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Sample records for patients undergoing high

  1. Erectile Dysfunction Among HIV Patients Undergoing Highly Active Antiretroviral Therapy: Dyslipidemia as a Main Risk Factor

    PubMed Central

    Romero-Velez, Gustavo; Lisker-Cervantes, Andrés; Villeda-Sandoval, Christian I; Sotomayor de Zavaleta, Mariano; Olvera-Posada, Daniel; Sierra-Madero, Juan Gerardo; Arreguin-Camacho, Lucrecia O; Castillejos-Molina, Ricardo A

    2014-01-01

    Objective To assess the prevalence and risk factors of erectile dysfunction (ED) in HIV patients from the HIV clinic of a tertiary referral center in Mexico City. Design Prevalence was obtained from cross-sectional studies, and the International Index of Erectile Function (IIEF), a standardized method, was used to assess ED. Methods A cross-sectional study was performed in the HIV clinic. Participants completed the IIEF to allow ED assessment. Information on demographics, clinical and HIV-related variables was retrieved from their medical records. Results One hundred and nine patients were included, with a mean age of 39.9 ± 8.8 years. ED was present in 65.1% of the individuals. Patients had been diagnosed with HIV for a mean of 92.7 ± 70.3 months and had undergone a mean 56.4 ± 45.5 months of HAART. The only variable associated with ED in the univariate analysis was dyslipidemia, and this association was also found in the multivariate analysis (P = 0.01). Conclusions ED is highly prevalent in HIV patients. Dyslipidemia should be considered as a risk factor for ED in HIV patients. Romero-Velez G, Lisker-Cervantes A, Villeda-Sandoval CI, Sotomayor de Zavaleta M, Olvera-Posada D, Sierra-Madero JG, Arreguin-Camacho LO, and Castillejos-Molina RA. Erectile dysfunction among HIV patients undergoing highly active antiretroviral therapy: Dyslipidemia as a main risk factor. Sex Med 2014;2:24–30. PMID:25356298

  2. The Role of Potentially Retrievable Inferior Vena Cava Filters in High-Risk Patients Undergoing Joint Arthroplasty

    PubMed Central

    Stulberg, S. David; Puri, Lalit; Karp, Jennifer; Ryu, Robert K; Lewandowski, Robert J

    2015-01-01

    Introduction Some patients undergoing total joint arthroplasty are at increased risk for venous thromboembolism (VTE). The aim of the present study was to evaluate the safety and efficacy of prIVCF in preventing PE in patients undergoing joint replacement surgery who are at high-risk for VTE. Materials and Methods In this prospective, IRB-approved study, prIVCF were placed in consecutive patients who met specific high-risk criteria (history of VTE or hypercoaguable state) prior to total joint arthroplasty. Patients were followed until the IVC filter was removed. Outcomes and complications were recorded per Society of Interventional Radiology guidelines. Results One hundred and nine potentially retrievable IVC filters were placed in 105 patients, who all subsequently underwent joint arthroplasty. One hundred eight IVC filters (98.9%) were retrieved successfully in a mean time of 44.1 days (range 13-183 days). There was 1 failed IVC filter retrieval attempt (0.9%) at 46 days post implantation. Two patients (1.9%) presented with recurrent PE and were successfully treated with anticoagulation prior to IVC filter retrieval. There were no fatalities from perioperative PE. In 1 patient (0.9%), a fractured filter leg had embolized during retrieval. Conclusion Potentially retrievable IVC filters are safe and effective for prophylaxis against PE in patients at high-risk for VTE undergoing joint arthroplasty. PMID:26816965

  3. Thoracic aortic atheroma severity predicts high-risk coronary anatomy in patients undergoing transesophageal echocardiography

    PubMed Central

    Shen, Xuedong; Aronow, Wilbert S.; Nair, Chandra K.; Korlakunta, Hema; Holmberg, Mark J.; Wang, Fenwei; Maciejewski, Stephanie; Esterbrooks, Dennis J.

    2011-01-01

    Introduction We hypothesized a relationship between severity of thoracic aortic atheroma (AA) and prevalence of high-risk coronary anatomy (HRCA). Material and methods We investigated AA diagnosed by transesophageal echocardiography and HRCA diagnosed by coronary angiography in 187 patients. HRCA was defined as ≥ 50% stenosis of the left main coronary artery or significant 3-vessel coronary artery disease (≥ 70% narrowing). Results HRCA was present in 45 of 187 patients (24%). AA severity was grade I in 55 patients (29%), grade II in 71 patients (38%), grade III in 52 patients (28%), grade IV in 5 patients (3%), and grade V in 4 patients (2%). The area under receiver operating characteristic curve for AA grade predicting HRCA was 0.83 (p = 0.0001). The cut-off points of AA to predict HRCA was > II grade. The sensitivity and specificity of AA > grade II to predict HRCA were 76% and 81%, respectively. After adjustment for 10 variables with significant differences by univariate regression, AA > grade II was related to HRCA by multivariate regression (odds ratio = 7.5, p< 0.0001). During 41-month follow-up, 15 of 61 patients (25%) with AA >grade II and 10 of 126 patients (8%) with AA grade ≤ 2 died (p= 0.004). Survival by Kaplan-Meier plot in patients with AA > grade II was significantly decreased compared to patients with AA ≤ grade II (p= 0.002). Conclusions AA > grade II is associated with a 7.5 times increase in HRCA and with a significant reduction in all-cause mortality. PMID:22291734

  4. Prevention of contrast induced nephropathy: recommendations for the high risk patient undergoing cardiovascular procedures.

    PubMed

    Schweiger, Marc J; Chambers, Charles E; Davidson, Charles J; Zhang, Shaoheng; Blankenship, James; Bhalla, Narinder P; Block, Peter C; Dervan, John P; Gasperetti, Christine; Gerber, Lowell; Kleiman, Neal S; Krone, Ronald J; Phillips, William J; Siegel, Robert M; Uretsky, Barry F; Laskey, Warren K

    2007-01-01

    Contrast induced nephropathy (CIN) is the third leading cause of hospital acquired renal failure and is associated with significant morbidity and mortality. Chronic kidney disease is the primary predisposing factor for CIN. As estimated glomerular filtration rate<60 ml/1.73 m2 represents significant renal dysfunction and defines patients at high risk. Modifiable risk factors for CIN include hydration status, the type and amount of contrast, use of concomitant nephrotoxic agents and recent contrast administration. The cornerstone of CIN prevention, in both the high and low risk patients, is adequate parenteral volume repletion. In the patient at increased risk for CIN it is often appropriate to withhold potentially nephrotoxic medications, and consider the use of n-acetylcysteine. In patients at increased risk for CIN the use of low or iso-osomolar contrast agents should be utilized and strategies employed to minimize contrast volume. In these patients serum creatinine should be obtained forty-eight hours post procedure and it is often appropriate to continue withholding medications such as metformin or non steroidal anti-inflammatories until renal function returns to normal. PMID:17139671

  5. Hemodynamic monitoring and management of patients undergoing high-risk surgery: a survey among Chinese anesthesiologists.

    PubMed

    Chen, Guo; Zuo, Yunxia; Yang, Lei; Chung, Elena; Cannesson, Maxime

    2014-09-01

    Hemodynamic monitoring and optimization improve postoperative outcome during high-risk surgery. However, hemodynamic management practices among Chinese anesthesiologists are largely unknown. This study sought to evaluate the current intraoperative hemodynamic management practices for high-risk surgery patients in China. From September 2010 to November 2011, we surveyed anesthesiologists working in the operating rooms of 265 hospitals representing 28 Chinese provinces. All questionnaires were distributed to department chairs of anesthesiology or practicing anesthesiologists. Once completed, the 29-item questionnaires were collected and analyzed. Two hundred and 10 questionnaires from 265 hospitals in China were collected. We found that 91.4% of anesthesiologists monitored invasive arterial pressure, 82.9% monitored central venous pressure (CVP), 13.3% monitored cardiac output (CO), 10.5% monitored mixed venous saturation, and less than 2% monitored pulse pressure variation (PPV) or systolic pressure variation (SPV) during high-risk surgery. The majority (88%) of anesthesiologists relied on clinical experience as an indicator for volume expansion and more than 80% relied on blood pressure, CVP and urine output. Anesthesiologists in China do not own enough attention on hemodynamic parameters such as PPV, SPV and CO during fluid management in high-risk surgical patients. The lack of CO monitoring may be attributed largely to the limited access to technologies, the cost of the devices and the lack of education on how to use them. There is a need for improving access to these technologies as well as an opportunity to create guidelines and education for hemodynamic optimization in China. PMID:25332709

  6. Favorable outcomes in elderly patients undergoing high-dose therapy and autologous stem cell transplantation for non-Hodgkin lymphoma.

    PubMed

    Dahi, Parastoo B; Tamari, Roni; Devlin, Sean M; Maloy, Molly; Bhatt, Valkal; Scordo, Michael; Goldberg, Jenna; Zelenetz, Andrew D; Hamlin, Paul A; Matasar, Matthew J; Maragulia, Jocelyn; Giralt, Sergio A; Perales, Miguel-Angel; Moskowitz, Craig H; Sauter, Craig S

    2014-12-01

    High-dose therapy and autologous stem cell transplantation (HDT-ASCT) can offer potential long-term remission or cure in patients with non-Hodgkin lymphoma (NHL). Limited experience is available on the safety and efficacy of HDT-ASCT in elderly patients. This is a single-center, retrospective study examining outcomes of HDT-ASCT for 202 NHL patients, ages 60 years and older, between January 2001 and December 2012. Overall survival (OS) and progression-free survival (PFS) were analyzed according to age at HDT-ASCT, hematopoietic cell transplantation comorbidity index (HCT-CI), NHL histology, and remission status at the time of HDT-ASCT. The median age was 65 years (range, 60 to 74) and the majority had either diffuse large B cell lymphoma (n = 73, 37%) or mantle cell lymphoma (n = 69, 34%). One hundred and fifteen patients (57%) had high HCT-CI scores at the time of HDT-ASCT. With a median follow-up of 3.6 years (range, 4 to 11.9 years) for survivors, PFS and OS at 3 years were 60% (95% confidence interval [CI], 53% to 68%) and 73% (95% CI, 67% to 80%), respectively. Transplantation-related mortality (TRM) was 4% both at 100 days and at 1 year after HDT-ASCT. Age and HCT-CI score were not associated with OS or PFS, and high HCT-CI did not correlate with TRM. Seven patients (4%) developed secondary myelodysplastic syndrome or acute myeloid leukemia at a median of 35 months (range, 6 to 48) after HDT-ASCT. In this single-center cohort of elderly patients with NHL undergoing HDT-ASCT, this intervention was proven tolerable and effective, with results similar to those of historic controls in younger patients. Our data suggest that age alone should not preclude HDT-ASCT in elderly patients. PMID:25175794

  7. High-Dose Weekly AmBisome Antifungal Prophylaxis in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplantation: A Pharmacokinetic Study

    PubMed Central

    Mehta, Parinda; Vinks, Alexander; Filipovich, Alexandra; Vaughn, Gretchen; Fearing, Deborah; Sper, Christine; Davies, Stella

    2016-01-01

    Disseminated fungal infection causes significant morbidity and mortality in children undergoing hematopoietic stem cell transplantation (HSCT). The widespread use of prophylactic oral triazoles has limitations of poor absorption, interindividual variability in metabolism, and hepatic toxicity. AmBisome (amphotericin B liposomal complex) has a better safety profile than the parent drug amphotericin B and produces higher plasma and tissue concentrations. We hypothesized that once-weekly high-dose AmBisome therapy could provide adequate fungal prophylaxis for immunocompromised children undergoing HSCT. We performed a pharmacokinetic pilot study to determine whether once-weekly high-dose AmBisome administration would result in effective concentrations throughout the dosing interval. A total of 14 children (median age, 3 years, 1 month; range, 4.5 months–9 years, 9 months) undergoing HSCT received once-weekly intravenous AmBisome prophylaxis (10 mg/kg as a 2-hour infusion). Blood samples for pharmacokinetic measurements were drawn around the first and the fourth weekly doses. The concentration of non–lipid-complexed amphotericin in plasma was determined by a validated bioassay. Pharmacokinetic parameters after single doses and during steady state were calculated using standard noncompartmental methods. AmBisome was well tolerated at this dose. Complete pharmacokinetic profiles for weeks 1 and 4 were obtained in 12 patients. The half-life calculated in this pediatric population was shorter on average than reported in adults (45 hours vs 152 hours). The volume of distribution correlated best with body weight (R2 = .55), and clearance was best predicted by initial serum creatinine level (R2 = .19). Mean (± standard deviation) individual plasma trough concentrations were 0.23 (0.13) mg/L after single doses and 0.47 (0.41) mg/L after multiple doses. Mean steady-state area under the curve was higher at week 4 than after a single dose (P < .05). Single-dose and steady

  8. Prospective randomised trial of amifostine cytoprotection in myeloma patients undergoing high-dose melphalan conditioned autologous stem cell transplantation.

    PubMed

    Spencer, A; Horvath, N; Gibson, J; Prince, H M; Herrmann, R; Bashford, J; Joske, D; Grigg, A; McKendrick, J; Prosser, I; Lowenthal, R; Deveridge, S; Taylor, K

    2005-05-01

    In this prospective multicentre trial, 90 patients undergoing autologous stem cell transplantation (ASCT) were randomised to receive (n=43) or not receive (n=47) amifostine 910 mg/m(2) prior to melphalan 200 mg/m(2). Patients were monitored for regimen-related toxicity, engraftment, supportive care, response and survival. Both groups underwent ASCT at a median of 8 months from diagnosis and were matched for disease characteristics, prior therapy and pre-ASCT disease responsiveness. Amifostine infusional side-effects were frequent, occurring in 65% of patients, but of mild severity. Amifostine use was associated with a reduction in the median grade of oral mucositis (1 vs 2, P=0.01) and the frequency of severe (WHO grades 3 or 4) mucositis (12 vs 33%, P=0.02), but no reduction in the requirement for parenteral nutrition or analgesic use. Conversion to complete remission post-ASCT occurred in 30 and 14% of the amifostine and control groups, respectively (P=0.09). With a median follow-up of 35 months, there was no statistically significant difference between the median progression-free or overall survival times for the two groups. We conclude that amifostine can be safely administered prior to high-dose melphalan and significantly reduces the frequency and severity of therapy-induced oral mucositis. PMID:15778725

  9. High burden of BK virus-associated hemorrhagic cystitis in patients undergoing allogeneic hematopoietic stem cell transplantation.

    PubMed

    Gilis, L; Morisset, S; Billaud, G; Ducastelle-Leprêtre, S; Labussière-Wallet, H; Nicolini, F-E; Barraco, F; Detrait, M; Thomas, X; Tedone, N; Sobh, M; Chidiac, C; Ferry, T; Salles, G; Michallet, M; Ader, F

    2014-05-01

    BK virus (BKV) reactivation has been increasingly associated with the occurrence of late-onset hemorrhagic cystitis (HC) after allogeneic hematopoietic SCT (allo-HSCT) resulting in morbidity and sometimes mortality. We investigated the incidence, risk factors and outcome of BKV-HC in 323 consecutive adult patients undergoing allo-HSCT over a 5-year period. BK viremia values for HC staging were evaluated, as well as the medico-economic impact of the complication. Forty-three patients developed BKV-HC. In univariate analysis, young age (P=0.028), unrelated donor (P=0.0178), stem cell source (P=0.0001), HLA mismatching (P=0.0022) and BU in conditioning regimen (P=0.01) were associated with a higher risk of developing BKV-HC. In multivariate analysis, patients receiving cord blood units (CBUs) (P=0.0005) and peripheral blood stem cells (P=0.011) represented high-risk subgroups for developing BKV-HC. BK viremia was directly correlated to HC severity (P=0.011) with a 3 to 6-log peak being likely associated with grades 3 or 4 HC. No correlation was found between BKV-HC and acute graft versus host disease or mortality rate. Patients with BKV-HC required a significantly longer duration of hospitalization (P<0.0001), more RBC (P=0.0003) and platelet transfusions (P<0.0001). Over the 5-year study period, the financial cost of the complication was evaluated at \\[euro]2 376 076 ($3 088 899). Strategies to prevent the occurrence of late-onset BKV-HC after allo-HSCT are urgently needed, especially in CBU and peripheral blood stem cell recipients. BK viremia correlates with the severity of the disease. Prospective studies are required to test prophylactic approaches. PMID:24488049

  10. Hemodynamic monitoring and management in patients undergoing high risk surgery: a survey among North American and European anesthesiologists

    PubMed Central

    2011-01-01

    Introduction Several studies have demonstrated that perioperative hemodynamic optimization has the ability to improve postoperative outcome in high-risk surgical patients. All of these studies aimed at optimizing cardiac output and/or oxygen delivery in the perioperative period. We conducted a survey with the American Society of Anesthesiologists (ASA) and the European Society of Anaesthesiology (ESA) to assess current hemodynamic management practices in patients undergoing high-risk surgery in Europe and in the United States. Methods A survey including 33 specific questions was emailed to 2,500 randomly selected active members of the ASA and to active ESA members. Results Overall, 368 questionnaires were completed, 57.1% from ASA and 42.9% from ESA members. Cardiac output is monitored by only 34% of ASA and ESA respondents (P = 0.49) while central venous pressure is monitored by 73% of ASA respondents and 84% of ESA respondents (P < 0.01). Specifically, the pulmonary artery catheter is being used much more frequently in the US than in Europe in the setup of high-risk surgery (85.1% vs. 55.3% respectively, P < 0.001). Clinical experience, blood pressure, central venous pressure, and urine output are the most widely indicators of volume expansion. Finally, 86.5% of ASA respondents and 98.1% of ESA respondents believe that their current hemodynamic management could be improved. Conclusions In conclusion, these results point to a considerable gap between the accumulating evidence about the benefits of perioperative hemodynamic optimization and the available technologies that may facilitate its clinical implementation, and clinical practices in both Europe and the United States. PMID:21843353

  11. Tibial Slope is Highly Variable in Patients Undergoing Primary Total Knee Arthroplasty: Analysis of 13,546 Computed Tomography Scans.

    PubMed

    Meric, Gokhan; Gracitelli, Guilherme C; Aram, Luke; Swank, Michael; Bugbee, William D

    2015-07-01

    The purpose of this study was to retrospectively measure with computed tomography (CT) the posterior tibial slope (PTS) to establish the average anatomy and the incidence of outliers in patients undergoing total knee arthroplasty (TKA). Our cohort included 13,546 arthritic patients: 8241 (61%) female; 5305 (39%) male. The average PTS angle was 7.2°±3.7° (range, -5° to 25°). The average of PTS angle of the males was 7.17°±3.82° and females was 7.24°±3.57°. A significant number of patients 35.0% (4149) were identified outliers in PTS. 1568 (11.6%) patients' PTS angle was less than 4°, 2581 (19.1%) patients' PTS angle was more than 10°. These data can be useful to determine optimum techniques and methodology to perform more accurate TKA. PMID:25795234

  12. Effects of remote ischemic preconditioning in high-risk patients undergoing cardiac surgery (Remote IMPACT): a randomized controlled trial

    PubMed Central

    Walsh, Michael; Whitlock, Richard; Garg, Amit X.; Légaré, Jean-François; Duncan, Andra E.; Zimmerman, Robert; Miller, Scott; Fremes, Stephen; Kieser, Teresa; Karthikeyan, Ganesan; Chan, Matthew; Ho, Anthony; Nasr, Vivian; Vincent, Jessica; Ali, Imtiaz; Lavi, Ronit; Sessler, Daniel I.; Kramer, Robert; Gardner, Jeff; Syed, Summer; VanHelder, Tomas; Guyatt, Gordon; Rao-Melacini, Purnima; Thabane, Lehana; Devereaux, P.J.

    2016-01-01

    Background: Remote ischemic preconditioning is a simple therapy that may reduce cardiac and kidney injury. We undertook a randomized controlled trial to evaluate the effect of this therapy on markers of heart and kidney injury after cardiac surgery. Methods: Patients at high risk of death within 30 days after cardiac surgery were randomly assigned to undergo remote ischemic preconditioning or a sham procedure after induction of anesthesia. The preconditioning therapy was three 5-minute cycles of thigh ischemia, with 5 minutes of reperfusion between cycles. The sham procedure was identical except that ischemia was not induced. The primary outcome was peak creatine kinase–myocardial band (CK-MB) within 24 hours after surgery (expressed as multiples of the upper limit of normal, with log transformation). The secondary outcome was change in creatinine level within 4 days after surgery (expressed as log-transformed micromoles per litre). Patient-important outcomes were assessed up to 6 months after randomization. Results: We randomly assigned 128 patients to remote ischemic preconditioning and 130 to the sham therapy. There were no significant differences in postoperative CK-MB (absolute mean difference 0.15, 95% confidence interval [CI] −0.07 to 0.36) or creatinine (absolute mean difference 0.06, 95% CI −0.10 to 0.23). Other outcomes did not differ significantly for remote ischemic preconditioning relative to the sham therapy: for myocardial infarction, relative risk (RR) 1.35 (95% CI 0.85 to 2.17); for acute kidney injury, RR 1.10 (95% CI 0.68 to 1.78); for stroke, RR 1.02 (95% CI 0.34 to 3.07); and for death, RR 1.47 (95% CI 0.65 to 3.31). Interpretation: Remote ischemic precnditioning did not reduce myocardial or kidney injury during cardiac surgery. This type of therapy is unlikely to substantially improve patient-important outcomes in cardiac surgery. Trial registration: ClinicalTrials.gov, no. NCT01071265. PMID:26668200

  13. Reducing psychological distress in patients undergoing chemotherapy.

    PubMed

    Milanti, Ariesta; Metsälä, Eija; Hannula, Leena

    Psychological distress is a common problem among patients with cancer, yet it mostly goes unreported and untreated. This study examined the association of a psycho-educational intervention with the psychological distress levels of breast cancer and cervical cancer patients undergoing chemotherapy. The design of the study was quasi-experimental, pretest-posttest design with a comparison group. One hundred patients at a cancer hospital in Jakarta, Indonesia, completed Distress Thermometer screening before and after chemotherapy. Fifty patients in the intervention group were given a psycho-educational video with positive reappraisal, education and relaxation contents, while receiving chemotherapy. Patients who received the psycho-educational intervention had significantly lower distress levels compared with those in the control group. Routine distress screening, followed by distress management and outcome assessment, is needed to improve the wellbeing of cancer patients. PMID:26911178

  14. Prasugrel Results in Higher Decrease in High-Sensitivity C-Reactive Protein Level in Patients Undergoing Percutaneous Coronary Intervention Comparing to Clopidogrel

    PubMed Central

    Hajsadeghi, Shokoufeh; Chitsazan, Mandana; Chitsazan, Mitra; Salehi, Negar; Amin, Ahmad; Bidokhti, Arash Amin; Babaali, Nima; Bordbar, Armin; Hejrati, Maral; Moghadami, Samar

    2016-01-01

    OBJECTIVES A growing body of clinical and laboratory evidence indicates that inflammation plays a crucial role in atherosclerosis. In the present study, we compared the effects of clopidogrel and prasugrel on high-sensitivity C-reactive protein (hs-CRP) in patients undergoing percutaneous coronary intervention (PCI). METHODS The present randomized, double-blind clinical trial included 120 patients who underwent PCI. Eligible patients were randomly assigned 2:1 to one of the two groups: 80 patients in the first group received clopidogrel (Plavix®; loading dose and maintenance dose of 300 and 75 mg daily, respectively) and 40 patients in the second group received prasugrel (Effient®; loading dose and maintenance dose of 60 and 10 mg, respectively) for 12 weeks. The hs-CRP levels between baseline and 12th week were compared. RESULTS Of the 120 patients, 69 patients (57.5%) were male. Pretreatment hs-CRP level was statistically comparable in clopidogrel (median, 15.10 mg/dL; interquartile range [IQR], 9.62–23.75 mg/dL) and prasugrel groups (median, 18 mg/dL; IQR, 14.25–22 mg/dL; P = 0.06). Patients taking clopidogrel showed a significant reduction in hs-CRP level compared with the baseline values (P < 0.001). Prasugrel administration also resulted in a significant reduction in hs-CRP level (P < 0.001). A significant 73% overall reduction in the hs-CRP level was seen with prasugrel compared with 39% overall reduction in hs-CRP level with clopidogrel (P = 0.002). CONCLUSION Prasugrel seems to be superior to clopidogrel in the reduction of hs-CRP in patients undergoing PCI. PMID:27597810

  15. Intracoronary versus intravenous high-dose bolus plus maintenance administration of tirofiban in patients undergoing primary percutaneous coronary intervention for acute ST elevation myocardial infarction.

    PubMed

    Candemir, Basar; Kilickap, Mustafa; Ozcan, Ozgur Ulas; Kaya, Cansin Tulunay; Gerede, Menekse; Ozdemir, Aydan Ongun; Ozdol, Cagdas; Kumbasar, Deniz; Erol, Cetin

    2012-07-01

    We aimed to examine whether intracoronary high-dose bolus of tirofiban plus maintenance would result in improved clinical outcome in STEMI patients undergoing primary PCI in this pilot trial. A total of 56 patients were enrolled to receive either intracoronary high-dose bolus plus maintenance (n = 34) or intravenous high-dose bolus plus maintenance (n = 22) of tirofiban. Pre and post intervention TIMI flow grades, myocardial blush grades, peak CKMB and troponin levels, time to peak CKMB and troponin, time to 50% ST resolution and major composite adverse cardiac event rates at 30 days were recorded. Although incidence of major adverse cardiac events was not different, post intervention TIMI flow and TIMI blush grades, peak CKMB and troponin levels, and time to peak CKMB and time to peak troponin were significantly different, favoring intracoronary strategy. In conclusion, this regimen improved myocardial reperfusion and coronary flow, and reduced myocardial necrosis, but failed to improve clinical outcomes at 30 days. PMID:22252901

  16. Impact of Conditioning Regimen on Outcomes for Patients with Lymphoma Undergoing High-Dose Therapy with Autologous Hematopoietic Cell Transplantation

    PubMed Central

    Logan, Brent; Zhu, Xiaochun; Akpek, Görgün; Aljurf, Mahmoud; Artz, Andrew; Bredeson, Christopher N.; Cooke, Kenneth R.; Ho, Vincent T.; Lazarus, Hillard M.; Olsson, Richard; Saber, Wael; McCarthy, Philip; Pasquini, Marcelo C.

    2015-01-01

    There are limited data to guide the choice of high-dose therapy (HDT) regimen prior to autologous hematopoietic cell transplantation (AHCT) for patients with Hodgkin (HL) and non-Hodgkin lymphoma (NHL). We studied 4,917 patients (NHL n=3,905; HL n=1,012) who underwent AHCT from 1995-2008 using the most common HDT platforms: BEAM (n=1730), CBV (n=1853), BuCy (n=789), and TBI-containing (n=545). CBV was divided into CBVhigh and CBVlow based on BCNU dose. We analyzed the impact of regimen on development of idiopathic pulmonary syndrome (IPS), transplant-related mortality (TRM), progression free and overall survival (PFS and OS). The 1-year incidence of IPS was 3-6% and was highest in recipients of CBVhigh (HR 1.9) and TBI (HR 2.0) compared to BEAM. 1-year TRM was 4-8% and was similar between regimens. Among patients with NHL, there was a significant interaction between histology, HDT regimen, and outcome. Compared to BEAM, CBVlow (HR 0.63) was associated with lower mortality in follicular lymphoma (p<0.001), and CBVhigh (HR1.44) with higher mortality in diffuse large B-cell lymphoma (p=0.001). For patients with HL, CBVhigh (HR1.54), CBVlow (HR1.53), BuCy (HR1.77) and TBI (HR 3.39) were associated with higher mortality compared to BEAM (p<0.001). The impact of specific AHCT regimen on post transplant survival is different depending on histology; therefore, further studies are required to define the best regimen for specific diseases. PMID:25687795

  17. Combined model of the EBMT score modified model and the HCT-CI improves the stratification of high-risk patients undergoing unmanipulated haploidentical blood and marrow transplantation.

    PubMed

    Chang, Ying-Jun; Wang, Hong-Tao; Xu, Lan-Ping; Wang, Yu; Liu, Kai-Yan; Zhang, Xiao-Hui; Liu, Dai-Hong; Chen, Huan; Chen, Yu-Hong; Wang, Feng-Rong; Han, Wei-; Sun, Yu-Qian; Yan, Chen-Hua; Tang, Fei-Fei; Mo, Xiao-Dong; Huang, Xiao-Jun

    2016-09-01

    Both European Group for blood and marrow transplantation risk score (EBMT score modified model) and hematopoietic cell transplantation comorbidity index (HCT-CI) are suitable for evaluating patients undergoing unmanipulated haploidentical blood and marrow transplantation (HBMT), while the predictive capacity of the combined model following haploidentical transplantation is still unknown. In this study, we calculated and validated 322 consecutive unmanipulated HBMT patients. Patients in groups with HCT-CI scores of 0 or 1-2 exhibited similar overall survival (OS), non-relapse mortality (NRM), and relapse rates, independent of their EBMT score modified model. In the group in which patients' HCT-CI scores were ≥3, patients with high EBMT score modified model showed lower OS (p = 0.003) and higher NRM (p = 0.001) than did patients with low EBMT score. In conclusion, this combined model can be used to predict outcomes and may improve the stratification of high-risk patients following unmanipulated HBMT. PMID:26857549

  18. Premature Progesterone Elevation Does Not Affect Pregnancy Outcome in High-Responder Patients Undergoing Short-Interval Coasting in IVF Cycles.

    PubMed

    Acet, Mustafa; Aktün, Lebriz Hale; Başaranoğlu, Serdar; Yorgunlar, Betül; Acet, Tuba; Deregözü, Aysegul

    2015-01-01

    BACKGROUND We aimed to present the relationship between premature progesterone elevation (PPE) and clinical outcomes in high-responder patients who had a coasting period of <4 days in length due to their high risk of developing ovarian hyperstimulation syndrome (OHSS) and who were treated with a long-acting gonadotropin-releasing hormone agonist (GnRH-agonist) protocol in in vitro fertilization-embryo transfer (IVF-ET) cycles. MATERIAL AND METHODS This retrospective study was conducted at the University Hospital Assisted Reproductive Technology Center. The outcomes of 101 patients undergoing IVF- intracytoplasmic sperm injection (ICSI) cycles who showed a high response to COH (estradiol >4000 pg/ml and/or >20 follicles each ≥10 mm in diameter and at least 20% ≥15 mm) and who were coasted for <4 days were evaluated. Number of oocytes, 2 pronuclei (PN) embryos, implantation rate, and live birth rate were measured. RESULTS The incidence of PPE was 32.6%. Compared with those without PPE, patients with PPE had a higher number of oocytes retrieved. Total mature and fertilized oocytes and the mean number of embryos transferred were not significantly different between groups. Live birth rates (41.9% vs. 38.7%) and implantation rates (26.5% vs. 23%) were also not significantly divergent in the PPE and non-PPE groups, respectively. CONCLUSIONS P concentrations ≥1.3 ng/ml on the day of human chorionic gonadotropin (hCG) administration, designated in this study as PPE, does not appear to be related to adverse effects in terms of clinical outcomes in high-responder patients undergoing coasting <4 days due to their high risk of developing OHSS treated with a long-acting GnRH-a protocol in IVF-embryo transfer cycles. PMID:26634938

  19. Oral surgery in patients undergoing chemoradiation therapy.

    PubMed

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

    2014-05-01

    Oral health care in patients undergoing chemotherapy and/or radiation therapy can be complex. Care delivered by a multidisciplinary approach is timely and streamlines the allocation of resources to provide prompt care and to attain favorable outcomes. A hospital dentist, oral and maxillofacial surgeon, and a maxillofacial prosthodontist must be involved early to prevent avoidable oral complications. Prevention and thorough preparation are vital before the start of chemotherapy and radiation therapy. Oral complications must be addressed immediately and, even with the best management, can cause delays and interruption in treatment, with serious consequences for the outcome and prognosis. PMID:24794266

  20. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials†.

    PubMed

    Pilarczyk, Kevin; Boening, Andreas; Jakob, Heinz; Langebartels, Georg; Markewitz, Andreas; Haake, Nils; Heringlake, Matthias; Trummer, Georg

    2016-01-01

    In contrast to the results of previous studies, recent randomized controlled trials (RCTs) failed to show a benefit of prophylactic aortic counterpulsation in high-risk patients undergoing cardiac surgery. The present analysis aims to redefine the effects of this treatment modality in the light of this new evidence. MEDLINE, EMBASE, CENTRAL/CCTR, Google Scholar and reference lists of relevant articles were searched for full-text articles of RCTs in English or German. Assessments for eligibility, relevance, study validity and data extraction were performed by two reviewers independently using prespecified criteria. The primary outcome was hospital mortality. A total of nine eligible RCTs with 1171 patients were identified: 577 patients were treated preoperatively with intra-aortic balloon pump (IABP) and 594 patients served as controls. The pooled odds ratio (OR) for hospital mortality (22 hospital deaths in the intervention arm, 54 in the control group) was 0.381 (95% CI 0.230-0.629; P < 0.001). The pooled analyses of five RCTs including only patients undergoing isolated on-pump coronary artery bypass grafting (n[IABP] = 348, n[control] = 347) also showed a statistically significant improvement in mortality for preoperative IABP implantation (fixed-effects model: OR 0.267, 95% CI 0.129-0.552, P < 0.001). The pooled OR for hospital mortality from two randomized off-pump trials was 0.556 (fixed-effects model, 95% CI 0.207-1.493, P = 0.226). Preoperative aortic counterpulsation was associated with a significant reduction in low cardiac output syndrome (LCOS) in the total population (fixed-effects model: OR 0.330, 95% CI 0.214-0.508, P < 0.001) as well as in the subgroup of CAGB patients (fixed-effects model: OR 0.113, 95% CI 0.056-0.226, P < 0.001), whereas there was no benefit in the off-pump population (fixed-effects model: OR 0.555, 95% CI 0.209-1.474, P = 0.238). Preoperative IABP implantation was associated with a reduction of intensive care unit (ICU) stay in

  1. Sleep Disorders in ESRD Patients Undergoing Hemodialysis.

    PubMed

    Abassi, Mohammad Reza; Safavi, Amin; Haghverdi, Masoumeh; Saedi, Babak

    2016-03-01

    Kidney failure affects different aspects of normal life. Among different manifestations, sleep problem can be considered as a common complaint of ESRD (End Stage Renal Disease) patients. In this study, we aimed to investigate the interrelationship between sleep disorders in ESRD patients and their characteristics. Through a cross-sectional study (2010-2011), 88 ESRD patients undergoing maintenance hemodialysis thrice weekly were recruited to enter the study. We used a self-administered questionnaire into which the data were reflected. The patients selected their specific sleep disorders using a nine-item scale while the Epworth Sleepiness Scale (ESS) determined both the presence and severity of sleep disorders. The data was finally analyzed with their baseline characteristics, dialysis characteristics, medication/stimulants use, and clinical and biochemical parameters. Over 95% of the patients had, at least, one specific sleep disorder while the ESS revealed 36.36% of patients as normal, 59.09% as having mild sleep disorders, and 4.54% as having moderate to severe sleep disorders. Sleep disorders were significantly correlated with older ages (P=0.035), dialysis dose (P=0.001), blood creatinine levels (P=0.037), upper airways obstruction (P=0.035), hepatomegaly (P=0.006), hepatic failure (P=0.001), higher blood TSH levels (P=0.039), history of hypothyroidism (P=0.005), and the use of levodopa (P=0.004), anti-hypertensive medications (P=0.006), benzodiazepines (P=0.006), Eprex (Erythropoietin) (P=0.001), Venofer (Iron Sucrose Injection) (P=0.013), and phosphate-binders agents (P=0.018). Sleep disorders are common findings among ESRD patients and seem to be a more complicated issue than a simple accumulation of the wastes products in the body. Whatever the causes of sleep disorders are, disorder-specific treatments should be considered. PMID:27107522

  2. Clinical characteristics associated with high on-treatment platelet reactivity of patients undergoing PCI after a 300 mg loading dose of clopidogrel, measured by thrombelastography

    PubMed Central

    Hou, Xu-Min; Han, Wen-Zheng; Qiu, Xing-Biao; Fang, Wei-Yi

    2013-01-01

    Background Dual antiplatelet therapy with clopidogrel and aspirin is the standard of care for patients undergoing percutaneous coronary intervention (PCI). Objective To determine the clinical characteristics associated with high on-treatment platelet reactivity (HPR) of patients undergoing PCI after a 300 mg loading dose of clopidogrel, measured by thrombelastography (TEG). Methods and results 394 consecutive patients were enrolled in this prospective observational study. All had been receiving aspirin 100 mg/day for more than 7 days, but were clopidogrel naïve. A 300 mg loading dose of clopidogrel was given more than 12 h before the procedure. The cut-off point for HPR was defined as ≥70% adenosine-5-diphosphate-induced aggregation. The prevalence of HPR was 21% as measured by TEG. More women than men (41.7% vs 27.1%, p=0.01) were found in the HPR group. Raised glycosylated haemoglobin (HbA1c) was more prevalent in the HPR group than in the group with normal on-treatment platelet reactivity (NPR) (45.2% vs 30.0%, p=0.009). Patients with HPR had a higher level of total plasma cholesterol (4.8±1.5 mmol/l vs 4.3±1.1 mmol/l, p=0.002) and low-density lipoprotein cholesterol (2.8±1.1 mmol/l vs 2.5±0.9 mmol/l, p=0.022) than those with NPR. Multivariable logistic regression analysis showed that female gender (OR=3.175, 95% CI 1.428 to 7.059, p=0.005) and raised HbA1c (OR=1.911, 95% CI 1.066 to 3.428, p=0.03) independently predicted the occurrence of HPR. Conclusions Despite pretreatment with aspirin and a 300 mg loading dose of clopidogrel, 21% patients undergoing PCI exhibited HPR measured by TEG. A raised level of HbA1c and female gender independently predicted the findings. PMID:27326080

  3. Hearing Preservation Among Patients Undergoing Cochlear Implantation

    PubMed Central

    Van Abel, Kathryn M.; Dunn, Camille C.; Sladen, Douglas P.; Oleson, Jacob J.; Beatty, Charles W.; Neff, Brian A.; Hansen, Marlan; Gantz, Bruce J.; Driscoll, Colin L. W.

    2015-01-01

    Introduction Despite successful preservation of low-frequency hearing in patients undergoing cochlear implantation (CI) with shorter electrode lengths, there is still controversy regarding which electrodes maximize hearing preservation (HP). The thin straight electrode array (TSEA) has been suggested as a full cochlear coverage option for HP. However, very little is known regarding its HP potential. Methods A retrospective review was performed at two tertiary academic medical centers, reviewing the electronic records for 52 patients (mean, 58.2 yr; range, 11–85 yr) implanted with the Cochlear Nucleus CI422 Slim Straight (Centennial, CO, USA) electrode array, referred to herein as the thin straight electrode array or TSEA. All patients had a preoperative low-frequency pure-tone average (LFPTA) of 85 dB HL or less. Hearing thresholds were measured at initial activation (t1) and 6 months after activation (t2). HP was assessed by evaluating functional HP using a cutoff level of 85 dB HL PTA. Results At t1, 54% of the subjects had functional hearing; 33% of these subjects had an LFPTA between 71 and 85 dB HL, and 17% had an LFPTA between 56 and 70 dB HL. At t2, 47% of the patients had functional hearing, with 31% having an LFPTA between 71 and 85 dB HL. Discussion Preliminary research suggests that the TSEA has the potential to preserve functional hearing in 54% of patients at t1. However, 22% (n = 6) of the patients who had functional hearing at t1 (n = 28) lost their hearing between t1 and t2. Further studies are needed to evaluate factors that influence HP with the TSEA electrode and determine the speech perception benefits using electric and acoustic hearing over electric alone. PMID:25575373

  4. Mortality among patients with pleural effusion undergoing thoracentesis.

    PubMed

    DeBiasi, Erin M; Pisani, Margaret A; Murphy, Terrence E; Araujo, Katy; Kookoolis, Anna; Argento, A Christine; Puchalski, Jonathan

    2015-08-01

    Of the 1.5 million people diagnosed with pleural effusion in the USA annually, ~178 000 undergo thoracentesis. While it is known that malignant pleural effusion portends a poor prognosis, mortality of patients with nonmalignant effusions has not been well studied.This prospective cohort study evaluated 308 patients undergoing thoracentesis. Chart review was performed to obtain baseline characteristics. The aetiology of the effusions was determined using standardised criteria. Mortality was determined at 30 days and 1 year.247 unilateral and 61 bilateral thoracenteses were performed. Malignant effusion had the highest 30-day (37%) and 1-year (77%) mortality. There was substantial patient 30-day and 1-year mortality with effusions due to multiple benign aetiologies (29% and 55%), congestive heart failure (22% and 53%), and renal failure (14% and 57%, respectively). Patients with bilateral, relative to unilateral, pleural effusion were associated with higher risk of death at 30 days and 1 year (17% versus 47% (hazard ratio (HR) 2.58, 95% CI 1.44-4.63) and 36% versus 69% (HR 2.32, 95% CI 1.55-3.48), respectively).Patients undergoing thoracentesis for pleural effusion have high short- and long-term mortality. Patients with malignant effusion had the highest mortality followed by multiple benign aetiologies, congestive heart failure and renal failure. Bilateral pleural effusion is distinctly associated with high mortality. PMID:25837039

  5. Screening for spinal stenosis in achondroplastic patients undergoing limb lengthening.

    PubMed

    Fernandes, James A; Devalia, Kailash L; Moras, Prem; Pagdin, Jonathan; Jones, Stanley; Mcmullan, John

    2014-03-01

    The need for a screening programme for spinal stenosis in children with achondroplasia undergoing limb lengthening was identified in a tertiary limb reconstruction service. The aim of this study was to evaluate whether screening would identify the 'at risk' group. A total of 26 achondroplastic patients underwent our screening programme. Canal diameters were measured by MRI. Neurosurgical interventions were recorded. Of the patients, 13 had severe foramen magnum narrowing. Six patients required single or multiple surgical decompressions. We identified female sex, delayed milestones and a tight cervicomedullary junction as high risks. We stress upon the importance of developing a nationalized screening programme with guidelines to identify a high-risk group. PMID:24345918

  6. Prognostic Impact of Baseline High-Sensitivity C-Reactive Protein in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention Based on Body Mass Index

    PubMed Central

    Ahmed, Khurshid; Chakraborty, Rabin; Cho, Kyung Hoon; Sim, Doo Sun; Hong, Young Joon; Ahn, Youngkeun; Hachinohe, Daisuke; Cho, Myeong Chan; Kim, Chong Jin; Kim, Young Jo

    2012-01-01

    Background and Objectives Serum high sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and may lead to the development of atherosclerosis, adversely affecting mortality. The aim of this study was to evaluate the relationship between baseline hs-CRP level and 12-month clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) according to their body mass index (BMI) status. Subjects and Methods Using data from the Korea Acute Myocardial Infarction Registry from November 2005 to September 2008, a total of 8174 consecutive AMI patients were studied. Cox proportional hazard model revealed that higher baseline levels of hs-CRP was associated with 12-month all-cause mortality (p=0.045). To further understand this association, patients were divided into 3 groups based on their body mass index: 1) overweight/obese, 2) normal weight, and 3) underweight patients. Then each group was stratified into quartiles based on their hs-CRP. Results In overweight/obese patients, Cox model showed significant association of hs-CRP with 12-month mortality when adjusted for age and gender (p<0.001), however, after adjustment with multiple covariates, mortality was highest in the 4th quartile {HR 2.382, (1.079-5.259), p=0.032} though statistically insignificant (p=0.172). We observed no significant association of serum hs-CRP with 12-month mortality in normal weight (p=0.681) and underweight (p=0.760) patients. Conclusion Higher baseline hs-CRP level (≥4.08 mg/dL) in overweight/obese AMI patients showed significant association with 12-month all-cause mortality independent of other prognostic markers. PMID:22493611

  7. Comparative Efficacy and Safety of Prasugrel, Ticagrelor, and Standard-Dose and High-Dose Clopidogrel in Patients Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis.

    PubMed

    Singh, Sukhchain; Singh, Mukesh; Grewal, Navsheen; Khosla, Sandeep

    2016-01-01

    Authors aimed to compare efficacy and safety of prasugrel, ticagrelor, and standard-dose (SD) and high-dose (HD) clopidogrel in patients undergoing percutaneous coronary intervention (PCI). PubMed, EMBASE, CENTRAL, and clinicaltrials.gov were searched for studies comparing prasugrel, ticagrelor, SD and HD clopidogrel in patients undergoing PCI. Frequentist and Bayesian network meta-analyses were performed besides direct pairwise comparisons. Thirty trials, comprising 34,563 person-year data, were included. Prasugrel emerged as a best drug to prevent definite or probable stent thrombosis, followed by HD clopidogrel and ticagrelor, with SD clopidogrel being the worst. Myocardial infarction was least likely to be prevented by SD clopidogrel after PCI, and remaining 3 were superior to it with little difference among them. SD clopidogrel was least effective in preventing cardiovascular deaths after PCI. Prasugrel was most effective in preventing cardiovascular deaths, although having only small advantage over ticagrelor and HD clopidogrel. Ticagrelor reduced all-cause mortality by a small margin compared with rest of treatments. SD clopidogrel, followed by ticagrelor, resulted in significantly lower thrombolysis in myocardial infarction major bleeding complications compared with prasugrel. Analysis of any bleeding revealed similar trend. HD clopidogrel performed better than prasugrel in terms of bleeding complications. In conclusion, Prasugrel is likely most effective drug to prevent post-PCI ischemic events but at the expense of higher bleeding. Ticagrelor followed by HD clopidogrel seems to strike the right balance between efficacy and safety. HD clopidogrel can be considered as an alternative to newer P2Y12 inhibitors. PMID:26448337

  8. Palonosetron has superior prophylactic antiemetic efficacy compared with ondansetron or ramosetron in high-risk patients undergoing laparoscopic surgery: a prospective, randomized, double-blinded study

    PubMed Central

    Kim, Sung-Hoon; Hong, Jeong-Yeon; Kim, Won Oak; Karm, Myong-Hwan; Hwang, Jai-Hyun

    2013-01-01

    Background Postoperative nausea and vomiting (PONV) continues to be a major problem, because PONV is associated with delayed recovery and prolonged hospital stay. Although the PONV guidelines recommended the use of 5-hydroxy-tryptamine (5-HT3) receptor antagonists as the first-line prophylactic agents in patients categorized as high-risk, there are few studies comparing the efficacies of ondansetron, ramosetron, and palonosetron. The aim of present study was to compare the prophylactic antiemetic efficacies of three 5HT3 receptor antagonists in high-risk patients after laparoscopic surgery. Methods In this prospective, randomized, double-blinded trial, 109 female nonsmokers scheduled for elective laparoscopic surgery were randomized to receive intravenous 4 mg ondansetron (n = 35), 0.3 mg ramosetron (n = 38), or 75 µg palonosetron (n = 36) before anesthesia. Fentanyl-based intravenous patient-controlled analgesia was administered for 48 h after surgery. Primary antiemetic efficacy variables were the incidence and severity of nausea, the frequency of emetic episodes during the first 48 h after surgery, and the need to use a rescue antiemetic medication. Results The overall incidence of nausea/retching/vomiting was lower in the palonosetron (22.2%/11.1%/5.6%) than in the ondansetron (77.1%/48.6%/28.6%) and ramosetron (60.5%/28.9%/18.4%) groups. The rescue antiemetic therapy was required less frequently in the palonosetron group than the other groups (P < 0.001). Kaplan-Meier analysis showed that the order of prophylactic efficacy in delaying the interval to use of a rescue emetic was palonosetron, ramosetron, and ondansetron. Conclusions Single-dose palonosetron is the prophylactic antiemetics of choice in high-risk patients undergoing laparoscopic surgery. PMID:23814652

  9. Platelet reactivity in patients undergoing transcatheter aortic valve implantation.

    PubMed

    Orvin, Katia; Eisen, Alon; Perl, Leor; Zemer-Wassercug, Noa; Codner, Pablo; Assali, Abid; Vaknin-Assa, Hana; Lev, Eli I; Kornowski, Ran

    2016-07-01

    Thromboembolic events, primarily stroke, might complicate transcatheter aortic-valve implantation (TAVI) procedures in 3-5 % of cases. Thus, it is common to administer aspirin and clopidogrel pharmacotherapy for 3-6 months following TAVI in order to prevent those events. The biologic response to the dual anti platelet treatment (DAPT) is heterogeneous, e.g. low response, known as high on treatment platelet reactivity (HTPR) may be associated with adverse thromboembolic events. Little is known about the prevalence of HTPR among patients undergoing TAVI. To assess the variability in response and rates of residual platelet reactivity in patients undergoing TAVI. We examined platelet reactivity in response to clopidogrel and aspirin in 40 consecutive patients (mean age 81.7 ± 6.5 years, 66.7 % women) who underwent successful TAVI using the VerifyNow P2Y12 assay and the multiple electrode aggregometry assay (Multiplate analyzer) in response to adenosine diphosphate and arachidonic acid respectively, at different time points before and following TAVI. Before TAVI, the majority of patients were on antiplatelet therapy (68.5 % aspirin, 12.5 % clopidogrel, 12.5 % DAPT). Following the procedure all patients were on DAPT or clopidogrel and warfarin. Among analyzed patients, 41 % had HTPR for clopidogrel and 12.5 % for aspirin at baseline, which did not significantly change 1-month following the procedure (p = 0.81 and p  = 0.33, respectively). In conclusion, patients undergoing TAVI for severe aortic stenosis and treated with DAPT have high rates of residual platelet reactivity during the peri-procedural period and up to 1-month thereafter. These findings may have clinical implications for the anti-platelet management of TAVI patients. PMID:26695072

  10. Fospropofol Disodium for Sedation in Elderly Patients Undergoing Flexible Bronchoscopy

    PubMed Central

    Silvestri, Gerard A.; Vincent, Brad D.; Wahidi, Momen M.

    2011-01-01

    Background Fospropofol disodium is a water-soluble prodrug of propofol. A subset analysis was undertaken of elderly patients (≥65 y) undergoing flexible bronchoscopy, who were part of a larger multicenter, randomized, double-blind study. Methods Patients received fentanyl citrate (50 mcg) followed by fospropofol at initial (4.88mg/kg) and supplemental (1.63mg/kg) doses. The primary end point was sedation success (3 consecutive Modified Observer's Assessment of Alertness/Sedation scores of ≤4 and procedure completion without alternative sedative or assisted ventilation). Treatment success, time to fully alert, patient and physician satisfaction, and safety/tolerability were also evaluated. Results In the elderly patients subset (n=61), sedation success was 92%, the mean time to fully alert was 8.0±10.9 min, and memory retention was 72% during recovery, and these were comparable with the younger patients subgroup (age, <65 y). Sedation-related adverse events occurred in 23% of the elderly and 18% of the younger patients (age, <65 y) group. Hypoxemia occurred in 26% of the elderly and 18% of the younger patients group, but no escalation of care was required. Conclusions Fospropofol provided safe and effective sedation, rapid time to fully alert, and high satisfaction in this elderly subset undergoing flexible bronchoscopy, which was comparable with outcomes in younger patients. PMID:21701693

  11. Knowledge of electromyography (EMG) in patients undergoing EMG examinations.

    PubMed

    Mondelli, Mauro; Aretini, Alessandro; Greco, Giuseppe

    2014-01-01

    The aim of this study was to evaluate knowledge of electromyography (EMG) in patients undergoing the procedure. In one year, 1,586 consecutive patients (mean age 56 years; 58.8% women) were admitted to two EMG labs to undergo EMG for the first time. The patients found to be "informed" about the how an EMG examination is performed and about the purpose of EMG numbered 448 (28.2%), while those found to be "informed" only about the manner of its execution or only about its purpose numbered 161 (10.2%) and 151 (9.5%), respectively. The remaining 826 (52.1%) patients had either no information, or the information they had was very poor or incorrect (this was particularly true if they had been consulting websites). Being "informed" was associated with level of education (high), type of referring physician (specialist) and with an appropriate referral diagnosis specified in the EMG request. The quality of patient information on EMG was found to be very poor and could be improved. Physicians referring patients for EMG examinations, especially general practitioners, should assume primary responsibility for patient education and counseling in this field. PMID:25473740

  12. Prospective Randomized Controlled Study on the Efficacy of Multimedia Informed Consent for Patients Scheduled to Undergo Green-Light High-Performance System Photoselective Vaporization of the Prostate

    PubMed Central

    Ham, Dong Yeub; Choi, Woo Suk; Song, Sang Hoon; Ahn, Young-Joon; Park, Hyoung Keun; Kim, Hyeong Gon

    2016-01-01

    Purpose The aim of this study was to evaluate the efficacy of a multimedia informed consent (IC) presentation on the understanding and satisfaction of patients who were scheduled to receive 120-W green-light high-performance system photoselective vaporization of the prostate (HPS-PVP). Materials and Methods A multimedia IC (M-IC) presentation for HPS-PVP was developed. Forty men with benign prostatic hyperplasia who were scheduled to undergo HPS-PVP were prospectively randomized to a conventional written IC group (W-IC group, n=20) or the M-IC group (n=20). The allocated IC was obtained by one certified urologist, followed by a 15-question test (maximum score, 15) to evaluate objective understanding, and questionnaires on subjective understanding (range, 0~10) and satisfaction (range, 0~10) using a visual analogue scale. Results Demographic characteristics, including age and the highest level of education, did not significantly differ between the two groups. No significant differences were found in scores reflecting the objective understanding of HPS-PVP (9.9±2.3 vs. 10.6±2.8, p=0.332) or in subjective understanding scores (7.5±2.1 vs. 8.6±1.7, p=0.122); however, the M-IC group showed higher satisfaction scores than the W-IC group (7.4±1.7 vs. 8.4±1.5, p=0.033). After adjusting for age and educational level, the M-IC group still had significantly higher satisfaction scores. Conclusions M-IC did not enhance the objective knowledge of patients regarding this surgical procedure. However, it improved the satisfaction of patients with the IC process itself. PMID:27169129

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

    PubMed Central

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

    2016-01-01

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

  14. Cardiac medical therapy among patients undergoing abdominal aortic aneurysm repair.

    PubMed

    Kurzencwyg, David; Filion, Kristian B; Pilote, Louise; Nault, Patrice; Platt, Robert W; Rahme, Elham; Steinmetz, Oren; Eisenberg, Mark J

    2006-09-01

    Open abdominal aortic aneurysm (AAA) repair is a common surgical procedure associated with high mortality rates. Our objective was to describe the use of in-hospital cardiac medical therapy among patients undergoing open AAA repair and to examine the effect of perioperative cardiac medical therapy on in-hospital mortality. We examined clinical data and in-hospital medication use among 223 patients who underwent open AAA repair at three North American hospitals, all of which used the Transition resource and cost accounting system. Medication use was described [angiotensin converting enzyme (ACE) inhibitors, aspirin, ss-blockers, and statins] within the cohort at five specific periods of time: presurgery, day of surgery, 1 day after surgery, postsurgery, and discharge. We then performed a matched case-control study where cases were defined as patients who died in-hospital. We compared medication use between cases and controls to assess its impact on in-hospital mortality. Most patients were elderly (mean age 72.5 +/- 9.8 years), 70.4% were male, and in-hospital mortality within the cohort was 10.8%. Medication use in all periods of administration was low. ss-Blocker use was highest among all classes on the day of surgery, with 20.6% of patients undergoing AAA repair receiving the medication. Less than 50% of patients received any of the medications at discharge. After adjusting for baseline differences, perioperative ACE inhibitor use showed a trend toward a protective effect [odds ratio (OR) = 0.09, 95% confidence interval (CI) 0.01-1.31, p = 0.08], and perioperative ss-blocker use was significantly associated with a decrease in mortality (OR = 0.07, 95% CI 0.01-0.87, p = 0.04). Cardiac medical therapy among patients undergoing AAA repair is low throughout all periods of hospitalization. ACE inhibitor and ss-blocker use may be associated with decreased in-hospital mortality. PMID:16794911

  15. [Significance of zinc and sarcopenia in patients undergoing surgery].

    PubMed

    Kaido, Toshimi; Tamai, Yumiko; Uemoto, Shinji

    2016-07-01

    Sarcopenia is characterized by muscle mass depletion and decrease in muscle power or physical activity. We evaluated significance of sarcopenia in patients undergoing living donor liver transplantation (LDLT). Patients with low skeletal muscle mass (SMM) had significantly worse survival compared with patients with normal/high SMM (p < 0.001). Correlations of preoperative zinc with prealbumin and branched-chain amino acids were significantly positive. While, correlations of zinc with tyrosine and ammonia levels were significantly negative. The low pre-transplant zinc level steeply dropped for 2/3 days after LDLT and subsequently increased back to reach the pre-transplant level around the postoperative day 5, and continued to increase until normalized during 2 weeks. Perioperative nutritional therapy including zinc supplement significantly increased survival in patients with low SMM (p = 0.009). PMID:27455815

  16. Cognitive function in patients undergoing coronary angiography

    PubMed Central

    Devapalasundarum, A N; Silbert, B S; Evered, L A; Scott, D A; MacIsaac, A I; Maruff, P T

    2010-01-01

    Objective To measure cognition in patients before and after coronary angiography. Design Prospective observational cohort study. Setting University teaching hospital. Patients 56 patients presenting for elective coronary angiography. Main outcome measures Computerised cognitive test battery administered before coronary angiography, before discharge from hospital and 7 days after discharge. A matched healthy control group was used as a comparator. Results When analysed by group, coronary angiography patients performed worse than matched controls at each time point. When the cognitive change was examined for each individual, of the 48 patients tested at discharge, 19 (39.6%) were classified as having a new cognitive dysfunction, and of 49 patients tested at day 7, six (12.2%) were classified as having a new cognitive dysfunction. Conclusions The results confirm that cognitive function is decreased in patients who have cardiovascular disease. Furthermore, coronary angiography may exacerbate this impaired cognition in some patients.

  17. Novel oral anticoagulants in patients undergoing cardioversion for atrial fibrillation.

    PubMed

    Briasoulis, Alexandros; Kottam, Anupama; Khan, Mazhar; Afonso, Luis

    2015-08-01

    Recent trials on novel oral anticoagulants (NOAC) in patients undergoing cardioversion showed that NOACs are as safe and effective as treatment with vitamin K antagonists in patients with atrial fibrillation undergoing electric or pharmacological cardioversion. We conducted an EMBASE and MEDLINE search for studies in which patients undergoing cardioversion were assigned to treatment with NOACs versus VKAs. We identified one prospective randomized study and three post hoc analysis of randomized trials which enrolled 2,788 controls that received NOACs and 1,729 patients that received VKAs. NOACs and VKAs had comparable effects on the rates of stroke/thromboembolism, major bleeding events and all-cause mortality. NOACs are safe and effective alternatives to VKA in patients with AF undergoing cardioversion. PMID:25542262

  18. A Value-Based Analysis of Hemodynamic Support Strategies for High-Risk Heart Failure Patients Undergoing a Percutaneous Coronary Intervention

    PubMed Central

    Gregory, David; Scotti, Dennis J.; de Lissovoy, Gregory; Palacios, Igor; Dixon, Simon; Maini, Brijeshwar; O'Neill, William

    2013-01-01

    for a pVAD than for an IABP on readmissions (3.88 days vs 7.00 days; P = .145). Reduction in major adverse cardiovascular and cerebrovascular events resulted in a projected gain of 0.26 QALYs over 10 years, yielding an incremental cost-effectiveness ratio of $39,389/QALY. Conclusions For high-risk patients with advanced heart failure undergoing PCI, the new pVAD reduced major adverse events, critical care and readmission length of stay, and readmission cost over the 90-day EOC, and was determined to be cost-effective over the long-term. These findings can assist decision makers in forming value-based judgments with regard to new hemodynamic support strategies. PMID:24991349

  19. Fat tissue and inflammation in patients undergoing peritoneal dialysis

    PubMed Central

    Rincón Bello, Abraham; Bucalo, Laura; Abad Estébanez, Soraya; Vega Martínez, Almudena; Barraca Núñez, Daniel; Yuste Lozano, Claudia; Pérez de José, Ana; López-Gómez, Juan M.

    2016-01-01

    Background Body weight has been increasing in the general population and is an established risk factor for hypertension, diabetes, and all-cause and cardiovascular mortality. Patients undergoing peritoneal dialysis (PD) gain weight, mainly during the first months of treatment. The aim of this study was to assess the relationship between body composition and metabolic and inflammatory status in patients undergoing PD. Methods This was a prospective, non-interventional study of prevalent patients receiving PD. Body composition was studied every 3 months using bioelectrical impedance (BCM®). We performed linear regression for each patient, including all BCM® measurements, to calculate annual changes in body composition. Thirty-one patients in our PD unit met the inclusion criteria. Results Median follow-up was 26 (range 17–27) months. Mean increase in weight was 1.8 ± 2.8 kg/year. However, BCM® analysis revealed a mean increase in fat mass of 3.0 ± 3.2 kg/year with a loss of lean mass of 2.3 ± 4.1 kg/year during follow-up. The increase in fat mass was associated with the conicity index, suggesting that increases in fat mass are based mainly on abdominal adipose tissue. Changes in fat mass were directly associated with inflammation parameters such as C-reactive protein (r = 0.382, P = 0.045) and inversely associated with high-density lipoprotein cholesterol (r=−0.50, P = 0.008). Conclusions Follow-up of weight and body mass index can underestimate the fat mass increase and miss lean mass loss. The increase in fat mass is associated with proinflammatory state and alteration in lipid profile. PMID:27274820

  20. Clopidogrel Responsiveness in Patients Undergoing Peripheral Angioplasty

    SciTech Connect

    Pastromas, Georgios Spiliopoulos, Stavros Katsanos, Konstantinos Diamantopoulos, Athanasios Kitrou, Panagiotis Karnabatidis, Dimitrios Siablis, Dimitrios

    2013-12-15

    Purpose: To investigate the incidence and clinical significance of platelet responsiveness in patients receiving clopidogrel after peripheral angioplasty procedures. Materials and Methods: This prospective study included patients receiving antiplatelet therapy with clopidogrel 75 mg after infrainguinal angioplasty or stenting and who presented to our department during routine follow-up. Clopidogrel responsiveness was tested using the VerifyNow P2Y12 Assay. Patients with residual platelet reactivity units (PRU) {>=} 235 were considered as nonresponders (NR group NR), whereas patients with PRU < 235 were considered as normal (responders [group R]). Primary end points were incidence of resistance to clopidogrel and target limb reintervention (TLR)-free survival, whereas secondary end points included limb salvage rates and the identification of any independent predictors influencing clinical outcomes. Results: In total, 113 consecutive patients (mean age 69 {+-} 8 years) with 139 limbs were enrolled. After clopidogrel responsiveness analysis, 61 patients (53.9 %) with 73 limbs (52.5 %) were assigned to group R and 52 patients (46.1 %) with 66 limbs (47.5 %) to group NR. Mean follow-up interval was 27.7 {+-} 22.9 months (range 3-95). Diabetes mellitus, critical limb ischemia, and renal disease were associated with clopidogrel resistance (Fisher's exact test; p < 0.05). According to Kaplan-Meier analysis, TLR-free survival was significantly superior in group R compared with group NR (20.7 vs. 1.9 %, respectively, at 7-year follow-up; p = 0.001), whereas resistance to clopidogrel was identified as the only independent predictor of decreased TLR-free survival (hazard rate 0.536, 95 % confidence interval 0.31-0.90; p = 0.01). Cumulative TLR rate was significantly increased in group NR compared with group R (71.2 % [52 of 73] vs. 31.8 % [21 of 66], respectively; p < 0.001). Limb salvage was similar in both groups. Conclusion: Clopidogrel resistance was related with

  1. Nutrition support to patients undergoing gastrointestinal surgery.

    PubMed

    Ward, Nicola

    2003-12-01

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

  2. Anticoagulation in patients with atrial fibrillation undergoing coronary stent implantation.

    PubMed

    Bernard, A; Fauchier, L; Pellegrin, C; Clementy, N; Saint Etienne, C; Banerjee, A; Naudin, D; Angoulvant, D

    2013-09-01

    In patients with atrial fibrillation (AF) undergoing coronary stent implantation, the optimal antithrombotic strategy is unclear. We evaluated whether use of oral anticoagulation (OAC) was associated with any benefit in morbidity or mortality in patients with AF, high risk of thromboembolism (TE) (CHA2DS2-VASC score ≥ 2) and coronary stent implantation. Among 8,962 unselected patients with AF seen between 2000 and 2010, a total of 2,709 (30%) had coronary artery disease and 417/2,709 (15%) underwent stent implantation while having CHA2DS2-VASC score ≥ 2. During follow-up (median=650 days), all TE, bleeding episodes, and major adverse cardiac events (i.e. death, acute myocardial infarction, target lesion revascularisation) were recorded. At discharge, 97/417 patients (23%) received OAC, which was more likely to be prescribed in patients with permanent AF and in those treated for elective stent implantation. The incidence of outcome event rates was not significantly different in patients treated and those not treated with OAC. However, in multivariate analysis, the lack of OAC at discharge was independently associated with increased risk of death/stroke/systemic TE (relative risk [RR] =2.18, 95% confidence interval [CI] 1.02-4.67, p=0.04), with older age (RR =1.12, 1.04-1.20, p=0.003), heart failure (RR =3.26, 1.18-9.01, p=0.02), and history of stroke (RR =18.87, 3.11-111.11, p=0.001). In conclusion, in patients with AF and high thromboembolic risk after stent implantation, use of OAC was independently associated with decreased risk of subsequent death/stroke/systemic TE, suggesting that OAC should be systematically used in this patient population. PMID:23846210

  3. Evaluation of hand function in patients undergoing long term haemodialysis

    PubMed Central

    Limaye, V; Frankham, A; Disney, A; Pile, K

    2001-01-01

    OBJECTIVE—Haemodialysis is associated with the deposition of β2 microglobulin in musculoskeletal structures, leading to the syndrome of dialysis related amyloidosis and impairment of hand function. This study aimed at assessing hand function using the Sollerman test in a cross section of patients undergoing haemodialysis.
METHODS—Recipients of haemodialysis underwent the Sollerman test of hand grip function, which assesses 20 activities of daily living using eight grip types, and the JAMAR grip strength test, visual analogue scales (VAS) for pain (VAS-P) and function (VAS-F), and Health Assessment Questionnaire (HAQ) were determined. Results—Thirty five subjects (26 male), with mean age 53.2 years, participated. The average duration of haemodialysis was 6.2 years (range one month to 25 years). The median Sollerman score was 77, with 19/35 (54%) patients receiving haemodialysis having a score below the lower normal value of 78-80. The log Sollerman score correlated poorly with age (rs=0.16, p=0.35), and significantly with the HAQ score (rs=−0.66, p<0.00005), duration of haemodialysis (rs=−0.39, p<0.05), VAS-F (rs=−0.41, p<0.05), VAS-P (rs=−0.34, p<0.05), and JAMAR score (rs=0.57, p<0.05). Sollerman scores were highly correlated between dominant and non-dominant hands (rs=0.69, p<000005).
CONCLUSIONS—Hand dysfunction is a common finding among patients undergoing long term haemodialysis. The Sollerman test accurately reflects patient function as measured by HAQ, VAS-F, and grip strength, but less so pain. Its use for the early detection of dialysis related amyloidosis and in the serial monitoring of the effects of hand treatment programmes is encouraged.

 PMID:11171692

  4. Antiplatelet Therapy in Hemodialysis Patients Undergoing Percutaneous Coronary Interventions

    PubMed Central

    Summaria, Francesco; Giannico, Maria B.; Talarico, Giovanni P.; Patrizi, Roberto

    2015-01-01

    Context: Coronary artery disease is highly prevalent among patients with end stage renal disease/hemodialysis (ESRD/HD) and coronary percutaneous interventions (PCI) has been increased by nearly 50% over the past decade. After PCI with stent placement, guidelines recommend dual antiplatelet therapy (DAPT), but no specifically tailored pharmacotherapy approach is outlined for this frail population, mostly excluded from large randomized clinical trials (RCTs). Evidence Acquisition: We reviewed current evidences on the use of antiplatelet therapy in patients with ESRD/HD undergoing PCI, focusing on the efficacy and safety of specific agents and their indications for detailed clinical settings. Results: Clinical setting in HD patients is the principal determinant of the type, onset, combination and duration of the DAPT. However, irrespective clinical setting, in addition to aspirin, clopidogrel is currently the most used antiplatelet agent even if no information derived from RCTs are available in ESRD. Due to the large experience acquired in routine clinical practice, the awareness of safety is higher for clopidogrel than newer antiplatelet agents. Because of lack of data, the use of prasugrel and ticagrelor is actually not recommended. However, in case of high ischemic and acceptable bleeding risk, they may be selectively used in ESRD/HD. Conclusions: This investigation might contribute to delineate the best treatment options for this high risk population. PMID:26528445

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

    PubMed Central

    Salehahmadi, Zeinab; Rafie, Seyyed Reza

    2012-01-01

    BACKGROUND Although, there have been extensive research on the motivations driving patient to undergo cosmetic procedures, there is still a big question mark on the persuasive factors which may lead individuals to undergo cosmetic surgery. The present study evaluated various factors affecting patients undergoing cosmetic surgery in Bushehr, Southern Iran. METHODS From 24th March 2011 to 24th March 2012, eighty-one women and 20 men who wished to be operated in Fatemeh Zahra Hospital in Bushehr, Southern Iran and Pars Clinic, Iran were enrolled by a simple random sampling method. They all completed a questionnaire to consider reasons for cosmetic procedures. The collected data were statistically analyzed. RESULTS Demographical, sociological and psychological factors such as age, gender, educational level, marital status, media, perceived risks, output quality, depression and self-improvement were determined as factors affecting tendency of individuals to undergo cosmetic surgery in this region. Trend to undergo cosmetic surgery was more prevalent in educational below bachelor degree, married subjects, women population of 30-45 years age group. Education level, age, marital status and gender were respectively the influential factors in deciding to undergo cosmetic surgery. Among the socio-psychological factors, self-improvement, finding a better job opportunity, rivalry, media, health status as well as depression were the most persuasive factors to encourage people to undergo cosmetic surgery too. Cost risk was not important for our samples in decision making to undergo cosmetic surgery. CONCLUSION We need to fully understand the way in which the combination of demographic, social and psychological factors influence decision-making to undergo cosmetic surgery. PMID:25734051

  6. Predictors of overall satisfaction of cancer patients undergoing radiation therapy

    PubMed Central

    Becker-Schiebe, Martina; Pinkert, Uwe; Ahmad, Tahera; Schäfer, Christof; Hoffmann, Wolfgang; Franz, Heiko

    2015-01-01

    Background Reporting the experiences and satisfaction of patients, as well as their quality of care scores is an emerging recommendation in health care systems. Many aspects of patients’ experience determine their overall satisfaction. The aim of this evaluation was to define the main factors contributing to the satisfaction of patients undergoing radiotherapy in an outpatient setting. Patients and methods A total of 1,710 patients with a histologically proven cancer, who were treated in our department between 2012 and 2014, were recruited for this prospective evaluation. At the end of therapy, each patient was asked to grade the skills and the care provided by radiation therapists, physicians, and physician’s assistants, as well as the overall satisfaction during therapy. Statistical analysis was performed to determine which parameters had the greatest influence on overall satisfaction. Results Overall satisfaction with the provided care was high with a mean satisfaction score of 1.4. Significant correlations were found between overall satisfaction and each of the following survey items: courtesy, protection of privacy, professional skills and care provided by the radiation therapists and physicians, accuracy of provided information, and cleanliness. Linear regression analysis demonstrated that courteous behavior and the protection of privacy were the strongest predictors for overall satisfaction (P<0.001), followed by care and skills of physicians and radiation therapists. Patients suffering from head and neck cancer expressed lower overall satisfaction. Conclusion Based on our prospectively acquired data, we were able to identify and confirm key factors for patient satisfaction in an outpatient radiooncological cancer center. From these results, we conclude that patients want most importantly to be treated with courtesy, protection of privacy and care. PMID:26491266

  7. Prediction of FEV1 reductions in patients undergoing pulmonary resection.

    PubMed

    Zoia, M C; Corsico, A; Fulgoni, P; Spagnolatti, L; Volpini, E; Barbano, L

    1998-06-01

    In the assessment of functional operability of lung cancer the simple calculation of predicted postoperative forced expiratory volume in one second (ppoFEV1) based on the number of the bronchopulmonary segments removed, has recently been found to underestimate the actual postoperative forced expiratory volume in one second (FEV1). We checked whether this could be accounted for by lesions causing uneven ventilation or perfusion. We performed a retrospective study of 12 patients with atelectasis, hilar disease or endobronchial involvement (Group A) versus 24 patients with peripheral lung cancer (Group B). Baseline and postoperative FEV1 were measured and ppoFEV1 and ppoFEV1/actual postoperative FEV1 were calculated. In all subjects in Group A ppoFEV1 grossly underestimated the measured postoperative FEV1 (mean (SD) ratio between the two parameters: 67.0 (12.1)%). In Group B, ppoFEV1 was almost identical to the measured value in all but three patients, in whom it only slightly underestimated the actual postoperative value (mean ratio between the two parameters: 94.9 (12.6) %). In conclusion, predicted postoperative forced expiratory volume in one second is useful in the preoperative assessment of patients undergoing lung resection for lesions other than those causing uneven ventilation or perfusion. When this condition is suspected, before declaring a given case ineligible for surgery or at high risk of complications, more sophisticated procedures, such as radionuclide perfusion studies, should be performed. PMID:9785807

  8. Sensitivity to implant materials in patients undergoing total hip replacement.

    PubMed

    Granchi, Donatella; Cenni, Elisabetta; Trisolino, Giovanni; Giunti, Armando; Baldini, Nicola

    2006-05-01

    Sensitivity to implant materials is an unpredictable event, which may contribute to the process leading to the failure of the total hip replacement (THR). The aim of the current study was to investigate the informative power of skin testing in detecting the sensitization to the implant components in patients undergoing THR. A consecutive series of 223 patients was enrolled in the study, including 66 candidates to THR, 53 with stable implant, and 104 with THR loosening. The patch testing was performed by using the most relevant components of cobalt-based alloys (CoCrMo), Ti-based alloys (TiAlV), and bone cements. The frequency of positive patch testing in preimplant patients did not differ from that observed after THR. Patients with CoCrMo-failed implant showed a significant low frequency of nickel-positive skin reaction, while patients with TiAlV-THR had a high incidence of vanadium-positive patch testing. The panel of haptens showed a good performance in the identification of patients known to have a contact dermatitis. With regard to the THR outcome, patch testing was not able to discriminate between stable and failed implant. Sensitivity to at least one hapten, namely bone cement, as well as the positive medical history of hypersensitivity, influenced negatively the THR survival. Our results show the reliability of patch testing for investigating the sensitivity to implant components. The cause-effect relationship between sensitization and negative outcome cannot be established, but the shorter lifespan of THR in patients who have a positive patch testing supports the significant role of this event in contributing to the implant failure. PMID:16265661

  9. Periodontal Management of a Patient Undergoing Liver Transplantation.

    PubMed

    Clozza, Emanuele; Segelnick, Stuart L; Sigal, Samuel H; Rovner, Deborah N; Weinberg, Mea A

    2016-01-01

    This case report describes the periodontal management of a patient with end-stage liver disease undergoing liver transplantation. In the first part of this article, all medical and dental findings are reported to elaborate adequate diagnoses. A patient-specific treatment plan was structured given the challenging periodontal and systemic scenarios. The second part describes the periodontal therapy delivered in close interaction with the referring physicians. Last, the article reviews current principles and protocols in managing these patients. PMID:26901304

  10. Review of nutritional guidelines for patients undergoing bariatric surgery.

    PubMed

    Leahy, Cheri Rebecca; Luning, Alyssa

    2015-08-01

    Health care providers often supply patients who are undergoing bariatric surgery with varying and sometimes conflicting information regarding nutrition before and after surgery. Nurses and other care providers can benefit from applying current nutritional guidelines to increase patients' understanding, compliance, nutrition, hydration, protein needs, and satisfaction. This article summarizes basic recommendations to help health care providers understand the patients' nutritional requirements and diet recommendations from two weeks before bariatric surgery to four to six weeks after surgery. PMID:26227519

  11. Radiation Dose Estimation for Pediatric Patients Undergoing Cardiac Catheterization

    NASA Astrophysics Data System (ADS)

    Wang, Chu

    Patients undergoing cardiac catheterization are potentially at risk of radiation-induced health effects from the interventional fluoroscopic X-ray imaging used throughout the clinical procedure. The amount of radiation exposure is highly dependent on the complexity of the procedure and the level of optimization in imaging parameters applied by the clinician. For cardiac catheterization, patient radiation dosimetry, for key organs as well as whole-body effective, is challenging due to the lack of fixed imaging protocols, unlike other common X-ray based imaging modalities. Pediatric patients are at a greater risk compared to adults due to their greater cellular radio-sensitivities as well as longer remaining life-expectancy following the radiation exposure. In terms of radiation dosimetry, they are often more challenging due to greater variation in body size, which often triggers a wider range of imaging parameters in modern imaging systems with automatic dose rate modulation. The overall objective of this dissertation was to develop a comprehensive method of radiation dose estimation for pediatric patients undergoing cardiac catheterization. In this dissertation, the research is divided into two main parts: the Physics Component and the Clinical Component. A proof-of-principle study focused on two patient age groups (Newborn and Five-year-old), one popular biplane imaging system, and the clinical practice of two pediatric cardiologists at one large academic medical center. The Physics Component includes experiments relevant to the physical measurement of patient organ dose using high-sensitivity MOSFET dosimeters placed in anthropomorphic pediatric phantoms. First, the three-dimensional angular dependence of MOSFET detectors in scatter medium under fluoroscopic irradiation was characterized. A custom-made spherical scatter phantom was used to measure response variations in three-dimensional angular orientations. The results were to be used as angular dependence

  12. Hemostatic management of patients undergoing ear-nose-throat surgery

    PubMed Central

    Thiele, Thomas; Kaftan, Holger; Hosemann, Werner; Greinacher, Andreas

    2015-01-01

    Perioperative hemostatic management is increasingly important in the field of otolaryngology. This review summarizes the key elements of perioperative risk stratification, thromboprophylaxis and therapies for bridging of antithrombotic treatment. It gives practical advice based on the current literature with focus on patients undergoing ENT surgery. PMID:26770281

  13. High-Dose Statin Pretreatment Decreases Periprocedural Myocardial Infarction and Cardiovascular Events in Patients Undergoing Elective Percutaneous Coronary Intervention: A Meta-Analysis of Twenty-Four Randomized Controlled Trials

    PubMed Central

    Wang, Le; Peng, Pingan; Zhang, Ou; Xu, Xiaohan; Yang, Shiwei; Zhao, Yingxin; Zhou, Yujie

    2014-01-01

    Background Evidence suggests that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE) for certain patients; however, previous analyses have not considered patients with a history of statin maintenance treatment. In this meta-analysis of randomized controlled trials (RCTs), we reevaluated the efficacy of short-term high-dose statin pretreatment to prevent PMI and MACE in an expanded set of patients undergoing elective percutaneous coronary intervention. Methods We searched the PubMed/Medline database for RCTs that compared high-dose statin pretreatment with no statin or low-dose statin pretreatment as a prevention of PMI and MACE. We evaluated the incidence of PMI and MACE, including death, spontaneous myocardial infarction, and target vessel revascularization at the longest follow-up for each study for subgroups stratified by disease classification and prior low-dose statin treatment. Results Twenty-four RCTs with a total of 5,526 patients were identified. High-dose statin pretreatment was associated with 59% relative reduction in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34–0.49; P<0.00001) and 39% relative reduction in MACE (OR: 0.61; 95% CI: 0.45–0.83; P = 0.002). The benefit of high-dose statin pretreatment on MACE was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50–0.95; P = 0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI: 0.12–0.65; P = 0.003); and for patients with acute coronary syndrome (OR: 0.52; 95% CI: 0.34–0.79; P = 0.003), but not for patients with stable angina (OR: 0.71; 95% CI 0.45–1.10; P = 0.12). Long-term effects on survival were less obvious. Conclusions High-dose statin pretreatment can result in a significant reduction in PMI and MACE for patients undergoing elective PCI. The positive effect of high-dose statin pretreatment on PMI and MACE is significant for statin

  14. The Effect of Bone Marrow Plasma Cell Burden on Survival in Patients with Light Chain Amyloidosis Undergoing High-Dose Melphalan and Autologous Stem Cell Transplantation.

    PubMed

    Dittus, Christopher; Uwumugambi, Nsabimana; Sun, Fangui; Sloan, J Mark; Sanchorawala, Vaishali

    2016-09-01

    The prognosis in light chain (AL) amyloidosis has been linked to several variables, which are primarily related to end-organ damage. Recently, bone marrow plasma cell (BMPC) burden >10% has also been described as an adverse prognostic factor. We reviewed data pertaining to 546 patients with AL amyloidosis who underwent high-dose melphalan (HDM) and stem cell transplantation (SCT) to determine if BMPC > 10% was a negative prognostic factor. Of these patients, 445 had a BMPC burden ≤ 10% and 101 had a BMPC burden > 10%. Patients with BMPC > 30% were excluded from the study. The median overall survival (OS) was 7.86 years (95% confidence interval [CI], 6.69 to 9.83) in patients with BMPC ≤ 10% and 6.8 years (95% CI, 5.75 to 10.17) for those with BMPC >10% (hazard ratio, 1.106; 95% CI, .78 to 1.45; P = .70) after HDM/SCT. Of the 101 patients with a BMPC burden > 10%, 25 received induction therapy. The median OS was 7.78 years (95% CI, 5.4 to 13.4) for those without induction therapy and 5.75 years (95% CI, 3.94 to not available; P = .28) for those with induction therapy. Furthermore, hematologic response and relapse rates did not differ in these 2 groups after HDM/SCT. We conclude that BMPC > 10% and < 30% is not a poor prognostic factor with respect to survival in patients with AL amyloidosis treated with HDM/SCT and that induction therapy in this group does not impact OS. PMID:27296954

  15. Prevention of heterotopic bone formation with early post operative irradiation in high risk patients undergoing total hip arthroplasty: comparison of 10. 00 Gy vs 20. 00 Gy schedules

    SciTech Connect

    Anthony, P.; Keys, H.; Evarts, C.M.; Rubin, P.; Lush, C.

    1987-03-01

    Prior studies have demonstrated the effectiveness of postoperative radiation therapy (RT) to the hip area following total hip replacement (THR) surgery in preventing the development of heterotopic bone formation in patients considered to be at high risk for development of this complication. Previously, patients received 20.00 Gy in 10 fractions (fx) over 2 weeks, beginning as soon postop as medically feasible (usually post-op day 2). In an effort to reduce hospital stay and risk of secondary malignancy, a prospective treatment program was initiated April 1982 using a reduced dose of 10.00 Gy in 5 fx over 5-7 days. As of February 1984, 46 consecutive hips determined to be at high risk were treated with this reduced dose. Prior studies have demonstrated that heterotopic bone is always radiographically evident by 8 weeks. Of the 46 hips, 41 had been evaluated with the minimum required 8 week follow-up X ray. Twenty-five of these hips, 61%, had a mean long term follow-up of 12 months. It historical control group, consisting of 54 consecutive high risk post-THR's, was shown to have a 68.5% incidence of heterotopic bone. The 20.00 Gy group, when RT was started by post-op day 5, demonstrated a 3.2% incidence, compared to 4.9% in the 10.00 Gy group. Complication rates were also comparable in the two RT groups, 19.4% and 7.3% respectively; 10.00 Gy is apparently as effective as 20.00 Gy in preventing heterotopic bone formation in high risk post-THR patients.

  16. Genetic Polymorphisms Influence Cognition in Patients Undergoing Carotid Interventions.

    PubMed

    Hitchner, Elizabeth; Morrison, Doug; Liao, Phoebe; Rosen, Allyson; Zhou, Wei

    2016-09-01

    While carotid interventions help decrease the risk of stroke, nearly 40% of patients experience cognitive deterioration. Genetic polymorphism in apolipoprotein E (ApoE) and brain-derived neurotrophic factor (BDNF) have been implicated in cognitive impairment; however, it is unclear whether they may influence cognitive changes in patients undergoing carotid intervention. In this study, we seek to assess the role of genetic polymorphisms in carotid intervention-related cognitive change. Polymorphisms related to cognitive function were chosen for this preliminary analysis. Over 2 years, patients undergoing carotid interventions were prospectively recruited. Patients underwent neuropsychological testing 2 weeks prior to and at 1 month following their procedure. Saliva samples were collected for genetic analysis. Logistic regressions were used to identify associations between polymorphisms and cognitive measures. A total of 91 patients were included; all were male with an average age of 70 years. The majority of patients exhibited hypertension (95%) and a history of smoking (81%). Presence of ApoE 4 allele was associated with depression (p= 0.047). After correcting for age and genetic polymorphisms in BDNF and serotonin transporter (5-HTT), ApoE 4 allele was associated with depression (p= 0.044) and showed a trend with baseline cognitive impairment (p= 0.10). Age ≥ 70 years was associated with baseline cognitive impairment after adjusting for the three genetic polymorphisms (p= 0.03). Patients with ApoE 4 and BDNF A polymorphisms performed less well on the visual and verbal memory measures, respectively. Polymorphisms in ApoE and BDNF may provide insight on cognition in patients undergoing carotid interventions; however, the mechanism of this relationship remains unclear. PMID:27574384

  17. Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery.

    PubMed

    Spiezia, Luca; Vasques, Francesco; Behr, Astrid; Campello, Elena; Maggiolo, Sara; Berizzi, Antonio; Gavasso, Sabrina; Woodhams, Barry; Biancari, Fausto; Simioni, Paolo

    2016-09-01

    Traditional coagulative parameters are of limited use in identifying perioperative coagulopathy occurring in patients undergoing major elective orthopedic surgery (MEOS). The aim of our study was to evaluate the coagulation changes in patients undergoing MEOS and to facilitate an early detection of perioperative coagulopathy in patients experiencing major intraoperative bleeding. We enrolled 40 consecutive patients (M/F 10/30, age range 34-90 years) who underwent MEOS at the Orthopedic Unit of the Padua University Hospital, Italy, between January 2014 and January 2015. Blood samples were obtained at the following time points: T0-pre: 30 min before surgery; T0-post: 30 min after the end of the procedure; T1: morning of the first postoperative day; T2: 7 ± 2 days after surgery. Patients who experienced an intraoperative blood loss ≥250 mL/h were considered as cases. Routine coagulative parameters, thromboelastometry and thrombin generation (TG) profiles were evaluated. At baseline, a significantly lower platelet count and FIBTEM MCF/AUC were observed in patents with excessive bleeding (p < 0.05 and 0.02/0.01, respectively). At T0-post and T1 intervals, cases showed hypocoagulation characterized by a significantly low platelet count (p = 0.001), prolonged CFT INTEM/EXTEM, reduction of alpha-angle and MaxV INTEM/EXTEM, MCF and AUC INTEM/EXTEM/FIBTEM (p < 0.05 in all comparisons). The only TG parameter standing out between study groups was time to peak at T0-pre. A low platelet count and fibrinogen activity were associated with significant intraoperative bleeding in patients undergoing MEOS. Thromboelastometry performed by ROTEM(®) identifies patients with coagulopathy. PMID:26951189

  18. Delayed awakening in dystonia patients undergoing deep brain stimulation surgery.

    PubMed

    Trombetta, Carlos; Deogaonkar, Anupa; Deogaonkar, Milind; Ebrahim, Zeyd; Rezai, Ali; Machado, Andre; Farag, Ehab

    2010-07-01

    We aimed to identify the incidence, duration and causes of delayed emergence from anesthesia in patients with dystonia undergoing surgery for deep brain stimulation (DBS) placement. A retrospective review of patients with dystonia who underwent DBS placement was conducted and the following characteristics were noted: age, gender, comorbid conditions, American Society of Anesthesiologists classification, anesthetic agents used, amount of initial dose, amount of infusion dose, duration of the infusion and the time needed for emergence. Twenty-four patients underwent 33 DBS procedures for dystonia. Propofol was administered to 21 patients, in 29 of the 33 procedures. Dexmedetomidine was administered to three patients, in four procedures. The average propofol loading dose was 0.7mg/kg, and the infusion rate was 80microg/kg per minute (min), for an average duration of 89min. The average time of emergence was 36min. Only 31% of patients emerged from propofol anesthesia during the expected time frame, 69% of patients had some degree of delayed emergence, and 24% had a significant delay in emergence. Delayed emergence was more common in younger patients due to the higher loading doses these patients received. This study shows a 69% incidence of delayed emergence in dystonia patients undergoing DBS surgery. It also suggests an association between delayed emergence and younger patients who receive higher loading doses. A possible cause of delayed emergence is excessive anesthetic potentiation of the low output pallidal state in dystonia which may depress the pallido-thalamo-cortical circuitry. Delayed emergence could also result from depression of the previously affected ventral pallidal inputs to the septo-hippocampal system that mediates general anesthesia and awareness. Complex neurotransmitter disturbances may also be involved. PMID:20466547

  19. Maintaining perioperative normothermia in the patient undergoing cesarean delivery.

    PubMed

    Carpenter, Lavenia; Baysinger, Curtis L

    2012-07-01

    Anesthesia and surgery interfere with normal thermoregulation, and nearly all patients will become hypothermic unless compensatory measures are used. Preoperative patient warming and intraoperative methods using forced air and warmed intravenous fluids are important methods for maintaining patient's core temperature during the perioperative period. The benefits of maintaining normothermia include reductions in postoperative wound infection, the risk of perioperative coagulopathy, and myocardial ischemia. These advantages, demonstrated in patients undergoing general surgery, would be expected in patients undergoing gynecological surgery but have not been specifically studied in that population. Few studies have examined the maternal and neonatal effects of hypothermia after cesarean delivery. The results conflict as to the effectiveness of maternal warming techniques used to prevent it and the effects on neonatal temperature and acid-base status at delivery. Large prospective studies will be required to show significant effects on rates of maternal wound infection after cesarean delivery. European and American national obstetrical organizations have not published recommendations regarding the perioperative thermal regulation for cesarean delivery. We review the physiology of thermal regulation and perioperative thermal management in surgical patients and the literature that has examined perioperative maternal warming for cesarean delivery. PMID:22926250

  20. Short communication: oral lesions in HIV/AIDS patients undergoing HAART including efavirenz.

    PubMed

    Aquino-García, S I; Rivas, M A; Ceballos-Salobreña, A; Acosta-Gio, A E; Gaitán-Cepeda, L A

    2008-06-01

    Oral lesions (OL) have an important prognostic value for HIV/AIDS patients. However, the behavior of OL in HIV/AIDS patients undergoing highly active antiretroviral therapy including efavirenz (HAART/EFV) has not been documented. Our objective was to establish the prevalence of OL in HIV/AIDS patients undergoing HAART/EFV and to compare it with the prevalence of OL in patients undergoing antiretroviral therapy including a protease inhibitor (HAART/PI). Seventy-three HIV/AIDS patients undergoing antiretroviral treatment for at least for 6 months at "La Raza" Medical Center's Internal Medicine Unit (IMSS, Mexico City) were included. To detect OL, a detailed examination of oral soft tissues was performed in each patient. Patient records recorded gender, seropositivity time, route of contagion, antiretroviral therapy type and duration, CD4 lymphocyte count/ml, and viral load. Two groups were formed: 38 patients receiving HAART/EFV [two nucleoside analogue reverse transcriptase inhibitors (NARTI) plus efavirenz] and 35 patients receiving HAART/PI (two NARTIs plus one PI). OL prevalence was established in each study group. The Chi-square test was applied (p < 0.05(IC95%)). OL prevalence in the HAART/EFV group (32%) was lower (p < 0.007) than in the HAART/PI group (63%). Candidosis was the most prevalent OL in both groups. Herpes labialis, HIV-associated necrotizing periodontitis, xerostomia, hairy leukoplakia, and nonspecific oral sores were identified. The highest prevalence for all OL was found in the HAART/PI group. These findings suggest that HIV/AIDS patients undergoing HAART/EFV show a lower prevalence of oral lesions than patients undergoing HAART/PI. PMID:18507528

  1. Investigation of Nausea and Vomiting in Cancer Patients Undergoing Chemotherapy.

    PubMed

    Lavdaniti, Maria; Tsitsis, Nikolaos

    2014-11-01

    Nausea and vomiting are the most important problems in patients undergoing chemotherapy, despite the recent improvements in the administration of antiemetic drugs. Through a review of the literature, we found that there are several nursing researches focusing on the effectiveness of interventions for the treatment of nausea and vomiting in cancer patients. The purpose of this study was to investigate the symptom of nausea and vomiting in patients undergoing chemotherapy. The study also investigated the impact of nausea and vomiting on patients' ability to respond to daily activities. The study is descriptive; the sample included patients with different types of cancer and receiving chemotherapy. The inclusion criteria were: the histological diagnosis of cancer, the administration of chemotherapy and the knowledge of the Greek language. The questionnaires used were: the MASCC (vomiting questionnaire), the Memorial Symptom Assessment Scale and the scale of functional assessment of cancer therapy. Data collection took place in oncological hospitals of Thessaloniki and Athens in Greece. For statistical analysis we used the statistical package SPSS 15.0. PMID:26973943

  2. Idarubicin-intensified BUCY2 conditioning regimen improved survival in high-risk acute myeloid, but not lymphocytic leukemia patients undergoing allogeneic hematopoietic stem cell transplantation: A retrospective comparative study.

    PubMed

    Fang, Jun; Zhang, Ran; Wang, Huafang; Hong, Mei; Wu, Qiuling; Nie, Dimin; You, Yong; Zhong, Zhaodong; Li, Weiming; Hu, Yu; Xia, Linghui

    2016-07-01

    The intensity of conditioning regimen is highly correlated with outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT). We have previously reported that idarubicin (IDA) intensified BUCY2 regimen could reduce relapse and improve survival for high-risk hematological malignancies undergoing allo-HSCT. However, there is no published study comparing the efficacy of IDA-BUCY2 regimen for high-risk acute myeloid leukemia (AML) versus acute lymphocytic leukemia (ALL). We further retrospectively compared therapeutic outcomes of intensified conditioning regimen on 140 high-risk AML and ALL patients in the data analyses. IDA 15mg/m(2)/d was administered by continuous infusion from day -11 to -9, followed by intravenous injection of busulfan (BU) (3.2mg/kg/d) from day -6 to -4, and intravenous injection of cyclophosphamide (CY) (1.8g/m(2)/d) from day -3 to -2 in IDA-BUCY2 regimen. For high-risk AML, cumulative probabilities of 3-year relapse rates in IDA-BUCY2 and traditional BUCY2 regimens were 16.9%, 43.3% (P=0.016). Cumulative probabilities of 3-year overall survival (OS) and disease-free survival (DFS) were 69.2% vs 44.0% (P=0.024), and 66.9% vs 38.2% (P=0.01). However, two regimens showed no significant differences for high-risk ALL. Multivariate analysis also indicated that IDA intensified BUCY2 conditioning was the favorable variable to reduce relapse and elevate survival for high-risk AML patients. In conclusion, IDA-BUCY2 regimen reduces relapse and improves survival for high-risk AML undergoing allo-HSCT, but not presenting uniform therapeutic effects for high-risk ALL. PMID:27131062

  3. Perioperative physiotherapy in patients undergoing lung cancer resection.

    PubMed

    Rodriguez-Larrad, Ana; Lascurain-Aguirrebena, Ion; Abecia-Inchaurregui, Luis Carlos; Seco, Jesús

    2014-08-01

    Physiotherapy is considered an important component of the perioperative period of lung resection surgery. A systematic review was conducted to assess evidence for the effectiveness of different physiotherapy interventions in patients undergoing lung cancer resection surgery. Online literature databases [Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, SCOPUS, PEDro and CINAHL] were searched up until June 2013. Studies were included if they were randomized controlled trials, compared 2 or more perioperative physiotherapy interventions or compared one intervention with no intervention, included only patients undergoing pulmonary resection for lung cancer and assessed at least 2 or more of the following variables: functional capacity parameters, postoperative pulmonary complications or length of hospital stay. Reviews and meta-analyses were excluded. Eight studies were selected for inclusion in this review. They included a total of 599 patients. Seven of the studies were identified as having a low risk of bias. Two studies assessed preoperative interventions, 4 postoperative interventions and the remaining 2 investigated the efficacy of interventions that were started preoperatively and then continued after surgery. The substantial heterogeneity in the interventions across the studies meant that it was not possible to conduct a meta-analysis. The most important finding of this systematic review is that presurgical interventions based on moderate-intense aerobic exercise in patients undergoing lung resection for lung cancer improve functional capacity and reduce postoperative morbidity, whereas interventions performed only during the postoperative period do not seem to reduce postoperative pulmonary complications or length of hospital stay. Nevertheless, no firm conclusions can be drawn because of the heterogeneity of the studies included. Further research into the efficacy and effectiveness of perioperative respiratory physiotherapy in

  4. Health State Utility Values in Patients Undergoing Endoscopic Sinus Surgery

    PubMed Central

    Soler, Zachary M.; Wittenberg, Eve; Schlosser, Rodney J.; Mace, Jess C.; Smith, Timothy L.

    2011-01-01

    OBJECTIVES/HYPOTHESIS The primary study goal was to measure health state utility values in patients with chronic rhinosinusitis (CRS) before and after undergoing endoscopic sinus surgery (ESS). A secondary goal was to assess the meaning of these values by comparing them with other chronic disease processes and currently available medical or surgical treatments. STUDY DESIGN Prospective, observational cohort study METHODS Adults with CRS were enrolled after electing ESS and observed over a 5-year period. Baseline demographic and medical comorbidities were recorded for each patient, as well as computed tomography (CT), endoscopy, olfaction, and disease-specific quality of life scores. Utility values were derived using the Short-Form 6D (SF-6D) at baseline and again after surgery. RESULTS The mean SF-6D utility value for the baseline health state of all patients with CRS (n=232) was 0.65 (95% CI: 0.63–0.66). Baseline utility values correlated with disease-specific QOL as measured by the Rhinosinusitis Disability Index (RSDI) (r=−0.660; P<0.001), but not baseline CT, endoscopy, or olfactory scores. Follow-up utility values (≥6 months) after ESS improved by 0.087 (95% CI: 0.06–0.12; P<0.001) in patients with no history of sinus surgery and 0.062 (95% CI: 0.04–0.09; P<0.001) in those undergoing a revision procedure. CONCLUSIONS Patients with CRS who failed medical therapy and elected to undergo ESS report health state utility values which are significantly lower than the United States population norm. Utility values showed improvement after ESS which was statistically and clinically significant. These results provide the initial data necessary for formal cost-effectiveness analyses incorporating ESS. PMID:22034223

  5. Immunomodulatory Effects of the Agaricus blazei Murrill-Based Mushroom Extract AndoSan in Patients with Multiple Myeloma Undergoing High Dose Chemotherapy and Autologous Stem Cell Transplantation: A Randomized, Double Blinded Clinical Study

    PubMed Central

    Tierens, Anne; Caers, Jo; Binsfeld, Marilene; Olstad, Ole Kristoffer; Trøseid, Anne-Marie Siebke; Wang, Junbai; Tjønnfjord, Geir Erland; Hetland, Geir

    2015-01-01

    Forty patients with multiple myeloma scheduled to undergo high dose chemotherapy with autologous stem cell support were randomized in a double blinded fashion to receive adjuvant treatment with the mushroom extract AndoSan, containing 82% of Agaricus blazei Murrill (19 patients) or placebo (21 patients). Intake of the study product started on the day of stem cell mobilizing chemotherapy and continued until the end of aplasia after high dose chemotherapy, a period of about seven weeks. Thirty-three patients were evaluable for all study endpoints, while all 40 included patients were evaluable for survival endpoints. In the leukapheresis product harvested after stem cell mobilisation, increased percentages of Treg cells and plasmacytoid dendritic cells were found in patients receiving AndoSan. Also, in this group, a significant increase of serum levels of IL-1ra, IL-5, and IL-7 at the end of treatment was found. Whole genome microarray showed increased expression of immunoglobulin genes, Killer Immunoglobulin Receptor (KIR) genes, and HLA genes in the Agaricus group. Furthermore, AndoSan displayed a concentration dependent antiproliferative effect on mouse myeloma cells in vitro. There were no statistically significant differences in treatment response, overall survival, and time to new treatment. The study was registered with Clinicaltrials.gov NCT00970021. PMID:25664323

  6. Measuring radiation dose to patients undergoing fluoroscopically-guided interventions

    NASA Astrophysics Data System (ADS)

    Lubis, L. E.; Badawy, M. K.

    2016-03-01

    The increasing prevalence and complexity of fluoroscopically guided interventions (FGI) raises concern regarding radiation dose to patients subjected to the procedure. Despite current evidence showing the risk to patients from the deterministic effects of radiation (e.g. skin burns), radiation induced injuries remain commonplace. This review aims to increase the awareness surrounding radiation dose measurement for patients undergoing FGI. A review of the literature was conducted alongside previous researches from the authors’ department. Studies pertaining to patient dose measurement, its formalism along with current advances and present challenges were reviewed. Current patient monitoring techniques (using available radiation dosimeters), as well as the inadequacy of accepting displayed dose as patient radiation dose is discussed. Furthermore, advances in real-time patient radiation dose estimation during FGI are considered. Patient dosimetry in FGI, particularly in real time, remains an ongoing challenge. The increasing occurrence and sophistication of these procedures calls for further advances in the field of patient radiation dose monitoring. Improved measuring techniques will aid clinicians in better predicting and managing radiation induced injury following FGI, thus improving patient care.

  7. Respiratory management of the obese patient undergoing surgery.

    PubMed

    Hodgson, Luke E; Murphy, Patrick B; Hart, Nicholas

    2015-05-01

    As a reflection of the increasing global incidence of obesity, there has been a corresponding rise in the proportion of obese patients undergoing major surgery. This review reports the physiological effect of these changes in body composition on the respiratory system and discusses the clinical approach required to maximize safety and minimize the risk to the patient. The changes in respiratory system compliance and lung volumes, which can adversely affect pulmonary gas exchange, combined with upper airways obstruction and sleep-disordered breathing need to be considered carefully in the peri-operative period. Indeed, these challenges in the obese patient have led to a clear focus on the clinical management strategy and development of peri-operative pathways, including pre-operative risk assessment, patient positioning at induction and under anesthesia, modified approach to intraoperative ventilation and the peri-operative use of non-invasive ventilation (NIV) and continuous positive airways pressure. PMID:26101653

  8. Respiratory management of the obese patient undergoing surgery

    PubMed Central

    Hodgson, Luke E.; Murphy, Patrick B.

    2015-01-01

    As a reflection of the increasing global incidence of obesity, there has been a corresponding rise in the proportion of obese patients undergoing major surgery. This review reports the physiological effect of these changes in body composition on the respiratory system and discusses the clinical approach required to maximize safety and minimize the risk to the patient. The changes in respiratory system compliance and lung volumes, which can adversely affect pulmonary gas exchange, combined with upper airways obstruction and sleep-disordered breathing need to be considered carefully in the peri-operative period. Indeed, these challenges in the obese patient have led to a clear focus on the clinical management strategy and development of peri-operative pathways, including pre-operative risk assessment, patient positioning at induction and under anesthesia, modified approach to intraoperative ventilation and the peri-operative use of non-invasive ventilation (NIV) and continuous positive airways pressure. PMID:26101653

  9. Impact of sarcopenia on survival in patients undergoing living donor liver transplantation.

    PubMed

    Kaido, T; Ogawa, K; Fujimoto, Y; Ogura, Y; Hata, K; Ito, T; Tomiyama, K; Yagi, S; Mori, A; Uemoto, S

    2013-06-01

    Skeletal muscle depletion, referred to as sarcopenia, predicts morbidity and mortality in patients undergoing digestive surgery. However, the impact on liver transplantation is unclear. The present study investigated the impact of sarcopenia on patients undergoing living donor liver transplantation (LDLT). Sarcopenia was assessed by a body composition analyzer in 124 adult patients undergoing LDLT between February 2008 and April 2012. The correlation of sarcopenia with other patient factors and the impact of sarcopenia on survival after LDLT were analyzed. The median ratio of preoperative skeletal muscle mass was 92% (range, 67-130%) of the standard mass. Preoperative skeletal muscle mass was significantly correlated with the branched-chain amino acids to tyrosine ratio (r = -0.254, p = 0.005) and body cell mass (r = 0.636, p < 0.001). The overall survival rate in patients with low skeletal muscle mass was significantly lower than in patients with normal/high skeletal muscle mass (p < 0.001). Perioperative nutritional therapy significantly increased overall survival in patients with low skeletal muscle mass (p = 0.009). Multivariate analysis showed that low skeletal muscle mass was an independent risk factor for death after transplantation. In conclusion, sarcopenia was closely involved with posttransplant mortality in patients undergoing LDLT. Perioperative nutritional therapy significantly improved overall survival in patients with sarcopenia. PMID:23601159

  10. Oral Health Status of Patients Undergoing Treatment for Head and Neck Oncology in Northern Ireland.

    PubMed

    Moore, Ciaran; Killough, Simon; Markey, Neill; Winning, Lewis; McKenna, Gerald

    2016-06-01

    This study aimed to collect data on the oral health status of patients undergoing treatment for head and neck oncology across Northern Ireland. Data were collected on all patients referred to the Northern Ireland Multidisciplinary Head and Neck Oncology Team for discussion and treatment planning. Each patient underwent pre-treatment dental assessment in the Centre for Dentistry, Queen's University Belfast, between June 2013 and November 2014. Data were collected from clinical oral examinations supplemented with intra-oral radiographs. During the course of the study 96 patients were assessed and the levels of dental disease observed in this cohort were high. On clinical examination 43% were diagnosed with caries and 46% with periodontal disease. Ten patients were completely edentate. The disease profile of this patient group presents significant challenges to dental services tasked with rendering patients dentally fit prior to undergoing oncology treatment. PMID:27424336

  11. Resistance to Clopidogrel among Iranian Patients Undergoing Angioplasty Intervention

    PubMed Central

    Haji Aghajani, Mohammad; Kobarfard, Farzad; Safi, Olia; Sheibani, Kourosh; Sistanizad, Mohammad

    2013-01-01

    To study the resistance to standard dosage of clopidogrel among Iranian patients following percutaneous coronary intervention measured by platelet aggregation test. Patients undergoing percutaneous coronary intervention in Imam Hussein Medical center, Tehran, Iran, who were under treatment with aspirin, but had no history of clopidogrel usage, entered the study. Patients received standard dosage of clopidogrel (Plavix®, Sanofi, France, 600 mg loading dose and 75 mg/day afterward). Platelet aggregation was measured using light transmission aggregometer. The response to the drug was categorized as complete resistance (platelet aggregation decreased less than 10%), intermediate resistance (platelet aggregation decreased between 10 to 30%) and complete response (platelet aggregation decreased to 30% or more). All patients were evaluated for major adverse cardio vascular events one month after the angioplasty based on MACE criteria by phone contact. Thirty-one patients with a mean age of 59 ± 13 entered the study. Sixty-five percent of patients showed complete response to clopidogrel (95% CI: 45% to 81%), 22% showed intermediate resistance (95% CI: 10-41%) and 13% showed complete resistance (95% CI: 4-30%). One month after the angioplasty, no major adverse cardiovascular event was recorded. Based on our findings, it seems that there is no major difference between Iranian population and other studies regarding the resistance to clopidogrel. Due to the limited number of participants in our study, further investigations with higher number of patients are recommended to more precisely calculate the percentage of resistance among Iranian patients. PMID:24250685

  12. Medanta insulin protocols in patients undergoing cardiac surgery

    PubMed Central

    Bansal, Beena; Mithal, Ambrish; Carvalho, Pravin; Mehta, Yatin; Trehan, Naresh

    2014-01-01

    Hyperglycemia is common in patients undergoing cardiac surgery and is associated with poor outcomes. This is a review of the perioperative insulin protocol being used at Medanta, the Medicity, which has a large volume cardiac surgery setup. Preoperatively, patients are usually continued on their preoperative outpatient medications. Intravenous insulin infusion is intiated postoperatively and titrated using a column method with a choice of 7 scales. Insulin dose is calculated as a factor of blood glucose and patient's estimated insulin sensitivity. A comparison of this protocol is presented with other commonly used protocols. Since arterial blood gas analysis is done every 4 hours for first two days after cardiac surgery, automatic data collection from blood gas analyzer to a central database enables collection of glucose data and generating glucometrics. Data auditing has helped in improving performance through protocol modification. PMID:25143899

  13. Quality of life in patients undergoing inguinal hernia repair.

    PubMed Central

    Lawrence, K.; McWhinnie, D.; Jenkinson, C.; Coulter, A.

    1997-01-01

    Inguinal hernia repair is one of the most common surgical procedures undertaken in the NHS. Despite this, no previous work has examined quality of life in this patient group. This study examines quality of life preoperatively and at 3 and 6 months postoperatively in 140 patients undergoing inguinal hernia repair in the context of a randomised controlled trial of laparoscopic versus open hernia repair. Surgery was undertaken on a day case basis, and quality of life was assessed using the Short Form 36 (SF36). In the initial phase of the study, 57% of those screened for suitability met the study inclusion criteria and were randomised. No significant differences were found between laparoscopic and open hernia repair in terms of quality of life at 3 and 6 months postoperatively. No difference was found between 3 and 6 month scores, suggesting that patients had already made a good recovery by 3 months. A significant improvement was found between preoperative and postoperative scores, with the greatest change arising on dimensions assessing pain, physical function, and role limitation owing to physical restriction. After standardising for age, sex, and social class, a comparison of the hernia patients to population norms for the SF36 was consistent with improvement from preoperative to postoperative assessment. This study has demonstrated the improvement in quality of life in patients undergoing elective inguinal hernia repair by experienced surgeons on a day case basis. It has also demonstrated the feasibility of assessing quality of life using generic measures in this patient group. Further work in this area is required. Ultimately, the priority given to elective inguinal hernia repair will depend on how the demonstrated benefits compare with those derived from other elective surgical procedures. PMID:9038494

  14. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    NASA Astrophysics Data System (ADS)

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-06-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1–5) and 6 to 20 (area 6–20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function.

  15. Substance P and Acute Pain in Patients Undergoing Orthopedic Surgery

    PubMed Central

    Lisowska, Barbara; Siewruk, Katarzyna; Lisowski, Aleksander

    2016-01-01

    Objective There is a limited information about the role of Substance P (SP) in acute pain nociception following surgical stimulation in patients with a chronic inflammatory state not to mention the link between this neuropeptide level changes and intensity of pain. The goal of the research was to find the correlation between SP level changes and acute pain intensity in patients with rheumatoid arthritis undergoing elective orthopedic surgery. Material and Methods Patients with rheumatoid arthritis (RA) were enrolled in the study. The correlation between acute pain intensity and concentration of SP in serum as well as in drainage fluid from postoperative wound was assessed in patients with RA who underwent Total Knee Replacement (TKA) under spinal anesthesia. Results In patients with RA a correlation between intensity of acute pain and serum SP was found postoperatively, whereas there was no correlation between intensity of acute pain and concentration of SP in drainage fluid. Conclusions 1. The correlation between acute pain intensity and SP serum concentration was found postoperatively in patients with RA. 2. The correlation between acute pain intensity and SP concentration in drainage fluid was not found postoperatively in patients with RA. PMID:26731421

  16. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    PubMed Central

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-01-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1–5) and 6 to 20 (area 6–20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function. PMID:27324066

  17. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis.

    PubMed

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-01-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1-5) and 6 to 20 (area 6-20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function. PMID:27324066

  18. Financial burden experienced by patients undergoing treatment for malignant gliomas

    PubMed Central

    Kumthekar, Priya; Stell, Becky V.; Jacobs, Daniel I.; Helenowski, Irene B.; Rademaker, Alfred W.; Grimm, Sean A.; Bennett, Charles L.; Raizer, Jeffrey J.

    2014-01-01

    Background Patients undergoing treatment for malignant gliomas (MGs) can encounter medical costs beyond what their insurance covers. The magnitude and type of costs experienced by patients are unknown. The purpose of this study was to have patients or their families report on the medical costs incurred during the patients MG treatment. Methods Patients with MG were eligible if they were within 6 months of diagnosis or tumor recurrence. Patients had to be ≥18 years of age, fluent in English, and not aphasic. Weekly logbooks were issued to patients for recording associated costs for ∼6 months or until tumor progression. “Out-of-pocket” (OOP) costs included medical and nonmedical expenses that were not reimbursed by insurance. Direct medical costs included hospital and physician bills. Direct nonmedical costs included transportation, parking, and other related items. Indirect medical costs included lost wages. Costs were analyzed to provide mean and medians with range of expenses. Results Forty-three patients provided cost data for a median of 12 weeks. There were 25 men and 18 women with a median age of 57 years (range, 24y–73y); 79% were married, and 49% reported annual income >$75 000. Health insurance coverage was preferred provider organizations for 58% of patients, and median deductible was $1 500. Median monthly OOP cost was $1 342 (mean, $2 451; range, $333.41–$17 267.16). The highest OOP median costs were medication copayments ($710; range, $0–13 611.20), transportation ($327; range, $0–$1 927), and hospital bill copayments ($403; range, $0–$4 000). Median lost wages were $7 500, and median lost days of work were 12.8. Conclusions OOP costs for MG patients can be significant and comprise direct and indirect costs across several areas. Informing patients about expected costs could limit additional duress and allow financial support systems to be implemented. PMID:26034619

  19. Evaluation of self-esteem in cancer patients undergoing chemotherapy treatment1

    PubMed Central

    Leite, Marilia Aparecida Carvalho; Nogueira, Denismar Alves; Terra, Fábio de Souza

    2015-01-01

    Objective: to evaluate the self-esteem of cancer patients undergoing chemotherapy. Method: descriptive analytical cross-sectional study with a quantitative approach. Around 156 patients that attended an oncology unit of a mid-sized hospital participated in the study. Results: we found a higher frequency of patients with high self-esteem, but some of them showed average or low self-esteem. The scale showed a Cronbach's alpha value of 0.746, by considering its acceptable internal consistency for the evaluated items. No independent variables showed significant associations with self-esteem. Conclusion: the cancer patients evaluated have presented high self-esteem; thus, it becomes crucial for nursing to plan the assistance of patients undergoing chemotherapy treatments, which enables actions and strategies that meet their physical and psychosocial conditions, aiming to maintain and rehabilitate these people's emotional aspects. PMID:26625999

  20. Predicting Infected Bile Among Patients Undergoing Percutaneous Cholecystostomy

    SciTech Connect

    Beardsley, Shannon L.; Shlansky-Goldberg, Richard D.; Patel, Aalpen; Freiman, David B.; Soulen, Michael C.; Stavropoulos, S. William; Clark, Timothy W.I.

    2005-04-15

    Purpose. Patients may not achieve a clinical benefit after percutaneous cholecystostomy due to the inherent difficulty in identifying patients who truly have infected gallbladders. We attempted to identify imaging and biochemical parameters which would help to predict which patients have infected gallbladders. Methods. A retrospective review was performed of 52 patients undergoing percutaneous cholecystostomy for clinical suspicion of acute cholecystitis in whom bile culture results were available. Multiple imaging and biochemical variables were examined alone and in combination as predictors of infected bile, using logistic regression. Results. Of the 52 patients, 25 (48%) had infected bile. Organisms cultured included Enterococcus, Enterobacter, Klebsiella, Pseudomonas, E. coli, Citrobacter and Candida. No biochemical parameters were significantly predictive of infected bile; white blood cell count >15,000 was weakly associated with greater odds of infected bile (odds ratio 2.0, p = NS). The presence of gallstones, sludge, gallbladder wall thickening and pericholecystic fluid by ultrasound or CT were not predictive of infected bile, alone or in combination, although a trend was observed among patients with CT findings of acute cholecystitis toward a higher 30-day mortality. Radionuclide scans were performed in 31% of patients; all were positive and 66% of these patients had infected bile. Since no patient who underwent a radionuclide scan had a negative study, this variable could not be entered into the regression model due to collinearity. Conclusion. No single CT or ultrasound imaging variable was predictive of infected bile, and only a weak association of white blood cell count with infected bile was seen. No other biochemical parameters had any association with infected bile. The ability of radionuclide scanning to predict infected bile was higher than that of ultrasound or CT. This study illustrates the continued challenge to identify bacterial cholecystitis

  1. Opportunistic microorganisms in patients undergoing antibiotic therapy for pulmonary tuberculosis

    PubMed Central

    Querido, Silvia Maria Rodrigues; Back-Brito, Graziella Nuernberg; dos Santos, Silvana Soléo Ferreira; Leão, Mariella Vieira Pereira; Koga-Ito, Cristiane Yumi; Jorge, Antonio Olavo Cardoso

    2011-01-01

    Antimicrobial therapy may cause changes in the resident oral microbiota, with the increase of opportunistic pathogens. The aim of this study was to compare the prevalence of Candida, Staphylococcus, Pseudomonas and Enterobacteriaceae in the oral cavity of fifty patients undergoing antibiotic therapy for pulmonary tuberculosis and systemically healthy controls. Oral rinsing and subgingival samples were obtained, plated in Sabouraud dextrose agar with chloramphenicol, mannitol agar and MacConkey agar, and incubated for 48 h at 37°C. Candida spp. and coagulase-positive staphylococci were identified by phenotypic tests, C. dubliniensis, by multiplex PCR, and coagulase-negative staphylococci, Enterobacteriaceae and Pseudomonas spp., by the API systems. The number of Candida spp. was significantly higher in tuberculosis patients, and C. albicans was the most prevalent specie. No significant differences in the prevalence of other microorganisms were observed. In conclusion, the antimicrobial therapy for pulmonary tuberculosis induced significant increase only in the amounts of Candida spp. PMID:24031759

  2. Optimization of the radiological protection of patients undergoing digital radiography.

    PubMed

    Zhang, Menglong; Chu, Cunkun

    2012-02-01

    Because of a much higher dynamic range of flat panel detectors, patient dose can vary without change of image quality being perceived by radiologists. This condition makes optimization (OT) of radiation protection undergoing digital radiography (DR) more complex, while a chance to reduced patient dose also exists. In this study, we evaluated the difference of patient radiation and image rejection before and after OT to identify if it is necessary to carry out an OT procedure in a routine task with DR. The study consisted of a measurement of the dose area product (DAP) and entrance surface dose (ESD) received by a reference group of patients for eight common radiographic procedures using the DR system before and after OT. Meanwhile image rejection data during two 2-month periods were collected and sorted according to reason. For every radiographic procedure, t tests showed significant difference in average ESD and DAP before and after OT (p < 0.005). The ESDs from most examinations before OT were three times higher than that after OT. For DAPs, the difference is more significant. Image rejection rate after OT is significantly lower than that before OT (χ (2) = 36.5, p < 0.005). The substantial reductions of dose after OT resulted from appropriate mAs and exposure field. For DR patient dose, less than recommended diagnostic reference level can meet quality criteria and clinic diagnosis. PMID:21725621

  3. Prediction of cardiac risk in patients undergoing vascular surgery

    SciTech Connect

    Morise, A.P.; McDowell, D.E.; Savrin, R.A.; Goodwin, C.A.; Gabrielle, O.F.; Oliver, F.N.; Nullet, F.R.; Bekheit, S.; Jain, A.C.

    1987-03-01

    In an attempt to determine whether noninvasive cardiac testing could be used to assess cardiac risk in patients undergoing surgery for vascular disease, the authors studied 96 patients. Seventy-seven patients eventually underwent major vascular surgery with 11 (14%) experiencing a significant cardiac complication. Thallium imaging was much more likely to be positive (p less than 0.01) in patients with a cardiac complication; however, there was a significant number of patients with cardiac complications who had a positive history or electrocardiogram for myocardial infarction. When grouped by complication and history of infarction, thallium imaging, if negative, correctly predicted low cardiac risk in the group with a history of infarction. Thallium imaging, however, did not provide a clear separation of risk in those without a history of infarction. Age and coronary angiography, on the other hand, did reveal significant differences within the group without a history of infarction. The resting radionuclide ejection fraction followed a similar pattern to thallium imaging. It is concluded that a positive history of myocardial infarction at any time in the past is the strongest risk predictor in this population and that the predictive value of noninvasive testing is dependent on this factor. Considering these findings, a proposed scheme for assessing risk that will require further validation is presented.

  4. Drug therapy in patients undergoing haemodialysis. Clinical pharmacokinetic considerations.

    PubMed

    Lee, C S; Marbury, T C

    1984-01-01

    Haemodialysis is utilised therapeutically as supportive treatment for end-stage renal disease (ESRD). In conjunction with haemodialysis therapy, ESRD patients frequently receive a large number of drugs to treat a multitude of intercurrent conditions. Because of the impaired renal function in ESRD patients, dosage reduction is often recommended to avoid adverse drug reactions, particularly for drugs and active metabolites with extensive renal excretion. On the other hand, if the removal of a drug by haemodialysis during concomitant drug therapy is significant, a dosage supplement would be required to ensure adequate therapeutic efficacy. Knowledge of the impact of haemodialysis on the elimination of specific drugs is therefore essential to the rational design of the dosage regimen in patients undergoing haemodialysis. This review addresses the clinical pharmacokinetic aspects of drug therapy in haemodialysis patients and considers: (a) the effects of ESRD on the general pharmacokinetics of drugs; (b) dialysis clearance and its impact on drug and metabolite elimination; (c) the definition of dialysability and the criteria for evaluation of drug dialysability; (d) pharmacokinetic parameters which are useful in the prediction of drug dialysability; and (e) the application of pharmacokinetic principles to the adjustment of dosage regimens in haemodialysis patients. Finally, drugs commonly associated with haemodialysis therapy are tabulated with updated pharmacokinetics and dialysability information. PMID:6362952

  5. Can patients with schizophrenia undergo renal transplantation with success?

    PubMed

    Bouhlel, Saoussen

    2014-05-01

    We report a case of a 41-year-old man suffering from paranoid schizophrenia. The patient has been consulting in our psychiatric hospital since he was 29 years old. Eight years later, he developed kidney failure and required peritoneal dialysis. After more than two years, the nephrology team indicated a renal transplantation and his brother suggested giving his kidney. There were no obstacles for transplantation in the immune and histological compatibilities; the psychiatric staff decided to check the patient's compliance with medication. The patient was compliant to all his medications and to the salt-free diet after the transplant operation. Few weeks later, he developed steroid-induced diabetes. Through the last two years, he had psychotic exacerbations with major anxiety and fear of losing the transplant. These relapses were managed by increasing doses of antipsychotics without need for hospitalization. At the present time, three years after transplantation, the nephrologists are decreasing the immunosuppressive agents and the steroids. The renal function is optimum and the diabetes is stabilized. This case exemplifies the potential for schizophrenic patients to undergo renal transplantation and to comply with follow-up medical care through a close cooperation between the patient's family, the psychiatric staff and the nephrology team. PMID:24821159

  6. Anxiety Levels in Patients Undergoing Sedation for Elective Upper Gastrointestinal Endoscopy and Colonoscopy

    PubMed Central

    Sargin, Mehmet; Uluer, Mehmet Selcuk; Aydogan, Eyüp; Hanedan, Bülent; Tepe, Muhammed İsmail; Eryılmaz, Mehmet Ali; Ebem, Emre; Özmen, Sadık

    2016-01-01

    Background: Anxiety is a common preprocedural problem and during processing especially in interventional medical processes. Aim: Aim of this study was to assess the level of anxiety in patients who will undergo upper gastrointestinal endoscopy and coloscopy. Methods: Five hundred patients scheduled to undergo sedation for elective upper gastrointestinal endoscopy and colonoscopy were studied. Beck Anxiety Inventory (BAI) was administered to each patient before brought to the endoscopy room. Demographic data of patients were collected. Results: BAI scores and anxiety levels were significantly lower in; males compared to females, patients with no comorbidity compared to patients with comorbidity (both P values < 0.001). BAI scores were significantly lower in patients educational status university and upper compared to patients educational status primary-high school (p=0.026). There were no significant difference between BAI and anxiety levels compared to procedures (Respectively, P=0.144 P=0.054). There were no significant difference between BAI scores and anxiety levels compared to age groups (Respectively, P=0.301 P=0.214). Conclusions: We think that level of anxiety in patients who will undergo upper gastrointestinal endoscopy and colonoscopy was effected by presence of comorbidities and gender but was not effected by features such as age, procedure type and educational status. PMID:27147784

  7. Obstructive sleep apnea affects the clinical outcomes of patients undergoing percutaneous coronary intervention

    PubMed Central

    Zhang, Jun-jie; Gao, Xiao-fei; Ge, Zhen; Jiang, Xiao-Min; Xiao, Ping-xi; Tian, Nai-liang; Kan, Jing; Lee, Chi-Hang; Chen, Shao-Liang

    2016-01-01

    Background There is a paucity of evidence regarding the association between obstructive sleep apnea (OSA) and patients undergoing percutaneous coronary intervention (PCI) for coronary artery disease. We sought to investigate whether OSA affects the clinical outcomes of patients undergoing PCI. Patients and methods All enrolled individuals treated with PCI were evaluated for OSA by polysomnography. The primary end point was defined as major adverse cardiac events (MACEs) at 2 years, including cardiac death, myocardial infarction (MI), and/or target vessel revascularization. Results A total of 340 consecutive patients undergoing PCI were assigned to the OSA (n=152, apnea–hypopnea index ≥15) and non-OSA (n=188, apnea–hypopnea index <15) groups. The incidence of OSA in patients with coronary artery disease undergoing PCI was 44.7%. Patients in the OSA group had more three-vessel disease (34.9%), increased number of total implanted stents (3.3±2.0), and longer total stent length (83.8±53.1 mm) when compared to the non-OSA group (23.4%, P=0.020; 2.8±1.9, P=0.007; 68.7±48.4, P=0.010). After a median follow-up of 2 years, the incidence of MACEs was significantly higher in patients with OSA (25.0% vs 16.0%, P=0.038), mainly driven by the increased periprocedural MI (19.2% vs 11.2%, P=0.038) in the OSA group. By Cox regression multivariable analysis, the independent predictor of MACEs was OSA (hazard ratio: 1.962, 95% confidence interval: 1.036–3.717, P=0.039). Conclusion There was a high prevalence of moderate-to-severe OSA in patients undergoing PCI, and OSA was associated with significantly increased MACE rate, mainly due to the increase in periprocedural MI rate. PMID:27284240

  8. Radiation dose estimation of patients undergoing lumbar spine radiography

    PubMed Central

    Gyekye, Prince Kwabena; Simon, Adu; Geoffrey, Emi-Reynolds; Johnson, Yeboah; Stephen, Inkoom; Engmann, Cynthia Kaikor; Samuel, Wotorchi-Gordon

    2013-01-01

    Radiation dose to organs of 100 adult patients undergoing lumbar spine (LS) radiography at a University Hospital have been assessed. Free in air kerma measurement using an ionization chamber was used for the patient dosimetry. Organ and effective dose to the patients were estimated using PCXMC (version 1.5) software. The organs that recorded significant dose due to LS radiography were lungs, stomach, liver, adrenals, kidney, pancreas, spleen, galbladder, and the heart. It was observed that the stomach recorded the highest dose (48.2 ± 1.2 μGy) for LS anteroposterior (AP). The spleen also recorded the highest dose (41.2 ± 0.5 μGy) for LS lateral (LAT). The mean entrance surface air kerma (ESAK) of LS LAT (122.2 μGy) was approximately twice that of LS AP (76.3 μGy), but the effective dose for both examinations were approximately the same (LS LAT = 8.6 μSv and LS AP = 10.4 μSv). The overall stochastic health effect of radiation to patients due to LS radiography in the University Hospital is independent of the projection of the examination (AP or LAT). PMID:24672153

  9. [QUALITY OF LIFE IN PATIENTS UNDERGOING PROSTATE CRYOABLATION].

    PubMed

    Govorov, A V; Vasil'ev, A O; Pushkar, D Ju

    2015-01-01

    Not long ago, survival rates were the primary outcome measures of surgical management of prostate cancer. Currently, more attention is paid to the quality of life, because even minor changes in the quality of life can lead to serious alterations in the psycho-emotional status and significantly reduce patients' self-esteem. Most experts believe that the quality of life of patients treated for prostate cancer, is mostly affected by urinary incontinence, erectile dysfunction, urethral stricture, and bowel dysfunction. Thanks to advances in the treatment of prostate cancer, the incidence of complications was reduced to a minimum. To some extent, this was due to the use of novel minimally invasive treatment for prostate cancer, such as cryoablation, interstitial brachytherapy and HIFU-therapy. The quality of life in 65 patients undergoing cryoablation of the prostate was evaluated using EORTC QLQ-C30 questionnaire. Analyzing the findings of the survey enabled us to estimate the patients' quality of life, as well as to identify the various components of the postoperative health problems. PMID:26390559

  10. Preoperative levosimendan decreases mortality and the development of low cardiac output in high-risk patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting with cardiopulmonary bypass

    PubMed Central

    Levin, Ricardo; Degrange, Marcela; Del Mazo, Carlos; Tanus, Eduardo; Porcile, Rafael

    2012-01-01

    BACKGROUND: The calcium sensitizer levosimendan has been used in cardiac surgery for the treatment of postoperative low cardiac output syndrome (LCOS) and difficult weaning from cardiopulmonary bypass (CPB). OBJECTIVES: To evaluate the effects of preoperative treatment with levosimendan on 30-day mortality, the risk of developing LCOS and the requirement for inotropes, vasopressors and intra-aortic balloon pumps in patients with severe left ventricular dysfunction. METHODS: Patient with severe left ventricular dysfunction and an ejection fraction <25% undergoing coronary artery bypass grafting with CPB were admitted 24 h before surgery and were randomly assigned to receive levosimendan (loading dose 10 μg/kg followed by a 23 h continuous infusion of 0.1μg/kg/min) or a placebo. RESULTS: From December 1, 2002 to June 1, 2008, a total of 252 patients were enrolled (127 in the levosimendan group and 125 in the control group). Individuals treated with levosimendan exhibited a lower incidence of complicated weaning from CPB (2.4% versus 9.6%; P<0.05), decreased mortality (3.9% versus 12.8%; P<0.05) and a lower incidence of LCOS (7.1% versus 20.8%; P<0.05) compared with the control group. The levosimendan group also had a lower requirement for inotropes (7.9% versus 58.4%; P<0.05), vasopressors (14.2% versus 45.6%; P<0.05) and intra-aortic balloon pumps (6.3% versus 30.4%; P<0.05). CONCLUSION: Patients with severe left ventricle dysfunction (ejection fraction <25%) undergoing coronary artery bypass grafting with CPB who were pretreated with levosimendan exhibited lower mortality, a decreased risk for developing LCOS and a reduced requirement for inotropes, vasopressors and intra-aortic balloon pumps. Studies with a larger number of patients are required to confirm whether these findings represent a new strategy to reduce the operative risk in this high-risk patient population. PMID:23620700

  11. Fibroblast Growth Factor 23 in Patients Undergoing Peritoneal Dialysis

    PubMed Central

    Isakova, Tamara; Xie, Huiliang; Barchi-Chung, Allison; Vargas, Gabriela; Sowden, Nicole; Houston, Jessica; Wahl, Patricia; Lundquist, Andrew; Epstein, Michael; Smith, Kelsey; Contreras, Gabriel; Ortega, Luis; Lenz, Oliver; Briones, Patricia; Egbert, Phyllis; Ikizler, T. Alp; Jueppner, Harald

    2011-01-01

    Summary Background and objectives Fibroblast growth factor 23 (FGF23) is an independent risk factor for mortality in patients with ESRD. Before FGF23 testing can be integrated into clinical practice of ESRD, further understanding of its determinants is needed. Design, setting, participants, & measurements In a study of 67 adults undergoing peritoneal dialysis, we tested the hypothesis that longer dialysis vintage and lower residual renal function and renal phosphate clearance are associated with higher FGF23. We also compared the monthly variability of FGF23 versus parathyroid hormone (PTH) and serum phosphate. Results In unadjusted analyses, FGF23 correlated with serum phosphate (r = 0.66, P < 0.001), residual renal function (r = −0.37, P = 0.002), dialysis vintage (r = 0.31, P = 0.01), and renal phosphate clearance (r = −0.38, P = 0.008). In adjusted analyses, absence of residual renal function and greater dialysis vintage associated with higher FGF23, independent of demographics, laboratory values, peritoneal dialysis modality and adequacy, and treatment with vitamin D analogs and phosphate binders. Urinary and dialysate FGF23 clearances were minimal. In three serial monthly measurements, within-subject variability accounted for only 10% of total FGF23 variability compared with 50% for PTH and 60% for serum phosphate. Conclusions Increased serum phosphate, loss of residual renal function, longer dialysis vintage, and lower renal phosphate clearance are associated with elevated FGF23 levels in ESRD patients undergoing peritoneal dialysis. FGF23 may be a more stable marker of phosphate metabolism in ESRD than PTH or serum phosphate. PMID:21903990

  12. Skull base defect in a patient with ozena undergoing dacryocystorhinostomy

    PubMed Central

    Earley, Marisa A.; Eloy, Jean Anderson

    2011-01-01

    Ozena, which is often used interchangeably with atrophic rhinitis or empty nose syndrome, is a progressive and chronically debilitating nasal disease that results in atrophy of the nasal mucosa, nasal crusting, fetor, and destruction of submucosal structures. Although the etiology is not completely understood, infection with Klebsiella ozaenae is widely believed to contribute to the destructive changes. We present a case of a patient with ozena secondary to K. ozaenae with extensive destruction of bony structures of the nasal cavity undergoing elective dacryocystorhinostomy. An extensively thinned skull base secondary to the disease process resulted in an unforeseen complication in which the skull base was entered leading to a cerebrospinal fluid leak. Patients with known history of ozena or atrophic rhinitis often have extensive destruction of the lateral nasal wall and skull base secondary to progression of disease. Submucosal destruction of these bony structures mandates the need for extreme caution when planning on performing endoscopic intervention at or near the skull base. If physical examination or nasal endoscopy is suspicious for atrophic rhinitis or a patient has a known history of infection with K. ozaenae, we recommend preoperative imaging for surgical planning with careful attention to skull base anatomy. PMID:22852113

  13. Removal of methadone by extended dialysis using a high cut-off dialyzer: implications for the treatment of overdose and for pain management in patients undergoing light chain removal.

    PubMed

    Arelin, Viktor; Schmidt, Julius J; Kayser, Nathalie; Kühn-Velten, W Nikolaus; Suhling, Hendrik; Eden, Gabriele; Kielstein, Jan T

    2016-06-01

    The synthetic opioid methadone hydrochloride has a low molecular weight of 346 D, a high volume of distribution (4 - 7 L/kg), and is lipophilic. It is used as an analgesic and for the maintenance treatment of opiate dependence. In drug addicts, methadone is frequently involved in mixed intoxications that can lead to death. Here we present the case of a drug addict in whom a high cut-off dialysis membrane together with extended dialysis was used in the setting of suspected overdose and acute kidney injury. Although the observed dialyzer plasma clearance (31.5 mL/min) and reduction ratio (38%) were higher than previously reported for standard hemodialysis, the total amount of methadone in the spent dialysate after 1 extended dialysis session was quite low. Hence, even extended dialysis with a high cut-off membrane does not seem to offer a clinically relevant benefit in the setting of overdose for enhanced methadone removal. On the other hand, in patients undergoing high cut-off dialysis for the removal of light chains, methadone could still be used as an analgesic without an additional dose after high cut-off hemodialysis. PMID:27116939

  14. A Phase IIb, Multicenter, Open-Label, Safety, and Efficacy Study of High-Dose, Propylene Glycol-Free Melphalan Hydrochloride for Injection (EVOMELA) for Myeloablative Conditioning in Multiple Myeloma Patients Undergoing Autologous Transplantation.

    PubMed

    Hari, Parameswaran; Aljitawi, Omar S; Arce-Lara, Carlos; Nath, Rajneesh; Callander, Natalie; Bhat, Gajanan; Allen, Lee F; Stockerl-Goldstein, Keith

    2015-12-01

    Autologous stem cell transplantation (ASCT) after high-dose melphalan conditioning is considered a standard of care procedure for patients with multiple myeloma (MM). Current formulations of melphalan (eg, Alkeran for Injection [melphalan hydrochloride]; GlaxoSmithKline, Research Triangle Park, NC, USA) have marginal solubility and limited chemical stability upon reconstitution. Alkeran requires the use of propylene glycol as a co-solvent, which itself has been reported to cause such complications as metabolic/renal dysfunction and arrhythmias. EVOMELA (propylene glycol-free melphalan HCl; Spectrum Pharmaceuticals, Inc., Irvine, CA, USA) is a new i.v. melphalan formulation that incorporates Captisol (Ligand Pharmaceuticals, Inc., La Jolla, CA, USA), a specially modified cyclodextrin that improves the solubility and stability of melphalan and eliminates the need for propylene glycol. This new formulation has been shown to be bioequivalent to Alkeran. EVOMELA (200 mg/m(2)) was administered as 2 doses of 100 mg/m(2) each in a phase IIb, open-label, multicenter study to confirm its safety and efficacy as a high-dose conditioning regimen for patients with MM undergoing ASCT. At 5 centers, 61 patients (26 women) with a median age of 62 years (range, 32-73) were enrolled. All patients achieved myeloablation with a median time of 5 days post-ASCT, and all successfully achieved neutrophil and platelet engraftment with median times of 12 days post-ASCT and 13 days post-ASCT, respectively; treatment-related mortality on day 100 was 0%. Overall response rate (according to independent, blinded review) was high (100%), with an overall complete response rate of 21% (13% stringent complete response; 8% complete response) and overall partial response rate of 79% (61% very good partial response; 18% partial response). The incidence of grade 3 mucositis and stomatitis was low (10% and 5%, respectively) with no grade 4 mucositis or stomatitis reported (graded according to National

  15. RISK OF SEVERE AND REFRACTORY POSTOPERATIVE NAUSEA AND VOMITING IN PATIENTS UNDERGOING DIEP FLAP BREAST RECONSTRUCTION

    PubMed Central

    MANAHAN, MICHELE A.; BASDAG, BASAK; KALMAR, CHRISTOPHER L.; SHRIDHARANI, SACHIN M.; MAGARAKIS, MICHAEL; JACOBS, LISA K.; THOMSEN, ROBERT W.; ROSSON, GEDGE D.

    2014-01-01

    Background Postoperative nausea and vomiting (PONV) are commonly feared after general anesthesia and can impact results. The primary aim of our study was to examine incidence and severity of PONV by investigating complete response, or absence of PONV, to prophylaxis used in patients undergoing DIEP flaps. Our secondary aims were definition of the magnitude of risk, state of the art of interventions, clinical sequelae of PONV, and interaction between these variables, specifically for DIEP patients. Methods A retrospective chart review occurred for 29 patients undergoing DIEP flap breast reconstruction from September 2007 to February 2008. We assessed known patient and procedure-specific risks for PONV after DIEPs, prophylactic antiemetic regimens, incidence, and severity of PONV, postoperative antiemetic rescues, and effects of risks and treatments on symptoms. Results Three or more established risks existed in all patients, with up to seven risks per patient. Although 90% of patients received diverse prophylaxis, 76% of patients experienced PONV, and 66% experienced its severe form, emesis. Early PONV (73%) was frequent; symptoms were long lasting (average 20 hours for nausea and emesis); and multiple rescue medications were frequently required (55% for nausea, 58% for emesis). Length of surgery and nonsmoking statistically significantly impacted PONV. Conclusion We identify previously undocumented high risks for PONV in DIEP patients. High frequency, severity, and refractoriness of PONV occur despite standard prophylaxis. Plastic surgeons and anesthesiologists should further investigate methods to optimize PONV prophylaxis and treatment in DIEP flap patients. PMID:24038427

  16. Dexmedetomidine in Postoperative Analgesia in Patients Undergoing Hysterectomy

    PubMed Central

    Ren, Chunguang; Chi, Meiying; Zhang, Yanwei; Zhang, Zongwang; Qi, Feng; Liu, Zhong

    2015-01-01

    Abstract Both dexmedetomidine and sufentanil modulate spinal analgesia by different mechanisms, and yet no human studies are available on their combination for analgesia during the first 72 hours after abdominal hysterectomy. This CONSORT-prospective, randomized, double-blinded, controlled trial sought to evaluate the safety and efficacy of the combination of dexmedetomidine and sufentanil in intravenous patient-controlled analgesia (PCA) for 72 hours after abdominal hysterectomy. Ninety women undergoing total abdominal hysterectomy were divided into 3 equal groups that received sufentanil (Group C; 0.02 μg/kg/h), sufentanil plus dexmedetomidine (Group D1; 0.02 μg/kg/h, each), or sufentanil (0.02 μg/kg/h) plus dexmedetomidine (0.05 μg/kg/h) (Group D2) for 72 hours after surgery in this double-blinded, randomized study. The primary outcome measure was the postoperative sufentanil consumption, whereas the secondary outcome measures were pain intensity (visual analogue scale), requirement of narcotic drugs during the operation, level of sedation, Bruggrmann comfort scale, and concerning adverse effects. The postoperative sufentanil consumption was significantly lower in Groups D1 and D2 than in Group C during the observation period (P < 0.05), but lower in Group D2 than in Group D1 at 24, 48, and 72 hours after surgery (P < 0.05). The heart rate after intubation and incision was lower in Groups D1 and D2 than in Group C (P < 0.05). On arrival at the recovery room, Groups D1 and D2 had lower mean blood pressure than Group C (P < 0.05). The intraoperative requirement of sevoflurane was 30% lesser in Groups D1 and D2 than in Group C. The sedation levels were greater in Groups D1 and D2 during the first hour (P < 0.05). Compared with Groups C and D1, Group D2 showed lower levels of the overall incidence of nausea and vomiting (P < 0.05). Among the tested PCA options, the addition of dexmedetomidine (0.05 μg/kg/h) and sufentanil (0

  17. A lipidomic analysis approach in patients undergoing lipoprotein apheresis.

    PubMed

    Schmöcker, C; Kassner, U; Kiesler, S; Bismarck, M; Rothe, M; Steinhagen-Thiessen, E; Weylandt, K H

    2016-06-01

    Lipoprotein apheresis such as heparin-induced extracorporal LowDensityLipoprotein (LDL) Cholesterol precipitation (HELP) reduces apolipoprotein B-containing lipoproteins, most importantly low-density-lipoprotein (LDL), and lipoprotein (a) [Lp(a)]. It is used in patients with atherosclerotic disease and therapy-refractory hypercholesterolemia or progressive atherosclerotic disease in patients with elevated Lp(a). While lipid-lowering effects of lipoprotein apheresis are well-established, there are only sparse data regarding the effect of apheresis on individual omega-6 and omega-3 polyunsaturated fatty acids (n-6 PUFA and n-3 PUFA), such as arachidonic acid (AA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which could increase (AA) or decrease (EPA and DHA) cardiovascular risk. Here we analyzed different omega-6 and omega-3 fatty acids in the blood of patients undergoing a single HELP apheresis procedure using gas chromatography (GC). Furthermore, we assessed the effect of HELP treatment on formation of lipid metabolites and mediators arising from these polyunsaturated fatty acids in the plasma by LC/ESI-MS/MS. Lipoprotein apheresis reduced the concentrations of fatty acids analyzed in the plasma by 40-50%. This was similar for AA, EPA and DHA. The reduction in fatty acid plasma levels was similar to the reduction of total triglycerides. However there was a trend towards an increase of PUFA metabolites associated with platelet activation, such as 12-hydroxyeicosatetraenoic acid (12-HETE) and 14-hydroxydocosahexaenoic acid (14-HDHA). These data indicate that HELP apheresis could interfere with achieving higher levels of n-3 PUFA in the plasma. Lipid apheresis treatment might also increase the formation of potentially pro- as well as anti-inflammatory lipid mediators derived from AA or EPA and DHA. PMID:27062407

  18. Dipyridamole-thallium scanning in patients undergoing vascular surgery. Optimizing preoperative evaluation of cardiac risk

    SciTech Connect

    Eagle, K.A.; Singer, D.E.; Brewster, D.C.; Darling, R.C.; Mulley, A.G.; Boucher, C.A.

    1987-04-24

    Dipyridamole-thallium imaging has been suggested as a method of preoperatively assessing cardiac risk in patients undergoing major surgery. To define more clearly its proper role in preoperative assessment, we prospectively evaluated 111 patients undergoing vascular surgery. In the first set of 61 patients, our data confirmed the value of preoperative dipyridamole-thallium scanning in identifying the patients who suffered postoperative ischemic events. Events occurred in eight of 18 patients with reversible defects on preoperative imaging, compared with no events in 43 patients with no thallium redistribution (confidence interval for the risk difference: 0.624, 0.256). The results also suggested that clinical factors might allow identification of a low-risk subset of patients. To test the hypothesis that patients with no evidence of congestive heart failure, angina, prior myocardial infarction, or diabetes do not require further preoperative testing, we evaluated an additional 50 patients having vascular procedures. None of the 23 without the clinical markers had untoward outcomes, while ten of 27 patients with one or more of these clinical markers suffered postoperative ischemic events (confidence interval for the risk difference: 0.592, 0.148). In the clinical high-risk subset, further risk stratification is achieved with dipyridamole-thallium scanning.

  19. Functional Assessments in Patients Undergoing Radial Forearm Flap Following Hemiglossectomy.

    PubMed

    Li, Xiangru; Sun, Qiang; Guo, Shu

    2016-03-01

    Our goal was to evaluate the functional outcomes following radial forearm free-flap reconstruction with a focus on radiotherapy. A 2-year prospective study was performed. A total of 47 patients were enrolled finally. They were asked to complete the swallowing, chewing, speech domains of the University of Washington Quality of Life questionnaire preoperatively and at 2 years postoperatively. Swallowing capacity was apparently affected after surgery, but no patients reported there was chokes cough during eating, the mean score was 51.1 (SD: 21.3). Most patients (70.2%) presented their articulation was good enough for everyday life, and the mean score was 60.0 (SD: 21.1). As for chewing, only 7 (14.9%) patients complained there was negative effect, and the mean score was as high as 92.6 (SD: 18.0). Compared to patients with surgery only, patients with postoperative radiotherapy only had significantly worse swallowing and speech capacity. Compared with patients with postoperative radiotherapy only, patients with both preoperative and postoperative radiotherapy tended to have better swallowing and speech. No significant differences were found between chewing and radiotherapy. In most patients, the results of swallowing, speech, and chewing are favorable. Postoperative radiotherapy has an apparent impact on functional impairment, but preoperative tends to preserve the original tongue function. PMID:26845095

  20. Developing a patient information leaflet to improve information offered to patients undergoing appendicectomy

    PubMed Central

    Smith, Radford; cross, Katie

    2016-01-01

    An appendicectomy is one of the most common operations performed in North Devon District Hospital (NDDH) with over 200 carried out between 2013 to 2014. Despite this, a patient information leaflet (PIL) about appendicectomy is unavailable, which is compromising standards of care and uncompliant with Trust policy. This project aimed to establish levels of written information offered to patients undergoing an appendicectomy, develop a PIL, and assess its impact on the provision of written information using Plan-Do-Study-Act (PDSA) methodology. Case notes of patients operated on between January 2013 to October 2014 were randomly sampled at baseline. The primary outcome measure was whether written information was offered, retrospectively determined by reviewing the medical record. A PIL was then designed following a standard protocol, published on NDDH's website and distributed onto surgical wards. Posters were displayed in staff rooms to encourage use of the PIL for PDSA cycle 1. An article further promoting the PIL was written for the wards monthly newsletter and a local presentation was delivered for PDSA cycle 2. Patients views about the PIL were assessed prospectively using a questionnaire. The primary outcome was measured at 10 weeks following PDSA cycle 1 and at 5 months following PDSA cycle 2. 17% (5/30) of patients were offered written information at baseline. Following PDSA cycle 1, this rose substantially to 53% (8/15) but rates fell to 46% (7/15) following PDSA cycle 2. 89% of patients (8/9) surveyed agreed or strongly agreed that the PIL was helpful. This project indicates that provision of written information is poor despite it being highly valued by patients. The first ever Trust appendicectomy PIL has been established which substantially improved provision of written information after 10 weeks. However, continued education of staff is essential to embed good practice over the long term. PMID:27158496

  1. Developing a patient information leaflet to improve information offered to patients undergoing appendicectomy.

    PubMed

    Smith, Radford; Cross, Katie

    2016-01-01

    An appendicectomy is one of the most common operations performed in North Devon District Hospital (NDDH) with over 200 carried out between 2013 to 2014. Despite this, a patient information leaflet (PIL) about appendicectomy is unavailable, which is compromising standards of care and uncompliant with Trust policy. This project aimed to establish levels of written information offered to patients undergoing an appendicectomy, develop a PIL, and assess its impact on the provision of written information using Plan-Do-Study-Act (PDSA) methodology. Case notes of patients operated on between January 2013 to October 2014 were randomly sampled at baseline. The primary outcome measure was whether written information was offered, retrospectively determined by reviewing the medical record. A PIL was then designed following a standard protocol, published on NDDH's website and distributed onto surgical wards. Posters were displayed in staff rooms to encourage use of the PIL for PDSA cycle 1. An article further promoting the PIL was written for the wards monthly newsletter and a local presentation was delivered for PDSA cycle 2. Patients views about the PIL were assessed prospectively using a questionnaire. The primary outcome was measured at 10 weeks following PDSA cycle 1 and at 5 months following PDSA cycle 2. 17% (5/30) of patients were offered written information at baseline. Following PDSA cycle 1, this rose substantially to 53% (8/15) but rates fell to 46% (7/15) following PDSA cycle 2. 89% of patients (8/9) surveyed agreed or strongly agreed that the PIL was helpful. This project indicates that provision of written information is poor despite it being highly valued by patients. The first ever Trust appendicectomy PIL has been established which substantially improved provision of written information after 10 weeks. However, continued education of staff is essential to embed good practice over the long term. PMID:27158496

  2. Evidence-Based Selection of Sedation Agents for Patients Undergoing Endoscopic Retrograde Cholangiopancreatography.

    PubMed

    Smith, Angela; Silvestro, Loraine; Rodriguez, Ricardo E; Austin, Paul N

    2016-01-01

    Sedating patients undergoing advanced endoscopic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) is challenging for the endoscopy team. Considering these challenges and concerns with the use of propofol for deep sedation of older adults and high-risk patients, colleagues of one of the authors (AS) were interested in the identification of techniques for the anesthetic management of subjects undergoing therapeutic ERCP. A search strategy revealed a total of 7 evidence sources. The appraised evidence examined the efficacy and sedation-related effects of anesthesia regimens. Deep sedation with propofol was identified as the most commonly used anesthetic technique for subjects undergoing therapeutic ERCP. The sedation-related unwanted effects of propofol appear to be dose-related and occur more frequently in the high-risk and elderly populations. However, the data were inconclusive in identifying an ideal agent offering superior efficacy with fewer unwanted sedation-related effects. Providers should strongly consider the subject's age, history of coexisting illness, and the pharmacological effects of selected anesthetic agents when choosing an appropriate anesthetic technique. Larger randomized controlled studies are needed to identify risk factors associated with sedation-related complications and to identify alternative options for the anesthetic management of subjects undergoing ERCP. PMID:26825562

  3. Prevalence of unrecognized diabetes, prediabetes and metabolic syndrome in patients undergoing elective percutaneous coronary intervention

    PubMed Central

    Balakrishnan, Revathi; Berger, Jeffrey S.; Tully, Lisa; Vani, Anish; Shah, Binita; Burdowski, Joseph; Fisher, Edward; Schwartzbard, Arthur; Sedlis, Steven; Weintraub, Howard; Underberg, James A.; Danoff, Ann; Slater, James A.; Gianos, Eugenia

    2015-01-01

    Background Diabetes mellitus (DM) and metabolic syndrome are important targets for secondary prevention in cardiovascular disease. However, the prevalence in patients undergoing elective percutaneous coronary intervention is not well defined. We aimed to analyse the prevalence and characteristics of patients undergoing percutaneous coronary intervention with previously unrecognized prediabetes, diabetes and metabolic syndrome. Methods Data were collected from 740 patients undergoing elective percutaneous coronary intervention between November 2010 and March 2013 at a tertiary referral center. Prevalence of DM and prediabetes was evaluated using Haemoglobin A1c (A1c ≥ 6.5% for DM, A1c 5.7–6.4% for prediabetes). A modified definition was used for metabolic syndrome [three or more of the following criteria: body mass index ≥30 kg/m2; triglycerides ≥ 150 mg/dL; high density lipoprotein <40 mg/dL in men and <50 mg/dL in women; systolic blood pressure ≥ 130 mmHg and/or diastolic ≥ 85 mmHg; and A1c ≥ 5.7% or on therapy]. Results Mean age was 67 years, median body mass index was 28.2 kg/m2 and 39% had known DM. Of those without known DM, 8.3% and 58.5% met A1c criteria for DM and for prediabetes at time of percutaneous coronary intervention. Overall, 54.9% met criteria for metabolic syndrome (69.2% of patients with DM and 45.8% of patients without DM). Conclusion Among patients undergoing elective percutaneous coronary intervention, a substantial number were identified with a new DM, prediabetes, and/or metabolic syndrome. Routine screening for an abnormal glucometabolic state at the time of revascularization may be useful for identifying patients who may benefit from additional targeting of modifiable risk factors. PMID:25728823

  4. Postoperative Adiponectin Levels in Pediatric Patients Undergoing Open Heart Surgery

    PubMed Central

    Thaler, A.; Kanety, H.; Avni, T.; Mishali, D.; Hemi, R.; Yissaschar, E.; Pariente, C.; Paret, G.; Modan-Moses, D.

    2013-01-01

    Background. Adipose tissue is an important endocrine organ that secretes cytokines, including adiponectin, levels of which are negatively correlated with the severity of the inflammatory process. Aim. To assess the time course of adiponectin levels following open heart surgery with cardiopulmonary bypass and its correlation with early postoperative outcomes. Materials and Methods. Blood samples were obtained from 24 children undergoing cardiac surgery and analyzed for adiponectin, C-reactive protein, and other inflammatory markers. Results. Baseline adiponectin levels were negatively correlated with patients' preoperative weight and age. Postoperative adiponectin levels decreased compared to baseline (P = 0.01) and correlated negatively with duration of cardiopulmonary bypass (r = −0.438, P = 0.037), length of stay in the pediatric intensive care unit (r = −0.457, P = 0.025), and the inotropic score (r = −0.471, P = 0.02). Adiponectin levels were positively correlated with sVCAM 1 levels; however, there was no correlation between adiponectin levels and sP selectin, tPA, MCP1, and sCD40. Conclusions. The inflammatory response after open heart surgery with cardiopulmonary bypass is associated with a reduction in adiponectin levels. Prolonged or more complicated surgery induced a more substantial inflammatory process characterized by a significant reduction in adiponectin levels over time and a delayed return to baseline levels. PMID:24224162

  5. Unfermented grape juice reduce genomic damage on patients undergoing hemodialysis.

    PubMed

    Corredor, Zuray; Rodríguez-Ribera, Lara; Coll, Elisabeth; Montañés, Rosario; Diaz, Juan Manuel; Ballarin, José; Marcos, Ricard; Pastor, Susana

    2016-06-01

    Chronic kidney disease (CKD) patients in dialysis (HD) are considered to be submitted to a continuous oxidative stress. This stress can cause damage on DNA and, consequently, contribute to the high levels of DNA damage observed in these patients. Due to the well-known role of polyphenols as antioxidant agents we proposed its use to reduce the levels of genotoxicity present in HD-CKD patients. The objective of this study was to evaluate the antigenotoxic effects of unfermented grape juice (UGJ) on HD-CKD patients. The levels of DNA damage were analyzed using different biomarkers, such as breaks and oxidized DNA bases by the comet assay, chromosome damage by the micronucleus test. In addition, TEAC (Trolox equivalent antioxidant capacity) was also evaluated. Thirty-nine patients were followed for six months, of whom 25 were supplemented by UGJ and 14 were not supplemented. The obtained results showed a significant decrease in the underlying levels of oxidative DNA damage, in the supplemented group. Regarding the clinical parameters, LDL and cholesterol, were significantly reduced in the patients studied after the supplementation period, although cholesterol was also decreased in the non-supplemented patients. In conclusion, in our studied group the supplementation with UGJ reduced the levels of oxidative DNA damage of HD-CKD patients. PMID:27016493

  6. Predictors of stroke in patients undergoing cardiac surgery

    PubMed Central

    dos Santos, Handerson Nunes; Magedanz, Ellen Hettwer; Guaragna, João Carlos Vieira da Costa; dos Santos, Natalia Nunes; Albuquerque, Luciano Cabral; Goldani, Marco Antonio; Petracco, João Batista; Bodanese, Luiz Carlos

    2014-01-01

    Objective To determine the risk factors related to the development of stroke in patients undergoing cardiac surgery. Methods A historical cohort study. We included 4626 patients aged > 18 years who underwent coronary artery bypass surgery, heart valve replacement surgery alone or heart valve surgery combined with coronary artery bypass grafting between January 1996 and December 2011. The relationship between risk predictors and stroke was assessed by logistic regression model with a significance level of 0.05. Results The incidence of stroke was 3% in the overall sample. After logistic regression, the following risk predictors for stroke were found: age 50-65 years (OR=2.11 - 95% CI 1.05-4.23 - P=0.036) and age >66 years (OR=3.22 - 95% CI 1.6-6.47 - P=0.001), urgent and emergency surgery (OR=2.03 - 95% CI 1.20-3.45 - P=0.008), aortic valve disease (OR=2.32 - 95% CI 1.18-4.56 - P=0.014), history of atrial fibrillation (OR=1.88 - 95% CI 1.05-3.34 - P=0.032), peripheral artery disease (OR=1.81 - 95% CI 1.13-2.92 - P=0.014), history of cerebrovascular disease (OR=3.42 - 95% CI 2.19-5.35 - P<0.001) and cardiopulmonary bypass time > 110 minutes (OR=1.71 - 95% CI 1.16-2.53 - P=0.007). Mortality was 31.9% in the stroke group and 8.5% in the control group (OR=5.06 - 95% CI 3.5-7.33 - P<0.001). Conclusion The study identified the following risk predictors for stroke after cardiac surgery: age, urgent and emergency surgery, aortic valve disease, history of atrial fibrillation, peripheral artery disease, history of cerebrovascular disease and cardiopulmonary bypass time > 110 minutes. PMID:25140462

  7. Infiltrative Hepatocellular Carcinoma: Assessment of Factors Associated With Outcomes in Patients Undergoing Hepatectomy.

    PubMed

    Yan, Xiaopeng; Fu, Xu; Deng, Min; Chen, Jun; He, Jian; Shi, Jiong; Qiu, Yudong

    2016-05-01

    Data on infiltrative hepatocellular carcinoma (iHCC) receiving hepatectomy are unclear. Our study assessed the outcomes, effects of anatomical resection, and prognostic factors in a cohort of Chinese patients with iHCC undergoing hepatectomy.Data from 47 patients with iHCC undergoing hepatectomy were analyzed in a retrospective study. Independent prognostic factors of overall survival (OS) and recurrence-free survival (RFS) were identified using univariate and multivariate analyses. Correlations between microvascular invasion (MVI) and clinicopathological features were assessed using the χ test, Student t test, or the Mann-Whitney U test. Survival outcomes were estimated using the Kaplan-Meier method.The median OS was 27.37 months and the 1-year RFS rate were 61.7%. Alpha-fetoprotein (AFP) level was not a specific parameter in iHCC patients undergoing hepatectomy. Anatomic resection was significantly associated with increased RFS (P = 0.007). Patients showing MVI were observed with decreased RFS (P < 0.001). A high lactate dehydrogenase (LDH) level was significantly associated with decreased OS and RFS (P = 0.003 and P = 0.020, respectively). MVI was shown correlated with the levels of aspartate aminotransferase (AST), gamma glutamyl transpeptidase (GGT), and LDH. Subgroup analysis indicated that in mild MVI group, survival outcome was significantly more favorable in patients with high LDH level (P = 0.019).iHCC patients are related with higher MVI rate and patients may still derive survival benefit from anatomic resection at early and intermediate stages. MVI classification could be used to identify iHCC patients with a poorer survival, especially those with a high preoperative LDH level. PMID:27175659

  8. Enhanced Recovery After Surgery Program in Patients Undergoing Pancreaticoduodenectomy

    PubMed Central

    Xiong, Junjie; Szatmary, Peter; Huang, Wei; de la Iglesia-Garcia, Daniel; Nunes, Quentin M.; Xia, Qing; Hu, Weiming; Sutton, Robert; Liu, Xubao; Raraty, Michael G.

    2016-01-01

    -regression analysis. Our study suggested that ERAS was as safe as CPC and improved recovery of patients undergoing PD, thus reducing in-hospital costs. General adoption of ERAS protocols during PD should be recommended. PMID:27149448

  9. Emergence in Elderly Patient Undergoing General Anesthesia with Xenon

    PubMed Central

    Wefki Abdelgawwad Shousha, Ahmed Abdelgawwad; Paparazzo, Antonella

    2013-01-01

    Introduction. It is a consensus that the postoperative cognitive function is impaired in elderly patients after general anaesthesia, and such category patient takes more time to recover. Xenon is a noble gas with anesthetic properties mediated by antagonism of N-methyl-D-aspartate receptors. With a minimum alveolar concentration of 0.63, xenon is intended for maintaining hypnosis with 30% oxygen. The fast recovery after xenon anaesthesia was hypothesized to be advantageous in this scenario. Case Presentation. We report the case of 99-year-old woman who underwent sigmoid colon carcinoma resection with colorectal anastomosis. We carried out the induction phase by propofol, oxygen, fentanil, and rocuronium bromide, and then we proceeded to a rapid sequence endotracheal intubation consequently. The patient was monitored by IBP, NIBP, ECG, cardiac frequency, respiratory rate, capnometry, TOF Guard, blood gas analysis, and BIS. For maintenance we administrated oxygen, remifentanil, rocuronium bromide, and xenon gas 60–65%. Shortly after the end of surgery the patients started an autonomous respiratory activity, and a high BIS level was also recorded. Decision was made by our team to proceed into the emergence phase. The residual neuromuscular block was antagonized by sugammadex, modified Aldrete score was implicated, and we got our patient fully awake without any cognitive dysfunction or delirium. Conclusion. The rapid emergence to full orientation in very elderly patient who had been anesthetized by xenon shows concordance to the high BIS values and the clinical signs of the depth of anesthesia. PMID:23762640

  10. Clearance and synthesis rates of beta 2-microglobulin in patients undergoing hemodialysis and in normal subjects

    SciTech Connect

    Floege, J.; Bartsch, A.; Schulze, M.; Shaldon, S.; Koch, K.M.; Smeby, L.C. )

    1991-08-01

    Retention of {beta} 2-microglobulin in patients undergoing hemodialysis is associated with a {beta} 2-microglobulin-derived amyloidosis. Removal of {beta} 2-microglobulin by renal replacement therapy has been proposed for the prevention of this amyloidosis. Currently, however, data on the {beta} 2-microglobulin synthesis rate in patients undergoing hemodialysis are scarce, and consequently it remains speculative how much removal would be necessary to counterbalance synthesis. The plasma kinetics of iodine 131-labeled {beta} 2-microglobulin were therefore examined in 11 patients with anuria who were undergoing long-term hemodialysis. Five healthy persons served as controls. Kinetic modeling of the plasma curves showed that the data fitted a two-pool model (r2 greater than 0.96) consisting of a rapid 2 to 4 hour distribution phase followed by a less steep curve, described by the plasma (metabolic) clearance (Clp). Synthetic rates were calculated from Clp and the {beta} 2-microglobulin steady state plasma concentration (plus {beta} 2-microglobulin removal during hemodialysis in the case of high flux hemodialysis). The results showed a significantly higher Clp in normal controls as compared with patients undergoing hemodialysis (65.5 {plus minus} 12.8 ml/min (mean {plus minus} SD) versus 3.4 {plus minus} 0.7 ml/min). In contrast, the {beta} 2-microglobulin synthesis rate in the patient group (3.10 {plus minus} 0.79 mg/kg/day) was not significantly different from that of normal controls (2.40 {plus minus} 0.67 mg/kg/day), which was due to markedly elevated {beta} 2-microglobulin plasma concentrations in the patients (37.6 {plus minus} 14.1 mg/L vs 1.92 {plus minus} 0.27 mg/L). These findings suggest that the presence of end-stage renal disease does not have a significant impact on the beta 2-microglobulin generation rate.

  11. Glycated Albumin Predicts Long-term Survival in Patients Undergoing Hemodialysis

    PubMed Central

    Lu, Chien-Lin; Ma, Wen-Ya; Lin, Yuh-Feng; Shyu, Jia-Fwu; Wang, Yuan-Hung; Liu, Yueh-Min; Wu, Chia-Chao; Lu, Kuo-Cheng

    2016-01-01

    Background: In patients with advanced renal dysfunction undergoing maintenance hemodialysis, glycated albumin (GA) levels may be more representative of blood glucose levels than hemoglobin A1C levels. The aim of this study was to determine the predictive power of GA levels on long-term survival in hemodialysis patients. Methods: A total of 176 patients with a mean age of 68.2 years were enrolled. The median duration of follow-up was 51.0 months. Receiver-operating characteristic curve analysis was utilized to determine the optimal cutoff value. We examined the cumulative survival rate by Kaplan-Meier estimates and the influence of known survival factors with the multivariate Cox proportional-hazard regression model. Results: In the whole patient group, cumulative survival in the low GA group was better than in the high GA group (p=0.030), with more prominence in those aged <70 years (p=0.029). In subgroup analysis, both diabetic (DM) and non-DM patients with low GA had a better cumulative survival compared with those with high GA. The risk of mortality increased by 3.0% for each 1% increase in serum GA level in all patients undergoing hemodialysis. Conclusions: In addition to serving as a glycemic control marker, GA levels may be useful for evaluating the risk of death in both DM and non-DM patients on hemodialysis. PMID:27226780

  12. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis.

    PubMed

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-07-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life. PMID:27512289

  13. Mucositis and salivary antioxidants in patients undergoing bone marrow transplantation (BMT)

    PubMed Central

    Mazzeo, Marcelo A.; López, María M.; Linares, Jorge A.; Jarchum, Gustavo; Wietz, Fernando M.; Finkelberg, Ana B.

    2014-01-01

    Objectives: High doses of chemotherapy generate DNA damage in patients undergoing bone marrow transplantation (BMT), due to the production of reactive oxygen species (ROS). In order to evaluate the local defensive effectiveness of the patient undergoing BMT, the concentrations of the antioxidants superoxide dismutase (SOD) and uric acid (UA) were measured in saliva. Study Design: Basal saliva samples were collected from 20 patients undergoing BMT at the Oncology Department, Sanatorio Allende (Córdoba), in the stages: initial, prior to conditioning therapy (I); middle: 7 to 10 days after BMT (M) and final stage, 30 days after discharge from isolation (F). SOD levels were determined using a RANDOX kit (RANSOD superoxide dismutase manual), and for uric acid enzymatic UOD / PAP spectrophotometric method, ( Trinder Color Kit , Wiener Lab) was used. Results: 85% of the patients developed oral mucositis. SOD concentration in the M stage was significantly higher (p<0.01) compared with stage I, and it reversed in stage F. UA concentration was significantly lower (p<0.001) in stage M compared with stage I, and in stage F it recovered the initial values. Conclusions: SOD increase in stage M coincided with the appearance of mucositis, which could be interpreted as a defensive mechanism of saliva against oxidative stress produced by chemotherapy. UA decrease in stage M would favour the development of higher degrees of mucositis. Key words:Bone marrow transplantation, mucositis, superoxide dismutase, uric acid. PMID:24608218

  14. A systematic review of sleep disorders in patients with chronic kidney disease undergoing hemodialysis

    PubMed Central

    Fonseca, Nina Teixeira; Urbano, Jessica Julioti; Nacif, Sergio Roberto; Silva, Anderson Soares; Peixoto, Roger Andre Oliveira; Urbano, Giovanni Julioti; Oliveira, Ezequiel Fernandes; Santos, Israel Reis; Oliveira, Claudia Santos; Insalaco, Giuseppe; Oliveira, Luis Vicente Franco

    2016-01-01

    The purpose of this study was to conduct a systematic review of the available evidence on sleep disorders in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD). [Subjects and Methods] Two independent reviewers performed a computer-assisted search of the MEDLINE, SciELO, LILACS, and BIREME Virtual Health Library medical databases from their inception to November 2015. [Results] One thousand one hundred twenty-six articles were found that met the inclusion criteria. Articles were excluded if they were not in English, the patients did not undergo HD, or the studies were not cross-sectional or clinical trials. After reading the full text, a further 300 studies were excluded because they did not use polysomnography. The remaining 18 studies with ESRD patients undergoing HD comprised 8 clinical trials and 10 cross-sectional studies. This systematic review followed the criteria outlined by the PRISMA declaration. [Conclusion] In this systematic review, a high prevalence of sleep disorders was observed in ESRD, including sleep-disordered breathing. This knowledge may enable health professionals to devise new strategies for the diagnosis and treatment of these patients, in order to reduce morbidity and mortality and improve their quality of life. PMID:27512289

  15. Motivational enhancement for 12-step involvement among patients undergoing alcohol detoxification.

    PubMed

    Kahler, Christopher W; Read, Jennifer P; Ramsey, Susan E; Stuart, Gregory L; McCrady, Barbara S; Brown, Richard A

    2004-08-01

    Forty-eight patients undergoing inpatient detoxification for alcohol dependence were assigned to either brief advice (BA) to attend Alcoholics Anonymous or a motivational enhancement for 12-step involvement (ME-12) intervention that focused on increasing involvement in 12-step self-help groups. Attendance at 12-step groups did not differ significantly by treatment condition over 6 months of follow-up, nor did drinking outcomes. There was a significant interaction between 12-step experience and treatment condition, indicating that ME-12 was associated with relatively better alcohol outcomes at the low ends of 12-step experience, whereas BA was associated with relatively better outcomes at the high ends of 12-step experience. Results indicate that among patients undergoing alcohol detoxification, ME-12 may be beneficial only for those who have little experience with 12-step groups. PMID:15301659

  16. Plasma MicroRNA-21 Predicts Postoperative Pulmonary Complications in Patients Undergoing Pneumoresection

    PubMed Central

    Liu, Yaling; Li, Peiying; Cheng, Xinyu; Yu, Weifeng; Yang, Liqun; Zhu, Hui

    2016-01-01

    Postoperative pulmonary complication (PPC) remains the most common postoperative complication in patients undergoing noncardiac thoracic surgery. We conducted the clinical study to determine the diagnostic role of miRNA-21 in noncardiac thoracic surgery. 368 patients undergoing noncardiac thoracic surgery were recruited. Blood samples were collected before anesthesia and 2 hours after incision during surgery for RT-PCR measurement of miRNA-21. PPC occurrence, extrapulmonary complications, duration of ICU stay, and death within 1 year were evaluated. The overall rate of PPCs following surgery was 10.32%. A high relative miRNA-21 level was an independent risk factor for PPCs within 7 days (OR, 2.69; 95% CI, 1.25–5.66; and P < 0.001). High miRNA-21 was also associated with an increased risk of extrapulmonary complications (OR, 3.62; 95% CI, 2.26–5.81; and P < 0.001), prolonged ICU stay (OR, 6.54; 95% CI, 2.26–18.19; and P < 0.001), increased death within 30 days (OR, 6.17; 95% CI, 2.11–18.08; and P < 0.001), and death within 1 year (OR, 7.30; 95% CI, 2.76–19.28; and P < 0.001). In summary, plasma miRNA-21 may serve as a novel biomarker of PPCs for patients undergoing noncardiac thoracic surgery. PMID:27293316

  17. Vocal changes in patients undergoing radiation therapy for glottic carcinoma.

    PubMed

    Miller, S; Harrison, L B; Solomon, B; Sessions, R B

    1990-06-01

    A prospective evaluation of vocal changes in patients receiving radiation therapy for T1 and T2 (AJC) glottic carcinoma was undertaken in January 1987. Vocal analysis was performed prior to radiotherapy and at specific intervals throughout the radiation treatment program. The voicing ratio was extrapolated from a sustained vowel phonation using the Visipitch interfaced with the IBM-PC. Preliminary observations suggested three distinct patterns of vocal behavior: 1. reduced voicing ratio with precipitous improvement within the course of treatment, 2. high initial voicing ratio with reduction secondary to radiation induced edema, with rapid improvement in the voicing component after the edema subsided, and 3. fluctuating voicing ratio during and following treatment. Enrollment of new patients and a 2-year follow-up of current patients was undertaken. PMID:2348739

  18. Vocal changes in patients undergoing radiation therapy for glottic carcinoma

    SciTech Connect

    Miller, S.; Harrison, L.B.; Solomon, B.; Sessions, R.B. )

    1990-06-01

    A prospective evaluation of vocal changes in patients receiving radiation therapy for T1 and T2 (AJC) glottic carcinoma was undertaken in January 1987. Vocal analysis was performed prior to radiotherapy and at specific intervals throughout the radiation treatment program. The voicing ratio was extrapolated from a sustained vowel phonation using the Visipitch interfaced with the IBM-PC. Preliminary observations suggested three distinct patterns of vocal behavior: 1. reduced voicing ratio with precipitous improvement within the course of treatment, 2. high initial voicing ratio with reduction secondary to radiation induced edema, with rapid improvement in the voicing component after the edema subsided, and 3. fluctuating voicing ratio during and following treatment. Enrollment of new patients and a 2-year follow-up of current patients was undertaken.

  19. Composition of joint fluid in patients undergoing total knee replacement and revision arthroplasty: correlation with flow properties.

    PubMed

    Mazzucco, Dan; Scott, Richard; Spector, Myron

    2004-08-01

    The protein, phospholipid and hyaluronic acid (HA) contents of joint fluid samples were determined in specimens obtained from patients undergoing total knee arthroplasty (TKA) and revision TKA. It was hypothesized that these components would vary widely among patients undergoing TKA, and that the composition of joint fluid in patients undergoing revision would differ from that in patients undergoing revision. It was further hypothesized that HA concentration and molecular weight would principally determine the flow properties previously reported. Biochemical assays were used to assess protein and phospholipid content, and size exclusion chromatography was used to determine HA concentration and molecular weight. Sixty samples were included in the study. HA, protein, and phospholipid concentrations all varied widely in patients undergoing index TKA and revision TKA. HA concentration was lower in patients undergoing revision arthroplasty due to wear-related failure compared to patients undergoing the index procedure (0.9 +/- 0.4 mg/ml versus 1.3 +/- 0.5 mg/ml, mean +/- standard deviation, p = 0.04). Other components were not different between the groups. Flow properties at high shear rates were correlated with HA concentration and, to a lesser extent, HA molecular weight, but neither protein nor phospholipid concentration. The composition of joint fluid is highly variable in the context of arthroplasty. Much of the variation in flow properties, especially at high shear rate, is explained by large variation in HA concentration and small variation in HA molecular weight. The variation in composition and lower HA concentration in joints necessitating revision may relate to variation in arthroplasty lubrication leading to highly variable wear rates and clinical outcomes. PMID:15046934

  20. Pharmacokinetics and dialysability of naltrexone in patients undergoing hemodialysis.

    PubMed

    Kambia, Nicolas K; Dine, Thierry; Odou, Pascal; Bah, Salmane; Azar, Raymond; Gressier, Bernard; Dupin-Spriet, Thérèse; Luyckx, Michel; Brunet, Claude

    2004-01-01

    The disposition of naltrexone (NLT) (REVIA), an opioid antagonist intended for patients with impaired renal function and with severe intractable itching refractory to regular antipruritic therapy, was characterized. Hemodialysis effects on both efficacy and elimination of NLT also were assessed. We developed a simple, sensitive and selective reverse-phase high-performance liquid chromatographic (HPLC) method for measuring NLT plasma concentration in hemodialysis patients treated to relieve pruritus. NLT and the internal standard, naloxone (NLX) were extracted from plasma using a solid-phase extraction method with sep-pack C18 cartridge. The method was employed to determine both naltrexone pharmacokinetics and dialysability parameters during 4-h in dialyzed patients with chronic renal impairment. Thus, seven patients (2 men, 5 women) with end-stage renal disease and pruritus on regular hemodialysis were included. They received one tablet of NLT (Revia, 50 mg) orally prior dialysis session. The Cmax at the inlet and at the outlet the dialyzer were higher (255+/-117 ng/mL and 206+/-137 ng/ml respectively) in comparison with healthy subjects (9 - 44 ng/mL). The decrease hepatic first-pass metabolism of NLT consecutive to end-stage renal disease and the renal impairment could explain the increased levels of the drug in plasma. Tmax before and after dialysis plates remain unchanged as healthy subjects (approximately 1h). With regard to dialysability, a high dialyzer extraction ratio averating 30 % was found with a low dialysis clearance of 58.70+/-17 mL/min. The amount removed by dialysis is only 1.27 mg. We concluded that hemodialysis has little effect on NLT blood levels, and consequently on drug pharmacokinetics, when the drug is delivered to dialyzed patients following oral route. Thus, dosage adjustement is not required in the presence of advanced dialysis-dependant renal failure. In patients with end-stage renal disease, hemodialysis does not result in clinically

  1. Mortality in patients with ST-segment elevation myocardial infarction who do not undergo reperfusion.

    PubMed

    Wood, Frances O; Leonowicz, Nicholas A; Vanhecke, Thomas E; Dixon, Simon R; Grines, Cindy L

    2012-08-15

    Reperfusion therapy reduces mortality in patients presenting with ST-segment elevation myocardial infarctions (STEMI). However, some patients may not receive thrombolytic therapy or undergo primary percutaneous coronary intervention. The decision making and clinical outcomes of these patients have not been well described. In this study, 139 patients were identified from a total of 1,126 patients with STEMI who did not undergo reperfusion therapy at a high-volume percutaneous coronary intervention center from October 2006 to March 2011. Clinical data, reasons for no reperfusion, management, and mortality were obtained by chart review. The mean age was 80 ± 13 years (61% women, 31% diabetic, and 37% known coronary artery disease). Of the 139 patients, 72 (52%) presented with primary diagnoses other than STEMI, and 39 (28%) developed STEMI >24 hours after admission. The most common reasons for no reperfusion were advanced age, co-morbid conditions, acute or chronic kidney injury, delayed presentation, advance directives precluding reperfusion, patient preference, and dementia. Eighty-four patients (60%) had ≥ 3 reasons for no reperfusion. Factors associated with hospital mortality were cardiogenic shock, intubation, and advance directives prohibiting reperfusion after physician consultation. In hospital and 1-year mortality were 53% and 69%, respectively. In conclusion, at a high-volume percutaneous coronary intervention center, most patients presenting with STEMI underwent immediate catheterization. The decision for no reperfusion was multifactorial, with advanced age reported as the most common factor. Outcomes were poor in this population, and fewer than half of these patients survived to hospital discharge. PMID:22633204

  2. Pharmacokinetic-directed high-dose busulfan combined with cyclophosphamide and etoposide results in predictable drug levels and durable long-term survival in lymphoma patients undergoing autologous stem cell transplantation.

    PubMed

    Zhang, Hongzheng; Graiser, Michael; Hutcherson, Donald A; Dada, M Olufemi; McMillan, Stephanie; Ali, Zahir; Flowers, Christopher R; Waller, Edmund K

    2012-08-01

    The clinical advantage of pharmacokinetic (PK)-directed-based dosing on intravenous (i.v.) versus oral busulfan-related toxicity and survival remains unclear. We performed a retrospective cohort study of sequential cohorts of patients comparing PK-directed oral and i.v. busulfan-based conditioning regimens in lymphoma patients undergoing autologous hematopoietic cell transplantation (ASCT). Patients received oral (n = 95), every 6 hours i.v. (IV16, n = 113), or once-daily i.v. (IV4, n = 86) busulfan, cyclophosphamide, and etoposide. PK-directed dosing was performed to achieve a predefined target area under the curve (AUC) of 20,000 μM-min (range: 18,400-21,600 μM-min). PK-directed dose adjustments markedly reduced the number of patients in the oral group with total AUC higher than the targeted AUC range, and reduced the variations of total AUC values in all patient groups. One hundred-day mortality was 2.1%, 3.6%, and 3.5% for oral, IV16, and IV4 cohorts, respectively. Five-year overall survival (OS) was 57% (95% confidence interval [CI] 45%-66%) and 64% (95% CI 53%-73%) for patients who received oral and i.v. busulfan, respectively. Both multivariable and instrumental variable analyses indicated the route of delivery had no significant impact on OS, whereas refractory disease and age ≥55 were significantly associated with poorer OS. In lymphoma patients undergoing ASCT, PK-directed i.v. or oral busulfan-based conditioning regimens have comparable toxicity and OS. PMID:22370160

  3. Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery

    PubMed Central

    Doger, Cihan; Kahveci, Kadriye; Ornek, Dilsen; But, Abdulkadir; Aksoy, Mustafa; Gokcinar, Derya; Katar, Didem

    2016-01-01

    Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n = 30) and low-flow sevoflurane anesthesia group (Group L, n = 30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy. PMID:27413741

  4. Effects of Low-Flow Sevoflurane Anesthesia on Pulmonary Functions in Patients Undergoing Laparoscopic Abdominal Surgery.

    PubMed

    Doger, Cihan; Kahveci, Kadriye; Ornek, Dilsen; But, Abdulkadir; Aksoy, Mustafa; Gokcinar, Derya; Katar, Didem

    2016-01-01

    Objective. The aim of this prospective, randomized study was to investigate the effects of low-flow sevoflurane anesthesia on the pulmonary functions in patients undergoing laparoscopic cholecystectomy. Methods. Sixty American Society of Anesthesiologists (ASA) physical status classes I and II patients scheduled for elective laparoscopic cholecystectomy were included in the study. Patients were randomly allocated to two study groups: high-flow sevoflurane anesthesia group (Group H, n = 30) and low-flow sevoflurane anesthesia group (Group L, n = 30). The fresh gas flow rate was of 4 L/min in high-flow sevoflurane anesthesia group and 1 L/min in low-flow sevoflurane anesthesia group. Heart rate (HR), mean arterial blood pressure (MABP), peripheral oxygen saturation (SpO2), and end-tidal carbon dioxide concentration (ETCO2) were recorded. Pulmonary function tests were performed before and 2, 8, and 24 hours after surgery. Results. There was no significant difference between the two groups in terms of HR, MABP, SpO2, and ETCO2. Pulmonary function test results were similar in both groups at all measurement times. Conclusions. The effects of low-flow sevoflurane anesthesia on pulmonary functions are comparable to high-flow sevoflurane anesthesia in patients undergoing laparoscopic cholecystectomy. PMID:27413741

  5. [Clinical study of patients undergoing paperless electroencephalography in emergency room].

    PubMed

    Inoue, Takeshi; Kawawaki, Hisashi; Nukui, Megumi; Kuki, Ichiro; Okazaki, Shin; Tomiwa, Kiyotaka; Amo, Kiyoko; Togawa, Masao; Rinka, Hiroshi; Shiomi, Masashi

    2012-07-01

    Fifty-eight patients who visited the emergency room of our center with febrile convulsions and impaired consciousness, and underwent paperless electroencephalography soon after arrival. They consisted of 25 male and 33 female children, ranging in age from 5 months to 15 years and 4 months, with a mean age of 4 years and 10 months. The final diagnoses were poor responsiveness associated with fever and febrile delirium in 5 patients, febrile convulsions in 26, encephalitis/encephalopathy in 24, convulsions associated with mild gastroenteritis in 2, and aseptic meningitis in 1. The appearance of spindle wave within 24 hours after admission was considered to be a favorable prognostic factor, whereas generalized high-amplitude delta waves without fast-wave components and dysrhythmic flat basic waves were considered poor prognostic factors. We conclude that bed-side paperless electroencephalography is useful for the evaluation of changes in the brain function and course of treatment. PMID:22844762

  6. Sarcopenia and Sarcopenic Obesity in Patients Undergoing Orthopedic Surgery

    PubMed Central

    Ji, Hyung-Min; Han, Jun; Jin, Dong San; Suh, Hyunseok; Chung, Yoon-Sok

    2016-01-01

    Background The purpose of this retrospective study was to determine the prevalence of sarcopenia and sarcopenic obesity among patients who underwent orthopedic surgery (OS). Methods A total of 222 patients were reviewed immediately after or prior to OS. In the control group, 364 patients from outpatient departments (OPDs) who did not have any OS were enrolled. Whole-body dual-energy X-ray absorptiometry was used to analyze body composition. Skeletal muscle mass was adjusted for height squared, total body weight, and height and fat mass (residuals). Obesity was defined as body mass index (BMI) > 25.0 kg/m2. Results The prevalence of sarcopenia in the OS group was 25.7%, 44.1%, and 26.6%, respectively, according to the 3 different criteria. The prevalence was significantly lower in the OPD group (6.0%, 33.1%, and 14.8%, respectively). The highest rates of sarcopenia with height-adjusted definition were seen in patients with a femoral neck fracture. In the multivariate analysis, factors associated with sarcopenia were male gender, older age, and lower BMI (odds ratio [OR]: 28.38, 1.03, and 1.83, respectively) when muscle mass was adjusted for height, whereas male gender, older age, and higher BMI were associated with sarcopenia (OR: 1.04, 2.57, and 1.83, respectively) when adjusted for weight. When residuals were used as a cutoff, decreased BMI and total hip bone mineral density (0.1 g/cm2) were independent risk factors associated with sarcopenia (OR: 1.09 and 1.05). The prevalence of sarcopenic obesity ranged from 1.8% to 21.2%. Conclusions Our study demonstrated a high prevalence of sarcopenia among OS patients. PMID:27247746

  7. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review.

    PubMed

    Oliver, C M; Walker, E; Giannaris, S; Grocott, M P W; Moonesinghe, S R

    2015-12-01

    Emergency laparotomies are performed commonly throughout the world, but one in six patients die within a month of surgery. Current international initiatives to reduce the considerable associated morbidity and mortality are founded upon delivering individualised perioperative care. However, while the identification of high-risk patients requires the routine assessment of individual risk, no method of doing so has been demonstrated to be practical and reliable across the commonly encountered spectrum of presentations, co-morbidities and operative procedures. A systematic review of Embase and Medline identified 20 validation studies assessing 25 risk assessment tools in patients undergoing emergency laparotomy. The most frequently studied general tools were APACHE II, ASA-PS and P-POSSUM. Comparative, quantitative analysis of tool performance was not feasible due to the heterogeneity of study design, poor reporting and infrequent within-study statistical comparison of tool performance. Reporting of calibration was notably absent in many prognostic tool validation studies. APACHE II demonstrated the most consistent discrimination of individual outcome across a variety of patient groups undergoing emergency laparotomy when used either preoperatively or postoperatively (area under the curve 0.76-0.98). While APACHE systems were designed for use in critical care, the ability of APACHE II to generate individual risk estimates from objective, exclusively preoperative data items may lead to better-informed shared decisions, triage and perioperative management of patients undergoing emergency laparotomy. Future endeavours should include the recalibration of APACHE II and P-POSSUM in contemporary cohorts, modifications to enable prediction of morbidity and assessment of the impact of adoption of these tools on clinical practice and patient outcomes. PMID:26537629

  8. Impact of body mass index on outcomes of 48281 patients undergoing first time cadaveric liver transplantation

    PubMed Central

    Ayloo, Subhashini; Hurton, Scott; Cwinn, Matthew; Molinari, Michele

    2016-01-01

    AIM: To investigate possible disparities in perioperative morbidity and mortality among different body mass index (BMI) groups and to simulate the impact that these differences might have had on the cohort of patients undergoing cadaveric liver transplantation (LT). METHODS: All adult recipients undergoing first time LT for benign conditions and receiving a whole graft from brain-dead donors were selected from the united network of organ sharing registry. From January 1994 to June 2013, 48281 patients satisfied the inclusion criteria and were stratified by their BMI. The hypothesis that abnormal BMIs were independent predictors of inferior outcomes was tested with univariate and multivariate regression analyses. RESULTS: In comparison to normal weight recipients, underweight and morbidly obese recipients had increased 90-d mortality (adjusted OR = 1.737; 95%CI: 1.185-2.548, P = 0.005) (adjusted OR = 1.956; 95%CI: 1.473-2.597, P = 0.000) respectively and inferior patients’ survivals (adjusted HR = 1.265; 95%CI: 1.096-1.461, P = 0.000) (adjusted HR = 1.157; 95%CI: 1.031-1.299, P = 0.013) respectively. Overall, patients’ 5-year survival were 73.9% for normal-weight, 71.1% for underweight, 74.0% for overweight, 74.4% for class I obese, 75.0% for class II obese and 71.5% for class III obese recipients. Analysis of hypothetical exclusion of underweight and morbidly obese patients from the pool of potential LT candidates would have improved the overall survival of the entire cohort by 2.7% (95%CI: 2.5%-3.6%). CONCLUSION: Selected morbidly obese patients undergoing LT for benign conditions had 5-year survival rates clinically comparable to normal weight recipients. Impact analysis showed that exclusion of high-risk recipients (underweight and morbid obese patients) would not significantly improve the overall survival of the entire cohort of patients requiring LT. PMID:27358781

  9. Spinal anesthesia reduces postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting.

    PubMed

    Tabatabaie, O; Matin, N; Heidari, A; Tabatabaie, A; Hadaegh, A; Yazdanynejad, S; Tabatabaie, K

    2015-01-01

    We investigated the effect of high spinal anesthesia on postoperative delirium in opium dependent patients undergoing coronary artery bypass grafting (CABG). The study was conducted in a tertiary referral university hospital on a population of 60 opium dependent patients undergoing CABG surgery. Patients were divided into two groups based on anesthesia protocol. One group were given general anesthesia (GA Group), the other group additionally received intrathecal morphine and bupivacaine (SGA Group). Postoperative delirium (POD) was defined as the main outcome of interest. Incidence of POD was significantly higher in patients of GA Group as compared with those in SGA Group (47% and 17% for GA and SGA respectively; P-value = 0.01). Time to extubation was on average 2.2 h shorter in SGA than in GA (7.1 h and 9.3 h respectively, P-value < 0.001). Intrathecal morphine and bupivacaine reduced the risk of POD after CABG in a population of opium dependent patients. PMID:26455008

  10. Radiation exposure to caregivers from patients undergoing common radionuclide therapies: a review.

    PubMed

    Stefanoyiannis, A P; Ioannidou, S P; Round, W H; Carinou, E; Mavros, M N; Liotsou, T; Geronikola-Trapali, X; Armeniakos, I; Chatziioannou, S N

    2015-12-01

    The contribution of radionuclide therapies (RNTs) to effective patient treatment is widely appreciated. The administration of high doses has necessitated investigating the potential radiation hazard to caregivers from patients undergoing RNTs. This work aimed to review the literature regarding measured effective doses to caregivers from such patients. The main selection criterion was the presence of real radiation exposure measurements. The results were categorised according to the treatment protocol and dose parameters. Analysis of the collected data demonstrated that the measured effective dose values were within the dose constraints defined by the International Commission on Radiological Protection, provided that the radiation protection instructions were followed by both patients and caregivers. In conclusion, the radiation risk for caregivers was almost negligible. In this context, treatments could be administered more often on an outpatient basis, once cost-effectiveness criteria were established and radiation protection training and procedures were appropriately applied. PMID:25431487

  11. Hospital volume influences outcome in patients undergoing pancreatic resection for cancer.

    PubMed Central

    Glasgow, R E; Mulvihill, S J

    1996-01-01

    Surgical resection is the only possibly curative treatment of malignant pancreatic neoplasms, but major pancreatic resection for cancer is associated with high rates of morbidity and mortality. The objective of this study was to determine the relation between hospital volume and outcome in patients undergoing pancreatic resection for malignancy in California. Data were obtained from reports submitted to the Office of Statewide Health Planning and Development by all California hospitals from 1990 through 1994. Patient abstracts were analyzed for each of 1,705 patients who underwent major pancreatic resection for malignancy. Of the 298 reporting hospitals, 88% treated fewer than 2 patients per year; these low-volume centers treated the majority of patients. High-volume providers had significantly decreased operative mortality, complication-associated mortality, patient resource use, and total charges and were more likely than low-volume centers to discharge patients to home. These differences were not accounted for by patient mix. This study supports the concept of regionalizing high risk procedures in general surgery, such as major pancreatic resection for cancer. PMID:8993200

  12. Red cell distribution width in anemic patients undergoing transcatheter aortic valve implantation

    PubMed Central

    Hellhammer, Katharina; Zeus, Tobias; Verde, Pablo E; Veulemanns, Verena; Kahlstadt, Lisa; Wolff, Georg; Erkens, Ralf; Westenfeld, Ralf; Navarese, Eliano P; Merx, Marc W; Rassaf, Tienush; Kelm, Malte

    2016-01-01

    AIM: To determine the impact of red blood cell distribution width on outcome in anemic patients undergoing transcatheter aortic valve implantation (TAVI). METHODS: In a retrospective single center cohort study we determined the impact of baseline red cell distribution width (RDW) and anemia on outcome in 376 patients with aortic stenosis undergoing TAVI. All patients were discussed in the institutional heart team and declined for surgical aortic valve replacement due to high operative risk. Collected data included patient characteristics, imaging findings, periprocedural in hospital data, laboratory results and follow up data. Blood samples for hematology and biochemistry analysis were taken from every patient before and at fixed intervals up to 72 h after TAVI including blood count and creatinine. Descriptive statistics were used for patient’s characteristics. Kaplan-Meier survival curves were used for time to event outcomes. A recursive partitioning regression and classification was used to investigate the association between potential risk factors and outcome variables. RESULTS: Mean age in our study population was 81 ± 6.1 years. Anemia was prevalent in 63.6% (n = 239) of our patients. Age and creatinine were identified as risk factors for anemia. In our study population, anemia per se did influence 30-d mortality but did not predict longterm mortality. In contrast, a RDW > 14% showed to be highly predictable for a reduced short- and longterm survival in patients with aortic valve disease after TAVI procedure. CONCLUSION: Age and kidney function determine the degree of anemia. The anisocytosis of red blood cells in anemic patients supplements prognostic information in addition to that derived from the WHO-based definition of anemia. PMID:26981217

  13. Prediction of coronary artery disease in patients undergoing operations for mitral valve degeneration

    NASA Technical Reports Server (NTRS)

    Lin, S. S.; Lauer, M. S.; Asher, C. R.; Cosgrove, D. M.; Blackstone, E.; Thomas, J. D.; Garcia, M. J.

    2001-01-01

    OBJECTIVES: We sought to develop and validate a model that estimates the risk of obstructive coronary artery disease in patients undergoing operations for mitral valve degeneration and to demonstrate its potential clinical utility. METHODS: A total of 722 patients (67% men; age, 61 +/- 12 years) without a history of myocardial infarction, ischemic electrocardiographic changes, or angina who underwent routine coronary angiography before mitral valve prolapse operations between 1989 and 1996 were analyzed. A bootstrap-validated logistic regression model on the basis of clinical risk factors was developed to identify low-risk (< or =5%) patients. Obstructive coronary atherosclerosis was defined as 50% or more luminal narrowing in one or more major epicardial vessels, as determined by means of coronary angiography. RESULTS: One hundred thirty-nine (19%) patients had obstructive coronary atherosclerosis. Independent predictors of coronary artery disease include age, male sex, hypertension, diabetes mellitus,and hyperlipidemia. Two hundred twenty patients were designated as low risk according to the logistic model. Of these patients, only 3 (1.3%) had single-vessel disease, and none had multivessel disease. The model showed good discrimination, with an area under the receiver-operating characteristic curve of 0.84. Cost analysis indicated that application of this model could safely eliminate 30% of coronary angiograms, corresponding to cost savings of $430,000 per 1000 patients without missing any case of high-risk coronary artery disease. CONCLUSION: A model with standard clinical predictors can reliably estimate the prevalence of obstructive coronary atherosclerosis in patients undergoing mitral valve prolapse operations. This model can identify low-risk patients in whom routine preoperative angiography may be safely avoided.

  14. Psychological predictors of survival in cancer patients undergoing radiation therapy.

    PubMed

    Leigh, H; Percarpio, B; Opsahl, C; Ungerer, J

    1987-01-01

    In a prospective study to identify psychological factors affecting survival in cancer patients receiving radiation therapy, 101 consecutive patients were evaluated for anxiety, depression, and perception of the seriousness of the condition. In 3 years, the survivors were compared to the nonsurvivors. The survivors had significantly higher mean trait anxiety (p less than 0.05) than the nonsurvivors. State anxiety and depression scores also tended to be higher in the survivors (p less than 0.01). Self-assessment of the seriousness of their disease did not differentiate the two groups. The nonsurvivors had significantly more pain (p less than 0.05). Within the nonsurvivor group, survival time was negatively correlated with state anxiety (p less than 0.01), trait anxiety (p less than 0.02), and depression (p less than 0.01). In the nonsurvivors, women rated their condition to be significantly more serious than men (p less than 0.01). Female nonsurvivors tended to rate their condition to be more serious than female survivors (p less than 0.1), while male nonsurvivors rated their condition to be significantly less serious than male survivors (p less than 0.01). Only among female nonsurvivors did the seriousness rating correlate significantly with anxiety (p less than 0.01). The sex differences confirm our previous finding that men may tend to cope with cancer with more massive denial than women. We hypothesize that patients with higher anxiety and depression in the nonsurvivor group had a massive defensive failure, while those who had high anxiety levels in the survivor group had been more realistic about their disease.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3449880

  15. Cryopreservation of ovarian tissue in pediatric patients undergoing sterilizing chemotherapy.

    PubMed

    Chambon, Fanny; Brugnon, Florence; Grèze, Victoria; Grémeau, Anne-Sophie; Pereira, Bruno; Déchelotte, Pierre; Kanold, Justyna

    2016-04-01

    Significantly improved survival rates in children and adolescents with cancer have put fertility preservation high on the pediatric oncology agenda. Here we report a retrospective single-center study of 13 years experience of ovarian tissue cryopreservation (OTC) before sterilizing treatment in order to define the safety/benefits of OTC and study clinical/hormonal outcomes in girls. From 2000 to 2013, OTC was performed in 36 girls: eight had non-malignant disease and 28 had malignant disease. Laparoscopy was used to collect a third of each ovary that was frozen by a slow cooling protocol. Indications for OTC were 13 auto-, 19 allo-stem-cell-transplantation and 4 sterilizing chemotherapy. Ovarian tissue harvested by intraumbilical laparoscopy led to no major postoperative complications and did not delay chemotherapy. Histological analysis of ovarian tissue showed an average of 9 primordial follicles/mm(2) [0-83] and no malignant cells were identified. Median post-harvest follow-up was 36 months [1-112]: 26 girls were alive in complete remission and 10 had died. Hormonal results were evaluable for 27 patients (median age 17 yrs [5-26]): 16 patients were in premature ovarian insufficiency. OTC sampling one third of each ovary appears to be an appropriate approach to preserve fertility in children without consequences on subsequent therapeutic program. PMID:27008573

  16. Nurse led Patient Education Programme for patients undergoing a lung resection for primary lung cancer

    PubMed Central

    Dixon, Sandra

    2015-01-01

    There has been an increase in the number of patients undergoing lung resection for primary or suspected primary lung cancer in the UK due to improved staging techniques, dedicated thoracic surgeons and other initiatives such as preoperative pulmonary rehabilitation. This has had an impact on local healthcare resources requiring new ways of delivering thoracic surgical services. When considering service changes, patient reported outcomes are pivotal in terms of ensuring that the experience of care is enhanced and may include elements such as involving patients in their care, reducing the length of inpatient stay and reducing postoperative complications. The implementation of a thoracic surgical Patient Education Programme (PEP) has the potential to address these measures and improve the psychological and physical wellbeing of patients who require a lung resection. It may also assist in their care as an inpatient and to enhance recovery after surgery both in the short and long term. PMID:25984358

  17. Manganese-induced Parkinsonism in a patient undergoing maintenance hemodialysis.

    PubMed

    Ohtake, Takayasu; Negishi, Kousuke; Okamoto, Kouji; Oka, Machiko; Maesato, Kyoko; Moriya, Hidekazu; Kobayashi, Shuzo

    2005-10-01

    We report a rare case of manganese (Mn)-induced parkinsonism in a patient on maintenance hemodialysis therapy who complained of gait disturbance and dysarthria. His symptoms and abnormal magnetic resonance imaging (MRI) findings of the brain were thought to be caused, at least in part, by long-term ingestion of a health supplement (Chlorella extract) that contained 1.7 mg of Mn in the usual daily dose. Elevated serum and cerebrospinal fluid Mn levels were detected, and brain MRI showed areas of abnormal intensity in the bilateral basal ganglia (low intensity on T1-weighted images and high intensity on T2-weighted images). Edetic acid infusion therapy dramatically improved the MRI abnormalities, after which his symptoms gradually improved 4 months later. PMID:16183431

  18. Pharmacokinetics of cefepime in patients undergoing continuous ambulatory peritoneal dialysis.

    PubMed Central

    Barbhaiya, R H; Knupp, C A; Pfeffer, M; Zaccardelli, D; Dukes, G M; Mattern, W; Pittman, K A; Hak, L J

    1992-01-01

    The pharmacokinetics of cefepime were studied in 10 male patients receiving continuous ambulatory peritoneal dialysis therapy. Five patients received a single 1,000-mg dose and the other five received a single 2,000-mg dose; all doses were given as 30-min intravenous infusions. Serial plasma, urine, and peritoneal dialysate samples were collected; and the concentrations of cefepime in these fluids were measured over 72 h by using a high-performance liquid chromatographic assay with UV detection. Pharmacokinetic parameters were calculated by noncompartmental methods. The peak concentrations in plasma and the areas under the plasma concentration-versus-time curve for the 2,000-mg dose group were twice as high as those observed for the 1,000-mg dose group. The elimination half-life of cefepime was about 18 h and was independent of the dose. The steady-state volume of distribution was about 22 liters, and values for the 1,000- and 2,000-mg doses were not significantly different. The values for total body clearance and peritoneal dialysis clearance were about 15 and 4 ml/min, respectively. No dose dependency was observed for the clearance estimates. Over the 72-h sampling period, about 26% of the dose was excreted intact into the peritoneal dialysis fluid. For 48 h postdose, mean concentrations of cefepime in dialysate at the end of each dialysis interval exceeded the reported MICs for 90% of the isolates (MIC90s) for bacteria which commonly cause peritonitis resulting from continuous peritoneal dialysis. A parenteral dose of 1,000 or 2,000 mg of cefepime every 48 h would maintain the antibiotic levels in plasma and peritoneal fluid above the MIC90s for the most susceptible bacteria for the treatment of systemic and intraperitoneal infections [corrected]. PMID:1510432

  19. Assessment of Symptoms in Cancer Patients Undergoing Chemotherapy in Northern Greece

    PubMed Central

    Lavdaniti, Maria

    2015-01-01

    Introduction: Cancer patients experience a variety of symptoms that can be physical or psychological. These symptoms may vary in terms of occurrence, severity and distress and can be the result of the illness or the treatment. Purpose: The purpose of this study is to investigate the frequency, severity and distress of symptoms that chemotherapy induces in cancer patients. Material-Method: This study included 200 cancer patients undergoing chemotherapy in a major city of Northern Greece. Data was collected using the Memorial Symptom Assessment Scale and Questionnaire, with demographic and clinical characteristics. Results: The vast majority of those included in the sample were male participants (n=127, 63.5%). Their mean age was 58.95 (SD=9.95, range 29-79). The most prevalent physical symptoms were numbness/tingling in the hands/feet (54%), followed by lack of energy (46%). Feeling nervous (52%) and having trouble sleeping (41%) were the two most common psychological symptoms. Conclusions: The results of this study demonstrate that cancer patients undergoing chemotherapy experience various symptoms in high prevalence, and that they are quite severe. Therefore nurses should take into account these findings and plan appropriate, suitable care plans and interventions in order to alleviate them and improve patients’ quality of life. PMID:26543418

  20. Coronary computer tomographic angiography for preoperative risk stratification in patients undergoing liver transplantation.

    PubMed

    Jodocy, Daniel; Abbrederis, Susanne; Graziadei, Ivo W; Vogel, Wolfgang; Pachinger, Otmar; Feuchtner, Gudrun M; Jaschke, Werner; Friedrich, Guy

    2012-09-01

    The assessment of the cardiovascular risk profile in patients with end-stage liver disease is essential prior to liver transplantation (LT) as cardiovascular diseases are major causes of morbidity and mortality in the posttransplant course. The aim of this study was to evaluate the accuracy of a 64-slice coronary computed tomographic angiography (CTA) and coronary calcium scoring (CCS) to predict the postoperative cardiovascular risk of patients assessed for LT. In this single center, observational study we included 54 consecutive patients who were assessed for LT and consequently transplanted. Twenty-four patients (44%) presented with a high CCS above 300 and/or a significant stenosis (>50% percent narrowing due to stenotic plaques) and were further referred to coronary angiography. Three of these patients had a more than 70% LAD stenosis with subsequent angioplasty (n=1) or conservative therapy (n=2). The other patients showed only diffuse CAD without significant stenosis. The remaining 30 patients with normal CTA findings were listed for LT without further tests. None of the 54 patients developed cardiovascular events peri- and postoperatively. This study indicated that CTA combined with CCS is a useful non-invasive imaging technique for pre-LT assessment of coronary artery disease and safe tool in the risk assessment of peri- and postoperative cardiovascular events in patients undergoing LT. PMID:21665396

  1. Individualized Comprehensive Lifestyle Intervention in Patients Undergoing Chemotherapy with Curative or Palliative Intent: Who Participates?

    PubMed Central

    Vassbakk-Brovold, Karianne; Lian, Henrik; Mjåland, Odd; Seiler, Stephen

    2015-01-01

    Objective Knowledge about determinants of participation in lifestyle interventions in cancer patients undergoing chemotherapy, particularly with palliative intent, remains poor. The objective of the present study was to identify determinants of participating in a 12 month individualized, comprehensive lifestyle intervention, focusing on diet, physical activity, mental stress and smoking cessation, in cancer patients receiving chemotherapy with curative or palliative intent. The secondary objective was to identify participation determinants 4 months into the study. Methods Newly diagnosed cancer patients starting chemotherapy at the cancer center in Kristiansand/Norway (during a 16 month inclusion period) were screened. Demographic and medical data (age, sex, body mass index, education level, marital status, smoking status, Eastern Cooperative Oncology Group performance status (ECOG), diagnosis, tumor stage and treatment intention) was analyzed for screened patients. Results 100 of 161 invited patients participated. There were more females (69 vs. 48%; P = 0.004), breast cancer patients (46 vs. 25%; P = 0.007), non-smokers (87 vs. 74%; P = 0.041), younger (mean age 60 vs. 67 yrs; P < 0.001) and fitter (82 vs. 64% with EGOC 0; P = 0.036) participants vs. non-participants included. In multivariate logistic regression analyses, age (Odds Ratio 0.94, 95% Confidence Interval 0.91, 0.97) and smoking (0.42, 0.18, 0.99) were negatively associated with participation. After 4 months, 63 participants were still participating. Cancer type, smoking and age increased the probability of dropping out. Multivariate logistic regression revealed that age was the only significant determinant of 4 month participation (0.95, 0.91, 0.99). Patients aged >70 years were less likely to participate at baseline and 4 months. Conclusion Individualized lifestyle interventions in cancer patients undergoing chemotherapy appear to facilitate a high participation rate that declines with increasing

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

    SciTech Connect

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

    1990-01-01

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

  3. Prevalence and Risk Factors of Deep Vein Thrombosis in Patients Undergoing Lumbar Interbody Fusion Surgery

    PubMed Central

    Yang, Si-Dong; Ding, Wen-Yuan; Yang, Da-Long; Shen, Yong; Zhang, Ying-Ze; Feng, Shi-Qing; Zhao, Feng-Dong

    2015-01-01

    Abstract This cross-sectional study was designed to obtain the current prevalence of deep vein thrombosis (DVT) and analyze related risk factors in patients undergoing lumbar interbody fusion. Medical record data were collected from Department of Spinal Surgery, The Third Hospital of Hebei Medical University, between July 2014 and March 2015. Both univariate analysis and binary logistic regression analysis were performed to determine risk factors for DVT. A total of 995 patients were admitted into this study, including 484 men and 511 women, aged from 14 to 89 years old (median 50, IQR 19). The detection rate of lower limb DVT by ultrasonography was 22.4% (223/995) in patients undergoing lumbar interbody fusion. Notably, average VAS (visual analog scale) score in the first 3 days after surgery in the DVT group was more than that in the non-DVT group (Z = −21.69, P < 0.001). The logistic regression model was established as logit P = −13.257 + 0.056∗X1 − 0.243∗X8 + 2.085∗X10 + 0.001∗X12, (X1 = age; X8 = HDL; X10 = VAS; X12 = blood transfusion; x2 = 677.763, P < 0.001). In conclusion, advanced age, high postoperative VAS scores, and blood transfusion were risk factors for postoperative lower limb DVT. As well, the logistic regression model may contribute to an early evaluation postoperatively to ascertain the risk of lower limb DVT in patients undergoing lumbar interbody fusion surgery. PMID:26632909

  4. A Longitudinal Investigation of Posttraumatic Growth in Adult Patients Undergoing Treatment for Acute Leukemia

    PubMed Central

    Danhauer, Suzanne C.; Russell, Gregory B.; Tedeschi, Richard G.; Jesse, Michelle T.; Vishnevsky, Tanya; Daley, Kristin; Carroll, Suzanne; Triplett, Kelli N.; Calhoun, Lawrence G.; Cann, Arnie; Powell, Bayard L.

    2013-01-01

    An acute leukemia diagnosis can be an extremely stressful experience for most patients. Posttraumatic growth (PTG) is positive psychological change experienced following a struggle with highly challenging life circumstances. The current study is the first longitudinal investigation of predictors of PTG and distress in adult acute leukemia patients undergoing induction chemotherapy. Findings suggest that these patients report PTG, and levels of PTG appear to increase over the weeks following leukemia diagnosis and induction chemotherapy. Variables associated with higher total PTG scores over time included greater number of days from baseline, younger age, and greater challenge to core beliefs. Variables associated with higher distress included greater number of days from baseline, greater perceived cancer threat, higher symptom severity, and lower spiritual well-being. Results underscore the critical role that examination of one’s core beliefs may play in the development of PTG over time. PMID:22739660

  5. Hemophagocytic syndrome in patients with acute myeloid leukemia undergoing intensive chemotherapy

    PubMed Central

    Delavigne, Karen; Bérard, Emilie; Bertoli, Sarah; Corre, Jill; Duchayne, Eliane; Demur, Cécile; Mas, Véronique Mansat-De; Borel, Cécile; Picard, Muriel; Alvarez, Muriel; Sarry, Audrey; Huguet, Françoise; Récher, Christian

    2014-01-01

    Hemophagocytic lymphohistiocytosis is a condition of immune dysregulation characterized by severe organ damage induced by a hyperinflammatory response and uncontrolled T-cell and macrophage activation. Secondary hemophagocytic lymphohistiocytosis typically occurs in association with severe infections or malignancies. Patients with acute myeloid leukemia may be prone to develop hemophagocytic lymphohistiocytosis because of an impaired immune response and a high susceptibility to severe infections. In a series of 343 patients treated by intensive chemotherapy over a 5-year period in our center, we identified 32 patients (9.3%) with fever, very high ferritin levels, and marrow hemophagocytosis (i.e. patients with hemophagocytic lymphohistiocytosis). Compared to patients without hemophagocytic lymphohistiocytosis, these 32 patients had hepatomegaly, pulmonary or neurological symptoms, liver abnormalities, lower platelet count and higher levels of C-reactive protein as well as prolonged pancytopenia. A microbial etiology for the hemophagocytosis was documented in 24 patients: 14 bacterial infections, 9 Herpesviridae infections and 11 fungal infections. The treatment of hemophagocytic lymphohistiocytosis consisted of corticosteroids and/or intravenous immunoglobulins along with adapted antimicrobial therapy. Patients with hemophagocytic lymphohistiocytosis had a median overall survival of 14.9 months, which was significantly shorter than that of patients without hemophagocytic lymphohistiocytosis (22.1 months) (P=0.0016). Hemophagocytic lymphohistiocytosis was significantly associated with a higher rate of induction failure, mainly due to deaths in aplasia. Hemophagocytic lymphohistiocytosis can be diagnosed in up to 10% of patients with acute myeloid leukemia undergoing intensive chemotherapy and is associated with early mortality. Fever, very high ferritin levels and marrow hemophagocytosis represent the cornerstone of the diagnosis. Further biological studies are

  6. Fractionated stem cell infusions for patients with plasma cell myeloma undergoing autologous hematopoietic cell transplantation.

    PubMed

    Landau, Heather; Wood, Kevin; Chung, David J; Koehne, Guenther; Lendvai, Nikoletta; Hassoun, Hani; Lesokhin, Alexander; Hoover, Elizabeth; Zheng, Junting; Devlin, Sean M; Giralt, Sergio

    2016-08-01

    We conducted a phase II trial investigating the impact of fractionated hematopoietic cell infusions on engraftment kinetics and symptom burden in patients with plasma cell myeloma (PCM) undergoing autologous hematopoietic cell transplant (AHCT). We hypothesized that multiple hematopoietic cell infusions would reduce duration of neutropenia and enhance immune recovery resulting in a better tolerated procedure. Twenty-six patients received high-dose melphalan followed by multiple cell infusions (Days 0, +2, +4, +6) and were compared to PCM patients (N = 77) who received high-dose melphalan and a single infusion (Day 0) (concurrent control group). The primary endpoint was number of days with ANC <500K/mcL. Symptom burden was assessed using the MSK-modified MD Anderson Symptom Inventory. Median duration of neutropenia was similar in study (4 days, range 3-5) and control patients (4 days, range 3-9) (p = 0.654). There was no significant difference in the number of red cell or platelet transfusions, days of fever, diarrhea, antibiotics, number of documented infections, or length of admission. Symptom burden surveys showed that AHCT was well-tolerated in both study and control patients. We conclude that fractionated stem cell infusions following high-dose melphalan do not enhance engraftment kinetics or significantly alter patients' clinical course following AHCT in PCM. PMID:26758672

  7. [Bladder drainage in patients undergoing the Pereyra surgical procedure].

    PubMed

    Rodríguez-Colorado, S; Villagrán, R; Escobar-Del Barco, L; Villalobos-Acosta, S; Kunhardt-Rasch, J; Delgado-Urdapilleta, J

    1996-07-01

    Postoperative acute urinary retention was evaluated in the patients who underwent Pereyra procedure. Comparison of suprapubic and urethral catheterization. Between January 1994 and July 1995, fifty two patients with urinary stress incontinence underwent Pereyra procedure, 31 female patient with suprapubic drainage (cistofix Ch 15) and 17 urethral catherization with a latex foley catheter. Sponatneous micturition and urinary retention was evaluated until the catheter was removed. Mean age was 43.8 years (32 a 66), the duration of suprapubic vesical drainage with suprapubic catheter were 3 days in 58.6% of the patients, and more than 3 days in 41.29%. Recatheterizacion in the patients with urethral drainage was more frequent. Urinary retention after 7 days was present in 23.99% with suprapubic vesical drainage and 28.5% with urethral catheter. Recatheterization is more frequent in patients with urethral catheter. PMID:8756195

  8. Association of Serum Bilirubin with SYNTAX Score and Future Cardiovascular Events in Patients Undergoing Coronary Intervention

    PubMed Central

    Chang, Chun-Chin; Hsu, Chien-Yi; Huang, Po-Hsun; Chiang, Chia-Hung; Huang, Shao-Sung; Leu, Hsin-Bang; Huang, Chin-Chou; Chen, Jaw-Wen; Lin, Shing-Jong

    2016-01-01

    Background Bilirubin has emerged as an important endogenous antioxidant molecule, and increasing evidence shows that bilirubin may protect against atherosclerosis. The SYNTAX score has been developed to assess the severity and complexity of coronary artery disease. The aim of this study was to evaluate whether serum bilirubin levels are associated with SYNTAX scores and whether they could be used to predict future cardiovascular events in patients undergoing coronary intervention. Methods Serum bilirubin levels and other blood parameters in patients with at least 12-h fasting states were determined. The primary endpoint was any composite cardiovascular event within 1 year, including death, nonfatal myocardial infarction, and target-vessel revascularization. Results In total, 250 consecutive patients with stable coronary artery disease (mean age 70 ± 13) who had received coronary intervention were enrolled. All study subjects were divided into two groups: group 1 was defined as high SYNTAX score (> 22), and group 2 was defined as low SYNTAX score (≤ 22). Total bilirubin levels were significantly lower in the high SYNTAX score group than in the low SYNTAX score group (0.51 ± 0.22 vs. 0.72 ± 0.29 mg/dl, p < 0.001). By multivariate analysis, serum total bilirubin levels were identified as an independent predictor for high SYNTAX score (adjusted odds ratio: 0.28, 95% confidence interval 0.04-0.42; p = 0.004). Use of the Kaplan-Meier analysis demonstrated a significant difference in 1-year cardiovascular events between high (> 0.8 mg/dl), medium (> 0.5, ≤ 0.8 mg/dl), and low (≤ 0.5 mg/dl) bilirubin levels (log-rank test p = 0.011). Conclusions Serum bilirubin level is associated with SYNTAX score and predicts future cardiovascular events in patients undergoing coronary intervention. PMID:27471354

  9. [Patients facing with the decision to undergo percutaneous coronary intervention].

    PubMed

    Bobbio, Marco

    2015-03-01

    Percutaneous coronary intervention (PCI) is a common procedure to treat coronary artery stenoses. Several studies had demonstrated that PCI does not reduce the risk of death or myocardial infarction when performed to patients with stable angina. However it has been observed that most patients believe that PCI will reduce their risk for death and myocardial infarction. On the other hand, cardiologists generally acknowledge the limitation of PCI according to the current literature.Cardiologists' decision to refer a patient to PCI is based on factors other then perceived benefits such as fear of missing a needed procedure, defensive medicine, desire of demonstrating their professional competence, vested professional and economic interests, accomplish patient expectation, the so called oculo-stenotic reflex, when a lesion is dilated regardless the clinical indication. Patients' misleading perception of harm and benefits of a procedure is mainly related to the cognitive dissonance, when individuals tend to reduce the conflict of an uncomfortable decision adopting information, which are likely to reduce their discomfort. Furthermore, patients believe that doing more means doing better, that technologic intervention are better than pharmacological treatment that in turn are better than doing nothing. Finally, they assume that a procedure is really effective since their physician suggested it.It should be emphasized that physicians and patients do not communicate successfully about key decision and how little we know about patient understanding of the factors that influence important medical care decisions. Although considerable attention is given to facilitating informed consent, patients' perceived benefits of elective PCI do not match existing evidence, as they overestimated both the benefits and urgency of their procedures. These findings suggest that an even greater effort at patient education is needed prior to elective PCI to facilitate fully informed decision

  10. Bacteria on Catheters in Patients Undergoing Peritoneal Dialysis

    PubMed Central

    Pihl, Maria; Davies, Julia R.; Johansson, Ann-Cathrine; Svensäter, Gunnel

    2013-01-01

    ♦ Background: Peritonitis is the leading cause of morbidity for peritoneal dialysis (PD) patients, and microbial biofilms have previously been identified on catheters from infected patients. However, few studies of catheters from patients without clinical signs of infection have been undertaken. The aim of the present study was to investigate the extent to which bacteria are present on catheters from PD patients with no symptoms of infection. ♦ Methods: Microbiologic culturing under aerobic and anaerobic conditions and confocal laser scanning microscopy were used to determine the distribution of bacteria on PD catheters from 15 patients without clinical signs of infection and on catheters from 2 infected patients. The 16S rRNA gene sequencing technique was used to identify cultured bacteria. ♦ Results: Bacteria were detected on 12 of the 15 catheters from patients without signs of infection and on the 2 catheters from infected patients. Single-species and mixed-microbial communities containing up to 5 species were present on both the inside and the outside along the whole length of the colonized catheters. The bacterial species most commonly found were the skin commensals Staphylococcus epidermidis and Propionibacterium acnes, followed by S. warneri and S. lugdunensis. The strains of these micro-organisms, particularly those of S. epidermidis, varied in phenotype with respect to their tolerance of the major classes of antibiotics. ♦ Conclusions: Bacteria were common on catheters from patients without symptoms of infection. Up to 4 different bacterial species were found in close association and may represent a risk factor for the future development of peritonitis in patients hosting such micro-organisms. PMID:22855889

  11. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery

    PubMed Central

    Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim

    2013-01-01

    The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described. PMID:24553513

  12. Alveolar recruitment maneuver and perioperative ventilatory support in obese patients undergoing abdominal surgery.

    PubMed

    Forgiarini Júnior, Luiz Alberto; Rezende, Juliana Castilhos; Forgiarini, Soraia Genebra Ibrahim

    2013-01-01

    The development of abdominal surgery represents an alternative therapy for the morbidly obese; however, patients undergoing this surgical procedure often experience postoperative pulmonary complications. The use of alveolar recruitment maneuvers and/or perioperative ventilatory strategies is a possible alternative to reduce these complications, focusing on the reduction of postoperative pulmonary complications. In this review, the benefits of perioperative ventilatory strategies and the implementation of alveolar recruitment maneuvers in obese patients undergoing abdominal surgery are described. PMID:24553513

  13. Dislipemia in patients undergoing continuous ambulatory peritoneal dialysis: pharmacological therapy (simvastatin) versus hemodialysis.

    PubMed

    Marangoni, R; Civardi, F; Masi, F; Cimino, R; Maltagliati, L; Romei Longhena, G

    1993-01-01

    Peritoneal dialysis can worsen dislipemia, which is frequent in chronically uremic patients. In order to verify the therapeutic possibilities, we retrospectively studied 20 chronically uremic patients who had been previously treated with continuous ambulatory peritoneal dialysis (CAPD) and who had developed an IV-type dislipemia. Twelve have continued CAPD treatment and have been simultaneously treated with simvastatin; 8 have withdrawn from CAPD and have begun HD, without any antidislipemic pharmacological support. The results, after 3, 6, 12, and 18 months of treatment, showed the following: in patients treated with CAPD and simvastatin, highly significant decreases were noted in total cholesterol (T-cho) and triglycerides (TG) (p < 0.001), and highly significant increases were noted in HDL-cholesterol (HDL-cho) (p < 0.005) and apolipoprotein-A1 (Apo-A1) (p < 0.01). In patients treated with HD, only slightly significant decreases were noted in T-cho (p < 0.01) and TG (p < 0.02), a slightly significant increase in Apo-A1 (p < 0.05), and no significant change in HDL-cho. Apolipoprotein-B showed no change in the two groups. Therefore, patients undergoing CAPD, with dislipemia only, can continue the treatment, because simvastatin is capable of correcting dislipemia, while those patients who have displemia as well as other complications strictly due to CAPD must abandon treatment and must be transferred to extracorporeal methods. PMID:8399632

  14. Risk factors in selected patients undergoing femoral embolectomy.

    PubMed Central

    Scott, D. J.; Davies, A. H.; Horrocks, M.

    1989-01-01

    Mortality rates after femoral embolectomy (FE) in patients with an acutely ischaemic leg vary from 20-40%. In the last 3 years we have adopted a policy of proceeding directly to femoral embolectomy in those patients with a strong clinical suspicion of an embolus. Where doubt exists about the diagnosis, arteriography is performed in combination with local streptokinase, balloon dilatation and/or reconstruction. In a prospective study between September 1984 and March 1987, 43 patients underwent femoral embolectomy with a limb salvage rate of 87%. The early mortality (within 30 days) was 16%, the late mortality was 26%, with a mean follow-up of 22 months. Of the seven patients who died within 30 days, one had a successful embolectomy but died from a cerebrovascular accident. The remaining six failed to improve clinically, all had poor backbleeding and no return of the peripheral pulses. None of these patients had an amputation. We recommend that femoral embolectomy be performed in those patients with a short history of ischaemia (less than 72 h), a risk factor suggesting an embolic source and no past history of intermittent claudication. If all three criteria are not met, arteriography should be performed with a view to fibrinolytic therapy or vascular reconstruction. In those patients who have had a failed embolectomy or where the circulation cannot be restored promptly, despite fibrinolytic therapy and/or distal reconstruction, early major amputation may be life-saving. PMID:2774451

  15. Prevalence of renal artery disease and its prognostic significance in patients undergoing coronary bypass grafting.

    PubMed

    Aboyans, Victor; Tanguy, Benedicte; Desormais, Ileana; Bonnet, Vincent; Chonchol, Michel; Laskar, Marc; Mohty, Dania; Lacroix, Philippe

    2014-10-01

    Several studies demonstrated the prognostic importance of renal failure and peripheral artery disease in patients undergoing coronary artery bypass grafting (CABG), but data regarding the prognostic value of renal artery disease in this context are scarce. We aimed to study the prevalence and prognostic value of renal artery disease in patients undergoing CABG. We assessed by duplex ultrasound the renal arteries of 429 consecutive patients who underwent CABG, of whom 401 had satisfactory imaging quality to detect >60% renal artery stenosis (RAS) and/or an elevated resistive index (ERI>0.80). Of the 401 subjects included (age 68±10 years, 83% men), 40 (10%) had RAS and 35 (9%) had ERI. Nine patients (2.2%) had both conditions. Patients were followed up for 12.4±7.0 months. The primary outcome was composite, including 30-day death, stroke, and/or myocardial infarction. In a multivariate model adjusted for age, gender, cardiovascular (CV) risk factors, renal function, chronic obstructive pulmonary disease, the use of off-pump CABG, CV co-morbidities, and drugs, the presence of ERI was strongly associated with the occurrence of the composite outcome (odds ratio 4.3, 95% confidence interval 1.7 to 9.9, p=0.0006). Similarly, ERI, not RAS, was significantly associated with the 30-day acute kidney disease and the midterm mortality, as well as fatal and nonfatal CV events. In conclusion, regardless of renal function and other factors, the renal resistive index is a strong predictor of CV and renal events after CABG. Renal duplex ultrasound can identify a subgroup of patients at high risk of CABG. PMID:25150754

  16. Tuberculosis in patients undergoing maintenance hemodialysis: one year follow up study from Nepal.

    PubMed

    Dhakal, S S; Bhattarai, L; Manandhar, D N; Devkota, K C; Sharma, S K; Bhatta, N

    2012-09-01

    In Nepal where tuberculosis is endemic and data regarding the prevalence of tuberculosis in patients undergoing maintenance haemodialysis is not known we tried to see the cumulative incidence of tuberculosis in these higher risk groups' patients. Forty patients were followed up for one year after initial screening for tuberculosis. Among forty patients 34 (85%) were male and 6 (15%) were female. During initial screening four patients had sputum positive tuberculosis and three more patients had sputum positive tuberculosis during follow up. Among nine patients with pleural effusion two patients had pulmonary tuberculosis. One patient had tubercular cervical lymphadenitis. Two patients died during follow up and the rest improved with anti tubercular treatment. So in the part of the world where tuberculosis is endemic patients undergoing maintenance haemodialysis should be screened for tuberculosis regularly. PMID:24047026

  17. Incidence and Predictors of Understaging in Patients with Clinical T1 Urothelial Carcinoma Undergoing Radical Cystectomy

    PubMed Central

    Ark, Jacob T.; Keegan, Kirk A.; Barocas, Daniel A.; Morgan, Todd M.; Resnick, Matthew J.; You, Chaochen; Cookson, Michael S.; Penson, David F.; Davis, Rodney; Clark, Peter E.; Smith, Joseph A.; Chang, Sam S.

    2013-01-01

    Summary Objective To evaluate predictors of understaging in patients with presumed non-muscle invasive bladder cancer (NMIBC) identified on transurethral resection of bladder tumor (TURBT) who underwent radical cystectomy (RC) with attention to the role of a restaging TURBT. Materials and Methods We retrospectively evaluated 279 consecutive patients with clinically staged T1 (cT1) disease following TURBT who underwent RC at our institution from April 2000 to July 2011. 60 of these cT1 patients had undergone a restaging TURBT prior to RC. The primary outcome measure was pathological staging of T2 or greater disease at the time of RC. Results 134 (48.0%) patients were understaged. Of the 60 patients who remained cT1 after a restaging TURBT, 28 (46.7%) were understaged. Solitary tumor (OR 0.43, 95% CI 0.25–0.76, p = 0.004) and fewer prior TURBTs (OR 0.84, 95% CI 0.71–1.00, p = 0.05) were independent risk factors for understaging. Conclusions Despite the overall improvement in staging accuracy linked to restaging TURBTs, the risk of clinical understaging remains high in restaged patients found to have persistent T1 urothelial carcinoma who undergo RC. Solitary tumor and fewer prior TURBTs are independent risk factors for being understaged. Incorporating these predictors into preoperative risk stratification may allow for augmented identification of those patients with clinical NMIBC who stand to benefit most from RC. PMID:24053444

  18. Postoperative Care of Patients Undergoing Same-Day Laparoscopic Cholecystectomy.

    PubMed

    Brenner, Patricia; Kautz, Donald D

    2015-07-01

    Elective laparoscopic cholecystectomies are common outpatient surgical procedures. After briefly discussing cholecystectomy and its indications, best practices in phase I, phase II, and phase III recovery are discussed. Typical pharmaceutical regimens for controlling pain and postoperative nausea and vomiting are summarized. By implementing best practices, nurses can prevent and recognize complications. The criteria for discharge, extended recovery, and inpatient admission are discussed, along with the required patient discharge teaching using the teach-back technique, as well as patient and family teaching needs in the immediate postoperative period. Nurses can optimize the patient's surgical experience and promote safety by implementing best practices in all phases of recovery from laparoscopic cholecystectomy. PMID:26119606

  19. Clinical effects of chlorhexidine mouthwashes on patients undergoing orthodontic treatment.

    PubMed

    Anderson, G B; Bowden, J; Morrison, E C; Caffesse, R G

    1997-06-01

    This study compared the short-term clinical effect of 0.12% chlorhexidine gluconate and placebo mouthrinses in 30 adolescents (ages 11 to 15) undergoing orthodontic treatment. Subjects were randomized into experimental (CHX) and control (C) groups. Baseline values were recorded 10 days after prophylaxis and included Plaque index (PI), Gingival index (GI), Rentention Index (RI), Discoloration index (DI), and probing depths (PD). Both groups (CHX and C) received soft toothbrushes with instructions to brush twice daily, as well as the CHX and placebo mouthrinses, respectively, with oral and written instructions for rinsing twice daily with 15 ml for 30 seconds. Reevaluations were performed 1, 2, and 3 months after baseline, except for the DI and PD, which were only assessed at 3 months. The Student's t test and the paired t test were used to analyze the data at the P < 0.05 level of significance. No differences between groups were seen at baseline for any of the parameters. At 30 days, there was a significant difference for the RI between CHX (0.15 +/- 0.16; mean +/- SD) and C (0.05 +/- 0.06) at the mesial buccal, and for CHX (0.07 +/- 0.10) and C (0.02 +/- 0.05) at the midbuccal. The 60-day evaluation showed similar results. At 90 days, lower PI were observed in the CHX group at the distal buccal (0.38 +/- 0.19), midbuccal (0.22 +/- 0.17), and mesial buccal (0.47 +/- 0.22) sites as compared with the C group (0.97 +/- 0.38, 0.83 +/- 0.40, and 0.95 +/- 0.43, respectively). A similar trend was noted with the GI, as the lower values were related to the CHX group. The changes of the PI and GI, at 30, 60, and 90 days, as analyzed by the paired t test, were statistically significant in the case of the experimental group, as the changes in the means were a reflection of significantly lower scores observed in the experimental group. After 3 months, the DI showed higher scores in the experimental group as compared with the control, but they were not statistically significant

  20. Use of herbal remedies among patients undergoing hemodialysis.

    PubMed

    Roozbeh, Jamshid; Hashempur, Mohammad Hashem; Heydari, Mojtaba

    2013-11-01

    This study aims to determine the prevalence, types, and associated factors for the use of herbal remedies in hemodialysis patients. Two hundred participants were selected by stratified sampling and were systematically interviewed. One hundred and twenty-six patients (63%) had used herbal remedies some time since their initiation of dialysis treatment. The users of herbal remedies had a significantly older age than nonusers, but no other significant differences were observed. The most prevalent complaints that led to herbal remedies use were gastroenterological complaints, flushing, and excessive thirst. Cichorium intybus, Borage officinalis, Mentha longifolia, and Matricaria recutita were the most prevalently used herbs in our patients. More study should be done on safety and efficacy of these herbs for hemodialysis patients. PMID:24241097

  1. [Nursing care in patients undergoing radiological surgery. A case report].

    PubMed

    Armero-Barranco, David; Ruiz-Mateos, María; Alcaraz-Baños, Miguel; Bernal-Páez, Fernando Luis

    2007-01-01

    We report the case of a 73-year-old man with medical diagnoses of long-standing diabetes mellitus, chronic ischemia of the lower limbs and intermittent claudication, for which the patient had been treated with minimally invasive radiological surgery. On arrival at the radiology unit, the patient had nursing diagnoses of anxiety and fear. Intraoperatively, the client had nursing diagnoses of pain, urine retention and infection risk. At discharge, a collaboration problem was detected and hemorrhagic risk. The patient received individualized nursing care. Interventions were planned following the nursing intervention classification (NIC) and the expected results for these interventions followed the Nursing Outcomes Classification (NOC) taxonomy. The application of an appropriate nursing care plan contributes to making the patient's hospital stay easier, more comfortable and less traumatic. PMID:17915125

  2. Electrocardiographic Abnormalities and QTc Interval in Patients Undergoing Hemodialysis

    PubMed Central

    Nie, Yuxin; Zou, Jianzhou; Liang, Yixiu; Shen, Bo; Liu, Zhonghua; Cao, Xuesen; Chen, Xiaohong; Ding, Xiaoqiang

    2016-01-01

    Background Sudden cardiac death is one of the primary causes of mortality in chronic hemodialysis (HD) patients. Prolonged QTc interval is associated with increased rate of sudden cardiac death. The aim of this article is to assess the abnormalities found in electrocardiograms (ECGs), and to explore factors that can influence the QTc interval. Methods A total of 141 conventional HD patients were enrolled in this study. ECG tests were conducted on each patient before a single dialysis session and 15 minutes before the end of dialysis session (at peak stress). Echocardiography tests were conducted before dialysis session began. Blood samples were drawn by phlebotomy immediately before and after the dialysis session. Results Before dialysis, 93.62% of the patients were in sinus rhythm, and approximately 65% of the patients showed a prolonged QTc interval (i.e., a QTc interval above 440 ms in males and above 460ms in females). A comparison of ECG parameters before dialysis and at peak stress showed increases in heart rate (77.45±11.92 vs. 80.38±14.65 bpm, p = 0.001) and QTc interval (460.05±24.53 ms vs. 470.93±24.92 ms, p<0.001). After dividing patients into two groups according to the QTc interval, lower pre-dialysis serum concentrations of potassium (K+), calcium (Ca2+), phosphorus, calcium* phosphorus (Ca*P), and higher concentrations of plasma brain natriuretic peptide (BNP) were found in the group with prolonged QTc intervals. Patients in this group also had a larger left atrial diameter (LAD) and a thicker interventricular septum, and they tended to be older than patients in the other group. Then patients were divided into two groups according to ΔQTc (ΔQTc = QTc peak-stress- QTc pre-HD). When analyzing the patients whose QTc intervals were longer at peak stress than before HD, we found that they had higher concentrations of Ca2+ and P5+ and lower concentrations of K+, ferritin, UA, and BNP. They were also more likely to be female. In addition, more cardiac

  3. Considerations for patients undergoing endovascular abdominal aortic aneurysm repair.

    PubMed

    Ullery, Brant W; Lee, Jason T

    2014-09-01

    Endovascular aneurysm repair has taken over open surgery as the primary strategy for treatment of patients with abdominal and thoracic aneurysms. The minimally invasive nature of these techniques requires alterations in preoperative workup, intraoperative management, and familiarity with unique complications that can occur. Familiarity from the anesthetic standpoint of endovascular techniques, including treatment of patients with fenestrated, chimney, snorkel, and periscope grafts, is necessary for the contemporary cardiac anesthesiologist. PMID:25113729

  4. Risks of packed red blood cell transfusion in patients undergoing cardiac surgery.

    PubMed

    Gerber, David R

    2012-12-01

    Packed red blood cell (PRBC) transfusion is common in patients undergoing cardiac surgery. Evidence has accumulated demonstrating that such patients can tolerate relatively low hemoglobins, and an extensive body of literature has developed demonstrating that patients undergoing such surgery who receive PRBC are at risk for several adverse outcomes including increased mortality, atrial fibrillation, and more postoperative infections, as well as numerous other complications. The PubMed database was searched for the English language literature on the topic of PRBC transfusion and outcomes in patients undergoing cardiac surgery, as well as alternatives to this intervention. Data were reviewed to assess the impact of transfusion in patients undergoing cardiac surgery on mortality, cardiac, infectious, and pulmonary, as well as a variety of miscellaneous complications. Patients receiving PRBC were consistently identified as being at higher risk for complications in all categories. The limited prospective data were consistent with the retrospective data, which comprised most of the literature. The preponderance of the literature suggests that patients undergoing cardiac surgery can tolerate lower hemoglobin/hematocrit values than traditionally appreciated. Most published data also indicate that PRBC transfusion should be reserved for patients with an identifiable clinical/physiologic indication fir this intervention, consistent with recent specialty society guidelines. PMID:22762927

  5. Exploring expectations and needs of patients undergoing angioplasty.

    PubMed

    Aazami, Sanaz; Jaafarpour, Molouk; Mozafari, Mosayeb

    2016-09-01

    This study aimed to explore needs and expectations of Iranian patients who undergone angioplasty procedures. Coronary artery disease is the leading cause of morbidity and mortality worldwide. Recently, Percutaneous Coronary Intervention (PCI) has frequently been used as a substitute for coronary artery surgery, representing a less invasive and more cost-effective procedure. However, little information is known about the experiences and needs of patients undergone PCI. This research involved a qualitative study that employed the content analysis method. A semi-structured in-depth interview protocol was carried out using a face-to-face approach. Researchers reached to theoretical saturation by interviewing 18 patients who undergone angioplasty. Constant comparison analysis was used with simultaneous data collection. Three themes emerged from this study including Uncertainty, Procedural knowledge and Social Support. The findings from this study enhance our understanding on expectations and needs of patients who undergone PCI. These findings help nurses and health-care providers to develop and provide pre and post-procedural care according to each individual needs and experiences. This Iranian study not only contributes to other international study but also, emphasizes on the need for pre-procedural awareness and post-procedural support of patients who undergone PCI. PMID:27568316

  6. Postoperative infection in patients undergoing inspection of orthopedic damage due to external fixation☆

    PubMed Central

    Foni, Noel Oizerovici; Batista, Felipe Augusto Ribeiro; Rossato, Luís Henrique Camargo; Hungria, José Octavio Soares; Mercadante, Marcelo Tomanik; Christian, Ralph Walter

    2015-01-01

    Objective To conduct a retrospective analysis on cases undergoing inspection of orthopedic damage, at an orthopedic emergency service in a teaching hospital, with the aim of evaluating patients with postoperative infection after conversion to internal osteosynthesis. Methods This was a retrospective analysis covering the period from June 2012 to June 2013, on patients who underwent inspection of orthopedic damage due to external fixation and subsequently were converted to definitive osteosynthesis using a nail or plate. Results We found an infection rate of 13.3% in our sample and, furthermore, found that there had been technical errors in setting up the fixator in 60.4% of the cases. Conclusion We found an infection rate that we considered high, along with inadequacies in constructing the external fixator. We emphasize that this procedure is not risk-free and that training for physicians who perform this procedure should be mandatory.

  7. The effect of recommended Azkar on anxiety, stress, and depression in families of patients undergoing open heart surgery

    PubMed Central

    Mehdipour-Rabori, Roghayeh; Nematollahi, Monirosadat

    2014-01-01

    Introduction: Admission of a family member to hospital would cause stress on other family members also. One of the most stressful treatment interventions imposing high level of anxiety to the families of patients is when the patients are undergoing a surgery, especially a cardiac surgery. So, we decided to investigate whether recommended Azkar could reduce stress, anxiety, and depression in families of the patients. Materials and Methods: This study is a quasi-experimental study conducted on 120 immediate relatives of patients undergoing a cardiac surgery. Families of patients undergoing open heart surgery were randomly divided into two groups of study and control. The Depression, Anxiety, and Stress Scales (DASS 21) questionnaires were completed by both groups. Then, some explanations about how to use recommended prayers were given to the study group, and an hour later, the questionnaires were completed again. The data were analyzed by SPSS. P < 0.05 were considered significant. Results: Stress, anxiety, and depression showed a significant difference in the study group before and after intervention. Similarly, there was a significant difference in the mean scores of anxiety, stress, and depression in the study and control groups after intervention. Conclusions: Findings of the present study showed that recommended religious prayers can significantly reduce anxiety, depression, and stress of families of the patients undergoing open heart surgery. PMID:24949060

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

    PubMed

    Basora Macaya, M

    2015-06-01

    Iron deficiency in patients with morbid obesity can occur before bariatric surgery due to its inflammatory component and after surgery as the result of implementing the malabsorptive techniques. For patients with morbid obesity, micronutrient deficiencies, such as vitamin B12, iron and folate, should be suspected. Iron deficiency and other hematinics should be corrected, even when anemia has not been established. Normal ferritin levels do not allow us to rule out a possible iron deficiency, given that ferritin can increase due to the chronic inflammatory condition of obesity. After bariatric surgery, patients should take iron supplements; however, these supplements are frequently poorly tolerated. Rapid and effective correction of hemoglobin levels might require the intravenous administration of iron preparations. PMID:26320349

  9. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery.

    PubMed

    Rizk, Paul; Morris, William; Oladeji, Philip; Huo, Michael

    2016-06-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms. PMID:27239384

  10. Effect of Intraoperative Dexmedetomidine Infusion on Postoperative Bowel Movements in Patients Undergoing Laparoscopic Gastrectomy

    PubMed Central

    Cho, Jin Sun; Kim, Hyoung-Il; Lee, Ki-Young; An, Ji Yeong; Bai, Sun Joon; Cho, Ju Yeon; Yoo, Young Chul

    2015-01-01

    Abstract Sympathetic hyperactivation is one of the causes of postoperative ileus, which occurs frequently after abdominal surgery and adversely influences the patient's prognosis. We aimed to investigate whether dexmedetomidine (DEX) could attenuate postoperative ileus in patients undergoing laparoscopic gastrectomy. Ninety-two patients were randomized to the control (n = 46) or DEX group (n = 46). DEX was administered at a loading dose of 0.5 μg/kg for 10 minutes, followed by an infusion rate of 0.4 μg/kg/h from insufflation of the pneumoperitoneum to the end of surgery. The primary goal was to compare postoperative bowel movements by evaluating the time to first flatus. The balance of the autonomic nervous system, duration of postoperative hospital stay, and pain scores were assessed. The time to first flatus was shorter in the DEX group compared with the control group (67.2 ± 16.8 hours vs 79.9 ± 15.9 hours, P < 0.001). The low-frequency/high-frequency power ratio during pneumoperitoneum increased in the control group, compared with baseline values and the DEX group. The length of postoperative hospital stay was shorter in the DEX group compared with the control group (5.4 ± 0.7 days vs 5.8 ± 1.1 days, P = 0.04). Patients in the DEX group had lower pain scores and required fewer analgesics at 1 hour postoperatively. DEX facilitated bowel movements and reduced the length of hospital stay in patients undergoing laparoscopic gastrectomy. This may be attributed to the sympatholytic and opioid-sparing effects of DEX.

  11. Effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis

    PubMed Central

    Rahimipour, Meisam; Shahgholian, Nahid; Yazdani, Mohsen

    2015-01-01

    Background: Renal failure is a major public health problem in the world. These patients experience high levels of psychological tension, anxiety, and depression, which leads to their lowered quality of life, increased health care costs, and early mortality. Due to medication side effects in these patients, non-medicational methods are more in demand now. This study aimed to investigate the effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis. Materials and Methods: This is a clinical trial. Fifty patients undergoing hemodialysis were selected. Patients were assigned to two groups of hope therapy and placebo. Intervention of hope therapy was administered for 60–90 min during dialysis sessions once a week for eight sessions. In the placebo group, non-specific intervention was administered with the same number of sessions. Depression, Anxiety, and Stress scale (DASS)-21 questionnaire was completed at the end of the last session and 4 weeks later. Data were analyzed by paired t-test, repeated measures analysis of variance (ANOVA), and least significant difference (LSD) post hoc test through SPSS 18. Results: There was a significant difference in mean scores of depression, anxiety, and stress in hope therapy group before, immediately after, and 1 month after intervention (P < 0.05), while there was no significant difference in mean scores of depression, anxiety, and stress before and immediately after intervention in the placebo group. Changes in mean scores of depression, anxiety, and stress were significantly higher in hope therapy group compared to placebo (P < 0.05). Conclusions: The obtained results showed that hope therapy is effective on reduction of depression, anxiety, and stress. PMID:26793255

  12. Increased body aluminum. An independent risk factor in patients undergoing long-term hemodialysis

    SciTech Connect

    Chazan, J.A.; Blonsky, S.L.; Abuelo, J.G.; Pezzullo, J.C.

    1988-08-01

    The clinical course and aluminum status of 38 patients who had been receiving dialysis for at least eight years and were still undergoing dialysis in 1985 were evaluated. Twenty-nine had evidence of increased aluminum burden, although only three had evidence of overt aluminum toxicity, and nine did not have evidence of increased aluminum burden. The patients in both the high- and low-aluminum group were similar with regard to age, the cause of their renal failure, presence of hypertension or coronary artery disease, previous parathyroidectomy, and a number of biochemical parameters, along with the amount of prescribed aluminum. All patients were followed up for the next two years or until they died. The amount of ingested aluminum was reduced, and in selected patients, treatment with intermittent infusions of deferoxamine mesylate was instituted. There were no deaths in the low-aluminum group, but ten of 29 died in the high-aluminum group: seven of vascular disease and three of infection. In addition, morbidity as defined by hospitalization for coronary or cerebral vascular disease or infection occurred in only two of the nine patients in the low-aluminum group and in 19 of the 29 patients in the high-aluminum group. These observations imply that the occurrence of increased body aluminum, as suggested by aluminum blood levels or by results of bone biopsies in some patients, has an adverse effect on morbidity and mortality and should be considered as a possible independent risk factor in patients who are receiving long-term hemodialysis.

  13. A Reduced-Intensity Conditioning Regimen for Patients with Dyskeratosis Congenita Undergoing Hematopoietic Stem Cell Transplantation.

    PubMed

    Nelson, Adam S; Marsh, Rebecca A; Myers, Kasiani C; Davies, Stella M; Jodele, Sonata; O'Brien, Tracey A; Mehta, Parinda A

    2016-05-01

    Allogeneic hematopoietic stem cell transplantation (HSCT) is the only curative option for progressive marrow failure, myelodysplastic syndrome, or leukemia associated with dyskeratosis congenita (DC). HSCT for DC is limited by a high incidence of treatment-related mortality, thought to be related to underlying chromosomal instability and sensitivity to chemotherapy and radiation. We report our experience in 7 patients with DC who underwent allogeneic transplantation using a reduced-intensity conditioning (RIC) preparative regimen that contained chemotherapy only (no radiation). This RIC regimen, designed specifically for patients with DC, contained alemtuzumab, fludarabine, and melphalan (with melphalan at 50% reduced dosing), with the goal of decreasing toxicity and improving outcome. All 7 patients engrafted, with none developing mixed chimerism or rejection. Two patients experienced acute graft-versus-host disease (GVHD) and 1 went on to develop limited chronic GVHD of the skin. Five patients remain alive and well at a median follow-up of 44 months (range, 14 to 57 months). We conclude that a radiation-free RIC regimen results in durable engraftment, acceptable toxicity, and improved overall survival in patients with DC undergoing allogeneic HSCT. PMID:26845033

  14. Increased Expression of CSF-1 Associates With Poor Prognosis of Patients With Gastric Cancer Undergoing Gastrectomy

    PubMed Central

    Liu, Hao; Zhang, Heng; Shen, Zhenbin; Lin, Chao; Wang, Xuefei; Qin, Jing; Qin, Xinyu; Xu, Jiejie; Sun, Yihong

    2016-01-01

    Abstract Clinical significance of diametrically polarized tumor-associated macrophages in gastric cancer has been elucidated in our previous study, whereas the role of cytokines that orchestrate tumor-associated macrophages polarization in gastric cancer remains elusive. The study aims to evaluate the prognostic value of colony-stimulating factor-1 expression in patients with gastric cancer. We examined the colony-stimulating factor-1 expression in tumor tissues by immunohistochemical staining in retrospectively enrolled 365 patients with gastric cancer undergoing gastrectomy at Zhongshan Hospital during 2008. Kaplan–Meier analysis and Cox regression models were used to evaluate the prognostic value of colony-stimulating factor-1 expression and its association with clinicopathological factors. A predictive nomogram by integrating colony-stimulating factor-1 expression with the TNM staging system was generated for overall survival evaluation of the patients. High colony-stimulating factor-1 expression predicted an unfavorable outcome in gastric cancer. The colony-stimulating factor-1 expression in tumor tissue could give a further discrimination for the prognosis of gastric cancer patients. Cox multivariate analysis identified the colony-stimulating factor-1 expression as an independent prognostic factor. The generated nomogram performed well in predicting the 3- and 5-year overall survival of gastric cancer patients. The colony-stimulating factor-1 is a potential independent adverse prognosticator for gastric cancer patients, which could be integrated with the tumor-associated macrophages staging system to improve the predictive accuracy for overall survival, especially in advanced tumors. PMID:26945355

  15. Luteal blood flow in patients undergoing GnRH agonist long protocol

    PubMed Central

    2011-01-01

    Background Blood flow in the corpus luteum (CL) is closely related to luteal function. It is unclear how luteal blood flow is regulated. Standardized ovarian-stimulation protocol with a gonadotropin-releasing hormone agonist (GnRHa long protocol) causes luteal phase defect because it drastically suppresses serum LH levels. Examining luteal blood flow in the patient undergoing GnRHa long protocol may be useful to know whether luteal blood flow is regulated by LH. Methods Twenty-four infertile women undergoing GnRHa long protocol were divided into 3 groups dependent on luteal supports; 9 women were given ethinylestradiol plus norgestrel (Planovar) orally throughout the luteal phase (control group); 8 women were given HCG 2,000 IU on days 2 and 4 day after ovulation induction in addition to Planovar (HCG group); 7 women were given vitamin E (600 mg/day) orally throughout the luteal phase in addition to Planovar (vitamin E group). Blood flow impedance was measured in each CL during the mid-luteal phase by transvaginal color-pulsed-Doppler-ultrasonography and was expressed as a CL-resistance index (CL-RI). Results Serum LH levels were remarkably suppressed in all the groups. CL-RI in the control group was more than the cutoff value (0.51), and only 2 out of 9 women had CL-RI values < 0.51. Treatments with HCG or vitamin E significantly improved the CL-RI to less than 0.51. Seven of the 8 women in the HCG group and all of the women in the vitamin E group had CL-RI < 0.51. Conclusion Patients undergoing GnRHa long protocol had high luteal blood flow impedance with very low serum LH levels. HCG administration improved luteal blood flow impedance. This suggests that luteal blood flow is regulated by LH. PMID:21219663

  16. Identification of distinct fatigue trajectories in patients with breast cancer undergoing adjuvant chemotherapy

    PubMed Central

    Junghaenel, Doerte U.; Cohen, Jules; Schneider, Stefan; Neerukonda, Anu R.; Broderick, Joan E.

    2015-01-01

    Purpose The goal of this study was to characterize changes in daily fatigue in women undergoing chemotherapy for breast cancer. We examined whether there are subgroups of patients with distinct fatigue trajectories and explored potential psychosocial and biomedical predictors of these subgroups. Methods Participants were 77 women with breast cancer receiving adjuvant chemotherapy with AC-T (2-week cycle) and TC or TCH (3-week cycle) regimens. They completed 28 daily ratings online using an adapted version of the Patient-Reported Outcomes Measurement Information System (PROMIS®) fatigue instrument. Results Both regimens followed an “inverted-U shaped” fatigue pattern over approximately 2 weeks. Growth mixture modeling identified three patient subgroups with distinct trajectories. Fatigue scores in the “low fatigue” group (23%) increased following the infusion and quickly abated. The “transient fatigue” (27%) group had a very pronounced increase. Patients in the “high fatigue” (50%) group reported consistently elevated fatigue with a relatively small increase. Demographic and medical variables were not associated with fatigue trajectory. Patients in the “high fatigue” group reported significantly poorer physical, emotional, and social functioning, poorer general health, and more depressed mood than patients in the “low fatigue” group. The “transient fatigue” group reported significantly better physical and social functioning than the “high fatigue” group, but emotional distress and depression similar to the “high fatigue” group. Conclusions The identification of patient subgroups with distinct fatigue trajectories during chemotherapy is an essential step for developing preventative strategies and tailored interventions. Our results suggest that different trajectories are associated with patients’ psychosocial and general health. PMID:25876159

  17. Preoperative Laboratory Testing in Patients Undergoing Elective, Low-Risk Ambulatory Surgery

    PubMed Central

    Benarroch-Gampel, Jaime; Sheffield, Kristin M.; Duncan, Casey B.; Brown, Kimberly M.; Han, Yimei; Townsend, Courtney M.; Riall, Taylor S.

    2012-01-01

    Background Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005–2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing. PMID:22868362

  18. Step activity monitoring in lumbar stenosis patients undergoing decompressive surgery

    PubMed Central

    Schubert, Tim; Winter, Corinna; Brandes, Mirko; Hackenberg, Lars; Wassmann, Hansdetlef; Liem, Dennis; Rosenbaum, Dieter; Bullmann, Viola

    2010-01-01

    Symptomatic degenerative central lumbar spinal stenosis (LSS) is a frequent indication for decompressive spinal surgery, to reduce spinal claudication. No data are as yet available on the effect of surgery on the level of activity measured with objective long-term monitoring. The aim of this prospective, controlled study was to objectively quantify the level of activity in central LSS patients before and after surgery, using a continuous measurement device. The objective data were correlated with subjective clinical results and the radiographic degree of stenosis. Forty-seven patients with central LSS and typical spinal claudication scheduled for surgery were included. The level of activity (number of gait cycles) was quantified for 7 consecutive days using the StepWatch Activity Monitor (SAM). Visual analogue scales (VAS) for back and leg pain, Oswestry disability index and Roland–Morris score were used to assess the patients’ clinical status. The patients were investigated before surgery and 3 and 12 months after surgery. In addition, the radiographic extent of central LSS was measured digitally on preoperative magnetic resonance imaging or computed tomography. The following results were found preoperatively: 3,578 gait cycles/day, VAS for back pain 5.7 and for leg pain 6.5. Three months after surgery, the patients showed improvement: 4,145 gait cycles/day, VAS for back pain 4.0 and for leg pain 3.0. Twelve months after surgery, the improvement continued: 4,335 gait cycles/day, VAS for back pain 4.1 and for leg pain 3.3. The clinical results and SAM results showed significant improvement when preoperative data were compared with data 3 and 12 months after surgery. The results 12 months after surgery did not differ significantly from those 3 months after surgery. The level of activity correlated significantly with the degree of leg pain. The mean cross-sectional area of the spinal canal at the central LSS was 94 mm2. The radiographic results did not

  19. Increased hypoxemia in patients with COPD and pulmonary hypertension undergoing bronchoscopy with biopsy

    PubMed Central

    Neuman, Yoram; Koslow, Matthew; Matveychuk, Alona; Bar-Sef, Avigdor; Guber, Alexander; Shitrit, David

    2015-01-01

    Background and objective Patients with pulmonary hypertension (PH) are considered to be at risk for complications associated with flexible bronchoscopy (FB), but data concerning the degree of PH are often lacking. We investigated whether COPD patients with PH who undergo bronchoscopy are at greater risk for complications. Methods This prospective study included 207 consecutive COPD patients undergoing FB. All underwent an echo-Doppler to evaluate pulmonary artery pressure on the day of the bronchoscopy procedure. Pulmonologists were blinded to the echocardiogram results. Results A total of 167 patients (80.7%) had normal pulmonary pressure. The remaining 40 patients (19.3%) had PH: 27 (13.0%) mild, eight (3.9%) moderate, and five (2.4%) severe. Noninvasive hemodynamic parameters between groups before and after FB were similar. Two patients with normal pulmonary pressure developed supraventricular tachycardia. None developed hemodynamically significant dysrhythmia. Bleeding episodes between groups in bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) did not differ. PH patients who underwent BAL and TBB had decreased O2 saturation during the procedure compared with the non-PH group (23.5% vs 6.9%, P=0.033). No deaths were attributable to FB. Conclusion PH is common among COPD patients undergoing FB. PH patients undergoing BAL and TBB are at higher risk of decreased O2 saturation than those without PH. Further studies should assess the risk among COPD patients with moderate-to-severe PH. PMID:26674252

  20. Thromboembolic disease in patients with rheumatoid arthritis undergoing joint arthroplasty: Update on prophylaxes

    PubMed Central

    Mameli, Antonella; Marongiu, Francesco

    2014-01-01

    The risk of venous thromboembolism (VTE) in rheumatoid arthritis (RA) and the higher incidence of RA patients undergoing major orthopedic surgery is well recognized. The objective of the present study is to describe the incidence of VTE and discuss the correct prophylaxis in RA patients undergoing knee or hip replacement. A systematic review of studies on thromboprophylaxis in RA patients undergoing major orthopedic surgery was performed. Detailed information was extracted to calculate the rate of VTE in RA orthopedic patients and analyze the thromboprophylaxis performed and bleeding complications. Eight articles were eligible for full review. No difference in the overall rate of VTE was observed between RA patients and controls. No significant differences were found in RA patients in terms of bleeding complications. The data on the optimal prophylaxis to be used in RA patients were insufficient to recommend any of the several options available. In the absence of dedicated guidelines for the care of RA patients undergoing orthopedic surgery, management must be individualized to obtain favorable patient outcome, weighing up all the factors that might put the patient at risk for higher bleeding and thrombotic events. PMID:25405093

  1. Mortality in Medicare Patients Undergoing Elective Percutaneous Coronary Intervention With or Without Antecedent Stress Testing

    PubMed Central

    Lin, Grace A.; Lucas, F.L.; Malenka, David J.; Skinner, Jonathan; Redberg, Rita F.

    2013-01-01

    Background Guidelines advise testing for ischemia – such as with stress testing – prior to elective percutaneous coronary intervention (PCI). However, pre-PCI stress testing is not always done; the implications of this practice are not known. Our objective was to evaluate whether receipt of stress testing prior to elective PCI predicts mortality. Methods and Results Using claims data from a 20% random sample of Medicare beneficiaries, we identified patients who had elective PCI in 2004 and followed them for a median of 3.4 years (N=23,887). Cox proportional hazards models were used to test the relationship of pre-PCI stress testing to survival. Population-based rates of elective PCI and stress testing were calculated for 306 hospital referral regions (HRR) and categorized into four groups: high stress test rate/high PCI rate, low stress test/low PCI, low stress test/high PCI, and high stress/low PCI regions. Cox modeling was used to test if category of HRR related to survival. Patients who underwent pre-PCI stress testing had a 13% lower risk of mortality than those who did not (adjusted hazard ratio (HR) 0.87, 95% CI 0.81–0.92) after median follow-up of 3.4 years. Patients in low stress test/high PCI regions had a 14% higher risk of mortality than those in high stress test/high PCI regions (adjusted HR 1.14, 95% CI 1.03, 1.26). Conclusions Pre-PCI stress testing is associated with lower mortality in patients undergoing elective PCI. Greater adherence to guidelines with respect to documenting ischemia prior to elective PCI may result in improved outcomes for patients. PMID:23674314

  2. Anesthesia Strategies and Perioperative Optimization for Patients with Ankylosing Spondylitis Undergoing Total Hip Replacement Surgery.

    PubMed

    2016-06-10

    Objective To identify the characteristics of anesthesia and perioperative management for ankylosing spondylitis (AS) patients undergoing total hip arthroplasty (THA). Methods Totally 63 patients scheduled for single THA in PUMC Hospital from January 1st 2013 to June 1st 2015 were included in this retrospective analysis,among whom 21 patients were diagnosed of AS. The perioperative clinical data included:demographic data,American Society of Anesthesiologists (ASA) classification,medical history,airway assessment,preoperative laboratory examinations,electrocardiogram,pulmonary function tests,intubation information,operation time,intraoperative intake and output volume,postoperative hospital stay,and postoperative complications. Results Significantly fewer AS patients undergoing THA were evaluated as ASA classification I than non-AS patients (9.5% vs. 33.3%,P=0.041). AS patients had significantly higher level of preoperative high-sensitivity C-reactive protein [(17.0±14.8)mg/L vs.(4.3±7.1)mg/L,P<0.001],platelets [(275.0±71.3)×10(9)/L vs. (237.7±68.0)×10(9)/L,P=0.048] and neutrophils [(4.7±1.7)×10(9)/L vs. (3.9±1.4)×10(9)/L,P=0.044] and higher incidence of pulmonary function abnormality (42.9% vs.16.7%,P=0.024).More AS patients were induced with scoline (14.3% vs.0,P=0.012). More AS patients underwent THA with Mallampati classification 3 (28.6% vs.7.1%,P=0.022),reduced neck extension(47.6% vs.2.4%,P<0.001),Cormack-Lehane classification2(56.3% vs.15.4%,P=0.002)and 3 (18.8% vs.0,P=0.005),while much fewer AS patients had Cormack-Lehane classification1 (25.0% vs.84.6%,P<0.001).A variety of difficult airway tools were used in intubation (AS group:Macintosh laryngoscope:14%,Macintosh laryngoscope with stylet:38%,visualization laryngoscope:24%,visualization stylet:10% and fiber bronchoscope:14%;non-AS group:57%,24%,12%,5% and 2%,respectively). The use of intraoperative autologous blood transfusion (33.3% vs.11.9%,P

  3. Contemporary anticoagulation therapy in patients undergoing percutaneous intervention.

    PubMed

    Bhatty, Shaun; Ali, Asghar; Shetty, Ranjith; Sumption, Kevin F; Topaz, On; Jovin, Ion S

    2014-04-01

    The proper use of anticoagulants is crucial for ensuring optimal patient outcomes post percutaneous interventions in the cardiac catheterization laboratory. Anticoagulant agents such as unfractionated heparin, a thrombin inhibitor; low-molecular weight heparins, predominantly Factor Xa inhibitors; fondaparinux, a Factor Xa inhibitor and bivalirudin, a direct thrombin inhibitor have been developed to target various steps in the coagulation cascade to prevent formation of thrombin. Optimal anticoagulation achieves the correct balance between thrombosis and bleeding and is related to optimal outcomes with minimal complications. This review will discuss the mechanisms and appropriate use of current and emerging anticoagulant therapies used during percutaneous interventions. PMID:24506409

  4. Peripheral doses in patients undergoing Cyberknife treatment for intracranial lesions. A single centre experience

    PubMed Central

    2011-01-01

    Background Stereotactic radiosurgery/radiotherapy procedures are known to deliver a very high dose per fraction, and thus, the corresponding peripheral dose could be a limiting factor for the long term surviving patients. The aim of this clinical study was to measure the peripheral dose delivered to patients undergoing intracranial Cyberknife treatment, using the MOSFET dosimeters. The influence of the supplemental shielding, the number of monitor units and the collimator size to the peripheral dose were investigated. Methods MOSFET dosimeters were placed in preselected anatomical regions of the patient undergoing Cyberknife treatment, namely the thyroid gland, the nipple, the umbilicus and the pubic symphysis. Results The mean peripheral doses before the supplemental shielding was added to the Cyberknife unit were 51.79 cGy, 13.31 cGy and 10.07 cGy while after the shielding upgrade they were 38.40 cGy, 10.94 cGy, and 8.69 cGy, in the thyroid gland, the umbilicus and the pubic symphysis, respectively. The increase of the collimator size corresponds to an increase of the PD and becomes less significant at larger distances, indicating that at these distances the PD is predominate due to the head leakage and collimator scatter. Conclusion Weighting the effect of the number of monitor units and the collimator size can be effectively used during the optimization procedure in order to choose the most suitable treatment plan that will deliver the maximum dose to the tumor, while being compatible with the dose constraints for the surrounding organs at risk. Attention is required in defining the thyroid gland as a structure of avoidance in the treatment plan especially in patients with benign diseases. PMID:22082279

  5. A prospective cohort study of intrathecal versus epidural analgesia for patients undergoing hepatic resection

    PubMed Central

    Kasivisvanathan, Ramanathan; Abbassi-Ghadi, Nima; Prout, Jeremy; Clevenger, Ben; Fusai, Giuseppe K; Mallett, Susan V

    2014-01-01

    Background The aim of this prospective observational study was to compare peri/post-operative outcomes of thoracic epidural analgesia (TEA) versus intrathecal morphine and fentanyl patient-controlled analgesia (ITM+fPCA) for patients undergoing a hepatic resection (HR). Method Patients undergoing elective, one-stage, open HR for benign and malignant liver lesions, receiving central neuraxial block as part of the anaesthetic, in a high-volume hepato-pancreato-biliary unit, were included in the study. The primary outcome measure was post-operative length of stay (LoS). Results A total of 73 patients (36 TEA and 37 ITM+fPCA) were included in the study. The median (IQR) post-operative LoS was 13 (11–15) and 11 (9–13) days in the TEA and ITM+fPCA groups, respectively (P = 0.011). There was significantly lower median intra-operative central venous pressure (P < 0.001) and blood loss (P = 0.017) in the TEA group, and a significant reduction in the time until mobilization (P < 0.001), post-operative intra-venous fluid/vasopressor requirement (P < 0.001/P = 0.004) in the ITM+fPCA group. Pain scores were lower at a clinically significant level 12 h post-operatively in the TEA group (P < 0.001); otherwise there were no differences out to day five. There were no differences in quality of recovery or postoperative morbidity/mortality between the two groups. Conclusion ITM+fPCA provides acceptable post-operative outcomes for HR, but may also increase the incidence of intra-operative blood loss in comparison to TEA. PMID:24467320

  6. Evaluation of current surgeon practice for patients undergoing lumbar spinal fusion surgery in the United Kingdom

    PubMed Central

    Rushton, Alison; White, Louise; Heap, Alison; Heneghan, Nicola

    2015-01-01

    AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic analysis. RESULTS: The response rate was 73.8%. Most surgeons (84%) were orthopaedic surgeons. Range of surgeon experience (1-15 years), number of operations performed in the previous 12 mo (4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients. CONCLUSION: Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfaction it is important that further research evaluates optimal management. PMID:26191495

  7. Intracranial meningiomas: Prognostic factors and treatment outcome in patients undergoing postoperative radiation therapy

    PubMed Central

    Anvari, Kazem; Hosseini, Sare; Rahighi, Saeid; Toussi, Mehdi Seilanian; Roshani, Nasrin; Torabi-Nami, Mohammad

    2016-01-01

    Background: Meningioma constitutes 20% of the intracranial neoplasms. Followed by surgery as the primary treatment for most patients, radiotherapy becomes indicated in high-grade tumors with incomplete surgical removal. We evaluated the prognostic factors and overall outcome in meningioma patients who underwent radiotherapy. Materials and Methods: In this retrospective analysis, data from all patients with documented diagnosis of meningioma who referred to the Omid and Ghaem Oncology Centers (Mashhad, Iran) from 2002 to 2013 were included. We calculated the overall survival rates using the Kaplan–Meier method and compared the survival curves between groups by the log-rank test. Results: Eighty-three patients with a median age of 50 years (ranging: 16–84) were included. Grade I, II, and III meningiomas were seen in 40 (48%), 31 (37%), and 12 (15%) patients, respectively. Radiation therapy was indicated due to tumor recurrence, incomplete excision, or tumor grade in 32, 8, and 43 patients, respectively. Tumor grade had a significant effect on the overall survival with a 3-year overall survival of 76.7%, 43.5%, and 13.3% in Grade I, II, and III, respectively (P < 0.001). Gender, age, and tumor location were not correlated with the overall survival. Moreover, patients with Grade II and III who underwent total resection had a significantly higher overall survival than those with subtotal resection or biopsy alone (5-year survival rates of 82% vs. 17.1%, respectively; P = 0.008). Conclusion: Tumor grade was the most important prognostic factor in meningioma patients undergoing radiation therapy. In patients with Grade II and III tumors, the extent of surgical resection is significantly correlated with the overall survival. PMID:27274498

  8. CLECOS_P: clinical evolution control system on Parkinsonian patients undergoing neural transplantation.

    PubMed

    Morales, F; Molina, H; Cruz, N; Valladares, P; Muñoz, J; Ortega, I; Torres, O; Leon, M

    1995-01-01

    The CLECOS_P system was conceived for registering and automating the processing of clinical evaluations performed on patients with Parkinson's disease who undergo functional neurosurgery and/or neural transplant. CLECOS_P represents the first time a computerized system is able to offer--with high precision and considerable time-savings--an integral analysis of the evolutive behavior of the universe in integrated variables at the core assessment program for intracerebral transplantations (CAPIT). CAPIT is used internationally for the evaluation and follow-up of patients with this pathology who have undergone neural transplant. We used the so-called MEDSAC methodology for the preparation of this system. The methodology that was used for the design of an intelligent system aimed at medical decision-making was based on the quantitative analysis of the clinical evolution. At the present moment, there are 20 patients controlled by this system: 11 bilaterally transplanted, 9 unilaterally (registered in ranks of 3 months before operation up to 1, 2, 3, 6, 9, 12, 18, and 24 months after operation). The application of CLECOS_P to these patients permitted the evaluation of 400 clinical variables, where a better evolutive characterization of the patients was obtained, thus getting most favorable results with personalized therapeutic methods aimed at raising their quality of life. CLECOS_P is used in a multi-user environment on a local area network running Novell Netware version 3.11. PMID:8591284

  9. A review of important medical and surgical considerations for obese patients undergoing arthroscopic surgery.

    PubMed

    Prodromo, John; Rackley, Justin; Mulcahey, Mary K

    2016-09-01

    Obesity represents a unique challenge in orthopaedic surgery, the impact of which is seen through all phases of injury: in the development of disease, during the operative procedure, and throughout the rehabilitation period. Given the high prevalence of obesity in the United States and around the world, this patient population represents a substantial proportion of patients in need of orthopedic care. The effects of this disease constrain both medical and financial resources. For obese patients undergoing orthopedic procedures, adequate steps must be taken to minimize the risks that occur before, during, and after surgical intervention. This literature review discusses the impact of obesity on arthroscopic procedures, with a focus on procedures involving the shoulder, hip, and knee. The management of obese patients during the perioperative period should address the specific concerns relating to these patients. Obesity is a risk factor for numerous comorbidities, is associated with surgical complications, and is a predictor of poor functional outcomes following arthroscopy. Efforts to minimize the negative impact of obesity on arthroscopic procedures are crucial. PMID:27578242

  10. Effects of neutrophil elastase inhibitor in patients undergoing esophagectomy: A systematic review and meta-analysis

    PubMed Central

    Wang, Zhi-Qiang; Chen, Long-Qi; Yuan, Yong; Wang, Wen-Ping; Niu, Zhong-Xi; Yang, Yu-Shang; Cai, Jie

    2015-01-01

    AIM: To evaluate the benefit and safety of sivelestat (a neutrophil elastase inhibitor) administration in patients undergoing esophagectomy. METHODS: Online databases including PubMed, EMBASE, the Cochrane Library, Web of Knowledge, and Chinese databases (Wanfang database, VIP and CNKI) were searched systematically up to November 2013. Randomized controlled trials and high-quality comparative studies were considered eligible for inclusion. Three reviewers evaluated the methodological quality of the included studies, and Stata 12.0 software was used to analyze the extracted data. The risk ratio (RR) was used to express the effect size of dichotomous outcomes, and mean difference (MD) or standardized mean difference was used to express the effect size of continuous outcomes. RESULTS: Thirteen studies were included in this systematic review and nine studies were included in the meta-analysis. The duration of mechanical ventilation was significantly decreased in the sivelestat group on postoperative day 5 [I2 = 76.3%, SMD = -1.41, 95%CI: -2.63-(-0.19)]. Sivelestat greatly lowered the incidence of acute lung injury in patients after surgery (I2 = 0%, RR = 0.27, 95%CI: 0.08-0.93). However, it did not decrease the incidence of pneumonia, intensive care unit stay or postoperative hospital stay, and did not increase the incidence of complications such as anastomotic leakage, recurrent nerve palsy, wound infection, sepsis and catheter-related fever. CONCLUSION: A neutrophil elastase inhibitor is beneficial in patients undergoing esophagectomy. More high quality, large sample, multi-center and randomized controlled trials are needed to validate this effect. PMID:25834341

  11. Aortic Wall Extracellular Matrix Proteins Correlate with Syntax Score in Patients Undergoing Coronary Artery Bypass Surgery

    PubMed Central

    Chiong, Terri; Cheow, Esther S. H.; Woo, Chin C.; Lin, Xiao Y.; Khin, Lay W.; Lee, Chuen N.; Hartman, Mikael; Sze, Siu K.; Sorokin, Vitaly A.

    2016-01-01

    Aims: The SYNTAX score correlate with major cardiovascular events post-revascularization, although the histopathological basis is unclear. We aim to evaluate the association between syntax score and extracellular matrix histological characteristics of aortic punch tissue obtained during coronary artery bypass surgery (CABG). This analysis compares coronary artery bypass surgery patients with High and Low syntax score which were followed up for one year period. Methods and Results: Patients with High (score ≥ 33, (n=77)) and Low Syntax Scores (score ≤ 22, (n=71)) undergoing elective CABG were recruited prospectively. Baseline clinical characteristics and surgical risks were well matched. At 1 year, EMACCE (Sum of cardiovascular death, stroke, congestive cardiac failure, and limb, gut and myocardial ischemia) was significantly elevated in the High syntax group (P=0.022). Mass spectrometry (MS)-based quantitative iTRAQ proteomic results validated on independent cohort by immunohistochemistry (IHC) revealed that the High syntax group had significantly upraised Collagen I (P<0.0001) and Elastin (P<0.0001) content in ascending aortic wall. Conclusion: This study shows that aortic extracellular matrix (ECM) differ between High and Low syntax groups with up-regulation of Collagen I and Elastin level in High Syntax Score group. This identifies aortic punches collected during CABG as another biomarker source related with atherosclerosis severity and possible clinical outcome. PMID:27347220

  12. Transfusion strategies in patients undergoing stem-cell transplantation.

    PubMed

    Radia, Rohini; Pamphilon, Derwood

    2011-04-01

    Hemopoietic stem-cell transplant patients may require intensive blood component support. Complications of transfusions include transmission of viral and bacterial infections, transfusion-associated graft-versus-host disease and transfusion-related acute lung injury. Alloimmunization to red cell antigens may cause difficulties in selecting compatible blood, while alloimmunization to HLA expressed on platelets may cause subsequent platelet transfusion refractoriness. It is essential to define robust transfusion policies and procedures and these should be regularly audited. This article reviews blood component transfusion in the setting of hemopoietic stem-cell transplant and specifically discusses the management of ABO-mismatched transplants, the prevention of cytomegalovirus transmission, the prevention of transfusion-associated graft-versus-host disease and the use of granulocyte transfusions. PMID:21495930

  13. Oral Complications and Management Strategies for Patients Undergoing Cancer Therapy

    PubMed Central

    2014-01-01

    With cancer survival rate climbing up over the past three decades, quality of life for cancer patients has become an issue of major concern. Oral health plays an important part in one's overall quality of life. However, oral health status can be severely hampered by side effects of cancer therapies including surgery, chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. Moreover, prevention and treatment of these complications are often overlooked in clinical practice. The present paper aims at drawing health care professionals' attention to oral complications associated with cancer therapy by giving a comprehensive review. Brief comments on contemporary cancer therapies will be given first, followed by detailed description of oral complications associated with cancer therapy. Finally, a summary of preventive strategies and treatment options for common oral complications including oral mucositis, oral infections, xerostomia, and dysgeusia will be given. PMID:24511293

  14. Predicting postoperative mortality in patients undergoing colorectal surgery.

    PubMed

    Slim, Karem; Panis, Yves; Alves, Arnaud; Kwiatkowski, Fabrice; Mathieu, Pierre; Mantion, Georges

    2006-01-01

    Well-known and suitable instruments for surgical audit are the POSSUM and P-POSSUM scoring systems. But these scores have not been well validated across the countries. The objective of the present study was to assess the predictive value of scores for colorectal surgery in France. Patients operated on for colorectal malignant or diverticular diseases, whether electively or on emergency basis, within a 4-month period were included in a prospective multicenter study conducted by the French Association for Surgery (Association Française de Chirurgie, AFC). The main outcome measure was postoperative in-hospital mortality. Independent factors leading to death were assessed by multivariate logistic regression analysis (AFC-index). The ratio of expected versus observed deaths was calculated, and the predictive value of the POSSUM and P-POSSUM scores were analyzed by the receiver operating characteristic (ROC) curve. A total of 1426 patients were included. The in-hospital death rate was 3.4%. Four independent preoperative factors (AFC-index) have been found: emergency surgery, loss of more than 10% of weight, neurological disease history, and age > 70 years. POSSUM had a poor predictive value; it overestimated postoperative death in all cases. P-POSSUM had a good predictive value, except for elective surgery, where it overestimated postoperative death twofold. The predictive value of the AFC-index was also good. It had the same sensitivity and specificity as the P-POSSUM. POSSUM has not been validated in France in the field of colorectal surgery. P-POSSUM was as predictive as the AFC-index which is a simpler instrument based on four clinical parameters (without any mathematical formulas). PMID:16369701

  15. [THE DIAGNOSTIC AND THERAPEUTIC BRONCHOSCOPY IN CARDIAC PATIENTS UNDERGOING MECHANICAL VENTILATION IN THE POSTOPERATIVE PERIOD].

    PubMed

    Titova, I V; Khrustaleva, M V; Eremenko, A A; Babaev, M A

    2016-01-01

    The review presents an analysis of domestic and foreign literature on the use of bronchoscopy in patients with obstructive respiratory failure in the ICU. Separately considered the issue of additional research when performing bronchoscopy and create an algorithmfor the application of diagnostic and therapeutic bronchoscopy in cardiac surgical patients undergoing mechanical ventilation. PMID:27192859

  16. Prevalence of congenital heart disease in patients undergoing surgery for major gastrointestinal malformations: an Indian study

    PubMed Central

    Gokhroo, Rajendra K; Gupta, Sajal; Arora, Garima; Bisht, Devendra S; Padmanabhan, Deepak; Soni, Varsha

    2015-01-01

    Background The association of congenital heart disease (CHD) with malformations of the gastrointestinal (GI) tract/abdominal wall is known. The rates of cardiac malformations reported in previous studies of these anomalies are highly variable. Objective To find the prevalence and pattern of CHD in patients with major gastrointestinal malformations (anorectal malformations, oesophageal atresia/tracheo-oesophageal fistula, and omphalocoele) undergoing surgery at a tertiary care hospital in India. Methods From July 2012 to December 2013, 43 patients (34 (79%) male, 9 (21%) female) were evaluated by clinical examination, ECG, chest radiography, and colour Doppler echocardiography. Results Of the 43 patients, 26 (60.46%) had CHD. The most common GI malformation was anorectal malformation: 32 cases (74.41%), of whom 16 (50%) had CHD. The second most common malformation was oesophageal atresia/tracheo-oesophageal fistula: 5 cases (11.62%), all (100%) with CHD. The third group comprised patients with omphalocoele: 4 cases (9.3%), 3 of whom (75%) had CHD. The fourth group comprised patients with VACTERAL (vertebral anomalies, anal atresia, cardiovascular malformations, tracheo-oesophageal fistula, renal and limb anomalies) association—2 cases (4.6%), all (100%) with CHD. The most common CHD was isolated atrial septal defect (ASD) (73%), followed by ASD + ventricular septal defect (VSD) + patent ductus arteriosus (PDA) (7.6%), ASD + VSD (3.8%), ASD + PDA (3.8%), VSD (3.8%), PDA (3.8%), and coarctation of the aorta (3.8%). Conclusions We found the frequency of CHD in patients with GI malformations was very high, the most common presentation being ASD. Our study indicates the need for larger scale studies to determine the prevalence of CHD in patients with GI malformations in the Indian population. PMID:27326210

  17. Practice patterns in the perioperative treatment of patients undergoing septorhinoplasty: a survey of facial plastic surgeons.

    PubMed

    Shadfar, Scott; Deal, Allison M; Jarchow, Andrea M; Yang, Hojin; Shockley, William W

    2014-01-01

    IMPORTANCE The common practices used in the perioperative care of patients undergoing septorhinoplasty are diverse and controversial. A consensus statement on the preferred clinical pathway in the perioperative treatment of patients undergoing septorhinoplasty has yet to be approached formally. OBJECTIVES To investigate the perioperative treatment of patients undergoing septorhinoplasty and to identify common practice patterns based on the preferences of leading facial plastic surgeons. DESIGN, SETTING, AND PARTICIPANTS We distributed an online survey to members of the American Academy of Facial Plastic and Reconstructive Surgery. Specifically, fellowship directors and academic contact members were anonymously polled and stratified by the number of septorhinoplasties performed annually. MAIN OUTCOME AND MEASURE A cohesive clinical guide to perioperative treatment after rhinoplasty. RESULTS Of the 92 members surveyed, 67 (73%) successfully completed the survey. The distribution of respondents included 43 academicians (64%) and 24 physicians in private practice (36%). Twenty-eight surgeons (42%) performed fewer than 50 rhinoplasties a year and 39 (58%), more than 50, representing 3510 to 4549 septorhinoplasties in total among respondents. Forty-four surgeons (66%) refrained from using any packing, and 41 (61%) used intranasal splints, with polymeric silicone splints the most popular of these (n = 24 [59%]). Sixty-six surgeons (99%) used external nasal splints, including 49 (74%) who used a thermoplastic splint and 49 (74%) who left the external nasal splint in place for 7 days or longer. The most common postoperative interventions to reduce edema and ecchymosis were elevation of the head of bed by 62 (93%), ice packs by 50 (75%), and Arnica montana by 33 (49%). Only 12 surgeons (18%) used postoperative corticosteroids to reduce edema. Fifty-six respondents (84%) prohibited participation in contact sports until at least 6 weeks after surgery. CONCLUSIONS AND

  18. Myenteric plexitis: A frequent feature in patients undergoing surgery for colonic diverticular disease

    PubMed Central

    Villanacci, Vincenzo; Sidoni, Angelo; Nascimbeni, Riccardo; Dore, Maria P; Binda, Gian A; Bandelloni, Roberto; Salemme, Marianna; Del Sordo, Rachele; Cadei, Moris; Manca, Alessandra; Bernardini, Nunzia; Maurer, Christoph A; Cathomas, Gieri

    2015-01-01

    Background Diverticular disease of the colon is frequent in clinical practice, and a large number of patients each year undergo surgical procedures worldwide for their symptoms. Thus, there is a need for better knowledge of the basic pathophysiologic mechanisms of this disease entity. Objectives Because patients with colonic diverticular disease have been shown to display abnormalities of the enteric nervous system, we assessed the frequency of myenteric plexitis (i.e. the infiltration of myenteric ganglions by inflammatory cells) in patients undergoing surgery for this condition. Methods We analyzed archival resection samples from the proximal resection margins of 165 patients undergoing left hemicolectomy (60 emergency and 105 elective surgeries) for colonic diverticulitis, by histology and immunochemistry. Results Overall, plexitis was present in almost 40% of patients. It was subdivided into an eosinophilic (48%) and a lymphocytic (52%) subtype. Plexitis was more frequent in younger patients; and it was more frequent in those undergoing emergency surgery (50%), compared to elective (28%) surgery (p = 0.007). All the severe cases of plexitis displayed the lymphocytic subtype. Conclusions In conclusion, myenteric plexitis is frequent in patients with colonic diverticular disease needing surgery, and it might be implicated in the pathogenesis of the disease. PMID:26668745

  19. Albumin Kinetics in Patients Undergoing Major Abdominal Surgery

    PubMed Central

    Norberg, Åke; Rooyackers, Olav; Segersvärd, Ralf; Wernerman, Jan

    2015-01-01

    Background The drop in plasma albumin concentration following surgical trauma is well known, but the temporal pattern of the detailed mechanisms behind are less well described. The aim of this explorative study was to assess changes in albumin synthesis and transcapillary escape rate (TER) following major surgical trauma, at the time of peak elevations in two well-recognized markers of inflammation. Methods This was a clinical trial of radiolabeled human serum albumin for the study of TER and plasma volume. Ten patients were studied immediately preoperatively and on the 2nd postoperative day after major pancreatic surgery. Albumin synthesis rate was measured by the flooding dose technique employing incorporation of isotopically labelled phenylalanine. Results Fractional synthesis rate of albumin increased from 11.7 (95% CI: 8.9, 14.5) to 15.0 (11.7, 18.4) %/day (p = 0.027), whereas the corresponding absolute synthesis rate was unchanged, 175 (138, 212) versus 150 (107, 192) mg/kg/day (p = 0.21). TER was unchanged, 4.9 (3.1, 6.8) %/hour versus 5.5 (3.9, 7.2) (p = 0.63). Plasma volume was unchanged but plasma albumin decreased from 33.5 (30.9, 36.2) to 22.1 (19.8, 24.3) g/L. (p<0.001). Conclusion Two days after major abdominal surgery, at the time-point when two biomarkers of generalised inflammation were at their peak and the plasma albumin concentration had decreased by 33%, we were unable to show any difference in the absolute synthesis rate of albumin, TER and plasma volume as compared with values obtained immediately pre-operatively. This suggests that capillary leakage, if elevated postoperatively, had ceased at that time-point. The temporal relations between albumin kinetics, capillary leakage and generalised inflammation need to be further explored. Trial Registration clinicaltrialsregister.eu: EudraCT 2010-08529-21 ClinicalTrials.gov NCT01194492 PMID:26313170

  20. A new method to evaluate the residual activity in patients undergoing (131)I thyroid therapy.

    PubMed

    Ostinelli, A; Duchini, M; Conti, V; Bonfanti, P; Rossi, S; Cacciatori, M

    2015-12-01

    The radioiodine administration is a standard therapeutic approach to both benign thyroid diseases, such as hyperthyroidism, and carcinomas. The high administered (131)I activities are of radiation protection concern, due to relevant patient residual contamination. The aim of this work was to develop a new procedure based on external radiometric surveys and on a mathematical model in order to estimate the (131)I activity in patients undergoing hyperthyroidism radioiodine therapy. In the first stage of this study, a suitable detector was chosen and its response vs. activity was characterized. The experimental verification was performed measuring the ambient dose equivalent rate from patients receiving radioiodine administration. The results confirm the reliability of the proposed method, as shown by the slight differences between the administered activities and the ones calculated from external measurements. Furthermore, the same procedure was applied to detect the percentage residual activity in patients at two preset time intervals: 4 hours and 4 days after the radioiodine administration. The obtained results clearly highlight that the method can ensure a level of reliability compatible with the radiation protection purposes. PMID:26429386

  1. Retinoic Acid Improves Morphology of Cultured Peritoneal Mesothelial Cells from Patients Undergoing Dialysis

    PubMed Central

    Retana, Carmen; Sanchez, Elsa I.; Gonzalez, Sirenia; Perez-Lopez, Alejandro; Cruz, Armando; Lagunas-Munoz, Jesus; Alfaro-Cruz, Carmen; Vital-Flores, Socorro; Reyes, José L.

    2013-01-01

    Patients undergoing continuous ambulatory peritoneal dialysis are classified according to their peritoneal permeability as low transporter (low solute permeability) or High transporter (high solute permeability). Factors that determine the differences in permeability between them have not been fully disclosed. We investigated morphological features of cultured human peritoneal mesothelial cells from low or high transporter patients and its response to All trans retinoic Acid (ATRA, vitamin A active metabolite), as compared to non-uremic human peritoneal mesothelial cells. Control cells were isolated from human omentum. High or low transporter cells were obtained from dialysis effluents. Cells were cultured in media containing ATRA (0, 50, 100 or 200 nM). We studied length and distribution of microvilli and cilia (scanning electron microscopy), epithelial (cytokeratin, claudin-1, ZO-1 and occludin) and mesenchymal (vimentin and α-smooth muscle actin) transition markers by immunofluorescence and Western blot, and transforming growth factor β1 expression by Western blot. Low and high transporter exhibited hypertrophic cells, reduction in claudin-1, occludin and ZO-1 expression, cytokeratin and vimentin disorganization and positive α-smooth muscle actin label. Vimentin, α-smooth muscle actin and transforming growth factor- β1 were overexpressed in low transporter. Ciliated cells were diminished in low and high transporters. Microvilli number and length were severely reduced in high transporter. ATRA reduced hypertrophic cells number in low transporter. It also improved cytokeratin and vimentin organization, decreased vimentin and α-smooth muscle actin expression, and increased claudin 1, occludin and ZO-1 expression, in low and high transporter. In low transporter, ATRA reduced transforming growth factor-β1 expression. ATRA augmented percentage of ciliated cells in low and high transporter. It also augmented cilia length in high transporter. Alterations in

  2. Clinical Effect of Human Papillomavirus Genotypes in Patients With Cervical Cancer Undergoing Primary Radiotherapy

    SciTech Connect

    Wang, Chun-Chieh; Lai, Chyong-Huey; Huang, Huei-Jean; Chao, Angel; Chang, Chee-Jen; Chang, Ting-Chang; Chou, Hung-Hsueh; Hong, Ji-Hong

    2010-11-15

    Purpose: To study the prognostic value of the human papillomavirus (HPV) genotypes in cervical cancer patients undergoing radiotherapy. Patients and Methods: A total of 1,010 patients with cervical cancer after radiotherapy between 1993 and 2000 were eligible for this study. The HPV genotypes were determined by a genechip, which detects 38 types of HPV. The patient characteristics and treatment outcomes were analyzed using the Cox regression hazard model and classification and regression tree decision tree method. Results: A total of 25 genotypes of HPV were detected in 992 specimens (98.2%). The leading 8 types were HPV16, 58, 18, 33, 52, 39, 31, and 45. These types belong to two high-risk HPV species: alpha-7 (HPV18, 39, 45) and alpha-9 (HPV16, 31, 33, 52, 58). Three HPV-based risk groups, which were independent of established prognostic factors, such as International Federation of Gynecology and Obstetrics stage, age, pathologic features, squamous cell carcinoma antigen, and lymph node metastasis, were associated with the survival outcomes. The high-risk group consisted of the patients without HPV infection or the ones infected with the alpha-7 species only. Patients co-infected with the alpha-7 and alpha-9 species belonged to the medium-risk group, and the others were included in the low-risk group. Conclusion: The results of the present study have confirmed the prognostic value of HPV genotypes in cervical cancer treated with radiotherapy. The different effect of the alpha-7 and alpha-9 species on the radiation response deserves additional exploration.

  3. Is manual palpation of the lung necessary in patients undergoing pulmonary metastasectomy?

    PubMed

    Macherey, Sascha; Doerr, Fabian; Heldwein, Matthias; Hekmat, Khosro

    2016-03-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether manual palpation of the lung is necessary in patients undergoing pulmonary metastasectomy. In total, 56 articles were found using the described search strategy. After screening these articles and their references, 18 publications represented the best evidence to answer the clinical question. No randomized controlled trial addressing the three-part question was available. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers were tabulated. The studies reported on 1472 patients with different primary cancers. The patients underwent more than 1630 pulmonary metastasectomies between 1990 and 2014 after the treatment of primary cancer. Almost three quarters of patients underwent open procedures like thoracotomy or sternotomy. Most frequently, helical CT with a slice thickness ranging between 1 and 10 mm was used for preoperative imaging. The sensitivity in detecting pulmonary nodules ranged from 34 to 97%. The corresponding sensitivity rates for PET-CT were 66-67.5 and 75% for high-resolution CT. The positive predictive value for lesions detected by helical CT varied from 47 to 96%. Helical CT reached a specificity between 54 and 93% in detecting pulmonary nodules. The surgeons identified more nodules by meticulous palpation than helical CT. It is noteworthy that up to 48.5% of these palpated nodules were benign lesions (false-positive). Patients with smaller imaged nodules, multiple imaged nodules or primary mesenchymal tumour are more likely to have occult pulmonary nodules. We conclude that not all palpable pulmonary nodules can be imaged preoperatively. Thoracotomy allows the manual palpation of the ipsilateral hemithorax and might be superior to video-assisted thoracic surgery regarding radical resection. However, not all palpable nodules are malignant, and the impact

  4. Leg scanning with radioisotope-labeled fibrinogen in patients undergoing hip surgery

    SciTech Connect

    LeMoine, J.R.; Moser, K.M.

    1980-05-01

    To establish whether radioisotope-labeled fibrinogen leg scanning is of value in the context of hip surgery, we propsectively studied 21 consectuvie patients undergoing either total hip replacement (14) or open repair of a hip fracture (seven) with leg scans, contrast phlebography, and ventilation and perfusion lung scans. We found that in eight patients (38%), venous thromboembolism developed postoperatively. Agreement between phlebographic and leg scanning results was excellent. In no patient as venous thrombosis limited to the thigh on the operated-on side, a vital consideration in application of fibrinogen leg scanning to this patient population. Two patients had lung scan changes indicative of embolism; both had thrombi extending into thigh veins. Leg scanning with radioisotope-labeled fibrinogen appears to be a useful method for monitoring patients undergoing hip surgery, if the upper three counting points on the operated-on side are excluded.

  5. Patients with atrial fibrillation undergoing percutaneous coronary intervention: current concepts and concerns: part II.

    PubMed

    Dzeshka, Mikhail S; Brown, Richard A; Lip, Gregory Y H

    2015-01-01

    Atrial fibrillation (AF) and coronary artery disease (CAD) often present concomitantly. Given the increased risk of thrombotic complications with either of them but different pathogenesis of clot formation, combined antithrombotic therapy is necessary in patients developing acute coronary syndrome and/or undergoing percutaneous coronary intervention (PCI). Different antithrombotic regimens in this group of patients have been summarized and discussed earlier. Triple therapy remains the treatment of choice in these patients despite the increased risk of hemorrhagic complications. Given the absence of evidence from randomized controlled trials, balancing the risk of stroke and stent thrombosis against the risk of major bleeding is a challenge. Precise stroke and bleeding risk assessment is an essential part of the decision making process regarding antithrombotic management. Continuing the discussion of current concepts and concerns of antithrombotic management in AF patients undergoing PCI, we emphasize the importance of various strategies to reduce bleeding in the modern era, namely, radial access combined with careful selection of a P2Y₁₂ receptor inhibitor, use of newer drug-eluting stents, and uninterrupted anticoagulation for patients undergoing procedures. We also focus on the role of the non-vitamin K oral anticoagulants (novel oral anticoagulants, eg, dabigatran, rivaroxaban, apixaban, and edoxaban) which are increasingly used for stroke prevention in AF. Finally, recent recommendations on the management of antithrombotic therapy in AF patients presenting with acute coronary syndrome and/or undergoing PCI as well as ongoing clinical trials and future directions are highlighted. PMID:25534093

  6. On-treatment platelet reactivity in patients with chronic obstructive pulmonary disease undergoing percutaneous coronary intervention.

    PubMed

    Campo, Gianluca; Pavasini, Rita; Pollina, Alberto; Tebaldi, Matteo; Ferrari, Roberto

    2014-01-01

    Patients with chronic obstructive pulmonary disease (COPD) show a poor prognosis after myocardial infarction (MI) and percutaneous coronary intervention (PCI). We evaluated on-treatment platelet reactivity (PR) and several gene polymorphisms related to PR in 130 patients undergoing PCI with and without COPD. Those with concomitant COPD showed higher on-treatment PR values both at the time of PCI and 1 month after. This finding may contribute to explain the poor prognosis of COPD patients after MI and PCI. PMID:23878160

  7. A prospective, randomized study of cryotherapy during administration of high-dose melphalan to decrease the severity and duration of oral mucositis in patients with multiple myeloma undergoing autologous peripheral blood stem cell transplantation.

    PubMed

    Lilleby, K; Garcia, P; Gooley, T; McDonnnell, P; Taber, R; Holmberg, L; Maloney, D G; Press, O W; Bensinger, W

    2006-06-01

    Forty patients with multiple myeloma scheduled to receive melphalan 200 mg/m(2) followed by autologous stem cell transplantation were randomly assigned to receive oral cryotherapy or room temperature normal saline rinses 30 min before and for 6 h after high-dose therapy. Patients were evaluated for the development of mucositis using the National Cancer Institute grading system as well as evaluation of secondary measures such as days of total parenteral nutrition (TPN), narcotic use, hospitalization, weight loss and resumption of oral caloric intake for 28 days after transplant. Patients self-scored their pain, swallowing, drinking, eating, sleeping and taste alterations for 28 days. The primary end point of this trial was the incidence of grades 3-4 mucositis. Compared to the normal saline group, patients using cryotherapy experienced less grade 3-4 mucositis, 14 vs 74%, P=0.0005. Patients receiving cryotherapy also had statistically lower uses of narcotics and TPN, although there were no differences in length of hospitalization or weight loss. Patient-reported pain was significantly lower and activities were significantly better in the cryotherapy group. PMID:16633359

  8. Black patients more likely than whites to undergo surgery at low-quality hospitals in segregated regions.

    PubMed

    Dimick, Justin; Ruhter, Joel; Sarrazin, Mary Vaughan; Birkmeyer, John D

    2013-06-01

    Research has shown that black patients more frequently undergo surgery at low-quality hospitals than do white patients. We assessed the extent to which living in racially segregated areas and living in geographic proximity to low-quality hospitals contribute to this disparity. Using national Medicare data for all patients who underwent one of three high-risk surgical procedures in 2005-08, we found that black patients actually tended to live closer to higher-quality hospitals than white patients did but were 25-58 percent more likely than whites to receive surgery at low-quality hospitals. Racial segregation was also a factor, with black patients in the most segregrated areas 41-96 percent more likely than white patients to undergo surgery at low-quality hospitals. To address these disparities, care navigators and public reporting of comparative quality could steer patients and their referring physicians to higher-quality hospitals, while quality improvement efforts could focus on improving outcomes for high-risk surgery at hospitals that disproportionately serve black patients. Unfortunately, existing policies such as pay-for-performance, bundled payments, and nonpayment for adverse events may divert resources and exacerbate these disparities. PMID:23733978

  9. Effectiveness of pranayama on cancer-related fatigue in breast cancer patients undergoing radiation therapy: A randomized controlled trial

    PubMed Central

    Chakrabarty, Jyothi; Vidyasagar, MS; Fernandes, Donald; Joisa, Ganapathi; Varghese, Prabha; Mayya, Sreemathi

    2015-01-01

    Context: Incidence of breast cancer is very high among women around the world. Breast cancer patients experience cancer-related fatigue at some points during the treatment for breast cancer. Since cancer-related fatigue is of multifactorial origin, there are no evidence-based treatment strategies for fatigue. This study tested the effectiveness of certain pranayama techniques in reducing cancer-related fatigue among breast cancer patients undergoing radiation therapy. Aims: The objective of this study was to determine the effectiveness of pranayama on cancer-related fatigue among breast cancer patients undergoing radiation therapy as measured by cancer fatigue scale. Settings and Design: Shirdi Sai Baba Cancer Hospital and Research Center, Kasturba Hospital Manipal. Materials and Methods: Study was a randomized controlled trial done among breast cancer patients receiving radiation therapy. Statistical Analysis Used: Demographic characteristics of the participants are presented as frequency and percentage. Comparison of means of cancer-related fatigue between the two groups is done by Mann-Whitney U-test and comparison of pre- and pos t-test means of cancer-related fatigue among the experimental group is done by Wilcoxon sign rank test. Results: There was a significant difference between the two groups with regard to the scores of cancer-related fatigue. The experimental group of patients who performed pranayama along with radiation therapy experienced less fatigue. Conclusions: Pranayama can be used as a supportive therapy for breast cancer patients undergoing radiation therapy. PMID:25558133

  10. Prognostic understanding, quality of life and mood in patients undergoing hematopoietic stem cell transplantation.

    PubMed

    El-Jawahri, A; Traeger, L; Kuzmuk, K; Eusebio, J; Vandusen, H; Keenan, T; Shin, J; Gallagher, E R; Greer, J A; Pirl, W F; Jackson, V A; Ballen, K K; Spitzer, T R; Graubert, T A; McAfee, S; Dey, B; Chen, Y-B A; Temel, J S

    2015-08-01

    Little is known about how patients undergoing hematopoietic stem cell transplantation (HCT) and their family caregivers (FC) perceive their prognosis. We examined prognostic understanding in patients undergoing HCT and their FC and its relationship with quality of life (QOL) and mood. We conducted a longitudinal study of patients (and FC) hospitalized for HCT. We used a questionnaire to measure participants' prognostic understanding and asked the oncologists to estimate patients' prognosis prior to HCT. We assessed QOL and mood weekly and evaluated the relationship between prognostic understanding, and QOL and mood using multivariable linear mixed models. We enrolled 90 patients undergoing (autologous (n=30), myeloablative (n=30) or reduced intensity allogeneic (n=30)) HCT. About 88.9% of patients and 87.1% of FC reported it is 'extremely' or 'very' important to know about prognosis. However, 77.6% of patients and 71.7% of FC reported a discordance and more optimistic prognostic perception compared to the oncologist (P<0.0001). Patients with a concordant prognostic understanding with their oncologists reported worse QOL (β=-9.4, P=0.01) and greater depression at baseline (β=1.7, P=0.02) and over time ((β=1.2, P<0.0001). Therefore, Interventions are needed to improve prognostic understanding, while providing patients with adequate psychological support. PMID:25961772

  11. Usefulness of Acoustic Monitoring of Respiratory Rate in Patients Undergoing Endoscopic Submucosal Dissection

    PubMed Central

    Tsuda, Shingo; Nakae, Hirohiko; Imai, Jin; Sawamoto, Kana; Kijima, Maiko; Tsukune, Yoko; Uchida, Tetsufumi; Igarashi, Muneki; Koike, Jun; Matsushima, Masashi; Suzuki, Toshiyasu; Mine, Tetsuya

    2016-01-01

    Aim. The study assessed the usefulness of a recently developed method for respiratory rate (RR) monitoring in patients undergoing endoscopic submucosal dissection (ESD) under deep sedation. Methods. Study subjects comprised 182 consecutive patients with esophageal cancer or gastric cancer undergoing ESD. The usefulness of acoustic RR monitoring was assessed by retrospectively reviewing the patients' records for age, gender, height, weight, past history, serum creatinine, RR before ESD, and total dose of sedative. Results. Respiratory suppression was present in 37.9% of (69/182) patients. Continuous monitoring of RR led to detection of respiratory suppression in all these patients. RR alone was decreased in 24 patients, whereas both RR and blood oxygen saturation were decreased in 45 patients. Univariate analysis showed female gender, height, weight, and RR before treatment to be significantly associated with respiratory suppression. Multivariate analysis showed RR before treatment to be the only significant independent predictor [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.73–0.95, and P = 0.006] of respiratory suppression. Conclusion. In this study, the difference in RR before treatment between patients with and without respiratory suppression was subtle. Therefore, we suggest that acoustic RR monitoring should be considered in patients undergoing ESD under sedation to prevent serious respiratory complications. PMID:26858748

  12. Infections in patients undergoing craniotomy: risk factors associated with post-craniotomy meningitis.

    PubMed

    Kourbeti, Irene S; Vakis, Antonis F; Ziakas, Panayiotis; Karabetsos, Dimitris; Potolidis, Evangelos; Christou, Silvana; Samonis, George

    2015-05-01

    OBJECT The authors performed a prospective study to define the prevalence and microbiological characteristics of infections in patients undergoing craniotomy and to clarify the risk factors for post-craniotomy meningitis. METHODS Patients older than 18 years who underwent nonstereotactic craniotomies between January 2006 and December 2008 were included. Demographic, clinical, laboratory, and microbiological data were systemically recorded. Patient characteristics, craniotomy type, and pre- and postoperative variables were evaluated as risk factors for meningitis RESULTS Three hundred thirty-four procedures were analyzed (65.6% involving male patients). Traumatic brain injury was the most common reason for craniotomy. Almost 40% of the patients developed at least 1 infection. Ventilator-associated pneumonia (VAP) was the most common infection recorded (22.5%) and Acinetobacter spp. were isolated in 44% of the cases. Meningitis was encountered in 16 procedures (4.8%), and CSF cultures were positive for microbial growth in 100% of these cases. Gram-negative pathogens (Acinetobacter spp., Klebsiella spp., Pseudomonas aeruginosa, Enterobacter cloaceae, Proteus mirabilis) represented 88% of the pathogens. Acinetobacter and Klebsiella spp. demonstrated a high percentage of resistance in several antibiotic classes. In multivariate analysis, the risk for meningitis was independently associated with perioperative steroid use (OR 11.55, p = 0.005), CSF leak (OR 48.03, p < 0.001), and ventricular drainage (OR 70.52, p < 0.001). CONCLUSIONS Device-related postoperative communication between the CSF and the environment, CSF leak, and perioperative steroid use were defined as risk factors for meningitis in this study. Ventilator-associated pneumonia was the most common infection overall. The offending pathogens presented a high level of resistance to several antibiotics. PMID:25343179

  13. Detailed Analysis of Peri-Procedural Strokes in Patients Undergoing Intracranial Stenting in SAMMPRIS

    PubMed Central

    Fiorella, David; Derdeyn, Colin P; Lynn, Michael J; Barnwell, Stanley L; Hoh, Brian L.; Levy, Elad I.; Harrigan, Mark R.; Klucznik, Richard P.; McDougall, Cameron G.; Pride, G. Lee; Zaidat, Osama O.; Lutsep, Helmi L.; Waters, Michael F.; Hourihane, J. Maurice; Alexandrov, Andrei V.; Chiu, David; Clark, Joni M.; Johnson, Mark D.; Torbey, Michel T.; Rumboldt, Zoran; Cloft, Harry J.; Turan, Tanya N.; Lane, Bethany F.; Janis, L. Scott; Chimowitz, Marc I.

    2012-01-01

    Background and Purpose Enrollment in the SAMMPRIS trial was halted due to the high risk of stroke or death within 30 days of enrollment in the percutaneous transluminal angioplasty and stenting (PTAS) arm relative to the medical arm. This analysis focuses on the patient and procedural factors that may have been associated with peri-procedural cerebrovascular events in the trial. Methods Bivariate and multivariate analyses were performed to evaluate whether patient and procedural variables were associated with cerebral ischemic or hemorrhagic events occurring within 30 days of enrollment (termed peri-procedural) in the PTAS arm. Results Of 224 patients randomized to PTAS, 213 underwent angioplasty alone (n=5) or with stenting (n=208). Of these, 13 had hemorrhagic strokes (7 parenchymal, 6 subarachnoid), 19 had ischemic stroke, and 2 had cerebral infarcts with temporary signs (CITS) within the peri-procedural period. Ischemic events were categorized as perforator occlusions (13), embolic (4), mixed perforator and embolic (2), and delayed stent occlusion (2). Multivariate analyses showed that higher percent stenosis, lower modified Rankin score, and clopidogrel load associated with an activated clotting time above the target range were associated (p ≤ 0.05) with hemorrhagic stroke. Non-smoking, basilar artery stenosis, diabetes, and older age were associated (p ≤ 0.05) with ischemic events. Conclusions Peri-procedural strokes in SAMMPRIS had multiple causes with the most common being perforator occlusion. Although risk factors for peri-procedural strokes could be identified, excluding patients with these features from undergoing PTAS to lower the procedural risk would limit PTAS to a small subset of patients. Moreover, given the small number of events, the present data should be used for hypothesis generation rather than to guide patient selection in clinical practice. PMID:22984008

  14. Anesthetic challenges of patients with cardiac comorbidities undergoing major urologic surgery

    PubMed Central

    2014-01-01

    The cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. Number of this group of patients having to go through this procedure is constantly increasing, due to prolonged life, increased agressiveness of surgery and increased anesthesia’s safety. The anesthesiologist usually has to deal with several problems of the patient, such as hypertension, chronic heart failure, coronary artery disease, rhythm disturbances, intraoperative hemodymanic changes, intraoperative bleeding, perioperative fluid imbalance, and metabolic disturbances. A cardiac patient undergoing major urologic surgery is a complex case requiring a great attention by the anesthesiologist. The scope of this review article is to present the most frequent issues encountered with this group of patients, and to synthetically discuss the respective strategies and maneuvers during perioperative period, which is the major challenge for the anesthesiologist. PMID:24791166

  15. Treatment-related problems experienced by cancer patients undergoing chemotherapy: a scoping review.

    PubMed

    Wagland, R; Richardson, A; Armes, J; Hankins, M; Lennan, E; Griffiths, P

    2015-09-01

    Cancer patients undergoing chemotherapy experience a range of treatment-related problems, and variations in prevalence exist between treatment centres. A scoping review was undertaken to map reported rates of problem prevalence in the literature. This will inform development of a patient-reported outcome measure (PROM) to monitor prevalence and severity of problems over time and assist service providers optimise supportive care provision. Two databases (Embase and Medline) were searched from 2002 to 2013. Fifty one published papers and conference abstracts reporting problem prevalence rates were identified. The papers reported 98 different problems, from which a typology of 27 problem domains was developed, including both physical symptoms and psychosocial issues. The problem domains most often studied were nausea, vomiting and fatigue. This review reflects the chemotherapy-associated problems to which researchers attach the most importance. The range in reported prevalence across studies was very broad (e.g. nausea: 9-74%), with even less frequently studied problems showing high prevalence in some studies (e.g. gynaecological problems: up to 94%). The wide variation in prevalence and range of problems experienced raises challenges for PROM development. Patients should therefore be involved in consensus exercises to assist selection of items to ensure any instrument is complete and robust. PMID:25296389

  16. Cardiac evaluation and risk reduction in patients undergoing major vascular operations.

    PubMed Central

    Potyk, D K

    1994-01-01

    Occult coronary artery disease often accompanies symptomatic peripheral vascular disease and has an important effect on survival. Most perioperative and late fatalities after peripheral vascular operations are due to cardiac causes. Noninvasive cardiac testing can identify patients at increased risk for postoperative cardiac complications, although controversy exists regarding the optimal preoperative evaluation. Risk reduction strategies for patients known to be at high risk are also controversial. Some authors advocate coronary revascularization with coronary artery bypass grafting or percutaneous transluminal coronary angioplasty before the vascular procedure. Others believe that the combined morbidity and mortality of 2 operations exceed those of a peripheral vascular operation performed with aggressive monitoring and medical therapy. Continuous electrocardiographic monitoring after an operation has identified silent myocardial ischemia as a powerful predictor of cardiac complications. Ongoing research is likely to provide insights into the pathogenesis of postoperative cardiac complications and may lead to specific therapeutic interventions. Few prospective studies have been done in this area, and the threshold for preoperative and postoperative intervention is unknown. I review the literature and present an algorithm to guide cardiac testing and risk reduction in patients undergoing elective vascular surgical procedures. PMID:7941507

  17. Insulin Resistance Increases the Risk of Contrast-Induced Nephropathy in Patients Undergoing Elective Coronary Intervention.

    PubMed

    Li, Yueping; Liu, Yuyang; Shi, Dongmei; Yang, Lixia; Liang, Jing; Zhou, Yujie

    2016-02-01

    We assessed the influence of insulin resistance (IR) on the development of contrast-induced nephropathy (CIN) in patients (n = 719) undergoing elective percutaneous coronary intervention (PCI). Patients were divided into diabetes mellitus (DM = 242), nondiabetic IR (IR = 120), and nondiabetic insulin sensitivity (IS = 357) groups according to medical history and homeostasis model assessment insulin resistance index. Serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) were measured before and 72 hours after PCI. There were no differences in SCr and eGFR among the groups before PCI; SCr increased and eGFR decreased significantly in the DM and IR groups post-PCI (P < .001). The incidence of CIN in the IR group was as high as in the DM group and were both significantly higher than in the IS group (6.7% vs 8.7% vs 2.2%, P < .05). Multivariate logistic regression analysis showed DM (odds ratio [OR] = 1.19, 95%CI = 1.08-1.510, P < .001), HOMA-IR (OR = 1.39, 95%CI = 1.23-1.58, P < 0.001), and eGFR (OR = 0.88, 95%CI = 0.84-0.92, P < .001) were independent risk factors in predicting CIN. Screening IR patients and taking appropriate prophylactic strategy before PCI may reduce the incidence of CIN. PMID:25843952

  18. Factors associated with mortality in patients undergoing coronary artery bypass grafting 1

    PubMed Central

    Koerich, Cintia; Lanzoni, Gabriela Marcellino de Melo; Erdmann, Alacoque Lorenzini

    2016-01-01

    ABSTRACT Objective: to investigate the factors associated with mortality in patients undergoing coronary artery bypass grafting in a cardiovascular referral hospital in Santa Catarina. Method: quantitative, exploratory, descriptive and retrospective study. The medical records of 1447 patients, from 2005 to 2013, were analyzed for statistically related variables, these being: profile, hospitalization diagnosis, risk factors for coronary artery disease, complications recorded during the hospitalization, length of hospitalization and cause of death. Results: the mortality rate was 5.3% during the study period. Death was more common in females and those of black skin color, with a mean age of 65 years. Acute myocardial infarction was the most common hospitalization diagnosis. The majority of the complications recorded during hospitalization were characterized by changes in the cardiovascular system, with longer hospitalization periods being directly related to death from septic shock. Conclusion: the data provide subsidies for nursing work with preventive measures and early detection of complications associated with coronary artery bypass grafting. This reinforces the importance of using the data as quality indicators, aiming to guarantee care guided by reliable information to guide managers in planning patient care and high complexity health services. PMID:27508918

  19. Preoperative usages of levosimendan in patients undergoing coronary artery bypass grafting

    PubMed Central

    Eris, Cuneyt; Yavuz, Senol; Toktas, Faruk; Turk, Tamer; Gucu, Arif; Erdolu, Burak; Goncu, M Tugrul

    2014-01-01

    Objectives: Levosimendan (LS) is a new inotropic drug which belongs to the group of drugs known as calcium sensitizers. It is different from other inotropic agents by its inotropic and vasodilatory actions without an increase in myocardial oxygen consumption and considered as a good choice in high-risk patients undergoing cardiac surgery. We aimed to investigate the proper time of the administration and the effect of prophylactic usage of LS in patients with low left ventricular ejection fraction (LVEF) undergoing coronary artery bypass grafting (CABG). Methods: Forty patients who underwent isolated CABG with LVEF) less than 30% were evaluated retrospectively. Patients were divided into 3 groups according to the induction time of LS during different phases of the operation and compared to a non-LS control group. LS infusion (0.2 μg/kg/min) was applied 12 hours before the operation in Group 1 (G1) (n=10), after the induction of anaesthesia in Group 2 (G2) (n=10) and during the pump removal period in Group 3 (G3) (n=10) and non-LS control group 4 (G4) (n=10). Demographic data, operative characteristics, hemodynamic parameters and serum lactate, troponin, creatinine levels were compared between groups before and after LS treatment during pre and postoperative period. Data were evaluated by Fisher exact, Kruskal-Wallis, Mann-Whitney U, Chi-square and Wilcoxon rank tests. Results: We found that the duration of tracheal intubation, the intensive care unit stay and the hospital stay were significantly decreased in G1 and G2 when compared to the patients in G3 and G4. During postoperative period, in G1 and G2 one (10%) patient from each required intraaortic balloon pump (IABP), while in G3 two (20%) patients and in G4 five (50%) patients required IABP. Cardiac index (CI) was significantly increased in all groups from baseline to intensive care unit (ICU)1h and ICU24h. When groups compared each other significant increase was found in G1-G4 (p=0.001) and G2-G4 (p=0.007) at

  20. A Model for Predicting Gastrostomy Tube Placement in Patients Undergoing Surgery for Upper Aerodigestive Tract Lesions

    PubMed Central

    Mays, Ashley C.; Moustafa, Farah; Worley, Mitch; Waltonen, Joshua D.; D'Agostino, Ralph

    2015-01-01

    IMPORTANCE Identifying high-risk patients in the preoperative period can allow physicians to optimize nutritional status early for better outcomes after head and neck cancer resections. OBJECTIVE To develop a model to predict preoperatively the need for gastrostomy tube (G-tube) placement in patients undergoing surgery of the upper aerodigestive tract. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review included all adult patients diagnosed with head and neck cancers who underwent tumor resection from 2007 through 2012 at Wake Forest Baptist Health, a level 1 tertiary care center. Records were screened for patient demographics, tumor characteristics, surgical treatment type, and postoperative placement of G-tube. A total of 743 patients underwent resection of head and neck tumors. Of these, 203 were excluded for prior G-tube placement, prior head and neck resection, G-tube placement for chemoradiotherapy, and resection for solely nodal disease, leaving 540 patients for analysis. MAIN OUTCOMES AND MEASURES Placement of postoperative G-tube. RESULTS Of the 540 included patients, 23% required G-tube placement. The following variables were significant and independent predictors of G-tube placement: preoperative irradiation (odds ratio [OR], 4.1; 95% CI, 2.4–6.9; P < .001), supracricoid laryngectomy (OR, 26.0; 95% CI, 4.9–142.9; P < .001), tracheostomy tube placement (OR, 2.6; 95% CI, 1.5–4.4; P < .001), clinical node stage N0 vs N2 (OR, 2.4; 95% CI, 1.4–4.2; P = .01), clinical node stage N1 vs N2 (OR, 1.6; 95% CI, 0.8–3.3; P = .01), preoperative weight loss (OR, 2.0; 95% CI, 1.2–3.2; P = .004), dysphagia (OR, 2.0; 95% CI, 1.2–3.2; P = .005), reconstruction type (OR, 1.9; 95% CI, 1.1–2.9; P = .02), and tumor stage (OR, 1.8; 95% CI, 1.1–2.9; P = .03). A predictive model was developed based on these variables. In the validation analysis, we found that the average predicted score for patients who received G-tubes was statistically

  1. Prognostic Understanding, Quality of Life, and Mood in Patients Undergoing Hematopoietic Stem Cell Transplantation

    PubMed Central

    El-Jawahri, Areej; Traeger, Lara; Kuzmuk, Kailyn; Eusebio, Justin; Vandusen, Harry; Keenan, Tanya; Shin, Jennifer; Gallagher, Emily R.; Greer, Joseph A.; Pirl, William F.; Jackson, Vicki A.; Ballen, Karen K; Spitzer, Thomas R.; Graubert, Timothy A.; McAfee, Steven; Dey, Bimalangshu; Chen, Yi-Bin A.; Temel, Jennifer S.

    2015-01-01

    Little is known about how patients undergoing stem cell transplantation (HCT) and their family caregivers (FC) perceive their prognosis. We examined prognostic understanding in patients undergoing HCT and their FC and its relationship with quality of life (QOL) and mood. We conducted a longitudinal study of patients (and FC) hospitalized for HCT. We used a questionnaire to measure participants’ prognostic understanding and asked the oncologists to estimate patients’ prognosis prior to HCT. We assessed QOL and mood weekly and evaluated the relationship between prognostic understanding and QOL and mood using multivariable linear mixed models. We enrolled 90 patients undergoing (autologous n=30); myeloablative (n=30) or reduced intensity allogeneic (n=30)) HCT. 88.9% of patients and 87.1% of FC reported it is ‘extremely’ or ‘very’ important to know about prognosis. However, 77.6% of patients and 71.7% of FC reported a discordance and more optimistic prognostic perception compared to the oncologist (P’s < 0.0001). Patients with a concordant prognostic understanding with their oncologists reported worse QOL (β = −9.4, P = 0.01) and greater depression at baseline (β = 1.7, P = 0.02) and over time ((β = 1.2, P < 0.0001). Therefore, Interventions are needed to improve prognostic understanding, while providing patients with adequate psychological support. PMID:25961772

  2. Cross-sectional area of the abdomen predicts complication incidence in patients undergoing sternal reconstruction

    PubMed Central

    Kozlow, Jeffrey H.; Lisiecki, Jeffrey; Terjimanian, Michael N.; Rinkinen, Jacob; Brownley, Robert Cameron; Agarwal, Shailesh; Wang, Stewart C.; Levi, Benjamin

    2015-01-01

    Background Sternal reconstruction with vascularized flaps is central to the management of sternal wound infections and mediastinitis but carries a high risk of complications. There is a need to identify reliable predictors of complication risk to help inform patients and clinicians in preparation for surgery. Unfortunately, body mass index and serum albumin may not be reliable predictors of complication rates. Analytic morphomics provides a robust quantitative method to measure patients’ obesity as it pertains to their risk of complications in undergoing sternal reconstruction. Methods We identified 34 patients with preoperative computed tomography scans of the abdomen from a cohort of sternal reconstructions performed between 1997 and 2010. Using semiautomated analytic morphomics, we identified the patients’ skin and fascia layers between the ninth and 12th thoracic spine levels; from these landmarks, we calculated morphomic measurements of the patients’ abdomens, including their total body cross sectional area and the cross sectional area of their subcutaneous fat. We obtained the incidence of complications from chart review and correlated the incidence of complications (including seroma, hematoma, recurrent wounds, mediastinitis, tracheostomy, and death) with patients’ morphomic measurements. Results Sixty-two percent of patients (n = 21) suffered complications after their operation. Those who suffered from complications, relative to those who did not have complications, had increased visceral fat area (12,547.2 mm2 versus 6569.9 mm2, P = 0.0080), subcutaneous fat area (16,520.2 mm2 versus 8020.1 mm2, P = 0.0036), total body area (91,028.6 mm2 versus 67,506.5 mm2, P = 0.0022), fascia area (69,238.4 mm2 versus 56,730.9 mm2, P = 0.0118), total body circumference (1101.8 mm versus 950.2 mm, P = 0.0017), and fascia circumference (967.5 mm versus 868.1 mm, P = 0.0077). We also demonstrated a significant positive correlation between the previously mentioned

  3. Prediction of Cardiovascular Events by Inflammatory Markers in Patients Undergoing Carotid Stenting

    PubMed Central

    Versaci, Francesco; Reimers, Bernhard; Prati, Francesco; Gaspardone, Achille; Del Giudice, Costantino; Pacchioni, Andrea; Mauriello, Alessandro; Cortese, Claudio; Nardi, Paolo; De Fazio, Anna; Chiariello, Giovanni Alfonso; Proietti, Igino; Chiariello, Luigi

    2012-01-01

    Objective To assess whether inflammatory markers predict atherosclerotic disease activity after carotid treatment in patients with severe carotid stenosis and nonsignificant coronary artery disease undergoing carotid stenting. Patients and Methods From March 1, 2004, to September 30, 2005, a total of 55 consecutive patients (mean ± SD age, 69±8.3 years; 26 men) with severe carotid stenosis and nonsignificant coronary artery disease were treated with carotid stent implantation. Patients were followed up for a period of 5 years for the occurrence of cardiovascular events. Results A significant correlation between quantitative analysis of debris entrapped in the filters and inflammatory markers was found. Moreover, the number of particles per filter, the total particles area, and the mean particle axis per filter were significantly higher in patients with clinical events at the follow-up compared with patients without events (87 vs 32, P=.006; 50,118.7 vs 17,782, P=.002; 33.9 vs 30.2, P=.03). At 5-year follow-up we recorded cardiovascular or neurologic events in 11 of the 55 patients (20%). Higher preprocedural levels of high-sensitivity C-reactive protein, interleukin 6 soluble receptor, and interleukin 6 were significantly associated with clinical events at follow-up (P<.001, P=.05, and P=.02, respectively). In particular high-sensitivity C-reactive protein measured at 24 and 48 hours after carotid stenting showed a significant correlation with clinical events (P=.001). Also preprocedural intracellular adhesion molecule 1 and circulating vascular cell adhesion molecule 1 blood concentrations were significantly correlated with a worse prognosis at follow-up (P=.04 and P=.03, respectively). Conclusion In patients with severe carotid stenosis and nonsignificant coronary artery disease, inflammation is associated with atherosclerotic disease activity and a worse prognosis. Interleukin 6, interleukin 6 soluble receptor, intracellular adhesion molecule 1, vascular cell

  4. Two Cases of Peritonitis Caused by Kocuria marina in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis▿

    PubMed Central

    Lee, Ja Young; Kim, Si Hyun; Jeong, Haeng Soon; Oh, Seung Hwan; Kim, Hye Ran; Kim, Yeong Hoon; Lee, Jeong Nyeo; Kook, Joong-Ki; Kho, Weon-Gyu; Bae, Il Kwon; Shin, Jeong Hwan

    2009-01-01

    Kocuria spp. are members of the Micrococcaceae family that are frequently found in the environment and on human skin. Few human infections have been reported. We describe what appear to be the first two cases of Kocuria marina peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. PMID:19692561

  5. Sleep apnoea adversely affects the outcome in patients who undergo posterior lumbar fusion

    PubMed Central

    Stundner, O.; Chiu, Y-L.; Sun, X.; Ramachandran, S-K.; Gerner, P.; Vougioukas, V.; Mazumdar, M.; Memtsoudis, S. G.

    2014-01-01

    Despite the increasing prevalence of sleep apnoea, little information is available regarding its impact on the peri-operative outcome of patients undergoing posterior lumbar fusion. Using a national database, patients who underwent lumbar fusion between 2006 and 2010 were identified, sub-grouped by diagnosis of sleep apnoea and compared. The impact of sleep apnoea on various outcome measures was assessed by regression analysis. The records of 84 655 patients undergoing posterior lumbar fusion were identified and 7.28% also had a diagnostic code for sleep apnoea. Compared with patients without sleep apnoea, these patients were older, more frequently female, had a higher comorbidity burden and higher rates of peri-operative complications, post-operative mechanical ventilation, blood transfusion, and intensive care. Patients with sleep apnoea also had longer and more costly periods of hospitalisation. In the regression analysis, sleep apnoea emerged as an independent risk factor for the development of peri-operative complications (Odds Ratio (OR) 1.50, Confidence Interval (CI) 1.38;1.62), blood transfusions (OR 1.12, CI 1.03;1.23), mechanical ventilation (OR 6.97, CI 5.90;8.23), critical care services (OR 1.86, CI 1.71;2.03), prolonged hospitalisation and increased cost (OR 1.28, CI 1.19;1.37; OR 1.10, CI 1.03;1.18). Patients with sleep apnoea who undergo posterior lumbar fusion pose significant challenges to clinicians. PMID:24493191

  6. Organization of Hospital Nursing and 30-day Readmissions in Medicare Patients Undergoing Surgery

    PubMed Central

    Ma, Chenjuan; McHugh, Matthew D; Aiken, Linda H

    2014-01-01

    Background Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing - a critical organizational component of hospital service system - in relation to readmissions. Objectives To determine the relationships between hospital nursing factors - nurse work environment, nurse staffing, and nurse education - and 30-day readmissions among Medicare patients undergoing general, orthopedic, and vascular surgery. Method and Design We linked Medicare patient discharge data, multi-state nurse survey data, and American Hospital Association Annual Survey data. Our sample included 220,914 Medicare surgical patients and 25,082 nurses from 528 hospitals in four states (CA, FL, NJ, & PA). Risk-adjusted robust logistic regressions were used for analyses. Results The average 30-day readmission rate was 10% in our sample (general surgery: 11%; orthopedic surgery: 8%; vascular surgery: 12%). Readmission rates varied widely across surgical procedures and could be as high as 26% (upper limb and toe amputation for circulatory system disorders). Each additional patient per nurse increased the odds of readmission by 3% (OR=1.03, 95% CI: 1.00-1.05). Patients cared in hospitals with better nurse work environments had lower odds of readmission (OR=0.97, 95% CI: 0.95-0.99). Administrative support to nursing practice (OR=0.96, 95% CI: 0.94-0.99) and nurse-physician relations (OR=0.97, 95% CI: 0.95-0.99) were two main attributes of the work environment that were associated with readmissions. Conclusions Better nurse staffing and work environment were significantly associated with 30-day readmission, and can be considered as system-level interventions to reduce readmissions and associated financial penalties. PMID:25373404

  7. Prevalence and risk factors of clopidogrel non-response among Saudi patients undergoing coronary angiography

    PubMed Central

    Sakr, Haitham I.; Alamri, Hussein S.; Almoghairi, Abdulrahman M.; Alkhudair, Ashraf A.; AlMasood, Ali S.

    2016-01-01

    Objectives: To estimate the prevalence of clopidogrel non-response and identify its risk factors among Saudi patients. Methods: This cross-sectional study was conducted at Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia between January and June 2013, to assess the degree of platelet inhibition using the VerifyNow assay (Accumetrics, San Diego, CA, USA) after receiving clopidogrel standard loading dose. Clopidogrel resistance was defined as ≤15% platelet inhibition or >213 P2Y12 reaction units (PRU). Results: Three hundred and four patients were included in the study. The mean age was 60.3 ± 11.4 years, and 73% were males. Clopidogrel doses were 300 mg (57%), 600 mg (27%), and 75 mg (16%). All patients used aspirin (81 mg in 94%). Approximately 66% (200/304) showed in vitro clopidogrel non-response, 54% had low platelet inhibitions, and 61% had high post-loading PRU. Using multivariate regression analysis that included all significant characteristics; only diabetes (odds ratio [OR]: 2.36, 95% confidence interval [CI]: 1.30-4.27, p=0.005) and higher preloading PRU (OR: 2.39, 95% CI: 1.40-4.11, p=0.002) remained significantly associated with higher clopidogrel non-response while myocardial infarction (OR: 0.34, 95% CI: 0.15-0.81, p=0.014) remained significantly associated with lower clopidogrel non-response. The associations of morbid obesity and diuretics use with higher clopidogrel non-response were slightly attenuated. Conclusion: Our findings indicate a high rate of clopidogrel in-vitro non-response among Saudi patients undergoing coronary angiography. PMID:26837400

  8. Toward an Earlier Diagnosis of Primary Ciliary Dyskinesia. Which Patients Should Undergo Detailed Diagnostic Testing?

    PubMed

    Kuehni, Claudia E; Lucas, Jane S

    2016-08-01

    Primary ciliary dyskinesia (PCD) is a rare, heterogeneous, recessive, genetic disorder of motile cilia, leading to chronic upper and lower respiratory symptoms. Prevalence is estimated at around 1:10,000, but many patients remain undiagnosed, whereas others receive the label incorrectly. Proper diagnosis is complicated by the fact that the key symptoms, such as wet cough, chronic rhinitis, and recurrent upper and lower respiratory infection, are common and nonspecific. There is no single gold standard test to diagnose PCD. Currently, the diagnosis is made in patients with a compatible medical history after a demanding combination of tests including nasal nitric oxide, high-speed video microscopy, and transmission electron microscopy and genetic and ciliary culture testing. These tests are costly and need sophisticated equipment and experienced staff, restricting use to highly specialized centers. Therefore, it would be desirable to have a screening test for identifying those patients who should undergo detailed diagnostic testing. Three recent studies focused on potential screening tools: one study assessed the validity of nasal nitric oxide for screening, and two studies developed new symptom-based screening tools. These simple tools are welcome, and it is hoped that they will assist physicians in determining whom to refer for definitive testing. However, they have been developed in tertiary care settings, where 10 to 50% of tested patients have PCD. The sensitivity and specificity of the tools are reasonable, but positive and negative predictive values may be poor in primary or secondary care settings. Although these studies are an important step toward an earlier diagnosis of PCD, more remains to be done before we have tools tailored to different health care settings. PMID:27258773

  9. Perioperative Complications in Patients with Inflammatory Arthropathy Undergoing Total Knee Arthroplasty.

    PubMed

    Schnaser, Erik A; Browne, James A; Padgett, Douglas E; Figgie, Mark P; D'Apuzzo, Michele R

    2015-09-01

    Little data exists comparing acute post-operative outcomes in patients with different types of inflammatory arthritis (IA) after undergoing a total knee arthroplasty (TKA). Our objectives were to compare perioperative complications and determine the most common complications between the different IA subtypes compared with patients with osteoarthritis undergoing primary TKA. We found significant differences when comparing complications within the different subtypes of IA. RA patients, despite having a greater number of comorbidities had a reduced rate of medical complications postoperatively compared to the OA cohort. All of the inflammatory subtypes had a higher rate of orthopedic complications postoperatively compared to the OA group except for patients with AS. However, ankylosing spondylitis had the highest mortality rate as well as medical complication rate among the subtypes. PMID:26111792

  10. Antithrombotic therapy for patients with nonvalvular atrial fibrillation undergoing percutaneous coronary intervention: a review.

    PubMed

    Krasner, Andrew; Halperin, Jonathan L

    2013-07-01

    Patients with atrial fibrillation who have risk factors for thromboembolism benefit from chronic oral anticoagulation therapy, and antiplatelet therapy alone is of relatively little benefit for prevention of ischemic stroke and systemic embolism. Patients undergoing percutaneous coronary intervention with drug-eluting stents require dual antiplatelet therapy with aspirin and a thienopyridine for 3 to 12 months or more prevention of stent thrombosis and recurrent ischemic events. When patients with atrial fibrillation undergo percutaneous coronary intervention, the need to combine dual antiplatelet therapy and warfarin raises the risk of major bleeding complications considerably. Recent trials have explored the option of omitting aspirin with promising results. The introduction of novel oral anticoagulants that specifically inhibit factor IIa (dabigatran) or factor Xa (rivaroxaban, apixaban, and edoxaban) and antiplatelet agents that inhibit the P(2)Y(12) receptor (prasugrel and ticagrelor) makes management of these patients even more challenging, but future trials addressing myriad alternative regimens may identify better tolerated strategies. PMID:23689944

  11. Predictive value of elevated D-dimer in patients undergoing primary angioplasty for ST elevation myocardial infarction.

    PubMed

    Akgul, Ozgur; Uyarel, Huseyin; Pusuroglu, Hamdi; Gul, Mehmet; Isiksacan, Nilgun; Turen, Selahattin; Erturk, Mehmet; Surgit, Ozgur; Cetin, Mustafa; Bulut, Umit; Baycan, Omer F; Uslu, Nevzat

    2013-10-01

    The aim of this study was to evaluate the prognostic value of D-dimer in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). The prognostic value of D-dimer has been documented in patients with acute coronary syndrome without ST-segment elevation. However, its value in acute ST-segment elevation myocardial infarction (STEMI) remains unclear. We prospectively enrolled 453 consecutive STEMI patients (mean age 55.6 ± 12.4 years, 364 male, 89 female) undergoing primary PCI. The study population was divided into tertiles based on admission D-dimer values. The high D-dimer group (n = 151) was defined as a value in the third tertile [>0.72 ug/ml fibrinogen equivalent units (FEU)], and the low D-dimer group (n = 302) included those patients with a value in the lower two tertiles (≤0.72 ug/ml FEU). Clinical characteristics, in-hospital and 6-month outcomes of primary PCI were analyzed. The patients of the high D-dimer group were older (mean age 60.1 ± 13.5 versus 52.4 ± 10.6, P < 0.001). Higher in-hospital cardiovascular mortality and 6-month all-cause mortality rates were observed in the high D-dimer group (7.2 versus 0.6%, P < 0.001 and 13.9 versus 2%, P < 0.001, respectively). In Cox multivariate analysis; a high admission D-dimer value (>0.72 ug/ml FEU) was found to be a powerful independent predictor of 6-month all-cause mortality (odds ratio: 10.1, 95% confidence interval: 1.24-42.73, P = 0.03). These results suggest that a high admission D-dimer, level was associated with increased in-hospital cardiovascular mortality and 6-month all-cause mortality in patients with STEMI undergoing primary PCI. PMID:23571687

  12. [Case report: 40-year-old patient with massive bleeding undergoing cesarean section].

    PubMed

    Thomas, Rainer; Thal, Serge

    2016-05-01

    We report a case of a 40-year-old patient suffering major bleeding when undergoing cesarean section for delivery with placenta previa. After surgery the patient suffered from severe bleeding several times and again underwent surgery with abdominal packing. After an abdominal compartment syndrome and an ARDS a post transfusion purpura was found to be the cause of the repeated bleeding and could successfully be treated with a cycle of plasmapheresis. PMID:27213602

  13. Long-term outcomes of patients with persistent indolent B cell malignancies undergoing nonmyeloablative allogeneic transplantation.

    PubMed

    Cassaday, Ryan D; Storer, Barry E; Sorror, Mohamed L; Sandmaier, Brenda M; Guthrie, Katherine A; Maloney, David G; Rajendran, Joseph G; Pagel, John M; Flowers, Mary E; Green, Damian J; Rezvani, Andrew R; Storb, Rainer F; Press, Oliver W; Gopal, Ajay K

    2015-02-01

    Relapse is least common in patients with indolent B cell (iB) malignancies (ie, iB non-Hodgkin lymphoma [NHL]) who undergo nonmyeloablative allogeneic transplantation (NMAT) in complete remission (CR). However, for the many patients unable to achieve this state, outcomes are poorly described and methods to improve results are unknown. We sought to describe the long-term follow-up and predictive factors for these poor-risk patients unable to achieve CR before NMAT. We identified and evaluated patients with iB-NHL including chronic lymphocytic leukemia treated with fludarabine/total body irradiation-based NMAT that had evidence of persistent disease before NMAT. From December 1998 to April 2009, 89 patients were identified, most commonly with small/chronic lymphocytic lymphoma (n = 62) and follicular lymphoma (n = 24). Pretransplant anti-CD20 radioimmunotherapy (RIT) using standard yttrium-90-ibritumomab tiuxetan was administered to 18 patients (20%) who more frequently had chemoresistant disease (81% versus 39%, P = .003), disease bulk > 5 cm (61% versus 15%, P < .001), thrombocytopenia < 25k/μL (33% versus 7%, P = .002), and Hematopoietic Cell Transplant Comorbidity Index scores ≥ 3 (72% versus 37%, P = .006). After adjusting for these imbalances, RIT-treated patients had improved rates of progression-free survival (PFS) (hazard ratio [HR] = .4; 95% confidence interval [CI], .2 to .9, P = .02) and overall survival (OS) (HR = .3; 95% CI, .1 to .8, P = .008) compared with the non-RIT group. The 3-year adjusted estimates of PFS and OS for the RIT and non-RIT groups were 71% and 87% versus 44% and 59%, respectively. The use of RIT was the only factor independently associated with improved PFS and OS. Rates of nonrelapse mortality and graft-versus-host disease (GVHD) were similar between the 2 groups, although over 70% of patients developed clinically significant acute or chronic GVHD. In conclusion, despite relatively high rates of GVHD, patients with persistent i

  14. Effects of different types of pharyngeal packing in patients undergoing nasal surgery: A comparative study

    PubMed Central

    Rizvi, Mohd Meesam; Singh, Raj Bahadur; Rasheed, Mohd Asim; Sarkar, Arindam

    2015-01-01

    Context: Postoperative throat complaints such as postoperative sore throat (POST), dysphagia, and hoarseness frequently arises after tracheal intubation and throat packing for patient undergoing general anesthesia. This condition is very disturbing to patient. Avoiding POST is a major priority for these patients because preventing postoperative complications contributes to patient satisfaction. Aims: To describe and analyze the postoperative throat effects of nasopharyngeal packing and oropharyngeal packing in patients undergoing nasal surgery. Settings and Design: A randomized comparative study. Subjects and Methods: After obtaining approval of Ethical Committee 40 patients were included in study. After this patient were randomly allocated into two groups of 20 each. Group A - in which the oropharynx was packed and Group B - inwhich the nasopharynx was packed. General anesthesia were given and throat packing was done and patients were interviewed postoperatively for any throat complications such as sore throat, difficulty in swallowing (dysphagia), hoarseness of voice, throat irritation, and any other symptom pertaining to the study were noted and data were analyzed. Statistical Analysis Used: T-test to compare the age, while Chi-square test and Fisher's exact test were used to compare sex distribution, sore throat, dysphagia, hoarseness, and throat irritation. Results: Results showed statistically significant difference in incidence and severity of POST in Group A patients when compared to Group B patients to be more. Patients in Group A had a higher incidence of dysphagia when compared to their Group B counterparts. With respect to the incidence of hoarseness and throat irritation, there was no statistical significance between the groups. Conclusion: We concluded that the site of pharyngeal packing influences the incidence and severity of POST and as well as the incidence of dysphagia after general anesthesia. The use of nasopharyngeal packing in the patients

  15. Intraoperative Frozen Section of the Prostate Reduces the Risk of Positive Margin Whilst Ensuring Nerve Sparing in Patients with Intermediate and High-Risk Prostate Cancer Undergoing Robotic Radical Prostatectomy: First Reported UK Series

    PubMed Central

    Vasdev, Nikhil; Agarwal, Samita; Rai, Bhavan P.; Soosainathan, Arany; Shaw, Gregory; Chang, Sebastian; Prasad, Venkat; Mohan-S, Gowrie; Adshead, James M.

    2016-01-01

    Introduction Nerve sparing during robotic radical prostatectomy (RRP) considerably improves post-operative potency and urinary continence as long as it does not compromise oncological outcome. Excision of the neurovascular bundle (NVB) is often performed in patients with intermediate and high risk prostate cancer to reduce the risk of positive surgical margin raising the risk of urinary incontinence and impotence. We present the first UK series outcomes of such patients who underwent an intra-operative frozen section (IOFS) analysis of the prostate during RRP allowing nerve sparing. Patients and Methods We prospectively analysed the data of 40 patients who underwent an IOFS during RRP at our centre from November 2012 until November 2014. Our IOFS technique involved whole lateral circumferential analysis of the prostate during RRP with the corresponding neurovascular tissue. An intrafascial nerve spare was performed and the specimen was removed intra-operatively via an extension of the 12 mm Autosuture™ camera port without undocking robotic arms. It was then painted by the surgeon and sprayed with “Ink Aid” prior to frozen section analysis. The corresponding NVB was excised if the histopathologist found a positive surgical margin on frozen section. Results Median time to extract the specimen, wound closure and re-establishment of pneumoperitoneum increased the operative time by 8 min. Median blood loss for IOFS was 130 ± 97 ml vs. 90 ± 72 ml (p = NS). IOFS was not associated with major complications or with blood transfusion. PSM decreased significantly from non-IOFS RRP series of 28.7 to 7.8% (p < 0.05). Intra-operative PSM on the prostate specimen was seen in 8/40 margin analysis (20%) leading to an excision of the contra-lateral nerve bundle. On analysis of the nerve bundle on a paraffin embedded block, 6 nerve bundle matched tumor on the specimen whereas 2 NVB were retrospectively removed unnecessarily in our series. All 40 patients have undetectable PSA

  16. Feasibility of an exercise programme in elderly patients undergoing allogeneic stem cell transplantation - a pilot study.

    PubMed

    Schuler, M K; Hornemann, B; Pawandenat, C; Kramer, M; Hentschel, L; Beck, H; Kasten, P; Singer, S; Schaich, M; Ehninger, G; Platzbecker, U; Schetelig, J; Bornhäuser, M

    2016-09-01

    It has been demonstrated that physical exercise benefits younger patients undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT). We designed a prospective pilot study investigating whether elderly patients (>60 years) would also be able to participate in such a programme. It consisted of physiotherapist-supervised alternating endurance and resistance workouts on 6 of 7 days a week. Sixteen consecutive patients undergoing allo-HSCT were enrolled into the study. The median age was 64.5 years. Twelve patients participated in the programme until the time of discharge (75%) from the transplant unit. Therefore, the predefined criteria regarding feasibility were met. The reason for drop out was transplantation associated mortality in all patients (n = 4). Adherence was very good with a median of 85% attended training sessions. No adverse events were recorded. The endurance capacity dropped by 7% and lower extremity strength improved by 2% over time. Quality of life decreased during the study period, with global health being significantly worse at the time of discharge. In conclusion, a combined and intensified strength and endurance exercise programme is feasible and safe in a population of elderly patients undergoing allo-HSCT. Further research should focus on exploring effect sizes of such an intervention by conducting randomised controlled trials. PMID:26526286

  17. Safety of Regular-Dose Imatinib Therapy in Patients with Gastrointestinal Stromal Tumors Undergoing Dialysis

    PubMed Central

    Niikura, Ryota; Serizawa, Takako; Yamada, Atsuo; Yoshida, Shuntaro; Tanaka, Mariko; Hirata, Yoshihiro; Koike, Kazuhiko

    2016-01-01

    The number of cancer patients undergoing dialysis has been increasing, and the number of these patients on chemotherapy is also increasing. Imatinib is an effective and safe therapy for KIT-positive gastrointestinal stromal tumors (GIST), but the efficacy and safety of imatinib in dialysis patients remain unclear. Because clinical trials have not been conducted in this population, more investigations are required. We report on a 75-year-old Japanese man undergoing dialysis who presented with massive tarry stool from a duodenal GIST. The duodenal GIST was 14 cm in diameter with multiple liver and bone metastases. The patient underwent an urgent pancreaticoduodenectomy to achieve hemostasis. After surgery, he was administered imatinib 400 mg/day. No severe adverse event including myelosuppression, congestive heart failure, liver functional impairment, intestinal pneumonia, or Steven-Johnson syndrome occurred, and the liver metastasis remained stable for 4 months. During chemotherapy, hemodialysis continued three times per week without adverse events. We suggest that regular-dose imatinib is an effective and safe treatment in patients with GIST undergoing dialysis. In addition, we present a literature review of the effectiveness and safety of imatinib treatment in dialysis patients. PMID:27403097

  18. Music and ambient operating room noise in patients undergoing spinal anesthesia.

    PubMed

    Ayoub, Chakib M; Rizk, Laudi B; Yaacoub, Chadi I; Gaal, Dorothy; Kain, Zeev N

    2005-05-01

    Previous studies have indicated that music decreases intraoperative sedative requirements in patients undergoing surgical procedures under regional anesthesia. In this study we sought to determine whether this decrease in sedative requirements results from music or from eliminating operating room (OR) noise. A secondary aim of the study was to examine the relationship of response to intraoperative music and participants' culture (i.e., American versus Lebanese). Eighty adults (36 American and 54 Lebanese) undergoing urological procedures with spinal anesthesia and patient-controlled IV propofol sedation were randomly assigned to intraoperative music, white noise, or OR noise. We found that, controlling for ambient OR noise, intraoperative music decreases propofol requirements (0.004 +/- 0.002 mg . kg(-1) . min(-1) versus 0.014 +/- 0.004 mg . kg(-1) . min(-1) versus 0.012 +/- 0.002 mg . kg(-1) . min(-1); P = 0.026). We also found that, regardless of group assignment, Lebanese patients used less propofol as compared with American patients (0.005 +/- 0.001 mg . kg(-1) . min(-1) versus 0.017 +/- 0.003 mg . kg(-1) . min(-1); P = 0.001) and that, in both sites, patients in the music group required less propofol (P < 0.05). We conclude that when controlling for ambient OR noise, intraoperative music decreases propofol requirements of both Lebanese and American patients who undergo urological surgery under spinal anesthesia. PMID:15845676

  19. Diagnostic Laparoscopy in the Pre-operative Assessment of Patients Undergoing Cytoreductive Surgery and HIPEC for Peritoneal Surface Malignancies.

    PubMed

    Seshadri, Ramakrishnan Ayloor; Hemanth Raj E

    2016-06-01

    The introduction of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has led to an improvement in the survival of select patients with peritoneal surface malignancies (PSM). However, it is important to carefully identify patients who will benefit from this procedure and to avoid an unnecessary laparotomy in those who will not. The currently available imaging modalities are unable to accurately predict the peritoneal cancer index (PCI) score or the completeness of cytoreduction. In this article, we review the current status of staging laparoscopy in the assessment of patients with PSM who are planned for CRS & HIPEC. We discuss the patient selection, techniques, complications and efficacy of staging laparoscopy. To summarise, staging laparoscopy is a safe and feasible method of pre-operative assessment of patients with PSM. It has a high sensitivity and positive predictive value in identifying patients who can undergo a complete cytoreduction, thereby preventing many patients from undergoing an unnecessary laparotomy. With the exception of pseudomyxoma peritonei, it should be considered as a part of the routine assessment of patients with PSM who are being considered for CRS & HIPEC. PMID:27065714

  20. The Prevalence of Undiagnosed Presurgical Cognitive Impairment and Its Postsurgical Clinical Impact in Older Patients Undergoing Lumbar Spine Surgery

    PubMed Central

    Lee, Young-Seok; Lee, Shin-Heon; Park, Yong-Sook; Park, Seung-Won

    2016-01-01

    Objective Because elderly patients are undergoing more surgeries, the importance of postoperative cognitive impairment (CI) evaluations is rising, especially for spine surgery, which is related to subjective pain. We investigated the prevalence of undiagnosed CI among elderly patients who underwent spine surgery and the impact of CI on postoperative outcomes. Methods The preoperative cognitive statuses of 129 patients over 65 who underwent lumbar spine surgery from 2012 to 2014 were determined with the Mini-Mental State Examination, and patients with scores under 24 were diagnosed with CI. The patients were then divided into a CI group (n=49) and non-cognitive impairment (NCI) group (n=80). Results Among the 129 patients, 49 (38.0%) were diagnosed with CI, and 9 (7.0%) had severe CI. The age of the CI group (72.88±6.20 years) was significantly greater than that of the NCI group (69.96±4.53 years). In contrast, the postoperative visual analog scale scores and performance statuses did not differ significantly. However, postoperative delirium was more frequent and the hospital stay length was longer in the CI group compared with the NCI group (p<0.05). Conclusion A high prevalence of undiagnosed CI was discovered among elderly patients undergoing spine surgery. The existence of CI was associated with higher rates of postoperative delirium and prolonged hospital stays, which affected clinical outcomes. Thus, CI assessments should be included in preoperative evaluations of elderly patients prior to spine surgery. PMID:27226862

  1. Prone Whole-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy in Women Undergoing Breast Conservation for Early Disease Yields High Rates of Excellent to Good Cosmetic Outcomes in Patients With Large and/or Pendulous Breasts

    SciTech Connect

    Bergom, Carmen; Kelly, Tracy; Morrow, Natalya; Wilson, J. Frank; Walker, Alonzo; Xiang Qun; Ahn, Kwang Woo; White, Julia

    2012-07-01

    Purpose: To report our institution's experience using prone positioning for three-dimensional conformal radiotherapy (3D-CRT) to deliver post-lumpectomy whole breast irradiation (WBI) in a cohort of women with large and/or pendulous breasts, to determine the rate of acute and late toxicities and, more specifically, cosmetic outcomes. We hypothesized that using 3D-CRT for WBI in the prone position would reduce or eliminate patient and breast size as negative prognostic indicators for toxicities associated with WBI. Methods and Materials: From 1998 to 2006, 110 cases were treated with prone WBI using 3D-CRT. The lumpectomy, breast target volumes, heart, and lung were contoured on all computed tomography scans. A dose of 45-50 Gy was prescribed to the breast volume using standard fractionation schemes. The planning goals were {>=}95% of prescription to 95% of the breast volume, and 100% of boost dose to 95% of lumpectomy planning target volume. Toxicities and cosmesis were prospectively scored using the Common Terminology Criteria for Adverse Effects Version 3.0 and the Harvard Scale. The median follow-up was 40 months. Results: The median body mass index (BMI) was 33.6 kg/m{sup 2}, and median breast volume was 1396 cm{sup 3}. The worst toxicity encountered during radiation was Grade 3 dermatitis in 5% of our patient population. Moist desquamation occurred in 16% of patients, with only 2% of patients with moist desquamation outside the inframammary/axillary folds. Eleven percent of patients had Grade {>=}2 late toxicities, including Grade 3 induration/fibrosis in 2%. Excellent to good cosmesis was achieved in 89%. Higher BMI was associated with moist desquamation and breast pain, but BMI and breast volume did not impact fibrosis or excellent to good cosmesis. Conclusion: In patients with higher BMI and/or large-pendulous breasts, delivering prone WBI using 3D-CRT results in favorable toxicity profiles and high excellent to good cosmesis rates. Higher BMI was

  2. Prone Whole-Breast Irradiation Using Three-Dimensional Conformal Radiotherapy in Women Undergoing Breast Conservation for Early Disease Yields High Rates of Excellent to Good Cosmetic Outcomes in Patients With Large and/or Pendulous Breasts

    PubMed Central

    Bergom, Carmen; Kelly, Tracy; Morrow, Natalya; Wilson, J. Frank; Walker, Alonzo; Xiang, Qun; Ahn, Kwang Woo; White, Julia

    2013-01-01

    Purpose To report our institution’s experience using prone positioning for three-dimensional conformal radiotherapy (3D-CRT) to deliver post-lumpectomy whole breast irradiation (WBI) in a cohort of women with large and/or pendulous breasts, to determine the rate of acute and late toxicities and, more specifically, cosmetic outcomes. We hypothesized that using 3D-CRT for WBI in the prone position would reduce or eliminate patient and breast size as negative prognostic indicators for toxicities associated with WBI. Methods and Materials From 1998 to 2006, 110 cases were treated with prone WBI using 3D-CRT. The lumpectomy, breast target volumes, heart, and lung were contoured on all computed tomography scans. A dose of 45–50 Gy was prescribed to the breast volume using standard fractionation schemes. The planning goals were ≥95% of prescription to 95% of the breast volume, and 100% of boost dose to 95% of lumpectomy planning target volume. Toxicities and cosmesis were prospectively scored using the Common Terminology Criteria for Adverse Effects Version 3.0 and the Harvard Scale. The median follow-up was 40 months. Results The median body mass index (BMI) was 33.6 kg/m2, and median breast volume was 1396 cm3. The worst toxicity encountered during radiation was Grade 3 dermatitis in 5% of our patient population. Moist desquamation occurred in 16% of patients, with only 2% of patients with moist desquamation outside the inframammary/axillary folds. Eleven percent of patients had Grade ≥2 late toxicities, including Grade 3 induration/fibrosis in 2%. Excellent to good cosmesis was achieved in 89%. Higher BMI was associated with moist desquamation and breast pain, but BMI and breast volume did not impact fibrosis or excellent to good cosmesis. Conclusion In patients with higher BMI and/or large–pendulous breasts, delivering prone WBI using 3D-CRT results in favorable toxicity profiles and high excellent to good cosmesis rates. Higher BMI was associated with moist

  3. EVALUATION OF HEPATIC FUNCTION AMONG PATIENTS UNDERGOING TOTAL HIP ARTHROPLASTY USING ENOXAPARIN

    PubMed Central

    Wink, Felipe Vitiello; Schwartsmann, Carlos Roberto

    2015-01-01

    Objective: To evaluate hepatic changes resulting from the use of enoxaparin for prophylaxis of deep vein thrombosis among patients undergoing total hip arthroplasty. Methods: Thirty-two patients underwent elective total hip arthroplasty, using enoxaparin, and were followed up for 65 days with serial hepatic enzyme assays. Results: Changes in laboratory parameters were found in up to 75% of the patients during the study, but the parameters normalized after suspension of the treatment. No clinical evidence of hepatic lesions was found. Conclusion: The hepatic enzyme levels increase in most patients using enoxaparin, but without clinical correlation, and the levels normalize after suspension of the treatment. PMID:27022533

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

    PubMed

    Montes, Felix R; Pardo, Daniel F; Carreño, Marisol; Arciniegas, Catalina; Dennis, Rodolfo J; Umaña, Juan P

    2012-01-01

    Antifibrinolytic agents are used during cardiac surgery to minimize bleeding and reduce exposure to blood products. Several reports suggest that tranexamic acid (TA) can induce seizure activity in the postoperative period. To examine factors associated with postoperative seizures in patients undergoing cardiac surgery who received TA. University-affiliated hospital. Case-control study. Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) between January 2008 and December 2009 were identified. During this time, all patients undergoing heart surgery with CPB received TA. Cases were defined as patients who developed seizures that required initiation of anticonvulsive therapy within 48 h of surgery. Exclusion criteria included subjects with preexisting epilepsy and patients in whom the convulsive episode was secondary to a new ischemic lesion on brain imaging. Controls who did not develop seizures were randomly selected from the initial cohort. From an initial cohort of 903 patients, we identified 32 patients with postoperative seizures. Four patients were excluded. Twenty-eight cases and 112 controls were analyzed. Cases were more likely to have a history of renal impairment and higher preoperative creatinine values compared with controls (1.39 ± 1.1 vs. 0.98 ± 0.02 mg/dL, P = 0.02). Significant differences in the intensive care unit, postoperative and total lengths of stay were observed. An association between high preoperative creatinine value and postoperative seizure was identified. TA may be associated with the development of postoperative seizures in patients with renal dysfunction. Doses of TA should be reduced or even avoided in this population. PMID:22234015

  5. Localization of gingival overgrowth in heart transplant patients undergoing cyclosporin therapy.

    PubMed

    Somacarrera, M L; Hernández, G; Acero, J; Moskow, B S

    1994-07-01

    This research was aimed at determining and comparing the pattern of localization of both cyclosporin-induced gingival overgrowth and associated periodontal variables in heart transplant patients. Thirty-nine patients undergoing cyclosporin treatment were studied for 6 months following transplant surgery. Oral hygiene and gingivitis were evaluated using the Silness-Löe and Löe-Silness indices. Gingival overgrowth was measured using a periodontal probe to determine the height of the gingiva at six points per tooth. Statistical hypothesis testing was applied to calculate the significance of the results. Overgrowth average showed a steady and significant growth. The graphs depicting average overgrowth localization, "standard periodontograms," showed remarkable symmetry, and a significantly anterior mandibular papillary distribution. No overgrowth was observed in edentulous areas. The localization of plaque and gingivitis followed a similar pattern; a highly significant correlation was found with the overgrowth localization pattern. It was concluded that the elimination of plaque is an important preventive measure for cyclosporin-induced gingival overgrowth, and that tooth or periodontium related factors have a significant impact on its pathogenesis. PMID:7608842

  6. Systematic review of measurement properties of patient-reported outcome measures used in patients undergoing hip and knee arthroplasty

    PubMed Central

    Harris, Kristina; Dawson, Jill; Gibbons, Elizabeth; Lim, Chris R; Beard, David J; Fitzpatrick, Raymond; Price, Andrew J

    2016-01-01

    Objectives To identify patient-reported outcome measures (PROMs) that have been developed and/or used with patients undergoing hip or knee replacement surgery and to provide a shortlist of the most promising generic and condition-specific instruments. Methods A systematic review of the literature was performed to identify measures used in patients undergoing hip and knee replacement and extract and evaluate information on their methodological quality. Results Thirty-two shortlisted measures were reviewed for the quality of their measurement properties. On the basis of the review criteria, the measures with most complete evidence to date are the Oxford Hip Score (OHS) (for patients undergoing hip replacement surgery) and the Oxford Knee Score (OKS), with OKS-Activity and Participation Questionnaire (for patients undergoing knee replacement surgery). Conclusion A large number of these instruments lack essential evidence of their measurement properties (eg, validity, reliability, and responsiveness) in specific populations of patients. Further research is required on almost all of the identified measures. The best-performing condition-specific PROMs were the OKS, OHS, and Western Ontario and McMaster Universities Osteoarthritis Index. The best-performing generic measure was the Short Form 12. Researchers can use the information presented in this review to inform further psychometric studies of the reviewed measures. PMID:27524925

  7. Atrioventricular conduction disturbances immediately after hepatic graft reperfusion and their outcomes in patients undergoing liver transplantation.

    PubMed

    Kim, Sung-Hoon; Moon, Young-Jin; Lee, Sooho; Jeong, Sung-Moon; Song, Jun-Gol; Hwang, Gyu-Sam

    2016-07-01

    Hemodynamic perturbation during hepatic graft reperfusion in patients undergoing liver transplantation (LT) is challenging and is frequently accompanied by bradyarrhythmia and even asystole. However, detailed data on electrocardiographic (ECG) changes during reperfusion are almost nonexistent, although the correct diagnosis by record is important for the treatment. We aimed to identify ECG rhythm disturbances during graft reperfusion and to investigate risk factors and outcomes. Data from 1065 consecutive patients who underwent adult LT were analyzed. The incidence, type, and detailed characteristics of ECG changes immediately after graft reperfusion were assessed using an electronically archived intraoperative ECG database. We analyzed risk factors, postoperative outcomes including major cardiovascular events, 30-day and 1-year mortalities of recipients based on the occurrence of atrioventricular (AV) block, and asystole during reperfusion. The typical pattern of postreperfusion bradyarrhythmia was progressive PR interval prolongation until a Mobitz type 1 AV block occurred. The overall incidence of AV block was 5.0% (53/1065), and 30.2% of them (16/53) had initiated as AV block and then progressed into ventricular asystole. Fulminant hepatic failure was a significant predictor for occurrence of AV block (odds ratio [OR], 7.20; 95% confidence interval, 3.38-15.32; P < 0.001). Patients with AV block showed significantly higher incidence of postoperative major cardiovascular events (P < 0.001) and 30-day mortality (P = 0.002) than those without AV block, whereas the 1-year mortality was not different between the 2 groups (P = 0.10). The postreperfusion asystole was consistently preceded by a Mobitz type 1 AV block. The occurrence of AV block and asystole appears to be an important prognosticator. Therefore, maintaining an optimal range of physiological status and gradual unclamping of the vena cava to avoid sudden atrial distension are recommended in high

  8. Tissue microRNAs as predictive markers for gastric cancer patients undergoing palliative chemotherapy.

    PubMed

    Smid, David; Kulda, Vlastimil; Srbecka, Kristyna; Kubackova, Dasa; Dolezal, Jan; Daum, Ondrej; Kucera, Radek; Topolcan, Ondrej; Treska, Vladislav; Skalicky, Tomas; Pesta, Martin

    2016-06-01

    MicroRNAs have the potential to become valuable predictive markers for gastric cancer. Samples of biopsy tissue, routinely taken from gastric cancer patients undergoing palliative chemotherapy, constitute suitable material for microRNA profiling with the aim of predicting the effect of chemotherapy. Our study group consisted of 54 patients, all of whom underwent palliative chemotherapy based on 5-fluorouracil (5-FU) or 5-FU in combination with platinum derivatives between 2000 and 2013. The expression of 29 selected microRNAs and genes BRCA1, ERCC1, RRM1 and TS, in gastric cancer tissue macrodissected from FFPE tissue samples, was measured by quantitative RT-PCR. The relationship between gene expression levels and time to progression (TTP) and overall survival (OS) was analysed. From the set of the 29 microRNAs of interest, we found high expression of miR-150, miR-342-3p, miR-181b, miR-221, miR-224 and low levels of miR-520h relate to shorter TTP. High levels of miR-150, miR-192, miR-224, miR-375 and miR-342-3p related to shorter OS. In routinely available FFPE tissue samples, we found 6 miRNAs with a relation to TTP, which may serve as predictors of the effectiveness of palliative treatment in gastric cancer patients. These miRNAs could also help in deciding whether to indicate palliative chemotherapy. PMID:27081844

  9. Preoperative Ambulatory Inspiratory Muscle Training in Patients Undergoing Esophagectomy. A Pilot Study

    PubMed Central

    Agrelli, Taciana Freitas; de Carvalho Ramos, Marisa; Guglielminetti, Rachel; Silva, Alex Augusto; Crema, Eduardo

    2012-01-01

    A major decline in pulmonary function is observed on the first day after upper abdominal surgery. This decline can reduce vital and inspiratory capacity and can culminate in restrictive lung diseases that cause atelectasis, reduced diaphragm movement, and respiratory insufficiency. The objective of this study was to evaluate the efficacy of preoperative ambulatory respiratory muscle training in patients undergoing esophagectomy. The sample consisted of 20 adult patients (14 men [70%] and 6 women [30%]) with a diagnosis of advanced chagasic megaesophagus. A significant increase in maximum inspiratory pressure was observed after inspiratory muscle training when compared with baseline values (from −55.059 ± 18.359 to −76.286 ± 16.786). Preoperative ambulatory inspiratory muscle training was effective in increasing respiratory muscle strength in patients undergoing esophagectomy and contributed to the prevention of postoperative complications. PMID:23113846

  10. Bivalirudin in Patients Undergoing PCI: State of Art and Future Perspectives.

    PubMed

    Galasso, G; Mirra, M; De Luca, G; Piscione, F

    2016-05-01

    Acute coronary syndrome (ACS) represents the most common cause of death worldwide. Percutaneous coronary intervention (PCI) is the management of choice in patients with ACS and occurrence of intra-procedural thrombotic complications are an independent predictor of mortality and other major adverse cardiovascular events in patients undergoing PCI. According to current guideline, anticoagulation therapy is indicated during PCI in order to reduce the risk of thrombotic complications such as stent thrombosis. Among currently available anticoagulant drugs, bivalirudin demonstrates a lower incidence of bleeding risk, despite it is associated with an increased risk of stent thrombosis. The aim of this paper is to discuss the pharmacology of bivalirudin and the clinical evidences of its use in patients undergoing PCI for ACS. PMID:27326396