. Recommendations on how to improve the waiting experience included periodic updates from the surgeon's office about their position on the wait list; a counselor who specializes in helping people going through this surgery, dietitian support and further information on what to expect after surgery, among others. Patients' perceptions of accessing and waiting for bariatric surgery are shaped by perceived

  11. [Patient suitability for cataract surgery under local anesthesia].

    Science.gov (United States)

    Vlajković, Gordana; Sindelić, Radomir; Marjanović, Ivan; Knezević, Miroslav

    2009-01-01

    In the past two decades local anesthesia has emerged as a reliable, safe and cost-effective first choice for cataract surgery in adults. However, the technique is not totally devoid of inherent risks, and requires not only an experienced and well-trained surgeon but also a cooperative patient. Thus, only the patient who is able to communicate, lie still in the supine position, and tolerate their face being covered by a drape is a suitable candidate for local anesthesia. In addition, the preoperative assessment should include particular features of the globe and orbit which may affect the operation as well as a history of allergy to local anesthetics. Finally, it is important to respond to patient preferences and wishes. A careful, patient selection for local anesthesia reduces the risk of surgical cancellation or delay and is essential for patient satisfaction and a successful visual outcome following cataract surgery.

  12. Propofol increased the interleukin-6 to interleukin-10 ratio more than isoflurane after surgery in long-term alcoholic patients

    DEFF Research Database (Denmark)

    Von Dossow, V; Baur, S; Sander, M

    2011-01-01

    This study investigated the effect of an anaesthetic regimen on the immune response in 40 long-term alcoholic patients undergoing surgery. Patients were randomly allocated to receive either propofol or isoflurane during surgery. Plasma cytokines interleukin (IL)-6 and IL-10 were measured at defined...... times and rates of post-operative infections were documented. The IL-6/IL-10 ratio significantly increased with propofol compared with isoflurane on day 1 after surgery and the IL-10 level significantly increased with isoflurane on day 1 after surgery. The overall post-operative infection rate...... was significantly higher in isoflurane-treated patients. Our findings indicate that propofol anaesthesia might be the more favourable regimen, with the IL-6/IL-10 ratio indicating an attenuation of the immune imbalance after surgery in long-term alcoholic patients. These results support the undertaking...

  13. Propofol increased the interleukin-6 to interleukin-10 ratio more than isoflurane after surgery in long-term alcoholic patients

    DEFF Research Database (Denmark)

    Von Dossow, V; Baur, S; Sander, M

    2007-01-01

    This study investigated the effect of an anaesthetic regimen on the immune response in 40 long-term alcoholic patients undergoing surgery. Patients were randomly allocated to receive either propofol or isoflurane during surgery. Plasma cytokines interleukin (IL)-6 and IL-10 were measured at defined...... times and rates of post-operative infections were documented. The IL-6/IL-10 ratio significantly increased with propofol compared with isoflurane on day 1 after surgery and the IL-10 level significantly increased with isoflurane on day 1 after surgery. The overall post-operative infection rate...... was significantly higher in isoflurane-treated patients. Our findings indicate that propofol anaesthesia might be the more favourable regimen, with the IL-6/IL-10 ratio indicating an attenuation of the immune imbalance after surgery in long-term alcoholic patients. These results support the undertaking...

  14. Reactivation of adiponectin expression in obese patients after bariatric surgery.

    Science.gov (United States)

    Hindle, A Katharine; Edwards, Claire; McCaffrey, Tim; Fu, Sidney W; Brody, Fred

    2010-06-01

    Bariatric surgery can resolve type 2 diabetes in morbidly obese patients. However, the underlying mechanism is unknown. This study aimed to identify potential biomarkers or molecular pathways that are altered after bariatric surgery in diabetic and nondiabetic patients. The study enrolled 17 morbidly obese patients undergoing bariatric surgery. Eight of the patients were diabetic, and nine were nondiabetic. In addition, a control group of four nonobese, nondiabetic volunteers was included. Patient blood samples were drawn before and after the operation. All blood samples were stabilized in Paxgene tubes (PreAnalytix). Total RNA was extracted and purified using the Paxgene Blood RNA Kit. For each sample, 100 ng of total RNA was amplified and labeled using the Ovation RNA Amplification System V2 with the Ovation Whole Blood reagent before hybridization to an Affymetrix Focus array containing more than 8,500 verified genes. Microarray results were analyzed with the GeneSpring GX 10.0 program, which uses an analysis of variance (ANOVA), and verified with real-time quantitative polymerase chain reaction (QPCR) using SYBR green (ABI). Microarray analysis showed that 167 genes were upregulated and 39 were downregulated in the obese diabetic patients. Preoperatively, adiponectin was downregulated 1.5-fold in diabetic versus nondiabetic patients. This was confirmed with quantitative PCR analysis. Preoperatively, morbidly obese patients showed a 3.12-fold downregulation of adiponectin expression versus the control group (p = 0.05). Interestingly, postoperative adiponectin levels were upregulated 2.79-fold (p = 0.02), which is close to the level of the normal control group. Adiponectin is dysregulated in obese patients and significantly dysregulated in obese diabetic patients. These findings correlate with the association between low levels of adiponectin and a predisposition to insulin resistance or diabetes. The data suggest that reactivation of adiponectin expression may

  15. Affective, anxiety, and substance-related disorders in patients undergoing herniated disc surgery.

    Science.gov (United States)

    Zieger, Margrit; Luppa, Melanie; Matschinger, Herbert; Meisel, Hans J; Günther, Lutz; Meixensberger, Jürgen; Toussaint, René; Angermeyer, Matthias C; König, Hans-Helmut; Riedel-Heller, Steffi G

    2011-11-01

    At present only a small number of studies have investigated psychiatric comorbidity in disc surgery patients. Objectives of this study are (1) to examine the prevalence rate of comorbid affective, anxiety, and substance-related disorders in nucleotomy patients in comparison to the German general population and (2) to investigate associations between psychiatric comorbidity and socio-demographic and illness-related characteristics. The study refers to 349 consecutive disc surgery patients (response rate 87%) between the age of 18 and 55 years. The final study sample consists of 239 lumbar and 66 cervical nucleotomy patients. Face-to-face interviews were conducted approximately 3.45 days (SD 3.170) after disc surgery, during hospital stay. Psychiatric comorbidity was assessed by means of the Composite International Diagnostic Interview (CIDI-DIA-X). The corresponding data of the German general population were derived from the German National Health Interview and Examination Survey (GHS). 12-Month prevalence rates of any affective, anxiety or substance-related disorders range between 33.7% in cervical and 23.5% in lumbar disc surgery patients. Four-week prevalence rates of any affective, anxiety or substance disorder vary between 13.2% in cervical and 14.0% in lumbar nucleotomy patients. Disc surgery patients suffer more often from affective disorders and illicit substance abuse than the general population. Significant associations were found between psychiatric comorbidity and gender, as well as pain intensity. Disc surgery patients show a higher risk to suffer from mental disorders than the general population. The assessment of psychiatric distress and the assistance by mental health professionals should be considered during hospital and rehabilitation treatment.

  16. Five-year survival after surgery in nonagenarian patients.

    Science.gov (United States)

    Fariña-Castro, Roberto; Roque-Castellano, Cristina; Marchena-Gómez, Joaquín; Rodríguez-Pérez, Aurelio

    2017-12-01

    In countries with longer life expectancies, the nonagenarian population is increasing. Therefore, there is greater demand for healthcare, including surgical procedures. The aim of the present study was to determine the outcomes of surgery carried out on nonagenarians in terms of long-term survival after the procedure. We carried out a cross-longitudinal study on a cohort of 159 nonagenarian patients, who underwent a non-cardiac, non-traumatic surgical procedure in our institution between January 1999 and December 2011. The following variables were recorded: sociodemographic characteristics, American Society of Anesthesiologists score, Charlson Comorbidity Index, surgical site, postoperative complications, operative mortality and long-term survival. The output variable was long-term survival. Of the 159 patients,99 women (62%) and 60 men (38%), with a mean age of 91.8 years (SD ± 2.0 years), 44 cases were operations for malignant disorders (28%), 117 cases (74%) under emergency conditions and 42 cases (26%) were elective treatments. The operative mortality was 29%, 4.8% for elective surgery and 37.6% for emergency surgery (P surgery (HR 1.64, 95% CI 1.05-2.57) and postoperative medical complications (HR 2.58, 95% CI 1.73-3.85) were independently related to 5-year survival. These findings support the perioperative safety of elective general surgery in nonagenarian patients. In selected nonagenarian patients with no cognitive impairment, surgery must not be denied. These data might be useful for surgical decision-making or informed consent for nonagerians. Geriatr Gerontol Int 2017; 17: 2389-2395. © 2017 Japan Geriatrics Society.

  17. The comparison of patient satisfaction after “surgery first” and conventional orthognathic surgery: An original research

    Directory of Open Access Journals (Sweden)

    Pritam Mohanty

    2017-01-01

    Full Text Available Aims and Objectives: We evaluated the factors which affect patient satisfaction and their expectations toward “surgery first” and conventional orthognathic surgery. Materials and Methods: Questionnaires consisting of 17 questions were given to the subjects postoperatively who had undergone Le fort 1 maxillary superior impaction for skeletal gummy smile correction with conventional orthognathic surgery and “surgery first” approach. Eleven-point rating scale based on a (visual analog scale; 0 = poor; 10 = excellent were used to answer six questions. Ten closed-form questions were also included as well as one open question for “further remarks.” Results: Nineteen patients (12 females, 07 males; mean age, 23.4 ± 4.9 [standard deviation] years gave their consent to participate in the study. The intention to undergo surgery only for esthetics was noted in 42.11% of patients; only improvement of chewing function in 21.05% and both in 36.84%. Conclusion: The most common factor for patient satisfaction after “surgery first” and conventional orthognathic surgery was facial esthetics, but masticatory function and even psychological aspects should be considered equally when planning surgery. The patient satisfaction was more in “surgery first” than conventional orthognathic surgery. The timing of treatment and immediate results are important factors toward patient satisfaction.

  18. Longitudinal analysis of serum oxylipin profile as a novel descriptor of the inflammatory response to surgery.

    Science.gov (United States)

    Wolfer, Arnaud M; Scott, Alasdair J; Rueb, Claudia; Gaudin, Mathieu; Darzi, Ara; Nicholson, Jeremy K; Holmes, Elaine; Kinross, James M

    2017-04-26

    Oxylipins are potent lipid mediators demonstrated to initiate and regulate inflammation yet little is known regarding their involvement in the response to surgical trauma. As key modulators of the inflammatory response, oxylipins have the potential to provide novel insights into the physiological response to surgery and the pathophysiology of post-operative complications. We aimed to investigate the effects of major surgery on longitudinal oxylipin profile. Adults patients undergoing elective laparoscopic or open colorectal resections were included. Primary outcomes were serum oxylipin profile quantified by ultra high-performance liquid chromatography-mass spectrometry, serum white cell count and C-reactive protein concentration. Serum samples were taken at three time-points: pre-operative (day zero), early post-operative (day one) and late post-operative (day four/five). Some 55 patients were included, of which 33 (60%) underwent surgery that was completed laparoscopically. Pre-operative oxylipin profiles were characterised by marked heterogeneity but surgery induced a common shift resulting in more homogeneity at the early post-operative time-point. By the late post-operative phase, oxylipin profiles were again highly variable. This evolution was driven by time-dependent changes in specific oxylipins. Notably, the levels of several oxylipins with anti-inflammatory properties (15-HETE and four regioisomers of DHET) were reduced at the early post-operative point before returning to baseline by the late post-operative period. In addition, levels of the pro-inflammatory 11-HETE rose in the early post-operative phase while levels of anti-thrombotic mediators (9-HODE and 13-HODE) fell; concentrations of all three oxylipins then remained fairly static from early to late post-operative phases. Compared to those undergoing laparoscopic surgery, patients undergoing open surgery had lower levels of some anti-inflammatory oxylipins (8,9-DHET and 17-HDoHE) in addition to

  19. 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.

  20. Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery

    Science.gov (United States)

    Chen, Catherine L.; Lin, Grace A.; Bardach, Naomi S.; Clay, Theodore H.; Boscardin, W. John; Gelb, Adrian W.; Maze, Mervyn; Gropper, Michael A.; Dudley, R. Adams

    2017-01-01

    BACKGROUND Routine preoperative testing is not recommended for patients undergoing cataract surgery, because testing neither decreases adverse events nor improves outcomes. We sought to assess adherence to this guideline, estimate expenditures from potentially unnecessary testing, and identify patient and health care system characteristics associated with potentially unnecessary testing. METHODS Using an observational cohort of Medicare beneficiaries undergoing cataract surgery in 2011, we determined the prevalence and cost of preoperative testing in the month before surgery. We compared the prevalence of preoperative testing and office visits with the mean percentage of beneficiaries who underwent tests and had office visits during the preceding 11 months. Using multivariate hierarchical analyses, we examined the relationship between preoperative testing and characteristics of patients, health system characteristics, surgical setting, care team, and occurrence of a preoperative office visit. RESULTS Of 440,857 patients, 53% had at least one preoperative test in the month before surgery. Expenditures on testing during that month were $4.8 million higher and expenditures on office visits $12.4 million higher (42% and 78% higher, respectively) than the mean monthly expenditures during the preceding 11 months. Testing varied widely among ophthalmologists; 36% of ophthalmologists ordered preoperative tests for more than 75% of their patients. A patient’s probability of undergoing testing was associated mainly with the ophthalmologist who managed the preoperative evaluation. CONCLUSIONS Preoperative testing before cataract surgery occurred frequently and was more strongly associated with provider practice patterns than with patient characteristics. (Funded by the Foundation for Anesthesia Education and Research and the Grove Foundation.) PMID:25875258

  1. Screening of adult ADHD among patients presenting for bariatric surgery.

    Science.gov (United States)

    Alfonsson, Sven; Parling, Thomas; Ghaderi, Ata

    2012-06-01

    In the field of bariatric surgery, research on symptoms of adult attention deficit hyperactivity disorder (ADHD) and their interrelationships with other psychological risk factors such as depression and anxiety is scarce. The symptoms of adult ADHD seem to be common in the obese population, but they are rarely investigated before bariatric surgery. ADHD-related symptoms such as impulsivity have at the same time been identified as potential risk factors for less successful weight loss among bariatric surgery patients. The aims of the current study were to screen for symptoms of adult ADHD and to investigate their relationships with other psychological risk factors. Candidates for bariatric surgery (N = 187) were anonymously screened for symptoms of anxiety, depression, and adult ADHD, in addition to disordered eating patterns, by means of questionnaires. The relations between these symptoms were investigated. In the current sample, 10% of patients screened positively for adult ADHD, and the symptoms of adult ADHD were significantly correlated with those of anxiety, depression, and disordered eating. The results show that adult ADHD is more common in this clinical group than in the general population (4%) and that adult ADHD is associated with disordered eating patterns, depression, and anxiety. Further prospective research, using multivariate analysis, is needed to investigate whether the symptoms of adult ADHD, and their interaction with anxiety, depression, or disordered eating, may possibly constitute a risk factor in terms of difficulties in adhering to the post-surgery regime and its potential unfavorable outcome.

  2. Incidence and hospital mortality of vascular surgery patients with ...

    African Journals Online (AJOL)

    Background: Perioperative myocardial infarction (PMI) and prognostically relevant myocardial injury following non-cardiac surgery (MINS) increases perioperative mortality. Studies in vascular patients show an increased incidence and mortality from PMI. However, there remains limited data on the relative prognostic ...

  3. An audit of documented preoperative evaluation of surgery patients ...

    African Journals Online (AJOL)

    and management.2. Takata et al. and Ausset et al. concluded that the quality of information recorded during the preoperative visit can be improved by using a standardised form.5,6 In 2003 and 2010, two .... An audit of documented preoperative evaluation of surgery patients at Universitas Academic Hospital, Bloemfontein.

  4. Patients` compliance with instructions after oral surgery in Nigeria ...

    African Journals Online (AJOL)

    Objective: To prospectively study the behaviour of oral surgery patients given verbal and written instructions, verbal instructions alone and written instructions alone after minor surgical procedures to return for review visits, remember correctly form of instruction given, compliance and level of satisfaction with treatment.

  5. Validation of the Euroscore on Cardiac Surgery Patients in Nairobi

    African Journals Online (AJOL)

    multiruka1

    curve analysis. Results: Of 109 patients, significant differences (Kenyan vs. AE derivation) were found in the prevalence of pulmonary y hypertension (58.7% vs. 2%) and isolated coronary artery bypass graft surgery. (4.6% vs. 65%). Only double valve replacement was a risk factor for operative mortality; odds ratio 5.98 (1.83.

  6. Bariatric surgery: An HIV-positive patient's successful journey.

    Science.gov (United States)

    Eddy, F; Elvin, S; Sanmani, L

    2016-01-01

    Bariatric surgery is becoming increasingly common in the UK. Little has been done to evaluate its place in HIV-positive patients. Here, we discuss a successful case and the complexities surrounding highly active antiretroviral therapy. © The Author(s) 2015.

  7. Incidence and hospital mortality of vascular surgery patients with ...

    African Journals Online (AJOL)

    The primary objective was to evaluate the incidence and prognosis of PMI and MINS in vascular surgical patients admitted to ... Keywords: brain natriuretic peptide, critical illness, myocardial injury after non-cardiac surgery, perioperative myocardial infarction .... cerebrovascular accident, smoking within six months) were.

  8. Nutritional status and life quality in patients undergoing bariatric surgery.

    Science.gov (United States)

    da Silva, Paulo Roberto Bezerra; de Souza, Marcela Ramos; da Silva, Evane Moises; da Silva, Silvia Alves

    2014-01-01

    The obesity has achieved an alarming increase in recent years, which led this disease to global epidemic condition. To evaluate the nutritional status as well as the quality of life of obese patients undergoing bariatric surgery. A transversal study was conducted with obese adults of both genders who underwent bariatric surgery by Fobi-Capella technique for at least 30 days. It was evaluated: age, gender, marital status, occupation, weight before surgery, current weight, height, preoperative and current BMI, weight loss and loss of excess weight percentages, presence of clinical manifestations and food intolerances. The sample consisted of 70 patients, being 81.4% female, 37.1% aged 30 to 39 years, 58.6% were married, 41.4% have undergone the bariatric surgery in the last 12 months. It was observed a reduction in BMI from 37.2 kg/m2 (one to three months) to 28.9 kg/m2 (>12 months) and consequent increase in weight loss and loss of excess weight percentages. The most frequent clinical manifestation was alopecia (62.9%). The most reported food intolerance was on the red meat (24%). According to the Baros questionnaire, 50% of patients were classified as having good quality of life. The operation of Fobi-Capella proved to be effective in promoting gradual and lasting weight loss. Quality of life was considered good in most patients, indicating that the operation had a positive impact on their lives.

  9. An experience with epidural morphine in lumbar surgery patients.

    Science.gov (United States)

    Ozuna, J; Snyder, G

    1987-10-01

    A chart review of the patients who received epidural morphine for lumbar surgery during the first year of implementation of the procedure was conducted. This article reviews the pharmacology and side effects of epidural morphine, describes the procedure of administering epidural morphine, discusses side effects and technical problems encountered, and presents implications for nursing practice.

  10. pulmonary indices in post—abdominal surgery patients

    African Journals Online (AJOL)

    Apical; lateral—costal; postero-basal and diaphragmatic breathing exercises. The elective ... Vital capacity and peak expiratory flow rates were measured daily after each exercise training session. ... that breathing exercise training improved vital capacity and peak expiratory flow rate of the abdominal surgery patients. It was.

  11. Robotic surgery in supermorbidly obese patients with endometrial cancer.

    Science.gov (United States)

    Stephan, Jean-Marie; Goodheart, Michael J; McDonald, Megan; Hansen, Jean; Reyes, Henry D; Button, Anna; Bender, David

    2015-07-01

    Morbid obesity is a known risk factor for the development of endometrial cancer. Several studies have demonstrated the overall feasibility of robotic-assisted surgical staging for endometrial cancer as well as the benefits of robotics compared with laparotomy. However, there have been few reports that have evaluated robotic surgery for endometrial cancer in the supermorbidly obese population (body mass index [BMI], ≥50 kg/m(2)). We sought to evaluate safety, feasibility, and outcomes for supermorbidly obese patients who undergo robotic surgery for endometrial cancer, compared with patients with lower body mass indices. We performed a retrospective chart review of 168 patients with suspected early-stage endometrial adenocarcinoma who underwent robotic surgery for the management of their disease. Analysis of variance and univariate logistic regression were used to compare patient characteristics and surgical variables across all body weights. Cox proportional hazard regression was used to determine the impact of body weight on recurrence-free and overall survival. The mean BMI of our cohort was 40.9 kg/m(2). Median follow up was 31 months. Fifty-six patients, 30% of which had grade 2 or 3 tumors, were supermorbidly obese with a BMI of ≥50 kg/m(2) (mean, 56.3 kg/m(2)). A comparison between the supermorbidly obese and lower-weight patients demonstrated no differences in terms of length of hospital stay, blood loss, complication rates, numbers of pelvic and paraaortic lymph nodes retrieved, or recurrence and survival. There was a correlation between BMI and conversion to an open procedure, in which the odds of conversion increased with increasing BMI (P = .02). Offering robotic surgery to supermorbidly obese patients with endometrial cancer is a safe and feasible surgical management option. When compared with patients with a lower BMI, the supermorbidly obese patient had a similar outcome, length of hospital stay, blood loss, complications, and numbers of lymph

  12. Effect of thoracoscopic esophagus cancer surgery on postoperative incision pain as well as non-specific and specific immune response

    Directory of Open Access Journals (Sweden)

    Jin-Long Wu1

    2017-04-01

    Full Text Available Objective: To explore the effect of thoracoscopic esophagus cancer surgery on postoperative incision pain as well as non-specific and specific immune response. Methods: 56 patients with esophageal cancer who accepted surgical treatment in our hospital between March 2011 and February 2016 were collected, the operation methods and related laboratory tests were reviewed, and then they were divided into the thoracoscope group (n=27 who accepted thoracoscopic surgery and the open surgery group (n=29 who accepted traditional thoracotomy. Before operation and 1 d after operation, immune scatter turbidimetry was used to detect serum levels of pain mediators, and flow cytometer was used to detect the levels of nonspecific immune indexes and specific immune indexes. Results: Before operation, the differences in serum pain mediators as well as nonspecific immune response and specific immune response indexes were not statistically significant between two groups of patients (P>0.05. 1 d after operation, serum pain mediators 5-HT, K+ and NE levels of thoracoscope group were lower than those of open surgery group (P<0.05; nonspecific immune response indexes NK cell as well as C3 and C4 levels in peripheral blood of thoracoscope group were significantly higher than those of open surgery group (P<0.05; specific immune response indexes CD4+, CD4+/CD8+, IgA and IgG levels in peripheral blood of thoracoscope group were significantly higher than those of open surgery group (P<0.05. Conclusion: Thoracoscopic esophagus cancer surgery causes less damage, has lighter inhibition on the immune response system, and is an ideal operation method for patients with early middle esophagus cancer.

  13. Spouses' use of pressure and persuasion to promote osteoarthritis patients' medical adherence after orthopedic surgery.

    Science.gov (United States)

    Stephens, Mary Ann Parris; Fekete, Erin M; Franks, Melissa M; Rook, Karen S; Druley, Jennifer Ann; Greene, Kenneth

    2009-01-01

    The authors investigated health-related effects of social control (influence) that spouses exert in relation to osteoarthritis patients' medical adherence after total knee replacement surgery. Patients' behavioral and emotional responses to control were examined as mediators of associations between spouses' use of two control strategies (pressure, persuasion) and patients' physical and psychological recovery. The authors used a three-wave panel design with assessments at one month before surgery, 1 month and 3 months after surgery. Data were collected during in-person interviews with 70 married, older adult patients. Recovery outcomes were assessed as improvement in knee limitations and depressive symptoms at the 3 month follow-up. Spousal pressure and persuasion at one month postsurgery were indirectly associated with patients' recovery outcomes through patients' positive emotional responses to control. Although there are often immediate behavioral benefits in response to partners' use of both pressure and persuasion, the long-term health effects of these strategies seem to be accounted for by their opposing links to positive emotions. Findings further refine theory on health-related social control in marriage. (c) 2009 APA, all rights reserved.

  14. Ambulatory orthopaedic surgery patients' knowledge with internet-based education.

    Science.gov (United States)

    Heikkinen, Katja; Leino-Kilpi, H; Salanterä, S

    2012-01-01

    There is a growing need for patient education and an evaluation of its outcomes. The aim of this study was to compare ambulatory orthopaedic surgery patients' knowledge with Internet-based education and face-to-face education with a nurse. The following hypothesis was proposed: Internet-based patient education (experiment) is as effective as face-to-face education with a nurse (control) in increasing patients' level of knowledge and sufficiency of knowledge. In addition, the correlations of demographic variables were tested. The patients were randomized to either an experiment group (n = 72) or a control group (n = 75). Empirical data were collected with two instruments. Patients in both groups showed improvement in their knowledge during their care. Patients in the experiment group improved their knowledge level significantly more in total than those patients in the control group. There were no differences in patients' sufficiency of knowledge between the groups. Knowledge was correlated especially with patients' age, gender and earlier ambulatory surgeries. As a conclusion, positive results concerning patients' knowledge could be achieved with the Internet-based education. The Internet is a viable method in ambulatory care.

  15. Deep venous thrombosis after orthopedic surgery in adult cancer patients.

    Science.gov (United States)

    Lin, P P; Graham, D; Hann, L E; Boland, P J; Healey, J H

    1998-05-01

    Patients with cancer and patients undergoing major orthopedic procedures are two groups at risk of deep venous thrombosis (DVT). The objective was to determine the rate of venous thromboembolic disease in patients with a malignant neoplasm and major orthopaedic surgery of the lower limb. The study included 169 patients. All patients were given knee-high intermittent pneumatic compression devices for prophylaxis. Postoperative surveillance for thrombosis was performed on all patients with venous duplex doppler ultrasonography. Proximal DVT occurred in 24 of 169 patients (14.2%). One patient (0.6%) developed a symptomatic, nonfatal pulmonary embolus (PE). The development of DVT was not associated with age, sex, type of surgery, type of neoplasm, location, or pathologic fracture. The addition of anticoagulant medication such as warfarin did not significantly reduce the rate of DVT in a subset of 54 patients. In three patients, the DVT occurred only in the contralateral limb, and in four patients, there were bilateral DVTs. When intermittent compression boots were used for prophylaxis in conjunction with ultrasound screening, the risk of proximal DVT was substantial (14.2%), but the rate of symptomatic PE was low (0.6%).

  16. Mitral valve surgery in the adult Marfan syndrome patient.

    Science.gov (United States)

    Bhudia, Sunil K; Troughton, Richard; Lam, Buu-Khanh; Rajeswaran, Jeevanantham; Mills, William R; Gillinov, A Marc; Griffin, Brian P; Blackstone, Eugene H; Lytle, Bruce W; Svensson, Lars G

    2006-03-01

    Because mitral valve dysfunction in adults with Marfan syndrome is poorly characterized, this study compares mitral valve pathophysiology and morphology with that of myxomatous mitral disease, documents types of mitral valve operations, and assesses long-term survival and durability of mitral valve surgery in Marfan patients. From May 1975 to June 2000, 27 adults with Marfan syndrome underwent mitral valve surgery. Their valve pathophysiology and morphology was compared with that of 119 patients with myxomatous mitral disease undergoing surgery from September 1995 to March 1999. Survival and repair durability were assessed at follow-up. Compared with myxomatous disease patients, Marfan patients had less posterior leaflet prolapse (44% versus 70%, p = 0.01), more bileaflet (44% versus 28%, p = 0.09) and anterior leaflet prolapse (11% versus 3%, p = 0.07), and presented earlier for surgery (age 41 +/- 12 years versus 57 +/- 13, p Marfan patients had longer and thinner leaflets. Mitral valve repair was performed less frequently in Marfan (16 of 27, 59%) than myxomatous disease patients (112 of 119, 94%). There were no hospital deaths; at 10 years, survival was 80% and freedom from reoperation 96%, with only 1 reoperation among the 16 repairs. Mitral valve pathophysiology and morphology differ between Marfan and myxomatous mitral valve diseases. Valve repair in Marfan patients is durable and gives acceptable long-term results, even in adults who present with advanced mitral valve pathology. With increasing use of the modified David reimplantation operation and sparing of the aortic valve, mitral valve repair is a greater imperative, particularly since we have not had to reoperate on any Marfan patients with reimplantations.

  17. 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.

  18. Preoperative asymptomatic leukocytosis and postoperative outcome in cardiac surgery patients.

    Directory of Open Access Journals (Sweden)

    Eitezaz Mahmood

    Full Text Available Despite showing a prognostic value in general surgical patients, preoperative asymptomatic elevated white blood cell (WBC count is not considered a risk factor for cardiac surgery. Whereas there is sporadic evidence of its value as a preoperative risk marker, it has not been looked at methodically as a specific index of outcome during cardiac surgery. Using a national database we sought to determine the relationship between preoperative WBC count and postoperative outcome in cardiac surgical patients.Cardiac surgeries were extracted from the 2007-2013 American College of Surgeons National Surgical Quality Improvement Program database. Leukocytosis was defined by a preoperative WBC count greater than 11,000 cells/μL. A univariate analysis compared the incidence of adverse outcomes for patients with and without leukocytosis. A multivariate logistic regression model was constructed in order to test whether leukocytosis was an independent predictor of morbidity and mortality.Out of a total of 10,979 cardiac surgery patients 863 (7.8% had preoperative leukocytosis. On univariate analysis, patients with leukocytosis experienced greater incidences of 30-day mortality, wound complications, and medical complications. Wound complications included surgical site infection as well as wound dehiscence. The medical complications included all other non-surgical causes of increased morbidity and infection leading to urinary tract infection, pneumonia, ventilator dependence, sepsis and septic shock. After stepwise model adjustment, leukocytosis was a strong predictor of medical complications (OR 1.22, 95% CI: 1.09-1.36, p = 0.002 with c-statistic of 0.667. However, after stepwise model adjustment leukocytosis was not a significant predictor of 30-day mortality and wound complications.Preoperative leukocytosis is associated with adverse postoperative outcome after cardiac surgery and is an independent predictor of infection-related postoperative complications.

  19. Vitreoretinal complications in Yemeni patients with keratorefractive surgery.

    Science.gov (United States)

    Bamashmus, Mahfouth A; Al-Salahim, Seddique A; Saleh, Mahmoud F; Awadalla, Mohamed A; Tarish, Nabil A

    2010-06-01

    To evaluate vitreoretinal complications in patients undergoing laser keratorefractive surgery. This retrospective observational non-comparative clinical study was carried out between June 2005 and March 2008, and included 4691 consecutive laser keratorefractive surgery procedures for 2480 patients performed in the Department of Refractive Surgery, Yemen Magrabi Hospital, Sana'a, Yemen. Patients were followed up for 12-36 months. The preoperative patient evaluation included manifest and cycloplegic refractions, uncorrected visual acuity, best spectacle-corrected visual acuity, slit-lamp biomicroscopy, and dilated vitreoretinal assessment. Retinal diseases were recorded and analyzed during the preoperative and postoperative care. Sixty-five (1.4%) of the 4691 eyes had posterior segment pathology requiring intervention. In the preoperative assessment, 57 eyes had prophylactic laser photocoagulation for retinal lesions. Seven eyes developed posterior vitreous detachment postoperatively, and 4 of these required prophylactic laser therapy for lattice degeneration and retinal breaks. Two eyes (0.04%) developed rhegmatogenous retinal detachment, which occurred spontaneously. One patient developed cystoid macular edema in both eyes. Most complications are related to the refractive outcome or to corneal and anterior segment injury. Posterior segment complications are rare, but dilated vitreoretinal assessment is important before and after laser keratorefractive procedures. Patients with suspicious retinal lesions need a comprehensive vitreoretinal evaluation by a retinal specialist.

  20. Waiting for scheduled surgery: A complex patient experience.

    Science.gov (United States)

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

    2017-03-01

    The aim of this study was to understand experiences of wait time among patients awaiting scheduled orthopaedic or cardiac surgery. Using a qualitative approach, 32 patients completed two interviews each regarding their wait time experiences, including effects of waiting. Patient experiences of wait time varied regardless of actual wait time and included reports of restriction, uncertainty, resignation, coping and opportunity. Participants' waiting experiences indicate a complex relationship between greater symptom severity and less tolerance for wait time. We suggest healthcare resources focus on alleviating the deleterious effects of waiting for certain patients rather than reducing absolute wait times.

  1. 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

    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. 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). 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. 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.

  2. 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

  3. 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.

  4. Effect of irrigation fluid temperature on core body temperature and inflammatory response during arthroscopic shoulder surgery.

    Science.gov (United States)

    Pan, Xiaoyun; Ye, Luyou; Liu, Zhongtang; Wen, Hong; Hu, Yuezheng; Xu, Xinxian

    2015-08-01

    This study was designed to evaluate the influence of irrigation fluid on the patients' physiological response to arthroscopic shoulder surgery. Patients who were scheduled for arthroscopic shoulder surgery were prospectively included in this study. They were randomly assigned to receive warm arthroscopic irrigation fluid (Group W, n = 33) or room temperature irrigation fluid (Group RT, n = 33) intraoperatively. Core body temperature was measured at regular intervals. The proinflammatory cytokines TNF-α, IL-1, IL-6, and IL-10 were measured in drainage fluid and serum. The changes of core body temperatures in Group RT were similar with those in Group W within 15 min after induction of anesthesia, but the decreases in Group RT were significantly greater after then. The lowest temperature was 35.1 ± 0.4 °C in Group RT and 35.9 ± 0.3 °C in Group W, the difference was statistically different (P irrigation fluid compared with warm irrigation fluid. And local inflammatory response is significantly reduced by using warm irrigation fluid. It seems that warm irrigation fluid is more recommendable for arthroscopic shoulder surgery.

  5. Attitudes of patients and care providers to enhanced recovery after surgery programs after major abdominal surgery.

    Science.gov (United States)

    Hughes, Michael; Coolsen, Marielle M E; Aahlin, Eirik K; Harrison, Ewen M; McNally, Stephen J; Dejong, C H C; Lassen, Kristoffer; Wigmore, Stephen J

    2015-01-01

    Enhanced recovery after surgery (ERAS) is a well-established pathway of perioperative care in surgery in an increasing number of specialties. To implement protocols and maintain high levels of compliance, continued support from care providers and patients is vital. This survey aimed to assess the perceptions of care providers and patients of the relevance and importance of the ERAS targets and strategies. Pre- and post-operative surveys were completed by patients who underwent major hepatic, colorectal, or oesophagogastric surgery in three major centers in Scotland, Norway, and The Netherlands. Anonymous web-based and article surveys were also sent to surgeons, anesthetists, and nurses experienced in delivering enhanced recovery protocols. Each questionnaire asked the responder to rate a selection of enhanced recovery targets and strategies in terms of perceived importance. One hundred nine patients and 57 care providers completed the preoperative survey. Overall, both patients and care providers rated the majority of items as important and supported ERAS principles. Freedom from nausea (median, 10; interquartile range [IQR], 8-10) and pain at rest (median, 10; IQR, 8-10) were the care components rated the highest by both patients and care providers. Early return of bowel function (median, 7; IQR, 5-8) and avoiding preanesthetic sedation (median, 6; IQR, 3.75-8) were scored the lowest by care providers. ERAS principles are supported by both patients and care providers. This is important when attempting to implement and maintain an ERAS program. Controversies still remain regarding the relative importance of individual ERAS components. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Use of the world wide web by cardiac surgery patients.

    Science.gov (United States)

    Lim, Jeffrey; Phillips, Alexander W; Sayeed, Rana

    2010-05-01

    Internet use has expanded globally over the last 10 years. The aim of this study was to determine the extent that cardiac patients researched their forthcoming procedures using the internet and to determine their perception of reliability. Sixty-eight consecutive cardiac patients (51 men, median age 67 years) were surveyed on their frequency of internet use, whether they used the internet to research their operation and how reliable they regarded the information found. Forty-two patients had access to the internet, 29 patients used the web on a regular basis but 33 reported that they never used the web. Fourteen patients used the internet to research their operation themselves. Patients internet access (Pinternet to do research is low irrespective of age (P=0.28). Forty-five patients felt that information found on the internet was reliable. Despite a general increase in internet access, there is still low usage amongst cardiac patients to research their operation. Patients do, however, have confidence in what is available on-line. Patient education by the multi-disciplinary team before surgery remains of paramount importance. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

  7. Raising the issue of DNAR orders in vascular surgery patients.

    Science.gov (United States)

    McIntosh, Rachel; Webb, Hannah; Hartley, Matthew; Brooks, Marcus

    2016-01-01

    The Tracey Report has recently raised the status of Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR) orders in the hospital setting.[1] Guidelines are in place both nationally and locally to provide advice to clinicians on when to discuss DNACPR, and the approach to be taken. There was concern that on a busy regional vascular surgery unit, discussion of resuscitation status was not regular practice. Consequently, some patients were at risk of being inappropriately resuscitated, particularly out of hours. The North Bristol Somerset and Gloucester DNAR decision tree[2] was the tool used to decide whether a patient should have a documented discussion and/or a DNACPR form completed. We correlated the outcome of the decision tree with the presence of a DNACPR form or documented resuscitation discussion. Baseline measurements from all vascular inpatients on the vascular surgery unit demonstrated that only 27% had a DNACPR form or documented discussion in concordance with the DNACPR Decision Tree outcome. The aim of this project was to increase the proportion of patients with concordance of the DNACPR decision tree outcome with documented discussion or DNACPR form. The following three simple interventions raised concordance from 27% to 64% of patients on the vascular surgery unit. 1. Including resuscitation status of each patient as a column in the doctors daily handover. 2. Posters in staff only areas to highlight the meaning of DNACPR and raise awareness of the DNACPR decision tree. 3. Educational meeting surrounding DNACPR with the vascular surgery consultants, led by a care of the elderly consultant . This project has highlighted how raising awareness around DNACPR increases discussion amongst the clinical team surrounding resuscitation status of a patient. Consequently, this enables discussion to be had with patient and their family.

  8. [Learning from aviation - how to increase patient safety in surgery].

    Science.gov (United States)

    Renz, B; Angele, M K; Jauch, K-W; Kasparek, M S; Kreis, M; Müller, M H

    2012-04-01

    During the last years attempts have been made to draw lessons from aviation to increase patient safety in medicine. In particular similar conditions are present in surgery as pilots and surgeons may have to support high physical and mental pressure. The use of a few safety instruments from aviation is feasible in an attempt to increase safety in surgery. First a "root caused" accident research may be established. This is achievable by morbidity and mortality conferences and critical incident reporting systems (CIRS). Second, standard operating procedures may assure a uniform mental model of team members. Furthermore, crew resource management illustrates a strategy and attitude concept, which is applicable in all situations. Safety instruments from aviation, therefore, seem to have a high potential to increase safety in surgery when properly employed. © Georg Thieme Verlag KG Stuttgart ˙ New York.

  9. The Prevalence of Helicobacter pylori in Estonian Bariatric Surgery Patients

    Directory of Open Access Journals (Sweden)

    Natalja Šebunova

    2018-01-01

    Full Text Available Helicobacter pylori (Hp is one of the most important human pathogens that can cause duodenal and gastric ulcers, gastritis and stomach cancer. Hp infection is considered to be a cause of limiting access to bariatric surgery. The aim of this study was to determine the prevalence of Hp in patients with obesity going into bariatric surgery and to reveal the relationship between Hp and clinical data. The study group was formed of 68 preoperative bariatric surgery patients (body mass index (BMI 44.7 ± 4.8. Gastric biopsies (antrum and corpus were used for histological and molecular (caqA and glmM genes examinations. The PCR method revealed Hp infection in 64.7% of obese patients that is higher in comparison with histological analysis (55.9%. The prevalence of cagA and glmM genes in antrum mucosa was 45.6% and 47.0% while in the corpus it was 41.2% and 38.3%, respectively. The coincidence of both cagA and glmM virulence genes in the antrum and corpus mucosa was 33.8% and 22.1%, respectively. Either of the genes was found in 58.8% of antrum and 57.3% of corpus mucosa. Presence of caqA and glmM genes was in association with active and atrophic chronic gastritis. In conclusion, our study demonstrated that two thirds of morbidly obese patients undergoing bariatric surgery are infected with Hp and have a high prevalence of cagA and glmM virulence genes that points out the necessity for diagnostics and treatment of this infection before surgery.

  10. Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass - a case series.

    Science.gov (United States)

    Träger, Karl; Skrabal, Christian; Fischer, Guenther; Datzmann, Thomas; Schroeder, Janpeter; Fritzler, Daniel; Hartmann, Jan; Liebold, Andreas; Reinelt, Helmut

    2017-05-29

    Infective endocarditis is a serious disease condition. Depending on the causative microorganism and clinical symptoms, cardiac surgery and valve replacement may be needed, posing additional risks to patients who may simultaneously suffer from septic shock. The combination of surgery bacterial spreadout and artificial cardiopulmonary bypass (CPB) surfaces results in a release of key inflammatory mediators leading to an overshooting systemic hyperinflammatory state frequently associated with compromised hemodynamic and organ function. Hemoadsorption might represent a potential approach to control the hyperinflammatory systemic reaction associated with the procedure itself and subsequent clinical conditions by reducing a broad range of immuno-regulatory mediators. We describe 39 cardiac surgery patients with proven acute infective endocarditis obtaining valve replacement during CPB surgery in combination with intraoperative CytoSorb hemoadsorption. In comparison, we evaluated a historical group of 28 patients with infective endocarditis undergoing CPB surgery without intraoperative hemoadsorption. CytoSorb treatment was associated with a mitigated postoperative response of key cytokines and clinical metabolic parameters. Moreover, patients showed hemodynamic stability during and after the operation while the need for vasopressors was less pronounced within hours after completion of the procedure, which possibly could be attributed to the additional CytoSorb treatment. Intraoperative hemoperfusion treatment was well tolerated and safe without the occurrence of any CytoSorb device-related adverse event. Thus, this interventional approach may open up potentially promising therapeutic options for critically-ill patients with acute infective endocarditis during and after cardiac surgery, with cytokine reduction, improved hemodynamic stability and organ function as seen in our patients.

  11. The use of contraception for patients after bariatric surgery.

    Science.gov (United States)

    Ostrowska, Lucyna; Lech, Medard; Stefańska, Ewa; Jastrzębska-Mierzyńska, Marta; Smarkusz, Joanna

    2016-01-01

    Obesity in women of reproductive age is a serious concern regarding reproductive health. In many cases of infertility in obese women, reduction of body weight may lead to spontaneous pregnancy, without the need for more specific methods of treatment. Bariatric surgery is safe and is the most effective method for body weight reduction in obese and very obese patients. In practice there are two bariatric techniques; gastric banding, which leads to weight loss through intake restriction, and gastric bypass, leads to weight loss through food malabsorption. Gastric bypass surgery (the more frequently performed procedure), in most cases, leads to changes in eating habits and may result in vomiting, diarrhea and rapid body mass reduction. There are reliable data describing the continuous increase in the number of women who are trying to conceive, or are already pregnant, following bariatric surgery. Most medical specialists advise women to avoid pregnancy within 12-18 months after bariatric surgery. This allows for time to recover sufficiency from the decreased absorption of nutrients caused by the bariatric surgery. During this period there is a need for the use of reliable contraception. As there is a risk for malabsorption of hormones taken orally, the combined and progestogen-only pills are contraindicated, and displaced by non-oral hormonal contraception or non-hormonal methods, including intrauterine devices and condoms.

  12. [Law and educational components of patient's safety in surgery].

    Science.gov (United States)

    Sazhin, V P; Karsanov, A M; Maskin, S S

    2018-01-01

    To evaluate law and educational components of patient's safety (PS) in surgery. In order to analyze complex causes of adverse outcomes in surgery we performed an interviewing of 110 surgeons, 42 emergency physicians and 25 health care managers. The main keynote consisted in assessing law and educational components of PS. The study revealed significant professional shortcomings in law PS level and low educational and motivational activity of physicians of all specialties. Multi-faceted nature of PS problem requires multidisciplinary training of modern surgeons not only in the knowledge of key risk factors for adverse outcomes, but also in satisfaction of non-medical expectations of patients. Due to numerous objective reasons Russian surgical school should have the opportunity not to blindly copy the experience of our foreign colleagues, but to scientifically substantiate the development of own national security system both for surgical patients and medical workers themselves.

  13. Surgery for Patients With Spontaneous Deep Supratentorial Intracerebral Hemorrhage

    Science.gov (United States)

    Zheng, Jun; Li, Hao; Zhao, He-Xiang; Guo, Rui; Lin, Sen; Dong, Wei; Ma, Lu; Fang, Yuan; Tian, Meng; Liu, Ming; You, Chao

    2016-01-01

    Abstract Spontaneous intracerebral hemorrhage (sICH) is one of the most dangerous cerebrovascular diseases, especially when in deep brain. The treatment of spontaneous deep supratentorial intracerebral hemorrhage is still controversial. We conducted a retrospective case-control study using propensity score matching to compare the efficacy of surgery and conservative treatment for patients with deep surpatentorial hemorrhage. We observed the outcomes of consecutive patients with spontaneous deep supratentorial hemorrhage retrospectively from December 2008 to July 2013. Clinical outcomes of surgery and conservative treatments were compared in patients with deep sICH using propensity score matching method. The primary outcome was neurological function status at 6 months post ictus. The second outcomes included mortality at 30 days and 6 months, and the incidence of complications. Subgroup analyses of 6-month outcome were conducted. Sixty-three (22.66%) of the 278 patients who received surgery had a favorable neurological function status at 6 months, whereas in the conservative group, 66 of 278 (23.74%) had the same result (P = 0.763). The 30-day mortality in the surgical group was 19.06%, whereas 30.58% in the conservative group (P = 0.002). There was significant difference in the mortality at 6 months after ictus as well (23.38% vs 36.33%, P = 0.001). The subgroup analyses showed significantly better outcomes for the surgical group when hematoma was >40 mL (13.33% vs 0%, P = 0.005) or complicated with intraventricular hemorrhage (16.67% vs 7.27%, P = 0.034). For complications, the risk of pulmonary infection, gastrointestinal hemorrhage, urinary infection, pulmonary embolus, and need for tracheostomy/long term ventilation in the surgical group was higher than the conservative group (31.29% vs 15.47%, P < 0.001; 6.83% vs 3.96%, P = 0.133; 2.88% vs 1.80%, P = 0.400; 1.80% vs 1.08%, P = 0.476; 32.73% vs 23.38%, P = 0

  14. Functional capacity and mental state of patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Bruna Corrêa

    Full Text Available Abstract Introduction: Cardiovascular diseases are a serious public health problem in Brazil. Myocardial revascularization surgery (MRS as well as cardiac valve replacement and repair are procedures indicated to treat them. Thus, extracorporeal circulation (ECC is still widely used in these surgeries, in which patients with long ECC times may have greater neurological deficits. Neurological damage resulting from MRS can have devastating consequences such as loss of independence and worsening of quality of life. Objective: To assess the effect of cardiac surgery on a patient’s mental state and functional capacity in both the pre- and postoperative periods. Methods: We conducted a cross-sectional study with convenience sampling of subjects undergoing MRS and valve replacement. Participants were administered the Mini-Mental State Exam (MMSE and the Duke Activity Status Index (DASI in the pre- and postoperative periods, as well as before their hospital discharge. Results: This study assessed nine patients (eight males aged 62.4 ± 6.3 years with a BMI of 29.5 ± 2.3 kg/m2. There was a significant decrease in DASI scores and VO2 from preoperative to postoperative status (p = 0.003 and p = 0.003, respectively. Conclusion: This study revealed a loss of cognitive and exercise capacity after cardiac surgery. A larger sample however is needed to consolidate these findings.

  15. The effect of music on the neurohormonal stress response to surgery under general anesthesia.

    Science.gov (United States)

    Migneault, Brigitte; Girard, François; Albert, Caroline; Chouinard, Philippe; Boudreault, Daniel; Provencher, Diane; Todorov, Alexandre; Ruel, Monique; Girard, Dominique C

    2004-02-01

    Several pharmacological interventions reduce perioperative stress hormone release during surgery under general anesthesia. Listening to music and therapeutic suggestions were also studied, but mostly in awake patients, and these have a positive effect on postoperative recovery and the need for analgesia. In this study, we evaluated the effect of listening to music under general anesthesia on the neurohormonal response to surgical stress as measured by epinephrine, norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) blood levels. Thirty female patients scheduled for abdominal gynecological procedures were enrolled and randomly divided into two groups: group NM (no music) and group M (music). In group M, music was played from after the induction of anesthesia until the end of surgery. In the NM group, the patients wore the headphones but no music was played. We established three sample times for hormonal dosage during the procedure and one in the recovery room. Hemodynamic data were recorded at all times, and postoperative consumption of morphine in the first 24 h was noted. There was no group difference at any sample time or in the postoperative period in terms of mean arterial blood pressure, heart rate, isoflurane end-tidal concentration, time of the day at which the surgery was performed, bispectral index (BIS) value, doses of fentanyl, or consumption of postoperative morphine. There was no difference between the two groups with regard to plasmatic levels of norepinephrine, epinephrine, cortisol, or ACTH at any sample time, although the blood level of these hormones significantly increased in each group with surgical stimulation. In conclusion, we could not demonstrate a significant effect of intraoperative music on surgical stress when used under general anesthesia. Listening to music under general anesthesia did not reduce perioperative stress hormone release or opioid consumption in patients undergoing gynecological surgery.

  16. Outcomes of 50 patients entering an adolescent bariatric surgery programme.

    Science.gov (United States)

    White, Billy; Doyle, Jacqueline; Matschull, Kirsten; Adamo, Marco; Christie, Deborah; Nicholls, Dasha; Kinra, Sanjay; Wong, Ian Chi Kei; Viner, Russell M

    2017-08-09

    Bariatric surgery is the most effective intervention for weight loss and obesity-related comorbidities currently available. Little is known about adolescents entering National Health Service (NHS) bariatric programmes. We aimed to characterise those entering a pathway and report their outcomes. Prospective service evaluation of patients assessed within a single NHS adolescent bariatric service. 50 patients assessed between 26 July 2007 and 27 January 2014; 6 (12%) were not eligible for surgery, 7 (14%) actively opted out, 8 (16%) were lost to follow-up and 29 (58%) underwent surgery (18 sleeve gastrectomy (SG) 11 Roux-en-y gastric bypass (RYGB) and 0 adjustable gastric band). Mean (SD) age at initial assessment was 16.0 (1.3) years and 18.3 (1.3) at surgery (youngest 15.7 years). Mean time taken to surgery was 1.8 years; longer in those with higher body mass index (BMI) and aged below 14 at first assessment. Mean (SD) BMI at surgery was 53.1 (8.3) kg/m 2 , lower in those undergoing RYGB (-5.2, 95% CI -11.6 to 1.13). Follow-up was inconsistent and challenging; 1/29 (3.5%) was transferred to a regional centre, 10/29 (34.5%) attended ongoing follow-up within our protocol, 6/29 (20.7%) had intermittent monitoring and 12/29 (41.4%) were lost to follow-up. Mean BMI change at 1 year (-14.0 kg/m 2 ) and complications were similar to published cohorts. Data from 11 lost to follow-up were obtained and outcomes appeared similar to those who actively followed up. Adolescent bariatric surgery in the NHS appears effective, with outcomes similar to those reported internationally. Further work is needed to optimise postsurgical surveillance and reduce age at surgery. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  17. The prevalence of alcohol misuse in patients undergoing cataract surgery.

    Science.gov (United States)

    Davis, A R; Wilkins, M; Dew, T; Sherwood, R; Coakes, R; Peters, T J

    1998-04-01

    If a factor could be identified which delayed the onset of cataract by 10 years, the number of annual cataract operations worldwide has been estimated to decrease by 45%. A case-control study compared alcohol consumption in 78 patients attending for routine cataract surgery in South East London with data from a large population-based survey. Male cataract patients had a significantly greater risk of being harmful drinkers (odds ratio = 8, p = 0.007) than the controls. The harmful male drinkers were significantly younger than the non-drinkers with cataract (mean difference 15 years, p < 0.007). Female cataract patients were not more likely to be excessive drinkers than controls. The female drinkers with cataract were of a similar age to the non-drinking female patients with cataract. Haematological and biochemical indices of alcohol toxicity indicated five patients who were likely to be harmful drinkers, but who had denied this on direct questioning. Seven (26%) of the male patients had a low serum 25 hydroxycholecalciferol although the levels were normal in the female patients. These results support the view that excess alcohol consumption is related to cataract formation and suggest that alcohol causes premature cataract formation in male, but not female patients. Alcohol consumption is amenable to intervention and suggests that such intervention could have a significant impact on the need for cataract surgery.

  18. Patient preference for bra or binder after breast surgery.

    Science.gov (United States)

    Laura, Sharon; Clark, David; Harvey, Fiona

    2004-06-01

    No data are currently available to assess the relative merits of breast binder or bra following breast surgery. A randomized controlled study was undertaken to compare a breast binder with a bra postoperatively for patients undergoing lumpectomies, partial mastectomies and total mastectomies. Fifty-eight patients were included in the study. Six different parameters were compared and the bra was found better on all criteria; a small group of patients who initially used a binder and then, for a second procedure, used a bra, found the bra more comfortable. Postoperative discomfort can be decreased by using a well-fitting bra rather than a breast binder.

  19. Cataract surgery in patients with pseudoexfoliation syndrome: current updates

    Directory of Open Access Journals (Sweden)

    Fontana L

    2017-07-01

    Full Text Available Luigi Fontana, Marco Coassin, Alfonso Iovieno, Antonio Moramarco, Luca Cimino Ophthalmology Unit, Arcispedale Santa Maria Nuova – IRCCS, Reggio Emilia, Italy Abstract: Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc., the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated. Keywords: pseudoexfoliation syndrome, cataract surgery, zonular laxity, intraocular lens implant, complications

  20. Arthroscopic knee surgery does not modify hyperalgesic responses to heat injury

    DEFF Research Database (Denmark)

    Werner, Mads U; Duun, Preben; Kraemer, Otto

    2003-01-01

    BACKGROUND: Experimental studies suggest that surgical injury may up- or down-regulate nociceptive function. Therefore, the aim of this clinical study was to evaluate the effect of elective arthroscopically assisted knee surgery on nociceptive responses to a heat injury. METHODS: Seventeen patients...... contralateral to the surgical side. Ibuprofen and acetaminophen were given for 2 days before the first burn injury and again from the time of surgery. In the controls, the two burn injuries were separated by 7 days. Sensory variables included cumulated pain score during induction of the burn (visual analog...... scale), secondary hyperalgesia area, and mechanical and thermal pain perception and pain thresholds assessed before and 1 h after the burn injury. RESULTS: The heat injuries induced significant increases in pain perception (P heat pain...

  1. 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

  2. Functional assessment of older obese patients candidates for bariatric surgery.

    Science.gov (United States)

    Pajecki, Denis; Santo, Marco Aurélio; Kanagi, Ana Lumi; Riccioppo, Daniel; de Cleva, Roberto; Cecconello, Ivan

    2014-01-01

    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. To describe profile functionality in obese elderly referred to a bariatric surgery program. 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 positive correlation of dependency in

  3. A nomogram for predicting surgical complications in bariatric surgery patients.

    Science.gov (United States)

    Turner, Patricia L; Saager, Leif; Dalton, Jarrod; Abd-Elsayed, Alaa; Roberman, Dmitry; Melara, Pamela; Kurz, Andrea; Turan, Alparslan

    2011-05-01

    To minimize morbidity and mortality associated with surgery risks in the obese patient, algorithms offer planning operative strategy. Because these algorithms often classify patients based on inadequate category granularity, outcomes may not be predicted accurately. We reviewed patient factors and patient outcomes for those who had undergone bariatric surgical procedures to determine relationships and developed a nomogram to calculate individualized patient risk. From the American College of Surgeons National Security Quality Improvement Program database, we identified 32,426 bariatric surgery patients meeting NIH criteria and treated between 2005 and 2008. We defined a composite binary outcome of 30-day postoperative morbidity and mortality. A predictive model based on preoperative variables was developed using multivariable logistic regression; a multiple imputation procedure allowed inclusions of observations with missing data. Model performance was assessed using the C-statistic. A calibration plot graphically assessed the agreement between predicted and observed probabilities in regard to 30-day morbidity/mortality. The nomogram model was constructed for maximal predictive accuracy. The estimated C-statistic [95% confidence interval] for the predictive nomogram was 0.629 [0.614, 0.645], indicative of slight to moderate discriminative ability beyond that of chance alone, and the greatest impacts on the estimated probability of morbidity/mortality were determined to be age, body mass index, serum albumin, and functional status. By accurately predicting 30-day morbidity and mortality, this nomogram may prove useful in patient preoperative counseling on postoperative complication risk. Our results additionally indicate that neither age nor presence of obesity-related comorbidities should exclude patients from bariatric surgery consideration.

  4. Should patients with symptomatic Hashimoto's thyroiditis pursue surgery?

    Science.gov (United States)

    McManus, Catherine; Luo, Jie; Sippel, Rebecca; Chen, Herbert

    2011-09-01

    In this study, patients with Hashimoto's Thyroiditis and significant symptoms were evaluated for improvement or resolution of preoperative symptoms after thyroidectomy. Hashimoto's thyroiditis (HT) is an organ-specific autoimmune disease characterized by production of antibodies such as anti-thyroperoxidase (TPO), which leads to destruction of the thyroid gland and a decrease in normal thyroid function. Thyroidectomy is not generally recommended because the dense inflammatory process that surrounds the thyroid gland can make resection more difficult. However, patients with HT are considered for surgery if they experience persistent symptoms after conservative therapy. We hypothesized that patients with HT and significant compressive and other associated symptoms may benefit from thyroidectomy for palliation. We identified 1791 patients who underwent thyroidectomy from May 1994 to December 2009. Of those 1791 patients, 311 were diagnosed with HT. Of these 311 patients, 133 had 170 significant preoperative symptoms, and served as our sample population. Patients were subjectively evaluated for improvement or relief of symptoms postoperatively. The mean age of the group was 46 ± 1 y, and 90% were female. Patients underwent lobectomy (33%), subtotal thyroidectomy (6%), or total thyroidectomy (61%). The overall rate of symptomatic improvement for HT patients was 90% after thyroidectomy. The most frequent preoperative symptom was compression, and >93% of patients experienced relief. In addition, we found high rates of improvement for HT patients with other preoperative symptoms including voice problems (77%), hormone imbalance (84%), and other (90%). The overwhelming majority of HT patients with significant symptoms appear to benefit from thyroidectomy. Therefore, HT patients should consider pursuing surgery for palliation if they suffer from persistent symptoms after conservative therapy. Copyright © 2011 Elsevier Inc. All rights reserved.

  5. Management of patients with type 2 diabetes before and after bariatric surgery: evolution and microvascular complications

    OpenAIRE

    L. L. Chuah; Carel W. le Roux

    2013-01-01

    Bariatric surgery is increasingly seen as a treatment option for patient with type 2 diabetes (T2DM) and severe complex obesity (SCO). There is however no consensus on how to manage this cohort preoperatively and postoperatively. Patients with T2DM having cardiac surgery benefit from glycaemic optimisation prior to surgery. National Health Service Diabetes in the United Kingdom recommends that glucose is optimised prior to all elective surgery. However, bariatric surgery such as gastric bypas...

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

    Directory of Open Access Journals (Sweden)

    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.

  7. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    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

  8. Laminectomy in patients with achondroplasia: the impact of time to surgery on long-term function.

    Science.gov (United States)

    Carlisle, Emily Streyer; Ting, Beverlie L; Abdullah, Madeel A; Skolasky, Richard L; Schkrohowsky, Joshua G; Yost, Mary T; Rigamonti, Daniele; Ain, Michael C

    2011-05-15

    Retrospective analysis, survey. To describe a cohort of individuals with achondroplasia undergoing thoracolumbar laminectomy and to examine if shorter time to surgery was related to improvement in long-term functional outcome. Data on the long-term benefits of laminectomy are mixed for such patients. Earlier intervention may be associated with greater likelihood of long-term benefit, but quantified data are lacking. We retrospectively studied 49 patients with achondroplasia who underwent primary laminectomy for spinal stenosis. Patients completed a questionnaire to assess symptoms, walking distance, and independence (per Modified Rankin Scale), before surgery and currently. Responses were analyzed for the likelihood of improved walking distance or Rankin level. Our patients had the following mean values: age, 37.7 ± 10.6 years; body mass index, 31.8 ± 5.5; symptom duration, 74.0 ± 100.1 months; preoperative symptom severity score, 2.7 ± 1.0 points; mean changes in blocks walked, +0.39 ± 2.0; and Rankin level, +0.08 ± 1.47. Patients with a time-to-surgery interval of 6 months. Intervals of up to 12 and 24 months were associated with increased likelihoods of 4.95 (95% CI, 1.41-17.41) and 3.43 (95% CI, 1.05-11.22), respectively, of improved walking distance compared with those with longer time-to surgery intervals, but those Rankin level improvements were not statistically significant. Time from symptom onset to surgery in patients with achondroplasia is an important predictor of long-term functional outcome. For sustained long-term postsurgical improvement, the window of opportunity might be relatively narrow. Patients with achondroplasia should seek medical advice for spinal stenotic symptoms as soon as possible.

  9. Psychometric evaluation of disordered eating measures in bariatric surgery patients.

    Science.gov (United States)

    Parker, Katrina; Mitchell, Sarah; O'Brien, Paul; Brennan, Leah

    2015-12-01

    Bariatric surgery is considered the most effective weight loss intervention for obese persons. However, accurate assessment is essential to identify disordered eating that may impair achievement of optimal post-surgical outcomes. Measures of disordered eating are yet to be thoroughly psychometrically evaluated in bariatric surgery patients, therefore their utility is unknown. Participants were 108 adults who completed psychological measures approximately 12 months after bariatric surgery. The fit of the original scale structures was tested using Confirmatory Factor Analysis (CFA) and alternative factor solutions were generated using Exploratory Factor Analysis (EFA). Reliability (internal consistency) and construct validity (convergent and divergent) were also assessed. Eating Disorder Examination Questionnaire (EDE-Q), Questionnaire of Eating and Weight Patterns Revised (QEWP-R), Three Factor Eating Questionnaire (TFEQ) and Clinical Impairment Assessment (CIA). CFA revealed none of the original disordered eating measures met adequate fit statistics. EFA produced revised scales with improved reliability (original scales α=0.47-0.94; revised scales α=0.76-0.98) and correlational analyses with measures of psychological wellbeing and impairment demonstrated adequate convergent validity. Reported prevalence of disordered eating behaviours differed between the EDE-Q and QEWP-R. Psychometric evaluation did not support the use of the commonly used disordered eating measures in bariatric patients in their original form. The revised version of the EDE-Q replicates findings from recent research in bariatric surgery candidates. The alternate structures of the CIA and TFEQ suggest differences in the manifestation of disordered eating following surgery. Results suggest that revised measures are required to overcome the limitations of existing measures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. 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.

  11. Single-incision laparoscopic surgery for diverticulitis in overweight patients.

    Science.gov (United States)

    Rink, Andreas D; Vestweber, Boris; Hahn, Jasmina; Alfes, Angelika; Paul, Claudia; Vestweber, Karl-Heinz

    2015-10-01

    Single-incision laparoscopic surgery (SILS) has been introduced as a new technique for the treatment of various colorectal diseases. Recurrent or complicated diverticulitis of the sigmoid colon is a frequent indication for minimally invasive sigmoid colectomy. The aim of this study was to investigate the impact of obesity on the outcome of SILS sigmoid colectomy. From September 2009 to October 2014, data from 377 patients who had intended SILS sigmoid colectomy for diverticulitis at our institution were collected in a prospective database. The patients were categorized in the following subgroups: group 1 (normal weight, body mass index (BMI)  35 kg/m(2)). The groups were equivalent for sex, age, status of diverticulitis, the presence of acute inflammation in the specimen, and the percentage of teaching operations, but the percentage of patients with accompanying diseases was significantly more frequent in groups 2, 3, and 4 (p = 0.04, 0.008, and 0.018, respectively). As compared to group 1, the conversion rate was significantly increased in groups 2 and 4 (2.3 vs. 9.3% (p = 0.013) and 2.3 vs. 12.5% (p = 0.017), respectively). The duration of surgery, hospitalization, and morbidity did not differ between the four groups. Up to a body mass index of 35 kg/m(2), increased body weight does not significantly reduce the feasibility and outcome of single-incision laparoscopic surgery for diverticulitis.

  12. 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.

  13. 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.

  14. Emergency surgery on mentally impaired patients: standard in consenting

    Directory of Open Access Journals (Sweden)

    Mihai Paduraru

    2018-04-01

    Full Text Available Emergency surgery is often performed on the elderly and susceptible patients with significant comorbidities; as a consequence, the risk of death or severe complications are high. Consent for surgery is a fundamental part of medical practice, in line with legal obligations and ethical principles. Obtaining consent for emergency services (for surgical patients with chronic or acute mental incapacity, due to surgical pathology is particularly challenging, and meeting the standards requires an up-to-date understanding of legislation, professional body guidelines, and ethical or cultural aspects. The guidance related to consent requires physicians and other medical staff to work with patients according to the process of ‘supported decision-making’. Despite principles and guidelines that have been exhaustively established, the system is sometimes vulnerable in actual clinical practice. The combination of an ‘emergency’ setting and a patient without mental ‘capacity’ is a challenge between patient-centered and ‘paternalistic’ approaches, involving legislation and guidelines on ‘best interests’ of the patient.

  15. Controlled invasive mechanical ventilation strategies in obese patients undergoing surgery.

    Science.gov (United States)

    Maia, Lígia de Albuquerque; Silva, Pedro Leme; Pelosi, Paolo; Rocco, Patricia Rieken Macedo

    2017-06-01

    The obesity prevalence is increasing in surgical population. As the number of obese surgical patients increases, so does the demand for mechanical ventilation. Nevertheless, ventilatory strategies in this population are challenging, since obesity results in pathophysiological changes in respiratory function. Areas covered: We reviewed the impact of obesity on respiratory system and the effects of controlled invasive mechanical ventilation strategies in obese patients undergoing surgery. To date, there is no consensus regarding the optimal invasive mechanical ventilation strategy for obese surgical patients, and no evidence that possible intraoperative beneficial effects on oxygenation and mechanics translate into better postoperative pulmonary function or improved outcomes. Expert commentary: Before determining the ideal intraoperative ventilation strategy, it is important to analyze the pathophysiology and comorbidities of each obese patient. Protective ventilation with low tidal volume, driving pressure, energy, and mechanical power should be employed during surgery; however, further studies are required to clarify the most effective ventilation strategies, such as the optimal positive end-expiratory pressure and whether recruitment maneuvers minimize lung injury. In this context, an ongoing trial of intraoperative ventilation in obese patients (PROBESE) should help determine the mechanical ventilation strategy that best improves clinical outcome in patients with body mass index≥35kg/m 2 .

  16. Dipyridamole thallium imaging may not be a reliable screening test for coronary artery disease in patients undergoing vascular surgery

    International Nuclear Information System (INIS)

    Marwick, T.H.; Underwood, D.A.

    1990-01-01

    Dipyridamole thallium imaging has been proposed for cardiac risk stratification in patients undergoing peripheral vascular surgery. The purpose of this study was to define the benefit of this investigation in routine preoperative evaluation of these patients. The outcome of 86 patients undergoing vascular surgery procedures was examined in light of preoperative clinical assessment and dipyridamole SPECT thallium imaging (DST). Fifty-one patients (59%) were considered at high risk on clinical grounds, and 22 patients (26%) had perfusion defects. Ten patients suffered a perioperative coronary event, including unstable angina, myocardial infarction, or cardiac death. Seven of the patients with such events were among the 51 clinically high-risk subjects (14%). Three perioperative events occurred in the group of 19 patients with positive DST images who underwent surgery (16%), but the DST test failed to identify 7 patients who suffered coronary events. The frequency of abnormal thallium imaging was similar to the prevalence of angiographically significant coronary disease reported previously at this center, but considerably less than the rate of abnormal thallium imaging in past studies of vascular surgery patients. The application of the test to a low to moderate risk population is probably responsible for its lower predictive accuracy for coronary events. DST is not an ideal routine noninvasive technique for risk stratification in patients undergoing vascular surgery

  17. 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

  18. 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.

  19. 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.

  20. The response of the microcirculation to cardiac surgery

    NARCIS (Netherlands)

    Kara, Atila; Akin, Sakir; Ince, Can

    2016-01-01

    Purpose of reviewCardiac surgery is associated with a wide range of microvascular derangements and with reduced tissue oxygenation. Although the macrohemodynamical targets during surgery may be achieved, the microcirculation may be damaged and remain dysfunctional. Direct observations of the

  1. 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

    2018-01-01

    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.

  2. Satisfaction and complications in post-bariatric surgery abdominoplasty patients.

    Science.gov (United States)

    Larsen, M; Polat, F; Stook, F P; Oostenbroek, R J; Plaisier, P W; Hesp, W L E M

    2007-01-01

    Bariatric surgery is an expanding field, with subsequent increases in the number of patients seeking additional corrective procedures including abdominoplasty. Complication rates and body image changes may be different from the general population seeking corrective procedures. We performed a retrospective study by questionnaire and chart-based review of the patients who underwent laparoscopic adjustable gastric banding (LAGB) and abdominoplasty at our hospital between 1995 and 2004. Outcome variables included minor and major complications and satisfaction with body image and functional outcome. Patients who returned the completed questionnaire were included in the study (n = 25). The most prevalent complications were seroma formation (25%) and wound infections requiring antibiotics (13%). Hygiene, mobility and general functional capacity improved in 68%, 72%, and 80%, respectively. Body satisfaction and body mass index (BMI) did not markedly change, while self-efficacy improved after abdominoplasty. Abdominoplasty is a safe and effective method of body contour correction in patients with massive weight loss after bariatric surgery. However, a BMI as close to the ideal as possible is necessary for the complication rate to approach that of the general population undergoing abdominoplasty. Patients should be made aware of the difference in body image changes after abdominoplasty as compared to post-LAGB, as well as the trend towards an unchanged BMI.

  3. Surgery as a Double-Edged Sword: A Clinically Feasible Approach to Overcome the Metastasis-Promoting Effects of Surgery by Blunting Stress and Prostaglandin Responses

    Energy Technology Data Exchange (ETDEWEB)

    Benish, Marganit; Ben-Eliyahu, Shamgar, E-mail: shamgar@post.tau.ac.il [Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv 69978 (Israel)

    2010-11-24

    Surgery remains an essential therapeutic approach for most solid malignancies, including breast cancer. However, surgery also constitutes a risk factor for promotion of pre-existing micrometastases and the initiation of new metastases through several mechanisms, including the release of prostaglandins and stress hormones (e.g., catecholamines and glucocorticoids). However, the perioperative period also presents an opportunity for cell mediated immunity (CMI) and other mechanisms to eradicate or control minimal residual disease, provided that the deleterious effects of surgery are minimized. Here, we discuss the key role of endogenous stress hormones and prostaglandins in promoting the metastatic process through their direct impact on malignant cells, and through their deleterious impact on anti-cancer CMI. We further discuss the effects of anesthetic techniques, the extent of surgery, pain alleviation, and timing within the menstrual cycle with respect to their impact on tumor recurrence and physiological stress responses. Last, we suggest an attractive perioperative drug regimen, based on a combination of a cyclooxygenase (COX)-2 inhibitor and a β-adrenergic blocker, which we found effective in attenuating immune suppression and the metastasis-promoting effects of surgery in several tumor models. This regimen is clinically applicable, and could potentially promote disease free survival in patients operated for breast and other types of cancer.

  4. [Risk factors for nosocomial pneumonia in patients with abdominal surgery].

    Science.gov (United States)

    Evaristo-Méndez, Gerardo; Rocha-Calderón, César Haydn

    2016-01-01

    The risk of post-operative pneumonia is a latent complication. A study was conducted to determine its risk factors in abdominal surgery. A cross-sectional study was performed that included analysing the variables of age and gender, chronic obstructive pulmonary disease and smoking, serum albumin, type of surgery and anaesthesia, emergency or elective surgery, incision site, duration of surgery, length of hospital stay, length of stay in the intensive care unit, and time on mechanical ventilation. The adjusted odds ratio for risk factors was obtained using multivariate logistic regression. The study included 91 (9.6%) patients with pneumonia and 851 (90.4%) without pneumonia. Age 60 years or over (OR=2.34), smoking (OR=9.48), chronic obstructive pulmonary disease (OR=3.52), emergency surgery (OR=2.48), general anaesthesia (OR=3.18), surgical time 120 minutes or over (OR=5.79), time in intensive care unit 7 days or over (OR=1.23), time on mechanical ventilation greater than or equal to 4 days (OR=5.93) and length of post-operative hospital stay of 15 days or over (OR=1.20), were observed as independent predictors for the development of postoperative pneumonia. Identifying risk factors for post-operative pneumonia may prevent their occurrence. The length in the intensive care unit of greater than or equal to 7 days (OR=1.23; 95% CI 1.07 - 1.42) and a length postoperative hospital stay of 15 days or more (OR=1.20; 95% CI 1.07 - 1.34) were the predictive factors most strongly associated with lung infection in this study. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  5. Outcome of Anesthesia and Open Heart Surgery in Pregnant Patients

    Directory of Open Access Journals (Sweden)

    Alireza Mahoori

    2007-03-01

    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. 

  6. Menstrual Concerns and Intrauterine Contraception Among Adolescent Bariatric Surgery Patients

    Science.gov (United States)

    Miller, Rachel J.; Inge, Thomas H.

    2011-01-01

    Abstract Objective Adolescent obesity has dramatically increased in recent decades, and along with that so have other medical comorbidities, such as hypertension, diabetes, hyperlipidemia, nonalcoholic steatohepatitis, polycystic ovary syndrome (PCOS), and pseudotumor cerebri. Obesity and related comorbidites may be contraindications to hormonal contraception, making contraception counseling of morbidly obese adolescents more challenging. Obese adolescent females seeking bariatric surgery need effective contraception in the postoperative period. This study is designed to determine the acceptance rate of the levonorgestrel-releasing intrauterine device (IUD) and describe common menstrual problems in obese adolescent bariatric surgery patients. Methods This is a historic cohort study of adolescent females who underwent bariatric surgery over a 2-year period at a tertiary referral center for pediatric obesity. Data were systematically abstracted. The percent of patients with menstrual problems and the acceptance rate for the levonorgestrel-releasing IUD were determined. Results Twenty-five adolescents met inclusion criteria. The mean age was 17.4 years (standard deviation [SD] 2.6), and the mean body mass index (BMI) was 51.4 (SD 6.3) kg/m2. Eighty-four percent were white. Twenty-eight percent had menorrhagia, 32% had oligomenorrhea, 40% had dysmenorrhea, and 36% had PCOS. Ninety-two percent (23 of 25) underwent IUD placement. Conclusions There was a high prevalence of menstrual problems among this sample of severely obese adolescent females. The majority accepted the IUD, indicating it is a viable option among this population. PMID:21413894

  7. Visual acuity and nystagmus following strabismus surgery in patients with oculocutaneous albinism.

    Science.gov (United States)

    Villegas, Victor M; Díaz, Lilliam; Emanuelli, Andres; Izquierdo, Natalio J

    2010-12-01

    To evaluate the effect of strabismus surgery on nystagmus and visual acuity in patients with oculocutaneous albinism. We conducted a non-concurrent retrospective study of 13 Puerto Rican patients with all types of oculocutaneous albinism who underwent strabismus surgery. Patients underwent genetic linkage analysis to reach a final oculocutaneous albinism classification prior to surgery. Strabismus surgery was modified by under-correction of 0.5 mm in each muscle from the standard Marshall Parks' measurements in all patients. Six of the 13 patients with oculocutaneous reported an improved best corrected visual acuity after surgery. Two of the 13 patients with oculocutaneous had no nystagmus following strabismus surgery. All patients were orthotropic following surgery. Strabismus surgical undercorrection may be of benefit in patients with oculocutaneous albinism.

  8. Anesthetic management of patients undergoing extra-anatomic renal bypass surgery for renovascular hypertension

    Directory of Open Access Journals (Sweden)

    Kumar Bhupesh

    2011-01-01

    Full Text Available Renal artery disease is the most common cause for surgically curable form of hypertension. In a small subset of patients with severe aortic disease where the aorta is not suitable for endovascular technique and to provide an arterial inflow, an extra-anatomic renal bypass surgery (EARBS is an option. Anesthetic management of such procedures has not been described so far in the literature. We retrospectively analyzed the anesthetic techniques used in all patients who underwent EARBS between February 1998 and June 2008 at this institute. We also further analyzed data concerning blood pressure (BP control and renal function response following surgery as outcome variable measures. A total of 11 patients underwent EARBS during this period. Five received oral clonidine with premedication. During laryngoscopy, esmolol was used in 4 patients, while lignocaine was used in remaining 7 patients. Of 11 patients, 7 showed significant hemodynamic response to laryngoscopy and intubation; among these, one had oral clonidine with premedicant, and 6 received lignocaine just before laryngoscopy. Intravenous vasodilators were used to maintain target BP within 20% of baseline during perioperative period. All patients received renal protective measures. During follow-up, 10% were considered cured, 70% had improved BP response, while 20% failed to show improvement in BP response. Renal functions improved in 54.5%, remain unchanged in 36.5%, and worsened in 9% of patients. Use of clonidine during premedication and esmolol before laryngoscopy were beneficial in attenuating hemodynamic response to laryngoscopy, while use of vasodilators to maintain target BP within 20% of baseline, and routine use of renal protective measures appear to be promising in patients undergoing EARBS.

  9. Transforaminal epidural steroid injections influence Mechanical Diagnosis and Therapy (MDT) pain response classification in candidates for lumbar herniated disc surgery.

    Science.gov (United States)

    van Helvoirt, Hans; Apeldoorn, Adri T; Knol, Dirk L; Arts, Mark P; Kamper, Steven J; van Tulder, Maurits W; Ostelo, Raymond W

    2016-04-27

    Prospective cohort study. Although lumbar radiculopathy is regarded as a specific diagnosis, the most effective treatment strategy is unclear. Commonly used treatments include transforaminal epidural steroid injections (TESIs) and Mechanical Diagnosis & Therapy (MDT), but no studies have investigated the effectiveness of this combination. MDT differentiates pain centralization (C) from non-centralization (NC), which indicates good vs. poor prognostic validity respectively. The main aims were 1) to determine changes in Mechanical Diagnosis and Therapy (MDT) pain response classifications after transforaminal epidural steroid injections (TESIs) in candidates for lumbar herniated disc surgery and 2) to evaluate differences in short and long term outcomes for patients with different pain response classifications. Candidates for lumbar herniated disc surgery were assessed with a MDT protocol and their pain response classified as centralizing or peripheralizing. For this study,only patients were eligible who showed a peripheralizing pain response at intake. All patients then received TESIs and were reassessed and classified using the MDT protocol, into groups according to pain response (resolved, centralizing, peripheralizing with less pain and peripheralising with severe pain). After receiving targeted treatment based on pain response after TESIs, ranging from advice, MDT or surgery, follow-up assessments were completed at discharge and at 12 months. The primary outcomes were disability (Roland-Morris Disability Questionnaire [RMDQ] for Sciatica), pain severity in leg (visual analogue scale [VAS], 0-100) and global perceived effect (GPE). Linear mixed-models were used to determine between-groups differences in outcome. A total of 77 patients with lumbar disc herniation and peripheralizing symptoms were included. Patients received an average of 2 (SD 0.7) TESIs. After TESIs, 17 patients (22%) were classified as peripheralizing with continuing severe pain.These patients

  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. Patient Positioning and Port Placement for Robot-Assisted Surgery

    Science.gov (United States)

    Chang, Charles; Steinberg, Zoe; Shah, Anup

    2014-01-01

    Abstract The introduction of robotic surgical systems and their integration into minimally invasive procedures have changed the landscape of laparoscopic surgery dramatically. Intuitive Surgical's da Vinci Surgical System was first approved by the Food and Drug Administration for cardiothoracic procedures in the late 1990s. This trend quickly spread through other surgical specialties, with urologists as one of the frontrunners in adoption. Subsequently, pediatric urologists have adopted robot-assisted procedures in selected centers, performing procedures such as pyeloplasty for ureteropelvic junction obstruction, partial and complete nephrectomy, and both intravesical and extravesical ureteral reimplantation. In this article, we will discuss technical considerations related to patient positioning and port placement in pediatric robot-assisted surgery. PMID:24548088

  12. Satisfaction among ambulatory surgery patients in two hospitals in Iceland.

    Science.gov (United States)

    Sigurthardottir, A K

    1996-03-01

    This study aims to investigate the level of satisfaction of care received among patients undergoing ambulatory surgery in two hospitals in Iceland, using the Patient Satisfaction Instrument (PSI). The PSI consists of 25 items, broken down into three sub-scales which measure the patients' attitude towards nursing care. The sample consisted of ambulatory patients undergoing orthopaedic, urological, hernia or varicose veins operations. The patients were 16 years or older and we enlisted 70 individuals from each hospital. Overall, the results show that patients are generally satisfied with the level of care they have received. The patients in group I are more satisfied than the patients in group II; however, only four out of the 25 items which were scored attracted a significance level of nurses as satisfactory but felt they did not receive enough information about their operation from the nurses. Although the patients were generally satisfied with the level of care received, they also identified instances where they felt that the level of care was inadequate; however, as results from other studies show, patients often experience difficulties articulating something negative about their nurses and the care they have received.

  13. 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...

  14. Venous thromboembolism prevention in patients undergoing colorectal surgery for cancer.

    Science.gov (United States)

    Holwell, Anna; McKenzie, Jo-Lyn; Holmes, Miranda; Woods, Rodney; Nandurkar, Harshal; Tam, Constantine S; Bazargan, Ali

    2014-04-01

    Patients undergoing surgery for colorectal cancer are at high risk of post-operative venous thromboembolism (VTE). Thromboprophylaxis has been shown to have significant risk reduction, although there remains some controversy surrounding the optimal duration of pharmacological prophylaxis. Our institution does not routinely practise extended prophylaxis. The aim of this study was to retrospectively review the rate of post-operative thromboprophylaxis in colorectal cancer patients, and incidence of symptomatic VTE. We conducted a retrospective audit of 200 consecutive patients who underwent colorectal surgery for cancer. Data to 90 days post-operatively were collected from medical records and imaging and phone calls to patients and family practitioners. Of the patients, 98% received pharmacological prophylaxis, with a median duration of eight days. Eight (4%) symptomatic VTEs were diagnosed within the 90-day follow-up period: two deep vein thrombosis (DVTs), five pulmonary emboli (PE) and one patient with both PE and DVT. A higher proportion of patients developed DVT/PE if they received prophylaxis other than low molecular weight heparin and similarly there was a trend in increased risk of DVT in the presence of metastatic disease. However, using univariate analysis, these results were not statistically significant (P = 0.18 and 0.11, respectively). The use of thromboprophylaxis was high in our centre, and the incidence of VTE was low when patients received a median of 8 days pharmacological prophylaxis combined with mechanical prophylaxis. The VTE incidence of 4% is similar to previous studies using extended prophylaxis. Our study findings do not support changing local protocol to extended prophylaxis. © 2013 Royal Australasian College of Surgeons.

  15. Patients' assessment of 4-week recovery after ambulatory surgery.

    Science.gov (United States)

    Brattwall, M; Warrén Stomberg, M; Rawal, N; Segerdahl, M; Jakobsson, J; Houltz, E

    2011-01-01

    patients' own assessment of recovery after ambulatory surgery has not been well studied. The aim was to study patients' self-assessed recovery, the occurrence and time course of post-operative problems in relation to the type of ambulatory surgery. a questionnaire was filled in by 355 patients at five time points: pre-operative, first day at home, 1, 2 and 4 weeks post-operatively. Consecutive patients who underwent either inguinal hernia repair (IHR), arthroscopic procedures (AS) or cosmetic breast augmentation (CBA) were included. unplanned return to hospital was rare (3/355). Health care contacts were noted for 9% of the patients during the first week; a total of 70 contacts occurred during the entire period. Pain was the most frequently reported symptom; 40% of the patients reported pain or mobility problems at 1 week, 28% after 2 weeks and 20% after 4 weeks. Pre-operative pain was associated with an increased level of pain during the early post-operative course, in the recovery room and at 1 week post-operatively. IHR was associated with an overall rapid recovery, while AS patients experienced a slower restitution. All AS patients who reported pain after 4 weeks had reported pain problems already pre-operatively. Pain was not present pre-operatively in the CBA group, but was common at 1 and 2 post-operative weeks and was still reported by 11% at 4 weeks. self-assessed recovery was found to cover several weeks with procedure-specific recovery patterns. Pain and mobility impairment were still frequently reported 4 weeks post-operatively. 2010 The Acta Anaesthesiologica Scandinavica Foundation.

  16. Cataract surgery in patients with neovascular age-related macular degeneration

    DEFF Research Database (Denmark)

    Kessel, Line; Theil, Pernille Koefoed; Sørensen, Torben Lykke

    2016-01-01

    Purpose To examine the outcome after cataract surgery in patients with neovascular age-related macular degeneration (AMD) treated with intravitreal anti-vascular endothelial growth factor (VEGF) injections in routine clinical practice. Methods We extracted information about patients recorded...... 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 being...... with an average of 1.5 in the 6 months before surgery versus 1.7 in the 6 months after surgery (p = 0.25). Visual improvement was greater in patients when the time from latest injection to cataract surgery was lower. Conclusions Cataract surgery improves vision in patients undergoing treatment for neovascular AMD...

  17. Trends and demographic characteristics of Saudi cosmetic surgery patients.

    Science.gov (United States)

    Alharethy, Sami E

    2017-07-01

    To  present the demographic characteristics of Saudi patients undergoing cosmetic procedures.  Methods: This prospective study survey was conducted in 3 private cosmetic surgery centers in different regions of Saudi Arabia (Riyadh and Jeddah) between January and August 2016. Validated questionnaire with modification was used and the following patient's information were provided: age group, height and weight, marital status, number of children, age of the patient's spouse, educational level, monthly income, name of the cosmetic procedure, names of any previous cosmetic procedures and their reason for cosmetic procedure. Results: The present study revealed that a typical Saudi cosmetic surgery patients are university graduates, married (46.8%), employed (68.3%), and middle aged 20-40 years of age (70%), with a fairly high typical monthly income.  Conclusion: There is a possible positive correlation between gender and undergoing cosmetic procedure. Laser hair removal, botox, liposuction, filler, and scar revision are common among females, while rhinoplasty is a common procedure among males.

  18. Barriers to nurse-patient communication in cardiac surgery wards: a qualitative study.

    Science.gov (United States)

    Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah

    2014-08-15

    An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care.

  19. Oncoplastic surgery; volume displacement techniques for breast conserving surgery in patients with breast cancer.

    Science.gov (United States)

    Gurleyik, Gunay; Karagulle, Hikmet; Eris, Esra; Aker, Fugen; Ustaalioglu, Basak O

    2017-06-01

    Surgical management of breast cancer has drastically changed. Breast-conserving surgery (BCS) has now become a commonly used method for its treatment. Oncoplastic techniques are widely applied with satisfactory aesthetic results. We evaluated the aesthetic and oncological outcomes of BCS with glandular tissue displacement techniques. Seventy-five patients with invasive breast cancer were surgically treated by oncoplastic techniques. Preoperative evaluations, including breast and tumor size, localizations and features, were performed by physical examination, imaging methods, and histopathological analysis. Appropriate volume displacement techniques were planned according to breast and tumor size and localization. Early and late aesthetic results were evaluated. The mean age of the patients was 54 years, and mean tumor size was 25 mm. Tumors were located in the upper-outer quadrant in 44% of patients. Glandular flaps were used in 55 (73%) patients. Racquet mammoplasty was the most preferred method. Nipple areolar complex (NAC) recentralization was performed in 26 (47.3%) of 55 patients with glandular tissue displacement. Therapeutic reduction mammoplasty was performed in 20 patients. All patients underwent adjuvant radiotherapy. After an average follow-up of 24 months, neither locoregional recurrence nor distant metastases were observed. Aesthetic results of the oncoplastic BCS method were very good in 54 (72%) patients. Breast remodeling by glandular flap displacement after a wide local excision should be the primary aim in patients with breast cancer for better aesthetic outcomes. NAC recentralization is the primary component that could be considered for achieving better results. BCS associated with oncoplastic techniques allows wide excision of larger tumors and provides good and satisfactory aesthetic results at long-term follow-up.

  20. Patients' perceptions of cosmetic surgery at a time of globalization, medical consumerism, and mass media culture: a French experience.

    Science.gov (United States)

    Lazar, Câlin Constantin; Deneuve, Sophie

    2013-08-01

    The global popularity of cosmetic surgery, combined with mass media attention on medical consumerism, has resulted in misinformation that may have negatively affected the "collective image" of aesthetic practitioners. The authors assess patients' perceptions of cosmetic surgery and analyze their decision-making processes. During a 2-year period, 250 consecutive patients presenting to either of 2 public hospitals for cosmetic surgery treatment were asked to complete a 7-item questionnaire evaluating their knowledge of opinions about, and referring practices for, aesthetic procedures. Patients undergoing oncologic, postbariatric, or reconstructive procedures were not included in the study. After exclusion of 71 cases for refusal or incompletion, 179 questionnaires were retained and analyzed (from 162 women and 17 men). Overall, repair (70.4%), comfort (45.3%), and health (40.8%) were the words most frequently associated with cosmetic surgery. Quality of preoperative information (69.3%), patient-physician relationship (65.4%), and results seen in relatives/friends (46.3%) were the most important criteria for selecting a cosmetic surgeon. Moreover, 82.7% of patients knew the difference between cosmetic surgery and cosmetic medicine. Although potential patients appear to be more educated about cosmetic surgery than they were several years ago, misinformation still persists. As physicians, we must be responsible for disseminating accurate education and strengthening our collaboration with general practitioners to improve not only our results but also the accuracy of information in the mass media.

  1. Efficacy of restarting anti-tumor necrosis factor α agents after surgery in patients with Crohn's disease

    Directory of Open Access Journals (Sweden)

    Sakiko Hiraoka

    2018-01-01

    Full Text Available Background/Aims: The efficacy of anti-tumor necrosis factor α (anti-TNFα antibodies for postoperative Crohn's disease (CD in patients who were treated with these agents prior to surgery is largely unknown. Methods: CD patients who underwent intestinal resection and received anti-TNFα agents after surgery were divided into 2 groups according to the presence or absence of preoperative anti-TNFα treatment: anti-TNFα restart group or anti-TNFα naïve group. Endoscopic recurrence after surgery was examined according to the preoperative conditions, including administration of anti-TNFα agents before surgery. Results: Thirty-six patients received anti-TNFα antibody after surgery: 22 in the anti-TNFα restart group and 14 in the anti-TNFα naïve group. Endoscopic recurrence after surgery was more frequently observed in the anti-TNFα restart group than in the anti-TNFα naïve group (68% vs. 14%, P<0.001. Multivariate analysis revealed the following significant risk factors of endoscopic recurrence after surgery: anti-TNF restart group (odds ratio [OR], 28.10; 95% CI, 3.08–722.00, age at diagnosis <23 years (OR, 24.30; 95% CI, 1.67–1,312.00, serum albumin concentration at surgery <3.3 g/dL (OR, 34.10; 95% CI, 1.72–2,804.00, and presence of inflammation outside of the surgical site (OR, 21.40; 95% CI, 1.02–2,150.00. Treatment intensification for patients with endoscopic recurrence in the anti-TNFα restart group showed limited responses, with only 1 of 12 patients achieving endoscopic remission. Conclusions: The efficacy of restarting anti-TNFα antibody treatment after surgery was limited, and treatment intensification or a change to different classes of biologics should be considered for those patients.

  2. Preoperative Consultations for Medicare Patients Undergoing Cataract Surgery

    Science.gov (United States)

    Thilen, Stephan R.; Treggiari, Miriam M.; Lange, Jane M.; Lowy, Elliott; Weaver, Edward M.; Wijeysundera, Duminda N.

    2014-01-01

    IMPORTANCE Low-risk elective surgical procedures are common, but there are no clear guidelines for when preoperative consultations are required. Such consultations may therefore represent a substantial discretionary service. OBJECTIVE To assess temporal trends, explanatory factors, and geographic variation for preoperative consultation in Medicare beneficiaries undergoing cataract surgery, a common low-risk elective procedure. DESIGN, SETTING, AND PARTICIPANTS Cohort study using a 5% national random sample of Medicare part B claims data including a cohort of 556 637 patients 66 years or older who underwent cataract surgery from 1995 to 2006. Temporal trends in consultations were evaluated within this entire cohort, whereas explanatory factors and geographic variation were evaluated within the 89 817 individuals who underwent surgery from 2005 to 2006. MAIN OUTCOMES AND MEASURES Separately billed preoperative consultations (performed by family practitioners, general internists, pulmonologists, endocrinologists, cardiologists, nurse practitioners, or anesthesiologists) within 42 days before index surgery. RESULTS The frequency of preoperative consultations increased from 11.3% in 1998 to 18.4% in 2006. Among individuals who underwent surgery in 2005 to 2006, hierarchical logistic regression modeling found several factors to be associated with preoperative consultation, including increased age (75–84 years vs 66–74 years: adjusted odds ratio [AOR], 1.09 [95% CI, 1.04–1.13]), race (African American race vs other: AOR, 0.71 [95% CI, 0.65–0.78]), urban residence (urban residence vs isolated rural town: AOR, 1.64 [95% CI, 1.49–1.81]), facility type (outpatient hospital vs ambulatory surgical facility: AOR, 1.10 [95% CI, 1.05–1.15]), anesthesia provider (anesthesiologist vs non–medically directed nurse anesthetist: AOR, 1.16 [95% CI, 1.10–1.24), and geographic region (Northeast vs South: AOR, 3.09 [95% CI, 2.33–4.10]). The burden of comorbidity was

  3. Effects of corneal cross-linking on ocular response analyzer waveform-derived variables in keratoconus and postrefractive surgery ectasia.

    Science.gov (United States)

    Hallahan, Katie M; Rocha, Karolinne; Roy, Abhijit S; Randleman, J Bradley; Stulting, R Doyle; Dupps, William J

    2014-11-01

    To assess changes in Ocular Response Analyzer (ORA) waveforms after UVA/riboflavin corneal collagen cross-linking (CXL) using investigator-derived and manufacturer-supplied morphometric variables in patients with keratoconus (KC) and postrefractive surgery ectasia. Prospective randomized trial of a standard epithelium-off CXL protocol. Patients with progressive KC (24 eyes of 21 patients) or postrefractive surgery ectasia (27 eyes of 23 patients) were enrolled. Replicate ORA measurements were obtained before and 3 months after CXL. Pretreatment and posttreatment waveform variables were analyzed for differences by paired Student t tests using measurements with the highest waveform scores. Corneal hysteresis, corneal resistance factor, 37-s generation manufacturer-supplied ORA variables, and 15 investigator-derived ORA variables. No variables were significantly different 3 months after CXL in the KC group, and no manufacturer-supplied variables changed significantly in the postrefractive surgery ectasia group. Four custom variables (ApplanationOnsetTime, P1P2avg, Impulse, and Pmax) increased by small but statistically significant margins after CXL in the postrefractive surgery ectasia group. Changes in a small subset of investigator-derived variables suggested an increase in corneal bending resistance after CXL. However, the magnitudes of these changes were low and not commensurate with the degree of clinical improvement or prior computational estimates of corneal stiffening in the same cohort over the same period. Available air-puff-derived measures of the corneal deformation response underestimate the biomechanical changes produced by CXL.

  4. C-Reactive protein level in morbidly obese patients before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    M.E. Rojano-Rodríguez

    2014-04-01

    Conclusions: Preoperative CRP had a significant lineal relation to weight and body mass index. Patients who underwent bariatric surgery had a significant decrease in CRP, weight, and fasting glucose at 6 months after surgery.

  5. Nutritional assessment of bariatric surgery patients presenting for plastic surgery: a prospective analysis.

    Science.gov (United States)

    Naghshineh, Nima; O'Brien Coon, Devin; McTigue, Kathleen; Courcoulas, Anita P; Fernstrom, Madelyn; Rubin, J Peter

    2010-08-01

    Assessment of nutritional status in the growing postbariatric patient population remains controversial. Previous literature suggests that these patients have poor nutrition that may have adverse effects on surgical outcomes. The authors sought to determine the optimal method of nutritional assessment in postbariatric patients. One hundred patients presenting for body contouring after bariatric surgery were consecutively enrolled in an institutional review board-approved prospective study. A trained nutritionist assessed protein and calorie intake. All patients underwent baseline laboratory assessment. Eighteen percent of subjects had less than the recommended daily protein intake. Hypoalbuminemia was observed in 13.8 percent of subjects, with hypoprealbuminemia in 6.5 percent. Nearly forty percent of all patients had evidence of iron deficiency, with vitamin B12 deficiency present in 14.5 percent. Ten percent of subjects (all women) were confirmed to have iron deficiency anemia. Impaired fasting glucose was seen in 6.2 percent of subjects, whereas 3.6 percent had hemoglobin A1c levels greater than 6.5. Increasing age (odds ratio, 1.07) and greater change in body mass index (odds ratio, 1.11) were predictors of low protein intake. Dumping syndrome led to 13.3 times increased odds of low albumin levels. The results suggest that inadequate nutrition is common among postbariatric patients presenting for body contouring. The lack of correlation between methods of nutritional assessment supports the combination of multiple methods in determining overall nutritional status. The presence of dumping syndrome, a large change in body mass index, and advanced age may help to identify patients with an increased risk of nutritional deficiency.

  6. Process efficiency. Redesigning social networks to improve surgery patient flow.

    Science.gov (United States)

    Samarth, Chandrika N; Gloor, Peter A

    2009-01-01

    We propose a novel approach to improve throughput of the surgery patient flow process of a Boston area teaching hospital. A social network analysis was conducted in an effort to demonstrate that process efficiency gains could be achieved through redesign of social network patterns at the workplace; in conjunction with redesign of organization structure and the implementation of workflow over an integrated information technology system. Key knowledge experts and coordinators in times of crisis were identified and a new communication structure more conducive to trust and knowledge sharing was suggested. The new communication structure is scalable without compromising on coordination required among key roles in the network for achieving efficiency gains.

  7. [Minor dentoalveolar surgery in patients ungergoing antithrombotic therapy

    DEFF Research Database (Denmark)

    Nielsen, J.D.; Laetgaard, C.A.; Schou, S.

    2009-01-01

    Minor oral dentoalveolar surgery can be performed safely without interrupting treatment with vitamin K antagonists provided the INR is within therapeutic range. Platelet inhibitors such as aspirin and clopidogrel may increase the risk of bleeding, but the risk of disabling or fatal sequelae...... is generally higher if the treatment is stopped. Application of local haemostatic agents and postoperative mouthwashes with tranexamic acid are recommended. Any changes in antithrombotic therapy must be undertaken in collaboration with the patient's prescribing physician Udgivelsesdato: 2009/4/20...

  8. Approaching revisional surgery in augmentation and mastopexy/augmentation patients.

    Science.gov (United States)

    Dickinson, Brian P; Handel, Neal

    2012-01-01

    Breast augmentation and mastopexy augmentation procedures are becoming more common. The young plastic and reconstructive surgeon is often challenged revisional surgery operations in these patients. These cases are challenging, require significant operative time, and can be associated with a high revision rate. It is important for the young surgeon to have an approach to deal with these common and difficult scenarios. A retrospective chart review was conducted on all patients who underwent a revision augmentation or revision mastopexy augmentation procedure between 2008 and 2010 by the authors. The most commonly encountered mitigating circumstances in the revision augmentation or revision mastopexy augmentation populations were identified and an algorithm was created on how to address these difficult problems. Between July 1, 2008 and July 1, 2010, 264 patients underwent revision augmentation or revision mastopexy augmentation procedures. The most commonly encountered patient scenarios were recurrence of ptosis, recurrent capsular contracture, implant malposition, rippling, and desiring a reduction in implant size. We encountered many mitigating circumstances that complicated the revisions. We devised a stepwise algorithmic approach to address these problems based on the following factors: (1) blood supply to the nipple-areola complex, (2) need to change implant plane, (3) patient desire to reduce or increase in breast implant volume, (4) need for total en bloc capsulectomy or capsulorrhaphy, (5) incision approach used to perform the capsulectomy, and (6) patient-related factors that need to be medically optimized or treated before, during, and after surgery. By adhering to these steps, outcomes can be accomplished more reliably and safely. Specialized preoperative planning is necessary to consistently deliver safe and aesthetic revision augmentation and revision mastopexy augmentation results. It is important for the operative surgeon to carefully consider the

  9. Prevalence of metatarsus adductus in patients undergoing hallux valgus surgery.

    Science.gov (United States)

    Aiyer, Amiethab A; Shariff, Raheel; Ying, Li; Shub, Jeffrey; Myerson, Mark S

    2014-12-01

    Metatarsus adductus (MA) is a congenital condition in which there is adduction of the metatarsals in conjunction with supination of the hindfoot through the subtalar joint. It is generally believed that MA precedes the development of hallux valgus. Historically, studies have demonstrated that patients with a history of MA were ~3.5 times more likely to develop hallux valgus. The purpose of this study was to identify the relative prevalence of MA in patients undergoing surgery for symptomatic hallux valgus. Between 2002 and 2012, 587 patients who underwent hallux valgus surgery were retrospectively identified following IRB approval and parameters including the hallux valgus angle (HVA), the intermetatarsal angle (IMA), and the metatarsus adductus angle (MAA) were recorded. The MAA was considered abnormal if the value was greater than 20 degrees. Interobserver and intraobserver reliability studies for the measurement of the MAA were completed as well. Using the modified Sgarlato technique for measurement of the MAA, there was a high interobserver and intraobserver reliability. The interclass and intraclass coefficients were greater than .90. The prevalence of MA in this patient population was found to be 29.5%. Of those patients with MA, 23 males and 150 females were identified. This gave a male to female ratio of 1:6.5 (P hallux valgus has been reported to be 35%. The data in this study indicate a comparable prevalence at 29.4%. The presence of concomitant MA may portend different outcomes for operative treatment of hallux valgus. Further research needs to delineate rates of persistence of deformity in this patient population to guide operative management. Level IV, case series. © The Author(s) 2014.

  10. The effect of music intervention in stress response to cardiac surgery in a randomized clinical trial.

    Science.gov (United States)

    Nilsson, Ulrica

    2009-01-01

    To evaluate the effect of bed rest with music on the first postoperative day to decrease stress for patients who have undergone heart surgery. A repeated-measures randomized controlled trial was used. The study took place in a cardiothoracic intermediary unit of a university hospital in Sweden. Fifty-eight patients who had undergone open coronary artery bypass grafting or aortic valve replacement surgery were included. Stress response was assessed by determining the serum cortisol, heart rate, respiratory rate, mean arterial pressure, arterial oxygen tension, arterial oxygen saturation, and subjective pain and anxiety levels. At 12:00 noon on postoperative day 1, patients were allocated to receive 30 minutes of uninterrupted bed rest with music and then 30 minutes of bed rest or alternatively 60 minutes of uninterrupted bed rest. The music was soft and relaxing, included different melodies in new-age style, played with a volume at 50 to 60 dB, and distributed through a music pillow connected to an MP3 player. After 30 minutes of bed rest, there was a significant difference in s-cortisol levels between the groups; 484. 4 mmol/L in the music group versus 618.8 mmol/L in the control group (P < .02). However, this difference in s-cortisol levels was not found 30 minutes later (ie, after a total of 60 minutes). There was no difference in heart rate, respiratory rate, mean arterial pressure, arterial oxygen tension, arterial oxygen saturation, and subjective pain and anxiety levels between the groups. There is sufficient practical evidence of stress reduction to suggest that a proposed regimen of listening to music while resting in bed after open heart surgery be put into clinical use.

  11. Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery.

    Science.gov (United States)

    Gessler, Florian; Mutlak, Haitham; Tizi, Karima; Senft, Christian; Setzer, Matthias; Seifert, Volker; Weise, Lutz

    2016-06-01

    OBJECTIVE The value of postoperative epidural analgesia after major spinal surgery is well established. Thus far, the use of patient-controlled epidural analgesia (PCEA) has been denied to patients undergoing debridement and instrumentation in spondylodiscitis, with the risk of increased postoperative pain resulting in prolonged recovery. The value of PCEA with special regard to infectious complications remains to be clarified. The present study examined the value of postoperative PCEA in comparison with intravenous analgesia in patients with spondylodiscitis undergoing posterior spinal surgery. METHODS Thirty-two patients treated surgically for spondylodiscitis of the thoracic and lumbar spine were prospectively included in a database and retrospectively reviewed for this study. Postoperative antibiotic treatment, functional capacity, pain levels, side effects, and complications were documented. Sixteen patients were given patient-demanded intravenous analgesia (PIA) followed by 16 patients assigned to PCEA. If PCEA was applied, the insertion of an epidural catheter was performed under the direct visual guidance of the surgeon at the end of the surgery. RESULTS Three patients intended for PCEA treatment were excluded due to predefined exclusion criteria. Postoperative pain was significantly lower in the PCEA group during the first 48 hours after surgery (p = 0.03). As determined by the trunk control test conducted at 8 (p spondylodiscitis.

  12. Anthropometric, haemodynamic, humoral and hormonal evaluation in patients with incidental adrenocortical adenomas before and after surgery.

    Science.gov (United States)

    Bernini, Giampaolo; Moretti, Angelica; Iacconi, Pietro; Miccoli, Paolo; Nami, Renato; Lucani, Barbara; Salvetti, Antonio

    2003-02-01

    To compare clinical and humoral parameters before and after surgery in patients with incidental adrenocortical adenomas. Six patients with subclinical Cushing's syndrome and nine with non-functioning adenomas were investigated before and 12 Months after removal of the mass. Anthropometric (body weight, body mass index and waist to hip ratio), haemodynamic (blood pressure and heart rate), metabolic (lipids and oral glucose tolerance test (OGTT)), hormonal (cortisol, plasma renin activity, aldosterone, androgens and catecholamines) and bone metabolism (hydroxyproline, parathyroid hormone, osteocalcin and ostase) parameters were evaluated. In the whole group, a significant decrease in body weight (69.7+/-3.5 vs 70.8+/-3.5 kg, P<0.03), in systolic (135.3+/-5.1 vs 145.6+/-4.9 mmHg, P<0.009) and diastolic (83.7+/-1.9 vs 91.0+/-3.5 mmHg, P<0.03) blood pressure and in glucose levels in response to OGTT (106.4+/-9.6 vs 127.5+/-6.5 mg/dl, P<0.05) was observed after surgery. All other parameters examined did not change significantly. This trend was also found in both groups separately. Analytical data showed a high frequency of overweight/obesity (66.6%), hypertension (66.6%) and impaired glucose profile (26.6%) in our patients, with a greater prevalence of these cardiovascular risk factors in the subclinical Cushing's syndrome group. After surgery, values normalized or improved in eight out of ten hypertensive patients and in three out of four patients with impaired glucose profile. Solid adrenocortical incidentalomas are associated with some cardiovascular risk factors which may be corrected after removal of the mass. Therefore, surgery may be an appropriate choice in patients with subclinical Cushing's syndrome but also in those with solid non-functioning adenomas and coexistent cardiovascular risk factors.

  13. 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.

  14. [Preoperative assessment of patient candidate to prostate cancer surgery].

    Science.gov (United States)

    Beauval, J-B; Mazerolles, M; Salomon, L; Soulié, M

    2015-11-01

    To determine the tools of therapeutic decision that push towards surgical treatment in non metastatic prostate cancer eligible to local treatment. The optimized assessment of the disease and eventual comorbidities improves the selection of patients. Patient's files will be presented in the uro-oncological multidisciplinary discussions to validate the customized therapeutic approach proposed. Literature review using Medline (National library of medicine, Pubmed) and Med Science databases based on the scientific pertinence. Research was focused on the diagnosis of prostate cancer, the evaluation of the disease and patient's characteristics, and finally the elements that are with a surgical treatment (past medical history, past surgical history, functional status, patient's comorbidities, and life expectancy). The pretherapeutic oncologic evaluation allows to estimate the risks associated with prostate cancer; it is an essential aspect of therapeutic decision. Several clinical, biological, imaging and pathological criteria allow to guide decision-making according to tumor aggressiveness and risk of recurrence, estimating the results of the different treatments proposed. On the other hand, the evaluation of lower urinary tract symptoms, urinary continence and sexual function, the integration of anatomical data, past medical and past surgical history are all essential for the therapeutic decision, in addition to the comorbidities (Charlson, ASA, ICD). These elements should be taken all together in order to decide for a radical or conservative management of PCa, they guide decision-making in patients candidate for surgery. For example, age plays a key role in the choice of treatment, even in older men at risk of developing high-risk PCa that can affect overall survival. The combined evaluation of the patient and disease characteristics is of utmost importance in oncology, and especially in the treatment of non-metastatic PCa. The role of the anesthesiologist in the

  15. Pre-operative nutrition support in patients undergoing gastrointestinal surgery.

    Science.gov (United States)

    Burden, Sorrel; Todd, Chris; Hill, James; Lal, Simon

    2012-11-14

    Post-operative management in gastrointestinal (GI) surgery is becoming well established with 'Enhanced Recovery After Surgery' protocols starting 24 hours prior to surgery with carbohydrate loading and early oral or enteral feeding given to patients the first day following surgery. However, whether or not nutritional intervention should be initiated earlier in the preoperative period remains unclear. Poor pre-operative nutritional status has been linked consistently to an increase in post-operative complications and poorer surgical outcome. To review the literature on preoperative nutritional support in patients undergoing gastrointestinal surgery (GI). The searches were initially run in March 2011 and subsequently updated in February 2012. Databases including all EBM Reviews (Cochrane DSR, ACP Journal Club, DARE, CCTR, CMR, HTA and NHSEED) MEDLINE, EMBASE, AMED, British Nursing Index Archive using OvidSP were included and a search was run on each database separately after which duplicates were excluded. The inclusion criteria were randomised controlled trials that evaluated pre-operative nutritional support in GI surgical participants using a nutritional formula delivered by a parenteral, enteral or oral route. The primary outcomes included post-operative complications and length of hospital stay. Two observers screened the abstracts for inclusion in the review and performed data extraction. Bias was assessed for each of the included studies using the bias assessment tables in the Cochrane Software Review Manager (version 5.1, Cochrane Collaboration). The trials were analysed using risk ratios with Mantel-Haenszel in fixed effects methods displayed with heterogeneity. Meta-analyses were undertaken on trials evaluating immune enhancing (IE) nutrition, standard oral supplements, enteral and parenteral nutrition (PN) which were administered pre-operatively.Study characteristics were summarised in tables. Dichotomous and ratio data were entered into meta-analyses for

  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. [Impact of bariatric surgery on vitamin metabolisms in obese patients].

    Science.gov (United States)

    Bodunova, N A; Askerkhanov, R G; Khatkov, I E; Sabelnikova, E A; Parfenov, A I; Tkachenko, E V; Varvanina, G G; Feydorov, I Yu

    2015-01-01

    To investigate the impact of bariatric surgery (BS) on the level of vitamins in obese patients. One hundred obese patients (78 women and 22 men) aged 19 to 61 years were examined. Controlled gastric banding (CGB) was carried out in 20 patients (mean body mass index (BMI), 41.3 ± 8.2 kg/m2); gastric sleeve resection (GSR) in 40 patients, and gastric shunting (GS) in 40 (the mean BMI in these groups were 41.1 ± 17.8 and 45.9 ± 6.2 kg/m2, respectively). A control group consisted of 10 apparently healthy individuals (BMI, 24.9 ± 3.2 kg/m2). An enzyme immunoassay was used to determine the serum concentrations of vitamins B1, B2, B5, B6, B9, B12, C, and D, niacin, biotin, and retinol-binding protein (RBP) before and 1 year after surgery. All the three groups showed a considerable decrease in the levels of vitamins C, B5, B6, and D, and RBP both prior to and following BS. More than 50% of the patients who had undergone GSR had also a lower baseline niacin level. A year after CGB, GSR, and GS, the number of patents with deficiency of these vitamins remained the same or increased. The majority of patients with the same level of vitamin B2, niacin, and folic acid (FA) were observed to have its decrease a year postsurgery. The concentration of the other test vitamins was also reduced a year after all operations; however, it remained within the normal range. GS had no substantial impact on the concentrations of FA, vitamins B2, B12, B1, and biotin. The lower serum vitamin levels were not accompanied by clinical symptoms in most patients following BS. In 80% of the patients with obesity, the levels of vitamins C, B6, and D were decreased to a variable degree. After BS, there was a rise in the number of patients with low serum vitamin C, D, B6, B5, niacin, FA, and RBP concentrations, at the same time the number of patients with FA deficiency increased by more than twice. BS did not significantly affect the metabolism of vitamins B1 B2 B12, and biotin.

  18. Enhanced Recovery After Surgery (ERAS) multimodal programme as experienced by pancreatic surgery patients: Findings from an Italian qualitative study.

    Science.gov (United States)

    Galli, Emanuele; Fagnani, Cristina; Laurora, Ilaria; Marchese, Carmen; Capretti, Giovanni; Pecorelli, Nicolò; Marzo, Elisabetta; Palese, Alvisa; Zannini, Lucia

    2015-11-01

    ERAS has recently been implemented in pancreatic surgery settings, but there is little evidence regarding the effects as perceived by patients. Given the lack of the knowledge in the field, the aim of this study was to capture the experience of patients undergoing pancreatic surgery who received perioperative care based on the ERAS programme. We designed a qualitative study undertaken in the pancreatic surgery unit of San Raffaele Hospital in Milan, Italy. Twenty-two consecutive patients were invited to participate in the study and 13 patients were interviewed. Data was collected between March and December 2012 either through face-to-face or semi-structured telephone follow-up from three to six weeks after discharge. Data was analysed using the interpretative phenomenological approach. Patients who underwent surgical pancreatic procedures and treated with ERAS programme reported experiences based on four themes: (1) Feeling prepared to face surgery, (2) Being actively "inside" or "outside" the programme, (3) Healing at home: the best setting, and (4) "Perceiving the ordinary as extraordinary": reaching independence, once at home. According to the findings, uncomplicated pancreatic surgery patients may benefit from the ERAS programme. Preadmission counselling should help patients to assume an active role. Once the patient returns home, the availability of a caregiver should be thoroughly assessed to guarantee the support needed by patients to successfully complete the ERAS(programme. Surgery and nursing staff should carefully monitor patients and suggest whether they continue, interrupt, or individualise the scheduled ERAS interventions in accordance with a patient's clinical condition and preferred personal timing. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  19. Surgery

    Science.gov (United States)

    ... and sterile gloves. Before the surgery begins, a time out is held during which the surgical team confirms ... the Consumer Version. DOCTORS: Click here for the Professional Version What Participants Need to Know About Clinical ...

  20. Cardiac Evaluation and Monitoring of Patients Undergoing Noncardiac Surgery

    Directory of Open Access Journals (Sweden)

    Arsalan Rafiq

    2017-01-01

    Full Text Available Surgical management of disease has a tremendous impact on our health system. Millions of people worldwide undergo surgeries every year. Cardiovascular complications in the perioperative period are one of the most common events leading to increased morbidity and mortality. Although such events are very small in number, they are associated with a high mortality rate making it essential for physicians to understand the importance of perioperative cardiovascular risk assessment and evaluation. Its involves a detailed process of history taking, patient's medical profile, medications being used, functional status of the patient, and knowledge about the surgical procedure and its inherent risks. Different risk assessment tools and calculators have also been developed to aid in this process, each with their own advantages and limitations. After such a comprehensive evaluation, a physician will be able to provide a risk assessment or it may all lead to further testing if it is believed that a change in management after such testing will help to reduce perioperative morbidity and mortality. There is extensive literature on the significance of multiple perioperative testing modalities and how they can change management. The purpose of our review is to provide a concise but comprehensive analysis on all such aspects of perioperative cardiovascular risk assessment for noncardiac surgeries and provide a basic methodology toward such assessment and decision making.

  1. Trends and demographic characteristics of Saudi cosmetic surgery patients

    Directory of Open Access Journals (Sweden)

    Sami E. Alharethy

    2017-07-01

    Full Text Available Objectives: To present the demographic characteristics of Saudi patients undergoing cosmetic procedures. Methods: This prospective study survey was conducted in 3 private cosmetic surgery centers in different regions of Saudi Arabia (Riyadh and Jeddah between January and August 2016. Validated questionnaire with modification was used and the following patient’s information were provided: age group, height and weight, marital status, number of children, age of the patient’s spouse, educational level, monthly income, name of the cosmetic procedure, names of any previous cosmetic procedures and their reason for cosmetic procedure. Results: The present study revealed that a typical Saudi cosmetic surgery patients are university graduates, married (46.8%, employed (68.3%, and middle aged 20-40 years of age (70%, with a fairly high typical monthly income. Conclusion: There is a possible positive correlation between gender and undergoing cosmetic procedure. Laser hair removal, botox, liposuction, filler, and scar revision are common among females, while rhinoplasty is a common procedure among males.

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

    NARCIS (Netherlands)

    van Dongen, Johanna M.; van Hooff, Miranda L.; Spruit, Maarten; de Kleuver, Marinus; Ostelo, Raymond W.J.G.

    2017-01-01

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

  3. The role of neck surgery in patients with primary oropharyngeal cancer treated by radiotherapy

    International Nuclear Information System (INIS)

    Peters, Lester J.; Weber, Randal S.; Morrison, William H.; Byers, Robert M.; Garden, Adam S.; Goepfert, Helmuth

    1996-01-01

    Purpose: The role of neck surgery in node- positive patients whose primary tumours are treated by definitive radiotherapy is controversial. A planned neck dissection following radiotherapy is frequently recommended regardless of response of the neck nodes to treatment. This analysis was undertaken to assess the risk of withholding planned neck dissection in patients who obtain a complete nodal response to irradiation. Materials and Methods: The analysis is based on all 100 patients treated using the concomitant boost protocol described below who presented between 1984 and 1993 with primary squamous cell carcinomas of the oropharynx and clinically positive cervical lymphadenopathy. There were 73 males and 27 females with a median age of 59. Primary disease site was base of tongue 39, tonsil 40, soft palate 14 and pharyngeal wall 7. Nodal stages were N1: 35, N2: 51 and N3: 15. Nodal size varied from 1 - 9 cm with a median of 3 cm. Radiotherapy consisted of 54 Gy in 30 fractions over 6 weeks to large fields with a boost to gross disease of 18 Gy in 12 fractions being delivered as a second daily fraction during the last 2.4 weeks of treatment. Seventy-five patients had their nodal disease treated definitively by radiotherapy; those who had complete clinical resolution of all nodal disease (62) had no planned surgery, while the remaining 13 underwent neck dissection for presumed residual disease. Twenty-five patients had either node excision (8) or neck dissection (17) prior to radiotherapy. Results: There were 8 cases of isolated neck failure of which 3 occurred in the 62 patients who had no planned neck surgery, 0 in the 13 patients who were operated for presumed residual disease (pathologically negative in 7) and 5 in the 25 patients who had initial neck surgery. Of the 62 patients who had a complete response to radiotherapy, the two year probability of neck control was 87% if the initial nodal size was ≤ 3 cm versus 85% for nodes > 3 cm. However the likelihood of

  4. An epidural hematoma in an adolescent patient after cardiac surgery.

    Science.gov (United States)

    Rosen, David A; Hawkinberry, Denzil W; Rosen, Kathleen R; Gustafson, Robert A; Hogg, Jeffery P; Broadman, Lynn M

    2004-04-01

    An 18-yr-old patient had a thoracic epidural placed under general anesthesia preceding an uneventful aortic valve replacement with a bioprosthetic valve. On the second postoperative day, he was anticoagulated and also received an antithrombotic medication. While ambulating, he experienced pain in his back, and there was blood in his epidural catheter. The catheter was removed, and he developed motor and sensory loss. Rapid surgical decompression resulted in recovery of his lost neurological function. Management and strategies for preventing this problem are discussed. Epidural hematoma is a rare complication of epidural anesthesia and has not been reported in pediatric patients undergoing cardiac surgery. The successful treatment of this complication requires swift recognition, diagnosis, and surgical intervention.

  5. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice12

    Science.gov (United States)

    Sherf Dagan, Shiri; Goldenshluger, Ariela; Globus, Inbal; Schweiger, Chaya; Kessler, Yafit; Kowen Sandbank, Galit; Ben-Porat, Tair; Sinai, Tali

    2017-01-01

    Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications. PMID:28298280

  6. Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice.

    Science.gov (United States)

    Sherf Dagan, Shiri; Goldenshluger, Ariela; Globus, Inbal; Schweiger, Chaya; Kessler, Yafit; Kowen Sandbank, Galit; Ben-Porat, Tair; Sinai, Tali

    2017-03-01

    Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1 ) presurgery nutritional evaluation and presurgery diet and supplementation; 2 ) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3 ) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications. © 2017 American Society for Nutrition.

  7. Inflammation and Oxidative Stress in Cardiac Surgery Patients Treated to Intensive Versus Conservative Glucose Targets.

    Science.gov (United States)

    Reyes-Umpierrez, David; Davis, Georgia; Cardona, Saumeth; Pasquel, Francisco J; Peng, Limin; Jacobs, Sol; Vellanki, Priyathama; Fayfman, Maya; Haw, Sonya; Halkos, Michael; Guyton, Robert A; Thourani, Vinod H; Umpierrez, Guillermo E

    2017-01-01

    We aimed to determine (a) longitudinal changes of inflammatory and oxidative stress markers and (b) the association between markers of inflammation and perioperative complications in coronary artery bypass surgery (CABG) patients treated with intensive vs conservative blood glucose (BG) control. Patients with diabetes (n = 152) and without diabetes with hyperglycemia (n = 150) were randomized to intensive (n = 151; BG: 100-140 mg/dL) or to conservative (n = 151; BG: 141-180 mg/dL) glycemic targets. Plasma cortisol, high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor-α, interleukin-6 (IL-6), thiobarbituric acid-reactive substances, and 2'-7'-dichlorofluorescein were measured prior to and at days 3, 5, and 30 after surgery. Intensive glycemic control resulted in lower mean BG (132 ± 14 mg/dL vs 154 ± 17 mg/dL, P < 0.001) in the intensive care unit. Plasma cortisol and inflammatory markers increased significantly from baseline after the third and fifth day of surgery (P < 0.001), and returned to baseline levels at 1 month of follow-up. Patients with perioperative complications had higher levels of cortisol, hsCRP, IL-6, and oxidative stress markers compared with those without complications. There were no significant differences in inflammatory and oxidative stress markers between patients, with or without diabetes or complications, treated with intensive or conventional glucose targets. We report no significant differences in circulating markers of acute inflammatory and oxidative stress response in cardiac surgery patients, with or without diabetes, treated with intensive (100-140 mg/dL) or conservative (141-180 mg/dL) insulin regimens. Copyright © 2017 by the Endocrine Society

  8. Collaboration with an infection control team for patients with infection after spine surgery.

    Science.gov (United States)

    Kobayashi, Kazuyoshi; Imagama, Shiro; Kato, Daizo; Ando, Kei; Hida, Tetsuro; Ito, Kenyu; Tsushima, Mikito; Matsumoto, Akiyuki; Morozumi, Masayoshi; Tanaka, Satoshi; Yagi, Tetsuya; Nishida, Yoshihiro; Ishiguro, Naoki

    2017-07-01

    The risk of infection, including surgical site infection (SSI), after spine surgery has increased due to aging and more immunocompromised hosts. An infection control team (ICT) is responsible for management of health care-associated infections at our institution. The study subjects were 40 patients (18 men and 22 women with an average age of 54 years) referred to the ICT after spine surgery since 2010. Pathogenic bacteria and treatment in these cases were reviewed. Collaboration with the ICT involved guidance on use of antibiotics for infection in 30 patients (16 SSI and 14 non-SSI) and a search for the infection focus for fever of unknown origin in 10 patients (7 patients were found to have urinary tract infections and 2 patients were found to have pneumonia). The detection rate of causative bacteria in ICT consultation was 88% (35 out of 40 patients). SSI patients with instrumentation involved had a significantly higher rate of methicillin-resistant Staphylococcus aureus infection compared with those without instrumentation (42% vs 13%; P < .05). All cases of SSI with instrumentation involved were cured by ICT support without removal of instrumentation. Early assistance from the ICT was important for prevention of worsening of methicillin-resistant S aureus infection. Collaboration with the ICT was helpful for detection of pathogenic bacteria and allowed appropriate use of antibiotics at an early stage. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  9. Surgery in metastatic breast cancer: patients with a favorable profile seem to have the most benefit from surgery.

    Science.gov (United States)

    Rashaan, Z M; Bastiaannet, E; Portielje, J E A; van de Water, W; van der Velde, S; Ernst, M F; van de Velde, C J H; Liefers, G J

    2012-01-01

    About 3-10% of breast cancer patients have distant metastases (Stage IV) at initial presentation; standard treatment (in the Netherlands) of these patients consists of palliative systemic therapy. However, retrospective studies have shown an improved survival in patients who received surgery for their primary tumor. The aim of this study was to assess characteristics associated with surgical treatment and to determine the impact on survival in women with stage IV breast cancer. A cohort of women with a diagnosis of breast cancer and concomitant distant metastases was retrospectively studied. Patient characteristics, treatment and survival distilled from medical files were evaluated using univariate and multivariable analysis. Of 171 patients included in this analysis, 59 underwent surgery. In multivariable analysis lower age, no medication use, lower clinical T-stage and lower grade were associated with receiving surgery. In 21 of the 59 patients (35%) who received surgery it was unknown at the time of surgery that the patient had metastatic disease. Stratified survival analyses showed an association between surgery and improved survival for young patients (HR 0.3; p = 0.02), without comorbidity (HR 0.4; p = 0.002), with no medication use (HR 0.5; p = 0.009), with a small tumor (HR 0.4; p = 0.01), no regional lymph node involvement (HR 0.4; p = 0.01), with positive Estrogen (HR 0.6; p = 0.02) or Progesterone receptor (HR 0.4; p = 0.03) and with only visceral metastases (HR 0.5; p = 0.03). In multivariable analyses, younger patients and patients without comorbidity that received surgery had an increased survival (HR 0.3; p = 0.03 and HR 0.5; p = 0.03, respectively). This study showed that patients with the most favorable profile receive local surgery and that a survival gain for operated patients was seen in young patients and in patients without comorbidity. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. A Psychosocial Analysis of the Effect of Body-Contouring Surgery on Patients After Weight Loss.

    Science.gov (United States)

    Alzahrani, Khalid J; Kattan, Abdullah E; Ezzat, Loui A; Alsaleh, Saud A; Murad, Khalid A; Alghamdi, Bader A

    2017-01-01

    Objectives (Background): Patients are often bothered by excess skin laxity and redundancy after weight loss. Body-contouring surgery offers a solution. This study assessed the psychosocial impact of body-contouring surgery on patients after weight loss. Methods (Settings, Design): In this cross-sectional study, a specifically designed questionnaire developed in collaboration with psychiatric department for our research was used for 43 patients who underwent body-contouring surgery. Data were collected during single visit to the plastic surgery clinic. All the patients had lost 20 kg or less before the surgery and were interviewed at least 6 months after the surgery. The questionnaire was used to compare the psychosocial status of the patients before and after surgery. Data were analyzed appropriately using Statistical Package for the Social Sciences. Results: The participants' mean age was 34 ± 10 years; the sample included 24 (55.8%) women and 19 (44.2%) men (total N = 43). The patients' quality of life improved significantly in the areas of social life ( P sexual activity ( P < .001). Moreover, while 17 (39.5%) patients suffered symptoms of depression before surgery, only 1 (2.3%) patient suffered symptoms of depression after surgery. The overall satisfaction was found to be 62.8%, with mammoplasty being the procedure with the highest satisfaction (66.6%). Conclusion: Body-contouring surgery after weight loss has shown to improve both psychological and social aspects of the patients' lives. Recall bias is the main limitation in our study.

  11. Attenuation of acute systemic inflammatory response after valve surgery

    Directory of Open Access Journals (Sweden)

    Najah R. Hadi

    2017-09-01

    Keywords montelukast, mitral and aortic valve replacement surgery, ischemia reperfusion injury, interleukin-6, cardiac troponin 1, tumor necrotic factor-alpha, alpha 2 macroglobulin/creatinine, ejection fraction, forced vital capacity (FVC, forced expiratory volume in one second (FEV1, FEV1/FVC ratio

  12. Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery.

    Science.gov (United States)

    Rosa, Simone Corrêa; Macedo, Jefferson Lessa Soares DE; Casulari, Luiz Augusto; Canedo, Lucas Ribeiro; Marques, João Vitor Almeida

    2018-01-01

    to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (pprofile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.

  13. 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

  14. 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.

  15. Surgical checklist for cataract surgery: progress with the initiative by the Royal College of Ophthalmologists to improve patient safety

    Science.gov (United States)

    Kelly, S P; Steeples, L R; Smith, R; Azuara-Blanco, A

    2013-01-01

    Purpose The World Health Organisation (WHO) identified patient safety in surgery as an important public health matter and advised the adoption of a universal peri-operative surgical checklist. An adapted version of the WHO checklist has been mandatory in the National Health Service since 2010. Wrong intraocular lens (IOL) implantation is a particular safety concern in ophthalmology. The Royal College of Ophthalmologists launched a bespoke checklist for cataract surgery in 2010 to reduce the likelihood of preventable errors. We sought to ascertain the use of checklists in cataract surgery in 2012. Patients and methods A survey of members of the Royal College of Ophthalmologists seeking views on the use of checklists in cataract surgery. Four hundred and sixty-nine completed responses were received (18% response rate). Results Respondents worked in England (75%), Scotland (11%), Wales (5%), Northern Ireland (2%), the Republic of Ireland (1%), and overseas (6%). Ninety-four per cent of respondents support the use of a checklist for cataract surgery and 85% say that they always use a checklist before cataract surgery. Sixty-seven per cent of cataract surgeons stated they undertake a pre-operative team brief. Thirty-six per cent use a cataract surgery checklist developed locally, 18% use the college's bespoke cataract surgery checklist, 39% use a generic surgical checklist, and 4% reported that they do not use a checklist. Conclusion Ninety-three per cent of cataract surgeons responding to the questionnaire report using a surgical checklist and 67% use a team brief. However, only 54% use a checklist, which addresses the selection of the correct intraocular implant. We recommend wider adoption of checklists, which address risks relevant to cataract surgery, in particular the possibility of selection of an incorrect IOL. PMID:23703633

  16. Effects of mitral valve surgery on myocardial energetics in patients with severe mitral regurgitation.

    Science.gov (United States)

    Chow, Benjamin J W; Abunassar, Joseph G; Ascah, Kathryn; Dekemp, Robert; Dasilva, Jean; Mesana, Thierry; Beanlands, Rob S; Ruddy, Terrence D

    2010-05-01

    Hemodynamically significant mitral regurgitation (MR) may alter left ventricular (LV) myocardial energy requirements. The effects of MR and subsequent corrective mitral valve (MV) surgery on myocardial energetics are not well understood. A better understanding of myocardial energetics and the LV responses to changes in preload and afterload may assist with the understanding of mitral regurgitation and its effect on the LV. We sought to determine the effects of MV surgery on forward stroke work, myocardial oxidative metabolism, and myocardial efficiency. Prospectively enrolled patients with chronic, severe, nonischemic mitral regurgitation underwent echocardiography, radionuclide angiography, and C-11 acetate positron emission tomography to measure LV volumes, ejection fraction, and oxidative metabolism before and 1 year after MV surgery. Forward and total stroke work corrected for oxidative metabolism was used to estimate efficiency using the work metabolic index. Fourteen patients (age, 59+/- 8 years) with myxomatous MV were enrolled. One year after MV surgery, there was a reduction in LV end-diastolic and end-systolic volumes (231+/-86 to 131+/-21 mL; P<0.01 and 98+/-53 to 55+/-17 mL; P<0.01). Forward stroke volume increased (58.1+/-15.0 to 75.5+/-23 mL; P<0.01), LV ejection fraction was preserved without a significant change in oxidative metabolism. Forward work metabolic index improved (4.99+/-1.32 x 10(6) to 6.59+/-2.45 x 10(6) mm Hg x mL/m(2); P=0.02). This was not at the expense of total work metabolic index, which was preserved. MV surgery has a beneficial effect on forward stroke volume and forward work metabolic index without adverse effects on oxidative metabolism or total work metabolic index.

  17. Beyond Weight Loss: Establishing a Postbariatric Surgery Patient Support Group—What Do Patients Want?

    Directory of Open Access Journals (Sweden)

    Saira Hameed

    2018-01-01

    Full Text Available Purpose. There are limited resources for long-term specialist follow-up after bariatric surgery. In selected centres, patients can access a postoperative support group, but there is no clear evidence to guide their delivery. Materials and Methods. A retrospective study of bariatric surgery patients (n = 152 who had been discharged from specialist follow-up (mean time since surgery 5.5 years, covering weight history, physical and psychosocial comorbidities, and the need for a postoperative bariatric support group. Results. Fifty-eight percent wanted a postbariatric surgery patient support group. This was not associated with operation type or the amount of weight lost or regained. However, those who wanted a support group were significantly more likely to be struggling to keep the weight off, to be unhappy with the way they look, or to be experiencing difficulties returning to work. Conclusions. These data point to an unmet patient requirement for a postoperative support group that is independent of weight loss success. More research is required to ascertain how such a group should be delivered, but our data would suggest that supporting patients with weight loss maintenance, body image, and return to work is an important part of postoperative care, and these needs extend well beyond the immediate period of specialist follow-up.

  18. Preparation of Plaster Moulage (Cast in Plastic Surgery patients

    Directory of Open Access Journals (Sweden)

    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.

  19. The impact of bariatric surgery on nutritional status of patients.

    Science.gov (United States)

    Jastrzębska-Mierzyńska, Marta; Ostrowska, Lucyna; Hady, Hady Razak; Dadan, Jacek; Konarzewska-Duchnowska, Emilia

    2015-04-01

    Currently, surgical treatment is considered to be the most efficient method of dealing with morbid obesity. To evaluate changes in nutritional status after surgical treatment of obesity in the early postoperative period. The study included 50 patients (30 women and 20 men) treated surgically due to morbid obesity. During the preliminary visit and during control visits measurements of body mass, height, and waist and hip circumference were conducted. Also, analysis of body content was performed and blood was taken for biochemical analysis. Statistical analysis was conducted using the program Statistica 10. Six months after the surgery, in the group of women, significant reduction of average body mass, average waist circumference, average hip circumference and average body mass index (BMI) was observed. Also, significant reduction of the percentage of body fat and an increase in the percentage of fat-free body mass were observed. A significant decrease in muscle mass was also noted. Both in women and in men, 6 months after the surgery, a significant decrease in fasting glucose concentration, fasting insulin and triglycerides in blood serum was observed. Bariatric procedures lead to significant body mass, BMI, waist and hip circumference reduction. Loss of body mass is caused mainly by the reduction of fat tissue. Application of surgical procedures in morbid obesity treatment also allowed us to achieve improvement in insulin, glucose and lipid metabolism.

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

    Science.gov (United States)

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

    2018-01-12

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

  1. 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)

  2. Evaluation of occupational and patient radiation doses in orthopedic surgery

    International Nuclear Information System (INIS)

    Sulieman, A.; Habiballah, B.; Abdelaziz, I.; Alzimami, K.; Osman, H.; Omer, H.; Sassi, S. A.

    2014-08-01

    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)

  3. Financial costs and patients' perceptions of medical tourism in bariatric surgery.

    Science.gov (United States)

    Kim, David H; Sheppard, Caroline E; de Gara, Christopher J; Karmali, Shahzeer; Birch, Daniel W

    2016-02-01

    Many Canadians pursue surgical treatment for severe obesity outside of their province or country - so-called "medical tourism." We have managed many complications related to this evolving phenomenon. The costs associated with this care seem substantial but have not been previously quantified. We surveyed Alberta general surgeons and postoperative medical tourists to estimate costs of treating complications related to medical tourism in bariatric surgery and to understand patients' motivations for pursuing medical tourism. Our analysis suggests more than $560 000 was spent treating 59 bariatric medical tourists by 25 surgeons between 2012 and 2013. Responses from medical tourists suggest that they believe their surgeries were successful despite some having postoperative complications and lacking support from medical or surgical teams. We believe that the financial cost of treating complications related to medical tourism in Alberta is substantial and impacts existing limited resources.

  4. The role of mental health professionals in gender reassignment surgeries: unjust discrimination or responsible care?

    Science.gov (United States)

    Selvaggi, Gennaro; Giordano, Simona

    2014-12-01

    Recent literature has raised an important ethical concern relating to the way in which surgeons approach people with gender dysphoria (GD): it has been suggested that referring transsexual patients to mental assessment can constitute a form of unjust discrimination. The aim of this paper is to examine some of the ethical issues concerning the role of the mental health professional in gender reassignment surgeries (GRS). The role of the mental health professional in GRS is analyzed by presenting the Standards of Care by the World Professional Association of Transgender Health, and discussing the principles of autonomy and non-discrimination. Purposes of psychotherapy are exploring gender identity; addressing the negative impact of GD on mental health; alleviating internalized transphobia; enhancing social and peer support; improving body image; promoting resilience; and assisting the surgeons with the preparation prior to the surgery and the patient's follow-up. Offering or requesting psychological assistance is in no way a form of negative discrimination or an attack to the patient's autonomy. Contrarily, it might improve transsexual patients' care, and thus at the most may represent a form of positive discrimination. To treat people as equal does not mean that they should be treated in the same way, but with the same concern and respect, so that their unique needs and goals can be achieved. Offering or requesting psychological assistance to individuals with GD is a form of responsible care, and not unjust discrimination. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

  5. Vulvar condylomatosis after sex reassignment surgery in a male-to-female transsexual: Complete response to imiquimod cream.

    Science.gov (United States)

    Labanca, Trinidad; Mañero, Ivan

    2017-05-01

    The number of patients seeking sex reassignment surgery is increasing. Approximately 1:30,000 adult males and 1: 100,000 adult females seek this procedure. Neovaginal-related disorders after sex reassignment surgery are increasingly more common. Vulvar condylomatosis is the clinical manifestation of HPV 6- and 11 infection in biological women. The same HPV-subtypes are associated with anogenital warts and penile intraepithelial neoplasia in biological men. We aim to present a case of vulvar condylomatosis after sex reassignment surgery in a male-to-female transsexual and its complete response to 5% imiquimod cream. We describe a case of a 19-year-old female transexual who presented one year after male to female sex reassignment surgery by inverted penile skin vaginoplasty with condyloma accuminata of the vulva. The patient had a complete response to imiquimod 5% cream 12 weeks after initiation of treatment. Gynecologists should be prepared to treat neovaginal-related disorders in male-to-female transsexuals.

  6. Assessment of disordered eating in bariatric surgery patients: diagnosis, measurement and psychometric evaluation

    OpenAIRE

    Parker, Katrina

    2017-01-01

    Eating disorders and disordered eating are prevalent in adults seeking surgical interventions for weight loss. While bariatric surgery is more effective than non-surgical interventions for weight loss and amelioration of physical health comorbidities, research findings are inconsistent regarding the impact of surgery on disordered eating and the impact of disordered eating on surgical outcomes. Not all bariatric surgery patients achieve optimal outcomes following surgery, and disordered eatin...

  7. The role of perioperative oral nutritional supplementation in elderly patients after hip surgery.

    Science.gov (United States)

    Liu, Ming; Yang, Jing; Yu, Xi; Huang, Xiao; Vaidya, Sushan; Huang, Fuguo; Xiang, Zhou

    2015-01-01

    The effect of perioperative oral nutritional supplementation (ONS) on elderly patients after hip surgery remains controversial. This study intended to ascertain whether perioperative ONS is beneficial for the rehabilitation of elderly patients after hip surgery. We searched databases including PubMed, Embase, and the Cochrane Central Register of Controlled Trials for articles published up to May 2014. Randomized controlled trials of ONS for elderly patients after hip surgery were included. The combined trials showed that ONS had a positive effect on the serum total protein (Pelderly patients recover after hip surgery and reduce complications.

  8. QUALITY OF LIFE OF HYDROCELE PATIENTS AFTER TRADITIONAL SURGERIES AND SCLEROTHERAPY

    Directory of Open Access Journals (Sweden)

    Z. A. Kadyrov

    2017-01-01

    Full Text Available The article analyzes quality of life of hydrocele patients after traditional surgeries and sclerotherapy. It is shown that pain intensity in the sclerotherapy group was 1.1 ± 0.10 points and lower than in the open surgery group where it was 2.6 ± 0.20 points. Physical activity in patients after sclerotherapy was 1.2 ± 0.20 points, while after traditional surgery it was 2.8 ± 0.24 points. Furthermore, mean number of inpatient bed-days and time to return to normal life were significantly lower in the sclerotherapy patients compared to patients who underwent open surgery.

  9. Tourniquet-induced systemic inflammatory response in extremity surgery.

    LENUS (Irish Health Repository)

    Wakai, A

    2012-02-03

    BACKGROUND: Tourniquet-induced reperfusion injury in animals produces significant systemic inflammatory effects. This study investigated whether a biologic response occurs in a clinically relevant model of tourniquet-induced reperfusion injury. METHODS: Patients undergoing elective knee arthroscopy were prospectively randomized into controls (no tourniquet) and subjects (tourniquet-controlled). The effects of tourniquet-induced reperfusion on monocyte activation state, neutrophil activation state, and transendothelial migration (TEM) were studied. Changes in the cytokines implicated in reperfusion injury, tumor necrosis factor-alpha, interleukin (IL)-1beta, and IL-10 were also determined. RESULTS: After 15 minutes of reperfusion, neutrophil and monocyte activation were significantly increased. Pretreatment of neutrophils with pooled subject (ischemia-primed) plasma significantly increased TEM. In contrast, TEM was not significantly altered by ischemia-primed plasma pretreatment of the endothelial monolayer. Significant elevation of tumor necrosis factor-alpha and IL-1beta were observed in subjects compared with controls after 15 minutes of reperfusion. There was no significant difference in serum IL-10 levels between the groups at all the time points studied. CONCLUSION: These results indicate a transient neutrophil and monocyte activation after tourniquet-ischemia that translates into enhanced neutrophil transendothelial migration with potential for tissue injury.

  10. Patients' experiences of varicose vein and arthroscopy day surgery.

    Science.gov (United States)

    Fitzpatrick, J M; Selby, T T; While, A E

    A small-scale telephone survey of day surgery patients' (n = 30) experience of pain, nausea and vomiting, wound healing and fatigue during the 7 days following discharge and their views of the service is described. Respondents who had undergone either varicose vein stripping (n = 15) or arthroscopy (n = 15) were interviewed using a semi-structured interview schedule. The findings indicated that most respondents expressed satisfaction with their recovery despite some evidence of postoperative morbidity. The majority of the sample indicated that they had received adequate information to enable them to cope at home and qualified nurses on the day unit were identified as a primary source of information. Following discharge, GPs or the day unit were key points of contact. The findings of this study, together with previous research, highlight important areas for further action by health professionals if this service is to be delivered effectively and efficiently.

  11. Patients' Reported Usage of Weight Management Skills Following Bariatric Surgery.

    Science.gov (United States)

    Essayli, Jamal H; LaGrotte, Caitlin A; Fink-Miller, Erin L; Rigby, Andrea

    2018-02-01

    Little is known about which specific weight management skills bariatric patients find most and least valuable. Participants completed a measure assessing their usage of weight management skills at a follow-up appointment one or more years after undergoing bariatric surgery. Decreased usage of skills was associated with unsuccessful weight outcome, defined as losing less than 50% of excess weight, as well as weight regain. Weighing regularly was the skill selected most often by successful participants as helpful, and was chosen by a significantly smaller percentage of unsuccessful participants and those who regained a clinically significant amount of weight. A majority of both successful and unsuccessful participants indicated that they had discontinued food journaling. Weighing regularly may be perceived as a more useful method of self-monitoring.

  12. Surgery

    Science.gov (United States)

    ... surgery has several common causes, including the following: Infections at the operative site Lung problems such as pneumonia or collapsed lung ... the trauma of an operation. The risk of infections at the operative site, DVTs, and UTIs can be decreased by meticulous ...

  13. PSYCHOLOGICAL PROFILE OF PATIENTS ELIGIBLE FOR BARIATRIC SURGERY.

    Science.gov (United States)

    Ribeiro, Graziela Aparecida Nogueira de Almeida; Giampietro, Helenice Brizolla; Belarmino, Lídia Barbieri; Salgado-Júnior, Wilson

    The psychologist who works in bariatric surgery has a role to receive, evaluate, prepare and educate the patient who will undergo the surgical procedure. Psychological evaluation becomes important in so far as allows us to obtain data on personal and familiar history and allow tracing of possible psychopathology. To collect data on psychological evaluations of patients in a bariatric surgery service of a public hospital in order to describe the psychological profile of patients in this service. Data were collected from 827 patients between 2001 and 2015, using data from an interview, Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Binge Eating Scale (BES). The mean age of patients before surgery was 39 years+/- 10, the mean BMI was 51 kg/m²+7, and most patients (81%) were female. The average score on the BDI was 14.8+8 and women had significantly higher scores than men. On the BAI the average score was 11+8 and on the ECAP was 14+8, both with no difference between groups. Psychosocial characteristics of the patients points to the significant presence of indicators of depression, with low levels of anxiety and binge eating. O psicólogo que atua na área da cirurgia bariátrica tem papel de acolher, avaliar, preparar e conscientizar o paciente que vai ser submetido ao procedimento cirúrgico. A avaliação psicológica reveste-se de importância na medida em que obtém dados sobre história pessoal e familiar, além do rastreio de possíveis alterações psicopatológicas. Analisar as avaliações psicológicas dos pacientes de um serviço de cirurgia bariátrica de um hospital público, buscando traçar o perfil psicológico dos pacientes deste serviço. Foram coletados dados de 827 pacientes entre 2001 e 2015, utilizando-se dados de uma entrevista, Inventário Beck de Depressão (BDI), Inventário Beck de Ansiedade (BAI) e Escala de Compulsão Alimentar Periódica (ECAP). A idade média dos pacientes antes da operação foi 39 anos+10 e o IMC m

  14. 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.

  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. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Patient function, long-term survival, and use of surgery in patients with kidney cancer.

    Science.gov (United States)

    Tan, Hung-Jui; Chamie, Karim; Daskivich, Timothy J; Litwin, Mark S; Hu, Jim C

    2016-12-15

    Beyond age and comorbidity, functionality can shape the long-term survival potential of patients with cancer. Accordingly, herein the authors compared mortality and receipt of cancer-directed surgery according to patient function among older adults with kidney cancer. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2000 through 2009, the authors studied 28,326 elderly subjects with primary kidney cancer. Patient function was quantified using function-related indicators, claims indicative of dysfunction and disability. Adjusting for patient and cancer characteristics, competing risk regression was used to assess the relationship between function-related indicator count and cause-specific mortality and then generalized estimating equations were used to quantify the probability of surgery. A total of 13,619 adult patients (48.1%) with at least 1 function-related indicator were identified. A higher indicator category was associated with older age, greater comorbidity, female sex, unmarried status, lower socioeconomic status, and higher stage of disease (Pkidney cancer mortality varied minimally with patient function. Patients with ≥ 2 indicators received cancer-directed surgery less often than those without disability (odds ratio, 0.61; 95% CI, 0.56-0.66), although treatment probabilities remained high for patients with locoregional disease and low for those with metastatic cancer. Among older adults with kidney cancer, functional health stands as a significant predictor of long-term survival. However, receipt of cancer-directed surgery appears largely determined by cancer stage. Patient function should be considered more heavily when determining treatment for older adults with kidney cancer. Cancer 2016;122:3776-3784. © 2016 American Cancer Society. © 2016 American Cancer Society.

  17. Patient expectations of hip and knee joint replacement surgery and postoperative health status.

    Science.gov (United States)

    Cross, Marita; Lapsley, Helen; Barcenilla, Annica; Parker, David; Coolican, Myles; March, Lyn

    2009-03-01

    To explore the relationship between preoperative patient expectations and postoperative health status in patients undergoing joint replacement surgery, with particular emphasis on the types of expectations held by patients. Respondents completed the Hospital for Special Surgery (HSS) Hip/Knee Replacement Expectations Questionnaires pre-surgery, in addition to the Western Ontario and McMaster Osteoarthritis Index (WOMAC™) and the Short-Form 36-Item (SF-36) Health Survey and the Arthritis Self-Efficacy Scale. The WOMAC™ Index and SF-36 were also completed 3 and 6 months post-surgery. A total of 106 patients (total hip replacement [THR] = 28; total knee replacement [TKR] = 78) completed questionnaires. No differences were seen in overall expectations between males and females or older or younger patients, although some differences between the age groups were seen for individual expectations on the HSS expectations questionnaires. For THR, a higher rating of the importance of expectations was correlated with a lesser improvement in pain from pre-surgery to 3 months post-surgery, whereas for TKR, a higher rating of expectations was associated with a greater improvement in function to 6 months post-surgery. Patients have high expectations of surgery, which are correlated with post-surgery pain and function. Identifying the broad range of expectations may be helpful in preparation for surgery and gaining greater satisfaction with outcomes.

  18. A comparative analysis of minimally invasive and open spine surgery patient education resources.

    Science.gov (United States)

    Agarwal, Nitin; Feghhi, Daniel P; Gupta, Raghav; Hansberry, David R; Quinn, John C; Heary, Robert F; Goldstein, Ira M

    2014-09-01

    The Internet has become a widespread source for disseminating health information to large numbers of people. Such is the case for spine surgery as well. Given the complexity of spinal surgeries, an important point to consider is whether these resources are easily read and understood by most Americans. The average national reading grade level has been estimated to be at about the 7th grade. In the present study the authors strove to assess the readability of open spine surgery resources and minimally invasive spine surgery resources to offer suggestions to help improve the readability of patient resources. Online patient education resources were downloaded in 2013 from 50 resources representing either traditional open back surgery or minimally invasive spine surgery. Each resource was assessed using 10 scales from Readability Studio Professional Edition version 2012.1. Patient education resources representing traditional open back surgery or minimally invasive spine surgery were all found to be written at a level well above the recommended 6th grade level. In general, minimally invasive spine surgery materials were written at a higher grade level. The readability of patient education resources from spine surgery websites exceeds the average reading ability of an American adult. Revisions may be warranted to increase quality and patient comprehension of these resources to effectively reach a greater patient population.

  19. Lidocaine Did Not Reduce Neuropsychological-Cognitive Decline in Patients 6 Months After Supratentorial Tumor Surgery: A Randomized, Controlled Trial.

    Science.gov (United States)

    Peng, Yuming; Zhang, Wei; Zhou, Xiaoli; Ji, Yong; Kass, Ira S; Han, Ruquan

    2016-01-01

    : There is equivocal evidence examining cognitive improvement in response to lidocaine during cardiac surgery; however, no study has examined its effect on postoperative neuropsychological-cognitive decline after supratentorial tumor surgery. Ninety-four patients scheduled for supratentorial craniotomy were enrolled. Patients received either a dose of lidocaine (2%) via an intravenous bolus (1.5 mg/kg) after induction followed by an infusion at a rate of 2 mg/kg/h until the end of surgery (Lidocaine group) or the same volume of normal saline. The neuropsychological-cognitive decline was evaluated using the following tests: the Mini-Mental State Examination, the Information-Memory-Concentration test, the Hamilton Rating Scale for Depression, and the Hamilton Rating Scale for Anxiety. The cerebral oxygen extraction ratio and the difference in lactic acid levels between the bulb of the jugular vein and a peripheral artery were measured. Eighty patients completed the neuropsychological tests, with 40 patients in each group. The incidence of postoperative decline at up to 6 months in the Lidocaine group was not significantly different than that in the Normal saline group. When the 2 cognitive tests were examined independent of the other tests, there was no difference between groups at 6 months. The cerebral oxygen extraction ratio was significantly lower in the Lidocaine group after surgery (Pcognitive decline in patients 6 months after supratentorial tumor surgery.

  20. Chilean patients' perception of oral health-related quality of life after third molar surgery.

    Science.gov (United States)

    Aravena, Pedro Christian; Delgado, Felipe; Olave, Hugo; Ulloa-Marin, Carolina; Perez-Rojas, Francisco

    2016-01-01

    To describe the perception of the quality of life in oral health based on the Health-Related Quality of Life instrument in its Spanish version (HRQOL-sp) in Chilean patients with third molar extraction surgery. A cross-sectional study. The HRQOL-sp was administered to dental patients at the Public Hospital in Rio Bueno in southern Chile treated for unilateral third molar extraction between March and June 2014. The instrument was applied by phone survey on the first, third, fifth, and seventh days after surgery. For the ordinal scale, the response was considered interference in the quality of life when patients selected the options "quite a bit of trouble" or "lots of trouble" for oral function and general activity; and selected complications-related signs and symptoms, a pain level score with a Verbal Rating Scale (range 0 to 7), and worst pain perceived. The patient's sociodemographic data, type of surgery, and the quality of life level were analyzed according to the domains of the HRQOL-sp instrument. A total of 106 patients were selected (age: 20.4±7.39 years; 71.7% women) and a total of 127 extracted third molars. On the first day of follow-up, most patients reported interference in their quality of life. The main problems were difficulty opening the mouth (50.94%) and swelling (83.02%). The worst symptom perceived was "bad breath" (>31%) and the worst pain felt was a mean of 4.31±1.62 on the Verbal Rating Scale. All items gradually reduced until the seventh day. The HRQOL-sp revealed substantial interference in the quality of life on the first postoperative day. It is suggested that the risk factors associated with quality of life be analyzed and the instrument in Spanish be validated.

  1. [Risk factors related to nosocomial pneumonia in pediatric patients undergoing heart surgery].

    Science.gov (United States)

    Fortanelli-Rodríguez, Rocío Elvira; Gómez-Delgado, Alejandro; Vera-Canelo, José Manuel; Alvarado-Diez, Miguel Ángel; Miranda-Novales, María Guadalupe; Furuya, María Elena Yuriko; Solórzano-Santos, Fortino; Vázquez-Rosales, José Guillermo

    2015-01-01

    Procalcitonin is a diagnostic marker useful to discern infections and non-infectious complications in heart surgeries. The aim is to describe risk factors related to nosocomial pneumonia and the predictive value of serum procalcitonin in pediatric patients undergoing heart surgery. During a year a nested case-control study was carried out in a third level hospital. All patients undergoing open-heart surgery were followed and clinical data searching for pneumonia were registered every day. Blood samples for determination of procalcitonin were taken 48 hours after surgery. Those patients who developed pneumonia based on CDC clinical criteria were defined as cases; and controls were those patients who did not developed pneumonia. 188 patients underwent heart surgery (15 % developed pneumonia). Ninety-seven patients were submitted to open-heart surgery: 24 cases and 73 controls. Seventy-eight % of cases developed pneumonia between second and fifth day after surgery. The average time of surgery, extracorporial bypass, aortic cross-clamp, and mechanical ventilation were greater in control patients. The frequency of open sternotomy, reintubation, and surgical wound infections was greater in case patients. Some of the events related to heart surgery and their subsequent management are associated significantly to the development of hospital-acquired pneumonia.

  2. Are patient-reported outcomes predictive of patient satisfaction 5 years after anterior cervical spine surgery?

    Science.gov (United States)

    Schroeder, Gregory D; Coric, Dom; Kim, Han Jo; Albert, Todd J; Radcliff, Kris E

    2017-07-01

    Patient satisfaction is becoming an increasing common proxy for surgical quality; however, the correlation between patient satisfaction and surgical outcomes 2 and 5 years after anterior cervical surgery has not been evaluated. The study aimed to determine if patient satisfaction is predicted by improvement in patient-reported outcomes (PRO) 2 and 5 years after anterior cervical spine surgery. This is a retrospective analysis of prospectively collected data. The sample included patients enrolled in the Food and Drug Administration investigational device exemption clinical trial comparing total disc replacement with Mobi-C cervical artificial disc and anterior cervical discectomy and fusion. The outcome measures were visual analog scale (VAS) neck pain score, Neck Disability Index (NDI), and Short-Form 12-Item scores, as well as patient satisfaction. Receiver operating characteristic curves were used to determine if improvement in different PRO metrics can accurately identify patient satisfaction. Additionally, a logistic regression analysis was performed on the results at 24 months and 60 months to identify independent predictors of patient satisfaction. This research was supported by LDR (Zimmer Biomet) 13785 Research Boulevard - Suite 200 Austin, TX 78750. Data were available for 512 patients at 60 months. At 24 months postoperatively, NDI score improvement (area under the curve [AUC]=0.806), absolute NDI score (AUC=0.823), and absolute VAS neck pain score (AUC=0.808) were all excellent predictors of patient satisfaction. At 60 months postoperatively, NDI score improvement (AUC=0.815), absolute NDI score (AUC=0.839), VAS neck pain score improvement (AUC=0.803), and absolute VAS neck pain score (AUC=0.861) were all excellent predictors of patient satisfaction. In patients undergoing one- and two-level anterior cervical spine surgery, between 2 and 5 years postoperatively, patient satisfaction is significantly predicted by PROs, including the VAS neck score and the

  3. Sensory retraining after orthognathic surgery: effect on patients' perception of altered sensation.

    Science.gov (United States)

    Phillips, Ceib; Essick, Greg; Preisser, John S; Turvey, Timothy A; Tucker, Myron; Lin, Dongming

    2007-06-01

    The primary research hypothesis was that the magnitude and duration of the perceived burden from altered sensation reported by patients after bilateral sagittal split osteotomy and trauma to the third division of the trigeminal nerve are decreased when facial sensory retraining exercises are performed in conjunction with standard opening exercises as compared with standard opening exercises alone. A total of 186 subjects were enrolled in a multicenter, double-blind, 2 parallel group-stratified block randomized clinical trial. Oral and facial pain, unusual sensations, numbness, and loss of sensitivity were scored from "no problem" to "serious problem" before surgery and 1 month, 3 months, and 6 months after surgery. A proportional odds model for the ordered multinomial response was used to compare the responses of the 2 exercise groups. The 2 exercise groups did not differ significantly at any postsurgical time in terms of perceived problem level from intraoral of facial pain. The difference between the 2 groups at each visit was not statistically significant for unusual sensations, although the trend was for the sensory retraining group to have a higher likelihood of reporting fewer problems. By 6 months, the likelihood of a subject reporting lower problem or interference level related to numbness or decreased lip sensitivity was significantly higher in the sensory-retraining group, approximately twice that of the opening exercise-only group. Our results support the premise that a simple noninvasive exercise program initiated shortly after orthognathic surgery can lessen the objectionable impression of negative altered sensations.

  4. In patients with rectoceles and obstructed defecation syndrome, surgery should be the option of last resort.

    Science.gov (United States)

    Hicks, Caitlin W; Weinstein, Milena; Wakamatsu, May; Savitt, Lieba; Pulliam, Samantha; Bordeianou, Liliana

    2014-04-01

    The indications for operation in patients with obstructed defecation syndrome (ODS) with rectocele are not well defined. A total of 90 female patients with ODS and rectocele were prospectively evaluated and treated with fiber supplements and biofeedback training. Univariate and multivariate regression was used to determine factors predictive of failing medical management. Obstructive symptoms were the most prevalent presenting complaint (82.2%). Ultimately, 71.1% of patients responded to medical management and biofeedback. Multivariate regression analysis suggested that the presence of internal intussusception was associated with a lower chance of undergoing surgery to address ODS symptoms [odds ratio 0.18; P = .05], whereas inability to expel balloon, contrast retention on defecography, and splinting were not (P ≥ .15). Rectoceles with concomitant intussusception in patients with ODS appear to portend a favorable response to biofeedback and medical management. We argue that all patients considered for surgery for rectoceles because of ODS should first undergo appropriate bowel retraining. Copyright © 2014 Mosby, Inc. All rights reserved.

  5. Life-quality of orthognathic surgery patients: The search for an integral diagnosis

    Directory of Open Access Journals (Sweden)

    José Augusto Mendes Miguel

    2014-01-01

    Full Text Available The decision on whether starting an orthosurgical treatment depends on the negative esthetic, functional and social impact the dentofacial deformity has on the quality of life of each patient. The objective of this article is to demonstrate the importance of assessing the quality of life of these individuals by means of applying specific questionnaires before treatment onset in order to increase the success rate of orthosurgical treatment. These questionnaires assess not only the esthetic factor, but also the functional conditions that may be affected as well as the psychological issues related to self-esteem and sociability, all of which must be assessed in order to enable the development of an individual treatment plan that meets patient's expectations. Thus, a more predictable level of satisfaction can be achieved at treatment completion, not only from a normative standpoint stated by professionals, but also from a subjective standpoint stated by patients. Although not enough comparable data is available in the literature for us to assess the extent of improvements produced by orthosurgical treatment, a few recent reports conducted by different universities around the world reveal a good response from the majority of patients after surgery, demonstrating great satisfaction with regard to esthetic, functional and psychosocial factors. Therefore, it is reasonable to conclude that the current objective of orthodontic treatment associated with orthognathic surgery consists not only in treating the esthetic functional components of dentofacial deformities, but also in considering patients' psychological factor.

  6. Psychological characterisation of severely obese patients: pre- and post-bariatric surgery

    Directory of Open Access Journals (Sweden)

    André Ferreira

    2013-06-01

    Full Text Available Although psychological disorders are more prevalent among candidates for bariatric surgery than among non-obese populations, there is limited knowledge about the impact of this type of surgery on psychopathology. The main goal of this study was to characterize the evolution of psychopathological morbidity among obese patients after surgery. This was an observational longitudinal study. All patients submitted to bariatric surgery between March 2008 and June 2010, in a general hospital located in the south of Portugal were invited to participate. Psychological assessment was done through structured clinical interviews and administration of MCMI-III. Participants were assessed with the same protocol before and after surgery (minimum, 12 months after surgery. Overall, 20 patients (19 women were assessed. The most prevalent clinical syndromes (axis I before surgery were: anxiety (40%, dysthymia disorder (20%, somatoform disorder and delusional disorder (both 15%. After surgery, the most prevalent clinical syndromes were: anxiety (40%, bipolar disorder, dysthymia disorder, and delusional disorder (all with 15%. Before surgery, compulsive personality was the most prevalent personality disorder (15%. After surgery, the most prevalent ones were: histrionic personality, compulsive personality disorder, and paranoia (all with 10%. These findings may suggest that bariatric surgery per se is not enough as treatment for the remission of psychopathology among severe obese patients.

  7. Duty hours, quality of care, and patient safety: general surgery resident perceptions.

    Science.gov (United States)

    Borman, Karen R; Jones, Andrew T; Shea, Judy A

    2012-07-01

    The balance between patient treatment risks and training residents to proficiency is confounded by duty-hour limits. Stricter limits have been recommended to enhance quality and safety, although supporting data are scarce. A previously piloted survey was delivered with the 2010 American Board of Surgery In-Training Examination (ABSITE). First postgraduate year (PGY1) and PGY2 trainees took the Junior examination (IJE); PGY3 and above took the Senior examination (ISE). Residency type, size, and location were linked to examinees using program codes. Five survey items queried all residents about the impact of further hour limits on care quality; online test residents answered 7 more items probing medical error sources. Data were analyzed using factorial ANOVA for association with sex, PGY level, and program demographics. There were 6,161 categorical surgery residents who took the ABSITE: 60% men, 60% ISE, and two-thirds in university programs. Paper (n = 5,079) and online (n = 1,082) examinees were similar. Item response rates ranged from 91% to 98%. Few (surgery residents do not perceive that reduced duty hours will noticeably improve quality of care. Resident perceptions of causes of medical errors suggest that system changes are more likely to enhance patient safety than further hour limits. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  8. The patient safety in surgery study: background, study design, and patient populations.

    Science.gov (United States)

    Khuri, Shukri F; Henderson, William G; Daley, Jennifer; Jonasson, Olga; Jones, R Scott; Campbell, Darrell A; Fink, Aaron S; Mentzer, Robert M; Steeger, Janet E

    2007-06-01

    The purpose of this article is to describe the background, design, and patient populations of the Patient Safety in Surgery Study, as a preliminary to the articles in this journal that will report the results of the Study. The Patient Safety in Surgery Study was a prospective cohort study. Trained nurses collected preoperative risk factors, operative variables, and 30-day postoperative mortality and morbidity outcomes in patients undergoing major general and vascular operations at 128 Veterans Affairs (VA) medical centers and 14 selected university medical centers between October 1, 2001 and September 30, 2004. An Internet-based data collection system was used to input data from the different private medical centers. Semiannual feedback of observed to expected mortality and morbidity ratios was provided to the participating medical centers. During the 3-year study, total accrual in general surgery was 145,618 patients, including 68.5% from the VA and 31.5% from the private sector. Accrual in vascular surgery totaled 39,225 patients, including 77.8% from the VA and 22.2% from the private sector. VA patients were older and included a larger proportion of male patients and African Americans and Hispanics. The VA population included more inguinal, umbilical, and ventral hernia repairs, although the private-sector population included more thyroid and parathyroid, appendectomy, and operations for breast cancer. Preoperative comorbidities were similar in the two populations, but the rates of comorbidities were higher in the VA. American Society of Anesthesiologists classification tended to be higher in the VA. The National Surgical Quality Improvement Program methodology was successfully implemented in the 14 university medical centers. The data from the study provided the basis for the articles in this issue of the Journal of the American College of Surgeons.

  9. "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.

  10. Dynamic muscle O2 saturation response is impaired during major non-cardiac surgery despite goal-directed haemodynamic therapy.

    Science.gov (United States)

    Feldheiser, A; Hunsicker, O; Kaufner, L; Köhler, J; Sieglitz, H; Casans Francés, R; Wernecke, K-D; Sehouli, J; Spies, C

    2016-03-01

    Near-infrared spectroscopy combined with a vascular occlusion test (VOT) could indicate an impairment of microvascular reactivity (MVR) in septic patients by detecting changes in dynamic variables of muscle O2 saturation (StO2). However, in the perioperative context the consequences of surgical trauma on dynamic variables of muscle StO2 as indicators of MVR are still unknown. This study is a sub-analysis of a randomised controlled trial in patients with metastatic primary ovarian cancer undergoing debulking surgery, during which a goal-directed haemodynamic algorithm was applied using oesophageal Doppler. During a 3 min VOT, near-infrared spectroscopy was used to assess dynamic variables arising from changes in muscle StO2. At the beginning of surgery, values of desaturation and recovery slope were comparable to values obtained in healthy volunteers. During the course of surgery, both desaturation and recovery slope showed a gradual decrease. Concomitantly, the study population underwent a transition to a surgically induced systemic inflammatory response state shown by a gradual increase in norepinephrine administration, heart rate, and Interleukin-6, with a peak immediately after the end of surgery. Higher rates of norepinephrine and a higher heart rate were related to a faster decline in StO2 during vascular occlusion. Using near-infrared spectroscopy combined with a VOT during surgery showed a gradual deterioration of MVR in patients treated with optimal haemodynamic care. The deterioration of MVR was accompanied by the transition to a surgically induced systemic inflammatory response state. Copyright © 2015 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Effect of long interval between hyperthermochemoradiation therapy and surgery for rectal cancer on apoptosis, proliferation and tumor response.

    Science.gov (United States)

    Kato, Toshihide; Fujii, Takaaki; Ide, Munenori; Takada, Takahiro; Sutoh, Toshinaga; Morita, Hiroki; Yajima, Reina; Yamaguchi, Satoru; Tsutsumi, Soichi; Asao, Takayuki; Oyama, Tetsunari; Kuwano, Hiroyuki

    2014-06-01

    Neoadjuvant chemoradiotherapy is commonly used to improve the local control and resectability of locally advanced rectal cancer, with surgery performed after an interval of a number of weeks. We have been conducting a clinical trial of preoperative chemoradiotherapy in combination with regional hyperthermia (hyperthermo-chemoradiation therapy; HCRT) for locally advanced rectal cancer. In the current study we assessed the effect of a longer (>10 weeks) interval after neoadjuvant HCRT on pathological response, oncological outcome and especially on apoptosis, proliferation and p53 expression in patients with rectal cancer. Forty-eight patients with proven rectal adenocarcinoma who underwent HCRT followed by surgery were identified for inclusion in this study. Patients were divided into two groups according to the interval between HCRT and surgery, ≤ 10 weeks (short-interval group) and >10 weeks (long-interval group). Patients in the long-interval group had a significantly higher rate of pathological complete response (pCR) (43.5% vs. 16.0%) than patients of the short-interval group. Patients of the long-interval group had a significantly higher rate of down-staging of T-stage (78.3% vs. 36.0%) and relatively higher rate of that of N-stage (52.2% vs. 36.0%) than patients of the short-interval group. Furthermore, apoptosis in the long-interval group was relatively higher compared to that of the short-interval group, without a significant difference in the Ki-67 proliferative index and expression of p53 in the primary tumor. In conclusion, we demonstrated that a longer interval after HCRT (>10 weeks) seemed to result in a better chance of a pCR, a result confirmed by the trends in tumor response markers, including apoptosis, proliferation and p53 expression. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  12. Third molar surgery: the patient's and the clinician's perspective

    Directory of Open Access Journals (Sweden)

    Jerjes Waseem

    2009-10-01

    Full Text Available Abstract Background In this report, the problems of third molar surgery have been reviewed from the perspective of both patient and clinician; additionally an overall analysis of preoperative imaging investigations was carried out. Specifically, three main areas of interest were investigated: the prediction of surgical difficulty and potential complications; the assessment of stress and anxiety and finally the assessment of postoperative complications and the surgeon's experience. Findings In the first study, the prediction of surgical difficulty and potential injury to the inferior alveolar nerve was assessed. This was achieved by examining the patient's orthopantomograms and by using the Pederson Difficulty Index (PDI. Several radiological signs were identified and a classification tree was created to help predict the incidence of such event. In the second study, a prospective assessment addressing the patient's stress and anxiety pre-, intra- and postoperatively was employed. Midazolam was the active drug used against placebo. Objective and subjective parameters were assessed, including measuring the cortisol level in saliva. Midazolam was found to significantly reduce anxiety levels and salivary cortisol was identified as an accurate anxiety marker. In the third study, postoperative complications and the surgeon's experience were examined. Few patients in this study suffered permanent nerve dysfunction. Junior surgeons reported a higher complication rate particularly in trismus, alveolar osteitis, infection and paraesthesia over the distributions of the inferior alveolar and lingual nerves. In apparent contrast, senior surgeons reported higher incidence of postoperative bleeding. Discussion These studies if well employed can lead to favourable alteration in patient management and might have a positive impact on future healthcare service.

  13. Postoperative abnormal response of C-reactive protein as an indicator for infectious complications after oral oncologic surgery with primary reconstruction.

    Science.gov (United States)

    Akashi, Masaya; Furudoi, Shungo; Hashikawa, Kazunobu; Sakakibara, Akiko; Hasegawa, Takumi; Shigeta, Takashi; Minamikawa, Tsutomu; Komori, Takahide

    2015-04-02

    C-reactive protein (CRP) screening has been reported to be reliable for detection of infectious complications. Postoperative abnormal response of CRP can predict wound infection in colorectal surgery. This study aimed to determine the efficacy of CRP monitoring to detect infectious complications in oral oncologic surgery. One hundred patients who underwent oral cancer resection with primary reconstruction were enrolled. Postoperative kinetics of CRP were classified into a normal or abnormal response. A normal CRP response after surgery was observed in 61 patients and an abnormal response was observed in 39. There were postoperative infectious complications in 21 patients, with surgical site infections in 13 patients (early onset in six and late onset in seven). Non-wound infections were found in nine patients. Sensitivity, specificity, the positive predictive value, and the negative predictive value for abnormal CRP response as a predictor for early infectious complications were 100%, 70.1%, 35.9%, and 100%, respectively. Postoperative serial CRP screening is a useful test as an indicator of infectious complications in oral oncologic surgery. Normal CRP responses can rule out almost all early infectious complications.

  14. Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder.

    Science.gov (United States)

    Gentil, Andre F; Lopes, Antonio C; Dougherty, Darin D; Rück, Christian; Mataix-Cols, David; Lukacs, Teagan L; Canteras, Miguel M; Eskandar, Emad N; Larsson, K Johan; Hoexter, Marcelo Q; Batistuzzo, Marcelo C; Greenberg, Benjamin D; Miguel, Euripedes C

    2014-07-01

    OBJECT.: Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%-41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the

  15. 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

  16. [Cosmetic surgery among Norwegian women].

    Science.gov (United States)

    von Soest, Tilmann; Kvalem, Ingela Lundin; Roald, Helge Einar; Skolleborg, Knut Chr

    2004-07-01

    There are few data on the frequency of cosmetic surgery among Norwegian women. A random sample of 2000 Norwegian women aged 22 to 55 received a questionnaire on cosmetic surgery, demographic data, self-esteem, and to what extent people around them accepted cosmetic surgery. The response rate was 46% (907 women). Of these, 7.7% indicated that they had undergone cosmetic surgery, while 22.6% wished to do so. Other people's degree of acceptance predicted both the wish to undergo cosmetic surgery and already conducted surgery. Low self-esteem was correlated with a wish to undergo surgery, though women who had done surgery had no lower self-esteem than non-patients. Although the response rate was relatively low, this study gives the first reliable data on the frequency of cosmetic surgery in Norway. The results indicate that other people's degree of acceptance of cosmetic surgery is a predictor of such surgery being chosen.

  17. A longitudinal study of patient and surgeon goal achievement 2 years after surgery following pelvic floor dysfunction surgery.

    Science.gov (United States)

    Srikrishna, S; Robinson, D; Cardozo, L

    2010-11-01

    To compare patient goal achievement in prolapse and continence surgery with objective/subjective outcomes; secondarily, to compare patient goal achievement with overall satisfaction and with that of the surgeon. Prospective longitudinal observational study, over 2 years. Tertiary urogynaecology centre. Women with prolapse or stress incontinence due for surgery. Patients and surgeons listed five goals that they hoped to achieve following surgery. Objective assessment was with Pelvic Organ Prolapse Quantification System (POP-Q) and videocystourethrography (VCU). Quality of life (QoL) was assessed with a Prolapse QoL questionnaire (PQoL), Kings Health questionnaire (KHQ) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS) and satisfaction was assessed with the Patient Global Impression of Improvement (PGI-I). Goal achievement was measured on a 100-mm visual analogue scale (VAS); objective cure of prolapse by POP-Q and of stress incontinence by VCU; QoL was assessed by KHQ, PQoL and GRISS; and satisfaction by PGI-I. Complete data were available for 112 women. POP-Q scores significantly improved (Pobjective cure of incontinence (from VCU) was 88.8%. All QoL questionnaires and PGI-I scores showed significant improvement (Pmeasures of success than continence surgery. Continence-related goals based on symptom relief were achieved more than those based on body image and sexuality. Surgeons reported a high achievement rate in anatomical restoration and functional improvement goals. Patient goal achievement correlates significantly with other measures of 'success' as well as with overall satisfaction. Surgeons and women have varying expectations of the outcome of surgery. Nearly 90% of goals are still achieved 2 years following surgery. © 2010 The Authors Journal compilation © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.

  18. Patient response to awake craniotomy - a summary overview.

    Science.gov (United States)

    Milian, Monika; Tatagiba, Marcos; Feigl, Guenther C

    2014-06-01

    Awake craniotomy is a valuable procedure since it allows brain mapping and live monitoring of eloquent brain functions. The advantage of minimizing resource utilization is also emphasized by some physicians in North America. Data on how well an awake craniotomy is tolerated by patients and how much stress it creates is available from different studies, but this topic has not consequently been summarized in a review of the available literature. Therefore, it is the purpose of this review to shed more light on the still controversially discussed aspect of an awake craniotomy. We reviewed the available English literature published until December 2013 searching for studies that investigated patients' responses to awake craniotomies. Twelve studies, published between 1998 and 2013, including 396 patients with awake surgery were identified. Eleven of these 12 studies set the focus on the perioperative time, one study focused on the later postoperative time. The vast majority of patients felt well prepared and overall satisfaction with the procedure was high. In the majority of studies up to 30 % of the patients recalled considerable pain and 10-14 % experienced strong anxiety during the procedure. The majority of patients reported that they would undergo an awake craniotomy again. A post traumatic stress disorder was present neither shortly nor years after surgery. However, a normal human response to such an exceptional situation can for instance be the delayed appearance of unintentional distressing recollections of the event despite the patients' satisfaction concerning the procedure. For selected patients, an awake craniotomy presents the best possible way to reduce the risk of surgery related neurological deficits. However, benefits and burdens of this type of procedure should be carefully considered when planning an awake craniotomy and the decision should serve the interests of the patient.

  19. Sex, race, and consideration of bariatric surgery among primary care patients with moderate to severe obesity.

    Science.gov (United States)

    Wee, Christina C; Huskey, Karen W; Bolcic-Jankovic, Dragana; Colten, Mary Ellen; Davis, Roger B; Hamel, Marybeth

    2014-01-01

    Bariatric surgery is one of few obesity treatments to produce substantial weight loss but only a small proportion of medically-eligible patients, especially men and racial minorities, undergo bariatric surgery. To describe primary care patients' consideration of bariatric surgery, potential variation by sex and race, and factors that underlie any variation. Telephone interview of 337 patients with a body mass index or BMI > 35 kg/m(2) seen at four diverse primary care practices in Greater-Boston. Patients' consideration of bariatric surgery. Of 325 patients who had heard of bariatric surgery, 34 % had seriously considered surgery. Men were less likely than women and African Americans were less likely than Caucasian patients to have considered surgery after adjustment for sociodemographics and BMI. Comorbid conditions did not explain sex and racial differences but racial differences dissipated after adjustment for quality of life (QOL), which tended to be higher among African American than Caucasian patients. Physician recommendation of bariatric surgery was independently associated with serious consideration for surgery [OR 4.95 (95 % CI 2.81-8.70)], but did not explain variation in consideration of surgery across sex and race. However, if recommended by their doctor, men were as willing and African American and Hispanic patients were more willing to consider bariatric surgery than their respective counterparts after adjustment. Nevertheless, only 20 % of patients reported being recommended bariatric surgery by their doctor and African Americans and men were less likely to receive this recommendation; racial differences in being recommended surgery were also largely explained by differences in QOL. High perceived risk to bariatric surgery was the most commonly cited barrier; financial concerns were uncommonly cited. Single geographic region; examined consideration and not who eventually proceeded with bariatric surgery. African Americans and men were less likely to

  20. Patient-Reported Outcomes in Weight Loss and Body Contouring Surgery

    DEFF Research Database (Denmark)

    Poulsen, Lotte; Klassen, Anne; Rose, Michael

    2017-01-01

    -related quality of life and appearance in a cohort of Danish patients at different phases in the weight loss journey: before bariatric surgery, after bariatric surgery, before body contouring surgery, and after body contouring surgery. METHODS: From June of 2015 to June of 2016, a cross-sectional sample of 493...... skin was significantly higher for five of seven appearance scales and four of five health-related quality-of-life scales. CONCLUSION: This study provides evidence to suggest that body contouring plays an important role in the weight loss patient's journey and that patients need access to treatments....

  1. 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

  2. Pang-Rotenberg sign--snoring surgery prognosticator: A prospective clinical trial of 153 patients.

    Science.gov (United States)

    Pang, Kenny P; Kishore, Srivinas; Kit, Joseph Chung Chun; Pang, Edward B; Chan, Yiong Huak; Keat, Siow Jin; Rotenberg, Brian

    2016-01-01

    To illustrate the reliability of the Pang-Rotenberg (PR) sign as a prognosticator of snoring surgery. Our hypothesis was that patients who are PR-positive have better snoring reduction scores and outcomes than PR-negative patients after nose and palate surgery. A multicenter prospective series of 153 patients with snoring. All patients graded the snoring intensity on a visual analog scale (VAS). All 137 patients enrolled had both the nose surgery and palate surgery. The control group consisted of 16 patients who underwent nasal surgery alone. There were 122 men and 15 women, the mean age was 44.6 years old, and mean body mass index was 26.1. There were 15 simple snorers and 122 obstructive sleep apnea patients. Patients who were PR-positive showed significantly better postoperative snoring VAS reduction (from 9.04 to 1.02) compared to those patients who were PR-negative (from 8.91 to 3.14) (P snoring VAS reduction from 9.21 to 6.72. After adjusting for covariates that influence the snoring VAS change due to surgery, we found that PR-negative patients achieved an average of 5.78 improvement in snoring VAS, whereas PR-positive patients achieved an average of 8.02 improvement in snoring VAS (P snoring reduction, after combined nose and palate surgery, for patients with troublesome snoring. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  3. Patient expectations before arthroscopic shoulder surgery: correlation with patients' reasons for seeking treatment.

    Science.gov (United States)

    Warth, Ryan J; Briggs, Karen K; Dornan, Grant J; Horan, Marilee P; Millett, Peter J

    2013-12-01

    Elevated expectations before orthopaedic procedures appear to correlate with inferior preoperative subjective measures. The purpose of this study was to evaluate preoperative patient expectations before arthroscopic shoulder surgery and to correlate them with preoperative subjective measures and patients' reasons for seeking treatment. We prospectively collected and retrospectively analyzed data from patients before elective arthroscopic shoulder surgery for a wide range of pathologic processes. Preoperative subjective data included QuickDASH scores, pain and functional components of the American Shoulder and Elbow Surgeons (ASES) score, and mental and physical components of the SF-12 score. Expectations data were collected and grouped on the basis of the reasons for seeking of medical treatment and ranked according to their relative importance. The study included 313 shoulders. There were 205 men and 108 women with a mean age at surgery of 48.7 years (range, 18-78 years). Overall, the most important expectations were for the "shoulder to be back to the way it was before the problem started" and to continue participation in sporting activities. Patients who presented with the "shoulder coming out" had fewer important expectations than did those who presented for other reasons. Those patients who indicated a desire to continue participation in sports had significantly less pain (improved ASES pain scores) compared with the rest of the population. Although return to sport was the most important expectation overall, the importance of other expectations varied by patients' reasons for seeking treatment. The current questionnaire may have limited use in patients with shoulder instability. Level III, cross-sectional design, epidemiology. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  4. Comparison of the Effect of Noise Levels on Stress Response in Two Different Operation Groups in an Orthopedic Surgery Room

    Directory of Open Access Journals (Sweden)

    Hasibe Baytan Yildiz

    2016-09-01

    Full Text Available Aim: The aim of this randomized, single-blinded study was to evaluate the effects of noise on hemodynamic and neuroendocrine stress response by measuring the level of noise in the surgery rooms of patients undergoing knee operations under neuroaxial anesthesia. Gerec ve Yontem: We compared patient responses from two groups of patients: those undergoing knee operations in a surgery room where the noise level (measured in decibels is high, and those undergoing meniscus operations in a surgery room with lower noise levels. The STAI, the State-Trait Anxiety Inventory (STAI-1, and the anxiety test (STAI-2wereperformed at preoperative and postoperative periods. 20 ml of blood sample was taken for basal, intraoperative 30th minute, and postoperative 1st hour measurements. Systolic, diastolic, and mean arterial blood pressures were found to be higher in the high noise level group. ACTH levels were increased during the early postoperative period and became normal during the late postoperative period in the high noise level group whereas ACTH levels were significantly decreased in the low-noise level group. Basal cortisol levels were significantly higher in the high noise level group. HCRP, an inflammatory response mediator was found to be decreased in both groups. Early and late blood glucose levels were significantly higher in the high noise group. There was a greater increase in early and late blood glucose levels in the high noise group. In the postoperative period, although the state-trait anxiety inventory (STAI-2 levels being higher in patients subject to noisier environment determines how people feel independent of the conditions and state they are in, this result made us consider that the noise the patients were subjected to in the intraoperative period may cause a stress response. Discussion: As a result we believe that standard noise levels should be achieved by reducing the factors causing high noise levels in the operating room. This will

  5. Barriers to Nurse-Patient Communication in Cardiac Surgery Wards: A Qualitative Study

    Science.gov (United States)

    Shafipour, Vida; Mohammad, Eesa; Ahmadi, Fazlollah

    2014-01-01

    Background: An appropriate and effective nurse-patient communication is of the most important aspect of caring. The formation and continuation of such a relationship depends on various factors such as the conditions and context of communication and a mutual understanding between the two. A review of the literature shows that little research is carried out on identification of such barriers in hospital wards between the patients and the healthcare staff. Objectives: The present study was therefore conducted to explore the experiences of nurses and patients on communication barriers in hospital cardiac surgery wards. Design and Methods: This qualitative research was carried out using a content analysis method (Graneheim & Lundman, 2004). The participants were selected by a purposeful sampling and consist of 10 nurses and 11 patients from the cardiac surgery wards of three teaching hospitals in Tehran, Iran. Data was gathered by unstructured interviews. All interviews were audio-taped and transcribed verbatim. Results: Findings were emerged in three main themes including job dissatisfaction (with the sub-themes of workload tension and decreased motivation), routine-centered care (with the sub-themes of habitual interventions, routinized and technical interventions, and objective supervision), and distrust in competency of nurses (with the sub-themes of cultural contrast, less responsible nurses, and their apathy towards the patients). Conclusions: Compared to other studies, our findings identified different types of communication barriers depending on the nursing settings. These findings can be used by the ward clinical nursing managers at cardiac surgery wards to improve the quality of nursing care. PMID:25363126

  6. Anatomical and physiological changes in pelvic diaphragm in patients with chagasic megacolon submitted to Duhamel surgery

    OpenAIRE

    Moreira Júnior,Hélio; Moreira,José P. T.; Isaac,Raniere R.; Almeida,Arminda C. de; Moreira,Hélio; Klug,Wilmar A.

    2013-01-01

    ORIGINAL CONTRIBUTION: understand the reasons why Duhamel surgery results in clinical improvement of constipation in patients with Chagasic colopathy. BACKGROUND: Duhamel surgery is one of the most widespread techniques for the treatment of Chagasic megacolon, with low rates of recurrence of constipation. OBJECTIVE: evaluate the anatomical and physiological changes in the pelvic diaphragm of patients with chagasic colopathy, as well as changes occurring after undergoing Duhamel surgery. DESIG...

  7. Anatomical and physiological changes in pelvic diaphragm in patients with chagasic megacolon submitted to Duhamel surgery

    OpenAIRE

    Hélio Moreira Júnior; José P.T. Moreira; Raniere R. Isaac; Arminda C. de Almeida; Hélio Moreira; Wilmar A. Klug

    2013-01-01

    Original contribution: understand the reasons why Duhamel surgery results in clinical improvement of constipation in patients with Chagasic colopathy. Background: Duhamel surgery is one of the most widespread techniques for the treatment of Chagasic megacolon, with low rates of recurrence of constipation. Objective: evaluate the anatomical and physiological changes in the pelvic diaphragm of patients with chagasic colopathy, as well as changes occurring after undergoing Duhamel surgery. Desig...

  8. Prognostic impact of immune response in resectable colorectal liver metastases treated by surgery alone or surgery with perioperative FOLFOX in the randomised EORTC study 40983.

    Science.gov (United States)

    Tanis, Erik; Julié, Catherine; Emile, Jean-Francois; Mauer, Murielle; Nordlinger, Bernard; Aust, Daniela; Roth, Arnaud; Lutz, Manfred P; Gruenberger, Thomas; Wrba, Fritz; Sorbye, Halfdan; Bechstein, Wolf; Schlag, Peter; Fisseler, Annette; Ruers, Theo

    2015-11-01

    To investigate whether the immune response in colorectal liver metastases is related to progression free survival (PFS) and if this may be influenced by systemic therapy. A retrospective central collection of tumour tissue was organised for the European Organisation for Research and Treatment of Cancer (EORTC) study 40983, where patients with colorectal liver metastases were treated by either resection alone or resection with perioperative FOLFOX. Immunostaining on whole slides was performed to recognise T-lymphocytes (CD3+, CD4+, CD8+), B-lymphocytes (CD20+), macrophages (CD68+) and mast cells (CD117+) inside the tumour, at the tumour border (TNI) and in normal liver tissue surrounding the tumour (0.5-2mm from the TNI). Immunological response was compared between treatment arms and correlated to PFS. Tumour tissue and immune response profiles were available for 82 resected patients, 38 in the perioperative chemotherapy arm and 44 in the surgery alone arm. Baseline patient and disease characteristics were similar between the treatment arms. In response to chemotherapy, we observed increased CD3+ lymphocyte and mast cell counts inside the tumour (p2 (10.8 versus 38.6 months, HR 0.51, p=0.04). Our analyses in the context of a randomised study suggest that chemotherapy influences immune cell profiles, independent of patient characteristics. Immune responses of lymphocytes and mast cells were associated with pathological response to chemotherapy and to increased PFS. High CD3+ lymphocytes at the tumour front and intratumoural mast cells appear to be prognostic for patients with colorectal liver metastases. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Quality of life among morbid obese and patients submitted to bariatric surgery

    Directory of Open Access Journals (Sweden)

    Lívia Moreira Barros

    2015-06-01

    Full Text Available The objective was to assess Quality of Life (QoL among obese waiting for bariatric surgery and post-surgery patients. A cross-sectional quantitative study conducted in a hospital reference in bariatric surgery in Fortaleza-CE. The sample was composed by 64 pre- and 92 post-surgery patients. Data was collected through the QoL questionnaire Moorehead-Ardelt II from the Bariatric Analysis and Reporting Outcome System (BAROS protocol. Most individuals at pre-surgery stage classified their QoL as minimal – 57,8% (37, while the post-surgery group observed a significant change where 75% (69 of participants considered their QoL very good after the procedure (p< 0,001. In both groups, the QoL aspects that presented worse evaluation were: physical activity, sexual interest and eating behavior. Bariatric surgery represents improvement in quality of life of individuals.

  10. Bariatric surgery

    Science.gov (United States)

    Karmali, Shahzeer; Stoklossa, Carlene Johnson; Sharma, Arya; Stadnyk, Janet; Christiansen, Sandra; Cottreau, Danielle; Birch, Daniel W.

    2010-01-01

    Abstract OBJECTIVE To review the management of bariatric surgical patients. QUALITY OF EVIDENCE MEDLINE, EMBASE, and Cochrane Library databases were searched, as well as PubMed US National Library, from January 1950 to December 2009. Evidence was levels I, II, and III. MAIN MESSAGE Bariatric surgery should be considered for obese patients at high risk of morbidity and mortality who have not achieved adequate weight loss with lifestyle and medical management and who are suffering from the complications of obesity. Bariatric surgery can result in substantial weight loss, resolution of comorbid conditions, and improved quality of life. The patient’s weight-loss history; his or her personal accountability, responsibility, and comprehension; and the acceptable level of risk must be taken into account. Complications include technical failure, bleeding, abdominal pain, nausea or vomiting, excess loose skin, bowel obstruction, ulcers, and anastomotic stricture. Lifelong monitoring by a multidisciplinary team is essential. CONCLUSION Limited long-term success of behavioural and pharmacologic therapies in severe obesity has led to renewed interest in bariatric surgery. Success with bariatric surgery is more likely when multidisciplinary care providers, in conjunction with primary care providers, assess, treat, monitor, and evaluate patients before and after surgery. Family physicians will play a critical role in counseling patients about bariatric surgery and will need to develop skills in managing these patients in the long-term. PMID:20841586

  11. Minimally Invasive, Single-Stage, Multilevel Surgery for Obstructive Sleep Apnea in Asian Patients.

    Science.gov (United States)

    Lin, Hsin-Ching; Friedman, Michael; Chang, Hsueh-Wen; Bonzelaar, Lauren; Salapatas, Anna M; Lin, Meng-Chih; Huang, Kuo-Tung

    2017-02-01

    from 11.6 (4.3) to 9.2 (3.1), with a mean (SD) difference of -2.4 (3.7) (95% CI, -3.5 to -1.3), and 9.4 (1.5) to 3.9 (1.9), with a mean (SD) difference of -5.6 (2.0) (95% CI, -6.2 to -5.0), respectively. The mean (SD) apnea-hypopnea index and lowest oxygen saturation changed from 30.5 (18.8) to 26.0 (16.5), with a mean (SD) difference of -4.5 (14.1) (95% CI, -8.6 to -0.3), and 78.2% (9.9%) to 80.8% (8.2%), with a mean (SD) difference of +2.6 (8.7) (95% CI, 0-5.1), respectively. The surgical response rate was 46.8% (22 of 47 patients) (95% CI, 32.5%-61.1%). The success rate by the classic definition was 14.9% (7 of 47 patients) (95% CI, 6.2%-28.3%). This study reveals the improvement of the 2 relevant clinical outcomes in snoring severity and daytime sleepiness after minimally invasive, single-stage, multilevel surgery for patients with OSA but the limited effects on the polysomnographic parameters. Although the current role of minimally invasive, single-stage, multilevel surgery for Asian adults with OSA remains to be established, it is hoped that ongoing and future studies will solidify their role in the treatment of OSA.

  12. Physiological and molecular responses to bariatric surgery: markers or mechanisms underlying T2DM resolution?

    Science.gov (United States)

    Hutch, Chelsea R; Sandoval, Darleen A

    2017-03-01

    Bariatric surgery is currently the most effective treatment for obesity and associated comorbidities, including rapid resolution of type 2 diabetes mellitus (T2DM). Although the weight loss itself has substantial impact, bariatric surgery also has weight loss-independent effects on T2DM. Several variations of bariatric surgery exist, including the widely studied Roux-en-Y gastric bypass and vertical sleeve gastrectomy. The success of both of these bariatric surgeries was originally attributed to restrictive and malabsorptive modes of action; however, mounting evidence from both human and animal studies implicates mechanisms beyond surgery-induced mechanical changes to the gastrointestinal (GI) system. In fact, with bariatric surgery comes a spectrum of physiological responses, including postprandial enhancement of gut peptide and bile acids levels, restructuring of microbial composition, and changes in GI function and morphology. Although many of these processes are also essential for glucoregulation, the independent role of each in the success of surgery is still an open question. In this review, we explore whether these changes are necessary for the improvements in body mass and glucose homeostasis or whether they are simply markers of the physiological effect of surgery. © 2016 New York Academy of Sciences.

  13. Dissociated incretin response to oral glucose at 1 year after restrictive vs. malabsorptive bariatric surgery

    DEFF Research Database (Denmark)

    Guldstrand, M; Ahrén, B; Näslund, E

    2009-01-01

    AIM: Compare the response to oral glucose of the two incretin hormones, glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) at 1 year after restrictive vs. malabsorptive bariatric surgery. METHODS: Vertical banded gastroplasty (VBG, n = 7) or jejunoileal bypass...... = 0.007). CONCLUSIONS: We conclude that at 1 year after bariatric surgery, the two incretins show dissociated responses in that the GIP secretion is higher after VBG whereas GLP-1 secretion is higher after JIB. This dissociated incretin response is independent from reduction in body weight, glucose...

  14. 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.

  15. MR imaging response of cerebral metastases and peritumoral edema after Gamma Knife surgery

    International Nuclear Information System (INIS)

    Guo Qi; Wang Congyin; Zhang Xuening; Zheng Jingjing; Xu Desheng; Zhang Yipei

    2012-01-01

    Objective: To evaluation the treatment response of Gamma Knife surgery (GKS) for the control of cerebral metastases and peritumoral edema using standard MRI. Method: 42 consecutive patients with 75 metastatic lesions were recruited in this study (28 men, 14 women; mean age 60±12 years). Gadolinium enhancement T 1 WI scans were performed on one day before and three months after GKS. Treatment response was evaluated by calculating the changes of tumor volume and edema index before and after GKS. Results: Mean tumor volumes on the baseline and post treatment were 7.0 cm 3 and 3.3 cm 3 respectively. Mean peritumoral edema indexes were 9.9 and 4.3 respectively. Tumor growth control rate and peritumoral edema control rate were 91% and 85% respectively. Conclusion: GKS is effective for both brain metastasis and peritumoral edema, and the tumor volume influences GKS efficacy. Conventional MRI provides useful information to predict treatment response of GKS for cerebral metastasis. (authors)

  16. Phacoemulsification cataract surgery in a large cohort of diabetes patients: visual acuity outcomes and prognostic factors

    DEFF Research Database (Denmark)

    Ostri, Christoffer; Lund-Andersen, Henrik; Sander, Birgit

    2011-01-01

    To assess visual acuity outcomes after phacoemulsification cataract surgery in a large population of diabetic patients with all degrees of diabetic retinopathy.......To assess visual acuity outcomes after phacoemulsification cataract surgery in a large population of diabetic patients with all degrees of diabetic retinopathy....

  17. Audit of definitive colorectal surgery in patients with early and advanced colorectal cancer.

    Science.gov (United States)

    Isbister, William H

    2002-04-01

    The role of surgery in patients with advanced colorectal cancer may be questioned in the era of specialized intensive palliative care. Should patients with advanced disease be advised against surgery because of the risks of the surgery itself? In this study, the perioperative outcomes in patients undergoing definitive surgery for early (Dukes' stages A, B and C) and advanced colorectal cancer (stage D) were examined. All patients undergoing definitive surgery for colorectal cancer during a 15-year period were identified. Details of tumour site and stage, surgery performed, perioperative complications and postoperative mortality were compared. A total of 374 patients underwent definitive surgery. There were 193 men, a male : female ratio of 1:0.9. Seventy-one patients had advanced disease. There were no differences between the early and advanced groups in perioperative requirements for either blood or total parenteral nutrition. In the advanced group, more operations were performed as emergencies than in the early group (32.4 vs 17.5%; P advanced group (23.9 vs 10.2%; P advanced groups and no differences between the operations performed except that endo-anal destruction was not performed in advanced patients. There were no differences in perioperative morbidity or mortality in the groups studied. Resection rates, operation type and postoperative morbidity and mortality were similar in patients with both early and advanced colorectal cancers. In terms of perioperative outcome, the presence of advanced cancer, per se, should not, therefore, be a justification to decline surgery.

  18. HGV/GB virus C transmission by blood components in patients undergoing open-heart surgery

    NARCIS (Netherlands)

    Sentjens, Roel; Basaras, Miren; Simmonds, Peter; Vrielink, Hans; Reesink, Henk

    2003-01-01

    BACKGROUND: To establish the rate of HGV/GB virus C (GBV-C) transmission by blood components in open-heart surgery patients. STUDY DESIGN AND METHODS: From 55 patients receiving blood components, sera were collected before and 2, 4, 6, 8, 10, 12, 16, 20, 26, and 32 weeks after heart surgery. Serum

  19. A COMPARISON OF TWO DIFFERENT DOSES OF DEXMEDETOMIDINE INFUSION DURING MAINTENANCE OF GENERAL ANAESTHESIA IN PATIENTS UNDERGOING SPINE SURGERIES, FUNCTIONAL ENDOSCOPIC SINUS SURGERY AND MIDDLE EAR SURGERIES

    Directory of Open Access Journals (Sweden)

    Bijay

    2016-03-01

    Full Text Available BACKGROUND This study is undertaken to compare the hemodynamic effects and reduction in the doses of volatile anaesthetics and muscle relaxants using two different doses of dexmedetomidine infusion during maintenance of anaesthesia in spine, functional endoscopic sinus surgery and middle ear surgeries. METHODS Sixty patients are randomly divided into 2 groups of 30 each. After shifting to the operation theatre baseline vitals were recorded. Anesthesia induced with thiopentone sodium and intubation done with the help of succinylcholine and maintained with oxygen, nitrous oxide and isoflurane. After 1 min of intubation, maintenance infusion of dexmedetomidine (0.4 mcg/kg/hr and 0.7 mcg/kg/hr for patients allotted in 2 separate groups was started and stopped 15 min before end of surgery. Hemodynamic parameters and any reduction in the doses of volatile anaesthetics and muscle relaxants was noted. RESULTS Dexmedetomidine infusion (0.4 mcg/kg/hr and 0.7 mcg/kg/hr in both groups reduced the requirements of muscle relaxants and volatile anaesthetics. Hemodynamic stability was better in the group receiving 0.4 mcg/kg/hr. Patients receiving 0.7 mcg/kg/hr had higher incidence of hypotension, bradycardia and delayed emergence from anaesthesia. CONCLUSION Dexmedetomidine infusion at 0.4 mcg/kg/hr during maintenance of anaesthesia in spine surgery, FESS and middle ear surgery would be good option to reduce the requirements of volatile anaesthetics, muscle relaxants and for better hemodynamic stability. OBJECTIVE OF STUDY: Primary Objective To compare and evaluate the hemodynamic effects and reduction in requirements of volatile anaesthetics and muscle relaxants with two different doses of dexmedetomidine infusion during maintenance of general anaesthesia in patients undergoing spine, FESS and middle ear surgeries.

  20. Adolescent Idiopathic Scoliosis – case report of a patient with clinical deterioration after surgery

    Directory of Open Access Journals (Sweden)

    Weiss Hans-Rudolf

    2007-12-01

    Full Text Available Abstract Background Although there is no evidence that the long-term effects of scoliosis surgery are superior to the long-term effects of Adolescent Idiopathic Scoliosis (AIS itself, patients can fear the consequences of not under going this surgery due to incorrect or insufficient information. The main indication for surgical treatment in patients with AIS, is cosmetic. However spinal surgery may, along with other negative side effects, actually cause postoperative clinical deterioration. This complication of surgery has not yet been described in international literature. Case presentation A 15-year old female patient originally presenting with a well-compensated double curve pattern scoliosis. The patient was advised to undergo surgery due to the long-term negative impact of signs and symptoms of scoliosis upon her health. The patient agreed to surgery, which was performed in one of Germanys leading centres for spinal surgery. The thoracolumbar curve was corrected and fused, while the thoracic curve, clearly showing wedged vertebrae, defined as structural scoliosis, remained untreated. This operation left the patient with an unbalanced appearance, with radiological and clinical imbalance to the right. The clinical appearance of the patient though clearly deteriorated post-surgery. Furthermore, the wedged disc space below the fusion area indicates future problems with possible destabilisation accompanied probably by low back pain. Conclusion Scoliosis surgery for patients with AIS is mainly indicated for cosmetic or psychological reasons. Therefore the treatment leading to the best possible clinical appearance and balance has to be chosen. Patients should be informed that surgery will not necessarily improve their health status. Clinical deterioration after surgery may occur, and such information is crucial for an adequate informed consent.

  1. Effects of Prostaglandin E1 on Patients Undergoing Major Gastrointestinal Surgery.

    Science.gov (United States)

    Hao, Fabao; Guo, Hongjie; Zhong, Jia; Geng, Qiankun; Yang, Yang; Chen, Bailin; Guo, Chunbao

    2018-04-01

    The aim of this study was to investigate the clinical effects of prostaglandin E1 (PGE1) in patients who underwent surgery for gastrointestinal (GI) trauma, perforation, or obstruction. PGE1 is thought to enhance intestinal blood supply and reduce GI complications during the postoperative period. The medical records of 889 patients undergoing major GI surgery were reviewed retrospectively. Propensity score matching was performed to adjust for any baseline differences. Clinical outcomes, including early GI function recovery, postoperative complications, and length of hospital stay, were evaluated in all patients. In 278 paired patients, selected nutritional, immunologic, and inflammatory variables were compared based on PGE1 administration. After propensity score 1:1 matching, the baseline characteristics were similar for both groups. PGE1 was associated with prompt postoperative GI function recovery, including first bowel movement [2.6 ± 0.9 vs 3.1 ± 1.0 days after surgery in patients with and without PGE1 treatment, risk ratio 0.51, 95% confidence interval (CI) 0.41-0.65, P < 0.001] and first feeding within postoperative day 3 [179 (64.39%) vs 152 (54.68%); risk ratio 0.61, 95% CI 0.42-0.90, P = 0.012]. A lower overall postoperative complication rate, including infectious complications [45 (16.2%) vs 68 (24.5%); odds ratio 0.60, 95% CI 0.39-0.91, P = 0.010] and major complications [23 (8.3%) vs 48 (17.3%); odds ratio 0.43, 95% CI 0.26-0.73, P = 0.001], was noted in patients with PGE1 treatment than in patients without PGE1 treatment. Furthermore, the immunologic and inflammatory variable C-reactive protein on postoperative day 3 was reduced by PGE1 treatment (52.5 ± 36.4 vs 89.6 ± 42.4 mg/L; P = 0.037, t test). PGE1 is associated with beneficial clinical effects, such as prompt postoperative GI function recovery and reduced overall postoperative complications after emergency GI surgery, which may be attributed to a reduced inflammatory

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

    DEFF Research Database (Denmark)

    Øland, Jesper; Jensen, John; Melsen, Birte

    2010-01-01

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

  3. Response to erlotinib in a patient with treatment refractory chordoma.

    Science.gov (United States)

    Singhal, Nimit; Kotasek, Dusan; Parnis, Francis X

    2009-11-01

    Chordomas are rare tumors arising from the axial skeleton. The disease is characterized by slow local growth, frequent local recurrences, and rare systemic spread. Surgery and local radiation remains the mainstay of treatment with minimal role of systemic therapy. Imatinib has been shown to be active in a phase II trial with symptomatic and radiological responses. We report a case where treatment with erlotinib, an epidermal growth factor receptor tyrosine kinase inhibitor, induced symptomatic and radiological response in a patient with disease refractory to imatinib and vascular disrupting agent.

  4. Patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer.

    Science.gov (United States)

    Landers, Margaret; McCarthy, Geraldine; Livingstone, Vicki; Savage, Eileen

    2014-08-01

    To investigate patients' bowel symptom experiences and self-care strategies following sphincter-saving surgery for rectal cancer and the relationship between bowel symptom experiences and the self-care strategies used. Earlier diagnosis of rectal cancer allows for less invasive surgical treatments such as sphincter-saving procedures to be performed. Although a permanent stoma is generally not required, patients experience changes in bowel function following this surgery. However, limited research exists on patients' bowel symptom experiences and the self-care strategies used to manage symptoms following sphincter-saving surgery of rectal cancer. Quantitative descriptive correlational. A convenience sample of 143 patients aged 30 to over 70 years was used. Data were collected (April 2010-December 2010) using the Illness Perception Questionnaires, the Difficulties of Life Scale and a researcher developed Self-care Strategy Measure. The research was underpinned by the Symptom Management Theory. Relating to the four most effective self-care strategies used respondents reporting more bowel symptom were more likely to use the self-care strategy proximity/knowing the location of a toilet at all times. Females, respondents with high timeline cyclical scores and respondents with high physiological responses scores were more likely to use protective clothing. Respondents reporting more bowel symptom and with high social responses scores were more likely to use bowel medication. Females were more likely to wear incontinence pads. This research provides insights into the daily bowel symptom experiences of patients following sphincter-saving surgery for rectal cancer. It demonstrates the range of self-care strategies that individuals use to manage their bowel symptoms and the self-care-strategies that were most effective for them. Patients should be encouraged to report on-going bowel problems following sphincter-saving surgery for rectal cancer. Supportive care for patients

  5. Increased Need for Gastrointestinal Surgery and Increased Risk of Surgery-Related Complications in Patients with Ehlers-Danlos Syndrome

    DEFF Research Database (Denmark)

    Kulas Søborg, Marie-Louise; Leganger, Julie; Rosenberg, Jacob

    2017-01-01

    . The purpose of this systematic review was to assess the causes of GI-related surgery and related mortality and morbidity in patients with EDSs. METHODS: A systematic search was conducted in PubMed, Embase, and Scopus to identify relevant studies. Preferred Reporting Items for Systematic Reviews and Meta...

  6. EFFECTS OF CORNEAL CROSSLINKING ON OCULAR RESPONSE ANALYZER WAVEFORM-DERIVED VARIABLES IN KERATOCONUS AND POST-REFRACTIVE SURGERY ECTASIA

    Science.gov (United States)

    Hallahan, Katie M.; Rocha, Karolinne; Sinha Roy, Abhijit; Randleman, J. Bradley; Stulting, R. Doyle; Dupps, William J.

    2014-01-01

    Purpose To assess changes in Ocular Response Analyzer (ORA) waveforms after UVA/riboflavin corneal collagen crosslinking (CXL) using investigator-derived and manufacturer-supplied morphometric variables in keratoconus (KC) and post-refractive surgery ectasia patients. Design Prospective, randomized trial of a standard, epithelium-off CXL protocol Participants Patients with progressive KC (24 eyes of 21 patients) or post-refractive surgery ectasia (27 eyes of 23 patients) were enrolled. Methods Replicate ORA measurements were obtained prior to and 3 months after CXL. Pre-treatment and post-treatment waveform variables were analyzed for differences by paired student’s t-tests using measurements with the highest waveform scores. Main Outcome Measures Corneal Hysteresis, Corneal Resistance Factor, 37 second-generation manufacturer-supplied ORA variables, 15 investigator-derived ORA variables Results No variables were significantly different 3 months after CXL in the KC group, and no manufacturer–supplied variables changed significantly in the post-refractive surgery ectasia group. Four custom variables (ApplanationOnsetTime, P1P2avg, Impulse, and Pmax) increased by small but statistically significant margins after CXL in the post-refractive surgery ectasia group. Conclusions Changes in a small subset of investigator-derived variables suggested an increase in corneal bending resistance after CXL. However, the magnitudes of these changes were low and not commensurate with the degree of clinical improvement or prior computational estimates of corneal stiffening in the same cohort over the same period. Available air-puff derived measures of the corneal deformation response underestimate the biomechanical changes produced by CXL. PMID:25365551

  7. Effect of Dex medetomidine on Neuromuscular Blockade in Patients Undergoing Complex Major Abdominal or Pelvic Surgery

    International Nuclear Information System (INIS)

    El-Awady, G.A.; Abdelhalim, J.M.K.; Azer, M.S.

    2003-01-01

    Dex medetomidine is a highly selective α2 agonist with anesthetic, analgesic and sympatholytic properties. Its neuromuscular effects in humans are unknown. This study evaluates the effect of dex medetomidine on neuromuscular block and hemodynamics during thiopental/ isoflurane anesthesia for patients with complex abdominal or pelvic surgery. Patients and methods: During thiopental/isoflurane anesthesia, the rocuronium infusion rate was adjusted in 20 complex surgery patients to maintain a stable first response (T1) in the train of four sequence of 50% ± 3 of the pre-rocuronium value. Dex medetomidine was then administered by infusion pump, targeting a plasma dex medetomidine concentration of 0.6 ng/dL for 45 min. The evoked mechanical responses of the adductor pollicis responses (T1 response and T4/T1 ratio), systolic blood pressure, diastolic blood pressure and heart rate (HR) were measured during the dex medetomidine infusion using repeated measures analysis of variance. Plasma levels ranged from 0.73 to 1.38 ng/mL. Results: T1 values decreased during the infusion from 55(ρ2 to 38±9 ((ρ< 0.05). T4/Tl values did not change during the infusion. Dex medetomidine increased SBP (ρ< 0.001) and decreased HR ((ρ< 0.05) (10 min median values) during the infusion compared with values before the infusion. This study demonstrated that dex medetomidine decreased T1, increased SBP and decreased HR during thiopental/isoflurane anesthesia. Conclusion: We conclude that dex medetomidine induced direct vasoconstriction may alter pharmacokinetics of rocuronium, therefore increasing plasma rocuronium concentration. Although these effects were statistically significant, further studies should be held for understanding and characterizing the peripheral vasoconstrictive effects of a2 agonists that allow better management and determination of drug dosing regimens

  8. The effect of mitral valve surgery on ventricular arrhythmia in patients with bileaflet mitral valve prolapse

    Directory of Open Access Journals (Sweden)

    Niyada Naksuk

    2016-11-01

    Conclusions: MV surgery does not uniformly reduce VE burden in patients with biMVP. However, those patients who do have a reduction in VE burden are younger, perhaps suggesting that early surgical intervention could modify the underlying electrophysiologic substrate.

  9. Negative predictors for satisfaction in patients seeking facial cosmetic surgery: a systematic review

    NARCIS (Netherlands)

    Herruer, J.M.; Prins, J.B.; Heerbeek, N. van; Verhage-Damen, G.W.; Ingels, K.J.A.O.

    2015-01-01

    BACKGROUND: Facial cosmetic surgery is becoming more popular. Patients generally indicate they are satisfied with the results. Certain patient characteristics, however, have been described as negative predictors for satisfaction. Psychopathology such as body dysmorphic disorder and personality

  10. Surgical and oncological outcome of laparoscopic surgery, compared to laparotomy, for Japanese patients with endometrial cancer

    Directory of Open Access Journals (Sweden)

    Yasuhisa Terao

    2016-05-01

    Conclusion: Laparoscopic surgery is safe and feasible for patients with early-stage endometrial cancer. However, patients with carcinosarcoma and other histologic types of endometrioid adenocarcinoma require special attention because of the high risk of recurrence and poor prognosis.

  11. Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

    Directory of Open Access Journals (Sweden)

    Ehab A. Wahby

    2016-08-01

    Conclusion: Tight glycemic control improved perioperative outcome in diabetic CABG patients. Maintaining perioperative blood glucose level between 110 and 149 mg/dl is safe and should be recommended as a routine practice in diabetic patients undergoing CABG surgery.

  12. Re-embodying eating: patients' experiences 5 years after bariatric surgery.

    Science.gov (United States)

    Natvik, Eli; Gjengedal, Eva; Moltu, Christian; Råheim, Målfrid

    2014-12-01

    Health experts advise and expect patients to eat healthily after bariatric surgery. For patients, difficulties with eating might have been a long-standing, problematic part of life-a part that is not necessarily healed by surgery. Empirical research on patients' experiences of eating practices after bariatric surgery is lacking. Aiming to contribute to the development of clinical practice, we explored meanings attached to eating in the long term and sought descriptions of change and bodily sensations. We interviewed 14 patients at least 5 years after bariatric surgery. The surgical restriction forced changes in the way patients sensed their own body in eating, but the uncertainty related to maintaining weight loss in the long term remained. Meanings attached to eating transcended food as choices situated in a nourishment and health perspective, and were not necessarily changed. Eating was an existential and embodied practice, which remained an ambiguous and sensitive matter after surgery. © The Author(s) 2014.

  13. 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

  14. The effectiveness of simultaneous oncoplastic breast surgery in patients with locally advanced breast cancer.

    Science.gov (United States)

    Emiroglu, Mustafa; Sert, Ismail; Karaali, Cem; Aksoy, Süleyman Ozkan; Ugurlu, Levent; Aydın, Cengiz

    2016-05-01

    Oncological outcomes of the oncoplastic breast surgery in patients with locally advanced breast cancer (LABC) are not well defined. This study examined the effects of oncoplastic techniques for LABC in terms of localized control and survival. We also evaluated the esthetic results of patients who had undergone oncoplastic breast conservation surgery (OBCS) and their satisfaction with the outcome. The files and Medula (Probel Co.) database records of the patients were studied retrospectively. The esthetic evaluation was conducted by a panel. A validated satisfaction study was also performed. In total, 42 LABC cases (median age 48 years; range 33-69 years) were included. The median observation period was 61 months (range 26-151 months). Neoadjuvant chemotherapy (NACT) was administered in 32 (76%) cases, and a pathologic complete response was observed in 7 (16.7%) cases. The median T size during the post-NACT pathological study was 27 mm (range 0-44 mm). Oncoplastic reduction surgery was performed in 13 cases, a glandular flap in 7, Grisotti flap in 5, and latissimus dorsi flap in 3 cases. The median specimen weight was 198 g (range 103-812 g), and the mean surgical margin length was 8.7 mm (range 5-17 mm). The margin was positive in 7.1% of cases, and the local repetition rate was 14.6%. The total survival rate was 86.6%, and disease-free survival was 59.6%. The rate of excellent and good ratings by the esthetic assessment panel was 79.4%. The satisfaction rate was 88.2%. The early and delayed complication rate was 16.7%. Oncoplastic techniques are suitable and safe for patients undergoing OBCS. These techniques do not pose a risk to oncological local control. No survival or follow-up problems were detected during the 5-year follow-up period, the esthetic results were acceptable, and the satisfaction rate was high.

  15. Patient and Referring Provider Characteristics Associated With the Likelihood of Undergoing Bariatric Surgery: A Systematic Review

    Science.gov (United States)

    Funk, Luke M.; Jolles, Sally; Fischer, Laura E.; Voils, Corrine I

    2016-01-01

    Importance Although bariatric surgery is the most cost-effective treatment for severe obesity, less than 1% of severely obese patients undergo it. Reasons for low utilization are unclear. Objectives To identify patient and referring provider characteristics associated with the likelihood of undergoing bariatric surgery. Evidence Review PubMed, PsycINFO, CINAHL, and the Cochrane databases were searched for reports published between January 1, 1998, and December 31, 2014. Reports were eligible if they presented descriptive data regarding facilitators or barriers to bariatric surgery or if they reported statistical associations between patient or provider characteristics and referral to or receipt of bariatric surgery. Frequency effect sizes were calculated as the proportion of studies reporting a finding. Findings Of the 7,212 reports identified in the initial search, 53 were included in full-text review. Nine reports met our inclusion criteria and were included in analyses. Of those, four included descriptive findings, six reported statistical associations, and one included both. One report included providers as study participants, whereas eight included patients. Four of nine studies identified an association between female gender and a greater willingness to undergo bariatric surgery. Lack of knowledge about bariatric surgery was a barrier in two studies. Five of nine cited patient concerns about the outcomes and safety of bariatric surgery as a barrier to undergoing it. Patients were more likely to pursue bariatric surgery when it was recommended by referring providers. Providers who believed that obesity treatment should be covered by insurance were more likely to recommend bariatric surgery. Conclusions and Relevance Limited patient and referring provider knowledge about the safety and effectiveness of bariatric surgery are important barriers to bariatric surgery utilization. Future efforts focused on improving knowledge and identification of the critical

  16. Epilepsy surgery series: a study of 502 consecutive patients from a developing country.

    Science.gov (United States)

    Alsemari, Abdulaziz; Al-Otaibi, Faisal; Baz, Salah; Althubaiti, Ibrahim; Aldhalaan, Hisham; Macdonald, David; Abalkhail, Tareq; Fiol, Miguel E; Alyamani, Suad; Chedrawi, Aziza; Leblanc, Frank; Parrent, Andrew; Maclean, Donald; Girvin, John

    2014-01-01

    Purpose. To review the postoperative seizure outcomes of patients that underwent surgery for epilepsy at King Faisal Specialist Hospital & Research Centre (KFSHRC). Methods. A descriptive retrospective study for 502 patients operated on for medically intractable epilepsy between 1998 and 2012. The surgical outcome was measured using the ILAE criteria. Results. The epilepsy surgery outcome for temporal lobe epilepsy surgery (ILAE classes 1, 2, and 3) at 12, 36, and 60 months is 79.6%, 74.2%, and 67%, respectively. The favorable 12- and 36-month outcomes for frontal lobe epilepsy surgery are 62% and 52%, respectively. For both parietal and occipital epilepsy lobe surgeries the 12- and 36-month outcomes are 67%. For multilobar epilepsy surgery, the 12- and 36-month outcomes are 65% and 50%, respectively. The 12- and 36-month outcomes for functional hemispherectomy epilepsy surgery are 64.2% and 63%, respectively. According to histopathology diagnosis, mesiotemporal sclerosis (MTS) and benign CNS tumors had the best favorable outcome after surgery at 1 year (77.27% and 84.3%, resp.,) and 3 years (76% and 75%, resp.,). The least favorable seizure-free outcome after 3 years occurred in cases with dual pathology (66.6%). Thirty-four epilepsy patients with normal magnetic resonance imaging (MRI) brain scans were surgically treated. The first- and third-year epilepsy surgery outcome of 17 temporal lobe surgeries were (53%) and (47%) seizure-free, respectively. The first- and third-year epilepsy surgery outcomes of 15 extratemporal epilepsy surgeries were (47%) and (33%) seizure-free. Conclusion. The best outcomes are achieved with temporal epilepsy surgery, mesial temporal sclerosis, and benign CNS tumor. The worst outcomes are from multilobar surgery, dual pathology, and normal MRI.

  17. Decreasing candidaemia rate in abdominal surgery patients after introduction of fluconazole prophylaxis*

    DEFF Research Database (Denmark)

    Holzknecht, B J; Thorup, J; Arendrup, M C

    2011-01-01

    Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients with gastrointes......Clin Microbiol Infect ABSTRACT: Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients...

  18. Psychometric properties of patient-reported outcome measures for hip arthroscopic surgery

    DEFF Research Database (Denmark)

    Kemp, Joanne L; Collins, Natalie J; Roos, Ewa M.

    2013-01-01

    Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown.......Patient-reported outcomes (PROs) are considered the gold standard when evaluating outcomes in a surgical population. While the psychometric properties of some PROs have been tested, the properties of newer PROs in patients undergoing hip arthroscopic surgery remain somewhat unknown....

  19. Neo-adjuvant chemotherapy followed by surgery and chemotherapy or by surgery and chemoradiotherapy for patients with resectable gastric cancer (CRITICS)

    International Nuclear Information System (INIS)

    Dikken, Johan L; Verheij, Marcel; Cats, Annemieke; Sandick, Johanna W van; Maurits Swellengrebel, HA; Lind, Pehr A; Putter, Hein; Jansen, Edwin PM; Boot, Henk; Grieken, Nicole CT van; Velde, Cornelis JH van de

    2011-01-01

    Radical surgery is the cornerstone in the treatment of resectable gastric cancer. The Intergroup 0116 and MAGIC trials have shown benefit of postoperative chemoradiation and perioperative chemotherapy, respectively. Since these trials cannot be compared directly, both regimens are evaluated prospectively in the CRITICS trial. This study aims to obtain an improved overall survival for patients treated with preoperative chemotherapy and surgery by incorporating radiotherapy concurrently with chemotherapy postoperatively. In this phase III multicentre study, patients with resectable gastric cancer are treated with three cycles of preoperative ECC (epirubicin, cisplatin and capecitabine), followed by surgery with adequate lymph node dissection, and then either another three cycles of ECC or concurrent chemoradiation (45 Gy, cisplatin and capecitabine). Surgical, pathological, and radiotherapeutic quality control is performed. The primary endpoint is overall survival, secondary endpoints are disease-free survival (DFS), toxicity, health-related quality of life (HRQL), prediction of response, and recurrence risk assessed by genomic and expression profiling. Accrual for the CRITICS trial is from the Netherlands, Sweden, and Denmark, and more countries are invited to participate. Results of this study will demonstrate whether the combination of preoperative chemotherapy and postoperative chemoradiotherapy will improve the clinical outcome of the current European standard of perioperative chemotherapy, and will therefore play a key role in the future management of patients with resectable gastric cancer. clinicaltrials.gov http://www.clinicaltrials.gov/ct2/show/NCT00407186

  20. Bone and Soft Tissue Changes after Two-Jaw Surgery in Cleft Patients

    Directory of Open Access Journals (Sweden)

    Yung Sang Yun

    2015-07-01

    Full Text Available BackgroundOrthognathic surgery is required in 25% to 35% of patients with a cleft lip and palate, for whom functional recovery and aesthetic improvement after surgery are important. The aim of this study was to examine maxillary and mandibular changes, along with concomitant soft tissue changes, in cleft patients who underwent LeFort I osteotomy and sagittal split ramus osteotomy (two-jaw surgery.MethodsTwenty-eight cleft patients who underwent two-jaw surgery between August 2008 and November 2013 were included. Cephalometric analysis was conducted before and after surgery. Preoperative and postoperative measurements of the bone and soft tissue were compared.ResultsThe mean horizontal advancement of the maxilla (point A was 6.12 mm, while that of the mandible (point B was -5.19 mm. The mean point A-nasion-point B angle was -4.1° before surgery, and increased to 2.5° after surgery. The mean nasolabial angle was 72.7° before surgery, and increased to 88.7° after surgery. The mean minimal distance between Rickett's E-line and the upper lip was 6.52 mm before surgery and 1.81 mm after surgery. The ratio of soft tissue change to bone change was 0.55 between point A and point A' and 0.93 between point B and point B'.ConclusionsPatients with cleft lip and palate who underwent two-jaw surgery showed optimal soft tissue changes. The position of the soft tissue (point A' was shifted by a distance equal to 55% of the change in the maxillary bone. Therefore, bone surgery without soft tissue correction can achieve good aesthetic results.

  1. The efficacy of a smoking cessation programme in patients undergoing elective surgery - a randomised clinical trial

    DEFF Research Database (Denmark)

    Azodi, O. Sadr; Lindstrom, D.; Adami, J.

    2009-01-01

    It is known that smokers constitute an important risk group of patients undergoing surgery. It is unknown how smoking cessation intervention initiated 4 weeks prior to elective surgery affects the probability of permanent cessation. We randomly assigned 117 patients, scheduled to undergo elective...... orthopaedic and general surgery, to smoking cessation intervention and control group. The intervention group underwent a programme initiated, on average, 4 weeks prior to surgery with weekly meetings or telephone counselling and were provided with free nicotine replacement therapy (NRT). The control group...

  2. Evaluation of response variables in computer-simulated virtual cataract surgery

    Science.gov (United States)

    Söderberg, Per G.; Laurell, Carl-Gustaf; Simawi, Wamidh; Nordqvist, Per; Skarman, Eva; Nordh, Leif

    2006-02-01

    We have developed a virtual reality (VR) simulator for phacoemulsification (phaco) surgery. The current work aimed at evaluating the precision in the estimation of response variables identified for measurement of the performance of VR phaco surgery. We identified 31 response variables measuring; the overall procedure, the foot pedal technique, the phacoemulsification technique, erroneous manipulation, and damage to ocular structures. Totally, 8 medical or optometry students with a good knowledge of ocular anatomy and physiology but naive to cataract surgery performed three sessions each of VR Phaco surgery. For measurement, the surgical procedure was divided into a sculpting phase and an evacuation phase. The 31 response variables were measured for each phase in all three sessions. The variance components for individuals and iterations of sessions within individuals were estimated with an analysis of variance assuming a hierarchal model. The consequences of estimated variabilities for sample size requirements were determined. It was found that generally there was more variability for iterated sessions within individuals for measurements of the sculpting phase than for measurements of the evacuation phase. This resulted in larger required sample sizes for detection of difference between independent groups or change within group, for the sculpting phase as compared to for the evacuation phase. It is concluded that several of the identified response variables can be measured with sufficient precision for evaluation of VR phaco surgery.

  3. Patients' preferences in mode of surgery of an adnexal mass

    NARCIS (Netherlands)

    Geomini, Peggy M. A. J.; Bremer, Gerard L.; Kruitwagen, Roy F. P. M.; Opmeer, Brent C.; Mol, Ben Willem J.

    2009-01-01

    Objective. We assessed the preferences of women with an adnexal mass for the mode of surgery. Methods. A structured interview was designed in which women, scheduled for surgery for an adnexal mass, were confronted with fictive scenarios of the different approaches. Women were asked at what

  4. The modified Glasgow prognostic score in patients undergoing surgery for bone and soft tissue sarcoma.

    Science.gov (United States)

    Morhij, Rossel; Mahendra, Ashish; Jane, Mike; McMillan, Donald C

    2017-05-01

    The prognostic significance of markers of the systemic inflammatory response in patients with soft tissue and bone sarcomas remains unclear. Therefore, the present study aimed to compare the prognostic value of markers of the systemic inflammatory response in patients undergoing surgery for primary soft tissue and bone sarcoma. Patients who underwent resection of primary soft tissue/bone sarcoma between 2008 and 2012 and had pre-operative measurements of the systemic inflammatory response [C-reactive protein, albumin, white cell, neutrophil, lymphocyte and platelet counts, and the combination of C-reactive protein and albumin (mGPS)] were included in the study (n = 111). The majority of the patients were ≤50 years old (84%), were female (63%), had soft tissue sarcoma (62%), and had tumours >10 cm (52%), mostly of high grade (85%). The median follow-up of survivors was 50 months (range 34-78); 24 (21%) developed local recurrence, 35 (31%) developed distant metastases and 30 (30%) died of their cancer. On univariate analysis, tumour size (P sarcoma. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  5. The effect of bariatric surgery on psychiatric course among patients with bipolar disorder.

    Science.gov (United States)

    Ahmed, Ameena T; Warton, E Margaret; Schaefer, Catherine A; Shen, Ling; McIntyre, Roger S

    2013-11-01

    Bariatric surgery is the most effective therapy for severe obesity. People with bipolar disorder have increased risk of obesity, yet are sometimes considered ineligible for bariatric surgery due to their bipolar disorder diagnosis. This study aimed to determine if bariatric surgery alters psychiatric course among stable patients with bipolar disorder. A matched cohort study (2006-2009) with mean follow-up of 2.17 years was conducted within Kaiser Permanente Northern California, a group practice integrated health services delivery organization that provides medical and psychiatric care to 3.3 million people. Participants were 144 severely obese patients with bipolar disorder who underwent bariatric surgery, and 1,440 control patients with bipolar disorder, matched for gender, medical center, and contemporaneous health plan membership. Controls met referral criteria for bariatric surgery. Hazard ratio for psychiatric hospitalization, and change in rate of outpatient psychiatric utilization from baseline to Years 1 and 2, were compared between groups. A total of 13 bariatric surgery patients (9.0%) and 153 unexposed to surgery (10.6%) had psychiatric hospitalization during follow-up. In multivariate Cox models adjusting for potential confounding factors, the hazard ratio of psychiatric hospitalization associated with bariatric surgery was 1.03 [95% confidence interval (CI): 0.83-1.23]. In fully saturated multivariate general linear models, change in outpatient psychiatric utilization was not significantly different for surgery patients versus controls, from baseline to Year 1 (-0.4 visits/year, 95% CI: -0.5 to 0.4) or baseline to Year 2 (0.4 visits/year, 95% CI: -0.1 to 1.0). Bariatric surgery did not affect psychiatric course among stable patients with bipolar disorder. The results of this study suggest that patients with bipolar disorder who have been evaluated as stable can be considered for bariatric surgery. © 2013 John Wiley & Sons A/S. Published by John

  6. Structural pathology is not related to patient-reported pain and function in patients undergoing meniscal surgery

    DEFF Research Database (Denmark)

    Christensen, Simon Tornbjerg; Nissen, Nis; Englund, Martin

    2017-01-01

    the Knee Injury and Osteoarthritis Outcome Score (KOOS), were obtained by online questionnaires prior to surgery. Knee pathology was assessed by the operating surgeons using a modified version of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification...... surgery were not associated with preoperative self-reported pain and function in patients with meniscal tears questioning inferences made about a direct relationship between these. Our findings question the role of arthroscopic surgery to address structural pathology as a means to improve patient...

  7. Depression and anxiety in patients undergoing herniated disc surgery: relevant but underresearched - a systematic review.

    Science.gov (United States)

    Zieger, M; Schwarz, R; König, H-H; Härter, M; Riedel-Heller, S G

    2010-02-01

    An association between depression and anxiety and musculoskeletal disorders has been consistently reported in the past years. This article provides a systematic overview of the literature on the prevalence rates of depression and anxiety in patients undergoing surgery for a herniated disc. A systematic literature search was conducted in the following electronic databases: PubMed, PsycINFO, Web of Science, Cochrane Library and PSYNDEXplus. The identified articles were evaluated for prevalence rates of depression and anxiety, methodological issues, change of depression and anxiety over time, and major findings on the impact of depression and anxiety on patients undergoing disc surgery. Fourteen studies were identified. Prevalence rates for depression and anxiety in patients undergoing disc surgery varied between 21.5% and 49.3% before and between 4.1% and 79.6% after disc surgery. The study designs, the use of assessment instruments and cut-off values varied greatly. Depression and anxiety decreased within the population of disc surgery patients over time. Depression and anxiety were found to have a great impact on the postoperative outcome of surgery, return to work, analgesia abuse, pain experience, and abnormal illness behaviour. Little research has been done to investigate depression and anxiety in patients undergoing surgery for a herniated disc. Evidently disc surgery patients are at higher risk of suffering from depression and anxiety than the general population. The review outlines the importance for clinicians to be more sensitive to psychological concerns in patients undergoing disc surgery. Psychological assessment and assistance from mental health professionals should be considered during the hospital stay and rehabilitation period, depending on local feasibility. Further investigations are necessary to examine whether the implementation of a multidisciplinary in-patient treatment program will improve postoperative outcome in patients undergoing

  8. Radiotherapy With or Without Surgery for Patients With Idiopathic Sclerosing Orbital Inflammation Refractory or Intolerant to Steroid Therapy

    International Nuclear Information System (INIS)

    Lee, Jong Hoon; Kim, Yeon-Sil; Yang, Suk Woo; Cho, Won-Kyung; Lee, Sang Nam; Lee, Kyung Ji; Ryu, Mi-Ryeong; Jang, Hong Seok

    2012-01-01

    Purpose: To evaluate the outcomes of patients with idiopathic sclerosing orbital inflammation (ISOI) treated with radiotherapy with or without surgery. Methods and Materials: We retrospectively reviewed 22 patients with histopathologically confirmed ISOI who had been refractory or intolerant to steroid therapy and treated with radiation with or without surgery. The radiation dose ranged from 20 to 40 Gy (median, 20 Gy) at 2 Gy per fraction. Presenting signs and treatment outcomes were assessed. Results: Proptosis was the most common sign at presentation, seen in 19 (86.3%) patients, followed by restriction of extraocular movements in 10 (45.4%) patients. Response to radiotherapy was complete in 15 (68.1%) patients, partial in 3 (13.6%) patients, and none in 4 (18.2%) patien