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Sample records for surgery preoperative evaluation

  1. Preoperative Evaluation for Noncardiac Surgery.

    Science.gov (United States)

    Cohn, Steven L

    2016-12-06

    This issue provides a clinical overview of preoperative evaluation for noncardiac surgery, focusing on risk factors, elements of evaluation, medication management, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  2. [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

  3. Role of multimodality cardiac imaging in preoperative cardiovascular evaluation before noncardiac surgery

    Directory of Open Access Journals (Sweden)

    Fathala Ahmed

    2011-01-01

    Full Text Available The preoperative cardiac assessment of patients undergoing noncardiac surgery is common in the daily practice of medical consultants, anesthesiologists, and surgeons. The number of patients undergoing noncardiac surgery worldwide is increasing. Currently, there are several noninvasive diagnostic tests available for preoperative evaluation. Both nuclear cardiology with myocardial perfusion single photon emission computed tomography (SPECT and stress echocardiography are well-established techniques for preoperative cardiac evaluation. Recently, some studies demonstrated that both coronary angiography by gated multidetector computed tomography and stress cardiac magnetic resonance might potentially play a role in preoperative evaluation as well, but more studies are needed to assess the role of these new modalities in preoperative risk stratification. A common question that arises in preoperative evaluation is if further preoperative testing is needed, which preoperative test should be used. The preferred stress test is the exercise electrocardiogram (ECG. Stress imaging with exercise or pharmacologic stress agents is to be considered in patients with abnormal rest ECG or patients who are unable to exercise. After reviewing this article, the reader should develop an understanding of the following: (1 the magnitude of the cardiac preoperative morbidity and mortality, (2 how to select a patient for further preoperative testing, (3 currently available noninvasive cardiac testing for the detection of coronary artery disease and assessment of left ventricular function, and (4 an approach to select the most appropriate noninvasive cardiac test, if needed.

  4. Magnetoencephalography in the preoperative evaluation for epilepsy surgery.

    Science.gov (United States)

    Anderson, Christopher T; Carlson, Chad E; Li, Zhimin; Raghavan, Manoj

    2014-05-01

    People with pharmacoresistant epilepsy are often candidates for resective epilepsy surgery. The presurgical evaluation for epilepsy aims to localize the epileptic network that initiates seizures (which should be disrupted or removed) and determine its spatial relationship to eloquent cortex (which should be preserved). Noninvasive functional imaging techniques play an increasingly important role in planning epilepsy surgery and assessing the feasibility, risks, and benefits of surgery. Magnetoencephalography (MEG) can be a very useful part of a comprehensive presurgical evaluation as it can model the sources of epileptiform activity and localize eloquent cortices within the same study. This review is designed to assist anyone in the field of neurology or related disciplines understand some methods and terminology relevant to clinical MEG. Every effort is made to present the information in nontechnical, approachable ways so that readers will come away with a basic understanding of how to interpret MEG findings when the reported data on one of their patients are presented to them.

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

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia 2015; 21(4):23-28 ... The information obtained from the standardised PAR form in each patient's file was audited using a ... inadequate preoperative assessment and management were.

  6. Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery

    OpenAIRE

    Costa, Jean Allan; Almeida, Maria Lucia Pereira; Estrada, Tereza Cristina Duque; Werneck,Guilherme Lobosco; Rocha, Alexandre Marins; Rosa,Maria Luiza Garcia; Ribeiro, Mario Luiz; Mesquita, Claudio Tinoco

    2016-01-01

    Background The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods A total of 211 patients referred for elective surgeries, without suspic...

  7. The usefulness of myocardial SPECT for the preoperative cardiac risk evaluation in noncardiac surgery

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Seok Tae; Lee, Dong Soo; Kang, Won Jon; Chung, June Key; Lee, Myung Chul [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)

    1999-02-01

    We investigated whether myocardial SPECT had additional usefulness to clinical, functional or surgical indices for the preoperative evaluation of cardiac risks in noncardiac surgery. 118 patients ( M: F=66: 52, 62.7{+-}10.5 years) were studied retrospectively. Eighteen underwent vascular surgeries and 100 nonvascular surgeries. Rest Tl-201/ stress Tc-99m-MIBI SPECT was performed before operation and cardiac events (hard event: cardiac death and myocardial infarction; soft event: ischemic ECG change, congestive heat failure and unstable angina) were surveyed through perioperative periods (14.6{+-}5.6 days). Clinical risk indices, functional capacity, surgery procedures and SPECT findings were tested for their predictive values of perioperative cardiac events. Peri-operative cardiac events occurred in 25 patients (3 hard events and 22 soft events). Clinical risk indices, surgical procedure risks and SPECT findings but functional capacity were predictive of cardiac events. Reversible perfusion decrease was a better predictor than persistent decrease. Multivariate analysis sorted out surgical procedure risk (p=0.0018) and SPECT findings (p=0.0001) as significant risk factors. SPECT could re-stratify perioperative cardiac risks in patients ranked with surgical procedures. We conclude that myocardial SPECT provides additional predictive value to surgical type risks as well as clinical indexes or functional capacity for the prediction of preoperative cardiac events in noncardiac surgery.

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

    Directory of Open Access Journals (Sweden)

    Arunotai Siriussawakul

    2013-01-01

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

  9. Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery

    Science.gov (United States)

    Costa, Jean Allan; Almeida, Maria Lucia Pereira; Estrada, Tereza Cristina Duque; Werneck, Guilherme Lobosco; Rocha, Alexandre Marins; Rosa, Maria Luiza Garcia; Ribeiro, Mario Luiz; Mesquita, Claudio Tinoco

    2016-01-01

    Background The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. Objectives To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. Methods A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study. Assessment of patients was conducted by conventional echocardiogram using the ultraportable V Scan (GE) device right after the pre-anesthetic clinical evaluation. We assessed the clinical impact of echocardiography results by using a questionnaire addressed to the anesthetist. Results Mean age of patients was 68.9 ± 7.0 years, 154 were women. The most frequent surgeries were: a) facectomy - cataract - 18; b) inguinal hernia surgery - 18; c) Cholecystectomy - 16. We found 58 normal tests (27.5%), 70 (33.2%) with mild valve reflux, and 83 (39.3%) with relevant abnormality, such as increase in heart chamber size, global and/or segmental contractile dysfunction, significant valve dysfunction or other unspecified. Test results caused delay of surgical procedure for a more detailed cardiac evaluation in 20 (9.5%) patients, and change in anesthetic management in 7 (3.3%). Conclusion There was a considerable clinical impact with the use of the ultraportable echocardiography, since one out of every ten patients evaluated had their clinical management changed due to the detection of previously unsuspected, significant heart diseases, with the potential for severe complications. PMID:27982268

  10. How accurate is preoperative evaluation of pelvic organ prolapse in women undergoing vaginal reconstruction surgery?

    Directory of Open Access Journals (Sweden)

    Haim Krissi

    Full Text Available OBJECTIVE: To evaluate the differences between the in-office and intraoperative techniques used to evaluate pelvic organ prolapse. MATERIALS AND METHODS: A prospective study included 25 women undergoing vaginal reconstruction surgery including vaginal hysterectomy for pelvic organ prolapse. The outpatient pelvic and site-specific vaginal examination was performed in the lithotomy position with the Valsalva maneuver. Repeated intraoperative examination was performed under general anesthesia with standard mild cervical traction. The Pelvic Organ Prolapse Quantification system (POPQ was used for both measurements and staging. The values found under the two conditions were compared. RESULTS: The intraoperative POPQ-measurements values were significantly higher than the outpatient values for apical wall prolapse in 17/25 (68% women and for anterior wall prolapse in 8/25 (32% women. There was not a significant difference in the posterior wall where increase in staging was shown in 3/25 (12% patients. CONCLUSIONS: Clinicians and patients should be alert to the possibility that pelvic organ measurements performed under general anesthesia with mild traction may be different from preoperative evaluation.

  11. Utility of Ultraportable Echocardiography in the Preoperative Evaluation of Noncardiac Surgery.

    Science.gov (United States)

    Costa, Jean Allan; Almeida, Maria Lucia Pereira; Estrada, Tereza Cristina Duque; Werneck, Guilherme Lobosco; Rocha, Alexandre Marins; Rosa, Maria Luiza Garcia; Ribeiro, Mario Luiz; Mesquita, Claudio Tinoco

    2016-11-01

    The ultraportable echocardiogram machine, with relevant portability and easiness in performing diagnoses, when in experienced hands, may contribute to the reliability of preoperative evaluation in noncardiac surgeries. To assess cardiac function parameters in patients aged older than 60 years, candidates of elective noncardiac surgeries, classified as ASA1 or ASA 2 according to surgical risk. A total of 211 patients referred for elective surgeries, without suspicion of previous heart diseases, were included in the study. Assessment of patients was conducted by conventional echocardiogram using the ultraportable V Scan (GE) device right after the pre-anesthetic clinical evaluation. We assessed the clinical impact of echocardiography results by using a questionnaire addressed to the anesthetist. Mean age of patients was 68.9 ± 7.0 years, 154 were women. The most frequent surgeries were: a) facectomy - cataract - 18; b) inguinal hernia surgery - 18; c) Cholecystectomy - 16. We found 58 normal tests (27.5%), 70 (33.2%) with mild valve reflux, and 83 (39.3%) with relevant abnormality, such as increase in heart chamber size, global and/or segmental contractile dysfunction, significant valve dysfunction or other unspecified. Test results caused delay of surgical procedure for a more detailed cardiac evaluation in 20 (9.5%) patients, and change in anesthetic management in 7 (3.3%). There was a considerable clinical impact with the use of the ultraportable echocardiography, since one out of every ten patients evaluated had their clinical management changed due to the detection of previously unsuspected, significant heart diseases, with the potential for severe complications. O ecocardiógrafo ultraportátil, com importante mobilidade e facilidade diagnóstica em mãos experientes pode contribuir para a segurança na avaliação pré-operatória em cirurgias não cardíacas. Avaliar os parâmetros de função cardíaca nos pacientes com mais de 60 anos de idade, candidatos

  12. Preoperative evaluation of basal free triiodothyronine in patients undergoing coronary artery bypass grafting surgery. Does it help?

    Directory of Open Access Journals (Sweden)

    Kaushal Kishore Tiwari

    2015-11-01

    Full Text Available noBackground & Objectives: The postoperative Low T3 syndrome has been considered as a possible source of reduced myocardial contractility, resulting in increased mortality after CABG. Effect of preoperative Low T3 has not been well studied in patients undergoing CABG surgery. Aim of our study is to evaluate effect of preoperative Low T3 syndrome in patients undergoing CABG surgery.Materials & Methods: Six hundred and six patients undergoing CABG were included in this prospective study. The impact of the base-line FT3 concentration and of preoperative low T3 syndrome on the risk of postoperative low cardiac output and hospital death was analyzed.Results: Fifteen patients (2.3% postoperatively and 159 (26.2% developed major complications. At univariate analysis a reduced EF, the presence of peripheral vascular disease, the NYHA class, the surgical urgency, the aortic cross-clamp time, the CPB time and the FT3 concentration at admission were significantly associated with low CO and higher mortality. At multivariate analysis, the CPB time, an emergency procedure, a reduced LVEF, and the fT3 concentration were independently related to the development of low CO. However, in multivariate analysis low EF, and the fT3 concentration were the only predictors of hospital death.Conclusion: We conclude that preoperative low EF and low T3 syndrome independently causes low cardiac output and higher mortality in patients undergoing CABG. Therefore, all patients undergoing CABG should be evaluated for low T3 syndrome and patients with low T3 syndrome should be considered at increased risk. Appropriate preoperative T3 replacement therapy could decrease the postoperative complications in patients undergoing CABG.JCMS Nepal. 2015; 11(2:1-7

  13. Preoperative education for lumbar surgery for radiculopathy

    OpenAIRE

    Louw, A; Louw, Q; L. Crous

    2009-01-01

    To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptive...

  14. Usefulness of an accelerated transoesophageal stress echocardiography in the preoperative evaluation of high risk severely obese subjects awaiting bariatric surgery

    Directory of Open Access Journals (Sweden)

    Tessier Michel

    2010-07-01

    Full Text Available Abstract Background Severe obesity is associated with an increased risk of coronary artery disease (CAD. Bariatric surgery is an effective procedure for long term weight management as well as reduction of comorbidities. Preoperative evaluation of cardiac operative risk may often be necessary but unfortunately standard imaging techniques are often suboptimal in these subjects. The purpose of this study was to demonstrate the feasibility, safety and utility of transesophageal dobutamine stress echocardiography (TE-DSE using an adapted accelerated dobutamine infusion protocol in severely obese subjects with comorbidities being evaluated for bariatric surgery for assessing the presence of myocardial ischemia. Methods Subjects with severe obesity [body mass index (BMI >40 kg/m2] with known or suspected CAD and being evaluated for bariatric surgery were recruited. Results Twenty subjects (9M/11F, aged 50 ± 8 years (mean ± SD, weighing 141 ± 21 kg and with a BMI of 50 ± 5 kg/m2 were enrolled in the study and underwent a TE-DSE. The accelerated dobutamine infusion protocol used was well tolerated. Eighteen (90% subjects reached their target heart rate with a mean intubation time of 13 ± 4 minutes. Mean dobutamine dose was 31.5 ± 9.9 ug/kg/min while mean atropine dose was 0.5 ± 0.3 mg. TE-DSE was well tolerated by all subjects without complications including no significant arrhythmia, hypotension or reduction in blood arterial saturation. Two subjects had abnormal TE-DSE suggestive of myocardial ischemia. All patients underwent bariatric surgery with no documented cardiovascular complications. Conclusions TE-DSE using an accelerated infusion protocol is a safe and well tolerated imaging technique for the evaluation of suspected myocardial ischemia and cardiac operative risk in severely obese patients awaiting bariatric surgery. Moreover, the absence of myocardial ischemia on TE-DSE correlates well with a low operative risk of cardiac event.

  15. Preoperative education for lumbar surgery for radiculopathy

    Directory of Open Access Journals (Sweden)

    A. Louw

    2009-02-01

    Full Text Available To date no studies have been published on preoperative education forpatients who had lumbar surgery. The aim of this study was to determine if there is a demand for preoperative education for patients who had lumbar surgery for radiculopathy. A convenience sample of 47 patients who had lumbar surgery and a random sample of 141 physiotherapists involved in treating patients who had lumbar surgery completed a newly developed spinal surgery questionnaire. The data were analyzed using descriptiveand inferential statistical tests. Results showed that 100% of the patients and 99% of therapists view preoperative education to be an important component for lumbar surgery for radiculopathy. The most important factors identifiedfor inclusion in preoperative educational programs were reason for surgery, risks associated with surgery, limitations following surgery and more education regarding pain. The preferred method of education delivery was verbal one-on-one education. This study demonstrates that there is a demand for preoperative education for patients who had lumbar surgery.

  16. Preoperative alcohol cessation prior to elective surgery

    DEFF Research Database (Denmark)

    Oppedal, Kristian; Møller, Ann Merete; Pedersen, Bolette

    2012-01-01

    Hazardous drinking has been associated with an increased postoperative complication rate after surgery. Common complications include postoperative infections, cardiopulmonary complications, and bleeding episodes. Preoperative abstinence may to some degree reverse alcohol-induced pathophysiological...

  17. Pulmonary function tests in the preoperative evaluation of lung cancer surgery candidates. A review of guidelines

    OpenAIRE

    Trzaska-Sobczak, Marzena; Skoczyński, Szymon; Pierzchała, Władysław

    2014-01-01

    Before planned surgical treatment of lung cancer, the patient's respiratory system function should be evaluated. According to the current guidelines, the assessment should start with measurements of FEV1 (forced expiratory volume in 1 second) and DLco (carbon monoxide lung diffusion capacity). Pneumonectomy is possible when FEV1 and DLco are > 80% of the predicted value (p.v.). If either of these parameters is < 80%, an exercise test with VO2 max (oxygen consumption during maximal exercise) m...

  18. Preoperative optimization of the vascular surgery patient

    Directory of Open Access Journals (Sweden)

    Zhan HT

    2015-07-01

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

  19. Pulmonary function tests in the preoperative evaluation of lung cancer surgery candidates. A review of guidelines.

    Science.gov (United States)

    Trzaska-Sobczak, Marzena; Skoczyński, Szymon; Pierzchała, Władysław

    2014-09-01

    Before planned surgical treatment of lung cancer, the patient's respiratory system function should be evaluated. According to the current guidelines, the assessment should start with measurements of FEV1 (forced expiratory volume in 1 second) and DLco (carbon monoxide lung diffusion capacity). Pneumonectomy is possible when FEV1 and DLco are > 80% of the predicted value (p.v.). If either of these parameters is VO2 max (oxygen consumption during maximal exercise) measurement should be performed. When VO2 max is VO2 max is in the range of 35-75% p.v. or 10-20 ml/kg/min, the postoperative values of FEV1 and DLco (ppoFEV1, ppoDLco) should be determined. The exercise test with VO2 max measurement may be replaced with other tests such as the shuttle walk test and the stair climbing test. The distance covered during the shuttle walk test should be > 400 m. Patients considered for lobectomy should be able to climb 3 flights of stairs (12 m) and for pneumonectomy 5 flights of stairs (22 m).

  20. An observational, prospective study to evaluate the preoperative planning tool "CI-Wizard" for cochlear implant surgery.

    Science.gov (United States)

    Pirlich, Markus; Tittmann, Mary; Franz, Daniela; Dietz, Andreas; Hofer, Mathias

    2017-02-01

    "CI-Wizard" is a new, three-dimensional software planning tool for cochlear implant surgery with manual and semi-automatic algorithms to visualize anatomical risk structures of the lateral skull base preoperatively. Primary endpoints of the study represented the evaluation of the CI-Wizards usability, accuracy, subjectively perceived and objectively measured time in clinical practice. In a period from January 2014 to March 2015, n = 36 participants were included in this study. These members were divided into three groups of equal number (n = 12), but different level of experience. Senior doctors and consultants (group 1), residents (group 2) and medical students (group 3) segmented 12 different CT-scan data sets of the CI-Wizard (four per participant). In total, n = 144 data sets were collected. The usability of the CI-Wizard was measured by the given questionnaire with an interval rating scale. The Jaccard coefficient (JT) was used to evaluate the accuracy of the anatomical structures segmented. The subjectively perceived time was measured with an interval rating scale in the questionnaire and was compared with the objectively mean measured time (time interact). Across all three groups, the usability of the CI-Wizard has been assessed between 1 ("very good") and 2 ("with small defects"). Subjectively, the time was stated as "appropriate" by questionnaire. Objective measurements of the required duration revealed averages of t = 9.8 min for creating a target view. Concerning the accuracy, semi-automatic anatomical structures such as the external acoustic canal (JT = 0.90), the tympanic cavity (JT = 0.87), the ossicles (JT = 0.63), the cochlea (JT = 0.66), and the semicircular canals (JT = 0.61) reached high Jaccard values, which describes a great match of the segmented structures between the partcipants and the gold standard. Facial nerve (JT = 0.39) and round window (JT = 0.37) reached lower Jaccard values. Very little overlap tendency was

  1. Preoperative evaluation of oesophageal adenocarcinoma.

    Science.gov (United States)

    Khanna, Lauren G; Gress, Frank G

    2015-02-01

    The preoperative evaluation of oesophageal adenocarcinoma involves endoscopic ultrasound (EUS), computed tomography (CT), and positron emission tomography (PET). With routine Barrett's oesophagus surveillance, superficial cancers are often identified. EUS, CT and PET have a limited role in the staging of superficial tumours. Standard EUS has limited accuracy, but high frequency ultrasound miniprobes are valuable for assessing tumour stage in superficial tumours. However, the best method for determining depth of invasion, and thereby stage of disease, is endoscopic mucosal resection. In contrast, in advanced oesophageal cancers, a multi-modality approach is crucial. Accurate tumour staging is very important since the treatment of advanced cancers involves a combination of chemotherapy, radiation, and surgery. EUS is very useful for staging of the tumour and nodes. High frequency ultrasound miniprobes provide the ability to perform staging when the lesion is obstructing the oesophageal lumen. CT and PET provide valuable information regarding node and metastasis staging.

  2. Implications of preoperative hypoalbuminemia in colorectal surgery

    Institute of Scientific and Technical Information of China (English)

    Adam Truong; Mark H Hanna; Zhobin Moghadamyeghaneh; Michael J Stamos

    2016-01-01

    Serum albumin has traditionally been used as a quantitative measure of a patient’s nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient’s chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery.

  3. [Preoperative evaluation of adult patients prior to elective, non-cardiac surgery: joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine].

    Science.gov (United States)

    2010-11-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non-cardiac and non-lung resection surgery. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

  4. [Preoperative evaluation of adult patients prior to elective, non-cardiac surgery. Joint recommendations of German Society of Anesthesiology and Intensive Care Medicine, German Society of Surgery and German Society of Internal Medicine].

    Science.gov (United States)

    2011-09-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e.g. blood chemistry, ECG, spirometry, chest-x-ray) can contribute to a reduction of perioperative risk is often not very well known or controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate and publish recommendations on the preoperative evaluation of adult patients prior to elective, non-cardiac and non-lung resection surgery. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

  5. [Preoperative evaluation of adult patients before elective, noncardiothoracic surgery : Joint recommendation of the German Society of Anesthesiology and Intensive Care Medicine, the German Society of Surgery, and the German Society of Internal Medicine].

    Science.gov (United States)

    Zwissler, B

    2017-06-01

    Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e. g. blood chemistry, ECG, spirometry, chest x‑ray) can contribute to a reduction of perioperative risk is often not very well known or is controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate recommendations on the preoperative evaluation of adult patients prior to elective, noncardiothoracic surgery, which were initially published in 2010. These recommendations have now been updated based on the current literature and existing international guidelines. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and

  6. A preoperative checklist in esthetic plastic surgery

    OpenAIRE

    Anger,Jaime; Letizio,Nelson; Orel,Maurício; Souza Junior,José Leão de; Santos,Márcio Martines dos

    2011-01-01

    The authors present a checklist to be used at the last stage of a preoperative visit for esthetic plastic surgery composed of 29 yes/no questions, four blank spaces for entering data, and one question for ranking the level of risk of deep vein thrombosis. The criteria are divided into three tables relating to three areas: anesthesia, psychological aspects, and clinical risk factors. The answers are framed in four colors that identify the level of risk and suggest the degree of attention warra...

  7. Evaluation of intraoperative bleeding during an endoscopic surgery of nasal polyposis after a pre-operative single dose versus a 5-day course of corticosteroid.

    Science.gov (United States)

    Atighechi, Saeid; Azimi, Mohammad Reza; Mirvakili, Seyyed Abbas; Baradaranfar, Mohammad Hossein; Dadgarnia, Mohammad Hossein

    2013-09-01

    Nasal polyps are associated with the inflammation of the nasal cavity and the sinus mucosa. When medical treatment cannot solve a patient's problem, a functional endoscopic sinus surgery may be indicated. Bleeding impairs the surgery field during operation and increases the operation risk and time. Pre-operative corticosteroids can reduce bleeding during surgery. In this study, we have evaluated the effect of pre-operative single-dose prednisolone (1 mg/Kg/dose 24 h before surgery) versus 5-day prednisolone (1 mg/Kg/day before operation) on the bleeding volume and the surgery field quality during FESS. In this mono blind randomized clinical trial, 80 patients with bilateral nasal polyps were randomly assigned in two groups. The first group (A) received a single dose of 1 mg/Kg/dose prednisolone on the day before the surgery. The second group (B) received 1 mg/Kg/day prednisolone for 5 days before the operation. The patients were operated on under general anesthesia through the same protocol. The mean arterial blood pressure was 70-80 mm Hg in both groups. The surgeons were not aware of the patients' group. The bleeding volume and the surgeons' opinion about the surgery field quality were recorded at the end of the procedure and analyzed by Chi-square and t test. The two groups were not significantly different in their overall demographic and clinical characteristics. The mean bleeding volume during the operation was 266.5 ± 96.31 ml in group A and 206 ± 52.81 ml in group B; there was a significant difference between the groups (P value = 0.038). There was no significant difference between the groups in the surgeons' opinion about the surgery field quality (P value = 0.09). In conclusion, unlike a single dose (1 mg/kg/dose), treatment with 5-day prednisolone (1 mg/kg/day) can reduce blood loss during FESS more efficiently and may improve the surgery field quality slightly. But this difference is not clinically significant.

  8. Hand-held echocardiography in the setting of pre-operative cardiac evaluation of patients undergoing non-cardiac surgery: results from a randomized pilot study.

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    Cavallari, Ilaria; Mega, Simona; Goffredo, Costanza; Patti, Giuseppe; Chello, Massimo; Di Sciascio, Germano

    2015-06-01

    Transthoracic echocardiography is not a routine test in the pre-operative cardiac evaluation of patients undergoing non-cardiac surgery but may be considered in those with known heart failure and valvular heart disease or complaining cardiac symptoms. In this setting, hand-held echocardiography (HHE) could find a potential application as an alternative to standard echocardiography in selected patients; however, its utility in this context has not been investigated. The aim of this pilot study was to evaluate the conclusiveness of HHE compared to standard echocardiography in this subset of patients. 100 patients scheduled for non-cardiac surgery were randomized to receive a standard exam with a Philips Ie33 or a bedside evaluation with a pocket-size imaging device (Opti-Go, Philips Medical System). The primary endpoint was the percentage of satisfactory diagnosis at the end of the examination referred as conclusiveness. Secondary endpoints were the mean duration time and the mean waiting time to perform the exams. No significant difference in terms of conclusiveness between HHE and standard echo was found (86 vs 96%; P = 0.08). Mean duration time of the examinations was 6.1 ± 1.2 min with HHE and 13.1 ± 2.6 min with standard echocardiography (P cardiac surgery, since it provided similar information but it was faster and earlier performed compared to standard echocardiography.

  9. Preoperative Evaluation: Estimation of Pulmonary Risk.

    Science.gov (United States)

    Lakshminarasimhachar, Anand; Smetana, Gerald W

    2016-03-01

    Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. CLINICAL EVALUATION OF PREOPERATIVE SKIN PREPARATION WITH AQUEOUS POVIDONE IODINE ONLY AND IN COMBINATION WITH ALCHOLIC CHLORHEXIDINE IN PATIENTS UNDERGOING ELECTIVE AND EMERGENCY SURGERIES

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    Latchu

    2015-10-01

    Full Text Available INTRODUCTION: Many techniques are there for skin preparation before surgery, the commonest being initial scrub with antiseptic soap solution, followed by painting the prepared area with antiseptic paint solution. But degerming of the skin can be done with antiseptics us ed for less than one minute which is as effective as five minute scrub with germicidal soap solution followed by painting with antiseptics . AIMS AND OBJECTIVES : 1. To evaluate the efficacy of povidone iodine alone and antiseptic agent containing alcoholic chlorhexidine with povidone iodine in preoperative skin preparation by taking swab culture. 2. To compare the rate of postoperative wound infection in both the groups . METHODS: STUDY DESIGN: Comparative study conducted on 100 patients in two groups. STUDY SETTING: Sri Venkateswara Medical College Tirupathi SOURCE OF DATA: 100 Patients (50 in each Group undergoing elective and emergency surgery admitted in the Department of General Surgery in S.V.R.R. Government General Hospital, Tirupati from 2013 to 2014. INCLUSION CRITERIA: 1. Patients undergoing elective & emergency surgery in department of general surgery. 2. Patients with no focus of infection anywhere on the body. 3. Patients irrespective of their age and sex. 4. Patients neither immunocompromised nor on any long term steroids. 5. Patients undergoing mes h repair of hernia are also included. EXCLUSION CRITERIA: 1. Immuno compromised patients and patients on long term steroids. 2. Patients with septicemia. 3. Patients suffering from malignancies or undergoing chemotherapy or radiation therapy. 4. Contaminat ed surgeries in which viscus was opened were excluded from the study. 5. Patients with co - morbid medical conditions like diabetes, hypertension etc. METHOD OF COLLECTION OF DATA: In each case preoperatively, detailed history was taken and routine investiga tions like haemoglobin, total count, differential count, ESR, RBS and chest X - ray, ultrasound were done to

  11. Preoperative factors influencing success in pterygium surgery

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    Torres-Gimeno Ana

    2012-08-01

    Full Text Available Abstract Background To identify preoperative, perioperative and postoperative risk factors that influence the success of pterygium surgery. Methods This is a prospective study of thirty-six patients with primary or recurrent pterygia. A detailed anamnesis and an ophthalmological examination were performed looking for the following factors: age, race, latitude and altitude of the main place of residence, hours of exposure to the sun, use of protective measures against UV-radiation, classification of pterygium, width of the pterygium at limbus, surgical technique (conjunctival autograft plus suturing versus tissue glue, graft alterations (misapposition, granuloma, haemorrhage, oedema, retraction or necrosis, and postoperative symptoms (foreign-body sensation, pain. The examinations were performed 2 and 7 days and 2, 6 and 12 months after surgery. In addition, recurrence was defined as any growth of conjunctiva into the cornea. Results A logistic regression and a survival analysis have been used to perform data analysis. A total number of 36 patients completed a one year follow-up. A total of 13 patients were born and lived in Spain, and 26 came from other countries, mostly Latin America. A total number of 8 males (no women presented a recurrence, mainly between 2 and 6 months. The hours of sun exposure through their life was independently related to surgical success. Pterygia of less than 5 mm of base width showed a weak positive correlation with recurrence. None of the other factors considered were significantly related to recurrence. Conclusions Male gender and high sun exposure are strongly and independently related to surgical success after the removal of pterygia.

  12. Carcinoid tumours of the lung and the ‘PEPPS’ approach: evaluation of preoperative bronchoscopic tumour debulking as preparation for subsequent parenchyma-sparing surgery

    Science.gov (United States)

    Neuberger, Michael; Hapfelmeier, Alexander; Schmidt, Michael; Gesierich, Wolfgang; Reichenberger, Frank; Morresi-Hauf, Alicia; Hatz, Rudolf A; Lindner, Michael

    2015-01-01

    Background Preoperative bronchoscopic tumour ablation has been suggested as a beneficial treatment for bronchopulmonary carcinoid tumours, although data regarding its effects and long-term outcome are lacking. Methods In our case-matched cohort study with 208 patients with bronchopulmonary carcinoid tumours we investigated the role of preoperative bronchoscopic interventions before subsequent surgery and analysed the safety of this Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (PEPPS) based on metastasis and recurrence rates as well as survival data from 1991 to 2010. The subsequent surgery was classified into parenchyma-sparing procedures and classical lobectomies, bilobectomies and pneumonectomies. Data were obtained from the tumour registry and medical reports. Outcomes were the frequency of parenchyma-sparing surgery after bronchoscopic treatment as well as rates of metastasis, recurrence and survival. Results 132 of 208 carcinoids were located centrally. Among them, 77 patients could be recanalised preoperatively. After bronchoscopic preparation, the rate of subsequent parenchyma-sparing surgery methods was higher (p=0.021). The effect was measured by the number of segments removed. The 10-year survival rate was 89% (typical carcinoids) and 68% (atypical carcinoids), respectively. After applying PEPPS, long-term survival was slightly higher (p=0.23). Metastasis and recurrence rates showed no relevant differences between the bronchoscopically treated or non-treated groups, or between the two types of surgery classes or between the PEPPS and non-PEPPS groups. Conclusions After preoperative bronchoscopic treatment, parenchyma-sparing surgery techniques can be applied more frequently. Furthermore, we detected no negative effects after PEPPS based on metastasis, recurrence and survival rates. PMID:26203359

  13. An evaluation of preoperative and postoperative ventilation and perfusion lung scintigraphy in the screening for pulmonary embolism after elective orthopedic surgery

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    Keenan, A.M.; Palevsky, H.I.; Steinberg, M.E.; Hartman, K.M.; Alavi, A.; Lotke, P.A. (Univ. of Pennsylvania, Philadelphia (USA))

    1991-01-01

    One hundred two patients undergoing elective knee or hip arthroplasty were studied with radionuclide ventilation scans (V) and perfusion scans (Q) preoperatively (preop) and postoperatively (postop) to assess their relative value in the diagnosis of asymptomatic pulmonary embolism (PE) after orthopedic surgery. Postop Q were read in combination with preop V and Q and postop V using prospective investigation of pulmonary embolism diagnosis (PIOPED) criteria. Of 25 postop Q interpreted as either high or intermediate probability for PE, preop Q were judged useful in 96%; the postop V were useful in 78%; and the preop V were not helpful in any of the cases. Of 63 postop Q interpreted as low probability, preop Q were useful in 74%; the postop V were useful in only 33%; and the preop V were useful in only one case. When postop Q were read as normal (14 cases), none of the three auxiliary studies were found to be useful. Overall, postop V were more helpful than preop Q in only 2%, and preop V contributed significantly in only 1%. This experience suggests that preop Q alone is the most useful adjunct to the postop Q in the postoperative evaluation for PE. The authors conclude that to screen for asymptomatic PE after elective orthopedic surgery, preop Q should be performed in all cases, preop V are not necessary, and postop V need be performed only if a baseline preop Q is not available.

  14. Psychologists in preoperative programmes for children undergoing surgery.

    Science.gov (United States)

    Cuzzocrea, Francesca; Costa, Sebastiano; Gugliandolo, Maria Cristina; Larcan, Rosalba

    2016-06-01

    This study aimed to verify whether psychologists and game activities could reduce preoperative anxiety and promote compliance in paediatric patients. More specifically, we sought to evaluate whether it would be better to propose contextualized games or just distracting activities. A total of 104 children undergoing surgery were assigned to the following 4 conditions of treatment: (1) contextual games and psychological accompaniment, (2) only contextual games, (3) distracting activities, and (4) only psychological accompaniment. Observed children's anxiety was assessed using modified Yale Preoperative Anxiety Scale and compliant behaviours with modified form of Induction Compliance Checklist. Children in the first condition (complete intervention - contextual games and psychological accompaniment) were less anxious and more cooperative in the preoperative period and during the induction of anaesthesia than in the other three conditions. In particular, contextual activities (second condition) were found to be more efficient than psychological accompaniment (fourth condition), whereas the worst condition was proposing only distracting activities (third condition). In order to help young hospitalized patients in paediatric surgery structures, it is necessary to propose games that can prepare them for what will happen as well as the support of a psychologist.

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

    Science.gov (United States)

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

    2005-02-01

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

  16. Preoperative physical therapy for elective cardiac surgery patients

    NARCIS (Netherlands)

    Hulzebos, E.H.J.; Smit, Y.; Helders, P.P.J.M.; Meeteren, N.L.U. van

    2012-01-01

    BACKGROUND: After cardiac surgery, physical therapy is a routine procedure delivered with the aim of preventing postoperative pulmonary complications. OBJECTIVES: To determine if preoperative physical therapy with an exercise component can prevent postoperative pulmonary complications in cardiac sur

  17. Effect of preoperative autologous blood donation on patients undergoing bimaxillary orthognathic surgery: a retrospective analysis.

    Science.gov (United States)

    Oh, A Y; Seo, K S; Lee, G E; Kim, H J

    2016-04-01

    The efficacy of preoperative autologous blood donation (PABD) was evaluated according to preoperative haemoglobin (Hb) values. The records of 295 patients who underwent bimaxillary orthognathic surgery between July 2007 and August 2008 were reviewed. The records for autologous blood donation, intraoperative transfusion, and related laboratory studies were also evaluated. The transfusion trigger used during this period was Hb bimaxillary orthognathic surgery, particularly in patients with a preoperative Hb < 14 g/dl. PABD could be used to reduce the frequency of intraoperative allogeneic blood transfusion in these patients. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Systematic review of obesity surgery mortality risk score--preoperative risk stratification in bariatric surgery.

    Science.gov (United States)

    Thomas, Harun; Agrawal, Sanjay

    2012-07-01

    Bariatric surgery is the best long term treatment for morbid obesity. However, it carries risks of considerable morbidity and potential mortality. There is no published review on pre-operative identification of high-risk patients in bariatric surgery. This systematic review analyses obesity surgery mortality risk score (OS-MRS) as a tool for pre-operative prediction of mortality risk in bariatric surgery. Medline and Embase was systematically searched using the medical subjects headings (MeSH) terms 'bariatric surgery' and 'mortality' with further free text search and cross references. Studies that described OS-MRS to predict mortality risk after bariatric surgery were included in this review. Six studies evaluated 9,382 patients to assess the validity of OS-MRS to predict the mortality risk after bariatric surgery. Patient's age ranged from 19 to 67 years, and the body mass index ranged from 30 to 84. There were 83 deaths among the 9,382 patients (0.88 %) with individual studies reporting a mortality range from 0 % to 1.49 %. There were 13 deaths among 4,912 (0.26 %) class A patients, 55 deaths among 4,124 (1.33 %) class B patients and 15 deaths among 346 (4.34 %) class C patients. Mortality in classes A, B and C was significantly different from each of the other two classes (P < 0.05, χ(2)). This systematic review confirms that OS-MRS stratifies the mortality risk in the three-risk classification subgroups of patients. The OS-MRS can be used for pre-operative identification of high-risk patients undergoing primary Roux-en-Y gastric bypass surgery.

  19. Preoperative Prevention of Heart Failure in Noncardiac Surgery

    Directory of Open Access Journals (Sweden)

    V. V. Likhvantsev

    2016-01-01

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

  20. Fine Needle Aspiration and Medullary Thyroid Carcinoma: The Risk of Inadequate Preoperative Evaluation and Initial Surgery When Relying Upon FNAB Cytology Alone

    NARCIS (Netherlands)

    Essig, G.F.; Porter, K.; Schneider, D.; Debora, A.; Lindsey, S.C.; Busonero, G.; Fineberg, D.; Fruci, B.; Boelaert, K.; Smit, J.W.A.; Meijer, J.A.M.; Duntas, L.; Sharma, N.; Costante, G.; Filetti, S.; Sippel, R.S.; Biondi, B.; Topliss, D.J.; Pacini, F.; Maciel, R.M.; Walz, P.C.; Kloos, R.T.

    2013-01-01

    Objectives: To evaluate the diagnostic accuracy of fine-needle aspiration biopsy (FNAB) to preoperatively diagnose medullary thyroid cancer (MTC) among multiple international centers and evaluate how the cytological diagnosis alone could impact patient management.Methods: We performed a retrospectiv

  1. Preoperative statin therapy and infectious complications in cardiac surgery

    NARCIS (Netherlands)

    Hartholt, N L; Rettig, T C D; Schijffelen, M; Morshuis, W J; van de Garde, E M W; Noordzij, P G

    AIM: To assess whether preoperative statin therapy is associated with the risk of postoperative infection in patients undergoing cardiac surgery. METHODS: 520 patients undergoing cardiac surgery in 2010 were retrospectively examined. Data regarding statin and antibiotic use prior to and after

  2. [Evaluation of preoperative non-invasive ventilation in thoracic surgery for lung cancer: the preOVNI study GFPC 12-01].

    Science.gov (United States)

    Paleiron, N; André, M; Grassin, F; Chouaïd, C; Venissac, N; Margery, J; Couturaud, F; Noël-Savina, E; Tromeur, C; Vinsonneau, U; Vedrine, L; Leroyer, C; Nowak, E; Berard, H; Thomas, P; Brouchet, L; Bagan, P; Fournel, P; Mottier, D; Robinet, G

    2013-03-01

    Surgical resection is the best treatment for stage I and II non-small cell lung cancer. Despite an improvement in the perioperative management of cancer patients and specialization of surgical teams, morbidity and mortality remains significant. Non-invasive ventilation (NIV) is an effective therapeutic option in hypercapnic respiratory failure. It also improves functional and gasometric parameters when undertaken before surgery. The objective of the preOVNI study is to demonstrate that preoperative non-invasive ventilation for 7 days, at home, reduces the postoperative respiratory and cardiovascular complications of lung resection surgery, in a high-risk population. A prospective, randomized, controlled open-labelled multicentric French study, under the supervision of the Groupe Français de Pneumocancérologie (GFPC), comparing 7 days of preoperative non-invasive ventilation with standard treatment. Inclusion criteria are: patients suitable for lobectomy or segmentectomy for primary bronchial carcinoma and presenting with obstructive or restrictive lung disease, obesity or chronic cardiac insufficiency. The primary criterion is a composite one, including all respiratory and cardiac complications. The number of patients is 150 in each treatment arm, 300 in total. We think that preoperative NIV will be able to reduce the rate of postoperative complications. If this objective is achieved, the management of these patients could be changed. Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  3. Preoperative respiratory physical therapy in cardiac surgery

    NARCIS (Netherlands)

    Hulzebos, H.J.

    2006-01-01

    Cardiac surgery is one of the most common surgical procedures and accounts for more resources expended in cardiovascular medicine than any other single procedure. Because cardiac surgery involves sternal incision and cardiopulmonary bypass, patients usually have a restricted respiratory function in

  4. Usefulness of CT in preoperative examinations for middle ear surgery

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    Kobayashi, Toshimitsu; Okitsu, Takuji; Sakurai, Tokio; Ikeda, Katsuhisa; Taniguchi, Kazuhiko; Takahashi, Kuniaki; Kusakari, Jun

    1985-02-01

    The usefulness of CT in preoperative examinations for middle ear surgery was evaluated on the basis of whether or not it can provide a surgon with useful information not available from the other preoperative examinations, such as microscopic examination, pure tone audiometry, impedance audiometry, equilibrium tests, conventional X-ray films, etc. The findings of CT were compared with those obatained during operations and the following conclusions were reached: CT is especially useful for the three purposes indicated below. (1) to determine the patency of the attic air route to the mastoid antrum. (2) to make differential diagnoses of middle ear diseases in the presence of obstructive pathology of the external auditory meatus. (3) to make a rough estimate of the extent of cholesteatoma growth in the middle ear cleft, and to diagnose labyrinthine fistulae. CT proved less effective or useless for the following three purposes. (1) to secure detailed information on the status of the ossicular chain. (2) to determine the precise extent of the growth of cholesteatoma. (3) to evaluate the postoperative status of the ear. (author).

  5. Preoperative predictors of weight loss following bariatric surgery: systematic review.

    Science.gov (United States)

    Livhits, Masha; Mercado, Cheryl; Yermilov, Irina; Parikh, Janak A; Dutson, Erik; Mehran, Amir; Ko, Clifford Y; Gibbons, Melinda Maggard

    2012-01-01

    Obesity affects 32% of adults in the USA. Surgery generates substantial weight loss, but 20-30% fails to achieve successful weight loss. Our objective was to identify preoperative psychosocial factors associated with weight loss following bariatric surgery. We performed a literature search of PubMed® and the Cochrane Database of Reviews of Effectiveness between 1988 and April 2010. Articles were screened for bariatric surgery and weight loss if they included a preoperative predictor of weight loss: body mass index (BMI), preoperative weight loss, eating disorders, or psychiatric disorder/substance abuse. One thousand seven titles were reviewed, 534 articles screened, and 115 included in the review. Factors that may be positively associated with weight loss after surgery include mandatory preoperative weight loss (7 of 14 studies with positive association). Factors that may be negatively associated with weight loss include preoperative BMI (37 out of 62 studies with negative association), super-obesity (24 out of 33 studies), and personality disorders (7 out of 14 studies). Meta-analysis revealed a decrease of 10.1% excess weight loss (EWL) for super-obese patients (95% confidence interval (CI) [3.7-16.5%]), though there was significant heterogeneity in the meta-analysis, and an increase of 5.9% EWL for patients with binge eating at 12 months after surgery (95% CI [1.9-9.8%]). Further studies are necessary to investigate whether preoperative factors can predict a clinically meaningful difference in weight loss after bariatric surgery. The identification of predictive factors may improve patient selection and help develop interventions targeting specific needs of patients.

  6. Preoperative evaluation for lung cancer resection

    Science.gov (United States)

    Spyratos, Dionysios; Porpodis, Konstantinos; Angelis, Nikolaos; Papaiwannou, Antonios; Kioumis, Ioannis; Pitsiou, Georgia; Pataka, Athanasia; Tsakiridis, Kosmas; Mpakas, Andreas; Arikas, Stamatis; Katsikogiannis, Nikolaos; Kougioumtzi, Ioanna; Tsiouda, Theodora; Machairiotis, Nikolaos; Siminelakis, Stavros; Argyriou, Michael; Kotsakou, Maria; Kessis, George; Kolettas, Alexander; Beleveslis, Thomas; Zarogoulidis, Konstantinos

    2014-01-01

    During the last decades lung cancer is the leading cause of death worldwide for both sexes. Even though cigarette smoking has been proved to be the main causative factor, many other agents (e.g., occupational exposure to asbestos or heavy metals, indoor exposure to radon gas radiation, particulate air pollution) have been associated with its development. Recently screening programs proved to reduce mortality among heavy-smokers although establishment of such strategies in everyday clinical practice is much more difficult and unknown if it is cost effective compared to other neoplasms (e.g., breast or prostate cancer). Adding severe comorbidities (coronary heart disease, COPD) to the above reasons as cigarette smoking is a common causative factor, we could explain the low surgical resection rates (approximately 20-30%) for lung cancer patients. Three clinical guidelines reports of different associations have been published (American College of Chest Physisians, British Thoracic Society and European Respiratory Society/European Society of Thoracic Surgery) providing detailed algorithms for preoperative assessment. In the current mini review, we will comment on the preoperative evaluation of lung cancer patients. PMID:24672690

  7. [The 'paper-based' preoperative evaluation: sometimes, a suitable alternative].

    NARCIS (Netherlands)

    Bucx, M.J.L.; Wolff, A.P.; Scheffer, G.J.

    2012-01-01

    In the Netherlands, the majority of elective-surgery patients are evaluated by the anaesthesiologist at the preoperative assessment clinic. We believe that this visit can be omitted in selected patients as it has only minimal benefit, whereas its disadvantages can be substantial. Alternatively, the

  8. Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

    Science.gov (United States)

    Guerrero-Orriach, José Luis; Ariza-Villanueva, Daniel; Florez-Vela, Ana; Garrido-Sánchez, Lourdes; Moreno-Cortés, María Isabel; Galán-Ortega, Manuel; Ramírez-Fernández, Alicia; Alcaide Torres, Juan; Fernandez, Concepción Santiago; Navarro Arce, Isabel; Melero-Tejedor, José María; Rubio-Navarro, Manuel; Cruz-Mañas, José

    2016-01-01

    Purpose To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV) dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL) and neuronal enolase. Methods This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels. Results After surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL), neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng/mL), or mean ± SD creatinine (1.06±0.24 mg/dL vs 1.25±0.37 mg/dL at 48 hours). RV dilatation decreased from 4.23±0.7 mm to 3.45±0.6 mm and pulmonary artery pressure from 58±18 mmHg to 42±19 mmHg at 48 hours. Conclusion Preoperative administration of levosimendan has shown a protective role against cardiac, renal, and neurological damage in patients with a high risk of multiple organ dysfunctions undergoing cardiac surgery. PMID:27143905

  9. Initially unresectable rectal adenocarcinoma treated with preoperative irradiation and surgery

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    Mendenhall, W.M.; Million, R.R.; Bland, K.I.; Pfaff, W.W.; Copeland, E.M. 3d.

    1987-01-01

    This is an analysis of 23 patients with clinically and/or surgically unresectable adenocarcinoma of the rectum on initial evaluation who were treated with preoperative irradiation and surgery between March 1970 and April 1981. All patients have had follow-up for at least 5 years. Five patients (22%) had exploratory laparotomy and diverting colostomy before irradiation. All patients were irradiated with megavoltage equipment to the pelvis at 180 rad/fraction, continuous-course technique. Total doses ranged from 3500 to 6000 rad with a mean of 4800 rad and a median of 5000 rad. All patients had surgery 2-11 weeks (mean: 4.9 weeks; median: 4 weeks) after radiation therapy. Twelve patients (52%) had lesions that were incompletely resected because of positive margins (7 patients), distant metastasis (1 patient), or both (4 patients). All of these patients died of cancer within 5 years of treatment. Eleven patients had an apparent complete excision of their rectal cancer; six patients (55%) subsequently had a local recurrence. The 5-year absolute survival rate for patients who had complete resection was 18% (2 of 11 patients). The 5-year absolute and determinate survival rates for the entire study were 9% (2 of 23 patients) and 9% (2 of 22 patients), respectively. One patient (in the incomplete resection group) died after operation secondary to sepsis and diffuse intravascular coagulation.

  10. Preoperative expectations and values of patients undergoing Mohs micrographic surgery.

    Science.gov (United States)

    Chuang, Gary S; Leach, Brian C; Wheless, Lee; Lang, Pearon G; Cook, Joel

    2011-03-01

    Dermatologists have championed Mohs micrographic surgery (MMS) for its unsurpassed treatment success for skin cancers, safety profile, cost-effectiveness, and tissue-sparing quality. It is unclear whether patients undergoing MMS also value these characteristics. To evaluate patients' preoperative expectations of MMS and identify the factors that may influence such expectations The study prospectively recruited participants who were newly diagnosed with skin cancer and referred for MMS. A questionnaire listing the characteristics of MMS was given to the participants asking them to score the importance of each characteristic on a 10-point scale. The participants were also asked to provide information regarding their gender, age, subjective health status, education level, family annual income, and their referral source On average, participants placed the highest value, in descending order, on a treatment that yielded the highest cure rate, reconstruction initiation only after complete tumor removal, and the surgeon being a skin cancer specialist. Overall, participants placed high values on characteristics of MMS that dermatologists have long esteemed. Our data corroborate that MMS is a valuable procedure that meets the expectations not just of physicians, but also of patients. The authors have indicated no significant interest with commercial supporters. © 2011 by the American Society for Dermatologic Surgery, Inc.

  11. Outcome of cardiac surgery in patients with low preoperative ejection fraction.

    Science.gov (United States)

    Pieri, Marina; Belletti, Alessandro; Monaco, Fabrizio; Pisano, Antonio; Musu, Mario; Dalessandro, Veronica; Monti, Giacomo; Finco, Gabriele; Zangrillo, Alberto; Landoni, Giovanni

    2016-10-18

    In patients undergoing cardiac surgery, a reduced preoperative left ventricular ejection fraction (LVEF) is common and is associated with a worse outcome. Available outcome data for these patients address specific surgical procedures, mainly coronary artery bypass graft (CABG). Aim of our study was to investigate perioperative outcome of surgery on patients with low pre-operative LVEF undergoing a broad range of cardiac surgical procedures. Data from patients with pre-operative LVEF ≤40 % undergoing cardiac surgery at a university hospital were reviewed and analyzed. A subgroup analysis on patients with pre-operative LVEF ≤30 % was also performed. A total of 7313 patients underwent cardiac surgery during the study period. Out of these, 781 patients (11 %) had a pre-operative LVEF ≤40 % and were included in the analysis. Mean pre-operative LVEF was 33.9 ± 6.1 % and in 290 patients (37 %) LVEF was ≤30 %. The most frequently performed operation was CABG (31 % of procedures), followed by mitral valve surgery (22 %) and aortic valve surgery (19 %). Overall perioperative mortality was 5.6 %. Mitral valve surgery was more frequent among patients who did not survive, while survivors underwent more frequently CABG. Post-operative myocardial infarction occurred in 19 (2.4 %) of patients, low cardiac output syndrome in 271 (35 %). Acute kidney injury occurred in 195 (25 %) of patients. Duration of mechanical ventilation was 18 (12-48) hours. Incidence of complications was higher in patients with LVEF ≤30 %. Stepwise multivariate analysis identified chronic obstructive pulmonary disease, pre-operative insertion of intra-aortic balloon pump, and pre-operative need for inotropes as independent predictors of mortality among patients with LVEF ≤40 %. We confirmed that patients with low pre-operative LVEF undergoing cardiac surgery are at higher risk of post-operative complications. Cardiac surgery can be performed with acceptable mortality rates

  12. [Relevance of preoperative anxiety for postoperative outcome in urological surgery patients: A prospective observational study].

    Science.gov (United States)

    Laufenberg-Feldmann, R; Kappis, B; Schuster, M; Ferner, M

    2016-04-01

    Preoperative anxiety is not systematically assessed during premedication appointments, although it may influence the postoperative course and outcome. The aim of this study was to assess preoperative anxiety in a sample of patients before major urological surgery and to characterize the impact on postoperative pain. An additional aim was to analyze the agreement between patients' self-ratings and physicians' anxiety ratings. In all, 127 male and 27 female patients participated in a prospective observational study. Preoperative anxiety was assessed with two validated instruments - the APAIS (Amsterdam Preoperative Anxiety and Information Scale) and the State Scale of the STOA questionnaire (State-Trait Operation Anxiety) - during the premedication appointment. Physicians provided their subjective ratings on patients' anxiety and need for information using the APAIS. The predictive value of preoperative anxiety for postoperative pain was evaluated. Nearly four out of ten patients were identified as "anxiety cases"; thereof women were more afraid than men were. Preoperative anxiety was not correctly assessed by physicians, who overestimated patients' anxiety. In female patients, preoperative anxiety was predictive of increased postoperative pain scores. Preoperative anxiety is a frequent concern and often not correctly assessed by physicians. The use of scoring systems to detect preoperative anxiety is useful in clinical routine and helps to decide on therapeutic interventions.

  13. The effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on outcomes after lung cancer surgery: a systematic review.

    Science.gov (United States)

    Schmidt-Hansen, Mia; Page, Richard; Hasler, Elise

    2013-03-01

    The preferred treatment for lung cancer is surgery if the disease is considered resectable and the patient is considered surgically fit. Preoperative smoking cessation and/or preoperative pulmonary rehabilitation might improve postoperative outcomes after lung cancer surgery. The objectives of this systematic review were to determine the effectiveness of (1) preoperative smoking cessation and (2) preoperative pulmonary rehabilitation on peri- and postoperative outcomes in patients who undergo resection for lung cancer. We searched MEDLINE, PreMedline, Embase, Cochrane Library, Cinahl, BNI, Psychinfo, Amed, Web of Science (SCI and SSCI), and Biomed Central. Original studies published in English investigating the effect of preoperative smoking cessation or preoperative pulmonary rehabilitation on operative and longer-term outcomes in ≥ 50 patients who received surgery with curative intent for lung cancer were included. Of the 7 included studies that examined the effect of preoperative smoking cessation (n = 6) and preoperative pulmonary rehabilitation (n = 1) on outcomes after lung cancer surgery, none were randomized controlled trials and only 1 was prospective. The studies used different smoking classifications, the baseline characteristics differed between the study groups in some of the studies, and most had small sample sizes. No formal data synthesis was therefore possible. The included studies were marked by methodological limitations. On the basis of the reported bodies of evidence, it is not possible to make any firm conclusions about the effect of preoperative smoking cessation or of preoperative pulmonary rehabilitation on operative outcomes in patients undergoing surgery for lung cancer.

  14. Impact of preoperative defecation pattern on postoperative constipation for patients undergoing cardiac surgery.

    Science.gov (United States)

    Iyigun, Emine; Ayhan, Hatice; Demircapar, Aslı; Tastan, Sevinc

    2017-02-01

    To analyse the impact of preoperative defecation pattern on postoperative defecation pattern for patients undergoing cardiac surgery. Constipation is a neglected problem that occurs frequently after cardiac surgery. Descriptive study. The study sample comprised 102 patients who underwent cardiac surgery. A Descriptive Information Form, Rome III Diagnostic Criteria, Constipation Severity Instrument, Postoperative Defecation Pattern Evaluation Form and Bristol Stool Form Scale were used for data collection and analysis. The Constipation Severity Instrument scores of just over one-third (37·2%) of the patients who were constipated prior to surgery were higher compared to those who were not constipated. Following cardiac surgery, 39·2% of patients developed constipation and 80% of these patients were constipated prior to cardiac surgery. The findings indicate a significantly high relationship between preoperative and postoperative defecation pattern (r = 0·71, p cardiac surgery. During the preoperative period, clinical nurses may evaluate the patients' defecation patterns using valid and reliable scales and follow the defecation of the patients, especially patients with defecation problems, during the postoperative period. © 2016 John Wiley & Sons Ltd.

  15. Preoperative use of pregabalin for acute pain in spine surgery

    Science.gov (United States)

    Jiang, Hai-liang; Huang, Shuang; Song, Jiang; Wang, Xiang; Cao, Zhong-shu

    2017-01-01

    Abstract Background: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of pregabalin for pain management following spine surgery. Methods: In September 2016, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared pregabalin with placebo were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12 hours, 24 hours, and 48 hours and cumulative morphine consumption at 24 hours and 48 hours. The secondary outcomes were complications of nausea, sedation, dizziness, headache, and visual disturbances. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary. Results: Ten clinical studies with 535 patients (pregabalin group = 294, control group = 241) were included in the meta-analysis. Pregabalin was associated with reduced pain scores at 12 hours, 24 hours, and 48 hours, corresponding to a reduction of 1.91 points (95% CI, –4.07 to 0.24 point) at 12 hours, 2.66 points (95% CI, –4.51 to –0.81 point) at 24 hours, and 4.33 points (95% confidence interval, –6.38 to –2.99 point) at 48 hours on a 100-point numeric rating scale. There was no significant difference between VAS scores with mobilization at 12 hours, 24 hours, or 48 hours. Similarly, pregabalin was associated with a reduction in cumulative morphine consumption at 24 hours (–7.07, 95% CI –9.84, –4.30) and 48 hours (–6.52, 95% CI –7.78, –5.25, P = 0.000). Furthermore, pregabalin can reduce the occurrence of nausea (RR 0.57, 95% CI 0.41, 0.79, P = 0.001, number needed to treat = 8.4). There were no significant differences in the occurrence of sedation, dizziness, headache, or visual disturbances. Conclusions: Preoperative use of pregabalin was

  16. Assessment of patient satisfaction with the preoperative anesthetic evaluation

    Directory of Open Access Journals (Sweden)

    Gebremedhn EG

    2014-09-01

    Full Text Available Endale Gebreegziabher Gebremedhn, Vidhya Nagaratnam Department of Anesthesia, School of Medicine, Gondar College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia Background: The evaluation of patient satisfaction is a core aspect of the continuous quality improvement in anesthesia service that can be affected by the preoperative anesthetist visit. This visit enables the anesthetist to know about the patient's general health status and the nature of surgery, to choose the type of anesthesia, and to discuss perioperative complications and their management with the patient. Patients have sometimes complained about the information given during the preoperative anesthetic evaluation in the University of Gondar teaching and referral hospital. The aim of this study was to determine the level of patient satisfaction with the preoperative anesthetist visit. Methods: A cross-sectional study was conducted from February 15 to April 15, 2013. All consecutive elective patients who were operated upon under anesthesia during the study period were interviewed 24 hours after operation. A pretested questionnaire and checklists, which were developed based on the hospital's anesthetic evaluation sheet, were used for data collection. Results: A total of 116 elective patients were operated upon under anesthesia during the study period. Of these, 102 patients were included in our study, with a response rate of 87.9%. Anesthetists introduced themselves to ~24% patients; provided information about anesthesia to ~32%, postoperative complications to ~21%, postoperative analgesia to ~18, and postoperative nausea and vomiting to ~21%; and spent adequate time with ~74%. Patients' questions were answered by the anesthetist in ~65% of cases, and ~65% of patients had reduced anxiety after the anesthetist visit. The patients' overall satisfaction with the preoperative anesthetist visit was ~65%. Conclusion and recommendation: Patient satisfaction with the

  17. Screening Models for Cardiac Risk Evaluation in Emergency Abdominal Surgery. I. Evaluation of the Intraoperative Period Risk based on Data from the Preoperative Period

    Directory of Open Access Journals (Sweden)

    Mikhail Matveev

    2008-04-01

    Full Text Available A classification of intraoperative cardio-vascular complications (CVC was performed, based on data from 466 patients subjected to emergency surgery, due to severe abdominal surgical diseases or traumas, in accordance with the severe criteria of ACC/AHA for CVC in noncardiac surgery. There were 370 intraoperative CVC registered, distributed as follows: groups with low risk (148, moderate risk (200, and high risk (22. Patient groups were formed, according to the CVC risk level, during the intraoperative period, for which the determinant factor for the group distribution of patients was the complication with the highest risk. Individual data was collected for each patient, based on 65 indices: age, physical status, diseases, surgical interventions, anaesthesiological information, intra and postoperative cardio-vascular complications, disease outcome, causes of death, cardiovascular disease anamnesis, anamnesis of all other nonsurgical diseases present, laboratory results, results from all imaging and instrumental examinations, etc. On the basis of these indices, a new distribution of the risk factors was implemented, into groups with different levels of risk of CVC during intraoperative period. This result is a solid argument, substantiating the proposal to introduce these adjustments for determining the severity of CVC in the specific conditions of emergency abdominal surgery.

  18. [Preoperative fasting period of fluids in bariatric surgery].

    Science.gov (United States)

    Simon, P; Pietsch, U-C; Oesemann, R; Dietrich, A; Wrigge, H

    2017-07-01

    Aspiration of stomach content is a severe complication during general anaesthesia. The DGAI (German Society for Anesthesiology and Intensive Care Medicine) guidelines recommend a fasting period for liquids of 2 h, with a maximum of 400 ml. Preoperative fasting can affect the patients' recovery after surgery due to insulin resistance and higher protein catabolism as a response to surgical stress. The aim of the study was to compare a liberal fasting regimen consisting of up to 1000 ml of liquids until 2 h before surgery with the DGAI recommendation. The prospective observational clinical study was approved by the ethics committee of the University of Leipzig. In the liberal fasting group (Glib) patients undergoing bariatric surgery were asked to drink 1000 ml of tea up to 2 h before surgery. Patients assigned to the restrictive fasting group (Gres) who were undergoing nonbariatric abdominal surgery were asked to drink no more than 400 ml of water up to 2 h preoperatively. Right after anaesthesia induction and intubation a gastric tube was placed, gastric residual volume was measured and the pH level of gastric fluid was determined. Moreover, the occurrence of aspiration was monitored. In all, 98 patients with a body mass index (BMI) of Glib 51.1 kg/m(2) and Gres 26.5 kg/m(2) were identified. The preoperative fasting period of liquids was significantly different (Glib 170 min vs. Gres 700 min, p Gres 5 ml, p = 0.355). The pH of gastric fluid was nearly similar (Glib 4.0; Gres 3.0; p = 0.864). Aspiration did not occur in any patient. There is evidence suggesting that a liberal fluid fasting regimen (1000 ml of fluid) in the preoperative period is safe in patients undergoing bariatric surgery.

  19. Efficacy of a Required Preoperative Weight Loss Program for Patients Undergoing Bariatric Surgery.

    Science.gov (United States)

    Conaty, Eliza A; Bonamici, Nicolas J; Gitelis, Matthew E; Johnson, Brandon J; DeAsis, Francis; Carbray, JoAnn M; Lapin, Brittany; Joehl, Raymond; Denham, Woody; Linn, John G; Haggerty, Stephen P; Ujiki, Michael B

    2016-04-01

    The efficacy of mandatory medically supervised preoperative weight loss (MPWL) prior to bariatric surgery continues to be a controversial topic. The purpose of this observational study was to assess the efficacy of a MPWL program in a single institution, which mandated at least 10% excess body weight loss before surgery, by comparing outcomes of patients undergoing primary bariatric surgery with and without a compulsory preoperative weight loss regimen. We analyzed our database of 757 patients who underwent primary bariatric surgery between March 2008 and January 2015. Patients were placed into two cohorts based on their participation in a MPWL program requiring at least 10% excess weight loss (EWL) prior to surgery. Patients were evaluated at 3, 6, 12, and 24 months after surgery for weight loss, comorbidity resolution, and the occurrences of hospital readmissions. A total of 717 patients met the inclusion criteria of whom 465 underwent surgery without a preoperative weight loss requirement and 252 participated in the MPWL program. One year after surgery, 67.1% of non-participants and 62.5% of MPWL participants showed a resolution of at least one of five associated comorbidities (p = 0.45). Non-participants showed an average of 58.6% EWL, while MPWL participants showed 59.1% EWL at 1 year postoperatively (p = 0.84). Readmission rates, excluding those which were ulcer-related, at 30 days (3.4 vs. 6.40%, p = 0.11) and 90 days (9.9 vs. 7.5%, p = 0.29) postoperatively were not significantly different between the non-participants and MPWL patients, respectively. A mandatory preoperative weight loss program prior to bariatric surgery did not result in significantly greater %EWL or comorbidity resolution 1 year after surgery compared to patients not required to lose weight preoperatively. Additionally, the program did not result in significantly lower 30- or 90-day readmission rates for these patients. The value of a MPWL program must be weighed against

  20. CLINICAL EVALUATION OF PREOPERATIVE SKIN PREPARATION WITH AQUEOUS POVIDONE IODINE ONLY AND IN COMBINATION WITH ALCHOLIC CHLORHEXIDINE IN PATIENTS UNDERGOING ELECTIVE AND EMERGENCY SURGERIES

    OpenAIRE

    Latchu; Sareen Babu; Balachandra; Madhusudhan; Lokesh; Mahesh Babu

    2015-01-01

    INTRODUCTION: Many techniques are there for skin preparation before surgery, the commonest being initial scrub with antiseptic soap solution, followed by painting the prepared area with antiseptic paint solution. But degerming of the skin can be done with antiseptics us ed for less than one minute which is as effective as five minute scrub with germicidal soap solution followed by painting with antiseptics . AIMS AND OBJECTIVES : 1. To evaluate the effic...

  1. Preoperative education interventions to reduce anxiety and improve recovery among cardiac surgery patients: a review of randomised controlled trials.

    Science.gov (United States)

    Guo, Ping

    2015-01-01

    To update evidence of the effectiveness of preoperative education among cardiac surgery patients. Patients awaiting cardiac surgery may experience high levels of anxiety and depression, which can adversely affect their existing disease and surgery and result in prolonged recovery. There is evidence that preoperative education interventions can lead to improved patient experiences and positive postoperative outcomes among a mix of general surgical patients. However, a previous review suggested limited evidence to support the positive impact of preoperative education on patients' recovery from cardiac surgery. Comprehensive review of the literature. The Cochrane Central Register of Controlled Trials from the Cochrane Library, MEDLINE, CINAHL, PsycINFO, EMBASE and Web of Science were searched for English-language articles published between 2000-2011. Original articles were included reporting randomised controlled trials of cardiac preoperative education interventions. Six trials were identified and have produced conflicting findings. Some trials have demonstrated the effects of preoperative education on improving physical and psychosocial recovery of cardiac patients, while others found no evidence that patients' anxiety is reduced or of any effect on pain or hospital stay. Evidence of the effectiveness of preoperative education interventions among cardiac surgery patients remains inconclusive. Further research is needed to evaluate cardiac preoperative education interventions for sustained effect and in non-Western countries. A nurse-coordinated multidisciplinary preoperative education approach may offer a way forward to provide a more effective and efficient service. Staff training in developing and delivering such interventions is a priority. © 2014 John Wiley & Sons Ltd.

  2. An evaluation of the validity of the pre-operative oxygen uptake efficiency slope as an indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery.

    Science.gov (United States)

    Bongers, B C; Berkel, A E; Klaase, J M; van Meeteren, N L

    2017-10-01

    This study aimed to investigate the validity of the oxygen uptake efficiency slope as an objective and submaximal indicator of cardiorespiratory fitness in elderly patients scheduled for major colorectal surgery. Patients ≥ 60 years of age, with a metabolic equivalent score using the Veterans Activity Questionnaire ≤ 7 and scheduled for major colorectal surgery participated in a pre-operative cardiopulmonary exercise test. The oxygen uptake efficiency slope was calculated up to different exercise intensities, using 100%, 90% and 80% of the exercise data. Data from 71 patients (47 men, mean (SD) age 75.2 (6.7) years) were analysed. The efficiency slope obtained from all the data was statistically significantly different from the values when 90% (p = 0.027) and 80% (p = 0.023) of the data were used. The 90% and 80% values did not differ significantly from each other (p = 0.152). Correlations between the oxygen uptake efficiency slope and the peak oxygen uptake ranged from 0.816 to 0.825 (all p < 0.001), and correlations between oxygen uptake efficiency slope and the ventilatory anaerobic threshold ranged from 0.793 to 0.805 (all p < 0.001). Receiver operating characteristic curves showed that the oxygen uptake efficiency slope is a sensitive and specific predictor of a peak oxygen uptake ≤ 18.2 ml.kg(-1) .min(-1) , with an area under the curve (95%CI) of 0.876 (0.780-0.972, p < 0.001) and a ventilatory anaerobic threshold ≤ 11.1 ml.kg(-1) .min(-1) , with an area under the curve (95%CI) of 0.828 (0.726-0.929, p < 0.001). These correlations suggest that the oxygen uptake efficiency slope provides a valid (sub)maximal measure of cardiorespiratory fitness in these patients, and the predictive ability described indicates that it might help discriminate patients at higher risk of postoperative morbidity. However, future research should investigate the prognostic value of the oxygen uptake efficiency slope for postoperative outcomes. © 2017 The Association of

  3. Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

    Directory of Open Access Journals (Sweden)

    Elinton Adami CHAIM

    Full Text Available ABSTRACT BACKGROUND Bariatric surgery has become the gold standard treatment for morbid obesity, but access to surgery remains difficult and low compliance to postoperative follow-up is common. To improve outcomes, enable access and optimize follow-up, we developed a multidisciplinary preoperative approach for bariatric surgery. OBJECTIVE To determine the impact of this program in the outcomes of bariatric surgery in the Brazilian public health system. METHODS A prospective evaluation of the individuals who underwent a preoperative multidisciplinary program for bariatric surgery and comparison of their surgical outcomes with those observed in the prospectively collected historical database of the individuals who underwent surgery before the beginning of the program. RESULTS There were 176 individuals who underwent the multidisciplinary program and 226 who did not. Individuals who underwent the program had significantly lower occurrence of the following variables: hospital stay; wound dehiscence; wound infection; pulmonary complications; anastomotic leaks; pulmonary thromboembolism; sepsis; incisional hernias; eventrations; reoperations; and mortality. Both loss of follow-up and weight loss failure were also significantly lower in the program group. CONCLUSION The adoption of a comprehensive preoperative multidisciplinary approach led to significant improvements in the postoperative outcomes and also in the compliance to the postoperative follow-up. It represents a reproducible and potentially beneficial approach within the context of the Brazilian public health system.

  4. Effect of Preoperative Play Interventions on Post Surgery Anxiety

    OpenAIRE

    Narges Alirezaei; Bahar Ashjaei; Zahra Shahrivar; Fatemeh Moharari; Javad Mahmoudi-gharaei; Jaleh Parizad

    2008-01-01

    "n "nObjective: Many studies have shown that the level of postoperative distress and anxiety in children is associated with the amount of anxiety during the pre operative period. In this study, we compared the effect of pre-operational attending in a playroom and using play activities on the level of anxiety increment after surgery in an intervention and a control group of Iranian children. "n "nMethod: In a clinical trial, 75 children aged 5 to 12 enrolled in the intervention and the control...

  5. Inadequate preoperative colonic evaluation for synchronous colorectal cancer

    DEFF Research Database (Denmark)

    Achiam, M P; Burgdorf, S K; Wilhelmsen, M

    2009-01-01

    synchronous lesions in 11-44%. The purpose of this study was to review all patients having surgery for CRC in our department since 2001, and to evaluate the extent of the perioperative colonic evaluation. MATERIALS AND METHODS: The records of all patients operated for CRC between Jan. 2001 and Dec. 2007...... in our department were reviewed. Only patients with CRC were included. Information regarding pre-, per- and postoperative colonic evaluation were obtained and occurrences of SC were evaluated. RESULTS: Of the 534 patients included 124 (23%) patients had an impassable stenosis. Full preoperative colonic...

  6. Preoperative Hemoglobin and Outcomes in Patients with CKD Undergoing Cardiac Surgery

    Science.gov (United States)

    Hitti, Sharbel; Silberman, Shuli; Tauber, Rachel; Merin, Ofer; Lifschitz, Meyer; Slotki, Itzchak; Bitran, Daniel; Fink, Daniel

    2014-01-01

    Background and objectives Preoperative anemia adversely affects outcomes of cardiothoracic surgery. However, in patients with CKD, treating anemia to a target of normal hemoglobin has been associated with increased risk of adverse cardiac and cerebrovascular events. We investigated the association between preoperative hemoglobin and outcomes of cardiac surgery in patients with CKD and assessed whether there was a level of preoperative hemoglobin below which the incidence of adverse surgical outcomes increases. Design, setting, participants, & measurements This prospective observational study included adult patients with CKD stages 3–5 (eGFR<60 ml/min per 1.73 m2) undergoing cardiac surgery from February 2000 to January 2010. Patients were classified into four groups stratified by preoperative hemoglobin level: <10, 10–11.9, 12–13.9, and ≥14 g/dl. The outcomes were postoperative AKI requiring dialysis, sepsis, cerebrovascular accident, and mortality. Results In total, 788 patients with a mean eGFR of 43.5±13.7 ml/min per 1.73 m2 were evaluated, of whom 22.5% had preoperative hemoglobin within the normal range (men: 14–18 g/dl; women: 12–16 g/dl). Univariate analysis revealed an inverse relationship between the incidence of all adverse postoperative outcomes and hemoglobin level. Using hemoglobin as a continuous variable, multivariate logistic regression analysis showed a proportionally greater frequency of all adverse postoperative outcomes per 1-g/dl decrement of preoperative hemoglobin (mortality: odds ratio, 1.38; 95% confidence interval, 1.23 to 1.57; P<0.001; sepsis: odds ratio, 1.31; 95% confidence interval, 1.14 to 1.49; P<0.001; cerebrovascular accident: odds ratio, 1.31; 95% confidence interval, 1.00 to 1.67; P=0.03; postoperative hemodialysis: odds ratio, 1.38; 95% confidence interval, 1.11 to 1.75; P<0.01). Moreover, preoperative hemoglobin<12 g/dl was an independent risk factor for postoperative mortality (odds ratio, 2.6; 95% confidence

  7. Cardiac, renal, and neurological benefits of preoperative levosimendan administration in patients with right ventricular dysfunction and pulmonary hypertension undergoing cardiac surgery: evaluation with two biomarkers neutrophil gelatinase-associated lipocalin and neuronal enolase

    Directory of Open Access Journals (Sweden)

    Guerrero-Orriach JL

    2016-04-01

    Full Text Available José Luis Guerrero-Orriach,1 Daniel Ariza-Villanueva,1 Ana Florez-Vela,1 Lourdes Garrido-Sánchez,2,3 María Isabel Moreno-Cortés,1 Manuel Galán-Ortega,1 Alicia Ramírez-Fernández,1 Juan Alcaide Torres,3 Concepción Santiago Fernandez,3 Isabel Navarro Arce,1 José María Melero-Tejedor,4 Manuel Rubio-Navarro,1 José Cruz-Mañas1 1Department of Cardio-Anaesthesiology, University Hospital Virgen de la Victoria, Málaga, Spain; 2CIBER Fisiología de la Obesidad y Nutrición (CIBEROBN, Instituto de Salud Carlos III, Málaga, Spain; 3Department of Nutrition and Endocrinology, Instituto de Investigaciones Biomédicas de Málaga (IBIMA, University Hospital Virgen de la Victoria, Málaga, Spain; 4Department of Cardiovascular Surgery, University Hospital Virgen de la Victoria, Málaga, Spain Purpose: To evaluate if the preoperative administration of levosimendan in patients with right ventricular (RV dysfunction, pulmonary hypertension, and high perioperative risk would improve cardiac function and would also have a protective effect on renal and neurological functions, assessed using two biomarkers neutrophil gelatinase-associated lipocalin (N-GAL and neuronal enolase. Methods: This is an observational study. Twenty-seven high-risk cardiac patients with RV dysfunction and pulmonary hypertension, scheduled for cardiac valve surgery, were prospectively followed after preoperative administration of levosimendan. Levosimendan was administered preoperatively on the day before surgery. All patients were considered high risk of cardiac and perioperative renal complications. Cardiac function was assessed by echocardiography, renal function by urinary N-GAL levels, and the acute kidney injury scale. Neuronal damage was assessed by neuron-specific enolase levels. Results: After surgery, no significant variations were found in mean and SE levels of N-GAL (14.31 [28.34] ng/mL vs 13.41 [38.24] ng/mL, neuron-specific enolase (5.40 [0.41] ng/mL vs 4.32 [0.61] ng

  8. Providing preoperative information for children undergoing surgery: a randomized study testing different types of educational material to reduce children's preoperative worries.

    Science.gov (United States)

    Fernandes, S C; Arriaga, P; Esteves, F

    2014-12-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery. The participants were randomly assigned to one of the seven independent conditions that were combined into the following three main groups: an experimental group, which received educational materials with information about surgery and hospitalization (a board game, a video or a booklet); a comparison group, which received entertaining material with the same format type; and a control group, which did not receive any material. Children's preoperative worries and parental anxiety were evaluated after the experimental manipulation. Children who received educational materials were significantly less worried about surgery and hospital procedures than children in the comparison and the control groups, although no statistically differences were found between the type of materials within the experimental group, and no significant effect occurred on parental state anxiety. These results do however support the hypothesis that providing preoperative materials with educational information reduce children's preoperative worries.

  9. Therapeutic Delay and Survival After Surgery for Cancer of the Pancreatic Head With or Without Preoperative Biliary Drainage

    NARCIS (Netherlands)

    W.J. Eshuis; N.A. van der Gaag; E.A.J. Rauws; C.H.J. van Eijck; M.J. Bruno; E.J. Kuipers; P.P. Coene; F.J.G.M. Kubben; J.J.G.M. Gerritsen; J.W. Greve; M.F. Gerhards; I.H.J.T. de Hingh; J.H. Klinkenbijl; C.Y. Nio; S.M.M. de Castro; O.R.C. Busch; T.M. van Gulik; P.M.M. Bossuyt; D.J. Gouma

    2010-01-01

    Objective: To evaluate the relation between delay in surgery because of preoperative biliary drainage (PBD) and survival in patients scheduled for surgery for pancreatic head cancer. Background: Patients with obstructive jaundice due to pancreatic head cancer can undergo PBD. The associated delay of

  10. Preoperative Antihypertensive Medication in Relation to Postoperative Atrial Fibrillation in Patients Undergoing Cardiac Surgery: A Meta-Analysis

    Science.gov (United States)

    Zhou, Ai-Guo; Chen, An-ji; Zhang, Xiong-fei; Deng, Hui-wei

    2017-01-01

    Background. We undertake a systematic review and meta-analysis to evaluate the effect of preoperative hypertension and preoperative antihypertensive medication to postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery. Methods. We searched PubMed, Embase, and Cochrane Library (from inception to March 2016) for eligible studies. The outcomes were the effects of preoperative hypertension, preoperative calcium antagonists regimen, preoperative ACE inhibitors regimen, and preoperative beta blocking agents regimen with POAF. We calculated pooled risk ratios (OR) and 95% CIs using random- or fixed-effects models. Results. Twenty-five trials involving 130087 patients were listed. Meta-analysis showed that the number of preoperative hypertension patients in POAF group was significantly higher (P < 0.05), while we found that there are no significant differences between two groups in Asia patients by subgroup analysis, which is in contrast to other outcomes. Compared with the Non-POAF group, the number of patients who used calcium antagonists and ACE inhibitors preoperatively in POAF group was significantly higher (P < 0.05). And we found that there were no significant differences between two groups of preoperative beta blocking agents used (P = 0.08). Conclusions. Preoperative hypertension and preoperative antihypertensive medication in patients undergoing cardiac operations seem to be associated with higher risk of POAF. PMID:28286753

  11. Preoperative embolization in carotid body tumor surgery: is it required?

    Science.gov (United States)

    Zeitler, Daniel M; Glick, Joelle; Har-El, Gady

    2010-05-01

    We compared estimated blood loss (EBL) in patients who underwent surgical excision of carotid body tumors (CBTs) after preoperative superselective angiography with embolization (PSE) with that in patients who underwent excision of CBTs without PSE. We performed a retrospective chart review of a consecutive case series in a single surgeon's practice within an academic tertiary care medical center. Twenty-five patients underwent surgical resection of a CBT from 1989 to 2009. From 1989 to 1996, 10 consecutive patients had PSE of the CBT, whereas the subsequent 15 patients (1996 to 2009) had no PSE. Demographic data including age, sex, and tumor size were collected. The EBL was obtained from intraoperative records and operative notes dictated at the time of surgery. Tumor size was based on preoperative radiographic measurements by a senior radiologist and the surgeon. In the 10 patients with PSE, the mean age was 41 years (range, 22 to 72 years) and the mean tumor size was 4.8 cm (range, 2.9 to 8.3 cm). The mean EBL was 305 mL (range, 50 to 1,000 mL); 2 patients had an EBL of more than 400 mL. In the 15 patients without PSE, the mean age was 43.7 years (range, 20 to 75 years) and the mean tumor size was 4.4 cm (range, 2.8 to 7.9 cm). The mean EBL was 265.6 mL (range, 40 to 900 mL); 2 patients had an EBL of more than 400 mL. There were no significant differences between the 2 groups with regard to age, tumor size, or EBL. Preoperative superselective angiography with embolization of a CBT does not lead to a significant reduction in intraoperative EBL.

  12. Desperdício de exames complementares na avaliação pré-operatória em cirurgias de catarata Waste of medical tests in preoperative evaluation for cataract surgery

    Directory of Open Access Journals (Sweden)

    Carlos Eduardo Leite Arieta

    2004-02-01

    Full Text Available O objetivo deste experimento clínico foi determinar a freqüência dos exames considerados dispensáveis numa rotina pré-operatória de facectomias e avaliar os gastos com eles. Se o paciente foi sorteado para testes-seletivos, solicitou-se que nenhum teste fosse executado, a menos que o paciente apresentasse um novo problema médico, ou piora de uma doença preexistente, a qual requeresse os testes independentemente da realização da cirurgia. Para pacientes sorteados para testes-rotineiros, foram solicitados: eletrocardiograma, dosagem de hemoglobina e glicemia de jejum. Foram calculados os gastos com exames considerados desnecessários. A amostra de 1.025 pacientes incluiu 513 sorteados para testes seletivos e 512 para testes rotineiros. A freqüência de eventos adversos intra-operatórios foi semelhante nos dois grupos (p = 0,923. O grupo de testes seletivos realizou de 60,7% menos exames que o de testes rotineiros. Os resultados sugerem que a requisição seletiva de exames pré-operatórios em facectomias, além de não prejudicar o paciente do ponto de vista de complicações clínicas intra-operatórias, possibilita expressiva economia de recursos quando comparada à atual rotina.The objective of this clinical trial was to determine the frequency of medical tests considered unnecessary in routine preoperative evaluation for cataract surgery. Unnecessary costs with these tests were also evaluated. For patients assigned to the selective testing group, it was requested that no preoperative testing be performed unless the patient presented a new or worsening medical problem warranting medical evaluation with testing. For patients assigned to the routine testing group, three tests were requested: a 12-lead electrocardiogram, complete blood count, and serum glucose level. The costs of tests considered unnecessary were calculated. The sample of 1,025 patients consisted of 512 assigned to the routine testing group and 513 to the selective

  13. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

    DEFF Research Database (Denmark)

    Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge;

    2010-01-01

    Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments...... might be too brief for the hospital to initiate these programmes. Therefore, it was relevant to evaluate a new clinical practice which combined the general practitioner's (GP) referral to surgery with a referral to a smoking and alcohol intervention in the surgical pathway....

  14. 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

    Introduction: Unexpected cardiopulmonary complications are a well-known and feared entity during surgery and anaesthesia, acknowledged in previous reports. Focus Assessed Transthoracic Echocardiography (FATE) has proven to be feasible in intensive care units and perioperatively for evaluation...... 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...

  15. Optimal time intervals between preoperative radiotherapy or chemoradiotherapy and surgery in rectal cancer?

    Directory of Open Access Journals (Sweden)

    Bengt eGlimelius

    2014-04-01

    Full Text Available Background In rectal cancer therapy, radiotherapy or chemoradiotherapy (RT/CRT is extensively used preoperatively to (i decrease local recurrence risks, (ii allow radical surgery in non-resectable tumours and (iii increase the chances of sphincter-saving surgery or (iv organ preservation. There is a growing interest among clinicians and scientists to prolong the interval from the RT/CRT to surgery to achieve maximal tumour regression and to diminish complications during surgery.Methods The pros and cons of delaying surgery depending upon the aim of the preoperative RT/CRT are critically evaluated. Results Depending upon the clinical situation, the need for a time interval prior to surgery to allow tumour regression varies. In the first and most common situation (i, no regression is needed and any delay beyond what is needed for the acute radiation reaction in surrounding tissues to wash out can potentially only be deleterious. After short-course RT (5Gyx5 with immediate surgery, the ideal time between the last radiation fraction is 2-5 days since a slightly longer interval appears to increase surgical complications. A delay beyond 4 weeks appears safe; it results in tumour regression including pathologic complete responses, but is not yet fully evaluated concerning oncologic outcome. Surgical complications do not appear to be influenced by the CRT-surgery interval within reasonable limits (about 4-12 weeks, but this has not been sufficiently explored. Maximum tumour regression may not be seen in rectal adenocarcinomas until after several months; thus, a longer than usual delay may be of benefit in well responding tumours if limited or no surgery is planned, as in (iii or (iv, otherwise not.Conclusions A longer time interval is undoubtedly of benefit in some clinical situations but may be counterproductive in most situations.

  16. [Evaluation of a preoperative virtual tour for parents and children].

    Science.gov (United States)

    Tourigny, Jocelyne; Chartrand, Julie

    2009-03-01

    A Canadian pediatric center has set a preoperative virtual tour on its website. This tour was evaluated by a descriptive study, in terms of utilization, efficacy and usefulness. The tour was utilized by 49.6% of the 123 families. Children of these families had a significant increase in knowledge from Time I (preop clinic) to Time 2 (day of surgery). Children and youth who did not use the tour reported themselves as more anxious the day of surgery but not significantly. There was no significant change in parents. The internet is a useful tool in families' preparation but cannot replace a direct interaction. Other researches are necessary in order to evaluate the impact of this type of preparation on the quality of care and on the child's recovery.

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

    LENUS (Irish Health Repository)

    O'Connor, D B

    2012-02-01

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

  18. Measuring preoperative anxiety in patients undergoing elective surgery in Czech Republic

    OpenAIRE

    Pavlína Homzová; Renáta Zeleníková

    2015-01-01

    Aim: The main aim of the study was to measure preoperative anxiety in patients in the Czech Republic before elective surgery, using the Visual Analogue Scale for Anxiety (VAS-A). Design: A cross-sectional descriptive study. Methods: The sample consisted of 344 patients undergoing elective surgery. The day before surgery patients completed a questionnaire consisting of demographic data, the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the VAS-A. Spearman correlation was use...

  19. Posterior-only surgery with preoperative skeletal traction for management of severe scoliosis.

    Science.gov (United States)

    Mehrpour, Saeedreza; Sorbi, Reza; Rezaei, Reza; Mazda, Keyvan

    2017-04-01

    The surgical treatment of severe adolescent spinal deformities is challenging and carries substantial risks of mortality and morbidity. To mitigate this risk, surgeons have employed various methods as this study designed to evaluate the safety and effectiveness of preoperative halo-femoral or halo gravity traction (HGT) followed by posterior-only surgery in the management of severe scoliosis. A total number of 23 patients with severe scoliosis treated by preoperative skeletal traction (halo gravity or halo femoral) followed by posterior fusion and instrumentation in one stage. All patients were followed for a minimum of 2 years after surgery. The average age of the patients was 12.7 years at the time of surgery. Mean of the Cobb angle improved from 99.9° ± 8.2° preoperatively to 75.3° ± 8° post-traction and 49.5° ± 7.7° postoperatively. Kyphosis angle corrected from 56.4° ± 9.5° to 38.6° ± 5.8°. The preop-FVC% was 41 ± 6.1% and after 1 year follow-up FVC% was 45.7 ± 7.7%. No patients required an anterior release due to amount of their deformity. Despite the benefits of modern instrumentation procedures, the treatment of severe scoliosis can be very competing. We think that by applying preoperative halo femoral traction and halo-gravity traction, managing severe scoliosis will be in safe and easy manner and can lead to better deformity correction and less neurological complications and facilitate to avoid anterior operation for severe scoliosis and its related complications.

  20. American Thyroid Association Statement on Preoperative Imaging for Thyroid Cancer Surgery

    Science.gov (United States)

    Bauer, Andrew J.; Bernet, Victor A.; Ferris, Robert L.; Loevner, Laurie A.; Mandel, Susan J.; Orloff, Lisa A.; Randolph, Gregory W.; Steward, David L.

    2015-01-01

    Background: The success of surgery for thyroid cancer hinges on thorough and accurate preoperative imaging, which enables complete clearance of the primary tumor and affected lymph node compartments. This working group was charged by the Surgical Affairs Committee of the American Thyroid Association to examine the available literature and to review the most appropriate imaging studies for the planning of initial and revision surgery for thyroid cancer. Summary: Ultrasound remains the most important imaging modality in the evaluation of thyroid cancer, and should be used routinely to assess both the primary tumor and all associated cervical lymph node basins preoperatively. Positive lymph nodes may be distinguished from normal nodes based upon size, shape, echogenicity, hypervascularity, loss of hilar architecture, and the presence of calcifications. Ultrasound-guided fine-needle aspiration of suspicious lymph nodes may be useful in guiding the extent of surgery. Cross-sectional imaging (computed tomography with contrast or magnetic resonance imaging) may be considered in select circumstances to better characterize tumor invasion and bulky, inferiorly located, or posteriorly located lymph nodes, or when ultrasound expertise is not available. The above recommendations are applicable to both initial and revision surgery. Functional imaging with positron emission tomography (PET) or PET-CT may be helpful in cases of recurrent cancer with positive tumor markers and negative anatomic imaging. PMID:25188202

  1. Preoperative autologous plateletpheresis in patients undergoing open heart surgery.

    Directory of Open Access Journals (Sweden)

    Tomar Akhlesh

    2003-01-01

    Full Text Available Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB. It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and difficulty in achieving the haemostasis and in patients with negative blood group and emergency operations, the availability of sufficient blood can be a problem. Harvesting the autologous platelet rich plasma (PRP can be a useful method of blood conservation in these patients. The above four categories of patients were prospectively studied, using either autologous whole blood donation or autologous platelet rich plasma (PRP harvest in the immediate pre-bypass period. Forty two patients were included in the study and randomly divided into two equal groups of 21 each, control group (Group I in which one unit of whole blood was withdrawn, and PRP group (Group II where autologous plateletpheresis was utilised. After reversal of heparin, autologous whole blood was transfused in the control group and autologous PRP was transfused in the PRP group. The chest tube drainage and the requirement of homologous blood and blood products were recorded. Average PRP harvest was 643.33 +/- 133.51 mL in PRP group and the mean whole blood donation was 333.75 +/- 79.58 mL in the control group. Demographic, preoperative and intra operative data showed no statistically significant differences between the two groups. The PRP group patients drained 26.44% less (p<0.001 and required 38.5% less homologous blood and blood products (p<0.05, in the postoperative period. Haemoglobin levels on day zero (day of operation and day three were statistically not different between the two groups. We

  2. [Beta-lactamic antibiotics allergy in cataract surgery. Prevalence and preoperative characteristics of allergic patients].

    Science.gov (United States)

    Fernández-Rubio, M E; Cuesta-Rodríguez, T; Urcelay-Segura, J L; Cortés-Valdés, C

    2014-03-01

    To describe the proportion of patients allergic to β-lactam antibiotics and the prevalence of preoperative conjunctival bacteria among those undergoing cataract surgery in our area. Retrospective cross-sectional study of prevalence of β-lactam allergic patients consecutively scheduled for cataract surgery from 11 July 2005 to November 2012. For studying the prevalence of conjunctival bacteria and clinical characteristics in the patients' preoperative examination, those under 18 years and those with cataract surgery combined with other eye surgeries were excluded. Data from the first preoperative examination of the remaining patients were selected. Clinical data were extracted from the database generated in the evaluation made for anesthetic purposes, and the microbiological data from the laboratory database. Both bases were linked through a patient history code. A comparison was made between the prevalence of conjunctival bacteria and clinical characteristics in allergic and non-allergic patients. From 12,409 adults selected for the bacteriological study, 862 (6.96%) were allergic to β-lactams, their mean age (74.45 years) was higher than that of the non-allergic (P=.005). The proportion of women (71.4%) in the allergic patient group was much higher than that of men. The prevalence of pathogenic bacteria (especially Bacillus spp and Pseudomonas aeruginosa), lung disease and heart failure, was higher in allergic patients. The prevalence of allergy to β-lactams in this study is within the range described in other populations. The higher prevalence of pathogenic bacteria and the predominance of women in those allergic to β-lactams are useful data to guide their surgical prophylaxis. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  3. ROLE OF PRE-OPERATIVE INVESTIGATIONS IN PREVENTING THE POST-OPERATIVE COMPLICATIONS OF THYROID SURGERY

    Directory of Open Access Journals (Sweden)

    Kamreddy Ashok

    2015-11-01

    Full Text Available Thyroid surgeries are performed worldwide for various indications. In the past complications of thyroid surgeries were reported more than 24%. With an increase in accuracy in Cytological reporting, non-invasive radiological investigations to know the extent of the tumor and infiltration of malignant tumors, the complications are reduced to less than 4%. AIM: To evaluate the predictability of pre-operative investigations in preventing the post-operative complications of thyroid surgery. MATERIALS AND METHODS: A prospective study conducted on 86 patients by investigating before thyroid surgeries with FNAC, ultrasonography, CT scan, X-ray Neck lateral view, MRI, 2D ECHO of Cardia, isotope scanning, video laryngoscopy and thyroid function tests. Demographic characteristics of the patients and indications for thyroid surgeries were used to predict the post-operative complications. Post-operative investigations included serum calcium levels, Thyroid function tests and serum Electrolyte levels to diagnose the complications. RESULTS: sensitivity of FNAC was 93.33%, ultra sound Neck was 92.83%, serum calcium was 89.16%, in thyroid function tests it was 77.66%. With X-Ray Neck the specificity was 57.66%, CT scan was 44.50%, MRI was 15%, and isotope study was 30.6%, Doppler study was 33.83% and 2DEcho was 27.83%. Pre-operative assessment was Airway obstruction 3.48%, hematoma formation 4.65%, RLN palsy 3.48%, Hypocalcaemia 33.72%, wound infection 4.65% were the complications encountered. CONCLUSIONS: Thorough investigations prior to surgery of thyroid, proper selection of the surgical procedure, tumor location knowledge, understanding the pathophysiology of the thyroid disease and type of anesthesia gives confidence to the surgeon and avoids complications. The methods applied in the present study had a definitive role in preventing hypocalcaemia with an incidence of 33.72% and RLN palsy 3.48%. These were added upon by the experience of the operating

  4. MRI for the preoperative evaluation of femoroacetabular impingement.

    Science.gov (United States)

    Li, Angela E; Jawetz, Shari T; Greditzer, Harry G; Burge, Alissa J; Nawabi, Danyal H; Potter, Hollis G

    2016-04-01

    Femoroacetabular impingement (FAI) refers to a condition characterized by impingement of the femoral head-neck junction against the acetabular rim, often due to underlying osseous and/or soft tissue morphological abnormalities. It is a common cause of hip pain and limited range of motion in young and middle-aged adults. Hip preservation surgery aims to correct the morphological variants seen in FAI, thereby relieving pain and improving function, and potentially preventing early osteoarthritis. The purpose of this article is to review the mechanisms of chondral and labral injury in FAI to facilitate an understanding of patterns of chondrolabral injury seen on MRI. Preoperative MRI evaluation of FAI should include assessment of osseous morphologic abnormalities, labral tears, cartilage status, and other associated compensatory injuries of the pelvis. As advanced chondral wear is the major relative contraindication for hip preservation surgery, MRI is useful in the selection of patients likely to benefit from surgery. Teaching points • The most common anatomical osseous abnormalities predisposing to FAI include cam and pincer lesions. • Morphological abnormalities, labral lesions, and cartilage status should be assessed. • In cam impingement, chondral wear most commonly occurs anterosuperiorly.• Pre-existing advanced osteoarthritis is the strongest predictor of poor outcomes after FAI surgery. • Injury to muscles and tendons or other pelvic structures can coexist with FAI.

  5. Mini-maze suffices as adjunct to mitral valve surgery in patients with preoperative atrial fibrillation

    NARCIS (Netherlands)

    Tuinenburg, AE; Van Gelder, IC; Tieleman, RG; Grandjean, JG; Huet, RCG; Van der Maaten, JMAA; Pieper, EG; De Kam, PJ; Ebels, MSCT; Crijns, HJGM

    2000-01-01

    Mini-Maze and Mitral Valve Surgery. Introduction: After mitral valve (MV) surgery, preoperative atrial fibrillation (AF) often recurs while cardioversion therapy generally fails. Additional Cox maze surgery improves postoperative arrhythmia outcome, but the extensive nature of such an approach limit

  6. [What preoperative information do the parents of children undergoing surgery want?].

    Science.gov (United States)

    Sartori, Josefina; Espinoza, Pilar; Díaz, María Soledad; Ferdinand, Constanza; Lacassie, Héctor J; González, Alejandro

    2015-01-01

    Parents feel fear and anxiety before surgery is performed on their child, and those feelings could obstruct their preparation for the surgery. Preoperative information could relieve those feelings. To determine the preoperative information needs of parents of children undergoing elective surgery. A study was conducted on the parents of children who underwent elective surgery. Demographic data of parents were recorded. Preoperative information received or would like to have received was assessed in terms of contents, methods, opportunity, place and informant. Descriptive statistics were used. Thirteen hundred parents were surveyed. More than 80% of them want preoperative information about anaesthesia, surgery, preoperative fasting, drugs and anaesthetic complications, monitoring, intravenous line management, pain treatment, postoperative feeding, anxiety control, hospitalisation room, recovery room, and entertainment in recovery room. Most want to be informed verbally, one to two weeks in advance and not on the same day of surgery. The informant should be the surgeon and in his office. In addition, they want information through leaflets, videos and simulation workshops, or guided tours. Parents need complete preoperative information about anesthesia, surgery and postoperative care, received verbally and in advance. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Preoperative prealbumin level as a risk factor for surgical site infection following elective spine surgery

    Directory of Open Access Journals (Sweden)

    David J Salvetti

    2015-01-01

    Conclusions: Our results reinforce the relationship between preoperative nutritional status and outcomes in elective spine surgery. The data indicate that preoperative prealbumin levels may be useful in risk stratification. Further study is needed to determine whether nutritional supplementation may reduce the risk of infection.

  8. Preoperative pulmonary rehabilitation in lung cancer patients undergoing lung resection surgery

    OpenAIRE

    Sebio García, Raquel

    2016-01-01

    [Abstract] INTRODUCTION: Lung resection surgery (LRS) remains the treatment of choice for early stages of lung cancer but significant morbidity is associated, especially among patients with poor preoperative status. Preoperative exercise training (PET) has been proposed as an effective way of optimizing patients’ condition before surgery and enhancing postoperative recovery. However, it remains unknown whether or not similar results can be achieved after video-assisted thora...

  9. Preoperative pulmonary rehabilitation in lung cancer patients undergoing lung resection surgery

    OpenAIRE

    Sebio García, Raquel

    2016-01-01

    [Abstract] INTRODUCTION: Lung resection surgery (LRS) remains the treatment of choice for early stages of lung cancer but significant morbidity is associated, especially among patients with poor preoperative status. Preoperative exercise training (PET) has been proposed as an effective way of optimizing patients’ condition before surgery and enhancing postoperative recovery. However, it remains unknown whether or not similar results can be achieved after video-assisted thora...

  10. Providing Preoperative Information for Children Undergoing Surgery: A Randomized Study Testing Different Types of Educational Material to Reduce Children's Preoperative Worries

    Science.gov (United States)

    Fernandes, S. C.; Arriaga, P.; Esteves, F.

    2014-01-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery. The…

  11. Providing Preoperative Information for Children Undergoing Surgery: A Randomized Study Testing Different Types of Educational Material to Reduce Children's Preoperative Worries

    Science.gov (United States)

    Fernandes, S. C.; Arriaga, P.; Esteves, F.

    2014-01-01

    This study developed three types of educational preoperative materials and examined their efficacy in preparing children for surgery by analysing children's preoperative worries and parental anxiety. The sample was recruited from three hospitals in Lisbon and consisted of 125 children, aged 8-12 years, scheduled to undergo outpatient surgery.…

  12. Emergency Off-Pump Coronary Artery Bypass Graft Surgery for Patients on Preoperative Intraaortic Balloon Pump.

    Science.gov (United States)

    Ito, Hisato; Mizumoto, Toru; Tempaku, Hironori; Fujinaga, Kazuya; Sawada, Yasuhiro; Teranishi, Satoshi; Shimpo, Hideto

    2016-09-01

    The aim of this study was to investigate early and long-term outcomes of patients with acute coronary syndrome preoperatively requiring intraaortic balloon pump support who underwent emergency off-pump coronary artery bypass graft surgery. One hundred and fifteen patients on preoperative intraaortic balloon pump receiving emergency off-pump coronary artery bypass graft surgery over an 11-year period were evaluated. The median age was 71 years (range, 33 to 87). Acute myocardial infarction and unstable angina were present in 54 patients (47.0%) and 61 patients (53.0%), respectively. Left main disease and triple-vessel disease without left main involvement were present in 74 patients (64.3%) and 33 patients (28.7%), respectively. There were 3 perioperative deaths. Complete surgical revascularization was accomplished in 82 patients (71.3%), and in situ internal thoracic artery graft was used in 96 (83.5%). Late survival, freedom from major adverse cardiac and cerebrovascular events, and freedom from repeat revascularization rates at 5 years were 83.3%, 73.5%, and 84.2%, respectively. The Cox multivariate prognostic predictors of total mortality were preoperative renal impairment (hazard ratio [HR] 7.90; 95% confidence interval [CI]: 3.06 to 20.4) and low ejection fraction (HR 0.94, 95% CI: 0.88 to 0.99). The multivariate risk predictors of major adverse cardiac and cerebrovascular events were preoperative renal impairment (HR 2.68, 95% CI: 1.00 to 7.19) and peripheral vascular disease (HR 2.81, 95% CI: 1.05 to 7.51), and complete revascularization was protective (HR 0.39, 95% CI: 0.19 to 0.81). The multivariate risk factor of repeat revascularization was previous percutaneous coronary intervention (HR 3.26, 95% CI: 1.14 to 9.33), and complete surgical revascularization was also protective (HR 0.30, 95% CI: 0.11 to 0.85). Off-pump coronary artery bypass graft surgery is a feasible option for patients requiring preoperative intraaortic balloon pump support. Copyright

  13. A randomized trial of preoperative oral carbohydrates in abdominal surgery

    OpenAIRE

    Sada, Fatos; Krasniqi, Avdyl; Hamza, Astrit; Gecaj-Gashi, Agreta; Bicaj, Besnik; Kavaja, Floren

    2014-01-01

    Background Carbohydrate-rich liquid drinks (CRLDs) have been recommended to attenuate insulin resistance by shortening the preoperative fasting interval. The aim of our study the effect of preoperative oral administration of CRLDs on the well-being and clinical status of patients. Methods A randomized, double blind, prospective study of patients undergoing open colorectal operations (CR) and open cholecyctectomy (CH) was conducted. Patients were divided into three groups: study, placebo, and ...

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

    Science.gov (United States)

    Ackerman, Ilana N; Bennell, Kim L

    2004-01-01

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

  15. Significance of preoperative calculation of uterine weight as an indicator for preserving the uterus in pelvic reconstructive surgery.

    Science.gov (United States)

    Sheng, Qingsong; Ma, Ning; Huang, Huijuan; Xu, Bo; He, Chunni; Song, Yanfeng

    2015-01-01

    Recently, increasing evidence has shown that uterus preservation is beneficial for pelvic organ prolapse (POP) patients, both physiologically and psychologically. However, the preoperative indicators for uterus preservation have rarely been examined. The current study was designed to determine the relationship between the preoperative evaluated uterus weight and the operation selection (preserving the uterus or not) in pelvic reconstructive surgery (PRS) using vaginal meshes. First, in a series of 96 patients undergoing hysterectomy, the uterine weight was calculated by preoperative ultrasound measurements, and was then compared with the postoperative actual weight of the uterus. Subsequently, in a series of 65 patients undergone PRS using vaginal meshes and preserving the uterus, the uterine weight was calculated by preoperative ultrasound measurements. Lastly, in a series of 43 patients with a uterine weight > 56.12 g who had undergone PRS using vaginal meshes, the operation success rate in patients with a preserved uterus was compared to patients for whom the uterus was not preserved. The results showed that uterus weight can be evaluated by ultrasound and used as a preoperative indicator for whether the uterus should be preserved or not in PRS when using vaginal meshes. It was indicated that preoperative evaluation of uterine weight is beneficial for surgical planning and guidance.

  16. Comparative analysis of late functional outcome following preoperative radiation therapy or chemoradiotherapy and surgery or surgery alone in rectal cancer.

    Science.gov (United States)

    Contin, Pietro; Kulu, Yakup; Bruckner, Thomas; Sturm, Martin; Welsch, Thilo; Müller-Stich, Beat P; Huber, Johannes; Büchler, Markus W; Ulrich, Alexis

    2014-02-01

    This study evaluates the anorectal and genitourinary function of patients treated by preoperative short-term radiotherapy (RT) or chemoradiotherapy (CRT) followed by surgery and surgery alone for rectal cancer. For this study, a total of 613 patients, who were identified from a prospective rectal cancer database, underwent anterior resection of the rectum between October 2001 and December 2007. Standardized questionnaires were used to determine fecal incontinence, urinary, and sexual function. Relevant clinical variables were evaluated using univariate and multivariate analyses. Independent predictors of functional outcome were identified by a binary logistic regression analysis. The data of 263 (43 %) patients were available for analysis. On multivariate analysis, neoadjuvant RT (P < 0.01) and low anterior resection (LAR) (P = 0.049) were associated with fecal incontinence. In univariate analysis, fecal incontinence was linked to preoperative neoadjuvant treatment (RT and/or CRT vs. LAR) (P < 0.01). The hazard ratio for developing fecal incontinence was 3.3 (1.6-6.8) for patients who received RT. One hundred twenty-five patients (51.2 %) experienced urinary incontinence following surgery, the majority of whom were female (P < 0.01). On univariate analysis, male sexual function was associated with age (P < 0.01), ASA class (P = 0.01) and LAR (P = 0.01). Multimodal therapy of low rectal cancer increases the incidence of fecal incontinence and negatively affects sexual function. The potential benefits of RT or CRT need to be balanced against the risk of increased bowel dysfunction when determining the appropriate treatment for individual patients with rectal cancer.

  17. The effects on surgery and preoperative patients with non-small cell lung cancer by preoperative bronchial artery infusion chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Shuhong Tang; Jilai Bian; Mingwu Li

    2008-01-01

    Objective: To study the efficiency, safety and feasibility of preoperative bronchial artery infusion (BAI) chemotherapy on operation in patients with locally advanced (stage Ⅲ) non-small cell lung cancer (NSCLC).Methods: 92 cases with locally advanced NSCLC patients were randomly divided into two groups: (1) BAI chemotherapy group: 39 cases were received BAI chemotherapy for 2 courses and followed surgery; (2) surgery alone group: 51 cases were treated by operation alone.The complete resection rate and preoperative complications were compared between these two groups.Results: In BAI chemotherapy group, the rate of clinical efficiency was 68.3% with slight toxicity.In BAI chemotherapy group the surgery complete resection rate was 89.7%, which was significantly higher than that in surgery alone group (72.5%, P<0.05).No significant differences of blood loss, operative complications and mortality were observed between these two groups.Conclusion: BAI neoadjuvant chemotherapy was safe and effective, which can increase the complete resection rate of the tumor and did not increase the operative complications and mortality.

  18. Preoperative evaluation : risk management and implementation aspects

    NARCIS (Netherlands)

    Klei, W.A. van

    2002-01-01

    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from

  19. Preoperative evaluation : risk management and implementation aspects

    NARCIS (Netherlands)

    Klei, W.A. van

    2002-01-01

    In preoperative risk management the anesthesiologist uses diagnostic information to estimate the probability of outcomes and to decide on the anesthetic strategy in a particular patient. The aim of this thesis was explore to what extent simple patient characteristics, particularly obtained from preo

  20. Clinically silent preoperative brain injuries do not worsen with surgery in neonates with congenital heart disease.

    Science.gov (United States)

    Block, A J; McQuillen, P S; Chau, V; Glass, H; Poskitt, K J; Barkovich, A J; Esch, M; Soulikias, W; Azakie, A; Campbell, A; Miller, S P

    2010-09-01

    Preoperative brain injury, particularly stroke and white matter injury, is common in neonates with congenital heart disease. The objective of this study was to determine the risk of hemorrhage or extension of preoperative brain injury with cardiac surgery. This dual-center prospective cohort study recruited 92 term neonates, 62 with transposition of the great arteries and 30 with single ventricle physiology, from 2 tertiary referral centers. Neonates underwent brain magnetic resonance imaging scans before and after cardiac surgery. Brain injury was identified in 40 (43%) neonates on the preoperative magnetic resonance imaging scan (median 5 days after birth): stroke in 23, white matter injury in 21, and intraventricular hemorrhage in 7. None of the brain lesions presented clinically with overt signs or seizures. Preoperative brain injury was associated with balloon atrial septostomy (P = .003) and lowest arterial oxygen saturation (P = .007); in a multivariable model, only the effect of balloon atrial septostomy remained significant when adjusting for lowest arterial oxygen saturation. On postoperative magnetic resonance imaging in 78 neonates (median 21 days after birth), none of the preoperative lesions showed evidence of extension or hemorrhagic transformation (0/40 [95% confidence interval: 0%-7%]). The presence of preoperative brain injury was not a significant risk factor for acquiring new injury on postoperative magnetic resonance imaging (P = .8). Clinically silent brain injuries identified preoperatively in neonates with congenital heart disease, including stroke, have a low risk of progression with surgery and cardiopulmonary bypass and should therefore not delay clinically indicated cardiac surgery. In this multicenter cohort, balloon atrial septostomy remains an important risk factor for preoperative brain injury, particularly stroke. 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

  1. Complications of pre-operative anorexia nervosa in bariatric surgery.

    Science.gov (United States)

    Shear, Matthew; DeFilippis, Ersilia M

    2015-01-01

    It is important to recognise that patients who seek weight loss surgery may have a history of restrictive eating or anorexia nervosa. The following case report describes a woman with a history of anorexia nervosa who underwent Roux-en-Y gastric bypass surgery. Her eating disorder symptoms subsequently reappeared and were largely resistant to treatment. To the best of our knowledge, this is the first case report of a bariatric surgery patient with a prior history of anorexia nervosa. Further research is required to determine how best to select patients for weight loss surgery.

  2. Meta-analysis of the association between preoperative anaemia and mortality after surgery.

    Science.gov (United States)

    Fowler, A J; Ahmad, T; Phull, M K; Allard, S; Gillies, M A; Pearse, R M

    2015-10-01

    Numerous published studies have explored associations between anaemia and adverse outcomes after surgery. However, there are no evidence syntheses describing the impact of preoperative anaemia on postoperative outcomes. A systematic review and meta-analysis of observational studies exploring associations between preoperative anaemia and postoperative outcomes was performed. Studies investigating trauma, burns, transplant, paediatric and obstetric populations were excluded. The primary outcome was 30-day or in-hospital mortality. Secondary outcomes were acute kidney injury, stroke and myocardial infarction. Predefined analyses were performed for the cardiac and non-cardiac surgery subgroups. A post hoc analysis was undertaken to evaluate the relationship between anaemia and infection. Data are presented as odds ratios (ORs) with 95 per cent c.i. From 8973 records, 24 eligible studies including 949 445 patients were identified. Some 371 594 patients (39·1 per cent) were anaemic. Anaemia was associated with increased mortality (OR 2·90, 2·30 to 3·68; I(2)  = 97 per cent; P anaemia was associated with stroke (OR 1·28, 1·06 to 1·55; I(2)  = 0 per cent; P = 0·009) but not myocardial infarction (OR 1·11, 0·68 to 1·82; I(2)  = 13 per cent; P = 0·67). Anaemia was associated with an increased incidence of red cell transfusion (OR 5·04, 4·12 to 6·17; I(2)  = 96 per cent; P anaemia is associated with poor outcomes after surgery, although heterogeneity between studies was significant. It remains unclear whether anaemia is an independent risk factor for poor outcome or simply a marker of underlying chronic disease. However, red cell transfusion is much more frequent amongst anaemic patients. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

  3. Economic impact of clinical variability in preoperative testing for major outpatient surgery.

    Science.gov (United States)

    Gil-Borrelli, Christian Carlo; Agustí, Salomé; Pla, Rosa; Díaz-Redondo, Alicia; Zaballos, Matilde

    2016-05-01

    With the purpose of decreasing the existing variability in the criteria of preoperative evaluation and facilitating the clinical decision-making process, our hospital has a protocol of preoperative tests to use with ASA I and ASA II patients. The aim of the study was to calculate the economic impact caused by clinicians' non-adherence to the protocol for the anaesthesiological evaluation of ASA 1 and ASA II patients. A retrospective study of costs with a random sample of 353 patients that were seen in the consultation for Anesthesiology over a period of one year. Aspects related to the costs, patient's profiles and specialties were analysed, according to the degree of fulfillment of the protocol. The lack of adherence to the the protocol was 70%. 130 chest X-rays and 218 ECG were performed without indication. This generated an excess costs of 34 € per patient. Taking into account the expenses of both tests and the attended population undergoing ambulatory surgery during the one-year period, an excess spending for the hospital of between 69.164 € and 83.312 € was estimated. Clinical variability should be reduced and the creation of synergies between the different departments should be enhanced in order to adjust the request for unnecessary complementary tests to decrease health care and to improve the quality of patient care. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Tourniquet-induced cardiovascular responses in anterior cruciate ligament reconstruction surgery under general anesthesia: Effect of preoperative oral amantadine

    Directory of Open Access Journals (Sweden)

    Ashraf Abd Elmawgood

    2015-01-01

    Conclusion: Preoperative oral amantadine reduced tourniquet induced hypertension and postoperative analgesic requirements in anterior cruciate ligament reconstruction surgery under general anesthesia.

  5. Update on three-dimensional image reconstruction for preoperative simulation in thoracic surgery

    Science.gov (United States)

    Chen-Yoshikawa, Toyofumi F.

    2016-01-01

    Background Three-dimensional computed tomography (3D-CT) technologies have been developed and refined over time. Recently, high-speed and high-quality 3D-CT technologies have also been introduced to the field of thoracic surgery. The purpose of this manuscript is to demonstrate several examples of these 3D-CT technologies in various scenarios in thoracic surgery. Methods A newly-developed high-speed and high-quality 3D image analysis software system was used in Kyoto University Hospital. Simulation and/or navigation were performed using this 3D-CT technology in various thoracic surgeries. Results Preoperative 3D-CT simulation was performed in most patients undergoing video-assisted thoracoscopic surgery (VATS). Anatomical variation was frequently detected preoperatively, which was useful in performing VATS procedures when using only a monitor for vision. In sublobar resection, 3D-CT simulation was more helpful. In small lung lesions, which were supposedly neither visible nor palpable, preoperative marking of the lesions was performed using 3D-CT simulation, and wedge resection or segmentectomy was successfully performed with confidence. This technique also enabled virtual-reality endobronchial ultrasonography (EBUS), which made the procedure more safe and reliable. Furthermore, in living-donor lobar lung transplantation (LDLLT), surgical procedures for donor lobectomy were simulated preoperatively by 3D-CT angiography, which also affected surgical procedures for recipient surgery. New surgical techniques such as right and left inverted LDLLT were also established using 3D models created with this technique. Conclusions After the introduction of 3D-CT technology to the field of thoracic surgery, preoperative simulation has been developed for various thoracic procedures. In the near future, this technique will become more common in thoracic surgery, and frequent use by thoracic surgeons will be seen in worldwide daily practice. PMID:27014477

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

    Science.gov (United States)

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

    2007-01-01

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

  7. Visual Analogue Scale for Anxiety and Amsterdam Preoperative Anxiety Scale Provide a Simple and Reliable Measurement of Preoperative Anxiety in Patients Undergoing Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Joaquín Hernández-Palazón

    2015-03-01

    Full Text Available Background: Anxiety is an emotional state characterized by apprehension and fear resulting from anticipation of a threatening event. Objectives: The present study aimed to analyze the incidence and level of preoperative anxiety in the patients scheduled for cardiac surgery by using a Visual Analogue Scale for Anxiety (VAS-A and Amsterdam Preoperative Anxiety and Information Scale (APAIS and to identify the influencing clinical factors. Patients and Methods: This prospective, longitudinal study was performed on 300 cardiac surgery patients in a single university hospital. The patients were assessed regarding their preoperative anxiety level using VAS-A, APAIS, and a set of specific anxiety-related questions. Their demographic features as well as their anesthetic and surgical characteristics (ASA physical status, EuroSCORE, preoperative Length of Stay (LoS, and surgical history were recorded, as well. Then, one-way ANOVA and t-test were applied along with odds ratio for risk assessment. Results: According to the results, 94% of the patients presented preoperative anxiety, with 37% developing high anxiety (VAS-A ≥ 7. Preoperative LoS > 2 days was the only significant risk factor for preoperative anxiety (odds ratio = 2.5, CI 95%, 1.3 - 5.1, P = 0.009. Besides, a positive correlation was found between anxiety level (APAISa and requirement of knowledge (APAISk. APAISa and APAISk scores were greater for surgery than for anesthesia. Moreover, the results showed that the most common anxieties resulted from the operation, waiting for surgery, not knowing what is happening, postoperative pain, awareness during anesthesia, and not awakening from anesthesia. Conclusions: APAIS and VAS-A provided a quantitative assessment of anxiety and a specific qualitative questionnaire for preoperative anxiety in cardiac surgery. According to the results, preoperative LoS > 2 days and lack of information related to surgery were the risk factors for high anxiety levels.

  8. Surgical bleeding after pre-operative unfractionated heparin and low molecular weight heparin for coronary bypass surgery.

    Science.gov (United States)

    Renda, Giulia; Di Pillo, Raffaele; D'Alleva, Alberto; Sciartilli, Adolfo; Zimarino, Marco; De Candia, Erica; Landolfi, Raffaele; Di Giammarco, Gabriele; Calafiore, Antonio; De Caterina, Raffaele

    2007-03-01

    Since the impairment of platelet function may cause excess peri-operative bleeding, pre-operative discontinuation of aspirin and heparin bridging are common for cardiac surgery. We evaluated the impact of pre-operative administration of enoxaparin and unfractionated heparin (UFH) on coagulation parameters and peri-operative bleeding in patients undergoing elective coronary artery bypass grafting (CABG) surgery after discontinuation of aspirin. Forty-three patients with three-vessel coronary artery disease undergoing elective CABG surgery discontinued aspirin and were randomized to receive either UFH 180 UI/Kg x 2/day s.c. or enoxaparin 100 UI/Kg x 2/day s.c. until 12 h before surgery (median pre-operative treatment 8 days, range 6-12 days). Surgery was performed as usual with UFH. Neither UFH nor any low molecular weight heparin was given in the immediate post-operative period. The effects of UFH and enoxaparin were monitored by the activated partial thromboplastin time (aPTT) and the Enox-test (sensitive to factor Xa inhibition) using a Rapidpoint Coagulation Analyzer. aPTT and factor Xa activity were also measured by standard methods. Peri-operative bleeding and the nadirs of hemoglobin concentration, hematocrit and platelet count were monitored post-operatively. Patients in the two groups were similar for number of bypasses, on-pump time, total surgery time, and time from the last heparin administration. Coagulation parameters increased significantly and similarly at 30 min and 6 h with both treatments, but returned within the normal range at 12 h. Hemoglobin, hematocrit and platelet counts significantly decreased to the same extent after CABG and re-normalized at the same time. Transfusional requirements of blood and plasma units were similar in the two groups. From the kinetics of coagulation parameters and the evaluation of bleeding, enoxaparin is a safe alternative to UFH as a bridging therapy to CABG after discontinuation of aspirin.

  9. Open Sinus Lift Surgery and the Importance of Preoperative Cone-Beam Computed Tomography Scan: A Review

    Science.gov (United States)

    Rahpeyma, Amin; Khajehahmadi, Saeedeh

    2015-01-01

    Open sinus lift surgery is a form of pre-prosthetic surgery for increasing the quality and quantity of bone in the posterior region of the maxilla. Pre-operative assessment of the maxillary sinus is essential for the success of this surgery. PubMed search was carried out in English language literature for open sinus lift surgery and cone-beam computed tomography (CBCT). The results focused on anatomic variants, vascular anatomy, complications, osteotomy/ostectomy window dimensions and thickness of the Schneiderian Membrane. 59 articles were included in this review. Features other than the height and the width of the residual alveolar ridge that should be evaluated in preoperative CBCT scan include the thickness of the lateral maxillary sinus wall, the presence of the alveolar antral artery and its diameter, the maxillary sinus floor width and angulation, irregularity of sinus floor, intimate relation of Schneiderian membrane with the roots of the adjacent teeth, sinus septum, and the quality of subantral bone. Other conditions that occasionally may be observed in special situations are also explained. More than ten parameters should be checked in evaluating CBCT images of paranasal sinuses other than the width and the length of the residual ridge in the posterior region of the maxilla. Each of them may have a significant impact on the results of the open sinus lift surgery. PMID:26435632

  10. A randomized trial of preoperative oral carbohydrates in abdominal surgery.

    Science.gov (United States)

    Sada, Fatos; Krasniqi, Avdyl; Hamza, Astrit; Gecaj-Gashi, Agreta; Bicaj, Besnik; Kavaja, Floren

    2014-01-01

    Carbohydrate-rich liquid drinks (CRLDs) have been recommended to attenuate insulin resistance by shortening the preoperative fasting interval. The aim of our study the effect of preoperative oral administration of CRLDs on the well-being and clinical status of patients. A randomized, double blind, prospective study of patients undergoing open colorectal operations (CR) and open cholecyctectomy (CH) was conducted. Patients were divided into three groups: study, placebo, and control. Visual analogue scale (VAS) scores for seven parameters (thirst, hunger, anxiety, mouth dryness, nausea, weakness and sleep quality) were recorded and compared for two different time periods (up to 24 h postoperatively and from 36 to 48 h postoperatively). The Simplified Acute Physiology Score changes (SAPS)-II between the three groups were also studied. There were 142 patients American Society of Anesthesiology (ASA) I or II enrolled in the study (CR = 71 and CH = 71). There were no significant differences in postoperative SAPS-II scores or lengths of hospital stay (LOS) between the groups. However, in CR patients, the degree of thirst was partially improved by drinking CRLDs (P = 0.027). In CH patients, on the other hand, feelings of thirst, hunger, mouth dryness, nausea and weakness showed significant improvement (P carbohydrate-rich liquid drinks (CRLDs) improves the well-being in patients undergoing CH, but the effect is less evident in patients undergoing CR. No significant improvements were seen in clinical status or in length of hospital stay in either group. ANZCTR.org.au: ACTRN12614000995673 (registered on 16/09/2014).

  11. Essential elements of the preoperative breast reconstruction evaluation

    OpenAIRE

    Cheng, Angela; Losken, Albert

    2015-01-01

    A plethora of options exist for breast reconstruction and preoperative evaluation must be thorough to lead to a successful outcome. We review multiple components of the preoperative assessment including the patient’s history, goals, imaging, and key elements of the physical exam. Consideration for tumor biology, staging, need or response to chemotherapy or radiation therapy is important in deciding on immediate versus delayed reconstruction. It is also important to consider the patient’s anat...

  12. Remote preoperative tonic-clonic seizures do not influence outcome after surgery for temporal lobe epilepsy.

    Science.gov (United States)

    Asadi-Pooya, Ali A; Rabiei, Amin H; Gracely, Edward J; Sperling, Michael R

    2016-10-15

    Tonic-clonic seizures are associated with greater chance of seizure relapse after anterior temporal lobectomy. We investigated whether the interval between the last preoperative tonic-clonic seizure and surgery relates to seizure outcome in patients with drug-resistant mesial temporal lobe epilepsy (MTLE). In this retrospective study, patients were prospectively registered in a database from 1986 through 2014. Postsurgical outcome was categorized as seizure freedom or relapse. The relationship between surgical outcome and the interval between the last preoperative tonic-clonic seizure and surgery was investigated. One-hundred seventy-one patients were studied. Seventy nine (46.2%) patients experienced tonic-clonic seizures before surgery. Receiver operating characteristic curve of timing of the last preoperative tonic-clonic seizure was a moderate indicator to anticipate surgery failure (area under the curve: 0.657, significance; 0.016). The best cutoff that maximizes sensitivity and specificity was 27months; with a sensitivity of 0.76 and specificity of 0.60. Cox-Mantel analysis confirmed that the chance of becoming free of seizures after surgery in patients with no or remote history of preoperative tonic-clonic seizures was significantly higher compared with patients with a recent history (i.e., in 27months before surgery) (p=0.0001). The more remote the occurrence of preoperative tonic-clonic seizures, the better the postsurgical seizure outcome, with at least a two year gap being more favorable. A recent history of tonic-clonic seizures in a patient with MTLE may reflect more widespread epileptogenicity extending beyond the borders of mesial temporal structures. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Developing and Evaluating Virtual Cardiotomy for Preoperative Planning in Congenital Heart Disease

    DEFF Research Database (Denmark)

    Sørensen, Thomas Sangild; Beerbaum, Philipp; Mosegaard, Jesper;

    2009-01-01

    Careful preoperative planning is of outmost importance -- in particular when considering complex corrective surgery on congenitally malformed hearts. As an aid to such decisionsmaking we describe a system for virtual reconstruction of patient-specific morphology from 3D-capable imaging modalities...... such as MRI and CT. We introduce and illustrate the concept of virtual cardiotomy as a new tool to preoperatively evaluate the feasibility of different surgical strategies by investigating the anatomical spatial relations through any number of virtual incisions. Ve review the technical and clinical...

  14. Pre-operative history of depression and cognitive changes in bariatric surgery patients.

    Science.gov (United States)

    Alosco, Michael L; Spitznagel, Mary Beth; Strain, Gladys; Devlin, Michael; Cohen, Ronald; Crosby, Ross D; Mitchell, James E; Gunstad, John

    2015-01-01

    Obesity-associated cognitive impairments may be partially reversible through bariatric surgery. Depression, a prevalent comorbidity in bariatric surgery candidates, is linked with cognitive impairment and poorer surgical outcomes in other populations. No study has examined the effects of pre-operative depression on cognitive changes in bariatric surgery patients. Sixty-seven bariatric surgery patients completed a computerized cognitive test battery prior to surgery and 12 months post-operatively. The structured clinical interview for the DSM-IV Axis I disorders assessed major depressive disorder (MDD). Pre-surgery history of MDD was found in 47.8% of patients, but was not associated with greater baseline cognitive impairments. Repeated measures revealed improved cognitive abilities 12 months after surgery. Pre-surgery history of MDD did not influence post-operative cognitive function. Pre-operative history of MDD did not limit post-operative cognitive improvements. Larger studies with extended follow-ups are needed to clarify our findings and identify factors (e.g. older age) that may modify cognitive changes following surgery.

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

    Science.gov (United States)

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

    2014-01-01

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

  16. Preoperative Evaluation of Patients with Diabetes Mellitus.

    Science.gov (United States)

    Miller, Joshua D; Richman, Deborah C

    2016-03-01

    There are more than 29 million people in the United States with diabetes; it is estimated that by 2050, one in 3 individuals will have the disease. At least 50% of patients with diabetes are expected to undergo surgery in their lifetime. Complications from uncontrolled diabetes can impact multiple organ systems and affect perioperative risk. In this review, the authors discuss principles in diabetes management that will assist the perioperative clinician in caring for patients with diabetes.

  17. Interdisciplinary preoperative patient education in cardiac surgery: effects of the implementation of an information protocol.

    NARCIS (Netherlands)

    Tromp, F.; Dulmen, S. van; Weert, J. van

    2004-01-01

    Background: In 1998, we carried out a study of interdisciplinary preoperative education in cardiac surgery given by nurses, physicians and health educators. Overlaps were found in gathering and providing information by physicians, nurses and health educators, and gaps were found in providing psychos

  18. Interdisciplinary preoperative patient education in cardiac surgery: effects of the implementation of an information protocol.

    NARCIS (Netherlands)

    Tromp, F.; Dulmen, S. van; Weert, J. van

    2004-01-01

    Background: In 1998, we carried out a study of interdisciplinary preoperative education in cardiac surgery given by nurses, physicians and health educators. Overlaps were found in gathering and providing information by physicians, nurses and health educators, and gaps were found in providing psychos

  19. Topics and structure in preoperative nursing consultations with patients undergoing colorectal cancer surgery.

    Science.gov (United States)

    Pettersson, Monica E; Öhlén, Joakim; Friberg, Febe; Hydén, Lars-Christer; Carlsson, Eva

    2016-11-08

    The preoperative education, which occurs in preoperative patient consultations, is an important part of the surgical nurse's profession. These consultations may be the building blocks of a partnership that facilitates communication between patient and nurse. The aim of the study was to describe topics and structure and documentation in preoperative nursing consultations with patients undergoing surgery for colorectal cancer. The study was based on analysis of consultations between seven patients and nurses at a Swedish university hospital. The preplanned preoperative consultations were audio-recorded and transcribed verbatim. The structure of the consultations was described in terms of phases and the text was analysed according to a manifest content analysis RESULTS: The consultations were structured on an agenda that was used variously and communicating different topics in an equally varied manner. Seven main topics were found: Health status, Preparation before surgery, Discovery, Tumour, Operation, Symptoms and Recovery after surgery. The topic structure disclosed a high number of subtopics. The main topics 'Discovery', 'Tumour' and 'Symptoms' were only raised by patients and occupied only 11% of the discursive space. Documentation was sparse and included mainly task-oriented procedures rather than patients' worries and concerns. There was no clear structure regarding preoperative consultation purpose and content. Using closed questions instead of open is a hindrance of developing a dialogue and thus patient participation. Preoperative consultation practice needs to be strengthened to include explicit communication of the consultations' purpose and agenda, with nurses actively discussing and responding to patients' concerns and sensitive issues. The results of the study facilitate the development of methods and structure to support person-centred communication where the patient is given space to get help with the difficult issues he/she may have when undergoing

  20. Risk reduction before surgery. The role of the primary care provider in preoperative smoking and alcohol cessation

    DEFF Research Database (Denmark)

    Tønnesen, Hanne; Faurschou, Pernille; Ralov, Helge

    2010-01-01

    Daily smokers and hazardous drinkers are high-risk patients, developing 2-4 times more complications after surgery. Preoperative smoking and alcohol cessation for four to eight weeks prior to surgery halves this complication rate. The patients' preoperative contact with the surgical departments m...

  1. Response to treatment and interval to surgery after preoperative short-course radiotherapy in rectal cancer.

    Science.gov (United States)

    García-Cabezas, Sonia; Rodríguez-Liñán, Milagrosa; Otero-Romero, Ana M; Bueno-Serrano, Carmen M; Gómez-Barbadillo, José; Palacios-Eito, Amalia

    2016-10-01

    Preoperative short-course radiotherapy with immediate surgery improves local control in patients with rectal cancer. Tumor responses are smaller than those described with radiochemotherapy. Preliminary data associate this lower response to the short period until surgery. The aim of this study is to analyze the response to preoperative short-course radiotherapy and its correlation with the interval to surgery especially analyzing patients with mesorectal fascia involvement. A total of 155 patients with locally advanced rectal cancer treated with preoperative radiotherapy (5×5Gy) were retrospectively analyzed. Tumor response in terms of rates of complete pathological response, downstaging, tumor regression grading and status of the circumferential resection margin were quantified. The mean interval from radiotherapy to surgery was 23 days. The rate of complete pathological response was 2.2% and 28% experienced downstaging (stage decreased). No differences between these rates and interval to surgery were detected. Eighty-eight patients had magnetic resonance imaging for staging (in 31 patients the mesorectal fascia was involved).The mean time to surgery in patients with involvement of the fascia and R0 surgery was 27 days and 16 days if R1 (P=.016). The cutoff of 20 days reached the highest probability of achieving a free circumferential resection margin between patients with mesorectal fascia involvement, with no statistically significant differences: RR 3.036 95% CI=(0.691-13.328), P=.06. After preoperative short-course radiotherapy, an interval>20 days enhances the likelihood of achieving a free circumferential resection margin in patients with mesorectal fascia involvement. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Prediction of postoperative facial swelling, pain and trismus following third molar surgery based on preoperative variables

    Science.gov (United States)

    de Souza-Santos, Jadson A.; Martins-Filho, Paulo R.; da Silva, Luiz C.; de Oliveira e Silva, Emanuel D.; Gomes, Ana C.

    2013-01-01

    Objective: This paper investigates the relationship between preoperative findings and short-term outcome in third molar surgery. Study design: A prospective study was carried out involving 80 patients who required 160 surgical extractions of impacted mandibular third molars between January 2009 and December 2010. All extractions were performed under local anesthesia by the same dental surgeon. Swelling and maximal inter-incisor distance were measured at 48 h and on the 7th day postoperatively. Mean visual analogue pain scores were determined at four different time periods. Results: One-hundred eight (67.5%) of the 160 extractions were performed on male subjects and 52 (32.5%) were performed on female subjects. Median age was 22.46 years. The amount of facial swelling varied depending on gender and operating time. Trismus varied depending on gender, operating time and tooth sectioning. The influence of age, gender and operating time varied depending on the pain evaluation period (p trismus and pain) differ depending on the patients’ characteristics (age, gender and body mass index). Moreover, surgery characteristics such as operating time and tooth sectioning were also associated with postoperative variables. Key words:Third molar extraction, pain, swelling, trismus, postoperative findings, prediction. PMID:23229245

  3. Relationship Between Preoperative Anemia and In-Hospital Mortality in Children Undergoing Noncardiac Surgery.

    Science.gov (United States)

    Faraoni, David; DiNardo, James A; Goobie, Susan M

    2016-12-01

    The relationship between preoperative anemia and in-hospital mortality has not been investigated in the pediatric surgical population. We hypothesized that children with preoperative anemia undergoing noncardiac surgery may have an increased risk of in-hospital mortality. We identified all children between 1 and 18 years of age with a recorded preoperative hematocrit (HCT) in the 2012, 2013, and 2014 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) pediatric databases. The endpoint was defined as the incidence of in-hospital mortality. Children with preoperative anemia were identified based on their preoperative HCT. Demographic and surgical characteristics, as well as comorbidities, were considered potential confounding variables in a multivariable logistic regression analysis. A sensitivity analysis was performed using propensity-matched analysis. Among the 183,833 children included in the 2012, 2013, and 2014 ACS NSQIP database, 74,508 had a preoperative HCT recorded (41%). After exclusion of all children children were anemic, and 39,071 (76%) were nonanemic. The median preoperative HCT was 33% (interquartile range, 31-35) in anemic children, and 39% (interquartile range, 37-42) in nonanemic children (P anemia was associated with higher odds for in-hospital mortality (OR, 2.17; 95% CI, 1.48-3.19; P anemia was also associated with higher odds of in-hospital mortality (OR, 1.75; 95% CI, 1.15-2.65; P = .004). Our study demonstrates that children with preoperative anemia are at increased risk for in-hospital mortality. Further studies are needed to assess whether the correction of preoperative HCT, through the development of a patient blood management program, improves patient outcomes or simply reduces the need for transfusions.

  4. Evaluating the effects of preoperative fasting and fluid limitation.

    Science.gov (United States)

    Tosun, Betül; Yava, Ayla; Açıkel, Cengizhan

    2015-04-01

    The aim of the study was to evaluate the effects of preoperative fasting and fluid limitation in patients undergoing laparoscopic cholecystectomy. Although traditional long-term fasting is not recommended in current preoperative guidelines, this is still a common intervention. Visual analogue scale was used to assess hunger, thirst, sleepiness, exhaustion, nausea and pain; State and Trait Anxiety Inventory was used to assess the preoperative anxiety of 99 patients undergoing elective laparoscopic cholecystectomy. Mean time of preoperative fasting and fluid limitation were, respectively, 14.70 ± 3.14 and 11.25 ± 3.74 h. Preoperatively, 58.60% of the patients experienced moderate anxiety. Patients fasting 12 h or longer had higher hunger, thirst, nausea and pain scores. The mean trait anxiety score of patients fasting 12 h or longer was statistically significantly higher. Receiving nothing by mouth after midnight preoperatively is a persisted intervention and results in discomfort of patients. Clinical protocols should be revised and nurses should be trained in current fasting protocols. © 2014 Wiley Publishing Asia Pty Ltd.

  5. Measuring preoperative anxiety in patients undergoing elective surgery in Czech Republic

    Directory of Open Access Journals (Sweden)

    Pavlína Homzová

    2015-12-01

    Full Text Available Aim: The main aim of the study was to measure preoperative anxiety in patients in the Czech Republic before elective surgery, using the Visual Analogue Scale for Anxiety (VAS-A. Design: A cross-sectional descriptive study. Methods: The sample consisted of 344 patients undergoing elective surgery. The day before surgery patients completed a questionnaire consisting of demographic data, the Amsterdam Preoperative Anxiety and Information Scale (APAIS and the VAS-A. Spearman correlation was used to test correlation between the VAS-A and the subscales of the APAIS. Analysis of Variance (ANOVA and the Kruskal-Walis test were used for group comparison. A p-value < 0.05 was considered to be significant. Results: Female patients and patients without previous experience of surgery had a significantly higher VAS-A score. The anxiety score measured by the VAS-A positively correlated with APAIS-Anxiety (r = 0.71 and its subscales. The results also showed that the most common anxieties resulted from postoperative pain, anaesthesiological complications, postoperative nausea and vomiting, concerns about regaining consciousness after anaesthesia, surgical errors, and postponement of surgery. Conclusion: The findings of this study support the utility of the VAS-A as a measure of preoperative anxiety. The VAS-A quickly and simply assesses anxiety and may be useful for research as well as clinical purposes when researchers or clinicians have very limited time.

  6. Influence of Music on Preoperative Anxiety and Physiologic Parameters in Women Undergoing Gynecologic Surgery.

    Science.gov (United States)

    Labrague, Leodoro J; McEnroe-Petitte, Denise M

    2016-04-01

    The aim of this study was to determine the influence of music on anxiety levels and physiologic parameters in women undergoing gynecologic surgery. This study employed a pre- and posttest experimental design with nonrandom assignment. Ninety-seven women undergoing gynecologic surgery were included in the study, where 49 were allocated to the control group (nonmusic group) and 48 were assigned to the experimental group (music group). Preoperative anxiety was measured using the State Trait Anxiety Inventory (STAI) while noninvasive instruments were used in measuring the patients' physiologic parameters (blood pressure [BP], pulse [P], and respiration [R]) at two time periods. Women allocated in the experimental group had lower STAI scores (t = 17.41, p music during the preoperative period in reducing anxiety and unpleasant symptoms in women undergoing gynecologic surgery.

  7. CHANGING PARADIGMS IN PREOPERATIVE FASTING: RESULTS OF A JOINT EFFORT IN PEDIATRIC SURGERY.

    Science.gov (United States)

    Carvalho, Carlos Augusto Leite de Barros; Carvalho, Augusto Aurélio de; Nogueira, Paulo Luiz Batista; Aguilar-Nascimento, José Eduardo de

    2017-01-01

    Current researches associate long fasting periods to several adverse consequences. The fasting abbreviation to 2 h to clear liquids associated with the use of drinks containing carbohydrates attenuates endocrinometabolic response to surgical trauma, but often is observed children advised to not intake food from 00:00 h till the scheduled surgical time, regardless of what it is. To evaluate the safety of a protocol of preoperative fasting abbreviation with a beverage containing carbohydrates, and early postoperative feeding in children underwent elective small/mid-size surgical procedures during a national task-force on pediatric surgery. Thirty-six patients were prospectively included, and for several reasons five were excluded. All 31 who remained in the study received a nutritional supplement containing 150 ml of water plus 12.5% maltodextrin 2 h before the procedure. Data of the pre-operative fasting time, anesthetic complications and time of postoperative refeeding, were collected. Twenty-three (74.2%) were males, the median age was 5 y, and the median weight was 20 kg. The median time of pre-operative fasting was 145 min and the time of post-operative refeeding was 135 min. There were no adverse effects on the anesthetic procedures or during surgery. Post-operatively, two children (6.5%) vomited. The abbreviation of pre-operative fasting to 2 h with beverage containing carbohydrate in pediatric surgery is safe. Early refeeding in elective small/mid-size procedures can be prescribed. Trabalhos atuais associam longos períodos de jejum com diversas consequências adversas. A abreviação do jejum de 2 h para líquidos claros associado ao uso de bebidas contendo carboidratos atenua resposta endocrinometabólica ao trauma, porém frequentemente as crianças são orientadas a não ingerir alimentos a partir das 00:00 h do dia anterior à operação, independente do horário do procedimento cirúrgico. Avaliar a segurança de um protocolo de abreviação do jejum pr

  8. Preoperative evaluation of synchronous colorectal cancer using MR colonography

    DEFF Research Database (Denmark)

    Achiam, Michael P; Andersen, Lars Peter Holst; Klein, Mads

    2009-01-01

    it is noninvasive, and most of the colon can be evaluated. Furthermore, it has higher patient acceptance, and no sedation or radiation is used. The purpose of this study was to determine the feasibility of performing MRC preoperatively in an everyday clinical situation in a group of patients who were not offered......RATIONALE AND OBJECTIVES: It is well known that synchronous cancers (incidence, 2%-11%) and polyps (incidence, 12%-58%) occur in patients with colorectal cancer. Magnetic resonance colonography (MRC) seems like the obvious choice as a diagnostic tool in preoperative evaluation, because...

  9. Effects of the preoperative anxiety and depression on the postoperative pain in ear, nose and throat surgery

    Directory of Open Access Journals (Sweden)

    Önder Kavakci

    2012-01-01

    Full Text Available Background: Anxiety and depressive disorders can be widespread among patients who are being treated in surgical clinics and they can affect operation outcomes. Objective: The aim of this study was to investigate the relationship between the level of their anxiety and depression in the preoperative period and the pain level in the postoperative period, analgesic requirement, development of complications and the duration of hospital stay in patients followed up in an ENT clinic. Materials and Methods : One hundred and three (n=103 subjects [male = 56 (%54, female = 47 (%45.6] filled out the Hospital Anxiety and Depression Scale, sociodemographic data evaluation form before the surgery. Postsurgical pain levels of the subjects were evaluated by the Visual Pain Scale. The analgesic requirements of the subjects were assessed and their duration of hospital stay was noted. Results: While the presence of preoperative anxiety was a predictor of postoperative pain, such a relationship was not found between depression and postoperative pain. On the Visual Pain Scale, it was observed that the anxiety levels were moderately correlated with the Visual Pain Scale assessments on the first day of postoperative period (r = 0.30, P < 0.00. Frequency of analgesic use and Visual Pain Scale assessments on the second day of postoperative period were negatively correlated (r = -0.43, P< 0.000. Conclusion: For elective conditions requiring short-term hospitalization in ENT surgery, presence of preoperative anxiety seems to be a significant predictor of postoperative pain.

  10. Prospective randomized trial of surgery combined with preoperative and postoperative radiotherapy for rectal carcinoma

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective To assess the effect of surgery combined with preoperative and postoperative radiotherapy(sandwich treatment)in rectal carcinoma.Methods From October 1990 to January 2002,260 patients with stage Ⅱ(117 patients)and stage Ⅲ(143 patients)rectal carcinoma were randomly divided into three groups:sandwich group(92 patients,group A),postoperative radiotherapy group(98 patients,Group B)and operation group(70 patients,Group C).The preoperative accelerated hyperfractionation(15Gy/6f/3d)was given for sandwic...

  11. Upper airway imaging and its role in preoperative airway evaluation

    Directory of Open Access Journals (Sweden)

    Jagadish G Sutagatti

    2016-01-01

    Full Text Available Ultrasonography (USG is well-known as a fast, safe, and noninvasive technique. Its application for imaging of the airway is now gaining momentum. The upper airway has a complex anatomy, and its assessment forms a vital part of every preanesthetic evaluation. Ultrasound (US imaging can help in upper airway assessment in the preoperative period. There are various approaches to upper airway USG. The technique has its own advantages, disadvantages, and limitations. This simple yet challenging imaging technique is all set to become an important part of routine preoperative airway evaluation. This article reviews the various approaches to upper airway US imaging, interpretation of the images, limitations, and disadvantages of the technique and its varied clinical applications in the preoperative period. The scientific material presented here was hand searched from textbooks and journals, electronically from PubMed, and Google scholar using text words.

  12. Magnetic resonance cisternography for preoperative evaluation of arachnoid cysts

    Energy Technology Data Exchange (ETDEWEB)

    Awaji, M. [Niigata University, Department of Radiology, Faculty of Medicine, Niigata (Japan); Okamoto, K. [Niigata University, Center for Integrated Human Brain Science, Brain Research Institute, Niigata (Japan); Nishiyama, K. [Niigata University, Department of Neurosurgery, Brain Research Institute, Niigata (Japan)

    2007-09-15

    With a high likelihood of clinical improvement and low rates of complications, minimally invasive neuroendoscopic surgery is becoming the treatment of choice for symptomatic or growing arachnoid cysts. In neuroendoscopic surgery, visualization of anatomical landmarks is essential in achieving successful fenestration without complications. Because of the restricted visual field in neuroendoscopic surgery, preoperative anatomical assessment is very helpful. Magnetic resonance cisternography (MRC) with high spatial resolution and contrast, using for example 3-D Fourier transformation constructive interference in steady state (CISS) or fast imaging employing steady-state acquisition (FIESTA) sequences, is able to detect the arachnoid cyst wall and neighboring anatomical structures as the anatomical landmarks. We retrospectively reviewed T2-weighted (T2-W) fast spin-echo images, and the MRC and intraoperative findings. Axial and coronal T2-W images (6 and 3 mm thickness, respectively) and axial and coronal 0.8 mm thick MRC images with CISS or FIESTA were obtained from four patients with arachnoid cysts treated by neuroendoscopic surgery. Intraoperative findings were reviewed on videotape recorded during the procedures. At the brain surface, the arachnoid cyst wall could be detected clearly in any of the four patients on MRC images, and was only partly seen in the fourth patient T2-W images. Adjacent important anatomical structures including vessels and cranial nerves, and an enough space for cystocisternostomy were identified on MRC images, and the findings were consistent with the findings during neuroendoscopic surgery. Preoperative identification of the arachnoid cyst wall and surrounding anatomical structures by MRC may help avoid complications and allow safer neuroendoscopic surgery. (orig.)

  13. Assessment of Preoperative Anxiety in Cardiac Surgery Patients Lacking a History of Anxiety: Contributing Factors and Postoperative Morbidity.

    Science.gov (United States)

    Hernández-Palazón, Joaquín; Fuentes-García, Diego; Falcón-Araña, Luis; Roca-Calvo, María José; Burguillos-López, Sebastián; Doménech-Asensi, Paloma; Jara-Rubio, Rubén

    2017-04-26

    The aim of this study was to measure the level of preoperative anxiety in patients scheduled for cardiac surgery, identify any influencing clinical factors, and assess the relationship between anxiety and postoperative morbidity. A prospective and consecutive study. A single university hospital. The study comprised 200 patients scheduled for cardiac surgery. Each patient was asked to grade his or her preoperative anxiety level using the Visual Analogue Scale for Anxiety, Amsterdam Preoperative Anxiety and Information Scale, and set of specific anxiety-related questions. Demographic data (age, sex, body mass index) and anesthetic and surgical data (American Society of Anesthesiologists physical status, EuroSCORE surgical risk, preoperative length of stay, and previous anesthetic experience) were registered. Also, postoperative morbidity was assessed. Twenty-eight percent of the patients developed high preoperative anxiety. The mean Amsterdam Preoperative Anxiety and Information Scale score was 11.4 ± 4.3, and the mean Visual Analogue Scale for Anxiety score was 48 ± 21. Patients scheduled for coronary artery bypass surgery, who had no previous anesthetic experience, and who were hospitalized before surgery, had higher anxiety scores. Coronary bypass surgery (odds ratio 3.026; 1.509-6.067; p = 0.002) was associated independently with preoperative high-level anxiety. Anxiety most commonly was caused by waiting for surgery, not knowing what is happening, fearing not being able to awaken from anesthesia, and being at the mercy of staff. Anxiety did not modify the postoperative course. In patients waiting to undergo cardiac surgery, both fear of the unknown and lack of information, especially related to the surgery, are crucial factors in high levels of preoperative anxiety in cardiac surgery. Coronary bypass surgery is a determining factor for preoperative anxiety. The anxiety level did not modify the postoperative course in these patients. Copyright © 2017 Elsevier

  14. Visual Analogue Scale for Anxiety and Amsterdam Preoperative Anxiety Scale Provide a Simple and Reliable Measurement of Preoperative Anxiety in Patients Undergoing Cardiac Surgery

    OpenAIRE

    Joaquín Hernández-Palazón; Diego Fuentes-García; Luis Falcón-Araña; Antonio Rodríguez-Ribó; Carlos García-Palenciano; María José Roca-Calvo

    2015-01-01

    Background: Anxiety is an emotional state characterized by apprehension and fear resulting from anticipation of a threatening event. Objectives: The present study aimed to analyze the incidence and level of preoperative anxiety in the patients scheduled for cardiac surgery by using a Visual Analogue Scale for Anxiety (VAS-A) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) and to identify the influencing clinical factors. Patients and Methods: This prospective, longitu...

  15. Can nurse-led preoperative education reduce anxiety and postoperative complications of patients undergoing cardiac surgery?

    Science.gov (United States)

    Kalogianni, Antonia; Almpani, Panagiota; Vastardis, Leonidas; Baltopoulos, George; Charitos, Christos; Brokalaki, Hero

    2016-10-01

    The effect of preoperative education on anxiety and postoperative outcomes of cardiac surgery patients remains unclear. The aim of the study was to estimate the effectiveness of a nurse-led preoperative education on anxiety and postoperative outcomes. A randomised controlled study was designed. All the patients who were admitted for elective cardiac surgery in a general hospital in Athens with knowledge of the Greek language were eligible to take part in the study. Patients in the intervention group received preoperative education by specially trained nurses. The control group received the standard information by the ward personnel. Measurements of anxiety were conducted on admission-A, before surgery-B and before discharge-C by the state-trait anxiety inventory. The sample consisted of 395 patients (intervention group: 205, control group: 190). The state anxiety on the day before surgery decreased only in the intervention group (34.0 (8.4) versus 36.9 (10.7); P=0.001). The mean decrease in state score during the follow-up period was greater in the intervention group (P=0.001). No significant difference was found in the length of stay or readmission. Lower proportions of chest infection were found in the intervention group (10 (5.3) versus 1 (0.5); P=0.004). Multivariate linear regression revealed that education and score in trait anxiety scale on admission are independent predictors of a reduction in state anxiety. Preoperative education delivered by nurses reduced anxiety and postoperative complications of patients undergoing cardiac surgery, but it was not effective in reducing readmissions or length of stay. © The European Society of Cardiology 2015.

  16. [Heart rate and blood pressure are not good parameters to evaluate preoperative anxiety.].

    Science.gov (United States)

    Conceição, Diogo Bruggemann da; Schonhorst, Leonardo; Conceição, Mário José da; Oliveira Filho, Getúlio Rodrigues de

    2004-12-01

    Surgical patients are subject to different levels of preoperative distress. Anxious patients may present unfavorable psychophysical reactions, such as hypertension and tachycardia. This study aimed at evaluating the level of preoperative anxiety in a population of surgical patients, and at detecting heart rate and blood pressure changes and their relationship with age, gender, education and previous surgical experience. Participated in this randomized study 145 adult patients of both genders, physical status ASA I - III, perfectly oriented in time and space, literate and scheduled for elective surgeries, to whom the Amsterdam preoperative anxiety questionnaire was applied during preanesthetic evaluation. Patients with scores > 11 were considered anxious. Age, gender, education, systolic and diastolic blood pressure, heart rate, previous surgical experience and history of hypertension were recorded. Sixty-nine patients (47.58%) were considered anxious, while 76 (52.41%) were considered not anxious. There were no significant differences between anxious and non-anxious patients in age, systolic and diastolic blood pressure, and heart rate. Among anxious patients 68.12% were females and 31.88% were males (p preoperative anxiety. Females are more anxious then males in the preoperative period.

  17. Fenestral otosclerosis: significance of preoperative CT evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Swartz, J.D.; Faerber, E.N.; Wolfson, R.J.; Marlowe, F.I.

    1984-06-01

    Thirty-five consecutive patients with the clinical diagnosis of fenestral otosclerosis were evaluated with high-resolution computed tomography (CT). Twenty-six were diagnosed as having this disorder by CT evidence of abnormal bony excrescences at or adjacent to the oval window. Sections were also evaluated for evidence of plaque formation elsewhere in the lateral wall of the labyrinth and for surgical obstacles such as an abnormally wide cochlear aqueduct, a high jugular vein, and a dehiscent facial nerve. It is concluded that fenestral otosclerosis may be accurately diagnosed with proper CT techniques.

  18. An augmented reality navigation system for pediatric oncologic surgery based on preoperative CT and MRI images.

    Science.gov (United States)

    Souzaki, Ryota; Ieiri, Satoshi; Uemura, Munenori; Ohuchida, Kenoki; Tomikawa, Morimasa; Kinoshita, Yoshiaki; Koga, Yuhki; Suminoe, Aiko; Kohashi, Kenichi; Oda, Yoshinao; Hara, Toshiro; Hashizume, Makoto; Taguchi, Tomoaki

    2013-12-01

    In pediatric endoscopic surgery, a limited view and lack of tactile sensation restrict the surgeon's abilities. Moreover, in pediatric oncology, it is sometimes difficult to detect and resect tumors due to the adhesion and degeneration of tumors treated with multimodality therapies. We developed an augmented reality (AR) navigation system based on preoperative CT and MRI imaging for use in endoscopic surgery for pediatric tumors. The patients preoperatively underwent either CT or MRI with body surface markers. We used an optical tracking system to register the reconstructed 3D images obtained from the CT and MRI data and body surface markers during surgery. AR visualization was superimposed with the 3D images projected onto captured live images. Six patients underwent surgery using this system. The median age of the patients was 3.5 years. Two of the six patients underwent laparoscopic surgery, two patients underwent thoracoscopic surgery, and two patients underwent laparotomy using this system. The indications for surgery were local recurrence of a Wilms tumor in one case, metastasis of rhabdomyosarcoma in one case, undifferentiated sarcoma in one case, bronchogenic cysts in two cases, and hepatoblastoma in one case. The average tumor size was 22.0±14.2 mm. Four patients were treated with chemotherapy, three patients were treated with radiotherapy before surgery, and four patients underwent reoperation. All six tumors were detected using the AR navigation system and successfully resected without any complications. The AR navigation system is very useful for detecting the tumor location during pediatric surgery, especially for endoscopic surgery. Crown Copyright © 2013. All rights reserved.

  19. [Pre-operative smoking cessation does not always reduce the incidence of surgical site infection after gastrointestinal surgery].

    Science.gov (United States)

    Kuri, Michioki; Yamada, Terumasa; Nakagawa, Masashi; Tanigami, Hironobu; Kishi, Yoshihiko

    2011-02-01

    Centers for Disease Control (CDC) recommend pre-operative smoking cessation to reduce the risk of surgical site infection (SSI). However, whether pre-operative smoking cessation reduces the incidence of SSI for gastrointestinal surgery is unclear. We investigated whether pre-operative smoking cessation reduces the incidence of SSI among patients undergoing gastrointestinal surgery. The study subjects were 512 consecutive patients undergoing gastrointestinal surgery at Osaka Medical Center for Cancer and Cardiovascular Diseases. SSI occurrence was determined by the hospital SSI surveillance team. Pre-operative smoking status was obtained by interview, and the patients were divided into four groups. Information on age, sex, operation time, operational organ, American Society of Anesthesiologists physical status (ASA-PS), elective or emergency surgery, co-existing procedures, use of scopes, ileo-colostomy, properties of drain tube, use of floss, and wound contamination was obtained from the medical records. The relationship between smoking status and incidence of SSI, and risk factors associated with the incidence of SSI were investigated. SSI occurred in 83 patients. Pre-operative smoking status had no relation with the incidence of SSI. Operation time, gallbladder and pancreatic surgery, colon surgery, emergency surgery, co-existing procedures, ilea-colostomy, closed drain, usage of floss, and wound contamination were related significantly with SSI. Pre-operative smoking cessation does not reduce the incidence of SSI. However, since continuation of smoking has no benefits for the safety of surgery, anesthesiologists must advice patients to quit smoking before surgery.

  20. Adenoid and tonsil surgeries in children: How relevant is pre-operative blood grouping and cross-matching?

    Directory of Open Access Journals (Sweden)

    Lucky Onotai

    2013-01-01

    Full Text Available Background: As a part of pre-operative evaluation, several otolaryngologists group and cross-match blood routinely for children undergoing adenoid and tonsil surgeries. This practice has generated several debates either in support or against this practice. The aim of this study is to critically evaluate the incidence of post-tonsillectomy (with or without adenoidectomy bleeding and blood transfusions in otherwise healthy children with adenoid/tonsil pathologies conducted in the University of Port Harcourt Teaching Hospital (UPTH. Patients and Methods: A descriptive retrospective study of children who underwent adenoid and tonsil surgeries in the Department of Ear, Nose and Throat (ENT surgery of UPTH from January 2003 to December 2012. Children with family history of bleeding disorders and derangement of clotting profile as well as different co-morbidity like sickle cell disease were excluded from this study. The patients′ data were retrieved from the registers of ENT out-patient clinics, theatre registers and patients case notes. Demographic data, indications for surgery, preoperative investigations, complications and management outcomes were recorded and analyzed. Results: Out of 145 children that had adenoid and tonsil surgeries; only 100 met the criteria for this study. The study subjects included 65 males and 35 females (male: female ratio 1.9:1 belonging to 0-16 years age group (mean age: 3.46 ± 2.82 years. The age group of 3-5 years had the highest (n = 40, 40% number of surgeries. Adenotonsillectomy was the commonest (n = 85, 85% surgery performed on patients who had obstructive sleep apnea (OSA. The commonest (n = 6, 6% complication was haemorrhage, and only few (n = 3, 3% patients had blood transfusion. However, mortality was recorded in some (n = 3, 3% patients. Conclusion: This study confirms that the incidence of post adenoidectomy/tonsillectomy bleeding in otherwise healthy children is low and rarely requires blood transfusion

  1. Efficacy of a liquid low-energy formula diet in achieving preoperative target weight loss before bariatric surgery

    DEFF Research Database (Denmark)

    Nielsen, Lone Vestergaard; Nielsen, Mette Søndergaard; Schmidt, Julie Berg;

    2016-01-01

    A preoperative weight loss of 8 % is a prerequisite to undergo bariatric surgery (BS) in Denmark. The aim of the present study was to evaluate the efficacy of a 7- or an 11-week low-energy diet (LCD) for achieving preoperative target weight before BS. A total of thirty obese patients (BMI 46·0 (sd...... 4·4) kg/m2) followed an LCD (Cambridge Weight Plan®, 4184 kJ/d (1000 kcal/d)) for 7 or 11 weeks as preparation for BS. Anthropometric measurements including body composition (dual-energy X-ray absorptiometry), blood parameters and blood pressure were assessed at weeks 0, 7 and 11. At week 7...... in TAG (P LCD within 7 weeks as part of preparation for BS...

  2. Development of preoperative planning software for transforaminal endoscopic surgery and the guidance for clinical applications.

    Science.gov (United States)

    Chen, Xiaojun; Cheng, Jun; Gu, Xin; Sun, Yi; Politis, Constantinus

    2016-04-01

    Preoperative planning is of great importance for transforaminal endoscopic techniques applied in percutaneous endoscopic lumbar discectomy. In this study, a modular preoperative planning software for transforaminal endoscopic surgery was developed and demonstrated. The path searching method is based on collision detection, and the oriented bounding box was constructed for the anatomical models. Then, image reformatting algorithms were developed for multiplanar reconstruction which provides detailed anatomical information surrounding the virtual planned path. Finally, multithread technique was implemented to realize the steady-state condition of the software. A preoperative planning software for transforaminal endoscopic surgery (TE-Guider) was developed; seven cases of patients with symptomatic lumbar disc herniations were planned preoperatively using TE-Guider. The distances to the midlines and the direction of the optimal paths were exported, and each result was in line with the empirical value. TE-Guider provides an efficient and cost-effective way to search the ideal path and entry point for the puncture. However, more clinical cases will be conducted to demonstrate its feasibility and reliability.

  3. Preoperative Biliary Drainage in Cases of Borderline Resectable Pancreatic Cancer Treated with Neoadjuvant Chemotherapy and Surgery

    Directory of Open Access Journals (Sweden)

    Tomofumi Tsuboi

    2016-01-01

    Full Text Available Objective. To elucidate the optimum preoperative biliary drainage method for patients with pancreatic cancer treated with neoadjuvant chemotherapy (NAC. Material and Methods. From January 2010 through December 2014, 20 patients with borderline resectable pancreatic cancer underwent preoperative biliary drainage and NAC with a plastic or metallic stent and received NAC at Hiroshima University Hospital. We retrospectively analyzed delayed NAC and complication rates due to biliary drainage, effect of stent type on perioperative factors, and hospitalization costs from diagnosis to surgery. Results. There were 11 cases of preoperative biliary drainage with plastic stents and nine metallic stents. The median age was 64.5 years; delayed NAC occurred in 9 cases with plastic stent and 1 case with metallic stent (p=0.01. The complication rates due to biliary drainage were 0% (0/9 with metallic stents and 72.7% (8/11 with plastic stents (p=0.01. Cumulative rates of complications determined with the Kaplan-Meier method on day 90 were 60% with plastic stents and 0% with metallic stents (log-rank test, p=0.012. There were no significant differences between group in perioperative factors or hospitalization costs from diagnosis to surgery. Conclusions. Metallic stent implantation may be effective for preoperative biliary drainage for pancreatic cancer treated with NAC.

  4. Poor preoperative nutritional status is an important predictor of the retardation of rehabilitation after cardiac surgery in elderly cardiac patients.

    Science.gov (United States)

    Ogawa, Masato; Izawa, Kazuhiro P; Satomi-Kobayashi, Seimi; Kitamura, Aki; Ono, Rei; Sakai, Yoshitada; Okita, Yutaka

    2017-04-01

    Preoperative nutritional status and physical function are important predictors of mortality and morbidity after cardiac surgery. However, the influence of nutritional status before cardiac surgery on physical function and the progress of postoperative rehabilitation requires clarification. To determine the effect of preoperative nutritional status on preoperative physical function and progress of rehabilitation after elective cardiac surgery. We enrolled 131 elderly patients with mean age of 73.7 ± 5.8 years undergoing cardiac surgery. We divided them into two groups by nutritional status as measured by the Geriatric Nutritional Risk Index (GNRI): high GNRI group (GNRI ≥ 92, n = 106) and low GNRI group (GNRI nutritional status as assessed by the GNRI could reflect perioperative physical function. Preoperative poor nutritional status may be an independent predictor of the retardation of postoperative rehabilitation in patients undergoing elective cardiac surgery.

  5. Role of preoperative sonography in predicting conversion from laparoscopic cholecystectomy to open surgery

    Energy Technology Data Exchange (ETDEWEB)

    Tosun, Alptekin, E-mail: tosun_alptekin@yahoo.com [Giresun University Hospital, Department of Radiology (Turkey); Hancerliogullari, Kadir Oymen [Giresun University Hospital, Department of Pediatric Surgery (Turkey); Serifoglu, Ismail [Bulent Ecevit University Hospital, Department of Radiology (Turkey); Capan, Yavuz [Gaziantep Primer Hospital, Department of Surgery (Turkey); Ozkaya, Enis [Dr. Sami Ulus Maternity and Children' s Health Training and Research Hospital, Department of Obstetrics and Gynecology (Turkey)

    2015-03-15

    Highlights: •The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. The study may be a guide for the surgeon to prefer laparoscopic or open surgery. -- Abstract: Background: Laparoscopic cholecystectomy is the first step treatment in cholelithiasis. The purpose of this study was to establish a radiologic view on prediction of conversion from laparoscopic cholecystectomy to open surgery. Methods: This study included 176 patients who had undergone laparoscopic cholecystectomy. Preoperative ultrasonographic findings were assessed and we gave points to each finding according to results from correlation analysis. After the scoring we investigated the relationship between ultrasonographic findings and conversion from laparoscopic cholecystectomy to open surgery. Results: Scoring significantly predicted failure in laparoscopic approach (AUC = 0.758, P = 0.003,). Optimal cut off score was found to be 1.95 with 67% sensitivity and 78% specificity. Score > 1.95 was a risk factor for failure in laparoscopic approach [odds ratio = 7.1(95% CI,2-24.9, P = 0.002)]. There were 8 subjects out of 36(22%) with high score underwent open surgery while 4 out of 128 (3%) subjects with low score needed open surgery (p = 0.002). Negative predictive value of 128/132 = 97%. Mean score of whole study population was 1.28 (range 0–8.8) and mean score of subjects underwent open surgery was 3.6 while it was 1.1 in successful laparoscopic approach group (p < 0.001). Mean Age and BMI were similar between groups (p > 0.05). Sex of subjects did not affect the success of surgery (p > 0.05). Conclusion: The contribution of preoperative ultrasonography is emphasized in many studies. Our study suggests quantitative results on conversion from laparoscopic cholecystectomy to open surgery. We believe that radiologists have to indicate the risk of conversion in their ultrasonography reports.

  6. Laparoscopic splenectomy: color Doppler flow imaging for preoperative evaluation

    Institute of Scientific and Technical Information of China (English)

    XU Wei-li; LI Suo-lin; WANG Yan; SHI Bao-jun; LI Meng; LI Ying-chao; ZHONG Zhi-yong; LI Zhen-dong

    2009-01-01

    Background Laparoscopic splenectomy (LS) is currently the standard approach for resection of a normal-sized spleen.However, this method becomes technical challenge in cases of splenomegaly due to intraoperative hemorrhage. A complete understanding of the splenic vessel anatomy is important to facilitate the difficult laparoscopic procedure. In this retrospective study, we examined the role of color Doppler flow imaging (CDFI) in splenic vessel anatomy and evaluated its value for LS.Methods Forty-eight patients who underwent splenectomy for various hematologic and autoimmune disorders from May 2004 to December 2007 were enrolled in this study. Twenty-three patients underwent preoperative CDFI examination that included examination of the anatomic type of splenic pedicle, the adjacent relationship between the splenic vessel and pancreas, and spleen size (CDFI group). In the remaining 25 patients, ultrasonic inspections of the splenic vessel were not performed (non-CDFI group). Laparoscopic splenectomies in the CDFI group were performed in accordance with the information provided by the preoperative CDFI in each patient. In the non-CDFI group, LS was performed according to the conventional method. In the CDFI group, the constituent ratios of the above-mentioned parameters by CDFI were compared with those recorded during LS using the chi square test. The effectiveness of the technique on surgery in both groups was compared with an independent sample Student's ttest.Results All laparoscopic splenectomies in both groups were performed successfully. However, 2 cases in the non-CDFI group were converted to LS with the assistance of micro-incision because the branches of the splenic vein were inadvertently torn. Two anatomic types of splenic pedicle and four different adjacent relationships between the splenic vessel and pancreas were detected by CDFI. About 80% of spleens fit the criteria of megalosplenia. There were no statistically significant differences between the

  7. Results of a selective policy for preoperative radiotherapy in rectal cancer surgery.

    Science.gov (United States)

    Gandy; O'Leary; Falk; Roe

    2000-01-01

    Preoperative radiotherapy (pRT) for rectal cancer may reduce local recurrence and improve survival. This study was undertaken to assess a selective policy of pRT in rectal cancer. The aim was to determine whether patients likely to have involved circumferential margins (CRM) could be reliably selected for pRT using clinical criteria. We have used CRM and delay in surgery as outcome measures. Seventy-nine patients with rectal cancer were assessed for preoperative radiotherapy using clinical criteria. Twelve of 26 (46%) pRT patients had positive CRM compared with three of 53 (5.6%) who did not receive pRT (P benefit from radiotherapy and has avoided excessive delays prior to surgery. However, almost half of the pRT patients did not have involved CRM. With improved imaging techniques we may be able to refine our selection criteria further.

  8. Preoperative breast MRI can reduce the rate of tumor-positive resection margins and reoperations in patients undergoing breast-conserving surgery

    NARCIS (Netherlands)

    A.I.M. Obdeijn (Inge-Marie); M.M.A. Tilanus-Linthorst (Madeleine); S. Spronk (Sandra); C.H.M. van Deurzen (Carolien); C. de Monyé (Cécile); M.G.M. Hunink (Myriam); M.B. Menke (Marian )

    2013-01-01

    textabstractOBJECTIVE. In breast cancer patients eligible for breast-conserving surgery, we evaluated whether the information provided by preoperative MRI of the breast would result in fewer tumor-positive resection margins and fewer reoperations. SUBJECTS AND METHODS. The study group consisted of 1

  9. PREOPERATIVE ORAL CODEINE EFFECT ON POSTOPERATIVE CAUGH CONTROL IN CATARACT SURGERY

    Directory of Open Access Journals (Sweden)

    H SOLTANI NEZHAD

    2003-03-01

    Full Text Available Introduction: cataract surgery is .one of the most common operation in ophthalmology. Post operative caught can lead to anterior chamber hemmorage and dehiscence of suture so we were going to finding a way to overcome to this problem. Method: This study is a clinical trial one which was done on 150 ASA 1, 2 patient that were over 45 years old age. These patient have cataract surgery under GA in Farabi Hospital of Esfahan medical university. All of the patient were intubated under direct laryngoscopy. Patients that have more of one laryngoscope, difficult intubation, thraceal intubation prolonged more than 15 seconds and those which have opiate addiction. We divided the patients into two 75 patient group by randomized selection. This study is double blind and 30mg codeine phosphate and placebo has given to the patient one hour preoperatively. Heart rate and systolic and diastolic, blood pressure has been recorded preoperatively, three minutes after intubation and three minutes after extubation respectively. Caught has been counted and recorded immediately. Five minutes and 30 minutes after extubation and results in contorol group are compared with the results in another group. Discussion: According to the statistical analysis t-student test, chi-square and non parametric test and Pvalue only changes in heart rate after extubation has been different in two groups and other findings make no difference in two groups. There was not any significant difference between two groups about age, sex, duration of surgery, preoperative mean heart rate and blood pressure. There was not any difference about mean number of coughs between two groups and according to this study oral codeine phosphate has administered preoperatively has not any effect on reducing postoperative caught in patients who have GA and tracheal incubation for cataract surgery.

  10. Treatment of resectable distal rectal cancer with preoperative chemoradiation and sphincter saving surgery

    Directory of Open Access Journals (Sweden)

    Omrani Pour R

    2000-06-01

    Full Text Available To determine if pre-operative combined chemoradiation therapy increase sphincter preservation in the treatment of low-lying rectal cancer, 15 patients were treated with pre-operative chemoradiation: 5FU plus mitomycin C plus 4500-5000 Rad concurrent external beam radiotherapy between Jan 1997 and Jan 1999. There were 10 men and 5 women (Mean age: 49 y with the diagnosis of invasive resectable primary adenocarcinoma of distal rectum limited to pelvis. Median tumor distance from anal verge was 3.3 cm (Range 0-5 cm and half of the patients were absolute candidate for abdominoperineal resection. After 4-6 weeks, all patients were undergone proctectomy and eventually sphincter preservation surgery was done on 9 patients with colonal anastomosis. Function of sphincter was excellent in 6 of them (66% and good in 3 patients (33%. There was no case of incontinence. Complications of surgery were minimal: One case of stricture (10% and one case of partial rupture of anastomosis (10%. Complete pathologic response was achieved on one patient (6.6% and combined pre-operative chemoradiation has changed the plane of surgery from abdominoperineal resection to sphincter saving in 69.2% of patients.

  11. Is the Preoperative Administration of Amiodarone or Metoprolol More Effective in Reducing Atrial Fibrillation: After Coronary Bypass Surgery?

    Science.gov (United States)

    Onk, Oruc Alper; Erkut, Bilgehan

    2015-10-01

    This study examined the influence of preoperative administration of amiodarone and metoprolol in preventing postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG) surgery.The study comprised 251 patients who underwent CABG surgery at our hospital between January 2012 and May 2014. The patients were randomly divided into 2 groups: amiodarone therapy group (n = 122 patients) and metoprolol therapy group (n = 129 patients).In the amiodarone group, the patients received amiodarone tablet orally 1 week before coronary bypass surgery and during the postoperative period. In the metoprolol group, the patients received metoprolol tablet orally 1 week before surgery and during the postoperative period. The AF development rate was retrospectively evaluated between the first 3 days and 4 weeks after surgery.AF developed in 14 patients in the amiodarone group and 16 patients in the metoprolol group 4 weeks after the operation (P = 0.612).No significant difference was observed between the groups in terms of intensive care unit and hospital stay. Furthermore, hospital charges were similar in both groups (P = 0.741).The results of the logistic regression analysis showed age, left ventricular ejection fraction, left atrial diameter, and aortic cross-clamping time to be predictors for postoperative AF.This study demonstrates that amiodarone and metoprolol have similar effects in prevention of AF after cardiac surgery. However, larger-scale studies need to be conducted to substantiate these findings.

  12. Association Between Preoperative Malnutrition and Postoperative Delirium After Hip Fracture Surgery in Older Adults.

    Science.gov (United States)

    Mazzola, Paolo; Ward, Libby; Zazzetta, Sara; Broggini, Valentina; Anzuini, Alessandra; Valcarcel, Breanna; Brathwaite, Justin S; Pasinetti, Giulio M; Bellelli, Giuseppe; Annoni, Giorgio

    2017-06-01

    To determine whether poor nutritional status can predict postoperative delirium in elderly adults undergoing hip fracture surgery. Prospective observational cohort study. Italian orthogeriatric unit. Individuals aged 70 and older (mean age 84.0 ± 6.6, 74.5% female) consecutively admitted for surgical repair of a proximal femur fracture between September 2012 and April 2016 (N = 415). Participants underwent a comprehensive geriatric assessment including nutritional status, which was evaluated using the Mini Nutritional Assessment Short Form (MNA-SF). The MNA-SF-based three-class stratification was tested using multivariable logistic regression to assess its role in predicting postoperative delirium (outcome). Seventy-eight malnourished individuals (MNA-SF score 0-7), 185 at risk of malnutrition (MNA-SF score 8-11), and 152 who were well nourished (MNA-SF score 12-14) were compared. On average, individuals with poor nutritional status were more disabled and more cognitively impaired than those who were well nourished and those at risk of malnutrition. Moreover, those who were malnourished were more likely to have postoperative delirium. Multivariate regression analysis adjusted for age, sex, comorbidity, functional impairment, preoperative cognitive status, and American Society of Anesthesiologists score showed that those who were at risk of malnutrition (odds ratio (OR) = 2.42, 95% confidence interval (CI) = 1.29-4.53) and those who were overtly malnourished (OR = 2.98, 95% CI = 1.43-6.19) were more likely to develop postoperative delirium. This is the first study in a Western population showing that risk of malnutrition and overt malnutrition, as assessed using the MNA-SF, are independent predictors of postoperative delirium. Accordingly, nutritional status should be assessed in individuals with hip fracture before surgery to determine risk of developing delirium. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  13. Evaluation of pre-operative staging of renal cell cancer with cine MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Uematsu, Hidemasa; Inoue, Hiroshi; Hayashi, Koji; Kitagawa, Akane; Yamamori, Sanae; Ishitoya, Satoshi; Ogura, Keiji [Rakuwakai Otowa Hospital, Kyoto (Japan); Yamada, Hiroki; Ishii, Yasushi

    1994-12-01

    To assess the utility of single section cine MR images in evaluation of extrarenal invasion of renal cell cancer. Six patients who subsequently underwent definitive surgery were examined. Sequential twenty FLASH images were acquired in coronal and parasagittal single section during one respiratory cycle. These images were evaluated in cine-loop mode to assess tumoral movement with adjacent structures. Cine MR images showed that the tumor in one patient were fixed to the spleen and the tumors in five patients showed free movement. At pathologic examination, cine MR findings were proved correct in all patients. Cine MR images may be useful for pre-operative evaluation of extrarenal invasion. (author).

  14. Preoperative Preparation for Cardiac Surgery Facilitates Recovery, Reduces Psychological Distress, and Reduces the Incidence of Acute Postoperative Hypertension.

    Science.gov (United States)

    Anderson, Erling A.

    1987-01-01

    Cardiac surgery patients were assigned to information-only, information-plus-coping, or control preoperative preparation groups. Preoperatively, both experimental groups were significantly less anxious than were controls. Both experimental groups increased patients' belief in control over recovery. Postoperatively, experimental patients were less…

  15. Preoperative Preparation for Cardiac Surgery Facilitates Recovery, Reduces Psychological Distress, and Reduces the Incidence of Acute Postoperative Hypertension.

    Science.gov (United States)

    Anderson, Erling A.

    1987-01-01

    Cardiac surgery patients were assigned to information-only, information-plus-coping, or control preoperative preparation groups. Preoperatively, both experimental groups were significantly less anxious than were controls. Both experimental groups increased patients' belief in control over recovery. Postoperatively, experimental patients were less…

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

  18. A study of a pre-operative intervention in patients with diabetes undergoing cardiac surgery.

    Science.gov (United States)

    Lee, G A; Wyatt, S; Topliss, D; Walker, K Z; Stoney, R

    2014-01-01

    Coronary heart disease is common in Type 2 diabetes and often requires cardiac surgery. However poorer outcomes have been reported including increased rates of post-operative infection and prolonged hospital stay. The aim of the study was to determine the feasibility and acceptability of a specialist consultation model (pre-operative medical and educational intervention) for type 2 diabetes in the cardiac surgery setting. Twenty four patients were assigned usual care or to the intervention group. The intervention group were assessed by a diabetes clinical nurse consultant, dietitian, and endocrinologist during a pre-operative visit. Specific diabetes questionnaires were administered, education was delivered, and protocol-driven changes to the medical regimen were instituted. Length of stay, incidence of post-operative complications, and number of post-operative inpatient review endocrinology visits required were recorded. Twenty four patients with a pre-operative HbA(1c) greater than 6.5% (48 mmol/mol) were studied (17 males and 7 females). In the usual care group (n = 15), HbA(1c) pre-operatively was 7.2% (55.2 mmol/mol) compared to 10.1% (86.9 mmol/mol) in the intervention group (n = 9). Six weeks post-operatively HbA(1c) fell significantly in the intervention group by 1.9% (to 8.2% [66.1 mmol/mol]) compared to a reduction of 1.2% (to 7.0% [53 mmol/mol]) in the usual care group (p cardiac surgery.

  19. Evaluation of static and dynamic MRI for assessing response of bone sarcomas to preoperative chemotherapy: Correlation with histological necrosis

    Directory of Open Access Journals (Sweden)

    Priyadarshi Amit

    2015-01-01

    Full Text Available Objectives: Preoperative chemotherapy plays a key role in management of bone sarcomas. Postoperative evaluation of histological necrosis has been the gold standard method of assessing response to preoperative chemotherapy. This study was done to evaluate the efficacy of static and dynamic magnetic resonance imaging (MRI for assessing response preoperatively. Materials and Methods: Our study included 14 patients (12 osteosarcomas and 2 malignant fibrous histiocytomas with mean age of 21.8 years, treated with preoperative chemotherapy followed by surgery. They were evaluated with static and dynamic MRI twice, before starting chemotherapy and again prior to surgery. Change in tumor volume and slope of signal intensity - time curve were calculated and correlated with percentage of histological necrosis using Pearson correlation test. Results: The change in dynamic MRI slope was significant (P = 0.001. Also, ≥60% reduction in slope of the curve proved to be an indicator of good histological response [positive predictive value (PPV =80%]. Change in tumor volume failed to show significant correlation (P = 0.071. Although it showed high negative predictive value (NPV = 85.7%, PPV was too low (PPV = 57.14%. Conclusions: Dynamic MRI correctly predicts histological necrosis after administration of preoperative chemotherapy to bone sarcomas. Hence, it can be used as a preoperative indicator of response to neoadjuvant chemotherapy. On the other hand, volumetric assessment by static MRI is not an effective predictor of histological necrosis. This study proves the superiority of dynamic contrast-enhanced study over volumetric study by MRI.

  20. Preoperative weight loss in patients with indication of bariatric surgery: which is the best method?

    Directory of Open Access Journals (Sweden)

    M. Adrianzén Vargas

    Full Text Available Background: Surgery is the only effective treatment for people with a body mass index (BMI greater than 40 Kg/m² or even greater than 35 Kg/m² when some diseases like diabetes or hypertension appear. In order to minimize surgical risk and improve postoperative results, preoperative preparation it's very important. "Acute" preoperative weight loss just before surgery plays a crucial role in that preparation and can be achieved through different ways like a low calorie diet, a very low calorie diet or with the use of an intragastric balloon. The advantages or particularities of every one of them will be summarized in this article. Material and methods: Literature review of the benefits, risks and complications of preoperative weight loss through a low calorie diet, a very low calorie diet or intragastric balloon placement. Results: Seven of thirteen initially selected reports from Medline search were considered relevant, including a total 371 patients (240 patients treated with low calorie diet, 90 with very low calorie diet and 41 cases of intragastric balloon placement. We found that weight loss was greater in patients with very low calorie diets and intragastric balloon groups but with a slightly increase in morbidity and cost. Conclusion: Although there are no comparative studies, data from the literature results show that diets very low in calories are more effective and require less time than low-calorie diets and cheaper with fewer side effects than the intragastric balloon.

  1. Role of Dynamic Magnetic Resonance Imaging in Preoperative Evaluation of Breast Conserving Surgery for Breast Cancer%动态磁共振成像在乳腺癌保乳术中的术前评估作用

    Institute of Scientific and Technical Information of China (English)

    范培芝; 张超杰; 刘鹏; 张志功; 唐梅徕; 顾晓文; 郑维; 李艳春

    2012-01-01

    [Objective] To evaluate the role of dynamic contrast-enhanced magnetic resonance imaging (MRI) in prcopcrativc evaluation of breast-conserving surgery for breast cancer. [Methods! Totally 65 female breast cancer patients with the average age of 35. 8 years old took prcopcrativc mammography and MRI examination. Mammography and MRI examination were used to evaluate the feasibility of breast-conserving surgery. Pathological diagnosis was used to evaluate the accuracy of MRI in the assessment of breast cancer in cutting edge and with multi-center lesions. [Results! Among 65 patients with breast cancer, 64. 6% of the patients could undergo breast-conserving surgery by mammography prcopcrativc evaluation which was lower than that by MRI cvaluation(83. 1 %) , and there was significant difference between thcm( P evaluation of young women with stage I~Iib breast cancer undergoing breast conserving surgery can more accurately determine multi-center lesion and incisal margin range than mammography, and is more helpful for deciding whether to adopt breast conserving surgery and more precisely determine surgical margin.%[目的]评价动态增强磁共振成像(MRI)在乳腺癌保乳根治术的术前评估作用.[方法]平均年龄35.8岁的65 例女性乳腺癌患者,术前均行钼靶及MRI检查,对钼靶、MRI评估是否可行保乳手术进行分析,通过病理诊断来评价MRI在评估乳腺癌多中心病灶以及切缘范围上的准确性.[结果]65例患者中,钼靶术前评估认为可保乳术患者64.6%,低于MRI评估的83.1%,且两者相比差异有显著性(P<0.05).对癌块切缘判断准确率MRI为80%,显著高于钼靶的53.8%(P<0.05).[结论]在中青年女性的I~IIb期乳腺癌保乳术的术前评估方法中,动态增强MRI成像较钼靶

  2. Surgery in elderly people: preoperative, operative and postoperative care to assist healing.

    Science.gov (United States)

    Hughes, Sarah; Leary, Antonella; Zweizig, Susan; Cain, Joanna

    2013-10-01

    Surgery for elderly women is likely to increase steadily as the population of elderly people increases globally. Although increasing age increases perioperative morbidity and mortality, the functional age and physiologic reserve rather than chronological age is more important in preventing complications. Preparation for surgery, with special attention to functional capacity and activity, mental status, and existing comorbid conditions, can improve outcomes. Perioperative management must be tailored to physiologic changes of ageing, which affect respiratory, cardiac and renal function, as well as guidelines for preventing infection and thrombotic events. Of particular note is the enhanced effect of narcotic medications in elderly people, which affects intraoperative and postoperative management of pain. Prevention of postoperative delirium is accomplished through preoperative and postoperative planning. Discharge planning, particularly for frail elderly people, must start before surgery. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Multi-slice CT angiography by triple-phase enhancement in preoperative evaluation of hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    XIAO Xi-gang; HAN Xue; SHAN Wei-dong; LI An-yuan

    2005-01-01

    Background Triple-phase enhancement of multi-slice computed tomography (MSCT) has markedly improved the diagnostic accuracy of hepatocellular carcinoma (HCC), and MSCT angiography (MSCTA) has been proved useful in detecting vascular anatomy noninvasively. This study aimed to explore the value of MSCTA by triple-phase enhancement in preoperative evaluation of HCC.Methods Fifty-six consecutive cases of primary HCC scheduled for resection were studied with MSCTA by triple-phase enhancement. The raw data images were processed on a workstation for multiplanar reconstruction (MPR) and three-dimensional (3D) reconstruction. The findings after processing of the data were compared with those after surgery or intraoperative sonography. Results The false positive rate of MSCTA by triple-phase enhancement was 10.1% and its false negative rate was 4.3% in detecting HCC. No significant difference was observed in MSCTA and surgery or intraoperative sonography in detecting vascular anatomy anomalies and pathologic variations, whereas significant difference was found in detecting bile duct invasion with MSCT compared to intraoperative sonography.Conclusions MSCTA by triple-phase enhancement not only improves the detection of HCC, but also provides valuable preoperative information about hepatic vascular architecture and parenchyma. MSCTA by triple-phase enhancement is worthy of application as a non-invasive method in preoperative evaluation of HCC.

  4. Preoperative Echocardiographic Indices of Diastolic Dysfunction and Brain Natriuretic Peptide in Predicting Postoperative Atrial Fibrillation After Noncardiac Surgery.

    Science.gov (United States)

    Brecher, Oren; Gulati, Harleena; Roistacher, Nancy; Zhang, Hao; Shi, Weiji; Thaler, Howard T; Amar, David

    2017-04-01

    We have shown previously that either echocardiographic indices of diastolic dysfunction or increased preoperative brain natriuretic peptide (BNP) predict postoperative atrial fibrillation (POAF). Because these 2 predictors of POAF have not been evaluated together, our goal was to further elucidate their concurrent role in patients undergoing noncardiac thoracic surgery. We retrospectively identified 191 patients who had a preoperative transthoracic echocardiogram and serum BNP level collected as part of routine care before major lung or esophageal resection. Clinical and echocardiographic data were compared between patients who did or did not develop POAF (>5 minutes), and prognostic factors for POAF were identified. Univariate associations with POAF (41 of 191; 22% patients) included older age (P = .04), male sex (P = .01), hypertension (P = .03), increased body mass index (P = .01), and prolonged transmitral flow deceleration time (P < .0001), whereas BNP was not statistically significant (P = .07). Stepwise logistic regression analysis showed that both increasing transmitral flow deceleration time (continuous data log base 2 transformed; odds ratio, 16.05; 95% confidence interval, 3.74-68.96; P = .0002) and left atrial diastolic volume index (continuous data log base 2 transformed; odds ratio, 3.29; 95% confidence interval, 1.22-8.91; P = .02) were independent risk factors of POAF (area under the receiver operating characteristic curve = 0.73). There was no significant interaction between BNP and the 2 independent variables (P = .60, and P = .90), respectively. In a cohort of patients who had echocardiography and BNP measurements before undergoing major thoracic surgery, this study showed that when evaluated together greater preoperative left atrial diastolic volume index and transmitral flow deceleration time but not BNP levels were independent predictors for POAF.

  5. Effect of preoperative angina pectoris on cardiac outcomes in patients with previous myocardial infarction undergoing major noncardiac surgery (data from ACS-NSQIP).

    Science.gov (United States)

    Pandey, Ambarish; Sood, Akshay; Sammon, Jesse D; Abdollah, Firas; Gupta, Ena; Golwala, Harsh; Bardia, Amit; Kibel, Adam S; Menon, Mani; Trinh, Quoc-Dien

    2015-04-15

    The impact of preoperative stable angina pectoris on postoperative cardiovascular outcomes in patients with previous myocardial infarction (MI) who underwent major noncardiac surgery is not well studied. We studied patients with previous MI who underwent elective major noncardiac surgeries within the American College of Surgeons-National Surgical Quality Improvement Program (2005 to 2011). Primary outcome was occurrence of an adverse cardiac event (MI and/or cardiac arrest). Multivariable logistic regression models evaluated the impact of stable angina on outcomes. Of 1,568 patients (median age 70 years; 35% women) with previous MI who underwent major noncardiac surgery, 5.5% had postoperative MI and/or cardiac arrest. Patients with history of preoperative angina had significantly greater incidence of primary outcome compared to those without anginal symptoms (8.4% vs 5%, p = 0.035). In secondary outcomes, reintervention rates (22.5% vs 11%, p angina. In multivariable analyses, preoperative angina was a significant predictor for postoperative MI (odds ratio 2.49 [1.20 to 5.58]) and reintervention (odds ratio 2.40 [1.44 to 3.82]). In conclusion, our study indicates that preoperative angina is an independent predictor for adverse outcomes in patients with previous MI who underwent major noncardiac surgery, and cautions against overreliance on predictive tools, for example, the Revised Cardiac Risk Index, in these patients, which does not treat stable angina and previous MI as independent risk factors during risk prognostication.

  6. Frequent change of procedure during coronary artery bypass surgery suggests insufficient preoperative diagnostic strategy

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Thayssen, Per

    2007-01-01

    We sought to evaluate how often and in what way surgeons change peroperatively their preoperative coronary artery bypass grafting strategy and to what degree these changes affect postoperative graft patency. A series of 109 patients with stable angina pectoris and at least one occluded coronary...... preoperatively planned grafts were inserted. When shifts occurred, no matter in which direction, it resulted in a decreased patency rate of the inserted grafts. This finding was significant for LAD (P=0.037). Our findings might indicate the necessity of future studies with the use of scintigraphy or fractional...

  7. [Preoperative preparation, antibiotic prophylaxis and surgical wound infection in breast surgery].

    Science.gov (United States)

    Rodríguez-Caravaca, Gil; de las Casas-Cámara, Gonzalo; Pita-López, María José; Robustillo-Rodela, Ana; Díaz-Agero, Cristina; Monge-Jodrá, Vicente; Fereres, José

    2011-01-01

    The impact of surgical wound infection on public health justifies its surveillance and prevention. Our objectives were to estimate the incidence of surgical wound infection in breast procedures and assess its protocol of antibiotic prophylaxis and preoperative preparation. Observational multicentre prospective cohort study of incidence of surgical wound infection. Incidence was evaluated, stratified by National Nosocomial Infection Surveillance (NNIS) risk index and we calculated the standardized incidence ratio (SIR). The SIR was compared with Spanish rates and U.S. rates. The compliance and performance of the antibiotic prophylaxis and preoperative preparation protocol were assessed and their influence in the incidence of infection with the relative risk. Ten hospitals from the Comunidad de Madrid were included, providing 592 procedures. The cumulative incidence of surgical wound infection was 3.89% (95% CI: 2.3-5.5). The SIR was 1.82 on the Spanish rate and 2.16 on the American. Antibiotic prophylaxis was applied in 97.81% of cases, when indicated. The overall performance of antibiotic prophylaxis was 75%, and 53% for preoperative preparation. No association was found between infection and performance of prophylaxis or preoperative preparation (P>.05). Our incidence is within those seen in the literature although it is somewhat higher than the national surveillance programs. The performance of prophylaxis antibiotic must be improved, as well as the recording of preoperative preparation data. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  8. Klatskin tumor: Diagnosis, preoperative evaluation and surgical considerations.

    Science.gov (United States)

    Molina, Víctor; Sampson, Jaime; Ferrer, Joana; Sanchez-Cabus, Santiago; Calatayud, David; Pavel, Mihai Calin; Fondevila, Constantino; Fuster, Jose; García-Valdecasas, Juan Carlos

    2015-11-01

    Hiliar cholangiocarcinoma is the most common type of cholangiocarcinoma, an represent around 10% of all hepatobiliary tumors. It is an aggressive malignancy, resectable in around 47% of the patients at diagnosis. Complete resection is the most effective and only potentially curative therapy, with a survival rate of less than 12 months in unresectable cases. Axial computerized tomography and magnetic resonance are the most useful image techniques to determine the surgical resectability. Clinically, jaundice and pruritus are the most common symptoms at diagnosis;preoperative biliary drainage is recommended using endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography. Surgery using extended liver resections with an en bloc resection of the liver with vascular reconstruction is the technique with the highest survival. Complete resection with histologically negative resection margins (R0), nodal involvement and metastases are the most important prognostic factors.

  9. Long-term outcomes of surgery alone versus surgery following preoperative chemoradiotherapy for early T3 rectal cancer

    Science.gov (United States)

    Cho, Seung Hyun; Choi, Gyu-Seog; Kim, Gab Chul; Seo, An Na; Kim, Hye Jung; Kim, Won Hwa; Shin, Kyung-Min; Lee, So Mi; Ryeom, Hunkyu; Kim, See Hyung

    2017-01-01

    Abstract Recently, a few studies have raised the question of whether preoperative chemoradiotherapy (PCRT) is essential for all T3 rectal cancers. This case-matched study aimed to compare the long-term outcomes of surgery alone with those of PCRT + surgery for magnetic resonance imaging (MRI)-assessed T3ab (extramural depth of invasion ≤5 mm) and absent mesorectal fascia invasion (clear MRF) in mid/lower rectal cancer patients. From January 2006 to November 2012, 203 patients who underwent curative surgery alone (n = 118) or PCRT + surgery (n = 85) were enrolled in this retrospective study. A 1:1 propensity score-matched analysis was performed to eliminate the inherent bias. Case-matching covariates included age, sex, body mass index, histologic grade, carcinoembryonic antigen, operation method, follow-up period, tumor height, and status of lymph node metastasis. The end-points were the 5-year local recurrence (LR) rate and disease-free-survival (DFS). After propensity score matching, 140 patients in 70 pairs were included. Neither the 5-year LR rate nor the DFS was significantly different between the 2 groups (the 5-year LR rate, P = 0.93; the 5-year DFS, P = 0.94). The 5-year LR rate of the surgery alone was 2% (95% confidence interval [CI] 0.2%–10.9%) versus 2% (95% CI 0.2%–10.1%) in the PCRT + surgery group. The 5-year DFS of the surgery alone was 87% (95% CI 74.6%–93.7%) versus 88% (95% CI 77.8%–93.9%) in the PCRT + surgery group. In patients with MRI-assessed T3ab and clear MRF mid/lower rectal cancer, the long-term outcomes of surgery alone were comparable with those of the PCRT + surgery. The suggested MRI-assessed T3ab and clear MRF can be used as a highly selective indication of surgery alone in mid/lower T3 rectal cancer. Additionally, in those patients, surgery alone can be tailored to the clinical situation. PMID:28328820

  10. The Coagulative Profile of Cyanotic Children Undergoing Cardiac Surgery: The Role of Whole Blood Preoperative Thromboelastometry on Postoperative Transfusion Requirement.

    Science.gov (United States)

    Vida, Vladimiro L; Spiezia, Luca; Bortolussi, Giacomo; Marchetti, Marta E; Campello, Elena; Pittarello, Demetrio; Gregori, Dario; Stellin, Giovanni; Simioni, Paolo

    2016-07-01

    The objective of this study is to evaluate the preoperative coagulation pattern and its association to postoperative blood products transfusion in children with congenital heart disease (CHD), focusing on cyanotic patients (oxygen saturation, SATO 2  < 85%). From January to August 2014, preoperative standard coagulation tests and rotational thromboelastometry assays were performed on 81 pediatric patients (<16 years old) who underwent surgery for CHD with the aid of cardiopulmonary bypass. Sixty patients (74%) were acyanotic and 21 (26%) cyanotic. Mean age at time of surgery was 7.9 months (interquartile range 2.9-43.6 months). Cyanotic patients had a significantly higher hematocrit (P < 0.001), a reduced prothrombin activity (PT) (P = 0.01) level, and a lower platelet count (P = 0.02) than acyanotic patients. An inverse linear association was found between patient's SATO2 and clot formation time (CFT) (INTEM, P = 0.001, and EXTEM, P < 0.0001). A direct linear association was found between patient's SATO2 and maximum clot firmness (MCF) (INTEM, P = 0.04, and EXTEM, P = 0.05). Preoperative cyanosis was also associated with a lower median MCF in FIBTEM (P = 0.02). Cyanotic patients required more frequent postoperative transfusions of fibrinogen (7/21 patients, 33% vs. 4/60 patients, 6.7%, P = 0.01) and fresh frozen plasma (14/21, 67% vs. 25/60, 42%, P = 0.08). Patients with a lower presurgery PT and platelet count subsequently required more fibrinogen transfusion P = 0.02 and P = 0.003, respectively); the same goes for patients with a longer CFT (INTEM, P = 0.01 and EXTEM, P = 0.03) and a reduced MCF (INTEM, P = 0.02 and FIBTEM, P = 0.01) as well. Cyanotic patients showed significant preoperative coagulation anomalies and required a higher postoperative fibrinogen supplementation. The preoperative MCF FIBTEM has become an important factor in our postoperative thromboelastometry-guided transfusion

  11. Evaluation of malnutrition in orthopaedic surgery.

    Science.gov (United States)

    Cross, Michael Brian; Yi, Paul Hyunsoo; Thomas, Charlotte F; Garcia, Jane; Della Valle, Craig J

    2014-03-01

    Malnutrition can increase the risk of surgical site infection in both elective spine surgery and total joint arthroplasty. Obesity and diabetes are common comorbid conditions in patients who are malnourished. Despite the relatively high incidence of nutritional disorders among patients undergoing elective orthopaedic surgery, the evaluation and management of malnutrition is not generally well understood by practicing orthopaedic surgeons. Serologic parameters such as total lymphocyte count, albumin level, prealbumin level, and transferrin level have all been used as markers for nutrition status. In addition, anthropometric measurements, such as calf and arm muscle circumference or triceps skinfold, and standardized scoring systems, such as the Rainey-MacDonald nutritional index, the Mini Nutritional Assessment, and institution-specific nutritional scoring tools, are useful to define malnutrition. Preoperative nutrition assessment and optimization of nutritional parameters, including tight glucose control, normalization of serum albumin, and safe weight loss, may reduce the risk of perioperative complications, including infection.

  12. Effect of Pre-Operative Use of Medications on the Risk of Surgical Site Infections in Patients Undergoing Cardiac Surgery.

    Science.gov (United States)

    Eton, Vic; Sinyavskaya, Liliya; Langlois, Yves; Morin, Jean François; Suissa, Samy; Brassard, Paul

    2016-10-01

    Median sternotomy, the most common means of accessing the heart for cardiac procedures, is associated with higher risk of surgical site infections (SSIs). A limited number of studies reporting the impact of medication use prior to cardiac surgery on the subsequent risk of SSIs usually focused on antibacterial prophylaxis. The objective of the current study was to evaluate the effect of medications prescribed commonly to cardiac patients on the risk of incident SSIs. The study analyzed data on consecutive cardiac surgery patients undergoing median sternotomy at a McGill University teaching hospital between April 1, 2011 and October 31, 2013. Exposure of interest was use of medications for heart disease and cardiovascular conditions in the seven days prior to surgery and those for comorbid conditions. The main outcome was SSIs occurring within 90 d after surgery. Univariate and multivariate logistic regression (adjusted odds ratio [AOR]) was used to evaluate the effect. The cohort included 1,077 cardiac surgery patients, 79 of whom experienced SSIs within 90 d of surgery. The rates for sternal site infections and harvest site infections were 5.8 (95% confidence interval [CI]: 4.4-7.3) and 2.5 (95% CI: 1.4-3.7) per 100 procedures, respectively. The risk of SSI was increased with the pre-operative use of immunosuppressors/steroids (AOR 3.47, 95% CI: 1.27-9.52) and α-blockers (AOR 3.74, 95% CI: 1.21-1.47). Our findings support the effect of immunosuppressors/steroids on the risk of SSIs and add evidence to the previously reported association between the use of anti-hypertensive medications and subsequent development of infection/sepsis.

  13. Pre-operative blood donation versus acute normovolemic hemodilution in cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mohammad Rezvan Nobahar

    2014-01-01

    Full Text Available Introduction: Acute normovolemic hemodilution (ANH and preoperative autologous blood donation (PABD have questionable efficacy, viral and bacterial infection risks, intermittent blood shortages as homeostasis problem, electrolyte and hemodynamic disturbances. Materials and Methods: In this cross sectional survey, we studied 70 patients undergoing open heart coronary artery bypass grafts [CABG] and different valvular replacement 1 ml surgery (35 in ANH, 35 in PABD in Shaheed Modares - Hospital. We measured electrolytes and homeostatic factors to evaluate the influence of two transfusion methods on homeostatic function and hemodynamic balance. Results: We compared 70 patients (38 male [54.3%] and 32 female [45.7%] with mean age 54.8 years undergoing open heart surgery (CABG and valvular. In ANH group, significant decrease was detected in Na (28.5% K (2.5%, prothrombin time (PT (88.57%, partial thromboplastin time (PTT (94.28%, creatine phosphokinase (CPK (11.4%, lactic dehydrogenase (LDH (11.43%, albumin (Alb (17.14%, globulin (91.43% and total protein (80%. Mean initial and post-operative hemoglobin was 14.12 ± 1.06 versus 11.97 ± 0.98, hematocrit 42.22 ± 3.45 versus 35.40 ± 2.88, systolic blood pressure 124.1 ± 14.4 versus 110.88 ± 15.6 (reduction 22.86% diastolic blood pressure 76.02 ± 10 versus 69.26 ± 11 (reduction 3% and pulse rate was 75.45 ± 10 versus 84.45 ± 12 (12% in this case difference between two groups was strongly significant (P = 0.001. In PABD group, significant decrease was detected in Na (20%, K (2.5%, PT (91.43% PTT (80%, CPK (8.57%, LDH (5.72%, Alb (57.15%, globulin (71.43% and total-protein (62.85%, the value of hemodynamic changes were in normal range. Conclusion: Though autologous blood transfusion (ANH and PABD was preferable to allogeneic transfusion in cardiac surgical patients; but PABD offers more advantages in homeostasis, hemodynamic stability and electrolyte balance.

  14. A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass.

    Science.gov (United States)

    Odaka, Mizuho; Minakata, Kenji; Toyokuni, Hideaki; Yamazaki, Kazuhiro; Yonezawa, Atsushi; Sakata, Ryuzo; Matsubara, Kazuo

    2015-08-01

    This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. This novel protocol was assessed by comparing patients undergoing open heart surgery before (control group; n = 30) and after its implementation (protocol group; n = 31) at Kyoto University Hospital between July 2012 and January 2013. Surgical site infections (SSIs) were observed in 4 control group patients (13.3 %), whereas no SSIs were observed in the protocol group patients (P protocol group (P protocol significantly decreased the total antibiotic dose used in the perioperative period (P protocol group patients required this additional change in the antibiotic regimen (P protocol based on preoperative kidney function effectively prevents SSIs in patients undergoing open heart surgery.

  15. The prevalence of abnormal preoperative coagulation tests in pediatric patients undergoing spinal surgery for scoliosis.

    Science.gov (United States)

    Ryan, Katie M; O'Brien, Kirsty; Regan, Irene; O'Byrne, John M; Moore, David; Kelly, Paula M; Noel, Jacques; Butler, Joseph; Nolan, Beatrice; Kiely, Patrick J

    2015-06-01

    Multilevel spinal fusion surgery for deformity correcting spinal surgery in pediatric patients with scoliosis has typically been associated with significant blood loss. The mechanism of bleeding in such patients is not fully understood. Coagulation abnormalities, which may be associated with scoliosis, are thought to play a role. To document and compare the prevalence of preoperative coagulation abnormalities among patients with scoliosis attending a pediatric orthopedic department for spinal fusion surgery with patients attending for minor surgery. An observational study. All patients were recruited from a pediatric tertiary referral center in Dublin, Ireland. Coagulation profile results were prospectively collected over a 2-year period from 165 spinal surgery patients. In total, 175 patients were included in the non-scoliosis group. These patients attended the day ward for minor procedures and were recruited over a 4-month period. The primary outcome measure was the coagulation profiles, which included prothrombin time, activated partial thromboplastin time (APTT), and thrombin time (TT). Levels of Coagulation Factors II, V, VII, and X were also recorded. All blood samples were sent to the haematology laboratory to establish the coagulation profile. The primary outcome was the presence of an abnormal coagulation screening test (if any of PT, APTT, or TT were abnormal). Prothrombin time, APTT, and TT were also analyzed as individual continuous variables, as well as Coagulation Factors II, V, VII, and X. Regression analysis was used to compare the coagulation profile of scoliosis patients with that of non-scoliosis patients. There were no outside funding sources or any potential conflict of interest associated with this study. The scoliosis patients were more likely to have an abnormal preoperative screening test compared with non-scoliosis patients, with an odds ratio of 2.6. Further analysis showed statistically significant longer clotting times for patients with

  16. Non-invasive Evaluation for Epilepsy Surgery

    Science.gov (United States)

    IWASAKI, Masaki; JIN, Kazutaka; NAKASATO, Nobukazu; TOMINAGA, Teiji

    2016-01-01

    Epilepsy surgery is aimed to remove the brain tissues that are indispensable for generating patient’s epileptic seizures. There are two purposes in the pre-operative evaluation: localization of the epileptogenic zone and localization of function. Surgery is planned to remove possible epileptogenic zone while preserving functional area. Since no single diagnostic modality is superior to others in identifying and localizing the epileptogenic zone, multiple non-invasive evaluations are performed to estimate the location of the epileptogenic zone after concordance between evaluations. Essential components of non-invasive pre-surgical evaluation of epilepsy include detailed clinical history, long-term video-electroencephalography monitoring, epilepsy-protocol magnetic resonance imaging (MRI), and neuropsychological testing. However, a significant portion of drug-resistant epilepsy is associated with no or subtle MRI lesions or with ambiguous electro-clinical signs. Additional evaluations including fluoro-deoxy glucose positron emission tomography (FDG-PET), magnetoencephalography and ictal single photon emission computed tomography can play critical roles in planning surgery. FDG-PET should be registered on three-dimensional MRI for better detection of focal cortical dysplasia. All diagnostic tools are complementary to each other in defining the epileptogenic zone, so that it is always important to reassess the data based on other results to pick up or confirm subtle abnormalities. PMID:27627857

  17. Inadequate preoperative colonic evaluation for synchronous colorectal cancer

    DEFF Research Database (Denmark)

    Achiam, M P; Burgdorf, S K; Wilhelmsen, M

    2009-01-01

    BACKGROUND AND AIMS: Synchronous cancers (SC) are well known (2-11%) in patients with colorectal carcinoma (CRC). One study has shown that intraoperative palpation can miss up to 69% of the SC while other studies have shown altered planned surgical procedure due to preoperatively diagnosed......-operation and one patient had pulmonary embolism as a complication to re-operation. CONCLUSIONS: The results show that many patients (78%) never underwent FPCE, but also that many of these patients never had a full postoperative colonic evaluation. SC being overlooked can lead to increased morbidity...... and the possibility of advanced staging of the cancer which is also exemplified in this study....

  18. Influence of preoperative emotional state on postoperative pain following orthopedic and trauma surgery

    Directory of Open Access Journals (Sweden)

    Gemma Robleda

    2014-10-01

    Full Text Available OBJECTIVES: to analyze the relationship between preoperative emotional state and the prevalence and intensity of postoperative pain and to explore predictors of postoperative pain.METHOD: observational retrospective study undertaken among 127 adult patients of orthopedic and trauma surgery. Postoperative pain was assessed with the verbal numeric scale and with five variables of emotional state: anxiety, sweating, stress, fear, and crying. The Chi-squared test, Student's t test or ANOVA and a multivariate logistic regression analysis were used for the statistical analysis.RESULTS: the prevalence of immediate postoperative pain was 28%. Anxiety was the most common emotional factor (72% and a predictive risk factor for moderate to severe postoperative pain (OR: 4.60, 95% CI 1.38 to 15.3, p<0.05, AUC: 0.72, 95% CI: 0.62 to 0.83. Age exerted a protective effect (OR 0.96, 95% CI: 0.94-0.99, p<0.01.CONCLUSION: preoperative anxiety and age are predictors of postoperative pain in patients undergoing orthopedic and trauma surgery.

  19. Use of positive pressure in preoperative and intraoperative of bariatric surgery and its effect on the time of extubation

    Directory of Open Access Journals (Sweden)

    Letícia Baltieri

    2015-04-01

    Full Text Available BACKGROUND AND OBJECTIVE: To investigate the influence of intraoperative and preoperative positive pressure in the time of extubation in patients undergoing bariatric surgery. METHOD: Randomized clinical trial, in which 40 individuals with a body mass index between 40 and 55 kg/m2, age between 25 and 55 years, nonsmokers, underwent bariatric surgery type Roux-en-Y gastric bypass by laparotomy and with normal preoperative pulmonary function were randomized into the following groups: G-pre (n = 10: individuals who received treatment with noninvasive positive pressure before surgery for 1 h; G-intra (n = 10: individuals who received positive end-expiratory pressure of 10 cm H2O throughout the surgical procedure; and G-control (n = 20: not received any preoperative or intraoperative intervention. Following were recorded: time between induction of anesthesia and extubation, between the end of anesthesia and extubation, duration of mechanical ventilation, and time between extubation and discharge from the post-anesthetic recovery. RESULTS: There was no statistical difference between groups. However, when applied to the Cohen coefficient, the use of positive end-expiratory pressure of 10 cm H2O during surgery showed a large effect on the time between the end of anesthesia and extubation. About this same time, the treatment performed preoperatively showed moderate effect. CONCLUSION: The use of positive end-expiratory pressure of 10 cm H2O in the intraoperative and positive pressure preoperatively, influenced the time of extubation of patients undergoing bariatric surgery.

  20. Copper as ancillary diagnostic tool in preoperative evaluation of possible papillary thyroid carcinoma in patients with benign thyroid disease.

    Science.gov (United States)

    Dragutinović, Vesna V; Tatić, Svetislav B; Nikolić-Mandić, Snežana D; Tripković, Tatjana M; Dunđerović, Duško M; Paunović, Ivan R

    2014-09-01

    Preoperative diagnosis of papillary thyroid carcinoma (PTC) comprises numerous diagnostic procedures which are mostly applicable in tertiary institutions. Normal thyroid function depends on the presence of many trace elements and copper (Cu) and zinc (Zn) are some of those. The study is based on retrospective review of 118 patients with preoperatively diagnosed benign thyroid disease (BTD) and 12 with PTC, who underwent thyroid surgery at the Center for Endocrine Surgery Clinical Center of Serbia, Belgrade, between 2010 and 2012. The objective was to evaluate concentrations of Cu and Zn in serum as possible prediction markers for PTC in patients who underwent surgery for preoperatively diagnosed BTD. Concentrations of Cu and Zn ions in serum were measured using atomic absorption spectrophotometer. Data were analyzed using methods of descriptive statistics, Anova and t-test (p papillary microcarcinoma-mPTC in 13 (11.0%) of BTD patients. The concentrations of Cu ions in serum of PTC patients as well as in serum of patients with mPTC were significantly higher than in serum of BTD patients (p thyroid surgery can be useful, easy available, and a low-cost tool in prediction of preoperatively undiagnosed PTC in patients with BTD.

  1. Impact of preoperative patient education on prevention of postoperative complications after major visceral surgery: study protocol for a randomized controlled trial (PEDUCAT trial).

    Science.gov (United States)

    Fink, Christine; Diener, Markus K; Bruckner, Thomas; Müller, Gisela; Paulsen, Lisa; Keller, Monika; Büchler, Markus W; Knebel, Phillip

    2013-08-26

    In line with the growing number of surgical procedures being performed worldwide, postoperative complications are also increasing proportionately. Prevention of these postoperative complications is a high medical priority. Preoperative education of patients, including provision of preparatory information about the correct behavior after surgery, could improve the postoperative outcome, but the evidence for this is inconclusive. The aim of the PEDUCAT trial is to evaluate the feasibility and the impact of preoperative patient education on postoperative morbidity, mortality and quality of life in patients scheduled for elective major visceral surgery. PEDUCAT is designed as a cluster-randomized controlled pilot study. The experimental group will visit a standardized preoperative seminar to learn how best to behave after surgery in addition to being given a standard information brochure, whereas the control group will only receive the information brochure. Outcome measures such as postoperative morbidity, postoperative pain, postoperative anxiety and depression, patient satisfaction, quality of life, length of hospital stay and postoperative mortality will be evaluated. Statistical analysis will be based on the intention-to-treat population. Analysis of covariance will be applied for the intervention group comparison, adjusting for age, center and quality of life before surgery. This is a pilot study to show the feasibility of the concept. Nevertheless, the planned sample size of n = 204 is large enough to show an effect with power of 90% and a significance level of 5%. German Clinical Trial Register number: DRKS00004226.

  2. Effects of preoperative bromocriptine treatment on prolactin-secreting pituitary adenoma surgery

    Science.gov (United States)

    CAO, YINGXIAO; WANG, FENGJU; LIU, ZHENBO; JIAO, BAOHUA

    2016-01-01

    Pituitary adenomas are benign intracranial endocrine tumors, accounting for ~10% of intracranial tumors. The aim of the present study was to analyze the effects of preoperative treatment with bromocriptine on the surgical treatment and postoperative complications of prolactin-secreting pituitary adenomas (prolactinomas). Data from 102 patients whose prolactinomas were surgically treated between March 2006 and March 2010 were retrospectively reviewed in the present study. The study group included 54 patients who had been treated preoperatively with bromocriptine. The patients were examined by magnetic resonance imaging (MRI) of the head and coronal computed tomography (CT) scanning, after which the pathological diagnosis of prolactinoma was confirmed. A total of 64 patients underwent total resection surgery through the nose and sphenoid sinus, and 25 patients underwent subtotal resection surgery or excision of a large portion of the tumor, leaving only a small quantity of residual tumor or tumor capsule. Patients were followed up for 1–9 months using MRI and measurements of serum prolactin levels. Seven patients were lost to follow-up. The results of the present study demonstrated that patients who were treated with large doses of bromocriptine or used bromocriptine chronically suffered from an increased rate of surgical difficulties and postoperative complications, as compared with the patents who had not been pre-treated with bromocriptine. In conclusion, oral administration of bromocriptine is important in the treatment of prolactinoma tumors. However, large doses or long-term use of bromocriptine may increase difficulties in surgery or postoperative complications, and reduce its ability to treat prolactinonas, as it can lead to hardening of the tumor tissue and capsules, and aggravate pituitary stalk adhesions. PMID:27168837

  3. Evaluation healing of jejunal anastomosis in preoperative dexamethasone treated dogs

    Directory of Open Access Journals (Sweden)

    A.S. Al-Qadhi

    2015-06-01

    Full Text Available The objective of this study is to evaluate the healing process of jejunal anastomosis by the aid of histopathology and measurement of bursting pressure of anastomosis site in thirty two adult preoperatively with dexamethasone. The animals were randomly divided into 2 equal groups: Group 1: consists of 16 dogs underwent apposition end-to-end jejunal anastomosis using simple interrupted suture technique which in turn divided into 2 subgroups: subgroup A: consists of 8 dogs treated preoperatively for 15 days with dexamethasone at a dose of (0.2mg/kg given I/M. Subgroup B: control group consists of 8 dogs not treated with dexamethasone. Group 2: consists of 16 dogs underwent inverted end-to-end jejunal anastomosis using continuous Lembert suture pattern that also divided into 2 subgroups: subgroup A: consists of 8 dogs treated preoperatively for 15 days with dexamethasone at a dose of (0.2mg/kg given I/M. subgroup B: control group consists of 8 dogs not treated with dexamethasone. The result of bursting pressure measurement showed higher tensile strength in the control groups (445±9.6 in comparison with the steroidal groups (255±25.3 for both techniques. The histopathological study showed that the healing was good in all groups but the rupture that occur due to shedding the pressure lead to non discrimination between which is better in terms of healing. Massonʼs trichrome showed that collagen content of subgroups taking dexamethasone was lower than that of subgroups not treated with dexamethasone.

  4. Brief preoperative smoking cessation counselling in relation to breast cancer surgery: a qualitative study

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Esbensen, Bente Appel; Samuelsen, Susanne

    2009-01-01

    of cancer diagnosis was difficult for some women. They relapsed to smoking as an ingrown response to emotional distress. The smoking intervention heightened the women's awareness of their addiction to smoking; however, they expressed a need for prolonged smoking cessation support. For others, the smoking......: In newly diagnosed breast cancer patients, brief preoperative smoking intervention motivated smoking cessation. However, prolonged intervention, pre- and postoperatively, may more effectively support cessation in breast cancer patients and should therefore be evaluated in this patient population....

  5. Impact of preoperative patient education on prevention of postoperative complications after major visceral surgery: study protocol for a randomized controlled trial (PEDUCAT trial)

    OpenAIRE

    Fink, Christine; Diener, Markus K; Bruckner, Thomas; Müller,Gisela; Paulsen, Lisa; Keller, Monika; Büchler, Markus W; Knebel, Phillip

    2013-01-01

    Background In line with the growing number of surgical procedures being performed worldwide, postoperative complications are also increasing proportionately. Prevention of these postoperative complications is a high medical priority. Preoperative education of patients, including provision of preparatory information about the correct behavior after surgery, could improve the postoperative outcome, but the evidence for this is inconclusive. The aim of the PEDUCAT trial is to evaluate the feasib...

  6. Successful Treatment of Mediastinal Unicentric Castleman’s Disease Using Video-Assisted Thoracoscopic Surgery with Preoperative Embolization

    Directory of Open Access Journals (Sweden)

    Yosuke Amano

    2013-01-01

    Full Text Available Unicentric Castleman’s disease is a rare, benign lymphoproliferative disorder that is curable with surgical resection. However, significant bleeding often occurs during surgery because of tumor hypervascularity. We herein present a case of hyaline-vascular-type mediastinal unicentric Castleman’s disease, successfully resected using video-assisted thoracoscopic surgery with preoperative embolization. In the present case, tumor hypervascularity and feeding vessels were revealed by computed tomography (CT, which led us to perform preoperative angiography and embolization to the tumor feeding arteries to reduce intraoperative bleeding. Castleman’s disease should be considered in the differential diagnosis of hypervascular mediastinal tumors. Tumor vascularity should be assessed prior to surgery, and preoperative embolization should be considered.

  7. CLINICAL EVALUATION OF EFFECTIVENESS OF ITRACONAZOLE IN PREOPERATIVE AND REFRACTORY POSTOPERATIVE PATIENTS OF ALLERGIC FUNGAL SINUSITIS

    Directory of Open Access Journals (Sweden)

    Ch. Venkatasubbaiah

    2016-07-01

    Full Text Available BACKGROUND Allergic Fungal Sinusitis (AFS is a noninvasive type of fungal sinusitis, clinically and pathologically a unique entity of chronic rhinosinusitis. The aetiology, pathogenesis, and treatment of AFS are subject to controversy. In spite of aggressive endoscopic surgery, pre- and postoperative steroids and immunotherapy recurrence rates are high. Many additions are made to its original description and management since its early description in 1980. The aim of the present paper was to evaluate clinically. The response to high-dose itraconazole before endoscopic sinus surgery and in refractory postoperative patients. Related literature was reviewed in the light of the present study. MATERIALS AND METHODS A 2 year prospective study conducted on 68 AFS patients divided into two groups to clinically evaluate the results after using oral itraconazole preoperatively in one group and in refractory postoperative period in another. RESULTS The mean age of patients with typical AFS was 36±3.9 years. Patients with AFS with an average follow up of 21 months were included. Recurrence was 6/34 (17.64% in itraconazole group and revision FESS done in 3/34 (08.82%. Recurrence in patients without itraconazole was 16/34 (47.05% and refractory to conventional treatment, but responded to itraconazole in 14/16 (87.50%. Revision surgery required in 2/16 (12.50% after starting oral itraconazole. No side effects or reactions were observed in a total of 7920 doses administered. CONCLUSION Itraconazole is well tolerated by patients and effective in shrinking the polyposis preoperatively with low recurrence. Postoperative refractory AFS is amenable in (87.50% of patients avoiding repeat FESS. Overall, low recurrence rate and minimizing revision surgery when compared to patients treated without itraconazole was evident in the study.

  8. Preoperative White Blood Cell Count and Risk of 30-Day Readmission after Cardiac Surgery

    Directory of Open Access Journals (Sweden)

    Jeremiah R. Brown

    2013-01-01

    Full Text Available Approximately 1 in 5 patients undergoing cardiac surgery are readmitted within 30 days of discharge. Among the primary causes of readmission are infection and disease states susceptible to the inflammatory cascade, such as diabetes, chronic obstructive pulmonary disease, and gastrointestinal complications. Currently, it is not known if a patient’s baseline inflammatory state measured by crude white blood cell (WBC counts could predict 30-day readmission. We collected data from 2,176 consecutive patients who underwent cardiac surgery at seven hospitals. Patient readmission data was abstracted from each hospital. The independent association with preoperative WBC count was determined using logistic regression. There were 259 patients readmitted within 30 days, with a median time of readmission of 9 days (IQR 4–16. Patients with elevated WBC count at baseline (10,000–12,000 and >12,000 mm3 had higher 30-day readmission than those with lower levels of WBC count prior to surgery (15% and 18% compared to 10%–12%, P=0.037. Adjusted odds ratios were 1.42 (0.86, 2.34 for WBC counts 10,000–12,000 and 1.81 (1.03, 3.17 for WBC count > 12,000. We conclude that WBC count measured prior to cardiac surgery as a measure of the patient’s inflammatory state could aid clinicians and continuity of care management teams in identifying patients at heightened risk of 30-day readmission after discharge from cardiac surgery.

  9. Efficacy of a liquid low-energy formula diet in achieving preoperative target weight loss before bariatric surgery

    DEFF Research Database (Denmark)

    Nielsen, Lone Vestergaard; Nielsen, Mette Søndergaard; Schmidt, Julie Berg

    2016-01-01

    A preoperative weight loss of 8 % is a prerequisite to undergo bariatric surgery (BS) in Denmark. The aim of the present study was to evaluate the efficacy of a 7- or an 11-week low-energy diet (LCD) for achieving preoperative target weight before BS. A total of thirty obese patients (BMI 46·0 (sd......, the majority of patients (77 %) had reached their target weight, and this was achieved after 5·4 (sem 0·3) weeks. Mean weight loss was 9·3 (sem 0·5) % (P weight loss was accompanied by a decrease in systolic and diastolic blood...... 4·4) kg/m2) followed an LCD (Cambridge Weight Plan®, 4184 kJ/d (1000 kcal/d)) for 7 or 11 weeks as preparation for BS. Anthropometric measurements including body composition (dual-energy X-ray absorptiometry), blood parameters and blood pressure were assessed at weeks 0, 7 and 11. At week 7...

  10. Relationship between the inability to climb two flights of stairs and outcome after major non-cardiac surgery: implications for the pre-operative assessment of functional capacity.

    Science.gov (United States)

    Biccard, B M

    2005-06-01

    Functional capacity is an integral component of the pre-operative evaluation of the cardiac patient for non-cardiac surgery. Stair climbing capacity has peri-operative prognostic importance. It may predict survival after lung resection and complications after major non-cardiac surgery. However, stair climbing cannot determine the aerobic metabolic capacity necessary to survive the peri-operative stress response. The potential benefits and current limitations of cardiopulmonary exercise testing to determine peri-operative aerobic capacity are discussed. Principles for the selection of an appropriate screening test of aerobic function are put forward.

  11. Perfluorocarbon in vitreoretinal surgery and preoperative bevacizumab in diabetic tractional retinal detachment

    Institute of Scientific and Technical Information of China (English)

    J; Fernando; Arevalo; Martin; A; Serrano; Juan; D; Arias

    2014-01-01

    AIM: To describe the en bloc perfluorodissection(EBPD) technique and to demonstrate the applicabilityof using preoperative intravitreal bevacizumab duringsmall-gauge vitreoretinal surgery(23-gauge transconjunctival sutureless vitrectomy) in eyes with advancedproliferative diabetic retinopathy(PDR) with tractionalretinal detachment(TRD).METHODS: This is a prospective, interventional caseseries. Participants included 114(eyes) with advancedproliferative diabetic retinopathy and TRD. EBPD wasperformed in 114 eyes(consecutive patients) during23-gauge vitrectomy with the utilization of preoperativebevacizumab(1.25 mg/-0.05 mL). Patients mean age was 45 years(range, 21-85 years). Surgical time had a mean of 55 min(Range, 25-85 min). Mean follow up of this group of patients was 24 mo(range, 12-32 mo). Main outcome measures included best-corrected visual acuity(BCVA), retinal reattachment, and complications.RESULTS: Anatomic success occurred in 100%(114/-114) of eyes. Significant visual improvement [≥ 2 Early Treatment Diabetic Retinopathy Study(ETDRS) lines] was obtained in 69.2%(79/-114), in 26 eyes(22.8%) BCVA remained stable, and in 8 eyes(7%) BCVA decreased(≥ 2 ETDRS lines). Final BCVA was 20/-50 or better in 24% of eyes, between 20/-60 and 20/-400 in 46% of eyes, and worse than 20/-400 in 30% of eyes. Complications included cataract in 32(28%) eyes, iatrogenic retinal breaks in 9(7.8%) eyes, vitreous hemorrhage requiring another procedure in 7(6.1%) eyes, and phthisis bulbi in 1(0.9%) eye.CONCLUSION: This study demonstrates the usefulne-ss of using preoperative intravitreal bevacizumab and EBPD during smallgauge vitreoretinal surgery in eyes with TRD in PDR.

  12. Preoperative evaluation with T-staging system for hilar cholangiocarcinoma

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM: To investigate the clinical value of T-staging system in the preoperative assessment of hilar cholangiocarcinoma.METHODS: From March 1993 to January 2006, 85 patients who had cholangiocarcinoma diagnosed by operative tissue-biopsy were placed into one of three stages based on the new T-staging system, and it was evaluated the resectability and survival correlated with T-staging.RESULTS: The likelihood of resection and achieving tumor-free margin decreased progressively with increasing T stage (P < 0.05). The cumulative 1-year survival rates of T1, T2 and T3 patients were 71.8%,50.8% and 12.9% respectively, and the cumulative 3-year survival rate was 34.4%, 18.2% and 0%respectively; the survival of different stage patients differed markedly (P < 0.001). Median survival in the hepatic resection group was greater than in the group that did not undergo hepatic resection (28 mo vs 18 mo;P < 0.05). The overall accuracy for combined MRCP and color Doppler Ultrasonagraphy detecting disease was higher than that of combined using CT and color Doppler Ultrasonagraphy (91.4% vs 68%; P < 0.05 ). And it was also higher in detecting port vein involvement (90% vs54.5%; P < 0.05).CONCLUSION: The proposed staging system for hilar cholangiocarcinoma can accurately predict resectability,the likelihood of metastatic disease, and survival.A concomitant partial hepatectomy would help to attain curative resection and the possibility of longterm survival. MRCP/MRA coupled with color Doppler Ultrasonagraphy was necessary for preoperative evaluation of hilar cholangiocarcinoma.

  13. Preoperative and post-operative sleep quality evaluation in rotator cuff tear patients.

    Science.gov (United States)

    Serbest, Sancar; Tiftikçi, Uğur; Askın, Aydogan; Yaman, Ferda; Alpua, Murat

    2017-07-01

    The aim of this study was to examine the potential relationship between subjective sleep quality and degree of pain in patients with rotator cuff repair. Thirty-one patients who underwent rotator cuff repair prospectively completed the Pittsburgh Sleep Quality Index, the Western Ontario Rotator Cuff Index, and the Constant and Murley shoulder scores before surgery and at 6 months after surgery. Preoperative demographic, clinical, and radiologic parameters were also evaluated. The study analysed 31 patients with a median age of 61 years. There was a significant difference preoperatively versus post-operatively in terms of all PSQI global scores and subdivisions (p Rotator Cuff Scale and the Constant and Murley shoulder scores (p ˂ 0.001). Sleep disorders are commonly seen in patients with rotator cuff tear, and after repair, there is an increase in the quality of sleep with a parallel improvement in shoulder functions. However, no statistically significant correlation was determined between arthroscopic procedures and the size of the tear and sleep quality. It is suggested that rotator cuff tear repair improves the quality of sleep and the quality of life. IV.

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

    Science.gov (United States)

    Wilder-Smith, Oliver Hamilton; Schreyer, Tobias; Scheffer, Gert Jan; Arendt-Nielsen, Lars

    2010-06-01

    Chronic pain is common and undesirable after surgery. Progression from acute to chronic pain involves altered pain processing. The authors studied relationships between presence of chronic pain versus preoperative descending pain control (diffuse noxious inhibitory controls; DNICs) and postoperative persistence and spread of skin and deep tissue hyperalgesia (change in electric/pressure pain tolerance thresholds; ePTT/pPTT) up to 6 months postoperatively. In 20 patients undergoing elective major abdominal surgery under standardized anesthesia, we determined ePTT/pPTT (close to [abdomen] and distant from [leg] incision), eDNIC/pDNIC (change in ePTT/pPTT with cold pressor pain task; only preoperatively), and a 100 mm long pain visual analogue scale (VAS) (0 mm = no pain, 100 mm = worst pain imaginable), both at rest and on movement preoperatively, and 1 day and 1, 3, and 6 months postoperatively. Patients reporting chronic pain 6 months postoperatively had more abdominal and leg skin hyperalgesia over the postoperative period. More inhibitory preoperative eDNIC was associated with less late postoperative pain, without affecting skin hyperalgesia. More inhibitory pDNIC was linked to less postoperative leg deep tissue hyperalgesia, without affecting pain VAS. This pilot study for the first time links chronic pain after surgery, poorer preoperative inhibitory pain modulation (DNIC), and greater postoperative degree, persistence, and spread of hyperalgesia. If confirmed, these results support the potential clinical utility of perioperative pain processing testing.

  15. Preoperative neutrophil response as a predictive marker of clinical outcome following open heart surgery and the impact of leukocyte filtration.

    LENUS (Irish Health Repository)

    Soo, Alan W

    2010-11-01

    Open heart surgery is associated with a massive systemic inflammatory response. Neutrophils, are the main mediator of this response. We hypothesised that the degree of neutrophil activation and inflammatory response to open heart surgery varies individually and correlates with clinical outcome. The aim of this study was to determine if individual clinical outcome can be predicted preoperatively through assessment of in-vitro stimulated neutrophil responses. Following that, the effects of neutrophil depletion through leukocyte filters are examined.

  16. Preoperative protein and energy intake and postoperative complications in well-nourished, non-hospitalized elderly cardiac surgery patients

    NARCIS (Netherlands)

    L.M.W. van Venrooij; P.A.M. van Leeuwen; R. de Vos; M.M.M.J. Borgmeijer-Hoelen; B.A.J.M. de Mol

    2009-01-01

    Background & aims: Little is known about the impact of preoperative protein or energy intake in relation to the occurrence of postoperative complications in patients who are not undernourished but cannot keep up their daily protein or energy requirements prior to cardiac surgery. Therefore, a prospe

  17. Role of contrast-enhanced MR venography in the preoperative evaluation of parasagittal meningiomas

    Energy Technology Data Exchange (ETDEWEB)

    Bozzao, Alessandro; Finocchi, Vanina; Romano, Andrea; Ferrante, Michele; Fasoli, Fabrizio; Fantozzi, Luigi Maria [S. Andrea Hospital, Neuroradiological Section, Rome (Italy); Trillo, Giuseppe; Ferrante, Luigi [S. Andrea Hospital, Neurosurgical Section, Rome (Italy)

    2005-09-01

    Parasagittal meningiomas (PSM) may pose a difficult surgical challenge since venous patency and collateral anastomoses have to be clearly defined for correct surgical planning. The aim of this study was to assess the diagnostic value of contrast-enhanced (CE) magnetic resonance venography (MRV) in the preoperative evaluation of venous infiltration and collateral venous anastomoses in patients with PSM. CE-MRV was compared with phase-contrast (PC) magnetic resonance (MR) angiography, conventional angiography (when available), and surgery as a reference. Twenty-three patients undergoing surgery for meningiomas located adjacent to the superior sagittal sinus were prospectively evaluated. All the patients underwent both conventional MR examination and MRV. This was performed by means of PC and CE techniques. Both sets of angiograms (CE and PC) were evaluated by two expert neuroradiologists to assess (1) patency of the sinus (patent/occluded), (2) the extent of occlusion (in centimeters), and (3) the number of collateral anastomoses close to the insertion of the meningioma. Eight patients underwent digital subtraction angiography (DSA). All patients were operated on, and intraoperative findings were taken as the gold standard to evaluate the diagnostic value of MRA techniques. PC-MRV showed a flow void inside the sinus compatible with its occlusion in 15 cases, whereas CE-MRV showed the sinus to be occluded in five cases. CE-MRV data were confirmed by surgery, showing five patients to have an occlusion of the superior sagittal sinus. The PC-MRV sensitivity was thus 100% with a specificity of 50%. In those cases in which both MRV techniques documented occlusion of the sinus, the extent of occlusion was overestimated by PC compared with CE and surgery. CE-MRV depicted 87% of collateral venous anastomoses close to the meningioma as subsequently confirmed by surgery, while PC showed 58%. In the preoperative planning for patients with meningiomas located close to a venous

  18. Long-term results of a randomized controlled trial evaluating preoperative chemotherapy in resectable non-small cell lung cancer

    Directory of Open Access Journals (Sweden)

    Chen ZW

    2013-06-01

    Full Text Available Zhiwei Chen,* Qingquan Luo,* Hong Jian, Zhen Zhou, Baijun Cheng, Shun Lu, Meilin LiaoShanghai Lung Tumor Clinical Medical Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China *These authors contributed equallyObjective: We aimed to evaluate whether preoperative chemotherapy provides benefits in the survival and prognosis of patients with non-small cell lung cancer (NSCLC in resectable stages I to IIIA, except T1N0. Methods: In this randomized, controlled trial, 356 patients with stage I (except for T1N0, II and IIIA NSCLC were assigned to either the preoperative chemotherapy plus surgery arm (179 patients or the primary surgery arm (177 patients. Both treatments were followed by adjuvant chemotherapy. The end point of this study included overall survival (OS, progression-free survival (PFS, and survival rate associated with clinical remission. Results: Statistical survival difference was found between the preoperative chemotherapy plus surgery arm and the surgery-alone arm. However, the median survival time (MST in the preoperative chemotherapy arm was lower than that of surgery-alone arm (MST, 45.42 months vs 57.59 months (P = 0.016. When comparing the effect of preoperative chemotherapy at each stage of NSCLC, a statistical survival difference was found in stage II NSCLC but not in stage I and IIIA (MST 40.86 months vs 80.81 months (P = 0.044. However, no statistically significant difference in PFS was noticed between the two arms, except for stage I NSCLC (hazard radio [HR] = 0.87; 95% CI, 0.561−1.629; P = 0.027. The survival rate was higher for patients who had clinical remission after preoperative chemotherapy, but the differences did not reach statistical significance (MST 42.10 months vs 35.33 months (P = 0.630. Conclusion: Preoperative chemotherapy did not show benefits in OS and PFS for stage I-IIIA NSCLC patients. Keywords: NSCLC, neoadjuvent, mitomycin, cisplatin, vindesine

  19. Prediction of perioperative cardiac events through preoperative NT-pro-BNP and cTnI after emergent non-cardiac surgery in elderly patients.

    Science.gov (United States)

    Ma, Jinling; Xin, Qian; Wang, Xiujie; Gao, Meng; Wang, Yutang; Liu, Jie

    2015-01-01

    Clinical risk stratification has an important function in preoperative evaluation of patients at risk for cardiac events prior to non-cardiac surgery. The aim of this study was to determine whether the combined measurement of pre-operative N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and cardiac troponin I (cTnI) could provide useful prognostic information about postoperative major adverse cardiac events (MACE) within 30 days in patients aged over 60 years undergoing emergent non-cardiac surgery. The study group comprised 2519 patients aged over 60 years that were undergoing emergent non-cardiac surgery between December 2007 and December 2013. NT-pro-BNP and cTnI were measured during hospital admission. The patients were monitored for MACE (cardiac death, non-fatal myocardial infarction, or cardiac arrest) during the 30-day postoperative follow-up period. MACE occurred in 251 patients (10.0%). Preoperative NT-pro-BNP and cTNI level were significantly higher in the individuals that experienced MACE than in those who did not (P 917 pg/mL (OR 4.81, 95% CI 3.446-6.722, P 917 pg/mL and cTnT ≥ 0.07 ng/mL had worse event-free survival than individual assessments of either biomarker. Preoperative plasma NT-proBNP and cTnI are both independently associated with an increased risk of MACE in elderly patients after emergent non-cardiac surgery. The combination of these biomarkers provides better prognostic information than using either biomarker separately.

  20. Preoperative Magnetic Resonance Imaging Evaluation in Patients with Adolescent Idiopathic Scoliosis

    Science.gov (United States)

    Lee, Choon Sung; Kim, Nam Heun; Noh, Hyun Min; Lee, Mi Young; Yoon, So Jung; Lee, Dong-Ho

    2017-01-01

    Study Design Retrospective case series. Purpose The purpose of this study was to examine the incidence of neural axis abnormalities and the relevant risk factors in patients with adolescent idiopathic scoliosis (AIS). Overview of Literature The use of preoperative magnetic resonance imaging (MRI) to assess the whole spine in patients with idiopathic scoliosis is controversial, and indications for such MRI evaluations have not been definitively established. However, we routinely use whole-spine MRI in patients with scoliosis who are scheduled to undergo surgical correction. Methods A total of 378 consecutive patients with presumed AIS who were admitted for spinal surgery were examined for neural axis abnormalities using MRI. To differentiate patients with normal and abnormal MRI findings, the following clinical parameters were evaluated: age, sex, menarcheal status, rotation angle (using a scoliometer), coronal balance, shoulder height difference, and low back pain. We radiographically evaluated curve type, thoracic or thoracolumbar curve direction, curve magnitude and flexibility, apical vertebral rotation, curve length, coronal balance, sagittal balance, shoulder height difference, thoracic kyphosis, and the Risser sign. Results Neural axis abnormalities were detected in 24 patients (6.3%). Abnormal MRI findings were significantly more common in males than in females and were associated with increased thoracic kyphosis. However, there were no significant differences in terms of the other measured parameters. Conclusions Among the patients with presumed AIS who received preoperative whole-spine MRI, 6.3% had neural axis abnormalities. Males and patients with increased thoracic kyphosis were at a higher risk. PMID:28243367

  1. Bariatric surgery in 1119 patients with preoperative body mass index<35 (kg/m(2)): results at 1 year.

    Science.gov (United States)

    Maiz, Cristóbal; Alvarado, Juan; Quezada, Nicolás; Salinas, José; Funke, Ricardo; Boza, Camilo

    2015-01-01

    The use of body mass index (BMI) as the only criterion to indicate bariatric surgery is currently under discussion. There is growing evidence that supports bariatric surgery in carefully selected patients with lower BMI. To report our experience in bariatric surgery in>1000 patients with BMI<35 kg/m(2) and their results at 1 year. University hospital (censored). A retrospective analysis was performed in patients who underwent laparoscopic Roux-en-Y gastric bypass (LRYGB) or sleeve gastrectomy (SG) with preoperative BMI<35 kg/m(2) from January 2008 to December 2011. Demographic and anthropometric data, preoperative co-morbidities, and perioperative variables were retrieved. Weight loss and co-morbidities progression were analyzed 1 year after surgery and compared among procedures. A P value<.05 was considered significant. We identified 1119 patients: mean age 38.8±11.4, 951 (85%) women, preoperative weight 87.5±9.3 kg and BMI 33.1 (31.9-34.1) kg/m(2). Preoperatively, 11.7% had type 2 diabetes mellitus, 25.9% arterial hypertension, 55.6% insulin resistance, and 53.2% dyslipidemia. In total, 283 patients (25.2%) underwent LRYGB and 836 (74.8%) SG. One year after surgery (follow-up: 66.67%) patients reached 24.5 (22.8-26.4) BMI and the percentage of excess of weight loss (%EWL) was 107.9±36.6%. Diabetes, hypertension, insulin resistance, and dyslipidemia remission/improvement rates were 54/39%, 58/29%, 72/17%, and 54/30%, respectively. Bariatric surgery in selected class I obesity patients can safely be performed. We have observed good results in terms of weight loss and co-morbidity improvement/remission. Long-term follow-up is required. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  2. European Society of Cardiology 2009 guidelines for preoperative cardiac risk assessment and perioperative cardiac management in noncardiac surgery. Key messages for clinical practice

    Directory of Open Access Journals (Sweden)

    Sanne E. Hoeks

    2010-07-01

    Full Text Available Patients undergoing noncardiac surgery are at risk of adverse perioperative and long-term outcome. When considering a patient for noncardiac surgery, a careful preoperative clinical risk evaluation and subsequent risk-reduction strategies are essential to reduce postoperative complications. To assist physicians with decision making, clinical guidelines are developed. The aim of clinical guidelines is to improve patient care by providing recommendations about appropriate healthcare in specific circumstances. Development of clinical guidelines is an important component in improving the quality of care. By translating the best available scientific evidence into specific recommendations, guidelines can serve as a useful tool to achieve effective and efficient patient care. In 2009, the first European Society of Cardiology guidelines on perioperative care were developed. This decisionmaking process integrates clinical markers, early coronary evaluation, functional capacity, and the type of surgery involved.

  3. The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery.

    Science.gov (United States)

    Singla, Anuj; Yang, Scott; Werner, Brian C; Cancienne, Jourdan M; Nourbakhsh, Ali; Shimer, Adam L; Hassanzadeh, Hamid; Shen, Francis H

    2017-03-14

    OBJECTIVE Lumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion. METHODS A nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI. RESULTS The overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p fusion more than 3 months after LESI. CONCLUSIONS Lumbar spinal fusion performed within 3 months after LESI may be associated with an increased rate of postoperative infection. This association was not found when lumbar

  4. Role of routine pre-operative screening venous duplex ultrasound in morbidly obese patients undergoing bariatric surgery

    Directory of Open Access Journals (Sweden)

    P Praveen Raj

    2017-01-01

    Full Text Available Background/Aims: It is well established that obesity is a strongly associated risk factor for post-operative deep vein thrombosis (DVT. Physical effects and pro-thrombotic, pro-inflammatory and hypofibrinolytic effects of severe obesity may predispose to idiopathic DVT (pre-operatively because of which bariatric patients are routinely screened before surgery. The aim of this study was to audit the use of routine screening venous duplex ultrasound in morbidly obese patients before undergoing bariatric surgery. Methods: We retrospectively reviewed 180 patients who underwent bariatric surgery from August 2013 to August 2014 who had undergone pre-operative screening bilateral lower-extremity venous duplex ultrasound for DVT. Data were collected on patient's demographics, history of venous thromboembolism, prior surgeries and duplex ultrasound details of the status of the deep veins and superficial veins of the lower limbs. Results: No patients had symptoms or signs of DVT pre-operatively. No patient gave history of DVT. No patient was found to have iliac, femoral or popliteal vein thrombosis. Superficial venous disease was found in 17 (8%. One patient had a right lower limb venous ulcer. Conclusion: Thromboembolic problems in the morbidly obese before bariatric surgery are infrequent, and screening venous duplex ultrasound can be done in high-risk patients only.

  5. Remote Digital Preoperative Assessments for Cleft Lip and Palate May Improve Clinical and Economic Impact in Global Plastic Surgery.

    Science.gov (United States)

    Hughes, Christopher; Campbell, Jacob; Mukhopadhyay, Swagoto; McCormack, Susan; Silverman, Richard; Lalikos, Janice; Babigian, Alan; Castiglione, Charles

    2017-09-01

    Reconstructive surgical care can play a vital role in the resource-poor settings of low- and middle-income countries. Telemedicine platforms can improve the efficiency and effectiveness of surgical care. The purpose of this study is to determine whether remote digital video evaluations are reliable in the context of a short-term plastic surgical intervention. The setting for this study was a district hospital located in Latacunga, Ecuador. Participants were 27 consecutive patients who presented for operative repair of cleft lip and palate. We calculated kappa coefficients for reliability between in-person and remote digital video assessments for the classification of cleft lip and palate between two separate craniofacial surgeons. We hypothesized that the technology would be a reliable method of preoperative assessment for cleft disease. Of the 27 (81.4%) participants, 22 received operative treatment for their cleft disorder. Mean age was 11.1 ± 8.3 years. Patients presented with a spectrum of disorders, including cleft lip (24 of 27, 88.9%), cleft palate (19 of 27, 70.4%), and alveolar cleft (19 of 27, 70.4%). We found a 95.7% agreement between observers for cleft lip with substantial reliability (κ = .78, P cleft palate, with a moderate interrater reliability (κ = .55, P = .01). We found only a 47.8% agreement between observers for alveolar cleft with a nonsignificant, weak kappa agreement (κ = .06, P = .74). Remote digital assessments are a reliable way to preoperatively diagnose cleft lip and palate in the context of short-term plastic surgical interventions in low- and middle-income countries. Future work will evaluate the potential for real-time, telemedicine assessments to reduce cost and improve clinical effectiveness in global plastic surgery.

  6. Bloodless surgery in a patient with thalassemia minor. Usefulness of erythropoietin, preoperative blood donation and intraoperative blood salvage.

    Science.gov (United States)

    Pérez Ferrer, A; Ferrazza, V; Gredilla, E; de Vicente, J; de la Rua, A; Larrea, A

    2007-05-01

    A patient with thalassemia minor and idiopathic scoliosis was scheduled for posterior vertebral arthrodesis. The diagnosis of thalassemia minor was made during the preoperative assessment. Preoperative blood cell count displayed the following data: red blood count 5.4 x 106/microL, haemoglobin 11.6 g/dL and hematocrit 36.9%. As corrective surgery for scoliosis is associated with major blood loss, the patient was scheduled for preoperative treatment with human recombinant erythropoietin (rHuEPO), autologous blood donation, intraoperative blood cell salvage and administration of tranexamic acid. The use of rHuEPO was intended to increase hemoglobin (12.1 g/dL) levels at the moment of surgery following the donation of 2 autologous blood units. 1000 mL of salvaged blood were processed. The output line of the blood cell salvage machine did not show any sign of increased red cell haemolysis. The postoperative course was uneventful and the patient was discharged from the postoperative intensive care unit on day 7 after surgery with no allogenic blood transfusion. No references detailing the use of rHuEPO and autologous blood donation preoperatively in patients with thalassemia minor and only one case report discussed the utility of intraoperative blood cell salvage in a patient with thalassemia intermedia. Although further experience is needed, this case report suggests that even for patients with thalassemia minor, methods focused on allogenic blood salvage can be used safely.

  7. Evaluation of the Association Between Preoperative Clinical Factors and Long-term Weight Loss After Roux-en-Y Gastric Bypass.

    Science.gov (United States)

    Wood, G Craig; Benotti, Peter N; Lee, Clare J; Mirshahi, Tooraj; Still, Christopher D; Gerhard, Glenn S; Lent, Michelle R

    2016-11-01

    Weight loss after bariatric surgery varies, yet preoperative clinical factors associated with long-term suboptimal outcomes are not well understood. To evaluate the association between preoperative clinical factors and long-term weight loss after Roux-en-Y gastric bypass (RYGB). From June 2001 to September 2007, this retrospective cohort study followed up RYGB patients before surgery to 7 to 12 years after surgery. The setting was a large rural integrated health system. Of 1033 eligible RYGB patients who consented to participate in longitudinal research and completed surgery before October 2007, a total of 726 (70.3%) had a weight entered in the electronic medical record 7 or more years after surgery and were included in the analyses after exclusions for pregnancy and mortality. Date of the long-term weight measurement was recorded between August 2010 and January 2016. The primary outcome was percentage weight loss (%WL) at 7 to 12 years after surgery. Preoperative clinical factors (>200) extracted from the electronic medical record included medications, comorbidities, laboratory test results, and demographics, among others. Among the 726 study participants, 83.1% (n = 603) were female and 97.4% (n = 707) were of white race, with a mean (SD) preoperative body mass index (calculated as weight in kilograms divided by height in meters squared) of 47.5 (7.4). From the time of surgery to long-term follow-up (median, 9.3 postoperative years), the mean (SD) %WL was 22.5% (13.1%). Preoperative insulin use, history of smoking, and use of 12 or more medications before surgery were associated with greater long-term postoperative %WL (6.8%, 2.8%, and 3.1%, respectively). Preoperative hyperlipidemia, older age, and higher body mass index were associated with poorer long-term postoperative %WL (-2.8%, -8.8%, and -4.1%, respectively). Few preoperative clinical factors associated with long-term weight loss after RYGB were identified. Preoperative insulin use was strongly

  8. Effects of preoperative ketamine on the endocrine-metabolic and inflammatory response to laparoscopic surgery

    Institute of Scientific and Technical Information of China (English)

    DU Jin; HUANG Yu-guang; YU Xue-rong; ZHAO Na

    2011-01-01

    Background Ketamine is hypothesized to reduce perioperative endocrine-metabolic and inflammatory responses in cardiac surgery patients.This randomized,placebo-controlled,double-blind study was performed to determine whether perioperative endocrine-metabolic and inflammatory responses are attenuated by preoperative administration of ketamine to healthy females receiving elective laparoscopic surgery.Methods Forty female patients with American Society of Anesthesiologist classification Ⅰ or Ⅱ who elected to receive gynecological laparoscopic surgery were randomly assigned to the ketamine-treated (group K; n = 20) or control (group C;n = 20) group.At 2 minutes prior to induction patients in group K received ketamine (0.25 mg/kg) whereas those in group C received normal saline.All patients received standardized general anesthesia.Serum glucose and cortisol values were measured before ketamine administration (TO),2 minutes after tracheal intubation (T1),30 minutes after skin incision (T2),2 minutes after tracheal extubation (T3) and 1 hour postoperatively (T4).Serum interleukin-6 and tumor necrosis factor-α values were determined at TO and T4.Postoperative analgesic efficacy,side effects of administered drugs,and time to discharge were recorded.Results Compared with subjects in group C,those in group K had lower serum glucose values at T1,T2,T3 and T4 and lower serum cortisol values at T4 (P <0.05).Postoperative interleukin-6 and tumor necrosis factor-α concentrations for group K were lower than those for group C (P <0.05).Postoperative visual analog scale scores at rest,cumulative fentanyl consumption,and time to discharge were lower in group K as compared to group C (P <0.05).No significant differences in drug side effects were observed postoperatively between the two groups.Conclusion Endocrine-metabolic and inflammatory responses to laparoscopic surgery are attenuated in part by pre-incisional administration of ketamine.

  9. Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies

    DEFF Research Database (Denmark)

    Philip Rothman, Josephine; Burcharth, Jakob; Pommergaard, Hans-Christian;

    2016-01-01

    BACKGROUND: Preoperative risk factors for the conversion of laparoscopic cholecystectomy to open surgery have been identified, but never been explored systematically. Our objective was to systematically present the evidence of preoperative risk factors for conversion of laparoscopic cholecystecto...... cholecystitis were risk factors for the conversion of laparoscopic cholecystectomy to open surgery. Furthermore, there was no association between diabetes mellitus or white blood cell count and conversion to open surgery....

  10. Engaging Patients, Health Care Professionals, and Community Members to Improve Preoperative Decision Making for Older Adults Facing High-Risk Surgery.

    Science.gov (United States)

    Steffens, Nicole M; Tucholka, Jennifer L; Nabozny, Michael J; Schmick, Andrea E; Brasel, Karen J; Schwarze, Margaret L

    2016-10-01

    Older patients are at greater risk for postoperative complications, yet they are less likely than younger patients to ask questions about surgery. To design an intervention to improve preoperative decision making and manage postoperative expectations. A Patient and Family Advisory Council (PFAC) was created to help identify preoperative decisional needs. The PFAC included 4 men and women who had previous experience with high-risk surgery as older patients or their family members; the PFAC met monthly at a local library from May 2014 to April 2015 to examine findings from a prior qualitative study and to integrate themes with PFAC members' experiences. Patient observations included 91 recorded conversations between patients and surgeons and 61 patient interviews before and after surgery. The PFAC members and other stakeholders evaluated 118 publicly available questions and selected 12 corresponding to identified needs to generate a question prompt list (QPL). Three focus groups, including 31 community members from diverse backgrounds, were conducted at community centers in Madison and Milwaukee, Wisconsin, to refine the QPL. A clinical pilot with 42 patients considering surgery was conducted in one outpatient surgical clinic in Madison. Generation of a QPL to address patients' preoperative informational and decisional needs. Through exploration of qualitative data, the PFAC noted 3 critical problems. Patients and family members believed surgery had to be done, were surprised that postoperative recovery was difficult, and lacked knowledge about the perioperative use of advance directives. The PFAC identified a need for more information and decisional support during preoperative conversations that included clarification of treatment options, setting postoperative expectations, and advance care planning. The following 3 question prompt categories arose: "Should I have surgery?" "What should I expect if everything goes well?" and "What happens if things go wrong?" The

  11. Development of a preoperative predictive model for major complications following adult spinal deformity surgery.

    Science.gov (United States)

    Scheer, Justin K; Smith, Justin S; Schwab, Frank; Lafage, Virginie; Shaffrey, Christopher I; Bess, Shay; Daniels, Alan H; Hart, Robert A; Protopsaltis, Themistocles S; Mundis, Gregory M; Sciubba, Daniel M; Ailon, Tamir; Burton, Douglas C; Klineberg, Eric; Ames, Christopher P

    2017-03-24

    OBJECTIVE The operative management of patients with adult spinal deformity (ASD) has a high complication rate and it remains unknown whether baseline patient characteristics and surgical variables can predict early complications (intraoperative and perioperative [within 6 weeks]). The development of an accurate preoperative predictive model can aid in patient counseling, shared decision making, and improved surgical planning. The purpose of this study was to develop a model based on baseline demographic, radiographic, and surgical factors that can predict if patients will sustain an intraoperative or perioperative major complication. METHODS This study was a retrospective analysis of a prospective, multicenter ASD database. The inclusion criteria were age ≥ 18 years and the presence of ASD. In total, 45 variables were used in the initial training of the model including demographic data, comorbidities, modifiable surgical variables, baseline health-related quality of life, and coronal and sagittal radiographic parameters. Patients were grouped as either having at least 1 major intraoperative or perioperative complication (COMP group) or not (NOCOMP group). An ensemble of decision trees was constructed utilizing the C5.0 algorithm with 5 different bootstrapped models. Internal validation was accomplished via a 70/30 data split for training and testing each model, respectively. Overall accuracy, the area under the receiver operating characteristic (AUROC) curve, and predictor importance were calculated. RESULTS Five hundred fifty-seven patients were included: 409 (73.4%) in the NOCOMP group, and 148 (26.6%) in the COMP group. The overall model accuracy was 87.6% correct with an AUROC curve of 0.89 indicating a very good model fit. Twenty variables were determined to be the top predictors (importance ≥ 0.90 as determined by the model) and included (in decreasing importance): age, leg pain, Oswestry Disability Index, number of decompression levels, number of

  12. DEVELOPMENT AND EVALUATION OF EVIDENCE BASED PRE-OPERATIVE PATIENT EDUCATION BOOKLET IN LUMBAR DISCECTOMY

    Directory of Open Access Journals (Sweden)

    Manish Nagpal

    2014-02-01

    Full Text Available Objective: The objective of this study was to contribute towards further understanding of the preoperative educational requirement of patients by developing and evaluating suitable evidence based patient education booklet in lumbar discectomy. Summary of background data: The primary surgical intervention for lumbar radiculopathy is lumbar discectomy but its result remains variable. Patient education has been found beneficial in various surgeries and resulted in enhanced outcome of the surgery with respect to pain, disability and quality of life. Methodology: It consists of 5 Steps. 1 Literature review, informal interview and questionnaire filled by 3 surgeons, 5 physiotherapists and 5 patients were used to determine the domains of the education booklet. 2 Literature review to develop the content for the domains of the booklet and formulate a rough draft of the booklet. 3 Modification in the booklet as recommended by surgeons and therapists to develop the final booklet. 4 Evaluation of the booklet on readability ease by Flesch reading ease and by Suitability assessment of Material questionnaire filled by surgeons and therapists. 5 Pilot study on patients to take their views regarding the booklet developed. Results: The domains determined in step 1 were: Anatomy, understanding the mechanism of pain, about the surgery, complications associated with surgery and role of physiotherapy. The content was developed and modified in step 2 and 3. In step 4 Flesch reading score is 70.5 and suitability assessment of material questionnaire score- 77.3%. In step 5 patients rated the booklet easy to read and understand. Conclusion: The developed patient education booklet came out to be fairly easy to read according to flesch reading ease and of superior quality according to suitability assessment of material questionnaire and hence should be made a part of patient education.

  13. Risk Factors for Preoperative Seizures and Loss of Seizure Control in Patients Undergoing Surgery for Metastatic Brain Tumors.

    Science.gov (United States)

    Wu, Adela; Weingart, Jon D; Gallia, Gary L; Lim, Michael; Brem, Henry; Bettegowda, Chetan; Chaichana, Kaisorn L

    2017-08-01

    Metastatic brain tumors are the most common brain tumors in adults. Patients with metastatic brain tumors have poor prognoses with median survival of 6-12 months. Seizures are a major presenting symptom and cause of morbidity and mortality. In this article, risk factors for the onset of preoperative seizures and postoperative seizure control are examined. Adult patients who underwent resection of one or more brain metastases at a single institution between 1998 and 2011 were reviewed retrospectively. Of 565 patients, 114 (20.2%) patients presented with seizures. Factors independently associated with preoperative seizures were preoperative headaches (P = 0.044), cognitive deficits (P = 0.031), more than 2 intracranial metastatic tumors (P = 0.013), temporal lobe location (P = 0.031), occipital lobe location (P = 0.010), and bone involvement by tumor (P = 0.029). Factors independently associated with loss of seizure control after surgical resection were preoperative seizures (P = 0.001), temporal lobe location (P = 0.037), lack of postoperative chemotherapy (P = 0.010), subtotal resection of tumor (P = 0.022), and local recurrence (P = 0.027). At last follow-up, the majority of patients (93.8%) were seizure-free. Thirty patients (5.30%) in total had loss of seizure control, and only 8 patients (1.41%) who did not have preoperative seizures presented with new-onset seizures after surgical resection of their metastases. The brain is a common site for metastases from numerous primary cancers, such as breast and lung. The identification of factors associated with onset of preoperative seizures as well as seizure control postoperatively could aid management strategies for patients with metastatic brain tumors. Patients with preoperative seizures who underwent resection tended to have good seizure control after surgery. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries

    OpenAIRE

    Gaonkar V; Daftary Swati

    2004-01-01

    In this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25) or peri-incisional infiltration (n=25) pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline. The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia...

  15. The prognostic value of pre-operative predicted forced vital capacity in corrective spinal surgery for Duchenne's muscular dystrophy.

    Science.gov (United States)

    Harper, C M; Ambler, G; Edge, G

    2004-12-01

    The majority of patients with Duchenne's muscular dystrophy require corrective spinal surgery for scoliosis to maintain seated balance and to slow the progression of respiratory compromise, thereby facilitating nursing and enhancing their quality of life. Traditionally patients with a pre-operative forced vital capacity (PFVC) of 30% or below predicted have been denied this surgery as it was thought that the incidence of postoperative complications was unacceptably high. We present data collected prospectively from 45 consecutive operations undertaken in our unit. These cases indicate that there is no clinically significant difference in operative and postoperative outcomes between patients with PFVC > 30% and vital.

  16. Preoperative nutritional status predicts the severity of the systemic inflammatory response syndrome (SIRS) following major vascular surgery.

    Science.gov (United States)

    Hassen, T A; Pearson, S; Cowled, P A; Fitridge, R A

    2007-06-01

    This study examined the relationship between pre-operative nutritional status and systemic inflammatory response syndrome (SIRS) or sepsis following major vascular surgery. Subjects undergoing open AAA repair, EVAR or lower limb revascularisation were studied prospectively. Pre-operative nutrition was assessed clinically using Mini-Nutritional Assessment (MNA) and body composition was measured by dual energy X-ray absorptiometry (DEXA) scanning. SIRS severity was assessed for 5 post-operative days and sepsis noted within 30 days of surgery. Using MNA, neither SIRS severity nor sepsis occurrence differed significantly between 'well-nourished' subjects and those 'at risk of malnutrition'. Using DEXA, negative associations existed between body mass index and both SIRS score and SIRS duration. Fat free mass (FFM) was negatively associated with SIRS score and duration. Negative associations also existed between skeletal muscle mass (SMM) and SIRS score and duration. SMM was also negatively correlated with post-operative length of stay in hospital. There were no significant correlations between sepsis and any nutritional indices. Lower pre-operative nutritional indices, indicating protein energy malnutrition, were associated with more severe systemic inflammatory responses following major vascular surgery.

  17. Evaluating the effect of preoperative oral gabapentin on ...

    African Journals Online (AJOL)

    2010-05-02

    May 2, 2010 ... 0riginal Research: Preoperative oral gabapentin in patients ... having pain scores ≥ 5 received rescue analgesia in the form of intravenous tramadol 0.5 mg.kg-1. If the ... decreases postoperative pain scores at zero hour and the rescue ... decreased physical and social function, as well as ... 2% lignocaine.

  18. Preoperative psychological evaluation of transplant patients: challenges and solutions

    Directory of Open Access Journals (Sweden)

    Kumnig M

    2015-06-01

    Full Text Available Martin Kumnig,1 Sheila Jowsey-Gregoire2 1Center for Advanced Psychology in Plastic and Transplant Surgery (CAPPTS, Department of Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria; 2Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA Abstract: Psychological assessments are crucial for the evaluation and optimization of the suitability of transplant patients. The interdisciplinary evaluation in modern transplantation medicine focuses on important psychosocial issues, such as assessing patients’ characteristics that predict best postoperative outcome after solid organ transplantation. When assessing patients for reconstructive hand transplantation, the psychological evaluation should identify whether reconstructive hand transplantation is the best treatment option to regain functionality and sensation, to resolve body image concerns, and to improve health-related quality of life (HRQOL for each patient. These psychosocial issues in transplantation medicine are receiving increased attention; however, standardized psychological evaluation and follow-up protocols are still being developed. Previously published reports in transplantation medicine have attempted to identify psychosocial factors important in the evaluation of transplant patients and that predict psychosocial outcomes. This review will provide an overview of recent investigations in solid organ and vascularized composite allotransplantation (VCA, including the domains of evaluation, pre- and posttransplant follow-up, psychiatric complications, evaluation of body image, and HRQOL. Recent work highlights the potential for a multicenter research approach utilizing standardized assessment strategies and emphasizing the need for a shared assessment approach to understand psychosocial outcomes. For example, the Chauvet Workgroup convened in 2014 in Paris with stakeholders in the assessment of psychosocial factors to discuss key areas and propose an

  19. Preoperative screening cultures in the identification of staphylococci causing wound and valvular infections in cardiac surgery

    NARCIS (Netherlands)

    E. J. Ridgway; A.P.R. Wilson; M. C. Kelsey

    1990-01-01

    textabstractCultures of nasal or presternal swabs form part of the routine preoperative screening of patients on the cardiac surgical ward. During a trial of antibiotic prophylaxis in 314 patients, preoperative isolates of Staphylococcus aureus and coagulase-negative staphylococci were compared with

  20. A randomised trial to evaluate preoperative oral carbohydrate administration on insulin resistance in off-pump coronary artery bypass patients.

    Science.gov (United States)

    Lee, Bora; Soh, Sarah; Shim, Jae-Kwang; Kim, Ha Y; Lee, Hyelin; Kwak, Young-Lan

    2017-04-21

    In fasting cardiac surgery patients, preoperative carbohydrate (CHO) drink intake attenuated insulin resistance and improved cardiac metabolism, although its beneficial effects were not evident after cardiac surgery possibly due to cardiopulmonary bypass-related extreme systemic inflammation. We aimed to evaluate whether preoperative CHO intake affected insulin resistance and free-fatty acid (FFA) concentrations in off-pump coronary revascularisation. A randomised controlled trial. Primary care in a university hospital in Korea from January 2015 to July 2016. Sixty patients who underwent elective multi-vessel off-pump coronary revascularisation were randomised into two groups. Three patients were excluded from analysis and 57 patients completed study. The CHO group received oral CHO (400 ml) the prior evening and 2 to 3 h before surgery, and the control group was fasted from food and water according to standard protocol. Insulin resistance was assessed twice, after anaesthetic induction and after surgery via short insulin tolerance test. FFA, C-reactive protein and creatine kinase-myocardial band concentrations were determined serially for 48 h after surgery. Insulin sensitivity was greater (P = 0.002) and plasma FFA concentrations were lower (P = 0.001) after anaesthetic induction in the CHO group compared with the Control group, although there were no intergroup differences after surgery. The postoperative peak creatine kinase-myocardial band concentration was significantly lower in the CHO group compared with the Control group [8.8 (5.4 to 18.2) vs. 6.4 (3.5 to 9.7) ng ml, P = 0.031]. A preoperative CHO supplement significantly reduced insulin resistance and FFA concentrations compared with fasting at the beginning of the surgery, but these benefits were lost after off-pump coronary revascularisation. Despite their transient nature, these beneficial effects resulted in less myocardial injury, mandating further studies focused on the impact

  1. Preoperative plasma leptin levels predict delirium in elderly patients after hip fracture surgery.

    Science.gov (United States)

    Chen, Xue-Wu; Shi, Jun-Wu; Yang, Ping-Shan; Wu, Zhu-Qi

    2014-07-01

    Leptin is considered to be a modulator of the immune response. Hypoleptinemia increases the risk for Alzheimer's disease and vascular dementia. The present study aimed to investigate the ability of plasma leptin level to predict delirium in elderly patients after hip fracture surgery. Postoperative delirium (pod) was evaluated using the Confusion Assessment Method. Prolonged postoperative delirium (ppod) was defined as delirium lasting more than 4 weeks. Plasma leptin levels of 186 elderly patients and 186 elderly controls were measured by an enzyme-linked immunosorbent assay. Plasma leptin level was substantially lower in patients than in controls (4.6±2.2ng/ml vs. 7.5±1.8ng/ml, Pdelirium and also prolonged delirium in elderly patients after hip fracture surgery.

  2. The Usefulness of the Preoperative Magnetic Resonance Imaging Findings in the Evaluation of Tarsal Tunnel Syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Hyun Jin; Lee, Sheen Woo; Jeong, Yu Mi; Choi, Hye Young; Kim, Hyung Sik [Dept. of Radiology, Gil Hospital, Gacheon University College of Medicine, Incheon (Korea, Republic of); Park, Hong Gi; Kwak, Ji Hoon [Dept. of Orthopedic Surgery, Gil Hospital, Gacheon University College of Medicine, Incheon (Korea, Republic of)

    2012-02-15

    The purpose of this study was to access the diverse conditions that lead to the clinical manifestations of tarsal tunnel syndrome and evaluate the usefulness of magnetic resonance imaging (MRI) in preoperative evaluation. Thirty-three patients who underwent ankle MRI and surgery under the impression of tarsal tunnel syndrome were retrospectively analyzed. The findings on ankle MRI were categorized into space occupying lesions within the tarsal tunnel, space occupying lesions of the tunnel wall, and non-space occupying lesions. Associated plantar muscle atrophy was also evaluated. Medical records were reviewed for correlation of nerve conduction velocity (NCV) and surgical findings. There were 21 space occupying lesions of the tarsal tunnel, and eight lesions of tarsal tunnel wall. There were three cases with accessory muscle, three with tarsal coalition, five with ganglion cysts, one neurogenic tumor, five flexor retinaculum hypertrophy, three varicose veins, and nine with tenosynovitis of the posterior tibialis, flexor digitorum longus, or flexor hallucis longus tendon. One patient was found to have a deltoid ligament sprain. Of the 32, eight patients experienced fatty atrophic change within any one of the foot muscles. NCV was positive in 79% of the MRI-positive lesions. MRI provides detailed information on ankle anatomy, which includes that of tarsal tunnel and beyond. Pathologic conditions that cause or mimic tarsal tunnel syndrome are well demonstrated. MRI can enhance surgical planning by indicating the extent of decompression required, and help with further patient management. Patients with tarsal tunnel syndrome can greatly benefit from preoperative MRI. However, it should be noted that not all cases with tarsal tunnel syndrome have MRI-demonstrable causes.

  3. [Impact of pre-operative uric acid on acute kidney injury after cardiac surgery in elderly patients].

    Science.gov (United States)

    Xu, Jiaqi; Chen, Yuanhan; Liang, Xinling; Hu, Penghua; Cai, Lu; An, Shengli; Li, Zhilian; Shi, Wei

    2014-11-01

    To investigate the impact of pre-operative uric acid on acute kidney injury (AKI) after cardiac surgery in elderly patients. Clinical data were collected from 936 elderly patients (age ≥ 60 years) undergoing cardiac surgery with cardiopulmonary bypass in Guangdong General Hospital between January 2005 and May 2011. The baseline serum creatinine was defined as the latest serum creatinine before surgery, and AKI was diagnosed according to RIFLE criteria. Patients were divided into three groups according to the sex-specific cutoff values of serum uric acid tertiles (group A: ≤ 384.65 µmol/L in men, and ≤ 354.00 µmol/L in women; group B:384.66-476.99 µmol/L in men and 354.01-437.96 µmol/L in women; group C: ≥ 477.00 µmol/L in men and ≥ 437.97 µmol/L in women). Multivariate logistic regression analysis was used to analyze the independent risk factors for AKI. Among 936 elderly patients, 576 cases (61.5%) developed AKI. Mean uric acid concentration was higher in AKI patients than in Non-AKI patients ( (436.6 ± 119.1) µmol/L vs. (398.0 ± 107.2) µmol/L, P cardiac surgery, eGFRsurgery, cardiopulmonary bypass operation time, aortic cross-clamping time, pre-operative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers and lipid-lowering drugs use, early postoperative angiotensin converting enzyme inhibitor or angiotensin II receptor blockers, diuretics and digoxin use, post-operation central venous pressure, risk of post operative AKI was significantly higher in group C than in group A (OR:1.897, 95%CI: 1.270-2.833, P = 0.002). Pre-operative elevated uric acid is an independent risk factor of AKI after cardiac surgery in elderly patients.

  4. Role of heart-rate variability in preoperative assessment of physiological reserves in patients undergoing major abdominal surgery

    Directory of Open Access Journals (Sweden)

    Reimer P

    2017-09-01

    Full Text Available Petr Reimer,1 Jan Máca,1 Pavel Szturz,1 Ondřej Jor,1 Roman Kula,1 Pavel Ševčík,1 Michal Burda,2 Milan Adamus3 1Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, 2Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, University of Ostrava, Ostrava, 3Department of Anesthesiology and Intensive Care Medicine, University Hospital Olomouc, Olomouc, Czech Republic Background: Major abdominal surgery (MAS is associated with increased morbidity and mortality. The main objective of our study was to evaluate the predictive value of heart-rate variability (HRV concerning development of postoperative complications in patients undergoing MAS. The secondary objectives were to identify the relationship of HRV and use of vasoactive drugs during anesthesia, intensive care unit length of stay (ICU-LOS, and hospital length of stay (H-LOS. Patients and methods: Sixty-five patients scheduled for elective MAS were enrolled in a prospective, single-center, observational study. HRV was measured by spectral analysis (SA preoperatively during orthostatic load. Patients were divided according to cardiac autonomic reactivity (CAR; n=23 and non-cardiac autonomic reactivity (NCAR; n=30. Results: The final analysis included 53 patients. No significant difference was observed between the two groups regarding type of surgery, use of minimally invasive techniques or epidural catheter, duration of surgery and anesthesia, or the amount of fluid administered intraoperatively. The NCAR group had significantly greater intraoperative blood loss than the CAR group (541.7±541.9 mL vs 269.6±174.3 mL, p<0.05. In the NCAR group, vasoactive drugs were used during anesthesia more frequently (n=21 vs n=4; p<0.001, and more patients had at least one postoperative complication compared to the CAR group (n=19 vs n=4; p<0.01. Furthermore, the NCAR group had more serious complications (Clavien–Dindo ≥ Grade

  5. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing open cardiothoracic or upper abdominal surgery: protocol for a systematic review

    OpenAIRE

    Mans Christina M; Reeve Julie C; Gasparini Catherine A; Elkins Mark R

    2012-01-01

    Abstract Background In patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources. Adequate preoperative respiratory muscle strength may help protect against the development of postoperative pulmonary complications and therefore preoperative inspiratory muscle training has been suggested to be of potential value in...

  6. The role of routine magnetic resonance imaging in the preoperative evaluation of adolescent idiopathic scoliosis.

    Science.gov (United States)

    Ozturk, Cagatay; Karadereler, Selhan; Ornek, Ibrahim; Enercan, Meric; Ganiyusufoglu, Kursat; Hamzaoglu, Azmi

    2010-04-01

    The routine use of magnetic resonance imaging (MRI) in adolescent idiopathic scoliosis remains controversial, and current indications for MRI in idiopathic scoliosis vary from study to study. The purpose of this study was to demonstrate the prevalence of neural axis malformations and the clinical relevance of routine MRI studies in the evaluation of patients with adolescent idiopathic scoliosis undergoing surgical intervention without any neurological findings. A total of 249 patients with a diagnosis of idiopathic scoliosis were treated surgically between the years 2002 and 2007. A routine whole spine MRI analysis was performed in all patients. On the preoperative clinical examination, all patients were neurologically intact. There were 20 (8%) patients (3 males and 17 females) who had neural axis abnormalities on MRI. Three of those 20 patients needed additional neurosurgical procedures before corrective surgery; the remaining underwent corrective spinal surgery without any neurosurgical operations. Magnetic resonance imaging may be beneficial for patients with presumed idiopathic scoliosis even in the absence of neurological findings and it is ideally performed from the level of the brainstem to the sacrum.

  7. What is the exact predictive role of preoperative white blood cell count for new-onset atrial fibrillation following open heart surgery?

    Directory of Open Access Journals (Sweden)

    Seyed Jalil Mirhosseini

    2013-01-01

    Full Text Available Background: Atrial fibrillation (AF occurs in 30% patients on the second or third day post operation; therefore, it is the most prevalent and complicated arrhythmia after open heart surgery. White blood cell (WBC count seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate the exact relationship between preoperative WBC count and post-Coronary artery bypass graft (CABG AF in patients with severe left ventricle (LV dysfunction who underwent elective off-pump coronary artery bypass. Methods: This study was conducted on 104 patients from among 400 patients with severe LV dysfunction undergoing elective off-pump CABG surgery from February 2011 to February 2012, in Afshar Cardiovascular Center, Yazd, Iran. Patients with emergency surgery, unstable angina creatinine higher than 2.0 mg/dL, malignancy, or immunosuppressive disease were excluded. Preoperative serological tests of the participants, such as WBC counts, were saved in their medical dossiers. Of the 400 patients undergoing CABG, AF was found in 54 cases; these 54 male patients formed the experimental group and 60 other patients in the intensive care unit (ICU and hospital stay without postoperative AF were part of the control group. Results: The average age of the patients was 68.5±12.8 years. WBC counts in patients with and without AF three days before surgery were 12,340±155 and 8,950±170, respectively. On surgical day, WBC counts in the patients with and without AF were 13,188±140 and 9,145±255, respectively (P value three days before surgery: 0.04; P value on surgical day: 0.01. Of the 54 male patients with postoperative AF (POAF, duration of AF was more in cases with elevated WBC count (12,000-14,000 than in those with lower elevated WBC count (10,000-12,000 ( P=0.025, but there was no relationship between frequency of recurrence of AF and grading of elevation of WBC count ( P=0.81. Conclusion: These findings show that three days

  8. 三维手术规划系统在原发性肝癌切除术前评估中的应用价值%Application value of three-dimensional surgery planning system in the preoperative evaluation of primary liver cancer resection

    Institute of Scientific and Technical Information of China (English)

    黄利利; 郑鹏飞; 毛杰; 李凡; 郑永光; 程志斌

    2014-01-01

    异有统计学意义(χ2=20.39,P<0.05)。CTA组对胆管扩张均未能显示,三维手术规划组对胆管扩张的显示率为19%(3/16)。在复杂肝癌患者中,三维手术规划系统预测肿瘤体积的中位数为218(129,429)ml,实际切除肿瘤质量为194(112,429)g,两者呈正相关(r=0.943,P<0.05),平均误差率为6.5%。在非复杂肝癌患者中,三维手术规划系统预测肿瘤体积为368(89,560)ml,实际切除肿瘤质量为395(126,578)g,两者呈正相关(r=0.958,P<0.05),平均误差率为6.3%。结论与CTA相比,三维手术规划系统能更好地显示肿瘤与周围组织的毗邻关系、腹腔血管以及胆管扩张情况,并能较准确地预测肿瘤切除体积,尤其适用于复杂肝癌患者。%Objective To investigate the application value of three-dimensional surgery planning system in the preoperative evaluation of primary liver cancer (PLC) resection. Methods A total of 44 patients with PLC [32 males and 12 females, mean age of (60±12) years old] in Department of General Surgery, Lanzhou University Second Hospital from June 2012 to June 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the ethics committee approval was received. According to random number table method, the patients were randomly divided into 2 groups: computed tomography angiography (CTA) group and three-dimensional surgery planning (3D) group. Subgroups of complex PLC and non-complex PLC were further defined in each group according to tumor size, tumor invasive extent and history of surgery. In CTA group, 8 cases was assigned in complex PLC subgroup and 14 cases in non-complex PLC subgroup, and 6, 16 cases respectively in 3D group. CTA was used in the preoperative evaluation of PLC resection in CTA group. Liver three-dimensional surgery planning system was used in the preoperative evaluation of PLC resection in 3D group. The intra-operative finding was taken

  9. The effect of preoperative intravenous paracetamol administration on postoperative fever in pediatrics cardiac surgery.

    Science.gov (United States)

    Abdollahi, Mohammad-Hasan; Foruzan-Nia, Khalil; Behjati, Mostafa; Bagheri, Babak; Khanbabayi-Gol, Mehdi; Dareshiri, Shahla; Pishgahi, Alireza; Zarezadeh, Rafie; Lotfi-Naghsh, Nazgol; Lotfi-Naghsh, Ainaz; Naghavi-Behzad, Mohammad

    2014-09-01

    Post-operative fever is a common complication of cardiac operations, which is known to be correlated with a greater degree of cognitive dysfunction 6 weeks after cardiac surgery. The aim of the present study was to examine efficacy and safety of single dose intravenous Paracetamol in treatment of post-operative fever in children undergoing cardiac surgery. In this randomised, double-blind, placebo-controlled clinical trial, 80 children, aged 1-12 years, presenting for open heart surgery were entered in the trial and randomly allocated into two groups: Placebo and Paracetamol. After induction of anaesthesia, 15 mg/kg intravenous Paracetamol solution was infused during 1 h in the Paracetamol group. Patients in placebo group received 15 mg/kg normal saline infusion during the same time. Since the end of operation until next 24 h in intensive care unit, axillary temperature of the two group patients was recorded in 4-h intervals. Any fever that occurred during this period had been treated with Paracetamol suppository (125 mg) and the amount of antipyretic drug consumption for each patient had been recorded. In order to examine the safety of Paracetamol, patients were evaluated for drug complication at the same time. Mean axillary temperature during first 24 h after operation was significantly lower in Paracetamol group compared with placebo group (P = 0.001). Overall fever incidence during 24 h after operation was higher in placebo group compared with Paracetamol group (P = 0.012). Of Paracetamol group patients, 42.5% compared with 15% of placebo group participants had no consumption of antipyretic agent (Paracetamol suppository) during 24 h after operation (P = 0.001). This study suggests that single dose administration of intravenous Paracetamol before paediatric cardiac surgeries using cardiopulmonary bypass; reduce mean body temperature in the first 24 h after operation.

  10. The effect of preoperative intravenous paracetamol administration on postoperative fever in pediatrics cardiac surgery

    Directory of Open Access Journals (Sweden)

    Mohammad-Hasan Abdollahi

    2014-01-01

    Full Text Available Background: Post-operative fever is a common complication of cardiac operations, which is known to be correlated with a greater degree of cognitive dysfunction 6 weeks after cardiac surgery. The aim of the present study was to examine efficacy and safety of single dose intravenous Paracetamol in treatment of post-operative fever in children undergoing cardiac surgery. Materials and Methods: In this randomised, double-blind, placebo-controlled clinical trial, 80 children, aged 1-12 years, presenting for open heart surgery were entered in the trial and randomly allocated into two groups: Placebo and Paracetamol. After induction of anaesthesia, 15 mg/kg intravenous Paracetamol solution was infused during 1 h in the Paracetamol group. Patients in placebo group received 15 mg/kg normal saline infusion during the same time. Since the end of operation until next 24 h in intensive care unit, axillary temperature of the two group patients was recorded in 4-h intervals. Any fever that occurred during this period had been treated with Paracetamol suppository (125 mg and the amount of antipyretic drug consumption for each patient had been recorded. In order to examine the safety of Paracetamol, patients were evaluated for drug complication at the same time. Results: Mean axillary temperature during first 24 h after operation was significantly lower in Paracetamol group compared with placebo group (P = 0.001. Overall fever incidence during 24 h after operation was higher in placebo group compared with Paracetamol group (P = 0.012. Of Paracetamol group patients, 42.5% compared with 15% of placebo group participants had no consumption of antipyretic agent (Paracetamol suppository during 24 h after operation (P = 0.001. Conclusion: This study suggests that single dose administration of intravenous Paracetamol before paediatric cardiac surgeries using cardiopulmonary bypass; reduce mean body temperature in the first 24 h after operation.

  11. Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

    OpenAIRE

    Marcela Cangussu Barbalho-Moulim; Gustavo Peixoto Soares Miguel; Eli Maria Pazzianotto Forti; Flavio do Amaral Campos; Dirceu Costa

    2011-01-01

    OBJECTIVE: To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery. DESIGN: Randomized controlled trial. SETTING: Meridional Hospital, Cariacica/ES, Brazil. SUBJECTS: Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle trainin...

  12. 类风湿关节炎患者全膝置换术术前评估%Preoperative evaluation of total knee arthroplasty in rheumatoid arthritis patients

    Institute of Scientific and Technical Information of China (English)

    刘大猛; 周新社

    2016-01-01

    Total knee arthroplasty ( TKA ) is developing. Rheumatoid arthritis ( RA ) patients, whose knee function is severely affected, have obtained good effects. RA can not only affect the joints, but a systemic and multi-systematic disease. When involving the cervical spine, RA can cause upper cervical instability. It is essential to pay more attention to asymptomatic patients, so as to select appropriate treatment measures. Preoperative heart function rating can assess the risk of surgery and the tolerance of patients. The pulmonary injury often slacks up lung functions too. RA patients also have higher prevalence of oral or periodontal diseases, which is related with artificial joint infection after the surgery. Anemia can lead to increased risk of infection and delayed wound healing. So for each body the comprehensive and systematic preoperative evaluation is necessary. In addition, degree of preoperative rheumatoid arthritis and inflammatory indexes such as blood sedimentation, c-reactive protein level are of controversy. The use of clinical drugs to relieve symptoms before surgery or not is worth the attention of orthopedic surgeons. Patients with long-term drug therapy, such as traditional DMARDs and biological agents, cortisol, have the risk of infection after the knee replacement. Researches on biological agents in the treatment of rheumatoid arthritis are being conducted in recent years. Foreigners also put forward the guide on the perioperative use of biological agents. Detailed preoperative evaluation and multidisciplinary cooperation are necessary to reduce the risk of surgery.

  13. Depression Subscale of the Hospital Anxiety and Depression Scale applied preoperatively in spinal surgery

    Directory of Open Access Journals (Sweden)

    Asdrubal Falavigna

    2012-05-01

    Full Text Available OBJECTIVE: To evaluate the accuracy of the Depression Subscale of Hospital Anxiety and Depression Scale (HADS-D in spine surgery, comparing it to Beck Depression Inventory (BDI. METHODS: In a cross-sectional study, the HADS-D and the BDI were applied to patients undergoing spine surgery for lumbar (n=139 or cervical spondylosis (n=17. Spearman correlation tests for HADS-D and BDI were applied. The internal consistency of HADS-D was estimated by Cronbach's alpha coefficient. RESULTS: According to the BDI, the prevalence of depression was of 28.8% (n=45. The Spearman r coefficient between HADS-D and BDI was 0.714 (p10, there was a sensitivity of 71.1%, specificity of 95.4%, and positive likelihood-ratio of 15.78. CONCLUSIONS: HADS-D showed a strong correlation with BDI and good reliability. HADS-D is a good alternative for screening depression and assessing its severity.

  14. Preoperative tranilast as adjunctive therapy to primary pterygium surgery with a 1-year follow-up

    Directory of Open Access Journals (Sweden)

    Gildásio C. Almeida Junior

    2015-02-01

    Full Text Available Purpose: To determine the efficacy of tranilast as an adjunctive therapy in conjunctival autograft. Methods: Twenty-nine patients were randomly allocated to the Tranilast Group (n=15 or the Control Group (n=14. The Tranilast Group received a subconjunctival injection of 0.5% tranilast 30 days prior to surgery. Conjunctival autograft was performed in both groups using fibrin sealant and 0.02% subconjunctival mitomycin C at the end of the surgery. After the resection of the pterygium, immunohistochemistry was performed with 100 cells to identify epithelial cells positive for transforming growth factor-β (TGF-β. Subjective symptoms were evaluated using a 5-point scale, and the recurrence rate was assessed. Results: Both groups showed improvements in their symptoms and similar clinical results. Compared with the Control Group, the Tranilast Group failed to show a decreased recurrence rate (p=0.59. However, the number of epithelial cells expressing TGF-β was lower in the Tranilast Group (5 cells; 95% CI: 2.56-13.15; Control Group, 16 cells, 95% CI: 11.53-24.76; p=0.01. Minimal but reversible complications, including glaucoma secondary to corticosteroids and granuloma, occurred during the study. Conclusion: Tranilast was effective in decreasing the number of pterygium epithelial cells expressing TGF-β.

  15. EEG, MRI, and SPECT in epilepsy. Relative contributions to preoperative evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Seki, Gaku [Luoyang Medical Coll. Associated Hospital (China); Hoshida, Tohru; Goda, Kazuo; Hashimoto, Hiroshi; Nakase, Hiroyuki; Hirabayashi, Hidehiro; Kawaguchi, Shoichiro; Morimoto, Tetsuya; Sakaki, Toshisuke

    1998-07-01

    We comparatively assessed detection of epileptogenic areas on preoperative evaluation in 33 patients with intractable partial epilepsy using scalp interictal and ictal electroencephalography (EEG), magnetic resonance imaging (MRI), and interictal single photon emission computed tomography (SPECT). There are 22 temporal and 11 extratemporal lobe epilepsies. All or almost of their seizures have stopped after resective surgery for more than 12 months follow-up period, averaged 43 months. MRI studies demonstrated 21 organic lesions, 11 mesial temporal sclerosis and one patient showed normal brain tissue. Scalp EEG could correctly identify the focus in 14 of 33 cases (42%), interictal SPECT in 18 of 26 (69%), MRI in 29 of 33 (88%), interictal scalp EEG-video monitoring in 17 of 24 (71%), and ictal scalp EEG-video monitoring in 15 of 22 (68%). Although neuroimaging studies, especially MRI, are useful to detect not only localization of epileptic lesions but also epileptogenic focus, for example, mesial temporal sclerosis, the exact localization of epileptogenic areas could be done by comprehensive evaluation including ictal scalp EEG-video monitoring. (author)

  16. Pre-operative testing for pregnancy in Dublin day surgery units.

    LENUS (Irish Health Repository)

    Wong, L F A

    2013-06-01

    The safety of anaesthetic agents in early pregnancy cannot be guaranteed. Certain types of surgery, particularly gynaecological, may also be dangerous. It is therefore important to ensure that, female patients are not inadvertently pregnant when undergoing elective surgery. Different hospitals have different policies and guidelines in place to determine female patients\\' pregnancy status prior to elective surgery.

  17. Bypass of an anesthesiologist-directed preoperative evaluation clinic results in greater first-case tardiness and turnover times.

    Science.gov (United States)

    Epstein, Richard H; Dexter, Franklin; Schwenk, Eric S; Witkowski, Thomas A

    2017-09-01

    We evaluated 4 hypotheses related to bypass of an anesthesiologist-directed preoperative evaluation clinics (APEC): 1) first-case tardiness and turnover times increased; 2) turnover times increased more than first-case tardiness; and higher American Society of Anesthesiologists Physical Status (ASA PS) resulted in both an ordered increase among ASA PS and within ASA PS in 3) first-case tardiness; and 4) turnover times. Retrospective observational study using electronic health records. One large, teaching hospital. An average of 14,310 patients per year undergoing elective surgery in the hospital's main opera rating rooms who were not inpatients preoperatively between 2006 and 2016. None. Average increases in first-case tardiness and turnover times between patients seen or not seen preoperatively in the APEC. APEC bypass increased first-case tardiness 2.58 min per case (CI 1.55-3.61; Ptardiness (difference=4.91 min; CI 3.76-6.06; Ptardiness (difference=5.71, CI 3.17-4.72; Ptardiness and turnover times with increasing ASA PS (Ptardiness (all P-valuestardiness and turnover times. A strategy of selective bypass of ASA PS 1-2 patients would not be effective economically because of substantial delays from ASA PS 2 patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. A qualitative study of the pre-operative preparation of children, young people and their parents' for planned continence surgery: experiences and expectations.

    Science.gov (United States)

    Bray, Lucy; Callery, Peter; Kirk, Sue

    2012-07-01

    The aim of this study is to explore children's, young people's and parents' pre-operative experiences of continent stoma formation. Current research investigating continent stoma surgery focuses on surgical outcomes including complication rates, adherence to management regimes, self-management practices and levels of continence achieved. Despite reports of pre-operative anxiety in families undergoing continent stoma surgery, there has been a lack of research exploring pre-operative experiences, information needs or decision-making processes in this group. A qualitative study. Forty-nine semi-structured interviews were conducted with 17 children, young people and their parents. Data were collected at key points in the surgical process that aimed to represent a longitudinal perspective of continent stoma formation. The interviews suggested that children's, young people's and parents' information needs in relation to the long-term implications of surgery and for their day-to-day lives were not being adequately met. The preparation process was described as being positively influenced by contact with a nurse specialist, being given time to make the decision and having access to different sources of information. Decisions regarding life-long planned surgery can be challenging. The individual involvement and information needs of children, young people and their parents need to be recognised during pre-operative preparation. Health professionals need to discuss the holistic implications of continent stoma surgery and provide families with the time and opportunity to consider surgery and access relevant sources of information pre-operatively. © 2012 Blackwell Publishing Ltd.

  19. Pre-operative assessment of cancer in the elderly (PACE) : A comprehensive assessment of underlying characteristics of elderly cancer patients prior to elective surgery

    NARCIS (Netherlands)

    Pope, D.; Ramesh, H.; Gennari, R.; Corsini, G.; Maffezzini, M.; Hoekstra, H. J.; Mobarak, D.; Sunouchi, K.; Stotter, A.; West, C.; Audisio, R. A.

    2006-01-01

    Background: Cancer is a disease that particularly affects the elderly and, although surgery is the first treatment choice, many elderly cancer patients do not receive standard surgery because they are considered unfit for treatment due to an inaccurate estimation of operative risk. Pre-operative Ass

  20. Pre-operative risk scores for the prediction of outcome in elderly people who require emergency surgery

    Directory of Open Access Journals (Sweden)

    Bates Tom

    2007-06-01

    Full Text Available Abstract Background The decision on whether to operate on a sick elderly person with an intra-abdominal emergency is one of the most difficult in general surgery. A predictive risk-score would be of great value in this situation. Methods A Medline search was performed to identify those predictive risk-scores relevant to sick elderly patients in whom emergency surgery might be life-saving. Results Many of the risk scores for surgical patients include the operative findings or require tests which are not available in the acute situation. Most of the relevant studies include younger patients and elective surgery. The Glasgow Aneurysm Score and Hardman Index are specific to ruptured aortic aneurysm while the Boey Score and the Hacetteppe Score are specific to perforated peptic ulcer. The Reiss Index and Fitness Score can be used pre-operatively if the elements of the score can be completed in time. The ASA score, which includes a significant element of subjective clinical judgement, can be augmented with factors such as age and urgency of surgery but no test has a negative predictive value sufficient to recommend against surgical intervention without clinical input. Conclusion Risk scores may be helpful in sick elderly patients needing emergency abdominal surgery but an experienced clinical opinion is still essential.

  1. Discrepancy between preoperative MRI evaluation and intraoperative or postoperative pathological findings for the extent of local invasion in maxillary squamous cell carcinoma.

    Science.gov (United States)

    Lee, D J; Lee, M J; Kwon, K H; Chung, E J; Yoon, D Y; Rho, Y S

    2014-06-01

    Preoperative radiological evaluation of the extent of local invasion in maxillary squamous cell carcinoma (SCC) is very important in planning curative surgery. The aim of this study was to examine the accuracy of preoperative radiological evaluation with magnetic resonance imaging (MRI) for the extent of local invasion in maxillary SCC. A retrospective study was conducted of 33 patients who underwent a maxillectomy for maxillary SCC. We compared the MRI findings for 18 structures around the maxillary sinus with intraoperative or postoperative pathological findings. Discrepancies were found between preoperative MRI findings and intraoperative or postoperative pathological findings for 22 patients (66.7%). Overall, the specificity, sensitivity, positive predictive value, and negative predictive value of MRI were 83.4%, 83.0%, 64.5%, and 90.4%, respectively. The receiver operating characteristic curve showed that MRI evaluation of the posterolateral structures including the pterygoid plate, pterygoid muscle, and infratemporal fossa had a lower area under the curve (0.614) and a significantly lower accuracy when compared with the other structures (P = 0.294, 95% confidence interval 0.405-0.822). In conclusion, as the accuracy of preoperative MRI evaluation of the posterolateral structures is low, careful evaluation of local extension to the posterolateral structures is needed when planning curative surgery for maxillary SCC. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  2. Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery.

    Science.gov (United States)

    Reiser, M; Scherag, A; Forstner, C; Brunkhorst, F M; Harbarth, S; Doenst, T; Pletz, M W; Hagel, S

    2017-02-01

    To evaluate the effect of pre-operative octenidine (OCT) decolonization on surgical site infection (SSI) rates. Before-and-after cohort study. Patients undergoing an elective isolated coronary artery bypass graft (CABG) procedure: control group (1(st) January to 31(st) December 2013), N=475; intervention group (1(st) January to 31(st) December 2014), N=428. The intervention consisted of nasal application of OCT ointment three times daily, beginning on the day before surgery, and showering the night before and on the day of surgery with OCT soap. A median sternotomy was performed in 805 (89.1%) patients and a minimally invasive direct coronary artery bypass procedure was performed in 98 (10.9%) patients. Overall, there was no difference in SSI rates between the control and intervention groups (15.4% vs 13.3%, P=0.39). The rate of harvest site SSIs was significantly lower in patients in the intervention group (2.5% vs 0.5%, P=0.01). Patients who had undergone a median sternotomy in the intervention group had a significantly lower rate of organ/space sternal SSIs (1.9% vs 0.3%, P=0.04). However, there was a trend towards an increased rate of deep incisional sternal SSIs (1.2% vs 2.9%, P=0.08). Multi-variate analysis did not identify a significant protective effect of the intervention (odds ratio 0.79, 95% confidence interval 0.53-1.15, P=0.27). Pre-operative decolonization with OCT did not reduce overall SSI rates in patients undergoing an elective isolated CABG procedure, but significantly decreased harvest site and organ/space sternal SSIs. Randomized controlled trials, including controlled patient adherence to the intervention, are required to confirm these observations and to determine the clinical utility of OCT in pre-operative decolonization. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  3. Improving breast cancer outcome by preoperative systemic therapy and image-guided surgery

    NARCIS (Netherlands)

    Mieog, Jan Sven David

    2011-01-01

    This thesis consists of two parts. In part I, we have demonstrated that preoperatively administrated systemic (neoadjuvant) therapy is a feasible treatment strategy in early stage breast cancer to achieve improved surgical options and to assess tumor response. We also demonstrated that overexpressio

  4. Effect of preoperative education of patients before hip or knee replacement surgery: A systematic review

    DEFF Research Database (Denmark)

    Aydin, Dogu; Klit, Jakob; Husted, Henrik

    2013-01-01

    , mobility, and expectations. Methods One reviewer searched the PubMed database in autumn 2012 and identified qualified studies. Three reviewers assessed the studies regarding inclusion criteria [lidt uforståeligt, umiddelbart]. Randomized studies of preoperative education (written, verbal and/or audio...

  5. Preoperative and Postoperative (1st and 3rd Month Metabolic Data of Patients Who Underwent Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Nilüfer Özdemir Kutbay

    2015-03-01

    Full Text Available Purpose: The growing prevalence of obesity has become a major concern. The efficacy of medical treatment, diet and behavior therapy in morbidly obese patients is limited. Obesity surgery is a treatment option for selected morbidly obese patients. Material and Method: Data of 47 patients (n=39 women, 8 men who underwent bariatric surgery were investigated. Results: Out of 47 patients, 20 underwent Roux-en-Y gastric bypass (RYGB (43% and 27 had sleeve gastrectomy (SG (57%. The mean age of the patients was 37±9.5 (19-59 years. 17% of patients were men and 83% were women. In the analysis of data on weight that could be found for 31 out of 47 patients, we detected preoperative and postoperative (1st and 3rd month mean weight values as 125.4±15.9 kg, 112.7±13.2 kg (p<0.001 and 100.9±17.5 kg (p<0.001, respectively. In addition, the analysis of the data on mean fasting plasma glucose (FPG levels which could be found for 23 out of 47 patients, showed us that preoperative and postoperative (1st and 3rd month FPG levels were 100.9±17.5 mg/dL, 91.6±10.9 mg/dL (p=0.03 and 87.3±2.0 mg/dL, respectively. Only 1 patient had diabetes before the surgery. In the RYGB group, the mean change in weight was 12.4±5.5 kg in the 1st month and 22.2±8.6 kg in the 3rd month (compared to the weights in the preoperative period. Moreover, in the SG group, the mean change in weight was 13.7±4.5 kg in the 1st month and 23.4±5.8 kg in the 3rd month. No statistically significant difference was found between the weight changes in the 1st and the 3rd month as for surgery types. Discussion: After bariatric surgery, significant loss in weight and reduction in FPG occurred in short-term.

  6. Bari-Active: A randomized controlled trial of a preoperative intervention to increase physical activity in bariatric surgery patients

    Science.gov (United States)

    Bond, Dale S.; Vithiananthan, Sivamainthan; Thomas, J. Graham; Trautvetter, Jennifer; Unick, Jessica L.; Jakicic, John M.; Pohl, Dieter; Ryder, Beth A.; Roye, G. Dean; Sax, Harry C.; Wing, Rena R.

    2014-01-01

    Background: Habitual physical activity (PA) may help to optimize bariatric surgery outcomes; however objective PA measures show that most patients have low PA preoperatively and make only modest PA changes postoperatively. Patients require additional support to adopt habitual PA. Objectives: Test the efficacy of a preoperative PA intervention (PAI) versus standard pre-surgical care (SC) for increasing daily moderate-to-vigorous PA (MVPA) in bariatric surgery patients. Setting: University Hospital, United States. Methods: Outcomes analysis included 75 participants (86.7% women; 46.0±8.9 years; Body Mass Index [BMI]=45.0±6.5 kg/m2) who were randomly assigned preoperatively to 6 weeks of PAI (n=40) or SC (n=35). PAI received weekly individual face-to-face sessions with tailored instruction in behavioral strategies (e.g., self-monitoring, goal-setting) to increase home-based walking exercise. The primary outcome, pre- to post-intervention change in daily bout-related (≥10-min bouts) and total (≥1-minute bouts) MVPA minutes, was assessed objectively via a multi-sensor monitor worn for 7 days at baseline- and post-intervention. Results: Retention was 84% at the post-intervention primary end point. In intent-to-treat analyses with baseline value carried forward for missing data and adjusted for baseline MVPA, PAI achieved a mean increase of 16.6±20.6 minutes/day in bout-related MVPA (baseline: 4.4±5.5 to post-intervention: 21.0±21.4 minutes/day) compared to no change (−0.3±12.7 minutes/day; baseline: 7.9±16.6 to post-intervention: 7.6±11.5 minutes/day) for SC (p=0.001). Similarly, PAI achieved a mean increase of 21.0±26.9 minutes/day in total MVPA (baseline: 30.9±21.2 to post-intervention: 51.9±30.0 minutes/day), whereas SC demonstrated no change (− 0.1±16.3 minutes/day; baseline: 33.7±33.2 to post-intervention: 33.6±28.5 minutes/day) (p=0.001). Conclusions: With behavioral intervention, patients can significantly increase MVPA before bariatric

  7. Evaluation of Stress Intensity and Anxiety Level in Preoperative Period of Cardiac Patients.

    Science.gov (United States)

    Rosiek, Anna; Kornatowski, Tomasz; Rosiek-Kryszewska, Aleksandra; Leksowski, Łukasz; Leksowski, Krzysztof

    2016-01-01

    The stress related to patient's stay in a hospital increases when it is necessary to perform a surgery. Therefore, the study of the phenomenon of stress intensity in hospitalized patients has become an important issue for public health. The study was conducted in University Hospital No. 1 in the cardiosurgery clinic. The study involved 58 patients who were admitted as planned to the hospital. The study used a standardized questionnaire measuring intensity of the stress and also deepened interviews with patients about stress and anxiety felt before the surgery. The greater the patient's anxiety resulting from his state of health, the greater the intensity of stress in the preoperative period. This relationship is linear. The results of the study also made it possible to see intrapersonal factors (pain, illness, and suffering) and extrapersonal factors (anesthesia, surgery, and complications after surgery), which are causes of anxiety before surgery. The research showed high (negative) results of anxiety and stress associated with the disease, surgery, and complications after cardiac surgery. Active involvement in hospitalization elements, such as patient education before surgery, psychological support, and medical care organization taking into account patient's preferences, reduces the impact of stressors.

  8. Relationship of short-course preoperative radiotherapy and serum albumin level with postoperative complications in rectal cancer surgery

    Directory of Open Access Journals (Sweden)

    Trifunović Bratislav

    2015-01-01

    Full Text Available Background/Aim. The identification of risk factors could play a role in improving early postoperative outcome for rectal cancer surgery patients. The aim of this study was to determine the relationship between short-course preoperative radiotherapy (RT, serum albumin level and the development of postoperative complications in patients after anterior rectal resection due to rectal cancer without creation of diverting stoma. Methods. This retrospective study included patients with histopathologically confirmed adenocarcinoma of the rectum by and the clinical stage of T2-T4 operated on between 2007 and 2012. All the patients underwent open anterior rectal resection with no diverting stoma creation. Preoperative serum albumin was measured in each patient. Tumor location was noted intraoperatively as the distance from the inferior tumor margin to the anal verge. Tumor size was measured and noted by the pathologist who assessed specimens. Some of the patients received short-course preoperative RT, and some did not. The patients were divided into two groups (group 1 with short-course preoperative RT, group 2 with no short-course preoperative RT. Postoperative complications included clinically apparent anastomotic leakage, wound infection, diffuse peritonitis and pneumonia. They were compared between the groups, in relation to preoperative serum albumin level, patients age, tumor size and location. Results. The study included 107 patients (51 in the group 1 and 56 in the group 2. There were no significant difference in age (p = 0.95, and gender (p = 0.12 and tumor distance from anal verge (p = 0.53. The size of rectal carcinoma was significantly higher in the group 1 than in the group 2 (51.37 ± 12.04 mm vs 45.57 ± 9.81 mm, respectively; p = 0.007. The preoperative serum albumin level was significantly lower in the group 1 than in the group 2 (34.80 ± 2.85 g/L vs 37.55 ± 2.74 g/L, respectively; p < 0.001. A significant correlation between the tumor

  9. Sensitivity of 3-Dimensional Sonography in Preoperative Evaluation of Parathyroid Glands in Patients With Primary Hyperparathyroidism.

    Science.gov (United States)

    Frank, Susan J; Goldman-Yassen, Adam E; Koenigsberg, Tova; Libutti, Steven K; Koenigsberg, Mordecai

    2017-09-01

    Preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism facilitates targeted surgery. We assessed the sensitivity of 3-dimensional (3D) sonography for preoperative localization of abnormal parathyroid glands. We conducted a retrospective review of patients who underwent parathyroidectomy for primary hyperparathyroidism at a single site at our institution. We compared preoperative 2-dimensional (2D) sonography, 3D sonography, and sestamibi scans with final gland localization at surgery. Two readers reviewed the sonograms to assess inter-reader variability. From January 2010 through April 2015, 52 patients underwent parathyroidectomy after preoperative 2D sonography, 3D sonography, and sestamibi scans. Three-dimensional sonography had sensitivity of 88-92% compared with 69-71% for 2D sonography for gland localization. In patients in whom sonography and sestamibi scans localized abnormalities to the same side, the sensitivities were 100% (43 of 43) for 3D sonography and 96% (48 of 50) for 2D sonography. Three-dimensional sonography had significantly higher sensitivity for localization of glands smaller than 500 mg compared with 2D sonography (88% versus 58%; P = .012). There was better inter-reader agreement between the radiologists when using 3D sonography (κ = 0.65) compared with 2D sonography (κ = 0.41). We found a significantly higher sensitivity and better inter-reader agreement for 3D sonography compared with 2D sonography for preoperative identification of abnormal parathyroid glands, especially among smaller glands. © 2017 by the American Institute of Ultrasound in Medicine.

  10. Preoperative evaluation of peripheral nerve injuries: What is the place for ultrasound?

    Science.gov (United States)

    Toia, Francesca; Gagliardo, Andrea; D'Arpa, Salvatore; Gagliardo, Cesare; Gagliardo, Giuseppe; Cordova, Adriana

    2016-09-01

    OBJECTIVE The purpose of this study was to evaluate the usefulness of ultrasound in the preoperative workup of peripheral nerve lesions and illustrate how nerve ultrasonography can be integrated in routine clinical and neurophysiological evaluation and in the management of focal peripheral nerve injuries. The diagnostic role and therapeutic implications of ultrasonography for different neuropathies are described. METHODS The authors analyzed the use of ultrasound in 119 entrapment, tumoral, posttraumatic, or postsurgical nerve injuries of limbs evaluated in 108 patients during 2013 and 2014. All patients were candidates for surgery, and in all cases the evaluation included clinical examination, electrodiagnostic studies (nerve conduction study and electromyography), and ultrasound nerve study. Ultrasound was used to explore the nerve fascicular echotexture, continuity, and surrounding tissues. The maximum cross-sectional area (CSA) and the presence of epineurial hyperechogenicity or intraneural hyper- or hypoechogenicity, of anatomical anomalies, dynamic nerve dislocations, or compressions were recorded. The concordance rate of neurophysiological and ultrasonographic data was analyzed, classifying ultrasound findings as confirming, contributive, or nonconfirming with respect to electrodiagnostic data. The correlation between maximum nerve CSA and neurophysiological severity degree in entrapment syndromes was statistically analyzed. RESULTS Ultrasonography confirmed electrodiagnostic findings in 36.1% of cases and showed a contributive role in the diagnosis and surgical planning in 53.8% of all cases; the findings were negative ("nonconfirming") in only 10.1% of the patients. In 16% of cases, ultrasound was not only contributive, but had a key diagnostic role in the presence of doubtful electrodiagnostic findings. The contributive role differed according to etiology, being higher for tumors (100%) and for posttraumatic or postsurgical neuropathies (72.2%) than for

  11. MRI diagnosis and preoperative evaluation for pure epidural cavernous hemangiomas

    Energy Technology Data Exchange (ETDEWEB)

    Feng, Jie; Xu, Yi-Kai; Yang, Rui-Meng; Yu, Tian; Lin, Bing-Quan [Nanfang Hospital, Southern Medical University, Department of Diagnostic Imaging Center, Guangzhou, Guangdong (China); Li, Long [Guangdong Provincial Corps Hospital, Chinese People' s Armed Police Forces, Department of Radiology, Guangzhou, Guangdong (China); Ye, Xiang-Hua [Nanfang Hospital, Southern Medical University, Department of Radiotherapy, Guangzhou, Guangdong (China); Zhang, Nan [Nanfang Hospital, Southern Medical University, Department of Pathology, Guangzhou, Guangdong (China)

    2009-11-15

    The aims of the study were to summarize the characteristics of the spinal epidural cavernous hemangioma, especially for the MRI, and to improve the accurate rate of the preoperative diagnosis. The clinical and medical imaging data of six patients with pure spinal epidural cavernous hemangioma proved by operation and pathology were analyzed retrospectively. The level was thoracic (n = 2), thoracolumbar (n = 1), lumbar (n = 1), and sacral (n = 2). The tumor showed lobulated contour, and the areas the tumors appeared were dorsal side of spinal cord (n = 2), ventral side (n = 1), and lateral side (n = 3). In all six patients, the lesions were isointense to the spinal cord on T{sub 1}-weighted images and hyperintense on T{sub 2}-weighted images and showed homogeneously strong enhancement on contrast-enhanced T{sub 1}-weighted images. The characteristic MRI features were named as the ''wafting-silk'' sign. Widening of the intervertebral neural foramen (n = 4) and erosion of the adjacent bones (n = 3) can be observed. MRI of the epidural cavernous hemangioma showed the characteristic lobulated contour, which encircled the spinal cord. T{sub 1}WI on the MRI presented as isointense and T{sub 2}WI presented as hyperintense and a homogeneously strong enhancement, so we first proposed the sign of wafting silk. The widening of the intervertebral neural foramen and erosion of the adjacent bones can easily be observed. MR imaging has an important role in the detection and diagnosis of pure spinal epidural cavernous hemangioma. (orig.)

  12. Comparative evaluation of oral gabapentin versus clonidine as premedication on preoperative sedation and laryngoscopic stress response attenuation for the patients undergoing general anesthesia

    OpenAIRE

    Saikat Majumdar; Anjan Das; Haripada Das; Sambhunath Bandyopadhyay; Bimal Kumar Hajra; Dipankar Mukherjee

    2015-01-01

    Background: Laryngoscopy and endotracheal intubation (L and I) is associated with rise in blood pressure (BP), heart rate (HR), leading to adverse cardiological outcome especially in susceptible individuals. To compare the BP, HR during L and I as well as to evaluate the preoperative sedation status between oral clonidine (Group C) and oral gabapentine (Group G) as premedication for the patients undergoing major surgery under general anesthesia (GA). Materials and Methods: From April 2008...

  13. Can preoperative sex-related differences in hemostatic parameters predict bleeding in orthognathic surgery?

    DEFF Research Database (Denmark)

    Jared Olsen, Jesper; Ingerslev, Janne; Thorn, Jens Jørgen

    2016-01-01

    -one consecutive patients undergoing bimaxillary OS were included and subsequently grouped according to sex (26 men and 15 women). The main finding was that male patients bled twice as much as female patients on average (400 mL [interquartile range, 300 to 500 mL] vs 200 mL [interquartile range, 63 to 288 mL]; P...... adjusted for these confounders (P = .18). CONCLUSIONS: Preoperative sex-related increases in measures of fibrin turnover predict IOB volume in bimaxillary OS, with women displaying a significantly lower IOB volume than men....

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

    Institute of Scientific and Technical Information of China (English)

    Bingqiang Ma; Hongguang Bao

    2009-01-01

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

  15. Preoperative glucocorticoid use and risk of postoperative bleeding and infection after gastric bypass surgery for the treatment of obesity.

    Science.gov (United States)

    Gribsholt, Sigrid Bjerge; Svensson, Elisabeth; Thomsen, Reimar Wernich; Richelsen, Bjørn; Sørensen, Henrik Toft

    2015-01-01

    Previous research suggests that patients using glucocorticoids may be at increased risk of postoperative bleeding and infection after major surgery. The objective was to investigate the association between preoperative glucocorticoid use and risk of bleeding and infection after Roux-en-Y gastric bypass surgery (RYGB). Nationwide cohort study of 13,195 patients, who underwent RYGB 2006-2012 using Danish population-based medical databases. Information was obtained on current (redeemed prescriptionsurgery), recent (prescription 60-180 d before surgery), or no glucocorticoid use, and postoperative bleeding or infection within 30 days of surgery. We computed risk differences and odds ratios (ORs) as a measure of relative risk with 95% confidence intervals (95% CIs) for the association between glucocorticoid use and bleeding or infection, adjusting for gender, age, and co-morbidities by logistic regression. Among RYGB patients, 325 (2.5%) were current glucocorticoid users, and 365 (2.8%) were recent users. The risk of bleeding was increased in current users: 2.8% versus 1.6% among nonusers (risk difference: 1.2%, 95% CI: -.6, 3.0) corresponding to an adjusted OR of 1.5 (95% CI: .8, 3.0). For recent users, the adjusted OR for bleeding was 1.2 (95% CI: .5, 2.5). The risk of infection did not differ materially between current (1.8%), recent (1.0%) and nonusers (1.7%), corresponding to an adjusted OR of .9 (95% CI: .4, 2.1) among current versus nonusers. Current use of glucocorticoids is associated with a slightly increased risk of postoperative bleeding, but not infection, after RYGB. No increased risks were found for recent users. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  16. Radioguided surgery and the GOSTT concept: From pre-operative image and intraoperative navigation to image-assisted excision.

    Science.gov (United States)

    Bowles, H; Sánchez, N; Tapias, A; Paredes, P; Campos, F; Bluemel, C; Valdés Olmos, R A; Vidal-Sicart, S

    Radio-guided surgery has been developed for application in those disease scheduled for surgical management, particularly in areas of complex anatomy. This is based on the use of pre-operative scintigraphic planar, tomographic and fused SPECT/CT images, and the possibility of 3D reconstruction for the subsequent intraoperative locating of active lesions using handheld devices (detection probes, gamma cameras, etc.). New tracers and technologies have also been incorporated into these surgical procedures. The combination of visual and acoustic signals during the intraoperative procedure has become possible with new portable imaging modalities. In daily practice, the images offered by these techniques and devices combine perioperative nuclear medicine imaging with the superior resolution of additional optical guidance in the operating room. In many ways they provide real-time images, allowing accurate guidance during surgery, a reduction in the time required for tissue location and an anatomical environment for surgical recognition. All these approaches have been included in the concept known as (radio) Guided intraOperative Scintigraphic Tumour Targeting (GOSTT). This article offers a general view of different nuclear medicine and allied technologies used for several GOSTT procedures, and illustrates the crossing of technological frontiers in radio-guided surgery. Copyright © 2016 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  17. B-Flow Twinkling Sign in Preoperative Evaluation of Cervical Lymph Nodes in Patients with Papillary Thyroid Carcinoma

    Directory of Open Access Journals (Sweden)

    Giuseppina Napolitano

    2013-01-01

    Full Text Available Papillary thyroid cancer (PTC is the most common histologic type of differentiated thyroid cancer. The first site of metastasis is the cervical lymph nodes (LNs. The ultrasonography (US is the best diagnostic method for the detection of cervical metastatic LNs. We use a new technique, B-flow imaging (BFI, recently used for evaluation of thyroid nodules, to estimate the presence of BFI twinkling signs (BFI-TS, within metastatic LNs in patients with PTC. Two hundred and fifty-two patients with known PTC were examined for preoperative evaluation with conventional US and BFI. Only 83 with at least one metastatic LN were included. All patients included underwent surgery; the final diagnosis was based on the results of histology. The following LN characteristics were evaluated: shape, abnormal echogenicity, absent hilum, calcifications, cystic appearance, peripheral vascularization, and BFI-TS. A total of 604 LNs were analyzed. Of these, 298 were metastatic, according to histopathology. The BFI-TS showed high values ​​of specificity (99.7% and sensitivity (80.9%. The combination of each conventional US sign with the BF-TS increases the specificity. Our findings suggest that BFI can be helpful in the selection of suspicious neck LNs that should be examined at cytologic examination for accurate preoperative staging and individual therapy selection.

  18. Images in plastic surgery: digital thermographic photography ("thermal imaging") for preoperative perforator mapping.

    Science.gov (United States)

    Chubb, Daniel; Rozen, Warren M; Whitaker, Iain S; Ashton, Mark W

    2011-04-01

    Preoperative imaging to identify the location of individual perforators has been shown to improve operative outcomes, and while computed tomographic angiography (CTA) and magnetic resonance angiography are currently the most widely used modalities, these have substantial limitations. Such limitations include the need for intravenous access, the need for iodinated contrast media, radiation exposure with CTA, and long scanning times with magnetic resonance angiography. Complications from the use of contrast media are also noteworthy, and can include anaphylactoid reactions and renal toxicity. In a move to avoid these problems, we have recently introduced a technique that is readily available and easy to implement for preoperative imaging, and may show an accuracy that matches the more advanced imaging modalities. Thermal imaging is a readily performed technique, and can be undertaken by the reconstructive surgeon themselves at the initial consultation, enabling prompt operative planning, and avoiding the need for delays in imaging, confusion in the interpretation of a radiologist report, and the need for an intermediary radiologist altogether. In our experience thus far, the technique matches the accuracy for location of CTA, and a larger clinical trial of the technique is underway.

  19. Can preoperative myocardial perfusion scintigraphy predict changes in left ventricular perfusion and function after coronary artery bypass graft surgery?

    DEFF Research Database (Denmark)

    Eckardt, Rozy; Kjeldsen, Bo Juel; Johansen, Allan;

    2012-01-01

    OBJECTIVESWe wanted to evaluate whether preoperative myocardial perfusion scintigraphy (MPS) could predict changes in cardiac symptoms and postoperative myocardial perfusion and left ventricular function after coronary artery bypass grafting (CABG).METHODSNinety-two patients with stable angina......%. Before CABG, one patient had normal perfusion; in the rest of them the defects were classified as follows: reversible (60%), partly reversible (27%) and irreversible (12%). Following CABG, 33% had normal perfusion; in the rest the defects were reversible in 29%, partly reversible in 12% and irreversible...... in 26%. Left ventricular ejection fraction (LVEF), which was normal before operation in 45%, improved in 40% of all patients. The increase in LVEF was not related to the preoperative pattern of perfusion defects. Of 30 patients with normalized perfusion after CABG, 29 (97%) had reversible defects...

  20. Comparison of preoperative infraorbital block with peri-incisional infiltration for postoperative pain relief in cleft lip surgeries

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    Gaonkar V

    2004-01-01

    Full Text Available In this prospective, randomized study, children undergoing cleft lip surgery were either given infra-orbital nerve block (n=25 or peri-incisional infiltration (n=25 pre-operatively with 0.25% bupivacaine in 1:2,00,000 adrenaline. The overall course of anesthesia in both the groups was smooth, with excellent hemodynamic stability, indicating better pain relief during the intra-operative period. The concentration of the anesthetic agent required was reduced and recovery from anesthesia was rapid and complete. There was excellent postoperative analgesia. The children were calm and comfortable postoperatively. We conclude that infra-orbital nerve block with 0.25% bupivacaine with adrenaline provides more prolonged analgesia than peri-incisional infiltration in cleft lip repair. Infra-orbital block given by modified approach is easy to perform and free of side-effects.

  1. ASSESSMENT OF BODY FAT IN OBESE PATIENTS PREOPERATIVELY FOR BARIATRIC SURGERY.

    Science.gov (United States)

    Fernandez, Mônica; Toimil, Rosana Farah; Rasslan, Zied; Ilias, Elias Jirjoss; Gradinar, Ana Lúcia Torloni; Malheiros, Carlos Alberto

    The study of body composition in patient candidates for bariatric surgery is directly related to the increase and distribution of body fat in the development of cardiovascular disease. To correlate anthropometric indicators and bioelectrical impedance in the assessment of body fat in female candidates for bariatric surgery. Cross-sectional, observational study of 88 women. The weight, height, body mass index and waist circumference data were evaluated in the anthropometric analysis. The body fat was determinate by bioelectrical impedance conducted according to the manufacturer´s recommended technique with a specific severe obesity formula. The patients were divided into two subgroups according to the average waist circumference and body mass index for better analysis of the results. The group had a mean age of 39.7 years (±7.2), average weight of 125.6 kg (±16.2), mean body mass index of 48.7 kg/m2 (±6.4) and the mean waist circumference 137.6 cm (±12.4). Negative and significant relationship between BMI values waist circumference and resistance obtained by bioelectrical impedance ​​were found. By analyzing the two groups the mean BMI and waist circumference, a significant relationship was observed, ie, the higher the degree of obesity less resistance was obtained by bioelectrical impedance. The higher is the obesity the lower is value found for resistance. The increase of anthropometric indicators (BMI and waist circumference) determined reduction in resistance and reactance obtained by bioelectrical impedance analysis in obese women candidates to bariatric surgery. O estudo da composição corporal em pacientes candidatas à cirurgia bariátrica tem relação direta com o aumento e distribuição da gordura corporal e no desenvolvimento de doenças cardiovasculares. Estudar a correlação entre indicadores antropométricos e da bioimpedância elétrica na avaliação da gordura corporal em mulheres candidatas à cirurgia bariátrica. Estudo transversal

  2. Preoperative Proteinuria Is Associated with Long-Term Progression to Chronic Dialysis and Mortality after Coronary Artery Bypass Grafting Surgery

    Science.gov (United States)

    Wu, Pei-Chen; Wang, Wei-Jie; Chao, Chia-Ter; Yang, Shao-Yu; Shiao, Chih-Chung; Hu, Fu-Chang; Lai, Chun-Fu; Lin, Yu-Feng; Han, Yin-Yi; Chen, Yih-Sharng; Hsu, Ron-Bin; Young, Guang-Huar; Wang, Shoei-Shen; Tsai, Pi-Ru; Chen, Yung-Ming; Chao, Ting-Ting; Ko, Wen-Je; Wu, Kwan-Dun

    2012-01-01

    Aims Preoperative proteinuria is associated with post-operative acute kidney injury (AKI), but whether it is also associated with increased long- term mortality and end -stage renal disease (ESRD) is unknown. Methods and Results We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+) or heavy (2+ to 4+) according to the results of the dipstick test. A total of 276 (29.8%) patients had mild proteinuria before surgery and 119 (12.9%) patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17) was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88) and heavy proteinuria ([HR], 2.28) to predict all–cause mortality compared to no proteinuria. Mild ([HR], 2.57) and heavy proteinuria ([HR], 2.70) exhibited a stepwise increased ratio compared to patients without proteinuria for long–term composite catastrophic outcomes (mortality and ESRD), which were independent of the baseline GFR and postoperative acute kidney injury (AKI). Conclusion Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients. PMID:22276092

  3. Preoperative proteinuria is associated with long-term progression to chronic dialysis and mortality after coronary artery bypass grafting surgery.

    Directory of Open Access Journals (Sweden)

    Vin-Cent Wu

    Full Text Available AIMS: Preoperative proteinuria is associated with post-operative acute kidney injury (AKI, but whether it is also associated with increased long-term mortality and end-stage renal disease (ESRD is unknown. METHODS AND RESULTS: We studied 925 consecutive patients undergoing CABG. Demographic and clinical data were collected prospectively, and patients were followed for a median of 4.71 years after surgery. Proteinuria, according to dipstick tests, was defined as mild (trace to 1+ or heavy (2+ to 4+ according to the results of the dipstick test. A total of 276 (29.8% patients had mild proteinuria before surgery and 119 (12.9% patients had heavy proteinuria. During the follow-up, the Cox proportional hazards model demonstrated that heavy proteinuria (hazard ratio [HR], 27.17 was an independent predictor of long-term ESRD. There was a progressive increased risk for mild proteinuria ([HR], 1.88 and heavy proteinuria ([HR], 2.28 to predict all-cause mortality compared to no proteinuria. Mild ([HR], 2.57 and heavy proteinuria ([HR], 2.70 exhibited a stepwise increased ratio compared to patients without proteinuria for long-term composite catastrophic outcomes (mortality and ESRD, which were independent of the baseline GFR and postoperative acute kidney injury (AKI. CONCLUSION: Our study demonstrated that proteinuria is a powerful independent risk factor of long-term all-cause mortality and ESRD after CABG in addition to preoperative GFR and postoperative AKI. Our study demonstrated that proteinuria should be integrated into clinical risk prediction models for long-term outcomes after CABG. These results provide a high priority for future renal protective strategies and methods for post-operative CABG patients.

  4. Comparison of Preoperative Administration of Rectal Diclofenac and Acetaminophen for Reducing Post Operative Pain in Septorhinoplastic Surgeries

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    E Allahyry

    2006-04-01

    Full Text Available ABSTRACT: Introduction & Objective: Post operative pain is usually treated by opioids, which is expensive and may induce various side effects. Non steroidal anti-inflammatory drugs have been considered recently for controlling pain due to their cheapness, fewer side effects and availability. This study compares the analgesic efficacy of preoperative administration of single dose of rectally diclofenac and acetaminophen for post operative analgesia in septorhinoplasty, one of the most common head and neck surgeries. Materials & Methods: Sixty adult patients with ASA =1 underwent septorhinoplasty were randomly divided into two equal groups. Thirty minutes before induction of anesthesia, 100 mg diclofenac suppository and 325 mg of rectal acetaminophen were given to group I and group II respectively. Induction and maintenance of anesthesia were similar in all patients. Then the severity of pain was graded 1, 2 and 4 hours after operation according to Visual Analogue Scale. Also the first time of analgesic request and total administered dose of analgesics were assessed by another person in all patients. Results: Results revealed that severity of pain in diclofenac group in all three defined times was significantly less than that in the other group (p<0.05. Also the average of first time analgesic request in group 1 and 2 was 205 and 97 minutes respectively and the average dose of administered pehtidine was 12.25 mg in diclofenac and 37.15 mg in acetaminophen group. Conclusion: The pre-operative administration of rectal diclofenac was more effective for post septorhioplasty analgesia than the rectal acetaminophen and thus it could be used and recommended as a safe, compensive and effective method for post operative pain relief in this common surgery.

  5. Preoperative predictors of adherence to multidisciplinary follow-up care postbariatric surgery.

    Science.gov (United States)

    Larjani, Soroush; Spivak, Israel; Hao Guo, Ming; Aliarzadeh, Babak; Wang, Wei; Robinson, Sandra; Sockalingam, Sanjeev; Aarts, Mary-Anne

    2016-02-01

    Long-term multidisciplinary care after bariatric surgery is important for weight maintenance and management of co-morbidities. Despite this, the rate of attendance to follow-up appointments is universally low. To identify patient factors that contribute to adherence to follow-up care after bariatric surgery. Three university-affiliated hospitals in Canada A cohort study of 388 patients who underwent bariatric surgery from January 2011 to December 2011 was performed. This program mandates multidisciplinary follow-up care at 3, 6, and 12 months, and annually thereafter. Patients' socioeconomic, psychosocial, and medical and psychiatric co-morbidities were recorded prospectively. Adherence to follow-up care was defined as having attended the majority of clinic visits (3 or 4 out of 4); all other patients were considered nonadherent. The mean age of patients was 45.0 years, 81.2% were female, and the majority underwent a gastric bypass (91.8%) versus a sleeve gastrectomy (8.2%); 62.1% of patients were adherent to follow-up appointments. Patients older than 25 years had a higher adherence rate than those who were younger (63.2% versus 37.5%, P = .040). Patients with full-time or part-time employment had a significantly higher adherence rate than those who were unemployed or retired (65.6% versus 50.0%, P = .017, odds ratio 1.9). Patients with obstructive sleep apnea (OSA) before surgery had higher follow-up adherence than those without OSA (62.2% versus 37.8%, P = .044). In multivariate analysis, employment remained an independent predictor of follow-up adherence (P = .017). Employment was the strongest predictor of attendance to follow-up clinic. Patients with OSA and older patients were also more likely to return consistently for scheduled follow-up. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

  6. [Preoperative evaluation and predictors of mortality in lung cancer resection].

    Science.gov (United States)

    Rojas, Andrés; Opazo, Marcela; Hernández, Marcela; Ávila, Paulina; Villalobos, Daniel

    2015-06-01

    Surgical resection of lung cancer, the only available curative option today, is strongly associated with mortality. The goal during the perioperative period is to identify and evaluate appropriate candidates for lung resection in a more careful way and reduce the immediate perioperative risk and posterior disability. This is a narrative review of perioperative risk assessment in lung cancer resection. Instruments designed to facilitate decision-making have been implemented in recent years but with contradictory results. Cardiovascular risk assessment should be the first step before a potential lung resection, considering that most of these patients are old, smokers and have atherosclerosis. Respiratory mechanics determined by postoperative forced expiratory volume in the first second (FEV1), the evaluation of the alveolar-capillary membrane by diffusing capacity of carbon monoxide and cardiopulmonary function measuring the maximum O2 consumption, will give clues about the patient's respiratory and cardiac response to stress. With these assessments, the patient and its attending team can reach a treatment decision balancing the perioperative risk, the chances of survival and the pulmonary long-term disability.

  7. Propensity-matched analysis of association between preoperative anemia and in-hospital mortality in cardiac surgical patients undergoing valvular heart surgeries

    Directory of Open Access Journals (Sweden)

    Shreedhar S Joshi

    2015-01-01

    Full Text Available Introduction: Anaemia is associated with increased post-operative morbidity and mortality. We retrospectively assess the relationship between preoperative anaemia and in-hospital mortality in valvular cardiac surgical population. Materials and Methods: Data from consecutive adult patients who underwent valvular repair/ replacement at our institute from January 2010 to April 2014 were collected from hospital records. Anaemia was defined according to WHO criteria (hemoglobin <13g/dl for males and <12g/dl for females. 1:1 matching was done for anemic and non-anemic patients based on propensity for potentially confounding variables. Logistic regression was used to evaluate the relationship between anaemia and in-hospital mortality. MatchIt package for R software was used for propensity matching and SPSS 16.0.0 was used for statistical analysis. Results: 2449 patients undergoing valvular surgery with or without coronary artery grafting were included. Anaemia was present in 37.1% (33.91% among males & 40.88% among females. Unadjusted OR for mortality was 1.6 in anemic group (95% Confidence Interval [95% CI] - 1.041-2.570; p=0.033. 1:1 matching was done on the basis of propensity score for anaemia (866 pairs. Balancing was confirmed using standardized differences. Anaemia had an OR of 1.8 for mortality (95% CI- 1.042 to 3.094, P=0.035. Hematocrit of < 20 on bypass was associated with higher mortality. Conclusion: Preoperative anaemia is an independent risk factor associated with in-hospital mortality in patients undergoing valvular heart surgery.

  8. Endometrial cancer--current state of the art therapies and unmet clinical needs: the role of surgery and preoperative radiographic assessment.

    Science.gov (United States)

    Hunn, Jessica; Dodson, Mark K; Webb, Joel; Soisson, Andrew P

    2009-08-10

    Endometrial carcinoma is the fourth most common cancer among women in the United States. Surgical pathologic staging has been the standard of care since 1988, which consists of analysis of collected peritoneal fluid, hysterectomy/oophorectomy, and pelvic and para-aortic lymphadenectomy. In 2005, it was further recommended that essentially all women with endometrial cancer who choose to undergo surgery have pelvic and para-aortic lymph node analysis. Despite this recommendation, there still remains controversy as to whether all patients with endometrial cancer should undergo full lymph node dissection. In this review, we assess the evidence surrounding this controversy and conclude that women with endometrial cancer should undergo complete lymphadenectomy at the time of surgery. Furthermore, we evaluate the evidence regarding laparoscopic surgical staging as a safe and effective alternative to the more invasive traditional laparotomy. Finally, for those patients who a gynecologic oncologist is not readily available to perform a complete lymph node dissection, we evaluate the various imaging studies and their utility as preoperative triage modalities.

  9. Effect of preoperative continuous positive airway pressure duration on outcomes after maxillofacial surgery for obstructive sleep apnoea.

    Science.gov (United States)

    Islam, Shofiq; Taylor, Christopher; Ormiston, Ian W

    2015-02-01

    Continuous positive airway pressure (CPAP) remains the first-line treatment for obstructive sleep apnoea (OSA), and is known to result in various physiological changes. The objective of this study was to evaluate the association between duration of preoperative CPAP therapy and outcome after maxillomandibular advancement (MMA) for OSA. We retrospectively analysed consecutive patients treated at our institution, and divided them into 2 groups based on duration of treatment with CPAP: short-term (up to 12 months) and long-term use (12 months or more). We controlled for baseline demographic and clinical characteristics. We compared postoperative scores for the apnoea/hypopnoea index (AHI) and the Epworth sleepiness scale (ESS), and lowest recorded oxygen saturation between groups. In 43 patients data were available on the preoperative use of CPAP, and in 37 of them preoperative and postoperative polysomnographic data were also available for inclusion. Most had bimaxillary advancement with genioplasty. Differences between the groups in mean reduction in the AHI and lowest oxygen saturation were not significant, and operative success rates were comparable. After operation, the reduction in ESS scores was significantly greater in the long-term group than in the short-term group (mean (SD) 8(3) compared with 2 (2), respectively, p<0.001). Our results suggest that the duration of use of CPAP preoperatively does not significantly influence objective outcome measures. The reduction in AHI scores after MMA was equivalent in both groups. The long-term group seemed to fare better than the short-term group on subjective outcome measures.

  10. Postoperative outcomes following preoperative inspiratory muscle training in patients undergoing open cardiothoracic or upper abdominal surgery: protocol for a systematic review

    Directory of Open Access Journals (Sweden)

    Mans Christina M

    2012-12-01

    Full Text Available Abstract Background In patients undergoing open cardiothoracic and upper abdominal surgery, postoperative pulmonary complications remain an important cause of postoperative morbidity and mortality, impacting upon hospital length of stay and health care resources. Adequate preoperative respiratory muscle strength may help protect against the development of postoperative pulmonary complications and therefore preoperative inspiratory muscle training has been suggested to be of potential value in improving postoperative outcomes. Methods/Design A systematic search of electronic databases will be undertaken to identify randomized trials of preoperative inspiratory muscle training in patients undergoing elective open cardiothoracic and upper abdominal surgery. From these trials, we will extract available data for a list of predefined outcomes, including postoperative pulmonary complications, hospital length of stay and respiratory muscle strength. We will meta-analyze comparable results where possible, and report a summary of the available pool of evidence. Discussion This review will provide the most comprehensive answer available to the question of whether preoperative inspiratory muscle training is clinically useful in improving postoperative outcomes in patients undergoing cardiothoracic and upper abdominal surgery. It will help inform clinicians working in the surgical arena of the likely effectiveness of instituting preoperative inspiratory muscle training programs to improve postoperative outcomes.

  11. Role of blood AFP mRNA and tumor grade in the preoperative prognostic evaluation of patients with hepatocellular carcinoma

    Institute of Scientific and Technical Information of China (English)

    Umberto Cillo; Giacomo Zanus; Vito De Pascale; Mario Plebani; Davide Francesco D'Amico; Alessandro Vitale; Filippo Navaglia; Daniela Basso; Umberto Montin; Marco Bassanello; Francesco D'Amico; Francesco Antonio Ciarleglio; Alberto Brolese

    2005-01-01

    AIM: To explore the potential prognostic role of preoperative tumor grade and blood AFP mRNA in a cohort of patients with hepatocellular carcinoma (HCC)eligible for radical therapies according to a well-defined treatment algorithm not including nodule size and number as absolute selection criteria.METHODS: Fifty patients with a diagnosis of HCC were prospectively enrolled in the study. Inclusion criteria were: (1) histological assessment of tumor grade by means of percutaneous biopsies; (2) determination of AFP mRNA status in the blood; (3) patient's eligibility for radical therapies.RESULTS: At preoperative evaluation, 54% of the study group had a well-differentiated HCC, 42% had AFP mRNA in the blood, 40% had a tumor larger than 5 cm and 56% had more than one nodule. Surgery (resection or liver transplantation) was performed in 29 patients,while 21 had percutaneous ablation procedures. After a median follow-up of 28 mo, 12-, 24-, and 36-mo survival rates were 78%, 58%, and 51%, respectively. Surgical therapy, performance status and three tumor-related variables (AFP mRNA, HCC grade and gross vascular invasion) resulted as significant survival predictors at univariate analysis. Nodule size and number did not perform as significant prognosticators. Multivariate study selected only surgical therapy and a biologically early HCC profile (AFP mRNA negative and well-differentiated tumor without gross vascular invasion) as independent survival variables.CONCLUSION: The preoperative determination of tumor grade and blood AFP mRNA status may potentially refine the prognostic evaluation of HCC patients and improve the selection process for radical therapies.

  12. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review

    DEFF Research Database (Denmark)

    Sangesland, Anders; Støren, Carl; Vaegter, Henrik B.

    2017-01-01

    Background Pain after surgery is not uncommon with 30% of patients reporting moderate to severe postoperative pain. Early identification of patients prone to postoperative pain may be a step forward towards individualized pain medicine providing a basis for improved clinical management through...... treatment strategies targeting relevant pain mechanisms in each patient. Assessment of pain processing by quantitative sensory testing (QST) prior to surgery has been proposed as a method to identify patients at risk for postoperative pain, although results have been conflicting. Since the last systematic...... review, several studies investigating the association between postoperative pain and more dynamic measures of pain processing like temporal summation of pain and conditioned pain modulation have been conducted. Objectives According to the PRISMA guidelines, the aim of this systematic review...

  13. Preoperative hemostatic testing and the risk of postoperative bleeding in coronary artery bypass surgery patients

    DEFF Research Database (Denmark)

    Rafiq, Sulman; Johansson, Pär I; Kofoed, Klaus F

    2016-01-01

    BACKGROUND: We sought to assess predictability of excessive bleeding using thrombelastography (TEG), multiplate impedance aggregometry, and conventional coagulation tests including fibrinogen in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS: A total of 170 patients were...... enrolled in this prospective observational study. TEG, Multiplate aggregometry, and coagulation tests were sampled on the day before surgery. Excessive bleeding was defined as >1000 mL over 18 hours. RESULTS: Multiplate-adenosine diphosphate (ADP) measurements were significantly lower in patients...... impedance aggregometry identified patients at risk for excessive bleeding after CABG. Low fibrinogen levels were associated with increased bleeding. Neither routine TEG parameters nor conventional coagulation tests were correlated with bleeding....

  14. Two large preoperative doses of erythropoietin do not reduce the systemic inflammatory response to cardiac surgery

    DEFF Research Database (Denmark)

    Poulsen, Troels Dirch; Andersen, Lars Willy; Steinbrüchel, Daniel

    2009-01-01

    OBJECTIVES: Cardiac surgery and cardiopulmonary bypass (CPB) induce an inflammatory reaction that may lead to tissue injury. Experimental studies suggest that recombinant human erythropoietin (EPO) independent of its erythropoietic effect may be used clinically as an anti-inflammatory drug...... of inflammatory cytokines. In contrast, EPO may augment the TNF-alpha and NT-proBNP response. Although the long-term clinical impact remains unknown, the findings do not support use of EPO as an anti-inflammatory drug in patients undergoing cardiac surgery........ This study tested the hypothesis that 2 large doses of EPO administered shortly before CPB ameliorate the systemic inflammatory response to CPB. DESIGN AND SETTING: A prospective, double-blind, placebo-controlled and randomized study at a single tertiary care hospital. PARTICIPANTS: Patients scheduled...

  15. Preoperative Glycosylated Hemoglobin and Postoperative Glucose Together Predict Major Complications after Abdominal Surgery.

    Science.gov (United States)

    Goodenough, Christopher J; Liang, Mike K; Nguyen, Mylan T; Nguyen, Duyen H; Holihan, Julie L; Alawadi, Zeinab M; Roth, John S; Wray, Curtis J; Ko, Tien C; Kao, Lillian S

    2015-10-01

    Glycosylated hemoglobin (HbA1c) is diagnostic of and a measure of the quality of control of diabetes mellitus. Both HbA1c and perioperative hyperglycemia have been targeted as modifiable risk factors for postoperative complications. The HbA1c percent cutoff that best predicts major complications has not been defined. A prospective study of all abdominal operations from a single institution from 2007 to 2010 was performed. All patients with HbA1c within 3 months before surgery were included. The primary end point was major complication, using the Clavien-Dindo complication system, within 30 days of surgery. Stepwise, multivariate analysis was performed including clinically relevant variables chosen a priori. Among 438 patients who had a measured HbA1c, 96 (21.9%) experienced a major complication. On multivariate analysis, HbA1c ≥ 6.5% (odds ratio = 1.95; 95% CI, 1.17-3.24; p = 0.01) was found to be the most significant predictor of major complications. Glyosylated hemoglobin and glucose were strongly correlated (correlation coefficient 0.414, p 30 kg/m(2), history of coronary artery disease, and nonwhite race were more likely to have a HbA1c ≥ 6.5%. Elevated HbA1c ≥ 6.5% and perioperative hyperglycemia were associated with an increased rate of major complications after abdominal surgery. Elevated peak postoperative glucose levels were correlated with elevated HbA1c and were independently associated with major complications. More liberal HbA1c testing should be considered in high-risk patients before elective surgery. Safe, feasible, and effective strategies to reduce both HbA1c and perioperative hyperglycemia need to be developed to optimize patient outcomes. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Shuh-Ping Sun

    2014-05-01

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

  17. Retrospective comparison between preoperative diagnosis by International Consensus Diagnostic Criteria and histological diagnosis in patients with focal autoimmune pancreatitis who underwent surgery with suspicion of cancer

    DEFF Research Database (Denmark)

    Ikeura, Tsukasa; Detlefsen, Sönke; Zamboni, Giuseppe

    2014-01-01

    OBJECTIVE: The objective of this study was to compare the preoperative diagnosis by International Consensus Diagnostic Criteria (ICDC) with histological diagnosis in patients with focal autoimmune pancreatitis (AIP) who underwent surgery. METHODS: Thirty patients (type 1 AIP in 23 and type 2 AIP ...

  18. EFFECT OF PREOPERATIVE USE OF LONG-ACTING OCTREOTIDE ON GROWTH HORMONE SECRETING PITUITARY ADENOMA AND TRANSSPHENOIDAL SURGERY

    Institute of Scientific and Technical Information of China (English)

    Jian Yin; Chang-bao Su; Zhi-qin Xu; Yi Yang; Wen-bin Ma; Wei Tao; Zhong Yang; Xue-wei Xia

    2005-01-01

    Objective To investigate whether somatostatin analog octreotide long acting release (LAR) shrinks growth hormone (GH) secreting adenomas, and improves the results of subsequent transsphenoidal surgery.Methods Seventeen previously untreated active acromegalic patients with pituitary adenomas were treated with LAR (30 mg intramuscular injection every 28 days) for 3 months prior to transsphenoidal surgery. Clinical reaction, mean GH secretion, and tumor volume were measured under basal conditions and after LAR treatment.Results Presurgical treatment improved acromegaly symptoms and induced a significant reduction of GH under the 5 ng/mL limit in microadenoma (P < 0.05), while only 18.2% (2/11) in macroadenoma. Meanwhile, tumor shrinkage occurred in 58.8% (10/17) patients, with 1 case in the microadenoma group. All marked shrinkage (> 25%) occurred in the macroadenoma group. Statistical analysis showed tumor shrinkage caused by LAR was greater in macroadenoma group than that in microadenoma group (P < 0.05). During operation, adenoma was soft in 15 cases, with the exception of 2cases in which the soft rumor was divided by fibrous septa, but all tumor removal was smooth.Conclusions A short term administration of preoperative LAR may induce a significant decrease in GH-secretion level and adenoma volume. Presurgical use of octreotide LAR improves surgical results especially in macroadenomas.

  19. Multiaxial mechanical properties and constitutive modeling of human adipose tissue: a basis for preoperative simulations in plastic and reconstructive surgery.

    Science.gov (United States)

    Sommer, Gerhard; Eder, Maximilian; Kovacs, Laszlo; Pathak, Heramb; Bonitz, Lars; Mueller, Christoph; Regitnig, Peter; Holzapfel, Gerhard A

    2013-11-01

    A preoperative simulation of soft tissue deformations during plastic and reconstructive surgery is desirable to support the surgeon's planning and to improve surgical outcomes. The current development of constitutive adipose tissue models, for the implementation in multilayer computational frameworks for the simulation of human soft tissue deformations, has proved difficult because knowledge of the required mechanical parameters of fat tissue is limited. Therefore, for the first time, human abdominal adipose tissues were mechanically investigated by biaxial tensile and triaxial shear tests. The results of this study suggest that human abdominal adipose tissues under quasi-static and dynamic multiaxial loadings can be characterized as a nonlinear, anisotropic and viscoelastic soft biological material. The nonlinear and anisotropic features are consequences of the material's collagenous microstructure. The aligned collagenous septa observed in histological investigations causes the anisotropy of the tissue. A hyperelastic model used in this study was appropriate to represent the quasi-static multiaxial mechanical behavior of fat tissue. The constitutive parameters are intended to serve as a basis for soft tissue simulations using the finite element method, which is an apparent method for obtaining promising results in the field of plastic and reconstructive surgery.

  20. [Predisposition to latex allergy undetected on preoperative evaluation: a case report].

    Science.gov (United States)

    Kimura, Yuriko; Okamura, Makoto; Harioka, Tokuya; Hara, Tadashi; Kamiya, Kiyoshi; Matsukawa, Takashi

    2013-12-01

    A 70-year-old man was scheduled to undergo laparoscopic total gastrectomy for stomach cancer. He had no history of atopy, fruit allergies, or frequent exposure to natural rubber. Preoperative latex-specific IgE antibodies were negative. Anesthesia was induced, and the surgery was started uneventfully. Soon after the surgeon had begun to manipulate the intestine, the blood pressure suddenly dropped to 27/21 mmHg. Facial flushing was also observed. Anaphylactic shock caused by latex was strongly suspected, and surgery was immediately halted. The surgical gloves were changed to latex-free ones, and adrenaline was administered. The blood pressure was gradually normalized within 30 min, and the facial flushing mostly disappeared. Postoperative laboratory examination revealed that serum tryptase had increased to 34.4 microg l-1, 40 minutes after the onset of anaphylaxis, and decreased to 19.4 microg l-1, 24 hours than later. Latex-specific IgE antibodies and a prick test with latex were both positive. Consequently, the diagnosis of latex-induced anaphylactic reaction was confirmed. Because even detailed questioning and examination does not always identify such a predisposition, avoiding contactwith latex products is more rational exhaustively checking every preoperative patient for latex allergy

  1. EFFECT OF PREOPERATIVE INTRAVENOUS CLONIDINE ON HEMODYNAMIC RESPONSE DURING LAPAROSCOPIC SURGERIES

    Directory of Open Access Journals (Sweden)

    Sreeraghu

    2014-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Laparoscopy is a minimally invasive procedure used as a diagnostic and therapeutic tool for abdominal and pelvic pathologies. Laparoscopy offers many benefits compared to open surgeries, but it leads to increase in stress hormon es, increased peripheral vascular resistance and decreased cardiac output causing hemodynamic fluctuation. In addition, ventilatory changes and increases in partial pressure of carbon dioxide also occur during laparoscopic surgeries due to pneumoperitoneum . To overcome these hemodynamic effects of insufflation various methods have been used like combined epidural with general anesthesia , propofol infusion, high dose of opioids, beta blockers, nicardipine, oral clonidine etc. In this study, we used intraveno us clonidine as premedication to suppress these changes. METHODS: After obtaining ethical committee clearance and informed consent from patient, we enrolled 60 adult patients, aged between 20 - 60 years, of ASA grade 1 and 2 posted for laparoscopic intra - abd ominal surgeries. The patients were divided into 2 groups of 30 each randomly, viz: Group C Study group : Injection clonidine, 2mcg/kg, as premedication was given intravenously, 15 min prior to induction of anesthesia . Group N Control group : received injec tion normal saline, 5cc, intravenously. For both the groups same type of anesthesia and analgesia was given. Heart rate, blood pressure, mean arterial pressure were recorded in both groups. Sedation, incidence of post - operative nausea vomiting after extubation were also observed. Statistical analysis was done using student T test and P value obtained. RESULTS: In the present study, decreases in heart rate, systolic, diastolic and mean arterial blood pressures were noticed in the clonidine group. Inspi te of maintaining normocapnia and keeping intra - abdominal pressure below 14mmm of Hg significant rises in heart rate, systolic, diastolic and mean arterial blood pressures were

  2. Return to work after lumbar disc surgery is related to the length of preoperative sick leave

    DEFF Research Database (Denmark)

    Andersen, Mikkel Ø; Ernst, Carsten; Rasmussen, Jesper

    2017-01-01

    INTRODUCTION: Lumbar disc herniation (LDH) is associated with high morbidity and significant socio-economic impact as the majority of the patients are of working age. The purpose of this study was to determine the impact of length of sick leave on the return-to-work rate after lumbar disc......% returned to work if surgically treated within three months. In contrast, only 50% of those whose sick leave exceeded three months returned to work. CONCLUSION: The present analysis suggests that the return-to-work rate after lumbar disc herniation surgery is affected by the length of sick leave. FUNDING...

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

    OpenAIRE

    2015-01-01

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

  4. Preoperative automatic visual behavioural analysis as a tool for intraocular lens choice in cataract surgery

    Directory of Open Access Journals (Sweden)

    Heloisa Neumann Nogueira

    2015-04-01

    Full Text Available Purpose: Cataract is the main cause of blindness, affecting 18 million people worldwide, with the highest incidence in the population above 50 years of age. Low visual acuity caused by cataract may have a negative impact on patient quality of life. The current treatment is surgery in order to replace the natural lens with an artificial intraocular lens (IOL, which can be mono- or multifocal. However, due to potential side effects, IOLs must be carefully chosen to ensure higher patient satisfaction. Thus, studies on the visual behavior of these patients may be an important tool to determine the best type of IOL implantation. This study proposed an anamnestic add-on for optimizing the choice of IOL. Methods: We used a camera that automatically takes pictures, documenting the patient’s visual routine in order to obtain additional information about the frequency of distant, intermediate, and near sights. Results: The results indicated an estimated frequency percentage, suggesting that visual analysis of routine photographic records of a patient with cataract may be useful for understanding behavioural gaze and for choosing visual management strategy after cataract surgery, simultaneously stimulating interest for customized IOL manufacturing according to individual needs.

  5. [Preoperative intravenous iron as a strategy for blood saving in surgery for hip fracture].

    Science.gov (United States)

    Blanco Rubio, Nieves; Llorens Eizaguerri, María; Seral García, Belén; Burillo Fuertes, Pilar; Ranera García, Miguel; Albareda Albareda, Jorge

    2013-11-02

    To determine whether administration of intravenous iron in a patient diagnosed with hip fracture reduces the need for blood transfusion. A retrospective observational case-control study was performed comparing a control group of 63 patients diagnosed with hip fracture with another group of 57 patients treated with parenteral iron. Demographic, clinical condition/clinical record and hematometric differences of the case-control patients were described. We analyzed the morbidity (post-surgical infection) and mortality rate. SPSS(®) was used for statistical studies. Being statistically significant, after the administration of intravenous iron sucrose, the need of blood transfusion was reduced in the case group, as well as the quantity of concentrates required (1.37 vs 0.6). In the case group, there was a statistically significant decreasing trend in hospital mortality rate (case group: 0.8%/control group: 8.3%). It was not been proven the relation between the decrease in nosocomial infection and the administration of intravenous iron The administration of intravenous iron sucrose in patients diagnosed with hip fracture before surgery could be effective blood saving measure in this type of trauma surgery. Furthermore, its use has been reliable without causing any side effects. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  6. Mild preoperative renal dysfunction as a predictor of long-term clinical outcome after coronary bypass surgery.

    Science.gov (United States)

    van de Wal, Ruud M A; van Brussel, Ben L; Voors, Adriaan A; Smilde, Tom D J; Kelder, Johannes C; van Swieten, Henry A; van Gilst, Wiek H; van Veldhuisen, Dirk Jan; Plokker, H W Thijs

    2005-02-01

    Renal dysfunction is a prognostic marker in patients with cardiovascular disease. However, no long-term follow-up studies on the influence of mild renal dysfunction on mortality in patients undergoing coronary bypass grafting have been reported. Therefore, we aimed to identify the significance of preoperative (mild) renal dysfunction as a long-term predictor of clinical outcome after coronary bypass surgery. In 358 patients who underwent isolated saphenous vein aorta-coronary artery bypass grafting, estimated glomerular filtration rates were calculated with the Cockroft-Gault equation (GFRc). Patients were categorized into 2 groups (group 1, GFRc >71.1 mL x min (-1) x 1.73 m (-2) ; group 2, GFRc <71.1 mL x min (-1) x 1.73 m (-2) ). Multivariate Cox proportional hazard analyses were performed to determine the independent prognostic value of GFRc. During a median follow-up of 18.2 years, 233 patients (65.1%) died. Patients who died had lower GFRc and were older. Multivariate analysis demonstrated that total mortality in patients with lower GFRc was significantly increased (lower GFRc group vs normal GFRc group: hazard ratio, 1.44; P = .019). Lower GFRc was also an independent predictor of cardiac mortality (hazard ratio, 1.51; P = .032). No significant differences were observed between groups in the occurrence of myocardial infarction and the need for reintervention. Our study demonstrates that after long-term follow-up, preoperative mild renal dysfunction is an independent predictor of long-term (cardiac) mortality in patients who undergo coronary artery bypass grafting.

  7. The effect of preoperative corticosteroids on peritoneal macrophage function after laparoscopic and open abdominal surgery in a rat model.

    Science.gov (United States)

    Schmelzer, Thomas M; Heath, Jessica J; Hope, William W; Mostafari, Ana; Novitsky, Yuri W; Heniford, B Todd

    2008-12-01

    Peritoneal macrophages play an important role in the immune response after abdominal operations. The stress response after these operations has been associated with impaired phagocytosis by peritoneal macrophages. This study examined the influence of minimally invasive techniques and preoperative corticosteroid administration on postoperative peritoneal macrophage phagocytic activity. After IACUC approval, 66 Sprague Dawley rats were randomly divided into 7 groups: baseline animals (B), anesthesia controls (AC), open cecectomy (OC), and laparoscopic cecectomy (LC). Within the AC, OC, and LC groups, half received intraperitoneal (IP) dexamethasone (10 mg/kg) 1 hour before surgery (+S), and the other half received an equal volume of normal saline IP (-S). Animals were observed postoperatively for 24 hours and were then euthanized. Peritoneal macrophages were harvested via intraperitoneal lavage. A phagocytosis assay was performed to calculate the net phagocytosis and percent response to the effector agent. Statistical analysis was performed using analysis of variance and a Student t test between groups. A P value of <.05 was considered significant. Significant differences were observed between groups. The B group had a response rate of 94.2% +/- 56.7%, which was not different from the AC groups (-S, P = .28; +S, P = .16) or the LC-S group (P = .9). The lowest phagocytic activity rate was in the OC-S group with a response rate of 33.8% +/- 28.5%. The highest phagocytic response rates occurred in the AC +S (145.2% +/- 60.2%) and LC +S (198.1% +/- 103.5%). These were not significantly different from each other (P = .3). The LC +S group had a significantly higher percent response than all of the other groups. The phagocytic response rate of the OC +S group was not different from either the AC-S group (P = .07) or the LC-S group (P = .8); however, it was less than the AC +S group (P = .02) and the LC +S group (P = .003). Open cecectomy resulted in greater impairment of

  8. Parent perceptions of pediatric ambulatory surgery: using family feedback for program evaluation.

    Science.gov (United States)

    Voepel-Lewis, T; Andrea, C M; Magee, S S

    1992-04-01

    Pediatric ambulatory surgery programs have grown tremendously during the past decade. However, limited nursing time places severe constraints on the care and education of surgical outpatients. Preoperative teaching, patient support, and postoperative instruction, previously conducted over days, is now completed in several hours. The ambulatory surgical program at Mott Children's Hospital was designed to provide thorough patient and family education, comprehensive patient care, and short-term follow-up. A formal evaluation of the program was conducted to ensure quality care for outpatients. This study evaluated preoperative and discharge preparation, postoperative problems and follow-up, preoperative waiting, stress, and privacy. The sample was composed of 332 families. Of the respondents, 289 (87%) felt very prepared overall for outpatient surgery; 33 families (10%) attended the preoperative tour, and felt significantly better prepared for surgery than families who did not attend; 322 families (97%) felt adequately prepared to very prepared for discharge; 245 families (76%) felt that the recovery time was just right; 40 parents (12%) felt that their children experienced more pain and 34 (10.4%) more nausea and vomiting than expected postoperatively; 54 families called a PACU nurse postoperatively with questions, and 92% rated the call as very helpful; 31 families called the surgical service with concerns, and 61% rated the surgeon as helpful; 83 families (25%) perceived the outpatient experience as being very stressful. Stress correlated significantly with preoperative preparation, preoperative wait, previous outpatient experience, and perceived postoperative pain. Privacy in the environment was rated as fair to poor by 192 families (59%).(ABSTRACT TRUNCATED AT 250 WORDS)

  9. A systematic review of pre-operative predictors of post-operative depression and anxiety in individuals who have undergone coronary artery bypass graft surgery.

    Science.gov (United States)

    McKenzie, Louise H; Simpson, Jane; Stewart, Marie

    2010-01-01

    In addition to the physical benefits, another important objective of coronary artery bypass graft (CABG) surgery is improvement of health-related quality of life. The aim of this systematic review is to provide an overview of the literature relating to the pre-operative prediction of post-operative depression and anxiety in individuals who have undergone CABG surgery. Forty-six studies were identified through a literature search of electronic databases conducted using explicit inclusion and exclusion criteria. The study characteristics, methodological features, and psychometric and clinical outcomes were summarised in a systematic manner. Collective appraisal of the studies indicated that symptoms of depression and anxiety exhibited after CABG surgery are best predicted by pre-operative measures of functioning in that area. Papers were inconclusive with respect to the predictive qualities of gender and age. Further research is required to clarify the predictive values of these and other factors, including pre-morbid ill health and socio-economic status. The findings of this review indicate a range of pre-operative predictors of post-operative depression and anxiety in patients with CABG. Chief among these are pre-operative depression and anxiety. These findings have clinical implications concerning the importance of pre and post-operative psychological assessment and intervention for individuals at risk of poor psychological recovery.

  10. Ultrasound evaluation on carpal tunnel syndrome before and after bariatric surgery

    Directory of Open Access Journals (Sweden)

    Adham do Amaral e Castro

    2014-12-01

    Full Text Available Objective: To evaluate the prevalence of carpal tunnel syndrome in candidates for bariatric surgery comparing with the non-obese population and verify the effects on it of bariatric treatment. Methods: We studied three groups of individuals: 1 patients waiting for bariatric surgery (preoperative; 2 individuals who had already undergone the procedure (postoperative; and 3 control group. We collected demographic and clinical data of carpal tunnel syndrome. The Ultrasound examination was carried out to diagnose the syndrome by measuring the median nerve area. Results: We included 329 individuals (114 in the preoperative group, 90 in the postoperative group and 125 controls. There was a higher prevalence of paresthesias (p=0.0003, clinical tests (p=0.0083 on the preoperative group when compared with controls (p<0.00001. There were lowe levels of paresthesias (p=0.0002 and median nerve area (p=0.04 in postoperative patients but with no significant difference in general. A significant difference was found between the preoperative and postoperative groups (p=0.05 in those who performed non-manual work. Conclusion: There was a higher prevalence of carpal tunnel syndrome in the preoperative group compared with the control one, but no significant difference was observed between the pre and postoperative groups in general. There was difference between pre and postoperative groups for non-manual workers.

  11. Anxiety in preoperative anesthetic procedures.

    Science.gov (United States)

    Valenzuela Millán, Jaquelyn; Barrera Serrano, José René; Ornelas Aguirre, José Manuel

    2010-01-01

    Preoperative anxiety is a common and poorly evaluated condition in patients who will undergo an anesthetic and surgical intervention. The objective of this study was to determine the prevalence of anxiety in a group of patients undergoing elective surgery, as assessed by the Amsterdam Anxiety Preoperative and Information (AAPI) scale. We studied 135 patients scheduled for elective surgery applying the AAPI scale 24 h before the surgical procedure to evaluate the presence of anxiety and patient characteristics. A descriptive analysis with mean +/- standard deviation for categorical variables was done. For intragroup differences, chi(2) test was used. Pearson correlation for the association between anxiety and postoperative complications was carried out. A value of p =0.05 was considered significant. One hundred six patients were surgically treated, 88% were female (average age 44 +/- 12 years). Some degree of preoperative anxiety was present in 72 patients (76%; p = 0.001) with a grade point average on the AAPI scale equal to 17 +/- 7 points, of which 95 (70%, OR = 5.08; p = 0.002) were females. Results of this study suggest the presence of high levels of preoperative anxiety in patients scheduled for elective surgery. The origin of the anxiety appears to be related to many factors that can be evaluated in pre-anesthetic consultation. Further study is needed to prevent the presence of this disorder.

  12. Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

    Directory of Open Access Journals (Sweden)

    David Provenzale Titinger

    2015-01-01

    Full Text Available Abstract Background: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS. Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001, as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006. Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001. The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001. SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001. However, as the EuroSCORE increased, there was significant difference (p < 0.0001 between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.

  13. Morphologic assessment of thoracic deformities for the preoperative evaluation of pectus excavatum by magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Lollert, A.; Funk, J.; Tietze, N.; Laudemann, K.; Dueber, C.; Staatz, G. [Medical Center of the Johannes Gutenberg University, Department of Diagnostic and Interventional Radiology, Section Pediatric Radiology, Mainz (Germany); Turial, S. [Medical Center of the Johannes Gutenberg University, Department of Pediatric Surgery, Mainz (Germany)

    2014-10-15

    To assess whether MRI is a suitable modality for the preoperative assessment and quantification of pectus excavatum. A total of 69 patients (57 male, 12 female; median age 15 years, range 5-35 years) with pectus excavatum were evaluated preoperatively using standardized MRI sequences on 1.5- and 3-Tesla systems (T2-HASTE/inspiration and expiration, T1-VIBE, T2-TRUFI free-breathing, T2-BLADE). The MR sequences were analysed for quality semiquantitatively. The Haller index, correction index, sternal rotation angle and asymmetry index were assessed; correlations between these indices and changes in inspiration and expiration were evaluated. T2-HASTE was the best sequence to assess pectus excavatum morphology, with a higher quality at 3 T than at 1.5 T. All indices could be assessed in every patient. A total of 37 patients had a symmetric deformity, 32 patients an asymmetric deformity. The Haller index correlated significantly (p < 0.001) with the correction index, both becoming higher in expiration. The asymmetry index correlated with the sternal rotation angle (p < 0.001) and did not change significantly in expiration (p = 0.28). Thoracic MRI is suitable for the preoperative evaluation of patients with pectus excavatum. An exact morphologic assessment is possible without radiation exposure as well as the determination of several indices to quantify the deformities. (orig.)

  14. Sensitivity and specificity of eight CT signs in the preoperative diagnosis of internal mesenteric hernia following Roux-en-Y gastric bypass surgery

    Energy Technology Data Exchange (ETDEWEB)

    Iannuccilli, J.D. [Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States)], E-mail: jiannuccilli@lifespan.org; Grand, D.; Murphy, B.L.; Evangelista, P. [Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States); Roye, G.D. [Department of Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States); Mayo-Smith, W. [Department of Diagnostic Imaging, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island (United States)

    2009-04-15

    Aim: To evaluate the sensitivity and specificity of eight previously reported computed tomography (CT) signs in diagnosing internal mesenteric hernia following Roux-en-Y gastric bypass surgery. Materials and methods: Preoperative CT images of nine patients with surgically proven internal mesenteric hernia as a complication of gastric bypass surgery and 10 matched control patients were reviewed in a blinded fashion by three radiologists. The presence of eight previously reported signs of internal mesenteric hernia was assessed: mesenteric swirl sign, hurricane eye sign, mushroom sign, small bowel obstruction, clustered small bowel loops, small bowel other than duodenum located behind the superior mesenteric artery (SMA), presence of the jejunal anastomosis to the right of the midline, and engorged mesenteric lymph nodes. The sensitivity and specificity were calculated for each sign, as well as inter-observer reliability in recognizing these signs. Results: Mesenteric swirl was the most predictive sign of internal hernia (sensitivity 78-100%, specificity 80-90%). Other CT signs showed good specificity (70-100%), but sensitivities were low (0-44%). The presence of a small-bowel obstruction and engorged mesenteric nodes was found to be 100% specific in predicting the presence of an underlying hernia. There was substantial inter-observer agreement in detecting mesenteric swirl sign ({kappa} = 0.48-0.79), but agreement was relatively poor for all other signs. Conclusion: Mesenteric swirl is an easily recognized CT sign, and is the best indicator of internal hernia following Roux-en-Y gastric bypass surgery. Other reported CT signs are diagnostically insensitive. The presence of small-bowel obstruction with engorged mesenteric nodes is highly specific in diagnosing internal mesenteric hernia.

  15. Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors.

    Science.gov (United States)

    Tolone, Salvatore; Gualtieri, Giorgia; Savarino, Edoardo; Frazzoni, Marzio; de Bortoli, Nicola; Furnari, Manuele; Casalino, Giuseppina; Parisi, Simona; Savarino, Vincenzo; Docimo, Ludovico

    2016-11-27

    Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors (PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH/impedance-pH monitoring) and clinical features (such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.

  16. Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis.

    Science.gov (United States)

    Yassa, Rafik Rd; Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

    2017-03-01

    The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. UK University Teaching Hospital. All patients (n = 460) presenting across a single year study period with a confirmed hip fracture. The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection (p-value: 0.0005). The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection.

  17. Validation of the French version of the Amsterdam preoperative anxiety and information scale (APAIS)

    OpenAIRE

    Maurice-Szamburski, Axel; Loundou, Anderson; Capdevila, Xavier; Bruder, Nicolas; Auquier, Pascal

    2013-01-01

    International audience; BackgroundMost patients are anxious before surgery. The level of preoperative anxiety depends on several factors and merits an objective evaluation. The Amsterdam Preoperative Anxiety and Information Scale (APAIS) is a self-report questionnaire comprising six questions that have been developed and validated to evaluate the preoperative anxiety of patients. This global index assesses three separate areas: anxiety about anaesthesia, anxiety about surgery, and the desire ...

  18. Evaluation of Functional Outcomes after Stapes Surgery in Patients with Clinical Otosclerosis in a Teaching Institution

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    Souza, José Celso Rodriques de

    2015-11-01

    Full Text Available Introduction Otosclerosis is a primary disease of the temporal bone that leads to stapes ankylosis. Hearing loss is the main symptom. Treatment includes surgery, medical treatment, and sound amplification therapy alone or in combination. Objective To evaluate the functional outcomes of patients with clinical diagnosis of otosclerosis undergoing primary stapes surgery in a teaching institution. Method Retrospective descriptive study. Results A total of 210 ears of 163 patients underwent stapes surgery. Of the 163 patients, 116 (71.2% underwent unilateral surgery and 47 (28.8% underwent bilateral surgery. Six of the 210 operated ears had obliterative otosclerosis. The average preoperative and postoperative air–bone gap was 32.06 and 4.39 dB, respectively. The mean preoperative and postoperative bone conduction threshold was 23.17 and 19.82 dB, respectively. A total of 184 (87.6% ears had a residual air–bone gap <10 dB, and 196 (93.3% had a residual air–bone gap ≤15 dB. Two patients (0.95% had severe sensorineural hearing loss. Conclusion Stapes surgery showed excellent functional hearing outcomes in this study. This surgery may be performed in educational institutions with the supervision of experienced surgeons.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-11-01

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

  20. Chronic depression: development and evaluation of the luebeck questionnaire for recording preoperational thinking (LQPT

    Directory of Open Access Journals (Sweden)

    Kühnen Tanja

    2011-12-01

    Full Text Available Abstract Background A standardized instrument for recording the specific cognitive psychopathology of chronically depressed patients has not yet been developed. Up until now, preoperational thinking of chronically depressed patients has only been described in case studies, or through the external observations of therapists. The aim of this study was to develop and evaluate a standardized self-assessment instrument for measuring preoperational thinking that sufficiently conforms to the quality criteria for test theory. Methods The "Luebeck Questionnaire for Recording Preoperational Thinking (LQPT" was developed and evaluated using a german sample consisting of 30 episodically depressed, 30 chronically depressed and 30 healthy volunteers. As an initial step the questionnaire was subjected to an item analysis and a final test form was compiled. In a second step, reliability and validity tests were performed. Results Overall, the results of this study showed that the LQPT is a useful, reliable and valid instrument. The reliability (split-half reliability 0.885; internal consistency 0.901 and the correlations with other instruments for measuring related constructs (control beliefs, interpersonal problems, stress management proved to be satisfactory. Chronically depressed patients, episodically depressed patients and healthy volunteers could be distinguished from one another in a statistically significant manner (p Conclusion The questionnaire fulfilled the classical test quality criteria. With the LQPT there is an opportunity to test the theory underlying the CBASP model.

  1. Prolonged analgesia following preoperative bupivacaine neural blockade for oral surgery performed under general anesthesia.

    Science.gov (United States)

    Chapman, P J; Ganendran, A

    1987-03-01

    The effectiveness of prolonged neural blockade following removal of impacted third molars under general anesthesia was evaluated in a controlled clinical study. There was a significant reduction in the amount of postoperative pain experienced, and no complications, either local or systemic, occurred. The technique has advantages, especially when general anesthesia is administered to outpatients.

  2. [Preoperative direct cortical and sub-cortical electric stimulation during cerebral surgery in functional areas].

    Science.gov (United States)

    Duffau, H; Capelle, L; Sichez, J P; Bitar, A; Faillot, T; Arthuis, F; Van Effenterre, R; Fohanno, D

    1999-09-01

    Indications of surgical treatment for lesions in functional cerebral areas depend on the ratio between the definitive neurological deficit and the beneficial effect of resection. Detection of eloquent cortex is difficult because of important individual variability. Peroperative direct cortical and subcortical electrical stimulations (DCS) provide the most precise and reliable method currently available allowing identification and preservation of neurons essential for motricity, sensitivity++ and language. We report our preliminary experience with DCS in surgery of intracerebral infiltrative tumors with a consecutive series of 15 patients operated from November 96 through September 97 in our institution. Presenting symptoms in the 15 patients (8 males, 7 females, mean age 43 years) were seizures in 11 cases (73%) and neurological deficit in 4 cases (27%). Clinical examination was normal in 11 patients and revealed hemiparesia in 4. Magnetic resonance imaging (MRI) with three-dimensional reconstruction showed a precentral tumor in 10 cases, central lesion in one patient, postcentral lesion in two cases, right insular tumor (non-dominant hemisphere) in one case. All patients underwent surgical resection using DCS with detection in 13 cases of motor cortex and subcortical pathways under genera anesthesia, in one case of somatosensory area under local anesthesia, and in one case of language areas also under local anesthesia. The tumor was recurrent in two patients had been operated earlier but without DCS. Resection, verified by postoperative MRI, was total in 12 cases (80%) and estimated at 80% in 3 patients. Histological examination revealed an infiltrative glioma in 12 cases (8 low grade astrocytomas, 3 low grade oligodendrogliomas, and one anaplastic oligodendroglioma), and metastases in 3 cases. Eight patients had no postoperative deficit, while the other 7 patients were impaired, with, in all cases except one, complete recovery in 15 days to 2 months. Direct

  3. Using preoperative unsupervised cluster analysis of chronic rhinosinusitis to inform patient decision and endoscopic sinus surgery outcome.

    Science.gov (United States)

    Adnane, Choaib; Adouly, Taoufik; Khallouk, Amine; Rouadi, Sami; Abada, Redallah; Roubal, Mohamed; Mahtar, Mohamed

    2017-02-01

    The purpose of this study is to use unsupervised cluster methodology to identify phenotype and mucosal eosinophilia endotype subgroups of patients with medical refractory chronic rhinosinusitis (CRS), and evaluate the difference in quality of life (QOL) outcomes after endoscopic sinus surgery (ESS) between these clusters for better surgical case selection. A prospective cohort study included 131 patients with medical refractory CRS who elected ESS. The Sino-Nasal Outcome Test (SNOT-22) was used to evaluate QOL before and 12 months after surgery. Unsupervised two-step clustering method was performed. One hundred and thirteen subjects were retained in this study: 46 patients with CRS without nasal polyps and 67 patients with nasal polyps. Nasal polyps, gender, mucosal eosinophilia profile, and prior sinus surgery were the most discriminating factors in the generated clusters. Three clusters were identified. A significant clinical improvement was observed in all clusters 12 months after surgery with a reduction of SNOT-22 scores. There was a significant difference in QOL outcomes between clusters; cluster 1 had the worst QOL improvement after FESS in comparison with the other clusters 2 and 3. All patients in cluster 1 presented CRSwNP with the highest mucosal eosinophilia endotype. Clustering method is able to classify CRS phenotypes and endotypes with different associated surgical outcomes.

  4. 3-dimensional echocardiography and its role in preoperative mitral valve evaluation.

    Science.gov (United States)

    Andrawes, Michael N; Feinman, Jared W

    2013-05-01

    Echocardiography plays a key role in the preoperative evaluation of mitral valve disease. 3-dimensional echocardiography is a relatively new development that is being used more and more frequently in the evaluation of these patients. This article reviews the available literature comparing the use of this new technology to classic techniques in the assessment of mitral valve pathology. The authors also review some of the novel insights learned from 3-dimensional echocardiography and how they may be used in surgical decision making and planning.

  5. A systematic review of the effects and mechanisms of preoperative 5α-reductase inhibitors on intraoperative haemorrhage during surgery for benign prostatic hyperplasia

    Institute of Scientific and Technical Information of China (English)

    Huan-Tao Zong; Xiao-Xia Peng; Chen-Chen Yang; Yong Zhang

    2011-01-01

    5α-reductase inhibitors (5α-RIs),including finasteride and dutasteride,are commonly used medical therapies for benign prostatic hyperplasia (BPH).Many studies reported that preoperative 5α-RI had impact on intraoperative haemorrhage during surgery for BPH,but it was still in controversial.So,we conducted a systematic review of the effects and mechanisms of 5α-RIs on intraoperative bleeding for BPH.MEDLINE,EMBASE,the Cochrane Controlled Trail Register of Controlled Trials and the reference lists of retrieved studies were searched in the analysis.Sixteen publications involving 15 different randomized controlled trials (RCTs) and a total of 1156 patients were used in the analysis,including 10 RCTs for finasteride and five RCTs for dutasteride.We found that preoperative finasteride treatment decreases microvessel density (MVD) in resected prostate specimens.Total blood loss,blood loss per gram of resected prostate tissue and decreases in haemoglobin were all greatly reduced in the finasteride group as compared to controls.Dutasteride appeared to have no effect on bleeding.This meta-analysis shows that preoperative finasteride treatment could decrease intraoperative haemorrhage during surgery for BPH.Preoperative dutasteride had no effect on intraoperative haemorrhage,but further high-quality prospective studies are still needed to confirm this observation.

  6. Design and results of preoperative questionnaire in bariatric surgery%减重手术术前调查问卷的设计及结果分析

    Institute of Scientific and Technical Information of China (English)

    杨宁琍; 戴晓冬; 梁辉; 管蔚; 汤娟

    2014-01-01

    目的 设计适合中国国情的减重手术术前问卷调查表.方法 我中心2010年1月起为接受减重手术的患者提供术前问卷调查表,至2014年1月共应用于401例患者,调查表的设计经历3个阶段:引进SCL-90量表,翻译后用于30例患者;根据中国的国情修改阶段用于90例患者;再次完善后应用于281例患者.对医生和患者满意度进行问卷后调查.结果 3个问卷版本医生满意度分别为73.3%、86.7%和96.8%;患者满意度分别是30.0%、40.0%、76.9%,不满意度分别为20.0%、11.1%、2.8%.结论 医生和患者对第三版问卷调查表满意度较高,适于临床推广应用.%Objective To design an appropriate preoperative questionnaire in Chinese bariatric surgery.Methods Bariatric surgery center carried out laparoscopic bariatric operation from January 2010,preoperative questionnaire before the operation were supplied.Till January 2014,a total of 401 patients replied to the survey.The questionnaires were designed through three stages:translated from the Cleveland Clinic (USA) and applied in 30 patients for the first survey; adjustments and changes to the contents of the questionnaire for 90 patients according to Chinese conditions in the second phase; in the third stage,the third edition questionnaire was used in 281 patients.The satisfaction degree of the doctors and patients about the content of the questionnaire was evaluated.Results For the three versions of the questionnaire,the doctor satisfaction rate was 73.3%,86.7% and 96.8%.Patients' satisfaction rate of three versions were 30.0%,40.0%,76.9%,not satisfactory rate was 20.0%,11.1%,2.8%.Conclusions The current preoperative questionnaire includes 11 categories with 101 items of the third edition,doctors and patients satisfaction rate is higher,and it is suitable for Chinese bariatric surgery.

  7. Evaluating the prognostic significance of preoperative thrombocytosis in epithelial ovarian cancer.

    Science.gov (United States)

    Allensworth, S K; Langstraat, C L; Martin, J R; Lemens, M A; McGree, M E; Weaver, A L; Dowdy, S C; Podratz, K C; Bakkum-Gamez, J N

    2013-09-01

    Preoperative thrombocytosis has been implicated as a negative prognostic marker for epithelial ovarian cancer (EOC). We assessed whether thrombocytosis is an independent risk factor for EOC recurrence and death. Perioperative patient characteristics and process-of-care variables (National Surgical Quality Improvement Program (NSQIP)-defined) were retrospectively abstracted from 587 women who underwent EOC staging between 1/2/03-12/29/08. Thrombocytosis was defined as platelet count > 450 × 10(9)/L. Disease-free survival (DFS) and overall survival (OS) were determined using Kaplan-Meier methods. Associations were evaluated with Cox proportional hazards regression and hazard ratios (HR). The incidence of preoperative thrombocytosis was 22.3%. DFS was 70.8% and 36.0% at 1 and 3 years. OS was 83.3% and 54.3% at 1 and 3 years. Ascites, lower hemoglobin, advanced disease, and receipt of perioperative packed red blood cell transfusion were independently associated with thrombocytosis. Older age and the presence of coronary artery disease were associated with lower likelihood of thrombocytosis. Overall, thrombocytosis was an independent predictor of increased risk of recurrence. Among early stage (I/II) cases, there was a 5-fold increase in the risk of death and nearly 8-fold risk of disease recurrence independently associated with thrombocytosis. Preoperative thrombocytosis portends worse DFS in EOC. In early stage disease, thrombocytosis is a potent predictor of worse DFS and OS and further assessment of the impact of circulating platelet-derived factors on EOC survival is warranted. Thrombocytosis is also associated with extensive initial disease burden, measurable residual disease, and postoperative sequelae. Preoperative platelet levels may have value in primary cytoreduction counseling. Copyright © 2013 Elsevier Inc. All rights reserved.

  8. The LIPPSMAck POP (Lung Infection Prevention Post Surgery - Major Abdominal - with Pre-Operative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial

    OpenAIRE

    Boden, Ianthe; Browning, Laura; Elizabeth H Skinner; Reeve, Julie; El-Ansary, Doa; Robertson, Iain K.; Denehy, Linda

    2015-01-01

    Background Post-operative pulmonary complications are a significant problem following open upper abdominal surgery. Preliminary evidence suggests that a single pre-operative physiotherapy education and preparatory lung expansion training session alone may prevent respiratory complications more effectively than supervised post-operative breathing and coughing exercises. However, the evidence is inconclusive due to methodological limitations. No well-designed, adequately powered, randomised con...

  9. Are surgical scrubbing and pre-operative disinfection of the skin in orthopaedic surgery reliable?

    Science.gov (United States)

    Salvi, M; Chelo, C; Caputo, F; Conte, M; Fontana, C; Peddis, G; Velluti, C

    2006-01-01

    This study attempts to establish the actual effectiveness of pre-surgical disinfection of the patient and surgeon's hands. We evaluated bacterial density and composition on the skin of 15 patients undergoing knee arthroscopy and the left hand of two surgeons after standard disinfection with povidone-iodine. Three samples were taken after the first 6-min scrub in the first surgical operation from the periungual space of the 1 degrees finger, from the interdigital space between the 2 degrees and 3 degrees fingers and from the transverse palmar crest of the left hand of two surgeons for seven consecutive surgical sessions, for a total of 42 samples, and two samples from the pre-patellar skin and from the popliteal skin of 15 patients undergoing knee arthroscopy, for a total of 30 samples. Pre-surgical handwashing and disinfection procedures were identical in each case. Pre-surgical disinfection of the patient's skin with povidone-iodine was shown to be completely effective, with 100% of samples negative. Samples taken from the interdigital space and the palmar crest (100% of samples negative) demonstrated the efficacy of disinfection of the surgeon's hands with povidone-iodine, while the periungual space was contaminated in 50% of the samples. The bacterial strains isolated belong to the staphylococcus genus in 100% of the cases, with pathogenic strains in 29.6% of the cases. Standard pre-surgical disinfection of skin in areas easily accessible to the disinfectant is sufficient in itself to guarantee thorough sanitization. Standard scrubbing of the surgeon's hands is insufficient in eliminating bacterial contamination, including pathogenic germs, in the periungual space, where it is probably difficult for the disinfectant to come into contact with the skin.

  10. Effects of preoperative inspiratory muscle training in obese women undergoing open bariatric surgery: respiratory muscle strength, lung volumes, and diaphragmatic excursion

    Directory of Open Access Journals (Sweden)

    Marcela Cangussu Barbalho-Moulim

    2011-01-01

    Full Text Available OBJECTIVE: To determine whether preoperative inspiratory muscle training is able to attenuate the impact of surgical trauma on the respiratory muscle strength, in the lung volumes, and diaphragmatic excursion in obese women undergoing open bariatric surgery. DESIGN: Randomized controlled trial. SETTING: Meridional Hospital, Cariacica/ES, Brazil. SUBJECTS: Thirty-two obese women undergoing elective open bariatric surgery were randomly assigned to receive preoperative inspiratory muscle training (inspiratory muscle training group or usual care (control group. MAIN MEASURES: Respiratory muscle strength (maximal static respiratory pressure - maximal inspiratory pressure and maximal expiratory pressure, lung volumes, and diaphragmatic excursion. RESULTS: After training, there was a significant increase only in the maximal inspiratory pressure in the inspiratory muscle training group. The maximal expiratory pressure, the lung volumes and the diaphragmatic excursion did not show any significant change with training. In the postoperative period there was a significant decrease in maximal inspiratory pressure in both the groups. However, there was a decrease of 28% in the inspiratory muscle training group, whereas it was 47% in the control group. The decrease in maximal expiratory pressure and in lung volumes in the postoperative period was similar between the groups. There was a significant reduction in the measures of diaphragmatic excursion in both the groups. CONCLUSION: The preoperative inspiratory muscle training increased the inspiratory muscle strength (maximal inspiratory pressure and attenuated the negative postoperative effects of open bariatric surgery in obese women for this variable, though not influencing the lung volumes and the diaphragmatic excursion.

  11. Preoperative red cell distribution width: Not a useful prognostic indicator for 30-day mortality in patients who undergo major- or ultra-major noncardiac surgery

    Directory of Open Access Journals (Sweden)

    Yik-Nang Cheung

    2016-01-01

    Full Text Available Background: Red cell distribution width (RDW has been shown to be associated with mortality in cardiac surgical patients. This study investigates the association of RDW with the 30-day mortality for those patients who undergo major- or ultra-major noncardiac surgery. Methods: Patients who received major- or ultra-major noncardiac surgery between July 2012 and May 2013 were included in the study and patients those with preoperative hemoglobin 13.35% (P = 0.025, odds ratio [OR]: 1.52, INR (P = 0.008, OR: 4.49, albumin level (P < 0.001, OR: 1.10, use of antihypertensives (P = 0.001, OR: 1.82, and preoperative pulse rate (P = 0.006, OR: 1.02 independently predicted the 30-day mortality. However, the area under receiver operating characteristic curve for the prediction of 30-day mortality using RDW was only 0.614. Conclusions: Although preoperative RDW independently predicted 30-day mortality in patients who underwent major- or ultra-major noncardiac surgery, it may not serve as an influential prognostic indicator in view of its low sensitivity and specificity.

  12. Optimism measured pre-operatively is associated with reduced pain intensity and physical symptom reporting after coronary artery bypass graft surgery

    Science.gov (United States)

    Ronaldson, Amy; Poole, Lydia; Kidd, Tara; Leigh, Elizabeth; Jahangiri, Marjan; Steptoe, Andrew

    2014-01-01

    Objective Optimism is thought to be associated with long-term favourable outcomes for patients undergoing coronary artery bypass graft (CABG) surgery. Our objective was to examine the association between optimism and post-operative pain and physical symptoms in CABG patients. Methods We assessed optimism pre-operatively in 197 adults undergoing CABG surgery, and then followed them up 6–8 weeks after the procedure to measure affective pain, pain intensity, and physical symptom reporting directly pertaining to CABG surgery. Results Greater optimism measured pre-operatively was significantly associated with lower pain intensity (β = − 0.150, CI = − 0.196 to − 0.004, p = .042) and fewer physical symptoms following surgery (β = − 0.287, CI = − 0.537 to − 0.036, p = .025), but not with affective pain, after controlling for demographic, clinical and behavioural covariates, including negative affectivity. Conclusions Optimism is a modest, yet significant, predictor of pain intensity and physical symptom reporting after CABG surgery. Having positive expectations may promote better recovery. PMID:25129850

  13. Groin sentinel node biopsy and (18)F-FDG PET/CT-supported preoperative lymph node assessment in cN0 patients with vulvar cancer currently unfit for minimally invasive inguinal surgery: The GroSNaPET study.

    Science.gov (United States)

    Garganese, G; Collarino, A; Fragomeni, S M; Rufini, V; Perotti, G; Gentileschi, S; Evangelista, M T; Ieria, F P; Zagaria, L; Bove, S; Giordano, A; Scambia, G

    2017-09-01

    The study aims were: 1) to verify the role of sentinel node biopsy (SNB) in a subset of patients with clinical N0 (cN0) invasive vulvar cancer (VC) who were still candidates for radical inguinal surgery according to the current guidelines; 2) to investigate whether a preoperative (18)F-FDG PET/CT (PET/CT) evaluation could improve the selection of node negative patients. From July 2013 to July 2016, all patients with VC admitted to our Division were evaluated by standard imaging and clinical exam. Among the patients assessed as cN0 we enrolled those unsuitable for SNB, due to: T > 4 cm, multifocal tumors, complete tumor diagnostic excision, contralateral nodal involvement and local recurrence. A preoperative PET/CT was performed. For each patient surgery included SNB, performed using a combined technique (radiotracer plus blue dye), followed by standard inguino-femoral lymphadenectomy. The reference standard was histopathology. Forty-seven patients entered the study for a total of 73 groins. Histopathology revealed 12 metastatic SNs in 9 groins. No false negative SNs were found (NPV 100%). PET/CT showed a negative predictive value of 93%. Our data suggest that SNB is accurate and safe even in cN0 patients currently excluded from this procedure, providing that a careful preoperative selection is performed. PET/CT allows a reliable assessment of LN status and may be an effective support for the selection of patients who are safe candidates for SNB. Copyright © 2017 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  14. Relationship between lower third molar and mandibular canal; Preoperative evaluation using CT scan

    Energy Technology Data Exchange (ETDEWEB)

    Itou, Masaki; Miyagishima, Toshio; Onizuka, Hiroyuki (Fujieda City Shida General Hospital, Shizuoka (Japan)); Takagi, Norio

    1994-01-01

    The mandibular canal is often closely related to the lower third molars. During the surgical removal of the third molar, the inferior alveolar nerve in the canal is sometimes damaged leading to impaired sensation in the lower lip. This is one of the most unpleasant postoperative complications. The buccolingual relationship between the lower third molar and the mandibular canal cannot be diagnosed by ortho-pantomography although preoperative evaluation must be carried out radiologically. In present study, the relationship was determined by using CT scan. Forty-seven lower third molars of 35 patients were evaluated preoperatively by CT scan. The mandibular canal of all cases overlapped with the third molar on ortho-pantomography. CT scan was taken in two ways. The first was the Tragion-Menton plane which was nearly parallel to the canal at the apex of the third molar. The second was the plane of the axis of the third molar. Axial CT scan was taken when the third molar erupted horizontally, and coronal CT scan was done when the molar erupted vertically. CT scan examination exactly revealed the position of the mandibular canal in relation to the root of the third molar. The canal was located buccally to the roots in 55 percent of cases, apicobuccally in 6 percent, apically in 23 percent, apicolingually in 6 percent, lingually in 2 percent, and between roots in 6 percent. The results of the present study were consistent with previous reports. In 12 cases, the inferior alveolar neurovascular bundle was visible during operation. It was visible in only 2 of 22 cases when the canal was located buccally. It was visible, on the other hand, in all cases in which the canal was located apicolingually, lingually, and between roots. It also tended to be visible when the canal overlapped more strongly with the third molar on preoperative ortho-pantomography. (author).

  15. CBCT fine preoperative evaluation of inflammatory radicular cysts and postoperative local integration appreciation of alloplastic grafts materials.

    Science.gov (United States)

    Nica, Diana; Ianes, Emilia; Brad, S

    2014-01-01

    The purpose of this paper is to point out the value of CBCT exam in pre and postoperative diagnosis assessment of inflammatory radicular cysts together with full appreciation of local integration of alloplastic graft materials used to repair the osseous defects. There were statistically retrospective evaluated the pre and postoperative results of CBCT and x-ray examinations of 34 patients with inflammatory radicular cysts clinically, biologically and histopathologically assessed at Oral and Maxilo-Facial Surgery Clinic from Timisoara. In all cases we proceeded to surgical radicular cysts removement, extraction of the associated non-vital tooth together with alloplastic graft materials repairement of the osseous defects. The CBCT preoperative scans clearly showed the extent, the morphological characteristics and the topoanatomic reports, in all 34 cases of inflammatory radicular cysts together with regional endodontic status. The CBCT postoperative scans revealed the very local integration of alloplastic graft materials used to repair the osseous defects and, in some cases, the dental rehabilitation by metallic implants. CBCT scan is the imaging method of choice in pre and postoperative diagnosis assessment of inflammatory radicular cysts together with alloplastic graft materials repairement of the osseous defects and dental rehabilitation by metallic implants, due to high specific abilities in bone tissue 3D evaluation.

  16. Preoperative diffuse leptomeningeal spread in a medulloblastoma: Paraplegia following surgery for posterior fossa and call for newer management protocols

    Directory of Open Access Journals (Sweden)

    Pravin Salunke

    2011-01-01

    Full Text Available Management of patients with medulloblastoma presenting with multiple metastasis in subarachnoid space preoperatively is unclear. An 11-year-old boy presented with vermian medulloblastoma with an unusually long segment cervico-dorsal lesion and suprasellar lesion. The child underwent a posterior fossa craniotomy (prone position and excision of vermian mass. He developed paraplegia in the immediate postoperative period, the possible causes for which are being discussed. Besides, treatment options for patients presenting with disseminated disease preoperatively have been highlighted. Preoperative chemotherapy to downstage such lesions may be tried and such complications could be avoided.

  17. Evaluation of Conventional Imaging Techniques on Preoperative Localization in Primary Hyperparathyroidism

    Directory of Open Access Journals (Sweden)

    Mesut Ozkaya

    2015-02-01

    Full Text Available We aimed to evaluate the diagnostic and preoperative localization capacity of 99mTc methoxyisobutylnitrile (MIBI parathyroid scintigraphy and ultrasonography (USG in enlarged parathyroid glands in the primary hyperparathyroidism (pHPT as well as the relationship between the success rate of these techniques and biochemical values. In this study, we retrospectively evaluated 39 patients with clinical and biological evidence of pHPT who referred to the university hospital for MIBI parathyroid scintigraphy. Patients were examined with USG and double-phase MIBI parathyroid scintigraphy for the detection of enlarged parathyroid glands. Preoperative serum intact parathyroid hormone (iPTH levels, calcium (Ca, phosphate and alkaline phosphatase measurements were obtained. A total of 45 parathyroid lesions in 39 patients were reviewed. Thirty-four patients had a single adenoma and 5 patients with multi-gland disease had 11 abnormal parathyroid glands including three adenomas, whereas the remaining 8 glands showed hyperplasia. The overall sensitivities of MIBI parathyroid scintigraphy, USG and combined techniques were 85.3%, 72.5% and 90.4%, respectively; the positive predictive values (PPV were 89.7%, 85.2% and 92.6%, respectively. The most successful approach for detection of enlarged parathyroid glands in hyperparathyroidism is the concurrent application of USG and MIBI parathyroid scintigraphy modalities. The concomitancy of thyroid diseases decreases the sensitivity of both MIBI parathyroid scintigraphy and USG in enlarged parathyroid glands.

  18. Importance of Radiological Evaluation of Global Spinal Balance Together with Lower Limb Alignment in Planning Lumbar Spine Deformity Surgery ? Illustrative Case Presentation

    OpenAIRE

    Głowacki, Mariusz; Walecki, Jerzy; Kołakowski, Przemysław; Kolońska, Danuta

    2017-01-01

    Summary Background The presented case illustrates the critical role of a detailed preoperative radiological evaluation in complex spine surgery. Case Report A 49-year-old patient was admitted for a revision surgery after L3?L5 fusion. Preoperative assessment showed preserved sagittal balance, coronal imbalance and valgus knee deformity. The patient reported pain of 8?10 in VAS (Visual Analogue Scale) and had an ODI (Oswestry Disability Index) of 60%. The first step of the surgery was L2?S1 fu...

  19. A STUDY OF COMPARATIVE EVALUATION OF PREOPERATIVE SKIN PREPARATION WITH CHLORHEXIDINE-ALCOHOL VERSUS POVIDONE-IODINE IN PREVENTION OF SURGICAL SITE INFECTIONS

    Directory of Open Access Journals (Sweden)

    Geetha Danasekaran

    2017-05-01

    Full Text Available BACKGROUND Surgical site infections is a dangerous condition posing a heavy burden on the patient and social health system. The use of preoperative skin preparation by effective antiseptic plays an important role in reducing postoperative wound infections. Hence, the present study was undertaken to compare and evaluate the efficacy of 2% chlorhexidine-alcohol versus 5% povidone-iodine in abdominal surgeries for prevention of SSI. MATERIALS AND METHODS The present one year randomised controlled trial was conducted in the Department of General Surgery, Government Rajaji Hospital, Madurai, over a period from 2014 to 2015 on 120 patients undergoing elective abdominal surgeries. The patients were divided into two groups by computer randomisation that is Group A (chlorhexidine-alcohol group and Group B (povidone-iodine group. The surgical wounds were examined for any infections present. RESULTS Most of the patients were males in both the groups (73.33% and 61.67% in group A and B, respectively. Half of the patients (50% in both the groups had chronic appendicitis. The mean duration of surgery in group A was 44.66 ± 5.86 minutes, and in group B, it was 45.00 ± 6.24 minutes. Staphylococcus aureus (1.67% in group A and 10% in group B was the most common organism isolated after skin preparation. After the application of antiseptic agents, there was reduction of bacterial colonisation in both the groups, but significant reduction was seen in chlorhexidine group. In group A, two patients had superficial SSIs compared to 14 patients in group B (p=0.001. The mean length of hospital stay in group A was significantly less (7.20 ± 1.10 vs. 8.67 ± 3.17. CONCLUSION Preoperative skin cleansing with chlorhexidine significantly reduces risk of postoperative SSIs and colonisation of bacteria in clean abdominal surgeries.

  20. Association between elevated pre-operative glycosylated hemoglobin and post-operative infections after non-emergent surgery

    Directory of Open Access Journals (Sweden)

    Joseph M. Blankush

    2016-09-01

    Conclusions: The risk factors of post-operative infection are multiple and likely synergistic. While pre-operative HbA1c level is not independently associated with risk of post-operative infection, there are scenarios and patient subgroups where pre-operative HbA1c is useful in predicting an increased risk of infectious complications in the post-operative period.

  1. Optimizing preoperative haemoglobin in major orthopaedic surgery using intravenous iron with or without erythropoietin. An epidemiologic study.

    Science.gov (United States)

    Basora, M; Colomina, M J; Tio, M; Mora, L; Sánchez-Etayo, G; Salazar, F; Ciércoles, E; Paños, M; Guerrero, E; Berge, R

    2015-01-01

    To evaluate the effectiveness of intravenous iron treatment, with or without associated erythropoietin (rHuEPO), measured as haemoglobin (Hb) increase. The relationships between the Hb increase and parameters used to evaluate anaemia were analysed. Retrospective observational study carried out in two third-level hospitals between January 2005 and December 2009. The study included patients with iron deficiency anaemia scheduled for elective orthopaedic surgery and treated with intravenous iron sucrose alone or associated with rHuEPO. Treatment efficacy was analysed based on the Hb increase from baseline to just before surgery. A total of 412 patients who received a median of 800mg of iron sucrose were included; 125 of them (30.4%) additionally received 2.4 vials of rHuEPO. The Hb increase was 0.8 (1.1) g/dL in patients treated with intravenous iron and 1.5 (1.3) g/dL in those additionally given rHuEPO(P<.01). The percentage of hypochromic red blood cells (r=0.52) and soluble transferrin receptor (r=0.59) value were significantly correlated to the Hb increase in patients receiving iron. In patients with iron deficiency anaemia, the effectiveness of iron sucrose treatment to optimize Hb before surgery was moderate; adjuvant administration of erythropoietin improved the results. Determination of functional iron status parameters may improve the treatment effectiveness. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, N.; Møller, Ann Merete;

    2010-01-01

    Background Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. Objectives The objective of this review...... was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Search strategy The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text......; pooled RR 10.76 (95% confidence interval (CI) 4.55 to 25.46, two trials) and RR 1.41 (95% CI 1.22 to 1.63, five trials) respectively. Four trials evaluating the effect on long-term smoking cessation found a significant effect; pooled RR 1.61 (95% CI 1.12 to 2.33). However, when pooling intensive...

  3. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Sonia Gaucher

    Full Text Available To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial.Multicenter, two-arm, parallel-group, open-label randomized controlled trial.11 university hospital ambulatory surgery units in Paris, France.Patients scheduled for ambulatory surgery and able to be reached by telephone.A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults, was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone.Rate of cancellation on the day of surgery or the day before.The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6% vs. 113 (5.8%, adjusted odds ratio [95% confidence interval] = 0.91 [0.65-1.29], (p = 0.57. Checklist administration revealed that 355 patients (28.0% had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0% still had questions concerning the fasting state.A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes.ClinicalTrials.gov NCT01732159.

  4. Assessment of a Standardized Pre-Operative Telephone Checklist Designed to Avoid Late Cancellation of Ambulatory Surgery: The AMBUPROG Multicenter Randomized Controlled Trial

    Science.gov (United States)

    Marchand-Maillet, Florence; Baron, Gabriel; Douard, Richard; Béthoux, Jean-Pierre

    2016-01-01

    Objectives To assess the impact of a standardized pre-operative telephone checklist on the rate of late cancellations of ambulatory surgery (AMBUPROG trial). Design Multicenter, two-arm, parallel-group, open-label randomized controlled trial. Setting 11 university hospital ambulatory surgery units in Paris, France. Participants Patients scheduled for ambulatory surgery and able to be reached by telephone. Intervention A 7-item checklist designed to prevent late cancellation, available in five languages and two versions (for children and adults), was administered between 7 and 3 days before the planned date of surgery, by an automated phone system or a research assistant. The control group received standard management alone. Main Outcome Measures Rate of cancellation on the day of surgery or the day before. Results The study population comprised 3900 patients enrolled between November 2012 and September 2013: 1950 patients were randomized to the checklist arm and 1950 patients to the control arm. The checklist was administered to 68.8% of patients in the intervention arm, 1002 by the automated phone system and 340 by a research assistant. The rate of late cancellation did not differ significantly between the checklist and control arms (109 (5.6%) vs. 113 (5.8%), adjusted odds ratio [95% confidence interval] = 0.91 [0.65–1.29], (p = 0.57)). Checklist administration revealed that 355 patients (28.0%) had not undergone tests ordered by the surgeon or anesthetist, and that 254 patients (20.0%) still had questions concerning the fasting state. Conclusions A standardized pre-operative telephone checklist did not avoid late cancellations of ambulatory surgery but enabled us to identify several frequent causes. Trial Registration ClinicalTrials.gov NCT01732159 PMID:26829478

  5. Effect of preoperative two-dimensional animation information on perioperative anxiety and knowledge retention in patients undergoing bowel surgery: a randomized pilot study.

    Science.gov (United States)

    Tou, S; Tou, W; Mah, D; Karatassas, A; Hewett, P

    2013-05-01

    The use of multimedia information provided preoperatively can potentially reduce anxiety in patients and improve the hospital experience. However, the use of two-dimensional (2D) animation (cartoon) to provide information to patients undergoing colorectal surgery has not been investigated. This study investigated the effect of preoperative 2D information on anxiety and knowledge retention in patients undergoing bowel surgery. Patients were randomized to one of two groups; the video group watched a 13-min cartoon animation whereas the nonvideo group did not. Anxiety levels were measured at the preadmission clinic, postvideo, on the day of admission for surgery, within 24-h after surgery and before discharge using the Spielberger state-trait anxiety inventory and visual analogue scale. Both groups completed a knowledge retention questionnaire and the video group completed a feedback questionnaire about the animation. Thirty-one patients (16 video, 15 nonvideo) participated in the study. There was no significant difference in baseline anxiety score between two groups. An immediate reduction (P = 0.03) in anxiety score was observed in the video group after watching the video compared with baseline. There was a significant reduction in anxiety score in the video group at discharge compared with the nonvideo group (P = 0.03). There was no significant difference in knowledge retention between two groups. Eighty-eight per cent of patients who watched the video found it beneficial. 2D animation is an effective medium for delivering information to patients undergoing bowel surgery and can potentially reduce anxiety related to surgery and improve the hospital experience. Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

  6. The Preoperative Evaluation of Infective Endocarditis via 3-Dimensional Transesophageal Echocardiography.

    Science.gov (United States)

    Yong, Matthew S; Saxena, Pankaj; Killu, Ammar M; Coffey, Sean; Burkhart, Harold M; Wan, Siu-Hin; Malouf, Joseph F

    2015-08-01

    Transesophageal echocardiography continues to have a central role in the diagnosis of infective endocarditis and its sequelae. Recent technological advances offer the option of 3-dimensional imaging in the evaluation of patients with infective endocarditis. We present an illustrative case and review the literature regarding the potential advantages and limitations of 3-dimensional transesophageal echocardiography in the diagnosis of complicated infective endocarditis. A 51-year-old man, an intravenous drug user who had undergone bioprosthetic aortic valve replacement 5 months earlier, presented with prosthetic valve endocarditis. Preoperative transesophageal echocardiography with 3D rendition revealed a large abscess involving the mitral aortic intervalvular fibrosa, together with a mycotic aneurysm that had ruptured into the left atrium, resulting in a left ventricle-to-left atrium fistula. Three-dimensional transesophageal echocardiography enabled superior preoperative anatomic delineation and surgical planning. We conclude that 3-dimensional transesophageal echocardiography can be a useful adjunct to traditional 2-dimensional transesophageal echocardiography as a tool in the diagnosis of infective endocarditis.

  7. Preoperative Evaluation with fMRI of Patients with Intracranial Gliomas

    Directory of Open Access Journals (Sweden)

    Ioannis Z. Kapsalakis

    2012-01-01

    Full Text Available Introduction. Aggressive surgical resection constitutes the optimal treatment for intracranial gliomas. However, the proximity of a tumor to eloquent areas requires exact knowledge of its anatomic relationships to functional cortex. The purpose of our study was to evaluate fMRI’s accuracy by comparing it to intraoperative cortical stimulation (DCS mapping. Material and Methods. Eighty-seven patients, with presumed glioma diagnosis, underwent preoperative fMRI and intraoperative DCS for cortical mapping during tumor resection. Findings of fMRI and DCS were considered concordant if the identified cortical centers were less than 5 mm apart. Pre and postoperative Karnofsky Performance Scale and Spitzer scores were recorded. A postoperative MRI was obtained for assessing the extent of resection. Results. The areas of interest were identified by fMRI and DCS in all participants. The concordance between fMRI and DCS was 91.9% regarding sensory-motor cortex, 100% for visual cortex, and 85.4% for language. Data analysis showed that patients with better functional condition demonstrated higher concordance rates, while there also was a weak association between tumor grade and concordance rate. The mean extent of tumor resection was 96.7%. Conclusions. Functional MRI is a highly accurate preoperative methodology for sensory-motor mapping. However, in language mapping, DCS remains necessary for accurate localization.

  8. Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study.

    Science.gov (United States)

    Taylor, Fiona G M; Quirke, Philip; Heald, Richard J; Moran, Brendan; Blomqvist, Lennart; Swift, Ian; Sebag-Montefiore, David J; Tekkis, Paris; Brown, Gina

    2011-04-01

    To assess local recurrence, disease-free survival, and overall survival in magnetic resonance imaging (MRI)-predicted good prognosis tumors treated by surgery alone. The MERCURY study reported that high-resolution MRI can accurately stage rectal cancer. The routine policy in most centers involved in the MERCURY study was primary surgery alone in MRI-predicted stage II or less and in MRI "good prognosis" stage III with selective avoidance of neoadjuvant therapy. Data were collected prospectively on all patients included in the MERCURY study who were staged as MRI-defined "good" prognosis tumors. "Good" prognosis included MRI-predicted safe circumferential resection margins, with MRI-predicted T2/T3a/T3b (less than 5 mm spread from muscularis propria), regardless of MRI N stage. None received preoperative or postoperative radiotherapy. Overall survival, disease-free survival, and local recurrence were calculated. Of 374 patients followed up in the MERCURY study, 122 (33%) were defined as "good prognosis" stage III or less on MRI. Overall and disease-free survival for all patients with MRI "good prognosis" stage I, II and III disease at 5 years was 68% and 85%, respectively. The local recurrence rate for this series of patients predicted to have a good prognosis tumor on MRI was 3%. The preoperative identification of good prognosis tumors using MRI will allow stratification of patients and better targeting of preoperative therapy. This study confirms the ability of MRI to select patients who are likely to have a good outcome with primary surgery alone.

  9. A novel index for preoperative, non-invasive prediction of macro-radical primary surgery in patients with stage IIIC-IV ovarian cancer-a part of the Danish prospective pelvic mass study.

    Science.gov (United States)

    Karlsen, Mona Aarenstrup; Fagö-Olsen, Carsten; Høgdall, Estrid; Schnack, Tine Henrichsen; Christensen, Ib Jarle; Nedergaard, Lotte; Lundvall, Lene; Lydolph, Magnus Christian; Engelholm, Svend Aage; Høgdall, Claus

    2016-09-01

    The purpose of this study was to develop a novel index for preoperative, non-invasive prediction of complete primary cytoreduction in patients with FIGO stage IIIC-IV epithelial ovarian cancer. Prospectively collected clinical data was registered in the Danish Gynecologic Cancer Database. Blood samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor removal. One hundred fifty patients with advanced epithelial ovarian cancer were treated with primary debulking surgery (PDS). Complete PDS was achieved in 41 cases (27 %). The receiver operating characteristic curves demonstrated an area under the curve of 0.785 for HE4, 0.678 for CA125, and 0.688 for age. The multivariate model (Cancer Ovarii Non-invasive Assessment of Treatment Strategy (CONATS) index), consisting of HE4, age, and performance status, demonstrated an AUC of 0.853. According to the Danish indicator level, macro-radical PDS should be achieved in 60 % of patients admitted to primary surgery (positive predictive value of 60 %), resulting in a negative predictive value of 87.5 %, sensitivity of 68.3 %, specificity of 83.5 %, and cutoff of 0.63 for the CONATS index. Non-invasive prediction of complete PDS is possible with the CONATS index. The CONATS index is meant as a supplement to the standard preoperative evaluation of each patient. Evaluation of the CONATS index combined with radiological and/or laparoscopic findings may improve the assessment of the optimal treatment strategy in patients with advanced epithelial ovarian cancer.

  10. Using 3 Tesla magnetic resonance imaging in the pre-operative evaluation of tongue carcinoma.

    Science.gov (United States)

    Moreno, K F; Cornelius, R S; Lucas, F V; Meinzen-Derr, J; Patil, Y J

    2017-09-01

    This study aimed to evaluate the role of 3 Tesla magnetic resonance imaging in predicting tongue tumour thickness via direct and reconstructed measures, and their correlations with corresponding histological measures, nodal metastasis and extracapsular spread. A prospective study was conducted of 25 patients with histologically proven squamous cell carcinoma of the tongue and pre-operative 3 Tesla magnetic resonance imaging from 2009 to 2012. Correlations between 3 Tesla magnetic resonance imaging and histological measures of tongue tumour thickness were assessed using the Pearson correlation coefficient: r values were 0.84 (p Tesla magnetic resonance imaging had 83 per cent sensitivity, 82 per cent specificity, 82 per cent accuracy and a 90 per cent negative predictive value for detecting cervical lymph node metastasis. In this cohort, 3 Tesla magnetic resonance imaging measures of tumour thickness correlated highly with the corresponding histological measures. Further, 3 Tesla magnetic resonance imaging was an effective method of detecting malignant adenopathy with extracapsular spread.

  11. Role of multislice CT and magnetic resonance cholangiography in preoperative evaluation of potential donor in living related liver transplantation

    Directory of Open Access Journals (Sweden)

    Hossam M. Abdel-Rahman

    2016-03-01

    Conclusion: Multislice CT is a valuable tool in the evaluation of potential living liver donors that provides complete information on the hepatic vascular anatomy, the liver parenchyma, and volumetric measurements. MRC with a 3.0-T MR system demonstrates the preoperative biliary evaluation very well with a high accuracy rate.

  12. Evaluation of macular thickness change after inferior oblique muscle recession surgery

    Directory of Open Access Journals (Sweden)

    Ece Turan-Vural

    2014-01-01

    Full Text Available Purpose: This study aimed to evaluate the changes in macular thickness following inferior oblique muscle recession surgery. Materials and Methods: Thirty-eight eyes from 21 patients undergoing ocular muscle surgery were included. Patients were grouped into three groups based on the type of surgical intervention: Group I (n = 12, inferior oblique recession surgery alone; Group II (n = 12, inferior oblique plus horizontal muscle surgery; Group III (n = 14, horizontal muscle surgery alone. Each eye was scanned using the optical coherence tomography (OCT device preoperatively and on the first postoperative day to measure macular thickness. Results: Following surgery, a significant increase in foveal thickness occurred in Group I (P < 0.05 and Group II (P < 0.01. In addition, a statistically significant difference was observed between the groups with regard to the increase in foveal thickness (P = 0.016, with significantly lower changes in Group III. Conclusion: Our findings suggested that inferior oblique muscle recession surgery is associated with an increase in macular thickness.

  13. Aortic valve stenosis: non-invasive preoperative evaluation using 64-slice CT angiography.

    Science.gov (United States)

    Ciolina, F; Sedati, P; Zaccagna, F; Galea, N; Noce, V; Miraldi, F; Cavarretta, E; Francone, M; Carbone, I

    2015-10-01

    In patients affected by aortic valve stenosis (AS) it is mandatory to rule out coronary artery disease (CAD). The role of retrospectively ECG-gated 64-slice CT angiography (64-SCTA) was assessed in patients with AS referred for surgical valve replacement. Forty-two patients with AS underwent ECG-gated 64-SCTA of thoracic aorta, including the heart and coronary arteries, before surgical valve replacement. Images were evaluated by two independent readers and compared with surgical findings in terms of aortic valve calcification grading, valvular morphology, aortic valve annulus and sino-tubular junction diameters, and valvular area planimetry. Quantitative evaluation of cusps opening was also performed. Finally, the presence of CAD, thoracic aortic aneurysm and left ventricle hypertrophy were assessed. Visualization of the aortic valve without motion artefacts was possible in 38 patients (90.5%). Valvular morphology was correctly assessed in all cases (100%). 64-SCTA correctly determined aortic valve calcification grading and the aortic valve annulus and sinotubular junction diameters in 100% of cases. The aortic valve planimetric area was assessed in 38 cases (90.5%). Ascending aortic aneurysms requiring surgical replacement were detected in 12 patients (28.6%). Significant left ventricle hypertrophy was found in 30 patients (71%). Preoperative evaluation of patients undergoing surgical replacement for AS with 64-SCTA is feasible. 64-SCTA can rule out CAD and evaluate the status of the aortic valve and thoracic aorta in the same examination, obtaining relevant information for surgical planning.

  14. Bleeding and first-year mortality following hip fracture surgery and preoperative use of low-dose acetylsalicylic acid: an observational cohort study

    Directory of Open Access Journals (Sweden)

    Apelqvist Anna

    2011-11-01

    Full Text Available Abstract Background Hip fracture is associated with high mortality. Cardiovascular disease and other comorbidities requiring long-term anticoagulant medication are common in these mostly elderly patients. The objective of our observational cohort study of patients undergoing surgery for hip fracture was to study the association between preoperative use of low-dose acetylsalicylic acid (LdAA and intraoperative blood loss, blood transfusion and first-year all-cause mortality. Methods An observational cohort study was conducted on patients with hip fracture (cervical requiring hemiarthroplasty or pertrochanteric or subtrochanteric requiring internal fixation participating in a randomized trial that found lack of efficacy of a compression bandage in reducing postoperative bleeding. The participants were 255 patients (≥50 years of whom 118 (46% were using LdAA (defined as ≤320 mg daily preoperatively. Bleeding variables in patients with and without LdAA treatment at time of fracture were measured and blood transfusions given were compared using logistic regression. The association between first-year mortality and preoperative use of LdAA was analyzed with Cox regression adjusting for age, sex, type of fracture, baseline renal dysfunction and baseline cardiovascular and/or cerebrovascular disease. Results Blood transfusions were given postoperatively to 74 (62.7% LdAA-treated and 76 (54% non-treated patients; the adjusted odds ratio was 1.8 (95% CI 1.04 to 3.3. First-year mortality was significantly higher in LdAA-treated patients; the adjusted hazard ratio (HR was 2.35 (95% CI 1.23 to 4.49. The mortality was also higher with baseline cardiovascular and/or cerebrovascular disease, adjusted HR 2.78 (95% CI 1.31 to 5.88. Patients treated with LdAA preoperatively were significantly more likely to suffer thromboembolic events (5.7% vs. 0.7%, P = 0.03. Conclusions In patients with hip fracture (cervical treated with hemiarthroplasty or pertrochanteric

  15. The superiority of 256-slice spiral computed tomography angiography for preoperative evaluation of surrounding arteries in patients with gastric cancer

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    Wu D

    2017-02-01

    Full Text Available Deqing Wu, Linyong Zhao, Ying Liu, Junjiang Wang, Weixian Hu, Xingyu Feng, Zejian Lv, Yong Li, Xueqing Yao Department of General Surgery, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China Objective: To evaluate the utilization of 256-slice spiral computed tomography (CT angiography in preoperative assessment of perigastric vascular anatomy in patients with gastric cancer. Methods: In this study, 80 gastric cancer patients were included. The medical procedure of 256-slice spiral CT angiography was performed on each of these patients consecutively. Thereafter, these patients were subjected to surgical treatment in our hospital. The techniques of volume rendering (VR and maximum intensity projection (MIP were used to image reconstruction of arteries around the stomach. Results: Both VR and MIP were applied to reconstruct the images of perigastric arteries. The results indicated that VR imaging was inferior to MIP in determining the variant small artery anatomy around the greater curvature and fundus. The respective rates of imaging produced by VR and MIP for left gastroepiploic artery, short gastric artery, and posterior gastric artery, were 32.50% versus 100%, 16.25% versus 87.50%, and 3.75% versus 25.00%, respectively. According to Hiatt’s classification, 75 out of 240 cases were abnormal types, among which we found Type II in 30 cases, Type III in 33 cases, Type IV in three cases, Type V in six cases, and Type VI in only three cases. There was no significant difference for total and every single variation type, between our group and Hiatt’s group (P>0.05. Conclusion: The 256-slice spiral CT angiography can be regarded as an effective and accurate diagnostic modality for preoperative assessing anatomical arterial variations in gastric cancer; MIP was superior to VR at identifying variations of some small artery, whereas VR was better than MIP at showing anatomical arterial variations

  16. Combination of European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Cardiac Surgery Score (CASUS) to Improve Outcome Prediction in Cardiac Surgery.

    Science.gov (United States)

    Doerr, Fabian; Heldwein, Matthias B; Bayer, Ole; Sabashnikov, Anton; Weymann, Alexander; Dohmen, Pascal M; Wahlers, Thorsten; Hekmat, Khosro

    2015-08-17

    BACKGROUND We hypothesized that the combination of a preoperative and a postoperative scoring system would improve the accuracy of mortality prediction and therefore combined the preoperative 'additive EuroSCORE' (European system for cardiac operative risk evaluation) with the postoperative 'additive CASUS' (Cardiac Surgery Score) to form the 'modified CASUS'. MATERIAL AND METHODS We included all consecutive adult patients after cardiac surgery during January 2007 and December 2010 in our prospective study. Our single-centre study was conducted in a German general referral university hospital. The original additive and the 'modified CASUS' were tested using calibration and discrimination statistics. We compared the area under the curve (AUC) of the receiver characteristic curves (ROC) by DeLong's method and calculated overall correct classification (OCC) values. RESULTS The mean age among the total of 5207 patients was 67.2 ± 10.9 years. Whilst the ICU mortality was 5.9% we observed a mean length of ICU stay of 4.6 ± 7.0 days. Both models demonstrated excellent discriminatory power (mean AUC of 'modified CASUS': ≥ 0.929; 'additive CASUS': ≥ 0.920), with no significant differences according to DeLong. Neither model showed a significant p-value (cardiac surgery by combining a preoperative and a postoperative scoring system. A separate calculation of the two individual elements is therefore recommended.

  17. Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation

    Directory of Open Access Journals (Sweden)

    Gema Ruíz-López del Prado

    Full Text Available Abstract Background and objectives: Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. Methods: Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. Results: The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71. The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. Conclusions: The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations.

  18. [Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation].

    Science.gov (United States)

    Ruíz-López Del Prado, Gema; Blaya-Nováková, Vendula; Saz-Parkinson, Zuleika; Álvarez-Montero, Óscar Luis; Ayala, Alba; Muñoz-Moreno, Maria Fe; Forjaz, Maria João

    Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  19. Design and validation of an oral health questionnaire for preoperative anaesthetic evaluation.

    Science.gov (United States)

    Ruíz-López Del Prado, Gema; Blaya-Nováková, Vendula; Saz-Parkinson, Zuleika; Álvarez-Montero, Óscar Luis; Ayala, Alba; Muñoz-Moreno, Maria Fe; Forjaz, Maria João

    Dental injuries incurred during endotracheal intubation are more frequent in patients with previous oral pathology. The study objectives were to develop an oral health questionnaire for preanaesthesia evaluation, easy to apply for personnel without special dental training; and establish a cut-off value for detecting persons with poor oral health. Validation study of a self-administered questionnaire, designed according to a literature review and an expert group's recommendations. The questionnaire was applied to a sample of patients evaluated in a preanaesthesia consultation. Rasch analysis of the questionnaire psychometric properties included viability, acceptability, content validity and reliability of the scale. The sample included 115 individuals, 50.4% of men, with a median age of 58 years (range: 38-71). The final analysis of 11 items presented a Person Separation Index of 0.861 and good adjustment of data to the Rasch model. The scale was unidimensional and its items were not biased by sex, age or nationality. The oral health linear measure presented good construct validity. The cut-off value was set at 52 points. The questionnaire showed sufficient psychometric properties to be considered a reliable tool, valid for measuring the state of oral health in preoperative anaesthetic evaluations. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  20. Prevalence of preoperative anaemia in patients having first-time cardiac surgery and its impact on clinical outcome. A retrospective observational study.

    Science.gov (United States)

    Kim, C J; Connell, H; McGeorge, A D; Hu, R

    2015-05-01

    The prevalence of anaemia is increasing globally. It has a close association with perioperative blood transfusion which, in turn, results in an increased risk of postoperative complications. Undesirable effects are not only limited to short-term, but also have long-term implications. Despite this, many patients undergo cardiac surgery with undiagnosed and untreated anaemia. We designed a retrospective, observational study to estimate the prevalence of anaemia in patients having cardiac surgery in Auckland District Health Board, blood transfusion rates and associated clinical outcome. Two hundred of seven hundred and twelve (28.1%) patients were anaemic. Red blood cell (RBC) transfusion rates were significantly higher in the anaemic group compared to the non-anaemic group (160 (80%) vs. 192 (38%), p-value Anaemia was significantly associated with the development of new infection (14 (7%) vs. 15 (2.9%), p-value 0.0193, RR (CI 95%) 2.389 (1.175-4.859)), prolonged ventilation time (47.01 hours vs. 23.59 hours, p-value 0.0076) and prolonged intensive care unit (ICU) stay (80.23 hours vs. 50.27, p-value 0.0011). Preoperative anaemia is highly prevalent and showed a clear link with significantly higher transfusion rates and postoperative morbidity. It is vital that a preoperative management plan for the correction of anaemia should be sought to improve patient safety and outcome.

  1. EVALUATION OF SURGERY IN SIMPLE OVARIAN CYSTS

    Institute of Scientific and Technical Information of China (English)

    丁晓曼; 冷金花; 郎景和; 李华军

    2003-01-01

    Objective. To evaluate the surgery in simple ovarian cysts.Methods. From Jan. 1994 to Dec. 1999, 221 women with simple ovarian cysts were admitted into ourhospital. The diameter of cysts was <5 cm in 76 cases, and was≥5 cm in 145 cases ultrasonically.One hundred and eighty-four patients underwent laparosocopy, and thirty-seven underwent laparotomy.Results. Histological findings showed no malignancy in this series. Simple cysts, paraovarian cystsand corpus luteum were found histologically in 90.8% of cases with cysts <5 cm, and 60% of those withcysts >7 cm respectively, their difference was significant (X2=-37.13, P<0.001). The simple cysts, paraovar-ian cysts and corpus luteum cysts were found in 81.5% of postmenopausal women and 84.0% of pre-menopausal women. Conclusion. Patients with cysts >7 cm are indicated for surgical procedures, while a period of fol-lowup is acceptable for patients with cysts <7 cm, and surgery is advisable if the cyst is persistent dur-ing followup. Postmenopausal women with cysts should have operations.

  2. Comparison of preoperative quality of life in breast reconstruction, breast aesthetic and non-breast plastic surgery patients: A cross-sectional study.

    Science.gov (United States)

    Duraes, Eliana F R; Durand, Paul; Duraes, Leonardo C; Orra, Susan; Moreira-Gonzalez, Andrea; Sousa, Joao Batista de; Djohan, Risal S; Zins, James; Bernard, Steven; Schwarz, Graham S

    2016-11-01

    A breast cancer diagnosis imposes significant emotional and psychological duress. The purpose of this study is to assess the baseline quality of life (QOL) of immediate, delayed, and secondary breast reconstruction patients, comparing these results with QOL in women seeking plastic surgery for cosmetic breast, and non-breast procedures. From 2012 through 2013, immediate (group 1), delayed (group 2), and secondary (Group 3) reconstruction patients, aesthetic breast (group 4) and non-breast plastic surgery patients (group 5) answered Breast-Q questionnaires. Groups 1, 2, 3, 4, and 5 answered 141, 12, 23, 72 and 160 preoperative questionnaires respectively. There was no difference (p = NS) in breast satisfaction, psychosocial well-being, physical well-being-chest, and sexual well-being between groups 1 and 5. Group 1 had higher satisfaction with breast (p breasts (p breasts, psychosocial, and sexual well-being, compared to groups 2 and 3. Group 4 had lower scores in all domains, compared to groups 1 and 5 (p reconstruction patients had similar satisfaction with breasts, psychosocial well-being, and chest physical well-being, compared to non-breast plastic surgery patients. Aesthetic breast surgery patients demonstrate similar low scores in satisfaction with breasts, psychosocial well-being, and sexual well-being to those of patients prior to delayed breast reconstruction, or secondary salvage procedures. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. The effect of preoperative oral immunonutrition on complications and length of hospital stay after elective surgery for pancreatic cancer

    DEFF Research Database (Denmark)

    Gade, Josephine; Levring, Trine; Hillingsø, Jens Georg;

    2016-01-01

    Major gastrointestinal surgery is associated with immune suppression and a high risk of postoperative complications. The aim of this open, randomized controlled trial was to examine the effect of supplementary per oral immunonutrition (IN) seven days before surgery for pancreatic cancer (PC...

  4. Evaluation of the response to preoperative chemotherapy with PET image in osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Dae Geun

    2001-01-01

    F18 FDG PET scan has an advantage in evaluating the biologic status of the tumors. The purpose of this study is evaluate the role of PET scan in pre- and postchemotherapeutic osteosarcomas and correlate the findings with pathologic examination. 18 cases of osteosarcomas had biopsy and preoperative chemotherapy at our department. All case had initial MRI and PET scan and those were repeated after 2 cycles of chemotherapy. Under PET image parameters such as VOI(volume of interest), total activity(SUV), ratio of pre- and postchemotherapy SUV, T/N(tumor/normal tissue) ratio were analyzed. There was a significant correlation between the calculated necrosis in PET and observed one on pathologic specimen(r2=0.78, P<0.05). Cross correlation among identified variables revealed meaningful result between SUV2/SUV1 ratio and tumor necrosis(r2=0.57, P=0.025). As the SUV2/SUV1 decrease, so much more the tumor necrosis was. F18 FDG PET scan could get objective data such as volume, degree of necrosis and total activity and was also useful in estimating the contribution of chemotherapy in tumor necrosis over the innate necrosis before treatment.

  5. Preoperative evaluation of patients submitted to pneumonectomy for lung carcinoma: role of exercise testing.

    Science.gov (United States)

    Villani, Fabrizio; Busia, Alessandra

    2004-01-01

    The aim of the present investigation was to evaluate which parameters of preoperative spirometry, arterial blood gas, radionuclide lung scanning and cardiopulmonary exercise test are the best predictor of postoperative morbidity and mortality in patients submitted to pneumonectomy. The study was conducted in 150 patients (mean age, 57.1). Forty-four patients (29.3%) had postoperative complications. Four patients (2.7%) died within one month of the pneumonectomy. Patients with complications had significantly lower ppoFEV1 as percentage of predicted and lower VO2 max, and those who died also had a significant decrease in PaO2 during exercise. Moreover, among patients with obstructive pulmonary disease (FEV1VO2 max in complicated patients. The present data support the suggestion that exercise testing could be a useful adjunct in the evaluation of postoperative risk for pneumonectomy, especially in patients with obstructive pulmonary disease. In particular, patients with VO2 max <50% of predicted should be considered at high risk of morbidity from cardiopulmonary causes.

  6. Tailored keyhole surgery for basal ganglia cavernous malformation with preoperative three-dimensional pyramidal tracts assessment and intraoperative electrophysiological monitoring

    Institute of Scientific and Technical Information of China (English)

    Kai Quan; Geng Xu; Fan Zhao; Wei Zhu

    2016-01-01

    Background:Accurately mapping the pyramidal tracts preoperatively and intraoperatively is the primary concern when operating on cavernous malformations (CMS) in the basal ganglia.We have conducted new methods for preoperative planning and have tailored lesion resection to prevent the damage of pyramidal tracts.Patients and methods:Eleven patients harboring cavernous malformations in basal ganglia were treated surgically from April 2008 to January 2015.Surgical planning was based on three-dimensional diffusion tensor pyramidal tractography and Virtual Reality system.Intraoperative detecting of pyramidal tracts with subcortical stimulation mapping and motor evoked potential monitoring were performed.The extent of resection and postoperative neurological function were assessed in each case.Results:Total removal of the cavernous malformations were achieved in each case.Four of the total eleven cases presented temporary neurological deficits,including one occurrence of hemiparesis and three occurrences of hemianesthesia.No permanent neurological deficit was developed in this series of cases.Conclusion:Three-dimensional diffusion tensor pyramidal tractography is quite helpful for preoperative planning of basal ganglia cavernous malformations,especially in choosing a suitable surgical approach.Intraoperative detection of pyramidal tracts with subcortical stimulation mapping and motor evoked potential monitoring play important roles in preventing damage to pyramidal tracts during lesion resection.

  7. Imaging evaluation of post pancreatic surgery

    Energy Technology Data Exchange (ETDEWEB)

    Scialpi, Michele [Department of Radiology, ' Santissima Annunziata' Hospital, Via Bruno 1, I-74100 Taranto (Italy)]. E-mail: michelescialpi@libero.it; Scaglione, Mariano [Department of Radiology, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Volterrani, Luca [Institute of Radiology, University of Siena, I-53100 Siena (Italy); Lupattelli, Luciano [Institute of Radiology, University of Perugia, I-06122 Perugia (Italy); Ragozzino, Alfonso [Department of Radiology, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Romano, Stefania [Department of Radiology, ' A. Cardarelli' Hospital, I-80131 Naples (Italy); Rotondo, Antonio [Section of Radiology, Department ' Magrassi-Lanzara' , Second University, I-80138 Naples (Italy)

    2005-03-01

    The role of several imaging techniques in patients submitted to pancreatic surgery with special emphasis to single-slice helical computed tomography (CT) and multidetector-row CT (MDCT) was reviewed. Several surgical options may be performed such as Whipple procedure, distal pancreatectomy, central pancreatectomy, and total pancreatectomy. Ultrasound examination may be used to detect peritoneal fluid in the early post-operative period as well as lesion recurrence in long-term follow-up. Radiological gastrointestinal studies has a major role in evaluation of intestinal functionality. In spite of the advent of other imaging modalities, CT is the most effective after pancreatic surgery. On post-operative CT, the most common findings were small fluid peritoneal or pancreatic collections, stranding of the mesenteric fat with perivascular cuffing, reactive adenopathy and pneumobilia. In addition, CT may demonstrate early (leakage of anastomosis, pancreatico-jejunal fistula, haemorrage, acute pancreatitis of the remnant pancreas, peritonitis), and late (chronic fistula, abscess, aneurysms, anastomotic bilio-digestive stenosis, perianastomotic ulcers, biloma, and intra-abdominal bleeding) surgical complications. In the follow-up evaluation, CT may show tumor recurrence, liver and lymph nodes metastasis. Magnetic resonance may be used as alternative imaging modality to CT, when renal insufficiency or contrast sensitivity prevents the use of iodinated i.v. contrast material or when the biliary tree study is primarily requested. The knowledge of the type of surgical procedures, the proper identification of the anastomoses as well as the normal post-operative imaging appearances are essential for an accurate detection of the complications and recurrent disease.

  8. Noncontrast-Enhanced Magnetic Resonance Versus Computed Tomography Angiography in Preoperative Evaluation of Potential Living Renal Donors.

    Science.gov (United States)

    Blankholm, Anne Dorte; Pedersen, Bodil G; Østrat, Ernst Ø; Andersen, Gratien; Stausbøl-Grøn, Brian; Laustsen, Susse; Ringgaard, Steffen

    2015-11-01

    Living renal donors undergo an extensive examination program. These examinations should be as safe, gentle, and patient friendly as possible. To compare computed tomography angiography (CTA) and an extensive magnetic resonance imaging (MRI) protocol without contrast agents to observations from nephrectomy in living renal donors and to evaluate whether noncontrast-enhanced MRI can replace CTA for vessel assessment in living renal donors. CTA and MRI results were compared to observations from nephrectomy, which served as the reference standard. Fifty-one potential kidney donors underwent imaging, and 31 donated a kidney. Comparisons in sensitivity, specificity, and accuracy were made with respect to the number of arteries, early branching, and the number of veins. Agreement was assessed using Cohen's kappa. The exact McNemar's test was used to test for statistically significant differences. In the assessment of more than one renal artery, the sensitivity and specificity of MRI and CTA were high and in perfect agreement compared to observations from surgery. The results for both MRI and CTA were as follows: (sensitivity 100%/specificity100%/accuracy 100%/Kappa = 1/P = 1). When comparing the ability to test for early branching we found, MRI: (sensitivity 33%/specificity 100%/accuracy 87%/Kappa = 0.45/P = 1) and CTA: (sensitivity 50%/specificity 100%/accuracy 90%/Kappa = 0.62/P = 1). When used to depict supernumerary veins, we found MRI: (sensitivity60%/specifivity100%/accuracy 93%/Kappa = 0.72/P = 1), whereas CTA showed: (sensitivity 40%/specificity 96%/accuracy 87% Kappa = 0.43/P = 1). In conclusion, an optimized MRI protocol that includes noncontrast-enhanced magnetic resonance angiography can be substituted for CTA for preoperative assessment of the renal vessels before living donor nephrectomy. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

  9. Preoperative evaluation and comprehensive risk assessment for children with Down syndrome.

    Science.gov (United States)

    Lewanda, Amy Feldman; Matisoff, Andrew; Revenis, Mary; Harahsheh, Ashraf; Futterman, Craig; Nino, Gustavo; Greenberg, Jay; Myseros, John S; Rosenbaum, Kenneth N; Summar, Marshall

    2016-04-01

    Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recommendations include obtaining a complete blood count to detect an increased risk for bleeding or stroke, and cardiology evaluation to identify patients with pulmonary hypertension, as well as undiagnosed or residual heart disease. Pediatric cardiac anesthesiologists and intensivists should be involved as needed. The potential for cervical spine instability should be considered, and the anesthesiologist may wish to have several options available both for the medications and equipment used. The child's family should always be asked if he or she is on any nutritional supplements, as some products marketed to families may have secondary effects such as inhibition of platelet function. Using this evaluation in presurgical planning will allow physicians to better consider the individual circumstances for their patients with Down syndrome. Our goal was to optimize patient safety by choosing the most appropriate setting and perioperative personnel, and to mitigate those risk factors amenable to intervention.

  10. Short-Term Preoperative Calorie and Protein Restriction Is Feasible in Healthy Kidney Donors and Morbidly Obese Patients Scheduled for Surgery

    Science.gov (United States)

    Jongbloed, Franny; de Bruin, Ron W. F.; Klaassen, René A.; Beekhof, Piet; van Steeg, Harry; Dor, Frank J. M. F.; van der Harst, Erwin; Dollé, Martijn E. T.; IJzermans, Jan N. M.

    2016-01-01

    Introduction. Surgery-induced oxidative stress increases the risk of perioperative complications and delay in postoperative recovery. In mice, short-term preoperative dietary and protein restriction protect against oxidative stress. We investigated the feasibility of a calorie- and protein-restricted diet in two patient populations. Methods. In this pilot study, 30 live kidney donors and 38 morbidly obese patients awaiting surgery were randomized into three groups: a restricted diet group, who received a synthetic liquid diet with 30% fewer calories and 80% less protein for five consecutive days; a group who received a synthetic diet containing the daily energy requirements (DER); and a control group. Feasibility was assessed using self-reported discomfort, body weight changes, and metabolic parameters in blood samples. Results. Twenty patients (71%) complied with the restricted and 13 (65%) with the DER-diet. In total, 68% of the patients reported minor discomfort that resolved after normal eating resumed. The mean weight loss on the restricted diet was significantly greater (2.4 kg) than in the control group (0 kg, p = 0.002), but not in the DER-diet (1.5 kg). The restricted diet significantly reduced levels of serum urea and plasma prealbumin (PAB) and retinol binding protein (RBP). Conclusions. A short-term preoperative calorie- and protein-restricted diet is feasible in kidney donors and morbidly obese patients. Compliance is high and can be objectively measured via changes in urea, PAB, and RBP levels. These results demonstrate that this diet can be used to study the effects of dietary restriction on surgery-induced oxidative stress in a clinical setting. PMID:27213441

  11. Short-Term Preoperative Calorie and Protein Restriction Is Feasible in Healthy Kidney Donors and Morbidly Obese Patients Scheduled for Surgery

    Directory of Open Access Journals (Sweden)

    Franny Jongbloed

    2016-05-01

    Full Text Available Introduction. Surgery-induced oxidative stress increases the risk of perioperative complications and delay in postoperative recovery. In mice, short-term preoperative dietary and protein restriction protect against oxidative stress. We investigated the feasibility of a calorie- and protein-restricted diet in two patient populations. Methods. In this pilot study, 30 live kidney donors and 38 morbidly obese patients awaiting surgery were randomized into three groups: a restricted diet group, who received a synthetic liquid diet with 30% fewer calories and 80% less protein for five consecutive days; a group who received a synthetic diet containing the daily energy requirements (DER; and a control group. Feasibility was assessed using self-reported discomfort, body weight changes, and metabolic parameters in blood samples. Results. Twenty patients (71% complied with the restricted and 13 (65% with the DER-diet. In total, 68% of the patients reported minor discomfort that resolved after normal eating resumed. The mean weight loss on the restricted diet was significantly greater (2.4 kg than in the control group (0 kg, p = 0.002, but not in the DER-diet (1.5 kg. The restricted diet significantly reduced levels of serum urea and plasma prealbumin (PAB and retinol binding protein (RBP. Conclusions. A short-term preoperative calorie- and protein-restricted diet is feasible in kidney donors and morbidly obese patients. Compliance is high and can be objectively measured via changes in urea, PAB, and RBP levels. These results demonstrate that this diet can be used to study the effects of dietary restriction on surgery-induced oxidative stress in a clinical setting.

  12. The Preoperative Controlling Nutritional Status Score Predicts Survival After Curative Surgery in Patients with Pathological Stage I Non-small Cell Lung Cancer.

    Science.gov (United States)

    Shoji, Fumihiro; Haratake, Naoki; Akamine, Takaki; Takamori, Shinkichi; Katsura, Masakazu; Takada, Kazuki; Toyokawa, Gouji; Okamoto, Tatsuro; Maehara, Yoshihiko

    2017-02-01

    The prognostic Controlling Nutritional Status (CONUT) score is used to evaluate immuno-nutritional conditions and is a predictive factor of postoperative survival in patients with digestive tract cancer. We retrospectively analyzed clinicopathological features of patients with pathological stage I non-small cell lung cancer (NSCLC) to identify predictors or prognostic factors of postoperative survival and to investigate the role of preoperative CONUT score in predicting survival. We selected 138 consecutive patients with pathological stage I NSCLC treated from August 2005 to August 2010. We measured their preoperative CONUT score in uni- and multivariate Cox regression analyses of postoperative survival. A high CONUT score was positively associated with preoperative serum carcinoembryonic antigen level (p=0.0100) and postoperative recurrence (p=0.0767). In multivariate analysis, the preoperative CONUT score [relative risk (RR)=6.058; 95% confidence interval (CI)=1.068-113.941; p=0.0407), increasing age (RR=7.858; 95% CI=2.034-36.185; p=0.0029), and pleural invasion (RR=36.615; 95% CI=5.900-362.620; pcancer-specific survival (CS), and overall survival (OS), the group with high CONUT score had a significantly shorter RFS, CS, and OS than did the low-CONUT score group by log-rank test (p=0.0458, p=0.0104 and p=0.0096, respectively). The preoperative CONUT score is both a predictive and prognostic factor in patients with pathological stage I NSCLC. This immuno-nutritional score can indicate patients at high risk of postoperative recurrence and death. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  13. Preoperative evaluation of pulmonary artery morphology and pulmonary circulation in neonates with pulmonary atresia - usefulness of MR angiography in clinical routine

    Directory of Open Access Journals (Sweden)

    Kawel Nadine

    2010-09-01

    Full Text Available Abstract Background To explore the role of contrast-enhanced magnetic resonance angiography (CE-MRA in clinical routine for evaluating neonates with pulmonary atresia (PA and to describe their pulmonary artery morphology and blood supply. CE-MRA studies of 15 neonates with PA (12 female; median weight: 2900 g were retrospectively evaluated by two radiologists in consensus. Each study was judged to be either diagnostic or non-diagnostic depending on the potential to evaluate pulmonary artery morphology and pulmonary blood supply. In those cases where surgery or conventional angiocardiography was performed results were compared. Results CE-MRA was considered diagnostic in 87%. Pulmonary artery morphology was classified as "confluent with (n = 1 and without (n = 1 main pulmonary artery", "non-confluent" (n = 6 or "absent" (n = 7. Source of pulmonary blood supply was "a persistent arterial duct" (n = 12, "a direct" (n = 22 or "indirect (n = 9 aortopulmonary collateral artery (APCA" or "an APCA from the ascending aorta" (n = 2. In no patient were there any additional findings at surgery or conventional angiocardiography which would have changed the therapeutic or surgical approach. Conclusions CE-MRA is a useful diagnostic tool for the preoperative evaluation of the morphology of pulmonary arteries and blood supply in neonates with PA. In most cases diagnostic cardiac catheterization can be avoided.

  14. Avaliação clínica e funcional no pré-operatório de doenças degenerativas da coluna vertebral Evaluación clínica y funcional en el preoperatorio de patologías degenerativas de columna Clinical and functional evaluation in preoperative period of degenerative disease spine surgery

    Directory of Open Access Journals (Sweden)

    Asdrubal Falavigna

    2009-09-01

    this study was to describe the methodology to evaluate spinal degenerative pathologies and verify the results. METHODS: after the indication of surgical treatment, the patients were invited to participate in the study by signing a letter of free and informed consent. The patients completed the questionnaires at the doctor's office, and were helped regarding doubts in filling them out by a person who was not involved in the surgery. All the evaluation instruments used are self-applied. The following were used: numerical rating scale of pain (NRS, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36, Fear-Avoidance Beliefs Questionnaire (FABq, Beck Depression Inventory (BDI, Hospital Anxiety and Depression (HAD Scale, Oswestry Disability Index (ODI and Neck Disability Index (NDI. RESULTS: 220 patients with lumbar spine pathologies and 32 with cervical pathologies were evaluated. The prevalence of depression, according to the BDI, was 28.0% and 31.2% in patients with lumbar and cervical surgical disease, and the prevalence of anxiety according to HAD-A was 40.1% and 46.9%, respectively. The mean of ODI was 46.5, and of NDI, 25.4. As to the feasibility of completing the questionnaires, it was observed that most of the patients, when they have been instructed about completing them, did not have any difficulty in finishing them. The mean time for the completion of all instruments was 25 to 35 minutes. CONCLUSION: the use of instruments validated to evaluate patients with degenerative spinal diseases is feasible and should be encouraged among the spinal surgeons.

  15. Multidetector computed tomography (MDCT angiography of thoracic aortic coarctation in pediatric patients: Pre-operative evaluation

    Directory of Open Access Journals (Sweden)

    Mohamad Zakaryia Al-Azzazy

    2014-03-01

    Conclusion: We concluded that MDCT angiography with multiplanar and three dimensional techniques can be considered the modality of choice for pre-operative assessment of coarctation of the thoracic aorta in pediatric patients.

  16. Evaluation of expert criteria for preoperative magnetic resonance imaging of newly diagnosed breast cancer.

    Science.gov (United States)

    Behrendt, Carolyn E; Tumyan, Lusine; Gonser, Laura; Shaw, Sara L; Vora, Lalit; Paz, I Benjamin; Ellenhorn, Joshua D I; Yim, John H

    2014-08-01

    Despite 2 randomized trials reporting no reduction in operations or local recurrence at 1 year, preoperative magnetic resonance imaging (MRI) is increasingly used in diagnostic workup of breast cancer. We evaluated 5 utilization criteria recently proposed by experts. Of women (n = 340) newly diagnosed with unilateral breast cancer who underwent bilateral MRI, most (69.4%) met at least 1 criterion before MRI: mammographic density (44.4%), under consideration for partial breast irradiation (PBI) (19.7%), genetic-familial risk (12.9%), invasive lobular carcinoma (11.8%), and multifocal/multicentric disease (10.6%). MRI detected occult malignant lesion or extension of index lesion in 21.2% of index, 3.3% of contralateral, breasts. No expert criterion was associated with MRI-detected malignant lesion, which associated instead with pre-MRI plan of lumpectomy without PBI (48.2% of subjects): Odds Ratio 3.05, 95% CI 1.57-5.91 (p adjusted for multiple hypothesis testing = 0.007, adjusted for index-vs-contralateral breast and covariates). The expert guidelines were not confirmed by clinical evidence.

  17. Orthognathic surgery improves quality of life and depression, but not anxiety, and patients with higher preoperative depression scores improve less.

    Science.gov (United States)

    Brunault, P; Battini, J; Potard, C; Jonas, C; Zagala-Bouquillon, B; Chabut, A; Mercier, J-M; Bedhet, N; Réveillère, C; Goga, D; Courtois, R

    2016-01-01

    This study assessed quality of life (QoL), depression, and anxiety before and after orthognathic surgery and identified risk factors for poorer postoperative outcome. This multicentre prospective study included 140 patients from five French medical centres. We assessed patients before surgery (T1), 3 months after surgery (T2), and 12 months after surgery (T3). We assessed the severity of the orofacial deformity, physical, psychological, social, and environmental QoL (WHOQOL-BREF), and depression and anxiety (GHQ-28). Risk factors for poorer outcome were identified using linear mixed models. Between baseline and 12 months, there was significant improvement in psychological and social QoL and in depression (although below the norms reported in the general population), but not in anxiety. Physical QoL was poorer in patients who were younger, who had a mild orofacial deformity, and who were depressed. Psychological QoL was poorer in younger patients and in depressed patients. Social QoL was poorer in patients who were single, who had a mild orofacial deformity, and who were depressed. Although orthognathic surgery provides a moderate improvement in psychological and social QoL, the systematic screening and treatment of depression could further improve QoL after surgery because it is a major predictor of poor QoL in this population.

  18. A novel index for preoperative, non-invasive prediction of macro-radical primary surgery in patients with stage IIIC-IV ovarian cancer-a part of the Danish prospective pelvic mass study

    DEFF Research Database (Denmark)

    Karlsen, Mona Aarenstrup; Fagö-Olsen, Carsten; Høgdall, Estrid Vilma Solyom;

    2016-01-01

    The purpose of this study was to develop a novel index for preoperative, non-invasive prediction of complete primary cytoreduction in patients with FIGO stage IIIC-IV epithelial ovarian cancer. Prospectively collected clinical data was registered in the Danish Gynecologic Cancer Database. Blood...... samples were collected within 14 days of surgery and stored by the Danish CancerBiobank. Serum human epididymis protein 4 (HE4), serum cancer antigen 125 (CA125), age, performance status, and presence/absence of ascites at ultrasonography were evaluated individually and combined to predict complete tumor.......688 for age. The multivariate model (Cancer Ovarii Non-invasive Assessment of Treatment Strategy (CONATS) index), consisting of HE4, age, and performance status, demonstrated an AUC of 0.853. According to the Danish indicator level, macro-radical PDS should be achieved in 60 % of patients admitted to primary...

  19. The role of preoperative prophylactic antibiotic administration in periapical endodontic surgery: a randomized, prospective double-blind placebo-controlled study.

    Science.gov (United States)

    Lindeboom, J A H; Frenken, J W H; Valkenburg, P; van den Akker, H P

    2005-12-01

    To determine the value of clindamycin prophylaxis in the prevention of postoperative wound infections in patients undergoing endodontic surgery. This study included 256 patients undergoing endodontic surgery in a prospective double-blind placebo-controlled trial comparing oral administration of an oral placebo versus a preoperative 600 mg dose of clindamycin. After randomization the study medication was administered orally 1 h before surgery in a double-blind fashion. For a period of 4 weeks the postoperative course was observed according to clinical parameters of infection. Primary end-point was infection at the surgical site. The mean age of the study population was 44.4 years (SD 11.4, range 18-82 years) with a sex distribution of 147 females (47.4%) and 109 males (42.6%). Mean age of the patients in the clindamycin group was 44.7 years (SD 12.0), and the mean age in the placebo group was 44.1 years (SD 10.8) (P = 0.49). In the clindamycin group, the mean duration of surgery was 32.3 min (SD 8.8) and in the placebo group the mean duration of surgery was 32.5 min (SD 8.4) (P = 0.89). Two infections [1.6%; 95 confidence interval (CI): 0.48-4.72] were identified in the clindamycin group and four (3.2%; 95 CI: 0.42-1.33) in the placebo group (P = 0.448). No statistically significant difference was found between clindamycin prophylaxis and placebo with regard to the prevention of postoperative infection in endodontic surgical procedures.

  20. 术前访视在预防心脏术后患者发生ICU综合征中的作用%The Role of Preoperative Interview in the Prevention of ICU Syndrome after Cardiac Surgery

    Institute of Scientific and Technical Information of China (English)

    鲁顺容; 张雪庆

    2016-01-01

    Objective:To evaluate the effect of preoperative interview in the prevention of ICU syndrome after cardiac surgery.Method:200 patients undergoing cardiac valve replacement were randomly selected,postoperative monitoring time was greater than 72 h,the experimental group(A group) 100 cases, by the ICU nurses for preoperative visit;the control group(B group) 100 cases,without the ICU nurses before surgery,the number of patients with ICU syndrome were compared between the two groups.Result:The number of patients with ICU syndrome was significantly less than the control group(P<0.05),the average length of stay was shorter in the experimental group than in the control group(P<0.05),the satisfaction of the experimental group was significantly higher than that of the control group(P<0.05).Conclusion:Preoperative visit to the prevention of cardiac surgery in patients with ICU syndrome has an important role.%目的:探讨术前访视对预防心脏术后患者发生ICU综合征的作用。方法:随机抽取200例行心脏瓣膜置换术患者,术后监护时间≥72 h,试验组(A组)100例,由ICU护士进行术前访视;对照组(B组)100例,未经ICU护士进行术前访视,比较两组患者ICU综合征确诊的例数。结果:试验组确诊ICU综合征的例数明显少于对照组(P<0.05),试验组的平均住院日明显短于对照组(P<0.05),试验组的满意度明显高于对照组(P<0.05)。结论:术前访视对预防心脏术后患者发生ICU综合征有重要作用。

  1. Preoperative planning of renal transplantation: a comparison of non-contrast-enhanced ultrasonography, computed tomography, and magnetic resonance angiography with observations from surgery.

    Science.gov (United States)

    Blankholm, Anne Dorte; Pedersen, Bodil G; Stausbøl-Grøn, Brian; Andersen, Gratien; Hørlyck, Arne; Østrat, Ernst Ø; Laustsen, Sussie; Ringgaard, Steffen

    2015-12-01

    Many candidates for kidney transplantation need to undergo vessel examination before the transplantation procedure. To identify the optimal preoperative modality for the examination of vessel status without the use of contrast agents in kidney transplant candidates. Fifty-three consecutive patients were examined and 31 patients were transplanted. Ultrasonography (US), non-contrast-enhanced computed tomography (NCCT), and non-contrast-enhanced magnetic resonance angiography (NCMRA) were compared using inspection during kidney transplantation (TX) as a reference standard. The sensitivity and specificity to severe arteriosclerotic changes and the accuracy were calculated. Kappa statistics were used to assess the agreement between TX and the different examination modalities, and McNemar's test was used to test for significant differences. US had higher sensitivity (1.0) and better agreement with observations from surgery (k = 0.89) than both NCCT (sensitivity = 0.60; k = 0.72) and NCMRA (sensitivity = 0.20; k = 0.30). No significant difference was found between TX and US (P = 0.3173) or TX and NCCT (P = 0.1573), but there was a significant difference between TX and NCMRA (P = 0.0455). US was inconclusive in 20% of cases, and the internal iliac artery could not be visualized in 69% of cases. Either US or NCCT can be used as the preferred preoperative imaging modality to examine vessel status before kidney transplantation, but a combination of the two is preferable. NCMRA should not be used as the sole imaging modality for preoperative imaging before kidney transplantation because of its low sensitivity in detecting severe arteriosclerotic disease without the presence of stenosis. © The Foundation Acta Radiologica 2014.

  2. Comparative Investigation of Postoperative Complications in Patients With Gastroesophageal Junction Cancer Treated With Preoperative Chemotherapy or Surgery Alone

    DEFF Research Database (Denmark)

    Achiam, M P; Jensen, L.B.; Larsson, H.

    2016-01-01

    complications of patients with cancer at the gastroesophageal junction treated with either neoadjuvant chemotherapy or surgery alone in patients from "The Danish Clinical Registry of Carcinomas of the Esophagus, the Gastro-Esophageal Junction and the Stomach." MATERIALS AND METHODS: A historical follow-up study......BACKGROUND AND AIM: Gastroesophageal junction cancer is one of the leading causes to cancer-related death and the prognosis is poor. However, progress has been made over the last couple of decades with the introduction of multimodality treatment and optimized surgery. Three-year survival rates have...... of Carcinomas of the Esophagus, the Gastro-Esophageal Junction and the Stomach. No difference was found in demographics between the two groups, except for alcohol consumption and a lower T and N stage in the surgery-only group, and no difference in complication rates was found. Furthermore, no variable...

  3. Cushing's Syndrome in a Morbidly Obese Patient Undergoing Evaluation before Bariatric Surgery

    Directory of Open Access Journals (Sweden)

    Livia Borsoi

    2014-06-01

    Full Text Available Objective: Cushing's syndrome (CS is extremely rare in morbidly obese patients. To date, no occurrences in obese patients with BMI above 60 kg/m2 have been reported in the literature. Case Report: This case report describes a patient who was admitted to the ward of the Clinical Division of Endocrinology and Metabolism of the Medical University of Vienna in preparation for bariatric surgery. The patient was a 49-year-old female who showed morbid obesity (BMI 61.6 kg/m2, hypertension, and substituted hypothyroidism. Preoperative work-up revealed CS due to an adrenal adenoma. Therefore, the patient underwent unilateral adrenalectomy followed by bariatric surgery 6 months later. Conclusion: Since undiagnosed CS might result in severe perioperative complications in a population already at increased risk, this case report underlines the importance of careful endocrine evaluation of morbidly obese patients. After all, even rare endocrine causes should be excluded.

  4. Long-term oncologic results in cancer of the rectum treated by preoperative chemoradiotherapy and surgery: an analysis of 500 cases

    Directory of Open Access Journals (Sweden)

    Javier A. Cienfuegos

    2015-06-01

    Full Text Available Background: The standard treatment for locally advanced cancer of the rectum (LACR and selective cases of stage IV disease is preoperative chemoradiotherapy (CRT followed by total mesorectal excision (TME. Despite reductions in local recurrence, disease-free survival (DSF has remained stable in recent years. Objective: The objective of this study is to analyze patterns of recurrence, long-term survival and prognostic factors in a program of neoadjuvant CRT and surgery in LACR. Methods: Between January 1992 and December 2011, 446 patients with LACR and 54 patients (with single metastases were treated with pre-operative long course CRT and surgery. Three hundred forty four (66.8% anterior resections of the rectum and 123 (24.6% abdomino-perineal resections were performed. Results: With a mean follow-up of 70.06 months, local recurrence was 4.8% and distant recurrence 25.5%. No differences were found in the histopathologic prognostic factors across the three groups studied depending on distance (cm from the anal margin. Involvement of the circumferential resection margin (CRM+ was significantly greater in tumors in the distal third of the rectum (8.5%; p = 0.04. 67 patients (13.4% showed a complete pathologic response. DSF at 5 and 10 years was significantly lower in patients with tumors affecting the distal third as compared to the middle third of the rectum (61.9% vs. 57.7%; p = 0.04. Tumors at this distal location resulted in a significantly higher incidence of lung metastases (p = 0.016.

  5. Preoperative medical treatment in patients undergoing diabetic foot surgery with a Wagner Grade-3 or higher ulcer: a retrospective analysis of 52 patients

    Directory of Open Access Journals (Sweden)

    Murat Korkmaz

    2012-08-01

    Full Text Available Diabetic foot ulcers (DFU are one of the most important complications in people with diabetes mellitus. The present study was aimed to retrospectively review the efficacy of at least 1-week medical treatment before any surgical intervention in patients with Grade-3 and higher DFU according to Wagner's classification. A total of 52 patients (36 males and 16 females hospitalized and treated between June 2006 and February 2009 and had initially received therapeutic treatment (local wound care, antibiotic therapy and blood glucose regulation for a period of at least 1 week were included in the study. The level of amputation, rates of reulceration and mortality in both groups were recorded in the following period of 2 years. Group 1 (did not respond to preoperative medical intervention included 16 patients where a surgical debridement, flap or skin graft surgery was performed in 2 (12.5% patients, major amputation was performed in another 2 (12.5% patients and minor amputation was performed in the remaining 12 (75% patients. Of 36 patients in Group 2 (did respond to preoperative medical intervention, 5 (13.9% patients underwent the surgical debridement, flap or skin graft surgery, 8 (22.2% patients had a major amputation and the remaining 23 (63.9% patients lead to a minor amputation. The ulcer recurrence and mortality rates were obtained as 2 (12.5% and 2 (12.5% in Group 1 and 2 (5.6% and 1 (2.8% in Group 2, respectively. Despite the lower rates of ulcer recurrence and mortality in patients having adequate responses to initial treatment before surgical procedures were performed, no statistically significant difference was observed between the 2 groups. In addition, there was no statistically significant difference between the levels of amputation in both groups.

  6. Investigation of psychological status of day surgery preoperative patients%日间手术患者术前心理状况的调查研究

    Institute of Scientific and Technical Information of China (English)

    崔菲菲; 余华; 杨金菊; 殷官书; 袁慧云

    2015-01-01

    目的:对日间手术室患者进行术前心理状况调查,为临床工作者今后采用针对性的心理护理提供理论依据,为日间手术患者采取积极有效的应对方式提供帮助。方法采用方便抽样,运用状态焦虑问卷(S-AI)医学应对方式问卷(MCMQ)和自制基本信息调查问卷对200例在日间手术室行手术的患者术前心理状况进行调查研究。结果日间手术室患者心理状态主要表现在焦虑高于国内常模;焦虑的影响因素有多个方面主要表现在年龄、家庭关系。结论日间手术室患者心理状态受到多种因素影响,护理人员应从多方面评估术前患者生理心理状况及应对方式,采取有效措施引导患者采取积极的应对方式。%Objective This thesis is to investigate about the psychological status of day surgery patient, to provide the theory of the clinic workers, and to offer the effective help for the day surgery operation patient. Methods The thesis used the methods of adopting sampling in a convenient way, used State Anxiety Inventory (S-al), Medical Coping Modes Questionnalre (MCMQ) and questionnalres made by ourselves, gave the investigation of the preoperative patients' psychological status in day surgery room. Results The malnly behavior of patients' psychological status is that they suffered higher anxiety than normal;The facts that effected anxiety had many aspects, malnly in ages and family relationships. Conclusion Patients' psychological condition in day surgery room is influenced by various facts, nurses should assess the physiological and psychological status of the preoperative patients and adopted methods from various aspects so as to guide the patients to take positive actions effectively.

  7. A novel virtual reality environment for preoperative planning and simulation of image guided intracardiac surgeries with robotic manipulators.

    Science.gov (United States)

    Yeniaras, Erol; Deng, Zhigang; Syed, Mushabbar A; Davies, Mark G; Tsekos, Nikolaos V

    2011-01-01

    The evolution of image-guided and robot-assisted procedures can be beneficial to intracardiac interventions. This paper proposes a novel approach and a virtual reality system for preoperative planning and intraoperative guidance of cardiac procedures, and for investigating the kinematics and control of a virtual robotic manipulator, based on MRI CINE images. The system incorporates dedicated software modules for processing MR images, generating dynamic trajectories in the continuously changing environment of a beating heart, controlling a specific generic virtual manipulator along those trajectories, and a virtual reality interface that fuses all those information. The proposed system is applied for the simulation of accessing the aortic valve annulus via a small incision on the apex by maneuvering a robotic manipulator through an access corridor that safely transverses the left ventricle (LV) of the beating heart.

  8. The effect of preoperative renal dysfunction with or without dialysis on early postoperative outcome following cardiac surgery.

    LENUS (Irish Health Repository)

    Al-Sarraf, Nael

    2011-01-01

    Although previous studies have shown increased mortality in renal dysfunction patients undergoing cardiac surgery, there is lack of data on the pattern of postoperative complications that occur in such patients and their distribution among dialysis and non-dialysis dependent renal dysfunction.

  9. Delivering tailored surgery to older cancer patients : Preoperative geriatric assessment domains and screening tools - A systematic review of systematic reviews

    NARCIS (Netherlands)

    Huisman, M. G.; Kok, M.; de Bock, G. H.; van Leeuwen, B. L.

    The onco-geriatric population is increasing and thus more and more elderly will require surgery; an important treatment modality for many cancer types. This population's heterogeneity demands preopeiative risk stratification, which has led to the introduction of Geriatric Assessment (GA) and

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

    Directory of Open Access Journals (Sweden)

    Schwarz Christian

    2009-07-01

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

  11. Fisioterapia respiratória e sua aplicabilidade no período pré-operatório de cirurgia cardíaca Respiratory physiotherapy and its application in preoperative period of cardiac surgery

    Directory of Open Access Journals (Sweden)

    Regina Coeli Vasques de Miranda

    2011-12-01

    Full Text Available Procedimentos cirúrgicos torácicos podem alterar a mecânica respiratória, repercutindo na função pulmonar. A presença de profissionais fisioterapeutas é fundamental no preparo e na reabilitação dos indivíduos que são submetidos à cirurgia cardíaca, visto que dispõem de um grande arsenal de técnicas. O objetivo foi verificar a efetividade de exercícios respiratórios, com e sem a utilização de dispositivos, e o treinamento muscular respiratório pré-cirurgia cardíaca na redução das complicações pulmonares pós-operatórias. Mesmo existindo controvérsias a respeito de qual técnica utilizar, estudos demonstram a eficácia da fisioterapia respiratória pré-cirúrgica na prevenção e na redução de complicações pulmonares pós-operatórias.Cardiac surgical procedures change respiratory mechanics, defecting in lung dysfunction. The physical therapists play an important role in the preparation and rehabilitation of individuals who are undergoing cardiac surgery, as they have a large quantity of techniques. The objective was to evaluate the effectiveness of breathing exercises with and without the use of devices, and respiratory muscle training in preoperative period of cardiac surgery in reducing postoperative pulmonary complications. Although there are controversies as to which technique to use, studies show the effectiveness of preoperative physiotherapy in the prevention and reduction of postoperative pulmonary complications.

  12. Usefulness of the evaluation of preoperative sternal shape for reconstruction of pectus excavatum using three-dimensional computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Noguchi, Masahiko; Kondoh, Shohji; Kondoh, Yoshiaki; Akabane, Genichiroh [Nagano Children`s Hospital (Japan); Matsuo, Kiyoshi

    1997-04-01

    In the reconstruction of the pectus excavatum deformity, when sternal growth must be considered, it is desirable that osteotomy of the sternum be performed if necessary. From this standpoint, we evaluate the preoperative sternal shape using three-dimensional computed tomography. The sternum is outlined on the mid-sagittal plane, and the curved portions are examined. Preoperatively, the sternums are classified into 3 groups based on the number of curved portions. On the basis of these observations, we determine the position and degree of the sternal osteotomy and, if necessary, combined sternal osteotomy and augmentation using resected cartilage. We think that this method is useful not only for reconstruction of pectus excavatum but also in evaluating the postoperative shape of the thorax. (author)

  13. Real-time MRI navigated ultrasound for preoperative tumor evaluation in breast cancer patients: Technique and clinical implementation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ah Young; Seo, Bo Kyoung [Dept. of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan (Korea, Republic of)

    2016-09-15

    Real-time magnetic resonance imaging (MRI) navigated ultrasound is an image fusion technique to display the results of both MRI and ultrasonography on the same monitor. This system is a promising technique to improve lesion detection and analysis, to maximize advantages of each imaging modality, and to compensate the disadvantages of both MRI and ultrasound. In evaluating breast cancer stage preoperatively, MRI and ultrasound are the most representative imaging modalities. However, sometimes difficulties arise in interpreting and correlating the radiological features between these two different modalities. This pictorial essay demonstrates the technical principles of the real-time MRI navigated ultrasound, and clinical implementation of the system in preoperative evaluation of tumor extent, multiplicity, and nodal status in breast cancer patients.

  14. Real-Time MRI Navigated Ultrasound for Preoperative Tumor Evaluation in Breast Cancer Patients: Technique and Clinical Implementation

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ah Young; Seo, Bo Kyoung [Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355 (Korea, Republic of)

    2016-11-01

    Real-time magnetic resonance imaging (MRI) navigated ultrasound is an image fusion technique to display the results of both MRI and ultrasonography on the same monitor. This system is a promising technique to improve lesion detection and analysis, to maximize advantages of each imaging modality, and to compensate the disadvantages of both MRI and ultrasound. In evaluating breast cancer stage preoperatively, MRI and ultrasound are the most representative imaging modalities. However, sometimes difficulties arise in interpreting and correlating the radiological features between these two different modalities. This pictorial essay demonstrates the technical principles of the real-time MRI navigated ultrasound, and clinical implementation of the system in preoperative evaluation of tumor extent, multiplicity, and nodal status in breast cancer patients.

  15. Preoperative preparation of children

    Directory of Open Access Journals (Sweden)

    Priya Reshma Aranha

    2017-01-01

    Full Text Available Surgery is a stressful and anxiety provoking experience for children. Millions of children undergo surgery every year. The majority of children experience significant preoperative anxiety which intern can affect their recovery. Preoperative anxiety may bring about physical and physiological changes in children, which can be particularly evident in terms of increased heart rate and blood pressure. To identify various strategies used to minimize the preoperative anxiety of children and update their clinical effectiveness among children undergoing surgery, the authors searched PubMed, MEDLINE, CINAHL, ScienceDirect, Google Scholar, Scopus, and Cochrane Library for identifying the relevant studies and retrieved available literature. It is concluded that utilization of the strategies available to reduce the preoperative anxiety of children will be a promising intervention to reduce anxiety, to promote relaxation, satisfaction, and speedy recovery. Many of these techniques are simple, cost-effective and can be easily carried out by nurses. It is essential to use the age appropriate and individualized methods in preparing children for surgery. Further research is required to strengthen the evidence.

  16. Interictal SPECT of rCBF is of clinical utility in the preoperative evaluation of patients with partial epilepsy

    DEFF Research Database (Denmark)

    Andersen, A.R.; Hansen, B.A.; Hogenhaven, H;

    1996-01-01

    Fifty-eight patients with drug-resistant partial epilepsy were studied preoperatively by interictal rCBF measurements using 99mTc-HMPAO and a dedicated brain SPECT camera (Tomomatic 64). Follow-up of seizure outcome, using the 'Engel score', was at least 3 years. The data were analyzed in a blind...... patients ictal SPECT of rCBF was additionally performed. In 2 cases it added further information to the patient evaluation...

  17. Interictal SPECT of rCBF is of clinical utility in the preoperative evaluation of patients with partial epilepsy

    DEFF Research Database (Denmark)

    Andersen, A R; Hansen, B A; Høgenhaven, H;

    1996-01-01

    Fifty-eight patients with drug-resistant partial epilepsy were studied preoperatively by interictal rCBF measurements using 99mTc-HMPAO and a dedicated brain SPECT camera (Tomomatic 64). Follow-up of seizure outcome, using the "Engel score", was at least 3 years. The data were analyzed in a blind...... patients ictal SPECT of rCBF was additionally performed. In 2 cases it added further information to the patient evaluation....

  18. MR evaluation of chronic achilles tendinosis. A longitudinal study of 15 patients preoperatively and two years postoperatively

    Energy Technology Data Exchange (ETDEWEB)

    Shalabi, A.; Kristoffersen-Wiberg, M.; Aspelin, P. [Huddinge Univ. Hospital (Sweden). Dept. of Radiology; Movin, T. [Huddinge Univ. Hospital (Sweden). Dept. of Orthopedic Surgery

    2001-05-01

    Purpose: To evaluate surgically treated patients with chronic Achilles tendinosis by MR. Material and Methods: Gd-contrast-enhanced (CME) T1-, precontrast T1-, PD- and T2-weighted images were obtained preoperatively and 2 years following surgical treatment on 15 middle-aged patients with severe symptoms of chronic Achilles tendinosis. MR evaluation included the depiction of intratendinous signal alterations and their volume, and also measurement of tendon diameter. A questionnaire and clinical examination evaluated the clinical outcome. Results: The most sensitive sequence to depict an intratendinous lesion was the CME T1-WI. There was marked regress of the estimated volume of the intratendinous signal alteration from a median of 1.2 cm{sup 3} preoperatively to 0.0 cm{sup 3} postoperatively on CME T1-WI. CME T1-WI showed a regress in intratendinous signal abnormality from 13 out of 15 patients preoperatively to 4 of 15 patients 2 years postoperatively. The a.p. dimension was 9 mm at both MR occasions. The clinical outcome was excellent in 8, good in 5, fair in 1 and poor in 1 patient. Conclusion: Surgical treatment of chronic Achilles tendinosis and its healing resulted in a decrease or elimination of the intratendinous signal alteration correlating to an improved clinical outcome 2 years postoperatively.

  19. Retinal evaluation and treatment after refractive corneal surgery.

    Science.gov (United States)

    Swinger, C A; Kraushar, M F

    1985-08-01

    Refractive corneal surgery (a collective term used to describe a variety of surgical procedures that alter the refractive status of the eye through the surgical modification of corneal curvature) shows promise for use in situations where current methods of optical correction do not meet the patient's needs. This article reviews our experiences with the retinal evaluation of patients who have undergone corneal refractive surgery and offers recommendations for the treatment of retinal pathology after such surgery.

  20. End-Stage Renal Disease After Renal Surgery in Patients with Normal Preoperative Kidney Function: Balancing Surgical Strategy and Individual Disorders at Baseline.

    Science.gov (United States)

    Capitanio, Umberto; Larcher, Alessandro; Terrone, Carlo; Antonelli, Alessandro; Volpe, Alessandro; Fiori, Cristian; Furlan, Maria; Dehò, Federico; Minervini, Andrea; Serni, Sergio; Porpiglia, Francesco; Trevisani, Francesco; Salonia, Andrea; Carini, Marco; Simeone, Claudio; Montorsi, Francesco; Bertini, Roberto

    2016-10-01

    Although nephron-sparing surgery (NSS) has demonstrated benefit in terms of renal function preservation, it is unclear whether NSS might also decrease the risk of end-stage renal disease (ESRD) relative to radical nephrectomy (RN). In the current paper, we aimed to report the rate and the predictors of ESRD after surgery, accounting for detailed individual baseline characteristics and comorbidities. A multi-institutional collaboration among five European tertiary care centers allowed study of 2027 patients with normal preoperative renal function and a clinically localized T1abN0M0 renal mass. Cox regression analyses were used to predict the risk of ESRD (defined as the onset of a postoperative estimated glomerular filtration rate <15ml/min per 1.73 m(2)) after adjusting for the individual baseline risk of developing chronic kidney disease. Univariable ESRD rates at 5 and 10 yr of follow-up were virtually equivalent for patients who underwent NSS (1.5% and 2.5%, respectively) versus RN (1.9% and 2.7%, respectively; hazard ratio [HR]: 0.8; 95% confidence interval [CI], 0.4-1.6). However, diabetes, smoking, uncontrolled hypertension, and other comorbidities were consistently more frequent in the NSS group relative to their RN counterparts. After adjusting for detailed baseline individual characteristics, NSS was shown to have an independent protective effect relative to RN (HR: 0.4; 95% CI, 0.2-0.8; p=0.02) at multivariable analyses.

  1. 磁共振成像在乳腺癌保乳术前评价中的应用%Application of preoperative MRI on breast cancer patients undergoing breast-conserving surgery

    Institute of Scientific and Technical Information of China (English)

    王文静; 洪庆山; 张嫣; 郭庆禄

    2014-01-01

    Objective To evaluate the influence of preoperative MRI on tumor-positive rate of resection margins in breast cancer patients eligible for breast-conserving surgery.Methods Study group consisted of 64 consecutive patients with breast cancer eligible for breast-conserving surgery,while 73 cases as history control group.For the two groups,a first plan for breast-conserving surgery was made on the basis of conventional imaging and clinical evaluation.Study group underwent preoperative breast MRI and re-evalu-ated before final surgical plan was made.Rates of tumor-positive resection margins were compared between the 2 groups.Surgical plan alteration was recorded in the study group.Results Study group had lower rate of tumor-positive resection margin compared with control group (9.6% vs 24.7%,P =0.04).Furthermore,18.8% of study group altered the finial surgical plan to mastectomy after breast MRI.Conclusion Preoperative breast MRI can more acurately evaluate the extent of breast cancer,therefore decrease rate of tumor-positive resection margin in breast cancer patients eligible for breast-conserving surgery.%目的:评价术前磁共振成像(MRI)对乳腺癌保乳术切缘阳性率的影响。方法收集乳腺癌患者64例为研究组,历史对照组73例乳腺癌患者,所有患者经常规检查及评估后均适合行保乳术。研究组患者术前行乳腺 MRI 检查,经评估后确定最终的手术计划。历史对照组未行 MRI 检查。比较2组患者的切缘阳性率差异,记录研究组的手术变更率。结果与对照组相比,研究组保乳术中的切缘阳性率降低(9.6% vs 24.7%;P =0.04)。术前 MRI 使18.8%的患者改变手术计划而行乳房全切术。结论术前乳腺 MRI 检查能更准确评估乳腺癌病灶的范围,从而有助于降低保乳术患者的术中切缘阳性率。

  2. Image analysis of the inner ear with CT and MR imaging; Pre-operative assessment for cochlear implant surgery

    Energy Technology Data Exchange (ETDEWEB)

    Kumakawa, Kohzoh; Takeda, Hidehiko; Mutoh, Naoko; Miyakawa, Kohichi (Toranomon Hospital, Tokyo (Japan)); Yukawa, Kumiko; Funasaka, Sohtaro

    1992-06-01

    Recent progress in magnetic resonance imaging (MRI) has made it possible to obtain detailed images of the inner ear by delineating the lymphatic fluid within the labyrinth. We analyzed CT scans and MR imaging in 70 ears manifesting profound deafness owing to inner ear lesions and compared their detective ability for inner ear lesions. The following results were obtained. CT scan examination showed slight to extensive ossification of the labyrinth in six ears (9%), whereas MRI examination revealed low to absent signal intensity of the inner ear in nine ears (13%). Therefore, it was concluded that MRI is more sensitive in detecting abnormalities of the inner ear than CT scan. MRI provided useful information as to whether the cochlear turn is filled with lymphatic fluid or obstructed. This point was one of the greatest advantages of MRI over CT scan. Abnormal findings in either or both the CT scan and the MRI were detected in suppurative labyrinthitis occurring secondary to chronic otitis media, bacterial meningitis and in inner ear trauma. However, such abnormal findings were not detected in patients with idiopathic progressive sensorineural hearing loss, ototoxity or sudden deafness. These findings should be taken into consideration in pre-operative assessment of cochlear implant candidates. (author).

  3. Protocol for a multicentre randomised feasibility trial evaluating early Surgery Alone In LOw Rectal cancer (SAILOR)

    Science.gov (United States)

    Thorne, Kymberley; Hutchings, Hayley; Islam, Saiful; Holland, Gail; Hatcher, Olivia; Gwynne, Sarah; Jenkins, Ian; Coyne, Peter; Duff, Michael; Feldman, Melanie; Winter, Des C; Gollins, Simon; Quirke, Phil; West, Nick; Brown, Gina; Fitzsimmons, Deborah; Brown, Alan; Beynon, John

    2016-01-01

    Introduction There are 11 500 rectal cancers diagnosed annually in the UK. Although surgery remains the primary treatment, there is evidence that preoperative radiotherapy (RT) improves local recurrence rates. High-quality surgery in rectal cancer is equally important in minimising local recurrence. Advances in MRI-guided prediction of resection margin status and improvements in abdominoperineal excision of the rectum (APER) technique supports a reassessment of the contribution of preoperative RT. A more selective approach to RT may be appropriate given the associated toxicity. Methods and analysis This trial will explore the feasibility of a definitive trial evaluating the omission of RT in resectable low rectal cancer requiring APER. It will test the feasibility of randomising patients to (1) standard care (neoadjuvant long course RT±chemotherapy and APER, or (2) APER surgery alone for cT2/T3ab N0/1 low rectal cancer with clear predicted resection margins on MRI. RT schedule will be 45 Gy over 5 weeks as current standard, with restaging and surgery after 8–12 weeks. Recruitment will be for 24 months with a minimum 12-month follow-up. Objectives Objectives include testing the ability to recruit, consent and retain patients, to quantify the number of patients eligible for a definitive trial and to test feasibility of outcomes measures. These include locoregional recurrence rates, distance to circumferential resection margin, toxicity and surgical complications including perineal wound healing, quality of life and economic analysis. The quality of MRI staging, RT delivery and surgical specimen quality will be closely monitored. Ethics and dissemination The trial is approved by the Regional Ethics Committee and Health Research Authority (HRA) or equivalent. Written informed consent will be obtained. Serious adverse events will be reported to Swansea Trials Unit (STU), the ethics committee and trial sites. Trial results will be submitted for peer review

  4. Comparative Evaluation of Handheld Robot-Aided Intraocular Laser Surgery

    Science.gov (United States)

    Yang, Sungwook; MacLachlan, Robert A.; Martel, Joseph N.; Lobes, Louis A.; Riviere, Cameron N.

    2015-01-01

    This paper presents robot-aided intraocular laser surgery using a handheld robot known as Micron. The micromanipulator incorporated in Micron enables visual servoing of a laser probe, while maintaining a constant distance of the tool tip from the retinal surface. The comparative study was conducted with various control methods for evaluation of robot-aided intraocular laser surgery. PMID:27019653

  5. Optimizing Mouse Surgery with Online Rectal Temperature Monitoring and Preoperative Heat Supply. Effects on Post-Ischemic Acute Kidney Injury.

    Science.gov (United States)

    Marschner, Julian A; Schäfer, Hannah; Holderied, Alexander; Anders, Hans-Joachim

    2016-01-01

    Body temperature affects outcomes of tissue injury. We hypothesized that online body core temperature recording and selective interventions help to standardize peri-interventional temperature control and the reliability of outcomes in experimental renal ischemia reperfusion injury (IRI). We recorded core temperature in up to seven mice in parallel using a Thermes USB recorder and ret-3-iso rectal probes with three different protocols. Setup A: Heating pad during ischemia time; Setup B: Heating pad from incision to wound closure; Setup C: A ventilated heating chamber before surgery and during ischemia time with surgeries performed on a heating pad. Temperature profile recording displayed significant declines upon installing anesthesia. The profile of the baseline experimental setup A revealed that temperature readings were within the target range of 36.5 to 38.5°C. Setup B and C increased the target range readings to 34.6 ± 28.0% and 99.3 ± 1.5%, respectively. Setup C significantly increased S3 tubular necrosis, neutrophil influx, and mRNA expression of kidney injury markers. In addition, using setup C different ischemia times generated a linear correlation with acute tubular necrosis parameters at a low variability, which further correlated with the degree of kidney atrophy 5 weeks after surgery. Changing temperature control setup A to C was equivalent to 10 minutes more ischemia time. We conclude that body temperature drops quickly in mice upon initiating anesthesia. Immediate heat supply, e.g. in a ventilated heating chamber, and online core temperature monitoring can help to standardize and optimize experimental outcomes.

  6. Adult Moyamoya disease: 320-Multidetector row CT for evaluation of revascularization in STA–MCA bypasses surgery

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Bing; Xu, Bing; Liu, Qi; Hao, Qiang; Lu, Jianping, E-mail: cjr.lujianping@vip.163.com

    2013-12-01

    Purpose: To evaluate the utility of 320-multidetector row whole-brain computed tomography perfusion (WBCTP) and whole-head subtracted dynamic angiography (WHSDCTA) for assessing the revascularization of blood flow after superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery in adults with Moyamoya disease (MD) in the short and long term. Patients and methods: 320-multidetector row WBCTP and WHSDCTA were applied in 20 patients with MD before and after surgery (for an average of 3 days and 3 months). The bypass arteries were investigated using WHSDCTA and compared with DSA. The regions of interests (ROIs) in the surgical and mirror sides of the cerebral cortex were drawn on a Vitrea Workstation. Cerebral blood volume (CBV), time to peak (TTP), cerebral blood flow (CBF), mean transit time (MTT), and delay time were recorded. Preoperative and postoperative perfusion parameters in the MCA distribution were compared using the paired t-test. Results: WHSDCTA could clearly demonstrate 24 bypass arteries in 26 arteries for 20 patients, results which were in accordance with the results of digital subtraction angiography (DSA). When comparing preoperative values to those within 3 days after surgery, only TTP and delay time were significantly different (P < 0.05). Values of CBV, TTP, CBF, delay time, and MTT 3 months after surgery were significantly different (P < 0.05) from those of preoperative perfusion. Conclusion: These data suggest that 320-multidetector row WBCTP and WHSDCTA can be used to evaluate the revascularization of blood flow after STA–MCA bypass surgery in patients with MD in the short and long term.

  7. Evaluation of Macular Thickness by Optical Coherence Tomography After Phacoemulsification Surgery

    Directory of Open Access Journals (Sweden)

    Mehmet Tetikoğlu

    2014-03-01

    Full Text Available Objectives: To evaluate the incidence of cystoid macular edema (CME, its risk factors, and macular changes by optical coherence tomography (OCT after phacoemulsification. Materials and Methods: This study included 99 eyes of 65 patients who underwent phacoemulsification surgery in Okmeydanı Training and Research Hospital, Department of Ophthalmology. Foveal thickness, macular volume, and mean macular thickness were measured by OCT preoperatively and at 1st day, 1st week, 1st, and 3rd months postoperatively. Results: In this study, the incidence of postoperative CME was 3%. The mean central foveal thickness was preoperatively 250.4 (±18.5 μm, and postoperatively was 252.08 (±23.2 μm at 1st day, 261.4 (±27.8 μm at 1st week, 270.6 (±44.4 μm at 1st month, and 265.4 (±41.6 μm at 3rd month. The statistically significant increase in foveal thickness was defined between preoperative and 1st week, 1st month, 3rd month as well as between 1st week, 1st month, and 3rd month (p<0.01. Increase in macular thickness was demonstrated in 44 eyes (44.4% which was most frequently located in the parafoveal region. Intraoperative complications like iris trauma, posterior capsule tear, and vitreous loss were increased risk of CME (p=0.001. Conclusion: Subclinical macular thickness increment begins at 1st week and reaches maximum point at 1st month. Incidence of CME increased in patients who had a complicated cataract surgery, so they should be followed closely by OCT. (Turk J Ophthalmol 2014; 44: 88-91

  8. Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

    NARCIS (Netherlands)

    Noyez, L.; Biemans, I.; Verkroost, M.W.; Swieten, H.A. van

    2013-01-01

    OBJECTIVE: This study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery. METHODS: Three thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the

  9. Is a sedentary lifestyle an independent predictor for hospital and early mortality after elective cardiac surgery?

    NARCIS (Netherlands)

    Noyez, L.; Biemans, I.; Verkroost, M.W.; Swieten, H.A. van

    2013-01-01

    OBJECTIVE: This study evaluates whether a sedentary lifestyle is an independent predictor for increased mortality after elective cardiac surgery. METHODS: Three thousand one hundred fifty patients undergoing elective cardiac surgery between January 2007 and June 2012 completed preoperatively the Cor

  10. The Use of a 3D Printer in Pre-operative Planning for a Patient Requiring Acetabular Reconstructive Surgery.

    Science.gov (United States)

    Duncan, James M; Nahas, Samuel; Akhtar, Kashif; Daurka, Jasvinder

    2015-01-01

    Surgical management of acetabular fractures is often highly complex, and a successful outcome depends upon an appreciation of the fracture pattern and the most appropriate approach to reduce and hold it. Currently, computed tomography (CT) images are used in conjunction with plain x-rays to identify the main fracture components and their spatial relationship to one another, and as such surgeons still have to make decisions based upon their ability to visualise the fracture from the images available. 3D printers have now become widely available and inexpensive, and can be used to rapidly produce life-size models based on CT scans of an individual patient. The availability of patient specific, accurate and detailed models of complex acetabular fractures can aid planning of surgical management on a patient specific basis. This report describes the use of a 3D printer to create a life-size model reconstruction of the pelvis of a 48 year old male patient who sustained a left sided associated both column acetabular fracture following a motorbike accident in the Sahara Desert. The model allowed visualisation of the multiple fracture fragments and their relative displacements. The tactile feedback allowed assessment of the different fracture fragments. The relative displacement of the quadrilateral plate and posterior column fragments could be assessed and the surgeon felt that these would be amenable to reduction from an ilioinguinal approach. An anatomic reduction was achieved and was held with the application of a pelvic brim plate with 2 screws lagging the posterior column/quadrilateral plate fragment. There are previous examples of 3D models being used in orthopaedic surgery through the use of rapid prototyping, however this method is usually expensive and time consuming. Advances in 3D printer technology offer surgeons a number of advantages when treating these complex fractures. With the ever-increasing economy, ease of use and speed of additive processing, the

  11. Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study.

    Directory of Open Access Journals (Sweden)

    Kasper Grosen

    Full Text Available BACKGROUND: Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. METHODS: Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2-5. Pain was reevaluated at six months postoperatively. RESULTS: Patients reporting persistent pain at six months follow-up (n = 15 were not significantly different from pain-free patients (n = 16 concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3 or level of catastrophizing (Z = 0.4, P = 1.0. In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007 whereas conditioned pain modulation predicted morphine consumption (β = -0.005, P = 0.001. CONCLUSIONS: Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute

  12. A comparison study between gross tumor volumes defined by preoperative magnetic resonance imaging, postoperative specimens, and tumor bed for radiotherapy after breast-conserving surgery

    Science.gov (United States)

    Zhang, Aiping; Li, Jianbin; Wang, Wei; Wang, Yongsheng; Mu, Dianbin; Chen, Zhaoqiu; Shao, Qian; Li, Fengxiang

    2017-01-01

    Abstract Background: The identification and contouring of target volume is important for breast-conserving therapy. The aim of the study was to compare preoperative magnetic resonance imaging (MRI), postoperative pathology, excised specimens’ (ES) size, and tumor bed (TB) delineation as methods for determining the gross tumor volume (GTV) for radiotherapy after breast-conserving surgery (BCS). Methods: Thirty-three patients with breast cancer who underwent preoperative MRI and radiotherapy after BCS were enrolled. The GTVs determined by MRI, pathology, and the ES were defined as GTVMRI, GTVPAT, and GTVES, respectively. GTVMRI+1 was defined as a 1.0-cm margin around the GTVMRI. The radiation oncologist delineated GTV of the TB (GTVTB) using planning computed tomography according to ≥5 surgical clips placed in the lumpectomy cavity (LC). Results: The median GTVMRI, GTVMRI+1, GTVPAT, GTVES, and GTVTB were 0.97 cm3 (range, 0.01–6.88), 12.58 cm3 (range, 3.90–34.13), 0.97 cm3 (range, 0.01–6.36), 15.46 cm3 (range, 1.15–70.69), and 19.24 cm3 (range, 4.72–54.33), respectively. There were no significant differences between GTVMRI and GTVPAT, GTVMRI+1 and GTVES, GTVES and GTVTB (P = 0.188, 0.070, and 0.264, respectively). GTVMRI is positively related with GTVPAT. However, neither GTVES nor GTVTB correlated with GTVMRI (P = 0.071 and 0.378, respectively). Furthermore, neither GTVES nor GTVTB correlated with GTVMRI+1 (P = 0.068 and 0.375, respectively). Conclusion: When ≥5 surgical clips were placed in the LC for BCS, the volume of TB was consistent with the volume of ES. Neither the volume of TB nor the volume of ES correlated significantly with the volume of tumor defined by preoperative MRI. PMID:28079816

  13. Evaluation of Pain Preoperatively and Postoperatively in Patients with Chronic Pancreatitis Undergoing Longitudinal Pancreaticojejunostomy.

    Science.gov (United States)

    Bhat, K R Seetharam; Khajanchi, Monty; Prajapati, Ram; Satoskar, R R

    2015-12-01

    Chronic pancreatitis is a fairly common condition with pain being the major symptom, and longitudinal pancreaticojejunostomy (LPJ) is performed for symptomatic relief. The aim of the study is to assess relief of pain post-LPJ for chronic pancreatitis and to evaluate the factors influencing relief of symptoms. A prospective observational non-interventional study enrolling 28 patients. This study involved a questionnaire studying various risk factors and pain related to chronic pancreatitis, pancreaticojejunostomy, and postoperative assessment of pain relief at 1 and 6 months from surgery. Pain was assessed using Visual analogue scale (VAS). In chronic pancreatitis, there is a significant relief in symptoms of pain post-LPJ; the degree of relief was less in the alcoholics vs non-alcoholics (p = 0.09) and smokers. There was also reduction in analgesic requirement and frequency of acute attacks of pain. Fifty-seven percent of patients had a complete remission of their pain after LPJ for CP. In chronic pancreatitis, there is a significant relief in symptoms of pain post-LPJ, although the degree of relief is less in the alcoholics and smokers.

  14. Infiltração de 5-fluorouracil no pré-operatório do pterígio Preoperative 5-fluorouracil infiltration in pterygium surgery

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    Claudia Akemi Shiratori

    2003-08-01

    Full Text Available OBJETIVO: Avaliar o efeito do 5-fluorouracil (5FU injetado intralesionalmente na cabeça do pterígio no período pré-operatório. MÉTODOS: Foram estudados 53 olhos (52 pacientes, sendo 28 pterígios primários e 25 recidivados, divididos em dois grupos: grupo 1 (G1, composto por indivíduos que receberam a injeção de 5-fluorouracil 30 dias antes do procedimento cirúrgico e grupo 2 (G2, no qual o 5-fluorouracil foi injetado 10 dias antes da cirurgia. Todas as cirurgias foram realizadas seguindo-se a mesma técnica cirúrgica, pelo mesmo cirurgião. Os pacientes foram reavaliados 7, 30 e 60 dias após a cirurgia. Os resultados observados foram submetidos à análise estatística. RESULTADOS: A amostra estudada foi constituída por 52,8% de pterígios primários e 47,2% de recidivados, sendo composta igualmente por indivíduos de ambos os sexos. Não ocorreram complicações decorrentes da infiltração da droga. A recidiva foi mais freqüente nos pterígios recidivados e no G1. CONCLUSÃO: O uso intralesional de 5-fluorouracil no pré-operatório do pterígio não provocou efeitos deletérios aos olhos estudados. Houve menor recorrência quando usado o 5-fluorouracil 10 dias antes da exérese cirúrgica, em relação à aplicação 30 dias antes do procedimento.PURPOSE: To assess the effect of 5-fluorouracil (5FU injected in pterygia before surgery. METHODS: 53 eyes of 52 patients (28 primary and 25 recurrent pterygia underwent subconjunctival 5-fluorouracil application 30 days before surgery - group 1 (G1 and 10 days before surgery - group 2 (G2. All surgeries were performed by the same surgeon, who used the same technique in all patients. Patients were assessed 7, 30 and 60 days after surgery. Results were submitted to statistical analysis (p<0,05. RESULTS: There were 52,8% primary and 47,2% recurrent pterygia, equally distributed regarding gender. There were no complications due to the infiltration of the drug. Recurrence occurred more

  15. Preoperative anxiety in neurosurgical patients.

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    Perks, Anna; Chakravarti, Sucharita; Manninen, Pirjo

    2009-04-01

    Anxiety is common in surgical patients, with an incidence of 60% to 92%. There is little information on the incidence and severity of preoperative anxiety in patients scheduled for neurosurgery. The aim of this study was to measure the level of preoperative anxiety in neurosurgical patients and to assess any influencing factors. After the Institutional Review Board approval and informed written consent, 100 patients booked for neurosurgery were interviewed preoperatively. Each patient was asked to grade their preoperative anxiety level on a verbal analog scale, Amsterdam Preoperative Anxiety and Information Scale, and a set of specific anxiety-related questions. The anxiety scores and the responses to the questions were compared between the sex, age, weight, diagnosis, and history of previous surgery. The mean age (+/-SD) was 50+/-13 years. The preoperative diagnosis was tumor (n=64), aneurysm (n=14), and other (n=22). Overall verbal analog scale was 5.2+/-2.7; the score was higher for female (5.8+/-2.8) than male patients (4.6+/-2.5) (PAmsterdam Preoperative Anxiety and Information Scale anxiety and knowledge scores were greater for surgery than for anesthesia. Questionnaire results showed that the most common anxieties were waiting for surgery, physical/mental harm, and results of the operation. In conclusion, our study showed that neurosurgical patients have high levels of anxiety, with a higher incidence in females. There was a moderately high need for information, particularly in patients with a high level of preoperative anxiety.

  16. Risk scores to facilitate preoperative prediction of transfusion and large volume blood transfusion associated with adult cardiac surgery.

    Science.gov (United States)

    Goudie, R; Sterne, J A C; Verheyden, V; Bhabra, M; Ranucci, M; Murphy, G J

    2015-05-01

    The aim of this study was to develop two novel risk prediction scores for transfusion and bleeding that would be used to inform treatment decisions, quality assurance, and clinical trial design in cardiac surgery. Clinical data prospectively collected from 26 UK cardiac surgical centres and a single European centre were used to develop two risk prediction models: one for any red blood cell (RBC) transfusion, and the other for large volume blood transfusion (≥4 RBC units; LVBT), an index of severe blood loss. 'Complete case' data were available for 24 749 patients. Multiple imputation was used for missing covariate data (typically data set containing 39 970 patients. Risk models were developed in the complete case data set, with internal validation using leave-one-centre-out cross-validation. The final selected models were fitted to the imputed data set. Final risk scores were then compared with the performance of three existing scores: the Transfusion Risk and Clinical Knowledge score (TRACK), the Transfusion Risk Understanding Scoring Tool (TRUST), and the Papworth Bleeding Risk Score (BRiSc). The area under the receiver operating characteristic curve (AUC) was 0.77 (95% confidence interval 0.77-0.77) for the any RBC transfusion score and AUC 0.80 (0.79-0.80) for the LVBT score in the imputed data set. The LVBT model also showed excellent discrimination (Hosmer-Lemeshow P=0.32). In the imputed data set, the AUCs for the TRACK and TRUST scores for any RBC transfusion were 0.71 and 0.71, respectively, and for LVBT the AUC for the BRiSc score was 0.69. Two new risk scores for any RBC transfusion or LVBT among cardiac surgery patients have excellent discrimination, and could inform clinical decision making. © The Author 2015. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  17. Clinical results of tumor shrinkage and evaluation of quality of life in low rectal carcinoma after preoperative combined treatment

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    Kojima, Osamu; Suganuma, Yasushi; Tamura, Takao; Ohnishi, Kazuyoshi; Nishiue, Takashi; Itoh, Masahiko; Horie, Hiroshi; Sawai, Seiji; Takahashi, Toshio (Kyoto Prefectural Univ. of Medicine (Japan))

    1992-10-01

    To improve the surgical rate and the quality of life (QOL) for patients with advanced low rectal carcinoma, we investigated whether preoperative treatments (irradiation and hyperthermia and 5-fluorouracil (5-FU) suppository, irradiation and hyperthermia, irradiation and 5-FU suppository, irradiation alone and 5-FU suppository alone) were useful. The tumor shrinkage rate after preoperative treatments was highest in the irradiation, hyperthermia and 5-FU suppository group. Pathologically complete regression was observed in the 2 of 18 cases (12%). According to our criteria of histological changes, the irradiation, hyperthermia and 5-FU suppository group showed the greatest effectiveness. The 4 year postoperative survival rate and the 4 year local recurrence rate were 100% and 8% in the irradiation, hyperthermia and 5-FU suppository group and the data suggest that these results were the best of the 5 treatments. After the carcinoma was shrunk after irradiation, hyperthermia and 5-FU suppository, the patients could receive curatively a sphincter-saving operation (super-low anterior resection and transanal rectal resection). The fecal continence of 7 patients after sphincter-saving operations was increased as good by manometric study, defecography and clinical evaluation. In conclusion, our data suggest that the preoperative combined treatment of irradiation, hyperthermia and 5-FU suppository prevents local recurrence and increases the possibility of a sphincter-saving operation for advanced rectal carcinoma. (author).

  18. Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

    Science.gov (United States)

    Batista, Claudio Sergio; Osako, Takasi; Clemente, Eliana Mara; Batista, Fernanda Carvalhido Antonio; Osako, Maurício Takeshi Janiques

    2012-01-01

    Background Despite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse. Methods A prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse. Results The age range of the women was 33–59 years, uterine volume was 300–900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%), with a surgery time of 30–60 minutes in 55 (59.82%) and 19 (15.98%) cases, respectively. Uterine volume reduction was performed in 41 (35.05%) cases, salpingectomy was the most common associated surgery (81.19%), and anesthesia was subdural (68.37%). Common intraoperative complications included bladder lesions (8.54%), with conversion to the abdominal route being necessary in one case (1.28%), and the most common postoperative complication being vaginal cupola granuloma (32.47%). There was a statistically significant relationship between surgery time and uterine volume (χ2 = 17.367; P = 0.002). Conclusion This study suggests that vaginal hysterectomy is a safe surgical procedure in view of its good performance and low complication rate. PMID:23071420

  19. Evaluation of patients undergoing lung volume reduction surgery: Ancillary information available from computed tomography

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    Cleverley, Joanne R.; Desai, Sujal R.; Wells, Athol U.; Koyama, Hiroshi; Eastick, Sian; Schmidt, Maria A.; Charrier, Clare L.; Gatehouse, Peter D.; Goldstraw, Peter; Pepper, John R.; Geddes, Duncan M.; Hansell, David M

    2000-01-01

    AIM: A number of imaging techniques have been used for the pre-operative assessment of patients for lung volume reduction surgery (LVRS). We evaluated whether data currently acquired from perfusion scintigrams and cine MR of the diaphragm are obtainable from high resolution CT (HRCT) of the thorax. MATERIALS AND METHODS: Thirty patients taking part in a randomized controlled trial of LVRS against maximal medical therapy were evaluated. HRCT examinations (n= 30) were scored for (i) the extent and distribution of emphysema; (ii) the extent of normal pulmonary vasculature; and (iii) diaphragmatic contour, apparent defects and herniation. On scintigraphy, (n28), perfusion of the lower thirds of both lungs, as a proportion of total lung perfusion (LZ/T{sub PERF}), was expressed as a percentage of predicted values (derived from 10 normal control subjects). On cine MR (n= 25) hemidiaphragmatic excursion and coordination were recorded. RESULTS: Extensive emphysema was present on HRCT (60% {+-} 13.2%). There was strong correlation between the extent of normal pulmonary vasculature on HRCT and on perfusion scanning (r{sub s}= 0.85, P< 0.00005). Hemidiaphragmatic incoordination on MR was weakly associated with hemidiaphragmatic eventration on HRCT (P0.04). CONCLUSION: The strong correlation between lung perfusion assessed by HRCT and lung perfusion on scintigraphy suggests that perfusion scintigraphy is superfluous in the pre-operative evaluation of patients with emphysema for LVRS. Cleverley, J.R. (2000)

  20. Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

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    Kelli Maria Souza Santos

    2014-09-01

    Full Text Available Introduction: Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective: To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods: This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors at three different times: preoperatively (M1, the day of discharge (M2 and hospital discharge (M3. Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results: Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1, with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion: The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline.

  1. Reduction effect of bacterial counts by preoperative saline lavage of the stomach in performing laparoscopic and endoscopic cooperative surgery.

    Science.gov (United States)

    Mori, Hirohito; Kobara, Hideki; Tsushimi, Takaaki; Fujihara, Shintaro; Nishiyama, Noriko; Matsunaga, Tae; Ayaki, Maki; Yachida, Tatsuo; Tani, Joji; Miyoshi, Hisaaki; Morishita, Asahiro; Masaki, Tsutomu

    2014-11-14

    To investigate the effects of gastric lavage with 2000 mL of saline in laparoscopic and endoscopic cooperative surgery. Twenty two patients who were diagnosed with a gastric gastrointestinal stromal tumor were enrolled. In former term, irrigations of the stomach were conducted whenever it was necessary, not systematically (Non systemic lavage group). In latter term, the stomach was thoroughly cleaned with 2000 mL of saline using an endoscope with a water jet, and Duodenal balloon occlusion was conducted to prevent refluxed bile and pancreatic juice (Systemic lavage+balloon occlusion group). The gastric wall was sprayed with 20 mL of distilled water, and 20 mL of gastric juice was collected in a sterile tube and submitted for culture. 20 mL of ascites was also collected from the laparoscopic ports and submitted for culture. We compared WBC, CRP, BT between two groups, and verify the reduction effect of bacterial counts in Systemic lavage+balloon occlusion group. WBC count before, 1 d after, and 3 d after laparoscopic and endoscopic cooperative surgery (LECS) were 5060 (95%CI: 4250-9640), 12140 (6050-14110), and 6910 (5320-12520) in Non systemic lavage group, 4400 (3660-7620), 8910 (6480-10980), and 5950 (4840-7860) in Systemic lavage+balloon occlusion group. Significant differences between two groups at the day after LECS (P = 0.029) and the 3 d after LECS (P = 0.042). CRP levels in Non systemic lavage group and in Systemic lavage+balloon occlusion group were significantly different at the day after LECS (P = 0.005) and the 3 d after LECS (P = 0.028). BTs (°C) in Non systemic lavage group and in Systemic lavage+balloon occlusion group were also significantly different at the day after LECS (P = 0.004) and the 3 d after LECS (P = 0.006). In a logarithmic comparison, bacterial load before gastric lavage, after lavage, and ascites culture were 6.08 (95%CI: 4.04-6.97), 0.48 (0-0.85), and 0.21 (0-0.56). The bacterial counts before and after gastric lavage were

  2. Preoperative evaluation of colorectal liver metastases: comparison between gadoxetic acid-enhanced 3.0-T MRI and contrast-enhanced MDCT with histopathological correlation

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    Scharitzer, M.; Ba-Ssalamah, A.; Ringl, H.; Koelblinger, C.; Weber, M. [Medical University of Vienna, Department of Radiology, Vienna (Austria); Gruenberger, T. [Medical University of Vienna, Department of Surgery, Vienna (Austria); Schima, W. [Department of Radiology, KH Goettlicher Heiland, KH der Barmherzigen Schwestern and St Josef-Krankenhaus, Vienna (Austria)

    2013-08-15

    The aim of this prospective study was to compare the diagnostic performance of 64-row MDCT and gadoxetic-acid-enhanced MRI at 3.0 T in patients with colorectal liver metastases in correlation with histopathological findings. Lesions detected at MDCT and MRI were interpreted by three blinded readers and compared with histopathological workup as the term of reference. Two subgroups of lesions were additionally evaluated: (1) metastases smaller than 10 mm and (2) lesions in patients with and without steatosis of the liver, assessed histopathologically. Surgery and histopathological workup revealed 81 colorectal liver metastases in 35 patients and diffuse metastatic involvement in 3 patients. In a lesion-by-lesion analysis, significant sensitivity differences could only be found for reader 1 (P = 0.035) and reader 3 (P = 0.003). For segment-based evaluation, MRI was more sensitive only for reader 3 (P = 0.012). The number of false-positive results ranged from 3 to 12 for MDCT and 8 to 11 for MRI evaluation. In the group of small lesions, the sensitivity differed significantly between both methods (P = 0.003). In patients with hepatic steatosis, MRI showed a trend toward better performance than MDCT, but without statistical performance. The 3.0-T MRI with liver-specific contrast agents is the preferred investigation in the preoperative setting, especially for the assessment of small colorectal liver metastases. (orig.)

  3. A and B mode ultrasonography in preoperative evaluation of lens and posterior segment of dogs eyes with cataract

    Directory of Open Access Journals (Sweden)

    Bianca C. Martins

    2010-02-01

    Full Text Available Ultrasonography of the lens and posterior segment is an indispensable step in the preoperative evaluation of dogs with cataracts, since ophthalmoscopy is not feasible when there is opacification of the lens. This study evaluated the echographic conditions of cataractous lens and fundus of the eye in dogs affected by cataracts. The study was conducted in 30 dogs (56 eyes, 10 males and 20 females, with different types of cataracts at different stages of development. Echography in A and B modes, simultaneously, was carried out for the examination of the lens and posterior segment. The examinations revealed anterior cortical, posterior cortical and nuclear cataract in 12 eyes (21.4%, anterior cortical, posterior cortical, nuclear and posterior capsular in 23 eyes (41%, anterior cortical, posterior cortical and posterior capsular cataract in one eye (1.7%, anterior cortical and nuclear cataract in one eye (1.7%, anterior cortical, nuclear and posterior capsular cataract in five eyes (8.9%, and anterior cortical cataract in seven eyes (12.5%. Abnormal ultrasonographic alterations were observed in the posterior segment in 26 eyes evaluated (46.4%. Vitreal degeneration was detected in 12 eyes (21.4%, images of vitreal exudate or hemorrhage in seven eyes (12.5%, persistence of hyaloid artery in four eyes (7.1% and lens subluxation in three eyes (5.3%. The results obtained reiterate the importance of ultrasonography in canine patients presented for cataract surgery given that alterations of the posterior segment are difficult to identify in a clinical examination when the lens is opacified.A ultrassonografia do segmento posterior do bulbo do olho é etapa indispensável na avaliação de cães com catarata que serão submetidos à facectomia, uma vez que a oftalmoscopia não é factível quando há opacificação da lente, notadamente nas cataratas maduras. Este estudo avaliou as condições ecográficas da lente cataratogênica e do fundo de olho de c

  4. Evaluation of Residual Cellularity and Proliferation on Preoperatively Treated Breast Cancer: A Comparison between Image Analysis and Light Microscopy Analysis

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    Valentina Corletto

    1998-01-01

    Full Text Available Histopathology has been suggested as a reliable method for tumour reduction evaluation of preoperatively treated breast cancer. Immunocytochemistry can be used to enhance the visibility of residual tumour cellularity and in the evaluation of its proliferative activity. We compared Image Analysis (IA with Light Microscopy Analysis (LMA on sections of breast carcinomas treated with preoperative chemo‐ or chemo/radiotherapy in the evaluation of the Neoplastic Cell Density (NCD (69 cases and the Proliferation Index (PI (35 cases. NCD was expressed as the immunoreactive area to cytokeratin over the total original neoplastic area and PI was expressed as the number of immunostained tumoural nuclei with MIB1 MoAb over the total of tumoural nuclei. The intraobserver agreement and that between IA and LMA for both indices were estimated by the common (Kw and the jackknife weighted kappa statistic (K˜w. The extent of agreement of each considered category was also assessed by means of the category‐specific kappa statistics (Kcs. The intraobserver agreement within LMA for NCD and PI and that between IA and LMA for PI were both satisfactory. Upon evaluation of the NCD, the agreement between IA and LMA showed unsatisfactory results, especially when the ratio between the residual tumour cells and the background was critical.

  5. Evaluation of residual cellularity and proliferation on preoperatively treated breast cancer: a comparison between image analysis and light microscopy analysis.

    Science.gov (United States)

    Corletto, V; Verderio, P; Giardini, R; Cipriani, S; Di Palma, S; Rilke, F

    1998-01-01

    Histopathology has been suggested as a reliable method for tumour reduction evaluation of preoperatively treated breast cancer. Immunocytochemistry can be used to enhance the visibility of residual tumour cellularity and in the evaluation of its proliferative activity. We compared Image Analysis (IA) with Light Microscopy Analysis (LMA) on sections of breast carcinomas treated with preoperative chemo- or chemo/radiotherapy in the evaluation of the Neoplastic Cell Density (NCD) (69 cases) and the Proliferation Index (PI) (35 cases). NCD was expressed as the immunoreactive area to cytokeratin over the total original neoplastic area and PI was expressed as the number of immunostained tumoural nuclei with MIB 1 MoAb over the total of tumoural nuclei. The intraobserver agreement and that between IA and LMA for both indices were estimated by the common (kappa(w)) and the jackknife weighted kappa statistic (kappa(w)). The extent of agreement of each considered category was also assessed by means of the category-specific kappa statistics (kappa(cs)). The intraobserver agreement within LMA for NCD and PI and that between IA and LMA for PI were both satisfactory. Upon evaluation of the NCD, the agreement between IA and LMA showed unsatisfactory results, especially when the ratio between the residual tumour cells and the background was critical.

  6. Preoperative Evaluation of Thyroid Epithelial Lesions by DNA Ploidy and Galectin-3 Expression in FNAC

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    Sonia L. Elsharkawy

    2014-12-01

    CONCLUSIONS: From the results of this study we can consider that DNA ploidy and Galectin-3 could refine the FNA results and  increase its sensitivity as a screening test from sensitivity(60% to reach sensitivity (93.3%, thus decreasing the false negative cases. From this study, it is concluded that the application of ancillary techniques as galectin-3 immunocytochemical markers may become a reliable indicator for surgical intervention, DNA ploidy measurements on the other hand may be of value in galectin-3 negative cases to determine the behavior of the lesion in such cases & refine the preoperative assessment by out ruling false negative cases.

  7. Paraganglioma of the heart. The value of magnetic resonance imaging in the preoperative evaluation.

    Science.gov (United States)

    Conti, V R; Saydjari, R; Amparo, E G

    1986-10-01

    Although the 131I-metaiodobenzylguanidine scan has proven reliable in identifying mediastinal paragangliomas, further localization has usually required dynamic computerized tomographic scanning which requires rapid bolus injection of contrast material. In the case presented herein, magnetic resonance imaging provided accurate preoperative localization and added important anatomic detail that was not appreciated with dynamic computerized tomograms or with other studies. Magnetic resonance imaging can accurately localize cardiac paragangliomas without injection of contrast material and may provide more detailed information for better guidance for surgical excision.

  8. Cloud-Based Service Information System for Evaluating Quality of Life after Breast Cancer Surgery.

    Directory of Open Access Journals (Sweden)

    Hao-Yun Kao

    Full Text Available Although recent studies have improved understanding of quality of life (QOL outcomes of breast conserving surgery, few have used longitudinal data for more than two time points, and few have examined predictors of QOL over two years. Additionally, the longitudinal data analyses in such studies rarely apply the appropriate statistical methodology to control for censoring and inter-correlations arising from repeated measures obtained from the same patient pool. This study evaluated an internet-based system for measuring longitudinal changes in QOL and developed a cloud-based system for managing patients after breast conserving surgery.This prospective study analyzed 657 breast cancer patients treated at three tertiary academic hospitals. Related hospital personnel such as surgeons and other healthcare professionals were also interviewed to determine the requirements for an effective cloud-based system for surveying QOL in breast cancer patients. All patients completed the SF-36, Quality of Life Questionnaire (QLQ-C30 and its supplementary breast cancer measure (QLQ-BR23 at baseline, 6 months, 1 year, and 2 years postoperatively. The 95% confidence intervals for differences in responsiveness estimates were derived by bootstrap estimation. Scores derived by these instruments were interpreted by generalized estimating equation before and after surgery.All breast cancer surgery patients had significantly improved QLQ-C30 and QLQ-BR23 subscale scores throughout the 2-year follow-up period (p<0.05. During the study period, QOL generally had a negative association with advanced age, high Charlson comorbidity index score, tumor stage III or IV, previous chemotherapy, and long post-operative LOS. Conversely, QOL was positively associated with previous radiotherapy and hormone therapy. Additionally, patients with high scores for preoperative QOL tended to have high scores for QLQ-C30, QLQ-BR23 and SF-36 subscales. Based on the results of usability testing

  9. Evaluation of usefulness and availability for orthopedic surgery using clavicle fracture model manufactured by desktop 3D printer

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    Oh, Wang Kyun [Dept. of Diagnostic Radiology, Cheongju Medical Center, Cheongju (Korea, Republic of)

    2014-09-15

    Usefulness and clinical availability for surgery efficiency were evaluated by conducting pre-operative planning with a model manufactured by desktop 3D printer by using clavicle CT image. The patient-customized clavicle fracture model was manufactured by desktop 3D printer of FDM wire laminated processing method by converting the CT image into STL file in Open Source DICOM Viewer Osirix. Also, the model of the original shape before damaged was restored and manufactured by Mirror technique based on STL file of not fractured clavicle of the other side by using the symmetry feature of the human body. For the model, the position and size, degree of the fracture was equally printed out. Using the clavicle model directly manufactured with low cost and less time in Department of Radiology is considered to be useful because it can reduce secondary damage during surgery and increase surgery efficiency with Minimal invasive percutaneous plate osteosynthesis(MIPO)

  10. Importance of Radiological Evaluation of Global Spinal Balance Together with Lower Limb Alignment in Planning Lumbar Spine Deformity Surgery - Illustrative Case Presentation.

    Science.gov (United States)

    Głowacki, Mariusz; Walecki, Jerzy; Kołakowski, Przemysław; Kolońska, Danuta

    2017-01-01

    The presented case illustrates the critical role of a detailed preoperative radiological evaluation in complex spine surgery. A 49-year-old patient was admitted for a revision surgery after L3-L5 fusion. Preoperative assessment showed preserved sagittal balance, coronal imbalance and valgus knee deformity. The patient reported pain of 8-10 in VAS (Visual Analogue Scale) and had an ODI (Oswestry Disability Index) of 60%. The first step of the surgery was L2-S1 fusion with decompression and spine deformity correction. The second step involved anti-valgus osteotomy of the right tibial bone. The assessment of global spinal balance together with lower extremity alignment should be strongly recommended.

  11. Preoperative and postoperative evaluation of somatosensorial evoked potentials of upper extremities in cervical intervertebral disc herniation.

    Science.gov (United States)

    Umur, Ahmet Sukru; Selcuki, Mehmet; Selcuki, Deniz; Temiz, Cuneyt; Akbasak, Aytac

    2013-01-01

    This study aims to determine the dysfunction caused by existing pathological condition in structures involved in the transfer of sensory functions of the neural system in cervical disc herniation, and to establish whether or not the level and degree of this anatomical damage can be anticipated by SEP (Somatosensorial Evoked Potentials). We compared the obtained SEP values for statistical significance using the Friedman Variation Analysis. In parameters with statistical significance, the Wilcoxon Signed Rank test was used to identify when significant improvements occurred. The study found that the statistical data of the latency of the N14 wave originating from the dorsal column nuclei of the medulla spinalis and dorsal column gray matter improved (p < 0.05) in the postoperative period compared with the preoperative values. Using the Wilcoxon Signed Rank test, we studied postoperative months separately in regard to the difference in the latency of the N14 wave, and found the statistically significant improvement to be marked particularly in months 3 and 6 postoperatively (p < 0.05). In conclusion, we suggest that SEP is a useful tool to check the functional condition of the dorsal spinal column. The benefit of the SEP utilization is the ability to determine the severity of the pathological condition preoperatively and follow the patient's functional postoperative improvement.

  12. Initial evaluation of the "Trauma surgery course"

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    Tugnoli Gregorio

    2006-03-01

    Full Text Available Abstract Background The consequence of the low rate of penetrating injuries in Europe and the increase in non-operative management of blunt trauma is a decrease in surgeons' confidence in managing traumatic injuries has led to the need for new didactic tools. The aim of this retrospective study was to present the Corso di Chirurgia del Politrauma (Trauma Surgery Course, developed as a model for teaching operative trauma techniques, and assess its efficacy. Method the two-day course consisted of theoretical lectures and practical experience on large-sized swine. Data of the first 126 participants were collected and analyzed. Results All of the 126 general surgeons who had participated in the course judged it to be an efficient model to improve knowledge about the surgical treatment of trauma. Conclusion A two-day course, focusing on trauma surgery, with lectures and life-like operation situations, represents a model for simulated training and can be useful to improve surgeons' confidence in managing trauma patients. Cooperation between organizers of similar initiatives would be beneficial and could lead to standardizing and improving such courses.

  13. Intramural and mesorectal distal spread detected by whole-mount sections in the determination of optimal distal resection margin in patients undergoing surgery for rectosigmoid or rectal cancer without preoperative therapy.

    Science.gov (United States)

    Shimada, Yoshifumi; Takii, Yasumasa; Maruyama, Satoshi; Ohta, Tamaki

    2011-12-01

    The current Japanese general rules for clinical and pathologic studies on cancer of the colon, rectum, and anus state that a 3-cm distal resection margin is needed in resecting rectosigmoid cancer and rectal cancer with a distal edge above the peritoneal reflection, and 2 cm is needed for rectal cancer with a distal edge below the peritoneal reflection. The appropriateness of these rules has not been proved. Our aim was to evaluate the appropriateness of the Japanese rules. We retrospectively analyzed surgical and pathology records of patients who underwent surgery at a tertiary care cancer center in Japan. The study included 381 consecutive patients with stage I to IV rectosigmoid or rectal cancer without preoperative chemotherapy or radiotherapy. We investigated both intramural and mesorectal distal spread, using whole-mount sections to measure the maximum length of distal spread. Long distal spread was defined as distal spread longer than the distal resection margin stated in the Japanese general rules. Risk factors for both distal spread and long distal spread were evaluated. Of 381 patients, 325 (85.3%) had no distal spread and a total of 56 (14.7%) had distal spread. Distal spread was within the limits specified by the Japanese general rules in 48 of the 381 patients (12.6%) and beyond the Japanese limits (long distal spread) in 8 patients (2.1%). The prevalence of distal spread increased with TNM stage (stage I, 2.7%; stage II, 5.3%; stage III, 17.4%; stage IV, 46.2%). Long distal spread was not observed in stage I or II, was found in only 1.4% of patients with stage III disease and in 11.5% of patients with stage IV. The maximum extent of distal spread in patients with rectosigmoid cancer or rectal cancer with the distal edge above the peritoneal reflection was 38 mm; in patients with rectal cancer with the distal edge below the peritoneal reflection, 35 mm. Multivariable analyses showed that nodal involvement and distant metastasis were independent risk

  14. Evaluation of stability after pre-orthodontic orthognathic surgery using cone-beam computed tomography: A comparison with conventional treatment

    Science.gov (United States)

    Ann, Hye-Rim; Jung, Young-Soo; Lee, Kee-Joon

    2016-01-01

    Objective The aim of this study was to evaluate the skeletal and dental changes after intraoral vertical ramus osteotomy (IVRO) with and without presurgical orthodontics by using cone-beam computed tomography (CBCT). Methods This retrospective cohort study included 24 patients (mean age, 22.1 years) with skeletal Class III malocclusion who underwent bimaxillary surgery with IVRO. The patients were divided into the preorthodontic orthognathic surgery (POGS) group (n = 12) and conventional surgery (CS) group (n = 12). CBCT images acquired preoperatively, 1 month after surgery, and 1 year after surgery were analyzed to compare the intergroup differences in postoperative three-dimensional movements of the maxillary and mandibular landmarks and the changes in lateral cephalometric variables. Results Baseline demographics (sex and age) were similar between the two groups (6 men and 6 women in each group). During the postsurgical period, the POGS group showed more significant upward movement of the mandible (p < 0.05) than did the CS group. Neither group showed significant transverse movement of any of the skeletal landmarks. Moreover, none of the dental and skeletal variables showed significant intergroup differences 1 year after surgery. Conclusions Compared with CS, POGS with IVRO resulted in significantly different postsurgical skeletal movement in the mandible. Although both groups showed similar skeletal and dental outcomes at 1 year after surgery, upward movement of the mandible during the postsurgical period should be considered to ensure a more reliable outcome after POGS. PMID:27668193

  15. The use of sensory action potential to evaluate inferior alveolar nerve damage after orthognathic surgery.

    Science.gov (United States)

    Calabria, Francesca; Sellek, Lucy; Gugole, Fabio; Trevisiol, Lorenzo; Trevisol, Lorenzo; Bertolasi, Laura; D'Agostino, Antonio

    2013-03-01

    To assess and monitor the common event of neurosensory disturbance to the inferior alveolar nerve (IAN) after bilateral sagittal split osteotomy, we used clinical sensory tests and neurophysiologic test sensory action potentials. The diagnostic value of these tests was evaluated by comparing them with the degree of nerve damage reported by patients. Fourteen patients undergoing bilateral sagittal split osteotomy were analyzed preoperatively and 2 years postoperatively. Patients were evaluated bilaterally for positive and negative symptoms: light touch sensation, paraesthesia, hyperesthesia, and dysaesthesia; a "sensation score" was then calculated for each patient. Patients were also asked if they would be willing to repeat the procedure knowing the sensation loss they had now. Next, the right and left IAN were evaluated using sensory action potential and correlated with the other results. Before surgery, the medium latency difference between left and right was lower compared with postsurgery, with all patients having some deficit. The reduction in medium amplitude of 67% after the intervention was statistically significant. The frequency of abnormal findings in the electrophysiologic tests indicating IAN injury correlated with subjective sensory alteration. All patients said that they would repeat the surgery. Electrophysiologic testing is recommended for the evaluation of nerve dysfunction and seems a sensitive method for accurately assessing postsurgical nerve conduction.

  16. Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study.

    Science.gov (United States)

    Sabbagh, C; Dumont, F; Fuks, D; Yzet, T; Verhaeghe, P; Regimbeau, J-M

    2012-02-01

    Progressive preoperative pneumoperitoneum (PPP) is used to prepare incisional hernias with loss of domain (IHLD) operations. The aim of the present study was to analyze the effect of PPP on peritoneal volume [measured using a new computed tomography (CT)-based method] and respiratory function. From July 2004 to July 2008, 19 patients were included in a prospective, observational study. The volumes of the incisional hernia (VIH), the abdominal cavity (VAC), the total peritoneal content (VP) and the VIH/VP ratio were measured before and after PPP using abdominal CT scan data. Spirometric parameters were measured before and after PPP, and postoperative clinical data were evaluated. Before and after PPP, the mean VIH was 1,420 cc and 2,110 cc (P  VIH before PPP. After PPP, the spirometric measurements revealed a restrictive syndrome. The overall postoperative morbidity rate was 37%. PPP increased the hernia and abdominal volumes. PPP induced a progressive, restrictive syndrome.

  17. 术前咨询干预对美容受术者术后满意度的影响%Effecttion of postoperative satisfaction on the subject of preoperative consulting in patients receiving cosmetic surgery

    Institute of Scientific and Technical Information of China (English)

    何清莲; 刘鸿雁; 蒋欣

    2012-01-01

    Objective To investigate the effecttion of postoperative satisfaction on the subject of preoperative consulting in patients receiving cosmetic surgery. Methods Five hundred patients receiving cosmetic surgery before surgery in our department from January 2008 to May 2011,who were randomly divided into the experimental group and control group.stochastic investigate the effecttion of postoperative satisfaction at one time on the subject of two different preoperative consulting methods in patients receiving cosmetic surgery. Results No difference of preoperative expecttion between the five hundred patients receiving cosmetic surgery (P>0.05).Two months after surgery,Self -assessment of the satisfaction rate in the experimental group (246 cases,97.3%) was remarkably higher than that in the control group (224 cases,90.7%),the bad review rate in the experimental group (7 cases,2.8%) was lower than that in the control group (23 cases,9.3%) (P<0.06). Conclusion An objective and personal preoperative consulting in patients receiving cosmetic surgery before surgery can increase the satisfaction rate in them.and is a most important to the medical cosmetic surgery.%目的:探讨美容受术者术前咨询经历对其术后的满意度的影响.方法:将2008年1月~2011年5月在我科进行美容术前咨询并实施手术者500例,随机分为实验组和对照组,随访分析两种咨询方法在术后一定时间内对受术者效果自评的影响.结果:500例受术者术前期待组间差异无统计学意义(P>0.05),术后两个月自评,实验组满意246例(97.3%),差7例(2.8%),对照组满意224例(90.7%),差23例(9.3%),组间比较差异有统计学意义(P<0.05).结论:术前提供客观、个性化的咨询服务能够增加美容受术者对手术的满意率,是医学美容手术前值得重视的环节.

  18. Evaluation of Body Image and Sexual Satisfaction in Women Undergoing Female Genital Plastic/Cosmetic Surgery.

    Science.gov (United States)

    Goodman, Michael P; Placik, Otto J; Matlock, David L; Simopoulos, Alex F; Dalton, Teresa A; Veale, David; Hardwick-Smith, Susan

    2016-10-01

    Little prospective data exists regarding the procedures constituting female genital plastic/cosmetic surgery (FGPS). To evaluate whether the procedures of labiaplasty and vaginoperineoplasty improve genital self image, and evaluate effects on sexual satisfaction. Prospective cohort case-controlled study of 120 subjects evaluated at baseline, 6, 12, and 24 months postoperative, paired with a demographically similar control group. Interventions include labiaplasty, clitoral hood reduction, and/or aesthetic vaginal tightening, defined as perineoplasty + "vaginoplasty" (aka "vaginal rejuvenation."). Outcome measures include body image, genital self-image, sexual satisfaction, and body esteem. As a group, study patients tested at baseline showing body dissatisfaction, negative genital self-image, and poorer indices of sexual satisfaction. Preoperative body image of study patients were in a range considered to be mild to moderately dysmorphic, but matched controls at one and two years; genital self-image scores at entry were considerably lower than controls, but by 2-year follow-up had surpassed control value at entry. Similarly, sexual satisfaction values, significantly lower at entry, equaled at one, and surpassed control values, at 2 years. Postoperatively, at all points in time, these differences in body image and genital self-image disappeared, and sexual satisfaction markedly improved. Overall body esteem did not differ between study and control groups, with the exception of the genital esteem quotient, which improved after surgery. Women requesting and completing FGPS, when tested by validated instruments, at entry report sexual dissatisfaction and negative genital self-image. When tested at several points in time after surgery up to two years, these findings were no longer present. When performed by an experienced surgeon, FGPS appears to provide sexual and genital self-image improvement. 2 Therapeutic. © 2016 The American Society for Aesthetic Plastic Surgery

  19. Morphological evaluation of damage to esophageal tumors caused by preoperative irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kanaev, S.V.; Stolyarov, V.I.; Serov, S.F.; Savel' eva, O.P.; Frolova, Z.V.; Volkov, O.N.; Nejshtadt, Eh.L. (Nauchno-Issledovatel' skij Inst. Onkologii, Leningrad (USSR))

    1982-01-01

    Post-radiation changes were studied in 21 patients suffering from esophageal cancer who had undergone preoperative irradiation. The results of quantitative morphological analysis were compared with the data obtained from examination of 15 patients operated for tumors but unexposed to radiation. Tumor damage index proved to be 35.0%+-4. Mitotic index remained unchanged, while pathological mitoses in tumors increased four times after irradiation (62.0%+-5.8 as compared with 15.4%+-4.4). They are mostly observed in the dispersion of chromosomes in metaphase. It is concluded that in order to adequately visualise radiation-induced damage to tumor, different morphological criteria should be used in its evaluaton, depending on the length of post-irradiation period.

  20. Evaluation of single-stage adjustable strabismus surgery under conscious sedation

    Directory of Open Access Journals (Sweden)

    Sharma Pradeep

    2009-01-01

    Full Text Available Purpose: To evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS performed under topical anesthesia. Materials and Methods: Forty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients′ experience of the surgery (by questionnaire were also compared. Results: Mean preoperative deviation for distance in Groups I, II, III was -41.67 prism diopter (pd ±9.0, -38.93 pd ±11.05 and -41.87 pd ±8.91 ( P =0.6 respectively. At three months, mean correction achieved for distance was +31.87 pd ±11.71, +35.47 pd ±10.86 and +42.80 pd ±10.71 respectively which was significantly different between Group III and Group I ( P =0.03. Intraoperatively all hemodynamic parameters remained stable and comparable ( P =0. 5 in all groups. Intraoperative pain ( P < 0.001 and time taken for surgery ( P < 0.001 was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups ( P = 0.5. Conclusions: SSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.

  1. Comparative Assessment of Preoperative versus Postoperative Dexamethasone on Postoperative Complications following Lower Third Molar Surgical Extraction

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    Hashem M. Al-Shamiri

    2017-01-01

    Full Text Available Aim. To evaluate the effect of preoperative versus postoperative administration of oral Dexamethasone on postoperative complications including pain, edema, and trismus following lower third molar surgery. Methods. 24 patients were divided into two equal groups receiving 8 mg Dexamethasone orally, one group one hour preoperatively and the other group immediately after surgery. Pain was measured using VAS, edema was measured using a graduated tape between 4 fixed points in the face, and the mouth opening was measured using a graduated sliding caliper. Results. In this study pain and trismus records were similar and statistically nonsignificant in both groups. The results had proven that preoperative administration was superior when compared to postoperative administration regarding edema (0.002. Conclusions. Preoperative oral administration of 8 mg Dexamethasone was superior to the postoperative administration of the same dose concerning edema after lower third molar surgery.

  2. Food quality in the late postoperative period of bariatric surgery: an evaluation using the bariatric food pyramid.

    Science.gov (United States)

    Soares, Fernando Lucas; Bissoni de Sousa, Larissa; Corradi-Perini, Carla; Ramos da Cruz, Magda Rosa; Nunes, Mario Gilberto Jesus; Branco-Filho, Alcides José

    2014-09-01

    Bariatric surgery is an effective intervention in the treatment of obesity, but lifestyle and diet should be monitored after this procedure to ensure success. The Bariatric Food Pyramid was created basing on long-term nutritional care that proposes a standard of healthy living and eating habits considering gastric capacity and specific nutritional needs. The purpose of the current study is to evaluate the life habits and diet quality of patients who have undergone bariatric surgery (who have been recovering for at least 6 months) based on the specific food pyramid. Retrospective data analysis was performed using medical records of patients who had been followed for at least 6 months after bariatric surgery. The following data were collected from patient records: age, gender, education level (years), BMI (preoperative and postoperative), percentage of excess weight loss (EWL) relative to the time of surgery, frequency of physical activity, use of nutritional supplements, usual dietary intake history, and fluid intake. Results were analyzed using descriptive statistics. We evaluated 172 patient records. In this study, there was a low prevalence of physical activity, use of vitamin-mineral supplements, and water intake. There also was low consumption of protein, fruit, vegetables, and vegetable oils. In addition, intake of carbohydrates, sugars, and fats were higher than the recommendations established by the pyramid. The results indicate that patients who have undergone bariatric surgery have an inadequate diet according to food evaluation with the specific pyramid. In the long term, this may lead to weight gain and vitamin and mineral deficiencies.

  3. Applicability of preoperative nuclear morphometry to evaluating risk for cervical lymph node metastasis in oral squamous cell carcinoma.

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    Masaaki Karino

    Full Text Available BACKGROUND: We previously reported the utility of preoperative nuclear morphometry for evaluating risk for cervical lymph node metastases in tongue squamous cell carcinoma. The risk for lymph node metastasis in oral squamous cell carcinoma, however, is known to differ depending on the anatomical site of the primary tumor, such as the tongue, gingiva, mouth floor, and buccal mucosa. In this study, we evaluated the applicability of this morphometric technique to evaluating the risk for cervical lymph node metastasis in oral squamous cell carcinoma. METHODS: A digital image system was used to measure the mean nuclear area, mean nuclear perimeter, nuclear circular rate, ratio of nuclear length to width (aspect ratio, and nuclear area coefficient of variation (NACV. Relationships between these parameters and nodal status were evaluated by t-test and logistic regression analysis. RESULTS: Eighty-eight cases of squamous cell carcinoma (52 of the tongue, 25 of the gingiva, 4 of the buccal mucosa, and 7 of the mouth floor were included: 46 with positive node classification and 42 with negative node classification. Nuclear area and perimeter were significantly larger in node-positive cases than in node-negative cases; however, there were no significant differences in circular rate, aspect ratio, or NACV. We derived two risk models based on the results of multivariate analysis: Model 1, which identified age and mean nuclear area and Model 2, which identified age and mean nuclear perimeter. It should be noted that primary tumor site was not associated the pN-positive status. There were no significant differences in pathological nodal status by aspect ratio, NACV, or primary tumor site. CONCLUSION: Our method of preoperative nuclear morphometry may contribute valuable information to evaluations of the risk for lymph node metastasis in oral squamous cell carcinoma.

  4. Observational evaluation of preoperative, intraoperative, and postoperative characteristics in 117 Brazilian women without uterine prolapse undergoing vaginal hysterectomy

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    Osako MT

    2012-09-01

    Full Text Available Claudio Sergio Batista,1 Takasi Osako,2 Eliana Mara Clemente,2 Fernanda Carvalhido Antonio Batista,3 Maurício Takeshi Janiques Osako41Department of Gynecology and Obstetrics of Faculty of Medicine of Petropolis, Petropolis, Rio de Janeiro, Brazil; 2Gynecology and Obstetrics, Casa Providencia Hospital, Petropolis, Rio de Janeiro, Brazil; 3School of Medicine of Technical Educational Foundation Souza Marques, Rio de Janeiro, Brazil; 4School of Medicine of University Gama Filho, Rio de Janeiro, BrazilBackground: Despite the introduction of minimally invasive approaches for various benign uterine problems, hysterectomy is often still performed abdominally, but the vaginal route should be used whenever possible. The aim of this study was to identify the preoperative, intraoperative, and postoperative characteristics of women undergoing vaginal hysterectomy in the absence of uterine prolapse.Methods: A prospective, descriptive, quantitative, noncomparative study was conducted in 117 women between August 2009 and February 2011 in Petropolis, Rio de Janeiro, Brazil. The women included had a uterine indication for hysterectomy, their surgeries were performed by the same team, and they were followed up for 12 months. An adapted Pelvic Organ Prolapse Quantification system was used to check for uterine prolapse.Results: The age range of the women was 33–59 years, uterine volume was 300–900 mL, and 73.50% has undergone prior cesarean section. The main indication for hysterectomy was uterine myoma (64.95%, with a surgery time of 30–60 minutes in 55 (59.82% and 19 (15.98% cases, respectively. Uterine volume reduction was performed in 41 (35.05% cases, salpingectomy was the most common associated surgery (81.19%, and anesthesia was subdural (68.37%. Common intraoperative complications included bladder lesions (8.54%, with conversion to the abdominal route being necessary in one case (1.28%, and the most common postoperative complication being vaginal

  5. Relationship between preschool children and the caregiver's preoperative anxiety. A cross study assessing modified Yale preoperative anxiety Scale (m-YPAS)

    OpenAIRE

    Emiliana Gomes de Mello; Vivian Brancalione Gonçalves; Neil Ferreira Novo; Eduardo Toshiyuki Moro

    2015-01-01

    Anxiety is a common event in children before surgery. Several ways have been proposed to assess the level of anxiety in pediatric patients. The modified Yale Preoperative Anxiety Scale (m-Ypas) was developed recently and allows the assessment of anxiety level from the observation of children's attitudes. The aim of the study was to evaluate the influence of variables such as anxiety of caregivers (parents or relatives), preoperative fasting and previous surgical experiences on children's anxi...

  6. Preoperative chemoradiotherapy followed by surgery versus surgery alone for resectable oesophageal carcinoma: A meta-analysis%术前放化疗与单纯手术治疗可切除食管癌的Meta分析

    Institute of Scientific and Technical Information of China (English)

    王亚梅; 王峰; 何炜; 樊青霞

    2012-01-01

    目的:探讨术前放化疗(chemoradiotherapy followed by surgery,CRTS)与单纯手术治疗对可切除食管癌患者生存及手术的影响.方法:检索PubMed、中国知网和万方数据资源系统中所有CRTS与单纯手术(surgery alone,SA)治疗可切除食管癌的随机对照研究(randomized controlled trial,RCT),应用RevMan 5.1软件进行Meta分析.结果:共21篇文献.CRTS组比SA组提高了1、3、5年生存率,差异均有统计学意义(P<0.05);提高了东方、西方、同步放化疗和鳞癌患者3、5年生存率,差异均有统计学意义(P<0.05).两组序贯放化疗、腺癌患者3、5年生存率相比差异均无统计学意义(P>0.05).SA组比CRTS组有较高的手术率,差异有统计学意义(P<0.05);而CRTS组比SA组有更显著的根治切除率、R0切除率和较低的术后局部复发率,差异均有统计学意义(P<0.05).两组术后并发症发生率、远处转移率及死亡率比较,差异均无统计学意义(P>0.05).结论:CRTS比SA明显改善了可切除食管癌患者的生存预后及手术情况.%AIM: To assess the efficacy of preoperative chemoradiotherapy followed by surgery (CRTS) in the management of resectable esophageal carcinoma. METHODS: Randomized controlled trials (RCTs) comparing the efficacy of preoperative chemoradiotherapy versus surgery alone (SA) in the treatment of resectable oesophageal carcinoma were searched in PubMed, China National Knowledge Infrastructure (CNKI) and Wan Fang databases. The RevMan 5.1 software was used for meta-analysis. RESULTS: This meta-analysis included 21 RCTs. Compared to the SA group, the 1-, 3-, and 5-year survival rates were significantly higher in the CRTS group (all P 0.05). Compared to the RCTS group, the surgery rate in the SA group was higher (P 0.05). CONCLUSION: CRTS can significantly improve the survival and surgical conditions of patients with resectable esophageal carcinoma.

  7. Significance of survivin (BIRC5 as a biomarker for the assessmet of preoperative cardiovascular risk in non-cardiac surgeries: Survivin (BIRC5 as a novel cardiac biomarker

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    Marković Danica

    2016-01-01

    Full Text Available Introduction: Survivin (BIRC5 is a member of the inhibitor of apoptosis family of proteins and has a very important role in the so-called 'point of no return' of cell apoptosis. The role of survivin in the development of tumors and autoimmune diseases has already been proven, however, there are increasing evidence that it is also sensitive to the existence of previous ischemic heart disease. Methods: This prospective pilot study included 78 patients who were preparing for one of the major non-cardiac surgeries. Blood was sampled within 7 preoperative days, serum was separated and frozen at -70°C. The level of survivin in serum was measured using the ELISA (Enzyme-linked immunosorbent assay method, and the results were read on DIAREADER Elx800G. Results: Patients of an average age of 71.46 ± 6.87 years had the median level of survivin 4.56 (0.00-76.78 pg/ml. Survivin has proven to be an excellent predictor of postoperative mortality (P0.05, ROC/AUC=0.782; P<0.05, ROC/ AUC=0.825;. After exclusion of extremely high values, the results in both groups were respectively: P<0.001, ROC/AUC=0.831; P<0.05, ROC/AUC=0.825. Conclusion: Survivin is a potential cardiac biomarker and itsspecificity and sensitivity has been demonstrated even in the group of patients who were not suffering from any kind of tumor.

  8. CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax

    Energy Technology Data Exchange (ETDEWEB)

    Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Matsui, Yusuke; Kanazawa, Susumu [Okayama University Medical School, Departments of Radiology, Okayama (Japan); Miyoshi, Shinichiro [Okayama University Medical School, General Thoracic Surgery, Okayama (Japan)

    2016-01-15

    To retrospectively evaluate the safety of computed tomography (CT) fluoroscopy-guided short hook wire placement for video-assisted thoracoscopic surgery and the risk factors for pneumothorax associated with this procedure. We analyzed 267 short hook wire placements for 267 pulmonary lesions (mean diameter, 9.9 mm). Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for pneumothorax. Complications (219 grade 1 and 4 grade 2 adverse events) occurred in 196 procedures. No grade 3 or above adverse events were observed. Univariate analysis revealed increased vital capacity (odds ratio [OR], 1.518; P = 0.021), lower lobe lesion (OR, 2.343; P = 0.001), solid lesion (OR, 1.845; P = 0.014), prone positioning (OR, 1.793; P = 0.021), transfissural approach (OR, 11.941; P = 0.017), and longer procedure time (OR, 1.036; P = 0.038) were significant predictors of pneumothorax. Multivariate analysis revealed only the transfissural approach (OR, 12.171; P = 0.018) and a longer procedure time (OR, 1.048; P = 0.012) as significant independent predictors. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occurred, but all complications were minor. A transfissural approach and longer procedure time were significant independent predictors of pneumothorax. (orig.)

  9. An evaluation of preoperative ibuprofen for treatment of pain associated with orthodontic separator placement.

    Science.gov (United States)

    Steen Law, S L; Southard, K A; Law, A S; Logan, H L; Jakobsen, J R

    2000-12-01

    Patients undergoing orthodontic treatment can experience significant levels of pain. This study assessed the effectiveness of preoperative ibuprofen in reducing the incidence and the severity of pain after orthodontic separator placement. Sixty-three adolescent patients (mean age, 13 years) were included in this randomized, double-blind, placebo-controlled, prospective study. Patients were randomly assigned to 1 of 3 experimental conditions: (1) 400 mg of ibuprofen taken orally 1 hour before separator placement and a lactose placebo taken orally immediately after the appointment, (2) a lactose placebo taken orally 1 hour before separator placement and 400 mg of ibuprofen taken orally immediately after the appointment, or (3) a lactose placebo taken orally 1 hour before separator placement and again immediately after the appointment. The patient's level of discomfort was assessed with a visual analog scale at 2, 6, and 24 hours, as well as at 2, 3, and 7 days after placement of the orthodontic separators. An analysis of variance and Duncan's multiple range test revealed that 2 hours after their orthodontic appointment the patients who had taken ibuprofen 1 hour before separator placement had significantly less pain with chewing than did the patients who received either ibuprofen postoperatively or a placebo. Additional measures suggest a trend for less pain for this group of patients. These results support the use of pretreatment ibuprofen for patients requiring analgesics for orthodontic discomfort. Future study of the use of preemptive analgesics in orthodontics is warranted.

  10. Effect of Toys and Preoperative Visit on Reducing Children’s Anxiety and their Parents before Surgery and Satisfaction with the Treatment Process

    Directory of Open Access Journals (Sweden)

    Fatemeh Ghabeli

    2014-02-01

    Full Text Available Introduction: Hospital anxiety and surgery has an unpleasant and disturbing feeling for a child and his/her family. This study aimed to determine the effect of toys and visit in reducing children’s anxiety before the surgery and their mothers and satisfaction with the treatment process. Methods: This was a quasi-experimental study in posttest design with a control group. 60 children aged 3 to 8 years, who were undergoing ear, nose and throat surgery in Tabriz Amiralmomenin hospital, were chosen, and regarding their age and gender, were recruited into the control or experiment group. For the experiment group, the interventions before surgery were applied. The level of anxiety in children and parents was evaluated by Observation Scale of Behavioral Distress (OSBD-R and Spielberger State Anxiety Inventory (STAI. The level of parental satisfaction with the treatment process before being discharged from the hospital was evaluated by the process of treatment satisfaction questionnaire (PSQ-18. Data were analyzed by SPSS ver.13. Results: Mean anxiety scores of the children and mothers in the experimental group were lower than the control group. Mean maternal satisfaction score of the treatment process in the experimental group was higher than the mean scores of the control group. However, in the subscales of general satisfaction, interpersonal behavior, and financial aspects of satisfaction with treatment, no statistical significant difference was found between the experimental and control groups. Conclusion: Based on the findings, providing toys for children and informing the parents about medical information has a major effect in reducing children’s and other’s anxiety and increasing maternal satisfaction with the treatment process.

  11. Utility of electrodiagnostic testing and computed tomography myelography in the preoperative evaluation of neonatal brachial plexus palsy.

    Science.gov (United States)

    Vanderhave, Kelly L; Bovid, Karen; Alpert, Hilary; Chang, Kate Wan-Chu; Quint, Douglas J; Leonard, James A; Yang, Lynda J S

    2012-03-01

    The rate of neonatal brachial plexus palsy (NBPP) remains 0.4%-4% despite improvements in perinatal care. Among affected children, the extent of brachial plexus palsy differs greatly, as does the prognosis. Controversial elements in management include indications and timing of nerve repair as well as type of reconstruction in patients in whom function will ultimately not be recovered without surgical intervention. Differentiating preganglionic (avulsion) from postganglionic (rupture) lesions is critical because preganglionic lesions cannot spontaneously recover motor function. Distinguishing between these lesions at initial presentation based on clinical examination alone can be difficult in infants. The purpose of the present study was to determine the sensitivity of preoperative electrodiagnostic studies (EDSs) and CT myelography (CTM) in determining the presence of nerve root rupture and avulsions in infants with NBPP. After receiving institutional review board approval, the authors conducted a retrospective review of patients referred to the Neonatal Brachial Plexus Program between 2007 and 2010. Inclusion criteria included children who underwent brachial plexus exploration following preoperative EDSs and CTM. The CTM scans were interpreted by a staff neuroradiologist, EDSs were conducted by a single physiatrist, and intraoperative findings were recorded by the operating neurosurgeon. The findings from the preoperative EDSs and CTM were then compared with intraoperative findings. The sensitivities and 95% confidence intervals were determined to evaluate performance accuracy of each preoperative measure. Twenty-one patients (8 male amd 13 female) met inclusion criteria for this study. The sensitivity of EDSs and CTM for detecting a postganglionic rupture was 92.8% (CI 0.841-0.969) and 58.3% (CI 0.420-0.729), respectively. The sensitivity for EDSs and CTM for preganglionic nerve root avulsion was 27.8% (CI 0.125-0.509) and 72.2% (CI 0.491-0.875), respectively. In

  12. Evaluating the Effectiveness of the General Surgery Intern Boot Camp.

    Science.gov (United States)

    Schoolfield, Clint S; Samra, Navdeep; Kim, Roger H; Shi, Runhua; Zhang, Wayne W; Tan, Tze-Woei

    2016-03-01

    The aim of our study is to evaluate the effectiveness of newly implemented general surgery intern boot camp. A 2-day didactic and skills-based intern boot camp was implemented before the start of clinical duties. Participants who did not attend all boot camp activities and had prior postgraduate training were excluded. A survey utilizing a 5-point Likert scale scoring system was used to assess the participants' confidence to perform intern-level tasks before and after the boot camp. Subgroup analyses were performed comparing changes in confidence among graduates from home institution versus others and general surgery versus other subspecialties. In the analysis, 21 participants over two years were included. Among them, 7 were graduates from home institution (4 general surgery, 3 subspecialty) and 14 were from other institutions (6 general surgery and 8 subspecialty). There were significant increases in overall confidence levels (pre = 2.79 vs post = 3.43, P surgery (2.78 vs 3.46, P = 0.001) and other specialties (2.74 vs 3.34, P surgery intern boot camp before the start of official rotation is effective in improving confidence level in performing level-appropriate tasks of the incoming new interns.

  13. Comparison of low-dose sequences of dual-source CT and echocardiography for preoperative evaluation of aortic valve disease

    Institute of Scientific and Technical Information of China (English)

    FENG Juan; WANG Xi-ming; JI Xiao-peng; LI Hai-ou; LI Qiao; GUO Wen-bin; WANG Zheng-jun

    2013-01-01

    Background Accurate evaluation of coronary artery,aortic valve annulus diameter (AVAD),and cardiac function in patients with aortic valve disease is of great significance for surgical strategy.In this study,we explored the preoperative evaluation of low-dose sequence (MinDose sequence) scan of dual-source CT (DSCT) for those patients.Methods Forty patients suspected for aortic valve disease (the experimental group) underwent MinDose sequence of DSCT to observe coronary artery,AVAD,and left ventricular ejection fraction (LVEF).Another 33 subjects suspected for coronary artery disease (the control group) underwent conventional retrospective electrocardiographically-gated sequence of DSCT.Two-dimensional transthoracic echocardiography (2D-TTE) and four-dimensional transthoracic echocardiography (4D-TTE) were applied in the experimental group to measure AVAD and LVEF and compared with MinDose-DSCT.Results There was a strong correlation between LVEFs measured by 2D-TTE and MinDose-DSCT (r=0.87,P <0.01),as well as between 4D-TTE and MinDose-DSCT (r=0.90,P <0.01).AVAD measured by MinDose-DSCT was in good agreement with corresponding measurements by 2D-TTE (r=0.90,P <0.01).The effective dose in the experimental group was 63.54% lower than that in the control group.Conclusions MinDose sequence of DSCT with a low radiation dose serving as a one-stop preoperative evaluation makes effective assessment of the coronary artery,AVAD,and LVEF for patients with aortic valve disease.

  14. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete

    2014-01-01

    : Randomized controlled trials that recruited people who smoked prior to surgery, offered a smoking cessation intervention, and measured preoperative and long-term abstinence from smoking or the incidence of postoperative complications or both outcomes. DATA COLLECTION AND ANALYSIS: The review authors......BACKGROUND: Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. OBJECTIVES: The objectives of this review...... are to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively, and on the incidence of postoperative complications. SEARCH METHODS: We searched the Cochrane Tobacco Addiction Group Specialized Register in January 2014. SELECTION CRITERIA...

  15. The value of preoperative neoadjuvant chemotherapy and surgery in treating resectable small cell lung cancer%新辅助化疗加手术在可切除小细胞肺癌中的疗效分析

    Institute of Scientific and Technical Information of China (English)

    周源; 汪栋; 韩开宝; 许罡; 路东明; 刘宏; 叶玉坤

    2012-01-01

    Objective To evaluate the value of preoperative neoadjuvant chemotherapy ( NAC) and surgery in the treatment of resectable small cell lung cancer ( SCLC). Methods Retrospective study was performed on the clinical and survival data from 82 patients with resectable SCLC who received surgical resection during Jan 2000 to Jan 2005. All patients were divided into two groups : NAC group (preoperative NAC followed by surgery ) and control group (surgery without NAC). Results NAC group had 53 patients and control group had 29 cases. The patients in NAC group were given 1 or 2 cycles of NAC with EP ( etoposide and cisplatin ) regimens , and operations were performed in 2 or 3 weeks after finishing the last chemotherapy. The tumor response to NAC was 81. 1% (43/53). 3 cases had histological complete response . The 1 -, 3 -, 5 -year survival rates were 86. 8 % , 49. 1 % , 28. 3 % in NAC group,and 79. 3% ,31. 0% , 10. 3% in control group respectively. The long-term survival rate in NAC group was remarkably higher than control group (P < 0. 05). The median overall survivals were 36 and 25 months respectively. Conclusions Combined therapy with surgery as the main treatment should be adopted in resectable SCLC . A definite pathological diagnose and NAC before operation could improve long -term survival furtherly.%目的 探讨可手术切除小细胞肺癌以外科手术为主综合治疗的意义.方法 回顾性分析2000年1月至2005年1月外科治疗82例小细胞肺癌的临床与生存资料,根据综合治疗方案中手术与化疗的先后顺序将本组患者分为新辅助化疗组(NAC组)与直接手术组.结果 NAC组53例,术前经1~2周期EP方案(足叶乙甙、顺铂)新辅助化疗,有效率81.1%(43/53),3例组织学完全缓解;直接手术组29例.NAC组1、3、5年生存率分别为86.8%、49.1%、28.3%,显著高于直接手术组的79.3%、31.0%、10.3%(P均<0.05),中位生存时间分别为36个月、25个月.结论 可手术切除小细胞肺癌应采

  16. Interventions for preoperative smoking cessation

    DEFF Research Database (Denmark)

    Thomsen, Thordis; Villebro, Nete; Møller, Ann Merete

    2010-01-01

    and keywords (surgery) or (operation) or (anaesthesia) or (anesthesia). MEDLINE, EMBASE and CINAHL were also searched, combining tobacco- and surgery-related terms. Most recent search April 2010. Selection criteria Randomized controlled trials that recruited people who smoked prior to surgery, offered......Background Smokers have a substantially increased risk of postoperative complications. Preoperative smoking intervention may be effective in decreasing this incidence, and surgery may constitute a unique opportunity for smoking cessation interventions. Objectives The objective of this review...... was to assess the effect of preoperative smoking intervention on smoking cessation at the time of surgery and 12 months postoperatively and on the incidence of postoperative complications. Search strategy The specialized register of the Cochrane Tobacco Addiction Group was searched using the free text...

  17. Mental Health Evaluations for Adolescents Prior to Bariatric Surgery: A Review of Existing Practices and a Specific Example of Assessment Procedures.

    Science.gov (United States)

    Sysko, Robyn; Zandberg, Laurie J; Devlin, Michael J; Annunziato, Rachel A; Zitsman, Jeffrey L; Walsh, B Timothy

    2013-06-01

    Best practice guidelines for adolescents considering bariatric surgery recommend a pre-operative mental health evaluation. However, only general information about these assessments appears in the literature, which makes consistency of administration challenging. This review proposes a specific empirically-derived format for pre-surgical mental health evaluations and summarizes currently available data on the psychiatric functioning of adolescents seeking bariatric surgery. Studies of mental health evaluations for adults preparing for bariatric surgery are reviewed, as is the limited literature relevant to adolescent evaluations. A specific and detailed example of an evaluation (clinical interview, self-report questionnaires, cognitive assessment) used for younger patients at a major metropolitan hospital center is presented, followed by data from an initial group of adolescents completing this evaluation. 200 adolescents (n=139 female; age: 14-18 y, BMI: 35.4-83.3 kg/m(2)) presenting for bariatric surgery. A notable subset of adolescents reported current Axis I conditions (31.5%) and current mental health treatment (29.5%), but reports of current illicit drug use (1.5%) and regular alcohol use (0.5%) were relatively rare. Procedures for using the completed evaluation and post-surgery monitoring of psychosocial issues are discussed. Adolescents considering weight loss surgery should receive comprehensive pre-surgical mental health evaluations, but additional data are needed to develop specific recommendations the use of these evaluations in post-operative care.

  18. Computed tomography perfusion evaluation after extracranial-intracranial bypass surgery

    NARCIS (Netherlands)

    Vos, P.C.; Riordan, A.J.; Smit, E.J.; Jong, H.W. de; Zwan, A. van der; Velthuis, B.K.; Viergever, M.A.; Dankbaar, J.W.

    2015-01-01

    OBJECTIVE: Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obt

  19. [Evaluation of quality of care in a general surgery department].

    Science.gov (United States)

    Visset, J; Paineau, J; Letessier, E; Hamelin, E; Hamy, A; Courant, O

    A permanent evaluation of a department's activity and the quality of health care it provides is needed to avoid inappropriate use resulting from a wide range of causes. The activity of a general surgery department treating and average of 1,500 patients per year and performing 1,200 operations was analyzed over the period 1986 to 1992. Post-operative hospital follow-up was noted for each patient and any complications were analyzed on discharge day by the surgeons, the anaesthesiologists and the nursing staff. A year-end sum up was conducted each year by homogeneous groups. Examples are presented: surgery for cancer of the oesophagus (122 cases), surgery for gastro-oesophageal reflux (120 cases), thyroid surgery (1,314 cases from 1988 to 1992). Complications, hospital stay and former pathologies were evaluated in order to determine the indications, prevent complications and evaluate more rapidly the advantages of modifications in techniques. The results were compared between surgeons. This daily evaluation allowed a better analysis than a retrospective study compared with data in the literature. Permanent personal reevaluation was one of the practical consequences of the study considered to be and enriching experience.

  20. Computed tomography perfusion evaluation after extracranial-intracranial bypass surgery

    NARCIS (Netherlands)

    Vos, Pieter C.; Riordan, Alan J.; Smit, Ewoud J.; de Jong, Hugo W. A. M.; van der Zwan, Albert; Velthuis, BK; Viergever, Max A.; Dankbaar, Jan Willem

    2015-01-01

    Objective: Perfusion imaging is increasingly used for postoperative evaluation of extracranial to intracranial (EC-IC) bypass surgery. Altered hemodynamics and delayed arrival of the contrast agent in the area fed by the bypass can influence perfusion measurement. We compared perfusion asymmetry obt

  1. Prediction of postoperative pain after mandibular third molar surgery

    DEFF Research Database (Denmark)

    Rudin, Asa; Eriksson, Lars; Liedholm, Rolf;

    2010-01-01

    To evaluate the predictive potential of preoperative psychological and psychophysiological variables in estimating severity of postoperative pain following mandibular third molar surgery (MTMS). Methods: Following ethical committee approval and informed consent, 40 consecutive patients scheduled...

  2. Prediction of postoperative pain after mandibular third molar surgery

    DEFF Research Database (Denmark)

    Rudin, Asa; Eriksson, Lars; Liedholm, Rolf

    2010-01-01

    To evaluate the predictive potential of preoperative psychological and psychophysiological variables in estimating severity of postoperative pain following mandibular third molar surgery (MTMS). Methods: Following ethical committee approval and informed consent, 40 consecutive patients scheduled ...

  3. Cataract surgery outcomes in a Tertiary Hospital, Riyadh

    Directory of Open Access Journals (Sweden)

    Bader Al-Qahtani

    2016-01-01

    Conclusion: Cataract removal is a safe and effective surgery which can improve the quality of life. It has some complications that can be minimised with good pre-operative evaluation and post-operative rehabilitation.

  4. Preoperative glutamine infusion improves glycemia in heart surgery patients Infusão pré-operatória de glutamina melhora a glicemia em pacientes submetidos à cirurgia cardíaca

    Directory of Open Access Journals (Sweden)

    Miguel Nasser Hissa

    2011-01-01

    Full Text Available PURPOSE: To evaluate the effects of pre-operative L-alanyl-glutamine (L-Ala-Gln on blood glucose control in patients with coronary obstruction, selected for myocardial revascularization. METHODS: Twenty-two patients (63±8 years were randomly assigned to receive 250ml of L-Ala-Gln 20% plus saline 750 ml (Group L- Ala-Gln, n=11 or saline 1000 ml (Group Saline, n=11 over 3 hours before operation. Pre-operative blood samples were collected 3h before (T-1 and at the beginning of the surgical procedure (T-2. Intra-operative samples were collected immediately before the start (T-3 and the end of extra-corporeal perfusion (T- 4. Post-operative samples were collected 12h (T-12 and 24h later (T-24. RESULTS: Glycemia decreased significantly in L-Ala-Gln treated patients during the intraoperative period. The same effect did not occur in saline patients. As the rate of insulin infusion, administered routinely to patients undergoing surgery with extracorporeal circulation was constant in both groups during surgery, the reduction of blood glucose in group L-Ala-Gln does not seem to be related to exogenous insulin. CONCLUSION: Pre-operative use of L-Ala-Gln improves glycemic control in patients with coronary artery occlusion, submitted to myocardial revascularization.OBJETIVO: Avaliar os efeitos do uso pré-operatório da L-alanil-glutamina (L-Ala-Gln no controle glicêmico em pacientes, selecionados para a revascularização do miocárdio. MÉTODOS: Vinte e dois pacientes cardiopatas (63±8 anos foram randomizados para receber 250 ml de L-Ala-Gln 20% em 750 ml de solução salina (Grupo L-Ala-Gln, n=11 ou soro fisiológico 1000 ml (Grupo Salina, n=11. Amostras de sangue foram coletadas no pré-operatório, três horas antes (T-1: basal e no início do procedimento cirúrgico (T-2; imediatamente antes do início (T-3 e no final da perfusão extra-corpórea (T-4; 12h (T-12 e 24h após a conclusão do procedimento. As infusões, com duração de 3 horas, foram

  5. Efficacy of Preoperative Administration of Paracetamol-Codeine on Pain following Impacted Mandibular Third Molar Surgery: A Randomized, Split-Mouth, Placebo-Controlled, Double-Blind Clinical Trial

    Science.gov (United States)

    La Monaca, Gerardo; De Angelis, Chiara

    2017-01-01

    Objectives. The aim of this study was to determine the effectiveness of preoperative administration of single-dose of paracetamol-codeine, in the relieving of acute postoperative pain after the surgical removal of an impacted mandibular third molar. Materials and Methods. The study cohort consisted of 32 Caucasian outpatients, giving a total of 64 bilateral symmetrical impacted mandibles. Patients were randomized in two experimental groups to receive a preoperative oral dose of paracetamol-codeine (analgesic group) or a placebo (placebo group) at the first and second surgeries. Study participants were asked to record pain intensity scores during the operation and the next 2 days, the time of the first request for rescue analgesic, and the total number of postoperative-supplement paracetamol-codeine tablets. Results. The pain intensity score on the first day was significantly lower in the analgesic group than in the placebo group (p paracetamol-codeine tablets used postoperatively did not differ between the analgesic and placebo groups (p = 0.104). Conclusions. Preoperative paracetamol-codeine is effective in providing immediate postoperative pain control after third molar surgery and in delaying the initial onset of pain. This trial is registered with ClinicalTrials.gov Identifier (Registration Number): NCT03049878.

  6. Prevalence and factors associated with preoperative anxiety in children aged 5-12 years

    OpenAIRE

    Louise Amália de Moura; Iohanna Maria Guimarães Dias; Lilian Varanda Pereira

    2016-01-01

    Abstract Objective: to estimate the prevalence and factors associated with preoperative anxiety in children who wait for outpatient surgery. Method: cross-sectional analysis of baseline data of a prospective cohort study that investigates the predictors of postoperative pain in children aged 5-12 years submitted to inguinal and umbilical hernia repair. It was selected 210 children, which were interviewed in the preoperative holding area of a general hospital. Anxiety was evaluated using the...

  7. Effect of interesting games on relief of preoperative anxiety in preschool children

    OpenAIRE

    Xing-Lian Gao; Ying Liu; Shi Tian; Dong-Qing Zhang; Qing-Ping Wu

    2014-01-01

    Purpose: To evaluate the effect of interesting games on reducing preoperative anxiety and improving compliance with anaesthesia in children. Methods: Ninety preschool-aged children undergoing elective surgery were randomly assigned to two groups. The children in the control group were admitted to a general preoperative room with one parent for 15–20 min, and were then taken into the anaesthesia room. During anaesthetic induction, the nurse attracted the children's attention using an intere...

  8. Same-Day Evaluation and Surgery for Otitis Media and Tympanostomy Tube Placement: A Feasibility Study.

    Science.gov (United States)

    Billings, Kathleen R; Hajduk, John; Rose, Allison; De Oliveira, Gildasio S; Suresh, Suresh S; Thompson, Dana M

    2016-10-01

    To determine the feasibility of providing streamlined same-day evaluation and surgical management of children with recurrent otitis media or chronic serous otitis media who meet criteria for tympanostomy tube (TT) placement. Retrospective matched case series. Tertiary care children's hospital. A comparison group (age, sex, insurance product) was utilized to determine if the same-day process decreased facility time and surgical time for the care episode. A parent satisfaction survey was administered. Thirty children, with a median age of 16 months (range, 12-22 months), participated in the same-day surgery process for TT. Twenty-one patients (70.0%) were male, and these patients were matched to a comparison group (similar age, sex, and insurance product) having non-same-day (routine) TT placement. The same-day patients spent significantly less time in clinic for the preoperative physician visit (average, 15 minutes) when compared with the non-same-day patients (average, 51.5 minutes; P otitis media. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  9. Indication for cataract surgery. Do we have evidence of who will benefit from surgery?

    DEFF Research Database (Denmark)

    Kessel, Line; Andresen, Jens; Erngaard, Ditte;

    2015-01-01

    The need for cataract surgery is expected to rise dramatically in the future due to the increasing proportion of elderly citizens and increasing demands for optimum visual function. The aim of this study was to provide an evidence-based recommendation for the indication of cataract surgery<